What to apply for edema
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Means used for pulmonary edema.
Widespread use in the treatment of pulmonary edemareceived drugs narcotic analgesics - morphine, fentanyl, talamonal. One of the explanations of the effectiveness of narcotic analgesics in this pathology is as follows. To reduce pulmonary edema at high arterial pressure, one of the main tasks is to lower blood pressure. To this end, ganglion blocking agents (hygronium, pentamine, benzohexonium), vasodilators of myotropic action (sodium nitroprusside), as well as preparations possessing a-adrenergic blocking activity (for example, phentolamine, small doses of aminazine, diprazine) are usually used. Due to lowering of blood pressure by these drugs, normal hemodynamics normalizes, cardiac efficiency improves, blood pressure in the small circulation decreases. Reduction of pulmonary edema can also be due to a decrease in the volume of circulating blood with the help of a number of active and fast-acting diuretics (furosemide, ethacrynic acid), which also have antihypertensive activity.
With swelling of the alveoli and education in their lumenfoam there is a pronounced hypoxia, which requires emergency intervention. In addition to the already mentioned groups of drugs, you can use so-called defoamers. The latter includes ethyl alcohol, which, when inhaled, lowers the surface tension of the foam bubbles and transfers it to a liquid occupying a small volume (the respiratory surface of the alveoli is released). Vapors of ethyl alcohol with oxygen are inhaled through the nasal catheter or through a mask. A frequent component in the complex of substances used in the treatment of pulmonary edema are glucocorticoids, which have an anti-inflammatory and immunosuppressive effect.
In all cases of pulmonary edema, universal therapy is oxygen therapy.
In addition, with certain indications forelimination of pulmonary edema can be used with cardiac glycosides (in cases of heart failure, however, it should be borne in mind that with stenosis of the mitral valve, increasing heart function with cardiac glycosides can aggravate stagnation in the small circulation and intensify pulmonary edema)
Furosemide, mannitol; dobutamine, dopamine, digoxin; nitroglycerin, glucocorticoids, ethyl alcohol.
Furosemidum. 4-Chloro-M- (2-furylmethyl) -5-sulfamoylanthranilic acid.
Synonyms: Laxix, Furanthryl, Afsamid, Arasemide, Diusemide, Diuzol, Dryptal, Edefrusex, Errolon, Franyl, Frugex, Frusemide, Frusolon, Furanthril, Furantral, Furfan, Furomex, Furosan, Furosemide, Fusid, Katlex, Kinex, Lasilix, Lasix, Nicorol, Profemin, Protargen, Rasisemid, Renex, Salix, Seguril, Trofurit, Uritol, Urosemid and others.
According to the chemical structure (the presence of a chlorine atom and a sulfonamide group in the phenyl nucleus) has similarities with dichlorothiazide and related compounds.
Furosemide is a strong diuretic(saluretic) agent. Effective for oral and parenteral use. Diuretic effect is associated with inhibition of the reabsorption of N and Cl ions, and this depression is observed not only in the proximal but also in the distal convoluted tubules, and in the region of the ascending section of the Henle loop. Reabsorption of potassium is also inhibited, but to a much lesser degree. There is no noticeable inhibition of carbonic anhydrase. The drug is equally effective in acidosis and alkalosis. Diuretic effect is most pronounced during the first 2 days of taking the drug, but does not disappear even with prolonged treatment.
The drug acts quickly. After intravenous injection, the diuretic effect begins in a few minutes, after ingestion - during the first hour. The duration of action after a single intravenous injection is 1, 5 - 3 hours after ingestion - 4 hours or more. A rapid effect with intravenous administration makes it possible to use furosemide in urgent cases (pulmonary edema, brain, etc.).
Furosemide is used as a diuretic forstagnant phenomena in the small and large circle of blood circulation caused by heart failure, with cirrhosis of the liver with the phenomena of portal hypertension, chronic and acute renal failure, edema of the lungs and the brain, poisoning with barbiturates, eclampsia.
Unlike thiazides, furosemide does not reduce glomerular filtration, and it is used in this regard for chronic renal failure (in the presence of indications for the use of diuretics).
In some cases, furosemide has a diuretic effect with insufficient effectiveness of other drugs.
The effectiveness of furosemide in the treatment of patients withcirculatory insufficiency is associated not only with a diuretic effect, but also with a direct dilating effect on peripheral vessels. The first (early) phase that develops within the first 30 minutes after the injection of the drug depends on its effect on the peripheral vessels, and the second (late) phase, developing 1 to 2 hours after the injection, is associated with diuretic action.
Furosemide also has an antihypertensive effect.
The drug is effective in various formshypertension, including severe forms, in which other saluretics are ineffective. The mechanism of antihypertensive action is basically the same as with the use of thiazide diuretics.
Furosemide is also used for the relief of severe hypertensive crises.
For prolonged therapy of patients with hypertension, dichlorothiazide is recommended (due to its less dramatic and longer effect).
Furosemide can be used in combination with other antihypertensive drugs.
Assign furosemide inside before meals, intravenously and intramuscularly, choosing doses depending on the severity of the disease and the observed effect.
After reducing edema, give in smaller doses with a break of 1 - 2 days.
If the drug can not be administered orally(with a loss of consciousness, difficulty absorption from the intestine) and if necessary to obtain a rapid effect of furosemide administered intramuscularly or intravenously. Enter the vein slowly. After the onset of the desired effect, they switch to taking the drug inside.
When furosemide is used, nausea, diarrhea, skin hyperemia, itching, hypotension, reversible hearing impairment, interstitial nephritis are possible.
Due to increased diuresis, dizziness, depression, muscle weakness, thirst may occur. There may develop hypokalemia, hyperuricemia, uricosuria, hyperglycemia.
If there are side effects, the dose should be reduced or canceled.
It is inappropriate to combine furosemide with cephalosporins, gentamicin and other drugs that have a nephrotoxic effect. Treatment should be conducted against a background of a diet rich in potassium.
Contraindications: first half of pregnancy, hypokalemia, hepatic coma, terminal stage of kidney failure, mechanical obstruction of the urinary tract.
Is a six-atom alcohol; belongs to the group of sugars.
Synonyms: Mannitol, Aerosmosol, Diosmol, Isotol, Manicol, Manitol, Mannidex, Mannigen, Mannistol, Mannitol, Mannyl, Osmitrol, Osmosal, Rectisol, Renitol.
For medical use, mannitol is injected for injections (Mannitum pro injectionibus).
Hypertensive solutions of mannitolstrong diuretic effect. The effect is due to an increase in the osmotic pressure of the plasma and a decrease in the reabsorption of water. Diuretic effect is characterized by the release of a large amount of free water, which distinguishes mannitol from other osmotic diuretics, in particular urea. The drug does not affect glomerular filtration. Diuresis is accompanied by a significant release of sodium without a significant effect on the release of potassium. The effect is higher the more the concentration of the drug. If there is a violation of the filtration function of the kidneys, the diuretic effect may be absent.
Apply mannitol in the form of 10 - 15 - 20% solutionfor lowering intracranial pressure and reducing cerebral edema, with acute renal or renal-hepatic insufficiency with preserved filtration ability of the kidneys and in other conditions requiring enhanced diuresis. In acute congestive glaucoma, mannitol may be used for dehydration (see Urea).
In connection with dehydrating action and a decrease in intracranial pressure, it is also prescribed for intensive therapy of convulsive status.
Mannitol is also recommended for use inoperations with artificial circulation in order to prevent kidney ischemia and associated acute renal failure. The drug provides increased fluid excretion after perfusion, lowers the resistance of renal vessels and intensifies the blood flow in them, promotes excretion of nephrotoxins. The drug is also effective in barbiturate poisoning.
Enter mannitol intravenously (struino slowly or drip). Mannitol is dissolved in sterile water for injection or in a 5% solution of glucose. Solutions should be colorless, transparent, odorless.
In operations with artificial (extracorporeal) circulation, 20-40 g of mannitol are injected directly into the apparatus immediately before the onset of perfusion.
Contraindications: violations of excretory function of the kidneys and severe circulatory failure. With excessive administration of mannitol, signs of dehydration may appear (dyspeptic phenomena, hallucinations, etc.). To avoid dehydration, it is necessary to introduce a liquid into the body (see Urea). Mannitol must be reintroduced under the control of the water-salt balance.
The drug is ineffective in azotemia in patients with cirrhosis and ascites.
Dobutaminum. (#) (4- [2-para-Oxyphenyl) -1-methylpropyl] -3,4-dioxyphenylethylamine (hydrochloride).
Synonyms: Dobuject, Dobuject, Dobutaminе, Dobutrex, Inotrex.
By chemical structure is catecholamine andis closest to dopamine (see), from which it is distinguished by the fact that one hydrogen atom of the amino group is substituted in it by a para-hydroxyphenylmethylpropyl radical.
Dobutamin is representative of the electionstimulators b 1 -adrenoreceptors of the myocardium and in this connection has a strong inotropic effect on the cardiac muscle. It acts directly on the receptors and differs from dopamine, which has an indirect effect (by displacing norepinephrine from granular depots). Dobutamine almost does not affect the adrenoreceptors of blood vessels. It has little effect on the automatism of the ventricles, has a weak chronotropic effect, and therefore, when it is used less (in comparison with other catecholamines), the risk of arrhythmias.
Unlike dopamine, dobutamine does not causeexpansion of the blood vessels of the kidneys, but in connection with increased cardiac output, it can improve renal perfusion and increase diuresis in patients with heart disease. In connection with the inotropic effect, coronary blood flow increases. Peripheral vascular resistance decreases somewhat.
Apply dobutamine as a cardiotonicif necessary short-term increase in myocardial contraction: in decompensation of cardiac activity associated with organic heart diseases or with surgical interventions on the heart. Apply the drug only in adults (due to the lack of sufficient experience in children).
The drug is diluted in sterile water for injectionor in a 5% solution of glucose. Do not mix a solution of dobutamine with alkali solutions). The speed and duration of administration are adjusted depending on the effect.
When using the drug tachycardia is possible,increased blood pressure, ectopic ventricular arrhythmias, as well as nausea, headache, pain in the heart. These phenomena occur with a decrease in the rate of administration.
The drug is contraindicated in idiopathic hypertrophic subaortic stenosis.
The original domestic "hybrid" (b + a) -adrenoblocker.
Has antihypertensive and antianginal action. Effectively reduces intraocular pressure in glaucoma.
For prolonged antihypertensive and antianginal therapy, they are prescribed inside.
When open-angle glaucoma is used in the form of 1% or 2% solution. Perhaps a combination with other anti-glaucomatous drugs.
Contraindications - see Labetalol.
Glycoside contained in the leaves of Digitalis lanata Ehrh.
Synonyms: C edoxin, Cordioxyl, Digolan, Digoxin, Dilanacin, Dixina, Lanacordin, Lanacrist, Lanicor, Lanoral, Lanoxin, Natidigoxine, Oxydigi toxin and others.
By action on the blood circulation is close to other cardiac glycosides.
Has high cardiotonic activity: 1 g of the preparation contains 4000 (3277 - 4347) CUD or 1950 - 2600 GED. Has a strong systolic effect, relatively slows down the heart rhythm. Has a relatively pronounced diuretic effect. Compared to digi toxin, it is quickly excreted from the body and less able to accumulate in the body. Digoxin is less than digitoxin and other glycosides of the capping cap, binds to serum proteins and approaches in this regard to strophanthin.
Digoxin is well absorbed when ingested. Cardiotonic effect usually occurs within 1 to 2 hours and reaches a maximum within 8 hours.
When administered to a vein, the effect is observed after 20 - 30 minutes and reaches a maximum after 3 hours.
Applied for chronic circulatory failure I - IIA and
IIB degree, as well as with tachyarrhythmic form of atrial fibrillation, paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia.
Assign digoxin inside or intravenously (struino or drip).
Rapid absorption and high activity givethe possibility of obtaining the necessary therapeutic effect when taking the drug inside. Intravenous injections are used for severe circulatory disorders.
ECG, respiration, diuresis. Depending on the effect, repeat the previous dose or gradually reduce it. The patient should be under close medical supervision.
After reaching the necessary therapeuticthe effect is transferred to treatment with maintenance doses of digoxin. Usually within 1 - 1, 5 weeks (sometimes earlier) it is possible to select the supporting dose of glycoside necessary for the patient for long-term use.
Doses for children are selected strictly individually; tentatively for "saturation" is used.
In case of an overdose, cardiac conduction slowdown, bigeminy, nausea, vomiting, loss of appetite and other side effects observed during an overdose of other cardiac glycosides are possible.
The use of digoxin requires caution whenacute coronary insufficiency, especially with acute myocardial infarction with ventricular extrasystole, as well as with active myocarditis and severe bradycardia.
Digoxin is contraindicated in cardiac blockades and intoxication with previously used digitalis preparations.
In patients with renal insufficiency, the dose is reduced (approximately 2-fold).
The introduction of strophanthin is allowed if necessary not earlier than 24 hours after the abolition of digoxin.
Chemically, nitroglycerin is glycerol trinitrate.
Synonyms: Angibid, Anginine [parmidina one of the synonyms (cm.)], Angiolingual, Angised, Angorin, Glyceryl trinitrate, Myoglycerin, Nitrangin, Nitrocardiol, Nitroglycerol, Nitroglyn, Nitromint, Nitrostat, Nitrozell, Trinitrin, Trinitroglycerol, Trinitrol et al.
For use in medical practice, nitroglycerin is available as ready-made dosage forms.
These dosage forms are used primarily for the relief of acute attacks of angina pectoris. To prevent attacks, mainly prescribed drugs of prolonged action (see below).
For intravenous administration, a special dosage form of nitroglycerin is produced.
Nitroglycerin is easily absorbed by the mucous membranes and skin, but badly from the gastrointestinal tract, so it is much more effective in sublingual administration.
With sublingual administration (in the form of a solution,tablets or capsules), nitroglycerin rapidly penetrates into the blood. The effect occurs after 1 - 2 minutes and lasts 20 - 30 minutes. When applied to mucous membranes in the composition of polymer films, nitroglycerin is absorbed more slowly, but it lasts longer. Even more slowly, nitroglycerin is absorbed and prolonged when administered in the form of special dosage forms (see Nitrogranulong, Sustak, etc.). With intravenous administration, the effect develops rapidly.
Depending on the dosage form and method of administration, nitroglycerin and its ready-made dosage forms are prescribed for arresting or preventing angina attacks.
Apply nitroglycerin also with left ventricular failure, including with myocardial infarction, sometimes - with embolism of the central artery of the retina.
Along with a decrease in the resistance of coronary andperipheral vessels, nitroglycerin reduces the venous return of blood to the heart, promotes redistribution of blood flow in the myocardium in favor of the focus of ischemia and decreases in myocardial infarction of foci of ischemic lesion, enhances the inotropic function of the myocardium. Like other organic nitrates, nitroglycerin improves metabolic processes in the myocardium, reduces the need for myocardium in oxygen.
Currently 1% (alcohol) solutionnitroglycerin for sublingual use is rarely used. More commonly used tablets or capsules. When applying 1% solution, apply 1 to 2 drops under the tongue or damp a small piece of sugar 2 to 3 drops and keep it in the mouth (under the tongue), not swallowing, until it is completely absorbed.
Tablets (1/2 - 1 tablet) are placed under the tongue and do not swallow (keep in the mouth also until full absorption).
The capsules are also kept under the tongue until they are fully resorbed, but to accelerate the effect, you can crush the capsule with your teeth.
Frequency and duration of application of drops,tablets and capsules depend on the frequency, intensity of angina attacks, efficacy and tolerability. Usually, after the relief of attacks, they switch to taking long-acting drugs. With sparse spasms, nitroglycerin is sometimes prescribed (1 - 2% alcohol solution) inward in a mixture with menthol or Validol, tincture of lily of the valley, belladonna (see "Drops of Votchal").
In the practice of emergency and first aid (withmyocardial infarction, acute heart failure) is prescribed nitroglycerin intravenously. Prior to intravenous administration, 1 to 2 tablets are given sublingually every 5 to 10 minutes.
When nitroglycerin (and other nitrates) is used,in different dosage forms, it should be taken into account that continuous, long-term administration leads to the development of tolerance, when an increase in the dose, and sometimes the frequency of receptions, is required to achieve the previous antianginal and hemodynamic effect.
The development of tolerance to organic nitrates is associated, apparently, with a gradual decrease in cGMP activity and a decrease in NO formation (see earlier).
As patients usually have tolong-term use of nitrates, it is necessary to constantly monitor the effectiveness of therapy, carefully adjust the dose, if necessary increase them, temporarily (for several days) to cancel the intake of these drugs and replace them with antianginal drugs of other groups.
When using nitroglycerin preparations oftenthere is a transient headache, dizziness, a decrease in blood pressure (especially with an upright position), and with an overdose, an orthostatic collapse.
Contraindications: cerebral hemorrhage, increased intracranial pressure, pronounced hypotension, and a closed-angle glaucoma with high intraocular pressure. With open-angle glaucoma, nitroglycerin is not
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