🅾️General principles

✅The goal of antiasthmatic pharmacotherapy is to counteract bronchoconstriction by reducing bronchial inflammation and parasympathetic tone.
Asthma relievers:

✅drugs effective in acute asthma exacerbation: SABAs, SAMAs, and systemic corticosteroids .

✅Asthma controllers: drugs effective in the long-term management of asthma (i.e., not for acute management)
Commonly used: LABAs, LAMAs, LTRAs, and systemic steroids

✅Not routinely used: monoclonal antibodies, mast cell stabilizers, leukotriene pathway modifiers, and methylxanthines.


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🅾️تذكر جيدا بأن ال
ICS( inhaler corticosteroids)
✅تستخد في حالة chronic asthma
✅أما ال oral corticosteroids تستخدم في حالة ال Acute asthma
💢وليس العكس.. 💢

🅾️ICS(inhaler corticosteroids)

✅The drug of choice for all levels of persistent asthma for all age groups(for chronic control ).
initiated on either daily low-dose ICS therapy along with a SABA as needed, or low-dose ICS–formoterol to use as needed.


🅾️Systemic corticosteroids :
✅Mainly for short term management of worsening asthma and acute
sever asthma
✅Oral rout is commonly used until PEF >70% or FOR (3-7 days ) Usually,
✔️Methylprednisolone,
✔️Prednisolone, and
✔️prednisolone
are used.
💡Dose of prednisolone 1-2mg/kg (children<12 years for 3-5 days) or 40-60 mg/day (>12 years and adults as single or divided dose for 5-7 days).


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#asthma
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🟡@WikipharmaDr 🟡

#معلومه
🅾️A high intake of fruits, vegetables, fiber, and vitamin A may be protective against developing PUD.

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💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

عيدكم مبارك،
وتقبل الله منّا ومنكم صالح الأعمال..! 💛

#معلومه
✅Heme iron is found in meat, fish, and poultry, and is about three times more 
absorbable than the 
nonheme iron found in vegetables, 
fruits, dried beans, nuts, grain products, and dietary supplements..

✅MCV is reduced earlier in IDA than Hb concentration

✅Hb, Hct, and RBC indices usually remain normal in early stages.

✅ In the early stages of IDA, RBC size is not changed.
 Low ferritin concentration 
is the earliest and most
sesitive indicator of iron 
deficiency.However, ferritin may not correlate with
iron stores in the bone
 marrow because renal or 
hepatic disease, 
malignancies, infection, or
 inflammatory processes 
may increase ferritin values


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✅ملاحظات بخصوص كيف نسوي PREVENTION للأطفال من الإصابة بال IDA

✅Maintain breast-feeding for the 1st 5–6 months of life when possible. Although the concentration of iron is lower in breast milk than in formula, iron in breast milk is more bioavailable (50% vs 10%).

✅Iron supplementation (1 mg/kg/d) for infants who are exclusively breastfed beyond 6 months of age

✅Iron-fortified formula for the 1st 12 months of life for infants who are not breastfed

✅Iron supplementation after 2 months of life for low-birth-weight and premature infants because of decreased iron stores and increased growth rate

✅Encourage iron-enriched cereal when infants are started on solid food.

✅Avoid whole cow’s milk during the 1st year of life, to prevent occult GI bleeding.

✅Screen hemoglobin level at periodic intervals. The American Academy of Pediatrics recommends 9 months, 5 years, and 14 years of age.


📌#Lexicomp
💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

Another algorithm of angioedema management .

أسعد الله أوقاتكم بكل خير وصحة وعافيه.. 🌷
⭕️معانا الليلة موضوع ال
Bronchospasm / Asthmatic Attack

✅سنتكلم عن التعريف والأسباب وعلامته وأعراضه وطريقة المعالجة بإذن الله ..

ننطلق
✅DEFINITION
هو عبارة عن حدوث انقباض عام للعضلات الملساء في ال
bronchi and bronchioles of the lungs.
⬅️ينتج عنها إعاقة أو صعوبة في إدخال وإخراج الهوء من الرئتين،
حيث تجد المريض يحصله صعوبه في إخراج الهواء أكثر من لما يستنشقه inhelatin في حالة ال   bronchospasm.

✅Susceptible patients are those with a history of allergies, asthma, COPD, and / or bronchitis.
..


✅#lexicomp
💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

⭕️الأسباب :

معانا  عدة الأسباب ممكن تسبب المرض ،
يعني قد تكون أسباب جينية أو أسباب بيئية وتكون كالتالي
✅Genetic - Inherited tendency for asthma - long-term (chronic) inflammation in the bronchial tubes

✅Environmental (eg, allergens, tobacco smoke)
✅Exercise

✅Emotional stress
✅Obesity

Abnormal backflow (reflux) of stomach contents into the esophagus (gastroesophageal reflux disease - GERD)
وهذه قد تسبب ما تسمى
( Asthma misdiagnosis)

✅Allergic reactions; if anaphylaxis suspected .

✅Pulmonary edema

✅Pneumonia

✅Foreign body

✅Pulmonary embolism

✅Bronchiectasis

✅Subglottic mass..


✅#lexicomp
💡#PharmaDr_Khalid
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⭕️SIGNS / SYMPTOMS / MANIFESTATIONS
العلامات والأعراض التي قد تظهر على المريض وتكون كالتالي :
✅Patient exhibits labored breathing or complains of shortness of breath
يعني صعوبة في التنفس
Wheezing
تسمع صوت أثناء ما يكح أو أثناءاستنشاق الهواء

✅Whistling noise that occurs when the larger airways of the lungs narrow because of inflammation or mucus buildup
تسمع مثل الضجيج بسبب ضيق مجرى التنفس ،التي تسببه الإلتهابات أو زيادة الإفرازات

✅As the bronchial tubes become smaller, wheezing is heard when a person exhales

✅As the episode becomes worse, wheezing may be heard when a person inhales

✅The severity of wheezing does not correlate with the degree of airway obstruction. The absence of wheezing may indicate critical airway obstruction.
عدم وجود ال. Wheezing قد يكون مؤشر الإنسداد الكامل لمجرى التنفس وهذه تعتبر حالة حرجة
✅Chest tightness

✅Anxiety

✅Bronchial cough

✅Increase in respiratory rate

✅Decreased oxygen saturation on the pulse oximeter

✅Decreased ventilation patterns on the capnograph

✅Cyanosis

هذه كانت أهم العلامات والأعراض الذي يجب التركيز عليها في مرضى ال Asthma attak..

✅#lexicomp
💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

⭕️الTREATMENT:

✅Immediately establish airway to maximize oxygen and minimize CO2 buildup
أول شيء نتأكد من التنفس ،من أجل تعويض الأكسجين ونجيب له  supplemental oxygen to keep SpO2 ≥90%

✅نعطيه أيضا  جرعة من ال
a short-acting beta-agonist (eg, albuterol) and an anticholinergic agent (eg, ipratropium)

نجيب له أيضا
Bronchodilating medications
وتكون كالتالي :

✅Albuterol (Ventolin):
Nebulization solution: 2.5 to 5 mg every 20 minutes
نجيبها له ثلاث جرع ثم نجيب له
2.5 to 10 mg every 1 to 4 hours as needed
أو إننا نجيب له
10 to 15 mg per hour by continuous nebulization

✅Metered-dose inhaler:
4 to 8 puffs immediately, then every 20 minutes for up to 4 hours

✅Ipratropium bromide (Atrovent):
في حالة ال
Asthma exacerbation, acute:
نعطيه
Nebulization: 500 mcg every 20 minutes
لمدة ثلاث جرع ،وبعدها نجيب له عند الحاحة
ملاحظة : هذا الدواء يجب أن نعطيه  combination مع ال
a short-acting beta-adrenergic agonist..

✅Metered-dose inhaler:
8 inhalations every 20 minutes as needed for up to 3 hours.
ثمان بخات كل عشرين دقيقة عند الحاجة حتى ثلاث ساعات ..

أيضا هذا الدواء يجب أن نعطيه  combination مع ال
a short-acting beta-adrenergic agonist.
في حالة ال
Bronchospasm associated with COPD:
نعطي ال
✅Nebulization: 500 mcg (one unit dose vial) 3 to 4 times/day with doses 6 to 8 hours apart.

✅Metered-dose inhaler: 2 inhalations 4 times/day, up to 12 inhalations/24 hours.

✅#lexicomp
💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

⭕️في حالة ال
ADVANCED Disease
تكون المعالجة كالتالي

✅Activate EMS
نتعامل معه بالطوارئ

✅CPR, if indicated (patient is unresponsive and not breathing or only gasping
نستخدم ال CPR إذا كان ما يتنفس

✅Inhaled beta-agonist drugs - first line of treatment for intraoperative bronchospasm
ويعتبر الخط العلاحي الأول

✅Epinephrine 0.2 to 0.5 mg using the 1 mg/mL (1:1000) solution IM (intramuscular)
ركز هنا نجيب الجرعة عضلي ،ونعيد الجرعة كل 20 دقيقة حتى نوصل لل maximum of 1 mg total


✅Prednisone 40 to 60 mg orally - one-time dose, OR methylprednisolone (Solu-Medrol) 40 to 80 mg IV if unable to tolerate oral medications

📛بالنسبة لل
OBTUNDED / NONINTUBATED PATIENTS:
نجيب لهم ال
Epinephrine 0.2 to 0.5 mg using the 1 mg/mL (1:1000) solution IM (intramuscular)

أما ال
IV epinephrine:
لا نعطيها إلا في حالة حصول severe bronchospasm only in patient with hypotension present
لأنه ممكن يسوي
precipitate serious dysrhythmias and/or hypertension
وخصوصا يكون خطير في المرضى
with cardiovascular disease
..

✅#lexicomp
💡#PharmaDr_Khalid
🟡@WikipharmaDr 🟡

الأخوة الكرام
تكرماً شاركوا معنا في هذه الدراسة عن خدمة التوصيل المنزلي للأدوية (الميزات والعيوب)...
ولكم جزيل الشكر والتقدير
https://docs.google.com/forms/d/e/1FAIpQLSfNy2kJP0cTqyccQRO3ytv4PPeEE3cKh_HP2oZM6ilwHjDpTQ/viewform

New Updated 2023
AGS Beers criteria.
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هذا ال pdf يحتوي على
® 2023 American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults..

📌#معلومه
✅Edetate (EDTA) calcium disodium (CaNa2 EDTA) is a parenteral chelating agent.
✔️It should never be used as the sole agent in patients manifesting with lead encephalopathy,
🔍because it does not cross the blood-brain barrier and can potentially lead to exacerbation of lead encephalopathy;
🔍dimercaprol, which does cross the blood-brain barrier, should be administered first.

✔️Life-threatening hypocalcemia has been reported when disodium EDTA was inadvertently substituted for CaNa2 EDTA..

Rf: #medscape
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✅Diphenhydramine may help alleviate the adverse effects of dimercaprol.

✅ Iron supplementation should be avoided in patients receiving dimercaprol chelation therapy because dimercaprol forms a complex with iron, leading to toxicity..

📌#medscape
🟡#pharmadr_khalid
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