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Drugs 2

  2. 2. STEROIDS 1. GLUCOCORTICOID MODE OF ACTION Mediated by glucocorticoid receptors Regulates the transcription of terget genes EXAMPLES Hydro cortisone Cortisone Dexamethasone
  3. 3. INDICATIONS Allergic reactions: Angioneurotic edema,asthma,bee stings, allergic rhinitis Collagen vascular disorer: Rheumatoid arthritis,Temporal arthritis lupus erythemetosis Eye disorders: Acute uveitis,allergic conjunctivitis Gastrointestinal disease: IBD, nontropical sprue
  4. 4. Infections: gram negativwe septicemia Neurological disorders; Cerebral edema , multiple sclerosis Pulmonary disease: Aspiration pneumonia,bronchial asthma sarcoidosis Renal disorders: Nephrotic syndrome Skin diseases: Atrophic dermatitis, dermatosis , xerosis
  5. 5. SIDE EFFECTS Iatrogenic cushing syndrome: weight gain, muscle wasting, thining of skin, skin striae, bruising, osteoprosis, hyperglycemia, diabetes Increased risk of infections Peptic ulceration Psychosis Depression CONTRAINDICATIONS Given with great caution in patients with peptic
  6. 6. ulceration,heart disease,hypertention,diabetes, osteoprosis,glaucoma,herpes simplex infection 2. MINRELOCORTICOIDS: Aldosterone Deoxycorticosterone Fludrocortisone
  7. 7. DIURETICS 1. CARBONIC ANHYDRASE INHIBITORS INDICATIONS: 1. Glaucoma 2. Urinary alkalinization 3. Metabolic Alkalosis 4.Acute mountain sickness
  8. 8. SIDE EFFECTS: Hyperchloremic metabolic acidosis Renal stones Renal potassium wasting Hypersensitivity reactions: Fever, rash, bone marrow suppression, interstitial nephritis.
  9. 9. 2. LOOP OF HENLE: INDICATIONS Hyperkalemia Acute renal failure Anion overdose TOXICITY Hypokalemic Metabolic Alkalosis Ototoxicity Hyperuricemia Hypomagnesemia
  10. 10. Allergic Reactions: Skin rashes, eosinophilia, interstitial nephritis CONTRAINDICATIONS: Used with caution in hepatic cirrhosis , renal failure and congestive heart failure.
  11. 11. 3. POTASSIUM SPARING DIURETICS INDICATIONS: Useful in state of mineralocorticoid excess: Conns syndrome, ectopic ACTH production Useful in Secondary aldosteronism: CCF , hepatic cirrhosis, nephrotic syndrome
  12. 12. SIDE EFFECTS: Hypertkalemia Hyperchloremic Metabolic Acidosis Gynecomastia Acute renal failure Kidney stones CONTRAINDICATIONS: Used with caution with Chronic renal failure and liver disease
  13. 13. 4. OSMOTIC DIURETICS INDICATIONS: To increase volume of urine volume Reduction of intracranial pressure Reduction of intraocular pressure SIDE EFFECTS: Extracellular volume expansion that may complicate CCF, pulmory edema Dehydration and Hypernatremia
  14. 14. HEPARIN TYPES: Unfractioned Heparin{Standard} Low molecular weight Heparin MODE OF ACTION: Activates prothrombin to inhibit procoagulant 11a, V11, 1X, X, X1.
  15. 15. INDICATIONS ANTICOAGULATION: Treatment and prevention of DVT Pulmonary Embolism Unstable angina Acute periphral arterial occlusion In patients of MI to prevent: Coronary reocclusion after thrombolysis Mural thrombosis
  16. 16. SIDE EFFECTS: Bleeding Transient reversible alopecia Osteoprosis Spontaneous fractures Transient thrombocytopenia CONTRAINDICATIONS: Hypersensitivity to heparin Active bleeding Hemophilia Thrombocytopenia
  17. 17. Purpura Severe hypertension Intracranial hemorrhage Infective endocarditis Active tuberculosis Ulcerative lesions of GIT Threatened abortion Visceral carcinoma Advanced hepatic or renal disease
  18. 18. ATROPINE Atropine is a an Anticholinergic and Antispasmodic INDICATIONS: Mydriasis and cycloplegia for examination of retina. Prophylaxis of motion sickness Antidoote in OPC poisoning Parkinsonism Antidote in mushroom poisoning
  19. 19. As pre anesthetic medication to reduce secretions in upper and lower respiratory tract Prophylaxis of motion sickness Urinary urgency caused by minor inflammatory bladder disorder Pain due to spasm of smooth muscles as in biliary colic, intestinal colic, renal colic and peptic ulcer
  20. 20. ADVERSE EFFECT Dry mouth Xerostomia Nausea, vomitng, constipation Urinary retention Blurred vision Photophobia Nervousness CONTRAINDICATION Angle closure glaucoma Urinary retention Paralytic ileus
  21. 21. ADRENALINE Adrenaline is a sympathomimmetic drug INDICATIONS Emergency management of complete heart block and cardiac arrest Anaphylaxis Bronchospasm Chronic orthostatic hypotension
  22. 22. Hypotension: Due to hypovolemic shock Cardiac arrythmia Neurogenic disease Adverse effects of antihypertensives Cardiogenic shock Combined with local anesthesia to prolong duration of infiltration of nerve block ADVERSE EFFECT: Anxiety
  23. 23. Tremors Palpitations Headache and restlessness Pulmonary edema CONTRAINDICATIONS: Hypertension Hyperthyroidism Ischemic heart disease Cardiac arrythmias
  24. 24. LIGNOCAIN It is a local anesthetic MODE OF ACTION: Blocks activated and inactivated Na channels INDICATIONS: Local anesthetics Antiarrythmic in Ventricular fibrillation and tachycardia
  25. 25. ADVERSE EFFECTS; Allergic reactions Hearing disturbances Slurred speech Paresthesia Convulsions Sleepiness Light headedness
  27. 27. MODE OF ACTION: Prevent salt and water retention Inhibit periphral arterial and venous vasoconstriction Inhibit activation of sympthatic system INDICATIONS: Congestive cardiac failure Hypertension
  28. 28. ADVERSE EFFECTS Dry cough Skin rashes Neutropenia Hyperkalemia Postural hypertension Angioedema
  29. 29. DIGOXIN MECHANISM OF ACTION: Inhibits Na_K ATPase resulting in intracellular Na accumulation resulting in activation of Na_Ca channels causing increase in intracellular Ca increasing force of contraction Positive ionotropic effect Increases refractory period of AV node
  30. 30. INDICATION Congestive cardiac failure Atrial fibrillation Atrial flutter Paroxysmal atrial tachycardia AV nodal tachycardia CONTRAINDICATIONS Cardiac temponade Constrictive pericarditis Hypertrophic obstructive cardiomyopathy Ventricular fibrillation Ventricular tachycardia
  31. 31. ADVERSE EFFECT Premature ventricular beats Ventricular tachycardia Ventricular fibrillation A V block Sinus arrythmia Paroxysmal and non paroxysmal atrial tachycardia Anorexia,nausea,vomiting and diarrhea Headache, fatigue, malaise, hallusinations
  32. 32. CALCIUM GLUCONATE INDICATIONS: Hypocalcemia Chronic calcium defeciency Rickets Osteomalacia Osteoporosis CONTRAINDICATIONS: Hypercalcemia
  33. 33. Hypercalciuria Renal failure Renal calculi Galactosemia ADVERSE EFFECTS Nausea Diarrhea Hypotension
  34. 34. H2 BLOCKER H2 RECEPTOR ANTAGONIST     Cimetidine Ranitidine Famotidine Nizatidine
  35. 35. INDICATION Duodenal ulcer Benign gastric ulcer Reflux esophagitis Zollinger _ Ellison syndrome prophylaxis of stess ulcer ADVERSE EFFECTS Drug interactions Skin rashes Headache
  36. 36. INSULIN INDICATION Type 1 diabetes Type 11 diabetes when hyperglycemia is not controlled with diet therapy or oral drugs 1. ULTRASHORT ACTING INSULIN 2. SHORT ACTING OR REGULAR INSULIN Indications: New cases of diabetes with dehydration and or ketoacidoses
  37. 37. In emergencies e.g ketoacidosis or surgical operations In all IDDM in combinition of intermediate or long acting insulin 3. INTERMEDIATE ACTING INSULIN Indicated in stable patients usually mixed with regular insulin 4. LONG ACTING INSULIN
  38. 38. COMPLICATIONS OF INSULIN: Lipoatrophy or Lipohypertrophy Insulin resistance Weight gain Local allergy Hypoglycemia Periphral edema
  40. 40. SULPHONYLUREAS Glibenclamide Gliclazide Glimepride Glipizide These agents are used in non obese patients of diabetes MECHANISM OF ACTION Improves early phase of insulin release Reduce periphral resistence to insulin actions Reducing hepatic release of glucose 
  41. 41. ADVERSE EFFECTS Hypoglycemia Hypersensitivity GIT disturbances Obesity Water intoxication and hyponatremia  BIGUINIDE Metformin MECHANISM OF ACTION Reduces hepatic gluconeogenesis Slows down glucose absorption from GIT
  42. 42. ADVERSE EFFECT Nausea , vomiting, diarrhea Lactic acidosis CONTRAINDICATION Renal failure Hepatic insufficiency Alcoholism Cardiac failure Respiratory Insufficiency
  43. 43. ALPHA GLUCOSIDASE INHIBITORS Acarboes Miglitol MECHANISM OF ACTION Inhibits glucose absorption from intestine Lowers the postprandial hyperglycemia ADVERSE EFFECTS Flatulence, abdominal bloating and diarrhea 
  44. 44. BRONCHODILATORS SALBUTAMOL SALBUTAMOL is a selective Beta 2 agonist INDICATIONS Bronchospasm Status asthmaticus Uncomplicated premature labour ADVERSE EFFECTS Fine tremors
  45. 45. Feeling of tension Headache Tachycardia Periphral vasodilatations USED WITH PRECAUTION IN: Hyperthyroidism Myocardial insuffeciency Angina Hypertension
  46. 46. BETA BLOCKERS INDICATIONS Hypertension Angina Arrythmia Atrial fibrillation Atrial flutter Myocardial Infarction Anxiety and tremor Obstructive cardiomyopathy
  47. 47. NITRATES ISOSORBIDE DINITRATE INDICATIONS Angina prophylaxis Acute myocardial infarction Hypertension CONTRAINDICATION Hypotension Marked anemia Cerebral haemorrhage
  48. 48. ADVERSE EFFECTS Headache Dizziness Cerebral ischemia Weakness Orthostatic hypotension Reflex tachycardia