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LECTURE No. 14. Medicinal disease in children



Complications are divided into:

1) medications, which are divided into the true side effects of drugs;

2) toxic effects of drugs;

3) complications associated with the sudden withdrawal of the drug;

4) individual intolerance to the drug.

Side effect of drugs: the undesirable effect of a drug, due to its structure and properties, which it has on the body along with its main actions. The toxic effects of drugs can be due to: overdose, rapid saturation of the body, rapid administration of medium and even minimal doses, insufficient function of the body of excretion, impaired neutralization of drugs in the body (with primary liver failure).

Complications due to the rapid withdrawal of drugs: withdrawal syndrome, withdrawal symptoms, exacerbation of those symptoms for which treatment was performed. Individual intolerance to drugs is divided into an unusual and perverse reaction. An unusual reaction of the body to the usual doses of drugs that are harmless to most people. Individual intolerance is a disease of altered reactivity, an illness of the body. Individual intolerance includes idiosyncrasy, an allergic reaction. Idiosyncrasy is a genetically determined, peculiar response to a certain drug at the first dose. The cause of idiosyncrasy is an insufficient number or low activity of enzymes (for example, a deficiency of the enzyme glucose-6-phosphate DH in response to taking certain quinidine drugs, CA drugs, aspirin, pyrazalones, antibiotics leads to the development of hemolytic anemia).

Factors for the development of drug disease are as follows.

1. Uncontrolled use of drugs by both doctors and patients themselves; the presence of the underlying disease changes the reactivity of the body, and the changed reactivity is manifested in unexpected effects when using drugs.

2. Polypharmacy, creating the conditions for multivalent sensitization; malnutrition when using drugs can change the body's reactivity and tolerance to drugs.

3. An age-related decrease in the participation of enzyme systems in the breakdown and neutralization of certain substances (higher sensitivity of children to barbiturates and salicylates, in the elderly to hypertension).

4. Genetic conditionality of a number of drug lesions.

5. The degree and rate of sensitization of the body partly depends on the route of drug administration (local applications and inhalations lead to increased sensitivity of the body; with iv administration of drugs, the sensitization of the body is less than with v / m and / c).

Allergic reactions are the most common cause of intolerance to certain medications.

Allergy is understood as the changed reactivity of an organism to the action of a given substance due to the hereditary high sensitivity of an organism.

Drug disease is one of the most significant clinical forms of the body’s allergic reaction to medications. Necessary steps for the development of drug allergies:

1) the transformation of the drug into a form that is able to interact with proteins;

2) the transformation of the drug into a form that can react with the proteins of the body with the formation of a complete antigen;

3) the body's immune response to this formed complex, which has become foreign, in the form of antibody synthesis through the formation of immunoglobulins.

Stages of allergic manifestations: pre-immunological is the formation of complete (full-fledged) allergens (antigens). Immunological, when the antigen-antibody reaction occurs in the tissues of shock organs. The antigen-antibody reaction is a specific reaction that is caused only by the introduction of a specific allergen.

Pathochemical reaction - as a result of the formation of the antigen-antibody complex, biologically active substances (histamine, heparin, serotonin, etc.) are released, the reaction is non-specific. The pathophysiological reaction is manifested by the action of biologically active substances on various organs and tissues.

Classification of allergic reactions.

1.
The immediate reaction is the presence of circulating antibodies in the blood. This reaction occurs 30-60 minutes after administration of the drug and after it is characterized by acute manifestations: local leukocytosis, in the blood test - eosinophilia.

2. The delayed type reaction is due to the presence of antibodies in tissues and organs, accompanied by local lymphocytosis, occurs 1-2 days after taking the drug.

Classification of allergic reactions according to the pathogenetic type.

1. True (allergic) reactions are divided into chimergic (B-dependent) and chitergic (T-dependent):

1) chimeric allergic reactions are caused by the reaction of antigen with antibodies, the formation of which is associated with B-

lymphocytes;

2) kitergic allergic reactions with allergen compounds with sensitized lymphocytes.

2. False (pseudo-allergic, non-immunological) reactions - do not have an immunological stage in their development.

Classification of drug disease.

1. Acute forms: anaphylactic shock, bronchial asthma, Quincke's edema, vasomotor rhinitis, acute hemolytic anemia.

2. Lingering forms: serum sickness, Lyell's syndrome, drug vasculitis, etc.

3. Mild (itching, Quincke's edema, urticaria), in which the symptoms disappear 3 days after the use of antihistamines; moderate severity (urticaria, eczematous dermatitis, erythema multiforme, fever up to 39 ° C, poly- or monoarthritis, toxic-allergic myocarditis). Symptoms disappear after 4-5 days, but require the appointment of HA in average doses of 20-40 mg.

4. Severe form (anaphylactic shock, exfoliative dermatitis, Lyell's syndrome), damage to internal organs (myocarditis with rhythm disorders, nephrotic syndrome). All symptoms disappear after 7-10 days of combined administration of HA, immunomodulators and antihistamines.

Diagnosis of drug disease: a carefully assembled allergic history. It should be borne in mind that many patients do not take for medication those drugs that they use daily (sedatives, laxatives, analgesics, eye drops, nose drops).

The essence of elimination tests is the abolition of absolutely all drugs.

Skin allergic tests (iv, scarification, application) give a sharply positive reaction with certain drug allergens.

Provocative tests (nasal, inhalation, conjunctival). Basophilic test. The hemagglutination reaction consists in agglutination of the patient with red blood cells loaded with an allergen. RBTL (lymphocyte blast transformation reaction) is used to diagnose a delayed-type allergic reaction. The patient’s lymphocytes are mixed with a possible allergen. After many days of incubation, the degree of transformation of lymphocytes is assessed according to the criteria of morphology or by the synthesis of DNA or RNA using the isotope label Lyell et al.

Treatment of drug illness: bed rest; non-irritating diet with sufficient fluid intake; withdrawal of all medications; desensitizing therapy (calcium chloride, antihistamines, calcium, glucocorticoids); specific hyposensitization is ineffective; not carried out with pancytopenia; symptomatic therapy.

Treatment for anaphylactic shock.

1. P / to enter 0.5-1 ml of a 0.1% solution of adrenaline.

2. Prevention of aspiration of vomit.

3. In / in to introduce 10.0 ml of a 10% solution of Ca chloride or in / to 10.0 ml of a 10% solution of Ca gluconate. 4. In / in a stream, then drip 300-500 ml of a 5% solution of glucose or saline + 0.5-1 ml of a 0.1% solution of adrenaline or 1.0 ml of a 1% solution of mesatone with HA.

5. With bronchospasm - 10 ml of a 2.4% solution of aminophylline, novocaine blockade.

6. In case of laryngeal edema - tracheostomy, moistened oxygen.

7. Antihistamines (suprastin 2% - 2.0, tavegil 0.1% - 1.0, diphenhydramine 1% - 1.0).

8. Cardiac glycosides.

9. With anaphylactic shock of penicillin etiology - up to 1 million units of penicillinase, again - after 6-8 hours.

10. Resuscitation (artificial ventilation of the lungs, closed cardiac massage with the cessation of respiratory and cardiac activity).
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LECTURE No. 14. Medicinal disease in children

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