Ticket 33.

Question 1. Features of the action and dosage of drugs for various routes of administration.

Question 2. Antipsychotics. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs. The concept of neuroleptanalgesia.

Question 3. Class IV antiarrhythmics (calcium channel blockers). Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Question 4. Antimicrobial agents - quinolone derivatives. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

1. Features of the action and dosage of medicinal substances for various routes of administration.

The rate of development of the effect, its severity and duration depends on the routes of administration and dose. Sometimes the route of administration determines the nature of the action. Routes of administration: enteral and parenteral.

Enteral: through the mouth, under the tongue, buccal, into the duodenum, rectally. When administered by mouth, sterility is not required. Absorption more often occurs in the small intestine (large absorption surface and intensive blood supply), the process is relatively slow, first the substances enter the liver, then into the blood. If the drug is destroyed by gastric juice or irritates the mucous membrane, it is prescribed in capsules. When administered under the tongue, absorption is fast, bypasses the hepatic barrier, even at a small dose. Into the 12-finger, the intestine is introduced through a tube. Rectally - enters the bloodstream, bypassing the liver; not affected by gastrointestinal enzymes.

Parenteral: subcutaneous, intramuscular, intravenous, intravenous, intrasternal, intraperitoneal, inhalation, subarachnoid, intrapleural, transdermal, intranasal. Most often under the skin, into a muscle, into a vein (the effect is the fastest). In oil, injected i / m to prolong the effect. Irritating substances in / m and s / c are not administered (necrosis). IV is injected slowly, insoluble compounds, oil solutions (embolism), irritating substances (thrombophlebitis), drugs that cause blood coagulation or hemolysis cannot be injected. In / arter introduction is used in the diagnosis of tumors, blood clots. Intrasternal route is taken if IV is impossible (children, old people). In / peritoneally enter during operations. Inhalation aerosols. Into the islands, poorly penetrating through the BBB, are introduced under the membranes of the brain. Dose - number of in-va for 1 reception. Distinguish between single, daily, doses, course dose (antibiotics), loading dose.

2. Antipsychotics. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs. The concept of neuroleptanalgesia.

Antipsychotics - ggroup of drugs with antipsychotic properties, i.e. the ability to eliminate or suppress the productive symptoms of psychosis in the form of disorders of thinking (delirium), perception (auditory, visual, olfactory hallucinations) and motor activity.

Classification:

BUT. Typical antipsychotics (often cause extrapyramidal disorders)

1.Phenothiazine derivatives: AMINAZINE, TRIFTHAZINE, FLUOROPHENAZINE, ETHAPERAZINE

2. Derivatives of butyrophenone: GALOPERIDOL, DROPERIDOL

3. Derivatives of thioxanthene : CHLORPROTIXENE

B. "Atypical" antipsychotics (do not cause or very rarely cause extrapyramidal disorders)

1. Derivatives of dibenzodiazepine: KLOZAPIN, QUETIAPIN

2. Benzamide derivatives: SULPIRIDE

3. Derivatives of benzisoxazole: RISPERIDON

The main mechanism of action of neuroleptics is blockade of dopamine receptors of the mesolimbic system, this action determines their ability to eliminate delusions, hallucinations, psychomotor agitation... In addition, antipsychotics can block serotonin, histamine, and alpha-adrenergic receptors in the central nervous system....

AMINAZINE has a pronounced effect on the central nervous system, as well as on peripheral innervation, executive organs and metabolism.

AMINAZIN is characterized by antipsychotic and sedative effects, the ability to cause extrapyramidal disorders with prolonged use. In large doses, it pulls out a hypnotic effect. Aminazine causes a decrease in motor activity, inhibits the center of heat regulation, hypotremia is observed, has an antiemetic effect, potentiates the action of neutrotropic drugs (anesthesia, opioid analgesics). Reduces blood pressure.

TRIFTHAZINEcharacterized by more selective than chlorpromazine, antipsychotic effect and less pronounced sedative. Differs in weak hypotensive and muscle relaxant action.

Indications for use - Psychoses of various origins - Acute psychomotor agitation - Vomiting of central genesis - Premedication - Neuroleptanalgesia - Hyperthermia - Severe hypertensive crises (chlorpromazine, droperidol) - Withdrawal syndrome in alcoholism and drug addiction

Side-by-side: - Extrapyramidal Disorders - fromdullness, lethargy, muscle weakness, depression - Hyperprolactinemia, galactorrhea, gynecomastia, amenorrhea, infertility, decreased potency - Increased appetite and body weight - Impaired thermoregulation (hypothermia) - Decreased blood pressure, orthostatic hypotension - Hematopoietic disorders (lekopenia, agranulocytosis, hemolytic anemia - Photosensitization and skin pigmentation

Contraindications: - Cardiovascular disease with decompensation - Pathology of the liver, kidneys (hepatitis, cirrhosis, nephritis) - ddepression - Parkinsonism - Hematopoietic disorders (leukopenia) - Diabetes - Glaucoma - Pregnancy, lactation

Neuroleptanalgesia is a combined method of intravenous general anesthesia, in which the patient is conscious, but does not experience emotions (neurolepsy) and pain (analgesia).