Ticket 25

1. Side and toxic effects of medicinal substances. Allergic and non-allergic side effects. Toxicity. Teratogenicity. Embryotoxicity. Carcinogenicity. Idiosyncrasy.

• Side effects - the rest, except for the main one, that is, beyond the scope of the purpose for which the drug is prescribed the effects of the drug when it is used in a therapeutic dose.

• Toxicity - the ability of a substance to cause disturbances in the physiological functions of the body. The toxic effect of medicinal substances develops, as a rule, with the growth of toxic doses of the substance into the body (with an overdose). In case of an absolute overdose (with an absolute excess of single, daily and course doses), excessively high concentrations are created in the blood and tissues. Toxic effect also occurs with a relative overdose of the drug, with the appointment of medium therapeutic doses to patients who have a reduced detoxification function of the liver or excretory function kidney, with long-term treatment with medicinal substances capable of cumulation.

• Allergic reactions (allos-other, ergon-action) - These reactions, which occur when drugs are re-administered, are based on immune mechanisms. Drugs in this case act as allergens. Allergic reactions do not depend on the dose of the administered substance and are varied in their own way nature and severity: from mild skin manifestations to anaphylactic shock. • Teratogenic action (teras-freak) - develops during 4-8 weeks of pregnancy. At this time, the formation of the skeleton and the laying of internal organs occurs. At this stage of pregnancy, organs and tissues are most sensitive to the action of damaging factors. Therefore, the use of medicinal substances can lead to abnormalities in the development of the skeleton and internal organs. in the first 12 weeks of pregnancy.

2. The history of the discovery of inhalation anesthesia (Pirogov, Kvarkov, Fedorov). Classification of drugs for anesthesia. Requirements for non-inhalation anesthetic drugs. Advantages and disadvantages of non-inhalation anesthesia in comparison with inhalation. Comparative characteristics of non-inhalation anesthetic drugs.

Classification: 1) HP, for inhalation anesthesia

Liquid: fluorothane; ENFLURANE; Ether for anesthesia

gas exchange: NITROGEN OXIDE; XENON

2) Ls, for non-inhalation anesthesia: HEXENAL; PROPOFOL; SODIUM OXIBUTIRATE; PROPANIDID

Chloroform was first used in Russia by N.I. Pirogov November 30, 1847 New discovery was marked by 1904, N.F. Kravkov and S.P. Fedorov was the first to use intravenous injection of hedonal, a derivative of barbituric acid, which was synthesized in 1903 by Fisher. Intravenous administration of barbiturates has become widely used both for independent anesthesia and in combination with ether anesthesia and local anesthesia.

Certain requirements are imposed on drugs for anesthesia. So, when using them, anesthesia should come quickly and, if possible, without the stage of excitement. A sufficient depth of anesthesia is required to ensure optimal conditions for the operation. An important point is good controllability of the depth of anesthesia during the use of anesthetic agents. Desirably, without consequences. This facilitates the post-anesthetic period.

The advantages of inhalation anesthesia are: • High controllability (the ability to change the depth of anesthesia, long-term maintenance of anesthesia and rapid awakening of the patient); • Possibility of combining the supply of anesthetic with mechanical ventilation, i. E. gas exchange control;

• Good compatibility with other drugs for general anesthesia and the provision of other components of anesthetic management.

Despite all the modifications of inhalation anesthesia, in general, a number of disadvantages are inherent:

• The dosage of inhalation anesthetics using imperfect anesthetic (most domestic) devices may be inaccurate; • Under any operating modes of the anesthesia machine, except for a closed circuit, the air in the operating room is contaminated with anesthetic vapors; • Inhalation anesthesia, especially when using reversible circuits, requires complex expensive equipment; • Anesthetic and respiratory equipment requires special sanitization, if improperly carried out, it can become a source of spread of pathogens of nosocomial infections (ventilator-associated pneumonia).

Propofol exit from anesthesia is very fast, has antiemetic activity. Longer anesthesia is provided by derivatives of barbituric acid sodium thiopental, hexanal.