Ticket 52

1. Conditions affecting the manifestation of the action of medicinal substances in the body. The importance of the psychogenic factor in the effectiveness of drug treatment; the word of the doctor and the prescription of drugs. The ethical side of the advertising of new drugs.

Age - there is perinatal pharmacology (from 24 weeks of the fetus to 4 weeks of newborn), newborns differ from adults (deficiency of enzymes, kidney function, ↑ BBB permeability, underdevelopment of the central nervous system). There is pediatric pharmacology - doses per kg of body weight. There is geriatric pharmacology - in people of age, the doses should be ↓ (since ↓ absorption, metabolism, excretion by the kidneys).

Gender - men are less sensitive to a number of substances than women (strychnine, nicotine).

Genetic factors - enzyme deficiency, atypical reactions (idiosyncrasy). Studying pharmacogenetics.

The state of the body - pharmacokinetics changes with illness, pregnancy, obesity.

Circadian rhythms (circadian) - studies chronopharmacology. The effect of substances changes qualitatively and quantitatively (pronounced effect during the period of maximum activity). Absorption, metabolism change during the day.

Psychogenic factor - if the patient is committed to treatment, trusts the doctor, follows the recommendations, the treatment will be effective. Otherwise, the effect of the treatment cannot be expected.

The word of the doctor is the therapeutic effect of the word of the doctor on the patient.

Ethics:

2. Sedatives. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Sedatives - Drugs that have a regulating effect on the functions of the central nervous system, enhancing inhibition processes and lowering arousal processes.

Classification:

1) Bromides: sodium bromide, potassium bromide.

Mechanism of action: increases the processes of inhibition to the process of excitation.

Indications: neurasthenia, neurosis, hysteria, increased irritability, insomnia, the initial form of hypertension.

Side effects: with prolonged use, the phenomena of bromism develop (skin rash, rhinitis, bronchitis, weakening of memory, hearing, vision), cough, runny nose, weakness.

2) Herbal preparations: valerian tincture, valerian infusion, thick valerian extract, motherwort tincture and extract, novo-passit.

Mechanism of action: suppresses the processes of excitation before inhibition.

Indications: CVS neuroses, insomnia, increased nervous excitement.

Side effects: allergies.

3) Combined drugs: corvalol, valocordin.

Indications for use: nervousness, irritability, neurasthenia, insomnia, of a particular neurological nature.

Contraindications: kidney disease.

3. Antihypertensive drugs of myotropic action. Classification. Mechanism of action. Side effects. Contraindications Comparative evaluation of drugs.

These are agents acting on the smooth muscles of the arterioles of the systemic blood flow.

Classification:

A) funds that do not affect ion channels:

- Direct vasodilators: dibazol, papaverine.

B) Means affecting ion channels:

- Calcium channel blockers: verapamil, diltiazem.

- Potassium channel activators: diazoxide, minoxidil.

Calcium channel blockers - reduces the penetration of calcium into myofibrils, reduces the activity of ATP-ase. They relax muscle fibers, improve coronary blood flow, supply the heart with oxygen, expand peripheral vessels, and lower blood pressure. The effect develops gradually. Antiarrhythmic action.

Side effects - nausea, dizziness, constipation.

Contraindications: hypersensitivity, severe hypotension, myocardial infarction.

Potassium channel activators - open potassium channels, hyperpolarization of the membrane of smooth muscle cells, a decrease in the intake of calcium into the cell, a decrease in blood pressure.

Side effects - facial hirsutism, edema.

Contraindications: myocardial infarction, acute cerebrovascular accident, ischemic heart disease.

Comparative evaluation:

Dibazol - hypotensive activity is very moderate, the effect is short-lived.

Diazoxide - affects mainly resistive vessels, inhibits the work of the heart, with enteral administration, the decrease in blood pressure occurs more gradually.

4. Antibiotics of the tetracycline and chloramphenicol group. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation.

Classification: Tetracyclines: natural (tetracycline) and semi-synthetic (doxycycline, morphocycline, metacyclin). Levomycetin belongs to nitrobenzenes.

Mechanism: inhibit protein synthesis.

Mode of action: bacteriostatic.

Spectrum: wide - gram (+) (-), suppresses aerobic and anaerobic bacteria, actinomycetes, legionella, spirochetes, leptospira, mycoplasma, ureaplasma, reketsia, plasmodia; levomycetin has a bacteriostatic effect on streptococci, gonococci, pneumococci, clostridia, anthrax pathogens, diphtheria, plague, whooping cough, salmonella, shigella, brucella.

Indications: rickettsiosis, chlamydial infections, pneumonia, bronchitis, sinusitis, syphilis, leptospirosis, brucellosis, tularemia, cholera, plague, anthrax, typhoid fever, meningitis caused by Haemophilus influenzae.

Side effects: a decrease in hematopoiesis to agranulocytosis, irritate the gastrointestinal tract, teratogenic (tetracyclines), allergies, dysbiosis, candidiasis.

Contraindications: liver, kidney, blood diseases, pregnancy, children under 8 years old.

Doxycycline and metacyclin last longer (up to 12 hours). All are reserve antibiotics (very toxic).

Tetracyclines are very toxic, therefore they are rarely used in children, especially those for 3-5 years. Levomycetin in children under 3 years of age is used to a limited extent, because toxic effects may occur