Home Stomatitis Memo on the use of medications. Drops, suppositories, patches, local preparations: rules for using various dosage forms A reminder to the patient about taking medications

Stomatitis

Memo on the use of medications. Drops, suppositories, patches, local preparations: rules for using various dosage forms A reminder to the patient about taking medications

Use of drugs for various diseases

Collection best medicines of the proven remedies are still not outdated and help better than others. Some medications have serious side effects, which patients should definitely be aware of. All this will help you stay healthy. But doctors warn: do not self-medicate.

Cold

Arbidol – increases the antiviral activity of all body systems.
Ibupron is a strong pain reliever, it acts quickly, in the form of effervescent tablets it is gentle on the stomach, and in suppositories it is convenient for children.
Coldrex is an excellent vasoconstrictor drug. It works quickly because it is dissolved in hot water.
Nazol – relieves a runny nose and prevents the nasal mucosa from drying out, lasts 12 hours.
Nurofen – ambulance, works quickly. There are suppositories for babies, but they greatly worsen the quality of the blood.
Paracetamol (Panadol, Efferalgan) is an excellent antipyretic, indispensable for asthmatics.
Polyoxidonium – stimulates immune system, prescribed to children, suitable for emergency care and for prevention during an epidemic.
Ribomunil - restores immunity, recommended for children as the most effective remedy.
Sanorin is the fastest remedy for a runny nose with antiallergic components.
Flukol-B is cheap and effective drug, but contains 8% alcohol and is contraindicated for drivers.

Liver

Antral is a domestic original drug, it has no analogues in the world, it protects liver cells from any microbial aggression.
Galstena - drops, an indispensable medicine for young children.
Lioliv - improves the condition of the liver in case of jaundice (low bilirubin).
Lipoferon - the drug is taken orally, it is 5 times cheaper than injectable interferons!
Potassium orotate – improves liver function, protein synthesis, and overall metabolism.
Silymarin is a hexal. Herbal preparation. It contains much more active ingredient than its analogues: karsil, silybor, hepaben.
Cholenzym is an inexpensive choleretic drug that helps digest food and improves the production of enzymes.
Holiver – choleretic drug plant origin.
Hepel is a homeopathic German remedy without side effects.
Essentiale – no more than 20 years old effective drug For .

Stomach

Altan – herbal preparation domestically produced, indispensable for peptic ulcers.
Acidin-pepsin. The drug increases acidity in the stomach.
Gastritol - drops of plant origin, good for babies.
Motilium - normalizes gastric motility, improves the movement of food through the stomach.
Sea buckthorn oil – reduces inflammatory processes in the stomach.
Pariet - from latest generation drugs that effectively reduce acidity in the stomach.
Pilobact – the latest remedy from Helicobacter.
Renorm is a domestic phytoconcentrate with a strong anti-inflammatory effect, normalizes digestion.
Riabal - good for relieving stomach cramps, it is prescribed to children. Available in syrup and drops.
Phosphalugel is a gel that removes well and is less toxic than its analogues.

Eyes

Zovirax – eye ointment, is indispensable for viral conjunctivitis.
Quinax is the best prophylactic for.
Korneregel is a gel that effectively restores the tear film on the cornea of the eye.
Xalacom – it combines two drugs xalatan and timalol. They enhance each other's action.
Xalatan (travatan) – effective for glaucoma, you can drop it once a day.
Systane is an artificial tear, the advantage is that you can drop it once a day.
Uniclofen is a good non-steroidal anti-inflammatory drug in drops.
Floxal - drops, antibiotic, acts on a wide range of microorganisms.
Floxal ointment is indispensable for bacterial conjunctivitis.
Cycloxan is a strong antibiotic in drops, a panacea for acute conjunctivitis.

Ears

Amoxicillin is an antibiotic that actively fights the main pathogens that cause ENT diseases.
Clavicillin-Amoxicillin + clavulanic acid. In addition to microorganisms sensitive to amoxicillin, the drug also has an active effect on certain types of bacteria.
Otofa – ear drops, antibiotic is used for inflammatory diseases middle ear.
Otipax – combination drug for local use with a pronounced analgesic and anti-inflammatory effect. The combination of phenazone and lidocaine reduces the time of onset of the anesthetic effect.
Nimesulide – has both analgesic, anti-inflammatory and antipyretic effects.
Noxprey - when administered through the nasal cavity, causes a narrowing of the mucous membrane, reduces its swelling, as well as swelling around the mouth eustachian tubes, improves drainage in case of eustachitis and otitis media.
Ciprofloxacin - effective local remedy for otitis, has an anti-inflammatory, antipruritic and vasoconstrictor effect, reduces swelling.
Cefaclor, cefixime, cefpodoxime, cefprozil, cefuroxime are second and third generation cephalosporins. They are prescribed to those who are not affected by ampicillin.
Edas-125 tonsillin - homeopathic drops, prescribed to children from 2 years of age for otitis, adenoids, chronic tonsillitis with water or on a piece of sugar.
Erythromycin - prescribed to those who are allergic to penicillin drugs.

Nerves

Venlaxor is an antidepressant with virtually no side effects and quickly relieves severe depression.
Busperone is a strong anti-anxiety drug and does not create the effect of inhibition. Can be used by drivers and students before the exam.
Gidazepam is a mild sleeping pill that does not affect the driver’s reaction. But you can get used to it - you can’t drink it for more than a month!
Zyprexa - has no serious side effects, provides immediate relief.
Imovan (sonap, somnol, sonavan) are the most modern sleeping pills.
Paxil is an antidepressant that effectively eliminates panic, fear, obsessive states (phobias), helps against anorexia, and also prolongs sexual intercourse as a side effect.
Pramestar improves memory in general and makes it easier to remember information.
Rispolept - long-lasting, convenient - dissolves in the mouth like candy.
Sulpiride (eglanil) - simultaneously treats nerves and stomach. Another plus: I drank today - today is the result.
Finlepsin – treats seizures and neuritis, and also stabilizes mood.

Kidneys

Aksef is an antibiotic, convenient because it can be taken as tablets or injected. It is sold individually, complete with solvent.
Blemaren is the most effective dissolver of kidney stones.
Canephron is a herbal preparation without side effects.
Movalis is a suppository, a non-hormonal anti-inflammatory drug that does not irritate the rectal mucosa.
Nephrofit is a combined herbal medicine with anti-inflammatory and diuretic effects. Without side effects, prescribed to children over 5 years old and pregnant women.
Ofloxin is not aggressive to the stomach and rarely causes allergies.
Urosept is a suppository that acts only on the urinary system.
Urolesan is a herbal preparation that removes sand well from the kidneys and is often prescribed to children. Available in syrup form.
Flemoclav solutab has a wide spectrum of antimicrobial action and is recommended for weakened patients.
Ceftriaxone is a broad-spectrum antibiotic with a minimum of side effects and is approved for use even by pregnant women.

Prostate

Azitrox is an antibiotic, convenient - one tablet per week.
Gatifloxacin is the most new antibiotic, fast acting.
Zoxon - gives minimal side effects, convenient - one tablet at night.
Penisten - reduces the volume of the prostate, reduces the risk of developing prostate cancer.
Prostamol UNO is a herbal preparation without side effects.
Prostatilen (Vitaprost) – extract from the prostate gland of a large cattle, biostimulant.
Proteflazide is a herbal immunostimulant, effective for prostatitis.
Focusin - no.
Funid – antifungal drug last generation.
Unidox Solutab is a broad-spectrum antibiotic that penetrates well into the prostate tissue.

Joints

Aspirin is indispensable for.
Alflutop – improves blood metabolism and activates metabolic processes in muscles.
Dona - strengthens cartilage tissue.
Dicloberl is a non-hormonal anti-inflammatory drug. They are used in suppositories, but injections can also be given.
Diclofen has fewer side effects than others.
Diclofenac is effective, but affects the condition of the blood.
Ketanov is an effective injection drug.
Olfen is convenient because it is in suppositories and does not harm the gastric mucosa.
Osteogenon is an effective chondoprotector that relieves joint laxity.
Retabolil - improves peripheral circulation.

Throat

Anaferon is a good homeopathic remedy for treatment viral infections upper respiratory tract.
Kolustan is an aerosol that relieves swelling and inflammation well.
Lugol's dissolved in glycerin is the best external application.
Proposol-N – has pronounced antimicrobial and anti-inflammatory properties, does not have an irritating effect on the body.
Sinupret - has an antibacterial and anti-edematous effect, can be prescribed to children - taken in the form of drops.
Tonsilgon is an anti-inflammatory and analgesic that helps reduce swelling of the mucous membrane of the respiratory tract.
Tonsilotren - increases the activity of the mucous membrane.
Flemoxin solutab is an effective instant antibiotic for purulent sore throat, used both internally and for rinsing.
Faringosept – antiseptic, pleasant to the taste (dissolves in the mouth). Does not affect intestinal microflora.
Falimint is a product with a cooling effect for the treatment of diseases of the oral cavity and pharynx. Indispensable on the eve of operations, during dental prosthetics and for lecturers.

Attention! The effect of these medications depends on concomitant medications and other nuances of treatment. Doctors warn: under no circumstances should you be treated without consulting a doctor!

Title Memo on safe use medicines
_Author
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Nowadays, it is rare to find a person who, at least occasionally, has not taken medications. But “ideal” drugs, as we know, do not yet exist. All of them, to a greater or lesser extent, have adverse effects that can negatively affect the patient’s health. But what to do if you can’t do without medicine? How can you make taking medication as minimally dangerous as possible? National Institute on Aging U.S. Department of Health and Human Services Public Health Service National Institutes of Health offer a fairly simple reminder for the patient, which in many cases will help minimize health risks when taking new medications.

Here is a list of questions to ask your doctor who is prescribing you a new drug.

What is the name of the medicine and why should I take it?
What is the generic name of the medicine and under what name is it marketed by other companies?
What diseases are treated with this medicine?
How does this medicine work?
How long does it last?
How often should it be taken?
How can I be sure this medicine is working?
How will I feel the first time I take this medicine?
When (in relation to time of day and meals) should I take the medicine, in what quantity and how many times?
If I accidentally missed a time to take my medication, for example, I forgot, what should I do?
What adverse effects should I expect while taking this medication? Should I tell my doctor if they occur? How can I minimize the likelihood of these effects occurring?
How long should I take the medicine?
What should I do if I see that the medicine is not working?
Does this medication interact with other medications, including herbal medications, as well as foods and dietary supplements that I also currently use.
When taking the medicine, should I avoid:
- driving?
- drinking alcohol?
- taking certain types of foods?
- taking certain medications?
Are there any other restrictions in the regimen, diet or lifestyle that should be observed while taking the medicine?
Should treatment with this medication be combined with another drug or drugs?
How (in what conditions) should the medicine be stored?
If I don't take the medicine, is there anything else that works similar to this medicine?

National Institute on Aging U.S. Department of Health and Human Services Public Health Service
National Institutes of Health -

RULES FOR TAKEN MEDICINES -
THE KEY TO SUCCESSFUL TREATMENT.

Efficiency drug therapy largely depends on how taking medications is related to food intake and its composition. Most instructions include instructions to take this drug before or after meals. Unless otherwise indicated, the drug is taken on an empty stomach. Taking the drug on an empty stomach is considered to be the use of the drug at least 60 minutes before a meal or 2 hours after a meal. What we take our medicines with is very important point, since this or that liquid (milk, juice of various fruits, mineral water, etc.) reacts with the drug, sometimes with the formation of insoluble complexes, destroying (modifying) the active medicinal substance. The drug turns out to be ineffective. The conditions for taking the drug (before or after meals, chewing or not, what to drink with it, what to dilute with it, whether it is necessary to treat the oral cavity after taking the medicine, etc.) must be indicated in the instructions for the drug in the section "Method of administration and dosage".

Order of the Ministry of Health of the Russian Federation dated March 26, 2001 N 88 approved the Industry Standard "State Information Standard of a Medicinal Product. Basic Provisions" 91500.05.0002-2001, in section 02.04.02 "Instructions for the use of a medicinal product" which states that instructions for the use of a medicinal product are divided into the following categories:

Instructions for use of the drug for specialists;

Instructions for use of the medicinal product for consumers (leaflet).

Instructions for use of the medicinal product for consumers (leaflet - insert) - official document, intended for the patient and containing information necessary for the correct independent use of the medicinal product.

The methodological recommendations of December 7, 2009 “Preparation of the text of instructions for the medical use of a medicinal product” set out the basic requirements for the construction and presentation of the texts of the instructions. Additional conditions are given that must be adhered to when using the drug: time of use, relationship with food intake ("before meals" 30 - 60 minutes before the start of a meal, "during meals" - the period of direct food intake for 30 minutes before its beginning or after its end, “after a meal” - a period within 30 - 120 minutes after a meal, “on an empty stomach” - no less than 60 minutes before the start of a meal and no earlier than 120 minutes after its end ), the need to follow a special diet, dose titration, and what the patient should do in case of missing a dose.

In the absence of any instructions in the package insert, the medicine should be taken 30 minutes before meals. This applies to the bulk of drugs.

Any Chemical substance- this is a foreign compound, which, if we are talking about a medicine, must be absorbed in the human body with the greatest benefit for his health. Meanwhile, following the rules of administration can greatly, if not decisively, affect the effect of the medicine.

If several are assigned medicinal drugs, they must be taken separately. Even the most harmless medications for the body, when taking several drugs at the same time, will put a lot of stress on the stomach and liver. In addition, no one will ever say how, under the influence of the individual environment of each person’s stomach, several medical supplies, taken at the same time. Will they cause the formation of toxic substances in the stomach? Therefore, reception medicines need to be diluted in time so that the interval between doses is at least 15-30 minutes.

What to drink with it?

It is best, unless there are special instructions, to drink it with plain boiled water. Water is a good solvent and does not affect the active substance.

You should not take medications with you milk, because the effectiveness of drugs similar in structure to proteins - cardiac glycosides, caffeine, antiulcer drugs - decreases. Do not take enzymes with milk. Antibiotics are not recommended to be combined with dairy products. Sometimes in the annotation to the drug you can find a direct mention of the inadmissibility of drinking milk.

It has been established that iron supplements cannot be taken with milk and foods high in oxalic acid and tannins (strong tea, coffee, spinach, blueberries).

Calcium supplements should not be taken with milk, sparkling water, or combined with foods rich in fat.

You should not take medications and tea. Tea contains tannin, which forms insoluble compounds with nitrogen-containing agents.

Separately, it should be said about the simultaneous administration drugs and alcohol . This absolutely should not happen. Practice shows that it is with such a combination that the most severe complications. For example, with long-term use non-steroidal drugs and alcoholic drinks, the gastric mucosa is damaged and an ulcer may form. A Antibiotics, when taken simultaneously with alcohol, not only lose half of their medicinal properties, but can also form chemical compounds harmful to the body.

Is this important - on an empty stomach, before meals, after? Typically accepted:

- On an empty stomach: tinctures, infusions, decoctions and similar preparations from plant materials.

- Before meals : diuretics;; sulfa drugs are recommended to be washed down with an alkaline drink, for example, mineral water, during treatment should be excluded food products containing sulfur (eggs, beans, tomatoes, liver); calcium gluconate (exclude products containing oxalic, acetic and fatty acids).

- Half an hour before meals: acidity reducing agents gastric juice(antacids and choleretic drugs); antiulcer drugs, antiarrhythmic drugs;

- While eating: stomach acid medications or digestive enzymes, as they help the stomach digest food; water soluble vitamins(C and Group B).

- After meal : painkillers(non-steroidal) anti-inflammatory drugs; fat soluble vitamins(A, D, E, K), complex multivitamin preparations; agents that are components of bile, cardiac glycosides (it is recommended to crush the tablets, wash them down with starchy mucus, and exclude protein foods); calcium chloride
- Regardless of food :bronchodilators; means that improve cerebral circulation.

- They don’t have their time medications prescribed " under the tongue».

Take your medications at regular intervals. Hormonal And " cardiac drugs, majority antibiotics should be taken strictly by the clock.

If the instructions indicate " three times a day“, this does not mean at all: breakfast - lunch - dinner. The medicine must be taken every eight hours so that its concentration is maintained evenly in the blood. Even at night it is necessary to take medications.

Treatment must be completed. This is especially true for antibiotic treatment. In no case should you stop taking antibiotics, even if the symptoms of the disease have decreased or disappeared. After all, when treating with these drugs, the weakest microorganisms die first, then the more resistant ones, and at the very end - all the rest. If the full course of treatment is not carried out, then the most resistant microorganisms will survive, adapt to these drugs, and in subsequent diseases they will no longer be sensitive to this antibiotic, or sensitive, but to a higher dose that is not harmless to the body.

It is not allowed to take medications that have expired. The least that will happen from this is the ineffectiveness of treatment, and the biggest is irreparable harm to health. After all, when the expiration dates expire, the reaction of the drugs when they enter the human body may differ for the worse from what is provided for in the instructions. The same applies equally to drugs that were stored incorrectly (temperature, humidity, light warnings were not observed).

KSKUZ "Center for Quality Control and Certification"
medicines"
Khabarovsk, st. Sovetskaya, 34

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Chapter 4. Pharmacotherapy of heart diseases

General considerations pharmacological treatment

1. Before prescribing any drug, you must once again carefully read the instructions for it, written for doctors, or the corresponding section in the pharmacological reference book.

2. When prescribing a new drug, you should make sure that it is registered with the Russian Ministry of Health and Social Development.

3. The minimum amount of medication possible for a given clinical situation should be prescribed, avoiding polypharmacy.

4. When prescribing several drugs, re-analyze information about their interactions.

5. Once again analyze the patient’s life history and illness and make sure there are no contraindications to taking the drug.

6. When prescribing medications that have multiple side effects, carefully weigh the risk/benefit ratio, avoiding situations of “treating one thing and damaging another.” The basic principle: treatment should not be more dangerous than the disease.

7. The saturating, or full therapeutic, dose is the amount of the drug that allows you to achieve the optimal therapeutic effect in the absence of pronounced signs of side effects.

8. A maintenance dose is the amount of the drug that allows you to maintain (consolidate) the achieved therapeutic effect and ensures the stability of the therapeutic concentration of the drug in the blood.

When prescribing pharmacotherapy, it is necessary to take into account the patient’s adherence to it, since the patient takes on the main part of the treatment (purchase and administration of medications, self-monitoring and follow-up visits to the doctor, etc.). If the patient is not sufficiently adherent to pharmacotherapy, then he refuses to take the drugs, no matter how effective, from the doctor’s point of view, they may be. Therefore, treatment should be prescribed not only taking into account indications or contraindications, but also taking into account the wishes of the patient, his lifestyle and many other factors listed below.

Factors influencing adherence to treatment: number of medications taken and frequency of dosing, timing of medications, educational, cultural and family status, gender, price pharmacological drugs and their availability, the number of visits to the doctor and follow-up examinations required during treatment, the time spent waiting for the doctor and examination, the individual level of the doctor, the effectiveness of the “doctor-patient” link.

After determining the treatment regimen, the patient should receive from the doctor detailed recommendations regarding the characteristics of the drugs taken, their side effects, criteria for their effectiveness, which the patient can evaluate independently, as well as recommendations for the frequency of outpatient treatment monitoring: laboratory and instrumental. When planning long-term treatment, it is also advisable to teach the patient the skills of keeping a self-monitoring diary, in which he should record the implementation of medical recommendations and self-monitoring data blood pressure, pulse rate, diuresis, etc., and also describe your subjective feelings. A self-monitoring diary not only disciplines the patient, but also allows the doctor to quickly obtain objective information about the progress of the patient’s treatment. The doctor should familiarize the patient with the following recommendations.

The patient should also pay special attention to the frequency and time of taking medications, which are often violated, and yet compliance with these conditions plays a big role in achieving the desired effect in treating the disease. What should the frequency of taking medications actually mean:

2 times a day - every 12 hours, morning and evening, at the same time (for example, at 8.00 and 20.00);

3 times a day - every 8 hours, morning, afternoon and evening, at the same time (and not at breakfast, lunch and dinner!);

at night - just before bedtime;

in the morning on an empty stomach - immediately after waking up.

...

NOTE FOR PATIENTS ABOUT TAKING MEDICINES

Tablets should not be chewed, tablets and capsules should not be broken, crushed or dissolved in water unless specifically instructed to do so.

It is preferable to buy medications in the dosage prescribed by your doctor, rather than splitting a higher dose tablet into several doses or taking several lower dose tablets at the same time.

Unless otherwise indicated, all medications are recommended to be taken 40–60 minutes after meals.

It is best to take medications with regular boiled water at room temperature.

If the tablet or capsule is difficult to swallow, you may want to drink a few sips of water slowly and follow the tablet with plenty of liquid before taking it. If this does not help, ask your doctor to change the dosage form or drug. The tablet should not get stuck in the throat, since the medicines are designed for the acidity and conditions of the stomach and duodenum, and not the esophagus (problems with the esophagus and a decrease in the effect of the medicine may occur).

When prescribing medications, be sure to check with your doctor about the dose, frequency of administration, dependence on food intake, withdrawal conditions (can you stop taking it immediately or should you gradually reduce the dose), possible side effects of the drugs.

If you need to take multiple medications at the same time, list them by hour to avoid confusion.

Discuss with your doctor in advance what to do if you forget to take your medicine on time. You should not take a forgotten dose as a supplement to the next one, as this can lead to an overdose and serious complications.

If you take medications (such as vitamins) or nutritional supplements on your own, tell your doctor.

When purchasing medications, make sure the packaging is intact, check the expiration date and dosage. Buy medicines from reliable pharmacies, not from hands or trays. Be wary of medications given to you by others who no longer need them or are not suitable: even if the medication’s expiration date has not yet expired, there is a danger that the storage conditions were not met.

Do not stockpile medications: your treatment regimen may change.

Store medications in a dry, dark place away from temperature changes and direct sunlight. The bathroom or kitchen is not a suitable place to store medications. Only those medications for which these conditions are indicated by the manufacturer are stored in the refrigerator. Keep medications out of the reach of children: most drugs used in cardiology are deadly. child's body even in minimal doses.

When choosing medications and their dosages must take into account the age of the patient. In elderly and elderly patients, there are peculiarities in the pharmacodynamics of most drugs associated with age-related changes functions of the liver and kidneys and causing more frequent development of side effects, the effect of cumulation and increased toxic effects.

Features of treatment of elderly patients:

starting treatment with small doses (usually half the recommended dose);

slowly increasing doses;

careful monitoring of side effects of medications.

Pharmacotherapy of certain diseases

Cardiac ischemia

The basic principles of pharmacological treatment of stable forms are discussed below. coronary disease hearts. Treatment of unstable forms is partially reflected in the chapter “Basic principles of diagnosis and treatment emergency conditions in cardiology,” but for the most part this is the prerogative of specialized clinics. In unstable forms of coronary artery disease, the main tasks of a doctor of any specialty are timely diagnosis of these conditions, ensuring the patient’s vital functions and preventing complications until qualified assistance becomes possible.

The main objectives of treatment of stable forms of coronary artery disease: prevention of attacks (antianginal therapy) and improvement of prognosis (prevention of complications, prevention of progression). Treatment components: non-drug methods, pharmacological therapy, surgical treatment.

General considerations for the treatment of stable forms of coronary artery disease

1. Rational treatment of IHD involves a combination of at least two components described above. The lack of non-drug methods makes treatment futile even with effective pharmacotherapy and/or successful surgical intervention. Surgery IHD is currently only palliative in nature, since it does not affect the cause of IHD (with the exception of IHD associated with birth defects coronary arteries). Only non-drug methods are practically ineffective even in the treatment of stable angina FC I.

2. Priority of pharmacological or surgical methods The doctor determines the treatment after full examination patient, which includes x-ray imaging of the coronary arteries (coronary angiography). The exception is patients with angina pectoris FC I, in whom, however, there is the prospect of invasive examination and subsequent surgical treatment if the condition worsens. In other words, if there are indications for coronary angiography, then it should be performed in as soon as possible. Pharmacotherapy in most cases should be considered as the main method of treatment only until the results of coronary angiography are available.

Indications and contraindications for coronary angiography are discussed in more detail in the corresponding chapter.

Non-drug methods

Non-drug methods for treating stable forms of coronary artery disease primarily involve addressing avoidable risk factors for disease progression. More detailed information about the methods of influence is contained in the chapter “Atherosclerosis. Modern concepts atherogenesis, prevention and treatment." The main components of non-drug treatment:

patient information and education;

individual diet, diet therapy;

to give up smoking;

weight correction;

physiotherapy;

psychotherapy and autogenic training;

Antiplatelet therapy

Antiplatelet drugs that improve the prognosis of coronary artery disease are recommended for all patients in the absence of contraindications, as well as for patients who have undergone myocardial revascularization.

Acetylsalicylic acid

The most commonly used antiplatelet agent is acetylsalicylic acid. Mechanism of antiplatelet action acetylsalicylic acid is based on the irreversible binding of platelet cyclooxygenase with a subsequent decrease in the synthesis of platelet aggregation inducers (prostaglandins, thromboxane).

IN last years Other equally important pharmacological effects of acetylsalicylic acid are being studied, for example, increasing the synthesis of ferritin, which is an antioxidant, reducing the ability of low-density lipoproteins to oxidize, as well as inducing the synthesis of adenosine, which has a powerful anti-inflammatory effect. Taking into account modern concepts of the occurrence and progression of atherosclerosis, these components of the pharmacological action of acetylsalicylic acid necessitate its administration to most patients with coronary artery disease.

If there are contraindications to aspirin, ticlopidine or clopidogrel is usually prescribed. If clopidogrel is contraindicated, warfarin is used until an INR level of 2–3.5 is achieved. Prescribing regimens for warfarin and monitoring therapy are described in the chapter “Surgical treatment of heart disease.”

1. Acetylsalicylic acid is indicated for all patients, regardless of the presence of symptoms and stage/type of coronary artery disease, at a dose of 50–325 mg/day.

2. When choosing a dose, it should be taken into account that acetylsalicylic acid blocks cyclooxygenase not only in platelets, but also in the vascular endothelium, reducing vascular wall production of prostacyclin, which has a vasodilator and antiplatelet effect. The effect of acetylsalicylic acid on prostacyclin synthesis is dose-dependent: it increases with increasing dose.

According to the results of the most authoritative studies in this area, the optimal doses of acetylsalicylic acid, which provide effective blocking of platelet cyclooxygenase with little effect on the formation of prostacyclin in the endothelium, are 50–100 mg/day.

Inhibition of prostacyclin synthesis by acetylsalicylic acid may help reduce some of the effects of ACE inhibitors, which must be taken into account when prescribing them simultaneously, especially in patients with chronic heart failure. Some authors consider it inappropriate to prescribe acetylsalicylic acid in any dose to patients taking ACE inhibitors, and it is recommended to replace it with another antiplatelet agent (ticlopidine, clopidogrel).

3. The antiplatelet effect of acetylsalicylic acid persists throughout life cycle platelet, that is, within 5–7 days, which should be taken into account first of all when forced to discontinue the drug (for example, due to the upcoming surgical intervention or with the development of bleeding). At the same time, it is the irreversible blocking of platelet aggregation that distinguishes acetylsalicylic acid from many other antiplatelet agents that have a short-term effect.

4. When choosing dosage forms acetylsalicylic acid, preference is recommended to be given to those whose use gives minimal side effects on the gastrointestinal tract, namely enteric forms. The following features should be taken into account:

despite the almost complete absence local impact on the gastric mucosa, enteric forms retain a systemic damaging effect (associated with inhibition of the synthesis of prostaglandins that protect the mucous membranes), so the risk of damage is still present, and the use of enteric forms of acetylsalicylic acid does not eliminate the need to fully monitor antiplatelet therapy (see. below);

When using enteric forms, the achievement of the peak concentration of the drug is delayed by an average of 2 hours compared to the period of action of conventional forms. This should be taken into account during emergency antiplatelet therapy (for example, in acute coronary syndrome). In such clinical situations, it is preferable to use rapidly dissolving forms of acetylsalicylic acid (effervescent tablets), and in their absence, tablets in enteric form should be chewed.

5. With long-term use of acetylsalicylic acid drugs, compensatory thrombocytosis may occur.

6. Nitric oxide donors (for example, nitrates) significantly reduce the risk of upper bleeding gastrointestinal tract in patients taking acetylsalicylic acid.

Control of antiplatelet therapy

Teaching patients self-diagnosis of possible bleeding, that is, the main signs of acute and chronic gastrointestinal bleeding: the appearance of black stools (melena), weakness, decreased blood pressure in combination with tachycardia. The patient should be warned about the need to control bleeding gums when brushing teeth - this early sign hypocoagulation.

Periodic endoscopy - once every 2 years in the absence of complaints.

Risk factors for gastrointestinal bleeding during antiplatelet therapy:

age over 65 years;

history of gastric and duodenal ulcers or peptic ulcers;

Helicobacter pylori infection;

alcohol abuse;

nutritional features - presence in daily diet a large number of spices and extractive products, such as pepper, onions, garlic, horseradish, mustard, etc.;

frequent use of non-steroidal anti-inflammatory drugs.

HMC-CoA reductase inhibitors

The mechanism of action and indications for the use of statins are described in more detail in the chapter “Atherosclerosis. Modern concepts of atherogenesis, prevention and treatment.”

Antianginal therapy

The main antianginal drugs used for treatment of ischemic heart disease: beta blockers, nitrates, calcium antagonists (calcium channel blockers).

The goal of antianginal therapy is to prevent angina attacks. Beta blockers and calcium antagonists also improve the prognosis in some categories of patients. In general, it is convenient to consider pharmacotherapy of stable forms of coronary artery disease according to the scheme “providing mechanisms – final goal – drug”.

Algorithm for prescribing antianginal therapy

1. In the absence of contraindications, beta blockers are the drugs of choice. It is necessary to evaluate the effectiveness of beta blockers for a particular patient, and if available, titrate the drug dose to the maximum therapeutic dose; assess the feasibility of using long-acting forms of beta blockers.

3. If the beta blocker is poorly tolerated or ineffective, it should be replaced with a nitrodrug with a duration of action corresponding to the class of angina (see recommendations below) or with a suitable calcium antagonist.

4. If the beta blocker is insufficiently effective at the maximum therapeutic dose, add a dihydropyridine calcium antagonist or an appropriate nitrate dosage form to the therapy.

5. If the decision on the need for combined antianginal therapy is made against the background of already being treated with one antianginal drug, then before prescribing a second one, the dose of the first should be increased to the maximum therapeutic one.

6. When prescribing a combination of antianginal drugs, it should be borne in mind that in some cases, when joint use of two antianginal drugs, their effect is not enhanced, but, on the contrary, weakened, but the side effects of both drugs are increased (for example, the combined use of nitrates and dihydropyridine calcium antagonists).

7. As an addition to antianginal therapy, metabolic drugs, such as trimetazidine, are prescribed. In rare situations - when the main antianginal drugs are poorly tolerated - metabolic drugs can be used as an alternative.

Nitro drugs

The most commonly used are 3 drugs in this group: nitroglycerin, isosorbide dinitrate, isosorbide-5-mononitrate. There are no fundamental differences in pharmacological action.

The classification of drugs by duration of action is more important:

short-acting nitrates (up to 1 hour);

nitrates of moderate prolonged action (up to 6 hours);

long-acting nitrates (up to 16 or 24 hours).

Nitrates exist in various dosage forms: tablets, aerosol sprays, patches with gradual release of the active substance, solutions for intravenous administration. In everyday life clinical practice the most commonly used are oral, cutaneous and aerosol routes of administration of nitrates. Parenteral methods are used primarily in the practice of emergency conditions and intensive care.

Pharmacological effect of nitrates:

decreased myocardial oxygen consumption;

decrease in preload - decrease in blood pressure, LV volume, peripheral vascular resistance;

antithrombotic and antiplatelet effects;

dilatation of epicardial coronary vessels and arterioles;

vasodilation of coronary vessels, including stenotic ones.

General Considerations for Nitrate Treatment

1. The choice of a nitrodrug for coronary artery disease should be individual for each patient and take into account not only the stage and extent of the disease, but also social aspects.

2. At the beginning of treatment, nitro drugs are most often prescribed normal action. In the future, you can switch to prolonged forms of administration, but it should be remembered that prolonged forms are more likely than regular-acting nitrates to cause an addictive effect.

3. A patient receiving nitro drugs as part of routine therapy should be explained the need to always have fast-acting nitrates with them: as a rule, nitroglycerin in tablets or nitrates in aerosol form (see the pharmacokinetics of nitrates in the same chapter). It is necessary to teach the patient how to take fast-acting nitrates (see below).

4. Long-term use of nitrates causes addiction to them and a decrease in the therapeutic effect. Increasing the dose often worsens side effects. The problem of developing tolerance to nitrates has not been solved to this day, however, if you follow a number of rules, you can overcome or significantly delay the addictive effect (see p. 291).

5. If nitrates are poorly tolerated, you can prescribe drugs that have a nitrate-like effect: molsidomine, Sidnopharm, Corvaton. It should be borne in mind that these drugs have a less pronounced vasodilating effect than nitrates, and they do not have prolonged forms.

6. Nitrates can be prescribed for vasospastic angina.

7. In addition to the development of tolerance, a significant drawback of nitrates is rebound syndrome, which occurs when the drug enters the body abruptly, which should be taken into account during long-term therapy.

The main side effects of nitrates: headache, arterial hypotension, tachycardia, orthostatic hypotension, fluid retention in the body.

With regular long-term use, the antianginal effect of nitrates may weaken or even disappear completely (development of tolerance).

Measures to prevent the development of tolerance to nitro drugs:

prescribing the minimum doses necessary to achieve a therapeutic effect;

prevention of fluid retention in the body;

compliance with the dosing regimen (the so-called asymmetrical administration), which provides for a minimum 6-8 hour break between taking doses of nitro drugs, as well as an optimal 12-13 hour break between evening and morning doses. As a rule, the nitrate-free period is planned for the night, when there is no great need for nitrates. The exception is in patients with severe angina, when continuous use of nitrates is recommended;

If possible, you should take breaks from treatment with nitro drugs (the so-called intermittent dosing method).

...

patient memo

HOW TO TAKE NITROGLYCERIN CORRECTLY

1. If an attack occurs, be sure to sit down or lie down.

2. Place a nitroglycerin tablet under your tongue and dissolve it until completely dissolved (or use an aerosol). You should not take food or liquid at the same time.

3. If there is no effect, take the nitroglycerin tablet again after 3-5 minutes.

4. If there is no effect, take a nitroglycerin tablet after another 3-5 minutes. Taking nitroglycerin more than three times is not advisable!

5. If the attack continues, call “emergency help.”

6. If the attack is stopped, sit or lie down for a while. You should not get up suddenly after taking nitroglycerin!

The table below shows the pharmacokinetics of a number of nitrates:

Scheme for prescribing nitrates depending on the functional class of angina:

angina pectoris functional class I

Intermittent intake of short-acting nitrates that provide a pronounced and brief effect - buccal plates, aerosols, etc.

These medications should be taken 5–10 minutes before physical activity, usually causing an attack;

angina pectoris functional class II

intermittent intake of moderately prolonged-acting nitrates;

angina pectoris functional class III

constant intake of nitrates of moderately prolonged or prolonged action with a nitrate-free period of 6–8 hours;

angina pectoris functional class IV

constant intake of nitrates, providing a round-the-clock effect.

Contraindications to the use of nitro drugs:

hypertrophic obstructive cardiomyopathy;

obstruction of the left ventricular outflow tract;

mitral regurgitation;

taking medications for treatment sexual dysfunction(the time difference must be at least 24 hours, including sublingual administration of nitrates. Taking such drugs is unacceptable while taking long-acting nitrates).