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*اذاعة محطة مصر

Admin

Admin

طبيب القلوب_المنصورة

hero simsim

dramadomido

تذكير بمساهمة فاتح الموضوع :

الروشته الاولى لعلاج : Impotance
/R
pregnyl 5000 امبول عضل / 10 ايام
proctan cap ك / يوميا
Anderiol cap ك / كل 12 ساعه
vasotal tab 400 ك / 12 ساعه
.........................................الشرح .................................................. ..
اول صنف :

pregnyl 5000 I.U ( Human chorionic gonadotrophin

واحيانا يوصف البروفاسي 5000 وحدة دولية ( نفس التركيبة )

الجرعة الموصوفة : حقنة عضل كل 10 ايام

يستخدم لعلاج ال 2nd testicular failure
و ال undescending testis في الاطفال بتركيز 1500 وحدة دولية
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

الثاني :

proctan cap

وهو عبارة عن مجموعة من الفيتامينات و الاعشاب الطبيعية لعلاج ال Impotance

الجرعة الموصوفة: كبسولة يوميا

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
الثالث :

Anderiol cap ) testosterone oenanthate 250 mg

يستخدم لعلاج ال hypogonadism

الجرعة الموصوفة : كبسولة مرتين يوميا ( كل 12 ساعة )
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

الرابع :

vasotal tab 400 mg ) pentoxifyline
لعلاج ال peripheral arterial circulatory disorders

البدائل : بيكسال 400 ، ترينتال 400 ، ريبكوفليكس 400 ، بينتال 400

الجرعة الموصوفة : كبسولة مرتين يوميا ( كل 12 ساعة )
>>>>>>>>>>""""""""">>>>>>>>>>>:::::::::>>>>>>>>>""
"">>>>>>

ملازم عدد الرسائل : 69 تاريخ التسجيل : 21/08/2009

بسم الله الرحمن الرحيم
تحليل a.s.o

A.S.O هو اختصار لـ anti-streptolysin O ودي عبارة عن اجسام مضادة بيكونها
الجسم في حالات الاصابه ببكتريا streptococci Group A وبالتالي يمكن من
خلال هذا التحليل معرفه هل الجسم مصاب بهذه البكتريا ام لا من خلال الكشف
عن antibodies A.S.O في الدم وبالتالي يمكن تشخيص العديد من الامراض التي
تسببها هذه البكتريا .

( صورة لبكتريا الاستربتوكوكس والتي يطلق عليها الميكروب السبحي )

النسبه الطبيعية : less than 200 IU/ml

امتى النسبة دي بتزيد ؟؟

زي ما قلنا ان أي اصابه بـ streptococci Group A هتزود نسبه ASO titre واشهر الامراض التي يمكن ان تزدااد فيها نسبه ASO:
1-الحمى الروماتيزميه rheumatic fever) ) ويمكن ان تصل فيها النسبه الي
800 IU/ml !! ويعتبر ASO من اهم التحاليل الازمة لتشخيص الحمى
الروماتيزمية وده طبعا بالاضافه لتحليل سرعة الترسيب ESR ( هنكلم عنه
لاحقا ان شاء الله )
2- الحمي القرمزية scarlet red ) )
3- في حالة الـ bacterial endocarditis الناتجة عن الـ streptococci

هل ممكن واحد سليم وتكون نسبه ASO عنده مرتفعه عن المعدل الطبيعي ؟؟
ايوه ممكن !! لان الاجسام المضادة antibodies A.S.O اللي بيكونها الجسم
ممكن تفضل لفترة كبيرة في الدم ممكن تصل الفترة دي لعدة شهور بعد الاصابة
يعني ممكن واحد اصيب بالـ strept. Group A واتعالج منها وبعد شهرين تلاته
يعمل تحليل ASO ويلاقيه مرتفع برده وعشان كده لا يمكن تشخيص المرض عن طريق
التحليل ده بس .. لازم يكون هناك تحاليل تانيه معاة بالاضافه طبعا للاعراض
اللي بتظهر علي المريض .

الوصفة الأولى:

عمر المريضة: 56 سنة

Osteomyelitis

Rx

Flucloxacillin 500mg cap 1 cap q.i.d

Q1-What is the sole indication for flucloxacillin?
And for how long we treat this patient?

Indications

Infections due to beta-lactamase-producing staphylococci including
otitis externa; adjunct in pneumonia, impetigo, cellulitis,
osteomyelitis and in staphylococcal endocarditis

Q2-What advisory labels should be given for patient on oral flucloxacillin?

flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin;
flucloxacillin should be used with caution in patients with hepatic impairment;

careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials.
Q3-What antibiotic you recommend if the patient is allergic to penicillins?

Osteomyelitis

Flucloxacillin or clindamycin if penicillin-allergic (or vancomycin if
resistant Staphylococcus epidermidis or meticillin-resistant Staph.
aureus)
Treat acute infection for 4–6 weeks and chronic infection for at least
12 weeks; combine vancomycin with either fusidic acid or rifampicin if
prostheses present or if life-threatening condition

الكلام الذي ورد أعلاه بخصوص fluxacillin ينطبق على الأدوية الأخرى من مجموعته مثل
cloxacillin, oxacillin, dicloxacillin, nafcillin
methcillin not used clinically due to its side effects

سؤال: هل هنالك فرق بين beta-lactamase resistant penicillins و penicillinase resistant penicillins وما هو الفرق؟

من الناحية السريرية الفرق يعتمد على spectrum of activity و site of
infection و severity of infection والمسائل الأخرى التي تؤثر في الفعالية
العلاجية

Narrow spectrum penicillinase-resistant penicillins
This group was developed to be effective against beta-lactamases
produced by Staphylococcus aureus, and are occasionally known as
anti-staphylococcal penicillin. Penicillin is rampantly used for curing
infections and to prevent growth of harmful mold.
وهي المجموعة نفسها التي ينتمي لها fluxacillin والتي ذكرت أدويتها أعلاه

Narrow spectrum β-lactamase-resistant penicillins
This molecule has a spectrum directed towards Gram negative bacteria
without activity on Pseudomonas aeruginosa or Acinetobacter spp. with
remarkable resistance to any type of β-lactamase.
مثال هذه المجموعة Temocillin

الوصفة 2

العمر: 1 سنة
الوزن:10 كغم
Community acquired pneumonia
Rx
Ampicillin 500 mg injection
1/2 inj. q.i.d for 10 days

Q4-What is the antibacterial spectrum of ampicillin?

broad or moderate spectrum
حسب المصدر ( قضية تصنيفية لكن الماشي broad )

Q5-Can we give the remaining half of the 500 mg injection for the next dose
(i.e. is it stable for the next dose )?

no
ممكن أن تراجعوا موضوعي حول stability of injections after reconstitution

Q6-If ampicillin is given orally, what advisory labels should be given to the patient?

واجب

العمر: 44 سنة
Otitis media
Rx
Amoxicillin 500mg cap.
1 cap t.i.d for seven days

Note: the patient was start to take Allopurinol for hyperuricaemia in the last week.

Q7-What are the difference between amoxicillin and ampicillin (spectrum, dosing frequency and absorption)?

Amoxicillin has a similar antibacterial spectrum

Amoxicillin has longer duration of action, so it is usually given 3 times daily, while ampicillin is given 4 times daily

It is better absorbed than ampicillin when given by mouth, producing
higher plasma and tissue concentrations; unlike ampicillin, absorption
is not affected by the presence of food in the stomach

Q8- 2 days later the patient return to your pharmacy complaining of rash !!
knowing that the patient had been use amoxicillin alone many times previously without any problem.
What is the most likely cause?
and what do you recommend?

The incidence of skin rashes among those taking either ampicillin or
amoxicillin is increased by the concurrent use of allopurinol

An established interaction of limited importance. There would seem to
be no strong reason for avoiding concurrent use, but prescribers should
recognise that the development of a rash is by no means unusual.
Whether this also occurs with penicillins other than ampicillin or
amoxicillin is uncertain, and does not seem to have been reported

راجع table 1 لمعرفة البدائل في حالة otitis media

الوصفة 4

العمر:66سنة

Sinusitis
Rx
Co-Amoxiclave 625mg(500/125) tab
1 tab t.i.d for 1 week

Q9-What is the idea behind amoxicillin/calvulanic acid combination?

Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor
clavulanic acid. Clavulanic acid itself has no significant
antibacterial activity but, by inactivating beta-lactamases, it makes
the combination active against beta-lactamase-producing bacteria that
are resistant to amoxicillin. These include resistant strains of Staph.
aureus, E. coli, and H. influenzae, as well as many Bacteroides and
Klebsiella spp. Co-amoxiclav should be reserved for infections likely,
or known, to be caused by amoxicillin-resistant
beta-lactamase-producing strains

Q10-Can you dispensed 2 tablets of augmentin® 375 mg (250/125) instead of the 625 tab which is unavailable in your pharmacy?

no
ممكن استخدام أوكمنتين 375 ملغ مع أموكسيسلين 250 ملغ وبهذه الحالة تعتبر بديل

Why?

هذي عليكم

Q11- the patient had been improved, but 2 days after the completion of
Augmentin course, the patient return to your pharmacy complaining of
dark urine, yellow eyes, and pruritis ( symptoms of cholestatic
jaundice)
What is the most likely cause?

Cholestatic jaundice can occur either during or shortly after the use
of co-amoxiclav. An epidemiological study has shown that the risk of
acute liver toxicity was about 6 times greater with co-amoxiclav than
with amoxicillin. Cholestatic jaundice is more common in patients above
the age of 65 years and in men; these reactions have only rarely been
reported in children. The duration of treatment should be appropriate
to the indication and should not usually exceed 14 days

Is it fatal?

Jaundice is usually self-limiting and very rarely fatal

Q12-If The Dr. want to prescribe Augmentin injection. can we give it by I.M. route?

No, I.V. only

الوصفة 5

العمر: 22سنة
Pseudomonas aeruginosa septicemia

Rx
Tazocin® 4.5 gm inj.
1 inj. t.i.d
Tobramycin 80 mg inj.
1 inj. t.i.d

Q13-what is Tazocin® and what is the principle indication for it?

Tazocin® contains the ureidopenicillin piperacillin with the beta-lactamase inhibitor tazobactam
It is used as antipseudomonal
يعني ممكن يستخدم بهذه الحالات:
1-Lower respiratory-tract, urinary-tract, intra-abdominal and skin infections, and septicaemia

2-Complicated appendicitis

3-Infections in neutropenic patients (in combination with an aminoglycoside)

Q14-Why it is combined with tobramycin ( one of the aminoglycosides) for this patient?

For pseudomonas septicaemias (especially in neutropenia or
endocarditis) these antipseudomonal penicillins should be given with an
aminoglycoside since they have a synergistic effect.

Q15-Can we mix penicillin and Aminoglycosides in the same syringe or infusion bottle?
(i.e. are they compatible or not?)

Penicillins and aminoglycosides must not be mixed in the same syringe or infusion

Q16-can we consider Timentin® as an alternative to tazocin?

The spectrum of activity of Tazocin® is comparable to that of the carbapenems, imipenem and meropenem

Which one is more active against Pseudomonas?

والله هذا السؤال دوخني وكل مصدر يقول كلام مختلف
لكن من الكلام أعلاه فكل منهما بديل للآخر ولكن الأفضل عمل culture حتى
نعرف الأدوية التي من الأفضل استخدامها لأن هذه الأدوية يجب أن لا تستخدم
إلا في حالة عدم توفر بديل

معلومة:
يعتبر imipenem هو broadest spectrum antibiotic

نتكلم الآن عن beta-lactamase inhibitors
وهي clavulanic acid, salbactam, tazobactam

ما هي ميزتها ولماذا تستخدم؟
بكل بساطة هي beta-lactamase inhibitors يعني تعمل كمثبط لإنزيم تفرزه بعض
أنواع البكتريا ومن أهمها Staphylococcus aureus وهو من أخطر أنواع
البكتريا ومن أكثرها انتشارًا
هذا الإنزيم يعمل على تحطيم هيكلية التركيب الكيمياوي لمركبات البنسلينات
ولذا لن تستطيع هذه المركبات أن تقوم بدورها تجاه هذه البكتريا ولذا وجدت
هذه الأنواع من الأدوية لكي تثبط عمل هذا الإنزيم وتترك الدواء الأصلي
يقوم بدوره
هذه المركبات تشابه من حيث التركيب البنسلينات لكنها ترتبط بالإنزيم وتمنعه من مقاومة المضاد الحيوي
وهذه المركبات ليس لها تأثير على البكتريا إذا استخدمت لوحدها لأنها تعمل على الإنزيمات فقط ولا تؤثر على البكتريا

هو ما سنتكلم عنه الآن

Augmentin يتكون من كلافيولانك اسيد وأموكسيسلين
كلافيولانك اسيد فيه مشكلة أنه يسبب jaundice بسبب تأثيره على الكبد لذا لا يجوز استخدامه أكثر من اسبوعين

ملاحظة أخرى
يوجد من الأوكمنتين أشكال دوائية مختلفة

Suspension - Amoxicillin/clavulanic acid
Augmentin 156 - 125/31.25mg
Augmentin 312 - 250/62.5mg

Tablet - Amoxicillin/clavulanic acid
Augmentin 375 - 250/125mg
Augmentin 625 - 500/125mg
Augmentin 1000 - 875/125mg

لاحظ أن نسبة كلافيولانك اسيد عند الجرع المخصصة للأطفال هي أقل من نظيراتها المخصصة للكبار
فعندما كان الاموكسيسلين 250 ملغ فنسبة كلافيولانك اسيد هي اقل عند الأطفال لأنه يؤثر في فعاليات الكبد عندهم
أما الجرع الأعلى بالنسبة للكبار فلم يتم زياد كمية كلافيولانك اسيد حتى لا يؤثر عليهم ( يعني كمية 125 ملغ بقيت ثابتة )

لذلك إذا لم يتم توفير أوكمنتين 625 فالمريض ليس بإمكانه أخذ قرصين من
أوكمنتين 375 لأنه سيكون قد أخذ 500 ملغ من الأموكسيسلين و 250 ملغ من
كلافيولانك اسيد
لذا فالبديل قرص واحد من أوكمنتين 375 مع كبسولة أموكسيسلين 250 ملغ

ما هي الفكرة من عمل compination بين أموكسيسلين أو أمبسلين مع فلوكلوكساسلين أو كلوكساسلين؟

الجواب:
لدينا أمثلية:
أمبسلين + كلوكساسلين ( أمبيكلوكس )
أمبسلين + فلوكلوكساسلين
أموكسيسلين + فلوكلوكساسلين

نحن نعرف أن أمبسلين وأموكسيسلين هما broad spectrum أي يؤثران على G+ve
وG-ve لكنه لا يؤثر على Staph. aureus بخلاف لكوكساسلين ومجموعته الذين هم
narrow spectrum ولكنهم penicillinase resistant مما يجعلهم
antistaphylococcal لذا فنحن سكون لدينا كومبينيشن ذا فعالية أوسع

امبسلين يستخدم 4 مرات يوميًا
أموكسيسلين يستخدم 3 مرات يوميًا

كلوكساسلين يستخدم 4 مرات يوميًا ولذا يستخدم مع أمبسلين
فلوكلوكساسلين يستخدم 3-4 مرات ولذا يستخدم مع أمبسلين وأموكسيسلين

يتوفر في العراق دواء اسمه Pulmoclox من انتاج شركة هندية ويتكون من أموكسيسلين وكلوكساسلين ويعتبر هذا خطا من الناحية السريرية

لماذا خطأ؟؟
جواب السؤال سيكون عليكم

الوصفة 6

العمر: 22سنة

Lower UTI
Rx
Cefalexin 500mg cap.
1 cap q.i.d

Q17-To which generation of cephalosporin, cefalexin belong?

First generation

Q18-If the patient is fasting ( in Ramadan), could you recommend cefadroxil as an alternative?

yes

Why?

Because it is belong to the same generation and it can be used twice daily only

Q19-what is the principle side effects of cephalosporins?

Side-effects
Diarrhoea and rarely antibiotic-associated colitis (CSM has warned both
more likely with higher doses), nausea and vomiting, abdominal
discomfort, headache; allergic reactions including rashes, pruritus,
urticaria, serum sickness-like reactions with rashes, fever and
arthralgia, and anaphylaxis; Stevens-Johnson syndrome, toxic epidermal
necrolysis reported; disturbances in liver enzymes, transient hepatitis
and cholestatic jaundice;
other side-effects reported include eosinophilia and blood disorders
(including thrombocytopenia, leucopenia, agranulocytosis, aplastic
anaemia and haemolytic anaemia); reversible interstitial nephritis,
hyperactivity, nervousness, sleep disturbances, hallucinations,
confusion, hypertonia, and dizziness

And if the patient told you that he had penicillin allergy, what would be your action ?

the patient must do a skin test

Why?

because their is a cross sensitivity

Q20-what will be the dose of cefalexin if it is indicated for prophylaxis of recurrent UTI in *****?

Prophylaxis of recurrent urinary-tract infection, ***** 125 mg at night

العمر:1سنة
الوزن:8 كغم

Chest infection

Rx

Cefixime( Suprax®) 100mg/5ml susp.
3ml once daily.

Q21- knowing that cefixime is an oral a 3rd generation cephalosporin, what is the advantage of it?

They are more effective against a wide range of bacterial species especially G-ve bacteria

Q22-Is this proper dose?

Dose
***** and child over 10 years: 200–400 mg daily in 1–2 divided doses
Child over 6 months: 8 mg/kg daily in 1–2 divided doses
or 6 months–1 year 75 mg daily
from 1–4 years 100 mg daily
from 5–10 years 200 mg daily

the dose is proper

Q23-The mother gives you another Rx, but it is for her chest infection
in which the Dr. prescribed Suprax 400mg cap. to be given twice daily,
knowing that the mother is pregnant woman (in the 2nd trimester) …what
is the problem in her Rx?

In pergnancy: Cefixime is not known to be harmful
The problem is in its dose, see dose above

Q24-what is the cefixime dose for the treatment of gonorrhea?

Gonorrhoea [unlicensed indication], 400 mg as a single dose

الوصفة 8

العمر: 1سنة
الوزن :10 كغم

chest infection

Rx

Cefotaxime(claforan®) 500mg inj.
1 inj. B.i.d for 5 days

Q25-To which generation of cephalosporin, cefotaxime belong?

third generation

What is the antibacterial spectrum of it ?

greater activity than the ‘second generation' cephalosporins against
certain Gram-negative bacteria. However, they are less active than
cefuroxime ( a second generation ) against Gram-positive bacteria, most
notably Staphylococcus aureus

Is this dose proper based on body weight?

Dose
child: 100–150 mg/kg daily in 2–4 divided doses increased up to 200 mg/kg daily in very severe infections

وبذلك تكون الجرعة 1غم-1.5غم مقسمة بين جرعتين إلى أربع جرعات

Q26-Knowing that the price of claforan® 500 mg injection is 1000
dinnars, while that of claforan® 1 gm injection is 1250 dinnars. Could
you dispense 5 injections of the 1 gm product instead of 10 injections
of the 500mg product in order to decrease the cost for the patient?

yes.
see:
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]

الوصفة 9

العمر:23 يوم
الوزن :3 كغم

Septicemia

Rx
Ceftriaxone 250mg inj. 150mg once daily

Note: the neonate had jaundice.

Q28- To which generation of cephalosporin, Ceftriaxone belong?

third generation

what are the advantages of it?

Ceftriaxone has a longer half-life and therefore needs to be given only
once daily. Indications include serious infections such as septicaemia,
pneumonia, and meningitis

Q29-What is the problem in this pre******ion?

Contra-indications: neonates with jaundice

Q30-If you recommend cefotaxime as an alternative , what would be the dose?

the dose will be 150 mg/day in 2–4 divided doses increased to 450–600 mg/day in severe infections

Q31-if the septicemia is caused by pseudomonas aeruginosa. Do you suggest to replace cefotaxime by ceftazidime ?

yes

why?

because ceftazidime has good activity against pseudomonas

الوصفة 10

العمر: 31سنة

Rx
Imipenem 500mg injection
500 mg T.I.D

Q27-what is the antibacterial spectrum of Imipenem?

Imipenem, a carbapenem, has a broad spectrum of activity which includes
many aerobic and anaerobic Gram-positive and Gram-negative bacteria

وكما ذكرنا فهو يعتبر broadest spectrum antibiotic لحد الآن

why it is combined with cilastatin ?

Imipenem is partially inactivated in the kidney by enzymatic activity
and is therefore administered in combination with cilastatin, a
specific enzyme inhibitor, which blocks its renal ----bolism

what are the advantages of Meropenem over Imipenem ?

Meropenem has a lower neurotoxicity incidence
Also, meropenem is similar to imipenem but is stable to the renal
enzyme which inactivates imipenem and therefore can be given without
cilastatin.
Meropenem has less seizure-inducing potential and can be used to treat central nervous system infection

الوصفة 11

العمر: 33 سنة

Exacerbation of chronic bronchitis

Rx
Tetracycline 250 mg cap.
1 cap q.i.d

Q32-What counseling should be given to the patient about oral intake of tetracycline?

Counselling Tablets should be swallowed whole with plenty of fluid while sitting or standing

Why ?

بسبب الأعراض الجانبية المحتمل حدوثها
Side effect: dysphagia, and oesophageal irritation

and what are the advisory labels of it?

Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine

Take at regular intervals. Complete the prescribed course unless otherwise directed

An hour before food or two hours after food or on an empty stomach

Q33-what are the most common side effects of tetracyclines?

Side-effects of the tetracyclines include nausea, vomiting, diarrhoea
(antibiotic-associated colitis reported occasionally), dysphagia, and
oesophageal irritation.
Also acute renal failure, skin discoloration

Q34-If the patient have renal impairment, does tetracycline still be used safely ?

No

what is the alternative?

Amoxicyclin or Erythromycin
see table 1

الوصفة 12

العمر: 33سنة

Acne

Doxycycline 100mg cap.
1 cap. Daily

Q35- What counseling should be given to the patient about oral intake of Doxycycline?

Counselling Capsules should be swallowed whole with plenty of fluid during meals while sitting or standing

Why ?

بسبب الأعراض الجانبية المحتمل حدوثها
Side effect: dysphagia, and oesophageal irritation
مثل تتراسايكلين

and what are the advisory labels of it?

Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine

Take at regular intervals. Complete the prescribed course unless otherwise directed

. . . with or after food

. . .with plenty of water

Compare it to that of tetracycline?

المقارنة واجبكم

Q36-the patient ask you to give her some antacid tablet for her GERD
symptoms that comes from time to time, What counseling you will give
her ?

يجب أن يكون هنالك فاصل زمني مقدراه ساعتين فأكثر

Why?

Antacids should preferably not be taken at the same time as other drugs since they may impair absorption

Q37-If the patient become pregnant, and then lactating mother, can Doxycycline still be used safely ?

Doxycycline - Pregnancy
First trimester: Effects on skeletal development in animal studies

Second, third trimesters: Dental discoloration; maternal hepatotoxicity with large parenteral doses

Lactation
Avoid (although absorption and therefore discoloration of teeth in
infant probably usually prevented by chelation with calcium in milk)

الوصفة 13

العمر:55سنة

UTI

Rx
Gentamicin 80mg inj.
1 injection t.i.d

Q38-What is the antibacterial spectrum of Aminoglycosides?

These include amikacin, gentamicin, neomycin, netilmicin, streptomycin,
and tobramycin. All are bactericidal and active against some
Gram-positive and many Gram-negative organisms. Amikacin, gentamicin,
and tobramycin are also active against Pseudomonas aeruginosa;
streptomycin is active against Mycobacterium tuberculosis and is now
almost entirely reserved for tuberculosis

Q39-What are the most important side effects of Aminoglycosides?

Most side-effects of this group of antibiotics are dose-related
therefore care must be taken with dosage and whenever possible
treatment should not exceed 7 days. The important side-effects are
ototoxicity, and nephrotoxicity

And when they occur commonly?

they occur most commonly in the elderly and in patients with renal failure

Q40-If the patient have Gentamicin–resistant G-ve bacilli, what is the preferred aminoglycoside in this case ?

Amikacin is used in the treatment of serious infections caused by gentamicin-resistant Gram-negative bacilli

why?

Amikacin is more stable than gentamicin to enzyme inactivation

Q41-If the patient have infection due to pseudomonas aeruginosa, what is the preferred aminoglycoside in this case?

Tobramycin

Q42- If the patient is already taking furosemide one tablet in the morning, is it prefer to give Gentamicin for him?

no

Why?

increase risk of ototoxicity and nephrotoxicity

And what do you recommend if the concurrent use of both drugs is unavoidable?

في هذه الحالة يتم متابعة حالة المريض وفي حالة ظهور اعراض الـtoxicity
مثل الطنين في الأذن والذي يدل على حالة ototoxicity يتم قطع استعمال
الدواء حالا ً

الوصفة 15

Mycoplasma pneumonia

Rx

Erythromycin 500mg cap
1 cap q.i.d

Q44-What is the antibacterial spectrum of Erythromycin?

Erythromycin has an antibacterial spectrum that is similar but not
identical to that of penicillin; it is thus an alternative in
penicillin-allergic patients.
Indications for erythromycin include respiratory infections, whooping
cough, legionnaires' disease, and campylobacter enteritis. It is active
against many penicillin-resistant staphylococci but some are now also
resistant to erythromycin; it has poor activity against Haemophilus
influenzae. Erythromycin is also active against chlamydia and
mycoplasmas

Q45-What are the important side effects of Erythromycin?

Erythromycin causes nausea, vomiting, and diarrhoea in some patients

Q46- If the patient is lactating mother, could she take Erythromycin safely?

yes

الوصفة 16

العمر:34 سنة

Chest infection

Rx

Azithromycin 250 mg cap, 2 cap once daily for three days

Q47-What are the difference between Azithromycin and Erythromycin (spectrum, duration, and severity of GIT side effects)?

Azithromycin is a macrolide with slightly less activity than
erythromycin against Gram-positive bacteria but enhanced activity
against some Gram-negative organisms including H. influenzae.

It has a long tissue half-life and once daily dosage is recommended

Azithromycin causes fewer gastro-intestinal side-effects than erythromycin

is this proper dose?

yes

Q48- What advisory labels should be given for patient taking Azithromycin capsules?

Do not take indigestion remedies at the same time of day as this medicine

Take at regular intervals. Complete the prescribed course unless otherwise directed

Swallowed whole, not chewed

what is the difference between the cap. And susp. in the advisory labels?

The last point is not recommended

الوصفة 16

العمر:40 سنة

Rx
1-Omeprazole 20mg cap
One cap bid for one week
2- Clarithromycin 500mg tab
two tab bid for one week
3-Amoxicillin 500 mg cap.
two cap bid for one week

Q6-What are the difference between Clarithromycin and Erythromycin (spectrum, duration, and severity of GIT side effects)?

Clarithromycin is an erythromycin derivative with slightly greater activity than the parent compound

It is given twice daily, while erythromycin is given 3-4 times daily

Clarithromycin cause fewer gastro-intestinal side-effects than erythromycin.

Q7-For what condition the above triple therapy is used

It is a regimens for Helicobacter pylori eradication
Helicobacter pylori may cause ulcer

Q8-What is the Klaricid XL ® ?

clarithromycin 500 mg tab in a modified release form

And what are the advisory labels of it?

Take at regular intervals. Complete the prescribed course unless otherwise directed

with or after food

swallowed whole, not chewed

الوصفة 18

العمر: 29 سنة

(pregnant)

Septic arthritis

Rx
Clindamycin (Dalacin C®) 150 mg cap
1 cap q.i.d for 6 weeks

Q51-Why clindamycin has limited use?

Clindamycin has only a limited use because of serious side-effects. Its
most serious toxic effect is antibiotic-associated colitis which may be
fatal and is most common in middle-aged and elderly women, especially
following operation. Although antibiotic-associated colitis can occur
with most antibacterials it occurs more frequently with clindamycin.
Patients should therefore discontinue treatment immediately if
diarrhoea develops

is it safe in pregnancy?

used with caution
Not known to be harmful

Q52- What is the antibacterial spectrum of Clindamycin?

Clindamycin is active against Gram-positive cocci, including
penicillin-resistant staphylococci and also against many anaerobes,
especially Bacteroides fragilis.

can we use clindamycin for meningitis ?

No

why ?

see the following table

Q53- What counseling and advisory labels should be given to the patient about oral intake of Clindamycin?

Take at regular intervals. Complete the prescribed course unless otherwise directed

Take with plenty of water

Patients should discontinue immediately and contact doctor if diarrhoea
develops; capsules should be swallowed with a glass of water

Q54-what are the contraindications for clindamycin

diarrhoeal states; avoid injections containing benzyl alcohol in neonates

الوصفة 19

العمر:26 سنة

Osteomyelitis due to penicillin –resistant staph.

Rx
sodium fusidate - Fucidin
250mg tab.
two tab. T.I.d

Q55-What is the main indication of fusidic acid?

The only indication for their use is in infections caused by
penicillin-resistant staphylococci, especially osteomyelitis, as they
are well concentrated in bone; they are also used for staphylococcal
endocarditis

Q56-what is the equivalent dose of fusidic acid suspension?

sodium fusidate 500 mg = fusidic acid 480 mg

why?

sodium content in salt

and what advisory labels should be given with suspension?

Take at regular intervals. Complete the prescribed course unless otherwise directed

with or after food

الوصفة 20

العمر:34 سنة

Endocarditis caused by methicillin resistant staph. MRSA

Rx
Vancomycin 1gm injection
1gm every 12 hours for 28 days
Rifampicin 300 mg cap
1cap t.i.d for 28 days.

Q57- What is the antimicrobial spectrum of Vancomycin?

Vancomycin has bactericidal activity against aerobic and anaerobic
Gram-positive bacteria including multi-resistant staphylococci

for what condition we give it orally?

antibiotic-associated colitis - pseudomembranous colitis

Q58-What are the side effects of vancomycin on kidney and ear ?

nephrotoxicity including renal failure and interstitial nephritis; ototoxicity

what happen if the drug is given rapidly by i.v route?

severe hypotension (including shock and cardiac arrest), wheezing,
dyspnoea, urticaria, pruritus, flushing of the upper body (‘red man'
syndrome), pain and muscle spasm of back and chest

Q59- what is the difference between vancomycin and teicoplanin (Targocid ® )?

Teicoplanin is very similar to vancomycin but has a significantly
longer duration of action allowing once-daily administration. Unlike
vancomycin, teicoplanin can be given by intramuscular as well as by
intravenous injection; it is not given by mouth

Q60-What counseling and advisory labels should be given for rifampicin?

Do not stop taking this medicine except on your doctor's advice

This medicine may colour the urine
urine orange-red

Take it half to one hour before food

It may discolour soft contact lenses

الوصفة 21

العمر:25 يوم

UTI

Rx

Co-trimoxazole (Metheprim®) 240mg/5ml susp 2.5mltwice daily. For seven days

Q61-what is co–trimoxazole?

It is a combination sulfamethoxazole (sulphamethoxazole) and trimethoprim

What is the problem in this Rx.(hint. check the age )?

الدواء لا يعطى لطفل عمره أقل من 6 أسابيع

which of the following could be used in this age (Nitrofurantoin, Nalidixic acid, or ampicillin)

ampicillin

Q62-What you will advice the patient to maintain?

maintain adequate fluid intake

Can we use it safely in patient with blood disorders?

avoid in blood disorders unless under specialist supervision

Q63-In the Co-trimoxazole preparations, there is a Septrin ® ***** suspension!!!! when we use it

الجواب على هذا السؤال سيكون استنتاجيًا وسيكون جوابه مطلوبًا منكم

الوصفة 22

العمر:33 سنة

Bacterial vaginosis

Rx

Metronidazole (flagyl®) 500mg tab
One tab B.i.d for 5 days

Q22- What is the antimicrobial spectrum of Metronidazole

Metronidazole is an antimicrobial drug with high activity against anaerobic bacteria and protozoa

Q23-What are the most common side effects of Metronidazole?

gastro-intestinal disturbances (including nausea and vomiting), taste disturbances, furred tongue, oral mucositis, anorexia

Q24- What advisory labels should be given for patient taking flagyl tab.?

Avoid alcoholic drink
Take at regular intervals. Complete the prescribed course unless otherwise directed
Take it with or after food
Take it swallowed whole, not chewed
Take it with plenty of water

Q25-Does the advisory labels of flagyl suspension similar to that of tab.??

No
The last three notes are not recommended
Flagyl suspension is to be taken on empty stomach