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مراجعة فارماكولوجى للخريجين

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  • مراجعة فارماكولوجى للخريجين

    السلام عليكم ورحمة الله وبركاته
    إن شاء الله سوف أنقل لكم بعض تلخيصات الفارما لخريجى صيدلة والموضوع منقول للأمانة من مواقع أخرى نبدأ الآن باسم الله:



    The autonomic nervous sysyem
    Anatomy
    I-Efferent neurons
    Carries nerve impulses from the CNS to the effector organs by way
    of 2 types of efferent neurons

    a) a preganglionic neuron
    Its cell body located within the CNS
    Emerge from the brain stem or the spinal cord
    Make a synaptic connection in ganglia which act as arelay station between the preganglionic neuron and the postganglonic neuron

    b) a postganglionic neuron
    Its cell body originating in the ganglia
    Terminates on effector organ such as
    Smooth muscle of the viscera
    Cardiac muscle
    Exocrine glands

    II- Afferent neurons
    are important in the reflex regulation of this system
    ex: sensing pressure in the carotid sinus and aortic arch and signaling the CNS to influence the efferent branch of the system to respond
    Sympathetuc neurons

    The preganglionic neurons of sympathetic system
    Come from thoracic and lumber regions of the spinal cord
    Synapse in 2 cord-like chains of ganglia that run parallel on each side of the spinal cord
    Axons of the postganglionic neurons extend from these ganglia to glands & viscera

    Special case : (The adrenal medulla) : acts like the sympathetic ganglia
    a)receives preganglionic fibers
    b)lacking axons
    c) if stimulated,it secretes the hormone(epinephrine= adrenaline) + less amount of norepinephrine which influence other organs
    Parasympathetic neurons

    The preganglionic fibers
    arise from the cranial and sacral areas of the spinal cord
    synapse in ganglia near the effector organs
    In both : postganglionic fibers extend from the ganglia to the effector organs

    Function of the sympathetic system
    Not essential for life
    Has the property of adjusting in response to stressful situations such as
    trauma - fear - hypoglycemia - cold - exercise

    Effects of stimulation of the sympathetic devision
    increase heart rate
    increase blood pressure
    mobilize energy stores in the body
    increase blood flow from the skin to skeletal muscles and heart
    diverting flow from the skin and internal organs
    stimulation of the pupils and bronchioles
    i.e : Fight &Flight response due to
    Direct sympathetic response
    Stimulation of adrenal medulla to release epinephrine and norepinephrine

    Functions of the parasympathetic system
    Essential for life
    Maintain essential body functions
    Usually acts to oppose or balance the actions of the sympathetic division
    It is a dominant over the sympathetic division in rest & digest stimulation
    Affect specific organs such as stomach and eye

    Innervation by the autonomic nervous system

    I- dual innervation

    Most organs in the body are innervated by both divisions
    'ex : the heart has
    a) vagal parasympathetic innervation which slows the rate of contraction
    b) sympathetic innervation speeds contraction
    c)the vagus is the predominant controlling factor for rate

    II- Organs receiving only sympathetic
    examples
    Adrena medulla
    Kidney
    Pilomotor muscle
    Sweat glands
    N.B :the control of blood pressure is also mainly a sympathetic activity
    Neurotransmitters

    Cholinergic and adrenergic neurotransmitters are the primarily chemical signals in the autonomic nervous system
    The autonomic nerve fibers can be classified into 2 groups based on the chemical nature of the neurotransmitter released

    Acetyl choline
    Released from the preganglionic neurons in
    both parasympathetic and sympathetic
    in adrenal medulla
    in neuromuscular junction

    Norepinephrine & epinephrine
    In sympathetic.it is released from the postganglionic neurons to the
    effector organs

    يتبع إن شاء الله


    اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
    "اللهم اشف مرضانا وارحم موتانا "
    "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

  • #2
    رد: مراجعة فارماكولوجى للخريجين

    أميرة بدينها

    جزيتِ خيرا أخيتي
    ونفع الله بكِ
    هذا لا ينفع الخريجين فقط
    بل ايضا يقدم المادة للطلبة بصورة عامةحتى يسهل عليهم
    ننتظر جديدكِ ونورتِ قسمنا
    اللّهُمَّ أَرضِنِي .. وَارْضَ عَنِّي
    اللهم اغفر لي ولوالدي وللمؤمنين والمؤمنات الأحياء منهم والأموات

    القرآن كلام الله .. خطاب الملك..القرآن عزيز .. مطلوب وليس طالب
    إذا تركته تركك .. وإذا ذهبت عنه ذهب

    تعليق


    • #3
      رد: مراجعة فارماكولوجى للخريجين

      جزاك الله خيرا أختى الكريمة ونفع الله بك وسدد خطاك على هدى النبى صلى الله عليه وسلم
      اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
      "اللهم اشف مرضانا وارحم موتانا "
      "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

      تعليق


      • #4
        رد: مراجعة فارماكولوجى للخريجين

        Introduction to pharmacology

        I- Routes of drug administration : 2 major routes
        A- Enteral
        Oral
        the most common route
        the most variable mode in amount of drugs reach the target tissues
        some drugs are absorbed from the stomach
        most drugs are absorbed from the duodenum
        most drugs absorbed from GIT enter the portal circulation and encounter the liver before they are distributed in the general circulation
        first pass ****bolism by intestine or liver limits the efficacy of many drugs when taken orally

        Sublingual
        the drug diffuses to the systemic circulation directly

        Rectal
        fifty percntage of the drug bypass the portal circulation
        Useful if the drug
        destructed by the intestinal enzymes
        destructed by the low pH of the stomach
        induce vomitting or the patient himself is vomitting
        B- Parenteral
        I.V
        the most common parenteral route
        drugs avoid first pass ****bolism
        permit a rapid effect
        permit the maximal degree of control over the circulating levels of drug
        the rate of infusion must be carefully controlled

        I.M
        main route used for depot preparations which dissolves slowly providing a sustained dose over an extended period of time
        used also for many aquous solutions of drugs

        S.C
        as I.M it requires absorbtion
        slower than I.V
        minimizes the risks associated with I.V injections
        Others
        Inhalation
        provides rapid delivery of drug producing rapid effect almost as that of I.V
        Intranasal e.g salmon calcitonin used in osteoporosis
        Intrathecal e.g methotrexate in leukemia
        Intraventricular
        Topical when local effect of the drug is required
        Transdermal e.g nitroglycerine when used as antianginal




        II- Absorbtion of drugs

        the transfer of a drug from its site of administration to
        blood streem
        the rate and the efficiency of absorbtion depend on the route of administration so in

        I.V : Complete absorbtion
        Other routes : partial absorbtion which lowers the bioavailability

        A- Transport of drugs from GIT

        depending on their chemical properities drugs may be absorbed from GIT by


        Passive diffusion
        Active transport


        B- physical factors influencing absorbtion

        blood flow to the absorbtion site
        total surface area available for absorbtion
        contact time at the absorbtion surface


        III-Bioavailability

        the fraction of administerd drug that reaches the systemic circulation in a chemically unchanged form

        ex : if 100 mg of the drug is administrated orally and 70 mg of this drug is absorbed unchanged ..the bioavailability is 70%

        Factors that influence bioavailability

        first pass hepatic ****bolism
        solubility of the drug
        chemical instability
        the nature of the drug formulation


        IV-Drug distribution

        the process by which a drug reversibly leaves the blood stream and enters the interstitium (extracellular fluid) and/or the cells of tissues

        Factors affect drug distribution

        A- blood flow

        B- capillary permeability which determined by

        Capillary structure
        ex : blood brain barrier : lipid soluble drugs readily penetrate to the CNS since they can dissolve in the membrane of its endothelial cells but ionized or polar drugs generally fail to enter the CNS

        Drug structure

        Binding of drugs to proteins

        reversible binding to plasma proteins sequesters drugs in a non diffusible form and slows their transfer out of the vascular compartment



        V-Binding of drugs to plasma proteins

        Usually albumin

        bound drugs are pharmacologically inactive ...only the free unbound drug can act on target sites in the tissues and elicit a biological response
        so hypoalbunemia may alter the level of free drug

        A- Binding capacity of albumin

        binding of drugs to albumin is reversible
        albumin may show

        Low capacity : one drug molecule per albumin molecule
        High capacity : a number of drug molecules per single albumin molecule

        albumin has the strongest affinity for anionic drugs(weak acids) and hydrophobic drugs

        most hydrophilic drugs and neutral drugs do not bind to albumin

        many of drugs are hydrophobic by design since this property permits absorbtion after oral administration

        B- Competition for binding between drugs & clinical imprtance of drug displacement

        ex : Tolbutamide is normally 95% bound and only 5% free so 95% is inert in its pharmacological action

        sulfonamid with higher affinity for albumin if adminiserd it displaces tolbutamide and now 100% of tolbutamide become free in plasma

        but note that.... the tolbutamide concentration does not remain elevated since the drug moves out of the plasma into the interstitial fluid and avhievs new equilibrium


        VI- Drug ****bolism

        drugs are most often eleminated by biotransformation and/or excretion into the urine or bile

        The liver is the major site for drug ****bolism

        Specific drugs may undergo biotransformation in other tissues

        some agents are initially administerd as inactive compounds(prodrugs) and must be ****bolized to thir active forms

        اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
        "اللهم اشف مرضانا وارحم موتانا "
        "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

        تعليق


        • #5
          رد: مراجعة فارماكولوجى للخريجين

          جزاكم الله خيرا ً

          هل ستتناولي أهم الأدوية المتداولة ؟؟؟؟

          اليوزيز والمود اوف اكشن والسايد افيكت ؟؟؟

          تعليق


          • #6
            رد: مراجعة فارماكولوجى للخريجين

            السلام عليكم ورحمة الله وبركاته
            إن شاء الله هيكون الكلام عن مرض معين مثلا ال بيصيب الجهاز التنفسى والادوية المستخدمة وإن شاء الله أحاول أجيبلك
            mode of action
            side effect
            وإن شاء الله يعيننى الله على ذلك
            اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
            "اللهم اشف مرضانا وارحم موتانا "
            "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

            تعليق


            • #7
              رد: مراجعة فارماكولوجى للخريجين

              وعليكم السلام ورحمة الله وبركاته
              بارك الله فيكِ اختنا
              هل انتي دكتورة ؟
              لا إله إلا أنت سبحانك إني كنت من الظالمين

              تعليق


              • #8
                رد: مراجعة فارماكولوجى للخريجين

                السلام عليكم ورحمة الله وبركاته
                دى محاضرات فارما شرح جزء AUTONOMIC إن شاء الله تستفيدوا منها
                ويا رب تكون الروابط صحيحة

                http://hotfile.com/dl/103493045/3038c46/Autonomic.1.Dr.Said.Abd.Elhady.mp3.html
                http://hotfile.com/dl/103493655/0654856/Autonomic.2.Dr.Said.Abd.Elhady.mp3.html
                http://hotfile.com/dl/103494362/d622a0e/Autonomic.3.Dr.Siad.Abd.Elhady.mp3.html

                http://hotfile.com/dl/103501147/a967b7b/Autonomic.4.Dr.Said.Abd.Elhady.mp3.html
                اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
                "اللهم اشف مرضانا وارحم موتانا "
                "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

                تعليق


                • #9
                  رد: مراجعة فارماكولوجى للخريجين

                  Drugs affecting the cardiovascular system
                  Treatment of congestive heart failure CHF

                  I- Overview of congestive heart failure CHF

                  it is a condition in which the heart is unable to pump sufficient blood to meet the needs of the body
                  it can be caused by
                  impaired ability of the cardiac muscle to contract
                  an increesed work load imposed on the heart

                  CHF is accompanied by abnormal increase in blood volume and interstitial fluid
                  the heart,veins,and capillaries therefore generally dilated with blood.Hence,the term (Congestive) heart failure

                  Underlying causes of CHF

                  arteriosclerotic heart disease
                  dilated cardiomyopathy
                  congential heart disease
                  valvular heart disease
                  left systolic dysfunction secondary to coronary artery disease is the most common cause of CHF

                  The therapeutic goal for CHF is to increase cardiac output

                  Three classes of drugs have been shown to be clinically effective in reducing symptoms and prolonging life
                  Vasodilators: reduce the load on the myocardium
                  Diuretic agents : decease extracellular fluid volume
                  Inotropic agents : increase the strength of contraction of
                  cardiac muscle

                  these agents
                  relieve the symptomps of cardiac insufficiency
                  do not reverse the underlying pathologic condition

                  Drugs that may preciptate or exacerbate CHF so should be
                  avoided as possble

                  non steroidal antiinflammatory drugs
                  alcohol
                  B blockers
                  calcium ghannel blockers
                  some antiarrythmic drugs


                  II- Vasodilators
                  In CHF,the impaired contractile function of the heart is exacerbated by compensatory increase in preload and afterload

                  Preload
                  the volume of blood that fills the ventricle during diastole
                  elevated preload causes overfilling of the heart which increases the work load
                  Afterload
                  the pressure that must overcome for the heart to pump blood into the arterial system
                  elevated afterload cause the heart to work harder to pump
                  blood into the arterial system

                  Vasodilators are useful in reducing excessive preload and afterload as follow
                  dilation of veinous blood vessels increases the venous capacitance by which a decrease in preload occurs
                  arterial dilators reduce systemic arteriolar resistance by which a decrease in afterload occurs

                  Classes of vasodilators

                  A- Angiotensin convertizing enzyme (ACE) inhibitors
                  ex : captopril - lisinopril - enalapril

                  Adverse effects

                  postural hypotension
                  renal insuffeciency
                  persistant dry cough
                  should not be used in pregnant women

                  B - Direct smooth muscle relaxants
                  ex: hydrazaline - isosorbide - sodium nitroprusside

                  III - Diuretics
                  ex : bu****nide - furosemide - hydrochlorothiazide

                  relieve pulmonary congestion and peripheral edema
                  useful in reducing the symptoms of volume overload
                  Thiazide diuretics are relatively mild diuretics and lose efficacy if patient creatinine clearance is less than 50 ml/min
                  Loop diuretics are used in patients with renal insuffiency
                  Overdoses of loop diuretics can lead to profound hypovolemia

                  IV- Inotropic agents

                  positive inotropic agents enhance cardiac muscle contractility
                  and increase cardiac output

                  although these drugs act by different mechanisms ,in each case the inotropic action is the result of an increased cytoplasmic calcium concentration that enhances the contractility of the cardiac muscle

                  A-Cardiac glycosides(Digitalis)=digoxin &digitoxin

                  digoxin(lanoxin) is the most widely used agent

                  Therapeutic uses

                  digoxin is indicated in patients with severe left ventricular systolic dysfunction after initiation of diuretic and vasodilation therapy
                  not indicated in patient with diastolic or right sided heart failure
                  patients with mild to moderate heart failure will often respond to treatment with ACE inhibitors and diuretics and do not require digoxin

                  N.B. The digitalis glycosides show only a small difference between a therapeutically effective dose and doses that are toxic or even fatal i.e. have low therapeutic index

                  Factors predisposing to digitalis toxicity

                  a) Electrolytic disturbances

                  hypokalemia can preciptate serious arrythmia
                  reduction of serum K levels is most frequently observed in patients receiving thiazide or loop diuretics
                  hypokalemia can be usually prevented by use of a K sparing diuretics or supplementation with potassium chloride
                  hypercalcemia and hypomagnesemia also predispose to digitalis toxicity

                  b)Drugs

                  Quinidine : can cause digitalis toxicity by
                  displacing digitalis from plasma protein binding sites
                  competing with digitalis for renal excretion
                  Verpamil(isoptin) : displace digitalis from( PPBS) and can increase digoxin levels by 50 to 75% which may require a reduction in the dose of digoxin

                  c)Others

                  potassium depleting diuretics
                  corticosteroids
                  hypothyrodism
                  hypoxia
                  renal failure
                  myocarditis

                  B- B adrenergic agonists
                  ex : dobutamine

                  improves cardiac performance by both
                  positive inotropic effects

                  vasodilation
                  must be given by I.V. infusion and is primarily used in the
                  treatment of acute heart failure in hospital setting

                  C- Phosphodiesterase inhibitors : not used clinically
                  thanks






                  منقول لأمانة
                  وياريت لو فيه أى خطأ يتم تصحيحه
                  ول عنده معلومة ياريت يضيفها
                  اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
                  "اللهم اشف مرضانا وارحم موتانا "
                  "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

                  تعليق


                  • #10
                    رد: مراجعة فارماكولوجى للخريجين

                    ربنا يبارك في حضرتك
                    اشكرك جدا واقول جزاكي الله خيرا لحاجتي لهذا الجهد اسال الله ان يكون مباركا
                    بوركتي



                    تعليق


                    • #11
                      رد: مراجعة فارماكولوجى للخريجين

                      Antianginal drugs


                      I- Overview


                      Angina pectoris : a characteristic chest pain causd by coronary blood flow that is insuffecient to meet the oxygen demands of the myocardium


                      The impalance between oxygen delivery and utilization may result from
                      a) a spasm of the vascular smooth muscle
                      b) obstruction of blood vessels caused by atherosclerotic lesions


                      Characters of angina :sudden severe pressing substernal pain radiating to the left arm


                      Three classes of drugs are effective either alone or in combination,in treating patients with stable angina


                      Nitrates : decrease coronary vasoconstriction or spasm and increase perfusion of the myocardium by relaxing coronary arteries


                      B blockers : decrease the oxygen demands of the heart


                      Calcium channel blockers


                      Prinizi****ls angina :a variant angina caused by spontaneous coronary spasm either at work or at rest ...rather than by increases in myocardial oxygen requirements


                      It is controlled by organic nitrates or calcium channel blockers but B blockers are contraindicated


                      II- Organic nitrates & nitrites
                      these compounds cause a rabid reduction in myocardial oxygen demand followed by rapid relief of symptoms


                      A- Nitroglycerin
                      its sublingual or spray forms are the drug of choice used for prompt relief of ongoing attagk of angina precipitated by excercise or emotional stress


                      Effects on cardiovascular system


                      at therapeutic doses :has 2 major effects


                      a) Dilation of the large veins resulting in pooling of blood in the veins which diminish the preload(discussed before) and reduces the work of the heart


                      b) Dilates the coronary vasculature providing increased blood supply to the heart muscle


                      The total effect is a decrease in myocardial oxygen cosumption because of decreased cardiac work


                      Adverse effects


                      long acting preparations cause headache in about 30% - 60% of patients
                      high doses can cause postural hypotension,flushing &tachycardia


                      B- Isosorbide dinitrate'
                      has a lower potency than nitroglycerin in relaxing vascular smooth muscle - can be used orally


                      III- B adrenergic blockers


                      Supress the activation of the heart by blocking B1 receptors
                      reduce the work of the heart by decreasing cardiac output and causing a slight decrease in blood pressure
                      Reduce the frequency and severity of angina attacks
                      Particullary useful in the treatment of patient with myocardial infarction


                      Contraindications


                      in diabetes
                      peripheral vascular disease
                      chronic obstructive pulmonary disease


                      IV- Calcium channel blockers


                      Inhibit the entrance of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds so
                      All of them are vasodilators and decrease smooth muscle tone and vascular resistance


                      A- Nifedipine


                      Mainly,an arteriolar vasodilator
                      Exerts greater effect on cardiac conduction and heart rate
                      Used in variant angina


                      B- Verpamil


                      Slows cardiac conduction directly which decrease the heart rate and the oxygen demand
                      Has negative inotropic effects greater than that of nifedipine but weaker as a vasodilator


                      Contraindications


                      in preexisting depressed cardiac function
                      in atrioventricular conduction abnormalities


                      Adverse effects


                      Used with caution in digitalis patients...discussed before
                      Constipation


                      C-Deltiazem


                      Its cardiovascular effects similar to verpamil
                      Reduce the heart rate but lesser than verpamil
                      Reduce blood pressure
                      Relieve coronary artery spasm so used in variant angina
                      Can be used in angina in patients with concomitant diseases


                      منقول

                      وده رابط فيه شرح ل الذبحة الصدرية بطريقة البوربوينت
                      http://hotfile.com/dl/105037047/3465a7c/Angina.ppt.html
                      اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
                      "اللهم اشف مرضانا وارحم موتانا "
                      "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

                      تعليق


                      • #12
                        رد: مراجعة فارماكولوجى للخريجين

                        أسئلة فى الذبحة الصدرية
                        1. Antianginal drug administered by inhalation:
                          1. ? isosorbide dinitrate (Isordil, Sorbitrate)
                          2. ? amyl nitrite
                          3. ? glyeryl trinitrate
                        2. A patient with a history of both angina and esophageal spasms is told by his physician that upon recurrence of pain, take a nitroglycerin tablet, sublingually and note what happens. When pain recurs, the patient takes the "nitro" and the pain goes away in about a minute. Reasonable analysis would suggest:
                          1. ? that the pain was due to myocardial oxygen insufficiency, relieved by the action of nitroglycerin on cardiac preload
                          2. ? that the pain is more likely due to esophageal spasm, because if it were due to the heart, relief would have taken longer.
                          3. :-) the test is inconclusive, since nitrates relax almost all smooth muscle--terminating anginal symptoms or symptoms of esophageal spasm
                        3. A 60 year old patient with multivessel coronary vascular disease has suffered several myocardial infarctions. The patient is in moderate heart failure precariously controlled with diuretics and cardiac glycosides and has exertional anginal episodes about twice a day. Consider a calcium channel blocker in management of this patient:
                          1. ? Diltiazem (Cardiazem) is an effective antianginal drug which would be appropriate in this case.
                          2. ? Diltiazem (Cardiazem) is only effective in Prinz****l's angina-as such it would not be appropriate here
                          3. ? Diltiazem (Cardiazem) is not appropriate because of its negative inotropic properties (decrease myocardial contractility) which would worsen left ventricular failure
                          4. ? Diltiazem (Cardiazem) in combination with propranolol (Inderal) would work since reflex tachycardia would be blocked
                        4. Calcium channel blocker(s) most likely to affect myocardial contractility and AV conduction:
                          1. ? nifedipine (Procardia, Adalat)
                          2. ? nicardipine (Cardene)
                          3. ? diltiazem (Cardiazem)
                        5. Prinz****l (variant) angina presents in a 25 year old female. Pharmacological management could include:
                          1. ? diltiazem (Cardiazem)
                          2. ? verapamil (Isoptin, Calan)
                          3. ? propranolol (Inderal)
                          4. ? A & B
                        6. Symptoms associated with nitrates:
                          1. ? bradycardia
                          2. ? hypotension
                          3. ? headache
                          4. ? B & C
                        7. 70 year old male with confirmed multi-vessel coronary vascular disease also suffers from COAD [chronic obstructive airway disease] and exertional angina. He is prescribed nifedipine for his angina, but shortly after beginning the medication complains of increased angina incidence. Choose an explanation:
                          1. ? Nifedipine (Procardia, Adalat) should not be used for angina.
                          2. ? Nifedipine (Procardia, Adalat), a calcium channel blocker, causes significant vasodilation. Hypotension and reflex cardiac stimulation result in increased anginal episodes
                          3. ? Nifedipine (Procardia, Adalat) in combination with propranolol, since propranolol would block reflex tachycardia due to nifedipine's vasodilatory effects.
                        8. Calcium and sodium channel blocker useful in treating chronic, stable angina not responsive to typical antianginal drugs:
                          1. ? diltiazem (Cardiazem)
                          2. ? bepridil (Vascor)
                          3. ? nifedipine (Procardia, Adalat)
                          4. ? lisinopril (Prinvivil, Zestril)
                        المصدر
                        http://www.pharmacology2000.com/learning2.htm
                        اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
                        "اللهم اشف مرضانا وارحم موتانا "
                        "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

                        تعليق


                        • #13
                          رد: مراجعة فارماكولوجى للخريجين

                          Antihypertensive drugs

                          I-Hypertension
                          a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure > 140 mm Hg

                          Chronic hypertension if not controlled can lead to

                          Congestive heart failure
                          Myocardial infarction
                          Renal damage
                          Cerebrovascular accidents

                          II- Etiology of hypertension

                          Secondary to other disease
                          Ninty percentage of patients from disorder of unknown origin affecting the blood pressure regulating mechanism
                          Family history of hypertension increases the liklihood of the disease

                          It occurs in blacks four times more than in whites
                          in middle aged males more than middle aged females

                          Predisposed factors
                          Stressful life style
                          High dietary intake of sodium
                          Obesity
                          Smooking

                          N.B NSAIDS interfere with the hypotensive action of many antihypertensives

                          III-Mechanisms for controlling blood pressure

                          Reducing the cardiac output
                          Deceasing the peripheral resistance

                          IV- Treatment sterategies

                          Mild hypertension can often be controlled with a single drug
                          More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen
                          Treatment is initiated with (a diuretic ,B blocker,ACE inhibitor or a Ca channel blocker ) depending on the individual patient

                          If not adequately controlled
                          B blocker is added if the initial was a diuretic or
                          a diuretic is added if the initial was a B blocker

                          A vasodilator can be added as a third step for those patients who still fail to response

                          A- Individual care

                          Black patients respond well to diuretics and Ca channel blockers
                          In elderly Ca channel .ACE inhibitors and diuretics are favored

                          N.B Hypertension may coexist with other disease that can be aggrevated by some of the antihypertensive drugs
                          ex
                          Diuretics and B blockers avoided in insulin dependant diabetes and in hyperlipidimia
                          B blockers avoided in asthma or chronic pulmonary disease

                          B-Patient compliance in antihypertensive therapy

                          ex B blockers can decrease libido and induce impotence in males particullary middle aged and elderly men
                          This this drug induced ***ual dysfunction may prompt the patient to discontinue therapy
                          Thus it is important to enhance compliance by carefully selecting a drug regimen that both

                          a) reduces advers effects
                          b) minimizes the number of doses required daily

                          V- Diuretics
                          Diuretics and/or B blockers are currently recommended as the first line drug therapy for hypertension
                          Recent data suggest that diuretics are superior to B blockers in older ******

                          A- Thiazide diuretics
                          ex: hydrochlorothiazide

                          the most widespread used diuretics

                          Therapeutic uses
                          Particularry useful in treatment of black or elderly patients
                          Can be used in those with chronic renal disease
                          Not effective in patients with inadequate kidney function i.e creatinine clearance less than 50 mls/min
                          N.B loop diuretics may be required in these patients

                          Adverse effects
                          Induce hypokalemia so serum ptassium level should be monitored closely in patients predisposed to cardiac arrythmia
                          Should be avoided in diabetes or hyperlipidemia

                          B-Loop diuretics

                          ex : bu****nide -furosemide
                          Act promptly even in patients who have poor renal function or have not respond to other diuretics

                          VI- B blockers
                          ex : atenolol - propranolol

                          Recommended as a first-line drug therapy for hypertension
                          Efficacious but have some contraindications

                          Propranolol : is the protoyype B blocker
                          acts on both B1 and B2 receptors so contraindicated in asthmatic patients

                          Atenolol : newer agents
                          selective for B1 receptors so commonly used in asthmatic patients

                          Therapeutic uses
                          Effective in white than in black
                          Effective in young than in elderly

                          Advers effects ... discussed

                          VII- ACE inhibitors
                          ex captopril - ramipril

                          Recommended when first- line agents are contraindicated or ineffective

                          Therapeutic uses
                          Most effective in white and young patients as B blockers
                          If used in combination with a diuretic the effectiveness will be similar in both white and black
                          Effective in patients with CHF ...unlike B blockers
                          A standard in care of patient following a myocardial infarction

                          Adverse effects
                          the most important are
                          Dry cough
                          Alterd taste
                          Hypokalemia :so K supplements and spironolactone are contraindicated
                          Fetotoxic : so must be avoided in pregnancy

                          VIII- Angiotensin
                          ex : losartan

                          Its phamacologic effects are similar to ACE inhibitors
                          Its adverse effects profile is improved over ACE inhibitors
                          Also fetotoxic

                          IX- Ca channel blockers
                          ex :Amlodipine - deltiazem - nifedipine - verpamil

                          Recommended when first line agents are contraindicated or ineffective
                          One study suggests that the use of short acting ones especially in high doses increase the risk of myocardial infarction

                          Deltiazem and Verpamil : discussed before

                          Amlodipine :a newer agent have the advantage that show little interaction with other cardiovascular drugs e.g : digoxin - warfarin

                          Therapeutic uses
                          Not usually require the addition of a diuretic
                          Can be used in asthmatic,diabetes,angina and/or peripheral vascular diseases

                          Adverse effects
                          The main ,is constipation in 10% of patients

                          X- Alpha adrenergic blocking agents
                          ex : prazosin - terazosin -oxazosin

                          May cause postural hypotension
                          Prazosin :Treat mild to moderate hypertension
                          prescribed in combination with propranolol or a diuretic for additive effect

                          XI- Centrally acting adrenergic drugs

                          A-Clonidine
                          Used for mild or moderate hypertension that has not responded adequately to diuretics alone
                          Useful in the treatment of hypertension complicated by renal diseases
                          As it causes sodium and water retention , it is usually administerd in combination with a diuretic

                          B- Alpha methyl dopa
                          Valuable in treating hypertensive patients with renal insufficiency
                          Can be used during pregnancy

                          XII- Vasodilators
                          ex :hydrazaline - minoxidil

                          Direct acting smooth muscle relaxants
                          Not used as hypotensives nowadays due to their serious adverse effects

                          Minoxidil : Nowadays used topically to treat male pattern baldness




                          اللهم صل على محمد وعلى آل محمد كما صليت على آل إبراهيم وبارك على محمد وآل محمد كما باركت على آل إبراهيم"
                          "اللهم اشف مرضانا وارحم موتانا "
                          "اللهم اجعل مصر أمنا سخاءا رخاءا وسائر بلاد المسلمين وجنبها الفتن ما ظهر منها وما بطن"

                          تعليق


                          • #14
                            رد: مراجعة فارماكولوجى للخريجين

                            ما شاء الله رائع جدا اختنا
                            ولو أمكن الترجمة بالعربية
                            ممكن نجعل هذا الموضوع كمرجع طبي

                            بارك الله فيكِ اختنا
                            لا إله إلا أنت سبحانك إني كنت من الظالمين

                            تعليق


                            • #15
                              رد: مراجعة فارماكولوجى للخريجين

                              السلام عليكم
                              بوركت أميرة بدينها
                              نفع الله بك

                              اخيتي مسلمة
                              حقيقة ارى ان الامر من الصعوبة بمكان
                              فبعض المصطلحات يصعب ترجمتها
                              وأمر اخر ان اللي فيها معلومات طبية صعب يستفيد منها اي شخص
                              بوركتِ
                              اللّهُمَّ أَرضِنِي .. وَارْضَ عَنِّي
                              اللهم اغفر لي ولوالدي وللمؤمنين والمؤمنات الأحياء منهم والأموات

                              القرآن كلام الله .. خطاب الملك..القرآن عزيز .. مطلوب وليس طالب
                              إذا تركته تركك .. وإذا ذهبت عنه ذهب

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