#Guidelines_watch 2023

🛑In patient with acute-on-chronic liver failure (ACLF)


⚫ Critically ill patients with ACLF and any form of upper gastrointestinal bleeding should be treated with prophylactic antibiotics, usually third-generation cephalosporins

⚫ Critically ill patients with ACLF and portal hypertensive bleeding should be treated with octreotide or a somatostatin analog (moderate quality evidence) and a proton pump inhibitor (low-quality evidence).
✅Critically ill patients with ACLF and SBP should receive broad-spectrum empirical antibiotics, including consideration of coverage for resistant organisms.
⚫ Patients with ACI.Fand SBP also should receive albumin, even if they are not clearly volume depleted.
(as moderate-quality evidence shows that albumin lowers risks for acute kidney injury and death)

anticoagulants in Atrial fibrillation Patient with ACS or CCC(need electivePCI)

اغلب ال
international guidelines
توصي إستخدام ال
Nitrofurantoin 100mg twice daily
لمدة 5 ايام في معالجة
u.UTI
except UK guidance, which recommends 3d

لكن ليست مبنية  RCTs
#massoud

#remember
Consider aortic dissection in the differential diagnosis of all patients presenting with acute chest or upper back pain.

#remember
Patients with chronic hemolysis should receive folate replacement (1 mg/day)

#secreat_book

#remember

✅The most important risk factors for ischemic stroke are a prior stroke and age.
✅ The most important modifiable risk factor for stroke is hypertension. Other risk factors for ischemic stroke include diabetes, smoking, carotid stenosis, and a lipid profile with low HDL, high triglycerides, and high LDL. Cardiac diseases such as atrial fibrillation and valvular disease are ischemic stroke risk factors. The most significant risk factor for the commonest type of hemorrhagic stroke is chronic hypertension.

#Cardiology Secrets 2023

#remember

✅The most common side effect of metformin is diarrhea. This side effect is usually transient and can be minimized by starting at a low dose (500 mg once daily) and titrating the dose slowly over time to a target dose of 2000 mg daily (usually 1000 mg twice daily), taking the medication with food, and using the extended-release formulation.

#remember

✅Insulin requirements decrease in the first pregnancy trimester but increase (two- to fourfold) in the second and third trimesters as a result of pregnancy-induced insulin resistance. 🤔Adding metformin to decrease insulin requirements is not the standard of care and may be associated with an increased risk of. small-for-gestational-age (SGA) infants.

#Diabetes_Secrets2022

#remember

✅Women with T1D or T2D who are considering pregnancy can reduce the risk for congenital abnormalities to the baseline population risk if A1c is ≤6.5% prior to conception (or before 5–8 weeks of gestation).
#Diabetes_Secrets2022

مشاركتي في مجلة قلم صيدلي بعنوان معالجة الارتجاع المريئي المَعدِي

#مجلة_قلم_صيدلي
#الاصدار_الخامس
#٢٥_سبتمر
#اليوم_العالمي_للصيدلة

🌺كل عام وانتم بخير 🌺

في الخامس والعشرون من شهر أيلول (سبتمبر) في هذا اليوم العظيم، نقف أحتراما لواحدة من أنبل المهن الإنسانيه، لصناع الدواء محاربي الداء، والمرهم الذي تطيب به الجِراح، والدّواء الذي تُشفى به الأسقام، مسكن الألم، وبلسم الأحزان، العمود الفقري للدواء، وا وَتٍين الطب وشريان المهن الطبية،
نقف بإحترام أمام هذا الصّرح الإنساني الذي خرّج أجيال من العاملين في هذه المهنة وكانوا شفاء وأمل لكل المرضى،
إلى كل صيدلاني وصيدلانية كلّ عام وأنتم بخير بمناسبة اليوم العالمي، كل عام وانتم البلسم الشافي
د. مسعود رسام

#remember
✅Cerebrovascular events are the leading cause of new‐onset seizures in older adults (approximately 55%)

✅The incidence of seizures is highest in those with hemorrhagic stroke and cortical stroke, usually in the middle cerebral artery
#ACCP2022

🛑Medication‐induced dysphaga First‐ and second‐generation antipsychotics ✅CNS‐acting agents can cause sedation and affect cognition
 ✅ Medications that cause xerostomia (dry mouth) 
✅Medications that can cause esophageal irritation when not taken properly (e.g., NSAIDS, bisphosphonates, potassium chloride, iron) 

كتاب Naplex 2023

👇🏼

Naplex 2023
#massoud

#remember

✅FONDAPARINUX for the treatment of adults presenting with Acute coronary syndromes (NSTEMI and Unstable Angina) - NOT for STEMI patients referred for Primary PCI

✅في حالة استخدام fondapranux لمريض بيخضع ل PCI ضروري تضيف الهيبارين 😁

#NHS guidelines

🛑Principles_ when prescribing NSAIDs:
✅i. Use lowest dose possible (not as relevant for short-term use)
✅a. Ibuprofen ≤1600 mg/day
✅. b. Naproxen ≤1000 mg/day

🛑Use for shortest duration possible
✅ Minimal evidence for harm if ≤ 30 days treatment
✅ Aim for ≤5 days in inpatient setting


❌ Risk factors for gastrointestinal (GI) adverse events:
✅a) Age >65 years
✅ b) High-dose NSAID use (e.g.: ibuprofen >1200 mg/day, diclofenac 150 mg/day, naproxen >1000 mg/day)
✅
c) Prolonged treatment with NSAID (e.g.: >7 days) d) Co-treatment with drugs that have additional GI bleeding risk (e.g. antiplatelets, anticoagulants, corticosteroids, selective serotonin reuptake inhibitors (SSRI’s) etc.) e) Previous gastro duodenal ulcer or GI bleeding
✅ f) Serious co-morbidities (cardiovascular, renal, hepatic, diabetes, hypertension)
✅g) Active smoker
✅h) Excessive alcohol consumption

#remember

🛑Carvedilol can increase digoxin levels. Patients, parents and carers should be counselled to monitor for signs of toxicity such as nausea and vomiting. Digoxin levels should be measured 7-14 days after initiation of Carvedilol and before each dose increment

#NUH_guidline

🛑متى استخدم ادوية PPI مثل omeprazole في مريض يستخدم ادويه corticosteroids??


✅الاجابه في حالتين اولا اذا كان المريض راح يستخدم ادويه corticosteroids لأكثر من ثلاثه أسابيع

✅ثانيا في مريض بحجه إلى  استخدم ادويه corticosteroids اكثر من ثلاث كورسات  في السنه مع وجود إحدى عوامل خطر لنزيف الجهاز الهضمي الآتية

✅History of gastrointestinal bleeding, peptic ulcer or gastroduodenal perforation 
✅ Aged 65 years
✅ Concomitant use of drugs known to increase the risk of gastrointestinal bleeding/dyspepsia (e.g. anticoagulants, aspirin, clopidogrel, prasugrel, ticagrelor, NSAIDs, antidepressants (selective serotonin reuptake inhibitors, venlafaxine or duloxetine)) 

✅ Significant co-morbidity (e.g. advanced cancer)
✅ Excessive alcohol consumption
✅ Heavy smoking


#NUH_guidline

#remember

✅the arterial thrombotic risk with diclofenac is similar to that of COX-2 inhibitors.
⛔️diclofenac is now contraindicated in patients with established
✅ischaemic heart disease
  ✅peripheral arterial disease 
✅cerebrovascular disease 
✅congestive heart failure (New York Heart Association [NYHA] classification II–IV)



🅾etoricoxib should not be prescribed to people whose blood pressure is persistently above 140/90 mmHg



🛑بالعربي كذا يعتبر ال diclofenac مثل ال selective COX-2 ( مثل دواء celecoxib )من حيث زيادة خطوره الخثرات  على الرغم من كونه semiselctive
❌ويمنع في حاله كان المريض مصاب بإحدى الأمراض التالية
✅مريض الشريان التاجي بجميع اقسامة ذبحه صدريه ..احتشاء الخ
✅مريض الشريان المحيطي الذي تصيب مرضى السكري وغيره
✅ مريض الجلطات الدماغيه
✅مريض الفشل القلبي



❌لايصرف دواء etoricoxib اذا كان ضغط الدم للمريض فوق 140/90