3) Drugs used in myocardial infarction. Classification. Mechanism of action. Side effects. Contraindications Indications for use. Comparative characteristics

Classification:

- narcotic analgesics

- antiarrhythmic

- vasopressor

-beta1-blockers

- anticoagulants

-antiplatelet agents

- fibrinolytic agents

1) Narcotic analgesics - fentanyl, morphine.

Mechanism of action:

1) Suppression of the conduction of pain impulses in the afferent pathways of the central nervous system.

2) Strengthening the inhibitory effect of the descending antinoceptive system on the conduction of pain impulses in the afferent pathways of the central nervous system.

3) Change in emotional assessment of pain.

Side effects - nausea, vomiting, respiratory depression.

Contraindications –Insufficiency of the respiratory center, children and old age, pregnant and lactating.

2) Antiarrhythmic-lidocaine.

Mechanism of action:They make it difficult for Ca to enter the cell. Reduce the automatism of the sinus-atrial node, inhibit conduction, increase the effective refractory period (in the AV node). Because of this, stimuli of excessively high frequencies do not go to the ventricles of the heart, their activity is normalized.

Side effects: ringing in the ears, blurred vision, diarrhea, lowering blood pressure.

Contraindications: atrioventricular block, liver disease.

3) Vasopressor means-mezaton.

4) Beta1-blockers-metoprolol. It is used to reduce the activity of the heart and with tachycardia.

Mechanism of action:blockade of beta-adrenergic receptors of the heart, blood vessels. They cause bradycardia, reduce the force of heart contractions, reduce the minute volume of the heart, blood pressure gradually decreases, the effect develops in 2-3 weeks.

Contraindications: AV block, heart failure, bradycardia.

Side effects: increase bronchial tone, vomiting, bradycardia, allergies.

5) Anticoagulants - unfractionated heparin.

Side effects: allergies, hemorrhages.

Contraindications: bleeding, decreased clotting rate, leukemia.

6) Antiplatelet agents - acetylsalicylic acid.

Side effects: dyspepsia, thrombocytopenia, allergies.

Contraindications: hypersensitivity, aortic aneurysm, heart failure.

7) Fibrinolytics:

Mechanism:1) act directly on the fibrin clot, promote thrombus lysis. Profibrinolysin penetrates deep into the clot, fibrinolysin acts superficially. 2) promote the conversion of profibrinolysin into fibrinolysin.

Side effects: bleeding, lowering blood pressure, fever, allergies.

Contraindications: bleeding, peptic ulcer, fibrinogenopenia.

four)Antibiotics from the group of macrolides and aminoglycosides. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Macrolides are low-toxic agents for oral administration for infections caused by G + bacteria and intracellular microorganisms.

IV. MACROLIDES

I generation Natural ERYTHROMYCIN OLEANDOMYCIN

II generation Natural SPIRAMYCIN (Rovamycin) JOSAMYCIN MIDECAMYCIN (Macropen) Semi-synthetic ROXITROMYCIN (Rulide) CLARITROMYCIN (Klacid, Fromilide)

III generation Semi-synthetic AZITROMYCIN (sumamed)

Mechanism of AB action - inhibit microbial cell protein synthesis

Macrolides, depending on the type of microorganism and dose, can have a bracteriostatic or bactericidal effect. Spectrum of action: staphylococcus, streptococcus, pneumococcus, meningococcus, gonococcus, corynebacterium diphtheria, clostridium gas gangrene

Macrolides are prescribed orally and some intravenously (erythromycin).

Macrolides:

- have a mucoregulatory effect

- weaken the inflammatory reaction as a result of inhibition of the synthesis of PG, LTE and IL

- about immunomodulatory properties

Indications for use:

- infections of the upper and lower respiratory tract

- whooping cough and its prevention

- diphtheria

- infections of the skin and soft tissues

- other functions of the oral cavity

- trachoma

- sexually transmitted infections

Side-by-side:

- nausea, vomiting

- cramping abdominal pain

- fever

- jaundice

- with i / v - thrombophlebitis,

Hearing impairment

Contraindications:

- hypersensitivity

- pregnancy

- breast-feeding

II. AMINOGLICOSIDES

I generation STREPTOMYCIN NEOMYCIN CANAMYCIN MONOMYCIN

II generation GENTAMYCIN TOBRAMYCIN NETILMYCIN (netromycin)

III generation AMIKACIN

There are 3 generations of aminoglycoside antibiotics (classification):

- I generation - streptomycin, kanamycin, neomycin (used only for local action);

- II generation - gentamicin, tobramycin, amikacin;

- III generation - netilmicin (has less oto- and vestibulotoxicity).

Streptomycin and kanamycin suppress mycobacterium tuberculosis, streptomycin is active against brucella, the causative agents of plague and tularemia. The most sensitive to neomycin are Escherichia coli, Klebsiella, Enterococcus, Proteus and Enterobacter species. Antibiotics of the II - III generation are toxic for E. coli, Klebsiella, Serration, Pseudomonas aeruginosa, Proteus species, Enterobacter and Acinetobacter. All aminoglycosides inhibit 90% of Staphylococcus aureus strains. Resistance to aminoglycosides is characteristic of anaerobic bacteria, hemolytic streptococci, and pneumococci.

The bactericidal effect of aminoglycosides is due to the formation of abnormal proteins and the detergent effect on the lipoprotein cytoplasmic membrane of microorganisms.

Antibiotics of the β-lactam group, inhibiting the synthesis of the cell wall, potentiate the antimicrobial effect of aminoglycosides. Levomycetin, blocking transport systems in the cytoplasmic membrane, weakens their action.

When these antibiotics are taken by mouth, dyspeptic disorders are common. Anaphylactic shock is mainly caused by streptomycin sulfate, which in this respect is in second place after penicillin preparations.

Aminoglycosides can disturb hearing, balance (in 10 - 25% of patients), kidney function, and cause neuromuscular blockade. At the beginning of aminoglycoside therapy, tinnitus appears.

Aminoglycosides are contraindicated in hypersensitivity, botulism, myasthenia gravis, Parkinson's disease, drug parkinsonism, hearing and balance disorders, severe kidney disease. Their use during pregnancy is allowed only for health reasons. During treatment, breastfeeding is stopped.

Indications:Tuberculosis-streptomycin, kanamycin; plague streptomycin; tularemia-streptomycin, gentamicin, brucellosis-streptomycin

purulent-septic diseases - sepsis, peritonitis, meningitis, abscess;

postoperative infectious complications;

kidney infections - pyelonephritis, respiratory tract - pneumonia, lung abscess;

infective endocarditis;