Pharmacy guide

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pharmacy guide

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2. .. . .. .. . 1. ...................................................... 1 1-1 3 1-2 9 1-3 22 1-4 24 1-5 36 2. ....................................... 55 2-1 57 2-2 65 2-3 73 2-4 79 2-5 82 2-6 86 2-7 89 2-8 92 2-9 94 3.................................... 95 3-1 97 3-2 105 3-3 123 3-4 135 3-5 148 3-6 164 3-7 177 3-8 190 3-9 196 3-10 206 3-11 210 4. .............................. 213 4-1 215 4-2 250 4-3 258 4-4 265 5. /..................................... 271 5-1 273 5-2 277 5-3 284 6. ......................................................... 289 6-1 291 6-2 295 6-3 310 6-4 320 . . . . 2549. 2006 3. 1-1 1-2 1-3 1-4 1-5 1 4. 1-1 3 1-1 (vaginitis vulvovaginitis) 1-1A vaginitis 1. spermicides 2. Trichomonas vaginitis Bacterial vaginosis Candida vulvovaginitis 3. 4. atrophic vaginitis spotting 5. 5. 14 1-1B pH 4.5 - Curd like Frothy Thin 6. 1-1 5 Differential Diagnosis of the Vaginitides 2: Differential Diagnosis of the Vaginitides Clinical Elements Bacterial Vaginosis Trichomoniasis Vaginal Candidiasis Vaginal odor + +/- - Vaginal discharge Thin, gray, homogenous Green-yellow White, curdlike Vulvar irritation +/- + + Symptoms Dyspareunia - + - Vulvar erythema - +/- +/- Bubbles in vaginal fluid + +/-Signs Strawberry cervix - +/- - - Saline wet mount Clue cells + - - Motile protozoa - + - KOH test Pseudohyphae - - + Whiff test + +/- - Microscopy pH >4.5 >4.5 4.5 clue cell 3: bacterial vaginosis 8. 1-1 7 Recommened Regimens : Metronidazole 500 mg bid 7 single dose Clindamycin Cream 2% 7 Metronidazole gel 0.75% 5 Alternative Regimens : Metronidazole (Flagyl 200, 400) 2 g single dose pc Clindamycin (Dalacin C 150, 300) 300 mg bid 7 days metronidazole Clindamycin ovules 100 g vaginally hs 3 3. Candida Valvovaginitis Candida albicans Normal flora STD pH S > O P O O O P O O O R1 R2 R1 R2 OH Cl Etidronate CH3 ClClodronate Tiludronate Pamidronate H OH CH2 CH2 NH2 S Cl Neridronate OH CH2 CH2 CH2 CH2 CH2 NH2 Olpadronate OH CH2 CH2 N CH3 CH3 Alendronate OH CH2 CH2 CH2 NH2 Ibandronate OH CH2 CH2 N CH3 (CH2 )4 CH3 Risedronate OH N Zoledronate OH N N Bisphosphonate 3: bisphosphonate Bisphosphonate Hydroxyapatite (bone resorption) bisphosphonate , lysosomal enzyme, prostaglandin, membrane permeability osteoclast osteoclast osteoclast life span Bisphosphonate 48. 1-5 47 60 bisphosphonate half-life 0.5-2 esophagitis 30 Osteomalacia3 Pagets disease etidronate 3 1-2 Ocular adverse reaction anterior uveitus, episcleritis, scleritis, conjunctivitis Pamidronate IV injection [4-6,14] Etidronate (Didronel 200,400 mg/tab- Usual dose : 5-10 mg/kg/day, NED , Preg. Cat. : B(oral), C (parenteral) ) potency osteoporosis Pagets disease cyclic dosing Etidronate disodium 400 mg/ 2 calcium supplement 2.5 Alendronate (Fosamax 5,10,35,40,70 mg/tab- Usual dose : 5 mg/day or 35 mg/week , NED , Preg. Cat. : C) potency Etidronate 1000 approved FDA osteoporosis Pagets disease Pamidronate (Aredia 30, 90 mg/vial (powder for reconstitute) - Usual dose : 90 mg/day, ED List: , Preg. Cat. : D) potency Etidronate 1000 Hypercalcemia malignancy tumor Pagets disease Risedronate (Actonel 5, 30, 35 mg/tab- Usual dose : 30 mg/day (Pagets disease), 5 mg/day or 35 mg/week(Osteoporosis) , NED , Preg. Cat. : C) potency Etidronate 1000-5000 osteoporosis Pagets disease 5. Calcitonin Calcitonin polypeptide hormone amino acid 32 3527 disulfide bridge amino acid 1 7 biological activity proline amide Calcitonin parafollicular cells Calcitonin , 3 Osteomalacia 49. 1 48 Calcitonin bone matrix Calcitonin Calcitonin receptor osteoclast osteoclast osteoclast calcitonin receptor precursor osteoclast differentiate osteoclast Calcitonin (IV) (IM) (SC) Calcitonin Calcitonin potency 25-50 salmon calcitonin Calcitonin [4-6,14] Salmon Calcitonin (Miacalcin 200 units/0.09ml(nasal spray), 200 units/ml(inj.) Usual dose 200 units/day(intra nasal), 100 units/day (SC, IM) ED List: , Preg Cat : C) 6. Parathyroid Hormone (PTH)[10] PTH hormone 115 Amino acid peptide PTH active vitamin D bone resorption , biosynthesis release vitamin D, PTH PTH osteoblast growth factor PTH 6-24 7. Vitamin D[13] Vitamin D Vitamin D 1. 1.1 Ergocalciferol (Vitamin D2) 50. 1-5 49 1.2 Cholecalciferol (Vitamin D3) 2. Stratum granulosum vitamin D : Organic Pharmaceutical Chemistry 2548 51. 1 50 [4-6] Ergocalciferol [Calciferol 500,000 units/ml (inj.), 8,000 units/ml (drops), Drisdol 50,000 units/cap., 8,000 units/ml (drops)] - Usual dose 400-600 units/day, ED List : , Preg Cat : A, C (dose exceeding recommend) 8. Calcium 1500 mg , , , 1,25- dihydroxyvitamin D, parathyroid hormone 52. 1-5 51 References [1] Barbara G. Wells, Joseph T. DiPiro, Terry L. Schwinghammer, Cindy W. Hamilton. Pharmacotherapy Handbook. 6th ed. New York: McGraw-Hill; 2006. P 304. [2] Carol S. Havens, Nancy D. Sullivan, and Patti Tilton. Manual of out patient Gynecology 3rd Edition: Little Brown and Company. New York 1996, P. 105-111 [3] Leon speroff and Marc A. Fritz. Clinical gynecology Endocrinology and Infertility. 7th Edition: Lippincoff Williams and Wilkins. New York 2005, P. 700-706 [4] Charles FL, Lora LA, Morton PG, and Leonard LL, eds. Drug Information Handbook. 13th ed. Ohio: Lexi-Comp; 2004. [5] Prof. Thep Himathongkam, Prof. Sming Kaojarem, Assoc. Prof. Pinit Kullavanijaya, et al, eds.MIMS Thailand. 95th ed. Bangkok: MediMedia (Thailand); 2004 [6] .. 2547 [7] , , , , . . : . . 4. : , 2547: 359-378. [8] . . 1. : , 2546: 302-303. [9] . . 2. : , 2538 : 203. [10] . . , ; 1 .. 2543. 93-149 [11] . . , ; 1 2546. 118- 121 [12] . . Dispensing Pharmacy Postmenopause Hormone 2548 [13] . . Organic Pharmaceutical Chemistry Vitamins 2548 [14] . . Organic Pharmaceutical Chemistry Calcium Homeostasis 2548 53. 1 52 Phytoestrogens Phytoestrogens 1. Isoflavonoids 2 1.1 Isoflavones (Soy) 1.2 Coumestans (Soybean sprouts) Clover 2. Lignans (Flaxseed) Hops (Bourbon) Phytoestrogens Isoflavones 2 Genistein Daiazein Lignans 2 Enterolactone Enterodiol Coumestrol Coumestans Phytoestrogens Isoflavonoids Lignans Conjugated glycosides Glycosidase (Active form) 1 Biochanin A Genistein P-Ethylphenol + Dihydrogenistein Formononeti Diadzein Equol + O-Desmethylangolensin Matairesinol Enterolacton Seoisolariciresinol Enterodiol Enterolacton 4: Phytoestrogens Phytoestrogens Active form Portal vein (Enterohepatic circulation) Phytoestrogens Phytoestrogens Phytoestrogens (Estrogenic and antiestrogenic effects) red clover Equol 54. 1-5 53 Phytoestrogens (Endogenous estrogen) Steroid . Aromatase Aromatase Androteindione Estrone ( Aromatase ) . 17-hydroxysteroid dehydrogenase 2 17-ketosteroids 17- hydroxysteroids Estrone Estradiol Phytoestrogens Estradiol . Tyrosine specific protein kinase Tyrosine kinase receptors growth factors Epidermal growth factor, Platelet-derived growth factor, Insulin Insuline-like growth factor Phytoestrogen Tyrosine kinase . DNA topoisomerase Genistein cell cycle G2 M . Angiogenesis Angiogenesis neovascularization Angiogenic factors, Phytoestrogens Angiogenesis . Sex hormone binding globulin (SHBG) Phytoestrogens Isoflavonoids Lignans SHBG SHBG Phytoestrogens (Hormone-dependent cancer) . Antioxidant Flavonoids Catechin Oxidation Low-density lipoprotein oxidized LDL Phytoestrogens 55. 1 54 Phytoestrogens (Climacteric symptoms) Phytoestrogens Phytoestrogens (Coronary heart disease) 47 Cholesterol 9.3 LDL cholesterol 12.4 Triglyceride 10.5 Cholesterol Cholesterol HDL cholesterol Isoflavones 40 HDL cholesterol 22 (Osteoporosis) Ipriflavone Isoflavones 500 Osteoclast Phytoestrogens Genistein Tyrosine kinase Angio-genseris Antioxidation Receptors (Unopposed Estrogen) Phytoestrogens Unopposed estrogen Phytoestrogens 56. 2-1 2-2 2-3 2-4 2-5 2-6 2-7 2-8 2-9 2 57. 2-1 57 2-1 (sclera) conjunctiva (cornea) (pupil) (lens) (retina) (aqueous humor) epilthlium ciliary body (posterior chamber) pupil (anterior chamber) aqueous humor (schlemm canal) iris muscle (trabecular muscle) 1: (glaucoma) (optic nerve head) 2-1A 1. (halos) (steroid) 58. 2 58 2. 2-1B 2 1. (Open Angle Glaucoma) (open angle glucoma) 2: (drainage canals) 2. (Closer Angle Glaucoma) (closer angle glaucoma) (iris) 48 3: (iris) 59. 2-1 59 2-1C , (ocular tumors), 2-1D 40 1.5 50 3 21 21 ( 10-20 ) : ( ) 2-1E (tonometry) (ophthalmoscopy) (perimetry) 60. 2 60 iris cornea (gonioscopy) 4: (); () 5: (); (); () 2-1F 1. 2 6: Timoptic Propine Trusopt Pilocarpine Xalatan Propine 61. 2-1 61 Cholinergic (Miotics) parasympathetic ciliary muscle aqueous humor Pilocarpine HCl 1%, 2%, 4% (Isopto carpine ) 2-4 onset 2 . duration 8 . : : S/E cholinergic Pilocarpine Anticholinesterase cholinesterase parasympathetic parasympathetic Physostigmine sulfate (Eserine ), Echothiophate iodide (Phospholine iodide ), Demecarium bromide 1-2 Physostigmine Adrenergic (Sympathomimetic) sympathetic -adrenergic receptor Dipivefrin HCl 0.1% (Propine ), Epinephrine HCl 1%, 2% (Epifrin ) 1-2 12 . : : Di