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Community Pharmacy Drug Album.. 4th year.. Faculty of Pharmacy.. Helwan University..

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Page 1: Community Pharmacy Drug Album

FIVE MINUTESILINICAL C ONSULT

Diarrhea

Constipation

Hemorrhoid

Peptic Ulcer

Gastrointestinal Reflex Disease

RespiratoryRespiratoryconditions

Page 2: Community Pharmacy Drug Album

CONSTIPPATION

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Definition:Constipation is the diffculity infrequent passage of stool .Normal stool frequency (2-3) times daily or weak.

Danger of contipation: Patinets often consider constipation as a simple complaint that is easy to manage ….!!!! complaint that is easy to manage ….!!!! However it can produce direct or indirect morbidity. 1)straining : lead to ischemic attcks and syncope 2)accumilation of feaces :lead to megarectum,megacolon. 3)Remaining:lead to dehydratin of feaces which can not pass through which can not pass through the anus . 4)paradoxic diarrhea.

OR

Constipation

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ConstipationSymptoms:1) abdominal discofort. 2) swelling.3) bloating. 4) low back pain.

Causes: a) Life style: 1) travelling diarrhea 2) inadequate fluid intake.3) inadequate exercise 4) inadequate fiber intake.3) inadequate exercise 4) inadequate fiber intake.5) loss of defecatory reflex.

b)Medical conditions ;1) pregnancy 2) irritable bowel syndrome.3) nerve damage 4) colorectal carcinoma. 5) anal fissure, anal fistula, herpes simplex and hemorrhoids.6) diabetes, chronic renal failure and parkinoson disease.7) prolonged colon transit time especially in females.7) prolonged colon transit time especially in females.

c) Medications:Opiates, diuretics, NSAIDs, anticholinergics, TCA, MAOI, Barbiturates, antihistaminics Fe,Ca contining drugs and antacids.

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Non Pharmacological :1) Take 8 glasses of non cafinated fluid.2) Avoid SOFT DRINKS3) Increase fiber intake.3) Exercise.4) Defecation After breakfast.5) for Pregnant5) for Pregnant Woman : avoid castor oil as laxativeBecause it causes immature labour, The most appropriate OTC drug.for pregnant is PSYLLIUM

PreventConstipation

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ConstipationPrecautions :-Before using this medicine, consult your doctor or pharmacist if you have: an obstruction of the intestine (gut), paralytic ileus (lack of bowel movements, leading to blockage of the gut), abdominal pain plus feeling sick (nausea) or vomiting, pain plus feeling sick (nausea) or vomiting, active and severe inflammatory bowel disease (such as ulcerative colitis, a disease of the lower intestine [colon] characterised by open sores [ulcers] with symptoms such as frequent diarrhoea mixed with blood), surgical abdominal (belly) conditions (such as appendicitis), or severe dehydration.(such as appendicitis), or severe dehydration.

PREGNANCYSodium picosulfate is suitable to take during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.It is sensible to limit use of medication during pregnancy whenever possible. HoweveHowever, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

Laxeol-PI

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ConstipationSame Precautions of Laxeol-PIbecause it has same ingtedients Sodium Picosulfate

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MinalaxPrecautions :Before taking this medication, tell your doctor or pharmacist if you are allergic to it or if you have any other allergies. This product may contain inactive ingredientswhich can cause allewhich can cause allergic reactions or otherproblems.

If you have any of the following health problems, consult your doctor or pharmacist before using this medication: severe abdominal pain, nausea, vomiting, sudden change in bowel habits over the previous 2 weeks.This medication should be used only when This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known if this drug passes into breast milk. Consult your doctor before breast-feeding.before breast-feeding.

Constipation

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DIARRHEEA

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What’s Diarrhea ?!Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool). Although changes in frequency of bowel movements and looseness of stools can vary independently of each other,changes often occur in both.changes often occur in both.

Diarrhea

Who is at Risk for Diarrhea ?!People with compromised immune systems are at risk for developing diarrhea. That population includes those who are HIV positive, people who have had organ transplants and people undergoing certain types chemotherapy. Those who are living or traveling in regionsThose who are living or traveling in regions with unsanitary water systems are also at risk. Young children, especially those who are in child care facilities, and the elderly, who may be unable to properly clean themselves can also be susceptible to diarrhea.

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DiarrheaWhat Causes Diarrhea?The most common cause of diarrhea is a virus that infects the gut. The infection usually lasts for two days and is sometimes called "intestinal flu" or "stomach flu." Diarrhea may also be caused by:* Infection by bacteria (the cause of most types of food poisoning)* Infections by other o* Infections by other organisms(eg.E-coli)* Eating foods that upset the digestive system* Allergies to certain foods* Medications(eg.Cholchicine)* Diseases of the intestines (Crohn's disease, ulcerative colitis)* Malabsorption (where the body is unable to adequately absorb certain nutrients from the diet)* Radiation therapy * Hyperthyroidism* Radiation therapy * Hyperthyroidism* Some cancers * Laxative abuse* Alcohol abuse * Digestive tract surgery* Diabetes * Competitive running* Some people get diarrhea while traveling (traveler's diarrhea).

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DiarrheaWhat About Symptoms?1. Watery, liquid stools : The stools may be any color. The passage of red stools suggests intestinal bleeding and could be a sign of a more severe infection,which indicate the probability of parasite infections (e.g) Giardia Lamblia

2. Abdominal cramps : Occasionally diarrhea is accompanied with mild-to-moderateabdominal pain. Severe abdominal or with mild-to-moderateabdominal pain. Severe abdominal or stomach pain is not common and, if present, may suggest more severe disease.

3. Fever : A high fever is not common. If present, the affected person may have a more severe illness than acute diarrhea,which indicate the probability of viral infection with (Rota virus in infants or Norwolk virus in adult or Adeno virus in all age gp).Adeno virus in all age gp).

4. Dehydration : If diarrhea leads to dehydration, it is a sign of potentially serious disease.

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How to prevent Diarrhea ? 1- Practice good hand-washing hygiene, especially when you are around a group of children, or after using public bathrooms or shopping. Wash your hands after you have a bowel movement, or after wiping up your children after their bowel movements. It's possible to spread bacteria. 2- 2- Avoid huge dietary changes. For example, don't go on an all-grapes diet. Introduce new foods slowly into your diet, especially fruits, vegetables, grains and milk products. 3- Throw food away if it drops onto the floor or the ground. Parasites and germs are found at ground level. 4- Wash fruits and vegetables thoroughly before eating. 5- Cook food thoroughly, especially meat. 6- 6- Avoid foods that have a tendency to loosen bowels, like the sorbitol found in many diet foods. 7- Practice good stress management if your diarrhea is caused by anxiety. 8- Forgo milk products.. if your diarrhea is caused by a lactose intolerance. 9- Cut back on caffeine, which can cause stools to loosen. 10- Read your medication labels carefull 10- Read your medication labels carefully. If one of the side effects is diarrhea, check with your physician about changing medications.

PreventDiarrhea

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DiarrheaStreptoquin Streptoquin is stable and can be used for 14 days after reconstitution or for 7 days ,when kept at roon temperature.

Precations :** The produt should be avoided if the pataint is hypersensitive to iodine or with impaired liver function .* Its use is best avoided in patiants with neurological disorders .* It should be used cautiously for thyroid patients , patients requiring thyriod function tests ,requiring thyriod function tests ,should inform their physician that they are taking this medicine since diiodoauin – bound iodine for up to 6 mouths .

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DiarrheaFlagylContraindication :* Hypersensitivity to inidazol derivatives .* Pregnant and breast feeding women .

WWarning and special precations :- Alcoholic drugs should be avoided during secnidol treatment .- Donot administer to subjects with a history of blood dyscrasia .

Pregnancy :No teratogenic effects is observed during animal experimentation during animal experimentationHowever , in view of theabsence of data in humans ,it is not recommended to take secnidazole during pregnancy.

Lactation :Secnidazol is excreted in breast milk.

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DiarrheaAntinal (Nifuroxazide)Contraindcation :Nifuroxazide is contraindicated in conditions like Paralytic ileus, Neonates, Hypersensitivity to any component of product.

Interaction :Interaction :Nifuroxazide is known to interact with other drugs like Alcohol.These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dosethe change of dose regimen or an alternative drug of choice that may strictly be required.

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HEMORRHHOID

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HemorrhoidWhat are Hemorrhoids ?Hemorrhoids, also called piles, are swollen and inflamed veins in your anus and lower rectumAnatomy of Hemorrhoid.The arteries supplying blood to the anal canal descend into thecanal from the rectum above and form a rich network of arteriesthat communicate with each other around the anal canal. that communicate with each other around the anal canal. Because of this rich network of arteries, hemorrhoidal blood vessels have a ready supply of arterial blood. This explains whybleeding from hemorrhoids is bright red (arterial blood) rather than dark red (venous blood), and why bleeding from hemorrhoids occasionally can be severe. The blood vessels that supply the hemorrhoidal vessels pass through the supporting tissue of the hemorrhoidal cushions.The anal veins drain blood tissue of the hemorrhoidal cushions.The anal veins drain blood away from the anal canal and the hemorrhoids. These veins drain in two directions. The first direction is upwards into the rectum, and the second is downwards beneath the skin surrounding the anus. The dentate line is a line within The dentate line is a line within the anal canal that denotes the transition from anal skin (anoderm)to the lining of the rectum.

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HemorrhoidWhat Causes Hemorrhoids ?1. inadequate intake of fiber2. prolonged sitting on the toilet3. chronic straining to have a bowel movement 4. constipation 5. Pregnancy 5. Pregnancy 6. Tumors in the pelvis also causeenlargement of hemorrhoids by pressing on veins draining upwards from the anal canal.

What About Symptoms ?• Bleeding during bowel movements • Protrusion during bowel movements • Itching in the anal area • Pain • Pain • Sensitive lump(s)

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HemorrhoidWhat are their Types ?* Internal hemorrhoids : With internal hemorrhoids, you may see bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may see blood on the surface of the stool.For convenience in describing the severity of internal hemorrhoids, For convenience in describing the severity of internal hemorrhoids, many physicians use a grading system:* First-degree hemorrhoids: Hemorrhoids that bleed but do not prolapse.* Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding).** Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger.* Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in.

* External hemorrhoids : External hemorrhoids can get irritated and clot under the skin, causing a hard painful lump. This is called a thrombosed, or clotted, hemorrhoid.This is called a thrombosed, or clotted, hemorrhoid.

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Hemorrhoid

FAKTU

Before you start to take Faktu, make sure you are not allergy to Faktu or any ingredient of Cinchocaine.

Contraindication :during Pregnancyduring Pregnancy

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HemorrhoidProcto-Glyvenol

Drug Interaction: No interactions have been reported to date.

When Procto-Glyvenol must not be used? In case of hypersensitivity In case of hypersensitivity to any of the active substances of Procto-Glyvenol.

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G

E

R

D

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What is GERD ?!!Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called( acid reflux )or( acid reguGER is also called( acid reflux )or( acid regurgitation),because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagusstomach acid touches the lining of the esophagusit may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does notnecessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually leadto more serious health problems. to more serious health problems. People of all ages can have GERD.

GERD

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Gastroesophageal Reflex Disease

What are the symptoms of GERD ?The main symptom of GERD in adults is frequent heartburn, also called( acid indigestion)—burning-type 2-pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or they may experience a dry cough, asthma symptoms, or trouble swallowing.

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Gastroesophageal Reflex Disease

What About causes ?The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthypeople over age 50. Most of the time, a hiatal hernia produces no symptoms.symptoms.Other factors that may contribute to GERD include•obesity •pregnancy •smokingCommon foods that can worsen reflux symptoms include•citrus fruits •chocolate •drinks with caffeine or alcohol•fatty and fried foods •garlic and onions•mint flavorings •spicy foods•mint flavorings •spicy foods•tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

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AntodinePrecautions and Warnings :- Famotidine is considered a pregnancy Category B medication. This means that it is probably safe for use during pregnancy. - Because the kidneys clear famotidine from - Because the kidneys clear famotidine from the body, famotidine dosing must be reduced in people with poor kidney function, including kidney failure (renal failure).- A potentially dangerous change in the heart rhythm (known as QT prolongation) has been rarely reported in people with kidney disease whose dose of famotidine was disease whose dose of famotidine was not adequately reduced. - Some of the symptoms of (GERD), heartburn, or ulcers are similar to symptoms of stomach cancer. The fact that famotidine helps relieve your symptoms does not rule out the does not rule out the possibility of stomach cancer.

Gastroesophageal Reflex Disease

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Gastroesophageal

Reflex DiseaseGastrolac ( Omeprazole )

Precautions and Warnings :-Studies indicate that people who take proton pump inhibitor medications (such as omeprazole) may be at an increased risk for broken bones. The risk appears to be highest for people The risk appears to be highest for people who take such medications at high doses or for long periods (over a year). You and your healthcare provider should take this into account when deciding if the benefits of this medication outweigh the risks for your particular situation. -The use of proton pump inhibitors -The use of proton pump inhibitors (including this medication) may increase the risk of a potentially serious condition known as Clostridium difficile-associated diarrhea (CDAD). If you develop diarrhea that does not seem to improve (especially if it is to improve (especially if it is watery and accompanied by a fever and abdominal pain), seek immediate medical attention.

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PEPTIC

UULCER

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Peptic UlcerWhat is Peptic Ulcer ?is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined asmucosal erosions equal to or greater than 0.5 cm. As many as70–90% of such ulcers are associated with Helicobacter pylori,a spiral-shaped bacterium that lives in the acidic environment of the stomach; howeveof the stomach; however, only 40% of those cases go to a doctor.

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Peptic Ulcer

What about Causes ?

The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following also raise your risk for peptic ulcers:The following also raise your risk for peptic ulcers:* Drinking too much alcohol* Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people.* Smoking cigarettes or chewing tobacco* Being very ill, such as being on a breathing machine* Having radiation treatments* Having radiation treatments

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid. Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home.

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Peptic UlcerWhat about Symptoms ?

Symptoms of ulcer disease are variable. Many ulcer patients experience minimal indigestion, abdominal discomfort that occurs after meals, or no discomfort at all. Some complain of upper abdominal burning or hunger pain one to three hours after meals or in the middle of the night.or in the middle of the night. These symptoms often are promptly relieved by food or antacids that neutralize stomach acid. The pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Some patients have persistent pain even after an ulcer is almost completely healed by medication. Others experience no pain at all. Ulcers often come and go spontaneously without the individual ever knowing go spontaneously without the individual ever knowing that they are present unless a serious complication (like bleeding or perforation) occurs.

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Peptic Ulcer

How Are Peptic Ulcer Diagnosed ?

The diagnosis of an ulcer is made by either a barium upper gastrointestinal X-ray (upper GI series) or an upper gastrointestinal endoscopy (EGD or esophagogastroduodenoscopy). The barium upper GI X-ray is easy to perform and involves no risk (other than exposure to radiation) or discomfort. Barium is a chalky substance that to radiation) or discomfort. Barium is a chalky substance that is swallowed. It is visible on X- rays, and allows the outline of the stomach to be seen on X-rays; however, barium X-rays are less accurate and may miss ulcers in up to 20% of the time.

An upper gastrointestinal endoscopy is more accurate than X-rays, but involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the esophagus, stomach, and duodenum. Upper endoscopy has the added stomach, and duodenum. Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection. Biopsies are also examined under a microscope to exclude a cancerous ulcer. While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous. Therefore, biopsies often are performed on gastric ulcers to exclude canceexclude cancer.

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Zantac (Ranitidine)Precautions and Warnings :- Ranitidine is considered a pregnancy Category B medication. This means that it is probably safe for use during pregnancy. - Because the kidneys clear Ranitidine from the body, Ranitidine dosing must be reduced in people with poor kidney function, including kidney failure (renal failure).including kidney failure (renal failure).- A potentially dangerous change in the heart rhythm (known as QT prolongation) has been rarely reported in people with kidney disease whose dose of famotidine was not adequately reduced.

Peptic Ulcer

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Peptic UlcerOmepral (Omeprazole)

Precautions and Warnings :-Studies indicate that people who take proton pump inhibitor medications (such as omeprazole) may be at an increased risk for broken bones. The risk appears to be highest for people The risk appears to be highest for people who take such medications at high doses or for long periods (over a year). You and your healthcare provider should take this into account when deciding if the benefits of this medication outweigh the risks for your particular situation.

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COMMON COLD

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RESPIRATORY CONDITIONSDefinition :The common cold is self-limiting inflammatory viral infections of the upper respiratory tract. It is the most frequent acute condition to which man is subjected. Pharmacists receive more questions related to common cold its therapy than all other medical conditions combined.medical conditions combined.

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SymptomsThe symptoms of the common cold typically begin two to three days after acquiring the infection (incubation period). Symptoms and signs of the common cold vary depending onthe virus responsible for the infection and may include the following :• nasal stu• nasal stuffiness or drainage, • sore or scratchy throat, • sneezing, • hoarseness,• cough, • watery eyes, • low-grade fever, •headache, • body aches, • fatigue.The cold may begin with a runny nose with clear nasal discharge, which later may become yellowish or greenishin color. Infants and children may also become more fussy and have decreased appetite.fussy and have decreased appetite.The symptoms of the common cold will typically last anywhere from four to 14 days, with most individuals improving in one week.

RESPIRATORY CONDITIONS

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DiagnosisThe physician or health-care practitioner will generally diagnose the common cold based on the description of your symptoms and the findings on your physical exam. Laboratory testing and imaging studies are generally not necessary unless there are concerns about another underlying medical condition or potential complications. medical condition or potential complications.

PreventionThe most important measure to prevent the common cold is to avoid infected individuals. Frequent hand washing is also extremely important, as this can destroy viruses that you have acquired from touching contaminated surfaces. Also, try to avoid sharing utensils and try to use disposable items (such as disposable cups) if someone in your family items (such as disposable cups) if someone in your family has a cold. Finally, lifestyle modifications such as smoking cessation and stress management may decrease your susceptibility to acquiring the common cold. At this time, an effective vaccine against the common cold is not available.

RESPIRATORY CONDITIONS

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TreatmentAntibiotics play no role in treating the common cold. Antibiotics are effective only against illnesses caused by bacteria, and colds are caused by viruses. Not only do antibiotics not help, but they can rarely also cause severeallergic reactions that can sometimes be fatalGenerallGenerally, the common cold can be treated at home and managed with over-the-counter medications. However, if you develop more severe symptoms such as shaking chills, high fever (greater than 102 F), severe headache, neck stiffness,vomiting, abdominal pain, difficulty breathing, chest pain, confusion, or failure to improve after 10 days, you should consult your physician or health-care practitioner immediatelphysician or health-care practitioner immediately. Infants 3 months of age or younger who develop a cold or fever should consult their health-care practitioner as well.If you have a sore throat and a fever with no other cold symptoms, you should also be evaluated by your physician. This illness may be strep throat, a bacterial infection requiring treatment with antibiotics.FinallFinally, if you notice facial pain or yellow/green drainage from your nose accompanied by a fever, it is possible that you have a sinus infection(sinusitis) that would benefit from a medical evaluation and a possible course of antibiotics.

RESPIRATORY CONDITIONS

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Claritine (loratadine)

Some Important Precautions:Before taking loratadine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause alleingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Do not self-treat with this medication without consulting your doctor first if you have certain medical conditions such as: kidney disease, liver disease.

Call your doctor at once Call your doctor at once if you have a serious side effect such as:fast or uneven heart rate;feeling like you might pass out;jaundice (yellowing of your skin or eyes); or seizures (convulsions).Less serious side effects may include:headache;headache;nervousness;feeling tired or drowsy;stomach pain, diarrhea;dry mouth, sore throat...

RESPIRATORY CONDITIONS

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Zyrtec( Cetirizine dihydrochloride )For Healthcare ProfessionalsNervous systemside effects have included headache (16%), fatigue (5.6%), and somnolence (5% to 20%). and somnolence (5% to 20%). Somnolence tends to be dose-related and generally occurs more frequently with doses higher than 10 mg per day. Other nervoussystem side effects include dizziness (1.8%), insomnia (1.5%), and nervousness (1.1%). Post and nervousness (1.1%). Post marketing reports have included aggression reaction and convulsions.Cetirizine appears to be more sedating than loratadine.Gastrointestinalside effects have included dry mouth (5.7%) and nausea or vomiting (5.7%) and nausea or vomiting (2.2%). Pharyngitis, dyspepsia, and increased appetite

RESPIRATORY CONDITIONS

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123 ( paracetamol )PARACETAMOL SIDE EFFECTSRarely:Hypersensitivity reaction (rashes and shortness of breath).

Very rarely:Blood disorders resulting in readiness to bruise or bleed (e.g. thrombocytopenia) or low numbers of white blood cells .

RESPIRATORY CONDITIONS

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RESPIRATORY CONDITIONS

Power Cold & FLUPARACETAMOL SIDE EFFECTSRarely:Hypersensitivity reaction (rashes and shortness of breath).Very rarely:Blood disorders resulting in Blood disorders resulting in readiness to bruise or bleed (e.g. thrombocytopenia) or low numbers of white blood cells (leucopenia).PARACETAMOL WARNINGSParacetamol should be used with caution in: those with liver or kidneycaution in: those with liver or kidney problems (including alcoholicliver disease), children, and in those who are deficient in the enzyme called glucose-6-phosphate dehydrogenase (commonest in peoples from Africa, Asia, Oceania and Southern Europe).It should not be Europe).It should not be used in: people taking another medication containing paracetamol or people taking medicines to thin the blood (e.g. warfarin).

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4011 Ahmed Abdullah 4013 Ahmed Elsnosy 4014 Ahmed Sakr4015 Ahmed Alshamy4017 Ahmed Gado4025 Esraa Ebrahim

4026 Esraa Osama Barakat4026 Esraa Osama Barakat4027 Esraa Osama Saleh4029 Esraa Adel4032 Esraa Ali

4033 Esraa Mohamed4034 Esraa Mohy El Dein