Bronchial Asthma

Presentation
Patient said he is asthmatic
‫… ه‬.. Complain of chest allergy
‫و‬ …..Dyspnea and chest wheeze
By examination….. Bilateral diffuse sibilant ronchi
Management
() ‫ ! ز أو ر‬+ ‫ل & أو‬ ' ٢٥٠ ‫ل وده رة‬ ! !
………………‫ ! ز‬+ ‫ش‬-. (/ 0‫ش & و‬-. 12 ‫ھ‬ 0 0‫ ا‬0 .
ventolin;0‫ ا‬. ‫ إدى‬cardiac patient 98 ‫ ش‬: ‫ وده‬NB…… 8 ‫' ا ل ا‬5 6 7
avil 8‫ ا ل أ‬bisolvon,‫ ن‬0 . ‫ ا ل‬1270‫( وا‬/ 0‫; ا‬0 > ?@ ‫ درون وده‬/ ‫ا ل د‬
. >.‫ ار ر‬C ‫ء أوى‬1 . ‫ وا ور ي‬F .‫ل‬ ( G ‫ت‬I ‫> ا‬.‫ر‬J‫ ى ا‬/B ‫و‬
‫ا‬
: ‫ رة‬C‫ت وھ‬ ٦ ! nebulizer ‫ ر‬0 ‫ ق‬L ‫ ; ا‬+ B@
farcolin (salbutamol) 0 !‫ ر‬8 ' ‫ا‬
saline & ‫ل‬ ' 2
anti muscrinic N 8‫ا ل ا (و‬
Atrovent to relive bronchial spasm in vials inhalation solutions
>.‫@ ر‬. )0‫(ر ا‬/ /B
‫ا‬
‫ (ة‬O:0‫ت ا‬I 0‫ ا‬98 (dexamethasone) solucortef 6 ‫! ر‬ ‫ىا ل‬
.‫ ر‬Q0‫ ا‬ST C ‫ ر‬U ‫ ر و (ض‬Q0‫ ا‬C ; ‫@; د‬R‫ أ‬B@ ‫( ا‬. ? 0‫و‬

Renal colic

; 5 '0J‫ ن ودش ا‬L 0 ‫ش ى اى‬-. CV Stone 98 ‫إن‬ ! history F‫ وا‬N ‫* وأ‬

‫ور ي‬ 0 ! + ‫ أو‬visceralgine )0‫ (ا‬8 ‫ أو‬buscopan ‫ ن‬. / . ‫ا ل‬
.W@ 0‫ ا‬V @ B! 1V8 / 0‫ و‬7 ‫ده‬ spasmofen 8 ‫أو ز‬glucolynamine
 :‫ ان‬X I
‫ أو‬burning ‫ ل زى ([ ن‬0‫ ا‬98 ( 2 C8‫ و‬S0 0‫ ن ا‬/ ‫أو‬ ZB0‫ ن ا‬/ ‫ أو‬loin pain ; + Y '0J‫ا‬
haematuria (G ‫ ان‬0‫> أو أ‬OV .

Management

( stone ; 8 0 ‫ ع‬B ) ‫ل‬ ' 250

‫ن‬. / .‫ا ل‬
0 ! +‫ا ل‬
)0‫ (ا‬8 ‫ا ل‬
‫ ل‬. B@ ‫@ ! ه‬. ; S O ‫زم‬I

‫ ل‬0‫ا‬ ^T

Crystals: ‫أو‬

‫ث (ات‬-d ‫ ! ب ء‬b C ‫ ار‬8 ! urosolvin eff. _F` urates 0 *

‫ا‬ ‫و‬ ‫و‬
Zyloric (200-800) tab Or No-uric (100-300) mg

oxalate 0*
‫ث (ات‬-d ‫ ! ب ء‬b C ‫ ار‬8 ! epimag eff
f 0‫ ي وا‬L0‫ ادق وا‬0‫ ط' وا‬BO0‫ وا‬0‫ (او‬0‫ ) وا‬B0‫ ا‬98 ‫ دة‬+ ‫ح‬- J‫ح وا‬- ‫و (م أ‬
. B N@ ‫ وط‬0 0‫ ذا أ د ا‬I‫ ار إ‬0‫ ? ا‬O 0 0‫ ا‬98

phosphate 0*
vitacid c tab F
pus :

;+ ‫ ش‬: HPF 98 ; BF [‫*ا‬

F ٣٠ ‫ ل‬٥ Q0‫د ا‬ 0*
١٢ ! ‫ ! ل‬Uvamine retard cap
٦ ! 0 ! Macrofuran(50-100)

UTI ‫ج‬- 98 ! Quinolones F ٥٠ ‫ ل‬٣٠ Q0‫ ا‬0*

‫ع‬ ‫ ة أ‬B0 ١٢ ! Ciprofar 250 or ciprofloxacin or bactiflox (250-500)
Kiroll or tarivan(ofloxacin200)
. . !J‫أو [ ا‬ . !J‫@ ا‬. ١٢ !
 9 l‫ ا‬6 7 /B *
‫ (ات‬٣ ‫ ! ب ء‬b C ! Coliurinal or proximol Antiseptic eff.
‫ت‬ ٨ ! ‫ ك‬Rowatinex cap Analgesic

1( ‫ه أ‬ ‫نھ‬ ‫ا‬ ‫يإ‬ ‫ د ع ا )( د ا‬+ ‫ ن‬,-. .‫ر‬0 1) ٥٠ !‫ا‬

vomiting
*You should at first exclude that:
Appendicitis
Acute abdomen
Insecticides
DKA
: Y0‫* ا ذ‬
cortigen B6 amp ‫ وا‬F ‫ ا‬0‫ط ل وا‬J‫ ا‬98 ?@ . ‫ أو ور ي‬9 7 ‫( (ان‬. ‫ا ل‬
‫ ات‬٣ ‫ ق‬MOTILIUM tab ‫ل ب‬0 ) ‫ ا ن ا‬1) ‫و‬

Hypotention less than 80/60

‫ درون‬/ ‫ل & وأ ل د‬ ' 500 F ‫ ء‬BG‫; أو إ‬F‫ اع دو‬U C/ L /B ‫@ ن‬0‫* ا‬
1270‫ول ا‬ N 0‫ ا‬98 ‫ ھ‬F ‫ ! ب ء‬b C 1V 10 effortil ; / ‫و‬

urine retention
‫ن‬L ‫ (ا‬C ‫ء و‬1 . 5 78 ‫(ه وا ه‬ ZB0‫ ? ا‬7 . ‫(ة‬O [ ;0 S!‫*ر‬
haematuria 6 C0‫دى إ‬p /B sudden decompression of bladder wall ‫ـ‬0‫ا‬

Epistaxis
‫@ ا‬0‫أھ' ا‬ ; J hypertension 1270‫ ا‬C ;0` ? @ ‫ ف ا ; وط‬. Y0 + ‫* ن‬
: 7 ‫ أ‬5 ‫ و‬6 J‫ ا‬6 0 ‫د‬pB0‫ا‬
Nasal trauma,dryness of nasal mucosa , bleeding disorders
*bleeding come mainly from kisselbach's plexus at anterior nasal septum.
 First aid
-venous pressure V ‫ ن‬L 0+‫ ن‬/
-Hand compress nostrils for 10 minutes
-Leaning forward
-May use cold compresses on nasal septum and not inside nose
-Add amp epinephrine to nasal pack for local use
‫ف‬ 9 0‫ ا‬6 J‫ا‬ 8 F‫ دا‬5@ ‫ و‬O[ @O[ C ‫ل وا‬ ‫تا‬ ‫(غ‬8
-Afrin adult spray 0.05%
‫ ة م وا‬B0 ‫ (ات‬٤ 6 s0 F :.
Management
+ 0‫ ا‬S ([ ‫ ن‬/ . C0‫ ف إ‬0‫ ن ا‬/ C pressure B@ ‫ ن‬L nasal pack ‫ ب‬6 0‫ ا‬6[ *
‫ ق زى‬0 ? N 0 ‫@ ن‬0‫ وط @ رأس ا‬Vaseline gauze 0‫ ز‬8 5 ;R L. ; B@ /B 9 J‫ا‬
(full flexed to avoid aspiration) 0 0 V .
C ; 7 ‫ ا ل وا ور أو‬haemostop ‫ـ‬0‫ ا‬-Z ‫ زى‬haemostatic ‫ ن ; دواء‬B! /B *
.‫( ا ل‬ethmasylate)dicynone 250 ‫ أو‬.Local6 0‫ ن ا‬/ C ;@7 ‫ و‬R L0‫ا‬
:‫ أدو ; زى‬C CLB /B ‫*و‬
Ruta-C tablets 1X3 ,heamostop tablets 1X3 or dicynone
Antihaemorrhagic and capillary protective ‫ ف‬0‫ > ا‬B .‫@ (ات و‬L0‫ ى ا‬V . ‫ودي‬
‫ ره دم‬U‫( ; ف و‬ B@ ; S O /B ‫*و‬
Pt=prothrombin time=10-15 sec
PTT=partial thromboplastin time=35-45 sec
Bleeding time=2-7 min
Platelet count =150,000 - 400,000
6@ 98 I‫ ف إ‬0 ‫دى‬p 0‫ ف و‬0‫ا‬ S 90 @0‫ ا‬1270‫ن ا‬I 1270‫ ا‬1 v ‫زم‬I @ ‫*وط‬
c 8 50 F [‫و‬ 0‫@ (ات ا‬L0‫ا‬

Hereditary hemorrhagic telangectasia=HHT S . ‫ ن‬/ ‫ ان‬/B recurrent epistaxis ‫ت‬I 98*

 Wounds
‫(ح؟‬+ C ( 2 ‫إزاى‬
‫)(ح‬0‫ ا‬1 : ‫ و‬6 0‫ ا‬6[ I‫(ز وإ‬G ‫ج‬ ? ‫ و‬9 F‫ دا‬6 ‫ ش‬5 ; ‫(ح `! ا‬+ ‫ول اى‬J‫ط @ ا‬
‫ول‬J‫ا‬
:‫ ر إزاى‬20‫ا‬
‫ د‬. @.‫ء أ! ) و‬ @.‫ ل & و‬B. ;0 9 0‫ ا‬VO B0‫)(ح وا‬0‫ ا ا‬+ ! ‫)(ح‬0‫ ا‬2 -
( -.‫ ش و‬R‫ و‬dressing ‫ـ‬0‫> ا‬7 ‫ و‬fucidin Z ‫ د ي‬7 '‫ (ھ‬6 7 /B -
( ‫ ر‬F‫ ا‬B @.) ‫ ات‬١٠ ‫ـ‬0‫ ق ا‬8 ; 0 ‫س‬ ;V -
‫ت‬ ٨ ! velosef 500 ‫ د ي‬7 C W (B 0 S / -
‫ث (ات‬-d brufen 400 tab / ‫و‬

‫س؟‬ 0‫_ ا‬F` ‫ھ اى )(وح‬

‫ ن أ ث‬/ '5 (+ ‫ ان‬B 9 0‫ ص ا‬:Rs0 CO@ B ‫ )(وح إ‬b:R /0 ;T O x 9 ‫ دا‬I ‫س‬ 0‫*ا‬
)0‫ اش و ا‬J‫ ا‬-Z ..... :0‫ ا‬U QF ‫ ا ت و‬0‫ت ا‬-7 .
(‫ ا ت‬0‫ت ا‬-78 ‫ ع‬QB0‫ ا‬9@ O0‫ د ا‬B 0‫ د ا‬+ 0)
; ‫(وب‬/ B0‫ن ا‬J Y0‫ و ذ‬....‫س‬ 0 9 ‫ دا‬-8 v 0‫ ! ا‬J‫ و ا‬S /B0‫ زل و ا‬B0‫ ا‬98 ‫)(وح‬0‫*أ ا‬
.‫ س‬0‫' ا‬v@ V @ B! ‫ أ ء‬Q0 . ‫ ة‬O2B0‫ ء ا‬RJ‫ ا ت ? ا‬0‫ت ا‬-78 ‫ ره‬Q

‫؟‬1 : ‫(ح‬+ ‫ھ اى‬

.; ‫ت‬ ٦ ‫ إذا (ت‬1 : I ‫)(ح‬0‫ظ ان ا‬ ‫*ھ ك‬

‫ ن‬. Q0‫ ء و ا‬B0 . 2 ‫ و‬1 : I ‫ ا ت‬0‫ ا‬W ) 0‫)(وح ا‬0‫*ا‬
.‫)(ح‬0‫ ا‬0‫ ا‬1270 . Q0‫ ھ ا‬F !` 0‫ ا‬S) B V0‫)(وح ا‬0‫* ا‬

Hepatic coma
diuretics ‫ ع‬B
Fluid replacement
‫ ه‬W (B0‫ن ا‬I & 0‫و‬ ٢٤ ! ٥٠٠ ‫و ر )(ز‬ ١٢ ! % ٥ ‫ ! ز‬+ ' 500 F
2ry hyperaldosteronism with salt and water retention
For liver support

Aminoleban ١٢ ! ' ٢٥٠ ‫ور ي‬

Hepamarin or Legalon tab (silymarin)‫ (ات‬٣ ‫[(ص‬
Tri-B ‫ ! م و م‬7 V
Essential forte tab ‫ (ات‬٣ ‫[(ص‬
Lactulose syr (Ammoniacal antagonist)‫ (ات‬٣ ‫ ! (ة‬V@
 (‫ط‬ /B NG TUBE W (B0‫ ا‬0 comatozed
‫ت‬ ٨ ! U(8 NEOMYCIN 500
:; ‫ ف‬7 ' ٢٥٠ %٢٥ ‫ ! ز‬+
hepa merz amp ‫ ھ (ز‬0 ‫ا‬
Nootropil amp 1000 ‫ ور ي‬.‫(و‬ 0 ‫ا‬: 5 B ‫ و‬/0‫ ا‬-F 1 L 0
fB0‫_ا!(ة وا‬0‫ ا‬6T ‫وظ‬ 0 oxybral amp 7 ‫او! (ال‬
( neomycin ') ٢ > ‫ دل‬0 . ‫! ز‬I ‫ ل‬/ ٥ + {8‫ ( ء دا‬0 ) ‫ت‬ 6 ! +(R ; V

MeasuresAgainst Hge. (If present)

IN UPPER GIT BLEEDING : NOTHING IS GIVEN BY MOUTH
‫ت‬ ٨ !DICYNONE ‫ا ل‬٢+KONAKION ‫ ا ل‬٢
١٢ !CYCLOKAPRON ‫ ا ل‬2
‫! ; ور ي‬

١٢ ! CEFOTAX 1gm ‫@ وى‬0‫ > ا‬B0*

9T‫ ا‬L (/ ; F ‫ و‬W (B0‫أھ ا‬ ! History F ‫زم‬I /0‫ ا‬. G ;0 98 ‫ش‬ *
(/ . G ? 5 ‫ ن `! أ‬L

(coma ) . 20‫ا‬
def.: loss of consciousness
Causes
*intracranial as:
head trauma & inrta cranial. Hge. (cerebrovascular stroke) with increased B.P
brain abscess, encephalitis ,meningitis, massive infarction ,hypertensive
encephalopathy, brain tumor. All intra cranial causes may &may not come with
lateralization signs which are :
* unequal pupil,*facial asymmetry,*unilateral hyper or hypotonia
*unilateral Babiniski, asymmetrical deep reflexes

*extra cranial causes:

toxic as co poisoning
-(D.M)may be: 1- hypoglycemic treated with 100 cm glucose 25% 2- DKA
-uraemic (CRF)
-AMI
-hepatic (Encephalopathy)
-resp. failure

Diagnosis:
history + complete physical exam. + Investigations like
*ABG 9 (L0‫ م ا‬0 . ‫ زات‬G
*renal function tests C ! 6T ‫وظ‬
*complete urine analysis ! ‫ ل‬.
*urea & creatinine (!‫ و‬0 .
*random blood sugar (R.B.S) ‫ م‬0 . 9T‫ ا‬L (/
* glucose & acetone in urine ‫ ل‬0‫ ا‬98 ‫( و أ ن‬/
* liver functions tests (L.F.T) ! 6T ‫وظ‬
*billirubin direct, indirect & total C !‫( و‬R ( G‫( و‬R ‫ (اء‬Q0‫ا‬
*SGOT & SGPT
*Prothrombin activity ‫(و‬d‫ (و‬0‫ ط ا‬L
*ECG
*Abdominal U/S
*Brain CT
TTT:
1- maintain adequate oxygenation
Care of patient during coma.

. ! Y ‫ درة‬.‫ ل و‬/. ‫ ك‬/ I‫ أ ! ا‬Y 0 > 0 + 6Q > 0‫ ا‬98 -

2-ttt of shock if present
*By insertion of nasogastric tube and feeding the patient with 2 liters of fluid
.( 0 ٢ 90‫ ا‬50-F T‫ ا‬0‫ ء ا‬O ‫ @ ة وإ‬. ‫ أ‬S !( -
*Insertion of Foley's catheter and estimation of urine in 24h
. ٢٤‫ ال‬98 ‫ ل‬0‫ ا‬B! ‫ و ب‬C0 8 . ‫ أ‬S !( -
١٢ ! '+١ ! ‫ا ل‬-
3-hospitalization &recording vital signs at regular intervals.

‫ ن‬L onset C ‫ ا `ل‬coma ‫ـ‬0‫; ا‬0 98 ;+ '‫*أھ‬

neurological cases and hypoglycemic coma ← sudden onset
hyperglycemic coma& DKAC /0‫ وا‬/0‫ ا‬. G ‫ زى‬metabolic coma ← gradual onset

Intracranial Heamorrhage
One of cerebrovascular stroke (C.V.S)

Patient clinically presents with History of hypertension, Right or lift hemiplegia,

hemiparesis, facial deviation, Coma, Slurred speech.

Investigations needed
*For hypertension
- Na, K
-‫ م‬0‫ ا‬98 d-d ‫ (ول ودھ ن‬0 !
-Cholesterol & TG in blood
-Urea &createnine
-Complete urine analysis
*For other causes
-Random blood glucose
-ECG
-Urgent CT brain
Treatment:
*Dehydrating measures and antihypertensives
-mannitol 20 % 250 cc IV
6[ 'd ‫ ة‬B0 ١٢ ! ‫ ى‬C
-lasix 40 mg amp.
٧٠\١٠٠ 1270‫ ا‬V I } . ١٢ ! ‫ا ل‬
-fortacortine amp. IV
6[ 'd (F‫آ‬ ‫ ة‬B0 ٢٤ ! ‫' ا ل‬d ‫ ة‬B0 ١٢ ! ‫ا ل ور ي‬

*Cerebral Stimulants :
-oxybral ampoule IM improve cerebral and memory condition
-Nootropil ampoule IV
‫ت ور ي‬ ٨ !‫ا ل‬٢
*Measures to prevent stress ulcer
-zantac amp.
( ١٥٠ ‫أو [(ص‬ ١٢ ! ‫ا ل‬
-motilium syp
‫ (ات‬٣ ‫ ! (ة‬V @
*Intubation
-Ryle catheter ordinary fluid and cannula and give 1.5 liter
-Foley's catheter
٢٤ ‫ل‬-F ‫ ل‬0‫ ا‬B! ‫ و ب‬C0 8 ‫(ة‬O [ S !(
*Care of comatozed patient
Y ‫ درة‬.‫ ل و‬/. ‫ ك‬/ I‫> دھ ن أ ! ا‬ ! W (B0‫ ا‬S V
*Specific measures to stop hge.
-dicynone amp IV ‫ت‬ ٨ ! ‫ا ل‬٢
-konakion amp‫ت‬ ٨ !‫ا ل‬٢
-cyclokapron amp‫ت‬ ٨ !‫ا ل‬
*if vomiting give primperan *abimol *flumox 500 mg
 Gastritis and hyperacidity
heart burn ‫ ر‬Q0‫ ا‬C B ‫@ه‬ 0 G‫ و‬burning pain in epigastrium ‫@ ة‬B0‫' ا‬8 98 '0‫*ا‬
nausea‫> أو‬+( /B ‫و‬
Management
'5 ‫ل‬ ' 250
tagamet(cimetidine)‫ أو‬zantac(ranitidine) ‫ا ل ز ك‬
‫ن‬. / .‫ا ل‬
>+( . 0 ‫( (ان‬. ‫ا ل‬
0 0‫ ا‬S C . ‫` ل ز ك‬. 9 / /B ‫و‬
@ ‫ ( (ان ط‬0‫ ا‬I‫( & إ‬ ‫@ ن‬0‫ا‬ 0 ‫ ل‬B0‫(ر ا‬/ /B ‫و‬

N 0‫ ا‬98 ‫ ه‬F ‫ج‬- C ;0 S !‫*وا‬

b . !J‫ م [ ا‬0‫ ا‬98 ( zantac 150 or 300 mg tab
‫ (ات‬٣ !I‫; ! (ة [ ا‬V @ mucogel susp or epicogel
omez or omepack ‫ زى‬proton pump inhibitor C ;0 S !‫ د ! ; ا‬B0‫ ; ا‬0 ‫@ ن‬0‫ ا‬0
‫ م‬0‫ ا‬98 ‫ (ة وا ة‬0 ! or losec
‫ ت‬. 5 0-0 ‫ دة‬7B0‫ وأدو ا‬Y B0‫! ا‬J‫ (اق وا‬0‫! ا‬J‫ ة وا‬5V0‫ ي وا‬L0‫ ا‬: C l‫ا‬ @ ;‫ا‬ ; ‫و‬
anti-inflammatory drugs as piroxicam ‫@ ة‬B0‫ ا‬C (d . C0‫إ‬
Alternatives:
Zantac (tab&amp) ,Ranitidine(tab&amp) ,Histac(tab&amp) Aciloc (tab) ,Ranitak(tab)

Fluid therapy
‫ج‬ ? ‫ و‬0 F = Fluid assessment
HYPOVOLEMIA HYPERVOLEMIA
B. pressure Systolic 100 or low High
Pulse rate & volume Tachycardia & small volume Normal & big volume
Central venous pressure zero high
tongue dry wet
Skin elasticity Loss of it Normal or peripheral edema
haematocrit increased decreased
Urine out put little normal

*Fluid replacement:

*Glucose 5% given
To replace water loss not associated with electrolyte disturbance
As solvent for many IV drugs
*Dextrose ,Glucose (20,25,40,50%) given in
As nutrient to give calories when GIT feeding isn't accessible as in deep coma
Strong hypertonic as in case of sever hypoglycemic coma
**25,40,50% are in bottles and amp. Amp=25 ml
*Saline (Nacl 0.9%) used in
Water loss with electrolyte loss
*Sodium bicarbonate
In cases of sever metabolic acidosis
0,5&4,2 % bottles
8,4% in amp.
Ringer solution 500 ml
Contain NaCl , CaCl , KCl

*Plasma expanders
*To maintain normal blood volume as in shock and hemorrhage
*Crystalloids
* As saline & ringer give transient effect
Fate: escape to interstitial space
*Glucose 5% fate is intracellular space
*Colloids
Mannitol, dextran, gelatin, albumin
Fate: intravascular space

Hypertension
More than 150/90 plus headache with or without epistaxis
‫ اع‬U C/ L W ( ‫ى‬J 1270‫[ س ا‬ . I Y0_0*
Investigations
d-d ‫ (ول ودھ ن‬0 ! •
(!‫ و‬0 . ‫' و‬T U‫ م و‬0 . 9T‫ ا‬L (/ •
٢٤ 98 ‫ ل‬0 . ‫(و ت‬. ‫ ل ! و‬. •
O 0‫ ا‬C U ‫ ق‬8 ‫ ت‬+ ‫ و‬S V0‫ ا‬C U ‫ ق‬8 ‫ ت‬+ ‫ و‬9.(5! S [ ' ‫ر‬ •
‫(و‬d‫(و‬. ‫ ط‬L ‫ و‬. + B 50‫ و ا‬S ( 0‫ م و ( ا‬0‫(و ت ا‬. •
‫م‬ .‫ د م و‬U •
Management
; 0 0 …‫ت‬ ٨ ! ; ‫ اد‬/B 1270‫ ا‬V ‫ (ات و‬٣ ‫ م‬B 0‫ ا‬F 'd ‫ ور ي‬lasix !‫ز‬I ‫*ا ل‬
( . 1270‫ ل ا‬. …. Y0 . C F . . ‫ ﺳ‬١٢ 1! ‫ ن‬0‫ ا‬N epilat 10mg ‫ت‬- ‫ ا‬0 ! 90
‫ ن‬0‫ ا‬N capoten 25 mg ‫ إدى [(ص‬/B …‫ ن ! ه‬L cerebral edema 98 F /B ‫و‬
1!=‫ ا‬1>? ‫ ت‬. ‫ ﺳ‬٨ 1! B ‫ا‬
Tritac tab 5 mg once daily ‫أو‬
 ( ‫ [(ص‬aldomet 250 N ‫ و‬0‫أو ا‬
( ‫ [(ص‬atenolol 50 ‫ ل‬0 ‫أو ا‬
Combination. ‫أو‬

‫ واء‬0‫; ا‬0 ‫ ر‬: ‫ ! ر‬0‫ وا‬1270‫ ا‬S ; ‫ ن @(ف إ‬L +‫ ر‬:0‫@ دة ا‬0‫ م ا‬C {) ‫ل‬ ;O2 B0‫*و‬
: ; 0 S B0‫ا‬
Drug choice
young adult First line is diuretics & b-blockers
2nd is ACE inhibitors as capoten or Ca channel blockers as Epilat

In old age 1st line is Ca channel blocker with or without diuretics

In H. failure Lasix –capoten

Nefidipine & B.Blockers C l‫ ع ا‬B

R. failure Lasix-nefidipine(epilat)-aldomet
9 l‫ ع ا‬B → thiazide diuretics & capoten (ACE inhibitors)

*Alternatives:
*Ca channel blockers
-Epilat , adalat 10 mg soft capsule (nifedipine) in HPN & unstable
angina(coronary & peripheral V.D)
-Epilat retad , adalat retard 20 mg

*ACE inhibitors
Captopril 25, 50 mg (capoten- capotril) short acting
ramipril 1,25 -2,5-5 mg (tritace –ramipril)long acting

*B.blockers
Atenolol 50,100 mg (atenolol-ateno-atelol)

Appendicitis
Presentation
1- Symptoms
> ( W 0‫ وا‬fever ; R : ‫ ن‬/ . ‫ دة‬, B 0‫ ; ا‬+ 98 '0`. 9) *
localized in R.iliac fossa B 0‫ ا‬S ) 0 ‫@ ! ه راح‬.‫ و‬periumblical ‫ (ة‬0‫ ا ء ل ا‬. '0J‫*ا‬
‫ د! ر‬b0 F ‫ودة‬ C anorexia !J‫ ; ا‬5R ‫* ? اى‬
vomiting > +( 98 /B ‫ أو‬nausea ‫ء‬C V 0 ; G‫ ر‬/B *
2- Signs
 macburny point98 5 ‫ ن ا ! أ‬L >. Q. ‫ ن‬/B0‫ ا‬C ‫ ور‬L ‫زم‬I b 0‫* > ا‬
rigidity 98 CV /B ‫ و‬tenderness and rebound tenderness ; 8 CV .*
;@+ B 0‫ ; ا‬+ ‫ ل‬BL0‫ ا‬S )0‫ ا‬C 12 ‫ ا‬cross tenderness*
C ? / ‫ أو‬/0‫ ا‬B/ ‫ رش‬V ; ‫; ا‬+‫ ر‬0 /0‫> ا‬ . '0J‫ ا‬cough tenderness*
. !(. O 0‫; ا‬ +(0‫> ا‬8‫> ر‬ . '0J‫ ان ا‬8 x . .‫ و‬5 B@ ;0` ‫ ھ‬9 0‫ وا ة ا‬C‫*ھ‬

Management
‫ ن‬. / . ‫) و ا ل‬0( 8 ‫ ; ا ل‬%٢٥ ‫ ! ز‬+ ‫ل‬ *
not mask the diagnosis ‫ ن‬L b0 F analgesic / ‫ ع إدى اى‬B : @‫ﺣ‬
renal colic ‫ ! ي‬b2 ? 5 ‫ أ‬C ‫ ن أ‬L ‫ ل‬. B ‫زم ا‬I ‫ د‬+ '0J‫ ; ا‬0 0*
60‫ أ‬١١ ( !‫ ن ا‬/ . B@ ‫زم‬I‫' و‬5 ‫ وده‬W. Blood cells ‫ ء‬7 0‫د !(ات دم ا‬ B ‫*وا‬
‫ زى‬W B0‫ ا‬98 ! L ‫ ? ! أو اى‬5 ‫ أ‬C ‫ ن‬L pelvis‫ـ‬0‫ ا‬C ‫ر‬ B ‫ ا‬N . 0‫*و‬
.‫ ة‬F . ‫ـ‬0‫ ا‬history 98 ‫ ورة‬0‫ ا‬98 ! L ‫ اى‬98 ‫ ھ `ل‬. Mid-cyclic pain
appendectomy ‫(ا‬+ ‫ ا ة‬0‫ ال ا‬C ? ‫ا‬ 0 ‫)(ا‬0‫ ا‬ST C B ‫*وا‬
( / 0‫ ط ا‬L C ‫(ة‬O 0 0‫ دات ا‬7B0‫ ام ا‬: ‫ > ا‬laparoscopy or laparotomy ‫ ام‬: .
peritonitis, septicemia and septic shock Z ! L 98 ‫ ل‬F 0‫ا‬ [ 0‫وا‬
C B 0‫ ا‬S )0‫ ا‬98 ‫أ‬ /B ‫ول‬J‫( ا‬typical) ‫ (ة‬0‫ ا‬0 9/ L '0J‫ ا ة ا‬0‫ت ا‬I ! ? .*
.‫ط ل‬
← 0 98 acute abdomen 98 analgesic ‫ ع ى‬B X I
mask diagnosis ‫ ا ة‬0‫ ا‬98
HCL ‫ ود‬. ‫ ن‬L gastritis C8‫و‬

Myositis or back pain or myalgia.

(5v0‫ ر أو ا‬Q0‫ أو ا‬O 0‫ ا‬98 ‫ ن‬/ ‫ اى‬98 '0‫ا‬
Management
* myolgen cap or norgesic tab or myolax ,myorelax ,myofen cap.
(sk.ms.relaxant&analgesic) or dimra or mark-fast( new)
‫ م‬0‫ ا‬98 ‫ث (ات‬-d
*cataflam 50 or ketofan 50 or antiflam 50, adwiflam 50, rheumaren 50, rheumafen
50, voltaren 50(anti inflammatory & anti rheumatic)
!J‫@ ا‬. (

* Felden gel or olfen gel

‫ء‬ ‫و‬ U '0J‫ ن ا‬/ C ‫دھ ن‬
*Neurovit amp or neuroton or tri B(vitamin B complex)
.‫ل م و م‬ ‫ا‬
 Toxicology Cases
organophosphate poisoning

Presentation
‫ ات‬B0‫' ا‬B ‫ت‬I b :L 98 ‫@(وف‬B0‫ ا‬9d-Z0‫ا‬
pin point pupil, bradycardia, hypotension
salivation, sweating, diarrhea ‫ه‬ C@ ; ! secretion ‫ـ‬0‫ه ا‬ . ‫@ ن‬0‫ش ا‬ ‫و‬
nausea, vomiting, dizziness 7 ‫ أ‬C/ L . W (B0‫ا‬

Management:
*for a case of acute intoxication 4 broad lines should be done.
1-first aid or supportive care
-which is life saving to maintain patent air way and removing secretions and
insertion of oropharyngeal tube.
2-prvention of further absorption of poison here by
- removing contaminated clothes and washing skin Also by insertion of ryle tube
16 and performing stomach wash
clear ‫ ن‬/ ^ 0‫ا‬ 0; ; B. G‫@ ! ه ا‬.‫ل & و‬ ' ٥٠٠ B@ ‫ ا‬:‫@ ة‬ G
ryle ‫(ا‬0‫ ا‬98 '5O ‫ ' ; وا‬٣٠٠ C '5 ‫( ا‬10 charcoal tab)' 0‫ب ا‬ ‫@ ! ه اط‬.

3-methods to increase elimination of poison

4- Use antidote
- Atropine 2 ampoule in one injection every 15 min
pupil fully dilated or pulse reaches120 CV 0 ;V [‫ د‬١٥ ! .‫ا (و‬ 0 ‫*ا‬
dry tongue ‫ ! ه‬IJ KF D B+ ‫ ﺳ ف‬H-? secretion ‫ ان‬B ‫ب‬ ‫ و‬+ ‫ ف ان ا‬.‫ ن ا‬,-. DEF G‫واھ‬
-parlidoxime (protopan chloride)
(choline estrase reactivatore) ‫ (ة رة‬O:0‫ت ا‬I 0‫ ا‬98*
b @. ) 0‫ وم وا‬0‫ا‬ ‫(ر‬/ ‫ء و‬9O. ‫ ء ور ي‬C ١٥ C0‫ ا‬8 7 ‫ ا ل‬٢ ‫ ى‬.
zantac ‫ ا ل ز ك‬F -

Home TTT
!I‫ [(ص [ ا‬spasmodigestin tab
gastrofate(sucralfate)mucosal protective
; 8‫ @ ة‬C b . !I‫[ ا‬ V@ C O

food poisoning
‫ن‬. / .‫ل‬ ‫ل ز ك وا‬ ‫@ ! ه ا‬. F ‫و‬ .‫ا @ ة‬ G‫ ! ; ا‬CT‫_ا‬20‫' ا‬B 0‫ت ا‬I 98
 Common cold
‫ى‬ 0‫ د ا‬7B0‫ ا‬+ ‫ (اض‬I‫ ا‬S ;+- ‫& و‬R(0‫ ; وا‬: 0‫ اع وا‬Q0‫ ا‬S . ‫ ارئ ا‬O0‫ ا‬C) .
Management:
‫ م‬0‫ ا‬98 ‫ث (ات‬-d flumox cap 500
!I‫@ ا‬. ; : 0‫ اع وا‬Q0‫ (اض ا‬J ‫ت وده‬ ٥ ! ‫ [(ص‬abimol extra tab
> 0‫ ا‬. @U ‫ ن‬L ‫ت‬ ٣ ! ‫ب‬- ‫ أ[(اص ا‬bradoral lozeng
B0‫ا‬ 0 ‫ (ة‬vitacid -c tab
(antihistaminic & decongestant) 0‫& وا‬R(0‫ (اض ا‬J ‫ (ات‬٣ ‫ [(ص‬Flurest tab

Alternatives
*Flumox, famox 500, flucamox (cap- vials) ampiclox (cap-vials 5oo-syr),
hi-flucil, miclox(250-500),amoclox(500)
*abimol,cetal,paracetamol,pyral,paramol,temporal,panadol
*flurest,sine-up,flustop,congestal,conta-flu tab,coldex cap, clarinase tab

Cough
Management
R ; ! 98 0 ‫ م‬0‫ ا‬98 ‫ (ات‬٣ coflin syr
‫ث (ات‬-d '2 . ; ! 0 mucophyline syr
phenadone syr
C ‫ى‬ ‫ ا م‬٣ ‫ ة‬B0 ( (antihistaminic –corticosteroid )
S@L 0 > ‫ث (ات‬-d Farcolin(salbutamol) tab

Alternatives
* Coflin contain(cough suppressant ,decongestant ,anti allergic),codilar,
tussilar,neo pulmolar, selgon, siloma
* Mucophyline, neominophyline, mucosin, mucovent, farcosolvin, trisolvin,
ambroxol, Koffex, Actifed, solvex
*Phenadone, vendexine, apidone syp
*Farcolin, ventolin, bronchovent, salbovent tab

gastroenteritis
* vomiting, diarrhea, abdominal pain with or without fever
Management
‫ د ھ‬7 avil 8‫ل ا‬
‫ ا‬+ ‫ ن‬. / . ‫ ا ل‬+ ‫( (ان‬. ‫ا ل‬
‫ [ ى‬/ adolor ‫ ر‬0‫ا ل ادو‬
dehydrated 0 U QF & ‫ل ر )( أو‬ C '5 /B
 Home TTT

‫ت‬ ٨ ! 0 ! ‫ ل‬5 ‚0 antennal cap or diax*

b2B0‫ ن ا‬L ‫ م‬0‫ ا‬98 ‫ (ات‬٣ ‫ [(ص‬spasmocin tab or no-spasm or visceralgine*
(‫ (از‬0 . ‫ ط‬: ‫ @ ; )دم و‬98 0 ‫ م‬0‫ ا‬98 ‫ (ات‬٣ flagyl 500 tab or amrizole*
( Motilium tab or domperidone or motinorm or gastromotil*
‫ث (ات‬-d Streptokine tab or entocid*
ciprofloxacin500 tab(quinolones) F chronic ;0 ‫ ; أو‬: ‫ د‬+‫ و‬98 U QF ‫ د ى‬7 ‫*و‬
. !I‫@ ا‬. ‫أو‬ . !I‫[ ا‬ ١٢ !
; ‫ ط‬0‫ دة ا‬C) ‫ و‬S 0‫ ا‬8(@B0 ‫(از‬. B@ CV ; R (V ; 0 B0‫*و‬

uncontrolled DM
Headache ,malaise ,blurring of vision history of DM or patient on anti DM ttt
‫ ز‬5)0‫ و! د وا‬CT‫ ا‬L (/ 1 (R S ‫اط‬
pin prick the finger tip ,put a blood drop on the tape mark ,put the tape in the
device, wait and read the resulting number ,if random blood sugar is:

)0‫ ا‬N CT 0 ‫ و ات ا‬BF-250 - 200

0 ‫( و ات ا‬L 300 - 250
‫( و ة‬L BF 300 - 350
‫( و ة‬L F 350- 400
‫ و ة‬٢٥ F ٤٠٠ ( !‫ا‬-
‫@ ! ه‬. C0 ; 0 0
;V [ 0‫ ا‬98 ;OV ٢٠ ‫@ ل‬B. () ‫ ' ر‬٥٠٠ C 0 ‫ و ة ا‬٢٥ F

‫ا> ل‬ ‫ن‬ ‫اﺳ‬ ‫ا> لو‬ ‫و دﺳ‬ > ‫ا> ل‬1- + ‫و‬

‫ س & ور ي‬٥٠٠ 7 ‫ ا‬CO@ ‫و‬ •

١٢ ! ‫ ن‬I‫ا‬ } 0‫ ل وا‬0‫ا‬ ‫@د‬ •
‫ (ات‬٣ ' ‫[(ص‬ •
( ١٥٠ ‫[(ص زا ك‬ •
neuritis ‫ ب‬Q I‫ ت ا‬. 5 0I ‫ م‬C ! C. ‫ا ل (اى‬ •

hyperglycemic coma and DKA

due to missing insulin dose in patient IDDM.
presentation
random blood glucose more than 400
acetone on urine ‫ ل‬0‫ ا‬98 ‫ ا ن‬C8‫ و‬, low potassium level
polyurea ,acetotic breathing rapid deep breathing, tender abdomen ,vomiting

Management
‫م‬ 0‫ ا‬W @ 0 kcl ‫م ! ر‬ .‫ا ل‬+& ‫ل‬ ' 500
‫م! ر‬ . ‫ ا ل‬+ () ‫ ' ر‬500
‫م! ر‬ .‫ا ل‬+& ‫ل‬ ' 500
‫م! ر‬ . ‫ ا ل‬+ () ‫ ' ر‬500
. 0‫ ا‬Z 0 I‫; ا‬ ' ‫و‬

How to begin ?
• iv fluid replacement
>.‫ل ار‬-F ( 0 ١ 'd ‫ل‬-F ‫ل‬ ( 0 ١ 'd ‫ل‬-F ‫ل‬ ( 0 ١ 'd ‫ن‬I‫ل & ا‬ (0‫ا‬
() ‫ل ر‬ > & B0‫ل ا‬ ‫ دل‬. ‫ت‬ ٨ ‫ل‬-F ( 0 ١ 'd ‫ت‬

• lowering blood glucose by insulin

! (/ 0‫ ن وا‬I‫@; ا‬. ‫ و‬١٠٠ ) ( . ‫ن‬I‫ ا‬7 CT 0 ‫و ة ا‬٢٥

(‫ن‬ I‫ د ا‬+‫ و‬98 ) % ٥ ‫ ! ز‬+ ' ٢٥٠ F ‫ م‬0‫ ا‬98 ٢٥٠ (/ 0‫ [ ا‬0
‫ م‬0‫ ا‬98 (/ 0‫ ا‬V 0 0‫ ا‬N ‫اذا‬
CRI ٢٠٠ [‫ا‬
7 0 ‫ و ات ا‬BF ٢٥٠ ‫ـ‬0 ٢٠٠
‫( و ات‬L ٣٠٠ ‫ـ‬0 ٢٥٠
‫( و ة‬L BF ٣٥٠ ‫ـ‬0 ٣٠٠
‫( و ة‬L ٤٠٠ ‫ـ‬0 ٣٥٠
‫ و‬٢٥ F ٤٠٠ ( !‫ا‬

• correction of potassium
potassium chloride two ampoule on 500 cc ringer

• correction of acidosis
250 > ١٢ ! ‫ د م‬U ‫ ت‬.(/ . ' ‫ل‬ B0‫ا‬

• prophylactic of DVT
500 N ‫) و ة ھ ر‬0‫ا‬

Blood glucose level S B! )0‫ ا‬N 0 ‫ ا‬CO@ (/ 0‫( ا‬B ‫ ن وا‬I‫ ا‬C F‫اذا ا‬
motilium,zantac,tri-B,prempran ‫دو‬I‫ ا‬C[ . >
 hypoglycemic coma
‫ ا‬D ‫ادو‬ ‫ !> ة‬D. ‫ ش أو وا‬EO ‫و‬ ‫ ا‬D. ‫إ وا‬ ‫ﺳ‬L
random blood sugar below 50mg/dl,wet tongue, sweating drowsiness
random blood glucose ‫ا ـ‬ ‫ و‬% ٥ ‫ أو‬% ٢٥ ‫ ! ز‬- G‫ ﺳ‬٥٠٠

intestinal obstruction
abdominal distension and colic ,vomiting ,absolute constipation

x ray show multiple air fluid level

; ‫)(ا‬0‫ [ ' ط ارئ ا‬98 0 0‫)(ا ; و ' ) ا‬0‫ ا‬ST ‫ء‬ ‫ا‬

Anaphylactic shock and Hypersensitivity reaction

clinical picture
sudden and important fall of blood pressure ,tachycardia, frequent ceutanous
manifestation erythema, urticaria ,quincke' oedema
inconstant respiratory manifestations as dyspnea or even bronchospasm

Management

١٢ ! fortacorten ‫ ر ! ر‬8 ‫ا ل‬ •
‫ (ة وا ة‬kenacort vial ‫ ا ل ! ! رت‬+( 0‫ت ا‬I 0‫ ا‬C8‫و‬ •
( Or claritine or tavegyl ) ( allergex tab ‫ ب‬B/ ‫ و‬avil 8‫ا ل ا‬ •
‫ و ء‬U Topical corticosteroid betaderm ‫دھ ن‬ •

heamatemesis
‫ ل‬F 0‫ _!(ة ا‬C ; ‫ ط‬. ‫ ل‬F‫ د‬B '
← I ‫ دم أو‬V ‫ج‬ ‫ وھ‬0 0‫ رة ا‬OF ‫ ن ا د‬L W (B0‫زم ا ل ا‬I
-first or recurrent attack
-amount of blood

-history of liver disease, DM, hypertension, analgesic abuse ← S 0‫ ن ا (ف ا‬L

d ! L 98 ‫ وإذا ! ن‬S 0‫ا‬ ! ‫نا‬L
-do general and local examination, comment on neck vein, LL oedema
hepatosplenomegaly, ascitis ,vital sign pulse BP temp, consciousness
 Management
Nothing P.O. (per oral) ...............' 0‫ا‬ (‫ط‬ ‫ء‬9R CO@ I •
8‫ ا‬0‫ ا‬B @.Q 0‫ا‬ ‫(ى‬L. ‫(ف ! دم‬U ' •
9 ; 0‫ ف ا‬7 %٥ ‫ ! ز‬+ ' 500 •
cyclokapron ‫(ون‬. ! / ‫ا ل‬ •
(tranexamic acid antifibrinolytic) •
haemostop ‫ب‬ B ‫ن أو ھ‬ ‫ا ل دا‬ •
antihaemorrhagic and capillary protective •
ranitidine ‫ا ل ز ك‬ •
7 Fp 78I‫ك ا‬ 8‫ا ل‬ •
amri-k or konakion or haemokion •
(١٠-٩-٧-٢ ) 1 ) 0‫ا ا‬ / 98 ‫!فھ‬ 8 •

Hyperkalemia
٥ K ‫ إ‬٣.٥ >E ‫ ﺳ م ا‬+ > ‫أو ا‬
asystole 98 ‫@ ن‬0‫ ا‬F /B 5 J S V0‫ ا‬C ‫ ا‬+ (OF ; ‫* ز د‬
١٠ C ‫ ! ز‬+١٠٠ 98 ‫ م‬0 ! ‫ ا ل أو ا‬W (B0‫ ا‬9O@ 90 ‫م‬ 0‫ ا‬N V0 0 + ‫* أول‬
90 @0‫م ا‬ 0‫ ( ا‬d` S V0‫ ا‬9B . ‫ وده‬T [‫د‬
.‫ ل‬B0‫ ا‬98 ;T O ‫ ا‬78J‫ وا‬R ‫ء‬1 . I‫ إ‬direct iv ‫ ش‬F ‫ م‬0 /0‫ش ان ا‬ *
ph ‫ـ‬0‫ ا‬+‫ در‬S ‫ ر‬0‫ ا‬98 ‫ل‬ ‫ د م‬U ‫ ت‬.‫ ر‬/ . ‫ ء‬O „. 5)0 @ ‫زم‬I Acidosis ; 8 0‫و‬
HCO3 deficit‫و‬
‫ وده‬VI 9T 0 ‫ و ات ا‬١٠ ‫ أو‬٥ > %٢٥ ‫ ! ز‬+ ' ١٠٠ W (B0‫ ء ا‬O ‫@ ! ه ا‬. 9 0‫ ة ا‬O:0‫*ا‬
Intracelluar shift of K ion B@ .
@ ‫ ل و‬0‫ ا‬98 ‫م‬ 0‫(از ا‬8‫ ھ ود ا‬0 2R /0‫ ا‬0 & ‫ل‬ > !‫ز‬I W (B0‫ ي ا‬7 ‫ أ‬/B ‫*و‬
I ‫ آ أم‬C0‫> إ‬+‫م ر‬ 0‫ ف ھ ا‬L ‫ج ده و‬-@0‫@ ا‬. 0‫ا‬
‫ أو‬tachycardia 98 ‫@ ن‬0‫ ? ا‬/ .‫ل‬ 0 0‫ زي ا‬beta agonist ‫ ي‬/B 90 ; 0 0‫*و‬
cardiac ‫ ن‬/
' )0‫ دة ا‬0‫م ا‬ 0‫ ا‬0‫زا‬x T‫! ي ط ر‬ G + ‫ دي‬/LB 0 ( FJ‫ ا‬0‫* وا‬
I‫ ; إ‬b : 0‫ ' ا‬I‫ و‬-:0‫ ا‬F‫ دا‬C0‫ دة إ‬0‫م ا‬ 0‫ ا‬V ‫ ھ‬58 ‫ ھ‬V. 0‫ ت ا‬+-@0‫} إن ! ا‬
.‫ ! ي‬L8 ‫ ده ه‬W (B0‫ ا‬0 ‫_ات‬0 . ‫ ي‬/0‫ا‬ 20 .

5B‫ وأھ‬98 5 ‫(ة‬Q : ‫(ة‬/8 F 8 ‫ ﺳ م‬+ > ‫أﺳ> ب ز دة ا‬

'‫ ط‬BO0‫ ز وا‬B0‫ ا‬Z ‫ ت ! (ة‬B/. ‫م‬ 0‫ا‬ 0 ; C ‫ي‬ ‫ ت‬.‫(و‬L ‫_ و‬G‫ ول أ‬-1
(T Q@0‫' ا اع ا‬v@ ‫ ط و‬O 0‫وا‬
/0‫ دا‬/0‫( )( وا‬0‫ زي ا‬0 ‫م‬ . C ‫ي‬ 0 ‫ ء‬O ‫ا‬-2
Beta blockers & & ACEI : -:0‫ ا‬C0‫; إ‬0 F‫ ل أو د‬0‫ ا‬98 ‫م‬ 0‫(اج ا‬F‫أ‬ V ‫أدو‬-3
spironolactone
B0‫ د وا‬0‫ ي ا‬/0‫ ا‬L 0‫ا‬-4
‫ ل‬0‫ ا‬98 ‫(ازه‬8‫ إ‬Y0_!‫ و‬-:0‫ ا‬98 ‫م‬ 0‫ ل ا‬F‫د‬ V 5 ‫` ا‬. Acidosis-5
.‫) ! ز‬0‫ ا‬Q. -:0‫ ا‬C0‫م إ‬ 0‫ ل ا‬F‫ د‬bV ‫ و‬0 J‫ ا‬bV ) (/ 0‫ (ض ا‬-٦
 Other prescriptions
• Impotence

‫ ا م‬١٠ / 7 ‫ل‬ ‫ ا‬pregnyl 5000

/ ‫ ك‬proctan cap
١٢ ! / ‫ ك‬Anderiol cap
١٢ / ‫ ك‬vasotal tab 400
.................................................. . .‫(ح‬L0‫ا‬.........................................

pregnyl 5000 I.U ( Human chorionic gonadotrophin)

(9!( 0‫ا‬ ) 0‫ و ة دو‬٥٠٠٠profasi 9 8‫ (و‬0‫ ا‬6U ‫وا‬
‫ ا م‬١٠ ! 7 V : 8 U B0‫)( ا‬0‫ا‬
2nd testicular failure ‫ـ‬0‫ج ا‬-@0 ‫ م‬:
0‫ و ة دو‬١٥٠٠ !( . ‫ط ل‬I‫ ا‬98 undescended testis ‫ـ‬0‫و ا‬

:9 Z0‫ا‬
proctan ST cap
Impotence ‫ـ‬0‫ج ا‬-@0 @ O0‫ ب ا‬L I‫ت و ا‬ 0‫ا‬ B) ‫رة‬ ‫وھ‬
FOR SEXUAL POWER IMPROVMENT
0 ! : 8 U B0‫)( ا‬0‫ا‬

:}0 Z0‫ا‬
(Andriol cap ) testosterone undecanthate 250 mg
hypogonadism ‫ـ‬0‫ج ا‬-@0 ‫ م‬:
( ١٢ ! ) ( 0 ! : 8 U B0‫)( ا‬0‫ا‬

: >.‫(ا‬0‫ا‬
(vasotal tab 400 mg ) pentoxifylline
peripheral arterial circulatory disorders‫ـ‬0‫ج ا‬-@0
it inhibit platelet aggregation, and decrease blood viscosity
٤٠٠pental ‫ ل‬. ، ٤٠٠riboflex / 8 / ‫ ر‬، ٤٠٠ trental ‫ ( ل‬، ٤٠٠pexal ‫ ل‬/ . : T‫ ا‬0‫ا‬
( ١٢ ! ) ( 0 ! : 8 U B0‫)( ا‬0‫ا‬
• Premature ejaculation

Prozac disp or anfranil 25 or 75 mg cap

Antidepressent (delay ejaculation) [I‫ ا‬C . ‫ ع‬B)0‫[ ا‬ 0 !
Xylocaine jelly (local anesthetic) 6Q . ‫ ع‬B)0‫ [ ا‬C@ ‫دھ ن‬
Or lignocaine spray‫ ع‬B)0‫ [ ا‬7@0‫ رأس ا‬C R‫ ر‬٢
 Common mistakes
: D J‫ه ا و‬T‫ھ‬ UE ‫*ھ ك‬
; ‫ ط‬. : S O0‫ ا‬bQ:
٤٠ 90‫(ھ ا‬B ‫ ة‬: W (B0‫ا‬
‫@ م‬O0‫ول ا‬ @. ‫ ة‬T‫زا‬ B - ‫ ا‬b2 – ‫ ت‬. 5 0I‫ ا‬W@. –– ‫ ل‬0‫ ا‬98 ‫ ([ ن‬: 0 0‫ا‬

Rx
• Ciprofar 500(-Ciprofloxacin-) tab ‫ ء‬L@0‫ ر وا‬O 0‫@ ا‬. ‫[(ص‬
Alternatives:(cipromax- Ciprobay -bactiflox 250,500,750)

• Diprofos- (betamethasone) – amp ‫(ر‬/ I‫ن و‬I‫ ا‬7 V

Alternatives: (decadron,dexamethason,solu cortef, kenacort A)

• Colostop-( piperment+anise oil) – caps ‫ وم‬0‫ا‬ !I‫ [ ا‬0 !

Alternatives: (gastrocare-master gest)digestant‫ (ات‬٣ !I‫@ ا‬. ‫ ! (ة‬V @

• Mucogel-( AlOH3+MgOH3- )susp ‫ (ات‬٣ !I‫@ ا‬. ‫ ! (ة‬V @

Alternatives: (epicogel,magsilon,sedo-mag)

Answer
‫ج‬ ‫_ي‬0‫" ا‬ciprofloxacin" ‫ي‬ ‫ د‬7 " ‫ول‬J‫ا‬ T‫ وا‬0‫ ا‬6U‫ و‬98 ‫ ; دي ھ‬R‫(و‬0‫ ا‬98 `O:0‫*ا‬
‫@ ه‬B0‫ ا‬98 97B 1 ‫ ; و‬B@0
‫م‬ G B0‫ ا‬C ‫ي‬ "antacid" ‫رة‬ ‫ " و ھ‬Mucogel " ( FJ‫ واء ا‬0‫ @; ا‬6U‫*وو‬
!‫ م ھ رو‬B0‫ أ‬Y0_! ‫ھ رو! و‬
/BB0‫ ا‬B8 ‫ واء‬0‫_ ا‬F‫ أ‬V (‫ ط‬98 ‫` ھ‬O:0‫ ا‬/0 ‫ ; وا ه‬R‫ رو‬98 W@. > T‫ وا‬0‫ ا‬. /. 0 `O:0‫*و ا‬
‫أو‬ ‫أو‬ . B 0‫ د ا‬7 [ ‫ ي‬0‫ د ا‬7B0‫ ا‬6U‫ ن و‬/ /0 ‫ @ و‬T‫ وا‬0‫ ا‬6U‫أن ' و‬
.‫ ي‬0‫ د ا‬7B0‫ ص ا‬Q ‫ن ھ_ا ف @ رض > ا‬J [J‫ ا‬C ‫ت‬ >.‫`ر‬. ‫@ ه‬.
()0‫ ا‬0 ‫ ن‬B!‫و‬ B 0 ‫ د‬7 ;@ _Fp -8 C7 1 ‫ و‬98 I‫ إ‬B@ I ! 8‫ (و‬0‫ ا‬I‫*او‬
.‫ و‬5+ ‫م‬ 0J‫م وا‬ G B0‫ ا‬. interaction Q ‫ ھ‬. / 9‫ ھ زي ھ‬F‫ ا‬W (B0‫ا‬
. ! 8‫ (و‬0‫ ص ا‬Q ‫ ا‬V @ ‫ وده ط‬d 5+ ciprofloxacin
0 ‫ ان‬9 @B. Fe ... ‫ أو‬Ca ‫ـ‬0‫ ا‬.‫ و‬ciprofloxacin ‫ـ‬0‫ ا‬. Q /B ‫ ده‬interaction ‫ـ‬0‫ ا‬Y0_!*
‫ج‬-@0 - 0‫ أو ا‬- -Z ‫ م‬v@0‫ ا‬R L‫ج ھ‬-@0 - ‫ م‬0 /0‫ ا‬9 ‫ي‬ ‫ج‬- ‫ اي‬5 8 ‫ ف‬U ‫ ; دي‬R‫(و‬0‫ا‬
‫ دي‬OV 0‫' ا‬50 . ‫ وا‬F 90 Q0‫ وا‬S O0‫زم ا‬I multivitamins ‫ ف‬U ‫ أو‬- B I‫ا‬
' (! J‫ ا‬- 0‫ا‬- ‫ دي‬. 0‫ا‬- )0‫ م زي ا‬0 /0‫ي ا‬ B@‫ > ول اي اط‬B ; ‫ ا‬W (B 0 ‫ ل‬V ‫زم‬I ‫(ده‬.
B@‫ط‬s0 0 . ‫ ل‬0‫ ا‬Y0_!‫[ و‬I‫ ا‬9 ‫ت‬ >.‫`ر‬. ‫@ ھ‬.‫و‬ . ciprofloxacin ‫ـ‬0‫ول ا‬ [
0‫ ا‬9 B0‫ا‬
 9 ‫(ده‬. O ‫ و‬quinolones ‫ـ‬0‫ا‬ B) 9[ . 9 O ciprofloxacin ‫ـ‬0‫ ا‬9 O 9 0‫وط @ ا‬
‫( ده‬v B0 . ; R‫ رو‬Y0 + ‫ (ض‬9 @ (macrolids) azithromycin

Rx
* Zithromax 250 -azithromycin- caps(azalide cap250,500,susp200)azrolid 500
* Xithrone-zisrocin –zithrokan
()0‫ ا‬S ‫ ام‬: I‫ا‬
‫ ا م‬٣ ‫ ة‬B0 0 ! 250
‫ ا م‬٣ ‫ ة‬B0 0 ! 500
‫ ا م‬٣ ‫ ة‬B0 ‫ زن‬0‫ ا‬S single dose ‫( وا ة‬+ Susp 200
[I‫ ا‬C . !I‫@ ا‬. ‫أو‬ . !J‫[ ا‬

*Mineravit- multivitamins- caps ‫ ر‬O 0‫@ ا‬. 0 !

‫ت‬ 0‫ا‬ (+ @. N[‫ و‬98 ‫ ن‬/ ‫زم‬I ! ‫و‬ 0‫ا‬ (+ ‫' ان‬5 ‫زم‬I W (B0‫ ا‬0 0‫ ھ_ه ا‬98
‫ت‬ >.‫`ر‬. ‫ اء‬20‫@ ا‬. -Z / 0‫و‬

: 0 Y0_0‫ و‬S ( G 0 0‫ ھ_ه ا‬98 betamethsone amp ‫ ء‬O ‫ ن ا‬B!‫*و‬

‫ة‬ B. ( / 0‫ ا‬Q0 ' ) 0 U( 0‫ ء ا‬O x ‫ ب‬5 0‫ د ا‬+‫ و‬0 98 ‫ ء ! ر ون‬O ‫ م ا‬... ‫ول‬I‫ا‬
‫ ر ون‬/0 . B0‫ ز ا‬5+ 1 Z ‫ ي و م‬0‫ د ا‬7B0‫ا‬
‫ م‬v@0‫ ا‬R L‫ ھ‬5 ‫ ورة و‬0‫ ع ا‬OV ‫ا‬ ! L ‫ اب‬.‫ ا‬C 9‫(ھ ھ‬B @.‫ر‬I‫ ا‬98 ‫ ان ا (أة‬... 9 Z0‫ا‬
.(‫ م‬B ‫(ر و! ه‬/ I 5 ‫ ب ا‬/ ; V 0‫ ا‬/0) ;d‫و‬ 0B ‫ا‬ ‫ ء ! ر ون‬O ‫ ا‬7 I‫و‬

: ‫ظ ھ‬
‫أو‬ . !I‫_ إ [ ا‬Fp ‫ ان‬S) ‫ دات‬7 ‫ ھ ك‬.... !I‫ ي و ; > ا‬0‫ د ا‬7B 0 0.
: ‫(ھ‬5R‫وأ‬ 0‫ دات ا‬7B0‫ ص و ھ_ه ا‬Q ‫ا‬ 9 ‫ا‬9 ‫ ل‬Q 0 . !I‫@ ا‬.
Z Macrolides B) Y0_!‫و‬ ! 8‫و ر‬ ! 8‫ (و‬0‫ ا‬Z quinolones B)
!I‫ ا [ ا‬/ ‫ ان‬7 rifampicin‫ و‬Penicellins )B! Y0_! ‫(و‬Z ‫ر‬I‫وا‬ ‫ز (و‬I‫ا‬
‫ ن‬/ ‫ > اي‬Q /B ‫ اي‬S ) ‫ ن‬L !I‫ ا > ا‬/ I 9 @ - . !I‫@ ا‬. ‫أو‬ .
- ‫@ م‬O0‫ ت ا‬/
!I‫@ ا‬. ‫أو‬ . !I‫_ [ ا‬Fp 0‫ دات ا‬7B0‫ > ا‬B+ " B5 ‫ [ ة‬/0‫ ا‬98 0 ‫ ا‬0 [ ‫*و! ا‬
)0‫ ا‬Cephalosporons B) Z ‫@ م‬O0 . (d` I 0‫ دات ا‬7B0‫ ا‬W@. ‫" ط @ ھ ك‬ .
'5 8 ‫ ن‬/ ‫? ھ‬ . !I‫@ ا‬. ‫أو‬ . !I‫ ت [ ا‬F ‫ ا‬0 /0 cephalexin ‫ـ‬0‫ زي ا‬5 ‫ول‬I‫ا‬
; /L
‫ ر‬O 0‫ ا‬. /B ‫ن‬I ‫ت‬ ٨ ! ‫أو‬ ١٢ ! 5 F ‫ ء‬L@0‫ ر وا‬O 0‫@ ا‬. S / ‫ش‬-. ‫ ن‬B!‫*و‬
. ‫ ا‬B0‫ ا‬98 'v ( G ; !‫أو ا‬ ١٢ ? / ‫ ء‬L@0‫وا‬

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