Ministry of healthcare of the Republic of Moldova

State University of medicine and pharmacy

"Nicolae Testemitanu"

Department of Pharmacology and clinical

pharmacology
Boss Chair -Corresponding member of the Academy of Sciences of Moldova,
Prof. V. Ghicavi
Group Leader -Academy of Sciences ACC. to uni. V. Gavrilua

Clinical observation sheet

Done By:1) YEHYA SINYAL
2) SHIBLI BILAL

Group 1546

I. General data
Last name and first name: Rostislav Drobuenco
Years: 14.10.1938 (74 years old)
Sex: M
Profession and specialty: retiree
Domicile: or.Chisinau, str.G.Vieru 21/4
Date of entry : 07.05.2013
The type of entry: urgent
Diagnosis at admission: Cerebral Infarction, without further specifying
Clinical diagnosis: BCVA. Massive ischemic in concomitant baz. cerebellar tonsil
vertebrobazilar/right/cerebellum/SD. SD. bulbar in HYPERTENSION.III.
II. PRIMARY EXAMINATION IN CLINICAL
1. Charges:
Complaint: general weakness with a focus on the right. Diplopia from the look to the right, away
from disturbances. Disturbances of sensitivity in hemicorpul. headache, nausea, facial
asymmetry.
2. the present condition in History:
The patient feels sick from 06.05.2013 when they emerged: general weakness, disturbances of
gait. Ask the team is transported to 903, CNSPMU, interned in the Neurology Department CVD
and subjected to a conservative treatment.
3. Treatments carried out previously: sub-class

4. physiological Antecedents: married, 3 children.

5. Antecedentepatologice (in chronological order) -deny,
critically important-collateral (family tree) -deny
6. the harmful Obinuine-nufumeaz, consumes alcohol occasionally.
7. environmental conditions:satisfactory
III. EXAM SOMATO-VISCERAL OBJECTIVE
Overall condition: medium severity
Consciousness: clear
Constitution normostenic, height: 171 cm, weight 70 kg, T 22.8 C
State of nutrition satisfactory:
Skin and mucous membranes : hyperimate, moist
Palpaia lymph nodes: lymph nodes are not palpated
Muscles and bone-joint system :d built muscular force sufficiently diminuatn the light
dreapti exam on the same side.
RESPIRATORY APPARATUS:
The frequency of respiration-18 r/min;
Rhythmic breathing: normal;
Auscultation: unable to determine the circumstances;
CARDIO-VASCULAR DEVICE:
TA-130/90 mm Hg; Ps-88 b/min
Heart clear rhythmic noises
Lower limb examination without particulars.

Pulsation characteristics of peripheral arteries (carotid, radial, a., a. temporal femoral popliteal,
a., a. dorsalis pedis) without its peculiarities, auscultation vessels (carotid and vertebral column)
without modification.
THE DIGESTIVE SYSTEM
Abdomen: supple, painless.
Liver: rebordului rib on the right.
Spleen: it is not palpated.
THE URO-GENITAL TRACT
Symptoms: Swelling present. No sphincter disorders absent.
INSPECTION: sweelings absent in the lumbar region. Hyperemia of skin in this region.
PALPATION: the kidneys are not palpated, the bladder palpation-indolor.
PERCUSSION: maneuver tapotament is negative.
NEUROLOGIC EXAMINATION
1. Scales and degrees of evaluation: GCS M5 V3 O3 = 11 p.
State of consciousness: denotes a cerebral moderate alteration (obnubilare, stupor)
2. the CRANIAL NERVES:
B. OLFACTORY:
The patient experiences symptoms of pathological-euosmie
B. OPTICAL:
Visual acuity. The palpebral symmetrical. The position of the eyeballs on the average. Motility
of eyeballs in full volume. Color: normal vision. Papilledema, venous congestion, stasis,
papillary atrophy (primary, secondary)-absent.
NN. OCULOMOTORI (III, IV, VI):
Mark Mann-Gurevichi absent. Convergence diminished. A conspicuous absentee paresis. His
pupils OD, OS round shape. Living Fotoreaction OD, OS.
Conclusion: the absence of suffering nerve III, IV, VI.

B. TRIGEMINAL:
Sensitivity towards enshrined.Palpaia emergen Walleix points: incizura supraorbital, foramen
infraorbitalis, mentalis foramen rifle. Motor (mm. jaw): relief, ordinary power.
Corneani conjunctival Reflex: D = S.
B. FACIAL:
Conjunctival reflex. Mandibular alive diminished reflex. Central type paresis on the right.
B. REDUCTION-VESTIBULAR:
Auditory acuity preserved, nystagmus, Vertigo is absent.
NN. GLOSOFARINGIAN, LOOSELY, THE HYPOGLOSSAL:
Palatine wave asleep on the centre line, the contraction on the midline, for swallowing solids,
liquids preserved; language at rest on the centre line, at protruzie on the midline, normal fetus
hypotrophy and fasciculations are missing. Torque: dysarthria. Phonation: normal. Reflexes: gag,
of Palatine, Emetic wave: kept.Salivary function: kept.
B. ACCESSOR:
Head and shoulders retained motility.
1. SENSITIVITY:

Kind of disturbing: hipoestezie on the right. Type of disorder: central.

2. MOTILITY

From: Attitude mild paresis on the right guy.

Ortostaiune: deficil appreciated.
Hiperchineze: abs.
Seizures: abs
.
Pathological: abs fasciculation.
The muscular hands D_4: S_5 _ _; D_4 S_5 _ _ legs.

Muscle tone: upper extremities were normotonus, D hipotonus, lower limbs moderate
Snormotonus, D hipotonus.
High Reflectivity (normal, low-n-r, absent, invigorated, overly-ex) (=, >, <)
the humeroscapular D n D S > S
bicipital in D n D S > S
the tricipital D n D S > S
stilo-radial in D n D S > S
abdominal in D n D S > S
patellar in D n D S > S
Achilles refl ex D in n D S > S
plantar in D n D S > S
Pathological Reflexes negative:
3. CEREBELLAR FUNCTION

sample index-nas: incorrectly on D;

sample c-knee: incorrectly on D;
Romberg test: unstable with diversion to D.
4. ELONGAIE MANEUVERS

Mark NeriMatkevici-No Mark

5. MENINGIENE SIGNS

Negative. Occipital joint stiffness.

AUTONOMIC NERVOUS SYSTEM
Autonomic crises with panic attack suprasegmentar: deny.
Dermografism: ABS. Chvostek Sign. Vasomotor manifestations abs.
Secretory and trophic disorders: abs.
NO SPHINCTER FUNCTIONS: neagravate

CORTICAL BRAIN FUNCTIONS:

Warning: euprosexie. Available: Euthymius. Language: dysarthria. Psychic: orientation in time
and space kept; memoriepstrat; emotions in balance. Sleep: drowsiness.
CLINICAL PREVENTIVE DIAGNOSIS :
On the basis of the complaint: general weakness with a focus on the right. Diplopia from the look
to the right, away from disturbances. Disturbances of sensitivity in hemicorpul. headache,
nausea, facial asymmetry. We can make the diagnosis of: BCVA. Massive ischemic in
concomitant baz. vertebrobazilar/right/cerebellar tonsil SD. SD. bulbar/cerebellum part of HTA
gr.III.
Differential DIAGNOSIS:
Hemorrhagic concomitant
1. Onset: acute
2. Signs of onset: headache, Vertigo, nausea, vomiting, loss of consciousness
3. neurological Phenomena. passing the flaccid hemiplegia spastic
4. Time of occurrence: the physical exertion or emotion
5. the age of 40-50 years:
6. para:p uncie lumbar Exams: LCR-sangvinolent, TC-hiperdensitate area, Angiography,
determine the respective artery aneurysm.
Concomitant ischemic :
1. Onset: slow, progressive
2. signs of onset. headache, paresthesia, paresis, ameeli, afazii, without loss of consciousness
3. neurological Phenomena: aphasia, hemiplegia, which appears slow
4. Time of occurrence: at night or in the morning
5. Age of:p is 60
6. para:P uncie lumbar Exams: shows no changes, TC: massive hipodense areas surrounded with
penumbr areas, Angiography: it determines the level of stenosis or embolului.
Subarachnoid Hemorrhage :

1. clinical signs: severe headache, vomiting, neck pain, syncopation, photophobia, diplopia,
PTOSIS, the presence of meningiene signs: neck, Kernig sign redoarea, mark Brudzinskii sup.
and inf.
2. Onset: fever 38-39,
3. Laboratory Examinations uncie lumbar:P: CRL-hemorrhagic shock; Cerebral angiographythe presence of ruptured aneurysm;TC: cerebral hematoma, ass eyes: sdr. Ich;MRI at 4 to 7-day
determine the source of hemorrhage.
INVESTIGATION PLAN:
1. AGS
2. AGU
3. Nr.16
4. Coagulogram blood
5. Ionograma
6. Lipidograma
7. ECG
8. Pulmonary radiography
9. Spondilografia
10. CT scan
11. Doppler
12. USG abdominal organs
13.

Results
EKG:
Sinus rhythm with ventricular extrasistolie.
FCC-88 beats/min.
AEC-horizontal.
Signs of left ventricular hypertrophy with myocardial cells.
Extracranian: Doppler
Brahiocefalice bilateral permiabile arteries. At the bilateral level bulbar atheroma plates
heterogen local stenosis, over 35%, < 30% left. The arterial wall endured.
Computerized tomography cranio-cerebral native
Conclusion: the repeated ischemic stroke in bas.a.vertebrobasilare with 4 cm extended outbreak
in right cerebellar tonsil intrafocal moderate edema deployed mostly cortical. Sechela absent
paraventricular left in the postischemic 2 x 3 mm.
Complete Blood Count:
Hb-130 g/l
Erythrocyte-4,5 x 10/l12
IC-0,91
Platelets-224 x 109/l
Leukocytes-6.7 x 109/l

Hematocrit-0.41%
Neutrophil nesegm. -1%
Neutrophils segm. -68%
Eosinophils-1%
Lymphocytes-22%
Monocytes-8%
VSH-6 mm/h
Conclusion: within the limits of the standard.
Biochemical analysis:
Total protein: 56 g/l
Urea-3,2 mmol/l
Total bilirubin-12 mmol/l
Free bilirubin-9mmol/l
Glucose-6.1 mmol/l
ALT-14 u/l
AST-18 u/l
B-lipoproteins-42 a
Triglycerides-1,3 mmol/l
Total cholesterol-3 mmol/l
Conclusion: within the limits of the rule
Summary of urine:
Quantity-60 ml
-Neutral reaction
Colour-yellow
Transparency-transparency
Glucose + ++
Leukocytes-3-4 cv
Conclusion: glucozurie.
.
Chest x-ray:
Conclusion: pulmonary venous Congestion. Diffuse changes of myocardium.

Clinical diagnosis
On the basis of the complaint: general weakness with a focus on the right. Diplopia from the look
to the right, away from disturbances. Disturbances of sensitivity in hemicorpul. headache,
nausea, facial asymmetry.Investigations:
Extracranian: Doppler
Brahiocefalice bilateral permiabile arteries.At the bilateral level bulbar atheroma plates
heterogen local stenosis, over 35%, < 30% left. The arterial wall endured.
Computerized tomography cranio-cerebral native

Conclusion: the repeated ischemic stroke in bas.a.vertebrobasilare with 4 cm extended outbreak

in right cerebellar tonsil intrafocal moderate edema deployed mostly cortical. Sechela absent
paraventricular left in the postischemic 2 x 3 mm.
We can provide clinical diagnosis:
BCVA. Massive ischemic in concomitant baz. vertebrobazilar/right cerebellar
tonsil/cerebellum/SD. SD. bulbar partially HTA gr.III.
Treatment plan:
A. nemedicamentos treatment
1. bed occupancy
2. 9 Diet
B. medication
1. Asparcam10, 0 + ground soil NaCl 0.9% 200,0 i/v
2. Ringer500 + sol Sol.. MgSO425%-10.0-i/v
3. Spironolactone 25 mg Tab.-2 morning tab
4. Lisinopril Tab 20,0-1/2 tab 2 times/day
5. Sol. Fraxiparin-0.3 ml subcutaneously-12.00
6. Tab Cardiopirin 325- tab/day
7. Sol. Vit. B1-5%-2ml-i/m 12.00
Medicines
The date of administration of drugs
7.0 8.0 9.0 10.0 11.0 05.12.0
5
5
5
5
5
6
Asparcam 10,0 +
Sol. sol. NaCl 0.9%
200,0 i/v
Sol. Ringer 500 +
ground.MgSO425
%-10.0-i/v
Spironolactone 25
mg Tab.
2-morning tab
Tab Lisinopril20
tab 2ori 1/2, 0/day,
YOUR control
Sol. Vit. B1-5%-2,0
i/m, 12.00
Fraxiparin 0.3 ml,
subcut-kristijan
100.000,00
Cardiopirin 325
Tab.
day tab
Sol.Ac.
nicotinic1%-2mli/m 19.00

Ma
y
14
+

13.0
5

15.0
5

160.
5

8. 1% Sol.Ac.nicotinic-2ml-i/m 19.00

Action mechanism of treatment in inpatient

1) izotonica Solution of sodium chloride (0.9%)
Properties
Sodium chloride contains over 90% of the serum inorganic salts. In solutions of sodium chloride
dissociates into ions of chloride (Cl-) and sodium (Na +) that are normal constituents of body
fluids (predominantly extracellular) and are essential in maintaining fluid and electrolyte
balance. The use of sodium chloride in saline (0.9%) solution as the vehicle for parenteral
administrrile of certain medicinal substances cannot affect electrolyte balance, except small
children. In the form of a 10% solution (hypertonic saline solution) is used in surgery for the
treatment of wounds (desiccant and antibacterial effect).
Indications
Dissolving or diluting substances administered i.v., i.m. or s.c., preparing solutions to rehydrate
the body, extemporale (isoton solution).
Contraindications
Congestive heart failure, circulatory insufficiency or renal hipoproteinemia.
Dosage
To rehydrate the body you use saline (salt solution isoton) in volume of 500 to 1000 ml in
infusion i. v. Rehydron form of peroral is given up to 1000 ml. isoton salt Solution is used as the
vehicle for the dissolution of medicinal substances and solutions; the volume depends on the
solubility of substances and their dose.
Adverse effects
Fizilogic serum may be responsible for fever, tachycardia, edema, dyspnea, headache, dizziness,
weakness, headaches, prolonged use, acidosis reactions anaphylactoid reactions to infusion
preparations with low temperatures, unqualified (this impurities).
2) Asparkam
Composition
Kalii aspartas Magnesii aspartas 45 mg, 40 mg. Vehiculum ad well.
Presentation
Solution for injection in vials 5 ml 10 N.
Pharmacological features
Magnesium and potassium ions involved in metabolic processes. Enter the cells thanks to
asparaginatului who plays the role of these intracellular anion transporter. Fluid and electrolyte
imbalance, banished preparation reduces the excitability and conductivity of the myocardium
(moderate antiarrhythmic effect).
Indications
Heart rhythm disturbances related to toxic effect of digitalei, extrasistolia, paroxysms of atrial
fluter.Chronic heart failure, angina pectoris, diverse States of shock of Genesis.
Therapeutic use
10-20 ml of the infusion i/v 1-2 times a day. The injection solution is diluted in 100 or 200 ml of
water for injection, or 5% glucose solution and is given by the rate of 25 drops/min can be given
in higher concentration solution jet injection in an equal volume of water for injection, or 5%
glucose solution. Speed infusion 5 ml/min.

Adverse Effects : Are possible dizziness disappear on decreasing the dose.

Contraindications Atrioventricular Block: grade II or III, particularly associated with other
rhythm disturbances. Acute or chronic renal failure, hyperkalemia.
Interactions : Reduces the effect of cardiac glycosides.
3 MAGNESIUM SULPHATE) 25%-10.0
Magnesii sulfas
Pharmaceutical form: solution for injection
The description of the preparation: Transparent, colorless liquid.
The composition of the preparation: 1 ml solution for injection contains: active substance:
magnesium sulfate 0.25 mg; auxiliary substances: water for injections.
Pharmacotherapeutic and ATC code: Electrolyte. Osmotic purgative.B05X A05.
PHARMACOLOGICAL PROPERTIES
Magnesium is the second cation according to potassium in intracellular fluid. It is essential in the
activity of many enzymes and enzymatic systems and plays an important role in the transmission
of the nervous impulse and muscle excitability. Magnesium in the extracellular fluid
insufficiency leads to removal of acetylcholine, increase excitability and muscle tetany, seizures,
tingling, depressive, ventricular tachycardia, extrasistolie, pectoral angor. Decreases the
frequency of sino-atrial node and in high concentrations (more than 15mEq/l) causes cardiac
arrest in diastole. Excess magnesium causes vasodilation through direct action on the vascular
musculature and indirect blockade of ganglia. The kidney is excreted by glomerular
filtration.Has properties hypotensive effects, sedatives, anticonvulsants and spasmolytic. The
intraduodenal stimulates the release of colecistochinin and elimination of bile from the gall
bladder (colecistocinetic effect).
Taken internally it acts as osmotic purgative.
THERAPEUTIC INDICATIONS
Puseurile with symptoms of hypertensive cerebral edema; Paintball toxicosis late pregnancy
(preeclampsia and eclampsia); convulsive syndrome. Hipomagnezemia and magnesium
deficiency in cases of undernourishment or unbalanced nutrition, treatment with contraceptives,
diuretics, muscle relaxants, chronic alcoholism, cardiac arrhythmias, particularly those
associated with or supraventricular antiarrhythmic treatment with corticosteroids or diuretics,
cardiac glycosides. Myocardial infarction. The States need in magnesium is increased (load,
stress). Intoxication with mercury, arsenic, lead-driven.
POSOLOGY AND METHOD OF ADMINISTRATION
5-10 ml i.m. or i.v. slowly. It is possible the rapid inhibition of the respiratory center. Internal 1530 g as an osmotic cathartic.
SIDE EFFECTS
Perspiraie, feeling the heat, hypotension, circulatory collapse, cardiac and CENTRAL
NERVOUS SYSTEM depression. Inhibition of breathing is the most serious struck.
CONTRAINDICATIONS
Diseases of the myocardium or cardiac blockade, myasthenia, severe bradycardia, severe renal
failure, hypotension, inhibition of respiratory center, hypocalcemia, caexia.
OVERDOSE
Symptoms: nausea, vomiting, respiratory inhibition, hypotension, bradycardia, inhibition of CNS
and dilating peripheral blood vessels.

Treatment: chloride or calcium gluconate i.v. (100-200 mg of calcium in 15-20 min.). Control of
CNS and cardiovascular system.
WARNINGS AND SPECIAL PRECAUTIONS FOR USE
Can be used in the treatment of status epilepticus (status epilepticus) as an adjuvant.In the coadministration with CNS depressants or in renal failure will adjust the dosage of magnesium
sulphate.During childbirth may inhibit uterine contractility.It is recommended always had the
chloride or calcium gluconate as an antidote.
INTERACTIONS WITH OTHER DRUGS
Increases the effects of general anesthetics, depressants and other inhibante hipnoticelor of the
CNS.Calcium ions necessarily antagonize each other effects of magnesium ions.
4 Ringer Solution) 500 ml
500 ml infusion solution in vials.
Composition
Sodium chloride 8.6 g, potassium chloride 0.3 g, calcium chloride 0.33 g, Vehicle ad 1000 ml
(Na+ 154 mmol/l, K+ 4 mmol/l, Ca++ 2.25 mmol/l, Cl- 155,6 mmol/l).
Therapeutic
Intake of liquids and electrolytes to fill the loss of liquids extracellular and losses of electrolytes .
Tips
Refill liquid-electrolyte losses, in case of dehydration hypo-and izotona, associated with the
following situations: soc ; collapse; Burns ; frostbite ; repeated vomiting; diarrhea etc.
Posology and method of administration
It's given intravenously infusion in slow (60-70 drops/minute), adults in a dose of 500-1 000 ml,
and in children depending on age and body weight.
Contraindications
Hipervolemie, hipercloremie, hypercalcemia .
Precautions
Because of the increased concentration of chlorine ions in solution compared to their blood
concentration, does not recommend prolonged administration of this solution.
Side effects: unknown.
SPIRONOLACTONE 25 mg)
Pharmacotherapeutic group: sparing agents; anta-goniti you aldosteronului.
Therapeutic indications
Treatment brief of preoperative hiperaldosteronismului. If the patient is inoperable or refuse

surgery, treatment may be permanent.

Swelling of various causes with hiperal-dosteronism, the Association of spironolactonei with
other diuretics, salt and fluid restriction, possibly bed rest.

Swelling jn the heart failure If the patient no longer responds to other diuretics and/or to
potentiate its effect.
Edema and/or ascites in patients with cirrhosis of the liver.
Nephrotic syndrome, if ill-treatment-iunii base or salt and fluid restriction, as well as taking
other Diuretics are proving ineffective.
Essential hypertension, in spe-cial in case of hypokalemia, is associated with medication
antihipertensiv. Hypokalemia, if it cannot be applied to other treatment.
Contraindications
Spironolactone and hypersensitivity to any of the excipients. Anuria, acute renal failure, chronic
renal insu-designed to be severe (creatinine clearance of created ' Nina < 10 mL/min).
Hyperkalaemia.
Acute or severe hepatic impairment. Concurrent treatment with salts of potassium and/or other
hiperkalemiante-diuretics (amiloride, triam-land).
Precautions
Extra potassium intake is contraindicated in treatment with spironolactone. Spironolactone
treatment usually requires the monitoring of renal function and serum electrolytes. Spironol '
actona like other diuretics in doping substances to athletes list.
Interactions
Spironolactone potentiates the effect of other diuretics or antihypertensives, when given in
association with them.It is therefore necessary to reduce the dosage of these drugs, particularly
patoplegicelor, sim when spironolactone is associated.
Concomitant administration of diuretics sparing, angiotensin-converting enzyme inhibitors (IEC)
or of indome-tacin can cause a severe hyperkalaemia.
Spironolactone decreases the vascular response to norepinephrine. Therefore caution is advised
in patients undergoing General or regional anaesthesia. Spironolactone prolongs the half-life of
Digoxin increased counselling secutiv toxic risks. If the patient has supravegheatatent
spironolactonei Association to avoid overdose of cardiac glicozidei. Spironolactone is not
associated with other diuretic hiperkaliemiante (triamterene, amiloride), potassium salts, with
angiotensin-converting enzyme inhibitors and with tacrolimus because of the risk of
hyperkalaemia, indicated especially in patients with renal insufficiency. The association with
lithium salts may cause increasing litemiei with desupradozaj symptoms.
Caution should be exercised when combined with high-dose salicylates: and ahtiinframatoare
drugs, iodine contrast products (risk of acute renal failure under conditions of dehydration),
baclofen (increase the hypotensive effect), metformin (increased risk of lactic acidosis, especially
in the presence of renal insufficiency). Spironolactone can interfere radioimunologic to digoxin
dosing, but significant clinical ficaia, this phenomenon is not known.
Special warnings
Spironolactone may cause electrolyte imbalances. In patients with kidney failure or who are
receiving potassium supplements can produce important disorders of hiperkaliemje heartbeat. in
the case of hyperkalaemia discontinue IUD-reticle, is injected intravenously
glucose and insulin. Cirrhosis from hyperkalemia may be accompanied by metabolic acidosis
hipercloremic reversible. At diabetic hyperglycemia growth potasemiei. He was also reported to
increase serum levels of urea, especially in the case of pre-existing renal impairment.
The ability to drive or operate machinery

At the beginning of treatment, patients should be warned to be cautious when carrying out
activities which require attention (e.g. driving or using machines complex). Subsequently, the
measures of restriction will be individualized.
Dosage and method of Administration
Primary hyperaldosteronism, to prepare-preoperative; 100 re-400 mg of spironolacto daily
missus.If the patient is inoperable, the initial dose may be reduced to once every 2 weeks until
the minimum effective dose, which is administered for a long time, if long-term treatment is
recommended to pair with other diuretics, to reduce the risk of the oppo-se.
Edema (heart failure congesti, cirrhosis, nephrotic syndrome) Adults: initially 100 mg
spironolactone/day in two doses; the dose may vary between 25 mg and 8 mg
spironolactone/day. For larger doses, association with other diuretics, without altering the dose of
spironolactone. Children: 3 mg/kg/day and spironolactone, in one or two doses.
High blood pressure: initially 50-1/day, spironolactone OOmg in two doses, in association with
other antihypertensives. Snakes-cold effect is entirely after those 2 weeks, it uses this period,
after which the dose eventually treatment is continuing and the dosage is individualized.
Hypokalemia: OOmg spironolactone 25-1, daily oral intake of potassium if you or other
potassium-saving method cannot be used for side effects
High doses of spironolactone and sweet treat-long tulle can be cause of Gynecomastia used
reversible.
Other common side effects are rare and reversible: sexual impotence, menstrual disorders,
digestive intolerance, rashes, drowsiness. Diureticul can grow moderately potasemia. In patients
with kidney failure when they are associated with salts of potassium and at ' eei under treatment
with IEC marked growths may occur in the kaliemiei. In this case discontinue spironolactonei
and correct this imbalance elec-trolitic.
There have been reported cases of breast carcinoma in patients treated with spironolac-tonne, but
the causal relationship has not been established.
Overdose: symptoms of overdose with spironolac-tonne are: oracit, hyperkalaemia, acidosis. in
case of overdose, it is necessary to administer diuretics that potassium (thiazides, furosemid),
and the introduction of parenteral glucose and insulin. in severe cases it is advisable to
hemodialysis.
6) LISINOPRIL 20,0
DCI active substances: Lisinoprilum
Pharmaceutical form: tablets
Description of preparation: for a dose of 10 mg tablets of white or white with yellowish shade,
sharp edges.
for a dose of 20 mg tablets of white or white with yellowish tinge to the Division diametral on
one side of the Tablet, sharp edges.
The composition of the preparation: lisinopril dihydrate 10 mg and 20 mg;
Auxiliary substances: lactose monohydrate, calcium stearate.
Pharmacotherapeutic and ATC code: C09A A03 Inhibitor of angiotensin-converting enzyme
inhibitor.
PHARMACOLOGICAL PROPERTIES
Pharmacodynamic properties
Angiotensin-converting enzyme Inhibitor.Inhibits the conversion of angiotensin I to Angiotensin

II. The latter has strong effects and effects, in addition, stimulates synthesis aldosteronului of
tre corticosuprarenale, which in turn retain water and sodium in the body. Decreases peripheral
vascular resistance formula, decreasing postsarcina, does not alter or even increase circulation
and renal glomerular filtration rate as urolithiasis, thus preventing the development of diabetic
nephropathy,.Lisinoprilul decreases blood pressure, causing no compensatory
tachycardia.Decreases also decreases pressure in presarcina, right atrium and small circuit
decreases the left ventricolului hypertrophy.Lisinoprilul does not affect glucose metabolism,
lipoprotein and sexual function.Antihypertensive effect is manifested in the upright position and
in a horizontal position. Sudden discontinuation of treatment does not lead to the rapid increase
in blood pressure. Inhibition of angiotensin-converting enzyme in myocardium cardioprotective
effects due to accumulation of bradykinin. The internal administration of hypotensive effect
develops over one hour, achieves maximum effect over 4-6 hours and is maintained up to 24
hours. To get a stable level of blood pressure is necessary to administer the preparation over the
course of a few weeks. In heart failure, the management of the preparation (over 6 months)
increase resistance to physical exertion, decrease heart size dilated, decreases mortality rates.
Pharmacokinetic properties
After internal administration is slowly absorbed Lisinoprilul from the gastrointestinal tract.
Absorption is about 25%. Maximum plasma concentration is reached over 7 hours.Plasma
protein is insignificant. Delete as with urine unchanged. In patients with intact renal function T
is 12 hours. Lisinoprilul can be removed from the body by hemodialysis.
THERAPEUTIC INDICATIONS
Essential hypertension, especially with hiperreninemie, alone or associated with diuretics;
diabetic nephropathy, secondary hyperaldosteronism, Raynoud disease, HYPERTENSION in
patients with Scleroderma; congestive heart failure.
POSOLOGY AND METHOD OF ADMINISTRATION
The dose is determined individually depending on the patient's condition.It is administered once
a day. The initial dose in HYPERTENSION is 2.5-10 mg. Dose of 5-40 mg. the highest dose
nictemeral-80 mg.
SIDE EFFECTS
The cardiovascular system: seldom-hypotension (orthostatic), defective orthostatic collapse,
heart rhythm disturbances, angina pectoris, myocardial infarction, cardiac arrest, heart
palpitations.
On behalf of the central and peripheral nervous system: headache, Vertigo, dizziness, feeling of
fatigue, acute cerebral circulation disorders, depression, ataxia, seizures, drowsiness or insomnia,
peripheral neuropathy, disturbances of consciousness, irritability, syncope, disturbance of
memory and vision, tinnitus.
The part of the respiratory system: often-dry cough (usually disappears after a few weeks after
the discontinuation of the preparation), changes in voice, tromboembolia branches pulmonary
artery, dyspnea, bronchospasm, bronchitis and other upper respiratory infections, lung malignant
tumors, rhinorrhoea, nasal hemorrhage, hemoptysis, pleural effusions.
The part of the digestive system: seldom-nausea, senses, taste disturbances, diarrhea, dry mouth,
vomiting, heartburn, flatulence, abdominal pain, gastritis, stomatitis, Glossitis, melen,
constipation, pancreatitis, liver function disorders: Hepatocellular necrosis, cholestatic jaundice,
liver transaminase level increase, hepatitis.
The Osteoarticular system: seldom-articular muscle cramps, arthritis, pain in the back.
Allergic reactions: rarely skin rashes, urticaria, angioedema, Stevens-Johnson Syndrome, toxic

epidermal necroliz.
Dermatological reactions: photosensitivity, Pemphigus rarely, herpes zoster, alopecia.
From the reno-urinary disorders: reversible renal function accompanied by increased
concentration of urea and creatinine in the blood, proteinuria, after suspending the preparation of
their respective indices are normal; acute renal failure, pyelonephritis, dysuria, oliguria, anuria,
decreased libido.
The hematopoietic system: seldom-inhibition of bone marrow, anemia, leukopenia,
thrombocytopenia, agranulocytosis, neutropenia.
Other: in the scientific literature have appeared information about lupic syndrome (hyperthermia,
arthralgia, myalgia, serozit, leukocytosis, Eosinophilia, Vasculitis).
(Increase) decrease in body weight, diabetes, gout, dehydration, hyperkalaemia, hiponatriemie.
CONTRAINDICATIONS
Hypersensitivity to the preparation, angioneurotic edema in history to management of other
inhibitors of angiotensin-converting enzyme, hyperkalemia, Porphyria, pregnancy, lactation, age
up to 18 years.
OVERDOSE
Symptoms: hypotension, marked up to development of the collapse, myocardial infarction, acute
movement disorders thromboembolic complications or brain, convulsions, stupor.
Treatment: horizontal position; gastric washings, activated charcoal; isotonic saline solution
intravenously infusion, hemodialysis.
WARNINGS AND SPECIAL PRECAUTIONS FOR USE
It is important to keep in mind that in patients with severe heart failure, serious impairment of
renal function, patients with disorders of fluid and electrolyte balance (caused by administration
of diuretics as a consequence of the restriction of salt pans, the patients who have recently
suffered from diarrhea, vomiting) hypotensive effect may occur later, over a few hours after
taking the first dose.
With caution, because of the risk of hypotension, indicate patients with ischemic heart disease,
cerebrovascular disease, severe aortic stenosis. In the event of hypotension patient needs to take
horizontal position and seek medical help. Arterial hypotension with severe consequences meets
infrequently and transitional nature. Transient hypotension low blood pressure is not a
contraindication to continuing treatment. To stabilize blood pressure treatment can be continued
in therapeutic doses.
If the patient with hypertension previously administered the diuretic should be discontinued with
2-3 days before the start of treatment with lisinopril, otherwise increase the risk of low blood
pressure. If the restriction is not possible, diureticului Lisinoprilul should be administered in
small doses. In the case of heart failure chronic dose diuretics shrinks.
Administration of the preparation is to be avoided in patients with bilateral renal artery stenosis
or stenosis of the artery only kidneys. Up to the onset of treatment and progress will monitor
renal function.
Patients with diabetes mellitus with normoalbuminurie lisinoprilul shall indicate only after
assessing renal functional reserve in the case of micro-and macroalbuminurie-without preventive
assessment.
During the treatment with lisinopril may increase potassium levels in blood, especially in
patients with chronic renal failure, diabetes mellitus, concomitant diuretic with potassium or with
highly prepared kalium promotes.These patients should be warned about the need for consulting
a doctor when the muscle weakness and arrhythmias. Patients taking lisinopril shall be prohibited

from drinking alcohol because of the risk of hypotension.

In the event of adverse effects or angioneurotic edema will stop taking lisinoprilului and indicate
that treatment.
It will prohibit the administration of preparation before researching parathyroid gland function.
Caution in carrying out the exercise in the warm period of the year because of the risk of
dehydrating and essential decrease of yours, as a consequence of the decrease in the volume of
circulating blood.
Before surgery is necessary for surgeon and anesteziologul about pre-empted the administration
of angiotensin-converting enzyme inhibitors.
While taking lisinopril in patients undergoing dialysis, allergic reactions may occur due to the
use of several types of membranes used in hemodialysis, Hemofiltration, etc. Do not take
preparation of children, since the efficacy and safety of lisinoprilului management in children is
not studied.
During the treatment with lisinopril needed refrained from driving and practicing activities that
require increased attention and psychomotor speed reactions.
INTERACTIONS WITH OTHER DRUGS
The concomitant administration with sparing diuretics (amiloride, triamterene, spironolacton) or
preparations of potassium, increases the risk hiperkaliemiei.
Management of lisinoprilului in combination with diuretics, beta-adrenoblocante, metildopa,
nitrates, calcium channel blockers, hidralazin, prazosin-hypotensive effect intensifies.
The coadministration of NSAIDs decreases antiinflamatoarelor effect of lisinoprilului
disturbance and increase the risk of renal function.
The coadministration of lisinoprilului with ethanol and other general anesthetics remedies
increases the risk of hypotensive.
Managing lisinoprilului with cardiac glycosides clinical significant interactions are not detected.
Lisinoprilul reduced action of theophylline-containing preparations.
The coadministration of lisinoprilului with lithium lithium elimination, decreases intensifies his
action and increase the risk of toxicity (will perform monitoring plasma concentration of
lithium).
The coadministration of cimetidine increased the period with lisinoprilului half-life of
lisinoprilului.
Imunodepresantele, alopurinolul, increase the risk of Hepatotoxicity cytostatic lisinoprilului.
Preparations which inhibits bone marrow function increase the risk of neutropeniei or
agranulocitozei to end lethal.

7, Fraxiparin injectable solution) 0.3 ml s.c.

Composites
For 1 ml injectable solution prefilled syringes: Nadroparina calcium salt (DCI) 9 500 IU anti-Xa;
calcium hydroxide solution or hydrochloric acid diluted q.s. ad pH 5,0-7,5; water for injection
q.s. ad 1 ml.
Excipients: calcium hydroxide Solution or hydrochloric acid diluted solution; water for
injections.
Pharmaceutical form: injectable Solution prefilled syringes in conditional

ntinand:
Tips
Prophylaxis of thromboembolic disorders: in particular, those associated with General or
orthopedic surgery; in patients at high risk (respiratory failure and/or respiratory infection and/or
heart failure), hospitalized in intensive care Service. Treatment of thromboembolic
disorders.Prevention of clotting during hemodialysis.Treatment of unstable angina and
myocardial infarction without Q wave.
Contraindications
Hypersensitivity to nadroparina; history of thrombocytopenia due to nadroparinei (see Special
Warnings); ongoing bleeding or hemorrhagic increased risk correlated with impaired hemostasis,
clotting intravasculare disseminated except neindusa of heparin; organic lesions capable of
spotting (such as pepetic active ulcer); hemorrhagic stroke; acute bacterial endocarditis.
Precautions
Monitoring the number of platelets. Due to the possible risk of heparin-induced
thrombocytopenia, during treatment with Fraxiparine must carry out periodic monitoring of the
number of platelets. There were some rare cases of thrombocytopenia, occasionally severe; they
can be associated (or not) with arterial or venous thrombosis, a situation in which the treatment
must be interrupted; This diagnosis should be considered in the following cases:
thrombocytopenia; any significant decrease in platelet numbers: 30-50% of the normal value;
makes initial thrombosis under treatment; thrombosis arising under treatment; disseminated
intravascular coagulation. These effects are probably the nature of the imunoalergica in the case
of an initial treatment they have been mainly reported between 5 and 21 days, but they can occur
much sooner, if there is an antecedent of thrombocytopenia due to heparin.
If there is a history of thrombocytopenia due to heparin (standard or low molecular weight), can
be considered a therapy with Fraxiparine, if the administration of heparin is required; in this
case, monitoring the platelet count of careful and clinic will be carried out at least every day. If
thrombocytopenia occurs, treatment should be stopped immediately, since recaderi have been
reported.
In case of trombocitopeniei during treatment with heparin (standard or low molecular weight),
can be taken into account when replacing with another low molecular weight heparin, heparin is
administered if necessary. In this case, monitoring will be done at least daily, and the treatment
will be interrupted as soon as possible, as they have described cases of thrombocytopenia, which
continued after the replacement of heparin.
Platelet aggregation assays in vitro are of limited value.
Concomitant use of NSAIDs or salicilati represent a relative contraindication to administration of
nadroparinei, as well as the use of antiplatelet agents. In case of unstable angina and myocardial
infarction without Q wave, treatment with Fraxiparine are associated with aspirin in doses of up
to 325 mg/day (see Dosage and administration and Drug Interactions).
Special precautions
Is administered with caution in the following cases: liver failure; renal failure (in patients with
severe renal failure can be considered low doses); severe hypertension; a history of peptic ulcers
or other organic lesions at risk for bleeding; vascular disorders of choroid and retina; in the postoperative period, provided the surgery on the brain, spinal cord and eyes. Heparin can suppress

the secretion of aldosterone, corticosuprarenala leading to hyperkalaemia, especially in patients

with increased levels of potassium in plasma, or at risk of increased plasma potassium, such as
patients with diabetes, chronic renal failure, metabolic acidosis pre-existence, or treatments with
drugs that can increase kaliemia (eg, angiotensin-converting enzyme, NSAIDs). Hiperkaliemiei
risk appears to increase with the duration of treatment, but usually it is reversible. Plasma
potassium should be monitored in patients at risk. The risk of spinal epidural hematoma/is
increased in case of using of epidural catheters or in case of concomitant administration of other
drugs that affect hemostasis, such as NSAIDs, platelet or other anticoagulants. Also, the risk
seems to be increased via punctiile epidural or spinal trauma, or repeated. Consequently, in the
following situations, concomitant with the prescribing a general anesthetic or anticoagulant
should be decided after a careful assessment of individual benefit/risc: To patients already being
treated with an anticoagulant, the benefits of a general anaesthesia must be carefully evaluated,
compared to the risks. Patients to undergo surgery with General anesthesia, selective,
anticoagulant therapy benefits must be carefully evaluated in comparison with the risks. In the
case of patients with rahianestezie lumbar puncture, or epidural anesthesia, have kept a sufficient
time interval between the moment of injection and insertion or removal of spinal or epidural
catheter or the needle.
Patients should be monitored frequently for signs and symptoms of neurological impairment, and
if a neurologic deficit discovery, treatment should be started.
Medicinal interactions
Concomitant use of aspirin (or other salicilati) or anti-inflammatory drugs is not recommended,
nor the use of antiplatelet agents (see Special Warnings) because they may increase the risk of
bleeding. If such combinations cannot be avoided, it should be done a careful clinical and
biological monitoring. Fraxiparine should be administered cautiously to patients under treatment
with oral anticoagulants (gluco-) systemic Corticoids and dextrani. If a initiated treatment with
oral anticoagulants in patients under nadroparina, administration of heparin will be continued
until the INR is stabilized at the desired value.

Adverse reactions
In common with other hemorrhagic Manifestations: heparine in several countries, most
commonly in patients with other associated risk factors (see Contraindications and Drug
Interactions). It was reported some cases of thrombocytopenia, sometimes trombogena (see
Special Warnings). The use of standard weight heparine molecular little reported some rare cases
of cutaneous necrosis, usually that will arise at the injection site; These are preceded by Crimson
or painful erythematous posters or infiltrates with or without systemic signs. In such cases,
treatment should be discontinued immediately.Slight bruising at the injection site.In some cases,
it may be observed emerging from nodules of consistency, which, however, does not indicate an
inchistare of heparin. These nodules disappear usually after a few days. Cutaneous reactions.
In addition, the following events may occur: Eosinophilia reversible after discontinuation of
treatment; generalized hypersensitivity reactions, including angioedema; increased transaminase,
usually transient; very rarely, priapism were reported and some cases of hyperkalaemia
reversible, due to suppress induced by aldosteronului heparin, especially in patients with risk
factors (see Special Warnings and special Precautions).

Pharmacodynamic properties
Fraxiparine is a low molecular weight heparin obtained by depolimerizarea standard heparin. It is
a glicozaminoglican with an average molecular weight of approximately 4 300 daltons. A report
of the activities of anti-Xa/anti-IIa. Antithrombotic action both possess Fraxiparine immediate
and prolonged.
Pharmacokinetic properties
Kinetics profile was determined by measuring plasma anti-Xa activity. the plasma Peak occurs in
4-6 hours after administration of subcutaneous injection. The Administration repeated
elimination Semiviata is about 8-10 hours. Anti-Xa activity (> 0.1 IU/ml) persist for at least 18
hours after administration. Bioavailability is almost full (about 98%).
Method of administration
General Surgery: Fraxiparine should be given in a single daily dose of 0.3 ml, on a usual period
of not less than 7 days; in all cases prevention must be continued throughout the period, and at
least until the patient has been discharged. In general surgery, the first dose should be
administered with 2-4 hours before surgery.
Thromboembolic disorders: treatment should be administered subcutaneously Fraxiparine, twice
a day (every 12 hours), usually for 10 days, the dose was adjusted to body weight, according to
the table below:
Treatment of thromboembolic disorders
Body weight (kg)
< 50
50-59
60-69
70-79
80-89
> 90

Fraxiparinea volume of
injected subcutaneously
twice/day
0.4 ml
0.5 ml
0,6 ml
0.7 ml
0.8 ml
0.8 ml

Oral anticoagulant treatment is initiated as soon as possible, if there's no contraindication.

Treatment with Fraxiparine should not be interrupted before it reaches the INR watched.
During treatment with platelet number Fraxiparine should be monitored (see Special Warnings).

8 Cardiopirin 0,325) tablets -internal; 1 tablet per day-more than one day
The active substance of INNS
Acidum tetracycline
Pharmacotherapeutic group
Antiinflammatory drugs.Derivations of the salicylic acid.Analgezice.Antipiretice.Antiagregante.

Properties
Analgesic, antipyretic action manifests, anti-inflammatory, antirheumatic, and antiagregant
through acetilarea and inactivation of the cyclooxygenase and prostaglandin synthesis, reduced
to2tromboxanului. Analgesic effect of peripheral and Central origin. At the periphery tissue
reduce prostaglandin levels decrease the sensitivity of receptors algogene substances, nociceptivi
and encephalon acts in the hypothalamus via an unknown mechanism. All in the hypothalamus
and antipyretic effect manifests, perhaps by reducing the concentration of prostaglandins and
termoreglator Centre due to peripheral and sudoraiei vasodilataiei. Synthesis of tromboxanului
in blood platelets is irreversible and the urmere effect of antiaggregatory agent. Platelet
cyclooxygenase activity gradually resumed since the emergence of the new stickers.
Indications
Weak and moderate similarity, rheumatic diseases, fevers, prophylaxis of thrombosis and
cerebral vascular disorders, emboliilor and coronary heart disease, infarction period.
Contraindications
Gastrointestinal Ulceraiile in a growing phase, hipocoagulabilitatea blood and bleeding of
diverse Genesis, pregnancy, hypertension, hypersensitivity to the preparation or salicylates.
Dosage
Adults up to 3 g per day.Children over 5 years 10-15 mg/kg in a pinch. In rheumatic diseases,
adults 3-4 g/day, children 0,2 g per year of life. That 300-325 antiaggregatory agent mg 3 times
daily prophylactic purposes, 100 mg/day or 250-300-325 mg twice a week.
Overdose
In mild cases nausea, vomiting, epigastric pain, tinnitus, dizziness, headache. In serious cases the
incoherent thinking, drowsiness, tremor, dyspnea, collapse, or hiperpnee, dehydration,
hyperthermia, alkaline urine, respiratory alkalosis, metabolic acidosis (gas), disorders of
carbohydrate metabolism, possible hyperactivity, convulsions, coma. Lethal dose is over 10 g for
adults and children over 3 g. Treatment: Vomiting induced or gastric lavage, activated charcoal,
saline laxative (osmotic). Depending on the acid-base balance and electrolyte-infusions of
sodium bicarbonate, sodium citrate or sodium lactate.Symptomatic therapy.
Interactions
Ascorbic acid increases the effect of indirect anticoagulants (risk of bleeding), the specific action
and side effects of steroidal, oral antidiabeticelor antiinflamatoarelor; decreases the effect of
diuretics, antigutoaselor uricozurice and antihipertensivelor.Glucocorticosteroizii increase the
risk of gastrointestinal bleeding.Pirazolonele grow ulcerigen effect.Effect of acetylsalicylic acid
decreases Fenobarbitalul by enzyme induction and stimulation of the hepatic metabolism of liver.
9) Sol. nicotinic Acid 1%-2ml -i/m; evening at 19.00
Acidum nicotinicum
The composition of the preparation
1 ml of solution contains:
active substance: nicotinic acid 0.01;
auxiliary substances: water for injection ad well.
Pharmacotherapeutic group
Vitamins. Nicotinati. Correction of microcirculation and Angioprotectoare.

Properties
Nicotinic acid or niacin is a water-soluble B-complex vitamin (vitamin PP). Coponena enters the
coenzymes NAD (NICOTINAMIDE adenin--dinucleotid) and NADP (NICOTINAMIDE
adenin-dinucleotid-phosphate), participates in the metabolism of lipids, amino acids, purines,
glicogenoliz and tissue respiration. Nicotinic acid (but not NICOTINAMIDE) lowers LDL
(Low density Lipoproteins) cholesterol and triglycerides in the blood that are a risk factor for
coronary artery disease, apolipoproteinei B, the main component of LDL (Low density
Lipoproteins) and VLDL (Very Low density Lipoproteins) which transports cholesterol in the
blood and the lipoproteinei, a variant of LDL is associated with risk of coronary heart disease.
Decrease liver esterification triglycerides. Reduces the concentration of Fibrinogen in plasma
and tissue of the level increases plasminogenului. It inhibits lipase fat. Peripheral dilation.
Indications
Prevention and treatment of pellagra; liver diseases (hepatitis, acute and chronic cirozele),
gastrointestinal (gastritis, enterocolitis, colitis), atherosclerosis, vascular spasms. Ischemic
Ictusul (adjuvant). Stomach ulcers and wounds train.
Contraindications
Areteriale hemorrhage, glaucoma, diabetes mellitus (high doses), gout, arterial hypotension,
active peptic ulcer, liver diseases, hypersensitivity to nicotinic acid.
Dosage
Hipercolesterolemiei and hipertrigliceridemiei In the treatment of the doses and frequency of
Administration is gradually adjusted depending on the effect obtained on the level of plasma
LDL-cholesterol or triglycerides. Usually 1-2ml day, intramuscularly.
Overdose
Vasodilatare, sensation of heat, low blood pressure. Supportive treatment.
Adverse effects
Allergic and anaphylactic, Recii feeling of warmth, redness of the face and throat, headache,
atrial fibrillation and other arrhythmias (tachycardia), Hyperglycemia (low tolerance to
carbohydrates), hyperuricemia and gout, myalgia, nausea and vomiting, jaundice, peptic ulcer,
acanthosis nigricans, xerodermie, pruritus.
Interactions
Lovastatin and other inhibitory of hipolipidemiante HMG-Co A reductase inhibitors increase the
risk such as rhabdomyolysis, and chenodiolul miopatiei and ursodiolul we decrease the effect.
Increases the effect of ganglioplegicelor and hipotensivelor. Acetylsalicylic acid increases the
metabolic clearance of nicotinic acid. Alcohol increases the risk of bufeurilor of heat and itching.
10) vitamin B1
PRESENTATION
Box of 3 or 100 vials well (0,010 g).Box of 5 or 100 ampoules of 1 ml (0,025 g). Box of 5 or 100
ampoules 2 ml (0.100 g).
TIPS
The disease beriberi, restrictive diets, convalescence, anorexia, hepatitis; digestive diseases with
impaired absorption; hipovitaminoze with high fever, migraine, rheumatic pain, neuritis,
polyneuritis (nicotinica, diabetic, alcoholic), neuralgia, paralysis and postdifterice
postpoliomielitice Wernicke's encephalopathy, mieloze,; autointoxicatii, neuritis, nausea and

vomiting in pregnancy, nutritional disorders, spasmophilia, increasing delays in children,

shingles, dermatosis, large burns, diabetes, hyperthyroidism. CONTRAINDICATIONS
Intolerance or allergy to thiamine (especially injectable form); incompatibility with vitamin B2
(riboflavin) and benzpenicilina.
ADVERSE REACTIONS
Occur very rarely, especially intravenously injected (tiaminic soc); Therefore, the parenterala is
used only when there is intestinal absorption disorders or serious carente. High doses may
interfere with the action of other B-complex vitamins with consecutive carentiale phenomena.
METHOD OF ADMINISTRATION
Adults: s.c., i.m., i.v.: 20-40 mg/day or 2 days, up to 100-300 mg/day or 2 days in serious
deficiencies. Children: s.c., i.m.: 5-20 mg/day. Do not administer i.v.
ACTION FARMACOTERAPEUTICA
Vitamin B1 participates in the metabolism of hidrocarbonatelor due to the cocarboxilaza function
of the pirofosforic ester of the thiamine (tiamin pyrophosphate) which is involved in pyruvic acid
degradation. That's why lack of vitamin B1 determine disorders of carbohydrate metabolism of
pyruvic acid accumulation in the blood and urine, about what favors the impairment of the CNS
with nerve and muscle disorders. Is also affected, and carbohydrate metabolism of heart muscle
and kidney damage. Vitamin B1 acts as efficacious in thiamine deficiency States, correction of
those disorders; stimulates the conversion of carbohydrates into fat, pyruvic acid and Alphacetoglutamic acid in amino acids; promotes liver glycogen deposition; increases tolerance to
carbohydrates; is involved in the synthesis of acetylcholine, favoring the nervous influx
transmission; participate in the synthesis and inactivation of thyrotropin hormone estrogen in the
liver. The daily requirement is between 200 mg and 1.5 mg (0-18 years) and 1-1,4 mg (over 18
years); It is supplemented in charge (100 mcg) and alaptarii (500 mg).
INTERACTIONS WITH OTHER DRUGS
Thiamine antagonists, 5-fluorouracilul thiosemicarbazone and neutralizes the effect of thiamine.
Inhibits the absorption of thiamine antacids.
Treatment analysis and conclusions
Taking into consideration the patient's general condition, the clinical diagnosis is established and
concomitant diseases, stands a few errors in the use and combination of medicinal remedies.
the interactions between madicamente have the following effects:
The interaction between Spironolactone Lisinopril +
Concomitant administration of diuretics sparing, angiotensin-converting enzyme inhibitors
(IEC)-lisinoprilsau can cause a severe hyperkalaemia.
Interaction between Fraxiparin + Cardioprin (acetylsalicylic ac.)
Concomitant use of aspirin (or other salicilati) or anti-inflammatory drugs is not recommended,
nor the use of antiplatelet agents as they can increase bleeding risk. If such combinations cannot
be avoided, it should be done a careful clinical and biological monitoring.
The interaction between Spironolactone + Cardioprin (acetylsalicylic ac.)
Inhibition of prostaglandin synthesis in the kidneys by vasodilators. shrinking effect = diuretic
acetylsalicylic
The interaction between Spironolactone + Asparcam = oracit
The interaction between Vit. B1 + Ac nicotinic = pharmaceutical Incompatibility.

Recommended treatment:
1. soil. Mannitol 20% -50,0-i/v
2. Tab Cardiopirin 325- tab/day
3. Tab Lisinopril 20,0-1/2 tab 2 times/day
4. nicotinic Sol.Ac. 1%-2ml-s/m
Rehabilitation treatment: acupuncture, physiotherapy exercises, massage, curative gymnastics.
Daily
7.05.2013
General condition-average severity. -Clear conscience.
Complaint: the General Weakness with an emphasis on right. Diplopia from the look to the right,
away from disturbances. Disturbances of sensitivity in hemicorpul. headache, nausea, facial
asymmetry.
Objective:
Hyperimate, warm skin; spontaneous breathing, free, auscultativ-vesicular murmur bilaterally,
FR = 18/min. cardiac rhythm, sound, Noises, TA 130/90 mm Hg, FCC = 88 b/min. Abs slim,
painless on palpation, regular Chair. Mark Giordani bilateral miciune negative, indolor.
Neurological status:
The palpebral OD = OS. Pupils round, D = S, fotoreacia. Convergence diminished. Nystagmus
is absent. Symmetrical face. Fonaia and swallowing. The language line. Sensitivity-hipoestezie
on the right. Active member movements in full volume, reduced in d. diminished muscle tone
and Strength on < dreaptaD. In the Romberg-unstable with deviation to the right. Riding-light on
the right. paresis Evidence of diminished coordination on the right. ROT (upper and lower) D >
S inviorate. Pathological reflexes. It also permits oral negative reflexes. Meningiene signs are not
causing.
09.05.2013
General condition-average severity. -Clear conscience.
Complaint: general weakness with a focus on the right. Diplopia from the look to the right, away
from disturbances. Disturbances of sensitivity in hemicorpul. headache, nausea, facial
asymmetry.
Objective:
Hyperimate, warm skin; spontaneous breathing, free, auscultativ-vesicular murmur bilaterally,
FR = 18/min. cardiac rhythm, sound, Noises, TA 130/90 mm Hg, FCC = 88 b/min. Abs slim,
painless on palpation, regular Chair. Mark Giordani bilateral miciune negative, indolor.
Neurological status:
The palpebral OD = OS. Pupils round, D = S, fotoreacia. Convergence diminished. Nystagmus
is absent. Symmetrical face. Fonaia and swallowing. The language line. Sensitivity-hipoestezie
on the right. Active member movements in full volume, reduced in d. diminished muscle tone
and strength on < dreaptaD. In the Romberg-unstable with deviation to the right. Riding-light on
the right. paresis Evidence of diminished coordination on the right. ROT (upper and lower) D >

S inviorate. Pathological reflexes. It also permits oral negative reflexes. Meningiene signs are not
causing.
Recommendations:
Continuation of treatment.
11.05.2013
The overall condition of the patient-selection in Dynamics. Consciousness maintained.
Objective:
Normal color skin, warm; spontaneous breathing, free, auscultativ-vesicular murmur bilaterally,
FR = 17/min. cardiac rhythm, sound, Noises, TA 130/80 mm Hg, FCC = 80 lithe Belly/min.,
painless on palpation, regular Chair. Mark Giordani bilateral miciune negative, indolor.
Neurologic status.
It is recommended to continue the treatment.

EPICRIZA
Drobusenco Rostislav 74 years, interned at 7.05.2013, with the following complaints: general
weakness with a focus on the right. Diplopia from the look to the right, away from disturbances.
Disturbances of sensitivity in hemicorpul. headache, nausea, facial asymmetry.
The history of the disease: the patient is considered to be ill on 06.05.2013 when they emerged:
general weakness, disturbances of gait. Ask the team is transported to 903, CNSPMU, interned in
the Neurology BCVi undergo a conservative treatment.
The diagnosis was established by:BCVA. Massive ischemic in concomitant baz.
vertebrobazilar/cerebellar right amygdala/cerebellum/SD. SD. bulbar in
HYPERTENSION.III.