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Indications |
Drugs |
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Disinfection of linen, clothing, patient care items | |
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To wash the surgeon's hands |
Aliphatic compounds, oxidizing agents, alkalis, halogen-containing preparations |
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Treatment of surgical tools |
substances, acids |
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For purulent-inflammatory processes |
Preparations of silver, copper, zinc, halogen-containing, oxidizing agents |
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Conservation of pharmacological Chinese drugs |
Derivative of aliphatic and aromatic series |
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Washing cavities |
Nitrofurans, dyes |
Antiseptic and disinfectants are used strictly for their intended purpose due to their pronounced toxic effect. Thus, mercury preparations penetrate the skin and mucous membranes and have an adverse resorptive effect. Acute poisoning with mercury compounds can also occur if they enter the body. The antidote is unithiol (an SH-group donor that binds mercury.
Modern antiseptic and disinfectants:
"Septotsid-synergy" (treatment of the surgical field, surgical asepsis of the skin of the hands).
"Chlormix"; "Hexadecone"; "B2"; "Javel solid"; “Polidez” are complex disinfectants that, depending on concentrations, have bactericidal, fungicidal, virucidal, and tuberculocidal effects. Used for disinfection of premises, patient care items, dishes, linen, and cleaning equipment.
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Name of the drug, its synonyms, storage conditions and procedure for dispensing from pharmacies |
Release form (composition), quantity of drug per package |
Method of administration, average therapeutic doses |
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Cetylperidinium chloride (Cerigel) |
400 ml bottles |
Treat your hands before surgery tion (3-4 ml of the drug on dry skin) |
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Chlorhexidine bigluconate Chlorhexidini bigluconas |
Bottles of 4% and 20% solution of 500 ml |
0.5-1% aqueous or alcohol solutions (for treating hands, wounds, sterilizing instruments); 0.1% solution (for disinfection); 0.02-0.05% solutions (for washing the bladder, individual prevention of sexually transmitted diseases) |
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Furacillin Furacilinum (B) |
Externally in the form of an aqueous 0.02% (1:5000) solution; alcohol 0.066% (1:1 500) solution |
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Ointment 0.2% at 25.0 | ||
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Pure phenol (carbolic acid) Phenolumpurum(B) |
Bottles of 3% glycerin solution, 10 ml |
10 drops 2-3 times a day, warm (ear drops) |
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Birch tar PixliquidaBetulae(OleumRusci) |
Contains Wilkinson's ointment, linim. Balsamic according to A.V. Vishnevsky and others. |
Topically on affected skin areas |
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Ointment 10% and 20% for 25.0 Candles 0.2 each No. 10 |
On the affected areas of the skin 1 suppository into the rectum 1-2 times a day |
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Mercury oxide yellow (B) Hydrargyrioxydumflavum |
Ointment 2% at 10.0 |
Place behind the eyelid and lubricate the affected areas of the skin. |
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Zinc sulfate |
0.1-0.5% solutions (eye drops, douching) |
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Silver nitrate Argenti nitras (A) |
2-10% solution (for lubricating the skin and cauterization); 1-2% eye ointments; 0.25-0.5% (for lubrication of mucous membranes) |
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Chloramine B |
1.5-2% solution (for washing wounds, for wetting napkins, tampons); 0.25-0.5% solutions (for hand treatment and disinfection of non-metallic instruments - ria); 1-5% solutions (for disinfection of care items and patient secretions) |
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Alcohol iodine solution Sol.Iodispirituosa(B) |
Bottles of 5% solution of 10, 15 and 25 ml Amp. 5% solution, 1 ml No. 10 |
For treating the surgical field and wound edges |
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Povidone-iodine |
Bottles of 10% solution of 30, 100 and 500 ml |
For treatment of the surgical field, wounds |
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Hydrogen peroxide solution, concentrated. (perhydrol) Sol. Hydrogenii peroxydi concentrata (B) |
Liquid in bottles (contains 27.5-31% hydrogen peroxide) |
Mix with water 1:10. Received 3% peroxide solution hydrogen is used for washing, rinsing |
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Potassium permanganate Kalii permanganas |
For washing, rinsing 0.1-0.5% (solutions for washing wounds); 0.01-0.05% solution (for rinsing the mouth and washing cavities); 2-5% solution (for lubricating ulcerative and burn surfaces) |
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Ethanol Spiritus aethylicus |
Liquid |
70-90% solution (for treating the surgical field, the surgeon’s hands); 40-50% solution (for compresses); 20-33% solution (10-20 ml per vein) |
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Formaldehyde solution Sol. formaldehydi |
Bottles of 10% solution, 100 ml |
2-5% solution (for disinfection of surgical gloves and instruments); 10% solution (for disinfection of sputum, hair brushes); 0.05-0.1% solutions (for douching) |
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Boric acid |
Bottles of 3% alcohol solution, 10 ml |
Drops in the ear (3-5 drops 2-3 times a day) |
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Ammonia solution (ammonia alcohol) Sol.Ammoniicaustici |
Bottles of 10% solution, 10, 40, 100 ml Amp. 10% solution, 1 ml No. 10 |
In surgical practice, for washing hands using the Spasokuko- Tskogo and Kochergin (25 ml per 5 liters of warm boiled water) On cotton wool or gauze for inhalation |
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Diamond green |
Bottles of 1% and 2% alcohol solution, 10 ml each |
On the affected areas of the skin |
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Ethacridine lactate (rivanol) Aethacridinilactas(B) |
0.05-0.2% solution (externally for washing, douching); 2.5% powder; 1% ointment; 5-10% paste |
Independent work of students
Task No. 1
Write it down in your notebook at home practical classes in the form of medical prescriptions and indicate the indications for use of the prescribed dosage forms.
Chloroquine
Hydroxychloroquine
Metronidazole
Pentamidine
Mebendazole
Praziquantel
Emetine hydrochloride
Alcohol iodine solution
Yellow mercury ointment
Brilliant green alcohol solution
Potassium permanganate for washing wounds, for treating burn surfaces
Task No. 2
Write out in the form of medical prescriptions:
A drug for the treatment of individual prevention of malaria.
A drug for public prevention of malaria.
Agent acting on tissue forms of amoebas.
Drug for giardiasis
Drug for ascariasis
Drug for opisthorchiasis
Drug for schistosomiasis
for treating surgeon's hands;
for disinfection of surgical instruments;
antiseptic for burns;
for the treatment of infected wounds;
for rinsing the mouth.
Situational tasks
Task No. 1
The patient was diagnosed with taeniasis. Fenasal was used as a therapeutic drug. A few days later the patient's condition deteriorated significantly. What is the reason for the deterioration of the condition? What mistake was made in the treatment?
Problem No. 2
Child 7 years old. He became restless, irritable, sleeps poorly, complains of itching in the perineum. In the class where the child is studying, several children were diagnosed with enterobiasis. What is your suspected diagnosis? Treatment methods?
Problem No. 3
A 4-year-old child suddenly stopped walking and moving his arms. The mother assumes that the child has ingested piperazine adipate. Explain the complications caused by the drug and the doctor’s further tactics.
Problem No. 4
A 1% bleach solution was used to disinfect the working surfaces of the operating unit. An hour after preparation, the solution was used.
Swabs were taken as a control. Bacteriological analysis showed the presence of pathogenic microflora. Explain the reason for the lack of disinfectant effect of bleach.
Test control:
Prevention of the disease in the focus of malaria is carried out with drugs that act on:
Pre-erythrocytic forms of Plasmodium malaria.
Erythrocyte forms of Plasmodium malaria.
Paraerythrocytic forms of Plasmodium malaria.
Sexual forms of Plasmodium malaria.
To eliminate the clinical manifestations of malaria, use:
Mefloquine.
Primaquine.
Hingamin.
Chloridine.
For individual chemoprophylaxis of malaria the following is used:
Hingamin.
Primaquine.
Chloridine.
Mefloquine.
For public chemoprophylaxis of malaria the following is used:
Primaquine.
Chloridine.
Hingamin.
Mefloquine.
Medicines used for intestinal amebiasis:
Metronidazole.
Hingamin.
Quiniophone.
Tetracyclines.
Medicines used for extraintestinal amoebiasis:
Metronidazole.
Quiniophone.
Tetracyclines.
Hingamin.
The effectiveness of tetracyclines for intestinal amebiasis is associated with:
Suppression of intestinal bacterial flora.
Direct amoebicidal effect.
For trichomoniasis use:
Metronidazole.
Hingamin.
Tinidazole.
Furazolidone
For giardiasis use:
Metronidazole.
Hingamin.
Furazolidone.
Aminoquinol.
For toxoplasmosis use:
Hingamin.
Metronidazole.
Chloridine
Sulfonamide drugs.
Antiseptics have wide range actions affect bacteria, fungi, protozoa and large viruses. They can cause protein denaturation, disrupt the permeability of the cytoplasmic membrane, and inhibit the activity of enzymes necessary for the life of microorganisms.
Halogen-containing products(iodine and chlorine preparations) due to the release of molecular halogens cause protein denaturation, oxidize organic compounds, and have a bactericidal and deodorizing effect. At local application Iodine preparations also have fungicidal and antiprotozoal effects. Depending on the concentration, an alcohol solution of iodine can have an astringent (anti-inflammatory), irritating and cauterizing effect. The resorptive effect of small doses of iodine and potassium iodide: increases tissue permeability, promotes the resorption of inflammatory infiltrates, increases the secretion of the salivary and bronchial glands.
Iodine preparations should not be used for diseases of the thyroid gland,
pregnancy and breastfeeding. With increased sensitivity or prolonged use of iodine preparations, phenomena of iodism are possible (tissue swelling, runny nose, salivation and lacrimation, sinusitis, frontal sinusitis, Quincke's edema, etc.).
Oxidizing agents(potassium permanganate and hydrogen peroxide) split off atomic oxygen, which has an antiseptic and deodorizing effect. When applied topically, potassium permanganate has a pronounced but short-term antiseptic, anti-inflammatory, cauterizing and deodorizing effect. Hydrogen peroxide has a local astringent (anti-inflammatory), cauterizing, deodorizing, hemostatic and whitening effect. Has weak antimicrobial activity. When applied to wounds, hydrogen peroxide breaks down to form molecular oxygen, resulting in the formation of foam that cleanses the surface of pus, blood, and tissue elements.
Weak acids(boric acid), interacting with the proteins of the skin and mucous membranes, form dense water-insoluble albuminates, compact the tissues on the surface, and have an astringent, anti-inflammatory effect. Boric acid has antibacterial, antifungal and anti-inflammatory effects. With the resorptive effect of acids, they can cause compensated acidosis, and then decompensated, which is manifested by a violation of vital functions. important functions body: drop in blood pressure, respiratory depression, coma.
Weak alkalis(sodium tetraborate), when applied to superficial tissues, interact with the proteins of the epidermis of the skin or oral mucosa, forming loose albuminates, soften the epidermis, dissolve mucin, mucus, have a cleansing, antiseptic, anti-inflammatory effect, and are used for candidiasis.
Heavy metal compounds(zinc oxide) has an astringent effect , anti-inflammatory and disinfectant effect. Heavy metal ions denature proteins of cells (including microbial ones) and tissues, forming albuminates. Zinc oxide has a predominantly astringent and weak antimicrobial effect, silver preparations have a cauterizing and pronounced antiseptic effect. The difference depends on the extent of protein denaturation, which is determined by the concentration of the ion and the degree of dissociation of the salt. A low concentration causes compaction of proteins on the surface of cells - an astringent effect, a high concentration - an irritating and cauterizing effect, respectively.
Dyes(diamond green, methylthioninium chloride, ethacridine) are active mainly against gram-positive flora, which allows them to be used for purulent infections of the skin and mucous membranes.
Detergents(miramistin, chlorhexidine) are surfactants that act on the wall of bacteria, cause their death, and have a bactericidal effect. Miramistin acts on gram-positive and gram-negative aerobic and anaerobic microorganisms, herpes viruses, fungi, affects the cellular and local humoral immune response, enhancing local protective reactions, and stimulates wound healing. Chlorhexidine containing about 27%
active chlorine, which is slowly released, has high antibacterial and fungicidal activity, and is one of the most widely used agents in dental practice. When rinsing, it can be absorbed and slowly released into saliva.
Petroleum products, synthetic balms(polyvinox, bismuth tribromophenolate/tar) have an antibacterial effect, accelerate
resolution of the inflammatory process. Polivinox has a bacteriostatic effect, helps cleanse wounds, stimulates regeneration and epithelization.
Bismuth tribromophenolate/tar has an antiseptic, mild irritant effect, improves tissue trophism and stimulates regeneration processes.
Preparations of plant and animal origin: calendula tincture,
Sanguinarine/Chelerythrine (Sangviritrin), Eucalyptus globulus leaf extract
(chlorophyllipt), eucalyptus rodophyllum extract (eucalymin). Calendula tincture acts mainly on gram-positive flora. Sanguinarine/chelerythrine (sangviritrin) is active against gram-positive and gram-negative microorganisms, yeast-like and filamentous fungi, and pathogenic protozoa. It is not recommended to use sanviritrin for fungal infections with symptoms of eczematization, epilepsy, hyperkinesis, bronchial asthma, angina pectoris, kidney and liver diseases.
Eucalyptus globulus leaf extract (chlorophyllipt), containing a mixture of chlorophylls, acts on gram-positive flora, incl. for staphylococci,
resistant to antibiotics, normalizes oxidative processes in tissues. Eucalyptus rodentosa extract (eucalyminum) has a bacteriostatic effect on gram-positive flora and has an anti-inflammatory effect.
Lysozyme is a natural antibacterial defense factor. It has a bactericidal effect mainly on gram-positive bacteria, is a factor in the body's nonspecific immune defense, and has an antiviral, anti-inflammatory and mucolytic effect.
Chemical antiseptic- destruction of microorganisms in the pathological focus or the patient’s body using various chemicals.
Classifications of antiseptics.
Disinfectants products are used for processing tools, washing walls, floors, processing care items, etc.
Antiseptic substances are used externally for treating the skin, surgeon's hands, washing wounds and mucous membranes.
Chemotherapy the drugs are administered orally and have a resorptive effect in the patient’s body, suppressing the growth of bacteria in various pathological foci.
Main groups of chemical antiseptics.
Group of halogens.
Iodine - 1-5% alcohol tincture. Antiseptic for external use. Used to treat the skin around the wound when dressing, to treat abrasions; scratches, superficial wounds. Has a pronounced tanning effect.
Iodinol - 1% solution, “blue iodine”. Antiseptic for external use. Used for washing wounds and rinsing the throat.
Iodonate and iodopyrone are organic iodine compounds. Use a 1% solution. Antiseptic agents for external use. Used to process the surgical field.
Povidone-iodine is an organic compound of iodine O, 1-1% free iodine). Antiseptic for external use. Used for treating skin during dressings and operations, as well as treating wounds (aerosol).
Lugol's solution - contains iodine and potassium iodide; an aqueous and alcoholic solution can be used. Combined action drug. As a disinfectant, it is used to sterilize catgut. As a chemotherapeutic agent for the treatment of thyroid diseases.
Chloramine B - 1-3% aqueous solution. Disinfectant. Used for disinfection of care items, rubber instruments, premises.
Salts of heavy metals.
Sublimate - in a concentration of 1:1000 for the disinfection of gloves, care items, as a step in the sterilization of silk. Currently, due to toxicity, it is practically not used.
Mercury oxycyanide is a disinfectant. In concentrations of 1:10000, 1:50000 are used for sterilization of optical instruments.
Silver nitrate is an antiseptic for external use. In the form of 0.1-2% solutions, it is used to wash the conjunctiva and mucous membranes. 5-20% solutions have a pronounced cauterizing effect and are used to treat excess granulations, accelerate navel scarring in newborns, etc.
Protargol, collargol - antiseptic agents for external use, have an astringent effect. Used to lubricate mucous membranes and rinse the bladder in the presence of an inflammatory process.
Zinc oxide is an antiseptic for external use. It is included in many powders and pastes that have an anti-inflammatory effect and prevents the development of skin maceration.
Alcohols.
Ethyl alcohol is used as a disinfectant (sterilization of suture material, treatment of instruments) and as an antiseptic for external use (treatment of the surgeon’s hands and the surgical field, wound edges during dressings, for compresses, etc.). 70° alcohol has an antiseptic effect, and 96° also has a tanning effect. Currently, the preparations AHD-2000X (active substances ethanol and polyol fatty acid ester) and AHD-2000-special (additionally containing chlorhexidine) are widely used for treating surgeon’s hands and surgical instruments.
Aldehydes.
Formalin is a 37% solution of formaldehyde. Strong disinfectant. 0.5-5% solutions are used to disinfect gloves, drains, and instruments. Effective against echinococcus. It is also used for fixing preparations for histological examination. In dry form it is used for sterilization in gas sterilizers, in particular, optical instruments.
Lysol - a strong disinfectant. A 2% solution is used to disinfect care items, premises, and soak contaminated instruments. Currently, it is practically not used due to high toxicity.
Phenols.
Carbolic acid is a strong disinfectant. A 2-3% solution was used in the past to disinfect gloves and care items. Now it is used only in combination with other drugs (included in powders and ointments).
Triple solution - contains 20 g of formalin, 10 g of carbolic acid, 30 g of soda and distilled water (up to 1 liter). Strong disinfectant. Used for processing instruments, care items, cold sterilization of cutting instruments.
Dyes.
Diamond green is an antiseptic for external use. A 1-2% alcohol (or aqueous) solution is used to treat superficial wounds and abrasions of the oral mucosa and skin.
Methylene blue is an antiseptic for external use. A 1-2% alcohol (or aqueous) solution is used to treat superficial wounds and abrasions of the oral mucosa and skin. 0.02% aqueous solution - for washing wounds.
Acids.
Boric acid is an antiseptic for external use. Its 2-4% solution is one of the main preparations for washing and treatment purulent wounds. Can be used in powder form and is included in powders and ointments.
Salicylic acid is an antiseptic for external use. Has a keratolytic effect. Used in the form of crystals (for tissue lysis), included in powders and ointments.
Alkalis.
Ammonia is an antiseptic for external use. Previously, a 0.5% solution was widely used to treat surgeon's hands (Spasokukotsky-Kochergin method).
Oxidizing agents.
Hydrogen peroxide is an antiseptic for external use. 3% solution -. the main drug for washing purulent wounds during dressings. Main properties: antiseptic (active agent - atomic oxygen); hemostatic (helps stop bleeding); deodorant; causes foaming, which improves wound cleansing. Included in Pervomura (a product for treating the surgeon’s hands and the surgical field). 6% hydrogen peroxide solution is an important disinfectant.
Potassium permanganate is an antiseptic for external use. A 2-5% solution is used to treat burns and bedsores (has a coagulating and tanning effect). Wounds and mucous membranes are washed with a 0.02% -0.1% solution. Has a pronounced deodorizing effect.
Detergents (surfactants).
Chlorhexidine bigluconate is an antiseptic for external use. A 0.5% alcohol solution is used to treat the surgeon’s hands and the surgical field. A 0.1-0.2% aqueous solution is one of the main preparations for washing wounds and mucous membranes and treating purulent wounds. Included in solutions for treating hands and the surgical field (Plivasept, AHD-special).
Zerigel is an antiseptic for external use. Used for hand treatment (film-forming antiseptic).
Degmin, degmicide - antiseptics for external use. Used to treat hands and the surgical field.
“Astra”, “Novost” - components of cleaning solutions for disinfecting instruments.
Nitrofuran derivatives.
Furacilin is an antiseptic for external use. A solution of 1:5000 is one of the main preparations for the treatment of purulent wounds, washing wounds and mucous membranes.
Lifusol - contains furatsilin, linetol, resins, acetone (aerosol). Antiseptic for external use. Applied in the form of a film. It is used to protect postoperative wounds and drainage holes from exogenous infection, as well as to treat superficial wounds.
Furadonin, furagin, furazolidone are chemotherapeutic agents, so-called “uroantiseptics”. In addition to urinary tract infections, they are used in the treatment of intestinal infections.
8-hydroxyquinoline derivatives.
Nitroxoline (5-NOK) is a chemotherapeutic agent, a “uroantiseptic”. Used for urinary tract infections.
Enteroseptol, intestopan are chemotherapeutic agents used for intestinal infections.
Quinoxaline derivatives.
Dioxidin is an antiseptic for external use. A 0.1-1% aqueous solution is used for washing purulent wounds and mucous membranes, especially when antibiotics and other antiseptics are ineffective. For sepsis and severe infections, it can also be administered intravenously.
Nitroimidazole derivatives.
Metronidazole (metragyl, flagyl, trichopolum) is a broad-spectrum chemotherapeutic agent. Effective against protozoa, bacteroides and a number of anaerobes.
Tars, resins.
Birch tar is an antiseptic for external use. Included as a component in Vishnevsky's ointment, used in the treatment of purulent wounds (in addition to the antiseptic effect, it stimulates the growth of granulations).
Ichthyol, naftalan - used in the form of ointments, have an anti-inflammatory effect.
Antiseptics of plant origin.
Chlorophyllipt, ectericide, balise, calendula - are mainly used as external antiseptics for washing superficial wounds, mucous membranes, and treating the skin. They have an anti-inflammatory effect.
Sulfonamide drugs- chemotherapeutic agents that have a bacteriostatic effect. They are used to suppress various foci of infection in the body, usually in tablet form. They are also included in ointments and powders for external use. Tablet drugs have different durations of action: from 6 hours to 1 day.
Streptocide, etazol, sulfadimezin - short-acting.
Sulfazin - medium-term action.
Sulfadimethoxine - long-acting.
Sulfalen - ultra-long-acting.
Biseptol (bactrim) is a combination drug that contains sulfanilamide, sulfamethoxazole and a diaminopyrimidine derivative - trimethoprim. It is a very common drug in the treatment of various inflammatory processes in the body.
Biological antiseptics. Types of biological antiseptics. Basic pharmacological drugs and methods of their use. Passive and active immunization in surgery. Immunocorrection and immunostimulation.
Types of biological antiseptics:
Biological antiseptics of direct action - the use of pharmacological preparations of biological origin that directly affect microorganisms;
Biological antiseptics of indirect action is the use of pharmacological drugs and methods of various origins that stimulate the ability of the macroorganism to fight microorganisms.
Basic pharmacological drugs and methods.
Pharmacological drugs of direct action on microorganisms:
Antibiotics.
Proteolytic enzymes: trypsin, chymotrypsin, chymopsin, terrilitin, iruksol.
Preparations for passive immunization: therapeutic sera, antitoxins, Y-globulins, bacteriophages, hyperimmune plasma.
Pharmacological preparations and methods for indirect action on microorganisms:
Methods that stimulate nonspecific resistance: quartz treatment, vitamin therapy, ultraviolet irradiation of blood, laser irradiation of blood, use of perfusate and xenospleen cells, transfusion of blood and its components.
Drugs that stimulate nonspecific immunity: thymus preparations (thymalin, T-activin), prodigiosan, levamisole, lysozyme, interferons, interleukins.
Drugs that stimulate specific immunity: vaccines, toxoids.
Antibiotics- substances that are a product of the vital activity of microorganisms that suppress the growth and development of certain groups of other microorganisms.
Main groups of antibiotics.
Penicillins(inhibit the synthesis of the cell wall of a microorganism (MO); mainly - a wide spectrum of action):
penicillin (sodium and potassium salts of benzylpenicillin);
semisynthetic: oxacillin, methicillin, ampicillin, amoxicillin;
prolonged: bicillin, bicillin-3, bicillin-5;
combined: ampiox (ampicillin + oxacillin), augmentin (amoxicillin + potassium salt of clavulonic acid), unasin (ampicillin + sulbactam).
Potassium clavulonate and sulbactam are inhibitors of penicillinase produced by microorganisms.
Streptomycins(suppress ribosome function MO; wide spectrum; oto-, nephro-, hepatotoxic, inhibit hematopoiesis): streptomycin.
Tetracyclines (suppress MO ribosome function; wide spectrum) tetracycline;
Macrolides(disturb protein synthesis in the MO; hepatotoxic, possibly disrupting the function of the gastrointestinal tract): erythromycin, oleandomycin, roxithromycin, azithromycin, clarithromycin.
Aminoglycosides(disturbs the synthesis of cellular synthesis of MO; wide spectrum; oto- and nephrotoxic): kanamycin, gentamicin, tobramycin, sisomycin; semisynthetic: amikacin, netromycin.
Levomycetins(disturbs protein synthesis in MO; wide spectrum; inhibits hematopoiesis): chloramphenicol.
Rifampicins(disrupt protein synthesis in MO; wide spectrum; cause hypercoagulation, hepatotoxic): rifampicin
Antifungal antibiotics: levorin, nystatin.
Polypeptides: disrupt the functions of cell membranes, nephrotoxic
Polymyxin B (acts on gram-negative MOs, including the blue-green pus stick).
Lincosamines(disturb protein synthesis in MO): lincomycin, clindamycin.
Cephalosporins (disturbs the synthesis of the MO cell wall; wide spectrum; nephrotoxic in high doses).
1st generation: cephalexin, cefazolin
2nd generation: cefamandole, cefmetazole, cefoxitin
3rd generation: ceftriaxone, cefotaxime
4th generation: cefpirom (keiten), cefenim
Fluoroquinolones (inhibit DNA hydrase MO; wide spectrum).
1st generation: ofloxacin, ciprofloxacin;
2nd generation: levofloxacin, fleroxacin, tosufloxacin.
Carbapenems (disturbs the synthesis of cell wall MO; wide spectrum): imipenem, meropenem.
Combination drug tienam (imipenem + cilastatin); cilastatin is an inhibitor of an enzyme that affects the metabolism of the antibiotic in the kidneys.
Glycopeptides(change permeability and disrupt cell wall synthesis MO, wide spectrum, oto- and nephrotoxic): vancomycin, erimomycin.
In addition to the presented classification by groups, antibiotics are divided into broad-spectrum and narrow-spectrum drugs.
Complications of antibiotic therapy.
Allergic reactions;
Toxic effect on internal organs;
Dysbacteriosis;
Formation of resistant strains of microorganisms.
Principles of rational antibiotic therapy.
The use of antibiotics according to strict indications, taking into account the identified sensitivity of the microflora.
Use the optimal route of administration (intramuscular, intravenous, intra-arterial, endolymphatic, oral).
Maintain the frequency of administration during the day to maintain a constant concentration of the drug in the blood, and the duration of the course.
Change the antibiotic if it is ineffective.
Consider synergism and antagonism when prescribing a combination of antibiotics.
To prevent allergic complications, carefully collect an allergic history and, if necessary, perform an allergy skin test.
For long courses of antibiotics, prescribe antifungal drugs to prevent dysbacteriosis, as well as vitamins.
Proteolytic enzymes - lyse necrotic tissue, fibrin, liquefy purulent exudate, and have an anti-inflammatory effect.
Trypsin, chymotrypsin, chymopsin are preparations of animal origin, they are obtained from the pancreas of cattle.
Terrylitin is a waste product of the mold fungus Aspergillis terricola.
Iruksol - an ointment for enzymatic cleansing - a combined preparation that includes the enzyme clostridyl peptidase and the antibiotic chloramphenicol.
Preparations for passive immunization.
Antitetanus serum and antitetanus γ-globulin for the prevention and treatment of tetanus.
Antigangrenous serum is used for the prevention and treatment of clostridial anaerobic infection.
Bacteriophages: antistaphylococcal, antistreptococcal, anticoli-, polyvalent are used locally for washing purulent wounds and cavities after identifying the pathogen.
Antistaphylococcal hyperimmune plasma is the native plasma of donors immunized with staphylococcal toxoid. Used for diseases caused by staphylococcus. Antipseudomonas hyperimmune plasma is also used.
Methods for stimulating nonspecific resistance.
Quartz treatment, vitamin therapy, good nutrition.
More complex techniques are ultraviolet and laser irradiation of blood. The methods lead to the activation of phagocytosis and the complement system, improve the oxygen transfer function and rheological properties of the blood.
A number of clinics use xenospleen (pig spleen) preparations. In this case, the properties of the lymphocytes and cytokines contained in it are used. Perfusion through whole or fragmented spleen is possible.
Important methods of stimulating the immune system are transfusions of blood and its components, primarily plasma and suspension of lymphocytes. However, these methods are not indifferent to the patient’s body and are used only in severe infectious processes (sepsis, peritonitis, etc.).
Drugs that stimulate nonspecific immunity.
Medicinal substances that stimulate nonspecific immunity include thymus preparations: Thymalin and T-activin. They are obtained from the thymus gland of cattle. They regulate the ratio of T and B lymphocytes and stimulate phagocytosis.
Prodigiosan and levamisole mainly stimulate the function of lymphocytes, while lysozyme enhances the bactericidal activity of the blood. But recently, interferons and interleukins, which have a more targeted and stronger effect on the immune system, have been used instead. The new drugs reaferon, roferon, roncoleukin and betaleukin, obtained by genetic engineering, are especially effective.
Drugs that stimulate specific immunity
Of the drugs used to stimulate active specific immunity in surgery, staphylococcal and tetanus toxoids are most often used.
Local anesthesia. History of local anesthesia. Types of local anesthesia. Preparations for local anesthesia. Technique of certain types of local anesthesia. Indications for use, types and techniques of novocaine blockades. Possible complications and their prevention.
1880 - V.K. Anrep - discovered the local anesthetic effect of cocaine.
1886 - A.I. Lukashevich - proposed conduction anesthesia.
1899 - A. Bier (A. Bier) proposed spinal anesthesia.
1905 - A. Einhorn (A. Einhorn) discovered novocaine.
1922 - A.V. Vishnevsky proposed his own method of anesthesia - “creeping infiltrate”.
Advantages:
effectiveness and speed of onset of analgesic effect;
ease of implementation, not requiring special equipment;
availability of the method for doctors of any specialty; (excluding some options for regional anesthesia that require special training);
possibility of use in military field conditions;
possibility of use in the absence of anesthesiologists;
the ability to use in patients with severe respiratory or cardiovascular diseases for whom the use of general anesthesia is contraindicated;
preservation of consciousness.
Ndeficiencies:
possible hemodynamic complications in conditions of hypovolemia and unstable hemodynamics;
maintaining a negative emotional background in the patient.
Mechanism of action.
The effect of local anesthetics is due to the interaction of the drug with specific receptors on ion channels of nerve cells. By reversibly blocking sodium channels, local anesthetics inhibit the formation of electrical impulses and their conduction along the axon membrane.
Characteristics of drugs for local anesthesia.
Based on their chemical structure, local anesthetics are divided into:
esters of aromatic acids with amino alcohols (novocaine, procaine, dicaine);
amides mainly of the xylidine series (lidocaine, trimecaine, mepivacaine, bupivacaine, ropivacaine).
Ether anesthetics are relatively unstable in solution, quickly hydrolyze in the blood and are excreted in the urine. May cause allergic reactions.
Amide anesthetics are relatively stable in solution, do not undergo hydrolysis, their biotransformation occurs in the liver, and rarely cause allergic reactions.
Esters of aromatic acids.
Novocaine (procaine) is the “standard” local anesthetic - its toxicity and potency are taken as unity. It is quickly destroyed in tissues, the duration of action is up to 30 minutes.
For infiltration anesthesia, 0.25-0.5% is used, for conduction anesthesia - 1-2% solution. Possible side effects are dizziness, nausea, general weakness, collapse, allergic reactions. The highest single dose of novocaine is 7 mg/kg.
Dicaine (tetracaine, pantocaine) is well absorbed through mucous membranes and is therefore used for superficial anesthesia of mucous membranes (1-3% solutions).
Dicaine is also used for epidural anesthesia. It is unsuitable for infiltration anesthesia, since it is 10 times more toxic than novocaine. The highest dose for adults is no more than 0.09 g.
Derivatives of the amide group
Lidocaine (xylocaine, xycaine) is 1.5 times more toxic than novocaine, but has 3-4 times greater potency. The duration of anesthesia is 4 times longer than with novocaine anesthesia, and the anesthesia effect occurs 5 times faster.
For infiltration anesthesia, 0.25-0.5% solutions are used; for conduction anesthesia – 1 - 2% solutions; epidural - 1-2% and spinal - 2% solutions. The highest dose for adults is 4.5 mg/kg.
Trimecaine (mesocaine) is 1.8 times more potent than novocaine, 1.4 times more toxic, but more than 2 times longer in duration of action. The maximum dose is 2 g. Side effects are the same as for novocaine.
For infiltration anesthesia, use 0.25% (up to 800 ml) - 0.5% (up to 400 ml) solution,
Bupivacaine (marcaine, anecaine) is 16 times more potent than novocaine and 8-12 times more toxic. Duration of action is 8-12 hours (16 times longer than novocaine). It is used for local infiltration anesthesia (0.25% solution), conductive anesthesia (0.25-0.5% solution - single dose 150-170 mg), epidural (0.75% solution).
Complications.
Nonspecific (arise as a result of the use of local anesthesia as such): allergic reactions; development of arterial hypotension; general toxic reactions; puncture of the vessel; mechanical and chemical damage to nerves.
Specific (related to the features and technical errors of specific techniques): puncture of cavities and organs; nerve trunk injury and hematoma formation; erroneous administration of an anesthetic into the spinal canal, epidural space, or vascular lumen; persistent arterial hypotension.
In children, it is not advisable to use local anesthesia, since with unmotivated screams and movements, the effectiveness of surgical intervention decreases or even becomes impossible.
Types of local anesthesia.
Local anesthesia is divided into 3 types: superficial (terminal), infiltration, regional (conduction anesthesia of the nerve plexuses, spinal, epidural, intraosseous).
Superficial anesthesia is achieved by applying an anesthetic (lubrication, irrigation, application) to the mucous membranes. High concentrations of anesthetic solutions are used - dicaine 1-3%, novocaine 5-10%. A variation is cooling anesthesia. It is used for minor outpatient procedures (opening ulcers).
Infiltration Anesthesia according to A.V. Vishnevsky is used for surgical interventions that are small in volume and duration. Use a 0.25% solution of novocaine. After anesthesia of the skin (“lemon peel”) and subcutaneous fatty tissue, the anesthetic is injected into the corresponding fascial spaces. Along the intended incision, a tight infiltrate is formed, which, due to high hydrostatic pressure, spreads along the interfascial canals, washing the nerves and vessels passing through them.
The advantage of the method is that the concentration of the anesthetic solution is low and part of it flows out through the wound during the operation, eliminating the risk of intoxication, despite the administration of large volumes of the drug.
Intraosseous regional anesthesia used for operations on the limbs.
Use a 0.5-1% solution of novocaine or a 0.5-1.0% solution of lidocaine.
A tourniquet is applied to a highly raised limb (for bleeding) above the site of the intended surgical intervention. The soft tissue above the site of needle insertion into the bone is infiltrated with an anesthetic solution to the periosteum. A thick needle with a mandrin is inserted into the cancellous bone, the mandrin is removed and an anesthetic is injected through the needle. The amount of anesthetic solution administered depends on the site of its administration: for foot surgery - 100-150 ml, for hand surgery - 60-100 ml.
Pain relief occurs within 10-15 minutes. In this case, the entire peripheral part of the limb is anesthetized to the level of application of the tourniquet.
Conductor anesthesia is carried out by introducing an anesthetic solution directly to the nerve trunk at various points along its passage - from the point of exit from the spinal cord to the periphery.
Depending on the location of the site where pain sensitivity is interrupted, there are 5 types of conduction anesthesia: stem, plexus (nerve plexus anesthesia), nerve ganglion anesthesia (paravertebral), spinal and epidural.
Stem anesthesia.
The anesthetic solution is injected along the nerve innervating this area.
Anesthesia according to A.I. Lukashevich-Oberst: Indications - operations on the finger.
A rubber bandage is placed at the base of the finger. Distally, from the dorso-lateral side, 2 ml of 1-2% novocaine solution is slowly injected through a thin needle on both sides in the area of the main phalanx.
PLexus Andparavertebral anesthesia.
The anesthetic solution is injected into the area of the nerve plexuses or into the area where the nerve nodes are located.
Spinal anesthesia.
The anesthetic is injected into the subarachnoid space of the spinal canal.
Indications: surgical interventions on organs located below the diaphragm.
Absolute contraindications: inflammatory processes in the lumbar region, pustular skin diseases of the back, uncorrected hypovolemia, severe anemia, mental illness, spinal curvature, increased intracranial pressure.
Relative contraindications : heart failure, hypovolemia, septic condition, cachexia, increased nervous excitability, history of frequent headaches, coronary heart disease.
Premedication: a) psychological preparation of the patient, b) prescription of sedatives on the eve of surgery, c) intramuscular administration of standard doses of narcotic and antihistamines 30-40 minutes before surgery.
Anesthesia technique. Puncture of the spinal space is performed with the patient sitting or lying on his side with a well-bent spine, hips pressed to the stomach and head bent to the chest.
The method requires strict asepsis and antisepsis, but iodine is not used due to the risk of aseptic arachnoiditis.
First, the tissue in the puncture area is infiltrated with anesthetic. A thick needle is passed strictly along the midline between the spinous processes at a slight angle in accordance with their inclination. The depth of needle insertion is 4.5-6.0 cm.
When the needle is slowly passed through the ligamentous apparatus, resistance from dense tissue is felt, which suddenly disappears after puncturing the ligamentum flavum. After this, the mandrel is removed and the needle is advanced 2-3 mm, piercing the dura mater. A sign of precise localization of the needle is the flow of cerebrospinal fluid from it.
Solutions of local anesthetics, depending on their relative density, are divided into hyperbaric, isobaric and hypobaric. When the head end of the operating table is raised, the hypobaric solution spreads cranially, and the hyperbaric solution spreads caudally, and vice versa.
Hyperbaric solutions: Lidocaine 5% solution in 7.5% glucose solution, Bupivacaine 0.75% in 8.25% glucose solution.
Possible complications:
breathing disorders.
bleeding (damage to vessels of the subdural and subarachnoid space);
damage to nerve formations;
leakage of cerebrospinal fluid with subsequent headaches;
a sharp decrease in blood pressure (hypotension);
Epidural anesthesia. A local anesthetic is injected into the epidural space, where it blocks the anterior and posterior roots of the spinal cord in a limited space.
Indications for epidural anesthesia and analgesia:
surgical interventions on the chest, abdominal organs, urological, proctological, obstetric and gynecological, operations on the lower extremities;
surgical interventions in patients with severe concomitant pathologies (obesity, cardiovascular and pulmonary diseases, impaired liver and kidney function, deformation of the upper respiratory tract), in elderly and senile people;
severe combined skeletal injuries (multiple fractures of the ribs, pelvic bones, lower extremities);
postoperative pain relief;
as a component of therapy for pancreatitis, peritonitis, intestinal obstruction, status asthmaticus;
to relieve chronic pain syndrome.
Absolute contraindications to epidural anesthesia and analgesia:
the patient's reluctance to undergo epidural anesthesia;
inflammatory skin lesions in the area of the proposed epidural puncture;
severe shock;
sepsis and septic conditions;
violation of the blood coagulation system (danger of epidural hematoma);
increased intracranial pressure;
hypersensitivity to local anesthetics or narcotic analgesics.
Relative contraindications to epidural anesthesia and analgesia:
spinal deformity (kyphosis, scoliosis, etc.);
diseases of the nervous system;
hypovolemia;
arterial hypotension.
Premedication: a) psychological preparation patient, b) prescription of sedatives on the eve of surgery, c) intramuscular administration of standard doses of narcotic and antihistamines 30-40 minutes before surgery.
Technique of epidural anesthesia. Puncture of the epidural space is performed with the patient sitting or lying on his side.
Sitting position: the patient sits on the operating table, the lower limbs are bent at a right angle at the hip and knee joints, the torso is bent forward as much as possible, the head is lowered down, the chin touches the chest, the hands are on the knees.
Lying position on the side: the lower limbs are maximally bent at the hip joints, the knees are brought to the stomach, the head is bent, the chin is pressed to the chest, the lower angles of the shoulder blades are located on the same vertical axis.
The puncture level is selected taking into account the segmental innervation of organs and tissues.
Following all the rules of asepsis and antiseptics, a 0.5% solution of novocaine anesthetizes the skin, subcutaneous tissue and supraspinous ligament.
The needle for epidural anesthesia is inserted strictly along the midline, corresponding to the direction of the spinous processes. The needle passes the skin, subcutaneous tissue, supraspinous, interspinous and yellow ligaments. When passing the latter, significant resistance is felt. Loss of resistance to fluid injection with free movement of the syringe piston indicates that the needle has entered the epidural space. This is also evidenced by the retraction of a drop into the lumen of the needle during a deep breath and the lack of flow of cerebrospinal fluid from the needle pavilion.
After making sure that the needle is positioned correctly, a catheter is inserted through its lumen, after which the needle is removed and the catheter is fixed with an adhesive plaster.
After catheterization of the epidural space, a test dose of local anesthetic is administered in a volume of 2-3 ml. The patient is observed for 5 minutes, and if there is no evidence of the development of spinal anesthesia, the main dose of local anesthetic is administered to achieve epidural anesthesia. Fractional injection of anesthetic provides anesthesia for 2-3 hours.
Use: Lidocaine 2% Trimecaine 2.5% Bupivacaine 0.5%
Complications of epidural anesthesia can be caused by technical factors (damage to the dura mater, venous trunk), entry of anesthetic into the spinal canal, infection of soft tissues and meninges (meningitis, arachnoiditis), overdose of anesthetic (drowsiness, nausea, vomiting, convulsions, respiratory depression) .
With increased sensitivity to local anesthetics, anaphylactic reactions, including shock, are possible.
Novocaine blockades.
One of the methods of nonspecific therapy, in which a low-concentrated solution of novocaine is injected into various cellular spaces to block the nerve trunks passing here and achieve an analgesic or therapeutic effect.
The purpose of this event is to suppress pain, improve impaired blood flow, and improve tissue trophism through local anesthesia; block autonomic nerve trunks.
Indications for use:
1) treatment of various nonspecific inflammatory processes, especially in the initial stage of the inflammatory reaction;
2) treatment of diseases of neurogenic etiology;
3) treatment of pathological processes in the abdominal cavity caused by disorders of the autonomic nervous system (spasm and atony of the intestinal muscles, spasm or atony of the stomach, spasm of the ureter, etc.).
Case anesthesia (blockade) according to A. V. Vishnevsky.
Indications: fractures, compression of the limbs, surgical interventions on the limbs.
Execution technique. To the side of the projection of the neurovascular bundle, 2-3 ml of a 0.25% novocaine solution is injected intradermally. Then, with a long needle, applying an anesthetic solution, they reach the bone (on the thigh, injections are made along the outer, anterior and posterior surfaces, and on the shoulder - along the posterior and anterior surfaces), the needle is pulled back 1-2 mm and injected, respectively, 100-130 ml and 150-200 ml of 0.25% novocaine solution. The maximum anesthetic effect occurs after 10-15 minutes.
Cervical vagosympathetic blockade.
Indications. Penetrating wounds chest. Carried out to prevent pleuropulmonary shock.
Technique. Position the patient on his back, place a cushion under his neck, and turn his head in the opposite direction. The surgeon uses his index finger to displace the sternocleidomastoid muscle along with the neurovascular bundle inward. Point of insertion: the posterior edge of the said muscle just below or above its intersection with the external jugular vein. Inject 40-60 ml of 0.25% novocaine solution, moving the needle inward and anteriorly, focusing on the anterior surface of the spine.
Intercostal blockade.
Indications. Rib fractures.
Technique. The patient's position is sitting or lying down. Novocaine is administered along the corresponding intercostal space in the middle of the distance from the spinous processes to the scapula. The needle is directed to the rib, and then slides down from it to the area where the neurovascular bundle passes. Inject 10 ml of 0.25% novocaine solution. To enhance the effect, add 1 ml of 96° alcohol to 10 ml of novocaine (alcohol-novocaine blockade). It is possible to use a 0.5% solution of novocaine, then inject 5 ml.
Paravertebral blockade.
Indications. Rib fractures, severe pain radicular syndrome, Degenerative-dystrophic diseases of the spine.
Technique. At a certain level, a needle is inserted, 3 cm away from the line of the spinous processes. The needle is advanced perpendicular to the skin until it reaches the transverse process of the vertebra, then the end of the needle is slightly shifted upward, advanced 0.5 cm in depth and 5-10 ml of a 0.5% novocaine solution is injected.
Perinephric blockade.
Indications. Renal colic, intestinal paresis, acute pancreatitis, acute cholecystitis, acute intestinal obstruction.
Technique. The patient lies on his side, with a bolster under his lower back, the leg from below is bent at the knee and hip joints, from above - extended along the body.
Find the intersection of the XII rib and the long back muscles. 1-2 cm are retreated from the top of the angle along a bisector and a needle is inserted. Direct it perpendicular to the surface of the skin. The needle is located in the perinephric tissue if, when removing the syringe from the needle, the solution does not drip from the pavilion, but when breathing the drop is drawn inward. 60-100 ml of 0.25% novocaine solution is administered.
Pelvic blockade (according to Shkolnikov-Selivanov).
Indications. Fracture of the pelvic bones.
Technique. On the injured side, a needle is inserted 1 cm inward from the superior anterior iliac spine and advanced perpendicular to the skin along the inner surface of the iliac wing. 200-250 ml of 0.25% novocaine solution is administered.
Mesenteric root block.
Indications. Performed as the final stage of all traumatic surgical interventions on organs abdominal cavity for the prevention of postoperative intestinal paresis.
Technique. 60-80 ml of a 0.25% novocaine solution is injected into the root of the mesentery under the peritoneum.
Blockade of the round ligament of the liver.
Indications. Acute diseases of the hepato-duodenal zone (acute cholecystitis, hepatic colic, acute pancreatitis).
Technique. Stepping back from the navel 2 cm upward and 1 cm to the right, advance the needle perpendicular to the skin until a sensation of piercing the aponeurosis appears. After this, 30-40 ml of a 0.25% novocaine solution is injected.
