The third stage - preventive therapy is aimed at preventing the development of relapses of the disease. It is carried out on an outpatient basis.

Indications for prescribing preventive therapy are: - the presence of at least two delineated affective episodes over the past two years;
- the presence of affective phases of a subclinical level in the pre-treatment period after the first episode in life;
- the first episode is severe, leading to hospitalization (the presence of psychotic symptoms, in case of depression - suicidal thoughts/tendencies).
Preventive therapy can be carried out indefinitely, but not less than 1 year. The question of stopping preventive therapy can be resolved positively in the case when the patient’s condition has been completely stable for five years, i.e. There were no affective disorders even at a subclinical level. It should be remembered that even against the background of complete well-being, cessation of preventive therapy can lead to the development of a phase and further aggravation of the course of the disease compared to the period before the start of treatment. In this regard, in cases where there are no objective medical indications for discontinuing preventive therapy (such actions, the occurrence of concomitant intercurrent diseases requiring the prescription of medications incompatible with the drugs used for prophylaxis, etc.), the doctor’s tactics should be aimed at continuing therapy indefinitely.
Examinations and consultations required upon admission to hospital
- clinical blood test (Clinical blood and urine tests are repeated once every three to four weeks at normal results.)
- biochemical analysis blood: total protein; total bilirubin; (bound bilirubin; free bilirubin; alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, thymol test) (If appropriate conditions are present.); prothrombin index; determination of blood sugar; blood test for RV; blood test for HIV;
- clinical urine test (Clinical blood and urine tests are repeated once every three to four weeks with normal results);
- ECG;
- analysis of a swab from the throat and nose for diphtheria bacillus;
- bacteriological analysis;
- consultation with a therapist;
- for female patients - consultation with a gynecologist;
- consultation with a neurologist;
- consultation with an ophthalmologist.F30 Manic episode

F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode, unspecified
Treatment conditions
Usually stationary. The length of hospital stay depends on the speed of symptom reduction, on average it is 2 - 3 months. Follow-up treatment is possible in semi-inpatient or outpatient settings.
For necessary examinations, see general part F3.
Principles and duration of therapy
All basic approaches and principles described for bipolar affective disorder (see section F31) are followed. At the stage of relief therapy, the first choice drugs are lithium salts (carbonate, hydroxybutyrate). Treatment is carried out under the control of lithium concentration in the blood plasma. The dose is selected so that the concentration of lithium in the blood plasma, determined in the morning, on an empty stomach, 8 to 12 hours after taking the last dose, is not lower than 0.8 and not higher than 1.2 mmol/l. Lithium oxybutyrate is administered intramuscularly, slowly intravenously or intravenously. To correct sleep disorders, add hypnotics (such as nitrazepam, flunitrazepam, temazepam, etc.).
With pronounced psychomotor agitation, aggressiveness, the presence of manic-delusional symptoms, or the absence of the effect of lithium, during the first days of therapy, antipsychotics are added to the regimen (mainly haloperidol, if necessary, parenterally), the dose of which, as the effect develops, is gradually reduced until complete withdrawal. It is possible to add sedative neuroleptics (see Table 1). Their use is symptomatic, that is, in the case of the development of motor agitation or sleep disorders. When using neuroleptic therapy, it is also necessary to follow the rules for relieving acute psychosis in schizophrenia (see section F20). If there is no effect in the first month of therapy, a transition to intensive care or anti-resistant measures: alternating high doses of incisive neuroleptics with sedatives (see Table 1), adding powerful tranquilizers (phenazepam, lorazepam), carbamazepine, sodium valproate, etc.
At the second stage - follow-up or stabilizing therapy, the use of lithium salts should continue until the spontaneous end of the phase, the duration of which is established according to the previous phases (on average 4 - 6 months). Lithium carbonate or its prolonged forms (contemnol, etc.) are used. In this case, the dose of the drug should be gradually reduced; the blood plasma concentration is maintained at 0.5 - 0.8 mmol/l. The issue of stopping lithium therapy is decided depending on the characteristics of the disease and the need for preventive therapy.
Expected treatment results
Relief of affective disorders

Drug therapy (Pharmacotherapy) is treatment with drugs, or otherwise, pharmacological agents. Chemotherapy refers to pharmacotherapy as applied to oncology. Pharmacotherapy is classified as conservative (non-invasive) methods of treatment. Pharmacotherapy is also the name of the branch of pharmacology that studies drug therapy.

Types of pharmacotherapy

The following types of pharmacotherapy are distinguished:

Etiotropic therapy - an ideal type of pharmacotherapy. This type of pharmacotherapy is aimed at eliminating the cause of the disease. Examples of etiotropic pharmacotherapy include treatment antimicrobial agents infectious patients (benzylpenicillin for streptococcal pneumonia), the use of antidotes in the treatment of patients with poisoning by toxic substances.

Pathogenetic therapy — aimed at eliminating or suppressing the mechanisms of disease development. Most currently used drugs belong specifically to the group of pathogenetic pharmacotherapy drugs. Antihypertensive drugs, cardiac glycosides, antiarrhythmic, anti-inflammatory, psychotropic and many other drugs have a therapeutic effect by suppressing the corresponding mechanisms of disease development.

Symptomatic therapy - aimed at eliminating or limiting individual manifestations of the disease. Symptomatic medications include painkillers that do not affect the cause or mechanism of development of the disease. Antitussives are also a good example of symptomatic remedies. Sometimes these drugs (elimination of pain during myocardial infarction) can have a significant impact on the course of the main pathological process and at the same time play the role of pathogenetic therapy.

Replacement therapy - used for deficiency of natural nutrients. Replacement therapy means include enzyme preparations(pancreatin, panzinorm, etc.), hormonal medications (insulin for diabetes, thyroidin for myxedema), vitamin preparations (vitamin D, for example, for rickets). Replacement therapy drugs, without eliminating the cause of the disease, can ensure the normal existence of the body for many years. It is no coincidence that such a severe pathology as diabetes- is considered a special lifestyle among Americans.

Preventive therapy - carried out to prevent diseases. Preventative drugs include some antiviral drugs (for example, during a flu epidemic - rimantadine), disinfectants and a number of others. The use of anti-tuberculosis drugs such as isoniazid can also be considered preventive pharmacotherapy. A good example of preventative therapy is the use of vaccines.

It should be distinguished from pharmacotherapy chemotherapy . If pharmacotherapy deals with two participants in the pathological process, namely the drug and the macroorganism, then with chemotherapy there are already 3 participants: the drug, the macroorganism (the patient) and the causative agent of the disease. The drug acts on the cause of the disease (treatment of infectious diseases with antibiotics; poisoning with specific antidotes, etc.).

One type of etiotropic therapy is replacement pharmacotherapy, in which drugs replace missing physiologically active substances (use of vitamins, hormonal drugs with insufficiency of glandular function internal secretion and etc.)

№p/p	Subject	number of hours	lecture date
	Basics of pharmacotherapy. Pharmacotherapy is the science of using medicinal substances with therapeutic purpose. The following types of pharmacotherapy are distinguished: etiotropic, pathogenetic, symptomatic, replacement and preventive. Study of clinical pharmacotherapy, tasks. Study of clinical pharmacokinetics. Basic questions of pharmacodynamics. Relationship between pharmacokinetics and pharmacodynamics. Medicines in modern medicine. Clinical pharmacology in the 20th century. Influence various factors on the effect of drugs. Mechanisms of action of drugs. Selectivity of drug action. Doses, tolerance, drug overdose. Drug interactions. Side effects of drugs. The role of the pharmacist in solving important problems of pharmacotherapy. Terminology.
	Diseases of the cardiovascular system. Pharmacotherapy of hypertension. Pharmacotherapy of heart failure. Pharmacotherapy coronary disease hearts. Pharmacotherapy of stenacordia, heart rhythm disturbances. Selection of drugs, dosage regimen. Methods for assessing effectiveness and safety. Diagnosis, correction and prevention of adverse drug reactions. Possible interactions when combined with drugs from other groups.

Topic 1. Basics of pharmacotherapy

Target: know the methodology of the subject.

Plan:

The concept of pharmacotherapy as a science.

Types of pharmacotherapy.

Basic concepts and terms of pharmacotherapy.

The tasks and significance of pharmacotherapy in medicine and pharmacy.

Ways of introducing drugs into the body.

Types of action of drugs

Compatibility of drugs.

Features of pharmacotherapy in children and the elderly.

Pharmacotherapy in elderly and senile people.

Features of pharmacotherapy in pregnant women and nursing mothers.

Pharmacotherapy - a branch of pharmacology that studies patient therapy with drugs.

Depending on the characteristics of the impact on the pathological process, the following types of pharmacotherapy are distinguished:

Etiotropic therapy is aimed at eliminating the cause (etiology) of the disease or reducing the effect of the causative factor of the disease, for example, the use of antimicrobial drugs for infectious diseases or antidotes (antidotes) for poisoning with toxic substances. This type of therapy is the most effective.

Pathogenetic therapy - the effect of drugs aimed at eliminating or suppressing the mechanisms of disease development. Most pharmacotherapeutic agents belong to pathogenetic drugs. For example, the use of antihypertensive, antiarrhythmic, anti-inflammatory, psychotropic and other drugs.

Symptomatic therapy is aimed at eliminating or reducing individual symptoms of the disease, eliminating or limiting individual manifestations of the disease. The use of drugs that do not affect the cause or mechanism of the disease. Medicines that eliminate individual manifestations of the disease are called symptomatic drugs. Their therapeutic effect is based only on the weakening of some symptom of the disease.

For example, the use of painkillers for headaches, the use of laxatives for constipation or astringents for diarrhea, acetylsalicylic acid for colds.

Replacement therapy used when there is a deficiency in the patient’s body of biologically active substances (hormones, enzymes, vitamins, etc.), the introduction of which, without eliminating the cause of the disease, ensures a normal life for a person for many years (type I diabetes, hypothyroidism, anemia associated with iron deficiency , deficiency of vitamin B2 and folic acid, chronic adrenal insufficiency, etc.).

Preventive therapy carried out to prevent diseases. The group of preventive agents includes some antiviral, disinfectant drugs, vaccines, serums, etc.

Currently, in connection with the practical needs of life, a new direction is being formed - pharmacology (valeology is the science of health), designed to improve people's health with the help of drugs with adaptogenic and antioxidant effects.

Pharmacotherapy strategy comes down to eliminating or reducing the effect of the causes that cause diseases, eliminating or suppressing the mechanisms of disease development, on the one hand, as well as stimulating natural protective mechanisms of compensation and recovery, on the other.

The fastest and most complete recovery is achieved with the simultaneous use of drugs that suppress the cause of the disease and the mechanisms of its development (pathogenesis), and drugs that strengthen the body’s defense mechanisms, so the doctor sometimes justifiably strives to simultaneously prescribe several drugs (polypharmacy).

The effectiveness of pharmacotherapy increases when it is carried out in combination with a certain regimen of rest or activity, an appropriate diet, and suitable physiotherapeutic procedures. It can be an addition to surgical treatment methods.

In carrying out rational individual pharmacotherapy based on knowledge of pharmacokinetics, drug metabolism, pharmacogenetics and pharmacodynamics, the pharmacist provides significant assistance to the doctor.

Clinical pharmacology is a science that studies the effects of drugs on the body of a sick person.

Her tasks:

1) testing new pharmacological agents;

2) development of methods for the most effective and safe use of drugs;

3) clinical trials and re-evaluation of old drugs;

4) information support and advisory assistance to medical workers.

Resolves issues such as:

1) selection of a drug for the treatment of a particular patient;

3) determining the route of administration of the medicinal substance;

5) prevention and elimination of adverse reactions of the medicinal substance.

In addition to the theoretical problems developed by clinical pharmacology, in practice it solves a number of other issues:

1) selection of medications for the treatment of a particular patient;

2) determination of the most rational dosage forms and mode of their use;

3) determination of routes of administration of the medicinal substance;

4) monitoring the effect of the drug;

5) prevention and elimination of adverse reactions and undesirable consequences of interaction medicinal substances.

Pharmacology is a medical and biological science about the effects of drugs on living organisms, the fate of drugs in the body, and the principles of creating new drugs. The word "pharmacology" comes from the Greek words pharmacon - medicine and logos - teaching, word. Thus, the literal translation: pharmacology is the science of medicines, drug science. Modern medicine is divided into pharmacy and pharmacology. Pharmaceutical sciences (pharmaceutical chemistry, pharmacognosy, pharmaceutical technology) study the physicochemical properties of medicines, medicinal raw materials of plant and animal origin, and the technology of manufacturing medicines in factories and pharmacies. Pharmacology studies changes in the body that occur under the influence of drugs (pharmacodynamics), as well as their absorption, distribution, biotransformation and excretion (pharmacokinetics). The mechanism of action of drugs is considered as an influence on biological systems of varying complexity - from the whole organism to individual cells, subcellular formations and cytoreceptors.

Medicine- is one or more substances used for the treatment and prevention of diseases. Dosage form is an easy-to-use form of drug release (solid, liquid, soft, extraction and maximally purified).

An important information characteristic of medicines is their international nonproprietary names (INN). They, identifying the active pharmaceutical substance (about 8,000 in the world), ensure communication and exchange of information between health care professionals and scientists from different countries, are in the public domain and are assigned by the World Health Organization (WHO). Commercial trade names are given to ready-made single- or multi-component drugs produced in a specific dose and dosage form. Trade names are the property of the manufacturer. In Russia

Only a small number of domestic drugs that have traditional national names have been preserved in the drug nomenclature.

The Russian “List of Vital and Essential Medicines” includes medicines, without the use of which life-threatening diseases and syndromes progress, their course worsens, complications appear, the patient’s death may occur, as well as medicines for the treatment of socially significant diseases. The list is regularly reviewed and updated.

Each stage life cycle the medicinal product complies with the standard of “good practice” (Good Practice) or code of professional practice. Standards guarantee the effectiveness, safety and pharmaceutical aspects of the quality of finished products, protect the interests of consumers and facilitate international trade by recognizing the results of work carried out in one country by other countries (Table 1).

Preclinical pharmacological studies are carried out on laboratory animals (intact and with models of human diseases), in culture of cells and their organelles. These studies must provide evidence and reliability of the data while respecting the principles of humane treatment of laboratory animals. The following experimental methods are used:

screening (English) to screen - sift) - standard methods assessment of the activity of chemical compounds in comparison with the effect of known drugs (the effectiveness of screening is low - on average, for one drug brought to the stage of clinical trials, there are 5 - 10 thousand pre-tested compounds);

in-depth study of the mechanism of action using physiological, biochemical, biophysical, morphohistochemical, electron microscopic methods, and molecular biology methods;

pharmacokinetics study;

determination of acute and chronic toxicity;

identification of specific types of toxicity (immunotoxic, allergenic, mutagenic, carcinogenic, embryotoxic, teratogenic, fetotoxic effects, the ability to cause drug dependence).

Clinical pharmacology studies the effects of drugs on the body of a sick person - pharmacodynamics and pharmacokinetics in a clinical setting. The tasks of clinical pharmacology are clinical trials of new drugs, re-evaluation of known drugs, development of methods for the effective and safe use of drugs, elimination of undesirable consequences of their interactions, conducting pharmacokinetic studies, organizing an information service.

Table1. Good Pharmaceutical Practice Standards

Stage of the drug life cycle	Standard
Preclinical studies	Rules before clinical trials safety and effectiveness of medicines { Good Laboratory Practice, GLP)
Clinical trials	Good clinical practice including planning, conducting, completing, verifying, reviewing, and reporting clinical trial results (Good Clinical Practice, GCP)
Production	Rules for organizing production and quality control of medicines (Good ManufacturinG Practice, GMP)
Wholesale trade	Wholesale trade rules (Good Distribution Practice, GDP)
Retail trade and pharmacies	Rules of pharmaceutical (pharmacy) practice (Good Pharmacy Practice, GPP)

Clinical trials of new drugs of phases I - IV (Table 2) are carried out in comparison with the effect of reference drugs of a given pharmacological group or placebo. Placebo (lat. placebo - I like it) is a dosage form that does not contain a drug, has the same appearance, smell, taste, just like a real medicine. The placebo effect is especially important in internal diseases with emotional disorders (arterial hypertension, angina pectoris, bronchial asthma, peptic ulcer), neurosis, mental disorders, pain syndromes.

Patients in the experimental and control groups should be the same in age, form and stage of the disease, and initial background treatment. Groups are formed by random distribution of patients (randomization).

Table 2. Clinical trial phases

	Based on the results of preclinical studies of efficacy and safety, the effect of the drug is studied in various doses in healthy volunteers (5 - 10 people) to assess the tolerability of the drug; determine pharmacokinetic parameters for single and repeated doses, interaction with food
	The effectiveness and safety of a drug in comparative terms (placebo, reference drug) are studied in a limited number of patients (100 - 200) with the disease for which the drug is intended to treat; determine the range of its therapeutic doses
	A comparative study of the drug in established therapeutic doses and specific dosage forms is carried out in a large number of patients of different ages, including patients with concomitant diseases of the cardiovascular system, kidneys and liver; interactions with other drugs are identified and pharmacoeconomic aspects are assessed. Based on the results of this phase of testing, a decision is made to register the drug
	The phase begins during the registration of the drug and continues after its appearance on the market. Its tasks: solving additional questions regarding the use of the drug, expanding the indications for its use, acquiring experience for doctors in its use, positioning the drug on pharmaceutical market
Post-registration surveillance (phase V)	Collection and analysis of reports of side effects of a drug, preparation of reviews on its safety based on studying the use of the drug in tens of thousands of patients, analysis of the effect on survival

During clinical trials, open, “single-blind” and “double-blind” methods are used. At "just a blind man" In this method, the patient is not told whether he has taken the test drug, the reference drug, or placebo. The doctor and the person requesting the study know this. At "double blind" In this method, neither the patient nor the attending physician has information. Only the person requesting the study is informed about how the clinical experiment is conducted. Clinical, instrumental, laboratory and morphological methods are used.

The scientific value of the results obtained during clinical trials should not conflict with ethical standards aimed at protecting the health and rights of patients. Patients are included in a clinical trial only subject to their voluntary informed consent and on the basis of a positive conclusion from an independent ethical committee.

The development of a new drug is an extremely expensive, complex and time-consuming process. Only one out of 10,000 investigational substances reaches registration and becomes a drug. The duration of collecting data on the drug being created reaches 8 - 12 years.

In addition to their beneficial therapeutic effects, many drugs can cause unwanted reactions, in some cases leading to severe complications and even death.

Adverse reactions and complications are possible when taking any medications.

Modern medicine has achieved great success in the prevention and treatment of various diseases, largely due to the availability of highly effective drugs. However, over the past half century, the number of complications from medications has increased dramatically. Their frequency in outpatient treatment reaches 10-20%, and 0.5-5% of patients require treatment.

The reasons for this are the not always justified rapid introduction of drugs into medical practice, the widespread use of polytherapy (polypharmacy), i.e. the simultaneous prescription of a large number of drugs, and, finally, self-medication.

The following types of side effects and complications of pharmacotherapy are distinguished:

1) side effects associated with the pharmacological activity of drugs;

2) toxic complications, regardless of dose;

3) secondary effects associated with a violation of the immunobiological properties of the body (decreased immunity, dysbacteriosis, candidomycosis, etc.);

4) allergic reactions;

5) withdrawal syndrome that occurs when you stop taking a drug.

Side effects of drugs associated with their pharmacological activity can occur both with an overdose of drugs and when they are used in therapeutic doses.

Drug overdose can be absolute (too large a dose is taken) and relative (the dose is therapeutic, but the concentration in the blood and cells is too high, due to the characteristics of the pharmacokinetics of the drug in a given patient). In case of overdose, there is a significant increase in the main and toxic effects of the drugs. For example, an overdose of vasodilators causes collapse, stimulants - convulsions, hypnotics - anesthesia, etc.

Complications when using the drug in normal therapeutic doses, not associated with overdose, do not occur in all patients and, as a rule, with long-term use. For example, tricyclic antidepressants (amitriptyline, etc.), in addition to the main effect on the central nervous system, cause dry mouth, constipation, accommodation disorders, etc.

Toxic complications, regardless of the dose, in some cases cannot be avoided at all for some drugs. For example, cytostatics not only suppress the growth of tumor cells, but also inhibit the bone marrow and damage all rapidly dividing cells.

Violation of the immunobiological properties of the body is possible when using highly active antibiotics and other antimicrobial agents that cause changes in the normal bacterial microflora (superinfection, dysbacteriosis, candidomycosis).

The side effects of drugs depend on the nature of the underlying disease. Systemic lupus erythematosus is often accompanied by steroid-induced arterial hypertension.

Allergic reactions are the most common complication of drug therapy. Allergic reactions are caused by the interaction of an antigen with an antibody and are not related to the dose of drugs. There are two types of immunopathological reactions that can be caused by drugs: 1) immediate type reaction (urticaria, bronchospasm, anaphylactic shock, rash, Quincke's edema, serum sickness, anaphylactoid reaction, necrotic focal lesions in organs); 2) delayed type reaction (arthritis, glomerulonephritis, hepatitis, myocarditis, vasculitis, lymphadenopathy). Such complications can be caused by antibiotics, sulfonamides, non-narcotic analgesics, vitamins, aminazine, local anesthetics, sulfonamides, antiepileptic drugs, iodine, mercury, arsenic, etc.

To prevent allergic complications, it is necessary to carefully collect anamnesis. If there is a history of predisposition to allergic diseases Long-acting drugs should not be prescribed. A thorough collection of family history will help to identify the presence of idiosyncrasy in the patient - primary intolerance to drugs that is inherited. Idiosyncrasy occurs with drugs such as iodine, quinine, sulfonamides, etc.

Withdrawal syndrome drug therapy manifests itself as a sharp exacerbation of the underlying disease. Thus, stopping the use of clonidine for hypertension can provoke the occurrence of a hypertensive crisis with corresponding symptoms.

A side effect can be primary, i.e. associated with a direct effect on certain organs and tissues, or secondary (indirect), not due to the direct effect of the drug on these organs and tissues. For example, non-narcotic analgesics have a direct irritant effect on the mucous membrane of the gastrointestinal tract and cause nausea, vomiting, and the formation of erosions on the gastric mucosa. Therefore, they should be used after meals. This is primary side effect non-narcotic analgesics. By affecting kidney enzymes, these drugs retain sodium and water in the body. The appearance of edema is a secondary or indirect effect of non-narcotic analgesics.

Side effects of drugs can manifest as general dysfunctions of the nervous system, gastrointestinal tract, liver, kidneys, cardiovascular system, hematopoietic organs, etc. Some groups of drugs give more specific complications.

Damage to the cardiovascular system is associated with the direct effect of drugs on the heart muscle, causing rhythm and conduction disturbances, a decrease or increase in blood pressure, and impaired myocardial contractility. Hypersensitivity reactions to drugs can cause the development of allergic myocarditis.

Possible disorders of the nervous system (depression, seizures, extrapyramidal disorders, decreased hearing and vision, polyneuropathy, etc.). Nerve cells are highly sensitive to chemicals, so drugs that penetrate the blood-brain barrier can impair performance, cause headaches, dizziness, lethargy, etc. Thus, with prolonged use of antipsychotics, parkinsonism develops, tranquilizers - gait disturbance (ataxia) and depression, stimulating - insomnia, etc. Exposure to drugs sometimes leads to dystrophic changes and even death of nerve fibers and cells. Thus, antibiotics of the aminoglycoside group (streptomycin, gentamicin, neomycin, etc.) can cause damage to the auditory nerve and vestibular apparatus, 8-hydroxyquinoline derivatives (enteroseptol, mexaform, etc.) - optic neuritis, etc. Some drugs also affect on the organ of vision, causing damage to the optic nerve, cataracts, increased intraocular pressure, retinopathy and conjunctivitis.

The liver is a barrier between the intestinal vessels and the general circulatory system. During enteral administration (especially) and during any other administration, it is here that most medicinal substances accumulate and undergo biotransformation. In this case, the liver may be damaged, especially if the drug is concentrated and retained in hepatocytes long time- the basis for the manifestation of hepatotoxicity. Cytostatics, some antibiotics, and a number of anti-inflammatory and analgesic drugs have a toxic effect on the liver, causing fatty degeneration, cholestasis, and necrosis of hepatocytes. Some drugs can cause the development of active hepatitis (methyldopa, sulfonamides, anti-tuberculosis drugs, paracetamol). Ethyl alcohol, halogen-containing drugs (fluorothane, aminazine, chloral hydrate, etc.), arsenic and mercury drugs, some antibiotics (tetracycline, streptomycin) and others are highly hepatotoxic. The liver, rich in glycogen and vitamins, is more resistant to the action of chemical agents.

The kidneys, as an excretory organ, concentrate drugs - the basis for the manifestation of nephrotoxicity. Damage to renal tissue is possible during treatment with sulfonamides, antibiotics (streptomycin, gentamicin, cephalosporins, rifampicin), non-steroidal anti-inflammatory drugs (brufen, butadione), thiazide diuretics, etc. Nephrotic syndrome occurs during treatment with D-penicillamine, gold and lithium preparations, tolbutamide, etc. Nephrotoxic effects are exerted by antibiotics of the aminoglycoside group (streptomycin, gentamicin, neomycin), butadione, sulfonamide drugs, vasoconstrictors, etc. Currently, it is believed that a significant part of nephrological disorders is associated with the occurrence of an allergic process. To the formation of stones in urinary tract with long-term use, calcium preparations, sulfonamides, etc.

Most drugs used orally affect the mucous membrane of the oral cavity and gastrointestinal tract. So, methotrexate leads to serious damage to the mucous membrane small intestine. Many anti-inflammatory drugs can cause gastritis, ulceration of the mucous membrane of the stomach and intestines, gastrointestinal bleeding, and exacerbation of pancreatitis. All this is the basis for the ulcerogenic effect (formation of ulcerations on the mucous membranes). Glucocorticoids, non-narcotic analgesics, reserpine, tetracycline, caffeine, etc. are ulcerogenic.

Many medications cause changes in the blood. One of the most dangerous complications of drug therapy is inhibition of hematopoiesis - hematotoxicity. Thus, when using antiepileptic drugs, anemia may occur; chloramphenicol, butadione, amidopyrine, sulfonamide drugs and others - leukopenia up to agranulocytosis, which is often manifested primarily by ulcerative-necrotic lesions of the oral mucosa. Agranulocytosis often develops when non-steroidal anti-inflammatory drugs are prescribed (amidopyrine, indomethacin, butadione), as well as when treated with captopril, chloramphenicol, ceporin, furosemide, etc. Hemolytic anemia occurs when using penicillin, cephalosporins, insulin, chlorpropamide and other drugs. Aplastic anemia is caused by butadiene and other non-steroidal anti-inflammatory drugs, as well as cytostatics, heavy metals, oral hypoglycemic drugs (chlorpropamide, tolbutamide), etc. Thrombocytopenia occurs during therapy with cytostatics, a number of antibiotics, and anti-inflammatory drugs. Vascular thrombosis develops as a result of taking contraceptives containing estrogens and gestogens.

Pharmacotherapy should be carried out with great caution in pregnant women, since many drugs easily penetrate the placental barrier (the porosity of which is especially high in the first 8 weeks of pregnancy) and have a toxic effect on the fetus. A teratogenic effect (teras, teratos - Greek, deformity), that is, causing developmental abnormalities, may have drugs that affect protein synthesis, the exchange of neurotransmitters, blood clotting, etc. Teratogenic effects have been found in glucocorticoids, salicylates, tetracyclines, synthetic antidiabetic drugs, anticonvulsants. Currently, all drugs are necessarily tested for teratogenic effects before being introduced into clinical practice.

Much attention is paid to studying the carcinogenic effects of drugs. Derivatives of benzene, phenol, tar ointments, and cauterizing agents have this activity. Sex hormones and other stimulators of protein synthesis can promote the growth and metastasis of tumors.

With the advent of chemotherapeutic agents, another group of complications associated with the antimicrobial activity of drugs has emerged. The use of antibiotics (penicillin, chloramphenicol) can cause the death and decay of a large number of pathogens and the entry of endotoxin into the blood. This leads to an exacerbation reaction or bacteriolysis. All symptoms of the disease sharply worsen, which requires the use of antitoxic therapy, antihistamines and glucocorticoids.

Broad-spectrum antibacterial drugs, especially antibiotics, suppress microflora that are sensitive to them, promote the proliferation of resistant microorganisms, and dysbacteriosis and superinfection occur. The Candida fungus begins to multiply most often. Candidiasis usually affects the oral mucosa. To prevent this complication, broad-spectrum antibiotics are combined with antifungal agents (nystatin, levorin, decamine).

The use of chemotherapy drugs changes the usual forms of the disease, suppresses the immunological reactivity of the body, changes the antigenic properties of the microorganism, reduces the amount of antigen, and erased forms of infectious diseases arise that do not leave lifelong immunity.

The problem of drug dependence or drug addiction. It was caused by the widespread use of psychotropic drugs. Drug dependence develops to narcotic analgesics, cocaine, sleeping pills, ethyl alcohol, tranquilizers, some stimulants, herbal drugs - hashish, marijuana, opium, etc.

Phenomena of cumulation, addiction and addiction to drugs. Various phenomena may be associated with the use of medications. Thus, with repeated or long-term use of the drug, the phenomenon of cumulation occurs, i.e., an increase in its effect. Cumulation can be the result of the accumulation of a substance (material, chemical cumulation) or the accumulation of dysfunctions (physiological, functional cumulation).

With prolonged and frequent use of the drug, addiction may occur - a decrease in the body's response to repeated use of the drug in the same doses. Addiction manifests itself in the fact that the required therapeutic effect is not achieved when administering the same dose of the drug; in this case, the dose of the drug should be increased or replaced with another drug of similar effect.

With the use of drugs acting on the central nervous system(psychotropic drugs), the phenomenon of addiction is associated, which is a drug dependence on a particular drug caused by its systematic use. Addiction is accompanied by a desire to increase the dose of the drug when taking it again. This is due to the fact that when such drugs are administered, a state of euphoria may occur, characterized by a decrease in unpleasant sensations and leading to a temporary improvement in mood. Addiction to such substances is otherwise called drug addiction.

Drug addiction can be caused by sleeping pills, narcotics, stimulants and painkillers. Accordingly, based on the name of the drug to which the addiction appeared, drug addictions are called alcoholism, etheromania, morphinism, cocaineism, etc. Drug addicts are seriously ill people who need qualified treatment from a medical specialist.

Combining medications (co-administration) can lead to a mutual enhancement of the effect (synergism) or a mutual weakening of it (antagonism). In cases of drug poisoning, it is necessary to use the principles of antagonism.

There are several types of antagonism:

Physico-chemical, based on the absorption of poisons

on the surface of an adsorbent substance (for example, the use of activated carbon for poisoning);

Chemical, based on the interaction of substances,

introduced into the body, as a result of which drugs lose their effect (for example, neutralization of acids with alkalis);

Physiological, based on the administration of drugs,

exerting the opposite effect on a given organ or tissue

action (for example, the introduction of stimulants in case of poisoning with depressants).

A medicinal substance is a chemical compound of natural or synthetic origin, which is the main active principle that determines medicinal properties. Included in the composition of the drug.

Medicinal raw materials are the source of the drug substance. The most common and long-known medicinal raw materials include many plants, both wild and cultivated by specialized farms. The second source of medicinal raw materials is the organs and tissues of various animals, waste products of fungi and bacteria, from which hormones, enzymes, antibiotics and other biologically active substances are obtained. Genetic engineering plays an important role in this, making it possible to obtain previously unknown substances. The third source is some natural and synthetic derivatives. After appropriate processing of medicinal raw materials, an active medicinal substance is obtained.

Depending on the method of processing medicinal raw materials, galenic and new galenic preparations are obtained.

Galenic preparations are preparations of complex chemical composition obtained from parts of plants or animal tissues. They contain active compounds in combination with ballast substances. Herbal preparations include infusions, decoctions, tinctures, extracts, syrups, etc.

New galenic preparations are aqueous-alcoholic extracts from plant medicinal raw materials, highly purified with the removal of all ballast substances. Thanks to this purification, drugs can be administered parenterally.

A drug (medicine) is “any substance or product used or intended to be used to modify or investigate physiological systems or pathological conditions for the benefit of the recipient” (WHO scientific group definition), may contain other substances that provide its stable form. The terms "drug" and "drug" are used interchangeably. The medicine can have a single-component or complex composition that has preventive and therapeutic effectiveness. In the Russian Federation, medicinal products are those that are approved for use by the Ministry of Health in accordance with the established procedure.

A medicinal product is a medicinal product in a form ready for use. This is a dosage medicinal product in a dosage form adequate for individual use and in optimal design with an annotation about its properties and use.

Dosage form - the physical state of the drug, convenient for use (see below).

For all of the above provisions, standards are developed that are approved by government agencies (Pharmacological Committee, Pharmacopoeial Committee).

All drugs are divided into three groups, taking into account their possible toxic effects on the human body if used incorrectly. Lists of these drugs are presented in the State Pharmacopoeia. List A (Venena - poisons) includes medicines, the prescription, use, dosage and storage of which, due to their high toxicity, must be carried out with extreme caution. This list also includes drugs that cause addiction. List B (heroica - potent) includes medicines, the prescription, use, dosage and storage of which must be carried out with caution due to possible complications when used without medical supervision. The third group is drugs dispensed from pharmacies without prescriptions.

A prescription is a written instruction from a doctor to a pharmacist about dispensing or preparing medicines for a patient with instructions for their use. A prescription is a legal document that can only be written by a doctor. A prescription is a doctor’s request to a pharmacist to dispense medication to a patient, indicating the dosage form, dose and method of administration. A prescription is a medical, legal and monetary document in the case of free or discounted medications. The writing of prescriptions and the dispensing of drugs according to them are carried out in accordance with the “Rules for writing prescriptions”, “Rules for storing records and dispensing toxic and potent substances” and other official documents, which are determined by orders of the Ministry of Health of the Russian Federation. Medicines prepared in a pharmacy or at pharmaceutical factories according to the prescription available in the Pharmacopoeia are called official, and those prepared according to doctor’s prescriptions are called manestral.

Drugs from the list of narcotic substances (that can cause drug dependence - drug addiction) are prescribed on special forms. Narcotic analgesics, psychostimulants (amphetamine, dexamphetamine and similar compounds). Narcotic antitussives (codeine, codeine phosphate, ethylmorphine hydrochloride). Sleeping pills (noxiron, etaminal sodium, etc.) Anorexigenic drugs (fepranon, desopimon, etc.) Cocaine hydrochloride, sombrevin.

A prescription for a narcotic drug must be written in the hand of the doctor who signed it and certified with a personal seal and signature. In addition, the prescription is signed by the chief physician of the medical institution or his deputy and certified with a round seal. This order of prescription is determined for drugs with anabolic activity (anabolic steroids) and intoxicating effects - phenobarbital, cyclodol, ephedrine hydrochloride, clonidine (eye drops, ampoules).

On other forms of prescription forms, antipsychotics, tranquilizers, antidepressants, drugs containing ethyl alcohol, etc. are prescribed.

The following medications are dispensed without a prescription, by manual sale: analgin with amidopyrine 0.25 (tab.), Avisan, dekamevit, validol, valerian preparations, Zelenin drops, Vishnevsky ointment, nitroglycerin, etc. It is prohibited to write out prescriptions for ether for anesthesia to outpatients , chloroethyl, fentanyl, etc.

Recipes consisting of one medicinal substance are called simple, those containing two or more substances are called complex. In complex prescriptions, the following order of recording medications is used: 1) main medicine; 2) auxiliary agents (strengthening or weakening the effect of the main drug), substances that improve the taste or smell of the drug or reduce its irritating properties (corrective); 3) formative substances (drugs that give the medicine a certain consistency).

Doses of medications. For medications to work properly, they must be used in an adequate dose. A dose is the amount of medicine that is introduced into the body and has a specific effect on it. The strength of the drug is determined by the dose and the order in which it is taken.

Dose is the amount of a medicinal substance introduced into the body, and is expressed in mass or volume units of the decimal system and denoted in Arabic numerals. The number of whole grams is separated by a comma. The unit of weight in the recipe is 1 g - 1.0; per unit volume - 1 ml. When taking medications, it is important to consider that in 1 tbsp. l. contains 15 g of water in 1 tsp. - 5 g; in 1 g of water - 20 drops; in 1 g of alcohol - 47-65 drops.

Depending on the mode of action, the dose can be minimal, therapeutic, toxic or lethal.

Minimum effective (threshold) dose - this is the minimum possible amount of medicine that can have a therapeutic effect.

Therapeutic dose - this is an amount of medicine that exceeds the minimum effective dose, which gives an optimal therapeutic effect and does not have a negative effect on the human body. Most often in medical practice, an average therapeutic dose is used, which in most cases gives an optimal therapeutic effect without pathological effects.

Toxic dose - this is the smallest amount of medicine that can cause a toxic effect on the body. For toxic and potent substances, the maximum single and daily doses for adults and children are indicated in accordance with the age of the patient. In case of an overdose of substances or when replacing one drug with another, poisoning may occur.

Minimum lethal dose is the amount of a drug that can cause death.

Depending on the amount of use per day, the dose can be single (single) or daily.

There are also:

Fixed doses. Many drugs have the desired clinical effect in doses below toxic ones (diuretics, analgesics, oral contraceptives, antibacterial agents, etc.), and individual variability is not significant.

Varying doses, difficult to adjust. Adequate dose selection is difficult because the final therapeutic outcome is difficult to quantify, such as depression or anxiety, or the effect develops slowly, such as in thyrotoxicosis or epilepsy, or varies depending on the pathological process (when treated with corticosteroids).

Variable doses, easily adjusted. Vital functions can change significantly and quickly under the influence of drugs, such as blood pressure and blood sugar levels. Dose adjustments can be made quite accurately, since the effect of the drug can be quantified. During corticosteroid replacement therapy, individual doses are also selected.

Maximum tolerated dose. Medicines that do not allow obtaining an ideal therapeutic effect due to undesirable reactions (anticancer, antibacterial) are used in maximum tolerated doses, i.e. they are increased until adverse reactions appear, and then slightly reduced.

Minimum tolerated dose. This dosing principle is used less frequently, usually with long-term administration of corticosteroids for inflammatory and immunological diseases, for example, bronchial asthma, rheumatoid arthritis. The dose to produce symptomatic improvement may be so high that severe adverse reactions are inevitable. The patient receives a dose that alleviates his condition and is safe. This is a difficult task.

The initial dose provides the desired effect and does not cause toxic reactions Often the same as the maintenance dose, ensuring stability of the therapeutic effect.

Vitamins are organic substances that are not synthesized in the body or synthesized in insufficient quantities, supplied with food and combined into a single group based on their absolute necessity for the body.

Vitamins play a primary role in metabolism, regulation of the processes of absorption and use of basic nutrients - proteins, fats (lipids) and carbohydrates, as well as in maintaining the normal physiological state of the nervous, cardiovascular, digestive, genitourinary, endocrine and hematopoietic systems. Consuming sufficient amounts of vitamins helps strengthen the body, increase its performance and resistance to harmful influences. environment.

Lack or absence of vitamins leads to weakening of the body and the development of characteristic diseases - hypo- and avitaminosis, in which metabolism and most body functions are disrupted. Hypervitaminosis is an excessive intake of vitamins into the body. The lack of vitamins is felt especially in the spring, when the consumption of vegetables, fruits and berries is reduced, and when the content of vitamins in them, especially C and P, decreases. At the same time, people experience weakness, increased fatigue, decreased performance and a decrease in the body's resistance to infections.

Exhibiting high biological activity in very small doses, vitamins are necessary:

For normal cellular metabolism and tissue trophism

For energy transformation

For plastic exchange

To maintain vital functions such as reproduction, growth and tissue regeneration

To ensure the body's immunological reactivity

For the normal functioning of all organs and tissues.

Pharmacotherapy is inextricably linked with toxicology.

WAYS OF ADMINISTRATION OF MEDICINES INTO THE BODY

There are enteral routes of administration through the digestive tract and parenteral routes, bypassing the digestive tract.

Enteral routes of administration