1. DRUGS
DR MARIA KHALIQ
HOUSE OFFICER MU1
HFH

2. STEROIDS
1.
GLUCOCORTICOID
MODE OF ACTION
Mediated by glucocorticoid receptors
Regulates the transcription of terget genes
EXAMPLES
Hydro cortisone
Cortisone
Dexamethasone

3. INDICATIONS
Allergic reactions:
Angioneurotic edema,asthma,bee stings,
allergic rhinitis
Collagen vascular disorer:
Rheumatoid arthritis,Temporal arthritis
lupus erythemetosis
Eye disorders:
Acute uveitis,allergic conjunctivitis
Gastrointestinal disease:
IBD, nontropical sprue

4. Infections:
gram negativwe septicemia
Neurological disorders;
Cerebral edema , multiple sclerosis
Pulmonary disease:
Aspiration pneumonia,bronchial asthma
sarcoidosis
Renal disorders:
Nephrotic syndrome
Skin diseases:
Atrophic dermatitis, dermatosis , xerosis

5. SIDE EFFECTS
Iatrogenic cushing syndrome:
weight gain, muscle wasting, thining
of skin, skin striae, bruising,
osteoprosis, hyperglycemia, diabetes
Increased risk of infections
Peptic ulceration
Psychosis
Depression
CONTRAINDICATIONS
Given with great caution in patients with peptic

6. ulceration,heart disease,hypertention,diabetes,
osteoprosis,glaucoma,herpes simplex infection
2. MINRELOCORTICOIDS:
Aldosterone
Deoxycorticosterone
Fludrocortisone

7. DIURETICS
1.
CARBONIC ANHYDRASE
INHIBITORS
INDICATIONS:
1. Glaucoma
2. Urinary alkalinization
3. Metabolic Alkalosis
4.Acute mountain sickness

8. SIDE EFFECTS:
Hyperchloremic metabolic acidosis
Renal stones
Renal potassium wasting
Hypersensitivity reactions:
Fever, rash, bone marrow suppression,
interstitial nephritis.

9. 2.
LOOP OF HENLE:
INDICATIONS
Hyperkalemia
Acute renal failure
Anion overdose
TOXICITY
Hypokalemic Metabolic Alkalosis
Ototoxicity
Hyperuricemia
Hypomagnesemia

10. Allergic Reactions:
Skin rashes, eosinophilia, interstitial
nephritis
CONTRAINDICATIONS:
Used with caution in hepatic cirrhosis , renal
failure and congestive heart failure.

11. 3. POTASSIUM SPARING
DIURETICS
INDICATIONS:
Useful in state of mineralocorticoid excess:
Conns syndrome, ectopic ACTH
production
Useful in Secondary aldosteronism:
CCF , hepatic cirrhosis, nephrotic
syndrome

12. SIDE EFFECTS:
Hypertkalemia
Hyperchloremic Metabolic Acidosis
Gynecomastia
Acute renal failure
Kidney stones
CONTRAINDICATIONS:
Used with caution with Chronic renal failure
and liver disease

13. 4. OSMOTIC DIURETICS
INDICATIONS:
To increase volume of urine volume
Reduction of intracranial pressure
Reduction of intraocular pressure
SIDE EFFECTS:
Extracellular volume expansion that may
complicate CCF, pulmory edema
Dehydration and Hypernatremia

14. HEPARIN
TYPES:
Unfractioned Heparin{Standard}
Low molecular weight Heparin
MODE OF ACTION:
Activates prothrombin to inhibit
procoagulant 11a, V11, 1X, X, X1.

15. INDICATIONS
ANTICOAGULATION:
Treatment and prevention of DVT
Pulmonary Embolism
Unstable angina
Acute periphral arterial occlusion
In patients of MI to prevent:
Coronary reocclusion after
thrombolysis
Mural thrombosis

16. SIDE EFFECTS:
Bleeding
Transient reversible alopecia
Osteoprosis
Spontaneous fractures
Transient thrombocytopenia
CONTRAINDICATIONS:
Hypersensitivity to heparin
Active bleeding
Hemophilia
Thrombocytopenia

17. Purpura
Severe hypertension
Intracranial hemorrhage
Infective endocarditis
Active tuberculosis
Ulcerative lesions of GIT
Threatened abortion
Visceral carcinoma
Advanced hepatic or renal disease

18. ATROPINE
Atropine is a an Anticholinergic and
Antispasmodic
INDICATIONS:
Mydriasis and cycloplegia for examination of
retina.
Prophylaxis of motion sickness
Antidoote in OPC poisoning
Parkinsonism
Antidote in mushroom poisoning

19. As pre anesthetic medication to reduce
secretions in upper and lower respiratory tract
Prophylaxis of motion sickness
Urinary urgency caused by minor inflammatory
bladder disorder
Pain due to spasm of smooth muscles as in
biliary colic, intestinal colic, renal colic and
peptic ulcer

20. ADVERSE EFFECT
Dry mouth
Xerostomia
Nausea, vomitng, constipation
Urinary retention
Blurred vision
Photophobia
Nervousness
CONTRAINDICATION
Angle closure glaucoma
Urinary retention
Paralytic ileus

21. ADRENALINE
Adrenaline is a sympathomimmetic drug
INDICATIONS
Emergency management of complete heart
block and cardiac arrest
Anaphylaxis
Bronchospasm
Chronic orthostatic hypotension

22. Hypotension:
Due to hypovolemic shock
Cardiac arrythmia
Neurogenic disease
Adverse effects of antihypertensives
Cardiogenic shock
Combined with local anesthesia to prolong
duration of infiltration of nerve block
ADVERSE EFFECT:
Anxiety

23. Tremors
Palpitations
Headache and restlessness
Pulmonary edema
CONTRAINDICATIONS:
Hypertension
Hyperthyroidism
Ischemic heart disease
Cardiac arrythmias

24. LIGNOCAIN
It is a local anesthetic
MODE OF ACTION:
Blocks activated and inactivated Na channels
INDICATIONS:
Local anesthetics
Antiarrythmic in Ventricular fibrillation and
tachycardia

25. ADVERSE EFFECTS;
Allergic reactions
Hearing disturbances
Slurred speech
Paresthesia
Convulsions
Sleepiness
Light headedness

26. ACE INHIBITOR
ANGIOTENSIN
CONVERTING ENZYME
INHIBITOR




CAPTOPRIL
ENALAPRIL
LISINOPRIL
RAMIPRIL

27. MODE OF ACTION:
Prevent salt and water retention
Inhibit periphral arterial and venous
vasoconstriction
Inhibit activation of sympthatic system
INDICATIONS:
Congestive cardiac failure
Hypertension

28. ADVERSE EFFECTS
Dry cough
Skin rashes
Neutropenia
Hyperkalemia
Postural hypertension
Angioedema

29. DIGOXIN
MECHANISM OF ACTION:
Inhibits Na_K ATPase resulting in intracellular
Na accumulation resulting in activation of
Na_Ca channels causing increase in intracellular
Ca increasing force of contraction
Positive ionotropic effect
Increases refractory period of AV node

30. INDICATION
Congestive cardiac failure
Atrial fibrillation
Atrial flutter
Paroxysmal atrial tachycardia
AV nodal tachycardia
CONTRAINDICATIONS
Cardiac temponade
Constrictive pericarditis
Hypertrophic obstructive cardiomyopathy
Ventricular fibrillation
Ventricular tachycardia

31. ADVERSE EFFECT
Premature ventricular beats
Ventricular tachycardia
Ventricular fibrillation
A V block
Sinus arrythmia
Paroxysmal and non paroxysmal atrial
tachycardia
Anorexia,nausea,vomiting and diarrhea
Headache, fatigue, malaise, hallusinations

32. CALCIUM GLUCONATE
INDICATIONS:
Hypocalcemia
Chronic calcium defeciency
Rickets
Osteomalacia
Osteoporosis
CONTRAINDICATIONS:
Hypercalcemia

33. Hypercalciuria
Renal failure
Renal calculi
Galactosemia
ADVERSE EFFECTS
Nausea
Diarrhea
Hypotension

34. H2 BLOCKER
H2 RECEPTOR
ANTAGONIST




Cimetidine
Ranitidine
Famotidine
Nizatidine

35. INDICATION
Duodenal ulcer
Benign gastric ulcer
Reflux esophagitis
Zollinger _ Ellison syndrome
prophylaxis of stess ulcer
ADVERSE EFFECTS
Drug interactions
Skin rashes
Headache

36. INSULIN
INDICATION
Type 1 diabetes
Type 11 diabetes when hyperglycemia is not
controlled with diet therapy or oral drugs
1. ULTRASHORT ACTING INSULIN
2. SHORT ACTING OR REGULAR INSULIN
Indications:
New cases of diabetes with dehydration and
or ketoacidoses

37. In emergencies e.g ketoacidosis or surgical
operations
In all IDDM in combinition of intermediate or
long acting insulin
3. INTERMEDIATE ACTING INSULIN
Indicated in stable patients usually mixed with
regular insulin
4. LONG ACTING INSULIN

38. COMPLICATIONS OF INSULIN:
Lipoatrophy or Lipohypertrophy
Insulin resistance
Weight gain
Local allergy
Hypoglycemia
Periphral edema

39. ORAL HYPOGLYCEMIC
DRUGS






SULPHOYLUREAS
BIGUINIDE
ALPHA GLUCOSIDASE INHIBITOR
NON SULPHONYLUREAS INSULIN
STIMULATION
PHENYLALANINE DERIVATIVE
THIAZOLIDINEDIONS

40. SULPHONYLUREAS
Glibenclamide
Gliclazide
Glimepride
Glipizide
These agents are used in non obese patients of
diabetes
MECHANISM OF ACTION
Improves early phase of insulin release
Reduce periphral resistence to insulin actions
Reducing hepatic release of glucose


41. ADVERSE EFFECTS
Hypoglycemia
Hypersensitivity
GIT disturbances
Obesity
Water intoxication and hyponatremia
 BIGUINIDE
Metformin
MECHANISM OF ACTION
Reduces hepatic gluconeogenesis
Slows down glucose absorption from GIT

42. ADVERSE EFFECT
Nausea , vomiting, diarrhea
Lactic acidosis
CONTRAINDICATION
Renal failure
Hepatic insufficiency
Alcoholism
Cardiac failure
Respiratory Insufficiency

43. ALPHA GLUCOSIDASE INHIBITORS
Acarboes
Miglitol
MECHANISM OF ACTION
Inhibits glucose absorption from intestine
Lowers the postprandial hyperglycemia
ADVERSE EFFECTS
Flatulence, abdominal bloating and diarrhea


44. BRONCHODILATORS
SALBUTAMOL
SALBUTAMOL is a selective Beta 2 agonist
INDICATIONS
Bronchospasm
Status asthmaticus
Uncomplicated premature labour
ADVERSE EFFECTS
Fine tremors

45. Feeling of tension
Headache
Tachycardia
Periphral vasodilatations
USED WITH PRECAUTION IN:
Hyperthyroidism
Myocardial insuffeciency
Angina
Hypertension

46. BETA BLOCKERS
INDICATIONS
Hypertension
Angina
Arrythmia
Atrial fibrillation
Atrial flutter
Myocardial Infarction
Anxiety and tremor
Obstructive cardiomyopathy

47. NITRATES
ISOSORBIDE DINITRATE
INDICATIONS
Angina prophylaxis
Acute myocardial infarction
Hypertension
CONTRAINDICATION
Hypotension
Marked anemia
Cerebral haemorrhage

48. ADVERSE EFFECTS
Headache
Dizziness
Cerebral ischemia
Weakness
Orthostatic hypotension
Reflex tachycardia