3. Preparations of pituitary hormones. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Share pituitary gland	Hormone	Hormone preparations
Front	Adrenocorticotropic hormone (ACTH)	Corticotropin Tetracosactide
	Growth hormone (growth hormone, STH, somatotropin)	Somatotropin Somatrem
	Thyroid stimulating hormone (thyrotropin, TSH)	Tyrotropin
	Follicle-stimulating hormone (follitropin, FSH)	Menotropins (menopausal gonadotropin, pergonal, menogon) Urofolitropin Folitropin alpha Folitropin beta
	Luteinizing hormone (lutotropin, LH)	Chorionic gonadotropin Lutropin alpha
	Lactotropic hormone (prolactin, LT)	Lactin
Average	Melanotropic hormone (melatropin, melanocyte-stimulating)	Intermedin
Back	Oxytocin	Oxytocin
	Vasopressin (antidiuretic hormone)	Vasopressin, Desmopressin Terlipressin Pituitrin Adiurecrin

Corticotropin - a diagnostic tool for assessing the reserves of the adrenal cortex in primary adrenal insufficiency or in case of its hypofunction against the background of prolonged use of glucocorticoids.

Tetracosactide (synacthen depot, cozintropin)

• has less immunogenicity

• less likely to cause allergic reactions

lasts longer and can be applied once a day.

Indications for use

- prevention of complications of long-term use of GC;

- in the complex therapy of connective tissue diseases, allergic diseases, dermatoses, ulcerative colitis.

Genetically engineered somatotropin analogs - sayen, humatrop, biosome, genotropin, zomactone, norditropin

Indications for use:

• pituitary dwarfism;

• growth disorders in children with chronic renal failure;

• gonadal dysgenesis (Shereshevsky-Turner syndrome)

Menotropins (menopausal gonadotropin, pergonal, menogon, humegon) - FSH and LH in a 1: 1 ratio (75 IU each).

Urofolitropin - FSH and a small amount of LH.

Follitropin alpha (gonal-F) and follitropin beta (puregon) - recombinant FSH.

Indications for use

Among women - anovulatory infertility due to hypothalamic-pituitary disorders during reproductive procedures.

in men - violation of spermatogenesis, hypothalamic-pituitary hypogonadism.

Oxytocin

Desaminooxytocin (Sandopart, Demoxytocin)

(tablet form, buccal, does not increase blood pressure)

Hyphotocin (pituitrin M)

Indications for use:

• stimulation of labor in post-term pregnancy, premature discharge of amniotic fluid, weakness of labor in the second stage of labor (expulsion of the fetus);

• treatment and prevention of atonic uterine bleeding after abortion, in the early postpartum period;

• to accelerate the involution of the uterus;

• hypolactation in the postpartum period.

4. Antibiotics from the group of macrolides and aminoglycosides. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Macrolides are low-toxic agents for oral administration for infections caused by G + bacteria and intracellular microorganisms. There are 3 generations of macrolides:

4. Erythromycin, oleandomycin

5. Spiramycin, dirithromycin

6. Azithromycin (sumamed)

Mechanism of action of AB - inhibit microbial cell protein synthesis

Origin classification:

Natural - erythromycin, oleandomycin, spiromycin

Prodrugs - oleandomycin-troleandromycin esters

Semi-synthetic - azithromycin

Macrolides, depending on the type of microorganism and dose, can have a bracteriostatic or bactericidal effect. Spectrum of action: staphylococcus, streptococcus, pneumococcus, meningococcus, gonococcus, corynebacterium diphtheria, clostridium gas gangrene

Macrolides are prescribed orally and some intravenously (erythromycin).

Macrolides:

- have a mucoregulatory effect

- weaken the inflammatory reaction as a result of inhibition of the synthesis of PG, LTE and IL

- about immunomodulatory properties

Indications for use: - infections of the upper and lower respiratory tract - whooping cough and its prevention - diphtheria - infections of the skin and soft tissues - other functions of the oral cavity - trachoma - sexually transmitted infections

Side-by-side: - nausea, vomiting - cramping abdominal pain - fever - jaundice - with i / v - thrombophlebitis, Hearing impairment

Contraindications: - hypersensitivity - pregnancy - breast-feeding

There are 3 generations of aminoglycoside antibiotics (classification):

- I generation - streptomycin, kanamycin, neomycin (used only for local action);

- II generation - gentamicin, tobramycin, amikacin;

- III generation - netilmicin (has less oto- and vestibulotoxicity).

Streptomycin and kanamycin suppress mycobacterium tuberculosis, streptomycin is active against brucella, the causative agents of plague and tularemia. The most sensitive to neomycin are Escherichia coli, Klebsiella, Enterococcus, Proteus and Enterobacter species. Antibiotics of the II - III generation are toxic for E. coli, Klebsiella, Serration, Pseudomonas aeruginosa, Proteus species, Enterobacter and Acinetobacter. All aminoglycosides inhibit 90% of Staphylococcus aureus strains. Resistance to aminoglycosides is characteristic of anaerobic bacteria, hemolytic streptococci, and pneumococci.

The bactericidal effect of aminoglycosides is due to the formation of abnormal proteins and the detergent effect on the lipoprotein cytoplasmic membrane of microorganisms.

Antibiotics of the β-lactam group, inhibiting the synthesis of the cell wall, potentiate the antimicrobial effect of aminoglycosides. Levomycetin, blocking transport systems in the cytoplasmic membrane, weakens their action.

When these antibiotics are taken by mouth, dyspeptic disorders are common. Anaphylactic shock is mainly caused by streptomycin sulfate, which in this respect is in second place after penicillin preparations.

Aminoglycosides can disturb hearing, balance (in 10 - 25% of patients), kidney function, and cause neuromuscular blockade. At the beginning of aminoglycoside therapy, tinnitus appears.

Aminoglycosides are contraindicated in hypersensitivity, botulism, myasthenia gravis, Parkinson's disease, drug parkinsonism, hearing and balance disorders, severe kidney disease. Their use during pregnancy is allowed only for health reasons. During treatment, breastfeeding is stopped.

Indications:Tuberculosis-streptomycin, kanamycin; plague streptomycin; tularemia-streptomycin, gentamicin, brucellosis-streptomycin

purulent-septic diseases - sepsis, peritonitis, meningitis, abscess;

postoperative infectious complications;

kidney infections - pyelonephritis, respiratory tract - pneumonia, lung abscess;

infective endocarditis;