‫ﻛﺘﺎﺏ‬

‫ﳐﺘﺼﺮ ﻋﻠﻢ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺴﺮﻳﺮﻱ‬

‫ﺍﻋﺪﺍﺩ‬
‫ﺍﻟﺪﻛﺘﻮﺭ ﺍﻟﺼﻴﺪﻻﻧﻲ‬
‫ﺍﻳﺎﺩ ﲪﻴﺪ ﺍﳋﺰﺍﻋﻲ‬

‫‪١‬‬
‫ﺍﻟﺼﻔﺤﺔ‬ ‫ﺍﳌﻮﺿﻮﻉ‬ ‫ﺍﻟﺘﺴﻠﺴﻞ‬
‫‪٤‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ‬ ‫‪١‬‬
‫‪١٥‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﳉﻬﺎﺯ ﺍﻟﻘﻠﺒﻲ ﺍﻟﻮﻋﺎﺋﻲ‬ ‫‪٢‬‬
‫‪٦٠‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ‬ ‫‪٣‬‬
‫‪٦٧‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ‬ ‫‪٤‬‬
‫‪٨٠‬‬ ‫ﺍﳌﻀﺎﺩ ﺍﳊﻴﻮﻳﺔ‬ ‫‪٥‬‬
‫‪٩٤‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﻟﻐﺪﺩ ﺍﻟﺼﻤﺎء‬ ‫‪٦‬‬
‫‪١٠٥‬‬ ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﻨﺴﺎﺋﻴﺔ ﻭﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ‬ ‫‪٧‬‬
‫ﻭﺍﻟﱪﻭﺳﺘﺎﺕ‬
‫‪١١٧‬‬ ‫ﺍﺩﻭﻳﺔ ﺍﳌﺴﻜﻨﺔ ﻟﻼﱂ‬ ‫‪٨‬‬

‫‪٢‬‬
 ‫ﺑﺴﻢ ﺍﷲ ﺍﻟﺮﲪﻦ ﺍﻟﺮﺣﻴﻢ‬

‫ﻋﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ ﻣﻦ ﺍﻟﻌﻠﻮﻡ ﺍﻟﻄﺒﻴﺔ ﺍﳌﻬﻤﺔ ﻻﻧـﻪ ﻳـﺸﻜﻞ ﺍﺣـﺪ ﺍﻻﺭﻛـﺎﻥ ﺍﻟﺮﺋﻴـﺴﻴﺔ ﰲ ﺗـﺪﺑﲑ ﺍﳊـﺎﻻﺕ‬
‫ﺍﳌﺮﺿﻴﺔ ‪،‬ﻭﻣﻦ ﻫﺬﺍ ﺍﳌﻨﻄﻠﻖ ﻳﻜﻮﻥ ﺻﺎﺣﺐ ﻫﺬﺍ ﺍﻟﻌﻠﻢ ﻭﻫﻮ ﺍﻟﺼﻴﺪﱄ ﻫﻮ ﺍﻳـﻀﺎ ﺍﺣـﺪ ﺍﻻﺭﻛـﺎﻥ ﺍﳌﻬﻤـﺔ‬
‫ﺿﻤﻦ ﺍﻟﻜﺎﺩﺭ ﺍﻟﻄﺒﻲ ﻻﻧﻪ ﻳﻮﻓﺮ ﳍﻢ ﺍﳌﻌﻠﻮﻣﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﰲ ﺃﻱ ﻭﻗﺖ ﳛﺘﺎﺟﻮﻧﻬﺎ ﺧﺎﺻﺔ ﺑﻌـﺪ ﺍﻟﺘﻮﺳـﻊ‬
‫ﺍﳊﺎﺻﻞ ﰲ ﺍﻻﺩﻭﻳﺔ ﻭﺍﺳﺘﻌﻤﻼﺗﻬﺎ ﻭﺗﺪﺍﺧﻼﺗﻬﺎ ﻭﻣﻮﺍﻧﻊ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻭﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻭﺑﺪﺍﺋﻠﻬﺎ ﺣﻴﺚ‬
‫ﺟﻌﻞ ﻫﺬﺍ ﺍﻟﺘﻮﺳﻊ ﻣﻦ ﺷﺒﻪ ﺍﳌﺴﺘﺤﻴﻞ ﻋﻠﻰ ﺍﻟﻄﺒﻴـﺐ ﺍﻻﳌـﺎﻡ ﺑﻬـﺬﺍ ﺍﻟﻜـﻢ ﺍﳍﺎﺋـﻞ ﻣـﻦ ﺍﳌﻌﻠﻮﻣـﺎﺕ‬
‫ﺍﻟﺪﻭﺍﺋﻴﺔ ‪.‬‬
‫ﻭﳍﺬﺍ ﺟﺎء ﻫﺬﺍ ﺍﻟﻜﺘﺎﺏ ﻟﻴﻮﻓﺮ ﻣﻨﻄﻠﻖ ﻟﻜﺜﲑ ﻣﻦ ﻃﻼﺏ ﺍﻟﻄﺐ ﻭﺍﻟـﺼﻴﺪﻟﺔ ﻟـﺪﺧﻮﻝ ﺍﱃ ﻛﺘـﺐ ﺍﺧـﺮﻯ‬
‫ﺍﻭﺳﻊ ‪ ،‬ﺣﻴﺚ ﺍﻥ ﻛﺜﲑ ﻣﻦ ﻃﻼﺏ ﺍﻟﻄﺐ ﻭﺍﻟﺼﻴﺪﻟﺔ ﺑﻌﺪ ﺍﻟﺘﺨﺮﺝ ﻳﺒﺤﺜﻮﻥ ﻋـﻦ ﻛﺘـﺎﺏ ﻳـﻀﻢ ﲨﻴـﻊ‬
‫ﺍجملﻤﻮﻋﺎﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻭﻟﻜﻦ ﺑﺼﻮﺭﺓ ﳐﺘﺼﺮﺓ ﺣﱴ ﳝﻜﻦ ﺍﻻﻃﻼﻉ ﻋﻠﻴﻬﺎ ﻭﻋﻨﺪ ﺍﻟﺘﻮﺳـﻊ ﻳﺮﺟﻌـﻮﻥ ﺍﱃ‬
‫ﺍﳌﺼﺎﺩﺭ ﺍﻻﺧﺮﻯ ﺍﻟﻜﺒﲑﺓ ‪.‬‬
‫ﻭﻗﺪ ﺗﻨﺎﻭﻟﺖ ﰲ ﻫﺬﺍ ﺍﻟﻜﺘﺎﺏ ﺷﺮﺡ ﺍﻏﻠﺐ ﺍجملﻤﻮﻋﺎﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺘﻲ ﳛﺘﺎﺟﻬﺎ ﺍﻟﻄﺒﻴﺐ ﻭ ﺍﻟﺼﻴﺪﱄ‬
‫ﰲ ﻋﻤﻠﻪ ﺑﺼﻮﺭﺓ ﺷﺎﻣﻠﺔ ﻟﻜﻦ ﳐﺘﺼﺮﻩ ﻭﻣﺒﺴﻄﺔ ‪.‬‬
‫ﻭﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﻜﺘﺎﺏ ﻫﻮ ﺍﻟﺘﺠﺮﺑﺔ ﺍﳋﺎﻣﺴﺔ ﱄ ﺑﺎﻋﺪﺍﺩ ﺍﻟﻜﺘﺐ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺑﻌﺪ ﻛﺘﺎﺏ‬
‫–ﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﺑـﲔ ﺍﻟـﺼﻴﺪﱄ ﻭﺍﻟﻄﺒﻴـﺐ – ﻭﻛﺘـﺎﺏ ﺻـﻴﺪﻟﺔ ﺍجملﺘﻤـﻊ – ﻭﻛﺘـﺎﺏ ﺍﻟـﻒ ﻣﻌﻠﻮﻣـﺔ‬
‫ﺻﻴﺪﻻﻧﻴﺔ – ﻭﻛﺘﻴﺐ ﻛﻴﻒ ﺗﻘﺮء ﲣﻄﻴﻂ ﺍﻟﻘﻠﺐ ﺍﻟﻜﻬﺮﺑﺎﺋﻲ ‪.‬‬
‫ﻭﻣــﺼﺎﺩ ﻫــﺬﺍ ﺍﻟﻜﺘــﺎﺏ ﻛﺜــﲑﻩ ﻭﻟﻜــﻦ ﺍﻫﻤﻬــﺎ ﻫــﻮ ﻛﺘــﺎﺏ ‪ BNF 67‬ﻭﻛﺘــﺎﺏ ‪Rapid clinical‬‬
‫‪ pharmacology‬ﻭﻛﺘﺎﺏ ‪ clinical pharmacy – walker‬ﻭﻫﻲ ﻛﺘﺐ ﺟﺪﺍ ﺭﺻﻴﻨﺔ ﻭﻣﻮﺛﻮﻗﺔ ﺑـﻞ‬
‫ﺗﻌﺘﱪ ﺍﳌﺎﺩﺓ ﺍﻻﺳﺎﺱ ﻟﻠﻤﻮﺍﺩ ﺍﻟﻌﻠﻤﻴﺔ ﰲ ﻛﻠﻴﺎﺕ ﺍﻟﺼﻴﺪﻟﺔ ﻭﺍﻟﻄﺐ ﻭﰲ ﻛﻼ ﺍﻟﺪﺭﺍﺳﺘﲔ ﺍﻻﻭﻟﻴﺔ ﻭﺍﻟﻌﻠﻴﺎ ‪.‬‬

‫ﺍﻟﺪﻛﺘﻮﺭ ﺍﻟﺼﻴﺪﻻﻧﻲ ‪.‬‬

‫ﺍﻳﺎﺩ ﲪﻴﺪ ﺍﳋﺰﺍﻋﻲ‬

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‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Proton pump inhibitors‬‬

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 ‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Proton pump inhibitors‬ﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Omeprazole,‬‬
‫‪.lansoprazole, esomeprazole, pantoprazole‬‬
‫ﺗﻌﻤﻞ ﻋﻠﻰ ﻣﻨﻊ ﺍﻓﺮﺍﺯ ﺗﻘﺮﻳﺒﺎ ‪ %٩٠‬ﻣﻦ ﺣﺎﻣﺾ ﺍﳌﻌﺪﺓ ‪.‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺗﺒﻄﻞ ﻣﻔﻌﻮﻝ ﺍﻟﺒﺒﺴﲔ ﺍﻳﻀﺎ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﺍﺧﺮ ﻣﺮﺣﻠﺔ ﻻﻓﺮﺍﺯ ﺣﺎﻣﺾ ﺍﳌﻌﺪﺓ ﻭﺗﺴﺘﻌﻤﻞ‬
‫ﰲ‪:‬‬
‫ﻣﻌﺎﳉﺔ ﺍﻟﻘﺮﺣﺔ ﺍﳌﻌﺪﻳﺔ ﻭﺍﻻﺛﻨﻲ ﻋﺸﺮﻱ ﺑﻔﻌﺎﻟﻴﺔ ﻋﺎﻟﻴﺔ ﺟﺪﺍ ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪Gastro-‬‬
‫‪.oesophageal reflux disease‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ‪ Zollinger-Ellison syndrome‬ﺍﻟﺘﻲ ﻋﺒﺎﺭﺓ ﻋﻦ ﻭﺭﻡ ﻳﻔﺮﺯ ﺣﺎﻣﺾ ﺑﺼﻮﺭﺓ ﻏﲑ‬
‫ﻃﺒﻴﻌﻴﺔ ﻭﺍﻛﺜﺮ ﻣﻦ ﺍﻟﻄﺒﻴﻌﻲ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺴﺮ ﺍﳍﻀﻢ ﺑﺴﺒﺐ ﺍﻓﺮﺍﺯ ﺍﳊﺎﻣﺾ ‪. Acid-related dyspepsia‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﻭﻣﻨﻊ ﺍﻟﻘﺮﺣﺔ ﺑﺴﺒﺐ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﻜﻨﺔ ‪Prevention and treatment‬‬
‫‪. of NSAID-associated ulcers‬‬

‫ﻭﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻻﺩﻭﻳﺔ ‪Proton pump inhibitors‬ﻫﻲ‪:‬‬

‫ﺍﱂ ﺍﻟﺒﻄﻦ‪.‬‬
‫ﻭﺍﻟﻐﺜﻴﺎﻥ ‪.‬‬
‫ﻭﺍﻟﺘﻘﻴﻮء ‪.‬‬
‫ﻭﺍﻻﺳﻬﺎﻝ ‪.abdominal pain, nausea, vomiting, diarrhea‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ gastric infections‬ﻧﺘﻴﺠﺔ ﻧﻘﺺ ﺍﻓﺮﺍﺯ ﺍﳊﺎﻣﺾ ﺍﻟﺬﻱ ﻣﻦ ﻓﻮﺍﺋﺪﻩ ﺍﻧﻪ‬
‫ﻣﻄﻬﺮ ﻣﻦ ﺍﻟﻌﺪﻭﻯ ﻭﺍﳉﺮﺍﺛﻴﻢ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻘﻠﻞ ﺍﻓﺮﺍﺯ ﺍﳊﺎﻣﺾ ﺑﻨﺴﺒﺔ ﺍﻛﺜﺮ ﻣﻦ ‪ % ٩٠‬ﻟﺬﺍ ﻓﻬﻲ ﺍﻛﺜﺮ ﻓﻌﺎﻟﻴﺔ ﰲ ﻣﻌﺎﳉﺔ‬
‫ﺍﻟﻘﺮﺣﺔ ﻣﻦ ﺍﺩﻭﻳﺔ ‪ H2 receptor antagonists‬ﺍﻟﺘﻲ ﺗﻘﻠﻞ ﺍﻓﺮﺍﺯ ﺍﳊﺎﻣﺾ ﺑﻨﺴﺒﺔ ﺍﻗﻞ ﻣﻦ ‪. %٦٠‬‬
‫ﻭﻣﻦ ﺍﻻﺳﺘﻌﻤﺎﻻﺕ ﺍﳌﻬﻤﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﻣﻌﺎﳉﺔ ﺍﻟﻨﺰﻳﻒ ﰲ ‪.acute upper GI bleeds‬‬
‫ﻭﺫﻟﻚ ﻋﻦ ﻃﺮﻳﻖ ﺍﻻﻋﻄﺎء ﺍﻟﻮﺭﻳﺪﻱ ﺍﻟﺒﻄﻲء ﻋﻦ ﻃﺮﻳﻖ ﺍﶈﺎﻟﻴﻞ ﻣﺜﻞ ‪. normal saline‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ﻭ ‪. biliary routes‬‬
‫ﻭﻫﻲ ﻣﺘﻮﻓﺮﺓ ﻋﻠﻰ ﺷﻜﻞ ﻛﺒﺴﻮﻝ ﻭﺣﻘﻦ ﰲ ﺍﻏﻠﺐ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﻗﺒﻞ ﺗﻨﺎﻭﻝ ﺍﻟﻄﻌﺎﻡ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Histamine type 2 receptor antagonists‬‬

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‫ﳎﻤﻮﻋﺔ ﺩﻭﺍﺋﻴﺔ ﻣﻬﻤﺔ ﻭﻫﻲ ‪. Histamine type 2 receptor antagonists‬‬

‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻓﺮﺍﺩ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻮ‪:‬‬
‫ﺩﻭﺍء ‪. Ranitidine‬‬
‫ﻭ ﺩﻭﺍء ‪. cimetidine‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺣﺒﺎﺋﻲ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ‪ all histamine type 2 receptors‬ﻭﺑﺎﻟﺘﺎﱄ ﻫﺬﺍ‬
‫ﻳﺆﺩﻱ ﺍﱃ ﻣﻨﻊ ﺧﺮﻭﺝ ﺣﺎﻣﺾ ﺍﳌﻌﺪﺓ ﺍﻟﺬﻱ ﻳﻔﺮﺯ ﻋﻦ ﻃﺮﻳﻖ ‪ parietal cells‬ﰲ ﺍﳌﻌﺪﺓ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﺳﺘﻌﻤﺎﻻﺕ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﻟﻘﺮﺣﺔ ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﺍﳌﻌﺪﺓ ﻭﺍﻻﺛﻨﻲ ﻋﺸﺮﻱ‬
‫ﺣﻴﺚ ﳛﺪﺙ ﺗﻘﺮﺡ ﰲ ﺟﺪﺍﺭ ﺍﳌﻌﺪﺓ ﺍﻭ ﺍﻻﺛﻨﻲ ﻋﺸﺮﻱ ﺍﻣﺎ ﻧﺘﻴﺠﺔ ﻗﻠﺔ ﻭﺳﺎﺋﻂ ﺍﳊﻤﺎﻳﺔ ﺍﻭ ﻧﺘﻴﺠﺔ ﺯﻳﺎﺩﺓ‬
‫ﺍﻓﺮﺍﺯ ﺍﳊﺎﻣﺾ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ‪ Gastro-oesophageal reflux‬ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﺿﻌﻒ‬
‫ﰲ ﺍﻟﻔﺘﺤﺔ ﺍﻟﻔﺆﺩﺍﻳﺔ ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺭﺟﻮﻉ ﺍﳊﺎﻣﺾ ﺍﳌﻌﺪﻱ ﺍﱃ ﺍﳌﺮﻱء ﻭﺣﺪﻭﺙ ﺍﻋﺮﺍﺽ ﺍﳌﺮﺽ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻭﻣﻨﻊ ﺣﺪﻭﺙ ﺍﻟﺘﻘﺮﺡ ﺑﺴﺒﺐ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻻﺩﻭﻳﺔ ﺍﳌﻀﺎﺩﺓ ﻟﻼﻟﺘﻬﺎﺏ‬
‫‪. NSAID-associated ulcers‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﺗﺎﺛﲑﻩ ﻋﻠﻰ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ﻭﺍﻫﻤﻬﺎ ﺣﺪﻭﺙ‬
‫‪. diarrhea‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺯﻳﺎﺩﺓ ﰲ ﺣﺠﻢ ﺍﻟﺜﺪﻱ ﻋﻨﺪ ﺍﻟﺮﺟﺎﻝ ‪ Gynaecomastia‬ﻭﺧﺎﺻﺔ ﻋﻨﺪ‬
‫ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء )‪. (cimetidine‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺒﻮﻝ ﻭﺍﻟﻨﺼﻒ ﺍﻟﻌﻤﺮﻱ ﳍﺎ ﻫﻲ ﻣﻦ ‪ ٣-٢‬ﺳﺎﻋﺔ ﻓﻘﻂ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺪﺍﺧﻼﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﳍﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻮ ﺗﺪﺍﺧﻞ ﺩﻭﺍء ‪ Cimetidine‬ﺍﻟﺬﻱ ﻳﺜﺒﻂ‬
‫‪ Cytochrome P450 activity‬ﰲ ﺍﻟﻜﺒﺪ ﳑﺎ ﻳﺰﻳﺪ ﻣﻦ ﺗﺎﺛﲑ ﺑﻌﺾ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺘﺎﻳﺾ ﺑﻮﺍﺳﻄﺔ‬
‫ﻫﺬﺍ ﺍﻻﻧﺰﻳﻢ ﻣﺜﻞ ﺩﻭﺍء ‪. warfarin, phenytoin and theophylline‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ ﺩﻭﺍء ‪ Ranitidine‬ﻳﺴﺘﻌﻤﻞ ﻗﺒﻞ ﺍﺟﺮﺍء ﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺎﻡ ﳌﻨﻊ ﻋﻤﻠﻴﺔ‬
‫‪ aspiration‬ﻟﻠﺤﺎﻣﺾ ﺍﺛﻨﺎء ﺍﻟﺘﺨﺪﻳﺮ ‪.‬‬

‫‪٦‬‬
 ‫ﺍﺩﻭﻳﺔ ‪.Antimuscarinics‬‬
‫**********************‬
‫ﺍﻥ ﺍﺩﻭﻳﺔ ‪ Antimuscarinics‬ﺗﺸﻤﻞ ﻋﺪﺓ ﺍﺩﻭﻳﺔ ﺍﻫﻤﻬﺎ ﻫﻲ ‪Atropine, hyoscine,‬‬
‫‪. procyclidine‬‬
‫ﻭﺗﻘﻮﻡ ﺑﻐﻠﻖ ‪ blocking specific muscarinic receptors‬ﻭﺗﺆﺩﻱ ﻣﻨﻊ ﺗﻘﻠﺺ ﺍﻟﻌﻀﻼﺕ‬
‫ﺍﳌﻠﺴﺎء ﻭﺍﻻﻧﺴﺠﺔ ﺍﻟﻐﺪﻳﺔ ﺍﻟﺘﻲ ﺗﻐﺬﻱ ﺑــ‪. postganglionic cholinergic neurons‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﻗﻠﺔ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ )‪.(atropine‬‬
‫ﻭﺍﻟﺘﻘﻠﺼﺎﺕ ﰲ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ)‪. (hyoscine‬‬
‫ﻭﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺳﻠﺲ ﺍﻟﺒﻮﻝ‪. Oxybutynin,‬‬
‫ﻭﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ )‪.(procyclidine‬‬
‫ﻭﳑﻨﻮﻉ ﰲ ﻣﺮﺽ ﺍﻟﻮﻫﻦ ﺍﻟﻌﻀﻠﻲ‪.‬‬
‫ﻭﺗﻀﺨﻢ ﺍﻟﱪﻭﺳﺘﺎﺕ ‪.‬‬
‫ﻭﺗﺴﺒﺐ ﺍﻟﻘﺒﺾ ﻭﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﻝ ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ﻭﺿﻄﺮﺍﺏ ﺍﻟﺮﺅﻳﺔ ﻭﺍﻳﻀﺎ ﺗﻨﻔﻊ ﰲ ﺗﻘﻠﻴﻞ ﺧﺮﻭﺝ‬
‫ﺍﻓﺮﺍﺯﺍﺕ ﺍﻟﺘﻨﻔﺲ ﺍﺛﻨﺎء ﺍﻟﺘﺨﺪﻳﺮ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﻳﺪ ﻧﻌﺎﺱ ﺍﺫﺍ ﰎ ﺍﻋﻄﺎء ‪. hyoscine given with alcohol‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﺍﱃ ﺷﻜﻞ ﻏﲑ ﻓﻌﺎﻝ ‪.‬‬
‫ﻭﻻﺗﻌﻄﻰ ﰲ ﺣﺎﻟﺔ‪ Pyloric stenosis‬ﻭﻻ ﰲ ‪. Paralytic ileus‬‬

‫ﻭﻫﺬﺍ ﺗﻠﺨﻴﺺ ﺑﺴﻴﻂ ﻋﻦ ﻋﻼﺝ ﺍﻻﺗﺮﻭﺑﲔ ‪.‬‬

‫*************************‬
‫ﺍﻥ ﺩﻭﺍء ‪ Atropine‬ﻳﺴﺒﺐ ‪:‬‬
‫ﻏﻠﻖ ﻣﺴﺘﻘﺒﻞ ‪.muscarinic‬‬
‫ﻭ ﻣﻨﻊ ﺍﻓﺮﺍﺯ ‪.gastric acid‬‬
‫ﻭ ﻭﺗﻘﻠﻴﻞ ﺍﳊﺮﻛﺔ ﺍﻟﺘﻤﻌﺠﻴﺔ ﻟﻠﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺘﻼﺯﻣﺔ ﺗﻬﻴﺞ ﺍﻟﻘﻮﻟﻮﻥ‪.‬‬
‫ﻭﻣﺴﺎﻋﺪ ﻟﻌﻼﺝ ﺍﻟﻘﺮﺣﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﻌﻤﻞ ﻣﻀﺎﺩ ﺗﺴﻤﻢ ﻟﺒﻌﺾ ﺍﻻﺩﻭﻳﺔ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪ xerostomia,‬ﻭ ‪. photophobia,‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻗﺒﺾ –ﺍﻣﺴﺎﻙ – ‪.‬‬
‫ﻭﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﻝ‪.‬‬

‫‪٧‬‬
 ‫ﻭﺍﻳﻀﺎ ﺗﻌﺘﱪ ﺍﳉﺮﻋﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺟﻔﺎﻑ ﺍﻟﻔﻢ ﺗﺴﺒﺐ ﻗﻠﺔ ﺑﺎﻓﺮﺍﺯ ﺣﺎﻣﺾ ﺍﳌﻌﺪﺓ ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪Dopamine antagonist anti-emetics‬‬

‫************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Dopamine antagonist anti-emetics‬ﺗﻀﻢ ﻛﻞ ﻣﻦ‪:‬‬

‫‪. Domperidone, metoclopramide‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪. Nausea and vomiting‬‬
‫ﻭﳑﻨﻮﻉ ﰲ ﺣﺎﻟﺔ ‪ Hyperprolactinaemia‬ﻭ ‪. Phaeochromocytoma‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪. Drowsiness‬‬
‫ﻭ ‪. Confusion‬‬
‫ﻭ ‪. Tardive dyskinesia‬‬
‫ﻭ ‪. Hyperprolactinaemia‬‬
‫ﻭ ‪. Extra-pyramidal symptoms‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﺛﻼﺙ ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻋﻠﻰ ﺷﻜﻞ ‪:‬‬
‫ﺍﻗﺮﺍﺹ ‪.‬‬
‫ﻭﺣﺒﻮﺏ ‪.‬‬
‫ﻭﺣﻘﻦ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﻗﺒﻞ ﺗﻨﺎﻭﻝ ﺍﻟﻄﻌﺎﻡ ‪.‬‬
‫ﻭﻣﻔﻴﺪﺓ ﻟﻼﻃﻔﺎﻝ ﻭﺍﻟﻜﺒﺎﺭ ﻭﺍﻟﺮﺟﺎﻝ ﻭﺍﻟﻨﺴﺎء ‪.‬‬
‫ﻭ ﺩﻭﺍء ‪Metoclopramide‬ﺗﺰﻳﺪ ﻣﻦ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻼﺯﻣﻲ ﻟﻜﻞ ﻣﻦ ‪. ciclosporin and NSAIDs‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻟﻘﻮﻝ ﺍﻥ ﺩﻭﺍء ‪ Ketoconazole‬ﻳﺰﻳﺪ ﻣﻦ ﺣﺪﻭﺙ ‪ arrhythmias‬ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ‬
‫‪. Domperidone‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﻣﻦ ﻧﺎﺣﻴﺔ ﻣﺮﺿﻴﺔ ﳚﺐ ﻋﺪﻡ ﺍﻻﻛﺘﻔﺎء ﲟﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺑﺪﻭﻥ ﻣﻌﺮﻓﺔ ﺳﺒﺒﻬﻤﺎ‬
‫‪.‬‬
‫ﻭﻋﻼﺝ ‪ Domperidone‬ﺟﺪﺍ ﻧﺎﻓﻊ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ‪:‬‬
‫‪ chemotherapy‬ﻭ ‪.radiotherapy‬‬

‫‪٨‬‬
 ‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ‪ severe extra-pyramidal side-effects‬ﻭﺧﺎﺻﺔ ﰲ ‪. elderly patients‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Laxatives‬‬

‫********************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Laxatives‬ﺗﺸﻤﻞ ﻋﺪﺓ ﺍﻧﻮﺍﻉ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻻﻭﻝ ﻣﻨﻬﺎ ‪ :‬ﻫﻮ ‪Bulk laxatives‬‬
‫ﺍﻟﺬﻱ ﻳﻀﻢ ﺍﺩﻭﻳﺔ ﻛﺜﲑﺓ ﺍﻫﻤﻬﺎ ‪. ispaghula husk‬‬
‫ﻭﺍﻟﺜﺎﻧﻲ ﻣﻨﻬﺎ‪ Osmotic laxatives :‬ﻣﺜﻞ ‪ lactulose,‬ﺣﻴﺚ ﺗﺰﻳﺪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺣﺠﻢ‬
‫ﺍﳌﺎء ﰲ ‪.bowel lumen‬‬
‫ﻭﺍﻟﺜﺎﻟﺚ ﻣﻨﻬﺎ‪ Stimulant laxatives :‬ﻣﺜﻞ ‪ docusate sodium‬ﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺯﻳﺎﺩﺓ‬
‫ﺗﻘﻠﺺ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﻭﺯﻳﺎﺩﺓ ﺍﳊﺮﻛﺔ ﺍﻟﺘﻤﻌﺠﻴﺔ ﺍﻟﺪﻭﺩﻳﺔ ﻟﻼﻣﻌﺎء ‪smooth muscle‬‬
‫‪contraction and increased peristalsis‬‬
‫ﻭﺍﻟﺮﺍﺑﻊ ﻣﻨﻬﺎ‪ Faecal softeners :‬ﻣﺜﻞ ‪ arachis oil‬ﺣﻴﺚ ﺗﺴﻤﺢ ﺑﺪﺧﻮﻝ ﺍﱃ ﺍﳌﺎء ﺍﱃ ﺍﳋﺮﻭﺝ‬
‫ﺍﻟﺼﻠﺐ ﻟﺘﺠﻌﻠﺔ ‪ soften faeces.‬ﻭﻳﺴﻬﻞ ﺧﺮﻭﺟﻪ ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲨﻴﻌﺎ ﰲ ﻣﻌﺎﳉﺔ ﺍﻻﻣﺴﺎﻙ ‪. Constipation‬‬
‫ﺍﻣﺎ ﻋﻼﺝ ‪ lactulose‬ﻓﻴﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ Hepatic encephalopathy‬ﻻﻧﻪ ﻳﻘﻠﻞ ﻣﻦ ﺍﻧﺘﺎﺝ‬
‫‪ ammonia-producing organisms‬ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﺗﺪﻫﻮﺭ ﻫﺬﺍ ﺍﳌﺮﺽ ‪.‬‬
‫ﻭﳚﺐ ﲡﻨﺐ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ‪:‬‬
‫ﺣﺎﻟﺔ ﺍﻧﺴﺪﺍﺩ ﺍﻻﻣﻌﺎء ‪. Bowel obstruction‬‬
‫ﻭﳚﺐ ﲡﻨﺐ ﺩﻭﺍء ‪ lactulose‬ﰲ ‪. Galactosaemia‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﻋﺪﻡ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ‪:‬‬
‫‪.Acute inflammatory bowel disease‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ‪. Severe dehydration‬‬
‫ﻭﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ‪:‬‬
‫ﺍﻧﺘﻔﺎﺥ ﺍﻟﺒﻄﻦ ﻭﺍﻟﻐﺎﺯﺍﺕ‪. Flatulence‬‬
‫ﻭﺍﻻﺳﻬﺎﻝ ‪. Diarrhoea‬‬
‫ﻭﺍﱂ ﺍﻟﺒﻄﻨﻮﺍﻟﺸﻌﻮﺭ ﺑﺎﻟﺘﻘﻠﺺ ﻭﻋﺪﻡ ﺍﻻﺭﺗﻴﺎﺡ ‪. Abdominal cramps‬‬
‫ﻭﺍﺿﻄﺮﺍﺏ ﰲ ‪. Electrolyte disturbances‬‬
‫ﻛﻤﺎ ﺍﻥ ﺩﻭﺍء ‪ Lactulose‬ﳝﻜﻦ ﺍﻥ ﻳﺰﻳﺪ ﻣﻦ ﻓﻌﻞ ﻋﻼﺝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﻣﺮﺽ ﻛﺒﺪﻱ‬
‫ﺷﺪﻳﺪ ‪.‬‬
‫ﻛﻤﺎ ﳚﺐ ﺍﻟﺘﻮﺿﻴﺢ ﻟﻠﻤﺮﻳﺾ ﺍﻥ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﻬﻠﺔ ﻣﻦ ﻧﻮﻉ ‪osmotic or bulking laxatives‬‬
‫ﲢﺘﺎﺝ ﺍﱃ ‪ ٣-٢‬ﻳﻮﻡ ﺣﱴ ﺗﻌﻄﻰ ﺍﻟﺘﺎﺛﲑ ﺍﻟﻌﻼﺟﻲ ﺍﻟﻜﺎﻣﻞ ﳍﺎ ‪.‬‬

‫‪٩‬‬
 ‫ﻣﻦ ﻧﺎﺣﻴﺔ ﺳﺮﻳﺮﻳﺔ ﻗﺒﻞ ﻭﺻﻒ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﻬﻠﺔ ﳚﺐ ﺍﻟﺒﺤﺚ ﻋﻦ ﺳﺒﺐ ﺍﻻﻣﺴﺎﻙ ﺍﻟﺮﺋﻴﺴﻲ ﻭﻻﻳﺼﺢ‬
‫ﺍﻻﻛﺘﻔﺎء ﺑﺎﳌﻌﺎﳉﺔ ﺍﻟﻌﺮﺿﻴﺔ ﻟﻠﺪﻭﺍء ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪Antihistamine anti-emetics‬‬

‫****************************‬
‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Antihistamine anti-emetics‬ﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Cyclizine,‬‬
‫‪. promethazine‬‬
‫ﺗﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ‪ H1 receptor antagonists‬ﺍﻟﺘﻲ ﺗﺜﺒﻂ ﻣﺒﺎﺷﺮﺓ ‪CTZ in the‬‬
‫‪. medulla‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﳚﻌﻠﻬﺎ ﲤﺘﻠﻚ ‪. anticholinergic and anti-emetic properties‬‬
‫ﻭﺍﻳﻀﺎ ﻋﻼﺝ ‪ Cyclizine‬ﻳﺰﻳﺪ ﻗﻮﺓ ‪ oesophageal sphincter‬ﺍﻟﺘﻲ ﺗﻘﻊ ﺍﺳﻔﻞ ﺍﳌﺮﻱء ﻭﺑﺪﺍﻳﺔ‬
‫ﺍﳌﻌﺪﺓ ﻭﺍﻳﻀﺎ ﻳﻘﻠﻞ ﻣﻦ ﲢﺴﺲ ‪. labyrinthine apparatus‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪ Nausea and vomiting‬ﺑﺼﻮﺭﺓ ﻋﺎﻣﺔ ‪.‬‬
‫ﻭﰲ ﺍﳊﻤﻞ ‪. Hyperemesis in pregnancy‬‬
‫ﻭﰲ ‪. labyrinthine disorders‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺬﻱ ﻳﻜﻮﻥ ﻣﺼﺎﺣﺐ ﳊﺎﻟﺔ ‪. motion sickness‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻟﺘﲔ ﻫﻤﺎ ‪:‬‬
‫ﺣﺎﻟﺔ ﺗﻀﺨﻢ ﺍﻟﱪﻭﺳﺘﺎﺕ ﺍﻟﺸﺪﻳﺪﺓ ‪ Severe prostatic hypertrophy‬ﺟﺪﺍ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﺍﳌﺮﺿﻰ ﺍﻟﻠﺬﻳﻦ ﻳﻜﻮﻥ ﻣﻌﺮﺿﻮﻥ ﲞﻄﺮ ﺷﺪﻳﺪ ﻟﻼﺻﺎﺑﺔ ﺑـ‪. closed-angle glaucoma‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪:‬‬
‫ﻫﻲ ‪. Drowsiness‬‬
‫ﻭﺍﻟﺼﺪﺍﻉ ‪. Headache‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪. Tachycardia‬‬
‫ﻭ ‪ Antimuscarinic effects‬ﻣﺜﻞ ﺟﻔﺎﻑ ﺍﻟﻔﻢ ﻭﺍﻟﻘﺒﺾ ﻭﺗﺸﻮﺵ ﺍﻟﺮﺅﻳﺔ ‪.‬‬
‫ﻭ ‪. Psychomotor impairment‬‬
‫ﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﺍﱃ ‪. inactive metabolite‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء ‪ cyclizine‬ﻫﻮ ‪ ٢٠‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ opiates‬ﻓﺎﻧﻪ ﻳﺰﻳﺪ ‪. sedative‬‬
‫ﻭﺍﻥ ﺍﻟﺘﺎﺛﲑ ‪ Sedative‬ﻳﺰﺩﺍﺩ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳌﻦ ﻳﻌﺎﻧﻲ ﺍﻣﺮﺍﺽ ﰲ ﺍﻟﻜﺒﺪ ﻻﻧﻪ ﻳﻘﻞ‬
‫ﺍﻻﻳﺾ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻭﺗﺒﻘﻰ ﻓﻌﺎﻟﺔ ‪.‬‬
‫ﻭﻛﻞ ﻣﻦ ﻋﻼﺟﻲ ‪ Cyclizine and promethazine‬ﺗﻌﺘﱪ ﺍﻣﻨﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬

‫‪١٠‬‬
‫ﻭﻣﻦ ﻧﺎﺣﻴﺔ ﺳﺮﻳﺮﻳﺔ ﳚﺐ ﺍﻥ ﺗﺘﻢ ﻣﻌﺮﻓﺔ ﺳﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻗﺒﻞ ﻭﺻﻒ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﻻﻳﻜﻮﻥ‬
‫ﺍﻟﻌﻼﺝ ﻫﻮ ﻣﻌﺎﳉﺔ ﻋﺮﺿﻴﺔ ﻓﻘﻂ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪5-HT3 antagonists‬‬

‫**************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ 5-HT3 antagonists‬ﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Ondansetron, granisetron‬‬

‫‪.‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﺍﳌﻌﺎﳉﺔ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ ﺑﺎﻻﺩﻭﻳﺔ ﺍﻟﻜﻴﻤﺎﺋﻴﺔ‬
‫ﻭﺍﻻﺷﻌﺎﻋﻴﺔ ‪. Nausea and vomiting associated with cytotoxic drugs‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﳉﺮﺍﺣﻴﺔ ‪Post-operative‬‬
‫‪. nausea and vomiting‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﻟﺼﺪﺍﻉ ‪. Headache‬‬
‫ﻭ ‪. Flushing‬‬
‫ﻭﺍﻻﻣﺴﺎﻙ ‪ constipation‬ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ‪. increased large bowel transit time‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻻﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻮ ‪ ٥‬ﺳﺎﻋﺎﺕ ﺗﻘﺮﻳﺒﺎ ‪.‬‬
‫ﻭﻳﻘﻞ ﺗﺎﺛﲑ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻣﻊ ‪phenytoin, carbamazepine,‬‬
‫‪. rifampicin‬‬
‫ﻻﻧﻬﺎ ‪ induce liver enzymes‬ﻓﺘﺰﻳﺪ ﻣﻦ ﺍﻳﻀﺎ ﺍﺩﻭﻳﺔ ‪. 5-HT3 antagonists‬‬
‫ﻭﻳﻘﻞ ﺗﺎﺛﲑﻫﺎ ﺍﻟﻔﻌﺎﻝ ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻳﻀﺎ ﺍﻥ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪ prolong the QT interval‬ﻟﺬﺍ ﳚﺐ ﺍﳊﺬﺭ ﻋﻨﺪ‬
‫ﺍﺳﺘﻌﻤﺎﳍﺎ ﻣﻊ ﺍﺩﻭﻳﺔ ﺍﺧﺮﻯ ﺗﺴﺒﺐ ‪ prolong the QT interval‬ﺍﻳﻀﺎ ‪.‬‬
‫ﻛﻤﺎ ﳚﺐ ﻣﻌﺮﻓﺔ ﺳﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻗﺒﻞ ﺍﳌﻌﺎﳉﺔ ﻭﻋﺪﻡ ﺍﻻﻛﺘﻔﺎء ﺑﺎﳌﻌﺎﳉﺔ ﺍﻟﻌﺮﺿﻴﺔ ﻓﻘﻂ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ‪Prolonged QT interval and cardiac‬‬
‫‪. conduction defects‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ﺍﻟﺘﺤﺴﺲ ‪ Hypersensitivity‬ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬

‫‪١١‬‬
 ‫ﺍﺩﻭﻳﺔ ‪Aminosalicylic acid compounds‬‬
‫********************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Aminosalicylic acid compounds‬ﺍﻟﺘﻲ ﻳﺮﻣﺰ ﳍﺎ ﺍﺧﺘﺼﺎﺭﺍ )‪. (ASAs‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪.‬‬
‫ﻣﺮﺽ ﺗﻘﺮﺡ ﺍﻟﻘﻮﻟﻮﻥ ‪. Ulcerative colitis‬‬
‫ﻭ ﻣﺮﺽ ‪. Rheumatoid arthritis‬‬
‫ﻭﻣﺮﺽ ‪. Crohn's disease‬‬
‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ‪:‬‬
‫‪. Salicylate hypersensitivity‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﰲ )‪. G6PD deficiency (sulfasalazine‬ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﻟﺼﺪﺍﻉ ‪.Headache‬‬
‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺪ ‪. Hepatitis‬‬
‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ ‪.Pancreatitis‬‬
‫ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ‪GI disturbance‬ﻣﺜﻞ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻻﺳﻬﺎﻝ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﻗﺪ ﺗﺴﺒﺐ ‪. Myocarditis/pericarditis‬‬
‫ﻭ ﻗﺪ ﺗﺴﺒﺐ ﺑﻌﺾ ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺪﻡ ﻣﺜﻞ‪:‬‬
‫)‪. (aplastic anaemia, leucopenia, thrombocytopenia‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ leucopenia‬ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪azathioprine and‬‬
‫‪.mercaptopurine‬‬
‫ﻭﳚﺐ ﻋﻠﻰ ﺍﻟﻄﺒﻴﺐ ﻭﺍﻟﺼﻴﺪﱄ ﺗﻮﺿﻴﺢ ﺑﻌﺾ ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻻﻋﺮﺍﺽ ﺍﻟﺘﻲ ﺗﺸﲑ ﺍﱃ ﺣﺪﻭﺙ ﺍﺿﻄﺮﺍﺏ‬
‫ﰲ ﺍﻟﺪﻡ ﻧﺘﻴﺠﺔ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻻﺩﻭﻳﺔ ﻣﺜﻞ ‪fevers, sore throat, malaise or unexplained‬‬
‫‪ bruising‬ﻟﲑﺍﺟﻊ ﺍﳌﺮﻳﺾ ﻋﻨﺪ ﺣﺪﻭﺛﻬﺎ ‪.‬‬
‫ﻛﻤﺎ ﳚﺐ ﻋﻤﻞ ﲢﻠﻴﻞ ﳊﺴﺎﺏ ﺍﻋﺪﺍﺩ ﺧﻼﻳﺎ ﺍﻟﺪﻡ ﻭﺍﻟﻴﻮﺭﻳﺎ ﻭﺍﻟﻜﲑﺍﺗﻨﲔ ﻭﻭﻇﺎﺋﻒ ﺍﻟﻜﺒﺪ ﻗﺒﻞ ﺍﻟﺒﺪء‬
‫ﺑﺎﳌﻌﺎﳉﺔ ﻭﻛﻞ ﺷﻬﺮ ﰲ ﺍﻭﻝ ﺛﻼﺙ ﺍﺷﻬﺮ ﻣﻦ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻟﺘﺠﻨﺐ ‪risk of haematological,‬‬
‫‪. renal and hepatic toxicity‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳝﻜﻦ ﺍﻥ ﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻭﻛﺬﻟﻚ ﳑﻜﻦ ﺍﻥ ﺗﻌﻄﻰ ﻋﻠﻰ ﺷﻜﻞ ‪enemas or‬‬
‫‪. suppositories for distal bowel disease‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﻭﳐﺎﻃﻴﺔ ﺍﻻﻣﻌﺎء ‪. liver and intestinal mucosa‬‬

‫‪١٢‬‬
 ‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻛﻤﻀﺎﺩ ﻟﻼﻟﺘﻬﺎﺏ ‪anti-inflammatory‬ﻭﻣﻌﺪﻝ ﻣﻨﺎﻋﻲ‬
‫‪immunomodulatory effect‬ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﺗﻜﻮﻳﻦ ﻛﻞ ﻣﻦ ‪prostaglandin and‬‬
‫‪. leukotriene‬‬

‫ﻛﻴﻔﻴﺔ ﺗﺸﺨﻴﺺ ﺳﺒﺐ ﺍﻻﺳﻬﺎﻝ ‪.‬‬

‫*********************‬
‫ﺍﻥ ﺍﻻﺳﻬﺎﻝ‪ diarrhea‬ﺍﺫﺍ ﻛﺎﻥ ﻣﺼﺤﻮﺏ ﺑﺎﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺣﺮﺍﺭﺓ ﻭﺗﻘﻴﻮء ﻓﺎﻧﻪ ﻗﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻻﻣﻌﺎء ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ‪ diarrhea‬ﻣﺼﺤﻮﺏ ﺑﺎﻧﺘﻔﺎﺥ ﻭﻏﺎﺯﺍﺕ ﻭﻣﺘﺒﻮﻉ ﺑﺎﻻﻣﺴﺎﻙ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺗﻬﻴﺞ ﺍﻟﻘﻮﻟﻮﻥ ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ‪ diarrhea‬ﻣﺼﺤﻮﺏ ﺑﺘﻐﻴﲑ ﻧﻮﻉ ﺍﳊﻠﻴﺐ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ‪. Dietary induced‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ‪diarrhea‬ﻣﺼﺤﻮﺏ ﺑﺮﻏﺒﺔ ﺑﺎﻟﺘﻐﻮﻁ ﻭﻟﻜﻦ ﻻﳛﺪﺙ ﻭﺧﺮﻭﺝ ﻗﻠﻴﻞ ﻭﺍﱂ ﻋﻨﺪ ﺍﳋﺮﻭﺝ ﻭﺍﳋﺮﻭﺝ‬
‫ﺑﺮﺍﺋﺤﻪ ﻛﺮﻳﻬﻪ ﻓﺎﻥ ﻗﺪ ﻳﺸﲑ ﺍﱃ ﺍﻟﺪﺯﻧﱰﻱ ‪. dysentery‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ‪diarrhea‬ﺣﺪﺙ ﻣﻊ ﺑﺪﺍﻳﺔ ﺗﻨﺎﻭﻝ ﺍﻻﺩﻭﻳﺔ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‪.‬‬
‫ﻭﻗﺪ ﻳﻜﻮﻥ‪ diarrhea‬ﺑﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ ﺍجملﺎﺭﻱ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺍﻟﻌﻠﻴﺎ ‪.‬‬

‫ﻛﻴﻔﻴﺔ ﺗﺸﺨﻴﺺ ﺳﺒﺐ ﺍﻟﺘﻘﻴﻮء‬

‫******************‬

‫ﺍﻥ ﺍﻟﺘﻘﻴﻮء ‪vomiting‬ﺍﺫﺍ ﻛﺎﻥ ﻣﺼﺤﻮﺏ ﺑﺎﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺍﳊﺮﺍﺭﺓ ﻭﺍﻟﺘﻘﻴﻮء ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻻﻣﻌﺎء‪ Gastroenteritis‬ﺍﻭ ﺍﻟﺰﺍﺋﺪﺓ ﺍﻟﺪﻭﺩﻳﺔ ‪appendicitis‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ﺍﻟﺘﻘﻴﻮء ﺣﺼﻞ ﻣﻊ ﺑﺪﺍﻳﺔ ﺗﻨﺎﻭﻝ ﺍﺩﻭﻳﺔ ﻣﻌﻴﻨﻪ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺗﻨﺎﻭﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪Drug‬‬
‫‪.induced vomiting‬‬
‫ﻭﺍﺫﺍ ﺣﺼﻞ ﺍﺛﻨﺎء ﺍﻟﺴﻔﺮ ﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ‪. Motion sickness‬‬
‫ﻭﰲ ﲨﻴﻊ ﺍﻻﺣﻮﺍﻝ ﳚﺐ ﺻﺮﻑ ﻣﻀﺎﺩ ﺗﻘﻴﻮء ‪.‬‬
‫ﻭ ﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﺳﺒﺎﺏ ﺣﺪﻭﺙ ﺍﻟﺘﻘﻴﻮء ﻫﻲ‪:‬‬
‫ﺍﳊﻤﻞ‪.‬‬
‫ﻭﺗﻨﺎﻭﻝ ﺑﻌﺾ ﺍﻻﺩﻭﻳﺔ‪.‬‬
‫ﻭ ‪.metabolic endocrine disorders‬‬
‫ﻭﻣﺸﺎﻛﻞ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ﻣﺜﻞ‪:‬‬
‫ﺍﻟﻘﺮﺣﺔ ﺍﳌﻌﺪﻳﺔ ﻭﺍﻻﺛﻨﻲ ﻋﺸﺮﻱ ‪.‬‬

‫‪١٣‬‬
 ‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﳌﻌﺪﺓ ﻭﺍﻻﻣﻌﺎء‪.‬‬
‫ﻭﻳﻀﺎ ﻣﺸﺎﻛﻞ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ‪.‬‬
‫ﻭﺍﻟﺘﻬﺎﺑﺎﺕ ﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ‪.‬‬
‫ﻭﺍﻣﺮﺍﺽ ﺍﻟﻜﻠﻴﺔ ‪.‬‬

‫ﻛﻴﻔﻴﺔ ﺗﺸﺨﻴﺺ ﺍﱂ ﺍﻟﺒﻄﻦ ‪.‬‬

‫*********************‬

‫ﺍﻥ ﺍﻻﱂ ﺍﻟﺒﻄﻨﻲ ‪Abdominal pain‬ﺍﺫﺍ ﻛﺎﻥ ﰲ ﺍﻋﻠﻰ ﺍﻟﺒﻄﻦ ﻓﺮﲟﺎ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ ﺍﳌﻌﺪﺓ ﺍﻭ‬
‫ﺑﺴﺒﺐ ﻣﺸﺎﻛﻞ ﰲ ﺍﳌﺮﺍﺭﺓ ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ‪Abdominal pain‬ﻳﻨﺘﻘﻞ ﺍﱃ ﺍﻟﻈﻬﺮ ﻣﻊ ﻣﺸﺎﻛﻞ ﰲ ﺍﻟﺒﻮﻝ ﻣﺜﻞ ﺍﳊﺮﻗﺔ ﻭﺍﻟﺘﻘﻄﻊ ﻓﻬﺬﺍ ﻗﺪ‬
‫ﻳﺸﲑ ﺍﱃ ﺍﻣﺎ ﺣﺼﻮﺓ ﺍﻟﻜﻠﻴﺔ ﺍﻭ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﻠﻴﺔ ﺍﻟﺒﻜﺘﲑﻱ ﻣﺜﻞ ﺍﻟﺘﻬﺎﺏ ﺣﻮﺽ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ﺍﻻﱂ ﺍﻟﺒﻄﻨﻲ‪ Abdominal pain‬ﻣﺼﺤﻮﺏ ﺑﺎﺭﺗﻔﺎﻉ ﺣﺮﺍﺭﺓ ﻭﺗﻘﻴﻮء ﻓﻘﻂ ﻓﻘﺪ ﻳﺸﲑ ﺍﱃ‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻻﻣﻌﺎء ﺍﻭ ﺯﺍﺋﺪﺓ ﺩﻭﺩﻳﺔ ﻭﺧﺎﺻﺔ ﺍﺫﺍ ﻛﺎﻥ ﺍﻻﱂ ﰲ ﺍﳉﻬﺔ ﺍﻟﻴﻤﲎ ﺍﻟﺴﻔﻠﻰ ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ﺍﻻﱂ ﺍﻟﺒﻄﻨﻲ‪ Abdominal pain‬ﻗﺒﻞ ﻣﻮﻋﺪ ﺍﻟﺪﻭﺭﺓ ﻋﻨﺪ ﺍﻟﻨﺴﺎء ﺑﺎﻳﺎﻡ ﻗﻠﻴﻠﺔ ﺍﻭ ﻣﻌﻬﺎ ﻓﻘﺪ‬
‫ﻳﻜﻮﻥ ﺑﺴﺒﺐ ‪. Menstrual pain‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ﺍﻻﱂ ﺍﻟﺒﻄﻨﻲ ‪Abdominal pain‬ﻣﺼﺤﻮﺏ ﺑﺎﻧﺘﻔﺎﺥ ﻭﻏﺎﺯﺍﺕ ﻭﺗﻘﻠﺼﺎﺕ ﻣﺘﻘﻄﻌﺔ ﻭﺭﺍﺣﺔ ﻋﻨﺪ‬
‫ﺍﻟﺘﻐﻮﻁ ﻓﻘﺪ ﻳﺸﲑ ﺍﱃ ﺗﻬﻴﺞ ﺍﻟﻘﻮﻟﻮﻥ ﻭﺧﺎﺻﺔ ﺍﺫﺍ ﻛﺎﻥ ﰲ ﺍﳌﻨﻄﻘﺔ ﺍﻟﻴﺴﺮﻯ ﺍﻟﺴﻔﻠﻰ ﺍﻭ ﺍﻋﻠﻰ ﺑﻘﻠﻴﻞ‪.‬‬
‫ﻭﺍﺫﺍ ﻛﺎﻥ ﺍﻻﱂ‪ Abdominal pain‬ﻓﻘﻂ ﺗﺸﻨﺞ ﺃﻱ ﻣﺘﻘﻄﻊ ﻓﻘﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺗﺸﻨﺞ ﺑﺴﻴﻂ ‪.‬‬

‫‪١٤‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺍﻟﻘﻠﺐ ﻭﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ‬

‫ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ‪.Diuretics‬‬

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‫ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﻬﻤﺔ ﻭﺍﻟﺸﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ﰲ ﺍﳌﺆﺳﺴﺎﺕ ﺍﻟﺼﺤﻴﺔﻭﺍﻟﺼﻴﺪﻟﻴﺎﺕ ﻫﻲ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ‬
‫‪.Diuretics‬‬
‫ﻟﺬﻟﻚ ﺍﻟﻴﻮﻡ ﺣﺒﻴﺖ ﺍﻧﻘﻞ ﻟﻜﻢ ﻣﻌﻠﻮﻣﺎﺕ ﺷﺎﻣﻠﺔ ﻋﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﻣﺼﺪﺭ ﺩﻭﺍﺋﻲ ﺣﺪﻳﺚ ﺟﺪﺍ ‪.‬‬
‫ﻭﻫﻮ ﻛﺘﺎﺏ ‪ BNF67‬ﻭﻣﻦ ﺍﺧﺮ ﻃﺒﻌﺎ ﲢﺪﻳﺪ ﻭﻫﻲ ﻟﻌﺎﻡ ‪.٢٠١٤‬‬
‫ﻭﻫﻮ ﺍﳌﺼﺪﺭ ﺍﻟﺬﻱ ﻳﻌﻠﻢ ﺯﻣﻼﺋﻨﺎ ﺍﻟﺼﻴﺎﺩﻟﺔ ﻫﻮ ﺍﳌﺼﺪﺭ ﺍﻟﺮﺋﻴﺴﻲ ﻟﻠﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻛﻤﺎ ﺻﺮﺣﺖ‬
‫ﺑﺬﻟﻚ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺮﺍﻗﻴﺔ ‪.‬ﺳﻮﻑ ﺍﻧﻘﻞ ﻟﻜﻢ ﺍﻟﻜﻼﻡ ﻋﻨﻬﺎ ﰲ ﺟﺰﺋﲔ ﻫﺬﺍ ﻫﻮ ﺍﻻﻭﻝ ‪.‬‬
‫ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺗﻀﻢ ﺃﻧﻮﺍﻉ ﻣﺘﻌﺪﺩﺓ ﻭﻣﻦ ﺍﻧﻮﺍﻉ ﻫﺬﺍ ﺍجملﻤﻮﻋﺔ ﻧﻮﻉ ‪ Thiazides‬ﺍﻟﺬﻱ‬
‫ﻭﺧﺎﺻﺔ ﺍﻟﺘﻲ ﲢﺪﺙ ﰲ ﻣﺮﺽ ﺍﻟﻔﺸﻞ ﺍﻟﻘﻠﺒﻲ‬ ‫ﻳﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﳌﻌﺎﳉﺔ‬
‫‪.‬‬ ‫ﺍﳌﺰﻣﻦ‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﲜﺮﻋﺔ ﺍﻗﻞ ﻣﻨﻬﺎ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‪.‬‬

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 ‫ﻭﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻫﻲ ‪ Loop diuretics‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﰲ ﻣﻌﺎﳉﺔ‬
‫ﺍﻟﺬﻱ‬ ‫‪ pulmonary odema‬ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﻓﺸﻞ ﺍﻟﺒﻄﲔ ﺍﻻﻳﺴﺮ‬
‫ﻳﻘﻮﻡ ﺑﻀﺦ ﺍﻟﺪﻡ ﺍﱃ ﲨﻴﻊ ﺍﺟﺰﺍء ﺍﳉﺴﻢ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺸﺮﻳﺎﻥ ﺍﻻﺑﻬﺮ ﻭﺍﻳﻀﺎ ﺍﻟﺘﻲ ﲢﺪﺙ‬
‫‪ pulmonary odema‬ﰲ ﻣﺮﺽ ﺍﻟﻔﺸﻞ ﺍﻟﻘﻠﺒﻲ ﺍﳌﺰﻣﻦ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ ﻳﺘﻢ ﺍﻟﺪﻣﺞ ﺑﲔ ﻫﺬﻳﻦ ﺍﻟﻨﻮﻋﲔ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﳌﻌﺎﳉﺔ ﺍﳊﺎﻻﺕ ﺍﳌﺮﺿﻴﺔ ﺍﻟﺘﻲ‬
‫ﺗﻘﺎﻭﻡ ﺍﺳﺘﻌﻤﺎﻝ ﻛﻞ ﻭﺍﺣﺪ ﻣﻨﻬﻤﺎ ﻭﻟﻜﻦ ﻗﺪ ﳛﺪﺙ ﺍﳔﻔﺎﺽ ﺷﺪﻳﺪ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ﻧﺘﻴﺠﺔ ﻫﺬﺍ‬
‫ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ ﻛﺘﺎﺛﲑ ﺟﺎﻧﺒﻲ ﻭﻟﻜﻨﻪ ﻟﻴﺲ ﺷﺎﺋﻊ ﺍﳊﺪﻭﺙ ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﺍﳔﻔﺎﺽ‬
‫ﺳﺮﻳﻊ ﰲ ﺗﺮﻛﻴﺰ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ﻭﻫﻮ ﺍﻣﺮ ﻏﲑ ﻏﻮﺏ ﺑﻪ ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻼﺣﻈﺎﺕ ﺍﻟﺘﻲ ﳚﺐ ﺍﻥ ﺗﺆﺧﺬ ﺑﻨﻈﺮ ﺍﻻﻋﺘﺒﺎﺭ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻨﺪ ﻛﺒﺎﺭ ﺍﻟﺴﻦ‬
‫‪ Elderly‬ﻭﻫﻲ ﳚﺐ ﺍﻟﺒﺪء ﺑﺎﻗﻞ ﺟﺮﻋﺔ ﳑﻜﻨﺔ ﻭﺫﻟﻚ ﻟﺘﺠﻨﺐ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ‬
‫ﺗﻈﻬﺮ ﺳﺮﻳﻌﺎ ﻋﻨﺪ ﻛﺒﺎﺭ ﺍﻟﺴﻦ ﻭﳚﺐ ﺍﻥ ﻳﻨﻈﻢ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻣﻊ ﻭﻇﻴﻔﺔ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻫﻲ‬ ‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳌﻬﻤﺔ ﺍﻟﺘﻲ ﲢﺪﺙ ﻣﻊ ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﻭﻫﺬﺍ ﺗﺎﺛﲑ ﻳﺰﺩﺍﺩ ﻣﻊ ﻗﻮﺓ ﺍﻟﺪﻭﺍء ﺍﳌﺴﺘﻤﻞ ﻭﺟﺮﻋﺘﻪ‬ ‫ﺍﳔﻔﺎﺽ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‬
‫‪.‬‬ ‫ﻣﻦ‬ ‫ﻭﻓﱰﺓ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻭﻫﻮ ﳛﺪﺙ ﺑﺼﻮﺭﺓ ﺍﻛﱪ ﰲ‬
‫ﻭﺧﻄﺮ ﺍﳔﻔﺎﺽ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻳﺰﺩﺍﺩ ﺑﺼﻮﺭﺓ ﺍﻛﺜﺮ ﺧﻄﻮﺭﺓ ﰲ ﺍﳌﺮﺿﻰ ﺍﳌﺼﺎﺑﲔ ﺑﺎﻣﺮﺍﺽ ﺍﻟﻘﻠﺐ ﻭﺍﻟﺬﻳﻦ‬
‫ﺍﻳﻀﺎ ﻳﺘﻨﺎﻭﻟﻮﻥ ﺍﺩﻭﻳﺔ ﺍﻟﺪﳚﺘﺎﻟﻴﺲ ﻣﺜﻞ ﺍﻟﺪﳚﻮﻛﺴﲔ ﻭﻧﻨﺼﺢ ﰲ ﻣﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺗﻨﺎﻭﻝ ﺍﳌﺪﺭﺭﺍﺕ‬
‫ﺍﻟﺘﻲ ﺗﺰﻳﺪ ﻣﻦ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺍﻻﺑﺘﻌﺎﺩ ﻋﻦ ﺍﳌﻜﻤﻼﺕ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﺗﺴﺒﺔ ﻋﺎﻟﻴﺔ ﻣﻦ‬
‫ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ‪.‬‬
‫ﺍﳔﻔﺎﺽ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺑﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ‬ ‫ﺍﺣﺒﺎﺋﻲ ﰲ ﻣﺮﺿﻰ‬
‫ﻭﺧﺎﺻﺔ ﰲ ﻣﺮﺽ ﺍﻟﺘﺸﻤﻊ ﺍﻟﻜﺒﺪﻱ ﺑﺴﺒﺐ ﺗﻨﺎﻭﻝ ﺍﻟﻜﺤﻮﻝ‬ ‫ﺣﺪﻭﺙ‬
‫‪.‬‬
‫ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ‬ ‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﳔﻔﺎﺽ ﺍﳌﻐﻨﻴﺴﻴﻮﻡ ﰲ ﻣﺮﺿﻰ‬
‫ﺣﺪﻭﺙ ﺗﺎﺛﲑ ﻋﻠﻰ ﻧﻈﺎﻡ ﺍﻟﺘﻮﺻﻴﻞ ﰲ ﺍﻟﻘﻠﺐ ﻭﻳﺴﺒﺐ ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﰲ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺍﻭ ﻣﺎ ﻳﻌﺮﻑ‬
‫‪. arrhythmias‬‬
‫ﻭﻫﻮ ﻳﻌﺘﱪ ﻣﻦ ﻧﻮﻉ‬ ‫ﺍﺣﺒﺎﺋﻲ ﺍﻟﻜﺮﺍﻡ ﻳﻮﺟﺪ ﺩﻭﺍء ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻳﺴﻤﻰ‬
‫ﺃﻱ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺰﻳﺪ ﻣﻦ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﻫﻮ ﺷﺎﺋﻊ‬
‫‪.‬‬ ‫ﺍﻟﺘﻲ ﲢﺪﺙ ﻋﻨﺪ ﻣﺮﺿﻰ‬ ‫ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ﰲ ﻣﻌﺎﳉﺔ‬

‫‪.‬‬
‫******************************‬

‫‪١٦‬‬
 ‫ﻭﺍﻟﺬﻱ ﻳﻌﺘﱪ ﻣﺘﻮﺳﻂ ﺍﻟﻘﻮﺓ ﻭﻟﻴﺲ ﻗﻮﻱ ﺟﺪﺍ ﰲ ﺣﺼﻮﻝ ﺍﻻﺩﺭﺍﺭ ﻭﺍﻧﺘﺎﺟﻪ ﻟﻠﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﺍﳌﻄﻠﻮﺏ‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺜﺒﻂ ﺍﻋﺎﺩﺓ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺗﺴﻤﺢ ﲞﺮﻭﺟﺔ ﻭﺑﺎﻟﺘﺎﱄ ﳜﺮﺝ ﺍﳌﺎء ﻣﻌﻪ ﺍﻳﻀﺎ ‪.‬‬
‫ﻻﻧﻪ ﻛﻤﺎ ﻳﻘﺎﻝ ﺍﻥ ﺍﺭﺗﺒﺎﻁ ﺍﳌﺎء ﻣﻊ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻫﻮ ﺍﺭﺗﺒﺎﻁ ﻭﺯﻭﺍﺝ ﻛﺎﺛﻮﻟﻴﻜﻲ ﻻ ﻃﻼﻕ ﻭﻻ ﺍﻓﱰﺍﻕ ﻓﻴﻪ ‪.‬‬
‫‪.‬‬ ‫ﻭﻫﺬﺍ ﺍﻟﺘﺜﺒﻴﻂ ﻻﻋﺎﺩﺓ ﺍﻻﻣﺘﺼﺎﺹ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻳﻘﻊ ﰲ ﻣﻨﻄﻘﺔ‬
‫ﻋﻠﻤﺎ ﺍﻳﻬﺎ ﺍﻟﺰﻣﻼء ﺍﻟﻜﺮﺍﻡ ﺍﻥ ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﻟﻨﻮﻉ ﺍﻟﺜﻴﺎﺯﺍﻳﺪ ﳛﺪﺙ ﺑﻌﺪ ‪ ٢-١‬ﺳﺎﻋﺔ ﻣﻦ ﺍﻻﻋﻄﺎء ﻋﻦ‬
‫ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻭﻳﺴﺘﻤﺮ ﻫﺬﺍ ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﻟﻔﱰﺓ ﺗﱰﺍﻭﺡ ﻣﻦ ‪ ٢٤- ١٢‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﳚﺐ ﺍﻟﺘﻨﺒﻴﻪ ﺍﻋﺰﺍﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﻋﻠﻰ ﺍﳌﺮﺿﻰ ﺍﻥ ﻳﺴﺘﻌﻤﻠﻮﺍ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺻﺒﺎﺣﺎ ﺣﱴ ﻻ ﺗﺘﺪﺍﺧﻞ‬
‫ﻣﻊ ﺍﻟﻨﻮﻡ ﻭﺗﺴﺒﺐ ﺍﺿﻄﺮﺍﺑﻪ ﳑﺎ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ ﺍﻥ ﻳﺘﺨﺬ ﺍﳌﺮﻳﺾ ﺑﱰﻙ ﺍﻟﺪﻭﺍء ‪.‬‬
‫ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺗﺆﺩﻱ ﺍﱃ‬ ‫ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﺍﻥ ﺍﺳﺘﻌﻤﺎﻝ ﺟﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﺍﺩﻭﻳﺔ‬
‫ﺧﻔﺾ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﱃ ﺍﻗﻞ ﻗﻴﻤﺔ ﳑﻜﻨﺔﺍﻣﺎ ﺍﺳﺘﻌﻤﺎﻝ ﺟﺮﻋﺔ ﺍﻋﻠﻰ ﻓﺎﻧﻪ ﻻﻳﻨﻔﻊ ﺑﻞ ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ‬
‫ﺍﺛﺎﺭ ﺟﺎﻧﺒﻴﺔ ﻛﺜﲑﺓ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺩﻭﻥ ﺍﻧﺘﺎﺝ ﻓﻌﻞ ﺩﻭﺍﺋﻲ ﻛﺒﲑ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﻟﺘﻲ ﺗﺴﺒﺒﻬﺎ ﻫﻲ ﺗﺎﺛﲑﺓ ﻋﻠﻰ ﺗﺮﻛﻴﺰ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺍﻟﻜﻠﻮﻛﻮﺯ‬
‫ﻭﺍﻟﻴﻮﺭﻙ ﻭﺍﻳﻀﺎ ﺍﻟﺪﻫﻮﻥ ‪.‬ﻭﺍﻻﺩﻭﻳﺔ ﺍﳌﻔﻀﻠﺔ ﻣﻦ ﻧﻮﻉ ﺍﻟﺜﻴﺎﺯﻳﺪ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻤﺎ ﻋﻼﺟﲔ‬
‫‪. Chlortalidone‬‬ ‫‪indapamide‬‬
‫ﺃﻡ ﻋﻼﺝ‪ Bendroflumethiazide‬ﻓﻴﻤﻜﻦ ﺍﺳﺘﻌﻤﺎﻟﺔ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﻟﺒﺴﻴﻂ ﺍﱃ‬
‫ﺍﳌﺘﻮﺳﻂ ﺍﻟﺸﺪﺓ ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﻟﻜﻦ ﻻﻳﻨﺼﺢ ﺑﺎﺳﺘﻌﻤﺎﻟﻪ‬
‫ﻛﺨﻂ ﻋﻼﺟﻲ ﺍﻭﻝ ﻟﻠﻔﱰﺓ ﻃﻮﻳﻠﺔ ‪.‬‬
‫ﻭﻛﻤﺎ ﻗﻠﻨﺎ ﰲ ﺑﺪﺍﻳﺔ ﺍﳌﻨﺸﻮﺭ ﺍﻥ ﻫﻨﺎﻙ ﺍﺩﻭﻳﺔ ﻟﻴﺴﺖ ﻣﻦ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻭﻟﻜﻨﻬﺎ ﲢﺴﺐ‬
‫ﺍﻟﺬﻱ ﳝﺘﺎﺯ ﺑﻜﻮﻧﻪ ﻃﻮﻳﻞ ﺍﳌﻔﻌﻮﻝ ﺍﻟﻌﻼﺟﻲ ﺍﻃﻮﻝ ﻣﻦ ﺑﺎﻗﻲ ﺍﺩﻭﻳﺔ‬ ‫ﻋﻠﻴﻬﺎ ﻣﺜﻞ‬
‫‪.‬‬ ‫ﲝﻴﺚ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻟﻪ ﺑﲔ ﻳﻮﻡ ﻭﺍﺧﺮ ﻭﻟﻴﺲ ﻳﻮﻣﻴﺎ ﻟﻠﺴﻴﻄﺮﺓ ﻋﻠﻰ‬
‫ﻫﻮ ﺩﻭﺍء ‪ Xipamide‬ﻭﻫﻮ‬ ‫ﻭﻣﻦ ﺍﻟﻌﻼﺟﺎﺕ ﻣﻦ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﻭﺍﻟﺬﻱ ﺗﺸﺒﻪ ﺩﻭﺍء‬
‫ﳝﺘﺎﺯ ﻋﻨﻪ ﺑﻜﻮﻧﻪ ﺍﻗﻞ ﺗﺎﺛﲑﺍ ﻋﻠﻰ ﺍﻟﻜﻠﻮﻛﻮﺯ ﲝﻴﺚ ﺍﻗﻞ ﺗﺎﺛﲑﺍ ﰲ ﺗﺪﻫﻮﺭ ﻭﲢﺮﻳﺾ‬
‫ﻧﺘﻴﺠﺔ ﺍﺭﺗﻔﺎﻉ ﺍﻟﺴﻜﺮ ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﻮﺍﺳﻄﺔ ﺍﻻﻧﻮﺍﻉ ﺍﻻﺧﺮﻯ ‪.‬‬
‫ﺍﻟﻌﻼﺝ ﺍﻻﺧﺮ ﰲ ﻫﺬﻩ ﺍﻟﻨﻮﻉ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻫﻮ ‪ Metolazone‬ﻭﺍﻟﺬﻱ ﻫﻮ ﻫﻮ ﻳﻌﻄﻰ ﻓﻌﺎﻟﻴﺔ ﺍﺫﺍ‬
‫ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ ﺍﺩﺭﺍﺭ ﺑﺼﻮﺭﺓ ﻗﻮﻳﺔ ﳑﺎ ﻳﺴﺘﺪﻋﻲ ﻋﻨﺪ‬ ‫ﰎ ﺩﳎﻪ ﻣﻊ‬
‫ﺍﺳﺘﻌﻤﺎﻟﺔ ﺍﺣﺒﺎﺋﻲ ﻣﺮﺍﻗﺒﺔ ﻟﻼﺿﻄﺮﺍﺑﺎﺕ ﺍﳌﺘﻮﻗﻌﺔ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭ ﻛﺎ ﺍﻟﺘﻐﲑ ﰲ ﺗﺮﻛﻴﺰ‬
‫ﺍﶈﺎﻟﻴﻞ ﻛﺎﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ‪.‬‬
‫ﺍﻣﺎ ﺑﺎﻗﻲ ﺍﺩﻭﻳﺔ ﺍﻟﺜﻴﺎﺯﺍﻳﺪ ﻓﻬﻲ ﻻﲣﺘﻠﻒ ﻛﺜﲑﺍ ﰲ ﻓﻌﻠﻴﺘﻬﺎ ﻋﻦ ﺍﻟﺬﻱ ﺫﻛﺮﻧﺎﻫﺎ ﻣﺜﻞ‬
‫‪.‬‬ ‫ﻭ‬
‫ﻧﺘﻴﺠﺔ‬ ‫ﳚﺐ ﺍﳊﺬﺭ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺣﺪﻭﺙ‬
‫ﻣﺜﻞ‬ ‫ﺗﺴﺒﺒﻬﺎ ﰲ ﺯﻳﺎﺩﺓ ﺍﻟﺴﻜﺮ ﻭ ‪ Uric acid‬ﻭﺍﻳﻀﺎ ﳑﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺑﻌﺾ‬
‫ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﳔﻔﺎﺽ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺧﺎﺻﺔ ﻋﻨﺪ ‪:‬‬

‫‪١٧‬‬
 ‫ﺍﺳﺘﻌﻤﺎﻝ ﺟﺮﻋﺔ ﻋﺎﻟﻴﺔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬ ‫‪-١‬‬
‫ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ‪.‬‬ ‫‪-٢‬‬
‫ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ‪. Renal impairment‬‬ ‫‪-٣‬‬

‫‪.‬‬ ‫ﻭﳚﺐ ﺍﻥ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲝﺬﺭ ﰲ ﻣﺮﺽ‬

‫ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻻﺕ‬
‫‪.‬‬ ‫ﻣﻨﻬﺎ‬
‫‪.‬‬ ‫ﻭﺍﻳﻀﺎ‬
‫ﻭﺍﻳﻀﺎ ﰲ ﺍﺭﺗﻔﺎﻉ ‪.uric acid‬‬
‫ﺍﻟﺬﻱ ﻳﺘﻤﻴﺰ ﺑﺎﳔﻔﺎﺽ ﻣﺴﺘﻮﻯ ﺍﻟﻜﻮﺭﺗﺰﻭﻥ ﰲ‬ ‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻉ ﰲ ﻣﺮﺽ‬
‫ﺍﳉﺴﻢ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﻪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳌﻦ ﻳﻌﺎﻧﻲ ﺍﳔﻔﺎﺽ ﰲ ﻣﺴﺘﻮﻯ ﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﲝﺬﺭ ﰲ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻜﺒﺪ ﺍﻟﺒﺴﻴﻂ ﺍﱃ ﺍﳌﺘﻮﺳﻂ‬
‫ﻭﳚﺐ ﺍﻥ ﻻﺗﻌﻄﻰ ﺍﺫﺍ ﻛﺎﻥ ‪ Sever‬ﻻﻧﻪ ﻗﺪ ﻳﺴﺒﺐ ﺍﳔﻔﺎﺽ ﺑﺎﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺍﻟﺬﻱ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺍﻻ ﺍﻧﻪ ﺍﻳﻀﺎ ﻗﺪ‬ ‫‪ coma‬ﻭﳝﻜﻦ ﺣﻞ ﻫﺬﺍ ﺍﳋﻠﻞ ﺑﺎﻋﻄﺎء‬
‫ﻳﺴﺒﺐ ﺍﳔﻔﺎﺽ ﺑﺎﳌﻐﻨﻴﺴﻮﻡ ﻭﺧﺎﺻﺔ ﰲ ﻣﺮﺽ ‪.alcoholic cirrhosis‬‬
‫ﻛﻤﺎ ﺗﻌﺮﻓﻮﻥ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻜﻮﻥ ﳑﻨﻮﻉ ﻋﻠﻰ ﻣﺮﻳﺾ ﺍﻟﻜﻠﻴﺔ ﰲ ﺣﺎﻟﺔ‬
‫ﻓﺎﻧﻪ ﻳﺒﻘﻰ ﻓﻌﺎﻝ ﻭﻟﻜﻦ ﳓﺬﺭ ﻓﻘﻂ‬ ‫ﺍﻻ ﻋﻼﺝ‬
‫‪.‬‬ ‫ﻣﻦ‬
‫ﺍﻣﺎ ﰲ ﺣﺎﻟﺔ ﺍﳊﻤﻞ ﻓﺎﻧﻪ ﳑﻨﻮﻉ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﺫﻟﻚ ﻻﻧﻬﺎ ﺗﺴﺒﺐ ‪:‬‬
‫‪.‬‬ ‫ﺣﺎﻟﺔ‬ ‫‪-١‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ‪. bone marrow suppression‬‬ ‫‪-٢‬‬
‫ﺍﻟﲑﻗﺎﻥ ‪.‬‬ ‫‪-٣‬‬
‫‪.‬‬ ‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ‬ ‫‪-٤‬‬
‫ﺍﳔﻔﺎﺽ ﺍﻟﺴﻜﺮ ﰲ ﺍﻟﺪﻡ ‪.‬‬ ‫‪-٥‬‬
‫‪.‬‬ ‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻧﻘﺺ ﰲ‬ ‫‪-٦‬‬
‫ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﳍﺎ ﰲ‬ ‫ﻭﺍﻳﻀﺎ ﰎ ﻣﻼﺣﻈﺔ‬ ‫‪-٧‬‬
‫ﺍﳊﻤﻞ ‪.‬‬
‫ﺍﻣﺎ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻓﱰﺓ ﺍﻻﺭﺿﺎﻉ ﺑﺎﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻓﺎﻧﻪ ﳝﻜﻦ ﺍﻥ ﻳﺴﺒﺐ ﺗﺜﺒﻴﻂ ﻻﻧﺘﺎﺝ‬
‫ﺍﳊﻠﻴﺐ ﻋﻨﺪ ﺍﻻﻡ ﺍﳌﺮﺿﻊ ﻟﺬﺍ ﻓﻴﺠﺐ ﻭﺿﻊ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﰲ ﺍﻟﺒﺎﻝ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻟﻼﻡ‬
‫ﺍﳌﺮﺿﻊ ‪.‬‬

‫‪١٨‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﺍﳔﻔﺎﺽ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﳌﻐﻨﻴﺴﻴﻮﻡ‬
‫ﻭﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﺭﺗﻔﺎﻉ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ﻭﺣﺎﻣﺾ ﺍﻟﻴﻮﺭﻙ ﻭﺍﻟﻜﻠﻮﻛﻮﺯ ﳑﺎ ﻗﺪ ﻳﺆﺩﻱ ﻛﻤﺎ ﺗﻌﺮﻓﻮﻥ ﺍﱃ‬
‫ﺣﺪﻭﺙ ﺍﻭ ﺗﺪﻫﻮﺭ ﻣﺮﺽ ﺍﻟﺴﻜﺮ ﻭﺣﺪﻭﺙ ﻣﺮﺽ ﺍﻟﻨﻘﺮﺱ ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﺣﺪﻭﺙ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻳﻀﺎ ﺣﺪﻭﺙ ﺍﻟﺘﺤﺴﺲ ﺍﻟﻀﻮﺋﻲ ﻭﺍﺿﻄﺮﺍﺏ ﰲ ﺍﻟﺪﻫﻮﻥ‬
‫ﻭﺗﺆﺛﺮ ﻋﻠﻰ ﺍﻟﺪﻡ ﻭﺗﺴﺒﺐ‬ ‫‪ Lipid‬ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﻫﺬ ﺍﻻﺩﻭﻳﺔ‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻧﻘﺺ ﰲ ﻋﺪﺩ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪. Loop diuretics‬‬

‫*********************‬

‫ﻭﻫﻲ ﳎﻤﻮﻋﺔ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﺍﻟﺘﻲ ﻻﲣﻠﻮ ﺻﻴﺪﻟﻴﺔ ﻣﻦ ﻭﺟﻮﺩ ﺍﺣﺪ ﺍﻓﺮﺍﺩﻫﺎ‪.‬‬
‫ﺍﻟﺬﻱ ﻳﻨﺘﺞ ﺑﺴﺒﺐ ﻓﺸﻞ ﺍﻟﺒﻄﲔ ﺍﻻﻳﺴﺮ‬ ‫ﺣﻴﺚ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‬
‫ﻭﺍﻻﻋﻄﺎء ﺍﻟﻮﺭﻳﺪﻱ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﻳﻘﻠﻞ ﻣﻦ‬
‫ﺑﺼﻮﺭﺓ ﺍﺳﺮﻉ ﻣﻦ ﺣﺪﻭﺙ ﺍﻻﺩﺭﺍﺭ‪.‬‬
‫‪.‬‬ ‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ‬
‫ﻭﺗﻌﺎﰿ ﺍﻳﻀﺎ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻟﻮﺫﻣﺔ ﺍﻟﺘﻲ ﺗﻘﺎﻭﻡ ﺑﺎﻗﻲ ﺍﳌﺪﺭﺭﺍﺕ‬
‫ﻭﺍﻳﻀﺎ ‪ Odema‬ﺍﻟﺘﻲ ﲢﺪﺙ ﺑﺴﺒﺐ ﺣﺎﻟﺘﲔ ﻫﻤﺎ ‪:‬‬ ‫ﻣﺎ ﻋﺪﺍ‬
‫‪.‬‬ ‫ﺑﺴﺒﺐ ﺍﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ‬ ‫‪-١‬‬
‫ﻭﺍﻟﺘﻲ ﲢﺪﺙ ﺑﺴﺒﺐ ‪. peripheral venous stasis‬‬ ‫‪-٢‬‬

‫ﺑﺎﺳﺘﻌﻤﺎﻝ‬ ‫ﻭﺗﻌﺎﰿ‬
‫‪.‬‬
‫ﺍﻋﺰﺍﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﻭﰲ ﺣﺎﻟﺔ ﺍﻟﻀﺮﻭﺭﺓ ﻧﻀﻴﻒ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﱃ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﻈﺔ ﻟﻠﻀﻐﻂ ﻟﻠﻮﺻﻮﻝ‬
‫ﺍﱃ ﺍﳌﺴﺘﻮﻯ ﺍﳌﻄﻠﻮﺏ ﻣﻦ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺫﻟﻚ ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﻨﻬﺎ ‪:‬‬
‫‪.‬‬ ‫ﺣﺎﻟﺔ‬ ‫‪-١‬‬
‫‪.‬‬ ‫ﻭﺣﺎﻟﺔ‬ ‫‪-٢‬‬
‫‪.‬‬ ‫ﻭﰲ ﺣﺎﻟﺔ‬ ‫‪-٣‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺣﺒﺎﺋﻲ ﺗﺜﺒﻂ ﺍﻋﺎﺩﺓ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺘﻲ ﲢﺼﻞ ﰲ‬
‫ﻭﺧﺎﺻﺔ ﰲ ‪ ascending limp‬ﺣﻴﺚ ﺗﻌﺘﱪ ﻣﻨﻄﻘﺔ ﺍﻋﺎﺩﺓ ﺍﻣﺘﺼﺎﺹ‬
‫ﻟﻨﺴﺒﺔ ﻛﺒﲑﺓ ﻣﻦ ﺍﻟﺴﻮﺍﺋﻞ ﻭﺍﶈﺎﻟﻴﻞ ﻣﺜﻞ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﳌﺎء ﻟﺬﻟﻚ ﻓﻤﻨﻊ ﻫﺬﺍ ﺍﻟﻔﻌﻞ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺍﺩﺭﺍﺭ ﻧﺴﺒﺔ ﻛﺒﲑﺓ ﻣﻦ ﺍﳌﺎء ﻭﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﻳﻨﺘﺞ ﻓﻌﻞ ﺍﺩﺭﺍﻱ ﻛﺒﲑ ﻭﳍﺬﺍ ﺗﻌﺪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﻮﻳﺔ ‪.‬‬

‫‪١٩‬‬
 ‫‪Furosemide‬‬ ‫ﻣﻦ ﺍﻫﻢ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺻﻴﺎﺩﻟﺘﻨﺎ ﺍﻻﻋﺰﺍء ﻫﻤﺎ ﺩﻭﺍﺋﲔ‬
‫‪ bumetanide‬ﻭﻫﻤﺎ ﻣﺘﺸﺎﺑﻬﲔ ﻣﻦ ﺣﻴﺚ ﺍﻟﻔﻌﺎﻟﻴﺔ ﻭﺗﻌﻄﻲ ﺍﻟﺘﺎﺛﲑ ﺍﻟﺪﻭﺍﺋﻲ ﺑﻌﺪ ﺳﺎﻋﺔ ﻣﻦ‬
‫ﺍﺳﺘﻌﻤﺎﳍﻢ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻭﻳﺴﺘﻤﺮ ﳌﺪﺓ ‪ ٦‬ﺳﺎﻋﺎﺕ ﻟﺬﺍ ﻳﻔﻀﻞ ﺍﻋﻄﺎءﻫﻤﺎ ﻣﺮﺗﲔ ﻳﻮﻣﻴﺎ‪.‬‬
‫ﺍﻣﺎ ﺍﺫﺍ ﰎ ﺍﻻﻋﻄﺎء ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﻓﺎﻥ ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﳍﺎ ﻳﻨﺘﺞ ﺑﻌﺪ ﻧﺼﻒ ﺳﺎﻋﺔ ﻭﻳﺰﺩﺍﺩ‬
‫ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﺑﺰﻳﺎﺩﺓ ﺍﳉﺮﻋﺔ ﺃﻱ ﻳﻌﺘﻤﺪ ﻋﻠﻰ ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﺍﻣﺎ ﺍﻟﺪﻭﺍء ﺍﻻﺧﺮ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻮ ﺩﻭﺍء ‪ Torasemide‬ﻭﺍﻟﺬﻱ ﻳﺸﺒﺔ‬
‫ﻭﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬ ‫ﺍﻟﺪﻭﺍﺋﲔ ﺍﻟﺴﺎﺑﻘﲔ ﻭﻳﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ‬
‫ﻭﻣﻦ ﺍﳌﻼﺣﻈﺎﺕ ﺍﳌﻬﻤﺔ ﺍﻟﺘﻲ ﳚﺐ ﺍﻻﻧﺘﺒﺎﻩ ﳍﺎ ﻗﺒﻞ ﻭﺻﻒ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﺿﺮﻭﺭﺓ ﺗﺼﺤﻴﺢ ﺃﻱ‬
‫ﻧﻘﺺ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻳﻀﺎ ﻗﻠﺔ ﺍﻟﺴﻮﺍﺋﻞ ﻻﻥ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺳﻮﻑ ﻳﻔﺎﻗﻢ ﺍﳊﺎﻟﺔ ﻭﺭﲟﺎ‬
‫ﻳﺴﺒﺐ ﺍﳉﻔﺎﻑ ﻭﺍﳔﻔﺎﺽ ﺷﺪﻳﺪ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﺍﻟﺴﻜﺮ ﻭﺣﺪﻭﺙ ﻣﺮﺽ ﺍﻟﻨﻘﺮﺱ ﻭﻟﻜﻦ ﺗﺎﺛﲑﻫﺎ ﻋﻠﻰ ﺍﻟﺴﻜﺮ ﻫﻮ‬
‫ﺍﻗﻞ ﻣﻦ ﺗﺎﺛﲑ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺜﻴﺎﺯﺍﻳﺪ ‪.‬ﻭﻣﻦ ﺍﳌﻬﻢ ﺻﻴﺎﺩﻟﺘﻨﺎ ﺍﻟﻜﺮﺍﻡ ﺍﻥ ﻧﺬﻛﺮ ﻭﻫﻲ ﺍﻳﻀﺎ ﺣﺎﻟﺔ ﺷﺎﺋﻌﺔ ﰲ‬
‫ﺭﺩﻫﺎﺕ ﺍﻟﻄﻮﺍﺭﻯء ﻫﻲ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺗﻀﺨﻢ ﰲ ﺍﻟﱪﻭﺳﺘﺎﺕ ﻓﺎﻧﻪ ﳑﻜﻦ ﺍﻥ ﳛﺼﻞ ﺍﺣﺘﺒﺎﺱ‬
‫ﺑﺎﻟﺒﻮﻝ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﻟﻜﻦ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﻳﻘﻞ ﺍﺫﺍ ‪:‬‬
‫ﺍﺳﺘﻌﻤﻠﻨﺎ ﺟﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬ ‫‪-١‬‬
‫ﺍﺳﺘﻌﻤﻠﻨﺎ ﻧﻮﻉ ﻣﻦ ﺍﳌﺪﺭﺭﺍﺕ ﺍﻗﻞ ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪. loop diuretic‬‬ ‫‪-٢‬‬
‫ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﺍﻃﻼﻗﺎ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﻧﻘﺺ ﺷﺪﻳﺪ ﰲ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﻧﻘﺺ‬
‫ﺷﺪﻳﺪ ﰲ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﻳﻀﺎ ﰲ ﺣﺎﻟﺔ ﻛﺎﻥ ﺍﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﺍﻻﻏﻤﺎء ﺍﻭ ﻗﺮﻳﺐ ﺍﻻﻏﻤﺎء ﺑﺴﺒﺐ ﻣﺮﺽ‬
‫‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﺍﻃﻼﻗﺎ ﺍﻋﺰﺍﺋﻲ ﰲ ﻣﺮﺽ ﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ ﺍﻟﺬﻱ ﺣﺪﺙ ﺑﺴﺒﺐ ﺍﺳﺘﻌﻤﺎﻝ‬
‫‪.‬‬ ‫‪ nephrotoxic drug‬ﺍﻭ ﺑﺴﺒﺐ‬

‫ﺍﻣﺎ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ‪ Hepatic impairment‬ﻓﺎﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺒﺐ ﺍﳔﻔﺎﺽ ﰲ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺍﻻﻏﻤﺎء ﻭﳝﻜﻦ ﺍﻟﺘﺨﻠﺺ ﻣﻦ ﻫﺬﺍ‬ ‫ﺍﻟﺬﻱ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺍﻟﺘﺎﺛﲑ ﻭﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺎﻣﺎﻥ ﰲ ﻣﺮﺽ ﺍﻟﻜﺒﺪ ﻭﺫﻟﻚ ﻋﻦ ﻃﺮﻳﻖ ﻭﺻﻒ‬
‫ﺣﻴﺚ ﲤﻨﻊ ﺣﺪﻭﺙ ﺍﳔﻔﺎﺽ ﺑﺎﻟﺒﻮﺗﺎﺳﻴﻮﻡ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﳚﺐ ﺍﻥ ﺗﻌﻠﻤﻮﺍ ﺍﻥ ﺍﻻﻋﻄﺎء ﺍﻟﻮﺭﻳﺪﻱ ﺍﻟﺴﺮﻳﻊ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻭ ﺍﻋﻄﺎءﻫﺎ ﲜﺮﻋﺔ ﻛﺒﲑﺓ ﰲ‬
‫ﻣﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ‪ renal impairment‬ﳑﻜﻦ ﺍﻥ ﺗﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ‬
‫ﻟﺬﺍ ﳚﺐ ﺍﳊﺬﺭ ﻭﻧﺼﺢ ﺍﻟﻄﺒﻴﺐ ﻭﺍﳌﻤﺮﺽ ﺑﺎﻥ ﻳﻘﻠﻞ ﺍﳉﺮﻋﺔ ﺍﻻﻭﻝ‪ -‬ﺍﻟﻄﺒﻴﺐ ‪-‬‬
‫ﰲ ﺍﳌﺮﺿﻰ‬ ‫ﻭﻳﻌﻄﻲء ﺑﻄﻲء ﺍﻟﺜﺎﻧﻲ – ﺍﳌﻤﺮﺽ – ﺍﻣﺎ ﺍﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻣﻦ ﺩﻭﺍء‬
‫‪. pain‬‬ ‫ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ‪ renal impairment‬ﻓﻤﻤﻜﻦ ﺍﻥ ﻳﺴﺒﺐ‬

‫‪٢٠‬‬
 ‫ﺗﻼﺣﻈﻮﻥ ﻫﺬﻩ ﺍﳌﻼﺣﻈﺎﺕ ﻛﻠﻬﺎ ﳚﺐ ﺍﻥ ﺗﻜﻮﻥ ﻣﻌﻠﻮﻣﺔ ﻟﺪﻯ ﺍﻟﺼﻴﺪﱄ ﺍﻟﺴﺮﻳﺮﻱ ﺣﱴ ﻳﻀﻌﻬﺎ‬
‫ﲞﺪﻣﺔ ﺍﻟﻜﺎﺩﺭ ﺍﻟﻄﺒﻲ ﻭﺍﻟﺼﺤﻲ ﻟﺘﺠﻨﺐ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﳋﻄﺮﺓ ‪.‬‬
‫ﺍﻣﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻋﻦ ﺍﳊﻤﻞ ﻓﻴﺠﺐ ﺍﻥ ﻻﻧﺴﺘﻌﻤﻞ ﺩﻭﺍﺋﻲ‬
‫ﳌﺎﺫﺍ ؟‬ ‫ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﳊﺎﻣﻞ‬
‫‪.‬‬ ‫ﺍﳉﻮﺍﺏ ‪:‬ﻻﻧﻬﺎ ﺗﺴﺒﺐ‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﺪ ﺗﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﺍﻟﻜﻮﻟﻴﺴﺘﲑﻭﻝ ﻭﺍﻟﺪﻫﻮﻥ ﺍﻟﺜﻼﺛﻴﺔ‪.‬‬
‫‪.‬‬ ‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﳔﻔﺎﺽ ﻛﻞ ﻣﻦ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺍﳌﻐﻨﻴﺴﻴﻮﻡ ﻭﻋﻠﻰ ﻛﻌﺲ ﺍﻟﺜﻴﺎﺯﺍﻳﺪ‬
‫ﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﳔﻔﺎﺽ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ﻭﺗﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻭﺍﻟﻴﻮﺭﻙ ‪. uric acid‬ﻭﳝﻜﻦ ﺍﻥ‬
‫ﺗﺴﺒﺐ ﺗﺸﻮﺵ ﰲ ﺍﻟﺮﺅﻭﻳﺔ‪.‬‬
‫ﻭ‬ ‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻧﻘﺺ ﺍﻟﻀﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺍﻳﻀﺎ‬
‫‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﺗﺴﺒﺐ ﻫﺬﻩ‬ ‫ﻭ‬ ‫ﻭﳝﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﲢﺴﺲ ﺿﻮﺋﻲ ﻳﺘﻀﻤﻦ‬
‫‪.‬‬ ‫ﺍﻻﺩﻭﻳﺔ‬
‫ﻭﻟﻠﻌﻠﻢ ﺍﻥ ﺍﻻﺳﻢ ﺍﻟﺘﺠﺎﺭﻱ ﻟﺪﻭﺍء ‪ Furosemide‬ﻫﻮ ‪. lasix‬‬

‫‪Aldosterone antagonists‬‬
‫***********************‬

‫ﻣﻦ ﺍجملﻤﻮﻋﺎﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻟﺸﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ﻭﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﺟﺪﺍ ﺧﻄﲑﻩ‬
‫ﻫﻲ ‪. Aldosterone antagonists‬‬
‫ﻭﺍﻫﻢ ﺍﻓﺮﺍﺩ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻋﺰﺍﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﻫﻮ ﺩﻭﺍء ‪. Spironolactone‬‬
‫‪.‬‬ ‫ﻭﺍﻟﺬﻱ ﻳﻘﻮﻡ ﺑﺘﻘﻮﻳﺔ ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﻻﺩﻭﻳﺔ‬
‫ﻻﻧﻪ ﻳﻘﻮﻡ ﺑﻔﻌﻠﲔ ﻣﻔﻴﺪﻳﻦ ﺟﺪﺍ‪:‬‬
‫ﺍﻟﺬﻱ ﻳﺴﺒﺐ ﺍﺣﺘﺒﺎﺱ ﺍﳌﺎء ﻭﺍﻟﺼﻮﺩﻳﻮﻡ ﰲ ﺍﳉﺴﻢ ﻓﻌﻨﺪﻣﺎ‬ ‫ﺍﻻﻭﻝ ﻫﻮ ﻣﻌﺎﻛﺴﺔ ﻟﻔﻌﻞ‬
‫ﻳﻘﻮﻡ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﲟﻌﺎﻛﺴﺔ ﻓﻌﻠﻪ ﻓﺎﻧﻪ ﻳﺴﺒﺐ ﺧﺮﻭﺝ ﺍﳌﺎء ﻭﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬ﻭﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﺍﻟﺜﺎﻧﻲ ﺍﳌﻬﻢ‬
‫ﳍﺬﺍ ﺍﻟﻌﻼﺝ ﻫﻮ ﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺑﺎﳉﺴﻢ ﻭﺑﺎﻟﺘﺎﱄ ﻳﻌﻮﺽ ﺍﻟﻨﻘﺺ ﺍﳊﺎﺻﻞ ﺑﺎﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻧﺘﻴﺠﺔ‬
‫‪.‬‬ ‫ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﺗﺸﻤﻊ ﺍﻟﻜﺒﺪ ‪.‬‬ ‫ﻭﳍﺬﺍ ﺍﻟﺪﻭﺍء ﺍﻫﻤﻴﺔ ﻛﺒﲑﺓ ﰲ ﻣﻌﺎﳉﺔ‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻭﻛﻤﺎ ﻫﻮ ﻣﻌﺮﻭﻑ ﺍﻥ ﺟﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺗﻨﻔﻊ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻔﺸﻞ‬
‫ﺍﻟﻘﻠﺒﻲ ﺍﳌﺘﻮﺳﻂ ﺍﱃ ﺍﻟﺸﺪﻳﺪ ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﻭﻛﺨﻂ ﻋﻼﺟﻲ ﺛﺎﻟﺚ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﻟﺬﻱ ﻻﻳﺴﺘﺠﻴﺐ ﻟﻼﺩﻭﻳﺔ ﺍﻻﺧﺮﻯ ‪.‬‬

‫‪٢١‬‬
 ‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳌﻌﺎﳉﺔ ﺯﻳﺎﺩﺓ ﺍﻻﻟﺪﺳﺘﲑﻭﻥ ﺍﻟﺘﻲ ﲢﺪﺙ ﰲ ﻣﺮﺽ‬
‫ﺣﻴﺚ ﻳﻌﻄﻰ ﺍﻳﻬﺎ ﺍﻻﺣﺒﺔ ﺍﻣﺎ ﻗﺒﻞ ﺍﻟﻌﻤﻠﻴﺔ ﺍﳉﺮﺍﺣﻴﺔ ﺍﻭ ﻋﻨﺪﻣﺎ ﺗﻜﻮﻥ ﺍﻟﻌﻤﻠﻴﺔ‬
‫ﺍﳉﺮﺍﺣﻴﺔ ﻏﲑ ﻣﻨﺎﺳﺒﺔ ﰲ ﺍﻗﻞ ﺟﺮﻋﺔ ﳑﻜﻨﺔ ﺗﻌﻄﻲ ﻓﻌﻞ ﻋﻼﺟﻲ ﻣﻔﻴﺪ ﳍﺬﺍ ﺍﳌﺮﺽ ‪.‬‬
‫ﺍﻟﺪﻭﺍء ﺍﻟﺜﺎﻧﻲ ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﺣﺒﺘﻲ ﻭﺍﻟﺬﻱ ﳚﺐ ﺍﻥ ﻧﻜﻮﻥ ﻟﺪﻳﻨﺎ ﻣﻌﺮﻓﺔ ﻣﻔﺼﻠﺔ ﻋﻨﻪ ﻫﻮ ﺩﻭﺍء‬
‫ﺍﻟﺬﻱ ﻳﻜﻮﻥ ﻣﺼﺤﻮﺏ ‪left‬‬ ‫‪ Eplerenone‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﰲ‬
‫‪. ventricular systolic dysfunction‬‬
‫ﻛﻤﺎ ﻗﻠﻨﺎ ﻓﺎﻥ ﻫﺬﺍ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺑﱰﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻓﻼﳚﻮﺯ ﺧﻼﻝ ﺗﻨﺎﻭﳍﺎ ﺍﻥ‬
‫ﻳﺘﻢ ﺍﻋﻄﺎء ﺍﳌﻜﻤﻼﺕ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺑﱰﺍﻛﻴﺰ ﻋﺎﻟﻴﺔ ‪.‬‬
‫ﺍﻳﻬﺎ ﺍﻟﺰﻣﻼء ﻭﻻ ﺑﺎﺱ ﺑﻨﺼﺢ ﺍﻟﻄﺒﻴﺐ ﺑﻘﻴﺎﺱ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻋﻨﺪ ﺍﻟﺒﺪء ﲟﻌﺎﳉﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‬
‫ﻭﻋﻨﺪ ﺗﻐﻴﲑ ﺍﳉﺮﻋﺔ ﻟﻠﺘﺎﻛﺪ ﻣﻦ ﻋﺪﻡ ﻭﺟﻮﺩ ﺍﺭﺗﻔﺎﻉ ﻓﻴﻪ ‪.‬‬
‫ﺍﻣﺎ ﺍﻟﺘﺎﺛﲑﺍ ﺍﳉﺎﻧﺒﻴﺔ ﻻﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻓﻬﻲ ﻛﺜﲑﺓ ﻭﻟﻜﻦ ﺍﻫﻤﻬﺎ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﺳﻬﺎﻝ ‪.‬‬
‫‪.‬‬ ‫ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ﻭﺍﻳﻀﺎ ﺣﺪﻭﺙ‬
‫ﻭﳚﺐ ﰲ ﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ ﻣﺘﺎﺑﻌﺔ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺑﺼﻮﺭﺓ ﺟﺪﺍ ﺷﺪﻳﺪﺓ ﻟﺘﺠﻨﺐ ﺧﻄﺮ ﺍﺭﺗﻔﺎﻋﻪ ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‬
‫ﻭﺍﻳﻀﺎ ﻧﻘﺺ ﰲ ﻋﺪﺩ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﺧﺎﺻﺔ ﺩﻭﺍء ‪ spironolactone‬ﺍﻟﺼﻠﻊ ﻭﻃﻔﺢ ﺟﻠﺪﻱ‬
‫‪.‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻟﺸﺎﺋﻌﺔ ﺟﺪﺍ ﻟﺪﻭﺍء ‪ spironolactone‬ﻫﻲ‬
‫‪.‬‬
‫ﻭﻫﺬﻳﻦ ﺍﻟﺪﻭﺍﺋﲔ ﰲ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻳﺘﻢ ﺍﻋﻄﺎءﻫﻤﺎ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﺟﺮﻋﺔ ﺩﻭﺍء ‪ EPLERENONE‬ﻫﻲ ‪ ٢٥‬ﻣﻠﻐﻢ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﺑﺎﻟﻴﻮﻡ ﳝﻜﻦ ﺍﻥ ﺗﺰﺩﺍﺩ ﺑﻌﺪ ‪ ٤‬ﺍﺳﺎﺑﻴﻊ‬
‫ﺍﱃ ‪ ٥٠‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ‪.‬‬

‫‪Calcium channel blockers.‬‬

‫************************‬
‫ﳎﻤﻮﻋﺔ ﺩﻭﺍﺋﻴﺔ ﺟﺪﺍ ﺷﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻭﻣﻬﻤﺔ ﻭﻫﻲ ‪:‬‬

‫‪٢٢‬‬
‫‪ Calcium channel blockers‬ﺣﻴﺚ ﺗﻀﻢ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻋﺪﺩ ﻛﺒﲑ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﻭﻣﻦ ﺍﻣﺜﻠﺘﻬﺎ‬
‫‪:‬‬
‫‪ Nifedipine‬ﺣﻴﺚ ﻳﻜﻮﻥ ﺍﻏﻠﺐ ﻋﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﺗﻮﺳﻴﻊ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﺸﺮﺍﻳﲔ ﻭﺍﱃ ﺣﺪ‬
‫ﻗﻠﻴﻞ ﺍﻻﻭﺭﺩﺓ‪.‬‬
‫ﻭﺍﳌﺜﺎﻝ ﺍﻟﺜﺎﻧﻲ ‪ Verapamil‬ﻭﺍﻛﺜﺮ ﻋﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﺍﻟﻘﻠﺐ ﺣﻴﺚ ﺑﻘﻠﻞ ﻣﻦ ﻋﺪﺩ ﺿﺮﺑﺎﺗﻪ ﻭﻗﻮﺓ‬
‫ﺗﻘﻠﺼﻪ‪.‬‬
‫ﻭﺍﳌﺜﺎﻝ ﺍﻟﺜﺎﻟﺚ ‪ Diltiazem‬ﻭﻫﻮ ﻳﻌﻤﻞ ﻋﻠﻰ ﻛﻞ ﻣﻦ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺗﻘﻮﻡ ﺑﻌﺪﺓ ﺗﺎﺛﲑﺍﺕ ﻣﻔﻴﺪﺓ ﰲ ﻣﻌﺎﳉﺎﺕ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﺧﻄﺮﺓ ﲢﺪﺙ ﻋﻠﻰ‬
‫ﺍﻟﻘﻠﺐ ﻭﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﻫﺬﻩ ﺍﻟﻔﺎﺋﺪﺓ ﺗﺎﺗﻲ ﻣﻦ ﻛﻴﻔﻴﺔ ﻋﻤﻞ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺣﻴﺚ ﺗﻘﻮﻡ‬
‫ﲟﻨﻊ ﺩﺧﻮﻝ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ﺍﱃ ﺍﳋﻠﻴﺔ ﻭﺑﺎﻟﺘﺎﱄ ﻣﻨﻊ ﺣﺪﻭﺙ ﺗﻘﻠﺺ ﰲ ﺍﻟﻌﻀﻠﺔ ﻭﻟﺬﺍ ﻓﻬﻲ ﺗﻘﻠﻞ ﻣﻦ ﻗﻮﺓ‬
‫ﺗﻘﻠﺺ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻻﻧﻬﺎ ﲤﻨﻊ ﺩﺧﻮﻝ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ﺍﻟﻴﻬﺎ ﻭﻫﺬﺍ ﻳﻔﻴﺪ ﰲ ﺗﻘﻠﻴﻞ ﺍﺳﺘﻬﻼﻙ ﺍﻻﻭﻛﺴﺠﲔ‬
‫ﺑﻮﺍﺳﻄﺔ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﻫﺬﺍ ﺍﻟﻔﻌﻞ ﻳﻔﻴﺪ ﻭﻳﻘﻠﻞ ﻣﻦ ﻣﺮﺍﺿﺔ ﺍﻟﺬﲝﺔ ﺍﻟﺼﺪﺭﻳﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻘﻮﻡ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺘﻮﺳﻴﻊ ﺍﻟﺸﺮﺍﻳﲔ ﺍﻟﺘﺎﺟﻴﺔ ﺍﻟﺘﻲ ﲢﻴﻂ ﺑﺎﻟﻘﻠﺐ ﻛﺎﻟﺘﺎﺝ ﻭﺗﻐﺬﻳﺔ ﻋﻀﻠﺘﻪ ﻋﻦ‬
‫ﻃﺮﻳﻖ ﻣﻨﻊ ﺩﺧﻮﻝ ﺍﻟﻜﻠﺴﻴﻮﻡ ﻭﺑﺎﻟﺘﺎﱄ ﻣﻨﻊ ﺣﺪﻭﺙ ﺗﻘﻠﺺ ﻓﻴﻬﺎ ﻭﻫﺬﺍ ﻳﻨﻔﻊ ﻛﺜﲑﺍ ﰲ ﻣﺮﺿﻰ ﺍﻟﺬﲝﺔ‬
‫ﺍﻟﺼﺪﺭﻳﺔ ﻭﺍﳉﻠﻄﺔ ﺍﻟﻘﻠﺒﻴﺔ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻛﻤﺎ ﺗﻌﺮﻓﻮﻥ ﺍﻥ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻭﺍﻟﺘﻲ ﺑﻌﻀﻬﺎ ﻣﺰﻋﺞ ﺟﺪﺍ‬
‫ﻭﻣﻦ ﺍﻣﺜﻠﺘﻬﺎ ﻫﻲ‪:‬‬
‫ﺍﻻﻣﺴﺎﻙ ﻟﺬﺍ ﻧﻨﺼﺢ ﺍﳌﺮﻳﺾ ﺑﺘﻨﺎﻭﻝ ﺍﻟﺴﻮﺍﺋﻞ ﻭﺍﻻﻟﻴﺎﻑ ﻭﺍﳊﺮﻛﺔ ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺑﻂء ﺑﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻳﻀﺎ ‪. edema‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻳﻀﺎ ﻫﻲ ‪. orthostatic hypotension‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺘﻌﻤﻞ ﰲ‪:‬‬
‫ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻌﺎﳉﺔ ‪. angina‬‬
‫ﻭﻫﻲ ﺍﻣﻨﻪ ﰲ ﻣﺮﺿﻰ ﺍﻟﺴﻜﺮﻱ ﻭﺍﻟﺮﺑﻮ ﻭﻻﺗﺆﺛﺮ ﻋﻠﻴﻬﻤﺎ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﻣﻊ ﺩﻭﺍء ﺍﻟﺪﳚﻮﻛﺴﲔ ﻻﻧﻬﺎ ﺗﺰﻳﺪ ﻣﻦ ﺗﺮﻛﻴﺰﻩ ﰲ ﺍﻟﺪﻡ‪.‬‬
‫ﻭﻻﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﳔﻔﺎﺽ ﺍﻭ ﺍﺭﺗﻔﺎﻉ ﰲ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻛﻤﺎ ﰲ ﺍﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ ‪ ACEI‬ﻭﺍﻻﺩﻭﻳﺔ‬
‫ﺍﳌﺪﺭﺭﺓ ‪.‬‬
‫ﻭﻻﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺮﻭﺩﺓ ﺍﻻﻃﺮﺍﻑ ﻛﻤﺎ ﰲ ﺍﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ ‪. Beta. Blocker‬‬
‫ﳚﺐ ﲡﻨﺒﻬﺎ ﰲ ﻣﺮﺿﻰ ﺍﻟﻔﺸﻞ ﺍﻟﻘﻠﺐ‬ ‫ﻭ‬ ‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺗﺪﻫﻮﺭ ﺍﻋﺮﺍﺿﺔ ﺑﺼﻮﺭﺓ ﺍﻛﺜﺮ ﺃﻱ ﺗﺰﻳﺪ ﻣﻦ‬ ‫ﻻﻧﻬﺎ ﺗﺴﺒﺐ‬
‫ﻋﻤﻠﻴﺔ ﻓﺸﻠﺔ ﻭﻋﺪﻡ ﻧﻬﻮﻇﺔ ‪.‬‬

‫‪٢٣‬‬
 ‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺍﻥ ﻫﻨﺎﻙ ﺍﺳﺘﻌﻤﺎﻝ ﺷﺎﺋﻊ ﻟﺪﻭﺍء‪ Verapamil‬ﺑﺎﻻﺿﺎﻓﺔ ﺍﱃ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ ﺍﳉﻠﻄﺔ‬
‫ﻭﺍﺭﺗﻔﺎﻉ ﺍﻟﻀﻐﻂ ﻭﻫﻮ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﻭﺍﺿﻄﺮﺍﺏ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‬
‫ﺣﻴﺚ ﻳﻘﻮﻡ ﺑﺘﻘﻠﻴﻞ ﺍﻟﺘﻮﺻﻴﻞ ﺍﻟﻜﻬﺮﺑﺎﺋﻲ ﻟﻠﻘﻠﺐ ﺑﲔ ﺍﻻﺫﻳﻨﲔ ﻭﺍﻟﺒﻄﻴﻨﲔ‬
‫‪.‬‬

‫ﻻﻧﻪ ﻳﺴﺒﺐ ﺑﻂء ﺷﺪﻳﺪ ﺑﻀﺮﺑﺎﺕ‬ ‫ﻭﳚﺐ ﺍﻥ ﻻﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﳎﻤﻮﻋﺔ‬
‫ﺍﻟﻘﻠﺐ ﻭﺍﳔﻔﺎﺽ ﺷﺪﻳﺪ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ‪،‬‬
‫ﺍﻟﺬﻱ ﻗﺪ ﳛﺪﺙ ﺑﻌﺪ‬ ‫ﻭﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻻﺗﻘﻠﻞ ﻣﻦ ﺣﺪﻭﺙ‬
‫‪ Unstable angina‬ﻟﺬﻟﻚ ﻓﻬﻲ ﻻﺗﻌﻄﻰ ﰲ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﻣﻦ ﺍﻟﺬﲝﺔ ﺍﻟﺼﺪﺭﻳﺔ ﺍﻻ ﺍﺫﺍ ﻛﺎﻥ ﻫﻨﺎﻙ‬
‫ﻣﻘﺎﻭﻣﺔ ﻭﻋﺪﻡ ﺍﺳﺘﺠﺎﺑﺔ ﻛﺎﻓﻴﺔ ﻻﺩﻭﻳﺔ ‪. Beta.blocker‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Nitrates‬‬

‫********************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Nitrates‬ﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ‪:‬‬

‫)‪. Glyceryl trinitrate (GTN), isosorbide mononitrate (ISMN‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻭﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻟﺬﲝﺔ ﺍﻟﺼﺪﺭﻳﺔ ‪Prophylaxis and treatment of‬‬
‫‪. angina‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﺒﻄﲔ ﺍﻻﻳﺴﺮ ‪. LVF‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ‪. Postural hypotension‬‬
‫ﻭﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‪.‬‬
‫ﻭ ‪. Dizziness‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ‪.‬‬
‫ﻭ ‪ t1/2‬ﻟﻌﻼﺝ ‪ for intravenous GTN‬ﻫﻮ ‪ ٦‬ﺩﻗﺎﺋﻖ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ‪. Hypersensitivity to nitrates‬‬
‫ﻭ ‪. Hypotension/hypovolaemia‬‬
‫ﻭ ‪. Closed-angle glaucoma‬‬
‫ﻭ‪. Cardiac outflow obstruction‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻘﻠﻞ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻻﺩﻭﻳﺔ ‪. low molecular weight heparin‬‬

‫‪٢٤‬‬
 ‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺣﺪﻭﺙ ﺧﻄﺮ ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ﻋﻨﺪﻣﺎ ﺗﺴﺘﻌﻤﻞ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ‬
‫‪ phosphodiesterase type 5 inhibitors‬ﻣﺜﻞ ﺩﻭﺍء ‪. sildenafil‬‬
‫ﻭﺍﻳﻀﺎ ﻫﻨﺎﻙ ﻇﺎﻫﺮﺓ ﲢﺪﺙ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﻫﻲ ﻇﺎﻫﺮﺓ ﺍﻟﺘﺤﻤﻞ ﺃﻱ ﺍﳔﻔﺎﺽ ﺍﻻﺳﺘﺠﺎﺑﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻟﺬﺍ‬
‫ﳚﺐ ﺗﺮﻙ ﻓﱰﺓ ﺯﻣﻨﻴﺔ ﻋﻠﻰ ﺍﻻﻗﻞ ‪ ٨‬ﺳﺎﻋﺎﺕ ﺧﺎﻟﻴﺔ ﻣﻦ ﻓﻌﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻻ ﰲ ﺣﺎﻟﺔ ﺍﻋﻄﺎء ﺍﻻﺩﻭﻳﺔ‬
‫‪. intravenously in the acute setting‬‬
‫ﻭﺗﻘﻮﻡ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺘﻮﺳﻴﻊ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﺘﺎﺟﻴﺔ‪ coronary artery dilatation‬ﳑﺎ ﻳﺰﻳﺪ‬
‫ﻣﻦ ﻋﻤﻠﻴﺔ ﻭﺻﻮﻝ ﺍﻟﺪﻡ ﻭﺑﺎﻟﺘﺎﱄ ﺍﻻﻭﻛﺴﺠﲔ ﺍﱃ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﻫﺬﺍ ﻣﺎ ﻳﻘﻠﻞ ﻣﻦ ﻣﺮﺽ ﺍﻟﺬﲝﺔ‬
‫ﻭﺍﳉﻠﻄﺔ ﺍﻟﺼﺪﺭﻳﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻮﺳﻊ ﺍﻻﻭﺭﺩﺓ ﻋﻦ ﻃﺮﻳﻖ ﺍﺳﱰﺧﺎء ﰲ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﺍﻟﻮﻋﺎﺋﻴﺔ ‪.‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ﻭﺣﺒﻮﺏ ﻭﻟﺼﻘﺎﺕ ﻭﺣﻘﻦ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪alpha-1 . blocker‬‬

‫************************‬
‫ﺩﻭﺭ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ alpha . blocker‬ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺣﻴﺚ ﺗﻘﻮﻡ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺑﻐﻠﻖ ‪ alpha receptor‬ﻭﺗﺆﺩﻱ ﺍﱃ ﺍﺳﱰﺧﺎء ﻭﺗﻮﺳﻊ ﺍﻻﻭﻋﻴﺔ‬
‫ﺍﻟﺪﻣﻮﻳﺔ ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺗﻘﻠﻴﻞ ﺍﳌﻘﺎﻭﻣﺔ ﻟﻀﺦ ﺍﻟﺪﻡ ﻭﻫﺬﺍ ﺟﺪﺍ ﻣﻬﻢ ﰲ ﺧﻔﺾ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺍﻭﻝ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻮ ﻋﻼﺝ ‪ Prazosin‬ﻭﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (Minipress‬‬
‫ﺣﻴﺚ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺑﺘﻮﺳﻴﻊ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺃﻱ ﺍﻻﻭﺭﺩﺓ ﻭﺍﻟﺸﺮﺍﻳﲔ ‪Arterial vasodilator‬‬
‫‪. and venodilator‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﺍﻣﺮﺍﺽ ﺍﻻﻭﻋﻴﺔ ﺍﻟﻄﺮﻓﻴﺔ‬
‫‪. Peripheral vascular diseases.‬‬
‫ﻭﺟﺮﻋﺔ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺗﱰﺍﻭﺡ ﺑﲔ ‪ ١‬ﺍﱃ ‪ ١٠‬ﻣﻠﻐﻢ ﺑﺎﻟﻴﻮﻡ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻲ ‪ First dose phenomenon‬ﻭﺍﻟﺘﻲ ﲢﺪﺙ ﺍﱃ‬
‫ﺣـــــــــــــﺪ ﺳﺎﻋﺘﲔ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻟﻈﺎﻫﺮ ﺗﺘﻤﺜﻞ ﻋﻨﺪ ﺍﺧﺬ ﺍﻟﺪﻭﺍء ﳛﺪﺙ ﺗﻮﺳﻊ ﻭﻋﺎﺋﻲ ﻛﺒﲑ ‪marked vasodilatation‬ﳑﺎ‬
‫ﻳﺆﺩﻱ ﺍﱃ ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﻣﻦ ﻧﻮﻉ ‪ postural hypotension‬ﺍﻭ ﺣﺪﻭﺙ ‪. syncope‬‬
‫ﻭﻟﺘﺠﻨﺐ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﳉﺎﻧﺒﻲ ﺍﻋﺰﺍﺋﻲ ‪:‬‬
‫ﳚﺐ ﺍﻥ ﻳﺘﻢ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ‬
‫ﻭﻋﻨﺪ ﺍﻟﺬﻫﺐ ﻟﻠﺴﺮﻳﺮ ﻟﻠﻨﻮﻡ‬

‫‪٢٥‬‬
 ‫ﻭﺑﺪﻭﻥ ﺍﺳﺘﻌﻤﺎﻝ ﺍﺣﺪ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳋﺎﻓﺾ ﻟﻠﻀﻐﻂ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻣﺜﻞ ﺍﻻﺩﻭﻳﺔ‬
‫ﺍﳌﺪﺭﺭﺓ‪ diuretics‬ﺍﻭ ﺍﺩﻭﻳﺔ ‪. Beta blocker‬‬
‫ﻭﻣﻦ ﺍﻻﻣﺜﻠﺔ ﺍﻻﺧﺮﻯ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻮ ﺩﻭﺍء ‪ doxazosin‬ﺍﻟﺬﻱ ﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (cardura‬‬
‫ﻭﻳﻌﻄﻰ ﲜﺮﻋﺔ ﺗﱰﺍﻭﺡ ﺑﲔ ‪ ٤ – ١‬ﻣﻠﻐﻢ ﻣﺮﺓ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻟﺪﻭﺍء ﺍﻻﺧﺮ ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪. terazosin‬‬
‫ﻭﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﲜﺮﻋﺔ ﻣﻦ ‪ ٥- ٢‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﺗﻀﺨﻢ ﺍﻟﱪﻭﺳﺘﺎﺕ ﺍﳊﻤﻴﺪ ‪.‬‬
‫ﻋﻠﻤﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻻ ﺗﻌﺘﱪ ﺍﳋﻂ ﺍﻟﻌﻼﺟﻲ ﺍﻻﻭﻝ ﻭﻻ ﺍﻟﺜﺎﻧﻲ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺑﻞ ﺗﻌﺘﱪ ﺧﻂ ﻋﻼﺟﻲ ﺛﺎﻟﺚ ﺑﻌﺪ ﺍﻥ ﻳﻔﺸﻞ ﺿﺒﻂ ﺿﻐﻂ ﺍﻟﺪﻡ ﺑﺎﺳﺘﻌﻤﺎﻝ ﻛﻞ ﻣﻦ ﳎﻤﻮﻋﺔ ‪ ACEI‬ﻭ‬
‫‪ Ca. channel blocker‬ﻭ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ‪.diuretics‬‬

‫‪. Angiotensin-converting enzyme inhibitors‬‬

‫******************************************‬

‫ﻫﻲ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻟﺸﻬﲑﺓ ﺟﺪﺍ ‪. Angiotensin-converting enzyme inhibitors‬‬

‫ﻭﺍﻟﺘﻲ ﻣﻦ ﺍﻫﻢ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻲ ﻛﻞ ﻣﻦ ‪Ramipril, lisinopril, perindopril‬‬
‫ﺑﺎﻻﺿﺎﻓﺔ ﺍﱃ ﺩﻭﺍء ‪.captopril‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻛﻤﺎ ﺗﻌﺮﻓﻮﻥ ﺯﻣﻼﺋﻨﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺜﺒﻂ ‪angiotensin-converting‬‬
‫‪ enzyme‬ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ ﲢﻮﻳﻞ ‪. angiotensin I to angiotensin II.‬‬
‫ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﻣﻨﻊ ﺗﻀﻴﻖ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺗﻮﺳﻌﻬﺎ ﻭﺑﺎﻟﺘﺎﱄ ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‪.‬‬
‫ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪ Hypertension‬ﻭﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﻻﺣﺘﻘﺎﻧﻲ ‪.Heart failure‬‬
‫ﻭﺍﻳﻀﺎ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺍﳌﺨﺎﻃﺮ ﺍﻟﻘﻠﺒﻴﺔ ﺑﻌﺪ ﺍﻟﺘﻌﺮﺽ ﻻﺣﺘﺸﺎء ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪cardiovascular events‬‬
‫‪. post-MI‬‬
‫ﻭﰲ ﻣﻌﺎﳉﺔ ﺍﻣﺮﺍﺽ ﺍﻟﻜﻠﻴﺔ ﺍﻟﺴﻜﺮﻳﺔ ‪. Diabetic nephropathy‬‬
‫ﺍﻋﺰﺍﺋﻲ ﻻ ﺗﺴﺘﻌﻤﻞ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﻨﻬﺎ ﻭﺟﻮﺩ ﺣﺎﻟﺔ ﺍﻟﺘﺤﺴﺲ ﻣﻦ ﻫﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﲤﻨﻊ ﰲ ‪. Renal artery stenosis‬‬

‫‪٢٦‬‬
 ‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ﺧﺎﺻﺔ ﻣﻊ ﺍﻭﻝ ﺟﺮﻋﺔ ﻭﺧﺎﺻﺔ‬
‫ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪ loop diuretics‬ﻭﻟﺬﻟﻚ ﳚﺐ ﺍﻥ ﺗﺎﺧﺬ ﺍﻭﻝ ﺟﺮﻋﺔ ﻣﻊ ﻣﺮﺍﻗﺒﺔ ﺿﻐﻂ ﺍﳌﺮﻳﺾ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﺑﱰﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﻟﺬﻟﻚ ﻓﻬﻲ ﳑﻨﻮﻋﺔ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺰﻳﺪ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‬
‫ﻟﻮﺣﺪﻫﻤﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﻟﺴﻌﺎﻝ ﺍﳉﺎﻑ ﺍﳌﺴﺘﻤﺮ ﻋﻨﺪ ﻧﺴﺒﺔ ﻛﺒﲑﺓ ﻣﻦ ﺍﳌﺮﺿﻰ ﻭﺧﺎﺻﺔ ﺍﻟﻨﺴﺎء ﻭﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﺍﻻﺩﻭﻳﺔ ‪ NSAID‬ﳌﻌﺎﳉﺔ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺍﻭ ﺗﺒﺪﻳﻠﻬﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﻟﻜﻦ ﺑﺼﻮﺭﺓ ﻧﺎﺩﺭﺓ ﻭﻟﻜﻦ ﺧﻄﺮﺓ ﻭﻫﻲ ‪. Angioedema‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﺘﻐﲑﻩ ﻣﺜﻼ)‪ ramipril (t½13–17 h‬ﺍﻣﺎ ‪lisinopril (t½ _12‬‬
‫)‪ h‬ﺣﻴﺚ ﻻﻳﻌﺎﻧﻲ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ﺍﻟﺘﺎﻳﺾ ‪.‬‬
‫ﺍﻋﺰﺍﺋﻲ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﻭﺍﻟﻔﻌﺎﻟﻴﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﻣﺘﺸﺎﺑﻬﺔ ﺑﲔ ﲨﻴﻊ ﺍﻻﺩﻭﻳﺔ ﻭﻟﻜﻨﻬﺎ ﲣﺘﻠﻒ‬
‫ﺑﻔﱰﺓ ﺍﻟﺘﺎﺛﲑﺓ ﻭﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺣﻴﺚ ﻳﻌﺘﱪ ﺩﻭﺍء ‪ lisinopril‬ﺍﻃﻮﻝ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ‬
‫ﻭﻟﺬﻟﻚ ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﻘﻮﻝ ﺍﻥ –‪ACEIs/ARBs are less effective in African‬‬
‫‪. Caribbean patients‬ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺗﻮﺟﺪ ﻓﺎﺋﺪﺗﲔ ﻻﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ‬
‫‪.‬‬
‫ﻫﻲ ﲪﺎﻳﺔ ﺍﻟﻜﻠﻴﺔ ‪ Nephroprotect‬ﻭﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺍﻟﻀﻐﻂ ﺍﻥ ﻛﺎﻥ ﻳﻌﺎﻧﻲ ﻣﻨﻪ ﻭﺍﻟﺜﺎﻧﻴﺔ ﺍﻧﻪ‬
‫ﻳﺴﺒﺐ ﺧﻔﺾ ﺳﻜﺮ ﺍﻟﺪﻡ ﻭﻟﺬﻟﻚ ﻳﻔﻀﻞ ﺗﻘﻠﻴﻞ ﺟﺮﻋﺔ ‪insulin, metformin and‬‬
‫‪ sulfonylureas‬ﺍﺫﺍ ﰎ ﺍﺳﺘﻌﻤﺎﳍﻤﺎ ﻣﻊ ﺍﺣﺪ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺗﺎﺛﲑ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﺾ ﻟﻠﻀﻐﻂ ﻳﻘﻞ ﺍﺫﺍ ﰎ ﺍﺳﺘﻌﻤﺎﻝ ‪ corticosteroids‬ﻣﻦ ﻗﺒﻞ‬
‫ﺍﳌﺮﻳﺾ ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺍﻥ ﻋﻼﺝ ‪ captopril‬ﻳﺆﺧﺬ ﻗﺒﻞ ﺍﻟﻄﻌﺎﻡ ﺑﺴﺎﻋﺔ ﺍﻭ ﺑﻌﺪﻩ ﺑﺴﺎﻋﺘﲔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻉ ﻋﻠﻰ ﺍﳌﺮﺽ ﺍﻟﻠﺬﻳﻦ ﻋﻨﺪﻫﻢ ﲢﺴﺲ ﻣﻦ ‪. sulfa group‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Angiotensin II receptor blockers‬‬

‫****************************************‬

‫ﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Angiotensin II receptor blockers‬ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ‬

‫ﻭﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪. Candesartan, losartan, valsartan, irbesartan‬‬
‫ﻭﻳﺮﻣﺰ ﳍﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﺧﺘﺼﺎﺭﺍ ﺑـ )‪. ARBs‬‬

‫‪٢٧‬‬
 ‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺛﻼﺙ ﺣﺎﻻﺕ ﺭﺋﻴﺴﻴﺔ ﻫﻲ ‪:‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺧﺎﺻﺔ ﻋﻨﺪ ﺍﻟﺸﺒﺎﺏ ‪.‬‬
‫ﻭﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻌﺎﳉﺔ ‪. Diabetic nephropathy in type 2 diabetes‬‬
‫ﻭﻻﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺑﻞ ﻫﻲ ﻫﻲ ﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻟﺘﲔ ﺭﺋﻴﺴﻴﺘﲔ ﻫﻤﺎ ‪:‬‬
‫ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬
‫ﻭﰲ ﺣﺎﻟﺔ ‪ Renal artery stenosis‬ﺗﻀﻴﻖ ﺍﻟﺸﺮﻳﺎﻥ ﺍﻟﻜﻠﻮﻱ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺧﺎﺻﺔ ﻣﻊ ﺍﻭﻝ ﺟﺮﻋﺔ ‪.‬‬
‫ﻭﺍﺭﺗﻔﺎﻉ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ‪.Hyperkalaemia‬‬
‫ﻭﺣﺎﻟﺔ ‪ Angioedema‬ﻭﻟﻜﻨﻬﺎ ﻧﺎﺩﺭﺍ ﺟﺪﺍ ‪.‬‬
‫‪ Renal impairment‬ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﺫﺍ ﰎ ﺍﻋﻄﺎء‬ ‫ﻭﻛﺬﻟﻚ ﻣﻦ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‬
‫ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪. renal impairment‬‬
‫ﺍﻣﺎ ﺍﻟﺴﻌﺎﻝ ﺍﳉﺎﻑ ﻓﻴﺤﺪﺙ ﺑﻨﺴﺒﺔ ﻗﻠﻴﻠﺔ ﺟﺪﺍ ‪.‬‬
‫ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻌﻼﺝ ‪ valsartan‬ﻫﻮ ‪ ٦‬ﺳﺎﻋﺎﺕ ﻭﳜﺮﺝ ﻏﲑ ﻣﺘﺎﻳﺾ ﻋﻦ ﻃﺮﻳﻖ ‪the biliary‬‬
‫‪. route‬‬
‫ﺍﻣﺎ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء ‪ losartan‬ﻫﻮ ‪ ٩-٦‬ﺳﺎﻋﺔ ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪biliary and urinary‬‬
‫‪. routes‬‬
‫ﻭﺗﻌﺘﱪ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻗﻠﻴﻠﺔ ﺍﻟﺘﺎﺛﲑ ﰲ ﻣﻌﺎﳉﺔ ﻛﻞ ﻣﻦ ‪. African/Caribbean patients‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﻌﺪ ﺗﻨﺎﻭﻝ ﺍﻭﻝ ﺟﺮﻋﺔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺛﺔ ﺍﺫﺍ ﰎ‬
‫ﺍﻋﻄﺎء ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﻈﺔ ﻟﻀﻐﻂ ﺍﻟﺪﻡ ﻣﺜﻞ ‪. loop diuretics‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻻﺩﻭﻳﺔ ‪ insulin, metformin and sulfonylureas‬ﻳﺰﺩﺍﺩ‬
‫ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ‪.‬‬
‫ﻭﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳋﺎﻓﺾ ﻟﻠﻀﻐﻂ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻳﻌﺎﻛﺲ ﻭﻳﻘﻞ ﺗﺎﺛﲑﻩ ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ ‪. corticosteroids‬‬

‫ﺍﺩﻭﻳﺔ ‪ Beta blocker‬ﰲ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪.Heart failure‬‬

‫***********************************************‬

‫‪٢٨‬‬
 ‫ﻛﺜﲑ ﻣﺎ ﻳﺴﺌﻞ ﺍﻟﺼﻴﺎﺩﻟﺔ ﺍﻟﺴﺮﻳﺮﻳﻦ ﻋﻦ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Beta blocker‬ﰲ ﻣﺮﺽ ﻓﺸﻞ‬
‫ﺍﻟﻘﻠﺐ ‪.Heart failure‬‬
‫ﻭﻟﻼﺟﺎﺑﺔ ﻋﻠﻰ ﻫﺬﺍ ﺍﻟﺴﻮﺍﺋﻞ ﻧﻘﻮﻝ ‪.‬‬
‫ﺍﻥ ﺗﻔﻌﻴﻞ ﺍﳉﻬﺎﺯ ﺍﻟﺴﻤﺒﺜﺎﻭﻱ ‪ sympathetic system‬ﻳﺆﺩﻱ ﺍﱃ ‪maintain cardiac‬‬
‫‪ output‬ﻭﺍﻟﺬﻱ ﻳﺴﺒﺐ ﺯﻳﺎﺩﺓ ‪ myocardial contractility,‬ﻭ ‪ heart rate‬ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ‬
‫‪. peripheral vasoconstriction‬‬
‫ﻭﺍﻥ ﻃﻮﻝ ﺣﺪﻭﺙ ﻫﺬﺍ ﺍﻟﺘﻔﻌﻴﻞ ﻟﻠﺠﻬﺎﺯ ﺍﻟﺴﻤﺒﺜﺎﻭﻱ ‪prolonged sympathetic stimulation‬‬
‫ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ ﻣﻮﺕ ﺧﻼﻳﺎ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪ cell death‬ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ‪hypertrophy and‬‬
‫‪. focal myocardial necrosis.‬‬
‫ﻭﻛﻤﺎ ﺗﺮﻭﻥ ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﺍﻥ ﻫﺬ ﺍﻟﺘﻔﻌﻴﻞ ﻟﻠﺠﻬﺎﺯ ﺍﻟﺴﻤﺒﺜﺎﻭﻱ ﺍﺩﻯ ﺍﱃ ﺣﺪﻭﺙ ﺗﺎﺛﲑﺍﺕ ﺧﻄﲑﺓ ﺟﺪﺍ‬
‫ﻋﻠﻰ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﺯﺍﺩ ﺗﺪﻫﻮﺭ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪. . Heart failure‬‬
‫ﻭﳌﻨﻊ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﻓﺎﻧﻨﺎ ﻧﺴﺘﻌﻤـــــــــــــــــــــــﻞ ﺍﺩﻭﻳﺔ ‪. Beta blocker‬‬
‫ﺣﻴﺚ ﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺿﺮﺑـــــــــــــﺎﺕ ﺍﻟﻘﻠـــــــــــــــــــﺐ‬
‫ﺍﻟﺬﻱ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﳛﺪﺙ ﻭﺍﻳﻀﺎ ﳝﻨﻊ ﺣﺎﻟﺔ ﺍﳌﻮﺕ ﺍﳌﻔﺎﺟﻰء ﺍﻟﺘﻲ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻟﺘﻲ ﲢﺪﺙ ﰲ ﻣﺮﺽ‬
‫ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪. prevent arrythmia and sudden death‬‬
‫ﻭﻟﻜﻦ ﺍﺣﺒﺎﺋﻲ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻥ ﻳﺘﻢ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ‪. low small dose‬‬
‫ﻣﺜﻞ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء )‪ bisoprolol (concor‬ﲜﺮﻋﺔ ‪ ٢.٥ – ١.٢٥‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪. metoprolol‬‬
‫ﻭﺗﺰﺩﺍﺩ ﻫﺬﻩ ﺍﳉﺮﻋﺔ ﺗﺪﺭﳚﻴﺎ ﻋﻨﺪ ﺍﳊﺎﺟﺔ ﻭﻟﻜﻦ ﻣﻊ ﻣﺮﺍﻗﺒﺔ ﺣﺎﻟﺔ ﺍﳌﺮﻳﺾ ‪.‬‬
‫ﻭﻟﻜﻦ ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﳚﺐ ﺍﻥ ﻧﻌﻠﻢ ﺍﻥ ﻗﻄﻊ ﺍﳉﺮﻋﺔ ﺍﻟﻜﺒﲑﺓ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪large dose of‬‬
‫‪ beta blocker‬ﻳﺴﺒﺐ ﺗﺪﻫﻮﺭ ﲝﺎﻟﺔ ﺍﳌﺮﻳﺾ ﺑﺼﻮﺭﺓ ﻛﺒﲑﺓ ﻭﺧﺎﺻﺔ ﰲ ﻣﺮﻳﺾ ‪acute heart‬‬
‫‪. failure‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Cardiac glycosides‬‬

‫*********************************‬

‫ﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Cardiac glycosides‬ﺍﻟﺘﻲ ﺗﻀﻢ ﺍﺩﻭﻳﺔ ﻣﻬﻤﺔ ﻣﻨﻬﺎ ‪. Digoxin‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺣﺎﻟﺘﲔ ﻣﺮﺿﻴﺘﲔ ﻣﻬﻤﺘﲔ ﻫﻤﺎ ‪:‬‬
‫ﺍﻻﻭﱃ ﻫﻲ ‪ Supraventricular arrythmias‬ﺍﻟﺘﻲ ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ ‪atrial fibrillation and‬‬
‫‪. atrial flutter‬‬
‫ﻭﺍﻟﺜﺎﻧﻴﺔ ﻫﻲ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪. Heart failure‬‬

‫‪٢٩‬‬
 ‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺎ ﻫﻲ ‪:‬‬
‫ﺗﺸﻮﺵ ﰲ ﺍﻟﺮﺅﻳﺔ ﻳﺘﻀﻤﻦ ‪. Blurred or yellow vision‬‬
‫ﻭﺣﺪﻭﺙ ﺍﱂ ﺍﻟﺒﻄﻦ ‪Abdominal pain‬ﺍﻟﺬﻱ ﻗﺪ ﻳﺸﲑ ﺍﱃ ﺗﺴﻢ ﺑﻬﺬﺍ ﺍﻟﻌﻼﺝ ‪. Digoxin‬‬
‫ﻭﺣﺪﻭﺙ ﺧﻠﻞ ﰲ ﺍﻟﺘﻮﺻﻴﻞ ﺍﻟﻜﻬﺮﺑﺎﺋﻲ ﻟﻠﻘﻠﺐ ‪. Arrhythmias/conduction defects‬‬
‫ﻭ ﺣﺪﻭﺙ ﺍﻟﻄﻔﺢ ﺍﳉﻠﺪﻱ ‪.Rash‬‬
‫ﻭ ‪.Dizziness‬‬
‫ﻭ‪ GI disturbance‬ﻣﺜﻞ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﺳﻬﺎﻝ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﻘﻮﻝ ﺍﻥ ﺣﺪﻭﺙ ‪ Hypokalaemia and hypercalcaemia‬ﻫﻮ ﻋﺎﻣﻞ‬
‫ﻣﺴﺎﻋﺪ ﳊﺪﻭﺙ ‪. digoxin toxicity‬‬
‫ﻛﻤﺎ ﺍﻥ ‪ Narrow therapeutic index‬ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻮ ﺳﺒﺐ ﰲ ‪. risk of toxicity‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ AV block and symptomatic bradycardia‬ﻋﻨﺪﻣﺎ ﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ‬
‫ﺍﻟﺪﻭﺍء ﻣﻊ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. b blockers‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ hypokalaem‬ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ‪.‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺍﻟﱰﻛﻴﺰ ﺍﻟﻌﻼﺟﻲ ﻟﺪﻭﺍء ﺍﻟﺪﳚﻮﻛﺴﲔ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻣﻊ ‪ verapamil and diltiazem‬ﻭ‬
‫‪ amiodarone‬ﻟﺬﻟﻚ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﺟﻴﺪﺍ ‪.‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء ﺍﻟﺪﳚﻮﻛﺴﲔ ﻫﻮ ‪ ٣٦‬ﺳﺎﻋﺔ ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﰲ‬
‫ﻛﺒﺎﺭ ﺍﻟﺴﻦ ﻭﺍﳌﺮﺿﻰ ﺍﻟﻠﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ‪. renal impairment‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﻌﻼﺝ ﺍﻟﺪﳚﻮﻛﺴﲔ ﻫﻲ ‪:‬‬
‫ﺣﺪﻭﺙ ‪. Complete heart block and second degree block‬‬
‫ﻭ ‪ Ventricular tachycardia/fibrillation‬ﻭﻫﻲ ﺣﺎﻟﺔ ﺧﻄﺮﺓ ﺟﺪﺍ ﻭﺗﺴﺘﺪﻋﻲ ﺗﺪﺧﻞ ﻃﺒﻲ‬
‫ﺳﺮﻳﻊ ﺟﺪﺍ ‪.‬‬
‫ﻭ ‪. Myocarditis/constrictive pericarditis‬‬
‫ﻭ ‪. Hypertrophic cardiomyopathy‬‬
‫ﻭﻳﻌﻤﻞ ﺍﻟﺪﳚﻮﻛﺴﲔ ﻋﻠﻰ ﺗﻘﻠﻴﻞ ﺿﺮﺑﺎﺕ ﺍﻟﺒﻄﲔ ﻭﺯﻳﺎﺩﺓ ﻗﻮﺓ ﺍﻟﻀﺮﺑﺔ ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻭﺍﻳﻀﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Aldosterone antagonists‬‬

‫**********************************‬

‫ﻭﻣﻦ ﺍﻫﻢ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻲ ‪:‬‬

‫ﺩﻭﺍء ‪. Spironolactone‬‬

‫‪٣٠‬‬
 ‫ﻭ ﺩﻭﺍء ‪. eplerenone‬‬
‫ﻭﻫﻲ ﺗﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ‪ at intracellular aldosterone receptors‬ﰲ ‪renal‬‬
‫‪. tubules‬‬
‫ﻭﺍﻟﺬﻱ ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ ﺗﻘﻠﻴﻞ ‪. production of aldosterone-induced proteins‬‬
‫ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺗﻘﻠﻴﻞ ﺧﺮﻭﺝ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﺯﻳﺎﺩﺓ ﺧﺮﻭﺝ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺍﳌﺎء ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﺍﻥ ﻋﻼﺝ ‪ Spironolactone‬ﻳﺆﺛﺮ ﻋﻠﻰ ﻣﺴﺘﻘﺒﻼﺕ ﺍﺧﺮﻯ ‪receptors‬‬
‫ﻭﻣﻦ ﺿﻤﻨﻬﺎ ﻣﺴﺘﻘﺒﻞ ﺍﻻﻧﺪﺭﻭﺟﲔ ‪. androgen receptors‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺍﻣﺮﺍﺽ ﻣﻨﻬﺎ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﻻﺣﺘﻘﺎﻧﻲ‬
‫‪. Congestive cardiac failure‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪. Oedema and ascites in liver disease‬‬
‫‪Post-MI heart‬‬ ‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﰲ ﻣﻌﺎﳉﺔ ﺑﻌﺪ ﺍﻟﺘﻌﺮﺽ ﻻﺣﺘﺸﺎء ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ‬
‫‪. failure‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Nephrotic syndrome‬‬
‫ﻭﻛﺬﻟﻚ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ Primary hyperaldosteronism‬ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﻋﺪﺓ ﺍﻣﺮﺍﺽ‬
‫ﻣﻨﻬﺎ ‪. Conn’s syndrome‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ‪:‬‬
‫ﺯﻳﺎﺩﺓ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﰲ ﺍﻟﺪﻡ ‪. hyperkalaemia‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺍﻟﺼﻮﺩﻳﻮﻡ ‪. hyponatraemia‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲝﺬﺭ ﺷﺪﻳﺪ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺧﻠﻞ ﰲ ﺍﻟﻜﻠﻴﺔ ‪renal impairment‬‬
‫‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﻌﺾ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳌﻀﺎﺩﺓ ﻟﻼﻧﺪﺭﻭﺟﲔ ‪Anti-androgenic‬‬
‫‪ effects‬ﻣﺜﻞ ‪:‬‬
‫ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ﻋﻨﺪ ﺍﻟﻨﺴﺎء ‪.‬‬
‫ﻭﺗﻀﺨﻢ ﺍﻟﺜﺪﻱ ﻋﻨﺪ ﺍﻟﺮﺟﺎﻝ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﻌﺾ ﺍﻻﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪. GI disturbance‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﱃ ﺷﻜﻞ ﻓﻌﺎﻝ ﺍﻳﻀﺎ ‪.‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﳍﺎ ﻫﻲ ‪ ٦٠‬ﺍﱃ ‪ ٩٠‬ﺩﻗﻴﻘﺔ ‪.‬‬
‫ﻭﻟﻜﻦ ﺍﻟﺸﻜﻞ ﺍﳌﺘﺎﻳﺾ ﳍﺎ ﻫﻮ ﳝﺘﻠﻚ ﻃﻮﻝ ﻋﻤﺮ ﻧﺼﻔﻲ ﻃﻮﻳﻞ ‪.‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺪﺍﺧﻼﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﳌﻬﻤﺔ ﻫﻲ‪:‬‬
‫ﺯﻳﺎﺩﺓ ﺣﺪﻭﺙ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪. with ACEIs/ARBs and amiloride‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﺩﺍﺩ ﺍﻟﻔﻌﻞ ﺍﳋﺎﻓﺾ ﻟﻠﻀﻐﻂ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪. antihypertensives‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﺩﺍﺩ ﲰﻴﺔ ﺍﻟﻜﻠﻴﺔ ‪ nephrotoxicity‬ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ﺍﺩﻭﻳﺔ ‪. NSAIDs‬‬

‫‪٣١‬‬
 ‫ﻭﻣﻦ ﺍﳌﻼﺣﻈﺎﺕ ﺍﳌﻬﺔ ﻣﻦ ﺍﻟﻨﺎﺣﻴﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻫﻲ ﺍﻥ ﺩﻭﺍء ‪ Eplerenone‬ﺍﻛﺜﺮ ‪more selective‬‬
‫ﻣﻦ ‪ spironolactone‬ﻭﻟﺬﻟﻚ ﺗﻜﻮﻥ ﺍﻗﻞ ﺗﺎﺛﲑﺍ ﻋﻠﻰ ‪ sex hormone‬ﻭﻫﺬﺍ ﻳﻘﻠﻞ ﺍﻟﺘﺎﺛﲑﺍﺕ‬
‫ﺍﳉﺎﻧﺒﻴﺔ ﻋﻠﻰ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ﻭﳚﻌﻠﻬﺎ ﻣﻨﺘﻈﻤﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﺩﻭﺍء ‪ Spironolactone‬ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻛﺨﻂ ﻋﻼﺟﻲ ﺛﺎﻟﺚ ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪Inotropic sympathomimetics‬‬

‫******************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Inotropic sympathomimetics‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Adrenaline,‬‬

‫‪. dopamine, dobutamine, isoprenaline‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺼﺪﻣﺔ ﺍﻟﻘﻠﺒﻴﺔ ‪ Cardiogenic shock‬ﻭ ﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ﺍﳊﺎﺩ ‪Acute‬‬
‫‪. hypotension‬‬
‫ﻭ ‪ Cardiac arrest‬ﺧﺎﺻﺔ ﻋﻼﺝ ‪. Adrenaline‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Septic shock‬‬
‫ﻭﳑﻨﻮﻋﺔ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ‪ Phaechromocytoma‬ﺧﺎﺻﺔ ﻋﻼﺝ ‪. dopamine‬‬

‫ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﺘﻤﻠﺔ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﳊﺎﻣﻞ‬

‫*******************************‬

‫ﻣﻮﺿﻮﻉ ﺍﳊﻤﻞ ﻭﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺍﳌﻮﺍﺿﻴﻊ ﺍﻟﺘﻲ ﻳﺴﺌﻞ ﻋﻨﻬﺎ ﺍﻟﺼﻴﺪﱄ ﻳﻮﻣﻴﺎ ﺳﻮﺍء ﰲ ﺍﻟﺼﻴﺪﻟﻴﺔ ﺍﻭ ﰲ‬
‫ﺍﻟﺮﺩﻫﺎﺕ ﺍﺛﻨﺎء ﺍﳉﻮﻟﺔ ﺍﻟﺼﺒﺎﺣﻴﺔ ﻣﻊ ﺍﻟﻄﺒﻴﺐ ﺍﳌﺨﺘﺺ ‪.‬‬
‫ﻭﳍﺬﺍ ﺍﻟﺴﺒﺐ ﺳﻮﻑ ﺍﺗﻜﻠﻢ ﻟﻜﻢ ﺍﻟﻴﻮﻡ ﻋﻦ ﻣﻮﺿﻮﻉ ﺟﺪﺍ ﻣﻬﻢ ﻭﻃﺎﺭﻯء ﻭﳛﺘﺎﺝ ﺍﻥ ﻳﻜﻮﻥ ﺍﻟﺼﻴﺪﱄ ﻣﻠﻪ‬
‫ﺑﻪ ﻭﳛﻔﻈﻪ ﻋﻦ ﻇﻬﺮ ﻗﻠﺐ ﻭﻫﻮ ﻣﻮﺿﻮﻉ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﳑﻜﻦ ﺍﻥ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ‬
‫ﺍﳌﺮﺍءﺓ ﺍﺛﻨﺎء ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬
‫ﺣﻴﺚ ﻳﻌﺘﱪ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﺛﻨﺎء ﻓﱰﺓ ﺍﳊﻤﻞ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ﺍﳋﻄﲑﺓ ﺟﺪﺍ ﻋﻠﻰ ﺍﻻﻡ ﻭﻋﻠﻰ ﺍﳉﻨﲔ‬
‫ﺍﺫﺍ ﱂ ﺗﻌﺎﰿ ‪.‬‬
‫ﻭﻋﺎﺩﺓ ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﳛﺪﺙ ﻫﺬﺍ ﺍﻻﺭﺗﻔﺎﻉ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ﺑﻌﺪ ﺍﻻﺳﺒﻮﻉ ﺍﻟﻌﺸﺮﻳﻦ ﻣﻦ ﺍﳊﻤﻞ ‪.‬‬

‫‪٣٢‬‬
 ‫ﻭﳛﻤﻞ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ﺧﻄﺮ ﺍﳌﺮﺍﺿﺔ ﻭﺣﺪﻭﺙ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳌﺮﺿﻴﺔ ﻋﻠﻰ ﺍﻟﻘﻠﺐ‬
‫ﻭﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺧﻄﺮ ﺍﻟﻮﻓﺎﺓ ﺍﺫﺍ ﱂ ﻳﻌﺎﰿ ‪.‬‬
‫ﻭﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﻳﺴﻤﺢ ﺑﺼﺮﻓﻬﺎ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﺛﻨﺎء ﻓﱰﺓ ﺍﳊﻤﻞ ﻫﻮ ﺩﻭﺍء ‪Labetalol‬‬
‫ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﻭﺍﺳﻌﺔ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﺛﻨﺎء ﺍﳊﻤﻞ ﻭﻫﻮ ﺍﳋﻴﺎﺭ ﺍﻻﻭﻝ ﻭﻳﻌﻄﻰ ﻋﻦ‬
‫ﻃﺮﻳﻖ ﺍﻟﻔﻢ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻻﺧﺮﻯ ﺍﻟﺘﻲ ﳝﻜﻦ ﺻﺮﻓﻬﺎ ﻟﻠﺤﺎﻣﻞ ﺍﳌﺼﺎﺑﺔ ﺑﺎﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻮ‬
‫‪ Methyldopa‬ﻭﻳﻌﺘﱪ ﺃﻣﻦ ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ﻭﻫﻮ ﺍﳋﻴﺎﺭ ﺍﻟﺜﺎﻧﻲ ﻳﻌﺘﱪ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﳝﻜﻦ ﺻﺮﻑ ﺩﻭﺍء ‪ nifedipine‬ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺧﺎﺻﺔ ﻋﻠﻰ‬
‫ﻭﻻﻳﻨﺼﺢ ﺑﺎﺳﺘﻌﻤﺎﻟﻪ‬ ‫ﻭﻟﻜﻨﻪ ﳑﻜﻦ ﺍﻥ ﻳﺜﺒﻂ‬ ‫ﺷﻜﻞ ﺑﻄﻲء ﺍﻟﺘﺤﺮﺭ‬
‫ﻗﺒﻞ ﺍﻻﺳﺒﻮﻉ ﺍﻟﻌﺸﺮﻳﻦ ﻣﻦ ﺍﳊﻤﻞ ﻭﻋﻠﻰ ﺍﻳﺔ ﺣﺎﻝ ﻓﺎﻧﻪ ﻳﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻟﺔ ﻓﺸﻞ ﺍﳌﻌﺎﳉﺔ ﺑﺎﻻﺩﻭﻳﺔ‬
‫ﺍﻻﺧﺮﻯ ﺍﻭ ﰲ ﺣﺎﻟﺔ ﻋﺪﻡ ﺍﻣﻜﺎﻥ ﺍﺳﺘﻌﻤﺎﳍﺎ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﻣﻦ ﺍﳌﻼﺣﻈﺎﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ ‪.‬‬
‫ﺍﻧﻪ ﳚﺐ ﺍﻥ ﲢﺪﺙ ﻣﺮﺍﺟﻌﺔ ﻟﻼﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﳌﺰﻣﻦ ﺍﺫﺍ ﺍﺻﺒﺤﺖ‬
‫ﺍﳌﺮﺍءﺓ ﺣﺎﻣﻞ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﻛﺎﻥ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﳌﺰﻣﻦ ﻋﻨﺪ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﻏﲑ ﻣﺼﺤﻮﺏ ﺑﻮﺟﻮﺩ ﻣﻀﺎﻋﻔﺎﺕ ﻓﺎﻧﻪ ﳚﺐ ﺍﻥ‬
‫ﺍﻗﻞ ﻣﻦ ‪ ١٠٠/ ١٥٠‬ﻣﻠﻢ ﺯﺋﺒﻘﻲ ‪.‬‬ ‫ﻳﻜﻮﻥ‬
‫ﺍﻣﺎ ﺍﺫﺍ ﻛﺎﻥ ﺍﺭﺗﻔﺎﻉ ﺍﻟﻀﻐﻂ ﺍﳌﺰﻣﻦ ﻋﻨﺪ ﺍﳊﺎﻣﻞ ﻣﻊ ﻭﺟﻮﺩ ‪ target organ damage‬ﺍﻭ ﻋﻨﺪ ﺍﻟﻮﻻﺩﺓ‬
‫ﺍﻗﻞ ﻣﻦ ‪٩٠/١٤٠‬ﻣﻠﻢ ﺯﺋﺒﻘﻲ ‪.‬‬ ‫ﻓﺎﻧﻪ ﳚﺐ ﺍﻥ ﻳﻜﻮﻥ‬
‫ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‬ ‫ﺍﺣﺒﺎﺋﻲ ﻭﻛﺬﻟﻚ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﺍﻟﺘﻲ ﺍﺳﺘﻌﻤﻠﺖ ﺩﻭﺍء‬
‫ﺍﺛﻨﺎء ﺍﳊﻤﻞ ﻓﺎﻧﻪ ﳚﺐ ﺍﻥ ﻳﻘﻄﻊ ﺑﻌﺪ ﻳﻮﻣﲔ ﻣﻦ ﺍﻟﻮﻻﺩﺓ ﻭﺗﺮﺟﻊ ﺍﱃ ﻋﻼﺟﻬﺎ ﺍﻟﺬﻱ ﻛﺎﻧﺖ ﺗﺴﺘﻌﻤﻠﻪ‬
‫ﻗﺒﻞ ﺍﳊﻤﻞ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻫﻨﺎﻙ ﻣﻼﺣﻈﺔ ﻣﻬﻤﺔ ﻭﻛﺜﲑ ﻣﺎ ﻧﺴﺌﻞ ﻋﻨﻬﺎ ﻧﻮﺿﺤﻬﺎ ﻭﻫﻲ ‪:‬‬
‫ﺍﺫﺍ ﻛﺎﻧﺖ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﻫﻨﺎﻙ ﺧﻄﺮ ﻋﻠﻴﻬﺎ ﻣﻦ ﺣﺪﻭﺙ ‪ preeclampsia‬ﻛﻤﺎ ﻟﻮ ﻛﺎﻧﺖ ﺗﻌﺎﻧﻲ ﻣﻦ‬
‫ﻭﺍﺣﺪ ﳑﺎ ﻳﺎﺗﻲ ‪:‬‬
‫ﻓﺸﻞ ﻛﻠﻮﻱ ﻣﺰﻣﻦ ‪.‬‬
‫ﺍﻭ ﻣﺮﺽ ﺍﻟﺴﻜﺮ ‪.‬‬
‫ﺍﻭ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﻣﺰﻣﻦ‪.‬‬
‫ﺍﻭ ﺃﻱ ﻣﺮﺽ ﻣﻨﺎﻋﻲ‪.‬‬
‫ﻓﺎﻧﻬﺎ ﳚﺐ ﺍﻥ ﺗﻨﺼﺢ ﺑﺎﺳﺘﻌﻤﺎﻝ ﻋﻼﺝ ﺍﻻﺳﱪﻳﻦ ﲜﺮﻋﺔ ‪ ٧٥‬ﻣﻠﻐﻢ ﻳﻮﻣﻴﺎ ﺍﺑﺘﺪﺍ ﻣﻦ ﺍﻻﺳﺒﻮﻉ ﺍﻟﺜﺎﻧﻲ‬
‫ﻋﺸﺮ ﺍﱃ ﺍﻟﻮﻻﺩﺓ ‪.‬‬
‫ﺍﻣﺎ ﻟﻮ ﻛﺎﻧﺖ ﺍﳌﺮﺍءﺓ ﺗﻌﺎﻧﻲ ﻣﻦ ﻭﺟﻮﺩ ﻋﺎﻣﻠﲔ ﳑﺎ ﻳﺎﺗﻲ ﻭﻫﻢ ‪:‬‬

‫‪٣٣‬‬
 ‫ﺍﻭ ﻋﻤﺮﻫﺎ ﺍﻛﱪ ﻣﻦ ‪ ٤٠‬ﺳﻨﺔ ﺍﻭ ﻗﺪ ﺍﺻﻴﺒﺖ ﺍﺣﺪ ﺍﻓﺮﺍﺩ ﻋﺎﺋﻠﺘﻬﺎ‬ ‫ﺍﻭﻝ ﲪﻞ‬
‫– ﺍﻭ‬ ‫_‬ ‫ﺍﻭ ﻛﺎﻧﺖ ﺑﻮﺯﻥ ﺍﻛﱪ ﻣﻦ ‪-‬‬ ‫ﲟﺮﺽ‬
‫ﱂ ﳛﺪﺙ ﻋﻨﺪﻫﺎ ﲪﻞ ﻣﻨﺬ ‪ ١٠‬ﺳﻨﻮﺍﺕ ‪.‬‬
‫ﻟﻮ ﺗﻮﻓﺮ ﻋﺎﻣﻠﲔ ﰲ ﺍﻣﺮﺍءﺓ ﺣﺎﻣﻞ ﻣﻦ ﺍﻟﻌﻮﺍﻣﻞ ﺍﻋﻼﻩ ﻓﺎﻧﻬﺎ ﺍﻳﻀﺎ ﳚﺐ ﺍﻥ ﺗﻨﺼﺢ ﺑﺎﺳﺘﻌﻤﺎﻝ ﻋﻼﺝ‬
‫ﺍﻻﺳﱪﻳﻦ ﲜﺮﻋﺔ ‪ ٧٥‬ﻣﻠﻐﻢ ﻳﻮﻣﻴﺎ ﺍﺑﺘﺪﺍ ﻣﻦ ﺍﻻﺳﺒﻮﻉ ﺍﻟﺜﺎﻧﻲ ﻋﺸﺮ ﺍﱃ ﺍﻟﻮﻻﺩﺓ ‪.‬‬
‫ﺍﻣﺎ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﺍﻟﺘﻲ ﺗﻌﺎﻧﻲ ﻣﻦ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻛﱪ ﻣﻦ ‪ ١١٠/ ١٦٠‬ﻣﻠﻢ ﺯﺋﺒﻘﻲ ﻓﺎﻧﻬﺎ ﳚﺐ ﺍﻥ‬
‫ﺗﻌﺎﰿ ﻓﻮﺭﺍ ﺑﺎﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ‪.‬‬
‫ﻭﻫﻮ ﺟﺪﺍ ﻓﻌﺎﻝ ﳍﺬﺍ ﺍﻟﻐﺮﺽ ﻭﻳﺴﺘﻌﻤﻞ ﺑﻜﺜﺮﺓ ﰲ‬ ‫ﻣﺜﻞ ﺩﻭﺍء‬
‫ﺭﺩﻫﺎﺕ ﺍﻟﻄﻮﺍﺭﻯء ‪.‬‬
‫ﺍﻭ ﻋﻼﺝ ‪ labetolol‬ﺍﻣﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺍﻭ ﻭﺭﻳﺪﻳﺎ ‪.‬‬
‫ﻭﻟﻜﻨﻪ ﻳﺒﻘﻰ ﺍﳋﻴﺎﺭ ﺍﻟﺜﺎﻟﺚ ﺍﺫﺍ ﱂ ﻧﺴﺘﻌﻤﻞ‬ ‫ﺍﻭ ﺩﻭﺍء‬
‫ﺍﻟﻌﻼﺟﲔ ﺍﻟﺴﺎﺑﻘﲔ ﺍﻭ ﻟﻔﺸﻠﻬﻤﺎ ‪.‬‬

‫ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‬

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‫ﺍﺣﺒﺎﺋﻲ ﺍﺫﻛﺮ ﻟﻜﻢ ﺑﻌﺾ ﺍﳌﻌﻠﻮﻣﺎﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻋﻦ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺍﻭﻝ ﻫﺬﻩ ﺍﳌﻌﻠﻮﻣﺎﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﺣﺒﺎﺋﻲ ‪.‬‬
‫ﺍﻥ ﻣﺮﻳﺾ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻛﺒﲑ ﺍﻟﺴﻦ ﻳﻔﻀﻞ ﺍﻥ ﻳﻌﺎﰿ ﲟﺠﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. ACEI‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻻﺧﺮﻯ ﺍﳌﻔﻀﻠﺔ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻛﺒﲑ ﺍﻟﺴﻦ ﻫﻲ ‪.‬‬
‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪.Ca. channel blocker‬‬
‫ﻭﻻﻳﻔﻀﻞ ﺍﺣﺒﺎﺋﻲ ﺍﳌﻌﺎﳉﺔ ﺑﺎﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ ‪.beta . blocker‬‬
‫ﻻﻧﻬﺎ ﻭﻣﻦ ﺧﻼﻝ ﺍﻟﺘﺠﺎﺭﺏ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻭﺟﺪﺕ ﻏﲑ ﻓﻌﺎﻟﺔ ‪.‬‬
‫ﻭﺍﳌﻌﻠﻮﻣﺔ ﺍﻟﺜﺎﻧﻴﺔ ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ‪.‬‬
‫ﻫﻲ ﺍﻥ ﻫﻨﺎﻙ ﺣﺎﻟﺔ ﻣﺮﺿﻴﺔ ﺟﺪﺍ ﺟﺪﺍ ﺧﻄﺮﺓ ﻗﺪ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ ﻣﺮﻳﺾ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻲ‬
‫‪ malignant hypertension‬ﻭﺍﻳﻀﺎ ﺣﺎﻟﺔ ‪. accelerated hypertension‬‬
‫ﻭﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻫﻲ ﻋﺒﺎﺭﺓ ﻋﻦ ﺍﺭﺗﻔﺎﻉ ﺷﺪﻳﺪ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﻻﻳﻔﻀﻞ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺧﻔﺾ ﺍﻟﻀﻐﻂ ﺑﺴﺮﻋﺔ ﺑﻞ ﳚﺐ ﺧﻔﻀﻪ ﺍﱃ ‪ ٩٠/ ١٥٠‬ﻣﻠﻢ ﺯﺋﺒﻘﻲ ‪.‬‬
‫ﺧﻼﻝ ﻓﱰﺓ ﻣﻦ ‪ ٢٤‬ﺍﱃ ‪ ٣٦‬ﺳﺎﻋﺔ ﻭﻟﻴﺲ ﺍﺳﺮﻉ ﻣﻦ ﻫﺬﺍ ﺍﻟﻮﻗﺖ ‪.‬ﳌﺎﺫﺍ ؟‬

‫‪٣٤‬‬
 ‫ﻻﻥ ﺧﻔﺾ ﺍﻟﻀﻐﻂ ﺑﺼﻮﺭﺓ ﺍﺳﺮﻉ ﻳﺆﺩﻱ ﺍﱃ ‪cerebral damage, coronary or renal‬‬
‫‪ insufficiency‬ﺑﺴﺒﺐ ﻧﻘﺺ ﺍﻟﱰﻭﻳﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺑﺴﺮﻋﺔ ﻭﺧﺎﺻﺔ ﰲ ﻫﺬﻩ ﺍﻻﻋﻀﺎء ﺍﳌﻬﻤﺔ ﻣﻦ ﺍﳉﺴﻢ‬
‫‪.‬‬
‫ﻭﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻟﺘﻲ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﺗﺴﺘﻌﻤﻞ ﰲ ﻋﻼﺝ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻣﻦ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻲ‬
‫ﻛﻞ ﻣﻦ ‪:‬‬
‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. beta blocker‬‬
‫ﻭ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪.ca. channel blocker‬‬
‫ﻭ ‪. Lasix and ACE inhibitors‬‬
‫ﻭﺗﻌﺘﱪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻔﻀﻠﺔ ﰲ ﻣﻌﺎﳉﺔ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻭﺗﺴﺘﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ‪.‬‬
‫ﻭﺍﳌﻌﻠﻮﻣﺔ ﺍﻟﺜﺎﻟﺜﺔ ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ‪.‬‬
‫ﺍﻥ ﻫﻨﺎﻙ ﺑﻌﺾ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺘﻌﻤﻞ ﻣﺮﺿﻰ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻣﺜﻞ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﲤﻨﻊ ﺍﻟﺘﺼﺎﻕ‬
‫ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ‪ Antiplatelet‬ﻣﺜﻞ ﺩﻭﺍء )‪. (Aspirin‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻟﺘﻘﻠﻴﻞ ‪. cardiovascular risk‬‬
‫ﻭﻟﻜﻦ ﺍﻻﺳﱪﻳﻦ ﻻﻳﺴﺘﻌﻤﻞ ﺍﻻ ﰲ ﺣﺎﻟﺔ ﻛﻮﻥ ﺍﻟﻀﻐﻂ ﻣﺴﻴﻄﺮ ﻋﻠﻴﻪ ﺑﺎﺩﻭﻳﺔ ﺍﻟﻀﻐﻂ ﳌﻨﻊ ﺣﺎﻟﺔ ﺍﻟﻨﺰﻑ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻧﺴﺘﻌﻤﻞ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﻈﺔ ﻟﻠﺪﻫﻮﻥ ‪ Lipid lowering drugs‬ﺍﻟﺘﻲ ﲤﻨﻊ ﺗﺼﻠﺐ ﺍﻟﺸﺮﺍﻳﲔ‬
‫ﺑﺎﻟﺪﻫﻮﻥ ﻭﺍﻟﺬﻱ ﻳﻌﺪ ﺳﺒﺐ ﺭﺋﻴﺴﻲ ﰲ ﺣﺪﻭﺙ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬

‫ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ‬

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‫ﻣﻦ ﺍﳌﻮﺍﺿﻴﻊ ﺍﳌﻬﻤﺔ ﺍﻟﺘﻲ ﺗﻮﺍﺟﻪ ﺍﻟﺼﻴﺪﱄ ﺍﻟﺴﺮﻳﺮﻱ ﻫﻲ ﺍﻟﺘﺪﺍﺧﻞ ﺑﲔ ﺍﻻﺩﻭﻳﺔ ﻭﺍﻻﻣﺮﺍﺽ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺧﺘﻴﺎﺭ ﺍﻟﺪﻭﺍء ﺍﻻﻓﻀﻞ ﻭﺍﻻﻣﺜﻞ ‪.‬‬
‫ﻧﺬﻛﺮ ﻟﻜﻢ ﻫﺬﺍ ﺍﻟﺘﺪﺍﺧﻞ ﺍﻟﺼﻴﺪﻻﻧﻲ ‪.‬‬
‫ﻭﻫﻮ ﰲ ﺣﺎﻟﺔ ﺗﻌﺮﺽ ﻣﺮﻳﺾ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﱃ ﻓﺸﻞ ﻛﻠﻮﻱ ﻓﻤﺎ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ‬
‫ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺣﻴﺚ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺍﻟﻀﻐﻂ ﻛﻞ ﻣﻦ ‪:‬‬
‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ beta blocker‬ﻣﺜﻞ ﺩﻭﺍء ‪. metoprolol‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ‪.ca. channel blocker‬ﻣﺜﻞ ﺩﻭﺍء ‪amlodipine‬‬

‫‪٣٥‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ﺍﳌﺪﺭﺭ ‪ Lasix‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﲜﺮﻋﺔ ﺟﺪﺍ ﻋﺎﻟﻴﺔ ﺗﺼﻞ ﰲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ‬
‫ﺍﱃ ‪ ١٠٠٠‬ﻣﻠﻐﻢ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪ Hydralazine‬ﺣﻴﺚ ﻳﺘﻮﻓﺮ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ﻭﺣﻘﻦ ‪.‬‬
‫ﺍﻣﺎ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACE inhibitors‬ﻓﻴﻤﻜﻦ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻭﻟﻜﻦ ﳚﺐ ﻣﺮﺍﻗﺒﺔ ﺍﳌﺮﻳﺾ ﻭﻣﺘﺎﺑﻌﺘﻪ ‪.‬‬

‫ﺩﻭﺍء ﺍﻻﺳﱪﻳﻦ ‪. Aspirin‬‬

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‫ﺩﻭﺍء ﺍﻻﺳﱪﻳﻦ ‪. Aspirin‬‬

‫ﻭﻳﻘﻮﻡ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻭﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻭﺗﺜﺒﻴﻂ ﻭﺑﺼﻮﺭﺓ ‪ Irreversibly‬ﺍﻧﺰﻳﻢ ‪cyclo-oxygenase‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ ﺗﻜﻮﻳﻦ ‪ thromboxane A2‬ﻭ ﻣﻦ ‪. prostacyclin‬‬
‫ﻭﻫﺬﺍ ﻣﺎ ﳝﻨﻊ ﺣﺪﻭﺙ ﺍﻟﺘﺼﺎﻕ ﻭﲡﻤﻊ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺗﻜﻮﻥ ﺍﳋﺜﺮﺓ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺍﻣﺮﺍﺽ‬
‫ﻛﺜﲑﺓ ‪.‬‬
‫ﻭﻟﻜﻦ ﺍﺣﺒﺎﺋﻲ ﺍﻥ ﻣﻨﻊ ﺗﻜﻮﻳﻦ ‪ thromboxane A2‬ﻫﻮ ﻃﻮﻝ ﻓﱰﺓ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﺒﺎﻟﻐﺔ‬
‫ﻋﺸﺮﺓ ﺍﻳﺎﻡ ﻓﻘﻂ ﺑﻴﻨﻤﺎ ﻣﻨﻊ ﺗﻜﻮﻳﻦ ‪ prostacyclin‬ﻫﻮ ﻭﻗﺘﻲ ﺟﺪﺍ ﺍﺫ ﺍﻧﻪ ﻳﺘﻜﻮﻥ ﻣﻦ‬
‫‪ production by endothelial cells‬ﺑﻌﺪ ﺫﻟﻚ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﻣﻨﻬﺎ ﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ﺍﺣﺘﺸﺎء ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ‬
‫‪ Prophylaxis of MI‬ﻭﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ﺍﻣﺮﺍﺽ ‪Prophylaxis of cerebrovascular‬‬
‫‪ AF‬ﺍﺫﺍ ﱂ ﻳﺘﻢ ﺍﻋﻄﺎء ‪ warfarin‬ﻭ ﻭﻳﺴﺘﻌﻤﻞ ﻟﺘﺴﻜﲔ ﺍﻻﱂ ﺍﳋﻔﻴﻒ‬ ‫‪ disease‬ﻭ ﻭﻳﺴﺘﻌﻤﻞ ﰲ‬
‫ﺍﱃ ﺍﳌﺘﻮﺳﻂ ‪ Mild to moderate pain‬ﻭﻭﻳﺴﺘﻌﻤﻞ ﳋﻔﺾ ﺍﳊﺮﺍﺭﺓ ‪. Pyrexia‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﻳﻀﺎ ﻟﻪ ﻣﻮﺍﻧﻊ ﺍﺳﺘﻌﻤﺎﻝ ﻻﻳﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩﻫﺎ ﺍﺑﺪﺍ ﻭﺍﻻ ﺳﺒﺐ ﻟﻨﺎ ﻣﺸﻜﻠﺔ‬
‫ﻗﺪ ﺗﺆﺩﻱ ﺍﱃ ﻣﻀﺎﻋﻔﺎﺕ ﻛﺒﲑﺓ ﻭﻣﻦ ﻫﺬﻩ ﺍﳌﻮﺍﻧﻊ ﻻﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ﺍﻻﺳﱪﻳﻦ ﻫﻲ ﻭﺟﻮﺩ ﻣﺮﺽ ﺍﻟﻘﺮﺣﺔ‬
‫‪ Active peptic ulcer‬ﻭﻭﻣﺮﺽ ﺍﻟﻨﺰﻑ ﺍﻟﺪﻡ ﺍﳍﻴﻤﻮﻓﻠﻴﺎ ‪ Haemophilia‬ﻭ ‪Bleeding‬‬
‫‪ diathesis‬ﻭﺍﻟﺘﺤﺴﺲ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ‪. Hypersensitivity‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻲ ﺗﻀﻴﻖ ﺍﻟﻘﺼﺒﺎﺕ ﻧﺘﻴﺠﺔ ﺯﻳﺎﺩﺓ ﺗﻜﻮﻳﻦ ﺍﻟﻠﻴﻜﻮﺗﺮﻳﻦ ﻭﺍﻳﻀﺎ ﻗﺪ‬
‫ﳛﺪﺙ ‪ GI and other haemorrhage‬ﺑﺴﺒﺐ ﻗﻠﺔ ﺗﻜﻮﻳﻦ ﺍﻟﻮﺍﻗﻲ ﺍﻟﺬﻱ ﳛﻤﻲ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ‬
‫ﻣﻦ ﺗﺎﺛﲑﺍﺕ ﺍﳊﺎﻣﺾ ﻭﻫﻮ ﺍﻟﱪﻭﺳﺘﻮﻛﻼﻧﺪﻳﻦ ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‪GI disturbance‬‬
‫ﻣﺜﻞ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺳﻮء ﺍﳍﻀﻢ ﻭﻏﲑﻫﺎ ‪.‬‬

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 ‫ﺍﻣﺎ ﺍﻟﺘﺪﺍﺧﻼﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﺔ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻮ ﺍﻥ ﺍﺳﺘﻌﻤﺎﻝ ﻛﻞ ﻣﻦ ‪aspirin and‬‬
‫‪ anticoagulants‬ﻳﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ﻭﻫﻮ ﺗﺎﺛﲑ ﺟﺪﺍ ﺧﻄﺮ ﺍﺫ ﺍﻧﻪ ﰲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ‬
‫ﻻﻳﻼﺣﻆ ﺑﺼﻮﺭﺓ ﻛﺒﲑﺓ ﺍﻻ ﺑﻌﺪ ﺣﺪﻭﺛﻪ ﺑﺸﻜﻞ ﻛﺒﲑ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻭﺗﺎﺛﲑﺍﺗﻪ ﻋﻠﻰ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ﻭﻻﺳﻴﻤﺎ ﺍﻟﺘﻘﺮﺡ ﺍﺫﺍ ﰎ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻣﻊ‬
‫‪ corticosteroids‬ﻓﻴﺠﺐ ﺍﳊﺬﺭ ﻓﻴﻪ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻭﻣﺮﺍﻗﺒﺔ ﺍﻻﻋﺮﺍﺽ ﺍﻟﺘﻲ ﻗﺪ ﺗﻨﺬﺭ ﲝﺪﻭﺙ ﺍﻟﺘﻘﺮﺡ‬
‫ﺍﻭ ﺍﻋﻄﺎء ﻋﻼﺝ ﻭﻗﺎﺋﻲ ﻣﺜﻞ ‪. PPI‬‬
‫ﺟﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﺍﻻﺳﱪﻳﻦ ‪ ٧٥‬ﻣﻠﻐﻢ ﻫﻲ ﺗﺴﺘﻌﻤﻞ ‪ long-term prophylaxis‬ﺍﻣﺎ ﺟﺮﻋﺔ ‪٣٠٠‬‬
‫ﻣﻠﻐﻢ ﻓﺘﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻟﺔ ‪. ischaemic event is suspected‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻭﳚﺐ ﺍﻻﻧﺘﺒﺎﻩ ﺍﱃ ﺍﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻗﺪ ﻳﺴﺒﺐ ‪ Reye’s syndrome‬ﺍﺫﺍ ﺍﻋﻄﻲ ﻟﻼﻃﻔﺎﻝ ﺍﻗﻞ‬
‫ﻣﻦ ﻋﻤﺮ ‪ ١٦‬ﺳﻨﺔ ‪.‬‬
‫ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﺍﺣﺒﺎﺋﻲ ﻳﺘﺎﻳﺾ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻪ ﻫﻮ ‪ ٤‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﰲ ﺣﺎﻟﺔ ‪ overdose‬ﻓﺎﻧﻪ ﻳﺴﺒﺐ ﰲ ﺍﻟﻜﺒﺎﺭ ‪ respiratory alkalosis‬ﺑﺴﺒﺐ‬
‫‪. hyperventilation‬‬
‫ﺍﻣﺎ ﰲ ﺍﻻﻃﻔﺎﻝ ﻓﻴﺴﺒﺐ ‪ metabolic acidosis‬ﺑﺴﺒﺐ ‪salicylate load and‬‬
‫‪ accumulation of lactic, pyruvic‬ﻭ ﲡﻤﻊ ﺍﻳﻀﺎ ‪. aceto-acetic acid‬‬

‫ﻋﻼﺝ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﳌﺼﺤﻮﺏ ﲟﺮﺽ ‪ischemic heart disease‬‬

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‫ﺍﺫﺍ ﺗﻌﺮﺽ ﺍﳌﺮﻳﺾ ﺍﻟﺬﻱ ﻳﻌﺎﻧﻲ ﻣﻦ ﺍﻣﺮﺍﺽ ‪ ischemic heart disease‬ﳌﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻓﻤﺎ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﳌﻔﻀﻞ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺍﳉﻮﺍﺏ ‪.‬ﺍﻥ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻮ ‪.‬‬
‫ﺍﻣﺎ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ beta blocker‬ﻣﺜﻞ ‪. atenolol‬‬
‫ﺍﻭ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Ca .channel blocker‬ﻣﺜﻞ ﻋﻼﺝ ‪. verapamil‬‬
‫ﻭﺍﻳﻀﺎ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACEI‬ﻣﺜﻞ ‪ Captopril‬ﺗﻨﻔﻊ ﰲ ﺍﳌﻌﺎﳉﺔ ﳌﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻻﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻔﻴﺪ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪ischemic heart‬‬
‫‪. disease‬‬
‫ﻭﻟﻜﻦ ﺍﺣﺒﺎﺋﻲ ﳚﺐ ﲡﻨﺐ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪. hydralazine‬ﳌﺎﺫﺍ ؟‬
‫ﻻﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ‪:‬‬
‫ﻳﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺑﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﻋﺪﻡ ﻭﺟﻮﺩ ﺍﻟﻮﻗﺖ ﺍﻟﻜﺎﻓﻴﺔ ﳌﻠﻰء ﺍﻟﺸﺮﺍﻳﲔ ﺍﻟﺘﺎﺟﻴﺔ ﺍﻟﺘﻲ ﺗﻐﺬﻱ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ‪.‬‬
‫ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﻗﻠﺔ ﺍﻟﱰﻭﻳﺔ ﺍﻟﺘﺎﺟﻴﺔ ﺍﻟﻘﻠﺒﻴﺔ‪.‬‬

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 ‫ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺗﺪﻫﻮﺭ ﺍﻻﻣﺮﺍﺽ ‪ ischemic heart disease‬ﺍﻟﺘﻲ ﺗﻌﺎﻧﻲ ﺍﺻﻼ‬
‫ﻣـــــــــــــــــــــــﻦ ﻧﻘﺺ ﰲ ﺍﻟﱰﻭﻳﺔ ﺍﻟﺘﺎﺟﻴﺔ ﻟﻌﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﳚﺐ ﲡﻨﺐ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪ nefadipine‬ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺍﻳﻀﺎ ‪.‬‬

‫ﻋﻼ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﳌﺼﺤﻮﺏ ‪Peripheral vascular disease‬‬

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‫ﺍﺫﺍ ﺗﻌﺮﺽ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻻ ﺣﺪ ﺍﻣﺮﺍﺽ ‪. Peripheral vascular disease‬‬

‫ﻓﺎﻥ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﳌﺨﺘﺎﺭﺓ ﳌﻌﺎﳉﺔ ﻣﺮﺽ ‪ Peripheral vascular disease‬ﻫﻲ ‪.‬‬
‫ﻟﻴﺲ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Beta .blocker‬‬
‫ﻻﻥ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Beta .blocker‬‬
‫ﻳﺆﺩﻱ ﺍﱃ ﻏﻠﻖ ‪. Beta receptor‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺍﻧﺘﻘﺎﻝ ﲨﻴﻊ ﻭﺳﺎﺋﻂ ﺍﳉﻬﺎﺯ ﺍﻟﺴﺒﻤﺜﺎﻭﻱ ﻣﺜﻞ ‪ norepinephrine‬ﺍﱃ ﻏﻠﻖ ‪Alpha‬‬
‫‪.receptor‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺣﺪﻭﺙ ﺗﻀﻴﻖ ﺷﺪﻳﺪ ﰲ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﻄﺮﻓﻴﺔ ﻭﺗﺪﻫﻮﺭ ‪Peripheral vascular‬‬
‫‪ disease‬ﺍﻟﺘﻲ ﻫﻲ ﺍﺻﻼ ﺣﺪﺛﺖ ﺑﺴﺒﺐ ﺗﻀﻴﻖ ﰲ ﻫﺬﻩ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ‪.‬‬
‫ﻟﺬﻟﻚ ﻓﺎﻻﻓﻀﻞ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Ca .channel blocker‬ﻣﺜﻞ ﺩﻭﺍء ‪.Verapamil‬‬
‫ﺍﻭ ﺩﻭﺍء ‪. Nefidipine‬‬
‫ﻻﻥ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪ Ca .channel blocker‬ﺗﺴﺒﺐ ﺗﻮﺳﻊ ﰲ ﻫﺬﻩ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﻄﺮﻓﻴﺔ‬
‫‪.‬‬

‫ﻋﻼﺝ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﳌﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ‬

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‫ﺍﺫﺍ ﺗﻌﺮﺽ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﺍﱃ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬

‫ﻓﻤﺎ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﳌﻔﻀﻞ ﻟﻌﻼﺝ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﺍﳉﻮﺍﺏ ﺍﻛﻴﺪ ﻟﻴﺲ ﻫﻮ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Beta .blocker‬‬
‫ﻻﻥ ﺍﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﳌﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻳﺆﺩﻱ ﺍﱃ ‪.‬‬
‫ﺣﺪﻭﺙ ﺗﺎﺛﲑﻳﻦ ﺟﺪﺍ ﺿﺎﺭﻳﻦ ﻋﻠﻰ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮ ‪:‬‬

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 ‫ﺍﻻﻭﻝ ﻫﻮ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Beta .blocker‬ﰲ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻳﺆﺩﻱ ﺍﱃ ﺣﺠﺐ‬
‫ﺍﻋﺮﺍﺽ ﺍﳔﻔﺎﺽ ﺍﻟﺴﻜﺮﻱ ﻣﺜﻞ ﺍﳋﻔﻘﺎﻥ ﻭﺍﻟﺮﺟﻔﻪ ﺍﻻ ﺍﻟﺘﻌﺮﻕ ‪.‬‬
‫ﻭﺍﻟﺜﺎﻧﻲ ﺍﻥ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻳﻌﺎﻧﻲ ﺗﻠﻘﺎﺋﻴﺎ ﻣﻦ ﺯﻳﺎﺩﺓ ﻭﺍﺿﻄﺮﺍﺏ ﰲ ﺗﺮﻛﻴﺰ ﺍﻟﺪﻫﻮﻥ ﰲ ﺍﻟﺪﻡ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﻭﺍﺿﻄﺮﺍﺏ ﰲ ﺗﺮﻛﻴﺰ ﺍﻟﺪﻫﻮﻥ ﰲ ﺍﻟﺪﻡ ﻓﺘﺰﻳﺪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺧﻄﺮ‬
‫‪. Hyperlipidemia‬‬
‫ﺍﺫﺍ ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﺍﻟﻜﺮﺍﻡ ﻓﺎجملﻤﻮﻋﺔ ﺍﳌﺨﺘﺎﺭﺓ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻫﻲ‬
‫ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺗﻮﺳﻊ ﻭﻋﺎﺋﻲ ﻣﺜﻞ ‪:‬‬
‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACE inhibitors‬ﺣﻴﺚ ﺗﻌﺘﱪ ﺍﳋﻴﺎﺭ ﺍﻻﻓﻀﻞ ﳍﺬﻩ ﺍﳊﺎﻟﺔ ﺑﺎﻻﺿﺎﻓﺔ ﺍﱃ ﺍﻧﻬﺎ ﲢﻤﻲ‬
‫ﺍﻟﻜﻠﻴﺔ ﻣﻦ ﺍﻟﻔﺸﻞ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Ca .Channel. B‬ﺣﻴﺚ ﻻﺗﺆﺛﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﻣﺮﻳﺾ‬
‫ﺍﻟﺴﻜﺮﻱ ﺑﻞ ﺗﻨﻔﻊ ﰲ ﺣﺪﻭﺙ ﺗﻮﺳﻴﻊ ﻭﻋﺎﺋﻲ ﻭﺗﻮﺻﻞ ﺍﻟﺪﻡ ﺍﱃ ﺍﻻﻃﺮﺍﻑ ﻭﺗﻨﻤﻊ ﺣﺪﻭﺙ ﺍﻻﻣﺮﺍﺽ‬
‫ﺍﻟﻮﻋﺎﺋﻴﺔ ﺍﻟﻄﺮﻓﻴﺔ ﺍﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﻭﺗﺴﺒﺐ ﻋﺪﺓ ﺗﺎﺛﲑﺍﺕ ﻣﻨﻬﺎ ﺍﻟﻌﺠﺰ ﺍﳉﻨﺴﻲ ‪.‬‬

‫ﻋﻼﺝ ﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﳌﺮﻳﺾ ﺍﻟﺮﺑﻮ‪.‬‬

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‫ﻭﻫﻲ ﻟﻮ ﺗﻌﺮﺽ ﻣﺮﻳﺾ ﺍﻟﺮﺑﻮ ﺍﻭ ﻣﺮﻳﺾ ‪ COPD‬ﻻﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬

‫ﻓﻤﺎ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﻟﻪ ‪.‬‬
‫ﺍﻛﻴﺪ ﻟﻴﺲ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﻟﻪ ﻫﻮ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Beta blocker‬ﻭﺧﺎﺻﺔ ﻧﻮﻉ ‪nonselective‬‬
‫ﻣﺜﻞ ﺩﻭﺍء ‪.inderal‬‬
‫ﻻﻧﻬﺎ ﺳﺘﺆﺛﺮ ﻋﻠﻰ ‪ Beta 2 Receptor‬ﻭﺗﺆﺩﻱ ﺍﱃ ﺗﻘﻠﺺ ﺍﻟﻘﺼﺒﺎﺕ ﻭﺍﻟﻘﺼﻴﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ ﻭﺗﺰﻳﺪ ﻣﻦ‬
‫ﺣﺎﻟﺔ ﺿﻴﻖ ﺍﻟﻨﻔﺲ ﺍﻟﺬﻱ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ ﻣﺮﻳﺾ ﺍﻟﺮﺑﻮ ﺍﻭ ﻣﺮﻳﺾ ‪. COPD‬‬
‫ﻭﻟﻜﻦ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﳌﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ‪.‬‬
‫ﻫﻮ ﺍﻣﺎ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Ca. channel blocker‬ﻣﺜﻞ ﺩﻭﺍء ‪.amlodipine‬‬
‫ﺍﻭ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACEI‬ﻣﺜﻞ ﺩﻭﺍء ‪. Captopril‬‬
‫ﻻﻥ ﻫﺎﺗﲔ ﺍجملﻤﻮﻋﺘﲔ ﻻﻳﺆﺛﺮﺍﻥ ﻋﻠﻰ ﺍﻟﻘﺼﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ ﻭﻳﺴﺒﺒﺎﻥ ﺗﻀﻴﻘﻬﻤﺎ ‪.‬‬

‫‪٣٩‬‬
‫ﺑﻞ ﺍﻟﻌﻜﺲ ﺭﲟﺎ ﻳﺴﺎﻋﺪﺍﻥ ﻋﻠﻰ ﺍﺳﱰﺧﺎء ﺍﻟﻌﻀﻼﺕ ﺍﶈﻴﻄﺔ ﺑﺎﻟﻘﺼﺒﺎﺕ ﻭﻳﺴﺎﻋﺪﺍﻥ ﻋﻠﻰ ﺗﻮﺳﻊ ﻫﺬﻩ‬
‫ﺍﻟﻘﺼﺒﺎﺕ ﻭﺑﺎﻟﺘﺎﱄ ﳛﺴﻨﺎﻥ ﻣﻦ ﺣﺎﻟﺔ ﺿﻴﻖ ﺍﻟﻨﻔﺲ ﺍﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ ﻣﺮﺿﻰ ﺍﻟﺮﺑﻮ ﺍﻭ ﻣﺮﻳﺾ‬
‫‪. COPD‬‬

‫ﻋﻼﺝ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﳌﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ‪.‬‬

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‫ﻋﻨﺪﻣﺎ ﻳﺘﻌﺮﺽ ﻣﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪ Heart failure‬ﺍﱃ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.Hypertension‬‬
‫ﻓﺎﻥ ﻋﻼﺝ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪ Hypertension‬ﺍﻻﻓﻀﻞ ﻫﻨﺎ ‪.‬‬
‫ﻟﻴﺲ ﻫﻮ ﻣﻦ ﺍﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ ‪ ، beta.blocker‬ﳌﺎﺫﺍ ؟‬
‫ﻻﻥ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪:‬‬
‫ﺗﻘﻠﻞ ﻣﻦ ‪ intropic effect‬ﻟﻌﻀﻠﺔ ﺍﻟﻘﻠﺐ ﺃﻱ ﺗﻘﻠﻞ ﻗﻮﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻘﻠﻞ ﻣﻦ ‪ choronotropic effect‬ﺃﻱ ﺗﻘﻠﻞ ﻋﺪﺩ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻛﻼ ﺍﻟﺘﺎﺛﲑﻳﻦ ﻏﲑ ﻣﻔﻴﺪﻳﻦ ﻟﻠﻤﺮﻳﺾ ﺍﻟﺬﻱ ﻳﻌﺎﻧﻲ ﻣﻦ ﻓﺸﻞ ﰲ ﺍﻟﻘﻠﺐ ﺑﻞ ﺳﻴﺆﺩﻳﺎﻥ ﺍﱃ ﺯﻳﺎﺩﺓ‬
‫ﺣﺪﻭﺙ ﺍﻻﻋﺮﺍﺽ ﻭﺗﺪﻫﻮﺭ ﺍﳊﺎﻟﺔ ﺍﳌﺮﺿﻴﺔ ﻟﻠﻤﺮﻳﺾ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻟﻴﺲ ﺩﻭﺍء ‪ ، verapamil‬ﳌﺎﺫﺍ ؟‬
‫ﻻﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﻳﻀﺎ ‪:‬‬
‫ﺗﻘﻠﻞ ﻣﻦ ‪ intropic effect‬ﻟﻌﻀﻠﺔ ﺍﻟﻘﻠﺐ ﺃﻱ ﺗﻘﻠﻞ ﻗﻮﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻘﻠﻞ ﻣﻦ ‪ choronotropic effect‬ﺃﻱ ﺗﻘﻠﻞ ﻋﺪﺩ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﰲ ﻣﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻫﻮ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪.ACEI‬‬
‫ﻻﻧﻬﺎ ﺗﻌﻤﻞ ﺗﻮﺳﻴﻊ ﻟﻼﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻻﻭﺭﺩﺓ ﻭﺍﻟﺸﺮﺍﻳﲔ ‪ ، Vasodilators‬ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﻣﻔﻴﺪ‬
‫ﻟﻜﻼ ﺍﳌﺮﺿﲔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪Hypertension‬ﻭﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪.Heart failure‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﰲ ﻣﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻫﻮ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻣﺜﻞ ﺩﻭﺍء ‪. Lasix‬‬
‫ﻻﻧﻬﺎ ﺳﺘﻘﻠﻞ ﻣﻦ ﲡﻤﻊ ﺍﻟﺴﻮﺍﺋﻞ ﻭﺗﻘﻠﻞ ﺣﺠﻢ ﺍﻟﺴﻮﺍﺋﻞ ﺍﻳﻀﺎ ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﻳﻀﺎ ﺟﺪﺍ ﻣﻔﻴﺪ ﳌﻌﺎﳉﺔ‬
‫ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪Hypertension‬ﻭﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪.Diuretics.‬‬

‫‪٤٠‬‬
 ‫ﻛﻴﻔﻴﺔ ﻣﻌﺎﳉﺔ ‪.acute left heart failure‬‬
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‫ﺍﻟﺼﻴﺪﱄ ﺍﻟﺴﺮﻳﺮﻱ ﻋﻨﺼﺮ ﻣﻬﻢ ﰲ ﻭﺿﻊ ﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﻻﻱ ﻣﺮﻳﺾ ‪.‬‬

‫ﻭﳍﺬﺍ ﳚﺐ ﺍﻥ ﺗﻜﻮﻥ ﻟﺪﻳﺔ ﺍﳌﻌﺮﻓﺔ ﺍﻟﻜﺎﻣﻠﺔ ﺑﺎﻻﺩﻭﻳﺔ ﻭﳎﺎﻣﻴﻌﻬﺎ ﻭﻛﻴﻔﻴﺔ ﻭﺿﻊ ﺍﳋﻄﻂ ﺍﻟﻌﻼﺟﻴﺔ ‪.‬‬
‫ﺍﲢﺪﺙ ﻟﻜﻢ ﺍﺣﺒﺎﺋﻲ ﺍﻟﻴﻮﻡ ﻋﻦ ﻛﻴﻔﻴﺔ ﻣﻌﺎﳉﺔ ‪. acute cardiogenic pulmonary edema‬‬
‫ﺍﻭ ﻣﺎ ﻳﺴﻤﻰ ‪. acute left heart failure‬‬
‫ﻭﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺍﳌﺮﺿﻴﺔ ﺟﺪﺍ ﺧﻄﺮﺓ ﻭﲢﺘﺎﺝ ﺍﱃ ﻣﻌﺎﳉﺔ ﻣﺴﺘﻌﺠﻠﺔ ‪.‬‬
‫ﻭﻛﺜﲑ ﻣﻦ ﺍﳌﺮﺿﻰ ﻳﺪﺧﻠﻮﻥ ﺍﱃ ﺭﺩﻫﺎﺕ ﺍﻟﻄﻮﺍﺭﻯء ﻭﺍﻟﻌﻨﺎﻳﺔ ﺑﻬﺬﺍ ﺍﳌﺮﺽ ﻭﻫﺬﻩ ﺍﳊﺎﻟﺔ ‪.‬‬
‫ﻭﺗﻌﺎﰿ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺍﻭﻻ ﺑﺎﺩﺧﺎﻝ ﺍﳌﺮﻳﺾ ﺍﱃ ﺍﳌﺴﺘﺸﻔﻰ‪ Hospitalization‬ﺍﺫﺍ ﻣﻦ ﺍﻟﺼﻌﻮﺑﺔ ﺍﻟﻌﻼﺝ‬
‫ﺧﺎﺭﺟﻪ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺍﻥ ﻳﻜﻮﻥ ﺍﳌﺮﻳﺾ ﰲ ﻭﺿﻊ ﺍﻟﺮﺍﺣﺔ ﻭﻋﻠﻰ ﺍﻟﻔﺮﺵ ﺷﺒﺔ ﺟﺎﻟﺲ ‪rest in bed in sitting‬‬
‫‪ position‬ﻟﺘﺤﺴﲔ ﻋﻤﻠﻴﺔ ﺍﻟﺘﻨﻔﺲ ﻟﺪﻳﻪ ﻭﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﺍﻻﻭﻛﺴﺠﲔ ‪ 02 therapy‬ﺑﱰﻛﻴﺰ ﻋﺎﱄ‬
‫ﻣﻦ ‪ % ٦٠‬ﺍﱃ ‪. %١٠٠‬‬
‫ﻭﳚﺐ ﺍﺣﺒﺎﺋﻲ ﻗﺒﻞ ﺍﻟﺒﺪء ﺑﺒﻘﺎﻱ ﺍﻻﺟﺮﺍءﺍﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻣﻌﺎﳉﺔ ﺍﻻﺳﺒﺎﺏ ﺍﻭ ﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﺘﻲ ﺯﺍﺩﺕ ﻣﻦ‬
‫ﺗﺪﻫﻮﺭ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺍﳌﺮﺿﻴﺔ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﺍﺣﺒﺎﺋﻲ ﻧﺒﺪء ﺑﺼﺮﻑ ﺩﻭﺍء ﺍﳌﻮﺭﻓﲔ ‪ Morphia 2-5 mg‬ﲜﺮﻋﺔ ‪ ٢.٥‬ﺍﱃ ‪ ٥‬ﻣﻠﻐﻢ ﻋﻦ ﻃﺮﻳﻖ‬
‫ﺍﻟﻮﺭﻳﺪﻱ ﺣﻴﺚ ﻳﻘﻠﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ‪ Venous pressure‬ﻭﻳﺆﺩﻱ ﺍﻳﻀﺎ ﺍﱃ ‪ sedation‬ﻭﳚﺐ ﺍﻥ‬
‫ﻳﻌﻄﻰ ﻣﻌﻪ ﺍﻳﻀﺎ ﻋﻼﺝ ‪ metoclopramide 10 mg IV‬ﳌﻨﻊ ﺣﺪﻭﺙ ﺍﻟﺘﻘﻴﻮء ‪prevent‬‬
‫‪ emesis‬ﺑﺴﺒﺐ ﺍﳌﻮﺭﻓﲔ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﳚﺐ ﺍﻥ ﻧﻌﻄﻲ ﻟﻠﻤﺮﻳﺾ ﺩﻭﺍء ‪ Furosemide‬ﺣﻴﺚ ﳝﺘﻠﻚ ﺗﺎﺛﲑﺍﺕ ﺭﺍﺋﻌﺔ‬
‫ﺟﺪﺍ ﳌﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻫﻲ ‪.‬‬
‫ﻣﻮﺳﻊ ﻭﻋﺎﺋﻲ ﻗﻮﻱ ﺟﺪﺍ ‪. a potent venodilator‬‬
‫ﻭﺍﻳﻀﺎ ﻳﻘﻠﻞ ﻣﻦ ﺣﺪﻭﺙ ‪ pulmonary congestion‬ﻭﻫﺬﻳﻦ ﺍﻟﺘﺎﺛﲑﻳﻦ ﻳﺴﺒﺒﻬﻤﺎ ‪Furosemide‬‬
‫ﻗﺒﻞ ﺑﺪء ﻓﻌﻠﻪ ﺍﳌﺪﺭﺭ ‪. diuretic action‬‬
‫ﻭﻳﻌﻄﻰ ﺩﻭﺍء ‪ Furosemide‬ﲜﺮﻋﺔ ‪ initial dose 20-40 mgIV‬ﺧﻼﻝ ﻋﺪﺓ ﺩﻗﺎﺋﻖ ‪.‬‬
‫ﻭﳝﻜﻦ ﺍﻥ ﺗﺰﺩﺍﺩ ﻫﺬﻩ ﺍﳉﺮﻋﺔ ﺍﱃ ‪. a maximum 200 mg‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻳﺘﻢ ﺻﺮﻑ ‪ Venous vasodilators‬ﻣﺜﻞ ﺩﻭﺍء ‪ nitroglycerin‬ﲜﺮﻋﺔ‬
‫‪ ١٠-٥‬ﻣﺎﻳﻜﺮﻭﻏﺮﺍﻡ ﺑﺎﻟﺪﻗﻴﺔ ﻭﺭﻳﺪﻱ ﺣﻴﺚ ﺍﻧﻪ ﺳﺮﻳﻊ ﻭﻓﻌﺎﻝ ‪.‬‬

‫‪٤١‬‬
 ‫ﻭﰲ ﺑﻌﺾ ﺍﳊﺎﻻﺕ ﺍﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ ﺍﳌﺮﻳﺾ ﺍﺭﺗﻔﺎﻉ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ﻧﺼﺮﻑ ﺍﻳﻀﺎ ﺩﻭﺍء ‪Na‬‬
‫‪ nitroprusside‬ﺍﻭ ﺑﺪﻳﻞ ﻟﻪ ﲜﺮﻋﺔ ‪ ٣٠-٢٠‬ﻣﺎﻳﻜﺮﻭﻏﺮﺍﻡ ﺑﺎﻟﺪﻗﻴﻘﺔ ﻭﺭﻳﺪﻳﺎ ﳊﻔﻆ ﺿﻐﻂ ﺍﻟﺪﻡ‬
‫ﺍﻻﻧﺒﺴﺎﻃﻲ ﺍﻗﻞ ﻣﻦ ‪ ١٠٠‬ﻣﻠﻢ ﺯﺋﺒﻘﻲ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻋﺰﺍﺋﻲ ﺍﻟﺼﻴﺎﺩﻟﺔ ﻧﺴﺘﻌﻤﻞ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ‪ positive inotropic‬ﻣﺜﻞ ﺩﻭﺍء ‪dopamine‬‬
‫‪. or dobutamine‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﻴﺎﻧﺎ ﻧﺼﻒ ﺍﺩﻭﻳﺔ ‪ IV digitalization‬ﰲ ﺣﺎﻟﺔ ﺍﳊﺎﺟﺔ ﺍﱃ ﺫﻟﻚ ﻛﻤﺎ ﻟﻮﺟﺪﺕ ﻣﻊ ﻫﺬﺍ ﺍﳌﺮﺽ‬
‫ﺣﺎﻟﺔ ‪. rapid AF.‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺼﺮﻑ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻋﻼﺝ ‪ Aminophylline,‬ﲜﺮﻋﺔ ‪٥‬‬
‫ﻣﻠﻐﻢ ‪/‬ﻛﻐﻢ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﳌﺪﺓ ‪ ١٠‬ﺩﻗﺎﺋﻖ ‪.‬‬
‫ﻭﺍﺫﺍ ﱂ ﺗﻨﻔﻊ ﺍﻻﺩﻭﻳﺔ ﺍﻋﻼﻩ ﻓﺎﻧﻪ ﻳﺘﻢ ﺍﻟﻠﺠﻮء ﺍﱃ ﺍﺟﺮﺍءﺍﺕ ﺗﻘﻨﻴﺔ ﻭﺟﺮﺍﺣﻴﺔ ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪. Beta bloker‬‬

‫********************‬

‫ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻟﺘﻲ ﻳﺴﺌﻞ ﻋﻨﻬﺎ ﺍﻟﺼﻴﺪﱄ ﺍﻟﺴﺮﻳﺮﻱ ﺩﺍﺋﻤﺎ ﻫﻲ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Beta‬‬
‫‪. bloker‬‬
‫ﻟﺬﺍ ﻓﺎﻟﻜﻼﻡ ﻋﻨﻬﺎ ﺟﺪﺍ ﻣﻬﻢ ﻭﳚﺐ ﺍﻥ ﻳﺘﻨﺎﻭﻝ ﺍﳉﺎﻧﺐ ﺍﻟﻌﻤﻠﻲ ﻓﻘﻂ ﻣﻨﻬﺎ ‪.‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﺣﺒﺎﺋﻲ ﻋﻦ ﻃﺮﻳﻖ ﻋﻤﻞ ‪ Negative inotropic‬ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺗﻘﻠﻴﻞ ﺍﺳﺘﻬﻼﻙ ﺍﻻﻭﻛﺴﺠﲔ ﻣﻦ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﺗﻘﻠﻴﻞ ﺍﳉﻬﺪ ﻋﻠﻰ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﺑﺘﻘﻠﻴﻞ ﻗﻮﺓ ﺗﻘﻠﺺ‬
‫ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﻫﺬﺍ ﺍﻟﻔﻌﻞ ﺟﺪﺍ ﻧﺎﻓﻊ ﰲ ﻛﺜﲑ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺧﻼﻝ ‪ Negative chronotropic‬ﺃﻱ ﺗﻘﻠﻞ ﻋﺪﺩ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺃﻱ‬
‫ﺗﺴﻤﺢ ﺑﻮﻗﺖ ﺍﻛﱪ ﻟﻠﺸﺮﺍﻳﲔ ﺍﻟﺘﺠﻴﺔ ﻟﻠﱰﻭﻳﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺃﻱ ﻳﺰﺩﺍﺩ ‪the time of coronary‬‬
‫‪ filling‬ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺟﺪﺍ ﻧﺎﻓﻊ ﰲ ﻣﻌﺎﳉﺔ ﻛﺜﲑ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ﺍﳋﻄﲑﺓ ‪.‬‬
‫ﺣﻴﺚ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺗﻘﺴﻢ ﺍﱃ ﻗﺴﻤﲔ ‪:‬‬
‫ﺍﻻﻭﻝ ﻳﺴﻤﻰ ‪ Non selective‬ﺃﻱ ﻳﺆﺛﺮ ﻋﻠﻰ ‪. B1 and B2 RECEPTOR‬‬
‫ﻭﻣﻦ ﺍﻣﺜﻠﺔ ﻫﺬﺍ ﺍﻟﻘﺴﻢ ‪.‬‬
‫ﺩﻭﺍء ‪ Propranolol‬ﺍﻟﺬﻱ ﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (lnderal‬‬

‫‪٤٢‬‬
 ‫ﻭﺍﻳﻀﺎ ﺩﻭﺍء ‪ Nadolol‬ﻭﺍﻟﺬﻱ ﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪.( Corgard‬‬
‫ﻭﻫﺬﺍ ﺍﻟﻘﺴﻢ ﻻﻳﺴﻤﺢ ﺑﺼﺮﻓﺔ ﻟﻠﻤﺮﺿﻰ ﺍﻟﺮﺑﻮﻳﲔ ﻻﻧﻪ ﻳﺆﺩﻱ ﺍﱃ ﺗﻔﺎﻗﻢ ﺗﻘﻠﺺ ﺍﻟﻘﺼﻴﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ‬
‫ﻭﻳﺰﻳﺪ ﻣﻦ ﺗﺪﻫﻮﺭ ﺍﳌﺮﺽ ‪.‬‬
‫ﺍﻣﺎ ﺍﻟﻘﺴﻢ ﺍﻟﺜﺎﻧﻲ ﻫﻮ ‪ Selective‬ﺃﻱ ﻳﺆﺛﺮ ﻋﻠﻰ ‪ B1 receptor‬ﻓﻘﻂ ‪.‬‬
‫ﻭﻣﻦ ﺍﻣﺜﻠﺔ ﻫﺬﺍ ﺍﻟﻘﺴﻢ ‪.‬‬
‫ﺩﻭﺍء ‪ Atenolol‬ﻭﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (Tenormin‬‬
‫ﻭﺍﻳﻀﺎ ﺩﻭﺍء ‪ Metoprolol‬ﻭﺍﻟﺬﻱ ﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (Betalock‬‬
‫ﻭﺍﻳﻀﺎ ﺩﻭﺍء ‪ Bisoprolol‬ﻭﺍﻟﺬﻱ ﻳﺴﻤﻰ ﲡﺎﺭﻳﺎ )‪. (Concor‬‬
‫ﻭﻫﺬﺍ ﺍﻟﻘﺴﻢ ﻋﺎﺩﺓ ﻭﺑﺎﳉﺮﻋﺔ ﺍﻟﻄﺒﻴﻌﻴﺔ ﻻﻳﺆﺛﺮ ﻋﻠﻰ ﺍﳌﺮﺿﻰ ﺍﻟﺮﺑﻮﻳﲔ ﻭﻟﻜﻨﻪ ﺑﺎﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻳﺴﺒﺐ‬
‫ﺗﻘﻠﺺ ﰲ ﺍﻟﻘﺼﺒﺎﺕ ﻭﻳﺰﻳﺪ ﻣﻦ ﺗﺪﻫﻮﺭ ﺍﳌﺮﺽ ﺍﻟﺘﻨﻔﺴﻲ ﻻﻧﻪ ﺳﻮﻑ ﻳﺆﺛﺮ ﻋﻠﻰ ‪. B2 receptor‬‬
‫ﻭﺍﻳﻀﺎ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻫﻨﺎﻙ ﺗﻘﺴﻴﻢ ﺛﺎﻧﻲ ﻻﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺟﺪﺍ ﻣﻔﻴﺪ ﻭﻫﻮ ‪:‬‬
‫ﺍﻟﻘﺴﻢ ﺍﻻﻭﻝ ﻭﻳﺴﻤﻰ ‪ Lipophilic B.B‬ﺃﻱ ﺍﻟﺘﻲ ﺗﺬﻭﺏ ﺑﺎﻟﺪﻫﻦ )‪ (lipid soluble‬ﻭﻫﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ﲤﺘﺺ ﺑﺼﻮﺭﺓ ﺟﻴﺪﺓ ﻭﻟﻜﻨﻬﺎ ﺗﺘﻌﺮﺽ ﺍﱃ ‪ extensive hepatic metabolism‬ﳑﺎ‬
‫ﳛﻌﻠﻬﺎ ‪ short half life‬ﻭﺍﻳﻀﺎ ﺗﺴﺘﻄﻴﻊ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﺒﻮﺭ ﺍﳊﺎﺟﺰ ﺍﻟﺪﻣﺎﻏﻲ ‪ B.B.B‬ﻭﻣﻦ ﺍﻣﺜﻠﺔ‬
‫ﻫﺬﺍ ﺍﻟﻘﺴﻢ ﻫﻮ ﺩﻭﺍء ‪. Propranolol‬‬
‫ﻭﺍﻟﻘﺴﻢ ﺍﻟﺜﺎﻧﻲ ﻭﻳﺴﻤﻰ ‪ Hydrophilic B.B‬ﺃﻱ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺬﺍﺋﺒﺔ ﺑﺎﳌﺎء‪ (water soluble):‬ﻭﻫﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ﻟﻴﺴﺖ ﺟﻴﺪ ﺍﻻﻣﺘﺼﺎﺹ ﻭﺑﻄﻴﺌﺔ ﺍﳋﺮﻭﺝ ﻣﻦ ﺍﳉﺴﻢ ﻭﻻﺗﻌﱪ ﺍﳊﺎﺟﺰ ﺍﻟﺪﻣﺎﻏﻲ ﻭﻣﻦ ﺍﻣﺜﻠﺘﻬﺎ‬
‫‪. Atenolol.Nadolol.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ﻛﺜﲑ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ﻣﻨﻬﺎ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‬
‫‪Hypertension.‬ﻭﻣﻌﺎﳉﺔ ﺍﻟﺬﲝﺔ ﺍﻟﺼﺪﺭﻳﺔ ‪Angina.‬ﻭﺍﳉﻠﻄﺔ ﻭﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺴﺘﻘﺮ ﻭﻣﺮﺽ ﻋﺪﻡ‬
‫ﺍﻧﺘﻈﺎﻡ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪.Arrythmia‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻣﺮﺍﺽ ﻏﲑ ﻗﻠﺒﻴﺔ ‪ Non cardiovascular uses‬ﻣﺜﻞ ﻣﺮﺽ‬
‫ﺗﺴﻤﻢ ﺍﻟﺪﺭﻗﻴﺔ ﻧﺘﻴﺠﺔ ﺯﻳﺎﺩﺓ ﻋﺎﻟﻴﺔ ﺑﻨﺸﺎﻃﻬﺎ ‪ Thyrotoxicosis.‬ﻭﻣﺮﺽ ﺍﻟﻘﻠﻖ ‪Anxiety.‬‬
‫ﻭﻣﺮﺽ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﻟﺒﻮﺍﺑﻲ ﺍﻟﻜﺒﺪﻱ ‪ Portal hypertension‬ﻭﻣﺮﺽ ‪Familial‬‬
‫‪ tremors‬ﻭﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ﺍﻟﺬﻱ ﳛﺪﺙ ﻧﺘﻴﺠﺔ ﻧﻘﺺ ﺍﻟﺪﻭﻣﺒﺎﻣﲔ ﻭﺯﻳﺎﺩﺓ ﺍﻻﺳﺘﻴﻞ ﻛﻮﻟﲔ‬
‫‪ Parkinsonism.‬ﻭﻣﺮﺽ ﺍﻟﺸﻘﻴﻘﺔ ﺍﻭ ﺍﻟﺼﺪﺍﻉ ﺍﻟﻨﺼﻔﻲ ‪ Migraine‬ﻭﻣﺮﺽ ‪ Glaucoma‬ﺣﻴﺚ‬
‫ﻳﺴﺘﻌﻤﻞ ﻟﻪ ﺩﻭﺍء ‪.(Timolol).‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺍﻟﺼﻴــــــــﺎﺩﻟﺔ ﻣﻦ ﺍﻫـــــــــــــﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴــﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪.‬‬
‫ﻗﻠﺔ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪ Bradycardia.‬ﻭﺍﺣﻴﺎﻧﺎ ﻓﺸﻞ ﰲ ﺍﻟﻘﻠﺐ ‪ Heart failure‬ﺑﻞ ﳑﻜﻦ ﺍﻥ ﳛﺪﺙ‬
‫‪. Heart block‬‬
‫ﻭﻛﺬﻟﻚ ﳑﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺍﻻﺣﻼﻡ ﺍﻟﻠﻴﻠﻴﺔ ﻭﺧﺎﺻﺔ ﻧﻮﻉ ‪ Lipophilic B.B‬ﻻﻧﻪ ﻳﻌﱪ ﺍﳊﺎﺟﺰ ﺍﻟﺪﻣﺎﻏﻲ‬
‫‪.‬‬

‫‪٤٣‬‬
 ‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﻟﺸﻌﻮﺭ ﺑﺎﻻﻛﺘﺌﺎﺏ ﻭﺍﻟﺘﻌﺐ ﻭﺿﻴﻖ ﺍﻟﻨﻔﺲ ﻭﺧﺎﺻﺔ ﻣﻊ ﻗﺴﻢ ﻫﻮ ‪. Non Selective‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺑﺮﻭﺩﺓ ﺍﻻﻃﺮﺍﻑ ﻭﻗﻠﺔ ﺑﺎﻟﻨﺸﺎﻁ ﺍﳉﻨﺴﻲ ‪.‬‬

‫ﻛﻴﻔﻴﺔ ﻣﻌﺎﳉﺔ ‪.chronic heart failure‬‬

‫****************************‬

‫ﻭﺗﺘﻀﻤﻦ ﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﳍﺬﺍ ﺍﳌﺮﺽ ﻫﻲ ‪.‬‬

‫ﺍﻟﺮﺍﺣﺔ ‪Rest‬ﺣﻴﺚ ﺗﻠﻌﺐ ﺩﻭﺭ ﺟﺪﺍ ﻣﻬﻢ ﰲ ﲢﺴﻦ ﺍﻻﻋﺮﺍﺽ ﺍﳌﺮﺿﻴﺔ ﻣﺜﻞ ﻗﺼﺮ ﺍﻟﻨﻔﺲ ﻭﺍﻟﺘﻌﺐ‬
‫ﺍﻟﺬﻱ ﻳﺸﻌﺮ ﺑﻪ ﺍﳌﺮﻳﺾ ﻧﺘﻴﺠﺔ ﻋﺪﻡ ﻭﺻﻮﻝ ﺍﻟﻜﻤﻴﺔ ﺍﻟﻜﺎﻓﻴﺔ ﻣﻦ ﺍﻟﺪﻡ ﺍﱃ ﺍﻋﻀﺎء ﺍﳉﺴﻢ ﺑﺴﺒﺐ ﻓﺸﻞ‬
‫ﺍﻟﻘﻠﺐ ﰲ ﺿﺦ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﺗﺰﻳﺪ ﺍﻟﺮﺍﺣﺔ ﻣﻦ ﻭﺻﻮﻝ ﺍﻟﺪﻡ ﺍﱃ ﺍﻟﻜﻠﻴﺔ ﻭﺗﺴﺒﺐ ﺍﻻﺩﺭﺍﺭ ﺍﻟﺬﻱ ﻟﻪ ﺩﻭﺭ ﻣﻬﻢ ﰲ ﺗﻘﻠﻴﻞ‬
‫ﺍﻟﺴﻮﺍﺋﻞ ﺍﻟﺘﻲ ﺗﺘﺠﻤﻊ ﻋﻨﺪ ﻣﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻟﻜﻦ ﳚﺐ ﺍﻥ ﺗﻜﻮﻥ ﺍﻟﺮﺍﺣﺔ ﳏﺪﻭﺩﺓ ﻭﻟﻴﺲ ﻣﺴﺘﻤﺮﺓ ﻻﻧﻬﺎ ﺳﺘﻮﺩﻱ ﺍﱃ ﺑﻌﺾ ﺍﳌﻀﺎﻋﻔﺎﺕ ﻣﺜﻞ‬
‫‪ Pulmonary embolism‬ﻭ ‪ Constipation, osteoporosis‬ﻭ ‪. DVT.‬‬
‫ﺍﻟﻌﻨﺼﺮ ﺍﻟﺜﺎﻧﻲ ﰲ ﻋﻼﺝ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻮ ﺗﻘﻠﻴﻞ ﺗﻨﺎﻭﻝ ﺍﻟﺴﻮﺍﺋﻞ ﻭﺍﻟﺼﻮﺩﻳﻮﻡ ﺣﻴﺚ ﺍﻟﻜﻤﻴﺔ‬
‫ﺍﳌﺴﻤﻮﺡ ﺗﻨﺎﻭﳍﺎ ﻣﻦ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻫﻲ ‪ ٢‬ﻏﻢ ‪/‬ﺍﻟﻴﻮﻡ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺗﻘﻠﻴﻞ ﺍﻟﺴﻮﺍﺋﻞ ﳌﻨﻊ ﺣﺪﻭﺙ ‪. volume overload,‬‬
‫ﺣﻴﺚ ﺍﻟﻜﻤﻴﺔ ﺍﳌﻄﻠﻮﺏ ﺍﻭ ﺍﳌﺴﻤﻮﺡ ﺗﻨﺎﻭﳍﺎ ﳌﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻲ ‪ ٥٠٠‬ﻣﻞ ﺑﺎﻻﺿﺎﻓﺔ ﺳﻮﺍﺋﻞ‬
‫ﲟﻘﺪﺍﺭ ‪ urine output‬ﰲ ﺍﻟﻴﻮﻡ ﺍﻟﺴﺎﺑﻖ ‪.‬‬
‫ﻛﻤﺎ ﳚﺐ ﲡﻨﺐ ﺗﻨﺎﻭﻝ ﺍﻟﻮﺟﺒﺎﺕ ﺍﻟﻐﺬﺍﺋﻴﺔ ﺍﻟﺜﻘﻴﻠﺔ ﻭﺍﻳﻀﺎ ﳚﺐ ﲡﻨﺐ ﺗﻨﺎﻭﻝ ﺍﻟﻜﺤﻮﻝ ﻻﻧﻪ ﳝﻠﻚ‬
‫‪. negative inotropic effect‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺗﻘﻠﻴﻞ ﻭﺯﻥ ﺍﳌﺮﻳﺾ ﻻﻧﻪ ﺳﻴﺆﺩﻱ ﺍﱃ ﺗﻘﻠﻴﻞ ‪. cardiac load‬‬
‫ﻛﻤﺎ ﻳﻨﺼﺢ ﺑﺘﻘﻠﻴﻞ ﺍﻭ ﺗﺮﻙ ﺍﻟﺘﺪﺧﲔ ﺍﻃﻼﻗﺎ ‪. stop smoking.‬‬
‫ﻭﺍﻟﻌﻨﺼﺮ ﺍﻟﺜﺎﻟﺚ ﰲ ﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻮ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ﺍﻟﺪﳚﻮﻛﺴﲔ ‪.‬‬
‫ﺍﻟﺬﻱ ﻳﺰﻳﺪ ﻣﻦ ﺗﻘﻠﺺ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻳﻘﻠﻞ ﻣﻦ ﻋﺪﺩ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‪.‬‬
‫ﻭﻫﺬﺍ ﺟﺪﺍ ﻣﻔﻴﺪ ﻓﺒﺰﻳﺎﺩﺓ ﺍﻟﺘﻘﻠﺺ ﻳﻮﺩﻱ ﺍﱃ ﺿﺮﺑﺔ ﻗﻮﻳﺔ ﻗﺎﺩﺭﺓ ﻋﻠﻰ ﺩﻓﻊ ﻛﻤﻴﺔ ﻛﺎﻓﻴﺔ ﻣﻦ ﺍﻟﺪﻡ ﺍﱃ‬
‫ﺍﻋﻀﺎء ﺍﳉﺴﻢ ‪.‬‬
‫ﻭﺗﻘﻠﻴﻞ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻳﺆﺩﻱ ﺍﱃ ﺗﻘﻠﻴﻞ ﺍﳉﻬﺪ ﻋﻠﻰ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻫﺬﺍ ﻳﻌﻨﻲ ﺍﻥ ﺍﻟﺪﳚﻮﻛﺴﲔ ﺳﻮﻑ ﻳﺰﻳـــــــــــــﺪ ﻣﻦ ﻗﻮﺓ ﺗﻘﻠﺺ ﺍﻟﺒﻄﻴﻨﲔ ‪.‬‬

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 ‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺍﻧﺘﺎﺝ ﺍﻟﻘﻠﺐ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﻗﻠﺔ ﺣﺠﻢ ﺍﻟﻘﻠﺐ ﺃﻱ ﻳﻘﻠﻞ ﺍﻟﺘﻮﺳﻊ ﻭﺍﻟﺘﻀﺨﻢ ﺍﳊﺎﺻﻞ ﺑﻪ‪.‬‬
‫ﻭﻳﻘﻠﻞ ‪ Venous pressure‬ﺣﻴﺚ ﻳﺰﻳﺢ ﺍﻟﺪﻡ ﻣﻦ ﺍﻻﻭﺭﺩﺓ ﺍﱃ ﺍﻟﺸﺮﺍﻳﲔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳛﺴﻦ ﻭﺻﻮﻝ ﺍﻟﺪﻡ ﺍﱃ ﺍﻟﺸﺮﺍﻳﲔ ﺍﻟﺘﺎﺟﻴﺔ ﻧﺘﻴﺠﺔ ﻗﻠﺔ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺃﻱ ﻳﺴﻤﺢ ﺑﻮﻗﺖ ﻟﻠﱰﻭﻳﺔ‬
‫ﺍﻟﺘﺎﺟﻴﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳛﺴﻦ ﻣﻦ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﳚﻌﻠﻪ ﻃﺒﻴﻌﻲ ﻻﻥ ﻣﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ﻗﻠﺔ ﰲ ﻧﺘﺎﺝ‬
‫ﺍﻟﻘﻠﺐ ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ﻭﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﳚﻮﻛﺴﲔ ﺳﻴﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ﻧﺘﺎﺝ ﺍﻟﻘﻠﺐ‬
‫‪ COP‬ﻭﺑﺎﻟﺘﺎﱄ ﺭﺟﻮﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﱃ ﺍﳌﺴﺘﻮﻯ ﺍﻟﻄﺒﻴﻌﻲ ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ ‪ % ٨٥‬ﻣﻦ‬
‫ﺍﻟﺪﳚﻮﻛﺴﲔ ﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ‪ the urine,‬ﻭ ‪ %١٥‬ﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. biliary excretion.‬‬
‫ﻛﻤﺎ ﳚﺐ ﺍﻥ ﻧﻌﺮﻑ ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﺍﻥ ﺍﳌﺴﺘﻮﻯ ﺍﻟﻌﻼﺟﻲ ﻟﻠﺪﻭﺍء ﺍﻟﺪﳚﻮﻛﺴﲔ ﳛﺼﻞ ﺑﻌﺪ ‪ ٥‬ﺍﻳﺎﻡ ﻣﻦ‬
‫ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ﲜﺮﻋﺔ ‪. maintenance therapy‬‬
‫ﻭﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﲜﺮﻋﺔ ‪ 0.25 mg‬ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﺍﻣﺎ ﺟﺮﻋﺔ ‪ loading dose‬ﻓﻬﻲ ﻧﻌﻄﻲ ‪ 0.25 - 0.5 mg orally or IV‬ﺧﻼﻝ ﻧﺼﻒ ﺳﺎﻋﺔ ﻣﺘﺒﻮﻋﺔ‬
‫ﲜﺮﻋﺔ ‪ 0.25‬ﻣﻠﻐﻢ ﻛﻞ ‪ ٦‬ﺳﺎﻋﺎﺕ ﻟﻴﻮﻡ ﻭﺍﺣﺪ ﻓﻘﻂ ﺛﻢ ﻧﻌﻄﻲ ﺟﺮﻋﺔ ﺍﳌﺘﺎﺑﻌﺔ ﻭﻫﻲ ‪0.125 - 0.25‬‬
‫‪. mg day‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻭﻳﻌﻄﻰ ﺍﻟﺪﳚﻮﻛﺴﲔ ﻭﺭﻳﺪﻳﺎ ﰲ ﺣﺎﻻﺕ ﻣﻨﻬﺎ ‪:‬‬
‫ﰲ ﺣﺎﻟﺔ ﻣﺮﺽ ‪. Severe left ventricular failure‬‬
‫ﻭﰲ ﺣﺎﻟﺔ ‪ Heart failure‬ﻣﺼﺤﻮﺏ ﻣﻊ ‪ Supraventricular tachycardia‬ﺍﻭ ﻣﻊ ‪. AF‬‬
‫ﻭﻟﻠﻔﺎﺋﺪﺓ ﺯﻣﻼﺋﻲ ﻳﻮﺟﺪ ﻫﻨﺎﻙ ﺍﺧﺮ ﺍﲰﻪ ‪ DIGITOXIN‬ﺣﻴﺚ ﳝﻠﻚ ‪ Half life‬ﲬﺴﺔ ﺍﻳﺎﻡ‬
‫ﻭﳜﺮﺝ ﻓﻘﻂ ‪ %١٥‬ﻣﻦ ﺧﻼﻝ ﺍﻟﻜﻠﻴﺔ ﻭﺍﻟﺒﺎﻗﻲ ﻣﻦ ﺧﻼﻝ ﺍﻟﻜﺒﺪ ‪.‬ﻭﻟﻜﻨﻪ ﺍﱃ ﺍﻥ ﻳﺼﻞ ﻣﺮﺣﻠﺔ ‪steady‬‬
‫‪ state‬ﻳﺎﺧﺬ ﻓﱰﺓ ‪ ٣‬ﺍﺳﺎﺑﻴﻊ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺍﻟﻌﻨﺼﺮ ﺍﻟﺮﺍﺑﻊ ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻓﺶ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻮ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ‪diuretic‬‬
‫‪. drugs‬‬
‫ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺟﺪﺍ ﻣﻬﻤﺔ ﰲ ﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﺣﻴﺚ ﺗﻌﻤﻞ ﻋﻠﻰ ﺯﻳﺎﺩﺓ ﻓﻘﺪﺍﻥ ﺍﻟﺴﻮﺍﺋﻞ‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﺗﻘﻞ ﺍﳉﻬﺪ ﻋﻠﻰ ﺍﻟﻘﻠﺐ ﻭﺍﻳﻀﺎ ﺗﻘﻠﻞ ﻣﻦ ﻭﺟﻮﺩ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺗﻘﻠﻞ ﺍﻳﻀﺎ ‪venous‬‬
‫‪. pressure‬‬
‫ﻭﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻮ ‪Furosemide.‬‬
‫ﺣﻴﺚ ﻳﻌﺘﱪ ﻣﻦ ﳎﻤﻮﻋﺔ ‪. loop diuretics‬‬
‫ﻭﻳﻌﻤﻞ ﻋﻠﻰ ﻣﻨﻊ ﺍﻋﺎﺩﺓ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺴﻮﺍﺋﻞ ﰲ ﻫﺬﺍ ﺍﳌﻮﻗﻊ ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺗﻮﺳﻴﻊ ﻟﻠﻮﺭﻳﺪ ﺍﻟﺮﺋﻮﻱ‬
‫‪ venodilator of pulmonary veins‬ﳑﺎ ﳛﺴﻦ ﻣﻦ ﺍﳉﻬﺪ ﻋﻠﻰ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳛﺴﻦ ﻣﻦ ﺍﻟﺘﻨﻔﺲ ﻭﻳﻌﻄﻰ ﲜﺮﻋﺔ ﺍﻣﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺍﻭ ﺍﻟﻮﺭﻳﺪ ‪ ١٦٠-٤٠‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ‪.‬‬

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 ‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﻣﺪﺭﺭ ﻣﻦ ﻧﻮﻉ ﺍﻟﺜﻴﺎﺯﺍﻳﺪ ﻣﺜﻞ ﺩﻭﺍء ‪ Chlorothalidone‬ﺍﻟﺬﻱ ﳝﺘﺎﺯ‬
‫ﺑﻜﻮﻧﻪ ﻃﻮﻳﻞ ﺍﳌﻔﻌﻮﻝ ﻭﻳﻌﻄﻰ ﲜﺮﻋﺔ ‪ ٢٥‬ﻣﻠﻐﻢ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﳝﻜﻦ ﺩﻣﺞ ‪ Thiazides in combination with loop diuretics‬ﳌﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ‬
‫ﺍﳌﺰﻣﻦ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺍﺳﺘﺠﺎﺑﺔ ﺩﻭﺍﺋﻴﺔ ﻛﺒﲑﺓ ﺍﺫﺍ ﱂ ﳓﺼﻞ ﻋﻠﻰ ﺍﺳﺘﺠﺎﺑﺔ ﻛﺎﻓﻴﺔ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﺍﺣﺪﻫﻤﺎ ‪.‬‬
‫ﻛﻤﺎ ﳝﻜﻦ ﺍﺣﺒﺎﺋﻲ ﺍﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪ Spironolactone‬ﲜﺮﻋﺔ ‪ ٢٥‬ﻣﻠﻐﻢ ﰲ ﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ‬
‫ﺍﳌﺰﻣﻦ ﺣﻴﺚ ﻳﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻛـــ ‪ aldosterone antagonism‬ﰲ ‪ distal tubules‬ﺣﻴﺚ‬
‫ﻳﻘﻠﻞ ﺧﺮﻭﺝ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻭﻳﻘﻠﻞ ‪ process of remodeling‬ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﰲ‬
‫ﻣﺮﻳﺾ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ‪.‬‬
‫ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﻌﻼﺝ ‪ Spironolactone‬ﻫﻲ ‪Hyperkalemia and‬‬
‫‪. gynaecomastia‬‬
‫ﻭﺑﺎﳌﻨﺎﺳﺒﺔ ﳚﺐ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ ﺍﺳﺘﻌﻤﺎﻝ ﺍﳌﺪﺭﺭﺍﺕ ﻣﻦ ﻧﻮﻉ ‪ mannitol.‬ﳑﻨﻮﻋﺔ ﰲ ﻓﺸﻞ ﺍﻟﻘﻠﺐ‬
‫ﺍﳌﺰﻣﻦ ﻻﻧﻬﺎ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﺴﻮﺍﺋﻞ ﻭﺗﺴﺒﺐ ‪.volume overload‬‬
‫ﺍﻣﺎ ﺩﻭﺍء ‪ acetazolamide‬ﻭﻫﻮ ﻣﺪﺭﺭ ﺍﻳﻀﺎ ﻭﻟﻜﻦ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ glaucoma‬ﻓﻘﻂ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﺍﺫﺍ ﺻﺎﺣﺒﻪ ﺗﻘﻠﺺ ﰲ ﺍﻟﻘﺼﺒﺎﺕ‬
‫‪ bronchospasm.‬ﻫﻮ ﺩﻭﺍء ‪.aminophyline‬‬
‫ﺣﻴﺚ ﻳﻌﻄﻰ ﳌﻌﺎﳉﺔ ﻫﺬﺍ ﺍﻻﻣﺮ ﻻﻧﻪ ‪:‬‬
‫ﻳﻮﺳﻊ ﺍﻟﻘﺼﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ‪.‬‬
‫ﻭﻳﻌﻤﻞ ﻋﻠﻰ ﺗﻘﻮﻳﺔ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻟﻪ ﻓﻌﻞ ﻣﺪﺭﺭ ﻻﻧﻪ ﻳﺰﻳﺪ ﻣﻦ ﻭﺻﻞ ﺍﻟﺪﻡ ﺍﱃ ﺍﻟﻜﻠﻴﺔ‪.‬‬
‫ﻭﳚﺐ ﺍﻥ ﺗﻌﻄﻰء ﺑﺒﻂ ﻟﺘﺠﻨﺐ ﺣﺪﻭﺙ ‪. arrhythmia.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ﻫﻲ ﺍﻻﺩﻭﻳﺔ ﺍﳌﻮﺳﻌﺔ ﻟﻼﻭﻋﻴﺔ‬
‫ﺍﻟﺪﻣﻮﻳﺔ ‪ vasodilator‬ﺣﻴﺚ ﺗﻘﻠﻞ ﻛﻞ ﻣﻦ ‪ preload‬ﻭﺍﻳﻀﺎ ‪. freload‬‬
‫ﻭﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﻛﻤﻮﺳﻊ ﻭﻋﺎﺋﻲ ﻫﻲ ‪ ACE inhibitors‬ﻣﺜﻞ ﺩﻭﺍء ‪ Captopril‬ﺣﻴﺚ‬
‫ﻳﻌﻄﻰ ﲜﺮﻋﺔ ﺗﺼﻞ ﺍﱃ ‪ ٥٠‬ﻣﻠﻐﻢ ﺛﻼﺙ ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﺍﻭ ﻋﻼﺝ ‪ ramipril‬ﺣﻴﺚ ﻳﻌﻄﻰ ﲜﺮﻋﺔ ﺗﺼﻞ ﺍﱃ ‪ ٥‬ﻣﻠﻐﻢ ﻣﺮﺗﲔ ﻳﻮﻣﻴﺎ ﺃﻱ ﻛﻞ ‪ ١٢‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺟﺪﺍ ﻣﻬﻤﺔ ﻭﺗﻘﻠﻞ ﻣﻦ ﻋﻤﻠﻴﺔ ‪ process of remodeling‬ﺍﻟﺘﻲ ﲢﺪﺙ ﻟﻠﻘﻠﺐ ﺍﺛﻨﺎء‬
‫ﺍﻻﺻﺎﺑﺔ ﲟﺮﺽ ﻓﺸﻞ ﺍﻟﻘﻠﺐ ﺍﳌﺰﻣﻦ ‪.‬‬

‫‪٤٦‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Vasoconstrictor sympathomimetics‬‬
‫********************************************‬

‫ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ ﻫﻲ ‪. Vasoconstrictor sympathomimetics‬‬

‫ﻭﺍﻟﺘﻲ ﻣﻦ ﺍﻫﻢ ﺍﻓﺮﺍﺩﻫﺎ ﻫﻲ ﻛﻞ ﻣﻦ ‪. Noradrenaline, ephedrine, phenylephrine‬‬
‫ﻭﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺗﻔﻌﻴﻞ ‪ alpha-adrenoceptors peripheral‬ﰲ ﺍﻻﻭﻋﻴﺔ ﻭﺗﺴﺒﺐ‬
‫‪ vasoconstriction‬ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ﺍﻟﻀﻐﻂ ﺍﻻﻧﺒﺴﺎﻃﻲ ﻭﺍﻻﻧﻘﺒﺎﺿﻲ ‪systolic and‬‬
‫‪. diastolic blood pressure‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﺳﺘﻌﻤﺎﻟﲔ ﺭﺋﻴﺴﲔ ‪.‬‬
‫ﻫﻤﺎ ‪ Acute hypotension‬ﻭ ‪. Cardiac arrest‬‬
‫ﻭﳑﻨﻮﻋﺔ ﰲ ‪. Hypertension‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪.‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‪. Hypertension‬‬
‫ﻭﺍﻟﺼﺪﺍﻉ‪. Headache‬‬
‫ﻭﺍﺿﻄﺮﺍﺏ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‪. Arrhythmias‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺍﻭ ﻗﻠﺘﻬﺎ ‪ Bradycardia/tachycardia‬ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ‬
‫ﻭﺍﻻﻧﺴﺠﺔ ﺍﻻﺧﺮﻯ ﻣﻦ ﺧﻼﻝ ﺍﻧﺰﳝﲔ ﻫﻤﺎ ‪ MAO‬ﻭ ‪. COMT.‬‬
‫ﻭﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺭﺗﻔﺎﻉ ﺷﺪﻳﺪ ﻭﻃﻮﻳﻞ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ﻓﻴﻤﺎ ﻟﻮ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪. MAOIs‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺩﻭﺍء ‪ Ephedrine‬ﰲ ﻣﻌﺎﳉﺔ ﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﻟﺬﻱ ﳛﺪﺙ ﻧﺘﻴﺠﺔ‬
‫‪.spinal/epidural anaesthesia‬‬
‫ﻭﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﻣﺮﺍﻗﺒﺔ ﺍﻻﻭﻛﺴﺠﲔ ‪.Monitoring of oxygen saturation‬‬
‫ﻭﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‪. cardiac monitoring‬‬
‫ﻭﻇﻴﻔﺔ ﺍﻟﻜﻠﻴﺔ ﻭﺧﺮﻭﺝ ﺍﻻﺩﺭﺍﺭ ‪. urine output and renal function‬ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ‬
‫ﺷﻜﻞ ﺣﻘﻦ ‪.‬‬

‫ﺩﻭﺍء ‪.Tranexamic acid‬‬

‫************************‬

‫‪٤٧‬‬
 ‫ﺍﻥ ﺩﻭﺍء ‪ Tranexamic acid‬ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺑﻌﺾ ﺍﻧﻮﺍﻉ ﺍﻟﻨﺰﻑ ‪.‬‬
‫ﻳﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﺗﻔﻌﻴﻞ ﲢﻮﻝ ﺍﻟﺒﻼﺯﻣﻴﻨﻮﺟﲔ ﺍﱃ ﺍﻟﺒﻼﺯﻣﲔ ‪plasminogen into‬‬
‫‪. plasmin‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ ﺣﻞ ﺍﻟﻔﺎﻳﱪﻳﻦ ﺍﻟﺬﻱ ﺑﺪﻭﺭﻉ ﳝﻨﻊ ﺣﺪﻭﺙ ﻧﺰﻑ‪.‬‬
‫ﻭﻋﻨﺪ ﺍﻋﻄﺎءﻩ ﲜﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻳﻌﻤﻞ ﺑﺼﻮﺭﺓ ﻣﺒﺎﺷﺮﺓ ﻋﻠﻰ ﺗﺜﺒﻴﻂ ﺍﻟﺒﻼﺯﻣﲔ ‪inhibit plasmin‬‬
‫‪. activity‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﰲ ﻣﻌﺎﳉﺔ ‪. Menorrhagia‬‬
‫ﻭﺍﻟﺮﻋﺎﻑ ‪. Epistaxis‬‬
‫ﻭﻣﻌﺎﳉﺔ ﺗﺎﺛﲑﺍﺕ ﺍﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻣﻦ ﺍﺩﻭﻳﺔ ‪. Thrombolytic overdose‬‬
‫ﻭﻣﻨﻊ ﺯﻳﺎﺩﺓ ﺍﻟﻨﺰﻑ ﰲ ‪. dental extraction in haemophilia‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ GI disturbance‬ﻭ ‪. Disturbance in colour vision‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻪ ﻫﻮ ‪ ٣-٢‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺪﺍﺧﻼﺗﻪ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻧﻪ ﻳﻌﺎﻛﺲ ﻓﻌﻞ ﺍﺩﻭﻳﺔ ‪ fibrinolytic agents‬ﻣﺜﻞ‬
‫‪.streptokinase, alteplase‬‬
‫ﻭﻋﻨﺪ ﻣﻌﺎﳉﺔ ‪ Menorrhagia‬ﻓﺎﻧﻪ ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﺧﻼﻝ ﺍﻳﺎﻡ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ‪.‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﺘﻮﻓﺮ ﰲ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ﻋﻠﻰ ﺷﻜﻞ ﺍﻣﺒﻮﻻﺕ ﻭﺍﻗﺮﺍﺹ ‪.‬‬

‫ﻋﻼﺝ ‪Warfarin‬‬
‫********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Warfarin‬ﻳﻌﺘﱪ ﻣﻦ ﺍﺩﻭﻳﺔ ‪:‬‬

‫‪. Coumarin anticoagulant.‬‬
‫ﻭﻳﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺗﺜﺒﻴﻂ ﻋﻮﺍﻣﻞ ﺍﻟﺘﺨﺜﺮ ﺍﳌﻌﺘﻤﺪﺓ ﻋﻠﻰ ﺗﻜﻮﻳﻦ ﻓﻴﺘﺎﻣﲔ ‪ K‬ﻭﺍﻟﺘﻲ ﻫﻲ ‪(II, VII, IX,‬‬
‫)‪ X‬ﻭﺍﻳﻀﺎ ﻳﺜﺒﻂ ﻋﻮﺍﻣﻞ ﲣﺜﺮ ﻣﻬﻤﺔ ﻣﺜﻞ )‪. (proteins C and S‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. DVT‬‬

‫‪٤٨‬‬
 ‫ﻭ ‪. PE‬‬
‫ﻭ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ‪ VTE in AF, rheumatic heart disease‬ﰲ ﺍﳌﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻋﻨﺪﻫﻢ‬
‫ﺻﻤﺎﻡ ﻗﻠﺐ ﺻﻨﺎﻋﻲ‪.‬‬
‫ﻭﻳﺘﻮﻓﺮ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻓﻘﻂ ﺍﻗﺮﺍﺹ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ‪.‬‬

‫ﻭﺍﻳﻀﺎ ‪.‬‬

‫ﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻝ ﻋﻼﺝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ‪:‬‬

‫‪. Peptic ulceration‬‬
‫ﻭ ‪. Severe hypertension‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ‪.‬‬
‫ﻭﺍﻟﺒﺪﻳﻞ ﻫﻮ ﺍﳍﻴﺒﺎﺭﻳﻦ ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﲝﺬﺭ ﰲ ‪. recent surgery‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻪ ﻫﻮ ‪ ٣٧‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﳍﺬﺍ ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ‪.‬‬

‫ﻭﺍﻥ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ‪ warfarin‬ﻳﺰﺩﺍﺩ ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ ‪. Antibiotics‬‬
‫ﻻﻧﻬﺎ ﺗﺴﺒﺐ ﺗﻘﻠﻞ ﺗﻜﻮﻳﻦ ﻓﻴﺘﺎﻣﲔ ‪ k‬ﺑﺴﺒﺐ ﻗﺘﻠﻬﺎ ﻟﻠﺒﻜﱰﻳﺎ ﺍﻟﻔﻠﻮﺭﺍ ﺍﻟﻄﺒﻴﻌﻴﺔ ‪reduced‬‬
‫‪. vitamin K synthesis by gut flora‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ ‪warfarin‬ﻣﻊ ‪. Amiodarone and diuretics‬‬
‫ﻻﻧﻬﻤﺎ ﻳﺰﳛﺎﻥ ﺍﻟﻮﺍﺭﻓﺮﻳﻦ ﻋﻦ ﺍﻟﱪﻭﺗﲔ ﻓﻴﺰﺩﺍﺩ ﺗﺮﻛﻴﺰ ﺍﻟﻔﺎﻝ ﻣﻨﻪ ﻭﻳﺰﺩﺍﺩ ﺍﺛﺮﻩ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ‬
‫‪. displace warfarin from plasma proteins‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ ‪ warfarin‬ﻣﻊ ‪. Cimetidine, fluconazole, alcohol‬‬
‫ﻻﻧﻬﻢ ﺍﻳﺾ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ﻓﻴﺰﺩﺍﺩ ﺍﻟﻔﻌﺎﻝ ﻣﻨﻪ ﻭﻳﺰﺩﺍﺩ ﺍﺛﺮﻩ ‪reduce metabolism of warfarin‬‬
‫‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ ‪warfarin‬ﻣﻊ ‪. Aspirin, clopidogrel, NSAIDs‬‬
‫ﻻﻧﻬﻢ ‪. impaired platelet function‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ ‪ warfarin‬ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ﺍﺧﺮﻯ ﻣﻨﻬﺎ ‪advanced age, biliary disease,‬‬
‫‪. hyperthyroidism, cranberry juice‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ‪ warfarin‬ﻳﻘﻞ ﺍﺫﺍ ﺍﻋﻄﻲ ‪ warfarin‬ﻣﻊ‬
‫‪. Antiepileptic agents, rifampicin, alcoholism‬‬

‫‪٤٩‬‬
 ‫ ﻭﻳﻘﻞ ﻓﻌﻠﻪ‬warfarin ‫ ﻓﻴﺰﺩﺍﺩ ﺍﻳﺾ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ‬induction of hepatic enzymes ‫ﻻﻧﻬﻢ‬
. ‫ﺍﻟﻌﻼﺟﻲ‬
increase ‫ ﻻﻧﻬﻢ‬Oestrogens and OCP ‫ ﻣﻊ‬warfarin ‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ‬
. concentration of vitamin K-dependent clotting factors
hypothyroidism and nephritic ‫ ﰲ ﺣﺎﻟﺘﲔ ﻣﺮﺿﻴﺘﲔ ﻫﻤﺎ‬warfarin ‫ﻭﺍﻳﻀﺎ ﺍﺫﺍ ﺍﻋﻄﻲ‬
. syndrome

. Glycoprotein IIb/IIIa inhibitors ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬

***************************************

. ‫ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳊﺪﻳﺜﺔ‬Glycoprotein IIb/IIIa inhibitors ‫ﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬

. Tirofiban, eptifibatide ‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ‬
aspirin ‫ ﺗﻌﻄﻰ ﻣﻊ‬Unstable angina/non-ST elevation MI ‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‬
. and heparin
. ‫ ﺍﺛﻨﺎء ﺍﻟﻘﺴﻄﺮﺓ ﺍﻟﻘﻠﺒﻴﺔ‬vascular occlusion ‫ﻭﻳﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﺗﻘﻠﻴﻞ ﺧﻄﺮ‬
: ‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‬
. Bleeding ‫ﺍﻟﻨﺰﻑ‬
. ‫ﻭ ﺍﻟﻐﺜﻴﺎﻥ‬
. ‫ﻭﺍﻟﺼﺪﺍﻉ‬
. ‫ﻭﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺍﳊﺮﺍﺭﺓ‬
. Reversible thrombocytopenia ‫ﻭﻧﻘﺺ ﰲ ﻋﺪﺩ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ‬
. ‫ ﺑﺪﻭﻥ ﺍﻥ ﺗﺘﻌﺮﺽ ﻟﻌﻤﻠﻴﺔ ﺍﻻﻳﺾ‬urine. ‫ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ‬
heparin and antiplatelet drugs ‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ‬
.
: ‫ﻭﻫﺬﺍ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ‬
. Active bleeding
. Major surgery or trauma in past 6 weeks ‫ﻭ‬
. Severe hypertension ‫ﻭ‬

٥٠
 ‫ﻭ ‪. Ischaemic stroke within 30 days‬‬
‫ﺍﻭ ‪. history of haemorrhagic stroke‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﻣﻨﻊ ‪ fibrinogen‬ﻣﻦ ﺍﻻﺭﺗﺒﺎﻁ ﺍﱃ ‪glycoprotein IIb/IIIa‬‬
‫‪ receptor‬ﻭﺑﺎﻟﺘﺎﱄ ﻫﺬﺍ ﳝﻨﻊ ﻣﻦ ‪.platelet aggregation‬‬

‫ﻋﻼﺝ ‪Clopidogrel‬‬
‫****************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Clopidogrel‬ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﻣﻀﺎﺩ ﻟﻠﺘﺠﻤﻊ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ‪.‬‬

‫ﻳﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺗﺜﺒﻴﻂ ﺍﺭﺗﺒﺎﻁ ‪ the binding of ADP‬ﺍﱃ ‪. platelet receptor‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﻳﺜﺒﻂ ﺗﻔﻌﻴﻞ ‪ of GPIIb/IIIa complex‬ﺍﻟﺬﻱ ﺑﺪﻭﺭﻩ ﻳﺜﺒﻂ ﲢﻤﻊ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ‬
‫ﻭﺗﻜﻮﻥ ﺍﳋﺜﺮﺓ ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ‪.‬‬
‫ﻣﻨﻬﺎ ‪. Acute coronary syndrome‬‬
‫ﻭ ‪. Acute ST elevation MI‬‬
‫ﻭ ﰲ ﺣﺎﻟﺔ ﺍﻟﺘﺤﺴﺲ ﺍﻻﺳﱪﻳﻦ ﺍﻭ ﻋﺪﻡ ﺍﻣﻜﺎﻧﻴﺔ ﺍﺳﺘﻌﻤﺎﻟﻪ ‪Aspirin‬‬
‫‪. intolerance/hypersensitivity‬‬
‫ﻭ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ‪. atherosclerotic events‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳑﻨﻮﻉ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﻣﺮﺽ ﻧﺰﰲ ﻣﺜﻞ ﺍﻟﻘﺮﺣﺔ ﻭﺍﳉﻠﻄﺔ ﺍﻟﺪﻣﺎﻏﻴﺔ ﺍﻟﻨﺎﺯﻓﺔ ‪Active‬‬
‫‪. bleeding‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Bleeding‬ﻭ ‪ GI disturbance‬ﻭ ‪Gastric and duodenal‬‬
‫‪. ulcers‬‬
‫ﻭﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ‪ prodrug‬ﻳﺘﺎﻳﺾ ﺍﱃ ﺷﻜﻞ ﻋﻼﺟﻲ ﻓﻌﺎﻝ ﻟﻪ ﻃﻮﻝ ﻋﻤﺮ ﻧﺼﻔﻲ ‪ ٨‬ﺳﺎﻋﺎﺕ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺪﺍﺧﻼﺗﻪ ﺍﻟﻌﻼﺟﻴﺔ ﻫﻲ ﺯﻳﺎﺩﺓ ﺍﺣﺘﻤﺎﻝ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ﻓﻴﻤﺎ ﻟﻮ ﺍﺳﺘﻌﻤﻞ ﻣﻊ‬
‫‪. antiplatelet, anticoagulant or fibrinolytics‬‬
‫ﻭﻟﻜﻦ ﳝﻜﻦ ﺍﻋﻄﺎء ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﺍﻻﺳﱪﻳﻦ ﰲ ﻣﻌﺎﳉﺔ ‪ in ACS and acute MI‬ﻭﻟﻜﻦ ﻟﻔﱰﺓ‬
‫ﳛﺪﺩﻫﺎ ﺍﻟﻄﺒﻴﺐ ﻻﺗﺘﺠﺎﻭﺯ ﺍﻟﺴﻨﺔ ﺍﻟﻮﺍﺣﺪﺓ ﰲ ﲨﻴﻊ ﺍﳊﺎﻻﺕ ‪.‬‬

‫‪٥١‬‬
 ‫ﻭﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﲜﺮﻋﺔ ‪ as loading dose‬ﻣﻦ ‪ ٣٠٠‬ﺍﱃ ‪ ٦٠٠‬ﻣﻠﻐﻢ ‪.‬‬
‫ﻭﳚﺐ ﺍﻥ ﻳﻮﻗﻒ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻗﺒﻞ ‪ ٧‬ﺍﻳﺎﻡ ﻣﻦ ﺍﻟﻌﻤﻠﻴﺔ ﺍﳉﺮﺍﺣﻴﺔ ﻭﺫﻟﻚ ﻟﺘﺠﻨﺐ ﺣﺪﻭﺙ‬
‫‪. peri-operative bleeding‬ﻭﺍﻳﻀﺎ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ﳌﻌﺎﳉﺔ ﺍﳌﺮﻳﺾ ﺍﻟﺬﻱ‬
‫ﻳﻌﺎﻧﻲ ‪ AF presenting with ACS‬ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺯﻳﺎﺩﺓ ﺍﺣﺘﻤﺎﻟﻴﺔ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Fibrates‬‬

‫*****************************‪.‬‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Fibrates‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪:‬‬

‫‪. Fenofibrate, bezafibrate, gemfibrozil‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﻣﻨﻬﺎ ‪:‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺍﻟﺪﻫﻮﻥ ﺍﻻﻭﱄ ‪. Primary hyperlipidaemia‬‬
‫ﻭ ‪. Serum triglycerides >10 mmol/l‬‬
‫ﻭ ﻋﺪﻡ ﲢﻤﻞ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ﺍﻟﺴﺘﺎﺗﲔ ﺍﰲ ﺣﺎﻟﺔ ﻛﺎﻧﺖ ﳑﻨﻮﻋﺔ ﻋﻠﻰ ﺍﳌﺮﻳﺾ ‪Intolerance to‬‬
‫‪. statins‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪ Cholestasis and increased risk of cholelithiasis‬ﻭ ‪. GI disturbance‬‬
‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﰲ ‪ Severe hepatic or renal impairment‬ﻻﻧﻬﺎ ﺗﺴﺒﺐ ‪low albumin‬‬
‫‪. e.g. nephrotic syndrome‬ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﲢﻠﻞ ﺍﻟﻌﻀﻼﺕ ‪rhabdomyolysis‬‬
‫ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ‪. statins‬‬
‫ﻛﻤﺎ ﺗﺰﻳﺪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﺪﻭﺍء ‪ warfarin‬ﳑﺎ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ ﺍﻟﻨﺰﻑ ﻟﺬﻟﻚ‬
‫ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ hypoglycaemia‬ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ‪oral antidiabetic‬‬
‫‪. agents‬‬
‫ﻭﻟﻜﻦ ﰲ ﺑﻌﺾ ﺍﳊﺎﻻﺕ ﻗﺪ ﳓﺘﺎﺝ ﺍﱃ ﺍﻋﻄﺎء ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ statins‬ﻟﻠﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺍﺭﺗﻔﺎﻉ ﺍﻟﺪﻫﻮﻥ‬
‫ﻭﻟﻜﻦ ﲢﺖ ﺍﺷﺮﺍﻑ ﻃﺒﻲ ﻣﺒﺎﺷﺮ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺰﻳﺪ ﻣﻦ ﻓﻌﺎﻟﻴﺔ ‪ lipoprotein lipase‬ﻟﻴﺴﻬﻞ ﻋﻤﻠﻴﺔ ﺗﻜﺴﺮ ‪ VLDL‬ﻭﺗﻘﻠﻴﻞ‬
‫ﺍﻟﺪﻫﻮﻥ ﺍﻟﺜﻼﺛﻴﺔ ﻛﻤﺎ ﻳﺰﻳﺪ ﻣﻦ ﺗﺮﻛﻴﺰ ‪ HDL particles‬ﺍﻟﺬﻱ ﻳﻨﻔﻊ ﰲ ﻧﻘﻞ ﺍﻟﺪﻫﻮﻥ ﻣﻦ ﺍﻻﻭﻋﻴﺔ‬
‫ﺍﻟﺪﻣﻮﻳﺔ ﺍﱃ ﺍﻟﻜﺒﺪ ‪.‬‬

‫‪٥٢‬‬
 ‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﺷﻜﻞ ﻛﺒﺴﻮﻝ ﻭﺗﻌﻄﻰ ﻗﺒﻞ ﺗﻨﺎﻭﻝ ﺍﻟﻄﻌﺎﻡ ﺑﻨﺼﻒ ﺳﺎﻋﺔ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪.Statins‬‬

‫*********************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺸﺎﺋﻌﺔ ﺟﺪﺍ ‪ Statins‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Simvastatin, atorvastatin,‬‬

‫‪. pravastatin, rosuvastatin‬‬
‫ﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪. Rhabdomyolysis‬‬
‫ﻭﺗﻐﲑ ﰲ ﻭﻇﺎﺋﻒ ﺍﻟﻜﺒﺪ ‪.Altered liver function tests‬‬
‫ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ‪.‬‬
‫ﻭﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻧﻬﺎﺋﻴﺎ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ﻭﺍﻟﺮﺿﺎﻋﺔ ‪. Pregnancy and breastfeeding‬‬
‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ ﺟﺪﺍ ﰲ ‪ Active liver disease‬ﺑﻞ ﻗﺪ ﲤﻨﻊ ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Primary hyperlipidaemia‬‬
‫ﻭ ﻣﻨﻊ ‪ cardi ovascular events‬ﰲ ﺍﳌﺮﺿﻰ ﺍﻟﻠﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ‪atherosclerotic‬‬
‫‪. disease or diabetes‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺎﻧﺰﻳﻢ ‪ Cytochrome P450‬ﻣﺎﻋﺪﺍ ‪ pravastatin‬ﻭ ;‪. simvastatin‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء ‪ atorvastatin‬ﻫﻮ ‪ ١٤‬ﺳﺎﻋﺔ ﻟﺬﺍ ﻳﺴﻤﻊ ﺑﺎﻋﻄﺎء ﺻﺒﺎﺣﺎ ﻋﻜﺲ ﺑﺎﻗﻲ ﺍﻻﺩﻭﻳﺔ‬
‫ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺗﻌﻄﻰ ﻟﻴﻼ ﻻﻧﻬﺎ ‪. shot acting‬‬
‫ﻛﻤﺎ ﳚﺐ ﻓﺤﺺ ﻭﻇﺎﺋﻒ ﺍﻟﻜﺒﺪ ‪ LFTs‬ﻛﻞ ‪ ٣‬ﺍﺷﻬﺮ ﺍﺛﻨﺎء ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬
‫ﻭﻳﻘﻞ ﺍﻟﱰﻛﻴﺰ ﺍﻟﺒﻼﺯﻣﻲ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻨﺪﻣﺎ ﻳﺴﺘﻌﻤﻞ ﻣﻊ ‪. rifampicin‬‬
‫ﻭﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻛﺜﺮ ﻓﻌﺎﻟﻴﺔ ﻣﻦ ‪ lipid-lowering agents‬ﺑﺼﻮﺭﺓ ﻋﺎﻣﺔ‪.‬‬
‫ﺍﻻ ﺍﻥ ﳎﻤﻮﻋﺔ ‪ fibrates,‬ﺍﻓﻀﻞ ﻣﻨﻬﺎ ﰲ ﺧﻔﺾ ﺍﻟﺪﻫﻮﻥ ﺍﻟﺜﻼﺛﻴﺔ ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺗﺮﻛﻴﺰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‬
‫ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ‪ grapefruit juice and macrolides‬ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﻟﺘﺠﻨﺐ‬
‫ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﺍﳋﻄﺮﺓ ﻣﺜﻞ ﲢﻠﻞ ﺍﻟﻌﻀﻼﺕ ‪.‬‬

‫‪٥٣‬‬
 ‫ ﻫﻮ ﺑﺎﺳﺘﻌﻤﺎﻝ ﺍﺣﺪ ﻫﺬﻳﻦ ﺍﻟﺪﻭﺍﺋﲔ‬reduction of LDL ‫ﻭﺍﻳﻀﺎ ﺍﻥ ﺍﻛﺜﺮ ﺗﺎﺛﲑﺍ ﰲ ﺣﺪﻭﺙ‬
. atorvastatin and rosuvastatin

Amiodarone ‫ﻋﻼﺝ‬
***********************

: ‫ ﻳﺴﺘﻌﻤﻞ ﰲ‬Amiodarone ‫ﺍﻥ ﻋﻼﺝ‬

. Nodal and ventricular tachycardias ‫ﻣﻌﺎﳉﺔ‬
. Atrial fibrillation and flutter ‫ﻭ‬
. Wolff–Parkinson–White syndrome ‫ ﺍﳌﺼﺤﻮﺏ ﺑـ‬Tachyarrhythmias ‫ ﻭ‬VF ‫ﻭ‬
:‫ﻭﲨﻴﻊ ﻫﺬﻩ ﺍﳊﺎﻻﺕ ﺧﻄﺮﺓ ﻭﺷﺎﺋﻌﺔ ﺍﳊﺪﻭﺙ ﰲ ﺍﳌﺴﺘﺸﻔﻴﺎﺕ ﻭﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ‬
. Sinus bradycardia
. SA node block ‫ﻭ‬
Hypothyroidism or ‫ ﻻﻧﻪ ﳑﻜﻦ ﺍﻥ ﻳﺴﺒﺐ‬Thyroid dysfunction ‫ﻭ‬
. hyperthyroidism
:‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‬
. Photosensitive rash
. Bradycardia ‫ﻭ ﺑﻂء ﺑﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‬
. Pulmonary fibrosis/pneumonitis ‫ﻭ‬
. ‫ ﻳﻮﻡ‬٥٠ ‫ﻭﺍﻥ ﻃﻮﻝ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻘﻲ ﻟﻪ ﻫﻮ ﺗﻘﺮﻳﺒﺎ‬
. intravenously ‫ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ‬ECG monitoring ‫ﻭﳚﺐ ﺍﻥ ﻳﻜﻮﻥ ﻫﻨﺎﻙ‬
. a central line or large IV cannula ‫ﻛﻤﺎ ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﻣﻦ ﺧﻼﻝ‬
warfarin, digoxin and ‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺯﻳﺎﺩﺓ ﺑﺎﻟﱰﻛﻴﺰ ﺍﻟﺒﻼﺯﻣﻲ ﻟﻜﻞ ﻣﻦ‬
. ‫ ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﺟﻴﺪﺍ ﺧﻮﻓﺎ ﻣﻦ ﺣﺪﻭﺙ ﺍﻟﺴﻤﻴﺔ ﺑﻬﺬﻩ ﺍﻻﺩﻭﻳﺔ‬phenytoin

٥٤
 Adenosine ‫ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﻻﻧﺒﻴﺔ ﻟﻌﻼﺝ‬
**************************

‫ ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ‬Adenosine ‫ﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﺪﻭﺍء‬
:‫ﺗﺘﻌﻠﻖ ﺑﻌﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻫﻲ‬
. Chest pain
. Dyspnoea ‫ﻭ‬
. Bronchospasm ‫ﻭ‬
. ‫ﻭﺍﻟﻐﺜﻴﺎﻥ‬
. ‫ﻭﺑﻂء ﺷﺪﻳﺪ ﺑﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ‬
. Light-headedness ‫ﻭ‬

Low molecular weight heparins ‫ﺍﺩﻭﻳﺔ‬

************************

.(LMWH) ‫ ﻭﺍﻟﺘﻲ ﻳﺮﻣﺰ ﳍﺎ ﺍﺧﺘﺼﺎﺭﺍ‬Low molecular weight heparins ‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬
Prevention of ‫ ﻭ ﺗﺴﺘﻌﻤﻞ ﰲ‬Dalteparin, enoxaparin, tinzaparin ‫ﺗﻀﻢ ﻛﻞ ﻣﻦ‬
. VTE
. Treatment of VTE and acute coronary syndrome/MI ‫ﻭ‬
. Prevention of clotting in extracorporeal circuits ‫ﻭ‬
:‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‬
. Bleeding ‫ﺍﻟﻨﺰﻑ‬
. ‫ ﻭﻟﻜﻦ ﺑﺼﻮﺭﺓ ﺍﻗﻞ ﻣﻦ ﺍﳍﻴﺒﺎﺭﻳﻦ‬Heparin-induced thrombocytopenia ‫ﻭ‬

٥٥
‫ﻭﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﺎﻡ ‪ Osteoporosis‬ﻭﻟﻜﻦ ﻓﻘﻂ ﻋﻨﺪ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻟﻔﱰﺓ ﻣﻄﻮﻟﺔ ﺗﻘﺮﻳﺒﺎ ﺍﻛﺜﺮ ﻣﻦ ﺳﺘﺔ‬
‫ﺍﺷﻬﺮ ‪.‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﺑﻮﺍﺳﻄﺔ ﺍﻧﺰﻳﻢ ‪ heparinase‬ﻭﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺒﻮﻝ ‪.‬‬
‫ﺍﻣﺎ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﳍﺎ ﻓﻬﻮ ﻣﻦ ‪ ٤-٢‬ﺳﺎﻋﺔ ﻭﻟﻜﻨﻪ ﻳﻄﻮﻝ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﻓﺸﻞ ﻛﺒﺪﻱ ﺍﻭ ﻛﻠﻮﻱ ‪.‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ﺍﻟﺪﺍﺧﻠﻲ ﺍﻭ ﺍﳋﺎﺭﺟﻲ ﻟﻮ ﺍﻋﻄﻴﺖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪NSAIDs‬‬
‫‪. (including aspirin), warfarin, clopidogrel‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻥ ﺍﻋﻄﺎء ‪ Nitrate infusion‬ﻳﻘﻠﻞ ﻣﻦ ﺍﻟﻔﻌﺎﻟﻴﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﺍﳊﻘﻦ ﲢﺖ ﺍﳉﻠﺪ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ‪:‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺷﺪﻳﺪ ﻟﻀﻐﻂ ﺍﻟﺪﻡ ‪. Severe hypertension‬‬
‫ﻭ ﻓﺸﻞ ﻛﻠﻮﻱ ﺍﻭ ﻛﺒﺪﻱ ﺷﺪﻳﺪ ‪. Severe hepatic or renal disease‬‬
‫ﻭ ﺍﳌﺮﺿﻰ ﺍﻟﺬﻱ ﻳﻌﺎﻧﻲ ﻣﻦ ﻋﻤﻠﻴﺔ ﺟﺮﺍﺣﻴﺔ ﰲ ﺍﻟﺪﻣﺎﻍ ﺍﻭ ﺍﻟﻌﲔ ‪patients undergoing‬‬
‫‪. surgery on brain, eye or spinal cord‬‬
‫ﻭ ﻣﺮﺽ ﺍﳍﻴﻤﻮﻓﻠﻴﺎ ﻭﺍﻣﺮﺍﺽ ﺍﻟﻨﺰﻑ ﺍﻻﺧﺮﻯ ﻣﺜﻞ ﺍﻟﻘﺮﺣﺔ ‪Haemophilia and other‬‬
‫‪. bleeding disorders‬‬
‫ﻭ ﻭﺍﻟﺘﺤﺴﺲ ﻟﻠﻬﻴﺒﺎﺭﻳﻦ ‪. Heparin sensitivity‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Fibrinolytics‬‬

‫***********************‬
‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Fibrinolytics‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Streptokinase, alteplase, reteplase,‬‬
‫‪.tenecteplase‬‬
‫ﻭﺗﻌﻤﻞ ﻋﻠﻰ ﺗﻔﻌﻴﻞ ﲢﻮﻳﻞ ﺍﻟﺒﻼﺯﻣﻨﻮﺟﲔ ﺍﱃ ﺑﻼﺯﻣﲔ ‪Activation of plasminogen to‬‬
‫‪. form plasmin‬‬
‫ﺍﻟﺬﻱ ﳛﻄﻢ ﺍﳋﺜﺮﺓ ﺍﳌﺘﻜﻮﻧﺔ ﻣﻦ ﺍﻟﻔﺎﻳﱪﻳﻦ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Acute MI‬‬
‫ﻭ ‪.Massive pulmonary embolus‬‬
‫ﻭ ‪.Acute ischaemic stroke‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬

‫‪٥٦‬‬
 ‫ﺍﻟﻨﺰﻳﻒ ﺍﻟﺬﻱ ﻗﺪ ﻳﺴﺒﺐ ‪. cerebral haemorrhage‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﺿﻄﺮﺍﺏ ﰲ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻧﺘﻴﺠﺔ ﺍﻋﺎﺩﺓ ﺍﻟﱰﻭﻳﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺑﻌﺪ ﺣﻞ ﺍﳋﺜﺮﺓ‬
‫‪. Reperfusion cardiac arrhythmias and ischaemia‬‬

‫ﻣﻌﻠﻮﻣﺎﺕ ﻋﻼﺟﻴﺔ ﻋﻦ ﺍﺩﻭﻳﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬

‫********************************‬

‫‪ -١‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺍﳌﺼﺎﺩﺭ ﺍﻟﻄﺒﻴﺔ ﺗﻮﺻﻲ ﺑﺎﻥ ﻳﺘﻢ ﲣﻔﻴﺾ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﱃ ﺍﻗﻞ ﻣﻦ ‪ ٩٠/ ١٥٠‬ﻣﻠﻢ‬
‫ﺯﺋﺒﻘﻲ ﻗﺒﻞ ﻭﺻﻒ ﺩﻭﺍء ﺍﻻﺳﱪﻳﻦ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻣﺮﺍﺽ ﺍﻟﻘﻠﺐ ﻭﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻣﺜﻞ ‪.angina‬‬

‫‪ -٢‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺎﻧﻌﺔ ﻟﻠﺤﻤﻞ ﺍﳌﺮﻛﺒﺔ ‪ Oral contraceptives‬ﺗﺴﺒﺐ ﰲ ﺍﺭﺗﻔﺎﻉ‬
‫ﺍﻟﻀﻐﻂ ﺑﺼﻮﺭﺓ ﻋﺎﻟﻴﺔ ﻋﻨﺪ ﺑﻌﺾ ﺍﳌﺴﺘﻌﻤﻠﲔ ﻭﻟﻜﻨﻪ ﻋﻨﺪ ﺍﻻﻛﺜﺮ ﻣﻨﻬﻢ ﻳﻜﻮﻥ ﺍﻻﺭﺗﻔﺎﻉ ﻟﻴﺲ ﺷﺪﻳﺪ‬
‫ﻭﺍﻻﻓﻀﻞ ﻋﻨﺪ ﺣﺪﻭﺙ ﺫﻟﻚ ﺍﺳﺘﻌﻤﺎﻝ ﻣﻮﺍﻧﻊ ﺍﳊﻤﻞ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﻋﻠﻰ ﺍﻟﱪﻭﺟﺴﺘﲑﻭﻥ ﻓﻘﻂ‬
‫‪ Progesterone-only‬ﻓﻬﻲ ﺍﻓﻀﻞ ‪.‬‬

‫‪ -٣‬ﻻ ﺗﺴﺘﻌﻤﻞ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACE inhibitors‬ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺩﻡ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﻻﻧﻬﺎ‬
‫ﺗﺴﺒﺐ ‪ oligohydramnios‬ﻭ ﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ ﻭ ‪. intrauterine death‬‬

‫‪ -٤‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺣﺪﻭﺙ ﺍﺭﺗﻔﺎﻉ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ﻋﻨﺪ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮﻱ ﺍﳌﺼﺎﺏ ﺑﺎﻟﻨﻮﻉ ﺍﻻﻭﻝ ﺍﳌﻌﺘﻤﺪ ﻋﻠﻰ‬
‫ﺍﻻﻧﺴﻮﻟﲔ ﻳﺸﲑ ﺍﱃ ﺣﺪﻭﺙ ‪ diabetic nephropathy‬ﻭﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﻟﻠﻤﻌﺎﳉﺔ ﻫﻮ ﻣﻦ ﳎﻤﻮ ﻋﺔ‬
‫ﺍﺩﻭﻳﺔ ‪ ACEI‬ﺍﻟﺘﻲ ﺗﻘﻠﻞ ﻣﻦ ﺍﻟﺘﺪﻫﻮﺭ ﰲ ﻭﻇﻴﻔﺔ ﺍﻟﻜﻠﻰ ﻭﺍﺫﺍ ﱂ ﻧﺴﻴﻄﺮ ﻋﻠﻰ ﺍﻟﻀﻐﻂ ﳑﻜﻦ ﺃﻱ‬
‫‪ B. blocker‬ﺍﻭ ‪ Ca . channel blocker‬ﺍﻭ‬ ‫ﺍﺿﺎﻓﺔ ﺃﻱ ﻋﻼﺝ ﻣﻦ ﺍجملﻤﻮﻋﺎﺕ ﺍﻻﺧﺮﻯ ﻣﺜﻞ‬
‫‪. diuretic‬‬

‫‪٥٧‬‬
‫‪ -٥‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺍﳌﺮﺿﻰ ﻛﺒﺎﺭ ﺍﻟﺴﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺗﻐﲑ ﺩﺍﺋﻢ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ﻟﺬﺍ ﻳﻨﺼﺢ ﺍﻻﻃﺒﺎء ﺑﻘﻴﺎﺱ‬
‫ﺿﻐﻂ ﺍﻟﺪﻡ ﻣﺮﺍﺕ ﻋﺪﻳﺪﺓ ﻭﰲ ﺍﻭﺿﺎﻉ ﳐﺘﻠﻔﺔ ﻭﰲ ﻛﻼ ﺍﻟﺬﺭﺍﻋﲔ ﺍﻛﺜﺮ ﻣﻦ ﺍﻟﺸﺒﺎﺏ ﻣﻦ ﺍﺟﻞ ﺍﻟﺘﺜﺒﺖ‬
‫ﻋﻠﻰ ﺍﻧﻪ ﻣﺮﻳﺾ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ‪.‬‬

‫‪ -٦‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ACE inhibitors‬ﲢﺘﻮﻱ ﻋﻠﻰ ﻋﺪﻳﺪ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﻣﺜﻞ ﺩﻭﺍء‬
‫‪ Ramipril‬ﻭ ‪ Lisinopril‬ﻭ ‪ Enalapril‬ﻭ ‪ Captopril‬ﻭ ‪ Perindopril‬ﻭﺗﺴﺘﻌﻤﻞ ﳎﻤﻮﻋﺔ ﻫﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺧﺼﻮﺻﺎ ﻟﺪﻯ ﺍﻟﺸﺒﺎﺏ ﻭﻣﺮﺿﻰ ﺍﻟﺴﻜﺮﻱ ﻭﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﺑﻌﺪ ﺍﻻﺻﺎﺑﺔ ﲟﺮﺽ ﺍﺣﺘﺸﺎء ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ﺍﻟﺴﻌﺎﻝ‬
‫ﺍﳉﺎﻑ ﻭﺯﻳﺎﺩﺓ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﰲ ﺍﻟﺪﻡ ﻭﺗﻐﲑ ﺍﻟﻄﻌﻢ ﻭﻇﻬﻮﺭ ﻃﻔﺢ ﺟﻠﺪﻱ ﻭﺣﺪﻭﺙ ‪Angioedema‬‬
‫‪،‬ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺘﱪ ﻏﺎﻟﻴﺔ ﺍﻟﺴﻌﺮ ﻧﻮﻋﺎ ﻣﺎ ‪.‬‬

‫‪ -٧‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﻋﻼﺝ ‪ Amlodipine‬ﻫﻮ ﻣﻦ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ ca .blocker‬ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ‬

‫ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Oedema‬ﻭ ‪ Headache‬ﻭ ‪ Postural hypotension‬ﻭﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ‬
‫ﻭﺍﻋﻠﻰ ﺟﺮﻋﺔ ﻟﻪ ﻫﻲ ‪ ١٠‬ﻣﻠﻐﻢ ﺑﺎﻟﻴﻮﻡ ‪.‬‬

‫‪ -٨‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳉﺎﻧﺒﻲ ‪ impotence‬ﺍﻟﺬﻱ ﳛﺪﺙ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻣﻦ ﻧﻮﻉ‬
‫‪ Loops:‬ﻳﻜﺜﺮ ﻭﻳﻈﻬﺮ ﺑﺼﻮﺭﺓ ﺍﻛﺜﺮ ﻋﻨﺪ ﻣﺮﺽ ﺍﻟﻔﺸﻞ ﺍﻟﻘﻠﺒﻲ ‪.‬‬

‫‪ -٩‬ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ جملﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Thiazides:‬ﻫﻮ ﺍﳔﻔﺎﺽ ﺑﻮﺗﺎﺳﻴﻮﻡ ﺍﻟﺪﻡ ﻭﻣﺮﺽ‬
‫ﺍﻟﻨﻘﺮﺱ ﻭﻋﺪﻡ ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺳﻜﺮ ﺍﻟﺪﻡ ﻭﺍﺭﺗﻔﺎﻉ ﻣﺴﺘﻮﻯ ﺍﻟﻜﻮﻟﻴﺴﺘﲑﻭﻝ ﻭﺍﻟﺪﻫﻮﻥ ﺍﻟﺜﻼﺛﻴﺔ ‪.‬‬

‫‪ -١٠‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺩﻭﺍء ‪ aliskiren‬ﻫﻮ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﻀﺔ ﻟﻠﻀﻐﻂ ﺍﳊﺪﻳﺜﺔ ﻭﻟﻜﻦ ﻧﺘﻴﺠﺔ ﺳﻌﺮﻩ‬
‫ﺍﻟﻐﺎﱄ ﻭﻋﺪ ﲡﺮﺑﺘﻪ ﺑﺼﻮﺭﺓ ﻭﺍﺳﻌﺔ ﻓﺎﻧﻪ ﻳﺴﺘﻌﻤﻞ ﻛﺨﻂ ﻋﻼﺟﻲ ﺛﺎﻧﻮﻱ ﳌﻌﺎﳉﺔ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻳﻀﺎ‬
‫ﻳﺴﺒﺐ ﺍﻻﺳﻬﺎﻝ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻟﻪ ﲜﺮﻋﺔ ﻋﺎﻟﻴﺔ ﻭﻳﻌﻤﻞ ﻫﺬﻩ ﺍﻟﺪﻭﺍء ‪ Renin antagonist‬ﻭﺍﻳﻀﺎ‬
‫ﻳﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺑﺎﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﰲ ﺍﻟﺪﻡ ‪.‬‬

‫‪٥٨‬‬
 ‫‪ -١١‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺩﻭﺍء ‪ Hydralazine‬ﻫﻮ ﻣﻮﺳﻊ ﻭﻋﺎﺋﻲ ﻳﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ‬
‫ﺍﻟﺸﺪﻳﺪ ﻭﺍﻟﻄﺎﺭﻯء ﻳﻜﻮﻥ ﻣﺼﺤﻮﺏ ﲝﺪﻭﺙ ‪ odema‬ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻟﺬﺍ ﻳﻔﻀﻞ ﻣﻌﻪ ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﺍﻻﺩﻭﻳﺔ ﺍﳌﺪﺭﺭﺓ ﻟﻠﺘﺨﻠﺺ ﻣﻦ ‪ odema‬ﻭﺍﺩﻭﻳﺔ ‪ B.blocker‬ﻟﻠﺘﺨﻠﺺ ﻣﻦ ﺳﺮﻋﺔ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻭﻣﻦ‬
‫ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺣﺪﻭﺙ ﻣﺮﺽ ‪. SLE‬‬

‫‪ -١٢‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﺍﻟﺴﺒﺐ ﺍﻟﺮﺋﻴﺴﻲ ﻭﺭﺍء ﻋﺪﻡ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﻟﻮﺍﺳﻊ ﺩﻭﺍء ‪ methydopa‬ﳌﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ‬
‫ﺿﻐﻂ ﺍﻟﺪﻡ ﻫﻮ ﺗﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻭﺍﻟﺘﻲ ﻣﻦ ﺍﻫﻤﻬﺎ ﺍﻟﺸﻌﻮﺭ ﺑﺎﻟﺘﻌﺐ ‪ tiredness‬ﻭﺣﺪﻭﺙ ﺍﻟﻜﺄﺑﺔ‬
‫ﻟﺪﻱ ﺍﳌﺮﻳﺾ ‪.depression‬‬

‫‪ -١٣‬ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ‪ ACE inhibitors‬ﺗﻐﻠﻖ ﺗﻜﻮﻳﻦ ﺍﻧﺰﻳﻢ ‪ kininase production‬ﻭﺍﻟﺬﻱ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﻣﻨﻊ ﲢﻄﻴﻢ ‪ bradykinin‬ﺍﻟﺬﻱ ﻳﻌﺪ ﺍﻟﺴﺒﺐ ﺍﻟﺮﺋﻴﺴﻲ ﳊﺪﻭﺙ ﺍﻟﺴﻌﺎﻝ ﺍﳉﺎﻑ ﻋﻨﺪ ‪ % ٢٠‬ﻣﻦ‬
‫ﻣﺴﺘﻌﻤﻠﻲ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬

‫‪٥٩‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪B2- adrenoceptor agonists‬‬

‫*****************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ B2 adrenoceptor agonists‬ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ ﰲ ﻣﻌﺎﳉﺔ‬

‫ﺑﻌﺾ ﺍﻣﺮﺍﺽ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﻣﺜﻞ ﻣﺮﺽ ﺍﻟﺮﺑﻮ ‪.‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺧﻼﻝ ﺍﻻﺭﺗﺒﺎﻁ ﺑـ ‪ Selective b2 adrenoceptor‬ﰲ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء‬
‫ﰲ ﺍجملﺎﺭﻱ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺍﻟﻌﻠﻴﺎ ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ‪. intracellular cAMP‬ﻭﺑﺎﻟﺘﺎﱄ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺍﺳﱰﺧﺎء ﻫﺬﻩ ﺍﻟﻌﻀﻼﺕ ﻭﺗﻮﺳﻊ ﺍﻟﻘﺼﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ ‪. bronchodilation.‬‬
‫ﻭﻳﻮﺟﺪ ﻧﻮﻋﲔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻻﻭﻝ ﻳﻌﻤﻞ ﻓﱰﺓ ﻗﺼﲑﺓ‪ Short-acting‬ﻣﺜﻞ ‪salbutamol,‬‬
‫ﻭﺍﻟﺜﺎﻧﻲ ﻳﻌﻤﻞ ﻓﱰﺓ ﻃﻮﻳﻠﺔ ‪ long-acting‬ﻣﺜﻞ ‪. salmeterol,‬‬

‫‪٦٠‬‬
 ‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺛﻼﺙ ﺍﺳﺘﻌﻤﺎﻻﺕ ﺭﺋﻴﺴﻴﺔ ‪ Acute asthma‬ﻭ ‪Chronic‬‬
‫‪ asthma/COPD‬ﻭ ‪. Premature labour‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﳌﻦ ﻳﻌﺎﻧﻲ ﲢﺴﺲ ﺑﺎﲡﺎﻩ ﺃﻱ ﻓﺮﺩ ﻣﻦ ﺍﺩﻭﻳﺘﻬﺎ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺎ ﻫﻲ ‪ Fine tremor‬ﻭ ‪ Hypokalaemia‬ﻭ ‪ Tachycardia‬ﻭ‬
‫‪. Headache‬‬
‫ﰲ ﺣﺎﻟﺔ ﻣﻌﺎﳉﺔ ‪ acute asthma‬ﺭﲟﺎ ﻳﻜﻮﻥ ﺣﺪﻭﺙ ‪ hypokalaemia‬ﺑﺼﻮﺭﺓ ﻛﺒﲑﺓ ﻧﺘﻴﺠﺔ‬
‫ﺣﺪﻭﺙ ‪ hypoxia‬ﻭ ﺍﺳﺘﻌﻤﺎﻝ ‪. theophylline, steroids and diuretics‬‬
‫ﻋﻼﺝ‪ Salbutamol‬ﺍﻟﺬﻱ ﻳﻌﺘﱪ ﻗﺼﲑ ﺍﳌﻔﻌﻮﻝ ﻗﺪ ﻳﺴﺘﻌﻤﻞ ﰲ ﺗﺪﺑﲑ ﺣﺎﻟﺔ ﺯﻳﺎﺩﺓ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‬
‫ﻭﺧﺎﺻﺔ ﺑﺎﺳﺘﻌﻤﺎﻝ ﺟﺮﻋﺔ ﻋﺎﻟﻴﺔ ‪ management of hyperkalaemia‬ﻭﻳﺘﻮﻓﺮ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻠﻰ‬
‫ﻋﺪﺓ ﺍﺷﻜﺎﻝ ﺻﻴﺪﻻﻧﻴﺔ ‪ inhaler, nebuliser or IV‬ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﺍﳍﺠﻤﺔ ﺍﻟﺮﺑﻮﻳﺔ ﺍﳊﺎﺩﺓ‬
‫ﻭﺍﻳﻀﺎ ﻳﺘﻮﻓﺮ ﻋﻠﻰ ﺷﻜﻞ ﺷﺮﺍﺏ ﻭﺣﺒﻮﺏ ‪.‬‬
‫ﻋﻼﺟﻲ ‪ b2 agonists salbutamol and terbutaline‬ﳝﻜﻦ ﺍﻥ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‬
‫‪ uncomplicated premature labour‬ﳌﺪﺓ ﻋﻠﻰ ﺍﻻﻗﻞ ‪ at least 48 h,‬ﺣﻴﺚ ﺗﺜﺒﻂ ﺗﻘﻠﺺ‬
‫ﻋﻀﻼﺕ ﺍﻟﺮﺣﻢ ‪. uterine contractions‬‬
‫ﺍﻻﺩﻭﻳﺔ ﻃﻮﻳﻠﺔ ﺍﳌﻔﻌﻮﻝ ﻣﻦ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺗﻌﻤﻞ ﳌﺪﺓ ‪ ١٢‬ﺳﺎﻋﺔ ﻭﺗﺘﺎﻳﺾ ﺑﺎﻟﻜﺒﺪ ‪.‬‬
‫ﻭﻃﻮﻝ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﳐﺘﻠﻒ ﺑﻴﻨﻬﻤﺎ ﻛﻤﺎ ﰲ ‪salbutamol 3–7 h; terbutaline 16–20 h.‬‬
‫‪.‬‬
‫ﻭﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﳌﺮﺽ ﺍﻟﺮﺑﻮ ﺑﺼﻮﺭﺓ ﳐﺘﺼﺮﺓ ﻫﻲ ﺍﻋﻄﺎء ﺩﻭﺍء ﻗﺼﲑﺓ ﺍﳌﺪﻯ ﻣﺜﻞ ‪salbutamol‬‬
‫ﻓﺎﺫﺍ ﱂ ﺗﺘﻢ ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺍﻻﻋﺮﺍﺽ ﻓﺎﻧﻪ ﻳﺘﻢ ﺍﻋﻄﺎء ‪inhaled corticosteroids and then‬‬
‫‪. long-acting b2 agonists‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Histamine type 1 receptor antagonists‬‬

‫***********************************************‬
‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Histamine type 1 receptor antagonists‬ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪:‬‬
‫‪. Cetirizine, chlorphenamine, desloratadine, fexofenadine‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻋﺮﺍﺽ ﺍﻟﺘﺤﺴﺲ ‪ allergy‬ﻭﺧﺎﺻﺔ ﺍﻟﺘﺤﺴﺲ ﺍﳌﻮﲰﻲ ﺍﻟﺬﻱ ﳛﺪﺙ ﻋﺎﺩﺓ ﰲ‬
‫ﺷﻬﺮﻳﻦ ﻫﻤﺎ ﺍﻟﺸﻬﺮ ﺍﻟﺮﺍﺑﻊ ﻭﺍﻟﻌﺎﺷﺮ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Pruritus‬‬
‫ﻭﰲ ﻣﻌﺎﳉﺔ ‪. Urticaria‬‬

‫‪٦١‬‬
 ‫ﻭﰲ ﻣﻌﺎﳉﺔ ﺍﳊﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ ﻟﻠﺘﺤﺴﺲ ‪treatment of anaphylaxis and angioedema‬‬
‫ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻋﻼﺝ ‪ chlorphenamine‬ﳍﺬﺍ ﺍﻟﻐﺮﺽ ‪.‬‬
‫ﻭﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻟﺔ ﻛﺎﻥ ﺍﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﺗﻀﺨﻢ ﺍﻟﱪﻭﺳﺘﺎﺕ ‪. Prostatic hypertrophy‬‬
‫ﻭ ﳑﻨﻮﻋﺔ ﺍﻳﻀﺎ ﰲ ﺣﺎﻟﺔ ﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﻝ ‪. Urinary retention‬‬
‫ﻭ ﳑﻨﻮﻋﺔ ﻛﺬﻟﻚ ﰲ ﺣﺎﻟﺔ ﻛﺎﻥ ﺍﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ‪. closed-angle glaucoma‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪ Sedation‬ﻭﺧﺎﺻﺔ ﰲ ﻋﻼﺟﻲ ‪. chlorphenamine and hydroxyzine‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ﺣﺪﻭﺙ ﺗﻬﻴﺞ ﰲ ﺍﻻﻃﻔﺎﻝ ﻭﻛﺒﺎﺭ ﺍﻟﺴﻦ ‪Rarely paradoxical‬‬
‫‪. excitation in children and elderly‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Antimuscarinic effects‬ﻣﺜﻞ ‪:‬‬
‫ﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﻝ ‪.‬‬
‫ﻭﺗﺸﻮﺵ ﺍﻟﺮﺅﻳﺔ ‪.‬‬
‫ﻭﺍﻻﻣﺴﺎﻙ ‪.‬‬
‫ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ‪.‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ hypnotics, anxiolytics or alcohol‬ﻓﺎﻧﻬﺎ ﺗﺰﻳﺪ ﻣﻦ ﻧﺴﺒﺔ‬
‫ﺣﺪﻭﺙ ‪. exacerbate drowsiness‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﺘﺎﺛﲑﺍﺕ ‪ antimuscarinic effects‬ﺗﺰﺩﺍﺩ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ‪MAOIs‬‬
‫‪. or TCAs‬‬
‫ﻭﺗﻘﺴﻢ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﱃ ﻧﻮﻋﲔ ﻫﻤﺎ‪:‬‬
‫)‪. sedating (e.g. chlorphenamine‬‬
‫)‪(e.g. cetirizine, desloratadine,‬‬ ‫ﻭ ‪non-sedating‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳉﺎﻧﺒﻲ ‪ Drowsiness‬ﻳﻘﻞ ﺑﻌﺪ ﺍﻳﺎﻡ ﻗﻠﻴﻠﺔ ﻣﻦ ﺍﻻﺳﺘﻤﺮﺍﺭ ﻋﻠﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﻟﻜﻦ‬
‫ﻣﻊ ﺫﻟﻚ ﳚﺐ ﺍﻻﺑﺘﻌﺎﺩ ﻋﻦ ﺍﻟﻨﺸﺎﻃﺎﺕ ﺍﳊﻴﺎﺗﻴﺔ ﺍﻟﺘﻲ ﺗﺘﻄﻠﺐ ﺍﻻﻧﺘﺒﺎﻩ ﻣﺜﻞ ﺳﻴﺎﻗﺔ ﺍﻟﺴﻴﺎﺭﺓ ‪.‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ‪ Histamine- 1-receptor‬ﻭﺑﺎﻟﺘﺎﱄ ﲤﻨﻊ ﺣﺪﻭﺙ‬
‫‪ vasodilatation‬ﻭ ‪ increased vascular permeability‬ﻭ ‪.. pain‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﺷﻜﻞ ﺣﺒﻮﺏ ﻭﺍﻗﺮﺍﺹ ﻭﺣﻘﻦ ﻭﻗﻄﺮﺍﺕ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Inhaled antimuscarinics‬‬

‫*********************************‬

‫‪٦٢‬‬
 ‫ﺗﻌﺘﱪ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺸﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ‪.‬‬
‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪. Ipratropium bromide, tiotropium‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﰲ ﻣﻌﺎﳉﺔ ‪:‬‬
‫)‪. Asthma (ipratropium bromide only‬‬
‫ﻭﻣﺮﺽ ‪. COPD‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﺍﻟﻐﺜﻴﺎﻥ ‪.‬‬
‫ﻭﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ‪.‬‬
‫ﺍﻣﺎ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻟﺮﺋﻴﺴﺔ ﻣﺜﻞ ﺍﳋﻔﻘﺎﻥ ﻭﺗﺸﻮﺵ ﺍﻟﺮﺅﻳﺔ ﻓﻨﺎﺩﺓ ﺍﳊﺪﻭﺙ ‪.‬‬
‫ﻭﻟﻜﻦ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺗﺰﺩﺍﺩ ﺍﺫﺍ ﰎ ﺍﻋﻄﺎء ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻊ ﺍﺩﻭﻳﺔ ﺍﺧﺮﻯ ﺗﻌﺘﱪ ﻣﻦ‬
‫‪. anticholinergic agents‬‬
‫ﻋﻼﺝ ‪ Ipratropium bromide‬ﻳﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﻟﻌﻼﺝ ‪ COPD‬ﻭﻟﻜﻨﻪ ﻗﺪ ﻳﻌﻄﻰ ﻣﻊ‬
‫‪ salbutamol‬ﳌﻌﺎﳉﺔ ‪ acute asthma not responsive to standard therapy‬ﻋﻠﻤﺎ ﺍﻥ‬
‫ﻋﻼﺝ ‪ Ipratropium bromide‬ﺗﺎﺛﲑﻩ ﻳﺒﺪﺍ ﺑﻌﺪ ‪ ٦٠-٣٠‬ﺩﻗﻴﻘﺔ ﻣﻦ ﺯﻣﻦ ﺍﻋﻄﺎءﻩ ﻭﻳﻌﺘﱪ ﻋﻼﺝ‬
‫‪ Tiotropium‬ﺍﻃﻮﻝ ﻓﱰﺓ ﺗﺎﺛﲑ ﻣﻨﻪ ﻟﺬﺍ ﻻﻳﻌﻄﻰ ﳌﻌﺎﳉﺔ ‪. acute bronchospasm‬‬
‫ﻭﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲝﺬﺭ ﳌﺮﺽ ‪. closed-angle glaucoma‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻻﺭﺗﺒﺎﻁ ﻭﻏﻠﻖ ‪ muscarinic (M3) receptors‬ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ‬
‫ﺗﻘﻠﺺ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﻟﻠﻘﺼﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ ﻓﻴﺴﻤﺢ ﺑﺘﻮﺳﻌﻬﺎ ‪.‬‬

‫ﻋﻼﺝ ‪Theophylline‬‬
‫*************************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Theophylline‬ﻳﺴﺘﻌﻤﻞ ﰲ ‪:‬‬

‫ﻣﻌﺎﳉﺔ ﺍﻻﺯﻣﺔ ﺍﻟﺮﺑﻮﻳﺔ ﺍﳊﺎﺩﺓ ‪. Acute severe asthma‬‬

‫‪٦٣‬‬
 ‫ﻭ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺮﺑﻮ ﺍﳌﺰﻣﻦ ‪. Chronic asthma‬‬
‫ﻭﰲ ﻣﻌﺎﳉﺔ ‪. Moderate to severe COPD‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﳔﻔﺎﺽ ﺗﺮﻛﻴﺰ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ‪. Hypokalaemia‬‬
‫ﻭ ﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻭﺍﳋﻔﻘﺎﻥ ‪. Tachycardia, palpitations and arrhythmias‬‬
‫ﻭ ﺍﻟﺼﺪﺍﻉ ﻭﺍﻻﺭﻕ ‪. Headache and insomnia‬‬
‫ﻭ‪ GI disturbances‬ﻭﺧﺎﺻﺔ ﺍﻟﻐﺜﻴﺎﻥ ‪.‬‬
‫ﻭ ﺍﻟﺘﺸﻨﺠﺎﺕ ‪. Convulsions‬‬
‫ﻭﺧﺎﺻﺔ ﺍﺫﺍ ﺍﻋﻄﻲ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﺑﺴﺮﻋﺔ‪.‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻜﺒﺪ ﺑﻮﺍﺳﻄﺔ ‪ Cytochrome P450‬ﻟﺬﺍ ﻓﱰﻛﻴﺰ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻳﻘﻞ ﺍﺫﺍ‬
‫ﺍﺳﺘﻌﻤﻞ ﻣﻦ ﻗﺒﻞ‪ smokers, chronic alcohol intake‬ﻭ ‪antiepileptics and‬‬
‫‪. rifampicin‬‬
‫ﻭﺗﺮﻛﻴﺰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﺰﺩﺍﺩ ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ ‪ CCBs, cimetidine, quinolones, macrolides‬ﻭ‬
‫‪. ketoconazole and fluconazole‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻪ ﻫﻲ ‪ ٩ – ٣‬ﺳﺎﻋﺔ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ ‪ Aminophylline‬ﻫﻮ ﻋﻼﺝ ﻣﺮﻛﺐ ﻣﻦ ‪theophylline and‬‬
‫‪ ethylenediamine‬ﺍﻟﺬﻱ ﻳﻜﻮﻥ ﺫﺍﺋﺐ ﺑﺎﳌﺎء ﺍﻛﺜﺮ ﻭﳍﺬﺍ ﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ‪an IV‬‬
‫‪ preparation‬ﻭﺍﻳﻀﺎ ﻳﺘﻮﻓﺮ ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ‪ phosphodiesterase‬ﻭﺑﺎﻟﺘﺎﱄ ﺗﺰﻳﺪ ﻣﻦ ‪increased‬‬
‫‪ cAMPlevels‬ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ‪ smooth muscle relaxation‬ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ ﺗﻮﺳﻴﻊ‬
‫ﺍﻟﻘﺼﺒﺎﺕ ﺍﳍﻮﺍﺋﻴﺔ ﻛﻤﺎ ﺍﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳛﻔﺰ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﻋﻦ ﻃﺮﻳﻖ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﳌﺮﻛﺰﻱ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Leukotriene receptor antagonists‬‬

‫*******************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Leukotriene receptor antagonists‬ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ ‪Montelukast,‬‬

‫‪. zafirlukast‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻟﺘﲔ ﺭﺋﻴﺴﻴﺘﲔ ﻫﻤﺎ‪:‬‬

‫‪٦٤‬‬
 ‫ﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺍﺯﻣﺔ ﺍﻟﺮﺑﻮﻳﺔ ‪.Prophylaxis of asthma‬‬
‫ﻭ ﺍﻟﺘﺤﺴﺲ ﺍﳌﻮﲰﻲ ‪. Seasonal allergic rhinitis‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﱂ ﺍﻟﺒﻄﻦ ﻭﺍﻟﺼﺪﺍﻉ ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ‪.‬‬
‫ﻭﺗﺘﺎﻳﺾ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. biliary route‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء ‪ zafirlukast‬ﻫﻮ ﻋﺸﺮ ﺳﺎﻋﺎﺕ‪.‬‬
‫ﺍﻣﺎ ‪ Montelukast‬ﻓﻬﻮ ﻣﻦ ‪ ٧-٣‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻨﻔﻊ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ‪. exercise-induced asthma‬‬
‫ﻭﻋﻼﺝ ‪ Montelukast‬ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺍﻣﺎ ‪ zafirlukast‬ﻓﻴﻌﻄﻰ ﻣﺮﺗﲔ‬
‫ﻳﻮﻣﻴﺎ ‪..‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﻣﻨﻊ ﻓﻌﻞ ‪ cysteinyl leukotrienes‬ﻋﻠﻰ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﰲ‬
‫ﺍجملﺎﺭﻱ ﺍﳍﻮﺍﺋﻴﺔ ﻓﻴﻤﻨﻊ ‪ inflammation‬ﺍﳌﺴﺌﻮﻝ ﻋﻦ ﺍﻻﻋﺮﺍﺽ ﺍﻟﺘﻲ ﲢﺪﺙ ﰲ ﺍﻟﺮﺑﻮ ﻭﺍﻟﺘﺤﺴﺲ‬
‫‪. symptomatic asthma and rhinitis‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Corticosteroids‬‬

‫‪********************************.‬‬

‫ﻣﻦ ﺍجملﺎﻣﻴﻊ ﻛﺜﲑﺓ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻭﰲ ﺍﻣﺮﺍﺽ ﳐﺘﻠﻔﺔ ﺟﺪﺍ ‪.‬‬

‫ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Prednisolone, hydrocortisone, dexamethasone,‬‬
‫‪. methylprednisolone‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﳐﺘﻠﻔﺔ ﻣﻨﻬﺎ ﺗﺜﺒﻴﻂ ﺍﻻﻟﺘﻬﺎ ﻭﺍﻟﺘﺤﺴﺲ ﰲ ﺑﻌﺾ ﺍﳊﺎﻻﺕ‬
‫‪. Suppression of inflammatory and allergic disorders‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Acute hypersensitivity reactions‬‬
‫ﻭﻛﺬﻟﻚ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Congenital adrenal hyperplasia‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Cerebral oedema associated with neoplastic disease‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻧﺘﻴﺠﺔ ﺍﻻﺩﻭﻳﺔ ﺍﻟﻜﻴﻤﺎﺋﻴﺔ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ ‪Nausea and‬‬
‫‪. vomiting due to chemotherapy‬‬

‫‪٦٥‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ ﻣﺮﺿﻰ ﺍﻟﺴﻜﺮﻱ ﻭﺗﻌﻄﻲ ﻟﻠﺤﺎﻣﻞ ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻭﻟﻔﱰﺓ ﻗﺼﲑﺓ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﺭﺗﻔﺎﻉ ﺳﻜﺮ ﺍﻟﺪﻡ ﻭﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﺎﻡ ﻭﺍﺭﺗﻔﺎﻉ ﺍﻟﻀﻐﻂ ﻭﺣﺪﻭﺙ ﺍﻟﻘﺮﺣﺔ‬
‫ﻭﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ﻋﻨﺪ ﺍﻟﻨﺴﺎء ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Proximal myopathy‬ﻭ ‪ Psychiatric reactions‬ﻣﺜﻞ‬
‫‪. mood and behavioural changes, insomnia, psychotic symptoms‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Increased susceptibility to infections‬ﻭ ‪Bruising‬‬
‫‪ and impaired healing‬ﻭ ‪ Ophthalmic effects‬ﻣﺜﻞ ‪subcapsular cataracts,‬‬
‫‪. glaucoma‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Cushing's syndrome‬ﻭﺍﻋﺮﺍﺿﻪ ﻫﻲ ‪moon face,‬‬
‫‪ truncal obesity, intrascapular fat pad, striae, acne‬ﻭﺯﻳﺎﺩﺓ ﺍﻟﻮﺯﻥ ‪.‬‬
‫ﻭﺗﺘﺎﻳﺾ ﲨﻴﻊ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﻳﻘﻞ ﺗﺎﺛﲑ ‪ antihypertensives‬ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻣﻊ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﻘﻞ ﺍﻟﺘﺎﺛﲑ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻻﺩﻭﻳﺔ ﺍﻟﺴﻜﺮ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻣﻊ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺍﳔﻔﺎﺽ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪glycosides,‬‬
‫‪ theophyllines, b2 agonists‬ﻭ ‪. potassium-losing diuretics‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﻟﺘﻘﺮﺡ ﻭﺍﻟﻨﺰﻑ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ‪. NSAIDs‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﺪ ﺗﺴﺒﺐ ‪ Adrenal atrophy‬ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ﺍﻛﺜﺮ ﻣﻦ‪ ٦-٣‬ﺍﺷﻬﺮ‬
‫ﺗﻘﺮﻳﺒﺎ ﻛﻤﺎ ﺍﻧﻬﺎ ﳚﺐ ﺍﻥ ﻻﺗﻘﻄﻊ ﻣﺒﺎﺷﺮﺓ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ﻻﻧﻬﺎ ﻗﺪ ﺗﺴﺒﺐ ‪life-‬‬
‫‪. threatening acute adrenal insufficiency‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﺘﻮﻓﺮ ﰲ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ﺑﺎﺷﻜﺎﻝ ﺻﻴﺪﻻﻧﻴﺔ ﳐﺘﻠﻔﺔ ﻣﺜﻞ‪:‬‬
‫ﺍﻗﺮﺍﺹ ‪.‬‬
‫ﻭﺣﺒﻮﺏ‪.‬‬
‫ﻭﺣﻘﻦ ‪.‬ﻭﻣﺮﺍﻫﻢ‪ .‬ﻭﻗﻄﺮﺍﺕ ﻋﻴﻮﻥ ﻭﻗﻄﺮﺍﺕ ﺍﺫﻥ ‪.‬‬

‫‪٦٦‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ‬

Benzodiazepines ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬

********************************

Diazepam, lorazepam, ‫ ﺗﻀﻢ ﻛﻞ ﻣﻦ‬Benzodiazepines ‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬

. chlordiazepoxide, midazolam, temazepam
:‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ‬
. Status epilepticus ‫ﺍﳊﺎﻟﺔ ﺍﻟﺼﺮﻋﻴﺔ‬
. Muscle spasm ‫ﻭﺍﻟﺘﺸﻨﺞ ﺍﻟﻌﻀﻠﻲ‬
. anxiety or insomnia ‫ﻭﳌﻌﺎﳉﺔ ﺍﻟﻘﻠﻖ ﺍﻭ ﺍﻻﺭﻕ‬

٦٧
 ‫ﻭﻟـ ‪.Sedation‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪:‬‬
‫ﺍﻻﻋﺘﻤﺎﺩ ﻭﺍﻻﺩﻣﺎﻥ ‪ Dependence‬ﻭ ‪ Drowsiness and lightheadedness‬ﻭ‬
‫‪. Confusion‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﻭﳍﺎ ﺍﻋﻤﺎﺭ ﻧﺼﻔﻴﺔ ﳐﺘﻠﻔﺔ‪.‬‬
‫ﻭﳑﻨﻮﻋﺔ ﰲ‪:‬‬
‫‪. Respiratory depression‬‬
‫ﻭ ‪. Acute pulmonary insufficiency‬‬
‫ﻛﻤﺎ ﳚﺐ ﺍﻥ ﻻﺗﻌﻄﻰ ﲟﻔﺮﺩﻫﺎ ﳌﻌﺎﳉﺔ ﺍﻻﻛﺘﺌﺎﺏ ‪. treat depression‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺍﻥ ﻻﺗﺴﺘﻌﻤﻞ ﻣﻊ ﺍﻟﻜﺤﻮﻝ ﻻﻧﻬﺎ ﺳﻮﻑ ﺗﺰﻳﺪ ﻣﻦ ‪. sedative effect‬‬
‫ﻭﺍﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺎﻛﺲ ﺑﺎﻋﻄﺎء ‪ flumazenil‬ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ‪.‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ﻭﺣﻘﻦ ﻭﻻﺗﺼﺮﻑ ﺍﻻ ﺑﻮﺻﻔﺔ ﻃﺒﻴﺔ ﺣﺼﺮﺍ ‪.‬‬

‫‪Gabapentin and pregabalin‬‬

‫*****************************‬

‫ﺍﻥ ﻋﻼﺟﻲ ‪ Gabapentin and pregabalin‬ﺗﻌﺘﱪ ﻣﻦ ‪ analogues of GABA‬ﻭﻟﻜﻨﻬﺎ‬

‫ﻻﺗﻌﻤﻞ ﻋﻠﻰ ‪. GABA receptors‬‬
‫ﺣﻴﺚ ﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﺧﻼﻝ ﺍﻻﺭﺗﺒﺎﻁ ‪ T . type Ca. channel‬ﻭﺑﺎﻟﺘﺎﱄ ﺗﺜﺒﻂ ﺧﺮﻭﺝ ﺑﻌﺾ‬
‫ﺍﻟﻮﺳﺎﺋﻂ ﺍﻟﻜﻴﻤﺎﺋﻴﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺑﻌﺾ ﺍﻟﺘﺎﺛﲑﺍﺕ ﻏﲑ ﺍﳌﺮﻏﻮﺏ ﺑﻬﺎ ‪.‬‬
‫ﻭﻳﻌﺘﱪ ﺩﻭﺍء ‪ Pregabalin‬ﻫﻮ ‪ higher potency analogue‬ﰲ ‪chronic pain control‬‬
‫‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ‪ Neuropathic pain‬ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪. Partial seizures‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ‬
‫ﻫﻲ ‪ GI disturbance‬ﻭ‪. Weight gain‬‬
‫ﻭ ‪ Hypertension‬ﻭ ‪ Dizziness and drowsiness‬ﻭ ‪. Leucopenia‬‬

‫‪٦٨‬‬
 ‫ﻭ ‪. Visual disturbances‬‬
‫ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻏﲑ ﻣﺘﻐﲑﺓ ﺃﻱ ﻻﺗﻌﺎﻧﻲ ﺍﻟﺘﺎﻳﺾ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻭﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ﻣﻀﺎﺩﺍﺕ ﺍﳊﻤﻮﺿﺔ ﻓﺎﻧﻬﺎ ﺗﻘﻠﻞ ﻣﻦ ‪. gabapentin bioavailability‬‬
‫ﻭﺍﻥ ﺍﻟﻘﻄﻊ ﺍﳌﺒﺎﺷﺮ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻳﺴﺒﺐ ﺗﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻫﻤﻬﺎ ‪anxiety,‬‬
‫‪. insomnia, pain and increases risk of seizures‬‬
‫ﻛﻤﺎ ﳚﺐ ﺗﻘﻠﻴﻞ ﺍﳉﺮﻋﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ‪. elderly and patients with renal impairment‬‬
‫ﻭﳚﺐ ﺍﻥ ﻳﺴﺘﻌﻤﻞ ﺩﻭﺍء ‪ Gabapentin‬ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﺛﻢ ﺗﺰﺩﺍﺩ ﺗﺪﺭﳚﻴﺔ ﻛﻞ ‪ ٣-٢‬ﻳﻮﻡ ﻻﻥ ﺯﻳﺎﺩﺓ‬
‫ﺍﳉﺮﻋﺔ ﺑﺴﺮﻋﺔ ﻳﺴﺒﺐ ‪. Sedation, confusion and ataxia‬‬
‫ﻭﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ opiates‬ﻓﺎﻧﻬﺎ ﺗﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ‪. risk of CNS depression‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﺍﺷﻜﺎﻝ ﺻﻴﺪﻻﻧﻴﺔ ﺍﻗﺮﺍﺹ ﻭﻛﺒﺴﻮﻝ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ )‪5-HT1 agonists (triptans‬‬

‫************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ )‪ 5-HT1 agonists (triptans‬ﻣﻦ ﺍجملﻤﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﻘﻠﻴﻠﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ‬
‫ﺟﺪﺍ ﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪.Sumatriptan, zolmitriptan‬‬
‫ﻭﻫﻲ ﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﰲ ‪:‬‬
‫ﻣﻌﺎﳉﺔ ﻧﻮﺑﺔ ﺍﻟﺸﻘﻴﻘﺔ ﺍﳊﺎﺩﺓ ‪. Treatment of acute migraine‬‬
‫ﻭ ﺍﻟﺼﺪﺍﻉ ﻣﻦ ﻧﻮﻉ ‪. Cluster headache‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻭﺍﳋﻔﻘﺎﻥ ‪.‬‬
‫ﻭﺑﺼﻮﺭﺓ ﻧﺎﺩﺓ ﻗﺪ ﺗﺴﺒﺐ ﺍﺣﺘﺸﺎء ﻋﻀﻠﺔ ﺍﻟﻘﻠﺐ ‪.‬‬
‫ﻭﻗﺪ ﺗﺴﺒﺐ ﺍﻳﻀﺎ ﺍﻟﻄﻨﲔ ﰲ ﺍﻻﺫﻥ ‪. Tinnitus‬‬
‫ﻭ ‪ Paraesthesia‬ﻭ ‪. Dizziness‬‬
‫‪.‬‬ ‫ﻟﺬﺍ ﻓﻬﻲ ﳑﻨﻮﻋﺔ ﰲ ‪Ischaemic heart disease‬‬

‫‪٦٩‬‬
 ‫ﻭﺍﺭﺗﻔﺎﻉ ﺷﺪﻳﺪ ﺑﻀﻐﻂ ﺍﻟﺪﻡ ‪. Severe hypertension‬‬
‫ﻭﺍﻻﻣﺮﺍﺽ ﺍﻟﻮﻋﺎﺋﻴﺔ ﺍﻟﻄﺮﻓﻴﺔ ‪. Peripheral vascular disease‬‬
‫ﻭ ‪. Previous stroke or TIA‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ‪. with SSRIs and MAOIs‬‬
‫ﻛﻤﺎ ﺗﺮﻛﻴﺰ ﻫﺬﻩ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻳﺰﺩﺍﺩ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ‪macrolides and b blockers‬‬
‫‪.‬‬
‫ﻭﻻﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﻧﻮﺑﺔ ﺍﻟﺸﻘﻴﻘﺔ ﺍﳊﺎﺩﺓ ‪ migraine prophylaxis‬ﺑﻞ‬
‫ﺗﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﺍﻟﻨﻮﺑﺔ ﺍﺛﻨﺎء ﻭﻗﻮﻋﻬﺎ ‪.‬‬
‫ﻛﻤﺎ ﻳﺘﻢ ﻭﺻﻒ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻟﻌﻼﺝ ﺍﻟﺼﺪﺍﻉ ﺍﻟﻨﺼﻔﻲ ﺍﻭ ﺍﻟﺸﻘﻴﻘﺔ ﻓﻴﻤﺎ ﻟﻮ ﱂ ﻳﺴﺘﺠﺐ‬
‫ﺍﳌﺮﻳﺾ ﻟﻼﺩﻭﻳﺔ ﺍﳌﺴﻜﻨﺔ ﺍﻟﺒﺴﻴﻄﺔ ‪. simple analgesia‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺗﻔﻌﻴﻞ ‪ Selective activation of 5-HT1 receptors‬ﺍﻟﺬﻱ‬
‫ﻳﻘﻊ ﰲ ‪ cranial blood vessel walls.‬ﻓﻴﺴﺒﺐ ‪ vasoconstriction‬ﻓﻴﺰﻳﻞ ﺍﻋﺮﺽ ﺍﻟﺼﺪﺍﻉ‬
‫ﻭﺍﻟﺸﻘﻴﻘﺔ ﺍﻟﺘﻲ ﲢﺪﺙ ﻧﺘﻴﺠﺔ ﺗﻮﺳﻊ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ‪dilatation of intra- and‬‬
‫‪.extracranial‬‬

‫ﻋﻼﺝ ‪Levodopa‬‬
‫***********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Levodopa‬ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Parkinson’s disease and parkinsonism‬‬

‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﺟﻔﺎﻑ ﺍﻟﻔﻢ ‪. Dry mouth‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.Postural hypotension‬‬
‫ﻭ ‪. Drowsiness and sudden onset of sleeping‬‬
‫ﻭﺣﺪﻭﺙ ﻫﻠﻮﺳﺔ ﻭﲣﻠﻴﻂ ﺫﻫﻨﻲ ﻭﺍﺣﻼﻡ ﻭﻛﻮﺍﺑﻴﺲ ﻏﲑ ﻃﺒﻴﻌﻴﺔ ﻭﺍﺭﻕ ‪hallucinations, confusion,‬‬
‫‪. abnormal dreams, insomnia‬‬
‫ﻭﺣﺪﻭﺙ ‪. Dystonia, dyskinesia and chorea‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﺼﻔﻲ ﻟﻪ ‪ ٩٠‬ﺩﻗﻴﻘﺔ ﻭﻟﻜﻨﻪ ﻳﻄﻮﻝ ﻋﻨﺪ ﺍﻟﻜﺒﺎﺭ‪.‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺑﻮﺍﺳﻄﺔ ‪ decarboxylation‬ﻟﻴﻜﻮﻥ ﺍﻟﺪﻭﺑﺎﻣﲔ ﻭﺑﻌﺪ ﺫﻟﻚ ﻳﺘﺎﻳﺾ ﺍﱃ‬
‫‪. inactive metabolites‬‬

‫‪٧٠‬‬
 ‫ﻛﻤﺎ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ‪ peripheral decarboxylase inhibitor‬ﳌﻨﻊ ﲢﻄﻢ ‪Levodopa‬‬
‫ﻭﲢﻮﻟﻪ ﺍﱃ ﺍﻟﺪﻭﺑﺎﻣﲔ ﻗﺒﻞ ﻭﺻﻮﻟﻪ ﺍﱃ ﺍﳌﻜﺎﻥ ﺍﳌﺨﺼﺺ ﻟﻪ ﰲ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﳌﺮﻛﺰﻱ ﻭﻟﺘﻘﻠﻴﻞ‬
‫ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ‪ peripheral dopamine action‬ﻣﺜﻞ ﺍﻟﻐﺜﻴﺎﻥ ‪.‬‬
‫ﻭﻻﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﻌﻼﺝ‪:‬‬
‫ﳌﻦ ﻳﺘﺤﺴﺲ ﻣﻨﻪ ‪. Hypersensitivity‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻉ ﰲ‪. Closed-angle glaucoma‬‬
‫ﻭ ‪. Severe heart failure and cardiac arrhythmias‬‬
‫ﻭ ‪. Severe neuropsychosis‬‬
‫ﻭﻳﻌﺎﰿ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﻧﻘﺺ ﺍﻟﺪﻭﺑﺎﻣﲔ ﻭﻧﻘﺺ ﺍﻻﺳﺘﻴﻞ ﻛﻮﻟﲔ‬
‫ﻋﻦ ﻃﺮﻳﻖ ﺗﻮﻓﲑ ﻭﺻﻮﻝ ﺗﺮﻛﻴﺰ ﻣﻨﺎﺳﺐ ﻟﻠﺪﻭﺑﺎﻣﲔ ﻭﻳﻘﻠﻞ ﺍﻋﺮﺍﺽ ﺍﳌﺮﺽ ﺍﻟﺘﻲ ﲢﺪﺙ ﺑﺴﺒﺐ ﻧﻘﺺ‬
‫ﺍﻟﺪﻭﺑﺎﻣﲔ ‪.‬‬

‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ‪.‬‬

‫******************************************‬

‫ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ﻫﻲ ‪Dopamine D2 receptor‬‬

‫‪. agonists‬‬
‫ﻭﺍﻟﺘﻲ ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪ ergot-derived – bromocriptine, cabergoline‬ﻭ ‪. ropinirole‬‬
‫ﻭﺗﻌﻤﻞ ﲨﻴﻌﻬﺎ ﻋﻦ ﻃﺮﻳﻖ ﻟﻌﺐ ﺩﻭﺭ ﻳﺸﺒﻪ ﺩﻭﺭ ﺍﻟﺪﻭﺑﺎﻣﲔ ﻭﺗﺮﺗﺒﻂ ﻣﻊ ‪dopamine receptors‬‬
‫ﻓﺘﻘﻮﻡ ﺑﺘﻔﻌﻠﻴﻪ ﻭﺗﺆﺩﻱ ﺍﻟﻔﻌﻞ ﺍﻟﻔﺴﻴﻮﻟﻮﺟﻲ ﺍﻟﺬﻱ ﻛﺎﻥ ﻳﺆﺩﻳﻪ ﺍﻟﺪﻭﺑﺎﻣﲔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﺎﰿ ﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ﻫﻲ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Catechol-O-‬‬
‫‪ methyltransferase (COMT) inhibitors‬ﻣﺜﻞ ﻋﻼﺝ ‪. entacapone‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻋﻠﻰ ﻣﻨﻊ ﲢﻄﻢ ‪ L-dopa‬ﻭﲢﻮﻟﻪ ﺍﱃ ‪ methyldopa‬ﺑﻮﺍﺳﻄﺔ‬
‫)‪ Catechol-O-methyltransferase (COMT‬ﺣﻴﺚ ﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻠﻰ ﲢﻄﻴﻢ ﻫﺬﺍ‬
‫ﻻﻧﺰﻳﻢ ﻭﺑﺎﻟﺘﺎﱄ ﻭﺻﻮﻝ ﻛﻤﻴﺔ ﻛﺒﲑﺓ ﻣﻦ ‪ L-dopa‬ﺍﱃ ﺍﻟﺪﻣﺎﻍ ﺍﻟﺬﻱ ﻳﺘﺤﻮﻝ ﺍﱃ ﺩﻭﺑﺎﻣﲔ ‪.‬‬

‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﺎﰿ ﻣﺮﺽ ﺑﺎﺭﻛﻨﺴﻮﻥ ﻫﻲ ‪. MAO-B inhibitors‬‬

‫‪٧١‬‬
 ‫ﻣﺜﻞ ﻋﻼﺝ )‪. selegiline‬‬
‫ﻭﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﻣﻨﻊ ﲢﻄﻴﻢ ﺍﻟﺪﻭﺑﺎﻣﲔ ﺑﺎﻧﺰﻳﻢ ‪ MAO-B‬ﺣﻴﺚ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲢﻄﻢ ﻫﺬﺍ‬
‫ﺍﻻﻧﺰﻳﻢ ‪.‬‬

‫ﺩﻭﺍء ‪Carbamazepine‬‬
‫************************‬

‫ﺍﻥ ﺩﻭﺍء ‪ Carbamazepine‬ﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ‪:‬‬

‫ﻏﻠﻖ ﻗﻨﺎﺓ ﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬‬
‫ﻓﻴﻤﻨﻊ ﺣﺪﻭﺙ ‪. action potential‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﲤﻨﻊ ﺍﻟﺘﻬﻴﺞ ﺍﻟﻌﺼﺒﻲ ﻭﳛﺪﺙ ﺍﻻﺳﱰﺧﺎء‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﺛﻼﺙ ﺣﺎﻻﺕ ﻫﻲ‪:‬‬
‫‪. Epilepsy‬‬
‫ﻭ ‪. Prophylaxis of bipolar disorder‬‬
‫ﻭ ‪. Trigeminal neuralgia‬‬
‫ﻭﻟﻜﻨﻬﺎ ﳑﻨﻮﻋﺔ ﰲ‪:‬‬
‫‪. bone marrow suppression‬‬
‫ﻭ ‪. AV conduction abnormalities‬‬

‫ﻭﻣﻦ ﺍﻫــــــــــــﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﺪﻭﺍء ‪ Carbamazepine‬ﻫﻲ‪:‬‬

‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪.‬‬
‫ﻭ ‪ Drowsiness‬ﻭ ‪. Leucopenia‬‬
‫ﻭ ‪.Cardiac conduction disturbances‬‬
‫ﻭ ‪. Generalised erythematous rash‬‬
‫ﺗﺘﺎﻳﺾ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ﺑﻮﺍﺳﻄﺔ ﺍﻧﺰﻳﻢ ‪. Cytochrome P450 3A4‬‬
‫ﻟﺬﺍ ﻓﺎﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺜﺒﻂ ﻫﺬﺍ ﺍﻻﻧﺰﻳﻢ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﻟﻌﻼﺟﻲ ﻣﺜﻞ ‪ isoniazid,‬ﻭ ‪verapamil‬‬
‫‪. and diltiazem‬‬
‫ﻭﻳﻘﻞ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﻟﻌﻼﺟﻲ ﻟﻪ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﲢﻔﺰ ﻭﺗﻘﻮﻱ ﻫﺬﺍ ﺍﻻﻧﺰﻳﻢ ﻣﺜﻞ‪:‬‬

‫‪٧٢‬‬
 ‫‪. phenytoin, phenobarbitone and theophylline‬‬
‫ﻛﻤﺎ ﺗﻘﻠﻞ ﺍﺩﻭﻳﺔ ‪ Carbamazepine‬ﻣﻦ ﺗﺎﺛﲑ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ‪. warfarin‬‬
‫ﻭﳚﺐ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﺗﺰﺩﺍﺩ ﺗﺪﺭﳚﻴﺎ ﻛﻞ ﺍﺳﺒﻮﻋﲔ ‪.‬‬

‫ﻭﺑﺘﻌﺒﲑ ﺍﺧﺮ ‪:‬‬

‫ﻋﻼﺝ ‪.Cabamazepine‬‬
‫************************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Cabamazepine‬ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺼﺮﻉ ‪.‬‬

‫ﻳﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻗﻨﺎﺓ ﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬‬
‫ﻭﻳﻌﺘﱪ ﺍﻗﻞ ﺍﺩﻭﻳﺔ ﺻﺮﻉ ﺗﺎﺛﲑﺍ ﻋﻠﻰ ﺍﳊﺎﻣﻞ ‪ It's the least teratogenic‬ﻭﺍﻳﻀﺎ‬
‫‪ Oxycarbazin‬ﻳﻌﺘﱪ ﺍﻗﻞ ‪. toxic‬‬
‫ﻳﻌﺘﱪ ﺯﻣﻼﺋﻨﺎ ﺍﻻﻋﺰﺍء ﻛﻞ ﻣﻦ ‪ Phenytoin‬ﻭ ‪ Cabamazepin‬ﻣﻦ ﺍﻟﻨﻮﻉ ‪. not sedative‬‬
‫ﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ‪. Potent enzyme inducer‬‬
‫ﻭﺍﻳﻀﺎ ﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳝﺘﻠﻚ ‪ T1/2‬ﺟﺪﺍ ﻃﻮﻳﻞ ﺣﻮﺍﱄ ‪ ٣٠‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻓﻘﻂ ‪.‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ﺑﺸﻜﻞ ﻣﺘﺎﻳﺾ ﻏﲑ ﻓﻌﺎﻝ ﺩﻭﺍﺋﻴﺎ ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﻣﻌﺎﳉﺔ ﺍﻧﻮﺍﻉ ﻣﻦ ﺍﻟﺼﺮﻉ ﻭﺧﺎﺻﺔ ﺍﻟﺼﺮﻉ ﺍﳉﺰﺋﻲ ‪. partial seizure‬‬
‫ﻭﻻﻳﺴﺘﻌﻤﻞ ﰲ ﻧﻮﻉ ‪. aSbsence febrile‬‬
‫ﻭﻻﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﻣﻌﺎﳉﺔ ﺍﳊﺎﻟﺔ ﺍﻟﺼﺮﻋﻴﺔ ﺍﳊﺎﺩﺓ ﺑﻞ ﳓﺘﺎﺝ ﺍﱃ ﺍﺩﻭﻳﺔ ﺍﺳﺮﻉ ﻣﺜﻞ‬
‫ﻓﻴﻨﻮﺑﺎﺭﺑﻴﺘﺎﻝ ﻭﺍﻳﻀﺎ ﻓﺎﻟﻴﻮﻡ ﻭﺍﻟﺪﻳﺒﺎﻛﲔ ‪.‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Trigeminal neuralgia‬‬
‫ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻲ ‪:‬‬
‫‪. Hyponatremia‬‬
‫ﻭ ‪. Congenital malformation‬‬
‫ﻭ ﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﻗﺪ ﻳﺴﺒﺐ ﲰﻴﺔ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﻳﺴﺒﺐ ‪. Aplastic anemia, Agranulocytosis‬‬
‫ﻭﺍﻳﻀﺎ ﻟﻮﺣﻆ ﺍﻧﻪ ﻳﺰﻳﺪ ﻣﻦ ﻛﻤﻴﺔ ﺩﻡ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ‪. Drowsiness,diplopia,ataxia&vertigo‬‬

‫‪٧٣‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Phenothiazine anti-emetics‬‬
‫***************************************‬

‫ﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Phenothiazine anti-emetics‬ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ ‪.‬‬

‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪. Prochlorperazine, chlorpromazine, promethazine‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺸﺪﻳﺪ ‪Severe nausea and‬‬
‫‪. vomiting‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ‪. Vertigo‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪. Labyrinthine disorders‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ‪. Psychotic disorders‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪. Sedation or agitation‬‬
‫ﻭﺍﻳﻀﺎ ‪. Extra-pyramidal symptoms‬‬
‫ﻭﺍﻳﻀﺎ ‪. Postural hypotension‬‬
‫ﻭﺍﻳﻀﺎ )‪ Cardiac arrhythmias (prolongation of QT interval‬ﻭﺍﻳﻀﺎ ﻳﺰﺩﺍﺩ ﺣﺪﻭﺙ ﻫﺬﺍ‬
‫ﺍﻟﺘﺎﺛﲑ ﺍﳉﺎﻧﺒﻲ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻣﻊ ﺍﺩﻭﻳﺔ ﺍﺧﺮﻯ ﺗﺴﺒﺐ ‪.prolong the QT interval‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﻳﺴﺒﺐ ‪. Rarely transient jaundice‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ﻭﳍﺎ ﺍﻋﻤﺎﺭ ﻧﺼﻔﻴﺔ ﳐﺘﻠﻔﺔ ﻣﺜﻼ ﻋﻼﺝ ‪ prochlorperazine.‬ﻋﻤﺮﻩ‬
‫ﺍﻟﻨﺼﻔﻲ ﻫﻮ ﻣﻦ ‪ ٧-٦‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺸﺪﻳﺪ ﺍﻟﺬﻱ ﻻﻳﺴﺘﺠﻴﺐ ﻟﻼﺩﻭﻳﺔ ﺍﻻﺧﺮﻯ ﻣﺜﻞ‬
‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﺍﻟﺸﺪﻳﺪ ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﺍﳊﻤﻞ ﻭﺑﻌﺪ ﺍﺟﺮﺍء ﺍﻟﻌﻤﻠﻴﺔ ‪PONV or in‬‬
‫‪. pregnancy‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺎﻛﺲ ﻓﻌﻞ ﻛﻞ ﻣﻦ ‪. anticholinergics and antiepileptic‬‬
‫ﻛﻤﺎ ﺍﻥ ﺗﺎﺛﲑﻫﺎ ﺍﳉﺎﻧﺒﻲ ﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ﻳﺰﺩﺍﺩ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪antihypertensive‬‬
‫‪. agents‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳌﺜﺒﻂ ﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﳌﺮﻛﺰﻱ ‪ CNS depressant‬ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻣﻊ‬
‫‪ opioids, anxiolytics, sedatives‬ﻭﺍﻳﻀﺎ ‪.hypnotics and alcohol‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻟﺔ ‪. Severe cardiovascular disease‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﰲ ‪. CNS depression/coma‬‬

‫‪٧٤‬‬
 ‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ ﰲ ‪. hepatic impairment‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻭﻣﻌﺎﻛﺴﺔ ﻓﻌﻞ ‪muscarinic, histaminergic,‬‬
‫‪ dopaminergic‬ﻭ ‪. serotonergic and adrenergic receptors‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Selective serotonin reuptake inhibitors‬‬

‫***************************************************‬

‫ﺗﻌﺘﱪ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺘﻲ ﻛﺜﺮ ﺍﺳﺘﻌﻤﺎﳍﺎ ﰲ ﺍﻻﻭﻧﺔ ﺍﻻﺧﲑﺓ ‪.‬‬
‫ﻭﺗﻀﻢ ﻛﻞ ‪. Sertraline, paroxetine, fluoxetine‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻻﻛﺘﺌﺎﺏ ‪.Depression‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪. Generalised anxiety disorder‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Panic disorder‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﻛﻞ ﻣﻦ ‪:‬‬
‫ﺣﺪﻭﺙ ‪. GI disturbance‬‬
‫ﻭﺣﺪﻭﺙ ﺣﺎﻟﺔ ‪. Hypersensitivity reactions‬‬
‫ﻭﺣﺪﻭﺙ ﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ﻭﻓﻘﺪﺍﻥ ﺍﻟﻮﺯﻥ ‪.‬‬
‫ﻭﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ‪.‬‬
‫ﻭﺣﺪﻭﺙ ‪. Sexual dysfunction‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﱰﻛﻴﺰ ﺍﻟﺒﻼﺯﻣﻲ ﻟﺒﻌﺾ ﺍﺩﻭﻳﺔ ‪ TCAs‬ﻭﺗﺰﻳﺪ ﺍﻳﻀﺎ ﻣﻦ ﺧﻄﺮ‬
‫ﺣﺪﻭﺙ‪ convulsions‬ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﳌﻀﺎﺩﺓ ﻟﻠﺼﺮﻉ ‪. antiepileptics‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺍﻟﻨﺰﻑ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻣﻊ ﺍﺩﻭﻳﺔ ‪. aspirin, warfarin and NSAIDs‬ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ‬
‫ﻳﻈﻬﺮ ﺗﺎﺛﲑﻫﺎ ﺍﻟﻌﻼﺟﻲ ﺑﻌﺪ ‪ ٤-٢‬ﺍﺳﺒﻮﻉ ﻣﻦ ﺍﻟﺒﺪء ﺑﺎﳌﻌﺎﳉﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻻﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻘﻮﻡ ‪ irreversible MAO inhibition‬ﻓﺎﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻟﺒﺪء ﺑﻬﺎ‬
‫ﺑﻌﺪ ‪ ٢‬ﺍﺳﺒﻮﻉ ﺗﺮﻙ ﻋﻼﺟﺎﺕ ‪. MAOIs‬‬
‫ﻭﳚﺐ ﺍﻥ ﺗﱰﻙ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺪﺭﳚﻴﺎ ﻭﻻﺗﻘﻄﻊ ﻣﺒﺎﺷﺮﺓ ﻻﻧﻬﺎ ﻗﺪ ﺗﺴﺒﺐ ‪. rebound depression‬‬
‫ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﺪ ﺗﺴﺒﺐ ﺍﻓﻜﺎﺭ ﺍﻧﺘﺤﺎﺭﻳﺔ ﻋﻨﺪ ﻣﺴﺘﻌﻤﻠﻴﻬﺎ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻓﱰﺓ ﺍﳌﻌﺎﳉﺔ ﺑﻬﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻥ ﺗﺴﺘﻤﺮ ﳌﺪﺓ ‪ ٦‬ﺍﺷﻬﺮ ﻭﺍﺫﺍ ﻛﺎﻧﺖ ﻫﻨﺎﻙ ﺣﺎﻟﺔ ﺣﺪﻭﺙ‬
‫‪ rebound depression‬ﻓﺎﻧﻪ ﳚﺐ ﺍﺳﺘﻤﺮﺍﺭ ﻟﻔﱰﺓ ﺳﻨﺘﲔ ‪.‬‬

‫‪٧٥‬‬
 ‫ﻋﻼﺝ ‪. sodium valproate‬‬
‫********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ sodium valproate‬ﺍﳌﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺼﺮﻉ‪.‬‬

‫ﻳﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻗﻨﺎﺓ ﺍﻟﺼﻮﺩﻳﻮﻡ ﻭﺯﻳﺎﺩﺓ ﺗﺮﻛﻴﺰ ‪ GABA‬ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﺍﻧﺰﻳﻢ ‪GABA‬‬

‫‪. transaminase‬‬

‫ﻭﳜﺮﺝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ‪ urine‬ﻭﻳﺘﺎﻳﺾ ﺍﱃ ﺷﻜﻞ ﻏﲑ ﻓﻌﺎﻝ ﻭﻳﻌﺘﱪ ‪. Enzyme inhibitor‬‬

‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﲨﻴﻊ ﺍﻧﻮﺍﻉ ﺍﻟﺼﺮﻉ ‪.‬‬

‫ﻭﻳﺴﺒﺐ ﻋﺪﺓ ﺗﺎﺛﲑﺍﺕ ﺟﺎﻧﺒﻴﺔ ﺍﻫﻤﻬﺎ ﻫﻲ ‪:‬‬

‫‪.Sedation and tremor‬‬

‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ‪ Thrombocytopenia.‬ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺳﻬﻮﻟﺔ ﺣﺪﻭﺙ ﺍﻟﻨﺰﻑ ﻭﺧﺎﺻﺔ‬

‫ﻟﺪﻯ ﺍﻟﻨﺴﺎء ‪.‬‬

‫ﻭﻳﺴﺒﺐ ‪. Hair loss‬‬

‫ﻭﻳﺴﺒﺐ ﺍﺣﺒﺎﺋﻲ ﺯﻳﺎﺩﺓ ﺑﺎﻟﻮﺯﻥ ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺟﺪﺍ ﻭﺍﺿﺢ ﰲ ﻣﺮﺿﻰ ﺍﻟﺼﺮﻉ ‪Increase body‬‬

‫‪. weight‬‬

‫ﻭﻳﺴﺒﺐ ﲰﻴﺔ ﺍﻟﻜﺒﺪ ﻭﺍﺣﻴﺎﻧﺎ ‪. Skin rash‬‬

‫ﻭﺑﺘﻌﺒﲑ ﺍﺧﺮ ‪:‬‬

‫ﻳﻌﺘﱪ ﻋﻼﺝ ‪ Sodium valproate‬ﻣﻦ ﺍﺩﻭﻳﺔ ﺍﻟﺼﺮﻉ ﺍﳌﻬﻤﺔ ‪.‬‬

‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Epilepsy – all forms‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺕ ﺟﺎﻧﺒﻴﺔ ﻫﺬﻩ ﺍﻟﺪﻭﺍء ﻫﻲ ‪:‬‬

‫‪٧٦‬‬
 ‫ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ‪. GI disturbance‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺍﻟﻮﺯﻥ ‪.‬‬
‫ﻭﻧﻘﺺ ﰲ ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺪﻣﻮﻳﺔ ‪.‬‬
‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ ﻭﻟﻜﻦ ﳛﺪﺙ ﺑﺼﻮﺭﺓ ﻧﺎﺩﺭﺓ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺒﺐ ‪. Hyperammonaemia‬‬
‫ﻭ ‪. Reduced bone mineral density‬‬
‫ﻭ ‪. Rarely liver dysfunction‬‬
‫ﻭ ‪. Reduced bone mineral density‬‬
‫ﻭ ‪ Rarely liver dysfunction‬ﻣﺜﻞ ‪. fatal hepatic failure‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺸﻨﺞ ﻳﻘﻞ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪antidepressants‬‬
‫‪. (SSRIs, TCAs), antimalarials‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺗﺸﻮﻩ ﺍﳉﻨﲔ ﻣﺜﻞ ‪ neural tube defects‬ﻋﻨﺪﻣﺎ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺛﻨﺎء‬
‫ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬

‫ﻋﻼﺝ ‪. Phenytoin‬‬
‫***********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Phenytoin‬ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺼﺮﻉ ‪.‬‬

‫ﻭﻳﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻗﻨﺎﺓ ﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬‬
‫ﳝﺘﺺ ﺑﺼﻮﺭﺓ ﺟﻴﺪﺓ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﻋﻀﻠﻲ ﻭﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ‪.‬‬
‫ﻭﻳﺘﺎﻳﺾ ﺍﱃ ﺷﻜﻞ ﻏﲑ ﻓﻌﺎﻝ ‪.‬‬
‫ﻭﻳﻌﺘﱪ ‪. Potent enzyme inducer‬‬
‫ﻭﺍﻟﻨﺼﻒ ﺍﻟﻌﻤﺮﻱ ﻟﻪ ﻫﻮ ‪ ٢٠‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻳﻌﱪ ﺍﳊﺎﺟﺰ ﺍﻟﺪﻣﺎﻏﻲ ‪.‬‬
‫ﻭﻳﺴﺘﺨﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ‪.‬‬

‫‪٧٧‬‬
‫ﻭﻳﻌﺘﱪ ‪ Fosphenytoin‬ﻫﻮ ‪ soluble in water‬ﻭﻳﻌﻄﻰ ﻋﻀﻠﻲ ﻭﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﻭﻳﻌﺎﰿ‬
‫ﺍﻻﻧﻮﺑﺔ ﺍﻟﺼﺮﻋﻴﺔ ‪. status epilepticus‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﲨﻴﻊ ﺍﻧﻮﺍﻉ ﺍﻟﺼﺮﻉ ﻣﺎﻋﺪﺍ ‪ absence seizures‬ﻭﺍﻟﺼﺮﻉ ﺍﳊﺮﺍﺭﻱ ﺃﻱ ﺍﻟﺬﻱ‬
‫ﻳﺘﻌﺮﺽ ﻟﻪ ﺍﳌﺮﻳﺾ ﺑﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺍﳊﺮﺍﺭﺓ‪.‬‬
‫ﻭﻳﻌﺎﰿ ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺍﻟﺘﻲ ﲢﺪﺙ ﺑﺴﺒﺐ ‪. digitalis‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﻪ ﻫﻲ‪:‬‬
‫‪. GIT upset.‬‬
‫ﻭ ‪. Sedation, headache, ataxia‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﳕﻮ ﺯﺍﺋﺪ ﻋﻠﻰ ﺍﻟﻠﺜﺔ ‪ Gingival hyperplasia‬ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻓﻘﺮ ﺩﻡ ﻣﻦ‬
‫ﻧﻮﻉ ‪. Megaloblastic anemia‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺣﺒﺎﺋﻲ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ‪ Hirstisum‬ﺍﻱ ﺯﻳﺎﺩﺓ ﺑﺎﻟﺸﻌﺮ ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ ﻛﺒﺪ ﺑﺼﻮﺭﺓ‬
‫ﻧﺎﺩﺭﺓ ﺟﺪﺍ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺍﻟﺘﻬﺎﺏ ﺍﻻﻋﺼﺎﺏ ﺍﻟﻄﺮﻓﻴﺔ ‪. Peripheral Neuropathy‬‬

‫ﻭﺑﺘﻌﺒﲑ ﺍﺧﺮ ﻧﺸﺮﺡ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ‪.‬‬

‫ﻋـــــــــــــــــــﻼﺝ ‪. Phenytoin‬‬
‫*******************************‬

‫ﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﳌﻬﻤﺔ ﻭﺍﳌﺘﻮﻓﺮ ﰲ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ‪.‬‬

‫ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ Epilepsy‬ﻣﺎﻋﺪﺍ ‪. absence seizures‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ‪. Trigeminal neuralgia‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Status epilepticus‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺕ ﺟﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪. Acne‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻻﺭﻕ ‪. Insomnia‬‬
‫ﻭﺍﻳﻀﺎ ‪. Gingival hypertrophy‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ‪. Coarse facies‬‬
‫ﻭﺍﻳﻀﺎ ‪. Transient nervousness‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺑﻌﺾ ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﻣﺴﺎﻙ ‪. GI disturbance‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬

‫‪٧٨‬‬
 macrolides, isoniazid, diltiazem and ‫ﻭﻳﺰﺩﺍﺩ ﺗﺮﻛﻴﺰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ‬
. Chronic alcohol ‫ ﻭﻛﺬﻟﻚ‬Acute alcohol ingestion ‫ ﻭﺍﻳﻀﺎ‬amiodarone
. rifampicin and theophyllines ‫ﻭﻳﻘﻞ ﺗﺮﻛﻴﺰﻩ ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ‬
. corticosteroids ‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﻘﻠﻞ ﺗﺎﺛﲑ‬
‫ ﺍﺫﺍ ﺍﻋﻄﻲ ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ﻟﺬﺍ ﻳﻔﻀﻞ ﲡﻨﺒﻪ ﺣﻴﺚ ﻣﻦ‬teratogenicity ‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ‬
. neural tube defects ‫ﺍﳌﻤﻜﻦ ﺍﻥ ﻳﺴﺒﺐ‬
. ataxia, slurred speech and nystagmus ‫ﻋﻼﻣﺎﺕ ﺍﻟﺘﺴﻤﻢ ﺑﻬﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ‬
Second and ‫ ﻭ‬SA node block ‫ ﻭ‬Sinus bradycardia ‫ﻭ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ‬
. Pregnancy ‫ ﻭ‬third degree heart block

٧٩
 ‫ﺍﳌﻀــــﺎﺩﺍﺕ ﺍﳊﻴﻮﻳﺔ‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Penicillins‬‬

‫****************************‬

‫ﻭﻫﻲ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﻘﺪﳝﺔ ﻭﺍﻟﺸﺎﺋﻌﺔ ﺟﺪﺍ ‪.‬‬

‫ﻭﺗﻀﻢ ‪ phenoxymethylpenicillin‬ﻭ ‪ ampicillin, amoxicillin‬ﻭ ;‪. flucloxacillin‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﺍﻫﻤﻬﺎ ‪:‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﻠﻮﺯﺗﲔ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺮﺋﺔ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻻﺫﻥ ﺍﻟﻮﺳﻄﻰ ﻭ ‪ Meningitis‬ﻭ ‪ Endocarditis‬ﻭ‬
‫‪ Rheumatic fever‬ﻭ ‪ Osteomyelitis‬ﻭ ‪. UTI‬‬
‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻋﻠﻰ ﺍﳌﺮﺿﻰ ﺍﻟﻠﺬﻳﻦ ﻳﺘﺤﺴﺴﻮﻥ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Joint pains‬ﻭ ‪ Antibiotic-associated colitis‬ﻭ‬
‫‪ Anaphylaxis‬ﻭ ‪ GI disturbance‬ﻭﺧﺎﺻﺔ ﺍﻻﺳﻬﺎﻝ ‪.‬ﻭﺍﻳﻀﺎ ﻣﻦ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ‪Urticarial‬‬
‫‪ rash‬ﻭ ‪ Fever‬ﻭ ‪ Stevens–Johnson syndrome‬ﻭﺑﺼﻮﺭﺓ ﻧﺎﺩﺭﺍ ﺟﺪﺍ ﳛﺪﺙ ‪cholestatic‬‬
‫‪ jaundice with flucloxacillin or co-amoxiclav‬ﻭﺧﺎﺻﺔ ﻣﻊ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪ the kidneys and biliary tract‬ﻭﳍﺎ ﺍﻋﻤﺎﺭ ﻧﺼﻔﻴﺔ ﳐﺘﻠﻔﺔ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﳌﺮﺍءﺓ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﻣﺎﻧﻊ ﲪﻞ ﻓﻤﻮﻱ ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﻋﻠﻴﻬﺎ ﺍﺳﺘﻌﻤﺎﻝ‬
‫‪ alternative contraceptive methods‬ﻻﻧﻪ ﻗﺪ ﳛﺪﺙ ﺍﳊﻤﻞ ‪.‬‬
‫ﺍﳌﺮﺿﻰ ﺍﳌﺼﺎﺑﲔ ﺑـ‪ infectious mononucleosis‬ﻓﺎﻧﻪ ﳛﺪﺙ ‪diffuse, erythematous,‬‬
‫‪ maculopapular‬ﻋﻨﺪﻣﺎ ﻳﻌﺎﳉﻮﻥ ﺑﺎﺩﻭﻳﺔ ‪. ampicillin or amoxicillin‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺘﱪ ﻭﺍﺳﻊ ﺍﻟﻄﻴﻒ ﻭﺗﻌﺎﰿ ﺍﻟﺒﻜﱰﻳﺎ ﻣﻮﺟﺒﺔ ﻭﺳﺎﻟﺒﺔ ﺍﻟﻐﺮﺍﻡ ‪.‬‬
‫ﻭﻋﻼﺝ ‪ Co-amoxiclav‬ﻫﻮ ﻣﺮﻛﺐ ﻣﻦ ‪. amoxicillin and clavulanic‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻣﻨﺔ ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ﻭﺍﻻﺭﺿﺎﻉ ‪.‬‬
‫ﻭﺍﻓﻀﻞ ﻭﻗﺖ ﻻﻣﺘﺼﺎﺻﻬﺎ ﻫﻮ ﻗﺒﻞ ﺗﻨﺎﻭﻝ ﺍﻟﻄﻌﺎﻡ ‪.‬‬

‫‪٨٠‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Aminoglycosides‬‬
‫***************************‬

‫ﺗﻌﺘﱪ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Aminoglycosides‬ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺸﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ‪.‬‬
‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪. Gentamicin, tobramycin, amikacin, neomycin, streptomycin‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﺣﻴﺚ ﺍﻧﻬﺎ ﺗﺆﺛﺮ ﺑﺼﻮﺭﺓ ﻛﺒﲑﺓ ﻋﻠﻰ ﺍﻟﺒﻜﱰﻳﺎ ﺍﻟﺴﺎﻟﺒﺔ‬
‫ﺍﻟﻐﺮﺍﻡ ‪ Gram-negative‬ﻣﺜﻞ ‪ Enterobacteria spp‬ﻭ ‪ Pseudomonas spp.‬ﺣﻴﺚ‬
‫ﺗﻐﻄﻲ ﺍﻻﻟﺘﻬﺎﺑﺎﺕ ﺍﻟﺘﻲ ﲢﺪﺙ ﰲ ‪. UTI, abdominal sepsis‬‬
‫ﺣﻴﺚ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Biliary tract infection‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Acute pyelonephritis and prostatitis‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ‪. Endocarditis‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ‪. Septicaemia‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ‪. Adjunct in Listeria meningitis‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ﻛﻞ ﻣﻦ ‪ Nephrotoxicity‬ﻭﻳﺰﺩﺍﺩ ﺣﺪﻭﺙ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ‬
‫ﺍﺫﺍ ﺍﺳﺘﻌﻤﻠﺖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ ciclosporin‬ﻭ )‪ ototoxicity‬ﻭﻳﺰﺩﺍﺩ ﺣﺪﻭﺛﻪ ﻟﻮ ﺍﺳﺘﻌﻤﻠﺖ ﻫﺬﻩ‬
‫ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪ loop diuretics‬ﻭ ‪ GI disturbance‬ﻭ ‪ Blood dyscrasias‬ﻭﻇﻬﻮﺭ ﺍﻟﻄﻔﺢ‬
‫ﺍﳉﻠﺪﻱ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺍﻟﻮﻫﻦ ﺍﻟﻌﻀﻠﻲ ﻟﻮ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ﺍﺩﻭﻳﺔ ‪non-depolarising‬‬
‫‪. muscle relaxants‬‬
‫ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺼﻮﺭﺓ ﻏﲑ ﻣﺘﺎﻳﻀﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺒﻮﻝ ﻋﻠﻤﺎ ﺍﻥ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء‬
‫‪ gentamicin‬ﻫﻮ ﻣﻦ ‪ ٣-٢‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﲤﺘﺺ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﺼﻮﺭ ﺟﺪﺍ ﺿﻌﻴﻔﺔ ﻣﻦ ﺧﻼﻝ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ﻟﺬﺍ ﻓﻬﻲ ﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ‬
‫ﺍﻟﻮﺭﻳﺪﻱ ﺍﻭ ﺍﻟﻌﻀﻠﻲ ﻣﺎﻋﺪﺍ )‪ neomycin‬ﻳﻌﻄﻰ ﻓﻤﻮﻱ ﻟﺒﻌﺾ ﺍﻻﻏﺮﺍﺽ ﺍﻟﻌﻼﺟﻴﺔ ‪.‬‬
‫ﻳﻔﻀﺎ ﺍﻋﻄﺎء ﲨﻴﻊ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲜﺮﻋﺔ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ﻭﻫﻲ ﻛﺎﰲ ﻋﻼﺟﻴﺎ ﺍﻻ ﰲ ﺣﺎﻟﺔ ‪bacterial‬‬
‫‪. endocarditis‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻻﺳﺘﻤﺮﺍﺭ ﺑﻬﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳌﺪﺓ ﺍﻛﺜﺮ ﻣﻦ ‪ ٧‬ﺍﻳﺎﻡ ﳚﻌﻞ ﺧﻄﺮ ﺣﺪﻭﺙ ‪nephrotoxicity and‬‬
‫‪ ototoxicity‬ﻛﺒﲑ ‪.‬‬
‫ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ‪. Myasthenia gravis‬‬
‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﰲ ﻣﺮﺿﻰ ﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ ﻭﺟﺮﻋﺘﻪ ﲢﺘﺎﺝ ﺍﱃ ﺗﻐﻴﲑ ‪.‬‬

‫‪٨١‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Macrolides‬‬
‫***************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Macrolides‬ﺗﺸﻤﻞ ﻋﺪﺓ ﺍﻓﺮﺍﺩ ﻣﻨﻬﺎ ‪:‬‬

‫‪ Erythromycin, azithromycin, clarithromycin‬ﻭﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺗﺜﺒﻴﻂ‪:‬‬
‫‪. bacterial RNA-dependent protein synthesis‬‬
‫ﻋﻦ ﻃﺮﻳﻖ ﺍﻻﺭﺗﺒﺎﻁ ‪. the 50S subunit of ribosomes‬‬
‫ﰲ ﺍﻟﺒﻜﱰﻳﺎ ﻓﻴﻤﻨﻊ ﺗﻀﺎﻋﻔﺔ ﻭﺗﻜﻮﻳﻦ ﺑﺮﻭﺗﲔ ﺟﺪﻳﺪ ﻟﻠﺒﻜﱰﻳﺎ ‪.‬‬
‫ﻓﻴﺆﺩﻱ ﺍﻣﺎ ﺍﱃ ﺗﺜﺒﻴﻂ ﳕﻮ ﺍﻟﺒﻜﱰﻳﺎ ﺍﻭ ﻗﺘﻠﻬﺎ ‪.‬‬
‫ﻭﳍﺎ ﻋﺪﺓ ﺍﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﺸﺎﺋﻊ ﻣﻨﻬﺎ ‪:‬‬
‫ﻣﻌﺎﳉﺔ ‪ Helicobacter pylori eradication‬ﺍﻟﺘﻲ ﺗﻜﻮﻥ ﺳﺒﺐ ﺭﺋﻴﺴﻲ ﰲ ﻣﺮﺽ ﺍﻟﻘﺮﺣﺔ‬
‫ﺑﺎﳌﺸﺎﺭﻛﺔ ﻣﻊ ﻣﻀﺎﺩﺍﺕ ﺣﻴﻮﻳﺔ ﺍﺧﺮﻯ ﻣﺜﻞ ‪ flagyl‬ﻭ ‪. Amoxil‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺘﻬﺎﺏ ﺍﻻﺫﻥ ﺍﻟﻮﺳﻄﻰ ‪.Otitis media‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻛﺬﻟﻚ ﰲ ﺍﻟﺴﻌﺎﻝ ﺍﻟﺪﻳﻜﻲ ﺍﻭ ﺍﻟﺸﺎﻫﻮﻕ ‪. Pertussis infection‬‬
‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﻻﺣﻠﻴﻞ ﻣﻦ ﻧﻮﻉ )‪ Urethritis (non-gonococcal‬ﻭﺍﻟﺘﻬﺎﺑﺎﺕ ﺍجملﺎﺭﻱ ﺍﻟﺘﻨﻔﺴﻴﺔ‬
‫ﺑﺼﻮﺭﺓ ﻋﺎﻣﺔ ﻭﻏﲑﻫﺎ ‪.‬‬

‫ﻭﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻻﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ ‪ Macrolides‬ﻫﻲ ‪:‬‬

‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪.‬‬
‫ﻭﺍﻻﺳﻬﺎﻝ ﻭﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺪ ﻭﺍﻟﺒﻨﻜﺮﻳﺎﺱ ‪.‬‬
‫ﻭﺗﺘﺎﻳﺾ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﺒﺪ ﻭﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. the biliary route‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ‪. warfarin‬‬
‫ﻭﺗﺜﺒﻂ ﺗﺎﻳﺾ ﻋﻼﺝ ‪ theophylline‬ﻭ ‪ carbamazepine‬ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ﺗﺮﻛﻴﺰﻩ ﻭﲰﻴﺘﻪ ‪.‬‬
‫ﻛﻤﺎ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺧﻄﺮ ﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﻟﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﻟﻮ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪ amiodarone‬ﺣﻴﺚ ﻳﺆﺩﻱ‬
‫ﺍﱃ ‪. QT prolongation‬‬

‫ﺍﻥ ﻋﻼﺝ ‪ Erythromycin‬ﳝﺘﻠﻚ ‪. similar bacterial sensitivity to penicillins‬‬

‫ﻟﺬﺍ ﻳﺴﺘﻌﻤﻞ ﻛﺒﺪﻳﻞ ‪. penicillins‬‬

‫‪٨٢‬‬
 community-acquired ‫ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‬Macrolides ‫ﻭﺍﻳﻀﺎ ﺍﺩﻭﻳﺔ ﳎﻤﻮﻋﺔ‬
. pneumonia
.‫ﺍﻟﺘﻲ ﲢﺪﺙ ﺑﺴﺒﺐ‬
.(Mycoplasma spp., Chlamydia spp., Legionella spp.)
‫ ﻛﻞ ﻣﻦ ﻣﻀﺎﺩﻳﻦ ﺣﻴﻮﻳﻦ ﻣﻊ ﺍﺣﺪ ﺍﺩﻭﻳﺔ‬Helicobacter pylori ‫ﻭﺍﻳﻀﺎ ﻧﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‬
either amoxicillin or metronidazole and ‫ ﳌﺪﺓ ﺍﺳﺒﻮﻉ ﻭﺍﺣﺪ ﻭﻫﻢ‬PPI.
. clarithromycin and a PPI
. ‫ ﻳﻮﻡ ﻟﺬﺍ ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻓﻘﻂ‬٤ ‫ ﺍﱃ‬٢ ‫ ﻫﻲ ﻣﻦ‬azithromycin ‫ﻛﻤﺎ ﺍﻥ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﺪﻭﺍء‬

. Quinolones ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‬

***************************

. ‫ﺗﻌﺘﱪ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺷﺎﺋﻌﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻭﻓﻌﺎﻟﺔ ﺟﺪﺍ‬

. Ciprofloxacin, levofloxacin, ofloxacin ‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ‬
. ‫ﻭﻫﻲ ﻃﻮﻳﻠﺔ ﺍﳌﻔﻌﻮﻝ ﻭﻳﻨﻔﻊ ﺍﻋﻄﺎءﻫﺎ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﻣﻨﻬﺎ ﺍﻟﺘﻬﺎﺏ ﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ ﺍﻟﺴﻔﻠﻰ ﻭﺍﻟﻌﻠﻴﺎ ﻭﺍﻳﻀﺎ ﰲ‬
. Infections of the GI system ‫ﻣﻌﺎﳉﺔ‬
. Typhoid fever ‫ﻭﻛﺬﻟﻚ ﰲ‬
. Bronchopulmonary infections ‫ﻭﺍﻳﻀﺎ ﰲ‬
. Gonorrhoea and non-gonococcal urethritis and cervicitis ‫ﻭﻛﺬﻟﻚ‬
. Anthrax ‫ﻭﺍﺧﲑﺍ ﰲ‬
Patients with a history of tendon disorders related ‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ‬
. to quinolones
risk ‫ ﻻﻧﻬﺎ ﺗﺴﺒﺐ‬Pregnancy, children and growing adolescents ‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﰲ‬
. ‫ ﻭﺍﻥ ﻛﺎﻧﺖ ﺑﻌﺾ ﺍﳌﺼﺎﺩﺭ ﺗﻘﻮﻝ ﺗﻌﻄﻰ ﲝﺬﺭ ﻟﻼﻃﻔﺎﻝ ﻭﻟﻴﺴﺖ ﳑﻨﻮﻋﺔ‬of joint arthropathy
. Tendon inflammation and damage ‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ‬
. Confusion, anxiety and depression ‫ﻭ‬
. Phototoxicity with excessive sunlight ‫ﻭ‬
. Rashes (including Stevens–Johnson syndrome) ‫ﻭ‬
. ‫ ﻭﺍﻟﺼﺪﺍﻉ ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ‬Dizziness ‫ﻭ‬

٨٣
 ‫ﻋﻼﺝ ‪ Ciprofloxacin‬ﳜﺮﺝ ﻏﲑ ﻣﺘﻐﲑ ﻣﻦ ﺧﻼﻝ ‪ unchanged in urine‬ﻭﺍﻳﻀﺎ ﻫﺬﺍ ﺍﻟﻌﻼﺝ‬
‫ﻳﺰﻳﺪ ‪.anticoagulant effect of warfarin‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﻟﺴﻤﻴﺔ ﺍﻟﻜﻠﻮﻳﺔ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪.ciclosporin‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺗﺸﻨﺠﺎﺕ ‪ convulsions‬ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻊ ‪NSAIDs or‬‬
‫‪ theophylline‬ﻭﻫﺬﺍ ﺍﻟﺘﺪﺍﺧﻞ ﺟﺪﺍ ﺷﺎﺋﻊ ﻭﺧﺎﺻﺔ ﻋﻨﺪ ﻣﺮﺿﻰ ﺍﻟﺼﺮﻉ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪. prolong the QT interval‬‬
‫ﻛﻤﺎ ﻳﻘﻞ ﺍﻣﺘﺼﺎﺹ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻣﻊ ‪aluminium- or magnesium-containing‬‬
‫‪.antacids or iron‬‬
‫ﻭﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺗﻌﺘﱪ ‪. The bactericidal action‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Tetracyclines‬‬

‫*****************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Tetracyclines‬ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ ‪Doxycycline, tetracycline,‬‬

‫‪ oxytetracycline‬ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ Urogenital tract infections‬ﻣﺜﻞ ‪urethritis‬‬
‫‪. caused by Chlamydia spp‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﻪ ﻫﻲ‪:‬‬
‫ﻋﺴﺮ ﺍﳍﻀﻢ ﻭﺗﻘﺮﺡ ﺍﳌﺮﻱء ‪. Dysphagia and oesophageal irritation‬‬
‫ﻭ ﺍﻟﺘﺤﺴﺲ ﺍﻟﻀﻮﺋﻲ ‪. Photosensitivity‬‬
‫ﻟﺬﺍ ﳚﺐ ﺍﻟﺘﺤﻔﻆ ﻣﻦ ﺍﻟﺘﻌﺮﺽ ﻻﺷﻌﺔ ﺍﻟﺸﻤﺲ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻭﺧﺎﺻﺔ ‪Doxycycline‬‬
‫ﻋﻦ ﻃﺮﻳﻖ ﺍﺳﺘﻌﻤﺎﻝ ‪. high-factor sun protection‬‬
‫ﻭﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ ﺛﻼﺙ ﺣﺎﻻﺕ ﻣﻨﻌﺎ ﺑﺎﺗﺎ ﻭﻫﻢ‪:‬‬
‫ﺍﳊﻤﻞ ‪.‬‬
‫ﻭﺍﻻﺭﺿﺎﻉ ‪.‬‬
‫ﻭﺍﻻﻃﻔﺎﻝ ﺍﻗﻞ ﻣﻦ ﻋﻤﺮ ‪ ٨‬ﺳﻨﺔ ‪.‬‬
‫ﻭﳑﻨﻮﻋﺔ ﰲ ‪. Chronic kidney disease‬‬

‫‪٨٤‬‬
 ‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Acne vulgaris and rosacea‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﲪﻰ ﻣﺎﻟﻄﺎ ﻣﻊ ﺍﻟﺮﻳﻔﺎﻣﺒﺴﲔ ‪.‬‬
‫ﻋﻼﺝ ‪ Tetracyclines‬ﻳﺰﻳﺪ ﻣﻦ ﻓﻌﻞ ﻋﻼﺝ ﺍﻟﻮﺍﺭﻓﺮﻳﻦ ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﻨﺎﻙ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ idiopathic intracranial hypertension‬ﻋﻨﺪﻣﺎ ﻳﺴﺘﻌﻤﻞ‬
‫‪. tetracyclines used with retinoids‬‬
‫ﻭﻋﻼﺝ ‪ Doxycycline‬ﻳﺰﻳﺪ ﻣﻦ ﺍﻟﱰﻛﻴﺰ ﺍﻟﻌﻼﺟﻲ ﻣﻦ ‪. ciclosporin‬‬
‫ﻭﺍﻳﻀﺎ ﻋﻼﺝ ﺍﻟﺘﱰﺍﺳﻴﻜﻠﲔ ﳚﺐ ﲡﻨﺒﺔ ﻋﻨﺪ ﻛﻞ ﻣﺮﻳﺾ ﻳﺘﻨﺎﻭﻝ ‪ hepatotoxic drugs‬ﻻﻥ ﻋﻼﺝ‬
‫ﺍﻟﺘﱰﺍﺳﻴﻜﻠﲔ ﻳﱰﻛﺰ ﻛﺜﲑﺍ ﰲ ﺍﻟﻜﺒﺪ ﻭﺍﳌﺮﺍﺭﺓ ‪.‬‬
‫ﻛﻤﺎ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﻭﻯ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﺍﻟﺴﻔﻠﻰ ‪Haemophilus‬‬
‫‪. influenzae infections in COPD patients‬‬

‫ﻋﻼﺝ ‪Nitrofurantoin‬‬
‫*********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Nitrofurantoin‬ﻳﺴﺘﻌﻤﻞ ﰲ ‪.‬‬

‫ﻣﻌﺎﳉﺔ ﺍﻟﺘﻬﺎﺏ ﺍﻭ ﻋﺪﻭﻯ ﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ ﻏﲑ ﺍﳌﺼﺤﻮﺑﺔ ﲟﻀﺎﻋﻔﺎﺕ ‪. Uncomplicated UTI‬‬
‫ﻭﺍﻥ ﺍﻣﺘﺼﺎﺹ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻳﺘﺄﺛﺮ ﺟﺪﺍ ﻋﻨﺪﻣﺎ ﻳﺆﺧﺬ ﻣﻌﻪ ‪magnesium-containing antacids‬‬
‫‪.‬‬
‫ﻭﻻﻳﻨﻔﻊ ﰲ ﻣﻌﺎﳉﺔ ‪ bacteraemia‬ﻻﻥ ‪ concentrations of the drug are low‬ﰲ‬
‫‪. plasma‬‬
‫ﻭﺍﻥ ﺍﻟﻜﻮﺭﺱ ﺍﻟﻌﻼﺟﻲ ﳌﺪﺓ ‪ ٣‬ﺍﻳﺎﻡ ﳌﻌﺎﳉﺔ ‪ Uncomplicated UTI‬ﻋﻨﺪ ﺍﻟﻨﺴﺎء ﻫﻮ ﻛﺎﰲ ‪.‬‬
‫ﻭﻣﻦ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﺍﳌﻬﻤﺔ‪.‬‬
‫ﻫﻲ ‪. Peripheral neuropathy‬‬
‫ﻭﺣﺪﻭﺙ ‪. Pulmonary fibrosis‬‬
‫ﻭ ﺍﻳﻀﺎ ﻳﺴﺒﺐ ﲢﻠﻞ ﺍﻟﺪﻡ ‪. Haemolytic anaemia‬‬
‫ﻭ ﺍﻥ ‪ % ٤٠‬ﻣﻨﻪ ﳜﺮﺝ ﻏﲑ ﻣﺘﺎﻳﺾ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺒﻮﻝ ‪.‬‬

‫‪٨٥‬‬
 ‫ﻭﻋﻤﺮﻩ ﺍﻟﻨﺼﻔﻲ ﻓﻘﻂ ‪ ٣٠‬ﺩﻗﻴﻘﺔ ‪.‬‬

‫ﺍﻥ ﻋﻼﺝ ‪ Nitrofurantoin‬ﻏﲑ ﻓﻌﺎﻝ ﺿﺪ ﺑﻜﱰﻳﺎ ‪ Proteus spp‬ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﻛﺜﲑﺍ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ‪.‬‬
‫ﻻﻧﻬﺎ ﻫﺬﻩ ﺍﻟﺒﻜﱰﻳﺎ ﲡﻌﻞ ﻭﺳﻂ ﺍﻟﺒﻮﻝ ﻗﺎﻋﺪﻱ ‪.alkaline‬‬
‫ﻋﻦ ﻃﺮﻳﻖ ﺍﻓﺮﺍﺯ ‪. ammonium-producing urease enzyme‬‬
‫ﻭﻫﺬﺍ ﺍﳌﻀﺎﺩ ﺍﳊﻴﻮﻱ ﻏﲑ ﻓﻌﺎﻝ ﰲ ﺍﻟﻮﺳﻂ ﺍﻟﻘﺎﻋﺪﻱ ‪. alkaline‬‬
‫ﻭﺍﻳﻀﺎ ‪.‬‬
‫ﻋﻼﺝ ‪ Nitrofurantoin‬ﳑﻨﻮﻉ ﺍﻻﺳﺘﻌﻤﺎﻝ ﰲ ‪.‬‬
‫ﻟﻠﺮﺿﻊ ﺍﻗﻞ ﻣﻦ ﻋﻤﺮ ‪ ٣‬ﺍﺷﻬﺮ ‪.‬‬
‫ﻭﺍﳌﺮﺍءﻩ ﺍﳊﺎﻣﻞ ﰲ ‪ at term‬ﻟﺘﺠﻨﺐ ﺣﺪﻭﺙ ‪ haemolytic anaemia‬ﰲ ‪. neonate‬‬
‫ﻛﻤﺎ ﻳﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ ﺟﺪﺍ ﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ‪ peripheral neuropathy‬ﻟﺘﺠﻨﺐ ﺣﺪﻭﺙ‬
‫‪. irreversible neuronal adverse affects‬‬
‫ﻭﻫﻮ ﳑﻨﻮﻉ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ‪. Renal impairment‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺰﻳﺪ ﻣﻦ ﺣﺪﻭﺙ ﺍﻟﻐﺜﻴﺎﻥ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﰲ ﺍﻭﻝ ﺍﺷﻬﺮ ﺍﳊﻤﻞ ﻻﻧﻪ ﻳﺴﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ﻛﺘﺎﺛﲑ‬
‫ﺟﺎﻧﺒﻲ ﻭﺍﻳﻀﺎ ﻃﺒﻴﻌﺔ ﺍﳊﻤﻞ ﰲ ﺑﺪﺍﻳﺘﻪ ﻳﺴﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ‪.‬‬

‫*****‬
‫**********‬
‫*********************‬

‫ﻋﻼﺝ ‪Trimethoprim‬‬
‫**************************‬

‫‪٨٦‬‬
‫ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﻋﻼﺝ ‪ Trimethoprim‬ﻳﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺍﻻﺭﺗﺒﺎﻁ ﺍﱃ ‪bacterial dihydrofolate‬‬
‫‪. reductase‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ ﻭﻳﺜﺒﻂ ﺗﻜﻮﻳﻦ ‪ production of tetrahydrofolate‬ﺑﺼﻮﺭﺓ ﻏﲑ ﻋﻜﺴﻴﺔ ‪.‬‬
‫ﺍﻟﺬﻱ ﻳﻌﺘﱪ ﻣﺼﺪﺭ ﺗﻜﻮﻳﻦ ‪ thymidine.‬ﻟﻠﺒﻜﱰﻳﺎ ﺍﻟﺬﻱ ﻳﺆﺩﻱ ﺍﱃ ﻣﻨﻊ ﺗﻜﻮﻳﻦ ‪bacterial DNA‬‬
‫‪ synthesis‬ﻭﺑﺎﻟﺘﺎﱄ ﺍﻟﺘﺨﻠﺺ ﻣﻦ ﻫﺬﻩ ﺍﻟﺒﻜﱰﻳﺎ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪. Hyperkalaemia‬‬
‫ﻭ ‪. Rashes‬‬
‫ﻭ ‪. Pruritis‬‬
‫ﻭ ‪. GI disturbance‬‬
‫ﻭﻳﺮﺗﺒﻂ ﻧﺼﻒ ﺗﺮﻛﻴﺰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﱃ ‪. plasma protein‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ‪. renal impairment‬‬
‫ﻭﻳﺰﻳﺪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺧﻄﺮ ﺣﺪﻭﺙ ‪ ventricular arrhythmias‬ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻣﻊ ‪. amiodarone‬‬
‫ﻛﻤﺎ ﺗﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ haematological toxicity‬ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻣﻊ ‪azathioprine‬‬
‫‪. and methotrexate‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻟﻘﻮﻝ ﺍﻥ ﻋﻼﺝ ‪ Co-trimoxazole‬ﻫﻮ ﻣﺮﻛﺐ ﻳﺘﻜﻮﻥ ﻣﻦ ‪trimethoprim and‬‬
‫‪. sulfamethoxazole‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Antituberculosis drugs‬‬

‫*********************************‬

‫ﻭﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻣﺮﺍﺽ ﳏﺪﺩﺓ ‪.‬‬
‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪ Ethambutol‬ﻭ ‪ Isoniazid‬ﻭ ‪ Pyrazinamide‬ﻭ ‪ Rifampicin‬ﻭ‬
‫‪. Streptomycin‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻋﺪﺓ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﺍﺑﺮﺯﻫﺎ ﻣﺮﺽ ﺍﻟﺘﺪﺭﻥ ﺍﻭ ﺍﻟﺴﻞ ﺍﻟﺮﺋﻮﻱ ‪Tuberculosis‬‬
‫‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻣﺮﺍﺽ ﺍﺧﺮﻯ ﻭﻟﻜﻨﻬﺎ ﻣﻨﻔﺮﺩﺓ ﻣﺜﻞ ﻋﻼﺝ ‪ Streptomycin‬ﻳﺴﺘﻌﻤﻞ ﰲ‬
‫ﻣﻌﺎﳉﺔ ﲪﻰ ﻣﺎﻟﻄﺎ ‪.‬‬

‫‪٨٧‬‬
 ‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪ Hepatotoxicity‬ﺣﻴﺚ ﻳﺴﺒﺒﻬﺎ ﻛﻞ ﻣﻦ‬
‫‪. (isoniazid, rifampicin, pyrazinamide‬‬
‫ﻭﺍﻳﻀﺎ )( ‪ Peripheral neuropathy‬ﺣﻴﺚ ﻳﺴﺒﺒﻬﺎ ‪. isoniazid‬‬
‫ﻭﺍﻳﻀﺎ ‪ Hyperuricaemia and gout‬ﺣﻴﺚ ﻳﺴﺒﺒﻬﺎ )‪. pyrazinamide‬‬
‫ﻭﺍﻳﻀﺎ ‪ Orange-red discolouration of urine and tears‬ﻭ ‪Flu-like’ symptoms‬‬
‫‪ and fever‬ﺣﻴﺚ ﻳﺴﺒﺒﻬﺎ )‪. rifampicin‬‬
‫ﻭﺍﻳﻀﺎ ‪ Ototoxicity and nephrotoxicity‬ﺣﻴﺚ ﻳﺴﺒﺒﻬﺎ )‪. streptomycin‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﻄﻰ ﲝﺬﺭ ﻋﻨﺪ ﻛﺒﺎﺭ ﺍﻟﺴﻦ ﻭﺍﳌﺼﺎﺑﲔ ﲞﻠﻞ ﻛﻠﻮﻱ ﺍﻭ ﻛﺒﺪﻱ ﺍﻭ ﰲ ﺍﻟﺴﻤﻊ ‪.‬‬
‫ﺍﻣﺎ ﰲ ﺍﳊﻤﻞ ﻓﻼﻧﻌﻄﻲ ﻋﻼﺝ ‪ . streptomycin‬ﻭﻋﻼﺟﻲ ‪ rifampicin and isoniazid‬ﺗﻌﻄﻰ‬
‫ﲝﺬﺭ ‪.‬‬
‫ﻭﻣﻦ ﻧﺎﺣﻴﺔ ﺳﺮﻳﺮﻳﺔ ﻓﺎﻥ ‪ Pulmonary tuberculosis‬ﺗﻌﺎﰿ ﺑﻜﻮﺭﺳﲔ ﺍﻻﻭﻝ ﻳﺴﺘﻤﺮ ﺷﻬﺮﻳﻦ‬
‫ﺑﺎﺭﺑﻊ ﺍﺩﻭﻳﺔ ﻭﺍﻟﺜﺎﻧﻲ ﺍﺭﺑﻊ ﺍﺷﻬﺮ ﺑﻌﻼﺟﲔ ﻫﻤﺎ ‪.rifampicin and isoniazid‬‬
‫ﻛﻤﺎ ﺍﻥ ﻋﻼﺝ ‪ Isoniazid‬ﻳﺰﻳﺪ ﻣﻦ ﺍﻟﱰﻛﻴﺰ ﺍﻟﺒﻼﺯﻣﻲ ﻻﺩﻭﻳﺔ ﺍﻟﺼﺮﻉ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻋﻼﺝ ‪ Rifampicin‬ﻳﻌﺘﱪ ‪ hepatic enzyme inducer‬ﻟﺬﺍ ﻓﻬﻮ ﻳﺴﺮﻉ ﺍﻳﺾ ﺑﻌﺾ‬
‫ﺍﻻﺩﻭﻳﺔ ﻣﺜﻞ ‪. oestrogens, corticosteroids, phenytoin and anticoagulants‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Amoebicides‬‬

‫*************************‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Amoebicides‬‬

‫ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ infection‬ﺑﺴﺒﺐ ﺍﻻﻣﻴﺒﻴﺎ ‪.‬‬
‫ﻭﺍﻭﻝ ﺍﻓﺮﺍﺩ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﻟﺸﻬﲑ ‪. Metronidazole‬‬
‫ﻭﺍﻟﺬﻱ ﻳﻌﺘﱪ ﺍﻟﻌﻼﺝ ﺍﻻﻓﻀﻞ ﳌﻌﺎﳉﺔ ‪ acute invasive amoebic dysentery‬ﻻﻧﻪ ﺟﺪﺍ ﻓﻌﺎﻝ ﺿﺪ‬
‫‪ vegetative form‬ﻟــــﻄﻔﻴﻠﻲ ‪. Entamoeba histolytica‬‬
‫ﻭﻳﻌﻄﻰ ﲜﺮﻋﺔ ‪ ٨٠٠‬ﻣﻠﻐﻢ ﺛﻼﺙ ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ‪ ٥‬ﺍﻳﺎﻡ ﻓﻘﻂ‪. .‬ﻭﺍﻟﻌﻼﺝ ﺍﻟﺜﺎﻧﻲ ﻣﻦ ﺍﺩﻭﻳﺔ ﻫﺬﻩ‬
‫ﺍجملﻤﻮﻋﺔ ﻫﻮ ﺩﻭﺍء ‪ Tinidazole‬ﻭﻫﻮ ﺍﻳﻀﺎ ﻓﻌﺎﻝ ﺑﻨﻔﺲ ﻓﻌﺎﻟﻴﺔ ‪. Metronidazole‬‬
‫ﻓﻌﺎﻟﲔ ﺍﻳﻀﺎ ﺿﺪ ﺍﻟﻄﻔﻴﻠﻲ ﺍﻻﻣﻴﺒﻴﺎ ﺍﻟﺬﻱ‬ ‫ﻭﺍﻟﻌﻼﺟﲔ‬
‫ﻳﺘﻮﺍﺟﺪ ﻭﻳﻬﺎﺟﺮ ﺍﱃ ﺍﻟﻜﺒﺪ ‪.‬‬

‫‪٨٨‬‬
 ‫ﳚﺐ ﺍﻥ ﻳﻜﻮﻥ‬ ‫ﻭﻋﻼﺝ ﻫﺬﺍ ﺍﻟﻄﻔﻴﻠﻲ ﺑﺎﻱ ﻣﻦ ﺍﻻﻋﻼﺟﲔ‬
‫ﻣﺘﺒﻮﻉ ﺑﺎﺳﺘﻌﻤﺎﻝ ﺩﻭﺍء ‪ Diloxanide furoate‬ﳌﺪﺓ ﻋﺸﺮﺓ ﺍﻳﺎﻡ ‪.‬‬
‫‪ E. histolytica‬ﺍﻟﺬﻱ ﻳﺘﻮﺍﺟﺪ ﰲ ﺧﺮﻭﺝ ﺍﳌﺮﻳﺾ‬ ‫ﻭﺩﻭﺍء ‪ diloxanide‬ﻓﻌﺎﻝ ﺟﺪﺍ ﳌﻌﺎﳉﺔ‬
‫ﺑﺪﻭﻥ ﺣﺪﻭﺙ ﺍﻋﺮﺍﺽ‪.‬‬
‫ﻓﻬﻤﺎ ﻏﲑ ﻓﻌﺎﻟﲔ ﻧﺴﺒﻴﺎ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ‬ ‫ﺍﻣﺎ ﻋﻼﺟﻲ‬
‫‪.‬‬
‫ﺧﺎﱄ ﻣﻦ ﺍﻻﻋﺮﺍﺽ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻟﺴﻤﻴﺔ ﻭﻳﻌﻄﻰ ﻛﻤﺎ ﻗﻠﻨﺎ ﰲ‬ ‫ﻭﻳﻌﺘﱪ ﺩﻭﺍء‬
‫ﻛﻮﺭﺱ ﻋﻼﺟﻲ ﳌﺪﺓ ﻋﺸﺮﺓ ﺍﻳﺎﻡ ﻭﻳﻌﻄﻰ ﺍﻣﺎ ﲟﻔﺮﺩﺓ ﳌﻌﺎﳉﺔ ﺷﻜﻞ ‪ cyst‬ﻣﻦ ﻃﻔﻴﻠﻲ ﺍﻻﻣﻴﺒﻴﺎ ﺍﻭ‬
‫ﻭﺍﻳﻀﺎ ﳌﺪﺓ ﻋﺸﺮﺓ ﺍﻳﺎﻡ‬ ‫ﻳﺴﺘﻌﻤﻞ ﺑﻌﺪ ﺍﳌﻌﺎﳉﺔ ﺑﺎﺣﺪ ﺩﻭﺍﺋﻲ‬
‫ﳌﻌﺎﳉﺔ ﺍﻟﺸﻜﻞ ﺍﻟﻜﻴﺴﻲ ﺍﳌﺘﺒﻘﻲ ﰲ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ﺑﻌﺪ ﺍﻟﻘﻀﺎء ﻋﻠﻰ ﺍﻟﺸﻜﻞ ‪ trophozoite‬ﺑﻮﺍﺳﻄﺔ‬
‫‪.‬‬
‫ﺯﻣﻼﺋﻲ ﺍﻻﻋﺰﺍء ﺍﻣﺎ ﻣﻌﺎﳉﺔ ‪ amoebic abscesses‬ﺍﻟﺬﻱ ﳛﺪﺙ ﰲ ﺍﻟﻜﺒﺪ ﻓﺎﻥ ﺩﻭﺍء‬
‫ﻫﻮ ﺍﻻﺧﺮ ﻓﻌﺎﻝ‪.‬‬ ‫ﻓﻌﺎﻝ ﺟﺪﺍ ﻭﺍﻳﻀﺎ ﺩﻭﺍء‬
‫ﺍﻭ ﻋﺪﻡ‬ ‫ﰲ ﺣﺎﻟﺔ ﺗﻮﻗﻊ ﺣﺪﻭﺙ‬ ‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺍﻟﺘﻔﻜﲑ ﺑﻌﻤﻞ ‪ aspiration‬ﻟﻠــ‬
‫‪.‬‬ ‫ﺍﻟﺘﺤﺴﻦ ﺑﻌﺪ ‪ ٧٢‬ﺳﺎﻋﺔ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻝ‬
‫ﺍﱃ ﻣﻮﻗﻊ‬ ‫ﻳﺴﺎﻋﺪ ﻋﻠﻰ ﺍﺧﱰﺍﻕ ﺩﻭﺍء‬ ‫ﻭﻋﻤﻠﻴﺔ ‪ aspiration‬ﻟﻠــ‬
‫ﺍﻟﻌﺪﻭﻯ ﺑﺼﻮﺭﺓ ﺍﻛﺜﺮ ﻓﻌﺎﻟﻴﺔ ﻭﻳﺰﻳﺪ ﻣﻦ ﳒﺎﺡ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﻌﻼﺟﻴﺔ ‪.‬‬
‫ﻳﻌﺘﱪ ﻏﲑ ﻓﻌﺎﻝ ﰲ ﻣﻌﺎﳉﺔ ﺍﻻﻣﻴﺒﻴﺎ ﺍﻟﺘﻲ ﺗﺘﻮﺍﺟﺪ ﰲ ﺍﻟﻜﺒﺪ‬ ‫ﻋﻼﺝ‬
‫‪ hepatic amoebiasis‬ﻭﻟﻜﻦ ﻣﻊ ﺫﻟﻚ ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﺑﻌﺪ ﺍﳌﻌﺎﳉﺔ ﺑﺪﻭﺍء‬
‫‪.‬‬ ‫ﳌﺪﺓ ﻋﺸﺮﺓ ﺍﻳﺎﻡ ﳌﻌﺎﳉﺔ‬
‫ﻫﻲ ﺣﺪﻭﺙ ﺍﻻﻧﺘﻔﺎﺥ ﰲ ﺍﻟﺒﻄﻦ‬ ‫ﺍﺣﺒﺎﺋﻲ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﺪﻭﺍء‬
‫ﻭﺍﻟﺘﻄﺒﻞ ﻭﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﳊﻜﺔ ﻭﺣﺪﻭﺙ ﻃﻔﺢ ﺟﻠﺪﻱ‬
‫‪.‬‬
‫ﻭﺟﺮﻋﺘﻪ ﻟﻼﻃﻔﺎﻝ ﻫﻲ ‪ ٢٠‬ﻣﻠﻐﻢ ‪/‬ﻛﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ﻣﻘﺴﻤﺔ ﻋﻠﻰ ‪ ٣‬ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ﻋﺸﺮﺓ ﺍﻳﺎﻡ ﻭﻣﺘﻮﻓﺮ‬
‫ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ‪.‬‬
‫ﻫﻲ ‪ ٢‬ﻏﻢ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ‪ ٣-٢‬ﻳﻮﻡ‬ ‫ﳌﻌﺎﳉﺔ‬ ‫ﺍﻣﺎ ﺟﺮﻋﺔ ﻋﻼﺝ‬
‫ﻭﺟﺮﻋﺘﻪ ﻟﻼﻃﻔﺎﻝ ﻫﻲ ‪ ٦٠‬ﻣﻠﻐﻢ ‪/‬ﻛﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ﳌﺪﺓ ﺛﻼﺛﺔ ﺍﻳﺎﻡ ﻓﻘﻂ ‪.‬‬
‫ﻓﻬﻲ ﻧﻔﺲ ﺍﳉﺮﻋﺔ ﺍﻟﺴﺎﺑﻘﺔ ﻭﻟﻜﻦ ﻟﻔﱰﺓ‬ ‫ﺍﻣﺎ ﺟﺮﻋﺘﻪ ﳌﻌﺎﳉﺔ‬
‫ﺍﻃﻮﻝ ﲤﺘﺪ ﺍﱃ ‪ ٦-٣‬ﺍﻳﺎﻡ ﻟﻠﻜﺒﺎﺭ ﻭ ‪ ٥‬ﺍﻳﺎﻡ ‪.‬‬

‫‪٨٩‬‬
 ‫ﻋﻼﺝ ‪Metronidazole‬‬
‫**********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Metronidazole‬ﻭﺍﻟﺬﻱ ﻳﺘﻮﻓﺮ ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ ﻭﺣﻘﻦ ﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ‬
‫ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻌﺪﻭﻯ ﺑﺎﻟﺒﻜﱰﻳﺎ ﺍﻟﻼﻫﻮﺍﺋﻴﺔ ﻭﺍﻟﻄﻔﻴﻠﻴﺎﺕ ﻣﻦ ﺍﳉﻴﺎﺭﺩﻳﺎ ﻭﺍﻻﻣﻴﺒﻴﺎ ﺣﻴﺚ ﻳﻌﻄﻰ‬
‫ﰲ ‪. Surgical prophylaxis‬‬
‫ﻭ ‪ Anaerobic infections‬ﺍﻟﺬﻱ ﻳﺘﻀﻤﻦ ﻛﻞ ﻣﻦ ‪. dental and abdominal sepsis‬‬
‫ﻭ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Protozoal infections‬‬
‫ﻭ ‪. Aspiration pneumonia‬‬
‫ﻭ ‪. Pelvic inflammatory disease‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ﺍﻟﺸﻌﻮﺭ ﺑﻄﻌﻢ ﻏﲑ ﻻﺋﻖ ﺑﺎﻟﻔﻢ ﺍﻟﺬﻱ ﻳﺸﻜﻮ ﻣﻨﻪ ﺍﻻﻃﻔﺎﻝ ﻛﺜﲑﺍ ﻭﻫﻮ‬
‫ﺳﺒﺐ ﻣﻦ ﺍﺳﺒﺎﺏ ﺍﻋﻄﺎءﻫﻢ ﺍﻟﺪﻭﺍء ﺑﺼﻌﻮﺑﺔ ‪.‬‬

‫ﻭﺍﻥ ﺍﳌﺮﻳﺾ ﺍﻟﺬﻱ ﻳﺘﻨﺎﻭﻝ ﻋﻼﺝ ‪ metronidazole‬ﳚﺐ ﺍﻥ ﻳﺘﺠﻨﺐ ﺗﻨﺎﻭﻝ ﺍﻟﻜﺤﻮﻝ ﳌﺪﺓ ‪ ٤٨‬ﺳﺎﻋﺔ‬
‫ﺑﻌﺬ ﺍﺧﺬ ﻛﻮﺭﺱ ﻋﻼﺟﻲ ﻣﻦ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ‪.‬‬
‫ﻭﺫﻟﻚ ﻟﺘﺠﻨﺐ ‪ severe disulfiram-like reaction‬ﺍﻟﺬﻱ ﻳﺘﻀﻤﻦ ‪flushing and‬‬
‫‪. hypotension‬‬
‫ﻫﺬﺍ ﺍﻟﻌﻼﺝ‪ metronidazole‬ﺍﻳﻀﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻟﻪ ﺧﻼﻝ ﺍﻻﺻﺎﺑﺔ ﲟﺮﺽ ﺍﻟﻔﺸﻞ ﺍﻟﻜﻠﻮﻱ ﺍﳌﺰﻣﻦ‬
‫‪. chronic renal failure‬ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﻳﻘﻮﻱ ﻋﻼﺝ ‪ metronidazole‬ﺍﻟﺘﺎﺛﲑ ﺍﳌﻀﺎﺩ‬
‫ﻟﻠﺘﺨﺜﺮ ﻻﺩﻭﻳﺔ ‪. anticoagulant therapy‬‬
‫ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﺟﻴﺪﺍ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪ Peripheral neuropathy‬ﻭﺧﺎﺻﺔ ﻣﻊ ﻃﻮﻝ ﻓﱰﺓ ﺍﺳﺘﻌﻤﺎﻟﺔ‬
‫‪.‬‬
‫ﻭﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ‪.‬‬
‫ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺪ ﻭﺍﻟﺒﻨﻜﺮﻳﺎﺱ ‪.‬‬

‫‪٩٠‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Glycopeptide antibiotics‬‬
‫***********************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Glycopeptide antibiotics‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Vancomycin,‬‬

‫‪. teicoplanin‬‬
‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ Gram-positive infections‬ﻣﺜﻞ ‪methicillin-resistant‬‬
‫‪. staphylococci‬‬
‫ﻭ ﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪ pneumococci‬ﺍﻟﺘﻲ ﺗﻘﺎﻭﻡ ‪. penicillin‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ‪. Prophylaxis and treatment of endocarditis‬‬
‫ﻭ ‪ Antibiotic-associated colitis due to Clostridium difficile‬ﺍﻟﺬﻱ ﻳﺴﻤﻰ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻟﻘﻮﻟﻮﻥ ﺍﻟﻜﺎﺫﺏ ﻭﻫﻲ ﺣﺎﻟﺔ ﺧﻄﺮﺓ ﺟﺪﺍ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪:‬‬
‫ﺍﻟﺴﻤﻴﺔ ﺍﻟﻜﻠﻮﻳﺔ ‪. Nephrotoxicity‬‬
‫ﻭ ‪ Ototoxicity‬ﺣﻴﺚ ﳛﺪﺙ ﻓﻘﺪﺍﻥ ﻟﻠﺴﻤﻊ ﻭﻃﻨﲔ ﰲ ﺍﻻﺫﻥ ﻭﻳﺴﺒﺐ ﺍﻳﻀﺎ ﻛﺘﺎﺛﲑ ﺟﺎﻧﺒﻲ‪.‬‬
‫ﻭﺭﺟﻔﺔ ﻭﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺍﳊﺮﺍﺭﺓ ‪. Fevers and chills‬‬
‫ﻭ ‪. Neutropenia‬‬
‫ﻭ ‪ hrombophlebitis‬ﰲ ﻣﻜﺎﻥ ﺍﻻﻋﻄﺎء ﺍﻟﻮﺭﻳﺪﻱ ‪.‬‬
‫ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻏﲑ ﻣﺘﺎﻳﻀﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻭﻫﻨﺎﻙ ﻣﻼﺣﻈﺔ ﻣﻬﻤﺔ ﻭﻫﻲ ﺍﻥ ﻫﺬﻩ ﺍﳌﻀﺎﺩﺍﺕ ﺍﳊﻴﻮﻳﺔ ﻏﲑ ﻗﺎﺩﺭﺓ ﻋﻠﻰ ﺍﺧﱰﺍﻕ ﻏﺸﺎء ﺧﻠﻴﺔ‬
‫‪ Gram-negative bacteria‬ﻻﻧﻪ ‪ high molecular weight‬ﻟﺬﻟﻚ ﻓﻬﻲ ﻓﻌﺎﻟﺔ ﺿﺪ ﺍﻟﺒﻜﱰﻳﺎ‬
‫ﺍﳍﻮﺍﺋﻴﺔ ﻭﺍﻟﻼﻫﻮﺍﺋﻴﺔ ‪ Gram-positive organisms‬ﻓﻘﻂ ﻣﺜﻞ ‪Staphylococcus spp.,‬‬
‫‪ Streptococcus spp‬ﻭ ‪. Enterococcus spp‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺘﱪ ‪ very irritant‬ﻟﺬﺍ ﻓﻴﺠﺐ ﺍﻥ ﻻﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ ﺍﻟﻌﻀﻠﻲ ﻻﻧﻬﺎ ﺗﺴﺒﺐ‬
‫‪ necrosis with IM route‬ﻭﻟﻜﻦ ﻫﺬﻩ ﺍﳌﺸﻜﻠﺔ ﺍﻗﻞ ﻣﻊ ﻋﻼﺝ‪ teicoplanin,‬ﻟﺬﻟﻚ ﳝﻜﻦ‬
‫ﺍﻋﻄﺎءﻩ ﺣﻘﻦ ﻋﻀﻠﻲ ﻭﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺘﺴﺮﻳﺐ ﺍﻟﻮﺭﻳﺪﻱ ﻭﻣﻊ ﺫﻟﻚ ﻓﺎﻥ ﺍﻻﻋﻄﺎء ﻋﻦ‬

‫‪٩١‬‬
‫ﻃﺮﻳﻖ ﺍﻟﺘﺴﺮﻳﺐ ﺍﻟﻮﺭﻳﺪﻱ ‪ IV infusion‬ﳚﺐ ﺍﻥ ﻳﻐﲑ ﻣﻜﺎﻥ ﺍﻻﻋﻄﺎء ﻭﺫﻟﻚ ﻟــ ‪minimise local‬‬
‫‪. irritation‬‬
‫ﻭﺍﻳﻀﺎ ﻋﻼﺝ ‪ Vancomycin‬ﻳﺴﺒﺐ ﲢﺮﺭ ‪ histamine‬ﺍﺫﺍ ﺍﻋﻄﻲ ﺑﺴﺮﻋﺔ ﻭﻳﺴﺒﺐ ﻇﺎﻫﺮﺓ ﺍﻟﺮﺟﻞ‬
‫ﺍﻻﲪﺮ ‪ ‘red man syndrome‬ﻟﺬﺍ ﳚﺐ ﺯﻳﺎﺩﺓ ﻓﱰﺓ ﺍﻻﻋﻄﺎء ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺍﻻﻣﺘﺼﺎﺹ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺟﺪﺍ ﻗﻠﻴﻞ ﺍﺫﺍ ﺍﻋﻄﻴﺖ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ‬
‫ﻭﻟﻜﻦ ﻣﻊ ﺫﻟﻚ ﻧﺴﺘﻌﻤﻠﻬﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻓﻘﻂ ﳌﻌﺎﳉﺔ ‪. C. difficile colitis‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻥ ﺗﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ ﻣﻊ ‪. ototoxic or nephrotoxic agents‬‬
‫ﻭﺗﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ‪. Inhibit bacterial cell wall synthesis‬‬
‫ﻭﺗﻌﻄﻰ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲝﺬﺭ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ‪ renal impairment‬ﻭﳑﻨﻮﻋﺔ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﲢﺴﺲ ﳍﺎ‬
‫‪. Hypersensitivity‬‬
‫ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺍﺿﻄﺮﺍﺏ ﺍﻟﺘﻬﺎﺑﻲ‪ inflammatory disorders‬ﰲ ﳐﺎﻃﻴﺔ ﺍﻻﻣﻌﺎء‬
‫‪intestinal mucosa‬ﻳﺆﺩﻱ ﺍﱃ ﺍﻣﺘﺼﺎﺹ ﻛﻤﻴﺔ ﻛﺒﲑﺓ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻟﻮ ﺍﻋﻄﻴﺖ ﻋﻦ ﻃﺮﻳﻖ‬
‫ﺍﻟﻔﻢ ﺣﻴﺚ ﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﺑﺪﺭﺟﺔ ﻛﺒﲑﺓ ‪increased risk of‬‬
‫‪. adverse effects‬‬

‫ﻋﻼﺝ ‪. AMPHOTERICIN B‬‬

‫************************‬

‫ﺍﻥ ﻋﻼﺝ ‪ AMPHOTERICIN B‬ﺍﳌﻀﺎﺩ ﻟﻠﻔﻄﺮﻳﺎﺕ ﻳﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﺍﻻﺭﺗﺒﺎﻁ ﺍﱃ ‪ ergosterol‬ﰲ‬

‫ﺍﻟﻐﺸﺎء ﺍﶈﻴﻂ ﺑﺎﻟﻔﻄﺮﻳﺎﺕ ﻓﻴﺆﺩﻱ ﺍﱃ ﺍﺿﻌﺎﻓﻪ ﻭﺑﺎﻟﺘﺎﱄ ﻣﻮﺕ ﺍﻟﻔﻄﺮﻳﺎﺕ ﻧﺘﻴﺠﺔ ﺧﺮﻭﺝ ﳏﺘﻮﻳﺎﺗﻬﺎ ﻣﻦ‬
‫ﺧﻼﻝ ﺍﻟﻐﺸﺎء‪.‬‬
‫ﻳﺴﺘﻌﻤﻞ ﰲ ﺍﻟﺘﻬﺎﺑﺎﺕ ﺍﻟﻔﻄﺮﻳﺎﺕ ﺍﻟﺸﺪﻳﺪ ﺃﻱ ‪. severe systemic infections‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﻟﺘﻲ ﻳﺴﺒﺒﻬﺎ ﻫﻲ ‪ fever & chills, N/V‬ﻭ ‪ –thrombophlebitis‬ﻭ‬
‫‪ nephrotoxic‬ﻭ ‪ seizures, anemia, hypokalemia‬ﻭﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻦ ﻃﺮﻳﻖ‬
‫ﺍﻟﻮﺭﻳﺪ ﻓﻘﻂ‪.‬‬
‫ﻻﻧﻪ ‪. very irritating‬‬

‫‪٩٢‬‬
 ‫ﻭﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﺑﺒﻂء ‪.‬‬
‫ﻻﻥ ﺍﻻﻋﻄﺎء ﺍﻟﺴﺮﻳﻊ ﻟﻪ ﻳﺴﺒﺐ ‪. cardiac toxicity‬‬
‫ﻭﳚﺐ ﺍﻥ ﻳﺘﻢ ﺍﻋﻄﺎء ﻣﻀﺎﺩ ﺗﻘﻴﻮء ‪ antiemetics‬ﻗﺒﻞ ‪ ٣٠‬ﺩﻗﻴﻘﺔ ﻣﻦ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء‬
‫ﲝﺬﺭ ﺷﺪﻳﺪ ﻣﻊ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﺘﱪ ‪ nephrotoxic drugs‬ﻭ ﻻﻳﺼﺢ ﺍﻋﻄﺎءﻩ ﻣﻊ ‪Normal saline‬‬
‫‪. solution‬‬
‫ﺑﻞ ﻓﻘﻂ ﻣﻊ ‪.D5W‬‬

‫‪٩٣‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ‪ Endocrine system‬ﻭﺍﻟﻀﻌﻒ ﺍﳉﻨﺴﻲ ‪.‬‬

‫‪Insulins‬‬
‫********************‬

‫ﺍﻥ ﺍﻟﻌﻼﺝ ﺍﻟﺸﻬﲑ ‪ Insulins‬ﻳﺘﻮﻓﺮ ﺑﻌﺪﺓ ﺍﻧﻮﺍﻉ ‪.‬‬

‫ﻣﻨﻬﺎ ‪ Short-acting – insulin aspart‬ﻣﺜﻞ ‪ NovoRapid‬ﻭ ‪ soluble insulin‬ﻣﺜﻞ‬
‫‪. Actrapid‬‬
‫ﻭ ‪ intermediate-acting – isophane insulin‬ﻣﺜﻞ ‪. Insulatard‬‬
‫ﻭ ‪ long-acting – insulin glargine‬ﻣﺜﻞ ‪. Lantus‬‬
‫ﻭﻳﻌﺘﱪ ﻋﻼﺝ ﺍﻻﻧﺴﻮﻟﲔ ﳑﺎﺛﻞ ﳍﺮﻣﻮﻥ ﺍﻻﻧﺴﻮﻟﲔ ﺍﻟﺬﻱ ﻳﻔﺮﺯ ﰲ ﺟﺴﻢ ﺍﻻﻧﺴﺎﻥ ﺣﻴﺚ ﻳﺰﻳﺪ ﻣﻦ‬
‫ﺗﻜﻮﻳﻦ ﺍﻟﻜﻼﻳﻜﻮﺟﲔ ﻭﳜﺰﻧﻪ ﰲ ﺍﻟﻜﺒﺪ ﻭﺍﻟﻌﻀﻼﺕ ﺍﳍﻴﻜﻠﻴﺔ ﻭﻏﲑﻫﺎ ‪.‬‬
‫ﻭﻳﻘﻠﻞ ﻣﻦ ﺗﻜﻮﻳﻦ ﺳﻜﺮ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻣﻦ ﻣﻮﺍﺩ ﻏﲑ ﻛﺎﺭﺑﻮﻫﻴﺪﺍﺗﻴﺔ ‪. gluconeogenesis‬‬
‫ﻭﻳﻘﻠﻞ ﻣﻦ ﲢﻮﻝ ﺍﻟﻜﻼﻳﻜﻮﺟﲔ ﺍﱃ ﻛﻠﻜﻮﺯ ‪ glycogenolysis‬ﻭﺑﺎﻟﺘﺎﱄ ﻳﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺍﻟﺴﻜﺮ ‪.‬‬
‫‪.‬ﻭﻳﻘﻠﻞ ﻣﻦ ﻋﻤﻠﻴﺔ ‪. proteolysis‬‬
‫ﻭﻳﺰﻳﺪ ﻣﻦ ﺩﺧﻮﻝ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ﺍﱃ ﺩﺍﺧﻞ ﺍﳋﻼﻳﺎ ‪.‬‬
‫ﻛﻤﺎ ﻳﺴﺒﺐ ‪ lipogenesis‬ﰲ ‪. peripheral tissue‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﺩﻭﺍء ﺍﻻﻧﺴﻮﻟﲔ ﰲ ﻣﻌﺎﳉﺔ ﺣﺎﻟﺘﲔ ﻣﺮﺿﻴﺘﲔ ﻫﻤﺎ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ‪Diabetes‬‬
‫‪.mellitus‬‬
‫ﻭﺍﺭﺗﻔﺎﻉ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ ‪. hyperkalaemia‬‬
‫ﻭﻫﻮ ﳑﻨﻮﻉ ﳌﻦ ﻳﻌﺎﻧﻲ ﺍﳔﻔﺎﺽ ﺳﻜﺮ ﺍﻟﺪﻡ‪. Hypogylcaemia‬‬
‫ﻭﻣﻦ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻳﺴﺒﺐ ﻫﺒﻮﻁ ﺍﻟﺴﻜﺮ ﻭﺯﻳﺎﺩﺓ ﺍﻟﻮﺯﻥ ﻭﺣﺎﻟﺔ ‪ Lipohypertrophy‬ﰲ ﻣﻜﺎﻥ‬
‫ﺍﳊﻘﻦ ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﻘﻮﻝ ﺍﻥ ﺍﻟﻔﻌﻞ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻟﺪﻭﺍء ﺍﻻﻧﺴﻮﻟﲔ ﻳﺰﺩﺍﺩ ﰲ ﺣﺎﻟﺔ ﺍﻋﻄﺎء ﻣﻌﺔ ﺍﻻﺩﻭﻳﺔ‬
‫ﺍﻟﻔﻤﻮﻳﺔ ﺍﳋﺎﻓﻀﺔ ﻟﻠﺴﻜﺮ ﻣﺜﻞ ﺍﳌﺘﻔﻮﺭﻣﲔ ﺍﻭ ﻣﻊ ﺍﻟﻜﺤﻮﻝ ﺍﻭ ﻣﻊ ﺍﺩﻭﻳﺔ ‪ACEIs, b blockers and‬‬
‫‪. MAOIs‬‬
‫ﻟﺬﺍ ﳚﺐ ﻣﺘﺎﺑﻌﺔ ﺍﳉﺮﻋﺔ ﺟﻴﺪﺍ ﻭﻣﺘﺎﺑﻌﺔ ﺳﻜﺮ ﺍﻟﺪﻡ ‪.‬‬
‫ﺍﻣﺎ ﺍﺩﻭﻳﺔ ‪ Corticosteroids‬ﻓﻬﻲ ﺗﻘﻠﻞ ﺍﻟﺘﺎﺛﲑ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻟﺪﻭﺍء ﺍﻻﻧﺴﻮﻟﲔ ‪.‬‬

‫‪٩٤‬‬
 ‫ﻭﻻﳝﻜﻦ ﺍﻋﻄﺎء ﺍﻻﻧﺴﻮﻟﲔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻻﻧﻪ ﻳﺘﺤﻄﻢ ﺑﺎﻧﺰﳝﺎﺕ ﻭﺣﺎﻣﺾ ﺍﳌﻌﺪﺓ ﺑﻞ ﻳﻌﻄﻰ ﲢﺖ‬
‫ﺍﳉﻠﺪ ﻭﻋﻨﺪ ﺍﻟﻀﺮﻭﺭﺓ ﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪﻱ ﻭﺍﻳﻀﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺘﺴﺮﻳﺐ ﺍﻟﻮﺭﻳﺪﻱ ‪.‬‬
‫ﻭﺑﻌﺾ ﺍﻧﻮﺍﻉ ﺍﻻﻧﺴﻮﻟﲔ ﺍﻥ ﱂ ﻳﻜﻦ ﲨﻴﻌﻬﺎ ﳚﺐ ﺍﻥ ﲢﻔﻆ ﰲ ﺍﻟﺜﻼﺟﺔ ﻭﰲ ﺣﺎﻟﺔ ﻋﺪﻡ ﻭﺿﻌﻬﺎ ﻓﺎﻧﻬﺎ‬
‫ﻗﺪ ﺗﻔﻘﺪ ﻓﻌﺎﻟﻴﺔ ﺍﻟﻌﻼﺝ ‪.‬‬
‫ﻭﰲ ﺑﻌﺾ ﺍﻟﻈﺮﻭﻑ ﺍﻟﺘﻲ ﻳﺘﻌﺮﺽ ﳍﺎ ﻣﺮﻳﺾ ﺍﻟﺴﻜﺮ ﻗﺪ ﻳﺘﻄﻠﺐ ﺯﻳﺎﺩﺓ ﺍﳉﺮﻋﺔ ﻣﻨﻬﺎ ‪intercurrent‬‬
‫‪ illness, stress, trauma and puberty‬ﻭﺫﻟﻚ ﻟﺰﻳﺎﺩﺓ ﺍﻧﺘﺎﺝ ﺍﳍﺮﻣﻮﻧﺎﺕ ﺍﳌﻀﺎﺩﺓ ﻟﻔﻌﻞ‬
‫ﺍﻻﻧﺴﻮﻟﲔ ﰲ ﻫﺬﻩ ﺍﻟﻈﺮﻭﻑ ﻣﺜﻞ ‪ cortisol, growth hormone‬ﺑﺎﻻﻇﺎﻓﺔ ﺍﱃ ﺍﳍﺮﻣﻮﻧﺎﺕ‬
‫ﺍﳉﻨﺴﻴﺔ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Sulfonylureas‬‬

‫*************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Sulfonylureas‬ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ ‪:‬‬

‫‪ Gliclazide, tolbutamide, glibenclamide, glipizide‬ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‪:‬‬
‫ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ﺍﻟﺬﻱ ﻻﻳﻌﺘﻤﺪ ﻋﻠﻰ ﺍﻻﻧﺴﻮﻟﲔ ‪. Type 2 diabetes mellitus‬‬
‫ﻭﳑﻨﻮﻋﺔ ﰲ ‪. Ketoacidosis‬‬
‫ﻭ ‪. Severe hepatic impairment‬‬
‫ﻭ‪. Acute porphyria‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ﺍﳔﻔﺎﺽ ﺍﻟﺴﻜﺮ ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪.‬‬
‫ﻭ‪. Blood disorders‬‬
‫ﻭ ‪. Hypersensitivity reactions‬‬

‫ﻭﺍﻥ ﺍﺩﻭﻳﺔ ‪ Sulfonylureas‬ﳑﻜﻦ ﺍﻥ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﰲ ﺍﻟﻮﺯﻥ ﻓﻴﺠﺐ ﺍﻥ ﻻﺗﻜﻮﻥ ﺍﳋﻴﺎﺭ ﺍﻟﻌﻼﺟﻲ‬
‫ﺍﻻﻭﻝ ﰲ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻠﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﺴﻤﻨﺔ ‪.‬‬
‫ﺑﻞ ﳚﺐ ﻭﺻﻒ ﺩﻭﺍء ‪ metformine‬ﳍﻢ ‪.‬‬

‫‪٩٥‬‬
 ‫ﻛﻤﺎ ﺍﻥ ﺍﺣﺪ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻭﻫﻮ ‪ Glibenclamide‬ﳝﺘﻠﻚ ﻓﻌﻞ ﻃﻮﻳﻞ ‪.‬‬
‫ﲝﻴﺚ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ﺍﳔﻔﺎﺽ ﻟﻠﺴﻜﺮ ﻭﺧﺎﺻﺔ ﻋﻨﺪ ﻛﺒﺎﺭ ﺍﻟﺴﻦ ﻛﻤﺎ ﺍﻥ ﺩﻭﺍء ‪Fluconazole‬‬
‫ﻳﺰﻳﺪ ﻣﻦ ‪. plasma sulfonylurea levels‬‬
‫ﻭ ﺍﻥ ﺍﻟﺘﺎﺛﲑ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻳﺰﺩﺍﺩ ﻣﻊ ﺗﻨﺎﻭﻝ ‪ warfarin‬ﻣﻊ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬

‫ﻭﺑﺘﻌﺒﲑ ﺍﺧﺮ ‪:‬‬

‫ﻣﻦ ﺍﻫﻢ ﺍﻻﻓﻌﺎﻝ ﺍﻟﺘﻲ ﺗﻘﻮﻡ ﺑﻬﺎ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Sulphonylureas‬‬
‫ﻭﺍﻟﺘﻲ ﺗﺴﺒﺐ ﲞﻔﺾ ﺳﻜﺮ ﺍﻟﺪﻡ ﻫﻲ‪:‬‬
‫ﺗﺰﻳﺪ ﺣﺴﺎﺳﻴﺔ ﺧﻼﻳﺎ ﺑﻴﺘﺎ ﻟﻠﻜﻠﻮﻛﻮﺯ ‪ b-cell sensitivity‬ﺍﻟﺬﻱ ﳛﻔﺰﻫﺎ ﻋﻠﻰ ﺍﻧﺘﺎﺝ ﺍﻻﻧﺴﻮﻟﲔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺰﻳﺪ ﻣﻦ ﻓﻌﺎﻟﻴﺔ ﺗﻘﺒﻞ ﺍﳋﻼﻳﺎ ﻟﻼﻧﺴﻮﻟﲔ ﲝﻴﺚ ﺗﺴﻤﺢ ﻟﻪ ﺑﺎﺩﺧﺎﻝ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻭﺍﻳﻀﺎ ﺗﺰﻳﺪ ﻣﻦ‬
‫ﺗﻮﺍﺟﺪ ﺍﻻﻧﺴﻮﻟﲔ ﺑﺎﻟﺪﻡ ﻋﻦ ﻃﺮﻳﻖ ﺗﻘﻠﻴﻞ ﺗﻜﺴﺮﻩ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Biguanides‬‬

‫***********************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Biguanides‬‬

‫ﺗﺸﻤﻞ ﺍﻻﻥ ﻋﻼﺝ ﻭﺍﺣﺪ ﻓﻘﻂ ﻫﻮ ‪. Metformin‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ‪. Type 2 diabetes mellitus‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﺗﻜﻴﺲ ﺍﳌﺒﺎﻳﺾ ‪. Polycystic ovarian syndrome‬‬
‫ﻭﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺧﺎﻓﺾ ﻟﻠﺴﻜﺮ ‪.‬‬
‫ﺣﻴﺚ ﻳﺰﻳﺪ ﻣﻦ ﺍﺳﺘﻬﻼﻙ ﺍﻟﺴﻜﺮ ﰲ ﺍﻟﻌﻀﻼﺕ ﺍﳍﻴﻜﻠﻴﺔ‪.‬‬
‫ﻭﻳﻘﻠﻞ ﻣﻦ ﻣﻘﺎﻭﻣﺔ ﺍﳋﻼﻳﺎ ﻟﻼﻧﺴﻮﻟﲔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﻘﻠﻞ ﻣﻦ ‪. gluconeogenesis and glycogenolysis‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﺿﻄﺮﺑﺎﺕ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪.‬‬
‫ﻭﺗﻐﲑ ﺍﻟﻄﻌﻢ ﺣﻴﺚ ﻳﺸﻌﺮ ﺍﳌﺮﻳﺾ ﺑﻄﻌﻢ ﻣﻌﺪﻧﻲ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻗﺪ ﻳﺴﺒﺐ ‪. Lactic acidosis‬‬

‫‪٩٦‬‬
 ‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ‪. Erythema, pruritus and urticaria‬‬
‫ﻭﺍﻥ ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ‪ T1/2‬ﻟﻌﻼﺝ ‪ metformin‬ﻫﻮ ‪ ٣‬ﺳﺎﻋﺎﺕ ‪.‬‬
‫ﻟﺬﻟﻚ ﻓﻬﻮ ﻳﻌﻄﻰ ‪ ٣‬ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﺑﻖ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻭﻻﻳﺘﻌﺮﺽ ﻟﻌﻤﻠﻴﺔ ﺍﻟﺘﺎﻳﺾ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ lactic acidosis‬ﻋﻨﺪﻣﺎ ﻳﺸﺮﺏ ﻣﻌﻪ ﻛﺤﻮﻝ ﺑﺼﻮﺭﺓ ﻛﺜﲑﺓ ‪.‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﻓﻌﻠﻪ ﺍﳋﺎﻓﺾ ﻟﺴﻜﺮ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻣﻊ ‪. ACEIs and MAOIs‬‬
‫ﻭﻛﺬﻟﻚ ﻳﻘﻞ ﻓﻌﻠﻪ ﺍﳋﺎﻓﺾ ﻟﻠﺴﻜﺮ ﻟﻮ ﺍﻋﻄﻲ ﻣﻊ ﺍﺩﻭﻳﺔ ‪. thiazide diuretics‬‬
‫ﻭﻳﻌﺘﱪ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﺍﳋﻴﺎﺭ ﺍﻟﻌﻼﺟﻲ ﺍﻻﻭﻝ ﰲ ﺍﳌﺮﺿﻰ ﺍﳌﺼﺎﺑﲔ ﺑﺎﻟﺴﻤﻨﺔ ‪.obese patients‬‬
‫ﻻﻧﻪ ﻻﻳﺰﻳﺪ ﺍﻟﻮﺯﻥ ﺑﻞ ﻳﻘﻠﻠﻪ ﻻﻧﻪ ﻳﻘﻠﻞ ﻣﻦ ﺍﻟﺸﻬﻴﺔ ‪.‬‬
‫ﻭﻻﻳﺆﺩﻱ ﻓﻌﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﱃ ﲢﻔﻴﺰ ﲢﺮﻳﺮ ﺍﻻﻧﺴﻮﻟﲔ ﻟﺬﻟﻚ ﻓﻬﻮ ﻻﻳﺴﺒﺐ ﻫﺒﻮﻁ ﺍﻟﺴﻜﺮ ‪.‬‬
‫ﺍﻻ ﰲ ﺍﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻭ ﻋﺪﻡ ﺗﻨﺎﻭﻝ ﺍﻻﻛﻞ ﺑﻌﺪﻩ ‪.‬‬
‫ﻭﳝﻜﻦ ﺍﻥ ﻳﺴﺒﺐ ‪ lactic acidosis‬ﻟﻮ ﺍﻋﻄﻲ ﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﺧﻠﻞ ﰲ ﺍﻟﻜﻠﻴﺔ ‪renal‬‬
‫‪. impairment‬‬
‫ﺍﻥ ﻋﻼﺝ ‪ Metformin‬ﳚﺐ ﺍﻥ ﻳﻘﻄﻊ ﻣﺒﺎﺷﺮﺓ ﺍﺫﺍ ﺗﻌﺮﺽ ﺍﳌﺮﻳﺾ ﺍﱃ ‪:‬‬
‫‪. hypoxia‬‬
‫ﺍﻭ ﺍﱃ ﺗﺪﻫﻮﺭ ﰲ ﻭﻇﻴﻔﺔ ﺍﻟﻜﻠﻴﺔ ‪.‬‬
‫ﻛﻤﺎ ﳝﻜﻦ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﺍﻻﻧﺴﻮﻟﲔ ‪insulin‬ﻭﺍﻳﻀﺎ ﻣﻊ ﺑﺎﻗﻲ ﺍﻻﺩﻭﻳﺔ ﺍﳋﺎﻓﻀﺔ ﻟﻠﺴﻜﺮ‬
‫‪ oral hypoglycaemic drugs‬ﰲ ﺣﺎﻝ ﺗﻄﻠﺐ ﺍﻻﻣﺮ ‪.‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳑﻨﻮﻉ ﰲ ﻋﺪﺓ ﺣﺎﻻﺕ ‪:‬‬
‫ﻣﻨﻬﺎ ‪. Ketoacidosis‬‬
‫ﻭ ﰲ ﺣﺎﻟﺔ ﺍﺳﺘﻌﻤﺎﻝ ‪.iodine-containing x-ray contrast media‬‬
‫ﻭ ﺍﺫﺍ ﻛﺎﻥ ‪ GFR‬ﺍﻗﻞ ﻣﻦ ‪ ٣٠‬ﻣﻞ ‪/‬ﺩﻗﻴﻘﺔ ‪.‬‬

‫ﻭﺑﺘﻌﺒﲑ ﺍﺧﺮ ‪:‬‬

‫ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﺪﻭﺍء ‪ metformine‬ﻭﺍﻟﺘﻲ ﲢﺪﺙ ﻋﻨﺪ ﺛﻠﺚ ﺍﳌﺮﺿﻰ ﺍﻟﺬﻳﻦ‬
‫ﻳﺴﺘﻌﻤﻠﻮﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻫﻲ ﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ﻭﺍﻟﺬﻱ ﻳﺴﺘﻔﺎﺩ ﻣﻨﻪ ﺣﺎﻟﻴﺎ ﰲ ﻣﻌﺎﳉﺔ ﺯﻳﺎﺩﺓ ﺍﻟﻮﺯﻥ ‪.‬‬
‫ﻭﺍﻥ ﻛﺎﻥ ﻫﺬﺍ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻏﲑ ﻣﺮﺧﺺ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ‪.‬‬
‫ﻭﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ‪. anorexia‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ‪. abdominal discomfort‬‬

‫‪٩٧‬‬
 ‫ﻭﻳﺴﺒﺐ ﺍﻳﻀﺎ ﺍﻻﺳﻬﺎﻝ ﺍﻟﺬﻱ ﻳﻜﻮﻥ ﺷﺪﻳﺪ ﰲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ ﳑﺎ ﳚﻌﻞ ﺑﻌﺾ ﺍﳌﺮﺿﻰ ﻳﱰﻛﻮﻥ ﺍﻟﺪﻭﺍء‬
‫ﻭﺍﳊﻞ ﻟﺘﻘﻠﻴﻞ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﻫﻮ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻛﺎﻟﺘﺎﱄ ﻫﻲ‪:‬‬
‫‪ ٥٠٠‬ﻣﻠﻐﻢ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ﺍﺳﺒﻮﻉ ‪.‬‬
‫ﺛﻢ ﺗﺰﺩﺍﺩ ‪ ٥٠٠‬ﻣﻠﻐﻢ ﻣﺮﺗﲔ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ﺍﺳﺒﻮﻉ ‪.‬‬
‫ﺛﻢ ﺗﺰﺩﺍﺩ ﺍﱃ ‪ ٥٠٠‬ﻣﻠﻐﻢ ‪ ٣‬ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ﳌﺪﺓ ﺍﺳﺒﻮﻉ ﺍﱃ ﺍﻥ ﻧﺼﻞ ﺍﱃ ﺟﺮﻋﺔ ﺗﻀﺒﻂ ﻣﺴﺘﻮﻯ ﺍﻟﺴﻜﺮﻱ‬
‫ﻟﺪﻱ ﺍﳌﺮﻳﺾ‪.‬‬
‫ﻭﻻﳚﺐ ﲡﺎﻭﺯ ﺍﻋﻠﻰ ﺟﺮﻋﺔ ﻟﻪ ﻭﺍﻟﺘﻲ ﻫﻲ ‪ ٢٥٥٠‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ‪.‬‬
‫ﻭﺍﳊﻞ ﺍﻟﺜﺎﻧﻲ ﻟﺘﺠﻨﺐ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻮ ﺗﻨﺎﻭﻝ ﺍﻟﺪﻭﺍء ﺑﻌﺪ ﺍﻟﻄﻌﺎﻡ ﻭﻋﻠﻰ ﺍﻟﻌﻤﻮﻡ ﻓﺎﻥ‬
‫ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ﻣﺆﻗﺘﻪ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Incretin mimetics‬‬

‫*******************************‬

‫ﻫﻞ ﺗﻌﻠﻢ ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Incretin mimetics‬ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﳊﺪﻳﺜﺔ ﻭﺍﻟﺘﻲ ﺗﺸﻤﻞ‬
‫ﻋﻼﺝ ‪. Exenatide‬‬
‫ﻭﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺍﻻﺭﺗﺒﺎﻁ ﻭﺗﻔﻌﻴﻞ ‪.glucagon-like peptide-1 (GLP-1) receptors‬‬
‫ﻓﻴﺆﺩﻱ ﻫﺬﺍ ﺍﻻﺭﺗﺒﺎﻁ ﻭﺍﻟﺘﻔﻌﻴﻞ ﺍﱃ ﺯﻳﺎﺩﺓ ﺻﻨﺎﻋﺔ ﻭﲢﺮﻳﺮ ﺍﻻﻧﺴﻮﻟﲔ ﻣﻦ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻓﻌﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻳﻌﺘﻤﺪ ﻋﻠﻰ ﺗﺮﻛﻴﺰ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻓﻌﻨﺪﻣﺎ ﻳﻘﻞ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻳﻘﻞ ﺻﻨﺎﻋﺔ ﻭﺍﻓﺮﺍﺯ‬
‫ﺍﻻﻧﺴﻮﻟﲔ ‪.‬‬
‫ﻛﻤﺎ ﺗﺜﺒﻂ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻻﻓﺮﺍﺯ ﻏﲑ ﺍﳌﻨﺎﺳﺐ ﳍﺮﻣﻮﻥ ‪ glucagons‬ﺍﻟﺬﻱ ﻳﺰﻳﺪ ﻣﻦ ﺳﻜﺮ ﺍﻟﺪﻡ‬
‫ﻭﺗﺜﺒﻴﻂ ﺧﺮﻭﺟﻪ ﻳﻘﻠﻞ ﻣﻦ ﺳﻜﺮ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ‪.‬‬
‫ﻭﻣﻦ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳌﻔﻴﺪﻩ ﻫﻲ ﻓﻘﺪﺍﻥ ﺍﻟﻮﺯﻥ ‪.‬‬
‫ﻭﺍﻥ ﻋﻼﺝ ‪ Exenatide‬ﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ ﲢﺖ‬
‫ﺍﳉﻠﺪ ‪ SC injections‬ﻣﺮﺗﲔ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﻭﻳﻌﺘﱪ ﺍﳋﻂ ﺍﻟﻌﻼﺟﻲ ﺍﻟﺜﺎﻟﺚ ‪.‬‬
‫ﻭﻳﻔﻀﻞ ﻟﻠﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﺴﻜﺮﻱ ﻭﺍﻟﺴﻤﻨﺔ‪.‬‬

‫‪٩٨‬‬
 ‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ﺍﻟﻮﺍﺭﻓﺮﻳﻦ ‪anticoagulant effect of‬‬
‫‪.warfarin‬‬
‫ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﻭﳜﺮﺝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ ‪. the renal route‬‬
‫ﻭﻣﻦ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ ﺍﳊﺎﺩ ﻭﻟﻜﻨﻪ ﻏﲑ ﺷﺎﺋﻊ ﺍﳊﺪﻭﺙ ‪. Acute pancreatitis‬‬
‫ﻭ ‪. Headache and dizziness‬‬
‫ﻭ ‪. Hypoglycaemia‬‬

‫ﺍﺩﻭﻳﺔ ‪Dipeptidylpeptidase-4 (DDP-4) inhibitors‬‬

‫********************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Dipeptidylpeptidase-4 (DDP-4) inhibitors‬ﺗﻀﻢ ﻛﻞ ﻣﻦ‬

‫‪. Sitagliptin, vildagliptin‬‬
‫‪incretin‬‬ ‫ﻭﺗﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻖ ﻓﻌﻞ ‪ dipeptidylpeptidase-4 enzyme‬ﺍﻟﺬﻱ ﳛﻄﻢ‬
‫‪ hormones‬ﻣﺜﻞ )‪. glucagon-like peptide-1 (GLP-1‬‬
‫ﺣﻴﺚ ﺍﻥ ‪ Incretin hormones‬ﺗﺰﻳﺪ ﻣﻦ ﺻﻨﺎﻋﺔ ﻭﺍﻓﺮﺍﺯ ﺍﻻﻧﺴﻮﻟﲔ ﻣﻦ ﺍﻟﺒﻨﻜﺮﻳﺎﺱ‪.‬‬
‫ﺍﻟﺬﻱ ﻳﺴﺎﻋﺪ ﺑﺪﻭﺭﻩ ﻋﻠﻰ ﺧﻔﺾ ﺳﻜﺮ ﺍﻟﺪﻡ ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﺍﻋﺮﺍﺽ ﻣﺮﺽ ﺍﻟﺴﻜﺮ ﻭﻣﻀﺎﻋﻔﺎﺗﻪ ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﰲ ‪:‬‬

‫ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ‪. Type 2 diabetes mellitus‬‬

‫ﻭﳑﻨﻮﻋﺔ ﺧﻼﻝ ﺍﳊﻤﻞ ﻭﺍﻟﺮﺿﺎﻋﺔ ‪.‬‬

‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻋﺔ ﰲ ‪. Diabetic ketoacidosis‬‬

‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬

‫‪. Upper respiratory tract infections‬‬

‫ﻭ ‪. Peripheral oedema‬‬

‫‪٩٩‬‬
 ‫ﻭﲣﺮﺝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺒﻮﻝ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻗﺪ ﺗﺰﻳﺪ ﻣﻦ ‪ digoxin concentrations‬ﻟﺬﻟﻚ ﳚﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ﺟﻴﺪﺍ ‪.‬‬

‫ﻭﻣﻦ ﻧﺎﺣﻴﺔ ﺳﺮﻳﺮﻳﺔ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻛﺨﻂ ﻋﻼﺟﻲ ﺛﺎﻧﻲ ﰲ ﺣﺎﻟﺔ ﻋﺪﻡ ﺿﺒﻂ ﺍﻟﺴﻜﺮ ﺑﺎﳊﻤﻴﺔ‬
‫ﺍﻟﻐﺬﺍﺋﻴﺔ ﻭﺍﻟﺘﻤﺎﺭﻳﻦ ﻭﺍﺣﺪ ﺍﻻﺩﻭﻳﺔ ‪. on either metformin or a sulfonylurea‬‬
‫ﻭﺭﲟﺎ ﺗﺴﺘﻌﻤﻞ ﻛﺨﻂ ﻋﻼﺟﻲ ﺛﺎﻟﺚ ﺍﻳﻀﺎ ‪.‬‬

‫ﺍﺩﻭﻳﺔ ‪Thiazolidinediones‬‬
‫***************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Thiazolidinediones‬ﺍﻟﺘﻲ ﺗﻀﻢ ‪. Pioglitazone‬‬

‫ﺗﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ – ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ﺍﻣﺎ ﻟﻮﺣﺪﻫﺎ ﺍﻭ ﻣﻊ ﺍﺩﻭﻳﺔ ﺍﺧﺮﻯ ﻣﺜﻞ‬
‫‪. metformin or sulfonylureas‬ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ‪:‬‬
‫ﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﺯﻳﺎﺩﺓ ﺍﻟﻮﺯﻥ‪.‬‬
‫ﻭﺍﺣﺘﺒﺎﺱ ﺍﻟﺴﻮﺍﺋﻞ‪.‬‬
‫ﻭﻓﻘﺮ ﺍﻟﺪﻡ‪.‬‬
‫ﻭ ‪. Dyslipidaemia‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ‪. Oedema‬‬
‫ﻭ ‪. Liver toxicity‬‬
‫ﻭﺗﺘﺎﻳﺾ ﺑﺎﻟﻜﺒﺪ ﻭﺧﺎﺻﺔ ‪ CYP2C8.‬ﻟﺬﺍ ﻓﻬﻲ ﻳﻘﻞ ﺗﺮﻛﻴﺰﻫﺎ ﺍﻟﻔﻌﺎﻝ ﻋﻨﺪﻣﺎ ﺗﻌﻄﻰ ﻣﻊ‬
‫‪ rifampicin, phenytoin, Phenobarbital‬ﻻﻧﻬﺎ )‪. (inducers of CYP2C8‬‬
‫ﻭﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﳍﺎ ﻫﻮ ‪ ٦-٥‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻗﺪ ﰎ ﻣﻨﻊ ﺍﺳﺘﻌﻤﺎﻝ ﻋﻼﺝ ‪ Rosiglitazone‬ﻻﻧﻪ ﻳﺴﺒﺐ ﺑﻌﺾ ﳐﺎﻃﺮ ﻋﻠﻰ ﺍﻟﻘﻠﺐ‪.‬‬
‫ﻭﺗﺘﻮﻓﺮ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ﻋﻠﻰ ﺷﻜﻞ ﺍﻗﺮﺍﺹ‪.‬‬
‫ﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺑﺎﺳﻌﺎﺭ ﻣﻨﺎﺳﺒﺔ ‪.‬‬
‫ﻭﻫﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺯﻳﺎﺩﺓ ﺗﻘﺒﻞ ﺍﳋﻼﻳﺎ ﻟﺘﺎﺛﲑ ﺍﻻﻧﺴﻮﻟﲔ ﻟﺘﺴﻤﺢ ﺑﺪﺧﻮﻝ ﺍﻟﻜﻠﻮﻛﻮﺯ ﻻﻧﺘﺎﺝ ﺍﻟﻄﺎﻗﺔ ‪.‬‬

‫‪١٠٠‬‬
 ‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Phosphodiesterase type 5 inhibitors‬‬
‫***********************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Phosphodiesterase type 5 inhibitors‬ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ‪:‬‬

‫‪. Sildenafil, vardenafil‬‬
‫ﻭﺗﻘﻮﻡ ﺑﺘﻮﺳﻴﻊ ﺍﻻﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺗﺰﻳﺪ ﻣﻦ ﺍﻟﺪﻡ ﺍﻟﻮﺍﺻﻞ ﺍﱃ ﺍﻻﻋﻀﺎء ﺍﳉﻨﺴﻴﺔ ﻓﻌﺎﰿ ﺍﻟﻀﻌﻒ‬
‫ﺍﳉﻨﺴﻲ ‪.‬‬
‫ﻭﻳﻌﺎﰿ ﺍﻳﻀﺎ ‪. Pulmonary artery hypertension‬‬
‫ﻭﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻋﻠﻰ ﻣﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ﺍﳔﻔﺎﺽ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﺍﺣﺘﻘﺎﻥ ﺍﻻﻧﻒ‪.‬‬
‫ﻭﺍﲪﺮﺍﺭ ﺍﻟﻮﺟﻪ‪.‬‬
‫ﻭﺍﳋﻔﻘﺎﻥ ‪.‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ‪.‬‬
‫ﻭﺍﻥ ﺍﺳﺘﻌﻤﺎﻝ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Phosphodiesterase type 5 inhibitors‬ﻣﺘﺰﺍﻣﻨﺎ ﻣﻊ‬
‫ﺍﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ ‪ nitrate-based medications‬ﻣﺜﻞ ‪ Angised‬ﻳﺆﺩﻱ ﺍﱃ ﺍﳔﻔﺎﺽ ﺷﺪﻳﺪ ﰲ‬
‫ﺿﻐﻂ ﺍﻟﺪﻡ ‪.‬‬
‫ﻟﺬﺍ ﳚﺐ ﺍﳊﺬﺭ ﻣﻦ ﺫﻟﻚ ﻭﲡﻨﺐ ﺍﻻﻋﻄﺎء ﺳﻮﻳﺔ ‪.‬‬
‫ﻛﻤﺎ ﳚﺐ ﻋﺪﻡ ﻭﺻﻒ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳌﻌﺎﳉﺔ ﺍﻟﻀﻌﻒ ﺍﳉﻨﺴﻲ ﺍﻻ ﺑﻌﺪ ﺍﺳﺘﺒﻌﺎﺩ ﺍﻻﻣﺮﺍﺽ ﺍﻻﺧﺮﻯ ﻣﺜﻞ‪:‬‬
‫‪. multiple sclerosis‬‬
‫ﺍﻭ ‪. severe distress‬‬
‫ﻭﺍﻥ ﻋﻼﺝ ‪ Sildenafil‬ﻳﺘﺎﻳﺾ ﺑﺎﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺍﻥ ﺍﻟﻨﺼﻒ ﺍﻟﻌﻤﺮﻱ ﻟﻪ ﻫﻮ ‪ ٦-٤‬ﺳﺎﻋﺎﺕ ‪.‬‬
‫ﻭﻫﻮ ﻳﻌﻄﻰ ﲜﺮﻋﺔ ﺍﻛﺜﺮﻫﺎ ‪ ١٠٠‬ﻣﻠﻐﻢ ‪/‬ﻳﻮﻣﻴﺎ ‪.‬‬

‫‪١٠١‬‬
 ‫ﻋﻼﺝ ‪Levothyroxine‬‬
‫********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Levothyroxine‬ﺍﻟﺬﻱ ﻳﻌﺘﱪ ﺍﻟﺸﻜﻞ ﺍﻟﺼﻨﺎﻋﻲ ﳍﺮﻣﻮﻥ ﺍﻟﻐﺪﺓ ﺍﻟﺪﺭﻓﻴﺔ ﺍﻟﺮﺑﺎﻋﻲ‬
‫)‪ tetraiodothyronine (T4‬ﻭﺍﻟﺬﻱ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ‪:‬‬
‫ﺍﳔﻔﺎﺽ ﻋﻤﻞ ﺍﻟﻐﺪﺓ ﺍﻟﺪﺭﻗﻴﺔ ‪. Hypothyroidism‬‬
‫ﻭ ﰲ ‪. Diffuse non-toxic goiter‬‬
‫ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﲝﺬﺭ ﰲ ﺍﻣﺮﺍﺽ ‪:‬‬
‫‪. ischaemic heart disease and hypertension‬‬
‫ﺣﻴﺚ ﳚﺐ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﺗﺰﺩﺍﺩ ﺗﺪﺭﳚﻴﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻉ ﺍﺳﺘﻌﻤﺎﻟﻪ ﰲ ‪. Thyrotoxicosis‬‬
‫ﻭﻃﻮﻝ ﻋﻤﺮﻩ ﺍﻟﻨﺼﻔﻲ ﻫﻮ ﺍﺳﺒﻮﻉ ﻟﺬﺍ ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﻓﻘﻂ ﻭﻳﺘﺎﻳﺾ ﺍﱃ ﺍﻟﺸﻜﻞ ﺍﻟﺜﻼﺛﻲ‬
‫)‪. triiodothyronine (T3‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. urine and in faeces‬‬
‫ﻭﺍﻥ ﺍﻣﺘﺼﺎﺹ ﺩﻭﺍء ‪ levothyroxine‬ﻳﻘﻞ ﻛﺜﲑﺍ ﻟﻮ ﺍﻋﻄﻲ ﻣﻊ ‪oral iron supplements,‬‬
‫‪ cimetidine‬ﻭ ‪. antacids‬‬
‫ﻭﺍﻥ ﺟﺮﻋﺔ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﺘﻌﻤﻠﺔ ﳌﻌﺎﳉﺔ ﺍﻟﺴﻜﺮ ﺭﲟﺎ ﳓﺘﺎﺝ ﺍﱃ ﺯﻳﺎﺩﺓ ﺟﺮﻋﺘﻬﺎ ﻟﻮ ﺍﻋﻄﻴﺖ ﻣﻊ‬
‫‪. levothyroxine‬‬
‫ﻛﻤﺎ ﺍﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء‪ levothyroxine‬ﻳﺰﻳﺪ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ﺍﻟﻮﺍﺭﻓﺮﻳﻦ ﻟﺬﺍ ﳚﺐ ﺿﺒﻂ‬
‫ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺕ ﻋﻼﺝ ‪ levothyroxine‬ﻫﻲ‪:‬‬
‫‪ Diarrhoea and vomiting‬ﻭﺧﺎﺻﺔ ﰲ ﺍﳉﺮﻋﺔ ﺍﻟﻌﺎﻟﻴﺔ‪.‬‬ ‫ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﺳﻬﺎﻝ‬
‫ﻭﻓﻘﺪﺍﻥ ﺍﻟﻮﺯﻥ ‪. Weight loss‬‬
‫ﻭﺿﻌﻒ ﺍﻟﻌﻀﻼﺕ ‪. Muscle weakness‬‬
‫ﻭﺧﻔﻘﺎﻥ ﻭﻋﺪﻡ ﺍﻧﺘﻈﺎﻡ ﺑﻀﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ‪. Palpitations and arrhythmias‬‬
‫ﻭﺭﺟﻔﺔ ﻭﲤﻠﻤﻞ ﻭﺍﺭﻕ ‪. Tremor, restlessness, excitability, insomnia‬‬
‫ﻭﻋﺪﻡ ﲢﻤﻞ ﺍﳊﺮﺍﺭﺓ ‪. Heat intolerance‬‬

‫‪١٠٢‬‬
 ‫ﻋﻼﺝ ‪Carbimazole‬‬
‫*********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Carbimazole‬ﻳﺴﺘﻌﻤﻞ ﰲ‪.‬‬

‫ﻣﻌﺎﳉﺔ ﺯﻳﺎﺩﺓ ﻧﺸﺎﻁ ﺍﻟﻐﺪﺓ ﺍﻟﺪﺭﻗﻴﺔ ‪. Hyperthyroidism‬‬
‫ﻭ ﻟﻠﺘﺤﻀﲑ ﻟﺮﻓﻊ ﺍﻟﺪﺭﻗﻴﺔ ‪ Hyperthyroidism‬ﻧﺘﻴﺠﺔ ‪. Hyperthyroidism‬‬
‫ﻳﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﻗﺒﻞ ﻭﺑﻌﺪ ﺍﳌﻌﺎﳉﺔ ﺑـــ ‪. radio-iodine treatment‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ‪.‬‬
‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺼﺪﺍﻉ ‪.‬‬
‫ﻭﳓﻮﻝ ﻭﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺣﺮﺍﺭﺓ ﺍﳉﺴﻢ‪.‬‬
‫ﻭﺗﺜﺒﻴﻂ ﳔﺎﻉ ﺍﻟﻌﻈﻢ ‪ Bone marrow suppression‬ﻭ ‪. Rash and pruritis‬‬
‫ﻛﻤﺎ ﻳﺴﺒﺐ ﺍﺿﻄﺮﺍﺑﺎﺕ ﰲ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﻋﻼﺝ ‪ Theophylline‬ﻗﺪ ﻳﺰﺩﺍﺩ ﺗﺮﻛﻴﺰﻩ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﻣﻊ ﻋﻼﺝ ‪ Carbimazole‬ﻟﺬﺍ‬
‫ﻓﻴﺠﺐ ﺿﺒﻂ ﺍﳉﺮﻋﺔ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Anti-androgens‬‬

‫************************************‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Anti-androgens‬‬

‫ﻭﻫﻲ ﺍجملﻤﻮﻋﺔ ﺍﻟﺘﻲ ﺗﻌﺎﻛﺲ ﺍﻻﻧﺪﺭﻭﺟﲔ ‪.‬‬
‫ﻭﻣﻦ ﺍﻣﺜﻠﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻫﻲ ‪. Cyproterone acetate, flutamide, bicalutamide‬‬
‫ﺣﻴﺚ ﺗﻐﻠﻖ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪ dihydrotestosterone receptors‬ﰲ ﺍﻧﺴﺠﺔ ﺍﳉﺴﻢ ﻣﺜﻞ‬
‫ﺍﻟﱪﻭﺳﺘﺎﺕ ‪.‬‬
‫ﺣﻴﺚ ﻳﺆﺩﻱ ﻫﺬﺍ ﺍﺭﺳﺎﻝ ﺭﺳﺎﻟﺔ ﺍﱃ ‪. the hypothalamo–pituitary axis‬‬
‫ﺍﻟﺬﻱ ﻳﻘﻠﻞ ‪. LH release‬‬

‫‪١٠٣‬‬
 ‫ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﻣﻦ ‪. testicular testosterone release‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﰲ ﺛﻼﺙ ﺣﺎﻟﺔ ﺭﺋﻴﺴﻴﺔ ‪.‬‬
‫ﻣﻨﻬﺎ ﺳﺮﻃﺎﻥ ﺍﻟﱪﻭﺳﺘﺎﺕ ‪. Prostate cancer‬‬
‫ﻭﻇﻬﻮﺭ ﺣﺐ ﺍﻟﺸﺒﺎﺏ ﻭﺍﻟﺸﻌﺮ ﰲ ﺍﻟﻨﺴﺎء ﰲ ﺍﻣﺎﻛﻦ ﻏﲑ ﻣﺮﻏﻮﺏ ﺑﻬﺎ ﻧﺴﺎﺋﻴﺎ ‪Acne and‬‬
‫‪ hirsutism in women‬ﻭﺧﺎﺻﺔ )‪(cyproterone‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ‪Severe hypersexuality and sexual deviation‬‬
‫‪.‬‬
‫ﻭﻟﻜﻨﻬﺎ ﻻﺗﻌﺪ ﻣﺎﻧﻊ ﻟﻠﺤﻤﻞ ﺭﺟﺎﱄ ﻭﺍﻟﺪﻭﺍء ﺍﳌﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻫﻮ ‪. cyproterone‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪.‬‬
‫ﺍﻟﺴﻤﻴﺔ ﺍﻟﻜﺒﺪﻳﺔ ‪. Hepatotoxicity‬‬
‫‪.‬‬ ‫ﻭ ﺗﻐﲑ ﰲ ﺍﻟﻮﺯﻥ ﻭﻇﻬﻮﺭ ﺍﻟﺸﻌﺮ ‪weight and hair distribution‬‬
‫ﻭﺍﻟﺘﻌﺐ ‪.Fatigue‬‬
‫ﻭﺗﻀﺨﻢ ﺍﻟﺜﺪﻱ ‪ Gynaecomastia‬ﻭ ‪. Dyspnoea‬‬
‫ﻭﺗﺘﺄﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻜﺒﺪ ﻭﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. biliary and renal routes‬‬
‫ﻭﻣﻦ ﺍﳌﻬﻢ ﺍﻟﻘﻮﻝ ﺍﻥ ﺩﻭﺍء ‪ Cyproterone acetate‬ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ﺣﺐ ﺍﻟﺸﺒﺎﺏ ﻭﻇﻬﻮﺭ‬
‫ﺍﻟﺸﻌﺮ ﻭﺧﺎﺻﺔ ﻋﻠﻰ ﺍﻟﻮﺟﺔ ﺍﻟﺬﻱ ﻳﻈﻬﺮ ﺍﺛﻨﺎء ﺍﻻﺻـــــــــــــــــــﺎﺑﺔ ﺑﺘﻜﻴﺲ ﺍﳌﺒﺎﻳﺾ ‪acne and‬‬
‫‪. hirsutism in women with PCOS‬‬
‫ﻻﻥ ﻫﺬﻩ ﺍﻻﻋﺮﺍﺽ ﲢﺪﺙ ﻧﺘﻴﺠﺔ ﺯﻳﺎﺩﺓ ﻫﺮﻣﻮﻥ ﺍﻻﻧﺪﺭﻭﺟﲔ ‪. elevated testosterone levels‬‬
‫ﺍﺩﻭﻳﺔ ‪ anti-androgens‬ﳚﺐ ﺍﻥ ﺗﻌﻄﻰ ﻗﺒﻞ ﺛﻼﺛﺔ ﺍﻳﺎﻡ ﻣﻦ ﺍﺩﻭﻳﺔ ‪gonadorelin‬‬
‫‪. analogues‬‬
‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪ anti-androgens‬ﺗﺰﻳﺪ ﻣﻦ ﻓﻌﻞ ﺍﺩﻭﻳﺔ ‪ thiazolidinediones‬ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ‬
‫ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺴﻜﺮﻱ ﺍﻟﻨﻮﻉ ﺍﻟﺜﺎﻧﻲ ﻟﺬﺍ ﳚــــــــــــــﺐ ﺗﻘﻠﻴﻞ ﺟﺮﻋﺔ ‪ thiazolidinediones‬ﻻﻥ‬
‫ﺍﺩﻭﻳﺔ ﺍﳌﻀﺎﺩﺓ ﻟﻼﻧﺪﺭﻭﺟﲔ ﺗﺜﺒﻂ ﺗﺎﻳﺾ ‪.thiazolidinediones‬‬
‫ﻭﺍﻳﻀﺎ ﳚﺐ ﺗﻘﻠﻴﻞ ﺟﺮﻋﺔ ‪ statin‬ﺍﳌﺴﺘﻌﻤﻠﺔ ﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺍﻟﺪﻫﻮﻥ ﺑﺎﻟﺪﻡ ﻟﻨﻔﺲ ﺍﻟﺴﺒﺐ ﺍﳌﺜﺒﻂ‬
‫ﻻﻳﺾ ﺍﺩﻭﻳﺔ ﺍﻟﺴﺘﺎﺗﲔ ‪.‬‬

‫‪١٠٤‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﰲ ﺍﻻﻣﺮﺍﺽ ﺍﻟﻨﺴﺎﺋﻴﺔ ﻭﺍجملﺎﺭﻱ ﺍﻟﺒﻮﻟﻴﺔ‬
‫ﻭﺍﻟﱪﻭﺳﺘﺎﺕ‬

‫ﺍﻻﺩﻭﻳﺔ ﺍﳌﺎﻧﻌﺔ ﻟﻠﺤﻤﻞ ﺍﳌﺮﻛﺒﺔ ﺍﻟﻔﻤﻮﻳﺔ ‪Contraceptives‬‬

‫*********************************************‬

‫ﺍﻥ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺎﻧﻌﺔ ﻟﻠﺤﻤﻞ ﺍﳌﺮﻛﺒﺔ ﺍﻟﻔﻤﻮﻳﺔ ‪ Contraceptives‬ﲢﺘﻮﻱ ﻋﻠﻰ ‪:‬‬

‫ﻛﻞ ﻣﻦ ‪. oestrogen and progesterone‬‬
‫ﺍﻟﺬﻱ ﻳﻘﻠﻞ ﻣﻦ ‪ GnRH secretion‬ﻣﻦ ‪ hypothalamus‬ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﻣﻦ ‪FSH and LH‬‬
‫‪. release from the anterior pituitary‬‬
‫ﻭﻏﻴﺎﺏ ﻛﻞ ﻣﻦ ‪ FSH and LH‬ﻳﺆﺩﻱ ﺍﱃ ‪:‬‬
‫ﻣﻨﻊ ﻋﻤﻠﻴﺔ ﻧﻀﻮﺝ ﺍﻟﺒﻴﻀﺔ ‪.‬‬
‫ﻭﺧﺮﻭﺟﻬﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻨﻊ ‪. development of the uterine endometrium‬‬
‫ﻭﻛﺬﻟﻚ ﻳﻘﻠﻞ ﻣﻦ ﺣﺠﻢ ﻭﻟﺰﻭﺟﺔ ‪. viscous cervical secretions‬‬

‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻻﺩﻭﻳﺔ ﻣﻨﻊ ﺍﳊﻤﻞ ﻫﻲ‪:‬‬

‫ﺍﻟﺼﺪﺍﻉ ﺍﻟﻨﺼﻔﻲ ‪ Migraine‬ﺣﻴﺚ ﳚﺐ ﻋﺪﻡ ﺍﺳﺘﻌﻤﺎﳍﺎ ﳌﻦ ﺗﻌﺎﻧﻲ ﻣﻦ ﻫﺬﺍ ﺍﳌﺮﺽ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪Nausea and vomiting‬ﻭﳚﺐ ﺍﻻﻧﺘﺒﺎﻩ ﺍﻥ ﺍﻟﺘﻘﻴﻮء ﺑﻌﺪ ﺗﻨﺎﻭﻝ‬
‫ﺣﺐ ﻣﻨﻊ ﺍﳊﻤﻞ ﻳﺴﺘﻮﺟﺐ ﺍﻋﺎﺩﺓ ﺍﻋﻄﺎء ﺍﳉﺮﻋﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻐﲑ ﰲ ﺍﻟﻮﺯﻥ ‪Changes in body weight‬ﳓﻮ ﺍﻟﺰﻳﺎﺩﺓ ﻭﻏﺎﻟﺒﺎ ﻣﺎ ﳛﺪﺙ ﻫﺬﺍ ﻧﺘﻴﺠﺔ‬
‫ﺍﺣﺘﺒﺎﺱ ﺍﻟﺴﻮﺍﺋﻞ ﺑﺪﺍﺧﻞ ﺍﳉﺴﻢ ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﺍﺣﺒﺎﺋﻲ ﻫﻲ‪:‬‬
‫ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ‪Hypertension‬ﻟﺬﺍ ﳚﺐ ﺍﳊﺬﺭ ﺑﺸﺪﺓ ﻣﻦ ﺍﻋﻄﺎءﻫﺎ ﳌﻦ ﺗﻌﺎﻧﻲ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ‬
‫ﺍﻟﺪﻡ ﻭﺧﺎﺻﺔ ﺍﳌﺮﻛﺒﺔ ﻣﻨﻬﺎ ‪.‬‬

‫‪١٠٥‬‬
 ‫ﻭﻣﻦ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳋﻄﺮﺓ ﺍﻳﻀﺎ ﳊﺒﻮﺏ ﻣﻨﻊ ﺍﳊﻤﻞ ﺍﳌﺮﻛﺔ ﻫﻲ ‪Venous thromboembolic‬‬
‫‪. disease‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺴﺒﺐ ﺑﻌﻀﻬﺎ ﺍﻧﻘﻄﺎﻉ ﺑﺎﻟﺪﻭﺭﺓ ﺍﻟﺸﻬﺮﻳﺔ ﺑﻌﺪ ﺍﻟﺘﻮﻗﻒ ﻋﻦ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﳌﻬﻢ ﺍﻟﻘﻮﻝ‬
‫ﺍﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﳌﺎﻧﻌﺔ ﻟﻠﺤﻤﻞ ﺗﺘﺎﻳﺾ ﰲ ﺍﻟﻜﺒﺪ ﺳﻮﺍء ﻛﺎﻧﺖ ﺍﻟﻔﻤﻮﻳﺔ ﺍﳌﺮﻛﺒﺔ ﺍﻭ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﻋﻠﻰ‬
‫ﺑﺮﻭﺟﺴﺘﲑﻭﻥ ﻓﻘﻂ ‪.‬‬

‫ﻋﻼﺝ ‪Mifepristone‬‬
‫*******************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Mifepristone‬ﺍﻟﺬﻱ ﻳﻌﻤﻞ ﻋﻠﻰ ﻣﻌﺎﻛﺴﺔ ﻓﻌﻞ ﺍﻟﱪﻭﺟﺴﺘﲑﻭﻥ ﰲ ‪progesterone‬‬

‫‪ receptors‬ﰲ ﺍﻟﺮﺣﻢ‪.‬‬
‫ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺗﻮﺳﻴﻊ ﻋﻨﻒ ﺍﻟﺮﺣﻢ ﻭﺗﻘﻠﺼﻪ ‪cervical dilatation and uterine‬‬
‫‪. contraction‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﰲ ‪. Medical termination of intrauterine pregnancy‬‬
‫ﻭ ﲢﻀﲑ ﻋﻨﻖ ﺍﻟﺮﺣﻢ ﻟــ‪. surgical termination of pregnancy‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﻧﺰﻳﻒ ﻣﻬﺒﻠﻲ ‪.‬‬
‫ﻭﺗﻘﻠﺺ ﰲ ﺍﻟﺮﺣﻢ ‪.‬‬
‫ﻭ ‪ Urticarial rash‬ﻭ ‪. GI cramps‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻜﺒﺪ‪.‬‬
‫ﻭﻋﻤﺮﻩ ﺍﻟﻨﺼﻔﻲ ‪ ١٨‬ﺳﺎﻋﺔ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﺟﺮﻋﺔ ﻭﺍﺣﺪﺓ ﻣﻦ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻣﻊ ‪ a dose of misoprostol‬ﻟﻌﻤﻠﻴﺔ ‪medical‬‬
‫‪. termination of pregnancy‬‬
‫ﻭﻗﺪ ﳛﺪﺙ ﻧﺘﻴﺠﺔ ﻫﺬﺍ ‪. severe vaginal blood loss‬‬
‫ﻟﺬﺍ ﳚﺐ ﺗﻨﺒﻴﻪ ﳍﺬﺍ ﺍﻻﻣﺮ‪.‬‬
‫ﻭﻻﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ‪:‬‬
‫‪. Uncontrolled severe asthma‬‬
‫ﻭ ‪.Suspected ectopic pregnancy‬‬
‫ﻭ ‪. Chronic adrenal failure‬‬

‫‪١٠٦‬‬
 ‫ﻋﻼﺝ ‪Oxybutynin‬‬
‫***********************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Oxybutynin‬ﻳﺴﺘﻌﻤﻞ ﰲ‪:‬‬

‫ﻣﻌﺎﳉﺔ ﺍﻟﺘﺒﻮﻝ ﺍﻟﻼﺭﺍﺩﻱ ‪.Nocturnal enuresis secondary to overactive bladder‬‬
‫ﻭ ‪. Urinary frequency, urgency and incontinence‬‬
‫ﻭ ‪. Neurogenic bladder instability‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺗﺸﻮﺵ ﺍﻟﺮﺅﻳﺔ ﻭﺍﻻﻣﺴﺎﻙ ‪.‬‬
‫ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ﻭﺍﳋﻔﻘﺎﻥ‪.‬‬
‫ﻭ ‪.Drowsiness‬‬
‫ﻭﺗﺰﺩﺍﺩ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻣﻊ ﺍﺩﻭﻳﺔ ‪TCAs and sedating‬‬
‫‪. antihistamines‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻜﺒﺪ ﺍﱃ ﺷﻜﻞ ﺧﺎﻣﻞ ﻏﲑ ﻓﻌﺎﻝ ﺑﻮﺍﺳﻄﺔ ‪Cytochrome P450‬‬
‫‪. enzymes‬‬
‫ﻭﻋﻤﺮﻩ ﺍﻟﻨﺼﻔﻲ ﻫﻮ ‪ ١٣‬ﺳﺎﻋﺔ ‪.‬‬
‫ﻭﻻﻳﺴﺘﻌﻤﻞ ﺑﻞ ﳑﻨﻮﻉ ﰲ ﺣﺎﻟﺔ ﻣﺮﺽ ﺍﻟﻮﻫﻦ ﺍﻟﻌﻀﻠﻲ ‪.Myasthenia gravis‬‬
‫ﻭﺍﻧﺴﺪﺍﺩ ﺍﻻﻣﻌﺎء ‪. Intestinal obstruction‬‬
‫ﻭﺍﻳﻀﺎ ﳑﻨﻮﻉ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺣﺎﻟﺔ ﺍﺣﺘﺒﺎﺱ ﺍﻟﺒﻮﻝ ‪.Urinary retention‬‬
‫ﻧﺘﻴﺠﺔ ﺗﻀﺦ ﺍﻟﱪﻭﺳﺘﺎﺕ ﺍﻭ ﻧﺘﻴﺠﺔ ﺃﻱ ﻣﺮﺽ ‪.‬‬
‫ﻭﺍﳌﺴﺘﺤﻀﺮﺍﺕ ﻣﻦ ﻧﻮﻉ ‪ Modified release preparations‬ﻫﻲ ﺍﻗﻞ ﺣﺪﻭﺛﺎ ﻟﻠﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ‬
‫ﻟﻜﻨﻬﺎ ﻏﺎﻟﻴﺔ ﻧﻮﻋﺎ ﻣﺎ ‪.‬‬
‫ﻭﻣﻦ ﺍﳌﻤﻜﻦ ﺍﻥ ﻳﺰﻳﺪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ﺣﺪﻭﺙ ‪ acute closed-angle glaucoma‬ﻭﻳﻔﺎﻗﻢ‬
‫ﺍﻋﺮﺍﺿﻬﺎ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺗﻬﻴﺞ ﻟﻜﻞ ﻣﻦ ‪. hyperthyroidism and cardiac failure‬‬
‫ﻛﻤﺎ ﻣﻦ ﺍﳌﻬﻢ ﺍﻥ ﻧﺬﻛﺮ ﺍﻥ ﻛﻞ ﻣﻦ ‪ Solifenacin and tolterodine‬ﻳﺴﺘﻌﻤﻼﻥ ﻟﻨﻔﺲ‬
‫ﺍﺳﺘﻌﻤﺎﻻﺕ ﺩﻭﺍء ‪ Oxybutynin‬ﻭﻳﻌﻤﻼﻥ ﺍﻓﻀﻞ ﻣﻨﻪ ﻭﺍﻗﻞ ﺗﺎﺛﲑﺍﺕ ﺟﺎﻧﺒﻴﺔ ﻣﻨﻪ‪.‬‬

‫‪١٠٧‬‬
 ‫‪.‬ﻛﻤﺎ ﺍﻥ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﻌﺎﻛﺲ ﻓﻌﻞ ﺩﻭﺍء ‪ metoclopramide‬ﻋﻠﻰ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪.‬‬

‫ﻋﻼﺝ ‪Oxytocin‬‬
‫**************************‬

‫ﺍﻥ ﻋﻼﺝ ‪ Oxytocin‬ﺍﻟﺬﻱ ﻳﺘﻮﻓﺮ ﺑﺼﻮﺭﺓ ﺩﺍﺋﻤﺔ ﰲ ﺻﺎﻻﺕ ﺍﻟﻮﻻﺩﺓ ﰲ ﻣﺴﺘﺸﻔﻴﺎﺗﻨﺎ ﻋﻠﻰ ﺷﻜﻞ‬
‫ﺍﻣﺒﻮﻻﺕ ﻳﺴﺘﻌﻤﻞ ﰲ ‪:‬‬
‫ﲢﻔﻴﺰ ﻋﻤﻠﻴﺔ ﺍﻟﻮﻻﺩﺓ ﺍﻟﻄﺒﻴﻌﻴﺔ ‪. Induction or augmentation of labour‬‬
‫ﻭ ﰲ ﺍﻛﻤﺎﻝ ﺧﺮﻭﺝ ﺍﻟﻄﻔﻞ ﰲ ﻋﻤﻠﻴﺎﺕ ﺍﻻﺳﻘﺎﻁ ﺍﻟﺘﻲ ﲢﺪﺙ ﺳﻮﺍء ﻛﺎﻥ ﺍﻻﺳﻘﺎﻁ ﺍﳌﻴﺖ ﰲ ﺑﻄﻦ ﺍﻻﻡ ﺍﻭ‬
‫ﺍﻻﺳﻘﺎﻁ ﻏﲑ ﺍﻟﻜﺎﻣﻞ ‪. Incomplete, inevitable or missed abortion‬‬
‫ﻭ ﰲ ﻋﻤﻠﻴﺔ ﻣﻨﻊ ﺍﻟﻨﺰﻑ ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﻌﺪ ﺍﻟﻮﻻﺩﺓ ‪Prevention of post-partum‬‬
‫‪. haemorrhage‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ‪. Nausea and vomiting‬‬
‫ﻭ ﺍﻟﺘﺤﻔﻴﺰ ﺍﻟﺸﺪﻳﺪ ﻟﻠﺮﺣﻢ ‪ Uterine hyperstimulation‬ﺍﻟﺬﻱ ﻗﺪ ﻳﺴﺒﺐ ﺍﻧﻔﺠﺎﺭ ﻭﲤﺰﻕ ﺍﻟﺮﺣﻢ‬
‫ﺍﻭ ﺍﺧﺘﻨﺎﻕ ﺍﻟﻄﻔﻞ ﺍﻭ ﺍﻟﻮﻓﺎﺓ‪.‬‬
‫ﻭ ﺍﳔﻔﺎﺽ ﰲ ﺿﻐﻂ ﺍﻟﺪﻡ ‪ Transient hypotension‬ﺍﺫﺍ ﺍﻋﻄﻲ ﺑﺴﺮﻋﺔ ﺑﺪﻭﻥ ﲣﻔﻴﻒ ﺑﺎﶈﺎﻟﻴﻞ ‪.‬‬
‫ﻭﻳﺴﺒﺐ ﺍﻳﻀﺎ ﺍﺣﺘﺒﺎﺱ ﻟﻠﺴﻮﺍﺋﻞ ‪. Fluid retention‬‬
‫ﻭﺑﺼﻮﺭﺓ ﻧﺎﺩﺭﺓ ﺟﺪﺍ ﻗﺪ ﳛﺪﺙ ﲣﺜﺮ ﻭﻋﺎﺋﻲ ﻣﻨﺘﺸﺮ ‪disseminated intravascular‬‬
‫‪. coagulation‬‬
‫ﺍﻟﻌﻤﺮ ﺍﻟﻨﺼﻔﻲ ﻟﻪ ﻫﻮ ‪ ٥‬ﺩﻗﺎﺋﻖ ﻭﳍﺬﺍ ﻓﻬﻮ ﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺘﺴﺮﻳﺐ ﺍﻟﻮﺭﻳﺪﻱ ‪.‬‬
‫ﻭﻳﺘﺎﻳﺾ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪. biliary and renal‬‬

‫‪١٠٨‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﻄﻲ ﻓﻌﻞ ﻣﺸﺎﺑﻬﺔ ﻟﻔﻌﻞ ‪ Prostaglandins‬ﺗﺰﻳﺪ ﻣﻦ ﺍﻟﻔﻌﻞ ﺍﻟﺪﻭﺍﺋﻲ ﻟﻌﻼﺝ‬
‫‪ oxytocin,‬ﻟﺬﺍ ﻳﺘﻄﻠﺐ ﻋﺪﻡ ﺍﻋﻄﺎءﻫﻤﺎ ﺳﻮﻳﺔ‪.‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺍﺭﺗﻔﺎﻉ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﺫﺍ ﺍﻋﻄﻲ ﻣﻊ ‪.sympathomimetic vasopressors‬‬
‫ﻭﺍﻳﻀﺎ ﳝﻜﻦ ﺍﻋﻄﺎء ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ ﺍﻟﻌﻀﻠﻲ ﻣﻊ ‪ ergometrine‬ﺍﻟﺬﻱ ﻳﻌﺘﱪ ﳏﻔﺰ‬
‫ﻟﻠﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﰲ ﺍﻟﺮﺣﻢ ﳌﻨﻊ ﻋﻤﻠﻴﺔ ﺍﻟﻨﺰﻑ ﺑﻌﺪ ﺍﻟﻮﻻﺩﺓ ‪. post-partum haemorrhage‬‬
‫ﻭﻳﻌﻄﻰ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﲝﺬﺭ ﻟﻜﻞ ﳑﺎ ﻳﺎﺗﻲ ‪:‬‬
‫ﻟﻠﻤﺮﺍءﺓ ﻓﻮﻕ ﻋﻤﺮ ‪ ٣٥‬ﺳﻨﺔ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻟـ ‪ lower-uterine segment caesarean section‬ﻭﺍﻳﻀﺎ ‪cardiovascular‬‬
‫‪ disease‬ﻭﻧﺘﺠﻨﺒﻪ ﰲ ﺣﺎﻝ ﻛﺎﻧﺖ ﺍﻣﺮﺍﺽ ﺍﻟﻘﻠﺐ ﺷﺪﻳﺪﺓ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ‪ pre-eclamptic toxaemia‬ﻭﻧﺘﺠﻨﺐ ﰲ ﺣﺎﻝ ‪. avoid if severe‬‬
‫ﻭﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻳﻌﻤﻞ ﻋﻠﻰ ﲢﻔﻴﺰ ﺗﻘﻠﺺ ﺍﻟﻌﻀﻼﺕ ﺍﳌﻠﺴﺎء ﰲ ‪. myometrium‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪5-apha-reductase inhibitors‬‬

‫***************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ 5-apha-reductase inhibitors‬ﺗﻀﻢ ﻛﻞ ﻣﻦ ‪Dutasteride,‬‬

‫‪. finasteride‬‬
‫ﺗﻌﻤﻞ ﻋﻠﻰ ﻣﻨﻊ ﲢﻮﻳﻞ ‪ testosterone‬ﺍﱃ ‪dihydrotestosterone (a more potent‬‬
‫‪. androgen) in peripheral tissues‬‬
‫ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﺍﻧﺰﻳﻢ ‪. 5a-reductase‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﰲ ﻣﻌﺎﳉﺔ ﺗﻀﺦ ﺍﻟﱪﻭﺳﺘﺎﺕ ﺍﳊﻤﻴﺪ ﺑﺪﻝ ﺍﻟﻌﻤﻞ ﺍﳉﺮﺍﺣﻲ ﺍﻭ ﻟﺘﺎﺟﻴﻞ‬
‫ﺍﻟﻌﻤﻞ ﺍﳉﺮﺍﺣﻲ ﺍﱃ ﻭﻗﺖ ﺍﺑﻌﺪ ﻭﻻﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻨﺴﺎء ﻭﺍﳌﺮﺍﻫﻘﲔ ‪women,‬‬
‫‪. children or adolescents‬‬
‫ﻭﺍﻣﺮﺍﺽ ﺍﻟﻜﺒﺪ ﺍﻟﺸﺪﻳﺪ ‪.Severe liver disease‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫‪. Impotence‬‬
‫ﻭ ‪. Decreased libido‬‬

‫‪١٠٩‬‬
 ‫ﻭ ‪. Ejaculation disorders‬‬
‫ﻭ ‪. Breast tenderness/enlargement‬‬
‫ﻛﻤﺎ ﺍﻥ ﻋﻼﺝ ‪ Finasteride‬ﳑﻜﻦ ﺍﻥ ﻳﻌﻄﻰ ﻣﻊ ﺩﻭﺍء ‪ doxazosin‬ﺍﻟﺬﻱ ﻫﻮ ﻣﻦ ﳎﻤﻮﻋﺔ‬
‫‪ Alpha Blocker‬ﳌﻌﺎﳉﺔ ﺗﻀﺨﻢ ﺍﻟﱪﻭﺳﺘﺎﺕ ﺍﳊﻤﻴﺪ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻟﻌﻼﺝ ﺑﻬﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳛﺘﺎﺝ ﺍﱃ ‪ require several months treatment‬ﻗﺒﻞ ﻣﻼﺣﻈﺔ‬
‫ﺍﻟﻔﺎﺋﺪﺓ ﺍﻟﻌﻼﺟﻴﺔ ﻣﻨﻬﺎ ‪.‬ﻭﻛﻤﺎ ﻫﻮ ﻣﻌﺮﻭﻑ ﺍﻥ ﻋﻠﻰ ﺍﳌﺮﺍءﺓ ﺍﳊﺎﻣﻞ ﲡﻨﺐ ﲪﻞ ﺍﳊﺒﺎﻳﺔ ﺍﳌﻜﺴﻮﺭﺓ ﻣﻦ‬
‫‪.Finasteride‬‬
‫ﻻﻧﻬﺎ ﺳﺘﺴﺒﺐ ﺍﺿﺮﺍﺭ ﻋﻠﻰ ﺍﳊﻤﻞ ﻧﺘﻴﺠﺔ ﺍﻣﺘﺼﺎﺻﻬﺎ ﺍﻟﺴﺮﻳﻊ ﻣﻦ ﺍﳉﻠﺪ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. Selective oestrogen receptor modulators‬‬

‫*************************************************‬

‫ﺗﻌﺘﱪ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﰲ ﺍﻻﻣﺮﺍﺽ ﺍﻟﻨﺴﺎﺋﻴﺔ ‪.‬‬
‫ﻭﺗﻀﻢ ﻛﻞ ﻣﻦ ‪ Tamoxifen‬ﺍﻟﺬﻱ ﻳﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﻣﻌﺎﻛﺴﺔ ﻓﻌﻞ ﺍﻻﺳﱰﻭﺟﲔ ﻭﻳﻘﻠﻞ ﺍﻧﻘﺴﺎﻡ ﺍﳋﻼﻳﺎ‬
‫ﻭﺧﺎﺻﺔ ﰲ ﺍﻧﺴﺠﺔ ﺍﻟﺜﺪﻱ ﻭﻟﻜﻨﻪ ﻳﻌﻤﻞ ﻋﻤﻞ ﻣﺸﺎﺑﻪ ﺟﺰﺋﻲ ﻟﻔﻌﻞ ﺍﻻﺳﱰﻭﺟﲔ ﰲ ﺑﻌﺾ ﺍﻻﻧﺴﺠﺔ ﻣﺜﻞ‬
‫‪endometrium, the urogenital epithelium, bone remodelling and‬‬
‫‪. cholesterol metabolism‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻀﻢ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Aromatase inhibitors‬ﻣﺜﻞ ﺍﺩﻭﻳﺔ ‪anastrozole,‬‬
‫‪ exemestane‬ﺍﻟﺘﻲ ﺗﻘﻮﻡ ﲟﻨﻊ ﲢﻮﻳﻞ ﺍﻻﻧﺪﺭﻭﺟﲔ ﺍﱃ ﺍﺳﱰﻭﺟﲔ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ‬
‫‪. aromatase enzyme complex‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ‪ Raloxifene‬ﺍﻟﺬﻱ ﻳﻌﺘﱪ ﻣﺸﺎﺑﻪ ﻟﻔﻌﻞ ﺍﻻﺳﱰﻭﺟﲔ ﻭﻳﻌﻤﻞ ﻋﻠﻰ‬
‫‪ on bone remodeling‬ﻭ ‪. lipid metabolism‬‬
‫ﻭﺍﻳﻀﺎ ﻣﻦ ﺍﺩﻭﻳﺔ ﻫﺬﻩ ﺍجملﻤﻮﻋﺔ ﺍﻟﻌﻼﺝ ﺍﻟﺸﻬﲑ ‪ Clomifene‬ﺍﻟﺬﻱ ﻳﻌﺘﱪ ‪oestrogen‬‬
‫‪ receptor antagonist‬ﺍﻟﺬﻱ ﻳﺆﺛﺮ ﻋﻠﻰ ‪ hypothalamus‬ﻟﺘﺜﺒﻴﻂ ﺍﻟﺘﻐﺬﻳﺔ ﺍﻟﻌﻜﺴﻴﺔ ﻭﺑﺎﻟﺘﺎﱄ‬
‫ﻳﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ﰲ ‪ GnRH and subsequent increases in FSH and LH.‬ﻭﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ‬
‫ﻳﺆﺩﻱ ﺍﱃ ‪. follicular development and ovulation‬‬
‫ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﻣﻌﺎﳉﺔ ‪ Breast cancer‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻛﻞ ﻣﻦ ‪tamoxifen and‬‬
‫‪. aromatase inhibitors‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ﰲ ‪ Anovulatory infertility‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻟﺬﻟﻚ ‪. Clomifene‬‬

‫‪١١٠‬‬
 ‫ﻭﺗﺴﺘﻌﻤﻞ ﺍﻳﻀﺎ ‪ Postmenopausal osteoporosis‬ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻟﺬﻟﻚ )‪. raloxifene‬‬
‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺧﻼﻝ ﻓﱰﺓ ﺍﳊﻤﻞ ﻭﺗﻌﻄﻰ ﲝﺬﺭ ﺷﺪﻳﺪ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺧﻠﻞ ﻛﻠﻮﻱ ﺍﻭ ﻛﺒﺪﻱ‬
‫ﻭﳌﻦ ﻳﻌﺎﻧﻲ ﻣﻦ ‪. VTE‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ ‪:‬‬
‫ﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﺎﻡ ﺣﻴﺚ ﻳﺴﺒﺐ ﺫﻟﻚ ﻋﻼﺟﺎﺕ ‪. (aromatase inhibitors‬‬
‫ﻭﺍﻳﻀﺎ ‪ Endometrial changes including cancer‬ﻳﺴﺒﺐ ﺫﻟﻚ )‪. tamoxifen‬‬
‫ﻭﺍﻳﻀﺎ ‪. GI disturbance‬‬
‫ﻭﺍﻳﻀﺎ ‪Menopausal symptoms (oedema, hot flushes and urogenital‬‬
‫)‪. atrophy‬‬
‫ﻭﺍﻳﻀﺎ ‪ VTE‬ﻭﻳﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﳉﺎﻧﺒﻲ ﻋﻼﺝ )‪. tamoxifen‬‬
‫ﻭﻣﻦ ﺍﻟﺘﺪﺍﺧﻼﺕ ﺍﻟﺼﻴﺪﻻﻧﻴﺔ ﺍﳌﻬﻤﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺍﻥ ﺍﻟﻔﻌﻞ ﺍﳌﻀﺎﺩ ﻟﻠﺘﺨﺜﺮ ﻟﻌﻼﺝ ﺍﻟﻮﺍﺭﻓﺎﺭﻳﻦ ﻳﺰﺩﺍﺩ‬
‫ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﻣﻊ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ‪.‬‬
‫ﻛﻤﺎ ﺍﻥ ﺍﻣﺘﺼﺎﺹ ﻋﻼﺝ ‪ raloxifene‬ﻳﻘﻞ ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﻣﻊ ‪. colestyramine‬‬
‫ﺑﺴﺒﺐ ﺧﻄﺮ ﺣﺪﺙ ﺳﺮﻃﺎﻥ ﺍﻟﺮﺣﻢ ﻓﺎﻥ ﻋﻼﺝ ‪ clomifene‬ﳚﺐ ﺍﻥ ﻻﻳﺴﺘﻌﻤﻞ ﻟﻔﱰﺓ ﺍﻛﺜﺮ ﻣﻦ ‪٦‬‬
‫ﺍﺷﻬﺮ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Antidiuretic hormone (ADH) analogues‬‬

‫*************************************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Antidiuretic hormone (ADH) analogues‬ﺗﻀﻢ ﻋﺪﺓ ﺍﺩﻭﻳﺔ ﻣﻨﻬﺎ‪:‬‬
‫‪ Vasopressin, terlipressin, desmopressin‬ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ‬
‫ﳐﺘﻠﻔﺔ ‪:‬‬
‫ﺣﻴﺚ ﻳﺴﺘﻌﻤﻞ ﻛﻞ ﻣﻦ ‪. vasopressin and desmopressin‬‬
‫ﰲ ﻣﻌﺎﳉﺔ ‪. Pituitary diabetes insipidus‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ ﻛﻞ ﻣﻦ ‪. vasopressin and terlipressin‬‬
‫ﰲ ﻣﻌﺎﳉﺔ ﻧﺰﻑ ﺩﻭﺍﱄ ﺍﳌﺮﻱء ‪. vasopressin and terlipressin‬‬
‫ﻭﻳﺴﺘﻌﻤﻞ )‪. desmopressin‬‬
‫ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﺘﺒﻮﻝ ﺍﻟﻼﺭﺍﺩﻱ ﻧﺘﻴﺠﺔ ﻧﻘﺺ ﺍﳌﻀﺎﺩ ﻟﻼﺩﺭﺍﺭ ‪. Primary nocturnal enuresis‬‬

‫‪١١١‬‬
 ‫ﻭﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳑﻨﻮﻋﺔ ﰲ ‪. Coronary artery disease‬‬

‫ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟــ ‪Intravenous fluids‬‬

‫***********************************‬

‫ﺍﻥ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟــ ‪ Intravenous fluids‬ﻫﻲ‪:‬‬

‫ﺯﻳﺎﺩﺓ ﰲ ﺍﻟﺴﻮﺍﺋﻞ ﰲ ﺍﳉﺴﻢ ‪. Fluid overload‬‬
‫ﻭ ﻋﺪﻡ ﺗﻮﺍﺯﻥ ﺗﺮﻛﻴﺰ ﺑﻌﺾ ﺍﳌﻮﺍﺩ ﻣﺜﻞ ‪:‬‬
‫ﺍﻟﺼﻮﺩﻳﻮﻡ ‪.‬‬
‫ﻭﺍﻟﻜﻠﻮﺭﻳﺪ ‪.‬‬
‫ﻭﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‪.‬‬
‫‪. Electrolyte imbalance‬‬
‫ﻭ ﺣﺪﻭﺙ ﲢﺴﺲ ﻻﺣﺪ ﻣﻜﻮﻧﺎﺗﻬﺎ ‪Hypersensitivity reactions to constituents of‬‬
‫‪. colloid solutions‬‬

‫‪١١٢‬‬
 ‫ﺍﻣــــــــــــﺮﺍﺽ ﺍﻟﺪﻡ ‪.‬‬

‫ﻣﻌﺎﳉﺔ ﻓﻘﺮ ﺍﻟﺪﻡ ﻣﻦ ﻧﻮﻉ ‪megaloblastic anaemia‬‬

‫****************************************‬

‫ﻣﻦ ﺍﳋﻄﻂ ﺍﻟﻌﻼﺟﻴﺔ ﺍﻟﺘﻲ ﳚﺐ ﺍﻥ ﻧﻜﻮﻥ ﳓﻦ ﻛﺼﻴﺎﺩﻟﺔ ﻋﺎﺭﻓﲔ ﺑﻬﺎ ﻫﻲ ﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﳌﻌﺎﳉﺔ ﻓﻘﺮ‬
‫ﺍﻟﺪﻡ ﻣﻦ ﻧﻮﻉ ‪. megaloblastic anaemia‬‬
‫ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﻧﻘﺺ ‪ folic acid‬ﻭﻓﻴﺘﺎﻣﲔ ‪. B12‬‬
‫ﺣﻴﺚ ﳛﺪﺙ ﻧﻘﺺ ﻓﻴﺘﺎﻣﲔ ‪ B12‬ﺑﺴﺒﺐ‬
‫ﺍﻣﺎ ﻧﺘﻴﺠﺔ ﻗﻠﺔ ﺗﻨﺎﻭﻝ ﺍﻻﻏﺬﻳﺔ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﻫﺬﺍ ﺍﻟﻔﻴﺘﺎﻣﲔ ‪.‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﻧﻘﺺ ‪ intrinsic factor‬ﺑﺴﺒﺐ ‪ atrophic gastritis‬ﻭﺍﻟﺬﻱ ﻳﻌﺘﱪ ﺿﺮﻭﺭﻱ ﺟﺪﺍ ﰲ‬
‫ﺍﻣﺘﺼﺎﺹ ﻓﻴﺘﺎﻣﲔ ‪. B12‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﻭﺟﻮﺩ ﺍﻣﺮﺍﺽ ﰲ ﺍﻻﻣﻌﺎء ﻣﺜﻞ ﺳﻮء ﺍﻻﻣﺘﺼﺎﺹ ﻭ ‪. Crahn's disease‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﺗﻨﺎﻭﻝ ﺑﻌﺾ ﺍﻻﺩﻭﻳـــــــــﺔ ﻣﺜﻞ ‪. colchicine, neomycin,‬‬
‫ﺍﻣﺎ ﻧﻘﺺ ‪ Folic acid deficiency‬ﻓﻴﺤﺪﺙ ﺍﻣﺎ ﺑﺴﺒﺐ ﻗﻠﺔ ﺗﻨﺎﻭﻝ ﻫﺬﺍ ﺍﻟﻔﻴﺘﺎﻣﲔ ﻛﻤﺎ ﰲ ﺍﻟﺮﺿﻊ‬
‫ﻭﺍﻻﻃﻔﺎﻝ ﻭﺍﻳﻀـــــــــﺎ ﺍﻟﺬﻳﻦ ﻳﺘﻨﺎﻭﻟﻮﻥ ﺍﻟﻜﺤﻮﻝ‪.‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﺳﻮء ﺍﻻﻣﺘﺼﺎﺹ ‪.‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺍﻻﺣﺘﻴﺎﺝ ﻛﻤﺎ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ‪.‬‬
‫ﺍﻭ ﺑﺴﺒﺐ ﺗﻨﺎﻭﻝ ﺑﻌﺾ ﺍﻻﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﻧﻘﺺ ﻫﺬﺍ ﺍﻟﻔﻴﺘﺎﻣﲔ ﻣﺜﻞ ‪Phenytoin -‬‬
‫‪. methotrexate – trimethoprim‬‬
‫ﻭﻳﻌﺎﰿ ﻫﺬﺍ ﺍﻟﻨﻮﻉ ﻣﻦ ﺍﻧﻮﺍﻉ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﺒﺴﺎﻃﺔ ﺑﺘﻌﻮﻳﺾ ﻧﻘﺺ ‪ folic acid‬ﻭﻓﻴﺘﺎﻣﲔ ‪. B12‬‬
‫ﺣﻴﺚ ﻳﺘﻢ ﺍﻋﻄﺎء ﺟﺮﻋﺔ ‪ ٥‬ﻣﻠﻐﻢ ﻣﻦ ﻋﻼﺝ ‪ folic acid‬ﻛﻞ ﻳﻮﻡ ﺍﱃ ﺍﻥ ﳛﺪﺙ ﲢﺴﻦ ﺍﻻﻋﺮﺍﺽ ﻟﺪﻯ‬
‫ﺍﳌﺮﻳﺾ ﺛﻢ ﻧﺴﺘﻤﺮ ﻋﻠﻰ ﺟﺮﻋﺔ ﳏﺎﻓﻈﺔ ‪ ١‬ﻏﻢ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﺍﻣﺎ ﻧﻘﺺ ‪ Vitamin 812 deficiency‬ﻓﻴﺘﻢ ﺗﻌﻮﻳﻀﺔ ﻣﻦ ﺧﻼ ﺍﻋﻄﺎء ‪Hydroxycobalamine‬‬
‫ﲜﺮﻋﺔ ‪ ١٠٠‬ﻣﺎﻳﻜﺮﻭﻏﺮﺍﻡ ﻣﺮﺗﲔ ﰲ ﺍﻭﻝ ﺍﺳﺒﻮﻉ ‪.‬‬
‫ﺛﻢ ﻳﻌﻄﻰ ﻣﺮﺓ ﻭﺍﺣﺪﺓ ﰲ ﺍﻻﺳﺒﻮﻉ ﳌﺪﺓ ﺳﺘﺔ ﺍﺳﺎﺑﻴﻊ ‪.‬‬
‫ﺛﻢ ﺑﻌﺪ ﺫﻟﻚ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﻳﻌﻄﻰ ﻛﻞ ﺛﻼﺙ ﺍﺷﻬﺮ ﺍﱃ ﻧﻬﺎﻳﺔ ﺍﳊﻴﺎﺓ ‪.‬‬

‫‪١١٣‬‬
 ‫ﺣﻴﺚ ﺍﻥ ﺍﻏﻠﺐ ﺍﳌﺮﺽ ﳛﺘﺎﺟﻮﻥ ﺍﳌﻌﺎﳉﺔ ﺑـ‪ Hydroxycobalamine‬ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻌﻀﻠﺔ ﻋﻠﻰ‬
‫ﻃﻮﻝ ﺍﳊﻴﺎﺓ ‪.‬‬
‫ﻭﻛﻼ ﺍﻟﺪﻭﺍﺋﲔ ﻣﺘﻮﻓﺮﻳﻦ ﰲ ﺍﻟﺼﻴﺪﻟﻴﺎﺕ ‪.‬‬

‫ﻛﻴﻔﻴﺔ ﻣﻌﺎﳉﺔ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﻨﻘﺺ ﺍﳊﺪﻳﺪ‬

‫*******************************‬

‫ﻛﺜﲑ ﺟﺪﺍ ﻣﺎ ﻳﺘﻢ ﺍﻟﺴﺆﺍﻝ ﻋﻦ ﻛﻴﻔﻴﺔ ﻣﻌﺎﳉﺔ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﻨﻘﺺ ﺍﳊﺪﻳﺪ ‪.‬‬
‫ﻭﻛﻴﻒ ﻳﺘﻢ ﺣﺴﺎﺏ ﺍﳉﺮﻋﺔ ؟‬
‫ﻭﻛﻢ ﻫﻲ ﺍﳌــــــــــــﺪﺓ ﺍﻟﺘﻲ ﻧﻌﺎﰿ ﺑﻬﺎ ﻫﺬﺍ ﺍﳌﺮﺽ ﺳﻮﺍء ﺑﺎﻻﻗﺮﺍﺹ ﺍﻭ ﺍﳊﻘﻦ ؟‬
‫ﻟﺬﺍ ﺳﺎﺗﻜﻠﻢ ﻟﻜﻢ ﻋﻦ ﺫﻟﻚ ﺑﺎﻟﺘﻔﺼﻴﻞ ﺗﺎﺑﻌﻮﺍ ﻣﻌﻨﺎ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﻨﻘﺺ ﺍﳊﺪﻳﺪ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ﺍﳌﺸﻬﻮﺭﺓ ﺟﺪﺍ ﻭﻫﻲ ﺗﺼﻴﺐ ﺍﻟﻜﺒﺎﺭ ﻭﺍﻟﺼﻐﺎﺭ ﻋﻠﻰ ﺣﺪﺍ‬
‫ﺳﻮﺍء ﺗﻘﺮﻳﺒﺎ ‪.‬‬
‫ﻭﺍﺫﺍ ﱂ ﻳﻌﺎﰿ ﻫﺬﺍ ﺍﳌﺮﺽ ﻓﺎﻧﻪ ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ ﻣﻀﺎﻋﻔﺎﺕ ﺧﻄﺮﺓ ﺟﺪﺍ ‪.‬‬
‫ﻭﻳﺸﺨﺺ ﻫﺬﺍ ﺍﳌﺮﺽ ﻋﻦ ﻃﺮﻳﻖ ﺍﻻﻋﺮﺍﺽ ﻣﺜﻞ ﺍﻟﺸﺤﻮﺏ ﻭﺳﺮﻋﺔ ﺍﻟﺘﻨﻔﺲ ﻭﺍﳋﻔﻘﺎﻥ ﻭﺍﻟﺘﻌﺐ ﻭﺍﻟﻨﺤﻮﻝ‬
‫ﻭﻋﺪﻡ ﺍﻟﻘﺪﺭﺓ ﺍﻟﻜﺎﻣﻠﺔ ﻋﻠﻰ ﺍﺩﺍء ﺍﻻﻋﻤﺎﻝ ﺑﺸﻜﻞ ﻃﺒﻴﻌﻲ ‪.‬‬
‫ﻳﻀﺎﻑ ﺍﱃ ﺫﻟﻚ ﺍﻟﺘﺸﺨﻴﺺ ﺑﺎﺟﺮﺍء ﺍﻟﺘﺤﺎﻟﻴﻞ ﺍﻟﻄﺒﻴﺔ ﺣﻴﺚ ﻳﻼﺣﻆ ﺍﳔﻔﺎﺽ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ‪.‬‬
‫ﻭﻋﻠﻰ ﺍﻳﺔ ﺣﺎﻝ ﻫﺬﺍ ﻫﻮ ﺃﻱ ﺍﻟﺘﺸﺨﻴﺺ ﻣﻦ ﻣﻬﺎﻡ ﺍﻟﻄﺒﻴﺐ ﺍﳌﺨﺘﺺ ﺑﻔﺮﻉ ﺍﻟﺪﻡ ‪.‬‬
‫ﳓﻦ ﻛﺼﻴﺎﺩﻟﺔ ﳚﺐ ﺍﻥ ﻳﻜﻮﻥ ﻟﺪﻳﻨﺎ ﺟﻮﺍﺏ ﻭﺍﺿﺢ ﻋﻦ ﺍﳋﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ‪.‬‬
‫ﻭﻳﺘﻢ ﻋﻼﺝ ﻫﺬﺍ ﺍﳌﺮﺽ ﺍﻣﺎ ﺑﺎﺳﺘﻌﻤﺎﻝ ﺍﻭ ﺍﳊﻘﻦ ‪.‬‬
‫ﺍﻻﻗﺮﺍﺹ ﺍﻟﺘﻲ ﺗﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﻫﺬﺍ ﺍﳌﺮﺽ ﻛﺜﲑﺓ ﻣﻨﻬﺎ ﻋﻼﺝ ‪ ferrous sulfate‬ﻭﺗﺘﻮﻓﺮ ﺑﱰﻛﻴﺰ‬
‫‪ ٢٠٠‬ﻣﻠﻐﻢ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺘﻮﻓﺮ ﻧﻮﻉ ﺍﺧﺮ ﻣﻦ ﺍﻻﻗﺮﺍﺹ ﺍﻟﻔﻤﻮﻳﺔ ﻟﻠﺤﺪﻳﺪ ﻫﻲ ‪ ferrous gluconate‬ﻭﻫﻮ ﺑﱰﻛﻴﺰ ‪٣٠٠‬‬
‫ﻣﻠﻐﻢ ‪.‬‬
‫ﻭﺍﻟﻜﻤﻴﺔ ﺍﻟﻴﻮﻣﺔ ﺍﳌﻄﻠﻮﺑﺔ ﻟﻠﻤﻌﺎﳉﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻣﻦ ﺍﳊﺪﻳﺪ ﻫﻲ ‪١٥٠‬ﻣﻠﻐﻢ ﻣﻦ ﻋﻨﺼﺮ ﺍﳊﺪﻳﺪ ‪.‬‬
‫ﻭﻟﺬﻟﻚ ﻳﺘﻢ ﻭﺻﻒ ‪ ferrous sulfate‬ﻛﻞ ‪ ٨‬ﺳﺎﻋﺎﺕ ﺃﻱ ﺛﻼﺙ ﻣﺮﺍﺕ ﺑﺎﻟﻴﻮﻡ ‪.‬‬
‫ﺣﻴﺚ ﺗﻌﻄﻴﻨﺎ ‪ ١٢٠‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ﻣﻦ ﻋﻨﺼﺮ ﺍﳊﺪﻳﺪ ‪.‬‬

‫‪١١٤‬‬
 ‫ﻭﻳﺘﻢ ﻭﺻﻒ ﺩﻭﺍء ‪ ferrous gluconate‬ﻛﻞ ‪ ١٢‬ﺳﺎﻋﺔ ﺃﻱ ﻣﺮﺗﲔ ﻳﻮﻣﻴﺎ ‪.‬‬
‫ﺣﻴﺚ ﻳﻌﻄﻴﻨﺎ ‪ ٧٠‬ﻣﻠﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ﻣﻦ ﻋﻨﺼﺮ ﺍﳊﺪﻳﺪ ﺃﻱ ﺍﻗﻞ ﻣﻦ ‪. ferrous sulfate‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻛﻤﺎ ﺗﻌﺮﻓﻮﻥ ﻓﺎﻥ ﺍﻓﻀﻞ ﺍﻣﺘﺼﺎﺹ ﻟﻠﺤﺪﻳﺪ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻳﺘﻢ ﺍﺫﺍ ﰎ ﺍﻋﻄﺎء ﻫﺬﻩ ﺍﻻﻗﺮﺍﺹ‬
‫ﺍﻣﺎ ﻗﺒﻞ ﺍﻟﻄﻌﺎﻡ ﺑﺴﺎﻋﺔ ﺍﻭ ﺑﻌﺪ ﺍﻟﻄﻌﺎﻡ ﺑﺴﺎﻋﺘﲔ ‪.‬‬
‫ﻭﻟﻜﻨﻪ ﳐﺪﺵ ﳉﺪﺭ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪ irritant‬ﻓﻴﺴﺒﺐ ﺍﻟﻐﺜﻴﺎﻥ ﻭﰲ ﻣﺜﻞ ﻫﺬﻩ ﺍﳊﺎﻝ ﻓﻴﺠﺐ ﺍﻥ‬
‫ﺗﻜﻮﻥ ﻟﺪﻯ ﺍﻟﺰﻣﻴﻞ ﺍﻟﺼﻴﺪﱄ ﺍﳊﻞ ﻟﺘﺨﻠﺺ ﻣﻦ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﳌﺰﻋﺞ ﻭﻫﻮ ‪:‬‬
‫ﺍﻣﺎ ﺍﻥ ﻳﺘﻢ ﺍﻟﺒﺪء ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﺛﻢ ﺗﺰﺩﺍﺩ ﺗﺪﺭﳚﻴﺎ ‪.‬‬
‫ﺍﻭ ﺍﺳﺘﻌﻤﺎﻝ ﻧﻮﻉ ﻣﻦ ﺍﻻﻗﺮﺍﺹ ﳛﺘﻮﻱ ﻛﻤﻴﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﺍﳊﺪﻳﺪ ﻣﺜﻞ ‪ ferrous gluconate‬ﺣﻴﺚ‬
‫ﲢﺘﻮﻱ ﻋﻠﻰ ﻛﻤﻴﺔ ﻗﻠﻴﻠﺔ ﻣﻦ ﺍﳊﺪﻳﺪ ﺑﻜﻞ ﻗﺮﺹ ‪ ٣٠٠‬ﻣﻠﻐﻢ ﻣﻨﻪ ﳛﺘﻮﻱ ﻋﻠﻰ ‪ ٣٥‬ﻣﻠﻐﻢ ﻣﻦ ﺍﳊﺪﻳﺪ ‪.‬‬
‫ﺍﻭ ﻳﺘﻢ ﻗﻄﻊ ﺍﻟﻌﻼﺝ ﺍﱃ ﺍﻥ ﺗﺰﻭﻝ ﺍﻻﻋﺮﺍﺽ ﻭﺍﻟﺮﺟﻮﻉ ﺑﺎﺳﺘﻌﻤﺎﻝ ﲜﺮﻋﺔ ﺗﺰﺩﺍﺩ ﺗﺪﺭﳚﻴﺎ ‪.‬‬
‫ﺍﻭ ﻳﺘﻢ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻊ ﺍﻟﻄﻌﺎﻡ ﻓﺎﻧﻪ ﻳﻘﻠﻞ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﺍﳌﺨﺪﺵ ‪.‬‬
‫ﺍﻭ ﻳﺘﻢ ﺍﺳﺘﻌﻤﺎﻝ ﻣﺴﺘﺤﻀﺮﺍﺕ ﺣﺪﻳﺪ ﺑﻄﻴﺌﺔ ﺍﻟﺘﺤﺮﺭ ‪.slow release formulation‬‬
‫ﻛﻤﺎ ﺗﻼﺣﻈﻮﻥ ﺯﻣﻼﺋﻨﺎ ﺍﻟﻜﺮﺍﻡ ﲬﺲ ﺣﻠﻮﻝ ﻟﺘﺨﻠﺺ ﻣﻦ ﻫﺬﺍ ﺍﻟﺘﺎﺛﲑ ﻭﳚﺐ ﺍﻥ ﺗﻜﻮﻥ ﻫﺬﻩ ﺣﺎﺿﺮ ﰲ‬
‫ﺫﻫﻦ ﺍﻟﺼﻴﺪﱄ ﻟﻴﻌﻄﻴﻬﺎ ﻟﺰﻣﻴﻠﻪ ﺍﻟﻄﺒﻴﺐ ﻟﻮ ﺍﺣﺘﺎﺟﻬﺎ ﻭﻫﻲ ﻣﻦ ﺍﻫﻢ ﻣﻬﺎﻡ ﺍﻟﺼﻴﺎﺩﻟﺔ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻟﻮ ﱂ ﺗﻨﻔﻊ ﻫﺬﻩ ﺍﳊﻠﻮﻝ ﲨﻴﻌﻬﺎ ﻭﱂ ﻳﺘﺤﻤﻞ ﺍﳌﺮﻳﺾ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﱂ ﺍﻟﺒﻄﻨﻲ‬
‫ﺍﻟﺬﻱ ﺣﺪﺙ ﻧﺘﻴﺠﺔ ﺍﺳﺘﻌﻤﺎﻝ ﺍﳊﺪﻳﺪ ﻭﻛﺬﻟﻚ ﺍﻻﻣﺴﺎﻙ ﺍﻭ ﺍﻟﻘﺒﺾ ‪.‬‬
‫ﻓﺎﻧﻪ ﳚﺐ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻧﻠﺠﺄ ﺍﱃ ﺍﺳﺘﻌﻤﺎﻝ ﻋﻼﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ ﺳﻮﺍء ﻛﺎﻥ ﺍﻟﻮﺭﻳﺪﻱ ﺍﻭ ﺍﻟﻌﻀﻠﻲ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻭﳝﻜﻦ ﻣﻌﺮﻓﺔ ﺍﻻﺳﺘﺠﺎﺑﺔ ﺍﻟﻌﻼﺟﻴﺔ ﻋﻠﻰ ﺍﳌﺮﻳﺾ ﻣﻦ ﺧﻼﻝ ﺍﻥ ﻫﻨﺎﻙ ﺯﻳﺎﺩﺓ ﺗﺒﺪﺍ ﺑﺎﳊﺼﻮﻝ ﰲ‬
‫ﻛﺮﻳﺎﺕ ﺍﻟﺪﻡ ﺍﳊﻤﺮﺍء ﺗﺒﺪﺍ ﻣﻦ ﺍﻟﻴﻮﻡ ﺍﻟﺮﺍﺑﻊ ﻟﻠﻤﻌﺎﳉﺔ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﻓﺎﻥ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﻳﺒﺪﺍ ﺑﺎﻻﺭﺗﻔﺎﻉ ﻣﻦ ﺑﻌﺪ ﺍﻟﻴﻮﻡ ﺍﻟﺴﺎﺑﻊ ﺍﱃ ﺍﻟﻌﺎﺷﺮ ﻣﻦ ﺍﻟﺒﺪء ﺑﺎﳌﻌﺎﳉﺔ‬
‫ﺣﻴﺚ ﻳﺮﺗﻔﻊ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﻛﻞ ‪ ٧‬ﺍﻳﺎﻡ ‪١‬ﻏﻢ ‪/‬ﺩﻳﺴﻴﻠﻴﱰ ﻭﻳﺮﺟﻊ ﺍﱃ ﻣﺴﺘﻮﺍﻩ ﺍﻟﻄﺒﻴﻌﻲ ﺑﻌﺪ ‪١٠-٤‬‬
‫ﺍﺳﺒﻮﻉ ﻣﻦ ﺑﺪء ﳌﻌﺎﳉﺔ ‪.‬‬
‫ﻭﻛﺬﻟﻚ ﳝﻜﻦ ﻣﻌﺮﻓﺔ ﺍﻻﺳﺘﺠﺎﺑﺔ ﺍﻟﻌﻼﺟﻴﺔ ﻣﻦ ﺧﻼﻝ ﲢﺴﻦ ﺍﻻﻋﺮﺍﺽ ﻋﻨﺪ ﺍﳌﺮﻳﺾ ‪.‬‬
‫ﻭﻳﻨﺼﺢ ﺍﻳﻬﺎ ﺍﻟﺰﻣﻼء ﺍﻟﺼﻴﺎﺩﻟﺔ ﻛﻤﺎ ﺗﻌﻠﻤﻮﻥ ﺍﻥ ﻳﺖ ﺍﺳﺘﻌﻤﺎﻝ ﻓﻴﺘﺎﻣﲔ ‪ C‬ﻣﻊ ﺍﻗﺮﺍﺹ ﺍﳊﺪﻳﺪ ﻻﻧﻪ‬
‫ﻳﺆﺩﻱ ﺍﱃ ﺯﻳﺎﺩﺓ ﺍﻣﺘﺼﺎﺹ ﺍﳊﺪﻳﺪ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺍﻣﺎ ﻓﱰﺓ ﺍﳌﻌﺎﳉﺔ ﺑﺎﻻﻗﺮﺍﺹ ﺍﻟﻔﻤﻮﻳﺔ ﻓﺘﺴﺘﻤﺮ ﻣﻦ ‪ ٤‬ﺍﱃ ‪ ١٠‬ﺍﺳﺎﺑﻴﻊ ﺣﱴ ﻳﺮﺟﻊ‬
‫ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﻃﺒﻴﻌﻲ ‪.‬‬
‫ﺛﻢ ﻧﺴﺘﻤﺮ ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ‪ low‬ﻟﺘﻌﻮﻳﺾ ﳐﺰﻭﻥ ﺍﳊﺪﻳﺪ ﳌﺪﺓ ‪ ٣‬ﺍﺷﻬﺮ ‪.replenish iron stores‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺩﻋﻨﺎ ﻧﺘﻮﺳﻊ ﻓﻨﺬﻛﺮ ﳌﺎﺫﺍ ﰲ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ ﻭﺑﺎﻟﺮﻏﻢ ﻣﻦ ﻭﺻﻒ ﺍﻟﺪﻭﺍء ﻻﳒﺪ ﺍﺳﺘﺠﺎﺑﺔ ﺩﻭﺍﺋﻴﺔ‬
‫ﳍﺬﺍ ﺍﳌﺮﺽ ‪.‬‬
‫ﺍﻛﻴﺪ ﺫﻟﻚ ﻳﻜﻮﻥ ﻟﻌﺪﺓ ﺍﺳﺒﺎﺏ ﻣﻨﻬﺎ ﻗﺪ ﻳﻜﻮﻥ ﺗﺸﺨﻴﺺ ﺍﳌﺮﺽ ﺧﺎﻃﻰء ﺃﻱ ﺍﻥ ﺍﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﻓﻘﺮ‬
‫ﺍﻟﺪﻡ ﻣﻦ ﻧﻮﻉ ﺍﺧﺮ ﻭﻟﻴﺲ ﻓﻘﺮ ﺍﳊﺪﻳﺪ ﻭﻗﺪ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ﺳﻮء ﺍﻻﻣﺘﺼﺎﺹ ﻟﻠﻌﻼﺝ ﺍﻭ ﺑﺴﺒﺐ ﺍﻥ ﺍﳌﺮﻳﺾ‬

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 ‫ﻳﻌﺎﻧﻲ ﻣﻦ ﻧﺰﻑ ﻣﺴﺘﻤﺮ ﺍﻭ ﻳﻌﺎﻧﻲ ﻣﻦ ‪ chronic infection‬ﺍﻭ ﺍﻥ ﺍﳌﺮﻳﺾ ﱂ ﻳﺘﺤﻤﻞ ﺍﻟﺪﻭﺍء ﻭﱂ‬
‫ﻳﺎﺧﺬ ﺍﳉﺮﻋﺔ ﺍﻟﻜﺎﻓﻴﺔ ﺍﻭ ﺍﻥ ﺍﳌﺮﻳﺾ ﻳﺘﻨﺎﻭﻝ ﺍﺩﻭﻳﺔ ﺍﺧﺮﻯ ﺗﻘﻠﻞ ﻣﻦ ﺍﻣﺘﺼﺎﺹ ﺍﳊﺪﻳﺪ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﺗﺘﺬﻛﺮﻭﻥ ﺍﻧﻨﺎ ﻗﻠﻨﺎ ﺍﻥ ﻫﻨﺎﻙ ﺣﻘﻦ ﺍﻳﻀﺎ ﺗﺴﺘﻌﻤﻞ ﳌﻌﺎﳉﺔ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﻨﻘﺺ ﺍﳊﺪﻳﺪ ﻭﻫﻲ ‪Iron‬‬
‫‪ dextran‬ﻭﲢﺘﻮﻱ ﻋﻠﻰ ‪ ١٠٠‬ﻣﻠﻐﻢ ﺣﺠﻤﻬﺎ ‪ ٢‬ﻣﻞ ﻭﺗﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻌﻀﻠﺔ ﺍﻭ ﻋﻦ ﻃﺮﻳﻖ‬
‫ﺍﻟﺘﺴﺮﻳﺐ ﺍﻟﻮﺭﻳﺪﻱ ‪.‬ﻭﺍﻳﻀﺎ ‪ Iron sorbitol‬ﲢﺘﻮﻱ ﻋﻠﻰ ‪ ٥٠‬ﻣﻠﻐﻢ ﻭﺗﻌﻄﻰ ﻋﻀﻠﻲ ﻓﻘﻂ ﻭﺍﻳﻀﺎ‬
‫‪ ferric gluconate 100 mg/5ml‬ﻭﻫﻮ ﻳﻌﻄﻰ ﻭﺭﻳﺪﻳﺎ ‪.‬‬
‫ﺍﺣﺒﺎﺋﻲ ﻧﻠﺠﺄ ﺍﱃ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﳊﻘﻦ ﺑﺪﻝ ﺍﱃ ﺍﻗﺮﺍﺹ ﺍﻟﻔﻤﻮﻳﺔ ﰲ ﺣﺎﻻﺕ ﻣﻨﻬﺎ ﻋﺪﻡ ﲢﻤﻞ ﺍﳉﺮﻋﺔ‬
‫ﺍﻟﻔﻤﻮﻳﺔ‪ Oral iron intolerance.‬ﺍﻭ ﺳﻮء ﺍﻻﻣﺘﺼﺎﺹ ‪ Malabsorption.‬ﺍﻭ ﺍﻟﻨﺰﻑ ﺍﳌﺴﺘﻤﺮ‬
‫‪ Chronic blood loss.‬ﺍﻭ ﺍﻟﺮﻏﺒﺔ ﺑﺎﳊﺼﻮﻝ ﻋﻠﻰ ﺍﺳﺘﺠﺎﺑﺔ ﺳﺮﻳﻌﺔ ‪rapid response is‬‬
‫‪ required‬ﻛﻤﺎ ﰲ ﻓﻘﺮ ﺍﻟﺪﻡ ﺍﻟﺸﺪﻳﺪ ‪.‬‬
‫ﺯﻣﻼﺋﻨﺎ ﺍﻟﺼﻴﺎﺩﻟﺔ ﺍﻻﻋﺰﺍء ﻭﻳﺘﻢ ﺣﺴﺎﺏ ﺍﳉﺮﻋﺔ ﺍﺫﺍ ﻛﺎﻥ ﺍﻻﻋﻄﺎء ﻋﻦ ﻃﺮﻳﻖ ﺍﳊﻘﻦ ﺣﺴﺐ ﺍﻟﻘﺎﻧﻮﻥ ﺍﻟﺘﺎﱄ‬
‫‪:‬‬
‫ﺍﳉﺮﻋﺔ ﺍﳌﻄﻠﻮﺑﺔ =))ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﺍﻟﻄﺒﻴﻌﻲ – ﻫﻴﻤﻮﻛﻠﻮﺑﲔ ﺍﳌﺮﻳﺾ(( ﻣﻀﺮﻭﺑﺔ ﺑﻮﺯﻥ ﺍﳌﺮﻳﺾ‬
‫ﻣﻀﺮﻭﺑﺔ ﰲ ‪. ٣‬‬
‫ﻓﻠﻮ ﻛﺎﻥ ﺭﺟﻞ ﺗﺮﻛﻴﺰ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﻟﻪ ‪. ٧‬‬
‫ﻭﻭﺯﻧﻪ ﻫﻮ ‪ ٨٠‬ﻛﻐﻢ ‪.‬‬
‫ﻓﺎﻥ ﺍﳉﺮﻋﺔ ﺍﳌﻄﻠﻮﺑﺔ ﻫﻲ = ) ‪( ٧- ١٥‬ﺿﺮﺏ‪ ٨٠‬ﺿﺮﺏ ‪. ٣‬‬
‫ﺍﳉﺮﻋﺔ ﺍﳌﻄﻠﻮﺑﺔ = ‪ ١٩٢٠‬ﻣﻠﻐﻢ ‪.‬‬
‫ﺃﻱ ‪ ٢٠‬ﺍﻣﺒﻮﻟﺔ ﻣﻦ ‪ ferric gluconate 100 mg/5m‬ﺗﻘﺮﻳﺒﺎ ﺗﻌﻄﻰ ﺑﲔ ﻳﻮﻣﺎ ﻭﺍﺧﺮ ﻟﺘﺼﺤﻴﺢ ﻓﻘﺮ‬
‫ﺍﻟﺪﻡ ‪.‬‬

‫ﺍﻣﺎ ﺍﻻﻃﻔﺎﻝ ﻓﺎﻥ ﺍﻟﻌﻼﺝ ﺑﺎﺣﺪ ﻣﺴﺘﺤﻀﺮﺍﺕ ﺍﳊﺪﻳﺪ ﺍﻟﻔﻤﻮﻳﺔ ﺟﺪﺍ ﻓﻌﺎﻝ ﰲ ﺍﻏﻠﺐ ﺍﳊﺎﻻﺕ‪.‬‬
‫ﻭﻳﻌﻄﻰ ﲜﺮﻋﺔ ‪٦‬ﻣﻠﻐﻢ ‪/‬ﻛﻐﻢ ‪/‬ﺍﻟﻴﻮﻡ ﺗﻘﺴﻢ ﺍﳉﺮﻋﺔ ﺍﱃ ﻣﺮﺗﲔ ﺍﱃ ﺛﻼﺙ ﻣﺮﺍﺕ ﺑﺎﻟﻴﻮﻡ ﺑﲔ ﺍﻻﻛﻞ ﺍﻭ‬
‫ﺑﻌﺪ ﺍﻻﻛﻞ ﻟﺘﺠﻨﺐ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﻟﻠﺤﺪﻳﺪ ﻋﻠﻰ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪.‬‬
‫ﻭﳚﺐ ﺍﻥ ﺗﺴﺘﻤﺮ ﺍﻟﻌﻼﺝ ﻣﻦ ‪ ٣-٢‬ﺛﻼﺙ ﺍﺷﻬﺮ ﻟﺘﻌﻮﻳﺾ ﺍﻟﻜﺎﻣﻞ ﻟﻌﻨﺼﺮ ﺍﳊﺪﻳﺪ ﰲ ﺍﳉﺴﻢ‪.‬‬
‫ﺍﻻﺳﺘﺠﺎﺑﺔ ﻋﺎﺩﺓ ﺗﻜﻮﻥ ﺳﺮﻳﻌﺔ ﻟﻠﻌﻼﺝ ﻭﺧﻼﻝ ‪ ٢٤‬ﺳﺎﻋﺔ ‪،‬ﻭﰲ ﺍﻟﻴﻮﻡ ﺍﻟﺮﺍﺑﻊ ﻳﺒﺪﺍ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ‬
‫ﺑﺎﻻﺭﺗﻔﺎﻉ ‪.‬‬
‫ﻭﰲ ﺣﺎﻟﺔ ﻓﺸﻞ ﺍﻻﺳﺘﺠﺎﺑﺔ ﻟﻠﻤﻌﺎﳉﺔ ﳝﻜﻦ ﺍﻥ ﻳﻜﻮﻥ ﺑﺴﺒﺐ ‪:‬‬
‫*ﺳﻮء ﺍﻻﻣﺘﺼﺎﺹ ‪.‬‬
‫*ﺍﺳﺘﻤﺮﺍﺭ ﺳﺒﺐ ﻓﻘﺪﺍﻥ ﺍﻟﺪﻡ ﺍﻭ ﻧﻘﺺ ﺍﳊﺪﻳﺪ ‪.‬‬
‫*ﺗﺸﺨﻴﺺ ﺧﺎﻃﺊ ﻟﻔﻘﺮ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﰲ ﺣﺎﻟﺔ ﺳﻮء ﺍﻣﺘﺼﺎﺹ ﻣﺰﻣﻦ ‪.‬‬

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 ‫ﻓﺎﻧﻪ ﻳﻌﻄﻰ ﺍﳊﺪﻳﺪ ﻋﻦ ﺍﻟﻄﺮﻳﻖ ﺍﻟﻌﻀﻠﻲ ﻣﺜﻞ )‪.(.iron dextran amp‬‬
‫ﻭﺍﳉﺮﻋﺔ ﻫﻲ ‪ ٤‬ﻣﻠﻐﻢ ‪/‬ﻛﻐﻢ ‪/‬ﺍﳉﺮﻋﺔ ﺗﻌﻄﻰ ﺑﲔ ﻳﻮﻡ ﻭﺍﺧﺮ ﳌﺪﺓ ‪ ٤-٣‬ﺍﻣﺒﻮﻻﺕ ﺣﻴﺚ ﺍﻥ ﻛﻞ ﺟﺮﻋﺔ‬
‫ﺳﻮﻑ ﺗﺰﻳﺪ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﲟﻘﺪﺍﺭ ‪١‬ﻣﻠﻐﻢ ‪/‬ﺩﻳﺴﻠﱰ ‪.‬‬
‫ﺍﻟﻌﻼﺝ ﺑــ ‪ packed red cell transfusion‬ﻭﻳﺘﻢ ﺍﳉﻮء ﺍﱃ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻋﻨﺪﻣﺎ ﻳﻜﻮﻥ ﻣﺴﺘﻮﻯ ‪HB‬‬
‫ﺍﻗﻞ ﻣﻦ ‪ ٥‬ﻏﻢ ‪/‬ﺩﻳﺴﻴﻠﻴﱰ ﻭﺍﻟﻜﻤﻴﺔ ﺍﻟﺘﻲ ﺗﻌﻄﻰ ﺧﻼﻝ ﺍﳌﺮﺓ ﺍﻟﻮﺍﺣﺪ ﳚﺐ ﺍﻥ ﻻﺗﻜﻮﻥ ﺍﻋﻠﻰ ﻣﻦ ‪٥‬ﻣﻞ‬
‫‪/‬ﻛﻐﻢ ‪.‬‬
‫ﻭﳚﺐ ﻣﺮﺍﻗﺒﺔ ﻋﺪﺩ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ﺧﻼﻝ ﺗﺴﺮﻳﺐ ﺍﻟﺪﻡ ‪،‬ﻣﺮﺓ ﺍﻭ ﻣﺮﺗﲔ ﻣﻦ ﻫﺬﻩ ﺍﻟﻜﻤﻴﺔ ﺳﻮﻑ ﺗﻜﻮﻥ‬
‫ﻛﺎﻓﻴﺔ ﻟﺮﻓﻊ ﻣﺴﺘﻮﻯ ﺍﳍﻴﻤﻮﻛﻠﻮﺑﲔ ﺍﱃ ﺍﳌﺴﺘﻮﻯ ﺍﳌﻄﻠﻮﺏ ‪.‬‬
‫ﺍﲤﲎ ﺍﻥ ﺍﳌﻮﺿﻮﻉ ﻧﺎﻝ ﺍﻋﺠﺎﺑﻜﻢ ﻭﴰﻞ ﲨﻴﻊ ﺍﳌﻌﻠﻮﻣﺔ ﻋﻦ ﻋﻼﺝ ﻓﻘﺮ ﺍﻟﺪﻡ ﺑﻨﻘﺺ ﺍﳊﺪﻳﺪ ‪.‬‬

‫*********************************************‬
‫*************************************‬
‫*************************‬
‫*******************‬
‫************‬

‫‪١١٧‬‬
 ‫ﺍﻻﺩﻭﻳﺔ ﺍﳌﺴﻜﻨﺔ ﻟﻼﱂ ﻭﺍﻣﺮﺍﺽ ﺍﳌﻔﺎﺻﻞ ﻭﺍﻟﻌﻈﺎﻡ‬

‫‪Opioid analgesia‬‬
‫*****************‬

‫ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﳌﻬﻤﺔ ﻫﻲ ‪ Opioid analgesia‬ﺣﻴﺚ ﺗﺸﻤﻞ ‪:‬‬

‫ﻛﻞ ﻣﻦ ‪ Weak opioids‬ﻣﺜﻞ ‪. codeine, tramadol‬‬
‫ﻭﺍﻳﻀﺎ ‪ strong opioids‬ﻣﺜﻞ ‪. morphine, oxycodone, methadone‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﰲ ﺣﺎﻟﺘﲔ ﺭﺋﻴﺴﻴﺘﲔ ﻫﻤﺎ‪:‬‬
‫‪. Moderate to severe pain‬‬
‫ﻭ ‪. Acute pulmonary oedema‬‬

‫ﻭﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ جملﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Opioid analgesia‬ﻫﻲ‪:‬‬

‫ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﻻﻣﺴﺎﻙ ‪.‬‬
‫ﻭﺍﳔﻔﺎﺽ ﺍﻟﻀﻐﻂ ‪.‬‬
‫ﻭﺗﺜﺒﻴﻂ ﺍﻟﺘﻨﻔﺲ ﻭ ‪. Sedation and coma‬‬
‫ﻭﻻ ﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ‪. Raised intracranial pressure‬‬
‫ﻭﻻ ﰲ ‪. Head injury‬‬
‫ﻭﻻ ﰲ ‪. Acute respiratory depression‬‬
‫ﻭﺗﺘﺎﻳﺾ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﺍﻥ ﺩﻭﺍء ‪ codeine‬ﻳﺘﺎﻳﺾ ﺍﱃ ‪. morphine‬‬

‫ﻭﺍﻥ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﳌﺘﻜﺮﺭ ﻭﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ ﻻﺩﻭﻳﺔ ‪ opioids‬ﻳﺆﺩﻱ ﺍﱃ ﺣﺪﻭﺙ‪:‬‬

‫ﺍﻻﻋﺘﻤﺎﺩ ﻭﺍﻻﺩﻣﺎﻥ ﻭﺍﻟﺘﻌﻮﺩ ﻭﻋﺪﻡ ﺗﺎﺛﲑ ﺍﳉﺮﻋﺔ ﻛﻤﺎ ﰲ ﺍﻭﻝ ﺍﻻﺳﺘﻌﻤﺎﻝ ‪dependence and‬‬
‫‪. tolerance‬‬

‫‪١١٨‬‬
‫ﻭﻋﻨﺪ ﻭﺻﻒ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﳚﺐ ﺍﻥ ﺗﻮﺻﻒ ﻣﻌﻪ ﻋﺎﺩﺓ ﻛﻞ ﻣﻦ ﻣﻀﺎﺩ ﻟﻠﺘﻘﻴﻮء ﻭﻣﺴﻬﻞ ‪an anti-‬‬
‫‪. emetic and laxative‬‬
‫ﻻﻥ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺗﺴﺒﺐ ﺍﻻﻣﺴﺎﻙ ﻭﺍﻟﺘﻘﻴﻮء ‪.‬‬
‫ﻭﺧﺎﺻﺔ ﻋﻨﺪ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﻟﻮﺭﻳﺪﻱ‪.‬‬
‫ﻭﻟﻔﱰﺓ ﻃﻮﻳﻠﺔ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻧﺬﻛﺮ ﺍﻥ ﺩﻭﺍء ‪ Diamorphine‬ﳝﺘﻠﻚ ﻓﻌﻞ ﻛﻞ ﻣﻦ ﻣﻮﺳﻊ ﻭﻋﺎﺋﻲ ‪venodilatory‬‬
‫‪ effects‬ﺣﻴﺚ ﻳﻘﻠﻞ ﻣﻦ ‪.preload of the heart‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﻣﻦ ‪ pulmonary oedema formation‬ﻭﺍﻳﻀﺎ ﳝﺘﻠﻚ ﻓﻌﻞ ﻣﻀﺎﺩ ﻟﻠﻘﻠﻖ‬
‫ﻭﺍﳋﻮﻑ ‪. anxiolytic‬‬

‫‪. Non-steroidal anti-inflammatory drugs‬‬

‫***************************************‬

‫ﻣﻦ ﺍجملﺎﻣﻴﻊ ﺍﻟﺪﻭﺍﺋﻴﺔ ﺍﻟﻜﺜﲑﺓ ﺍﻻﺳﺘﻌﻤﺎﻝ ﻫﻲ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Non-steroidal anti-‬‬

‫‪. inflammatory drugs‬‬
‫ﻭﻳﺮﻣﺰ ﳍﺎ ﺍﺧﺘﺼﺎﺭﺍ )‪.(NSAIDs‬‬
‫ﻭﺗﻀﻢ ﺍﺩﻭﻳﺔ ﻛﺜﲑﺓ ﻣﻨﻬﺎ ‪:‬‬
‫‪ Ibuprofen, diclofenac, naproxen, indometacin‬ﻭﺗﺴﺘﻌﻤﻞ ﰲ ‪:‬‬
‫ﻣﻌﺎﳉﺔ ﻭﺗﺴﻜﲔ ﺍﻻﱂ ﺍﳋﻔﻴﻒ ﺍﱃ ﻣﺘﻮﺳﻂ ﺍﻟﻘﻮﺓ ‪. Mild to moderate pain‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺘﻌﻤﻞ ﰲ ‪. Inflammatory musculoskeletal disorders‬‬
‫ﻭﰲ ﻣﻌﺎﳉﺔ ﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺣﺮﺍﺭﺓ ﺍﳉﺴﻢ ‪. Fever‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﻣﻌﺎﳉﺔ ﺍﻟﻨﻘﺮﺱ ﺍﳊﺎﺩ ﻣﺎﻋﺪﺍ ﺍﻻﺳﱪﻳﻦ )‪. Acute gout (excluding aspirin‬‬
‫ﻭﳝﻨﻊ ﺍﺳﺘﻌﻤﺎﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﰲ ﺣﺎﻟﺘﲔ ﻫﻤﺎ‪:‬‬
‫‪. History of active peptic ulcers‬‬
‫ﻭ ‪. Hypersensitivity‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻬﺎ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ‪:‬‬
‫‪. Headaches and dizziness‬‬

‫‪١١٩‬‬
 ‫ﻭ ‪. Bronchospasm‬‬
‫ﻭ ‪. Fluid retention‬‬
‫ﻭ ‪.Renal impairment‬‬
‫ﻭ ‪. GI disturbance‬‬
‫ﻭﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﲣﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻴﺔ‪.‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺧﻄﺮ ﺣﺪﻭﺙ ‪ nephrotoxicity‬ﻋﻨﺪﻣﺎ ﺗﺴﺘﻌﻤﻞ ﻣﻊ ‪. nephrotoxic drugs‬‬
‫ﻭﺍﻳﻀﺎ ﺗﺰﻳﺪ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻣﻦ ﻓﻌﻞ ﻋﻼﺝ ‪ warfarin‬ﻓﺮﲟﺎ ﺗﺴﺒﺐ ﺍﻟﻨﺰﻑ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﺗﻘﻠﻞ ﻣﻦ ﺧﺮﻭﺝ ﺩﻭﺍء ‪. lithium‬‬
‫ﻭﻫﻨﺎﻙ ﻗﺴﻢ ﻣﻦ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻳﺴﻤﻰ ‪.COX-2 selective inhibitors‬‬
‫ﻳﻀﻢ ﻋﺪﺓ ﺍﺩﻭﻳﺔ ﻣﻨﻬﺎ ‪ celecoxib, etoricoxib‬ﻳﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺣﺪﻭﺙ ‪thrombotic‬‬
‫‪ events‬ﻣﺜﻞ ‪ MI and stroke‬ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻭﻟﻜﻦ ﺍﻗﻞ ﺗﺎﺛﲑﺍ ﻋﻠﻰ ﺍﳌﻌﺪﺓ ﻭﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ‬
‫‪.‬ﻭﺗﺘﻮﻓﺮ ﳎﻤﻮﻋﺔ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﺑﻌﺪﺓ ﺍﺷﻜﺎﻝ ﺻﻴﺪﻻﻧﻴﺔ ﻛﺜﲑﺓ ﻣﺜﻞ ‪:‬‬
‫ﺍﻟﺘﺤﺎﻣﻴﻞ ‪.‬‬
‫ﻭﺍﳊﺒﻮﺏ ‪.‬‬
‫ﻭﺍﻻﻗﺮﺍﺹ ‪.‬‬
‫ﻭﺍﳊﻘﻦ ‪.‬‬
‫ﻭﻟﺼﻘﺎﺕ ‪.‬‬
‫ﻭﻣﺮﺍﻫﻢ ‪.‬‬
‫ﻭﻗﻄﺮﺍﺕ ﻟﻠﻌﲔ ﻭﺍﻻﺫﻥ ‪.‬‬

‫ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪Bisphosphonates‬‬

‫******************************‬

‫ﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪: Bisphosphonates‬‬

‫ﺗﺸﻤﻞ ﻛﻞ ﻣﻦ ‪. Alendronate, etidronate, pamidronate, risedronate‬‬
‫ﻭﻫﻲ ﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﻣﻨﻊ ﺗﻜﺴﲑ ﺍﻟﻌﻈﺎﻡ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ‪ osteoclasts‬ﻭﺗﻔﻌﻴﻞ‬
‫‪ osteoblast‬ﻭﺯﻳﺎﺩﺓ ﺩﺧﻮﻝ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ﻟﻠﻌﻈﺎﻡ ‪.‬‬
‫ﻭﺗﺴﺘﻌﻤﻞ ﺑﺼﻮﺭﺓ ﺭﺋﻴﺴﻴﺔ ﻻﺭﺑﻌﺔ ﺣﺎﻻﺕ ﻣﺮﺿﻴﺔ ﻫﻲ‪:‬‬

‫‪١٢٠‬‬
 ‫ﺍﻟﻮﻗﺎﻳﺔ ﻭﺍﳌﻌﺎﳉﺔ ﻣﻦ ﻣﺮﺽ ﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﻢ ‪.‬‬
‫ﻭﻋﻼﺝ ﺯﻳﺎﺩﺓ ﺗﺮﻛﻴﺰ ﻛﺎﻟﺴﻴﻮﻡ ﺍﻟﺪﻡ ‪.‬‬
‫ﻭﻋﻼﺝ ﻣﺮﺽ ﺑﻬﺠﺖ ‪. Paget's disease‬‬
‫ﻭﰲ ﻋﻼﺝ ﻣﺮﺽ ‪. Bony metastases‬‬
‫ﻭﻫﻲ ﳑﻨﻮﻋﺔ ﰲ ﺍﳊﻤﻞ ﻭﺗﻀﻴﻖ ﺍﳌﺮﻱء ‪.‬‬

‫ﻭﺍﻥ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪ Bisphosphonates‬ﻳﻘﻞ ﺍﻣﺘﺼﺎﺻﻬﺎ ﻟﻮ ﺍﺳﺘﻌﻤﻠﺖ ﻣﻊ ‪antacids,‬‬

‫‪. calcium salts and iron supplements‬‬
‫ﻭﰲ ﺣﺎﻝ ﻭﺻﻔﻬﺎ ﳌﻌﺎﳉﺔ ﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﺎﻡ ‪ osteoporosis‬ﳚﺐ ﺍﻥ ﻳﺼﺮﻑ ﻣﻌﻬﺎ ﺍﺩﻭﻳﺔ ‪calcium‬‬
‫‪. and vitamin D‬‬
‫ﻭﻋﻨﺪ ﺗﻨﺎﻭﻝ ﻫﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ‪:‬‬
‫ﳚﺐ ﺍﻥ ﻳﻌﻄﻰ ﻋﻠﻰ ﻣﻌﺪﺓ ﻓﺎﺭﻏﺔ ﻗﺒﻞ ﺗﻨﺎﻭﻝ ﺍﻟﻄﻌﺎﻡ ﺑﻨﺼﻒ ﺳﺎﻋﺔ ﻣﻊ ﻗﺪﺡ ﻣﺎء ﻛﺒﲑ ‪.‬‬
‫ﻭﺍﻟﺒﻘﺎء ﻭﺍﻗﻒ ﳌﺪﺓ ﻧﺼﻒ ﺳﺎﻋﺔ ﳌﻨﻊ ﺣﺪﻭﺙ ‪. oesophageal irritation‬‬
‫ﻭﺍﻳﻀﺎ ﻋﻼﺝ ‪ Pamidronate‬ﳝﻜﻦ ﺍﻥ ﻳﻌﻄﻰ ﻭﺭﻳﺪﻱ ﳌﻌﺎﳉﺔ ‪. acute hypercalcaemia‬‬
‫ﺍﻣﺎ ﻋﻼﺝ ‪ alendronate‬ﻓﻴﻤﻜﻦ ﺍﺳﺘﻌﻤﺎﻟﻪ ﻛﺎﺣﺪ ﺍﳋﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺟﻴﺔ ﰲ ﻣﻌﺎﳉﺔ ﻫﺸﺎﺷﺔ ﺍﻟﻌﻈﺎﻡ‬
‫ﺍﻟﺬﻱ ﺗﺘﻌﺮﺽ ﻟﻪ ﺍﳌﺮﺍءﺓ ﺑﻌﺪ ﺳﻦ ﺍﻟﻴﺄﺱ ﳌﻨﻊ ﺣﺪﻭﺙ ‪ fragility fractures‬ﻋﻨﺪﻫﺎ ‪.‬‬
‫ﻭﺍﻥ ﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ جملﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ‪. Bisphosphonates‬‬
‫ﲣﺪﺵ ﰲ ﺍﳌﺮﻱء‪. Oesophageal irritation‬‬
‫ﻭ ﺣﺪﻭﺙ ﺍﻋﺮﺍﺽ ﺗﺸﺒﺔ ﺍﻻﻧﻔﻠﻮﻧﺰﺍ ‪. Flu-like symptoms‬‬
‫ﻭ ﺍﻟﺼﺪﺍﻉ ‪. Headache‬‬
‫ﻭ ﺍﳔﻔﺎﺽ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ‪. Hypocalcaemia‬ﻟﺬﺍ ﻳﺘﻄﻠﺐ ﻣﺘﺎﺑﻌﺔ ﺗﺮﻛﻴﺰ ﺍﻟﻜﺎﻟﺴﻴﻮﻡ ‪.‬‬
‫ﻭ ﺍﱂ ﰲ ﺍﻟﻌﻀﻼﺕ ﺍﳍﻴﻜﻠﻴﺔ ‪. Musculoskeletal pain‬‬
‫ﻭ ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ‪. GI disturbance‬‬

‫ﺩﻭﺍء ‪Allopurinol‬‬
‫*********************‬

‫ﺍﻥ ﺩﻭﺍء ‪ Allopurinol‬ﻳﺜﺒﻂ ‪ xanthine oxidase‬ﺍﻟﺬﻱ ﳝﻨﻊ ﲢﻮﻳﻞ ‪ xanthine‬ﺍﱃ ‪uric‬‬

‫‪ acid.‬ﻭﺑﺎﻟﺘﺎﱄ ﳝﻨﻊ ﺣﺪﻭﺙ ﻣﺮﺽ ﺍﻟﻨﻘﺮﺱ ﺍﻟﺬﻱ ﳛﺪﺙ ﺑﺴﺒﺐ ﺯﻳﺎﺩﺓ ﺗﺮﻛﻴﺰ ‪. uric acid.‬‬

‫‪١٢١‬‬
 ‫ﻭﻳﺴﺘﻌﻤﻞ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ‪gout and of uric acid and calcium‬‬
‫‪.oxalate renal calculi‬‬
‫ﻭﺍﻳﻀﺎ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ ﺣﺪﻭﺙ ‪. hyperuricaemia associated with cytotoxic drugs‬‬
‫ﻭﳚﺐ ﺍﻥ ﻻﻳﻌﻄﻰ ﰲ ﺣﺎﻟﺔ ﺍﻟﻨﻘﺮﺱ ﺍﳊﺎﺩ ‪. Acute gout‬‬
‫ﻭﻳﻌﻄﻰ ﲝﺬﺭ ﰲ ﻣﺮﺿﻰ ﺍﻟﻜﺒﺪ ﻭﺍﻟﻜﻠﻴﺔ ‪. renal and hepatic impairment‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺍﻟﺘﺎﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴﺔ ﳍﺬﻩ ﺍﻻﺩﻭﻳﺔ ﻫﻲ‪:‬‬
‫ﺣﺪﻭﺙ ﺍﻟﻄﻔﺢ ﺍﳉﻠﺪﻱ ﻭﺍﻟﺘﺤﺴﺲ ‪. Rash and hypersensitivity reactions‬‬
‫ﻭﺍﻳﻀﺎ ﻳﺴﺒﺐ ﺑﻌﺾ ﺍﺿﻄﺮﺑﺎﺕ ﺍﻟﻘﻨﺎﺓ ﺍﳍﻀﻤﻴﺔ ‪. GI disturbance‬‬
‫ﻭﺗﺴﺒﺐ ﺍﺣﻴﺎﻧﺎ ﻭﺑﺼﻮﺭﺓ ﻧﺎﺩﺭﺓ ‪. hepatotoxicity or blood disorders‬‬
‫ﻭﳜﺮﺝ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺑﻌﺪ ﲢﻮﻟﻪ ﺍﱃ ‪ oxipurinol‬ﺑﻮﺍﺳﻄﺔ ﺍﻧﺰﻳﻢ ‪. xanthine oxidase‬‬
‫ﻭﺗﺰﺩﺍﺩ ﲰﻴﺔ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻋﻨﺪﻣﺎ ﻳﺴﺘﻌﻤﻞ ﻣﻊ ﳎﻤﻮﻋﺔ ﺍﺩﻭﻳﺔ ‪. ACEIs‬‬
‫ﻛﻤﺎ ﻳﺰﺩﺍﺩ ﺣﺪﻭﺙ ﺍﻟﻄﻔﺢ ﺍﳉﻠﺪﻱ ﻭﺍﻟﺘﺤﺴﺲ ﻓﻴﻤﺎ ﻟﻮ ﺍﺳﺘﻌﻤﻞ ﻣﻊ ‪amoxicillin or thiazide‬‬
‫‪ diuretics‬ﻭﺍﻳﻀﺎ ﺩﻭﺍء‪. ampicillin,‬‬
‫ﻛﻤﺎ ﻳﺰﻳﺪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ﻓﻌﻞ ‪ warfarin‬ﳑﺎ ﻗﺪ ﻳﺆﺩﻱ ﺍﱃ ﺍﻟﻨﺰﻑ ﻓﻴﻢ ﻟﻮ ﱂ ﺗﻀﺒﻂ ﺍﳉﺮﻋﺔ ‪..‬‬
‫ﻛﻤﺎ ﻳﺰﻳﺪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻣﻦ ﻓﻌﻞ ﻭﺗﺎﺛﲑ ‪ azathioprine and mercaptopurine‬ﻟﺬﺍ ﳚﺐ ﻣﺘﺎﺑﻌﺔ‬
‫ﺍﳉﺮﻋﺔ ﺍﳌﺴﺘﻌﻤﻠﺔ ﳌﻨﻊ ﺣﺪﻭﺙ ﻫﺬﻩ ﺍﻟﺘﺎﺛﲑﺍﺕ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﺰﻳﺪ ﻣﻦ ﻓﱰﺓ ‪ acute gout‬ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﺧﻼﻝ ﻓﱰﺓ ﺍﻟﻨﻘﺮﺱ ﺍﳊﺎﺩ ﺑﻞ ﳚﺐ ﺍﻥ‬
‫ﻳﺴﺘﻌﻤﻞ ﺑﻌﺪ ‪ ٢-١‬ﺍﺳﺒﻮﻉ ﺑﻌﺪ ﺍﻟﺒﺪء ﺍﻟﺘﻌﺮﺽ ﳍﺠﻤﺔ ﻧﻘﺮﺳﻴﺔ ﺣﺎﺩﺓ ﻭﻟﻜﻦ ﺍﺫﺍ ﻭﻗﻌﺖ ﺧﻼﻝ ﻓﱰﺓ‬
‫ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ﻓﻴﺠﺐ ﺍﻻﺳﺘﻤﺮﺍﺭ ﺑﺎﺳﺘﻌﻤﺎﻟﻪ ﻣﻊ ﺍﺳﺘﻌﻤﺎﻝ ‪ colchicine or a NSAID‬ﳌﻌﺎﳉﺔ‬
‫ﺍﳍﺠﻤﺔ ﺍﻟﻨﻘﺮﺳﻴﺔ ﺍﳊﺎﺩﺓ ‪.‬‬

‫ﻋﻼﺝ ‪. Colchicine‬‬
‫*********************‬

‫ﻳﻌﺘﱪ ﻫﺬﻩ ﺍﻟﺪﻭﺍء ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺍﻟﻘﻠﻴﻠﺔ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺟﺪﺍ ‪.‬‬

‫ﻭﻫﻮ ﻳﺴﺘﻌﻤﻞ ﰲ ﻣﻌﺎﳉﺔ ‪. Acute gout‬‬
‫ﻭﺍﻳﻀﺎ ﰲ ﺍﻟﻮﻗﺎﻳﺔ ﲜﺮﻋﺔ ﻗﻠﻴﻠﺔ ﻭﻟﻔﱰﺓ ﻗﺼﲑﺓ ﻋﻨﺪ ‪. initiation of therapy with allopurinol‬‬
‫ﻭﻣﻦ ﺍﻫﻢ ﺗﺎﺛﲑﺍﺗﻪ ﺍﳉﺎﻧﺒﻴﺔ ﻫﻲ ‪:‬‬
‫ﺣﺪﻭﺙ ‪ GI disturbance‬ﻣﺜﻞ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﺘﻘﻴﻮء ﻭﺍﱂ ﺍﻟﺒﻄﻦ ﻭﺍﻻﺳﻬﺎﻝ ‪.‬‬
‫ﻭﺍﻳﻀﺎ ‪ Myelosuppression, myopathy and peripheral neuropathy‬ﻭﺧﺎﺻﺔ ﻋﻨﺪ‬
‫ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﳌﻄﻮﻝ ‪.‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﳑﻨﻮﻉ ﰲ ﻓﱰﺓ ﺍﳊﻤﻞ ﻭﻳﻌﻄﻰ ﲝﺬﺭ ﰲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺧﻠﻞ ﻛﻠﻮﻱ ﺍﻭ ﻛﺒﺪﻱ ‪.‬‬

‫‪١٢٢‬‬
 ‫ﻭﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻻﻳﺘﺎﻳﺾ ﻭﳜﺮﺝ ﻋﻦ ﻃﺮﻳﻖ ‪ the biliary route‬ﻭﻋﻤﺮﻩ ﺍﻟﻨﺼﻔﻲ ﻫﻮ ‪ ١٠‬ﺳﺎﻋﺎﺕ ‪.‬‬
‫ﻭﺗﺰﺩﺍﺩ ﺣﺎﻟﺔ ﲰﻴﺔ ﻫﺬﺍ ﺍﻟﺪﻭﺍء ﺍﺫﺍ ﺍﺳﺘﻌﻤﻞ ﻣﻊ ‪. macrolides and ciclosporin‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻓﻌﺎﻝ ﻣﺜﻞ ‪ NSAIDs‬ﰲ ﺍﻟﻨﻘﺮﺱ ﺍﳊﺎﺩ ﻭﻫﻮ ﺍﳌﻔﻀﻞ ﺍﺫﺍ ﻛﺎﻥ ﺍﳌﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ‪heart‬‬
‫‪ failure and on anticoagulants‬ﻻﻥ ‪ colchicines‬ﻻﻳﺴﺒﺐ ﺍﺣﺘﺒﺎﺱ ﻟﻠﺴﻮﺍﺋﻞ ﻭﻻﻳﺰﻳﺪ‬
‫ﺧﻄﺮ ﺍﻟﻨﺰﻑ ﻛﻤﺎ ﰲ ‪. NSAIDs‬‬
‫ﺍﻣﺎ ﺍﻟﺒﺪﻳﻞ ﻟﻪ ﰲ ﺣﺎﻝ ﻛﺎﻥ ﳑﻨﻮﻉ ﻓﻬﻮ )‪. Corticosteroid therapy (prednisolone‬‬
‫ﻭﻫﺬﺍ ﺍﻟﺪﻭﺍء ﻳﻌﻤﻞ ﻣﻦ ﺧﻼﻝ ﺗﺜﺒﻴﻂ ‪migration of granulocytes into inflamed areas‬‬
‫ﻭﺑﺎﻟﺘﺎﱄ ﻳﻘﻠﻞ ﻣﻦ ﲢﺮﺭ ‪ pro-inflammatory enzymes and cytokines‬ﻭﻫﺬﺍ ﻳﺆﺩﻱ ﺍﱃ‬
‫ﺗﻮﻗﻒ ‪. inflammatory response‬‬

‫****************************************‬
‫*********************************‬
‫************************‬

‫ﺃﺩﻭﻳــــــــــــــــﺔ ﺍﻟﻌﻴﻮﻥ‬
‫********************‬

‫‪Antiglaucoma drugs‬‬
‫************************‬

‫ﻫﻨﺎﻙ ﲬﺴﺔ ﺍﻧﻮﺍﻉ ﻣﻦ ﺍﻻﺩﻭﻳﺔ ﺗﻌﺘﱪ ﻛــ‪ Antiglaucoma drugs‬ﻭﻫﻲ‪:‬‬

‫ﺍﺩﻭﻳﺔ ‪ b. blockers‬ﻣﺜﻞ ﺩﻭﺍء ‪ timolol‬ﻭﺗﻘﻮﻡ ﺑﺘﻘﻠﻴﻞ ﻭﺗﺜﺒﻴﻂ ﺍﻧﺘﺎﺝ ‪aqueous humour‬‬
‫ﰲ ﺍﻟﻌﲔ ‪.‬‬

‫‪١٢٣‬‬
‫ﻭﺍﻳﻀﺎ ﺍﺩﻭﻳﺔ ‪ Prostaglandin analogues‬ﻣﺜﻞ ﺩﻭﺍء ‪ latanoprost‬ﻭﺗﻘﻮﻡ ﺑﺘﻘﻠﻴﻞ ﺍﻟﻀﻐﻂ‬
‫ﺩﺍﺧﻞ ﺍﻟﻌﲔ ‪. reduce intraocular pressure‬‬
‫‪aqueous humour‬‬ ‫ﻭﺍﻳﻀﺎ ﺍﺩﻭﻳﺔ ‪ Sympathomimetics‬ﻣﺜﻞ ‪ brimonidine‬ﻭﺗﻘﻠﻞ‬
‫‪ production‬ﻋﻦ ﻃﺮﻳﻖ ﺯﻳﺎﺩﺓ ﺍجملﺮﻯ ﺧﺎﺭﺝ ﺍﻟﻌﲔ ﻋﻦ ﻃﺮﻳﻖ ‪. trabecular meshwork‬‬
‫ﻭﺍﺩﻭﻳﺔ ‪ Carbonic anhydrase inhibitors‬ﻣﺜﻞ ‪ acetozolamide,‬ﺣﻴﺚ ﺗﻘﻠﻞ ﻣﻦ‬
‫‪ aqueous humour‬ﻭﺍﻳﻀﺎ ﺍﺩﻭﻳﺔ ‪ Miotics‬ﻣﺜﻞ ‪ pilocarpine‬ﺣﻴﺚ ﺗﻌﻤﻞ ﺗﻘﻠﺺ ﻭﻋﺎﺋﻲ‬
‫ﻳﺆﺩﻱ ﺍﱃ ﻓﺘﺢ ‪ trabecular meshwork‬ﻭﺧﺮﻭﺝ ‪. aqueous humour‬‬

‫ّ‬
‫ﻣﺎﻫﻮ ﺍﻟـﺪﻭﺍء ؟‬
‫********************‬

‫ّ‬ ‫ً‬
‫ﻣﺎﺩﺓ ﻳﺘﻨﺎﻭﳍﺎ ﺍﻹﻧﺴﺎﻥ ﺍﳌﺮﻳﺾ ﺑﻨﺎءﺍ ﻋﻠﻰ ﻧﺼﻴﺤﺔ ﻃﺒﻴـﺔ ﻟﺘﺤﻘﻴﻖ ﺃﺣﺪ ﺍﻷﻏﺮﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ ‪:‬‬
‫‪ -١‬ﺍﻟﺸﻔــﺎء ﻣﻦ ﻣﺮﺽ ﻣﻌﲔ ‪.‬‬
‫ﻣﺜﻞ ‪ :‬ﺍﺳﺘﻌﻤﺎﻝ ﻣﻀﺎﺩﺍﺕ ﺣﻴﻮﻳﺔ ﻟﻠﺸﻔﺎء ﻣﻦ ﻋﺪﻭﻯ )‪ (Infection‬ﺑﻮﺍﺳﻄﺔ ﺍﻟﺒﻜﺘﲑﻳﺎ ‪.‬‬
‫‪ -٢‬ﺍﻟﺘﺨﻠﺺ ﻣﻦ ﺃﻋﺮﺍﺽ ﻣﻌﻴﻨﺔ ﻏﲑ ﻣﺮﳛﺔ ‪.‬‬
‫ﻣﺜﻞ ‪ :‬ﺍﺳﺘﻌﻤﺎﻝ ﻣﻀﺎﺩﺍﺕ ﺍﳊﻤﻮﺿﺔ )‪ (Hyper acidity‬ﻹﺯﺍﻟﺔ ﺍﳊﻤﻮﺿﺔ ﻣﻦ ﺍﳌﻌﺪﺓ ‪.‬‬
‫ﺃﻭ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻷﺩﻭﻳﺔ ﺍﳌﺴﻜﻨﺔ ﻟﻸﱂ ﻣﺜﻞ ‪ :‬ﺃﻋﺮﺍﺽ ﺍﻟﺼﺪﺍﻉ )‪. (Headache‬‬
‫‪ -٣‬ﺍﻟﺘﻌﻮﻳﺾ ﻣﻦ ﻧﻘﺺ ﻣﻌﲔ ﰲ ﺍﳉﺴﻢ ‪.‬‬
‫ﻣﺜﻞ ‪ :‬ﺍﻟﻔﻴﺘﺎﻣﻴﻨﺎﺕ ﺃﻭ ﺍﳍﺮﻣﻮﻧﺎﺕ ) ﻧﻘﺼﻬﺎ ﰲ ﺍﳉﺴﻢ ﻳﺴﺒﺐ ﺃﻣﺮﺍﺽ ﻣﻌﻴﻨﺔ (‬
‫ّ‬
‫ﻣﻦ ﺃﻳﻦ ﻳﺄﺗﻲ ﺍﻟـﺪﻭﺍء ؟‬
‫ﺍﳌﺴﺘﺤﻀﺮ ﺍﻟﺼﻴﺪﻻﻧﻲ ﻟﻠﺪﻭﺍء ﻗﺪ ﻳﻜﻮﻥ ﻣﺮﻛﺐ ﻣﻦ ﻣﺎﺩﺓ ﻭﺍﺣﺪﺓ ﺃﻭ ﻋﺪﺓ ﻣﻮﺍﺩ ﻭﻳﻘﻮﻡ ﺑﻌﻼﺝ ﻣﺮﺽ ﺃﻭ‬
‫ّ‬
‫ﺧﻠﻞ ﰲ ﺍﳉﺴﻢ ‪ ،‬ﻭﻳﺘﻢ ﺍﳊﺼﻮﻝ ﻋﻠﻰ ﺍﳌﺎﺩﺓ ﺍﻟﻔﻌﺎﻟﺔ ﻣﻦ ﺃﺣﺪ ﺍﳌﺼﺎﺩﺭ ﺍﻟﺘﺎﻟﻴﺔ ‪:‬ﺍﻟﻨﺒﺎﺕ ﺍﻭ ﺍﻻﻧﺴﺎﻥ ﺍﻭ‬
‫ّ‬
‫ﺍﳊﻴﻮﺍﻥ ﻣﺼﻄﻠﺤـﺎﺕ ﺍﻟﺪﻭﺍء ‪:‬‬
‫ُ ّ‬ ‫ّ‬
‫ﺍﻟـﺪﻭﺍء )‪ : (Medicine‬ﺃﻱ ﻣﺎﺩﺓ ﺃﻭ ﻣﺴﺘﺤﻀﺮ ﻣﺴﺠﻞ ﰲ ﺩﺳﺘﻮﺭ ﺍﻷﺩﻭﻳﺔ ﺃﻭ ﺍﻷﻏﺮﺍﺽ ﻟﻺﺳﺘﻌﻤﺎﻝ‬
‫ﺍﻟﺪﺍﺧﻠﻲ ﺃﻭ ﺍﳋﺎﺭﺟﻲ ﺑﻬﺪﻑ ﺍﻟﻮﻗﺎﻳﺔ ﺃﻭ ﺍﻟﻌﻼﺝ ﺃﻭ ﺍﻟﺘﺸﺨﻴﺺ ﰲ ﺍﻹﻧﺴﺎﻥ ﺃﻭ ﺍﳊﻴﻮﺍﻥ ﻣﻦ ﻣﺮﺽ ﻣﻌﲔ‬
‫‪.‬‬

‫‪١٢٤‬‬
 ‫ﻋﻠﻢ ﺍﻷﺩﻭﻳﺔ )‪ : (Pharmacology‬ﺍﺷﺘﻘﺖ ﻫﺬﻩ ﺍﻟﻜﻠﻤﺔ ﻣﻦ ﺍﻟـ ‪ Pharmacon‬ﻭﺗﻌﻨﻲ ﺍﻟﺪﻭﺍء ﻭﺍﻟـ‬
‫‪ Logy‬ﻭﺗﻌﻨﻲ ﻣﺒﺤﺚ ﻋﻦ ﺍﻟﺪﻭﺍء ‪ .‬ﻭﻳﺒﺤﺚ ﻋﻠﻢ ﺍﻷﺩﻭﻳﺔ ﻋﻦ ﺍﻟﺘﺪﺍﺧﻞ ﺍﳌﺘﺒﺎﺩﻝ ﺑﲔ ﺍﳌﺮﻛﺒﺎﺕ‬
‫ﺍﻟﻜﻴﻤﻴﺎﺋﻴﺔ ﺃﻭ ﺍﻷﺟﻬﺰﺓ ﺍﻟﺒﻴﻮﻟﻮﺟﻴﺔ ‪.‬‬
‫ﻋﻠﻢ ﺍﻟﻌﻘﺎﻗﲑ )‪ : (Pharmacogoncy‬ﻫﻮﻋﻠﻢ ﻳﺘﻌﺮﻑ ﻋﻠﻰ ﺍﻷﺩﻭﻳﺔ ﻭﻃﺮﻕ ﲢﻀﲑﻫﺎ ﻣﻦ ﻣﺼﺎﺩﺭ‬
‫ﺍﻟﻄﺒﻴﻌﺔ ﺍﻟﻨﺒﺎﺗﻴﺔ ﺃﻭ ﺍﳊﻴﻮﺍﻧﻴﺔ ﺃﻭ ﺍﳌﻌﺪﻧﻴﺔ ‪ .‬ﻭﺗﺪﻝ ﻛﻠﻤﺔ )‪ (Pharmaco‬ﻋﻠﻰ ﺍﻟﺪﻭﺍء ﻭﻛﻠﻤﺔ‬
‫ّ‬
‫)‪ (Cogency‬ﺗﻌﻨﻲ ﺍﻟﺘﻌﺮﻑ ﻋﻠﻴﻪ‬
‫ﻋﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ )‪ : (Pharmacy‬ﻫﻮ ﻋﻠﻢ ﲢﻀﲑ ﻭﺗﺮﻛﻴﺐ ﻭﺗﺴﻮﻳﻖ ﻭﺻﺮﻑ ﺍﻷﺩﻭﻳﺔ ‪ .‬ﻭﺍﳌﻔﻬﻮﻡ ﺍﳉﺪﻳﺪ‬
‫ﻟﻌﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ ﻳﺸﺘﻤﻞ ﻋﻠﻰ ﻣﺘﺎﺑﻌﺔ ﻭﻣﻼﺣﻈﺔ ﺍﻟﺘﺄﺛﲑﺍﺕ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻟﻸﺩﻭﻳﺔ ‪.‬‬
‫ﻋﻠﻢ ﺍﻟﻌﻘﺎﻗﲑ )‪ : (Pharmacogoncy‬ﻫﻮﻋﻠﻢ ﻳﺘﻌﺮﻑ ﻋﻠﻰ ﺍﻷﺩﻭﻳﺔ ﻭﻃﺮﻕ ﲢﻀﲑﻫﺎ ﻣﻦ ﻣﺼﺎﺩﺭ‬
‫ﺍﻟﻄﺒﻴﻌﺔ ﺍﻟﻨﺒﺎﺗﻴﺔ ﺃﻭ ﺍﳊﻴﻮﺍﻧﻴﺔ ﺃﻭ ﺍﳌﻌﺪﻧﻴﺔ ‪ .‬ﻭﺗﺪﻝ ﻛﻠﻤﺔ )‪ (Pharmaco‬ﻋﻠﻰ ﺍﻟﺪﻭﺍء ﻭﻛﻠﻤﺔ‬
‫ّ‬
‫)‪ (Cogency‬ﺗﻌﻨﻲ ﺍﻟﺘﻌﺮﻑ ﻋﻠﻴﻪ ‪.‬‬
‫ﻋﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ )‪ : (Pharmacy‬ﻫﻮ ﻋﻠﻢ ﲢﻀﲑ ﻭﺗﺮﻛﻴﺐ ﻭﺗﺴﻮﻳﻖ ﻭﺻﺮﻑ ﺍﻷﺩﻭﻳﺔ ‪ .‬ﻭﺍﳌﻔﻬﻮﻡ ﺍﳉﺪﻳﺪ‬
‫ﻟﻌﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ ﻳﺸﺘﻤﻞ ﻋﻠﻰ ﻣﺘﺎﺑﻌﺔ ﻭﻣﻼﺣﻈﺔ ﺍﻟﺘﺄﺛﲑﺍﺕ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻟﻸﺩﻭﻳﺔ ‪.‬‬
‫ﻋﻠـﻢ ﺍﻷﺩﻭﻳــﺔ‬

‫ﺩﺳﺘﻮﺭ ﺍﻷﺩﻭﻳﺔ )‪: (Pharmacopeias‬‬

‫ﻟﺪﻭﺍء ﻣﺎ ﻛﱰﻛﻴﺒﻪ‬
‫ٍ‬ ‫ﻭﻫﻮ ﺍﳌﺮﺟﻊ ﺍﻟﺪﻭﺍﺋﻲ ﻟﻸﺩﻭﻳﺔ ﺍﳌﺴﺠﻠﺔ ﻟﺪﻭﻟﺔ ﻣﺎ ‪ ،‬ﻭﳛﺘﻮﻱ ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎﺕ ﻣﻬﻤﺔ‬
‫ﺃﻭ ﺗﻔﺎﻋﻠﻪ ﺃﻭ ﺟﺮﻋﺘﻪ ﻭﻃﺮﻕ ﺍﻟﻜﺸﻒ ﻋﻨﻪ ﻭﺍﻟﺘﻌﺮﻑ ﻋﻠﻴﻪ ‪.‬‬

‫ﺳﻮء ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﺪﻭﺍء ) ‪: (Drug abuse‬‬

‫ﻭﻫﻮ ﺍﺳﺎءﺓ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﺪﻭﺍء ﻷﻏﺮﺍﺽ ﻏﲑ ﻃﺒﻴﺔ ﻭﻳﺆﺛﺮ ﺫﻟﻚ ﻋﻠﻰ ﺃﺟﻬﺰﺓ ﺍﳉﺴﻢ ‪.‬‬
‫ﺍﻹﺩﻣــﺎﻥ )‪: (Addiction‬‬
‫ﺣﺴﺐ ﺗﻌﺮﻳﻒ ﻣﻨﻈﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﳌﻴﺔ )‪: (WHO‬‬
‫ُ‬
‫ﻫﻮ ﺧﺪﺭ ﺃﻭ ﺳﻜﺮ ﻣﺰﻣﻦ ﻟﻠﻔﺮﺩ ﺃﻭ ﺍجملﺘﻤﻊ ﻭﻳﻨﺠﻢ ﻋﻦ ﺗﻌﺎﻃﻲ ﺍﻟﻔﺮﺩ ﻟﻐﺮﺽ ﻏﲑ ﻃﺒﻲ ﻷﺣﺪ ﺍﻷﺩﻭﻳﺔ‬
‫ﺍﳌﺆﺛﺮﺓ ﻋﻠﻰ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﳌﺮﻛﺰﻱ ‪.‬‬
‫ّ ﱡ‬
‫ﺍﻟﺘـﺤﻤﻞ )‪: (Tolerance‬‬
‫ّ‬
‫ﻫﻮ ﺗﺪﻧﻲ ﺍﻟﺘﺠﺎﻭﺏ ﺍﻟﻔﺴﻴﻮﻟﻮﺟﻲ ﻣﻊ ﺗﻜﺮﺍﺭ ﺗﻨﺎﻭﻝ ﺍﳉﺮﻋﺎﺕ ﻣﻦ ﺍﻟﺪﻭﺍء ﺫﺍﺗﻪ ﻭﺍﳊﺎﺟﺔ ﺍﱃ ﺯﻳﺎﺩﺓ‬
‫ﺍﳉﺮﻋﺔ ﻟﻺﺑﻘﺎء ﻋﻠﻰ ﺗﺄﺛﲑ ﺛﺎﺑﺖ ‪.‬‬
‫ّ‬
‫ﻭﻳﻨﻘﺴﻢ ﺍﻟﺘﺤﻤـﻞ ﺇﱃ ﺛﻼﺛﺔ ﺃﻗﺴﺎﻡ ‪:‬‬
‫ّ ﱡ‬
‫ﺃﻗﺴﺎﻡ ﺍﻟﺘـﺤﻤﻞ )‪(Tolerance‬‬
‫ّ‬
‫ﺍﻟﺘﺤﻤﻞ ﺍﻹﺳﺘﻘﻼﺑﻲ )‪: (Metabolic Tolerance‬‬
‫ﻫﻮ ﺯﻳﺎﺩﺓ ﻧﺸﺎﻁ ﺍﺳﺘﻘﻼﺏ ﺍﻟﺪﻭﺍء ﺩﺍﺧﻞ ﺍﳉﺴﻢ ﻭﻳﺆﺩﻱ ﺫﻟﻚ ﺇﱃ ﺳﺮﻋﺔ ﺗﻜﺴﺮﻩ ﻭﺑﺎﻟﺘﺎﱄ ﺗﺪﻧﻲ ﺗﺄﺛﲑﻩ‬
‫ﻋﻠﻰ ﺍﳉﺴﻢ ‪.‬‬

‫‪١٢٥‬‬
 ‫ﺍﻟﺘﺤﻤﻞ ﺍﳋﻠﻮﻱ )‪: (Cellular Tolerance‬‬
‫ﺍﳌﺴﺘﻘﺒﻞ ﻭﺑﺎﻟﺘﺎﱄ ﺗﺘﻀﺎءﻝ ﻗﺪﺭﺗﻪ ﻋﻠﻰ ﺍﻹﺳﺘﺠﺎﺑﺔ ‪،‬‬
‫ِ‬ ‫ﻫﻮ ﺗﻀﺎﺅﻝ ﺗﺄﺛﲑ ﺍﻟﺪﻭﺍء ﻧﺘﻴﺠﺔ ﺣﺴﺎﺳﻴﺘﻪ ﻋﻠﻰ‬
‫ّ‬
‫ﻭﺗﺆﺩﻱ ﻫﺬﻩ ﺍﻟﻈﺎﻫﺮﺓ ﺇﱃ ﺗﻜﻴﻒ ﺧﻠﻮﻱ ﻏﲑ ﻣﻌﺮﻭﻑ ﰲ ﺁﻟﻴﺔ ﻋﻤﻞ ﺍﻟﺪﻣﺎﻍ ‪.‬‬
‫ّ‬
‫ﺍﻟﺘﺤﻤﻞ ﺍﳌﺘﺼﺎﺋﺐ )‪: (Cross Tolerance‬‬
‫ّ‬
‫ﻫﻮ ﺃﻥ ﻳﺆﺩﻱ ﺗﻨﺎﻭﻝ ﺩﻭﺍء ﻣﺜﺒﻂ ﻟﻮﻇﻴﻔﺔ ﻣﻦ ﻭﻇﺎﺋﻒ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺑﻜﺜﺮﺓ ﺇﱃ ﻇﻬﻮﺭ ﲢﻤﻞ ﻟﺪﻭﺍء‬
‫ﻣﺜﺒﻂ ﺁﺧﺮ ‪.‬‬

‫ﺍﳉﺮﻋـﺔ )‪: (Dose‬‬

‫ﻫﻲ ﻛﻤﻴﺔ ﺍﻟﺪﻭﺍء ﺍﻟﻼﺯﻣﺔ ﺗﻐﲑ ﻭﻇﻴﻔﺔ ﻋﻀﻮﻳﺔ ﻷﺟﻞ ﻋﻼﺝ ﺃﻭ ﺗﺸﺨﻴﺺ ﺃﻣﺮ ﻣﻌﲔ ﺃﻭ ﻣﺮﺽ ﻣﻌﲔ ‪.‬‬
‫ﺍﻟﻨﻈﺎﻡ ﺍﻟﻌﻼﺟﻲ )‪: (Dosage regimen‬‬
‫ﻫﻮ ﺍﺳﺘﻤﺮﺍﺭ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ‪ ،‬ﻭﻳﺸﻤﻞ ﺍﳉﺮﻋﺔ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻭﺗﻜﺮﺍﺭ ﺍﺳﺘﻌﻤﺎﳍﺎ ﻭﻣﺪﺓ ﺇﻋﻄﺎﺋﻬﺎ ‪.‬‬
‫ﺍﳉﺮﻋﺔ ﺍﳌﺘﻮﺳﻄﺔ )‪: (Average dose‬‬
‫ﻫﻲ ﺍﳉﺮﻋﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺍﺳﺘﺠﺎﺑﺔ ﺍﻟﺸﺨﺺ ﺍﻟﻌﺎﺩﻱ ﻭﻻﺗﻈﻬﺮ ﻋﻠﻴﻪ ﺃﻋﺮﺍﺽ ﺍﳊﺴﺎﺳﻴﺔ ﺍﳌﻔﺮﻃﺔ ﻟﻠﺪﻭﺍء‬
‫ﻭﻳﺴﺘﻌﻤﻠﻬﺎ ﻣﻌﻈﻢ ﺍﻟﻨﺎﺱ ‪.‬‬
‫ﺍﳉﺮﻋﺔ ﺍﻟﻌﻼﺟﻴﺔ )‪: (Therapeutic dose‬‬
‫ﱢ‬ ‫ُ‬
‫ﺗـﺤﺪﺙ ﺃﻓﻀﻞ ﲡﺎﻭﺏ ﺑﲔ ﺍﻟﺪﻭﺍء ﺍﳌﺆﺛﺮ ﻭﺍﳉﺴﻢ‬
‫ِ‬ ‫ﻫﻲ ﺍﳉﺮﻋﺔ ﺍﻟﺘﻲ‬
‫ﺍﳉﺮﻋﺔ ﺍﻟﺒﺪﺍﺋﻴﺔ )‪: (Initial dose‬‬
‫ً‬ ‫ُ‬
‫ﻫﻲ ﺃﻭﻝ ﺟﺮﻋﺔ ﺗـﻌﻄﻰ ﻣﺒﺎﺷﺮﺓ ﻋﻨﺪ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ‪.‬‬
‫ﺟﺮﻋﺔ ﺷﻔﺎء ‪ %٥٠‬ﻣﻦ ﺍﳊﻴﻮﺍﻧﺎﺕ‪:‬‬
‫ُ‬
‫ﻫﻲ ﺍﳉﺮﻋﺔ ﺍﻟﺘﻲ ﻳﺆﺩﻱ ﺍﺳﺘﻌﻤﺎﳍﺎ ﺍﱃ ﺷﻔﺎء ‪ %٥٠‬ﻣﻦ ﺍﳊﻴﻮﺍﻧﺎﺕ ﺍﻟﺘﻲ ﻳﺠﺮﻯ ﻋﻠﻴﻬﺎ ﺍﻟﺘﺠﺎﺭﺏ ‪.‬‬
‫ّ‬
‫ﺍﻟﺘــﺂﺯﺭ )‪: (Synergism‬‬
‫ً‬
‫ﳛﺪﺙ ﻋﻨﺪﻣﺎ ﻳﺰﻳﺪ ﺩﻭﺍء ﻣﻦ ﻓﻌﺎﻟﻴﺔ ﺩﻭﺍء ﺁﺧﺮ ‪ ،‬ﲝﻴﺚ ﻳﻜﻮﻥ ﺗﺄﺛﲑﻫﻤﺎ ﻣﻌﺎ ﺃﻛﱪ ﻣﻦ ﺍجملﻤﻮﻉ ﺍﳊﺴﺎﺑﻲ‬
‫ً‬ ‫ُ‬
‫ﻟﺘﺄﺛﲑ ﺍﻟﺪﻭﺍﺋﲔ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ ﻛﻼ ﻣﻨﻬﻤﺎ ﻋﻠﻰ ﺣﺪﻩ ‪.‬‬
‫ﺍﻹﺿﺎﻓـﺔ )‪: (Addition‬‬
‫ُ‬ ‫ُ‬
‫ﳛﺪﺙ ﻋﻨﺪﻣﺎ ﻳﻀﺎﻑ ﺗﺄﺛﲑ ﺩﻭﺍء ﻟﺘﺄﺛﲑ ﺩﻭﺍء ﺁﺧﺮ ﻭﻳﺴﺎﻭﻯ ﺍﻟﺘﺄﺛﲑ ﺍﻹﲨﺎﱄ ﻟﺘﺄﺛﲑﻫﻤﺎ ﻋﻨﺪﻣﺎ ﻳﻌﻄﻰ‬
‫ً‬
‫ﻛﻼ ﻣﻨﻬﻤﺎ ﻋﻠﻰ ﺣﺪﺓ ‪.‬‬

‫ﺍﻟﺘﺄﺛﲑﺍﺕ ﺍﳉﺎﻧﺒﻴـﺔ )‪: (Side effects‬‬

‫ً‬ ‫ً‬ ‫ُ‬
‫ﻫﻲ ﺍﻟﺘﺄﺛﲑﺍﺕ ﺍﻟﻐﲑ ﻣﺮﻏﻮﺑﺔ ‪ ،‬ﻭﺗﻜﻮﻥ ﺃﻋﺮﺍﺽ ﺧﻔﻴﻔﺔ ﻣﺤﺘﻤﻠﺔ ﻻﺗﱰﻙ ﺃﺛﺮﺍ ﺧﻄﲑﺍ ﻟﻠﺪﻭﺍء ‪ ،‬ﻣﺜﻞ ‪:‬‬
‫ً‬
‫ﺍﻟﺼﺪﺍﻉ ‪ ،‬ﻭﺍﻟﻐﺜﻴﺎﻥ ‪ ،‬ﻭﺍﳊﻜﺔ ﻭﺑﻌﺾ ﺍﻟﺒﻘﻊ ﻋﻠﻰ ﺍﳉﻠﺪ ﻭ ﺯﻏﻠﻠﺔ ﺍﻟﻌﻴﻨﲔ ‪ ،‬ﻭﻗﺪ ﻳﻜﻮﻥ ﺍﻟﺘﺄﺛﲑ ﺧﻄﲑﺍ‬
‫ً ُ‬ ‫ُ ّ ً‬
‫ﻭﻣﺪﻣﺮﺍ ﺃﺣﻴﺎﻧﺎ ﺍﺧﺮﻯ ‪.‬‬
‫ﺗﺄﺛﲑ ﺍﳌﺴـﺦ )‪: (Teratagenicity‬‬

‫‪١٢٦‬‬
 ‫ﻫﻮ ﺗﺄﺛﲑ ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ ﰲ ﺍﻟﺴﻴﺪﺍﺕ ﺍﳊﻮﺍﻣﻞ ‪ ،‬ﻭﳛﺪﺙ ﺗﺸﻮﻫﺎﺕ ﻟﻸﺟﻨﺔ ﻧﺘﻴﺠﺔ ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳊﻤﺾ‬
‫ﱠ‬ ‫ّ‬
‫ﺍﻟﺼﺒﻐﻴـﺎﺕ ﻣﺜﻞ ‪ :‬ﺍﺻﺎﺑﺔ ﺍﻟﻮﺟﻪ ﻭﺍﻟﺮﺃﺱ ﻭﺍﻟﺮﻗﺒﺔ ‪ ،‬ﺃﻭﺍﺻﺎﺑﺎﺕ ﺩﺍﺧﻠﻴﺔ ﻣﺜﻞ ﺍﺻﺎﺑﺔ‬
‫ِ‬ ‫ﺍﻟﻨﻮﻭﻱ ﻭﺷﺪﻭﺩ‬
‫ّ‬ ‫ّ‬
‫ﺍﻷﺟﻨـﺔ ﻋﻴﻮﺏ ﻭﻻﺩﻳﺔ ‪.‬‬
‫ِ‬ ‫ﺍﻟﻘﻠﺐ ‪ ،‬ﻭﻳﻄﻠﻖ ﻋﻠﻰ ﺗﺸﻮﻫﺎﺕ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴـﺎﺋﻲ )‪: (Chemotherapy‬‬
‫ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺋﻲ ﻟﻸﻣﺮﺍﺽ ﺍﻟﻨﺎﲨﺔ ﻋﻦ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﻔﲑﻭﺳﺎﺕ ‪ ،‬ﻭﺍﳉﺮﺍﺛﻴﻢ ‪ ،‬ﻭﺍﻟﻔﻄﺮﻳﺎﺕ ‪،‬‬
‫ﱢ‬ ‫ُ‬
‫ﻭﻳﻬﺪﻑ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺋﻲ ﻟﻠﻘﻀﺎء ﻋﻠﻰ ﺍﻟﻜﺎﺋﻨﺎﺕ ﺍﳌـﺘﻄﻔـﻠﺔ ‪.‬‬
‫ُ‬
‫ﻭﻳﻄﻠﻖ ﺍﻵﻥ ﻣﺼﻄﻠﺢ ) ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺋﻲ ( ﻋﻠﻰ ﻋﻼﺝ ﻣﺮﺽ ﺍﻟﺴﺮﻃـﺎﻥ ‪.‬‬
‫ﻛﻴﻒ ﻳﺼﻞ ﺍﻟﺪﻭﺍء ﺍﱃ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ؟‬
‫ﻳﺼﻞ ﺍﻟﺪﻭﺍء ﺍﱃ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ﺑﺎﻧﺘﻘﺎﻟﻪ ﻣﻦ ﻣﻜﺎﻥ ﺇﻋﻄﺎﺋﻪ ﺃﻭ ﺗﻨﺎﻭﻟﻪ ﻋﱪ ﺍﻟﻘﻨﻮﺍﺕ ﺍﳌﺨﺘﻠﻔﺔ ﰲ ﺍﳉﺴﻢ‬
‫ﻟﻴﺼﻞ ﻟﻠﺪﻭﺭﺓ ﺍﻟﺪﻣﻮﻳﺔ ﻭﻣﻨﻬﺎ ﺍﱃ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ‪ ،‬ﻭﻳﻌﺘﻤﺪ ﺍﻧﺘﻘﺎﻝ ﺍﻟﺪﻭﺍء ﻋﱪ ﻫﺬﻩ ﺍﻟﻘﻨﻮﺍﺕ ﻋﻠﻰ‬
‫ّ‬ ‫ّ‬
‫ﻗﺪﺭﺓ ﻧﻔﺎﺫﻳﺘﻪ ﻋﱪ ﺍﻷﻏﺸﻴﺔ ﺍﳋﻠﻮﻳﺔ ‪ ،‬ﻭﻫﻨﺎﻟﻚ ﻋﺪﺓ ﻋﻮﺍﻣﻞ ﺗﻌﺘﻤﺪ ﻋﻠﻴﻬﺎ ﻧﻔﺎﺫﻳﺔ ﺍﻟﺪﻭﺍء ‪:‬‬
‫‪ -١‬ﺍﻟﻮﺯﻥ ﺍﳉﺰﻳﺌﻲ ﻟﻠﺪﻭﺍء ‪.‬‬
‫‪ -٢‬ﺩﺭﺟﺔ ﺫﻭﺑﺎﻧﻪ ﰲ ﺍﻟﺸﺤﻮﻡ ‪.‬‬
‫ّ‬
‫‪ -٣‬ﺩﺭﺟﺔ ﺗﺄﻳـﻨﻪ ﰲ ﺍﻟﻮﺳﻂ ﺍﳊﻴﻮﻱ ﺍﻟﺬﻱ ﻳﻮﺟﺪ ﻓﻴﻪ ﻫﺬﺍ ﺍﻟﺪﻭﺍء‪.‬‬
‫‪ -١‬ﺍﻹﻧﺘﺸﺎﺭ ﺍﳌﺎﺋﻲ ‪:‬‬
‫ﺣﻴﺚ ﻳﻨﺘﻘﻞ ﺍﻟﺪﻭﺍء ﻋﱪ ﺍﻟﻐﺸﺎء ﺍﳊﻴﻮﻱ ﺧﻼﻝ ﺍﻟﻘﻨﻮﺍﺕ ﺍﳌﻤﻠﻮءﺓ ﺑﺎﳌﺎء ‪ ،‬ﻭﻟﻜﻲ ﳝﺮ ﺍﻟﺪﻭﺍء ﻋﱪ‬
‫ﺍﻟﻘﻨﻮﺍﺕ ﻻﺑﺪ ﺍﻥ ﻳﻜﻮﻥ ﺫﻭ ﺣﺠﻢ ﺟﺰﻳﺌﻲ ﺃﻗﻞ ﻣﻦ )‪١٥٠‬ﺟﻢ‪/‬ﻣﻮﻝ( ‪ ،‬ﻭﺃﻥ ﺗﻜﻮﻥ ﻟﻪ ﻗﺎﺑﻠﻴﺔ ﺍﻟﺬﻭﺑﺎﻥ ﰲ‬
‫ﺍﳌﺎء ‪ ،‬ﻭﺗﻮﺟﺪ ﻫﺬﻩ ﺍﻟﻘﻨﻮﺍﺕ ﺑﻜﺜﺮﺓ ﰲ ﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﺸﻌﺮﻳﺔ ﺧﺎﺭﺝ ﺍﳉﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﳌﺮﻛﺰﻱ ‪ ،‬ﻛﻤﺎ‬
‫ٌ‬
‫ﺍﻥ ﻭﺟﻮﺩﻫﺎ ﳏﺪﻭﺩ‬
‫ّ‬
‫ﻣﺎﻫﻮ ﺍﻹﻧﺘﺸﺎﺭ ﺍﻟﺴﻠﺒـﻲ )‪ (Passive‬؟‬
‫ﻫﻮ ﺍﺳﺘﻌﻤﺎﻝ ﺍﻟﺪﻭﺍء ﻋﱪ ﺍﻷﻏﺸﻴﺔ ﺍﳊﻴﻮﻳﺔ ﻣﻦ ﺗﺮﻛﻴﺰ ﺃﻋﻠﻰ ﺇﱃ ﺗﺮﻛﻴﺰ ﺃﺩﻧﻰ ﺑﺪﻭﻥ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻄﺎﻗﺔ‬
‫ﰲ ﻋﻤﻠﻴﺔ ﺍﻟﻨﻘﻞ ‪.‬‬
‫ّ‬
‫ﻣﺎﻫﻮ ﺍﻹﻧﺘﺸﺎﺭ ﺍﻟﻨـﺸﻂ )‪ (Active‬؟‬
‫ﻫﻮ ﺍﻧﺘﻘﺎﻝ ﺍﻟﺪﻭﺍء ﻣﻦ ﺗﺮﻛﻴﺰ ﺃﺩﻧﻰ ﺇﱃ ﺗﺮﻛﻴﺰ ﺃﻋﻠﻰ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﻄﺎﻗﺔ ﰲ ﻋﻤﻠﻴﺔ ﺍﻟﻨﻘﻞ ‪(Active‬‬
‫)‪. diffusion‬‬
‫ّ‬
‫‪ -٢‬ﺍﻹﻧﺘﺸﺎﺭ ﺍﻟﺪﻫﻨـﻲ )‪: (Lipids‬‬
‫ّ‬
‫ﳝﺮ ﺍﻟﺪﻭﺍء ﻋﱪ ﺍﻟﻐﺸﺎء ﺍﳊﻴﻮﻱ ﺍﻟﺸﺤﻤﻲ ﻧﻔﺴﻪ ‪ ،‬ﺣﻴﺚ ﻳﻌﺘﻤﺪ ﻣﺮﻭﺭﻩ ﻋﻠﻰ ‪ :‬ﺩﺭﺟﺔ ﺫﻭﺑﺎﻥ ﺍﻟﺪﻭﺍء ﰲ‬
‫ﺍﻟﺸﺤﻢ ‪ ،‬ﻓﻜﻠﻤﺎ ﻛﺎﻥ ﻣﻌﺎﻣﻞ ﺍﻟﺬﺍﺋﺒﻴﺔ ﻋﺎﱄ ﻛﻠﻤﺎ ﺩﻝ ﺫﻟﻚ ﻋﻠﻰ ﺃﻥ ﺍﻟﺪﻭﺍء ﺫﺍﺋﺐ ﰲ ﺍﻟﺸﺤﻮﻡ ‪ ،‬ﻭﻣﻦ ﺛﻢ‬
‫ﻣﺮﻭﺭﻩ ﺑﻴﺴﺮ ﻭﺳﻬﻮﻟﺔ ﻋﱪ ﺍﻻﻏﺸﻴﺔ ﺍﳊﻴﻮﻳﺔ ‪.‬‬
‫* ﺩﺭﺟﺔ ﺍﻟﺘﺄﻳﻦ )‪: (Degree of ionization‬‬
‫ّ‬
‫ﻳﻌﺒﺮ ﻋﻦ ﺩﺭﺟﺔ ﺍﻟﺘﺄﻳﻦ ﻟﻠﺪﻭﺍء ﰲ ﺍﻟﻮﺳﻂ ﺍﳊﻴﻮﻱ ‪ ،‬ﻭﻳﻜﻮﻥ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﻮﺳﻂ ﺍﳊﻴﻮﻱ ﻟﻠﺠﺴﻢ ﺇﻣﺎ ﻋﻠﻰ‬
‫ﻫﻴﺌﺔ ﻣﺘﺄﻳﻨﺔ )ﺣﺎﻣﻞ ﻟﻠﺸﺤﻨﺔ( ﺃﻭ ﻋﻠﻰ ﻫﻴﺌﺔ ﻏﲑ ﻣﺘﺄﻳﻨﺔ )ﻏﲑ ﺣﺎﻣﻞ ﻟﻠﺸﺤﻨﺔ( ‪.‬‬

‫‪١٢٧‬‬
 ‫* ﺍﳉﺰء ﺍﻟﻐﲑ ﺣﺎﻣﻞ ﻟﻠﺸﺤﻨﺔ )ﺍﻟﻐﲑ ﻣﺘﺄﻳﻦ( ﻫﻮ ﺍﻟﺬﻱ ﻳﺴﺘﻄﻴﻊ ﺍﳌﺮﻭﺭ ﻋﱪ ﺍﻷﻏﺸﻴﺔ ﺍﳋﻠﻮﻳﺔ ‪ ،‬ﻷﻥ‬
‫ﺩﺭﺟﺔ ﺫﻭﺑﺎﻧﻪ ﻋﺎﻟﻴﺔ ﰲ ﺍﻟﺸﺤﻮﻡ ‪.‬‬
‫* ﺍﻷﺱ ﺍﳍﻴﺪﺭﻭﺟﻴﻨﻲ ﻟﻠﻮﺳﻂ ﺍﳊﻴﻮﻱ )‪: (PH‬‬
‫ﻳﺆﺛﺮ ﺍﻟـ)‪ (PH‬ﻋﻠﻰ ﺩﺭﺟﺔ ﺗﺄﻳﻦ ﺍﻟﺪﻭﺍء ‪ ،‬ﻓﻔﻲ ﺍﻟﻮﺳﻂ ﺍﻟﻘﻠﻮﻱ ﺗﺘﺄﻳﻦ ﺍﻷﲪﺎﺽ ﺍﻟﻀﻌﻴﻔﺔ ﻭﺗﻘﻞ ﺑﺬﻟﻚ‬
‫ﻓﺮﺻﺔ ﻣﺮﻭﺭﻫﺎ ﻋﱪ ﺍﻷﻏﺸﻴﺔ ﺍﳋﻠﻮﻳﺔ ‪ ،‬ﻭﳛﺪﺙ ﺍﻟﻌﻜﺲ ﻟﻠﻘﻮﺍﻋﺪ ﺍﻟﻀﻌﻴﻔﺔ ‪ ،‬ﺃﻣﺎ ﰲ ﺍﻟﻮﺳﻂ ﺍﳊﻤﻀﻲ‬
‫ﻓﻴﺘﻢ ﺗﺄﻳﻦ ﺍﻟﻘﻮﺍﻋﺪ ﺍﻟﻀﻌﻴﻔﺔ ﻭﻻﺗﺘﺄﻳﻦ ﺍﻷﲪﺎﺽ ﺍﻟﻀﻌﻴﻔﺔ ‪ ،‬ﻭﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﳋﺎﺻﻴﺔ ﰲ ﺍﻟﺘﺨﻠﺺ ﻣﻦ‬
‫ُ ّ‬
‫ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ ﻋﻨﺪ ﺗﻨﺎﻭﳍﺎ ﲜﺮﻋﺎﺕ ﺳﻤﻴﺔ ﻋﺎﻟﻴﺔ ‪.‬‬
‫‪ -٣‬ﺍﻹﻧﺘﺸﺎﺭ ﺍﳊـﺎﻣﻞ ‪:‬‬
‫ﺣﻴﺚ ﺗﻮﺟﺪ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﺑﻌﺾ ﺍﳋﻼﻳﺎ ﻋﻠﻰ ﺍﻟﻐﺸﺎء ‪ ،‬ﻭﺗﻘﻮﻡ ﲝﻤﻞ ﺍﻟﺪﻭﺍء ﻣﻦ ﺟﻬﺔ ﺇﱃ ﺟﻬﺔ ﺃﺧﺮﻯ‬
‫‪.‬‬
‫‪ -٤‬ﺍﻹﻣﺘﺼﺎﺹ ﺍﳋﻠـﻮﻱ ‪:‬‬
‫ُ‬
‫ﺣﻴﺚ ﺗﺘﻢ ﺑﻠﻌﻤﺔ ﺟﺰﻳﺌﻴـﺔ ﻟﻠﺪﻭﺍء ﺑﻮﺍﺳﻄﺔ ﺣﻮﻳﺼﻼﺕ ﻣﻌﻴﻨﺔ ﻣﻮﺟﻮﺩﺓ ﰲ ﺍﻟﻐﺸﺎء ﺍﳊﻴﻮﻱ ‪ ،‬ﻭﻫﺬﻩ‬
‫ّ‬
‫ﺍﳊﻮﻳﺼﻼﺕ ﺗﻨﻘﻞ ﺍﻟﺪﻭﺍء ﺇﱃ ﺍﳉﻬﺔ ﺍﻷﺧﺮﻯ ﺣﻴﺚ ﻳﺘﻢ ﺍﺧﺮﺍﺟﻪ ‪ ،‬ﻭﻫﺬﺍ ﺍﻟﻨﻘﻞ ﻗﻠﻴﻞ ﻭﻧﺎﺩﺭ ﺍﳊﺪﻭﺙ ‪.‬‬
‫ﻋﻠﻢ ﺣﺮﻛﻴﺔ ﺍﻟﺪﻭﺍء ‪:‬‬
‫ّ‬
‫ﺇﻥ ﻋﻠﻢ ﺣﺮﻛﻴﺔ ﺍﻟﺪﻭﺍء ﻳﻌﺘﻨﻲ ﲟﺎ ﻳﻔﻌﻠﻪ ﺍﳉﺴﻢ ﺑﺎﻟﺪﻭﺍء ‪ ،‬ﺃﻱ ﻛﻴﻔﻴﺔ ﺣﺮﻛﺔ ﺍﻟﺪﻭﺍء ﰲ ﺍﳉﺴﻢ ﻭﻣﺎﺫﺍ‬
‫ّ‬
‫ﳛﺪﺙ ﻟﻪ ﺇﱃ ﺃﻥ ﻳﺘﻢ ﺍﻟﺘﺨﻠﺺ ﻣﻨﻪ ‪ ،‬ﻭﺫﻟﻚ ﻋﻦ ﻃﺮﻳﻖ ﺍﻣﺘﺼﺎﺻﻪ ﻭﻣﻦ ﺛﻢ ﺗﻮﺯﻳﻌﻪ ‪ ،‬ﺛﻢ ﺍﺳﺘﻘﻼﺑﻪ‬
‫ً‬
‫ﻭﺃﺧﲑﺍ ﺍﺧﺮﺍﺟﻪ ‪.‬‬
‫ً‬
‫ﺃﻭﻻ – ﺍﻹﻣﺘـﺼﺎﺹ ‪:‬‬
‫ﻭﻳﻌﺘﻤﺪ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﻋﺪﺓ ﻋﻮﺍﻣﻞ ﻧﺬﻛﺮ ﻣﻨﻬﺎ ‪:‬‬
‫‪ -١‬ﻃﺮﻳﻘﺔ ﺗﻨﺎﻭﻝ ﺍﻟﺪﻭﺍء ‪:‬‬
‫ﱟ‬ ‫ُ‬
‫ﻳﺘﻨﺎﻭﻝ ﺍﻟﺪﻭﺍء ﺑﻐﺮﺽ ﺍﻟﻌﻼﺝ ﺑﻌﺪﺓ ﻃﺮﻕ ﻟﻜﻞ ﻣﻨﻬﺎ ﺳﻠﺒﻴﺎﺗﻬﺎ ﻭﺍﳚﺎﺑﻴﺎﺗﻬﺎ ‪ ،‬ﺣﻴﺚ ﺗﺆﺛﺮ ﻃﺮﻳﻘﺔ‬
‫ﺍﻟﺘﻨﺎﻭﻝ ﻋﻠﻰ ﺩﺭﺟﺔ ﺍﻹﻣﺘﺼﺎﺹ ‪.‬‬

‫* ﺃﻫﻢ ﻃﺮﻕ ﺗﻨﺎﻭﻝ ﺍﻟﺪﻭﺍء ‪:‬‬

‫ﺃ(‪ -‬ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔـﻢ )‪: (Oral‬‬

‫ُ‬
‫ﻣﻌﻈﻢ ﺍﻷﺩﻭﻳﺔ ﻳﺘﻢ ﺗﻨﺎﻭﳍﺎ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ‪ ،‬ﻭﻟﺬﻟﻚ ﻓﺈﻥ ﳍﺎ ﻋﺪﺓ ﻣﺰﺍﻳﺎ ﻓﻬﻲ ﺳﻬﻠﺔ ﺍﻟﺘﻨﺎﻭﻝ ﻭﺁﻣﻨﺔ‬
‫ً‬
‫ﻭﺃﻛﺜﺮ ﺍﻗﺘﺼﺎﺩﺍ ﰲ ﺍﻟﺘﻜﻠﻔﺔ ‪ ،‬ﻭﻻﳓﺘﺎﺝ ﻟﺸﺨﺺ ﻣﺘﺨﺼﺺ ﻹﻋﻄﺎء ﺍﻟﺪﻭﺍء ‪.‬‬
‫ّ‬
‫ﺳﻠﺒـﻴﺎﺗﻬﺎ ‪:‬‬
‫‪ -١‬ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ ﺗﺘﻜﺴﺮ ﺑﺎﳌﻌﺪﺓ ﻭﺍﻷﻣﻌﺎء ﻓﻼ ﺗﺼﻞ ﺇﱃ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ﺍﳌﻄﻠﻮﺏ ‪ ،‬ﻭﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ‬
‫َ‬ ‫ُ‬ ‫ُ‬
‫ﻻﺗـﻤﺘﺺ ﺑﺸﻜﻞ ﻛﺎﻑٍ ‪ ،‬ﻭﺑﻌﻀﻬﺎ ﺗـﺴﺘﻘﻠﺐ ﻧﺘﻴﺠﺔ ﻣﺮﻭﺭﻫﺎ ﻋﱪ ﺍﻟﻜﺒﺪ ‪.‬‬

‫‪١٢٨‬‬
‫‪ -٢‬ﻫﻨﺎﻟﻚ ﺍﺧﺘﻼﻑ ﺑﲔ ﺍﻷﺷﺨﺎﺹ ﰲ ﺩﺭﺟﺔ ﺇﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء‪،‬ﻛﻤﺎ ﻻﳝﻜﻦ ﺍﻋﻄﺎء ﺍﻟﺸﺨﺺ ﺍﻟﺪﻭﺍء ﺇﻥ ﱂ‬
‫ُ‬ ‫ً‬
‫ﻳﻜﻦ ﺭﺍﻏﺒﺎ ﻓﻴﻪ‪ ،‬ﺃﻭﺇﺫﺍ ﻛﺎﻥ ﰲ ﺣﺎﻟﺔ ﻏﻴﺒﻮﺑﺔ‪ ،‬ﻭﺗﻤﺘﺺ ﺍﻷﺩﻭﻳﺔ ﻋﱪﺍﳉﻬﺎﺯ ﺍﳍﻀﻤﻲ ﻭﻫﻲ ﰲ ﺣﺎﻟﺔ ﻏﲑ‬
‫ﻣﺘﺄﻳﻨﺔ )ﺗﺬﻭﺏ ﰲ ﺍﻟﺸﺤﻮﻡ ﺑﺸﻜﻞ ﺟﻴﺪ(ﻭﻟﺬﻟﻚ ﻓﻤﻦ ﺍﳌﺘﻮﻗﻊ ﺃﻥ ﻳﺘﻢ ﺍﻣﺘﺼﺎﺹ ﺍﻷﺩﻭﻳﺔ ﺍﻟﻘﻠﻮﻳﺔ‬
‫ُ‬
‫ﺍﻟﻀﻌﻴﻔﺔ‪ ،‬ﻓﺘﻤﺘﺺ ﻣﻦ ﺍﻷﻣﻌﺎء ﻷﻥ ﺍﻷﺱ ﺍﳍﻴﺪﺭﻭﺟﻴﻨﻲ ﰲ ﺍﻷﻣﻌﺎء ﻗﻠﻮﻱ‪ ،‬ﻭﺑﺬﻟﻚ ﺗﻜﻮﻥ ﻫﺬﻩ ﺍﻷﺩﻭﻳﺔ‬
‫ﻏﲑﻣﺘﺄﻳﻨﺔ‪.‬‬
‫ﺏ(‪ -‬ﻋﻦ ﻃﺮﻳﻖ ﺍﳊـﻘﻦ )‪: (Injection‬‬
‫ﻫﻨﺎﻟﻚ ﻋﺪﺓ ﻃﺮﻕ ﳊﻘﻦ ﺍﻟﺪﻭﺍء ‪ ،‬ﻣﻨﻬﺎ ‪:‬‬
‫‪ -‬ﺍﳊﻘﻦ ﺍﻟﻮﺭﻳﺪﻱ )‪. (Intravenous‬‬
‫‪ -‬ﺍﳊﻘﻦ ﺍﻟﻌﻀﻠﻲ )‪. (Intramuscular‬‬
‫‪ -‬ﺍﳊﻘﻦ ﲢﺖ ﺍﳉﻠﺪ )‪. (Intracutaneous‬‬
‫ً‬
‫ﻭﻫﻲ ﲨﻴﻌﺎ ﺗﺸﱰﻙ ﰲ ﻋﺪﺓ ﻣﺰﺍﻳﺎ ﺃﻫﻤﻬﺎ ﺃﻧﻪ ﺑﺎﻹﻣﻜﺎﻥ ﺇﻋﻄﺎﺅﻫﺎ ﻟﻠﻤﺮﻳﺾ ﻭﻫﻮ ﰲ ﺣﺎﻟﺔ ﻏﻴﺒﻮﺑﺔ ‪.‬‬
‫ﺟـ(‪ -‬ﻋﻦ ﻃﺮﻳﻖ ﺍﻹﺳﺘﻨﺸﺎﻕ )‪: (Inhalation‬‬
‫ُ ﱢ‬ ‫ُ‬ ‫ُ‬
‫ﻳﻌﻄﻰ ﺍﻟﺪﻭﺍء ﻋﱪ ﺍﳉﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻐﺎﺯﺍﺕ ﺃﻭ ﺍﻟﺴﻮﺍﺋﻞ ﺍﳌﺘﻄﺎﻳﺮﺓ ﻣﺜﻞ ‪ :‬ﺍﳌﺒـﻨﺠﺎﺕ ‪ ،‬ﻛﻤﺎ‬
‫ّ‬ ‫ُ‬
‫ﻳﻌﻄﻰ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﻫﻴﺌﺔ ﳏﻠﻮﻝ ﺭﺫﺍﺫﻱ ‪ ،‬ﻭﻣﺜﺎﻝ ﺫﻟﻚ ‪ :‬ﺃﺩﻭﻳﺔ ﺍﻟﺮﺑﻮ ‪.‬‬
‫‪ -٢‬ﺇﻋﻄﺎء ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﺷﻜﻞ ﻣﻮﺿﻌﻲ ‪:‬‬
‫ﻭﺫﻟﻚ ﺑﺘﻄﺒﻴﻘﻪ ﻋﻠﻰ ﻋﺪﺓ ﺃﻣﺎﻛﻦ ﰲ ﺍﳉﺴﻢ ‪ ،‬ﻛﺎﳉﻠﺪ ﺃﻭ ﺍﻷﻏﺸﻴﺔ ﺍﳌﺨﺎﻃﻴﺔ‪ ،‬ﻋﻠﻰ ﻫﻴﺌﺔ ﻛﺮﳝﺎﺕ ﺃﻭ‬
‫ُ‬
‫ﻣﺮﺍﻫﻢ ‪ ،‬ﺃﻭ ﻳﺴﺘﻌﻤﻞ ﺍﻟﺪﻭﺍء ﰲ ﺃﻱ ﺟﺰء ﻣﻦ ﺍﳉﺴﻢ ‪.‬‬
‫ُ‬
‫* ﺗﻌﺘﻤﺪ ﻛﻤﻴﺔ ﺍﻟﺪﻭﺍء ﺍﳌﻤﺘﺼﺔ ﰲ ﻫﺬﻩ ﺍﳊﺎﻟﺔ ﻋﻠﻰ ﻣﺴﺎﺣﺔ ﺍﳌﻨﻄﻘﺔ ﺍﳌﻮﺟﻮﺩﺓ ﻋﻠﻰ ﺍﳉﺴﻢ ‪ ،‬ﻭﻋﻠﻰ‬
‫ﺩﺭﺟﺔ ﺫﻭﺑﺎﻥ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﺸﺤﻮﻡ ‪ ،‬ﻭﻋﻠﻰ ﻭﺟﻮﺩ ﺍﻟﺘﻬﺎﺏ ﰲ ﻣﻜﺎﻥ ﻭﺿﻊ ﺍﻟﺪﻭﺍء ‪.‬‬
‫ُ‬
‫‪ -٣‬ﺻﻴﻐﺔ ﺍﳌﺴﺘﺤﻀﺮ ﺍﻟﺼﻴﺪﻻﻧﻲ ‪:‬‬
‫ُ‬ ‫ُ‬ ‫ُ‬
‫ﻭﺟﻮﺩ ﺍﻟﺪﻭﺍء ﰲ ﻣﺴﺘﺤﻀﺮ ﻣﺎﺋﻲ ﻳﺴﺮﻉ ﻣﻦ ﺇﻣﺘﺼﺎﺻﻪ ‪ ،‬ﺃﻣﺎ ﻭﺟﻮﺩﻩ ﰲ ﻣﺴﺘﺤﻀﺮ ﺯﻳﺘﻲ ﻓﺈﻧﻪ ﻳﺒﻄﻲء‬
‫ﻣﻦ ﺍﻣﺘﺼﺎﺻﻪ ‪.‬‬
‫ﻓﺪﺭﺟﺔ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء ﻋﻠﻰ ﺍﳍﻴﺌﺔ ﺍﻟﺼﻠﺒﺔ )‪ (Tablets‬ﻳﻌﺘﻤﺪ ﻋﻠﻰ ﺳﺮﻋﺎﻥ ﺫﻭﺑﺎﻥ ﺍﻟﻘﺮﺹ ﰲ‬
‫ُ‬
‫ﺍﻷﻣﻌﺎء ‪ ،‬ﻛﻤﺎ ﻳﺆﺛﺮ ﺍﳌﺴﺘﺤﻀﺮ ﺍﻟﺼﻴﺪﻻﻧﻲ ﻋﻠﻰ ﺩﺭﺟﺔ ﺍﻹﻣﺘﺼﺎﺹ ‪.‬‬
‫‪ -٤‬ﻣﺴﺎﺣﺔ ﺍﻹﻣﺘﺼـﺎﺹ ‪:‬‬
‫ّ‬ ‫ُ‬
‫ﻛﻠﻤﺎ ﻛﱪﺕ ﻣﺴﺎﺣﺔ ﺍﻹﻣﺘﺼﺎﺹ ﺍﻟﺘﻲ ﻳﺘﻌﺮﺽ ﺍﻟﻴﻬﺎ ﺍﻟﺪﻭﺍء ‪ ،‬ﻛﻠﻤﺎ ﺯﺍﺩﺕ ﺍﻟﻜﻤﻴﺔ ﺍﳌﻤﺘﺼﺔ ﻣﻦ ﺍﻟﺪﻭﺍء‬
‫ُ‬
‫‪ ،‬ﻟﺬﻟﻚ ﻓﺎﻷﻣﻌﺎء ﻭﺍﻟﺮﺋﺘﲔ ﺗﻮﻓﺮﺍﻥ ﻣﺴﺎﺣﺔ ﻭﺍﺳﻌﺔ ﻟﻺﻣﺘﺼﺎﺹ ‪ ،‬ﻓﺤﲔ ﺃﻥ ﻣﻠﺘﺤﻤﺔ ﺍﻟﻌﲔ ﳍﺎ ﻣﺴﺎﺣﺔ‬
‫ﺻﻐﲑﺓ ﻟﻺﻣﺘﺼﺎﺹ ﻟﺬﻟﻚ ﻻﻳﺼﻞ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻟﺪﻡ ﺑﱰﻛﻴﺰ ﻋﺎﱄ ‪.‬‬
‫ﱡ‬ ‫ُ‬
‫ﻣﺎﻟﻔﺮﻕ ﺑﲔ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﻜﱪﻯ ﻭﺍﻟﺼﻐﺮﻯ ؟)ﺍﲝﺚ ﻋﻦ ﺍﻻﺟﺎﺑﻪ(‬
‫ُ‬ ‫َ‬
‫* ﻛﻠﻤﺎ ﺯﺍﺩ ﺟﺮﻳﺎﻥ ﺍﻟﺪﻡ ﺍﱃ ﺍﻟﻌﻀﻮ ﺍﳌﻌﻨﻲ ﻹﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء ‪ ،‬ﻛﻠﻤﺎ ﺯﺍﺩﺕ ﻧﺴﺒﺔ ﺍﻟﺪﻭﺍء ﺍﳌﻤﺘﺼﺔ ‪،‬‬
‫ّ‬
‫ﻟﺬﻟﻚ ﻓﺈﻥ ﻋﻤﻠﻴﺔ ﺗﺪﻟﻴﻚ ﺍﳌﺮﻫﻢ ﻋﻠﻰ ﺍﻟﻌﻀﻮ ﺗﺰﻳﺪ ﻣﻦ ﺳﺮﻋﺔ ﺍﻹﻣﺘﺼﺎﺹ ‪ ،‬ﻷﻥ ﺍﻟﺘﺪﻟﻴﻚ ﻳﻮﺳﻊ‬
‫ﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺑﺎﻟﺘﺎﱄ ﻳﺰﻳﺪ ﺗﺪﻓﻖ ﺍﻟﺪﻡ ﻓﻴﻬﺎ ‪ ،‬ﻟﺬﻟﻚ ﺗﺰﻳﺪ ﺳﺮﻋﺔ ﺇﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء ‪.‬‬

‫‪١٢٩‬‬
 ‫* ﻭﺍﻟﻌﻜﺲ ﻋﻨﺪ ﺍﻧﻘﺒﺎﺽ ﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ‪ ،‬ﻋﻨﺪ ﺍﻟﱪﺩ ﺍﻟﺸﺪﻳﺪ ﺃﻭ ﺍﳋﻮﻑ ﺃﻭ ﺍﻟﻘﻠﻖ ﺃﻭ ﻧﺘﻴﺠﺔ ﺑﻌﺾ‬
‫ﺍﻷﺩﻭﻳﺔ ‪ ،‬ﻓﺈﻥ ﺍﻣﺘﺼﺎﺹ ﺍﻟﺪﻭﺍء ﻳﻘﻞ‪.‬‬
‫ً‬
‫ﺛﺎﻧﻴﺎ – ﺗﻮﺯﻳـﻊ ﺍﻟﺪﻭﺍء ‪:‬‬
‫ُ‬
‫ﻋﻨﺪﻣﺎ ﻳﺼﻞ ﺍﻟﺪﻭﺍء ﺇﱃ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﻜﱪﻯ ﻋﻦ ﻃﺮﻳﻖ ﺍﻹﻣﺘﺼﺎﺹ ‪ ،‬ﻳﺮﺗﺒﻂ ﺟﺰء ﻣﻨﻪ ﻣﻊ ﺑﺮﻭﺗﲔ‬
‫ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ﻭﺧﺎﺻﺔ ﻣﺎﺩﺓ )ﺍﻷﻟﺒﻴﻮﻣﲔ( )‪ ، (Albumin‬ﻭﻳﻌﺘﻤﺪ ﻫﺬﺍ ﺍﻟﱰﺍﺑﻂ ﻋﻠﻰ ﻧﻮﻋﻴﺔ ﺍﻟﺪﻭﺍء‬
‫ﻭﻋﻠﻰ ﺣﺪﻭﺙ ﺍﻟﱰﺍﺑﻂ ﺑﻨﺴﺒﺔ ﻋﺎﻟﻴﺔ ﻣﻊ ﺑﺮﻭﺗﲔ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ‪.‬‬
‫ﻋﻤﻠﻴﺔ ﺍﻟﱰﺍﺑﻂ ﻣﻊ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ﻫﻲ ﻋﻤﻠﻴﺔ ﻣﻌﻜﻮﺳﺔ ‪:‬‬
‫ُ‬
‫]ﻣﺮﻛﺐ ﺍﻟﺪﻭﺍء‪-‬ﺑﺮﻭﺗﲔ[‪+‬ﺩﻭﺍء ﺣﺮ‬ ‫ﺩﻭﺍء‪+‬ﺑﺮﻭﺗﲔ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ‬
‫ُ‬ ‫ُ‬
‫* ﺍﳉﺰء ﺍﳊﺮ ﻣﻦ ﺍﻟﺪﻭﺍء ﻫﻮ ﺍﻟﺬﻱ ﻳﺘﻌﺮﺽ ﺍﱃ ﻫﺬﺍ ﺍﻟﺘﻮﺯﻳﻊ ﻭﺍﻹﻓﺮﺍﻍ ﻭﺍﻹﺳﺘﻘﻼﺏ ‪ ،‬ﺃﻣﺎ ﺍﳉﺰء ﺍﳌﱰﺍﺑﻂ‬
‫ُ‬ ‫ُ ّ ً‬
‫ﻣﻊ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ﻳﺒﻘﻰ ﻣﺨﺰﻧﺎ ‪ ،‬ﻭﻳﻘﻮﻡ ﺑﺈﻓﺮﺍﺯ ﺍﻟﺪﻭﺍء ﺑﺒﻂء ‪ ،‬ﻭﻳﺘﻢ ﺗﻮﺯﻳﻊ ﺍﳉﺰء ﺍﳊﺮ ﻣﻦ ﺍﻟﺪﻭﺍء ﺍﱃ‬
‫ّ‬
‫ﺍﳊﻴﺰﺍﺕ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﻋﻠﻰ ﺳﻮﺍﺋﻞ ﺍﳉﺴﻢ ‪..‬‬
‫ّ‬
‫ﳒﺪ ﺃﻥ ﻣﺎء ﺍﳉﺴﻢ ﻣﻘﺴﻢ ﺍﱃ ﺃﺭﺑﻊ ﺣﻴﺰﺍﺕ ‪ ،‬ﻫﻲ ‪:‬‬
‫ُ ّ‬
‫‪ -١‬ﺣﻴﺰ ﻣﺎء ﺍﻟﺒﻼﺯﻣﺎ ‪ :‬ﻳﻜﻮﻥ )‪ (5%‬ﻣﻦ ﻭﺯﻥ ﺍﳉﺴﻢ ‪.‬‬
‫ّ‬
‫‪ -٢‬ﺣﻴﺰ ﺍﳌﺎء ﺍﳋﻼﱄ ‪ :‬ﻳﻜﻮﻥ )‪ (16%‬ﻣﻦ ﻭﺯﻥ ﺍﳉﺴﻢ ‪.‬‬
‫ّ‬
‫‪ -٣‬ﺣﻴﺰ ﺍﳌﺎء ﺩﺍﺧﻞ ﺍﳋﻼﻳﺎ ‪ :‬ﻳﻜﻮﻥ )‪ (35%‬ﻣﻦ ﻭﺯﻥ ﺍﳉﺴﻢ ‪.‬‬
‫ّ‬
‫‪ -٤‬ﺣﻴﺰ ﺍﳌﺎء ﺧﺎﺭﺝ ﺍﳋﻼﻳﺎ ‪ :‬ﻳﻜﻮﻥ )‪ (2.5%‬ﻣﻦ ﻭﺯﻥ ﺍﳉﺴﻢ ‪.‬‬
‫ّ‬ ‫ُ ّ‬ ‫ّ‬
‫* ﺗﻮﺟﺪ ﺟﺰﻳﺌﺎﺕ ﺍﻟﺪﻭﺍء ﰲ ﺍﳊﻴﺰﺍﺕ ﺇﻣﺎ ﺣﺮﺓ ﺃﻭ ﻣﱰﺍﺑﻄﺔ ‪ ،‬ﻭﻳﻌﺘﻤﺪ ﺍﻧﺘﻘﺎﻝ ﺍﻟﺪﻭﺍء ﻋﱪ ﺣﻴﺰﺍﺕ ﺍﳉﺴﻢ‬
‫ﻋﻠﻰ ﻋﺪﺓ ﻋﻮﺍﻣﻞ ﻣﻨﻬﺎ ‪) :‬ﺩﺭﺟﺔ ﺍﻟﱰﺍﺑﻂ( ‪ ،‬ﻭ)ﺍﻟﻔﺮﻕ ﰲ ﺍﻷﺱ ﺍﳍﻴﺪﺭﻭﺟﻴﻨﻲ ﻣﺎﺑﲔ ﺍﳊﻴﺰﺍﺕ ﺍﳌﺨﺘﻠﻔﺔ(‬
‫‪ ،‬ﻭ)ﺩﺭﺟﺔ ﺍﻟﺬﻭﺑﺎﻥ ﰲ ﺍﻟﺸﺤﻮﻡ( ‪.‬‬
‫ُ ّ‬
‫* ﻭﻳﻌﺒﺮ ﻋﻦ ﺣﺮﻛﺔ ﺍﻟﺪﻭﺍء ﻣﺎﺑﲔ ﺣﻴﺰﺍﺕ ﺳﻮﺍﺋﻞ ﺍﳉﺴﻢ ﺑـ)ﺣﺠﻢ ﺍﻟﺘﻮﺯﻳﻊ ﺍﻟﻈﺎﻫﺮﻱ( ‪(Apparent‬‬
‫)‪. Valium Distribution‬‬

‫ﻓﻨﺠﺪ ﺃﻥ ﺍﻟﺪﻭﺍء ﺫﻭ ﺍﻟﱰﺍﺑﻂ ﺍﻟﺸﺪﻳﺪ ﻣﻊ ﺑﺮﻭﺗﲔ ﺍﻟﺒﻼﺯﻣﺎ ‪ ،‬ﺃﻭ ﺍﻟﺪﻭﺍء ﺫﻭ ﺍﳉﺰء ﺍﻟﻜﺒﲑ ‪ ،‬ﻻﻳﺴﺘﻄﻴﻌﺎﻥ‬
‫ّ‬ ‫ّ‬ ‫ّ‬
‫ﺍﻟﻨﻔﺎﺫ ﻋﱪ ﺍﻟﺒﻼﺯﻣﺎ ﺍﱃ ﺍﳊﻴﺰﺍﺕ ﺍﻷﺧﺮﻯ ‪ ،‬ﻭﻛﺬﻟﻚ ﺍﻷﺩﻭﻳﺔ ﺫﺍﺕ ﺍﻟﺘـﺄﻳﻦ ﺍﻟﻌﺎﱄ ﺗﺒﻘﻰ ﰲ ﺍﻟﺴﺎﺋﻞ ﺧﺎﺭﺝ‬
‫ّ‬
‫ﺍﳋﻼﻳﺎ ﻭﻻﺗﺴﺘﻄﻴﻊ ﺍﳌﺮﻭﺭ ﺍﱃ ﺍﻟﺪﺍﺧﻞ ﻟﻘﻠﺔ ﺫﻭﺑﺎﻧﻬﺎ ﰲ ﺍﻟﺸﺤﻮﻡ‬

‫ﺃﻣﺎ ﺍﻷﺩﻭﻳﺔ ﺫﺍﺕ ﺍﻟﺬﻭﺑﺎﻥ ﺍﻟﻌﺎﱄ ﰲ ﺍﻟﺸﺤﻮﻡ ﻓﺈﻧﻬﺎ ﲤﺮ ﻋﱪ ﺍﻷﻏﺸﻴﺔ ﺍﱃ ﺩﺍﺧﻞ ﺍﳋﻠﻴﺔ ‪ ،‬ﻭﻟﺬﻟﻚ ﻓﺈﻥ‬
‫ﺍﳌﺮﻛﺒﺎﺕ ﺍﻟﺬﺍﺋﺒﺔ ﰲ ﺍﻟﺸﺤﻮﻡ ﺗﻘﻮﻡ ﺑﺎﻟﱰﺍﺑﻂ ﻣﻊ ﺷﺤﻮﻡ ﺍﳉﺴﻢ ﻭﻋﻀﻼﺗﻬﺎ ‪.‬‬
‫َ‬
‫ﺗﺮﻭﻳﻪ ﺩﻣﻮﻳﺔ ‪،‬‬
‫* ﻣﻦ ﻧﺎﺣﻴﺔ ﺃﺧﺮﻯ ﳝﺮ ﺍﻟﺪﻭﺍء ﻣﻦ ﺍﻟﺒﻼﺯﻣﺎ ﺍﱃ ﺃﻋﻀﺎء ﺍﳉﺴﻢ ﺍﻟﺘﻲ ﲢﺘﻮﻱ ﻋﻠﻰ ِ‬
‫ﺣﻴﺚ ﻳﺪﺧﻞ ﺍﻟﺪﻭﺍء ﳍﺬﻩ ﺍﻷﻋﻀﺎء ﺧﻼﻝ ﺩﻗﺎﺋﻖ ﻣﻦ ﺍﻣﺘﺼﺎﺻﻪ ﻭﺩﺧﻮﻟﻪ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺪﻣﻮﻳﺔ ‪ ،‬ﻋﻨﺪﻫﺎ ﻳﺘﻢ‬
‫ﺗﻮﺯﻳﻊ ﺍﻟﺪﻭﺍء ﺍﱃ ﺃﻧﺴﺠﺔ ﺍﳉﺴﻢ ﺍﻷﺧﺮﻯ ﺍﻟﺘﻲ ﺗﺴﺘﻘﺒﻞ ﺗﺮﻭﻳﻪ ﺩﻣﻮﻳﺔ ﺃﻗـﻞ ﻣﺜﻞ ‪ :‬ﺍﳉﻠﺪ ‪ ،‬ﻭﺍﻷﻣﻌﺎء‬
‫ﺍﻟﺪﺍﺧﻠﻴﺔ ‪.‬‬

‫‪١٣٠‬‬
‫ﻭﰲ ﺍﻟﻨﻬﺎﻳﺔ ﻳﻨﺘﻘﻞ ﺍﻟﺪﻭﺍء ﺍﱃ ﺷﺤﻮﻡ ﺍﳉﺴﻢ ﻭﺍﻟﻌﻀﻼﺕ ﻭﺍﻟﺘﻲ ﲣﺰﻥ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻥ ﻳﺘﻢ ﺍﻓﺮﺍﺯ )ﺍﺧﺮﺍﺝ(‬
‫ﺍﻟﺪﻭﺍء ﻣﻨﻬﺎ ﺑﺒﻂء ‪.‬‬
‫* ﺗﻮﺯﻳﻊ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻟﺪﻣـﺎﻍ ‪:‬‬
‫ﱂ ﳚﻌﻞ ﺍﳋﺎﻟﻖ ﻋﺰ ﻭﺟﻞ ﻟﺒﻄﺎﻧﺔ ﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﺍﻟﺸﻌﺮﻳﺔ ﺃﻱ ﻗﻨﻮﺍﺕ ﳑﻠﻮءﺓ ﺑﺎﳌﺎء ‪ ،‬ﻟﺬﻟﻚ ﻻ ﻳﻮﺟﺪ‬
‫ﺃﻱ ﺍﻧﺘﺸﺎﺭ ﻣﺎﺋﻲ ﻟﻸﺩﻭﻳﺔ ﺍﱃ ﺩﺍﺧﻞ ﺍﻟﺪﻣﺎﻍ ‪ ،‬ﻭﻣﻦ ﺛﻢ ﻻﺗﺪﺧﻞ ﺃﻱ ﻣﺎﺩﺓ ﻣﻮﺟﻮﺩﺓ ﰲ ﺍﻟﺪﻡ ﺍﱃ ﺍﻟﺪﻣﺎﻍ‬
‫ُ‬
‫‪ ،‬ﻫﺬﺍ ﺍﻟﺘﺄﺛﲑ ﺳﻤﻲ ﺑـ)ﺍﻟﺴﺎﺋﻞ ﺍﻟﺪﻣﻮﻱ ﺍﻟﺪﻣﺎﻏﻲ( ‪.‬‬

‫* ﻛﻴﻒ ﺗﺪﺧﻞ ﺍﻷﺩﻭﻳﺔ ﺍﱃ ﺍﻟﺪﻣﺎﻍ ؟‬

‫ﺑﻮﺍﺳﻄﺔ ﺍﻹﻧﺘﺸﺎﺭ ﺍﻟﺪﻫﻨﻲ ‪ ،‬ﺃﻱ ﺃﻥ ﺍﻟﺪﻭﺍء ﺫﺍ ﺫﻭﺑﺎﻥ ﻋﺎﱄ ﰲ ﺍﻟﺸﺤﻮﻡ )ﻏﲑ ﻣﺘﺄﻳﻦ( ‪ ،‬ﻓﻴﺪﺧﻞ ﺍﱃ‬
‫ﺍﻟﺪﻣﺎﻍ ‪ ،‬ﻭﻛﻠﻤﺎ ﺯﺍﺩﺕ ﺩﺭﺟﺔ ﺍﻟﺬﻭﺑﺎﻥ ﰲ ﺍﻟﺸﺤﻮﻡ ‪ ،‬ﺯﺍﺩﺕ ﺳﺮﻋﺔ ﺩﺧﻮﻝ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻟﺪﻣﺎﻍ ‪.‬‬
‫* ﺗﻮﺯﻳﻊ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻟﻌﻈـﺎﻡ ‪:‬‬
‫ً‬
‫ﺗﻮﺯﻳﻊ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﻟﻌﻈﺎﻡ ﻣﻬﻢ ﺟﺪﺍ ‪ ،‬ﻭﺧﺎﺻﺔ ﻣﻊ ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ ﻭﺍﳌﻮﺍﺩ ﺍﻟﺴﺎﻣﺔ ‪ ،‬ﻓﺎﻟﻌﻈﺎﻡ ﻣﺜﻼ ﺗﻘﻮﻡ‬
‫ﺑﺘﺨﺰﻳﻦ ﺍﻟﺮﺻﺎﺹ ﻭﺑﻌﺾ ﺍﳌﻌﺎﺩﻥ ﺍﻷﺧﺮﻯ ‪ ،‬ﺛﻢ ﺗﻔﺮﺯﻫﺎ ﺑﺒﻂء ﺍﱃ ﺃﻋﻀﺎء ﺍﳉﺴﻢ ﻣﺜﻞ ‪ :‬ﺍﻟﺪﻣﺎﻍ ‪ ،‬ﳑﺎ‬
‫ﻳﺴﺒﺐ ﺗﻠﻒ ﺑﻄﻲء ﻟﺘﻠﻚ ﺍﻷﻋﻀﺎء ‪ ،‬ﻛﻤﺎ ﺗﻘﻮﻡ ﺑﺘﺨﺰﻳﻦ ﺍﻷﺩﻭﻳﺔ ﻣﺜﻞ‪ :‬ﺍﳌﻀﺎﺩﺍﺕ ﺍﳊﻴﻮﻳﺔ ‪ ،‬ﻟﺬﻟﻚ‬
‫ﻻﺗﺴﺘﻌﻤﻞ ﻫﺬﻩ ﺍﻷﺩﻭﻳﺔ ﺩﻭﻥ ﺳﻦ ﺍﻟﺜﺎﻣﻨﺔ ﻣﻦ ﺍﻟﻌﻤﺮ ‪.‬‬
‫* ﺗﻮﺯﻳﻊ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﳉﻨﻴـﻦ ‪:‬‬
‫ﺍﳉﻨﲔ ﻳﺘﻌﺮﺽ ﺍﱃ ﲨﻴﻊ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺘﻨﺎﻭﳍﺎ ﺍﻷﻡ ‪ ،‬ﺣﻴﺚ ﺗﻨﺘﻘﻞ ﻫﺬﻩ ﺍﻷﺩﻭﻳﺔ ﺇﻟﻴﻪ ﻋﱪ ﺍﳌﺸﻴﻤﺔ‬
‫‪ ،‬ﻭﻳﻌﺘﻤﺪ ﺗﺮﻛﻴﺰ ﺍﻟﺪﻭﺍء ﺍﻟﺬﻱ ﻳﺼﻞ ﺍﱃ ﺍﳉﻨﲔ ﻋﻠﻰ ﺩﺭﺟﺔ ﺫﻭﺑﺎﻧﻪ ﰲ ﺍﻟﺸﺤﻮﻡ ‪ ،‬ﻭﺑﺎﻟﺘﺎﱄ ﺯﻳﺎﺩﺓ ﻛﻤﻴﺔ‬
‫ﺍﻟﺪﻭﺍء ﺍﻟﺘﻲ ﺗﺼﻞ ﺍﱃ ﺍﳉﻨﲔ ﰲ ﺭﺣﻢ ﺍﻷﻡ ‪..‬‬
‫ُ‬
‫ﻭﻭﺻﻮﻝ ﺍﻟﺪﻭﺍء ﺍﱃ ﺍﳉﻨﲔ ﰲ ﺍﻟﺸﻬﻮﺭ ﺍﻟﺜﻼﺛﺔ ﺍﻷﻭﱃ ﻳﺴﺒﺐ ﺗﺸﻮﻫﺎﺕ ﺧﻠﻘﻴﺔ ‪ ،‬ﻟﺬﺍ ﻣﻦ ﺍﳌﺴﺘﺤﺴﻦ‬
‫ﺍﻻﺑﺘﻌﺎﺩ ﻋﻦ ﺍﻷﺩﻭﻳﺔ ﺧﻼﻝ ﺍﻷﺷﻬﺮ ﺍﻷﻭﱃ ﻣﻦ ﺍﳊﻤﻞ ‪.‬‬
‫ً‬
‫ﺛﺎﻟﺜﺎ – ﺍﻹﺳﺘﻘﻼﺏ )‪: (Metabolism‬‬
‫ُ‬
‫ﻫﻮ ﺍﻟﺘﺤﻮﻳﻞ ﺍﳊﻴﻮﻱ )‪ ، (Biotransformation‬ﻭﻫﻮ ﲢﻮﻳﻞ ﺍﻟﺪﻭﺍء ﺍﱃ ﻣﺴﺘﻘﻠﺐ )‪(Metabolite‬‬
‫ً‬ ‫ً‬
‫ﺃﻛﺜﺮ ﺗﺄﻳﻨﺎ ﻭﺃﻛﺜﺮ ﺫﻭﺑﺎﻧﺎ ﺑﻬﺪﻑ ﲣﻠﺺ ﺍﳉﺴﻢ ﻣﻨﻪ ﺑﻴﺴﺮ ﻭﺳﻬﻮﻟﺔ ﻋﻦ ﻃﺮﻳﻖ ﺍﻹﺧﺮﺍﺝ ‪.‬‬

‫ً‬
‫* ﺗﺘﻢ ﻋﻤﻠﻴﺔ ﺍﻹﺳﺘﻘﻼﺏ ﺑﻮﺍﺳﻄﺔ ﺃﻧﺰﳝﺎﺕ ﻣﻌﻴﻨﺔ ﻣﻮﺟﻮﺩﺓ ﺃﺳﺎﺳﺎ ﰲ ﺍﻟﻜﺒﺪ ﻭﺍﻟﻜﻠﻰ ﻭﺍﳉﻬﺎﺯ‬
‫ﺍﳍﻀﻤﻲ ﻭﺍﻟﺮﺋﺘﲔ ﻭﻛﺬﻟﻚ ﺍﻟﺒﻼﺯﻣﺎ ‪ ،‬ﻭﻳﺒﻘﻰ ﺍﻟﻜﺒﺪ ﻫﻮ ﺍﳌﻜﺎﻥ ﺍﻷﺳﺎﺳﻲ ﻹﺳﺘﻘﻼﺏ ‪..‬‬

‫ﺗﺘﻢ ﻋﻤﻠﻴﺔ ﺍﻹﺳﺘﻘﻼﺏ ﻋﻠﻰ ﻣﺮﺣﻠﺘﻴـﻦ ‪:‬‬

‫‪ -١‬ﺍﳌﺮﺣﻠﺔ ﺍﻷﻭﱃ ‪ :‬ﺗﺴﻤﻰ )ﺍﻟﻄﻮﺭ ﺍﻷﻭﻝ ﻟﻺﺳﺘﻘﻼﺏ(‬
‫‪ -٢‬ﺍﳌﺮﺣﻠﺔ ﺍﻟﺜﺎﻧﻴﺔ ‪ :‬ﺗﺴﻤﻰ ) ﺍﻟﻄﻮﺭ ﺍﻟﺜﺎﻧﻲ ﻟﻺﺳﺘﻘﻼﺏ(‬
‫ﻭﺳﻮﻑ ﳔﺘﺼﺮ ﺍﳊﺪﻳﺚ ﻋﻦ ﻛﻼ ﺍﳌﺮﺣﻠﺘﲔ ﺑﺸﻜﻞ ﻛﺒﲑ ‪..‬‬
‫ﺃ(‪ -‬ﺇﺳﺘﻘﻼﺏ ﺍﻟﻄﻮﺭ ﺍﻷﻭﻝ ‪:‬‬

‫‪١٣١‬‬
 ‫ﻳﺘﺤﻮﻝ ﺍﻟﺪﻭﺍء ﺍﱃ ﻣﺮﻛﺐ ﺫﻭ ﳎﻤﻮﻋﺔ ﻧﺸﻄﻪ )‪ (active group‬ﺑﺎﺳﺘﻄﺎﻋﺘﻬﺎ ﺍﻟﱰﺍﺑﻂ ﻣﻊ‬
‫ً‬ ‫ً‬
‫)ﺟﻠﻜﻮﺭﻭﻧﻴﺪ( ﻭﺫﻟﻚ ﻹﻧﺘﺎﺝ ﻣﺮﻛﺐ ﺃﻛﺜﺮ ﺗﺄﻳﻨﺎ ﻭﺃﻛﺜﺮ ﺫﻭﺑﺎﻧﺎ ﰲ ﺍﳌﺎء ‪ ،‬ﻭﻫﺬﻩ ﺍﻟﻌﻤﻠﻴﺔ ﻳﻨﺘﺞ ﻋﻨﻬﺎ ﰲ‬
‫ً‬
‫ﺍﻟﻐﺎﻟﺐ ﻓﻘﺪﺍﻥ ﻓﻌﺎﻟﻴﺔ )ﺗﺄﺛﲑ( ﺍﻟﺪﻭﺍء ‪ ،‬ﻭﺃﺣﻴﺎﻧﺎ ﻳﺘﺤﻮﻝ ﺍﻟﺪﻭﺍء ﻣﻦ ﻣﺮﻛﺐ ﻏﲑ ﻓﻌﺎﻝ ﺍﱃ ﻣﺮﻛﺐ ﻓﻌﺎﻝ ‪،‬‬
‫ﻭﻳﺘﻢ ﺇﺳﺘﻘﻼﺏ ﺍﻟﻄﻮﺭ ﺑﻮﺍﺳﻄﺔ ‪:‬‬
‫‪ -٣‬ﺍﳊﻠﻤﺄﺓ ‪.‬‬ ‫‪ -٢‬ﺍﻹﺧﺘﺰﺍﻝ‬ ‫‪ -١‬ﺍﻷﻛﺴﺪﺓ‬
‫‪ -١‬ﺍﻷﻛﺴـﺪﺓ )‪: (Oxidation‬‬
‫ّ‬ ‫ُ‬
‫ﺗﺘﻢ ﺍﻷﻛﺴﺪﺓ ﰲ ﺍﻟﺒﻼﺯﻣﺎ ﺍﻟﺪﺍﺧﻠﻴﺔ ﺍﻟﻜﺒﺪﻳﺔ ﺑﻮﺍﺳﻄﺔ ﺃﻧﺰﳝﺎﺕ ﺗﻌﺮﻑ ﺑـ)ﺃﻧﺰﳝﺎﺕ ﺍﻷﺟﺴﺎﻡ ﺍﻟﺼﻐﺎﺋﺮﻳﺔ(‬
‫)‪ (Liver micromole enzymes‬ﻭﺃﻫﻤﻬﺎ ﺃﻧﺰﻳﻢ )‪ (Cytochrom P45‬ﻭﻳﻮﺟﺪ ﻣﻨﻪ ‪ ١٠٠-٣٠‬ﻧﻮﻉ ‪،‬‬
‫ﻛﻞ ﻣﻨﻬﺎ ﻣﺴﺆﻭﻝ ﻋﻦ ﺃﻛﺴﺪﺓ ﳎﻤﻮﻋﺔ ﳐﺘﻠﻔﺔ ﻣﻦ ﺍﻷﺩﻭﻳﺔ ‪.‬‬
‫ﻭﺗﺸﺘﻤﻞ ﺍﻷﻛﺴﺪﺓ ﻋﻠﻰ ‪:‬‬
‫‪ -١‬ﻧﺰﻉ ﳎﻤﻮﻋﺔ ﺃﻟﻜﻴﻞ )‪ (Dealkylation‬ﻣﻦ ﺫﺭﺗﻲ ‪ N‬ﻭ ‪ O‬ﰲ ﺍﳌﺮﻛﺐ‪.‬‬
‫‪ -٢‬ﺍﺿﺎﻓﺔ ﳎﻤﻮﻋﺔ ﻫﻴﺪﺭﻭﻛﺴﻴﺪ )‪ (Hydroxylation‬ﺍﱃ ﺍﻟﺴﻠﺴﻠﺔ ﺍﻷﻟﻴﻔﺎﺗﻴﺔ ﺃﻭ ﺍﻷﺭﻭﻣﺎﺗﻴﺔ ﻟﻠﻤﺮﻛﺐ ‪.‬‬
‫‪ -٣‬ﻧﺰﻉ ﳎﻤﻮﻋﺔ ﺍﻷﻣﲔ )‪ (Diminution‬ﻛﻤﺎ ﳛﺪﺙ ﰲ ﻣﺮﻛﺐ ﺍﳊﻠﻤﺄﺓ )‪. (Hydrolysis‬‬
‫‪: (Hydrolysis) -٢‬‬
‫ّ‬
‫ﻻﲢﺪﺙ ﺗﻔﺎﻋﻼﺕ ﺍﳊﻠﻤﺄﺓ ﺑﻮﺍﺳﻄﺔ ﺍﻷﻧﺰﳝﺎﺕ ﺍﻟﺼﻐﺎﺋﺮﻳﺔ ﰲ ﺍﻟﻜﺒﺪ ‪ ،‬ﻭﻟﻜﻦ ﺑﻮﺍﺳﻄﺔ ﺍﻧﺰﳝﺎﺕ ﻣﻌﻴﻨﺔ‬
‫ﻣﻮﺟﻮﺩﺓ ﺑﺄﻧﺴﺠﺔ ﺍﳉﺴﻢ ﻭﺳﻮﺍﺋﻠﻪ ﺍﳌﺨﺘﻠﻔﺔ ‪ ،‬ﻭﲢﺪﺙ ﺍﳊﻠﻤﺄﺓ ﻟﻠﻤﺮﻛﺒﺎﺕ ﺍﶈﺘﻮﻳﺔ ﻋﻠﻰ ﺭﻭﺍﺑﻂ ﺃﻣﻴﺪﻳﺔ‬
‫)‪ (Amide bonds‬ﺃﻭ )‪. (Esters bonds‬‬
‫‪ -٣‬ﺍﻹﺧﺘـﺰﺍﻝ )‪: (Reduction‬‬
‫ّ‬
‫ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ ﻳﺘﻢ ﺍﺳﺘﻘﻼﺑﻬﺎ ﺑﺎﻹﺧﺘﺰﺍﻝ ‪ ،‬ﻭﺗﺴﺘﺨﺪﻡ ﺗﻔﺎﻋﻼﺕ ﺍﻹﺧﺘﺰﺍﻝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻷﺟﺴﺎﻡ ﺍﻟﺼﻐﺎﺋﺮﻳﺔ‬
‫ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﺏ(‪ -‬ﺇﺳﺘﻘﻼﺏ ﺍﻟﻄﻮﺭ ﺍﻟﺜﺎﻧﻲ ‪:‬‬
‫ﺗﻬﺪﻑ ﺍﳌﺮﺣﻠﺔ ﺍﻟﺜﺎﻧﻴﺔ ﰲ ﺍﺳﺘﻘﻼﺏ ﺍﻟﺪﻭﺍء ﺇﱃ ﺭﺑﻄﻪ ﰲ ﳎﻤﻮﻋﺔ ﺧﺎﺻﺔ ﳉﻌﻠﻪ ﺃﻛﺜﺮ ﺗﺄﻳﻦ ﻭﺃﻛﺜﺮ ﺫﻭﺑﺎﻥ‬
‫ﰲ ﺍﳌﺎء ‪ ،‬ﻭﻣﻦ ﺛﻢ ﺍﻟﺘﺨﻠﺺ ﻣﻨﻪ ﰲ ﺍﻟﺒﻮﻝ ‪ ،‬ﻭﳛﺪﺙ ﺗﺮﺍﺑﻂ ﻣﺴﺘﻘﻠﺐ ﺍﻟﺪﻭﺍء ﻣﻊ ﺇﺣﺪﻯ ﺍﳌﺮﻛﺒﺎﺕ‬
‫ﺍﻟﺘﺎﻟﻴﺔ ‪:‬‬
‫‪ -١‬ﺍﻟﱰﺍﺑﻂ ﻣﻊ )‪. (Glucuronide‬‬
‫‪ -٢‬ﺍﻟﱰﺍﺑﻂ ﻣﻊ )‪. (Acetic acid‬‬
‫‪ -٣‬ﺍﻟﱰﺍﺑﻂ ﻣﻊ )‪. (Glycine‬‬
‫‪ -٤‬ﺍﻟﱰﺍﺑﻂ ﻣﻊ )‪. (Sulfate‬‬
‫* ﺣﺎﻟﺔ ﺍﻟﻜﺒـﺪ )‪: (Liver‬‬
‫ﻗﺪ ﻳﺆﺛﺮ ﻣﺮﺽ ﺍﻟﻜﺒﺪ ﰲ ﺑﻌﺾ ﺍﻷﺣﻴﺎﻥ ﻋﻠﻰ ﺍﺳﺘﻘﻼﺏ ﺑﻌﺾ ﺍﻷﺩﻭﻳﺔ‪ ،‬ﻭﺗﺄﺛﲑ ﻣﺮﺽ ﺍﻟﻜﺒﺪ ﻋﻠﻰ‬
‫ُ ّ‬
‫ﺍﺳﺘﻘﻼﺏ ﺍﻟﺪﻭﺍء ﻳﻜﻮﻥ ﺑﺸﻜﻞ ﻣﻌﻘﺪ‪،‬ﺣﻴﺚ ﻳﻌﺘﻤﺪ ﻋﻠﻰ ﻧﻮﻉ ﺍﳌﺮﺽ ﺍﻟﺬﻱ ﻳﺼﻴﺐ ﺍﻟﻜﺒﺪ ‪ ،‬ﻓﻔﻲ‬
‫ﺇﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺪ ﺍﻟﻮﺑﺎﺋﻲ )‪ (Acute viral hepatitis‬ﻻﳛﺪﺙ ﺗﻐﲑ ﻛﺒﲑ ﰲ ﻗﺪﺭﺓ ﺍﻟﻜﺒﺪ ﻋﻠﻰ ﺇﺳﺘﻘﻼﺏ‬

‫‪١٣٢‬‬
 ‫ﺍﻟﺪﻭﺍء ﺣﱴ ﺗﺒﻘﻰ ﺗﻐﺬﻳﺔ ﺍﻟﻜﺒﺪ ﰲ ﺍﻟﺪﻡ ﻋﺎﻟﻴﺔ ‪ ،‬ﺃﻣﺎ ﰲ ﺑﻌﺾ ﺍﻷﻣﺮﺍﺽ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺗﻠﻒ ﺍﻟﻜﺒﺪ‬
‫ً‬
‫ﻓﺘﻨﺘﺞ ﻋﻦ ﻧﻘﺺ ﺗﺪﻓﻖ ﺍﻟﺪﻡ ﺇﱃ ﺍﻟﻜﺒﺪ ‪ ،‬ﻭﺑﺎﻟﺘﺎﱄ ﻧﻘﺺ ﻭﻇﻴﻔﺔ ﺍﻟﻜﺒﺪ ﳑﺎ ﻳﺆﺛﺮ ﺳﻠﺒﺎ ﻋﻠﻰ ﺇﺳﺘﻘﻼﺏ‬
‫ُ‬
‫ﺍﻟﺪﻭﺍء ‪ ،‬ﻭﰲ ﻣﻌﻈﻢ ﺍﻷﺣﻴﺎﻥ ﻻﻧﺴﺘﻄﻴﻊ ﺍﳉﺰﻡ ﻷﻥ ﺍﻟﺪﻭﺍء ﺍﻟﺬﻱ ﻳﺴﺘﻘﻠﺐ ﰲ ﺍﻟﻜﺒﺪ ﺳﻴﺘﺄﺛﺮ ﺳﺮﻋﺔ‬
‫ﺍﺳﺘﻘﻼﺑﻪ ﲟﺮﺽ ﻣﺎ ﰲ ﺍﻟﻜﺒﺪ ‪.‬‬
‫ﻭﻣﻌﻈﻢ ﺍﻷﺩﻭﻳﺔ ﻳﺘﻢ ﺇﺳﺘﻘﻼﺑﻬﺎ ﺑﺎﻟﻄﻮﺭ ﺍﻷﻭﻝ ﻗﺒﻞ ﺃﻥ ﺗﺼﻞ ﺇﱃ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺪﻣﻮﻳﺔ ‪ ،‬ﻭﺇﺫﺍ ﻛﺎﻥ ﻫﻨﺎﻟﻚ‬
‫ُ‬
‫ﺧﻠﻞ ﻣﺎ ﰲ ﺍﻟﻜﺒﺪ ﻓﺈﻥ ﻣﻌﻈﻢ ﺍﳉﺮﻋﺔ ﺳﻮﻑ ﺗﻨﺠﻮ ﻣﻦ ﺍﺳﺘﻘﻼﺏ ﺍﻟﻄﻮﺭ ﺍﻷﻭﻝ ﻭﺗﺼﻞ ﺇﱃ ﺍﻟﺪﻭﺭﺓ‬
‫ُ ّ ّ‬
‫ﺍﻟﺪﻣﻮﻳﺔ ‪ ،‬ﻭﻣﻦ ﺍﻟﻜﺒﺪ ﺍﱃ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ﲜﺮﻋﺔ ﻋﺎﻟﻴﺔ ﳑﺎ ﻳﻨﺘﺞ ﻋﻨﻪ ﺳﻤﻴـﺔ ﻋﺎﻟﻴﺔ‪ .‬ﻭﻣﻦ ﺍﻷﻣﺜﻠﺔ‬
‫ﺍﳌﺸﻬﻮﺭﺓ ﻟﻸﺩﻭﻳﺔ ﺍﻟﺘﻲ ﻳﺰﻳﺪ ﺗﺮﻛﻴﺰﻫﺎ ﰲ ﺍﻟﺪﻡ ﻧﺘﻴﺠﺔ ﺗﻠﻒ ﺍﻟﻜﺒﺪ ﺩﻭﺍء )ﺍﻟﺒﺎﺭﺃﺳﻴﺘﺎﻣﻮﻝ( ﺍﻟﺬﻱ ﻳﺰﻳﺪ‬
‫ﺗﺮﻛﻴﺰﻩ ﰲ ﺍﻟﺪﻡ ﲟﻘﺪﺍﺭ ﺍﻟﻨﺼﻒ ‪ ،‬ﻛﻤﺎ ﺃﻥ ﺍﳌﺮﺽ ﺍﻟﻜﺒﺪﻱ ﻗﺪ ﻳﺆﺛﺮ ﻋﻠﻰ ﺩﺭﺟﺔ ﺗﺮﺍﺑﻂ ﺍﻟﺪﻭﺍء ﻣﻊ‬
‫ُ‬
‫ﺑﺮﻭﺗﲔ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ‪ ،‬ﻓﻬﺬﺍ ﻳﺆﺛﺮ ﻋﻠﻰ ﺍﻟﻜﻤﻴﺔ ﺍﳊﺮﺓ ﻣﻦ ﺍﻟﺪﻭﺍء ﺍﳌﺘﻮﻓﺮﺓ ﰲ ﻣﻜﺎﻥ ﺍﻟﺘﺄﺛﲑ ﳑﺎ ﻳﺆﺛﺮ‬
‫ُ ّ‬
‫ﺑﺪﻭﺭﻩ ﻋﻠﻰ ﺍﻟﺘﺄﺛﲑ ﺍﻟﻌﻼﺟﻲ ﺍﳌﺘﻮﻗﻊ ﻟﻠﺪﻭﺍء ‪.‬‬
‫* ﺍﻟﻌﻮﺍﻣﻞ ﺍﳌﺆﺛﺮﺓ ﻋﻠﻰ ﺍﻹﺳﺘﻘﻼﺏ ‪:‬‬
‫‪ -١‬ﺍﻟﻮﺭﺍﺛﺔ ‪:‬‬
‫ً‬
‫ﲣﺘﻠﻒ ﺳﺮﻋﺔ ﺍﻹﺳﺘﻘﻼﺏ ﻣﺎﺑﲔ ﺍﻟﺒﺸﺮ‪ ،‬ﻭﺫﻟﻚ ﺣﺴﺐ ﺳﻼﻟﺔ ﺍﻹﻧﺴﺎﻥ ﻓﻤﺜﻼ ﻧﺸﺎﻁ ﺍﻹﻧﺰﳝﺎﺕ ﺍﳌﺴﺆﻭﻟﺔ‬
‫ﻋﻦ ﺍﻷﻛﺴﺪﺓ ﲣﺘﻠﻒ ﻣﻦ ﺷﺨﺺ ﻵﺧﺮ‪ ،‬ﻭﻟﻴﺲ ﳍﺬﺍ ﺍﻹﺧﺘﻼﻑ ﺃﻫﻤﻴﺔ ﺇﻛﻠﻴﻨﻴﻜﻴﺔ ﰲ ﺍﻟﻐﺎﻟﺐ ‪ ،‬ﻭﻟﻜﻨﻪ‬
‫ً‬
‫ﻳﺼﺒﺢ ﻣﻬﻤﺎ ﰲ ﺑﻌﺾ ﺍﻷﺷﺨﺎﺹ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﻧﻘﺺ ﻧﺸﺎﻁ ﻫﺬﻩ ﺍﻹﻧﺰﳝﺎﺕ ‪ ،‬ﺇﺫ ﻳﺘﻌﺮﺽ ﺍﳌﺮﻳﺾ‬
‫ّ ّ‬
‫ﺍﱃ ﺍﻟﺘﺄﺛﲑﺍﺕ ﺍﻟﺴﻤﻴـﺔ ﻟﻠﺪﻭﺍء ﺍﻟﺬﻱ ﻳﻌﺘﻤﺪ ﺍﺳﺘﻘﻼﺑﻪ ﻋﻠﻰ ﻧﺸﺎﻁ ﺇﻧﺰﳝﺎﺕ ﺍﻷﻛﺴﺪﺓ ‪.‬‬
‫‪ -٢‬ﺍﻟﺘﺪﺍﺧﻞ ﺍﻟﺪﻭﺍﺋﻲ ‪:‬‬
‫ً‬ ‫ً‬ ‫ً‬
‫ﺗﻨﺎﻭﻝ ﺩﻭﺍﺋﲔ ﻣﻌﺎ ﰲ ﻧﻔﺲ ﺍﻟﻮﻗﺖ ﻗﺪ ﻳﺴﺒﺐ ﺗﺪﺍﺧﻼ ﺩﻭﺍﺋﻴﺎ ﻣﺎﺑﲔ ﻫﺬﻳﻦ ﺍﻟﺪﻭﺍﺋﲔ ‪ ،‬ﻭﻫﺬﺍ ﺍﻟﺘﺪﺍﺧﻞ‬
‫ً‬
‫ﻗﺪ ﻳﺴﺒﺐ ﺇﺑﻄﺎء ﺃﻭ ﺇﺳﺮﺍﻉ ﻋﻤﻠﻴﺔ ﺇﺳﺘﻘﻼﺏ ﺃﻳﺎ ﻣﻦ ﺍﻟﺪﻭﺍﺋﲔ ‪ ،‬ﻭﺃﺷﻬﺮ ﺃﻧﻮﺍﻉ ﺍﻟﺘﺪﺍﺧﻼﺕ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻋﻨﺪ‬
‫ﻣﻮﺿﻊ ﺍﻹﺳﺘﻘﻼﺏ ﰲ ﺍﻹﻧﺰﳝﺎﺕ ﺍﳌﺴﺆﻭﻟﺔ ﻋﻦ ﺍﻷﻛﺴﺪﺓ ‪ ،‬ﺇﻧﺰﳝﺎﺕ ﺍﻷﺟﺴﺎﻡ ﺍﳌﻀﺎﺩﺓ ﰲ ﺍﻟﻜﺒﺪ ‪ ،‬ﻭﻫﻨﺎﻟﻚ‬
‫ﻣﻦ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺯﻳﺎﺩﺓ ﻧﺸﺎﻁ ﺍﻹﻧﺰﳝﺎﺕ ‪ ،‬ﻭﺑﺎﻟﺘﺎﱄ ﺗﺰﺩﺍﺩ ﺳﺮﻋﺔ ﺍﺳﺘﻘﻼﺑﻬﺎ ‪ ،‬ﻭﻫﻨﺎﻟﻚ ﺃﺩﻭﻳﺔ‬
‫ﻋﻜﺲ ﺫﻟﻚ ‪.‬‬
‫‪ -٣‬ﺣﺎﻟﺔ ﺍﻟﻜﺒـﺪ ‪:‬‬
‫ﺳﺒـﻖ ﺷﺮﺣـﻪ ‪..‬‬
‫ُ‬
‫‪ -٤‬ﺍﻟﻌﻤـﺮ )‪: (Age‬‬
‫ﻳﺆﺛﺮ ﺍﻟﻌﻤﺮ ﻣﺒﺎﺷﺮﺓ ﻋﻠﻰ ﻋﻤﻠﻴﺔ ﺍﻹﺳﺘﻘﻼﺏ ‪ ،‬ﻓﺴﺮﻋﺔ ﺍﻹﺳﺘﻘﻼﺏ ﰲ ﺍﻷﻃﻔﺎﻝ ﺍﳊﺪﻳﺜﻲ ﺍﻟﻮﻻﺩﺓ ﺗﻜﻮﻥ‬
‫ﺑﻄﻴﺌـﺔ ‪) ..‬ﻋﻠﻞ ؟(‬
‫ﻭﺫﻟﻚ ﻷﻥ ﺍﻹﻧﺰﳝﺎﺕ ﺍﳌﺴﺆﻭﻟﺔ ﻋﻦ ﺍﻹﺳﺘﻘﻼﺏ ﱂ ﺗﻜﺘﻤﻞ ‪ ،‬ﻛﻤﺎ ﺃﻥ ﺳﺮﻋﺔ ﺇﻓﺮﺍﻍ ﺍﻟﺪﻭﺍء ﻣﻦ ﺍﳉﺴﻢ‬
‫ﻭﺧﺎﺻﺔ ﺗﻠﻚ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻌﺘﻤﺪ ﰲ ﺇﻓﺮﺍﻏﻬﺎ ﻋﻠﻰ ﺍﻟﻜﻠﻴﺔ ﺗﻜﻮﻥ ﺑﻄﻴﺌﺔ ﺑﻨﺴﺒﺔ ﻗﺪ ﺗﺼﻞ ﺇﱃ ‪ %٣٠‬ﻣﻦ‬
‫ُ‬
‫ﻭﺟﺪﺕ ﻣﻌﺎﻳﲑ ﺍﻟﺪﻭﺍء ﺃﻭ ﺟﺮﻋﺎﺕ ﺩﻭﺍء ﺧﺎﺻﺔ ﻟﻠﻤﻮﺍﻟﻴﺪ ﺣﺪﻳﺜﻲ‬
‫ﺳﺮﻋﺔ ﺍﻹﻓﺮﺍﻍ ﻋﻨﺪ ﺍﻟﺒﺎﻟﻐﲔ‪ ،‬ﻭﳍﺬﺍ ِ‬

‫‪١٣٣‬‬
‫ﺍﻟﻮﻻﺩﺓ ‪ ،‬ﻭﻻ ﳛﺪﺙ ﺗﻐﻴﲑ ﻛﺒﲑ ﰲ ﺣﺮﻛﺔ ﺍﻟﺪﻭﺍء ﻋﻨﺪﻣﺎ ﻳﺘﻘﺪﻡ ﺍﻹﻧﺴﺎﻥ ﰲ ﺍﻟﻌﻤﺮ‪ ،‬ﻣﺎﻋﺪﺍ ﺑﻌﺾ ﺍﻟﻨﻘﺺ‬
‫ﻣﻊ ﺑﺮﻭﺗﲔ ﺑﻼﺯﻣﺎ ﺍﻟﺪﻡ ﳑﺎ ﻳﺆﺩﻱ ﺍﱃ ﺳﺮﻋﺔ ﺍﻹﺳﺘﻘﻼﺏ ﻭﺍﻹﻓﺮﺍﻍ ‪.‬‬
‫ً‬
‫ﺭﺍﺑﻌﺎ – ﺍﻹﻓﺮﺍﻍ )‪: (Excretion‬‬
‫ّ‬
‫ﺍﻟﻜﻠﻰ ﺃﻭ ﰲ ﺍﻟﺼﻔﺮﺍء ﺃﻭ‬
‫ﻳﺘﻢ ﺇﺧﺮﺍﺝ ﺍﻟﺪﻭﺍء ﻭﻫﻮ ﰲ ﺻﻮﺭﺗﻪ ﺍﳌﺘﺄﻳﻨﺔ ﺃﻭ ﺍﳌﱰﺍﺑﻄﺔ ﺃﻭ ﺍﻟﺬﺍﺋﺒﺔ ﰲ ﺍﳌﺎء ﻋﱪ ِ‬
‫ﺍﳉﻠﺪﻱ ﺃﻭ ﺍﻟﻠﻌﺎﺑﻲ ﺃﻭ ﺣﻠﻴﺐ ﺍﻷﻡ ﺃﻭ ﺍﻟﱪﺍﺯﻱ ﺃﻭ ﺍﻟﺮﺋﺘﲔ ‪.‬‬
‫ُ َ‬
‫ﺍﻟﻜﻠﻰ ﺍﻟﻌﻀﻮ ﺍﻷﺳﺎﺳﻲ ﺍﻟﺬﻱ ﻳﺘﺤﻤﻞ ﻣﺴﺆﻭﻟﻴﺔ ﺇﻓﺮﺍﻍ ﺍﻷﺩﻭﻳﺔ ‪ ،‬ﺣﻴﺚ ﻳﺘﻢ ﺍﻹﻓﺮﺍﻍ ﺑﺎﻟﱰﺷﻴﺢ‬ ‫ِ‬ ‫ﻭﺗﻌﺪ‬
‫ﺍﻟﻜﺒﻴﺒـﻲ ﺃﻭ ﺑﺎﻹﻓﺮﺍﺯ ﺍﻷﻧﺒﻮﺑﻲ ‪.‬‬

‫ُ ّ‬
‫ﺍﻟﱰﺷﻴﺢ ﺍﻟﻜﺒﻴﺒﻲ ﻳﺨﻠﺺ ﺍﳉﺴﻢ ﻣﻦ ‪ %٢٠‬ﻣﻦ ﻛﻤﻴﺔ ﺍﻟﺪﻭﺍء ﺍﳌﻮﺟﻮﺩﺓ ﰲ ﺍﻟﺒﻼﺯﻣﺎ ﺃﻭ ﺍﻟﺪﺍﺧﻠﺔ ﺍﱃ‬
‫ﺍﻟﻜﻠﻴﺔ ‪ ،‬ﺃﻣﺎ ﺍﻹﻓﺮﺍﺯ ﺍﻷﻧﺒﻮﺑﻲ ﻓﻴﺘﻢ ﺍﻟﺘﺨﻠﺺ ﻣﻦ ‪ %٨٠‬ﻣﻦ ﻛﻤﻴﺔ ﺍﻟﺪﻭﺍء ﰲ ﺍﻟﺪﻡ ‪.‬‬

‫ﺍﻧﺘــــــــــﻬﻰ‬

‫ﺍﳊـــــــــــــــــﻤﺪ ﷲ‬

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