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Summer Training Guide For Fourth Stage Pharmacy Students ( ٍْ صَالس إِرَا ٍَبدَ

Summer Training Guide For Fourth Stage Pharmacy Students ( ٍْ صَالس إِرَا ٍَبدَ اثُِْ آدًََ اّْقَطَعَ عَََئُُ إِال ٍِِ: ٍْ صَذَقَخ ٍِِ َْٗجَبسٌَِخٍ ، أ ِِٔعِيٌٍْ ٌُْْزَفَعُ ث َُٔ، أَْٗ َٗىَذٍ صَبىِحٍ ٌَذْعُ٘ ى) حذٌش ّج٘ي ششٌف .....إٕذاء إىى .... ًصٗجز ( ٗأٗالدي ٌبعش ٗحَضح ....) .... ٌٖعيى ٍب أخزد ٍِ ٗقذ ٕ٘ ٍِ حق .... إٔذي عَـــــــــــــــــــيً ٕـــــــــــــــــــزا ظٍبء 8102 رٍَٖـذ ث ٌٍِِغٌِْ هللاِ اىشَّحَِِْ اىشَّح ( ْٰ َٕو قَبهَ ىَُٔ ٍُ٘عَى ْ رُعَيََِِِّ ٍََِّب عُيَِّْذَ سُشْذًا ٰ أَُ أَرَّجِعُلَ عَيَى) ﴿ ع٘سح اىنٖف اٌَخ ٦٦﴾ ٌ َضو اىزذسٌت اىصٍفً ىطالة اىَشحي خ اىشاثعخ فً ميٍبد اىصٍذىخ ٌاىقغ ٍِ ًّاىضب ٍزطيجبد اى ًزذسٌت اىصٍفً ثعذ رذسٌت اىَشحيخ اىضبىضخ ٗرأر إٍَزٔ ٍِ مُ٘ اىطبىت ٌذخو ٕزا اىقغٌ ٗقذ اعزنَو دساعخ عيٌ االدٌٗخ مبٍال ٍع دساعخ صٍذىخ اىَجزَع ٗ قغَب ٍَٖب ٍِ اىصٍذىخ اىغشٌشٌخ ٔٗثبىزبىً فأُ اغيت ٍب ٌشآ ٍِ ادٌٗخ ٗاٍشاض عزنُ٘ ٍَب عجق ى دساعزٖب ّظشٌب ٗعَيٍب فً اىنيٍخ...اُ اىطبىت فً ٕزٓ اىَشحيخ ٌنُ٘ قذ اٗشل عيى اىزخشط.. ٗثبىزبىً فأُ االّخشاغ فً اج ٘اء اىَْٖخ ٗاىزَبط ًاىَجبشش ٍع عبىٌ االدٌٗخ ٗاى٘صفبد ٗاىَشظى ..رحذ اششاف اىصٍذى ِغجعب.. ٌصجح ظشٗسح ٍيحخ ىيزٍٖؤ ىجٍئخ اىعَو مصٍذالًّ ٍغؤٗه ع ( صحخ ٗعالٍخ اىَشٌط.. اُ ٕزا اىنزبة ٌعذ اعزنَبال ىنزبة دىٍو اىزذسٌت اىصٍفً.. ىطالة اىَشحيخ اىضبىضخ فً ميٍبد اىصٍذىخ.) .رٌ اىز٘عع ثٔ امضش ًاّغجبٍب ٗاىَشحيخ اىذساعٍخ.. غٍش اُ اىز٘عع ىٌ ٌخشط عِ اىز٘جٔ اىعب ( ىينزبة ٕٗ٘ رشمٍضٓ عيى اىَعيٍ٘بد االعبعٍخ.. ٗاىََٖخ.. راد اىطبثع اىعَيً ٗاىقبثو ىيزطجٍق ) اىخبصخ ثنو ٍجَ٘عخ دٗائٍخ اٗ احذ ادٌٗزٖب...ٗقذ حبفظْب عيى اعي٘ة ٗرشرٍت دىٍو اىَشحي خ اىضبىضخ ٍِ ّبحٍخ رقغٌٍ اىفص٘ه ٗرجٌ٘ت اىَجبٍٍع اىذٗائٍخ ٗعشض اىَعيٍ٘بد ٗاىجذاٗه اىَيحقخ اىخبصخ ثأعَبء االدٌٗخ اىزجبسٌخ (االمضش شٍ٘عب) ٗاشنبىٖب اىصٍذالٍّخ ٗاىزً رَأل ..ٍِ قجو اىطبىت اىَزذسة إُ عَيً ٕزا قذ ال ٌخي٘ ٍِ قص٘سٍ، ٗىنِ ٗمَب ٌِّّق٘ه اىقبظً اىفبظو:" إ ًَّ سأٌذُ أَّّٔ ال ٌنزُتُ إّغبٌُ مزبثًب فً ٌٍِ٘ٔ؛ إال ًَِّقبهَ فً غَذِِٓ: ى٘ غٍُِّشَ ٕزا ىنبُ أحغَِ، ٗى٘ صٌِذَ مزا ىنبُ ٌُغزَحغَُِ، ٗى٘ قُذ ٌْ أعظٌَِ اىعِجَشِ، ٕٗ٘ دىٍو ٕزا ىنبُ أفعوَ، ٗى٘ رُشِكَ ٕزا ىنبُ أجَوَ. ٕٗزا ٍِِ ِعيَى اعزٍالءِ اىَّْقصِ عيَى جَُيخ " ِاىجَشَش .. ُٗأخٍشا الثذ ٍِ اإلشبسح إىى إ ٕزا اىذىٍو قذ اعذ ىٍنُ٘ ٍغبعذا ىطيجزْب األعضاءًف ٕ٘ٗ ًاىزذسٌت اىصٍف ىٍظ ثذٌال عِ اىزذسٌت فً إي حبه :اّغجبٍب ٍع اىحنَخ اىزعيٍٍَخ اىقبئيخ .. (قو ىً..ٗع٘ف أّغى..أسًّ .. ٗع٘ف أرزمشًْأششم .. ٌٗع٘ف أرعي) .. ٍِٗ اىيـــ ـــــــــــــــٔ اىز٘فٍـــــــــــــــق ظٍــــــبء 8102 Contents Page Title Chapter's number 0 Cardiovascular System 0 82 Gastro-intestinal System 8 74 Respiratory System 3 28 Central nervous system 7 47 Infections 5 010 Endocrine system 2 080 Genito-urinary system 4 034 Immune system and malignant disease 2 072 Nutrition and blood 7 028 Musculoskeletal and joint diseases 01 042 Eye 00 022 Ear, nose, and oropharynx 08 077 Skin 03 1 Chapter One: Cardiovascular System 1.1-Angiotensin-converting enzyme inhibitors (ACE inhibitors) 1-They inhibit ACE, thereby inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor (1) . 2-Examples include (captopril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril) (2). 3-They act as vasodilators. The main uses of ACE inhibitors are in the management of heart failure, hypertension, and myocardial infarction (3). In addition, they are used for the prevention and treatment of diabetic nephropathy (1). 4-Treat all patients with diabetes and hypertension with an ACE inhibitor or angiotensin II receptor blockers (ARBs). Both classes provide nephroprotection and reduced CV risk (4). 5-It may take several weeks before the full antihypertensive effects of ACEIs are seen. Therefore, evaluating BP response 2 to 4 weeks after starting or changing the dose of an ACEI is appropriate (5). 6-Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (5). Patients with an increase in serum creatinine of greater than 30% should have their ACEI therapy temporarily discontinued (5) until further evaluation can be made (6). 7-Pronounced hypotension may occur at the start of therapy with ACE inhibitors (first dose hypotension) (3). Therefore: A-Therapy should be started with low doses followed by gradual titration as tolerated to target doses (4). B-For hypertension the first dose should preferably be given at bedtime (2). 8-Other adverse effects include persistent dry cough (3)(see ARBs below). 9-Angioedema is a serious potential complication of ACEi therapy. It occurs in less than 1% of the population. Symptoms include lip and tongue swelling and possibly difficulty breathing (4). 10-An ACEi, as well as an ARB or direct renin inhibitor, are absolutely contraindicated in pregnancy (4). 2 ACE inhibitors Scientific name Trade names Dosage form 1 2 3 4 5 Any extra notes: 1.2-Angiotensin II receptor blockers(ARBs). 1-They block the binding of angiotensin II to the AT1 receptor, thereby inhibiting the effects of angiotensin II (1). 2-Examples include (Azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan , and valsartan)(sartans) (2). 3-They are used for hypertension, heart failure, diabetic nephropathy, and myocardial infarction (1). 4-Imortant: unlike ACE inhibitors, they are less likely to cause the persistent dry cough which can complicate ACE inhibitor therapy. They are therefore a useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough (2). 5-In select situations, the addition of ARBs to ACE-Is for patients with HF has demonstrated additional incremental benefits and may be considered if aldosterone antagonists are not indicated or tolerated (6). 6-Like ACE inhibitors, they may cause renal insufficiency, hyperkalemia, and orthostatic hypotension (4). 7-Patients with a history of ACEi angioedema can be treated with an ARB when needed (4). 3 Angiotensin II receptor blockers Scientific name Trade names Dosage form 1 2 3 4 Any extra notes: 1.3-Beta-adrenoceptor blocking drugs (beta-blockers) 1-Examples include (Atenolol, bisoprolol, carvedilol, metoprolol, nadolol, oxprenolol, pindolol, and propranolol) (2). 2-Oxprenolol, and pindolol have intrinsic sympathomimetic activity (ISA); they tend to cause less bradycardia than the other beta-blockers and may also cause less coldness of the extremities (2). 3-Atenolol, and nadolol are the most water soluble; they are less likely to enter the brain, and may therefore cause less sleep disturbance and nightmares. They are excreted by the kidneys and dosage reduction is often necessary in renal impairment (2). 4-Beta blockers are used in the management of: A-Cardiovascular disorders such as hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction, and some of them are used for heart failure (3). B-They are also given to control symptoms of sympathetic overactivity, anxiety states, hyperthyroidism, tremor and in the prophylaxis of migraine (2, 3). C-Some Beta blockers used as eye drops (e.g. timolol) to reduce raised intra- ocular pressure in glaucoma (3). 5-Important: A-Bisoprolol , carvedilol , metoprolol and nebivolol are the beta-blockers that are used to treat heart failure (other beta- blokers are contraindicated) (2, 3). 4 B-When used for heart failure, β-blockers should be started in very low doses with slow upward dose titration (2) (start low, go slow) (Doses should be doubled no more often than every 2 weeks, as tolerated, until the target dose or the maximally tolerated dose is reached) (4) e.g. : Carvedilol start with 3.125 mg 6.25 mg 12.5 mg 25 mg) (2). C-When used in heart failure, carvedilol should be taken with food (2, 3) to reduce the risk of hypotension (3). 6-Esmolol is a relatively cardioselective beta-blocker with a very short duration of action, used intravenously for the short-term treatment of supraventricular arrhythmias (2). 7-Sotalol, a non-cardioselective beta-blocker with additional class III anti- arrhythmic activity, is used for prophylaxis in paroxysmal supraventricular arrhythmias (2). 8-Important: A-β-blockers are effective for reducing blood pressure but other antihypertensives are usually more effective for reducing the incidence of stroke, myocardial infarction, and cardiovascular mortality, especially in the elderly (2). Therefore, β-blocker is no longer recommended as one of the first-line treatment option for hypertension (5). B-β-Blockers are only considered appropriate first-line agents to treat specific compelling indications (e.g., post-MI and coronary artery disease) (4). 9-Beta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma (2). 10-Atenolol, bisoprolol, metoprolol, and nebivolol, have less effect on the β2 (bronchial) receptors and are, therefore, relatively cardioselective. They have a lesser effect on airways resistance but are not free of this side-effect (2). 11-Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers) (2). 12-Beta-blockers can mask the signs and symptoms of hypoglycemia (such as tachycardia) (except sweating). However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers may be preferred (2, 5). 13-Abrupt cessation of β-blocker therapy may produce unstable angina, MI, or even death in patients with coronary disease. In patients without heart disease, abrupt discontinuation of β-blockers may be associated with tachycardia, sweating, 5 and generalized malaise in addition to increased BP. For these reasons, the dose should always be tapered gradually over 1 to 2 weeks before discontinuation (4). Beta-blockers Scientific name Trade name Dosage form 1 2 3 4 5 6 Any extra notes: 1.4-Neprilysin inhibitors (Sacubitril) 1-Sacubitril (a neprilysin inhibitor) inhibits the breakdown of natriuretic peptides resulting in varied effects including increased diuresis, natriuresis, and vasodilation (2). uploads/Geographie/ fourth-stage-guide.pdf