Applied Therapeutic ıı
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بالاعتماد على المنهج الموحد ٢٠٢٦

1. Adrenal Gland Disorders
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2. Thyroid Gland Disorders
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3. Alzheimer Disease
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4. Anxiety Disorders
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5. Depressive Disorders
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6. Schizophrenia
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7. Insomnia
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8. Contraception
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9. Hormone Replacement Therapy
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10. Menstruation Related Disorders
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11. Cancer Chemotherapy & Treatment
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12. Leukemias
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13. Lymphomas
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14. Breast Cancer
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15. Prostate Cancer
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16. Adverse Effects Of Chemotherapy
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All Lectures

𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼𓄹𓄼
حلول اسئلة العلاجيات للدور الاول 2026

#شخابيط

Notes:
#adrenal_disorders
#thyroid_disorders
#alzheimer
#MDD
#anxiety
#schizophrenia
#insomnia
#contraception
#HRT
#MRD
#Leukemia
#Lymphoma
#Breast_Cancer
#Prostate_Cancer
#ad_effect_CT

𝗔𝗥𝗢𝗡 𝗦𝗧𝗨𝗗𝗬

💢 Nonpharmacologic therapy for dysmenorrhea includes:

Exercise
Topical heat therapy
Acupuncture
A low-fat vegetarian diet


💢Pharmacologic Therapy

🔹NSAIDs are the first-line treatment for dysmenorrhea ➔ effective in up to 80% of patients

They work by inhibiting prostaglandin production, reducing pain, uterine contractions, and menstrual blood flow

🫆Commonly used NSAIDs:
Ibuprofen
Naproxen


Aspirin is not recommended ➔ less potent at usual doses

ننطي الـ NSAIDs قبل يوم او يومين من mc او قبل بداية الالم وتستمر عليهم المريضة يومين الى ثلاث ايام لحين اختفاء الالم

بالعادة ننطي بالبداية double dose وبعدين نرجع ننطي الجرعة الاعتيادية

A 22-year-old female presented with severe dysmenorrhea. She had a history of peptic ulcer disease with recurrent gastric bleeding. Which of the following is the most appropriate management?

a- Aspirin
b- Ibuprofen
c- Naproxen
d- Combined hormonal contraceptives (CHCs)
e- High-dose NSAIDs

في حالة كان ال nsaids غير فعالة او اكو مانع من استخدامها ، البديل هو CHC

🔹CHC improve dysmenorrhea by suppressing ovulation and reducing endometrial growth, leading to decreased prostaglandin and leukotriene production

ممكن تستمر عليهم المريضة
2-3months
او حتى ممكن توصل فترة الاستخدام الى 6 اشهر

Cyclic (28 tab) and Extended (91 tab) regimens are effective

الـ Continuous CHCs يخفف الالم اسرع من الـ cyclic regimens
لكن بالنهاية بعد 6 اشهر تكون الفعالية متساوية

اذا كانت الحالة secondary dysmenorrhea بسبب endometriosis بطانة الرحم المهاجرة ف الخط الاول هو Extended (91 tab) CHC

🔹Progestin-only contraceptives help treat dysmenorrhea by reducing or stopping menstruation over 6–12 months, which decreases prostaglandin release

🫆Long-acting options include:
Depot medroxyprogesterone acetate (DMPA)
Etonogestrel implant
Levonorgestrel-releasing IUD

levonorgestrel-releasing IUD saw a reduction in their symptoms from 60% to 29% after 3 years of
therapy

🔺In adolescents, the first-line treatment for dysmenorrhea is
NSAIDs

🔺 If there is no improvement after 3 menstrual cycles → switch to combined hormonal contraceptives (CHCs)

🔺If symptoms persist after 3–6 months of NSAIDs and CHCs → first check treatment adherence

🔺If adherence is confirmed and there is still no improvement → laparoscopy is recommended for further evaluation


🔺DMPA should be used with caution in adolescents because long-term use may reduce bone mineral density (BMD), which may not be fully reversible → so other options are preferred first-line



#MRD

💢Nonpharmacologic treatment for amenorrhea depends on the cause:

If due to undernutrition or anorexia → improve with weight gain and psychotherapy


If due to excessive exercise → managed by reducing exercise intensity

In functional hypothalamic amenorrhea → try psychological therapy (e.g., CBT), nutritional support, and/or exercise modification before starting medications

💢Pharmacologic Therapy

🔺Estrogen/progestin therapy (Oral contraceptives, CEE, estradiol patch) was previously used for most cases of primary or secondary amenorrhea

سابقا جانت تستخدم اما حاليا ف الـ
combined hormonal contraceptives (CHCs) and synthetic estrogens
ما تعتبر خط علاجي اول للـ
functional hypothalamic amenorrhea

🫆 لذلك حسب
the 2017 Endocrine Society guideline:

اولا نستخدم
nonpharmacologic therapy (psychological support + nutritional therapy)

وراها اذا ما صار تحسن نلجأ لاستخدام
use short-term transdermal estrogen + cyclic oral progestins

🔺Dopamine Agonists

In amenorrhea caused by hyperprolactinemia, the treatment of choice is dopamine agonists



These drugs lower prolactin levels, leading to:

Resolution of amenorrhea
Restoration of ovulation in 80–90% of women

🫆Common agents:
Bromocriptine
Cabergoline (more effective and better tolerated)

🔺Progestins are used to induce withdrawal bleeding in secondary amenorrhea

Withdrawal bleeding occurs in:
~70% with intramuscular progesterone

~95% with oral medroxyprogesterone acetate (MPA)

🫆Usual regimen:
Oral MPA 10 mg daily for 7–10 days



🔺 insulin-sensitizing drugs : In PCOS-related amenorrhea, like metformin may be beneficial

لانه يقلل مقاومة الانسولين ويقلل الوزن ف يقلل من تكيس المبايض

🫆ممكن انه نستخدم مكملات غذائية Ca + D3

🫆ممكن انه يتم استخدام ال letrozole اذا جانت اكو رغبة بالحمل لانه يحفز عملية ال ovulation

💢 Adolescents with primary ovarian insufficiency may require higher estrogen doses than menopausal women for bone health


🫆If breast development is absent or incomplete:
Start estrogen therapy
first Increase dose gradually
Add progesterone later to support breast development and avoid tubular breasts

🫆After puberty is completed: Goal is to maintain
normal estradiol levels Recommended:

Estradiol 100 mcg daily (oral
, transdermal, or sometimes vaginal)

🔺Add cyclic progesterone for 10–12 days/month to prevent endometrial hyperplasia and cancer


🔺Oral contraceptives are not first-line, because they often contain higher estrogen doses than needed

#MRD

Anovulatory bleeding

#MRD