[Type the company name]

CURSURI FARMACOLOGIE

[Type the abstract of the document here. The abstract is typically a short summary of the contents of the document. Type the abstract of the document here. The abstract is typically a short summary of the contents of the document.]

RAMURILE FARMACOLOGIEI

Ramurile farmacologiei sunt mprite n 3 categorii cu caracter fundamenta cu caracter ap !cat!" a te ramur! a e farmacoo#!e!

a! Ramuri cu caracter fun"amental 1) Farmacocinetica: Stud!a$% tra&eu med!camentu u! 'n or#an!&m de a !n#erare p(n% a e !m!nare) 2) Farmacodinamia: Stud!a$% mecan!&me e de ac*!une +! efecte e &u,&tan*e or med!camentoa&e a d!fer!te n!"e ur!mo ecu ar. ce u ar. or#an. *e&ut/ &au a &cara 'ntre#u u! or#an!&m) 3) Farmacotoxicologia: Stud!a$% reac*!! e ad"er&e a e med!camente or/farmacodependen*a/!nto0!ca*!! e acute/ cron!ce etc)

#! Ramuri cu caracter aplicati$ 1) Farmacoterapia: Stud!a$% ut! !$area terapeut!c% a med!camente or/cu &cop prof! act!c/ curat!" &au !n"e&t!#a*!ona ) Se ut! !$ea$% 'n tratamentu med!camento& pe concep*!a-.alopat contrar!a contrar!& curantur .%omeopat- &!m! !a &!m! !,u& curantur 2) Farmacoepidemiologia: Stud!a$% contra!nd!ca*!! e/precau*!! e +! po&!,! e e !nterac*!un! med!camentoa&e) 3) Farmacografia: 1

Stud!a$% forme e farmaceut!ce/do$e e/modu de adm!n!&trare c(t +! moda !t%*! e de pre&cr!ere +! e !,erare a med!camente or d!n farmac!e)

c! Alte ramuri ale farmacologiei 1) Cronofarmacologia: Stud!a$% modu 'n care momentu adm!n!&tr%r!! d!n $!/poate !nf uen*a efectu farmacod!nam!c) 2) Farmacologia experimental 3) Farmacologia clinic 4) Farmacogenetic 5) Farmacocibernetic 6) Gerontofarmacologie 7) Farmacologia informaional ) Farmacologia f!ndamental "#1)

2314 Farmaco o#!e #enera % 1556 7 Ioan Rad 8

I) FARMACOLOGIA S9C &'& (A)E FI)IO*+A,OLOGICE :omen!! e- . co !ner#!c . adrener#!c . dopam!ner#!c . &eroton!ner#!c . GA;A.er#!c . # utamater#!c . op!o!der#!c

&'- (A)E FARMACO.I/AMICE

C a&!f!carea med!camente or cu ac*!une a n!"e S9C a4Sen&u ac*!un!!-. !nh!,!toare S9C . &t!mu atoare S9C . modu atoare S9C ,4Ac*!un! a&upra une! anum!te func*!! f!$!o o#!ce a S9C- . ne&pec!f!ce . &pec!f!ce c4<n func*!e de &en&= &pec!f!c!tate= ac*!unea farmacoterapeut!c%

9ES>ECIFICE . 'n &en& !nh!,!tor- .ane&te$!ce #enera e/ h!pnot!ce +! &edat!"e . 'n &en& &t!mu ator- e0c!tante S9C 2cort!ca e3/,u ,are/medu are4 3&e num!te +! p&!ho&t!mu ante/+! &e !ncadrea$% 'n c a&a p&!hoana ept!ce or/ a %tur! de ant!depre&!"e

S>ECIFICE ?

. a&upra proce&e or p&!h!ce 72>SI@OTRO>E4 . tranch! !$ante/ neuro ept!ce/ ant!depre&!"e . a&upra proce&e or p&!h!ce +! memor!e!- . med!ca*!a ,o !! A $he!mer . a&upra func*!e! motor!!- . m!ore a0ante centra e/ ant!con"u &!"ante/ ant!parA!n&on!ene/ coreea @unt!n#ton/ med!ca*!a &c ero$e! atera e am!otrof!ce . a&upra proce&e or durer!! +! &en&!,! !t%*!! motor!!- . ana #e$!ce morf!nom!met!ce/ ana #e$!ce. ant!p!ret!ce . a&upra meta,o !&mu u! neurona / 'n &en& re# ator- . 9EUROTO9ICE

CLA0IFICAREA +0I1O,RO+ELOR

1)1)1 Func*!e de &en&. p&!ho ept!ce - tranch! !$ante/ neuro ept!ce . p&!hoana ept!ce - ant!depre&!"e2 . p&!hod!& ept!ce - p&!hotom!net!ce e0) LS: 7nu &unt cupr!n&e 'n cate#or!a med!camente or/e e produc(nd p&!ho$e a n!"e e0per!menta 222 1)1)1 C a&!f!carea med!camente or p&!hotrope. p&!hotrope propr!u.$!&e - . tranch! !$ante/ neuro ept!ce/ ant!depre&!"e . p&!hotrope 'n &en& ar# - p&!hotrope propr!u.$!&e/ h!pnot!ce +! &edat!"e/ p&!ho&t!mu ante

d4<n func*!e de &!&temu tran&m!&!ona &!napt!c a n!"e u c%ru!a ac*!onea$% TA;ELUL I) . Co !ner#!ce centra e 7 ,oa a A $he!mer 1 :OME9IUL COLI9ERGIC . Ant!co !ner#!ce centra e. coreea @unt!n#ton/ ,oa a A $he!mer . Ant!co !ner#!ce centra e. ,oa a >arA!n&on . St!mu atoare a e e !,er%r!! A:R +! !nh!,!toare a e recapt%r!! dopam!ne!2 p&!ho&t!mu ante cort!ca e +! anore0!#ene/ t!p amfetam!n%4 . Inh!,!toare a e recapt%r!! A:R2ant!depre&!"e t!mo ept!ce B

:OME9IUL A:RE9ERGIC

ener#!$ante4 . IMAO +! IMAO.A &e ect!"e2ant!depre&!"e t!meret!ce/c a&!ce +! &e ect!"e moderne4 . Inh!,!toare a e recapt%r!! B.@T 2ant!depre&!"e&e ect!"e moderne4 8 :OME9IUL . A#on!+t! pre&!napt!c! B.@T1A 2an0!o !t!ce4

SEROTO9I9ERGIC . Anta#on!+t! B.@T1A = anta#on!+t! :1 2neuro ept!ce moderne 'n &ch!$ofren!a cu &!mptome ne#at!"e4 . A#on!+t! +! anta#on!+t! B.@T1C ore0!#ene/ ne&tupef!ante4 2anore0!#ene/re&pect!"

. Anta#on!+t! B.@T8 centra ! +! per!fer!c! 2ant!"om!t!"e potente moderne4 . :opam!ner#!ce 2ant!parA!n&on!ene4 ? :OME9IUL :O>AMI9ERGIC . IMAO.; &e ect!"! 2ant!parA!n&on!ene &e ect!"e moderne4 . Anta#on!+t! :1 = anta#on!+t! B.@T1 2neuro ept!ce c a&!ce4 .Anta#on!+t! po&t.&!napt!c! GA;A.A B :OME9IUL GA;A.ERGIC . tranch! !$ante ,en$od!a$ep!n!ce 2I- ne"ro$e4 . h!pnot!ce- ,en$od!a$ep!ne/ ,ar,!tur!ce/ c!c op!ro one/ !m!da$op!r!d!ne 2I- h!po&omn!!4 . ant!con"u &!"ante- ,en$od!a$ep!ne/ ,ar,!tur!ce 2I- ep! ep&!e4 . ane&te$!ce #enera e- ,ar,!tur!ce +! ,en$od!a$ep!ne . A#on!+t! hetero.&!napt!c! GA;A.;- m!ore a0ante 2I- m!oton!e4 .Inh!,!tor! GA;A.T - ant!con"u &!"ante / t!p "a proat C :OME9IUL GLUTAMAT.ERGIC :OME9IUL GLICI9.ERGIC 6 :OME9IUL >URI9ERGIC C .G utamat.er#!ce 2neuroton!ce4 .Ant!# utamater#!ce 2I- &c ero$% atera % am!otrof!c%4 .Anta#on!+t! a! receptor! or # !c!ne! 2ec0!tante medu are/ t!p &tr!cn!n%4 .Anta#on!+t! >1.A1 2e0c!tante cort!ca e/ t!p cafe!n%4

. Anta#on!+t! F +! = &au A 2ana #e$!ce morf!nom!met!ce4 E :OME9IUL O>IOI:.ERGIC . Anta#onn!+t! F 2ant!dotur! morf!nom!met!ce4 e0) !nto0!ca*!a acut% cu

-' A/E0,E)ICE GE/ERALE

-'& (A)E FARMACOLOGICE -'&'& .EFI/I3IE

Cu"(ntu ane&te$!e pro"!ne d!n !m,a #reac% G an$ fr ai%t&e%i%$ %en'aie Ane&te$!ce e #enera e &unt !nh!,!toare S9C ne%pecifice a"(nd efecte. depr!marea pro#re&!"% a &e#mente or S9C . Supr!marea func*!! or S9C 'n ord!nea urm%toare- . &en&!,! !tateHcuno+t!n*%Hmot! !tate "o untar% +! ref e0% 7 temporar% +! re"er&!,! % 'n ord!ne !n"er&%) . a do$e to0!ce +! eta e !nh!,% centr!! "!ta ! ,u ,ar! 7re&p!rator +! "a&omotor. pro"oc(nd moarte pr!n opr!rea re&p!ra*!e!)

>ropr!et%*! e unu! ane&te$!c #enera !dea &unt. man!a,! !tate . &!#uran*a ut! !$%r!! . durata ane&te$!e! 'n func*!e de !nter"en*!a ch!rur#!ca % . !nduc*!a ane&te$!e! +! tre$!rea d!n ane&te$!e rap!d% . re a0are mu&cu ar% . a,&en*a !nterac*!un! or med!camentoa&e . tre$!re rap!d% +! f%r% &eche e . a,&en*a to0!c!t%*!! D

Deoarece nu exist un anestezic general ideal, se asociaz adjuvani ai anestezicelor, n cadrul tehnicilor de anestezie.

-'&'- CLA0IFICARE

<n func*!e deadm!n!&trare propr!et%*! f!$!co.ch!m!ce &tructur% ch!m!c%

a4 Ane&te$!ce #enera e adm!n!&trate pr!n !nha a*!eGa$oa&e - . proto0!d de a$ot . c!c opropan

L!ch!de "o at! e - . eter! 2eter d!et! !c4 . h!drocar,ur! ha o#enate 2ha otan4 . eter! ha o#ena*! 2enf uran/!&of uran/de&f uran4

Ane&te$!ce #enera e adm!n!&trate !)") .;ar,!tur!ce- . t!openta . he0o,ar,!ta .;en$od!a$ep!ne- . m!da$o am .A te &tructur!- . Aetam!na . propofo

Structurile chimice sunt foarte diferite,dar toate au o proprietate fizic comun: lipofilie nalt (coeficien de partiie lipide ap foarte mare! 6

,4Med!ca*!e adIu"ant% ane&te$!ce or #enera eMed!ca*!a preane&te$!c% - . ant!co !ner#!ce . ant!emet!ce . ,ar,!tur!ce . ,en$od!a$ep!ne . op!o!de M!ore a0ante &au curar!$ante 'n ca$u 'n care ane&te$!cu ut! !$at nu a !ndu& o m!ore a0are &uf!c!ent%)

-'&'3 FARMACO.I/AME

-' &' 3' &' Mecanism "e aciune

Se#mente e S9C !mportante pentru ac*!unea ane&te$!c% #enera % &unt.corte0u cere,ra .&!&temu ret!cu ar a&cendent act!"ator Mecan!&mu comun e&te mecan!&mu e ecrof!$!o o#!c- h!perpo ar!$are cu !nh!,!*!e neurona %) <n ace&t mecan!&m/ !pof! !a 'na t% a ane&te$!ce or #enera e Ioac% un ro !mportant)

Mecanismele4la ni$el celular*molecular pot fi .cre+terea !nf u0u u! mem,ranar de !on C . pr!n de&ch!derea cana e or de c or .&c%derea permea,! !t%*!! cana e or de 9aJ = KJ = Ca1J .de&ch!derea cana e or de KJL e0) ane&te$!ce #enera e !nha ator!!

,eoria lipi"ic So u,! !tatea 'n !p!de e&te m%&urat% 'n coeficientul de partiie lipide"ap, sau lipide"gaz / coef!c!ent ce ref ect% repart!*!a 'n !p!de e mem,ranare/'n re a*!e d!rect propor*!ona %)

,eoria proteic Teor!a prote!c% demon&trea$% faptu c% ane&te$!ce e #enera e pot !nterac*!ona nu numa! cu prote!ne e mem,ranare c! +! cu domen!! e h!drofo,e a e prote!ne or mem,ranare func*!ona e/de a n!"e u cana e or !on!ce mem,ranare modu ate de receptor!)

-'&'3'- Fa5ele aneste5iei generale 6*narco5ei*!

I' +erioa"a "e in"ucie I)1 Fa$a de ana #e$!e I)1 Fa$a de e0c!ta*!e

II' +erioa"a "e aneste5ie propriu*5is II)1 Fa$a de &omn &uperf!c!a II)1 Fa$a de &omn profund II)8 Fa$a de a arm%.preto0!c%

III' +erioa"a to7ic Are o &!n#ur% fa$%/cea de &uprado$are) Fa$e e narco$e! d!fer% de durat% +! "!te$% de &ucce&!une/ 'n func*!e de urm%tor!! factor!.ane&te$!cu #enera .ca ea de adm!n!&trare .pac!ent cu e0c!ta,! !tate part!cu ar% .tehn!ca de ane&te$!e 15

I8' Re$enirea "in aneste5ie Se produce dup% 'ntreruperea adm!n!&tr%r!! une! do$e terapeut!ce) M!te$a de re"en!re dup% de durata narco$e! +! de ane&te$!c. dup% #a$e. c(te"a m!nute . dup% !ch!de "o at! e cca) N h

-'&'9 FARMACO,ERA+IE

In"icaii .!nter"en*!! ch!rur#!ca e .endo&cop!e

Meto"e :i te%nici "e aneste5ie

In"ucia aneste5iei !)") - ,ar,!tur!ce/ ,en$od!a$ep!ne2 m!da$o am/d!a$epam4/Aetam!na !nha ator - eter/ proto0!d de a$ot

+reaneste5ie <na!ntea ane&te$!e! #enera e &e adm!n!&trea$% med!camente Opreane&te$!ceP/ a&tfe &cade e0c!ta,! !tatea S9C +! S9M cu d!m!nuarea do$e! de ane&te$!c #enera +! totodat% a r!&cur! or) Med!camente ut! !$ate 'n preane&te$!e.depr!mante S9C- h!pnot!ce/ tranch! !$ante .ana #e$!ce- morf!nom!met!ce .ant!"om!t!"e- fenot!a$!ne .para&!mpato !t!ce- atrop!na/ &copo am!na 11

>ara&!mpato !t!ce e atenuea$% une e reac*!! ad"er&e pro"ocate de !ntu,a*!e +! anum!te ane&te$!ce #enera e/cum &unt h!per&ecre*!a ,ron+!c%/&a !"ar%/&pa&mu ar!n#!an +! ,ron+!c/ ,rad!card!a +! h!poten&!unea !ntraoperator!e)

Aneste5ie potenat Tehn!c! e de !nducere/de preane&te$!e &au ane&te$!e poten*at% perm!t u ter!or !ntu,area trahea %/ pentru adm!n!&trarea ane&te$!ce or #enera epe ca e !nha ator!e/'n c!rcu!t 'nch!& &au &em!'nch!&/ 'n &copu men*!ner!! ane&te$!e! #enera e)

/euroleptanalge5ie Tehn!c% de ane&te$!e/'n care &e a&oc!a$% un morf!nom!met!c putern!c +! un neuro ept!c !nc!&!"/ pe ca e !)") re$u t(nd o Oane&te$!e "!#! %P 'n care.&tarea de cuno+t!n*% e&te p%&trat% .cu p!erderea &en&!,! !t%*!! dureroa&e +! reac*!e! a durere

-'&'; FARMACO,O<ICOLOGIE =I FARAMCOE+I.EMIOLOGIE

S!ndromu ant!co !ner#!c centra /apare 'n fa$a po&tana&te$!c% a ma0) 1Q d!n ca$ur!)>oate f! !ndu& de med!camente cu ac*!une ant!co !ner#!c%.ane&te$!ce #enera e .med!camente d!n preane&te$!e &au ane&te$!e poten*at% Se man!fe&t% pr!n.efecte centra e- de$or!entare/ha uc!na*!!/!ncoordonare motor!e/depr!marea re&p!rator!e/ h!perterm!e .efecte per!fer!ce- tah!ar!tm!!/&c%derea per!&ta t!&u u! d!#e&t!"/reten*!e ur!nar% Anum!te #rupe farmacod!nam!ce +! med!camente !nterac*!onea$% cu ane&te$!ce e #enera e +! pot pro"oca acc!dente) E e tre,u!e&c cuno&cute +! 'ntrerupte/ a un anum!t !nter"a de t!mp/'na!ntea ane&te$!e!) 11

-'&'> I/,ERAC3IU/I

S!ner#!&m Ane&te$!ce e #enera e !nterac*!onea$% cu.depr!mante S9C .ant!h!perten&!"e .ant!,!ot!ce , ocante neuromu&cu are 2am!no$!de4 .S!mpatom!met!ce.Adrena !na.

-'- A/E0,E)ICE GE/ERALE I/1ALA,ORII -'-'& (A)E FARMACOLOGICE

>ropr!et%*! f!$!co.ch!m!ceStarea f!$!c%- #a$e &au !ch!de "o at! e ( ciclopropan!l )i eter!l etilic din moti*e de %ig!ran n! %e mai !tili'ea' "pericol de explo'ie) Ane&te$!ce e !nha ator!! au o &o u,! !tate r!d!cat% 'n !p!de/a&tfe pr!n d!fu$!unea rap!d% pr!n ,ar!era hematocefa !c% &e d!&tr!,u!e cu rap!d!tate 'n cre!er) -'-'&'& Farmacocinetic Ca e de adm!n!&trare e&te cea !nha ator!e)A,&or,*!a +! e !m!narea &e produce a n!"e a "eo ar) (iotransformarea Conduce a dou% t!pur! de meta,o !*!/to0!c!-. to0!c! hepat!c! . to0!c! rena ! Cinetica ane&te$!ce or #enera e !nha ator!! 7 "!te$e e de a,&or,*!e/ d!&tr!,u*!e +! e !m!nare 7 determ!n% "!te$e e de !nduc*!e a ane&te$!e! +! de re"en!re d!n ane&te$!e) -'-'&'- Farmaco"inamie >oten*a ane&te$!ce or #enera e !nha ator!! e&te m%&urat% 'n un!t%*! MAC'

18

MAC e&te concentra*!a a "eo ar% m!n!m% de #a$/ ce pre"!ne mot! !tatea ca reac*!e a o !nc!$!e ch!rur#!ca % &tandard/ pentru B5Q d!ntre pac!en*!) MAC e&te e0pr!mat% procentua 2procentu de #a$ d!ntr.un ame&tec4) Ane&te$!ce e potente au MAC m!c2ha otan4 / ane&te$!ce e cu poten*% redu&% au MAC r!d!cat 2proto0!d de a$ot4)

-'-'&'3 Farmacoto7icologie Reac*!! e ad"er&e raportate pentru ane&te$ce e #enera e !nha ator!!/ &unt de t!pRA card!o"a&cu are- . depr!mare card!o"a&cu ar% . d!&r!tm!! card!ace :epr!mare re&p!rator!e To0!c!tate hepat!c% @!perterm!a ma !#n% To0!c!tate rena %

-'-'&'9 Farmacoterapie4farmacografie

A/E0,E)ICE I/1ALA,ORII U,ILI)A,E ?/ +RE)E/, >roto0!d de a$ot @a otan I&of uran Enf uran :e&f uran Se"of uran /U 0E MAI U,ILI)EA)@ C!c opropan Eteru Meto0!f uran

:e e ec*!e 'n ped!atr!e +! a a&tmat!c!- %alotanul7nu pre$!nt% hepatoto0!c!tate +! re a0ea$% mu+ch!! nete$! ,ron+!c!/are m!ro& p %cut) 1?

A$antaAe terapeutice .!nduc*!e rap!d% .re"en!re rap!d% .ana #e$!e ,un% .m!ore a0are ,un% .e5a$antaAe terapeutice .ane&te$!e !ncomp et% .a,&en*a m!ore a0%r!! .h!poten&!une arter!a % .r!&c de hepatoto0!c!tate .h!perterm!e ma !#n% -'- GA)E &' +roto7i" "e a5ot F"in' :i Fter' .ana #e$!c ma! potent dec(t ane&te$!c #enera .!nduc*!e &curt%- 1.? m!n .re"en!re rap!d%- 1.? m!n In"' 'n !nduc*!a ane&te$!e! #enera e) Fto7' - efect !muno&upre&!"/ anem!e

-'-'3 .ERI8A3I .E 1ALOGE/A3I &' 1alotan Fcin' .&tocare 'n *e&utu ad!po&/cu efecte re$!dua e .,!otran&formare &emn!f!cat!"% a n!"e hepat!c/produce meta,o !*! or#an!c! hepatoto0!c! Fter' :i F"in' 1B

.poten*% ane&te$!c% mare .per!oada de !nduc*!e &curt%- 8.B m!n .tre$!re rap!d%- B.15 m!n .efect m!ore a0ant ,un/a"(nd efect +! a n!"e u mu+ch! or nete$! ,ron+!c!2 'n ca$u a&tmat!c! or4 Fto7' .depr!m% re&p!ra*!a .depr!m% !n!ma cu ,rad!card!e .r!&c cre&cut de hepatoto0!c!tate -' Enfluran >rof! farmaco o#!c &!m! ar 1alotanului A$antaAe .!nduc*!e +! re"en!re rap!d% .,!otran&formare ma! redu&% .r!&c &c%$ut de hepatoto0!c!tate .re a0are mu&cu ar% ma! ,un% .e5a$antaAe .r!&c & a, de con"u &!! .CI) 'n !n&ufuc!en*% rena %

3'Isofluran >rof! farmaco o#!c &!m! ar Enfluranului A$antaAe *meta,o !$are redu&% GR to0!c!tate hepat!c%=rena % redu&% .e5a$ataAe .r!&c de prec!p!tare a !&chem!e! m!ocard!ce

1C

9'.esfluran >rof! farmaco o#!c &!m! ar Isofluranului A$antaAe .!nduc*!e +! re"en!re rap!d% .e5a$antaAe .!r!tarea tractu u! re&p!rator/cu tu&e +! ,ronho&pa&m

-'3'A/E0,E)ICE GE/ERALE I'8'

Sunt ut! !$ate pentru !ntroducerea rap!d% a ane&te$!e!/care u ter!or e&te men*!nut% cu uun ane&te$!c #enera !nha ator)Se !nIectea$% ent)

-'3'&' (ar#iturice &',iopental Fcin' .d!&tr!,u!re ,!fa$!c%-.u trarap!d% 'n S9C .urmat% de red!&tr!,u!re u trarap!d% 'n *e&utu ad!po& F"in' .!nduc*!e +! durat% u tra&curte Fto7' .depr!m% re&p!ra*!a/pro"oac% ar!n#o&pa&m Fter' .!nduc*!a ane&te$!e!/ !nter"en*!! &curte are ut! !$are ar#%

-'3'-' (en5o"ia5epine &'Mi"a5olam F"in' .an0!o !t!c/m!ore a0ant/ant!con"u &!"ant/h!pno!nductor .ane&te$!c #enera cu !nduc*!e &curt%.1 m!n/ durat% re at!" &curt%.?B m!n Fter' :i Fgraf' .Ind!ca*!!-. !nduc*!a ane&te$!e!/preane&te$!e/h!pnot!c/procedee endo&cop!ce 1D

-'3'3' Alte structuri &'Betamina F"in' :i Fter' .!nduce ane&te$!e d!&oc!at!"%/pac!entu f!!nd con+t!ent/dar amne$!c/!mo,! +! !n&en&!,! durere/poate produce @TA .!nduc*!e +! durat% &curt% .ut! % a pac!en*!! cu depr!mare card!o"a&cu are a

Fto7' :i Fgraf' .depr!m% re&p!ra*!a .cre+te f u0u &an#u!n cere,ra .produce ha uc!na*!! po&toperator Cin"' .acc!dent "a&cu ar cere,ra .@TA

3' 1I+/O,ICE =I 0E.A,I8E 3'&' (A)E FI)IO+A,OLOGICE =I FARMACOLOGICE 3'&'&' (a5e fi5iopatologice 3' &' &' &' 0omnul fi5iologic

Somnu repre$!nt% o &tare de repau& a or#an!&mu u!/care a ternea$% per!od!c cu &tarea de "e#he/ cont!nu!nd ,!or!tmu "e#he.&omn)Se man!fe&t% mod!f!c%r! de ord!n cant!tat!" a e func*!! or p&!h!ce/motor!!/ +! "e#etat!"e/ comparat!" cu &tarea de "e#he) Mo"ificrile funciilor fi5iologice n timpul somnului fi5iologic .toate func*!! e f!$!o o#!ce &e af % a n!"e ,a$a .mot! !tatea "o untar% e&te a,o !t% 16

.mu+ch!! &tr!a*! &unt u+or re a0a*! ,ipuri "e somn .somnul lent 29REMGnon rap!d eye mo"ement4GR na+te "!&e .somnul rapi"4 para"o7al 2REM4.e&te &omnu reech! !,rator +! &ta,! !$ator p&!h!c/m%re+te autocontro u /d!m!nuea$% &en&!,! !tatea a &tre&

3'&'&'-' 1iposomniile Tu ,ur%r! e &omnu u! pot f!.h!per&omn!e .h!po&omn!e In&omn!a ade"%rat% e&te e0trem de rar%) @!po&omn!a pro"oac% &en$a*!a de o,o&ea %/!nd!&po$!*!e/!nef!cac!tate 'n act!"!tate/randament &c%$ut/eror! repetate) @!po&omn!a poate &% apar%.rar- . a oamen! &%n%to+!/cu durat% &curt%/dator!t% unor factor! e0tern!/temporar! .frec"ent/'n ,o ! e p&!h!ce- . &ch!$ofren!e/&t%r! depre&!"e/ &au 'n ca$u durer! or/etc)

Clasificarea %iposomniilor 'n func*!e de momentu man!fe&t%r!! 'n func*!e de et!o o#!e 'n func*!e de durat%

3'&'&'3' ,erapia %iposomniilor Con&t% 'n.tartamentu cau$e or 1E

.p&!hoterap!e .&edat!"e .h!pnot!ce.'n ca$u 'n care ce e a te m%&ur! nu au a"ut &ucce&

3'&'- .efiniie 1I+/O,ICELE 6C0OM/IFERELE! .depr!mante ne&e ect!"e a e S9C . a do$e terapeut!ce forea5 &au fa$ori5ea5 !n&ta are unu! &omn a&em%n%tor ce u! f!$!o o#!c .produc temporar p!erderea cuno+t!n*e!

0E.A,I8ELE Sunt depr!mante ne&e ect!"e a e S9C/care/ a do$e terapeut!ce &edat!"e/produc o &tare de !n!+te/ pr!n d!m!nuarea h!pere0c!ta,! !t%*!! &en$!t!"e +! p&!homotor!!) .h!pnot!ce e/ a do$e m!c!/au efect &edat!"

3'&'3 Clasificare

a!?n funcie "e criteriile farmaco"inamic :i farmacoterapeutic4%ipnoticele se mpart n "ou mari grupe .h!pnocoerc!t!"e 2for*ea$% &omnu 4 .h!pno!nductoare &au h!pno#ene 2fa"or!$ea$% &omnu 4 1ipnocoerciti$ele .&unt depr!mate S9C ne&e ect!"e .reduc durata &omnu u! parado0a REM +! o cre&c pe cea a &omnu u! ent 9REM .produc o,!+nu!n*%/ cu tend!n*% a m%r!rea do$e or

15

.produc dependen*% f!$!c%/cu &!ndrom de a,&t!nen*%/man!fe&tate pr!n &!mptome de e0c!ta*!e S9C/ p(n% a con"u &!! .&uprado$area poate f! fo o&!t% 'n &cop &u!c!da 1ipnoin"uctoarele .depr!marea S9C nu e&te #radat% do$%.dependen*%/nu produce &omn narcot!c .ac*!onea$% &e ect!" .!ntrarea=!e+!rea d!n &omn e&te 'n&o*!t% de &omno en*% !nc!p!ent%/re&pect!" re$!dua % .tre$!rea d!n &omn e&te u+oar% .de$"o t% & a, &au de oc o,!+nu!n*% +! farmacodependen*% .&uprado$area nu poate f! fo o&!t% 'n &cop &u!c!da a!?n funcie "e structura c%imic4%ipnocoerciti$ele se mpart n .,ar,!tur!ce h!pnot!ce- feno,ar,!ta /amo,ar,ta /c!c o,ar,!ta /pento,ar,!ta .ure!de ac!c !ce- ,rom!$o"a /car,roma #!?n funcie "e structura c%imic4%ipnoin"uctoarele sunt .,en$od!a$ep!ne- n!tra$epam/ f un!tra$epam/ f ura$epam/ m!da$o am .!m!da$op!r!d!ne- $o p!dem .c!c op!ro one- $op!c on c!?n funcie "e mecanismul "e aciune .ne&pec!f!ce 7 &unt h!pnocoerc!t!"e .&pec!f!ce 7 &unt h!pno!nductoare "!0e"ati$ele sunt .,ar,!tur!ce h!pnot!ce/ a do$e m!c! &edat!"e .,romur! 2,romur! de ca c!u !)")4 .&edat!"e "e#eta e 2Ma er!ana/>a&&!f ora4

3'-' 1I+/O,ICE (AR(I,URICE 11

3'-'&' Relaii structur*aciune

(ar#ituricele sunt "eri$ai ai .ac!du u! ,ar,!tur!c .&u,&t!tu!*! a CB 2,ar,!tur!ce h!pnot!ce4 .9.a ch! a*! 2,ar,!tur!ce narcot!ce4 .der!"a*! a! ac!du u! t!o,ar,!tur!c 2,ar,!tur!ce narcot!ce4 Forme .cat!on!c% .eno !c%/cu caracter & a, ac!d L!po&o u,! !tatea e&te foarte r!d!cat% a ,ar,!tur!ce e narcot!ce/care d!fu$ea$% rap!d pr!n ,ar!era hemato.encefa !c%/au d!&tr!,u!re ,!fa$!c%/cu aten*a +! durata de ac*!une narcot!c% u tra&curte)

3'-'-' Farmacocinetic A,&or,*!e ,un% pe toate c%! e/!nc u&!" pr!n mucoa&a #a&tr!c%) Tran&port 'n &(n#e/ 'n forma e#at% de a ,um!ne p a&mat!ce/pr!n e#%tur! !on!ce/procente d!fer!te /'ntre 5.CBQ) :!fu$!une ,un%-.'n *e&utur! .pr!n ,ar!era hemato.encefa !c% .p acent% Induc*!e en$!mat!c%/con&ec!n*a con&t(nd 'n to eran*% propr!e 'ncruc!+at% cu d!m!nuarea ef!cac!t%*!!) E !m!nare rena %/ ca meta,o !*! +! form% netran&format%) :urata de ac*!une dep!nde de urm%toare e proce&e farmacoc!net!ce.d!fu$!unea 'n S9C +! red!&tr!,u!rea/'n func*!e de m%r!mea coef!c!entu u! de partaI !p!de=ap% .,ar,!tur!ce e narcot!ce au !po&o u,! !tate 'na t% +! ca urmare/ aten*a +! durata u tra&curte <n !nto0!ca*!! e cu ,ar,!ta &au feno,ar,!ta /&e #r%,e+te e !m!narea rena %/d!m!nu(nd rea,&or,*!a tu,u ar%/pr!n a ca !n!$area ur!n!!) 11

3'-'3' Framaco"inamie Mecan!&m de ac*!une.ne&pec!f!c .&pec!f!c Ac*!un! 'n meta,o !&mu neurona .depr!marea re&p!ra*!e! ce u are .!nh!,% o0!darea # uco$e! ., ochea$% &!nte$a de AT> .&cad con&umu de o0!#en +! de # uco$%/a cre!eru u! Ac*!un! farmacod!nam!ce.La do$e terapeut!ce.depr!mare S9C/de !nten&!tate #radat% do$%.dependent%2&edare.&omn h!pnot!c4 .ac*!une h!pnocoerc!t!"% .ac*!une ant!con"u &!"ant%.'n trat) ep! ep&!e! .La do$e mar!.depr!mare S9C maIor%.com% .a,o !rea ref e0u u! ocu ar a um!n%/'n &tare de com% .depr!marea centr! or "!ta ! ,u ,ar!/re&p!rator +! "a&omotor

3'-'9 Clasificarea #ar#ituricelor a!Fuuncie "e utilitatea terapeutic .,ar,!tur!ce narcot!ce .,ar,!tur!ce h!pnot!ce +! &edat!"e . der!"a*! ac!du u! ,ar,!tur!c &u,&t!tu!*! numa! a CB #!Funcie "e "urata aciunii terapeutice .durat% u tra&curt% 215.15m!n4 -,ar,!tur!ce narcot!ce-t!openta /metohe0!ta /he0o,ar,!ta .durat% &curt% 21.? h4 aten*% 1B.15m!n -,ar,!tur!ce h!pnot!ce- c!c o,ar,!ta /pento,ar,!ta 18

.durat% med!e 2B.Dh4 aten*% 15.85m!n -,ar,!tur!ce h!pnot!ce- amo,ar,!ta .durat% un#% 26.1Eh4 aten*% 1h -,ar,!tur!ce h!pnot!ce- feno,ar,!ta / ,ar,!ta Feno,ar,!ta u e&te ut! !$at ca &edat!" a do$e m!c!/&u,h!pnot!ceL +! ana ept!c

3'-'; Farmacoto7icologie 3'-';'& Reacii a"$erse Reacii a"$erse "e tip .efecte &ecundareL .&en&!,! !$are.erup*!! cutanateL .to eran*% do,(nd!t%)o,!+nu!n*%L .dependen*% f!$!c%L Mecanismele o#i:nuinei .!n&ta area !nduc*!e! en$!mat!ceL .de&en&!,! !$areGR re# are OdoSnPGreduce num%ru de receptor! Mecanismele sin"romului "e a#stinen*se$raA .&en&!,! !$area/ hetero.re# are OupP 0imptomatologia sin"romului "e a#stinen .forma u+oar% +! med!e-.&tare de e0c!ta*!e S9C 2a#!ta*!e/tremor/!n&omn!e/fe,r%/ha uc!na*!!/de !r4 .forma #ra"%- cr!$a con"u &!"ant% de mare r%u ep! ept!c +rofilaxia %indrom!l!i de ab%tinen,%cderea treptat a do'elorInto7icaia acut Suprado$are 'n &cop &u!c!da .do$e e to0!ce &unt de cca) B0 do$e e h!pnot!ce .do$e e eta e &unt de cca) 150 do$e e h!pnot!ce

3'-'; Farmacoterapie 1?

In"icaii .!n&omn!!- ,ar,!tur!ce h!pnot!ce de durat% &curt% &au med!e .ca &edat!"e- ,ar,!tur!ce h!pnot!ce/ a do$e m!c!.apro0) 1=B d!n do$a h!pnot!c% .'n ep! ep&!e- feno,ar,!ta .'n preane&te$!e- ,ar,!tur!ce cu durata med!e .'n ane&te$!e #enera %- ,ar,!tur!ce e narcot!ce/ !)")t!openta /metohe0!ta

3'-'> Farmacoepi"emiologie CI .conduc%tor! auto .!n&uf!c!en*% hepat!c%=rena % .pruden*% a ,%tr(n!

3'-'D' Interaciuni 0inergism cu a te depr!mante S9C/!nc u&!" a coo L Antagonism Aten*!eT a adm!n!&trarea de ant!coa#u ante cumar!n!ce/dup% un tratament cu ,ar,!tur!ce/ ef!cac!tatea poate f! redu&% a do$e e o,!+nu!te terapeut!c)Tre,u!e mon!tor!$at% atent po&o o#!a ant!coa#u ante or)

3'-'E' Me"icamente %ipnocoerciti$e &'Ciclo#ar#ital Fter'F F"in'F Fgraf)L ,ar,!tur!c h!pnocoerc!t!".laten :i "urat scurt .'n !n&omn!! !nc!p!ente datorate h!pere0c!ta,! !t%*!! ner"oa&e 1B

>o&o o#!e- p)o) 155.155 m# 'na!nte de cu care Aten*!e- &e adm!n!&trea$% pe termen &curt

-'Amo#ar#ital Fter'F F"in'F Fgraf'F ,ar,!tur!c h!pnocoerc!t!".laten :i "urat me"ie .'n !n&omn!! !nterm!tente Se adm!n!&trrea$% pe termen &curt .enumire comercial .Am!ta 155 7Arena Group SA

3'Feno#ar#ital Fter'F F"in'F Fgraf'F ,ar,!tur!c h!pnocoerc!t!".laten :i "urat lung Se adm!n!&trea$% ca ,ar,!tur!c h!pnot!c/&edat!"/+! ant!con"u &!"ant Fto7' .E&te putern!c !nductor en$!mat!c +! poate #enera !nterac*!un!/ a a&oc!erea cu numeroa&e med!camente) E&te contra!d!cat 'n porf!r!a hepat!c%) .enumire comercial *Feno,ar,!ta 155m# 7 Arena Group SA

3'3 1I+/O,ICE (E/)O.IA)E+I/E

Fter' :i F"in' Sunt h!pnot!ce moderne/preferate h!pnot!ce or c a&!ce h!pnocoerc!t!"e) A"antaI- 9u mod!f!c% &tructura &omnu u!/nu reduc durata &omnu u! REM.parado0a

&'/itra5epam Fcin' .a,&or,*!e d!#e&t!"% ,un%/pe&te B5Q .do$e e &e ca cu ea$% !nd!"dua !$at Fter'FF"in'FFgraf' ant!con"u &!"ant .h!pnot!c modern/ efect foarte aprop!at de &omnu f!$!o o#!c/

.!nduce &omn de C.6 ore/ aten*% 85.C5m!n 1C

In"icaii .!n&omn!!/ep! ep&!e/preane&te$!e .o5e %ipnotice .adu *!- B.15m# &eara a cu care Fto7' .9u &e adm!n!&trea$% +ofer! or &au per&oane or care nece&!t% "!#! en*% cre&cut% .enumiri comerciale # .itra'epam 5mg/ Gedeon 0ic&ter

-'Flunitra5epam Fcin' . are poten*% ma! mare dec(t 9!tra$epamu Fter' .ca h!pnot!c/'n preane&te$!e

3'Mi"a5olam Fter'F Fgraf' .h!pnot!c/'n preane&te$!e/'n !nduc*!a ane&te$!e! !)") .enumiri comerciale .1ormic!m 7,5 / 2erapia 34

9'(romuri Fcin' .e !m!nare ent%. p(n% a o un% Fto7' .efect !r!tant t!&u ar .&en&!,! !$are.erup*!! cutanate Fgraf' .adm!n!&trare e0c u&!" !)" +! per o& dup% me&e

3'9' 1ipnotice mo"erne cu profil similar (E/)O.IA)E+I/ELOR Repre5entani .c!c op!ro one- 5opiclon .!m!da$op!r!d!ne- 5olpi"em

1D

&')opiclon Fcin' .a,&or,*!e rap!d% per o& . T1=1 re at!" &curt F"in' .nu afectea$% &omnu REM .h!pno!nductor Fto7' .!nduce farmacodependen*% In"icaii 'n !n&omn!! tran$!tor!! &au cron!ce .enumire comercial 5mo*ane 7,5 / 6ab- 4*enti% Frana

-')olpi"em Fcin-t!mp de 'nIum%t%*!re &curt F"in' *&e ect!" ac*!une h!pnot!c%.&e ect!"% Fto7' *nu de$"o t% o,!+nu!n*% +! farmacodependen*% .!nd!ce e terapeut!c e&te r!d!cat Fter' *'n !n&omn!! tran$!tor!! &au cron!ce .enumiri comerciale 3an*al 17mg / 6e8 +&armace!tical% 3tilnox 17mg / 3anofi Frana

9' ,RA/C1ILI)A/,E 6A/<IOLI,ICE! 9'& (a5e fi5iopatologice 9'&'& An7ietatea :!n !m,a latin an7ietasC nelini:te 0in"romul an7ios 16

.S!mptome- . p&!ho&omat!ce- ten&!une ner"oa&%/atacur! de pan!c%/teama nedef!n!t% . p&!homotor!!- e0per!en*a fe*e! part!cu ar% . neuro"e#etat!"e- !n&omn!e/anore0!e/tah!card!e/h!per# !cem!e

9'&'- (a5e neuroc%imice <n f!$!opato#en!a an0!et%*!! &unt !ncr!m!nate func*!a sistemului a"renergic +! "ereglarea sistemului serotoninergic /eurome"iatori implicai n an7ietate .cateco am!ne e.9AL A:R .&eroton!na. B.@T Receptori cu rol n fenomenul an7ios .adrener#!c!- U1 .&eroton!ner#!c!- B.@T 1A Ro f!$!o o#!c ant!an0!o&.an0!o !t!c !mportant de*!ne tran&m!&!a pr!nc!pa % !nh!,!toare d!n S9C/ GA;A.er#!c%) Agoni:ti me"icamento:i selecti$i ai receptorilor GA(A GA(A.A tranch! !$ante h!pnot!ce ,en$od!a$ep!ne m!ore a0ante ant!con"u &!"ante !nductoare ane&te$!e! ae ,ac ofen m!ore a0ant GA(A.(

h!pnot!ce ,ar,!tur!ce ant!con"u &!"ante ane&te$!ce #enera e 1E

c!c op!ro one !m!da$op!ro one

+! h!pnot!ce

Antagoni:ti me"icamento:i selecti$i ai receptorilor GA(A*A antidot 9n intoxicaia c! ben'odia'epine: $lumanezil

9'&'-' .efiniie Tranch! !$ante e !nf uen*ea$% predom!nant une e proce&e p&!h!ce +! fac parte d!n c a&a mare a med!camente or p&!hotrope/grupa psi%oleptice'

9'&'3 Farmaco"inamie Ac*!un! e tranch! !$ante or.d!m!nu!area an0!et%*!! .ca marea e0c!ta*!e! p&!homotor!! .temperarea reac*!! or emo*!ona e/afect!"e .poten*ea$% a te depr!mante S9C .a,&en*a !nf uen*%r!! "!#! !t%*!!/facu t%*! or !nte ectua e A te ac*!un! a e tranch! !$ante or.m!ore a0ant%- mepro,amatL d!a$epam .ant!con"u &!"ant%- d!a$epamL c ona$epam .h!pno!nductoare 'n !n&omn!!- d!a$epamL n!tra$epamL f un!tra$epam .!nductoare a ane&te$!e! #enera e- m!da$o am 9'&'9 Clasificarea tranc%ili5antelor a!Funcie "e mecanism "e aciune .&t!mu ant a tran&m!&!e! !nh!,!toare GA;A .!nh!,!tor a tran&m!&!e! &eroton!ner#!ce 85

.&!mpato !t!c centra ,eta.adreno !t!c ,4Func*!e de &tructura ch!m!c%.mepro,amat .,en$od!a$ep!ne-d!a$epam/meda$epam/,roma$epam/o0a$epam/ ora$epam/a pra$o am .a$a&p!rodecand!one- ,u&p!rona 9'&';' Farmacoto7icologie Reac*!! ad"er&e .&omno en*% .tu ,ur%r! de coordonare motor!e .o,!+nu!n*% +! dependen*% f!$!c% 9'&'>' Farmacoterapie 9'&'>'&' In"icaii 0e a"ministrea5 ca .an0!o !t!ce .h!pno!nductoare .m!ore a0ante .ant!con"u &!"ante .!nductoare a e ane&te$!e! #enera e .adIu"ante 'n ,o ! &omat!ce 9'&'>'-' Farmacoepi"emiologie CI .conduc%tor! auto .m!a&ten!a #ra"!&

9'-' ,ranc%ili5ante #en5o"ia5epine Sunt med!camente !pof! e cu coef!c!entu de !pof! !e r!d!cat) 81

9'-'& Clasificarea #en5o"ia5epinelor a!Clasificare c%imic 1/?.,en$od!a$ep!ne .Grupu I- d!a$epam/meda$epam/,roma$epam . T N un# .Grupu II- o0a$epam/ ora$epam 7 T N !ntermed!ar +! &curt .Grupu III G .n!tra$epam .Grupu IM- a pra$o am 7 T N &curt +! !ntermed!ar .Grupu M- o0a$o am/ Aeta$o am .Grupu MI 3 .m!da$o am 1/B.,en$od!a$ep!ne 1/8.,en$od!a$ep!ne 3Grupu III +! Grupu MI repre$!nt% #rupu ,en$od!a$ep!ne or h!pnot!ce ca n!tra$epam/ m!da$o am #!Clasificarea farmacocinetic4funcia "e semi$iaa eliminrii . un#% 85.E5 ore GR) I .med!e.!ntermed!ar% 15.85 ore GR) II.III.IM .&curt% &u, 15 ore GR) II +! IM .u tra&curt% &u, B ore GR MI

9'-'-' Farmacocinetic 9'-'-'&' +rofilul farmacocinetic al #en5o"ia5epinelor .A,&or,*!a per o& e&te ,un%/cu "!te$e d!fer!te/'n func*!e de #radu de !pof! !eL !)m) rata a,&or,*!e! ma! m!c% dec(t per o&) .:!fu$!unea rap!d% pr!n ,ar!era hematoJencefa !c% 'n S9C e&te urmat% de red!&tr!,u!re 'n *e&utu ad!po&L "!te$a d!&tr!,u!r!! ,!fa$!ce e&te core at% d!rect cu #radu de !pof! !e) 81

.Le#area de prote!ne e p a&mat!ce e&te 'n procent mare 2D5.E5Q4/core at cu #radu de !pof! !e2e0) E5Q a d!a$epam4 .Med!camente e &au a !mente e care &unt !nh!,!tor! en$!mat!c! a! c!tocromu u! >?B5 pot d!m!nua ,!otran&formarea ,en$od!a$ep!ne or/re$u t(nd efecte de &uprado$are):e e0emp u/!nh!,!tor!! de CV>8A? 7 er!trom!c!na/c ar!trom!c!na/Aetocona$o /!trocona$o ca +! &ucu de #rapefru!t) .E !m!narea &e face pe ca e ,! !ar% +! rena % .T!mpu de 'nIum%t%*!re p a&mat!c a meta,o !*! or act!"! 9.de$a ch! a*! e&te un# 2pe&te ?5.B5 ore4) .T N a meta,o !*! or act!"! h!dro0! a*! poate f! !ntermed!ar 'n ca$u der!"a*! or de 8.h!dro0! a*! 2T N G C.11 ore4

9'-'3' Farmaco"inamie Mecanism "e aciune a4poten*area neurotran&m!&!e! !nh!,!toare med!at% de GA;A ,4!nh!,area recapt%r!! adeno$!ne! 'n neuron! Aciuni farmaco"inamice .an0!o !t!c% 7&e ect!"% - Meda$epam .&edat!".h!pno!nductoare- !nten&% a :!a$epam .m!ore a0ant%- !nten&% a :!a$epam .ant!con"u &!"ant%- !nten&% a :!a$epam +! C ona$epam

+rofilul farmacoterapeutic al unor #en5o"ia5epine

Efect3 ;en$od!a$ep!na ,ranch! !$ant 0edat!". @!pnot!c M!ore a0ant Ant!Ep! ept! c 88

Ind!ca*!! Terapeut!ce

:o$a u$ua % 2m#=o dat%

A pra$o am ;roma$epam C o,a$am C ona$epam C ora$epat :!a$epam F un!tra$epam Lora$epam Meda$epam 9!tra$epam O0a$epam

8 B 8 1 8 B 8 ? 1 8 ?

1 8 1 ? 1 8 B 8 1 ? 8

1 8 1 1 1 B 1 1 1 1 1

1 8 8 B 8 ? 8 1 1 8 1

, , , AE , ,4M4AE 1 , , 1 ,

5/1B.5/B 1/B.8 15.15 1.1 B.15 B.15 1.1 1.1 15 1/B.B 15.15

GInten&!tatea efecte or pre$entat% 'n #rade e de a 12efect foarte & a,4 a B 2efect foarte putern!c4 re$u t% d!ntr.un &tud!u c !n!c de t!p 'ncruc!+at) .0omnolena e&te cea ma! frec"ent% reac*!e &ecundar% a ,en$od!a$ep!ne or .O#i:nuina &e !n&ta ea$% dup% o adm!n!&trare 'nde un#at% cu tend!n*a cre+ter!! do$e or .Farmaco"epen"ena e&te de$"o tat% a adm!n!&trarea do$e or mar!/t!mp 'nde un#at Ind!ce e terapeut!c 'n ca$u ,en$od!a$ep!ne or e&te mare IT1555 'n compara*!e cu !nd!ce e terapeut!c a ,ar,!tur!ce or IT155)

9'-';' Farmacoterapie 'n &!ndromu an0!o&- .meda$epam 'n h!po&omn!!- .n!tra$epam 'n con"u &!! +! ep! ep&!e- .c ona$epam/d!a$epam/n!tra$epam 'n &pa&me mu&cu are- .d!a$epam 'm !nduc*!a ane&te$!e! #enera e- .m!da$o am/d!a$epam 8?

9'-'>' Interaciuni 0inergism .Efecte e ,en$od!a$ep!ne or &unt c!met!d!na/paracetamo /d!&u f!ram Antagonism .A&oc!erea ,en$od!a$ep!ne or 'ntre e e tre,u!e e"!tat%)Cre+terea do$e or/ca urmare/pro"oac% !nto0!ca*!! cu efecte parado0a e- de$or!entare/a#!ta*!e) poten*ate de !nh!,!toare e en$!mat!cee0)

9'-'D' Me"icamente tranc%ili5ante (E/)O.IA)E+I/E %&'$() $*&+*,',(-./(,: 2 : 6;.G 15<67 =0>,1;042? 6;.G? 1> 4C@5;.>Repre5entani d!a$epam/ meda$epam/ ,roma$epam/ c ora$epa& d!Aa !! &'.ia5epam Fcin' . !pof! !e 'na t%/cu a,&or,*!e per o& rap!d% +! comp et%L .&e d!&tr!,u!e rap!d pr!n ,ar!era hemato.encefa !c%/+! e&te urmat% de de red!&tr!,u!rea 'n *e&utu ad!po& Fter' .Ac*!une an0!o !t!c% . 8015m#=$! .Ac*!une m!ore a0ant% 7 85m#=$! .Ac*!une ant!con"u &!"ant% .Efect &edat!".h!pno!nductor. 'n h!po&omn!! B.15m# a cu care RA secun"are .&omno en*% .!ncoordonare motor!e.'n m!a&ten!a #ra"!& .depr!mare re&p!rator!e marcat% 2 inter5is consumul "e alcool 2 8B

.enumire comercial 1ia'epam 17mg / 2erapia 34 -'Me"a5epam +rofil farmacologic a&em%n%tor d!a$epamu u!L .T N un# .an0!o !t!c de !nten&!tate ma! redu&% .efecte & a,e ca m!ore a0ant/&edat!"/h!pnot!c/ant!con"u &!"ant Fter' Fgraf' .!nd!ca*!e ca an0!o !t!c/per o&/ 8 0 15m#=$! .enumire comercial 4n%ilan 17mg / 6e8 +&armace!tical%, 3lo*enia 0!dotel 17mg / 4A1 +&arma, Germania

3'(roma5epam +rofil farmacologic a&em%n%tor d!a$epamu u! cu poten*% ma! mare .T N e&te ma! m!c/ cca) 15.15 ore Fter' .!nd!cat ca an0!o !t!c/&edat!".h!pnot!c/m!ore a0ant .enumire comercial Calmepam 1,5mg B 3mg / Glaxo 3mit&8line, >gipt

9'Clora5epas "iHalii +rofil farmacologic a&&em%n%tor d!a$epamu u! .,!otran&formarea are oc 'n med!u #a&tr!c Fter' .!nd!cat ca an0!o !t!c +! ant!con"u &!"ant 8C

Fgraf' .ora 1B.15 m# 'n ma! mu te pr!$e .enumire comercial 2ranxene 5mgC 17mg / 3anofi, Frana

9'-'D'-' (en5o"ia5epine tip O<A)E+AM +rofil farmacocinetic- ,!tran&formare d!rect%/ T N &curt / durat% de ac*!une &curt% Repre5entani o0a$epam/ ora$epam &! Lora5epam Fcin' * T N !ntermed!ar/ poten*% ma! mare Fto7' .&omno en*% Fter' * !nd!cat ca an0!o !t!c +! &edat!".h!pnot!c .enumire comercial' 4nxiar 1mg / Gedeon 0ic&ter, 0omDnia

9'-'D'3' (en5o"ia5epine "e tip AL+RA)OLAM +rofil farmacocinetic T N +! durata de ac*!une &unt &curte p(n% a med!! Repre5entani- a pra$o am/tr!a$o am

&! Alpra5olam Fcin' *a,&or,*!e rap!d% per o& .T N de 15.1B ore F"in)-.an0!o !t!c cu aten*% +! durat% &curt% .nu are efect &edat!".h!pnot!c 4*antaE: efect!l antidepre%i* Fter' *depre&!e an0!oa&%/ atac de pan!c% 7 &e poate at!n#e do$a de 15m#=$! 8D

.enumire comercial 4lpra'olam 6+F / 6aborGed +&arma 34 ,0omDnia Hanax / Ielgia 9'-'D'9' (en5o"ia5epine tip ,OFI0O+AM &!,ofisopam Fcin' a,&or,*!e rap!d% +! comp et% Fter' an0!o !t!c cu aten*% +! durat% &curte In"icaie- ca an0!o !t!c Fto7' !nduce uneor! &omno en*%

9'3' ,ranc%ili5ante agoni:ti ;*1,&A Mecanism "e aciune4in"irect * a#on!&t a receptor! or B.@T1A pre.&!napt!c! . fa"or!$ea$% recaptarea &eroton!ne! +rofil farmaco"inamic: %electi* anxiolitic/nu are efect &edat!".h!pnot!c/m!ore a0ant

&! (uspirona Fcin' * ,!od!&pon!,! !tate per o& m!c% .e !m!nare rena % +! d!#e&t!"% Fter)-.'n an0!etatea cron!c% Fepi"' *Sedare & a,% Fto7' *re at!" frec"ente &unt- ame*e !/cefa ee/&tare de e0c!ta*!e/#rea*%

9'9' Alte tranc%ili5ante

&!1i"ro7i5in Aciuni *ant!&pa&t!c% 86

.ant!h!&tam!n!c% @1 .ant!&eroton!n!c% .efect ant!emet!c

-!Mepro#amat F"in' *poten*area depr!m%r!! S9C p(n% a com% .efect m!ore a0ant !nten& CI' *m!a&ten!a #ra"!& .cop!! &u, 8 an!

8E