Safe drugs during pregnancy & Lactation

1st trimester 3 
Risks Benefits 
systemic drugs local preparations 
systemic drugs 

Category Pregnancy Breast-feeding

Antibiotics 1. Penicillins
2. Cephalosporins
3. Erythromycin

Tetracycline – Quinolones –
Aminoglycoside - Chloramphenicol

Nitrofurantoin
Uvamine retard caps

Analgesics Paracetamol

NSAIDS
e.g. Brufen – cataflam
nd
2 trimester
 Gastro-enteritis

Diagnosis

 Presentation
Diarrhea ± vomiting & abdominal pain & fever

– –
 Examination
Abdominal examination History
Exclusion of Acute abdomen
Guarding Rigidity Tenderness
“Surgical abdomen”
 1ry or 2ry ?
1ry GE :
2ry GE :
2ry causes are important & fatal
GE Pupil
 Botulism
 Dilated fixed pupils
 Ptosis + generalized weakness
 NO gag reflex

 Organo-phosphorus Poisoninig
Pinpoint pupils + salivation , lacrimation , urination

 Zinc phosphide
Hx of intake + severe irritability & shock
  If 1ry, what is the organism ?
Viral GE Bacterial GE Parasitic GE
- Most common - High grade fever - Diarrhea + cramps
- Low grade fever - Toxic look ± blood or mucus
- Non-toxic patient - Bloody diarrhea - Peri-anal itching
- Profuse watery diarr. may occur

Toxic
Toxic ±

 Complicated or not ?

 Diagnosis of dehydration
1. Delayed Skin turgor
2. Dry mucous memb. Dry
3. Sunken eye
4. Oliguria
Oliguria is the surest sign of dehydration

ER management

Dehydration
Ringer

Visceralgine + Primperan
IV infusion 052
 Buscopan , Viscerlagine
Spasmofen ampoule (hyoscine + ketoprofen)
Acute abdomen
Anti-spasmodics

Home treatment

1. Antibiotics

Bacterial GE

Shigella Bloody diarrhea 02 – 7

Quinolones Salmonella

Viral or Parasitic GE
5

Gastro-enteritis is usually cause by Gram –ve bacteria

 Quinolones (Ciprofloxacin)
Ciprofar 500 tab 10 tab .. 20 LE
Cipro 500 tab 10 tab .. 11.5 LE
Ciprobay 500 tab 10 tab .. 46 LE
5 21

Salmonella (Typhoid) & Shigella

 Headache

Diagnosis

 History
 Onset, course, duration
 Site, character
 What ↑ & ↓
 Associated symptoms – – –

RED Flags for headache (SNOOP)

(Urgent CT & referral to a specialist)
1. Systemic symptoms
High fever – Persistent vomiting – Neck rigidity
2. Neurological symtoms
Disturbed consciousness – Seizures – Focal neurological signs
3. Onset : Sudden , Severe
4. Onset : Above 40 years
5. Previous headache with different characters

NEVER MISS Meningitis & Encephalitis

1. Meningitis
Fever – disturbed consciousness – meningism

2. Encephalitis
Fever - disturbed conscious. – seizures – focal neuro. lesion
 Ask about 8 common causes of chronic headache

1. Eye : Error of refraction

2. Nose : Sinusitis

3. Ear : Otitis Media or Externa

4. Mouth : Tooth pain

5. Fever & any source of infection e.g. common cold

– – –

6. Chronic constipation
ER management

Exclude Hypoglycemia in any patient with convulsions

Any patient with convulsions + fever , exclude :

Meningitis & Encephalitis
Febrile convulsions
5– 5

During seizure

1. Oxygen by mask
2. Recovery position
3. Suction of secretion
4. Anticonvulsant
 Diazepam
Neuril ampoule (10 mg in 2 ml) Amp .. 0.5 LE

02

6
02 0
Rectal
022 21 1.2 
2 
0 11 
 Local anathesia

 Mepacaine 1.8 ml)

 Mepacaine –L adrenalized)
Penis Toes Fingers
 Xylocaine 2% vial (50 ml)
 Lido / Lignocaine spray

0 0

Maximum dose : 5 mg / Kg
02 72
Suspect toxicity if : headache, drowsiness, circumoral numbness

Subcutaneous Intradermal

 Swelling of edges
 Resistance on injection
 Pain on injection

02 – 55
 Anti-Cough medications

Most common practical causes of DRY cough

1. Current Flu or Flu that passed recently




Post-Viral cough
Acute Bronchitis
2. ACE inhibitors e.g. Capotril & Capoten

ACEI
3. GERD

aspiration & irritation of acid

Drugs for “Dry cough” contains :

Cough suppressants
e.g. dextromethorphan
 Drugs for “Productive cough” contains :

 Mucolytics
e.g. bromohexine, ambroxol
 Expectorant
e.g. guainfenesin
 Bronchodilator
e.g. aminophylline, terbutaline

 Antihistaminic
e.g. chloropheniramine, oxomemazine

0
0
 Parasitic infection in adults

Presentation

1. Diarrhea , constipation , tenesmus

2. Bloody or mucoid stool

3. Abdominal cramps
4. Peri-anal itching
5. Anemia

Entamoeba - Giardiasis – Oxyuris – ascaris – Anklystoma

Treatment

Entamoeba Hystolytica
1. Vegetative form
Metronidazole
 Metronidazole
Flagyl 500 tab 20 tab .. 6 LE
Amrizol 500 tab 20 tab .. 5 LE
3
 Secnidazole
Fladazole 500 tab 4 tab .. 10 LE
 Tinea Versicolor

Presentation

 Most common type of tinea

usually occur in summer

 Commonly pale & less

commonly dark lesions
usually scaly & tend to
merge forming larger patch
usually occur in trunk, neck,
proximal extremities

Treatment

1. Instructions

2. Topical anti-fungal

 In small lesions
Dermatin cream (Clotrimazole 1%) 1.5 LE
Miconaz cream (Miconazole 2%) 3 LE
Batrafen cream (Ciclopirex 1%) 5 LE
Lamisil cream (Terbinafene 1%) 13 LE
  In large lesions or hairy area e.g. scalp
Nizapex shampoo (ketoconazole 2%) 17 LE
Nizoral shampoo (ketoconazole 2%) 23 LE

02

 Resistant cases
Selsun blue shampoo 32 LE

02

3. Systemic anti-fungal (Fluconazole is the best)

Flucoral caps 2 capsules ..14.5 LE
Fungican caps 1 capsule .. 10 LE

Tinea Versicolor
Rx/ Nizapex shampoo

02
Rx/ Flucoral caps
 Tonsillitis

Criteria of Bacterial Tonsillitis

 Age : 2-12 years (usually >4 years)
 Toxic-look
 High-grade fever
 Enlarged tender cervical LN
 Red spots over pharynx

Treatment

1. Analgesic & Antipyretic

– – –

Paracetamol 0 
Ibuprofen Paracetamol – 0 
Declophenac Ibuprofen Paracetamol 

 Ibuprofen
Brufen 100 mg/5ml syrup 6 LE
10 - 15 mg/Kg/day

per dose (divided every 4 - 6 hours)

0 5 0
 Paracetamol
Cetal suppositories 5 supp .. 1.5 LE
Pyral suppositories 5 supp .. 1.5 LE
0
 Treatment of Type 2 DM

1. Patient education / Diet / Exercise

2. Oral anti-diabetic drugs

1. Biguanides (Metformine)
2. Sulphonylureas
3. Repaglinide
4. Combinations


Repaglinide Sulphonyl Metformin

Metformin + Sulphonylurea

Sulphonylurea

General Contraindications of sulphonylurea

1. Renal failure
2. Hepatic failure
3. G6PD deficiency
1. Gliclazide
 Trade names
Diamicron tab (80 mg) 20 tab .. 9 LE
Diamicron 30 MR tab 30 tab .. 14 LE
Diamicron 60 MR tab 30 tab .. 26 LE
 Dose
Starting dose = 40-80 mg & Maximum dose = 320 mg
Diamicron 
Diamicron MR 

Diamicron 
short acting

Diamicron MR (Modified Release) 

2. Glibenclamide
 Trade names
Daonil tab (5 mg) 20 tab .. 6 LE
Glibenase tab (5 mg) 20 tab .. 1.5 LE

 Dose
Starting dose = 5 mg (2.5 in old age) & Maximum dose = 15 mg

long acting 
3 