Ticket 8

one. Basic principles and methods of testing new medicinal substances. The concepts of "placebo" and "blind" control. The ethical side of prescribing a placebo.

Principles of clinical research of new drugs:

• Selection of a homogeneous population of patients;

• Exact e-z b-no and a similar severity of the disease;

• Control group b-n;

• Similar dosage of drugs;

• Pharmacokinetic research;

• Choice of sensitivities of the effects typical for the given island;

• Quantification of effects;

• Sufficient volume of research for stat processing;

• Use of "placebo" and "double-blind method" research;

• Comparison with reference drugs of this group;

• Simultaneous research of new and reference drugs;

• Compliance with ethical principles.

A placebo is taken when the element of suggestion plays a role in the effect. Placebo drugs do not contain. In the case of "blind control", the patient alternates between medicine and placebo in a sequence unknown to him, only the attending physician knows when the patient is taking a placebo. In case of "double blind control" the third person knows about it. This principle of research allows you to objectively assess the e-v-v.

2. H-cholinomimetic substances. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Compare the markup of drugs.

- Cititon (ampoules for i / v)

- Lobelin

They work for 5-10 minutes and are available in the form of ampoules for intravenous administration.

Mechanism of action: they have an effect on n-cholinergic receptors in two phases - the stage of excitation is replaced by the stage of oppression. They speed up breathing, constrict blood vessels, increase blood pressure.

Indications: respiratory depression, the threat of stopping it (carbon monoxide poisoning, mechanical asphyxia, drowning), newborn asphyxia, shock, collapse, are part of Lobelin and Tabex tablets, which are used for smoking cessation.

Side effects: nausea, vomiting, weakness, dizziness.

Contraindications: atherosclerosis, high blood pressure, bleeding from large vessels, pulmonary edema.

Lobelin and tsititon are respiratory analeptics of reflex action. In phase I, receptors are excited, the glomeruli of the carotid sinuses are most sensitive - the respiratory center is excited. Excitation of the chromaffin substance of the adrenal glands - an increase in blood pressure (lobelin lowers blood pressure).

3. Anticoagulants. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Classification:

I - straight lines (heparin, hirudin, sodium citrate);

II - indirect (neodikumarin, syncumar, phenylin).

Mechanism of action: direct - directly affect the coagulation factor in the blood; act quickly. Indirect - they do not affect blood coagulation factors, disrupt the synthesis of coagulation factors in the liver, the effect develops slowly.

Heparin is a mucopolysaccharide. It is synthesized and deposited in mast cells. Action: 1) antithromboplastin, 2) antiprothrombin, 3) antithrombin, 4) reduces platelet aggregation, 5) increases fibrinolysis. Action 1,2,3 - the transformation of prothrombin into thrombin, fibrinogen into fibrin is disrupted. Indications: heart attack, thrombosis, vascular embolism, hemodialysis, blood transfusion, topically for phlebitis. Side effects - allergies, hemorrhages. Cannot be used for bleeding, decreased clotting rate, septic endocarditis, leukemia.

Hirudin - leeches (secrete hirudin); indications: hypertensive crisis, superficial thrombophlebitis.

Na citrate - for blood preservation, mechanism: calcium binding and clotting disorders.

Indirect anticoagulants - all have a common mechanism. They have a structural similarity to vitamin K. They interfere with the metabolism and disrupt the synthesis in the liver of prothrombin, proconvertin, factors 9 and 10. The latent period is 24-72 hours, after cancellation the action lasts 2-5 days. Indications: thrombophlebitis, thrombosis, heart attack, ischemic heart disease. Cannot be used for endocarditis, peptic ulcer disease, pregnancy. Side effects - hemorrhages, cumulation.

four. Antibiotics of the group of Lincosamides and Glycopeptides. Classification. Mechanisms of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Classification: lincosamides - lincomycin, clindamycin; glycopeptides - vancomycin.

Mechanism: lincosamides inhibit protein synthesis and ribosome function, glycopeptides disrupt cell wall synthesis.

Mode of action: lincosamides - bacteriostatic, glycopeptides - bactericidal.

Spectrum of action: anaerobes, streptococci, staphylococci.

Indications: for bacteroid infections, diphtheria.

Side effects: allergies, liver damage, leukopenia, lincosamides - pseudomembranous colitis.

Contraindications: pregnancy, liver disease, kidney disease.

Clindamycin is stronger than lincomycin, it does not penetrate the BBB. Vancomycin - penetrates the BBB, is toxic (nephro, oto). Lincomycin - accumulates in bone tissue, most effective in the treatment of bone diseases.