Hypertension, edema in CHF; Spironolactone (an aldosterone antagonist) is also used for hyperaldosteronism.
Side: dyspeptic symptoms, azotemia, cramps in the lower extremities, hyperkalemia.
Osmotic diuretics
Mannitol (mannitol)
Designed for intravenous drip injection in a volume of 200-400 ml. Mannitol is filtered through the endothelium of the capillaries of the renal glomeruli and maintains a high osmotic pressure in the lumen of the nephron tubules. The drug is not reabsorbed and therefore retains water in all parts of the nephron, especially in the proximal tubules, resulting in a significant increase in urine volume. In addition to the diuretic effect, mannitol has a dehydrating effect by increasing the osmotic pressure of blood plasma.
Indications for use:Pulmonary edema, cerebral edema; Acute poisoning (for forced diuresis); Acute attack of glaucoma
NB! In case of impaired renal excretory function, mannitol is ineffective and contraindicated!
Side effects:
Dry mouth, tachycardia, nausea, vomiting, convulsive reactions are possible.
Carbonic anhydrase inhibitors
Indications for use:• After suffering strokes, brain injuries, neuroinfections, neurosurgical interventions • Intracranial hypertension • Internal hydrocephalus • Some forms of epilepsy, cerebral palsy • Chronic alcoholism • Open-angle glaucoma • Prevention and relief of mountain (high-altitude) sickness
Dorzolamide (Trusopt) is used topically in the form of eye drops for open-angle glaucoma.
Side effects:• Metabolic acidosis (for its prevention after 4-5 days of administration - a break of 2-3 days) • Increased blood glucose levels • Moderate hypokalemia and hypomagnesemia
• Diarrhea. • Teratogenic effect (contraindicated in pregnancy).
four). Dyes. Detergents. Oxidizing agents. Acids and alkalis. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
Dyes:Brilliant green, methylene blue, ethacridine lactate
Detergents:Zerigel, roccal
Oxidants:Potassium permanganate, hydrogen peroxide solution
Acids and alkalis:Boric acid, salicylic xylot; ammonia solution, sodium bicarbonate.
Detergents (roccal, cerigel) - cationic soaps with detergent and antiseptic properties.
Mechanism of action: violation of the structure of the cell membrane, denaturation of proteins and inhibition of enzymes of the microbial cell.
Indications: treatment of the surgeon's hands, sterilization of instruments.
Side effects: they do not cause irritation of tissues in usual concentrations.
Cannot be combined with anionic soaps as their activity decreases.
Oxidants
Hydrogen peroxide
Mechanism of action:upon contact with tissues, it decomposes with the release of molecular oxygen, which is released in the form of bubbles from the wound, mechanically cleans it. It also has a deodorant and hemostatic effect.
Indications: used for the primary treatment of superficial contaminated wounds, cleansing wounds from pus and blood clots, stopping capillary bleeding (including nasal), for rinsing the mouth and throat).
Potassium permanganate
Mechanism of action:in the presence of organic substances, it splits off atomic oxygen, the antiseptic effect of atomic oxygen is more pronounced than molecular one; provides antimicrobial and deodorizing effects, and the resulting manganese oxide is an astringent.
Indications: it is used for treating wounds, rinsing the mouth and throat, 0.02-0.1% solution is used for washing and douching for gynecological and urological inflammatory diseases, as well as for washing the stomach in case of poisoning.
Acids and alkalis.
Boric acid, salicylic acid.
Mechanism of action: the antimicrobial properties of acids are due to the specific action of molecules and the ability to change the pH of the medium towards the acidic side. This shift is unfavorable for the development of many microorganisms.
Indications: Boric acid (2-4% solution) is used to rinse the mouth and throat, wash the eyes; 2% alcohol solution is used in the form of ear drops for otitis media, for treating affected skin areas with pyoderma, diaper rash; 5% ointment - for the treatment of head lice. Boric acid is a part of combined ointments, liniment, pastes.
Salicylic acid in the form of an ointment, paste, alcohol solution, as well as in combination preparations is used as an antiseptic, irritant and keratolytic agent for infected lesions, fungal skin diseases.
Ammonia solution and sodium bicarbonate solution.
Indications:10% ammonia solution (ammonia) - as an ambulance to stimulate breathing and remove from fainting. Sodium bicarbonate has good detergent properties, it is used for rinsing the mouth and throat with tonsillitis, washing the eyes, sterilizing instruments.
Dyes.
Mechanism of action: have some selectivity of action against certain microorganisms. They not only denature the proteins of microorganisms, but even in low concentrations bind to DNA and quickly lead to the death of bacteria.
Side: non-irritating to tissues, non-toxic in the concentrations used.
Indications: brilliant green in the form of 1-2% alcohol (or water) solution is used for lubrication with pustular skin lesions (pyoderma, folliculitis), with small skin cuts, infectious diseases of the eyelids (blepharitis).
Methylene blue is used for washing with cystitis, urethritis. This drug is an antidote for cyanide poisoning, since in certain doses it is able to convert hemoglobin into methemoglobin, which binds to cyanide and forms non-toxic cyanmethemoglobin.
• Side effects - the rest, except for the main one, that is, beyond the scope of the purpose for which the drug is prescribed the effects of the drug when it is used in a therapeutic dose.
• Toxicity - the ability of a substance to cause disturbances in the physiological functions of the body. The toxic effect of medicinal substances develops, as a rule, with the growth of toxic doses of the substance into the body (with an overdose). In case of an absolute overdose (with an absolute excess of single, daily and course doses), excessively high concentrations are created in the blood and tissues. Toxic effect also occurs with a relative overdose of the drug, with the appointment of medium therapeutic doses to patients who have a reduced detoxification function of the liver or excretory function kidney, with long-term treatment with medicinal substances capable of cumulation.
• Allergic reactions (allos-other, ergon-action) - These reactions, which occur when drugs are re-administered, are based on immune mechanisms. Drugs in this case act as allergens. Allergic reactions do not depend on the dose of the administered substance and are varied in their own way nature and severity: from mild skin manifestations to anaphylactic shock. • Teratogenic action (teras-freak) - develops during 4-8 weeks of pregnancy. At this time, the formation of the skeleton and the laying of internal organs occurs. At this stage of pregnancy, organs and tissues are most sensitive to the action of damaging factors. Therefore, the use of medicinal substances can lead to abnormalities in the development of the skeleton and internal organs. in the first 12 weeks of pregnancy.
2. The history of the discovery of inhalation anesthesia (Pirogov, Kvarkov, Fedorov). Classification of drugs for anesthesia. Requirements for non-inhalation anesthetic drugs. Advantages and disadvantages of non-inhalation anesthesia in comparison with inhalation. Comparative characteristics of non-inhalation anesthetic drugs.
Classification: 1) HP, for inhalation anesthesia
Liquid: fluorothane; ENFLURANE; Ether for anesthesia
gas exchange: NITROGEN OXIDE; XENON
2) Ls, for non-inhalation anesthesia: HEXENAL; PROPOFOL; SODIUM OXIBUTIRATE; PROPANIDID
Chloroform was first used in Russia by N.I. Pirogov November 30, 1847 New discovery was marked by 1904, N.F. Kravkov and S.P. Fedorov was the first to use intravenous injection of hedonal, a derivative of barbituric acid, which was synthesized in 1903 by Fisher. Intravenous administration of barbiturates has become widely used both for independent anesthesia and in combination with ether anesthesia and local anesthesia.
Certain requirements are imposed on drugs for anesthesia. So, when using them, anesthesia should come quickly and, if possible, without the stage of excitement. A sufficient depth of anesthesia is required to ensure optimal conditions for the operation. An important point is good controllability of the depth of anesthesia during the use of anesthetic agents. Desirably, without consequences. This facilitates the post-anesthetic period.
The advantages of inhalation anesthesia are: • High controllability (the ability to change the depth of anesthesia, long-term maintenance of anesthesia and rapid awakening of the patient); • Possibility of combining the supply of anesthetic with mechanical ventilation, i. E. gas exchange control;
• Good compatibility with other drugs for general anesthesia and the provision of other components of anesthetic management.
Despite all the modifications of inhalation anesthesia, in general, a number of disadvantages are inherent:
• The dosage of inhalation anesthetics using imperfect anesthetic (most domestic) devices may be inaccurate; • Under any operating modes of the anesthesia machine, except for a closed circuit, the air in the operating room is contaminated with anesthetic vapors; • Inhalation anesthesia, especially when using reversible circuits, requires complex expensive equipment; • Anesthetic and respiratory equipment requires special sanitization, if improperly carried out, it can become a source of spread of pathogens of nosocomial infections (ventilator-associated pneumonia).
Propofol exit from anesthesia is very fast, has antiemetic activity. Longer anesthesia is provided by derivatives of barbituric acid sodium thiopental, hexanal.
Classification: 1) Central type of action: A) Narcotic type of action: CODEIN; CODEINE PHOSPHATE; ETHYLMORPHINE HYDROCHLORIDE; DEXTROMETORFAN
C) Non-narcotic action: GLAUCIN HYDROCHLORIDE; OXELADIN; LADY; BITIDION; BUTAMIRAT
2) Peripheral type of action: Prenoxidiazine; LEVODROPROPEZIN
3) Mixed action type: BITHIODINE
• Mechanism: centrally acting HP-inhibit dts. Peripheral action - associated with anesthetic effect on the mucous membrane of the upper respiratory tract, as well as bronchodilator properties.
• Indication: bronchitis; pneumonia; tracheitis; tracheobronchitis; pleurisy; bronchial asthma in various forms; whooping cough; lungs' cancer; tuberculosis
• Side effects: Dizziness; nausea; weakness; decrease in blood pressure; allergic reactions.
Contraindications: Hypersensitivity arterial hypotension myocardial infarction hyperproduction of sputum.
Codeine has a pronounced antitussive activity, in addition, it has a weak analgesic effect. In terms of the effect on the cough center of ethylmorphine hydrochloride, it is similar to codeine, but somewhat more active.
4. Antibiotics of the cephalosporin group. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
Classification:
a) Generation I (highly active against G + bacteria): cefazolin, cephalothin, cefapirin, cefradine, cephalexin
b) Generation II (highly active against G-bacteria): cefamandol, cefuroxime, cefaclor, cefoxitin, cefmetazole
c) III generation (with high activity against Pseudomonas aeruginosa): cefotaxime, ceftazidime, cefoperazone, cefixime
d) IV generation (active against bacteroids and other anaerobes): cefpirome
Mechanism: inhibit the synthesis of peptidoglycan of the cell wall, inhibit the synthesis of murein. prevent the formation of peptide bonds due to transpeptidase.
Character: bactericidal action.
I - act on gram (+) and some gram (-) and do not act on Pseudomonas aeruginosa, Proteus, bacteroids
II - act on gram (+) and some gram (-), proteus and enterobacteria, do not act on Pseudomonas aeruginosa
III - stronger by gram (-), penetrate the BBB;
IV - act on gram (+), Pseudomonas aeruginosa, gram (-)
Spectrum: wide. Penicillinase resistant, but destroyed by beta-lactamase (I).
IndicationsI:
urinary, respiratory tract infections
meningitis
prevention of septic complications during surgery
pyelonephritis, cystitis
streptococcal tonsillopharyngitis
exacerbation of chronic bronchitis
community-acquired pneumonia requiring hospitalization
community-acquired infections of the skin and soft tissues of mild to moderate severity
infections against the background of neutropenia and immunodeficiency states
sepsis
Side effects:
allergies
kidney damage
diarrhea
bleeding
thrombocytopenia
dysbiosis
pseudomembranous colitis
Contraindications:
hypersensitivity
pregnancy
breast-feeding
gastrointestinal diseases
bleeding