The steal syndrome is characteristic of the conventional dosage form. Features of the use of medicines

The rebound syndrome develops against the background of long-term use of drugs of various groups and its subsequent abrupt withdrawal. Usually, with a gradual decrease in dosage until the complete cessation of taking drugs, the phenomenon of drug withdrawal does not occur, but for some groups of drugs there are certain risks against the background of a systematic dose reduction. These include antihistamines, hormonal drugs and antidepressants.

Spectrum of medications

Features of the phenomenon

The first information about the drug withdrawal syndrome and the adverse effects of a significant decrease in active substances in the blood plasma dates back to the days of the formation of medicine. Disputes about the connection between the deterioration of the patient's health and the withdrawal of drugs have not subsided so far. The rebound syndrome consists in the disinhibition of regulatory mechanisms. If, against the background of taking drugs, various pathogenic reactions were suppressed, then after interrupting the course, a pronounced exacerbation of these reactions occurs. Many experts synonymize the concept of "rebound phenomenon" and "withdrawal syndrome", but it is definitely impossible to combine these concepts, since they have completely different mechanisms of action:

withdrawal phenomenon - insufficiency of organs, tissues or systems as a result of the cessation of drug replacement therapy;
rebound syndrome (recoil, reverse) - exacerbation of the reactions of organs or systems in their pathology against the background of drug therapy withdrawal.

Rebound syndrome is more a variation of the withdrawal phenomenon than a synonym. Despite this, many clinicians quite arbitrarily combine both terms into one and give it equal meanings. The withdrawal syndrome occurs with long-term drug correction of mental illness or metabolic disorders. Such reactions often occur after the withdrawal of medications that have an overwhelming or depressing effect on the body of one degree or another.

Aspects of medical treatment

An important point in the organization of the management of an individual patient is the choice of drugs that will activate the necessary receptors, inhibit pathogenic phenomena or conditions, and also improve the patient's well-being. The algorithm of any assignment includes the following nuances:

choice of pharmacological group;
selection of a representative of the pharmacological group;
generics (analogues) or originals;
formulating an appropriate dosage.

The algorithm is completely built on laboratory and instrumental studies on a specific disease, general complaints of the patient, his clinical history. The general somatic status of the patient, his age, psycho-physical development and psycho-emotional state are taken into account. With long-term use of certain drugs, it is important to take into account the financial capacity of the patient. For example, if a patient is forced to take expensive originals of the drug for life, and he does not always have the opportunity to provide himself with such, then systematic interruptions in taking can affect the treatment and general condition, up to the development of the “rebound” syndrome.

Development factors

There are a number of specific factors that are not related to the usual understanding of the "rebound" syndrome, but which take place in clinical practice. In prevailing cases, a similar phenomenon is observed against the background of taking drugs that have a short half-life and excretion from the body. The intensity of the syndrome in this case depends on the speed of excretion of the active substance from the blood plasma. The condition can also develop when the drugs themselves do not have any effect on the existing problem. Such addiction occurs with prolonged ineffective use of a group of cardiological drugs, in which nitrates prevail. With intermittent treatment, the pathological condition occurs quite often with independent prescriptions, inadequate dosage preparation, and with the patient's indiscipline. There is another type of intermittent therapy, when the syndrome can occur in the interval between taking the next doses (for example, if the next dose should be taken 5 hours after the first, then the phenomenon may occur during this time period). In extremely rare cases, a rebound syndrome has been described as a result of the primary and only use of the drug due to the rapid decrease in its concentration in the blood.

Important! A suggestive factor in the development of the drug withdrawal phenomenon is the route of administration. So, with intravenous (parenteral) administration, pathology develops much more often. With oral administration and other methods of absorption of drugs by the body, the concentration of the active substance in the blood plasma decreases gradually.

Etiological factors

The abstinence syndrome is rather complicated due to the difficulty of instantly rebuilding the body to exist without medication. Addiction provocateurs are often classified as psychoactive, so many patients experience nervous disorders and emotional instability. These conditions can cause deep depression. Antidepressants belong to this group of drugs, cause persistent disorders of consciousness, psyche. Cancellation of hormonal drugs often leads to hormonal disorders, metabolic disorders. The main causes of recoil syndrome are:

incorrect dosing;
mental illness of the patient;
drug replacement of the function of an organ or system;
other addictions against the background of medicinal (toxic, alcoholic and others).

This is interesting! Only in gynecology the withdrawal syndrome is a positive moment. With a long absence of pregnancy, women are prescribed hormonal drugs, which are then excluded. Against the background of the withdrawal syndrome, a hormonal surge occurs, ovulation is stimulated, which significantly increases a woman's chances of becoming pregnant. When the drug course is interrupted, a withdrawal syndrome occurs, which does not depend on a decrease in the effect of active substances.

Signs and manifestations

The symptomatic complex of the withdrawal syndrome develops according to the scenario of a concomitant disease. With mental disorders and long-term use of antidepressants, patients experience exacerbation of existing pathologies. The same applies to hormonal diseases. Among the main common symptoms are:

decrease in working capacity;
depression and apathy;
emotional disorders;
deterioration of health according to the main diagnosis;
development of a depressive syndrome;
decreased function of internal organs and systems;
sweating and shortness of breath;
tachycardia, trembling of the limbs.

Apathy and indifference during withdrawal of psychoactive drugs

Important! The psychological factor in the withdrawal syndrome plays an important role, since often the very thought of canceling the drug contributes to fixing on this event. During the period of the “rebound phenomenon”, addiction to the drug replaces all other primary needs (sexual intimacy, communication, nutrition).

Signs of withdrawal of hormonal drugs

The recoil syndrome after the abolition of hormonal medications provokes the development of some specific signs. After long-term treatment with glucocorticosteroids, there is a decrease in adrenal function, a decrease in cardiac output fraction, up to cardiac arrest. To date, rebound syndrome after interruption of the course can be avoided by following clear patterns. It is necessary to cancel the drugs of this group with a gradual decrease in the dose.

Signs of Antidepressant Withdrawal

The treatment of psycho-dependent conditions is always associated with the risks of withdrawal syndrome, since antidepressants directly affect the human autonomic system, control brain receptors and behavioral responses. Among the main symptoms are:

insomnia and anxiety;
convulsive syndrome:
tremor of the limbs;
increased heart rate.

Important! Today, this is more often due to the patient's indiscipline in complying with the drug regimen. With adequate dosage and full medical management of the patient, such phenomena occur less and less. Despite this, it is worth remembering that the withdrawal syndrome can develop according to an aggressive scenario, up to a fatal outcome.

Preventive actions

Prevention consists in choosing a specialized doctor and following all the rules for taking prescribed drugs. It is important not to self-medicate and get involved in the uncontrolled intake of any medicines. This is especially true for patients with burdened clinical history.

Doctor's advice about the drug regimen

Some patients are forced to take certain replacement drugs for life to replace the lost function of organs, tissues or systems. Rebound syndrome is a dependence on a drug with severe symptoms of an existing pathology. The condition requires correction by prescribing similar, milder drugs, herbal teas, vitamin complexes, or the usual expectation. In case of any disturbing conditions, you should contact a specialist.

Steal syndrome is the general name of clinical syndromes caused by unfavorable redistribution of blood between organs and tissues through collaterals, leading to the occurrence or aggravation of their ischemia. So, with occlusion of the superior mesenteric artery, which has anastomoses with the celiac trunk system, mesenteric steal syndrome can be observed: the outflow of blood through the anastomoses causes ischemia of the organs supplied by the branches of the celiac trunk, clinically manifested by abdominal toad. Pain in the abdomen when walking, passing at rest, in patients with lesions of the iliac and mesenteric arteries may occur as a result of an actively functioning mesenteric-iliac-femoral collateral circulation. The brain steal syndrome with the development of ischemia of a part of the brain tissue occurs as a result of aggravation of circulatory insufficiency in the affected vascular pool due to the redistribution of blood flow in favor of the adjacent, usually more intact vascular pool. For example, when a blockage at a certain level of the subclavian artery, the blood supply in the affected arm is compensated by the vertebral artery on the opposite side, which leads to the development of brain steal syndrome. In this case, with an increase in the functional load on the arm, dizziness, imbalance, and transient visual impairment occur. Aggravation of ischemia in the affected area of the brain tissue is also possible when using vasodilator drugs that affect ch. arr. on intact vessels (eg, papaverine). With angina pectoris, coronary steal syndrome can also develop with the use of certain drugs. For example, dipyridamole, expanding preim. unaffected vessels of the heart, worsens the blood supply to the ischemic area of the myocardium. Its intravenous administration is used for diagnostic purposes to provoke myocardial ischemia, detected by radionuclide research.

The clinical picture is usually characterized by symptoms of vertebrobasilar vascular insufficiency and ischemia of the upper limb.

The dominant, as a rule, is cerebrovascular insufficiency, which is usually manifested by short-term paroxysmal, within a few minutes, crises: headache, dizziness, short-term attacks of loss of consciousness, blackout in the eyes, loss of visual fields, sensation of rotation of objects, paresthesia, unsteady gait, dysarthria . Seizures usually resolve without leaving permanent neurologic deficits.

It is typical to worsen or develop brain symptoms with increased blood flow to the upper extremity, such as after loading the upper extremity.

Signs of ischemia of the upper extremities are usually expressed mildly in the form of fatigue, weakness, numbness, chilliness, moderate pain when the limbs are loaded.

In a clinical study, neurological symptoms are usually not detected, but signs of arterial insufficiency of the upper extremities are found - a decrease in skin temperature, a decrease in blood pressure, noise in the neck during auscultation.

An exact topical diagnosis and the nature of the reversal of blood flow are established according to angiography.

Differential diagnosis aims to establish the cause that caused vertebrobasilar vascular insufficiency: occlusive vascular damage, pathological tortuosity, anomaly, compression of the vertebral artery or still syndrome. This is necessary for choosing a method of surgical treatment. In addition, it is important to identify possible multiple lesions of the brachiocephalic arteries.

It is necessary to exclude intracranial tumors, cerebral hemorrhage, intracranial aneurysms, cerebral and extracranial artery embolism, Meniere's syndrome, eye diseases, spondylosis and other pathologies of the cervical spine.

Aortoarteriography data, as well as other clinical and special research methods (X-ray of the skull and cervical spine, examination of the fundus and neurological status) are of decisive importance for establishing the diagnosis.

Once a child is diagnosed with diabetes, parents often go to the library for information on the subject and are faced with the possibility of complications. After a period of worries, parents take another hit when they learn the statistics of diabetes-related morbidity and mortality.

Viral hepatitis in early childhood

Relatively recently, the alphabet of hepatitis, which already included hepatitis viruses A, B, C, D, E, G, was replenished with two new DNA-containing viruses, TT and SEN. We know that hepatitis A and hepatitis E do not cause chronic hepatitis and that hepatitis G and TT viruses are likely to be "innocent spectators" that are transmitted vertically and do not infect the liver.

Measures for the treatment of chronic functional constipation in children

In the treatment of chronic functional constipation in children, important factors in the child's medical history must be considered; establish a good relationship between the health worker and the child-family in order to properly implement the proposed treatment; much patience on both sides, with repeated assurances that the situation will gradually improve, and courage in cases of possible relapse, constitute the best way to treat children suffering from constipation.

Scientists study results challenge understanding of diabetes treatment

The results of a 10-year study have undeniably proven that frequent self-monitoring and maintaining blood glucose levels close to normal leads to a significant reduction in the risk of late complications caused by diabetes mellitus and a decrease in their severity.

Manifestations of rickets in children with impaired formation of the hip joints

In the practice of pediatric orthopedic traumatologists, the question of the need to confirm or exclude violations of the formation of the hip joints (hip dysplasia, congenital hip dislocation) in infants is often raised. The article shows an analysis of the examination of 448 children with clinical signs of violations of the formation of the hip joints.

Medical gloves as a means of ensuring infectious safety

Most nurses and doctors dislike gloves, and for good reason. When wearing gloves, the sensitivity of the fingertips is lost, the skin on the hands becomes dry and flaky, and the tool strives to slip out of the hands. But gloves were and remain the most reliable means of protection against infection.

Lumbar osteochondrosis

It is believed that every fifth adult on earth suffers from lumbar osteochondrosis, this disease occurs in both young and old age.

Epidemiological control of health workers who had contact with the blood of HIV-infected

(to help medical workers of medical institutions)

The guidelines cover the issues of monitoring medical workers who had contact with the blood of an HIV-infected patient. Actions are proposed to prevent occupational HIV infection. A register of records and an act of an internal investigation were developed in case of contact with the blood of an HIV-infected patient. The procedure for informing higher authorities about the results of medical supervision of health workers who have been in contact with the blood of an HIV-infected patient has been determined. Are intended for medical workers of treatment-and-prophylactic establishments.

Chlamydial infection in obstetrics and gynecology

Genital chlamydia is the most common sexually transmitted disease. Worldwide, there has been an increase in chlamydia infections among young women who have just entered sexual activity.

Cycloferon in the treatment of infectious diseases

Currently, there is an increase in certain nosological forms of infectious diseases, primarily viral infections. One of the ways to improve treatment methods is the use of interferons as important nonspecific factors of antiviral resistance. Which include cycloferon - a low molecular weight synthetic inducer of endogenous interferon.

Dysbacteriosis in children

The number of microbial cells present on the skin and mucous membranes of a macroorganism in contact with the external environment exceeds the number of cells of all its organs and tissues combined. The weight of the microflora of the human body is on average 2.5-3 kg. The importance of microbial flora for a healthy person was first noticed in 1914 by I.I. Mechnikov, who suggested that the cause of many diseases are various metabolites and toxins produced by various microorganisms that inhabit the organs and systems of the human body. The problem of dysbacteriosis in recent years has caused a lot of discussions with an extreme range of judgments.

Diagnosis and treatment of female genital infections

In recent years, throughout the world and in our country, there has been an increase in the incidence of sexually transmitted infections among the adult population and, which is of particular concern, among children and adolescents. The incidence of chlamydia and trichomoniasis is on the rise. According to WHO, trichomoniasis ranks first in frequency among sexually transmitted infections. Every year 170 million people fall ill with trichomoniasis in the world.

Intestinal dysbacteriosis in children

Intestinal dysbiosis and secondary immunodeficiency are increasingly common in the clinical practice of physicians of all specialties. This is due to changing living conditions, the harmful effects of the preformed environment on the human body.

Viral hepatitis in children

The lecture "Viral hepatitis in children" presents data on viral hepatitis A, B, C, D, E, F, G in children. All clinical forms of viral hepatitis, differential diagnosis, treatment and prevention that currently exist are given. The material is presented from modern positions and is designed for senior students of all faculties of medical universities, interns, pediatricians, infectious disease specialists and doctors of other specialties who are interested in this infection.

4.6. Syndrome "steal"

In a broad sense, the “steal” syndrome is understood as such a type of side effect when a drug that improves the functional state of an organ causes a parallel deterioration in the functional state of other organs or body systems. Most often, the “steal” syndrome is observed at the level of the circulatory bloodstream in cases where expansion under the influence of vasodilators of some vascular areas and, consequently, an improvement in blood flow in them, leads to a deterioration in blood flow in other vascular areas adjacent to them. Specifically, this type of side effect of drugs can be considered on the example of the coronary "steal" syndrome.

Coronary steal syndrome develops when two branches of the coronary artery, extending from one main vessel, for example, from the left coronary artery, have different degrees of stenosis (narrowing). At the same time, one of the branches is slightly affected by atherosclerosis and retains the ability to expand or contract in response to changes in myocardial oxygen demand. The other branch is significantly affected by the atherosclerotic process and therefore is constantly maximally expanded, even with a low myocardial oxygen demand. The appointment in this situation to the patient of any arterial vasodilator, for example, dipyridamole, can cause a deterioration in the nutrition of that area of \u200b\u200bthe myocardium that is supplied with blood by the coronary artery affected by atherosclerosis, i.e. provoke an attack of angina pectoris (Fig. 10).

Rice. 10. Scheme of the development of coronary "steal" syndrome: A, B, A", I"-diameters of the coronary artery

Atherosclerotic branch of a coronary artery A expanded as much as possible in order to ensure adequate blood supply to the area of the myocardium irrigated by it (see Fig. 10, A). After the introduction of a coronary lytic, i.e. A drug that dilates the coronary arteries, for example, dipyridamole, coronary vessels expand and, consequently, the volumetric velocity of coronary blood flow through them increases. However, the vessel A had already been expanded to the maximum (diameter A equal to the diameter L "). The vessel, located nearby, expands (diameter B smaller diameter B"), resulting in the volumetric velocity of blood flow in the vessel B" increases, and in the vessel A", according to the laws of hydrodynamics, significantly decreases. In this case, a situation is possible when the direction of blood through the vessel A" will change and it will begin to flow into the vessel B"(see Fig. 10, 6).

4.7. Syndrome "ricochet"

The "rebound" syndrome is a type of side effect of drugs, when for some reason the effect of the drug changes to the opposite. For example, the osmotic diuretic drug urea, due to an increase in osmotic pressure, causes the transfer of fluid from edematous tissues into the bloodstream, dramatically increases the volume of blood circulation (BCC), which leads to an increase in blood flow in the glomeruli of the kidneys and, as a result, greater urine filtration. However, urea can accumulate in the tissues of the body, increase the osmotic pressure in them and, in the end, cause a reverse transition of fluid from the circulatory bed to the tissues, i.e. not reduce, but increase their swelling.

4.8. drug addiction

Drug dependence is understood as a type of side effect of drugs, which is characterized by a pathological need to take drugs, usually psychotropic, in order to avoid withdrawal syndrome or mental disorders that occur when these drugs are abruptly stopped. Allocate mental and physical drug dependence.

Under mental addiction understand the patient's condition, characterized by an unmotivated need to take any drug, often psychotropic, in order to prevent mental discomfort due to discontinuation of the drug, but not accompanied by the development of abstinence.

physical addiction- this is a patient's condition characterized by the development of an abstinence syndrome due to discontinuation of the drug or after the introduction of its antagonist. Under withdrawal or withdrawal syndrome understand the patient's condition that occurs after stopping taking any psychotropic drug and is characterized by anxiety, depression, loss of appetite, crampy abdominal pain, headache, trembling, sweating, lacrimation, sneezing, goosebumps, fever, etc. .

4.9. drug resistance

Drug resistance is a state in which there is no effect from taking a drug, which is not overcome by increasing the dose and persists even when prescribing such a dose of the drug, which always causes side effects. The mechanism of this phenomenon is not always clear, it is possible that it is based not on the resistance of the patient's body to any drug, but on a decrease in individual sensitivity to the drug, due to the genetic or functional characteristics of a particular patient.

4.10. Paramedical action of drugs

The paramedical effect of drugs is not due to their pharmacological properties, but to the emotional, psychogenic reaction of the patient to a particular drug.

For example, a patient has been taking a calcium ion antagonist for a long time nifedipine, manufactured by AWD (Germany) under the name "corinfarus". The pharmacy where he usually bought this drug did not have the drug manufactured by AWD, and

The patient was offered nifedipine called "adalat", manufactured by Bayer (Germany). However, taking Adalat caused the patient to experience severe dizziness, weakness, etc. In this case, we can talk not about the own side effect of nifedipine, but about a paramedical, psychogenic reaction that arose in the patient subconsciously due to the unwillingness to change Corinfar for a similar drug.

CHAPTER 5 DRUG INTERACTIONS

IN In terms of practical healthcare, physicians very often have to deal with a situation where the same patient has to prescribe several drugs at the same time. This is largely due to two fundamental reasons.

L At present, no one doubts that effective therapy for many diseases can be carried out only with the combined use of drugs. (For example, hypertension, bronchial asthma, gastric ulcer, rheumatoid arthritis, and many, many others.)

2. Due to the increase in life expectancy of the population, the number of patients suffering from comorbidity, which includes two, three or more diseases, is constantly increasing, which, accordingly, requires the appointment of several drugs simultaneously and / or sequentially.

The simultaneous administration of several drugs to one patient is called polypharmacy. Naturally, polypharmacy can be rational, i.e. useful for the patient, and vice versa, to harm him.

As a rule, in practice, the appointment of several drugs at the same time for the treatment of one specific disease has 3 main goals:

increasing the effectiveness of therapy;

reducing the toxicity of drugs by reducing the doses of combined drugs;

prevention and correction of side effects of drugs.

At the same time, combined drugs can affect both the same links of the pathological process, and different links of pathogenesis.

For example, the combination of two antiarrhythmics, etmozine and disopyramide, belonging to the IA class of antiarrhythmic drugs, i.e. drugs with similar mechanisms of action and realizing their pharmacological effects at the level of the same link in the pathogenesis of cardiac arrhythmias, provide

bakes a high level of antiarrhythmic effect (66-92% of patients). Moreover, this high effect is achieved in most patients when using drugs in doses reduced by 50%. It should be noted that with monotherapy (therapy with one drug), for example, supraventricular extrasystole, disopyramide at the usual dose was active in 11% of patients, and etmozin - in 13%, and with monotherapy with a half dose, a positive effect could not be achieved in any of them. from patients.

In addition to influencing one link of the pathological process, a combination of drugs is very often used to correct different links of the same pathological process. For example, in the treatment of hypertension, a combination of calcium channel blockers and diuretics may be used. Calcium channel blockers have powerful vasodilatory (vasodilating) properties, mainly in relation to peripheral arterioles, lower their tone and, thereby, help reduce blood pressure. Most diuretics lower blood pressure by increasing the excretion (excretion) of Na + ions in the urine, reducing BCC and extracellular fluid and reducing cardiac output, i.e. two different groups of drugs, acting on different links in the pathogenesis of hypertension, increase the effectiveness of antihypertensive therapy.

An example of combining drugs to prevent side effects is the appointment of nystatin to prevent the development of candidiasis (fungal lesions of the mucous membranes) during long-term treatment with antibiotics of the penicillin, tetracycline, neomycin, etc. group, or the appointment of drugs containing K + ions to prevent the development of hypokalemia during treatment with cardiac glycosides in patients with heart failure.

Knowledge of the theoretical and practical aspects of the interaction of drugs with each other is necessary for every practical medical worker, since, on the one hand, they allow, due to the rational combination of drugs, to enhance the effect of the therapy, and on the other hand, to avoid complications arising from the use of irrational combinations of drugs, as a result of which their side effects increase up to lethal outcomes.

So, the interaction of drugs is understood as a change in the pharmacological effect of one or more drugs with their simultaneous or sequential use. The result of such an interaction may be an increase in pharmacological effects, i.e. the combined drugs are synergists, or a decrease in the pharmacological effect, i.e. interacting drugs are antagonists.

The toxic effect of drugs can be divided into both general and local, as well as organ-specific (neuro-, nephro-, hepato-ototoxicity, etc.).

The local toxic effect of drugs can manifest itself, for example, in the form of abscess formation at the site of the intramuscular injection of a 40% glucose solution or in the form of phlebitis (inflammation of the vein wall at the site of the intravenous administration of the cytostatic drug emhibin.

The general (generalized, systemic) side effect of a drug is characterized by a systemic manifestation of the damaging effect of the drug. For example, orthostatic hypotension after the administration of the ganglioblocker pentamine or severe hypotension after the administration of the class I antiarrhythmic novocainamide.

A general toxic effect can also be exhibited by JICs administered in therapeutic doses, but capable of cumulating (accumulating) in the body, for example, cardiac glycosides (digoxin, celanide, etc.).

The general toxic effect of drugs can also be due to a violation of the functional state of the organ through which it is excreted from the body. In these cases, the drug prescribed in a therapeutic dose will gradually accumulate in the body, as a result of which its concentration will exceed the therapeutic one.

A number of drugs have an organ-specific, i.e. realized in any particular organ, toxic effect:

Neurotoxic (antimicrobial drug - lomefloxacin - insomnia, dizziness);

Hepatotoxic (a / b lincomycin - jaundice);

Nephrotoxic (a/b gentamicin);

Ototoxic, hematotoxic, damage to the organs of vision, mutagenic.

Oncogenicity is the ability of a drug to cause malignant neoplasms.

Side effects of drugs caused by increased tissue sensitivity

Idiosyncrasy is a congenital hypersensitivity to JIC, usually due to hereditary (genetic) enzymopathies.

Allergic reactions. If idiosyncrasy develops on the first drug intake, then an allergic reaction to the drug is always realized only after its repeated administration, i.e. in cases where the patient's body was previously sensitized to it. In other words, an allergic reaction to a drug is understood as such a type of interaction of a drug or its metabolite with the human body, as a result of which a pathological process develops when the drug is taken again.

There are 4 principal types of allergic reactions involving drugs.

The first type of allergic reaction of the body to drugs is reaginic (or immediate-type allergic reactions - anaphylaxis). This type of allergic reaction develops when drugs that first enter the body sensitize tissues and fix on mast cells.

The second type of an allergic reaction of the body to drugs - a cytotoxic reaction - develops when a drug, having entered the body for the first time, forms antigenic complexes with proteins located on the membrane of blood cells. The resulting complexes are perceived by the body as foreign proteins and specific antibodies are produced to them.

A cytotoxic allergic reaction can be caused by antibiotics of the penicillin and cephalosporin groups, class I antiarrhythmic quinidine, centrally acting antihypertensive drug methyldopa, non-steroidal anti-inflammatory drugs from the salicylates group, etc.

The third type of allergic reaction of the body to drugs - the formation of immune toxic complexes - develops in those cases when drugs, having first entered the body, cause the formation of toxic immune complexes with the participation of immunoglobulins M and G (IgM, IgG), most of which are formed in endothelial cells vessels. When JIC enters the body again, damage to the vascular wall occurs due to the release of biologically active substances (bradykinin, histamine, etc.).

The fourth type of an allergic reaction of the body to drugs - a delayed-type allergic reaction - develops 24-48 hours after the second dose of the drug

According to the intensity of clinical manifestations, allergic reactions of the body to JIC are divided into fatal, severe, moderate and mild forms.

Fatal (fatal) allergic reactions, for example, include allergic shock.

An example of severe allergic reactions is, for example, the development of the Morgagni-Adams-Stokes syndrome - a reversible sudden loss of consciousness, accompanied by convulsions, pallor, followed by cyanosis, respiratory failure, severe hypotension. This syndrome may develop as a result of an allergic reaction to the class I antiarrhythmic quinidine.

A moderate reaction is, for example, an attack of bronchial asthma in response to repeated administration of the non-steroidal anti-inflammatory drug acetylsalicylic acid, the so-called "aspirin" asthma.

Naturally, severe and moderate manifestations of an allergic reaction to JIC require immediate discontinuation of the drug and special desensitizing therapy.

Mild forms of an allergic reaction, as a rule, do not require special desensitizing therapy and quickly disappear when the drug that caused the allergy is discontinued.

In addition, allergic reactions to drugs according to the time of their occurrence are divided into: acute - occur instantly or within a few hours from the moment of repeated administration of drugs (for example, anaphylactic shock); subacute - occur within a few hours or the first 2 days from the moment of repeated administration of drugs (for example, thrombocytopenia); delayed or delayed type (eg, serum sickness).

It should also be remembered that the development of cross-allergy to drugs is also possible, i.e. in cases where the patient is allergic to some drug, for example, the sulfa drug sulfapyridazine, then the first dose of the sulfa drug sulfadimethoxine, which is close to it in chemical structure, may develop an allergic reaction

Side effects of drugs caused by a change in the functional state of the body

This type of side effect of drugs can occur in patients suffering from a disease of any organs, when prescribing drugs in medium therapeutic doses.

When prescribing cardiac glycosides in medium therapeutic doses to patients with acute myocardial infarction, severe cardiac arrhythmias may develop due to the positive inotropic effect caused by these drugs, i.e. strengthening the contractile function of the myocardium, which entails an increase in the need of the heart for oxygen, a deterioration in the state of the focus of ischemia, etc. At the same time, the same patient before the development of a heart attack could take cardiac glycosides in average therapeutic doses without developing any side effects.

drug withdrawal syndrome

In patients, as a rule, taking certain drugs for a long time (antihypertensive drugs of central action, for example, clonidine. Sudden discontinuation of their intake may lead to a sharp deterioration in their condition. For example, with a sudden discontinuation of the antihypertensive drug clonidine, a hypertensive crisis may develop (details about methods prevention and side effects of JIC.

Syndrome "steal"

In a broad sense, the “steal” syndrome is understood as such a type of side effect when a drug that improves the functional state of an organ causes a parallel deterioration in the functional state of other organs or body systems. Most often, the “steal” syndrome is observed at the level of the circulatory bloodstream in cases where expansion under the influence of vasodilators of some vascular areas and, consequently, an improvement in blood flow in them leads to a deterioration in blood flow in other vascular areas adjacent to them. Specifically, this type of side effect of drugs can be considered on the example of coronary steal syndrome.

Coronary steal syndrome

develops when two branches of the coronary artery, extending from one main vessel, for example, from the left coronary artery, have different degrees of stenosis (narrowing). At the same time, one of the branches is slightly affected by atherosclerosis and retains the ability to expand or contract in response to changes in myocardial oxygen demand. The other branch is significantly affected by the atherosclerotic process and therefore is constantly maximally expanded, even with a low myocardial oxygen demand. The appointment in this situation to the patient of any arterial vasodilator, for example, dipyridamole, can cause a deterioration in the nutrition of that area of \u200b\u200bthe myocardium that is supplied with blood by the coronary artery affected by atherosclerosis, i.e. provoke an attack of angina pectoris.

Syndrome "ricochet"

The "rebound" syndrome is a type of side effect of drugs, when for some reason the effect of the drug changes to the opposite. For example, the osmotic diuretic drug urea, due to an increase in osmotic pressure, causes the transfer of fluid from edematous tissues into the bloodstream, dramatically increases the volume of blood circulation (BCC), which leads to an increase in blood flow in the glomeruli of the kidneys and, as a result, greater urine filtration. However, urea can accumulate in the tissues of the body, increase the osmotic pressure in them and, in the end, cause a reverse transition of the fluid from the circulatory bed into the tissues, i.e. not reduce, but increase their swelling.

drug addiction

Drug dependence is understood as a type of side effect of drugs, which is characterized by a pathological need to take drugs, usually psychotropic, in order to avoid withdrawal syndrome or mental disorders that occur when the JIC data is abruptly stopped. Allocate mental and physical drug dependence.

Mental dependence is understood as a patient's condition, characterized by an unmotivated need to take any drug, more often psychotropic, in order to prevent mental discomfort due to discontinuation of the drug, but not accompanied by the development of withdrawal symptoms.

Physical dependence is a patient's condition characterized by the development of an abstinence syndrome due to discontinuation of the drug or after the introduction of its antagonist. Abstinence or withdrawal syndrome is understood as a patient's condition that occurs after stopping taking any psychotropic drug and is characterized by anxiety, depression, loss of appetite, crampy abdominal pain, headache, trembling, sweating, lacrimation, sneezing, goosebumps, fever body, etc

drug resistance

Paramedical action of drugs

The paramedical effect of drugs is not due to their pharmacological properties, but to the emotional, psychogenic reaction of the patient to a particular drug.

For example, a patient has been taking the calcium ion antagonist nifedipine for a long time, manufactured by AWD (Germany) under the name "Corinfar". In the pharmacy where he usually bought this drug, the drug manufactured by AWD was not available, and the patient was offered nifedipine called "adalat" manufactured by Bayer (Germany). However, taking Adalat caused the patient to experience severe dizziness, weakness, etc. In this case, we can talk not about the own side effect of either Fedipin, but about a paramedical, psychogenic reaction that arose in the patient subconsciously due to the unwillingness to change Corinfar for a similar drug.

4. Interaction of drugs

At present, no one doubts that effective therapy for many diseases can be carried out only with the combined use of drugs. Simultaneous administration of several drugs to one patient is called polypharmacy. Naturally, polypharmacy can be rational, that is, useful for the patient, and vice versa, harm him.

Knowledge of the theoretical and practical aspects of the interaction of drugs with each other is necessary for every practical medical worker, since, on the one hand, they allow, due to the rational combination of drugs, to enhance the effect of the therapy, and on the other hand, to avoid complications arising from the use of irrational combinations of drugs, in as a result of which their side effects increase up to lethal outcomes.

Synergism is a type of drug interaction in which the pharmacological effect or side effect of one or more drugs is enhanced.

There are 4 types of drug synergism:

sensitization or sensitizing effect of drugs;

additive action of drugs;

effect summation;

effect potentiation.

With sensitization as a result of the use of several drugs with different, often heterogeneous mechanisms of action, the pharmacological effect of only one of the drugs included in the combination is enhanced.

an example of the sensitizing effect of drugs can be an increase in the concentration of iron ions in the blood plasma with the joint appointment of ascorbic acid (vitamin C) with preparations containing iron.

This kind of JIC interaction is expressed by the formula 0 + 1 = 1.5.