,

--Prostate????

#Dr_Wessam_nounou O:)
============================

Congestal , powercaps , comtrex , cold free,......

* *
Pseudoephedrine#

(Tachycardia) &

increase blood pressure

Pseudoephedrine is sympathomimetic & makes Vasoconstriction#

--->>ALPHA-receptor
, -->>

==============================

,--->>

-->>Paracetamol

.......,ex: Panadol, Adol , Abimol , Paramol

-----------------------------------------------------------------
-->>
2nd-generation antihistaminic drug

ex
Cetrizine-->>in>> Zyrtec or histazine tab#
or
Loratadine-->>in-->>Claritine or lorano tab#

<< --
===========================
---------------------------------------------------------------------------------------------------------------------

????????? ANTI-CCP
#Dr_wessam_nounou )O: )O:

Rheumatoid arthritis (':

#Anti_cyclic_Citrullinated_Peptide (anti-CCP) Antibodiess :

Anti-CCP antibodies are potentially important (: markers for diagnosis and prognosis in rheumatoid
arthritis (RA), because they:
(:

are as sensitive as, and more specific than, IgM rheumatoid factors (RF) in early and fully
established disease
(':

may predict the eventual development into RA when found in undifferentiated arthritis
):

are a marker of erosive disease in RA

(:

...
Antibiotics
!!!
) *(
...................








 ......................

.......
Macrolide ...


!!Jack of all trades ,master of none
... some
Some gram negative bacteria
Some positive bacteria
Some atypical bacteria
Some Mycobacteria
Some spirochetes
..................
Respiratory infection
.................

Clarythromin
Azithromycin
Erythromycin
Respiratory tract infection

H.Influenza
.....................
Clarythromin

H.Influenza

H.pylori
.............
Azithromycin
Respiratory tract
H.Influenza


3
Therapeutic levell
!!! 6

.....................

Mild to moderate UTI
.....................

....................

QT prolongation
ECG

..........
Ketolides
!!!
................
.... Quinolones
...............................
qluroquine
..............................
L ciprofloxacin
L M N O

Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
...........................
Gemifloxacin
...........................

DNA replicationn

DNA coiling

........................
Gram -ve
Gram +ve
Atypical bacteria
Mycobacteria
.......................
Ciprofloxacin
mild to moderate Gram - ve

Atypical
.......................
Levofloxacin /ofloxacin
coverage
ofloxacin Levofloxacin
 ciprofloxacin
severe
Streptococcal pneumonie

.....................
Moxifloxacin /Gemifloxacin

Strepto.pneumanie
penicillin resistant
Atypical bacteria
aerobic Gram -
ve
Gemifloxacin
................

Lower respiratory tract infection
Bone and joint infection
Infectious diarrhoea
UTI
skin infection
Sexually transmitted disease
!!!!
.....................
cartilage abnormality



QT interval prolongation

Cardiac arrhythmia
....................

Antacids
..
arrhythmia thyophylline
......

!!!!!!!

...................

.... Metronidazole
.............................
!!!
 .................

serum levell

oral obstacles
.........................

Anaerobic Bacteria

bacterial electrons
metabolism
....................................
mixed infection

..................................

warfarin
.................................

GIT upset
Mettalic taste
Headache dizziness prepheral neuritis
................................

clostridium difficules
vancomycin (oral
................................
... anaerobes clindamycin
.....
!! !

...........

.... sulfa drugs

............................
!!!
...........................

Target DNA &Replication
......... ......
3
Dapson
leprosy
 ........................
Sulfizoxazole
!!!!
..................

Trimethoprim sulfamexazole

Gram + ve bacteria
)(Some staph-some Strepto.pneumanie -liesteria monocytogeness

Gram - ve Bacteria
)(Some H.Influenza -some Enterobacter
!!!!
..................................
dihydropterote enzymes
folic acid
DNA replicationn

folic acid
...............................

.........................

Steven Johnson syndrome
Leucopenia
Thrombocytopenia

............
!!!
...........
.... Nitrofurantoin

.......................
!!!!

Uncomplicated urinary tract infection

Target organ
MIC
!!!

Pylonephritis UTI
.............................

E.choli
Klebsiella
Proteous
Enterocoli
Staphylococcus
Proteous
.............................
CATEGORY B FDA
hemolytic anaemia 38
favism
.............................

lung
Interstitial pneumonitis
...................................
100
..................................
!!!
.... Vancomycin
.....................
Glycopeptides

bacterial cell envelope

...............................
telavancin
................................
I.V parenteral
..............................
porinss

Gram + ve bacteria
...........
staph
MRSA
...................
Strept

Methicillin resistant Strepto.pneumanie
...........................

L.monocytogenies
 atypical Bacteria
(( )
......................
Anaerobic
c.difficille
............................
ototoxicity aminoglycosides
.............
erythematous rash red man syndrome
Slow infusion rate
.................

!!!!! .......
.............
. ... Carbapenems
....................... .........
)( spot

........................


porins 1....
2...
affinity3.....
Penicillin binding protein
........... . . .............
4
Imipenim
Meropenim
Doripenim
Ertapenim
.............................
Imipenim


Anaerobic Bacteria Gram - ve Bacteria Gram + ve
MRSA
Clostridium difficille

seizures
...............................
Doripenim
!!!
 ................................
Meropenim

............ ....................
Ertapenim
acintobacter sup pseud.aeurogenosa

...................................
cell envelope
)(
.....
!!!
...........
.... Penicillin
!!!!! ! suspense
........................
19288
37 28

.........................................
beta lactam
.........................................
bacterial cell envelope
peptidoglycan
Cell wall

)Cell membrane(inner

Penicillin binding protein PBPs
.................................

!!!!!!!


!!! P
... PP 6
Penetration
rickettesia/legionlla Atypical Bacteria
Porins

phospholipid peptidoglycan

 E.choli shigella proteus salmonella
3..
Pump efflux
P.Aeurogenosa MICC
4...
Pencillinase
beta lactam beta lactamase
!!
enteric Haemophylus Neisseria
staph

5..
PBPs
Penicillin binding protein
6....
Peptidoglycan
peptidoglycan
....................
!!!
!!! 6

Natural penicillin
Antistaphylococcal penicillin
Amino penicillin
Broad spectrum penicillin

_#

........
Natural penicillin
4
1..
) Penicillin G (benzyl penicillin
gasric acidity G


1000000 vial
2...
) Penicillin V (phenoxymethyl penicillin
oral V
3....
porcaine penicillin


4.....
Benthazine penicillin

mold
rheumatic fever

..................................

Anaerobicc spirochetes


resistant staph

Antistaphylococcal penicillin
.................................................
Antistaphylococcal penicillin
3
Naficillin
Oxacillin
Dicloxacillin

Pencillinase resistant
beta lactam

Staphylococcus aures
Staphylococcus epidermis

MRSA
MRSE
!!
PBPs
amoxicillin flucloxacillinn
ampicillin ampiflox
Natural penicillin streptococci
Gram - ve Bacteria
...........................

!!! ! Gram - ve Bacteria
!!!

!!!
amino beta lactam ring
 Gram - ve Bacteria more heterophilic
S.Enterica
E.choli
Sigella

Amoxicillin
Ampicillin
!!!!
!!!!
Beta lactamase
!!!
beta lactamase inhibitors
beta lactam ring

Amoxicillin +clavulanic acid=Augmantin
Ampicillin +sulbactam=Unacyn

!!!!!
........................


Broad spectrum penicillin
3
Ticercillin
Carbencillin
Piperacillin
side polar chain 2
Gram - ve Bacteria porins
Pencillinase
Gram + ve bacteria
!!!

Beta lactamase inhibitors
Ticercillin + clavulanic acid
Piperacillin +tazobactam
Gram - ve Bacteria Gram + ve bacteria
...............

Gram - ve Bacteria Natural penicillin

N.meningitides
H.Influenza
 ...........
Antistaphylococcal penicillin
Gram - ve Bacteria
...............

Amino penicillin
Gram - ve Bacteria
N.meningitides
H.Influenza
Gram - ve Bacteria Beta lactamase

E.choli
S.Enterica
Shigella
...................
extended spectrum penicillin
Gram - ve bacilli
P.Aeurogenosa
...................
Extended spectrum penicillin +beta lactamase inhibitors

Gram - ve Bacteria
Gram + ve bacteria
.......