Ticket 15
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.
2. Nootropics. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
3. Antihypertensive drugs of peripheral neurotropic action. Classification. Mechanism of action. Side effects. Contraindications Comparative evaluation of drugs.
4. Anti-tuberculosis drugs. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
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. Nootropics. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
Nootropic drugs (Greek noos - soul. Thought, tropos - direction) - a group of drugs that have a selective mnemotropic effect, improve the higher integrative functions of the brain - intelligence, attention, short- and long-term memory, creating the ability to quickly reproduce information, accelerating learning, as well as weakening the perception of stressful situations and increasing the brain's resistance to harmful influences.
Classification
1. Means affecting specific neurotransmitter systems
∙ Catecholaminergic drugs PIRIBEDIL
(pronoran,)
GUANFACIN
(estulik)
∙ GABAergic agents: ∙ GABA AMINALON
(gammalon, ganervin)
∙ GABA + nicotine acid PICAMILON
∙ phenyl derivative of GABA PENIBUT
2. Drugs with neurometabolic action
∙ Animal origin ACTOVEGIN
∙ Plant origin EXTRACT
LEAVES
GINKGO BILOBA
(tanakan, ginos,
bilobil, memoplant)
∙ Synthetic: ∙ amino acids GLYCINE (glycol)
∙ analogue of coenzyme Q10 IDEBETON (noben)
∙ pyrrolidone derivatives PIRACETS
(nootropil)
(cyclic derivatives of GABA) EPIRACETS
AMERACETS
OXYRATE
POLSIRACETAM
∙ pyridoxine derivatives PYRIDITOL (enerbol,
pyritinol, ecephabol)
GLUTAMINE ∙ ∙ dimethylamineethanol derivatives DEMANOL
ECLIDAN
ACEFEN
∙ HOPANTHENIC ACID (pantogam)
3. Drugs with neurotrophic action
CORTEKSIN
Cerebrolysin
4. Funds with vasoactive action
∙ Ca² antagonists + CINNARIZINE (stugerone, vertizin)
∙ Derivatives of alkaloids DIHYDROERGOCRYPTIN
ergot NITSERGOLIN (sermion)
∙ Derivatives of alkaloids CAVINTON (vinpocetine)
periwinkle VINKAMIN (oxybral)
VINCANOR
5. Combined funds
FESAM (PIRACETS + CINNARIZINE)
Mechanisms of action
1. Improving the bioenergetics of the brain.
Nootropic drugs increase the synthesis of ATP and cAMP, glucose utilization, increase glycolysis and aerobic respiration, and promote an increase in the activity of adenylate cyclase (for aging and neuropsychiatric diseases, energy deficiency and a decrease in the activity of adenylate cyclase in neurons are characteristic).
2. Increased synthesis and release of neurotransmitters.
Nootropic drugs activate the synthesis, release and turnover of dopamine, norepinephrine, acetylcholine, inhibit MAO, increase the formation of β - adrenergic receptors, cholinergic receptors and neuronal uptake of choline. In the mechanism of neurotransmitter release, the blockade of potassium channels is important, which facilitates membrane depolarization.
3. Increase in protein synthesis and membrane phospholipids.
Nootropic drugs improve the regeneration of neurons, activate their genome and increase the synthesis of informational neuropeptides, enhance the metabolism of phosphatidylcholine and phosphatidylethanolamine.
4. Improvement of cerebral blood flow and hemorheological parameters.
Nootropic drugs dilate cerebral vessels, improve blood flow in areas of cerebral ischemia, prevent the development of cerebral edema, block platelet aggregation, thrombus formation, improve the elasticity of erythrocytes and microcirculation. Nicotinic acid in PICAMILON has a direct vasodilating and anti-sclerotic effect.
5. Antioxidant action.
Nootropic drugs, inhibiting free radical peroxidation, protect against destruction of phospholipids of neuronal membranes, which facilitates the fixation of memory traces. Lipid peroxidation increases in the brain during organic diseases, aging and stress.
6. Potentiation of non-tropic effects of memory neuropeptides
PIRACETAM, whose pyrrolidone ring does not open to form a linear GABA molecule, is an agonist of receptors that receive signals from memory neuropeptides (fragments of ACTH, vasopressin, substance P). In terms of chemical structure, PIRACETS is similar to the cyclic form of the terminal amino acid of memory neuropeptides - pyroglutamate and affects receptors as an exogenous ligand. Probably, the most important for the mnemotropic action of PIRACETAM is the activation of AMPA - glutamic acid receptors.