Ticket number 28

1. Combined action of medicinal substances. Synergy. Antagonism. Antidote.

Medical statistics show that for the treatment of an "average" patient in a hospital, he is prescribed in parallel from 4-6 to 10 or more different drugs. The justification for combined treatment is obvious: the need to influence different links of the pathological process, which allows you to achieve better results and at the same time reduce the dose of each of the components. Despite all reasonable arguments, the world experience of medicine shows that the greatest number of complications is associated precisely with polypharmacy, that is, with the simultaneous and insufficiently substantiated (according to the choice of components and doses) the appointment of several potent substances without taking into account their interaction in the conditions of the patient's organism and the presence of diseases associated with the main, age-related and other conditions.

When several drugs are used together, it should be remembered that they can change both the pharmacinetics and pharmacodynamics of each other. There are the following types of drug interactions: 1) Pharmacokinetic (with absorption, binding to plasma proteins, distribution, biotransformation and excretion); 2) Pharmacodynamic (at the level of receptors, ion channels, enzymes, pharmacological effects, etc.); 3) Physicochemical interaction between substances in the environments of the body.

The unidirectional end effect of two or more substances is denoted by the term synergism. The action can be implemented as a simple addition of unidirectional effects (summation).

Drug interactions can be of the opposite type, i.e. lead to mutual weakening, repayment of the final pharmacological effect - drug antagonism. Antagonism is widely used in medicine to correct adverse reactions (it can only concern them), to treat poisoning with drugs and poisons in general. In the latter case, one speaks of an antidote action. Interactions (and antidote effects) can sometimes result from direct chemical binding with neutralization or loss of absorption.

2. Psychostimulants. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Classification: 1) Phenylalkylamines-phenamine; 2) Derivativeth piperidine-pyridrol, meridil; 3) Etcderivatives of sydnoneimine-sydnocarb; 4) Methylxanthines-caffeine.

Mechanism of action: improves mood, the ability to perceive external stimuli, psychomotor activity, performance, reduces fatigue, the need for sleep. The stimulating effect is associated with the stimulation of the reticular formation.

Indications: depression, narcolepsy.

Side effects: dependence, dyspepsia, agitation, insomnia, tachycardia, arrhythmias.

Contraindications: hyperexcitability, insomnia, ↑ blood pressure, glaucoma, CVS disease.

Phenamine - all properties, reduces hunger, stimulates the respiratory center, ↑ blood pressure, cumulates (causes addiction).

Pyridrol is like phenamine, meridil is weaker, both drugs have no effect on CVS.

Sydnocarb is less toxic, the effect develops gradually, hemodynamics does not suffer.

Caffeine - increases arousal in the central nervous system, reduces internal inhibition. The effect depends on the dose and the type of central nervous system. Increases skeletal muscle tone, diuresis and basal metabolism, slows down the heart rate. It stimulates the respiratory and vasomotor centers. Dependence is possible.

3. Preparations of thyroid hormones. Antithyroid drugs. Preparations of hormones of the parathyroid glands. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

THYROID HORMONE PREPARATIONS

Classification

one) Thyroxin preparations: LEVOTYROXIN

2) Triiodothyronine preparations: TRIODTHYRONINE

3) Combined drugs: THYREOIDIN, TYREOTOM, TYREOCOMB, NOVOTIROL

INDICATIONS FOR USE - Hypothyroid conditions, myxedema, cretinism, Autoimmune thyroiditis, Thyroid carcinoma, Endemic and sporadic goiter.

SIDE EFFECTS - Tachycardia, arrhythmias, pain in the heart, Tremor, Diarrhea, vomiting.

CONTRAINDICATIONS - Thyrotoxicosis, Myocardial infarction, IHD, Acute myocarditis, Uncontrolled adrenal insufficiency, Severe arrhythmias.

ANTITHERIOID DRUGS

Classification:

one) Drugs that reduce the production of thyroid-stimulating hormone and its release from the pituitary gland: SODIUM IODIDE, POTASSIUM IODIDE, DIODTHYRONINE

2) Drugs that inhibit the synthesis of thyroid hormones in the thyroid gland: MERCAZOLIL, PROPILTHIOURACIL

3) Drugs that interfere with the absorption of iodine by the thyroid gland: POTASSIUM PERCHLORATE

four) Drugs that destroy the cells of the thyroid follicles: RADIOACTIVE IODINE

1. MECHANISM OF ACTION - When the level of iodine in the blood rises, the production of thyroliberin in the hypothalamus decreases due to negative feedback, as a result of which the synthesis of thyroid-stimulating hormone in the pituitary gland decreases and its stimulating effect on the thyroid gland decreases.

INDICATIONS FOR USE - Hyperfunction of the thyroid gland:

SIDE EFFECTS - Allergic reactions, Dyspeptic symptoms, Signs of iodism

CONTRAINDICATIONS - Hypersensitivity to iodine, Benign tumors of the thyroid gland, Hemorrhagic diathesis, Urticaria.

2. MECHANISM OF ACTION - Suppress the synthesis of thyroxine in the thyroid gland, blocking peroxidase, which provides iodination of di-, tri- and tetraiodothyronine.

INDICATIONS FOR USE - Diffuse toxic goiter of varying severity SIDE EFFECTS - Goitrogenic effect, leukopenia, agranulocytosis, Nausea, vomiting, Liver dysfunction, allergies, Pain in joints and muscles.

CONTRAINDICATIONS - Pregnancy, lactation, Severe leukopenia, granulocytopenia, Nodular goiter.

3. MECHANISM OF ACTION - Reduces the ability of the thyroid gland to accumulate iodine, which leads to inhibition of the formation of thyroxine.

INDICATIONS FOR USE - Diffuse toxic goiter of mild to moderate severity.

SIDE EFFECTS - Thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, Zobogenic effect.

CONTRAINDICATIONS - Pregnancy, Peptic ulcer of the stomach and duodenum, Diseases of the hematopoietic system.

4. MECHANISM OF ACTION - Radioactive iodine is captured by the cells of the thyroid gland - Cell destruction.

INDICATIONS FOR USE - Hyperfunction of the thyroid gland:

SIDE EFFECTS - Signs of radiation sickness, Hypothyroidism.

CONTRAINDICATIONS - Pregnancy, lactation.

PREPARATIONS FOR PARTHYGROID HORMONES

PARATYREODIN

INDICATIONS FOR USE - Chronic hypoparathyroidism, Tetania in adults, spasmophilia in children.

SIDE EFFECTS - General weakness, Nausea, vomiting, diarrhea

CONTRAINDICATIONS - hypercalcemia.

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

Classification: Tetracyclines: in the structure of 4 condensed cycles: natural (tetracycline) and semi-synthetic (doxycycline, morphocyclin, metacyclin). Levomycetin belongs to nitrobenzenes.

Mechanism: inhibit protein synthesis and ribosome function.

Mode of action: bacteriostatic. Penetrate barriers.

Spectrum: wide - gram (+) (-), amoebae, spirochetes, pathogens of AOI, rickettsia, chlamydia. I do not act on Proteus, Pseudomonas aeruginosa, viruses, fungi.

Indications: tetracycline - broad. Levomycetin - typhoid fever, salmonellosis, rickettsioses

Side effects: a decrease in hematopoiesis to agranulocytosis, irritate the gastrointestinal tract, teratogenic (tetracyclines), allergies, dysbiosis, candidiasis.

Contraindications: allergies, liver, kidney, blood diseases, pregnancy, children.

Doxycycline and metacyclin last longer (up to 12 hours). All are reserve antibiotics (very toxic).

Tetracyclines are very toxic, therefore they are rarely used in children, especially those for 3-5 years. Levomycetin in children under 3 years of age is used to a limited extent, because toxic effects may occur.