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Раздел 5. Фармакология средств, влияющих на функции
исполнительных органов
Цель занятия: получить представления о механизмах действия средств, влияющих на функции органов пищеварения; знать классификацию препаратов, основные фармакологические эффекты, клиническую эффективность при заболеваниях органов пищеварения; уметь выбирать препараты в зависимости от их фармако-клинической эффективности и безопасности.
Вопросы и задания для самостоятельной подготовки студентов к занятию
1. Противоязвенные средства:
Антисекреторные средства:
Н2-гистаминоблокаторы (ранитидин, циметидин, фамотидин);
М-холиноблокаторы (пирензепин (гастрозепин), метацин);
блокаторы "протонной помпы": омепразол, ланзопразол, рабепразол, эзомепразол, пантопразол.
Антациды (алмагель А, фосфалюгель, маалокс и др.).
Гастропротективные средства (мизопростол, сукральфат, де-нол)
Антигеликобактерные средства (метронидазол, амоксицилин, кларитромицин)
Показания к применению. Механизм действия препаратов отдельных групп, фармакологические свойства и особенности применения, побочные эффекты.
2. Ферментные препараты, улучшающие процессы пищеварения (панкреатин, панцитрат, креон, мезим-форте, фестал, панзинорм). Фармакодинамика, показания к применению, побочные эффекты.
3. Желчегонные средства. Препараты, усиливающие секрецию желчи (холензим, аллохол, лиобил, оксафенамид, вигератин), и средства, усиливающие выделение желчи (ксилит, сорбит, маннит, сульфат магния и др.). Механизмы действия препаратов и показания для их применения. Гепатопротекторы (легалон, силибор, неоселен, ессенциале). Механизмы действия препаратов и показания для их применения.
4. Слабительные средства: сульфат магния, бисакодил, препараты сенны, лактулоза, макроголь-4000 (форлакс), мукофальк др. Точки приложения действия и показания к применению.
5. Средства, влияющие на моторно-эвакуаторные функции пищеварительного тракта:
прокинетики (метоклопрамид, домперидон, тримебутин); спазмолитики (мебеверин, дротаверин, бускапан и др.); антидиарейные средства (лоперамид, октреотид). Точки приложения действия и показания к применению.
Самостоятельная работа
Составить таблицы по фармакологической и клинической эффективности и безопасности препаратов: ранитидин, омепразол, де-нол, креон, аллохол, бисакодил, метоклопрамид, лоперамид.
Клинико-фармакологическая эффективность препаратов
Группа
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Фармакологические эффекты
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Показания для применения
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Препараты
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Противоязвенные средства
Антисекреторные
Гастропротекторы
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Ферментные препараты
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Желчегонные средства
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Слабительные средства
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Средства, влияющие на моторно-эвакуаторные функции
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Уметь выбрать группу и конкретный препарат, его лекарственную форму, дозу, путь введения, схему дозирования для терапии заболеваний и выписать в рецептах: альмагель А, ранитидин, омепразол, де-нол, креон, аллохол, бисакодил, форлакс, лоперамид, метоклопрамид
№
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Рецепт
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Показания к применению препарата
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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Аудиторная работа
1. Выполнить тестовые задания
1. Укажите антисекреторный препарат, блокирующий «протоновый насос» клеток желудка:
А. Гастрозепин Б. Омепразол В. Фамотидин Г. Сукральфат Д. Альмагель
2. Какой препарат оказывает местный защитный эффект в зоне язвы:
А. Гастроцепин Б. Де-нол В. Циметидин Г. Рабепразол Д. Фестал
3. У больных с нарушениями полостного пищеварения при панкреатите эфективен:
А. Креон Б. Фамотидин В. Лиобил Г. Форлакс Д. Париет
4. Выберете основное показание для применения слабительных средств:
А. Непроходимость кишечника
Б. Хронические запоры
В. Синдром раздраженной кишки
Г. Хронический панкреатит
Д. Язвенная болезнь желудка
5. Укажите препарат, усиливающий секрецию желчи:
А. Сорбит Б. Мизопростол В. Панцитрат Г. Лактулоза Д. Лиобил
2. Определить точки приложения действия лекарственных средств для лечения заболеваний органов пищеварения
Группа, препарат
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Молекулярный механизм действия
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Системный механизм действия
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Н2-гистаминоблокаторы
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Блокаторы протонной помпы
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Антациды
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Де-нол
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Креон
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Форлакс
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Метоклопрамид
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Мебеверин
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