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

Curariform funds - drugs that block neuromuscular transmission and relax skeletal muscles.

Classification:

1) Antidepolarizing- tubocurarine, pancuronium.

Mechanism of action: block H-cholinergic receptors and prevent the depolarizing effect of acetylcholine.

2) Depolarizing-ditilin

Mechanism of action: excite H-cholinergic receptors and cause persistent depolarization of the postsynaptic membrane.

3) Mixed action-dioxonium.

Muscle Relaxation Procedure: first the muscles of the head and neck, then the limbs, trunk, respiratory, the last - the diaphragm.

Indications:during operations to relax muscles, to facilitate intubation, for reposition of bone fragments and in case of dislocations, with tetanus and strychnine poisoning. They are not absorbed into the gastrointestinal tract - they are administered parenterally. Apply only if there are conditions for performing the arts of breathing.

Contraindications: diseases of the liver, kidneys, senile age, myasthenia gravis.

Side: muscle pain after surgery, increased blood pressure, arrhythmia, increased IOP

Tubocurarine - lowers blood pressure, increases the tone of the bronchi.

Pancuronium - M-anticholinergic action on the heart (tachycardia).

Ditilin - arrhythmias, increased blood pressure and intraocular pressure, muscle pain after surgery.

Dioxonium - lasts 20-40 minutes.

3. Means that affect appetite. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Funds affecting appetite are divided into 2 groups:

1.Appetite stimulants (carminatives)

2. Drugs that reduce appetite (anorexigenic drugs)

1.Media that stimulate appetite:

Bitterness

Insulin

Bitterness - plant-based substances containing glycosides with a strong bitter taste:

- Tincture of wormwood

- Bitter tincture

- Dandelion roots

- Calamus root

- Yarrow Herb

Mechanism of action: By irritating the taste buds of the mucous membrane of the mouth and tongue, they reflexively excite the center of hunger. With the subsequent meal, the first (complex reflex) phase of secretion of the stomach glands increases, appetite increases and digestion improves.

Indications for use: in case of impaired appetite in patients recovering from infectious diseases, after surgical interventions, in some neurological diseases accompanied by anorexia, as well as in hypoacid conditions, chronic atrophic gastritis.

Contraindications: with increased gastric secretion, gastric ulcer and duodenal ulcer, reflux esophagitis.

Insulinstimulates the hunger center, as it lowers blood glucose. There is an assumption that in the saturation center there are special "glycoreceptors" that respond to arteriovenous differences in glucose concentration. Assign 4-8 units in a vein.

Some psychotropic drugs (chlorpromazine, amitriptyline, lithium carbonate), neurotropic antihypertensive drugs (clonidine) and anabolic steroids also have a stimulating effect on appetite.

2. Drugs that suppress appetite (anorexigenic drugs).

Anorexigenic drugs are a group of sympathomimetic amines that stimulate the satiety center and depress the hunger center.

Anorexigenic drugs can be represented by the following groups of drugs:

1. Drugs affecting the catecholaminergic system:

Fepranone (amfepranone)

Dexfenfluramine (Isolipan)

2. Drugs affecting the catecholaminergic and serotonergic systems:

Sibutramine (meridia)

3. Cannabinoid receptor blocker (CB - 1):

Rimonabant (acomplia)

Indications for use:

1. Alimentary obesity with a body mass index of 30 kg / m² or more.

2. Alimentary obesity with a body mass index of 27 kg / m² or more in the presence of risk factors due to overweight (type II diabetes mellitus or dyslipoproteinemia). The drugs are used in combination with a low-calorie diet, 30-40 minutes before meals in the first half of the day. Treatment must be carried out under the supervision of a physician.

Fepranone (amfepranone) is an analogue of phenamine with a more selective, anorexigenic effect, as well as phenamine, fepranone enhances the release of norepinephrine and dopamine from nerve endings and inhibits their reuptake, which leads to stimulation of central adrenergic receptors and pre-familial receptors and oppression of the center of hunger.

Side effects:on the part of the cardiovascular system (tachycardia, increased blood pressure, arrhythmias), the central nervous system (anxiety, sleep disturbances), the gastrointestinal tract (GIT) (dry mouth, nausea, constipation or diarrhea). Addiction and physical drug dependence may develop.

Dexfenfluramine (Isolipane) is structurally similar to phenamine, but has a weak central stimulating activity and, at the same time, has a strong anorexigenic effect.

The side effects are the same as for Fepranone.

Sibutramine (meridia) inhibits the reuptake of serotonin, norepinephrine and dopamine, reduces the concentration of uric acid in the blood serum, and has a beneficial effect on lipid levels.

Side effects: possible increased blood pressure, tachycardia, sleep disturbance, headache, constipation, excessive loss of appetite.

Rimonabant (acomplia) blocks the CB-1 cannabinoid receptors, which leads to the suppression of the hunger center. Similar in effectiveness to sibutramine. Take it inside. T1 / 2 depends on body weight (ranges from 6-9 to 16 days). The drug is well tolerated.

Side effects: nausea, diarrhea, dizziness, depression, etc. are possible.

Contraindications to the appointment of anorexigenic drugs:

1.arterial hypertension

2.coronary insufficiency

3.disorders of cerebral circulation

4.neural diseases, accompanied by increased excitability and convulsions

5.tachycardia, arrhythmias

6. Simultaneous reception or a period of up to 2 weeks. after the abolition of MAO inhibitors.

7.hyperthyroidism

8.pheochromocytoma

9.glaucoma

10. drug or alcohol addiction

11.pregnancy, lactation

12.hypersensitivity to the drug

4. ANTISEPTICS OF AROMATIC AND ALIPHATIC SERIES. CLASSIFICATION. MECHANISM OF ACTION. INDICATIONS FOR USE. SIDE EFFECTS. CONTRAINDICATIONS. COMPARATIVE EVALUATION OF PREPARATIONS. Classification:

Organic antiseptics: aromatic (phenol group, nitrofuran production, dyes), aliphatic (formaldehyde group, alcohols, detergents).

Phenol group - phenol, resorcinol, birch tar. Nitrofuran derivatives - furacilin. Dyes - brilliant green, ethacridine lactate, methylene blue. Formaldehyde group - formalin, lysoform. Alcohols - ethyl alcohol. Detergents - chlorhexidine, cerigel, roccal

The mechanism of action of different antiseptics is not the same, it is aimed either at protein denaturation, violation of the permeability of the plasma membrane, inhibition of enzymes important for the vital activity of microorganisms.

Detergents (for example, cerigel) disrupt the structure of the cell membrane, cause denaturation of proteins, inhibition of enzymes. Used for processing hands, tools

Nitrofurans with a broad spectrum of action, are destructive for gram-positive and g- (treatment of wounds, mucous membranes, for washing serous, articular cavities) side: sometimes causes sensitization, dermatitis

Phenols: for vegetative forms of bacteria and fungi. (Disinfection of tools, household items) side: headache, collapse, shortness of breath.

Resorcinol - less antiseptic, keratoplastic and keratolytic action; with skin diseases.

Tar - antimicrobial, keratoplastic, keratolytic, irritating effect; for skin diseases, scabies.

Furacilin - antibacterial action; for treating wounds, washing cavities.

Dyes - antiseptic effect, antidote for cyanide poisoning; outwardly for the treatment of wounds.

Formalin, lysoform - disinfectant and deodorizing for sweating, for washing hands.

Hexamethylenetetramine (urotropine) is an antiseptic for diseases of the urinary tract.

Alcohols - for disinfection of instruments, treatment of the hands of the surgeon and the operating field.