Neurotropic agents I. Agents affecting the peripheral nervous system: 1) Agents affecting the afferent innervation (conduction of excitation from organs and tissues to the central nervous system): A) agents that inhibit afferent innervation: -local anesthetics, astringents, absorbent, enveloping agents. B) funds that stimulate afferent innervation (substances of reflex action) 2) Means that affect efferent innervation (conduction of excitation from the central nervous system to organs and tissues). II. Drugs affecting the central nervous system.

There are 2 families of acetylcholine receptors: 1) muscarinic and 2) nicotinic receptors, which differ from each other based on their different affinities for substances that mimic the action of acetylcholine. 1. Muscarinic receptors. Excited by acetylcholine, and muscarine, an alkaloid of poisonous fly agaric. Found in the heart, smooth muscles and endocrine glands. 2. Nicotinic receptors. Cylindrical structure with Na + channel inside. Binds acetylcholine and nicotine. Nicotine first stimulates, then blocks the receptor. Found in the central nervous system, adrenal glands, ganglia and neuromuscular junctions. The nicotinic receptors of the ganglia are different from the receptors for the neuromuscular junction.

Drugs affecting the transmission of excitation in cholinergic synapses Drugs, stimulating: drugs, blocking: M-cholinomimetics M-cholinolytics N-cholinomimetics N-cholinolytics: M-, H-cholinomimetics -ganglioblockers Anticholinesterase -myorelaxants

Substances acting on cholinergic synapses: I. Agents that stimulate cholinergic synapses 1) Cholinomimetics a) M-cholinomimetics (selectively stimulate Mcholinergic receptors) Aceclidine, pilocarpine. b) H-cholinomimetics (selectively stimulate Ncholinoreceptors) Lobelin, cititon, nicatin (tabex). c) M-, H-cholinomimetics (simultaneously excite M- and H-cholinergic receptors) Acetylcholine, Carbacholine d) Anticholinesterase substances (indirect cholinomimetics) Proserin, physostigmine

2) drugs that block cholinergic synapses: A) M-anticholinergics: Atropine, platifillin, belladonna preparations, scopolamine ( vegetable origin); Ipratropium bromide, tiotropium bromide, tropicamide (synthetics) B) H-anticholinergics: -ganglioblockers: Benzohexonium, pentamine, hygronium- drugs that block neuromuscular synapses (muscle relaxants): Arduan, Ditilin, Listenon

M - cholinomimetics drugs of this group have a direct stimulating effect on M - cholinergic receptors located at the endings of postganglionic parasympathetic nerve fibers. As a result, they reproduce the effects of acetylcholine associated with the excitation of parasympathetic innervation: constriction of the pupil (miosis), spasm of accommodation (the eye is set for near vision), narrowing of the bronchi, profuse salivation, increased secretion of bronchial, digestive and sweat glands, increased motility gastrointestinal tract, increasing tone Bladder, bradycardia.

Mechanism of action of M-cholinomimetics Excite muscarinic receptors on cells of glands, heart and smooth muscles (in a pair sympathetic system) and cells of sweat glands (in the sympathetic system) M 1 -CNS-control of mental and motor functions, autonomic ganglia M 2 -cardia-bradycardia, weakening of atrial contractions, M 3 -smooth muscles - increasing tone; circular and ciliary muscle of the eye

Pilocarpine is an alkaloid of plant origin. Obtained synthetically, available in the form of pilocarpine hydrochloride. Its effect is to reduce intraocular pressure, it is used to treat glaucoma (increased intraocular pressure up to 50 -70 mm Hg. Art.). The use of pilocarpine causes a constriction of the pupil due to contraction of the circular muscle of the iris, facilitates the outflow of fluid from the anterior chamber of the eye to the posterior chamber due to contraction of the ciliary muscle. At the same time, a spasm of accommodation develops (the curvature of the lens increases). Pilocarpine is used only topically, since it is quite toxic. Used for glaucoma, with atrophy of the optic nerve, to improve the trophism of the eye, etc. Has a slight irritant effect. Part of the combined eye drops"Fotil", "Pilotim".

Release form 1%, 2% eye drops 5 and 10 ml each, tube drops 1, 5 ml, 1 and 5% eye ointment, eye films, soda 0, 0027 g of pilocarpine. Decrease in IOP after 10-30 minutes, the patient's condition is relieved by 4-8 hours

Aceclidine-causes an increase in the organs fats, innervated by cholinergic nerves (increases tone and enhances the peristalsis of the gastrointestinal tract, bladder, uterus. Used in ophthalmic practice (with glaucoma), parenterally with bowel and bladder atony (difficulty in emptying).

N-cholinomimetics Nicotine-alkaloid from tobacco leaves. The effects of small doses of nicotine stimulating effect: increased pulmonary ventilation, increased blood pressure, activation of motility of the K-SC, increased secretion of bronchial glands, inducing effect, possible nausea and vomiting effects of large doses of nicotine depressing effect: respiratory depression, decreased blood pressure, inhibition of peristalsis KISHNCHNIKA, reduces THE SECRETARY ACTIVITY OF THE IRONS, SLEEPY DEVELOPS, ALTHOUGH IN THE BEGINNING CONTRIBUTIONS MAY DEVELOP.

H-cholinomimetics (cytiton, lobelin) excite H-cholinergic receptors of the carotid sinus glomeruli, which leads to reflex stimulation of the respiratory and vasomotor centers. There is an increase and deepening of breathing. Simultaneous excitation of the synaptic nodes and the adrenal glands leads to an increase in the release of adrenaline and an increase in blood pressure. Cytiton and Lobelina hydrochloride are stimulants of respiration of reflex action and can be used for reflex cessation of respiration (carbon monoxide poisoning, drowning, suffocation, electrical injuries, etc.), for asphyxiation of newborns. More widely, these substances are used to treat tobacco smoking. As part of tablets Tabex (cytisine) is used to facilitate smoking cessation. For this purpose, small doses of nicotine are also used (Nicorette chewing gums, Nicotinell patch). These medicines reduce the physical dependence on nicotine. Tobacco alkaloid - nicotine is also an H-cholinomimetic, but it is not used as a drug. It enters the body when smoking tobacco and has a variety of effects. Nicotine affects both peripheral and central N-cholinergic receptors, and it has a two-phase effect: the first stage - arousal - is replaced by a depressing effect. The constant effect of nicotine is its vasoconstrictor effect, due to the fact that nicotine stimulates the H-cholinergic receptors of the sympathetic ganglia, chromaffin cells of the adrenal glands and the carotid sinus zone, stimulates the release of adrenaline and reflexively excites the vasomotor center. In this regard, nicotine increases blood pressure and contributes to the development of hypertension. Severe vascular disease of the lower extremities - obliterating endarteritis - occurs almost exclusively in smokers. Nicotine narrows the blood vessels of the heart and promotes the development of angina pectoris, myocardial infarction, tachycardia. Serious changes are observed on the part of the central nervous system. Shows nicotine and carcinogenic effects.

N-CHOLINOMETICS Cytisine (thermopsis alkaloid) - Tabex tablets and Lobelin (lobelia alkaloid) - Lobesil tablets (to ease smoking cessation) are similar in action to nicotine, but differ in less activity and toxicity.

Indications for the appointment of M-N cholinomimetics Acetylcholine (a mediator through which excitation is transmitted in all cholinergic synapses). - almost never used as a drug, since its action is short-lived for several minutes. They are widely used in experimental work. Carbachol (Carbacholine) works longer. - with atony of the intestines and bladder, sometimes with glaucoma.

By its effect on M-cholinergic receptors, it is close to atropine, but inferior to it in activity. Has a calming effect on the central nervous system. Used for spasms of smooth muscles internal organs, peptic ulcer stomach, bronchial asthma, and also as a drug that dilates the pupil.

Ganglion blockers - drugs that block the H-cholinergic receptors of the ganglia of the sympathetic and parasympathetic systems, the adrenal medulla, the carotid glomeruli. Used for hypertensive crisis, combined therapy of the lungs and brain, heart.

Classification according to the duration of action Hexamethonium benzosulfonate (benzohexonium) and azamethonium bromide (pentamine) -4-7 hours long-acting. Trepyria iodide (hygronium) -1015 min

storage conditions of Pilocarpini hydrochoridum (A) Tabex Neostigminum (Proserinum) (A) Galantaminihydrobromidum (Nivalinum) (A) Distigminibromidum (Ubretidum) (A) Forms of issue Methods of application Ch. drops 2% solution - 2 ml m 1%, 2%, 10% solution - 5 ml, 10 Into the conjunctival cavity 11 -2 drops 2-3 times a day ml Place behind the eyelid 1 time per day Ch. films Tab. 0, 0015 Take according to the scheme 1 table. 2-3 times a day Tab. 0.015 Subcutaneous 1 ml Amp. 0.05% - 1 ml Into the conjunctival cavity 1-2 drops 2-3 times in Ch. drops 0.5% - 5 ml per day Table. 0.02; 0, 005 1 tab. 2-3 times a day after eating Amp. 0.25%; 0.5%; 1% solution - 1 ml. 1 ml under the skin Tab. 0, 005 1 tab. 1 time per day Amp. 0.05%; 0.1% solution - 1 ml. Under the skin, 1 ml Ch. drops of 1% solution - 5 ml Into the conjunctival cavity 1 -2 drops T-ra Belladonnae (B) "Becarbonum" Amp. 0.1% solution - 1 ml Flac. 10 ml Offic. tab. Under the skin 0.25 -1 ml 5 -10 drops per dose 1 table. 2-3 times a day "Anusolum" Offic. candles 1 candle into the rectum at night Atropini sulfas (A) Amp. 0.05% solution - 1 ml Office. tab. Into the conjunctival cavity 1-2 drops 2-3 times a day Under the skin 0.5-1 ml 1-2 table. before the flight Metacinium iodidum (Methacinum) (A) Tab. 0.02 Amp. 0, 1% solution - 1 ml 1-2 tab. 2-3 times a day Under the skin (into the muscle, into the vein) 1 ml each Pirenzepinum (Gastrilum, Gastrozepinum) 0.025; 0.05 Amp. 0.5% solution - 2 ml Table 2 2 times a day before meals Into the muscle (into the vein) 2 ml of Ipratropium bromidum (Atroventum) Tab. 0, 01 Aerosol 300 doses 1 tab. 2-3 times a day before meals Inhale 2-3 times a day Hexamethonium (Benzohexonium) (B) Tab. 0, 1; 0.025 Amp. ... 2, 5% solution - 1 ml 1-2 tab. 3-4 times a day Under the skin (into the muscle) 1 ml 1-2 times a day Trepirium iodidum (Hygronium) (B) Amp. 0, 1 dry substance Into a vein with 0.9% sodium chloride solution Tubocurarini chloridum (A) Diplacinum (A) Suxamethonium Amp. 1% solution - 1, 5 ml Amp. 2% solution - 5 ml Into a vein at 0.5 ml per 1 kg of body weight Into a vein at 0.25 ml per 1 kg of body weight Scopolamini hydrobromidun (A) Aeronum (B) Flac. 0.25% solution - 5 ml

Localization of cholinergic receptors and adrenergic receptors Cholinergic receptors M 1 M 2 M 3 Ng Nm CNS, autonomic ganglia Heart Circular and ciliary muscle of the eye, smooth muscles of internal organs, glands. Ganglia, adrenal medulla, carotid glomeruli Skeletal muscles Adrenoreceptors α 1 α 2 β 1 β 2 β 3 Radial muscle of the eye, vessels of smooth muscles of organs, skin, kidneys, veins, arterioles, liver, myometrium of the central nervous system, peripheral vessels, Platelets Heart, juxtaglomerular apparatus of the kidneys, ciliary body of the eyes, platelets Smooth muscles of the bronchi, liver, myometrium, coronary vessels. Fat cells

EFFECTS - ADRENO BLOCKERS Decrease in peripheral resistance, venous return, cardiac output, decrease in blood pressure, hypotension. Reflex tachycardia. Miosis - blockade of α-receptors of the radial muscle of the eye. Swelling of the nasal mucosa - blockade of α-receptors of the vessels of the mucous membrane. Increased intestinal motility diarrhea. Decreased renal blood flow, decreased filtration rate, retention of sodium ions and water in the body. Decreased potency in men.

-ADRENOBLOCKERS indications for the use of Non-selective 1 -, 2 -adrenoceptor blockers: Relief of hypertensive crises (phentolamine, tropafen). Long-term treatment of pheochromocytoma (phenoxybenzamine). Violation of peripheral circulation. Vestibular disorders (pyrroxan). Relief of acute migraine attacks - (ergot alkaloids). Vascular diseases of the brain (vazobral, nicergldin). Selective 1 -, 2 - adrenergic blockers: Arterial hypertension. Prostate adenoma (tamsulosin). Violation of peripheral circulation.

Classification of β-blockers Non-selective (1+ 2): A. without internal sympathomimetic activity - propranolol (anaprilin), sotalol, timolol; B. with internal sympathomimetic activity - pindolol, oxprenolol, alprenolol; Cardioselective (1):. A. without internal sympathomimetic activity - atenolol, metoprolol, bisoprolol, nebivolol, betaxolol, talinolol; B. with internal sympathomimetic activity - acebutolol, praktolol; Selective (2): - butoxamine

Pharmacological effects of β-blockers Blockade of 1 heart receptors - weakening of the force of heart contractions - decrease in the automatism of the atrioventricular node - inhibition of atrioventricular conduction - decrease in the automatism of the atrioventricular node and Purkinje fibers Decrease in cardiac output (minute volume), heart function and myocardial oxygen demand - decrease

Pharmacological effects of β-blockers Blockade of 2 receptors constriction of blood vessels Increase in bronchial tone Increase in the contractile activity of the myometrium Decrease in the hyperglycemic action of adrenaline eye fluid... 2 Pupil size and accommodation do not change. It is used in the treatment of glaucoma. CNS - sedation, drowsiness, lethargy, depressive states. Sexual function - decreased libido, decreased potency.

Indications Arterial hypertension! Ischemic heart disease (treatment and prevention)! Tachyarrhythmias! Glaucoma (timolol, proxodolol) Strengthening of labor, stopping uterine bleeding Prevention of some forms of tremor

• endogenous primary - inflammation of various origins, circulatory disorders, diseases of the endocrine system;
• endogenous secondary - changes, malfunction of neurons and neurotransmitters;
• exogenous primary - poisons, pesticides, trauma (craniocerebral trauma, bruises), rabies viruses, lack of glucose, oxygen, microbial toxins;
• exogenous secondary - drugs that cause seizures.

With biochemical disorders, the destruction of nerve cells in the brain occurs. The reasons for the destructive action:

• damage to brain cells;
• multiple sclerosis;
• Parkinson's disease;
• Alzheimer's disease;
• epilepsy;
• schizophrenia.

Neuroprotective agents are able to compensate for the consequences of biochemical and pathophysiological disorders. Primary neuroprotection interrupts the rapid mechanisms of cell destruction. With the help of the secondary, there is a decrease in the long-term consequences of cell damage.

Classification of neuroprotectors

The list of drugs is long, the mechanism of action is very complicated. They are difficult to classify, each has its own structure, action, chemical composition(contain plant extracts, protein components, hydroxy acids, amino acids). The main classification is based on the principle of action. Based on the mechanism of action, there are:

1. Antioxidants
2. Nootropics.
3. Combined drugs.
4. Vascular drugs.
5. Adaptogens.

Neuroprotective agents are used for prophylactic and therapeutic purposes. Allowed for children of different age groups, the dosage is selected according to their age and weight.

Antioxidants

Their main action is to reduce the manifestations of oxygen starvation. They neutralize free radicals that have a harmful effect on the body.

Free radicals are not harmful to humans. They protect the body from viruses and bacteria. But if there are too many of them in the body, this leads to cell aging and the manifestation of a number of serious diseases.

Antioxidants are able to regulate the amount of radicals, protecting against premature aging. They help cells to recover, protect themselves from electromagnetic and radioactive radiation, and reduce the risk of developing cancer. Lack of antioxidants in the body is characterized by loss of hair and teeth, the appearance of rough skin areas (especially on the elbows), dry skin, apathy and depression. This group includes many drugs, the effect of each is determined by the composition.

Mexidol

A powerful drug for eliminating hypoxia in strokes and epileptic seizures. Its action:

• stimulates the body's defenses;
• increases resistance to stress, harmful effects of the environment;
• improves blood circulation to the brain, rheological properties of blood;
• reduces the level of low density lipoproteins;
• effective for vegetative-vascular dystonia, dulling of the processes of thinking and perception (typical of senile dementia), decreased performance, alcohol intoxication.

Taking Mexidol helps to improve visual acuity, enhance the activity of the optic nerve. Contraindications for use are impaired renal and liver function.

Glycine

An amino acid involved in the metabolic processes of the central nervous systems s. It is produced by the human body, but under the influence of unfavorable factors (stress, tension, overwork), its level decreases. Glycine affects brain metabolism, enhances the mental performance of the brain.

It is used for psychoemotional disorders, reducing aggressiveness and excessive activity. Effective in menopause in women. In complex therapy, it is used for chronic alcoholism, lesions of the central nervous system, neuroses, encephalopathies.

In children, it normalizes sleep, promotes calm falling asleep, reduces manifestations of hyperactivity and increases interest in the world around them. In infants, it reduces the frequency of night awakenings, excessive tearfulness. Contraindications to the use of glycine - individual intolerance. Medicines have a cumulative effect: a decrease in the manifestation of symptoms of the disease occurs after a certain level of an amino acid in the body is reached.

Glutamic acid

The main action is associated with the ability to regulate the activity of the central nervous system. It is a mediator in the transmission of nerve impulses. Glutamic acid is produced in the human body on its own, is part of the white and gray matter of the brain. It is a component of many medicines - bioregulators (Vezugen, Pinealon, Likam, Amitabs-3, Amitabs-5, Temero Genero). It neutralizes and removes ammonia from the body, participates in the synthesis of amino acids, serotonin, enzymes, carbohydrates.

In addition, it stimulates recovery processes, improves metabolism, and increases the resistance of brain tissue to oxygen starvation. It is used in complex therapy for the treatment of psychosis, schizophrenia, epilepsy, meningitis, birth traumatic brain injury. Children are prescribed for Down's disease, cerebral palsy, toxic neuropathy.

Emoxipin

An angioprotector with pronounced antihypoxidant and antioxidant properties. It has a fibrinolytic ability, reduces blood viscosity, prevents the formation of blood clots in blood vessels. Prescribed for myocardial infarction, diabetes, neurological diseases, patients with coronary insufficiency. In ophthalmology, it is used in complex therapy for intraocular hemorrhage, retinal damage from light (sun, laser burns), cataract, glaucoma, corneal inflammation.

Nootropics

They stimulate the activity of the brain, eliminate neuropsychiatric disorders. Translated from the ancient Greek, nootropics are “mind-altering” drugs. Cerebroprotective agents accumulate in cells, therefore, for visible results of treatment, the reception is prescribed in courses. Often used by students during the session to speed up the learning and memorization processes.

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Piracetam

A synthetic drug used in neurological and drug addiction practice. Stimulates the synthesis of phospholipids, RNA, utilizes glucose. Promotes concentration of attention, improves memory, ensures normal performance of the brain. Protects the body from oxygen starvation and intoxication. In pediatrics, Piracetam is prescribed for mental retardation, cerebral palsy, mental retardation, impaired reading and writing ability.

In narcology, complex therapy is prescribed for the relief of withdrawal symptoms, chronic alcoholism with mental impairment. Effective for relieving delirium tremens attacks. Piracetam is widely used to treat and prevent neurological diseases. The indications for prescribing the drug are:

• acute and chronic circulatory disorders;
• intoxication;
• brain injury;
• dizziness, impaired coordination of movements.

Cerebrolysin

Hydrolyzate obtained from pig brain. During processing, whey protein with aminopeptides is isolated. The drug is able to penetrate the blood-brain barrier, showing a therapeutic effect. Cerebrolysin increases the energy metabolism of the brain, improves protein synthesis in the aging brain. Protects neurons from free radicals, hypoxia, ischemia, neurotoxic effects of glutamate. In neurology, it is used for Alzheimer's disease, dementia, spinal cord and brain injuries, and cerebrovascular insufficiency. Allowed the appointment of the drug to children. In pediatrics, indications for prescription are mental retardation, attention deficit; in complex therapy, it helps with endogenous depression.

It is forbidden to use the drug for generalized epilepsy. After using Cerebrolysin, the frequency and duration of attacks may increase.

Picamilon

It has antioxidant and antiplatelet properties, is a psychostimulant. Affects metabolism in brain cells, improves cerebral circulation, microcirculation, reduces blood viscosity, reducing the risk of blood clots. Prescribed for severe fatigue, psychoemotional overload. When applied as a course, it reduces headache, normalizes sleep, reduces stress, attacks of anxiety and fear.

In complex therapy, Picamilon is prescribed for severe physical and mental stress (restoration of performance in athletes), TBI, neuroinfections, encephalopathies, migraines. In pediatrics, the drug works for urinary disorders. It can be used in ophthalmology for open-angle glaucoma.

Combined drugs

Combined action drugs have the properties of several groups at the same time. They have vasoactive and metabolic properties, due to which they have a pronounced therapeutic effect:

1. Phezam is a drug with a nootropic, vasodilating and antihypoxic effect. Increases the resistance of cells to oxygen starvation, dilates blood vessels, improves impulse transmission between nerve cells, and stimulates the central nervous system. It is prescribed for cerebral circulation insufficiency, intoxication, after craniocerebral trauma, with dizziness, tinnitus.
2. Thiocetam is a drug with nootropic, antioxidant and anti-ischemic effects. Affects vascular walls and neural transmission. It is used to improve learning processes, eliminate amnesia, and improve memory. Indications for use - chronic ischemia brain and diabetic encephalopathy.

Vascular drugs

There are 4 types: anticoagulants, antiplatelet agents, calcium channel blockers, vasodilators.

Anticoagulants

Anti-clotting drugs. They are divided according to the mechanism of action into direct and indirect. The former act directly on thrombin, reducing its activity. Indirect anticoagulants do not inhibit the activity of thrombin, but completely destroy it. Action of direct and indirect anticoagulants leads to a decrease in the viscosity of the blood, preventing the formation of clots, resorption of blood clots.

The most popular drugs are Heparin, Warfarin, Fenilin. They disrupt the synthesis of blood clotting factors. Prescribed for the treatment and prevention of thrombophlebitis, thrombosis, ischemia, atherosclerosis, varicose veins, thrombotic stroke. Effective in the complex treatment of mitral heart diseases, atrial fibrillation, aortic aneurysm.

Antiplatelet agents

A group of drugs that prevent cells from sticking together. The main purpose is the prevention of thrombus formation. They are widely used in cardiology and surgery (before performing abdominal operations). Doctors prescribe antiplatelet agents for cardiovascular diseases: angina pectoris, atherosclerosis, ischemic disease, after coronary artery bypass grafting. The most popular are Aspirin and Curantil; also antiplatelet agents include Ticlopidine, Clopidogrel, Dipyridamole, Eliquis and others.

Aspirin is a non-steroidal drug that has antipyretic, anti-inflammatory effects. It is used in preventive courses for thrombosis, cerebrovascular accidents, after strokes, heart attacks. For symptomatic treatment, it is used for headaches, elevated temperature, sore throat.

Curantil has become popular due to the fact that it can be taken by pregnant, lactating mothers. Increases the rheological properties of blood, protects the fetus from hypoxia. The drug improves blood supply to tissues, ensures the delivery of the required amount of oxygen, dilates blood vessels, and prevents the formation of blood clots.

Calcium channel blockers

The so-called drugs that do not allow calcium to enter the cell through calcium channels. When ingested, calcium causes muscle contraction and the release of neurotransmitters. Calcium channel blockers act on heart cells, vascular smooth muscle and myometrium. They reduce blood pressure, slow down the heart rate, and reduce vascular tone. Blockers are prescribed when high blood pressure, angina pectoris, arrhythmias, pulmonary hypertension, subarachnoid hemorrhages.

Nifedipine - dilates coronary and peripheral vessels, lowers blood pressure. Reduces the oxygen demand of the heart muscle. Nifedipine is prescribed for ischemic heart disease, arterial hypertension, Raynaud's disease.

Amlodipine - has a long-term hypotensive effect. Expands peripheral, coronary arteries, reduces the load on the heart. It has a cardioprotective effect in coronary heart disease. Amlodipine is prescribed for angina pectoris, arterial hypertension.

Vasodilators

A group of drugs with vasodilating properties. Used to treat cardiovascular diseases, circulatory disorders, hypertension. Depending on which vessels act on, vasodilators are divided into groups:

• cerebral - affect the vessels of the brain;
• peripheral - reduce the tone of the distal vessels;
• mixed - affect both veins and arteries.

Affecting the muscular wall of blood vessels, it is prescribed to relieve spasms and pain. The most popular drugs in this group are No-shpa (drotaverine), Atropine, Platyphyllin, Theophylline.

Adaptogens

Herbal remedies with neurotropic action. Adaptogens help a person adapt to stress and become more resistant to disease. They have general tonic properties, affect the central nervous system, accelerate metabolic processes, increase physical and mental performance.

Indications for use:

• increased physical activity (in athletes);
• difficult climatic conditions;
• chronic fatigue syndrome;
• hypotension;
• anorexia;
• stress.

The list of adaptogens is huge. The most popular are ginseng root, lemongrass, echinacea, eleutherococcus, sea buckthorn, astragalus, licorice root, rosemary.

Neuroprotective agents can improve the quality of human life. The use of drugs of this group can prolong the life of the brain and each cell. They are able to protect the body from daily stress and the effects of neurological diseases. Neuroprotective agents affect the central nervous system, therefore, taking medications is possible only after consulting a specialist.

21. Neurotropic drugs central action, classification. Anesthesia (general anesthesia) definition, classification of anesthetic drugs; comparative characteristics of drugs for inhalation anesthesia. Means for non-inhalation anesthesia, their comparative characteristics. The concept of combined anesthesia and neuroleptanalgesia.

Centrally acting neurotropic agents, classification (?)

Sleeping pills
Antiepileptic drugs
Antiparkinsonian drugs
Pain relievers (analgesics)
Analptics
Antipsychotics
Antidepressants
Anxiolytics
Sedatives
Psychostimulants
Nootropic drugs

Anesthesia products

Anesthesia - an insensitive, unconscious state caused by anesthesia, a cut is accompanied by a loss of reflexes, a decrease in the tone of skeletal muscles, but at the same time the functions of the respiratory, vasomotor centers and the work of the heart remain at a level sufficient to prolong life. Anesthetic drugs are administered by inhalation and non-inhalation (into a vein, muscles, rectally). Inhalation anesthetic agents must satisfy a number of requirements: a quick onset of anesthesia and a quick exit from it without unpleasant sensations; the ability to control the depth of anesthesia; adequate relaxation of skeletal muscles; wide range of anesthetic action, minimal toxic effects.

Anesthesia is caused by substances of various chemical structures - monoatomic inert gases (xenon), simple inorganic (nitrous oxide) and organic (chloroform) compounds, complex organic molecules (haloalkanes, ethers).

The mechanism of action of inhalation anesthesiaGeneral anesthetics alter the physicochemical properties of the lipids of neuronal membranes and disrupt the interaction of lipids with ion channel proteins. At the same time, the transport of sodium ions to neurons decreases, the release of less hydrated potassium ions remains, the permeability of chlorine channels controlled by GABA A receptors increases 1.5 times. The result of these effects is hyperpolarization with an increase in inhibition processes. General anesthetics suppress the entry of calcium ions into neurons, blocking H-cholinergic receptors and NMDA-receptors of glutamic acid; reduce the mobility of Ca 2+ in the membrane, therefore, prevent calcium-dependent release of excitatory neurotransmitters. The classical four stages of anesthesia are caused by ether:

Analgesia(3 - 8 min) Clouding of consciousness (disorientation, incoherent speech), loss of pain, then tactile and temperature sensitivity are characteristic, at the end of the stage amnesia and loss of consciousness occur (oppression of the cerebral cortex, thalamus, reticular formation). 2. Excitation(delirium; 1 - 3 min, depending on the individual characteristics of the patient and the qualifications of the anesthesiologist) There is incoherent speech, motor restlessness with the patient's attempts to leave the operating table, Typical symptoms of excitement are hyperventilation, reflex secretion of adrenaline with tachycardia and arterial hypertension (the operation is inadmissible. 3 ... Surgical anesthesia, consisting of 4 levels (occurs 10 - 15 minutes after the start of inhalation. Level of eye movement (light anesthesia).Corneal reflex level (severe anesthesia) The eyeballs are fixed, the pupils are moderately narrowed, the corneal, pharyngeal and laryngeal reflexes are lost, the tone of skeletal muscles decreases as a result of the spread of inhibition to the basal ganglia, the brain stem, and the spinal cord. Pupil dilation level (deep anesthesia) Pupils dilate, react sluggishly to light, reflexes are lost, skeletal muscle tone is reduced, breathing is shallow, frequent, and becomes diaphragmatic. 4. Awakening The functions are restored in the reverse order of their disappearance. IN agonal stage breathing becomes shallow, the coordination in the respiratory movements of the intercostal muscles and the diaphragm is disrupted, hypoxia progresses, the blood becomes dark, the pupils expand as much as possible, do not react to light. Blood pressure drops rapidly, venous pressure increases, tachycardia develops, heart contractions are weakened. If you do not urgently stop anesthesia and do not provide emergency care, death occurs from paralysis of the respiratory center. Inhaled anesthetics are volatile liquids and gases.

Modern anesthesia - volatile liquids (fluorotane, enflurane, isoflurane, desflurane) are halogenated derivatives of the aliphatic series. Halogens enhance the anesthetic effect. The drugs do not burn, do not explode, have a high evaporation temperature. Surgical anesthesia begins 3 to 7 minutes after the start of inhalation. Muscle relaxation is significant due to the blockade of H-cholinergic receptors in skeletal muscles. Awakening after anesthesia is fast (in 10 - 15% of patients, mental disorders, tremors, nausea, vomiting are possible). Fluorothane in the stage of surgical anesthesia depresses the respiratory center, reducing its sensitivity to carbon dioxide, hydrogen ions and hypoxic stimuli from the carotid glomeruli (blockade of H-cholinergic receptors). Respiratory distress is facilitated by strong relaxation of the respiratory muscles. Ftorotan dilates the bronchi as a blocker of H-cholinergic receptors of the parasympathetic ganglia, which is used to relieve severe attacks of bronchial asthma. cardiac output by 20 - 50%. The mechanism of the cardiodepressive effect is due to the blockage of calcium ions entering the myocardium. Ftorotan causes severe bradycardia, as it increases the tone of the center of the vagus nerve and directly inhibits the automatism of the sinus node (this action is prevented by the introduction of M-anticholinergics). Ftorotan causes severe hypertension due to several mechanisms: it inhibits the vasomotor center; blocks the H-cholinergic receptors of the sympathetic ganglia and the adrenal medulla; has an α-adrenergic blocking effect; stimulates the production of endothelial vasodilating factor - nitric oxide (NO); reduces the minute blood volume. A decrease in blood pressure with fluorotanic anesthesia can be used as a controlled hypotension, however, in patients with blood loss, there is a risk of collapse; during operations on organs with a rich blood supply, bleeding increases. To stop the collapse, the selective -adrenergic agonist mezaton is injected into the vein. Norepinephrine and adrenaline, which have β-adrenomimetic properties, provoke arrhythmia. Among other effects of fluorothane are an increase in coronary and cerebral blood flow, an increase in intracranial pressure, a decrease in oxygen consumption by the brain, despite adequate delivery of oxygen and oxidation substrates with the blood; Fluorotane is hepatotoxic, as it is converted into free radicals in the liver - initiators of lipid peroxidation, and also forms metabolites (fluoroethanol) covalently binding to biomacromolecules. The incidence of hepatitis is 1 case per 10,000 anesthesia in adult patients. ENFLURANE and Isoflurane Both drugs strongly depress respiration (with anesthesia, artificial ventilation of the lungs is required), disrupt gas exchange in the lungs, dilate the bronchi; cause arterial hypotension; relax the uterus; do not damage the liver and kidneys. DESFLURANE evaporates at room temperature, has a pungent odor, strongly irritates the respiratory tract (danger of coughing, laryngospasm, reflex respiratory arrest). Depressing respiration, causing arterial hypotension, tachycardia, does not change the blood flow in the brain, heart, kidneys, increases intracranial pressure.

GAS ANESTHESIS Nitrous oxide is a colorless gas, stored in metal cylinders under a pressure of 50 atm in a liquid state, does not burn, but maintains combustion, is poorly soluble in blood, but dissolves well in central nervous system lipids, so anesthesia occurs very quickly. To obtain deep anesthesia, nitrous oxide is combined with inhalation and non-inhalation anesthetics and muscle relaxants. Application: for induction anesthesia (80% nitrous oxide and 20% oxygen), combined and potentiated anesthesia (60 - 65% nitrous oxide and 35 - 40% oxygen), labor pain relief, trauma, myocardial infarction, acute pancreatitis (20% nitrous oxide ). Contraindication in hypoxia and severe lung diseases, accompanied by impaired gas exchange in the alveoli, in severe pathology of the nervous system, chronic alcoholism, alcoholic intoxication (danger of hallucinations, excitement). Not used for pneumoencephalography and operations in otorhinolaryngology.

Xenoncolorless, does not burn and does not have a smell, when in contact with the mucous membrane of the mouth creates a sensation of a bitter metallic taste on the tongue. Differs in low viscosity and high solubility in lipids, excreted by the lungs unchanged. The mechanism of the anesthetic effect - blockade of cytoreceptors of excitatory neurotransmitters - H-cholinergic receptors, NMDA-receptors of glutamic acid, as well as the activation of receptors for the inhibitory neurotransmitter glycine. Xenon exhibits antioxidant and immunostimulant properties, reduces the release of hydrocortisone and adrenaline from the adrenal glands. Anesthesia with xenon (80%) mixed with oxygen (20%)

Waking up after cessation of xenon inhalation is quick and pleasant, regardless of the duration of anesthesia. Xenon does not cause significant changes in pulse, heart rate, at the beginning of inhalation increases cerebral blood flow. Xenon can be recommended for anesthesia in patients with compromised cardiovascular systems oh, in pediatric surgery, during painful manipulations, dressings, for pain relief of childbirth, relief of pain attacks (angina pectoris, myocardial infarction, renal and hepatic colic). Xenon anesthesia is contraindicated in neurosurgical operations.

Non-inhalation anesthetics are injected into the vein, muscles and intraosseous .

Non-inhalation anesthesia are divided into three groups: Drugs short acting(3 - 5min)

· PROPANIDID(SOMBREVIN)

· PROPOFOL (DIPRIVAN, RECOFOL)

Medium duration drugs (20 - 30 min)

· KETAMINE(CALYPSOL, KETALAR, KETANEST)

· MIDAZOLAM(DORMICUM, FLORMIDAL)

· HEXENAL(HEXOBARBITAL-SODIUM)

· THIOPENTHAL-SODIUM (PENTOTAL) Long-acting drugs (0.5 - 2 hours)

· SODIUM OXIBUTIRATE

PROPANIDID- an ester, chemically similar to novocaine. When injected into a vein, it has an anesthetic effect for 3 - 5 minutes, as it undergoes rapid hydrolysis by blood pseudocholinesterase and is redistributed into adipose tissue. Blocks sodium channels of neuronal membranes and disrupts depolarization. Turns off consciousness, in sub-drug doses has only a weak analgesic effect.

Propanidide selectively stimulates the motor zones of the cortex, therefore, it causes muscle tension, flinching, and increases spinal reflexes. Activates the vomiting and respiratory centers. With propanidide anesthesia, hyperventilation is observed in the first 20-30 seconds, followed by respiratory arrest for 10-15 seconds due to hypocapnia. Weakens heartbeats (before cardiac arrest) and induces hypotension by blocking β - adrenergic receptors of the heart. When prescribing propanidide, there is a risk allergic reactions caused by the release of histamine (anaphylactic shock, bronchospasm). Cross-allergy with novocaine is possible.

Propanidide is contraindicated in shock, liver disease, kidney failure; it is used with caution in violation of coronary circulation, heart failure, arterial hypertension.

PROPOFOL.He is an antagonistNMDBUT-receptors of glutamic acid, enhances GABAergic inhibition, blocks voltage-gated calcium channels of neurons. It has a neuroprotective effect and accelerates the recovery of brain functions after hypoxic damage. Inhibits lipid peroxidation, proliferation T- lymphocytes, their release of cytokines, normalizes the production of prostaglandins. The extrahepatic component plays a significant role in the metabolism of propofol, inactive metabolites are excreted by the kidneys.

Propofol induces anesthesia after 30 seconds. Severe pain is possible at the injection site, but phlebitis and thrombosis are rare. Propofol is used for induction anesthesia, maintenance of anesthesia, provision of sedation without switching off consciousness in patients undergoing diagnostic procedures and intensive therapy.

During induction of anesthesia, twitching of skeletal muscles and convulsions sometimes appear, respiratory arrest develops for 30 s, due to a decrease in the sensitivity of the respiratory center to carbon dioxide and acidosis. The oppression of the respiratory center is potentiated by narcotic analgesics. Propofol, by expanding peripheral vessels, briefly lowers blood pressure in 30% of patients. Causes bradycardia, reduces cerebral blood flow and oxygen consumption by the brain tissue. Awakening after anesthesia with propofol is rapid, occasionally there are convulsions, tremors, hallucinations, asthenia, nausea and vomiting, and intracranial pressure rises.

Propofol is contraindicated in allergies, hyperlipidemia, cerebrovascular accidents, pregnancy (crosses the placenta and causes neonatal depression), children under one month of age. Anesthesia with propofol is carried out with caution in patients with epilepsy, pathology of the respiratory, cardiovascular systems, liver and kidneys, hypovolemia.

KETAMINEcauses anesthesia when injected into a vein for 5 - 10 minutes, when injected into the muscles - for 30 minutes. There is experience of epidural use of ketamine, which prolongs the effect up to 10 - 12 hours. The ketamine metabolite - norketamine has an analgesic effect for 3 - 4 hours after the end of anesthesia.

Anesthesia with ketamine is called dissociative anesthesia: the anesthetized person has no pain (felt somewhere off to the side), consciousness is partially lost, but reflexes are preserved, the tone of skeletal muscles increases. The drug disrupts the conduction of impulses along specific and nonspecific pathways to the associative zones of the cortex, in particular, it interrupts the thalamo-cortical connections.

The synaptic mechanisms of action of ketamine are manifold. It is a noncompetitive antagonist of excitatory brain mediators glutamic and aspartic acids in relation to NMDA-receptors ( NMDA- N-methyl- D-aspartate). These receptors activate sodium, potassium and calcium channels of neuronal membranes. With blockade of receptors, depolarization is disturbed. In addition, ketamine stimulates the release of enkephalins and β-endorphins; inhibits neuronal seizure of serotonin and norepinephrine. The latter effect is manifested by tachycardia, an increase in blood pressure and intracranial pressure. Ketamine dilates the bronchi.

When exiting ketamine anesthesia, delirium, hallucinations, motor agitation are possible (these undesirable phenomena are prevented by the introduction of droperidol or tranquilizers).

An important therapeutic effect of ketamine is neuroprotective. As you know, in the first minutes of brain hypoxia, there is a release of excitatory mediators - glutamic and aspartic acids. Subsequent activation NMDA-receptors, increasing

in the intracellular environment, the concentration of sodium and calcium ions and osmotic pressure, causes swelling and death of neurons. Ketamine as an antagonist NMDA-receptors eliminates the overload of neurons with ions and the associated neurological deficits.

Contraindications to the use of ketamine are disorders of cerebral circulation, arterial hypertension, eclampsia, heart failure, epilepsy and other convulsive diseases.

MIDAZOLAM- non-inhalation anesthetic of benzodiazepine structure. When injected into a vein, it causes anesthesia for 15 minutes, when injected into the muscles, the duration of action is 20 minutes. Affects benzodiazepine receptors and allosterically enhances the cooperation of GABA with GABA-type receptors BUT. Like tranquilizers, it has muscle relaxant and anticonvulsant effects.

Midazolam anesthesia is carried out only with artificial ventilation of the lungs, since it significantly inhibits the respiratory center. This drug is contraindicated in myasthenia gravis, circulatory failure, in the first 3 months. pregnancy.

Barbiturates HEXENAL and THIOPENTHAL-SODIUM after injection into a vein, anesthesia is caused very quickly - "at the end of the needle", the anesthetic effect lasts 20-25 minutes.

During anesthesia, reflexes are not completely inhibited, skeletal muscle tone increases (H-cholinomimetic effect). Intubation of the larynx without the use of muscle relaxants is unacceptable because of the danger of laryngospasm. Barbiturates do not have an independent analgesic effect.

Barbiturates depress the respiratory center, reducing its sensitivity to carbon dioxide and acidosis, but not to reflex hypoxic stimuli from the carotid glomeruli. Increase the secretion of bronchial mucus, independent of cholinergic receptors and not eliminated by atropine. They excite the center of the vagus nerve with the development of bradycardia and bronchospasm. They cause arterial hypotension, as they inhibit the vasomotor center and block the sympathetic ganglia.

Hexenal and thiopental sodium are contraindicated in diseases of the liver, kidneys, sepsis, fever, hypoxia, heart failure, inflammatory processes in the nasopharynx. Hexenal is not administered to patients with paralytic intestinal obstruction (it strongly inhibits motility), thiopental sodium is not used for porphyria, shock, collapse, diabetes mellitus, bronchial asthma.

Non-inhalation anesthetic agents are used for induction, combined anesthesia and independently for short-term operations. In outpatient practice, propanidide is especially convenient, which does not have aftereffect. Midazolam is used for sedation, and is also prescribed internally as sleeping pills and a tranquilizer.

SODIUM OXIBUTIRATE (GHB), when injected into a vein, causes anesthesia after 30 - 40 minutes for a duration of 1.5 - 3 hours.

This drug is converted into a GABA mediator, which regulates inhibition in many parts of the central nervous system (cerebral cortex, cerebellum, caudate nucleus, pallidum, spinal cord). GHB and GABA reduce the release of excitatory mediators and enhance postsynaptic inhibition by affecting GABA A receptors. With sodium oxybutyrate anesthesia, reflexes are partially preserved, although strong muscle relaxation occurs. Relaxation of skeletal muscles is due to the specific inhibitory effect of GABA on the spinal cord.

Sodium oxybutyrate does not inhibit the respiratory, vasomotor centers, heart, moderately increases blood pressure, sensitizing vascular -adrenergic receptors to the action of catecholamines. It is a strong antihypoxant in the brain, heart, retina.

Sodium oxybutyrate is used for induction and basic anesthesia, labor pain relief, as an anti-shock agent, in the complex therapy of hypoxia, including cerebral hypoxia. It is contraindicated in myasthenia gravis, hypokalemia, it is prescribed with caution for toxicosis of pregnant women, accompanied by arterial hypertension, as well as for people whose work requires quick mental and motor reactions.

COMBINED ANESTHESIS (multicomponent)

Neuroleptanalgesia (Greek neuron nerve + lepsis grasping, attack + Greek neg. prefix ana- + algos pain) - a combined method of intravenous general anesthesia, in which the patient is conscious, but does not experience emotions (neurolepsy) and pain (analgesia). Thanks to this, the protective reflexes of the sympathetic system are turned off and the tissue demand for oxygen decreases. The advantages of neuroleptanalgesia also include: a wide range of therapeutic action, low toxicity and suppression of the gag reflex. Anesthesia is an insensitive, unconscious state caused by anesthetic drugs, which is accompanied by a loss of reflexes, a decrease in skeletal muscle tone, but at the same time the functions of the respiratory, vasomotor centers and the work of the heart remain at a level sufficient to prolong life.

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Neuroprotective agents are a group of pharmaceuticals that protect the cells of the nervous system from the effects of negative factors. They help to quickly adapt the brain structures to pathological changes that occur in the body during stroke, TBI, neurological diseases. Neuroprotection allows you to preserve the structure and function of neurons. Under the influence of neuroprotective drugs, metabolism in the brain is normalized, and the energy supply to nerve cells is improved. Specialists-neurologists began to actively prescribe these drugs to patients since the end of the last century.

Neuroprotective agents are cytoprotective drugs, the action of which is provided by the correction of the membrane stabilizing, metabolic and mediator balance. Any substance that protects neurons from death has a neuroprotective effect.

According to the mechanism of action, the following groups of neuroprotectors are distinguished:

• Nootropics,
• Antioxidants,
• Vascular drugs,
• Combined medications,
• Adaptogenic agents.

Neuroprotectors or cerebroprotectors are drugs that stop or limit damage to brain tissue caused by acute hypoxia and. As a result of the ischemic process, cells die, hypoxic, metabolic and microcirculatory changes occur in all organs and tissues, up to the development of multiple organ failure. To prevent neuronal damage during ischemia, neuroprotective agents are used. They improve metabolism, reduce oxidation processes, increase antioxidant protection, and improve hemodynamics. Neuroprotective agents prevent damage to the nervous tissue during frequent climate changes, after neuro-emotional stress and overstrain. Due to this, they are used not only for therapeutic, but also for prophylactic purposes.

For the treatment of children, a huge number of neuroprotectors with different mechanisms of action are used in a dosage corresponding to age and body weight. These include typical nootropics - "Piracetam", vitamins - "Neurobion", neuropeptides - "Semax", "Cerebrolysin".

Such drugs increase the resistance of nerve cells to the aggressive effects of traumatic factors, intoxication,. These drugs have a psychostimulating and sedative effect, reduce the feeling of weakness and depression, and eliminate the manifestations of asthenic syndrome. Neuroprotective agents affect higher nervous activity, perception of information, and activate intellectual functions. The mnemotropic effect is to improve memory and learning, the adaptogenic effect is to increase the body's ability to withstand the harmful effects of the environment.

Under the influence of neurotropic drugs, headaches and dizziness decrease, others disappear. In patients, clarity of consciousness appears and the level of wakefulness increases. These drugs are not addictive and psychomotor agitation.

Nootropic drugs

• Anticoagulants: Heparin, Sincumarin, Warfarin, Fenilin. These drugs are anticoagulants that disrupt the biosynthesis of blood clotting factors and inhibit their properties.
• Antiplatelet the action is possessed by "Acetylsalicylic acid". It inactivates the enzyme cyclooxygenase and reduces platelet aggregation. Moreover, in of this drug there are indirect anticoagulant properties realized by inhibiting blood coagulation factors. "Acetylsalicylic acid" is prescribed for prophylactic purposes to persons with cerebrovascular accidents, stroke and myocardial infarction. Plavix and Tiklid are analogs of Aspirin. They are prescribed in cases where their "Acetylsalicylic acid" is ineffective or contraindicated.
• "Cinnarizin" improves blood flow, increases the resistance of muscle fibers to hypoxia, increases the plasticity of erythrocytes. Under its influence, the vessels of the brain expand, improve cerebral blood flow, and activate the bioelectric capacity of nerve cells. "Cinnarizine" has an antispasmodic and antihistamine effect, reduces the reaction to some vasoconstrictor substances, reduces the excitability of the vestibular apparatus, while not affecting blood pressure and heart rate. It relieves spasms of blood vessels and reduces cerebroasthenic manifestations: tinnitus and severe headache. Prescribe a medication to patients with ischemic stroke, encephalopathy, Meniere's disease, dementia, amnesia and other pathologies accompanied by dizziness and headache.
• "Vinpocetine"- a semi-synthetic vasodilator that eliminates hypoxia and increases the resistance of neurons to oxygen deficiency. It reduces platelet aggregation, increases cerebral blood flow, mainly in ischemic areas of the brain. Vinpocetine and Cinnarizine are indirect antihypoxants. Their therapeutic effect is due to the transfer of the body to more low level functioning, allowing you to perform full physical and mental work. The antihypoxic effect of these drugs is considered to be mediated.
• "Trental" dilates blood vessels, improves microcirculation and cerebral blood flow, provides brain cells with the necessary nutrition, activates metabolic processes. It is effective for osteochondrosis of the cervical spine and other diseases, accompanied by a significant deterioration in local blood flow. The main active substance the drug causes relaxation of the smooth muscle wall of blood vessels, increases their diameter, improves the elasticity of the walls of erythrocytes, so that they calmly pass through the vessels of the microvasculature. The drug mainly expands the vessels of the heart and brain structures.

Combined drugs

Combined neuroprotective drugs have metabolic and vasoactive properties that provide the fastest and best therapeutic effect when treated with low doses of active substances.

1. "Thiocetam" possesses the self-potentiating effect of "Piracetam" and "Thiotriazolin". Along with cerebroprotective and nootropic properties, the drug has antihypoxic, cardioprotective, hepatoprotective, immunomodulatory effects. "Thiocetam" is prescribed to patients suffering from diseases of the brain, heart and blood vessels, liver, viral infections.
2. "Phezam"- a drug that dilates blood vessels, improves the absorption of oxygen by the body, contributing to an increase in its resistance to oxygen deficiency. The drug contains two components "Piracetam" and "Cinnarizin". They are neuroprotective agents and increase the resistance of nerve cells to hypoxia. "Phezam" accelerates protein metabolism and glucose utilization by cells, improves interneuronal transmission in the central nervous system and stimulates blood supply to ischemic brain areas. Asthenic, intoxication and psychoorganic syndromes, impaired thinking, memory and mood are indications for using Phezam.

Adaptogens

Adaptogens include herbal products that have a neurotropic effect. The most common among them are: tincture of Eleutherococcus, ginseng, Chinese magnolia vine. They are designed to combat increased fatigue, stress, anorexia, hypofunction of the gonads. Adaptogens are used to facilitate acclimatization, prevention colds, accelerating recovery after acute illness.

• "Liquid extract of Eleutherococcus"- phytopreparation that has a general tonic effect on the human body. This is a dietary supplement, for the manufacture of which the roots of the plant of the same name are used. The neuroprotector stimulates the immune system and the adaptive capabilities of the body. Under the influence of the drug, drowsiness decreases, metabolism accelerates, appetite improves, and the risk of developing cancer is reduced.
• "Ginseng tincture" is of plant origin and has a positive effect on the body's metabolism. The drug stimulates the work of the human vascular and nervous systems. It is used as part of general strengthening therapy in debilitated patients. "Ginseng tincture" is a metabolic, antiemetic and biostimulating agent that helps the body to adapt to atypical loads, increases blood pressure, lowers blood sugar levels.
• "Tincture of Chinese lemongrass" is a common remedy for drowsiness, fatigue and long-term energy recharge. This remedy restores the state after depression, provides a surge of physical strength, perfectly tones, has a refreshing and stimulating effect.

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Disorders of the functioning of cerebral structures occur as a result of a long course of vascular disorders, deviations in the development of infectious and inflammatory diseases, congenital structural anomalies and similar problems. Up to injuries, atherosclerosis with ischemic processes.

Ultimately, there is almost always a lack of nutrition and cellular respiration at the local level, which leads to stroke, destruction of brain tissue and disability of varying degrees of severity.

Neuroprotectors are drugs of several pharmaceutical groups, united by the ability to qualitatively influence the state of blood flow, gas exchange and nutrition in the nervous structures. They are prescribed in long courses as part of the therapy of pathological processes.

In total, there are five groups of neuroprotective drugs:

• Nootropics. Actually accelerate metabolic phenomena in the brain.
• Cerebrovascular drugs. To correct local blood flow.
• Adaptogenic agents. They allow the body to adapt to negative conditions.
• Antioxidants Prevent oxidation of the artery walls, normalize the functioning of cerebral structures in this way.
• Mixed or combined medicines.

Application without the approval and prescription of a doctor is not recommended. Since, in addition to the beneficial effect, a lot of negative phenomena are possible. Up to the opposite effect if the dosage is exceeded or if it is used incorrectly.

Nootropic medicines

This group medicines used as a supportive measure. It is mainly prescribed in short courses, but long-term systematic use is possible. The question remains at the discretion of the doctor.

The pharmacological effect is based on several abilities:

• Acceleration of the synthesis of specific substances that ensure the normal conduction of nerve fibers. This is the main quality of such names.
• Stabilization of regenerative properties, an increase in the intensity of all healing processes. This is mainly required for patients after emergency conditions such as stroke or hematoma, trauma.
• Restoration of normal gas exchange. Nootropic drugs contribute to the correction of oxygen supply to nerve tissues. Given that the brain is extremely picky about the O2 concentration, this effect is observed almost from the first receptions.

In addition, nootropics indirectly provide normal mental activity and are able to restore memory and cognitive abilities in a short time. However, when using and prescribing, care must be taken in general.

High dosages cause side effects. In addition, it should be borne in mind that in the presence of brain tumors of any localization, it is an absolute contraindication for the use of nootropics. Since there is a high probability of accelerated growth of neoplasia. Including benign, up to a typical pituitary adenoma. This is a direct path to mental and organic disorders.

There are many names of neurotropic drugs for restoring metabolic processes in the brain. Consider a particularly popular one in the medical environment.

Piracetam

Perhaps the very first of the drugs of the type in question. It is used in a wide range of situations, it is a kind of universal name. It is mainly prescribed as a preventive measure or therapy for chronic ischemic brain processes.

A rather long course is required to correct cognitive abilities, nutritional disorders of the brain.

It has a minimum of side effects, therefore, despite the long history of its existence, it still retains its positions in the conditional ratings of neurologists.

Has a narrow scope of use, restores the membranes of nerve cells and prevents their further death. Among the indications, there are traumas of any nature, as well as ischemic and hemorrhagic strokes.

It makes sense to use a similar drug throughout the entire rehabilitation period.

Refusal occurs gradually, until the condition returns to normal. In the future, other medications are prescribed as secondary prevention.

Cerebrolysin

Approximately equal in intensity to the neuroprotective effect of Piracetam. It is created on the basis of a preparation of the brain of pigs, produced in the form of a solution for injection. Has a natural, natural origin. Therefore, there are a minimum of contraindications, as well as the likelihood of side effects.

However, you cannot take the medicine on your own. The consequences are unpredictable.

Semax

It is a mixed neuropeptide, provides not only the acceleration of neurometabolism, but also the restoration of adequate blood flow. Refers to synthetic, universal means, applied at the discretion of specialists.

There are other names, but they are assigned much less frequently. The choice of the necessary medication depends on the specific clinical case.

Read a detailed review of nootropics here.

Cerebrovascular

Vascular means form the basis of the systemic correction of many processes: from hypertension to chronic encephalopathy, disturbances in the normal nutrition of cerebral structures.

They are versatile compared to nootropics, but they have a lot more side effects. The group is heterogeneous and includes a number of subtypes, which are combined according to the mechanisms of beneficial effects on the patient's body.

• Restoration of blood flow. By reducing the rate of synthesis of some specific substances, those that disrupt the tone of large arteries. There are also other ways of direct exposure, biochemical characteristics depend on the specific name and subgroup.
• Normalization of the rheological properties of blood. Thinning, increasing fluidity. Which becomes the factors of eliminating malnutrition. Although not always.
• Correction of the state of the vascular walls. Decrease in the rate of oxidation, restoration of elasticity. Such a preventive effect of neuroprotective agents helps to prevent many problems, including reducing the likelihood of hemorrhagic stroke or cerebral aneurysms in the future.

Indirectly, cerebrovascular drugs improve mental activity, memory, attention and relieve symptoms of neurological deficits: from headaches to others.

If we talk about the specific names of such cerebroprotectors:

Antiplatelet agents

Disrupt the process of platelet aggregation. In fact, this effect provides an increase in blood fluidity. Many medicines of this kind have a mild effect, therefore they create a minimum of danger with a high therapeutic ability.

The classic names include products based on acetylsalicylic acid: Aspirin, Thrombo ass. More modern types that do not have this substance in the structure and composition: Clopidogrel, Ticlopidine and others. They are used strictly according to indications.

The group of antiplatelet agents is described in detail in this article.

Anticoagulants

Much more powerful pharmacological group. They are capable of disrupting the synthesis of coagulation factors. These medications have many more side effects. Use is possible only in a limited number of cases. Presented preparations are anticoagulants with heparins of various weights.

For a detailed overview of anticoagulants, read here.

Cinnarizine

The combined drug allows you to immediately solve a group of problems: to normalize blood flow due to minimal antiplatelet activity, to stop spasms of the cerebral arteries, to restore the level of pressure, intellectual abilities, and the ability to think.

The medicine has relatively few side effects, but if used incorrectly, it provokes obvious asthenic phenomena - fatigue, decreased performance. This must be taken into account when prescribing treatment.

Vinpocetine

Available in the form of tablets and ampoules for injection. Has a specific effect. Functions as a vasodilator. That is, it dilates blood vessels, helps to improve the nutrition of brain tissues (a group of vasodilating drugs is described in detail here).

On the other hand, the medication helps to reduce the oxygen demand of neurons and helps to optimize the functioning of cerebral structures. It is used in a wide range of cases.

Neuroprotective therapy includes not only nootropics or cerebrovascular, as a rule, several names are used different types to solve specific treatment problems. There are usually many of them, especially in patients with ischemic disorders.

Adaptogens

Basically, they do not belong to classic medicines. Most drugs of this type are representatives of the naturopathic direction.

However, they cannot be called fully folk, since these are actually recognized drugs, with proven efficacy, confirmed by clinical trials.

Among the main ones:

• Eleutherococcus tincture. Helps to activate the protective processes, as well as restore the nutrition of the cerebral structures. On the other hand, it has a high tonic potential.

If used incorrectly, it provokes an increase in blood pressure. This can be dangerous for hypertensive patients.

• Ginseng tincture. Accelerates metabolism. Has about the same effect as Eleutherococcus.

Both names can be used strictly according to indications. These are not the dietary supplements that can be taken without permission, without consulting a doctor.

Conventionally, most of the nootropics can also be attributed here, since they allow the brain to work in conditions of insufficient oxygen.

Antioxidants

The positive effect is based on the dual ability of this type of drugs.

• On the one hand, the ability to neutralize free radicals. To put it more clearly, the term refers to the ions of various substances. On contact with the vascular wall, brain cells and other structures, they enter into an oxidation reaction, which causes destruction and ultimately leads to many diseases.

The ability to neutralize free radicals helps to restore the performance of cells and maintain their functional activity. It also prevents cancerous processes in the body, albeit indirectly.

• On the other hand, antioxidants increase the rate of oxygen processing. In other words, the gas exchange efficiency rises sharply. With the same amount of O2 in the body, it turns out to be enough to support the main processes.

All the work of antioxidants is based on this mechanism. There are very few such medicines in their pure form. They usually have several pharmacological capabilities.

List of antioxidant neuroprotective drugs:

• Glycine is a classic medicine that belongs to nootropic drugs. But due to the ability of the neurotransmitter and the acceleration of oxygen utilization, the fight against free ions in the body, it can also be considered an antioxidant.

Used in clinical practice most widely. Mainly due high efficiency and low cost. However, the likelihood of allergic reactions is high. When taking, you need to carefully monitor your well-being.

• Mexidol. A tool with a relatively narrow scope. Basically, it is prescribed as part of the correction of encephalopathy and other dyscirculatory disorders. It can be used for the prevention of ischemic stroke and other similar processes.

Mexidol is prescribed by doctors as a complex treatment, but not for monotherapy (one and only).

• Glutamic acid. It is similar in clinical capabilities to Glycine, but has a wide range of applications.

• Emoxipin. It is prescribed as a remedy for the treatment of the consequences of a heart attack, stroke, as well as pathologies of an ocular origin and profile. For example, glaucoma, diabetic retinopathy. The range of cases where the application is possible is rather narrow.

Antioxidants have mixed qualities, making them suitable for use in a variety of situations. Apart from the group of exceptions.

Combined medicines

Basically, these funds include several previously announced names. In the complex, the effect becomes more pronounced.

It is important that the manufacturer takes compatibility into account and creates new types of products based on this.

Among the most popular:

• Phezam. It is a combination of Piracetam and Cinnarizine. It is used in similar situations. Causes a minimum of side effects. But all the same it is impossible to accept it arbitrarily.

• Thiocetam. It is used in approximately the same cases. There is no fundamental difference between the names.

Combined drugs are prescribed less frequently. Substances of neurotropic action in this case cannot be varied as needed by the doctor, therefore the possibility of "maneuver" is severely limited.

The question of the advisability of prescribing such drugs remains at the discretion of a specialist.

Neurotropic action is the ability to restore normal blood flow and optimize metabolism in the brain. A similar effect is required in most neurological diseases affecting cerebral structures. The names and schemes of use are selected by a specialized doctor after assessing the situation.

Source: CardioGid.com

Classification

Neurotropic drugs include anxiolytics along with antidepressants, local irritants, anesthetics, anesthetic drugs, neuroleptics, nootropics, tonic drugs and adaptogens. In addition, this category of drugs includes antiparkinsonian and antiepileptic drugs, hypnotics and sedatives, psychostimulants, as well as drugs that affect neuromuscular transmission. Let's look at these categories separately and start with anxiolytics.

Let us consider in more detail the classification of neurotropic drugs.

Anxiolytics and their effects

Anxiolytic effects are mainly exerted by substances that are classified as tranquilizers. They are used mainly when patients have neuroses with a state of mental stress and fear. Drugs in this category have not only anxiolytic effects. They also have, to varying degrees, hypnotic, muscle relaxant and anticonvulsant properties.

Tranquilizers in particular have anxiolytic and sedative effects. The hypnotic effect is expressed in facilitating the onset of sleep, enhancing the effects of hypnotics, analgesics and narcotics.

The muscle relaxant activity of anxiolytics, which is associated with effects on the nervous system, and not with peripheral effects, often serves positive factor as part of the use of tranquilizers to relieve tension with a sense of fear and excitement. True, such drugs are not suitable for those patients whose work requires a concentrated reaction.

When choosing anxiolytics for clinical use, differences in the spectrum of action of drugs are taken into account. Some of them have all the properties characteristic of tranquilizers, for example, "Diazepam", while others have a more pronounced anxiolytic effect, for example, "Medazepam". In high dosages, any anxiolytics exhibit pharmacological properties characteristic of this category of medicines. Anxiolytics include Alzolam along with Alprazolam, Atarax, Bromazepam, Gidazepam, Hydroxyzin, Grandaxin, Diazepabene, Diazepam and others.

Antidepressants: description and action of drugs

The common property of all antidepressants is their thymoleptic effect, that is, they have a positive effect on the patient's affective sphere. Thanks to the use of these medications, people have seen an improvement in their overall mental health and mood. Antidepressants differ from one another. For example, in "Imipramine" and a number of other antidepressants, the thymoleptic effect can be combined with a stimulating effect. And drugs such as "Amitriptyline", "Pipofezin", "Fluatsizin", "Clomipramine" and "Doxepin" have a more pronounced sedative effect.

The drug "Maprotiline" combines antidepressant effects with sedative and anxiolytic effects. Monoamine oxidase inhibitors, such as Nialamide and Eprobemide, have stimulating properties. The medicine "Pirlindol" relieves the symptoms of depression in people, showing nootropic activity and improving the cognitive functions of the nervous system. Antidepressants find their application not only in the psychiatric field, but also in the treatment of neurovegetative and somatic diseases.

The therapeutic effect of oral and parenteral antidepressants usually develops gradually and appears only ten days after the start of treatment. This can be explained by the fact that the antidepressant effect is associated with the accumulation of neurotransmitters in the region of nerve endings, and in addition, with a slowly emerging adaptive change. Antidepressants include drugs in the form of "Azafen", "Befol", "Bioxetine", "Gidifen", "Deprex", "Zoloft", "Imizin", "Lerivon", "Petilil" and other drugs.

The classification of neurotropic antihypertensive drugs is presented below.

Local irritants

Local irritating medications excite the endings of the nerves in the skin, causing a local and reflex reaction, which helps to improve tissue trophism and blood supply. These drugs can also help relieve pain. The local release of histamine and prostaglandins also plays a role in their mechanism of action.

Irritation of receptors of mucous membranes, subcutaneous formations and skin, as a rule, is accompanied by the release and formation of dynorphins, enkephalins, endorphins and peptides, which have great importance for the perception of pain. Some local drugs of this category can be absorbed to one degree or another and thereby cause a resorptive systemic effect, while they affect various regulatory processes.

The integral reflex effect of irritating substances can be accompanied by vasodilatation, since tissue trophism improves along with the outflow of fluid. In addition, pain relief is observed. The immediate area of ​​application of irritating drugs includes, first of all, bruises, myositis and neuritis. It is also advisable to use them for arthritis, sprains, circulatory disorders, and the like.

Local irritating medicines include Apifor along with Betalgon, Vipralgon, Kapsikam, Menthol, Nikoflex, Pikhtanol, Spirol, Finalgon, and so on.

What other drugs are on the list of neurotropic drugs?

Local anesthetics: description and action of the drug subgroup

Local anesthetics are aimed at lowering, as well as completely suppressing the excitability of sensitive nerve endings in the skin, mucous membranes and other tissues in direct contact. Depending on the use of the local anesthetic, terminal anesthesia is released, in which the anesthetic is applied to the surface on which it blocks the endings of the most sensitive nerves, and infiltration, when the skin and deeper tissues are successively impregnated with the anesthetic solution. In addition, conduction anesthesia is isolated, in which the anesthetic is injected along the nerve, thereby blocking the conduction of excitation along the nerve fibers. These neurotropic agents are very popular in pharmacology.

The first component that was found to have local anesthetic activity was the alkaloid of cocaine. Due to its high toxicity, this substance is currently almost never used. In modern anesthesiology, physicians use a variety of local synthetic anesthetics. These include "Anestezin" along with "Novocain", "Trimekain", "Dikain" (this drug is mainly used in ophthalmic practice), "Pyromecaine" and "Lidocaine". Recently, long-term local anesthetics have been developed, such as Bupivacaine.

The scope of application of various drugs directly depends on their pharmacological and physicochemical properties. For example, the insoluble substance anesthesin is used only superficially. As for soluble drugs, they are used for different types local anesthesia.

A number of local anesthetics have antiarrhythmic activity. "Lidocaine" is relatively widespread in some types of arrhythmias. For the same purposes, "Trimekain" is used. Among local anesthetics, it is also worth mentioning drugs in the form of "Dikain", "Inocaine", "Xylocaine", "Markain", "Naropin", "Pramoxin", "Rikhlokain", "Scandonest" and "Cytokain".

What other neurotropic drugs are there?

Anesthetic drugs and their description

For the purpose of general anesthesia, that is, directly for anesthesia or general anesthesia, various drugs are used in modern anesthesiology. Depending on their physical and chemical properties, and in addition, methods of application, they are divided into inhalation drugs and non-inhalation.

Medications for inhalation anesthesia include a number of easily evaporating liquids in the form of a substance called "fluorothane" and gaseous elements, mainly nitrous oxide. Due to its good narcotic properties and safety, fluorinated hydrocarbons, especially fluorothane, are widely used in anesthetic practice, displacing the previously used cyclopropane. Chloroform has lost its significance as a substance for anesthesia. Substances for non-inhalation anesthesia include barbiturates in the form of sodium thiopental and non-barbituric agents such as ketamine hydrochloride and propanidide.

For immersion in anesthesia, non-inhalation narcotic neurotropic drugs of peripheral action are often used, which are administered intravenously or intramuscularly. The main anesthesia is carried out with inhalation or non-inhalation drugs. The main anesthesia can be one-component or multi-component. Introductory anesthesia is carried out with special concentrations of agents, for example, using nitrous oxide mixed with oxygen.

In preparation for the operation, a premedication procedure is performed, which includes the appointment of analgesic, sedative, anticholinergic and other drugs to the patient. Such funds are used to reduce the negative impact on the body of emotional stress, which usually precedes the operation. Thanks to these medicines, it is possible to prevent possible side effects that are associated with anesthesia and surgical intervention, we are talking about reflex reactions, hemodynamic disorders, increased secretion of glands respiratory tract etc. Premedication helps to facilitate the administration of anesthesia. Thanks to premedication, the concentration of the substance used for anesthesia decreases, and at the same time, the excitation phase is less pronounced.

The anesthetic drugs currently used include drugs in the form of "Ketalar", "Narcotan", "Recofol", "Thiopental", "Urethane", "Chloroform" and others.

Antipsychotics also belong to neurotropic drugs.

Description and action of antipsychotics

Antipsychotics include drugs that are intended to treat psychosis and other severe mental disorders in people. The category of antipsychotics includes a number of phenothiazine derivatives, for example, Chlorpromazine, butyrophenones in the form of Haloperidol and Droperidol, and diphenylbutylpiperidine derivatives - Fluspirilene.

These centrally acting neurotropic agents can have multifaceted effects on human body... To their main pharmacological properties include a kind of calming effect, which is accompanied by a decrease in the response to external stimuli. In this case, a weakening of psychomotor excitement can be observed along with affective tension, a weakening of aggressiveness and suppression of a sense of fear. Such medications can suppress hallucinations, delusions, automatism, and other psychopathological syndromes. Thanks to antipsychotics, it turns out therapeutic effect on patients with schizophrenia and other mental illnesses.

Antipsychotics do not have a pronounced hypnotic effect in usual dosages, but they are capable of causing a drowsy state, thereby facilitating the onset of sleep and increasing the effect of hypnotics and other sedative medications. They potentiate the effects of analgesics, drugs, local anesthetics, weakening the effects of psychostimulating drugs. Antipsychotics, first of all, include "Solian" along with "Sonapax", "Teralen", "Tizercin", "Fluanksol", "Chlorpromazin", "Eglek", "Escazin" and others.

Neurotropic antihypertensive drugs

Peripheral neurotropic drugs include ganglion blockers, sympatholytics, and adrenergic blockers.

Ganglion blockers block the conduction of vasoconstrictor impulses at the level of the sympathetic ganglia. MD is due to inhibition of n-HR, which makes it difficult to conduct excitation from preganglionic to postganglionic fibers. This is accompanied by a decrease in the tone of arterioles and general peripheral vascular resistance, a decrease in venous tone and venous return of blood to the heart. At the same time, blood pressure, cardiac output decreases, blood is deposited in the veins of organs abdominal cavity, in lower limbs and the mass of circulating blood decreases, the pressure in the right ventricle and pulmonary artery decreases, reflex vasoconstrictor reactions are inhibited. Today, ganglion blockers for the treatment of hypertension are used little, since they give many side effects: orthostatic hypotension, inhibition of intestinal motility, constipation, atony of the bladder, etc.

Addiction develops rapidly to neurotropic antihypertensive drugs. Applied for severe (complicated) hypertensive crises, progressive hypertension, not amenable to the action of other drugs. Very carefully it is necessary to appoint patients over 60 years of age. In crises, parenteral drugs of intermediate duration (benzohexonium, pentamine) are usually prescribed, and for long-term use- pyrylene inside (valid for 10-12 hours). For controlled hypotension, short-acting neurotropic antihypertensive drugs (hygronium, arfonade) are used. Ganglion blockers are also used in the treatment of local vascular spasms (endarteritis, Raynaud's disease, acrocyanosis).

Sympatholytics. The main drug is Octadin. MD is associated with depletion of norepinephrine reserves in sympathetic endings, and as a result, the transmission of vasoconstrictor impulses in peripheral adrenergic synapses is inhibited. The antihypertensive effect develops gradually (after 1-3 days) and lasts 1-3 weeks after the withdrawal of this drug from the group of neurotropic antihypertensive drugs. PE: orthostatic hypotension, bradycardia, dyspeptic disorders, exacerbation of peptic ulcer and bronchial asthma.

"Clonidine" ("Clonidine") - antihypertensive effect the drug is due to the effect on adrenaline A2 and imidazoline I2 receptors in the centers of the medulla oblongata. When using the drug, renin production in renal cells decreases, cardiac output decreases, blood vessels expand. Lasts 6-12 hours;

"Guanfacin" and "Methyldopa" also promote vasodilation and slow down cardiac activity. They work longer than "Clonidine", up to 24 hours. These substances, like Clonidine, have a number of significant side effects. Significantly pronounced sedative effect, a feeling of dry mouth, depression, edema, constipation, dizziness and drowsiness;

"Moxonidine" is a second-generation centrally acting neurotropic antihypertensive agent, its mechanism of action is more perfect. It selectively acts on imidazoline receptors and inhibits the action of sympathetic NS on the heart. It is characterized by fewer side effects than the above-described centrally acting agents.

Action and description of sedatives

Sedatives are drugs that have a general sedative effect on the nervous system. The sedative effect is manifested in a decrease in the reaction to various external stimuli. Against the background of their use in humans, there is a slight decrease in daily activity.

Drugs in this category regulate the functions of the nervous system, enhancing the processes of inhibition and reducing arousal. They usually enhance the effects of sleeping pills, facilitating onset and natural sleep. They also enhance the effect of analgesics and other drugs that are aimed at suppressing the nervous system.

Let's consider these neurotropic agents and drugs in more detail. Sedatives include bromine preparations, namely sodium and potassium bromide, camphor bromide and agents made from medicinal plants such as valerian, motherwort, passionflower and peony. Bromides began to be used in medicine a long time ago, back in the century before last. The effect of bromine salt on nervous activity was studied by I. Pavlov and his students.

According to the data, the main effect of bromides is directly related to the ability to enhance the processes of inhibition in the brain. Thanks to these drugs, the disturbed balance between the process of inhibition and excitation is restored, especially with increased excitability of the nervous system. The effect of bromides largely depends on the type of higher nervous activity, and in addition, on the functional state of the nervous system. Under experimental conditions, it was proved that the lower the severity functional impairment in the cerebral cortex, the lower the dosage is required to correct these failures.

The direct dependence of the size of the therapeutic dosage of bromides on the type of nervous activity has been confirmed in the clinic. It is in this regard that it is required to take into account the type and state of the nervous system in the process of selecting an individual dose.

The main indication for the appointment of sedatives is increased nervous irritability. Other indications are irritability along with vegetative-vascular disorders, sleep disorders, neuroses and neurosis-like states. Sedatives (especially herbal ones) may be less sedative than hypnotics. It should be noted that sedatives are well tolerated along with the absence of serious adverse reactions. They usually do not cause drowsiness, ataxia, habituation, or mental dependence. Because of these advantages, sedatives are now widely used in daily outpatient practice. The most popular of them are Valokordin along with Valoserdin, Kliofit, Lavocordin, Melaxen, Nervoflux, Novopassit, Patrimin and others.

The classification of neurotropic drugs does not end there.

Sleeping pills

Sleeping pills are currently represented by drugs of various chemical groups. Barbiturates, which for a long time were the main sleeping pills, are now losing their leading role. But more and more widely used compounds from the benzodiazepine series in the form of "Nitrazepam", "Midazolam", "Temazepam," Flurazepam "and" Flunitrazepam ".

It is important to remember about the incompatibility of neurotropic drugs, chemotherapy drugs and alcohol.

All tranquilizers are capable of having a sedative effect on the human body to some extent, contributing to the onset of sleep. According to the intensity of some aspects of the impact various drugs this category may differ slightly from each other. The drugs that have the most pronounced hypnotic effect include "Triazolam" and "Phenazepam".

So, we have reviewed the main categories of neurotropic drugs that are currently widely used in various areas of medical practice.

Source: FB.ru

Nootropic drugs

Nootropics are drugs that stimulate metabolism in the nervous tissue and eliminate neuropsychiatric disorders. They rejuvenate the body, prolong life, activate the learning process and speed up memorization. The term "nootropic" in translation from the ancient Greek language literally means "change the mind."

• "Piracetam"- the most famous representative of nootropic drugs, widely used in modern traditional medicine for the treatment of neuropsychiatric diseases. It increases the concentration of ATP in the brain, stimulates the synthesis of RNA and lipids in cells. "Piracetam" is prescribed to patients during the rehabilitation period after acute cerebral ischemia. The drug is the first nootropic to be synthesized in Belgium in the last century. Scientists have found that this drug significantly increases mental performance and information perception.
• Cerebrolysin is a hydrolyzate obtained from the brain of young pigs. It is a partially degraded whey protein rich in aminopeptides. Due to the low molecular weight"Cerebrolysin" quickly penetrates the blood-brain barrier, reaches the brain cells and exerts its therapeutic effect. This medicine is of natural origin, due to which it has no contraindications and rarely causes side effects.
• Semax- a synthetic neuropeptide complex that has a pronounced nootropic effect. It is analogous to a fragment of adrenocorticotropic hormone, but does not have hormonal activity and does not affect the work of the adrenal glands. "Semax" adapts the work of the brain and promotes the formation of resistance to stress damage, hypoxia and ischemia. This medicine is also an antioxidant, antihypoxant and angioprotective agent.
• prescribed to patients who have had a stroke. It restores damaged nerve cell membranes and prevents their further death. For patients with TBI, the drug allows you to quickly get out of post-traumatic coma, reduces the intensity of neurological symptoms and the duration of the rehabilitation period. In patients after active therapy with the drug, such Clinical signs as lack of initiative, memory impairment, difficulties in the process of self-service, the general level of consciousness rises.
• "Picamilon"- a drug that improves cerebral circulation, activates metabolism in the brain tissue. The medicine has the properties of an antihypoxant, antioxidant, antiplatelet and tranquilizer at the same time. In this case, there is no depression of the central nervous system, drowsiness and lethargy do not occur. "Picamilon" eliminates the symptoms of overwork and psycho-emotional overload.

Antioxidants

Antioxidants are drugs that neutralize the pathogenic effects of free radicals. After treatment, the cells of the body are renewed and healed. Antihypoxants improve the utilization of oxygen circulating in the body and increase the resistance of cells to hypoxia. They prevent, reduce and eliminate the manifestations of oxygen deficiency, maintaining energy metabolism at an optimal level.

List of antioxidant neuroprotective drugs:

1. "Mexidol" effective in combating hypoxia, ischemia, convulsions. The drug increases the body's resistance to stress, stimulates its adaptive capacity to the damaging effects of the environment. This medicine is included in complex treatment discirculatory changes occurring in the brain. Under the influence of "Mexidol", the processes of perception and reproduction of information are improved, especially in the elderly, alcohol intoxication organism.
2. increases the activity of antioxidant enzymes, reduces the formation of prostaglandins, prevents thromboaggregation. "Emoxipin" is prescribed to patients with signs of acute cerebral and coronary insufficiency, glaucoma, intraocular hemorrhage, diabetic retinopathy.
3. "Glycine"- an amino acid that is a natural metabolite of the brain and affects functional state its specialized systems and nonspecific structures... It is a neurotransmitter that regulates metabolic processes in the central nervous system. Under the influence of the drug, psycho-emotional stress decreases, brain function improves, the severity of asthenia and pathological dependence on alcohol decreases. "Glycine" has an anti-stress and sedative effect.
4. "Glutamic acid"- a drug that stimulates recovery processes in the body, normalizes metabolism and transmission of nerve impulses. It increases the resistance of brain cells to hypoxia and protects the body from the toxic effects of toxic substances, alcohol, and certain drugs. The medicine is prescribed for patients with schizophrenia, epilepsy, psychosis, insomnia, encephalitis and meningitis. "Glutamic acid" is included in complex therapy children's cerebral palsy, polio, Down's disease.
5. "Complamin"- a neurotropic drug that improves blood flow to the brain, promotes the flow of oxygenated blood to the brain tissue, suppressing platelet aggregation. "Complamin" is an indirect antioxidant that activates lipid and carbohydrate metabolism, has a hepatoprotective effect.

Vascular drugs

Classification of the most commonly used vascular drugs: anticoagulants, antiplatelet agents, vasodilators, calcium channel blockers.

• Anticoagulants: Heparin, Sincumarin, Warfarin, Fenilin. These drugs are anticoagulants that disrupt the biosynthesis of blood clotting factors and inhibit their properties.
• Antiplatelet the action is possessed by "Acetylsalicylic acid". It inactivates the enzyme cyclooxygenase and reduces platelet aggregation. In addition, this drug has indirect anticoagulant properties, realized by inhibiting blood coagulation factors. "Acetylsalicylic acid" is prescribed for prophylactic purposes to persons with cerebrovascular accidents, stroke and myocardial infarction. Plavix and Tiklid are analogs of Aspirin. They are prescribed in cases where their "Acetylsalicylic acid" is ineffective or contraindicated.
• "Cinnarizin" improves blood flow, increases the resistance of muscle fibers to hypoxia, increases the plasticity of erythrocytes. Under its influence, the vessels of the brain expand, improve cerebral blood flow, and activate the bioelectric capacity of nerve cells. "Cinnarizine" has an antispasmodic and antihistamine effect, reduces the reaction to some vasoconstrictor substances, reduces the excitability of the vestibular apparatus, while not affecting blood pressure and heart rate. It relieves spasms of blood vessels and reduces cerebroasthenic manifestations: tinnitus and severe headache. Prescribe a medication to patients with ischemic stroke, encephalopathy, Meniere's disease, dementia, amnesia and other pathologies accompanied by dizziness and headache.
• "Vinpocetine"- a semi-synthetic vasodilator that eliminates hypoxia and increases the resistance of neurons to oxygen deficiency. It reduces platelet aggregation, increases cerebral blood flow, mainly in ischemic areas of the brain. Vinpocetine and Cinnarizine are indirect antihypoxants. Their therapeutic effect is due to the transfer of the body to a lower level of functioning, allowing full physical and mental work to be performed. The antihypoxic effect of these drugs is considered to be mediated.
• "Trental" dilates blood vessels, improves microcirculation and cerebral blood flow, provides brain cells with the necessary nutrition, activates metabolic processes. It is effective for osteochondrosis of the cervical spine and other diseases, accompanied by a significant deterioration in local blood flow. The main active ingredient of the drug causes relaxation of the smooth muscle wall of blood vessels, increases their diameter, improves the elasticity of the walls of erythrocytes, so that they calmly pass through the vessels of the microvasculature. The drug mainly expands the vessels of the heart and brain structures.

Combined drugs

Combined neuroprotective drugs have metabolic and vasoactive properties that provide the fastest and best therapeutic effect when treated with low doses of active substances.

1. possesses the self-potentiating effect of "Piracetam" and "Thiotriazolin". Along with cerebroprotective and nootropic properties, the drug has antihypoxic, cardioprotective, hepatoprotective, immunomodulatory effects. "Thiocetam" is prescribed to patients suffering from diseases of the brain, heart and blood vessels, liver, viral infections.
2. - a drug that dilates blood vessels, improves the absorption of oxygen by the body, contributing to an increase in its resistance to oxygen deficiency. The drug contains two components "Piracetam" and "Cinnarizin". They are neuroprotective agents and increase the resistance of nerve cells to hypoxia. "Phezam" accelerates protein metabolism and glucose utilization by cells, improves interneuronal transmission in the central nervous system and stimulates blood supply to ischemic brain areas. Asthenic, intoxication and psychoorganic syndromes, impaired thinking, memory and mood are indications for using Phezam.

Adaptogens

Adaptogens include herbal products that have a neurotropic effect. The most common among them are: tincture of Eleutherococcus, ginseng, Chinese magnolia vine. They are designed to combat increased fatigue, stress, anorexia, hypofunction of the gonads. Adaptogens are used to facilitate acclimatization, prevent colds, and accelerate recovery from acute diseases.

• "Liquid extract of Eleutherococcus"- phytopreparation that has a general tonic effect on the human body. This is a dietary supplement, for the manufacture of which the roots of the plant of the same name are used. The neuroprotector stimulates the immune system and the adaptive capabilities of the body. Under the influence of the drug, drowsiness decreases, metabolism accelerates, appetite improves, and the risk of developing cancer is reduced.
• "Ginseng tincture" is of plant origin and has a positive effect on the body's metabolism. The drug stimulates the work of the human vascular and nervous systems. It is used as part of general strengthening therapy in debilitated patients. "Ginseng tincture" is a metabolic, antiemetic and biostimulating agent that helps the body to adapt to atypical loads, increases blood pressure, lowers blood sugar levels.
• "Tincture of Chinese lemongrass" is a common remedy for drowsiness, fatigue and long-term energy recharge. This remedy restores the state after depression, provides a surge of physical strength, perfectly tones, has a refreshing and stimulating effect.

At the moment the following questions are answered: A. Olesya Valerievna, Ph.D., teacher of a medical university

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