Deferoxamine (DFO), also known as Desferal , is a chelating agent used to treat iron and aluminum toxicity. It binds excess metals in the body, forming complexes that are excreted in urine. DFO is mainly used for conditions like iron overload in thalassemia patients and acute iron poisoning. It is given by injection and plays a key role in preventing organ damage caused by metal accumulation.

2) BY :Ebrahim Ayman Mostafa Elalfy

Calcitriol is the biologically active form of vitamin D and therefore has a more immediate onset of action (maximal effect in <4 d) and a much shorter time for dissipation of effect in the event of toxicity (1–7 d). It is therefore the drug of choice for the treatment of hypoparathyroidism. Calcitriol can also be used prior to surgical parathyroidectomy for treatment of hyperparathyroidism.

Formulations and dose rates

It is available as 250 or 500 ng capsules and is administered orally at an initial dose of 30–60 ng/kg/24 h. If administered at a dose of approximately 7.5 ng/kg/24 h in the 5–7 d preceding surgery for primary hyperparathyroidism, active calcium absorption will be expected in the immediate postsurgical period when the risk of hypoparathyroidism is high.

At lower dose (2.5–3.5 ng/kg/d) calcitriol inhibits PTH secretion and it is this dose that is recommended for renal secondary hyperparathyroidism although studies clearly evaluating its efficacy are lacking. The available capsule size limits the use of this drug at low doses or in small dogs or cats. Regular monitoring of circulating calcium concentration is required using the lowest possible dose to maintain calcium concentration in the lower end of the reference range.

The most common side effect of calcitriol is high calcium levels (hypercalcemia) (see below), which can be serious.

There may be other side effects of calcitriol that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. 

What are the serious side effects of calcitriol?

While less common, the most serious side effects of calcitriol are described below, along with what to do if they happen.

Severe Allergic Reactions. Calcitriol may cause allergic reactions, which can be serious. Stop using calcitriol and get help right away if you have any of the following symptoms of a serious allergic reaction.

Breathing problems or wheezing

Racing heart

Fever or general ill feeling

Swollen lymph nodes

Swelling of the face, lips, mouth, tongue, or throat

Trouble swallowing or throat tightness

Itching, skin rash, or pale red bumps on the skin called hives

Nausea or vomiting

Dizziness, feeling lightheaded, or fainting

Stomach cramps

Joint pain

High Calcium Levels (Hypercalcemia). Calcitriol can cause high calcium levels, also called hypercalcemia. Hypercalcemia can lead to serious problems with your kidneys, heart, or bones. Stop using calcitriol and call your health care provider if you have any of the following symptoms.

• feeling more tired than usual

• loss of appetite

• loss of concentration or interest

• constipation

• low mood or increase in irritability

• feeling thirsty

• passing urine more than usual

• dry mouth

• nausea and vomiting

• drowsiness or confusion

• muscle spasms

• palpitation or irregular heartbeat

3) BY :Ismail Elsayed Ismail Elsayed Elhoot

Sildenafil, commonly known as Viagra, is a groundbreaking medication primarily used to treat erectile dysfunction (ED) and pulmonary arterial hypertension (PAH). It represents a pivotal advancement in sexual health and has undergone significant development since its introduction in 1998.

Origins and Approval

Sildenafil was originally developed by Pfizer in the early 1990s as a treatment for angina (chest pain related to heart issues). However, during clinical trials, it was discovered that the drug had a remarkable side effect: it induced erections in male participants, leading to its repurposing for men suffering from erectile dysfunction. The U.S. Food and Drug Administration (FDA) approved Sildenafil as the first oral treatment for ED in 1998, heralding a new era in sexual medicine

History of Sildenafil

🔬 Discovery: A Serendipitous Find

Early 1990s: Scientists at Pfizer in the UK were researching a compound, later known as sildenafil citrate, as a treatment for angina pectoris (chest pain due to heart disease).

It worked by dilating blood vessels via the nitric oxide–cGMP pathway, which seemed promising for improving heart blood flow.

😲 Unexpected Effect

During clinical trials, sildenafil didn’t significantly relieve chest pain...

But: Male participants reported unexpected erections!

Pfizer quickly shifted focus from heart disease to erectile dysfunction (ED).

🚀 FDA Approval & Launch

1998: The U.S. Food and Drug Administration (FDA) approved sildenafil for ED under the brand name Viagra.

It became the first oral treatment for ED — and was a game-changer.

Within weeks, it became a cultural phenomenon and a blockbuster drug.

💡 Medical and Cultural Impact

Removed stigma around discussing male sexual health.

Led to a surge in men seeking help for ED.

Inspired jokes, ads, and even political debates — Viagra became more than a medicine; it was a pop culture icon.

💊 Expansion of Use

2005: Approved as Revatio to treat pulmonary arterial hypertension (PAH).

Research into other uses followed (e.g., heart failure, Raynaud’s, altitude sickness).

💼 Generic Availability

2013–2017: Patents expired in various countries.

Multiple pharmaceutical companies began manufacturing generic sildenafil, greatly reducing its cost.

🌐 Today

One of the most widely recognized and prescribed drugs globally.

Still used for both ED and PAH.

Ongoing research explores other vascular and neurological applications.

Precautions Before Using Sildenafil

Patients should inform their healthcare provider about the following:

🫀 Cardiovascular Health

History of heart disease, heart failure, arrhythmias, stroke, or myocardial infarction (heart attack).

Risk of sexual activity should be assessed in men with significant cardiac conditions.

💊 Medication Use

Concomitant use of nitrates (e.g., nitroglycerin) or nitric oxide donors is dangerous and strictly contraindicated.

Caution with drugs that affect CYP3A4 metabolism (e.g., ketoconazole, ritonavir) due to increased sildenafil levels.

👁️ Eye Conditions

Rare cases of non-arteritic anterior ischemic optic neuropathy (NAION) reported—avoid in patients with a history of NAION or hereditary retinal disorders (like retinitis pigmentosa).

🧠 Neurological Risk

Use cautiously in those with a history of seizures or intracranial hemorrhage.

🩺 Liver or Kidney Impairment

Dose adjustments may be required in hepatic or severe renal impairment.

🔼 Low Blood Pressure (Hypotension)

May cause a drop in blood pressure—caution in those with resting hypotension or on antihypertensive therapy.

❗ Other Considerations:

Priapism risk in patients with anatomical deformation of the penis (e.g., Peyronie’s disease) or predisposition to prolonged erections (e.g., sickle cell anemia, leukemia).

Not approved for use in women or children (except for PAH in some pediatric cases under medical supervision).

🚫 Contraindications

Sildenafil should NOT be used in the following situations:

Concurrent use of nitrates (e.g., for angina) → risk of life-threatening hypotension.

Severe cardiovascular disorders:

Recent heart attack (within 6 months)

Recent stroke

Unstable angina

Severe hypotension (BP <90/50 mmHg)

Severe liver impairment

Hereditary degenerative retinal disorders (e.g., retinitis pigmentosa)

Known hypersensitivity/allergy to sildenafil or any excipients

BY :Fatma Ali Abdullah 

Flumazenil is a benzodiazepine antagonist typically used in overdose emergencies. The primary FDA-approved clinical uses for flumazenil include reversal agents for benzodiazepine overdose and postoperative sedation from benzodiazepine anesthetics. Flumazenil injection is indicated for a complete or partial reversal of the sedative effects of benzodiazepines in conscious sedation and general anesthesia in adult and pediatric populations. This activity focuses on the indications, mechanism of action, dosing, significant adverse effects, contraindications, monitoring, and toxicity of flumazenil so clinicians can direct patient therapy for optimal outcomes in benzodiazepine reversal. Empowering clinicians with the necessary knowledge and skills to navigate flumazenil therapy is paramount.

Nervous system:Dizziness (vertigo, ataxia) occurring in approximately 10% of patients; headache and paresthesia (abnormal sensations) are also reported.

Psychiatric: Agitation, anxiety, nervousness, dry mouth, tremor, palpitations, insomnia, dyspnea, hyperventilation, and emotional lability.

Cardiovascular:Cutaneous vasodilation (sweating, flushing, hot flushes); less commonly, cardiac dysrhythmias such as ventricular tachycardia and junctional tachycardia.

Other: Fatigue, malaise, injection site pain, abnormal vision (visual field defects, diplopia), and hiccups.

Serious adverse events, such as convulsions, have occurred, particularly in patients with severe hepatic impairment, those dependent on benzodiazepines, or those who have ingested large doses of other drugs in addition to benzodiazepines.

BY :Asmaa Shaaban Morsi El-Sherbiny

Desmopressin is a synthetic analog of the hormone vasopressin (antidiuretic hormone - ADH), and it is primarily used to treat conditions related to water balance disorders in the body.

Desmopressin is a hormonal medication used to replace the deficiency of vasopressin, which helps reduce urine output and increase urine concentration. It is commonly used to treat:

Diabetes insipidus, caused by a lack of antidiuretic hormone (ADH).

Nocturnal enuresis (bedwetting) in children.

Certain bleeding disorders, such as von Willebrand disease and mild hemophilia A, as it stimulates the release of von Willebrand factor and factor VIII.

Desmopressin is available in several pharmaceutical forms, including tablets, nasal spray, and injections. It should be used with caution to avoid hyponatremia (low sodium levels in the blood), especially in children and the elderly.

Side Effects of Desmopressin Common:

Headache

Nausea

Abdominal pain

Nasal congestion or runny nose (especially with the nasal spray)

Fluid retention

2. Serious (but rare):

Hyponatremia (low blood sodium):

One of the most serious complications, which may lead to:

Severe headache

Nausea and vomiting

Seizures

Confusion or coma

3. Less common side effects:

High or low blood pressure

Dizziness

Skin rash or allergic reaction

Weight gain (due to fluid retention)

1. Nocturnal Enuresis (Bedwetting):

Studies have shown Desmopressin's effectiveness in reducing nighttime bedwetting in children, with significant improvement, especially in studies conducted in Egypt.

2. Nocturia in Adults:

Studies have demonstrated Desmopressin's effectiveness in reducing the number of nighttime urinations in women and patients suffering from excessive nighttime urination.

3. Bleeding Disorders:

Studies have shown that Desmopressin is effective in reducing bleeding and improving clotting factor levels in patients with Hemophilia A and certain types of von Willebrand disease.

4. Side Effects and Safety:

Studies confirm that Desmopressin is safe and effective in improving nighttime urination, with a need to monitor for side effects such as fluid retention.

BY: Aalanour Medhat hamed

N-acetylcysteine, also known as Acetylcysteine and NAC, is a medication that is used to treat paracetamol (acetaminophen) overdose and to loosen thick mucus in individuals with chronic bronchopulmonary disorders, such as pneumonia and bronchitis. It has been used to treat lactobezoar in infants

1. Antioxidant:

NAC supplies cysteine to boost glutathione (GSH) production, which protects cells by neutralizing harmful reactive oxygen species (ROS).

2. Mucolytic:

It breaks disulfide bonds in mucus, reducing its thickness and making it easier to clear from the lungs.

3. Antidote for Paracetamol Overdose:

NAC restores glutathione levels, helping detoxify the harmful metabolite (NAPQI) and preventing liver damage.

4. Anti-inflammatory:

It reduces inflammation by inhibiting certain cellular signaling pathways like NF-κB.

Sure! Here's a summary of the indications for N-acetylcysteine (NAC):

 Indications of N-Acetylcysteine (NAC)

 1. Acetaminophen (Paracetamol) Overdose

Primary indication
NAC replenishes glutathione, allowing the body to detoxify the harmful metabolite (NAPQI) of acetaminophen.
Most effective if given within 8–10 hours of overdose, but can still be beneficial later.

2. Mucolytic Agent (Respiratory Conditions)

Breaks disulfide bonds in mucus, reducing viscosity
Used in chronic bronchitis, cystic fibrosis, and other respiratory diseases with thick mucus
Available as inhalation or oral solution

 3. Prevention of Contrast-Induced Nephropathy

Used off-label (controversial benefit)
Administered before and after contrast exposure in high-risk patients (e.g., with renal impairment)

4. Chronic Obstructive Pulmonary Disease (COPD)

• Acts as an antioxidant and mucolytic to reduce exacerbations (used more in some countries like Europe)
  
  

5. Psychiatric and Neurological Uses (Off-label)

• Investigated in conditions like:
  Obsessive-Compulsive Disorder (OCD)
  Addiction (e.g., cannabis, cocaine, nicotine)
  Schizophrenia
  Bipolar disorder
  Works as a glutamate modulator and antioxidant
  
  

 6. Liver Protection in Non-Acetaminophen Liver Injury (Off-label)

• Sometimes used in acute liver failure due to other causes (e.g., viral hepatitis), especially in early stages

1. Nausea

2. Vomiting

3. Diarrhea

4. Abdominal pain

5. Unpleasant sulfur-like taste or smell

Less Common / Serious Side Effects:

1. Allergic reactions (rash, itching, swelling)

2. Bronchospasm (especially in asthma patients)

3. Hypotension (low blood pressure – mainly with IV use)

4. Anaphylactoid reactions (flushing, chest tightness, shortness of breath – usually with IV)

BY: Ahmed belal Mohamed shabana 

Zoledronic acid is a bisphosphonate medication used to prevent bone loss. It works by inhibiting bone resorption, making bones stronger and reducing the risk of fractures.

2. Mechanism of Action

Zoledronic acid inhibits the enzyme farnesyl pyrophosphate synthase in the mevalonate pathway. This disrupts the function and survival of osteoclasts (bone-resorbing cells), leading to reduced bone resorption and increased bone density.

• BY: Asmaa Reda Abo Alwafa 

Octreotide is a synthetic analog of somatostatin, a naturally occurring hormone that inhibits the release of several other hormones and substances in the body. It is most commonly used to manage symptoms of hormone-secreting tumors and to treat conditions like acromegaly, carcinoid syndrome, and VIPomas (vasoactive intestinal peptide tumors).

Key Points:

• Brand names include: Sandostatin, Sandostatin LAR Depot.
  
  

• It mimics somatostatin, but has a longer half-life, allowing it to be more effective in clinical use.
  
  

• Works by reducing the secretion of serotonin, growth hormone, insulin, glucagon, and other peptides.
  
  

• Available in both short-acting (injection multiple times daily) and long-acting (monthly injection) forms.

Acromegaly

Neuroendocrine tumors (e.g., carcinoid, VIPoma)

Severe diarrhea (e.g., due to tumors or HIV)

Esophageal variceal bleeding

Pancreatic fistulas/postoperative support

Common Side Effects:

• Gastrointestinal:
  Nausea
  Vomiting
  Abdominal pain
  Bloating
  Diarrhea or constipation
  Flatulence
  
  

• Injection site reactions:
  Pain
  Redness
  Swelling
  
  

• Gallbladder-related:
  
  

  • Gallstones or biliary sludge (due to reduced gallbladder motility)
    
    

🔹 Endocrine/Metabolic:

• Hyperglycemia or hypoglycemia
  Because octreotide affects insulin and glucagon secretion
  
  

• Hypothyroidism (rare, especially with long-term use)
  
  

🔹 Cardiovascular:

• Bradycardia (slow heart rate)
  Conduction abnormalities on ECG (e.g., prolonged QT interval in rare cases)
  
  

🔹 Other Possible Effects:

• Headache
  Dizziness
  Fatigue
  Hair loss (rare)
  
  

🚨 Serious but Rare Side Effects:

  Pancreatitis
  Severe bradycardia or heart block
  Allergic reactions (e.g., rash, anaphylaxis — very rare)

Precautions:

1. Gallbladder Issues:

May cause gallstones or biliary sludge with long-term use.

2. Glucose Metabolism:

Can cause hypo- or hyperglycemia due to effects on insulin and glucagon secretion. Monitor blood sugar levels closely.

3. Cardiac Effects:

May lead to bradycardia, conduction abnormalities, or QT prolongation. Use cautiously in patients with cardiac disease.

4. Thyroid Function:

Can decrease TSH secretion, possibly leading to hypothyroidism.

5. Renal Impairment:

Dosage adjustment may be needed, especially for long-acting forms.

6. Injection Site Reactions:

Pain, swelling, or nodules can occur with subcutaneous injections.

Contraindications:

1. Hypersensitivity to octreotide or any of its components.

2. Caution in pregnancy and lactation – safety not fully established.

By: Alzhraa Medhat

Dimercaprol is used in the treatment of:

Acute arsenic poisoning

Mercury and lead poisoning

Gold poisoning

Wilson’s disease (alternative copper chelator)

Radiation exposure (e.g., mercury or polonium-210

BY :Ahmed khaled Soliman 

Erythropoietin is a natural hormone mainly produced by the kidneys. It plays a key role in stimulating the bone marrow to produce red blood cells in response to low oxygen levels in the blood. As a medication, erythropoietin is used to treat anemia, especially in patients with chronic kidney disease or those undergoing chemotherapy.

Mechanism of Action of Erythropoietin (EPO):

1. Low oxygen (hypoxia) → kidneys sense the drop.

2. Kidneys release EPO into the blood.

3. EPO travels to bone marrow.

4. EPO binds to receptors on red blood cell precursors.

5. Stimulates red blood cell production.

6. More RBCs → more oxygen → EPO levels decrease (feedback control)

By: Ahmed reda mobarak

Filgrastim is a medication that belongs to a class of drugs known as granulocyte colony-stimulating factors (G-CSFs). It is primarily used to stimulate the bone marrow to produce more white blood cells, particularly neutrophils. This makes it especially useful in treating or preventing neutropenia—a condition characterized by a low neutrophil count—which can result from chemotherapy, bone marrow transplantation, certain cancers, or congenital disorders.

Filgrastim is a recombinant form of the natural G-CSF protein produced using genetic engineering techniques. It is administered via subcutaneous or intravenous injection and helps reduce the duration and severity of neutropenia, thereby lowering the risk of infections in immunocompromised patients.

Common Side Effects:

Bone pain: This is the most common side effect, typically felt in the lower back, hips, or limbs. It happens as the bone marrow increases its production of white blood cells.

Muscle or joint pain: Some people may experience discomfort in their muscles or joints.

Headache: Mild to moderate headaches are frequently reported.

Fatigue or weakness: Patients may feel unusually tired or weak during treatment.

Fever: A mild fever can develop, especially if the body is reacting to the medication.

Nausea: Some may feel nauseous, particularly at the start of treatment.

Skin rash or itching: A mild rash or itching may occur as the body adjusts to the medication.

Injection site reactions: Redness, swelling, or pain at the site of the injection is common and typically temporary.

---

Less Common but Serious Side Effects:

Splenomegaly (enlarged spleen): Can cause pain in the left upper abdomen or shoulder tip. In rare cases, the spleen can rupture, which is a medical emergency.

Allergic reactions: Swelling, trouble breathing, rash, or anaphylaxis (rare but serious).

Acute Respiratory Distress Syndrome (ARDS): Severe shortness of breath and lung problems, usually in very ill patients.

Capillary Leak Syndrome: A rare condition where fluids leak from blood vessels, causing low blood pressure, swelling, and risk of organ failure.

Myelodysplastic syndrome or leukemia: In patients with certain risk factors or previous cancers, there may be a small increased risk.

Alendronate works by targeting the cells responsible for bone resorption called osteoclasts. Normally, osteoclasts break down old or damaged bone tissue, a process balanced by osteoblasts that build new bone. In osteoporosis, this balance is disrupted, with bone resorption outpacing bone formation, leading to fragile bones.

BY:Maryam Elsayed Elsayed Shadad 

Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. The toxin is also used commercially for medical and cosmetic purposes. Botulinum toxin is an acetylcholine release inhibitor and a neuromuscular blocking agent

Botulinum toxin acts by binding presynaptically to high-affinity recognition sites on the cholinergic nerve terminals and decreasing the release of acetylcholine, causing a neuromuscular blocking effect. This mechanism laid the foundation for the development of the toxin as a therapeutic tool.

Recovery occurs through proximal axonal sprouting and muscle re-innervation by formation of a new neuromuscular junction. De Paiva and colleagues suggest that eventually the original neuromuscular junction regenerates. 

BoNT-A and BoNT-E cleave synaptosome-associated protein (SNAP-25), a presynaptic membrane protein required for fusion of neurotransmitter-containing vesicles. 

BoNT-B, BoNT-D, and BoNT-F cleave a vesicle-associated membrane protein (VAMP), also known as synaptobrevin.

BoNT-C acts by cleaving syntaxin, a target membrane protein.

WHAT IS THE SIDE EFFECTS OF BOTOX ?

Common Side Effects:

• Pain, swelling, bruising, or redness at the injection site

• Flu-like symptoms

• Headache

• Neck pain

• Dry mouth

• Tiredness

• Eye problems such as double vision, blurred vision, drooping eyelids, or dry eyes

• Drooping eyebrows

Serious Side Effects (Seek immediate medical attention):

• Spread of toxin effects, which can cause botulism-like symptoms such as loss of strength and muscle weakness all over the body, double or blurred vision, drooping eyelids, hoarseness or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing or swallowing

• Allergic reactions, which can manifest as breathing problems or wheezing, racing heart, fever, swollen lymph nodes, swelling of the face/lips/mouth/tongue/throat, trouble swallowing or throat tightness, itching/skin rash/hives, nausea/vomiting, dizziness, stomach cramps, or joint pain

• Breathing, swallowing, or speaking problems, which can occur hours, days, or weeks after injection due to muscle weakness

• Eye surface problems, such as eye dryness or irritation, which can lead to corneal ulcers, especially in those with certain nerve disorders

• Eye bleeding, which can affect blood flow to the retina and cause vision problems

• Dysphagia (difficulty swallowing)

• Muscle weakness

The risk of serious side effects is higher when botulinum toxin is used therapeutically rather than cosmetically, as therapeutic uses often involve larger doses. If you experience any concerning side effects after receiving botulinum toxin injections, contact your healthcare provider immediately

Precautions for Botulinum Toxin Use

Qualified Provider: Ensure injections are administered by a licensed and trained medical professional to avoid overdose or improper injection, which can cause iatrogenic botulism.

Avoid Touching Treated Area: Do not rub, massage, or touch the injection site for at least 24 hours to prevent spreading the toxin beyond the target muscle.

Post-Injection Positioning: Sit upright for at least 4 hours after injection; avoid lying down or bending over to reduce toxin migration and bruising risk.

Avoid Alcohol and Blood Thinners: Refrain from alcohol consumption 24 hours before and after injection, as it increases bruising risk. Inform your doctor about blood thinners or medications that may increase bleeding.

• Absolute Contraindications

Pregnancy and breastfeeding: Safety not established; use is not recommended.

Allergy or hypersensitivity: Known allergy to botulinum toxin type A or any formulation components such as human albumin.

Active infection or skin conditions: Infection, rash, or inflammatory skin disease at the injection site increases risk of complications.

Neuromuscular disorders: Conditions like myasthenia gravis, Eaton-Lambert syndrome, ALS, or other muscle weakness disorders increase risk of serious adverse effects such as respiratory difficulties.

Hypersensitivity to other neurotoxins: Cross-reactivity may pose risks.

Relative Contraindications (require caution)

Certain medications: Aminoglycoside antibiotics, muscle relaxants, anticoagulants, and NSAIDs may enhance botulinum toxin effects or increase bleeding risk.

Compromised immune system or history of antibody formation: May reduce efficacy or increase adverse effects.

Urinary tract infection or inability to empty bladder: Relevant for bladder-related indications.

Patients with these contraindications should avoid or delay treatment, and practitioners should carefully evaluate risks before proceeding.