‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬

sysTemic DrUgs ‫اﻷدوﯾﺔ اﻟﺟﮭﺎزﯾﺔ‬

Drugs acting on Gastro-Intestinal-Tract (G.I.T)
‫*اﻟﺗرﻛﯾب اﻟﻠﺗﺷرﯾﺣﻲ ؟؟‬
‫*اﻟوظﺎﺋف اﻟﻔﺳﯾوﻟوﺟﯾﺔ؟؟‬
Drugs:

1-Antacides :
Antacides are the agents that neutralize excess gastric acid and lower
the acidity to provide relief from pain.

.HCL ‫ھﻲ ﻗﻠوﯾﺎت ﺿﻌﯾﻔﺔ ﯾﺗم إﺳﺗﺧداﻣﮭﺎ ﻓﻰ ﺣﺎﻟﺔ زﯾﺎدة اﻟﺣﻣض اﻟﻣﻌدى‬

‫؟؟‬HCL ‫*اﻟوظﺎﺋف اﻟﻔﺳﯾوﻟوﺟﯾﺔ ل‬

*Antacids are not longer prescribed for treating ulcers because of their
following limitations:

-large doses are required, frequent administration is

necessary,Inconvenient, Rebound acidity, bowel upset, Poor patient
compliance.

# Indication:

Dyspepsia & Reflux

*Symptoms & signs??:

=dyspepsia: pain,fullness, early satiety and nausea.

1
- Causes: gastric and duodenal ulceration and gastric cancer, but most
commonly it is of no origin.

= GOR(Gastro-oesophageal Reflux): associated with heart burn, acid

regurgitation and dyspepsia, oesophagitis, ulceration.

# Contra-Indication:

Neonates, children less than 12 years, hypophosphataemia,patients

suffering from oedema and heart failure specially antacids sodium
containing, patients with renal impairment should not be given antacids
containing magnesium or alumonium.

# Side effects:

Diarrhoea(mg2+ salts), Constipation(Al3+ salts)

= Types of antacids:

1- Systemic or absorbable antacids:??

2- Non systemic or non absorbable antacids:??

=Drugs:

1-Alumonium hydroxide

2-Magnesium hydroxide

3-Magnesium carbonate

4-Magnesium tri silicate

5-Sodium carbonate

6-Magaldrate 7-Calcium carbonate

2
‫??‪*Combination antacids:‬‬

‫*ﻣﻼﺣظﺎت‪:‬‬
‫‪-1‬ﺣﺎﻻت ﻋﺳر اﻟﮭﺿم واﻷﻣراض اﻹرﺗﺟﺎﻋﯾﺔ ﻓﻲ اﻟﻐﺎﻟب ﺗﺻﺎﺣب ﺑﻧﻔﺎخ؛ ﻟذﻟك ﺗﺿﺎف ﻣﺎدة‬
‫ﻣزﯾﻠﺔ ﻟﻠﻧﻔﺎخ )ﻣﺿﺎدة ﻟﻺﻧﺗﻔﺎخ( ﻟﮭذه اﻷدوﯾﺔ‪.‬‬
‫‪-2‬ﯾﻔﺿل ان ﻻ ﺗؤﺧذ ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ﻣﺗزاﻣﻧﺔ ﻣﻊ ﺑﻌض اﻷدوﯾﺔ‪،‬‬
‫ﻣﺛل‪,Ciprofloxacin,Tetracyclines:‬؛ ﻷﻧﮭﺎ ﺗؤﺛر ﻓﻰ إﻣﺗﺻﺎص ﺗﻠك اﻷدوﯾﺔ‪.‬‬

‫‪ -3‬ﻟﺗﻘﻠﯾل اﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ وزﯾﺎدة اﻟﻔﻌﺎﻟﯾﺔ ﯾﺗم اﻟﺟﻣﻊ ﺑﯾن أﻛﺛر ﻣن ﻗﻠوي ﻓﻰ ﺷﻛل ﺻﯾدﻻﻧﻰ واﺣد‬
‫‪،‬ﺣﯾث أن أﻣﻼح اﻷﻟﻣوﻧﯾوم وﺣدھﺎ ﺗؤدي إﻟﻰ إﻣﺳﺎك؛ﺑﯾﻧﻣﺎ أﻣﻼح اﻟﻣﺎﻏﻧﯾزﯾوم ﺗؤدي إﻟﻰ إﺳﮭﺎل‪.‬‬
‫‪ #‬أھم اﻷﺳﻣﺎء اﻟﺗﺟﺎرﯾﺔ واﻷﺷﻛﺎل اﻟﺻﯾدﻻﻧﯾﺔ‪:‬‬
‫‪Maalus,Amigel,Sigel,Trisil,Actnorm,Antacid mixture‬‬

‫‪= Susspension, chewable tabs‬‬

‫*ﻣزﯾﻼت اﻟﻧﻔﺎخ‪:‬‬
‫‪: Simethicone-‬ﯾوﺟد ﻣﻊ ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ﻓﻰ ﺷﻛل ‪ ،combination‬أو ﻟوﺣده‬
‫ﺑﺎﻷﺳﻣﺎء اﻟﺗﺟﺎرﯾﺔ اﻟﺗﺎﻟﯾﺔ‪:‬‬
‫‪Diflat,Disflatydil,Flatydil,Gazix‬‬

‫‪Chewable tabs or oral drops‬‬

‫?? ‪*Acicone-s‬‬

‫‪-‬اﻟﻔﺣم اﻟﻧﺷط )اﻟﻛرﺑون(‬

‫ﯾﺳﺗﺧدم ﻓﻰ ﺣﺎﻟﺔ اﻟﺗﺳﻣم ﻛﻣﺎدة ﻣﻣﺗزة )إدﻣﺻﺎص( ‪– adsorption‬وﻣطﮭرة ﻟﻠﺟﮭﺎز اﻟﮭﺿﻣﻰ‪-‬‬
‫وﻣﺿﺎد ﻟﻠﻐﺎزات)اﻹﻧﺗﻔﺎخ(‪Eucarbon chewable tabs.‬‬

‫‪3‬‬
2-Anti-secritory drugs:
-HCL, Histamine, Pepsin

A. H₂-Receptors antagonists:

*These are the drugs that effectively block the actions of histamine.

# Indication: benign gastric & duodenal ulceration/ reflux oesophagitis/

to prevent aspiration of gastric fluids/ as adjuncts in the treatment of
urticaria, if H₁ antihistamines alone are found to be ineffective.

# Cautions: renal impairment/ pregnancy/ breast feeding

# Side effects: diarrhea/ altered liver function tests/ headache/

dizziness/ confusion/ depression/ hallucination in elderly/
gynaecomastia and impotence.

= Drugs:

Generic name Trade name Dosage form

1-Cimitidine Duodin,Tagamet,Cimet Tabs.200mg,400mg-
Inj.200mg/2ml
2-Famotidine Famodar Tabs.20mg,40mg
3-Ranitidine Rancid,Zantac,Ranzol Tabs.150mg,300mg-
Inj.50mg/2ml
4-Nizatidine AXID Tabs.150mg,300mg

*NB: Interaction of Cimitidine: Warfarin, phenytoin, theophylline,

nifedipine,Metronidazole,phenobarbitone.

4
B. Proton Pump Inhibitors: PPIs

# Indication: gastric & duodenal ulcers (they are the drugs of choice),
GOR , H.pylori & NSAIDs associated ulcers, prophylaxis of acid
aspiration due to general anaesthesia.

# Contra-indication: hypersensitivity,hypocalcaemia,patients with

compromised hepatic function.

# Caution: liver disease/ pregnancy /breast feeding.

# Side effects: NVD,abdominal pain, headache, dizziness, dry mouth,

blurred vision.

= Drugs:

Generic name Trade name Dosage form

1-Omeprazole Omiz,Ocid,Oprazole,Omyl, Tabs.20mg,40mg,-
Lokit,Risk,Amiprazole,Lomac Caps.20mg-
Inj.40mg
2-Pantoprazole Pantodac,Proton,Perloc Tabs.20mg,40mg-
Inj.40mg
3-Lansoprazole Lanso,Amilans,Lancid,Lansofast Caps.15mg,30mg
4-Esomeprazole Protas,Nexium,Nexus,Esomezal Tabs.20mg,40mg-
Inj.40mg
5-Rabeprazole Rabemac,Pariet Tabs.10mg,20mg

*NB: Omiz Plus caps. 20mg, 40mg = Omeprazole+Sodium bicarbonate

5
‫‪3- Treatment of Ulcer:‬‬
‫‪# Defensive mechanism:‬‬ ‫‪# Aggrassive factors:‬‬

‫‪1-Mucous membrane‬‬ ‫‪1-HCl‬‬

‫‪2-Bicarbonate‬‬ ‫‪2-Pepsin‬‬

‫)‪3-Prostaglandine (PGE₂‬‬ ‫‪3-H.pylori‬‬

‫*أھم أﺳﺑﺎب اﻟﻘرﺣﺔ؟؟‬

‫‪ %80-‬ﻣن اﻟﺗﻘرﺣﺎت ﺗﺻﺎﺣﺑﮭﺎ إﺻﺎﺑﺔ ﺑﺎﻟﺑﻛﺗﯾرﯾﺎ‬

‫‪-‬وﺟد أﻧﮫ ﻣن ﻣﺳﺑﺑﺎت اﻟﻘرﺣﺔ ﻋﻣوﻣﺎ‪،‬اﻟﺿﻐط اﻟﻧﻔﺳﻰ اﻟذى ﯾؤدى إﻟﻰ إﻓراز اﻟﺣﻣض اﻟﻣﻌدي‬
‫‪-‬اﻹﺳﺗﺧدام اﻟﻣﻔرط واﻟﻣطول ﻟﻣﺿﺎدات اﻹﻟﺗﮭﺎب ﻏﯾر اﻹﺳﺗﯾروﯾدﯾﺔ‬
‫‪-‬أورام اﻟﻣﻌدة= زﯾﺎدة اﻓراز اﻟﺣﻣض‬
‫‪-‬اﻟﺗدﺧﯾن‪ ،‬ﺗﻧﺎول اﻟﻛﺣول‪ ،‬اﻟﻌﻼج اﻹﺷﻌﺎﺋﻰ‪....‬‬
‫*أﻋراض وﻋﻼﻣﺎت اﻟﻘرﺣﺔ‪:‬‬
‫‪-1‬أﻟم وﺣرﻗﺎن ﻓﻰ اﻟﺑطن‬

‫‪-2‬إﻧﺗﻔﺎخ ﻓﻰ اﻟﺑطن‬

‫‪-3‬ﻗﺊ وﻏﺛﯾﺎن ﺧﺎﺻﺔ ﻓﻰ اﻟﻣﺳﺎء = ﻗﺊ ﻣدﻣم‬

‫‪-4‬ﻓﻘدان اﻟﺷﮭﯾﺔ وﺑﺎﻟﺗﺎﻟﻰ ﻓﻘدان اﻟوزن‬

‫‪-5‬ﺑراز أﺳود‬

‫*اﻟﻣﺿﺎﻋﻔﺎت؟؟‬
‫‪-‬ﻧزﯾف وﺑﺎﻟﺗﺎﻟﻰ ﻓﻘر دم‪،‬دوﺧﺔ وﻓﻘدان اﻟوزن‬
‫‪-‬ﺛﻘب ﺟدار اﻟﻣﻌدة أو اﻹﻣﻌﺎء وﯾﺗﻣﯾز ﺑﺎﻷﻟم اﻟﺣﺎد‬

‫‪6‬‬
 ‫ ﺣﻣﻰ وأﻟم‬:‫إﻟﺗﮭﺎب اﻟﺑرﯾﺗون‬-
‫ وﯾﺗﻣﯾز‬،‫اﻧﺳداد ﻓﺗﺣﺔ اﻟﻣﻌدة اﻟﻰ اﻹﻣﻌﺎء ﻧﺗﯾﺟﺔ ﻟﻠﺗورم ﺣول اﻟﻘرﺣﺔ ﻣﻣﺎ ﯾﻣﻧﻊ ﻣرور اﻟطﻌﺎم‬-
.‫ﺑﺎﻟﻘﺊ‬
I.B.S/Ulcer (benign,cancer)‫*اﻟﺗﺷﺧﯾص واﻟﺗﺷﺧﯾص اﻟﺗﻔرﯾﻘﻰ ؟؟‬
:‫* اﻟﻌﻼج‬
(‫اﻟﺦ‬...‫ﺿﻐوطﺎت‬،‫ﺗﻐﯾﯾر ﻧﻣط اﻟﺣﯾﺎة )أﻛل‬-1

‫اﻹﺑﺗﻌﺎد ﻋن اﻟﻣﮭﯾﺟﺎت واﻟﻣﺛﯾرات‬-2

.(‫إﺳﺗﺧدام اﻷدوﯾﺔ )اﻟﻌﻼج اﻟﺛﻼﺛﻰ‬-3

Treatment:

1.Acid suppressant + anti bacterial

Acid suppressant Amoxicillin Clarithromycin Metronidazole

Omeprazole 500mg TDS/ 250- 500mg BDS 250- 500mg TDS
20mg ODS/BDs 1gm BDS

2. Cytoprotective agent:

A- Sucralfate = susp, 1g. It forms white yellowish viscous sticky gel

( on acidic media) that protect the ulcer.

B- PGE₂ = Misoprostol , Tabs. 200 mcg

-Use: peptic ulcer

-Mechanism of action: Increase mucous secretion, Increase

bicarbonate, decrease acid secretion.

-Side effects: Uterine Contraction. -Contra-indications: Pregnancy.

7
 4- Anti-spasmodics:
-Indication: GIT muscle spasm / colic.

-Contra-indication: myasthenia gravis, paralytic ileus, pyloric stenosis

and prostatic enlargement.

-Side effects: constipation, urine retention, dry mouth, flushing and dry
skin, glaucoma and confusion in elderly.

Drugs:

Group name Generic name Trade name Dosage form

Anti- muscarnic Atropine Spasmocin Inj.0.6mg/ml,E/D.
0.5%, 1%
Anti- muscarinic Hyoscine butyl Buscopan, Scopinal Tabs.10mg, Syr.5mg,
bromide Inj 20mg, 0.125mg
Prifinium bromide Riabal Tabs.30mg, oral
drop.7.5mg/5ml,
Inj.15mg/2ml
Mebeverine Duspatalin, Tabs.135mg,
Duspain, Caps.200mg
Verine,Spasmotalin

*Propantheline??

*Hyoscyamine??

8
5-Emetics & Anti-emetics drugs:
-Emesis or vomiting: it is defined as the forcefull expulsion of the
contents of stomach and proximal part of small intestine through the
oesophagus by mouth and sometimes also by nose.

-Emesis is often preceded by nausea, which is a sensation or a feeling of

an urge to vomit and excessive secretion of sweat, saliva, and bronchial
fluid.

= emetics?? Are the drugs which are used to produce vomiting by

stimulating the vomiting center via (CTZ).

Emetics are mainly useful to treat poisoning caused due to the

ingestion of toxic substances, they should be administrated carefully
with proper therapeutic drug monitoring , they must be use only when
gastric lavage is not possible.

Drugs: -Morphine,Apomorphine inj 5mg/ml, Hypertonic Nacl solution,

etc…

=Anti-emetics: are the drugs which are used to control emesis or

vomiting.

Common causes of vomiting:

1-Cancer chemotherapy

2-Side effect of some drugs

3-General anaesthesia

4-GIT infections

5-Early pregnancy 6-Mountain/ motion sickness.

9
 Drugs:

Group Generic name Trade name Dosage form

1-Anti-histamines 1.Promethazine Phenergan,Promegan, Tabs.25mg,
Histazine, Inj.50mg/2ml
Syr.5mg/5ml

= 2.Cinnarizine Stugeron, Cinnaron Tabs.25mg,75mg

Caps.75mg
2-Phenothiazines 1.Chlorpromazine Largectil Tabs.25mg,50mg,
100mg
= 2.Prochlorperazine Stematil, Stabil Tabs-syr 5mg
3-D-antagonist 1.Metoclopramide Pasperon Tabs.10mg-Inj-syr
= 2. Domperidone Zydom- Tabs.10mg,
10,Motilat,Vomlux, syr 5mg/5ml
Prokinin
4- 5HT3 1.Ondansetron Ondal ,Vomiz Tabs.4mg,8mg.
antagonists Inj.8/4ml
5- Vit. 1. Vit.B₆ Tabs- Inj. 40mg
Vit + anti- 2.Vit.B₆+Meclizine Vominor,Vomizal, Tabs. 50+25 mg
histamine Avonil,Navoproxin.
*Dexamethasone, Haloperidol ??

6- Anti-diarrhoeal drugs:
-Diarrhoea is frequent passage of liquid faeces.

-Contra-indications: children and antibiotic-associated colitis.

= Causes , Types( severity-causes) and compilacation of diarrhoea??

‫* اﻟﻔﻛرة اﻟﻌﺎﻣﺔ ﻟﻌﻼج اﻹﺳﮭﺎل؟؟‬

‫اﻟﺦ‬...(‫ﻧﺷوﯾﺎت‬/‫اﻟﺗﻐذﯾﺔ اﻟﺟﯾدة)ﺑروﺗﯾﻧﺎت‬،‫إﻋﺎدة اﻟﺗروﯾﺔ‬-

10
*infectious diarrhoea:

-Metronidazole,Ciprofloxcin,Doxycyclin,Azithromycin??

Drugs:

Group Generic name Trade name Dosage form

Opioid Codiene / Morphine ?? ??
Lopramide Imodium,Lopracima Tabs,Caps.2mg
Diphenoxylate+Atropine Diaxine, Motilex Tabs.2.5+0.025
mg

*ORS / Zinc sulphate /I.V Infusion ??

7- laxatives:
-laxatives are drugs promote the evacuation of the bowel. they either
hasten the passage of stools or reduce their consistency.

-Purgatives or cathartics: are the drugs which exhibit very strong action.
they promote complete evacuation of bowel along whith excess of
fluids. these are generally used for cleaning the colon before
endoscopy, abdominal surgery or X-ray.

=magnesium sulphate,magnesium hydroxide,sodium sulphate,sodium

phosphate,senna,cascara,aloe,castor oil, sodium picosulphate,
bisacodyl,phenolphthalein.

-Constipation: is the passage of hard stools less frequently or decrease

in the frequency of evacuation of normal stool, less than three times
per week. It generally occurs due to the impairment in the normal
functioning of colon or large intestine.

11
Uses of laxatives:

1-treatment of constipation

2-for cleaning the G.I.T prior to surgery or diagnosis

3- to treat poisoning or over dose of drugs

4-to promote bowel evacuation in bedridden patients

5-to prevent unnecessary strain and pressure in patients suffering from

cardiovascular diseases,hernia, and haemorrhoids.

Drugs:

a. Osmotic laxatives:

Increase the water content of the faeces.

1- Lactulose syr: Duphalac, Hilac, Sedalac. Bottle & Sachet

2-Glycerine Supp ( Adult 1.47g, Pediatric )

3-Sodium salt rectal enema , enemax- Microenema

b.Stimulant Laxatives:

:‫ وﺑﺎﻟﺗﺎﻟﻰ ﻣن أھم آﺛﺎرھﺎ اﻟﺟﺎﻧﺑﯾﺔ‬Increase Peristalsis.،‫ﺗزﯾد ﻣن اﻟﺣرﻛﺔ اﻟدودﯾﺔ ﻟﻺﻣﻌﺎء‬

.‫ﺗﺳﺑب ﻣﻐص ﺷدﯾد ﻟﺑﻌض اﻟﻣرﺿﻰ‬
1-Bisacodyl : Laxin,Lax-tab,Novolux = Tabs: 5,10mg.

2-Castor oil

3-Senna tab

4-Aleo

5-Cascara

12
 c-Bulk forming laxatives:

Increase the volume of non absorbable solid residue.

-Dietary Fibers : e.g Grain,Fruits,Vegetable.

-Normacol. Sachets

-Hashimi spaghole sachets

-Fiber plus ??

-Greeny ??

d- Faecal softeners:

-Liquid Paraffin

e- mg so₄= Laxofen??

8- Drugs for Irritable Bowel Syndrome ( I.B.S):

*Diagnosis, differential diagnosis, Treatment ??

Drugs:

Generic name Trade name Dosage form

1-Chlordiazepoxide +Clidinium bromide Librax ,Bralix ,Epirex Tabs. 5+2.5mg
2- Chlordiazepoxide +Propantheline Medospas Caps. 4+10mg
bromide
3- Chlordiazepoxide +Amitriptyline Hayapoxide Tabs. 12.5+5mg
4- Diazepam + Clidinium bromide Distedon Tabs. 2+2.5mg
5- Mebeverine ?? ??

*Deanexit ??

13
9- Anti- Haemorrhoidal drugs:
Usually contain: steroids (Anti-inflammatory) e.g ,Triamcinolone – local
anaesthetic e.g , lidocaine and soothing agent e.g ,menthol.

.‫*إذا ﻛﺎﻧت اﻟﺑواﺳﯾر ﺗﺣﺗوي ﻋﻠﻰ دم ﯾﻌطﻰ اﻟﻣرﯾض ﻣﺿﺎد ﺣﯾوى ﺛم ﻣﺳﺗﺣﺿرات اﻟﺑواﺳﯾر‬
.‫*اﻟﻣرأة اﻟﺣﺎﻣل ﻣن اﻷﺣﺳن ﺗﺗﺟﻧب اﻟﻣﺳﺗﺣﺿرات اﻟﺗﻰ ﺗﺣﺗوى ﻋﻠﻰ اﻹﺳﺗﯾروﯾد‬
-Haemoproct oint – supp

-Proctoheal oin - supp

-Xyloproct , Sedoproct-s, Lignopanthene.

*Sealar ??

*Home work: Daflon Tabs. 500mg

10- Appetite Stimulans and Suppressants :??

a-Alcohol,Megestrol,Dexamethasone..etc.
b-Amphetamine,Methylcellulose…etc.

11-Digestants and Enzymes:

-Omizyme, Greenzyme, Zymogen.

‫ﺗم ﺑﺣﻣد ﷲ‬

‫ﻋﻴﺴﻰ ﻋﻠﻰ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻰ‬.‫ د‬/‫إﻋﺪاد‬

14
‫‪Drugs acting on Cardiovascular System ( C.V.S ):‬‬
‫= اﻟﻘﻠب ‪ +‬اﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ ‪ +‬اﻟدم‬ ‫*اﻟﺗرﻛﯾب اﻟﺗﺷرﯾﺣﻲ ؟؟‬
‫*اﻟوظﺎﺋف اﻟﻔﺳﯾوﻟوﺟﯾﺔ؟؟‬

‫‪1. Anti-Hypertensive drugs:‬‬

‫*إرﺗﻔﺎع ﺿﻐط اﻟدم‪ : Hypertension ( HTN )/High Blood pressure :‬ﺣﺳب ﺗﻌرﯾف‬
‫ﻣﻧظﻣﺔ اﻟﺻﺣﺔ اﻟﻌﺎﻟﻣﯾﺔ ‪:WHO‬‬

‫ﻓﺈن اﻟﺷﺧص ﯾﻌﺗﺑر ﻣرﯾﺿﺎ ﺑﺈرﺗﻔﺎع ﻓﻲ ﺿﻐط اﻟدم؛ إذا ﻣﺎ وﺻل ﺿﻐطﮫ اﻹﻧﻘﺑﺎﺿﻰ‪Systolic‬‬
‫إﻟﻰ ‪150‬ﻣﻠم‪/‬زﺋﺑق أو أﻛﺛر‪ ،‬واﻟﺿﻐط اﻻﻧﺑﺳﺎطﻰ‪ diastolic‬إﻟﻰ ‪ 95‬ﻓﺄﻛﺛر )ﻣﻊ وﺿﻊ اﻟﻌﻣر ﻓﻰ‬
‫اﻹﻋﺗﺑﺎر(‪.‬‬
‫وﻟﻛن ﻣن اﻟﻣﺗﻌﺎرف ﻋﻠﯾﮫ أن زﯾﺎدة ﺿﻐط اﻟدم اﻹﻧﺑﺳﺎطﻰ ﻋن ‪ 100‬ﯾﻘﺗﺿﻰ اﻟﺑﺣث واﻟﺗدﻗﯾق‬
‫وﯾﻠزم إﺳﺗﻌﻣﺎل اﻷدوﯾﺔ اﻟﻣﻌﺎﻟﺟﺔ ﻟﮭذا اﻹرﺗﻔﺎع‪.‬‬
‫*اﻟﻌواﻣل اﻟﺗﻰ ﺗؤﺛر ﻋﻠﻰ ﺿﻐط اﻟدم‪:‬‬
‫‪ -3‬اﻟﮭﺿم‬ ‫‪ -2‬اﻟﻠﯾل واﻟﻧﮭﺎر‬ ‫‪ -1‬اﻟﻌﻣر‬

‫‪ -4‬اﻟﻌواطف ﺧﺎﺻﺔ اﻟﻌواطف اﻟﺟﯾﺎﺷﺔ‪ ،‬ﻣﺛل‪ :‬اﻟﻔرح أو اﻟزﻋل اﻟﺷدﯾدﯾن أو اﻟﻣﻔﺎﺟﺋﯾن‬

‫‪-5‬اﻟﻧوم‬

‫‪-6‬اﻟوﺿﻊ ‪ :Posture‬اﻟﺿﻐط اﻹﻧﺑﺳﺎطﻰ أﻋﻠﻰ ﻓﻰ وﺿﻊ اﻹﻧﺳﺎن اﻟواﻗف ﻋﻧﮫ أﺛﻧﺎء اﻟﺟﻠوس‬
‫وأﻗل ﻣﺎ ﯾﻣﻛن أﺛﻧﺎء اﻟﻧوم ؛ أﻣﺎ ﺑﺎﻟﻧﺳﺑﺔ ﻟﻠﺿﻐط اﻹﻧﻘﺑﺎﺿﻰ ﻓﺈﻧﮫ ﻻ ﯾﺗﺄﺛر ﺑﺎﻟوﺿﻊ‪.‬‬
‫*اﻟﻌواﻣل اﻟﺗﻰ ﺗزﯾد ﻣن إرﺗﻔﺎع ﺿﻐط اﻟدم‪) :‬ﻋواﻣل ﻣﮭﯾﺋﺔ(‬
‫‪ -1‬ﻋواﻣل وراﺛﯾﺔ‪ :‬ﺗﺎرﯾﺦ اﻟﻣرض ﻓﻰ اﻟﻌﺎﺋﻠﺔ‪ ،‬اﻟﺟﻧس‪ ،‬اﻟﺗﻘدم ﻓﻰ اﻟﻌﻣر‪ ،‬اﻟﻣﻛﺎن اﻟﺟﻐراﻓﻰ‪.‬‬

‫‪ -2‬ﻋواﻣل ﺛﺎﻧوﯾﺔ‪ :‬اﻟﺳﻣﻧﺔ‪ ،‬اﻟﺿﻐط اﻟﻧﻔﺳﻰ‪ ،‬ﻗﻠﺔ اﻟﺗﻣﺎرﯾن‪ ،‬زﯾﺎدة اﻟزﯾوت اﻟﺛﻼﺛﯾﺔ ﻓﻰ اﻟﺟﺳم‪.‬‬

‫‪ -3‬ﻋواﻣل أﺳﺎﺳﯾﺔ‪ :‬زﯾﺎدة اﻟﻛوﻟﯾﺳﺗرول‪ ،‬اﻟﺳﻛرى‪ ،‬اﻟﺗدﺧﯾن‪.‬‬

‫‪15‬‬
*Types of Hypertension (HTN):

# According to the causes:

- primary hypertension:‫ﯾرﺗﻔﻊ اﻟﺿﻐط ﻣن دون ﻣرض أو ﺳﺑب ﻋﺿوي ظﺎھري‬

- Secondary HTN :‫ﻣﺷﺎﻛل‬،‫ﯾرﺗﻔﻊ اﻟﺿﻐط ﺑﺳﺑب ﻧوع ﻣن اﻷﻣراض)ﻓﺷل ﻛﻠوى‬
.‫ اﻟﺳﻛرى( أو ﺑﺳﺑب ﻧوع ﻣن اﻟﻌﻼﺟﺎت‬،‫اﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ‬
# According to severity:

- Mild HTN
- Moderate HTN
- Severe HTN
 Normal Blood pressure (B.P) = 120/80
 Complications: stroke, coronary events, heart failure, and renal
impairment.
 Treatment:

-Non drug therapy=life style changes: smoking cessation, wt

reduction, exercise, reduction of dietary salt and fats.

-Drug therapy: aiming at systolic ≤ 130 mm/Hg and diastolic =80-

90 mm/Hg.

16
 1.1- ACEIs (Angiotensin Converting Enzyme Inhibitors):

-Indications: hypertension, heart failure, diabetic nephropathy.

-Contra-indications: hypersensitivity, pregnancy.

-Side effects: hypotension, renal impairment, persistant dry

cough, hyperkalaemia, hypoglycaemia, N,V,D.

-Drugs:

Generic name Trade name Dosage form

Captopril Capoten Tabs.12.5mg-25mg-50mg
Lisinopril Zestril,Zinopril,linopril,Azapril Tabs.2.5mg-5mg-10m-20mg
Enalapril Enam Tabs.5mg-10mg-20mg
Ramipril Ramiril Caps.2.5mg-5mg-10mg

1.2- Angiotensin-II receptors antagonists:

-Indications: hypertension, heart failure, diabetic nephropathy.

- Contra-indications: pregnancy, breast feeding.

- Side effects: hypotension, dizziness, hyperkalaemia.

17
 -Drugs:

Generic name Trade name Dosage form

1/ Losartan Loscar,Cozal,Amilosan Tabs.25mg-50mg-100mg

-Losartan potassium+ Loscar-H Tabs.50mg+12.5mg

hydrochlorothiazide
2/ Valsartan Diovan,Tabuvan Tabs.80mg-160mg-320mg

- Valsartan+ Co-Diovan,Co-tabuvan Tabs.80mg+12.5mg-

hydrochlorothiazide 160mg+12.5mg-
160mg+25mg-
320mg+12.5mg-
320mg+25mg.
3/ Candesartan Atacand,Candestan Tabs.8mg-16mg-32mg.

- Candesartan+ Atacand plus Tabs.16mg+12.5mg.

hydrochlorothiazide

1.3-Beta-blockers:

-Indications: HTN, angina, MI, arrhythmias, heart failure, and

thyrotoxicosis.

-Contra-indications: hypotension, asthma, bradycardia.

-Side effects: hypotension, bradycardia, bronchospasm, dizziness,

fatigue, sexual disfunction, sleep disturbance.

18
-Drugs:

Generic name Trade name Dosage form

Propranolol Inderal,Cimadral Tabs. 10mg- 40mg

Atenolol Atenozal,Totamol,Amitenol Tabs. 50mg- 100mg

Bisoprolol Amicor, Cardex, Bisocard, Tabs. 2.5mg-5mg-

B-cor 10mg
Carvedilol Dilatrend Tabs. 6.25mg-
12.5mg- 25mg

*Apimol®, Xolamol®,Timodor® Xola®, Betoptic® ??

1.4- calcium channel blockers:

-Indications: HTN, angina prophylaxis.

-Contra-indications: unstable angina, breast feeding.

-Side effects: hypotension, bradycardia, headache, dizziness, oedema,

N,V,D.

19
-Drugs:

Generic name Trade name Dosage form

Amlodipine Amlodac,Amilo,Nordip,Lopine,Lotens Tabs.5mg-10mg

Nifedipine Adalat,Nifelat Tabs.10mg-20mg,

SR 20mg
Diltiazem Diltiaz Tabs.60mg-
SR 90mg
Verapamil Caveril Tabs. 40mg-80mg

-Exphorge ?? -Lotevan plus ??

1.5- Centrally acting:

-Indications: HTN, and hypertension with pregnancy.

-Contra-indication: depression, active liver disease.

-Side effects: postural hypotension, dizziness, oedema, headache,

sedation, bradycardia, impotence and gynaecomastia.

-Drugs:

1-Methyldopa : Aldomet Tabs. 250 mg

2-Clonidine ??

20
1.6- Alpha-blockers:

-Indications: HTN, benign prostatic enlargement.

-Contra-indication: HF

-Side effects: N,V,D, postural hypotension, dizziness, oedema,

headache, sleep disturbance.

-Drugs:

1- Doxazosin = Curicard®, Cardiosyr®, prosta® = Tabs. 1mg-2mg-4mg.

2- Prazosin = Minipress®, alpha-press® = Caps. 1mg-2mg-5mg.

3- Alfuzosin = Uritab XL® Tabs. 5mg, 10mg.

4- Tamsulin = Omni cocas® = Tabs. 0.4mg

‫ وﻛذﻟك ﯾﻣﻛن أن ﯾﺳﺗﺧدم‬،‫ﯾﻌﺗﺑرأﻓﺿل ﻣن اﻷدوﯾﺔ اﻟﺳﺎﺑﻘﺔ ﻓﻰ ﻣﻌﺎﻟﺟﺔ ﺗﺿﺧم اﻟﺑروﺳﺗﺎت‬

.‫ﻟﻠﺗﺧﻠص ﻣن ﺣﺻوات اﻟﻛﻠﻲ‬
5- Yohimbine = Yocon®= Tabs. 5mg

1.7- Direct Vasodilators:

-Indications: hypertensive emergency.

-Contra-indications: myocardial insufficiency, pregnancy and breast

feeding.

-Side effects: N,V,D, hypotension, tachycardia, dizziness, fatigue,

palpitation, sodium and water retention.

21
-Drugs:

Generic name Trade name Dosage form

Hydralazine Apresoline Tabs.10,25,50,100mg, -
Inj 20mg
Diazoxide 15mg/ml,300mg/20ml.
Sodium nitroprusside Pruside,Nipride Inj 50mg
Minoxidil Minoxidine,Hair grow, Tabs.2.5mg,5mg,10mg-
Hair gain Sol 2%, 5%

*Topical minoxidil is now used as a stimulant to hair growth for

correction of baldness.

1.8- Diuratics:

a.Thiazides:

-Indications: HTN, CHF.

-Contra-indications: hypokalaemia, hyponatraemia, hyperurcaemia

and hypercalcaemia.

-Side effects: postural hypotension, hypokalaemia, hyponatraemia,

hyperurcaemia, gout, blood disorders and impotence.

-Drugs:

Generic name Trade name Dosage form

Hydrochlorothiazide Esidrex, Modrex Tabs.25mg-50mg
Indapamide Natrilix Tabs.2.5mg-1.5mg SR
Chlorthalidone Hygruton Tabs. 50mg

22
 b- Loop diuretics:

-Indications: Pulmonary oedema, CHF.

-Contra-indications: hypovolaemia, dehydration, severe hypokalaemia,

severe hyponatraemia, and coma associated with liver disease.

-Side effects: hypotension, GIT disturbances, hypokalaemia,

hyponatraemia, hyperglycaemia, hyperurcaemia, gout and blood
disorders.

-Drugs:

 Furosemide sodium = Lasix- Tabs 40mg, Inj 20mg

c-Potassium sparing diuretics:

- Indications: ascites caused by liver cirrhosis, congestive heart failure.

- Contra-indications: hyperkalaemia, hyponatraemia.

- Side effects: GIT disturbances, hyperkalaemia,impotence,

gynaecomastia, menstrual irregularities.

-Drugs:

Generic name Trade name Dosage form

Spironolactone Aldacton,Spirolon Tabs.25mg-50mg-
100mg
Amiloride Midamor Tabs. 5mg
*Amiloride+Hydrochlorothiazide = Uniretic= Tabs. 5mg+50mg

*KCL= Slow-K ?? Tabs. 600mg, Inj 15%.

*Cardiac glycosides (Digitalis) = Digoxin, Digitoxin??

23
d- Osmotic diuretics:

-Indications: cerebral oedema.

-Contra-indications: pulmonary oedema and congestive heart failure.

-Side effects: chills and fever.

-Drugs:

 Mannitol IV infusion 10% ,20%.

*C.A.Is:

-Acetazolamide = Diamox Tabs. 250mg ??.

2. Anti-Coagulants:

2.1- Injectables anti-coagulants:

-Indications: Deep venous thrombosis (DVT), Pulmonary embolism, MI,

haemodialysis, bedridden patients for long time.

-Contra-indications: haemophilia, haemorrhage, severe hypertension,

peptic ulcer, severe liver disease and thrombocytopenia.

-Side effects: bleeding, thrombocytopenia, Osteoprosis, alopecia.

24
 -Drugs:

Generic name Trade name Dosage form

Heparin Inj.5000 IU/ml-25000IU/5ml

Enoxaparin Clexane 2000 IU-4000 IU-6000 IU-

8000 IU-10000 IU.
Tinzaparin Na⁺ Innohep 3,500 IU-4,500 IU- 10000 IU-
18000 IU.
*NB: Protamine sulphate is used for overdose of heparin.

2.2- Oral anti-coagulants:

- Indications: Deep venous thrombosis (DVT), Pulmonary embolism,

Prothetic heart valves.

- Contra-indications: Pregnancy, peptic ulcer, severe HTN.

-Side effects: N.V.D, bleeding, hypersensitivity, rash, alopecia.

-Drugs:

 Warfarin = Warf Tabs. 1mg,3mg,5mg.

*NB: Vit k is used for overdose of warfarin.

* Tranixamic acid = Co-agulant ‫ﻣوﻗف ﻟﻠﻧزﯾف‬

.‫ﺷﻛل ﻣن أﺷﻛﺎل اﻷﺣﻣﺎض اﻷﻣﯾﻧﯾﺔ ﯾﺳﻣﻰ ﻻﯾﺳﯾن‬

‫ ﻧزﯾف اﻟدورة اﻟﺷﮭرﯾﺔ‬،‫ اﻟﻧزﯾف اﻟﺣﺎد ﺧﻼل أو ﺑﻌد ﻋﻣﻠﯾﺎت إزاﻟﺔ اﻟﺑروﺳﺗﺎت‬:‫ﯾﺳﺗﻌﻣل ﻓﻰ‬
‫ ﺣﺎﻻت وﺟود اﻟدم ﻓﻰ‬،‫ ﻋﻣﻠﯾﺎت اﻷﺳﻧﺎن ﻓﻰ ﻣرﺿﻰ اﻟﮭﯾﻣوﻓﯾﻠﯾﺎ‬،‫ ﻧزﯾف اﻷﻧف اﻟﺣﺎد‬،‫اﻟﺣﺎد‬
.‫ إﻧﺧﻔﺎض وظﺎﺋف اﻟﻛﻠﻰ‬،‫اﻟﺑول‬

* Coumarins ‫ اﻟﻜﻮﻣﺎرﻳﻨﺎت‬:‫واﺟﺐ ﻣﻨﺰﻟﻰ‬

25
 2.3- Anti-platelets:

- Indications: Prophylaxis of cerebro-vascular disease, MI.

- Contra-indications: peptic ulcer, pregnancy,haemophilia,

active bleeding, breast feeding.

-Side effects: bleeding, gastric ulcer.

-Drugs:

Generic name Trade name Dosage form

Acetyl Salisylic Acid Aspirin,Ascard,Amicardin,Cafalgin Tabs.75mg-81mg-

100mg-300mg
Clopidogrel Plagrine,Plavix,Pedovix,Hivix Tabs. 75mg

Dipyridamole Persantin Tabs. 75mg

3. Ischaemic Heart Disease ( I H D ):

a.Angina b.Myocardial infarction ( MI )

* Treatment of angina:

- Life style changes.

- S/L glyceryl trinitrate.

- Aspirin 75mg/day.

- Beta-blockers, Ca⁺⁺ channel blockers, Sta ns.

26
 * Management of MI:

Short term treatment:

- Oxygen
- Morphine
- Aspirin
- Beta-blockers
- ACEIs
- Thrombolytic agents
- Nitrates
Long term treatment:
- Aspirin/Clopidogrel/Warfarin
- Beta-blockers
- ACEIs
- Verapamil
- Nitrates / Statins

*Nitrates:

‫ وﯾﺗم إﻣﺗﺻﺎﺻﮭﺎ ﺳرﯾﻌﺎ‬S/L ‫ وﺗﻌطﻰ‬،‫ﺗﺳﺗﻌﻣل ﻟﻣﻌﺎﻟﺟﺔ اﻷﻟم اﻟﺣﺎد اﻟﻧﺎﺗﺞ ﻋن اﻟذﺑﺣﺔ اﻟﺻدرﯾﺔ‬
‫ دﻗﺎﺋق ﺗﺻل ﻣﻛﺎن اﻟﺗﺄﺛﯾر وﺗﻌطﻰ ﻣﻔﻌوﻟﮭﺎ؛ وذﻟك ﺑﺗوﺳﯾﻊ اﻟﺷراﯾﯾن واﻷوردة‬10-5 ‫ﺧﻼل‬
‫ وﯾﻣﻛن إﻋطﺎﺋﮭﺎ ﻋن طرﯾق ﻟﺻﻘﺎت ﺗوﺿﻊ ﻓﻰ اﻟﺟﮭﺔ اﻟﯾﺳرى ﺣﯾث ﺗﻣﺗص ﻋن طرﯾق‬، ‫اﻟﻘﻠﺑﯾﺔ‬
.‫اﻟﺟﻠد وﺗﺻل اﻟﻘﻠب وﺗﻌطﻰ وﻗﺎﯾﺔ ﻟﯾوم ﻛﺎﻣل‬
-Indications: Prophylaxis and treatment of angina.

-Contra-indications: hypotension, hypovolaemia.

-Side effects: postural hypotension, Tachycardia, dizziness,

throbbing headache (severe headache), N,V.

27
 -Drugs:

Generic name Trade name Dosage form

Glyceryl trinitrate=GTN=Nitroglycerine Myonit S/L Tabs.0.5mg-

Inj.5,10mg-spray-
Plaster-Oint.
Iso-sorbide di nitrate Isordil,Isorem Tabs.5mg,10mg,20mg
.
Iso-sorbide mono nitrate Monis,Monomak Tabs.20mg,40mg,
60mg.

.‫*اﻟﻌﻘﺎر اﻷول ھو اﻟدواء اﻟﻣﻔﺿل وﯾﺳﺗﺧدم ﻟﻠذﺑﺣﺔ اﻟﺣﺎدة‬

.‫ ﺳﺎﻋﺎت‬8-6 ‫ ﺳﺎﻋﺔ وﯾﺳﺗﻣر اﻟﻣﻔﻌول‬3-2 ‫*اﻟﻌﻘﺎر اﻟﺛﺎﻧﻰ ﯾﺑدأ ﻣﻔﻌوﻟﮫ ﺑﻌد‬

*Fibrinolytic drugs:

-Indications: acute MI, DVT, pulmonary embolism.

-Contra-indications: haemorrhage, trauma or surgery, peptic ulcer,

severe HTN, oesophageal varices and pancreatitis.

-Side effects: N,V, bleeding, hypotension, allergy.

-Drugs:

 Streptokinase Inj 750,000 IU – 1500,000 IU.

4. Lipid Lowering drugs = Lipid Regulating drugs = Anti-

hyperlipidaemic =Anti-dyslipidaemic:

4.1- Statins:

*the drug of choice.

28
- Indications: coronary artery disease, cardiovascular disease, and
hypercholestrolaemia.

- Contra-indications: active liver disease, pregnancy, breast feeding.

- Side effects: N,V,D, dizziness, insomnia, altered liver function tests.

- Drugs:

Generic name Trade name Dosage form

Atorvastatin Atorva,Atorvazal,Amistatin Tabs.10mg-20mg-40mg.
Simvastatin Simvas,Stavine Tabs.10mg-20mg.
Pravastatin Pravecor Tabs.10mg-20mg-40mg.
Rosuvastatin Rovista,Ivarin Tabs. 5mg-10mg-20mg.

4.2- Fibrates:

- decrease serum TG.

- Indications: hyperlipidaemia.

- Contra-indications: severe hepatic and renal impairment, pregnancy

and breast feeding.

- Side effects: renal impairment, dizziness, headache.

- Drugs:

 Gemfibrozil = Lopid® Tabs. 300mg-600mg.

‫ﺗﻢ ﺑﺤﻤﺪ اﷲ‬

‫ﻋﻴﺴﻰ ﻋﻠﻰ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻰ‬.‫ د‬/‫إﻋﺪاد‬

29
Drugs acting on Respiratory system:
‫اﻟﺘﺮﻛﯿﺐ اﻟﺘﺸﺮﯾﺤﻰ واﻟﻮظﺎﺋﻒ اﻟﻔﺴﯿﻮﻟﻮﺟﯿﺔ ؟؟‬
1. Anti-asthmatic:
1.1-Bronchodilaters:
‫ھﻲ ﻣرﻛﺑﺎت ﺗوﺳﻊ اﻟﺷﻌب اﻟﮭواﺋﯾﺔ ﻣﻣﺎ ﯾؤدى إﻟﻰ إﻧﺧﻔﺎض اﻟﻣﻘﺎوﻣﺔ ﺿد اﻟﮭواء وزﯾﺎدة ﺗدﻓﻘﮫ‬
.‫إﻟﻰ اﻟرﺋﺗﯾن‬
1.1.a- ß₂-agonists: there are two categories of ß₂-agonists used in
asthma:

-short acting: produces immediate bronchodilation e.g Salbutamol.

-Long acting: used for prophylaxis e.g Salmeterol.

- Side effects: fine tremor, headache, palpitation, tachycardia,

hypotension.

-Drugs:

Generic name Trade name Dosage form

Salbutamol Vental,Ventolin,Asthalin Tabs.2mg,4mg- syr

2mg/5ml-Sol.0.5%-
inhaler.100mcg/dose.
Terbutaline Aironyl, Bronclyn Tabs.2.5mg,125mg-
syr.1.5mg/5ml,0.3mg/ml
Inj. 1mg/ml
Salmetrol Servent Inhaler 25mcg/dose

Formoterol Inhaler 4.5mcg/dose,

9mcg/dose

30
 Salbutamol solution:

-Adult= 2cc x 4cc water every 1/3 hrs.

-child= 1-0.5cc x 4cc water every 1/3 hrs.

1.1.b- Anti-Muscarinic:

-Indications: short term for chronic asthma, chronic obstructive

pulmonary disease (COPD).

-Side effects: dry mouth, nausea, headache, tachycardia, palpitation,

urine retention, constipation.

-Drugs:

Generic name Trade name Dosage form

Ipratropium bromide Atropulm,Ipravent Inhaler.200mcg/dose

*Ipratropium bromide + Salbutamol sulphate= Combivent=

inhaler(120mcg+21mcg)/dose.

1.1.C- Methyl Xanthines:

* They are a class of drugs derived from the purine base xantthine.

- Indications: acute severe asthma, treatment of airways obstruction.

- Side effects: tachycardia, palpitation, nausea, headache, insomnia,

arrhythmia.

* Caffeine, Theobromine ??

31
 - Drugs:

Generic name Trade name Dosage form

Theophylline Theophyl, Theo SR Tabs.200mg,300mg SR-

Caps.100mg SR,200mg
SR,300mg SR.
Aminophylline Inj. 250mg/10ml,25mg/ml

1.2- Corticosteroids: *anti-inflammatory.

- Indications: Prophylaxis of asthma, acute severe asthma.

- Side effects: peptic ulcer, acute pancreatitis, immuno suppression,

osteoporosis, tendon rupture, weight gain, cushing’s syndrome,
glaucoma, cataract.

- Drugs:

Generic name Trade name Dosage form

Hydrocortisone Hydrocort Tabs.10mg- inj.100mg

Beclomethasone Beclosone,Beclate Inhaler.50mcg/dose,100mcg/dose,250mcg/

dose
Budesonide Pulmicort, Turbuhaler 200mcg/dose, 400mcg/dose
Rhinocort,Resata N.spray 32mcg/dose,64mcg/dose,100mcg/
dose
Fluticasone Flixotide Inhaler.50mcg/dose,125mcg/dose,250mcg/
dose
Mometasone Tabunex Inhaler- Sol.0.1%- N.spray 50mcg/dose.

32
 1.3- Compound Drugs:

- Beta₂ agonists + Corticosteroids

- Drugs:

Generic name Trade name Dosage form

Fluticasone+Salmetrol Sertide Inhaler.(50mcg+100mcg)/dose

(50mcg+250mcg)/dose
Budesonide+Formoterol Symbicort Turbohaler.(80mcg+4.5mcg)/dose
(160mcg+4.5mcg)/dose
Formoterol+ Budesonide Formonide Inhaler. (6mcg+100mcg)/dose
(6mcg+200mcg)/dose

1.4- Cromoglycate:

- Indications: prophylaxis of asthma, allergic conjunctivitis, allergic

rhinitis.

- Side effects: Cough, throat irritation.

- Drugs:

Generic name Trade name Dosage form

Sodium cromoglycate Apicrom, Nasotal N/D-E/D 2%,4%-
Inhaler.

*Home work:

- Oxymetazoline, Xylometazoline, Naphazoline, Tetrahydrozoline ??

33
 2. Anti-histamines:

- Indications: allergy ( nasal, eye, skin), Cold, Some are anti-emetics.

- Side effects: headache, dry mouth, urine retention, blurred vision,

palpitation, hypotension, Sedating anti-histamines my cause
sedation, drowsiness.

- Drugs:

* NB:- H₂-receptors antagonists ??

- Adrenaline inj 1mg/ml??

2.1- Sedating anti-histamines (first generation of anti-histamines):

Generic name Trade name Dosage form

Chlorpheniramine maleate Antestin,Histop,Amihistin Tabs.4mg-syr.2mg/5ml-

inj.10mg
Ketotifen Zaditen,Profilar,Ketofen Tabs.1mg-syr.1mg/5ml-
Noxtor E/D. E/D. 0.025%
Clemastine Tavegyl Tabs.1mg

Promethazine ?? ??

*NB: Diphenhydramine – Meclizine – Triprolidine - Cyproheptadine.??

34
2.2- Non sedating anti-histamines:

Generic name Trade name Dosage form

Cetirizine Allercet,Finalerg,Alatrol Tabs.10mg (o.n)

Loratidine Restamine,Oradine,Zylorate Tabs.10mg (o.n)

Levocetirizine Levohist Tabs. 5mg

*NB: Betaserc,Lavistina, Ebastil, Antelukast, (Montiget),

Fexofenadine. ??

3. Decongestants:

They are may be taken orally or used directly in the nose or eye for a
local effect, to relieve congestion by reducing swelling, inflammation
and mucous formation.

- Indications: conditions associated with nasal or eye congestion

e.g:(hay fever, cold, flu, sinusitis, rhinitis or allergies).

- Side effects: increase in BP, rebound congestion when it,s used regular
and long term (more than 5 days), stimulates Heart rate and C.N.S

- Drugs:

Oxymetazoline, Xylometazoline, Naphazoline, Tetrahydrozoline,

Ephedrine,Pseudoephedrine,Phenyl ephrine.

35
4. Mucolytics:

Are the agents which decrease the viscosity of sputum and thereby
facilitate its removal from the repiratory tract either by ciliary action or
by coughing.

- Indications: as mucolytic expectorants in the treatment of cough,

treatment of paracetamol toxicity(N-Acetylcysteine), treatment of
dry eyes (Medically referred as keratoconjunctivitis sica).
- Contra-indications: breast feeding, active peptic ulceration.
- Side effects: N,V,D, gastric irritation, stomatitis, rhinorrhoea,
bronchospasm.

- Drugs:

Generic name Trade name Dosage form

Ambroxol Ambolar,Mucoram,Mucosolvan Tabs.30mg-

syr.15mg/5ml-
Caps.75mg
Bromhexine Mucolan,Muconab,Solvexin Tabs.4mg,8mg-
syr.4mg/5ml- oral drop
2mg/ml

36
5. Cough Preparations:

4.1- Anti-tussive = Cough Suppressants = Cough Sedatives

- Use : Dry cough.

- Drugs:

Generic name Trade name Dosage form

Dextromethorphan Amylin DM,Unifed DM Syr 10mg

*Opioid drugs: Morphine,Codiene..??

4.2- Expectorants:

- Use : Productive cough.

- Drugs:

Generic name Trade name Dosage form

Ammonium chloride Histalix-Amylin Exp. Syr
Ipecacuanha Broncholase Syr
Guaiphensine Unifed Exp. Syr
Simple linctus Fast Syr
*Prospan,Zecuf,Miniguava,Bulsam??

*Menthol ??

4.3- Expectorant + Anti-tussive :

- Drugs:

* Bronchopan,Tussilar,Pulmocar,Isilin..

37
* NB:

Cough syrups contains: Anti-cough + Anti-histamines ( e.g:

Diphenhydramine,Chlorpheniramine,Triprolidine) + Decongestants (
e.g: Ephedrine,Pseudoephedrine,Phenyl ephrine).

6. Cold Preparations (Rhinitis):

‫ﻧزﻻت اﻟﺑرد ﻏﺎﻟﺑﯾﺗﮭﺎ إﺻﺎﺑﺎت ﻓﯾروﺳﯾﺔ وﺑﺎﻟﺗﺎﻟﻰ ﻻ ﺗﺳﺗﺟﯾب ﻟﻠﻣﺿﺎدات اﻟﺣﯾوﯾﺔ؛ ﻓﻌﻠﻰ اﻟﻣرﯾض‬
:‫إﺗﺑﺎع اﻵﺗﻰ‬
‫ واﻟﻔﺎﯾﺗﻣﯾﻧﺎت)ﻟدﻋم ﺟﮭﺎز‬،(‫ﺷرب ﻛﻣﯾﺎت ﻛﺎﻓﯾﺔ ﻣن اﻟﺳواﺋل )ﻟﻔﻘدان اﻟﺳواﺋل ﻣﻊ اﻟرﺷﺢ‬-1
.(‫اﻟﻣﻧﺎﻋﺔ‬
.‫ أﺧذ اﻟراﺣﺔ اﻟﺗﺎﻣﺔ واﻟﺗﻐذﯾﺔ اﻟﺟﯾدة‬-2

.‫ ﻋﻼج أﻋراض اﻟزﻛﺎم ﺑﺎﺳﺗﺧدام أدوﯾﺔ ﻧزﻻت اﻟﺑرد واﻟﺗﻰ ﺳﺗرد ذﻛرھﺎ ﻻﺣﻘﺎ‬-3

‫ إﻻ إذا ﻛﺎﻧت ھﻧﺎﻟك إﺻﺎﺑﺔ ﺑﻛﺗﯾرﯾﺔ ﺛﺎﻧوﯾﺔ وذﻟك ﺑﻣﻘﺎﺑﻠﺔ‬، ‫ ﻻ ﯾﺄﺧذ اﻟﻣرﯾض أي ﻣﺿﺎد ﺣﯾوي‬-4
‫اﻟطﺑﯾب واﻟﻔﺣص اﻟﻣﻌﻣﻠﻰ وﻋﻣل زراﻋﺔ ﻟﻠﺑﻛﺗﯾرﯾﺎ وإﺧﺗﺑﺎر اﻟﺣﺳﺎﺳﯾﺔ ﺣﺗﻰ ﯾﺗم إﺧﺗﯾﺎر اﻟﻣﺿﺎد‬
.‫اﻟﻣﻧﺎﺳب‬

 Cold Preparations contains: Paracetamol + Anti-histamines ( e.g:

Diphenhydramine,Chlorpheniramine,Triprolidine) +
Decongestants ( e.g: Ephedrine,Pseudoephedrine,Phenyl ephrine).
 Trade names : Flutab tab, Sedophan tab-syr, Trifed tab, Trifed plus
tab-syr,Noflu tab, amidol cold&flu tab, cityflu tab, unifed syr,
Flutab sinus tab,Eliflu,….etc.

‫ﺗﻢ ﺑﺤﻤﺪ اﷲ‬

‫ﻋﻴﺴﻰ ﻋﻠﻰ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻰ‬.‫ د‬/‫إﻋﺪاد‬

38
 ‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬

‫اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ ‪*Nervous System :‬‬

‫ھو اﻟﺟﮭﺎز اﻟذي ﯾﺗﺣﻛم ﻋﻠﻲ اﻟﺟﺳم وﯾﻧﻘﺳم اﻟﻲ ‪:‬‬

‫‪ -1‬ﺟﮭﺎز ﻋﺻﺑﻲ ﻣرﻛزي )‪ (C.N.S‬وھو اﻟذي ﯾﺗﺣﻛم ﻓﻲ اﻟﻌﺿﻼت واﻻطراف ﻛﺎﻻﯾدي واﻻرﺟل‬
‫وﯾﺿم اﻟدﻣﺎغ واﻟﻧﺧﺎع اﻟﻣﺳﺗطﯾل واﻟﺣﺑل اﻟﺷوﻛﻲ‬
‫اﻟدﻣﺎغ ﯾﻠﻌب دور رﺋﯾﺳﻲ ﻓﻲ اﻟﺳﯾطره ﻋﻠﻲ ﻣﻌظم وظﺎﺋف اﻟﺟﺳم ﺑﻣﺎ ﻓﻲ ذاﻟك اﻟوﻋﻲ واﻻدراك‬
‫واﻻﺣﺎﺳﯾس واﻻﻓﻛﺎر واﻟﻛﻼم واﻟذاﻛره ‪.‬‬
‫‪ -2‬ﺟﮭﺎز ﻋﺻﺑﻲ طرﻓﻲ ) ‪ (P.N.S‬وﯾﺿم اﻻﻋﺻﺎب اﻟطرﻓﯾﮫ‬
‫اﯾﺿﺎ ھﻧﺎﻟك ﺗﻘﺳﯾم ﻟﻠﺟﮭﺎز اﻟﻌﺻﺑﻲ ‪:‬‬
‫‪ -1‬ﺟﮭﺎز ﻋﺻﺑﻲ ارادي و ﯾﺗﺣﻛم ﻓﻲ اﻟﺣرﻛﺎت اﻻرادﯾﮫ ﻣﺛل ‪ :‬رﻓﻊ اﻟﯾد او اﻻرﺟل او اﻻﻟﺗﻔﺎت‬
‫‪.....‬اﻟﺦ‬
‫‪ -2‬ﺟﮭﺎز ﻋﺻﺑﻲ ﻻ ارادي)ﺗﻠﻘﺎﺋﻰ( ‪ :‬ھو اﻟذي ﯾﺳﯾطر ﻋﻠﻲ ﺑﻌض اﻋﺿﺎء اﻟﺟﺳم اﻟﺗﻲ ﺗﻌﻣل ﺗﻠﻘﺎﺋﯾﺎ‬
‫دون ﺗدﺧل اﻟﻛﺎﺋن اﻟﺣﻲ ﻓﻲ وظﺎﺋﻔﮭﺎ ﻣﺛل ‪) :‬اﻟﻘﻠب ‪ ،‬اﻟﻣﻌده ‪ ،‬اﻻﻣﻌﺎء ‪ ،‬اﻟرﺋﺗﯾن ‪،‬اﻻوﻋﯾﮫ اﻟدﻣوﯾﮫ‬
‫‪....‬اﻟﺦ( ‪ :‬وﯾﺿم ‪:‬اﻟﺟﮭﺎز اﻟودي واﻟﺟﮭﺎز اﻻودي‬
‫‪ ‬اﻟﻧواﻗل اﻟﻌﺻﺑﯾﺔ ‪ Neurotransmitters:‬؟؟‬
‫‪ ‬اھم اﺿطراﺑﺎت اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ‬
‫‪ -1‬اﻟﻘﻠق‬
‫‪ -2‬اﻻﻛﺗﺋﺎب‬
‫‪ -3‬اﻟذھﺎن‬
‫‪ -4‬اﻟﺻداع‬
‫‪ -5‬اﻟﺷﻠل اﻟرﻋﺎﺷﻲ‬
‫‪ -6‬اﻟزھﺎﯾﻣر ‪ -7‬اﻟﺻرع‪.‬‬

‫ﺗﻧﻘﺳم ادوﯾﮫ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي اﻟﻲ ‪:‬‬

‫أ‪ -‬ﻣﻧﺑﮭﺎت ال ‪ :C.N.S‬ﻣﺛل اﻟﻛﺎﻓﯾﯾن واﻟﻛوﻛﺎﯾﯾن ‪ ،‬وﻓﻲ اﻟﻐﺎﻟب ﻻ ﻧﺣﺗﺎج اﻟﻲ ﺗﻧﺑﯾﮫ اﻟﺟﮭﺎز‬
‫اﻟﻌﺻﺑﻲ اﻻ ﻓﻲ ﺑﻌض اﻟﺣﺎﻻت اﻟﺳرﯾرﯾﮫ اﻟﻘﻠﯾﻠﺔ ‪.‬‬
‫ب‪ -‬ﻣﺛﺑطﺎت ال ‪ ، : C.N.S‬وھذه ﺗﺳﺗﺧدم ﻓﻲ اﺿطراﺑﺎت اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي اﻟﻣﺧﺗﻠﻔﮫ‪،‬‬
‫وﻣن أھم آﺛﺎرھﺎ اﻟﺟﺎﻧﺑﯾﺔ‪:‬‬
‫‪ -3‬اﻟﺗﺣﻣل‬ ‫‪ -2‬اﻹدﻣﺎن‬ ‫‪ -1‬اﻟﺗﻌود)اﻻﻋﺗﻣﺎد(‬

‫‪39‬‬
 ‫‪ ‬اﻟﻘﻠق ‪: Anxiety‬‬

‫ھو اﺣﺳﺎس ﯾﻧﺗﺎب ﻛل اﻟﺑﺷر ﻓﻲ ﻟﺣظﺎت ﻣﻌﯾﻧﮫ ‪ ،‬وھو ﯾﺳﺎﻋد اﻻﻧﺳﺎن وﯾﻘوم ﺑﺗﮭﯾﺋﺗﮫ ﻟﻣواﺟﮭﺔ‬
‫اﻟﺗﻐﯾﯾر او اﻟﺧﺑرات اﻟﺟدﯾده ﻓﻲ اﻟﺣﯾﺎة او اﻟﻣﺟﮭول ﻋﻣوﻣﺎ ‪.‬‬

‫وھو ﻋﺑﺎره ﻋن اﺣﺳﺎس ﻏﺎﻣض ﻏﯾر ﻣرﯾﺢ وﯾﻛون ﻣﺻﺣوﺑﺎ ﺑزﯾﺎدة ﻧﺷﺎط اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ‬
‫)اﻟﻌﺎطﻔﻲ اﻟودي( ﻣﻣﺎ ﯾﻧﺗﺞ ﻋﻧﮫ‪:‬‬

‫اﻟﺗﻌرق ‪ ،‬اﻟﺻداع ‪ ،‬ﺗﺳﺎرع ﺿرﺑﺎت اﻟﻘﻠب ‪ ،‬ﺿﯾق ﻓﻲ اﻟﺻدر واﻟﻣﻌده ‪ ،‬واﯾﺿﺎ ﯾﻛون‬
‫ورﺟﻔﮫ ﻓﻲ‬ ‫ﻣﺻﺣوب ﺑﺎﻻﺳﮭﺎل واﻻﺣﺳﺎس ﺑﺎﻟدوﺧﮫ ‪ ،‬ﺗوﺳﯾﻊ ﺣدﻗﺔ اﻟﻌﯾن‬
‫اﻷطراف‪)).‬اﻻدرﯾﻧﺎﻟﯾن ((‬

‫‪ #‬ﯾﺧﺗﻠف اﻟﻘﻠق ﻋن اﻟﺧوف ﻓﻰ ان اﺳﺑﺎﺑﮫ داﺧﻠﯾﮫ وﻏﯾر واﺿﺣﮫ ‪،‬ﻋﻠﻲ ﻋﻛس اﻟﺧوف ‪.‬‬

‫‪ ‬اﻻﺳﺑﺎب اﻟﻌﺿوﯾﮫ ﻟﻠﻘﻠق ‪:‬‬

‫اﺿطراﺑﺎت اﻟﻐدد‪ :‬اﻟدرﻗﯾﮫ ‪ ،‬اﻟﻛظرﯾﮫ ‪ ،‬اﻟﻧﺧﺎﻣﯾﮫ‬ ‫‪-1‬‬
‫ﻧﻘص اﻟﺳﻛر‬ ‫‪-2‬‬
‫اﻟﺳرطﺎﻧﺎت اﻟﻣﺧﺗﻠﻔﮫ )اﻻﻣراض(‬ ‫‪-3‬‬
‫اﻻﻟﺗﮭﺎب اﻟدﻣﺎﻏﯾﮫ‬ ‫‪-4‬‬
‫اﺧﺗﻼل ﻧﺳﺑﺔ اﻟﻌﻧﺎﺻر اﻟﺿرورﯾﮫ ﻟﻠﺟﺳم‬ ‫‪-5‬‬
‫اﻟﻘﻠق اﻟﻧﺎﺗﺞ ﻋن اﻟﻌﻘﺎﻗﯾر اﻟطﺑﯾﮫ‬ ‫‪-6‬‬

‫*اﻟﻘﻠق اﻟﻧﺎﺗﺞ ﻋن اﻟﻌﻘﺎﻗﯾر اﻟطﺑﯾﮫ‪:‬‬

‫‪ .1‬اﺳﺗﺧدام ﻣﻧﺑﮭﺎت ال ‪ C.N.S‬ﻣﺛل ‪ :‬اﻟﻛﺎﻓﯾﯾن – اﻟﻛوﻛﺎﯾﯾن –اﺗروﺑﯾن‬

‫‪ .2‬اﻟﻣﺧدرات‬
‫‪ .3‬اﻻﻣﻔﺗﻣﯾن = ﯾؤدي اﻟﻰ ‪Euphoria‬‬

‫‪ ‬اﻻدﻣﺎن ‪ /‬اﻻﻋﺗﻣﺎد ‪Addiction/ Dependance‬‬

‫ھو اﻟﺗﻌود ﻋﻠﻲ ﺗﻌﺎطﻲ ﻣﺎدة ﻣﻌﯾﻧﮫ ﺗؤﺛر ﻋﻠﻲ اﻟﻌﻘل او اﻟﻣزاج ﻣﻊ اﻟرﻏﺑﮫ اﻟﻣﻠﺣﮫ ﻟﻠﻌوده ﻟﺗﻌﺎطﻲ ﺗﻠك اﻟﻣﺎده‬
‫ﻟﻼﺳﺗﻣﺗﺎع ﺑﺎﻻﺛر اﻟذي ﺗﺣدﺛﮫ ﻋﻠﯾﮫ ‪ ،‬وﺑﺎ ﺳﺗﻣرار اﻟﺗﻌﺎطﻲ ﯾزﯾد اﻟﺗﺣﻣل ‪.‬‬

‫‪40‬‬
 ‫‪ ‬اﻟﺗﺣﻣل ‪Tolerance :‬‬

‫ھو ان ﺗﺻﺑﺢ اﻟﻛﻣﯾﮫ اﻟﻣﺣدودة ﻣن اﻟﻣﺎدة ﻏﯾر ﻛﺎﻓﯾﮫ ﻻﺣداث اﻻﺛر اﻟﻣطﻠوب ﻣﻣﺎ ﯾﺗطﻠب زﯾﺎدة اﻟﺟرﻋﮫ‬
‫ﻻﺣداث اﻻﺛر او ﺗﻌﺎطﻲ ﻣﺎدة اﺧري اﻛﺛر ﻓﻌﺎﻟﯾﮫ ‪.‬‬

‫‪ #‬اﻧواع اﻻدﻣﺎن ‪:‬‬

‫ادﻣﺎن ﻧﻔﺳﻲ ‪ :‬ھو ﺗﻌود ﻧﻔﺳﻲ ﻋﻠﻲ ﺷﺊ او ﻣﺎده ﻣﻌﯾﻧﮫ ﻣﻊ ﺻﻌوﺑﺔ اﻟﺗﺧﻠص ﻋﻧﮭﺎ‪ ،‬وﻋدم ﺗﻌﺎطﻲ‬ ‫‪-1‬‬
‫اﻟﻣﺎده ﻻﯾﺣدث اﻋراض اﻧﺳﺣﺎﺑﯾﮫ‬
‫إدﻣﺎن ﻓﺳﯾوﻟوﺟﻲ ‪ :‬وﻓﻲ ھذه اﻟﺣﺎﻟﮫ ﺗﺣدث اﻋراض اﻧﺳﺣﺎﺑﯾﮫ ‪، withdrawal symptoms‬ﻓﻲ‬ ‫‪-2‬‬
‫ﺣﺎﻟﺔ اﻟﺗوﻗف ﻋن ﺗﻌﺎطﻲ اﻟﻣﺎدة اﻟﻣﻌﯾﻧﮫ‬
‫‪ ‬اﺳﺑﺎب اﻻدﻣﺎن‬
‫ﺿﻌف اﻟوازع اﻟدﯾﻧﻲ‬ ‫‪-1‬‬
‫اﻟﺗﻔﻛك اﻻﺳري واﻻﺟﺗﻣﺎﻋﻲ‬ ‫‪-2‬‬
‫اﻟﻌطﺎﻟﮫ‬ ‫‪-3‬‬
‫اﻻﺿطراﺑﺎت اﻟﻧﻔﺳﯾﮫ ﻣﺛل ‪ :‬اﻟﻘﻠق واﻻﻛﺗﺋﺎب واﺿطراﺑﺎت اﻟﻧوم واﻧﻔﺻﺎم اﻟﺷﺧﺻﯾﮫ‬ ‫‪-4‬‬
‫اﺧطﺎء طﺑﯾﮫ‬ ‫‪-5‬‬

‫)‪Drugs acting on Central Nervous System (C.N.S‬‬

‫‪1- Sedatives – Hypnotics‬‬

‫‪A: Sedatives (Anxiolytics):‬‬

‫ﺗﺳﺗﺧدم ﻣﺟﻣوﻋﮫ ‪ Benzodiazepines‬ﻻﺣداث اﻟﺗﮭدﺋﮫ ﻓﻰ ﺑﺎدئ اﻷﻣر وﺑﻌد ﺳﻧوات ﻣن ظﮭورھﺎ ﺗﺑﯾن أﻧﮫ‬
‫ﯾﻣﻛن إﺳﺗﺧداﻣﮭﺎ ﻛﻣﻧوﻣﺎت ‪ ،‬ﺣﯾث ﺟﺎءت ﻟﺗﺣل ﻣﺣل أدوﯾﺔ اﻟﺑﺎرﺑﯾﺗﯾورﯾت ﻧﺗﯾﺟﺔ ﻟﻠﻣﺷﻛﻼت اﻟﻧﺎﺟﻣﺔ ﻋﻧﮭﺎ‪،‬‬
‫ﻣﺛل‪ :‬ﺳﮭوﻟﺔ اﻹﻋﺗﻣﺎد ﻋﻠﯾﮭﺎ‪ ،‬وإﻣﻛﺎﻧﯾﺔ إﺳﺗﺧداﻣﮭﺎ ﻓﻰ اﻹﻧﺗﺣﺎر‪.‬‬

‫دواﻋﻲ اﻻﺳﺗﻌﻣﺎل ‪:‬‬ ‫‪‬‬

‫اﻟﻘﻠق اﻟﺣﺎد )اﻟﻌﻘﺎﻗﯾر طوﯾﻠﺔ اﻟﻣﻔﻌول ﻣﻧﮭﺎ( ‪short term for severe anxiety‬‬ ‫‪-1‬‬
‫اﻻرق )اﻟﻌﻘﺎﻗﯾر ﻗﺻﯾرة اﻟﻣﻔﻌول ﻣﻧﮭﺎ( ‪insomnia‬‬ ‫‪-2‬‬
‫اﻟﺻر ع‬ ‫‪-3‬‬
‫ﺗﺷﻧﺟﺎت ‪Febrile convulsions‬‬ ‫‪-4‬‬
‫ﻗﺑل اﻟﻌﻣﻠﯾﺎت اﻟﺟراﺣﯾﮫ ‪Pre-medication‬‬ ‫‪-5‬‬
‫ﻟﺗﻼﻓﻲ اﻷﻋراض اﻻﻧﺳﺣﺎﺑﯾﮫ اﻟﻧﺎﺗﺟﺔ ﻋن ﺗوﻗف ﺗﻌﺎطﻰ اﻟﺧﻣور ‪Alcohol withdrawal‬‬ ‫‪-6‬‬

‫‪41‬‬
 ‫‪ ‬ﻣواﻧﻊ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫اﻟﻔﺷل اﻟﺗﻧﻔﺳﻲ – اﻟوھن اﻟﻌﺿﻠﻲ – اﻧﻘطﺎع اﻟﺗﻧﻔس اﺛﻧﺎء اﻟﻧوم ‪–sleep apnea‬اﻟﻘﺻور اﻟﻛﺑدي اﻟﺣﺎد‬

‫‪ ‬اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ ‪:‬‬

‫دوﺧﮫ – ﺻداع – ارﺗﺑﺎك – ﺗرﻧﺢ ‪ -‬ﺗﻌود وإدﻣﺎن – اﻋراض اﻧﺳﺣﺎﺑﯾﮫ – اﻧﺧﻔﺎض ﺿﻐط اﻟدم ‪.‬‬

‫اﻻدوﯾﮫ‬

‫‪Diazepam -1‬‬
‫‪Ropam® – Valium®= Tabs 5mg -10mg , Inj‬‬ ‫‪10 mg .‬‬
‫‪Lorazepam -2‬‬

‫‪Lorans®= Tabs 1mg - 2mg.‬‬

‫‪Clonazepam -3‬‬

‫‪Rivotril®= Tabs 0.5 mg -2mg.‬‬

‫‪Bromazepam -4‬‬

‫‪Lexotanil® - Lexilium®= Tabs 1.5mg - 3mg -6mg‬‬

‫‪ :‬ﯾﺳﺗﺧدم ﻟﻠﻣﺻران اﻟﻌﺻﺑﻲ ‪.‬‬

‫‪Chlordiazepoxide ?? -5‬‬

‫‪b.Hypnotics‬‬

‫وﺗﺳﺗﺧدم ھذه اﻟﻣﺟﻣوﻋﮫ ﻻﺣداث اﻟﺗﻧوم‬

‫دواﻋﻲ اﻻﺳﺗﻌﻣﺎل ‪ :‬اﻻرق ) اﺳﺗﺧدام ﻟﻔﺗره ﻗﺻﯾرة (‬

‫ﻣواﻧﻊ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫اﻟﻔﺷل اﻟﺗﻧﻔﺳﻲ – اﻟوھن اﻟﻌﺿﻠﻲ – اﻧﻘطﺎع اﻟﺗﻧﻔس اﺛﻧﺎء اﻟﻧوم – اﻟﻘﺻور اﻟﻛﺑدي اﻟﺣﺎد‬

‫اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ ‪ :‬دوﺧﮫ – ﺻداع – ارﺗﺑﺎك – ﺗرﻧﺦ – ﺗﻌود – اﻋراض اﻧﺳﺣﺎﺑﯾﮫ ‪.‬‬

‫اﻻدوﯾﮫ ‪:‬‬

‫‪Temazepam – Caps 15mg – 30mg‬‬

‫‪42‬‬
 ‫‪2- Barbiturates‬‬

‫دواﻋﻲ اﻻﺳﺗﻌﻣل ‪:‬‬

‫‪ -1‬اﻻرق اﻟﺣﺎد ‪Sever insomnia‬‬

‫‪ -3‬ﻋﻣﻠﯾﺎت اﻟﺗﺧدﯾر اﻟﻌﺎم ﻗﺑل إﺟراء اﻟﻌﻣﻠﯾﺎت اﻟﺟراﺣﯾﺔ‪.‬‬ ‫‪ -2‬اﻟﺻرع‬

‫ﻣواﻧﻊ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫اﻟﺳﮭر ﺑﺳﺑب اﻻﻟم – اﻟﻘﺻور اﻟﻛﺑدي اﻟﺣﺎد – ﺗﻧﺎول اﻟﻛﺣول أوﺳوء إﺳﺗﻌﻣﺎل اﻷدوﯾﺔ ‪– Drug abuse‬‬
‫اﻟﻣرأة اﻟﺣﺎﻣل – اﻟﻣرأة اﻟﻣرﺿﻊ‪.‬‬

‫اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ ‪:‬‬

‫دوﺧﮫ – ﺗرﻧﺢ – اﻟﻔﺷل اﻟﺗﻧﻔﺳﻲ – ارﺗﺑﺎك‬

‫اﻻدوﯾﮫ ‪:‬‬

‫‪Phenobarbiton -1‬‬

‫اﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ ‪Tabs 30 mg :‬‬

‫‪3-Anti – depressants:‬‬

‫وﺗﺳﺗﺧدم ﻟﻌﻼج اﻟﻣﺷﺎﻋر اﻟﺳﻠﺑﯾﺔ واﻟﺗﻰ ﺗﺗراوح ﺑﯾن ﺗﻌﻛر اﻟﻣزاج‪ ،‬واﻹﻛﺗﺋﺎب اﻟﻣﺻﺣوب ﺑﻣﯾول إﻧﺗﺣﺎرﯾﺔ‪.‬‬

‫دواﻋﻲ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫اﻻﻛﺗﺋﺎب ‪ –depression‬اﻟﺗﺑول اﻟﻼ ارادي ‪ – nocturnal enuresis‬ﻋﻼج اﻟوﺳواس اﻟﻘﮭري‬

‫ﻣواﻧﻊ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫ﻓرط اﻟﺣﺳﺎﺳﯾﮫ‬

‫اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ ‪:‬‬

‫ﺧﻔﻘﺎن اﻟﻘﻠب – زﯾﺎدة ﺿرﺑﺎت اﻟﻘﻠب – اﻧﺧﻔﺎض ﺿﻐط اﻟوﺿﻊ – ارﺗﺑﺎك –زﯾﺎدة اﻟوزن‪ -‬ﺗﺄﺛﯾر ﻣﮭدئ‪-‬‬
‫ﺗﺄﺛﯾرات ﺗﺷﺑﮫ اﻷﺗروﺑﯾن؟؟‬

‫‪43‬‬
 : ‫اﻻدوﯾﮫ‬

Tri – Cyclic Anti – Depressant ‫ ﻣﺿﺎدات اﻻﻛﺗﺋﺎب ﺛﻼﺛﯾﮫ اﻟﺣﻠﻘﮫ‬:A

Imipramine -1

Tofranil ® Tabs 25mg

Clomipramine -2

Anafranil ® Tabs 10mg, 25 mg , 50 mg , 75mg SR, Inj

Amitriptyline -3

Amirol® , Amiram® , Tryptizol®= Tabs 25 mg , 10 mg

(MAOIs) Monoamine Oxidase Inhibitors:B

Phenelzine ??

‫ھرﻣوﻧﺎت اﻟﺳﻌﺎده ؟؟‬

(( ‫))ھرﻣوﻧﺎت اﻟﺳﻌﺎدة‬Selective Serotonin Reuptake Inhibitor (SSRIs): C

Citalopram -1

Cipram® – Tabs : 20 mg

Escitalopram -2

Cipralex® – Depralex ®= Tabs 10 mg , 20mg

Fluoxitine -3

-Plazeron® –Prozac®= -Caps 20mg

Sertaline -4

Zoloft®- Lustral® =Tabs. 50mg, 100mg

Paroxetin -5

Xet® = Tabs. 10mg, 20mg

44
 4- Anti – psychotic ‫ﻣﺿﺎدات اﻟذھﺎن‬

: ‫دواﻋﻲ اﻻﺳﺗﻌﻣﺎل‬

Treatment of sever depression-Dementia – schizophrenia- mania ‫اﻟﮭوس‬

: ‫اﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ‬

Urine ‫– اﻟﻌﺟز اﻟﺟﻧﺳﻲ – ﻋﺳر اﻟﺣرﻛﮫ – ﺗﺷﻧﺟﺎت – ﺣﺑس ﺑول‬Amenorrhoea ‫اﻧﻘطﺎع اﻟطﻣث‬
Retension

: ‫اﻻدوﯾﮫ‬

Group Generi name Trade nam Dosig form

‫ ﻣﺷﺗﻘﺎت اﻟﻔﯾﻧو ﺛﯾﺎزﯾن‬1-Chlorpromazine Largactil ‫اﻧظر ﻣﺿﺎدات اﻟﻘﺊ‬
Phenothiazines 2-Thioridazine Melleril Tabs 25mg, 50mg
,100mg
3-Fluphenazine Modecate Inj 25 mg /ml
4-Haloperidol Haloxen Tab 0.5mg ,1.5mg
,2mg 5mg ,inj

5-Resperidone Risina,Ridon Tabs 2mg ,3mg

-- ,4mg inj
6-Olanzapine Olan,oleandus Tabs 5mg ,10 mg
7-flopenthixol Fluanxol Tabs 0.5mg , 1mg,
3mg- ing 20mg/ml

*NB:

- Quetiapine ??

45
‫‪5-Anaesthetics‬‬

‫ﺗﺳﺗﺧدم ھذه اﻟﻌﻘﺎرات ﻻﺣداث ﺣﺎﻟﮫ اﻟﺗﺧدﯾر ﻟﺗﻣﻛن اﻟطﺑﯾب ﻣن اﺟراء اﻟﻌﻣﻠﯾﮫ ﺑﺎرﺗﯾﺎح ﻣن ﺟﺎﻧب وﺗﺳﻛﯾن‬
‫وﺗﺧﻔﯾف اﻻﻟم ﻟﻠﻣرﯾض ﻣن ﺟﺎﻧب آﺧر‪.‬‬

‫ﺗﻧﻘﺳم اﻟﻣﺧدرات اﻟﻲ ‪:‬‬

‫‪ -1‬ﻣﺧدرات ﻋﺎﻣﺔ ‪General Anaesthetics,‬‬

‫وھﻲ ﺗؤﺛر ﻋﻠﻲ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي ﻻﺣداث اﻟﺗﺧدﯾر اﻟﻌﺎم ‪ ،‬ﻣﻊ ﻓﻘدان اﻟوﻋﻲ واﻻﺣﺗﻔﺎظ ﺑﺎﻟوظﺎﺋف‬
‫اﻟﺣﯾوﯾﮫ ﻓﻲ اﻟﺟﺳم واﺣﯾﺎﻧﺎ ﺗﺳﺗﺧدم ﻣﻌﮭﺎ ﻣرﺧﯾﺎت اﻟﻌﺿﻼت ‪ Muscle relaxant‬ﻟﺳﮭوﻟﺔ اﺣداث اﻟﻘطﻊ‬
‫اﻟﺟراﺣﻲ ‪.‬‬

‫وھﻲ ﺗﻧﻘﺳم اﻟﻲ ﻗﺳﻣﯾن ﺣﺳب طرﯾﻘﺔ اﻻﻋطﺎء‬

‫أ‪ -‬ﻣﺧدرات ﻋﺎﻣﮫ اﺳﺗﻧﺷﺎﻗﯾﮫ ‪Inhaled General Anaesthetics‬‬

‫ﻣﺛل ‪:‬‬

‫‪1- Nitrous oxide 4-Ether‬‬

‫‪2- Halothane‬‬
‫‪3- Isoflurane‬‬
‫ب‪ -‬ﻣﺧدرات ﻋﺎﻣﮫ ورﯾدﯾﮫ ‪I.V General anaesthetics‬‬
‫‪1- Thiopentane‬‬ ‫‪2- Thiopental sodium inj 0.5g, 1g‬‬
‫‪Inj 500 mg‬‬

‫‪3- Propfol‬‬

‫‪inj – 10 mg / ml‬‬
‫‪- 1%‬‬

‫‪4- Ketamine‬‬

‫‪inj 50 mg‬‬

‫‪46‬‬
 ‫اﻟﻣﺧدرات اﻟﻣوﺿﻌﯾﮫ ‪local Anaesthetics :‬‬

‫وھذه ﺗزﯾل وﺗﺳﻛن اﻻﻟم ﻣوﺿﻌﯾﺎ وﻟﻛﻧﮭﺎ ﻻﺗؤﺛر ﻋﻠﻲ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي وﺑﺎﻟﺗﺎﻟﻲ ﯾﻛون اﻟﻣرﯾض‬
‫واﻋﯾﺎ ‪ .‬وﺗزداد اﻟﻔﻌﺎﻟﯾﺔ ﻣﻊ إﻋطﺎء ﻣﺿﯾﻘﺎت اﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ‪ ،‬ﻣﺛل‪ :‬اﻷدرﯾﻧﺎﻟﯾن‪.‬‬

‫‪-Lidocaine ,Lignocaine, Xylocaine, Cocaine, Procaine..etc‬‬

‫®‪* liocaine‬‬ ‫اﺳﻣﺎء اﻟﺗﺟﺎرﯾﮫ )ﻟﯾدوﻛﺎﯾﯾن(‬

‫اﻻﺷﻛﺎل اﻟﺻﯾدﻻﻧﯾﮫ ‪) :‬ﻟﯾدوﻛﺎﯾﯾن(‬

‫‪- Spray 10 %, oint , jelly 2 % , inj 0.5%, 1%, 2% , 10%‬‬

‫اﻟﺑواﺳﯾر‬ ‫‪‬‬
‫اﻟﻘﺳطره اﻟﺑوﻟﯾﮫ‬ ‫‪‬‬
‫اﻟﺧراج‬ ‫‪‬‬
‫ﻧظﺎﻓﺔ اﻟﺟروح‬ ‫‪‬‬
‫اﻟﺧﺗﺎن‬ ‫‪‬‬

‫‪*Skeletal Muscle Relaxants:‬‬

‫??‪1- Baclofen‬‬
‫??‪2- Chlorzoxasone‬‬

‫‪47‬‬
‫اﻟﻣﺳﻛﻧﺎت اﻷﻓﯾوﻧﯾﺔ )ﻣﺳﻛﻧﺎت ﻣرﻛزﯾﺔ(‪6- Opioid Analgesics‬‬

‫دواﻋﻲ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫‪ -1‬اﻵﻻم اﻟﻣﺗوﺳطﮫ اﻟﻲ اﻟﺣﺎدة‬

‫‪ -2‬ﺑﻌد اﻟﻌﻣﻠﯾﺎت اﻟﺟراﺣﯾﮫ‬
‫‪ -3‬ﺑﻌﺿﮭﺎ ﯾﺳﺗﺧدم ﻟﻼﺳﮭﺎل او اﻟﻛﺣﮫ ) ﻛودﯾﯾن‪ ،‬ﻣورﻓﯾن (‬

‫ﻣواﻧﻊ اﻻﺳﺗﻌﻣﺎل ‪:‬‬

‫‪ -1‬اﻟﻔﺷل اﻟﺗﻧﻔﺳﻲ ‪ -2‬ﺗﻌﺎطﻲ اﻟﻛﺣول )ﻣدﻣﻧﻲ اﻟﻛﺣول( ‪ -3 Acute alcoholism‬إﺻﺎﺑﺎت اﻟرأس ‪.‬‬

‫اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ ‪:‬‬

‫طﻣﺎم – اﺳﺗﻔراغ – اﻣﺳﺎك‬ ‫‪‬‬

‫اﻧﺧﻔﺎض ﺿﻐط اﻟدم – اﻟﻔﺷل اﻟﺗﻧﻔﺳﻲ – دوﺧﮫ‬ ‫‪‬‬
‫ﺟﻔﺎف اﻟﻔم – ﺗﻌرق – ﺻداع – زﯾﺎدة ﺿرﺑﺎت اﻟﻘﻠب‬ ‫‪‬‬
‫ﺧﻔﻘﺎن اﻟﻘﻠب – اﻋﺗﻣﺎد )اﻟﺗﻌود( – ﺗﺣﻣل‬ ‫‪‬‬

‫وﺗﺿم اﻻدوﯾﮫ اﻟﺗﺎﻟﯾﮫ ‪:‬‬

‫‪ :Morphine -1‬ﯾﺳﺗﺧرج ﻣن ﻧﺑﺗﺔ اﻟﺧﺷﺧﺎش‬

‫اﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‪inj 2mg /ml, 5mg/ml :‬‬
‫‪Tabs. 15mg, 30mg, 60mg :Codeine -2‬‬
‫‪ Diamorphine -3‬وﯾﻌرف ب ‪ Heroin‬اﺳم ﺗﺟﺎري ‪ :‬ﺑودرة‬
‫ﯾﻌرف ﺑﺎﻟﺳم اﻷﺣﻣر وھو أﻗوي ﻓﻌﺎﻟﯾﺔ ﻣن اﻟﻣورﻓﯾن ﻓﻰ ﺗﺳﻛﯾن اﻷﻟم ﺑـ‪ 8-4‬ﻣرات‪.‬‬
‫وھو ﻣن أﺧطر اﻟﻣرﻛﺑﺎت اﻟﻣورﻓﯾﻧﯾﺔ اﻟﻣﺣدﺛﺔ ﻟﻺدﻣﺎن ﻓﻰ اﻹﻧﺳﺎن واﻟذي ﯾﺳﺗﻣر ﻟﻌدة أﯾﺎم؛ ﻟذﻟك‬
‫ﯾﺣظر إﺳﺗﺧداﻣﮫ‪.‬‬

‫‪Inj 50 mg /ml‬‬ ‫‪ :Pethidin - 4‬ﯾﺳﺗﺧدم ﻟﻼﻻم اﻟﺣﺎده ﺑﻌد اﻟﻌﻣﻠﯾﺎت اﻟﺟراﺣﯾﮫ‬

‫‪ :Tramadol -5‬ﯾﺳﺗﺧدم ﻻﻻم اﻟﻐﺿﺎرﯾف‬

‫ﺗﺟﺎرﯾﺎ ﯾﻌرف ‪Tarmol‬‬

‫اﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬
‫‪Tabs 100 mg , Caps :50 mg-100mg ,inj 50mg/ml‬‬
‫‪ NB :Naloxone is the antidote for Morphine Overdose‬‬
‫‪ Naltraxone = inj 0.4mg/ml‬‬ ‫?? ‪*Nalorphine‬‬

‫‪48‬‬
7-Migraine:

*prophylaxis:

Drugs:

1- Beta-blockers ( See Anti –hypertensive )

2- Pizotifen = Sandomigraine®, Mesogor® Tabs 0.5mg
3- Topiramate = Topomax, Hitop Tabs 25 mg , 50mg ,100mg , 200mg

 Acute migraine
1- Non opioid Analgesics: e.g Aspirin ,Paracetamol
2- 5HT Agonists:
- Contra-Indications: IHD ,Previous MI, sever hypertension
- Side effects : sensation of tingling , Heat , heaviness
- Drugs :

Generic name Trade name Dosage form

- Sumatriptan Apigrain Tabs 100 mg
- Zolmitriptan Zomitan Tabs 2.5 mg , 5mg

3- Ergot alkaloids
 Contra – indications
- Peripheral vascular disease , IHD, Hepatic and renal impairment
 Side effects NVD ,Headache , vertigo
 Drugs :

Ergotamine tartrate 1mg + Caffiene 100m. Tabs : Asiamigrain ‫اﺳم ﺗﺟﺎري‬

: ‫ ﻣﻠﺣوظﮫ‬
‫ ﯾﺗﺑﻊ ﻟﮭذه اﻟﻣﺟﻣوﻋﺔ " وﻟﻛﻧﮫ ﯾﺳﺗﺧدم ﻻﯾﻘﺎف‬:Ergometrine
. ‫اﻟﻧزﯾف اﻟرﺣﻣﻲ‬
inj 0.1mg, 0.2mg ‫اﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬
‫ ھرﻣون ﯾﺳﺗﺧدم ﻟدﻋم اﻟوﻻده‬: Oxytocin = Syntocinone®
. ‫)) ﺣﻘﻧﮫ اﻟطﻠق (( ﻋﺑﺎره ﻋن ﺑروﺗﯾن‬
Inj 10 IU/ml

49
8-Anti – epileptics

‫واﻟﺗﺷﻧﺟﺎت ﯾﻣﻛن ان ﺗﻛون ﺟزﺋﯾﮫ )ﻓﻲ ﻣﻛﺎن‬، ‫وھو ﻋﺑﺎره ﻋن ﺗﺷﻧﺟﺎت ﻧﺗﯾﺟﮫ ﻻﺿطراﺑﺎت ﻓﻲ ﻛﮭرﺑﯾﮫ اﻟدﻣﺎغ‬
‫ﻣﻌﯾن ( او ﻋﺎﻣﮫ ﻓﻲ ﻛل اﻟﺟﺳم‬

‫؟؟‬: ‫ اﻻﺳﻌﺎﻓﺎت اﻻوﻟﯾﮫ‬

 Combination therapy may be needed
 Cautions : withdrawal , driving, pregnancy and breast feeding.

Drugs

Generic name Trad name Dosag form

1- Carbamazepine Carbatol , Cabamatol Tab 200mg , 400mg
Tegretol , Tegretone 200mg CR,400mg CR-
SYR 2%

2- Lamotrigine Lamitor,Larogen Tabs 25 mg ,50mg

,100mg
3- Phenytion Epetoin ,yesytoin Tabs 100mg ,
inj 250mg /5ml
4- Sodium valporate Epilim,valpron,petilin, Tabs 200mg ,500mg –
Depakine caps 200mg 300mg ,
syr 200mg /5ml
5- Gabapentin * Gabix, Gabtin , Conventin Caps 100mg ,300mg
Neuroplex ,400mg
6- Pregabalin* Nervax,Gabica,Prex,Lyrica Caps 50mg ,75mg ,150
mg
7- Phenobarbitone See barbitrates ??
8- Diazepam See sedatives & hypnotics ??
9- Midazolam Inj 15 mg /5ml
10- Clonazepam See sedative –hypnotics ??
NB *

.‫ ﯾﻣﻛن ان ﺗﺳﺗﺧدم ﻓﻲ ﺣﺎﻟﺔ اﻋﺗﻼل اﻻﻋﺻﺎب اﻟطرﻓﯾﮫ واﻵﻻم اﻟﺣﺎدة‬: 6‫ و‬5 ‫ اﻟدواء‬-

50
 ‫ ﯾﻣﻛن أن ﯾﺳﺗﺧدم ﻛﻌﻼج ﻣﺳﺎﻋد أﯾﺿﺎ ﻟﻠﺳﯾطرة ﻋﻠﻰ ﻧوﺑﺎت اﻟﺻرع )أﻧظر ﻣدرات اﻟﺑول‬:Diamox® -
.(C.A.Is

Home work ?? Piracetam = Neuroctet®, Neurocetam®= Caps 400mg, Syr 2%

9-Anti –Parkinsonian

‫اﻟﺷﻠل اﻟرﻋﺎﺷﻲ‬:( Parkinsonian / Parkinson’s disease ) ‫ﻣرض ﺑﺎرﻛﻧﺳون‬

‫ واﻟﺧرف‬mask face ‫ وﺗﺟﮭم اﻟوﺟﮫ‬tremors ‫ واﻟرﺟﻔﮫ‬rigidity ‫ھو ﻣرض ﺣرﻛﻲ ﯾﺗﻣﯾز ﺑﺎﻟﺗﺻﻠب‬
‫ ﻧﺗﯾﺟﮫ ﻟﻧﻘﺻﺎن اﻟﻧﺎﻗل اﻟﻌﺻﺑﻲ اﻟدوﺑﺎ ﻣﯾن ﻓﻲ اﻟدﻣﺎغ‬dementia

I. Drugs Replace Dopamine

- Indications : Parkinsonism
- Side effects : Vomiting – Postural hypotension – arrhythmia – depression
- Contra- indication : PUD- cardiac disease

Drugs

Levodopa+ Carbidopa ‫اﻻﺳم اﻟﻌﻠﻣﻲ‬

: ‫اﻻﺳﻣﺎء اﻟﺗﺟﺎرﯾﮫ واﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬

Levocar Tabs . (250+25) mg, (100+25)mg

*NB:Interaction : vit- B6 increases degradation of levodopa leading to reduction

of therapeutic effectiveness .there for, vit- B6 not used for vomiting caused by
Levodopa, Domperidone used for this purpose.

II. D-agonist

- indications: Parkinsonism – Hperprolactinaemia

- Side effects: vomiting – cardiovascular events

51
 Drugs :

1- Bromocriptine

-: ‫اﻻﺳﻣﺎء اﻟﺗﺟﺎرﯾﮫ واﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬

- Parlodel , Letroz, Medocriptine

- Tabs 2.5mg

2- Cabergoline

Dostinex ‫ اﻻﺳم اﻟﺗﺟﺎري‬, Tabs 0.5mg ‫اﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬

III. MAO inhibitors

MAO is a co-enzyme that metabolized Dopamine

- Drugs

Selegiline

Selagil Tabs 5mg ‫اﻻﺳم اﻟﺗﺟﺎري واﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬

IV. Amantadine: Caps. 100mg

 Anti – viral agent that effect release and synthesis of dopamine
 Side effect : oedema- CHF –Urine retention
V. Ach Blocking agents :
 They are centrally acting muscarinic antagonist

Deugs:

- Trihexyphenidyl= benzhexol
- Tabs 2m,5mg Akisol : ‫اﻻﺳم اﻟﺗﺟﺎري واﻟﺷﻛل اﻟﺻﯾدﻻﻧﻲ‬

‫ﺗﻢ ﺑﺤﻤﺪ اﷲ‬

‫ﻋﻴﺴﻲ ﻋﻠﻲ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻲ‬. ‫ د‬/‫إﻋﺪاد‬

52
 Drugs acting on Endocrine System :
.‫ ﺗﻌرﯾف اﻟﮭرﻣون ؟؟‬، ‫ أﻧواع اﻟﻐدد ﻣن ﺣﯾث اﻹﻓراز‬، Gland: ‫*ﺗﻌرﯾف اﻟﻐدة‬

1.Pancreas:

*Diabetes Mellitus = D.M:It is a clinical syndrome characterized by

hyperglycaemia. due to Insulin deficiency or resistant.

Diagnosis of diabetes:

 Fasting plasma glucose ≥ 126 mg/dl.

 Random plasma glucose ≥ 200 mg/dl with symptoms ( polyuria,
polydypsia and unexplained wt.loss).

# Causes of D.M ??

# Type of D.M:

1- Type І = IDDM

2- Type ІI= NIDDM

3- Pregnancy diabetes.

‫ وھو ﻻﯾﻧﺗﺞ ﻣن ﺧﻠل ﻓﻰ‬، ‫*اﻟﺳﻛرى اﻟﻛﺎذب ؟؟ ﯾﻌطﻰ ﻧﻔس أﻋراض اﻟﺳﻛرى اﻟﺣﻘﯾﻘﻰ‬
‫اﻟﺑﻧﻛرﯾﺎس أو اﻹﻧﺳوﻟﯾن ﺣﯾث ﻧﺳﺑﺔ ﺳﻛر اﻟدم طﺑﯾﻌﯾﺔ؛وإﻧﻣﺎ ﯾﻧﺗﺞ ﻟﻧﻘﺻﺎن اﻟﮭرﻣون اﻟﻣﺿﺎد‬
ADH.‫ﻟﻺﺑﺎﻟﺔ‬

1. Type І :

 Insulin:
- Side effects of insulin: hypoglycaemia ( Sign: Sweating- hunger-
Tremor- Lethargy ), Lumpy bumby shape at a site of injection.

53
 - Types of insulin:
Properties Trade name
Type of insulin
Soluble insulin= Short acting,Rapid on Actrapid
Human insulin Set of action,Clear
Insulin Zinc Intermediate acting, Isophane , insulatard.
Slow on Set action,
Turbid.
Mixturd insulin Intermediate acting, Insulin Mix ,
Rapid on Set action, Humalin 70/30.
Turbid.
*NB:

Diabetes Ketoacidosis (DKA):

- Symptoms:↑ Respira on, Fruity odor, Dehydration, Cramp,

Nausea. It a result of lipolysis which lead to production of
acetone.

2. Type ІI :

 Oral hypoglycaemic drugs:

‫ﺑﺎﻟرﻏم ﻣن أن آﻟﯾﺎت ﺗﺄﺛﯾر ھذه اﻷدوﯾﺔ ﻣﺧﺗﻠﻔﺔ؛ إﻻ أن ﻣﻌظﻣﮭﺎ ﯾﻌﺗﻣد ﻋﻠﻰ‬
‫ وﺑذﻟك ﻟﯾس ﻟﮭﺎ أي ﺗﺄﺛﯾر ﺧﺎﻓض ﻟﺳﻛر اﻟدم ﻋﻧد‬،‫ﺗﺄﻣﯾن اﻹﻧﺳوﻟﯾن داﺧﻠﻰ اﻟﻣﻧﺷﺄ‬
.‫اﻟﻣﺻﺎﺑﯾن ﺑﺎﻟﺳﻛرى ﻣن اﻟﻧوع اﻷول‬
1/ Sulphonylureas:

- Stimulate secretion of insulin.

- Indications : type 2 DM.
- Contra-indications: hepatic and renal impairment, pregnancy,
breast feeding.

54
 - Side effects: N,V,D,hypoglycaemia.
- Drugs:

Generic name Trade name Dosage form

Glibenclamide Daonil,Aminil,Glibiton Tabs. 5mg

Gluconil
Glimepride Amaryl,Pyramil,Glimadin Tabs. 1mg-2mg-3mg-4mg.
Getryl,Diapred
Gliclazide Diamicron, Diabyl Tabs. 80mg-
30mg MR-60mgMR

2/ Biguanides:

- Acts by decreasing glconeogenesis and increasing peripheral

utilization of glucose.
- Indications: type 2 DM, polycystic ovary.
- Contra-indication: renal impairment, Pregnancy, breast feeding.
- Side effects: N,V,D, Anorexia.
- Drugs:
 Metformin = Glucophage,Diaphage,Formit,….etc.
Tabs. 500mg,850mg,1000mg.

*NB: - Gluconil advanced Tabs. 2.5mg +500mg, 5mg +500mg.

- Galvus met/Stevia plus Tabs. 50mg +850mg, 50mg+1000mg

3/ Di Peptidyl Peptidase-4 inhibitors =DPP-4 Is:

55
 :‫*آﻟﯾﺔ اﻟﺗﺄﺛﯾر‬
.‫ﺗﻌزز ﻗدرة اﻟﺟﺳم اﻟذاﺗﯾﺔ ﻋﻠﻰ ﺧﻔض اﻟﺟﻠﻛوز ﻓﻰ اﻟدم ﻋﻧدﻣﺎ ﯾرﺗﻔﻊ‬
‫*ھذه اﻟﻣﺟﻣوﻋﺔ ﺗﻌﻣل ﻓﻘط ﻋﻧدﻣﺎ ﺗﻛون ﻧﺳﺑﺔ اﻟﺳﻛر ﻓﻰ اﻟدم ﻣرﺗﻔﻌﺔ ﻟذﻟك ﻻ ﺗﺳﺑب‬
.‫ھﺎﯾﺑوﻏﻼﯾﺳﯾﻣﯾﺎ‬
- Drugs:

Generic name Trade name Dosage form

Sitagliptin Januvia,Trevia Tabs. 50mg,100mg

Vildagliptin Galvus Tabs. 50mg

4/ Alpha glucosidase Inhibitors:

- Prevent breakdown of carbohydrates in intestine.

 Acarbose = Glucobay® Tabs. 25mg,50mg.
 ‫ﯾؤﺧذ اﻟدواء ﻣﻊ ﻛل وﺟﺑﺔ‬
5/ Glitazones:

- Reduce insulin resistance.

.‫ أﺛرھذه اﻷدوﯾﺔ ﺑطﺊ ﻗد أﯾﺎم إﻟﻰ أﺳﺎﺑﯾﻊ ﻟﺑدء اﻟﻌﻣل وﺷﮭر إﻟﻰ ﺷﮭرﯾن ﻟﻠﺗﺄﺛﯾر اﻟﻛﺎﻣل‬-
‫ ﻣن آﺛﺎرھﺎ اﻟﺟﺎﻧﺑﯾﺔ ﺗراﻛم اﻟﺳواﺋل )وزﻣﺔ وﻋﺎﺋﯾﺔ(؛ ﻟذا ﯾﺟب ﺗﺟﻧب إﺳﺗﺧداﻣﮭﺎ ﻟدى‬-
.‫اﻟﻣﺻﺎﺑﯾن ﺑﻘﺻور اﻟﻘﻠب‬
- Drugs:
Generic name Trade name Dosage form
Roseglitazone Avandia, Rosicon Tabs. 2mg, 4mg

Pioglitazone Actos,Pio,Pionorm Tabs. 15mg, 30mg

56
 ‫‪2. Thyroid gland:‬‬
‫*ﺗﻧظﯾم ھرﻣوﻧﺎت اﻟﻐدة‪ ،‬وظﺎﺋف اﻟﻐدة اﻟدرﻗﯾﺔ ؟؟‬
‫‪ Thyroid disorders:‬‬
‫‪ Diagnosis of Thyroid disorders:‬‬
‫‪- Blood test for T₃, T₄, TSH.‬‬
‫‪- RAIU (Radio-Active-Iodine-Uptake).‬‬

‫‪1. Hypothyrodism:‬‬

‫‪- Symptoms: Depression, dry skin, dry hair, Wt.gain, Lethargy,‬‬

‫‪Enlarged thyroid.‬‬

‫‪Drugs:‬‬

‫‪ Thyroxin(Levothyroxin) = Eltroxin®,Euthyrox® =Tabs.‬‬

‫‪50mcg,100mcg.‬‬
‫‪ Myxedema coma:‬‬

‫ھو أﺷد أﺷﻛﺎل ﻗﺻور اﻟﻐدة اﻟدرﻗﯾﺔ‪ ،‬وھو أﻣر ﻧﺎدر اﻟﺣدوث‪.‬‬
‫وﺗﺣدث ﻋﻧدﻣﺎ ﺗﻛون ﻣﺳﺗوﯾﺎت ھرﻣوﻧﺎت اﻟﻐدة ﻣﻧﺧﻔﺿﺔ ﻟﻠﻐﺎﯾﺔ؛ وھذا ﻧﺎﺟم ﻋن ﻋدوى‬
‫ﻣرﺿﯾﺔ أو اﻷﺷﺧﺎص اﻟذﯾن ﯾﻌﺎﻧون ﻣن ﻗﺻور اﻟﻐدة دون ﻋﻼج‪.‬‬
‫وھﻲ ﺣﺎﻟﺔ طﺎرﺋﺔ ﯾﺟب ﻋﻼﺟﮭﺎ ﺑﺎﻟﻣﺳﺗﺷﻔﻰ‪ ،‬ﺑﻌض اﻟﻣرﺿﻰ ﻗد ﯾﺣﺗﺎج ﻟﻸوﻛﺳﺟﯾن‪،‬‬
‫اﻟﺗﻧﻔس اﻟﺻﻧﺎﻋﻰ‪،‬واﺳﺗﺑدال اﻟﺳواﺋل واﻟﻌﻧﺎﯾﺔ اﻟﻣرﻛزة‪.‬‬
‫اﻷﺷﺧﺎص اﻟذﯾن ﯾﻌﺎﻧون ﻣن ﻗﺻور اﻟﻐدة دون ﻋﻼج ﻣﻌرﺿون ﻟﺧطر ﻣﺗزاﯾد ﻣن‪:‬‬
‫اﻟﻌدوى‪،‬اﻟﻌﻘم‪،‬اﻹﺟﮭﺎض‪،‬وﻻدة طﻔل ﺑﻌﯾوب ﺧﻠﻘﯾﺔ‪،‬أﻣراض اﻟﻘﻠب‪.‬‬

‫‪57‬‬
 2. Hyperthyrodism (Thyrotoxicosis):

- Symptoms: Tremor, Lethargy, Nervousness, Loss of weight,

Irregular period in female.

 Treatment :
 Anti-thyroid :
- Use for hyperthyroidism either for long term therapy or to
prepare patient for thyroidectomy.
- Cautions: liver disease, pregnancy, breast feeding.
- Side effects: headache, rash, arthralgia, alopecia, bone marrow
suppression.
- Drugs:

1- Carbimazole = Neomercazole® Tabs. 5mg.

2- Propylthiouracil= tabs.

3- Iodides:

‫اﻟﯾود ﯾﻌﻣل ﻋﻠﻰ ﻗﻔل إﻓراز وﺗﺛﺑﯾط ﺗﺻﻧﯾﻊ ھرﻣوﻧﺎت اﻟدرﻗﯾﺔ؛ وذﻟك ﺑﺎﻟﺗداﺧل ﻣﻊ اﻟﯾود‬
.‫اﻟداﺧﻠﻰ اﻟﻣوﺟود ﻓﻰ اﻟﻐدة اﻟدرﻗﯾﺔ‬
Saturated Solution Potassium Iodide (SSKI 38 mg) ‫ﯾوﺟد ﻓﻰ ﺷﻛل ﻣﻠﺢ‬
‫ﺑوﺗﺎﺳﯾوم‬
4- Beta-blockers:
‫ زﯾﺎدة ﺿرﺑﺎت اﻟﻘﻠب واﻟﻘﻠق‬:‫ﻏﺎﻟﺑﺎ ﯾﺳﺗﺧدم ﺑروﺑراﻧوﻟول ﻟﺗﺧﻔﯾف اﻷﻋراض اﻷﺧرى ﻣﺛل‬
.‫واﻟرﺟﻔﺔ‬

58
 3. Adrenal gland:

 Corticosteroids:

- Indications: replacement therapy (HRT), anti-inflammatory ( used in

asthma, aczema, allergy ), Immunosuppressants, Rhumatic disease.

- Side effects: peptic ulcer, acute pancreatitis, osteoporosis, tendon

rupture, weight gain, Cushing’s syndrome, glaucoma, cataract,
Polycythemia.

‫ وﻣدة اﻟﻌﻼج ﺑﺎﻹﺳﺗﯾروﯾد؛ ھذه اﻵﺛﺎر‬،‫ طرﯾﻘﺔ اﻟﻌﻼج‬،‫*ھﻧﺎﻟك آﺛﺎر ﺟﺎﻧﺑﯾﺔ ﻋدﯾدة ﺗﺗﻌﻠق ﺑﺎﻟﺟرﻋﺔ‬
.‫ﻋﺎدة ﻣﺎ ﺗظﮭر ﺑﺳﺑب اﻟﺟرﻋﺎت اﻟﻛﺑﯾرة أو اﻟﻌﻼج اﻟﻣﺗواﺻل‬
- Contra-indications: Systemic infections.

* Withdrawal: it is recommended that systemic corticosteroids should

be stopped gradually.

Cushing’s Syndrome:‫*ﻣﺗﻼزﻣﺔ ﻛوﺷن‬

‫ﺗﺣدث ﻧﺗﯾﺟﺔ ﻟزﯾﺎدة إﻓراز اﻟﻘﺷرة اﻟﻛظرﯾﺔ ﻣﻣﺎ ﯾؤدي إﻟﻰ زﯾﺎدة اﻟﺟﻠﻛوز اﻟﻣﺳﺗﻣر ﻓﻰ‬
.‫ وﯾﻛون اﻟوﺟﮫ ھﻼﻟﻰ اﻟﺷﻛل‬،(‫وإﺣﺗﻘﺎن اﻟﻣﺎء واﻷﻣﻼح)وزﻣﺔ‬،‫ﻣﺻﺣوﺑﺎ ﺑﻧﻘص اﻟﺑروﺗﯾﻧﺎت‬،‫اﻟدم‬
Addison’s disease:‫*ﻣرض أدﯾﺳون‬

‫ وﯾؤدي إﻟﻰ ﻧﻘﺻﺎن اﻟﺟﻠﻛوز واﻟﺻودﯾوم وزﯾﺎدة‬،‫ﯾﺣدث ﻧﺗﯾﺟﺔ ﻟﻧﻘص ﻓﻰ إﻓراز اﻟﻘﺷرة اﻟﻛظرﯾﺔ‬
.‫ وﻓﻘدان ﺣﺎد ﻟﻠﺳواﺋل وھﺑوط‬،‫اﻟﺑوﺗﺎﺳﯾوم‬

59
 - Drugs:

Generic name Trade name Dosage form

Prednisolone Xylone,Optepred,Yesolone Tabs.5mg,20mg-
Syr.5mg/5ml- E/D.
Methyl Prednisolone Medrone, Depomedrol Tabs.2mg,4mg-
inj.40mg,80mg.
Hydrocortisone Hydrocort, Alphacort, Tabs – inj –cream-
Monicort ( comp ). oint-E/D-E/O.
Betamethasone Betnovate,Ophtamesone,Betaderm, Cream-Oint-Lotion-
Betamed,Salibet (comp). E/D.
Triamcinolone Lonacort, Kenacort-A, Oralog Cream-Oint-Oral
paste- inj.40mg.
Mometasone Metaz, Elica Cream-Oint-Lotion
0.1%.
Clobetasol Dermovate,Cloderm,Gamavate,Civic Cream-Oint.
Beclomethasone Beclosone Cream-Oint.
Dexamethasone Dexamed,Apidex,Maxidex,Optidex- Tabs. 0.5mg,1.5mg-
T(comp),Tubradex(comp),Maxitrol inj.4mg-Oral paste-
(comp), Polytrol(comp). E/D- E/O.

*NB:

-Orazone syrup ??

- Azathioprin ??

- Methotrexate ??

60
 ‫‪*Dexamethasone:‬‬

‫ﻣن اﻟﻘﺷراﻧﯾﺎت اﻟﺳﻛرﯾﺔ ﯾﺳﺗﺧدم ﻛﻣﺿﺎد ﻟﻠﺣﺳﺎﺳﯾﺔ وﻣﺿﺎد ﻟﻺﺳﺗﻔراغ وﻓﺎﺗﺢ ﻟﻠﺷﮭﯾﺔ‪.‬‬
‫*اﻵﻟﯾﺔ‪ :‬ﯾﻌﻣل ﻋﻠﻰ إﺣﺗﺟﺎز اﻟﻣﺎء ﻓﻰ اﻟﺟﺳم )وزﻣﺔ(‪،‬ﻧﺗﯾﺟﺔ ﻟزﯾﺎدة اﻷﻣﻼح وإﻧﺧﻔﺎض اﻟﺑوﺗﺎﺳﯾوم‬
‫واﻟﻛﺎﻟﺳﯾوم‪،‬وزﯾﺎدة اﻟﺷﮭﯾﺔ وﺑﺎﻟﺗﺎﻟﻰ زﯾﺎدة اﻟوزن‪.‬‬
‫*اﻟدﻛﺳﺎ وﺣﺎﻻت اﻟﻌدوي اﻟﻔﯾروﺳﯾﺔ ؟؟‬
‫*ﺗﻧوﯾﮫ‪ :‬ﯾﻣﻧﻊ إﺳﺗﺧدام اﻟدﻛﺳﺎ ﻓﻰ اﻟﺣﺎﻻت اﻟﺗﺎﻟﯾﺔ‪:‬‬
‫‪-‬ﻓﻰ ﺣﺎﻟﺔ اﻟﺗﻔﻛﯾر ﻟﻠﺗطﻌﯾم‪،‬ﺧﺎﺻﺔ إذا ﻛﺎن اﻟﻠﻘﺎح ﻓﯾروﺳﻰ ﺣﻲ‪.‬‬
‫‪-‬اﻟﺣﺎﻻت اﻟﻌﻘﻠﯾﺔ )اﻟﺻرع‪،‬اﻟﺻداع اﻟﻧﺻﻔﻰ‪(...‬‬
‫‪-‬اﻷﻣراض اﻟﺟﮭﺎزﯾﺔ‪ ،‬ﻣﺛل‪ :‬اﻟﺳل‬
‫‪-‬اﻟﺟﻼﯾﻛوﻣﺎ أو اﻟﻘرﺣﺔ‪.‬‬
‫*أھم اﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ‪:‬‬
‫‪ -‬ﻣﺷﺎﻛل ﻋﻘﻠﯾﺔ واﻟﺗﻔﻛﯾر ﻓﻰ اﻹﻧﺗﺣﺎر واﻟﺷﻌور ﺑﺎﻹﻛﺗﺋﺎب‬
‫‪ -‬زﯾﺎدة اﻟﻌدواﻧﯾﺔ واﻟﻌﻧف ‪ ،‬وإﺣﺗﻣﺎﻟﯾﺔ إدﻣﺎن ﻧﻔﺳﻲ‪.‬‬
‫‪ -‬اﻟﺷﻌور ﺑﺎﻟذات اﻟﻌﺎﻟﻰ وﺟﻧون اﻟﻌظﻣﺔ أو اﻟﻣزاج اﻟﻣﺗﻘﻠب‬
‫‪ -‬اﻟﺷﻌور ﺑﺎﻟﻘﻠق وﻣﺷﺎﻛل ﻓﻰ اﻟﻧوم وﺻﻌوﺑﺔ ﻓﻰ اﻟﺗﻔﻛﯾر أو ﻋدم اﻟﺗرﻛﯾز اﻟﺷدﯾد‬
‫‪ -‬اﻟﺷﻌور ﺑﺄﺷﯾﺎء أو ﻣﺷﺎھدﺗﮭﺎ أو ﺳﻣﺎﻋﮭﺎ وﻗد ﻻ ﺗﻛون ﻣوﺟودة ﻓﻰ اﻟواﻗﻊ‪ ،‬ﻣﻊ اﻟﺷﻌور ﺑﺄﻓﻛﺎر‬
‫ﻏرﯾﺑﺔ وﻣﺧﯾﻔﺔ ﻣﻊ اﻟﺷﻌور ﺑﺎﻟوﺣدة‬
‫‪ -‬ﻋدم إﻧﺗظﺎم اﻟدورة اﻟﺷﮭرﯾﺔ أو ﺗﺄﺧرھﺎ ‪ ،‬إﻧﺗﻔﺎخ اﻟوﺟﮫ )اﻟوﺟﮫ اﻟﺑدرى(‪.‬‬
‫‪ -‬ﻋﻘم وﻣﺷﺎﻛل ﺟﻧﺳﯾﺔ‬
‫‪ -‬ﺿﻣور ﺣﺟم اﻟﺻدر ﻟدى اﻟﻧﺳﺎء وﺗﺿﺧم اﻷﻋﺿﺎء اﻟﺗﻧﺎﺳﻠﯾﺔ‪.‬‬

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‫‪4. Gonads:‬‬

‫* ﺗﻧظﯾم اﻷﺳرة‪:‬‬
‫ﯾﻘﺻد ﺑﮫ اﻟﺗﺑﺎﻋد ﺑﯾن اﻟوﻻدات‪ ،‬او ﺗﺣﺎﺷﻰ اﻷﺣﻣﺎل اﻟﻐﯾر ﻣرﻏوب ﻓﯾﮭﺎ؛ وذﻟك ﺑﮭدف إﺗﺎﺣﺔ‬
‫اﻟﻔرﺻﺔ ﻟﻸم ﻟﻺﻋﺎدة وﺿﻌﮭﺎ اﻟﺻﺣﻰ اﻟطﺑﯾﻌﻰ ﻣن ﺟﺎﻧب‪ ،‬واﻟﺟﻧﯾن ﻣن ﺟﺎﻧب آﺧر‪.‬‬
‫*ﺗﻘﺎرب اﻟوﻻدات ﯾﻌﺗﺑر ﻣن اﻟﻌﺎدات اﻟﺿﺎرة اﻟﺗﻰ ﺗﻌﺎﻧﻰ ﻣﻧﮭﺎ اﻟدول اﻟﻧﺎﻣﯾﺔ‪ ،‬ﻣﺛﻠﮭﺎ‬
‫ﻣﺛل‪ :‬ﺧﻔﺎض اﻟﺑﻧﺎت‪ ،‬اﻟزواج اﻟﻣﺑﻛر‪ ،‬اﻟوﺷم‪ ،‬اﻟﺷﻠﺦ‪ ،‬دق اﻟﺷﻔﺎه‪ ،‬اﻟﺗﻐذﯾﺔ‬
‫اﻟﺧﺎطﺋﺔ)ﺳوء اﻟﺗﻐذﯾﺔ(‪ ،‬ﺗﻌﺎطﻲ اﻟﻣﺧدرات‪.‬‬
‫*ﯾﺗم ﺗﻧظﯾم اﻷﺳرة ﺑﻌدة وﺳﺎﺋل؛ وﻟﻛن ھﻧﺎﻟك ﺷروط ﻹﺧﺗﯾﺎر اﻟوﺳﯾﻠﺔ اﻟﻣﻧﺎﺳﺑﺔ ﻟﺗﻧظﯾم‬
‫اﻷﺳرة‪:‬‬
‫‪ -1‬أن ﺗﻛون اﻟوﺳﯾﻠﺔ ذا ﻓﻌﺎﻟﯾﺔ‪.‬‬
‫‪ -2‬أن ﺗﻛون ﻣﻘﺑوﻟﺔ ﻟدي اﻟزوﺟﯾن‪.‬‬
‫‪ -3‬ان ﺗﺗوﻓر ﻓﯾﮭﺎ درﺟﺔ ﻋﺎﻟﯾﺔ ﻣن اﻷﻣﺎن‪.‬‬
‫‪ -4‬إﻧﻌدام أو ﻗﻠﺔ اﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ‪.‬‬
‫‪ -5‬أن ﺗﻛون ﺳﮭﻠﺔ اﻹﺳﺗﻌﻣﺎل‪.‬‬
‫*اﻟطرق واﻟوﺳﺎﺋل اﻟﻣﺳﺗﺧدﻣﺔ ﻟﺗﻧظﯾم اﻷﺳرة‪:‬‬
‫أوﻻ‪ :‬اﻟطرق اﻟطﺑﯾﻌﯾﺔ‪ ،‬وﺗﺷﻣل‪:‬‬
‫‪ -1‬إﺧﺗﯾﺎر ﻓﺗرة اﻷﻣﺎن‪ :‬وھﻰ اﻟﻔﺗرة اﻟﺗﻰ ﺗﻛون ﻓﯾﮭﺎ إﺣﺗﻣﺎل اﻟﺣﻣل ﺿﻌﯾف او‬
‫ﻣﻌدوم‪.‬وذﻟك ﺑﺎﻹﻣﺗﻧﺎع ﻋن اﻟﺟﻣﺎع ﻓﻰ أﯾﺎم اﻟﺧﺻوﺑﺔ ﻓﻰ ﻣﻧﺗﺻف دورة اﻟﺣﯾض‪ ،‬أو‬
‫ﺑﻌد ﻣرور أرﺑﻌﺔ ﻋﺷر ﯾوﻣﺎ ﻣن آﺧر دورة ﺣﯾض‪.‬‬
‫‪-2‬إﺧﺗﺑﺎر اﻟﺳﺎﺋل اﻟﻣﮭﺑﻠﻰ‪ :‬وھﻲ ﻣن أﺳﮭل اﻟطرق وآﻣﻧﺔ‪ ،‬وﺗﺗم ﺑﺄﺧذ ﻋﯾﻧﺔ ﻣن اﻟﺳﺎﺋل‬
‫اﻟﻣﮭﺑﻠﻰ ﺑﺎﻟﯾد؛ ﻓﺈذا ﻛﺎﻧت اﻟﻠزوﺟﺔ ﻛﺑﯾرة واﻟﻣطﺎطﯾﺔ ﻋﺎﻟﯾﺔ ﺗﻌﺗﺑر ﻓﺗرة ﺧﺻوﺑﺔ‪،‬‬
‫واﻟﻌﻛس‪.‬‬
‫‪ -3‬اﻟﻌزل‪ :‬وﻟﻛﻲ ﺗﻧﺟﺢ ھذه اﻟطرﯾﻘﺔ ﻻﺑد ﻣن أن ﯾﻛون اﻟرﺟل ﻋﻠﻰ ﺛﻘﺔ ﻣن ذﻟك‪ ،‬وﺗﺗم‬
‫ﺑﻘذف اﻟرﺟل ﻟﻠﺳﺎﺋل اﻟﻣﻧوى ﺧﺎرج اﻟﻣﮭﺑل‪.‬‬
‫‪ -4‬اﻟرﺿﺎﻋﺔ اﻟطﺑﯾﻌﯾﺔ‪ :‬ﺗؤﺧر اﻟﺣﻣل ﻟﻌدة أﺷﮭر ﺑﻌد اﻟوﻻدة‪ ،‬وﻟﻛﻧﮭﺎ ﻻ ﺗﻌﺗﺑر ﻓﻌﺎﻟﺔ؛‬
‫ﻷن ﺣدوث اﻟﺣﻣل ﻣﻣﻛن ﺑﻌد ﻓﺗرة وﺟﯾزة ﻣن اﻟوﻻدة‪.‬‬

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 ‫ﺛﺎﻧﯾﺎ‪ :‬اﻟطرق اﻟﻣﯾﻛﺎﻧﯾﻛﯾﺔ‪:‬‬
‫وﯾﺗم ﻓﯾﮭﺎ ﻣﻧﻊ وﺻول اﻟﺣﯾواﻧﺎت اﻟﻣﻧوﯾﺔ إﻟﻰ اﻟرﺣم ﻋن طرﯾق إﺳﺗﻌﻣﺎل اﻟﻣواﻧﻊ‬
‫ﺑواﺳطﺔ طﺑﯾب‪ ،‬وھﻰ ﺻﻧﺎﻋﯾﺔ‪ ،‬ﻣﺛل‪ :‬اﻟﻠوﻟب واﻟواﻗﻰ اﻟذﻛرى ﻟﻠرﺟل واﻟﻌﺎزل‬
‫اﻟﻣﮭﺑﻠﻰ ﻟﻠﻣرأة‪.‬‬
‫ﺛﺎﻟﺛﺎ‪ :‬اﻟطرق اﻟﺟراﺣﯾﺔ‪:‬‬
‫وﺗﺗم ﻋن طرﯾق اﻟﺗدﺧل اﻟﺟراﺣﻰ)ﻣﻧﻊ اﻟﺣﻣل اﻟداﺋم(‪ ،‬ﻣﺛل‪:‬‬
‫‪-‬ﻗطﻊ ورﺑط ﻗﻧﺎة ﻓﺎﻟوب‬
‫‪-‬ﻗطﻊ ورﺑط اﻟﻘﻧﺎة اﻟﻣﻧوﯾﺔ‪.‬‬
‫راﺑﻌﺎ‪ :‬اﻟطرق اﻟﻛﯾﻣﯾﺎﺋﯾﺔ‪:‬‬
‫وﯾﻘﺻد ﺑﮭﺎ إﺳﺗﻌﻣﺎل اﻟﻌﻘﺎﻗﯾر اﻟطﺑﯾﺔ أواﻟﻛﯾﻣﯾﺎﺋﯾﺔ )ﻣواﻧﻊ اﻟﺣﻣل ﻛﺎﻟﺣﺑوب أو اﻟﺣﻘن(‪،‬‬
‫وھﻲ ھرﻣوﻧﺎت ﺗﻣﻧﻊ اﻟﺗﺑوﯾض‪.‬‬
‫*ﻛﻣﺎ ﯾﻣﻛن إﺳﺗﻌﻣﺎل ﻣﺑﯾدات اﻟﺣﯾواﻧﺎت اﻟﻣﻧوﯾﺔ ﺑﺄﻧواﻋﮭﺎ وھﻲ ﻣﺟﻣوﻋﺔ ﻣن اﻟﻣراھم‬
‫واﻟﻛرﯾﻣﺎت‪ ،‬ﺗﺣﻘن داﺧل اﻟﻣﮭﺑل ﻗﺑل اﻟﺟﻣﺎع ﻓﺗﻘﺗل اﻟﺣﯾواﻧﺎت اﻟﻣﻧوﯾﺔ ﻗﺑل وﺻوﻟﮭﺎ‬
‫اﻟرﺣم‪.‬‬
‫*وﻗد ﺗﺳﺗﻌﻣل اﻟوﺳﺎﺋل اﻟﻣﯾﻛﺎﻧﯾﻛﯾﺔ واﻟﻛﯾﻣﯾﺎﺋﯾﺔ ﻟزﯾﺎدة ﻓﻌﺎﻟﯾﺔ ﻣﻧﻊ اﻟﺣﻣل‪.‬‬
‫‪* Contraceptives:‬‬
‫*ﺗوﺟد اﻟﻌدﯾد ﻣن اﻷﺷﻛﺎل اﻟﺻﯾدﻻﻧﯾﺔ ﻟﻣواﻧﻊ اﻟﺣﻣل‪ ،‬ﻣﺛل‪ :‬اﻟﺣﺑوب‪ ،‬اﻟﺣﻘن‪ ،‬ﺣﺑوب‬
‫ﻣﮭﺑﻠﯾﺔ‪ ،‬وﺷرﯾﺣﺔ ﺗﺣت اﻟﺟﻠد‪.‬‬
‫*ﺗﺗﻣﯾز اﻟﺣﺑوب ﻣﺎﻧﻌﺎت اﻟﺣﻣل ﺑﺈﺣﺗواﺋﮭﺎ ﻋﻠﻰ ﻛﻣﯾﺔ ﻗﻠﯾﻠﺔ ﺟدا ﻣن اﻟﮭرﻣوﻧﺎت‪ ،‬ﻣﻘﺎرﻧﺔ‬
‫ﺑﺎﻟﺣﺑوب أو اﻟﺣﻘن اﻟﺗﻰ ﺗﺳﺗﺧدم ﻟﻠﻌﻼج اﻟﺗﻌوﯾﺿﻰ ﻟﻠﮭرﻣوﻧﺎت‪.‬‬
‫‪1. Oral Contraceptives:‬‬
‫‪1.1- Progesterone Only Pills (POP):‬‬
‫*ﺗﺣﺗوى ﻋﻠﻰ أﺣد ﻧظﺎﺋر أو ﻣﺷﺗﻘﺎت اﻟﺑروﺟﯾﺳﺗرون‪.‬‬
‫*ﺗﺳﺗﺧدم ﻟﻣﻧﻊ اﻟﺣﻣل ﻋﻧد اﻟﻣرﺿﻌﺎت ‪ ،‬ﺣﯾث أن اﻟﻣرأة اﻟﻣرﺿﻊ ﯾﻣﻧﻊ إﺳﺗﺧداﻣﮭﺎ‬
‫ﻟﻣواﻧﻊ اﻟﺣﻣل اﻟﺗﻰ ﺗﺣﺗوى ﻋﻠﻰ اﻹﺳﺗروﺟﯾن‪ ،‬ﺣﯾث أﻧﮫ ﯾؤﺛر ﻋﻠﻰ ﻣﺳﺗوى وﻛﻣﯾﺔ‬
‫اﻟﻠﺑن ﻟدي اﻟﻣرﺿﻊ‪.‬‬
‫*ﻋدد اﻟﺣﺑوب اﻟﻣوﺟودة ﻓﻰ ﻛورس ﻣﻧﻊ اﻟﺣﻣل ﻟﻠﻣرﺿﻌﺎت داﺋﻣﺎ ‪ 28‬ﺣﺑﺔ‪.‬‬

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 - Contra-indications: pregnancy, undiagnosed vaginal bleeding,
Liver adenoma.
- Side effects: N,V, menstrual irregularities, depression, weight
gain, headache.
- Drugs:
Generic name Trade name Dosage form

Norgestrel Ovrette Pills. 0.075mg

Levonorgestrel Microlut Pills.

Lynestrenol Exluton Pills.

Norethisterone Micronor,Primolot Tabs. 5mg- Pills.

‫ ﺳﻧﺔ‬3 ‫ﻣدة اﻟﻔﻌﺎﻟﯾﺔ‬، ‫ = ﺷرﯾﺣﺔ ﺗﺣت اﻟﺟﻠد‬Norplant = (‫ ﻣﻠﺟم‬36) ‫*ﻧورﺟﯾﺳﺗرﯾل‬

1.2- Combined oral contraceptives (Oestrogen + Progeterone):

- Oestrogen = Suppresses development of overian follicles, Progeterone

prevents ovulation.

- Reliable, reversible, reduced dysmenorrhoea.

- Contra-indications: Pregnancy, DVT, migraine, Liver disease.

- Side effects: headache, wt. gain, thrombosis, HTN, N,V.

‫ إﺣﺗﻘﺎن وﺗﯾﺑس اﻟﺛدى وﻋﺎدة ﯾزول ﺑﻌد دورة اﻟﻰ دورﺗﯾن ﺑﻌد اﻟﺑدء‬،‫ظﮭور اﻟﻛﻠف ﻋﻠﻰ اﻟﺑﺷرة‬
.‫ اﻹﻛﺗﺋﺎب وﺳرﻋﺔ اﻹﻧﻔﻌﺎل‬،(‫ ﻣن اﻟﺣﺎﻻت‬%1) ‫ ﺿﻌف اﻟرﻏﺑﺔ اﻟﺟﻧﺳﯾﺔ‬،‫ﺑﺈﺳﺗﺧدام اﻟﺣﺑوب‬

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 - Drugs:

Generic name Trade name Dosage form

Levonorgestrel + ethenylestradiol Famila28(0.15mg+0.03mg) Pills

Nordette(0.10mg+0.02mg)
Microgynon
Desogestrel + ethenylestradiol Marvelon Pills

Drospirenone + ethenylestradiol Yasmin (3mg + 0.03mg) Pills

Norgestrel + ethenylestradiol Orval 28 (0.5mg + 0.05mg) Pills

Norgestimate + ethenylestradiol Cilest Pills

:‫*ﻣﻠﺣوظﺔ‬
:‫ﺣﺑوب ﻣﻧﻊ اﻟﺣﻣل ﯾﻣﻛن أن ﺗﺳﺗﺧدم ﻓﻰ‬
‫ ﻓﻰ ﺑﻌض اﻷﺣﯾﺎن ﻋﻼج ﺣب اﻟﺷﺑﺎب‬-2 ‫ ﺗﻧظﯾم اﻟدورة اﻟﺷﮭرﯾﺔ‬-1

‫ ﻓﻰ ﺑﻌض اﻷﺣﯾﺎن ﻋﻼج آﻻم ﻣﻧﺗﺻف اﻟدورة اﻟﺷﮭرﯾﺔ‬-3

‫ ﻗﻠق واﺿطراﺑﺎت ﻗﺑل اﻟدورة؛ وﻓﯾﮭﺎ ﺗﺣدث ﻟﻠﻣرأة أﻋراض ﻧﻔﺳﯾﺔ وﺟﺳدﯾﺔ ﺷدﯾدة ﻣن اﻟﯾوم‬-4
.‫ ﻗﺑل ﺑداﯾﺔ اﻟدورة‬14-10

2. Parenteral progesterone only contraceptives:

- Hydroxyprogesteron = Proluton

. ‫ ﯾوم‬14-8 ‫*ﺣﻘن ﺑﺎﻟﻌﺿل = ﻣدة اﻟﻔﻌﺎﻟﯾﺔ ﻣن‬

- Medroxyprogesterone = Megestron, Prover

. ‫ أﺳﺑوع‬12-4 ‫*ﺣﻘن ﺑﺎﻟﻌﺿل = ﻣدة اﻟﻔﻌﺎﻟﯾﺔ ﻣن‬

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‫*ﺗﺳﺗﺧدم ﺣﻘن ﻣﻧﻊ اﻟﺣﻣل ﻋﺎدة ﻟﻣﻧﻊ اﻟﺣﻣل ﻟﻔﺗرات طوﯾﻠﺔ ﺗﺗراوح ﻣﺎ ﺑﯾن ﺷﮭر إﻟﻰ ‪ 3‬ﺷﮭور‪.‬‬

‫‪* Other Drugs:‬‬

‫? ‪1- Progyluton‬‬

‫? ‪2- Cycloprogynova‬‬

‫‪3- Femoston: 1/10, 2/10 (Estradiol+Dydrogesterone).‬‬

‫‪ #‬اﻹﺳﺗﺧدام‪:‬‬
‫‪ -1‬أﻋراض اﻟﻧﻘص ﻓﻰ اﻹﺳﺗروﺟﯾن اﻟﺗﻰ ﺗﻌﺎﻧﻰ ﻣﻧﮭﺎ اﻟﻧﺳﺎء ﺧﻼل ‪ 6‬ﺷﮭور ﻋﻠﻰ اﻷﻗل ﻣن آﺧر‬
‫دورة‬
‫‪ -2‬ھﺷﺎﺷﺔ اﻟﻌظﺎم ﻟدى اﻟﻣرأة اﻟﺗﻰ ﺗﺟﺎوزت ﺳن اﻟﯾﺄس واﻟﻣﻌرﺿﺔ ﻟﻛﺳور ﻓﻰ اﻟﻌظﺎم ان ﻛﺎﻧت‬
‫ﻻ ﺗﺗﺣﻣل أو ﯾﻣﻧﻊ ﻋﻠﯾﮭﺎ إﺳﺗﻌﻣﺎل أي دواء آﺧر ﻣﻌﺗﻣد ﻟﻠوﻗﺎﯾﺔ ﻣن ﺗرﻗق اﻟﻌظﺎم‪.‬‬
‫)‪4- Dupbaston®=Dirogest® (Dydrogesterone‬‬

‫‪ #‬اﻹﺳﺗﺧدام‪:‬‬
‫*ﻋﻼج ﺗﻌوﯾﺿﻰ ﻟﻧﻘﺻﺎن اﻟﺑروﺟﯾﺳﺗرون‪:‬‬
‫‪ -‬ﻋدم إﻧﺗظﺎم اﻟدورة‬
‫‪ -‬اﻟﻧزﯾف اﻟرﺣﻣﻰ‬
‫‪ -‬اﻹﺟﮭﺎض ﺑﺳﺑب ﻧﻘﺻﺎن اﻟﺑروﺟﯾﺳﺗرون‬
‫‪ -‬اﻟﻌﻘم ﺑﺳﺑب ﻋدم ﻛﻔﺎﯾﺔ اﻟﺟﺳم اﻷﺻﻔر‪.‬‬
‫?? ‪5 – Primolot-depot inj 250mg‬‬

‫??‪6 – HCG = Pregnyl inj 5000 IU.‬‬

‫‪7 – FSH + LH (Menotrophin) = IVF-M, Menogon inj 75 IU.‬‬

‫‪* Human menopausal gonadotropin‬‬

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8 – D.agonists: Dostinex, Bromocriptine??

9- Anti-oestrogens:

I- Tamoxifen = Novofen® Tabs. 10mg,20mg

.‫ أو ﺳرطﺎن اﻟﺛدى‬،‫ اﻟﻌﻘم اﻟﻧﺎﺗﺞ ﻣن ﻓﺷل اﻟﺗﺑوﯾض‬:‫ﯾﺳﺗﺧدم ﻟـ‬

II- Clomiphene Citrate: Ova-met®,Clomid®,Clomin®,Clomit®=Tabs.50mg.

.‫ﻣن ﻣﻧﺷطﺎت اﻟﻣﺑﺎﯾض‬

‫ﺗﻢ ﺑﺤﻤﺪ اﷲ‬

‫ﻋﻴﺴﻰ ﻋﻠﻰ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻰ‬.‫ د‬/‫إﻋﺪاد‬

67
‫‪Urinary TracT:‬‬
‫*اﻟﺗرﻛﯾب اﻟﺗﺷرﯾﺣﻰ واﻟوظﺎﺋف اﻟﻔﺳﯾوﻟوﺟﯾﺔ؟؟‬
‫‪1- UTIs‬‬
‫ﺗﺣدث ﻧﺗﯾﺟﺔ ﻟﻌدوى ﺑﻛﺗﯾرﯾﺔ‪ ،‬وﯾﻣﻛن ﻋﻼﺟﮭﺎ ﺑﺎﻟﻣﺿﺎدات اﻟﺣﯾوﯾﺔ؛ ﺣﯾث ﯾﻌﺗﻣد إﺧﺗﯾﺎر اﻟﻣﺿﺎد‬
‫اﻟﻣﻧﺎﺳب ﻋﻠﻰ ﻧوع اﻟﻣﺳﺑب‪ ،‬وﻣدى ﻣﻘﺎوﻣﺗﮫ ﻟﻠﻣﺿﺎد اﻟﺣﯾوى‪،‬وﺷدة اﻷﻋراض‪ ،‬وإﻣﻛﺎﻧﯾﺔ ﺣدوث‬
‫ﻣﺿﺎﻋﻔﺎت ﻣن ﻗﺑل اﻟدواء وﻗدرة اﻟﻣرﯾض ﻋﻠﻰ ﺗﻧﺎول اﻟدواء ﺑﺎﻟﻔم‪.‬‬
‫وھﻧﺎﻟك ﻋدة ﻣﺿﺎدات ﺣﯾوﯾﺔ ﺗﺳﺗﺧدم ﻟﻣﻌﺎﻟﺟﺔ إﻟﺗﮭﺎب اﻟﻣﺟﺎري اﻟﺑوﻟﯾﺔ‪ ،‬ﻣﻧﮭﺎ‪ :‬ﻣرﻛﺑﺎت‬
‫اﻟﺳﻠﻔﺎ‪،‬اﻟﺑﻧﺳﻠﯾﻧﺎت‪،‬اﻟﺳﯾﻔﺎﻟوﺳﺑورﯾﻧﺎت‪،‬اﻟﻛﯾﻧوﻟوﻧﺎت‪.‬‬
‫?? ‪2- Diuretics‬‬

‫??‪3- Doxazosin‬‬

‫‪4- Alfuzosin = Uritab XL® Tabs. 5mg, 10mg‬‬

‫‪5- Finasteride = Finiscar® Tabs. 5mg, 10mg‬‬

‫‪6- Prostanorm Caps‬‬

‫‪7- Prostamol UNO‬‬

‫‪8- Nitrofurntoin = Colifuran® Tabs.100mg‬‬

‫‪9-Khellin Tabs. 20mg‬‬

‫‪10- Urinex Caps‬‬

‫‪11- Rowatinex‬‬
‫ﻟﻌﻼج اﻟﻣﻐص اﻟﻛﻠوى‪ ،‬ﻋﻼج اﻹﻟﺗﮭﺎب اﻟﻣراﻓق ﻟﻠﺣﺻﻰ ﻟﻠﻛﻠوى‪ ،‬ﯾﺳﺎﻋد ﻋﻠﻰ ﺗذوﯾب وطرد‬
‫اﻟﺣﺻﻰ‪.‬‬
‫‪11- Coli-urinal = Effervescent granules‬‬

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‫‪12- Pot-Cit, Potamax = Sachetes‬‬

‫‪13- Kellagon = Caps, Schetes‬‬

‫‪14- Proximol = Effervescent granules‬‬

‫‪15- Solifenacin succinate = Urilax® Tabs. 5mg,10mg‬‬

‫ﯾﺳﺗﺧدم ﻟﻠﺗﺑول اﻟﻺرادي؛ ﻣﺛل ﻓرط ﻧﺷﺎط اﻟﻣﺛﺎﻧﺔ واﻟﺑول اﻟﻣﻔﺎﺟﺊ وﺗﺑﻠﯾل اﻟﻣرﯾض ﻧﻔﺳﮫ ﺑﺎﻟﺑول‪.‬‬
‫‪16- Tadalafil = Golden tab® 10mg, 20mg.‬‬

‫ﯾﺳﺗﺧدم ﻟﻌﻼج ﻗﺻور اﻹﻧﺗﺻﺎب أﺛﻧﺎء اﻹﺛﺎرة اﻟﺟﻧﺳﯾﺔ‪ ،‬وﻟﯾس ﻟﮫ أي أﺛر ﻓﻰ ﻏﯾﺎب اﻹﺛﺎرة‬
‫اﻟﺟﻧﺳﯾﺔ‪.‬‬
‫‪17- Saldenafil = Adenafil®, Penegra®, Vero®, Viagra®= tabs.50mg,100mg‬‬

‫ﯾﺳﺗﺧدم ﻟﻌدم اﻟﻘدرة ﻋﻠﻰ اﻹﻧﺗﺻﺎب‪ ،‬وﯾؤﺧذ ﻗﺑل ‪ 3-1‬ﺳﺎﻋﺔ ﻣن اﻟﻧﺷﺎط اﻟﺟﻧﺳﻰ‪.‬‬

‫‪18- Dapoxetine (SSRIs) = Lejam®, Joytab® Tabs. 30mg, 60mg.‬‬

‫ﯾزﯾد ﻣن اﻟﻔﺗرة اﻟﻼزﻣﺔ ﻟﻠﻘذف وﯾﺣﺳن ﻣن اﻟﺗﺣﻛم‪ ،‬وھذا ﯾﻘﻠل ﻣن اﻹﺣﺑﺎط أو اﻟﻘﻠق اﻟﻧﺎﺗﺞ ﻣن‬
‫ﺳرﻋﺔ اﻟﻘذف )ﯾﺳﺗﺧدم ﻓﻰ ﻋﻼج ﺳرﻋﺔ اﻟﻘذف؛ وھﻲ اﻟﻘذﻓﺔ ﻧﺗﯾﺟﺔ إﺳﺗﺛﺎرة ﺟﻧﺳﯾﺔ ﻗﻠﯾﻠﺔ دون‬
‫رﻏﺑﺔ اﻟرﺟل‪ ،‬ﻣﻣﺎ ﻗد ﯾﺗﺳﺑب ﺑﻣﺷﺎﻛل ﻓﻰ اﻟﻌﻼﻗﺔ اﻟﺣﻣﯾﻣﺔ(‪.‬‬
‫)‪19- Yohimbine = Yohimbex®- Yocon®= Tabs. 5mg - (see alph- blockers‬‬

‫ﯾﺳﺗﺧدم ﻓﻰ ﺣﺎﻟﺔ ﺿﻌف اﻹﻧﺗﺻﺎب‪Erectile dysfunction‬‬

‫ﻷﻧﮫ ﯾزﯾد ﻣن ﻛﻣﯾﺔ اﻟدم داﺧل اﻟﻘﺿﯾب ﻋﺑر اﻟﺷراﯾﯾن‪ ،‬ﻣﻣﺎ ﯾﺳﺑب إﻧﺗﺻﺎب اﻟﻘﺿﯾب‪.‬‬

‫وآﺧﺮ دﻋﻮاﻧﺎ أن اﻟﺤﻤﺪ ﷲ رب اﻟﻌﺎﻟﻤﻴﻦ‬

‫إﻋﺪاد‪ /‬د‪.‬ﻋﻴﺴﻰ ﻋﻠﻲ ﻋﺒﺪاﻟﺮﺣﻤﻦ ﺟﺎﻟﻲ‬

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