Main Groups Of Drugs Research Articles

MODERN ONCO DRUG FOR INTERNAL USE

Despite the development of biotherapy, chemotherapy remains one of the main methods of treatment of cancer patients. Currently, there are more than 100 anticancer drug substances, however, every year new drugs enter clinical practice and various therapeutic regimens are tested, expanding the possibilities of therapy and improving the results of treatment. Therefore, the adequate use of modern chemotherapy requires constant updating of information about anticancer drugs and methods of their use. Oral administration of drugs is the most natural and convenient way to introduce drugs into the human body. There are about 75% of orally administered drugs that have the ability to be absorbed in the gastrointestinal tract within 1−3 hours after administration. Oral dosage forms (DF) are most common due to the relative simplicity of their production, convenience of use, accuracy of dosing and high stability. Therefore, pharmaceutical companies often reproduce generics in the form of tablets and capsules for oral administration. However, most active pharmaceutical ingredient (API) are destroyed by the action of the gastrointestinal tract environment, which makes it impossible to use the oral administration. This review of the literature describes the main groups of anticancer drugs that are effective when taken orally.The aimof the study is to compile the information on the main groups of anticancer drugs used internally.Materials and methods.The object of the study was well-known anticancer drugs approved for oral administration. The study was conducted using search information and library databases (eLibrary, PubMed, CyberLeninka, ResearchGate), as well as State Register of Medicinal Remedies.Results and discussion.Analyzing the arsenal of cytotoxic drugs, it should be noted that antitumor substances are characterized by high chemical lability they are photosensitive, heat-labile, hygroscopic and hydrolytically unstable. These properties complicate both obtaining reproducible therapeutic effect when taken orally and technological inprocesses. In addition, anticancer drugs have mutagenic, teratogenic, sensitizing and allergenic effects.Conclusion.Lack of sufficient selectivity of the antitumor effect of cytotoxic drugs and a small breadth of pharmacological action require the use of DF, ensuring control of drug delivery to the body, including dosage accuracy and standard bioavailability. DF plays a very important role in the delivery of drugs to the lesion site. Capsules and coated tablets are necessarily created to avoid high toxicity of anticancer drugs and local tissue reactions when taken orally.

Constipation needs to be treated

The article presents etiology, pathophysiology and epidemiology of constipation. The main groups of drugs that are used for this pathology are described in the section Treatment of Constipation. Stimulant laxatives are the most commonly demanded by the patients. The article provides the analysis of the use of sodium picosulfate in various clinical studies. Sodium picosulfate is one of the main drugs from the stimulant laxative group.

What is common between functional dyspepsia and bacterial overgrowth syndrome

The article presents the results of a review of various syndromes that occur in the pathology of the digestive system. Functional dyspepsia and the principles of its treatment are considered in detail. Proton pump inhibitors are one of the main groups of drugs used to treat functional dyspepsia. A serious complication of prolonged use of proton pump inhibitors is the syndrome of small intestinal bacterial overgrowth. The main principles of treatment of this complication are antibacterial therapy and probiotics. Enterobseptic Novobismol® and modern probiotic Maxilak® can be drugs of choice in this situation.

Medical therapy in patients with thoracic aortic aneurism

Aneurysm of the thoracic aorta of any origin is traditionally considered a pathology for surgical correction. Traditionally the patients are referred for the surgery (prosthetics or endovascular treatment) when thoracic aorta diameter achieves 50–55 mm. However, the management strategy and conservative treatment in case of the smaller aorta dilations are not well elucidated in еру guidelines. The medication therapy aims at the decrease of the hemodynamic stress in the aortic wall, as well as at the correction of risk factors and accompanying diseases, including coronary heart disease, diabetes mellitus, hypertension, etc. Since drug therapy of this pathology is not sufficiently developed, its choice is difficult for physicians. The paper reviews the main groups of drugs and their effectiveness in patients with thoracic aorta aneurism resulted from different causes, including atherosclerosis, genetic pathology (Marfan syndrome, Loeys-Dietz syndrome, etc.). Currently, no drugs are considered as first line therapy. The evidence suggests the use of beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers only in genetic pathology.

Graft outcomes following immunosuppressive therapy with different combinations in kidney transplant recipients: a nationwide cohort study.

BackgroundImmunosuppression plays an essential role to overcome immune-related allograft rejection, but it also causes some nephrotoxicity. This study aimed to investigate how the immunosuppressant combinations affect graft outcomes in kidney transplant recipients.MethodsA nationwide population-based cohort study using the Taiwan National Health Insurance Database was conducted. A total of 3,441 kidney transplant recipients who underwent kidney transplantation during the targeted period were included. The effects on graft outcomes contributed by conventional immunosuppressants, including corticosteroid, calcineurin inhibitors, antimetabolite purine antagonists, and mammalian target of rapamycin inhibitors, were compared.ResultsA total of 423 graft failures developed after the index date. Therapy regimens incorporated with purine antagonists had a comparable reduction of graft failure among four main drug groups regardless of whether they were given as monotherapy or in combination (adjusted hazard ratio: 0.52, 95% confidence interval: 0.42–0.63). Corticosteroid was found to have inferior effects among four groups (adjusted hazard ratio: 1.67, 95% confidence interval: 1.28–2.21). Furthermore, all 15 arrangements of mutually exclusive treatment combinations were analyzed by referencing with corticosteroid monotherapy. As referenced with steroid-based treatment, regimens incorporated with purine antagonists all have superior advantage on graft survival regardless of whether given in monotherapy (65% of graft failure reduced), dual therapy (48%–67% reduced), or quadruple therapy (43% reduced). In all triple therapies, only corticosteroid combined with calcineurin inhibitor and purine antagonist demonstrated superior protection on graft survival (52% of graft failure reduced).ConclusionThe results may recommend several superior regimens for contributing to graft survival, and for supporting a steroid-minimizing strategy in immunosuppression maintenance.

Perioperative management of patients with depression

One of the most common mental illnesses, occurring in more than 5 % of the adult population, is depression. In the management of patients with this concomitant pathology in the perioperative period, the anesthesiologist must take into account a number of characteristics. These may be possible difficulties in communication due to patient closure, the risk of developing a “withdrawal syndrome” of antidepressants, side effects, as well as undesirable interactions of these drugs with anesthetics. The article reviews the publications of Russian and foreign articles and manuals on the perioperative management of patients with depression. The characteristics of the main groups of modern drugs for the treatment of depression, the tactics of their withdrawal or continuation of admission before the operation, the features of anesthesia against the background of long-term intake of various groups of antidepressants are presented. The problem of such complication of therapy with these drugs, such as serotonin syndrome, its differential diagnosis is considered. The review also includes non-pharmacological treatments for depression, their complications and anesthesia in electroconvulsive therapy.

Perioperative management of patients with schizophrenia

This article is a review of publications on clinical research and recommendations for managing patients with schizophrenia in the perioperative period in surgical interventions not associated with psychopathology. An anesthesiologist may face behavioral, cognitive and emotional problems in patients with schizophrenia at all stages of the perioperative period. When anesthetizing such patients, it is necessary to take into account the undesirable side effects of antipsychotics, as well as the risk of their interaction with anesthetics. It is also known that schizophrenia often combines with cardiovascular and endocrine diseases, which further increases the risk of anesthesia. The article gives a description of the main groups of drugs for the treatment of schizophrenia — typical and atypical antipsychotics, a tactic of withdrawal or continuation of their admission during the perioperative period. The problem of neuroleptic malignant syndrome is considered — a potentially lethal complication of therapy with these drugs.

Dislipidemia: definition, diagnostics and treatment

The review article presents the pathogenetic role of atherosclerotic vascular lesions in the development of cardiovascular diseases. The relationship between atherosclerosis and inflammation, which is characterized by the identical mechanism in the early phases, which includes the enhancement of the interaction between the vascular endothelium and circulating leukocytes is shown. The definition of such concepts as dyslipidemia, hyperlipoproteinemia and hyperlipidemia is given. The classification of hyperlipoproteinemia by Fredrickson, the clinical classification of dyslipidemia, proposed by the Ukrainian Scientific Society of Cardiologists, 2011 is considered. The correction of dyslipidemia, by both non-medicamentous measures, and drug treatment according to different variants of dyslipidemia is shown. The main groups of lipid-lowering drugs are listed. Their main mechanisms of action to reduce blood lipid levels are noted, and their side effects are listed. General recommendations are given on the monitoring of lipids and liver enzymes in patients taking lipid-lowering therapy.

Iatrogenic lesions of the skeleton

Osteoporotic fractures are an important public health problem due to their negative impact on the quality of life and life expectancy, as well as high cost of treatment and rehabilitation. Along with the major risk factors for osteoporotic fractures, such as low bone mineral density (BMD), age, low body weight, frequent falls and previous fractures, an important secondary risk factor, especially among susceptible individuals, is taking certain medications. The difficulty in assessing fracture risk when taking various drugs, as well as the development of appropriate methods of prevention and treatment, is often due to the absence of large randomized trials with a sufficient level of evidence, as well as the heterogeneity of the main risk factors for fractures in studied groups of patients. We focus on the main groups of drugs for which there is evidence of a negative impact on bone metabolism, BMD and fracture risk. In addition to drugs, bone metabolism is also influenced by bariatric surgery, transplantation of solid organs, gonadectomy for various diseases.
 
 This article is the RePrint from the original publication in Obesity and Metabolism 2016; 13(2); pp. 41-47. doi: 10.14341/omet2016241-47

8 faktów o kandesartanie

Actual guidelines of the Polish Society of Hypertension on the management of patients with hypertension suggest 5 main groups of drugs used in the treatment of hypertension: angiotensin-converting enzyme inhibitors, calcium channel antagonists, angiotensin II receptor blockers, diuretics and β-blockers. Each of these groups has interesting substances that despite the same mechanism of action present certain additional properties. Candesartan, a representative group of antagonists of angiotensin II receptors have been shown to reduce morbidity and mortality in patients with heart failure, effectively lower blood pressure, reduce the risk of stroke in patients with isolated systolic hypertension, and possibly reduce the risk of development of diabetes. At the same time, it is very well tolerated drug. Candesartan with its efficacy and good tolerance of the treatment is a good alternative for the treatment of a wide range of patients with hypertension.

Nephrolithiasis coexisting with type 2 diabetes: current concept of the features of stone formation and the effects of hypoglycemic therapy on lithogenesis

The article analyzes Russian and international literature examining specific features of the pathogenesis of renal stones in the setting of carbohydrate metabolism disorders. The authors outline the renal effects of the main pharmacological groups of oral hypoglycemic drugs regarding metaphylaxis of nephrolithiasis. An increased risk of nephrolithiasis in type 2 diabetes mellitus is realized through hyperuricemia with concurrent urine acidification. Current literature is lacking studies on the effects of oral hypoglycemic drugs on urine properties. There are reports about the tendency of biguanides (metformin) to shift the urine reaction to the acid side. Derivatives of sulfonylureas, incretins and inhibitors of dipeptidyl peptidase-4, do not significantly affect the urinary acidity and urinary salt excretion. Inhibitors of sodium-glucose cotransporter type 2 (gliflozins) tend to reduce the blood level of urate, but the mechanism of this effect and the safety of these drugs in the setting of urolithiasis have not yet been investigated.

Comparison of the effect of treatment with the main groups of antihypertensive drugs on the quality of life in patients with stable arterial hypertension

When appointing antihypertensive drugs to patients with stable mild to moderate arterial hypertension (AH) it is necessary to take into account the effect of treatment on the quality of life (QoL) of these patients. The aim of the study was to compare the effect of prolonged use of antihypertensive drugs from the main treatment groups on QoL of patients with stable AH in 5 controlled trials. The results of monotherapy efficacy were assessed by 24-hour blood pressure monitoring and QoL patients were studied before and after long-term monotherapy according to the results of a database analysis of 5 studies performed in our center for the last 4 years. After the period of withdrawal of antihypertensive therapy, patients underwent 24-hour blood pressure monitoring, QoL was evaluated. According to 24-hour blood pressure monitoring, diltiazem had an antihypertensive effect, comparable to the effect of enalapril. Both drugs had no effect on the circadian rhythm of arterial pressure and the outpatient heart rate. Long-term use of none of the antihypertensive drugs (diltiazem, amlodipine, enalapril, metoprolol, telmisartan) did not worsen QoL. The greatest impact on QoL was provided by the group of angiotensin-converting enzyme inhibitors, enalapril, significantly improving QoL.

Circadian peculiarities of antioxidant and membrane-protective properties of glutargin in acute chrono-determined paracetamol-induced hepatitis

Hepatobiliary system diseases take a leading position among diseases of the gastrointestinal tract. One of the main groups of drugs used for their treatment is hepatoprotectors. Active development of chronophysiology, chronopatology and chronopharmacology creates the possibility of determining chronoportraits of drugs. Considering the latter it allows significantly optimizing the pharmacotherapy. Aim. To assess the circadian dependence of the antioxidant and membrane-protective activity of glutargin. The choice of the drug as the object of our study was made due to its frequent use in clinical practice. Materials and methods. The study was conducted on the model of acute paracetamol-induced hepatitis in the following chronosimulated mode: in the morning (09.00), in the daytime (15.00), in the evening (21.00) and at night (03.00). The dose of paracetamol in the experiment was 1000 mg/kg in rats. Glutargin was administered in the therapeutic and preventive mode in the dose of 135 mg/kg, i.e. an hour before administration of paracetamol and 2 hours after it. Results. The study conducted revealed the peculiarities of dysinchronosis of the prooxidant-antioxidant balance and the activity of cytolysis markers depending on the period of the day, in which paracetamol-induced hepatitis was simulated; it allowed determining the peculiarities of their correction with glutargin. The most distinct decrease in the AlAT and AsAT activity when using glutargin was observed against the background of night and day simulation of hepatitis. It is probably due to the circadian peculiarities of antioxidant and membrane-stabilizing properties of this drug. Conclusions . The circadian regulation peculiarities of prooxidant-antioxidant balance obtained with glutargin against the background of paracetamol-induced hepatitis should be considered when developing a comprehensive chronoportrait of this drug.

Antiviral therapy of patients with influenza A

Traditionally the influenza is an important problem of modern medicine. The risk is determined primarily by the severity of the complications, in some cases, exacerbates chronic somatic diseases. This requires the use for the treatment of antiviral drugs with direct antiviral effect. The list of their very limited there are two main groups of drugs having direct antiviral effects: blockers of M2 channels (rimantadine) and neuraminidase inhibitors (oseltamivir, zanamivir).The objective: was to examine the effectiveness of Remavir/riman tadine in patients with moderate course of influenza and its out comes.Patients and methods. It was examined 28 patients with influenza, who received rimantadine scheme with no hereditary history, 18 patients with influenza a (control group) was administered patho genetic and symptomatic therapy.Conclusion. Аntiviral remantadin’s therapy of influenza is effective still: at the patients with a moderate course a therapy has been result ed in a shortening of intoxication syndrome and catarrhal phenome non, and for the increase of frequency complications too.Results. Сonfirmed the positive impact of Remavir on the course of influenza. Its inclusion in the treatment of patients with the moder ate course led to a statistically significant reduction in the duration of symptoms of intoxication and catarrhal symptoms, reduce the incidence of complications. Tolerability is good, side effects were recorded.

MODERN OPPORTUNITIES IN UVEITIS TREATMENT

Uveitis is a heterogeneous group of inflammatory diseases of the choroid and adjacent structures. The pathophysiology of uveitis may be different. The treatment approach of infectious and non-infectious uveitis or masquerade syndrome is also different, but the correction of immune disorders of any uveitis should play a leading role. Infectious etiology requires the pathogen eradication with adequate antimicrobial therapy. Therapy of noninfectious uveitis based on the suppression of the local immune response. Depending on the activit y of the inflammatory process it may require system or topical anti-inflammatory and/or immunosuppressive treatment with corticosteroids or immunomodulatory therapeutic agents. The main groups of drugs are presented with the immunosuppressive alkylating agents, corticosteroids, antimetabolites, T-cell inhibitors and biological modulators of the immune response. They can reduce the amount and intensit y of recurrence, the number of complications, decrease the dose of corticosteroids or even replace them in the case of the development of side effects and resistance. An alternative uveitis treatment is extracorporal efferent-quantum hemocorrection methods. The most commonly used is plasmapheresis based on the removal of plasma with dissolved mediators of inflammation, immune complexes, antibodies, exoand endotoxins. Treatment should be pathogenetically oriented and localized to the affected tissue in order to maximize the ratio of efficacy / side effect. Often, however, this can’t be achieved. So the search continues to develop new therapies for use in uveitis that aim to suppress inflammatory activit y, prevent accumulation of damage, and preserve visual function for patients with the minimum possible side effects.

COMBINED ANTIHYPERTENSIVE THERAPY IN REAL CLINICAL PRACTICE. FOCUS ON FIXED COMBINATIONS OF ANTIHYPERTENSIVE DRUGS (According to the Data of Outpatient Registries RECVASA and PROFILE)

On Behalf of the Working Groups of the Registries PROFILE and RE С VASA. Working Group of the PROFILE Registry : Akimova A.V., Voronina V.P., Dmitrieva N.A., Zakharova A.V., Zakharova N.A., Zagrebelnyy A.V., Kutishenko N.P., Lerman O.V., Lukina Yu.V., Tolpygina S.N., Martsevich S.Y. Working Group of the RECVASA Registry : Vorobyev A.N., Zagrebelnyy A.V., Kozminsky A.N., Lukina Yu.V., Loukianov M.M., Moseichuk K.A., Nikulina N.N., Pereverzeva K.G., Pravkina E.A., Boytsov S.A., Martsevich S.Yu., Yakushin S.S. Aim. To assess the frequency of prescription of different combinations of the main groups of antihypertensive drugs (AHD) and their fixed combinations to patients with arterial hypertension by physicians according to two outpatient registries. Material and methods . Hypertension was diagnosed in 3648 (98.9%) patients of the RECVASA registry and in 1230 patients of the PROFILE registry (80.3%). Data on doctor’s prescriptions reflected in the outpatient charts of patients of the both registries were analyzed. The following information of the prescribed antihypertensive therapy was studied in details: AHD, including fixed and free combinations, original and generic AHD. Data on the achievement/non-achievement of target blood pressure (BP) level in patients with hypertension were also analyzed. Results. Women were predominated among hypertensive patients of the RECVASA registry, (71.9%). The ratio of men and women was close to 1:1 in the PROFILE registry. Patients of the registry RECVASA were older: the average age was 66.2±12.8 years compared to 63.7±11.4 years in patients of the PROFILE registry, respectively. The majority of patients in the RECVASA registry (61.4%) had hypertension of the 3rd degree, patients of the PROFILE registry revealed mostly hypertension of the 2 degree (53.3%). Fixed combinations were prescribed to 14% of patients in the registry of RECVASA and to 16% of patients in the PROFILE registry. Doctors of the PROFILE registry often prescribed original AHD; 75% of patients from RECVASA registry received generics. The most popular combinations in both registries were combinations of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers with thiazide/thiazide-like diuretics. The target level of BP was more often achieved in the patients of the PROFILE registry: 37.6% vs 26.1% in the RECVASA registry. Conclusion . The results of the analysis of the presented registries demonstrate the low frequency of prescribing fixed combinations in real clinical practice, the inertness of physicians in achieving the target BP levels and the low efficiency of antihypertensive therapy.

Ankylosing spondylitis and comorbidity: safety of long-term use of nimesulide

Ankylosing spondylitis (AS) is a socially significant rheumatic disease that generally starts in young adults and, if untreated, often leads to temporary incapacitation, and by 40 years, and to disability. Despite the relatively young age of patients, the course of AS is accompanied by a number of comorbidities that most commonly include hypertension, dyslipidemia, and involvement of the gastrointestinal tract and kidney. The main group of drugs recommended for the treatment of the disease is nonsteroidal anti-inflammatory drugs (NSAIDs) that, when used long, exert analgesic, anti-inflammatory, and even disease-modifying effects on the one hand and can cause adverse reactions on the other. When choosing NSAIDs, one should consider not only the activity of the pathological process, but also the presence of comorbidities in the patient. The paper gives data on the efficacy and safety of nimesulide in AS. The drug has proven its efficacy and safety in various rheumatic diseases over nearly a quarter century of its use in Russia.

Differences of the antiplatelet treatment with acetylsalicylic acid

According to the statistical forecasting the cardiovascular mortality will be 25 million cases per year in 2020. Therefore, the search for effective ways to treat and prevent cardiovascular diseases is the primary objective of the current medicine. It has been shown that one of the main groups of drugs that positively affect the duration and quality of life, are antiplatelet agents. Acetylsalicylic acid is an antiplatelet agent that is most widely used for both the primary and secondary prevention of cardiovascular diseases. This article discusses the problems of aspirin resistance, possible ways to improve the efficacy and safety of acetylsalicylic acid therapy, the impact of gender on its effectiveness, and others. There is the need for further development of methods for determining the mechanisms of formation of sensitivity and the rational prescription and correction of the therapy with acetylsalicylic acid.

Anxiety Syndrome in Neurologic Practice: Possibilities and Strategies of Pharmacotherapy

In the present paper a modern approaches to pharmacotherapy of anxiety syndrome in neurological practice have been looked. An advantages and disadvantages of main groups of drugs, using with this purpose have been analyzed. A main attention paid to possibilities of drugs representing “small neuroleptics” and its “golden standard” sulpiride (Eglonil) as an instrument of complex correction of anxiety, phobic, depressive and psychoautonomic symptoms of neurological pathology. A questions of safety during therapy of sulpiride (Eglonil) as one of the main choice criteria of this drug have been looked. An expedience of use of sulpiride (Eglonil) in treatment of different forms of anxiety disorders in neurology has been grounded.

Proteflazid®: clinical and economic substantiation for use in therapy of herpes infection

Epidemiological data indicate the widespread dissemination and constant dynamics of the incidence rate of herpesvirus infections due to a variety of forms and transmission paths of the virus, highly contagious and life-long persistence of the herpes virus in the body of the infected persons and the lack of effectiveness of existing treatments. Acyclic guanosine derivatives are the main group of antiviral drugs traditionally used for the causal treatment of herpes infections. They have a number of disadvantages, in particular formation of the virus resistance in a long-term use, the need to involve immunotherapy, as well as the high cost of treatment. The accumulated clinical experience with the original Ukrainian drug Proteflazid® (drops) in treating viral infections, including HHV- infections, shows its high clinical efficacy and safety. A relative estimation of the course treatment costs of herpes-induced infections using antiviral drugs has demonstrated the economic expediency of Proteflazid® with the purpose of treatment and maintenance therapy. Proteflazid® takes the medium sized niche among other antiherpetic drugs. In addition, due to the multi-vector nature of its pharmacodynamic effects (direct antiviral, immunomodulating, interferon-stimulating, antioxidant, apoptosis-modulating, etc.) Proteflazid® allows to exclude antioxidants, immunomodulators from the antiherpetic therapy scheme, or to adjust their use, and it can significantly reduce the cost per a course of treatment.