*▶COPD*: chronic abstructive pulmonary disease
*causes*:
1- mortality from COPD has increase steadily over the past three decades due to
1- smoking
2-accupational expsure & air pollution
3- gentic susceptibility ( alpha 1 anti trypsin deficiency)
*pharmacologic therapy of COPD*:
1⃣ Group A patient: have few symptoms and low risk of exacerbation
This traetment by
1-fist choice : short acting bronchodilator
2- long acting antichinergic or long acting beta agonist
3- Alternative: theophylline
2⃣ Group B patient: have more significant symptomes but still a low risk of exacerbation
This treatment by:
1- first choice : regular treatment with along acting bronchodilator
2- seconed choice : regular treatment with long acting anticholinergic and long acting beta agonist
3- Alternativ : theophylline
3⃣ Group C patient: have few symptomes but a high risk of exacerbation this treatment by:
1- first choice: regular treatment with a combination long acting beta agonist and inhaled glucocorticoid or long acting anticholinergic
2- seconed choice :regular treatment with acting anticholinergic and long acting beta agonist Alternative:* phosphodiesterase 4 inhibitor (cilomilast and roflumilast) if chronic bronchitis
* theophylline
* consider surgical treatment
4⃣Group D patient : have many symptoms and high risk of exacerbation
This treatment by:
1-First choice : regular treatment with combination inhaled glucocorticoid and a long acting beta agonist or a long acting anticholinergic alone
2- second choice : regular treatment with one of the following combinations :
A- inhaled glucocorticoid and long acting anticholinergic
B- inhaled glucocorticoid and a long acting beta agonist plus a long acting anticholinergic
C- inhaled glucocorticoid and a long acting beta agonist puls a phosphodiesterase 4 inhibitor
D- long acting anticholinergic and along acting beta agonist
E- long acting anticholinergic and a phosphodiesterase 4 inhibitor
3- Alternative : *carbocystein
* theophylline
*consider surgical treatments.
د.ص / سهير الصوفي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
https://news.1rj.ru/str/ppdprogram
*causes*:
1- mortality from COPD has increase steadily over the past three decades due to
1- smoking
2-accupational expsure & air pollution
3- gentic susceptibility ( alpha 1 anti trypsin deficiency)
*pharmacologic therapy of COPD*:
1⃣ Group A patient: have few symptoms and low risk of exacerbation
This traetment by
1-fist choice : short acting bronchodilator
2- long acting antichinergic or long acting beta agonist
3- Alternative: theophylline
2⃣ Group B patient: have more significant symptomes but still a low risk of exacerbation
This treatment by:
1- first choice : regular treatment with along acting bronchodilator
2- seconed choice : regular treatment with long acting anticholinergic and long acting beta agonist
3- Alternativ : theophylline
3⃣ Group C patient: have few symptomes but a high risk of exacerbation this treatment by:
1- first choice: regular treatment with a combination long acting beta agonist and inhaled glucocorticoid or long acting anticholinergic
2- seconed choice :regular treatment with acting anticholinergic and long acting beta agonist Alternative:* phosphodiesterase 4 inhibitor (cilomilast and roflumilast) if chronic bronchitis
* theophylline
* consider surgical treatment
4⃣Group D patient : have many symptoms and high risk of exacerbation
This treatment by:
1-First choice : regular treatment with combination inhaled glucocorticoid and a long acting beta agonist or a long acting anticholinergic alone
2- second choice : regular treatment with one of the following combinations :
A- inhaled glucocorticoid and long acting anticholinergic
B- inhaled glucocorticoid and a long acting beta agonist plus a long acting anticholinergic
C- inhaled glucocorticoid and a long acting beta agonist puls a phosphodiesterase 4 inhibitor
D- long acting anticholinergic and along acting beta agonist
E- long acting anticholinergic and a phosphodiesterase 4 inhibitor
3- Alternative : *carbocystein
* theophylline
*consider surgical treatments.
د.ص / سهير الصوفي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶Food poisoning
Food poisoning is rarely serious and usually gets better within a week.
Check if you have food poisoning
Symptoms of food poisoning include:
feeling sick (nausea)
diarrhoea
being sick (vomiting)
stomach cramps
a high temperature of 38C or above feeling generally unwell – such as feeling tired or having aches and chills The symptoms usually start within a few days of eating the food that caused the infection.
Sometimes they start after a few hours or not for a few weeks.
How you get food poisoning
You can catch food poisoning if you eat something that has been contaminated with germs.
This can happen if food:
isn't cooked or reheated thoroughly
isn't stored correctly – for example, it's not been frozen or chilled
is left out for too long
is handled by someone who's ill or hasn't washed their hands is eaten after its "use by" date.
د.ص / أسماء الورافي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
https://news.1rj.ru/str/ppdprogram
Food poisoning is rarely serious and usually gets better within a week.
Check if you have food poisoning
Symptoms of food poisoning include:
feeling sick (nausea)
diarrhoea
being sick (vomiting)
stomach cramps
a high temperature of 38C or above feeling generally unwell – such as feeling tired or having aches and chills The symptoms usually start within a few days of eating the food that caused the infection.
Sometimes they start after a few hours or not for a few weeks.
How you get food poisoning
You can catch food poisoning if you eat something that has been contaminated with germs.
This can happen if food:
isn't cooked or reheated thoroughly
isn't stored correctly – for example, it's not been frozen or chilled
is left out for too long
is handled by someone who's ill or hasn't washed their hands is eaten after its "use by" date.
د.ص / أسماء الورافي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PPDPROGRAM-PHARMACEUTICS:
▶️drug delivery systems (DDS): Systems which are designed e.g. for improving poor absorption, non-compliance of patients, or inaccurate targeting of therapeutic agents, e.g. topical release systems such as transdermal patches (having the advantage that they are not subject to first-pass metabolism) or iontophoresis, parenteral drug delivery (depot injections, osmotic pumps, pulse infusion pumps, bio-degradable polymer carriers), inhalation therapy (such as powder inhalers), carrier based delivery (e.g. lipid based systems, liposomes, gene therapy, monoclonal antibodies), or photodynamic therapy to treat cancer.
https://news.1rj.ru/str/joinchat/AAAAAEMEz1DH-RmtRXAh-A
https://news.1rj.ru/str/ppdprogram
▶️drug delivery systems (DDS): Systems which are designed e.g. for improving poor absorption, non-compliance of patients, or inaccurate targeting of therapeutic agents, e.g. topical release systems such as transdermal patches (having the advantage that they are not subject to first-pass metabolism) or iontophoresis, parenteral drug delivery (depot injections, osmotic pumps, pulse infusion pumps, bio-degradable polymer carriers), inhalation therapy (such as powder inhalers), carrier based delivery (e.g. lipid based systems, liposomes, gene therapy, monoclonal antibodies), or photodynamic therapy to treat cancer.
https://news.1rj.ru/str/joinchat/AAAAAEMEz1DH-RmtRXAh-A
https://news.1rj.ru/str/ppdprogram
Telegram
PPDPROGRAM-PHARMACEUTICS
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROF/MAHMOUD MAHYOOB ALBURYHI
💊 RANOLAZINE 💊
✨an anti-ischemic agent ✨
◀ يستخدم في علاج الذبحة الصدرية المستقرة.
*⃣ M.O.A :
ranolazine Inhibits the late sodium influx ➡reducing intracellular sodium ➡ decrease intracellular calcium overload through the sodium / calcium exchanger ➡ which
prevents ischemia induced contractile dysfunction and delays the onset of angina.
تكمن آليه العمل للدواء بقفل قنوات الصوديوم ⬅ تثبيط دخول الصوديوم ⬅ يقل دخول الكالسيوم الى عضلة القلب ⬅ يقل نشاط عضلة القلب .
◀ يتميز هذا الدواء على أدوية الذبحة بعدم تأثيره على ضربات القلب أو ضغط الدم فيعتبر خط اول لعلاج الذبحة الصدرية المستقرة بجميع مراحلها وتم اثبات أن له فعالية وتأثير قوي ولكنه يستخدم للحالات التي لاتستجيب لبقية الأدوية بسبب ارتفاع التكلفة .
أيضا يعتبر دواء بديل للبيتابلوكر عندما يمنع استخدامه .
*⃣ The drug is extensively metabolized in the liver through both cytochrome P-450 enzymes 😣🤢
الدواء يحصل له استقلاب في الكبد بشكل رئيسي في الكبد بواسطة انزيمات ال cytochrome P -450 وايضا يعتبر منشط و مثبط لبعض هذه الانزيمات هذا يؤدي إلى التداخل مع العديد من الادوية ☹ ☹
👇🏻 👇🏻 👇🏻 👇🏻
1⃣CYP3A4 substrate, So
❌Tx with potent CYP3A4 inhibitors
(💊ketoconazole, clarithromycin, and nelfinavir) ➡increases ranolazine conc (3.2-fold with ketoconazole)
Or ❌inducers (eg, 💊rifampin, phenobarbital, phenytoin, carbamazepine, and St. John’s wart) ➡ ⬇ the efficacy of ranolazine (by 95% with rifampin).
❌ Also 💊diltiazem, verapamil, grapefruit juice, erythromycin, and fluconazole➡
⬆ranolazine plasma conc (2 fold with diltiazem and verapamil) .
2⃣weak CYP2D6 substrate,
3⃣CYP2D6 inhibitor
4⃣ CYP3A3 inhibitor ,So
❌Ranolazine may⬇ the metabolism of CYP3A3 substrates as 💊Simvastatin , so the dose of simvastatin should not exceed 20 mg in patients treated with ranolazine.
5⃣OCT2 inhibitor , So
❌Ranolazine may ⬆ exposure to drugs transported by OCT2; as 💊 metformin so, doses should not exceed 1700 mg/day in patients treated with ranolazine 1000 mg twice daily.
6⃣ both an inhibitor and substrate of P-glycoprotein (P-gp) , So
❌Ranolazine should be used cautiously with P-gp inhibitors(eg, 💊cyclosporine) which ⬆ ranolazine absorption Up to a 50% ➡ ⬆in ranolazine plasma conc has been observed in renal impairment
❌and substrates (eg,
💊 digoxin)➡ (⬆ digoxin plasma conc by 1.5 fold)
❌Liver cirrhosis
➡increases ranolazine plasma conc by 30%–80% ➡resulting in increased risk for QT interval prolongation .
❌The use of ranolazine is contraindicated in patients with significant hepatic disease.
when combined with moderate CYP3A4 inhibitors including diltiazem and verapamil.
❇ OCT2 >> Organic Cation Transporter 2.
🔅 🔅 🔅 🔅 🔅
صيدلانية / #نور نجيب
12 - 12 - 2018.
مجال الصيدلة السريرية
https://news.1rj.ru/str/joinchat/B56piw6Ku2s--H4ZKGqWjQ
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
#مدير البرنامج
#البروف_محمود البريهي
#أستاذ مشارك الصيدلانيات
كلية الصيدلة جامعة صنعاء.
✨an anti-ischemic agent ✨
◀ يستخدم في علاج الذبحة الصدرية المستقرة.
*⃣ M.O.A :
ranolazine Inhibits the late sodium influx ➡reducing intracellular sodium ➡ decrease intracellular calcium overload through the sodium / calcium exchanger ➡ which
prevents ischemia induced contractile dysfunction and delays the onset of angina.
تكمن آليه العمل للدواء بقفل قنوات الصوديوم ⬅ تثبيط دخول الصوديوم ⬅ يقل دخول الكالسيوم الى عضلة القلب ⬅ يقل نشاط عضلة القلب .
◀ يتميز هذا الدواء على أدوية الذبحة بعدم تأثيره على ضربات القلب أو ضغط الدم فيعتبر خط اول لعلاج الذبحة الصدرية المستقرة بجميع مراحلها وتم اثبات أن له فعالية وتأثير قوي ولكنه يستخدم للحالات التي لاتستجيب لبقية الأدوية بسبب ارتفاع التكلفة .
أيضا يعتبر دواء بديل للبيتابلوكر عندما يمنع استخدامه .
*⃣ The drug is extensively metabolized in the liver through both cytochrome P-450 enzymes 😣🤢
الدواء يحصل له استقلاب في الكبد بشكل رئيسي في الكبد بواسطة انزيمات ال cytochrome P -450 وايضا يعتبر منشط و مثبط لبعض هذه الانزيمات هذا يؤدي إلى التداخل مع العديد من الادوية ☹ ☹
👇🏻 👇🏻 👇🏻 👇🏻
1⃣CYP3A4 substrate, So
❌Tx with potent CYP3A4 inhibitors
(💊ketoconazole, clarithromycin, and nelfinavir) ➡increases ranolazine conc (3.2-fold with ketoconazole)
Or ❌inducers (eg, 💊rifampin, phenobarbital, phenytoin, carbamazepine, and St. John’s wart) ➡ ⬇ the efficacy of ranolazine (by 95% with rifampin).
❌ Also 💊diltiazem, verapamil, grapefruit juice, erythromycin, and fluconazole➡
⬆ranolazine plasma conc (2 fold with diltiazem and verapamil) .
2⃣weak CYP2D6 substrate,
3⃣CYP2D6 inhibitor
4⃣ CYP3A3 inhibitor ,So
❌Ranolazine may⬇ the metabolism of CYP3A3 substrates as 💊Simvastatin , so the dose of simvastatin should not exceed 20 mg in patients treated with ranolazine.
5⃣OCT2 inhibitor , So
❌Ranolazine may ⬆ exposure to drugs transported by OCT2; as 💊 metformin so, doses should not exceed 1700 mg/day in patients treated with ranolazine 1000 mg twice daily.
6⃣ both an inhibitor and substrate of P-glycoprotein (P-gp) , So
❌Ranolazine should be used cautiously with P-gp inhibitors(eg, 💊cyclosporine) which ⬆ ranolazine absorption Up to a 50% ➡ ⬆in ranolazine plasma conc has been observed in renal impairment
❌and substrates (eg,
💊 digoxin)➡ (⬆ digoxin plasma conc by 1.5 fold)
❌Liver cirrhosis
➡increases ranolazine plasma conc by 30%–80% ➡resulting in increased risk for QT interval prolongation .
❌The use of ranolazine is contraindicated in patients with significant hepatic disease.
when combined with moderate CYP3A4 inhibitors including diltiazem and verapamil.
❇ OCT2 >> Organic Cation Transporter 2.
🔅 🔅 🔅 🔅 🔅
صيدلانية / #نور نجيب
12 - 12 - 2018.
مجال الصيدلة السريرية
https://news.1rj.ru/str/joinchat/B56piw6Ku2s--H4ZKGqWjQ
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
#مدير البرنامج
#البروف_محمود البريهي
#أستاذ مشارك الصيدلانيات
كلية الصيدلة جامعة صنعاء.
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶️Pharmacy Preparation:
Pharmacy preparation allows the doctor and pharmacist to provide individualised and tailor-made pharmaceutical care.
The preparation of a medicine in the pharmacy fulfils a need when the licensed pharmaceutical preparation is not available or when a licensed pharmaceutical preparation does not satisfy a specific situation.
However, pharmacy prepared products are not subject to the same levels of scrutiny with respect to quality assurance and efficacy as licensed medicines; therefore prescribers and pharmacists cannot make the same assumptions of quality, safety and efficacy about these products as they do for licensed medicines. This is due to the wide range of elevated risks associated with pharmacy preparation, including calculation and manipulation errors, formulation failures leading to overdose or underdose, possible toxicity from raw materials and microbiological contamination. The relative lack of pharmacovigilance or monitoring systems for pharmacy prepared products also means that the likelihood of detection for any errors that lead to side effects is low.
Therefore, upon receipt of a request from the doctor, the pharmacist must examine the situation and decide whether the request is appropriate and judge the level of risk associated with proceeding with the request. Before proceeding, the pharmacist should review all other potential treatment options. The use of a licensed product in line with its approved indication should be strongly advocated unless there is a specific reason not to use such a medicine. However, the pharmacist must also consider the risks of not supplying a medicine which may lead to the patient not receiving treatment. In this context, it should be recognised that some patients do have special clinical needs which cannot be met by other viable options.
https://news.1rj.ru/str/ppdprogram
Pharmacy preparation allows the doctor and pharmacist to provide individualised and tailor-made pharmaceutical care.
The preparation of a medicine in the pharmacy fulfils a need when the licensed pharmaceutical preparation is not available or when a licensed pharmaceutical preparation does not satisfy a specific situation.
However, pharmacy prepared products are not subject to the same levels of scrutiny with respect to quality assurance and efficacy as licensed medicines; therefore prescribers and pharmacists cannot make the same assumptions of quality, safety and efficacy about these products as they do for licensed medicines. This is due to the wide range of elevated risks associated with pharmacy preparation, including calculation and manipulation errors, formulation failures leading to overdose or underdose, possible toxicity from raw materials and microbiological contamination. The relative lack of pharmacovigilance or monitoring systems for pharmacy prepared products also means that the likelihood of detection for any errors that lead to side effects is low.
Therefore, upon receipt of a request from the doctor, the pharmacist must examine the situation and decide whether the request is appropriate and judge the level of risk associated with proceeding with the request. Before proceeding, the pharmacist should review all other potential treatment options. The use of a licensed product in line with its approved indication should be strongly advocated unless there is a specific reason not to use such a medicine. However, the pharmacist must also consider the risks of not supplying a medicine which may lead to the patient not receiving treatment. In this context, it should be recognised that some patients do have special clinical needs which cannot be met by other viable options.
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶️The Renal drugs:
The use of drugs in patients with impaired renal function can give rise to problems for several reasons:
▶️• Altered pharmacokinetics of some drugs, i.e. changes in absorption, tissue distribution, extent of plasma protein binding, metabolism and excretion. In renal impairment these parameters are often variable and interrelated in a complex manner. This may be further complicated if the patient is undergoing renal replacement therapy.
▶️• For many drugs, some or even all, of the altered pharmacokinetic parameters and modified interrelationships are unknown. In such circumstances, the informed professional judgement
of clinicians and pharmacists must be used to predict drug disposition. This must be based on knowledge of the drug, its class, chemistry and pharmacokinetics in patients with normal renal function.
▶️• Sensitivity to some drugs is increased, even if elimination is unimpaired.
▶️• Many side-effects are particularly poorly tolerated by renally impaired patients.
▶️• Some drugs are ineffective when renal function is reduced.
▶️• Renal function generally declines with age, and many elderly patients have a GFR less than 50 mL/min which, because of reduced muscle mass, may not be reflected by an elevated creatinine. Consequently, one can justifiably assume mild renal impairment when prescribing for the elderly.
https://news.1rj.ru/str/ppdprogram
The use of drugs in patients with impaired renal function can give rise to problems for several reasons:
▶️• Altered pharmacokinetics of some drugs, i.e. changes in absorption, tissue distribution, extent of plasma protein binding, metabolism and excretion. In renal impairment these parameters are often variable and interrelated in a complex manner. This may be further complicated if the patient is undergoing renal replacement therapy.
▶️• For many drugs, some or even all, of the altered pharmacokinetic parameters and modified interrelationships are unknown. In such circumstances, the informed professional judgement
of clinicians and pharmacists must be used to predict drug disposition. This must be based on knowledge of the drug, its class, chemistry and pharmacokinetics in patients with normal renal function.
▶️• Sensitivity to some drugs is increased, even if elimination is unimpaired.
▶️• Many side-effects are particularly poorly tolerated by renally impaired patients.
▶️• Some drugs are ineffective when renal function is reduced.
▶️• Renal function generally declines with age, and many elderly patients have a GFR less than 50 mL/min which, because of reduced muscle mass, may not be reflected by an elevated creatinine. Consequently, one can justifiably assume mild renal impairment when prescribing for the elderly.
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
Forwarded from PPDPROGRAM-CLINICAL PHARMACOKINETICS
▶️Amoxicillin
▶️Clinical use
Antibacterial agent
▶️Dose in normal renal function
250 mg – 1 g every 8 hours (maximum 6 g per day, up to
12 g in endocarditis)
▶️Pharmacokinetics
Molecular weight (daltons) 365.4
% Protein binding 20
% Excreted unchanged in urine 60
Volume of distribution (L/kg) 0.3
Half-life — normal/ESRF (hrs)
1–1.5 / 7–20
▶️Metabolism
Amoxicillin is metabolised to a limited extent to penicilloic acid which is excreted in the urine. About 60% of an oral dose of amoxicillin is excreted unchanged in the urine by glomerular filtration and tubular secretion.
Probenecid reduces renal excretion. High concentrations
have been reported in bile; some may be excreted in the
faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 250 mg – 1 g every 8 hours (Maximum 6 g per day in endocarditis.)
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10mL/ min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Amoxicillin can reduce the excretion of methotrexate
(increased risk of toxicity).
▶️Administration
Reconstitution
IV: Dissolve each 250 mg in 5 mL water for injection
IM: Dissolve 250 mg in 1.5 mL water for injection; 500
mg in 2.5 mL water for injection; 1 g in 2.5 mL water for
injection or 1% sterile lidocaine hydrochloride
Route Oral, IV, IM
Rate of administration
Slow bolus IV over 3–4 minutes
Infusion over 30–60 minutes
▶️Comments
IV Infusion: Dilute in 100 mL glucose 5% or sodium chloride 0.9%
Stability in infusion depends upon diluent
▶️Other information
• Sodium – 3.3 mmol/g vial of Amoxil.
• Do not mix with
aminoglycosides.
◀️قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/675
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
Antibacterial agent
▶️Dose in normal renal function
250 mg – 1 g every 8 hours (maximum 6 g per day, up to
12 g in endocarditis)
▶️Pharmacokinetics
Molecular weight (daltons) 365.4
% Protein binding 20
% Excreted unchanged in urine 60
Volume of distribution (L/kg) 0.3
Half-life — normal/ESRF (hrs)
1–1.5 / 7–20
▶️Metabolism
Amoxicillin is metabolised to a limited extent to penicilloic acid which is excreted in the urine. About 60% of an oral dose of amoxicillin is excreted unchanged in the urine by glomerular filtration and tubular secretion.
Probenecid reduces renal excretion. High concentrations
have been reported in bile; some may be excreted in the
faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 250 mg – 1 g every 8 hours (Maximum 6 g per day in endocarditis.)
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10mL/ min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Amoxicillin can reduce the excretion of methotrexate
(increased risk of toxicity).
▶️Administration
Reconstitution
IV: Dissolve each 250 mg in 5 mL water for injection
IM: Dissolve 250 mg in 1.5 mL water for injection; 500
mg in 2.5 mL water for injection; 1 g in 2.5 mL water for
injection or 1% sterile lidocaine hydrochloride
Route Oral, IV, IM
Rate of administration
Slow bolus IV over 3–4 minutes
Infusion over 30–60 minutes
▶️Comments
IV Infusion: Dilute in 100 mL glucose 5% or sodium chloride 0.9%
Stability in infusion depends upon diluent
▶️Other information
• Sodium – 3.3 mmol/g vial of Amoxil.
• Do not mix with
aminoglycosides.
◀️قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/675
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
برنامج تطوير مهنة الصيدلة - PPDPROGRAM:
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/676
https://news.1rj.ru/str/ppdprogram
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/676
https://news.1rj.ru/str/ppdprogram
Telegram
PPDPROGRAM-CLINICAL PHARMACOKINETICS
▶️Aspirin
▶️Clinical use
NSAID:
• Analgesic and antipyretic
• Prophylaxis of cerebrovascular disease or myocardial infarction
▶️Dose in normal renal function
• Analgesia: Oral: 300–900 mg every 4hours
• Maximum 4g daily in acute conditions
• PR:…
▶️Clinical use
NSAID:
• Analgesic and antipyretic
• Prophylaxis of cerebrovascular disease or myocardial infarction
▶️Dose in normal renal function
• Analgesia: Oral: 300–900 mg every 4hours
• Maximum 4g daily in acute conditions
• PR:…
Forwarded from PPDPROGRAM-CLINICAL PHARMACOKINETICS
▶️Ceftriaxone
▶️Clinical use
Antibacterial agent
▶️Dose in normal renal function
• 1 g daily (severe infections: 2-4g daily)
• Gonorrhoea: single dose 250mg IM
▶️Pharmacokinetics
Molecular weight (daltons) 661.6 (as sodium salt)
% Protein binding 85–95
% Excreted unchanged in urine 40–60
Volume of distribution (L/kg) 0.12–0.18
Half-life — normal/ESRF (hrs) 6–9/ 14.7
▶️Metabolism
About 40–65% of a dose of ceftriaxone is excreted unchanged in the urine, principally by glomerular
filtration; the remainder is excreted in the bile and is
ultimately found in the faeces as unchanged drug and
microbiologically inactive compounds.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
Maximum 2 g daily.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Not dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Unknown dialysability. Dose as in
GFR<10 mL/min.
CAV/VVHD Unknown dialysability. 2 g every 12–24 hours.1
CVVHD/HDF Likely dialysability. 2 g every 12–24
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anticoagulants: effects of coumarins may be enhanced.
• Ciclosporin: may cause increased ciclosporin levels.
▶️Administration
Reconstitution
• 250 mg: IV – 5 mL water for injection; IM – 1 mL
1% lidocaine hydrochloride.
• 1 g: IV – 10 mL water for injection; IM – 3.5 mL
1% lidocaine hydrochloride.
• Infusion: 2 g in 40 mL of calcium-free solution, e.g.
sodium chloride 0.9%, glucose 5%.
• Incompatible with calcium containing solutions, e.g.
Hartmann’s, Ringer’s.
▶️Route
IV, IM, SC
Rate of administration
• Bolus: over 2–4 minutes.
• Infusion: over at least 30 minutes.
▶️Comments
• For IM injection: doses greater than 1 g should be divided and injected at more than one site.
▶️Other information
• Calcium ceftriaxone has appeared as a precipitate
in urine, or been mistaken as gallstones in patients receiving higher than recommended doses.
• Contains 3.6 mmol sodium per gram of ceftriaxone.
• Information from the company shows that the bioavailability of SC administration is equivalent to IV. The maximum amount able to be given in a single
SC injection is 500 mg dissolved in 2 mL lidocaine 1%. Administration was said to be tolerable.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/678
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
Antibacterial agent
▶️Dose in normal renal function
• 1 g daily (severe infections: 2-4g daily)
• Gonorrhoea: single dose 250mg IM
▶️Pharmacokinetics
Molecular weight (daltons) 661.6 (as sodium salt)
% Protein binding 85–95
% Excreted unchanged in urine 40–60
Volume of distribution (L/kg) 0.12–0.18
Half-life — normal/ESRF (hrs) 6–9/ 14.7
▶️Metabolism
About 40–65% of a dose of ceftriaxone is excreted unchanged in the urine, principally by glomerular
filtration; the remainder is excreted in the bile and is
ultimately found in the faeces as unchanged drug and
microbiologically inactive compounds.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
Maximum 2 g daily.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Not dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Unknown dialysability. Dose as in
GFR<10 mL/min.
CAV/VVHD Unknown dialysability. 2 g every 12–24 hours.1
CVVHD/HDF Likely dialysability. 2 g every 12–24
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anticoagulants: effects of coumarins may be enhanced.
• Ciclosporin: may cause increased ciclosporin levels.
▶️Administration
Reconstitution
• 250 mg: IV – 5 mL water for injection; IM – 1 mL
1% lidocaine hydrochloride.
• 1 g: IV – 10 mL water for injection; IM – 3.5 mL
1% lidocaine hydrochloride.
• Infusion: 2 g in 40 mL of calcium-free solution, e.g.
sodium chloride 0.9%, glucose 5%.
• Incompatible with calcium containing solutions, e.g.
Hartmann’s, Ringer’s.
▶️Route
IV, IM, SC
Rate of administration
• Bolus: over 2–4 minutes.
• Infusion: over at least 30 minutes.
▶️Comments
• For IM injection: doses greater than 1 g should be divided and injected at more than one site.
▶️Other information
• Calcium ceftriaxone has appeared as a precipitate
in urine, or been mistaken as gallstones in patients receiving higher than recommended doses.
• Contains 3.6 mmol sodium per gram of ceftriaxone.
• Information from the company shows that the bioavailability of SC administration is equivalent to IV. The maximum amount able to be given in a single
SC injection is 500 mg dissolved in 2 mL lidocaine 1%. Administration was said to be tolerable.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/678
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
Forwarded from PPDPROGRAM-CLINICAL PHARMACOKINETICS
▶️Paracetamol
▶️Clinical use
Analgesia and antipyretic
▶️Dose in normal renal function
500 mg – 1 g every 4–6 hours, maximum 4 g daily
(IV: if <50 kg, dose is 15 mg/kg)
▶️Pharmacokinetics
Molecular weight (daltons) 151.2
% Protein binding 20–30
% Excreted unchanged in urine <5
Volume of distribution (L/kg) 1
-2
Half-life — normal/ESRF (hrs) 1–4 / Unchanged
▶️Metabolism
Paracetamol is metabolised mainly in the liver and excreted in the urine mainly as the glucuronide and sulfate conjugates. Less than 5% is excreted as unchanged
paracetamol. A minor hydroxylated metabolite (N-acetyl-p-benzoquinoneimine), is usually produced in very small amounts by cytochrome P450 isoenzymes (mainly CYP2E1 and CYP3A4) in the liver and kidney. It is usually detoxified by conjugation with glutathione but may accumulate after paracetamol overdosage and cause tissue damage.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 500 mg – 1 g every 6–8 hours.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Unknown dialysability. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• None known
▶️Administration
Reconstitution
▶️Route
Oral, rectal, IV
Rate of administration
15 minutes
▶️Other information
• Beware sodium content of soluble tablets (1 tablet ≡18.6 mmol sodium).
• Nephrotoxic in overdose due to a reactive alkylating metabolite.
• Metabolites may accumulate in CKD 5; normal doses are used in CKD 5.
• In smaller patients with CKD 5 a maximum oral dose of 3 g per day should be considered.
• IV preparation starts working within 5–10 minutes with peak activity after 60 minutes.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/679
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
Analgesia and antipyretic
▶️Dose in normal renal function
500 mg – 1 g every 4–6 hours, maximum 4 g daily
(IV: if <50 kg, dose is 15 mg/kg)
▶️Pharmacokinetics
Molecular weight (daltons) 151.2
% Protein binding 20–30
% Excreted unchanged in urine <5
Volume of distribution (L/kg) 1
-2
Half-life — normal/ESRF (hrs) 1–4 / Unchanged
▶️Metabolism
Paracetamol is metabolised mainly in the liver and excreted in the urine mainly as the glucuronide and sulfate conjugates. Less than 5% is excreted as unchanged
paracetamol. A minor hydroxylated metabolite (N-acetyl-p-benzoquinoneimine), is usually produced in very small amounts by cytochrome P450 isoenzymes (mainly CYP2E1 and CYP3A4) in the liver and kidney. It is usually detoxified by conjugation with glutathione but may accumulate after paracetamol overdosage and cause tissue damage.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 500 mg – 1 g every 6–8 hours.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Unknown dialysability. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• None known
▶️Administration
Reconstitution
▶️Route
Oral, rectal, IV
Rate of administration
15 minutes
▶️Other information
• Beware sodium content of soluble tablets (1 tablet ≡18.6 mmol sodium).
• Nephrotoxic in overdose due to a reactive alkylating metabolite.
• Metabolites may accumulate in CKD 5; normal doses are used in CKD 5.
• In smaller patients with CKD 5 a maximum oral dose of 3 g per day should be considered.
• IV preparation starts working within 5–10 minutes with peak activity after 60 minutes.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/679
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶️Aminophylline
▶️Clinical use
• Reversible airways obstruction
• Acute severe asthma
▶️Dose in normal renal function
• Modified release: 225–450 mg twice daily
• IV loading dose: 5 mg/kg (250–500 mg)
• Maintenance dose: 0.5–0.7 mg/kg/hour adjusted according to levels
▶️Pharmacokinetics
Molecular weight (daltons) 420.4
% Protein binding 40–60 (theophylline)
% Excreted unchanged in urine <10
Volume of distribution (L/kg) 0.4–0.7
(theophylline)
Half-life — normal/ESRF (hrs) 4–12 / Unchanged (theophylline)
▶️Metabolism
Aminophylline is metabolised to theophylline in vivo.
Theophylline is excreted in the urine as metabolites, mainly 1,3-dimethyluric acid and 3-methylxanthine, and about 10% is excreted unchanged.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function and adjust in accordance with blood levels.
10–20 Dose as in normal renal function and adjust in accordance with blood levels.
<10 Dose as in normal renal function and adjust in accordance with blood levels.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min. Monitor blood levels. See 'Other information'.
HD Not dialysed. Dose as in GFR<10 mL/min. Monitor blood levels. See 'Other information'.
HDF/High flux Unknown dialysability. Dose as in
GFR<10 mL/min. Monitor blood levels. See 'Other information'.
CAV/VVHD Not dialysed. Dose as in GFR=10–20mL/min. Monitor blood levels. See 'Other information'.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Antibacterials: increased concentration with azithromycin, clarithromycin, erythromycin, ciprofloxacin, norfloxacin and isoniazid; decreased erythromycin levels if erythromycin is given orally; increased risk of convulsions if given with quinolones; rifampicin accelerates metabolism of aminophylline.
• Antidepressants: concentration increased by fluvoxamine – avoid or halve theophylline dose and monitor levels; concentration reduced by St John’s wort – avoid.
• Antiepileptics: metabolism increased by carbamazepine, phenobarbital and primidone; concentration of both drugs increased with fosphenytoin and phenytoin.
• Antifungals: concentration increased by fluconazole and ketoconazole.
• Antivirals: metabolism of aminophylline increased by ritonavir; concentration possibly increased by aciclovir.
• Calcium-channel blockers: concentration increased
by diltiazem and verapamil and possibly other calcium-channel blockers.
• Deferasirox: concentration of aminophylline increased.
• Feboxostat: use with caution.
• Interferons: reduced metabolism of aminophylline.
• Tacrolimus: may increase tacrolimus levels.
• Ulcer-healing drugs: metabolism inhibited by cimetidine; absorption possibly reduced by sucralfate.
▶️Administration
▶️Reconstitution
—
▶️Route
IV, oral
Rate of administration
Loading dose over 20 minutes by slow IV injection.
▶️Comments
• Can be added to glucose 5%, sodium chloride 0.9% and compound sodium lactate.
• Minimum volumes range from 2–25 mg/mL, give concentrated solution via central line.
▶️Other information
• Aminophylline: 80% theophylline + 20% ethylenediamine.
• In bodily fluids, aminophylline rapidly dissociates from ethylenediamine and releases free theophylline in the body. It is therefore not present in the body long enough to be dialysed, whereas theophylline is dialysed, see theophylline monograph.
• Optimum response obtained at plasma theophylline levels of 10–20 mg/L (55–110 micromol /L).
• Increased incidence of GI and neurological side effects in renal impairment at plasma levels above optimum range.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/680
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
• Reversible airways obstruction
• Acute severe asthma
▶️Dose in normal renal function
• Modified release: 225–450 mg twice daily
• IV loading dose: 5 mg/kg (250–500 mg)
• Maintenance dose: 0.5–0.7 mg/kg/hour adjusted according to levels
▶️Pharmacokinetics
Molecular weight (daltons) 420.4
% Protein binding 40–60 (theophylline)
% Excreted unchanged in urine <10
Volume of distribution (L/kg) 0.4–0.7
(theophylline)
Half-life — normal/ESRF (hrs) 4–12 / Unchanged (theophylline)
▶️Metabolism
Aminophylline is metabolised to theophylline in vivo.
Theophylline is excreted in the urine as metabolites, mainly 1,3-dimethyluric acid and 3-methylxanthine, and about 10% is excreted unchanged.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function and adjust in accordance with blood levels.
10–20 Dose as in normal renal function and adjust in accordance with blood levels.
<10 Dose as in normal renal function and adjust in accordance with blood levels.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min. Monitor blood levels. See 'Other information'.
HD Not dialysed. Dose as in GFR<10 mL/min. Monitor blood levels. See 'Other information'.
HDF/High flux Unknown dialysability. Dose as in
GFR<10 mL/min. Monitor blood levels. See 'Other information'.
CAV/VVHD Not dialysed. Dose as in GFR=10–20mL/min. Monitor blood levels. See 'Other information'.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Antibacterials: increased concentration with azithromycin, clarithromycin, erythromycin, ciprofloxacin, norfloxacin and isoniazid; decreased erythromycin levels if erythromycin is given orally; increased risk of convulsions if given with quinolones; rifampicin accelerates metabolism of aminophylline.
• Antidepressants: concentration increased by fluvoxamine – avoid or halve theophylline dose and monitor levels; concentration reduced by St John’s wort – avoid.
• Antiepileptics: metabolism increased by carbamazepine, phenobarbital and primidone; concentration of both drugs increased with fosphenytoin and phenytoin.
• Antifungals: concentration increased by fluconazole and ketoconazole.
• Antivirals: metabolism of aminophylline increased by ritonavir; concentration possibly increased by aciclovir.
• Calcium-channel blockers: concentration increased
by diltiazem and verapamil and possibly other calcium-channel blockers.
• Deferasirox: concentration of aminophylline increased.
• Feboxostat: use with caution.
• Interferons: reduced metabolism of aminophylline.
• Tacrolimus: may increase tacrolimus levels.
• Ulcer-healing drugs: metabolism inhibited by cimetidine; absorption possibly reduced by sucralfate.
▶️Administration
▶️Reconstitution
—
▶️Route
IV, oral
Rate of administration
Loading dose over 20 minutes by slow IV injection.
▶️Comments
• Can be added to glucose 5%, sodium chloride 0.9% and compound sodium lactate.
• Minimum volumes range from 2–25 mg/mL, give concentrated solution via central line.
▶️Other information
• Aminophylline: 80% theophylline + 20% ethylenediamine.
• In bodily fluids, aminophylline rapidly dissociates from ethylenediamine and releases free theophylline in the body. It is therefore not present in the body long enough to be dialysed, whereas theophylline is dialysed, see theophylline monograph.
• Optimum response obtained at plasma theophylline levels of 10–20 mg/L (55–110 micromol /L).
• Increased incidence of GI and neurological side effects in renal impairment at plasma levels above optimum range.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/680
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
🌾*الشــــ*Barley*ـعيـر*🌾
----------------------------------------
الشعير نبات معروف ...ويذكر انه من اقدم النباتات التي استخدمها الانسان في الغذاء, وهو يشبه. القمح الئ حد كبير, حتى في قيمته الغذائيه, الا انه يفوق القمح في نسبه الالياف... ولذا فهو اصعب هضما من القمح ... كما انه يفوق القمح في بعض الاملاح المعدنيه مثل <<الفسفور ـ الكالسيوم ـ البوتاسيوم >> ويصنع منه الخبز في المناطق الفقيره من العــــالم, ولقد كان الشعير هو المصدر الاساسي لدقيق الخبز حتى القرن السادس عشر ...
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
⭕الجزء المستخدم ↜الحبــــه
⭕القيمه الغذائيه للشعير ↜ترجع اهميه الشعير الغذائيه الى احتوائه على كثير من العناصر الغذائيه الهامه بروتين-دهون - نشــاء ـ الياف ـ املاح معدنيه مثل الحديد والكالسيـوم والفسفور والبوتاسيوم
والمنجنيــــز ـ ب الاضافه الى نسبه من الماء ـ ويحتوي ايضا على بعض الفيتامينات الهامه مثل : فيتامين(ب)- وفيتامين (هـ)..
🍃🍂🍃🍂🍃🍂🍃
بعض الاستخدامات الطبيه لـ الشعيــــر
⇓
▫يضاف طحين الشعير الى انواع الشوربه كغذاء شهي سهل الهضم
▫يستعمل مغلي او منقوع الشعير كمطهر للمسالك البوليـــه حيث يفيد في ادرار البول والتخلص من حصوات الكلى والحالب
▫يفيد مغلي نخاله الشعير في غسل الجروح والتقيحات الجلديه.
▫لراغبـات الجمال ينصح بعمل قناع الشعير 👸🏻كمايلي:
🔘تخلط ملعقه من طحين الشعير مع ملعقه من اللبن ويضاف الى المخلوط ملعقه كبيره من عصير الليمون ويمزج جيدا لتكوين عجينه متجانسه.
توضع هذه العجينه على الوجه لمده ربع ساعه وبعدها يشطف بالما۽ الفـــاتر .
▫في حاله قله ادرار اللبن اثناء الرضاعه ينصح بتناول حبه البركه مع ما۽ الشعير وذالك ب اضافه ملعقتين من مسحوق حبه البركه الئ لتر ونصف من ماء الشعير مع الغلي جيدا لمده ربع ساعه ثم يترك ليبرد ويشرب منه على فترات اثناء اليوم ..
... ..... The Єⴄď🍃..........
الصيدلانيـــــه
⇓
*ياسمين مطهر الرميمه*
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
*مجال العقاقيـــــــر والاعشاب الطبيه🍃
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
*برنامج تطويـــــــر مهنة الصيدلــــة
https://news.1rj.ru/str/ppdprogram
----------------------------------------
الشعير نبات معروف ...ويذكر انه من اقدم النباتات التي استخدمها الانسان في الغذاء, وهو يشبه. القمح الئ حد كبير, حتى في قيمته الغذائيه, الا انه يفوق القمح في نسبه الالياف... ولذا فهو اصعب هضما من القمح ... كما انه يفوق القمح في بعض الاملاح المعدنيه مثل <<الفسفور ـ الكالسيوم ـ البوتاسيوم >> ويصنع منه الخبز في المناطق الفقيره من العــــالم, ولقد كان الشعير هو المصدر الاساسي لدقيق الخبز حتى القرن السادس عشر ...
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
⭕الجزء المستخدم ↜الحبــــه
⭕القيمه الغذائيه للشعير ↜ترجع اهميه الشعير الغذائيه الى احتوائه على كثير من العناصر الغذائيه الهامه بروتين-دهون - نشــاء ـ الياف ـ املاح معدنيه مثل الحديد والكالسيـوم والفسفور والبوتاسيوم
والمنجنيــــز ـ ب الاضافه الى نسبه من الماء ـ ويحتوي ايضا على بعض الفيتامينات الهامه مثل : فيتامين(ب)- وفيتامين (هـ)..
🍃🍂🍃🍂🍃🍂🍃
بعض الاستخدامات الطبيه لـ الشعيــــر
⇓
▫يضاف طحين الشعير الى انواع الشوربه كغذاء شهي سهل الهضم
▫يستعمل مغلي او منقوع الشعير كمطهر للمسالك البوليـــه حيث يفيد في ادرار البول والتخلص من حصوات الكلى والحالب
▫يفيد مغلي نخاله الشعير في غسل الجروح والتقيحات الجلديه.
▫لراغبـات الجمال ينصح بعمل قناع الشعير 👸🏻كمايلي:
🔘تخلط ملعقه من طحين الشعير مع ملعقه من اللبن ويضاف الى المخلوط ملعقه كبيره من عصير الليمون ويمزج جيدا لتكوين عجينه متجانسه.
توضع هذه العجينه على الوجه لمده ربع ساعه وبعدها يشطف بالما۽ الفـــاتر .
▫في حاله قله ادرار اللبن اثناء الرضاعه ينصح بتناول حبه البركه مع ما۽ الشعير وذالك ب اضافه ملعقتين من مسحوق حبه البركه الئ لتر ونصف من ماء الشعير مع الغلي جيدا لمده ربع ساعه ثم يترك ليبرد ويشرب منه على فترات اثناء اليوم ..
... ..... The Єⴄď🍃..........
الصيدلانيـــــه
⇓
*ياسمين مطهر الرميمه*
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
*مجال العقاقيـــــــر والاعشاب الطبيه🍃
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
*برنامج تطويـــــــر مهنة الصيدلــــة
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
◀️ الهيئة العليا للأدوية بالتعاون مع منظمة الصحة العالمية WHO ستقام ورشة خلال الفترة الأربعاء والخميس الموافق 27-26ديسمبر 2018 لتحديث القائمة الأساسية للأدوية
◀️ قائمة الأدوية الأساسية النموذجية لمنظمة الصحة العالمية:
( WHO Model List of Essential Medicines)
وتدعى اختصارًا EML، هي قائمة نشرتها منظمة الصحة العالمية، وتحتوي على الأدويةِ الأكثرِ فعاليةً وأماناً في تلبيةِ أهمِ احتياجاتِ نظامِ الرعايةِ الصحية. تُستعملُ هذه القائمة كثيرًا في الدولِ للمساعدةِ على تطويرِ قوائمَ محليةٍ للأدوية الأساسية. منذُ عام 2016، قامت 156 دولة على الأقل بإنشاءِ قوائمَ محليةٍ وطنية للأدويةِ الأساسية مُعتمدةً على القائمة النموذجية لمنظمة الصحة العالمية،وتشمل دولًا مُتقدمة وأُخرى نامية.
تُقسَمُ القائمةُ إلى عناصرَ أساسيةٍ وأُخرى تكميلية. تُعتبر العناصر الأساسية الخيارات الأكثرُ فعالية من حيث التكلفة للمشاكل الصحية الرئيسية ويُمكنُ استخدامها في ظلِ مواردِ الرعاية الصحية الإضافية القليلة، أما العناصر التكميلية فهي إما تمتلكُ نسبة تكلفة-فائدة مُنخفضة، أو تتطلبُ بنية تحتية إضافية مثل مقدمي رعاية صحية مُدرَّبينَ بشكلٍ خاص أو معداتِ تشخيص. حوالي 25% من العناصر هي في القائمة التكميلية، وهُنالكَ أدوية مُدرجة ضمن القائِمتين. بالرغم من أنَّ مُعظم الأدوية المدرجة في القائمة تتوافر كدواءٍ جنيس، إلا أنها تَخضع لبراءة الاختراع وهذا لا يستبعدُ إدراجها.
نُشرت أولُ قائمة في عام 1977 حيثُ تضمنت 212 دواءً، وتقوم منظمة الصحة العالمية بتحديثِ القائمة كل سنتين. نُشرت القائمة الرابعة عشرة في عام 2005 وتضمنت 306 دواءً، وفي عام 2015 نُشرت النسخة التاسعة عشرة حيثُ احتوت على 410 دواءً. نُشرت النسخة العشرين في عام 2017، وتَضُم 433 دواء. تحتوي القوائم المحلية على ما بين 334-580 دواء.
أُنْشِئت قائمةٌ مُنفصلة للأطفال تحتَ سنِ 12 عامًا وتُعرف باسم قائمة الأدوية الأساسية النموذجية لمنظمة الصحة العالمية الخاصة بالأطفال، حيثُ أنشِئت عام 2007 في نسختها السادسة، وتهدفُ للتأكيد على احتياجاتِ الأطفال بشكلٍ منظم مثل توافرِ تركيباتٍ مُناسبة. جميع الأدوية في قائمة الأطفال مُضمنة في القائمة الرئيسية. ترتكز القائمة والملاحظات على الطبعة التاسعة عشرة والعشرين من القائمة الرئيسية، أما ألفا فهي تُشيرُ إلى أنَّ الدواء ضمن القائمة التكميلية فقط.
◀️ قوائم الأدوية الأساسية النموذجية ل منظمة الصحة العالمية الرابط ⬇️:
https://www.who.int/medicines/publications/essentialmedicines/ar/
برنامج تطوير مهنة الصيدلة :
https://news.1rj.ru/str/ppdprogram/1585
◀️ قائمة الأدوية الأساسية النموذجية لمنظمة الصحة العالمية:
( WHO Model List of Essential Medicines)
وتدعى اختصارًا EML، هي قائمة نشرتها منظمة الصحة العالمية، وتحتوي على الأدويةِ الأكثرِ فعاليةً وأماناً في تلبيةِ أهمِ احتياجاتِ نظامِ الرعايةِ الصحية. تُستعملُ هذه القائمة كثيرًا في الدولِ للمساعدةِ على تطويرِ قوائمَ محليةٍ للأدوية الأساسية. منذُ عام 2016، قامت 156 دولة على الأقل بإنشاءِ قوائمَ محليةٍ وطنية للأدويةِ الأساسية مُعتمدةً على القائمة النموذجية لمنظمة الصحة العالمية،وتشمل دولًا مُتقدمة وأُخرى نامية.
تُقسَمُ القائمةُ إلى عناصرَ أساسيةٍ وأُخرى تكميلية. تُعتبر العناصر الأساسية الخيارات الأكثرُ فعالية من حيث التكلفة للمشاكل الصحية الرئيسية ويُمكنُ استخدامها في ظلِ مواردِ الرعاية الصحية الإضافية القليلة، أما العناصر التكميلية فهي إما تمتلكُ نسبة تكلفة-فائدة مُنخفضة، أو تتطلبُ بنية تحتية إضافية مثل مقدمي رعاية صحية مُدرَّبينَ بشكلٍ خاص أو معداتِ تشخيص. حوالي 25% من العناصر هي في القائمة التكميلية، وهُنالكَ أدوية مُدرجة ضمن القائِمتين. بالرغم من أنَّ مُعظم الأدوية المدرجة في القائمة تتوافر كدواءٍ جنيس، إلا أنها تَخضع لبراءة الاختراع وهذا لا يستبعدُ إدراجها.
نُشرت أولُ قائمة في عام 1977 حيثُ تضمنت 212 دواءً، وتقوم منظمة الصحة العالمية بتحديثِ القائمة كل سنتين. نُشرت القائمة الرابعة عشرة في عام 2005 وتضمنت 306 دواءً، وفي عام 2015 نُشرت النسخة التاسعة عشرة حيثُ احتوت على 410 دواءً. نُشرت النسخة العشرين في عام 2017، وتَضُم 433 دواء. تحتوي القوائم المحلية على ما بين 334-580 دواء.
أُنْشِئت قائمةٌ مُنفصلة للأطفال تحتَ سنِ 12 عامًا وتُعرف باسم قائمة الأدوية الأساسية النموذجية لمنظمة الصحة العالمية الخاصة بالأطفال، حيثُ أنشِئت عام 2007 في نسختها السادسة، وتهدفُ للتأكيد على احتياجاتِ الأطفال بشكلٍ منظم مثل توافرِ تركيباتٍ مُناسبة. جميع الأدوية في قائمة الأطفال مُضمنة في القائمة الرئيسية. ترتكز القائمة والملاحظات على الطبعة التاسعة عشرة والعشرين من القائمة الرئيسية، أما ألفا فهي تُشيرُ إلى أنَّ الدواء ضمن القائمة التكميلية فقط.
◀️ قوائم الأدوية الأساسية النموذجية ل منظمة الصحة العالمية الرابط ⬇️:
https://www.who.int/medicines/publications/essentialmedicines/ar/
برنامج تطوير مهنة الصيدلة :
https://news.1rj.ru/str/ppdprogram/1585
www.who.int
منظمة الصحة العالمية | قوائم الأدوية الأساسية النموذجية لمنظمة الصحة العالمية
يجري تحديث قوائم الأدوية الأساسية النموذجية لمنظمة الصحة العالمية كل سنتين منذ عام 1977. الإصدارات الحالية هي قائمة الأدوية الأساسية الثامنة عشر لمنظمة الصحة العالمية وقائمة الأدوية الأساسية الرابعة لمنظمة الصحة العالمية الخاصة بالأطفال في أبريل/نيسان 2013.
Forwarded from PPDPROGRAM-CLINICAL PHARMACOKINETICS
▶️Ampicillin
▶️Clinical use
Antibacterial agent
Dose in normal renal function
• Oral: 250 mg – 1 g every 6 hours
• IM / IV: 500 mg – 2 g every4-6 hours
▶️Pharmacokinetics
Molecular weight (daltons) 349.4
% Protein binding 20
% Excreted unchanged in urine Oral: 20–60;
Parenteral: 60–80
Volume of distribution (L/kg) 0.17–0.31
Half-life — normal/ESRF (hrs) 1–1.5 / 7–20
▶️Metabolism
Ampicillin is metabolised to some extent to penicilloic
acid which is excreted in the urine.
Renal clearance of ampicillin occurs partly by glomerular
filtration and partly by tubular secretion; it is reduced by
probenecid. About 20–40% of an oral dose and 60–80%
of an IV dose may be excreted unchanged in the urine
in 6 hours. High concentrations are reached in bile; it undergoes enterohepatic recycling and some is excreted in the faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 250 mg – 2 g every 6 hours.
<10 250 mg – 1 g every 6 hours.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Dialysed. Dose as in GFR=10–20
mL/min. See 'Other information'.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Ciclosporin: may increase ciclosporin levels.
• Reduces excretion of methotrexate (increased risk of toxicity).
▶️Administration
Reconstitution
Use water for injection: 5 mL for each 250 mg (1.5 mL for 250 mg or 500 mg for IM administration).
▶️Route
Oral, IV, IM
Rate of administration
Slow IV bolus over 3–4 minutes. Doses greater than 500mg should be given by infusion.
Infusion: 30–60 minutes.
▶️Comments
Can be diluted in 100 mL glucose 5% or sodium chloride 0.9%.
▶️Other information
• Rashes more common in patients with renal impairment.
• Can cause nephrotoxicity if dose not reduced in renal
impairment.
• Sodium content of injection 1.47 mmol/500 mg vial.
• Ampicillin may be used in peritoneal dialysis fluids
for treatment of peritonitis.
• Do not mix with aminoglycosides.
• Doses in renal impairment estimated from evaluation
of pharmacokinetics.
• There are several methods of dosing drugs while a patient is undergoing continuous renal replacement therapy (CRRT) including the following guideline:
The patient’s GFR is equated to the total fluid ‘flux’within the filter circuit by adding up all the fluid going through the filter circuit i.e. blood flow, citrate,
dialysate fluid and replacement fluid and dividing it by 60, which gives a value in mL /minute, equated to a patient GFR. E.g. blood flow rate =
100 mL/min, filtration fluid flow rate = 1000 mL/hr, dialysis flow rate = 1000 mL/hr, replacement rate (post filter) =
200 mL/hr – this gives a CRRT dose of 2200 mL/hr. This is then divided by 60 to give an approximate GFR of 36.7 mL /min. Dose would then be according to the GFR rather than using the dialysis recommendations.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/683
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
Antibacterial agent
Dose in normal renal function
• Oral: 250 mg – 1 g every 6 hours
• IM / IV: 500 mg – 2 g every4-6 hours
▶️Pharmacokinetics
Molecular weight (daltons) 349.4
% Protein binding 20
% Excreted unchanged in urine Oral: 20–60;
Parenteral: 60–80
Volume of distribution (L/kg) 0.17–0.31
Half-life — normal/ESRF (hrs) 1–1.5 / 7–20
▶️Metabolism
Ampicillin is metabolised to some extent to penicilloic
acid which is excreted in the urine.
Renal clearance of ampicillin occurs partly by glomerular
filtration and partly by tubular secretion; it is reduced by
probenecid. About 20–40% of an oral dose and 60–80%
of an IV dose may be excreted unchanged in the urine
in 6 hours. High concentrations are reached in bile; it undergoes enterohepatic recycling and some is excreted in the faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 250 mg – 2 g every 6 hours.
<10 250 mg – 1 g every 6 hours.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in GFR<10 mL/min.
HD Dialysed. Dose as in GFR<10 mL/min.
HDF/High flux Dialysed. Dose as in GFR<10 mL/min.
CAV/VVHD Dialysed. Dose as in GFR=10–20
mL/min. See 'Other information'.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Ciclosporin: may increase ciclosporin levels.
• Reduces excretion of methotrexate (increased risk of toxicity).
▶️Administration
Reconstitution
Use water for injection: 5 mL for each 250 mg (1.5 mL for 250 mg or 500 mg for IM administration).
▶️Route
Oral, IV, IM
Rate of administration
Slow IV bolus over 3–4 minutes. Doses greater than 500mg should be given by infusion.
Infusion: 30–60 minutes.
▶️Comments
Can be diluted in 100 mL glucose 5% or sodium chloride 0.9%.
▶️Other information
• Rashes more common in patients with renal impairment.
• Can cause nephrotoxicity if dose not reduced in renal
impairment.
• Sodium content of injection 1.47 mmol/500 mg vial.
• Ampicillin may be used in peritoneal dialysis fluids
for treatment of peritonitis.
• Do not mix with aminoglycosides.
• Doses in renal impairment estimated from evaluation
of pharmacokinetics.
• There are several methods of dosing drugs while a patient is undergoing continuous renal replacement therapy (CRRT) including the following guideline:
The patient’s GFR is equated to the total fluid ‘flux’within the filter circuit by adding up all the fluid going through the filter circuit i.e. blood flow, citrate,
dialysate fluid and replacement fluid and dividing it by 60, which gives a value in mL /minute, equated to a patient GFR. E.g. blood flow rate =
100 mL/min, filtration fluid flow rate = 1000 mL/hr, dialysis flow rate = 1000 mL/hr, replacement rate (post filter) =
200 mL/hr – this gives a CRRT dose of 2200 mL/hr. This is then divided by 60 to give an approximate GFR of 36.7 mL /min. Dose would then be according to the GFR rather than using the dialysis recommendations.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/683
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶️Aceclofenac
▶️Clinical use
NSAID and analgesic
▶️Dose in normal renal function
100 mg twice daily
▶️Pharmacokinetics
Molecular weight (daltons) 354.2
% Protein binding >99
% Excreted unchanged in urine 66 (mainly as metabolites)
Volume of distribution (L/kg) 25 Litres
Half-life — normal/ESRF (hrs) 4 / Unchanged
▶️Metabolism
About two-thirds of a dose is excreted in the urine,
mainly as hydroxymetabolites, the principal one being
4-hydroxyaceclofenac. A small amount is converted to diclofenac.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function but use with caution.
10–20 Dose as in normal renal function but avoid if possible.
<10 Dose as in normal renal function but only if on dialysis.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function. See ‘Other information’.
HD Not dialysed. Dose as in normal renal function. See 'Other information'.
HDF/High flux Unknown dialysability. Dose as in
normal renal function. See 'Other information'.
CAV/VVHD Not dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• ACE inhibitors and angiotensin-II antagonists:
antagonism of hypotensive effect; increased risk of
nephrotoxicity and hyperkalaemia.• Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects);
avoid with ketorolac (increased risk of side effects and haemorrhage).
• Antibacterials: possible increased risk of convulsions with quinolones.
• Anticoagulants: effects of coumarins and phenindione enhanced; possibly increased risk of bleeding with heparins, dabigatran and edoxaban –
avoid long term use with edoxaban.
• Antidepressants: increased risk of bleeding with SSRIs and venlaflaxine.
• Antidiabetic agents: effects of sulphonylureas enhanced.
• Antiepileptics: possibly increased phenytoin concentration.
• Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir.
• Ciclosporin: may potentiate nephrotoxicity
• Cytotoxics: reduced excretion of methotrexate; increased risk of bleeding with erlotinib.
• Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diuretics.
• Lithium: excretion decreased.
• Pentoxifylline: increased risk of bleeding.
• Tacrolimus: increased risk of nephrotoxicity.
▶️Administration
Reconstitution
—
▶️Route
Oral
Rate of administration
—
▶️Other information
• Use with caution in uraemic patients predisposed to
gastrointestinal bleeding or uraemic coagulopathies.
• Inhibition of renal prostaglandin synthesis by
NSAIDs may interfere with renal function, especially in the presence of existing renal disease
– avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID therapy
– if raised, discontinue NSAID therapy.
• Use normal doses in patients with ESRD on dialysis if they do not pass any urine.
• Use with great caution in renal transplant recipients;
it can reduce intrarenal autocoid synthesis.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/684
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
NSAID and analgesic
▶️Dose in normal renal function
100 mg twice daily
▶️Pharmacokinetics
Molecular weight (daltons) 354.2
% Protein binding >99
% Excreted unchanged in urine 66 (mainly as metabolites)
Volume of distribution (L/kg) 25 Litres
Half-life — normal/ESRF (hrs) 4 / Unchanged
▶️Metabolism
About two-thirds of a dose is excreted in the urine,
mainly as hydroxymetabolites, the principal one being
4-hydroxyaceclofenac. A small amount is converted to diclofenac.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function but use with caution.
10–20 Dose as in normal renal function but avoid if possible.
<10 Dose as in normal renal function but only if on dialysis.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function. See ‘Other information’.
HD Not dialysed. Dose as in normal renal function. See 'Other information'.
HDF/High flux Unknown dialysability. Dose as in
normal renal function. See 'Other information'.
CAV/VVHD Not dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• ACE inhibitors and angiotensin-II antagonists:
antagonism of hypotensive effect; increased risk of
nephrotoxicity and hyperkalaemia.• Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects);
avoid with ketorolac (increased risk of side effects and haemorrhage).
• Antibacterials: possible increased risk of convulsions with quinolones.
• Anticoagulants: effects of coumarins and phenindione enhanced; possibly increased risk of bleeding with heparins, dabigatran and edoxaban –
avoid long term use with edoxaban.
• Antidepressants: increased risk of bleeding with SSRIs and venlaflaxine.
• Antidiabetic agents: effects of sulphonylureas enhanced.
• Antiepileptics: possibly increased phenytoin concentration.
• Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir.
• Ciclosporin: may potentiate nephrotoxicity
• Cytotoxics: reduced excretion of methotrexate; increased risk of bleeding with erlotinib.
• Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diuretics.
• Lithium: excretion decreased.
• Pentoxifylline: increased risk of bleeding.
• Tacrolimus: increased risk of nephrotoxicity.
▶️Administration
Reconstitution
—
▶️Route
Oral
Rate of administration
—
▶️Other information
• Use with caution in uraemic patients predisposed to
gastrointestinal bleeding or uraemic coagulopathies.
• Inhibition of renal prostaglandin synthesis by
NSAIDs may interfere with renal function, especially in the presence of existing renal disease
– avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID therapy
– if raised, discontinue NSAID therapy.
• Use normal doses in patients with ESRD on dialysis if they do not pass any urine.
• Use with great caution in renal transplant recipients;
it can reduce intrarenal autocoid synthesis.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/684
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶️Atorvastatin
▶️Clinical use
Hyperlipidaemia and hypercholesterolaemia
▶️Dose in normal renal function
10–80 mg daily
▶️Pharmacokinetics
Molecular weight (daltons) 558.6 (1209.4 as calcium salt)
% Protein binding >98
% Excreted unchanged in urine Negligible
Volume of distribution (L/kg) 381 Litres
Half-life — normal/ESRF (hrs) 14 (active metabolite
20–30) / Unchanged
▶️Metabolism
Atorvastatin undergoes extensive presystemic clearance in gastrointestinal mucosa and/or hepatic first-pass metabolism. Atorvastatin is metabolised by cytochrome
P450 3A4 to ortho- and parahydroxylated derivatives
and various beta-oxidation products. These products are further metabolised via glucuronidation. Approximately 70% of circulating inhibitory activity for HMG-CoA reductase is attributed to active metabolites.
Atorvastatin is eliminated primarily in bile as active metabolites following hepatic and/or extrahepatic metabolism, but does not appear to undergo significant
enterohepatic recirculation.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function.
HD Not dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in
normal renal function.
CAV/VVHD Not dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anti-arrhythmics: concentration possibly increased by dronedarone.
• Antibacterials: azithromycin, erythromycin, clarithromycin or fusidic acid possibly increased
risk of myopathy – avoid atorvastatin for at least 7 days after fusidic acid stopped; concentration increased by clarithromycin – do not exceed 20 mg of atorvastatin1 ; avoid with telithromycin; increased
risk of myopathy with daptomycin; concentration
possibly reduced by rifampicin.
• Anticoagulants: may transiently reduce anticoagulant effect of warfarin.
• Antifungals: increased risk of myopathy with itraconazole – do not exceed 40 mg of atorvastatin1 ; increased risk of myopathy with fluconazole, ketoconazole, posaconazole, voriconazole and possibly other imidazoles and triazoles – avoid.
• Antivirals: increased risk of myopathy with atazanavir, boceprevir (reduce atorvastatin dose), and possibly darunavir, fosamprenavir, indinavir,
lopinavir, ritonavir, saquinavir or tipranavir (max dose of atorvastatin 10 mg); concentration reduced
by efavirenz and possibly etravirine; avoid with dasabuvir, ombitasvir, paritaprevir and telaprevir; possible increased risk of myopathy with ledipasvir – reduce atorvastatin dose; concentration increased
by simeprevir – consider reducing atorvastatin dose.
• Calcium channel blockers: concentration increased
by diltiazem – increased risk of myopathy; concentration of verapamil increased also possible increased risk of myopathy – consider reducing
atorvastatin dose.
• Ciclosporin: increased risk of myopathy – do not exceed 10 mg of atorvastatin1
• Cobicistat: reduce atorvastatin dose.
• Colchicine: possible increased risk of myopathy.
• Grapefruit juice: concentration possibly increased.
• Lipid lowering agents: increased risk of myopathy
with fibrates, gemfibrozil (avoid) and nicotinic acid.
▶️Administration
Reconstitution
—
▶️Route
Oral
▶️Other information
• Rhabdomyolysis with renal dysfunction secondary
to myoglobinaemia has been reported with other statins.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/685
https://news.1rj.ru/str/ppdprogram
▶️Clinical use
Hyperlipidaemia and hypercholesterolaemia
▶️Dose in normal renal function
10–80 mg daily
▶️Pharmacokinetics
Molecular weight (daltons) 558.6 (1209.4 as calcium salt)
% Protein binding >98
% Excreted unchanged in urine Negligible
Volume of distribution (L/kg) 381 Litres
Half-life — normal/ESRF (hrs) 14 (active metabolite
20–30) / Unchanged
▶️Metabolism
Atorvastatin undergoes extensive presystemic clearance in gastrointestinal mucosa and/or hepatic first-pass metabolism. Atorvastatin is metabolised by cytochrome
P450 3A4 to ortho- and parahydroxylated derivatives
and various beta-oxidation products. These products are further metabolised via glucuronidation. Approximately 70% of circulating inhibitory activity for HMG-CoA reductase is attributed to active metabolites.
Atorvastatin is eliminated primarily in bile as active metabolites following hepatic and/or extrahepatic metabolism, but does not appear to undergo significant
enterohepatic recirculation.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function.
HD Not dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in
normal renal function.
CAV/VVHD Not dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anti-arrhythmics: concentration possibly increased by dronedarone.
• Antibacterials: azithromycin, erythromycin, clarithromycin or fusidic acid possibly increased
risk of myopathy – avoid atorvastatin for at least 7 days after fusidic acid stopped; concentration increased by clarithromycin – do not exceed 20 mg of atorvastatin1 ; avoid with telithromycin; increased
risk of myopathy with daptomycin; concentration
possibly reduced by rifampicin.
• Anticoagulants: may transiently reduce anticoagulant effect of warfarin.
• Antifungals: increased risk of myopathy with itraconazole – do not exceed 40 mg of atorvastatin1 ; increased risk of myopathy with fluconazole, ketoconazole, posaconazole, voriconazole and possibly other imidazoles and triazoles – avoid.
• Antivirals: increased risk of myopathy with atazanavir, boceprevir (reduce atorvastatin dose), and possibly darunavir, fosamprenavir, indinavir,
lopinavir, ritonavir, saquinavir or tipranavir (max dose of atorvastatin 10 mg); concentration reduced
by efavirenz and possibly etravirine; avoid with dasabuvir, ombitasvir, paritaprevir and telaprevir; possible increased risk of myopathy with ledipasvir – reduce atorvastatin dose; concentration increased
by simeprevir – consider reducing atorvastatin dose.
• Calcium channel blockers: concentration increased
by diltiazem – increased risk of myopathy; concentration of verapamil increased also possible increased risk of myopathy – consider reducing
atorvastatin dose.
• Ciclosporin: increased risk of myopathy – do not exceed 10 mg of atorvastatin1
• Cobicistat: reduce atorvastatin dose.
• Colchicine: possible increased risk of myopathy.
• Grapefruit juice: concentration possibly increased.
• Lipid lowering agents: increased risk of myopathy
with fibrates, gemfibrozil (avoid) and nicotinic acid.
▶️Administration
Reconstitution
—
▶️Route
Oral
▶️Other information
• Rhabdomyolysis with renal dysfunction secondary
to myoglobinaemia has been reported with other statins.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/685
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
#مفهوم_الرعاية_الصحية ،،
#التي_ يقدمها _الصيدلاني_ للمريض
قد تبدوا الأشياء النمطية بلا معنى ،، تلك التي لا تخرج عن نطاق التشابه ..
كسيمفونية قديمة و رتيبة ،،
كفنجان قهوة مكرر المذاق ،،
أو كمفهوم الصيدلاني عند العامة !
أعني أولئك الذين لا يرون في الصيدلاني إلا انساناً يقف وراء الرفوف الخرساء ،،
في حين مفهوم الصيدلاني يتجسد في الرعاية الصحية التي يقدمها ،،
*و التي تتلخص في محورها حول التالي* :
1) تقييم أدوية المريض والخطة العلاجية تؤدي إلى تحسن النتائج 😌
2) تلبية احتياج المريض ذات الصلة بالأدوية و اختيار الدواء الأنسب حيث يظل الصيدلاني الاذرع المفتوحة دائماً للمريض ،، 💛
3) العمل بشكل وثيق جداً مع الطبيب من أجل الحصول على الفهم الصحيح لأهمية و تأثير الأدوية المختلفة على المريض ،،😃
4) تركيب الأدوية ،، نعم إنها ذلك الفن الدوائي الذي يجعلك تنافس دافنشي و جوخ في لوحاتهم 😍
5) معالجة حالات معينه من المرضى وصرف الأدوية (OTC) لبعض الأمراض المصرح للصيدلي علاجها والتى لا تستدعي لإستشارة الطبيب، و احالة المرضى إلى الطبيب المختص في الحالات التي تحتاج لذلك.
صيدلانية / حنان القباطي
مجال التثقيف الدوائي
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
#مدير البرنامج
#البروف_محمود البريهي
#أستاذ مشارك الصيدلانيات
كلية الصيدلة جامعة صنعاء.
#التي_ يقدمها _الصيدلاني_ للمريض
قد تبدوا الأشياء النمطية بلا معنى ،، تلك التي لا تخرج عن نطاق التشابه ..
كسيمفونية قديمة و رتيبة ،،
كفنجان قهوة مكرر المذاق ،،
أو كمفهوم الصيدلاني عند العامة !
أعني أولئك الذين لا يرون في الصيدلاني إلا انساناً يقف وراء الرفوف الخرساء ،،
في حين مفهوم الصيدلاني يتجسد في الرعاية الصحية التي يقدمها ،،
*و التي تتلخص في محورها حول التالي* :
1) تقييم أدوية المريض والخطة العلاجية تؤدي إلى تحسن النتائج 😌
2) تلبية احتياج المريض ذات الصلة بالأدوية و اختيار الدواء الأنسب حيث يظل الصيدلاني الاذرع المفتوحة دائماً للمريض ،، 💛
3) العمل بشكل وثيق جداً مع الطبيب من أجل الحصول على الفهم الصحيح لأهمية و تأثير الأدوية المختلفة على المريض ،،😃
4) تركيب الأدوية ،، نعم إنها ذلك الفن الدوائي الذي يجعلك تنافس دافنشي و جوخ في لوحاتهم 😍
5) معالجة حالات معينه من المرضى وصرف الأدوية (OTC) لبعض الأمراض المصرح للصيدلي علاجها والتى لا تستدعي لإستشارة الطبيب، و احالة المرضى إلى الطبيب المختص في الحالات التي تحتاج لذلك.
صيدلانية / حنان القباطي
مجال التثقيف الدوائي
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
#مدير البرنامج
#البروف_محمود البريهي
#أستاذ مشارك الصيدلانيات
كلية الصيدلة جامعة صنعاء.
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
▶Mesalazine:
Mesalazine, also known as mesalamine or 5-aminosalicylic acid (5-ASA), is an aminosalicylate anti-inflammatory drug used to treat inflammatory bowel disease, including ulcerative colitis, or inflamed anus or rectum, and to maintain remission in Crohn's disease.
له كثير من الفوائد التي تُساعد في علاج القولون التقرحي في حالة إهمال علاجه يؤدي إلى الكثير من المشاكل الأخرى بالصحة كما يوجد به بعض الأضرار التي نصح الأطباء بتجنبها حتى لا تتعرض الصحة لمُضاعفات.
🔽دواعي استعمال بنتازا
▶يُعالج التهاب القولون التقرحي الذي يُصيب الأمعاء و يعالج الحالات التالية .
▶التهاب الأمعاء بشكل سريع.
▶ حالات الإسهال.
▶ مرضى الكرون.
▶ آلام البطن والمعدة.
▶ مرضى نزيف المستقيم.
▶ الأمعاء الغليظة وما تتعرض له من مُضاعفات.
▶ حالات الروماتويدي.
🔽الجرعة الموصى به لتناول دواء بنتازا:
الجرعة المسموح بها للبالغين قرص واحد بمعدل 500 ملجم ثلاثة مرات في اليوم.
يُفضل تناول العقار مع الأكل أو بتناوله مع كمية كبيرة من الماء.
يجب الاستمرار في العلاج حتى بعد التحسن.
🔽الآثار الجانبية لدواء بنتازا:
◀الشعور بالصداع المُزمن.
◀غثيان وقيء شديد.
◀إسهال ومغص بالمعدة.
◀التهاب شديد بالحنجرة.
◀ظهور طفح جلدي.
◀تورم شديد في الوجه والشفتين.
◀شحوب الجلد واصفراره.
◀التهاب في الحنجرة.
◀آلام في عضلات الجسم.
◀فقدان في الشهية.
◀صعوبة كبيرة في البلع.
◀حدوث نزيف.
◀تعب شديد وضعف
🔼موانع استعمال الدواء
يوجد بعض التحذيرات التي أوضحها الأطباء يجب أخذها في الحُسبان عند تناول أقراص بنتازا فهناك بعض الحالات التي يكون من الخطر عليها تناول هذا الدواء وسوف نوضح هذه الحالات عبر مقالنا هذا.
يحذر من تناوله عند الإصابة بأحد أمراض الجهاز التنفسي مثل الربو.
عند الإصابة بأي مشاكل في الكلي والكبد.
ضرورة عدم تناوله في فترة الحمل.
من يُصاب بأمراض في الجهاز التناسلي البولي.
عدم أخذ جرعة زيادة لتعويض نسيان أحد الجرعات.
عدم تناول هذه الأقراص لمن يُعانون من مشاكل في وظائف الكبد..
الصيدلانيه : روفندا الخليدي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
Mesalazine, also known as mesalamine or 5-aminosalicylic acid (5-ASA), is an aminosalicylate anti-inflammatory drug used to treat inflammatory bowel disease, including ulcerative colitis, or inflamed anus or rectum, and to maintain remission in Crohn's disease.
له كثير من الفوائد التي تُساعد في علاج القولون التقرحي في حالة إهمال علاجه يؤدي إلى الكثير من المشاكل الأخرى بالصحة كما يوجد به بعض الأضرار التي نصح الأطباء بتجنبها حتى لا تتعرض الصحة لمُضاعفات.
🔽دواعي استعمال بنتازا
▶يُعالج التهاب القولون التقرحي الذي يُصيب الأمعاء و يعالج الحالات التالية .
▶التهاب الأمعاء بشكل سريع.
▶ حالات الإسهال.
▶ مرضى الكرون.
▶ آلام البطن والمعدة.
▶ مرضى نزيف المستقيم.
▶ الأمعاء الغليظة وما تتعرض له من مُضاعفات.
▶ حالات الروماتويدي.
🔽الجرعة الموصى به لتناول دواء بنتازا:
الجرعة المسموح بها للبالغين قرص واحد بمعدل 500 ملجم ثلاثة مرات في اليوم.
يُفضل تناول العقار مع الأكل أو بتناوله مع كمية كبيرة من الماء.
يجب الاستمرار في العلاج حتى بعد التحسن.
🔽الآثار الجانبية لدواء بنتازا:
◀الشعور بالصداع المُزمن.
◀غثيان وقيء شديد.
◀إسهال ومغص بالمعدة.
◀التهاب شديد بالحنجرة.
◀ظهور طفح جلدي.
◀تورم شديد في الوجه والشفتين.
◀شحوب الجلد واصفراره.
◀التهاب في الحنجرة.
◀آلام في عضلات الجسم.
◀فقدان في الشهية.
◀صعوبة كبيرة في البلع.
◀حدوث نزيف.
◀تعب شديد وضعف
🔼موانع استعمال الدواء
يوجد بعض التحذيرات التي أوضحها الأطباء يجب أخذها في الحُسبان عند تناول أقراص بنتازا فهناك بعض الحالات التي يكون من الخطر عليها تناول هذا الدواء وسوف نوضح هذه الحالات عبر مقالنا هذا.
يحذر من تناوله عند الإصابة بأحد أمراض الجهاز التنفسي مثل الربو.
عند الإصابة بأي مشاكل في الكلي والكبد.
ضرورة عدم تناوله في فترة الحمل.
من يُصاب بأمراض في الجهاز التناسلي البولي.
عدم أخذ جرعة زيادة لتعويض نسيان أحد الجرعات.
عدم تناول هذه الأقراص لمن يُعانون من مشاكل في وظائف الكبد..
الصيدلانيه : روفندا الخليدي
مجال التثقيف الدوائي
https://news.1rj.ru/str/joinchat/B56piwzD3oV5A-Ne1Uo6JA
برنامج تطوير مهنة الصيدلة
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PPDPROGRAM-CLINICAL PHARMACOKINETICS:
▶️Clopidogrel
▶️Clinical use
Antiplatelet agent
▶️Dose in normal renal function
75 mg daily
Acute coronary syndrome and post-MI: 300 mg loading dose then 75 mg daily (with aspirin 75–325 mg daily)
Prevention of atherothrombotic events in PCI (adjunct with aspirin) if patient not already on clopidogrel:
Loading dose 300–600 mg before procedure
▶️Pharmacokinetics
Molecular weight (daltons) 419.9 (as hydrogen sulphate)
% Protein binding 98
% Excreted unchanged in urine 50
Volume of distribution (L/kg) No data
Half-life — normal/ESRF (hrs) 8 (active metabolite)
▶️Metabolism
Clopidogrel is a prodrug and is extensively metabolised in
the liver, mainly to the inactive carboxylic acid derivative;
metabolism is mediated by cytochrome P450 isoenzymes
including CYP3A4 and CYP2B6, CYP1A2, CYP1A1, and CYP2C19. The active metabolite appears to be a thiol derivative.
Clopidogrel and its metabolites are excreted in urine and in faeces; about 50% of an oral dose is recovered from the urine and about 46% from the faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Unlikely to be dialysed. Dose as in normal renal function.
HD Unlikely to be dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in normal renal function.
CAV/VVHD Unlikely to be dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Antibacterials: antiplatelet effect possibly reduced by
erythromycin.
• Anticoagulants: enhanced anticoagulant effect with
coumarins and phenindione; manufacturer advises to
avoid with warfarin.
• Heparin: increased risk of bleeding.
• Antidepressants: antiplatelet effect possibly reduced by fluoxetine, fluvoxamine and moclobemide.
• Anti-diabetics: avoid with repaglinide if possible due to increased repaglinide exposure.
• Antiepileptics: antiplatelet effect possibly reduced by carbamazepine and oxcarbazepine.
• Antifungals: antiplatelet effect possibly reduced by fluconazole, itraconazole, ketoconazole and voriconazole.
• Antivirals: antiplatelet effect possibly reduced by etravirine.
• Statins: concentration of rosuvastatin increased, maximum rosuvastatin dose is 20 mg.
• Ulcer healing drugs: antiplatelet effect possibly
reduced by cimetidine, lansoprazole, pantoprazole
and rabeprazole; antiplatelet effect reduced by omeprazole and esomeprazole – avoid concomitant use if possible.
▶️Administration
Reconstitution
—
▶️Route
Oral
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/686
https://news.1rj.ru/str/ppdprogram
▶️Clopidogrel
▶️Clinical use
Antiplatelet agent
▶️Dose in normal renal function
75 mg daily
Acute coronary syndrome and post-MI: 300 mg loading dose then 75 mg daily (with aspirin 75–325 mg daily)
Prevention of atherothrombotic events in PCI (adjunct with aspirin) if patient not already on clopidogrel:
Loading dose 300–600 mg before procedure
▶️Pharmacokinetics
Molecular weight (daltons) 419.9 (as hydrogen sulphate)
% Protein binding 98
% Excreted unchanged in urine 50
Volume of distribution (L/kg) No data
Half-life — normal/ESRF (hrs) 8 (active metabolite)
▶️Metabolism
Clopidogrel is a prodrug and is extensively metabolised in
the liver, mainly to the inactive carboxylic acid derivative;
metabolism is mediated by cytochrome P450 isoenzymes
including CYP3A4 and CYP2B6, CYP1A2, CYP1A1, and CYP2C19. The active metabolite appears to be a thiol derivative.
Clopidogrel and its metabolites are excreted in urine and in faeces; about 50% of an oral dose is recovered from the urine and about 46% from the faeces.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Unlikely to be dialysed. Dose as in normal renal function.
HD Unlikely to be dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in normal renal function.
CAV/VVHD Unlikely to be dialysed. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Antibacterials: antiplatelet effect possibly reduced by
erythromycin.
• Anticoagulants: enhanced anticoagulant effect with
coumarins and phenindione; manufacturer advises to
avoid with warfarin.
• Heparin: increased risk of bleeding.
• Antidepressants: antiplatelet effect possibly reduced by fluoxetine, fluvoxamine and moclobemide.
• Anti-diabetics: avoid with repaglinide if possible due to increased repaglinide exposure.
• Antiepileptics: antiplatelet effect possibly reduced by carbamazepine and oxcarbazepine.
• Antifungals: antiplatelet effect possibly reduced by fluconazole, itraconazole, ketoconazole and voriconazole.
• Antivirals: antiplatelet effect possibly reduced by etravirine.
• Statins: concentration of rosuvastatin increased, maximum rosuvastatin dose is 20 mg.
• Ulcer healing drugs: antiplatelet effect possibly
reduced by cimetidine, lansoprazole, pantoprazole
and rabeprazole; antiplatelet effect reduced by omeprazole and esomeprazole – avoid concomitant use if possible.
▶️Administration
Reconstitution
—
▶️Route
Oral
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/686
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PPDPROGRAM-CLINICAL PHARMACOKINETICS:
▶️Bisoprolol fumarate
▶️Clinical use
Beta-1 adrenoceptor blocker:
• Hypertension
• Angina
• Adjunctive treatment for heart failure
▶️Dose in normal renal function
• 5–20 mg daily
• Heart failure: 1.25 mg daily increasing to 10 mg daily
▶️Pharmacokinetics
Molecular weight (daltons) 767
% Protein binding 30
% Excreted unchanged in urine 50
Volume of distribution (L/kg) 3.5
Half-life — normal/ESRF (hrs) 9–12 / 18–24
▶️Metabolism
Bisoprolol is excreted from the body by two routes. 50%
is metabolised by the liver to inactive metabolites which are then excreted by the kidneys. The remaining 50% is excreted by the kidneys in an unmetabolised form.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function.
HD Not dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in normal renal function.
CAV/VVHD Unknown dialysability. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anaesthetics: enhanced hypotensive effect.
• Analgesics: NSAIDs antagonise hypotensive effect.
• Anti-arrhythmics: increased risk of myocardial
depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodarone; increased risk of myocardial
depression and bradycardia with flecainide.
• Antibacterials: concentration reduced by rifampicin.
• Antidepressants: enhanced hypotensive effect with
MAOIs.
• Antihypertensives; enhanced hypotensive effect;
increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosin.
• Antimalarials: increased risk of bradycardia with mefloquine.
• Antipsychotics enhanced hypotensive effect with phenothiazines.
• Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem;
hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe
hypotension and heart failure with verapamil.
• Cytotoxics: possible increased risk of bradycardia
with crizotinib.
• Diuretics: enhanced hypotensive effect.
• Fingolimod: possibly increased risk of bradycardia.
• Moxisylyte: possible severe postural hypotension.
• Sympathomimetics: severe hypertension with adrenaline and noradrenaline, and possibly with dobutamine.
▶️Administration
Reconstitution
—
▶️Route
Oral
Rate of administration
—
▶️Other information
• Use with caution in patients with chronic obstructive airways disease, asthma or diabetes.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/687
https://news.1rj.ru/str/ppdprogram
▶️Bisoprolol fumarate
▶️Clinical use
Beta-1 adrenoceptor blocker:
• Hypertension
• Angina
• Adjunctive treatment for heart failure
▶️Dose in normal renal function
• 5–20 mg daily
• Heart failure: 1.25 mg daily increasing to 10 mg daily
▶️Pharmacokinetics
Molecular weight (daltons) 767
% Protein binding 30
% Excreted unchanged in urine 50
Volume of distribution (L/kg) 3.5
Half-life — normal/ESRF (hrs) 9–12 / 18–24
▶️Metabolism
Bisoprolol is excreted from the body by two routes. 50%
is metabolised by the liver to inactive metabolites which are then excreted by the kidneys. The remaining 50% is excreted by the kidneys in an unmetabolised form.
▶️Dose in renal impairment GFR (mL/min)
20–50 Dose as in normal renal function.
10–20 Dose as in normal renal function.
<10 Dose as in normal renal function.
▶️Dose in patients undergoing renal replacement therapies
APD/CAPD Not dialysed. Dose as in normal renal function.
HD Not dialysed. Dose as in normal renal function.
HDF/High flux Unknown dialysability. Dose as in normal renal function.
CAV/VVHD Unknown dialysability. Dose as in normal renal function.
▶️Important drug interactions
Potentially hazardous interactions with other drugs
• Anaesthetics: enhanced hypotensive effect.
• Analgesics: NSAIDs antagonise hypotensive effect.
• Anti-arrhythmics: increased risk of myocardial
depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodarone; increased risk of myocardial
depression and bradycardia with flecainide.
• Antibacterials: concentration reduced by rifampicin.
• Antidepressants: enhanced hypotensive effect with
MAOIs.
• Antihypertensives; enhanced hypotensive effect;
increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosin.
• Antimalarials: increased risk of bradycardia with mefloquine.
• Antipsychotics enhanced hypotensive effect with phenothiazines.
• Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem;
hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe
hypotension and heart failure with verapamil.
• Cytotoxics: possible increased risk of bradycardia
with crizotinib.
• Diuretics: enhanced hypotensive effect.
• Fingolimod: possibly increased risk of bradycardia.
• Moxisylyte: possible severe postural hypotension.
• Sympathomimetics: severe hypertension with adrenaline and noradrenaline, and possibly with dobutamine.
▶️Administration
Reconstitution
—
▶️Route
Oral
Rate of administration
—
▶️Other information
• Use with caution in patients with chronic obstructive airways disease, asthma or diabetes.
◀️ قناة حركية الدواء السريرية
https://news.1rj.ru/str/CLINICPHARMA/687
https://news.1rj.ru/str/ppdprogram
Telegram
برنامج تطوير مهنة الصيدلة - PPDPROGRAM
PHARMACY PROFESSION DEVELOPMENT PROGRAM
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.
PROF/MAHMOUD MAHYOOB ALBURYHI
PROFESSOR OF PHARMACEUTICS AND INDUSTRIAL PHARMACY, FACULTY OF PHARMACY, SANA'A UNIVERSITY, YEMEN.