Drugs 2

DRUGSDRUGS

DR MARIA KHALIQ DR MARIA KHALIQ

HOUSE OFFICER HOUSE OFFICER MU1MU1

HFHHFH

STEROIDSSTEROIDS

1.1. GLUCOCORTICOIDGLUCOCORTICOID MODE OF ACTIONMODE OF ACTION Mediated by glucocorticoid receptorsMediated by glucocorticoid receptors

Regulates the transcription of terget Regulates the transcription of terget genesgenes

EXAMPLESEXAMPLES Hydro cortisoneHydro cortisone Cortisone Cortisone Dexamethasone Dexamethasone

INDICATIONINDICATIONSS Allergic reactions:Allergic reactions: Angioneurotic edema,asthma,bee Angioneurotic edema,asthma,bee

stings,stings, allergic rhinitisallergic rhinitis Collagen vascular disorer:Collagen vascular disorer: Rheumatoid arthritis,Temporal Rheumatoid arthritis,Temporal

arthritisarthritis lupus erythemetosislupus erythemetosis Eye disorders:Eye disorders: Acute uveitis,allergic Acute uveitis,allergic

conjunctivitisconjunctivitis Gastrointestinal disease:Gastrointestinal disease: IBD, nontropical sprueIBD, nontropical sprue

Infections:Infections: gram negativwe septicemiagram negativwe septicemia Neurological disorders;Neurological disorders; Cerebral edema , multiple sclerosisCerebral edema , multiple sclerosis Pulmonary disease:Pulmonary disease: Aspiration pneumonia,bronchial Aspiration pneumonia,bronchial

asthmaasthma sarcoidosissarcoidosis Renal disorders:Renal disorders: Nephrotic syndromeNephrotic syndrome Skin diseases:Skin diseases: Atrophic dermatitis, dermatosis , Atrophic dermatitis, dermatosis ,

xerosisxerosis

SIDE EFFECTSSIDE EFFECTS

Iatrogenic cushing syndrome:Iatrogenic cushing syndrome:

weight gain, muscle wasting, weight gain, muscle wasting, thiningthining

of skin, skin striae, bruising, of skin, skin striae, bruising,

osteoprosis, hyperglycemia, osteoprosis, hyperglycemia, diabetesdiabetes

Increased risk of infectionsIncreased risk of infections

Peptic ulcerationPeptic ulceration

Psychosis Psychosis

DepressionDepression

CONTRAINDICATIONSCONTRAINDICATIONS

Given with great caution in patients with Given with great caution in patients with pepticpeptic

ulceration,heart ulceration,heart disease,hypertention,diabetes, disease,hypertention,diabetes, osteoprosis,glaucoma,herpes osteoprosis,glaucoma,herpes simplex infectionsimplex infection

2. MINRELOCORTICOIDS:2. MINRELOCORTICOIDS:

AldosteroneAldosterone

DeoxycorticosteroneDeoxycorticosterone

FludrocortisoneFludrocortisone

DIURETICSDIURETICS

1.1. CARBONIC ANHYDRASE CARBONIC ANHYDRASE

INHIBITORSINHIBITORS INDICATIONS:INDICATIONS:

1. Glaucoma1. Glaucoma

2. Urinary alkalinization2. Urinary alkalinization

3. Metabolic Alkalosis3. Metabolic Alkalosis

4.Acute mountain sickness4.Acute mountain sickness

SIDE EFFECTS:SIDE EFFECTS:

Hyperchloremic metabolic acidosisHyperchloremic metabolic acidosis

Renal stonesRenal stones

Renal potassium wastingRenal potassium wasting

Hypersensitivity reactions:Hypersensitivity reactions:

Fever, rash, bone marrow Fever, rash, bone marrow suppression, suppression,

interstitial nephritis.interstitial nephritis.

2.2. LOOP OF HENLE:LOOP OF HENLE: INDICATIONSINDICATIONS HyperkalemiaHyperkalemia Acute renal failureAcute renal failure Anion overdoseAnion overdose TOXICITYTOXICITY Hypokalemic Metabolic AlkalosisHypokalemic Metabolic Alkalosis OtotoxicityOtotoxicity HyperuricemiaHyperuricemia HypomagnesemiaHypomagnesemia

Allergic Reactions:Allergic Reactions:

Skin rashes, eosinophilia, Skin rashes, eosinophilia, interstitial interstitial

nephritisnephritis

CONTRAINDICATIONS:CONTRAINDICATIONS:

Used with caution in hepatic Used with caution in hepatic cirrhosis , renal cirrhosis , renal

failure and congestive heart failure and congestive heart failure.failure.

3.3. POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS

INDICATIONS:INDICATIONS:

Useful in state of mineralocorticoid Useful in state of mineralocorticoid excess:excess:

Conns syndrome, ectopic ACTHConns syndrome, ectopic ACTH

productionproduction

Useful in Secondary aldosteronism:Useful in Secondary aldosteronism:

CCF , hepatic cirrhosis, CCF , hepatic cirrhosis, nephrotic nephrotic

syndromesyndrome


HypertkalemiaHypertkalemia

Hyperchloremic Metabolic AcidosisHyperchloremic Metabolic Acidosis

GynecomastiaGynecomastia

Acute renal failureAcute renal failure

Kidney stonesKidney stones


Used with caution with Chronic Used with caution with Chronic renal failure and liver diseaserenal failure and liver disease

4. OSMOTIC DIURETICS4. OSMOTIC DIURETICS INDICATIONS:INDICATIONS:

To increase volume of urine volumeTo increase volume of urine volume

Reduction of intracranial pressureReduction of intracranial pressure

Reduction of intraocular pressureReduction of intraocular pressure


Extracellular volume expansion Extracellular volume expansion that may that may

complicate CCF, pulmory edemacomplicate CCF, pulmory edema

Dehydration and HypernatremiaDehydration and Hypernatremia

HEPARINTYPES:TYPES: Unfractioned Heparin{Standard}Unfractioned Heparin{Standard} Low molecular weight HeparinLow molecular weight Heparin

MODE OF ACTION:MODE OF ACTION: Activates prothrombin to inhibit Activates prothrombin to inhibit

procoagulant 11a, V11, 1X, X, X1. procoagulant 11a, V11, 1X, X, X1.

INDICATIONSINDICATIONS ANTICOAGULATION:ANTICOAGULATION: Treatment and prevention of DVTTreatment and prevention of DVT Pulmonary EmbolismPulmonary Embolism Unstable anginaUnstable angina Acute periphral arterial occlusionAcute periphral arterial occlusion In patients of MI to prevent:In patients of MI to prevent: Coronary reocclusion after Coronary reocclusion after thrombolysisthrombolysis Mural thrombosisMural thrombosis

SIDE EFFECTS:SIDE EFFECTS: BleedingBleeding Transient reversible alopeciaTransient reversible alopecia Osteoprosis Osteoprosis Spontaneous fracturesSpontaneous fractures Transient thrombocytopeniaTransient thrombocytopeniaCONTRAINDICATIONS:CONTRAINDICATIONS: Hypersensitivity to heparinHypersensitivity to heparin Active bleedingActive bleeding HemophiliaHemophilia ThrombocytopeniaThrombocytopenia

PurpuraPurpura

Severe hypertensionSevere hypertension

Intracranial hemorrhageIntracranial hemorrhage

Infective endocarditisInfective endocarditis

Active tuberculosisActive tuberculosis

Ulcerative lesions of GITUlcerative lesions of GIT

Threatened abortionThreatened abortion

Visceral carcinomaVisceral carcinoma

Advanced hepatic or renal diseaseAdvanced hepatic or renal disease

ATROPINEAtropine is a an Anticholinergic and Atropine is a an Anticholinergic and

AntispasmodicAntispasmodicINDICATIONS:INDICATIONS: Mydriasis and cycloplegia for Mydriasis and cycloplegia for

examination of examination of retina.retina. Prophylaxis of motion sicknessProphylaxis of motion sickness Antidoote in OPC poisoningAntidoote in OPC poisoning ParkinsonismParkinsonism Antidote in mushroom poisoningAntidote in mushroom poisoning

As pre anesthetic medication to reduce As pre anesthetic medication to reduce

secretions in upper and lower secretions in upper and lower respiratory tractrespiratory tract

Prophylaxis of motion sicknessProphylaxis of motion sickness

Urinary urgency caused by minor Urinary urgency caused by minor inflammatoryinflammatory

bladder disorderbladder disorder

Pain due to spasm of smooth muscles Pain due to spasm of smooth muscles as in as in

biliary colic, intestinal colic, renal biliary colic, intestinal colic, renal colic andcolic and

peptic ulcerpeptic ulcer

ADVERSE EFFECTADVERSE EFFECT

Dry mouthDry mouth

XerostomiaXerostomia

Nausea, vomitng, constipationNausea, vomitng, constipation

Urinary retentionUrinary retention

Blurred visionBlurred vision

PhotophobiaPhotophobia

NervousnessNervousness

CONTRAINDICATIONCONTRAINDICATION

Angle closure glaucomaAngle closure glaucoma

Urinary retentionUrinary retention

Paralytic ileusParalytic ileus

ADRENALINEADRENALINEAdrenaline is a sympathomimmetic drugAdrenaline is a sympathomimmetic drug

INDICATIONSINDICATIONS

Emergency management of complete Emergency management of complete heart heart

block and cardiac arrestblock and cardiac arrest

AnaphylaxisAnaphylaxis

BronchospasmBronchospasm

Chronic orthostatic hypotensionChronic orthostatic hypotension

Hypotension:Hypotension:

Due to hypovolemic shockDue to hypovolemic shock

Cardiac arrythmiaCardiac arrythmia

Neurogenic diseaseNeurogenic disease

Adverse effects of antihypertensivesAdverse effects of antihypertensives

Cardiogenic shockCardiogenic shock

Combined with local anesthesia to Combined with local anesthesia to prolong prolong

duration of infiltration of nerve blockduration of infiltration of nerve block

ADVERSE EFFECT:ADVERSE EFFECT:

AnxietyAnxiety

TremorsTremors

PalpitationsPalpitations

Headache and restlessnessHeadache and restlessness

Pulmonary edemaPulmonary edema


HypertensionHypertension

HyperthyroidismHyperthyroidism

Ischemic heart diseaseIschemic heart disease

Cardiac arrythmiasCardiac arrythmias

LIGNOCAINLIGNOCAINIt is a local anestheticIt is a local anesthetic

MODE OF ACTION:MODE OF ACTION:

Blocks activated and inactivated Na Blocks activated and inactivated Na channelschannels


Local anestheticsLocal anesthetics

Antiarrythmic in Ventricular Antiarrythmic in Ventricular fibrillation and tachycardiafibrillation and tachycardia

ADVERSE EFFECTS;ADVERSE EFFECTS;

Allergic reactionsAllergic reactions

Hearing disturbancesHearing disturbances

Slurred speechSlurred speech

ParesthesiaParesthesia

ConvulsionsConvulsions

SleepinessSleepiness

Light headednessLight headedness

ACE INHIBITORACE INHIBITORANGIOTENSIN ANGIOTENSIN

CONVERTING ENZYME CONVERTING ENZYME INHIBITORINHIBITOR

CAPTOPRILCAPTOPRIL ENALAPRILENALAPRIL LISINOPRILLISINOPRIL RAMIPRILRAMIPRIL

MODE OF ACTION:MODE OF ACTION:

Prevent salt and water retentionPrevent salt and water retention

Inhibit periphral arterial and venous Inhibit periphral arterial and venous

vasoconstrictionvasoconstriction

Inhibit activation of sympthatic Inhibit activation of sympthatic systemsystem


Congestive cardiac failureCongestive cardiac failure


ADVERSE EFFECTSADVERSE EFFECTS

Dry coughDry cough

Skin rashesSkin rashes

NeutropeniaNeutropenia

HyperkalemiaHyperkalemia

Postural hypertensionPostural hypertension

AngioedemaAngioedema

DIGOXINDIGOXINMECHANISM OF ACTION:MECHANISM OF ACTION:

Inhibits Na_K ATPase resulting in Inhibits Na_K ATPase resulting in intracellular Na accumulation resulting intracellular Na accumulation resulting in activation of Na_Ca channels causing in activation of Na_Ca channels causing increase in intracellular Ca increasing increase in intracellular Ca increasing force of contraction force of contraction

Positive ionotropic effectPositive ionotropic effect

Increases refractory period of AV nodeIncreases refractory period of AV node

INDICATIONINDICATION Congestive cardiac failureCongestive cardiac failure Atrial fibrillationAtrial fibrillation Atrial flutterAtrial flutter Paroxysmal atrial tachycardiaParoxysmal atrial tachycardia AV nodal tachycardiaAV nodal tachycardiaCONTRAINDICATIONSCONTRAINDICATIONS Cardiac temponadeCardiac temponade Constrictive pericarditisConstrictive pericarditis Hypertrophic obstructive cardiomyopathyHypertrophic obstructive cardiomyopathy Ventricular fibrillationVentricular fibrillation Ventricular tachycardiaVentricular tachycardia


Premature ventricular beatsPremature ventricular beats

Ventricular tachycardiaVentricular tachycardia

Ventricular fibrillationVentricular fibrillation

A V blockA V block

Sinus arrythmiaSinus arrythmia

Paroxysmal and non paroxysmal atrial Paroxysmal and non paroxysmal atrial tachycardiatachycardia

Anorexia,nausea,vomiting and diarrheaAnorexia,nausea,vomiting and diarrhea

Headache, fatigue, malaise, Headache, fatigue, malaise, hallusinationshallusinations

CALCIUM GLUCONATECALCIUM GLUCONATE

INDICATIONS:INDICATIONS: HypocalcemiaHypocalcemia Chronic calcium defeciency Chronic calcium defeciency RicketsRickets OsteomalaciaOsteomalacia OsteoporosisOsteoporosisCONTRAINDICATIONS:CONTRAINDICATIONS: HypercalcemiaHypercalcemia

HypercalciuriaHypercalciuria

Renal failureRenal failure

Renal calculiRenal calculi

GalactosemiaGalactosemia


NauseaNausea

DiarrheaDiarrhea

HypotensionHypotension

H2 BLOCKERH2 BLOCKERH2 RECEPTOR H2 RECEPTOR ANTAGONISTANTAGONIST

CimetidineCimetidine RanitidineRanitidine FamotidineFamotidine NizatidineNizatidine

INDICATIONINDICATION Duodenal ulcerDuodenal ulcer Benign gastric ulcerBenign gastric ulcer Reflux esophagitisReflux esophagitis Zollinger _ Ellison syndromeZollinger _ Ellison syndrome prophylaxis of stess ulcerprophylaxis of stess ulcerADVERSE EFFECTSADVERSE EFFECTS Drug interactionsDrug interactions Skin rashesSkin rashes HeadacheHeadache

INSULININSULININDICATIONINDICATION Type 1 diabetesType 1 diabetes Type 11 diabetes when hyperglycemia is Type 11 diabetes when hyperglycemia is

not not controlled with diet therapy or oral controlled with diet therapy or oral

drugsdrugs1. ULTRASHORT ACTING INSULIN1. ULTRASHORT ACTING INSULIN2. SHORT ACTING OR REGULAR INSULIN2. SHORT ACTING OR REGULAR INSULIN Indications:Indications: New cases of diabetes with New cases of diabetes with

dehydration and or ketoacidosesdehydration and or ketoacidoses

In emergencies e.g ketoacidosis or surgical In emergencies e.g ketoacidosis or surgical

operationsoperations

In all IDDM in combinition of intermediate In all IDDM in combinition of intermediate or or

long acting insulinlong acting insulin

3. INTERMEDIATE ACTING INSULIN3. INTERMEDIATE ACTING INSULIN

Indicated in stable patients usually mixed Indicated in stable patients usually mixed with with

regular insulinregular insulin

4. LONG ACTING INSULIN 4. LONG ACTING INSULIN

COMPLICATIONS OF INSULIN:COMPLICATIONS OF INSULIN:

Lipoatrophy or LipohypertrophyLipoatrophy or Lipohypertrophy

Insulin resistanceInsulin resistance

Weight gainWeight gain

Local allergyLocal allergy

HypoglycemiaHypoglycemia

Periphral edemaPeriphral edema

ORAL ORAL HYPOGLYCEMIC HYPOGLYCEMIC

DRUGSDRUGS SULPHOYLUREASSULPHOYLUREAS BIGUINIDEBIGUINIDE ALPHA GLUCOSIDASE INHIBITORALPHA GLUCOSIDASE INHIBITOR NON SULPHONYLUREAS INSULIN NON SULPHONYLUREAS INSULIN

STIMULATIONSTIMULATION PHENYLALANINE DERIVATIVEPHENYLALANINE DERIVATIVE THIAZOLIDINEDIONSTHIAZOLIDINEDIONS

SULPHONYLUREASSULPHONYLUREAS

GlibenclamideGlibenclamide

GliclazideGliclazide

GlimeprideGlimepride

GlipizideGlipizide

These agents are used in non obese These agents are used in non obese patients of diabetespatients of diabetes

MECHANISM OF ACTIONMECHANISM OF ACTION

Improves early phase of insulin releaseImproves early phase of insulin release

Reduce periphral resistence to insulin Reduce periphral resistence to insulin actionsactions

Reducing hepatic release of glucoseReducing hepatic release of glucose

ADVERSE EFFECTSADVERSE EFFECTS HypoglycemiaHypoglycemia HypersensitivityHypersensitivity GIT disturbancesGIT disturbances ObesityObesity Water intoxication and Water intoxication and

hyponatremiahyponatremia BIGUINIDEBIGUINIDE MetforminMetformin MECHANISM OF ACTIONMECHANISM OF ACTION Reduces hepatic gluconeogenesisReduces hepatic gluconeogenesis Slows down glucose absorption from Slows down glucose absorption from

GITGIT


Nausea , vomiting, diarrheaNausea , vomiting, diarrhea

Lactic acidosisLactic acidosis

CONTRAINDICATIONCONTRAINDICATION

Renal failureRenal failure

Hepatic insufficiencyHepatic insufficiency

AlcoholismAlcoholism

Cardiac failureCardiac failure

Respiratory InsufficiencyRespiratory Insufficiency

ALPHA GLUCOSIDASE INHIBITORSALPHA GLUCOSIDASE INHIBITORS

AcarboesAcarboes

MiglitolMiglitol

MECHANISM OF ACTIONMECHANISM OF ACTION

Inhibits glucose absorption from Inhibits glucose absorption from intestine intestine

Lowers the postprandial Lowers the postprandial hyperglycemiahyperglycemia


Flatulence, abdominal bloating and Flatulence, abdominal bloating and diarrheadiarrhea

BRONCHODILATORSBRONCHODILATORSSALBUTAMOLSALBUTAMOL

SALBUTAMOL is a selective Beta 2 SALBUTAMOL is a selective Beta 2 agonistagonist

INDICATIONSINDICATIONS

BronchospasmBronchospasm

Status asthmaticusStatus asthmaticus

Uncomplicated premature labourUncomplicated premature labour


Fine tremorsFine tremors

Feeling of tensionFeeling of tension

HeadacheHeadache

TachycardiaTachycardia

Periphral vasodilatationsPeriphral vasodilatations

USED WITH PRECAUTION IN:USED WITH PRECAUTION IN:

HyperthyroidismHyperthyroidism

Myocardial insuffeciencyMyocardial insuffeciency

AnginaAngina


BETA BLOCKERSBETA BLOCKERSINDICATIONSINDICATIONS HypertensionHypertension AnginaAngina ArrythmiaArrythmia Atrial fibrillation Atrial fibrillation Atrial flutterAtrial flutter Myocardial InfarctionMyocardial Infarction Anxiety and tremorAnxiety and tremor Obstructive cardiomyopathyObstructive cardiomyopathy

NITRATESNITRATESISOSORBIDE DINITRATEISOSORBIDE DINITRATE

INDICATIONSINDICATIONS Angina prophylaxisAngina prophylaxis Acute myocardial infarctionAcute myocardial infarction HypertensionHypertensionCONTRAINDICATIONCONTRAINDICATION HypotensionHypotension Marked anemiaMarked anemia Cerebral haemorrhageCerebral haemorrhage


HeadacheHeadache

DizzinessDizziness

Cerebral ischemiaCerebral ischemia

WeaknessWeakness

Orthostatic hypotensionOrthostatic hypotension

Reflex tachycardiaReflex tachycardia

Education

Drugs 2