Classification: proteolytic (trypsin, chymotrypsin), fibrinolytic (fibrinolysin, streptolyase), depolymerization agents (ribonuclease, deoxyribonuclease), which reduce the viscosity of hyalurones to-you (lidase, ronidase), "immobilized" enzymes (streptoferinated coxalavate) ), digestive (pepsin, festal, pancreatin, mezim-forte), inhibitors of proteolytic enzymes (pantripin, ingitril).
Trypsin is an endogenous enzyme that breaks peptide bonds in a protein molecule. Breaks down necrotic tissue, liquefies secretions, exudates, blood clots; anti-inflammatory effect. Used for pulmonary diseases, thrombophlebitis, periodontal disease, osteomyelitis, sinusitis. Side effects - increased t, tachycardia, allergies. Cannot be used for heart and respiratory failure, liver cirrhosis, hepatitis, kidney disease, endophytic cancers.
Fibrinolysin - dissolves fibrin strands. Used for fresh thrombosis, thromboembolism of the pulmonary artery, brain, heart attack, thrombophlebitis. Side effects - hemorrhages, allergies, chest pain, chills, increased t. It is impossible
apply for bleeding, open wounds, peptic ulcer, radiation sickness, hypertension.
Ribonuclease - depolymerizes RNA, liquefies pus, phlegm, anti-inflammatory effect, inhibits the multiplication of RNA-containing viruses. Indications, side effects, contraindications like trypsin.
Deoxyribonuclease - with neuritis of the facial nerve.
Lidase, ronidase - contains hyaluronidase. Used for scars, hematomas. Side effects are allergies. Cannot be used for cancer, infections.
Streptodecase - has a prolonged fibrinolytic effect. Used for thrombosis. Side effects are allergies. Do not use for ulcers, bleeding, acute streptococcal infection, acute inflammation of diseases, pregnancy, hypertension, cancer.
Pantripine, ingitril - inhibits trypsin, etc. Used in acute pancreatitis.
4. The concept of antiseptic and disinfecting action. Conditions that determine the antimicrobial activity of drugs. Nitrofuran derivatives. Classification. Mechanism of action. The nature of the action. Spectrum of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.
Disinfecting action is the action of drugs aimed at destroying pathogens in the external environment (neutralizing patient care items, rooms, clothing).
Antiseptic action is the action of drugs aimed at pathogens on the surface of the human body (skin, mucous membranes, wounds).
Conditions that determine the antimicrobial activity of drugs:
- establishing an accurate bacteriological diagnosis, establishing the sensitivity of a microorganism to various drugs.
- early start of treatment.
- creation and maintenance of a constant effective concentration of the antimicrobial drug in the body.
- it is desirable to use antimicrobial agents in combination (preventing the development of resistance).
- correct determination of the duration of treatment.
- in the complex of treatment, use means that increase the body's resistance (vitamins, serums).
Nitrofurans
Furadonin, Furagin, Furazolidone, Furacilin,
Nifuroxazide (enterofuril), Nifuratel (makmiror)
The nature of the action - bactericidal
Mechanism of action - violation of protein synthesis
Spectrum of activity - wide
Gr (+) cocci: streptococci, staphylococci (except MRSA),
enterococci are insensitive
Gr (-) coli: E. coli, salmonella, shigella, klebsiella, enterobacteria
The simplest: lamblia, Trichomonas (furazolidone, nifurantel), amoeba (nifurantel)
Resistant anaerobes, Pseudomonas aeruginosa, Proteus, Serrata, acinetobacters
Nitrofuran resistance is rare.
Furadonin and furagin create high concentrations in the urine, while the antimicrobial activity increases with an acidic reaction of urine and weakened - with an alkaline
• Acute cystitis, prevention of exacerbations in chronic pyelonephritis, prevention of infectious complications in urology (operations, cystoscopy, catheterization)
NB! In acute pyelonephritis, they are not used, because poorly penetrate the kidney tissue
Nifuroxazide (Enterofuril)used for intestinal infections (acute infectious diarrhea, enterocolitis). Practically not absorbed in the digestive tract. Does not disturb the normal intestinal microflora
Furazolidoneis currently used only for giardiasis as a reserve drug. NB! In combination with alcohol, it can cause a teturam-like reaction. Inhibits MAO, therefore, in combination with other MAO inhibitors, sympathomimetics, tricyclic antidepressants and tyramine-containing foods, there is a risk of developing a hypertensive crisis
Nifuratel (makmiror) used for intestinal infections (acute infectious diarrhea, enterocolitis), giardiasis, intestinal amebiasis, trichomonas vulvovaginitis
Furacilin is used as an antiseptic for treating wounds, skin, mucous membranes, for washing serous and articular cavities
Side effects
Hepatotoxicity: cholestasis, jaundice, hepatitis
Hematotoxicity: hemolytic anemia (with a deficiency of glucose-6-phosphate dehydrogenase in erythrocytes), leukopenia, agranulocytosis, thrombocytopenia
Neurotoxicity: dizziness, nystagmus, intracranial hypertension, paresthesia
Gastrointestinal tract: nausea, vomiting (taken with or after meals)
Allergic reactions
Pulmonary reactions (furadonin): bronchospasm, pulmonary edema, pulmonary fibrosis
Teturam-like effect (furazolidone)
Tyramine syndrome (furazolidone)
Depending on the dose of the drug, the rate of development of the effect, its severity, duration, and sometimes character change. Usually, with an increase in the dose (concentration), the latency period decreases and the severity and duration of the effect increases. Dose is the amount of a substance per dose. It is indicated in grams or fractions of a gram. For a more accurate dosage of drugs, their amount is calculated per 1 kg of body weight. Sometimes substances are dosed based on the size of the body surface (per 1 m ^ 2) Therapeutic doses: • minimum (threshold) therapeutic dose - the minimum amount of a drug that causes a therapeutic effect; • average therapeutic dose - the range of doses in which the drug has the optimal prophylactic or therapeutic effect in most patients; • maximum therapeutic dose - the maximum amount of a drug that does not have a toxic effect. Lethal doses: • minimum lethal dose (LD10) - the dose causing death in 10% of cases; • average lethal dose (LD50) - the dose causing death in 50% of cases; • maximum lethal dose (LD100) - the dose that causes the death of all poisoned animals. The therapeutic range is the range between the average and maximum therapeutic doses. To achieve a quick therapeutic effect, drugs are sometimes prescribed in shock doses (antibiotics, sulfonamides). Drugs capable of cumulation are used in maintenance doses. In pediatric practice, drugs are dosed based on the weight or surface of the child's body. The method of administration of the drug is directly related to its dosage form. So liniment is applied externally, rubbing with a thin layer on the affected area. Tablets are used enterally, and solutions in ampoules are used parenterally.
Curariform funds - drugs that block neuromuscular transmission and relax skeletal muscles.
Classification:
1) Antidepolarizing- tubocurarine, pancuronium.
Mechanism of action: block H-cholinergic receptors and prevent the depolarizing effect of acetylcholine.
2) Depolarizing-ditilin
Mechanism of action: excite H-cholinergic receptors and cause persistent depolarization of the postsynaptic membrane.
3) Mixed action-dioxonium.
Muscle Relaxation Procedure: first the muscles of the head and neck, then the limbs, trunk, respiratory, the last - the diaphragm.
Indications:during operations to relax muscles, to facilitate intubation, for reposition of bone fragments and in case of dislocations, with tetanus and strychnine poisoning. They are not absorbed into the gastrointestinal tract - they are administered parenterally. Apply only if there are conditions for performing the arts of breathing.
Contraindications: diseases of the liver, kidneys, senile age, myasthenia gravis.
Side: muscle pain after surgery, increased blood pressure, arrhythmia, increased IOP
Tubocurarine - lowers blood pressure, increases the tone of the bronchi.
Pancuronium - M-anticholinergic action on the heart (tachycardia).
Ditilin - arrhythmias, increased blood pressure and intraocular pressure, muscle pain after surgery.
Dioxonium - lasts 20-40 minutes.
Funds affecting appetite are divided into 2 groups:
1.Appetite stimulants (carminatives)
2. Drugs that reduce appetite (anorexigenic drugs)
Bitterness
Insulin
Bitterness - plant-based substances containing glycosides with a strong bitter taste:
- Tincture of wormwood
- Bitter tincture
- Dandelion roots
- Calamus root
- Yarrow Herb
Mechanism of action: By irritating the taste buds of the mucous membrane of the mouth and tongue, they reflexively excite the center of hunger. With the subsequent meal, the first (complex reflex) phase of secretion of the stomach glands increases, appetite increases and digestion improves.
Indications for use: in case of impaired appetite in patients recovering from infectious diseases, after surgical interventions, in some neurological diseases accompanied by anorexia, as well as in hypoacid conditions, chronic atrophic gastritis.
Contraindications: with increased gastric secretion, gastric ulcer and duodenal ulcer, reflux esophagitis.
Insulinstimulates the hunger center, as it lowers blood glucose. There is an assumption that in the saturation center there are special "glycoreceptors" that respond to arteriovenous differences in glucose concentration. Assign 4-8 units in a vein.
Some psychotropic drugs (chlorpromazine, amitriptyline, lithium carbonate), neurotropic antihypertensive drugs (clonidine) and anabolic steroids also have a stimulating effect on appetite.
2. Drugs that suppress appetite (anorexigenic drugs).
Anorexigenic drugs are a group of sympathomimetic amines that stimulate the satiety center and depress the hunger center.
Anorexigenic drugs can be represented by the following groups of drugs:
1. Drugs affecting the catecholaminergic system:
Fepranone (amfepranone)
Dexfenfluramine (Isolipan)
2. Drugs affecting the catecholaminergic and serotonergic systems:
Sibutramine (meridia)
3. Cannabinoid receptor blocker (CB - 1):
Rimonabant (acomplia)
Indications for use:
1. Alimentary obesity with a body mass index of 30 kg / m² or more.
2. Alimentary obesity with a body mass index of 27 kg / m² or more in the presence of risk factors due to overweight (type II diabetes mellitus or dyslipoproteinemia). The drugs are used in combination with a low-calorie diet, 30-40 minutes before meals in the first half of the day. Treatment must be carried out under the supervision of a physician.
Fepranone (amfepranone) is an analogue of phenamine with a more selective, anorexigenic effect, as well as phenamine, fepranone enhances the release of norepinephrine and dopamine from nerve endings and inhibits their reuptake, which leads to stimulation of central adrenergic receptors and pre-familial receptors and oppression of the center of hunger.
Side effects:on the part of the cardiovascular system (tachycardia, increased blood pressure, arrhythmias), the central nervous system (anxiety, sleep disturbances), the gastrointestinal tract (GIT) (dry mouth, nausea, constipation or diarrhea). Addiction and physical drug dependence may develop.
Dexfenfluramine (Isolipane) is structurally similar to phenamine, but has a weak central stimulating activity and, at the same time, has a strong anorexigenic effect.
The side effects are the same as for Fepranone.
Sibutramine (meridia) inhibits the reuptake of serotonin, norepinephrine and dopamine, reduces the concentration of uric acid in the blood serum, and has a beneficial effect on lipid levels.
Side effects: possible increased blood pressure, tachycardia, sleep disturbance, headache, constipation, excessive loss of appetite.
Rimonabant (acomplia) blocks the CB-1 cannabinoid receptors, which leads to the suppression of the hunger center. Similar in effectiveness to sibutramine. Take it inside. T1 / 2 depends on body weight (ranges from 6-9 to 16 days). The drug is well tolerated.
Side effects: nausea, diarrhea, dizziness, depression, etc. are possible.
Contraindications to the appointment of anorexigenic drugs:
1.arterial hypertension
2.coronary insufficiency
3.disorders of cerebral circulation
4.neural diseases, accompanied by increased excitability and convulsions
5.tachycardia, arrhythmias
6. Simultaneous reception or a period of up to 2 weeks. after the abolition of MAO inhibitors.
7.hyperthyroidism
8.pheochromocytoma
9.glaucoma
10. drug or alcohol addiction
11.pregnancy, lactation
12.hypersensitivity to the drug
4. ANTISEPTICS OF AROMATIC AND ALIPHATIC SERIES. CLASSIFICATION. MECHANISM OF ACTION. INDICATIONS FOR USE. SIDE EFFECTS. CONTRAINDICATIONS. COMPARATIVE EVALUATION OF PREPARATIONS. Classification:
Organic antiseptics: aromatic (phenol group, nitrofuran production, dyes), aliphatic (formaldehyde group, alcohols, detergents).
Phenol group - phenol, resorcinol, birch tar. Nitrofuran derivatives - furacilin. Dyes - brilliant green, ethacridine lactate, methylene blue. Formaldehyde group - formalin, lysoform. Alcohols - ethyl alcohol. Detergents - chlorhexidine, cerigel, roccal
The mechanism of action of different antiseptics is not the same, it is aimed either at protein denaturation, violation of the permeability of the plasma membrane, inhibition of enzymes important for the vital activity of microorganisms.
Detergents (for example, cerigel) disrupt the structure of the cell membrane, cause denaturation of proteins, inhibition of enzymes. Used for processing hands, tools
Nitrofurans with a broad spectrum of action, are destructive for gram-positive and g- (treatment of wounds, mucous membranes, for washing serous, articular cavities) side: sometimes causes sensitization, dermatitis