4. Complications arising from the use of antibiotics, measures for their prevention.

1. Neurotoxic - damage to 8 pairs of cranial nerves, neuromuscular block.

2. Nephrotoxic; 3. Inhibition of hematopoiesis; 4. Irritation of the gastrointestinal tract; 5. Teratogenic action; 6. Dysbacteriosis, candidomycosis; 7. Allergic reactions - skin, anaphylactic shock, serum sickness, agranulocytosis; 8. Reduction of the therapeutic effect - with the indiscriminate use of antibiotics, non-compliance with dosages, frequency of use, course doses.

The success of antibiotic therapy depends on the fulfillment of the following basic conditions:

- it is necessary not only to choose the right antibiotic, but also to cancel it in a timely manner;

- when finishing antibiotic therapy, the drug is canceled immediately, and not gradually;

- the duration of the course of antibiotic treatment should be at least 6 - 8 (sometimes 10) days;

- with combined treatment with antibiotics with glucocorticoids, the antibiotic is canceled 3 to 5 days after the end of the course of hormone therapy;

- uncontrolled prescription of antibiotics leads to allergization of patients and an increase in the number of antibiotic-resistant microorganisms;

- the method of administration of antibiotics is selected depending on the localization of the infection, must be individual and quickly create the optimal concentration of the drug in the focus of infection;

- the frequency of antibiotic administration is determined by the duration of the bacteriostatic or bactericidal concentration of the drug in the blood;

- the maximum effectiveness of antibiotics is achieved when combined with other antimicrobial, antihistamines and vitamin preparations.

Ticket 32.

Question 1. Absorption of medicinal substances from the injection site. Transport of drugs across cell membranes.

Question 2. H-cholinomimetic substances. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Question 3. Stimulants of respiration. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

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

1. Absorption of medicinal substances from the injection site. Transport of drugs across cell membranes.1. Peroral route. The medicine taken by mouth first meets the acidic environment of the stomach and may lose its effectiveness. In addition, some foods slow down the process of digestion and evacuation from the stomach. Therefore, drugs must be taken either 30 minutes before meals, or 1 hour after. Solutions and powders are absorbed faster than tablets and capsules. Medicines designed for intestinal absorption (protected by a membrane from the effects of acid and pepsin) are resorbed in a weakly alkaline medium (pH 8.0 - 8.5). Fat-soluble drugs are also absorbed from oil solutions (for example, vitamins D, E, A, etc.), but only after the oil is emulsified with bile acids. After absorption in the stomach and intestines, medicinal substances enter the liver through the portal vein system, where they are partially bound and rendered harmless. Only after passing through the liver,

Sublingual path. Due to the rich vascularization of the oral cavity, the absorption of the preparations occurs quickly. They are not affected by proteolytic enzymes and hydrochloric acid. Such prepats are in the process of emergency assistance (antianginal). They enter the superior portal vein system and further into the general bloodstream, bypassing the liver.

Rectal pathway. The rectal route is used when it is impossible to use drugs inside (vomiting, unconsciousness). From the rectum, 50% of the dose is absorbed into the inferior vena cava system, bypassing the liver, 50% enters the portal vein and is partially inactivated in the liver.

Subcutaneous route. The drugs should not have an irritating effect (subcutaneous fatty tissue is rich in nerve endings) and cause vasospasm. The pharmacological effect occurs 15 to 20 minutes after injection. When solutions of the irritating substance calcium chloride and the strong vasoconstrictor noradrenaline are injected under the skin, necrosis occurs. This route of administration is commonly used in emergency response at the scene of a disaster for injections of pain relievers, vasoconstrictors, psychosedatives, tetanus toxoid, etc. This is the usual route of administration of insulin.

Intramuscular route. The introduction by this method is less painful than the introduction into the subcutaneous tissue. The most rapidly resorption comes from the deltoid muscle of the shoulder, more often in practice it is done in the outer upper quadrant of the gluteus muscle (it is more voluminous, which is important with multiple injections). When injecting oil solutions or suspensions, you must first make sure that the needle does not get into the vessel. Otherwise, vascular embolism with serious consequences is possible. Absorption can be accelerated by applying a heating pad or, alternatively, slowed down with an ice pack.

Intravenous route. Here, in a short time, the maximum (peak) concentrations of the substance in the heart are reached, high - in the central nervous system, only then its distribution in the body occurs. Some drugs may experience sensitization (that is, they have become allergens for the patient) or genetically determined hypersensitivity (idiosyncrasy). refusal of some drugs is required (novoca-ina, penicillins, etc.). Idiosyncrasy causes lightning-fast development of toxic reactions, which are impossible to predict. Therefore, injections of substances that are especially dangerous in this regard (iodine-reducing X-ray contrast drugs, quinine, etc.) are made in two stages: first,

a test dose (no more than 1/10 of the total) and, after making sure that the drug is sufficiently tolerated, the rest is injected after 3 - 5 minutes. Some substances irritate the vein wall. They should first be strongly diluted in an infusion solution (saline, glucose) and administered drip.

Intra-arterial pathway. The introduction of drugs into an artery is resorted to for special purposes, when it is necessary to create a large concentration of a drug (for example, an antibiotic, an antitumor agent, etc.) in the tissue or organ supplied by it.

It should be borne in mind that the walls of the arteries, in contrast to the venous ones, contain a significant amount of bound catecholamines (norepinephrine, adrenaline), which, when a substance with irritating properties is injected, can be released and cause a persistent spasm of the vessel with necrosis of the supplied tissue.

Intraosseous pathway. In terms of the rate of distribution of matter in the body, this path approaches the intravenous route. Applied only for extensive burns or situations that do not allow to enter otherwise.

Intracardiac path. This method of administering drugs (usually adrenaline) is practiced only in one case - during emergency therapy for cardiac arrest. The injection is made into the cavity of the left ventricle and accompanied by cardiac massage.

Subarachnoid path. It is used to inject local anesthetics or morphine-like analgesics (spinal anesthesia) into the spinal canal with a puncture of the membranes of the brain, as well as for chemotherapy of meningitis - infections that nest in the meninges and are difficult to access for drugs (penicillins, aminoglycosides, etc. etc.) introduced in other ways. Injections are usually done at the level of the lower thoracic - upper lumbar vertebrae. and. For punctures, it is advisable to use thin needles, since the hole in the dura mater is poorly tightened and the cerebrospinal fluid oozes through it into the tissue. This causes changes in intracranial pressure and severe headaches.

Biological barriers: mucous membrane of the stomach, intestines, oral cavity, nasopharynx, skin, geb, placental, mammary epithelium, renal.

Diffuse transport. The bottom line is that lipid-soluble substances easily dissolve in the membrane and move inside the cell by diffusion until the concentration outside and inside becomes the same. Moreover, they can accumulate in the membrane. (alcohols, ethers, etc.). Pinocytosis. The substance comes into contact with the membrane and this area bends inward, the edges close, a bubble is formed. It is transferred inside the cell. Some proteins are polypeptide hormones.

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).