Ticket 21

1. Basic principles of first aid for acute drug poisoning.

Poisoning can be accidental, deliberate and associated with the characteristics of the profession. Most often - poisoning with ethyl alcohol, sleeping pills, psychotropic, narcotic and non-narcotic analgesics, insecticides. The main task is to remove from the org-ma the substance that caused the intoxication. Detoxification principles: • delay absorption (gastric and intestinal lavage, adsorbents, laxatives, with parenteral administration - inject with adrenaline (vasoconstriction), ice pack, tourniquet); • to accelerate its withdrawal from the orgma - forced diuresis, peritoneal dialysis, hemodialysis, hemosorption, blood replacement, plasmapheresis, lymphodialysis, pulmonary hyperventilation, artificial respiration; • neutralize with antidotes. Antidotes: cause deionization of the poison, compete with biochemical structures for the capture of poison, compete with the poison for the capture of biochemical structures;

2. Alpha-adrenergic blocking agents. Classification. Mechanism of action. Indications for use. Side effects. Contraindications. Comparative evaluation of drugs.

Alpha-adrenergic blockers are substances that block alpha-adrenergic receptors and prevent their connection with catecholamines. Classification: I. Blocking alpha-adrenergic receptors:

1) Non-selective: fasting and presynaptic

-Phentolamine (alpha1, alpha2)

-Tropafen (alpha1, alpha2)

Nicergoline, pyrroxane, dihydroergotomin

2) Selective: postsynoptic

-Prazosin (alpha1), doxazosin, urapidil

Mechanism of action: block adrenergic receptors, disrupting interaction with mediators.

Main effects: vasodilation of the skin, mucous membranes, celiac vessels, ↓ blood pressure, improved tissue nutrition. Indications: hypertensive crises, migraines, peripheral vascular spasms, Raynaud's disease, leg ulcers, diagnosis and treatment of pheochromocytoma, peripheral circulation disorders, ischemic cerebral circulation, sympathoadrenal and diencephalic crises, neurodermatitis, withdrawal symptoms. Side effects: tachycardia, nausea, diarrhea, collapse, dizziness, vomiting. Contraindications: organic diseases of the heart and blood vessels, pregnancy, childhood, hypotension, impaired liver and kidney function.

Phentolamine - enhances gastrointestinal motility, increased secretion of gastric juice, quickly becomes addictive, acts for 10-15 minutes, improves the blood supply to organs, especially the skin, expands the pulmonary circulation, weakly absorbed from the gastrointestinal tract.

Tropafen - acts for a long time, lowers blood pressure, causes a slight tachycardia.

Prazosin is 10 times more active than phentolamine, does not affect heart rate, the duration of action is 6-8 hours.

3.Calcium channel blockers for the treatment of coronary heart disease. Classification Mechanism of action Side effects Contraindications Comparative assessment of drugs

Classification:

1) Diphenylalkylamines - verapamil, halopamil.

2) Benzothiazepines-diltiazem, clentiazem

3) Dihydropyridines-phenigidine, nifedipine, amlodipine, nislodipine, lerkamen

Mechanism of action: disrupt the entry of calcium into the muscle cells of the heart and blood vessels through slow calcium channels. They reduce the work of the heart, dilate the coronary vessels, reduce the need for and increase the delivery of oxygen.

Side effects: lowering blood pressure, increased heart failure, vomiting, dizziness, allergies.

Contraindications: arrhythmias caused by glycosidic intoxication.

Phenigidine - causes a pronounced expansion of the coronary vessels, lowers blood pressure, has a weak antiarrhythmic effect, the effect develops after 20 minutes for 6-8 hours.

Verapamil - reduces the flow of calcium into the cell, reduces potassium in the cell. The effect of coronary expansion, reduces the activity of the myocardium, blood pressure, oxygen consumption, reduces venous tone and platelet aggregation, increases urine output. The action develops after 2 hours.

Diltiazem - the action develops after 30 minutes.

4. Antibiotics of the penicillin group. Classification. Mechanism of action. Action character. Spetr of action. Indications for use. Side effects. Contraindications Indications. Comparative evaluation of drugs.

Classification: Natural (biosynthetic)

Parenteral: short-acting (3-4 hours) benzylpenicillin sodium salt

long-acting (depot-penicillin): benzylpenicillin novocaine salt, bicillin 1.5

Oral: phenoxymethylpenicillin

Semi-synthetic: a) resistant to penicillase: oxacillin, nafcillin, cloxocillin.

b) Broad spectrum of action: ampicillin, amoxicillin

c) A broad spectrum of action with antipseudomonal activity: carbenicillin

d) Inhibitor-protected: amoxiclav, trifamox, tazocin, tymentin.

e) Combined: ampiox.

Mechanism: inhibit the synthesis of cell wall components, prevent the formation of peptide bonds.

Mode of action: bactericidal, affect only dividing cells.

Spectrum e: gram (+) predominantly staphylococci, streptococci, meningococci, gonococci, spirochetes, clostridia, causative agents of diphtheria, anthrax, listeria.

Indications: upper respiratory tract infections (scarlet fever), erysipelas, rheumatism, pneumonia, meningitis, endocarditis, syphilis, leptosporosis, anaerobic infections.

Side effects: allergies, dysbiosis, glossitis, stomatitis, dyspepsia.

Contraindications: individual intolerance, allergies.

Benzylpenicillins act briefly (3-4 hours), bicillin - long-term (once every 7-14 days, months). Oxacillin is resistant to penicillinase, it is destroyed in an acidic environment. Nafcillin penetrates the BBB. Ampicillin is destroyed by penicillinase, acid-resistant. Carbenicillin is destroyed in an acidic environment and by penicillinase.

Benzylpenicillin is widely used in pediatrics because low toxicity, it can be administered in large doses. Not effective when taken by mouth, even in young children with low gastric acidity. Penicillin is a GABA antagonist and can cause seizures when given in large doses. The younger the child, the greater the risk of developing seizures. Ampicillin, when administered orally, causes diarrhea in a third of children. Oxacillin is capable of impairing liver function.