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►All anti-inflammatory drugs are divided into 2 groups: (a) Nonsteroid anti-inflammatory) drugs ; (b) Steroid anti-inflammatory drugs Nonsteroid anti-inflammatory drugs are classified according to chemical structure and anti-inflammatory activity.I group – preparations with strong anti-inflammatory activity A. Nonselective inhibitors of cyclooxygenase (COX) I. Acid derivatives 1) Derivatives of salicylic (ortho-oxybenzoic) acid Acetylsalicylic acid (Aspirin) Lysine acetylsalicylate Sodium salicilate Methyl salicylate 2) Pyrazolone derivatives Phenylbutazone 3) Derivatives of indole-acetic acid Indomethacin Sulindac Derivatives of phenylacetic acid Diclofenac Sodium (Voltaren) Derivatives of propionic acid Ibuprofen Ketoptofen Naproxen Derivatives of anthranylic acid Mefenamic acid Oxicam derivatives Piroxicam Tenoxicam Lornoxicam II. Non-acidic derivatives B. Preferential inhibitors of COX2 Meloxicam Nimesulide Nabumetone C. Selective inhibitors of COX2 Celecoxib Rofecoxib
II group – preparations with poor anti-inflammatory activity Pyrazolone derivative Metamizol Paraaminophenol derivatives Paracetamol (Acetaminophen) Preparations of other chemical structure- Ketorolac
► Antihistaminic drugs – blockers of H1-histaminic receptors: Drugs of the first generation (”old”): Diphenhydramine (Dimedrol) Promethazine (Diprazine, Pipolphen) Chloropyramine (Suprastin) Clemastine (Tavegyl) Phencarol Mebhydroline (Diazoline) Antihistamines of the second generation: Loratadine (Claritine, Clarotadin) Acrivastine (Semprex) Azelastine Cetirizine (Zyrtec) Ebastine (Kestine) Desloratadine (Aerius) Fexofenadine (Telfast) Inhibitors of mast cell and basophile degranulation: for internal use – Ketotifen for inhalation: Cromoglicic acid (Intal) Nedocromil (Tilade) combined drugs (cromoglicic acid +fenoterol = Ditec) for local use: Cromoglicic acid (Ifiral) Cromohexal Others drugs with antiallergic action: glucocorticoids antileukotriene drugs: - lipoxygenase blockers: zileuton - blockers of leukotriene receptors: zafirlukast, montelukast
►Classification of analgesics,I. Narcotic analgesicsII. Non-narcotic analgesics1. Narcotic analgesics containing alkaloids of opium. Among these are Morphine and Codeine.
1. Synthetic narcotic analgesics. • Trimeperidine (Promedol) • Fentanyl • Piritramide• Pentazocine• Tramadol• ButorphanolClassification of narcotic analgesics according to their
action on different types of opioid receptors.
A. Full agonists of opioid receptors. They stimulate all types of opioid receptors. Among these are Morphine, Trimeperidine, Fentanyl.
B. Partial agonists of opioid receptors. The drugs are also called agonists-antagonists because they stimulate some types of opioid receptors and block others. Among these are:
• Pentazocine• Butorphanol• Nalbuphine• Buprenorphine• PiritramideC. Narcotic analgesics with a mixed mechanism of action.
For example,Tramadol.
2.Non-narcotic analgesics of different chemical groups.
The main non-narcotic analgesics are nonsteroidal anti-inflammatory drugs (NSAID).
1. Pyrazolone derivatives: Metamizole sodium2. Paraaminophenol derivatives: Paracetamol3. Heteroaryl-acetic acid derivatives: Ketorolac4. Drugs with a high anti-inflammatory activity can be
recommended for the treatment of pain syndrome caused by inflammation of peripheral tissues. Among these are Diclofenac, Indometacin, Acetylsalicylic acid and Meloxicam.
►AGENTS ACTING ON FUNCTIONS OF DIGESTIVE APPARATUS
I. Agents influencing an appetitea) stimulants of an appetite (bitter stuffs)b) preparations inhibiting an appetite (anorectics)
• Phepranone• Sibutramine
II. Agents regulating motor (motional) function of GIT1. Emetics
a) emetic drugs of direct action• Apomorphine
b) emetic drugs of reflex action• preparations of Thermopsis
2. Antiemetics a) blockers of dopamine receptors of trigger zone of vomiting centre
They more influence on artery tone then on myocardium.
2) Benzothiazepine derivatives• DiltiazemEqual influence both artery and myocardium.
3) Phenylalkylamine derivatives
• VerapamilInfluence on myocardium is greater then on arteries. So it is used
in arrhythmia and coronary heart disease.
According to generation
Generation 1(short term action)
• Nifedipine• Nicardipine• Diltiazem• Verapamil
Generation 2(prolonged forms of preparations of generation I, retard-forms or new compounds with long time of action)
• Isradipine• Nimodipine
Generation III
• Amlodipine • Lacidipine
Antihypotensive drugs.
Hypotension (low blood pressure) can be acute and chronic. Acute hypotension is observed in collapse, shock and faint. Chronic hypotension is characterized by permanent low arterial blood pressure. For the treatment of hypotension depending on its cause the following groups of preparations are used.
1. Vasoconstrictive agents:
a) Agonists of angiotensin II
• Angiotensinamide (synthetic analogue of endogenous angiotensinamide).
It is manufactured in the form of powder in vials. It is dissolved ex tempore and administered intravenously. Angiotensinamide has short-time but vigourous action.
b) Adrenoceptor agonists (mainly α- adrenoceptor agonists)
4. General tonic (general stimulants) – they increase a tone of CNS.
• Ginseng• Aralia• Devil's-club• SchizandraTinctures from the plants are used in chronic hypotension conditions.
5. If hypotension is due to loss of blood then preparations increasing volume of blood circulation - plasma-substituting solutions, colloid solutions, crystalloid solutions (salt solutions).
Classification of antiarrhythmic drugs, their groups and preparations.
I. Drugs blocking ion channels of cardiac hystiocytes (conducting system of heart and contractile myocardium)
1. Drugs blocking sodium channels (membrane stabilizers; group IA)
Subgroup IA (quinidine and quinidine like drugs):
Quinidine sulfate Disopyramide
Procainamide Ajmaline
Subgroup IB:
Lidocain Phenytoin
Subgroup IC:
Flecainide Propafenone Ethmosine Ethacizine
2. Drugs blocking L-type of calcium channels (group IV)
Verapamil Diltiazem
3. Drugs blocking potassium channels (drugs increasing repolarization duration and action potential; group III)
Amiodaron (Cordaron) Ornid Sotalol
II. Drugs mainly influencing on receptors of heart efferent innervation
Drugs weakening adrenergic influences:
β- adrenergic blockers
Anaprilin and etc.
Drugs increasing adrenergic influences:
β- adrenergic agonists
Isoprenaline
sympathomimetics
Ephedrine
Drugs weakening cholinergic influences:
muscarinic receptor blocker
Atropine sulfate
III. Different drugs having antiarrhythmic activity
Potassium and magnesium drugs Cardiac glycosides Adenosine
Antiarrhythmic drugs are also classified into following groups:
A.Drugs used in tachyarrhythmia and extrasystoles• Drugs blocking sodium channels• Drugs blocking calcium channels• Drugs blocking potassium channels• β- adrenergic blockers• Cardiac glycosides (digitalis drugs)• Adenosine• Potassium and magnesium drugs B.Drugs used in bradyarrhythmia and conduction
1. Aminoglycosides of the 1st generation: Streptomycin, Kanamycin, Neomycin
2. Aminoglycosides of the 2nd generation: Gentamycin, Tobramycin, Netilmicin
3. Aminoglycosides of the 3rd generation: Amikacin
►Quinolones and fluoroquinolones:
1. Drugs of the 1st generation: non-fluorinated quinolones
Nalidixic acid Oxolinic acid Pipemidic acid
2. Drugs of the 2nd generation: Ciprofloxacin Norfloxacin Ofloxacin Pefloxacin Lomefloxacin (2 F)
3. Drugs of the 3rd generation: Levofloxacin Sparfloxacin Temafloxacin (3F) Enoxacin Tosufloxacin Fleroxacin Rufloxacin
4. Drugs of the 4th generation: Moxifloxacin Clinafloxacin Gatifloxacin Trovafloxacin (3F)
1. Classification of antituberculous drugs (groups and medicines).
According to their chemical structure antituberculous drugs can be divided into:
I. Antituberculous antibiotics: Rifampicin Rifabutin Capreomycin Cycloserine Streptomycin Kanamycin
AmikacinII. Hydrazides of isonicotinic acid: Isoniazid Metazide Opiniazide FtivazideIII. Derivatives of para-aminosalicylic acid: Para-aminosalicylic acidIV. Synthetic drugs with other chemical structure: Pyrazinamide Ethionamide Ethambutol ThiacetazoneV. Fluoroquinolones: Lomefloxacin Ciprofloxacin OfloxacinVI Macrolides :
Clarithromycin Azithromycin
According to their clinical utility antituberculous drugs can be divided into:
I. Drugs of first line: These drugs have high antitubercular efficacy as well as low toxicity; are used routinely
Streptomycin Rifampicin Isoniazid Ethambutol PyrazinamideII. Drugs of second line: These drugs have either low antitubercular efficacy or high toxicity or both; are used in special circumstances only.
Capreomycin Cycloserine Kanamycin Amikacin
Para-aminosalicylic acid Lomefloxacin
Classification of antifungal drugs:
According to their chemical structure drugs are divided into following groups:
Derivatives of purine alkaloids (caffeine, theobromine) increase cerebral blood flow. From this drug group Pentoxyphylline (Agapurin, Trental) is used now for stroke treatment. It takes moderate vasodilating action, decreases platelet aggregation, increases erythrocyte membrane elasticity and improves microcirculation. The vasodilating effect is due to the adenosine receptor block. Besides the drug inhibits phosphodiesterase and increases the cyclic adenosine monophosphate contents in platelets. Pentoxyphylline is also used in peripheral circulation disorders, diabetic angiopathy, eye blood flow disorders. Adverse effects include dyspepsia, dizziness, redness.
Classification of drugs influencing tone and contractions of myometrium
A. AGENTS INCREASING STRENGTH AND FREQUENCY OF RHYTHMIC CONTRACTION OF UTERUS (DELIVERY STIMULATING)