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‫اﻻﺳﺘﺎﻳﻞ اﻻﻓﺘﺮاﺿﻲ اﻟﺘﺴﺠﻴﻞ‬

‫ﻣﻨﺘﺪى ﻛﻠﻴﺔ اﻟﺼﻴﺪﻟﺔ ‪ -‬ﺟﺎﻣﻌﺔ اﻟﻤﻨﺼﻮرة‬

‫اﻟﺮﺋﻴﺴﻴﺔ اﻟﻤﺤﺎﺿﺮات ﻣﺸﺎرﻛﺎت اﻟﻴﻮم اﻟﺒﺤﺚ‬

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‫‪and Toxicology‬‬

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‫أرﺷﻴﻒ إﻛﻠﻨﻴﻜﻲ ‪<2011‬ﺷﺮح ﻣﺒﺴﻂ ﻟﻠــ‪Pharmacology‬‬
‫‪BoNbOoNa 12:47 AM 19-07-2009‬‬

‫‪،‬‬ ‫اﺿﻊ ﺑﻴﻦ اﻳﺪﻳﻜﻢ ﺗﻤﻬﻴﺪ ﺟﻤﻴـﻞ ﺟﺪا ﻟﻠﻔﺎرﻣﺎﻛﻮﻟﻮﺟﻲ‬

‫ﻟﻜﻦ اﺣﺐ اوﺿﺢ ﻓﻲ اﻷول اﻧﻪ ﻣﻨﻘــﻮل ﻣﻦ ﻗﺴﻢ اﻟﻔﺮﻗﺔ اﻟﺜﺎﻟﺜﺔ ‪،‬‬

‫ﺧﻴــﺮا‬ ‫ﺻﺎﺣﺐ اﻟﻤﻮﺿﻮع ﻫﻮ دﻛﺘﻮر ‪ ، le pharmacien‬ﺟﺰاه ا‬

‫اﺗﻤﻨﻲ ان اﻟﻤﻮﺿﻮع ﻳﻔﻴﺪﻛﻢ زي ﻣﺎ اﻓﺎدﻧﻲ ‪،‬‬

‫دﻋﻮاﺗﻲ ﻟﻜﻢ ﺑﺎﻟﺘﻮﻓﻴــﻖ‬

‫‪----‬‬

‫" ﺷﻜﺮ ﺧﺎص ﻟــﺤﺒـﻴـﺒـﺘﻲ ‪ amira‬ﻋﻠﻲ اﻟﻤﺴﺎﻋﺪة ﻓﻲ اﻟﻨﻘﻞ و اﻟﺘﻨﺴﻲق "‬

‫‪le pharmacien 02:38 PM 23-09-2010‬‬

‫اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ‬ ‫ﺑﺴﻢ ا‬
 ‫اﻟﻤﻮﺿﻮع ده ﻫﻴﺒﻘﻰ ﻋﺒﺎره ﻋﻦ ﺷﺮح ﻓﺎرﻣﺎ ﻛﻮﻟﻮﺟﻰ‬
‫ﻫﻮه ﻃﺒﻌﺎ ﻣﻮﺿﻮع ﻣﻨﻘﻮوووووووووووول ﻟﻘﻴﺘﻮا ﻋﻠﻰ اﻟﻨﺖ ﺗﺤﺖ اﺳﻤﺎء ﻧﺎس ﻛﺘﻴﺮ‬
‫ﻓﻤﻌﺮﻓﺘﺶ اﺳﻢ اﻟﻠﻰ ﻋﺎﻣﻠﻮا ﻋﻠﺸﺎن اﻛﺘﺒﻮا ﺑﺲ اﺳﺎﻟﻜﻢ اﻟﺪﻋﺎء ﻟﻪ‬
‫اﻟﺤﻠﻘﺔ اﻷوﻟﻰ‬

‫أول ﺣﺎﺟﺔ ﻳﺎ ﺟﻤﺎﻋﺔ ﻻزم ﺗﻌﺮﻓﻮﻫﺎ ان ﻋﻠﻢ اﻟﻔﺎرﻣﺎ ﻫﻮ دراﺳﺔ ﻟﻜﻴﻔﻴﺔ ﺗﻌﺎﻣﻞ ﻣﺎدة ﻣﺎ ﻣﻊ اﻟﻌﻀﻮ ﻟﻜﻲ ﺗﺆدي وﻇﻴﻔﺘﻬﺎ‬
‫اﻟﻤﺎدة دﻳﻪ ﻻزم أﻋﺮف ﻋﻨﻬﺎ ﺣﺎﺟﺘﻴﻦ‬

‫)‪ (Pharmacokinetics‬وﻫﻲ ﺣﺮﻛﻴﺔ اﻟﻤﺎدة وﺗﺘﻀﻤﻦ ﻣﺎﻳﺤﺪث ﻟﻠﻤﺎدة داﺧﻞ اﻟﺠﺴﻢ إﻟﻰ ان ﻳﺘﺨﻠﺺ ﻣﻨﻬﺎ اﻟﺠﺴﻢ‬

‫)‪ (Pharmacodynamics‬وﻫﻲ ﻣﺎ ﺗﻔﻌﻠﻪ اﻟﻤﺎدة ﻓﻲ اﻟﺠﺴﻢ ﺣﻴﺚ ﺗﺆﺛﺮ ﻋﻠﻰ ﻋﻀﻮ ﻣﻌﻴﻦ‬

‫‪Pharmacokinetics‬‬
‫‪It includes Absorbtion ,Distribution ,****bolism & Excretion‬‬

‫وﻫﺬه اﻷرﺑﻊ ﻋﻤﻠﻴﺎت ﺗﻌﺘﻤﺪ ﻋﻠﻰ ﺟﺮﻋﺔ اﻟﻤﺎدة وﻣﻌﺪل اﻣﺘﺼﺎﺻﻬﺎ واﻧﺘﺸﺎرﻫﺎ ﻓﻲ اﻟﺠﺴﻢ وﻣﻌﺪل ارﺗﺒﺎط اﻟﻤﺎدة‬
‫ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم ﻓﻲ اﻟﺠﺴﻢ‬

‫‪Dose ,rate and extend of absorbtion ,distribution & binding to plasma protein and‬‬
‫‪tissues‬‬

‫وﻻﺑﺪ ان اﻟﻤﺎدة ﻋﺸﺎن ﺗﻨﺘﺸﺮ ﺧﻼل ﺧﻼﻳﺎ اﻟﺠﺴﻢ أن ﺗﻜﻮن ﻟﻬﺎ ﻧﺴﺒﺔ ذوﺑﺎن ﻓﻲ اﻟﺪﻫﻮن‬
‫)‪(lipid soluble‬‬
‫ﻃﺐ ﻟﻴﻪ ؟؟‬
‫ﻷن ﻏﺸﺎء اﻟﺨﻼﻳﺎ ﻧﻔﺴﻪ ﻋﺒﺎرة ﻋﻦ "‪ "lipid‬وﺑﺎﻟﺘﺎﻟﻲ ﻻ ﺗﻤﺮ اﻟﻤﺎدة ﺧﻼل اﻟﻐﺸﺎء إﻻ اذا ﻛﺎﻧﺖ ﺗﺬوب ﻓﻲ اﻟﺪﻫﻮن‬

‫وﻻﺣﻆ ‪..‬‬
‫‪The ability of substance to cross cell membrane determine the route of administration‬‬

‫ﺑﻤﻌﻨﻰ ان درﺟﺔ ذوﺑﺎن اﻟﻤﺎدة ﻓﻲ اﻟﺪﻫﻮن ﻳﺤﺪد ﻃﺮﻳﻘﺔ ﺗﻨﺎول اﻟﺪواء اذا ﻛﺎن ﻣﺜﻼ ﻳﺆﺧﺬ ﻋﻦ ﻃﺮﻳﻖ اﻟﻔﻢ أو ﺑﺎﻟﺤﻘﻦ‬

‫أو اذا ﻛﺎن ﻟﻪ اﻟﻘﺪرة ﻋﻠﻰ ﻋﺒﻮر ﻏﺸﺎء اﻟﻤﺦ واﻟﺬي ﻳﺴﻤﻰ"‪"BBB‬‬

‫‪Blood Brain Barrier‬‬

‫ﻷن ﻫﺬا اﻟﻐﺸﺎء ﻻ ﻳﺴﺘﻄﻴﻊ اﻟﺪواء ان ﻳﻌﺒﺮه إﻻ اذا ﻛﺎن ﻟﻪ درﺟﺔ ذوﺑﺎن ﻓﻲ اﻟﺪﻫﻮن ﻋﺎﻟﻴﺔ‬

‫ﻟﺬﻟﻚ ﻧﺠﺪ ان ﻣﻌﻈﻢ اﻷدوﻳﺔ اﻟﻠﻲ ﻟﻴﻬﺎ درﺟﺔ ذوﺑﺎن ﻓﻲ اﻟﺪﻫﻮن ﻋﺎﻟﻴﺔ ﻳﻜﻮن ﻟﻬﺎ آﺛﺎر ﺟﺎﻧﺒﻴﺔ ﻛﺜﻴﺮة ﻋﻠﻰ اﻟﻤﺦ‬
‫ﻛﺎﻟﺰﻏﻠﻠﺔ واﻟﺸﻌﻮر ﺑﺎﻟﻐﺜﻴﺎن واﻟﺪوﺧﺔ واﻟﺪوار واﻟﻨﺴﻴﺎن وﻋﺪم اﻟﺘﺮﻛﻴﺰ واﻟﻨﻮم اﻟﻜﺜﻴﺮ‬

‫ذﻟﻚ ﻷن اﻟﺪوا اﻟﺬي ﻳﻌﺒﺮ اﻟﻤﺦ ﻗﺪ ﻳﺴﺒﺐ ﺧﻠﻞ ﻓﻲ ﻛﻴﻤﻴﺎﺋﻴﺔ اﻟﻤﺦ أي ﺧﻠﻞ ﻓﻲ اﻟﻤﻮاد اﻟﺘﻲ ﺗﻔﺮز ﻓﻲ اﻟﻤﺦ‬

‫وأﻳﻀﺎ ﺗﺆﺛﺮ درﺟﺔ ذوﺑﺎن اﻟﺪواء ﻓﻲ اﻟﺪﻫﻮن ﻋﻠﻰ ﺣﺪوث‬

‫"‪ "tubular reabsorbtion‬ﻟﻠﺪواء وﻫﻲ أن ﻳﺤﺪث إﻋﺎدة اﻣﺘﺼﺎص ﻟﻠﺪواء ﻋﻦ ﻃﺮﻳﻖ ﻗﻨﻮات اﻟﻜﻠﻴﺔ ﻓﻴﺴﺒﺐ‬
‫زﻳﺎدة ﺗﺮﻛﻴﺰ اﻟﺪواء ﻓﻲ اﻟﺪم‬

‫وﻃﺒﻌﺎ اﻟﻤﻮﺿﻮع ده ﻻزم اﺣﻄﻪ ﻓﻲ اﻻﻋﺘﺒﺎر ﻋﺸﺎن اﻋﺮف اﻟﺪواء ده ﺣﻴﻌﺎد اﻣﺘﺼﺎص اد اﻳﻪ ﻣﻨﻪ ﻋﺸﺎن ﺗﺮﻛﻴﺰه‬
‫ﻣﻴﺰدش ﻓﻲ اﻟﺪم وﻳﻮﺻﻞ ﻟﻤﺮﺣﻠﺔ اﻟﺠﺮﻋﺔ اﻟﺴﺎﻣﺔ‬
‫"‪"toxic dose‬‬
‫ﻻﺣﻆ ﻣﻌﺎﻳﺎ أن ال"‪ "urine‬ﺑﺘﻜﻮن "‪ "aquas‬ﻳﻌﻨﻲ أي دواء ﻻزم ﻳﺘﺤﻮل ﻣﻦ ‪ lipid soluble‬إﻟﻰ ‪H2O soluble‬‬
‫ﺣﺘﻰ ﻳﺘﻢ إﺧﺮاﺟﻪ ﻣﻦ اﻟﺠﺴﻢ‬

‫‪-----‬‬
‫اﻟﺤﻠﻘﺔ اﻟﺜﺎﻧﻴﺔ‬
‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﻋﺒﻮر اﻟﻤﺎدة ﺧﻼل ﻏﺸﺎء اﻟﺨﻠﻴﺔ‬
‫وده ﻟﻪ أﻧﻮاع ﻛﺜﻴﺮة ﺣﺴﺐ ﺗﺮﻛﻴﺰ اﻟﻤﺎدة وﻣﺪى ﻧﻔﺎذﻳﺔ اﻟﻐﺸﺎء ﻟﻠﻤﺎدة‬

‫‪Types of passage across cell membrane‬‬

‫‪Simple diffusion‬‬
‫‪The substance passes without energy or carrier from the high concentration to the‬‬
‫‪"low concentration "passes with concentration gradient‬‬
‫ﻫﻲ ﻋﺒﻮر اﻟﻤﺎدة ﺧﻼل اﻟﻐﺸﺎء ﺑﺴﻬﻮﻟﺔ وﻻ ﺗﺤﺘﺎج إﻟﻰ ﻃﺎﻗﺔ أو ﺷﻲء ﻳﺤﻤﻠﻪ ﻣﻦ ﺧﺎرج إﻟﻰ داﺧﻞ اﻟﺨﻠﻴﺔ‬
‫وﻓﻴﻪ ﺗﻌﺒﺮ اﻟﻤﺎدة ﻣﻦ اﻟﺘﺮﻛﻴﺰ اﻟﻌﺎﻟﻲ إﻟﻰ اﻟﺘﺮﻛﻴﺰ اﻟﻘﻠﻴﻞ أي ﻓﻲ اﺗﺠﺎه اﻟﻤﺤﺘﻮى اﻟﺘﺮﻛﻴﺰي‬

‫‪Filteration‬‬
‫‪The substance is dissolved in the solvent and passes through the membrane pores‬‬
‫أي ان اﻟﻤﺎدة ﺗﺬوب ﻓﻲ اﻟﻤﺬﻳﺐ وﺗﻌﺒﺮ ﺧﻼل اﻟﺜﻘﻮب اﻟﻤﻮﺟﻮدة ﻓﻲ اﻷﻏﺸﻴﺔ‬
‫وﻫﺬه اﻟﻌﻤﻠﻴﺔ ﺗﺤﺪث ﻓﻲ أﻏﺸﻴﺔ اﻟﻜﻠﻴﺔ ﻓﻴﻤﺎ ﻳﺴﻤﻰ‬
‫"‪"glomerular filtration‬‬
‫ﻷن اﻟﺪواء ﻳﺼﻔﻰ ﻓﻲ أﻏﺸﻴﺔ اﻟﻜﻠﻴﺔ ﻟﻜﻲ ﻳﻌﺒﺮ ﻣﻊ اﻟﺴﻮاﺋﻞ اﻟﺘﻲ ﺳﻴﺘﻢ إﺧﺮاﺟﻬﺎ‬

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 ‫‪Active transport‬‬
‫‪The substance need energy and carrier to pass from the low concentration to high‬‬
‫‪"concentration "against concentration gradient‬‬
‫أي أن اﻟﻤﺎدة ﺗﻌﺒﺮ ﻣﻦ اﻟﺘﺮﻛﻴﺰ اﻟﻘﻠﻴﻞ إﻟﻰ اﻟﺘﺮﻛﻴﺰ اﻟﻌﺎﻟﻲ ﻋﻜﺲ اﺗﺠﺎه اﻟﻤﺤﺘﻮى اﻟﺘﺮﻛﻴﺰي ﻟﺬا ﻓﻬﺬه اﻟﻌﻤﻠﻴﺔ‬
‫ﺗﺤﺘﺎج إﻟﻰ ﻃﺎﻗﺔ وﺷﻲء ﻳﺤﻤﻠﻪ ﻣﻦ ﺧﺎرج إﻟﻰ داﺧﻞ اﻟﺨﻠﻴﺔ‬
‫‪Facilitated diffusion‬‬
‫‪The substance need carrier only ,and pass from high concentration to low‬‬
‫‪"concentration "with concentration gradient‬‬
‫أي أن اﻟﻤﺎدة ﻻ ﺗﺤﺘﺎج إﻟﻰ ﻃﺎﻗﺔ‬
‫ﻓﻘﻂ ﺗﺤﺘﺎج إﻟﻰ ﺷﻲء ﻳﺤﻤﻠﻬﺎ ﻣﻦ ﺧﺎرج إﻟﻰ داﺧﻞ اﻟﺨﻠﻴﺔ وﺗﺴﺮي ﻓﻲ اﺗﺠﺎه اﻟﻤﺤﺘﻮى اﻟﺘﺮﻛﻴﺰي ﻣﻦ اﻟﺘﺮﻛﻴﺰ‬
‫اﻷﻋﻠﻰ إﻟﻰ اﻟﺘﺮﻛﻴﺰ اﻷﻗﻞ ﻟﺬا ﻓﻴﻄﻠﻖ ﻋﻠﻴﻬﺎ ﻋﻤﻠﻴﺔ ﻣُ َﺴ ّﻬﻠﺔ ﻷﻧﻪ ﺗﻢ ﺗﺴﻬﻴﻠﻬﺎ ﻋﻦ ﻃﺮﻳﻖ اﻟﺤﺎﻣﻞ ﺑﺎﻟﺮﻏﻢ ﻣﻦ أﻧﻬﺎ ﺗﻌﺒﺮ‬
‫ﻓﻲ اﺗﺠﺎه اﻟﻤﺤﺘﻮى اﻟﺘﺮﻛﻴﺰي‬

‫‪Pinocytosis‬‬
‫‪The substance is absorbed through invagination of part of cell membrane then‬‬
‫‪releasing inside the cell‬‬
‫أي أن اﻟﻤﺎدة ﺗﻤﺘﺺ ﻛﺎﻟﺘﺎﻟﻲ‬
‫ﻳﺘﻘﻮس ﻏﺸﺎء اﻟﺨﻠﻴﺔ إﻟﻰ اﻟﺪاﺧﻞ وﻳﻌﻤﻞ ﻛﺄﻧﻪ ﻳﺒﺘﻠﻊ اﻟﻤﺎدة وﻳﺰﻳﺪ اﻟﺘﻘﻮس ﺣﺘﻰ ﻳﺤﻴﻂ ﺑﺎﻟﻤﺎدة ﻛﻠﻬﺎ ﺛﻢ ﻳﻔﺘﺢ‬
‫ﻓﺘﺤﺔ ﻣﻦ ﻧﺎﺣﻴﺔ داﺧﻞ اﻟﺨﻠﻴﺔ وﺗﻌﺒﺮ اﻟﻤﺎدة إﻟﻰ اﻟﺪاﺧﻞ‬
‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻌﻤﻠﻴﺔ دﻳﻪ ﻣﻮﺿﺤﺔ ﻓﻲ اﻟﺼﻮرة اﻟﺘﺎﻟﻴﺔ‬
 ‫‪-----‬‬
‫اﻟﻤﺤﺎﺿﺮة اﻟﺜﺎﻟﺜﺔ‬

‫ﻣﻘﺘﻄﻒ ﻣﻦ اﻟﻤﺤﺎﺿﺮة اﻟﺜﺎﻧﻴﺔ‬

‫‪Pinocytosis‬‬
‫‪The substance is absorbed through invagination of part of cell membrane then‬‬
‫‪releasing inside the cell‬‬
‫أي أن اﻟﻤﺎدة ﺗﻤﺘﺺ ﻛﺎﻟﺘﺎﻟﻲ‬
‫ﻳﺘﻘﻮس ﻏﺸﺎء اﻟﺨﻠﻴﺔ إﻟﻰ اﻟﺪاﺧﻞ وﻳﻌﻤﻞ ﻛﺄﻧﻪ ﻳﺒﺘﻠﻊ اﻟﻤﺎدة وﻳﺰﻳﺪ اﻟﺘﻘﻮس ﺣﺘﻰ ﻳﺤﻴﻂ ﺑﺎﻟﻤﺎدة ﻛﻠﻬﺎ ﺛﻢ ﻳﻔﺘﺢ‬
‫ﻓﺘﺤﺔ ﻣﻦ ﻧﺎﺣﻴﺔ داﺧﻞ اﻟﺨﻠﻴﺔ وﺗﻌﺒﺮ اﻟﻤﺎدة إﻟﻰ اﻟﺪاﺧﻞ‬
‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻌﻤﻠﻴﺔ دﻳﻪ ﻣﻮﺿﺤﺔ ﻓﻲ اﻟﺼﻮرة اﻟﺘﺎﻟﻴﺔ‬

‫اﻧﺘﻬﻰ اﻟﻤﻘﺘﻄﻒ‬
 ‫ﻧﺪﺧﻞ ﺑﻘﻰ ﻓﻰ اﻟﻤﺤﺎﺿﺮة اﻟﺜﺎﻟﺜﺔ‬

Pinocytosis

Pinocytosis is theingestion of dissolved materials by endocytosis. The cytoplasmic

membrane invaginates and pinches off placing small droplets of fluid in a pinocytic
.vesicle. The liquid *******s of the vesicle is then slowly transferred to the cytosol

‫او ﺑﻤﻌﻨﻰ آﺧﺮ‬

pinocytosis
Introduction of fluids into a cell by invagination of the cell membrane, followed by
.formation of vesicles within the cells

‫ﺑﻤﻌﻨﻰ آﺧﺮ ﻛﻤﺎن ﻋﻠﺸﺎن ﻛﻠﻨﺎ ﻧﻔﻬﻢ ﻫﺬه اﻟﻌﻤﻠﻴﺔ ﺑﺎﻟﺘﻔﺼﻴﻞ اﻟﻤﺒﺴﻂ‬

Pinocytosis

.In the process of pinocytosis the plasma membrane froms an invagination

.What ever substance is found within the area of invagination is brought into the cell
In general this material will be dissolved in water and thus this process is also refered
to as "cellular drinking" to indicate that liquids and material dissolved in liquids are
.ingested by the cell
This is opposed to the ingestion of large particulate material like bacteria or other
.cells or cell debris

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‫اﻟﻤﺤﺎﺿﺮة اﻟﺮاﺑﻌﺔ‬

Simple Diffusion
 ‫ال‪ simple diffusion‬زي ﻣﺎﻗﻠﻨﺎ ﻫﻮ ﻋﺒﺎرة ﻋﻦ اﻧﺘﺸﺎر ﺑﺴﻴﻂ ﺑﺪون اﻟﺤﺎﺟﺔ اﻟﻰ ﻃﺎﻗﺔ او ﺣﺎﻣﻞ وﻓﻲ اﺗﺠﺎه اﻟﻤﺤﺘﻮى‬
‫اﻟﺘﺮﻛﻴﺰي‬

‫ﺑﺲ ﺧﺪ ﺑﺎﻟﻚ ﻣﺶ ﺑﻴﺤﺼﻞ اﻻﻧﺘﺸﺎر ده إﻻ ﻟﻠﻤﺎدة اﻟﻐﻴﺮ ﻣﺘﺄﻳﻨﺔ‬

‫ﻳﺒﻘﻰ اﻟﻤﺎدة اﻟﻐﻴﺮ ﻣﺘﺄﻳﻨﺔ ﺑﺲ ﻫﻲ اﻟﻠﻲ ﺑﻴﺤﺼﻠﻬﺎ اﻧﺘﺸﺎر ﺑﺎل‪simple diffusion‬‬
‫وﺑﺎﻟﺘﺎﻟﻲ رﻛﺰوا ﻣﻌﺎﻳﺎ ‪ ...‬اﻳﻪ اﻟﻠﻲ ﻣﻤﻜﻦ ﻳﺄﺛﺮ ﻋﻠﻴﻬﺎ‬
‫أﻛﻴﺪ ال ‪ pH‬ﺑﺘﺎﻋﺔ اﻟﻮﺳﻂ اﻟﻤﺤﻴﻂ‬
‫ﻟﻴﻪ ؟؟؟؟‬
‫ﻷن ال ‪ pH‬ﺣﺘﺤﺪد اذا ﻛﺎن ﺣﻴﺤﺼﻞ ﺗﺄﻳﻦ ﻟﻠﻤﺎدة وﻟﻼ ﻷ‬
‫ازاي ؟؟؟؟‬
‫اﻟﻮﺳﻂ اﻟﺤﻤﻀﻲ ﺣﻴﺄﻳﻦ اﻟﻤﺎدة اﻟﻘﻠﻮﻳﺔ واﻟﻮﺳﻂ اﻟﻘﻠﻮي ﺣﻴﺄﻳﻦ اﻟﻤﺎدة اﻟﺤﻤﻀﻴﺔ‬
‫أوﻛﻴﻪ !! ﻳﺒﻘﻰ ﻧﺴﺘﻨﺘﺞ أن اﻟﻤﺎدة اﻟﺤﻤﻀﻴﺔ ﺣﺘﻤﺘﺺ ﻓﻲ اﻟﻮﺳﻂ اﻟﺤﻤﻀﻲ ﻷﻧﻪ ﻻ ﻳﺴﺒﺐ ﺗﺄﻳﻨﻬﺎ‬
‫واﻟﻤﺎدة اﻟﻘﻠﻮﻳﺔ ﺣﺘﻤﺘﺺ ﻓﻲ اﻟﻮﺳﻂ اﻟﻘﻠﻮي ﻷﻧﻪ ﻻ ﻳﺴﺒﺐ ﺗﺄﻳﻨﻬﺎ‬

‫‪acidic subs. absorbed in acidic medium & basic subs. absorbed in basic medium‬‬
‫ﻃﺎب ﻳﺒﻘﻰ ﻛﺪه أول ﺣﺎﺟﺔ ﺑﺘﺄﺛﺮ ﻋﻠﻰ ال‪ simple diffusion‬ﻫﻲ ال ‪pH‬‬
‫ﺑﻌﺪ ﻛﺪه ﻋﻨﺪي اﻟﺪوا ﻗﺒﻞ ﻣﺎﻳﺤﺼﻠﻪ اﻣﺘﺼﺎص ﻣﻦ اﻟﺪم ﻟﺨﻼﻳﺎ اﻟﺠﺴﻢ أو ﻟﺨﻼﻳﺎ ﻋﻀﻮ ﻣﻌﻴﻦ ﺑﻴﻜﻮن اﻟﺪواء ﻣﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت‬
‫اﻟﺪم وﺑﻴﻜﻮن ﻓﻲ اﻟﺤﺎﻟﺔ اﻟﻤﺘﺄﻳﻨﺔ‬
‫ﻣﻌﻨﻰ ﻛﺪه أﻧﻪ ﻋﺸﺎن ﻳﺤﺼﻠﻪ اﻣﺘﺼﺎص ﻻزم ﻳﺒﻘﻰ ﺣﺮ وﻏﻴﺮ ﻣﺘﺄﻳﻦ‬
‫ﻳﺒﻘﻰ أﻛﻴﺪ درﺟﺔ ارﺗﺒﺎط اﻟﺪواء ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم ﺗﺆﺛﺮﻋﻠﻰ ﺗﺄﻳﻨﻪ وﺑﺎﻟﺘﺎﻟﻲ ﺗﺆﺛﺮ ﻋﻠﻰ اﻣﺘﺼﺎﺻﻪ‬
‫ﻳﺒﻘﻰ ﻋﻨﺪي ﺗﺎﻧﻲ ﻋﺎﻣﻞ ﻳﺆﺛﺮ ﻋﻠﻰ اﻣﺘﺼﺎص اﻟﺪواء ﺑﺎل‪ simple diffusion‬ﻫﻮ درﺟﺔ ارﺗﺒﺎط اﻟﺪواء ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم‬

‫‪Factors affecting simple diffusion‬‬

‫‪PH‬‬
‫‪protein binding of drugs‬‬

‫وﺑﻜﺪه ﺗﻜﻮن اﻧﺘﻬﺖ اﻟﻤﺤﺎﺿﺮة اﻟﺮاﺑﻌﺔ‬

‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮة اﻟﺨﺎﻣﺴﺔ‬
 ‫اﺣﻨﺎ ﻛﻨﺎ اﺗﻜﻠﻤﻨﺎ ﻋﻦ ال‪pharmacokinetics‬‬
‫ﻗﻠﻨﺎ اﻧﻬﺎ ﻫﻲ ﺣﺮﻛﻴﺔ اﻟﻤﺎدة وﺗﺘﻀﻤﻦ ﻣﺎﻳﺤﺪث ﻟﻠﻤﺎدة داﺧﻞ اﻟﺠﺴﻢ إﻟﻰ ان ﻳﺘﺨﻠﺺ ﻣﻨﻬﺎ اﻟﺠﺴﻢ‬
‫وﻗﻠﻨﺎ ﻛﻤﺎن اﻧﻬﺎ ﺗﻀﻢ اﻟﻌﻤﻠﻴﺎت اﻟﺘﺎﻟﻴﺔ‬
‫‪Absorbtion ,Distribution ,****bolism & Excretion‬‬
‫‪Absorbtion: is the process by which the drug is available in fluids of **** for distribution‬‬
‫ﻳﻌﻨﻲ ﻋﻤﻠﻴﺔ وﺻﻮل اﻟﺪواء ﻟﺴﻮاﺋﻞ اﻟﺠﺴﻢ ﻟﻜﻲ ﻳﺤﺪث اﻟﻌﻤﻠﻴﺔ اﻟﺘﺎﻟﻴﺔ ﻟﻬﺎ وﻫﻲ اﻻﻧﺘﺸﺎر‬
‫‪affected by drug solubility ,blood flow to tissues ,routes of administration‬‬
‫ووﺳﻴﻠﺔ ﺗﻨﺎول اﻟﺪواء ‪ route of administration‬ﺗﺆﺛﺮ ﻓﻲ اﻣﺘﺼﺎص اﻟﺪواء ﺣﺴﺐ اﻟﻮﺳﻴﻠﺔ‬
‫‪Orally ,sublingual ,rectally ,parentral ,pulmonary & topically‬‬
‫ﻛﻞ وﺳﻴﻠﺔ ﺗﺨﺘﻠﻒ ﻣﻦ ﺣﻴﺚ ﺳﺮﻋﺔ وﺻﻮل اﻟﺪوا ﻟﻠﺪم ‪,‬ﻋﺪم ﺗﻌﺮﺿﻪ ﻟﻠﺘﻜﺴﻴﺮ ‪,‬ﻋﺪم وﺟﻮد دوا آﺧﺮ ﻳﺘﻔﺎﻋﻞ ﻣﻌﻪ ‪,‬وﺻﻮﻟﻪ ﻟﻠﺪم‬
‫ﺑﺎﻟﻜﻤﻴﺔ اﻟﻜﺎﻓﻴﺔ ﺑﺤﻴﺚ ﻻ ﻳﻘﻞ ﻋﻦ اﻟﺘﺮﻛﻴﺰ اﻟﻤﺆﺛﺮ وﻻ ﻳﺰﻳﺪ إﻟﻰ اﻟﺠﺮﻋﺔ اﻟﺴﺎﻣﺔ‬
‫‪meaning rapid or slow absorbtion ,not be ****bolised ,not interacting with another drug‬‬
‫‪,absorbed in effective dose & not reach the toxic dose‬‬
‫ﻣﻔﻬﻮم ﻛﺪه ﻟﺤﺪ دﻟﻮﻗﺘﻲ ‪....‬‬
‫ﻃﻴﺐ دﻟﻮﻗﺘﻲ ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﻣﻠﺤﻮﻇﺔ ﻣﺘﻌﻠﻘﺔ ﺑﻤﻮﺿﻮع اﻻﻣﺘﺼﺎص‬
‫دﻟﻮﻗﺘﻲ أﺛﻨﺎء اﻻﻣﺘﺼﺎص ﻣﻤﻜﻦ ﻳﺤﺺ اي ﺣﺎﺟﺔ ﺗﺨﻠﻲ اﻟﺪوا ﻣﺎﻳﻤﺘﺼﺶ أو ﻳﻤﺘﺺ ﺑﻨﺴﺒﺔ ﺻﻐﻴﺮة ﻻ ﺗﺆدي اﻟﺘﺄﺛﻴﺮ اﻟﻤﻄﻠﻮب‬
‫‪ .....‬ﻃﻴﺐ زي أﻳﻪ ؟؟؟ رﻛﺰوا ﻣﻌﺎﻳﺎ‬
‫‪Formation of ppt or complex‬‬
‫ﻳﻌﻨﻲ اﻟﺪوا ﻳﺘﺮﺳﺐ أو ﻳﻜﻮن ﻣﺮﻛﺐ ﻣﻌﻘﺪ ﺑﺴﺒﺐ ﺗﻔﺎﻋﻠﻪ ﻣﻊ ﻣﺎدة ﺗﺎﻧﻴﺔ‬
‫زي اﻳﻪ‪ ...‬؟‬
‫‪Tetracycline & Calcium‬‬

‫‪Rapid emptying of GIT *******s‬‬

‫ﻳﻌﻨﻲ اﻟﺪواء ﻳﺘﻢ ﺗﻔﺮﻳﻐﻪ ﻣﻦ اﻟﻤﻌﺪة ﺑﺴﺮﻋﺔ ﻋﺎﻟﻴﺔ‬
‫وده أﺣﻴﺎﻧﺎ ﻛﺘﻴﺮة ﺑﻴﻜﻮن ﻏﻴﺮ ﻣﻨﺎﺳﺐ ﻷن ﻣﻤﻜﻦ ﻳﻜﻮن اﻟﺪواء ﺣﻴﻤﺘﺺ ﻣﻦ ﻣﻜﺎن ﻣﻌﻴﻦ ﻣﻦ ال‪GIT‬‬
‫زي ﻣﺜﻼ ‪ vit.B12‬ﺑﻴﻤﺘﺺ ﻣﻦ ال‪ duedenum‬ﻣﻌﻨﻰ ﻛﺪه اﻧﻪ ﻟﻮ ﺣﺼﻞ ﺗﻔﺮﻳﻎ ﺳﺮﻳﻊ ﻣﺶ ﺣﻴﻌﺪي ﻋﻠﻰ ﻣﻜﺎن اﻻﻣﺘﺼﺎص‬
‫ﺑﻮﻗﺖ ﻛﺎﻓﻲ وﺑﺎﻟﺘﺎﻟﻲ ﻣﺶ ﺣﻴﺤﺼﻠﻪ اﻣﺘﺼﺎص ﻛﻮﻳﺲ‬
‫ﻃﻴﺐ زي اﻳﻪ ﻣﺜﻼ اﻷدوﻳﺔ اﻟﻠﻲ ﺑﺘﺴﺮع اﻟﺘﻔﺮﻳﻎ ﻣﻦ اﻟﻤﻌﺪة ‪..‬؟؟‬
‫‪as laxatives & purgatives (MgSo4) speed up GIT emptying‬‬
‫‪so decrease contact time between drug & absorbtion surface‬‬

‫‪Reduced GIT motility‬‬

‫ﻳﻌﻨﻲ اﻟﺪواء ﻳﺒﻘﻰ ﻓﻲ اﻟﻤﻌﺪة ﻣﺪة ﻃﻮﻳﻠﺔ وﻻ ﻳﻤﺘﺺ‬
‫ﻳﻌﻨﻲ ﺳﺮﻋﺔ اﻟﺘﻔﺮﻳﻎ وﺑﻄﺌﻪ ﻏﻴﺮ ﻣﺴﺘﺤﺐ‬
‫ﺧﻴﺮ اﻷﻣﻮر اﻟﻮﺳﻂ !!!!‬
‫ﻷن ﻣﺶ ﻛﻞ اﻷدوﻳﺔ ﺣﺘﻤﺘﺺ ﻣﻦ ال‪ GIT‬وﺑﺎﻟﺘﺎﻟﻲ ﻻﺑﺪ ﻳﺤﺪث ﻟﻬﺎ ﺗﻔﺮﻳﻎ ﺣﺘﻰ ﻳﺼﻞ ﻛﻞ دواء إﻟﻰ ﻣﻜﺎن اﻣﺘﺼﺎﺻﻪ‬
‫ﻃﻴﺐ زي أﻳﻪ ﻣﻦ اﻷدوﻳﺔ ﺑﻴﺴﺒﺐ ﺑﻂء اﻟﺘﻔﺮﻳﻎ ‪...‬؟؟‬
‫‪ Atropine‬وده دواء ﺑﻴﺴﺒﺐ ﺗﻮﻗﻒ ﺣﺮﻛﺔ اﻷﻣﻌﺎء وﺑﺎﻟﺘﺎﻟﻲ ﻻ ﻳﺤﺪث ﻟﻠﺪواء ﺗﻔﺮﻳﻎ ﻣﻦ ال‪GIT‬‬
‫ﻳﻌﻨﻲ ﻻ ﻳﺼﻠﺢ ﺗﻨﺎول دواء ﻳﺤﺘﺎج ﻟﺘﻔﺮﻳﻎ ﻣﻦ اﻟﻤﻌﺪة ﺑﺎﻟﻤﻌﺪل اﻟﻄﺒﻴﻌﻲ ﻟﺸﺨﺺ ﻳﺘﻨﺎول ال‪ atropine‬ﻣﻦ اﻷول ﻷن ال‪GIT‬‬
‫ﻋﻨﺪه ﺣﺮﻛﺘﻬﺎ ﺑﻄﻴﺌﺔ ﺟﺪا‬
 ‫وده ﻳﻌﺘﺒﺮ ﺗﺪاﺧﻞ ﻓﻲ ﻣﻔﻌﻮل اﻷدوﻳﺔ ﺑﻤﻌﻨﻰ أن دواء ﻳﺴﺒﺐ ﺗﺄﺛﻴﺮ ﻏﻴﺮ ﻣﺮﻏﻮب ﻟﺪوا آﺧﺮ‬
‫وﻏﻴﺮ ال‪ atropine‬ﻳﻮﺟﺪ أﻳﻀﺎ ال ‪ ganglion blocker‬ودﻳﻪ ﻣﺠﻤﻮﻋﺔ ﻣﻦ أدوﻳﺔ ﻣﻌﻴﻨﺔ ﺗﻌﻤﻞ ﻋﻠﻰ إﻳﻘﺎف اﻟﻨﺎﻗﻞ اﻟﻌﺼﺒﻲ‬
‫ﻋﻨﺪ اﻷﻋﺼﺎب اﻟﺘﻲ ﺗﻐﺬي اﻟﻤﺴﺘﻘﺒﻼت اﻟﻤﻮﺟﻮدة ﻓﻲ ال‪ GIT‬وﺑﺎﻟﺘﺎﻟﻲ ﺗﻮﻗﻒ ﻋﻤﻠﻬﺎ وﺣﺮﻛﺘﻬﺎ ‪ .....‬ﺣﺘﻌﺮﻓﻮﻫﺎ ﺑﻌﺪﻳﻦ‬
‫‪..‬ﻣﺘﻘﻠﻘﻮش‬

‫‪meaning these drugs cause slow movement of GIT so the drug won't reach absorbtion site in‬‬
‫‪sufficient dose‬‬

‫‪Reduced availability‬‬
‫وده ﺑﻴﺒﻘﻰ ﻧﺘﻴﺠﺔ ان اﻟﺸﺨﺺ ﻳﺘﻨﺎول دواء آﺧﺮ ﻳﺮﺗﺒﻂ ﺑﺎﻟﺪواء اﻵﺧﺮ وﻳﻤﻨﻊ اﻣﺘﺼﺎﺻﻪ‬
‫ﻃﻴﺐ زي اﻳﻪ ‪..‬؟؟‬
‫‪ Cholestyramine‬ودﻳﻪ ﻣﺎدة ﺑﺘﺮﺗﺒﻂ ﺑﺎل ‪ acidic drugs‬زي ال ‪aspirin‬‬
‫ﻓﻴﻔﻘﺪ ال ‪ aspirin‬ﻓﻌﺎﻟﻴﺘﻪ‬

‫‪le pharmacien 03:01 PM 23-09-2010‬‬

‫‪Drug interaction at absorbtion site‬‬
‫‪Formation of ppt or cplx‬‬
‫‪Rapid emptying of GIT *******s‬‬
‫‪Reduced GIT motility‬‬
‫‪Reduced availability‬‬

‫‪N.B‬‬
‫‪Particle size affect absorbtion of poorly absorbed drug‬‬
‫‪ex : Digoxin‬‬

‫‪-----‬‬

‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮة اﻟﺴﺎدﺳﻪ‬
‫ﺑﻌﺪ ﻣﺎﺗﻜﻠﻤﻨﺎ ﻋﻦ ال ‪ Absorbtion‬ﺣﻨﺘﻨﻘﻞ ﻟﻠﻌﻤﻠﻴﺔ اﻟﻠﻲ ﺑﻌﺪﻫﺎ وﻫﻲ ‪..‬‬
‫‪Distribution :it's the process by which the drug reach the site of‬‬
‫‪action‬‬
‫ﻳﻌﻨﻲ اﻟﻌﻤﻠﻴﺔ اﻟﻠﻲ اوﺻﻞ ﺑﻬﺎ اﻟﺪوا ﻟﻤﻜﺎن ﺗﺄﺛﻴﺮه‬
‫ﺑﻌﺾ ﺟﺰﻳﺌﺎت اﻟﺪوا ﺗﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم وﺑﻌﻀﻬﺎ ﻳﻨﺘﺸﺮ ﻓﻲ اﻟﺨﻼﻳﺎ‬
 ‫وﻟﻜﻦ ﻟﻜﻲ ﻳﺼﻞ اﻟﺪوا داﺧﻞ اﻟﺨﻠﻴﺔ ﻻﺑﺪ ان ﻳﻌﺒﺮ ﻏﺸﺎء اﻟﺨﻠﻴﺔ‬
‫وزي ﻣﺎﻋﺮﻓﻨﺎ ﻗﺒﻞ ﻛﺪه ان ﻏﺸﺎء اﻟﺨﻠﻴﺔ ﺑﻴﻜﻮن ‪ lipid‬وﻗﻠﻨﺎ ﻻزم ﻳﻜﻮن اﻟﺪواء ﻳﺬوب‬
‫ﻓﻲ اﻟﺪﻫﻮن ﻟﻜﻲ ﻳﻌﺒﺮ ﻫﺬا اﻟﻐﺸﺎء‬
‫ﻃﻴﺐ ﻟﻜﻦ ﻣﺶ ﻛﻞ اﻷدوﻳﺔ ﺑﺘﺬوب ﻓﻲ اﻟﺪﻫﻮن ﻳﺒﻘﻰ ﺣﻴﻌﺪوا أزاي ؟؟‬
‫‪Lipid soluble drugs : pass through membrane‬‬
‫‪Small lipid insoluble drugs : pass through pores‬‬
‫‪Large lipid insoluble drugs : stay in plasma‬‬
‫ﻣﻌﻨﻰ ﻛﺪه ان اﻟﺪواء ﻻزم ﻳﻜﻮن ذاﺋﺐ وإن ﻟﻢ ﻳﻜﻮن ذاﺋﺐ ﻓﻲ اﻟﺪﻫﻮن ﻳﺒﻘﻰ ﻻزم‬
‫اﻋﻤﻠﻪ ﻋﻠﻰ ﻫﻴﺌﺔ ﺟﺰﻳﺌﺎت ﺻﻐﻴﺮة ﻟﻜﻦ أﺣﻴﺎﻧﺎ ﻣﺶ ﺑﺤﺘﺎج ان اﻟﺪوا ﻳﺪﺧﻞ اﻟﺨﻠﻴﺔ‬
‫وﺑﺒﻘﻰ ﻋﺎﻳﺰاه ﻳﺒﻘﻰ ﻓﻲ اﻟﺪم وﺳﺎﻋﺘﻬﺎ ﻳﺒﻘﻰ ﻣﺶ ﻣﺤﺘﺎﺟﺔ أﻋﻤﻠﻪ ﻋﻠﻰ ﻫﻴﺌﺔ ﺟﺰﻳﺌﺎت‬
‫ﺻﻐﻴﺮة‬
‫زي ﻣﺜﻼ ال ‪ dextran‬وده ﺑﻴﺴﺘﺨﺪم ‪ as plasma substitute‬ﻋﺸﺎن اذودﻫﺎ‬
‫ﻳﺒﻘﻰ ﻻزم اﻟﺪوا ﻳﻜﻮن ﻓﻲ اﻟﺪم‬
‫ﻓﻴﻪ ﻋﻮاﻣﻞ ﻋﺪﻳﺪة ﺑﺘﺄﺛﺮ ﻋﻠﻰ اﻧﺘﺸﺎر اﻟﺪواء داﺧﻞ اﻟﺨﻼﻳﺎ‬
‫ﻃﺐ زي اﻳﻪ ؟؟‬
‫‪Binding to plasma protein‬‬
‫ارﺗﺒﺎط اﻟﺪواء ﺑﺎﻟﺒﺮوﺗﻴﻦ ﻳﻜﻮن اﻷﻳﻮﻧﻴﺔ ﻣﻌﻨﻰ ﻛﺪه اﻧﻪ ﻣﺶ ﺣﻴﻌﺪي ﻷن زي ﻣﺎ ﻗﻠﻨﺎ‬
‫ﻗﺒﻞ ﻛﺪه ان اﻟﺪواء ﻻزم ﻳﻜﻮن ﻓﻲ اﻟﺤﺎﻟﺔ اﻟﻐﻴﺮ ﻣﺘﺄﻳﻨﺔ ﻛﻲ ﻳﻌﺒﺮ ﻏﺸﺎء اﻟﺨﻠﻴﺔ‬
‫وﺑﺮوﺗﻴﻦ اﻟﺪم اﻟﻤﺸﻬﻮر ﻫﻮ ال ‪ albumin‬وده ﺑﻴﻜﻮن زي ﻣﺨﺰن ﻟﻠﺪوا ﺑﺤﻴﺚ ﻳﻄﻠﻊ‬
‫اﻟﻜﻤﻴﺔ اﻟﻤﺆﺛﺮة ﻣﻦ اﻟﺪوا وﻟﻤﺎ ﻳﺒﺪأ ﻳﺘﻜﺴﺮ ﻳﻄﻠﻊ ﺑﺪﻻ ﻣﻨﻪ ﻛﻤﻴﺔ ﻣﻦ اﻟﻤﺮﺗﺒﻄﺔ‬
‫ﺑﺎﻟﺒﺮوﺗﻴﻦ‬
‫ﻷن اﻟﺪوا وﻫﻮ ﻣﺮﺗﺒﻂ ﺑﺎﻟﺒﺮوﺗﻴﻦ ﻻ ﻳﻜﻮن ﻟﻪ ﺗﺄﺛﻴﺮ وﻻ ﻳﺘﻌﺮض ﻟﻠﺘﻜﺴﻴﺮ‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻛﺪه ﺑﻴﺰود ﻣﻦ ﻓﺘﺮة وﺟﻮد ﻛﻤﻴﺔ ﻣﻦ اﻟﺪوا ﻓﻌﺎﻟﺔ وﺗﺆدي وﻇﻴﻔﺘﻬﺎ ﻋﻦ‬
‫ﻃﺮﻳﻖ ﺗﻨﻈﻴﻢ ﺧﺮوﺟﻪ ﻓﻲ اﻟﺼﻮرة اﻟﻔﻌﺎﻟﺔ‬
‫وأﺣﻴﺎﻧﺎ ﻳﺎﺧﺪ اﻟﻤﺮﻳﺾ دوا ﻳﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻦ اﻟﺪم وﻳﺎﺧﺪ دوا آﺧﺮ ﻟﻪ ﻗﻮة اﻛﺒﺮ ﻋﻠﻰ‬
 ‫اﻻرﺗﺒﺎط ﺑﺒﺮوﺗﻴﻦ اﻟﺪم ﻓﻴﺤﻞ ﻣﺤﻠﻪ أي ﻳﻌﻤﻠﻪ ‪replacement‬‬
‫ودﻳﻪ ﺑﺘﻜﻮن ﺿﺎرة ﻏﺎﻟﺒﺎ ﻷن ﻣﻤﻜﻦ اﻟﺪوا اﻷول اﻟﻠﻲ ﺣﺼﻠﻪ اﺳﺘﺒﺪال وزادت ﻧﺴﺒﺘﻪ ﻓﻲ‬
‫اﻟﺪم ﻳﻜﻮن ‪ potent‬أي أﻧﻪ ﻳﺼﻞ إﻟﻰ ال ‪ toxic dose‬ﺑﺴﺮﻋﺔ ﻓﻴﺴﺒﺐ ﺳﻤﻴﺔ‬
‫ﻳﻌﻨﻲ ﻻزم اﻟﻨﻘﻄﺔ دﻳﻪ اﺣﻄﻬﺎ ﻓﻲ اﻻﻋﺘﺒﺎر ﻣﻦ ﺗﺄﺛﻴﺮات اﻷدوﻳﺔ ﻋﻠﻰ ﺑﻌﻀﻬﺎ‬

‫وﻣﻦ ﺿﻤﻦ اﻟﻌﻮاﻣﻞ أﻳﻀﺎ اﻟﻠﻲ ﺑﺘﺄﺛﺮ ﻋﻠﻰ اﻧﺘﺸﺎر اﻟﺪواء داﺧﻞ اﻟﺨﻼﻳﺎ اﻟﺘﺎﻟﻲ ‪...‬‬
‫‪Blood flow to tissues‬‬
‫ﻟﻮ زادت ﻛﻤﻴﺔ اﻟﺪم اﻟﻠﻲ ﺑﺘﻐﺬي اﻟﺨﻼﻳﺎ ﻳﺒﻘﻰ أﻛﻴﺪ ﻛﻤﻴﺔ اﻟﺪوا اﻟﻠﻲ ﺑﺘﻮﺻﻞ اﻟﺨﻼﻳﺎ‬
‫أﻛﺜﺮ‬

‫‪TAKE THE FIRST‬‬

‫‪STEPS TO ISO 9001‬‬

‫واﻷﻋﻀﺎء اﻟﻠﻲ ﺑﻴﺼﻠﻬﺎ إﻣﺪاد ﻛﺒﻴﺮ ﻣﻦ اﻟﺪم ﻫﻲ اﻟﻜﻠﻴﺔ واﻟﻜﺒﺪ واﻟﻤﺦ واﻟﻘﻠﺐ‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻳﺼﻠﻬﺎ ﻧﺴﺒﺔ أﻛﺒﺮ ﻣﻦ اﻟﺪواء‬

‫وأﻳﻀﺎ ﻓﻴﻪ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﻠﻲ ﺑﺘﺄﺛﺮ ﻋﻠﻰ اﻧﺘﺸﺎر اﻟﺪواء داﺧﻞ اﻟﺨﻼﻳﺎ‬
‫‪Cellular binding‬‬
‫ﻛﻞ ﻣﺎزاد ارﺗﺒﺎط اﻟﺪواء ﺑﺎﻟﺨﻠﻴﺔ ﻳﺒﻘﻰ أﻛﻴﺪ ﻧﺴﺒﺘﻪ ﺣﺘﺰﻳﺪ ﻓﻲ اﻟﺨﻠﻴﺔ‬
‫ﺑﻤﻌﻨﻰ ان ﻓﻴﻪ ادوﻳﺔ ﺗﻔﻀﻞ اﻟﺘﺮاﻛﻢ ﻓﻲ ﻣﻜﺎن ﻣﻌﻴﻦ ﻓﻲ اﻟﺠﺴﻢ ﻛﺎﻟﺘﺎﻟﻲ‬
‫‪Chlorpromazine prefer Brain‬‬
‫‪Digitoxin prefer Liver ,Kidney & Heart‬‬
‫‪Tetracycline prefer Bones & Teeth‬‬
‫‪Calcium prefer Collagen‬‬
‫‪Arsenic prefer Keratin‬‬
‫‪Iodine prefer Thyroid gland .... and so on‬‬
‫وأﻳﻀﺎ ﻣﻦ ﺿﻤﻦ اﻟﻌﻮاﻣﻞ ﻣﺎﻳﻠﻲ‬
‫‪Concentration of drug in body fats‬‬
‫ﻛﻞ ﻣﺎذادي ﻗﺎﺑﻠﻴﺔ اﻟﺪواء اﻧﻪ ﻳﺘﺨﺰن ﻓﻲ اﻻﺟﺴﺎم اﻟﺪﻫﻨﻴﺔ ﻛﻞ ﻣﺎﺣﺘﻘﻞ ﻛﻤﻴﺔ اﻟﺪوا‬
‫اﻟﻤﺘﻮﻓﺮة ﻻﻧﺘﺸﺎره داﺧﻞ اﻟﺨﻠﻴﺔ وﺑﻴﺠﻌﻞ اﻟﺪوا ﺑﻄﻲء ﻓﻲ اﻣﺘﺼﺎﺻﻪ‬
‫‪The blood brain barrier‬‬
‫ﻏﺸﺎء اﻟﻤﺦ دﻫﻨﻲ ﺟﺪا ﻳﻌﻨﻲ ﻟﻮ ﻛﺎن اﻟﺪوا ﺑﻴﺬوب ﻓﻲ اﻟﺪﻫﻮن ﺑﺸﺪة ﺳﻮف ﻳﻌﺒﺮه‬
‫ﺑﺴﻬﻮﻟﺔ وﺑﺎﻟﺘﺎﻟﻲ اﻟﺪواء ﻣﻤﻜﻦ ﻳﻜﻮن ﻟﻪ آﺛﺎر ﺟﺎﻧﺒﻴﺔ ﻋﻠﻰ اﻟﻤﺦ‬

‫ﻳﻌﻨﻲ ﻣﻤﻜﻦ ﻧﻘﻮل‬

‫‪BBB is Permeable to lipid sol. drugs‬‬

‫‪impermeable to H2O sol. drugs‬‬
‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮةاﻟﺴﺎﺑﻌﻪ‬

‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ أول ﺣﺎﺟﺔ واﺳﻤﻬﺎ =======<<‬

‫‪Volume Of Distribution Vd‬‬
‫رﻛﺰ أوي‬

‫وده ﻣﻌﻨﺎه اﻟﺤﺠﻢ اﻟﻠﻲ ﺣﻴﻨﺘﺸﺮ ﻓﻴﻪ اﻟﺪوا‬

‫ﺑﻤﻌﻨﻰ ‪ ..‬ﻣﻤﻜﻦ اﻟﺪوا ﻳﻨﺘﺸﺮ ﻓﻲ اﻟﺒﻼزﻣﺎ ﻓﻘﻂ وﻻ ﻳﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم ﻳﺒﻘﻰ‬
‫ﻣﻌﻨﻰ ﻛﺪه ان ﺣﺠﻢ اﻟﺴﻮاﺋﻞ اﻟﻠﻲ ﺣﻴﻨﺘﺸﺮ ﻓﻴﻬﺎ اﻟﺪوا ﻳﺴﺎوي ﺣﺠﻢ اﻟﺒﻼزﻣﺎ ﻓﻘﻂ‬
 ‫ﻃﺐ وﻟﻮ اﻧﺘﺸﺮ ﻓﻲ اﻟﺒﻼزﻣﺎ وارﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم ﻛﻤﺎن ﻳﺒﻘﻰ اﻳﻪ ؟؟‬
‫ﻳﺒﻘﻰ ﺣﺠﻢ اﻟﺴﻮاﺋﻞ اﻟﻠﻲ ﺣﻴﻨﺘﺸﺮ ﻓﻴﻬﺎ ﻫﻲ ﺣﺠﻢ اﻟﺪم ﻛﻠﻪ ﻷن اﻟﺪم ﻫﻮ ﺑﻼزﻣﺎ‬
‫وﺑﺮوﺗﻴﻦ‬
.. ‫ﻳﻌﻨﻲ ﻧﻘﺪر ﻧﻘﻮل اﻟﺘﺎﻟﻲ‬
It's the volume in which the amount of drug would need to be
uniformly distributed in ,to produce the observed blood
concentration
OR
It's the volume of fluids which contain the total amount of drug
at the same concentration as that present in plasma

<<< ======== ‫ﻣﻦ ﻗﻮاﻧﻴﻦ اﻟﺤﺠﻮم ﻧﺠﺪ اﻧﻪ ﻳﺴﺎوي‬

Vd =Q/C
Q ==> total amount of drug ‫ﺣﻴﺚ ان‬
C ==> conc. in plasma ‫وان‬

‫ ﻗﻠﻴﻠﺔ زي‬Vd ‫ﻣﺜﻼ ﻓﻴﻪ أدوﻳﺔ ﻟﻬﺎ‬

‫ ﻋﺎﻟﻲ وﺑﺎﻟﺘﺎﻟﻲ ﻣﺎﺑﻴﻨﺘﺸﺮش أوي ﻏﻴﺮ اﻧﻪ ﻟﻪ‬Molecular size ‫ ﻋﺸﺎن ﻟﻪ‬Heparin
‫ ﻳﻌﻨﻲ ﺑﻴﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم‬ionic nature ‫ﻃﺒﻴﻌﺔ أﻳﻮﻧﻴﺔ‬
Sulphonamide ,Phenylbutazone & Evan's blue ‫وزي ﻛﻤﺎن‬

.... ‫ﻣﻠﺤﻮﻇﺔ أﺧﻴﺮة وﻫﻲ‬

‫ﺑﻌﺾ ﺗﺄﺛﻴﺮات اﻷدوﻳﺔ ﻋﻠﻰ ﺑﻌﺾ ﻋﻨﺪ ﻣﻮﻗﻊ اﻻرﺗﺒﺎط ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم‬
Important drug interactions at protein binding sites

Chloral hydrate ,clofibrate ,phenybutazone can displace

coumarin
 ‫ﻃﺐ واﻟﻜﻮﻣﺎرﻳﻦ ده اﻳﻪ ﺑﺎﻟﻀﺒﻂ ؟؟‬
‫ده ﻋﺒﺎرة ﻋﻦ ‪ anticoagulant‬ﻳﻌﻨﻲ ﺿﺪ ﺗﺠﻠﻂ اﻟﺪم‬
‫ﻣﻌﻨﻰ ﻛﺪه اﻧﻪ ﺑﻴﺴﺒﺐ ﺳﻴﻮﻟﺔ ﻟﻠﺪم ﻓﺒﻴﺴﺘﺨﺪم ﻟﻠﻨﺎس اﻟﻠﻲ ﻋﻨﺪﻫﺎ ﺟﻠﻄﺎت أو ﻗﺎﺑﻠﻴﺔ‬
‫ﻋﺎﻟﻴﺔ ﻟﺘﺠﻠﻂ اﻟﺪم‬
‫ﺑﺎﻟﺘﺎﻟﻲ ﻟﻮ ﻛﺎن ﺑﻴﺴﺘﺨﺪم ﻟﻮﺣﺪه ﻣﺜﻼ اﻟﺸﺨﺺ ﺑﻴﺎﺧﺪ ﺑﺠﺮﻋﺔ ﻣﻌﻴﻨﺔ‬
‫ﻳﺒﻘﻰ ﻟﻮ اﺳﺘﺨﺪم ﻣﻌﺎه دوا ﻣﻦ اﻟﺜﻼﺛﺔ اﻟﻠﻲ ﺑﻴﺤﻠﻮا ﻣﺤﻠﻪ ﺳﻴﺼﺒﺢ اﻟﻜﻤﻴﺔ اﻟﺤﺮة ﻓﻲ‬
‫اﻟﺪم أﻛﺒﺮ وﻣﻌﻨﻰ ﻛﺪه ان ﺗﺄﺛﻴﺮه ﺣﻴﺰﻳﺪ )ﻷن اﻟﺪوا اﻟﺤﺮ اﻟﻐﻴﺮ ﻣﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻦ اﻟﺪم‬
‫ﻫﻮ ﺑﺲ اﻟﻠﻲ ﻟﻴﻪ ﺗﺄﺛﻴﺮ( وﺑﺎﻟﺘﺎﻟﻲ ﻣﻤﻜﻦ ﻳﺴﺒﺐ ﺳﻴﻮﻟﺔ ﻋﺎﻟﻴﺔ ﻟﻠﺪم وﻳﺴﺒﺐ‬
‫‪bleeding‬‬
‫ً‬
‫ﺟﻴﺪا‬ ‫ﺑﻘﻰ ﻛﺪه ﻻزم أﺧﺪ ﺑﺎﻟﻲ ﻣﻦ ﺗﺄﺛﻴﺮ اﻷدوﻳﺔ ﻋﻠﻰ ﺑﻌﺾ واﻇﺒﻂ اﻟﺠﺮﻋﺔ‬

‫‪Salicylates can displace Tolbutamide‬‬

‫ﻃﺐ واﻟﺘﻮﻟﺒﻴﻮﺗﺎﻣﻴﺪ ده ﻋﺒﺎرة ﻋﻦ اﻳﻪ ده ﻛﻤﺎن ؟؟‬
‫ده ﻋﺒﺎرة ﻋﻦ ‪ Hypoglycemic drug‬ﻳﻌﻨﻲ ﺑﻴﻘﻠﻞ ﺳﻜﺮ اﻟﺪم ﻋﻨﺪ ﻣﺮﺿﻰ اﻟﺴﻜﺮ‬
‫ﻣﻌﻨﻰ ﻛﺪه زي اﻟﻠﻲ اﻟﻤﺜﺎل اﻟﻠﻲ ﻓﺎت ‪..‬‬
‫ﺣﻴﻌﻤﻞ اﻳﻪ ؟؟‬
‫ﺣﻴﺰﻳﺪ ﻛﻤﻴﺘﻪ اﻟﺤﺮة ﻓﻲ اﻟﺪم واﻟﺘﻲ ﺗﺴﺒﺐ زﻳﺎدة ﺗﺄﺛﻴﺮه ﻓﻴﻘﻠﻞ اﻟﺴﻜﺮ ﺑﺸﺪة وﻳﺴﺒﺐ‬
‫ﻏﻴﺒﻮﺑﺔ ﺗﺴﻤﻰ‬
‫‪Hypoglycemic shock‬‬
‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮه اﻟﺜﺎﻣﻨﻪ‬
‫ﺑﻌﺪ ﻣﺎﺗﻜﻠﻤﻨﺎ ﻋﻦ اﻟﻌﻤﻠﻴﺘﻴﻦ ‪ absorbtion & distribution‬ﺣﻨﺘﻜﻠﻢ‬
‫ﻋﻦ اﻟﻌﻤﻠﻴﺔ اﻟﺜﺎﻟﺜﺔ‬
‫****‪bolism‬‬
‫ﻫﻲ اﻟﻌﻤﻠﻴﺔ اﻟﺘﻲ ﻳﺘﻜﺴﺮ ﺑﻬﺎ اﻟﺪواء ﻟﻜﻲ ﻳﺼﻞ إﻟﻰ اﻟﻤﺮﺣﻠﺔ اﻟﻐﻴﺮ ﻓﻌﺎﻟﺔ واﻟﺘﻲ ﺗﻜﻮن‬
‫أﻛﺜﺮ ذوﺑﺎﻧﺎ ﻓﻲ اﻟﻤﺎء وزي ﻣﺎﻗﻠﻨﺎ ﻗﺒﻞ ﻛﺪه ان ال‪ urine‬ﻣﺎﺋﻴﺔ ﻳﻌﻨﻲ ‪ aquas‬ﻳﻌﻨﻲ‬
‫ﻻزم اﻟﺪوا ﻋﺸﺎن ﻳﺨﺮج ﻣﻦ اﻟﺠﺴﻢ ﻳﻜﻮن ‪ H2O soluble‬وده اﻟﻠﻲ ﺑﻴﺤﺼﻞ ﻓﻲ‬
‫ﻋﻤﻠﻴﺔ اﻷﻳﺾ اﻟﻐﺬاﺋﻲ ****‪blism‬‬
‫‪meaning that most drugs are ****bolised to give ****bolites‬‬
‫‪which are less active & most water soluble to be excreted safely‬‬
‫‪out of the body‬‬
‫ﻃﻴﺐ اﻳﻪ اﻷﻣﺎﻛﻦ اﻟﻠﻲ ﺑﻴﺨﺮج ﻣﻨﻬﺎ اﻻدوﻳﺔ‬
‫‪Sites of ****bolism‬‬
‫‪ ) liver mainly‬ﻳﻌﻨﻲ ﻣﻌﻈﻢ اﻷدوﻳﺔ ﺑﺘﺘﻜﺴﺮ ﻓﻲ اﻟﻜﺒﺪ(‬
‫‪) gut wall‬زي ال‪(tyramine‬‬
‫‪) lung‬زي ال‪(Isoprenaline ,Ethyl morphine‬‬
‫‪) blood‬زي ال‪(Acetyl choline‬‬
‫ﻣﻠﺤﻮﻇﺔ‬
‫ﻓﻴﻪ ﺑﻌﺾ اﻻدوﻳﺔ ﻟﻤﺎ ﻳﺤﺼﻠﻬﺎ ****‪ bolism‬ﺗﺘﺤﻮل ﻟﻠﺼﻮرة اﻷﻛﺜﺮ ﻓﻌﺎﻟﻴﺔ أو‬
‫ﻟﺼﻮرة أﻗﻞ ﻓﻌﺎﻟﻴﺔ‬
‫ﻳﻌﻨﻲ ﻣﺶ ﻛﻞ اﻷدوﻳﺔ ﻟﻤﺎ ﻳﺤﺼﻠﻬﺎ ****‪ bolism‬ﺗﺘﺤﻮل ﻟﺼﻮرة ﻏﻴﺮ ﻓﻌﺎﻟﺔ‬
‫وﻓﻴﻤﺎ ﺑﻌﺪ ﺳﻨﺘﻌﺮض ﻟﺒﻌﺾ اﻻدوﻳﺔ اﻟﺘﻲ ﺗﺆﺧﺬ ﻓﻲ ﺻﻮرة ﻏﻴﺮ ﻓﻌﺎﻟﺔ وﻋﻨﺪﻣﺎ ﺗﺼﻞ‬
‫ﻟﻞ‪ site of action‬ﺑﺘﺘﺤﻮل ﻟﻠﺼﻮرة اﻟﻔﻌﺎﻟﺔ‬
‫وﻓﻴﻪ ﺑﻌﺾ اﻷدوﻳﺔ ﺗﺆﺧﺬ ﻓﻲ اﻟﺼﻮرة اﻟﻔﻌﺎﻟﺔ وﺗﺆدي اﻟﺘﺄﺛﻴﺮ ﺑﺘﺎﻋﻬﺎ وﻟﻤﺎ ﻳﺤﺼﻠﻬﺎ‬
‫****‪ bolism‬ﺑﺘﺘﺤﻮل ﻟﺼﻮرة ﻓﻌﺎﻟﺔ أﻳﻀﺎ وﻟﻜﻦ ﺑﺪرﺟﺔ أﻗﻞ وﻋﻨﺪﺋﺬ ﻧﻘﻮل اﻧﻬﺎ‬
‫ذات ﺗﺎﺛﻴﺮ ﻣﻤﺘﺪ‬
‫وﺑﺎﻟﺘﺎﻟﻲ اﻟﻨﻘﻄﺔ دﻳﻪ ﺑﺮده ﻻزم ﺗﻜﻮن ﻓﻲ اﻻﻋﺘﺒﺎر ﻋﺸﺎن ﻻزم اﻟﺪوا ﻳﺆﺧﺬ ﺑﺤﻴﺚ‬
‫ﺗﻜﻮن اﻟﻔﺘﺮة ﻣﺎﺑﻴﻦ ﺟﺮﻋﺘﻴﻦ ‪ dose interval‬ﺗﻜﻮن ﻣﻨﺎﺳﺒﺔ ﺣﺘﻰ ﻻ ﻳﺼﻞ اﻟﺪوا‬
‫ ﻷن ﻧﻮاﺗﺞ ﺗﻜﺴﻴﺮ اﻟﺪواء أﺻﻼ ﺑﺘﻜﻮن ﻣﺎزاﻟﺖ ﻓﻌﺎﻟﺔ‬toxic dose‫إﻟﻰ اﻟﺘﺮﻛﻴﺰ اﻟﺴﺎم‬
‫ﺣﺘﻰ ﻳﺘﻢ إﺧﺮاﺟﻬﺎ ﻣﻦ اﻟﺠﺴﻢ ﺗﻤﺎﻣﺎ‬
Effect of ****bolism on drug activity
Termination of activity
ً‫ زي اﻳﻪ ﻣﺜﻼ‬.. ‫ﻳﻌﻨﻲ ﻳﻨﺘﻬﻲ ﺗﺄﺛﻴﺮ اﻟﺪوا ﺗﻤﺎﻣﺎ‬
Oxidation of barbiturates ,phenytoin ,alcohol
Hydrolysis of succinylcholine
Conjugation of isoprenaline & salicylates

Promotion of activity
‫ زي‬.. ‫ﻳﻌﻨﻲ ﺿﺒﻂ اﻟﻔﻌﺎﻟﻴﺔ ﺑﻤﻌﻨﻰ ﺗﺤﻮﻳﻞ اﻟﺼﻮرة اﻟﻐﻴﺮ ﻓﻌﺎﻟﺔ إﻟﻰ اﻟﺼﻮرة اﻟﻔﻌﺎﻟﺔ‬
ً‫اﻳﻪ ﻣﺜﻼ‬
(Chloralhydrate to trichlorethanol (Hypnotic
(Phenacetin to paracetamol (Analgesic

No change on activity
‫ زي‬.. ‫ﻳﻌﻨﻲ ﻻ ﺗﻐﻴﻴﺮ ﻓﻲ اﻟﻔﻌﺎﻟﻴﺔ ﺑﻤﻌﻨﻰ اﻧﻪ ﻓﻌﺎل وﻳﺘﻜﺴﺮ إﻟﻰ ﺻﻮرة أﻳﻀﺎ ﻓﻌﺎﻟﺔ‬
ً‫اﻳﻪ ﻣﺜﻼ‬
Dealkylation of tricyclic antidepressants {TCA} &
benzodiazepines

‫ ودﻳﻪ ﻣﻘﺴﻤﺔ ﻟﻘﺴﻤﻴﻦ‬bolism**** ‫ﺑﻌﺪ ﻛﺪه ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﻣﺮاﺣﻞ اﻷﻳﺾ اﻟﻐﺬاﺋﻲ‬

‫ﻛﺎﻟﺘﺎﻟﻲ‬

Phases of ****bolism
PHASE 1
non synthetic reactions
for all types of drugs
involve ****bolic modifications which may give more active
compounds than original
EX
Oxidation : methyl alc. is oxidized to formic acid==> toxic
phenacetin is oxidized to paracetamol
tremorine is oxidized to oxotremorine==>tremor inducing drug
Reduction : trichloroethanol is reduced to chloral hydrate
Hydrolysis : Acetyl salicylate is hydrolyzed to acetate & salicylate

PHASE 2
synthetic reactions
for only some drugs
involve conjugation to give water sol. subs. easily to be excreted
Conjugation is done with glucoronic acid (mainly) ,acetic acid
,glycine ,or sulphate
Ex
Benzoic acid + Glycine =====> Hippuric acid

‫ﻣﻠﺤﻮﻇﺔ‬
‫ ﺗﻌﻨﻲ ﻣﺎدة ﺗﺴﺒﺐ رﻋﺸﺔ وﺑﺎﻟﺘﺎﻟﻲ ﻓﺈذا ﺗﺮاﻛﻤﺖ ﻓﻲ اﻟﺠﺴﻢ‬tremor inducing drug
‫ﻗﺪ ﺗﺴﺒﺐ ﺳﻤﻴﺔ ﺗﺘﻤﺜﻞ ﻓﻲ رﻋﺸﺔ ﻟﻠﺠﺴﻢ‬

-----
‫اﻟﺤﻠﻘﺔ اﻟﺘﺎﺳﻌﻪ‬

‫ وﺗﺄﺛﻴﺮه وﻣﺮاﺣﻠﻪ‬bolism**** ‫ﻛﻨﺎ اﺗﻜﻠﻤﻨﺎ ﻋﻦ اﻷﻳﺾ‬

‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ آﺧﺮ ﺣﺎﺟﺔ ﻣﺘﺼﻠﺔ ﺑﻴﻪ وﻫﻲ اﻟﻌﻮاﻣﻞ اﻟﻤﺆﺛﺮة ﻋﻠﻴﻪ‬
‫ﻣﻬﻢ ﺟﺪا ﺗﻌﺮﻓﻮا أن اﻷﻳﺾ ﺑﻴﺤﺼﻞ أﺳﺎﺳﺎ ﻓﻲ اﻟﻜﺒﺪ وﺑﻴﺤﺼﻞ ﻓﻲ أﻋﻀﺎء ﺗﺎﻧﻴﺔ ﻟﻜﻦ ﺑﻨﺴﺒﺔ ﺿﺌﻴﻠﺔ‬
Microsomal Enzymes ‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﻳﺾ ﻓﻲ اﻟﻜﺒﺪ ﺑﻴﺤﺼﻞ ﻋﻦ ﻃﺮﻳﻖ ﻣﺎﻳﻜﺮوزوﻣﺎل إﻧﺰﻳﻢ‬
‫وﺑﺎﻟﺘﺎﻟﻲ اﻟﻌﻮاﻣﻞ اﻟﻤﺆﺛﺮة ﻋﻠﻰ ﻫﺬه اﻻﻧﺰﻳﻤﺎت ﻫﻲ اﻟﻌﻮاﻣﻞ اﻟﻠﻲ ﺑﺘﺄﺛﺮ ﻋﻠﻰ اﻷﻳﺾ‬

Factors affecting (microsomal enzymes' activity) ****bolism

Physiological factors
AGE
in neonates & infants ==>LMEs are immature meaning not well-developed
in geriatric ==>LMEs are impaired meaning their activity decrease
SO we can say that we must adjust drug dose for pediatrics & geriatrics carefully
***
males have higher activity of LMEs than females WHY
because male *** hormones are microsomal enzyme inducers but female ***
hormones are microsomal enzyme inhibitors
‫ﺑﻤﻌﻨﻰ ان ﻫﺮﻣﻮﻧﺎت اﻟﺬﻛﻮرة اﻟﺠﻨﺴﻴﺔ ﺗﺰﻳﺪ ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ ﻓﺘﻜﺴﺮ اﻷدوﻳﺔ اﺳﺮع‬
‫ﻋﻠﻰ اﻟﻌﻜﺲ ﻣﻦ ﻫﺮﻣﻮﻧﺎت اﻷﻧﻮﺛﺔ اﻟﺠﻨﺴﻴﺔ ﺗﺜﺒﻂ ﻣﻦ ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ ﻓﻴﻈﻞ ﺗﺮﻛﻴﺰ اﻷدوﻳﺔ ﻋﺎﻟﻲ ﻟﻔﺘﺮة‬
‫أﻃﻮل‬
HORMONES
as corticosreroids are LME inducers
‫ﻳﻌﻨﻲ ﺑﺘﺰود ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ‬
NUTRITION
‫ﻃﺒﻴﻌﻲ ان اﻟﺘﻐﺬﻳﺔ ﺗﺆﺛﺮ ﻋﻠﻰ ﻧﺸﺎط اﻻﻧﺰﻳﻤﺎت ﺑﻤﻌﻨﻰ‬
malnutrition decreases activity of LME

Genetic factors
due to species & individual differences
‫ﻳﻌﻨﻲ ﺣﺴﺐ اﻟﻨﻮع ﻳﻌﻨﻲ ﻣﺜﻼ ﻓﺌﺔ ﻣﻌﻴﻨﺔ ﺗﻌﻴﺶ ﻓﻲ ﻣﻨﺎخ ﻣﻌﻴﻦ ﻣﻤﻜﻦ ﻳﻜﻮن ﻟﻪ ﺗﺄﺛﻴﺮ ﻋﻠﻰ ﻓﻌﺎﻟﻴﺔ اﻻﻧﺰﻳﻤﺎت‬
Environmental factors
STRESS
leads to increased ****bolism HOW
stress increases blood level of glucocorticoids which are LME inducers
FOREIGN COMPOUNDS
as insecticides & preservatives ==> LME inducers
DRUGS
there are LME inducers & LME inhibitors
‫ﻟﻜﻦ ﻣﻌﻈﻢ اﻻدوﻳﺔ ﺗﺰﻳﺪ ﻓﻌﺎﻟﻴﺔ اﻻﻧﺰﻳﻤﺎت ﻓﺘﺆدي ﻟﺘﻜﺴﻴﺮ اﻷدوﻳﺔ ﺑﺴﺮﻋﺔ‬
LME inducers ‫ﻳﻌﻨﻲ ﻣﻌﻈﻤﻬﻢ‬

‫دﻟﻮﻗﺘﻲ ﺣﻨﺘﻜﻠﻢ ﺑﺎﻟﺘﻔﺼﻴﻞ ﺷﻮﻳﺔ ﻋﻠﻰ ﺣﺎﺟﺔ ﻣﻬﻤﺔ وﻫﻲ‬

Enzyme induction
it's enhancement of enzyme activity due to an increase in the amount of enzyme
proteins present in the cell
‫ﺑﻤﻌﻨﻰ ان اﻟﺒﺮوﺗﻴﻦ اﻟﻤﻜﻮن ﻟﻼﻧﺰﻳﻤﺎت ﻣﻮﺟﻮد ﺑﻮﻓﺮة ﻓﻴﺘﻜﻮن اﻻﻧﺰﻳﻢ ﺑﻮﻓﺮة‬
‫ﻷن أﺳﺎﺳﺎ زي ﻣﺎ ﻻزم ﻧﻜﻮﻧﻮا ﻋﺎرﻓﻴﻦ ان اﻧﺰﻳﻤﺎت وﻫﺮﻣﻮﻧﺎت اﻟﺠﺴﻢ ﻣﺎ ﻫﻲ اﻻ ﺑﺮوﺗﻴﻨﺎت ذات وﻇﻴﻔﺔ ﻣﻌﻴﻨﺔ‬
‫ ﻳﻌﻨﻲ اﻟﺪوا اﻟﻠﻲ ﻳﻴﺰود ﻣﻦ ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ ﺑﻴﺰود ﻣﻦ ﺳﺮﻋﺔ ﺗﻜﺴﻴﺮ‬LME inducer drugs ‫ﺧﻠﻲ ﺑﺎﻟﻚ‬
‫اﻷدوﻳﺔ وﻛﺬﻟﻚ ﺗﻜﺴﻴﺮ اﻟﺪوا ﻧﻔﺴﻪ ﺑﻤﻌﻨﻰ‬
Drugs causing LME induction can increase the rate of ****bolism of themselves &
other unrelated drugs
‫‪N.B‬‬
‫‪as most ****bolites are pharmacologically inactive or less active so we can say that‬‬
‫‪enzyme induction leads to‬‬
‫‪Decrease duration of drug action‬‬
‫‪Decrease intensity of drug action‬‬
‫‪Decrease toxicity of the drug‬‬
‫‪Increase tolerance to the drug‬‬
‫ﻳﻌﻨﻲ ﻳﻘﻠﻞ ﻓﺘﺮة وﺷﺪة ﺗﺄﺛﻴﺮ اﻟﺪواء وﺑﺎﻟﺘﺎﻟﻲ ﻳﻘﻠﻞ اﻟﺴﻤﻴﺔ‬
‫وﻗﺪ ﻳﻈﻬﺮ ﻟﻨﺎ اﻧﻬﺎ ﻣﻴﺰة ﻓﻲ ﺗﻘﻠﻴﻞ اﻟﺴﻤﻴﺔ وﻟﻜﻦ ﻫﻨﺎك ﻋﻴﺐ ﺧﻄﻴﺮ وﻫﻮ اﻧﻪ ﻳﺰﻳﺪ ﺳﺮﻋﺔ اﻟﺘﻌﻮد ﻋﻠﻰ اﻟﺪواء‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻳﺼﺒﺢ اﻟﺪواء ﺑﻌﺪ ﻓﺘﺮة ﺻﻐﻴﺮة ﻻ ﻳﺼﻠﺢ ﻟﻼﺳﺘﻌﻤﺎل‬

‫ﻣﻠﺤﻮﻇﺔ ﻟﻠﻌﻠﻢ ‪:‬‬

‫اﻟﺪواء ﻟﻜﻲ ﻳﺆدي ﺗﺄﺛﻴﺮه اﻟﻤﺮﻏﻮب ﻻﺑﺪ ﻣﻦ وﺻﻮﻟﻪ ﻟﻞ‪ site of action‬ﺑﻜﻤﻴﺔ ﻣﻌﻴﻨﺔ‬
‫ﻣﺎ اﻟﺬي ﻳﺠﻌﻞ اﻻﻧﺴﺎن ﻳﺘﻌﻮد ﻋﻠﻰ اﻟﺪواء وان اﻟﺪواء اﺻﺒﺢ ﻻ ﺗﺄﺛﻴﺮ ﻟﻪ ؟؟‬
‫ان ﻳﺴﻲء اﻻﻧﺴﺎن اﺳﺘﺨﺪام اﻟﺪواء ﻓﻤﺜﻼ ﺟﺮﻋﺔ دوا ﻣﻌﻴﻦ ﻫﻲ ﻛﺒﺴﻮﻟﺔ ‪500‬ﻣﺠﻢ ﻓﻴﺄﺧﺬه اﻟﺸﺨﺺ ﺑﺠﺮﻋﺔ‬
‫‪250‬ﻣﺠﻢ ﻣﻦ ﺑﺎب اﻟﺘﻘﻠﻴﻞ ﻣﻦ آﺛﺎره اﻟﺠﺎﻧﺒﻴﺔ أو ﻣﻦ ﺑﺎب اﻟﺘﻮﻓﻴﺮ أو‪ ..‬أو‪ ..‬وﻫﻜﺬا‬
‫ﻓﻴﺼﻞ ﻛﻤﻴﺔ ﻏﻴﺮ ﻛﺎﻓﻴﺔ اﻟﻰ ﻣﻜﺎن اﻟﺘﺄﺛﻴﺮ وﻻ ﺗﺆدي ﺗﺄﺛﻴﺮﻫﺎ اﻟﻤﻄﻠﻮب‬
‫ﺛﻢ ﺑﻌﺪ ﻓﺘﺮة ﻳﻀﻄﺮ اﻟﺸﺨﺺ ان ﻳﺰﻳﺪ اﻟﺠﺮﻋﺔ ﺑﻌﺪ ان ﺗﻌﻮد ﺟﺴﻤﻪ ﻋﻠﻴﻬﺎ ﻓﻴﺄﺧﺬ ‪500‬ﻣﺠﻢ واﻳﻀﺎ ﻻ ﺗﺆدي‬
‫اﻟﺘﺄﺛﻴﺮ ﻷن ﺟﺴﻢ ﺗﻌﻮد ﻋﻠﻰ اﻟﺪواء‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻧﻘﻮل ان زﻳﺎدة ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ ﺗﺆدي اﻟﻰ ﺳﺮﻋﺔ ﺗﻜﺴﻴﺮ اﻟﺪواء وﺑﺎﻟﺘﺎﻟﻲ ﺗﺆدي اﻟﻰ ﺗﻘﻠﻴﻞ‬
‫اﻟﻜﻤﻴﺔ اﻟﻤﺘﻮﻓﺮة ﻓﻲ ال ‪ site of action‬ﻓﻼ ﻳﺆدي اﻟﺘﺄﺛﻴﺮ وﻛﻤﺎ ﺳﺒﻖ ﺷﺮﺣﻪ ﻳﺆدي ﻓﻲ اﻟﻨﻬﺎﻳﺔ اﻟﻰ اﻟﺘﻌﻮد ﻋﻠﻰ‬
‫اﻟﺪواء وﻋﺪم ﺻﻼﺣﻴﺘﻪ ﻟﻼﺳﺘﺨﺪام‬

‫ﻃﻴﺐ ﻧﺎﺧﺪ اﻣﺜﻠﺔ ﻟﻸدوﻳﺔ اﻟﺘﻲ ﺗﺰﻳﺪ ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ‬

‫‪Barbiturates ,Phenytoin ,DDT ,Phenothiazine ,Rifampicin ,male *** hormones‬‬
‫‪,Phenylbutazone ,Ethanol ,Lindane ,Grisofulvin ,Glutethimide‬‬
‫‪Increase rate of ****bolism of drugs‬‬
‫ﻃﻴﺐ ﻧﺎﺧﺪ أﻣﺜﻠﺔ ﻟﻸدوﻳﺔ اﻟﺘﻲ ﺗﻘﻠﻞ ﻧﺸﺎط اﻧﺰﻳﻤﺎت اﻟﺘﻜﺴﻴﺮ‬
‫‪Chloroform ,Carbon monoxide ,Ozone ,female *** hormones ,Disulfuram‬‬
‫‪Decrease rate of ****bolism of drugs‬‬
‫ﻛﺪه ﺧﻠﺼﻨﺎ ﻛﻼم ﻋﻦ اﻷﻳﺾ اﻟﻐﺬاﺋﻲ ****‪bolism‬‬
‫ﻣﻠﺤﻮﻇﺔ‪:‬‬
‫‪ disulfuram‬ﻋﺒﺎرة ﻋﻦ ‪ antabuse‬ﻳﻌﻨﻲ ﻳﺴﺘﺨﺪم ﻋﻼج إدﻣﺎن اﻟﻜﺤﻮﻟﻴﺎت ﻷﻧﻪ ﺑﻴﻤﻨﻊ ﺗﻜﺴﻴﺮ اﻻﺳﻴﺘﺎﻟﺪﻫﻴﺪ‬
‫اﻟﻨﺎﺗﺞ ﻣﻦ اﻟﻜﺤﻮل ﻓﻴﺘﺮاﻛﻢ اﻻﺳﻴﺘﺎﻟﺪﻫﻴﺪ ﻓﻲ اﻟﺠﺴﻢ وﺗﻈﻬﺮ أﻋﺮاﺿﻪ اﻟﺴﺎﻣﺔ ﻓﻴﻜﺮه اﻟﻤﺪﻣﻦ اﻟﻜﺤﻮﻟﻴﺎت وﻳﻤﺘﻨﻊ‬
‫ﻋﻨﻬﺎ‬
‫ﻳﻌﻨﻲ ﻫﻮ ﻋﺒﺎرة ﻋﻦ ﺗﻬﻴﺌﺔ ﻧﻔﺴﻴﺔ ﻋﺸﺎن اﻟﻤﺪﻣﻦ ﻳﻜﺮه اﻟﻜﺤﻮﻟﻴﺎت وﺑﺎﻟﺘﺎﻟﻲ ﻳﻤﺘﻨﻊ ﻋﻨﻬﺎ‬
 ‫‪le pharmacien 03:30 PM 23-09-2010‬‬

‫اﻟﺤﻠﻘﻪ اﻟﻌﺎﺷﺮه‬
‫ﺑﻌﺪ ﻣﺎﺗﻜﻠﻤﻨﺎ ﻋﻦ ال ‪absorbtion ,distribution ,****bolism‬‬
‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ آﺧﺮ ﻋﻤﻠﻴﺔ ﻣﻦ ﻋﻤﻠﻴﺎت ال ‪pharmacokinetics‬‬

‫‪Excretion‬‬
‫ودﻳﻪ ﺑﻨﻌﺘﺒﺮﻫﺎ اﻟﻌﻤﻠﻴﺔ اﻟﺜﺎﻧﻴﺔ اﻟﺘﻲ ﻳﻘﻮم ﻓﻴﻬﺎ اﻟﺠﺴﻢ ﺑﺈﻧﻬﺎء ﺗﺄﺛﻴﺮ اﻟﺪواء وﻟﻜﻦ ﻫﻨﺎ‬
‫ﺑﺸﻜﻞ ﻧﻬﺎﺋﻲ أﻣﺎ اﻟﻌﻤﻠﻴﺔ اﻷوﻟﻰ وﻫﻲ ال****‪ bolism‬ﻓﻬﻲ ﻗﺪ ﻳﻨﻬﻲ اﻟﺠﺴﻢ ﻓﻴﻬﺎ‬
‫ﺗﺄﺛﻴﺮ اﻟﺪواء وﻗﺪ ﻳﻀﻌﻔﻪ ﻓﻘﻂ وﻗﺪ ﻻ ﻳﺆﺛﺮ ﻓﻴﻪ‬
‫‪ROUTES OF EXCRETION‬‬
‫ﺣﻨﻼﻗﻲ ان وﺳﺎﺋﻞ اﻻﺧﺮاج ﻛﺘﻴﺮة ﺟﺪا وﻟﻜﻦ ﺗﺨﺘﻠﻒ ﻧﺴﺒﺔ ﻛﻞ وﺳﻴﻠﺔ ﻓﻲ ﻋﻤﻠﻴﺔ‬
‫اﻻﺧﺮاج‬
‫‪Kidney‬‬
‫ودﻳﻪ ﻃﺒﻌﺎ اﻟﻐﺎﻟﺒﺔ ﻷﻧﻬﺎ ﺗﻘﻮم ﺑﺘﻨﻘﻴﺔ اﻟﺪم اﻟﺬي ﻣﺮّ ﻋﻠﻰ ﻛﻞ اﻷﻋﻀﺎء وأﺧﺬ ﻛﻞ‬
‫اﻟﻤﺨﺮﺟﺎت‬

‫‪Bile‬‬
‫ودﻳﻪ ﻋﻦ ﻃﺮﻳﻖ ان اﻟﻤﺮارة اﻟﻠﻲ ﺑﺘﻔﺮز اﻧﺰﻳﻤﺎت ﻟﻬﻀﻢ اﻟﺪﻫﻮن ﺗﻘﻮم ﺑﺘﺼﻨﻴﻌﻬﺎ ﻣﻦ‬
‫اﻟﻜﻮﻟﻴﺴﺮﺗﻮل‬
‫ﻟﺬا ﻧﺠﺪ اﻧﻪ ﻓﻲ ﺑﻌﺾ اﻷﺣﻴﺎن اﻟﻨﺎس اﻟﻠﻲ ﻋﻨﺪﻫﺎ ﻧﺴﺒﺔ ﻛﻮﻟﻴﺴﺘﺮول ﻋﺎﻟﻴﺔ ﻓﻲ‬
‫اﻟﺠﺴﻢ ﺑﻴﺘﻌﺎﻟﺠﻮا ﻋﻦ ﻃﺮﻳﻖ أدوﻳﺔ ﺗﺰﻳﺪ ﻣﻦ إﺧﺮاج اﻟﻌﺼﺎرة اﻟﻤﺮارﻳﺔ ﻟﻜﻲ أﺟﺒﺮ‬
‫اﻟﻤﺮارة ان ﺗﺴﺘﺨﺪم اﻟﻜﻮﻟﻴﺴﺘﺮول ﻓﻲ ﺗﺼﻨﻴﻊ ﻋﺼﺎرﺗﻬﺎ ﻣﻦ ﺟﺪﻳﺪ وﺑﺎﻟﺘﺎﻟﻲ ﺑﺘﺴﺘﻬﻠﻚ‬
‫ﻛﻤﻴﺔ أﻛﺒﺮ ﻣﻦ اﻟﻜﻮﻟﻴﺴﺘﺮول‬

‫‪Lungs‬‬
‫ﻋﻦ ﻃﺮﻳﻖ إﺧﺮاج ‪carbon dioxide, volatile substances‬‬
‫‪GIT‬‬
‫ﻋﻦ ﻃﺮﻳﻖ اﻟﺘﺨﻠﺺ ﻣﻦ اﻟﻄﻌﺎم اﻟﺬي ﻟﻢ ﻳﺴﺘﻔﻴﺪ ﻣﻨﻪ اﻟﺠﺴﻢ ﻋﻦ ﻃﺮﻳﻖ آﺧﺮ ﺟﺰء‬
‫ﻣﻨﻬﺎ وﻫﻮ ‪colon‬‬
‫‪Sweat‬‬
‫ﻋﻦ ﻃﺮﻳﻖ اﻟﻌﺮق أﻗﺪر اﺗﺨﻠﺺ ﻣﻦ اﻟﻤﻴﺎه اﻟﺰاﺋﺪة وﺑﻌﺾ اﻟﻤﻮاد أو اﻷدوﻳﺔ اﻟﺘﻲ ﻗﺪ‬
‫ﺗﻨﺘﺸﺮ ﺗﺤﺖ اﻟﺠﻠﺪ واﻟﻤﻮاد اﻟﻄﻴﺎرة‬

‫‪Saliva‬‬
‫ﺣﻴﺚ ﻳﻮﺟﺪ ﺑﻌﺾ اﻷدوﻳﺔ ﺗﺨﺮج ﻓﻲ اﻟﻠﻌﺎب ﻟﺬﻟﻚ أﺣﻴﺎﻧﺎ ﻳﻜﻮن ﻓﻴﻪ دواء ﻳﺄﺧﺬه‬
‫اﻟﻤﺮﻳﺾ وﻳﻜﻮن ﻣﻦ اﻋﺮاﺿﻪ اﻟﺠﺎﻧﺒﻴﺔ اﻧﻪ ﻳﻠﻮن اﻟﻠﻌﺎب وده ﻻزم اﻟﻤﺮﻳﺾ ﻳﻌﺮﻓﻪ‬
‫ﻋﺸﺎن ﻣﻴﻘﻠﻘﺶ‬

‫‪Milk‬‬
‫أﺣﻴﺎﻧﺎ ﺑﺮده ﻓﻴﻪ أدوﻳﺔ ﺑﺘﺨﺮج ﻣﻊ ﻟﺒﻦ اﻷم وﺑﺘﻜﻮن ﻣﻤﻨﻮﻋﺔ ﻟﻸم اﻟﻤﺮﺿﻌﺔ ﻋﺸﺎن‬
‫ﻣﺘﺄذﻳﺶ اﻟﻄﻔﻞ‬
‫اﻟﻌﻀﻮ اﻹﺧﺮاﺟﻲ اﻟﺴﺎﺋﺪ ﻫﻨﺎ ﻫﻮ اﻟﻜﻠﻴﺘﻴﻦ ﻟﺬا ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﺧﻄﻮات اﻹﺧﺮاج ﻓﻴﻪ‬
‫وﻫﻲ‪:‬‬
‫‪Steps of renal excretion‬‬
‫‪Glomerular Filteration‬‬
‫وﻫﻨﺎ اﻟﺪوا اﻟﻠﻲ ﺣﻴﺨﺮج ﻫﻮ اﻟﺪوا اﻟﻐﻴﺮ ﻣﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم‬
‫أي ان اﻟﺪم ﻳﻤﺮ ﻋﻠﻰ اﻟﻜﻠﻴﺔ وﺗﻘﻮم اﻟﻜﻠﻴﺔ ﺑﺘﺼﻔﻴﺘﻪ ﺑﺄن ﺗﺄﺧﺬ اﻟﺪواء اﻟﻐﻴﺮ ﻣﺮﺗﺒﻂ‬
‫ﺑﺒﺮوﺗﻴﻦ اﻟﺪم ﻷﻧﻪ ﻋﻤﻞ اﻟﺘﺄﺛﻴﺮ ﺑﺘﺎﻋﻪ وﺧﻼص وﺗﺘﺮك اﻟﺪوا اﻟﻤﺮﺗﺒﻂ ﺑﺎﻟﺒﺮوﺗﻴﻦ ﻷﻧﻪ‬
‫ﻳﻌﻤﻞ ﻛﻤﺨﺰن ‪ as a recervoir‬ﻟﻜﻲ ﻳﻌﻄﻲ اﻟﺘﺄﺛﻴﺮ ﻓﻴﻤﺎ ﺑﻌﺪ‬
‫‪The non protein bound drug is filtered through the glomeruli‬‬
‫ﺛﻢ ﻳﺤﺪث ﻟﺠﺰء ﻣﻦ اﻟﻤﺎء واﻷدوﻳﺔ واﻟﻤﻮاد اﻟﻬﺎﻣﺔ ﻟﻠﺠﺴﻢ إﻋﺎدة اﻣﺘﺼﺎص‬
‫‪Tubular Reabsorbtion‬‬
‫‪part of water ,important nutrients ,& some of drug are‬‬
‫‪reabsorbed passively back to‬‬
‫‪blood‬‬
‫‪Active Tubular Secretion‬‬
‫ﺑﻌﺪ ﻣﺎ ﺣﺼﻞ إﻋﺎدة اﻣﺘﺼﺎص ﻟﺠﺰء ﻣﻦ اﻟﻤﺎء واﻟﻤﻮاد اﻟﻬﺎﻣﺔ ﻳﺘﻢ إﻋﺎدة أﺧﺮى‬
‫ﻟﻼﻣﺘﺼﺎص ﻟﻜﻲ ﻳﺘﻢ إﺧﺮاج اﻟﻮاد اﻟﺘﻲ ﻻ ﻳﺤﺘﺎﺟﻬﺎ اﻟﺠﺴﻢ ﻓﻘﻂ وﻳﻌﺎد اﻻﺳﺘﻔﺎدة‬
‫ﻣﻦ اﻟﻤﻮاد اﻟﻬﺎﻣﺔ واﻟﻤﺎء‬
‫ﻣﻠﺤﻮﻇﺔ ﻫﺎﻣﺔ ﺟﺪا‬
‫ﻟﻴﻪ أﺛﻨﺎء ‪ glomerular filteration‬ﺑﻴﻌﺪي اﻟﺪوا اﻟﻐﻴﺮ ﻣﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻨﺎت اﻟﺪم‬
‫ﻓﻘﻂ ؟؟‬
‫ﻷن ﺑﺒﺴﺎﻃﺔ ﺟﺪا ‪...‬‬
‫‪Bowman's capsule can allow passing of water & substances of‬‬
‫‪M.wt less than 5000‬‬
‫ﻟﻜﻦ ال ‪ albumin‬ﻟﻪ ‪ M.wt‬أﻛﺒﺮ ﻣﻦ ‪5000‬‬
‫‪So, albumin & protein bound drugs cann't pass‬‬
‫ﻟﻜﻦ ﻃﺒﻌﺎ ﻓﻲ ﺣﺎﻟﺔ اﻟﻔﺸﻞ اﻟﻜﻠﻮي "رﺑﻨﺎ ﻳﻜﻔﻴﻨﺎ ﺷﺮه" ﺣﻨﻼﻗﻲ ان ﺣﺼﻞ ﺧﻠﻞ‬
‫ﺣﻨﻼﻗﻲ ان اﻟﻜﺎﺑﺴﻮﻟﺔ ﺑﻮﻣﺎن اﻟﻠﻲ ﺑﺘﻤﻨﻊ ﻣﺮور ‪ albumin‬ﻓﻴﻬﺎ ﺧﻠﻞ ﺟﻌﻠﻬﺎ ﺗﺴﺢ‬
‫ﺑﻤﺮور ‪ albumin‬وﻳﺘﻢ إﺧﺮاﺟﻪ ﻣﻦ اﻟﺠﺴﻢ وﻏﺎﻟﺒﺎ ده ﺑﻴﻜﻮن ‪ nephritis‬اﻟﻠﻲ‬
‫ﺑﻴﺴﺒﺐ ﺑﻌﺪ ﻛﺪه ﻓﺸﻞ ﻛﻠﻮي‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻣﻦ اﻟﻄﺒﻴﻌﻲ ﺟﺪا ان ‪albumin‬ﻻ ﻳﺘﻮاﺟﺪ أﺑﺪا ﻓﻲ ال‪urine‬‬
‫وﻣﺶ ﻣﻦ اﻟﻄﺒﻴﻌﻲ اﺑﺪا اﻧﻲ أﻻﻗﻲ ‪albumin‬ﻓﻲ ‪ urine‬وﻟﻮ ﺑﻨﺴﺒﺔ ﺻﻐﻴﺮة‬
‫وﺑﺎﻟﺘﺎﻟﻲ ﻟﻤﺎ ﻳﺘﻮاﺟﺪ ‪ albumin‬ﻓﻲ ‪ urine‬ﺑﻘﻮل اﻧﻪ ﺣﺼﻞ ‪ albuminurea‬ﻣﺶ‬
‫‪hyperalbumiurea‬‬
‫ﻷن ﺑﺒﺴﺎﻃﺔ ﻣﺶ ﻣﺤﺘﺎﺟﺔ ان ﺗﻜﻮن ﻧﺴﺒﺘﻪ ﻛﺒﻴﺮة ﻓﻲ اﻟﻴﻮرﻳﻦ ﻋﺸﺎن اﻗﻮل اﻧﻪ‬
‫ﺣﺪث ﺧﻠﻞ ﻓﻲ اﻟﻜﻠﻴﺔ‬
‫‪All drugs (polar & non polar) can pass in the filterate‬‬
‫ﺑﺸﺮط ﻣﺘﻜﻮﻧﺶ ﻣﺎﺳﻜﺔ ﻓﻲ اﻟﺒﻼزﻣﺎ ﺑﺮوﺗﻴﻦ‬
‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮة اﻟﺤﺎدﻳﻪ ﻋﺸﺮ‬

‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ أﻣﺜﻠﺔ ﻟﻞ ‪ drug interaction‬ﻋﻨﺪ ال ‪ excretion sites‬واﻟﻠﻲ ﻏﺎﻟﺒﺎ‬
‫ﻳﺘﺴﺒﺐ ﻓﻲ ﻣﺸﺎﻛﻞ ﻻﺑﺪ ﻣﻦ وﺿﻌﻬﺎ ﻓﻲ اﻻﻋﺘﺒﺎر ﻷن ﻣﻤﻜﻦ ﺗﺴﺒﺐ زﻳﺎدة ﺗﺮﻛﻴﺰ دواء‬
‫ﻓﻴﺼﻞ ﻟﻠﺴﻤﻴﺔ أو ﻗﻠﺔ ﺗﺮﻛﻴﺰ دواء ﻳﺴﺒﺐ ﻋﺪم اﻻﺳﺘﺠﺎﺑﺔ ﻟﻪ‬

‫‪drug may increase till the over dose or may decrease till the‬‬
‫‪subdose‬‬
‫ﻋﻨﺪﻧﺎ ﻣﺜﺎﻟﻴﻦ ﻣﻬﻤﻴﻦ ﺟﺪا رﻛﺰوا ﻣﻌﺎﻳﺎ ﻋﺸﺎن ﻓﻴﻪ واﺣﺪ ﻣﻨﻬﻢ ﻓﻴﻪ ﻋﻼﻗﺔ ﻋﻜﺴﻴﺔ‬
‫‪Probenicid is a uricosuric agent‬‬
‫ﻳﻌﻨﻲ ﻣﺎدة ﺗﺴﺎﻋﺪ ﻋﻠﻰ إﺧﺮاج ال ‪uric acid‬‬
‫‪it competes with penicillin "antibiotic" for the carrier system‬‬
‫‪responsible for its excretion‬‬
‫ﺑﻤﻌﻨﻰ ان اﻟﺒﻨﻴﺴﻴﻠﻠﻴﻦ واﻟﺒﺮوﺑﻨﺴﻴﺪ ﻳﺘﻢ إﺧﺮاﺟﻬﻢ ﻋﻦ ﻃﺮﻳﻖ ‪ carrier‬ﻣﺸﺘﺮك وﻟﻤﺎ‬
‫اﻟﻤﺮﻳﺾ ﻳﺎﺧﺪﻫﻢ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ ﻳﺘﻨﺎﻓﺴﻮا ﻋﻠﻰ ال ‪ carrier‬ﻳﺒﻘﻰ اﻛﻴﺪ ﻓﻴﻪ واﺣﺪ‬
‫ﻓﻴﻬﻢ ﻟﻪ ﻗﺎﺑﻠﻴﺔ أﻛﺘﺮ ﻟﻞ‪ .. carrier‬ﺣﻨﻼﻗﻲ ان اﻟﺒﺮوﺑﻨﺴﻴﺪ ﻫﻮ اﻟﻠﻲ ﺑﻴﻜﺴﺐ وﻳﺘﻢ‬
‫إﺧﺮاﺟﻪ ﻣﻦ اﻟﺠﺴﻢ وﻳﺘﺒﻘﻰ اﻟﺒﻨﺴﻴﻠﻠﻴﻦ ﻣﻮﺟﻮد ﻓﻲ اﻟﺠﺴﻢ وﻳﺘﺄﺧﺮ إﺧﺮاﺟﻪ‬
‫‪meaning that penicillin excretion decrease causing prolongation‬‬
‫‪of its action‬‬
‫ﺧﻠﻮا ﺑﺎﻟﻜﻢ ﻣﻦ اﻻﺳﻤﻴﻦ ﻷﻧﻬﻢ ﻣﺘﺸﺎﺑﻬﻴﻦ‬
‫اﻟﻤﻬﻢ ﺗﻌﺮﻓﻮا ان اﻟﻤﺎدة اﻟﻠﻲ ﺑﺘﺨﺮج اﻟﻴﻮرﻳﻚ "اﻟﺒﺮوﺑﻨﺴﻴﺪ" ﻟﻤﺎ ﺗﺆﺧﺬ ﻣﻊ اﻟﻤﻀﺎد‬
‫اﻟﺤﻴﻮي "اﻟﺒﻨﻴﺴﻴﻠﻠﻴﻦ" ﺑﻴﻨﺘﺞ ﻋﻨﻪ ﺗﺄﺧﻴﺮ إﺧﺮاج اﻟﻤﻀﺎد اﻟﺤﻴﻮي واﺳﺘﻤﺮار ﺗﺄﺛﻴﺮه‬
‫ﻳﺒﻘﻰ ﻧﺎﺧﺪ ﺑﺎﻟﻨﺎ ﻣﻦ اﻟﺠﺮﻋﺔ اﻟﻤﻌﻄﺎة ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﺔ ﻳﻌﻨﻲ ﻻزم ﺗﻘﻞ ﺟﺮﻋﺔ اﻟﻤﻀﺎد‬
 ‫ﺷﻮﻳﺔ ﻋﺸﺎن ﻣﻴﺘﺮاﻛﻤﺶ ﻓﻲ اﻟﺠﺴﻢ ‪ ......‬ﻓﻬﻤﺘﻮا ؟؟‬
‫ﻃﻴﺐ اﻟﻤﺜﺎل اﻟﻠﻲ ﺑﻌﺪ ﻛﺪه ﺑﻘﻰ ﻻ زم ﺗﺮﻛﺰوا ﻓﻴﻪ أﻛﺜﺮ‬
‫‪Salicylates as acetyl salicylate "NSAID" compete with uric acid‬‬
‫‪for the carrier‬‬
‫‪NSAID meaning non steroidal anti inflammatory drug‬‬
‫ﻳﻌﻨﻲ اﻻﺗﻨﻴﻦ ﺑﻴﺨﺮوﺟﻮا ﻋﻦ ﻃﺮﻳﻖ ‪ carrier‬ﻣﺸﺘﺮك وﺑﺎﻟﺘﺎﻟﻲ ﺑﻴﺤﺼﻞ ﺗﻨﺎﻓﺲ‬
‫ﺣﻨﻼﻗﻲ ان ال ‪ salicylates‬ﻫﻲ اﻟﻠﻲ ﺑﺘﻔﻮز ﺑﺎل ‪ carrier‬وﻳﺘﻢ إﺧﺮاﺟﻬﺎ ﻣﻦ‬
‫اﻟﺠﺴﻢ وﺗﺨﺰﻳﻦ اﻟﻴﻮرﻳﻚ داﺧﻞ اﻟﺠﺴﻢ‬
‫‪meaning uric acid excretion decrease causing retension of uric‬‬
‫‪acid & gout‬‬
‫ﻣﻌﻨﻰ ﻛﺪه اﻧﻚ ﻣﻤﻜﻦ ﺗﻔﺘﻜﺮ ان ال ‪salicylate is contra-indicated in gout‬‬
‫ﺣﻘﻮﻟﻚ اﻧﺖ ﻓﻌﻼ ﻓﺎﻫﻢ ﻟﻜﻦ ﻓﻴﻪ ﻫﻨﺎ ﻋﻼﻗﺔ ﻋﻜﺴﻴﺔ ‪ ..‬إزاي؟‬
‫أﻗﻮﻟﻚ ان ال ‪ salicylate‬أﺻﻼ ﺑﻴﺴﺘﺨﺪم ﻓﻲ ﻋﻼج اﻟﻨﻘﺮص ‪ gout‬ﻟﻴﻪ وازاي؟‬
‫ﺑﻴﺴﺘﺨﺪم ﻓﻲ ﻋﻼج اﻟﻨﻘﺮص ﻟﻜﻦ ‪ in high doses‬ﻷﻧﻪ ﺑﻜﺪه ﺣﻴﻐﻴﺮ ال ‪ pH‬ﺑﺘﺎﻋﺔ‬
‫اﻟﻴﻮرﻳﻦ وﻳﺠﺒﺮ اﻟﻴﻮرﻳﻚ ﻋﻠﻰ اﻟﺨﺮوج ﻣﻦ اﻟﺠﺴﻢ‬
‫ﻳﻌﻨﻲ ﺑﺎﺧﺘﺼﺎر ﻳﺎ ﺟﻤﺎﻋﺔ ﻋﺸﺎن ﻣﻨﺘﻬﺶ ﻣﻦ ﺑﻌﺾ‬
‫ال ‪ salicylate‬ﻟﻤﺎ ﻳﺴﺘﺨﺪم ‪ in small doses‬ﻛﻤﺴﻜﻦ ﻋﺎدي ﺑﺠﺮﻋﺎت ﺻﻐﻴﺮة‬
‫ﺣﻨﻼﻗﻲ اﻧﻪ ﺑﺎﺳﺘﻤﺮاره ﺑﻌﺪ ﻛﺪه ﻣﻤﻜﻦ ﻳﺴﺒﺐ ﻧﻘﺮص أو ﺣﺘﻰ آﻻم ﻓﻲ اﻟﻘﺪم ﻛﺒﺪاﻳﺔ‬
‫ﻟﻠﻨﻘﺮص‬
‫ﻟﻜﻦ ﻟﻤﺎ آﺟﻲ اﺳﺘﺨﺪﻣﻪ ﻟﻮاﺣﺪ ﻋﻨﺪه ﻧﻘﺮص ﻛﻤﻀﺎد ﻟﻼﻟﺘﻬﺎﺑﺎت ﺣﺪﻳﻬﻮﻟﻪ ‪in high‬‬
‫‪ doses‬ﻋﺸﺎن ﻳﺆدي وﻇﻴﻔﺘﻪ ﺑﺄﻧﻪ ﻳﻐﻴﺮ ال ‪ pH‬وﻳﺠﺒﺮ اﻟﻴﻮرﻳﻚ ﻋﻠﻰ اﻟﺨﺮوج ﻣﻦ‬
‫اﻟﺠﺴﻢ‬

‫ﺷﻮﻳﺔ ﻣﻼﺣﻈﺎت ﻟﻠﻌﻠﻢ ﻓﻘﻂ‬

‫‪Examples on extrarenal routes of excretion‬‬
‫‪Gaseous & volatile anaesthetics are absorbed & excreted across‬‬
‫‪the pulmonary alveolar membrane by the process of simple‬‬
‫‪diffusion‬‬
‫ﻳﻌﻨﻲ ﺑﻌﺾ اﻷدوﻳﺔ اﻟﻄﻴﺎرة أو ﺑﺘﺆﺧﺬ ﻓﻲ ﺻﻮرة ﻏﺎزﻳﺔ زي ال ‪inhalers‬ﻳﺘﻢ‬
‫اﻣﺘﺼﺎﺻﻬﺎ وإﺧﺮاﺟﻬﺎ ﻋﻦ ﻃﺮﻳﻖ اﻟﺮﺋﺔ ﺑﻄﺮﻳﻘﺔ ال ‪simple diffusion‬‬
‫ﻷﻧﻬﺎ ﺑﺘﺘﻘﻞ ﻣﻦ ﺗﺮﻛﻴﺰ ﻋﺎﻟﻲ ااﻟﻲ ﻫﻮ ﺟﺮﻋﺔ اﻟﺪواء اﻟﻠﻲ ﺑﻴﺴﺘﻨﺸﻘﻬﺎ اﻟﻤﺮﻳﺾ إﻟﻰ‬
‫اﻟﻐﺸﺎء اﻟﺮﺋﻮي ﺛﻢ ﺑﻌﺪ ﻣﺎﺗﻌﻄﻲ اﻟﺘﺄﺛﻴﺮ ﺑﺘﺎﻋﻬﺎ ﺗﻨﺘﻘﻞ ﻣﻦ اﻟﻐﺸﺎء اﻟﺮﺋﻮي اﻟﻠﻲ ﻓﻴﻪ‬
‫اﻟﺠﺮﻋﺔ ﻛﻠﻬﺎ إﻟﻰ اﻟﺨﺎرج أﺛﻨﺎء اﻟﺰﻓﻴﺮ‬
‫‪Many drugs are excreted in the bile as they are conjugated " as‬‬
‫‪glucoronides or sulphates then enter the GIT & leave the body in‬‬
‫‪feaces but some drugs can be deconjugated & reabsorbed into‬‬
‫‪circulation‬‬
‫ﻳﻌﻨﻲ اﻳﻪ اﻟﻜﻼم ده ؟؟‬
‫دﻟﻮﻗﺘﻲ ‪ conjugation‬ده ﻋﺒﺎرة ﻋﻦ اﺗﺤﺎد اﻟﺪواء ﺑﻤﺎدة ﻟﺘﺠﻌﻠﻪ ﻗﺎﺑﻼ ﻟﻠﺨﺮوج ﻣﻦ‬
‫اﻟﺠﺴﻢ ﻓﻴﻜﻮن ﻣﺜﻼ ﻓﻲ ﺻﻮرة ‪sulphate or glucoronide‬‬
‫ﻧﺠﺪ ان ﺑﻌﺾ اﻷدوﻳﺔ ﻳﺤﺪث ﻟﻬﺎ ال ‪ conjugation‬ﻟﻜﻲ ﺗﺨﺮج ﻣﻦ اﻟﺠﺴﻢ وﻟﻜﻦ‬
‫ﻣﻤﻜﻦ ﺟﺰء ﻣﻨﻬﺎ ﻳﺤﺪث ﻟﻪ اﻟﻌﻜﺲ ﻣﺮة ﺛﺎﻧﻴﺔ ‪ deconjugation‬ﻟﻜﻲ ﻳﺘﻢ إﻋﺎة‬
‫اﻣﺘﺼﺎﺻﻪ ﺧﻼل اﻟﻘﻨﺎة اﻟﻤﻌﻮﻳﺔ ﻣﺮة ﺛﺎﻧﻴﺔ ‪....‬ﻳﺎﺗﺮى ﻓﺎﻫﻤﻴﻦ‬
‫‪Excretion of drugs in milk & sweat is minor but drugs which‬‬
‫‪excreted in milk may be a sourse of undesired effects to the‬‬
‫‪nursing infants‬‬
‫ﻳﻌﻨﻲ ﺳﺎﻋﺎت اﻟﺪواء ﻳﺨﺮج ﻣﻊ ﻟﺒﻦ اﻷم وﺳﺎﻋﺘﻬﺎ ﺑﻴﻜﻮن ﺷﻲء ﻏﻴﺮ ﻣﺴﺘﺤﺐ ﻟﻠﻄﻔﻞ‬
‫وﺳﺎﻋﺘﻬﺎ ﺑﻴﺤﺎول اﻟﺪﻛﺘﻮر ﻳﺘﺠﻨﺐ ﻛﺘﺎﺑﺔ اأدوﻳﺔ‬
‫‪-----‬‬

‫اﻟﻤﺤﺎﺿﺮة اﻟﺜﺎﻧﻴﻪ ﻋﺸﺮ‬

‫‪Adverse effect can be‬‬
‫‪Side effect : it's not the wante deffect but sometimes it's considered among the‬‬
‫‪clinical uses of drug‬‬
‫ﻳﻌﻨﻲ ﺗﺄﺛﻴﺮ ﻏﻴﺮ ﻣﺮﻏﻮب ﻓﻴﻪ وﻟﻜﻦ ﻻ ﻳﻀﺮ وﻟﺬا أﺣﻴﺎﻧﺎ ﻳﺴﺘﺨﺪم ﻣﻦ أﺟﻞ اﻟﺤﺼﻮل ﻋﻠﻰ ﻫﺬا اﻟﺘﺄﺛﻴﺮ‬
 ‫زي اﻳﻪ ﻣﺜﻼ ﻋﺸﺎن ﻧﺴﺘﻮﻋﺐ‬
‫ﻣﺜﻼ ﻋﻨﺪﻧﺎ ﻣﺎدة ال ‪ atropine‬دﻳﻪ ﺑﺘﺴﺘﺨﺪم ﻛﻤﻀﺎد ﻟﻠﺘﻘﻠﺼﺎت‬
‫وﻟﻪ ﻋﺮض ﺟﺎﻧﺒﻲ ﻏﻴﺮ ﻣﺮﻏﻮب ﻓﻴﻪ وﻟﻜﻦ ﻻ ﻳﻀﺮ وﻫﻮ اﻧﻪ ﻳﺴﺒﺐ ﺟﻔﺎف اﻟﻔﻢ‬
‫ﻃﻴﺐ ودﻳﻪ ﻣﻤﻜﻦ اﺳﺘﺨﺪﻣﻬﺎ ﻓﻲ اﻳﻪ ؟؟‬
‫اﺳﺘﺨﺪﻣﻬﺎ اﺛﻨﺎء اﻟﺠﺮاﺣﺔ ﺣﺘﻰ ﻧﺘﺠﻨﺐ اﻓﺮازات اﻟﻔﻢ ودﺧﻮﻟﻬﺎ ﻟﻠﺮﺋﺔ اﻟﺘﻲ ﺗﺴﺒﺐ ﻣﺸﺎﻛﻞ ﺗﻨﻔﺲ‬

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‫ﻳﻌﻨﻲ ﻧﻘﺪر ﻧﻘﻮل ‪:‬‬

‫‪Atropine‬‬
‫‪main effect is antispasmodic , side effect is mouth dryness‬‬
‫‪we use the side effect in surgery to prevent obstruction of respiratory tract‬‬
‫ﻟﻜﻦ ﻻﺣﻈﻮا ﻫﻨﺎ ﺣﺎﺟﺔ ﻣﻬﻤﺔ‬
‫دﻟﻮﻗﺘﻲ اﻻﺗﺮوﺑﻴﻦ ﺑﻴﺴﺘﺨﺪم ﻓﻲ ﻋﻼج اﻟﺘﻘﻠﺼﺎت اﻟﻠﻲ ﻫﻲ ﻋﺒﺎرة ﻋﻦ اﻧﻘﺒﺎﺿﺎت ﺷﺪﻳﺪة ﻓﻲ اﻟﻘﻨﺎة اﻟﻤﻌﻮﻳﺔ وﻟﻪ‬
‫ﺗﺄﺛﻴﺮ ﺟﺎﻧﺒﻲ‬
‫ﻃﺐ دﻟﻮﻗﺘﻲ ﻟﻤﺎ اﺳﺘﺨﺪﻣﻪ ﻟﻠﻤﺮﻳﺾ اﺛﻨﺎء اﻟﺠﺮاﺣﺔ ﻓﺪه ﺑﻴﺴﺒﺐ ﻟﻪ اﻟﻌﺮض اﻟﺠﺎﻧﺒﻲ وﻫﻲ ﺟﻔﺎف اﻟﻔﻢ وﻟﻜﻦ ﺑﺮده‬
‫ﺣﻴﺴﺒﺐ ﺗﺄﺛﻴﺮه اﻟﺮﺋﻴﺴﻲ اﻟﻠﻲ ﻫﻨﺎ ﺣﻴﻌﺘﺒﺮ ﺗﺄﺛﻴﺮ ﺟﺎﻧﺒﻲ ﻷﻧﻪ ﺣﻴﺴﺒﺐ ﻟﻠﻤﺮﻳﺾ إﻣﺴﺎﻟﻚ ﺑﺴﺒﺐ ﻣﻨﻌﻪ ﻻﻧﻘﺒﺎﺿﺎت‬
‫اﻟﻘﻨﺎة اﻟﻤﻌﻮﻳﺔ‬
‫ﻳﺎﺗﺮى ﻓﻬﻤﺘﻮا ﻗﺼﺪي ‪...‬؟؟؟‬
‫‪Undesired effect : it's effect which is completely undesired‬‬
‫‪these undesirable effect may be‬‬
‫‪Idiosyncrasy .. Tolerance .. Dependance .. Iatrogenic effect .. Teratogenic effect‬‬
‫ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﻛﻞ واﺣﺪة ﻣﻨﻬﻢ ﺑﺎﺧﺘﺼﺎر‬
‫‪ Idiosycrasy‬ﺗﺄﺛﻴﺮ ﻻ ﻳﺘﻌﻠﻖ ﺑﺎﻟﺪواء ﻧﻔﺴﻪ‬
‫‪abnormal reactivity to chemicals due to genetic factors which not discovered except‬‬
‫‪after administration of some drugs‬‬
‫‪EXAMPLES‬‬
 ‫‪Pseudocholinesterase deficiency‬‬
‫ده ﻋﺒﺎرة ﻋﻦ اﻧﺰﻳﻢ ﻣﻮﺟﻮد ﻓﻲ اﻟﺠﺴﻢ ﻟﺘﻜﺴﻴﺮ اﻻﺳﻴﺘﻴﻞ ﻛﻮﻟﻴﻦ وﻣﺸﺘﻘﺎﺗﻪ‬
‫‪if abnormally absent "as a genetic deficiency" succinylcholine (which may be used as‬‬
‫‪anaesthetic,muscle relaxant) will accumulate in the body causing over relaxation of‬‬
‫‪muscles & cause succinylcholine apnea‬‬
‫ﻳﻌﻨﻲ اﻳﻪ ﺑﻘﻰ ؟؟‬
‫اﻧﺰﻳﻢ اﻟﺴﻮدوﻛﻮﻟﻴﻨﺴﺘﺮﻳﺰ ﻣﻮﺟﻮد اﺻﻼ ﻓﻲ اﻟﺠﺴﻢ‬
‫ﻳﻌﻨﻲ ﻟﻮ ﻣﺮﻳﺾ اﺧﺪه أﺛﻨﺎء ﻋﻤﻠﻴﺔ ﺟﺮاﺣﻴﺔ ﻛﻤﺴﻜﻦ وﻋﺸﺎن ﻳﻌﻤﻞ ارﺗﺨﺎء ﻟﻠﻌﻀﻼت اﻟﻤﻔﺮوض اﻻﻧﺰﻳﻢ ﻳﻜﺴﺮه‬
‫اول ﺑﺄول ﻋﺸﺎن ﻣﻴﺘﺮﻛﻤﺶ ﻓﻲ اﻟﺠﺴﻢ ﺣﻴﺚ اﻧﻪ ﻳﺘﻢ اﻋﻄﺎؤه ﻟﻠﻤﺮﻳﺾ ﻗﻄﺮة ﺑﻘﻄﺮة‬
‫ﻃﺐ ﻟﻮ اﻻﻧﺰﻳﻢ ده ﻣﺶ ﻣﻮﺟﻮد اﻳﻪ اﻟﻠﻲ ﺣﻴﺤﺼﻞ ؟؟‬
‫اﻟﺴﻜﺴﻴﻨﻴﻞ ﻛﻮﻟﻴﻦ ﺣﻴﺘﺮﻛﻢ ﻓﻲ اﻟﺠﺴﻢ وﻳﺴﺒﺐ ارﺗﺨﺎء ﺷﺪﻳﺪ ﺟﺪا ﻟﻠﻌﻀﻼت وﻣﻨﻬﺎ ﻋﻀﻼت اﻟﺮﺋﺔ ﻓﻴﺴﺒﺐ‬
‫ﺻﻌﻮﺑﺔ اﻟﺘﻨﻔﺲ ﺑﺸﺪة ﻷﻧﻪ اﻟﺮﺋﺔ ﻟﻤﺎ ﺗﺮﺗﺨﻲ ﺑﺸﺪة ﺗﻜﻮن ﻣﺤﺘﺎﺟﺔ ﻟﻜﻢ أﻛﺜﺮ ﻣﻦ اﻟﻬﻮاء ﺣﺘﻰ ﻳﻤﻸﻫﺎ واﻟﻤﺮﻳﺾ‬
‫ﻃﺒﻌﺎ اﺻﻼ ﻓﺎﻗﺪ اﻟﻮﻋﻲ وﻣﻴﻘﺪرش ﻳﺎﺧﺪ ﻧﻔﺲ ﻋﻤﻴﻖ ﻓﻴﺴﺒﺐ ﺻﻌﻮﺑﺔ ﺗﻨﻔﺲ ﺗﺴﻤﻰ ‪succinylcholine‬‬
‫‪apnea‬‬

‫‪Hereditary methemoglobinemia‬‬
‫‪occur due to deficiency of in NAD-dependent methemoglobin reductase‬‬
‫وده ﻋﺒﺎرة ﻋﻦ اﻧﺰﻳﻢ ﻳﻜﻮن اﻟﻬﻴﻤﻮﺟﻠﻮﺑﻴﻦ ﻓﻲ آﺧﺮ ﺧﻄﻮة ﻣﻦ ﺗﻜﻮﻳﻨﻪ‬
‫ﻳﻌﻨﻲ اﺛﻨﺎء ﺗﺼﻨﻴﻊ اﻟﻬﻴﻤﻮﺟﻠﻮﺑﻴﻦ ﺗﺘﻜﻮن ﺻﻮرة ﻗﺒﻠﻪ ﻫﻲ اﻟﻤﺖ ﻫﻴﻤﻮﺟﻠﻮﺑﻴﻦ وﻫﺬا اﻻﻧﺰﻳﻢ ﻳﻘﻮم ﺑﺂﺧﺮ ﺧﻄﻮة‬
‫وﻫﻲ ﺗﻜﻮﻳﻦ اﻟﺼﻮرة اﻻﺧﻴﺮة ﻣﻦ اﻟﻬﻴﻤﻮﺟﻠﻮﺑﻴﻦ‬
‫ً‬
‫ﺟﻴﻨﻴﺎ ﻳﺴﺒﺐ ﻋﺪم ﺗﻜﻮن اﻟﻬﻴﻤﻮﺟﻠﻮﺑﻴﻦ وﻳﺴﺒﺐ ﻣﺖ ﻫﻴﻤﻮﺟﻠﻮﺑﻴﻨﻴﻤﻴﺎ‬ ‫وﻋﻨﺪﻣﺎ ﻳﻨﻘﺺ ﻫﺬا اﻻﻧﺰﻳﻢ ﻓﻲ اﻟﺠﺴﻢ‬
‫وراﺛﻴﺔ‬

‫‪Malignant Hyperthermia‬‬
‫ودﻳﻪ ﺗﺒﻊ اﻟﺴﻜﺴﻴﻨﻴﻞ ﻛﻮﻟﻴﻦ ﻟﻤﺎ ﺣﺪ ﻳﺎﺧﺪه ‪as skeletal muscle relaxant‬‬
‫ﻓﻤﻤﻜﻦ ﻟﻮ اﻻﻧﺰﻳﻢ اﻟﻠﻲ ﺑﻴﻜﺴﺮه ﻣﺶ ﻣﻮﺟﻮد ﻳﺴﺒﺒﻠﻪ اﻵﺗﻲ‬
‫‪ muscular rigidity‬وده ﻣﻦ ﺷﺪة ارﺗﺨﺎء اﻟﻌﻀﻼت‬
‫‪high fever & lactic acidosis‬‬
‫‪-----‬‬
‫اﻟﻤﺤﺎﺿﺮة اﻟﺜﺎﻟﺜﻪ ﻋﺸﺮ‬

‫اﺣﻨﺎ اﺗﻜﻠﻤﻨﺎ ﻋﻦ ال ‪idiosycrasy‬‬

‫ودﻟﻮﻗﺘﻲ ﺣﻨﺘﻜﻠﻢ ﻋﻦ ﺗﺎﻧﻲ ﺣﺎﺟﺔ ﻓﻲ ال ‪ undesired effect‬وﻫﻲ‬

‫‪ Tolerance‬ﻳﻌﻨﻲ اﻟﺘﻌﻮد ﻋﻠﻰ اﻟﺪواء‬

‫‪when we tolerate the drug ,we need to increase the dose to maintain the same given‬‬
‫‪therapeutic effect‬‬
‫وده ﻛﻨﺖ اﺗﻜﻠﻤﺖ ﻋﻨﻪ ﻗﺒﻞ ﻛﺪه ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻨﺎس اﻟﻠﻲ ﺑﺘﺎﺧﺪ اﻟﺠﺮﻋﺔ ﻣﺶ ﻛﺎﻣﻠﺔ ﻓﺒﻴﺨﻠﻲ اﻟﺠﺴﻢ ﻳﺘﻌﻮد ﻋﻠﻴﻪ وﺳﺎﻋﺘﻬﺎ‬
‫ﻳﻀﻄﺮ اﻧﻪ ﻳﺰودﻫﺎ ﺷﻮﻳﺔ وﻟﻜﻦ ﺑﺪون ﻓﺎﺋﺪة‬
‫وﻣﺶ ﻛﺪه وﺑﺲ ﻻ ﻣﻤﻜﻦ ﻳﻜﻮن اﻟﻤﺮﻳﺾ ﺑﻴﺎﺧﺪ اﻟﺠﺮﻋﺔ ﻣﻈﺒﻮط وﻟﻜﻦ ﻣﻊ ﻣﺮور اﻟﺰﻣﻦ ﻳﺒﺪأ اﻟﺠﺴﻢ ﻳﺘﻌﻮد ﻋﻠﻰ اﻟﺪوا‬
‫ﻳﻌﻨﻲ ﻣﻤﻜﻦ ﺗﺤﺼﻞ ﻣﻊ اﻻﺳﺘﺨﺪام اﻟﻼ ﻧﻬﺎﺋﻲ‬
‫‪this occur over a long period of time but doesn't develop to all effects of the drug‬‬
‫ﻳﻌﻨﻲ ﻣﻤﻜﻦ اﻟﺠﺴﻢ ﻳﺤﺼﻠﻪ ‪ tolerance‬ﻟﺘﺄﺛﻴﺮ واﺣﺪ وﻟﻜﻦ ﺷﻐﺎل ﻣﻊ ﺑﺎﻗﻲ اﻟﺘﺄﺛﻴﺮات‬
‫ﻣﺜﻼ ﻟﻮ دواء ﻟﻪ ﺧﻤﺲ او ﺳﺖ ﺗﺎﺛﻴﺮات ﻳﺤﺼﻞ ال ‪ tolerance‬ﻟﺘﺄﺛﻴﺮﻳﻦ ﻣﺜﻼ‬
‫دﻟﻮﻗﺘﻲ ﺣﻨﺘﻜﻠﻢ ﻋﻦ أﻧﻮاع ال ‪tolerance‬‬
‫‪Individual tolerance‬‬
‫‪As genetic variation may increase drug ****bolism in some persons‬‬
‫ﻳﻌﻨﻲ ﻣﻤﻜﻦ اﻟﻮراﺛﺔ ﺗﺘﺪﺧﻞ ﻓﻲ ﻣﻮﺿﻮع اﻟﺘﻌﻮد ﻋﻠﻰ اﻟﺪوا‬
‫‪Species tolerance‬‬
‫‪Rabbits can tolerate high doses of atropine & hyoscyamine‬‬
‫ﻳﻌﻨﻲ ﻓﺼﺎﺋﻞ ﻣﻌﻴﻨﺔ ﻣﻦ اﻟﻜﺎﺋﻨﺎت اﻟﺤﻴﺔ ﻣﻤﻜﻦ ﺗﺤﺼﻠﻬﺎ ﺗﻌﻮد ﻋﻠﻰ دوا ﻣﻌﻴﻦ‬
‫‪Racial tolerance‬‬
‫‪Mongols tolerate the mydiatric action of ephedrine‬‬
‫ﺑﺘﻮع ىﺴﻴﺎ ﻣﺜﻼ ﻣﺶ ﺑﻴﺘﺄﺛﺮوا ﺑﺘﺄﺛﻴﺮ اﻻﻓﺪرﻳﻦ ﻋﻠﻰ اﻟﻌﻴﻦ وﻫﻮ اﺗﺴﺎع ﺣﺪﻗﺔ اﻟﻌﻴﻦ‬

‫ﻣﻠﺤﻮﻇﺔ ﻫﺎﻣﺔ‬
‫ً‬
‫ﻧﻔﺴﻴﺎ ﺑﺴﺒﺐ ان اﻻﻧﺴﺎن اﺗﻌﻮد اﻧﻪ ﻳﺄﺧﺬه ﺑﺎﺳﺘﻤﺮار زي ﻣﺜﻼ اﻟﺸﺎي واﻟﻘﻬﻮة‬ ‫‪ Habituation‬ﺗﻌﻨﻲ اﻟﺘﻌﻮد ﻋﻠﻰ ﺷﻲء‬
‫ووووو ﻫﻜﺬا‬
‫وﻛﻴﻤﻴﺎﺋﻴﺎ وﻻ ﻳﺴﺘﻄﻴﻊ إﻳﻘﺎﻓﻪ ﻓﺠﺎة ً‬
‫أﺑﺪا زي ﻣﺜ ً‬
‫ﻼ اﻟﻤﻮرﻓﻴﻦ‬ ‫ً‬ ‫ً‬
‫ﻧﻔﺴﻴﺎ‬ ‫‪ Addiction‬ﺗﻌﻨﻲ إدﻣﺎن اﻟﺸﻲء واﻟﺘﻌﻮد ﻋﻠﻴﻪ‬
‫"ﻣﻔﻴﺶ ﻣﺪﻣﻦ ﻓﻲ اﻟﺪﻧﻴﺎ ﻳﻘﺪر ﻳﻮﻗﻔﻪ ﻓﺠﺄة ﻷﻧﻪ ﻛﻴﻤﻴﺎﺋﻴﺔ اﻟﺠﺴﻢ اﺗﻌﻮدت ﻋﻠﻴﻪ"‬

‫‪le pharmacien 06:41 PM 29-09-2010‬‬

‫‪/http://pharmacologycorner.com/pharmacology-animations‬‬
‫ده ﻟﻴﻨﻚ ﻓﻰ اﻧﻴﻤﻴﺸﻦ‬

‫‪BoNbOoNa 08:24 AM 29-10-2010‬‬

‫‪..‬‬ ‫‪ ..‬ﺗــﻢ ﺑﺤﻤــﺪ ا‬

‫ﻣﺤﻤﺪ ﻣﺼﻄﻔﻰ ‪AM 29-10-2010 10:49‬‬

‫ﻛﻞ ﺧﻴﺮ‬ ‫ﺟﺰاﻛﻢ ا‬

‫وﻓﻰ ﺳﺆاال ﺑﺮئ‬