3

2554

 3
10
2554





2554

1.

2. Antibiotics

30

3.

36

4.

51

5.

68

6.

77

7.

88

8.

98

9.

100

10.

102

11.

110

12.

115

13.

122

14.

130

15.

137

 | 1

200



1-3

1.
2. ? ?
3.
4. ? ?
5. ?
6.
7.
8.
9.
pseudoephedrine
pseudoephedrine
Bactrim Erythromycin , Penicillin

Antihistamine
Antibiotic

1.
o Antipyretic & Analgesic
o Antihistamine
o Expectorant
o Mucolytic
o Antitussive
o Nasal Decongestant
o Antibiotic

 | 2
2.
o
o
o
o
1. Antipyretic & Analgesic
1.1 Paracetamol ( Acetaminophen )
Hypothalamic heat regulatory center Antiinflammatory
( 7 ) paracetamol
Acetylcysteine powder

: 500 1000 mg.q 4-6 hr. ( Not excess 4000 mg per day )
: 10 mg/ kg/dose
Phenobarb
Temperature
1. 37.3 38.3 o C :
2. 38.4 39. o C :
3. 39.1 40 o C :
4. > 40 o C
:

1. Tablet : 325 mg , 500 mg ,

2. Syrup : 60 mg/0.6 ml ( infant ) , 120 mg/ 5 ml , 250 mg/ 5 ml
3. Suspension : 60 mg/0.6 ml ( infant ) , 120 mg/ 5 ml , 250 mg/ 5 ml

10-15 g. 25 g.
Activated
charcoal 4 . NAcetylcysteine 24 hr.

Paracetamol

1.2 Aspirin Prostaglandins

 | 3

: 325 1000 mg.q 4 hr.

: 80 - 100 mg/ kg/dose

1. Tablet : 60 mg. , 300 mg , 500 mg ,

2. Suppository : Aspirin suppository ( Grain II)
1.3 Ibuprofen Aspirin Ibuprofen
Paracetamol , Aspirin

: 400 mg. t.i.d

: 5 mg/ kg/dose < 39 o C q. 6-8 hr.
: 10 mg/ kg/dose > 39 o C q. 6-8 hr.

1. Tablet : 200 mg , 400 mg , 600 mg.

2. Suspension : 100 mg/ 5 ml

SLE

2. Antihistamine -

1. Histamine
2.
3. 50 60 %
4. Antihistamine shock
3
2.1 Classic antihistamine
a. permeability

 | 4
Drug
Chlorpheniramine
Tablet : 2 mg , 4 mg
Syrup : 2mg/5 ml
Brompheniramine
Tablet : 4 mg
Elixir : 2 mg/ 5 ml
Tripolidine
Tablet : 2.5 mg+ Pseudoephedrine HCl
60 mg
Syrup : 1.25 mg +
Pseudoephedrine HCl 30 mg/5 ml

Dose

Trade Name

1 Tab q 6 hr.
0.35 mg / kg/ dose 3- 4

Piriton
Chloreate , Chlorphen

1 Tab q 6 hr.
0.125 mg / kg / dose q 6 hr

Dimetane , Rhinophen C
Dimetapp

1 Tab q 6 hr

Actifed , Nasolin
Profed , Sulidine
Actifed syrup , Sulidine syrup
Nasolin syrup

2 5 year : 1 tsp t.i.d

6 12 year : 1- 2 tsp t.i.d

b.
- Diphenhydramine
Capsule : 25 mg ( Benadryl ) 1 cap t.i.d
Syrup : 125 mg / 5 ml ( Benadryl syrup ) 5 mg/kg/dose 3
( )
c. ( motion sickness )


30
- Dimenhydrinate ( Dramamine )

Tablet : 50 mg

: 1 tab q 6 hr.
: 2 - 5 year : 12.5 25 mg q 6 hr.
: 6 -12 year : 25 50 mg q 6 hr.
d. ( )
- Hydroxyzine ( Atarax , Atalog , Cerax , Hizin )

Tablet : 10 mg , 25 mg
Syrup : 5 mg/ 5 ml

: 10 mg. t.i.d
: 0.6 mg/kg/dose q 6 hr.

 | 5
e.
- Cyproheptadine ( Periactin )

Tablet : 4 mg

antihistamine : 4 20 mg / dose 8 .
: 4 mg hs
Growth hormone
2.2 Non Sedative Antihistamine
- Astemizole ( Hismanal , Tenon )

Tablet : 10 mg

1 tablet OD
-

Loratadine ( Clarityne , Lorsedin , Clarinose )

Tablet : 10 mg
Syrup : 5 mg/ 5 ml

: 1 tablet OD
30 : 2 tsp OD
30 : 1 tsp OD

Cetirizine ( Zyrtec , Fatec , Allertec )

Tablet : 10 mg
Syrup : 1 mg/ ml

: 10 mg OD
6 : 10 mg OD
2 6 : 5 mg OD or 2.5 mg b.i.d.
** onset antihistamine
dose

Side effect : sedative ( )

1. Diphenhydramine
2. Dimenhydrinate
3. Hydroxyzine
4. Cyproheptadine
5. Tripolidine
6. Doxylamine
7. Cinnarizine

 | 6
8.
9.
10.
11.
12.
13.

CPM
Brompheniramine maleate
Mebhydrolin napadisylate
Astimizole
Terfenadine
Loratadine

3. Nasal decongestant
histamine (
histamine receptor )


2
nasal decongestant



5
3.1

3-5
a. 6
- Oxymetazoline HCl 0.025 % ( Iliadine Merck 0.025 % )
: 1 -2 2-3
onset
rebound
Ephedrine 0.01 %
rebound
b. 6
- Oxymetazoline HCl 0.05 % ( Iliadine Merck 0.05 % )
- Xylometazoline 1 mg ( Otrivin )
: 2- 3 4- 6 .
1- 2 4- 6 .
c.
- Tymazoline HCl ( Pernazene )

 | 7
-

Naphazoline HCl 1 mg Chlorprophenpyridamine maleate 2.5 mg

( Nasol )
- Oxymetazoline ( Iliadine )
1-2 puff 2-3 6 .
Steroid nasal decongestant
steroid

steroid nasal
decongestant nasal decongestant
steroid
- Budesonide 100 , 200 mcg/puff ( Rhinocort Aqua )
- Beclomethazone 50 mcg/puff ( Beconase )
- Fluticasone proprionate 0.05 % w/w ( Fixonase )
- Mometasone fuorate 50 mcg/dose ( Nasonex )
3.2
- Pseudoephedrine HCl 60 mg ( maxiphed )
: 60 mg t.i.d.
: 4 mg/kg/dose 4-6

- Tripolidine HCl + Pseudoephedrine HCl

- Brompheniramine mallet + Phenylephrine HCl
- Loratadine + Pseudoephedrine ( Clarinase ) 1 tab OD

1.
2.
3.
4.
4. ( Antitussive )




- Dextromethrophan HBr ( Romilar , Terco D )

 | 8

Tablet : 15 mg
Syrup : per 5 ml each contain
Dextromethrophan HBr 15 mg
Ammonium Chloride 90 mg
Dexpanthenol
50 mg
: 15-30 mg t..q.i.d. max dose 120 mg/day
: 1 mg/kg/dose 3-4

Codeine



Euphoria

Tablet : 15 mg
Syrup : per 5 ml each contain
Dextromethrophan HBr 15 mg
Ammonium Chloride 90 mg
Dexpanthenol
50 mg

: 15-30 mg t..q.i.d. max dose 120 mg/day

: 1 mg/kg/dose 3-4

Diphenhydramine
histamine

: 15-30 mg. t.q.i.d.
: 1 mg/kg/Dose 3-4

- Na dibunate ( Becantex DS ) 400 mg

- Clobutinol ( Silomat ) 40 mg
( Brown mixture ) Opium

1. Bronchodilator
Terbutaline , Aminophilline , Salbutamol
Antihistamine
5. Expectorant

 | 9
-

Glyceryl Guaiacolate
Ammonium Chloride

6. Mucolytic
cilia

mucopolysaccharides DNA
disulfide bond


1. (hydration)
2. pH NaHCO3
3. disulfide bond acetylcysteine
4. mucopolysaccharide fibers bromhexine

acetylcysteine,methylcysteine,carbocysteine bromhexine
acute & chronic respiratory disease
bronchitis,asthma
Acetylcysteine (N-acetyl cysteine)

Acetylcysteine free sulfhydryl group (-SH) disulfide linkage

mucopolysaccharide mucopolysaccharide

deacetylate cysteine amino acid

(bronchoconstriction)

- methylcysteine carboxymethyl cysteine

 | 10
Bromhexine hydrochloride

acid mucopolysaccharide

(Mucolytic)
N-acetylcysteine
(Flumicin Acetin )
>6

200 mg 3
2-6
200 mg 2

Carbocysteine
Bromhexine
(Flemex)
(Bisolvon)
750 mg tid 8-16 mg tid
1.5 mg
2-4 mg tid
2-5 62.5-125 mg qid
6-12 250 mg tid

antihistamine , decongestant

antihistamine histamine
H1-receptor 2 sedative antihistamine non
sedative antihistamine
decongestant 2 alpha receptor
alpha beta receptor

2

rebound congestion
3
2 (1) narcotic antitussive
(2) non narcotic analgestic

 | 11
cilia
acute & chronic respiratory
disease bronchitis,
asthma acetylcysteine,carbocysteine bromhexine
7. Antibiotic
Penicillin V

Phenoxymethyl Penicillin

Pen-V Atlantic, Fenocin, Pen-V, General Drugs House

Streptococcal,
Pharyngitis
Otitis media
bacterial endocarditis
Pneumococcal
Staphylococcal
Fusospirochetosis of the oropharynx

Pharmacokinetics
Absorption
Pen V Pen G acid and
potassium salt Pen G GI tract 60-73 %
single dose Pen V Pen V potassium Pen V potassium peak serum
concentrations Pen V ( peak serum concentration 30-60 )
GI tract peak serum concentrations Pen V
2 5 peak serum
concentrations AUC ( area under the serum concentration time curve ) Pen V
potassium
Distribution
Pen V distribute ascitic, synovial, pleural pericardial fluide

 | 12
bile, tonsils, maxillary, sinus secretions and saliva CSF
Protein binding 75-89 % placenta
Elimination serum T1/2 0.5 .
Pen V Pen V potassium oral metabolize penicilloic acid
( inactive ) 35-90 %
6-APA ( 6aminopenicillanic acid )
hydroxylate active metabolite 1
single dose Pen V Pen V potassium 26-65
% unchanged drug metabolite 68 . 32 %
renal clearance Pen V delay neonate young infants
Pen V remove hemodialysis peritoneal dialysis

125-500 mg 4
(creatinine clerance < 10 ml/min) 250 mg 6 .
25-50 mg /kg/ 6-8 .

Penicillin V potassium tablets powders

15-30 c
2-8 c 14

 | 13
Ampicillin

Ampicillin

Amilin, Ampat, Ampexin, Ampicillin Pharmacia, Ampicyn

meningitis N-meningitis gram-possitive
Pharmacokinetics
Absorption
fasting adults- anhydrous ampicillin ampicillin trihydrate
30-55 % GI tract
oral peak serum concentrations 1 .
maximum serum concentration 2 .
peak serum concentrations AUCs oral
anhydrous ampicillin ampicillin trihydrate
ampicillin 500 mg- 2 g
GI tract nonlinear dosage and peak serum
concentrations or AUCs ampicillin
GI tract rate extent
ampicillin sodium IM peak serum concentrations
oral
serum ampicillin concentrations T1/2

premature full-term neonates 6 serum concentrations

full-term neonates 6
Distribution

1-12 g 4-6 .
50-200 mg /kg/ 4-6 .

7 2,000 g - 100 mg /kg/ 6 . (meningitis 200 mg /kg/)

 | 14
7 2,000 g - 75 mg/kg/ 8 . (meningitis 150 mg/kg/)
7 2,000 g - 75 mg/kg/ 8 . (meningitis 150 mg/kg/)
7 2,000 g - 50 mg/kg/ 12 (meningitis 100 mg/kg/)

penicillin
mononucleosis

7 ( 25 77
)

Polyclox

Ampicillin 250 mg + Cloxacillin 250 mg

Ampiclox

Ampicillin 250 mg + Cloxacillin 250 mg

Ampiplus

Ampicillin 250 mg + Dicloxacillin 250 mg

Amoxycillin

Amoxycillin

Amoxy, Biomox, Ibiamox, AmoxilBencard, Amoxcillin

Gram-negative, Gram-possitive

 | 15
Pharmacokinetics
Absorption
74-92 % single oral dose
GI tract GI tract ampicillin peak serum concentrations
ampicillin 2-2.5
amoxicillin oral dose absorb GI tract
peak serum concentrations and AUCs linear
amoxicillin capsules, tablets oral suspension oral peak serum
concentrations 1-2 . GI tract peak serum
concentrations

500 mg 3 8 .
250 mg 3 8 .

liquid drops

hives

penicillin

 | 16

capsule tablet
liquid drops

Erythromycin

Erythromycin

ESS 400, Ericin (s), Erysil, liosone

Streptococcus,

1 .
2 .
tablets capsules controlled-release
liquid mark

tablet
Pediatric drops

3-4 7-14

, hives,

 | 17

carbamazepine,
cyclosporine, theophylline, triazolam warfarin Erythromycin

liquid
capsules, tablets pediatric drops

Co-trimoxazole

bactericidal trimethoprim ( bactericidal) sulfa (bacteriostatic)

folic acid pathway antibacterial synergism 2 step

Co-trimoxazole (trimethoprim sulfamethoxazole)

Bactrim

2-4
Pharmacokinetics
Absorption GI tract Peak serum concentration
1-2 mg/ml trimethoprim 40-60 mg/ml unbound sulfamethoxazole 160
mg trimethoprim 800 mg sulfamethoxazole Peak serum concentration
single oral dose 1-4 . multiple dose steady
state peak serum concentrations single dose 50 %
IV infusion trimethoprim 160 mg sulfamethoxazole 800 mg 8 .
mean peak steady-state serum concentrations

 | 18
trimethoprim = 9 m g/ml sulfamethoxazole 105 m g/ml
Distribution
sputum, aqueous humor, middle
ear fluid, prostatic fluid, vaginal fluid, bile CSF bronchial
secretion
Vd trimethoprim sulfamethoxazole trimethoprim Vd= 100-120 L
sulfamethoxazole 12-18 L CSF
trimethoprim sulfamethoxazole 50% 40%
middle ear fluid trimethoprim sulfamethoxazole 75% 20%

prostatic fluid trimethoprim sulfamethoxazole 200% 35%

plasma protein binding trimethoprim sulfamethoxazole 44% 70%

trimethoprim sulfamethoxazole
80% 50%
trimethoprim sulfamethoxazole 125% 10%
Elimination
trimethoprim sulfamethoxazole 8-11 1013 . 10 7.7 5.5
creatinine clearance trimethoprim sulfamethoxazole 10-30 0-10
ml/minute
chronic renal failure 3
metabolize trimethoprim metabolize oxide and hydroxylate metabolizes
sulfamethoxazole metabolize N-acetylated conjugate glucuronic
acid 2 glomerular filtration tubular secretion
trimethoprim sulfamethoxazole 50-60 % 45-70 %

mark

8 ( )

 | 19
2-3

methotrexate, phenytoin warfarin

sulfa,
G-6-PD deficiency

Tetracycline

Tetracycline

Achromycin, Dumocycline, Lenocin, Pantocycline, Servitet

Pharmacokinetics
Absorption
fasting adults 60-80 % GI tract /
50%

 | 20
IM
fasting adults oral peak serum concentrations
1.5-4 .
Distribution
pleural fluid, bronchial
secretions, sputum, saliva, ascitic fluid, synovial fluid, aqueous and vitreous humor and prostatic
and seminal fluids
serum proteins = 20-67 %
taken up reticuloendothelial cells bone marrow
CSF oral, IM, IV
biliary obstruction concurrent serum
concentrations 2-32
tumor necrotic ischemic tissue
form stable tetracycline-calcium orthophosphate complexs new bone
formation and calcification dentin and enamel complexs
antimicrobial activity
placenta maternal serum
concentrations
Elimination
serum T1/2 tetracycline = 6-12 . T1/2
multiple doses
serum concentrations tetracycline T
bile duct
T1/2
remove hemodialysis peritoneal dialysis

 | 21

8


2 . 3 .
1 . 2 .
anticoagulants warfarin, penicillin,

8.
Aminophylline

Aminophylline

Pharmacokinetics
Absorption: oral: 100 % formulation used
Distribution: Vd = 0.45 L/kg, (approximates serum concentration)
placenta
Metabolism: demethylation oxidation
Half life: , liver function, cardiac function, lung disease

 | 22
Elimination: urine 10% unchanged drug, neonates
unchanged drug ( 50%)

6, 8 12 .

()

allopurinol, cimetidine,
erythromycin, lithium, propranolol
theophylline
theophylline
ephedrine, epinephrine,
phenylephrine, phenylpropanolamine pneudoephedrine

glaucoma

 | 23

Asmeton-S

Chlorpheniramine maleate 2 mg + Methoxyphenamine HCI 12.5

mg + Aminophylline 25 mg + Noscapine 7 mg

Theophylline

Theophylline

Almarion, Asmasolon, Franol, Xanthium, Theo-Dur

Pharmacokinetics
Absorption: oral: 100 % formulation used
Distribution: Vd = 0.45 L/kg, ( approximates serum concentration)
placenta
Metabolism: demethylation oxidation
Half life: , liver function, cardiac function, lung disease

Elimination: urine 10% unchanged drug, neonates

unchanged drug ( 50%)

6, 8, 12 24 .

 | 24

( )

allopurinol, cimetidine,
erythromycin, lithium, propranolol
theophylline
theophylline
ephedrine, epinephrine,
phenylephrine, phenylpropanolamine pneudoephedrine

glaucoma

 | 25

Almasal

Theophylline 60 mg + Salbutamol sulfate 2 mg

Asianbron

Theophylline anhydrous 150 mg + Glyceryl guaiacolate 90 mg

Bronchil

Guaifenesin 90 mg + Theophylline 150 mg

Polyphed

Theophylline 150 mg + Glyceryl guaiacolate 90 mg

Theosal

Theophylline 60 mg + Salbutamol 2 mg

Terbutaline

Terbutaline

Bricanyl, Bricanyl terbuhaler, Salterline, Terbuno Vaccanyl

Pharmacokinetics

Onset of action: oral = 30-45

Protein binding : 25%
Metabolism: inactive sulfate conjugates
Half life: 11-16
Elimination :

3-4 4-6 .
30

(
)

 | 26

, drowsiness, dizziness,

, palpitations,

overactive,

MAO inhibitors (isocarboxazid,
phenelzine tranylcypromine) b-blockers (atenolol,
carteolol, esmolol, labetalol, metoprolol, nadolol, propranolol, sotalol timolol)

Bricanyl expectorant

Terbutaline sulfate 0.3 mg/ml + Guaifenesin 13.3 mg/ml

Med-Broncodil Expectorant Terbutaline sulfate 1.5 mg/5ml + Guaifenesin 66.5 mg/5ml

Terbosil Expectorant

Terbutaline sulfate 0.3 mg/ml + Guaifenesin 13.3 mg/ml

Terbron Expectorant

Terbutaline sulfate 1.5 mg/5ml + Guaifenesin 66.5 mg/5ml

Terbulin

Terbutaline sulfate 1.5 mg/5ml + Guaifenesin 66.5 mg/5ml

 | 27
Salbutamol

Salbutamol

Asmasal, Bronchosol, Butamol, Ventolin, Salmol

Pharmacokinetics
Peak effect:
Oral: 2-3 Nebulization/oral inhalation: 0.5-2
Duration of action:
Oral: 4-6 Nebulization/oral inhalation: 3-4
Metabolism: inactive sulfate ; 28% unchanged drug
Half life: Oral: 2.7-5 Inhalation: 3.8
Elimination: 30% urine unchanged drug

2-4
4-6 .
15
5-15 3-4 .

 | 28

overactive,

MAO inhibitors
(isocarboxazid, phenelzine tranylcypromine) betablockers (atenolol, carteolol, esmolol, labetalol, metoprolol, nadolol, propranolol, sotalol
timolol)

syrup

Almasal

Salbutamol sulfate 2 mg + Theophylline 60 mg

Asmasal Expectorant

Salbutamol 1 mg + Guaifenesin 50 mg

Clenil compositum

Salbutamol 100 mg + Beclomethasone dipropionate 50 mg

Theosal

Salbutamol 2 mg + Theophylline 60 mg

Ventolin Expectorant

Salbutamol sulfate 1 mg + Guaifenesin 50 mg

Ketotifen

orally active agent antihistamine antianaphylactic

Ketotifen

Amitone, Asmahoc, Katifen, Ketofen, Sykofen, Zediten

 | 29

antiasthmatic agent

sedation drowsiness
,
dizziness giddiness

1.
2.

 | 30

Antibiotics
antibiotics :
1. age ( )
2. weight
3.
4. ( underlying diseased)
antibiotic doxycycline
Penicillin, Erythromycin
5. Genetic diseased G-6-PD Deficiency antibiotic Penicillin, Erythromycin
ANB :
-

bacteriostatic bacteriocidal
Bacteriostatic
Bacteriocidal

ANB :
-

spectrum

bacteriocidal/static

absorbtion

metabolite /

ANB
1. Sinusitis
: -
ANB
:

Cotrimoxazole

2x2 pc. 7-14 days

Doxycycline

1x2 pc. 7-14 days

 | 31
Minocycline

1x2 pc. 7-14 days

Erythromycin

2x4 pc. 7-14 days

Rolid

1x2 ac./pc. 7-14 days

Cephalosporin
:
-

Antihistamine

Mexiphed
Paracetamol
Danzen

2.

: - sinusitis ANB

- H2O2

1. Cotrimmoxazole bid. 7 days

2. Doxycycline bid.
3. Amoxycillin
4. Cephalosporin 1st

eg. Cefaclor (Distaclor)

** H2O2
** Pseudoephedrine

-
-

() 4-5
: - Nizoral
- Cotrimazole ear drop
-

Tiger Thimerosal ()

 | 32

: - ANB
- Maxiphed
-

infection eg. Cinnarizine

3.
Infection :
:

Terramycin eye/ear drop (Chloram.)

Polymyxin eye drop

eg. Poly Oph

Neosfotin
Neopolycin

Cloxacillin

250 500 mg 1x4 ac. 5-7 days

: = virus
:

Chloramphenicol
Amoxicillin 2nd infection
Incidal

Non Infection :
:

Antihistamine

eg. Hista oph

Opsa-His
EYE MO
Spersallerg

:
steroid eye drop short-term virus
eg.

Spersadexoline (Chloram. / Dispersa / Dexamethasone)

Dex oph

 | 33
Opsadex
4. Cystitis
: , , ,
: , , ,
:

Acute : - Cotrimoxazole

2x2 5-7 days

- Norfloxacin

200 mg bid. 5-7 days

Chronic : - 7-14 days

-

Pyridium (Antiseptic)
- Donagan (Antispasmodic)

5.
: - Dicloxacillin

250 / 500 mg

Dicloxacillin + Cotrimoxazole
6.
-

Tetracycline
- Ampicillin / Amoxicillin / Bacampicillin
- Cotrimoxazole

Cloxacillin
- Dicloxacillin

- Cotrimoxazole + Cloxacillin
Clotrimoxazole + Metronidazole ( anaerobe )

Danzen
7. URI
(Measles / Rubeola) ()
: Koplikspots

 | 34
7

(Rubella/German measles)
:
()
(<2 yrs.)
:
:
Paracetamol

Antihistamine

Brufen

** 8 &

(Chickenpox/Varicella)
:
: ** aspirin**
Paracetamol
ANB bacteria
Antihistamine
Acyclovir
(Herpes Zoster)
: 1-2
(vesicle) (sensory nerve)
: 1-2

 | 35
Paracetamol
Antihistamine

:

:
: Prednisolone
Danzen

tid.pc.
tid.pc.

8. (Tonsillitis)
: tonsil tonsil (strep. Gr.A)
:

Penicillin group URI

Erythromycin
Cotrimoxazole
Cephalosporin
** Rheumatic fever

 | 36

1.

()

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
2.
2.1

- NaHCO3
-
-

- Hericobactor pyroli
- /
- HCl, pepsin, Gastrin

 | 37

1
2.2 ,

-
-
- ,
-
- 1-2

-
-
-

 | 38
-

2.3

- :
- ,
- :

-
-
-

1. (antacid): pH pH 4
Al(OH)3 Mg(OH)2
: 7 1-2 2 1 3

: Mg Al
*
2. (Antisecretory drug):
H2RA Cimetidine, Ranitidine
* 4
3. Proton pump inhibitor:
Omeprazole
* 4
3. Gastro-esophageal Reflux Disease (GERD)
Gastro-esophageal Reflux Disease: GERD

3.1 :

 | 39
3.2
-
-
-
- 3
-
4.
4.1
-
-
-
-
-
-
-
-
-
3
1.
2.
3.

(80-90%) morning sickness

4.2
:
- 10-15
-
- carbohydrate protein
-
: antihistamine
(dimenhydrinate)

 | 40
: antihistamine
1
:
!!! !!!
- ,
- , 1
-
5.
( )
( 200 60-80%)

5.1
5.1.1 :
1.1.1.1 :
1.1.1.2 :
- :
- : ampicillin tetracycline
- :
5.1.2 ( 7 ):
-
- :
- lactase

- (malabsorption)

-
5.2
:
:
3
:
-
-
-

 | 41
Vibrio cholera
2-3

*
: Cotrimoxazole forte, Norfloxacin, ORS

:

1. Staphylococcus aureus

2. Streptococcus 4-12

1. (Oral Rehydration Salt : ORS)

2. : kaolin, pectin, charcoal
3. : 5
ORS

- 1 750
( 750 = 1 )
- 2 750
-

- 24
-
-
-
-

 | 42

1.
2.
3.
4.



6.

1
3


6.1

1.
-
- ,
-
-
-
2.
6.2
1.
2.
3.



methylcellulose

 | 43
7.

7.1
1.


2.

3.


7.2
-
-
- Mixture carminative 1-2 3-4
-
8.



8.1
2
1. : Strongyloids
2. :

 | 44

3.2

 | 45
()
()
1






10

( )

-
-
- , , ,

14-21

 | 46




8.2
:
1. : Albendazole, Mebendazole
Albendazole Mebendazole

2. :
- : Niclosamide + Magnesium
- : Praziquantel
8.3
-
-
- : 6
-
-

9.
30
2:1
9.1

1.
2.
3.
4.
5.

 | 47
9.2

1:

2:

3:

4:

9.3

1.
-
-
-
-
-
-
2.
-
-
- 80-90%
-
3.
4.
5.
-
-
-
-
-
-
:

 | 48

10.

1-2


7-14

1.
2. 2-3
3. ,
4. Kenalog
5. 3
11.



3-4 5-7
12.

1.
2.
3. : 2
13.

 | 49

1. 1
2.
14.
2

2

2 3
2

1.
:
:
8 -10
:
2.
:
:
3.
:
:
4.
: Anthraquinone
:
:


5.
: Anthraquinone

 | 50
: Bisacodyl
:

6.
: Glucomannan
:
7.
: Glucomannan
:

8.
: Glucomannan
:
:

9.
:
:
10.
:
:
11.
:
:

 | 51

DRUG USED IN PAIN, GOUT AND ARTHRITIS
1. Drug Used in Pain

Opioid or Narcotic
Analgestics drugs

Non-Opioid
analgesics drugs

NSAIDs
Paracetamol
Pyrazolonesderivatives

Adjuvant
analgesic drugs

Anticonvulsant
Antidepressant
Antianxiety

2.Drugs Used in Gout

Acute

Chronic

Colchicine
NSAIDs
Corticosteroids

Uricosurics agent
Allopurinol

3.Drugs Used in Rheumatoid

Arthritis

Gold
compound

Antimalarial
Drugs

Methotrexate

A
n
t
i
x
i
o
l
y
t
i
c
A
n
t
i
x
i
o
l
y
t
i
c
A
n
t
i
x
i
o
l
y
t

 | 52

1. (Drug Used in Pain)

(Pain)
(pain receptors)

1. Mild pain
2. Mild to moderate pain
3. Moderate to severe pain
4. Severe pain
1, 2 non-narcotic 3,4
narcotic

(Opioid or Narcotic analgestics drugs)

Non opioid analgesic drugs
Adjuvant analgesic drugs
Non opioid analgesic drugs Adjuvant analgesic drugs
1. Non opioid analgesic drugs

1.1
NSAIDs (Non Steroidal Anti-Inflammatory Drugs)
1.2
Paracetamol Acetaminophen
1.3
Pyrazolone derivative
1.1

NSAIDs (Non Steroidal Anti-Inflammatory Drugs)

1. cyclooxygenase enzyme; COX (

) arachidonic metabolism Prostaglandin (PG)
1
2. (Mild to moderate pain)
Prostaglandins peripheral tissue
cyclooxygenase enzyme prostaglandins mediators
prostaglandins
3.
hypothalamus
prostaglandins prostaglandins
NSAIDs pyrogens

 | 53

Phospholipid
Phospholipase A2

Arachidonic acid

Lipoxygenase enzyme

Leukotrienes

HETE

Inhibit by NSAIDs

Cyclooxygenase enzyme

Thromboxane A2

Prostaglandin
s

1 arachidonic metabolism NSAIDs

4. NSAIDs Thromboxane A2
(Homeostatic effect)
(Bleeding disorder)
NSAIDs
Salicylate group Aspirin, Sodium Salicylate (Salicylate Group aspirin)
Non-salicylate group Indomethacin, Ibuprofen, Piroxicam, Nabumetone
ASPIRIN
NSAIDs Salicylate Cyclooxygenase Enzyme acetylated
enzyme enzyme (Irreversible) NSAIDs

1.
2.
3. Rheumatoid arthritis

325 650 mg 4
tablet , enteric coated tablet , rectal suppository

 | 54

1. GI bleeding

2.

Aspirin (1-2 /) aspirin

Aspirin (> 5 /)
reabsorption
Aspirin gout
3. (Acute urticaria), angioedema
anaphylaxis
4. Aspirin salicylism

5. Cyclooxygenase enzyme
Thromboxane A2
(antiplatelet aggregation) (7-11 ) aspirin 1
6.
prostaglandins prostaglandins aspirin
7. Prostaglandins Aspirin

(Intracranial Hemorrhage)
8. Prostaglandins NSAIDs
GFR Renal Blood Flow
9.

1. (Third or last trimeter)

2.
3.
4. Ryes syndrome
4.

1.
2.

 | 55

1. (Oral anticoagulant) Heparin

2. (Uricosuric agent)
3. pH Vitamin C, Ammonium chloride pH
, Antacid pH aspirin
aspirin
Non Salicylate Group

1.
Mefenamic acid Piroxicam mefenamic acid

2.

Indomethacin
3. Fenoprofen
4. ThromboxaneA2
(antiplatelet aggregation)
cyclooxygenase (reversible) Thromboxane A2

5.
NSAIDs prodrug
Sulindac, Fenbufen
enterohepatic circulation
(active form) NSAIDs
prostaglandin analog prostaglandin analog
NSAIDs PPI H2-receptor antagonist
NSAIDs (t1/2 = 1-8 )
Indomethacin, Ibuprofen, Ketoprofen,
Salicylate (low dose), Meclofenamate, Mefenamic acid, Etodolac
NSAIDs (t1/2 = 10-20 )
Fenbufen, Diflunisal, Naproxen, Sulindac, Salicylate (high dose)
NSAIDs

 | 56

Nabumetone, Piroxicam (t1/2 = 24-36 )

Phenylbutazone (t1/2 > 48 )

NSAIDs
NSAIDs
Aspirin
Indomethacin
Ibuprofen
Diclofenac
Naproxen
Meclofenamate
Tiaprofenic acid
Fenbufen
Sulindac
Diflunisal
Piroxicam
Ketoprofen
Tenoxicam
Nabumetone
Tolmetin sodium

60-100 mg/kg/d
75-200 mg/d
1200-2400 mg/d
3-4 mg/kg/d
15 mg/kg/d
3-7.5 mg/kg/d
600 mg/d
600-900 mg/d
400 mg/d
500-1000 mg/d
0.3-0.5 mg/kg/d
50-100 mg/d
20-40 mg/d
1000 mg/d
1200 mg/d

1.2

Paracetamol Acetaminophen

prostaglandins (CNS) aspirin
prostaglandins peripheral tissue () paracetamol
10
10 mg/kg 4-6

1. hypersensitivity
2. neutropenia, pancytopenia

paracetamol 10 (hepatic damage) 15

 | 57
N-acetylcysteine metabolite paracetamol
activated charcoal activated charcoal
N-acetylcysteine N-acetylcysteine
1.3

Pyrazolones Derivative
Phenylbutazone, Oxyphenylbutazone, Dipyrone

Phenylbutazone

Bone marrow suppression aplastic anemia agranulocytosis

2.

Adjuvant Analgesic
()
2.1
(Anticonvulsant)
trigeminal neuralgia, glossopharyngeal neuralgia, various neuropathies, post-herpetic neuragia
carbamazepine
2.2
Antidepressant TCA (Tricyclic antidepressant) analgesics effect
( ) psychotropic effect () Amitryptylline, Doxepine, Despiramine

2.3
(Antianxiety drugs) Benzodiazepine, Phenothiazine

1. Narcotic analgesic Mild Moderate Non

narcotic analgesic drug
2. NSAIDs
3. NSAIDs ()
1-2
NSAIDs

4.
NSAIDs
Antidepressant, Antianxiety drug
NSAIDs peptic ulcer,
paracetamol

 | 58

1. Tension Headache
80-90%

( )

Tension Headache
1.1
Aspirin Paracetamol

1.2
Tricyclic antidepressant Amitriptylline, Nortriptylline
1.3
Antianxiety drugs severe chronic pain

2.

Migraine
() 5 -10%
10-30

40
( 40-50 ) 50
2 3

( )
(Retina)
migraine 2
2.1
Antimigraine
Acute migraine attack
2.1.1 Ergotamine (Ergot Alkaloid)
drug of choice acute migraine attack serotonin
agonist alpha adrenergic receptor agonist
2 /

2.1.1.1 ergotamine tartrate caffeine

ergotamine
2 mg 1 mg 30-60 6 mg 10 mg
, IM, SC Suppository

 | 59

1.
2.
3.
4.
5.
6.
7.
2.1.1.2 Dihydroergotamine
Ergotamine (Vasoconstrictor)
Ergotamine SC, IM, IV Intranasal
spray
2.1.2

Sumatriptan
serotonin agonist ergotamine 24
ergotamine (Vasoconstriction) ergotamine
sumatriptan 6 nasal spray
tingling, flushing, burning
(Coronary Artery Disease; CAD),
Menopause, 40 CAD Hypertension, Hypercholesterolemia

2.2

Migraine Prophylaxis


3 / ergotamine

2.2.1 Beta adrenergic blocking agents Beta Blocker
intrinsic sympathomimetic activity (ISA)
Propanolol Timolol
2.2.2 Serotonin antagonist
Methylsergide ergot alkaloid 4-8 mg/d
, refractory severe migraine 16
Pizotifen, Cyproheptadine
2.2.3 Calcium channel blocker Verapamil, nifedipine, cinnarizine, flunarizine

 | 60
2.2.4 Tricyclic antidepressant Amitriptyline, Notriptyline, Doxepine
block reuptake serotonin Norepinephrine

2.
9-10
30

(Hyperuricemia)
Tophi
gout hyperuricemia

7 7.5 mg/dl
6 6.5 mg/dl
2
1. purine


Xanthine xanthine
oxidase
2. purine

metabolism purine
purine

1.
hyperuricemia (Acute gouty attack)
3 PMN chemotactic factor
phagocytosis
1.1

Colchicine

PMN Chemotactic factor PMN

Colchicine NSAIDs

 | 61
(Adverse Drug Reaction)

0.6 mg 4-6 (Maximum 4 /)

0.6 mg 1-2 /
1-2 1-2
Colchicine
1.2

NSAIDs

prostaglandins phagocytosis
Indomethacin, Ibuprofen, Naproxen, Piroxicam, Sulindac, Diclofenac
NSAIDs 5-7

1.3

Corticosteroid

, Intramuscular (IM) Intravenous (IV)

1-2
Colchicine NSAIDs IM IV
NSAIDs Colchicine
Steroid Systemic (, IM, IV) Rebound
Colchicine
2.

2.1
Uricosuric agent
Reabsorption proximal tubule

Sodium bicarbonate
2-6 pH
2.1.1

Probenecid

 | 62

Chronic gout arthritis

250 mg 2 500 mg 2
2-3
700 mg/day 4 500 mg
maximum dose 2-3 /

1. headache , anorexia ,GI upset ,nausea ,vomiting

2. dizziness, flushing, sore gums, opecia, urinary frequency, leukopenia anemia

1.
2. Blood dyscrasia uric acid kidney stones
3.
4. hypersensitivity probenecid

Reabsorption proximal tubule Methotrexate, Salicylate,

Barbiturate, Sulphonylurea
2.1.2

Sulfinpyrazone

Chronic gout arthitis 200-400 mg/ 2 1

400 mg/ 2
200 mg/ 800 mg/

1. Upset GI Disturbance

2. Rash, Blood dyscrasia

2.1.3

Benzbromarone
Reabsorption proximal
tubule allopurinol
2.2

Xanthine Oxidase Inhibitor

 | 63
xanthine oxidase enzyme Xanthine
allopurinol
2.2.1

Allopurinol

200- 300 mg/ Mild Gout

400-600 mg/ Moderate to Severe Gout
300 mg 800 mg/
(6 -12 ) 1 mg/kg/ 6 600 mg/
Allupurinol Uricosuric agent
reabsorption
7 mg%
tophi

1. purine
2. alcohol

3. Rheumatoid Arthritis
Rheumatiod Arthritis
( 3 )
(Morning Stiffness)
6 Rheumatoid Arthritis
Rheumatoid Arthritis
2
1.
(NSAIDs) Aspirin
2-3
2 NSAIDs Corticosteroid

2.
NSAIDs Corticosteriod
(Disease Modifying Antirheumatic Drugs; DMARDs) Remission inducing drug

 | 64
4

2.1

(Gold Compound)

(IM) Gold Sodiumthiomalate Gold
thioglucose Gold Sodiumthiomalate
Auranofin

Gold compound
Rhuematoid arthritis

Gold Compound

1.

Vasomotor Reaction
34

Nonvasomotor Reaction 24
2-3 Auranofin
15
2.
60-80
2-3
2-4
antihistamine steriod
3. proteinuria, nephrotic syndrome
4. Eosinphilia aplasia
2.2

(Antimalarial Drugs)
Chloroquine Hydroxychloroquine

Gold compound D-penicillamine

Retinopathy ( Chloroquine
250 mg/d Hydroxychloroquine 450 mg/d) Hydroxychloroquine

 | 65
Chloroquine

2.3

Methotrexate

Methotrexate

( ) Stomatitis (
)

2.4

Sulfasalazine

penicillamine Sulfasalazine

D-

Enteric Coated
Complete Blood Count 1-2 Sulfasalazine
2.5

D-penicillamine
Metabolite Penicillin
1

Proteinuria
Rheumatoid Arthritis
1.
2. NSAIDs

1. Tension Headache Aspirin, Paracetamol

Tricyclic antidepressant, Antianxiety drug
2. Migraine Drug of Choice Ergotamine (Ergot alkaloid)
Sumatriptan 3 / Ergot

 | 66
Beta adrenergic blocker, Serotonin antagonist
Calcium channel blocker Tricycliantidepressant
3. 2 1 Colchicine, NSAIDs
Corticosteroids Colchicine
NSAIDs Gout
Aspirin NSAIDs 5-7
Corticosteroids 2
Uricosuric agent probenecid sulfinpyrazone Reabsorption
Allopurinol
Xanthine oxidase enzyme
4. Rheumatoid arthritis 2 1
NSAIDs Aspirin 2 (DMARDs)

1.
:
:

2.

:
:
:
3.
:
:
:

4.
: Zingiber purpureum Rosc.
: ZINGIBRACEAE.
: () ()
( - )

 | 67

1. 1


2. 2 1
4 10
4 2 -
( . .)

 | 68

Urinary Tract Infection

1. Uncomplicated UTI
(dysuria) (frequent urinate)
(urgency) (suprabupic pain)

beta-lactam,
fluoroquinolones,
TMP-SMX,
nitrofurantoin fosfomycin 3-7
fluoroquinolones first-line therapy half-lives post-antibiotic effects
(Gram-negative rod, Pseudomonas, Gram-positive cocci) oral
bioavailability
ciprofloxacin gold standard UTI
4
suprabubic dysuria paracetamol
phenazopyridine (100-200 mg) BID
1 Antibiotic therapy for uncomplicated UTI in adults
Agent of Choice:
Fluoroquinolone (initial agent of choice)
Ciprofloxacin extended release (CiproXR) 500 mg po QD 3 days
Altenative First-line agents:
Fluoroquinolones (alternative)
Levofloxacin 250 mg po QD 3 days
Ofloxacin 200 mg po BID 3 days
Norfloxacin 400 mg po BID 3 days
Trimethoprim/Sulfamethoxazole* 160/800 mg po bid 3 days
Secondary alternatives:
Amoxicillin 500 mg po TID 7-10 days (known enterococcus infection only)
Nitrofurantoin 100 mg po BID 7 days
Amoxicillin-clavulanic acid 250 mg po QID 7 days
Fosfomycin One 3-g sachet orally
*
Only if E. coli resistance is < 10-20% in patient population (based on reginal resistance surveillance data)
2. Complicated UTI

immunosuppressive (urine catheter)

 | 69
uncomplicated UTI 7-14

1. Underlying anatomical urinary tract abnormality
2. Immunocompromised host (diabetes mellitus, cancer, sickle cell disease, transplant
patients)
3. Urinary tract obstruction
4. Failed outpatient management of pyelonephritis
5. Progression of uncomplicated UTI
6. Persistent vomiting
7. Renal failure
8. Suspected urosepsis
9. Age older than 60
10. Poor social situation
11. Inadequate access to follow-up
3. Upper UTI (Actue pyelonephritis)
(shaking chill)
1 3 bacteremia

(patient counseling)
1.

2. UTI , ,
defense mechanism
3.
4.
UTI
anticholinergic bethanechol
5. phenazopyridine, rifampin


Vaginitis & Vulvitis
(Physiological change)
secretion secretion

 | 70

1. (Trichomoniasis)
: secretion -
:
Tinidazole
4 tabs single dose
Naxogin 500 4 tabs single dose
Nimorazole
Tinidazole
Metronidazole 250 mg
tid. 7 days
400 mg
5 tabs./ 2 days or 2 3 tabs. 2 days

Cotrimazole 100 mg 2 tabs. OD. 3 days

500 mg single dose
Gynecon
1 tabs. OD. 7 days
Nystatin
di-iodohydroxyquinoline
Benzalkonium Cl
Albothyl
1 tabs. 7 tabs. (14 days)
Metacresolsulfonic acid
Ginetris
1 tabs. hs. 7 days
Chloramphenical
Myralact
Cloponone
2. Candida vaginitis
:
: , , , , ,
:

Cotrimazole 2 /day hs. 3 days

Canesten
Fungicon
Clotricin
Nystatin 1x2 / 10 days

Ketoconazole 1 tab. bid. 5 days

Kenazole

 | 71
Itraconazole 4 tabs. single dose
SE: N/V 2x2 1 day OR 2x1 3 days
Sporal
Candidiasis

Imidazole Cream
Canesten cream
Gentian violet 2
6 .
Brompheniramine maleate
Atarax
:
Sanaco lotion
normal flora
Candidiasis Ketoconazole 1 tab. bid 5
days

-
- Quinolone Gonorcin 400 (Norfloxacin)
Doxycycline
Estrogen Deficiency
:
:
Premarin oral
- Natural conjugated oestrogens
Premarin vaginal cream, gel
=
:
:

1. Quinolone
Norfloxacin
2. Cotrimoxazole 2x2
3. Antiseptic

- Acute 2x2
- Chronic 4x2

5-7 days
7-14 days

 | 72
Pyridium
4.Antispasmodic
:

: Lactacyd pH ( 4-5)
- Lactoserum atomizate
- Lactic acid
- Phosphoric acid to pH 3.5

Renal Failure
1. (/)
-
-

-BUN, -Clearance,

- electrolyte

: 2
1. CAPD (Continuous Ambulatory Peritoneal Dialysis)
2. Hemodialysis

2. (Acute Glomerulonophritis / AGN)
N/V

- albumin RBC
- BP
:
- Norfloxacin 200-400 mg tid
- Lasix
- BP D2
3. (Pyelonephritis)
- infection

 | 73
- 2
-
: Norfloxacin 200-400 mg tid. 7-10
- paracetamol
- Complication: BP .
4. (Renal store)
-

oxalate

oxalate

:
1.

Rowatinex 2 tid. ac.

2.

Uralyte-U stick

5. (Ureteric stone)
-

: Antispasmodic
6.

3-4 /
(Vasicular Stone)

P oxalate

Cystoscope

 | 74
Cystitis ()

1.
2.
3. Honeymoon's Cystitis
Cystitis

55

cystoscope
: . ---> cathetic
-

circumcission

1.
2.
3.
-

 | 75
-

mens.

complication

: antispasmodic
-

amoxicillin qid. 3 10

Dismenorrhea
2
-

15-25 25
25 3
1.
2.
3.

: paracetamol
ponstan
NSAID Indomethacin, Brufen, Naprosyn, Oruvail
pills (21 tabs.) 3-6 hormone Ovral, Eugynon
Amenoohea

 | 76
DUB (Disfunction Uterine Bleeding)
-

hormone estrogen progesterone imbalance bleeding

: progesterone high dose Premolute-N

Eugynon

1 tab. Tid. 5-7 days

1 tab. Tid
Ovral

mens. 2-3

: 3
Endometriosis


-

Pill 6-9

1-4
: hormone
Hyperemesis gravidarum =
:
-

Vomimox 1-2 tabs. hs.

 | 77

DRUG USED IN CONTRACEPTION

2





2

2
1. (Combined oral contraception)

1.1 Monophasic or Fixed dose pill
3
1.1.1 (High dose)
1

 | 78
1
/

Estrogen ()

Progestogen ()

Estrogen()

Ovulen

M100

Ethynodiol Diacetate 1000

2,100

Lyndiol

M75

Lynestrenol 2500

1,575

Anovlar

EE50

Norethisterone Acetate 4000

1,050

Gynovlar

EE50

Norethisterone Acetate 3000

1,050

Minilyn

EE50

Lynestrenol 2500

1,050

Ovostat

EE50

Lynestrenol 1000

1,050

Eugynon

EE50

Nogestrel 500

1,050

1.1.2 (Low dose) 50

30 35
2
2
/

Estrogen

Progestogen

Estrogen

Diane-35

EE 35

Cyproterone acetate 2000

735

Preme

EE 35

Cyproterone acetate 2000

735

Tina

EE 35

Cyproterone acetate 2000

735

Sucee

EE 35

Cyproterone acetate 2000

735

Cilest

EE 35

Norgestimate 250

735

Yasmin

EE 30

Drospirenone

630

1.1.3 (Ultralow dose) 20

3

 | 79
3

Estrogen
()

Progestogen
()

Estrogen
()

Progestogen
()

Mercilon

EE 20

DG 150

420

3,150

Meliane

EE 20

GSD 75

420

1,575

1.2 Multiphasic pills

triphasic three steps pills 4
4

Triquilar

/
Estrogen ()

Progestogen ()

EE (30x6)+(40x5)+ (10x30) LNG (50x6)+(75x5)+(10x125)

Trinordiol
EE (30x6)+(40x5)+ (10x30) LNG (50x6)+ (75x5)+(10x125)
Oilezz
EE (40x7)+(30x15)
DG (25x7)+ (125x15)
LNG=Levonorgestrel

Estrogen
Progestogen
() ()
680
1,925
680
730

1,925
2,050

2.
microdose
35

0.75


2
1. (Combined Pill
Regimens)
2. (Progestin-Only Pill Regimens)

 | 80

1.

1.1. estrogenic ( progestogen )
- 6
- 26 ()
-
-
1.2
- 4-6
-
1.3 progestonic ( estrogen )
- 4
- 30()
-
-
-
-
2. 2
2.1

2.2

3. 16
40

4. 20

6

5
20

 | 81

21 28
- 28 7 2228
- 21 7 8
21 2-3 8
- 12 (3 )

12-28 (3-7 ) 3

1. 1
2. 2 2

3. 3
4.

""

" " "" "morning after"

21 28

" " IUD

()

(unprotected sex)

1 ( 28 )

 | 82
2
(Combined Pill
Regimens : Yuzpe Method) (ethinyl estradiol)
0.1 (levonorgestrel) 0.5
(Progestin-Only Pill Regimens)
(levonorgestrel) 0.75

//

()

3
1. (Postinor)
2. (Madonna)
3. (Mary pink)

1. 2 72

2. 12
3. 2

21 28

 | 83

1
2
(2)
Engynon
2
2

Exlution
1?
1?

Nordette
3
3

Microgynon
3
3

Microgest
3
3

Anna
3
3

Marvelon
3
3

Trinordiol
4 ()
4 ()

-
-
-

1. 2-3
2
- 1
-
2
2.

3. 5

4.

 | 84
5. 20

6.
8.

1.
2.
3.
4.
5.
6.
7. 3
8.
9.

2
, ,
20

(unprotected sex)
..2539
(American College of Obstetrics and Gynecology-ACOG)

 | 85

85%

2
1. (Drug decreases effectiveness of oral
contraceptive pills)
- Amoxicillin
- Ampicillin
- Carbamazepine (Tegretol)
- Ethosuximide (Zarontin)
- Metronidazole (Flagyl)
- Phenobarbital
- Phenytoin (Dilantin)
- Primidone (Mysoline)
- Rifampin (Rifadin)
- Tetracycline
- Troglitazone (Rezulin)
- Clofibrate (Atromid-S)
- Lorazepam (Ativan)
- Oxazepam (Serax)
- Salicylates
- Temazepam (Restoril)

drug)

2. (Oral contraceptive pills potentiate effect of

- Benzodiazepines
- Beta blockers
- Caffeine
- Corticosteroids
- Theophylline
- Tricyclic antidepressants

 | 86

Humen Chorionic Gonadotrapin
(hCG) 25-50 mlU/ml immonochromatography
1 1-5 99%
3
1) (Strip style)
2) (Cassette style)

3) (Midstream style)
2

1.
2. 3

3. 1-5

1.
2.
3. 1-5

 | 87

1.
5
2. 1-5

hCG
2
() 350-850
Lutienizing Hormone (LH) 12-24
LH

1. 5
2. 3 - 5

 | 88

Family Planning and Contraception counseling
(Definition of family planning)
(Family planning)
1.
2.
3.
4.
(
, 2540)

3
1. 2
2. 2 3
3. 20

(Definition of contraception)
(Contraception)

1.

2.

3.

4. 2

 | 89

1.
2.
3.

4.

5.

6.

7.

8.

1. (Temporary contraception)

2. (Permanent contraception)
(Temporary contraception)
1. (Non-appliance methods)
1.1
(fertile period)

(Calendar method,
Calendar rhythm, Ogino-Knaus method) (Basal body temparature)
Temperature method Thermal method (Cervical mucous method, Ovulatory
method, Billings method) (Sympto-thermal method STM)
(Predictable ovulation method)
1.2
(Coital interruption)
(withdrawal)
( ,
2540)


(Fathalla, 1990)
(orgasm)

 | 90
1.3
(Coital reservation)

1.4
(Prolonged lactation)
(postpartum amenorrhea)
(anovulation)

Folicular Stimulating Hormone (FSH)
Lutinizing Hormone (LH) FSH LH
( , 2528)

2. (Barrier contraceptive methods)




2.1 (condom)

2
(natural skin condom) 0.3-0.6 ..
HIV
. (Male Condom)
sheath, prophylactic,
protective, French letter, English cap
2
1.
2

. (Female condom)

 | 91
(Polyurethane)
15
7 5.5

6.1 (King, 1999:145)

1.
2.
3.
4.

5.

6.2 (King, 1999:142)

2.2 (Vaginal diaphragm and cervical cap)

 | 92
(Diaphragm)
posterior fornix
6

(Cervical cap)

48

(Hatcher, et al., 2001)
(a)
(b)

6.3 (a) (b)(King, 1999:147)

2.3

14 6

24
(toxic shock syndrome)

2.4 (Spermicides) Nonylphenoxy-polyethoxyethanol (Nonoxynol)
(foaming tablets) (creams and jellies) (soluble
film) (Modern vaginal sponge) ( , 2540)

1

()

 | 93
3. (Intra-uterine contraceptive device)

2
1. (Lippes loop) polyethelene
(stainless steel)
2. (copper
bearing IUDs Cu IUDs) ( Tcu-380A) (hormonal releasing IUDs)
( Levonorgestrel)

(Hatcher, et al., 2001)

6.4 (King, 1999:148)

1.
2. 2-3


3.


4.


5. 1, 3, 6, 12

 | 94
4. (Contraceptive pills)
(Estrogen) (Progestogen)
(Progestins) 2
4.1. (low-dose combined oral contraceptive)
(Estrogen) (Progestogen) 21 28 (21
7 )
4.2. (progestogen-only pills) (low-dose
progestogen mini-pill) 35 (postcoital pill)

(Progestogen) (Postinor) 1 72
1 12 4 5

5. (Long-acting hormonal contraception)
5.1 (Injectable contraception)
(Progestogen) 2
( , 2540)
1. Medroxyprogesterone acetate (MPA) DMP
7
0.5 4
2. Norethisterone enanthate NET-EN (Progestogen)
60
(Prostaglandin)
Misoprostal (
(Cytotec) 200 Oxytocin (H.P.Rang, 2003)


5
1 2-3
5.2 (Contraceptive implant)
(Progesterone) (silastic)

(nonbiodegradable implants) (biodegradable implants)

7
2-3 4-6 ( , 2540)
5.3 (Vaginal contraceptive ring)

 | 95
(silastic) 50 60
7.5-9.5 (upper vagina)
( , 2540)
2
1. (Combined estrogen-progesterone ring)
(estradiol) (levonorgestrel)
6 1 5
3 1
(low dose oral contraception)
2. (progestin)
3
3.5 100
5.4



99 % 20

(.. )
( 24 ) 7

4 4 7 7

(Permanent contraception or sterilisation)

1. (Female sterilisation or tubal ligation)
(tubal ligation and
resection) 2
(minilaporotory method) laparoscope (laparoscopic
sterilization) 2 (puerperal period)
(non-puerperal period/ interval sterilisation)
(delivery room tubal sterilisation)

 | 96

( , 2540)
1. modified minilaparotomy technique
3-5 5 (pyramidalis)

2. (laparoscope)
4

(veress needle) (trocar)
2. (Male sterilisation or vasectomy)

(Vasectomy) 100

2
(Conventional technique) median raphe
1
(non-scalpel vasectomy technique)
dissecting forceps
()

6 6
48 24
10
3 15 20
(semen)
( , 2540)
1.
.

.
1-2

 | 97
. 2-5
.
2.
. Sperm granuloma

. Spontaneous recanalisation

. Sperm antibodies


(male infertility)

 | 98

Mebendazole
Fugacar tablet

500 mg

Fugacar suspension

2%

Benda tablet

500 mg

Benda syrup

100 mg / 5 ml

Albendazole
Zentel

1 200 mg

, Strongeloid

2x1

2x2

Alben tablet

200 mg

Alben

100 mg / 5 ml ( > 2 400 mg)

Niclosamide ()
Yomesan

4 0.5 g

Niclosamide
Hexin (Niclo + phenopgthalein)
Anaworm ()
Praziquantel
Pontel tablet

600 mg

o , ,

25 mg / kg tid. 1-2

20 40 mg / kg 3

 | 99
o

15 20 mg / kg 5

- Praziquantel

25 mg / kg 3 1 dose

Quinine antiinflam

Steroid

Analgesic Danzen

***

 | 100

1. Antihistamine

Sperpallerg
Hista-oph
Opsa-his
Oculosan
Opsil-a
2. steroid

steroid/denzen + antihist steroid
Prednisil
Syntophtone
Spersadexoline
Dexopph
Opsardex
Sofradex
FML-Neo
Effemoline
3. antibiotic

Bacteria

Chloramphenicol
Polymyxin B
Polyoph
Terramycin
Optin
*** Effemoline , Sofradex , Pred forte
5 miscellaneous
Catalin
Quinac

 | 101
Isoptocarpine

1. :

2. : steroid
3. : antibacterial
antihistamine

 | 102

Vitamins and Minerals

(Organic)

(Immune System)
A, C, D E B

-
-
-
-
-
-

- A 1,000 R.E. 5,000 I.U.

- A 800 R.E. 4,000 I.U.
- 1,000 R.E. 5,000 I.U.
- A 10,000 I.U.

 | 103
C

-
-
- (MUTATION)
- (SIDS)
-
-
-

- C 1,000 mg

D
2-3

- B6
()

- D 1,000 I.U

- E (OXIDATION)

-
-
-
-

 | 104
-

- E 400 I.U. 2 -
-
100 I.U. 200 I.U. 400 I.U.
- E E
E 8-12

B
B1 Thiamin

-

- (Herpes Zoster)

- 1 100 mg
- B1 B Complex (
)
- B1
- B1
- B1
-

B6 Pyridoxine

- Niacin B3

-
-
-
-

 | 105
-

- B6
- B6
B12 Cobalamin

-
-
-
-

- B12
- B12
- B12

B3 Niacin

-
-
-
-
-
-
-

- B3 100 - 2,000 mg
- 7,000-8,000 mg
B5 Pantoyhenic Acid

- Immune System

 | 106
- B5

-
-
-

- B5 2 100 mg
B Complex

-
-
-
-
- 70
B Complex

- 2
- 2 300-400 mg
3,000-5,000 mg

VITAMIN & MINERAL

Insoluble Vitamin
1.Vit A
- 8
-
-
2.Vit D
- A+D
- 1000 4000 IU
- 200000 IU
3.Vit E
-
-

 | 107
-Vit A+E
4.Vit K
- 10 20 mg
Soluble Vitamin
1.Vit B1
- 30 100 mg
2.Vit B2
- 10 25 mg
3.Vit B6
-
- blood
4. Vit B12
- 1000 g
5.Vit Combine
Prince-B-Forte
Nevamin

Neurobion
6. Vit C
- 50,100,1000 IU
-
-
MINERAL
1.Niacin 50 mg
2.Folic acid 5 mg
3.Ferrous 325 mg tid.pc.
4.Fluoride
Dose : age 0-2 yrs. 0.25 drop OD. pc.
2-3 yrs. 0.5 drop OD pc.
>3 yrs. 1.0 drop OD pc.
5.Calcium

 | 108

Ostocalcium 1tab hs
Ca-C 1000 sandoz 1tab hs
VITAMIN + MINERAL
Z-BAC
Supradyn N
Viterra-M
Stress tab + Zn
Theragram-M
VITAMIN
Obimin-AF
Nataral-E2
Prenamin
Natabec

1.Amino acid
Banner protein = Mild
Anabolic amino = Medium
KAL 1000 mg =

 | 109
2.
3.Garlic cholesterol 5 600 mg bid
4.Sun chlorella free radical
5.beta carotene / ferr radical
6.Lacithin
- memory
-
- 6 x 1200 mg / day in individual dose B6 250 mg

 | 110

DRUG USE IN CIRCULATION SYSTEM

ANTIHYPERTENSIVE DRUG
1.DIURETICS
Dose : 1 tab. OD.
-

Lasix 40mg
Moduretic 5 , 50 mg
Aldactone 50 mg
Dichlotride 50 mg
Dyazide 25 , 50 mg
2. VASODILATOR
Dose : 1 tab. OD.
Loniten 5 mg
Apresoline 10/25/50 mg
3.SYMPATHOMIMETICS DRUG
I CNS & Peripheral
Reserpine 0.1-0.5 mg SE hallucination
Aldomet 150 , 250 mg SE : , Dose : OD. tid
II 2-Blocker
Minipress 1mg/2mg bid
III -Blocker
3.1 Non selective OD. tid
*** Inderal & Blocadren long term MI
3.2 Selective 1-reception OD. tid
bronchodilator
Betaloc ** MI

 | 111
Tenormin
Concor
Spectral
IV.Combinad drug OD. - tid
Brinerdin
Iso-triranpin
Ser-Ap-Es
4.Calcium chanel blocker dose : OD. tid , SE :
Isoptin 40mg
Adalat 5mg
Adalat 10mg
Adalat retard 20mg
Nificard 10mg
Nalapine

5mg

Baypress

10mg

Plendil

5mg

Munobal

5mg

Cardepine

10mg

Herbesser

60mg

Norvase 5mg
Dynacirc 2.5mg

BP

complication

CVA

5. ACEI
Renitec

Dose : OD./bid , SE :
5/20 mg

 | 112
Accupril 5/20 mg
Capoten25 mg
Zestril

5/10 mg

Ramace 1.25/2.5/5 mg
Inhibace 0.5/2.5/5 mg
Sufrexal 20/40 mg

ANGINA PECTORIS
I.Nitrate
1. oral form
Isodil

10mg

Elantan

20 mg

Sorbitrate

10/20 mg

Peritrate 10 mg
Ismo

20 mg

** nitrate
2. Sublingual
Isordil

5 mg

Angised 500 g
3. spray = vasodilate
Isoket

375mg/15ml

Iso-MACK

1.25mg/0.09ml

4.

serious case

Nitroderm TTS5 25mg/TTS

II Miscellaneous
Vastarel 20 mg
III Ca Blocker

 | 113
Adalat
Nifedipine
CHF DRUG
Digoxin
Lanoxin

ANTIARRYTHMIC DRUG
Kinidin Durules

200 mg

Thrombus
Thrombus brain
: hyperlipidemia
Flexibility RBC flow
brain
CEREBROACTIVE DRUG
Brain accident memory

Hydergine

tid

Hydergine FAS

OD

brain
Fludilat

tid

memory , nerve flexibility RBC

Sermion tid
Nootropil

tid

Tebokan

tid

Tanakan 40 mg

 | 114
()
Duxaril

tid

Effortil

5mg

Sibelium

1-2 tab hs= migraine , 1 bid =

Stugeron
-1 * 3 = antihistamine

1.stugeron , sibilium
- hypertention , migraine ,
2. hypotention postural hypotention
:
-
- hypoglycemia
3.
Valve - vein Blood flow
Tx
/ elastic bandage
4. hypotention
Tx
ferrous sulfate tid

1.
:
:
:

 | 115

DIABETES MELLITUS
I.SULFONYLUREA
Mech : 6: insulin
Inhibit hepatic glucose production
6 :
action site of insulin = insulin
insulin receptor sensitivity
:

fibrinolytic activity
Long Acting
Diabenise

1 tab OD. ac

Intermediate acting
Glybenclamide tab 5 mg OD bid
Activity
Diamicron

bid tid max dose 4tab/d

Minidiab bid tid max dose 6 tab/d

II BIGUANIDE
Mech :

cell
Anacrobic Glycolysis

*** = DM

III INSULN
1.Fast acting
- humulin R
Onset : 1/2hr
2.Intermediatte acting
- Humulin N
Onset 1 2 hr
-Monotard HM
Onset - 1hr

 | 116
-Nordisk Retard
Onset 1.5 hr
-Humulin 70/30
Onset hr
3.Long acting duration ~ 36 hr
TOXIC GOITOR

:
hormone
Autoimmune
:
hyperactivity (hormone )


Tx : thyroid gland
-

PTU

Tapazole

50 mg
5 mg

SIMPLE GOILTOR
: thyroxine hormone ( iodine)
Thyroid gland
Tx
Eltroxine
100mcg
** dose 1 2 tabs.
Maintain hormone

 | 117

150

 | 118

131.
132.
133.
134.

135.
136.
137.
138.

139.
140.
141.
142.

143.
144.
145.
146.

147.
148.
149.
150.

Mucilage Pectin

:
:

Linalyl acetate, benzyl acetate, Linalool, geraniol


:
: 90-120 g 2 -

 | 119


Anthraquinone Barbaloin (aloe-emodin anthrone
C-10 glucoside) Polysaccharide Insulin

:
: 2X2 3

glucosinolates, isothiocyanates, alkaloids (moringine moringinine),
flavonoids (kaemferol, rhamnetin, isoquercitrin kaempferitrin), b-sitosterol

:
: 90-120 g - 1
-
:
1)

2)


3)

 | 120

Polysaccharide ganoderan A, B, C
Insulin
:
:

2-10 g
1 1 g 12 2 - 3 2 - 5
2 -

charantin Insulin
Insulin
:
: 6-15
500-1,000 mg 1-2

 | 121

Methylhydroxy chalcone polymer; MHCP Insulin
Insulin
:
: 1 1,200 mg 4
:

Picroretin Diterpenoid Tinosporan
Insulin
:
: 30-40 g

 | 122

DRUG USED IN DYSLIPIDEMIA

Normal value

- cholesterol 200 mg% (mg / dl)

- triglyceride 50 165 mg%

cholesterol

- form cpx. lipoprotein eg. Apo A

- ,
- inh. HMG reductase enz. cholesterol acetyl co-A

cholesterol value = 200 240 mg / dl

> 240 mg / dl

- Diet food
- Antihyperlipidemia drug
lab

total cholesterol

LDL Cholesterol

* LDL Cholesterol = total cholesterol - (HDL TG / 5)

(TG = triglyceride)

:
I.

Bile and Sequestrants

- Questran
* Anhydrous Cholestyramine
mech : form cpx. bile acid

4 mg / 9 gm power

bile acid Met. Cholesterol

bile acid ( bile acid , cholesterol)

cholesterol TG

- diarrhea bulk

+ toxin

- jaundice bilirubin skin form cpx. bile acid

bilirubin
II.

Nicotinic acid derivatives

 | 123
Mech :
- Nicotinic acid
dev.

SE : flushing

- Olbetam

bid. tid.

- Acipimox
* TG > cholesterol
III.

250 mg
* Hypertriglyceride

Fibrastes

Mech : - enz. Lipoprotein lipase fat

- VLDL Synthesis
- Bezalip
-Bezafibrate

OD bid
200 mg

- Bezalip (400 mg) retard

- Lopid

OD bid
-Gemfibrozil

- Lipanthyl

300, 600 mg
100 / 300 mg

- Fenofibrate
* TG & Cholesterol
* HDL level
SE : myopathy
combined Fibrate

- risk myopathy
- liver toxic

IV.

HMG CO A reductase inhibitor

Mech : inh. HMG reductase enz. (enz. cholesterol)

- Zocor

OD (high potency)
- Simvastatin

* cholesterol

10 mg

 | 124
SE : myopathy (high dose)
V.

Misellaneous

- Furselle
- Probucol

250 mg

* cholesterol
dose : 2 tabs bid pc
: drug combination :
1. I + IV

cholesterol

2. III + IV

Myopathy

3. combine
4. Ticlid

= (Antiplatelet)

Ticlopidine HCl

250 mg

(konjak) Glucomannan
50 - 60



A, D, E, K Carotenoid Beta-carotene Glucomannan

:
: 1 1 2-3

 | 125

mucilage

:
:
2 1
10 - 15

Hydroxy Citric Acid (HCA) HCA
ATP Citrate Lyase Kreb's cycle (
)





300 600 mg HCA 60-70%

 | 126
HCA 30%
1000 mg
:
: 600 mg 2 ( 300 mg 4 )
3 1


8-10 (600 mg)

anthraquinones sennoside A, B, C, D

:
: 2 2 10-15 1 5

( )

 | 127




:
: -

Linoleic acid
cholesterol LDL-C

:
: 2 (2.5 )

Capsaicin

 | 128

:
: 5 g

GLA
: 2,000-3,000 mg

Allicin cholesterol triglyceride

:
: 10 g (3-5 )
0.25 1

 | 129

:
:

: HDL
:

 | 130

(Parkinsons Disease, PD) (Neurodegenerative

Disorders)
.. 1817 Shaking Palsy
Basel Ganglia ( Caudate
putamen, Globus pallidus interna, Globus pallidus externa, Subthalamic necleus Substantia Nigra )

" (Dopamine)" Direct Indirect pathway
Basal ganglia

(Dopaminergic cells) Substantia nigra pard compecta (SNc) 60

55-60 50
Young-onset Parkinson's disease (YOPD) 40

(Neurodegenerative disorders)

55-60 50
Young-onset Parkinson's disease (YOPD)
40

50 YOPD
JP (First degree relatives)

Suvstantia nigra Substantia

nigra pard compecta (SNc) SNc
Basal ganglia Steiatum
Direct Indirect pathway Basal ganglia
(Dopaminergic cells) SNc
60%
Substantia nigra
Lewy body (inclusion) Cytoplasm
SNc, Locus coeruleus, Thalamus Cerebral cortex Lewy

 | 131
body Lewy body

SNc Dopamine
Dopamine amino acid tyrosine Tyrosine hydroxylase (TH)
TH
Monoamine oxidase(MAO) Cathechol-O-methyl transferase(COMT)
Homovanillic acid(HVA) MAO COMT

SNc
Dorsal motor nucleus of
vagus nerve Brainstem Medulla
Caudal-Rostral extension Dorsal motor
nucleus of vagus nerve, Olfactory bulb Intermediolateral column ( Stage 1, 2 )

Predromal symptoms Midbrain SNc

Temporal cortex Cerebral cortex

Basal ganglia
Basal ganglia Substantia nigra Extrapyramidal
syndrome
1. (Bradykinesia) (Hypokinesia)
2. (Rigidity)
3. (Tremor)
4. (Postural instability)
(Definite Parkinson's disease)
3 4 2 4 1
Probable parkinson's disease 2 4
1 Possible Parkinson's disease 1 4

 | 132

Pill rolling tremor 2
( Rest tremor) 4-7 Hz
40%

2 Essential tremor

(Rigidity)

Rigidity
(Bradykinesia and hypokinesia)


Akinesia
(Shuffle) (Festination)
(Gait freezing)
(Visual cues)
(Stoop)
Camptocormia
(Enblocturn)
Pull test

(Postural
hypotension) (Dementia) (Anxiety) (Visual
hallucination)

Young-onset Parkinson's disease(YOPD)

Young-onset Parkinson's disease 40
YOPD

 | 133
(Natural history)
(Better prognosis) YOPD
Dopaminergic (Motor fluctuation)
2
Dopaminergic YOPD

Substantia nigra pars compacta

Nigrostriatal dopamine Dopaminergic therapy
Levo-dopa L-dopa Levodopa Levodopa
30
Levodopa Aromatic acid decarboxylase(AADC) Catechol-O-Methyl
transferase (COMT) 2 Levodopa
Carbidopa Benserazide Peripheral decarboxylase inhibitors Levodopa
Madopar(Levodopa/ Benserazide)
Sinemet(Levodopa/ Carbidopa) Entacapone COMT (COMT inhibitor)
Comtan Tolcapone COMT inhibitor
Stalevo Levodopa, Carbidopa Entacapone
Levodopa Blood brain barrier Dopamine Dopadecarboxylase
Vesticular monoamine transporter type 2 Synaptic site
Synaptic cleft Dopamine Presynaptic site Dopamine
transporter (DAT) Dopamine Homovanillic acid COMT
Monoamineoxidase type -B (MAO-B) MAO-B
MAO-B inhibitor Selegiline Dopamine Striatum
Dopamine agonists Postsynaptic dopamine receptors
D2 D3 receptors Dopamine metabolism turnover
Levodopa Ergot dopamine agonist
Bromocriptine, Lisuride, Pergolide Cabergoline Nonergot dopamine agonists Apomorphine,
Piribedil Pramipexole Dopamine agonist Levodopa
Levodopa

 | 134
Dopaminergics Levodopa Levodopa
Half-life 1.5
Levodopa 2-3 /
Dopamine Synaptic vesicle
nigrostriatal
Dopamine Dopamine
Dopamine

Levodopa
Dopamine agonists
Motor fluctuation Dopamine
agonists Levodopa Selegiline MAO-B inhibitor
Neuroprotection Selegiline Dopamine agonists
Selegiline (Gait freezing)

Motor
fluctuations (Nonmotor manifestation)
Autonomic
Motor fluctuations 4
8 On
Levodopa
(Wearing off) (Dyskinesia)
(On-Off fluctuations)
(Freezing gait) Off
Motor fluctuations Levodopa
Levodopa

30-45

Wearing-off Motor fluctuations
3-4
Wearing off Levodopa
COMT inhibitor Entacapone Levodopa 20%
Levodopa Entacapone 200 mg

 | 135
Levodopa Dyskinesia Dyskinesia Dyskinesia
Levodopa

Dyskinesias Dyskinesia
Levodopa Levodopa-induced dyskinesia Levodopa
Peak-dose dyskinesias Diphasic dyskinesia
Parkinsonism-dyskinesia-improvement-dyskinesia-parkinsonism Punding
Dyskinesia
Peak dose Levodopa
Dyskinesia Off time Wearing off
Dopamine agonists Levodopa on time
Dyskinesia Levodopa Amantadine Dyskinesia
Atypical neuroleptics Olanzepine Clozapine Dyskinesia
Olanzapine Parkinsonism Clozapine Agranulocytosis
Clozapine
On-Off fluctuations
Off dystonia
Immediate released levodopa Levodopa dispersible
On-off fluctuations Dopamine agonists
Long-half life Dopamine
agonists

Deep brain
stimulation(DBS) DBS Lesions

DBS Lesion Pallidotomy
Transplantation DBS Food and Drug
Administration(FDA)
DBS 3 Subthalamioc nucleus (STN), Globus pallidus interna(GPi) VIM
nucleus Thalamus VIM GPi STN

Off DBS
DBS

 | 136
DBS

DBS Electrode
(Internal pulse generator) Pacemaker
4-5
2-3 DBS STN
25%
GPi
3-5 STN DBS
GPi
DBS
DBS
Nonmotor
> 80
DBS

 | 137

1-3

20%
20%

1.

 | 138

2.

3. (Antralin)


4. 3 (Calcipotriol)

3

Atopic dermatitis



, ,

,


5



( 1) ,

 | 139

1.

2. , ,
,

 | 140
3.

4.

5.
6.

1.
()
2.

3.

,
4.

5. , , , , ,

6. ,
()
3- 5
7.

8.

9.


10.
,

 | 141
10 15

11.

(Eczema Dermatitis)

(Exogenous Contact dermatitis)

(Endogenous eczema)

(Irritant contact dermatitis) Atopic dermatitis, Seborrheic
dermatitis, Discoid Number dermatitis
70-80%
(Allergic contact dermatitis)
20-30% Patch
Test

( , , )
( , , )

3
(Acute stage) ,
(subacute stage)
(Chronic stage) , (Lichenification)

1.
1.1 : Burrow 1:40 Boric Acid 3% 3-4

1.2 :

 | 142
1.3 : Salicylic Acid

2.
Antihistamine
Antihistamine
Steroid
3.

(Definition) (pilosebaceous unit)

40
(Diagnosis)
1. (Clinical criteria)
1.1 comedone (ductal hypercornification) lesion
. - closed comedone open comedone . - papule - pustule
- nodule open
comedone 1 (acne conglobata) - cyst
. Pitted scar, papulo - nodular scar, keloid
1.2
1.3 - Acne vulgaris - Acne conglobata, Acne fulminans, Pyoderma
faciale - Steroid induced acne - Chlor acne ( (Chlorinated hydrocarbon) Cosmetic acne - Endocrine acne Polycystic ovary syndrome (PCOS) - Infantile acne - Acne
excorie'e - etc.
1.4 - (mild)
- (moderate) papule pustule nodule
- (severe) papule pustule nodule cyst nodule
sinus tract
2. - endocrine acne

 | 143
- gram-negative folliculitis Bacterial culture - Pityrosporum bacterial folliculitis
pus smear and stain Gram Methylene blue - Biopsy
3. (Acne-like conditions) - Pityrosporum folliculitis - Gram
negative folliculitis - Acneiform drug eruption
1.
1.1

1.2
2-3 4-8


2. Standard treatment Mild Acne Benzoyl peroxide 2.5%-5% - Retinoic acid 0.01%-0.05% - Clindamycin 1% solution - Erythromycin 2%-4%
solution gel - Sulfur, resorcinol Clindamycin Erythromycin
Benzoyl peroxide Moderate Acne ( mild acne)
Tetracycline 500 - 1000 mg Tetracycline erythromycin 1000
mg/day Severe Acne
1. Alternative treatment
4 - 6
1.1 : synthetic retinoid (adapalene, tazarotene, isotretinoin)
comedone : 20% azelaic acid comedone
1.2 ( ) : - trimethoprim-sulfamethoxazole
amoxycillin gram negative folliculitis - doxycycline 100-200mg/d minocycline 50100mg/d tetracycline : Low dose estrogen plus cyproterone
acetate
1.3
. retinoid 13-cis-retinoic acid (Nodulo- cystic acne)

. systemic corticosteroid severe nodular acne ( 15 ./ )
1 . Intralesional steroid crystalline suspension of traimcinolone acetonide
1 - 2.5 mg./ ml. 0.05 ml. 10 mg.
systemic side effect

 | 144
2. Option - Spironolactone - Antibiotic sensitivity - Physical
agents - chemosurgery, dermabrasion,
laserbrasion, collagen injection - Chemical peeling

1. 1-4
2. 1-3
3. 4 6

4.
retinoic acid

1. Tretinoin (trans-retinoic acid, vitamin A acid) Comedolytic

. epidermal cell turnover comedone closed
comedone open comedone follicle . horny cells
horny cell comedone prophylactic
treatment . granulomatous reaction .
papillary dermis blood flow .
(new collagen) photoaging
- comedone - antibiotics -
acne cosmetica, pomade acne, oil acne and chloracne - prophylaxis
control systemic drug - 2-3 /
relapse - -
cream gel 0.01%, 0.025%, 0.05% 0.1% 1
1-2

2-3 systemic
toxicity 3-4%
2. Benzoyl peroxide 1. gram positive organism & yeast ,
P.acnes normal flora GI tract oral antibiotic normal flora
oxidise protein P.acnes 2.
epidermal mitosis acanthosis & hyperkeratosis
3. irritating effect peeling action

4. sebostatic - mild to moderate papulopustular acne comedonal
acne aquagel, alcohol acetone gel 2.5%, 4%, 5%
10% 1. 15

 | 145
2. retinoic acid 3. 4.
allergic contact dermatitis
5. 3. Topical antibiotics
- 1%
clindamycin phosphate lotion gel, 1-2% erythromycin base solution gel -
2-3 - clindamycin erythromycin
clindamycin bloody diarrhoea & colitis
erythromycin

(vehicle) 4. Azelaic acid - mild to moderate acne 20% cream 2 - 5.
Adapalene (Naphthoic acid) synthetic retinoic analoque - comedone open &
closed 0.1% gel - -
6. Topical Isotretinoin mild to moderate acne comedone
0.05% gel

1. Tetracycline - open & closed comedone comedolytics

papulopustules
P.acnes microcomedones 500-1000 ./ 1500
./ - moderate to papulopustular acne - acne conglobata - 12
- form tetracycline hydrochloride, phosphate, oxytetracycline, doxytetracycline -

() -
250 ./ 3
3-6 -
tetracycline erythromycin 1000 ./
2. Isotretinoin (13-cis-retinoic acid)
rosacea, gram negative folliculitis, dissecting cellulitis of scalp
pyoderma faciale 0.1 1 mg./kg/d.
teratogenic effect paraben paraben
preservative gelatin capsule
1

1. Cheilitis dose vaseline ointment

2. Dry skin upper arm, wrist, lower leg
scaling, icthyosiform dermatitis

 | 146
3. Ophthalmologic side effects ( contact lens) cornea
night vision
4. Hair loss, increase sunburn, skin infection
5. Sticky palms & soles
6. Friction blister
7. Musculo-skeletal symptoms arthralgia 15%
activity
8. Hyperostosis and diffuse interstitial skeletal hyperostosis(DISH)
9. Pseudotumor cerebri benign intracranial hypertension
tetracycline
10. Early epiphyseal closure 18
3. Sulfamethoxazole trimethoprim combination 160 mg. Trimethoprim, 800 mg.
Sulfamethoxazole 2 - Gram negative folliculitis
4. - Spironolactone(aldosterone antagonist) - Antiandrogen and estrogen
2 mg. Cyproterone acetate + 50 mg. Ethinyl estradiol (Diane) 2 mg. Cyproterone acetate + 35 mg.
Ethinyl estradiol (Diane 35) resistant papulopustular acne, refractory
acne conglobata irregular menstruation PCOS 25-35%
menstrual abnormality, breast tenderness & enlargement, nausea & vomiting, fluid retention,
leg edema, headache, melasma, coronary and peripheral thrombosis.

1.
2.
3.
4.
5.
6.
7.
8.

1.
: Allium sativum Linn.

 | 147
: ALLIACEAE
: ()
() ()
( - )

30-45 30-45 .
1-2.5 . 3060 .
6

1.

3-4 7
2. 5-7

2.
: Alpinia nigra (Gaertn.) B.L., Burtt
: ZINGIBERACEAE
: ()

1-2
5-11 . 20-40 .
1 .

1.
1 3-4

 | 148
7 (
2 -
)
2.
3.
Cassia alata Linn.
: LEGUMINOSAE
: ()
() ()
() (-)

1-5 4-20

3-7 . 5-15 . 4

1.

3-4 7
2.
- 1
- 12
- 3-6
120 10
3
3. 1 1 3 2
10
4.
: Piper betel Linn.
: PIPERACEAE

 | 149
: (-)
()

10-13 .
..2527 63

40,000

1. 1-2

2.
4-5
5.
: Rhinacanthus nasutus (Linn.) Kurz.
: ACANTHACEAE
: ()

0.5-1

3-12 . 1 .

()

(
) 7 34 7

 | 150
1.
: Sapindus rarak A.DC.
: SAPINDACEAE
:
(-)
(, )
()

5-10

5-12

5 4

5 1
2 - () 1
1

1.
: Centella asiatica (Linn.) Urban
: APIACEAE
: ()
(-)

10-15 .

 | 151

1
( 3-4 )
2.
: Aloe vera linn. var. chinensis (Haw.) Berg.
: ALOACEAE
: (), (

3-5 .
20-50 .

3-4

1.
2.
3.
: Gynura pseudochina
DC.var.hispida Thv.
: ASTERACEAE
:

 | 152
2.58 . 6-30 .

3-4

1.
: Curcuma longa Linn
: ZINGIBERACEAE
: () ()
(-) (-)

50-70 .
12-15 . 30-40 .
7-15.
3-4 3

50 /
mucin

1. ()
1-2
500 4

 | 153

2. 2

3. 1-2
2-3
4

1.
: Piper betel Linn.
: PIPERACEAE
: (-)
()

10-13 .
..2527 63

40,000

1. 1-2

2.
4-5

1.
: clinacanthus nutans (Burm.f) Lindau

 | 154
: ACANTHACEAE
: ()
() ()
()

0.5-1.5 . 2.5 - 13 ..
3-6 2 3.5 . 2

10-15 ()
1
()

1.
: Annona squamosa Linn.
: ANNONACEAE
: () ()
( - ), ()
(-), ()

()

10 1

 | 155
(15 ) 1 - 2
( )


1. . . :
, 2543.
2. . . ,
2542.
3. . . 2. : Text and Journal Publication, 2538.
4. . Drugs used in Pain, Headache, gout and Arthritis.
. , 2541.
5. . . 2. : , 2538.
6. Lacy C.F., Armstrong L.L., and Goldman M.P. Drug Information Handbook with International
tradenames Index American Pharmacist association 2010-2011, 19th edition. Lexi-comp, USA.
2010.