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Description
The immune system, which appeared in the process of evolution, provides the body with a high level of protection, and its disorders are the cause of a number of diseases.
Recently, the development and study of specific agents that stimulate or suppress immune responses have been given great importance. It became obvious that the positive effect of many drugs is due to an increase in the overall resistance of the body, its nonspecific immunity, as well as the activation of specific immune responses. Immunomodulators, immunostimulants, immunosuppressors are substances that modify the immune response and affect immunocompetent cells. The sources of their production are very diverse: microorganisms, plants, tissues and organs of animals, chemical synthesis. Immunostimulants and immunosuppressants can be antigens and non-antigens, specifically or non-specifically change the functioning of the entire system or its individual links (immunocompetent cells and subcellular formations).
Head of the Department of PharmacologyProfessor V.E. Novikov Immunotropic drugs - drugs that have
predominant (or selective) effect on the immune
human system in diseases or conditions, in
which are based on any disorders of the immune
body reactions.
There are 3 main groups
immunotropic (immunocorrective)
HP:
Immunostimulants
Immunosuppressants (immunosuppressants)
Immunomodulators IMMUNOSTIMULATORS - stimulate the immune system.
These drugs activate immune responses or individual
links of cellular and humoral immunity, increase
activity of both damaged (depressed) and
intact parts of the immune system.
IMMUNOSUPPRESSORS are drugs that suppress
activity of the immune system.
IMMUNOMODULATORS are drugs that restore pathologically altered parts of the immune system,
that have different effects on the immune
system depending on its initial state:
capable of raising low and lowering high
indicators of the immune status, i.e. simulate immune
answer.
MECHANISMS OF ACTION OF IMMUNOTROPIC DRUGS
They can exercise their influencein the following ways:
- stimulate the production of immune cells
by influencing the hematopoietic system
(colony stimulating factors);
- interact with receptors
immune cells, increasing or decreasing
specific sensitivity
receptors; - stimulate or inhibit secretion
cytokines;
- Influence the formation of active
(vaccines, toxoids) and passive
(sera, immunoglobulins)
anti-infective immunity;
- act as an immune regulator
response with a lack of central or
peripheral organs of immunity
(thymus preparations).
CLASSIFICATION OF IMMUNOMODULATORS BY ORIGIN
1. Preparations of microbial origin:Natural
- Microbial lipopolysaccharides (pyrogenal, prodigiosan)
- Highly purified bacterial lysates with vaccine
effect (IRS-19, broncho-munal, bronchovaxone, imudon,
biostim, ruzam, paspat)
- Combined immunocorrectors containing
bacterial ribosomes (vaccinal effect) and
membrane fractions of bacteria (non-specific
immunomodulation) (ribomunil)
Semi-synthetic
- Analogue of membrane fractions of bacteria (licopid) 2. Thymic preparations
origin
Thymus Natural Preparations:
thymalin, taktivin, timoptin, timaktid,
thymomulin, vilozen;
Synthetic analogues of thymic factors:
thymogen, imunofan
3.Bone marrow preparations
origin (myelopeptides)
Natural bone marrow preparations: myelopid
Synthetic: seramyl, bivalen 4. Cytokines
Natural (natural)
Complex of natural cytokines:
Leukinferon, Superlymph
Recombinant
Interleukin preparations:
Betaleukin (IL-1β), Roncoleukin and Aldesleukin (IL-2)
Colony stimulating factor preparations:
Molgramostim - GM-CSF (granulocytic-macrophage
colony stimulating factor)
Sargramomtim – GM-CSF
Lenograstim - G-CSF
Filgramostim – G-CSF 5. Nucleic acids
Natural:
Sodium nucleinate (a mixture of nucleic acids from
yeast)
Derinat (DNA from sturgeon milk)
Zymosan (suspension of polysaccharides from bakery
yeast)
Synthetic
Poludan (complex of polyadenyl and
polyuridic acid
6. Vegetable
Immunal - Echinacea purpurea juice
Manax - lyophilized liana extract
Peruvian 7. SYNTHETIC (Chemically pure)
Low molecular weight
Levamisole, Diucifon, Galavit, Gepon,
Alloferon, Glutoxim
macromolecular
Polyoxidonium
CHARACTERISTICS OF GROUPS OF IMMUNOMODULATORS
Immunomodulators of microbial origincan be divided into 3 generations:
Preparations of the 1st GENERATION:
BCG vaccine
Pyrogenal, Prodigiosan
Their main mechanism of action is related to
activating effect on functional
macrophage status. These drugs stimulate
phagocytosis and through it can affect
immunocompetent cells. Prodigiosan
High polymer lipopolysaccharide complex,
isolated from the microorganism. rodigiosum.
Properties. Stimulates factors of non-specific and
specific resistance of the organism,
macrophage phagocytosis. Activates the T-system
immunity and function of the adrenal cortex, induces
formation of interferons, stimulates
antibody production.
Indications: chronic sluggish inflammatory
processes, long-term non-healing wounds
chills, headache, arthralgia, muscle pain
Release form: ampoules 0.005% solution - 1 ml Pyrogenal (Pyrogenalum)
Lipopolysaccharide Рseudomonas aeruginosa and other micro-moves
Properties. Is an interferon inducer, mimics
effects of interleukin-1, stimulates factors
nonspecific and specific resistance
organism, macrophage phagocytosis.
Indications: for resorption of pathological scars,
adhesions after burns, injuries, prolonged recurrent
infectious and inflammatory diseases.
Side effects: fever,
chills, headache, vomiting.
Release form: in ampoules containing 1 ml
isotonic sodium chloride solution 100; 250; 500
or 1000 MTD. The activity of the drug is determined
biologically and expressed in MTD (minimum
pyrogenic dose). 1 MTD is the amount of substance,
causing intravenous administration to rabbits
an increase in body temperature by 0.60C or more. Microbial preparations of the 2nd GENERATION include
lysates (BRONCHOMUNAL, BRONCHOVAXOM, IRS19, IMUDON) and bacterial ribosomes (RIBOMUNIL) -
pathogens, mainly respiratory infections
(Streptococcus pneumoniae, Streptococcus pyogenes,
Hemophilus influenzae, Klebsiella pneumoniae, etc.)
These drugs have a specific (vaccinating)
and non-specific (immunostimulating) action.
Bacterial lysates are designed to stimulate
specific body defense against pathogens
exposure to those microbes whose antigenic substrates
are included in the preparation. With immunotherapy
bacterial lysates increase
the content of specific antibodies to microbes,
included in the preparation. BRONCHOMUNAL
contains lyophilized bacterial lysates
the most common causative agents of respiratory diseases
(streptococcus, pneumococcus, Haemophilus influenzae,
Klebsiella, Staphylococcus aureus, Branhamella)
Properties. Immunocorrective. Increases humoral
and cellular immunity, stimulates peritoneal
macrophages. Increases: the number of T-lymphocytes, Ig class A, G,
M, NK activity (natural killer cells), production
IFN, IL-2, TNF-α (tumor necrosis factor). is increasing
the amount of antibodies in the airways.
often accompanied by recurrent
bacterial infections of the bronchopulmonary apparatus
For use in pediatric practice
Bronchomunal P, which contains half an adult
dose of bacterial lysate.
Adverse reactions: dyspepsia, pain in
epigastrium, rarely - hypersensitivity to
drug. IRS-19
A mixture of bacterial lysates. The drug is prepared from 19
strains of the most common bacterial pathogens
respiratory tract infections: Dipplococcus pneumoniae,
Streptococcus
faecalis,
Streptococcus
pyogenes,
Hemophilus influenzae, Klebsiella pneumoniae, Micrococcus
pyogenes, Neisseria catarralis, Neisseria perflava, Gaffkya
tetragena, Neisseria flava, Moraxella.
IRS-19 is a drug for local immunotherapy.
Properties.
Immunomodulating.
Activates
specific
and
non-specific
protective
mechanisms in the respiratory tract (activation of phagocytosis,
increase in the amount of lysozyme and interferon,
an increase in the formation of specific antibodies of secretory immunoglobulins of class A (sIgA).
The drug contains elements of a polypeptide structure,
admission
which
in
organism
hinders
the formation of sensitizing antibodies. IRS-19 is produced in the form of an aerosol, after spraying
which forms a thin layer covering
nasal mucosa and promotes rapid
drug penetration. IRS-19 reduces swelling
in the nasal cavity, liquefies the exudate of the mucous membrane
and facilitates its release.
Indications. Prevention and treatment of inflammatory and
infectious diseases in the ear, throat and nose,
VDP: rhinitis, nasopharyngitis, otitis media, sinusitis, etc.).
Prevention of influenza complications, prevention
infections during operations on the ENT organs.
Side effects. The drug is well tolerated,
be transient rhinorrhea. It is advisable not to use
along with vasoconstrictors. Ribomunil
complex preparation containing ribosomal
fractions of bacteria (4 species) and proteoglycans of cellular
Klebsiella pneumomae membranes
Properties. Activates humoral and cellular immunity.
Combining antigenic carriers of bacteria
(ribosomes) and active non-antigenic components
bacterial membrane (proteoglycans), causes
vaccinal and immunomodulatory effects.
Indications. Ribomunyl is indicated for adults and children with
recurrent infections of the ear, throat, nose and
bronchopulmonary apparatus (rhinopharyngitis, laryngitis,
sinusitis, tonsillitis, otitis, tracheobronchitis).
Side effects. Hypersalivation. nasal
mucus hypersecretion. allergic reactions
Form fpuska: granules for the preparation of solution, tab. To microbial preparations of the 3rd GENERATION
applies Likopid - a synthetic analogue
bacterial cell wall (muramyl dipeptide). Structurally
lycopid is represented by a repeating fragment
cell wall peptidoglycan of all known bacteria.
Properties. Vaccine-like immunomodulator. Stimulates
cellular and humoral immunity, increases
cytotoxic properties of lymphocytes. Mechanism
action is associated with the ability to stimulate
phagocytosis and, indirectly, T- and B-links of immunity.
Indications. Psoriasis, purulent-inflammatory diseases
skin and soft tissues, chronic respiratory infections
ways.
Likopid is well tolerated, may be short-term
increase in body temperature to subfebrile.
Release form: tab., 1 and 10 mg
Under the direction of acad. R.V. Petrova from the thymus gland
(thymus) immunoregulatory peptides have been isolated,
restoring cellular and humoral immunity. To
preparations containing thymic peptide complex
relate:
TAKTIVIN (T-activin), TIMALIN, TIMOPTIN,
TIMACTID,
To thymus extracts - VILOSEN, THYMOSTIMULIN
Thymic drugs of the second and third generation
are synthetic analogues of natural
thymus hormones (α-thymosin and thymopoietin) or
fragments of these hormones - IMUNOFAN, THYMOGEN
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
The main mechanism of action of thymus preparationsis the potentiation of functional activity
T-lymphocytes, induction of T-cell differentiation, which
leads to an increase in anti-infective and
antitumor
resistance
slowdown
regression of immunocompetent cells.
Thymic preparations are indicated
in complex therapy for immunodeficiency
conditions with a predominant lesion of the T system of immunity (both in primary and in
secondary defects in cellular immunity).
Side effects: allergic reactions
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
TaktivinT-immunomimetic (immunomodulating agent)
Properties. Normalizes the indicators of the T-system.
Stimulates the synthesis of interferons, activates stem
hematopoietic cells.
Indications. Used in adults in complex therapy
infectious, purulent, septic processes, with
lymphoproliferative diseases
(lymphogranulomatosis, lymphocytic leukemia), with disseminated
sclerosis, psoriasis, recurrent ophthalmic herpes and
other diseases associated
immunodeficiency state.
The drug is contraindicated in atopic form
bronchial asthma, pregnancy.
Release form: 0.01% solution (amp., vial.) 1 ml
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
TimalinT-immunomimetic
Properties. Normalizes violations of phagocytosis. Raises
reduced indicators of the T-system of immunity.
Normalizes the ratio of T-helpers, T-suppressors and B lymphocytes. Enhances regeneration processes.
Indications. Used in adults and children with acute and
chronic inflammatory diseases, burn
diseases, trophic ulcers, with suppression of immunity
after radiation therapy.
Release form: vial., 0.01
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
VILOSENT-immunomimetic
Properties. Possesses immunomodulatory
activity, stimulates proliferation and
differentiation of T-lymphocytes.
Unlike thymalin and taktivin, vilozen
applied topically in the form of instillations into the nose
or intranasal inhalation with
allergic diseases of the upper
respiratory tract.
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
ThymogenIt has an immunostimulating effect and enhances
non-specific resistance of the body
Properties. Similar mechanism of action. Normalizes
indicators of the T-system of immunity, activates
innate immune factors (neutrophils,
monocytes, macrophages and NK cells)
Indications. The same indications for use with
other drugs. At the same time, thymogen exhibits
its activity in lower therapeutic
concentrations than natural thymic peptides.
PHARMACOLOGICAL CHARACTERISTICS OF THYMUS PREPARATIONS
IMUNOFAN Oligopeptide immunomodulatorSynthetic analogue of thymus preparations
Properties. In addition to stimulating the T-cell link,
stimulates the synthesis of immunoglobulins A, M, G.
Has a hepatoprotective effect,
antioxidant, detoxifying.
Indications. Secondary immunodeficiencies, cancer
diseases, treatment of post-traumatic stress
disorders, infectious diseases,
rheumatoid arthritis, psoriasis.
Produced in ampoules of 1 ml of 0.005% solution.
Pharmacological characteristics of immunomodulators of bone marrow origin
MYELOPID (complex of low molecular weight peptides(myelopeptides) isolated from bone marrow
mammals. T and B - immunomimetic
Properties. Increases the number of T- and B-lymphocytes,
mature plasma cells, blood phagocytes and
peripheral lymphoid organs. Stimulates
antitumor immunity and erythropoiesis
The drug is indicated for transient immunodeficiencies,
developed on the background of surgical interventions,
injury, chemotherapy or radiotherapy, to treat complications
with non-specific pulmonary diseases,
chronic pyoderma, etc.
Undesirable effects: dizziness, weakness
nausea, hyperemia and soreness at the injection site,
increase in body temperature.
The immune response is regulated by cytokines
regulatory peptides of cells of the immune system, devoid of
specificity for antigens and contributory
intercellular communication in hematopoiesis, inflammation,
immune response and intersystem interactions.
Cytokines act on the basis of a receptor mechanism. To
cytokines include interleukins, interferons, chemokines,
tumor necrosis factors, colony stimulating factors.
Based on cytokines, a group of natural
(LEUKINFERON, SUPERLYMF) and recombinant
(BETALEYKIN, RONKOLEUKIN, MOLGRAMOSTIM, etc.)
immunomodulators.
CHARACTERISTICS OF CYTOKINE PREPARATIONS
LEUKINFERON contains a mixture of leukocyte α-IFN,interleukins 1, 2, 6, 8; tumor necrosis factor (TNF) and
other factors.
antitumor.
SUPERLYMF contains IL 1, 2, 6, 8, TNF, other factors
and intended primarily for local
applications. It is the first cytokine preparation for
local immunocorrection.
Properties. It has a predominant effect on
neutrophils, monocytes, macrophages. Regulates migration
phagocytes into the inflammatory focus, enhances the absorption
bacterial leukocytes. Regulates collagen synthesis.
Has antioxidant activity.
CHARACTERISTICS OF CYTOKINE PREPARATIONS
RONKOLEUKIN - dosage form of recombinantIL-2.
Properties. Immunomodulating. Stimulates
proliferation of T and B lymphocytes. Replenishes
deficiency of endogenous IL-2, reproduces it
effects.
BETALEYKIN - dosage form of recombinant
IL-1β, which plays an important role in the activation of factors
innate immunity, the development of inflammation and the first
stages of the immune response.
Properties. Immunostimulating. The main action activates myelopoiesis and leukopoiesis. Manifests
radioprotective properties.
INDICATIONS FOR THE USE OF CYTOKINES
Secondary immunodeficiency states,developing after severe injuries, as a result of
purulent-septic and purulent-destructive
processes, after extensive surgical
interventions
Secondary immune deficiency in the background
sepsis.
Toxic leukopenia (BETALEYKIN)
Kidney cancer (RONKOLEUKIN)
Treatment of influenza and other viral infections
(LEUKINFERON)
This group includes SODIUM NUCLEINATE, DERINAT,
ZIMOSAN, POLUDAN, RIDOSTIN.
All drugs of the nucleic acid group are strong
interferon inducers (IFN). At the same time, drugs
nucleic acids containing DNA precursors and
RNA, induce the growth and reproduction of cells (for example,
sodium nucleinate is able to stimulate the growth and
bacterial growth).
The main pharmacological effect of nucleic acids is
stimulation of leukopoiesis, regeneration processes and
repair, functional activity of almost all
immune system cells
CHARACTERISTICS OF NUCLEIC ACID PREPARATIONS
Derinat sodium deoxyribonucleateProperties. Immunomodulatory, hematopoietic,
improves blood supply to the myocardium and lower
limbs, anti-inflammatory, regenerative,
wound healing.
Indications. Outwardly: trophic ulcers, burns, treatment
transplant before and after transplantation, etc. Parenterally:
prostatitis, chronic bronchitis, purulent-septic
processes, ischemic heart disease, gastric ulcer, etc.
POLUDAN Preparation of polyadenyl-uridylic acid.
Interferonomimetic. Stimulates endogenous
interferonogenesis.
Indications. Viral diseases of the eye.
The drugs of this group have a non-selective
immunostimulating effect
To stimulate the immune system used:
Echinacea purpurea preparations, such as IMMUNE
Properties. Immunomodulatory, leukopoietic.
Indications. Prevention of colds.
Preparation from the herb of alpine kopeechnik ALPIZARIN
Used for viral diseases of the skin and mucous membranes.
Preparation from cotton seeds GOSSYPOL
Properties. Immunomodulatory, antiviral,
antipsoriatic.
Indications. Shingles, psoriasis, herpes simplex.
CHARACTERISTICS OF HERBAL DRUGS
Polyphenol condensation product from cottonMEGOSIN
Properties. Immunomodulating, antiviral.
Suppresses the reproduction of the herpes virus. Apply when
skin herpes.
Preparation from Amur velvet leaves and velvet
Laval FLACOSIDE
Properties. Antiviral, hepatoprotective,
antioxidant. Indications. Acute viral hepatitis
(A and B), chicken pox, measles, herpes simplex.
Preparation from lespedeza penny HELEPIN
Properties. Antiviral
Preparations of licorice naked LIQUIRITON, GLYCYRAM
This group is divided into low molecular weight:
Levamisole (phenylimidothiazole). Renders
immunocorrective, anthelmintic action.
Normalizes the functions of T-lymphocytes and macrophages.
GALAVIT (a derivative of phthalhydrozide). Possesses
immunomodulatory and anti-inflammatory activity
GEPON (oligopeptide of 14 amino acids). Properties.
Immunomodulatory and antiviral.
GLUTOXIM (bis- (gamma-L-glutamyl) - L-cysteinyl-bisglycine disodium salt. It is a representative of a new
LV-thiopoietin class. Metabolic immunomodulator.
Regulates endogenous production of IL, stimulates
lymphopoiesis, erythropoiesis, granulocytopoiesis, phagocytosis,
has a systemic cytoprotective effect LEVAMIZOL
An imidazole derivative. Levamisole and the resulting
from it a metabolite (the latter is much more active),
activate T-lymphocytes, monocytes, macrophages and
neutrophils. Levamisole stimulates cell-mediated immune responses. He
potentiates the division and differentiation of T-lymphocytes, their reaction to antigens, but only
in the presence of a certain factor in the body,
immunologically similar to thymopoietin.
The ability of the drug to mimic
the activity of this hormone. Levamisole has
anti-inflammatory properties and
ability to inhibit the formation and activity
free oxygen radicals. When using levamisole, you may experience
serious complications.
leukopenia, agranulocytosis is possible (the drug should not be
combined with anti-inflammatory drugs and
antibiotics, especially with chloramphenicol,
tetracyclines, co-trimoxazole, etc.);
respiratory arrest, as the drug reduces
release of acetylcholine from presynaptic terminals
(levamisole should not be administered together with muscle relaxants,
magnesium preparations, as well as patients with myasthenia gravis);
hypertension in the pulmonary circulation, leading to
right ventricular failure and hypotension in large
circle of blood circulation is the result of the ability
levamisole disrupt the neuronal uptake of catecholamines;
proteinuria, etc.
Therefore, this drug is currently
recommended only in patients with colon cancer IV
stages. LEAKADIN (2-Carbamoylaziridine)
The drug has an immunocorrective effect,
promotes increased cytotoxicity of killer cells
and monocytes, inhibition of tumor growth.
Apply leadadin in adults in a combined
therapy for oncological diseases.
Side effects: nausea, vomiting, leukopenia,
thrombocytopenia, increased blood pressure.
Leakadin is contraindicated in leukopenia, thrombocytopenia, gastric ulcer and duodenal ulcer.
intestines, hypertension, thrombophlebitis in the phase
exacerbations.
Release form: lyophilized powder in vials
0.1 and 0.5 g each and in 0.1 g ampoules. Enter intravenously.
CHARACTERISTICS OF CHEMICALLY PURE IMMUNOMODULATORS
To high-molecular chemically pureimmunomodulators include
POLYOXIDONIUM (a polyethylenepiperazine derivative)
Properties. Immunomodulating. Stimulates activity
macrophages and phagocytes. Increases specific
antibodygenesis. Promotes adsorption of circulating
blood of toxic substances (the drug has a high
molecular mass). Has antioxidant and
membrane protective properties.
Indications. Secondary immunodeficiency states,
accompanied by viral, bacterial and
fungal infections of various localization.
INTERFERONS
GENERAL PROPERTIES:Biologically active proteins synthesized by the cell
defensive reaction process
Secreted into extracellular fluid
receptors act on other cells
resistance to microorganisms (especially viruses)
Have no specificity
The main mechanism is the suppression of the synthesis of viral
proteins
MAIN EFFECTS:
Antiviral
Immunomodulatory
Antiproliferative
INTERFERONS
Natural (derived from human blood):INF-alpha - leukocyte (wellferon,
egiferon, human leukocyte
interferon); IFN-beta - fibroblastic
(feron, human fibroblast IFN);
IFN-gamma (human immune IFN, IFN-gamma).
Recombinant (by genetic engineering):
IFN-alpha (REAFERON, realdiron, viferon,
roferon, intron A, inrek); IFN-beta (berofor,
betaferon); IFN-gamma (gamma-feron).
INF-alpha preparations (human interferon
leukocyte, lokferon) contain a mixture of various
subtypes of natural interferon alpha from leukocytes
human blood. They have antiviral, immunomodulatory and antiproliferative effects. AT
based on the antiviral effect of interferon alpha -
tropism for cytoreceptors uninfected with the virus
cells. The interaction of alpha-interferon with
receptors on the cell membrane is accompanied
stimulation of specific enzymes, which prevents
virus replication. The immunomodulatory effect is associated with
activation of killer cells (NK). NK stimulation
also has an antiproliferative effect.
Indications: for intranasal use -
prevention and treatment of SARS; for rectal
applications - acute and chronic viral hepatitis; for
parenteral use - hepatitis C, pointed
warts, hairy cell leukemia, multiple
myeloma, mycosis fungoides, Kaposi's sarcoma in patients
AIDS.
Characteristics of interferon preparations
Preparations interferon alfa-2a (roferon-A,reaferon) contain highly purified
recombinant protein, similar
human leukocyte interferon
alpha 2a. Main biological effects -
antiviral, anticancer and
immunomodulatory activity.
Indications for use:
acute and prolonged viral hepatitis B,
chronic active hepatitis B and C,
viral, viral-bacterial and
mycoplasma meningoencephalitis,
viral conjunctivitis, keratitis,
keratoconjunctivitis,
oncological diseases.
Side and undesirable effects when using interferon preparations
They are much more common with parenteraluse than with other routes of administration. Possible
flu-like conditions, dyspeptic disorders,
asthenia, granulocytopenia. Rarely - dysfunction
liver, neuropsychiatric changes, alopecia,
skin manifestations (dryness, exanthema).
Contraindications: severe organic diseases
heart, liver, kidney, autoimmune hepatitis,
pregnancy, breastfeeding.
INDUCTORS OF INTERFERONS
Stimulate the synthesis of endogenous interferon:cycloferon, amiksin (tiloron), ridostin, megosin,
poludan, arbidol, neovir, bendazol
Cycloferon is a synthetic analogue of natural
an alkaloid derived from Citrus grandis.
Mechanism of action - stimulation of the synthesis of alpha, beta,
and interferon gamma by immunocompetent cells
organism. Increased synthesis of endogenous interferon
leukocytes, macrophages, fibroblasts and
epithelial cells.
Indications: complex therapy of herpetic and
cytomegalovirus infection, viral hepatitis A,
B, C, reactive arthritis and degenerative-dystrophic diseases of the joints, chronic
viral and bacterial infections, chlamydia.
It has low toxicity, does not accumulate
Release form: tab., amp., vial.
IMMUNODEPRESSANTS
Drugs that suppressimmune response - chemicals
or biological origin
inhibitory proliferative
processes in lymphoid tissues and/or
nucleic acid biosynthesis
IMMUNOSUPPRESSIVE (IMMUNOSUPRESSIVE) DRUGS
Have immunosuppressive activity:Glucocorticosteroids (PREDNISOLONE, etc.)
Cytostatics are drugs used as
antitumor agents (cyclophosphamide, azathioprine,
thiophosphamide, 6-mercaptopurine, methotrexate, etc.)
Immunosuppressors. Specific T cell inhibitors
(Cyclosporin, Tacrolimus, Batriden, Antilympholin)
Drugs used in systemic diseases
connective tissue. Small immunosuppressants
(Chloroquine, Penicillamine, Crisanol)
Monoclonal antibodies (MUROMONAB,
BASILIXIMAB, DACLIZUMAB, INFLIXIMAB,
RITUXIMAB, ANTILYMPHOCYTE
IMMUNOGLOBULIN, etc.)
THE MECHANISM OF THE IMMUNODEPRESSIVE ACTION OF GLUCOCORTICOIDS
They suppress the phase of proliferation of lymphocytes (especially T-lymphocytes).Suppress antigen recognition (possibly due to
effects on macrophages).
Reduce the production of a number of interleukins, as well as
gamma interferon.
Reduce the cytotoxicity of certain populations
T-lymphocytes (the so-called killers).
Inhibit the formation of an inhibitory factor
macrophage migration.
At therapeutic doses, GCs do not
significant impact on the products of specific
antibodies and formation of an antigen-antibody complex.
CHARACTERISTICS OF CYTOSTATS
CyclophosphamideSuppresses (like other cytostatics) proliferation
involved in the immune response of lymphocytic clones,
acts predominantly on B-lymphocytes.
Used for glomerulonephritis, lupus erythematosus,
rheumatoid arthritis
Side effects: nausea and vomiting, partial or complete
alopecia, sometimes there are dizziness, worsening
vision, dysuric phenomena, hematuria, bone pain.
CHARACTERISTICS OF CYTOSTATS
AZATHIOPRIN (Imuran)It has cytostatic activity and has
immunosuppressive effect. Inhibits function
bone marrow, inhibits proliferation
granulocytes, causes leukopenia.
Used to suppress the reaction of tissue
incompatibility in organ transplantation, as well as in
some autoimmune diseases.
The drug may cause nausea, vomiting, loss of
appetite. With prolonged use, it may
develop toxic hepatitis; possible
allergic reactions, oppression of a hemopoiesis.
CHARACTERISTICS OF IMMUNODEPRESSANTS
cyclosporinePeptide nature (consists of 11 amino acids. For the first time
has been isolated from certain types of fungi
Powerful immunosuppressant.
Mechanism of action: inhibits formation and secretion
lymphokines and their binding to specific
receptors, inhibits the production of interleukin-2 and
T-cell growth factor, which leads to suppression
differentiation and proliferation of T cells,
involved in transplant rejection.
Used in organ transplantation, as well as in transplantation
bone marrow.
Side effects: impaired function of the kidneys, liver,
gastrointestinal tract (nausea, vomiting, anorexia),
gingival hyperplasia, thrombocytopenia, fluid retention
in the body, convulsions, etc.
MONOCLONAL ANTIBODIES
MUROMONAB - mouse monoclonalantibodies against CD3 antigen-recognizing
T-helper receptors.
Binding of muromonab to CD3 disrupts
binding of an antigen to a T cell
receptor. As a result, it prevents
involvement of T cells in the immune response.
Indications. It is prescribed in complex therapy
in organ transplants.
MONOCLONAL ANTIBODIES
ANTITHYMOTIC(ANTILYMPHOCYTE) IMMUNOGLOBULIN
(heterogeneous) - purified clonal antibodies
horses or rabbits, immunized
human thymic lymphocytes.
It binds to T-lymphocytes, inhibits them.
Appointed. With organ transplants.
May cause serum sickness
anaphylactic shock.
MONOCLONAL ANTIBODIES
ANTI-RH IMMUNOGLOBULIN - anti-Rho(D)- targeted immunoglobulin, obtained
from human blood with a high antibody titer
against Rh (D) antigen. binds to rhesus
antigen and does not allow it to induce
the formation of antibodies in Rh-negative
patients
Indication. It is prescribed for the prevention of Rh conflict in Rh-negative women after
abortion or childbirth (to prevent hemolytic
diseases of the newborn)
biostimulators
The name "biogenic stimulants" has been proposedacad. V.P. Filatov.
A group of substances that are formed in
certain conditions in isolated tissues
animal and plant origin and
capable of providing, when introduced into the body,
stimulating effect and accelerate processes
regeneration.
Such substances are formed when tissues are placed in
unfavorable conditions for them. The appearance of these
substances should be considered as a regulatory
adaptation of tissues to adverse conditions
CLASSIFICATION OF BIOSTIMULATORS (by origin)
1. Animal originACTOVEGIN (from the blood of calves)
SOLCOSERYL
ERIGEM (from human red blood cells)
POLYBIOLIN (from placental blood serum
person)
erythrophosphatide (from human red blood cells)
KERAKOL (from bovine cornea)
HONSURID (from the trachea (hyaline cartilage) of a large
cattle)
CHONDROLONE, STRUKTUM, RUMALON (extract from
cartilage of young animals)
EPITHALAMIN (from the epithalamic-epiphyseal region
bovine brain) 2. Vegetable origin
ALOE (extract, juice, liniment, tab.) KALANCHOE (juice)
BIOSED (extract from the herb stonecrop)
TRIANOL (African plum bark extract)
BEFUNGIN (extract from outgrowths of birch fungus chaga)
3. Mineral origin
FiBS for injections (distillation of firth mud)
PELOIDIN (extract from silt therapeutic mud)
PEAT (product of peat distillation)
4. Various origins
ZYMOZAN SUSPENSION (polysaccharides obtained from
baker's yeast cultures)
PROPER- MIL (mushrooms-saccharomycetes)
ENCAD (yeast enzymatic hydrolysis product)
VULNUSAN (extract from Pomorie salted mother liquors)
lakes)
The effect of biostimulants on the body
Normalize trophic processes,stimulate the nervous system, tone up
cardiovascular system, activate
metabolic processes and accelerate healing
wounds, promote resorption
infiltrates.
Preparations containing chondroitin sulfuric
acid (chonsuride, chondroxide, structum)
slow down the degeneration of cartilage,
normalize the production of joint fluid 5. DRUGS - LIFE PRODUCTS
BEES AND SNAKE
PROPOLIS (bee glue) - used as a tincture) and
is part of the preparations:
PROPOCEUM (ointment)
PROPOSOL (aerosol) and PROPOMIZOL
PROPOLINE (table)
APILAC (dry matter of native royal jelly)
(secret of allotrophic glands of worker bees)
Has anti-inflammatory, analgesic and
wound healing action. Used for inflammatory
diseases of the mouth and throat, skin diseases, not
healing ulcers.
Preparations containing bee venom (apifor, apizartron,
ungapiven) and snakes (nayaxin, vipraksin, viprosal)
They have an irritating effect, improve microcirculation and
trophism, stimulate metabolism, immunity, affect
regulatory processes.
Immunotropic called means that are characterized by a direct or indirect effect on the activity of the immune system. In a broad sense, almost all currently known agents can be attributed to immunotropic drugs, since the immune system is highly sensitive and always reacts in a certain way to the introduction of certain substances. However, in practice, immunotropic drugs proper are understood only as those drugs whose main pharmacological effect is directly related to the effect on immune processes.
Today there is no unified classification of immunotropic drugs. The classification of immunotropic drugs most commonly used in clinical practice is as follows:
1. Products of physiological (biological) origin: taktivin, timimulin, vilozen, thymalin, tim-uvokal, timaktid, myelopid, splenin, laferobion, realdiron, imukin, leukinterferon, leukomax, granocyte, immunoglobulins, etc.
2. Products of microbial origin:
- live bacteria (BCG);
- extracts (biostim, picibanil, urovaxom);
- lysates (bronchomunal, IRS-19, postpat, imudon, urostim, diribiotin, etc.);
- lipopolysaccharides (pyrogenal, prodigiosan);
- yeast polysaccharides (zymosan, sodium nucleinate);
- fungal polysaccharides (kestin, bestatin, lentinan, glucan);
- ribosomes + proteoglycan (ribomunil);
- probiotics (blasten, biosporin, lineks).
3. Synthetic drugs: thymogen, licopid, diucifon, levamisole, kemantan, leakadin, polyoxidonium, isoprinosine, neovir, cycloferon, copaxone;
4. Vitamins and antioxidants.
5. Herbal preparations: proteflazid, manax, immunal, panavir, mangoherpin.
6. Enterosorbents: belosorb, ensoral, mikoton, sillard, antralen.
7. Immunosuppressors: glucocorticoids, cytostatics.
8. Complex enzyme preparations: wobenzym, phlogenzym, wobe-mugos.
All known immunotropic agents can be divided by origin into natural, synthetic and recombinant. Natural immunotropic agents, in turn, are divided into vegetable (preparations of Echinacea purpurea, licorice, Uncaria fomentosa, etc.), animals (for example, thymic preparations, Erbisol, immunoglobulin preparations), bacterial (Imudon, IRS-19), fungi ( zymosan suspension, imunomax, sodium nucleinate). Synthetic immunotropic drugs include polyoxidonium, galavit, levamisole and many others. Recombinant are those immunotropic drugs that are obtained using genetic engineering technologies. In particular, the classical recombinant immunotropic agents are preparations of interferons and interleukins.
All immunotropic drugs can be divided into those used for therapeutic purposes (the vast majority) and those used for the specific prevention of infectious diseases (vaccines, serums). According to the principle of action, all immunotropic drugs for therapeutic purposes are divided into immunostimulators, immunomodulators, immunocorrectors and immunosuppressants. Today it has been established that such a distribution is rather arbitrary, since the same immunotropic drug can exhibit different properties, depending on the dose and the specific clinical situation. Therefore, it is more correct to talk about immunostimulation, immunocorrection, immunomodulation as the direction of immunotherapy, and not about immunomodulators, immunocorrectors and immunostimulants.
According to the mechanism of action, there are agents that act mainly on the system of innate resistance (methyluracil, polyoxidonium, dibazol, likopid, etc.), on the cellular (imunofan, levamisole, interferon preparations, etc.) and on the humoral link of immunity (myelopid, splenin, immunoglobulin preparations). and etc.).
A fairly large number of immunotropic drugs are presented on the modern market. The appointment of such funds should be carried out under the mandatory control of the immunogram, since each of the drugs has a predominant effect on certain parts of the immune system. Stimulation of an undisturbed link can lead to an increase in the imbalance in the immune response and deepening of the existing defect. In table 31, the main immunotropic agents are grouped according to their profile of action.
The main and unconditional rule for children's clinical immunologists should be the restoration of the damaged link of the immune system by correct intervention in its work. Table 32 lists immunotropic drugs that can be recommended for widespread use in diseases of the immune system in children.
Here we would like to discuss some common mistakes made in prescribing immunotropic drugs.
First, immunotropic drugs cannot be prescribed empirically, since each drug has a different mechanism of action. Activation of the undisturbed link of immunity can lead to an even greater imbalance in the immune status. It is necessary to select immunotropic agents on the basis of a thorough immunological examination of the patient.
Secondly, immunotropic drugs should be prescribed only in the evening, not in the morning. This is due to the circadian rhythm of the human body. In the morning, the adrenal cortex is most active, and therefore, the concentration of glucocorticoids in the blood serum increases, so the appointment of immunomodulators during this period is ineffective. In the evening, on the contrary, the activity of the immune system prevails, which justifies the expediency of immunotherapy during this period.
Thirdly, most immunomodulators cannot be prescribed for acute infectious episodes, when active lymphoproliferation occurs due to intense antigenic irritation. The addition of an immunotropic drug that enhances the multiplication of lymphocytes can cause the phenomenon of pathological apoptosis of immunocompetent cells with the further development of lymphopenia and immunosuppression. In some cases, the opposite picture can be observed, i.e. development of lymphoproliferative complications. The exception is immunoglobulin preparations, which can be used both in the acute period and during remission.
Immunotropic drugs (ITLS) include drugs that correct the processes of immunity (immunomodulators, immunocorrectors).
Immunostimulators cause the activation of immunity, and immunomodulators have a multidirectional effect on the immune system, depending on its initial state. This implies that such a drug increases low and lowers high levels of immune status.
According to the mechanism of action All ITLS can be divided into the following groups:
- 1. Immunostimulants (T-, B-, A-systems).
- 2. Means of substitution therapy.
- 3. Interferon group.
- 4. Vitamins.
- 5. Biogenic stimulants and adaptogens.
- 6. Drugs that stimulate metabolic processes.
- 1st Group . Immunostimulants.
According to their origin, they are divided into the following subgroups
- 1.1. Immunostimulants of microbial origin:
- a) fungal lipopolysaccharides (sodium nucleinate, milife, etc.);
- b) purified bacterial lysates (bronchomunal, imudon IRS-19, solkourovak, solcotrikhovac, uro-vaxom, broncho-vaxom, biostim, etc.);
- c) immunostimulating membrane fractions of bacteria, bacterial lipopolysaccharides (pyrogenal, licopid, posterizan, etc.);
- d) association of ribosomes and membrane fractions (ribomunil, etc.).
- 1.2. Immunostimulants of animal origin (hormone-like thymic factors):
- a) immunoregulatory peptides (thymogen, thymalin, taktivin, thymoptin, myelopid, etc.);
- b) cytokines (leukomax, betaleykin, affinoleukin, proleukin, roncoleukin, granocyte, etc.).
- 1.3. Synthetic or chemically pure immunostimulants (diucifon, polyoxidonium, groprinosin, revlimid, decaris, glutoxim, molixan, immunorix, thymogen, immunofan, gepon, licopid, isoprinosin, galavit poludan, etc.).
- 1.4. Immunostimulants of plant origin: polysaccharides, phenylpropanoids, flavonoids, xanthones, saponins (alpizarin, immunal, echinacea tincture, etc.).
- 1.5. Immunostimulants of biological origin (splenin, derinat, deoxynate, etc.).
- 2nd Group . Means of substitution therapy.
Intravenous immunoglobulins (pentaglobin, hepatect, normal human immunoglobulin with a titer of antibodies to the herpes virus, normal human immunoglobulin, normal human immunoglobulin with a titer of antibodies to the cytomegaly virus, normal human immunoglobulin for intravenous administration, intraglobulin, intraglobin, complex immunoglobulin preparation, octagam, cytotect, biaven, kipferon, etc.).
- 3rd Group . Interferons (reaferon, leukocyte interferon, alfaferon, betaferon, avonex, berofor, betaleykin, wellferon, viferon, gammaferon, fluferon, interferon alfa-2 recombinant hydrogel-based ointment, intron-A, leukinferon, lokferon, realdiron, roferon-A, rebif , pegasis, etc.); interferon inducers (amiksin, arbidol, kagocel, levomax, chimes, iodantipyrin, neovir, ridostin, cycloferon, etc.).
- 4th Group . Vitamins of synthetic and natural origin (ascorbic acid, multivitamin plants and various preparations - supradin, biovital, vetoron, etc.).
- 5th Group . Biogenic stimulants, tonics and adaptogens based on phenylpropanoids and saponins (dosage forms of Rhodiola rosea, eleutherococcus prickly, common lilac, echinacea, licorice, aloe, bioaron C, gumizol, etc.).
- 6th Group . Drugs that stimulate metabolic processes.
Pyrimidine derivatives (methyluracil, potassium orotate, pentoxyl, etc.)
7th group. Probiotics and eubiotics (bifidumbacterin, bifikol, lactobacterin, etc.).
The action of drugs of the fourth, fifth, sixth and seventh groups is only indirectly aimed at immunity. They increase metabolism, improve the general condition of the body.
Origin immunomodulators are divided into exogenous, endogenous and chemically pure, most often synthetic. In turn, drugs of exogenous origin are divided into the following groups:
- 1. Immunomodulators of bacterial origin (bronchomunal, IRS-19, imudon, ribomunil, etc. - 19%).
- 2. Immunomodulators of animal origin (thymogen, taktivin, thymalin, myelopid, laennec, betaleykin, etc. - 19%).
- 3. Immunomodulators of plant origin (preparations of Echinacea purpurea, Echinacea angustifolia, Eleutherococcus senticosus, Rhodiola rosea, ginseng and other plants - 23%).
It is noteworthy that the share of drugs of the exogenous group, including agents of bacterial, animal and plant origin, is over 60%. The share of synthetic agents (arbidol, polyoxidonium, neovir, cycloferon - interferon inducers) is 13%. A fairly large percentage (19%) falls on immunotropic drugs of biological origin (splenin, derinat, deoxynate, etc.). (see figure 3).
Fig.3.
The share of vitamin preparations (ascorbic acid, etc.), calculated from the total sales of medicines, is 5--6%, which should be recognized as quite significant both in the pharmaceutical market segment and in terms of their importance for increasing the nonspecific resistance of the human body . It should also be emphasized that in relation to the manifestation of universal organ-protective properties, ascorbic acid (vitamin C), vitamins A (including carotenoids), E (tocopherol), P (rutin, etc.) are of particular importance.
Immunotropic agents
- Mechanisms of the immune response and immune disorders. Primary and secondary immunodeficiencies, autoimmune reactions, rejection reactions during organ and tissue transplantation, allergic reactions.
- Immunostimulants:
immunostimulants of bacterial origin - prodigiosan, ribomunil, licopid, imudon;
immunostimulants of animal origin - thymalin, taktivin, myelopid, splenin;
immunostimulants of endogenous origin - pentaglobin, sandoglobulin, gamimun H;
Recombinant cytokines - betaleykin, roncoleukin, interferon-alpha, interferon-beta, interferon-gamma;
synthetic immunostimulants - imunofan, thymogen, levamisole, cycloferon, amixin.
The mechanism of influence of drugs on the immune system. pharmacological properties. Indications for use. Features of the dosing regimen of drugs. Side effects and contraindications for use.
- Immunosuppressors:
Cyclosporine, tacrolimus, pimecrolimus, methotrexate, cyclophosphamide, basiliximab, antilymphocyte globulin, Rh-D immunoglobulin, prednisolone, beclomethasone , dexamethasone.
Pharmacodynamics and pharmacokinetics of drugs. Features of the action on autoimmune reactions and rejection reactions of organs and tissues. Indications for use. Side effects and contraindications. Interaction with other drugs.
Antiallergicfunds
- Mechanisms of occurrence of allergic reactions. Principles of action of antiallergic drugs.
- Antiallergic drugs:
— H1-histamine receptor antagonists or antihistamines –
suprastin, tavegil, fencarol, terfenadine, loratadine, erius,;
— drugs that prevent the synthesis and release of allergy mediators- prednisolone, beclomethasone , fluticasone;
— drugs that inhibit the release of allergy mediators- cromolyn sodium, nedocromil sodium, ketotifen.
— leukotriene receptor antagonists- zafirlukast, montelukast, zileutin.
— drugs that prevent the formation and release of mediators of allergy and inflammation (glucocorticosteroids)- prednisolone, budesonide, fluticasone, triamcinolone, dexamethasone. Mechanisms of antiallergic action. Pharmacokinetics and pharmacodynamics of drugs. Indications and contraindications for use.
- Means that eliminate the general manifestations of allergic reactions(adrenaline hydrochloride, beclomethasone and etc.). Mechanism of action. pharmacological effects. Indications for use.
Compose tables on the pharmacological and clinical efficacy of drugs and the assessment of the safety of their use. Include in the tables drugs: thymogen, imunofan, myelopid, levamisole, cyclophosphamide, cyclosporine, Rh-D-immunoglobulin, chloropyramine, loratadine, nedocromil sodium, beclomethasone.
Pharmaco-clinical efficacy of drugs
| Group | Pharmacological effects | Indications for use | Preparations |
| Immunostimulants of bacterial origin | Immunostimulatory effect Anti-inflammatory effect Stimulating regeneration effect |
- Trophic ulcers (sluggish). Elimination of tissue swelling after surgical interventions. |
Prodigiosan |
| Immunostimulants of animal origin | Immunostimulatory effect | - Immunodeficiency states (transient and chronic) with a predominant lesion of the humoral link of immunity; - purulent and septic processes. - secondary immunodeficiency (exacerbations of chronic infectious diseases). - leukemia (complex treatment). — prevention of infectious complications after surgical operations, mechanical, thermal and chemical injuries. |
Myelopid |
| Recombinant cytokines | Immunostimulatory effect Leukopoietic effect |
- as a stimulator of leukopoiesis in toxic leukopenia II - IV degree, complicating chemotherapy and radiotherapy of malignant tumors. - as a protector of leukopoiesis, if necessary, chemotherapy under conditions of a leukopenic background (the number of peripheral blood leukocytes is not less than 3x10 (9) / l). |
Betaleukin |
| Synthetic immunostimulants
|
Immunostimulatory effect | - Immunomodulatory and biostimulating therapy in adults and children with conditions and diseases accompanied by a decrease in cellular immunity: acute and chronic purulent-inflammatory diseases of bones and soft tissues, acute and chronic viral and bacterial infections, impaired regenerative processes, conditions associated with thymus hypofunction, with suppression of immunity and hematopoiesis after radiation therapy or chemotherapy in cancer patients; - in obstetric and gynecological practice with anemia, toxicosis, purulent-inflammatory and other diseases and conditions with initially reduced indicators of cellular immunity. - The drug is also used to prevent infectious complications, suppression of immunity, hematopoiesis, regeneration processes in the post-traumatic and postoperative period, during radiation therapy or chemotherapy, when using massive doses of antibiotics. |
Thymogen |
| Hepatoprotective effect Immunostimulatory effect Detoxification effect | -Applied in adults for the prevention and treatment of immunodeficiency states of various etiologies. | Imunofan | |
| Immunostimulatory effect Anthelmintic effect | - Ascariasis, hookworm, necatoriasis, strongyloidiasis, trichostrongylosis, trichuriasis, enterobiasis. - Infectious diseases (recurrent herpes, herpes zoster, chronic active hepatitis B, persistent viral hepatitis); - rheumatoid arthritis, Crohn's disease, Reiter's disease, aphthous stomatitis, SLE (to maintain remission); malignant neoplasms (after surgical, radiation or chemotherapy treatment) of the bronchi, colon, mammary glands, in remission with Hodgkin's disease, in the intervals of cytostatic treatment of leukemia. |
Levamisole | |
| Immunosuppressants
|
Antitumor effect. Alkylating compound |
- Small cell lung cancer, ovarian cancer, breast cancer, lymphogranulomatosis, lymphosarcoma, reticulosarcoma, osteogenic sarcoma, multiple myeloma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, Wilms' tumor, Ewing's sarcoma, testicular seminoma; - autoimmune diseases: rheumatoid arthritis, psoriatic arthritis, collagenosis, autoimmune anemia, nephrotic syndrome, suppression of transplant rejection. |
Cyclophosphamide |
| Immunosuppressive effect | - used in adults for transplantation of kidneys, heart, pancreas, bone marrow, skin grafts, implantation of artificial heart valves and pacemakers. - to prevent GVHD; With autoimmune diseases. |
Cyclosporine | |
| Immunosuppressive effect | Immunoglobulin antirhesus - Rh o (D) of a person is used in Rh o (D) - negative puerperas, non-sensitized to Rh o (D) isoantigen, who gave birth to Rh o (D) - a positive child compatible with the mother according to the blood groups of the ABO system. | Rh— D-immunoglobulin | |
| Drugs that inhibit the release of allergy mediators | Antiallergic effect. Mast Cell Membrane Stabilizer |
Nedocromil sodium | |
| Drugs that prevent the release of mediators of inflammation and allergies (glucocorticosteroids)
|
Glucocorticosteroid effect Immunosuppressive effect Antiallergic effect Anti-inflammatory effect |
- Circulatory collapse: shock during or after surgery, trauma, blood loss, myocardial infarction, burns. - Severe infections: toxemia, vascular collapse with meningococcal infection, septicemia, diphtheria, typhoid fever, pneumonia, influenza, peritonitis, eclampsia. - Emergency allergic conditions: status asthmaticus, laryngeal edema, dermatosis, acute anaphylactic reaction to drugs, transfusion of serum and antibiotics, pyrogenic reactions. - Acute and chronic polyarthritis, scapulohumeral periarthritis, ankylopoietic spondyloarthritis, rheumatic fever, rheumatic carditis. - Bronchial asthma, status asthmaticus, various acute and chronic allergic diseases (hypersensitivity to drugs, serum sickness, urticaria, allergic rhinitis, hypersensitivity to chemicals, Quincke's edema). - Addison's disease, Hodgkin's disease, acute adrenal insufficiency, adrenogenital syndrome. - Hepatitis, hepatic coma, hypoglycemic conditions, lipoid nephrosis, agranulocytosis, various forms of leukemia, lymphogranulomatosis, thrombocytopenic purpura, hemolytic anemia. - Disseminated lupus erythematosus, pemphigus, periarthritis nodosa, eczema, itching, expoliative dermatitis, psoriasis. - Eye diseases (sympathetic ophthalmia, allergic forms of conjunctivitis, non-purulent keratitis, iritis, iridocyclitis, uveitis, choroiditis). |
Prednisolone |
| H1-histamine receptor antagonists | Antihistamine effect. H1-histamine blocking effect. |
Allergic rhinitis, allergic conjunctivitis, chronic urticaria, pseudo-allergic reactions against the background of histamine liberators, allergic reactions to insect bites, itchy dermatoses, allergic dermatitis, eczema, Quincke's edema. | Loratadine |
| Antiallergic effect. sedative effect. Antipruritic effect. Sleeping effect. |
pollinosis (hay fever); allergic conjunctivitis; contact dermatitis; acute and chronic eczema; serum sickness; insect bites; |
Chloropyramine | |
| Leukotriene receptor antagonists
|
Anti-inflammatory effect Anti-asthma effect prevents bronchospasm |
Bronchial asthma (prevention of attacks and maintenance therapy), incl. with the ineffectiveness of beta-stimulants. | Zafirlukast |
Characteristics of the safety of the use of drugs
| Contraindications to the appointment | ||||
| Prodigiosan | ||||
| Myelopid | ||||
| Betaleukin | ||||
| Thymogen | ||||
| Imunofan | ||||
| Levamisole | ||||
| Cyclophosphamide | ||||
| Cyclosporine | ||||
| Rh— D-immunoglobulin | ||||
| Nedocromil sodium | ||||
| Prednisolone | ||||
| Loratadine | ||||
| Zafirlukast | ||||
| Chloropyramine (suprastin) | - lethargy, weakness, drowsiness, slowing down of psychomotor reactions. dizziness, slight tremor, coordination disorders. |
|||
Choose a drug for the treatment of diseases of the immune system, write in a prescription: levamisole, thymogen, taktivin, myelopid, cromolyn sodium, ketotifen, cyclosporine, chloropyramine, loratadine, beclomethasone.
| № | Recipe | Indication for the use of the drug |
| 1 | Rp.:Tab. Levamisoli 0.15 N.10 S. 1 tablet 1 time per day 30 minutes before meals, for 3 days every 2 weeks. As an immunostimulant. |
Rheumatoid arthritis; primary and secondary immunodeficiency states; autoimmune diseases; chronic and recurrent infections; complex therapy of malignant neoplasms; intestinal nematodes (ascariasis). |
| 2 | Rp.:Sol. Thymogeni 0.01%-1.0ml. D.t.d. N.6 in amp. S. Inject intramuscularly, 1 ml, 1 time per day, within 6 days. For prevention infectious complications in the postoperative |
Immunomodulating and biostimulating therapy in adults and children with conditions and diseases accompanied by a decrease in cellular immunity: acute and chronic purulent-inflammatory diseases of bones and soft tissues, acute and chronic viral and bacterial infections, impaired regenerative processes, conditions associated with thymus hypofunction, with suppression of immunity and hematopoiesis after radiation therapy or chemotherapy in cancer patients; in obstetric and gynecological practice with anemia, toxicosis, purulent-inflammatory and other diseases and conditions with initially reduced indicators of cellular immunity. The drug is also used to prevent infectious complications, suppression of immunity, hematopoiesis, regeneration processes in the post-traumatic and postoperative period, during radiation therapy or chemotherapy, when using massive doses of antibiotics. |
| 3 | Rp.:Sol.Tactivini 0.01% - 1.0ml D.t.d. N.10 in amp. S. Subcutaneously 1 ml 1 time per day at bedtime a course of 10 days. In order to stimulate the immunological activity in focal tuberculosis. |
Immunodeficiency conditions in adults with a predominant lesion of the T-system of immunity, arising from infectious, purulent and septic processes, lymphoproliferative diseases (lymphogranulomatosis, lymphocytic leukemia, multiple sclerosis, tuberculosis, recurrent ophthalmic herpes, psoriasis, etc.). |
| 4 | Rp.: Myelopidi 0.003 S. Dissolve the contents of the vial in 2 ml isotonic sodium chloride solution for injections. Administer intramuscularly from the calculation 0.05 mg/kg of body weight once a day, daily for 5 days. For prevention infectious complications after surgery. |
Immunodeficiency states (transient and chronic) with a predominant lesion of the humoral link of immunity; purulent and septic processes, secondary immunodeficiency (exacerbations of chronic infectious diseases), leukemia (complex treatment), prevention of infectious complications after surgical operations, mechanical, thermal and chemical injuries. |
| 5 | Rp.:Aer. Nedocromili 0.002 D.S. 2 inhalations 4 times a day for 3 days, then 2 ings 2 times a day. In bronchial asthma, allergic origin. |
Monotherapy of respiratory diseases with the presence of reversible obstruction in patients of different age groups: bronchial asthma of various origins; asthmatic bronchitis; bronchospastic reactions caused by a number of stimuli, such as cold air, inhaled allergens, atmospheric pollution, and a number of others. — Complex therapy in patients with asthma. |
| 6 | Rp.:Tab. Ketotifeni 0.001 N.30 D.S. 1 tablet 2 times a day, morning and evening. With chronic urticaria. |
Prevention of allergic diseases: bronchial asthma (atopic form), allergic bronchitis, hay fever, allergic rhinitis, allergic dermatoses, chronic urticaria, allergic conjunctivitis. |
| 7 | Rp.:Cyclosporini 0.1 D.t.d. N.50 in caps. S. 1 capsule 2 times a day. For severe rheumatoid arthritis |
In adults with transplantation of kidneys, heart, pancreas, bone marrow, skin grafts, implantation of artificial heart valves and pacemakers; to prevent GVHD; with autoimmune diseases. |
| 8 | Rp.:Tab.Suprastini 0.025 N.20 D.S. 1 tablet 3 times daily with meals. With hay fever. |
urticaria and angioedema (Quincke's edema); pollinosis (hay fever); allergic rhinitis and rhinopathy; allergic conjunctivitis; the initial stages of mild bronchial asthma (as part of complex therapy); contact dermatitis; acute and chronic eczema; itching dermatoses, neurodermatitis; drug rashes, toxicoderma; serum sickness; insect bites; acute respiratory diseases and intestinal infections in children (in combination with antipyretics). |
| 9 | Rp.:Tab.Loratadini 0.01 N.10 S. 1 tablet 1 time per day. With pollinosis. |
Allergic rhinitis (seasonal and year-round), conjunctivitis, hay fever, urticaria (including chronic idiopathic), angioedema, pruritic dermatosis; pseudo-allergic reactions caused by the release of histamine; allergic reactions to insect bites. |
| 10 | Rp.:Aer. Beclometasoni 15.0ml. N.1 D.S. 2 inhalations 4 times a day. With a hormone-dependent form of bronchial severe asthma. |
Bronchial asthma (for long-term regular use); Bronchial asthma in patients in whom the use of bronchodilators has become less effective; Bronchial asthma in patients who have insufficient effect of the combined use of bronchodilators and sodium cromoglycate; If there are contraindications for the use of bronchodilators; Hormone-dependent form of severe bronchial asthma in adults and children; Chronic obstructive pulmonary disease; chronic obstructive bronchitis (with a pronounced inflammatory component); Prevention and treatment of year-round and seasonal allergic rhinitis, including hay fever rhinitis, vasomotor rhinitis; Recurrent nasal polyposis, nasal polyps; Dysphonia in systemic lupus erythematosus, persistent inflammation of the middle ear in children, bronchopulmonary dysplasia of newborns. |
Classroom work
- Complete test tasks
- Immunostimulants of microbial origin include:
A. Prodigiosan B. Timalin V. Levamisole G. Pentaglobin D. Myelopid.
- Thymic immunostimulants include:
A. Myelopid B. Pentaglobin C. Levamisole G. Timalin D. Imunofan
- The main indication for the appointment of taktivin:
A. Prevention of recurrent infections of the upper respiratory tract against the background of secondary immunodeficiency
B. Treatment of lower respiratory tract infections C. Treatment of autoimmune diseases D. Prevention of rejection reaction after kidney transplant E. Primary T-cell immunodeficiency
- The main indication for the appointment of myelopide:
A. Burns, in which the patient has a content of T-lymphocytes less than 300 per µl B. Viral diseases, in which the content of T-lymphocytes is more than 800 per µl C. Burns with insufficient antibody production and leukopenia D. ENT infections
- Specify the drug with immunosuppressive properties:
A. Levamisole B. Indomethacin C. Myelopid G. Cyclosporine D. Timalin
- Fill in the tables
- Solving drug selection problems
Ztask number 1
Patient K., aged 38, diagnosed with frequent recurrent respiratory diseases. Laboratory studies have revealed the insufficiency of the T-cell link of immunity. What is the preferred drug?
Ztask number 2
Patient T., 14 years old, diagnosed with frequent recurrent respiratory diseases. Laboratory studies revealed a deficiency in the B-cell link of immunity. What is the preferred drug?
- Timalin 2. Imukin 3. Immunoglobulin preparations 4. Myelopid 5. Prodigiosan
Task #3
Patient M., aged 42, diagnosed with brucellosis. Laboratory established insufficiency of natural immunity and antibody production. What is the preferred drug?
- Timalin 2. Imunofan 3. Pentaglobin 4. Myelopid 5. Prodigiosan
Task #4
The patient underwent a kidney transplant operation. Specify the drug to suppress the reaction of its rejection:
Task #5
The patient underwent a bone marrow transplant. Specify the drug to suppress the rejection reaction:
- Basiliximab 2. Tacrolimus 3. Cyclosporine 4. Prednisolone 5. Cyclophosphamide
Zadacha №6
The main indication for the appointment of cromolyn sodium is the presence of the patient:
- Allergic rhinitis 2. Bronchial asthma 3. Recurrent urticaria 4. Food allergy.
- Solve situational problems for the choice of pharmacotechnology for the treatment of various forms of diseases
Zdacha number 7
Choose the technology of prophylactic administration of thymalin to prevent recurrent acute respiratory viral infections in frequently ill patients:
Zadacha №8
Choose a technology for prescribing levamisole to prevent recurrent acute respiratory viral infections in frequently ill patients:
- 4-5 injections every other day 2. 10 injections every other day 3. 15 injections every other day 4. 3 injections every other day
Zadacha №9
Choose a technology for prescribing tactivin for the treatment of secondary immunodeficiency in destructive pneumonia:
- 4-5 injections every other day 2. 10 injections every other day 3. 15 injections every other day 4. 3 injections every other day
- Solve situational problems for the choice of a drug, taking into account the state of organs and systems of the patient's body, side and toxic effects of drugs.
Zadacha №10
The appointment of cyclosporine is contraindicated in:
- Pathologies of the cardiovascular system 2. Liver lesions 3. Bronchial asthma 4. Autoimmune diseases
Task #11
Appointment diphenhydramine is contraindicated in:
- Prostate adenoma 2. Glaucoma 3. Bronchial asthma 4. Stomach ulcer
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