Analgesic means – big medical encyclopedia hypoxia and anoxia

ANALGESIC MEANS ( analgetica; greek to deny. The an-and algos prefix — pain; synonym anesthetics) — the means which are selectively weakening or eliminating pains as a result of influence it is preferential on the central nervous system. On the mechanism and features of action of ampere-second. Divide on narcotic and non-narcotic.

Narcotic analgesic means

The greatest practical value have derivatives of phenanthrene — morphine (see), codeine (see) and their analogs — hydrocodon (see), thecodinum (see), ethyl morphine (see), lemoranum (see); derivatives of piperidine — promedolum (see) and fentanyl; derivative a geptanona — fenadonum (see); dextromoramidum (see), on chemical structure close to fenadonum.Hypoxia and anoxia

In a pharmacodynamics of narcotic ampere-second. The main thing is their influence on c. N of page and first of all soothing action. Drugs of this group are effective at pains of any intensity and various origin, especially at the constant dull aches connected with diseases of internals. Soothing action differs in sharp selectivity: it develops irrespective of sedative and somnolent effects; other types of feelings are not suppressed (thresholds tactile, acoustical, flavoring, vibration and other types of sensitivity do not raise). Under the influence of narcotic ampere-second. Reactions to pain as physical (the protective movements) and some vegetative, and mental decrease (fear, concern), the attention of the subject to pain is weakened and the concern connected with anticipation of pain decreases.Hypoxia and anoxia

Narcotic ampere-second. Have the expressed psychotropic effect. At introduction of small doses revival of perceptions is observed, intellectual activity improves. At increase in a dose tension of a thought and focusing is at a loss, idea of time changes, the need for intellectual and physical activity decreases, there is an apathy. For the majority of narcotic ampere-second. More or less expressed somnolent action is characteristic.

Narcotic ampere-second. Weaken the negative emotions (fear, alarm, depression, etc.) caused by many adverse factors (excessive cold or a heat, hunger and thirst, mental injuries etc.). Action of these means is characterized by emergence of euphoria — feeling physical and peace of mind, wellbeing.Hypoxia and anoxia euphoric effect of ampere-second. — the main pathogenetic factor in development medicinal dependence (see). It is supposed that analgesic effect of narcotic ampere-second. — one of manifestations of the easing of negative emotions caused by them.

The mechanism of soothing effect of morfinopodobny drugs, despite a large number of researches, is insufficiently clear. Apparently, the major role is played by influence of ampere-second. On the central origins of emotions, in particular change of functions of a hypothalamus and structures of so-called limbic system.

An important link in the mechanism of soothing action of narcotic ampere-second. Their blocking action on carrying out excitement in the afferent ascending ways is.Hypoxia and anoxia they selectively block receipt of somatic touch information in associative talamo-cortical system, reticular structures of a thalamus and rostral departments of a mesencephalon. Ways of visceral sensitivity are blocked already at the level of a spinal cord. At the same time carrying out excitement on classical afferent pathways of a brain is not oppressed.

Central action of narcotic ampere-second. It consists of the oppressing and exciting effects. The ratio of these effects at various animals is unequal. Narcotic analgetics cause excitement in the majority of animals. At the person, and also at monkeys, dogs, rabbits effects of oppression prevail; excitement is shown only by increase in separate reflexes (tendinous and labyrinth), and also strengthening of reaction to not pain stimulations (tactile and sound).Hypoxia and anoxia exciting action of narcotic ampere-second. Is a consequence of oppression of processes of the central braking. Narcotic ampere-second. Exert the direct oppressing impact on a respiratory center of a myelencephalon therefore its sensitivity to carbonic acid decreases. In this regard the role of reflexes from the sino-aortal chemoceptors sensitive to an anoxemia increases in regulation of breath.

For narcotic ampere-second. Mystical action (the narrowing of pupils which is followed by increase in tension of accommodation and decrease in intraocular pressure) caused by excitement of a kernel of a third cranial nerve is characteristic. Miotic effect of narcotic ampere-second. At the person correlates with soothing effect.Hypoxia and anoxia as a result of direct irritant action on a hemoretseptorny zone (trigger zone) of a myelencephalon narcotic analgetics make sick and vomiting. At the same time narcotic ampere-second. Have antiemetic properties: against the background of their action vomitives are inefficient. Morphine and its analogs influence on went. – kish. A path, raising a tone of smooth muscles, weakening a peristaltics, reducing department of gastric and pancreatic juice and bile, causing development of a lock. Narcotic ampere-second reduce a sphincter of a bladder that often leads to a delay of an urination, raise a tone of muscles of bronchial tubes. Action of these funds for muscles of a uterus is insignificant and changeable.Hypoxia and anoxia fenadonum and promedolum have spasmolytic effect on smooth muscles. Promedolum raises a tone and strengthens reductions of a uterus.

Narcotic ampere-second. Cause a hyperglycemia, reduction of a diuresis and, in high doses, decrease in body temperature, caused by exciting action of these funds for a hypothalamus that leads to increase in products of adrenaline and increase in a tone of adrenergic nerves, strengthening of secretion of antidiuretic hormone of a hypophysis, increase in a thermolysis. Action of narcotic ampere-second. The nek-eye is followed by decrease in standard metabolism. Narcotic ampere-second. Are brought out of an organism of hl. Obr. With urine preferential in the connected look.Hypoxia and anoxia at diseases of a liver process of removal is slowed down. Narcotic analgetics more or less easily get through a placental barrier.

On soothing activity, or, otherwise, in size of an effective dose, narcotic ampere-second. Considerably differ from each other. E.G., fentanyl surpasses morphine approximately by 100 times. There is no parallelism between analgesic and other effects of means of this group. Chemical constitution of narcotic ampere-second. — see the scheme.

Chemical constitution narcotic analgeziruyushchnkh means (scheme)

The analgesic effect of morphine, just as influence on breath and smooth muscles, is connected with existence in its molecule of not closed phenolic hydroxylic group.Hypoxia and anoxia binding of the last (codeine, ethyl morphine) leads to easing of the specified effects. To the contrary, the free spirit hydroxylic group reduces analgesic effect therefore replacement or elimination of this radical leads to strengthening of soothing action and relative weakening of influence on intestines (a hydrocodon, thecodinum, dilaudid, metopon) and breath (metopon thecodinum). It is peculiar also to derivatives of N-methylmorphinum (lemoranum demorphanum). The derivatives of morphine deprived of both or one of free hydroxyls, have weaker emetic effect and stronger stimulate c. N of page, having, in particular, convulsive effect.

For narcotic ampere-second. Emergence at repeated use of a phenomenon of tolerance is characteristic.Hypoxia and anoxia at the same time analgesic and euphoric effects and to a lesser extent influence on intestines sharply decrease; mystical and other exciting effects do not decrease. Development of tolerance happens not equally quickly to different substances. The phenomenon of cross tolerance takes place: the stability arising to one substance extends also to other ampere-second. This group.

Substances of this group apply almost only as analgesic cure for pains of various origin: traumatic, including postoperative, connected with malignant tumors, inflammatory diseases, a spasm of smooth muscles, neuralgic, etc., and also for treatment and prevention of traumatic shock. The choice of this or that drug is defined by character and intensity of pains.Hypoxia and anoxia so, at the pains connected with a spasm of smooth muscles it is reasonable to apply promedolum and fenadonum, for a labor pain relief promedolum and thecodinum, less toxic are more preferable to a fruit. Drugs of group of morphine widely use for premedication at an anesthesia. Some narcotic ampere-second. (e.G. Fentanyl) apply for neyroleptanalgeziya (see). Sometimes narcotic ampere-second. Appoint for reduction of an asthma at cardiac asthma, a fluid lungs, for weakening of a vermicular movement of intestines at peritonitis and damages. During the definition of indications and a route of administration of narcotic ampere-second. Their property to cause medicinal dependence is considered. Narcotic ampere-second.Hypoxia and anoxia appoint in the minimum doses and enter with perhaps big intervals, at different times days, avoiding a regularity. The patient shall be under careful observation of the doctor and shall not know what drug to it is administered. Due to the danger of development of medicinal dependence strong protivokagalevy action of narcotic ampere-second is seldom used. In these cases apply hl. Obr. Codeine, ethyl morphine, a hydrocodon, demorphanum (with respect for all precautions).

Narcotic ampere-second. Appoint with care at respiratory depression, an anoxemia, emphysema of lungs, bronchial asthma, insufficient function of a liver, increase in intracerebral pressure. At a hypometabolism of substances and at senile age narcotic ampere-second.Hypoxia and anoxia apply in the reduced doses. To children up to 2 years drugs of this group are not appointed.

At overdose of narcotic ampere-second. There can be acute poisoning: coma, a sharp miosis, cyanosis, deep respiratory depression with the subsequent falling of arterial pressure, weakening of action of the heart and expansion of pupils. Measures of the help: introduction of specific antagonists of narcotic ampere-second. – nalorfinum (see and a levallorfana; a gastric lavage (in case of intake) with the subsequent introduction via the probe of salt laxative; stimulation of breath (corazolum, cordiaminum, caffeine, phenaminum); long artificial ventilation of the lungs; warming of the patient; administration of solution of glucose, plasma, physiological, ringerovsky solutions; bowel emptying and bladder (catheterization); frequent change of position of a body for prevention of hypostatic pneumonia.Hypoxia and anoxia purpose of emetic is inexpedient. Stimulators and specific antagonists it is recommended to apply in the minimum doses sufficient for maintenance of the vital functions (e.G., breath). Picrotoxin and strychnine are contraindicated.

Non-narcotic analgesic means

Non-narcotic analgesic means: derivatives of pyrazyl ketone — pyramidon (see), analginum (see), antipyrine (see), butadionum (see), aniline — monoacetylaniline (see), paracetamol (see), acetphenetidiene (see); salicylic to – you — acetylsalicylic acid (see), sodium salicylate (see), salicylamidum (see).

On soothing activity these means considerably concede to narcotic ampere-second.; besides, they are effective only at some types of pains (neuralgic, head, tooth, at arthritises, miozita, etc.).Hypoxia and anoxia means of this group do not drowse, do not influence the respiratory and tussive centers, uslovnoreflektorny activity, do not cause euphoria and medicinal dependence. At feverish states they cause the febrifugal effect caused strengthening of a thermolysis as a result of impact on the centers of thermal control in a brain. Mechanism of soothing action of non-narcotic ampere-second. It is a little studied. Assume that it is connected with influence of drugs of this group on thalamic structures. Besides, an essential role is played by reduction of intensity of inflammatory processes as source of pain. Non-narcotic ampere-second. Reduce permeability of capillaries, increase their resistance, limit exudation and reduce temperature in the center of an inflammation (antiinflammatory action).Hypoxia and anoxia on a nek-eye to data, under the influence of non-narcotic ampere-second. Sensitivity of afferent nerve terminations to irritant action of «mediators of an inflammation» decreases. Derivatives salicylic to – you and pyrazyl ketone have antirheumatic effect.

Apply non-narcotic ampere-second. At pains of various origin, as antipyretics, at acute rheumatism, arthritises and some other inflammatory diseases.

From the side effects caused by derivatives of pyrazyl ketone the disturbances of a hemopoiesis (a granulocytopenia, an agranulocytosis) arising sometimes and an acute anaphylaxis are most dangerous. At prolonged use of these substances the regular blood analysis is necessary. Derivatives of aniline in high doses can cause a methemoglobinemia, derivatives salicylic to – you — dispeptic frustration, the injury of a mucous membrane of a stomach which is expressed bleeding, a sonitus, deterioration in hearing, increase of attacks of bronchial asthma.Hypoxia and anoxia

At acute poisoning with non-narcotic ampere-second. It is necessary to make a gastric lavage, to appoint salt laxative, means of symptomatic therapy (barbiturates at spasms), to warm the patient, to enter solutions of glucose, sodium chloride, plasma, etc., if necessary to make hemotransfusion.

The main kliniko-pharmacological data on drugs of group of analgetics — see the table.

Bibliography: krayevskiyv. I. O comparative influence of morphine and its various derivatives (heroin, a peroshga, dionine and codeine) on respiratory activity, spb., 1902; kuvshinsky P. D. About influence of some food and pharmaceuticals on department of pancreatic juice, spb., 1888, bibliogr.; N of e-teas A. And. About the oppressing influence on department of a gastric juice: atropine, morphine, chlorali hydras and irritation of sensory nerves, spb., 1882, bibliogr.; analgetics, in book: medicinal chemistry, ed.Hypoxia and anoxia by G. De stevens, v. 5, N. Y. — L., 1965, bibliogr.; domino E. F. Sites of action of some central nervous system depressants, ann. Rev. Pharmacol., v. 2, p. 215, 1962, bibliogr.; it, effects of narcotic analgesics on sensory input, activating system and motor output, res. Publ. Ass. Nerv. Ment. Dis., v. 46, p. 117, 1968, bibliogr.; guzman P. Lim R. K. S. The mechanism of action of the non-narcotic analgesics, med. Clin. N.Amer., v. 52, p. 3, 1968, bibliogr.; M a r t i n W. R. Analgesic and antipyretic drugs, in book: physiol. Pharmacol., ed. By W. S. Root a. F. G. Hofmann, v. 1, p. 275, N.Y., 1963, bibliogr.; randall L. P. Non-narcotic analgesics, ibid., p.314, bibliogr.; schaumann O. Morphin und morphinannlich wirkende verbindungen, handb.Hypoxia and anoxia exp. Pharmakol., begr. H. Heffter, bd 12, S. 367, B. U. A., 1957, bibliogr.; wikler A. Sites and mechanisms of action of morphine and related drugs in the central nervous system, pharmacol. Rev., v. 2, p. 435, 1950, bibliogr.: about and e, opiates and opiate antagonists, washington, 1958, bibliogr.

H. A. Krugloye; authors of the tab. V. A. Svetlov, A. M. Hilkin.