Medicinal forms of enzymes. Clinical pharmacology of enzyme preparations. Classification, pharmacodynamics, pharmacokinetics, indications, side effects, contraindications, interaction with other means. The use of enzyme preparations
E.V. Koltsova, K.T.N., N.A. Vashchenkova, Ph.D.
FSUE "HigronImenedprom"
Enzymes - specific biological catalysts of protein nature, accelerating the flow of chemical reactions in cells. The absence of enzyme synthesis or persistent functional failure of enzyme systems of organs and tissues determine the development of pathological processes. Hereditary enzymopathy is associated with genetically determined failure of one or several enzymes. More than 200 hereditary enzymopathies are known, for which the essence of gene mutation is established, errors in the synthesis of the protein enzyme molecule are determined, and the corresponding mutated genes are mapped on chromosomes. Acquired enzymopathy can be due to a long deficit of protein in nutrition, disruption of the biosynthesis of coenzymes in vitamin deficiency, inhibition of the synthesis of metal farms with a low content in the diet of the corresponding mineral substances.
According to the main focus and clinical use, enzyme preparations are separated into the following groups: preparations used for purulent necrotic processes, drugs with fibrinolytic properties and drugs that improve digestion processes.
The first group includes trypsin, chymotrypsin, chemicalsin, ribonuclease and others. They are used mainly for the treatment of purulent and trophic ulcers, laying out, as well as to disperse viscous secrets for diseases of the respiratory tract (pneumonia, bronchitis).
The second group of enzyme preparations includes fibrinolysin, streptoliasis, urokinase, thrombolytine used to dissolve fresh thrombus.
The third group includes such drugs such as pepsin, pancreatin, gastric juice, abomin, as well as a variety of comprehensive preparations of the festal type, Digestal and others. These drugs are prescribed in case of insufficiency of the secreter activity of the pancreas, the glazes of the gastric mucosa and other violations of functions gastrointestinal tract.
In addition to the above groups, medicines also contain enzymes and other pharmacological properties are used in medical practice. In very general They can be divided into drugs with antitumor and antiviral activity and preparations effective in the treatment of diseases of the cardiovascular system.
To treat tumor diseases, vegetable enzymes and the complex of animals and plant enzymes were previously proposed, currently asparaginases are used to treat leukemia. Preparations for the treatment of cardiovascular system have special significance. The drug deficient in Russia is produced in a number of countries to treat violations of cerebral circulation and coronary atherosclerosis, reciprocal of newborns. The drug is able to improve tissue respiration in disorders of the oxidative process in tissues, and the presence of an antihypoxic effect and the absence of side effects make it particularly significant.
In the Russian Federation, the production of enzyme preparations is carried out at 14 enterprises of the medical industry, but the volume and range of products are insignificant. The largest share of the range of enzyme preparations is produced by FSUE NPO "Microgen" and "ICN Lexers" (table). In 1993, the enterprises of the industry carried out the production of enzymes used for purulent-necrotic processes (7 trade names), improving digestion (8 trade names) and proteolysis inhibitors (one trading name).
Enhancement enzyme preparations
A particularly promising area of \u200b\u200buse of enzymes is their use for replacement therapy in the treatment of gastrointestinal pathologies.
The main advantages of modern dosage forms of gastrointestinal enzyst and intestinal drugs can be attributed to the high activity of the enzymes included in it, the ability to optimize not only intestinal, but also gastric digestion.
The global market of digestive enzyme preparations has developed, mainly in the 70s. In terms of its composition and activity, these drugs meet all the requirements of the chemical-pharmaceutical product market required for the treatment of lungs and severe forms of bowel disease, stomach, liver, biliary tract, pancreatic glands. Preparations are used to treat both adults and children, including young children and newborns who have digestion disorders especially often and present a serious danger to life. But the largest part of consumers of enzyme preparations make up the faces of the elderly and senile ages, in which the weakening of the digestive function of the stomach, intestines and the pancreas is often developing.
A feature of the enzyme gastrointestinal enzyme preparations is the presence of an animal enzymes included in Pancreatin, and the enzymes obtained as a result of microbiological synthesis. Most of the drugs contain bacterial enzymes used, mainly to compensate for the dietary masses in the stomach. The enzymes of mold fungi and yeast are also used, which have different substrate specificity, thermolabilicity and spectrum of action. Enzyme preparations Gastrointestinal action differ in composition (the presence of microbial acid enzymes, pepsin, chymotrypsin, bile), as well as the activity of microbial enzymes, which fluctuates in large limits - as well as the dose of pancreatin.
Obtaining purified monoenzyme preparations with an applied goal requires great effort and therefore is not practiced by most firms from economic considerations. At the same time, taking into account the ability of microorganisms to produce several enzymes creates multi-nominal compositions.
The most commonly used dosage forms in Europe - dragee, less often with shell-covered pills; In Japan, it is most often made in the form of capsules, and children's dosage forms - in the form of granules and powder for adding a newborn in a mixture.
The firms of the leading countries of Japan, the USA, Germany produce dozens of drugs containing enzyme preparations that improve digestion. In the Russian market, digestive enzymes are represented by drugs as domestic and imported production from 13 countries: Germany, France, Finland, India, Lithuania, Slovenia, Pakistan, Turkey, Hungary, Ukraine, Belarus, and even San Marino. The main supplier is Germany, exporting 46% of complex drugs - such as Creon, Pancreeoflat, Vobenzym, etc.
According to the State Statistics Committee of Russia, in the structure of the overall incidence of the Russian Federation, the disease of the digestive organs is 8%; The number of patients registered in 2002 amounted to 16 million people, the annual gain of the disease is approximately 2%. Of particular anxiety is the fact that annually an increase in the number of adolescents suffering from disorder of digestion organs increases by 3.3%.
The nomenclature of domestic enzyme preparations that optimize digestion is limited, as well as the volumes of their release. Thus, the range of domestic enzymes registered by the Ministry of Health of the Russian Federation has 22 trade names, and those produced (in 2003) - 8 trade names, which indicates a slight saturation of the domestic market by Russian medicines.
Pancreatins (TB P / O), Ferestal (TB P / O) and ABOMIN (TB), are used by the greatest demand among domestic enzyme preparations that improves digestion.
For the first 9 months of 2003, 21721.1 thousand packs were issued. NO 10 tablets and 4.4 thousand pack. NO 10 oral solutions, sales, respectively, amounted to 21404.5 thousand UE. and 4.7 thousand pack. Comparison of production and sales of food enzymes for 9 months 2002 and 2003. showed an increase in the production of oral forms of abomine, pancreatin, equine solutions. At the same time, the release of a pepsin solution from the gastric glands of dogs, the peeper tablets decreased significantly, and Digiestal and Pankrenorma suspended.
Anti-inflammatory enzyme preparations
In the global market of chemical and pharmaceutical products there are a variety medications anti-inflammatory action. These are more often an outdoor drugs in the form of ointments and powders for the preparation of solutions. Injection and significantly less frequent injectable drugs are widely offered.
The external drug forms of enzyme preparations are used, mainly to attenuate the inflammatory process in wound and burn lesions, accompanied by tissue necrosis with the formation of drafts, fibrous-necrotic and purulent-fibrin raids or exudates in the cavities of pleura, peritoneum, joints, etc. This connection is used by enzymes, diluting exudates dissolving fibrin, which have necrolitic properties (tripsin, chymotrypsin, papain). In modern dosage forms in Japan, the ferriment of serratopeptidase and trypsin with papain is used. Along with enzymes, preparations may contain antibiotics (for example, neomycin) and painkillers (for example, lidocaine, promethazine), since native enzymes often cause pain when entering a healthy granulation tissue.
Russia also developed anti-inflammatory enzyme-containing drugs of animal origin, as well as derived from crops of microorganisms. The range of domestic enzyme preparations for the treatment of purulent necrotic processes, registered by the Ministry of Health of the Russian Federation, contains 29 trade names of enzyme drugs, mainly for external use: suspensions, solutions, ointments, extracts, lyophilized powders for the preparation of solutions for local applications. Injection forms of apricinine (inhiprol, inhydril), hyaluronidase (lidase, leafing, nydase), collalizine and immobilized elastograes (napkins) are developed and registered. However, not all drugs are currently produced on an industrial scale at the medical industry enterprises; In 2003, only seven trade names of drugs were produced.
Among the domestic enzyme preparations with anti-inflammatory effects, lyophilized hyaluronidase powders used with the greatest demand used to increase the permeability of tissues and ensure the movement of the fluid in the interstitial spaces during arthritis, hematomas, with a red loll. The external dosage forms of this enzyme are recommended for the treatment of inflammatory edema in varicose veins, hemorrhoids, injuries.
In the pharmaceutical market of Russia of hyaluronidase is represented by drugs in the form of lyophilic powders for cooking injection solutions domestic production (Lydase, Nidase, Lyraza) and medicines under trade name Lidase delivered from Belarus and Ukraine. In the state register of drugs included the drug of Ronidase in the form of a powder for outdoor use, but currently the production of this dosage form is missing.
In the first 9 months of 2003, 899.6 thousand UEs were produced. NO 10 hyaluronidase (lidase + Liraza + Nidase), which amounted to 72.1% compared with the volume of drug production for the same period of 2002. The decline in the production of lidase and Nidase is marked by 44.3% and 28.6%, respectively, and an increase of 2.1 times the release of the lesion. The total sales of hyaluronidase preparations for the first 9 months of 2003 also decreased and amounted to 957.4 thousand UE. NO 10 (77.7%).
The situation in the production of other enzyme preparations used in the treatment of purulent-necrotic pathologies is also not unambiguous. Thus, compared with 2002, the release of collalizin and regionitin increased by 2.2 and 1.4 times, respectively, with simultaneous increase in sales volumes. At the same time, the volume of production and sales of trypsin amorphous and crystalline decreased.
Other enzyme preparations
In Russia, they were developed and even produced, albeit in limited quantities, cytochrome C, L-asparaginase, as well as penicillinase used in acute allergic reactions and anaphylactic shock caused by the preparations of the penicillin group. However, currently listed drugs at the factories of the medical industry are not issued.
For the treatment of acute pancreatitis and with other indications to reduce the activity of proteolytic and fibrinolytic enzymes, medicines that inhibit proteolysis are used, in particular, inhydral derived from light cattle. The drug refers to the vital and most important drugs and is produced at FSUE NPO "Microgen" enterprises. The growth rate of production and sales of this drug for the first 9 months of 2003 was 131% and 102.8% compared to the same period last year, respectively.
In conclusion, it should be emphasized that enzyme preparations belong to drugs with low toxicity, are well transferred to patients for a long time, and by-effects caused by enzymes are observed in a small number of patients and quickly pass after cancellation of drugs. Use of enzymes B. therapeutic purposes is a developing direction and occupies a binding place in modern complex therapy. In countries with a developed biochemical industry, dozens of items of enzyme-containing drugs of a diverse spectrum of action are produced. For Russian Federation economically appropriate, in our opinion, is not an uncontrolled increase in the number of enzyme medicines, but replacing outdated more modern drugscorresponding to the requirements of the global chemical and pharmaceutical market in order to meet the demand of the country's population and reduce imports.
When own digestive system The enzymes needed to digest food in insufficient quantities, it needs to help cope with the load. Numerous preparations containing the components of the pancreas enzymes, bile and additional additives are available for these purposes.
You can take them not only for diseases, but also with absolutely healthy stomach and pancreas in cases where the food turned out to be very "heavy", for example, too fat or praised. Enzyme preparations, especially recent generationsQuickly solve this problem, they do not need to take a course, they are able to help and at one time receptions.
Indications
General testimony for receiving enzyme preparations are states and diseases:
- insufficient secretion of the stomach;
- obstruction of biliary tract or pancreatic ducts;
- inflammatory diseases of the gastrointestinal tract;
- resection or irradiation leading to digestive disorders;
- diet violation;
- long bed;
- violation of chewing function.
Application
These drugs are accepted while eating or immediately after meals. The dosage depends on the specific medication and the appointment of the doctor if some individual disease is adjusted. It is necessary to swallow a tablet (capsule), not allowing damage to the shell.
Side effects
Usually enzyme preparations do not cause adverse Reactions. But occasionally there is nausea, discomfort in the area of \u200b\u200bthe stomach, constipation or diarrhea, with an increased individual sensitivity - allergic, long use and elevated doses - Hipuricozuria.
Classification
Enzyme preparations are divided into several categories.
1. Pancreatic enzymes in the minimum dosage
The composition of the same for all drugs of the group:
- lipase 3500 IU (under its action, fats are disintegrated to fatty acids and glycerin);
- amylase 4200 IU (splits carbohydrates to monosaccharides);
- protease 250 IU (proteins decompose to amino acids).
The most famous and popular drugs of this composition are:
- pancreatin No. 60 (Russia);
- mezim Forte No. 20 (Germany);
- penzital No. 100 (India);
- gastenorm Forte No. 20 (India).
2. Preparations with bull bile
This group includes pancreatin preparations in the same minimum dosage with the addition of bovine bile extract. It improves food digestion with an insufficient gallbladder function.
Preparations:
- festal №100 (India);
- enzystal No. 80 (India).
3. Pancreatine preparations with increased dosage
The composition is:
- lipase 10,000 IU (20,000 IU);
- amylase 7500 IU (12000);
- proteasa 375 IU (900).
Preparations:
- mezim Forte 10 ends (20 text) - Germany;
- panzinorm 10 ease (20 year.) - Slovenia;
4. Preparations manufactured using microcapsulation technology
Preparations of this group are considered the most efficient. In the gelatin capsule is located medicinal substance In the form of a microsphere at different speeds. When the capsule disintegrates in the stomach, the microspheres are mixed with the contents of the stomach and enter the delicate intestine, where they begin to dissolve, but not everything is simultaneously, but gradually, one before, others later. This, extended dissolution, increases the total duration of the drug.
The group includes the following medicines:
- creon 10 (25 ease., 40 ease.);
- micrazim 10 ease. (25 ease.);
- pangarol 10tes. (25 ease.);
- ermitial 10 year. (25 ease., 36 text);
5. Other drugs
They can be attributed to UNIENZIM, which includes:
- fungal diastasis (enzyme fungi);
- papain (plant enzyme);
- siemeticone;
- nicotinamide;
- coal activated;
Thanks to this composition, UNIANZIM helps to digest "heavy" food, prevents gas formation and scattering of the intestine due to poorly digested food.
Enzyme preparations - this group pharmacological meanscontributing to the improvement of the digestion process.
Disorders of digestion and suction of food (dyspeptic syndrome, malabsorption syndrome) are characterized by a violation of the functions of the stomach, thin gut, liver or pancreas. The main clinical manifestations of dyspepsia are a feeling of pain and gravity in the stomach, belching, bloating and a rumbling in the stomach, and Mal Absorption syndrome - diarrhea, mainly osmotic, loss of body weight, protein and vitamin failure, dehydration, ion deficiency.
Enzyme preparations are used, as a rule, with a substantive goal in a sufficient dose (in low doses, they are ineffective) and for a long time. Treatment with enzyme preparations does not exclude the appointment of LS of other groups.
Classification of enzyme preparations
The following groups of enzyme preparations distinguish.
· Preparations containing pancreatin (Pancreatin, Penzal, Mesim Forte, Panzinorm Forte - H, Creon, Poletrath).
· Preparations containing pancreatin, bile components, hemicelylase and other components (festal, Digestal, Enzystal, Panzinorm Fort).
· Preparations of plant origin, containing papain, rice mushroom extract and other components (pep infusion, oraza).
· Combined enzymes containing pancreatin in combination with vegetable enzymes, vitamins (vitamins, phlohenzim).
All enzyme LS differ in the activity of enzymes, their composition and exist in different dosage forms. In some cases, these are single-layer tablets, soluble only in the intestines, in others - two-layer, such as a panzinorm. The outer layer is dissolved in the stomach, contains extract of the gastric and amino acid mucosa, and the second acid-resistant shell dissolves in the intestine, contains pancreatin and high-horned potty extract.
Along with the enzymes of the pancreas and the stomach, the combined enzyme preparation (for example, festal) is often included with hemicelylase, which contributes to the splitting of plant shells, which reduces the severity of fermentation processes, reduces gas formation in the intestine.
Side effects in the use of enzyme preparations are extremely rare (less than 1%) and are most often disseminated. In the urine of patients using high doses of pancreatic enzymes, may be observed. increased content uric acid.
With caution, enzyme preparations are used in patients with gout.
In some cases, patients receiving enzymes can disturb diarrhea, constipation, discomfort in the area of \u200b\u200bthe stomach, nausea, irritation of the perianal area.
Contraindications To the appointment of enzyme preparations containing bile components:
o acute pancreatitis;
o chronic pancreatitis;
o acute and chronic hepatitis;
o. ulcerative disease stomach and duodenal estate;
o Inflammatory bowel diseases.
Thus, therapy by enzyme preparations should be carried out differentiated taking into account the mechanism for the development of the disease underlying digestion disorders.
94.Chronic hepatitis. Etiology. Definition. Classification. Main clinical symptoms. Principles of treatment.
Chronic hepatitis - inflammatory liver diseases various etiology (viruses, toxic agents, autoimmune processes, etc.) duration of more than 6 months. For clinical and morphological features, 3 main types of chronic hepatitis are distinguished:
· chronic persistent hepatitis (CPG) - Chronic inflammatory liver disease with predominant damage to portal tracts, which is usually without a pronounced tendency to spontaneous progression without the development of large liver failure and portal hypertension.
· chronic Lobular Hepatitis (HLG) - chronic inflammatory liver disease with a predominant defeat of the liver, partially and portal paths actually. Large liver failure and portal hypertension is not observed. In the pathogenetic terms, as it were, "frozen" acute hepatitis.
· chronic Active Hepatitis (Hug) - A relatively rare systemic inflammatory disease that flows with preferably lesions of the liver (both hepatic lobes and portal tracts and periportal spaces), characterized by severe immune disorders and often spontaneously unwelling the activity of the pathological process in the liver. It often evoluates in cirrhosis and may end with death as a result of the development of large liver failure or manifestations of portal hypertension. It is customary to allocate two main variants of the disease: a highly active (progressive) and lowactive (slowly progressive).
The liver inflammation (hepatitis) can be caused by various factors ( hepatotropic factors), capable of damaging the liver parenchyma. The etiotropic classification of hepatitis includes
1. Infectious (viral) hepatitis:
· Hepatitis A (Botkin's disease) - the disease is transmitted by an alimentary way. The virus enters the human body with contaminated food, water, consideration. Patients with rude diseases of the disease are the main source of infection (rude-owned). If you get into the gastrointestinal tract, the virus penetrates through the intestinal mucosa and with a blood current is entered into the liver, where it is introduced into the liver cells and begins to be actively multiplied. Liver damage is associated with a direct destructive action of the virus on hepatocytes (liver cells).
The main symptoms are:
General ailment
Fever,
Muscle pains
Stupid pain B. the right hypochondrium,
Dark urine color.
· Hepatitis B - Sources of infection serve patients with sharp and chronic forms Hepatitis, as well as virosters. The transmission of the virus is carried out by parenterally natural and artificial paths. Of the natural paths, the most common sexual path of transmission of infection is most common. An infection is also possible during childbirth from a sick mother or transplantary fetal infection during pregnancy. Artificial Path The transmission of infection is carried out when overflowing infected blood or its components, using non-saturated surgical or dental instruments, syringes.
Most often the yellow form develops. Patients complain of disorder of digestion, pain in the joints, weakness. In some cases, items appear on the skin.
· Hepatitis C is transmitted during contact with infected blood. Hepatitis C can lead to the development of chronic hepatitis, completing cirrhosis of the liver and liver cancer.
In the clinical picture of chronic hepatitis with the most characteristic asthenic syndrome:
Weakness,
Fast fatiguability,
Progressive disintegration of working capacity
Sleep disturbance.
· Hepatitis D - Delta virus is able to multiply in liver cells only in the presence of hepatitis B virus, as it uses hepatitis Virus Virus proteins to exit a cell of the Delta-Virus particle
The source of the virus serves a sick person or a viroster. Infection with the virus D occurs when the virus is hit directly into the blood. The transmission paths are similar to those in hepatitis B or C. Clinical picture Reminds the clinic of viral hepatitis B, however the course of the disease is usually more severe.
· Hepatitis E - It can be transmitted through the water infected with the virus, and besidesly, through blood.
· Hepatitis F.
· Hepatitis G.
· Bacterial hepatitis: under leptospirosis, syphilis.
2. Toxic hepatitis:
· Alcohol hepatitis
· Medicinal hepatitis
· Hepatitis in poisoning with various chemicals
3. radiation hepatitis (ray disease component)
4. Hepatitis as a result autoimmune diseases
Treatment:
Sick chronic hepatitis, aggressive and persistent, should adhere to a special diet. It implies a refusal of fried food, spicy and sharp dishes.
With any exacerbations of hepatitis, hospitalization, bedding, as well as observance of a strict diet, in which the patient will receive the required amount of vitamins and proteins will receive. The doctor may prescribe vitaminotherapy (ascorbic, folic and a nicotinic acid, B12, B6, B2, B1 vitamins).
Viral hepatitis:
- Interferonotherapy (Feron, Roiferon - A (3-6 months - depending on the dose)
Base therapy for 7 - 10 days (hemodez, inside lactulose)
Autoimmune hepatitis:
1. Prednisolone (glucocorticoid) 30 mg per day for a month, further supporting dose (10 mg per day) for several years.
2. Azatioprin (immunosperessant) - originally 50 mg per day, supporting the dose (for several years) 25 mg per day.
3. Polyefermen preparations - Creon or Poletuts for 2 weeks quarterly.
95. Clinical pharmacology hepatoprotectors Classification, pharmacodynamics, pharmacokinetics, indications, side effect, contraindications, interaction with other means.
This group includes drugs that increase the stability of hepatocytes to the unfavorable effects of various factors.
These include:
o inhibitors of perikisal oxidation of lipids,
o essential phospholipids,
o Preparations of plant origin.
1) lipid peroxidation inhibitor (floor) - tioctic acid , which is a coenzyme of oxidative decarboxylation of peyrogradic acid and alpha ketok acid, normalizes energy, carbohydrate and lipid exchanges, regulates the XC metabolism. For course treatment, the drug improves:
Reduces the damaging effect of toxic exogenous and endogenous substances.
Pharmacokinetics:
Tioxtic acid is quickly absorbed from the intestine. Bioavailability is approximately equal to 30%, in the liver the drug is subjected to oxidation and conjugation, is removed mainly by the kidneys in the form of inactive metabolites (80-90%). T 1/2 is 20- 50 min.
Side effect:
When adopting the drug may develop hypoglycemia,
Allergic reactions,
Interactions with other drugs:
Incompatible with ringer and glucose solutions.
2) Essential phospholipids are contained in esssential Forte N.. Phospholipids (linoleic, linolenic and other unsaturated fatty acids) during course treatment normalize metabolism and microcirculation processes in the liver, improve its detoxifying function, and also have a normalizing effect on the lipid composition of the blood.
3) Hepatoprotectors of plant origin include:
- Hepatofalc Plata. Contains dry fruit fruit fruit dry extract, Grass Large and Turmeric Yavanskaya.
The drug stabilizes hepatocyte membranes, has antioxidant activity, prevents the penetration of a number of hepatotoxic substances into the cell. In addition, it increases protein synthesis in the liver, has anti-inflammatory and antibacterial activity.
Indications for use:
Toxic lesions of the liver (including alcoholic and medicinal),
Acute and chronic hepatitis of various etiology and cirrhosis of the liver (as supportive therapy),
Pain syndrome (spastic nature) for diseases of the gallbladder and biliary tract ( chronic cholecystitis, cholangitis, dyskinesia gallbladder and biliary tract) and other diseases of the gastrointestinal tract,
Dilatation of bile ducts and varicose veins of the veins of the gastrointestinal bodies,
Dyspepsia.
Contraindications:
Increased sensitivity K. components of the drug,
Blockage of biliary tract
Obstructive jaundice.
Side effect:
Allergic reactions,
With prolonged use - dyspeptic disorders.
- Silibinininteracts in liver with free radicals, interrupts the floor process, prevents the destruction of cellular structures.
In hepatocytes, it stimulates the synthesis of structural and functional proteins, stabilizes cell membranes, accelerates cell regeneration.
Pharmacokinetics:
Poorly absorbed in Gastroyit is exposed to intestinal and liver circulation, the metabol is aimed in the liver by conjugation, is removed mainly with hens in the form of glucuronides and sulfates. Half-lifethe drug is 6 h.
Indications for use:
Condition after transferred hepatitis viral and toxic etiology, liver injuries;
Chronic hepatitis, liver cirrhosis;
Toxic lesions of the liver (incl. Due to the use of aminoglycosides, tetracycline, immunosuppressants, NSAIDs, anti-tuberculosis drugs, barbiturates, tranquilizers);
Prevention of atherosclerosis.
Contraindicated with hypersensitivity to its components.
Side effect: When receiving the drug, the development of diarrhea is possible.
96.Chronic cholecystitis. Etiology. Definition. Main clinical symptoms. Principles of treatment.
Chronic cholecystitis - chronic inflammatory disease of the gallbladder, combined with motor-tonic disorders (dyskinesia) of biliary tract and changes in the physicochemical properties and biochemical composition of the bile duration of the disease for more than 6 months (by lecture).
Etiology:
o. Bacterial infection (staphylococci, streptococci)
o duodeny-biliary reflux
o Allergy
o Chronic inflammatory diseases gasts
o Acute cholecystitis
Pre-providing factors: dyskinesia of biliary tract, intestinal dysbiosis, metabolic disorders (obesity, diabetes), hereditary burden (by a lecture).
· Pain syndrome
With dyskinesia biliary tract hykokinetic type- Pains are stupid, novice, pressing character, almost constant
With diskinesia in hyperkinetic type characterized by grabs-shaped, stitching, cutting, drilling pains appearing in the form of periodic attacks
With right-sided irradiation
Provokes the appearance of pain consumption: oily, fried, sharp dishes, eggs, cold and carbonated drinks, alcohol
· Disps syndrome
· Vegetative dystonia syndrome.
Principles of treatment:
Conservative treatment of cholecystitis and other inflammatory diseases of the biliary tract is directed mainly on the suppression of infection (antibiotics and other antimicrobial drugs are applied), as well as to strengthen the outflow of bile (special diet, choleretic (Alohol, Holyagol, Holosmismolytic (but-shop , Papaverin) means).
With a combination of cholecystitis with pancreatitis, the doctor may prescribe the preparations of festal, Creon, Panzinorm, Mezim.
Significant role as conservative treatment Cholecystitis plays a diet with the exception of mechanically and chemically irritating food.
97.Clinical pharmacology of choleretic drugs. Classification, pharmacodynamics, pharmacokinetics, indications, side effects, contraindications, interaction with other means.
Choleretic means - drugs, reinforcing boring or contributing to the release of bile in duodenal gut.
I.Preparations, stimulating borders - choleretics
A. Increasing the secretion of bile and formation of bile acids (true choleretics):
1) Preparations containing bile acids:
o Allohol (shell-coated tablets) (Contained besides bile acids of nettle and garlic extract, as well as activated carbon).
o Holenzim (shell-covered tablets) (preparation from bile and pancreatic enzymes and livestock intestines).
o Libil (Tablets covered with intestinal-soluble shell).
Bile acids, sucking into the blood, stimulate the bormering function of hepatocytes, the non-disgraced part performs the substitution function. In this group, preparations that are bile acids increase the volume of bile, and the preparations containing bile animals are to the greater the content of chelates (bile salts).
2) Synthetic preparations:
· Hydroxymethylnicotinamide (Nicodein)
· Osalmid (Oxafenamide)
· Cyclovalon (cycvalon)
Medicinal interactions: Enhances effects indirect anticoagulantov. The effect is reduced against the background of the simultaneous purpose of morphine, which causes the sphincter sphincter Oddi. Two-way antagonism when combined with metoclopramide.
These drugs have a pronounced choleretic effect, but they do not change significantly excretion in bile phospholipids. After receipt from blood to hepatocytes, these LS are secreted in bile and dissociate, forming organic anions. High concentration Anions creates a osmotic gradient between bile and blood and causes osmotic filtering of water and electrolytes to the bile capillaries. In addition to choleretic, synthetic choleretics have a number of other effects:
Antispasmodic action (oxafenamide, gimekromon),
Hypolypidemic (oxafenamide),
Antibacterial (hydroxymethylnicotamide),
Anti-inflammatory (cyclicovalon).
3) Preparations of plant origin:
o Sandmade sand mill flowers
o corn storks,
o Pijma Ordinary (Tanatschol),
o Rosehip Fruits (Holys),
o Berberina Bisulfat
o Bear kidney and others.
The effect of vegetable preparations is associated with the influence of a complex of components included in their composition, incl. such as essential oils, resins, flavones, phytosterols, phytoncides, some vitamins and other substances. Preparations of this group:
Increase the functional ability of the liver,
Increase the secretion of bile,
Reduce bile viscosity.
Along with the strengthening of the secretion of bile, most of the phytopreparations of this group increase the tone of the gallbladder while relaxing the smooth muscles of the biliary tract and sphincters Oddy and Lutcens.
The choleretic phytopreparations also have an essential influence on other functions of the body:
Normalize and stimulate the secretion of the glands of the stomach, pancreas,
Enhance the enzymatic activity of gastric juice,
Enhance the intestinal peristaltics at its atony.
Usually adopt phytopreparations 30 minutes before meals, 3 times a day.
B. Preparations that increase the secretion of bile at the expense of the water component (hydrochloricoles):
· Mineral waters ("Essentuki" №17 (strongly mineralized) and No. 4 (weakly mineralized), "Smirnovskaya", "Slavyanovskaya").
Mineral waters are usually used in warm form for 20-30 minutes before meals.
· Sodium salicylate,
· Valerian preparations.
Mineral waters increase the amount of secreted bile, make it less viscous. Mechanism of action choleretic means This group is due to the fact that, sucking in the gastrointestinal tract, they are allocated by hepatocytes into primary bile, creating increased osmotic pressure in bile capillaries and contributing to an increase in the aqueous phase. In addition, the reverse absorption of water and electrolytes in bile bubble and biliary traits, which significantly reduces the viscosity of bile.
Indications for use:
§ Chronic inflammatory diseases of the liver and biliary tract,
§ apply them when dyskinesia biliary tract,
§ When treating constipation.
If necessary, choleretics are combined with antibiotics, analgesics and spasmolitics, with laxative means.
Side effects:
ü Allergic reactions,
ü diarrhea (due to stimulation of intestinal motility).
Contraindications:
ü sharp hepatitis
ü Obstructive jaundice,
ü ulcent stomach and duodenal ulcer,
ü acute pancreatitis.
Medicinal interactions: There are no information about adverse interactions with other drugs.
For normal digestion, biological catalysts are needed - enzymes. These are complex protein molecules, in the presence of which all chemical reactions proceed to dozens and hundreds of times faster! Without them, the process of digestion would occupy years.
Each enzyme has its own specification: amylase destroys carbohydrates to monomers, lipase - fats, proteases - proteins. There are separate types of enzymes for nucleic acids (nucleases) and some other substances. But they all obey certain rules:
- Each enzyme has an active center that is only suitable for the same type of digestible product;
- Each enzyme is active at a certain pH;
- Each enzyme is secreted in inactive form, otherwise it will digest own fabrics;
- All enzymes, having completed its functions, are absorbed back into the blood or destroy to amino acids, thus their cycle occurs.
The process of enzymatic digestion of food begins in oral cavityHere the amylase destroys starch. In the gastric juice contains pepsin - an enzyme splitting protein into smaller fragments - peptides.
The duodenum of the pancreas (PJ) is published in the duodenum, and it is it that synthesizes the main amount of the necessary digestive enzymes - amylases, proteases and lipases. Moreover, lipase is predominantly pancreatic origin, while amylase and proteases in sufficient quantities are allocated by cells of the small intestine. That is why if diseases of the pancreas, the digestion of fats suffers first, the person is forced to sit on a nice diet, since the taking oily food causes nausea, epigastric pain and diarrhea (bold foamy chair).
The spectrum of pancreatic enzymes is very volatile and adapts to the usual human diet. Vegetarians almost do not have proteases, people who do not consume lipases in pancreatic juice. That is why, if diet violations, digestion disorders may arise.
Pancreatic enzymes are active in an alkaline medium of a duodenal intestine, where many bile and bicarbonates. The bile also emulses fats, contributing to digestion.
Surrender pancreatic insufficiency occurs with pancreatitis, long-term strict diet, tumors and general exhaustion, protein starvation. Often hepatitis and gastritis are accompanied by a violation of the secretion of enzymes. First of all, this state is manifested by a lack of lipase, and even then - all other components of pancreatic juice. Vomiting, nausea, weakness, weight loss, signs of lack of vitamins, decrease in appetite, unstable stools - signs of lack of pancreatic enzymes and, as a result, disruption of the digestion of the most important nutrients.
Enzyme preparations
For more than 100 years, the pharmaceutical industry produces pancreatic enzymes in the form of pancreatin - Powder from the pancreas of pigs. The activity of all drugs is standardized precisely regarding pancreatin on lipase, and ranges from 15 to 45 units.
Classification of enzyme preparations
- extracts of the gastric mucosa containing pepsin (abomin, acidinpepsin, pepsin, acidine). Applied in atrophically gastritis with reduced acidity, contraindicated with excessive deficiency of PJ.
- pancreatic containing amylase enzymes, lipase and trypsin (Pancreatin, Poletraths, Mezim Forte, Creon)
- pancreatic enzymes with the addition of bile (Digestal, Festal), cellulose and other components (Panzinorm-Forte, Enzystal). The hemicellulose in the Festale contributes to the normalization of the chair and microflora, bile stimulates bile, motorcy and secretion, fights with constipation. This group of drugs is used in the combined pathology of the liver and pancreas, constipation, hypodynamies, short-term errors in the diet. They cannot be used for a long time and during the spastic type of dyskinesia of biliary tract and SRK.
Preparations containing bile can not be applied at:
- pancreatitis
- hepatitis
- ulcers of any localization
- inflammation of gasts
- diarrhea
4. Plant enzymes - papain, etc. (pepfiz, oraza)
The group of plant enzymes includes:
- nigedaz - contains only vegetable lipase, applied with pancreatin;
- oraza - complex of enzymes of fungal origin (lipase, amylase, maltase, protease from Aspergillus fungus);
- pepfis - fungal diastase (amylase), papain and symmetics;
- solisim - Lipasa from penicillin fungus;
- socomilaise - carses and mushroom amylase;
- uNIENZIM - fungal amylase, papain, simeticone, activated carbon, nicotinamide;
- vobenzym - Pankreatin, Papain, Bromelin, Trypsin, Hymmipcin, Rutoside;
- meringzim - Pancreatin, Bromelin, bile;
- flogenzyme - Bromelain, Tripsin, Rutoside.
They are prescribed with allergies to animal proteins. However, plant enzymes can not be applied at bronchial asthma and allergies on fungi and antibiotics penicillin row. Plant enzymes did not find wide use, because 75 times less effective than animals.
5. Pancreatic and vegetable enzymes (Vobenzym, Flogenzym)
Separately worth combined drug Panzinorm. It contains pancreatic enzymes, pepsin and amino acids and can be used in patients with reduced acidity, violation of the function of the pancreas and bore.
How to choose an enzyme preparation
- depending on the acidity of the gastric juice: with a reduced acidity of the showing the Panzinorm Forte, other drugs can be used in other cases;
- in case of insufficient breech division, enzyme and bile complexes are used;
- preparations containing simethicone or dimethicone are well suited to patients with meteorism and SRK (Pepfiz, UNIENZIM);
- in children, with pancreatitis of easy degree, episodic overeating, chronic gastritis and enterocolite, functional dyspepsiaThe dysfunction of the bustling bubble can be used vegetable enzymes.
It must be remembered that in the first 7-10 days of acute pancreatitis (and 3-5 days of the exacerbation of chronic), as well as allergies to animal protein, from the appointment and reception of enzymes should be refrained!
If enzymes are effective ...
... the chair is normalized, fats, starch and intoleranceable muscle fibers disappear from it (creative), the mass of the body normalizes.
The dose is selected individually during the week, it is possible to start with 1000 units of lipase per 1 kg of body weight per day, that is, 60000-70000 units divided into 3-4 meals. In the case of severe disorders, the dose increases to 4000-5000 units, the reception is stopped after the disappearance of symptoms and disorders in the coprogram.
If enzymes are ineffective ...
... So, there are several reasons:
- insufficient dosage, improper storage with loss of enzyme activity, incorrect reception;
- inactivation of enzymes in the acid content of the stomach, go of the duodenum;
- dysbacteriosis.
When diarrhea and steatherea are in no hurry to disappear?
Under the SRC and the organic pathology of the intestine, the absorption of fats may be broken during their normal digestion, while the fat in the chair is preserved. In this case, it is necessary to increase the dose of the drug.
With high acidity of gastric and intestinal contents, the bias poorly emulates fats, and the enzymes are inactive, which also causes steamer. Antacids and proton pump inhibitors help here.
And, finally, if the enzyme comes out of the stomach with food, it can also cause problems solved by the right reception (on an empty stomach or during meals, in no case after, because it reduces their effect on no) and the use of microcapsulated forms. Creon and similar preparations contain particles less than 2 mm in diameter, which allows for an ad-lacing digestion and the simultaneous exit of the enzyme from the stomach - along with the portions of food).
Dynamic equilibrium exchange processes In the body regulates biological catalysts (enzymes), inhibitors (antifimensions) and coenzyme enzyme preparations are medicines containing enzymes. Drugs used in order to suppress the activity of enzymes are called enzyme inhibitors. The coenzyme is involved in enzymatic catalysis, performing the functions of active enzyme centers.
Enzymes- These are biological catalysts that accelerate biochemical reactions. Enzyme preparations are dosage forms of enzymes that are used to treat diseases (so-called SE). The activity of enzymes is determined by the biological method and expressed in units of action. In medical practice, animal enzymes (tripsin, chymotrypsin, pepsin, hyaluronidase), vegetable (papain, bromelain) and bacterial origin (clostridylpeptidase, streptocyse), as well as enzymes obtained by genetic engineering (Alposa).
The international classification of enzymes is based on the type of reaction catalyzed by the enzyme, and the substrate of this reaction. Pharmacological classification Also takes into account the clinical use of enzymes and has the following form:
1. Peptidases (pepsin).
2. Protease (crystalline tripsin, crystalline chymotrypsin).
3. Nucleases (ribonuclease, deoxyribonuclease).
4. Preparations of hyaluronidase (lidase, ronidase).
5. Fibrinolytic enzymes (fibrinolysin, streptocinase, urocinase, alteplosis).
6. Oxidoreductase and enzyme preparations of another mechanism of action (superoxide dismutase, cytochrome C, penicillinase, L-asparaginase).
7. Polyfenimatic drugs (Pancreatin, Creon, Festal, Vobenzym).
The most important for the clinic has peptidases, proteases and nucleases that
it is carried out by hydrolytic cleavage of proteins, peptides or nucleic acids to low molecular weight connections.
Peptidase. Pepsin is one of the main proteolytic enzymes of the digestive tract. It is produced in the cells of the gastric mucosa as the pro-ferry of the pepsinen, which turns into an active enzyme in the gastric content. In the acidic area of \u200b\u200bthe stomach hydrolyzes proteins to peptides.
Acidine-pepsin is the most common preparation of pepsin. Its tablets contain pepsin and betaine hydrochloride (acidine). Pepsin cleaves proteins, and betaine hydrochloride (acidine) creates an optimal pH for its activity. Acidine-pepsin is used as a means of substitution therapy with a reduced secretion of gastric juice. Indications for use are hypo and anacid gastritis, dyspepsia. When applying acidine-pepsin possible (rarely) light nausea and heartburn. The drug is contraindicated in hyperacid gastritis, increased acidity of gastric juice.
Natural gastric juice It is also a preparation of pepsin with hydrochloric acid. It is obtained through the fistula of the stomach from horses or dogs, purified and used as a means of substitution therapy in secretory stomach failure.
Protease. TRIPSIN and HYMOTPSIN - pancreatic proteases that hydrolysis of peptide bonds and differ at the place of action on the protein polypeptide chain. The Tripsin absorption center interacts with the Lisin / Arginine residue. Himotrypsin acts on the side chains of hydrophobic amino acids (phenylalanine, tyrosine, tryptophan). Trypsin and Chimotrypsin are important not only in the process of digestion, but also in the destruction of foreign protein material. Especially high affinity of protease data has to denatured proteins, which are formed during the fill process. Proteisis of manure leads to its vacuum, contributes to the improvement of the evacuation of purulent exudate, accelerates the purification of wounds and bronchi (Fig. 11.1). In this regard, trypsin and chymotrypsin were widely used in the treatment of purulent processes.
Now the possibility of absorption of proteolytic enzymes in the intestines in blood or lymph is proved. The absorption of proteases depends on their molecular weight and varies from hundredths of the percent to 30-40%. The suction mechanism includes
Fig. 11.1. The action of proteases and nucleases in the focus of purulent inflammation
absorption through the end of microorusins, endocytosis on the surface of peer plaques, as well as absorption using migratory lymphocytes. After administration or suction in the intestine, proteases with antiprotezes of blood are bonded, the main of which is α2-macroglobul and n. As part of these complexes, protease retain their activity and transported to damaged tissues. At the system level, they carry out the hydrolysis of inflammatory peptides, control the state of imunoactive substances (cytokines, growth factors) and receptors to ensure the removal of immune complexes and adhesion molecules activate fibrinolysis.
Tripsin crystal Produced in the form of lyophilisate for the preparation of a solution for injection and local application. It is protein with relative molecular weight 21 kDa, which is obtained from the pancreas of cattle.
Pharmacokinetics. In case of diseases of the respiratory, the drug is used intramuscularly and in the form of inhalations, with diseases of the pleura-intrashnex, morally. In Surgery, parenteral administration combines with local application. In ophthalmology is introduced into the rear chamber of the eye or under the conjunctival. In LOR-Practice, administration of the middle ear can be introduced into the hymorospheric cavity. In the blood of trypsin binds to α2-macrobulin.
Pharmacodynamics. The enzyme is active at pH 5.0-8.0 with the optimum activity at pH 7.0. It is able to split dead sections of fabrics, fibrinous education, viscous secrets and exudates. Relatively healthy fabrics enzyme is inactive and safe due to the presence of trypsin inhibitors in them. The drug has anti-inflammatory and anti-ethnic effects, activates fibrinolysis.
Indications. The main indications for the use of trypsin are diseases of the respiratory organs with thick purulent wets, purulent wounds, burns and beds, thrombophlebitis, purulent sinusites, purulent average otitis and Eustachitis with viscous exudate, retinal vessel thrombosis, turbidity fiscame body, Cataract extraction.
Side effect. When using trypsin, temperatures increases, tachycardia, minor soreness and hyperemia at the injection site, allergic reactions. Introduction to the respiratory tract sometimes causes irritation of the mucous membranes of the upper respiratory tract.
Contraindications. The drug is contraindicated in decompensated heart failure, lung emphysema with respiratory failure of stage III, complicated forms of tuberculosis of lightweight, severe liver diseases, pancreatitis, high bleeding. Trepsin should not be introduced into the focus of inflammation, as well as apply (like other proteolytic enzymes) on the surface malignant tumors. It is forbidden to introduce the drug intravenously.
Chimothrixin crystal It has pharmacological properties and use, similar to trypsin. It has a slightly greater stability in the body and other restriction sites, hydrolyzing mainly bonds formed by aromatic amino acids and causing deeper protein cleavage.
Nuclease. This class of hydrolytic enzymes includes ribonuclease and deoxyribonuclease. Ribonuclease depolymerizes RNA to mono and oligonucleoty-virgins. Deoxyribonuclease - Albumin-type protein, which hydrolyzes (breaks) DNA in deoxyribonucleotides. For clinical application It is important that nuc
aza reduce the density and viscosity of manure, which always contains a large number of nucleic acids resulting from destroyed leukocytes.
Ribonuclease. Available in the form of lyophilisate for the preparation of solutions obtained from the pancreas of cattle. According to the localization of the pathological process, the remedy is injected intramuscularly, endotrachically, in the body cavity, are used locally. The preparation of depolymerizes RNA and, as a result, dilutes the pus, mucus, viscous purulent sputum; It has an anti-inflammatory effect, which is secondary. It delays the reproduction of some RNA-containing viruses. The main indications for the use of ribonuclease there are diseases of the respiratory tract with viscous purulent sputum, periodontalosis, gingivitis; osteomyelitis, fistula, abscesses, trophic ulcers, sinusitis, otitis, thrombophlebitis; ticky encephalitis; Viral meningitis. During treatment, irritation of the mucous membranes of the respiratory tract may occur, allergic reactions. Ribonuclease is contraindicated in hypersensitivity, chronic heart, respiratory and liver failure, open-shaped tuberculosis, bleeding.
Deoxyribonuclease. Causes DNA depolymerization and manure praise. It has the ability to delay the development of herpes viruses, adenoviruses and other viruses containing DNA. This enzyme preparation is used for herpetic and adenoviral infections, as well as to reduce viscosity and improve the evacuation of sputum and ingredients in patients with purulent diseases of the lungs.
Galuronidase preparations. Hyaluronidase causes a decay of hyaluronic acid, which is a "cementing" intermediate substance connective tissueAnd thereby leads to an increase in the permeability of tissues and improve the movement of the intercellular fluid. This mechanism determines the participation of this enzyme in the regulation of inflammation, edema, vehicles of substances, the elasticity of the connective tissue (Fig. 11.2). The effect of hyasouronidase revolt.
Fig. 11.2. Galuronidase action mechanism
Lidasa - A enzyme preparation from cattle seeds, which the basis of which is represented by hyaluronidase. The lidase is introduced subcutaneously, under the hand-channeling fabrics, intramuscularly, methods of electrophoresis or appliques for mucous membranes (in the eye practice). The duration of action reaches 48 hours. The effect of the drug lies in the appearance of the mobility of the joints, softening scars, eliminate or decrease contractures, resorbing the hematomas. The action is most pronounced in early stages pathological processes. Indications of lidase - contractures of joints, ankylosing spondyloarthritis, scar changes in skin, hematoma, chronic ulcers, sclerodermia. Apply in ophthalmological practice, as well as with the productive nature of the inflammation of the lungs. Lidase is used to accelerate the suction of various medicines (local anesthetics, antibiotics, glucocorticoids). The drug is well tolerated, but sometimes allergic reactions can occur. The use of this enzyme tool is contraindicated with malignant neoplasms, sharp inflammatory processes, pulmonary bleeding and hemoptysis.
Ronidasa - drug hyaluronidase, in its origin and pharmacological properties Close to the lidase. At the same time, Ronidase has a smaller degree of purification and applies only locally in the form of wet bandages for the treatment of contractures of joints, scars, hematomas, chronic tendovaginitis, wounds that are not healing for a long time.
Fibrinolytic enzymes. Fibrinolytic enzymes include fibrinolysin and fibrinolysis activators ( streptokinaza , urokinza , alteplelase). According to the mechanism of action, they are all proteases, but pharmacodynamics and the use of therapy for throm-free therapy give grounds for the allocation of these enzymes into a separate classification unit. These drugs are discussed in detail in the section "Means affecting blood coagulation and fibrinolysis".
Oxidoreduktaz and other enzymes. Cytochrome C is an enzyme that participates in tissue breathing. This enzyme is used in asphyxia of newborns, as well as for the treatment of hypoxic states that occur with bronchial asthma, heart failure, ischemic Disease Hearts. Orally prescribed at high physical exertion.
Superoxiddismutaza - the key enzyme antioxidant cell protection, which inhibits the SRO processes. It is used in ophthalmology for the treatment of eye diseases accompanied by tissue hypoxia and oxidative stress.
Penicillinase - an enzyme produced by some types of microorganisms and has the ability to inactivate penicillin. It is used in acute allergic reactions and anaphylactic shock caused by antibiotics of the penicillin group.
L-Asparaginaz He is an enzyme that splits asparagin amino acid. Asparagina deficiency is a factor that limits the separation and development of leukemic cells. This drug is used to treat sharp leukemia and hematosarcom.
Palifermen. Polyefermen preparations contain several enzymes that produce a comprehensive effect on the body. They can be divided into two groups: means of improving the processes of digestion in the gastrointestinal tract (Pancreatin, Creon, Festal), and means for SE (Vobenzym).
Pancreatin - Polyfefer drug, improves digestion. It contains trypsin, amylase and lipase. In case of pancreas diseases, the drug compensates for the insufficiency of its exhaustory function and contributes to the improvement of digestion. Pancreatins are prescribed chronic pancreatitis, fibrosis, chronic inflammatory-dystrophic diseases of the stomach, intestines, liver, gallbladder. The drug can be used in persons with the normal function of the gastrointestinal tract in the event of merors in nutrition. The dose is selected individually. The course of treatment can last from several days to several months and even years if necessary for constant replacement therapy.
Creon He is the original dosage form of pancreatin. Its capsules contain pancreatin in mini-microspheres resistant to the action of gastric juice. After dissolving the capsule in the stomach, pancreatine granules are mixed with chimus and fall into the duodenum, where the protective shell is quickly dissolved and releases the enzymes. It provides the physiological process of digestion and avoids losses of enzymatic activity. Indications for the use of Creon, as for pancreatin, there are diseases accompanied by exocrine pancreatic failure. The drug is well tolerated, but in some cases gastrointestinal disorders are possible.
Festal - Polyefermes for improving digestion. It contains pancreatic enzymes (protease, amylase, lipase) and bile components. The presence of bile components stimulates the selection of bile and contributes to the emulsification of fats, which makes them available to pancreatic lipase. Festal has advantages in cases where the insufficiency of the outer-generating function of the pancreas is combined with bortoid violations.
Vobenzym - Polyenimensional preparations for SE, that is, the reform actions of the complex of hydrolytic enzymes of plant and animal origin on pathophysiological processes. It contains pancreatin, papain, bromelain, lipase, amylase, trypsin, chymotrypsin, rutin. After admission, part of the enzymes is absorbed into thin intestines In blood, where reaches the maximum concentration in 2-4 hours, the rest are involved in digestion. In the blood, proteolytic enzymes are associated with A2-macroglobulin and are transported into damaged tissues, where they implement their therapeutic effects. The half-life is 8:00. The preparation has anti-inflammatory, immunomodulatory and fibrinolytic properties. It is used as a non-specific component of therapy with: inflammation of ENT organs and respiratory tract, pancreatitis, ulcerative colitis, crown disease, multiple sclerosis, ischemic heart disease, myocardial infarction, rheumatoid arthritis, rheumatism, osteoarthritis, diseases of Bekhterev, post-traumatic and postoperative edema, thrombophlebitis, post-tombotic syndrome, vasculitis, bombing, lymphedem, inflammation urinary tract, prostatitis, chronic infection in gynecology, mastopathy, fractures, inflammatory processes of soft tissues, dislocation. During treatment, possible dispersal phenomena, rarely allergic reactions. The drug is contraindicated with increased sensitivity to its components, blood coagulation disorders, diseases with an increased probability of bleeding.
