Ticket 51

1. Features of the action and dosage of medicinal substances for various routes of administration.

The rate of development of the effect, its severity and duration depends on the routes of administration and dose. Sometimes the route of administration determines the nature of the action. Routes of administration: enteral and parenteral.

Enteral: through the mouth, under the tongue, buccal, into the duodenum, rectally. When administered by mouth, sterility is not required. Absorption often occurs in the small intestine (large absorption surface and intensive blood supply), the process is relatively slow, first the substances enter the liver, then into the blood. If the drug degrades absorption quickly, the hepatic barrier bypasses, even at a small dose. Into the 12-finger, the intestine is introduced through a tube. Rectally - enters the bloodstream, bypassing the liver; not affected by gastrointestinal enzymes.

Parenteral: subcutaneous, intramuscular, intravenous, intravenous, intrasternal, intraperitoneal, inhalation, subarachnoid, intrapleural, transdermal, intranasal. Most often under the skin, into a muscle, into a vein (the effect is the fastest). In oil, injected i / m to prolong the effect. Irritating substances in / m and s / c are not administered (necrosis). IV is injected slowly, insoluble compounds, oil solutions (embolism), irritating substances (thrombophlebitis), drugs that cause blood coagulation or hemolysis cannot be injected. In / arter introduction is used in the diagnosis of tumors, blood clots. Intrasternal route is taken if IV is impossible (children, old people). In / peritoneally enter during operations. Inhalation aerosols. Into the islands, poorly penetrating through the BBB, are introduced under the membranes of the brain. Dose - number of in-va for 1 reception. Distinguish between single, daily, doses, course dose (antibiotics), loading dose.

2. Alpha and alpha, beta adrenomimetic substances. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Classification:

1. Stimulating alpha and beta-adrenergic receptors: ADRENALINE HYDROCHLORIDE (beta 1,2, alpha 1,2) NORADRENALINE HYDROTARTRAT (alpha 1,2, beta1)

2. Stimulating predominantly alpha-adrenergic receptors: MESATON (alpha1), NAFTHISIN, GALAZOLINE (alpha2)

3. Stimulating predominantly beta-adrenergic receptors: ISADRIN (1,2). SALBUTAMOL, PHENOTHEROL (2). DOBUTAMINE (1)

ADRENALIN - belongs to the group of phenylalkylamines, is a biogenic catecholamine.

Main pharmacological effects:

CNS - increases excitability, improves cerebral circulation, stimulates the secretion of adrenorcorticotropic hormone (ACTH) by the adenohypophysis

EYE- dilates the pupil due to contraction of the radial muscle of the iris, practically does not affect accommodation (since there are no adrenergic receptors in the ciliary muscle). It complicates the outflow of intraocular fluid, but reduces its production (inflow) due to the narrowing of the retinal vessels. The latter effect is predominant; therefore, intraocular pressure as a whole is somewhat reduced. This makes it possible to use the drug in the open-angle form of glaucoma (associated with excessive production of intraocular fluid), but in the closed-angle form (associated with a deterioration in outflow), adrenaline is contraindicated

SPLEEN - reduces the capsule and trabeculae, which leads to the release of deposited erythrocytes and platelets into the blood.

BRONCHI - expands

A HEART - increases the strength of heart contractions, conduction, excitability, automatism, increases stroke and minute blood volumes. It mainly causes tachycardia, which, however, can be replaced by bradycardia. The latter is associated with the emergence of vagal reflexes from vascular baroreceptors (aortic arch, carotid sinus zone) in response to an increase in the stroke volume of blood.

Activates metabolic processes in the myocardium. Improves blood supply to the myocardium (due to the expansion of the coronary vessels)

Epinephrine is effective when administered locally and parenterally (subcutaneous, intravenous, intramuscular). Duration of action - from 5 to 30 minutes

Indications Locally - as a vasoconstrictor for rhinitis, conjunctivitis - open-angle glaucoma - to enhance and prolong the action of local anesthetics Resorptively: - anaphylactic shock, status asthmaticus, serum sickness, angioedema - hypoglycemic coma - cardiac arrest

Side effects: insomnia, tremors, hypertension, tachycardia, arrhythmias, pain in the heart, nausea, vomiting

Contraindications:hypertension, atherosclerosis, ischemic heart disease, hyperthyroidism, diabetes mellitus, pregnancy, angle-closure glaucoma, fluorothane and cyclopropane anesthesia (these anesthetics increase the sensitivity of the myocardium to catecholamines, as a result of which arrhythmias can develop, up to ventricular fibrillation and death). Adrenaline is contraindicated in all types of shock, with the exception of anaphylactic

MEZATONE - Causes a vasoconstrictor effect and raises blood pressure weaker than adrenaline and norepinephrine, but for a longer period (intravenously - up to 20 minutes, subcutaneously - 40-50 minutes). This is due to the fact that mezaton is a synthetic preparation, it is not a catecholamine, therefore it is not destroyed by the COMT enzyme. Effective when taken orally. It can be used in conditions of cyclopropane and fluorothane anesthesia. From the heart causes bradycardia (reflex)

Indications Locally - as a vasoconstrictor for rhinitis, conjunctivitis - open-angle glaucoma - to enhance and prolong the action of local anesthetics resorptively (intravenous, intramuscular, subcutaneous) - collapse and hypotension of vascular origin, preparation for surgery, intoxication, infectious diseases with a decrease in blood pressure

Side effects insomnia, tremors, hypertension, tachycardia, arrhythmias, pain in the heart, nausea, vomiting

Contraindications - cardiogenic shock - hypovolemic - hypertension, - atherosclerosis, - coronary artery disease, - hyperthyroidism, - diabetes, - pregnancy, - angle-closure glaucoma