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CAFEINA (metilxantina)
antagonist adenozinic A1 si A2; inhibitor neselectiv a fosfodiesterazelor
Efecte: SNC (vasoconstrictie; psihoanaleptic; iritabilitate; tremuraturi fine ale extremitatilor); CV (CID
pozitiv; creste RP; scade TA prin tahicardie); respirator (bronhodilatatie); AI si imunosupresor; antialergic;
renal (slab diuretic); GI (hipersecretie); slab analgezic
I: psihoanaleptic
EA: GI (greata, varasturi, reflux); CV (ES, tahicardie, angina, hTA); SNC (insomnie, iritabilitate, anxietate,
cefalee, convulsii
CI: IMA; aritmii; epilepsie; bipolari; IH; ulcer gastric; asociere cu psihostimulatoare si chinolone de
generatia 3
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ANTITIROIDIENE
SUBSTITUENTI TIROIDIENI
OCTREOTID
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NEOMICINA (aminoglicozid)
inhiba sinteza P bacteriana prin cuplarea la subunitatea 30S a ribozomilor bacterieni
FC: adm p.o. in infectii intestinale, reducerea florei pre-operator; in coma hepatica (se abs din intestin prin
ulceratii); topic pe mucoase, tegumente; aerosoli; trec BFP
I: encefalopatie portala; pregatire preoperatorie a intestinului
CI: miastenia gravis, sarcina; perioperator ca sa nu interfereze cu curarizantele
EA: nefrotoxicitate; ototoxicitate; mimeaza curarizantele; durere la locul injectarii
CLOTRIMAZOL (antifungic local)
Activ si pe BG+
Spectru: candida, microsporum, corynebacterium minutissium
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ZOLPIDEM (imidazopiridina)
actioneaza pe subunitati a rec BZD (BZalfa1), dar nu este o BZD, dar la fel de eficient, iar FLUMAZENIL
antagonizeaza efectele sale; anticonvulsivant si miorelaxant redus
Avantaj: nu da sevraj. Dar Dz ↓ la batrani, IH, in trat cu CIMETIDINA
BENZODIAZEINE SI BARBITURICE
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INSULINA
ANTIDIABETICE ORALE (ADO)
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NEUROLEPTIC ANTIPSIHOTIC
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LEVODOPA (in Parkinson) - devine ineficienta pe parcursul tratamentului "efect wearing off"
(initial hipermotilitate → hipomotilitate → akinezie)
precursor DOPA; T1/2 ↓; trece BHE (DOPA nu trece)
In periferie: LEVODOPA → DOPA (DOPA-decarboxilaza periferica transforma LEVODOPA in DOPA).
Se adm CARBIDOPA / BENSERAZIDA (nu trec BHE) care inhiba DOPA-decarb perif (CARBIDOPA ↓
cu 75% necesarul)
La nivel GI: LEVODOPA → metilDOPA (inactiv. Scindat prin COMT). Se adm TALCAPONE si
ENTACAPONE (nu trece BHE) care inhiba COMT
EA: stimularea chemoreceptorilor din bulb (anorexie, greata, varsaturi); excesul de DOPA (dischinezie,
halucinatii vizuale); stimulare adrenergica (midriaza); degradarea NA in exces (coloratia bruna a salivei si
urinei); tahicardie, ESV; hTA; akinezia de dimineata
AMANTADINA (antiviral si antiparkinsonian) - nu are efect cand deja se elib. cantit. max. de
DOPA in mod fiziologic, dar insuficiente
↑elib. DOPA din terminatiile nervoase; reduce recaptarea DOPA; sensibilizeaza rec DOPA; inhiba r-NMDA-
GLUT
I: Parkinson (in bradikinezie si rigiditate); nevralgie postherpetica; antiviral pt v. Influentzae
EA: ataxie; reflexe diminuate; edeme; confuzie; convulsii
PARKINSON
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LIDOCAINA (anestezic local amidic; antiaritmic clasa IB) - anestezic de infiltratie (de electie)
inhiba susbstanta P; agonist selectiv alfa2 in SNC; blocant a canalelor de Na+ (poarta interna)
I: aritmii V; tahi V; previne FiV; anestezie locala de suprafata, tronculara, epidurala, intrarahidiana,
infiltratie, stomatologie
EA: hTA, aritmii, deprimare respiratorie
ANESTEZICE LOCALE
ANESTEZICE GENERAL INHALATORII SI I.V.
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TRAMADOL
agonist partial a receptorilor opiozi miu; blocand recaptare NA si SER (de asta nu se adm. cu ATC sau IRS)
I: dureri moderate
Antiepilepticele ↑GABA (sunt inhibitori), ↑nr GABA-r; inhiba activ. rec GLUT (sunt excitatori)
ANTIEPILEPTICE
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ACETAMINOFEN (analgezic)
analgezic mediu (la copii cu infectii virale); nu este AINS; antipiretic (inhiba recp. pt IL-1); vasodilatatie
(stim. NO)
FC: metabolizat la N-acetilbenzoquinonamina (puternic hepatotoxic), iar antidot in itx este N-
Acetilcisteina
EA: hepatotoxicitate; nefrotoxic; anemie hemolitica (↓G6PD); methemoglobinemie; in supradoza hepatita
acuta fulminanta
MELOXICAM (AINS)
inhiba COX1 si relativ COX2
FD: AI si analgezic puternic
FC: abs buna; se leaga de alb; metab hepatic; elim renala (TENOXICAM cel mai lung T1/2)
se C% in sinoviala cu leziuni↓
I: reumatism, tendinite, periartrite; criza de guta
EA: SC (tinitus, vertij); iritatie GI↓; retentie hidrosalina
FENILBUTAZONA (AINS)
inhiba COX1 > COX2
FD: AI; analgezic, antipiretic puterinic
FC: abs buna; se leaga de alb; metab hepat la compusi activi; se elimina renal
I: reumatism; in criza de guta; tromboflebite; tromboze; mialgii
EA: GI (ulceratii, hemoragii); retentie hidrosalina; hepato-, nefro-, medulo- toxicitate; nevrita optica
KETOPROFEN (AINS)
inhiba COX1, COX2, LOX, sinteza de LT B4
FD: AI mediu; analgezic puternic (PIRPROFEN cel mai puternic); antipiretic mediu; antiagregant indiferent
de doza; se poate adm in astm bronsic
FC: abs rapid; se poate adm. de max 2 ori pe zi; doar el se poate adm impreuna cu ADO si digitalice
I: reumatism; ORL; ginecologie; in criza de guta
CI: ulcer gastric; hemofilie; IR; IH; IC; HTA; IMA; alergii; copii (fara IBUPROFEN)
CELECOXIB (AINS)
inhibitor selectiv COX2
FD: inhiba natriureza → retentie hidrosalina
FC: grasimile intarzie abs; metab hepatica; eliminare renala
I: in inflamatii articulare (poliartrita reumatoida)
EA: GI (diaree, greata, HDS); HTA; edeme ale memb inf de la retentia hidrosalina
CI: IRn
PIROXICAM (AINS)
inhiba COX1 > COX2
FD: AI; analgezic puternic
FC: abs neinfluentata de alimente; se leaga de P plasmatice; metab hepatica; eliminare renala; T1/2 ↑
Avantaje: se C% in sinoviale cu lezare slaba a cartilajului
I: reumatism; periartrite; tendinite; criza de guta
EA: iritatie gastrica; retentie hidrosalina; tinitus; vertij; cefalee
TENOXICAM (AINS)
inhiba COX1 si COX2
FD: AI si analgezic puternic
FC: abs buna; metab hepatica; eliminare renala; T1/2 foarte lung
Avantaje: se C% in sinoviala, lezeaza putin cartilajul
I: reumatism; periatrite; tendinite; criza de guta
EA: SNC (tinitus; vertij; cefalee); iritant GI; retentie hidrosalina
AINS
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