Basic clinical pharmacology. Pharmacokinetics and pharmacodynamics icon

Basic clinical pharmacology. Pharmacokinetics and pharmacodynamics




НазваBasic clinical pharmacology. Pharmacokinetics and pharmacodynamics
Дата27.08.2012
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BASIC CLINICAL PHARMACOLOGY. PHARMACOKINETICS AND PHARMACODYNAMICS.

The task for initial level.


  1. To determined the basic of pharmacokinetics

    1. The half-life of elimination

    2. Absorbtion of drugs.

    3. Concepts about bioavailability and bioequivalence of medicines.

    4. Drug distribution.

    5. Biotransformation of the drugs at the organism. Drug metabolism. The meaning of the liver microsomal enzymes.

    6. Drug elimination (excretion) from the organism

  2. The basic of pharmacodynamics

    1. Concept about primary (molecular targets for the drugs actions) and secondary pharmacological reaction

    2. Types of drug action: local and resorptive, direct and indirect; specific and nonspecific; reversible and irreversible; basic and side; desirable and adverse

    3. Types of mechanisms of drug action. Drug receptors, agonists and antagonists. Pharmacologycal effects. “doze-effects”.

    4. Influence of organism state (age, sex, illness) of the action of drugs

3. Action of the drugs in the repeated use. Tolerance, dependence, cumulation

4. Classification of medicines interactions

4.1. Types of the combined medicine effect. Synergism, antagonism.

4.2. Synergism: addiction, potentiation.

4.3. Antagonism: physical, chemical, physiological

4.4. Incompability of medicines (pharmaceutical, pharmacological)


Control questions of an investigated theme

  1. Combinations of drugs:

    1. Additions

    2. Summations

    3. Potentions

  2. To base combined medicinal therapy necessity.

  3. Concept about safety, undesirable (collateral) effect, reaction.

  4. Division of collateral reaction (unknown, serious, possible, expected, probable).

  5. Classification of toxic effects by a pathogenetic principle

5.1. Doze-dependent, organotoxic

5.2. Not connected to a doze

5.3. At long application

5.4. The deferred action

  1. To forecast side-effects of MM:

    1. Idiosyncrasy

    2. Sensibilization

    3. Allergic reaction

    4. Tachyphylaxis

    5. Tolerance

  1. To base combined medicinal therapy necessity, to propose possible variants of safe combination of MM.

  2. To forecast side-effects of MM which are prescribed for the patient and to plan their revelation.

  3. The basic ways of the salvation of safety of treatment. Concept of pharmacological supervision.



Classification of toxic effects by a pathogenetic principle

  1. Doze-dependent, organotoxic (type A)

  1. connected to pharmacological activity

  2. at absolute or relative overdose of medicines

  3. at interaction of medicines

  1. Doze-independent (type B – unpredictable)

  1. immunologic reactions (allergic, infringements immunological properties of an organism)

  2. pseudo-allergic reaction

  3. pharmacogenetic variability (idiosyncrasy)

  4. at local application

3. At long application:

a) adaptive changes

b) at cancellation of medicines (a phenomenon of “feed-back” and “cancellations”

c) organotoxic effects (nephro-, hepato-, oto-, neuro-, hematotoxic)

4. The deferred action:

a) blastomogenic (cancerogenic)

b) the effect connected to reproductive function – lowered fertility, mutagenicity, cancerogenicity, teratogenety, embriotoxity, fetotoxity)


Type A – most frequently meet and, as a rule, are organotoxic.

They can be caused:

  1. By the pharmacological properties of a medicine shown:

1.1.in a therapeutic doze, also are inevitable at carring out of therapy

1.2.pharmaceutical, pharmacokinetical, pharmacodynamic reactions, causing stronger pharmacological effect, turning into collateral effect

1.3.change of components of the medicinal form, impurity of a medicine, pyrogenety

a) pharmacokinetical (change of conditions which influence on absorbtion, biotransformation, elimination, genetically caused – slow and fast “acetilation”, oxidizers”

b) pharmacodynamic – influence of diseases of a liver, changes of a water-salt exchange and so forse

2. Owing to application of the big dozes or overdose of medicines – therapeutic index (breadth of therapeutic effect)

3. Collateral reactions at interaction of medicines

Type B

  1. Infringements of immunobiological properties of an organism (changes of normal microflora, easing of immunity)

  2. Immunologic (an allergy on a medicine)

  3. Pharmacogenetically caused changes (idiosyncrasy)

The factors promoting occurrence of toxic effects

  1. Not connected to a medicine (features of an organism of the patient, therapy spent by the doctor)

  2. Connected to the clinic-pharmacological characteristic of medicines and connected to quality of it.


Situation problems solution

  1. At the patient through 20 minutes after taking local anesthetic novocaine, pain behind a breast, sharp decrease of the ABP, loss of consciousness has appeared. What phenomenon took place?

  2. At the patient after repeated appliance of natrium salts benzylpenicilline the skin has reddened, the rash, an itch has appeared. How this complication refers to?

  3. At the patient with a diabetes, accepting insulin, has developed hypoglucemic coma. What kind of negative action took place?

  4. The patient with epilepsy took long Phenobarbital, in connection with that efficiency of a medicine has sharply decreased, it was replaced on dyphenine. After a cancellation of Phenobarbital the patients dream has worsened, became superficial with dreadful dreams. What phenomenon took place?

  5. What toxic effects can arise at the patient with chronic heart isufficiency, taking long digitoxine?

  6. What consequences there can be at the child, whose mother accepts narcotics?

^ THE AGENTS ACTING ON VASCULAR TONUS

The task for initial level.

1. Classification of acute and chronic circulatory insufficiency.

2. Ethiology and pathogenesis of hypertension (essential hypertension).

3. To call antihypertensive drugs classification on strength and activity duration.

4. To call pathogenic mechanisms determining hypotonic states and being exposed with medicamentous correction.

5. To enumerate clinical and laboratory criteria of therapeutic effectiveness of hypotonic and hypertonic MM use.

6. To formulate urgent medicamentous therapy for hypertonic crisis, shock, collapse.


Control questions of an investigated theme

1. Classification of antihypertensive drugs (The first line – Diuretics, ACE-inhibitors, Beta-adrenergic blockers, Blockers of ATR, Ca-channal blockers, and the other groups – Central-acting adrenergic drugs, Alfa-adrenergic blockers, Ganglionic blockers ).

2. Classification of hypertension drugs (Adrenergyc agonists, Dopaminergic agonists, Analeptics, Drugs action on angiotensin system, Glucocorticoides).

3. Mechanism of action, therapeutic effects, adverse effects, treatment strategies of antihypertension drugs.

5. To enumerate clinic-pharmacological principles of MM selection and the choice of their doses with arterial hypertension.

6. The best combination of antihypertensive drugs.

7. The negative combination of antihypertensive drugs.

8/ The most impotent side-effects of antihypertensive drugs.


Situation problems solution


1. A patient of 54 years old and 82 kg weight has hypertonic disease more 10 years. In last months she is registering becoming more frequent increases of ABP to 220/140 mer.mm which are accompanied with hard throbbing headache. Puls – 55/min. Hypertrophy and overload of the left ventricle, diffuse dystrophic changes of the myocardium with signs of coronary insufficiency are arisen with ECG examination. The patient registers shin edemata and pastotic face appearance.

To propose DMM as a component of complex therapy of this patient.


2. A man of 33 years old complains of palpitations, non-effective inhalations, moderate heaviness in the heart region, throbbing headache, hot plush to the face, trembling in the body, sweating, nervous alerthness. The state had been became acute worse after psycho-emotional stress. In anamnesis hypertonic disease of the 1st. Medicinal therapy was episodic. Objectively: the face skin is hyperemic. He is normosthenic, slightly heightened feeding. Pulse is 94/min., rhythmic. ABP is 198/96 mer. mm. The left border of the heart changes position on 1.5 cm outside. The 2nd sound accent is auscultated on the pulmonic artery. To make more precise crisis character. To select MM for its arrest.



  1. The man of 65 years with IHD (stable stenocardia, CHF II). Objectively: the general state is heavy. The skin is pale, covered with excessive cold sweat, it is marked acrocianosis. Puls is 120/min, ABP 70/40 mer.mm. Deaf heart sounds. To select MM for its arrest.

  2. The woman of 56 years old long time with essential hypertension. The therapy – Metoprolol 25 mg – 3 per day, Clonidine 0,000075 - 2 per day. Suddenly the patient break off the Clonidine. What the reaction will be at the nearest time (the mechanism of this reaction)? What drug will use in this case?

Clinic-pharmacology and use medicines (agents) for treatment the ischemic heard disease and the congestive heart failure.

The task for initial level.

  1. Classification of cardiac insufficiency.

  2. Ethiology and pathogenesis of ischemic heart disease.

  3. Ethiology and pathogenesis of congestive heart disease.

  4. Requirements for antianginal drugs.

  5. Classification of antianginal drugs.

  6. Classification of diuretic drugs

  7. Common principles of diuretic prescribing.

  8. Classification of angioprotectors.

  9. Classification of cardiotonic drugs.

  10. Conception of cardioprotective effect of drugs.

  11. Classification of cardiac glycosides.

  12. Absolute and relative indications and contraindications for cardiac glycosides prescription


Control questions of an investigated theme

  1. Complex therapy of ischemic heart disease.

  2. The pharmacological characteristic of different classes of antianginal drugs (the comparative characteristic of nitrates, beta-adrenoblockers, , calcium channel blockers). Undesirable effects. Contraindication.

  3. Drugs improving delivery of oxygen to myocardium (coronarolytics). Reflectory action. Concept about syndrome”stealing”.

  4. Principles and complex therapy of acute heart ischemia

    1. elimination pain syndrome

    2. the prevention and treatment thrombosis

    3. restriction of necrosis

    4. restoration of pumping activity of myocardium

  5. Complex therapy of chronic ischemic heart disease

    1. application of anti-aggregantes

    2. indication to application of hypolipodemic agents

    3. indication of syndrome “tolerance to nitrates”

    4. indication to application of hypolipodemic agents.

    5. indication the drugs to survival the patients with chronic ischemic heart disease.

  6. Complex therapy of congestive heart failure

  7. The conception and clinical significance of therapeutic and toxic phases of cardiac glycosides activity.

  8. To enumerate clinic-pharmacological principles of DMM selection and the choice of their doses with general and local edematic syndrome, pulmonary edema.

  9. How are DMM combined for maximal diuretic effect (forced diuresis) receiving? Indication of tolerance to furosemide.

  10. The concept of cardiotonic drugs for congestive heart failure.

  11. To call indications and contraindication (absolute and relative) for cardiac glycosides use.


Situation problems solution

1. At the department has arrived patient in occasion of acute ischemia on ECG. He have essential hypertension in anamnesis (usual ABP 160-180/90-100). ABP 120/70 mer.mm, Puls 120/min. Name a choice-preparation.


2. A patient being conveyed with acute gross myocardial infarction was in a cardiological department. The patient’s state was middle heavy. Pulse was 100/min. and rhythmic. Heart sounds were indistinct. Vesicular respiration was in lungs. The liver was not increase. Edemata were absent. Strophantin was taken for the patient. Single extrasystoles had been arisen after minimal dose (0.05% sol. 0.025 ml.) introduction. Bigeminy had been evoluted after the 2nd introduction of such dose. To evaluate patient conduct tactics. To explain complications cause.


  1. Cardiac asthma attack have arisen in a patient of 52 years old. Examination: pulse is 78/min, rhythmical, ABP is 170/100 mer.mm, heart sounds are indistinct. The liver is increase. Shins edemata are moderate. A physician have prescribed interovenous introduction of furosemide.

Name a choice-preparation to the therapy.


4. Cardiac asthma attack is in a patient. ABP is 140/80 mer. mm. A physician gives nitroglycerin tablet under the tongue, introduces lasix 4.0 ml, strophantine o,05%0.5 ml on physiologic sol. 10 ml intravenous and inhalates oxygen to the patient. Does the physician do right? To explain each MM pharmacodynamics in this situation.


5.A man of 50 years old complains of retrosternal compression pains which are arisen with walking on the plate area to 100 m. Indicated attack are earmarked during 3 years. He is ill with hypertension about 5 years. Maximal ABP is 180/100 mer.mm. Acute myocardial infarction 2 years ago. Objectively: the general state is medium heavy. Cyanosis in the lips is. Left-side pyramidal insufficiency is present. The 2nd heart sound accent and systolic murmur is on the aorta. Pulse is 80/min, ABP 180/100 mer.mm.. Hypertrophy of the left ventricular is present. Vesicular respiration and marginal crepitating are on the lungs. The abdomen is soft, painless. The liver stands on 2sm by the right medioclavicular line. Edemata are absent. To select MM and to program combined therapy.


6.A woman of 55 years old complains of retrosternal compression pains which are arisen with walking on the plate area to 200 m, with rising on the 2d floor, dispnea with physical load. Indicated attack are earmarked during 3 years. She is ill with hypertension about 5 years. Maximal ABP is 180/100 mer.mm. Objectively: the general state is medium heavy. Cyanosis in the lips is. The 2nd heart sound accent and systolic murmur is on the aorta. Pulse is 55/min, ABP 180/100 mer.mm. Hypertrophy of the left ventricular is present. Vesicular respiration are on the lungs. The abdomen is soft, painless. The liver stands on 3sm by the right medioclavicular line. Edemata are absent. To select MM and to program combined therapy


7.A man of 48 years old complains of retrosternal compression pains which are arisen with nervous stress. Indicated attack are earmarked during 3 months. He resorted to sublingval tacking of nitroglycerine. He declined taking from further application because of it provoked violent heardache and low the ABP. To evaluate the rightness of recommended therapy.


Clinic-pharmacologic methods for basis prescription, choice the regime of dosage and appraisal the effectiveness medical agents which are using of respiratory disorders (bronchial obstruction syndrome - BOS).


The task for initial level.

    1. Ethiology, pathogenesis of BOS

    2. Classification of bronchial asthma.

    3. To indicate the ways of pharmacological influence with various types of BOS.

    4. Drugs used at asthma and BOS – classification.

    5. Mechanism of action bronchodilators

    1. adrenomimetics,

    2. M-cholinoblockers,

    3. myotropic spasmolytic drugs,

    4. glucocorticoids

    5. stabilizers of corpulent cells

    6. antagonists of leukotriene receptors.

  1. The role of glucocorticoids in treatment of patients with BOS.

  2. To formulate urgent medicinal help with status asthmaticus.


Control questions of an investigated theme

  1. What are principles grounded in classification of MM influencing on bronchial conduction.

  2. To explain the adrenaline and ephedrine bronchospasmolytic activity mechanism. To enumerate non-wanted effects which are arisen against a background of their use.

  3. To explain the aerosol beta-adrenomimetic substance use method and their activity mechanism. To enumerate non-wanted effects which are arisen against a background of their use

  4. To base glucocorticoid prescription necessity with bronchial asthma (aerosol- topical form and systemic drugs). To enumerate non-wanted effects which are arisen against a background of their use

  5. The glucocorticoid therapy effectiveness and safety criteria.

  6. The base of broncolyrtic activity of euphilline analogist. To earmark their safety criteria, side-effects.

  7. To formulate the significance and regulations expectorant and mucolytic agents.

  8. To plan treatment of a patient with different step (stage) of bronchial asthma.


Situation problems solution

  1. A patient of 34 years old with diagnosis: infective-allergic asthma from 8 years. Attacks were provoked by home dust. The patient took theophedrinum (10 tabl/day) fo arrest of attacks. Signs of bronchial obstruction marked syndrome and theophedrinum overdosage are in the patient against a background of basic disease clinics. To propose a disease treatment plan with indication concrete medicine and introduce methods.

  2. A woman 45 years old with bronchial asthma usually used aerosol of the salbutamol 4-th/day. The BOS worse near 2 weeks ago after virus respiration infection. The asthmatic attack 4-th per day and 1-2 – per night. Objective: breathing is hurried (26/min), multiple dry sibilant rales are auscultated on the lung. Pulse 100/min, ABP 120/80 mer.mm. FEV =60%. To select MM and to program combined therapy.

  3. A patient of 60 years old has chronic obstructive bronchitis and ischemic heart diseases. She took propranolol and euphilline. She had been conveyed in a department because she had lost consciousness against a background of increased bronchospasm. ECG – tachiarhythmia, left ventricular extrasystoles (4-5/min).

Clinic-pharmacologic methods for basis prescription, choice the regime of dosage and appraisal the effectiveness medical agents, used to the acid-dependent diseases.


The task for initial level

  1. Modern views on the etiopathogenesis of a peptic ulcer.

  2. Classification, mechanism of action preparations used at ACID-peptic diseases

    1. Antacides

    2. Antisecretory (antagonists H2-histaminereceptors, inhibitors of proton pomp)

    3. The agents lowering a tonus of gastrointestinal tract.

    4. Gastromucoprotective agents

    5. Antihelicobacter preparation.

  3. Determine the mechanism of medical effect of antisecretion MM.


Control questions of an investigated theme

1.Define clinical-pharmacological principles of a choice and selection MM at hyperacid.

2. H2-hystamine blockaders – indication to application, collateral action and side-effects.

3. Inhibitors of proton pomp - indication to application, collateral action and side-effects.

4. Antacides - indication to application, collateral action and side-effects.

5. Define the purpose of assignment at ulcer of stomach and duodenum.

6. What principles are fixed in a guidelines of treatment ulcer of stomach and duodenum by Maaсhstrih- consensus? The principles of antihelicobacter therapy.

7. Control effectiveness and safety of ulcer-therapy.

8. Ulcerogenic effect of nonsteroidal antiinflommatory drugs.


Situation problems solution

  1. The patient 26 years old with chronic gastritis with increase gastric secretion. The Almagel and atropine sulfate were used in treatment. After 1 week pain and heartburn considerably have decreased, but there was a dryness in a mouth, nose, sight has worsened a little. Give an estimation of atropine pharmacodynamics. What future tactics of application of the given preparation?




  1. The patient 32 years old with ulcer in ampulla of duodenum (H. pillory - negative). Define effective MM for complex treatment, their dose, time and grade of introduction, duration of treatment.




  1. The patient 54 years old with chronic ulceral illness. At fractions research of gastric contents the increase gastric secretion with H. pillory +++, at endoscope – ulcer in ampulla of duodenum. He gave complex treatment (amoxicillin, claritromycin, famotidin) 5 weeks ago. Define effective MM for complex treatment, their dose, time, duration of treatment.




  1. The patient 48 years old with pain in the knee and chronic gastritis in anamnesis. In complex therapy to the patient is nominated NSAID. Define effective MM for complex treatment, their dose, time, duration of treatment.



^ MODERN PRINCIPLES OF ANTIMICRIBIAL THERAPY. ANTIBIOTICS AND CHEMOTHERAPY AGENTS.


The task for initial level examination

    1. To enumerate antibiotics activity pathogenic mechanisms.

    2. To call basic classifications of antibiotics.

    3. To enumerate basic groups of antibiotics having bactericidal and bacteriostatic activity.

    4. To call classification of penicillins, cephalosporines, aminoglicosides and tetracyclines.

    5. To call criteria determining the choice of antibiotic for treatment for infectious process.

    6. To call classification of chemotherapy agents.

    7. To enumerate non-wanted effects of chemotherapy agents in respect of organs and system of adults, children, pregnants, to call contraindications for their use.



Control questions for the studied theme


  1. To call antibiotic selection and choice clinic-pharmacology principles with treatment for infectious process.

  2. What is difference between penicillines?

  3. To call common characteristics of penicillins and cephalosporines. What practical significance with patient treatment and combined therapy selection does it have?

  4. To classify macrolydes, peculiarities of used, its side-effects

  5. To call basic agent of aminoglycosides – indications to application, the dose with treatment and side-effects (undesirable action).

  6. To call common side-effects by long-term antibacterial treatment

  7. To enumerate antibiotic activity effectiveness criteria

  8. To enumerate clinic-pharmacological principles of sulfanilamidums prescription - indications to application, the dose with treatment and side-effects (undesirable action).

  9. To enumerate clinic-pharmacological principles of treatment of fluorochinolonums - indications to application, the dose with treatment and side-effects (undesirable action).

  10. What are criteria of effectiveness antibacterial treatment?

  11. Kinds of resistance to antibacterial treatment.



Situation problems solution

The decision of situational tasks


1. A patient of 35 years and 78 kg weight enters in a department. He has chronic obstructive bronchitis in exacerbation period. Pathogenic strain of staphylococcus is determined with bacterial examination of patient’s sputum inoculation.

To recommend treatment.


2. A patient of 52 years old has uric acid diathesis, and chronic pyelonephritis in exacerbation per. Urolisan and sulfalene in adequate doses were prescribed for this patient with the medicinal purpose, But on the 3rd of treatment pains in the lumbar region have been increase, oliguria have been arisen, there are an increase in the number of protein, latest and lixiviational eryhrocytes in urine analysis. Crystalluria is presence.

To explain the cause of patient’s state worsening. To recommend treatment.


  1. A patient of 42 years old had been conveyed in a department. She had complained of body’s temperature increase to 39.8 C, the cough with a little number of sputum, sweating. The loss of resonance is lower than shoulder blade, harsh breathing, moist and bubbling rale are in the right lung.

To prescribe therapy, to call an agent of the 1st line.


  1. To select antibiotic for a patient with cholecystitis, pyelonephritis. Flora is sensitive to tetracycline and kefsol in both cases.

  2. Carbocelline was prescribed for a patient of 67 years after prostatectomy in a urological clinic.

What can another antibiotic change carbocelline with taking into account its specific activity?

  1. A duty physician was called to a patient of 27 years old that is in a department. He had pneumonia. He complained of weakness, vertigos. He was covered with cold sweat,lips were cyanotic,pulse was 93/min, rhythmic and weak. ABP was 90/55 mer.mm. The voice was hoarse slightly. A nurse informed that injections of penicillin had been 40 min ago.

To diagnose. To indicate the variant and patient’s state heaviness degree. To plan treatment. Prophylactics.


  1. A patient of 27 years is in a gynecological department. She has exacerbation of chroic adnexitis. She is taking injection form of biseptol intravenous jets twos a day (5ml ampoule is diluted in sodium chloride 0.9% sol. 10ml.). A patient earmarks the heaviness in the epigastrium, in the right hypochondrium. It had been arisen on the 3-4 day of treatment. The patient o-complains of nausea and anorexia. The liver is increase on 4-5cm, it’s inferior margin is compact-flexible and painful with palpation.

Is connexion between liver affection manifesting and SMM use possible? To prescribe necessary examination, to give recommendation about treatment.


  1. A surgeon of 50 years old and 96 kg weight ill with acute bronchitis. He practiced self-treatment and took orraly sulfaethidole 0.5 g in combination of iboprophen 1 tabl. 3 a day. On the 4th day of treatment the state had improved and treatment was stopped. After 3 days the state had became worse and double lower-lobular multifocal pneumonia was diagnosed.

To explain inflammatory process dissemination in pulmonary tissue against a background of conducted therapy. What defects were in conducted therapy?


^ INTENSIVE THERAPY

The task for initial level.

1. Ethiology, pathogenesis,classification of arterial hypertension, hypertension crises, arterial hypotension, HID.

2. To enumerate pathogenetic mechanisms of arterial hypertension which are the object for influence of hypotonic MM.

3. To call pathogenetic mechanisms determining hypotonic states and being exposed with medicamentous correction.

4. To enumerate basic groups of hypotensic and antianginal MM.

5. To do clinic-pharmacological characteristics of MM which are broadly used in urgent practice of vascular tension disorders: diazepam, reserpine, clopheline, phentolamine, propranolon, pendiomud, bendasol, verapamil hydrochlorid, lasix, adrenaline,mesaton,camphora,cordiamin,hydrocortisone,prednisolone,nitroglycerin,nitrong.


Control questions of an investigated theme


1. To enumerate clinic-pharmacology principles of the choice and the selection of MM with arterial hypertension, arterial hypotension, coronary insufficiency.

2. What principles are found in classification of hypertonic, hypotonic and antianginal MM?

3.What hemodynamic changes are taken place in the organism against background of beta-blocators activity?

4. To enumerate MM and basic mechanisms causing vasodilatation.

5. To explain the mechanism of hypotonic activity of MM influencing on humoral links of arterial pressure regulation. To formulate indication for their prescription.

6. What influence on arterial pressure, heart work, peripheral blood circulation does mezaton have? Basic indications for its prescription.

7. To explain antianginal effect of nitroglycerin, approaches to selection of single dose and agent taking frequency.

8. To state short activity glucocorticoids (hydrocortisone, prednisolone) hypertensive activity mechanism and to enumerate hypotensive states when thier are not idicated.


Situation problems solution


1. Cardiac asthma attack is in a patient. ABP is 140/80 mer.mm. A physician gives nitroglycerine tablet under the tongue, introduces lasix 4.0ml, strophantine 0,05% 0.5 ml. on physiologic solution 10 ml intravenous and inhalates oxygen to the patient.

Does the physician do right? To explain each MM parmacodynamics in this situation.


2.Cardiac asthma attack have arisen in a patient of 52 years old. Examination:pulse is 78/min, rhythmical, ABP is 170/100 mer. mm., heart sounds are indistinct. The liver is increase. Shins edemata are moderate. A physician have prescribed intravenous introduction of strophanthine.

To evaluate patient conduct tactics. To plan patient treatment correction.

^ THE EDUCATION-RESEARCH WORK OF STUDENTS (SERW) –THE ANALYSIS OF EFFECTIVENESS AND SAFETY OF PHARMACOTHERAPY OF A CURATED PATIENT

To familiarize oneself with basic principles of pharmacotherapy selection, control of its effectiveness and safety with taking into account next information:

    1. age;

    2. weight;

    3. clinic diagnosis (basic disease, complications, concomitant diseases);

    4. the duration of basic disease;

    5. heaviness of basic disease;

    6. previous pharmacotherapy and its effectiveness;

    7. functional condition of the gastrointestinal tract (GIT) and basic organs eliminating the medicines (kidneys, the lever);

    8. the presence of allergic constitution and medicamentous allergy.




  1. Individual work on the study




  1. To examine a curated patient, to diagnose basic and concomitant disease.

  2. To plan treatment and to prescribe pharmacotherapy.

  3. To familiarize oneself with case history and physician prescription leaf.

  4. To compare planed treatment with such in a physician prescription leaf.

  5. To lead expert evaluation of the physician prescription leaf.

  6. To select patient complex therapy finally.

  7. To lead final selection of clinic and laboratory indices are being changed in process of treatment.

  8. To make a list of possible side-effects of each MM and their combinations.

  9. To control disease tendency and side-effects of medical therapy on the base of clinic and laboratory indices dynamics.


Headaches, nausea had been arisen in a man of 58 years 2 days ago. This symptoms have being increased. Vomiting was three times but didn’t lightened. Weakness, gait instability, vertigo, periodic difficulty of the speech were disturbed. The state had became worse nervous overpressure.

In anamnesis: during last 25years he is ill with arterial hypertension. During last 2 years he takes regularly 0.000075 g of clonidine befor the sleep. Maximal ABP is 230/139 mer.mm. Work ABP is 170/100 mer.mm. His mother had hypertonic disease and deceased in consequence of cerebral vascular insult. The medicamentous allergy is absent.

Objectivity: the patient is drowsy and sluggish. He is hypersthenic. He has adiposity of the 2nd st. Xanthelasmae are in the region of the right upper eyelid. Pulse is 54/min., rhythmic. ABP is 221/154 mer.mm. Hypertrophy of the left ventricle is presence. The 2nd sound accent is auscultated on the aorta.

Vesicular respiration is auscultated in the lungs. The liver stands on by the right costal line. Edemata are absent.


The analysis of blood: E 5,2 x 10 12, L 4,9 x 10 9 Hb 140 g/l, SEF 8 mm/h

The analysis of urine: 1018, L 1-5 in a/v, prot - neg


ECG: RSR, 55/min, deviation of an electrical axis of heart to the left, decrease of T-wave amplitude in V3-V6 leads, RV5V6>RV4 – attributes of left ventricular hypertrophy.


^ THE EDUCATION-RESEARCH WORK OF STUDENTS (SERW) –THE ANALYSIS OF EFFECTIVENESS AND SAFETY OF PHARMACOTHERAPY OF A CURATED PATIENT

To familiarize oneself with basic principles of pharmacotherapy selection, control of its effectiveness and safety with taking into account next information:

      1. age;

      2. weight;

      3. clinic diagnosis (basic disease, complications, concomitant diseases);

      4. the duration of basic disease;

      5. heaviness of basic disease;

      6. previous pharmacotherapy and its effectiveness;

      7. functional condition of the gastrointestinal tract (GIT) and basic organs eliminating the medicines (kidneys, the lever);

      8. the presence of allergic constitution and medicamentous allergy.



Individual work on the study



    1. To examine a curated patient, to diagnose basic and concomitant disease.

    2. To plan treatment and to prescribe pharmacotherapy.

    3. To familiarize oneself with case history and physician prescription leaf.

    4. To compare planed treatment with such in a physician prescription leaf.

    5. To lead expert evaluation of the physician prescription leaf.

    6. To select patient complex therapy finally.

    7. To lead final selection of clinic and laboratory indices are being changed in process of treatment.

    8. To make a list of possible side-effects of each MM and their combinations.

    9. To control disease tendency and side-effects of medical therapy on the base of clinic and laboratory indices dynamics.


A woman of 44 years old complains of sharp headache, vision reduction., nausea, repeated vomiting weakness in right arm and the right leg, periodical obnubilation on consciousness. The state had became worse 50 min ego.

In anamnesis: during 10 years she is ill with hypertonic disease. Maximal ABP is 220/130 mer.mm. Work ABP is 160/100 mer.mm. Last 1.5 years she often call physicians of the 1st aid in connexion of arterial pressure increase. The medicamentous allergy is absent.

Objectively: the general state is heavy. The consciousness is clouded periodically. Convulsiver twitching are in the extremities. Pulse is 72/min, rhythmic. ABP is 240/140 mer.mm. Hypertrophy of the left ventricle is presence. The 2nd sound accent and systolic murmur are auscultated on the aorta.

Vesicular respiration is auscultated in the lungs. The liver stands on by the right costal line. Edemata are absent.


The analysis of blood: E 4,2 x 10 12, L 4,8 x 10 9 Hb 120 g/l, SEF 5 mm/h

The analysis of urine: 1014, L 2-4 in a/v, prot 0.2 g/l


ECG: RSR, 72/min, deviation of an electrical axis of heart to the left, RV5V6>RV4 – attributes of left ventricular hypertrophy.


^ THE EDUCATION-RESEARCH WORK OF STUDENTS (SERW) –THE ANALYSIS OF EFFECTIVENESS AND SAFETY OF PHARMACOTHERAPY OF A CURATED PATIENT

To familiarize oneself with basic principles of pharmacotherapy selection, control of its effectiveness and safety with taking into account next information:

      1. age;

      2. weight;

      3. clinic diagnosis (basic disease, complications, concomitant diseases);

      4. the duration of basic disease;

      5. heaviness of basic disease;

      6. previous pharmacotherapy and its effectiveness;

      7. functional condition of the gastrointestinal tract (GIT) and basic organs eliminating the medicines (kidneys, the lever);

      8. the presence of allergic constitution and medicamentous allergy.



Individual work on the study



  1. To examine a curated patient, to diagnose basic and concomitant disease.

  2. To plan treatment and to prescribe pharmacotherapy.

  3. To familiarize oneself with case history and physician prescription leaf.

  4. To compare planed treatment with such in a physician prescription leaf.

  5. To lead expert evaluation of the physician prescription leaf.

  6. To select patient complex therapy finally.

  7. To lead final selection of clinic and laboratory indices are being changed in process of treatment.

  8. To make a list of possible side-effects of each MM and their combinations.

  9. To control disease tendency and side-effects of medical therapy on the base of clinic and laboratory indices dynamics.


Sick woman of 34 years old with acute bronchopneumonia. Cough, dyspnea, fear, anxiety have being 3 days ago.

Anamnesis: the medicamentous allergy is absent. A hedache, vertigo, noises in the ears, nausea, vomiting, pain in the abdomen have being suddenly arisen after intracutaneous test on penicillin in a patient.


Objectively: the general state is heavy. The consciousness is clouded. Foam go out from the mouth, convulsions, involuntary defecation and urination are presence. The skin is pale with cyanotic shade. Pulse is 120/min, rhythmic, deficient, fiiform. ABP is 60/20 mer.mm. Deaf heart sounds are presence. Rough vesicular respiration and diffused dry rattle are auscultated in the lungs, and some moist rattle are auscultated in the low area of right lungs. The liver stands on by the right costal line. Edemata are absent.


The analysis of blood: E 4,5 x 10 12, L 12,1 x 10 9 Hb 120 g/l, SEF 15 mm/h

The analysis of urine: 1017, L 2-5 in a/v, prot - neg


ECG: RSR, 120/min, normal ECG with tachycardia.


At Rg: focus of inflammatory in the bottom of the right lungs.


^ THE EDUCATION-RESEARCH WORK OF STUDENTS (SERW) –THE ANALYSIS OF EFFECTIVENESS AND SAFETY OF PHARMACOTHERAPY OF A CURATED PATIENT

To familiarize oneself with basic principles of pharmacotherapy selection, control of its effectiveness and safety with taking into account next information:


  1. age;

  2. weight;

  3. clinic diagnosis (basic disease, complications, concomitant diseases);

  4. the duration of basic disease;

  5. heaviness of basic disease;

  6. previous pharmacotherapy and its effectiveness;

  7. functional condition of the gastrointestinal tract (GIT) and basic organs eliminating the medicines (kidneys, the lever);

  8. the presence of allergic constitution and medicamentous allergy.



Individual work on the study



    1. To examine a curated patient, to diagnose basic and concomitant disease.

    2. To plan treatment and to prescribe pharmacotherapy.

    3. To familiarize oneself with case history and physician prescription leaf.

    4. To compare planed treatment with such in a physician prescription leaf.

    5. To lead expert evaluation of the physician prescription leaf.

    6. To select patient complex therapy finally.

    7. To lead final selection of clinic and laboratory indices are being changed in process of treatment.

    8. To make a list of possible side-effects of each MM and their combinations.

    9. To control disease tendency and side-effects of medical therapy on the base of clinic and laboratory indices dynamics.


A man of 60 years old complains of headaches, vertigos, head noises, morning nausea, night sleep absence, vision reduction, stenocardiac pains in the heart region arising after 50-100 m of walking, with rising on the 1 st floor, dyspnea with physical load, intermissions in heart operation.

In anamnesis: he is ill with hypertonic disease about 30 years. Maximal ABP is 160/120 mer.mm. He had myocardial infarction 5 years ago, acute insufficiency of cerebral blood circulation in the right medium cerebral artery basin 2 years ago.

Objectively: the general state is medium heavy. Cyanosis of the lips is. Left-side pyramidal insufficiency is presence. The 2nd heart sound accent and systolic murmur is on the aorta. Pulse is 84/min, arrhythmic by extrasystolic arrhythmia type (6-10/min), hard. ABP is 180/130 mer.mm. Hypertrophy of the left ventricle is presence. Vesicular respiration and marginal crepitating are on the lungs. The abdomen is soft, painless. The liver stands on 2sm by the right costal line. Edemata are absent.


The analysis of blood: E 4.9 x 10 12, L 5,0 x 10 9 Hb 120 g/l, SEF 10 mm/h

The analysis of urine: 1012, L 5-7 in a/v, prot 0.2 g/l


ECG: RSR, 55/min, deviation of an electrical axis of heart to the left, negative T-wave in V3-V6 leads, RV5V6>RV4 – attributes of left ventricular hypertrophy, postinfarction changes of front wall of LV.

^ THE EDUCATION-RESEARCH WORK OF STUDENTS (SERW) –THE ANALYSIS OF EFFECTIVENESS AND SAFETY OF PHARMACOTHERAPY OF A CURATED PATIENT

To familiarize oneself with basic principles of pharmacotherapy selection, control of its effectiveness and safety with taking into account next information:

  1. age;

  2. weight;

  3. clinic diagnosis (basic disease, complications, concomitant diseases);

  4. the duration of basic disease;

  5. heaviness of basic disease;

  6. previous pharmacotherapy and its effectiveness;

  7. functional condition of the gastrointestinal tract (GIT) and basic organs eliminating the medicines (kidneys, the lever);

  8. the presence of allergic constitution and medicamentous allergy.



Individual work on the study



    1. To examine a curated patient, to diagnose basic and concomitant disease.

    2. To plan treatment and to prescribe pharmacotherapy.

    3. To familiarize oneself with case history and physician prescription leaf.

    4. To compare planed treatment with such in a physician prescription leaf.

    5. To lead expert evaluation of the physician prescription leaf.

    6. To select patient complex therapy finally.

    7. To lead final selection of clinic and laboratory indices are being changed in process of treatment.

    8. To make a list of possible side-effects of each MM and their combinations.

    9. To control disease tendency and side-effects of medical therapy on the base of clinic and laboratory indices dynamics.


A boy of 14 years old, 53 kg, has secondary chronic pyelonephritis with arterial hypertension, chronic renal insufficiency of 1 deg.

Anamnesis: he takes ampicillin 500 mg 4 a day intramuscular, furazolidone 0,2 g 4 a day because of regular exacerbation of disease (proteus susceptible to ampicillin is identified in urine).

The patient regular takes many sour-milk foods (cheese, cottage, sour cream). Aches in the lain have been abated, body’s temperature have been normalized, dysurical symptoms have been vanished on the 10th day of treatment. But sharp diffuse headache, nausea, pulsation feeling in the back of the head have been arisen.

Objectively: the general state is heavy. The consciousness is clouded periodically. Pulse is 130/min, rhythmic, ABP 200/100 mer.mm. (150/90 mer.mm with coming in). Hypertrophy of the left ventricle is presence. The 2nd sound accent and systolic murmur are auscultated on the aorta.

Vesicular respiration is auscultated in the lungs. The liver stands on by the right costal line. Edemata are present on the legs.

The analysis of blood: E 3,2 x 10 12, L 4,9 x 10 9 Hb 110 g/l, SEF 15 mm/h

The analysis of urine: 1010, L 12-15 in a/v, prot 1 g/l

Blood residual nitrogen is 17.45 mmole/l (with 14.3-25 mmole/l in nirm). 1.2 x 10 16erythrocytes (with to 1x10 6 norm), 3.2 x 10 6 leucocytes (with to 2x 10 6 in norm) are in Addis-Kakovsky urine sediment count.

ECG: RSR, 55/min, deviation of an electrical axis of heart to the left, decrease of T-wave amplitude in V3-V6 leads, RV5V6>RV4 – attributes of left ventricular hypertrophy.

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