In the recipe for a unit of mass adopted one gram (1,0), per unit volume - one milliliter (1 ml).

If a drug substance in drops is included in the drug, the number of drops indicate the Roman digit, before which they write gTTS.(Abbreviated from Guttas - accusative case of a plural).

If the drug duty includes a medicinal substance dosing in units of action, then in the recipe instead of weight quantities indicate the number of units of action - Units.

When dispensing medicinal substances, it is necessary to use the values \u200b\u200bless than one gram:

· Dose - This is the amount of medicinal substance introduced into the body. Distinguish doses appointed for one reception -within 24 hours daily on the course of treatment - course. Each of these doses can be an average therapeutic, higher therapeutic or minimal (threshold). Medium therapeutic it is called an effective dose that causes a certain therapeutic effect. Higher therapeutic it is called a dose of a drug that does not reach its minimum toxic dose and conditionally adopted for the greatest permissible for the introduction into the body. Minimum or threshold, dose - this is the smallest dose, causing changes at the body level, leaving the limits of physiological reactions.

The magnitude of the therapeutic dose may vary depending on age, weight, paths of administration of the medicinal substance, the desired therapeutic effect. The usual therapeutic doses offered in various reference publications are designed for a person 24 years weighing 70 kg. When recalculating doses for people over 60 years old, age sensitivity to various groups of drugs is taken into account. Doses of preparations, depressing CNS ( snow pills, neuroleptics, narcotic analgesics), heart glycosides, diuretics are reduced by 50 %. Doses of other drugs belonging to the list A and B are reduced by 1/3. Dose antibacterial drugs And vitamins usually do not reduce. When appointing medicines Children recalculate by 1 kg of body weight, 1 m 2 of the surface of the body or 1 year of the child's life. There are empirical formulas for calculating doses of drugs for children, where the dose of adult is taken as the basis.

Recalculation by weight:

In children with excess or insufficient body weight, an overdose or a small dosage can be marked when calculating the body weight. In this case, it is better to use the calculation on the body surface area. There are special normograms that allow you to move when calculating the mass of the patient to the body surface area (offered in the relevant reference books).

Recalculation by age (for children older than one year):

However, with such a recalculation, the pharmaco-dynamics of the substance, the age characteristics of stability and sensitivity to this medicine, as well as the individual features of a particular child are not taken into account. Therefore, doses of drugs for children are determined in clinical trials, and they are available in relevant reference editions.

Recipe and its structure

· Recipe - This is a written appeal of a doctor in a pharmacy for a patient of the drug in a certain dosage form (drug preparation) with an indication of the dosage and method of its use.

Recipe is official form Relations between the doctor (therapeutic institution) and the pharmacist (pharmacy). The recipe is one of the forms of medical documentation, that is, a medical and legal document. In the event of doubt in the correctness of treatment, the recipe can serve as an acquittal document testifying in favor of the doctor. In the case of free vacation drugs, the recipe is also a financial document and serves as the basis for settlements between pharmacies and therapeutic institutions.

The recipe must necessarily have a stamp with the name of the institution, the seal of this institution "for recipes" and personal printing of the doctor. Blanks are built in such a way that they are filled with a doctor and pharmacist. Actually, the recipe fills the doctor, and the marks about the cost, preparation of drugs are made by the pharmacist in the pharmacy.

The recipe consists of 5 parts.

· First part of the recipe Imcriptio.- The inscription) make up the date of statement, surname and name of the patient, its age and address (or n medical card), surname and initials of the doctor.

·The second part of (Invocatid)- This is the appeal of the doctor to the pharmacist. The word is written here Recipe:(Abbreviated RPS)what does "take" mean.

·The third part (Praescriptio)contains the transfer of medicinal substances that are part of this dosage form:

·Fourth part Subscription- This is an indication of the pharmacist, in which medicine should be released the medicine.

The second is the fourth part of the recipe filled in Latin.

· Fifth of the recipe (Signatura.- Designation) - prescription of the method and time of use of this medicine. It begins in a word SIGNA.(Abbreviated S.),behind which follow:

Corrections in the recipe are not allowed. On the same form discharges one drug. The recipe ends with a doctor's signature.

When dispensing a liquid drug, the doctor should know that:

Recipes for drug addiction drugs and drugs equal to them (included in the special list) are written out on special blanks of the established sample with a stamp application, a round printing institution, personal press of the doctor and signatures of the doctor and the head of the department of this medical institution. The remaining drugs of the list A are written out on ordinary recipes and without a recipe in pharmacies are not released. Drugs Group b are also released in pharmacies only by recipes. Recipe for a medicine containing a potent or poisonous substance, Valid within 30 days from the date of issuing it.

In cases where there is a need for accelerated making and drug leave, in the upper left corner of the recipe form written "Cito" (quickly) or "Statum" (immediately). Words emphasize or put an exclamation mark.

If you need to repeat medicinal recipe on the recipe, also specified in the upper left corner "Repetatur" (let it be repeated), "BIS Repetatur" (let it be repeated twice) or "Semper Repetatur" (Let it always be repeated).

When a doctor discharges a medicine for himself, "Pro audore" (for the author) is written on the recipe.

Discern abbreviated and deployed drugs. In the deployed medicinal register list all the ingredients and quantities in the drug ingredients. IN abbreviated medicinal register at first, the dosage form indicates, then the name of the drug, the concentration (if necessary) and the amount, that is, the auxiliary, corrective and forming indifferent substances are not specified.

Medicationsmanufactured by the Chemical Pharmaceutical Industry for Pharmacopoeia Putyasm called official (from Officina - Pharmacy). These drugs are discharged in the abbreviated form. Medicinal preparations made in a pharmacy strictly according to the recipe compiled at the discretion of the doctor, with the listing of all ingredients of the dosage form, called trunk (from Magister - Teacher). These drugs are discharged in a detailed form. In practical activity, it is recommended to use ready-made dosage forms (asphic drugs and abbreviated drugs). IN pediatric practice The trunk drugs are used more often, since the pharmacopoeia is in most cases compiled with the calculation of the adult population.

Dosage forms can be dosed and affected. Dosage dosage forms they call those forms for which the recipe is given a dose of the drug for one reception and then it follows -da tales doses numero ... (D. t. d. n ....) - "Give such doses number ...". Underwritten dosage forms call those forms for which in the recipe drug is discharged by a total of all techniques. The patient must divide it on the corresponding number of techniques, as indicated in the signature (according to the i tablespoon, 10 drops, etc.).

The dose is the number of drugs introduced into the body and causing any pharmacological effect.

Usually, doses are expressed in units of mass, volume (grams, milliliters). In units of action (units), some drugs of biological origin with non-permanent activity (hormones, antibiotics, heparin, etc.) are dosed.

Dose classification

By the time of administration:

• daily;

  course.

According to the action:

therapeutic or therapeutic (minimum, medium, higher);

toxic (minimum, medium, lethal).

A saturation dose - dose, with the help of which it is possible to create the necessary concentrations of drugs in the tissues (for example, when treating cardiac glycosides).

Supporting dose - dose, with which you can maintain a plasma and tissue concentration of drugs, which decreases the drug in the process of elimination (for example, digitalization).

Shock dose - dose that allows you to create optimal concentrations of the drug necessary for its competition with a specific endogenous substrate (for example, a shock dose of sulfonamide, necessary for competition with para-aminobenzoic acid (PABK) for a place in the structure of the molecule folic acid At the stage of its synthesis). As a rule, medications are prescribed in medium therapeutic doses, which most patients have an optimal therapeutic effect without toxic manifestations. Typically, such a dose is 1/2 or 1/3 from the maximum therapeutic.

The safety of the medicinal substance is judged by the latitude of therapeutic effect or by therapeutic index.

The range of doses between the minimum therapeutic and minimum toxic is called latitude of therapeutic action(Pleep) . The greater the latitude of therapeutic action, the safer of drugs (Fig. 16).

Fig. 16. Therapeutic latitude

1 - minimum therapeutic dose, 2 - average therapeutic dose,

3 - Maximum therapeutic dose, 4 - minimum toxic dose

Therapeutic index (TI) is the ratio of toxic dose to the average therapeutic, determined by the formula:

where TD 50 is a dose causing poisoning in 50% of patients;

EF 50 is an average therapeutic dose, that is, a dose that causes the healing effect in 50% of patients.

The larger, the safer LS. In order for the drug to be safe, it should be more than 3.

In children and senior people, the dispensation of drugs has its own characteristics, which is associated with the physiological differences of these groups.

Features of the children's body:

failure of the metabolizing liver function (therefore drugs are more toxic);

the skin and mucous membranes are richly vascuated (therefore, drugs are absorbed better than in adults);

BBB is more permerable (this creates a relatively large concentration of drugs in the brain);

fewer adhesive tissue;

LS is less binding to plasma proteins (this can lead to toxic reactions, since the free (active) fraction increases);

reduced excretory kidney function (this leads to more long action Hp).

Thus, the incomplete development of the organism of newborns leads to the fact that they have the risk of the appearance of side effects on the reception of drugs to a substantial extent higher than in adults.

In view of the presence of sufficiently significant differences in Pharmacodynamics and Pharmacokinetics of drugs in children and adults, a simple proportional age Reduction of the dose of adults when calculating the dose of drugs for a child is unacceptable, because May lead to unpredictable consequences.

The dose in children is counting on 1 kilogram of body weight, for the year of life, on the surface area of \u200b\u200bthe body. For example:

Child dose \u003d adult dose × baby weight / 70 kg

The physiological features of the people of senile age:

violation of the metabolism of drugs in the liver as a result of atrophic and dystrophic changes;

reducing proteins in the plasma (this leads to an increase in the free fraction of the LS);

progressive decrease in the excretory function of the kidneys;

CNS and cardiovascular system are more sensitive to the action of medicinal substances.

Given the defective metabolism of medicines in the liver and slowing the excretory function of the kidneys in the elderly, the initial doses of drugs up to 1/2-2 / 3 from the dose, usually recommended by a more young age, should be reduced.

Option 7. (inaccurate).

Comparative characteristics of parenteral routes of administration

medicinal substances

The choice of drugs from the standpoint of evidence-based medicine is especially important in pediatrics. It is in this field of medicine that the high frequency of the use of "unresolved" drugs (LS) is recorded, which are not officially recommended for use in children due to the lack of data on pharmacokinetics, security or shortage of clinical studies.

The drug to children is customary to prescribe at the rate of 1 kg of body weight, 1 m 2 of the surface of the body or the year of the child's life. There are various approaches to the calculation of doses for children based on the dose of the drug for an adult:

Based on body weight (Clark rule);

Based on age (Yang rule);

Based on the body surface area;

Based on the dose of factor.

Calculation of doses to children based on body weight is carried out according to the following formula ( clark rule):

Example 1.. Calculate the dose for the newborn according to the Clarke rule based on body weight.

Body mass of newborn 3 kg. The average therapeutic dose of the drug for an adult is 350 mg.

Thus, the dose of the drug for a child is 15 mg.

Calculation of doses of medicines for children, based on age based on the Yang Rule:

Example 2.. We will calculate a dose for a 6-year-old child. The dose for an adult is 350 mg.

The dose of the drug for a six-year-old child will be 117 mg.

Dose calculations, based on age or body weight, are traditional and tend to the premissance of the required dose.

In children with excess or insufficient body weight, an overdose or a small dosage can be marked when calculating the body weight. In this case, it is better to use the calculation on the body surface area. There are special nomograms that allow you to move upon the calculation of the body mass of the patient to the surface of the body surface (Table 1 and Table 2). It should be noted that the calculations that take into account the surface area of \u200b\u200bthe body are more adequate to choose the dose of the medicinal substance.

Table 1

Nonograms that allow you to move from the body weight of a person to the body surface area.

table 2

Determination of the dose of the drug through the body surface area.

Example 3.Calculation of a dose for a newborn baby. The dose of the medicinal substance is 5 mg / kg for an adult patient.

The dose for an adult patient will be 70 kg x 5 mg / kg \u003d 350 mg.

We will recalculate the dose on the body weight of a newborn, equal to 3 kg.

We will recalculate the dose taking into account the surface area

The correction coefficient is 0.12 (12%)

Dose of this medicinal product for a newborn is: 14 mg / kg

For children with excess or insufficient body weight, it is advisable to determine the individual dose based on the "dose factor". To this end, the dose for an adult, pronounced by 1 kilogram of body weight, is prolonged to a dose factor, which is individual for each child's age. Calculations based on a "dose factor" take into account the dose recalculation coefficient in various age categories (Tab. 3).

Table 3.

Indicator "Dosis factor" for various age categories.

Example 4.. The dose of the drug for an adult (mass 70 kg) is 500 mg. Calculate the dose for an 8-year-old child weighing a body of 26 kg.

The dose for an adult is 500 mg / 70 \u003d 7.14 mg / kg

The baby's mass of the child is 26 kg.

Dose of the drug for the child is 7.14x26x1,4 \u003d 260 mg

The reaction to the medicinal substance of children of different ages depends on such a large number of factors that A priori is unpredictable. In this regard, the dosing of drugs in children cannot be based on the formulas of recalculation of doses of medicines from an adult to a child of a certain age. However, in such a recalculation, pharmacodynamics of the substance, age characteristics of stability and sensitivity to this medicine, as well as the individual features of a particular child are not taken into account. Therefore, doses of drugs for children are determined in clinical trials.

It should be noted that despite the presence of numerous articles, a number of guidelines and other sources, reflecting issues related to the choice and dosing of medicinal substances in pediatrics, including textbooks for pediatric pharmacology, we did not find an accurate answer to this difficult issue of pharmacology in the literature available to us.

To optimize medicinal support and increasing the rationality of pharmacotherapy, various restrictive lists are used: List of Zvlns, pediatric form.

The List of Zhvlns is a list of drugs annually approved by the Government of the Russian Federation (the Order of the Government of the Russian Federation of July 30, 2012 No. 1378-R "On the establishment of a list of vital and most important drugs for 2013"). Prices and markdowns for drugs from this list to be subject to government regulation.

In 2007, the Formural Committee of the RAM was published a pediatric form.

The main criteria for making a decision on the inclusion of the drug in the formulant list are:

1. Documenting its clinical value (that is, efficiency and safety) on the basis of these evidence-based medicine;

2. An acceptable coefficient of cost-effective relationship.

Its content includes 370 items of drugs from the generally accepted ATC groups of the first level. In the pediatric form 274 (74.1%), the names of drugs belong to the List of ZVLNS. In the List of Zhvlns, only 10 drugs are indicated by dosage forms "for children" and only five of them are included in the pediatric form. When analyzing instructions for use, it was revealed that 60 drugs of the pediatric formulator (16.2%) are not recommended for use in children (as a rule, due to lack of data). For 55 drugs (14.9%), age restrictions on their use are not specified. In the instructions for use for 93 drugs (25.1%) information about the possibility or limitations of application in children is not specified. These results of the critical analysis of the pediatric form show the need for its revision and additions, in particular, instructions dosage forms and age restrictions on the use of drugs.

Comparative expert assessment of the pediatric form with an exemplary WHO list of basic medicines for children (WHO Forms) showed that 115 names of the drugs of the pediatric form (31.1%) are included in the WHO Form. Among them, eight drugs do not belong to Zhvlts.

Thus, it can be concluded that the List of ZVLNS does not take into account the peculiarities of the use of drugs in children (51.1% of drugs of this list are not included in the pediatric form), therefore, it cannot be used as a restrictive when medicinal provision Pediatric hospitals patients.

However, the formulas of drugs are advisory. The following are the formulas of WHO drugs for 2007 and 2012. Edition. The highest and daily doses of poisonous and potent drugs for children of different ages are shown in the Table x Pharmacopoeia of the USSR, but it was published in 1968. It indicates that when calculating higher doses for drugs that have not included in the table, doses reduce depending on age approximately: for young people 18 years old - 3/4 doses from adults.

For children 14 years old - 1/2 dose of adults

For children 7 years - 1/3 Adult doses

For children 6 years old - 1/4 doses of adults

For children 4 years old - 1/6 dose of adults

For children 2 years old - 1/8 doses of adults

For children 1 year - 1/12 dose of adults

For children up to 1 year - 1/24 - 1/12 dose for adults.

The highest doses of poisonous and potent drugs for adults are designed for adult 25 years of age and are indicated in a separate list of X State Pharmacopoeia of the USSR.

Analyzing the data of this section of the methodological manual, it should be noted that it is necessary to rely on information on pediatric doses, which is provided by the manufacturer in instructions in medical application drug. In the absence of such information, it is necessary to adhere to the methods of recalculation taking into account the mass of the body, age and surface area of \u200b\u200bthe body. But it should always be remembered that the pediatric dose should never exceed an adult dose! And finally, only the conduct of clinical studies of drugs by pediatricians will be able to make a complete clarity in the dosing problem with children.

Picture. 1. Principles for calculating the dose of medicinal substance for children.