• What is stroke and what are the types of it?
• What is the role of the following in stroke : oxygen depredation, clots, vessel damage, high blood pressure & arterial atherosclerosis?
• What is the meaning of the following : hemorrhagic stroke, ischemic stroke, thrombolic, embolic, thromboembolic & transient ischemic attack ?

• Obsessive–compulsive disorder (OCD) is a condition in which patients are unable to stop thinking certain thoughts and undertaking particular actions. Their repetitive behavior greatly interferes with the patient’s normal lifestyle and the daily life of their family.

- Prepared by: Dr. Mohamed Abdel Rahman (pharmacist). - Resources:  -  Clinical physiology and pharmacology,Farideh Javid and Janice McCurrie 2008. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

- Prepared by: Dr. Mohamed Abdel Rahman (pharmacist). - Resources:  -  Clinical physiology and pharmacology,Farideh Javid and Janice McCurrie 2008. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

- Prepared by: Dr. Mohamed Abdel Rahman (pharmacist). - Resources:  -  Clinical physiology and pharmacology,Farideh Javid and Janice McCurrie 2008. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

- Prepared by: Dr. Mohamed Abdel Rahman (pharmacist). - Resources:  -  Clinical physiology and pharmacology,Farideh Javid and Janice McCurrie 2008. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

•  Introduction.
•  Symptoms.
•  Infection.
•  complications.
•  Treatment and drugs.
•  Prevention.

 

 

Introduction:-

• Shingles is a viral infection that causes a painful rash on one side of the body. Often appears as a band of blisters that wraps between 2-3 weeks.
• Shingles is caused by the varicella-zoster virus (the same virus that causes chickenpox). After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.
• Causes of reactivation are unknown but mostly due to decreased immunity (more occurrence>50 years) and stress. 
• While it isn't a life-threatening condition, shingles can be very painful.

 

Symptoms:-

 

• Pain, burning, numbness or tingling.
• A red rash that begins a few days after the pain.
• Fluid-filled blisters that break open and crust over.
• Itching.

• Fever and chills.
• General achiness.
• Headache.
• Fatigue.

• The pain and rash occur near your eyes. If left untreated, this infection can lead to permanent eye damage.
• You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness).
• The rash is widespread and painful.

• You can't catch shingles from someone else who has shingles. But a person with a shingles rash can spread chickenpox to another person who hasn't had chickenpox and who hasn't gotten the chickenpox vaccine. 
• If you have shingles, you are contagious especially the open sores of the shingles rash so avoid direct contact with people (especially newborns, pregnant women, any one has a weak immune system) until shingles blisters scab over. 
• Having had chickenpox can develop shingles.

 

Complications:- 

• Most people who get shingles will get better and will not get it again.

• Complications from shingles can range from a mild to severe, ranging from minor skin infections to post herpetic neuralgia (damaged nerve fibers with exaggerated pain).
• Other problems may be Vision loss, Encephalitis, an inflammation of the brain, Hearing or balance problems, Facial paralysis.
• If shingles blisters aren't properly treated, bacterial skin infections may develop.

• An episode of shingles usually heals on its own within a few weeks, but prompt treatment can ease pain, speed healing and reduce your risk of complications.
• There is no cure for shingles, but treatment may help you get well sooner and prevent other problems.

• Acyclovir (Zovirax), Valacyclovir (Valtrex), Famciclovir (Famvir).
• Drugs for the pain such as: Narcotics (e.g. oxycodone).
• Tricyclic antidepressants, such as amitriptyline
• Anticonvulsants, such as gabapentin (Neurontin).
• Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch.

• Anti-itch cream or calamine lotion.
• Oral antihistamines, such as diphenhydramine (Benadryl, others).

Prevention:-

 

• Two vaccines may help prevent shingles :  the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

• Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted disease.

- Prepared by: Dr. Mustafa Abdel Tawab (pharmacist). - Resources:  -  mayoclinic.com  -  webmd.com.   -  Wikipedia.com. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

Drug name	# Allopurinol.
Brand name	# Zyloric, Zyloprim, Aloprim.
Class of drug	# Treatment for gout, prophylaxsis for chemotherapy induced hyperuricemia.
Indications	# PO for maintenance of moderately severe tophaceous Gout. # PO for control of gout. # PO or IV for secondary hyperuricemia associated with vigorous treatment of malignancies.
Mechanism of action	# Inhibits xanthine oxidase, the enzyme that converts hypoxanthine to xanthine. Xanthine is a precursor for uric acid production; thus uric acid production is decreased.
route / Dosage form	# Route : Oral and parintinal. # Dosage form : Tab 100, 300 mg; Inj 500 mg..
Dose	# Mild gout: 200–300 mg/d. # Moderate or severe gout: 400–600 mg/d. # Prophylaxis against acute attack: 100 mg/d. Maximum: 800 mg/d. # Prevention of hyperuricemia during cancer chemotherapy: * Adults, children >10 years: 600–800 mg/d, 2–3 divided doses, 1–2 days before chemotherapy for 2–3 days. IV 200–400 mg/m2/d. * Children <10 years: 200–300 mg/m2/d, 2–4 divided doses. IV 200–300 mg/m2/d.
Pregnancy / Lactation	# Pregnancy: Category C. # Lactation: Appears in breast milk. Considered compatible by American Academy of Pediatrics.
Adverse reactions	# Common: skin rash (generally maculopapular). # Serious: agranulocytosis, aplastic anemia, thrombocytopenia, hepatic injury, Stevens–Johnson syndrome, vasculitis, toxic epidermal necrolysis, neuritis, cataracts, renal toxicity.
Important interactions	# Drugs that increase effects/toxicity of allopurinol: thiazide diurectics, ACE inhibitors, vitamin C. # Allopurinol increases effects/toxicity of the following: ampicillin, amoxicillin, oral anticoagulants, 6-mercaptopurine, cyclophosphamide,  theophylline, chlorpropamide, alcohol.
Contraindications / precautions	# Children (except for hyperuricemia secondary to malignancy). # Do not restart the drug in patients who have developed severe reactions.
Other notes	# Food: Take with meals or immediately after eating. Have patient drink large amounts of fluids. # reduced dosage in renal impairment.
Practical notes	# Limit foods with high purine content (liver or other organ meats, salmon, and sardines). # Do not take large amounts of vitamin C. # Avoid alcohol and other CNS depressants such as opiate analgesics and sedatives (eg, diazepam [Valium]) when taking this drug. # Do not take iron salts while on allopurinol. # Limit exposure to UV light as this may increase the risk of cataracts. # This drug may be taken with food, milk, or an antacid to minimize stomach upset. Adults should drink at least 10–12 full glasses (each containing 8 fluid ounces) of fluid each day. # Report any skin rash, painful urination, blood in urine, eye irritation, swelling of lips or mouth, itching, chills, fever, sore throat, nausea, or vomiting while taking this drug. # Allopurinol can cause drowsiness; use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity. # Because the incidence of acute attacks of gout may increase during the first few months of treatment with allopurinol; Colchicine, a uricosuric agent, or an NSAID should be added to the regimen as a prophylactic measure.
Generic names	# Egypt : Zyloric, No-uric, Lessuric, Uric- pure, crystasol, High pure . # KSA :- Zyloric, Apurol,Loric,No-uric,Purinol,Uroquad.

- Prepared by: Dr. Mohamed Abdel Rahman (pharmacist). - Resources:  -  Clinical physiology and pharmacology,Farideh Javid and Janice McCurrie 2008. - Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.