Monotherapy of epilepsy. Polyteralic epilepsy

Monotherapy What is it?

Monotherapy - what is it?

Monotherapy

What is monotherapy

Monotherapy of epilepsy

starts with monotherapy.

Monotherapy of epilepsy

Polyterapia result

With polyterapia

So, the advantages monotherapy epilepsy In comparison, polyterapia:

1. High efficiency.
2. Convenient pattern of therapy.
3. More confidence in the doctor.

According to the results of the majority monotherapy studies

monotherapy).

When selfies monotherapy

For example,

lookinzhin in myoclonies;

phenobarbital with absans.

side effects drugs .

Among frequent:

1. Toxic hepatitis
2. Hematological disorders

Preparations

monotherapy

anti-epileptic drugs

Side effects

when using anti-epileptic drugs

Another complication

Epilepsy - what it is. The causes of the occurrence and symptoms.

Epilepsy - What is it? Brain pathology manifested by short-term, sudden attacks that are not provoked visible external factors. Excess (abnormal) discharge of neurons of the brain causes an epileptic attack, as a result of which spontaneous transistor phenomena add up to a certain clinical picture - disorders of motor-motor, mental, vegetative, sensitive functions, loss and change of consciousness, etc.

Epilepsy refers to sufficiently common neurological pathologies. According to WHO, every hundredth resident of the planet faces epileptic seizures. The attacks provoked by the brain tumor, the cranial and brain injury and other clearly observed reasons, do not always indicate the epilepsy patient.

Causes of epilepsy

To date, the exact causes of epilepsy are not established. Scientists suggest that heredity is the main risk factor of pathology (up to 40% of all cases develop in patients whose relatives suffered from this disease).

For reasons that causes epilepsy, also includes various damage to the brain, in particular:

As a rule, the attack of epilepsy is preceded by sleep disorders, dizziness, the noise in the ears, the feeling of numbness of the language and lips, comes in the throat, loss of appetite, total weakness, Patient lethargy, as well as excessive irritability and migraine pain. In front of the seizure, all epileptics arises aura lasting in a few seconds, after which the loss of consciousness and the following clinical manifestations are possible:

• croutons due to spasm in the voice gap;
• tonic convulsions and characteristic heading of the head, body strength and limbs (phase lasts up to 20 seconds);
• ability of breathing with swelling of vessels in the neck;
• pallor skin;
• compression of jaws under the influence of convulsion;
• clonic convulsions that appear after the tonic phase with the thick movements of the muscles of the body, limbs and neck;
• the spares of the language, hoarse and noisy breathing, isolation of foam from the mouth, sometimes together with blood due to biting of the cheek or language (this phase has a duration of up to 3 minutes);
• weakening seizures and complete relaxation of the patient's body.

Treatment of epilepsy

After a complete examination of the patient and studying the results of the MRI and EEG, the doctor prescribes adequate treatment aimed at termination epileptic seizures and improved quality of life. In 70% of cases, timely therapy eliminates the risk of new attacks. The patient's hospital is delivered in the following cases: the first attack of epilepsy (previously no deviations were observed), epileptic status ( convulsive attacks, repeating over each other without intervals), the need for surgery.

Monotherapy is one of the basic principles of appointing drugs against epilepsy.

Reception of antiepileptic dosage forms (Okskarbazepine, Typiramat, Levetyracetam, Carbamazepine, Valproic Acid) is carried out only under the supervision of the doctor in connection with possible side effects. Permanent control of the concentration of active compounds in the blood is required. The dose is prescribed in each individual case. The choice of the drug and the dosage depends on the age, the patient's sex, related pathologies and form of epilepsy.

Assistance during the attack of epilepsy:

• put a person on a flat surface, under the head lay a soft roller (moving to another place is undesirable);
• the patient's convulsions and movements cannot be limited;
• teeth can not be squeezed;
• to prevent the vane language and penetration of saliva in airways The patient's head is placed on the side;
• in case of vomiting, not only the head, but also the whole body of a person gently turn on the side;
• the end of the attack may be accompanied by a violation of memory, weakness, confusion of consciousness, so a person needs to come to himself for half an hour;
• after graduating, the female patient should be delivered home and let go for several hours.

Complications for epilepsy and prevention

The attack lasting for more than 30 minutes is called epileptic status. Most often, the state is developing against the background of a sharp abolition of received anti-platic drugs. The result of this state may be the stop of the heart, a violation of respiratory activities, the resulting mass of the respiratory bodies, the edema of the brain, coma, and even the fatal outcome.

Secondary epilepsy prevents the following recommendations:

• refusal to smoking and drinking alcohol;
• exclusion from the ration of caffean-containing products (black, energy, coffee);
• minimizing consumption of heavy dishes;
• healthy sleep;
• prevention of supercooling or overheating of the body;
• protection against any head injuries, brain concussion;
• enrichment of the diet with fresh fruits and dairy products;
• regular long walks;
• alternation of labor and recreation.

Folk recipes from epilepsy

The use of non-traditional medicine is only auxiliary treatment And it should be agreed with the observing patient by a specialist.

➡ Aromatherapy. For patients with epilepsy, it is recommended to carry out the aromatization of the room every day. essential oil Mirra (5-7 drops of 15 square meters. meters). Helps and layout in the room slices of resin Mirra.

➡ Healing baths. Prepare a decoction of a fragrant fresh hay of forest herbs (two or three handful of herbs to knocked on a small fire in 3 liters of water, filter and pour into the bath filled with warm water, the time of procedure is a quarter of an hour, frequency - once a few days).

➡ Morning Rosa. Soak dew dropping on plants at dawn, sheet or bedspread, blame into the fabric and sit until it is completely drying.

➡ Owin. 10 grams of dry grass of the souls are sealed in a thermos in 300 ml of boiling water, allowed about 2 hours and filtered. Revolutionary infusion - on ½ cup three times a day before meals in warmth. Treatment is long - up to 3 years.

➡ Lavender. Lavender decoction has a soothing effect, normalizes sleep and improves condition nervous system. A teaspoon of dry grass is brewed in a glass of boiling water, and then tomatin on a water sauna for about 5 minutes. The drink cold at room temperature is filled and accepted on a glass after dinner or before bedtime. The course of treatment is 2 weeks.

➡ Collection of herbs. Nather's root, hop flowers, molding grass, melissa and mint to combine in equal proportion. Collection of grinding in a stupe or coffee grinder and use for cooking infusion: a tablespoon of plants to fervent in a thermos in a glass of boiling water, insist for 2 hours, profile. Taking a drink for 2 glasses per day (it is necessary to choose an individual dose, based on the sensation). Course treatment - 2 months.

➡ from the seizure. Some people's lycari recommend during an attack put the patient's left hand on the floor and step (slightly) to the little finger.

➡ Schemble Baikal. The tincture of the brass roots is well helped from epilepsy. The recipe is popular in Siberia and the Far East. The raw materials insist in medical alcohol in the ratio of 1:10 for 10 days. Reception of 20 drops divorced in half a cup drinking water, half an hour to the main trapes (three times a day).

Naturally, a person suffering from epilepsy can not drive a car, ride on business trips, implicit in night shifts, swim in open reservoirs without accompanying, work with automated mechanisms. Most of Patients receiving adequate treatment and comply with all recommendations and appointments lead a normal lifestyle without attacks. Be healthy!

Monotherapy What is it?

Monotherapy - what is it?

Monotherapy - treatment with the help of one drug.

What is monotherapy

Monotherapy of epilepsy

In accordance with the international principles of approach to epilepsy, treatment starts with monotherapy.

Monotherapy of epilepsy - This is the use of one anti-epileptic drug.

In many patients therapy with one drug, properly chosen in accordance with the type of attacks and the form of epilepsy, immediately leads to a cessation or significant decrease in attacks.

What does the concept of "polyterapy" mean?

In case of preserving the attacks, an attempt is attempting to add a second anticonvulsant drug. But the effectiveness of therapy from the introduction of the second anticonvulsant increases a maximum of up to 10%, and from the third drug - up to 5%. And the fourth drug is intact.

All anti-epileptic drugs have side effects. The tolerance of treatment is worsening, while using several drugs. Anticonvulsant can enter into unwanted interactions with each other, as well as with other medicines. Polyterapia result - Reducing efficiency and deterioration of the tolerance of treatment.

The reception of several drugs several times a day makes every day that any person becomes difficult or impossible to accurately implement the recommendations of the doctor. There are passes of reception of drugs. From irregular or late treatment, efficiency is reduced.

The problem of therapy is to create a constant therapeutic concentration of the drug in the blood. The reception of tablets is important every day by the hour.

What time is anti-epileptic drugs:

With a single application, most often, the drug is prescribed for the night - at 21 o'clock.

With twofold use of drugs in chronoform - at 8 o'clock and at 20 o'clock; or at 9 o'clock and at 21 o'clock.

With threefold use of drugs - at 8 o'clock, 16 hours and at 22 hours.

With polyterapia The patient begins to take drugs irregularly or does not observe the time of reception of drugs.

So, the advantages monotherapy epilepsy In comparison, polyterapia:

1. High efficiency.
2. Less probability of side effects.
3. No undesirable pharmacokinetic interactions of drugs.
4. Convenient pattern of therapy.
5. Lower cost of treatment.
6. More confidence in the doctor.

According to the results of the majority monotherapy studies anti-epileptic preparations allows you to end epileptic attacks 65 - 70% of cases.

Treatment begins with the preparation of the first choice under this form of epilepsy.

Preparation of the first choice in epilepsy - This is a drug that is recognized as the most effective in this form of the disease and makes it possible to reduce the frequency of attacks in most patients.

In the case when the preparation of the first choice is not effective or poorly transferred, it is necessary to gradually reduce the dose of the ineffective drug and at the same time select the second anti-epileptic drug. After replacing the second drug, continue treatment with one drug (in monotherapy).

When selfies monotherapy Switch to polyterapics - treatment at the same time with two drugs. There are severe forms of epilepsy, at which starting polyterapy is shown.

When polyterapics, we comply with the rules:

1. We assign combinations with different mechanisms of action.
2. The daily dose of the first is changing, taking into account the possible option medicinal interactions with the second drug.
3. We avoid combinations with obvious depressing or toxic side effects in both drugs.

Part of the anticonvulsants, suppressing the seizure of the same type, can provoke the seizures of another type.

For example, reception of carbamazepine and phenitone is contraindicated in absans and myoclonies;

lookinzhin in myoclonies;

phenobarbital with absans.

To reduce the likelihood of side effects of AEP required monitoring anti-epileptic drugs in the blood.

Analysis on the determination of the concentration of drugs in the blood shows, in which dose you need to assign it.

Otherwise, we treat "blindly". If the drug is not enough, the attacks are preserved. And when abolishing drugs, a high risk of recurrence occurs in a few years.

If the drug is adopted in doses exceeding therapeutic, then patients appear side effects of drugs .

Among dose-dependent side effects of anti-epileptic drugs Frequent:

1. When using barbiturates and benzodiazepines, signs of oppression - drowsiness, lethargy, apathy, disruption of trainee.
2. When using carbamazepine - dizziness, headache, ataxia, nystagm.
3. Valproat, ethosuximide cause gastrointestinal disorders in the form of nausea, pain in the stomach, stool disorders.
4. Valproat leads to an increase in appetite, therefore, to an increase in body weight.
5. Valproat may be the cause of tremor and hair loss.
6. Phenytoin leads to dizziness, gait, nystagma, gum hyperplasia.

Dosone-dependent side effects of anti-epileptic drugs arise due to hypersensitivity.

1. Toxic hepatitis - It is manifested by jaundice, rash, fever, lymphoenopathy, eosinophilia.
2. Hematological disorders in the form of aplastic and megaloplastic anemia (more often when taking phenytoin and carbamazepine).

In the case of hypersensitivity, the preparations require hospitalization, immediately the complete abolition, treatment of complications, selection of another anti-epileptic drug.

What is epilepsy monotherapy

Preparations With a large period of half-life (phenobarbital, ethosuximide, clonazepam), if necessary, prescribe 1 time per day, however, a sharp increase in the peak of the concentration after one-time reception of the daily dose increases the amplitude of the oscillations of the blood concentration, risk and degree of inxication.

Currently, epilepsy treatment tactics is universally recognized by one drug - monotherapy. In case of failure, the drug is replaced by the drug next selection queue. If it does not help, polyterapia can be applied. However, unfortunately, in many cases, with the failure of monotherapy, it turns out ineffective and polyterapetes. There are forms of epilepsy, at which start-up polyhyrapia is shown. Thus, with infant spasme - ACTH or its analogs (synacten) or glucocorticoids plus the basic AEP (Valproate primarily), with Lennox syndrome - Gasto - Basic AEP plus Lamotinin et al.

It should be borne in mind that some anti-epileptic drugs, suppressing the seizure of the same type, can increase and even cause the seizures of another type. As a result, certain contraindications arise for their destination. Carbamazepine and Phoeniton have absneses and myoclonies, Lookidzhina - Mioclonia, at Fenobarbital - Absans. Perhaps the only preparation that can be applied in any kind of seizures, i.e. Not having contraindications by type of seizures, is the Valproat. The most effective is its prolonged form - Depakin-Chrono.

Frequent phenomenon. True, the monitoring of anti-epileptic drugs in the blood allows in many cases to avoid them or minimize them. With a gradual increase in doses, they are also expressed less. Most side symptoms are up to-hot. Most characteristic of the use of barbiturates and benzodiazepines Signs of sedation - lethargy, drowsiness, disagreement of disability, etc.; for carbamazepine - dizziness, headache, ataxia, nystagm; For valgogram, ethosuximide, often prison - gastrointestinal disorders (nausea, epigastric pain, diarrhea, constipation), and for Valpro-Ata, an increase in body weight, tremor, hair loss; For phenytoin - dizziness, instability gait, ataxia, nistagm, gum hyperplasia.

Another number of unwanted phenomena when using anti-epileptic drugs does not have a dose-dependent factor, and the result of hypersensitivity to the appropriate drugs, which may occur both at the first receptions of drugs and in one or another stage chronic application. These symptoms with a complete base should be attributed to complications of treatment, therefore it is required to cancel the appropriate drug. So, the hepatotoxicity of AEP, the most expressed in the valigroat, can cause toxic hepatitisIn addition to jaundice, it is also manifested by a rash, fever, lymphoenopathy, eosinophilia.

Another complication anti-epileptic drug therapy - Hematological disorders, namely aplastic and megaloplastic anemia (more often when taking phenytoin and carbamazepine). Complications from the nervous system caused by phenytino are primarily attributed to cerebellum disorders. Immune disorders can rarely occur. In all these cases, the corresponding drug should be canceled.

7503 0

Most (if not all) patients with arterial hypertension therapy must be started carefully, gradually (within a few weeks) reducing hell to the target level. To achieve targets, hell in most cases requires the appointment of more than one drug. The proportion of patients receiving combination therapy depends on the initial blood pressure. For arterial hypertension The I degrees of monotherapy will be effective in more patients. In research among patients diabetes It was found that most patients received at least two drugs, and in two studies in diabetic nephropathy to the sconium used as a studied drug, it was necessary to add 2.5-3.0 LS.

Depending on the initial level of blood pressure, as well as on the presence or absence of complications, it is advisable to begin therapy or with a low dose of one drug, or with a low-dose combination of two LS (Fig. 1). If low-dose monotherapy is selected, but the blood pressure targets are not achieved, the following step can be the transition to therapy to another drug in a low dose, increase the dose of the first drug (with a greater probability of side effects) or the transition to combined therapy. If the treatment has begun from a low-dose combination, it is possible to use a combination of drugs in higher doses or adding a third LAN in a low dose.

Fig. 1. Monotherapy in comparison with combined drug treatment

The following double combinations proved its effectiveness and good tolerability (Fig. 2):

• diuretik and IAPF;
• diuretik and Bra;
• blocator of slow calcium channels (dihydropyridine) and β-adrenoblocator;
• blocator of slow calcium channels and IAPF;
• blocator of slow calcium channels and sconces;
• blocator of slow calcium channels and a diuretic.

Fig. 2. Possible combinations of antihypertensive drugs. Preferred combinations in the overall population of patients with arterial hypertension are marked with black lines. Frames indicate classes whose action is proved in clinical studies. APE - angiotensin-turning enzyme.

If necessary, it is possible to use other combinations, in some cases it may be necessary to assign three or four drugs.

Daily applications recommended drugs long action Or form of drugs that provide 24-hour efficiency. The advantages of such funds are to improve the commitment of patients therapy and minimizing blood variability, which may provide better protection against the development of basic cardiovascular events and targeting organs.

Particular attention should be paid to undesirable phenomena and even subjective sensations, as they can cause poor treatment commitment. Patients need to ask about unwanted effects and carry out appropriate changes in the treatment scheme. Even within the same class, there are preparations characterized by a reduced probability of the development of a certain undesirable phenomenon. For example, among β-adrenoblockers, the weakness and phenomenon of Rhino are less pronounced when using drugs with vasodilator properties; Among the block plants of slow calcium channels, constipation does not occur when taking dihydropyridines, and tachycardia - when using verapamil and diltiazem; When using different blocks of slow calcium channels, the severity of edema is different.

SVERRE E. KJELDSEN, TONJE A. Aksnes, Robert H. Fagard and Giuseppe Mancia

Arterial hypertension

Arterial hypertension accompanies many people. To correct the condition at elevated pressure there are several groups of medicines. To one of them - inhibitors of an angiotensin glider enzyme - the drugs are leased and enalapril. What is the difference between one tool from the other? Which of them acts better with the smallest severity of side effects? It is important to deal with such issues, as they arise in patients who received a recipe from the doctor with the appointment of one of the specified items.

Composition of drugs

An angiotensin glittering enzyme inhibitors are special effective action on the patient's body. They lead to the process of slowing the action of the enzyme, which is a link in the reaction leading to the vasoconstrictor effect.

Preparations are able to interfere with the mechanism of destruction of substances causing the extension of blood vessels, contribute to a decrease in pressure (systolic and diastolic), reduce the load on myocardium.

Named medicinal products Different in composition. Active substance Lysinopril - leasing dihydrate. He and other components do not affect exchange processesproviding the life of the patient. Additional components of the drug are:

• magnesium stearate;
• lactose monohydrate;
• methylene chloride;
• silicon dioxide;
• povidone;
• corn starch.

In the production of ENALAPRIL, ENALAPRIL Maleat, which acts as an active substance. For the therapeutic effect of its reception, it is required that in the patient's body metabolism occurred - the transition of the main means of medication into the active, current component. Supplement the composition of the medicine other components that are used in their production:

• magnesium stearate;
• sodium bicarbonate;
• lactose monohydrate;
• cellulose;
• sugar;
• talc.

The form of the release of drugs

The drug leaser produces in tablet form. Depending on the peculiarities of the flow of arterial hypertension in a particular patient, the doctor may write a medicine with different quantitative content of the active ingredient. Manufacturers produce lease drive tablets with dosage:

• 5 mg;
• 10 mg;
• 20 mg.

Depending on the duration of the upcoming treatment, the patient in the hospital is recommended to acquire the required amount of medication. A pack may contain from 1 to 5 plates in each of which 10 tablets.

The drug Enalapril is a pill. The concentration in each of them of the active substance is similar - 5, 10, 20 mg. The box contains 2 blisters of 10 tablets. The active component of Enalapril Maleat is used in the solution for injection, which is prescribed by patients with hospitalization with a diagnosis of hypertensive crisis.

Indications for the appointment of drugs

The main indication to the appointment of the two preparations under consideration is arterial hypertension. Each of the drugs has other testimony for its intended purpose. Enalapril is also used in patient therapy with a confirmed diagnosis:

• dysfunction of the left ventricle of the heart;
• cardiac insufficiency in chronic flow.

Other reasons for the use of lysinopril:

• cardiovascular insufficiency of chronic type;
• myocardial infarction B. acute form (subject to the absence of arterial hypotension);
• development of diabetes mellitus accompanied by diabetic nephropathy.

Dosage and treatment diagram of APE Group

General approaches to receiving medicines described:

• tablets are used regardless of meals;
• treatment is carried out at a certain time;
• the drug is powered by a small amount of water.

Enalapril: Features of application

Depending on the diagnosis, the reception of the Tablets Enalapril is prescribed according to the different schemes, different daily dosages are used.

1. Arterial hypertension. Monotherapy begins with the establishment of a daily dose - 5 mg. If the pressure in the patient remains high, the dosage of the medication is adjusted to 10 mg. The beginning of treatment, an increase in the amount of the drug (the first hours after receiving the means before stabilization of the blood pressure) should be monitored by a specialist. The maximum daily dose of the drug is 40 mg, which is divided into 2 receptions. The doctor then evaluates the effect of the drug and prescribes the patient supporting therapy with an individual dosage from 10 to 40 mg, which must be taken on time or divide for 2 daily use. With a renovascular type hypertension, the drug dosage requires an individual selection, the treatment starts with 5 mg of the drug, increasing the daily reception to 20 mg if necessary.
2. Cardiac and vascular failure. The beginning of the use of enalapril is beginning with a low dose - 2.5 mg. The doctor assesses the patient's condition for several weeks, adjusts the dosage of the drug, brings its daily reception of no more than 20 mg. The medicine should be used in two receptions. The use of the drug is preceded full examination patient.
3. Dysfunction of the left ventricle heart. The condition causes a myocardial infarction. Treatment is appointed by an individual scheme.

Lysinopril: Features of use

What may differ use? Use one-time reception of the drug. Doctors recommend drinking tablets in the morning. During therapy, there are no identical treatment regimens, each patient receives recommendations related to the drug receipt having a difference.

1. With arterial hypertension, the reception is not complemented by other drugs. It is proposed to begin treatment with 5 mg per day. If pressure indicators remain the same or decrease slightly across a large period of time, the doctor may decide to increase the dosage of the lease drive, which can be increased to 20-40 mg. According to statistics, the patient sufficiently use no more than 20 ml of the drug per day. The desired therapeutic result in most cases is achieved 2 weeks after it started, in some patients after a month of treatment. Renovascular hypertension requires a reduced drug dosage. The daily reception at the beginning will be 2.5-5 mg, then the dosage is adjustable.
2. Diagnosis Heart failure (chronic). Tablets are consumed in an amount of 2.5 mg per day, then a supporting dose of drugs up to 5-20 mg is installed.
3. Acute myocardial infarction. It is assumed to use lichen in combination with other drugs. Tablets are applied by a special way: 1 day - 5 mg, after a day - 5 mg. Then the 48-hour break follows, the treatment is resumed by the use of 10 mg of the drug, such a daily dosage remains at least 6 weeks. If the heart attack is accompanied by low pressure, the specified dosages will be doubled.
4. Diagnosis of diabetic nephropathy. Lysinopril (10 mg) is assigned for one-time reception per day. In some cases, the dose increases to 20 mg.

How to act medicines to the patient's body

Despite the fact that leaser and enalapril refer to the same group medicinal preparationsThere is a difference in medical effects on the human body.

Regular use of enalapril leads to the following results:

• the walls of the arteries walls are reduced or eliminate;
• it is normalized by arterial, earlier high pressure - at the same time systolic and diastolic;
• improved blood circulation;
• the ability of blood to the formation of blood clots is reduced;
• the condition associated with heart failure is improved;
• adjusts hypertrophy of the left heart ventricle;
• there is a diuretic effect.

If the patient was discharged lysinopril, during treatment with the drug the following is achieved:

• the pressure is in the values \u200b\u200bclose to the norm;
• reduced myocardial hypertrophy, vascular walls;
• the stability of the muscles of the heart increases when strengthening physical LoadsWhat is important in the diagnosis of heart failure;
• disagreement from the body excess sodium salts.

In which cases, drugs are contraindicated

The treatment for the treatment of one of the described drugs may prevent the disease diagnosed in patient or pathological conditions. The doctor will prohibit the use of lichen in cases:

• swelling of quinque (hereditary);
• increased sensitivity to the components of the drug;
• aortic stenosis;
• brain circulation disorders;
• pathologies of coronary vessels;
• ischemic heart disease;
• diseases associated with dysfunction of blood formation;
• pathological conditions of connective tissues;
• disorders of the kidney functions of a pronounced nature;
• hypoglycemic state;
• low pressure indicators.

Treatment with lysinopril is prohibited by children to achieve majority, elderly people. The use of such tablets during pregnancy is eliminated.

If a woman continues to receive medication, the risk of developing pathologies in a child - skull hypoplasies, hypercalemia, improper development and kidney functioning. The intrauterine development of the fetus can end with his death.

Enalapril treatment is not prescribed if the patient is diagnosed:

• bilateral stenosis of the kidney arteries;
• porphyrin disease;
• pathology of the mitral valve;
• violation of the liver function;
• hypercalemia;
• severe heart failure;
• pondimopathy hypertrophic pit;
• the intolerance of the components of the drug.

Enalapril does not apply in children's therapy under 12 years old. The medicine is dangerous for pregnant women. Prohibited treatment with a drug for young mothers preferring breast-feeding kid.

Danger of side effects

In case of treatment with drugs, enalapril and leasing, some patients note the occurrence of side effects that appear when receiving each of the items:

• sharp, significant reduction in blood pressure;
• the appearance of headaches accompanied by strong dizziness, noise in the ears;
• emerging pain in the heart area;
• long cough, which is characterized as dry and adsatory, barking;
• changing taste sensations;
• pathological change in blood composition;
• changes in the operation of the gastrointestinal tract;
• allergic reactions;
• sleep disorders.

What is the difference between side effects? Enalapril negatively affects the functions of the liver, lysinopril can disrupt the work of the kidneys. Such a difference obliges a doctor to carefully study the state of health, provide all available risks for the patient before the recipe for the purchase of medication.

To use drugs only good effectIt is required to pay attention to the compliance with the rules:

• conducting regular monitoring of blood pressure indicators;
• periodic clinical studies blood comparing their results (before treatment and in the process of it);
• regular visit to the doctor, for diagnostics of heart, liver, kidney, evaluation general status, identifying the presence of side manifestations;
• consumption of only recommended doses of drugs, treatment according to the agreed scheme;
• the elimination of the use of any alcohol during treatment.

What is the most effective drug?

The question of how Lysinopril or Enalapril acts, which is better and more efficient, not only consumers of drugs. Comparison medical properties Tablets conducted doctors. A group of patients undergoing treatment from arterial hypertension, in which pressure indicators were in the value of 140/90 mm Hg. Art. Assigned one of the drugs. In each case, the dosage of drugs was used, the diagram of its reception required for the treatment of a particular patient.

In the treatment of each drug in patients, a qualitative result was observed - arterial pressure was in the value of the norm. The obtained indicators remained more for a long time In patients who took lichen, that is, this medicine has a higher efficiency, which showed comparison of their therapeutic effects.

It should be remembered that high blood pressure It is a sign of many dangerous pathologies. Assign any means, even having only positive feedback, is very dangerous, it can entail not only the deterioration of health, but also the death of a person.

Learn more about action aPF inhibitors It is possible from the video where the doctor answers popular questions of patients receiving drugs from this group:

Also an interesting video, helping to understand the extensive choice of drugs from hypertension, their actions and pharmacological propertiesSubmitted below:

All about the preparation of Perines and its analogues

1. Regulation Hell in the body
2. Perines: how it acts
3. How to apply Perininu
4. When to start using perinnev
5. Reception mode and dose selection principles
6. special instructions
7. Overdose and side effects
8. Perinvestus analogues
9. Reviews
10. conclusions

Perines - a drug intended for the treatment of increased blood pressure. The active ingredient of the perineus - perindopril - refers to the class of inhibitors of angiotensin surgery enzyme (ACE). Releases the drug Slovenian company Krkka, which has a production branch in Russia.

Regulation Hell in the body

To understand exactly how the tool acts, you need to know how arterial pressure is regulated in the body. Regulation mechanisms are systemic and local. Local acts at the vascular wall level and "adjust" the result of the operation of system mechanisms, based on the momentary needs of a particular organ.

System mechanisms regulate blood pressure at the level of the body as a whole. According to the mechanism of action, they are divided into nervous and humoral. As clearly from the name, the nervous mechanisms are regulated using the peripheral nervous system. Gumoral mechanisms regulate systemic blood flow using active substances dissolved in the blood.

One of the main mechanisms, managing systemic bloodstream and, as a result, blood pressure regulating is a renin-angiotensin-aldosterone system.

Renin is a hormone-like substance that is produced in the cells of the arteriole of vascular shorts of the kidneys. It also synthesizes endotheliums - the inner sheath of the vessels of the brain, myocardium, the glomerular zone of the adrenal cortex. Renin production is adjustable:

• Blood pressure in the blood supply, namely, the degree of its stretching;
• Sodium content in the distal kidney channels - than it is more, the more active Renin secretion;
• Sympathetic nervous system;
• According to the principle of negative feedback, reacting to the content in the blood of angiotensin and aldosterone.

Renin transforms an angiotensinogen protein synthesized by the liver in a low-effective hormone angiotensinogen I. With the current of the blood, he enters the lungs, where under the action of angiotensin-glossing enzyme (ACE) turns into active angiotensin II.

Functions angiotensin II:

• Narrows artery, including coronary;
• Causes myocardial hypertrophy;
• Stimulates the release of vasopressin (he is an antidiuretic hormone) in the pituitary gland, which holds water in the body, reducing its highlighting by the kidneys;
• Stimulates the production of aldosterone in adrenal glands,

Perines: how it acts

Perines blocks ACE, thus reducing the amount of angiotensin II in the body and eliminating its vasoconstrictor effects. In parallel, the secretion of aldosterone is reduced, sodium delay and fluid delay decreases. This reduces the volume of circulating blood and, as a result, reduces pressure in the arterial system.

In general, drug effects can be divided into the following groups:

Changes in the cardiovascular system:

Effects from the kidneys:

• Normalization of intracralobic hemodynamics;
• Reducing proteinuria.

From the endocrine system:

• Reduction of tissue resistance to insulin (important for patients with metabolic syndrome and type 2 diabetes);
• prevention of angiopathies and nephropathy caused by diabetes.

From other exchange processes:

• An increase in removal by the kidneys of urinary acid (important for patients with gout);
• Anti-seaterosclerotic action: reduces the permeability of the cells of the inner wall (endothelium) of the vessels and reduces the number of lipoproteins in them.

With prolonged regular use of Perines, it shows the so-called chronic antihypertensive effect. The reproduction and growth of smooth muscle cells in the middle wall of the artery is reduced, which increases their clearance and restores elasticity.

How to apply Perininu

• Arterial hypertension
• For cardioprotection in chronic heart failure,
• For cardio limits after myocardial infarction or surgery on coronary arteries, subject to the stability of the ischemic process,
• To prevent the recurrence of a stroke in patients, once undergoing it.

When to start using perinnev

The main indication for this is arterial hypertension. Under it means an increase in systolic, "top" blood pressure\u003e 140 mm.RT. Art and / or diastolic, "lower" blood pressure\u003e 90 mm. RT. Art. Increased pressure may be secondary caused by diseases of other organs (glomerulonephritis, adrenal tumors, etc.) and primary when it is impossible to identify and eliminate the cause of the disease.

Primary (essential) hypertension is 90% of all cases of increased blood pressure and is referred to as hypertension. Ministry of Health of the Russian Federation B. clinical recommendations from 2013 offers the following criteria For its diagnosis:

Reception mode and dose selection principles

The recommended target adhesive numbers are less than 140/90 (for diabetic patients - less than 140/85). Used previously, the concept "Working pressure" is recognized as incorrect - for the prevention of complications and a reduction in the probability of cardiovascular death, it is necessary to achieve targets. If the pressure is overly high and its sharp normalization is poorly tolerated, the correction is carried out in several stages.

In the first 2-4 weeks, hell is lowered by 10-15% of the initial level, then the patient is given a month for addiction to such values \u200b\u200bof pressure. Next, the rate of reduction is selected individually. The lower limit of the garden is 115-110 mm.

The medicine is accepted once a day, in the morning. The initial dosage of 4 mg, for pensioners - 2 mg, gradually increasing to 4 mg. Patients taking diuretic, it is necessary to stop using them 2-3 days before the arrival of the perineus, or begin treatment with 2 mg dosage, also gradually increasing to 4 mg. In the same way, doses for patients suffering from chronic heart failure are chosen.

After a month of regular reception, the effectiveness of the drug is estimated. If the target hell is not achieved, it is necessary to go to the dosage of 8 mg.

Patients with a stable IBS Perines are prescribed in the starting dosage of 4 mg, after 2 weeks they go to 8 mg.

Contraindications:

special instructions

Perineva can provoke an excessive decrease in blood pressure at:

• Cerebrovascular pathologies,
• Simultaneously receiving diuretic products
• Loss of electrolytes: after a diet that excludes salt, vomiting or diarrhea,
• After hemodialysis,
• Stenosis of mitral or aortic valves - insofar as cardiac ejection With these states, it cannot increase, it is not able to compensate for the decrease in the peripheral resistance of the vessels,
• Renovascular hypertension,
• Chronic cardiovascular insufficiency in the decompensation stage.

May increase renal failure in patients having bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney.

Extremely carefully you need to apply the perinem women of fertile age. The planned pregnancy is an indication for changing the antihypertensive drug.

Overdose and side effects

In overdose, the blood pressure is overly reduced, up to shock, develops renal failure, breathing intensity (hypoventilation) is reduced, the heart rate may change both toward tachycardia and bradycardia, perhaps dizziness, anxiety, cough.

When overdose, you need to put a patient, raising my legs, fill the BCC, intravenous administration solutions. Angiotensin II is also introduced intravenously, with its absence - catecholamines.

Side effects:

Perinvestus analogues

To date, more than 19 drug-based drugs are registered in the Russian Federation. Here is some of them:

• Preshaurium. The drug was produced by the French company "Servier", was the first medicine based on Perjnopril, which appeared at the disposal of doctors. It was on this drug that all studies were carried out on the effectiveness of perindopril, a decrease in cardiovascular risk (a decrease of 20%) was proved, positive effect on the state of the vessel walls. Cost from 433 rubles.
• Perindopril Richter. Production of the Hungarian company Gideon Richter. Price from 245 rubles.
• Parothel. Production of the Russian company Ozone. Price from 308 rubles.

Choosing from possible options optimal in terms of value and quality ratio, it should be remembered that today from all manufacturers of generic drugs bioequivalence (compliance with the original medicine) has proven its own to the means of Krkka.

The cost of perinema in pharmacies from 244 rubles.

Ko-Perines

Monotherapy in perindopril (perighta) allows you to achieve the target values \u200b\u200bof the blood pressure in patients with 1-2 stages of hypertension in 50% of cases. In addition, often therapy of arterial hypertension should immediately begin with a combination of two actors.

The combination of perindopril and indapamide (thiazid diuretics) showed itself one of the most effective. For the convenience of patients, the combination is produced in the form of one tablet.

Ko-Perineva produced in 3 dosages:

1. Perindopril 2 mg + indapamide 0,625 mg;
2. Perindopril 4 mg + indapamide 1.25 mg;
3. Perindopril 8 mg + indapamide 2.5 mg.

Cost in pharmacies - from 269 rubles.

Contraindications

In addition to those already specified for perindopril, for Ko-Perinineau:

• Azotemia, Anuria;
• Liver failure.

Side effects

In addition to unwanted phenomena, characteristic of Perineva, Ko-Perines can cause:

• Hemolytic anemia, hemorrhagic vasculitis - extremely rarely;
• Photosensitivity, multiform erythema - very rarely;

Capecitabine is effective and safe preparationwhich can be used after chemotherapy using taxanes and anthracycline, in patients with metastatic Her2 negative RMW. The purpose of this study was to study the effectiveness and safety of Kapecitabine as a monotherapy of the first line in patients with HER-2-negative metastatic RMG.

Methods and research design

In this single-center study, 109 patients with Her-2 negative metastatic RMH were participated, which were treated with capecitabin as a monotherapy in the first line from 2003 to 2014. An analysis of survival was carried out using the Kaplan-Meyer method of survival indicators without progression of the disease (VPPZ) and general survival (s). The levels of the two-way P-value \u003d lt; 0.05 were recognized as statistically significant.

results

The average VPPD was 7.0 ± 0.67 (the confidence interval (di) 5.6-8.3) months and the average s) was 30 ± 4.1 (di 21.8-38.1) months. The use of Kapecitabine as therapy in the first line in patients with Her-2 negative IPMG has shown a greater efficacy in ER-positive patients compared to ER-negative patients. The average WPPZ 9 months. Compared with 4 months (p \u003d 0.002), average s 33 months. Compared with 21 months (p \u003d 0.01), respectively.

The rate of response to treatment in a group of ER-negative patients was 16%, and in the ER-positive patient group - 38%. Although most patients received therapy with higher doses of Kapecitabine (1250 mg / m 2), the side effects of 3-4 gravity were observed less often than in some studies of Capecitabine II and III phases.

conclusions

Capecitabine monotherapy is effective and safe for ER-positive patients with HER-2 negative metastatic RMZH. Low toxicity profile Capecitabine compared to others cytotoxic drugs for intravenous application, and simplicity oral application Make it with a drug selection for doctors and patients.

Pharmacology is widely used in treatment mental disorders, border states and neurological diseases. Developed several classes of psychotropic drugs. Some drugs, invented more than fifty years ago, are still used in treatment, and about once every 4-5 years new drugs appear.

However, unfortunately, it is necessary to recognize that modern science knows very little about the work of the brain, and psychiatry is the least studied area of \u200b\u200bmedicine. Causes and biological development mechanisms mental diseases So far, remain the object of study. In such a situation, the question of effective and safe treatment is sharp.

What is monotherapy?

Pharmacotherapy offers a wide range of psychotropic drugs for the treatment of mental disorders. Today it is customary to select one psychotropic drug that is best suited to the patient. Why alone? Many psychotropic drugs have serious side effects: an increase in the content of the prolactin hormone in the blood associated with this increase in body weight, hypotension, edema, resistant involuntary movements and others. To reduce this "set" of side effects, in most cases one preparation is selected. This approach is called medicinal monotherapy.

Medicine monotherapy is an approach in pharmacological treatment, which implies the use of only one (rarely - two drugs) in the treatment of one or another disease.

It is often the patients themselves, and doctors face that the appointed drugs give a large number of side effects, can be mutually intercoured, or on the contrary, reduce the effectiveness of each other's action. Take a large amount of drugs - this is undoubtedly difficult in all respects.

Therefore, more and more often in world practice, doctors, if there is an opportunity, go from the appointment of several drugs at once, preferring to them new in the treatment of mental disorders.

Monotherapy in the clinic D.M.N. Minotko

Our clinic monotherapy implies a thorough preliminary examination of the patient and the subsequent purpose of the minimum necessary dose, which is quite sufficient to achieve a sustainable effect.

Monotherapy of mental illness, whether treatment of depression, psychosis, neurosis allows you to solve several problems at once:

• Choose a safe dosage and a preparation scheme based on their individual patient features.
• Eliminate the possibility of overdose and side effects, tracking the effectiveness of the effect of the drug on the body.
• Reduce the load on those organs and systems that participate in the metabolism of medicinal substances.
• To give the patient to live the usual, active life.
• To reduce the cost, as it is obvious: the purchase of one drug is cheaper than several at the same time.

Medicine monotherapy is a reasonable approach in safe treatment.