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uchebno-metodicheskaya rekomendatsiya (keys – stadi) po klinicheskoy farmakologii antiaritmicheskix lekarstvennix sredstv

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ministerstvo zdravooxraneniyarespubliki uzbekistan tashkentskaya meditsinskaya akademiya kafedra klinicheskoy farmakologii keys-texnologiya po teme: «klinicheskaya farmakologiya antiaritmicheskix lekarstvennix sredstv» uchebno-metodicheskaya rekomendatsiya (keys – stadi) prednaznachena dlya prepodavateley i studentov 5- kursa meditsinskix vuzov tashkent – 2015 pedagogicheskaya annotatsiya uchebniypredmet: «klinicheskaya farmakologiya» tema: «klinicheskaya farmakologiya antiaritmicheskix lekarstvennix sredstv» tsel dannogo keysa:nauchit studentov znaniyam klinicheskoy farmakologii antiaritmicheskixpreparatov, obuchit studentov znaniyu osnovnix printsipov i umeneniyu individualnogo podbora s lekarstvennix sredstv s uchetom farmakodinamiki, farmakokinetiki, pobochnogo deystviya, a takje osobennostey deystviya i ot razlichnix faktorov. planiruemie uchebnie rezultati – po rezultatam raboti s keysom studenti priobretayut naviki: · sovremennaya klassifikatsiya antiaritmicheskix sredstv · mexanizm deystviya antiaritmicheskix sredstv · farmakodinamicheskie effektii farmakokineticheskie parametrirazlichnix grupp antiaritmicheskix sredstv · pokazaniya i protivopokazaniya k antiaritmicheskim sredstvam · rejim dozirovaniya preparatov · pobochnie effekti · naibolee znachimie vzaimodeystviya · kontrol effektivnosti i bezopasnosti antiaritmicheskiz sredstv · opredelenie problemi i ee reshenie; · primenenie teoreticheskix znaniy pri reshenii situatsionnix zadach; dlya uspeshnogo …
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ie klinicheskoy retsepturi. danniy keys otrajaet realnuyu situatsiyu v usloviyax pervichnogo zvena istochniki informatsii keysa 1. v.g. kukes. klinicheskaya farmakologiya. m., 2008. 2. yu.b. belousov. klinicheskaya farmakologiya i farmakoterapiya. m., 2003. 3. yu.m. mamadov. klinik farmakologiya. tashkent, 2006. 4. bertram kattsung. bazisnaya i klinicheskaya farmakologiya. m., 2001. xarakteristika keysa soglasno tipologicheskim priznakam danniy keys otnositsya k kategorii kabinetniy, syujetniy. on ob'emniy, strukturirovanniy. eto keys-vopros. po didakticheskim tselyam keys treningoviy, stimuliruyushiy mishlenie v realnoy situatsii v usloviyax svp i gvp. keys mojet bit ispolzovan po distsiplinam:klinicheskaya farmakologiya, terapiya. ikeys «klinicheskaya farmakologiya antiaritmicheskix lekarstvennix sredstv» vvedenieantiaritmicheskie preparati (aap) primenyayutsya dlya lecheniya ostrix aritmiy i profilaktiki narusheniy ritma. effektivnaya terapiya etix sostoyaniy vozmojno tolko pri pravilnom vibore preparata. pravilniy vibor osnovan na ponimanii mexanizma razvitiya aritmiy, znaniy elektrofiziologicheskix osobennostey i serdechnoy kletki, a takje klinicheskoy farmakologii antiaritmicheskix ls. v svyazi etim i na osnovanii samostoyatelnoy podgotovki studenti vmeste s prepodavatelem korotko povtoryayut mexanizm …
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icheski ne vliyayushie na skorost depolyarizatsii i ukorachivayushie repolyarizatsiyu (lidokain, meksilitin, tokainid). is – ls, zamedlyayushie skorost depolyarizatsii i prakticheski ne izmenyayushie repolyarizatsiyu (propafenon, flekainid, enkainid, moratsizin, etatsizin). · ii klass – beta-adrenoblokatori (propranolol, atenolol, metaprolol, nadolol, atsebutolol, karvedilol). · iii klass – preparati, preimushestvenno deystvuyushie na kalievie kanali i udlinyayushie repolyarizatsiyu (amiodaron, sotalol, bretiliya tozilat i butilid). · iv klass – blokatori medlennix kaltsievix kanalov (verapamil, diltiazem). klass i – membranostabiliziruyushie preparati obshie svoystva – sposobnost blokirovat natrievie kanali, chto privodit k snijeniyu skorosti depolyarizatsii. pri etom preparati ia klassa obladayut sposobnostyu k umerennoy blokade kalievix kanalov, chto soprovojdaetsya udlineniem repolyarizatsii. xinidin pri prieme vnutr vsasivaetsya na 80-90%, pisha zamedlyaet skorost vsasivaniya. pik kontsentratsii preparata v plazme krovi obnarujivaetsya cherez 2ch, kontsentratsiya v tkanyax serdtsa previshaet takovuyu v krovi v 4-10 raz. svyaz s belkami plazmi bolee 90%. do 70% xinidina metaboliziruetsya v pecheni, period poluvivedeniya 5-8ch. pronikaet cherez …
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r xorosho vsasivaetsya. neznachitelno (menee 40%) metaboliziruetsya v pecheni s obrazovaniem aktivnogo metabolita n-atsetilprokainamida so svoystvami antiaritmicheskogo deystviya tretego klassa. nemetabolizirovannaya chast preparata (60%), a takje metaboliti vivodyatsya pochkami. svyaz s belkami plazmi prakticheski neznachimaya. period poluvivedeniya 3-5ch. pri v/v vvedenii prokainamid nachinaet deystvovat nemedlenno i potomu ispolzuetsya dlya kupirovaniya ostrix narusheniy ritma (jeludochkovie aritmii, paroksizmi predserdiy). dizopiramid (ritmodan, norpeys) obladaet kak i xinidin xolinoliticheskimi svoystvami, no menee virajennimi chem u pervogo. tem ne menee pri ego naznachenii vozmojno uchashenie sinusovogo ritma i uluchshenie av-provodimosti. pri prieme vnutr vsasivaetsya na 80-90%, maksimalnaya kontsentratsiya v krovi otmechaetsya cherez 2-3ch. bolshaya chast preparata (okolo 60%), vivoditsya pochkami v neizmenennom vide, ostalnaya chast metaboliziruetsya v pecheni. preparati klassa iv preparati etoy gruppi blokiruyut bistrie natrievie kanali. iz-za osobennosti kinetiki svyazivanie preparata s ionnimi kanalami oni ne vizivayut zamedlenie depolyarizatsii v normalnoy tkani i pri normalnoy chastote ritma. lidokain pri prieme vnutr xorosho vsasivaetsya, …
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ie 3ch. pribegayut ix kombinirovannomu vvedeniyu preparata: snachala v/v vvodyat 80mg lidokaina i v/m 400mg, a zatem kajdie 3ch v/m po 400mg. preparati is klassa · v nashey respublike v osnovnom ispolzuetsya propafenon – visoko effektivnoe antiaritmicheskoe sredstvo s mestno anesteziruyushim i membranostabiliziruyushim deystviem. preparat chastichno blokiruet beta-adrenergicheskie retseptori i kaltsievie kanali, v rezultate chego sposoben prirost chss pri nagruzke. rejim dozirovaniya doza preparata podbiraetsya individualno pod nablyudeniem kardiologa, chastim kontrolem ekg i ad, osobenno pri v/v vvedenii. v/v vvodyat v doze 0,5-10mg/kg medlenno v techenii 3-6min. pri neobxodimosti dozu mojno povtorit cherez 90-120min, obshaya sutochnaya doza 560mg. klass ii – beta-adrenoblokatori preparati etoy gruppi umenshayut avtomatizm predserdiy i jeludochkov, snijayut naklon krivoy v faze 0 transmembrannogo potentsiala, zamedlyayut predserdno-jeludochkovuyu provodimost, snijayut sokratimost miokarda, a sledovatelno i ad i potrebnost miokarda v kislorode. ustranyayut i predotvrashayut ishemiyu (vajniy faktor induktsii aritmii). v otlichie ot «klassicheskix aap» babl ne indutsiruyut razvitie …

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ministerstvo zdravooxraneniyarespubliki uzbekistan tashkentskaya meditsinskaya akademiya kafedra klinicheskoy farmakologii keys-texnologiya po teme: «klinicheskaya farmakologiya antiaritmicheskix lekarstvennix sredstv» uchebno-metodicheskaya rekomendatsiya (keys – stadi) prednaznachena dlya prepodavateley i studentov 5- kursa meditsinskix vuzov tashkent – 2015 pedagogicheskaya annotatsiya uchebniypredmet: «klinicheskaya farmakologiya» tema: «klinicheskaya farmakologiya antiaritmicheskix lekarstvennix sredstv» tsel dannogo keysa:nauchit studentov znaniyam klinicheskoy farmakologii antiaritmicheskixpreparatov, obuchit studentov znaniyu osnovnix printsipov i umeneniyu individualnogo podbora s lekarstvennix sredstv s uchetom farmakodinamiki, farmakokinetiki, pobochnogo deystviya, a takje osobe...

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