‫له‌‌هه‌موو‌زانستێک‌شتێک‌بزان ‌ه‬

‫له‌‌زانستێک‌هه‌موو‌شتێک‌بزانه‌!‬
Moderate
Acute
Intra-
Sever Chronic
post
Types of drugs :
Syrup(suspension )(liquid) Ointment ( oint ) Spry

Tablet(TAB)pill or(enteric-coated ) Gel (internal-external ) Shampoo

Capsule (cap) Cream Soap

Vial Powder Lotion

Ampule (amp) Effervescent (effer) Fluids

(N/S & D/W & RL)
Suppository (supp) Patches Drops
(rectal-vaginal )
Routes of administration Drugs :
1) Oral , Sublingual-Rectal…
2) Otic & Optic &Nasal
3) Vagina
4) Inhalations
5) Injections :
a) IM ( intra-muscular ) (90 degree )
b) ID ( intra-dermal ) (10-15 degree )
c) IV ( intra-venous ) ( 25 degree )
d) Sc ( subcutaneous ) (45 degree )
 Pharmacology
• Pharmacology : is a science that deals with the origin & nature &chemistry & effects and uses of
drugs…
• Branches of pharmacology :
a) Pharmacodynamic : its study of mechanism of their action
b) Bioavailability : its study of amount of active substance
c) Toxicology : the branch of science concerned with the nature and detection of poisons.
d) Pharmacokinetic : its study of :
1) Absorption: movement of a drug from the site of administration to bloodstream
2) Distribution : describes the reversible transfer of a drug from one location to another within the
body.
3) Metabolism: breakdown of drugs by living organisms, usually through specialized enzymatic
systems
4) Excretion : a process in which the drug passes through many ways such as (Urine, Feces, sweat,
saliva, milk (via lactation), Tears, breathing…
ABSORPTION Metabolism DISTRIBUTION EXCRETION.
*Drugs may be prescribed to:
Drugs: is a chemical substance used to :

• Promote healing
• Cure diseases
• Control or slow progression of diseases
• Prevent diseases
• Decrease risk of complications
• Reduce excessive activity in the body
 Name of drugs :
 The most important things in pharmacology is
groups of drugs and Generic & Trade name of
all groups …
 Generic& scientific name:(not capitalized ):
E. g/ azithromycin & amoxicillin
 Trade &Brand &Marketing Name :
(are capitalized )…
e. g\Zaha or Zomax & Penamox.
MFD(g) & EXP

EXP301018
Months of Year …

January ( JAN) 1 August (AUG) 8

February (FEB) 2 September (SEP) 9
March 3 October (OCT) 10
April (APR) 4 November ( NOV) 11
May 5 December ( DEC) 12
Jun 6
July (JUL) 7
 Allergy with drug
 Why do drug allergies happen?
 Your immune system helps protect you from disease. It’s designed to fight
foreign invaders such as viruses, bacteria, parasites, and other dangerous
substances. With a drug allergy, your immune system mistakes a drug that
enters your body for one of these invaders. In response to what it thinks is a
threat, your immune system begins to make antibodies. These are special
proteins that are programmed to attack the invader. In this case, they attack
the drug…

 What are the differences between side effects and a drug allergy?!
Pregnancy category!
Category Risks
Category A Generally acceptable ,controlled
studies in pregnant women show no
risk.
Category B Maybe acceptable ,in animal studies
showed risk and in human also no risks!

Category C Use with caution if benefits more than

risks, animal studies show risks but in
human studies no risk !
Category D Use in life-threatening emergencies when no
safer drug available and mother’s life in danger
!
Category X Do not use in pregnancy risks are more than
benefits!
NSAID(Non Steroidal anti-inflammatory Drugs) And
OTC:Over-the-counter drugs.
*This groups are used to (inflammatory –antypyretic-analgesics):

 Aspirin (acetylsalicylic acid) also used to anti-platelet. A.S.A

 Celecoxib (Celebrex ).
 Diclofenac-Sodium &potassium (Voltarin )
 Ibuprofen ( Profen )
 Indomethacin (indocid).
 naproxen (naprosyn )
 Piroxicam (Feldene)
 Mefenamic acid ( Ponstan )
 Meloxicam ( Mobic )(
 Acetaminophen (paracetamol & Adol )
Analgesics :
 They are used as Analgesics to relieve the symptoms of pain , such as:
a) Dysmenorrhea .except (Ibuprofen )!
b) Back pain
c) Headache
d) Toothache
e) Post-operative …
 They act on both of (COX1-COX2) .

 COX(cyclooxygenase)is an enzyme normally present in all tissues and cells.

A) COX-1 : Present in platelets and GIT and Kidneys.

B) COX-2 : Present in brain ,Bone , Female Reproductive System …

Which patient should not be used ??
Before taking this drugs tell your physician if you have history of :

A. Asthma
B. Peptic ulcer
C. HTN
D. Liver & kidneys & Heart diseases.
E. Pregnant & lactation.
F. Allergy with it.

 Mefenamic acid (ponstan) should not be used by pregnant women

because it may lead to uterine contraction.

 Ibuprofen should not be used during dysmenorrhea because it may lead

to PCOS!
Side effects of NSAIDs:
1. Stomach pain &ulcers & heartburn.
2. Ringing in the ears
3. Skin rash & wheezing & throat swelling
4. Liver & kidney problem
5. HTN
6. Leg swelling…
 Anti-biotics:
 Antibiotic is a type of antimicrobial substance active against bacteria and is
the most important type of antibacterial agent for fighting bacterial infections.
antibiotics produced naturally from microbes or synthesized chemically .
 bacteriostatic: stop bacterial growth and inhibit spread of infection.
 bactericidal : its killing bacterial and without respond immune system.
 Spectrum activity has two main branches :
A-Narrow spectrum antibiotic: they act on single or limited groups of bacteria.
B-broad spectrum antibiotic: they act on gram-positive and gram-negative
bacteria and large groups of bacteria.
*Resistance:it’s a using of antibiotics for unlimited and it lead
to no responding on bacterial in our body...
*Antibiotics should be used limited !
Groups of Anti-biotics :
 Penicillin
 Cephalosporins
 Macrolides
 Fluoroquinolones
 Sulfonamides (sulfa )
 Tetracyclines
 Aminoglycosides
 Most antibiotics have two names, brand name, created by the drug company
that manufactures the drug, and a generic name, based on the antibiotic's
chemical structure or chemical class. Trade names such as Keflex and
Zithromax are capitalized. Generics such as cephalexin and azithromycin are
not capitalized…
‫■پێویستە ماوەی بەکارهێنانی دژە هەوکردنەکان چەند ڕۆژ بێت ئەوە زۆ زۆر گرنگە بە نەخۆش‬
‫بگوترێت!!‬
‫●پێنج ڕۆژ‪ :‬بۆ هەوکردنی خوارووی قوڕگ و لوت و بۆڕیچکەکانی هەوا‬
‫●حەوت ڕۆژ‪:‬بۆ هەوکردنی گەدە و لەوزەتێنەکان‬
‫●ده ڕۆژ‪-‬بۆ دوو‪-‬هەفتە‪:‬بۆ هەوکردنی سییەکان و میزەڵدان و گرانەتا‬
‫●چەند مانگێك بۆ هەوكردنى ئێسك‪.‬‬
‫•‬ ‫لە کاتی پێدانی دژە بەکتریاکان بە نەخۆش زۆر گرنگە پێی بڵێیت بەپێی کات دەرمانەکەت بخۆ‬
‫نەوەک)بەیانی‪..‬نیوەڕۆ‪..‬ئێوارە‬
‫)‪1×1(every 24hrs‬‬
‫)‪1×2(every 12 hrs.‬‬
‫)‪1×3(every 8 hrs.‬‬
‫) ‪1×4(every 6 hrs.‬‬
Penicillin :
 Are most widely used and most effect of antibiotic, least toxicity
but resistance limited their use.
 Examples : ( Amoxicillin , Ampicillin , penicillin G and V , Ampiclox
,Amoxiclav, Oxacillin… )
 Mode of action ( cell wall synthesis of bacteria inhibitor ).
 Uses of Penicillin :
a) UTI(urinary tract infection )
b) Septicemia
c) Meningitis
d) Pneumonia
e) Syphilis
f) Otitis media …
Side effects of penicillin :
1. Skin rash
2. Diarrhea
3. Hematological toxicity (anemia )
4. Nausea
5. Vomiting
6. Allergy
7. Abdominal pain
8. Nephritis
Cephalosporins :
 Cephalosporins are bactericidal beta-lactam Antibiotics.

 They inhibit enzymes in the cell wall of susceptible bacteria.

 cephalosporins somehow act like penicillin.

 Like penicillin has same side effects.

 Cephalosporines are 5 Generations.

First Generation:
 All of first generation cephalosporin drugs is against gram-positive
bacteria such as staphylococci and streptococci.
1st generation Dose Route

Cefazolin 1-2gm IV\IM

Cephalothin 1-2gm IV\IM

Cephapirin 0.5-1gm IV\IM

Cephalexin (Keflex ) 250-500mg PO

Cefadroxil 500mg PO

Cephradine 250-500mg PO
Second generation :
 The drugs that come under second generation have more spectra against
gram-negative bacteria (Haemophilus influenzae, Enterobacter aerogenes)…
2nd generation Dose Route
Cefamandole 1-2gm IV\IM
Cefuroxime 0.750-1.5gm 250-500mg IV\IM , PO
Cefoxitin 1-2gm IV\IM
Cefotetan 1-2-gm IV\IM
Cefmetazole 2gm IV

Cefaclor 250-500mg PO
Cefpodoxime 200-400 PO
Third generation :
 Drugs are broad spectrum and the effective against both gram positive and
gram negative bacteria.
3rd generation Dose Route

Cefotaxime (claforan ) 1-2gm IV\IM

Ceftriaxone 1-2gm IV\IM

ceftizoxime 1-2gm IV\IM

Ceftazidime 1-2gm IV\IM

Cefoperazone 1-2gm IV\IM

Cefixime (suprax ) 200-400mg PO

Forth generation :
Against multi-resistant Gram-negative bacteria

4th generation Dose Route

Cefepime 2gm IV
Fifth generation :
.
It is active against -resistant Gram-positive bacteria
5th generation Dose Route

Ceftaroline 600mg IV

Ceftobiprole 500mg IV
Therapeutic use Cephalosporines:
 They are used against both Gram-negative and gram-positive bacteria …
 Used for :
1) Lower respiratory tract infections
2) Acute otitis media
3) Skin infections
4) UTI
5) Pelvic infections
6) Bone and joint infections
7) Intra-abdominal infection
8) Meningitis

‫ پێویسته‌وریابین‌کاتێک‌کهسێک‌ههستیاری‌به‌پهنسلینهکان‌ههبێت‌ئهوە‌به‌ئهگهرێکی‬:‌‫تێبینی‬
‫‌چونکه‌ههردوو‌كۆمهڵهکه‌سهر‌به‌گرووپی‬،‫زۆر‌ههستیاری‌به‌سیفالۆسپۆرینهکانیش‌ههیه‬
B-lactam
Tetracyclines:
 Tetracyclines
have a broad spectrum of activity against many
gram-positive

and gram-negative bacteria as well as Mycoplasma,

Chlamydia , and amoebae, They are usually bacteriostatic, also
used to treat of Acne…

 mechanism of their action is inhibit protein of bacteria

(tRNA)…
 Minocycline

Tetracycline Tetracyclines Doxycycline

1)Demeclocycli
ne
Tetracycline
Doxycycline
Mycoplasma infection
Chlamydia (Oral)
Chlamydia (STD)
Side effect of tetracyclines :
1) Gastric discomfort (gastric pain )
2) Nausea & Vomiting…
3) Photo toxicity(while using tetracyclines should be avoid of Sunlight or
using sun protection)
4) Dizziness
5) Vertigo
6) Effects on calcified tissue (deposition on the bone )
7) Hepatotoxicity in high doses!
8) Renal disorders should be avoided !

*tetracyclines should not be used in pregnant & lactation!

* Should not be used in children less than 12 years of age !
Aminoglycosides :
 The aminoglycoside(bactericidal) are acting by inhibit protein of
bacteria and class of antibiotics consists of many different agents
and they are used to treatment of serious infections due to aerobic
gram-Negative, also they are not manufactured for oral because
cant breakdown by intestines so its has only IV-IM therapy…
 Aminoglycosides are:
a. Amikacin
b. Gentamicin (garamycin )
c. Neomycin
d. Streptomycin
e. Tobramycin (tobradex )eye drop.
Upper respiratory tract infection
Urinary tract infection (UTI)
Skin infection
Meningitis
Side effects of aminoglycosides :
a) Ototoxicity : is directly related to high peak plasma and duration of
treatment.

b) Nephrotoxicity.

c) Neuro paralysis : its associated with a rapid increase in

concentrations that high doses infused over a short period !

d) Allergic reactions : contact dermatitis is a common reactions to

topically , Use with gloves!
Hearing problems
Allergy
Renal Failure
Fluoroquinolones (Quinolones )
 Are broad-spectrum synthetic antibiotics used in the treatment of a wide
variety of infections including those of the urinary tract, respiratory-tract,
gastro-intestinal system, bones and joints, as well as gonorrhea, chlamydia
and septicemia. ( Bactericidal )
 Quinolones includes :
1. Ciprofloxacin(ceprodar )
2. Levofloxacin (levoquin )
3. Ofloxacin (oflox)
4. Norfloxacin
5. Nalidixic acid
6. Moxifloxacin
Therapeutic uses of Quinolones :
 Norfloxacin : its infrequently prescribed due to poor oral bioavailability and
short half-life(3-4hrs) . its effective in treating non-systemic infections, such as
UTI, Prostatitis, infectious diarrhea

 Ciprofloxacin(Ciprodar): is effective in treatment of many systemic infections

caused by Gram-Negative bacilli. And Traveler's diarrhea caused by E.coli
and typhoid fever caused by Salmonella typhi , also used as a second-line
agent in the treatment of Tuberculosis (TB).

 Levofloxacin: its used a wide range of infections, including skin infections and
pneumonia ,unlike ciprofloxacin it has excellent activity against respiratory
infections also has %100 bioavailability and is dosed once daily.
half-life(8hrs).
 Side effects :
1) Nausea , Vomiting , diarrhea ,headache and dizziness .
2) This patients with central nerve system (CNS) disorders , such as
epilepsy, should be treated with caution .
3) They can cause photo toxicity , so patients should be used
sunscreen and avoid to sunlight.

Note : patients who used ANTIACID should be discontinue

 contraindications :
1) Pregnancy and Lactation should be Avoided .
2) Children less than 18 years old should be Avoided .
 Macrolides
 The Macrolides are bacteriostatic antibiotics with a broad spectrum
of activity against many gram-positive bacteria. Currently
available macrolides are well tolerated, orally available and widely
used to treat mild-to-moderate infections.

 Macrolides are :
1) erythromycin
2) clarithromycin
3) azithromycin (Zomax , Zithrox , ZAHA)
Therapeutic uses :
 Erythromycin : this drug is effective against many of the same
organism as penicillin and it may used in patients with penicillin
allergy .

 Clarithromycin : it has activity similar to erythromycin but its also

effective against (Haemophilus influenzae) , and used to chlamydia
and urea plasma also used to H.Pylori and its higher effective than
erythromycin.

 Azithromycin : its used to against many organisms in your body that

caused by bacteria such as : bronchitis , tonsillitis , typhoid fever ,
otitis media.
Treatment of H.Pylori
 Important Warnings!
1. Antibiotic-associated diarrhea warning: Almost all antibiotics, including azithromycin,
can cause diarrhea. It may cause mild diarrhea to severe inflammation of your
colon, which can cause death. Call your doctor if you have severe diarrhea or
diarrhea that lasts after you stop taking this drug.

2. Liver problems warning: In rare cases, this drug can cause liver problems. If you
already have liver disease, it could make your liver function worse. Your doctor may
need to monitor your liver function. They may do blood tests to check how well your
liver is working. If your liver isn’t working well, your doctor may have you stop taking
this drug, because its accumulate in liver and excretion by stool.
3. irregular heart rhythm.

4. Not recommended under 6 months .

5. Not recommended for Lactation and safe in Pregnancy!

Side effects…
a) Gastric discomfort

b) Ototoxicity :while using erythromycin in high doses can lead to

deafness !

c) Stomach pain

d) Diarrhea

e) Vomiting

f) Abnormal taste in your mouth

Anti-Fungal Drugs
 Areused to treat fungal infections, which most commonly
affect your skin, between fingers, hair and nails also Vaginal
and Oral. They work by killing the fungal cells …
 nystatin
 clotrimazole
 econazole
 miconazole
 fluconazole
 ketoconazole
Antifungals can treatment of :
Ringworm
athlete's foot
fungal nail infection
vaginal thrush
severe dandruff
Fungal can be dangers!!!
 Less commonly, there are also more serious fungal infections that
develop deep inside the body tissues, which may need to be treated in
hospital.

 Examples include:
1) aspergillosis which affects the lungs.
2) fungal meningitis, which affects the brain.

 You're more at risk of getting one of these more serious fungal infections
if you have a weakened immune system!!
aspergillosis
Fungal meningitis
Side effects of antifungal :
A. Itching or burning
B. Redness
C. Feeling sick
D. Abdominal pain
E. Diarrhea
F. Vomiting and nausea
G. Loss of appetite
*Also can lead to severe reactions , such as :
a) Allergic reactions on face and neck or tongue or difficulty breathing
b) Liver damage may lead to Jaundice
c) Dark urine
d) Weakness and tiredness
Metronidazole ( Flagyl )+Tinidazole
 Tinidazole &Metronidazole(250-500mg) is an antibiotic Agent that is used to
treat a wide variety of infections. It works by stopping the growth of certain
bacteria and parasites such as:
 (Vaginosis caused by Bacteria, Diabetic Foot Infection, infection around a
tooth, intestinal infections …)

 To prevent stomach upset, take this medication with food or a full glass of
water or milk. The dosage is based on your medical condition and response to
treatment.

 Side effects (Dizziness –Redness –Gastric discomfort – Abnormal taste… )

 Anti-viral
 Most viral diseases, with the exception of those caused by human
immunodeficiency virus, are self-limited illnesses that do not require specific
antiviral therapy. This group metabolized and excreted by kidneys !

 The currently available antiviral drugs target 3 main groups of viruses: herpes,
hepatitis, and influenza viruses.
Anti viral drugs includes :
1) Acyclovir
2) Valacicylovir
3) Famciclovir
4) Foscarnet
5) Valganciclovir
Side effect of Anti-viral
a) Nausea and vomiting
b) Headache
c) Fever
d) Anemia
e) Weakness
f) Mood sickness

Note : Patients with Renal problems should be used cautiously or

Avoided !
Tonsillitis
Anthelmintic Drugs
 Anthelmintic or anthelminthic are a group of antiparasitic drugs that expel parasitic
worms and other internal parasites from the body

(intestinal or GIT) by either stunning or killing them and without causing significant
damage to the host.
 mechanism of their action is work by preventing the worms from absorbing the
sugars they need for survival , such as (Tapeworms, Ascaris ,Hookworm , Giardia )
 Anthelmintic drugs include :
1) Albendazole (Albenza)
2) Emverm
3) Hetrazan
4) Mebendazole ( Vermox &Antiver)
5) Ivermectin
Tape-worm
Hookworm
Giardia
Ascaris
Intestinal surgery
Important Notes !!
1) there’s interaction between Mebendazole
&Metronidazole should be used one of them!

2) Takes long time to start working in our body so the

best time for using at morning before meal!

3) Pregnancy and lactation should be used in caution!

Hypertension & hypertensive(HTN)

STAGE 1 or Prehypertension 120/80 to 139/89

STAGE 2 or Mild Hypertension 140/90 to 159/99
STAGE 3 or Moderate 160/100 to 179/109
Hypertension
STAGE 4 or Severe
Hypertension
180/110 or higher
Anti-Hypertension Drugs(HTN)
 drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent
the complications of high blood pressure, such as stroke and myocardial infarction
also There are many classes of antihypertensives, which lower blood pressure by
different means.
 Anti-Hypertension drugs include :
1) Beta-blockers (BBs)
2) Calcium-Channel blockers (CCBs)
3) Angiotensin Converting Enzyme-Inhibitor (ACE-I)
4) Angiotensin II Receptor blockers
5) Diuretics : A) Thiazide B) loop C) Potassium-sparing
Notes :
1) All hypertension drugs should be prescribed by specialist Doctor and Never give any
of these drugs randomly because its Life-threatening and should not decrease or
increase Dosages…!
2) Never change groups of drugs because they have deferent of mechanism of action!
Beta-Blockers (BBs)
 They are reduce BP and primarily by decreasing Cardiac-output , and also inhibit the
release of rennin from the kidneys.
 Beta-blockers are used to (Tachycardia, Angina, Glaucoma, Migraine, CHF, MI ,SVT)
 Beta-blockers has 3 main types :
A. Beta1 (heart) decreasing of contraction .
B. Beta-2 RELAXIATION of (lungs bronchial muscle) ,GIT, Liver, uterus…
 Beta-blockers has many types of drugs such as :
1) Carvedilol ( carvil & Coreg ) 3.12-6.25-12.5-25mg
2) Atenolol ( Tenormin ) 25-50-100mg
3) Propranolol ( Inderal )10-20-40-60-80mg
4) Timolol (optimal ) 5-10-20mg
5) Labetalol ( 100-200-300mg )
6) Bisoprolol ( Concor ) 5-10mg
7) Metoprolol ( betaloc ) 25-50-100
Important Notes of BBs :
1) BBs may cause bradycardia or hypotension .

2) Effect on CNS such as : insomnia , fatigue.

3) Erectile dysfunction .

4) It may disturb lipid metabolism and decreasing HDL and increase TG, patient
should be monitor lipid Profile while using BBs.

5) History of difficulty breathing and Asthma should be avoided.

6) BBs are Hide Mask of DM , so patients has DM should be avoided .

Calcium-Channel blockers (CCBs)
 CCBs are recommended treatment hypertensive patients with DM and Angina
 All CCBs are useful in the treatment of angina.
 CCBs has many drugs , includes :
1) Amlodipine (Amlong –Norvasc )2.5-5-10mg
2) Diltiazem 30-60-90-120-180-240mg
3) Felodipine 2.5-5-10mg
4) Isradipine 2.5-5mg
5) Nifedipine (Adalat )30-60-90mg
6) Verapamil 40-80-120mg
 Mechanism of their action by blocking calcium entry smooth muscles.
 Verapamil : its used to treat angina and prevent migraine and cluster
headache.
Side effect of CCBs
 Constipation while using verapamil .

Nifedipine and amlodipine has interaction with Digoxin.

Peripheral edema .

Dizziness &Headache & fatigue because decrease BP.

Hypotension.
Angiotensin Converting Enzyme-Inhibitor (ACE)
 (ACE) inhibitors are heart medication that widen, or dilate, your blood vessels. That
increases the amount of blood your heart pumps and lowers BP.
 They also raise blood flow, which helps to lower your heart’s workload.

 Mechanism of their action is ACE inhibitors produce vasodilation by inhibiting the

formation of angiotensin II…

 ACE-I used to treatment of CHF and prevention of Heart Attack.

 ACE-I has many types of drugs , includes :

1) Captopril (capoten ) 12.5-25-50-100mg

2) Ramipril (Altace ) 1.25-2.5-5-10mg
3) Enalapril (Anapril )2.5-5-10-20mg
4) Lisinopril 2.5-5-10-20-30-40mg
Side effects of ACE-I
Red & itchy skin
Dizziness
Metallic or salty taste
The most common adverse is Dry-Cough !
Pregnant & lactation women not recommended !
They all has interaction with NSAIDs.
This drugs are only giving with prescribed by Doctor !
Angiotensin II Receptor blockers (ARBs)
 Angiotensin II receptor blockers (ARBs) are medications that block
the action of angiotensin II by preventing angiotensin II from
binding to angiotensin II receptors on the muscles surrounding
blood vessels.

As a result, blood vessels enlarge (dilate) and blood pressure is

reduced also they decreasing the amount of Salt and water .

 They may be used as first-line agents for treatments of HTN in

patients presented with (DM&HF&CKD)!
ARBs includes :
1) Candesartan (atacand ) 4-8-16mg
2) Irbesartan (Avapro )75-150-300mg
3) Losartan (cozaar )25-50-100mg
4) Valsartan ( Diovan )40-80-160mg
5) Telmisartan (Tolura )20-40-80mg
6) Eprosartan109 (Eveten )400-600mg
Side effect of ARBs :
 Similar with ACE-I has risk of Cough !
 Should not be combined with ACE-I
 Its not safe for pregnancy may lead to Teratogenic
 Nausea
 Vomiting
 Diarrhea
 Dizziness
Diuretics ( water pills )
Diuretics, also called water pills, are medications designed to increase the amount of
water and salt expelled from the body as urine. They’re often prescribed to help
treat HTN.

The most common condition treated with diuretics is high blood pressure. The drugs
reduce the amount of fluid in your blood vessels, and this helps lower your blood
pressure.
Other conditions are also treated with diuretics. CHF, for instance, keeps your heart from
pumping blood effectively throughout your body. This leads to a buildup of fluids in your
body, which is called edema. Diuretics can help reduce this fluid buildup.

 The three types of diuretic medications are called thiazide, loop, and potassium-
sparing diuretics. All of them make your body excrete more fluids as urine, Such as :
a) Thiazide
b) Loop
c) Potassium-sparing
A) Thiazide Diuretics :
 Thiazides are the most commonly prescribed diuretics. They’re most often used
to treat high blood pressure. These drugs not only decrease fluids in your body,
they also cause your blood vessels to relax. Thiazides are sometimes taken
with other medications used to lower blood pressure, and can be combined
with ARBs &ACE-I &BBs. They are include :
1) chlorothiazide
2) chlorthalidone
3) hydrochlorothiazide (HCT)
4) metolazone
5) indapamide

 they are safe &inexpensive &effective on stroke and MI

Monitoring should be done for all patients receiving Diuretics !
Safe in pregnancy and lactation but with caution!
B) Loop Diuretics :
 Loop diuretics are often used to treat heart failure and they act by
blocking sodium and chloride Re-absorption by kidneys even in
patients with poor renal function or those who have not respond to
thiazide diuretics, they are include :
1) ethacrynic acid
2) bumetanide
3) Furosemide (Lasix )20-40-80-160mg
4) torsemide
 Lasix has interaction with Gentamycin and amikacin (deafness )
 can be used in pregnancy but should be monitored fetal growth
can effect on birth weight !
3) Potassium-sparing Diuretics
 Potassium-sparing diuretics reduce fluid levels in your body without causing you to
lose potassium, an important nutrient. The other types of diuretics cause you to lose
potassium, which can lead to health problems such as arrhythmia.

 Potassium-sparing diuretics may be prescribed for people at risk of low potassium

levels, such as those who take other drugs that deplete potassium.

 Potassium-sparing diuretics don’t reduce blood pressure as well as the other types of
diuretics do. Therefore, your doctor may prescribe a potassium-sparing diuretic with
another drug that also lowers blood pressure. They are include :
1) Amiloride ( Midamor )
2) Eplerenone
3) Triamterene
4) Spironolactone (Aldacton )
Side Effect Of Diuretics:
a) Xerostomia
b) Thirsty
c) Muscle spasms
d) Skin rash
e) Irregular heartbeat
 Before taking diuretics tell your doctor if you have :
1) DM
2) Dehydration
Preeclampsia
 Preeclampsia
 Preeclampsia is a pregnancy complication characterized by high blood
pressure and signs of damage to another organ system,
most often the liver and kidneys. Preeclampsia usually begins
after 20 weeks of pregnancy in women whose blood pressure had been
normal…

 Left untreated, preeclampsia can lead to serious — even fatal —

complications for both you and your baby. If you have preeclampsia,
the most effective treatment is delivery of your baby. Even after
delivering the baby, it can still take a while for you to get better…
Signs & Symptoms Of Preeclampsia:
1) Excess protein in your urine (proteinuria) or additional signs of kidney
problems.
2) Severe headaches.
3) Changes in vision, or light sensitivity.
4) Decreased urine output.
5) Shortness of breath.
6) Upper abdominal pain, usually under your ribs on the right side.

 Sudden weight gain and swelling (edema) — particularly in your face and
hands — may occur with preeclampsia. But these also occur in many normal
pregnancies, so they're not considered reliable signs of preeclampsia…
The best known and safest drug for this
condition is methyldopa ( Aldomet )
Side effect of Methyldopa :

1) Urine colorless
2) Sedative
3) Confusion
4) Anemia
5) Fever
Anti-hyperlipidemia (Statins )
 "Statins" is a class of drugs that lowers the level of cholesterol in the blood by
reducing the production of cholesterol by the liver. (The other source of
cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the
liver that is responsible for making cholesterol. This enzyme is called
hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase).
Statins are :
1) Rosuvastatin (crestor ) 5-10-20-40mg
2) Atorvastatin (AVAS) 10-20-30-80mg
3) Simvastatin (ZOCOR) 10-20-40-80mg
4) Lovastatin
5) Paravastatin
Side effects of STATINS
Nausea , Vomiting , Diarrhea .
Headache
Constipation
Muscles pain

Not recommended for Pregnancy and lactation !

Not recommended for patients has DM(increase blood sugar )!
Should not be used with : (Interaction )
a)Macrolides
b)Anti-fungal drugs
Diabetes Mellitus Drugs(DM)
 Diabetes is a condition that leads to high levels of blood glucose (or sugar) in
the body.

 This happens when your body can’t make or use insulin like it’s supposed to.
Insulin is a substance that helps your body use the sugar from the food you
eat.

 There are two different types of diabetes: type 1 diabetes and type 2 diabetes.
People with either type of diabetes need medications to help keep their blood
sugar levels normal…
Type-1 of DM :
 Type 1 diabetes is a chronic disease. In type 1 diabetes cells in the pancreas
that make insulin are destroyed, and the body is unable to make insulin.

 Insulin is a hormone that helps your body’s cells use a natural sugar
called glucose for energy. Your body obtains glucose from the food you eat.

 Insulin allows the glucose to pass from your blood into your body’s cells. Your
liver and muscle tissues store extra glucose, also called blood sugar. It’s
released when you need extra energy, such as between meals, when you
exercise, or when you sleep.

 The exact cause still unknown but it is thought to be an autoimmune disease or

family history or Race …! >>>
Signs of DM-1:
1) excessive hunger
2) excessive thirst
3) excessive urination
4) dramatic weight loss in a short period of time
5) fatigue
6) blurry vision
Treatment of type-1 :
1) Insulin : People with type 1 diabetes must take insulin every day. You usually take the
insulin through an injection. Should be stored in (2-8C)

2) Diet and exercise : People with type 1 diabetes should eat regular meals and snacks
to keep blood sugar stable.
Routes of administration Insulin
Type-2 of DM
 Diabetes is a chronic medical condition in which sugar, or glucose,
levels build up in your bloodstream. The hormone insulin helps move the
sugar from your blood into your cells, which are where the sugar is used
for energy.

 In type 2 diabetes, your body’s cells aren’t able to respond to insulin as

well as they should. In later stages of the disease your body may also not
produce enough insulin.

 Uncontrolled type 2 diabetes can lead to chronically high blood sugar

levels, causing several symptoms and potentially leading to serious
complications.
Signs of type-2 DM :
1) Blurry vision
2) Dry mouth

3) Lack of energy
4) Constant hunger

5) Feelings of numbness in your extremities, or neuropathy.

6) Foot pain & hot sensation .
Medications for type 2DM
 lifestyle changes are enough to keep type 2 diabetes under control. If not, there are several
medications that may help.
1) Biguanides : Metformin (Glucophage ) lower your blood sugar levels and improve how your
body responds to insulin.(decrease GIT glucose absorption & hepatic glucose production).
2) Sulfonylureas :Glimepiride (Amaryl1-2-3-4) which help your body make more insulin.
3) Meglitinides : Repaglinide, stimulate your pancreas to release more insulin.
4) Thiazolidinediones : Pioglitazone (Actos),Rosiglitazone, make your body more sensitive to
insulin.

5) Dipeptidyl peptidase-4 inhibitors: Sitagliptin, Vildagliptin, help reduce blood sugar levels,
(expensive cost ).
6) Glucagon: lixisenatide, slow digestion and improve blood sugar levels.
7) Sodium-glucose :dapagliflozin, help prevent the kidneys from reabsorbing sugar into the
blood and sending it out in your urine.
Gestational Diabetes
Gestational Diabetic
 Gestational diabetes is high blood sugar (glucose) that
develops during pregnancy and usually disappears after
giving birth. It can happen at any stage of pregnancy, but
is more common in the second or third trimester.
The only and safest drug for this condition is :
metformin
Proton Pump Inhibitors (PPI)s
 PPIs work by blocking and reducing the production of stomach acid. This
gives any damaged esophageal tissue time to heal.
PPIs also help prevent heartburn, the burning sensation that often
accompanies GERD.
 PPIs includes :
 Omeprazole (Lomac-losec-GASEC-RISEK ) 20-40mg
 Pantoprazole (Pantoloc ) 20-40mg
 Esomeprazole (Nexium-esomac-esofag )20-40mg
 Rabeprazole (Rabezol )20-40mg
 Lansoprazole (Lancid )15-30mg
Side effect of PPIs
1) They may increase the risk of fractures ,if the duration of use is 1 year or more.

2) Hypomagnesaemia may occur in long duration !

3) Flatulence

4) Fever
5) Skin rash

6) Headache
7) Nausea
H2-histamine receptor blockers
 H2 blockers are a group of medicines that reduce the amount of acid
produced by the cells in the lining of the stomach. They are also called
'histamine H2-receptor antagonists' but are commonly called H2 blockers…
 H2 blockers are :
1. Cimetidine (Tagamet )
2. Famotidine (Pepcid )
3. Nizatidine
4. Ranitidine ( Zantac ) .
When you take an H2 receptor blocker, the active ingredients travel to
specific receptors on the surface of the stomach cells that release acids. The
medication inhibits certain chemical reactions in these cells so that they aren’t
able to produce as much acid…
Side effects of H2 Blockers
1)Constipation
2)Difficulty sleeping
3)Dry mouth
4)Headache

H2 receptor blockers might cause more serious side effects, such
as:
1)Vision change
2)Chest pain
3)Irregular heartbeat
Antidiarrheals Drugs
 Antidiarrheals are the name given to certain types of medicines that stop or
slow diarrhea. Antidiarrheals only relieve the symptoms of diarrhea…
 This group of drug includes : Loperamide and Diphenoxylate.

The best known drug of anti-diarrheal is Loperamide (Imodium ).

Loperamide : its widely used to control diarrhea , its enteric nervous system to
inhibit Acetylcholine release and decrease peristalsis .

Because this drug can be cause to toxic megacolon , they should not be used
in young children or in patients with sever colitis !

Most common side effect is Toxic megacolon & blurred vision …

Laxative Drugs
 Laxatives are commonly used for treatment for constipation to accelerate the
movement of food through GIT and soft stool…
 Laxative drugs are :
1) Senna :its stimulant and taken Orally also its works in the bowls within 8-10
hours also cause water and electrolyte secretion into the bowel…
2) Bisacodyl : available as Supp and coated –tablets and its stimulation of colon
and directly acts on nerve fibers of the colon …
3) Casteroil : this agent is broken down in the small intestine and increases
peristalsis , also pregnant women should be avoid to use this agent because it
may lead to uterine contraction!
4) Mineral oil & glycerin : available as supp and act to stimulation hard stools ,
and Mineral oil should be taken orally in up-right position to avoid aspiration
and pneumonia!
 this group has two side effects (abdominal Pain &vomiting )…
Enema
Routes of Administration
Steroids
 There are some types of steroids present within the body. Corticosteroids are
produced in the adrenal gland located above the kidney.
 These hormones include aldosterone, which helps regulate sodium
concentration in the body, and cortisol, which plays many roles in the body,
including serving as part of the body's stress response system to decrease
inflammation…
 Commonly prescribed corticosteroid medications, like :
1) Prednisolone (PDN)
2) Dexamethasone (Dexa &Decadron )
3) betamethasone, (Celestone & Betacort &Beta)
4) Triamcinolone (Kenacort )
5) Hydrocortisone (H.C & cortisone )
Steroids
 The second group of steroids, anabolic steroids, are hormones made in the body to
regulate the manufacture of testosterone in the Testicles and Ovaries. The androgenic
part of testosterone is involved in developing the male sex characteristics, while the
anabolic part is involved in increasing the amount of body tissue by increasing protein
production. The Pituitary gland, located at the base of the brain, helps regulate
testosterone production and hormone secretion. Growth hormone and follicle
stimulating hormone (FSH) are among the hormones that stimulate testis and ovary
function and are two of the many hormones secreted by the pituitary Gland .
 Examples of anabolic steroids are :
1) THG
2) HGH(human growth hormone )
3) Anabolic
 These hormone drugs must be given under professional doctor and not able to
increase or decrease the amount of Doses and stop it with asking your doctor !
Side effects of steroids :
1) may lead to decrease in Testicle size and amount of sperms ( for male )
2) Infertility!
3) Baldness!
4) the excess steroid can be converted to estrogen in males and may lead to
(Gynecomastia )!
5) In females, the excess testosterone production may lead to a deeper voice,
changes in the Period, and increased hair production. Baldness may also be
seen in women.
6) Leads to Acne
7) liver cancer at risks !
8) the heart muscle may enlarge just like any other muscle in the body and
sudden Cardiac death !
Anti-Histamine (H1)
 When you have an allergic reaction, your body releases a substance called
histamine by ( Hypothalamus )that located brain near pituitary gland …

 Antihistamines work by decreasing the effects of histamine at certain cell

receptors…
 This group has two generations and also have one different between this
generations :

1) The 1st generation can entry to brain and lead to the patients to
sleepy .
2) The 2nd generation cant entry to brain and not effect in patients
to sleepy .
Histamine Generations
1st generation (sedative ) 2nd generation (non-sedative )

Chlorpheniramine (alarmin ) Fexofenadine (fenadone)

Clementina (clemastine ) Loratadine (lorten )

Promethazine Desloratadine (Deslort)

Cyproheptadine (pryacten ) Cetirizine (Zyrtec)

Triplidine Levocetirizine

Dimenhydrinate

Hydroxyzine (Atarax )
Uses of anti-histamine
 In generally both generations are used to :

1)Used to skin allergy

2)Sleep troubles
3)Travel Sickness (Dimenhydrinate )
4)Helps relieve Runny nose,
5)Sneezing, itchy or watery eyes
6)Nose or Throat itching…
Side effects of Anti-histamine
1. Dry mouth
2. Decreased amount of tears
3. Trouble urination
4. Blurred vision
5. Constipation
Patients who has presented with this diseases should used in caution or on needed :
a) Seizure
b) Glaucoma
c) Problem of passing urine
d) Thyroid disorders
e) HTN
f) DM
 The best and safest drug while in pregnancy is (Chlorpheniramine )!
Inhaler for Asthma
 Pregnancy journey
 The period from conception to birth. After the egg is fertilized by a sperm and then imp
lanted in the lining of the uterus,
 It develops into the placenta and embryo, and later into a fetus.
 Pregnancy usually lasts 40 weeks, beginning from the first day of the woman’s
last menstrual period, and is divided into three trimesters, each lasting three months.

 every single doses should be used with caution while pregnancy because it may
lead to danger for mother or baby or Both!
 Every chemical drugs has category for drug using while pregnancy .
 Every single dose should be taken by an important rule that is (How many risks&
benefits ).
 Pregnancy category includes fife stages ,each stages has different studies.
Safest Drugs in pregnancy
Ear &nose & throat infection Amoxicillin is safest
UTI and otitis media use Cefixime & Cephalexin
Analgesics and pains use Paracetamol
All types of allergy use (loratadine & Alarmin )
Dry cough with sputum use lozenges and honey .
Wet cough use a herbal syrup that contain IVY leaf
Nausea and vomiting use B6 tablet or Meclizine
Acidity of stomach use ( ranitidine & omeprazole )
While constipation the best treatment is life style changing such drinking more liquids
and soft foods or an apple at morning before meal , on needed use (laculose syrup )
For Preeclampsia safest drugs is methyldopa (alldomet )
3 months before gestation and 1st trimester should be used folic acid for healthy
journey and healthy baby …
Vitamin A
Vitamins
Retinol
Vitamin C Ascorbic acid
Vitamin D Calciferol
Vitamin E Alpha-tocopherol
Vitamin K Phytonadione
Vitamin B1 Thiamine
Vitamin B2 Riboflavin
Vitamin B3 Niacin
Vitamin B5 Pantothenic Acid
Vitamin B6 Pyridoxine
Vitamin B7 Biotin
Vitamin B9 Folic acid
Vitamin B12 Cobalamin
Viagra
Pregnancy Home Testing
USP & BP
Male Condom
Hand-fingers
Finger-split
Wrist support
Thumb support
Thigh support
Arm support
Palm support
Name of Countries…

SWITZERLAND

AUSTRIA USA(AMERICA )

DENMARK KSA (SAUDIA )

GERMAN UAE( EMIRATE )

EGYPT JORDAN

IQ(IRAQ)-------IR(IRAN) AUSTRIA (namsa)

The best known pharma industrial companies
Prescription
 Prescriptions should be written legibly in ink or
otherwise so as to be should be dated, should state
the name and address of the patient, the address of
the prescriber, an indication of the type of
prescriber, and should be signed in ink by the
prescriber (computer-generated signatures do not
meet the legal requirement). The age and the date
of birth of the patient should preferably be stated ,
also should be write scientific name and doses and
time of giving with route of giving…
Fb & Insta/ WHO
Facebook/ KMCA
Fb/ FDA
“I am always doing that which I cannot do, in
order that I may learn how to do it.”

 Facebook/ farhang byara