Ticket 36

1) The founder of Russian pharmacology N.P. Kravkov. The main directions of the school of N.P. Kravkov.

2) Local anesthetic substances. Classification. Mechanism of action. Indications for use. Contraindications Comparative evaluation of drugs.

3) Anti-atherosclerotic drugs. Classification, Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation

4) Antimalarial drugs. Classification. Mechanism of action, indications for use. Contraindications Side Effects Comparative assessment of preparations.

1) The founder of Russian pharmacology N.P. Kravkov. The main directions of the school of N.P. Kravkov.Nikolay Pavlovich Kravkov (1865-1924) - pharmacologist, founder of Russian pharmacology, headed the Department of Pharmacology at the St. Petersburg Military Medical Academy.

Kravkov was the first to study the effect of pharmacological substances on isolated organs. He studied the problems of general pharmacology: the dependence of the biological effect on dose and concentration, the combined effect of drugs, the relationship between the structure of compounds and their physiological activity, studied the pharmacodynamics and pharmacokinetics of substances against the background of diseases. He also worked on toxicology (gasolines, BOV), offered a drug for intravenous anesthesia (hedonal), combined anesthesia. Wrote the manual "Fundamentals of Pharmacology".

Among other things, the outstanding scientist N.P. Kravkov founded the national school of pharmacologists (S.V. Anichkov, V.V. Zakusov, etc.). The main directions of the scientific school of N.P. Kravkov are the study of life processes, the search for new medicinal substances, means of symptomatic and pathogenetic therapy.

2. Local anesthetic substances. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Local anesthetics - drugs that reversibly inhibit the excitation of afferent nerve endings, as well as the generation and conduction of nerve impulses along the fibers with the loss of all types of sensitivity.

Mechanism of action: they block voltage-gated sodium channels, prevent both the emergence of an action potential and its conduction.

Classification of local anesthetics

Aromatic acid esters	Aromatic amine amides
[Cocaine]	Lidocaine
Procaine (novocaine)	Trimecaine
Tetracaine (dicain)	Articaine (ultracaine)
Benzocaine (anesthesin)	Bupivacaine (marcaine)
Oxybuprocaine (inocaine)	Ropivacaine (Naropine)

Indications for the use of local anesthetics:

1. Infiltration anesthesia. Apply 0.25-0.5% solutions of procaine, 0.125-0.5% solutions of lidocaine, 0.125-0.25% solutions of bupivacaine. The duration of procaine anesthesia usually does not exceed 20-30 minutes, lidocaine - up to 1 hour, bupivacaine - more than 2 hours.

2. Conductive anesthesia. Use 1-2% solutions of procaine, lidocaine, articaine and 0.25-0.5% solutions of bupivacaine and ropivacaine. When repositioning dislocations, reposition of bone fragments, blockade of the trigeminal nerve, brachial, sacral plexuses.

3. Spinal anesthesia (subdural). It is more often produced with a 2-5% solution of lidocaine, sometimes with a 0.25-0.5% solution of bupivacaine or ropivacaine. In the absence of these drugs, procaine (5% solution) can be used. When carrying out lower-thoracic, urological operations.

4. Terminal anesthesia of the mucous membranes is achieved by using solutions of tetracaine (rarely), lidocaine or trimecaine (with the addition of epinephrine, preferably just before anesthesia).

5. Epidural anesthesia for abdominal operations, in obstetric and gynecological practice, in the postoperative period.

6. Lidocaine, trimecaine with ventricular extrasystole and tachycardia, especially with MI, prevention of ventricular fibrillation.

Comparative evaluation: by duration: long-term - anesthesin, pyromecaine, lidocaine, bupivacaine;

short-acting - cocaine, novocaine, dicaine; toxicity: the most toxic dicain, less toxic - novocaine, mepivacaine, pyromecaine.

Contraindications: hypersensitivity to drugs, decompensated heart failure, severe organic lesions of the central nervous system, septicemia.

Side effects:

1. drowsiness, lethargy, dizziness, impaired consciousness, thermor, convulsions;

2. tachycardia, bradycardia, decreased A, arrhythmias, collapse;

3. blurred vision, diplopia;

4. allergic reactions;

5. respiratory depression.