Therapy aimed at eliminating the cause of the disease. Preventive treatment of syphilis. Workshop for the course of lectures "General History"

Although there is convincing evidence that prompt use of antibiotics for streptococcal infections reduces the incidence of rheumatic fever, there is no equally convincing evidence that treating recurrent infections in a patient who has already had an attack of rheumatic fever can reduce the frequency of repeated attacks. but preventative therapy can prevent further attacks from occurring. There are several methods of such prevention.

The first studies were carried out with sulfonamides; taking 1 g of sulfadiazine per day is undoubtedly an effective means of preventing infections caused by group A hemolytic streptococcus. For patients with mature heart disease, sulfonamides can be given some preference over, since the risk of developing subacute bacterial endocarditis caused by penicillin-resistant pathogens is minimized.

However, most patients are treated with penicillin - 250 mg orally 2 times a day or benzathine penicillin - intramuscularly 1,000,000 - 2,000,000 units once a month. Both methods are equally effective. Only very rarely does penicillin cause hypersensitivity reactions, most often in the form of urticaria or some other types of rash.

More serious reactions are very rare, especially after intramuscular injections, which themselves can also cause pain at the injection site. If hypersensitivity to penicillin develops, prophylactic use of erythromycin 125 mg twice daily may be considered.

Relapses most often occur in the first year after the attack, so prevention is mandatory in the first few years. It is important, however, to realize that relapses of rheumatism are possible at any age, even in an adult, and that they tend to repeat the character of the first attack, so that if carditis occurs during the first attack, it will recur during subsequent ones.

Therefore, it is generally believed that prophylaxis should be continued indefinitely in patients with residual carditis. The most dangerous age seems to be adolescence, when preventive treatment is often forgotten, so repeated reminders of the importance of that therapy are necessary.

If, despite the fact that the patient receives preventive therapy, he develops a streptococcal infection, the latter must be treated quickly and with full therapeutic doses of penicillin for at least 10 days or, if the patient is hypersensitive to penicillin, erythromycin 250 mg 4 times a day. within 10 days.

Prevention of bacterial endocarditis

In patients with damage to the heart valves, bacteremia caused by tooth extraction or any other dental intervention, including manipulations performed for periodontal disease, removal of pharyngeal tonsils and adenoids, or occurring after instrumental examination conditions of the urinary or reproductive tract, can cause bacterial endocarditis. Therefore, the goal of prophylactic use of antibiotics before these procedures is to prevent the development of bacteremia or, if it does occur, to reduce its severity and duration.

Penicillin remains the best drug for this purpose in dental treatment and operations on the pharyngeal tonsils and adenoids. It is administered intramuscularly 1 - 2 hours before these manipulations, and then continued to be administered in full dose for at least 48 hours. Before surgery, the drug must be administered intramuscularly, and then you can switch to oral administration. In cases of hypersensitivity to penicillin, erythromycin can be used.

Drug therapy (Pharmacotherapy) is treatment with drugs, or otherwise, pharmacological agents. Chemotherapy refers to pharmacotherapy as applied to oncology. Pharmacotherapy is classified as conservative (non-invasive) methods of treatment. Pharmacotherapy is also the name of the branch of pharmacology that studies drug therapy.

Types of pharmacotherapy

The following types of pharmacotherapy are distinguished:

Etiotropic therapy - an ideal type of pharmacotherapy. This type of pharmacotherapy is aimed at eliminating the cause of the disease. Examples of etiotropic pharmacotherapy can be the treatment of infectious patients with antimicrobial agents (benzylpenicillin for streptococcal pneumonia), the use of antidotes in the treatment of patients with poisoning by toxic substances.

Pathogenetic therapy — aimed at eliminating or suppressing the mechanisms of disease development. Most currently used drugs belong specifically to the group of pathogenetic pharmacotherapy drugs. Antihypertensive drugs, cardiac glycosides, antiarrhythmic, anti-inflammatory, psychotropic and many other drugs have a therapeutic effect by suppressing the corresponding mechanisms of disease development.

Symptomatic therapy - aimed at eliminating or limiting individual manifestations of the disease. Symptomatic medications include painkillers that do not affect the cause or mechanism of development of the disease. Antitussives are also a good example of symptomatic remedies. Sometimes these drugs (elimination of pain during myocardial infarction) can have a significant impact on the course of the main pathological process and at the same time play the role of pathogenetic therapy.

Replacement therapy - used for deficiency of natural nutrients. Replacement therapy means include enzyme preparations(pancreatin, panzinorm, etc.), hormonal medications (insulin for diabetes, thyroidin for myxedema), vitamin preparations (vitamin D, for example, for rickets). Replacement therapy drugs, without eliminating the cause of the disease, can ensure the normal existence of the body for many years. It is no coincidence that such a severe pathology as diabetes mellitus is considered a special lifestyle among Americans.

Preventive therapy - carried out to prevent diseases. Preventative drugs include some antiviral drugs (for example, during a flu epidemic - rimantadine), disinfectants and a number of others. The use of anti-tuberculosis drugs such as isoniazid can also be considered preventive pharmacotherapy. A good example preventive therapy is the use of vaccines.

It should be distinguished from pharmacotherapy chemotherapy . If pharmacotherapy deals with two participants in the pathological process, namely the drug and the macroorganism, then with chemotherapy there are already 3 participants: the drug, the macroorganism (the patient) and the causative agent of the disease. The drug acts on the cause of the disease (treatment of infectious diseases with antibiotics; poisoning with specific antidotes, etc.).

One type of etiotropic therapy is replacement pharmacotherapy, in which drugs replace physiologically missing active substances(use of vitamins, hormonal drugs with insufficiency of the function of the endocrine glands, etc.)

The third stage - preventive therapy is aimed at preventing the development of relapses of the disease. Held in outpatient setting.

Indications for prescribing preventive therapy are: - the presence of at least two delineated affective episodes over the past two years;
- the presence of affective phases of a subclinical level in the pre-treatment period after the first episode in life;
- the first episode is severe, leading to hospitalization (the presence of psychotic symptoms, in case of depression - suicidal thoughts/tendencies).
Preventive therapy can be carried out indefinitely, but not less than 1 year. The question of stopping preventive therapy can be resolved positively in the case when the patient’s condition has been completely stable for five years, i.e. There were no affective disorders even at a subclinical level. It should be remembered that even against the background of complete well-being, cessation of preventive therapy can lead to the development of a phase and further aggravation of the course of the disease compared to the period before the start of treatment. In this regard, in cases where there are no objective medical indications for discontinuing preventive therapy (such actions, the occurrence of concomitant intercurrent diseases requiring the prescription of medications that are incompatible with the drugs used for prophylaxis, etc.), the doctor’s tactics should be aimed at continuing therapy indefinitely.
Examinations and consultations required upon admission to hospital
- clinical blood test ( Clinical tests blood and urine are produced again once every three to four weeks at normal results.)
- biochemical blood test: total protein; total bilirubin; (bound bilirubin; free bilirubin; alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, thymol test) (If appropriate conditions are present.); prothrombin index; determination of blood sugar; blood test for RV; blood test for HIV;
- clinical urine test (Clinical blood and urine tests are repeated once every three to four weeks with normal results);
- ECG;
- analysis of a swab from the throat and nose for diphtheria bacillus;
- bacteriological analysis;
- consultation with a therapist;
- for female patients - consultation with a gynecologist;
- consultation with a neurologist;
- consultation with an ophthalmologist.F30 Manic episode

F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode, unspecified
Treatment conditions
Usually stationary. The length of hospital stay depends on the speed of symptom reduction, on average it is 2 - 3 months. Follow-up treatment is possible in semi-inpatient or outpatient settings.
For necessary examinations, see general part F3.
Principles and duration of therapy
All basic approaches and principles described for bipolar affective disorder (see section F31) are followed. At the stage of relief therapy, the first choice drugs are lithium salts (carbonate, hydroxybutyrate). Treatment is carried out under the control of lithium concentration in the blood plasma. The dose is selected so that the concentration of lithium in the blood plasma, determined in the morning, on an empty stomach, 8 to 12 hours after taking the last dose, is not lower than 0.8 and not higher than 1.2 mmol/l. Lithium oxybutyrate is administered intramuscularly, slowly intravenously or intravenously. To correct sleep disorders, add hypnotics (such as nitrazepam, flunitrazepam, temazepam, etc.).
In cases of severe psychomotor agitation, aggressiveness, the presence of manic-delusional symptoms, or the absence of the effect of lithium, during the first days of therapy, antipsychotics are added to the regimen (mainly haloperidol, if necessary, parenterally), the dose of which is gradually reduced until complete withdrawal as the effect develops. It is possible to add sedative neuroleptics (see Table 1). Their use is symptomatic, that is, in the case of the development of motor agitation or sleep disorders. When using antipsychotic therapy, it is also necessary to follow the rules of relief acute psychosis for schizophrenia (see section F20). If there is no effect in the first month of therapy, a transition to intensive care or anti-resistant measures: alternating high doses of incisive neuroleptics with sedatives (see Table 1), adding powerful tranquilizers (phenazepam, lorazepam), carbamazepine, sodium valproate, etc.
At the second stage - follow-up or stabilizing therapy, the use of lithium salts should continue until the spontaneous end of the phase, the duration of which is established according to the previous phases (on average 4 - 6 months). Lithium carbonate or its prolonged forms (contemnol, etc.) are used. In this case, the dose of the drug should be gradually reduced; the blood plasma concentration is maintained at 0.5 - 0.8 mmol/l. The issue of stopping lithium therapy is decided depending on the characteristics of the disease and the need for preventive therapy.
Expected treatment results
Relief of affective disorders

A method of treating and preventing diseases, which is based on the use of drugs of natural or artificial origin, is called drug therapy. In other words, this is a general concept that implies treatment with medications.

Drug therapy is divided into several types. Doctors use symptomatic therapy based on eliminating a specific symptom of the disease. An example is the prescription of antitussive drugs for bronchitis.

Causal therapy destroys the causative agent of the disease with the help of medications, that is, it eliminates the causes of the disease. For example, the use of chemotherapeutic agents in the treatment of infectious lesions.

Elimination of the main mechanism of development of the pathological process is ensured by pathogenetic therapy. An example of medicinal effects in this type of therapy is the use of painkillers for various injuries. First of all, the medications used counteract the development of pain.

Replacement therapy is also included in a number of types of drug treatment. It includes the process of restoring the deficiency of substances that form in the human body. These substances include vitamins, enzymes, hormones that regulate basic physiological functions. Replacement therapy is not intended to eliminate the causes of the disease, but it can ensure normal human life for a long time. An example of the use of replacement therapy is the administration of insulin to a patient suffering from. With regular use of insulin, normal carbohydrate metabolism in the body is ensured.

Finally, another form drug effects is considered preventive therapy aimed at preventing the occurrence of diseases. For example, the use of disinfectants or antiviral drugs during influenza epidemics. Similarly, the use of anti-tuberculosis drugs helps to counter the occurrence of exceeding the epidemiological threshold. An illustrative example of preventive therapy is routine vaccination of the population.

When considering the above types of drug therapy in more detail, it should be noted that in practice the noted directions in pure form are implemented quite rarely. The course of pathological processes can be influenced by various therapeutic methods and types of medications. For example, replacement therapy may well be used for preventive purposes. Physiological and biological processes are highly interconnected in the human body. Therefore, the influence of drugs on systems, organs, and tissues is multiple.

When prescribing medications to a patient, the doctor must constantly take into account many different individual factors and choose the most appropriate type of therapy from the many available treatment options. Therefore, the doctor's decision-making is based on strategic principles. The main thing is that in each specific case it is necessary to ensure a reasonable balance between the safety, tolerability and therapeutic effectiveness of the drug used.

An important role in the process of drug therapy is played by the timeliness and correctness of diagnosis. The doctor must adequately assess and take into account the patient’s condition, the capabilities of his body’s defenses, age, gender, the presence of concomitant diseases, and sensitivity to a certain type of medication. The specialist is obliged to take into account the possible reaction of the patient’s body when prescribing several drugs simultaneously. Of course, the behavior of the patient himself, how accurately he follows all the instructions and recommendations of the attending physician, is of significant importance in any type of therapy.

Each drug has a number of specific pharmacological characteristics, therefore, to obtain the desired effect from treatment, medications are introduced into the body in various ways. Enteral administration involves taking the medication through the mouth. In this case, the medication is absorbed through the intestines into the blood. The use of the medicine sublingually, under the tongue, makes it possible to receive remedy into the mucous bloodstream, bypassing the intestines. Direct administration of the medication into the rectum is called rectal. Medicines are also delivered to the body through injections, inhalations, and electrophoresis. All methods of administering medications are an integral part of any type of therapy.

Well-chosen medicinal product allows you to solve the main task of the doctor - to cure the patient.