2). Antiepileptic drugs. Classification. Mechanism of action. Side effects. Contraindications Comparative evaluation of drugs.

Classification of antiepileptic drugs according to the mechanism of action.

I. Means that block the sodium channels of neurons:Sodium valproate; Lamotrigine; Topiramate; Diphenin; Carbamazepine; Hexamidine

II. Drugs blocking calcium channels of neurons:Sodium Valproate; Etosuximide; Trimetin

III. Agents that activate the gabAergic system

1. Increasing the affinity of GABA to GABAA receptors: Benzodiazepines (diazepam, lorazepam, clonazepam); Phenobarbital; Topiramate

2. Contributing to the formation of GABA and preventing its inactivation: Sodium valproate

3. Interfering with GABA inactivation: Vigabatrin

4. Blocking neuronal and glial uptake of GABA: Tiagabin

5. Enhancing the release of GABA into the synaptic cleft: Gabapentin

IV. Agents that lower the activity of the glutamatergic system

1 drugs that reduce the release of glutamate from presynaptic endings: Lamotrigine

2.Media blocking glutamate receptors: Topiramate.

Mechanism of action: inhibit interneuronal transmission of excitation (by all mechanisms described in the classification).

Side effects:

1. Sedation, impaired ability to concentrate and slow down the speed of psychomotor reactions; 2. Dyspeptic disorders (nausea, vomiting, epigastric discomfort); 3. Inhibition of hematopoiesis; 4. Hepatotoxicity (diphenin, sodium valproate); 5. Allergic reactions; 6. Neurotoxicity; 7. Teratogenicity (sodium valproate, diphenin, carbamazepine); 8. Carbamazepine (with prolonged use) - bradycardia, arrhythmia, antidiuretic effect with the appearance of edema, in women - the risk of polycystic ovary disease; 9. Sodium valproate - weight gain, polycystic ovary; 10. Diphenin - gingival hyperplasia; 11. Etosuximide - parkinsonism, photophobia.

Contraindications:

1. Hypersensitivity to the drug; 2. Severe violations of the liver and kidneys; 3. Heart failure, bradycardia; 4. Pregnancy (I trimester); 5. Lactation period; 6. Myasthenia gravis; 7. Diseases of the hematopoietic system; 8. Potentially hazardous activities requiring increased attention and speed of psychomotor reactions.

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

Classification by mechanisms and localization of action:

1. Means directly affecting the function of the epithelium of the renal tubules:

● acting in the initial section of the distal tubules (blockers of Na + -Cl- transport, reduce sodium and water reabsorption)

–Thiazide diuretics - hydrochlorothiazide, cyclomethiazide

–Thiazide-like diuretics - clopamide, chlorthalidone, indapamide

● acting in the thick segment of the ascending part of Henle's loop ("loop" diuretics, blockers of Na + -K + transport, inhibits the reabsorption of chlorine and sodium)

–Furosemide, torasemide, ethacrynic acid, xypamide

● acting in the end section of the distal tubules and collecting ducts

–Blockers of Na + channels - triamterene, amiloride

- aldosterone antagonists - spironolactone (increase urinary excretion of sodium, chlorine and water).

2. Osmotic diuretics (act in all parts of the nephron, but to a greater extent - in the proximal tubules, increase the osmotic pressure in the renal tubules, while reducing the reabsorption of water and sodium).

mannitol (mannitol)

3. Carbonic anhydrase inhibitors (reduced reabsorption of bicarbonate, act in the proximal tubules)

acetazolamide (diacarb), dorzolamide (trussopt).

Mechanisms: from the classification.

Thiazide and thiazide-like diuretics.

Indications for use:Arterial hypertension; Edema with CHF; Edema in liver and kidney pathology (ineffective in acute renal failure); Urolithiasis (in the presence of calcium stones); Indapamide - arterial hypertension only.

Side: hypokalemia, hypomagnesemia, nausea, vomiting, diarrhea, weakness, hyperglycemia, allergies.

Loop diuretics (have the fastest and most powerful effect).

Indications for use:Pulmonary edema, cerebral edema; Acute poisoning (for forced diuresis); Edema in heart failure (AHF and CHF); Edema with pathology of the liver and kidneys; Acute renal failure (in the oliguric phase); Hypertensive crisis and severe forms of hypertension; Hypercalcemia (eg, with an overdose of ergocalciferol)

Side: headache, hearing loss, allergic reactions, dry mouth.

Potassium-sparing diuretics

The diuretic activity of potassium-sparing drugs is low, so they are usually used together with thiazide, thiazide-like or loop diuretics to prevent and correct hypokalemia.