د.انتصار قالت مهمه في الاورال

https://t.me/c/1899217638/172

هذينا يلي ركزت عليهن الدكتورة

اهم نقاط الانيميا

في IDA كله ⬇️ ماعدا
TOTAL IRON BINDING CAPACITY⬆️⬆️
ك PROPHYLACTIC نعطي
30-60mg/d elemental iron
ك ttt نعطي
200-400 mg/d elemental iron

هذينا فيهن 12-33% من elemental iron⬅️
oral:ferrous (gluc,sul,fum,)
ferric ammonium citrate

New Agents: Expensive
Polysaccharide-Iron Complex, Carbonyl Iron, Heme iron polypeptide(100%elemental iron)

Parenteral Iron therapy:
```
Iron Dextran

```
New agents Nanoparticles:
Ferric Carboxymaltose & Ferumoxytol (Only I/V) impppppp

*📍Advantages of Total Dose Infusion (TDI):1)Avoids non-compliance of the patient.
2)Avoids unpleasant effects of IMI.
3)Allows delivery of the entire dose of iron necessary to correction deficiency
at one time
هذه قالت عليها مهمه⬆️*

Acute Iron Toxicity:Rx:➡️Deferoxamine.........الانتي دوت

chronic Iron Toxicity:Rx:➡️phlebotomy
Deferoxamine ومعاه 2 اخرى يبدن بنفس الحروف

B12 deficiency anemia :
كله نازل ماعدا MCV
Schilling test:
1. Testing for intrinsic factor antibodies
2.Testing for elevated homocysteine and methylmalonic acid levels.

Neurological manifestations✅

Rx: (Parenteral): Cyanocobalamin / Hydroxocobalamin
Oral VitB12: Cyanocobalamin
Hydroxocobalamin is preferred because:
1. More slowly absorbed.
2. More bound to plasma proteins.
3. Slowly excreted.
4. More sustained rise in serum cobalamin

given I/M or deep subcutaneous injections

Folic acid tablets should be prescribed with Vit B12 treatment, but folic acid cannot be
used before a confirmed diagnosis of anemia as may worse neurological symptoms•Neomycin, colchicine, and Antiepileptic drugs (reduce the absorption of B12).
**•Pernicious anemia: Vitamin B12 is given for life by IMI.

Folic acid deficiency anemia:
causes:
Drugs: Phenytoin, Phenobarbitone & Oral contraceptives.Methotrexate, Trimethoprim Pyrimethamine (Treated by folinic acid**)

Folate deficiency develops more rapidly than vitamin B12 deficiency?The daily requirement is high and the body store of folate is low.
**without neurological manifestation

Rx: Folic acid tabletsTherapeutic uses:
.Pregnant women.(To prevent neural tubal defect in newborns)
.Patients with liver disease &with hemolytic anemia.
.With Anticonvulsant drugs**.
.Patients on dialysis (as Folic acid is removed frequently).

❖Erythropoietin (epoetin alfa & beta): are effective in treatment of anemia due to end-stage renal failure❖Darbepoetin is long-acting erythropoietin❖ Granulocyte colony-stimulating factor (G-CSF )(Filgrastim): is used in
cases of neutropenia❖ Interleukin-11, Romiplostim are used in cases of **thrombocytopenia

❖Agents used to treat sickle cell disease:
Hydroxyurea** is an oral ribonucleotide reductase inhibitor

📍Drugs are given locally and systemic circulation terminate its action.
📍At physiological pH, the charged form LAs will be greater than the uncharged (pKa of most LAs 7.5-9)
📍Local anesthetics are less effective when they are injected into infected tissues
because the low extracellular pH favors the charged form (ionized).
📍All local anesthetics, except mepivacaine prilocaine and cocaine are vasodilators (MPC)v imppp
📌That’s why a vasoconstrictor (adrenaline) is added to LA to ⬆️ the duration and
⬇️ systemic absorption and systemic toxicity.

📍Redistribution is the major determinant of anesthesia duration IMP
📍LA with lower pKa has a rapid onset
📍higher solubility makes LA potent and with longer duration
📍Ester LAs have lesser duration because they are prone to hydrolysis (pseudocholinesterase).
📍Amide LAs metabolized in liver
📍Allergy is more common with ester than with amide و لو صارت مع نوع واحد معناها حتى الباقيات نفس الشي لان كلهن فيهن
(PABA)
📍Systemic absorption is determined by dosage, injection site, blood flow, tissue binding and chemistry of LA
📌Treatment for LAST include IMP1- Antiseizure
2- Airway management.
3- Cardiopulmonary support.
4- Administration of 20% lipid emulsion infusion.

Lidocaine: Unfortunately,its use in spinal anesthesia is associated with TNS🦷Articaine : for dental anesthesia,more effective and possibly safer than lidocaine

🍫Benzocaine:topical anesthesia, lead to (methemoglobinemia مع خوه من امه (الامايد) Prilocaine)

Bupivacaine:cardiotoxicity ❤️‍🩹
Low concentration is used to attain prolonged peripheral anesthesia and
analgesia for postoperative pain and labor pain.

may be used in spinal anesthesiaمتاعين الفارما ماعجبهمش الوضع دارو واحد اخرى
Levobupivacaine: less cardiotoxicity,It is less potent🤦🏻‍♀️ but has longer duration of action.

Chloroprocaine: without the risk of TNSrapidly hydrolyzed so less risk of systemic toxicity and less fetal exposure.
It is not preferred as epidural anesthetic because of its neurologic injury🤷🏻‍♀️

Mepivacaine:it causes vasoconstriction, When used for spinal anesthesia, it has less incidence of TNS.
Slowly metabolized by fetus🚫pregnancy

Prilocaine:highest clearance among amide anesthetics🧹
Its metabolites lead to methemoglobinemia قصة خوه يلي مبدري👆🏼
It is used for spinal anesthesia with less risk of TNS than lidocaine

Cocaine:restricted to topical anesthesia
It has intense vasoconstriction which help to reduce bleeding😍, its use
is avoided because it is abuse substance.🥲

EMLA:
lidocaine + prilocaine
هن ال2 فيهن حرف L
commonly used in children to permit the venipuncture for I/V catheter

افطنو لقصة يلي يديرن في MPC↩️VC
قال الدكتور تلقى 2 i معناها amide
كان 1 معناها ايستر
LA💉

و هذا قال جايبه من قبل