OTC

Dr-GAD
OTC

.~.~. The Pharmacy

Ph-Mohamed Gad

OTC

OTC

OTC

The Pharmacy .~.~.

By

https://www.facebook.com/pages/The-Pharmacy%D8%A7%D9%84%D8%B5%D9%8A%D8%AF%D9%84%D
9%8A%D9%87/190742807724454

Ph-Mohamed Gad

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.
### ( )

Dr-GAD

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Ph-Mohamed Gad

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(








[

]

( )
Cross Sales
(

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Ph-Mohamed Gad

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Co-Enzyme Q10 statin-induced

) myalgia





Dr-GAD

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Ph-Mohamed Gad

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) ( 9 + =
* = 8
* = 9

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Ph-Mohamed Gad

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DOSE

@ Azithromycin for child 10mg/kg/day. One dose daily

@Amoxicyllin 20-40 mg/kg/day every 8 hours
25-45 mg/kg/day every 12 hrs.
@ Amox.Clav. 25-50 mg/kg/day
( ) 5 - 27- 2 - 5 - 52 8
( ER - 1g - 1gSR ) 5 - 77 - 8
@ Cefixime. 8 mg/kg in one or two divided doses
@ Cefaclor 20-40 mg/kg in three divided doses
@ Cephalexin. 25-50 > up to 100 in severe cases in 2 to 4 divided doses
@ Cephadroxil. 25-50 mg/kg in 1 or 2 divided doses

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Ph-Mohamed Gad

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@ Cefuroxim. 10-15 mg/kg in two divided doses

@ Cefprozil. 20 mg/kg in 2 divided doses max 500mg/day
@ Cefdinir. 14 mg/kg in 2 divided doses
@ Cefpodoxim. 10 mg/kg in 2 divided doses
Ibuprofen. 20-30 mg/kg in 3 or 4 divided doses > above 1 year
Mefenamic . 25 mg/kg in three or four divided doses
Paracetamol 10-15 mg/kg/dose.>>>> up to 4g.
Diclofenac > 0.5-1 mg/kg/dose
> 2-2.5 mg/kg/day

)
http://www.mediafire.com/download.php?887ac8aa3nh293x

2
>> 7=8+*2
Tosillitis Otitis media
Maximum dose
( -7//)
>> 7=7*
77 77
> 77 -----
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Ph-Mohamed Gad

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> 7 -----

7 > ------------
( // >>>> ) 7
> 5 -------
> 7 -------
72 5 ( )

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Ph-Mohamed Gad

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@

@ ( )

@


@

@

@

( )

@

@

@

@
( 5 )
@
7
@

@

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Ph-Mohamed Gad

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Anti-Prolactin drugs









@ Uses
- Weaning
- Infertility to decrease
prolactin hormone
- Anti-Parkinsonism ..>
Parlodel
- Abortion
@ Drug used
- Bromocriptin ....>
parlodel
- Lisuride ............> Dopergin
- Cabergoline .....> Dostinex
@ Doses
- for abortion .....> 2 tablets one time
Weaning .....> gradual dose ( 1/2 tab once daily for 2 days then then 1/2 tab
for 2 days then 1/2 tab three twice daily
times daily)
- for infertility ....> 1/2 tab or 1 tab twice weekly
@ side effects
gradual - cardiovascular ( postural hypotension )
GIT upset
CNS ( hallucination )
@

Ph-Mohamed Gad

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Sun block

UVA,UVB
Erythema, Hyperpigmentation, Photoaging or Skin cancer
SPF
Sun Protection Factor
(
SPF 2 )
SPF15


SunScreens
>> Physical ( mineral ) only cause reflection

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Ph-Mohamed Gad

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Like Titanium Dioxide, ZnO, iron oxide

>> )Chemical ( cause absorption of light
Like Benzyledin camphre, octocrylin ~~ anti UVB
cinnamates, Mexoryl SX, Tinosorb S ~~ anti UVB/UVA short
Dibenzoylmethan, Mexoryl XL ~~~~~~~ anti UVA long
>> )Organic (cause reflection and absorption
Like Tinosorb M

@
- - @
- Physical sunscreen ..... - Chemical ........@
- ..... - ..... emulsion

>>> Tanning



self tan

Sun tan

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Ph-Mohamed Gad

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Dr-GAD

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new line of treatment





lines
cross sales

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Ph-Mohamed Gad

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lines of treatment
@ ( )
@ ( )
@

@
@
@
cross sales
@
@
@

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Ph-Mohamed Gad

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@

blisters oozing lesion


@
>> Contact dermatitis

>> Atopic dermatitis

>> Seborrhoeic dermatitis

>> Varicose eczema

>> Infective Eczematous
Dermatitis
(
)
>> Discoid Eczema

@ ( )
( ) fexofenadin 180 infective15Page

Ph-Mohamed Gad

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Calcineurin inhibitors pimecrolimus (Elidel)cr.) or Tacrolimus ( Protopic cr.

infective infective anxiolytic@
@ ( )
( .....)
( ....)

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Ph-Mohamed Gad

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line

Scabies

**


**

**

Lines of ttt.
Warm bath with sulphur soap

) Anti-Mites ( Eurax

Systemic anti-histamine
2

Topical soothing agent

If 2ry bacterial infection with

itching systemic antibiotic or if pus
presents
(
)

Duration of ttt >>>>> 3 to 4 days

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Ph-Mohamed Gad

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Cross sales

2
() (
) 2

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Ph-Mohamed Gad

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( ) (
) Rosacea

) ( sebaceous glands








>>

###
>> ( Doxycycline or
) Clindamycin
( ) Benzoyl peroxide ) ( Azelaic . (
)Isotretinoin, Tretinoin or adapalene
sebum

comedon
azelaic

azelaic
(
)
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Ph-Mohamed Gad

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> 2 5
> 2 ( non-
) Androgenic progesteron
___________________________________________________
>> ( )
) (Roaccutan cap . Or high doses of antibiotics
> 8/

2 //
2 5
@ Roaccutan


*****
( anti-androgenic
( [Cyproteron( androcure)] with a non-androgenic contraceptive


###
( )





Roaccutan

@@


>>

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Ph-Mohamed Gad

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Ph-Mohamed Gad

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Urticaria

inflammatory mediators








angioedema
@@

@@
( ) fexofenadine 180
( )
(
)
( -)

@@

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Ph-Mohamed Gad

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@@
Tinea capitis ##



(
)

cicatricial allopecia

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Ph-Mohamed Gad

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>>

( )
( ) ..
( )
>>

Tinea pedis ##

( )
(
)

>>



>>

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Ph-Mohamed Gad

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@ Tinea versicolor

( )
>>
( )
( )

>>


@ Tinea corporis



Active raised
edges covered
with minute
papules,
vesicle


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Ph-Mohamed Gad

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<<
( )
( )

>>




@ Tinea barbae

@ Tinea cruris
Tinea corporis

@ Tinea ungium


Loceryl nail laquir

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Ph-Mohamed Gad

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Ph-Mohamed Gad

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callus & warts
Warts

Callus




@ Keratolytic

@
@
>>>





>>>





callus
wart
@ keratolysis Podophyllotoxin warts

7

Dr-GAD
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Ph-Mohamed Gad

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@ Oral
Contraceptive CC

1- One hormone CC
>>> progesteron only

viscosity
of cervical mucous
Cirazette and
Microlut

7

(
)

2- Two hormones CC >>> estrogen with progesteron

2
>> one phase ..... Gynera , yasmin , dian 35 , marvelon and cilest

>> two phases ..... Gracial

>> three phases .... Logynon
7 2

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Ph-Mohamed Gad

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@@
- >>
-


2
2 7

7


>>>


( )chest pain

Blurred vision


( )
Water retension >> weight gain
Mood change
Photosensitivity

CC
Decrease hairing and adjust the secondary character of female >> diane >> also
acne ttt
Regulating the cycle
Retardation of the cycle
Shemale character
Polycystic ovary
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Ph-Mohamed Gad

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drug-drug interaction

Macrolides , Rifampicin , anti Epilepsy drugs , anti migrain drugs

======================================================








@ primolut N >>>1*3
7

@ duphastone >> 1*2


@ provera >> like primolut
>> @ evra patches

>> @ nuva ring
@ yasmin

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Ph-Mohamed Gad

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Ph-Mohamed Gad

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.......

@ Dysmenorrhea... Painful period
( )
diuresis

@ Menorrhagia
( )
Haemotonic and vitamins
@ Toxic Shock Syndrom


( )
drugs regulating the cycle
@ progluton
@ climen

2

menorrhagia


@ long term injection

2 5

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Ph-Mohamed Gad

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@ Nuva ring

@ Evra patches
2

@ IUD.
) ( mirena
) ( novaloop , multiload cu
pelvix

@ Local


@ Condom >> physical contraceptive for men
Ovulation Period
8 7 2 2

2 2
2 5 2


Postmenopausal Women
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Ph-Mohamed Gad

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Ph-Mohamed Gad

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Vaginal problems


vagina PH
PH 228


@ fungal infection

2
( )
PH
@ bacterial infection



@ trichomonas vaginalis
transmitted


@ dryness

infection

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Ph-Mohamed Gad

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ANTIAnthelmintic
drugs

( Entrobius vermicularis , Exuris , Ascaris , Round worms

) Ancylostoma

Mebendazol ( 1*2*3) then repeate after 15 days @
Or Albendazol ( 1*1) then repeat after 15 days

( Tinea saginata, Tinea solium , Hymenolipus nana, Tape worms

) Diphollobathirium latum
Niclosamide @

7 >>
7 >>

>>

) Trematodes ( Schistozomas, Fasciolas

Praziquantil @

7 >>
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Ph-Mohamed Gad

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>>
2-/
-/

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Ph-Mohamed Gad

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@
Polyurea , polyphagia, tiredness, loss of weight , slow healing of wounds , blurred
vision and recurrent infection.
@

sexual dysfunction ( erectile ) and ( )
stop healing of wounds > gangrene
) (

. 7
7 2
8 5
--------------------------------------------------------------------------------------
1 ) ( HbA1c ( . % 52 )
2 ( 8 ) 5 / ( 7 / ) .3 ( 7 ) / ( 2 / ) .
4 / ( 2 / ) .
( : ) ADA 2013

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Ph-Mohamed Gad

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#
@
duration of action
* ultra short acting
novorapid , apidro & humalog
peak
* regular & rapid acting
actrapid & humulin R peak 2

* intermediate acting
insulitard & humulin N peak
8
* long acting
lantus & levemir 2 peak 8
8 7
* mixed type insulin
mixtard & novomix short acting with intermediate
acting




2



(
)
=====================================

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Ph-Mohamed Gad

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>>> Insulin Secretagogues -1


@ Glibenclamide , Glipizide , Gliclazide , Glimepride >>> Sulphonyl Urea

Glimepride

@ Repaglinide >>> Metaglinides

short duration
glucose regulation

Hypoglycemia
>>> Insulin Sensitizers -


@ Metformin >>> Biguanides
obese

Polycystic ovary
GIT Upset Lactoacidosis
@ ) Pioglitazone ( Actos >>> ThiazolidineDiones

arrythmia 7 hepatotoxicity
) Acarbose (Glucobay >>>> Alpha-Glucosidase Inhibitors -2

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Ph-Mohamed Gad

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Sitagliptin (Januvia) , >>> Di Peptidyl Peptidase-4 Inhibitors DDP-4 -7

)Vildagliptin(Galvus

Mechanism ( very important ) please read it carefully
Sitagliptin works to competitively inhibit the enzyme dipeptidyl peptidase 4 (DPP4). This enzyme breaks down ( the incretins GLP-1 and GIP, gastrointestinal
.hormones released )in response to a meal
By preventing GLP-1 and GIP inactivation, they are able to increase the secretion
of insulin and suppress the release of glucagon by the pancreas. This drives
.blood glucose levels towards normal
As the blood glucose level approaches normal, the amounts of insulin released
and glucagon suppressed diminishes, thus tending to prevent an "overshoot" and
subsequent
low blood sugar (hypoglycemia) which is seen with some other oral hypoglycemic
.agents
hypohlycemic action
Combination -


Cross sales @@

B12


@@
) (

Ph-Mohamed Gad

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(




.....--7-2--

)
.





~ ~ Dr-GAD

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Ph-Mohamed Gad

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@
>> ) Primary ( Essential
>> Secondary ( accompanied with another
problem ) Renal , Pregnant , Endocrine
@@
-

@ 5-7 9 high normal

@ 5 9

@@@
>> >> >> >> >> >> >>

@@

Cerebral complications , Renal comp. , Cardiac comp. , Optic comp. and others
##
( )


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Ph-Mohamed Gad

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cross sales

B-blockers ##
) ..Selective ( atenolol---
) Non selective ( propranolol --- bradycardia , Sexual dysfunction
Ca-channel blockers ##
) Di hydropyridines ( deltiazem, verapamil ---oedema , bradycardia and Orthostatic hypotension
Reflex tacchycardia >>> )..Non dihydro. ( Amlodipine,nifedipine ---)... ACE Inhibitors ( lisinopril ##
Dry cough,chest pain , Hyperkalemia, tacchycardia
).ARBs ( losartan , valsartan ##

) alpha2 antagonists ( a-methyldopa ##
dizziness, Orthostatic hypotension
severe hypertension
flu-like syptoms ... Sexual dysfunction, tacchycardia ,
bronchospasm

sexual dysfunction
cross sales

long effect & moderate strength >> )thiazide like ( indapamide &Thiazide ##

Orthostatic hypotension, arrythmia( electrolyte imbalance) ,
Calcemia) and dry mouth & hyper(glycemia,uricemia
strong & short duration >>> )Loop diuretics ( furosemide, bumetinide ##
effect

Ph-Mohamed Gad

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Hypocalcemia
transiet earloss
Spironolactone ##
)hyperkalemia , GIT upset, Gynecomastia...(anti androgenic effect
irregular mensis
hepatic oedema
Plastic anemia >>>> Amiloride ##
@@@ Angina
orthostatic hypotension


@@

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Ph-Mohamed Gad

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drug of choice









@ Tonsillitis






Penicillins or Penicillin cominations( augmentin ) >>>> watch sensitivity
Cephalosporins ( cefaclor ) >>> if sensitive to penicillin he will be sensitive to
cephalo.
Macrolides ( azithromycin ) >>> used if there is sensitivity to penicillin
(
)

@ Otitis media





maximum dose

@ Gonorrhea

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Ph-Mohamed Gad

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Quinolones >>> 18 years and over , watch epilepsy, photosensitive

Macrolides
Cefaclor and its family
Togomycin

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Ph-Mohamed Gad

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-1 ( ) conjunctivitis

" "

( )naphcon A

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Ph-Mohamed Gad

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-infected conjunctivitis

( )

(
tobradex > watch glucoma
(

dry eye -

@
@

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Ph-Mohamed Gad

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Diarrhea

( )




Pseudomembranous Colitis

Acute
infective agent (
)Cholera,Staph.,Clo.wellchii,Entamoeba hist.,Reovirussalmonella,shigella,E.coli

>> astringent
Dietary

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Ph-Mohamed Gad

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>>
Traveler diarrhea
)infective( bacteria,viral or amoebic


astringent
( )
astringent
loperamide astringent
Astringent
( )
(
) .. ( IBS[irritable bowel syndrome] ,UC [ ulcerative colitis
])...
( ) Rota virus Rice watery diarrhea with
nausea,vomiting,tiredness
ASTRINGENT
2 Refer to the doctor .....

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Ph-Mohamed Gad

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1- Cell wall inh. >>> B-lactam gp. ( Penicillin , cephalosporin , carbapenem )

>>> non B-lactam ( phosphomycin , vancomycin )
2- DNA synthesis inh.
>>> DNA gyrase inh. ( Quinolones)
>>> DiHydroFolate Synthetase inh. ( Sulfonamide)
>>> DiHydroFolate Reductase inh. ( Trimethoprim )
3- Protein Synthesis inh.
>>> inhibitition of bacterial ribosome to bind with mRNA
@ 30S subunit ---> reversible ( Tetracycline) ....... Bacteriostatic
---> irreversible ( aminoglycoside ) ... Bacteriocidal
@ 50S subunit ---> reversible ( chloramphenicol ) .... Bacteriostatic
---> irreversible ( macrolides, clindamycin,lincosamide)
=================================================

Ph-Mohamed Gad

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@ Penicillin
> side effects .... Hypersensitivity , Anaphylactic shock , diarrhea ( pseudo
membranous colitis )
> advantages .... Cross BBB , drug of choice in tosillitis
>> may be short acting ( P.G sodium ) or long acting ( Benzathin P.)
>>> amoxycillin is highly absorbed ..
787 8

cobination

@ Cephalosporins
generations7
From 1st gen. To 4th gen. Spectrum on G-ve bacteria increase and side effects
decrease
1st >>> cephalexin, cephradin, dose 1*3
2nd >>> cephadroxil

, cefaclor ( conc. 250&500 1*3) ,cefuroxim ( cross BBB) , cefprozil, dose 1*2
3rd >>> cefixim ( conc.200 1*2 & conc. 400 1*1 ) , cefdinir( dose 1*1)
cefpodoxim , cefditoren , dose 1*2
4th >>> cefopral , dose 1*1

@ Tetracycline
Broad spectrum bacteriostatic
Dose 1*4 or 1*3
New generation Doxycycline 1*2
and for acne may be once daily in regimen
For trachoma & brucella once daily for two weeks

>>> S.E.
GIT upset, Vistibular reaction, nephro and hepato toxicity , chelation with Ca , Fe
& antacids

Ph-Mohamed Gad

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>>> Precautions
Not with milk products, not with children less than 12 years (
) , not for pregnants , photosensitivity (so avoid light ) ,
used with large amount of water

__________________________________________________________________

@ Quinolones
-broad spectrum except nalidixic acid
-Activity against Gram -ve ( E.coli, H.influenza, Typhoid, Brucella, Enteritis, Ps.
Aerugenosa, Malaria,..)
>> 1st gen. ( nalidixic .) ---- narrow spectrum,Safe in pregnant,for UTI , Dose
1*3
>> 2nd gen. ( norfloxacin,ofloxacin, ciprofloxacin, enoxacin ) , Dose 1*2
>> 3rd gen. ( levofloxacin,gemifloxacin, gatifloxacin,, Moxifloxacin{ cosidered
4th gen.}) Dose 1*1 ...... May cause arrythmia
anaerobic bacteria & Gram +ve

>>> Contra indications

In children less than 18 years as it cause erosion in articular joints & in old more
than 70 year and in pregnancy ( except nalidixic )
>>> Precaution in epilepsy ..... Increase the episodes
>>> Used in Gonorrhea ttt,,,, less effective in Staph. aerius ,,, not used in
syphilis
>>> Side effects
, may cause arrhythmia --> Nausea, vomiting, skin rash, tendonitis
inc. QV intervals

Ph-Mohamed Gad

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@ Macrolides
- Erythromycin ----------> 1*3
- Clarithromycin --------> 1*2 and for XL 1*1
- Azithromycin ----------> Quantity *1

- Roxithromycin --------> 1*2
- Josamycin -------------> 2*2
- Spiramycin ------------> 1*2
>> Side effects
- mild GIT upset
- disturbance in smell & taste
- liver inhibiting enzymes { erythromycin }
- hepatotoxicity & cholestatic jaundice
>> Azithromycin suspension only one concentration with different volume ( 40
mg/ ml) to cover all ages of children

@ Aminoglycosides ( neomycin , gentamycin , lincomycin, streptomycin,... )
- large molecule , not absorbed orally ( except neomycin )

- used in hepatic coma
- the most are injection
- effective on G-ve so can be used with penicillins
>> Streptomycin ----- 2nd line ttt of TB and the drug of choice in Brucella
>>> Side Effect
Ototoxicity , nephrotoxicity , neuromuscular blockage
_____________________________________________
@ Lincosamide ( clindamycin,..)
- Drug of choice in sensitivity of penicillin
- highly effective on soft tissue infection
- short duration of action ..... Dose 1*3
- Concentrations. ( 150,300 Cap. - solution 1% { oily skin} - lotion 1% { dry } -

Ph-Mohamed Gad

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vaginal cream 2% - gel 1% { all skin types }

>>> Side Effect ..... Diarrhea & Pseudomembranous Colitis
_______________________________________________
@ Chloramphenicol ( chloram., thiophenicol
- ttt of typhoid
>> Contra indication
- in babies ------> grey's syndrome ( vascular collapse)
>> Side Effect
Bone marrow depression , Optic nerve atrophy , bleeding
_______________________________________________
@ Sulphonamides
- Co-trimoxazol -----> longer duration 1*2
Concentrations
Syrup... 200/40/5 ml -----> quantity* 2
Tablet ... 400/80 -----------> 2*2
.... 800/160 ( forte tab. ) ----> 1*2
>> Side effects
- Sensitivity, hemolytic anemia , photosensitivity, urine crystallization ,
hepatotoxicity , nephrotoxicity
>> precautions
- sensitivity, Favism, Hepatic problems, nephro problems, avoid light, with large
amount of water
- age less than 1 year ----> hemolytic anemia ---> Kernicterus ---> damage of
brain cells
__________________________________________

Ph-Mohamed Gad

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antibiotics
G-6-PD. Favism

low risk
- Paracetamol, INH,Colchicin, antihistamines, Vit.C, Ibuprofen
high risk
- Sulphonamide, Aspirin, Antimalarial, chloramphenicol, Quinolone,
Nitrofurantoin, Furosemide, Ipanutin, Lamictal, Mesalazine, Sulphasalazine
drug of choice

Dr-GAD

Ph-Mohamed Gad

58Page

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@

>......

2- 2- 2 7-2@


5
8


@
adipose tissue >...
chitosan gemina silvister extract

>... xenical orlistat

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Ph-Mohamed Gad

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neopuntia

Vit K,E,D,A
>... Glucosanol
2
>... Hi-Chrom chromium picolinate
2
>... 2 Bran
@

@

@ Cross sales


Dr-GAD

60Page

Ph-Mohamed Gad