PSYCHOTROPIC DRUGS Lector prof. Posokhova K.A.. PSYCHOTROPIC DRUGS Drugs with depressive type of action 1. Neuroleptics (antipsychotics) 2. Tranquilizers.
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PSYCHOTROPIC DRUGSPSYCHOTROPIC DRUGS
Lector prof. Posokhova K.A.Lector prof. Posokhova K.A.
PSYCHOTROPIC DRUGSPSYCHOTROPIC DRUGSDrugs with Drugs with depressivedepressive type of actiontype of action
1.1. Neuroleptics Neuroleptics ((antipsychoticsantipsychotics))2.2. Tranquilizers Tranquilizers ((anxiolyticsanxiolytics))3.3. Sedative drugsSedative drugs4.4. Normotymics Normotymics ((tymolepticstymoleptics, , tymoanalepticstymoanaleptics))
Drug withDrug with stimulativestimulative actionaction1.1. Antidepressants Antidepressants 2.2. Psychomotor stimulantsPsychomotor stimulants3.3. Nootropic drugsNootropic drugs4.4. Drugs which increase general tone Drugs which increase general tone ((adaptogensadaptogens))
PsychotomimeticsPsychotomimetics ((psychodyslepticspsychodysleptics))1.1. LSD LSD 2.2. Cannabis sativa L.Cannabis sativa L.
NEUROLEPTICSNEUROLEPTICSDerivatives of Derivatives of phenotiazinephenotiazine:: aminasineaminasine, , triftiazinetriftiazine, , etaperasine, tioridazineetaperasine, tioridazine
Derivatives of Derivatives of tioxantentioxanten: : chlorprotixenchlorprotixen
Derivatives of Derivatives of butyrophenonbutyrophenon: : galoperidolgaloperidol, , droperidoldroperidol
Derivatives of Derivatives of piperasine-piperasine-dibenzodiazepinedibenzodiazepine: : clozapineclozapine
Derivatives of Derivatives of indoleindole: : reserpin, sulpyrid reserpin, sulpyrid (eglonil)(eglonil)
NEUROPLEPTICSNEUROPLEPTICS““TypicalTypical”” – – derivatives of phenotiazine, derivatives of phenotiazine,
tioxanten, butyrophenon – they cause tioxanten, butyrophenon – they cause disorders of extrapyramidal system disorders of extrapyramidal system functionfunction – – syndrome of syndrome of parkinsonismparkinsonism
“ “AtypicalAtypical”” – – derivatives of indole, derivatives of indole, benzodiazepinebenzodiazepine – – they cause those they cause those negative reactions very rarelynegative reactions very rarely
Aminasine (chlorpromasine)Aminasine (chlorpromasine)
1951 – 1951 – aminasine was introduced into aminasine was introduced into clinical practiceclinical practiceIt brought considerable changes into It brought considerable changes into situations of psychiatric clinicssituations of psychiatric clinicsBefore appearance of aminasine for Before appearance of aminasine for treatment of psychologically sick patients treatment of psychologically sick patients insulin or electric shock were widely usedinsulin or electric shock were widely used, , in in some casessome cases - - lobotomylobotomy
Mechanism of action of Mechanism of action of neurolepticsneuroleptics
Influence on Influence on dopamine dopamine ((DD22),), noradrenergicnoradrenergic, , serotoninergicserotoninergic, , GABAGABA--
ergicergic, , cholinergiccholinergic receptorsreceptors
Properties of neurolepticsProperties of neuroleptics
Antipsychotic actionAntipsychotic action - - they eliminate they eliminate productive symptoms of psychosisproductive symptoms of psychosis ((delirium and hallucinationsdelirium and hallucinations), ), affective affective disordersdisorders
They eliminate psychomotor excitationThey eliminate psychomotor excitation with condition of consciousness with condition of consciousness
Administration of antipsychotic Administration of antipsychotic action of action of neurolepticsneuroleptics
Treatment of psychosisTreatment of psychosisSchizophreniaSchizophrenia
Maniac-depressive psychosisManiac-depressive psychosis
Alcohol psychosisAlcohol psychosis
Reactive psychosisReactive psychosis
In a case of psychomotor excitationIn a case of psychomotor excitationof various etiologyof various etiology
Delirium tremens Delirium tremens – – alcohol psychosisalcohol psychosis
Influence of neuroleptics on Influence of neuroleptics on psychical activitypsychical activity
1. 1. Drugs with Drugs with psychosedative actionpsychosedative action – – they they cause condition of psychomotor indifference cause condition of psychomotor indifference ((apathy, apathy, decreasing of moving activitydecreasing of moving activity,, retarded emotions and retarded emotions and wishes, disappearance of initiativewishes, disappearance of initiative) )
Aminazine, clozapineAminazine, clozapine ( (leponexleponex), ), chlorprotyxenchlorprotyxen, , haloperidolhaloperidol, , droperidoldroperidol
Peculiarities of usagePeculiarities of usage: : psychosis with manifestations psychosis with manifestations of excitationof excitation
ContraindicationsContraindications: : psychosis with retardness, inertia, psychosis with retardness, inertia, depression, stupor, apatho-abulic syndromedepression, stupor, apatho-abulic syndrome
Neuroleptics withNeuroleptics with psychosedative actionpsychosedative action
Influence of neuroleptics on Influence of neuroleptics on psychical activitypsychical activity
2. 2. Drugs which stimulate psychical Drugs which stimulate psychical activityactivity ((increase mimics and livelinessincrease mimics and liveliness, , increase increase moving activity, improve the moodmoving activity, improve the mood))
Triftazin, ethaperazin, moditen, majeptilTriftazin, ethaperazin, moditen, majeptil Peculiarities of usagePeculiarities of usage: : psychosis with psychomotor retardnesspsychosis with psychomotor retardness, ,
apatho-abulic conditionsapatho-abulic conditions, , stupor conditionsstupor conditions ContraindicationsContraindications:: affective disturbancesaffective disturbances, ,
mania, psychomotor excitation mania, psychomotor excitation
Other properties and indications Other properties and indications for administration of neurolepticsfor administration of neuroleptics
Drugs with psychosedative actionDrugs with psychosedative action – – forfor potentiationpotentiation of of actionaction of soporifics, opioid and nonopioid analgesics, drugs of soporifics, opioid and nonopioid analgesics, drugs for general anesthesia, local anestheticsfor general anesthesia, local anesthetics,, for example, for example, neuroleptanalgesianeuroleptanalgesiaAnti-emetic actionAnti-emetic action ( (elimination of elimination of vomiting of central vomiting of central originorigin): ): brain tumors, radial and chemical therapy, intestinal brain tumors, radial and chemical therapy, intestinal impassability, intoxication with heart glycosides, impassability, intoxication with heart glycosides, apomorphine and other drugsapomorphine and other drugsDecreasing ofDecreasing of body temperaturebody temperature (only in the case of (only in the case of simultaneous hypothermia)simultaneous hypothermia)Decreasing of Decreasing of blood pressureblood pressure ((alpha-adrenoblocking alpha-adrenoblocking propertiesproperties – – aminasine, droperidolaminasine, droperidol) – ) – in case of hypertensive in case of hypertensive crisis, lungs edemacrisis, lungs edema
Side effects of neurolepticsSide effects of neurolepticsExtrapyramidal disordersExtrapyramidal disorders:: muscular hypertonusmuscular hypertonus, , general constraint, tremor of hands, tongue, mandible, head, general constraint, tremor of hands, tongue, mandible, head, seizure contractions of muscles, vegetative crisisseizure contractions of muscles, vegetative crisis
For treatment For treatment – – cyclodolcyclodol (levodopa is contraindicated (levodopa is contraindicated because it diminishes therapeutic effect of neurolepticsbecause it diminishes therapeutic effect of neuroleptics))Orthostatic collapseOrthostatic collapseComplicated nose breathing, hypostatic, aspirate pneumoniaComplicated nose breathing, hypostatic, aspirate pneumoniaDyspeptic disordersDyspeptic disorders: : anorexia, changes of tasteanorexia, changes of tasteAbdominal painAbdominal painConstipationConstipationDamage of the liverDamage of the liver ( (cholestasis)cholestasis)Granulocytopenia Granulocytopenia ((especially clozapinespecially clozapin))Hyperglycemia, dysmenorrheaHyperglycemia, dysmenorrhea, , galactorrheagalactorrhea, , hyperthyrosis, hyperthyrosis, gynecomastia, impotencegynecomastia, impotenceAminasine has a considerable irritable actionAminasine has a considerable irritable action
syndrome of parkinsonismsyndrome of parkinsonism
TRANQUILIZERSTRANQUILIZERSAgonists of benzodiazepine receptorsAgonists of benzodiazepine receptors::
- - derivatives of benzodiazepinederivatives of benzodiazepine – – chlozepid, chlozepid, sybazon, phenazepam, gidazepamsybazon, phenazepam, gidazepam
Agonists of serotonine receptorsAgonists of serotonine receptors: : buspyronebuspyrone
Drugs with other mechanisms of actionDrugs with other mechanisms of action::
-- derivatives of diphenilmethanderivatives of diphenilmethan: : amisylamisyl
- - derivatives of propanediolederivatives of propanediole: : meprotanmeprotan
Properties of tranquilizersProperties of tranquilizers
Anxiolytic propertiesAnxiolytic properties – – eliminate feeling eliminate feeling of anxiety, restlessness, fear, of anxiety, restlessness, fear, aggressiveness, irritabilityaggressiveness, irritability, , cause peace, cause peace, careness, decreasing of moving activitycareness, decreasing of moving activity
Hypnotic Hypnotic ((somnolentsomnolent) ) actionaction
MyorelaxingMyorelaxing actionaction ( (of central genesisof central genesis))
AntiseizureAntiseizure actionaction
Duration of action of tranquilizersDuration of action of tranquilizers
Drugs of Drugs of long lastinglong lasting actionaction::
diazepamdiazepam, phenazepam, chlozepid, phenazepam, chlozepid
Drugs of Drugs of mediummedium action durationaction duration: :
lorazepam, alprazolamlorazepam, alprazolam
Drugs of Drugs of shortshort action durationaction duration: :
midazolammidazolam
““DAYDAY” ” TRANQUILIZERSTRANQUILIZERS
GidazepamGidazepam
MezapamMezapam ( (rudotelrudotel))
GrandaxynGrandaxyn ( (tophizopamtophizopam))
TrioxazynTrioxazyn
BuspyronBuspyron
Administration of tranquilizersAdministration of tranquilizers
Anxiolytic actionAnxiolytic actionTreatment of neurosis, accompanied by fear, Treatment of neurosis, accompanied by fear, anxiety, exertion, increased irritability, insomniaanxiety, exertion, increased irritability, insomnia
In case of headache and heart pain of neurotic In case of headache and heart pain of neurotic originorigin, , so called organic neurosisso called organic neurosis
In case of abstinence in alcohol and drugs addictsIn case of abstinence in alcohol and drugs addicts
In case of diencephalons crisisIn case of diencephalons crisis ( (sybazonsybazon))
Tranquilizers do not diminish productive Tranquilizers do not diminish productive symptoms of psychosissymptoms of psychosis!!
Usage of tranquilizersUsage of tranquilizers
HypnoticHypnotic actionaction – – they cause sleep, which they cause sleep, which is very close to physiological one is very close to physiological one according to its parametersaccording to its parameters
NitrazepamNitrazepam PhenazepamPhenazepam
DiazepamDiazepam ChlozepidChlozepid
Depression of CNSDepression of CNS – – forfor atharalgesiaatharalgesia
SybazonSybazon MidazolamMidazolam
Administration of tranquilizersAdministration of tranquilizers
Anti-seizure and myorelaxing actionAnti-seizure and myorelaxing action ((depression of CNS structures, braking polysynaptic depression of CNS structures, braking polysynaptic
spinal reflexesspinal reflexes) )
sybazonsybazon, , fenazepamfenazepamIn a case of seizures of any etiologyIn a case of seizures of any etiology (epileptic (epileptic status, tetanus, poisoning with seizure causing status, tetanus, poisoning with seizure causing poisons)poisons) sybazon is introduced intravenously sybazon is introduced intravenously (intramuscularly) – (intramuscularly) – 2-4 2-4 ml of ml of 0,5 % 0,5 % solution solution repeatedlyrepeatedly ( (maximal daily dosemaximal daily dose – 14 – 14 mlml))
To eliminate muscle tension in a case of radiculitis, To eliminate muscle tension in a case of radiculitis, arthritis, myositis, bursitisarthritis, myositis, bursitis
SeizuresSeizures(tetanus)(tetanus)
drug of a first choice drug of a first choice
- - SibazonSibazon
SIDE EFFECT OF TRANQUILIZERSSIDE EFFECT OF TRANQUILIZERSPsychological and physical addictionPsychological and physical addiction
ProphylaxisProphylaxis: :
1.1. Duration of treatment course should not be more than 2 monthsDuration of treatment course should not be more than 2 months
2.2. Repeated course Repeated course – – not earlier than after 3 weeks breaknot earlier than after 3 weeks break
Sleepiness, reeling walk, retarded reactionsSleepiness, reeling walk, retarded reactions tranquilizers should not be administered in ambulatories to people tranquilizers should not be administered in ambulatories to people
whose professions are connected with quick reactionswhose professions are connected with quick reactions
Paradox reaction of excitation, insomniaParadox reaction of excitation, insomnia
Dizziness, decreasing of libido, Dizziness, decreasing of libido, disturbances of menstrual cycle disturbances of menstrual cycle
Uncontrolled urination, defecation, ataxia, Uncontrolled urination, defecation, ataxia, dysartriadysartria
Acute poisoning in case of overdosingAcute poisoning in case of overdosing
FLUMAZENILFLUMAZENIL ( (ANEXATANEXAT)) ANTAGONIST OF TRANQUILIZERSANTAGONIST OF TRANQUILIZERS
Combination of tranquilizers Combination of tranquilizers with alcohol-containing with alcohol-containing
drinks is absolutely drinks is absolutely contraindicatedcontraindicated
(pathological alcohol intoxication)(pathological alcohol intoxication)
LITHIUM DRUGSLITHIUM DRUGS
LITHIUM CARBONATELITHIUM CARBONATE
INDICATIONS FOR ADMINISTRATION INDICATIONS FOR ADMINISTRATION OF LITHIUM DRUGSOF LITHIUM DRUGS
Prophylaxis and treatment of endogen Prophylaxis and treatment of endogen (affective) psychosis(affective) psychosis: : maniac-depressive, maniac-depressive, schizo-affective, organic affectiveschizo-affective, organic affective
Prophylaxis and treatment of affective Prophylaxis and treatment of affective disturbances in patients with epilepsydisturbances in patients with epilepsy,, chronic alcoholism, in psychopaths chronic alcoholism, in psychopaths
Method of lithium drugs Method of lithium drugs administration administration
It is administered orallyIt is administered orallyTreatment concentration of lithium in Treatment concentration of lithium in blood – blood – 0,6-0,8 0,6-0,8 mmolmmol//ll ( (not more thannot more than 1,5-1,6 1,5-1,6 mmolmmol//ll))The effect develops after few daysThe effect develops after few days – 5-6 – 5-6 monthsmonthsSmall width of therapeutic actionSmall width of therapeutic action ((treatment with lithium drugs needs the treatment with lithium drugs needs the same attentiveness from the doctor as same attentiveness from the doctor as treatment with insulintreatment with insulin))
Acute poisoning with lithium drugsAcute poisoning with lithium drugsIt develops if the concentration is overIt develops if the concentration is over 1,5-2 1,5-2 mmolmmol//ll
Development of constant nausea and tremor during Development of constant nausea and tremor during treatment with lithium treatment with lithium means that the dose should be means that the dose should be
decreaseddecreasedSYMPTOMS OF POISONINGSYMPTOMS OF POISONING
Nausea, vomiting, diarrheaNausea, vomiting, diarrheatremor, general muscular weaknesstremor, general muscular weakness, , twitching musclestwitching musclesNoise in the ears, unclear visionNoise in the ears, unclear vision, , somnolence, dysartriasomnolence, dysartria
Changes of handwritingChanges of handwriting: : massive, boldmassive, boldLocal neurological symptomsLocal neurological symptoms, , meningismmeningism
OliguriaOliguriaChanges in ECGChanges in ECG, , arrhythmiaarrhythmia, , decreasing of BPdecreasing of BP
Sopor, comaSopor, comaDeathDeath – – from hypostatic pneumoniafrom hypostatic pneumonia
Treatment of intoxication with lithium Treatment of intoxication with lithium drugsdrugs
A lot of drinking, 10% solution of sodium chloride A lot of drinking, 10% solution of sodium chloride (till 300 ml/day), 5(till 300 ml/day), 5% % solution of sodium solution of sodium hydrocarbonatehydrocarbonate ( (tilltill 300 300 mlml / / dayday)) intravenously intravenously
Mannit, ureaMannit, urea ( (saluretics are contraindicatedsaluretics are contraindicated!)!)
Pyracetam, vinpocetinPyracetam, vinpocetin
Prophylaxis of pneumoniaProphylaxis of pneumonia – – antibioticsantibiotics
Control of water-electrolyte balance, acid-base Control of water-electrolyte balance, acid-base balancebalance
Symptomatic therapy, for example, in case of Symptomatic therapy, for example, in case of seizures - sybazonseizures - sybazon
Haemodialysis if necessaryHaemodialysis if necessary
Prophylaxis of intoxication with Prophylaxis of intoxication with lithium drugslithium drugs
Salt in day ration should not be limitedSalt in day ration should not be limited
A lot of drinkingA lot of drinking
Do not indicate saluretics, sweat-Do not indicate saluretics, sweat-stimulating drugsstimulating drugs
Heavy physical work or other situations, Heavy physical work or other situations, accompanied by considerable sweating accompanied by considerable sweating should be avoidedshould be avoided
SEDATIVE DRUGSSEDATIVE DRUGS
BromidesBromides
Drugs of plant originDrugs of plant origin: : valerian, dog nettle, valerian, dog nettle, melissa, passiflora etc.melissa, passiflora etc.
They do not cause addiction, somnolence, They do not cause addiction, somnolence, myorelaxation, ataxiamyorelaxation, ataxia
ValerianaValeriana
PASSIFLORAPASSIFLORA
Leonurus L.Leonurus L. dog nettledog nettle
ADMINISTRATION OFADMINISTRATION OF
SEDATIVE DRUGSSEDATIVE DRUGS
NeurosisNeurosis
NeurastheniaNeurasthenia
Hysteria Hysteria
Increased irritabilityIncreased irritability
Insomnia Insomnia
Primary stages of essential hypertensionPrimary stages of essential hypertension
BromismBromism
Cause Cause – – accumulation of bromide ions in accumulation of bromide ions in organism in case of their prolonged organism in case of their prolonged administration as a result of material administration as a result of material accumulationaccumulation
SymptomsSymptoms: : rhinitisrhinitis, , cough, conjunctivitis, skin cough, conjunctivitis, skin rash, general weakness, memory disordersrash, general weakness, memory disorders
TreatmentTreatment: : sodium chloridesodium chloride (10-20 (10-20 gg / / dayday), ), a a lot of drinkinglot of drinking (3-5 (3-5 ll / / dayday), ), regular and regular and frequent cleaning of skin and digestive tractfrequent cleaning of skin and digestive tract
DRUGS FOR GENERAL DRUGS FOR GENERAL ANESTHESIAANESTHESIA
General anesthesia = Narcosis General anesthesia = Narcosis ((from the Greek from the Greek narkosis – narkosis – numbness numbness, , rigidityrigidity)) – –
Generalized reversible depression of the central nervous Generalized reversible depression of the central nervous system such that perception of all senses is ablated,system such that perception of all senses is ablated,condition which is characterized by loss of condition which is characterized by loss of consciousness, pain feelings, depression of reflexes and consciousness, pain feelings, depression of reflexes and relaxation of skeletal muscles and which is obtained by relaxation of skeletal muscles and which is obtained by administration of drugs for general anesthesiaadministration of drugs for general anesthesia
“Gentlemen, this is no humbug.” 1846 TG Morton: First public demonstration of ether administration
for excision of neck mass
Desirable Components of Desirable Components of AnesthesiaAnesthesia
1.1. Immobility in response to noxious stimulusImmobility in response to noxious stimulus
2.2. AmnesiaAmnesia
3.3. AnalgesiaAnalgesia
4.4. UnconsciousnessUnconsciousness
5.5. Muscle relaxationMuscle relaxation
6.6. Loss of autonomic reflexesLoss of autonomic reflexes
7.7. AnxiolysisAnxiolysis
Inhalational agentsInhalational agentsprimarily used for maintenanceprimarily used for maintenance
•Volatile agentsVolatile agentsIsofluraneIsofluraneSevofluraneSevofluraneDesfluraneDesfluraneHalothaneHalothane ( (FtorothaneFtorothane)) EnfluraneEnflurane
•Anesthetic gasesAnesthetic gasesNitrous Oxide Nitrous Oxide - currently used- currently used
CLASSIFICATION OF GENERAL CLASSIFICATION OF GENERAL ANESTHETICSANESTHETICS
Intravenous agentsIntravenous agentsprimarily used for inductionprimarily used for induction
•Barbiturates (Thiopental-Barbiturates (Thiopental-sodium)sodium)•Benzodiazepines (Benzodiazepines (Midasolam, Midasolam, diazepam)diazepam)•EtomidateEtomidate•KetamineKetamine•PropofolPropofol•PropanididPropanidid•Sodium oxybutyrateSodium oxybutyrate•PredionPredion
CLASSIFICATION OF GENERAL CLASSIFICATION OF GENERAL ANESTHETICSANESTHETICS
General General anesthesia can be anesthesia can be caused by a caused by a remarkable remarkable number of number of structurally structurally diverse moleculesdiverse molecules
Unitary HypothesisUnitary Hypothesis
Xe
Isoflurane
Halothane
......Cellular (synapses)Cellular (synapses)
MolecularMolecular(lipids & (lipids &
receptors)receptors)
Molecular Mechanism(s) of General Molecular Mechanism(s) of General AnesthesiaAnesthesia
A Working HypothesisA Working Hypothesis
Anesthetics Anesthetics enhance inhibitoryenhance inhibitory postsynaptic channel activity postsynaptic channel activity (GABA(GABAAA and glycine receptors) and glycine receptors)
Anesthetics Anesthetics inhibit excitatoryinhibit excitatory synaptic channel activity (nicotinic synaptic channel activity (nicotinic acetylcholine and glutamate acetylcholine and glutamate receptors)receptors)
Effects of General AnesthesiaEffects of General Anesthesia
Low Dose EffectsLow Dose Effects
•AmnesiaAmnesia
•EuphoriaEuphoria
•AnalgesiaAnalgesia
•HypnosisHypnosis
•ExcitationExcitation
•HyperreflexiaHyperreflexia
High Dose EffectsHigh Dose Effects
•Deep sedationDeep sedation
•Muscle relaxationMuscle relaxation
•Diminished motor responsesDiminished motor responses
•Diminished autonomic Diminished autonomic responsesresponses
•Myocardial protection from Myocardial protection from ischemiaischemia
•Cardiovascular/respiratory Cardiovascular/respiratory depressiondepression
•HypothermiaHypothermia
• MAC: MAC: mminimum inimum aalveolar lveolar cconcentration oncentration
• MAC is the concentration of MAC is the concentration of anesthetic that produces anesthetic that produces immobility in 50% of patients immobility in 50% of patients exposed to a noxious exposed to a noxious stimulus.stimulus.
• MACMACawakeawake: MAC at which response : MAC at which response to commands are lost to commands are lost
• amnesia, loss of awarenessamnesia, loss of awareness
• MACMACBARBAR: : bblunt lunt aautonomic utonomic rresponseesponse• MACMACintubationintubation: response to intubation: response to intubation
Measures of Anesthetic PotencyMeasures of Anesthetic Potency
Stages of narcosisStages of narcosis
І. І. Stage of analgesia Stage of analgesia Loss of pain feelings along with normal or Loss of pain feelings along with normal or
dimmed consciousnessdimmed consciousness
Duration Duration fromfrom the beginning of inhalation of the beginning of inhalation of
narcosis substance and till the moment of narcosis substance and till the moment of loss of patient’s consciousnessloss of patient’s consciousness
Sometimes during this stage small Sometimes during this stage small surgical interventions are performedsurgical interventions are performed ((opening of abscesses, teeth extraction, opening of abscesses, teeth extraction, taking of the stitches etc.taking of the stitches etc.))
ІІ. ІІ. Stage of excitation (no desirable!!! Stage of excitation (no desirable!!! dangerous)dangerous)
Duration Duration from the moment of loss of patient’s consciousness from the moment of loss of patient’s consciousness till the stage of surgical narcosistill the stage of surgical narcosis
Complications Complications language and motor excitement,language and motor excitement,increasing of secretor activity of salivary and bronchial increasing of secretor activity of salivary and bronchial glandsglands,,vomiting,vomiting, variation of arterial pressurevariation of arterial pressure,,changes of breathing frequencychanges of breathing frequency
Heavy complicationsHeavy complications
Laryngospasm, bronchospasm, respiratory arrest, Laryngospasm, bronchospasm, respiratory arrest, cardiac arrhythmias, cardiac arrestcardiac arrhythmias, cardiac arrest
ІІІ. ІІІ. Stage of surgical anesthesiaStage of surgical anesthesia11st levelst level
Skeletal muscles aren’t relaxedSkeletal muscles aren’t relaxed, , conjunctive and pharyngeal reflexes conjunctive and pharyngeal reflexes disappeardisappear ( (it is possible to perform intubationsit is possible to perform intubations))
22nd levelnd levelReaction of frequent breathing as a respond cut on the skin disappearReaction of frequent breathing as a respond cut on the skin disappear
((deep analgesiadeep analgesia),), laryngeal reflexes disappearlaryngeal reflexes disappear ( (it is possible to perform endotracheal it is possible to perform endotracheal
intubationintubation);); good miorelaxationgood miorelaxation
33rd levelrd levelDecreasing of blood pressureDecreasing of blood pressure,,
Full relaxation of musclesFull relaxation of muscles,, step by step intercostal muscles get turned off,step by step intercostal muscles get turned off,
Type of breathing changes into abdominalType of breathing changes into abdominal; ; Corneal and pupil reflexes disappearCorneal and pupil reflexes disappear
44thth level levelmuscular tone is lowmuscular tone is low,,
full paralysis of intercostal musclesfull paralysis of intercostal muscles;; decreasing of blood pressure;decreasing of blood pressure;
dilated pupil which don’t react on lightdilated pupil which don’t react on light
IV. IV. Agony stageAgony stage ( (occurs in a case of occurs in a case of overdosing of drugs for narcosisoverdosing of drugs for narcosis))
Characteristics Characteristics decreasing of breathing and vaso-motor decreasing of breathing and vaso-motor
centers of medulla oblongatacenters of medulla oblongata
Typical manifestationsTypical manifestationsfull paralysis of breathing muscles, full paralysis of breathing muscles,
respiratory arrest, collapse; cardiac arrestrespiratory arrest, collapse; cardiac arrest
Surgical interventions are Surgical interventions are performed on 1st and 2nd performed on 1st and 2nd
levels, approximately till half of levels, approximately till half of 3rd level of third stage of 3rd level of third stage of
narcosisnarcosis
Drugs for inhalative Drugs for inhalative narcosisnarcosis
Ether for narcosisEther for narcosisNarcosis develops afterNarcosis develops after 10-20 10-20 minmin, , stage of excitationstage of excitation - 10-20 - 10-20 minmin, , strongly expressed after-narcosis strongly expressed after-narcosis depressiondepression, , high width of narcotic action (broad high width of narcotic action (broad therapeutic window) therapeutic window)
Side effects and complicationsSide effects and complicationsbright stage of excitationbright stage of excitation
Increasing of tone of n. vagiIncreasing of tone of n. vagiIncreasing of secretion of salivary, bronchial glands, coughing; Increasing of secretion of salivary, bronchial glands, coughing; laryngospasm, bronschospasm, vomiting with the following laryngospasm, bronschospasm, vomiting with the following aspiration of the masses bradycardia, stop of heart beataspiration of the masses bradycardia, stop of heart beat
Increasing of tone of sympathetic nervous systemIncreasing of tone of sympathetic nervous systemTachycardia, hyperglycemiaTachycardia, hyperglycemia
Ftorothane Ftorothane ((halothanehalothane))Power of narcosis action of ftorothan is higher than of Power of narcosis action of ftorothan is higher than of ether, it has a large width of narcotic action, doesn’t ether, it has a large width of narcotic action, doesn’t irritate mucous membranes of breath tractsirritate mucous membranes of breath tracts, , doesn’t cause doesn’t cause laryngeal and bronchial spasm, speed of development of laryngeal and bronchial spasm, speed of development of narcosisnarcosis – 3-5 – 3-5 min., after narcosis depression is not min., after narcosis depression is not expressedexpressed
Side effects and complicationsSide effects and complications
hypotension and cardiac arresthypotension and cardiac arrest,, sensitizationsensitization ( (increased sensitivityincreased sensitivity) ) of myocardium of myocardium
towards catecholaminestowards catecholamines acute damage of liveracute damage of liver – – halothane hepatitishalothane hepatitis,, teratogenic actionteratogenic action
Nitrogenous oxideNitrogenous oxideSmall power and width of narcosis actionSmall power and width of narcosis action,, stage of excitation stage of excitation
is presentis present, , quick entry and exit from narcosisquick entry and exit from narcosis (1-2 (1-2 minmin))
Administration Administration as an as an analgesicanalgesic:: pregnancypregnancy,, teeth extractionteeth extraction,, bandaging in case of burnsbandaging in case of burns, , cleaning and revisions of woundscleaning and revisions of wounds,, iscemic heart attacks and iscemic heart attacks and myocardium infarctionmyocardium infarction,, colicscolics,, traumastraumas,, acute pancreatitisacute pancreatitis,, pain relief in post-operative periodpain relief in post-operative period
Induction SpeedInduction Speed
Anesthetic of the Future: Anesthetic of the Future: XenonXenon
•Rare gas extracted from airRare gas extracted from air
•Very expensive to produceVery expensive to produce
•Close to ideal anestheticClose to ideal anesthetic
•Low blood and tissue solubilityLow blood and tissue solubility
(rapid induction/recovery)(rapid induction/recovery)
•PotentPotent
•Not metabolizedNot metabolized
•NonflammableNonflammable
•Minimal side effectsMinimal side effects
Drugs for Drugs for noninhalative noninhalative
narcosisnarcosis
ThiopentalThiopental--sodiumsodiumAfter administration of the drug narcosis develops in After administration of the drug narcosis develops in 1-2 1-2 min.min., , awakening awakening occurs inoccurs in 20-30 20-30 minmin..
Administration Administration introduction narcosisintroduction narcosis,, basis narcosisbasis narcosis,, mononarcosis in case of short-lasting mononarcosis in case of short-lasting
operative interventions operative interventions ((dentistry, gynecologydentistry, gynecology,, traumatologytraumatology),),
anti-seizure druganti-seizure drug..
Side effectsSide effectscoughcough, , laryngeal and bronchial spasmlaryngeal and bronchial spasm
In case of rapid introductionIn case of rapid introduction – – depression of centers of medulla depression of centers of medulla oblongataoblongata
. . In case of contact of the drug with skin, it’s separation may occur, In case of contact of the drug with skin, it’s separation may occur, contact with nervous trunk or near it – irreversible paralysis, contact contact with nervous trunk or near it – irreversible paralysis, contact with an artery – thrombosis with the following gangrene of the with an artery – thrombosis with the following gangrene of the extremityextremity
Propanidid Propanidid ((sombrevinsombrevin))Narcosis develops afterNarcosis develops after 30-40 30-40 sec from the beginning of intravenous sec from the beginning of intravenous
introduction of the drugintroduction of the drug (“ (“on the edge of the needle”on the edge of the needle”). ). Stage of Stage of surgical narcosis lasts forsurgical narcosis lasts for 3-4 3-4 minmin
AdministrationAdministration for mononarcosis during short operative interventions in surgery, for mononarcosis during short operative interventions in surgery, dentistry, gynecology, urologydentistry, gynecology, urology,, painful diagnostic procedurespainful diagnostic procedures,, sometimes sometimes – – for introduction into narcosisfor introduction into narcosis
Side effects and complicationsSide effects and complications
Frequent breathing (tachypnoe) with the following stopping of Frequent breathing (tachypnoe) with the following stopping of breathingbreathing ( (apnoeapnoe),),phlebitis and thrombosis in the place of introductionphlebitis and thrombosis in the place of introductionanaphylactic reactionsanaphylactic reactions
Sodium oxybutyrateSodium oxybutyrate in case of intravenous introduction narcosis develops afterin case of intravenous introduction narcosis develops after 15-40 15-40 minmin. . id id administered orally sleep comes afteradministered orally sleep comes after 30-60 30-60 minmin. . duration of narcosis isduration of narcosis is 1,5-3 1,5-3 hourshours. . It manifestsIt manifests antihypoxia propertiesantihypoxia properties
Administration Administration mononarcosis – to perform long-lasting surgeries but with small traumatic mononarcosis – to perform long-lasting surgeries but with small traumatic
effecteffect premedicationpremedication,, introduction and basis narcosisintroduction and basis narcosis.. drug of choice for narcosis in case of intoxications, sepsisdrug of choice for narcosis in case of intoxications, sepsis,,
disturbance of functions of parenchymatous organsdisturbance of functions of parenchymatous organs,, analgesia during child-deliveryanalgesia during child-delivery. . to decrease psycho-motor excitation, seizures,to decrease psycho-motor excitation, seizures, insomniainsomnia
Side effectsSide effectsmotor excitationmotor excitationseizure twitching of extremities and tongueseizure twitching of extremities and tonguevomitingvomiting hypopotassiumemiahypopotassiumemia..
Ketamine hydrochlorideKetamine hydrochloride ( (ketalar, kalipsolketalar, kalipsol))
During intravenous introduction of the drug narcosis develops afterDuring intravenous introduction of the drug narcosis develops after 15- 15-3030secsec, , lasts forlasts for 8-10 8-10 minmin, , during intramuscular introduction – after during intramuscular introduction – after 2-3 2-3 minmin, , lasts forlasts for 20-30 20-30 minmin
Administration Administration introduction and basis narcosisintroduction and basis narcosis mononarcosis during surgeries which don’t need muscular relaxationmononarcosis during surgeries which don’t need muscular relaxation as a part of combined narcosisas a part of combined narcosis
Side effectsSide effects during coming out of narcosis – unpleasant dreamsduring coming out of narcosis – unpleasant dreams,, deliriumdelirium, , hallucinationhallucination,, seizures,seizures, nausea, vomiting,nausea, vomiting, increasing of blood pressureincreasing of blood pressure,, increasing of frequency and power of heart contractionsincreasing of frequency and power of heart contractions The drug is able to raise intracranial pressureThe drug is able to raise intracranial pressure,, oxygen consumption by brain and intraoccular pressureoxygen consumption by brain and intraoccular pressure
PROPOFOLPROPOFOL ( (DIPRIVANDIPRIVAN))drug with ultra-short actiondrug with ultra-short action
Narcosis develops afterNarcosis develops after 30-40 30-40 sec after intravenous introductionsec after intravenous introduction, , lasts forlasts for 3-5 3-5 minmin
Administration Administration Mononarcosis Mononarcosis
Polycomponent narcosisPolycomponent narcosis
Artificial ventilation of lungsArtificial ventilation of lungs
Positive Positive momentsmoments:: can’t be accumulated, doesn’t have after-can’t be accumulated, doesn’t have after-narcosis depressionnarcosis depression, , possesses anti-vomiting actionpossesses anti-vomiting action
Negative Negative momentsmoments:: doesn’t have analgesic actiondoesn’t have analgesic action
((it is often combined with fentanil, ketamineit is often combined with fentanil, ketamine),),
possible hypotension, short apnoepossible hypotension, short apnoe
Ethomidate Ethomidate ((hipnomidatehipnomidate))drug of ultra-short actiondrug of ultra-short action
During introduction into vein effect develops after 1 min and During introduction into vein effect develops after 1 min and lasts for lasts for 3-5 3-5 minmin
AdministrationAdministrationIntroduction narcosisIntroduction narcosisMononarcosis during short-lasting surgeriesMononarcosis during short-lasting surgeriesPerforming of diagnostic manipulationsPerforming of diagnostic manipulations
DisadvantagesDisadvantages: : doesn’t have analgesic activitydoesn’t have analgesic activity, , promotes vomiting, in case of long lasting promotes vomiting, in case of long lasting introduction depending on dose it depresses introduction depending on dose it depresses synthesis of hormones of adrenal cortexsynthesis of hormones of adrenal cortex
MononarcosisMononarcosis((simplesimple,, single-component single-component))
Polynarcosis Polynarcosis ((multi-multi-componentcomponent, , combinedcombined))
Induction narcosisInduction narcosis most frequently is achieved by most frequently is achieved by
intravenous introduction of intravenous introduction of noninhalative narcosis drugs which noninhalative narcosis drugs which
don’t cause excitation stagedon’t cause excitation stage::
ketamineketamine, , thiopental-sodium, thiopental-sodium, propofol (diprivan), propofol (diprivan),
ethomidate (hypnomidate)ethomidate (hypnomidate)
Basis - narcosisBasis - narcosis– – element of combined analgesiaelement of combined analgesia (most often it is an (most often it is an intravenous narcosisintravenous narcosis, , which acts during all the which acts during all the surgerysurgery))
Following drugs are usedFollowing drugs are used::
Sodium oxybutyrateSodium oxybutyrate
Tiopental-sodiumTiopental-sodium
KetamineKetamine
Potentiated narcosisPotentiated narcosis– – is a kind of general analgesia,during which for potentiation is a kind of general analgesia,during which for potentiation of action of main narcosis substance drugs which don’t have of action of main narcosis substance drugs which don’t have
narcosis activity but narcosis activity but depress CNS depress CNS are used are used ::
Neuroleptics Neuroleptics Tranquilizers Tranquilizers
Opioid analgesicsOpioid analgesicsAntihistamine drugsAntihistamine drugs
Scopolamine Scopolamine Myorelaxants Myorelaxants
NeuroleptanalgesiaNeuroleptanalgesia
– – method of general analgesia when narcolepticmethod of general analgesia when narcoleptic ((droperidoldroperidol) ) and narcotic analgesic (and narcotic analgesic (fentanylfentanyl)) are are
combinedcombined. . Combined drugCombined drug - - talamonaltalamonal
Advantages of neuroleptanalgesiaAdvantages of neuroleptanalgesia inconsiderable toxicityinconsiderable toxicity large therapeutical width,large therapeutical width, deep analgesiadeep analgesia,, anti-shock actionanti-shock action,, considerable anti-vomiting effectconsiderable anti-vomiting effect,, stability of hemodynamicsstability of hemodynamics,, quick developing of narcosisquick developing of narcosis,, quick coming out of narcosisquick coming out of narcosis
Ataralgesia Ataralgesia Combined administration of narcotic analgesic and Combined administration of narcotic analgesic and
tranquilizertranquilizer
((diazepam or midasolamdiazepam or midasolam))
AdvantagesAdvantagesTranquilizing actionTranquilizing action ( (until full turning off until full turning off
consciousness under the influence of midasolamconsciousness under the influence of midasolam),), anterograde amnesiaanterograde amnesia ( (the patient doesn’t remember the patient doesn’t remember
events which happened after introduction of the events which happened after introduction of the drugdrug),),
relaxation of the musclesrelaxation of the muscles,, anti-seizure effectanti-seizure effect,,
minimal influence on blood circulationminimal influence on blood circulation
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