4. Antiseptics - metal compounds. Classification. Mechanism of action. Side effects. Contraindications Comparative evaluation of drugs.

Antiseptics are medicinal substances that suppress microorganisms on the surface of the body, on the skin and mucous membranes.

Compounds of metals: mercury dichloride, silver nitrate, zinc oxide, yellow mercury oxide, copper sulfate, zinc sulfate.

Mechanism of action: interacts with proteins, leading to the appearance of salt-like compounds, albuminates, blocks thiol groups in enzymes, disrupting cellular respiration. In high concentrations, depending on the nature of the metal and acid residue, salt concentration, different effects can occur: astringent, irritating, cauterizing.

Indication: mercury dichloride: for the disinfection of mercury oxide yellow for pustular skin diseases, in eye practice

Silver preparations: in dermatology, ophthalmology, urology, for cauterization of warts, ulcers, erosions.

Side effects: poisoning with mercury compounds (mercuric chloride).

Ticket 49

one. Basic principles and methods of testing new medicinal substances. The concepts of "placebo" and "blind" control. The ethical side of prescribing a placebo.

Principles of clinical research of new drugs: • Selection of a homogeneous population of patients; • Exact e-z b-no and a similar severity of the disease; • Control group b-n; • Similar dosage of drugs;

• Pharmacokinetic research; • Choice of sensitivities of the effects typical for the given island; • Quantification of effects; • Sufficient volume of research for stat processing; • Use of "placebo" and "double-blind method" research; • Comparison with reference drugs of this group; • Simultaneous research of new and reference drugs; • Compliance with ethical principles.

A placebo is taken when the element of suggestion plays a role in the effect. Placebo drugs do not contain. In the case of "blind control", the patient alternates between medicine and placebo in a sequence unknown to him, only the attending physician knows when the patient is taking a placebo. In case of "double blind control" the third person knows about it. This principle of research allows you to objectively assess the e-v-v.

2. HISTORY OF DISCOVERY OF ANESTHESIS (MORTON, PIROGOV). THE CONCEPT OF BIOLOGICAL AND MEDICAL ANESTHESIA. CLASSIFICATION OF DRUGS FOR ANESTHESIA. MECHANISM OF ACTION OF INHALATION ANESTHESIC PREPARATIONS. SIDE EFFECTS. CONTRAINDICATIONS. COMPARATIVE EVALUATION OF PREPARATIONS.

1846 - the discovery of anesthesia. Morton (1819-69) was an American dentist who first introduced ether anesthesia into a surgeon's practice. Pirogov (1810-81) - Russian surgeon and anatomist, the main field of military surgery. For the first time he performed an operation under anesthesia on the battlefield (1847).

Classification of drugs for anesthesia.

Inhalation : volatile liquids: ether, fluorothane, sevoflurane, isoflurane, methoxyflurane

Gaseous substances: nitrous oxide, cyclopropane, xenon.

Non-navigational : derivatives of barbituric and thiobarbituric acids: thiopental sodium, thiobutal, hexenal

Steroids: Predion.

GHB salts: sodium oxybutyrate.

Others: propofol, propanidide, ketamine.

Anesthesia is a condition characterized by the shutdown of consciousness, suppression of sensitivity, reflex reactions, and decreased tone of skeletal muscles.

The actions of anesthetic drugs are associated with the fact that they inhibit the interneuronal transmission of excitation in the central nervous system. Dysfunction of the membrane. One of the manifestations of the interaction of drugs for anesthesia with the postsynaptic neuronal membrane is a change in the permeability for ion channels (for example, for K ions), which disrupts the process of depolarization, and, consequently, interneuronal impulse transmission.

Receptor component of the action of drugs for anesthesia. All inhalation (volatile) and non-inhalation drugs (except for ketamine) in narcotic concentrations interact with GABA receptors, potentiating their action. Nitrous oxide does not affect gamk. Ketamine is an NMDA receptor antagonist. The same receptors are blocked by xenon. Ftorotane is widely used. It is characterized by high drug activity, a short stage of arousal. anesthesia is easily controlled, after the patient stops inhaling fluorothane, awakening will occur in 3-5 minutes. In terms of fire, it is safe. Has no irritating effect on the mucous membrane of the respiratory tract (unlike ether)

Respiratory side effects of fluorothane: moderately inhibits the respiratory center.

CCC: weakens myocardial contractility, reduces stroke volume, lowers blood pressure. The mechanism of hypotension is associated with inhibition of the vasomotor center and impaired transmission of vasoconstrictor impulses in the ganglia and the endings of sympathetic nerves., Cardiac arrhythmias are possible.

Kidneys: fluorothane reduces renal blood flow, SKF, diuresis, respectively.

Liver: with a healthy liver does not cause significant changes, is contraindicated in persons with liver disease. Ether. It has a pronounced narcotic activity, sufficient arcotic breadth, relatively low toxicity. Less manageable. Irritates mucous membranes, causes a pronounced stage of arousal, explosive. Side effects: profuse secretion of the salivary and bronchial glands (the result of irritation of the mucous membranes), aspiration with vomit, which interferes with airway patency, bradycardia and even cardiac arrest due to reflex excitement of the vagus nerve. Ether is administered only against the background of premixing. Ether promotes the release of catecholamines from the adrenal medulla. This can lead to an increase in glycogenolysis, hyperglycemia (therefore, contraindicated in diabetes mellitus)

On CVS: increased stroke and minute volume of the heart, increased heart rate, moderate narrowing of the peripheral vasculature. Liver: hepatotoxic (but less than fluorothane),

Kidneys: decreased renal blood flow, skf, urine output.

Metabolism: a pronounced change in metabolism due to hyperglycemia, increased lactic acid, pyruvic acidosis.

In the postoperative period, vomiting is noted.

Nitrous oxide. Immediate onset of anesthesia, without arousal stage. This is the effect of low plasma solubility. Because of this, the patient awakens quickly. Penetrates quickly into the central nervous system. Used for pain relief in myocardial infarction, severe trauma, childbirth, etc. the main disadvantage: low drug activity. Therefore, it is necessary to combine with other anesthetic drugs. Should not be used for long-term analgesia. In the postoperative period, nausea and vomiting may occur. Respiration: does not irritate mucous membranes. CVS: not accompanied by changes in heart function. Liver: does not cause Kidney: a transient decrease in urine output is due to constriction of the renal arteries, an increase in the production of ADH. Metabolism: does not cause Blood system: use of nitrous oxide for a long time may cause thrombocytopenia,