‫اﻟﻣﺣﺎﺿرة ﻛﺗﯾر ﻓﯾﮭﺎ إﻋﺎدة‬

‫ﻟﻧﻔس اﻷﺷﯾﺎء ﻋﺷﺎن ھﯾك ﻣﺎ‬  Lecture 17 

‫ﺑﺗﺎﺧذ ﻛﺗﯾر وﻗت‬
Drug Interactions
• Drug Interaction: influence of drug actions by another chemical
substances, like:
1- Drug -drug interaction: most important and common
2- Drug with other chemicals rather than drugs like:
a. Herbs: can cause Hypokalemia (low calcium), enzyme inhibition or
induction. Sometimes, these reactions can be dangerous.
b. Food: it can be important clinically.
c. Environmental pollution: active or passive smoking, dust, or any
change in the environment.
• Effects of drug interactions (mostly based on drug- drug interactions):
1) Synergistic: (syn: together/ erg:work) 2 drugs have the same action
(like: 2 drugs that lower blood pressure)
2) Antagonistic: 2 drugs have opposite interactions
• The effect of drugs interactions can be:
1. Harmful: most common, causes adverse effects.
2. Beneficial: like in combination therapy (using multiple drugs)
‫ زﻣﺎن ﻛﻧﺎ اذا اﻟدوا ﻣﺎ‬،‫ اﻧﮫ ﻧﺳﺗﺧدم اﻛﺛر ﻣن دواء ﻟﻌﻼج اﻟﻣرض‬combination therapy :‫ ﺷرح‬
‫ﯾﻌطﻲ ﻣﻔﻌول ﻗوي او ﻣﻧﺎﺳب ﻟﻠﻣرض ﺑﻧزﯾد اﻟﺟرﻋﺔ ﻋﺷﺎن ﻣﺎ ﻛﺎن ﻋﻧﺎ ﻛﺗﯾر ادوﯾﺔ وھﺎد اﻻﺷﻲ ﻣش‬
‫ وﻣﮭﻣﺎ زدﻧﺎ اﻟﺟرﻋﺔ ﻓﻲ ﺣد ﻣﻌﯾن ﻟﻠدوا ﻋﻠﻰ اﻟﻣرض‬adverse effects ‫ﻣﻧﯾﺢ ﻻﻧﮫ ﺑﯾزﯾد ﻣن ال‬
‫ ھﻸ ﻷﻧﮫ ﺻﺎر‬combination therapy ‫ ﻋﺷﺎن ھﯾك ﺑﻧﺳﺗﺧدم‬،(‫)اﻟﻲ ﻣﻣﻛن ﻣﺎ ﯾﻛون ﻛﺎﻓﻲ ﻟﻠﻣرﯾض‬
.‫ﻋﻧﺎ ﻛﺗﯾر ادوﯾﺔ ﻟﻌﻼج اﻟﻣرض ﻧﻔﺳﮫ‬
• Most drugs interactions are insignificant clinically (‫)ﯾﻌﻧﻲ ﻣﺎ ﺑﺗﻔﯾد اﻻطﺑﺎء‬
• Drugs interaction, that are significant clinically, can be:
1- Some interactions should be described accurately ‫)اﻧﮫ ﻛﺗﯾر ﻣﮭﻣﯾن‬
(‫ودﻗﯾﻘﯾن‬
o Examples:
bound ‫ﻻﻧﮫ ﻛﻠﻣﺎ زاد ال‬ a. Plasma protein interactions:
‫ )اﻟﻲ ھوه‬free‫رح ﯾﻘل ال‬ - It’s significant only if the binding is >90% ()
‫ وھﯾك أي‬،(action‫ﺑﯾﻌﻣل ال‬
- Like Warfarin (oral anti-coagulant) and Aspirin
‫ ﺑﯾﻛون‬free ‫زﯾﺎدة ﺑﺳﯾطﺔ ﺑﺎل‬
clinically ‫اﻟﮫ اﺛر واﺿﺢ و‬ (analgesic -pain killer-)
significant
‫ ﺑﯾﺻﯾر ال‬aspirin ‫ وﻟو ﺿﻔﻧﺎ ﻣﻌﺎه‬action is 2% ‫ اﻟﻲ ھوه ﺑﯾﻌﻣل ال‬free‫ ﻧﺳﺑﺔ ال‬Warfarin :‫ ﺷرح‬
‫ ﺑﯾزﯾد‬plasma protein ‫ ﻣن ال‬warfarin ‫ ﻟل‬displacement ‫ ﻻﻧﮫ ﺑﯾﻌﻣل‬4% ‫ اﻟﺿﻌف ﯾﻌﻧﻲ‬free
‫ ﻓﻣﺛﻼ ﺑﻌد ﻣﺎ اﻟﻣرﯾض ﯾﻌﻣل ﻋﻣﻠﯾﺔ ﻓﻲ اﻟﻘﻠب ﺑﯾﻌطوه‬،‫ وھﺎد ﻣﺷﻛﻠﺔ ﻛﺑﯾرة‬،‫ ﺑﺎﻟﺟﺳم‬free ‫ﻧﺳﺑﺔ ال‬
‫ ﺑﺎﻟﻠﯾل ﺑﻌد اﻟﻌﻣﻠﯾﺔ ﻣﻣﻛن ﯾﺻﯾر وﺟﻊ ﺷدﯾد‬،‫ ﻋﺷﺎن ﻣﺎ ﯾﺻﯾر ﺗﺟﻠطﺎت ﺑﺎﻟدم اﺛﻧﺎء اﻟﻌﻣﻠﯾﺔ‬Warfarin
aspirin ‫ﺑﺎﻟﺻدر ﻻﻧﮫ اﻟﺟﺳم ﻋم ﺑﯾﺗﻌﺎﻣل ﻣﻊ اﻟﺟرح ﺗﺑﻊ اﻟﻌﻣﻠﯾﺔ ﻓﺎﻟدﻛﺗور اﻟﻲ ﻣش ﻣﺗﻣرس ﻣﻣﻛن ﯾﻌطﯾﮫ‬
‫ ﻋﻧد اﻟﻣرﯾض وﻣﻣﻛن ﯾؤدي‬bleeding ‫ اﻟﺿﻌف ﻓﮭون ﻣﻣﻛن ﯾﺻﯾر‬warfarin ‫وھﺎد ﺑﯾزﯾد ﻣن ﻓﻌﺎﻟﯾﺔ ال‬
‫ﻟﻠوﻓﺎة‬
2- Some interactions are clinically significant, but the timing makes it
less important or more important. 2 types:
a- Rapid interactions: happen within minutes like plasma protein
binding displacement interactions ( ‫ﻣﺷروح ﺑﺎﻟﻣﺛﺎل ﺗﺑﻊ‬warfarin
‫وال‬aspirin)
b- Slow interactions: like enzyme inhibition (5 days of daily dose) or
induction (7 days of daily dose)
‫ ﻣﻌﯾن ﻻزم‬enzyme system (or complex) ‫ ﯾﻌطﻲ ﻣﺛﻼ ﺑدي اﻋطﻲ ﻟﻠﻣرﯾض دوا ﺑﯾﺗﺄﺛر ب‬
‫ أﯾﺎم وﺑﻌدﯾﮭﺎ اﻋطﯾﮫ ھﺎد اﻟدوا‬5‫ ل‬inhibitor ‫اﻋطﯾﮫ ال‬

• Interactions are clinically important in:

1) Drugs with:
1- Low therapeutic index
- Safety margin is very low
‫ ﻛﺗﯾر ﻗﻠﯾل وھﺎد اﻻﺷﻲ ﯾﻌﻧﻲ اﻧﮫ اذا‬toxic dose ‫ وال‬therapeutic dose ‫ ﯾﻌﻧﻲ اﻟﻔرق ﺑﯾن ال‬-
toxicity ‫ ﺑﺷﻛل ﻗﻠﯾل ﻣﻣﻛن ﯾﻌﻣل‬response ‫زاد ال‬

2- Steep dose -response curve

‫ ﺑﯾﻌﻣل اﺛر ﻛﺗﯾر ﻛﺑﯾر‬conc. in plasma ‫ وﺑﺎﻟﺗﺎﻟﻲ ﺑﺎل‬dose‫ ﯾﻌﻧﻲ أي زﯾﺎدة ﺑﺳﯾطﺔ ﺑﺎل‬-
response‫ﺑﺎل‬
effect ‫ ﻣﺎ اﻟﮭﺎ‬dose ‫ اﻟﻲ ھﯾﮫ اﻟﻌﻛس )اﻧﮫ اﻟزﯾﺎدة ﺑﺎل‬:Resultant dose- response curve -
less clinically significant ‫ ﻋﺷﺎن ھﯾك ﺑﯾﻛون‬response ‫ﻛﺑﯾر ﺑﺎل‬
3- Enzyme inducers or inhibitors (‫)زي ﻣﺎ ﺷرﺣﻧﺎ ﻗﺑل ﺑﮭﺎي اﻟﻣﺣﺎﺿرة‬
4- Zero order and saturation kinetics:
- Zero order: there is constant amount of drug gets
eliminated that means higher amount of this drug will
cause toxicity ( ‫ﻻﻧﮫ ﻣﮭﻣﺎ زدﻣﺎ ﻛن ﺗرﻛﯾز اﻟدوا ﻧﻔس اﻟﻛﻣﯾﺔ رح‬
(‫ﯾﺻﯾرﻟﮭﺎ اﯾض وھﺎد ﯾؤدي ﺗراﻛﻣﮫ ﺑﺎﻟﺟﺳم وأﺧﯾرا ﺑﯾﻌﻣل ﺗﺳﻣم‬
 - First order drugs have same rate of metabolism and
elimination which means higher dose will be
metabolized and eliminated faster (therefore, no
accumulation and no toxic response)
2) Patient – related factors
1- Receiving multiple drugs
- Higher number of drugs, higher change of drug
interactions
2- Severely ill patients
- Patients with cardio-vascular disease will be affected
faster than normal patient
- Any drug effects can affect the patient severely and may
lead to death
3- Impaired liver or renal function
- Liver is important in lipophilic drugs elimination.
Therefore, any problem in liver function can cause
toxicity from lipophilic drugs.
- Kidneys is important in hydrophilic drugs. So, renal
impairment can cause toxicity from there drugs.
4- Age extremes
- Drug toxicity is important in pediatric and geriatric
patients and can be fatal, therefore, drug interactions
are very important in these patients.

• Types of drug interactions:

1) Outside the body (in-vitro interactions) (pharmaceutical
interactions: pharmaceutical incompatibly (deactivation) and it’s
important in drug preparation and storage. It can be:
a- Physical changes in the drug, like soluble drugs become
insoluble, precipitation reaction (‫)ﺗﻔﺎﻋﻼت ﺗرﺳﯾب‬, color changes.
b- Chemical changes: if alkaline drug interacts with acidic drug, the
drug will be deactivated.
c- Physical-chemical changes
- Examples:
1- Alkaloids are precipitated by iodides (common in
expectorant drugs (‫)اﻟطﺎردة ﻟﻠﺑﻠﻐم‬and thyroid drugs) and
heavy metals (like iron)
- Alkaloid drugs usually ends with (ine) like morphine,
atropine, strychnine…etc.
- However, drugs that end with (in) is acidic like heparin
(the strongest acid in the body), aspirin, penicillin…etc.
2- Fe (iron) and tannins (tannic acid)
- Tannins is available in plants like tea; therefore, tea
drinkers usually have anemia.
- It leads to change in color (blue color appears) and, ofc,
change in action (antagonist effect).
- The interaction is binding interaction which leads to
inactivation of iron.
3- Syringe interactions: happens when mixing drugs in the
syringe like:
a. Insulin glargine + other insulin preparations
- It’s used in combination therapy, because insulin
glargine is ultralong-acting form of insulin ( ‫ﺑﯾﻛﻔﻲ ﻟطول‬
‫)اﻟﯾوم‬, so, we give insulin preparation that is rapid-acting
for diabetic patients to have rapid response.
- So, to avoid this problem, we give them in separate
syringes.
b. Penicillin + Aminoglycosides (as gentamycin)
- Penicillin is antibiotic for gram-positive bacteria and
aminoglycosides are gram-negative antibiotic. So, we
may use them together.
c. Cytotoxic drugs
- Important for cancer therapy. We use combination
therapy in cancer therapy; however, we give them in
different syringes to avoid syringe interactions (like
basic-acidic drugs interactions and precipitation
interactions)
 2) Inside the blood (in-vivo interaction)
- More common and more important
- It has 2 types: pharmacokinetics and pharmacodynamics
interactions.
- Examples:
1- Drug- excipient interactions
- Excipients are inactive substance that serves as the
vehicle or medium for a drug or other active substance.
(‫ﺷرﯾف‬.‫)اﻟﻲ ﺣﻛﯾﻧﺎ ﻋﻧﮭم ﻣن اول ﻣﻊ د‬
- Like: Aerosol Propellants (used to make the release of
inhaled drugs easier), Antioxidant (obviously to avoid
oxidation of the drug), binders (binding drug particles),
colors, disintegrant (helps in drug disintegration), fillers,
flavors, lubricants (make swallowing the drug easier),
preservatives, solubilizers, solvents, surfactants,
suspending agents, sweeteners…etc.
- It can cause allergic reaction.
‫ وﺧﺻوﺻﺎ‬malignancy ‫ اﻧﮫ ﺑﯾﻌﻣل‬peptic ulcer ‫ ﻣﺛﺎل ﻋﻠﻰ اﻟﻣﺷﻛﻠﺔ ھﺎي دوا ﺑﯾﺳﺗﺧدم ﻟﻌﻼج‬-
‫ ﻓﺎﻟﺟﮭﺎت اﻟﺻﺣﯾﺔ ﺑﺗﻧﺷر اﻧذار ﺑﺳﺣب‬،(‫ )اﻟﻲ ﺑﯾﻛون ﻣﻔﻌوﻟﮭﺎ طوﯾل‬slow preparation drugs
‫ وﻻ ﻣن‬preservatives‫اﻟدوا وﺑﯾﻌﻣﻠوا ﻋﻠﯾﮫ ﺗﺟﺎرب وﯾﺗﺄﻛدوا اذا اﻟﻣﺷﻛﻠﺔ ﻣن اﻟدواء وﻻ ال‬
.diabetes ‫ وﺻﺎر ﻗﺑل ﻣﻊ دوا ﻟل‬.‫اﻟﺷرﻛﺔ ﻟﺣﺗﻰ ﻣﺎ ﯾﺗﺄﻛدوا‬
2- Drug containers interactions
- Sorption to plastic materials leading to inactivation of
the drug like IV infusion preparations
.‫ﻟﻠدوا‬inactivation ‫ وھﺎد اﻻﺷﻲ ﺑﯾﻌﻣل‬plastic containers‫ ﯾﻌﻧﻲ ﺟزﯾﺋﺎت اﻟدوا ﺑﺗﻠزق ﻋﻠﻰ ال‬-
3- Glucose infusion or IVI:
- 5% glucose solution makes the media acidic (ph= 3.5-
5.5) which is unstable for some drugs.

‫ ﻓﺑﯾﻌطﻲ ﺑس اﻟﻔﻛرة ﺑﺷﻛل ﻋﺎم ﻋﺷﺎن ھﯾك ان ﺷﺎء‬general knowledge ‫**اﻟدﻛﺗور ﺣﻛﺎ اﻧﮫ ﺑﯾﻌطﯾﻧﺎ‬
‫ اﻷﻣﺛﻠﺔ ﻋﻠﻰ ھدول اﻷﺷﯾﺎء ﺑﻧﻛﺗﺑﮭﺎ ﻋﻠﻰ ورﻗﺔ وﺑﻧﺧﻠﯾﮭﺎ ﻣﻌﻧﺎ ﻋﺷﺎن ﻣش ﻣﻧطﻖ‬:’) ‫ﷲ اذا ﺻرﻧﺎ دﻛﺎﺗرة‬
‫ﻧﺣﻔظ ﻛل اﺷﻲ ﺑﺎﻟﺣﯾﺎة‬
 ‫اﻧﺗﺑﮭوا اﻧﮫ ھون ﺗﺣت‬
‫ ﻓﻲ ﻛﻣﺎن‬absorption
‫اﻟﻲ ھوه‬subtitles
‫اﻟﺗﻔﺎﻋﻼت ﺑﯾن اﻻدوﯾﺔ واﻻﻛل‬
‫واﻷدوﯾﺔ ﻣﻊ ﺑﻌﺿﮭﺎ‬
NASID: Nonsteroidal anti-
inflammatory drugs like
aspirin.
Sometimes, aspirin is used
as buffer in antacid drugs to
make it less gastric irritant,
therefore, the absorption
will decrease, thus, lower
effect. This is a precaution
not contradiction
- Examples on drug- food interactions
- Examples on pharmacokinetics-related interactions:
1) Absorption interactions
- Examples on Drug-drug interaction
a- pH: antacids make the media alkaline (pH ↑) which
makes the absorption of acidic drugs lower ↓ (Like
NSAIDs () and Fe)
b- GIT motility can be
- Increased ↑ by anticholinergic drugs which leads to
slower↓ but more adsorption↑ of drugs (because the
drug spends more time in GIT).
- Decreased↓ by purgatives (used for constipation –
‫ )اﻹﻣﺳﺎك‬which leads to decrease↓ in absorption of drugs
(vice versa, the drug spends less time in GIT)
c- Tetracyclines lowers↓ the absorption of Ca++
d- Paraffin (mineral oil): lowers↓ the absorption of fat-
soluble vitamins as vitamin D,K and A
1- Food decreases↓ absorption of oral penicillin,
omeprazole (peptic ulcer) and captopril (hypertension).
- Because the drugs that are taken before eating is closer
intestinal and gastric mucosa. However, if taken after it
will be in the central which means lower absorption. So,
in small doses, the plasma conc. wont reach to MEC,
therefore no action.
- To avoid that, the drugs are given 30-60 min before
meals.
2- Food may delay the absorption of drugs.
- All drug amount will be absorbed eventually
- But the drug won’t reach peak (high drug conc. in
plasma)-(it will be more plateau) and therefore the drug
won’t give maximum therapeutic effect and it will be
slower.
- Like in loop diuretics which are used to treat edema
 ‫ ﯾﻌﻧﻲ ﻣرات اذا اﻟدوا ﺑﯾﺗﺎﺧذ ﺑﻌد اﻻﻛل ھﺎد اﻻﺷﻲ رح ﯾطول ﻓﺗرة اﻣﺗﺻﺎص اﻟدوا )ﺑس ﻛل اﻟدوا رح‬-
‫ ﯾﻌﻧﻲ ﺗراﻛﯾز‬plateau ‫ اﻟﮫ ﻓﻲ اﻟﺑﻼزﻣﺎ )ﺑﺻﯾر ﻋﻠﻰ ﺷﻛل‬peak ‫ﯾﻣﺗص( وھﯾك ﺑﯾﻣﻧﻊ اﻧﮫ اﻟدوا ﯾوﺻل‬
maximum ‫ﻗﻠﯾﻠﺔ ﺛﺎﺑﺗﺔ ﻋﻠﻰ ﻓﺗرات زﻣﻧﯾﺔ طوﯾﻠﺔ( وھﺎد اﻻﺷﻲ رح ﯾﺧﻠﻲ اﻟدوا ﻣﺎ ﯾﻌطﻲ‬
‫ وﺑﯾﻛون اﺑطﺄ وھﺎد اﻻﺷﻲ ﻣش ﻣﻧﯾﺢ طﺑﻌﺎ‬therapeutic effect
3- Food increases absorption of some drugs
- By increasing↑ tablet disintegration, drug dissolution
and effects on gastric emptying
- Like Beta blockers and Diazepam
4- Specific foods:
- High fiber diet lowers↓ Ca++ and plant Fe absorption.
- Milk lowers↓ tetracycline absorption
2) Distribution reactions
Potentiation:
1- Plasma protein binding
‫ﻣﻌﻧﺎھﺎ ﻟﻣﺎ ﯾﺻﯾر ﺗﻧﺎﻓس ﻋﻠﻰ‬ - Potentiation (already explained in Warfarin + Aspirin
‫ ﻣﻌﯾن‬carrier ‫ او‬receptor
‫ﺑﯾن ﻣﺎدﺗﯾن )اﻻدوﯾﺔ( ﻣﺛل‬ reaction)
Aspirin ‫ وال‬Warfarin - Like in acidic drug, such as NSAID, oral anticoagulants,
oral hypoglycemics
2- Tissue binding sites interaction
Digoxin treat heart failure,
- Also called potentiation, however, it’s in the tissue.
but it causes cardiac
arrhythmia (‫ﻋدم اﻧﺗظﺎم‬ - Example: Quinidine (antiarrhythmic drug) displaces
‫( )ﺿرﺑﺎت اﻟﻘﻠب‬fibrillation- Digoxin (arrhythmic drug) causing fatal toxicity
-‫رﺟﻔﺎن‬and tachycardia). - Mechanism: they have the same receptor in the
However, we don’t treat it
with Quinidine
tissue Quinidine displaces Digoxin increase in the
(antiarrhythmic drug) free Digoxin conc.  Digoxin has low safety margin,
because it may lead to therefore any small increase in free particles leading to
death due to potentiation. cardiac arrythmia and death.
3) Metabolism interactions
1- Enzyme induction and inhibition (already explained)
4) Excretion interactions
1- pH of urine
- As we know, acidic drugs are excreted more in alkaline
urine due to ionization reaction and vice versa.
- So, we can use it in beneficial interaction to treat drug
toxicity.
 2- Acidic drugs compete (with each other) for renal tubular
secretion causing potentiation or toxicity
- Because they have the same carrier used for tubular
secretion in the kidney.
- Like: NSAID, oral anticoagulants, oral hyperglycemia,
thiazides, loop diuretics, lithium…etc.

- Examples on pharmacodynamics interactions:

- 2 types of action:
1) Synergistic: actions in the same direction (already explained)
2) Antagonistic: actions on the opposite directions (already
explained)
- Drug-drug interactions like: NSAID, oral hypoglycemia, oral
It is so important anticoagulant, thiazide and loop diuretics, oral
cause it may lead to
contraceptives, Digoxin, antiepileptics and Beta blockers
death
- Drug-food interactions:
- Sugars antagonize↓ the following drugs:
1- Oral hypoglycemia: by decreasing↓ number of insulin
receptors & decreasing↓ receptors signaling.
2- Lipid-lowering agent (used to treat hyperlipidemia)
because sugars  cholesterol in the body.
GERD: Gastroesophageal
Reflux Disease – ‫ارﺗداد ﻣرﯾﺋﻲ‬
3- Immunomodulators (increases↑ the risk of infection)
4- Drugs for treating GERD: sugars lower↓ LESP, so, HCl
LESP: Lower Esophageal
Sphincter Pressure
gets to esophagus leading to GERD -‫ﻋﺷﺎن ھﯾك ﻻ ﯾﻧﺻﺢ‬
‫ﺑﺎﻧﮫ اﻟﺷﺧص ﯾﺎﻛل ﺣﻠوﯾﺎت وﯾﻧﺎم‬
5- Drugs used for erectile dysfunction: sugars decrease↓
the sexual activity especially in patients taking aspirin
because aspirin lower↓ prostaglandin (which is very
important for sexual activity in men)
6- Drugs used for treating of diseases related to
metabolic syndrome
 • Paradoxical drug interactions
- Effect of combination of 2 drugs is opposite to the action of each
drug alone
- Example: Beta blockers and Clonidine (each alone in hypotensive)
but they are mixed: Beta blocker + Clonidine  hypertension

• Beneficial drugs interactions (all these are examples on combination

therapy):
1) Increase effect:
1- Antiulcer drugs
2- Antihypertensives
2) Minimize adverse effects: Hypokalemia
1- Thiazide or loop diuretics (cause loss of K+) + k+ sparing diuretics
2- Heparin + protamine
3- Acidic drugs for treating susceptible (harmful) alkaline media
:‫**ﻓﻲ ﺑﻌض اﻻدوﯾﺔ ﻣﻊ اﻻﺳﺗﺧدام ﻟﻔﺗرات طوﯾﻠﺔ ﻣﻣﻛن ﯾﻌﻣل ﻣﺷﺎﻛل ﺻﺣﯾﺔ ﻓﮭون ﻋﺷﺎن اﺗﻔﺎدى ھﺎي اﻟﻣﺷﻛﻠﺔ ﯾﺎ اﻧﮫ‬
‫ وھون ﻻوم أﻛون ﻋﺎرف طرﯾﻘﺔ ﻋﻣل اﻟدواء ﻋﺷﺎن ﻣﺎ اﻋطﻲ اﻛﺛر ﻣن دوا ﺑﯾﺄﺛروا ﻋﻠﻰ‬combination therapy ‫ ﺑﻌﻣل‬-1
mechanism‫ﻧﻔس اﻟﻣﻛﺎن او ﻧﻔس ال‬
Thiazide or loop diuretics+ k+ sparing diuretics ‫ اﻟﻲ ﺳﺑﺑﮫ اﻟدوا ﻣﺛل‬side effect‫ ﺑﻌﺎﻟﺞ ال‬-2
‫ ﺑﻐﯾر اﻟدوا ﻟدوا ﺛﺎﻧﻲ ﻟﻔﺗرة وﺑﻌدﯾن ﺑرﺟﻌﻠﮫ‬-3

{END OF LEC17}
Live meeting ‫**ھﻸ أﺟوﺑﺔ ﻻﺳﺋﻠﺔ اﻟطﻼب ﺳﺄﻟوھﺎ واﻻﺷﯾﺎء اﻟﻲ ﺷرﺣﮭﺎ ﺑﺎل‬
 The difference between refraction and tolerance
- Tolerance: chronic over long period accompanied with decrease in the
response
‫ ﻣﻊ‬.edema ‫ ﺑﻧﺳﺗﺧدﻣﮭم ﻟﻣﺎ ﯾﻛون ﻋﻧد اﻟﻣرﯾض‬Thiazide and loop diuretic :‫ اﻟﺷرح‬-
‫ ھﻸ ﻓﻲ ﺑﻌض اﻷدوﯾﺔ اذا زدﻧﺎ ال‬.edema ‫اﻻﺳﺗﺧدام اﻟﻔﻌﺎﻟﯾﺔ ﻟﻠدوا رح ﺗﻘل ﻋﺑﯾن ﻣﺎ ﯾﺑطل ﯾﺄﺛر ﻋﻠﻰ‬
Thiazide and ‫ وﻟﻛن ﻓﻲ ادوﯾﺔ ﻣﺛل‬tolerance ‫ ھون ﺑﯾﻛون‬action‫ اﻟدوا ﺑﯾرﺟﻊ ﯾﻌﻣل‬dose
.refraction ‫ ھون ﺑﯾﻛون‬edema‫ ﻣﺎ رح ﺗروح ال‬dose‫ اذا زدﻧﺎ ال‬loop diuretic
Fluid-electrolytes ‫ و‬Electrolytes changes ‫ ﻟﯾش ھﯾك ﺑﯾﺻﯾر؟ ﻻﻧﮭﺎ ھدول اﻻدوﯾﺔ ﺑﯾﻌﻣﻠوا‬-
‫ )زي ﻣﺎ ﺣﻛﯾﻧﺎ( ﻓﺎﻟﺟﺳم‬Hypokalemia ‫ ﺑﺳﺑب اﻧﮫ ﺑﯾﻌﻣل‬Acid-base imbalance ‫ و‬imbalance
k+ sparing diuretics ‫ واﻟدوا ﺑﯾﺑطل ﻓﻌﺎل ﻋﺷﺎن ﻧﺗﻔﺎدى ھﺎد اﻻﺷﻲ ﺑﻧﻌطﻲ ﻣﻌﮫ‬feedback ‫ﺑﯾﻌﻣل‬
.‫)زي ﻣﺎ ﺣﻛﯾﻧﺎ( ﻋﺷﺎن ﻧﺗﻔﺎدى ھﺎي اﻟﻣﺷﻛﻠﺔ‬
  The difference between tolerance and tachyphylaxis:
- Tachyphylaxis is acute over short periods
- Tolerance is chronic over long periods

‫ ﻧﻔس اﻟﻛﻼم اﻟﻣوﺟود ﻛﺎن‬.....live meeting‫** اﻟدﻛﺗور ﻗﻌد ﯾرﺟﻊ ﯾﺷرح اﻷﺷﯾﺎء اﻟﻲ ﺷرﺣﮭم ﺑﺎل‬
‫ ﺑس اذا ﻣش ﻓﺎھم ﻣﻧﯾﺢ ﺑﺑﻠش ﻣن‬already ‫ﺑﺎﻟﻣﺣﺎﺿرات ﻓﻣﺎ ﻓﻲ داﻋﻲ ﺗدرﺳوه ﻟﺣﺎﻟﮫ ﻻﻧﮫ ﻣﺷروح‬
1:11:38