pharma

• COX-1


  Constitutive "physiological"
• COX-2


  Inducible by inflammation "pathological"
• Selective COX-ΙΙ Inhibitors


  Less gastric toxicity than aspirin
• Aspirin inhibition


  Both cox-1 & Cox-2 both in CNS & periphery
• Paracetamol inhibition


  Cox-3 in ONLY CNS
• Aspirin make hemolytic anemia
• Aspirin is used with Prophylaxis of thromboembolic disease
• Misoprostol for peptic ulcer of aspirin
• 1. acetylcysteine for toxicity of paracetamol "paracetamol antagonist"
• Naloxone for acute toxicity of morphine and neonatal asphyxia "morphine antagonist"
• The Flumazenil is a Specific antidote for Benzodiazepines by repeated I.V
• Dantrolene treat the Malignant hyperthermia of halothane
• Aspirin should be stopped one week before operations
• Aspirin is contraindicated in gout only if used in small dose
• 95% of the Paracetamol is metabolized and the another 5% is hydroxylated to NABQI
• The aspirin and paracetamol have negative effect on the kidney
• The paracetamol and halothane have negative effect on the liver
• The paracetamol has only analgesic & antipyretic effects
• Side effects of Diclofenac & Ketorolac

  • Renal troubles in risky patients
  • ↑ Liver transaminases
• Narcotic analgesics in large dose produce drowsiness & prolonged use produces tolerance & dependence
• The morphine given IV in shock
• Morphine


  • During pregnancy → congenital malformations & fetal addicti
  • During labor → depresses fetal R.C → neonatal asphyxia
• Methadone for chronic toxicity of morphine
• Heroin is highly addictive
• Tolerance to morphine ONLY with analgesia & depression of R.C
• Meperidine or pethidine


  The drug with choice for obstetric " هدلاولا"
• Meperidine or pethidine


  Morphine like + Atropine like
• Meperidine or pethidine is less analgesics than morphine
• In Preanesthetic medication the meperidine better than morphine
• Fentanyl


  Used as I.V anesthetic, strong analgesic 80 times more than morphine
• Pentazocine, nalbuphine act as


  • Agonist in absence of morphine → κ → analgesic
  • Antagonist in presence of morphine → μ → withdrawal symptoms
• Diagnosis of opiate addicts: Pentazocine, Nalbuphin and Naloxone
• IV diazepam in status epilepticus and as IV anesthetic
• Benzodiazepines


  • Long acting: Diazepam, clonazepam
  • Short acting: Triazolam & midazolam
• Buspirone is ONLY has antianxiety effect
• Propranolol is contraindicated with bronchial asthma as it non selective B blockers
• Increase MAO


  Decrease noradrenalin → Higher depression
• Decrease MAO


  Increase noradrenalin → less depression
• Halothane useful in plastic surgery
• Halothane lead to Malignant hyperthermia which treated by dantrolene