www.prometric-questions.com 1 www.prometric-questions.com 2 Table of Contents Introduction........................................................................................................................................................ 4 Dosage calculation .............................................................................................................................................. 6 Abbreviation Meaning ...................................................................................................................................... 10 Route of administration .................................................................................................................................... 12 C.N.S (central nervous system) ......................................................................................................................... 13 Autonomic nervous system ............................................................................................................................... 19 Drug affecting Muscular system ....................................................................................................................... 22 Drug affecting respiratory system ..................................................................................................................... 23 None steroidal anti inflammatory drugs (NSAIDs) ........................................................................................... 26 Cardiovascular system ...................................................................................................................................... 31 Drug acting on the blood and blood forming..................................................................................................... 43 Drugs used in treatment of gastric ulcer ........................................................................................................... 47 Hormone and antagonists ................................................................................................................................. 53 Introduction to Parasitology ............................................................................................................................. 60 Chemotherapy of microbial disease .................................................................................................................. 63 Antifungal Drugs .............................................................................................................................................. 71 Antiviral Drugs ................................................................................................................................................. 72 Cancer chemotherapy ....................................................................................................................................... 72 Vitamins ........................................................................................................................................................... 74 Skin and scalp preparation ............................................................................................................................... 76 www.prometric-questions.com 3 prometric-questions.blood flow 2-Capillary permeability: Only lipid –soluble drugs in small particles can penetrate the BBB شح١ئبد صغ٠ عضٚاء رْٚ اٌذٛى٠ ٌٓىٚ ٝس ػجش اٌؾبعض اٌّخٚغ اٌّش١غزط٠ ٜ فمظ اٌزٛ٘ ٝز٠اء اٌضٚ اْ اٌذٕٝثّؼ 3-binding of drugs to plasma.Active transport ب اوجش ِغبؽخ اِزابِٙٔٓ للاي االِؼبء ال ؾذس االِزاب٠ Drug distribution: the drug leaves the bloodstream and enters the cells of tissues It depends on 1.albumin 4-Volume of distribution www.com 4 .Passive diffusion 2.Introduction Pharmacokinetics Is movement of drug over time through the body? It is the way that body deal with the drug It composed of 4 stages االٍرصاص اىرىصٌع االسرقالب اإلخشاج األٍعاء ًاىذ اىنثذ اىنيى ًوسٍيح دخىه اىذواء إىى اىذ ًذىصٌع اىذواء ٍِ خاله اىذ اسرقالب اىذواء فً اىنثذ )إخشاج اىذواء ٍِ خاله اىنيى ( اىثىه اءٚ اٌذٍٝش اٌغغُ ػ١رأص A D M E absorption Distribution Metabolism Excretion mainly through intestine Through blood Through liver Through kidney Drug absorption: The transfer of a drug from its site of administration to blood stream The drug may be absorbed from the GIT tract either by 1. Drug metabolism: elimination of drug and excreted into the urine or bile Liver is the major site for drug metabolism اءٚض ٌٍذ٠بد اال١ٍّخ ػ١ؾذس ف٠ ْ اوضش ِىبٛ٘ اٌىجذ Occurs in two phases 1.Phase 1 : oxidation –reduction-hydrolysis 2.prometric-questions.Phase 2 : conjugation reaction Drug excretion: kidney is the most important organ for excreting drugs خ٠ٌٚخ ػٓ الشاط األدٛ اوضش االػضبء اٌّغئٝ٘ ٍٝاٌى Pharmacodynamics What a drug does to the body ُ اٌغغٍٝاء ػٚش اٌذ١رأص Drug desired action (uses) and undesired action (side effect) Drug drug interaction: Any interaction between drugs when they are used for the same patient in short duration of time that will affect Pharmacokinetics or Pharmacodynamics. pharmaceutical interaction خ٠ذ٠سًٌٛ ا١ٌ اٌّؾبٍٝضغ ػٛ رٝخ اٌز٠ٚٓ لبسط اٌغغُ ِضً االد١ائٚؾذس رفبػً ِغ د٠ ْ إٝثّؼ pharmacokinetic interaction ) –االلشاطًٝ اٌغزائ١ اٌزّض-غ٠صٛ–اٌز Pharmacodynamics interaction *synergism (1+1≥ 2) *addition or summation (1+1=2) *potentiation (0+1≥ 1) *antagonism ٖش١مًٍ ِٓ رأص٠ٚذ ا٠ض٠ اء الش اِبٚخ د١ٍ فبػٍٝاء ػٚؤصش د٠ ْ إٝثّؼ www.com ش( االِزاب١اء الش ِٓ ؽٚ دٍٝاء ػٚؤصش د٠ ْ إٝثّؼ 5 . how many mg in the vial? خ١ٌاد اٌزبّٛىٓ إرجبع اٌخط٠ ِغأٌخٞ أٟخ ف١ائٌٚؾغبة اٌغشػخ اٌذ 10 ml vial 10 mg per ml 10 mg per ml will convert to 10 mg ؽذرٗ لبسط اٌّغأٌخٚ ٗوزبثٚ ٗ اٌّضبي الثذ ِٓ وزبثزٟ سلُ فٞأ.-1 َِمبٚ سح ثغظٛ صٌٝب إٍٙ٠ٛس إٌغجخ ال ثذ ِٓ رؾٛسٖ ِٓ صٛ صٞأ.prometric-questions.-2 1 ml َاٌّمبَ ِضً اٌّمبٚ ) ؽذاد (اٌجغظ ِضً اٌجغظٌٛ أوضش ِٓ ٔغجخ ) ثششط رٕبعت اٞٚ ػًّ رٕبعت (رغب-3 10 mg = 1 ml mg ml ةٍٛ اٌّىبْ اٌّطٟبَ فٙضغ ػلاِخ اعزفٚ ٓ اٌغؤاي٠ أظش أ-4 ةٍٛ اٌّطٍٝي ػٛاٌؾاٚ ٓ١ اٌطشفٟٓ ف١عطٌٛخ ضشة ا١ٍّ ػ-5 10 mg = 1 ml ? mg 10 ml The answer is 100 mg www.com 6 .Bioavailability خ٠ٛ١االربؽخ اٌؾ The fraction of administered drug that reach the systemic circulation َ اٌذٌّٝخ ا١ٍ راً عٝاء اٌزٚخ اٌذ١ّو *If 100 mg of a drug are administered orally & 70 mg are absorbed unchanged So the bioavailability is 70 % Dosage calculation Example You find 10 ml vial of aminophylline with supply label 10 mg per ml. 000 Kilo= 10 hecto = 100 deka = 1000 ….240 pound 1 grain (gr) = 0.065 mg www.prometric-questions. =10000 deci = 100000 centi = 1000000 milli = 1000 000 000 micro Conversion: Exact equivalents are used for the conversion of specific quantities in the pharmaceutical formulas and prescription compounding Unit Mass 1 gram (g) = 15.com 7 . gram .432 grain 1 kilogram (kg) = 2. meter deci (d) centi (c) milli(m) micro (mc) is number = 100 is number = 10 is number = 1 is number = 1/10 is number = 1/100 is number = 1/1000 is number = 1/1000.Pharmaceutical Calculations Systems of weight and Measures Metric System: Units of weight is: gram (g) Units of volume is: liter (l) Units of length is: Meter (m) Each of them takes unit number one (1) Kilo (k) is number = 1000 Example kilogram (kg) = 1000 gram Kilometer (km) = 1000 meter Kilolitre (kl) = 1000 liter hecto (h) deka (dK) litre . if the dose is 200mg? Number of doses = 10g/ 0.com 8 .) = 15ml 1 milliliter (ml) = 16 drops (dps or gtts) Calculation of doses: Total amount of doses = size of dose + number of doses.2 fluid ounces= 0.54 cm House hold measurement 1 tea spoonful (tsp.) = 5ml 1 table spoonful (tbsp.37inches 1 inch = 2. Example # 1: How many drops would be prescribed in each dose of liquid medicine in 15ml contained 60 doses? 1 ml = 16 drops 15ml =?? Drops → 480 dps or gtts Size of dose = 240dps /60 doses = 4 dps or gtts Example # 2: How many doses are found in 10g.prometric-questions.2g= 50 doses Example # 3: How many milliliters of liquid medicines would provide a patient with 2 table spoonful twice a day for 8 days? Total amount = 2 ×15ml ×2 × 8= 480ml Temperature conversion To convert temperature from Fahrenheit scale (F) to Celsius (centigrade) (C) we use the formula 5F = 9C + 160 Where www.Unit Volume 1 liter (1) = 35.22 gallon 1 fluid ounce = 30 ml Unit Length 1 meter (m) = 39. Chemical name : exact description of chemical structure 2.prometric-questions.5 c) Drug name There are three names of drug 1.com 9 .Scale Boiling point Freezing point Fahrenheit 212 32 Celsius 100 0 Example Convert temperature 5F = 9C + 160 5F= 9×30 + 160 5F= 270 + 160 5F= 430 30 C to F the answer (86 f) F = 430÷ 5 = 86 Convert temperature 150 F to C 5F = 9C + 160 5×150 = 9C + 160 750 = 9C + 160 750 – 160 = 9C 590 = 9C C = 590 ÷ 9 = 65.Trade name : brand name or proprietary name www.5 the answer (65.Generic name : shorten Chemical name 3. prometric-questions.com 11 .Abbreviation Meaning am aq ad as au bid Cap. gtt h hs inj nebul non rep noct at no ou od os po pc morning water right ear left ear each ear twice a day capsule drop hour at bed time injection a spray do not repeat at night number each eye right eye left eye By mouth after eating pm evening prn pulv qs Qd Qh Qid soln stat supp syp tab tid tbsp tsp IM IV QOD Sos after noon evening when needed a powder quantity every day sufficient every hour four times day solution immediately suppository syrup tablet three times a table day spoonful tea spoonful intramuscular Intravenous Every other If necessary day I Ii Iii Iv V Vi Vii 1 2 3 4 5 6 7 Viii Ix X L C D M 8 9 10 50 100 500 1000 www. Emulsion 6. 8. www.Ointments & creams drug molded into shape for insertion in a body opening drug suspended in some base for external use Liquid preparation 1. sugar . flavoring substance alcoholic solution of ostrichion substance All alcoholic preparation is a) Potent b) take in small dose c) never to be injected d) never to applied to open lesion 5.Suspension 7.Powder 2.Tablet drug in powder form drug in gelatin container compressed solid mass Semi Solid preparation 1.Capsule 3.Syrup 9.Preparation and administration of medicine Solid preparation 1.Tincture alcoholic solution of drug alcoholic solution of volatile substance solution containing alcohol .Fluid extract 2.Suppository 2.Liniment highly concentrated sugar solution solution of drug in oily or alcoholic or soapy base intended For external use only.com 11 .Spirit 3.Lotion mixture of two liquid usually oil & water liquid preparation containing un dissolved material liquid preparation containing un dissolved material for external Use only.Elixir 4.prometric-questions. Route of administration 1. Intra muscular (IM) : Injection deeply into muscle tissue (aqueous or oily) D.Transdermal : nitroglycerin patch. Intra-arterial (IA) : used in chemotherapy & diagnostic procedures 9.Sublingual : resemble oral but tablet dissolved under the tongue (not swallowed) 3.com 12 .Vaginal / urethral : local effect 6. insulin F. vomiting And unconsciousness 5.Topical : applied to surface of the skin 8.g.Inhalation : through respiration then go to systemic circulation 7. Intra dermal(ID) : the top few layer of the skin E.Parenteral : A.prometric-questions.Rectal : local or systemic effect which suitable for pediatric . Intra thecal C.Buccal :resemble oral but tablet dissolved in the pouch of the cheek (Not swallowed) 4.Oral : swallowed by mouth to give systemic effect 2. Sub cutaneous(SC) :into the fatty layer e.nicotine patch 1 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض : خ١ٌ ِشاعؼخ االعئٍخ اٌزبٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض 96-44-42-41-39-38-37-34-33 : 1 رطّٛٔ 155-99-98-66-51-55-49-48-47-44-43-42-36-35: 2 رطّٛٔ 155-65-59-58-57-55-54-53-52-51-46-12-15-9-8-5-3 : 3 رطّٛٔ 82-81-85-79-78-77-76-75-74-73-72-71 : 4 رطّٛٔ 72-71-75-69-68-67-66-61 -65 -59 : 6 رطّٛٔ 85 -51 : 7 رطّٛٔ 98 -97 -93 -89 -73 -65 -58 -57 -56 -55 : 8 َّىرج 151 -91 -76 -71 -67 -66 -65 -63 -62 -58 -57 -47 -42 -38 -35: 9 َّىرج 66-63-61-58-56 -51 -55 -34 : 15 َّىرج 37-36-34 -9-7 :11 َّىرج www. Intra venous (IV) : Injection directly into veins ( most rapid ) for aqueous only : Injection directly into spine B. N.prometric-questions. analgesia.somatic nervous system C.Afferent 2.Central 2.efferent nervous system Efferent nervous system is divided into 1.com 13 .N.S (nervous system) Nervous system is divided into 1.autonomic nervous system 2.S (central nervous system) General anesthesia Agent used for induce loss of consciousness. relaxation Classification Inhalation anesthesia Route Control Uses Mix with oxygen Well control Intravenous anesthesia Directly with blood Difficult to control Long term operation maintenance Short term Nitrous oxide Thiopental Ketamine Examples Ether halothane www.peripheral nervous system Peripheral nervous system is divided into 1. Haloperidol Side effect: parkinsonian like syndrome (extra pyramidal side effect) www. hallucination and thought disorder Aim of therapy: to block centeral dopamine receptor Typical Antipsychotic drug 1.Local anesthesia Agent used for induce loss of sensation without affecting. Vaproic acid 5.prometric-questions. benzocaine (topical {surface} application) Procaine. local injection) Antiepileptic drug Epilepsy is violent involuntary contraction of voluntary muscle which is characterized by 1-Chronic 2. bupivacaine .usually episodes of unconsciousness or amnesia Antipsychotic drug Psychosis is disorder of mood. Phenytoin 2.recurrent 3. mepivacaine ( local injection ) Lidocaine (both topical. consciousness Example: cocaine. Ethoxsumide 3. Chloropromazine 2. thought and behavior It is characterized by delusion. Carbamazepine 4.com 14 . New : lamotrigine (only for petit mal epilepsy) 4.typical Drugs 1. Risperidone Side effect: fewer parkinsonian like syndrome (extra pyramidal side effect) Drug for Parkinsonism disease Parkinsonism is movement disorder characterized by muscle rigidity and postural instability Aim of therapy: is to increase central dopamine Anti parkinsonian drug: 1. Strong analgesic 2. Cough suppressant ( central antitussive ) 3. Addiction 2. Selegline 3.dopa (levodopa) 2. L. Amantidine Side effect: excess dose may lead to psychosis Narcotic analgesic *Morphine and related opoid has the following effect 1. Constipation www.Atypical Antipsychotic drug 1. Bromocriptine 4. Respiratory depression 3. Anti diarrheal Side effect 1.com 15 . Olanzapine 3.prometric-questions. Clozapine 2. Analgesics Drugs for prophylaxis (for vasoconstriction) 1.com 16 .prometric-questions. Serotonin receptor blocker www. Sumatriptan 3. Beta blocker 2. Ergotamine 2. Calcium channel blocker 3.*Codeine is Morphine derivative which is only central antitussive Loperamide and diphenoxylate are Morphine derivative which used only to control diarrhea *Meperidine *Methadone *Fentanyl *Propoxyphene *Tramadol Antagonists *Naloxone *Naltrexone Migraine severe headache in which patient complain from only one side of head Patient suffer first from stage of aura (vasoconstriction) then stage headache (vasodilatation) Drugs for acute attack (for vasodilatation) 1. sertraline. fluoxetine. Tricyclic antidepressant (TCA) :e. Monoamine oxidase inhibitor (MAO inh) 2. Selective serotonin reuptake inhibitor (SSRI) : e.g.triazolam *intermediate –acting (5-20 hours) عطخِٛز lorazepam.com 17 . clonazepam Benzodiazepines antagonist 2-Barbiturates : flumanezil : * ultra short acting (15-30 min) Thiopental *short –acting (2-4 hours) Pentobarbital. secobarbital *intermediate –acting (4-6 hours) amobarbital *long-acting (6-8 hours) phenobarbital www. amitryptillin .g.g. oxazepam *long –acting (60 hours) ٍٜخ اٌّذ٠ٛط Diazepam. Citalopram Sedative & hypnotics It's called also * anxiolytics * Minor tranqulizers * All sedative become hypnotics at large dose 1.Benzodiazepines: GABA agonist: * ultra short acting (4 hours) ٜشٖ اٌّذ١لا midazolam.prometric-questions. phenelzine :e.Antidepressants Disorder of mood is characterized by decreased self esteem and increased sadness drugs 1. imipramine 3. lithium 2.alcohol 2.Cocaine 6.Opium alkaloids www.prometric-questions.Methaqualone 7.Zolpidem 4.amphetamines 3.3.risperidone Drugs of abuse ْٝ غشض ػلاعٚ رغزخذَ ِٓ دٝخ اٌز٠ٕٚ٘بن ثؼض األد : بِٕٙٚ بٙٔ ادِبٌٝ اٜغبٌجب ِب رؤد 1.Zaleplon 5.com 18 .barbiturates 4.Buspirone Antimania It's called (bipolar disorder) 1.benzodiazepines 5.olanzapine 3. .. N. hysocine and atropine substitute (e.Indirect acting (physostigmine .) خ١ٍ وً األػضبء اٌذالٟ٘ ِغبصاٚ خ٠ظبئف اٌلاإسادٌٛ وً اٟ فٞ اٌلاإسادٟبص اٌؼاجٙزؾىُ اٌغ٠ parasympathetic nervous system (P...com 19 ..g.. Pilocarpine ) 2. carbacol . Action on heart is relaxation that leads to slow action of heart Action on blood vessel is relaxation that leads to dilates blood vessel...Atropine.ٚ Gland وبٔذٌٛ secretion ٟٕرؼٚ muscle ٌٍــــcontraction ٟ٘ بدح٠د ثىٍّخ صٛاٌّماٚ Example (P. Drugs Parasympathomimetic (Parasympathetic agonist) cholinomimetic 1.) Action on respiratory muscle is contraction that leads to asthma Action on Intestinal muscle is contraction that leads to digestion Action on Uterine muscle is contraction that leads to excretion of urine Action on salivary gland is contraction that leads secretion of saliva and so on….direct acting (acetylcholine .S.S.B excess contraction of intestinal muscle will cause spasm in abdomen and so on….Autonomic nervous system Is a part of peripheral nervous system associated with the involuntary action? Is divided into 1.S. homatropine…) www.) 2...Parasympathetic (cholinergic) nervous system (P.) خ٠ِٛخ اٌذ١ػٚاألٚ ظبئف اٌغغُ ِب ػذا اٌمٍتٚ ًٌضٌذ ِٓ و .prometric-questions. bethanecol ....sympathetic (adrenergic) nervous system (S. neostigmine organophosphorus compound) Parasympatholytic (Parasympathetic antagonist) 1. it will block the action of the receptor Site Heart Blood vessel Lung Receptor Beta 1 Beta 2 (β1) (β2) Drug agonist contraction contraction relaxation Drug antagonist relaxation relaxation contraction sympathetic Alpha 1 (α1) www... Site Heart sympathetic Blood vessel Lung Receptor Beta 1 Beta 2 (β1) (β2) Alpha 1 (α1) Action contraction contraction relaxation Any drug act on sympathetic system either enhance or inhibit action of sympathetic nervous system Drug agonist mean that. sympathetic nervous system (S.ٚ Gland وبٔذٌٛ decrease secretion ٟٕرؼٚ muscle ٌٍــــrelaxation ٟ٘ ً١ٍد ثىٍّخ رمٛاٌّماٚ Example (S...) خ٠ِٛخ اٌذ١ػٚاألٚ ظبئف اٌغغُ ِب ػذا اٌمٍتٚ ًٌقيو ِٓ و . it will stimulate function of the receptor Drug antagonist (blocker) mean that..com 21 ..) Action on respiratory muscle is relaxation that leads to dilatation of lung Action on Intestinal muscle is relaxation that stops digestion Action on Uterine muscle is relaxation that leads to inhibit excretion of urine Action on salivary gland is decrease secretion that decrease secretion of saliva and so on ………...prometric-questions.. Action on heart is contraction that lead to strengthens action of heart Action on blood vessel is contraction that lead to increase blood pressure.... Example Drug name Salbutamol ( ventolin®) Atenolol (tenormin®) Description (β2) agonist (β1) blocker Receptor (β2) (β1) (β1) (α1) β1 β2 β1 β2 (α1) β1 β2 Site of action Action Lung Agonist Effects Dilate lung for asthmatic patient slow action of heart strengthens action of heart Dilate Blood vessel strengthens action of heart Dilate lung for asthmatic patient slow action of heart Asthma Contract Blood vessel (HTN) strengthens action of heart Dilate lung for asthmatic patient Heart Blocker Dobutamine (β1) agonist (α1) blocker Heart agonist Prazocin Blood vessel blocker Non Isoprenaline selective β stimulant Non Propranolol ( inderal®) selective β blocker Heart Agonist Lung Agonist Heart Lung Blood vessel blocker blocker Agonist Epinephrine Mixed agonist Heart Agonist (adrenaline) Lung Agonist Dou you know why propranolol can be used for hypertensive patient but cause asthma while atenolol will not cause asthma? Dou you know why propranolol is contraindicated with asthmatic patient? www.com 21 .prometric-questions. Drug affecting Muscular system Skeletal muscle relaxant Neuromuscular blocking agents E. cyclobenzaprine 2 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض :خ١ٌ ِشاعؼخ االعئٍخ اٌزبٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض 45-13 -6 :1 رطّٛٔ 85-18 : 2 رطّٛٔ 99-98-72-71-75-69-67-61-47-43 -39 -36 : 3 رطّٛٔ 87-86-85-84 – 38 ُ ص36:1 ِٓ أعئٍخ: 4 رطّٛٔ 74-73-65-62 : 6 رطّٛٔ 85 -75 -74 -73 -72 -66 -27.g.com 22 .prometric-questions. diazepam.g. orphenadrine . chlorozoxazone ( parafon®) . curare and succinylcholine Centrally acting skeletal muscle relaxant E.-25 -23 -19 -15: 7 رطّٛٔ 92 -91 -95 -76 -74 -63 -62 : 8 رطّٛٔ 94 -85 -56 -53 -43 -33 -35 -28 -27 -24 -18 -8 : 9 رطّٛٔ 95 -89 -68 -65 -59 -44 -29 -22-17-12-6 : 15 رطّٛٔ 25 -23 -4 -3 : 11 رطّٛٔ www. isoprenaline .Drug affecting respiratory system Bronchial asthma Definition: functional airway obstruction due to hyperactivity of airway muscle to Variety of muscle Drugs: 1. tiotropium 2.mast cell stabilizers : e. zafirlukast www. ephedrine b) short acting selective β2 agonist: as Salbutamol . albuterol.g. pirbuterol c) long acting selective β2 agonist: as salmeterol .bronchodilator : *beta agonists a) none selective β agonist (β1 .com 23 .nedocromil 3. sodium cromoglycate . theopromine . terbutaline.g.anti inflammatory : 1.corticosteroid : e. hydrocortisone Inhibit Ag-Ab reaction.prometric-questions. β2) as : adrenaline . inhibit release of inflammatory mediator 2.antileukotriene : e. prednisone .g. formoterol *xanthenes a) natural : theophylline . beclomethasone . caffeine b) synthetic : aminophylline This agent block adenosine receptor (adenosine cause bronchoconstriction) *cholinergic antagonists e. ketotifen . ipratropium . montelukast .g. acetyl cystine.Expectorants: substance encourages coughing E. Bromhexine . potassium iodide 3. creosote . carbocisteine www.g. stem of inhalation of menthol 2. Guaifenesin (cause sedation) .Peripheral antitussive E. ambroxol . useless Not associated by sputum Treated by antitussive productive cough Useful cough Associated by sputum Treated by expectorants and mucolytic 1.com 24 .Central antitussive E. Liquorices lozenges. dextromethorphan ( none addictive ) B.antitussive: substance reduce frequency and/or intensity of coughing A.Cough: None productive cough Dry . Codeine (addictive) .Mucolytic: substances liquefy bronchial secretion (reduce viscosity) E.g.prometric-questions.g.g. guiacol . prometric-questions.Antihistaminic H1 blockers: first generation antihistaminic : produce sedation رغجت إٌؼبط *chlorpheniramine *cyclizine *diphenydramine ( used in motion sickness ) * dimenhydrinate ( used in motion sickness ) * hydroxyzine * meclizine ( used in pregnancy ) * promethazine second generation antihistaminic : non sedating –long acting ي) – ال رغجت إٌؼبطٍٛخ اٌّفؼ٠ٛ عبػخ( ط24 ٚ ا12 ًرغزخذَ و *cetirizine * desloratadine * loratadine 4-3 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض : خ١ٌ ِشاعؼخ االعئٍخ اٌزبٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض 53-28 :1 رطّٛٔ 53-52-22-21-8 :2 رطّٛٔ 94-83-66.35-29 : 8 رطّٛٔ 73 -37 -26-22-21 :9 رطّٛٔ 85-55 : 15 رطّٛٔ 38 -35 : 11 رطّٛٔ www.78.65 :3 رطّٛٔ 64 :6 رطّٛٔ 93 -22-21 : 7 رطّٛٔ 96-95.41.com 25 . Analgesics. anti platelet ٌُِغىٓ ٌأل لبفض ٌٍؾشاسح بثبدِٙضبد ٌلاٌز خ٠ِِٛبٔغ ٌزغّغ اٌافبئؼ اٌذ www.. ) ٍَنِ ٌؤدي إىى أىٌ فحَى..Pharmacological effect ( therapeutics uses ) ًاىرأثٍش اىذوائ 1...اىخالصح أُ أي اىرهاب (ٍثال تسثة تنرٍشٌا أو مذٍح أو ٍٍنشوب وىزىل أي ٍعاد ىالىرهاب هى فً ّفس اىىقد ٍسنِ ىألىٌ وخافط ىيحشاسج NSAIDs ِ ٍعيىٍاخ ظشوسٌح ٍهٌ جذا ٍعشفرها ع4 هْاك 1.com 26 ....None steroidal anti inflammatory drugs (NSAIDs) Inflammatory response Inflammation) Cellular damage Inflammatory cell Inflammatory mediator Inflammatory phases Rapid chronic vasodilatati on Fever blood flow Increase edema Pain .. antipyretic. anti-inflammatory 4.. 3..prometric-questions.. احَشاس. 2... prometric-questions....Mechanism of action inhibit cyclo-oxygenase (co-x) enzyme )inhibit both co-x 1 ( constitutive form present in normal tissue ) and co-x 2 ( inducible form present only at site of inflammation سثة اَالً اىرً ٌشعش تها اىَشٌط هى وصىه وسائػ االىرهاب إىً ٍناُ اإلصاتح عِ غشٌق COX 1 & COX 2 جٍَع NSAIDsذعَو عيى ٍْع هزا ))cyclo oxygenase ٛ٘Cox 1طش٠ك دائُ ِٓٚللاٌٗ رّش ٚعبئظ االٌزٙبة ِّب رغجت inflammatory responseاٌّزوٛس عبثمب ٛ٘Cox 2طش٠ك ِؤلذ ٠ؾذس فمظ أصٕبء االٌزٙبة ٕ٘ بن ػلالخ ػىغ١خ ث١ٌٚ ( Cox 1 ٓ١ظ ِ )Cox 2غ اٌّؼذح ثؾ١ش أْ عّ١غ ِغىٕبد األٌُ اٌز ٟرؼًّ ػٍCox 1ٝ رض٠ذ ِٓ إفشاص ؽّض اٌّؼذح ِّٚ HCLىٓ رؤد ٞإٌ ٝلشؽخ ِّ ىٓ رّض٘ ً١زا ِضً إشبسح اٌّشٚس ٚطش٠ك اٌخذِبد ثؾ١ش أْ اٌطش٠مبْ اٌّزمبثلاْ ّ٘ب stomach & cox 1 ٚاٌخذِبد ٘ Cox 2 ٛاٌز١ٌ ٞظ ٌٗ ػلالخ ثبإلشبسح www......com 27 .......تَعْى أُ أي ٌَ NSAIDsنِ أُ ٌنىُ ٍسنِ وخافط ىيحشاسج وٍعاد ىالىرهاتاخ وٍاّع ىرجَع اىصفائح اىذٍىٌح فً ّفس اىىقد وىنِ ذخريف قىٓ اىذواء فً هزٓ األستعح تحٍث ٍَنِ ٌنىُ ٍسنِ قىي جذا وىنْح ٍعاد ىالىرهاب ظعٍف و. آىٍح اىعَو 2.. Bleeding 4. less irritation ) www.Non selective co-x inhibitors Generic name Indomethacin Diclofenac Ibuprofen Mefenamic acid Meloxicam Piroxicam Loronoxicam Paracetamol Acetyl salicylic acid Trade name Indocid Voltaren.com 28 . Reyes syndrome 7. rheumafen Brufen maximum dose 3. Celecoxib 2. gastrointestinal irritation as ulcer لشؽخ 2. Hypersensitivity 3.B. Prolonged labor 8.NSAIDs ًّخ ػ١ٌُ آٙ ٌف9 & 8 & 7 & 6 & 5 ُ سلٛ٠ذ١أظش اٌف 3.2 gm / day ? Ponstan Mobic Feldin Xefo Panadol Aspirin maximum dose 4 gm / day 4. aspirin 1.A. Salicylism 4.Selective cox-2 inhibitors 1. Renal impairment 5. Hepatotoxic 6.Adverse effects e.prometric-questions. Rofecoxib (Celebrex®) (less anti platelet.g. Paracetamol هاً جذا جذا It is only The only NSAIDs The only NSAIDs Adverse effects Children dose Maximum adult dose Management overdose analgesic. Probencid Increase uric acid excretion (prevent uric acid reabsorption) N.com اىعالج اىىقاٌح 29 .B. antipyretic for pregnant for asthmatic patient Hepatotoxic and nephrotoxic 10 – 15 mg /kg/6 hour 4 gram per day N-acetyl cysteine شح١بٖ وج١ِ بد١ّ ثىٚغ اٌّغىٕبد ثؼذ األوً أ١ّرألز ع selective cox-2 inhibitor ُ ِغ لشؽخ اٌّؼذح ِب ػذاِٙع رّبِب اعزخذإِّٛ Gout )داء اىَيىك (اىْقشص Definition Inflammatory arthritis due to deposition of uric acid crystal in the joint غجت ثبألَ إٌمش٠ اٌّفبصً ِّبٟه ف٠سٛ١ٌساد ؽّض اٍٛت ث١رشع Treatment strategy during acute attack Reduce inflammatory o Colichicine ( may prevent precipitation of uric acid in joint) o NSAIDs as indomethacine.) 2. allopurinol Decrease uric acid synthesis ( xanthine oxidase inh. probencid action is antagonized by salicylate www. o Intra-articular steroid treatment strategy In between attack (chronic) 1.prometric-questions. Urea Purine Xanthin Uric acid Protein reabsorbtion Pyrimidin Joints 9-8-7-6-5 ُ سلvideo ٗ ِشاعؼٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض ة ؽً أعئٍخ اٌّزوشحٍِٛط 155 – 68 – 65 – 61 – 53 – 28 – 23 – 18 – 5 – 4 األعئٍخ1 رطّٛٔ 83 – 77 – 62 – 59 – 54 – 45 – 13 – 12 – 1 األعئٍخ2 رطّٛٔ 96 – 83 – 82 – 81 – 45 – 34 – 21 – 17 – 15 األعئٍخ3 رطّٛٔ 57-53-55-49-45-34-33 -15-6-5-4-3-2-1 األعئٍخ6 رطّٛٔ 155 -81 : االعئٍخ7 رطّٛٔ 53 -45 -38 : االعئٍخ8 رطّٛٔ 99 -65 -55 -39 -29 -15 -7 : االعئٍخ9 رطّٛٔ 37 -36 -25 -11 : االعئٍخ15 رطّٛٔ 27 -26 -5 : االعئٍخ11 رطّٛٔ Excretion Blood Gout www.com 31 .prometric-questions. This is the diastolic pressure.prometric-questions. 8.com . your blood pressure falls. 5. or between 80 and 89 for the bottom number is prehypertension خ٠ِٛخ اٌذ١ػٚ عذساْ األٍٝضغظ ػ١ؼخ ِٓ اٌذَ ف٠ ؽشوخ عشٛ٘ ضغظ اٌذَ اٌّشرفغ ٟؼ١ ضخ اٌُ ِٓ اٌمٍت أعشع ِٓ اٌطجٚخ أ٠ِٛخ اٌذ١ػٚ األٟك ف١ إِب ضٛ٘ ؼخ٠عجت ٘زٖ اٌؾشوخ اٌغش ) اٌّخ. Hypertension Blood pressure is the force of your blood pushing against the walls of your arteries. When your heart is at rest. 6. This is called systolic pressure. 4. it pumps out blood into the arteries. the systolic and diastolic pressures. between beats. A reading of 120/80 or lower is normal blood pressure 140/90 or higher is high blood pressure 120 and 139 for the top number. pumping the blood. 7.Cardiovascular system High Blood Pressure Also called: HBP. 2. Each time your heart beats. HTN. Your blood pressure reading uses these two numbers.َ اٌذ. Usually they are written one above or before the other. اٌمٍت. Diuretics Drug affecting the rennin angiotensin system Direct acting vasodilator Centrally acting antihypertensive drugs Adrenergic neuron blocking agent Alpha adrenoreceptor blocking drugs Beta adrenoreceptor blocking drugs Calcium channel blocker 31 www.ٍٝ أِبوٓ ( اٌى4 ٌٍٝؼلاط ضغظ اٌذَ ٔؼًّ ػ ٜد ِشح ألشٛ صُ رؼٍٝؼ ثبٌى١ اٌغغُ وٍٗ صُ رز٘ت ٌٍزششٍٝخ ٌزّش ػ١ػٚصع اٌذَ ثبألٛ٠ٚ اِشٖ ِٓ اٌّخٚألز اٌمٍت أ٠ ٌٍمٍت ٜ األِبوٓ األلشٍٝسح ِٓ اٌؼًّ ػٛ ألً لطٚ خ١ب ألً أػشاض عبٔجٙٔ ألٍٝ اٌىٍٝفضً األطجبء اٌؼًّ ػ٠ Antihypertensive agent 1. Your blood pressure is highest when your heart beats. 3. pulmonary edema. anti androgenic www.……) Hyponatermia hypokalemia hypocalcemia ototoxic Loop Diuretics Furosemide (Lasix® ) bumetanide (bumex®) Chlorothiazide (Diuril®) Edematous Inhibit Na & Cl reabsorption state (CHF.v Osmosis 2-Decrease intra cranial pressure Ethacrynic Acid (Edecrin ®) Uses Adverse effect Glaucoma hypokalemia Edema dehydration Edematous Inhibit Na & Cl reabsorption state (CHF.prometric-questions. gynecomastia. pulmonary edema …) Hyponatermia hypokalemia hypercalcemia No ototoxic Thiazides diuretic Hydrochlorothiazide (Hydro®) indepamide (natrilix®) Spironolactone Potassium Sparing diuretic (Aldactone®) Triamterene ( Dyrenium®) amilorid (midamor®) 1-Aldosterone antagonist 2-non aldosterone antagonist Potassium depletion CHF hypertension hyperkalemia.1-Diuretics Classification Example اءٚاٌذ Carbonic anhdrase inhibitor Acetazolamide Dorzolamide Mechanism Carbonic anhdrase inhibitor 1-Glaucoma Osmotic diuretic Mannitol i.com 32 . v Urea Yes Yes Yes IOP Yes Yes No ICP NO Yes Yes -5اٌّغّٛػخ اٌضبٌضخ Loop Diuretics :اشٙش أد٠ٚزٙب Furosemide اعّٗ اٌزغبس٠ (lasix) ٞؼبٌظ اٌضغظ اٌّشرفغ ٌٚىٓ ٠غجت أ -عّ١خ ثبألرْ ototoxicity ةٔ -مص ٌىً أٔٛاع اٌّؼبدْ hypo …….com 33 .. Hypo natremia .C.Pالمٌاه الزرقاء ( زٌادة ضغط الدم بالعٌن ) -2المجموعة الثانٌة osmotic diuretic :تشمل الدواء mannitolأٌضا ال ٌعالج الضغط الشامل ) glaucoma ( intra ocular pressure )(I. hypo kalemia .O. hypo calcemia الؽع اْ Naصٛد ٚ َٛ٠اٌجٛربعٚ K َٛ١اٌىبٌغCa َٛ١ -6اٌّغّٛػخ اٌشاثؼخ thiazide Diuretics :اشٙش أد٠ٚزٙب indepamide اعّٗ اٌزغبس٠ (natrilix) ٞؼبٌظ اٌضغظ اٌّشرفغ ٚاٌفشق ػٓ اٌّغّٛػٗ اٌغبثمخ أ -ال ٠غجت عّ١خ ثبألرْ no ototoxicity ةٔ -مص ٌىً أٔٛاع اٌّؼبدْ ِ hypo ……. Hypo natremia .C.بػذا اٌىبٌغ َٛ١فبٔٗ ٠ض٠ذ رشو١ضٖ hyper …….prometric-questions. hypo kalemia .O.Pفقط Diuretic Acetazolamide Mannitol i. hyper calcemia -7ألطش ػشض عبٔجٔ ٛ٘ ٟمص اٌجٛربعٌٍ hypo kalemia َٛ١مبػذح ال ٛ٠عذ أجغبط ٌٍمٍت إال فٚ ٟعٛد اٌجٛربعٚ َٛ١ال ٛ٠عذ أمجبض ٌٍمٍت إال فٚ ٟعٛد اٌىبٌغَٛ١ www.مالحظات هامة جدا -: -1المجموعة األولى Carbonic anhdrase inhibitor :تشمل الدواء acetazolamideاسمه التجاري ) (diamoxوال ٌعالج الضغط الشامل ولكن ٌعالج glaucoma ( intra ocular pressure ) )(I.Pزٌادة ضغط الدم بالجمجمة ) ولكن ٌعالج بالعٌن ) وال ٌؤخذ إال عن طرٌق الورٌد IV ٌ -3ستخدم أٌضا لعالج الجلوكوما كال من )pilocarpine & timolol ) drops -4هناك أٌضا الٌورٌا ureaمن مدرات البول وتستخدم لعالج I.Pالمٌاه الزرقاء ( زٌادة ضغط الدم ٌ +عالج ) ( ( intra cranial pressure )(I. angina . angina . arrhythmia HTN..pril أي دواء ٌنتهً ب ( Capoten ) ٞ اعّخ اٌزغبسCaptopril ٛ٘ ACE inh خ٠ٚش أدٙ أش www.ٟ٘ٚ ََ ثبٌذٛ١ربعٛ ٔغجخ اٌجٍٝذح رؾبفع ػ٠ي عذٛ ذٌ الزشاع ِذساد ٌٍج-8 Spironolactone بٙز٠ٚش أدٙ أشPotassium Sparing Diuretics : ػخ اٌخبِغخّٛاٌّغ غجت٠ ٌٓىٚ ؼبٌظ اٌضغظ اٌّشرفغ٠ (Aldactone) ٞاعّٗ اٌزغبس hyper kalemia َٛ١ربعٛبدح اٌج٠ ص ثخِٛضبد ٌٍخاAnti androgenic ي اٌغبثكٚخ ِٓ اٌغذ٠ب اٌزغبسٙ ثبٌىبًِ ثأعّبئdiuretic خ٠ُٚ عذا ِؼشفخ أدِٙ -9 2. angina . arrhythmia HTN.com 34 . angina .I.Drug affecting angiotensin system drug captopril Mechanism ACEInh indication HTN. arrhythmia Side effects Cough Hypotension Proteinuria Fetal renal damage (C. arrhythmia HTN.in pregnancy) hyperkalemia As ACEInh without cough lisinopril ACEInh enalapril ACEInh losartan (AT-1) blocker Angiotensin converting enzyme inhibitor (ACEInh) Angiotensin receptor (AT-1) blocker الكل ى حساسة جدا لكمٌة المٌاه الموجودة بالجسم فمثال عندما ٌكون االنسان صائم ٌقل اخراج البول والعكس صحٌح Angiotensin II الذي ٌتحول بدوره الىAngiotensin I التً بدورها تقوم بتنشٌطrennin تفرز الكلى مادة أقوى مسبب النقباض االوعٌة الدموٌة بالجسم مما ٌسبب ارتفاع مفرط بضغط الدمAg II ٌعتبر ACE inhibitor بواسطةAg II الىAg I نمنع تحوٌلAg II لتقلٌل تكوٌن ACE inhibitor … ٌنتمً لل.prometric-questions. prometric-questions. (25 mg) األعراض الجانبٌة تشمل Hyper kalemia & dry persistent cough losartan ( مثل دواءAT-1 blocker ) الى مستقبالتهAg II هناك طرٌقة أخرى عن طرٌق منع وصول 3.com 35 . الجرعه الٌومٌة القصوى Capoten maximum daily dose 150 mg / day either 3 tablet (50 mg) or 6 tab.direct acting vasodilator drug Hydralazine Minoxidel Diazoxide Nitroprusside mechanism arteriolar dilatation arteriolar dilatation arteriolar dilatation indication Moderate HTN Moderate HTN Side effects tachycardia tachycardia HTN emergency tachycardia Veno-arteriolar dilatation HTN emergency tachycardia أحٌانا ٌكون هناك حاالت طوارئ من ارتفاع مفرط من ضغط الدم وفً هذه الحالة نلجأ هذه المجموعة وأشهرهم nitroprusside &Hydralazine www. ًِاٛػ ٌٍؾّٛذ اٌّغ١ؽٌٛاء اٚاٌذ 5.prometric-questions.Centrally acting drug Methyl dopa Clonidine mechanism indication Side effects α2 agonist Moderate HTN Sedation. depression Orthostatic hypotension Inhibit NE release HTN guanithidine Inhibit NE release HTN 6.com 36 . dizziness α2 agonist Moderate HTN Sedation.4.Adrenergic neuron blocker drug reserpine mechanism indication Side effects Sedation.O.C drug of choice in pregnancy. rebound hypertension Methyl dopa (aldomet®) D.Alpha adrenoreceptor blocking drugs drug prazocin terazocin mechanism indication Side effects Orthostatic hypotension Orthostatic hypotension Orthostatic hypotension Alpha (α1) blocker HTN Alpha (α1) blocker HTN doxazocin Alpha (α1) blocker HTN Alpha (α1) blocker azoocin قط ء ن أ Alpha (α1) blocker used also in benign prostate hyperplasia (BPH) www. 7. CHF.prometric-questions. esmolol خ٠غجت أصِخ صذس٠ ؼبٌظ اٌضغظ ال٠ selective B blocker ِٓ اءٚ دٞأ Treat hypertension without causing asthma labetalol & carvidalol are α and β1 blocker : ظخٍِٛؾ www. arrhythmia HTN.olol ةٟٕٙز٠ اءٚ دٞأ Example timolol . arrhythmia beta ( β 1) blocker beta ( β 1) blocker Used I. N فٚجذأ ثأؽذ ؽش٠ٚ ……. nadalol خ٠غجت أصِخ صذس٠ ٌٓىٚ ؼبٌظ اٌضغظ٠ non selective B blocker ِٓ اءٚ دٞأ Treat hypertension but cause asthma selective B1 blocker ْٛى٠ T .com 37 . pindalol . Bradycardia CHF.blocker ْٛى٠ ……. bradycardia pindalol atenolol esmolol HTN. angina . angina .V for hypertensive emergencies Note propranolol is contraindicated with asthmatic patient B.olol ةٟٕٙز٠ اءٚ دٞأ Example atenolol . bradycardia CHF. N فٚجذأ ثأؽذ ؽش٠ الٚ …….Beta (β) blocker drug propranolol mechanism Non selective β blocker Non selective β blocker indication HTN. propranolol .olol ةٟٕٙز٠ اءٚ دٞأ non selective B blocker ْٛى٠ T . angina . arrhythmia HTN. CHF. bradycardia Asthma. angina . P . arrhythmia Side effects Asthma. acebutalol . P . nausea. arrhythmia HTN. angina . diltiazem Amlodipine .8. heart block Amlodipine (CCBs) Constipation . nausea. nausea. arrhythmia HTN.prometric-questions. tachycardia خاص بقنوات الكالسٌوم فً القلب nifedipine (CCBs) Verapamil .com 38 . angina . angina . arrhythmia block Ca on heart Side effects Constipation .Calcium channel blocker Calcium channel blocker (CCBs) Block calcium block contractility of heart and induce vasodilatation of blood vessel Drug Verapamil mechanism Indication (CCBs) HTN. Constipation . angina . nausea. arrhythmia HTN. nifedipine block Ca on Blood vessel خاص بقنوات الكالسٌوم فً األوعٌة الدموٌة Trade name of nifidepine is (adalat®) www. flushing. heart block diltiazem (CCBs) Constipation . Diuretics (see hypertension ) www.prometric-questions.F) Definition Condition in which cardiac output is less than body need ) غخ اؽزمبْ ( اِزلاء١فزٗ ٔز١ظٛبَ ث١ اٌمٟفشً اٌمٍت ف Treatment )اإلسرشاذٍجٍح اىعالجٍح أوال صٌادج ّشاغ اىقية ( ذقىٌح ععيح اىقية وصٌادج االّقثاض I.Vasodilators (see hypertension ) III. Less oral absorption 2.com 39 . Hepatic elimination 4.Positive inotropic effects (increase contraction of cardiac muscle by) 1-Cardiac glycoside Digoxine 1. Oral administration 2-Β1 agonist (dobutamine ) اٌمٍتٍٝ) ػload) ً١ًّ اٌزؾ١ٍ رمٌٝ ٍٔغأ إٌٝٚخ األ١غ١إرا ٌُ ٔزّىٓ ِٓ اإلعزشار II. High Oral absorption 2. Shorter duration 3. Longer duration 3. Renal elimination 4.Congestive heart failure (C.H.v administration Digitoxine 1. i. Oral . disopyramide Class I B Na+ channel blocker Lidocaine i.prometric-questions.Arrhythmia Definition Abnormal heart beat due to disorder of impulse formation. conduction or combination ػذَ أزظبَ ضشثبد اٌمٍت Classification mechanism drug Quinidine. Class I A Na+ channel blocker procainamide.com 41 .v phenytoin Flecainide ecanide Propranolol atenolol Amiodarone bretylium Verapamil deltiazem Adenosine Un classified digoxin atropine adrenalie Decrease Increase Action Potential Class I C Na+ channel blocker Β blocker No effect Class II Decrease Class III K + channel blocker Increase Class IV Ca+ channel blocker www. Long acting nitrate Isosorbid mono or dinitrate oral 2.v. and/or lipoprotein in blood www.prometric-questions.com 41 .hypertension 3. or i.Calcium channel blocker 4-Anti platelet Hyperlipidemia Coronary heart disease is one of the major causes of the death The incidence of CHF is correlated with elevated levels of LDL. Other risk factors include 1.Beta blocker 3. cholesterol triglyceride with low level of HDL. Target of anti hyperlipidemic agent is LDL (border line of LDL is 130 – 160 mg/dl) Patient with serum level 160mg/dl with one or more risk factor should start drug therapy Patient with serum level 130mg/dl with two or more risk factor should start drug therapy Definition Condition of high level of cholesterol.cigarette smoking 2. triglyceride. Infusion isosorbid dinitrate sublingual Treatment In between attack 1.diabetes.obesity 4.Angina Definition Acute chest pain (squeezing) occur when coronary blood flow is inadequate To supply the oxygen required by the heart Treatment During acute attack 1.short acting nitrate Nitroglycerin sublingual . prometric-questions.com low density lipoprotein It is increase HDL ( good cholesterol ) high density lipoprotein S.Anti hyperlipidemic agent aim of therapy: It is decrease LDL ( bad cholesterol ) Decrease triglyceride Class Resins HMG CoA reductase inhibitor Nicotinic acid derivative Fibrates ↓↓ ↓ ↑↑ ↑ ↓ ↓↓↓ Gemifibrozil ↓↓↓ ↑ ↓ LDL ↓↓ HDL No effect Triglyceride Slight ↑ Drug Cholestyramine Simvastatin Atorvastatin Pravastatin Gastrointestinal irritation 91 .E ……Statin ثّمطغHMG خ٠ٚغ أد١ّبء عٙالؽع أز 16-15-14-13-12-11-15 ُ سلvideo ٗ ِشاعؼٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض ة ؽً أعئٍخ اٌّزوشحٍِٛط 88 – 83 – 82 – 81 – 85 – 77 – 76 – 74– 55 – 54 -51-32– 31 – 35 – 21 -17 – 8 -1 األعئٍخ1 رطّٛٔ 42 .95 – 92 – 86 – 75 -74-69– 68 – 67 – 64 – 41 – 45 – 31 – 4 – 3 األعئٍخ2 رطّٛٔ 81 -81-76 -75– 74 – 73 – 68 – 51 – 49 – 48 – 38 – 33 – 18-2 األسئلة3 نموذج 61 -55 -51 -47 -46 -45 -44 -43 -41 -14 -8 -6 -5 -3 : االسئلة7 نموذج 94 -72 -68 -64 -61 -48 -47 -43 -27 -26 -25 -19 – 18-13 : االسئلة8 نموذج 114 -112 -97 -91 -84 -79 -48 -41 -32 -25 -23 -9 -6 -3 : االسئلة9 نموذج 94 -83 -78 -74 -69 -53 -47 -42 -41 -39 -38 -35 -26 -14 -8 -7 : االسئلة11 نموذج 6 : االسئلة11 نموذج www. Patenteral Iron dextran and iron sorbitol P ain brownish discoloration at site of injection Antidote desferoxamine www. Gastrectomy. bleeding) بدح اٌطٍت٠ص بدح اٌفمذ٠ص خ٠ء رغزٛع ُء ٘ضٛع Iron therapy Oral iron Ferrous form not ferric?????? Blackening of teeth and stool Abdominal discomfort Duration of therapy (3 – 6) month.com 43 . starvation) Decrease absorption E.prometric-questions.g. Pregnancy & lactation) Increase loss (e.Drug acting on the blood and blood forming Anemia iron deficiency anemia Iron is required for haemoglobin production Iron deficiency lead to hypochromic microcytic anaemia Main dietary source is meat & liver A etiology Decrease intake (e. excess tannic acid {tea} Increase requirement (e.g.g.g. P Treat pernicious anemia with folic acid alone improve symptoms however neurological damage will occur www.g.g.g.I.megaloblastic anemia Vitamin B12 .2. Lack of transcoplamine ( vit B 12) . hydroxycoblamine folic acid Folic acid (oral) folinic acid ( Parenteral ) V. Pregnancy & lactation) Decrease utilization خ٠ء رغزٛع ُء ٘ضٛع بدح اٌطٍت٠ص َلٍخ االعزخذا (E.folic acid is essential for DNA synthesis deficiency of both lead to megaloblastic anemia Deficiency of Vitamin B12 alone due to lack of gastric intrinsic factor lead to type of megaloblastic anemia called pernicious anemia pernicious anemia cause neurological damage if not treated Main dietary source of Vitamin B12 is animal product Main dietary source of folic acid is vegetables A etiology Decrease intake (e.prometric-questions. trimethoprime) Therapy Vitamin B12 (Parenteral) cyanocoblamine .com 44 . starvation) Decrease absorption (e.g. Gastrectomy) Increase requirement (e. Use of drugs as methotrexate . Parenteral anti coagulant 2. enlargement of clot ) اٌؼذدٚ ُبدح اٌؾغ٠ اٌغٍطخ ( صّٛٔ خ رّٕغ٠ٚ أد Do not lyses clot ت اٌغٍطخ٠ ال رز Types 1.C Tablet Liver slow chronic vivo only I. Oral anti coagulant ٓك اٌؾم٠ػٓ طش ُك اٌف٠ػٓ طش ي ٘بَ عذاٚ٘زا اٌغذ Drug Route Heparin (enoxparin deltparin) warfarin I.V and Blood Action Rapid Acute Site Antidote vivo and vitro Protamine sulfat S.V vitamin K + fresh frozen plasma Not used Pregnancy Used OTCاءٚط ٘زا اٌذٚص ِطٍمب لشٛغ٠الٚ ْزؼبًِ ِؼٗ اإلٔغب٠ ٟخ اٌز٠ٚٓ ِٓ ألطش األد٠اسفبسٌٛؼزجش ا٠ www.I-anti coagulant drug َخ اٌّضبدح ٌزغٍظ اٌذ٠ٚاألد بٙ ػلاعٟب رّبِب فِٕٙ غت اٌؾزس٠ ٟ رغٍظ اٌذَ ِٓ األِشاض اٌزٚإْ رخضش اٌذَ أ بح١ اٌؾٍٝسح ػٛ لطٌٝ إٞؤد٠ اٌذَ ِّبٜؾذس أغذاد ٌّغش٠ بٙ١ٍطشح ػ١زُ اٌغ٠ ٌُٚ ض عٍطخ٠ ؽذس ػٕذ اٌّشٌٛ ٍٟف دال٠ ٔضٌٝ إٞؤد٠ ض عشػخ صائذح ِٓ اٌؼلاط لذ٠ ألز اٌّشٌٛ Drugs which inhibit development.com 45 .prometric-questions. antiplatelet Drugs which inhibit platelet aggregation. clopidogrel 4. Ticlopidine . Dipyridamole www. 3. selective Fibrinolytic non selective Fibrinolytic Site Act on both bound .prometric-questions.II-Fibrinolytic drugs ---Lytic mean lyses ( dissolve ) ت اٌغٍطخ٠ رزٟخ اٌز٠ٚاألد Drugs which dissolve thrombus by formation of Fibrinolytic plasmin from plasminogen Type 1.com 46 . aspirin 2. Abciximab 5. free plasminogen urokinase streptokinase aminocaproic acid tranxamic acid selective Fibrinolytic Act on bound plasminogen only alteplase reteplase tenecteplase aminocaproic acid tranxamic acid Members antidote of bleeding III. so inhibit clot formation Used as prophylaxis against thrombus Members 1. non selective Fibrinolytic 2. receptor antagonist e.receptor antagonist www. ranitidine. nizatidine. 18-17 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض ة ؽً أعئٍخ اٌّزوشحٍِٛط 71 -48-47– 18 األعئٍخ1 رطّٛٔ 71 – 38 األعئٍخ2 رطّٛٔ 79 – 78 . H2.com 47 . cimitidine.77 األسئلة3 نموذج 91-58. famotidine Action H2.g. photo ِشاعؼخٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض Drugs used in treatment of gastric ulcer 1. PowerPoint .prometric-questions.57 – 56 – 55 -54-53-52-51– 49 – 37 األسئلة4 نموذج 151 -99 -94 -79 -45 -39 -38 -35 -7 االعئٍخ7 رطّٛٔ 3 االعئٍخ8 رطّٛٔ 98 -96 -95 -82 -15 -4 االعئٍخ9 رطّٛٔ 71 -33 -15 -9 -4 -3 االعئٍخ15 رطّٛٔ 55 -47 -8 -2 االعئٍخ11 رطّٛٔ video . ranitidine. Ca salt Example NaHCO3 2.prometric-questions.com 48 . Proton pump(H/K ATPase) inhibitor E. omeprazole. lansoprazole. Adverse effects A. rabeprazole action Proton pump(H/K ATPase) inhibitor Totally block parietal cell (more effective than H2 antagonist) Adverse effects G. mineral Enteric infection due to decrease acidity – Omeprazole decrease activity of hepatic enzyme 3.T disturbance Decrease absorption of vitamin B12. Cimitidine antiandrogenic effect Decrease activity of hepatic enzyme ( enzyme inhibitor ) B.I. famotidine More effective No antiandrogenic effect No interfere with activity of hepatic enzyme 2. pantoprazole. Antacids action Type neutralize gastric acidity Absorbable Non Absorbable 1. nizatidine.g. Mg salt Ca salt Side effect alkalosis cause Constipation AL salt cause Constipation Mg salt cause Diarrhea All can cause hypokalemia www. AL salt 3. E.D for 14 days ( ( B. creating a protective layer against acid Constipation prostaglandin analogue (misoprostol ) (cytotec®) 1. unconsciousness 4.D for 14 days ( then Continue for 4-6 week ( B. S. Action 2. gastric mucous barrier diarrhea *Contraindicated in pregnancy (cause abortion) Drugs to eradicate helicobacter pylori bacteria microorganism that can cause chronic gastritis and peptic ulcer disease • New triple therapy • Proton pump inhibitor ( B.g.I.I. drug over dose 3. Emesis Used if recently ingested toxic substance.g. Action 2.E.com 49 .I.N.prometric-questions.I. S. caustic substance. E.S depression. Drugs that protect mucosa Sucralfate (aluminum sucrose sulfate) 1. Contraindication with C. apomorphine directly acting on CTZ Respiratory depression which is treated By naloxone www.D for 14 days ( • Clarithromycin (500 mg) • Amoxicillin ( 1g) • If patient sensitive to amoxicillin replaced by Metronidazole (500 mg) B.4.D Vomiting • Emetics 1. Agent induce reflex vomiting 2. Ipecac directly acting on CTZ Indirectly acting gastric mucosa cardiotoxic if reach systemic circulation E. g. anticholinergic E. sedation hyperprolactinemia block 5HT3 receptors chemically induced vomiting atropine like effect block M receptors motion sickness and vertigo atropine like effect motion sickness and vertigo atropine like effect www. Serotonin (5HT3) antagonist E. 5HT3 receptors chemically induced vomiting Vomiting of pregnancy Adverse effect 5. meclizine Uses Adverse effect 2.g. ondasetron .C) vomiting of pregnancy dry mouth. metoclopramide . Hyoscine Action Uses Adverse effect 3. dolasetron Action Uses Adverse effect 4. granisetron . H1 antagonist E. diphenhydramine .prometric-questions. Dopamine (D2)antagonist E.• Anti emetic drug 1. domperidone Action Uses block D2.com 51 .g.g. dimenhydrinate . Vitamin B6 Action Uses Adverse effect regulate of GABA/glutamate balance (D.O. High fever 3. methyl cellulose • 2.Purgative Drug that used to evacuate bowel if its mild purgative called (laxative) If its severe purgative called (cathartics) • 1. bran. biscacodyl. aloe.S side effects Adsorbents Kaolin.com 51 . senna • 4.N. diphenoxylate C.g. Systemic toxicity Opioid agonists : Natural : morphine Synthetic: loperamide . Bloody diarrhea 2. lactulose. pectin Safe www. MgSo4.Bulk forming purgative E.osmotic purgative E. psyllium.prometric-questions.Lubricant purgative E. mineral oil (liquid paraffin) Anti diarrheal drug • Drug used to control diarrhea • Should not be used in 1. castor oil.g.Stimulant purgative E.g. Na/K tartarate • 3.g. hyoscine 2. Anti cholinergic as atropine . Colloidal bismuth salt Bile salt binding resin cholestyramine or colestipol Astringents : Tannic acid Antibacterial : cotrimoxazole When the bacterial is the cause of diarrhea Oral rehydration solution Oral administration of glucose containing salt Antispasmodics • Drug used for the relief of the painful biliary.prometric-questions. Smooth muscle relaxants as papaverine . ureteral or colonic spasm 1. Antispasmodics seen before 2. cholecystokinin www. ii. mebeverine Drug affecting biliary system 1. Drug dissolve gallstone i. bile acid as chenodeoxycholic acid (CDCA). ursodeoxycholic acid (UDCA) 3. Cholinokinetics (cholagogues) Stimulate gall bladder empty Used for diagnostic purposes As egg yolk. MgSO4.com 52 . Potassium iodid 4. Radioactive iodine www.com 53 . Liotrix (4:1) mixture of T4:T3 Agents Used in treatment of hyperthyroidism 1. Liothyronine (T3) 3.prometric-questions.21 -25-19 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض : ؽً اعئٍخ اٌّزوشحٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض 14-12 : األعئٍخ1 رطّٛٔ 61-58-57-56-55-23-25-15-14 : األعئٍخ2 رطّٛٔ 97-95-45 : األعئٍخ3 رطّٛٔ 75 ٌٝ ا59 ِٓ ُص55 -48-47 ُ ص45 ٌٝ ا38 ِٓ : األعئٍخ4 رطّٛٔ 34 ٌٝ ا18 ِٓ : األعئٍخ5 رطّٛٔ 97 -83 -78 : االعئٍخ7 رطّٛٔ 79 -54 -42 -33 -28 -17 -15 -11 : االعئٍخ8 رطّٛٔ 86 -74 -17 : االعئٍخ9 رطّٛٔ 88 -79 -75 -46 -19 : االعئٍخ15 رطّٛٔ 29 -21 -1 : االعئٍخ11 رطّٛٔ Hormone and antagonists Thyroid hormones • • • T3 (tri iodo thyronine) Responsible for Optimal growth T4 )tetra iodo thyronine) ( thyroxin ) Responsible for Optimal growth Calcitonin Responsible for Regulation calcium metabolism Agents used in hypothyroidism (myxedema) 1. Carbimazole 2. Levothyroxine (T4) 2. propylthiouracil methimazole thiocyanate lugols iodine(I2.KI) Potassium percholate 3. Hypertension 3. Cataract 4. desoxycorticodterone( DOCA) Derivative from mineralocorticoid • Adrenal cortex also secrete sex hormones in small amount as androgen.prometric-questions.com 54 . progesterone • Clinical uses of steroids Replacement therapy In Addison's disease (primary adrenal insufficiency) Supplementary therapy Anti inflammatory. anti shock. water retention 2. dexamethasone Derivative from Glucocorticoids with no mineralocorticoid activity fludrocortisone . Sodium . buffalo hump …) www. cortisol (hydrocortisone) Its function as anti inflammatory Mineralocorticoid : e. anti stress Suppression therapy Suppress rejection in tissue transplantation • Adverse effect of glucocorticoids 1. aldosterone desoxycorticosterone( DOCA) Its function as salt retaining Synthetic betamethasone.Adrenocorticosteroids • They steroid hormone secreted by adrenal cortex • Naturally occuring Glucocorticoids : e.g. cortisone .g. Glaucoma 5. Cushing syndrome ( moon face . contraception.g.prometric-questions. fat deposition mestranol diethylstilbestrol www.6. raloxifene These compounds have selective tissue estrogenic activity • Selective estrogen receptor modulator (SERM) development of breast . Hyperglycemia 7. uterine bleeding .com 55 . tamoxifen . hormonal replacement in menopause. increase risk of endometrial & breast carcinoma Antagonist • Clomiphene (fertility drug) Used in induction of ovulation Side effect is multiple births • Selective estrogen receptor modulator (SERM) E. prostate carcinoma Adverse effect • Risk of thrombosis . Peptic ulcer 8. Osteoporosis Cushing syndrome is excess secretion of glucocorticoids Gonadal hormones Estrogen Natural • Estradiol estrone estriol ٟؼ١اء اٌطجٚخ اٌذ٠الؽع ثذا Synthetic • Ethinyl estradiol Function • Endometrial proliferation • Genitalia development Clinical use • Female hypogonadism . com 56 . uterine bleeding ٌّٖٕٛ increase LDL norgestrel ف إٌّبعجخٚئخ اٌظش١ٙي ػٓ رٛٓ ِغئ١عغزّٕٚب اٌجش١ٓ ث١ٕئخ اٌّىبْ إٌّبعت العزمجبي اٌغ١ٙي ػٓ رٛٓ ِغئ١عٚاالعزش www. hormone replacement therapy Adverse effect • Decrease HDL Antagonist • Mifepristone Used for Adverse effect termination of early pregnancy (abortification) abdominal pain.prometric-questions.Drug estrogen tamoxifen Raloxifene bone agonist agonist agonist breast agonist antagonist antagonist endometrial agonist Uses Adverse effect Risk of thrombosis Partial agonist Breast cancer Risk of thrombosis osteoporosis Risk of thrombosis Progestin Natural • Progesterone Synthetic • MedroxyProgesterone Function • Maintain of pregnancy stimulate endometrial glandular secretion Clinical use • Contraception . com . Post coital ( emergency ) estrogen alone in high dose within 72 hr of intercourse followed after 12 hr by second dose Mifepristone + misoprostol taken once • Parenteral ( depot contraception ) MedroxyProgesterone I.prometric-questions. Minipill progestin only daily without interruption 3. and MODY type) (secondary to other cause as chronic pancreatitis) (pregnancy diabetes) (glucose between normal and diabetic) Type 2 Insulin resistance ٍٍِقاوٍح اىَسرقثالخ ىألّسىى MODY Type Intermediate between1&2 Young Obese Older ٓوجبساٌغ Obese ٓ١ّع Oral Antidiabetic ± Oral Antidiabetic insulin 57 www.C implantation ( last for 5 year ) Drugs used in diabetes mellitus (DM) • Primary DM • Secondary DM • Gestational DM • Impaired glucose tolerance Primary DM Cause Type 1 insulin deficiency ٓ١ٌٛٔمص األٔغ Patient age Patient description Treatment Young ٓصغبس اٌغ Non obese ف١ٔؾ Insulin injection ٓ١ٌٛؽمٓ األٔغ (type 1 . 2 .Hormonal contraception • Oral 1.M every 3 mounth • Implanted norgestrel S. Combination method ( estrogen + progestin ) taken 21 day then 7 day free period 2. C) ؤلز٠ ٞ٘زا اٌزٚ ٓ اٌّؼىش١ٌٛ األٔغّٝغ٠ • Human insulin ( humulin ) ( clear .V) Origin of insulin • Animal insulin beef AND pork (I.C) • Less often intramuscular injection (I. S.Second generation • Glipizide Gliclazide Glimepride Glyburide 3-Biguanides • Drug • Mechanism – Stimulate glycolysis – Reduce gluconeogenesis – slow glucose absorption www.M) • Emergency intravenous injection (I.com Metformin Unknown but suggestion 58 . hypoglycemic coma (main side effect ) األلطشٛ٘ٚ ٔمص اٌغىش • Weight gain • Insulin resistance • Allergic reaction 2-Sulphonyl urea • Mechanism: insulin secretagogue (stimulate endogenous secretion) بدح اإلفشاص٠ صٍٝرؼًّ ػ Insulin sensitizer (increase sensitivity of insulin receptor) خ اٌّغزمجلاد١بدح ؽغبع٠ صٍٝرؼًّ ػ • Classification 1. colorless .First generation • Tolbutamide tolzalamide acetohexamide chloropropamide(long act) 2.M . watery ) ٗٔض ثأ١ّز٠ٚ Adverse effects of insulin • Hypoglycemia .1-insulin has no oral absorption so Route of administration of insulin • Usually Subcutaneous (S.prometric-questions. V ٝؼط٠ ٞذ اٌز١ؽٌٛٓ ا١ٌٛاألٔغ by recombinant RNA technology in E.31 -27 -15 االسئلة11 نموذج 46 -16 االسئلة11 نموذج www.GIT disturbance شٙك األش٠ اٌطشٛ٘ ٘زاٚ S.C ٌٓىٚ ُك اٌف٠ٓ ػٓ طش١ٌٛ األٔغٝؼط٠ ال S.prometric-questions.coli Human insulin = humulin = regular type خ٠ٛ دسعخ ِئ8 – 2 ِٓ دسعخ ؽشاسحٟ فٍٟ اٌشف اٌغفٟ اٌضلاعخ فٟٓ ف١ٌٛؾفع األٔغ٠ Insulin is preserved in lower shelf of refrigerator in 2-8°C Mixtard insulin had duration of action 12 – 24 hour so can be taken once daily Drug generic name Glibenclamide Gliclazide Glimepride Metformin Trade name Doanil Diamicron Minidiab Glucophage ة ؽً أعئٍخ اٌّزوشحٍِٛط 62-52 – 55 – 49-26 األعئٍخ1 رطّٛٔ 97 – 95 – 95 – 84 – 78 – 65 – 35 – 29 -28-27-26-25– 7 – 6 األعئٍخ2 رطّٛٔ 64 – 63 – 62 – 42 – 31 – 29 – 28 – 4 األسئلة3 نموذج 36 -26 -12 -9 االسئلة7 نموذج 85 -84 -83 -82 -81 -77 -51 -44 -14 االسئلة8 نموذج 87 -75 -52 -31 -14 -13 -11 االسئلة9 نموذج 82 -67 -43 -32.V ٚ ٗؼ١ٕزُ را٠ٚ ٞٓ اٌجشش١ٌٛ األٔغٛ٘ I.C ثؼذI.• adverse effect lactic acidosis .com 59 .M ٚ اسئٛ ؽبالد اٌطٟ فI. O. Drugs used ( chloroquine . www. and those arthropods that directly cause disease or act as vectors of various pathogens A parasite is a pathogen that simultaneously injures and derives sustenance from its host The unicellular parasites is (protozoa) multicellular parasites are (helminthes. primaquine . quinine .com 61 . parasitic helminthes (worms).C) is chloroquine There are more than 100 species of malaria (plasmodium).prometric-questions.Introduction to Parasitology Medical parasitology traditionally has included the study of three major groups of animals: parasitic protozoa. fansidar ) • Amoeba (D. liver intestinal wall ) or intestinal lumen Patients have acute or chronic diarrhea. which may progress to dysentery. mefloquine .O. parasitic organisms typically go through several developmental stages that involve changes not only in structure but also in biochemical and antigenic composition Protozoa • Malaria (D. Patient suffers from recurrent severe fever every 3 or 4 days. arthropods) During their life.C)is metronidazole Protozoan Entamoeba histolytica Parasites lives in tissue ( lung . Only 4 capable of infecting human. Disease is transmitted to human by bits of infected female anopheles mosquito Parasites multiplicate in liver then migrate to blood. pentamidine . rare in men characterized by vaginitis. Melarsoprol for African type o o o o African Trypanosomiasis (Sleeping Sickness) Trypanosoma brucei sub spp rhodesiense and gambiense Early symptoms are an inoculation chancre. lymphadenopathy.C) is nifurtimox for American Trypanosomiasis American Trypanosomiasis (Chagas Disease) Trypanosoma cruzi Early symptoms include fever. and die unless treated www. a vaginal discharge.C) is metronidazole Traveler's diarrhea Giardia infection may be asymptomatic or it may cause disease 6Ranging from a self-limiting diarrhea to a severe chronic syndrome • Trypanosome o o o o o (D.C) is metronidazole sexually transmitted diseases Symptomatic infection is common in women. fever. headache and lymphadenopathy meningoencephalitis.O. tachycardia. become somnolent.prometric-questions. heart enlargement.eflornithine. and dysuria Relapses occur if the infected partner not treated simultaneously Giardia (D. local or general edema. and myocarditis Heart alterations appear as late sequelae Suramin .O.com 61 .• Trichomonas • (D.O. Hyterophyes Liver flukes infection a. larvae.ascaris 2.Fasciola hepatica www.prometric-questions.Anti helmintics drugs Helminthes are transmitted to humans in many different ways (accidental ingestion of infective eggs. Adult cestoda are flattened.filaria worms 2. Flukes are also named (Trematodes) Drug of choice for intestinal nematode mebendazole 1.drancunculus (medina worm) 3. hence the common name roundworm.Schistosoma hemotobium b.entrobius 5.Schistosoma jabonicum Intestinal fluke infection a. penetrate the skin ) In several cases. hence the common name tapeworms.ancylstoma 3.com 62 .strongloides Drug of choice for tissue nematode is thiabendazole except filaria 1.larva migrains cutaneous larva migrains Visceral larva migrains only and Drug of choice for filarial is Diethyl carbamazine Drug of choice for Flukes (Trematodes) is praziquantel except Fasciola Blood flukes infection ( schistosomiasis ) ( schistosomiasis )a.trichuris 4.Schistosoma mansoni c. infection requires an intermediate host vector intermediate vector transmits infective stages when it bites or eaten by the host The levels of infection in humans therefore depend on standards of hygiene Type of helminthes: Nematodes are cylindrical. T side effect خ١ ِشاعؼخ االعئٍخ االرٝشع٠ 95 -7-64 : األعئٍخ1 رطّٛٔ 89 : األعئٍخ2 رطّٛٔ 31 -15 -2 : االعئٍخ7 رطّٛٔ 22 : االعئٍخ8 رطّٛٔ 2 : االعئٍخ9 رطّٛٔ 72 -31 : االعئٍخ15 رطّٛٔ Chemotherapy of microbial disease Selection of antimicrobial agent • Antimicrobial spectrum • Host factor 1. Concomitant disease status 3. Impaired elimination or detoxification of the drug (renal & hepatic function) 4. Hypersensitivity 2.I. pharmacokinetic 2. Pregnancy • Pharmacological factor 1.prometric-questions.B All Anthilmentics mechanism is paralysis for helminthes All Anthilmentics side effects is mild G. Age 5. Available dosage form 3.Drug of choice for Fasciola is bithionol then dehydroemetin N. Drug drug interaction • Others Cost of therapy www. Toxicity 4.com 63 . sulfadiazine 2.topical Silver sulfadiazine Crystal G+ve G-ve Chlamydia toxoplasma p.Gonorrhea 7.RTI ( respiratory tract infection ) 3.com 64 .Typhoid 4.Osteomylitis ٛ٘ خ٠ٛ١ة ِؼشفزٗ ِٓ اٌّضبداد اٌؾٍٛ ِطٛ٘ أُ٘ ِب Group ٗ ٔفغٞٛ١ػٗ اٌّضبد اٌؾِّٛغ ًّخ اٌؼ١ٌآ ًِاٛاعزخذاِٗ ِغ اٌؾ خ١األػشاض اٌغبٔج Key word ٞٛ١ ٘زا اٌّضبد اٌؾّٟٕز٠ ٗػّٛ ِغٞ أٌٝب رؼشف إٌٙ ِٓ للاٟاٌىٍّخ اٌز Mechanism Pregnancy Adverse effect Sulfonamide Drug Bacterial action Chemistry Mechanism Classification Spectrum 1-oral Analogue of PABA absorbed sulfadoxine.oral poor absorbed sulfathalidine 3.dysentery 3 Chlamydia infection urea hemolytic anemia nephrotoxic Not used Uses Adverse effects pregnancy bacteriostatic Sulfonamide (Para amino bezoic acid) kernicterus www.UTI ( urinary tract infection ) 5.Meningitis 2. Inhibit folic acid Synthesis Key word Sulfa………. tonsil. ear… G –ve bacteria are deep infection that cause mainly 1.Prostatitis 6. eye.falciparum 1 meningitis 2.Spectrum of antibiotic: Generally G+ve bacteria & G –ve bacteria G+ve bacteria are mainl superficial infection foe skin.prometric-questions.. Quinolones Bacterial action Adverse effects Drug Chemistry Mechanism Classification Spectrum 1st narrow Uses 1.RTI 6. sulfacetamid used as eye drop for eye infection Sulfathiazole for wounds in absence of pus Sulfamfenide for wounds and burn in presence of pus Sulfonamide combination : .prometric-questions.Co trimoxasole ( sulfamethoxazole + trimethoprime ) It is bactericidal that use for treat G-ve infection -Silver sulfadiazine is applied locally to prevent infection of wounds and burn.oxacin synthesis 1 generation 2 3 nd rd st G-ve 3rd 4th Tendonitis Cartilage damage Headache Dizziness Not used generation generation G+ve & G-ve as 2nd + as 3rd + 4th generation pseudomonas anaerobic 1st generation is nalidixic acid 2nd generation pipemidic acid (oxacin ) ةٟٕٙز٠ ال 3rd generation ciprofloxacin .Prostatitis pregnancy Analogue of nalidixic acid Bactericidal Quinolones Inhibit DNA Key word …….B. …….typhoid 3-osteomyelities 4.N. norfloxacin ..meningitis 2nd 2. 4th generation trovafloxacin Both 3rd and 4th generation used for treat G-ve infection www.com 65 .UTI 5. Amidinopenicillin : meciliinam Both 3 and 4 mainly used for G-ve bacteria infection All of the above are suspected to β.Benzyl penicillin injection as (penicillin G) Benzyl penicillin oral as (penicillin V) ٓك اٌؾم٠فمظ ػٓ طش ُك اٌف٠فمظ ػٓ طش 2.Antistaph penicillin ) staph.B. staphylococcus aureus destroy penicillin by producing β.diphtheria Chemistry Mechanism Classification Spectrum Uses Adverse effects used pregnancy Key word ……cillin 1.amino Inhibit cell wall synthesis penicillan ic acid Bactericidal Penicillin 1.lactamase enzyme V. (carbinicillin. pivampicillin) is pro drug Both 1 and 2 mainly used for G+ve bacteria N.benzyl Pen 2-broad spectrum Pen 3-anti pseudomonal 4-amidino pen 5-antistaph Pen G+ve G-ve spirochetes actinomyces 1-meningitis 2. piperacillin) 4. amoxicillin ) (talampicillin.Gonorrhea 4.syphilis hypersensitivity 3.Penicillins Drug Bacteria l action 6.com .lactamase inhibitor ٖ ثفشدamoxicillin ِٓ ٜٛ ألAugementin® ( amoxicillin + clavulanic acid ) ؼزجش٠ ٌزٌهٚ 3.prometric-questions.broad spectrum penicillin as ( Ampicillin . ticaricillin .) ٗؼ١َٕ ثزاٛ رمٟش اٌز١ُ اٌزىغ٠ِخ إلٔضٚٓ ِمب١ٍػٗ ِٓ اٌجٕغِّٛغ ب٠ش١ثىز 66 www.P use combination of clavulanic acid or sulbactam with Ampicillin or amoxicillin as β.I.anthrax 6.g.anti pseudomonal penicillin E.typhoid 5.lactamase enzyme 5. azlocillin . lactamase ( penicillinase ) resistant penicillin E. synthesis pseudomonas Prostatitis 4th as 3rd + anaerobic Gonorrhea 1st generation e. cephalexin (Duricef®) يًٚ األ١ ِٓ اٌغF ظ١ٌٚ Ph ثبيCepha ٞأ 2nd generation e.g. Cefa………. Cephradin. cefoxitin ( zinnat ®) ( ceclor ®) 3rd generation 4th generation e.g.g. cloxacillin .. naficillin Cephalosporin Bacterial action Adverse effects Drug Chemistry 7.amino cephaosporinic Mechanism Classification Spectrum 1st G+ve Uses Meningitis pregnancy cephalosporin Bactericidal acid Inhibit cell wall 1st generation 2nd generation 3rd generation 4th generation 2nd G+ve & RTI G-ve 3 rd Typhoid as 2 + nd UTI Nephrotoxic used Key word Cepha………. cefoperazone .prometric-questions. cefepime ً اٌشاثغ١ ٌٍغّٟٕز٠ ٞذ اٌز١ؽٌٛاء اٚ اٌذٛ٘ www. cephadroxil.com 67 . methicillin .g. cefotaxime . cefaclor cefuroxime . ……… e.g. flucloxacillin. cefotriaxone .β. amikacin Mainly G-ve Narrow spectrum G+ve 1.acne 5dysentery Classification Spectrum Uses Adverse effects Nephrotoxic hepatotoxic yellow discoloratio n of teeth pregnanc y Not used tetracycline bacteriostatic last choice ؼزجش٠ ٛ٘ خ ٌزٌه١ األػشاض اٌغبٔجٟػبد فِّٛٓ ألطش اٌّغ insoluble in absorbable complex ٌٝ إٞؤد٠ ٗٔ ألmilk of mineral ْ اٌّؼبدٚت أ١ٍؤلز ِغ اٌؾ٠ ال ً األلٍٝٓ ػ١ُ ٌّذح عبػزٕٙ١ اٌفاً ثٛ٘ زٖ اٌّشىٍخٌٙ ًاٌؾ Not used actinomycetes www.kanamycin 5.TB 2.gentamycin 4.doxycycline 3demeclocyclin e minocycline 4G+ve G-ve Chlamydi a rikettesia 1-cholera 2.syphilis 3Gonorrhe a 4.hepatic coma 4peritonitis Nephrotoxic ototoxic Chemistry Mechanism Classification Spectrum Uses Adverse effects pregnancy aminoglycoside soil Bactericidal Tetracycline Drug Bacteria l action Derived of soil streptomyce s Chemistry Mechanis m Inhibit protein synthesis through 30s Key word ……cyclin ribosome 1-tetracycline 2.prometric-questions.mycin ribosome 1streptomycin 2.neomycin 3.com 68 .Aminoglycoside Drug Bacterial action Derived of Inhibit protein synthesis through 30s Key word …….gut sterile 3. prometric-questions. LINEZOLID .com 69 . www.) Large lactone ring Key word thromycin Inhibit protein synthesis through 50s ribosome erythromycin azithromycin clarithromycin Chemistry Mechanism Classification Spectrum Uses Adverse effects pregn ancy used Mainly G+ve Chlamydia mycoplasma syphilis Gonorrhea diphtheria toxoplasma GIT upset cholestatic hepatitis Clarithromycin trade name (Klacid®) azithromycin trade name ( zithromax®) Chloramphinicol Drug Bacterial action bacteriostatic Key word Chloramphinicol Inhibit Chloramphinicol Broad Thiamephinicol spectrum against G+ve .Macrolides Drug Bacterial action bacteriostatic (in low macrolides conc. G-ve Life ……phinicol protein synthesis through 50s ribosome Chemistry Mechanism Classification Spectrum Uses Adverse effects Anemia Not used pregnancy threatening gray infection if no alternative exist baby syndrome Chloramphinicol is the lastest one which is bacteriostatic mainly used for typhoid infection Its side effect because bone marrow depression not used in pregnancy or children because of gray baby syndrome. VANCOMYCIN ..) Bactericidal (in high conc. OTHERS: CLINDAMYCIN.……. tetracycline . macrolides ًّاٍؼ ٌٍؾ٠ aminoglycoside .Initial intensive course (2-4 month) at least 3 drug. chloramphenicol ٓ١رٚغ اٌجش١ّٕٕغ را٠ thromycin ةmacolides ّٟٕٙب رٕز١ ثmycin ةaminoglycoside ٟٙ رٕز Antituberculosis Drugs for (M.TB) (mycobacterium tuberculosis) 1st line treatment Rifampicin Iso. macrolides . tetracycline . Regimen of therapy 1. cephalosporin .com 71 . sulfonamide رؼزجش penicillin . if resistant add the third drug.prometric-questions.ٍٝخ اٌغبِخ ٌٍى٠ٚ األدnephrotoxic ِٓ Aminoglycoside . if resistant add the fourth drug 2.2nd line drug used only if resistance or severe side effect of 1st line drugs.niazide (INH) it's side effect is peripheral neuropathy Pyrazinamide Ethambutol HCL 2nd line treatment Cycloserine Para amino salicylic acid (PAS). 3. خ٠ٚ أد4 : 3 ٗػّٛش ِٓ ِغٙ ش9 – 6 ِٓذح اٌؼلاط ال رمً ػ www.Continuation phase (4-12 month) 2 drug. Antileprotic drugs for (mycobacterium lepra) 1.com 71 .Clofazimine 3.72 – 65 – 63 .Dapson 2.prometric-questions.46 – 37 – 34 – 33 – 32 – 24 – 19 – 17 – 11 – 15 – 9 األعئٍخ2 رطّٛٔ 96 – 88 89 – 88 – 87 – 86 – 85 – 84 – 32 – 27 – 26 – 19 األسئلة3 نموذج 92 -82 -76 -71 -69 -67 -65 -64 -65 -59 -58 -57 -18 -16 -13 -11 االعئٍخ7 رطّٛٔ 87 -86 -85 -66 -59 -46 -45 -39 -21 االعئٍخ8 رطّٛٔ 155 -68 -59 -51 -45 -36 -34 -19 -3 -1 االعئٍخ9 رطّٛٔ 95.Rifampicin Duration of treatment from 2 – 4 years of combination Rifampicin is used in treatment of lipra while INH not used Rifampicin turns urine color into red َ اٌغضاٝغزخذَ ف٠ الINH ْ األؽّشٌٍٛ اٌٝي إْٛ اٌجٌٛ يٛؾ٠ 22 ُ سلٛ٠ذ١ ِشب٘ذح اٌفٝشع٠ ؼ١ضٛذ ِٓ اٌز٠ٌّض ة ؽً أعئٍخ اٌّزوشحٍِٛط 92 – 87 – 79 – 78 – 46-29.25 األعئٍخ1 رطّٛٔ – 87 – 82-81-81.85 -28 -2 االعئٍخ15 رطّٛٔ 42 -14 االعئٍخ11 رطّٛٔ Antifungal Drugs Drug *Amphtericin Bِ * Nystatin * Fluconazole * Itraconazole * Ketoconazole * Miconazole * Grisofulvin * Terbinafin * Clotrimazole Trade name Fungi zone Mycostatin Diflucan Sporanox Nizoral Daktarin Grizovin Lamisil Canesten www. e. Methotrexate . Miconazole . busulan 2. bleomycin .Antimetabolite Drugs that structurally related to naturally occurring compounds thus incorporated into DNA or RNA thus interfere with cell growth and proliferation.Alkylating agent Introducing alkyl group into nucleophilic sites whitin the cells.g.prometric-questions.Antibiotics E. forming covalent bonds.g. Clotrimazole For skin scalp we use Nystatin . Clotrimazole . mercaptopurine (6-MP) . . Ketoconazole . Clotrimazole For mouth thrush we use Nystatin .g. RNA and various enzyme. cytarabine 3.com 72 . Grisofulvin . Ketoconazole . Cyclophosphamide. chlorambucil. gancyclovir Cancer chemotherapy Aim of therapy: destroy DNA of cancer cell 1. Doxorubicin.For vaginal thrush we use Nystatin . the macromlucular sites of alkylation damage DNA. Miconazole . flurouracil (5-FU) . melphalan . E. dactinomycin www. Terbinafin Antiviral Drugs Drug * Acyclovir * Zidovudine * Lamivudine * Zalcitabine Trade name Zovirax Retrovir Zeffix Hivld Human Immunodeficiency Virus (HIV) cause AIDS which is treated by Zidovudine (Herpes simplex virus) is treated by acyclovir. 4- Plant derivative E.g. Vicristine , vinblastin , etoposide Immunostimulant Also called biological response modifier or Immunomodulating agent Used For immunodeficiency diseases as autoimmune disorder, cancer disease, some viral And fungal infections. 1. Bacillus Calmette – Guerin (BCG) Stimulate T-cell and natural killer cell. Successful in treatment of bladder cancer. 2. Levamisole It is anti helminthes drug that efficiency used in treating chronic infection Used in combination of fluorouracil in the treatment of colorectal cancer. 3. Interleukin-2 (IL-2) Promote proliferation, differentiation, recruitment of T-B lymphocytes, natural killer Cells and thymocytes. 4. Interferones ( alpha , beta , gamma ) INF-α used clinically in treatment of chronic hepatitis B and C, leukemia, melanoma. INF-β used clinically in treatment of multiple sclerosis. INF- δ used clinically in treatment of chronic granulomatous disease. خ١ٌ ِشاعؼخ االعئٍخ اٌزبٝشع٠ 93 -89 -66 -65 -35 -24 -22 -16 -7 االعئٍخ1 رطّٛٔ 91 -76 -75 االعئٍخ2 رطّٛٔ 92 -91 -95 االعئٍخ3 رطّٛٔ 89 -88 االعئٍخ4 رطّٛٔ 153 -95 -87 -71 -75 -68 -56 -54 -53 -52 -24 االعئٍخ7 رطّٛٔ 75 -75 -69 -36 -31 -23 -16 االعئٍخ8 رطّٛٔ 75 -16 -12 االعئٍخ9 رطّٛٔ 93 -77 -25 -24 -5 االعئٍخ15 رطّٛٔ www.prometric-questions.com 73 Vitamins Introduction; Essential in small amounts for regulation of normal metabolism, growth, function of body Not all vitamins are synthesized in body there for external source is a must Deficiency disease occurs due to insufficient ingestion, irregular absorption or impaired use Vitamin toxicity due to excessive quantity is mainly observed with fat soluble vitamin and water Water soluble is less toxic (not stored in the body) Fat soluble vitamin Vitamin Scientific Name Vitamin A Retinol Vitamin D Calciferol In fat In fat Animal Vision Animal Calcium absorption Vitamin E Tocopherol Vitamin K menadione In fat In fat Animal Anti oxidant Plant Blood clot Night blind Rickets osteomalacia Anemia haemorrhage Muscle weaknes hepatosplenomegaly Hypercalcemia Solubility Source Function Deficiency Toxicity www.prometric-questions.com 74 Water soluble vitamin Vitamin Vitamin C Scientific Name Ascorbic acid Solubility Source In water Plant Function Anti oxidant Deficiency Scurvy Toxicity No med. important Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B6 Vitamin B12 Folic acid Thiamine In water Plant carbohdrate metabolism Beriberi No med. important No med. important Riboflavin In water Plant Oxidation reduction A riboflavinosis Niacin In water Plant Oxidation reduction Pellagra No med. important Pyridoxine In water Plant Amino acid transformation Neurological symptoms Pernicious anemia No med. important No med. important No med. important Cyanocobolamine In water Animal erythropoiesis Folic acid In water Plant erythropoiesis Megaloplastic anemia ّخِٙ خ١غ١ِبد سئٍٛ ِؼ3 ( generic name) ٍّٟاعّٗ اٌؼٚ (solubility) ٗٔثبٚرٚ )A or B or … ( ٓ١ِزب١سِض اٌف pernicious anemia megaloplastic anemia ضخ١ب اٌخج١ّ١ٔ ػلاط االٟ فB12 ٓ١ِزب١غزخذَ ف٠ ػلاطٟ فVit B 12 + folic acid ……. Mcg? ٚ أ50 000 – 200 000 IU ٟ٘ Vit A ب ٌؼلاط ٔمصٙ ثٝصٌّٛ اٌغشػٗ ا ة ؽً أعئٍخ اٌّزوشحٍِٛط 99 – 98 – 94 – 86 – 85 – 84 – 71 – 15 – 9 األعئٍخ1 رطّٛٔ 44-39-35 األعئٍخ2 رطّٛٔ 77 – 35 األسئلة3 نموذج 152 -63 -42 -35 -29 االعئٍخ7 رطّٛٔ 24 -8 -7 -6 -5 االعئٍخ8 رطّٛٔ 153 االعئٍخ9 رطّٛٔ www.prometric-questions.com 75 g. UVB) E. chloroxine.Keratolytic and keratoplastic They are agent used for induce sloughing of cornified epithelium Keratolytic agent used for removes warts and corns Keratoplastic agent used for treatment of acne.Avoid getting the prepared solution in contact with eyes 1.Counter irritant They are irritating agent applied to intact skin to block deep pain of muscle or viscera E. vegetable oil (olive.Locally acting drugs for external use only . chloroform liniments 4.Skin and scalp preparation .prometric-questions. zinc oxide.g. UVB) Physical sunscreen : obaque ingredient ( unacceptable by patient ) reflect and scatter (UVA.g. whitening and reduce inflammation of mucous membrane E.Sun screens Topical agent are used to reduced amount of ultraviolet radiation (UVA. selenium sulfide 6. oil of winter green (methyl salicylate). talc. salicylic acid.Antiseborrheic Agents used for management of dandruff and seborrheics E.g. psoriasis and seborrheic dermatitis E. shrink skin.Emollient There are oily substances which soften and protect skin E. calamine lotion and phenolated . and kaolin www. camphor oil. sulfur and tretenoin ( retin A) 5. cotton seed …) fat and waxes 2.com 76 . methanolated calamine lotion 3.g.g. magnesium oxide. eczema.Astringents They are agents that dry mucous secretion. prometric-questions.g.B.Tazarotene Given topically Adverse effects : burning sensation . women of childbearing must be advised of the risk prior initiating therapy 3.B. treat of androgenic alopecia Drugs used in treatment of psoriasis: Psoriasis is chronic scaling skin eruption characterized by keartinocyte hyper proliferation 1. Acitretin should not be used by women who are pregnant or may become pregnant While undergo treatment for at least 3 year after discontinuation of Acitretin Patient must not donate blood during treatment and for 3 year after discontinuation of Acitretin 2.amino benzoic acid.Acitretin Given orally Adverse effects : hair loss . liver function abnormality and teratogenic N. peeling and erythema its absorbed percutaneously ( if applied to more than 20% of body surface area it will be teratogenic N.com 77 .Calcipotriene ( synthetic vit D3) Effective in plaque type www.Miscellaneous agent Hydroquinone: cause reversible depigmentation of the skin Minoxidil : FDA approved for stimulating hair growth . Chemical sunscreen : E. cinnamates and salicylates 7. p. and cyclosporine ٌرجى مراجعة االسئلة التالٌة 3 : االسئلة1 نموذج 28 : االسئلة7 نموذج 67 -37 -9 : االسئلة8 نموذج 78 -61 : االسئلة9 نموذج www.4.prometric-questions.Others : Steroids.com 78 .Coal tar ointment : Combined with daily exposure to UVB irradiation 6. Methotrexate.Psoralens and UVA ( PUVA) Approved photochemotherpay Psoralens is given orally or locally then (after 1 – 2 hour) UVA exposure 5.