essay

• Side effects of Aspirin :-

  1. Hypoprothrombinemia → bleeding tendency.
  2. G.I.T irritation: nausea, vomiting, pain, ulceration & bleeding. Misoprostol is useful in treatment of of NSAIDs induced peptic ulcer
  3. Allergy (hypersensitivity): rash, urticaria, angio-edema.
  4. Reye's syndrome: salicylates in infant & children (< 10 years) with chickenpox or influenza → fatal hepatotoxicity & encephalopathy.
  5. Teratogenicity: cardiac septal defect.
  6. Idiosyncrasy: hemolysis in patient with favism.
  7. Nephropathy.
  8. Bronchial asthma in susceptible patient. (shift to LOX
• Uses of paracetamol

  1. Peptic ulcer.
  2. Gout.
  3. Bleeding tendency.
  4. Bronchial asthma.
  5. Children with viral infection.
  6. During oral anticoagulant therapy
• Contraindications of morphine

  • Extremities of age (very young or very old) → defective metabolism
  • Head injuries as morphine produces: Supresses R.C → CO2 accumulation → cerebral VD → increase ICP
  • Miosis → mask sign of lateralization (diagnosis)
  • Increased intra-cranial pressure & epilepsy
  • Impaired pulmonary functions e.g. bronchial asthma & COPD & emphysema
  • Impaired liver functions
  • Alone in biliary or renal colic
  • Acute abdomen e.g. appendicitis (relieve pain but this will mask the diagnosis)
  • During pregnancy & lactation: neonatal addiction then withdrawal syndrome (crying, irritability, diarrhea & convulsions)
  • During labor: supresses RC → neonatal asphyxia
  • Endocrinal disease: myxedema (decreases BMR) or Addison due to prolonged response
  • History of allergy & history of addiction
• Short acting penicillin

  • Benzyl penicillin (penicillin G):
  • Acid sensitive, so given I.M. or I.V. / 6 hrs.
  • Narrow spectrum
  • Penicillinase sensitive (B-lactamase sensitive)
  • Short duration due to rapid renal excretion by tubules (90%) and glomeruli. Probenecid inhibits renal tubular secretion so ↑ penicillin level in blood.
• long acting penicillin

  • Procaine penicillin G /12-24 hrs (penicillin G + procaine)
  • Benzathine penicillin G / 4 weeks.
  • They are acid sensitive, so given I.M.
  • Narrow spectrum ▪ Penicillinase sensitive.
• Acid resistant penicillins

  • orally Phenoxymethyl penicillin = penicillin V 500 mg /4-6 hrs. •
  • Penicillinase sensitive.
• Penicillinase resistant penicillins

  Penicillinase resistant penicillins: Oxacillin, cloxacillin, dicloxacillin & flucloxacillin orally.

  Nafcillin has incomplete oral absorption, used IM. Methicillin I.M. (acid sensitive) it is nephrotoxic (rarely used).

  Some strains of staphylococci become resistant to methicillin (MRSA)
• Broad spectrum penicillins

  1. (Aminopenicillins): H. influenza, proteus mirabilis, listeria monocytogenesis.
  2. Ampicillin and amoxycillin orally; They are penicillinase sensitive so can be combined with penicillinase resistant penicillin (e.g., ampiclox) or penicillinase enzyme inhibitor as clavulanic acid or sulbactam.
  3. b- Ampicillin esters
• Anti pseudomonas penicillins

  extended spectrum penicillins
• Side effects of penicillin :-

  • Hypersensitivity reaction:. 2
  • Diarrhea by disruption of normal balance of intestinal microorganisms with incompletely absorbed penicillin and superinfection may occur.
  • High concentration produces local pain, induration, and thrombophlebitis.
  • Acute interstitial nephritis with methicillin (rarely used).
  • Platelets dysfunction and decreased agglutination with carbenicillin, ticarcillin and to some extent with penicillin G.
  • With high doses or intrathecal administration may produce seizures and epilepsy.
• Uses of cephalosporin

  • Serious infections caused by klebsiella, enterobacter and haemophilus species.
  • Gonorrhea (ceftriaxone is the drug of choice).
  • Meningitis (third and fourth generation cephalosporins). Cefotaxime is the choice of meningitis caused by H. influenza
  • Alternative to penicillin in streptococcal and staphylococcal infection.
  • Anaerobic infection (cefoxitin).
  • Urinary tract infection.
  • Typhoid fever (third generation cephalosporins).
  • Otitis media.
• Uses of benzodiazepines

  • Anxiety
  • Insomnia initiate sleep by triazolam, maintain sleep by temazepam or flurazepam
  • Preanesthetic medication eg. Diazepam
  • IV anesthetic eg diazepam
  • Antispasticity for skeletal muscle spasm eg clonazepam
  • Anticonvulsant : oral clonazepam is a broad spectrum antiepileptics
  • Alprazolam for psychic depression , panic attacks
  • Alcohol withdrawal , use long t1/2 as diazepam
• Advantages of LMWH

  • Less incidence of bleeding.
  • Easy calculation of dose.
  • Less need for close monitoring (↓↓ nursing time and costs).
  • Can be used easily for inpatient and outpatient therapy.
  • Longer duration of action (single daily dose).
  • Equal efficacy as HMWH.
• compare between heparin and warfarin

  compare

  A) parentral (not IM)

  B) oral

  C) blood effective both in vivo and in vitro

  D) liver effective in vivo only

  E) immediate

  F) delayed 2-3 days

  G) short 4 hours

  H) long 2-5 days

  I) APTT

  J) PT and INR

  K) protamine sulfate

  L) vitamin K fresh plasma transfusion

  M) yes

  N) no

  O) route

  P) site of action

  Q) onset

  R) duration of action

  S) lab control of dose

  T) antidote

  U) safety with pregnancy