The liquid state of the blood and the closedness (integrity) of the bloodstream is the necessary conditions of vital activity. These conditions create:

1. Thromboed system (blood coagulation and platelet aggregation)

2. Thrombolytic (fibrinolytic) system.

These two systems are in the body in dynamic equilibrium. They provide the liquid state of the circulating blood and restore the integrity of the paths of its circulation, by forming blood thrombus (plugs) in damaged vessels.

The thromb-forming system or the hemocoagulation system includes blood and tissues that produce necessary for coagulation of the substance.

The blood plasma contains coagulation factors that are denoted by Roman numbers in the order of their chronological opening:

Factor I - fibrinogen is the largest molecular weight plasma protein. It is formed in the liver.

Factor P - Protromine - Glycoprotein, is formed in the liver with the participation of Vitamin K.

Factor III - fabric thromboplastin - phospholipid.

Factor IV-Calcia.

Factor V, VI - Proactor and Akelerin.

Factor VII - convertine, synthesized in the liver under the influence of vitamin K.

Factor VIII - Antigemophilic Globulin A.

Factor IX - Christmas factor or anti-emophilic globulin B is formed in the liver in the presence of vitamin K.

Factor X - Factor of Stuart Puera, is formed in the liver in the presence of vitamin K.

Factor XI - a plasma precursor of thromboplastin, formed in the liver in the presence of vitamin K.

Factor XP - Factor Hageman.

The FIBR inhibitory factor is a fibrinstabirling factor - glycoprotein, formed in the liver.

All blood cells and especially platelets are involved in hemostasis. Thrombocytes contain many substances involved in blood clotting. They are called thrombocyte factors and numbers by Arabic numbers. For example:

Factor 3 - thrombopitarian thromboplastin.

Factor 4 - antigeparine.

Factor 5 - coagulating factor or fibrinogen, etc ..

Plasma and thrombopyitar factors take part in coagulative hemostasis flowing into three phases.

1 Phase - the formation of the promotibamine, the process is started by fabric thromboplastin, which is highlighted from the walls of the damaged vessel. This phase lasts 5-7 minutes.

2 phase - thrombin formation, duration 2-5 seconds.

3 Phase - Fibrin Education.

After the formation of the fibrin thrombus, the process of retraction is a seal and fastening of the thrombus in a damaged vessel. And then, at a slow speed, fibrinolysis begins - the fibrin cleavage in order to restore the lumen of the vessel clogged with a clot. Fibrin cleavage is carried out by a proteolytic plasmin enzyme.

Scheme of coagulative hemostasis

If the equilibrium is violated between thrombosis to fibrinolysis, it may be possible or increased bleeding or widespread thrombosis. Both states require correction by appointing drugs.

Classification of drugs affecting blood clotting.

I substances that hovering blood clotting

1. Anticoagulants.

but). Anticoagulants direct action.

Heparin, sodium hydrocenterath.

b). Anticoagulants indirect action.

Cumarine derivatives: Neodyacumarine, Synkum.

Indandion derivatives: Fennlin.

2. Antiagregative agents: acetylsalicylic acid, digshridamol, pentoxyphyllen. Tiklopidine.

3. Fibrinolytic agents,

but). Fibrinolities of direct action: fibrinol.

b). Fibrinolytic indirect effects: streptocinase, streptodecadis, urock.

II hemostatic agents.

1. Coagulant

but). Directly coagulants, thrombin, fibrinogen.

b). Indirect Action Coagulants: Vitamin K - Phyomena, Vikasol (see Vitamins).

2. Stimulants of platelet aggregation (agregants): calcium salts, ADROCON.

3. Fibrinolysis inhibitors.

but). Synthetic fibrinolysis inhibitors: aminocapron

acid, amben.

b). Inhibitors of fibrinolysis (proteolysis) of animal origin: pippin, conflict, mining (see Lecture Enzymes and Antimement drugs)

Aticoagulants direct action - substances affecting coagulation factors directly in the blood. They are active not only in the conditions of a whole organism, but in vitro.

Heparin - mucopolysaccharide produced in body cells in the body. Contains sulfuric acid residue in molecuo. In solution bears a strong negative charge, which contributes to the interaction of heparin with proteins involved in blood coagulation. Heparin is considered by the co-factor of antithrombin and takes part in the inactivation of HP, XI. X, IX, VII blood coagulation factors. It blocks the progromine transition in thrombin and initiates blood bin (s). Heparin Effeneinven under parenteral administration, most often used intravenously. The action starts quickly and lasts 2-6 hours. Heparin is inactivated in the liver enzyme heparinase. Heparin has not only an anticoagulant effect. It is inhibited by the activity of hyaluronidase, improves coronary blood flow. The introduction of heparin to the body is accompanied by a decrease in cholesterol content, but due to the risk of bleeding, it does not change as a hypocholesterolemic agent. The drug has an immunosuppressive effect, due to the suppression of cooperation T and in cells. Heparin is used for the profile and therapy of various thromboembolic processes with myocardial infarction, trombam-embolism of the main veins and arteries, to maintain the liquid state of the blood in the artificial blood circulation devices. Side effect - bleeding. The heparin antagonist is Protamina sulfate. The activity of heparin is determined by the biological method according to the method of lengthening the blood coagulation time (expressed in the unit). The drug is produced in 5 ml vials with a 5000,10000 and 20000 units / ml activity.

Sodium citrate is a direct anticoagulant. The mechanism of action - binds calcium ions non-climbing for the transformation of prothrombin in thrombin. The drug is used to stabilize blood when it is conservation.

Anticoagulants indirect action - substances that depress the synthesis of blood rolling factors in the liver (ProtromBin et al.). Preparations: Cumarine derivatives: Neodyacumarine, Synkum;

indandian derivatives: Phenylin.

All drugs are vitamin K antagonists. They prevent the reduction to 1 - oxide to the active form to 1, which blocks the synthesis P, VII, IX, X of coagulation factors. In the face of heparin, these drugs are effective only in the conditions of a whole organism, they are injected through the mouth. Latent period - 2-3 hours, maximum actions after 24-30 hours, duration of action 2-3 days. Preparations can be cumulated. Indications - Prevention and treatment of thrombosis, thrombophlebitis, embolocal strokes. In case of overdose and long-term use, the pre-paper can cause serious bleeding associated not only with a change in blood clotting, but also with an increase in capillary permeability. When bleeding, drugs should be canceled and prescribed vitamins K, P, C. Anticoagulants are not prescribed with hemorrhea diathesis, increased permeability of vessels, pregnancy, during menstruation, with a torment of the liver and kidney functions, gusts ulcers.

Antiagregative agents - means of reducing the danger of thrombosis. The agro-gas of platelets is regulated by the thromboxane system - prostacyclin. These compounds are forming cyclic endoperoxides that are products of conversion in the organism of arachidonic acid. Thromboxane A2 will cause platelet aggregation and causes a pronounced vessels. It is synthesized in thrombocytes. Thromboxane - Connection is very unstable, TL / 2 - 30 seconds. The opposite role is played by Prostacyclin (Prostaglandin 1 2). It prevents platelet aggregation and causes extension of vessels. This is the most active endogenous in-hibitor of platelet aggregation. Prostacyclinin is synthesized by vessels endothelium. The mechanism of its action is the stimulation of adenylate cyclase and an increase in the content of the CAMF in platelete and the wall of the vessels.

Acetylsalicylic acid - Inhibitor of cyclooxygenase. Itibing leads to an on-destruction of the synthesis of cyclic endoproxides and their metabolites of thromboxane and ethoxycline. Platelet cyclooxygenase is more sensitive than the same choroid wall enzyme. In this, the synthesis of thromboxane is suppressed to a greater extent than the synthesis of prostacyclin. The developing antiagregant effect lasts several days. The duration of the effect explains the irreversibility of the inhibitory effect of acetylsalicylic acid on platelet cyclooxygenase. Reduced cyclooxygenase platelets are not synthesized. It is replenished only in the process of formation of new platelets (the life expectancy of platelets is 7-10 days).

The cyclooxygenase of the vessel wall restores its activity within a few hours. Therefore, the duration of a reduction in the content of thromboxane is greater than that of prostacyclin.

Dipyridamol - enhances the coronary blood circulation, slows down the aggregation of platelets. Antiagregative properties are binding to the oppression of phosphodiesterase, an increase in the contents of the CAMP and the potentiation of adenosine, which itself slows down the platelet aggregation.

Ticlopidine - inhibits platelet aggregation caused by ADP, causes an increase in disaggregation, reduces the concentration of the GU factor. There is more active acetylsalicy acid acid.

Indications for the appointment of antiagregants: Prevention of thrombosis in ischemic disorders caused by the atherosclerotic process of vessels of the brain, heart, limbs; Postin hunting period. Side effects: bleeding.

Fibrin-filtic agents - Substances capable of dissolving already formed clomes. From either the physiological fibrinolysis system is activated, or the missing fibrinolysin is replenished.

Direct fibrinolities. Fibrinolysin (plasmnn) is an enzyme formed when plasminogen contained in the blood (profibrinolese). Fibrinolysin is the physiological component of the natural great-absorbing system of the body. The basis of its actions is the ability to dissolve the fibrin fibrin threads in vitro. The most youthful effect of fibrinolysin on fresh blood clots.

Fibrinolites NEPRIMOTO Action. Streptocinase - enzyme enzyme resulting from the culture of beta hemolytic streptococcus. The drug interacts with the profibrinoleseine, and the resulting complex acquires proteolytic activity and activates the transition of profibrinolysin into fibrinolysin. The drug causes blood lysis, acting on them not only, ko from the surface, but also penetrating inside the thrombus.

Streptodecase is a drug that has an extensive action. The one-time administration of the average therapeutic dose ensures an increase in the fibrinolytic activity of the blood to 48-72 hours.

Apply fibrinolities to restore trombewed vessels (Embo Lia pulmonary artery, acute myocardial infarction, superficial and deep veins thrombosis, etc.). Contraindications - bleeding. Side effects are allergic disorders, especially. Streptocinases and Stretodecases. Preparations are introduced intravenously, dose in units of action.

Hemostatic means.

Direct coagulant. Thromubin is the natural component of the blood coagulation system, obtain from the plasma of donors. The thrombin solution apply only the place of the day of the remain-new bleeding.

Fibrinogen is also obtained from the plasma of donors. Used in hypo-and afibrinogenemia, bleeding in traumatological, surgical, oncological glitter. Enter Venza\u003e.

Indirect Action Coagulants: Vitamin K - Phyomenadion, Vikasol (see Vitamins).

Stimulants of platelet aggregation (aggregates): calcium salts, ADROCONS. Fibrinolysis inhibitors.

Synthetic fibrinolysis inhibitors. Aminocaproic acid - inhibits the transmissation of fundamental and fibrinolysin and has a direct depressing effect on fibrinolysin. Prescribe a drug to stop bleeding in which the fibrinolytic essential blood and tissues (injuries, surgery, liver cirrhosis, uterine bleeding). Prescribed in / specime and inside. The drug is small toxic. Amben - acts like aminocaproic acid, but more active.

Fibrinolysis inhibitors (proteolysis) Animal origin: Plippine, Contractor, Galds. All drugs are proteinase inhibitors (plasmin, trypsin, chymotrypsin) (see lecture enzymes and antimenimen drugs).

The means affecting the blood formation drugs affecting the blood formation can be divided into:

I means affecting erythropoes:

1. Stimulating erythropoes.

2. Depressing erythropoes.

P. Means affecting leukopoies:

1. Stimulating leukopoez.

2. Thoring leukopoez.

Erythroproszes stimulating products are used for anemia.

Anemia is pathological processes, which are characterized by a decrease in the amount of erythrocytes or hemoglobin in a unit of blood volume. Depending on the specific pathogue-neutic mechanisms underlying the development of anemic syndromes distinguish.

1. Iron deficiency anemia (hypochromic). The reasons for these anemia are chronic blood loss. Pathology from gastrointestinal tract, pregnancy, congenital shortage of the same-lyza, alimentary (food) iron deficiency. Iron deficient anemia are the most common and amount to about 80% of all anemia.

2. B12- and folic-deficiency anemia (hyperchromic). The development of these anemia is associated with impaired absorption, increasing flow rate or alimentary insufficiency of vitamin B12 and folic acid in atrophy of the mucous membrane of the stomach resection, lesion of the liver, plaque invasions, etc.

3. hemolytic anemia The reasons for them are the impact of various factors contributing to the destruction of erythrocytes (the formation of antibodies, hemolytic poisons).

4. Aplastic anemia. They occur with the oppression of the function bone marrow ionizing radiation, chemical compounds, viral infections, etc.

Conductible anemia (hypochromic)

The iron enters the body with food, the ionization is undergoing and forms low-melt-lary complexes with amino acids, fructose, ascorbic acid. Then there is a pre-becoming of iron to bivalent and absorption of it, mainly in the twelfth-night intestine. The presence of hydrochloric acid (translates the molecular iron in the ioniziro-bathroom shape) and ascorbic acid (restores the trivalent iron in duvelanet) contributes to the absorption of iron from the digestive tract. When suction first, the active seizure of water-soluble iron complexes of the brush cut of the intestinal mucosa (for its normal activity is necessary folic acid). Then in the cells of the epithelium iron is released from the complex and is transported by simply diffuse-zi (according to the concentration gradient), or in a complex with a special carrier protein (apotheferritin), whose synthesis is rising during anemia. The activity of this carrier protein depends on the energy supplied by the hem-containing enzymes and protein containing copper. When re-saturated with the body with iron, transporting it through the intestine epithelium slows down, and then it stops at all. The non-oxidic part of the iron, associated with Apotheferritin, is excreted from the body with the epithelium of the mucous membrane during its desquamation (lubrication). The iron, the spawn of the intestinal epithelial, falls into the bloodstream, where it is oxidized to the trivalent state and is connected with transferrrin (sederophiline) transporting it to the blood formation organs (bone marrow) or the deposit authorities (liver, spleen).

The iron is a component of a number of enzymes as a hemerine structure (hemoglobin, mioglobin, cytochrome, peroxidases) and an overhead structure (sucytdehydehydrogenase, acetyl-co-dehydrogenase, etc.). Geminic enzymes are involved in the transport of oxygen, the deletion of peroxide, and the miston enzymes - in the breath of tissues, creatine phosphate, ATP. Therefore, in the insufficiency of iron in the body, not only the content of hemo-globin in red blood cells (hypochromic anemia), but also the activity of respiratory enzymes in tissues is developing hypotrophy.

Means for the treatment of iron deficiency anemia

For the treatment of iron deficiency anemia, iron preparations are used.

Iron preparations are introduced enteralo and parenterally. Inside used advantage bivalent glazeSince the trivalent iron is worse from Ki-Choke and causes strong irritation of its mucous membrane.

The drugs taken inward are divided into organic (iron lactate. Hemostimulin, ferrocal, ferroplex) and inorganic (iron sulfate).

For injection, drugs containing drugs trivalent iron In a complex with organic components (Ferbitol. Ferruum Lek). Most of the drugs other than iron samo contains additional substances that increase the bioavailability of iron. For example: hemostimulin contains copper sulfate, ferroplex - ascorbic acid, Ferken - Cobalt, Ferrum Lek - Maltose.

Side effects: During the reception of iron preparations, dyspeptic effects (nausea, vomiting), constipation may occur, since the iron binds in the intestine of hydrogen sulfide, a javal of the physiological stimulant of the peristalticism. Iron activates free radical processes, therefore, a large amount of free iron can damage the cell membranes, cause hemolysis of erythrocytes. In case of overdose of drugs, the peripheral resistance of the vessels decreases, falls arterial pressure. To assist in acute poisoning with iron, substances that form comprehensive compounds are used, which are spilled from the body through the kidneys or intestines. The most effective antidote is deferoxamine (desferla), it is prescribed inside, in / muscularly, in Venno.

Treatment of hyperchromic anemia

For the treatment of hyperchromic anemia, vitamin B 12 (cyankobalamin) and folic acid are used.

Vitamin B12 (cyancobalamin) enters the body with dairy and meat food, the microfloraine of the intestines is illicious. Cyancobalamin B is absorbed thin intestines. For its suction, special mucoprotein of the stomach mucosa is needed - "Internal Castle Factor"; The complex formed with him enters thin gut, joins the top of the epithelial cells, after which it is with the help of a special protein receptor and the absorption of vitamin. In the blood, it binds to transcalaminamins I and n, transporting it into the tissue. Cyanocobalamin accumulates in the liver. With bile, he may be discovered in the intestines and again absorbed from it.

Cyanocobalamin in the body stopped in Cofackers - Deoxyadenosylcobalamin and methylcobalamin. Cofactors are part of various reductases: in the reductase, translating folic acid into tetrahydrofolia, this cyanocobalamin contributes to blood formation: in the reductase supporting sulfhydryl groups in various proteins and enzymes, including in Koo, glutathione, the latter supports the integrity of cell membranes, including and red blood cells, pretending to be premature hemolysis observed in Megaloblastic anemia. The deoxyadenozincoobalamine is necessary for the conversion of methylmalone acid into the amber, part of the lipid portion of myeline. Methylkobalamin ensuring the transfer of mobile methyl groups of needed for the synthesis of holil, acetylcholine, methionine. Superflower Vitamin B12 manifests in the form of megaloblastic anemia, hypotrophy, damage to the gastrointestinal tract, violations of the functions of the central and peripheral nervous system (The insufficiency of Mitionin and Acetyllcholina affects).

Vitamin B12 is used primarily with the Megaloblastic Adison Birmer anemia (pernicious malignant anemia). This disease is the result of atrophy of the grazing gastric bonding area producing the gastromoucoprotein necessary for the absorption of vitamin B12. Its reception restores the normalized blood-formation, normalizes the life expectancy of the erythrocytes, eliminates neurological disorders, disorders of the secretion of gastric juice. It is mixed with other anemia - hypochromic (together with the preparations of iron, folic acid). In addition, it is used in hypotrophies, for diseases of the liver, since the choline formed during its participation prevents its obesity; with different radiculitis, child cerebral palsybecause It normalizes the structure of nerve pro-vodnikov (their myelin shells). Vitamin is contraindicated with elevated blood coagulation, thromboembolism, eritremia. We produce a solution of vitamin B12 in ampoules. Vitamin B12 preparations include vitogeat and sirepar, which are obtained from the liver of belly.

Folic acid (vitamin B c) is synthesized by the intestine microflora, is contained in fresh vegetables, liver, kidneys. Folic acid consists of xantopterine, paramondobenzoic and glutamic acid. Folic acid in the liver under the influence of reductase is subjected to recovery and turns first in dihydro-, and then to the tegongidrofolytic acid -TGFC. Attachment to the last formal group turns THFK into folinic acid. The activity of reductase depends on the presence of vitamin B12 ascorbic acid, biotin. Folinic acid enters the enzyme systems involved in the transport of single-carbon OS-Tatwood, which are on the construction of purine and pyrimide bases, individual amino acids. In this regard, folic acid is necessary for the synthesis of nucleic acids - both RNA and DNA, i.e. Ultimately for cell division. It is especially expressed by its influence on the division of the Clear current of rapid regenerating tissues: the hematopoietic and mucous membrane of the gastrointestinal tract.

In addition, folic acid is necessary for hemoglobin synthesis. It contributes to the delay and optical "YashPG\u003e in the body of purine bases, enhances the utilization of glutamic acid in the process of intracellular protein synthesis. All this leads to stimulation of erythro, leuko- and thrombocytopower, as well as to stimulate plastic and regenerator processes to the body.

Folinic acid participates in the regulation of synthesis, transport of methyl groups, change-tilting. Together with the Cyanocobalamin, it reduces the need for choline, methionine, the failover of them and in connection with this applies to the number of lipotropic factors.

At acute foliage deficiency, aleicia and agranulocytosis develop, with chronic - macrocytic anemia. The synthesis of nucleoproteins is hampered stronger than ge-can, so the erythrocytes contain an increased amount of hemoglobin (hyperchromic anemia). Folic acid failure can lead to a sharp impaired of the function of the gastrointestinal tract (nausea, vomiting, diarrhea).

Indications for use: macrobicitarian anemia, megaloblastic anemia, but is obliged together with the cyanocobalamin. One folic acid in this pathology is applied to Nel-Zya, as its reception predominantly increases the use of vitamin B12 to activate the reductase and aggravates neurological manifestations. Folic acid is successfully used in the treatment of iron deficiency anemia, since it is necessary for the normal absorption of the same-lease, erythropoese, and the inclusion of iron into hemoglobin. Folic acid is used for leice-singing, thrombocytopenia, diseases of the gastrointestinal tract, hypotrophy. Sideflines It is rare, but when using large doses, an increase in the excitability of the CNS, a sleepless, a seizure can occur.

Means, oppressing erythropoes

This group of drugs is used to treat Eritremia. Eritremia is a disease that begins to a group of benign tumors of the blood system, in which the proliac-faction of all sprouts of blood formation increases, and especially erythroid. The main preparation is imyphos.

Imifos is a drug from a group of alkylating substances (see lecture on anticolum-left means). Enter it to / specifically or in / muscularly. When using imifos, the leukopenia and thrombocytopenss can develop. In the absence of effect, another CSMTostatic is prescribed - Melosan.

Means stimulating leukopoies

Lakeopoese stimulants include - methyluracil, Petnoxyl, leucogen. sodium nucleicate, melting. Preparations are used for leukopenia and agranulocytosis; (Alimentar-no-toxic aleicia, in poisoning with chemicals, with radiation sickness, but drugs are effective only with light forms of leukopenia.

Methyluracyl - Pyrimidine derivative. The drug stimulates leukeopoes, has anabolic and anti-boliac activity, accelerates cell regeneration processes, accelerates wound healing, stimulates cell and humoral protection factors. Methyluracil is used in the oppression of leukopoiesis, with slicking wounds, burns, bone fractures, peptic disease stomach. Methilorash is usually well tolerated. Anti-zasannya - Ost-rye and chronic forms leukemia. Release Forms - Tablets, Candles, Ointment

Pentoxyl - Pyrimidine derivative, similar pharmacological properties with methyluracyl. Unlike the latter, it does not apply it, because possesses annoying, action. When taking inside, it may cause dyspeptic phenomena.

MRRAGRAPHENIA (LUKOKOMAKS) - Human granulocy-macrophage colonistimulating factor obtained by the method genetic engineering. Thus, the milk is an endogenous factor involved in the regulation of blood formation, functional actively leukocytes. It stimulates the proliferation and differentiation of predecessors of the blood-creative cells, as well as the growth of granular and monocytes. The drug is used for leukopenia. AIDS. Released in the form of a lyophilized powder in bottles.

Sodium nucleinate - sodium salt nucleic acid obtained by hydrolysis of yeast. The drug enhances regenerative processes, stimulates the bone marrow activity, increases the immunity (stimulates the cooperation T and in lymphocytes, the phagocytic activity of macrophages).

Tools inhibitory leukopoese

(See the lecture "Antiochole Means" "Glucocorticoids")

To the means applied when various forms leukemia belongs to many antitumor drugs: cyclophosphane, chlorobutin, Melosan (alkylantic agegnites). Megotrexate and mercaptopurine (antimetabolites), prednisolone, dexametaimon (hormones), L-asparginiasis (enzyme). Most of the listed drugs have low selectivity, therefore, in addition to the oppression of the leukopopower, they suppress the proliferation of the intestinal mucous membrane, inhibit sex glands, they can get a mutant and teratogenic effect, and their total toxicity is high.

A. Anticoagulanty

direct: Heparin

indirect: Neodyacumarine, Syncumar (Kumarin derivatives), Phenylin (Indandion derivative)

B. Fibrinolitics: streptocinase, urock, streptodecadis

B. Antiagregants: Acid Acetylsalicyl, Prostaziklin, Dipyridamol, Anthouran

G. Hemostatics

local: thrombin, hemostatic sponge

system Action: Fibrinogen, Gelatin, Vikasol

D. Antifibrinolitiki

Specific: Acid aminocapronovaya, amben

nonspecific: Contrikal

Anticoagulants

Anticoagulants of direct action - act on coagulation factors in the blood. Anticoagulants of indirect action - violate the formation of prothrombin in the liver.

Heparin - Natural anticoagulant, which is obtained from animal tissues. Heparin in a complex with antithrombin III inhibits blood coagulation factors (thrombin), IXA, XA, XIA, XIIA. Thus, under the action of heparin, the activity of thrombin decreases, and the formation of thrombin from Prombrin is disturbed. The duration of the drug is 4-12 h (depending on the dose and route of administration). Enter intravenously and subcutaneously. After stopping the action of heparin, blood coagulation increases. It is used for the prevention and treatment of deep veins thrombosis, pulmonary artery thromboembolism, during angina, myocardial infarction, for the prevention of peripheral arterial thrombosis.

Side effects: hemorrhages, hypersensitivity reactions (urticaria, angioedema edema, anaphylaxis), thrombocytopenia, hypercalemia (should not be used in conjunction with ACE inhibitors); for long use - osteoporosis. Protamine sulfate is used as an antagonist. Heparin is contraindicated in violations of blood coagulation, hemorrhagic diathesis, ulcerative disease, uterine and hemorrhoidal bleeding, after surgery.

Syankum, Neodyacumarine, Phenylin They act as vitamin K antagonists and in connection with this violate the formation of blood coagulation factors in the liver - II (Protromine), VII, IX, X. The action is evolving after 24-48 hours. Take inside. Possess the ability to cumulate in the body. Apply for long-term prevention and treatment of deep veins thrombosis, thromboembolic complications with atrial fined arrhythmia.

Side effects: bleeding, liver function disorders, allergic reactions. Vitamin K (Vikasol, Phyomenadion) preparations are used as antagonists.

Fibrinolities.

Streptokinaza - fibrinolitic, isolated from the culture of hemolytic streptococcus. The profibrinolysine forms a complex that helps to convert fundreviation into fibrinolysin in the region of blood cloth and in the blood plasma. The fibrinolysine formed in the blood plasma destroys the fibrinogen, so platelet aggregation decreases. Fibrinogen conversion products reduce blood clotting. The action is saved for several hours. Side effects: bleeding, hypersensitivity reactions, bradycardia, decreased blood pressure.

Created a preparation streptocinase prolonged action - streptodekaza. After one-time administration, the fibrinolytic effect is preserved 48-72 hours.

Urokinza- The preparation of natural fibrinolytic, obtained from the culture of human kidney cell. It contributes to the transformation of funds to fibrinolysin in the region of blood cloth and in the blood plasma.

Streptocinase and urocinase introduced intravenously droplet with acute myocardial infarction, pulmonary artery embolism, deep veins thrombosis and peripheral arteries. Preparations are contraindicated in hemorrhagic diathesis, ulcerative disease, brain tumors, severe liver diseases, with recent injuries, within 10 days after surgical operations.

Antiagreganta Warning the aggregation of platelets, i.e. The initial stage of the formation of thrombus. Used to prevent thrombosis during angina, myocardial infarction, with ischemic stroke.

Acetylsalicylic acid (Aspirin) irreversibly inhibits cyclooxygenase in platelets and blood endothelium and thus violates the formation of thromboxane A 2 and prostacyclin. Prescribed inside 100 mg 1 time per day.

Prostacyclin (Prostaglandin I 2) stimulates prostacycline receptors and associated adenylate cyclase and increases the content of the CAMF in platelets and the wall of the vessels (the content of intracellular Ca 2+ decreases, the aggregation of platelets is reduced. causes vasodilation and reduces blood pressure in. The limbs are also used for hemosorption and vitro blood circulation.

Dipyridamol.(Kuraltil) - anti-aggress and coronary separating agent. Supports platelet aggregation, since: 1) inhibits phosphodiesterase, inactivating CAMF, and in connection with this increases the level of CAMF (the level of Ca 2+ in platelet cytoplasm decreases); 2) increases the level of adenosine (prevents adenosine seizure with erythrocytes and endothelium cells; inhibits adenosine formamine), which is activated by adenylate cyclase, and therefore it has antiagregative properties. Apply for the prevention of coronary insufficiency and ischemic strokes.

Anthouranit is an opponentic agent. It suppresses platelet adhesion and has antiagregative activity. It is possible that the effect is associated with the oppression of cyclooxygenase or with its action on the platelet membrane and a decrease in the release of ADF and serotonin, contributing to the aggregation of platelets.

Hemostatics - Tools that increase blood coagulation.

Synthesis in the liver of coagulation factors depends on vitamin K. Apply vitamin preparations phyomenadion(inside) and vikasol(inside and intramuscularly) during bleeding, associated with the hypoprothrombinemia, when overdosing an indirect anticoagulant. Side Effects: Allergic reactions (rash, itching, erythema, bronchospasm).

For hemostatic action is also used gelatin, Fibrinogen.

Hemostatic sponge (collagen, gelatin)and thrombin (Get from the blood plasma of donors) are used locally to stop bleeding from capillaries (nasal, after removal of the tooth, etc.) and parenchymal organs.

Antifibrinolics.

Aminocaproic acid Inhibits tissue profibrinolese activator and prevents the transformation of profibrinolysin into fibrinolysin. It is introduced intravenously with bleeding, associated with increased fibrinolysis, during operations, gastrointestinal bleeding, in the overdose of fibrinolithics.

Similar to acid with acid AMINOCAPROR mechanism and properties has a drug amben (pamba).

Concrikal (apricin) inhibits fibrinolysin. Apply with bleeding related to hyperfibrinolysis (intravenously).

1. Coagulants (funds stimulating the formation of fibrino thrombus):

a) direct action (thrombin, fibrinogen);

b) indirect action (vikasol, phytomenadion).

2. Fibrinolysis inhibitors:

a) synthetic origin (aminocapron and transcamic acid, amben);

b) animal origin (apricin, conficilla, piping, gondalous "Gideon

Richter, "Hungary);

3. Stimulants aggregation of platelets (serotonin adipient, calcium chloride).

4. Means reduced vessel permeability:

a) synthetic (adroxon, ethanzite, iprazhemom) b) vitamin preparations (ascorbic acid, rutin, quercetin).

c) Preparations of plant origin (nettle, yarrow, viburnum, water pepper, arnica, etc.)

II. Funds lowering blood coagulation, or antithrombotic agents:

1. Anticoagulants:

a) direct action (heparin and its preparations, weightlifting, sodium citrate, antithrombin III);

b) indirect action (neodykumarine, synctum, phenylin, fepromarone).

2. Fibrinolities:

a) direct action (fibrinolysin or plasmin);

b) indirect (plasminogen activators) actions (streptoliasis, streptocinase, urocking, activation).

3. Antiagregants:

a) platelet (acetylsalicylic acid, dipyridamol, pentoxifyllin, tickopidine, indocent);

b) Erythrocyte (pentoxifillalin, Reopolyglyukin, Reoplumanum, Rondex).

Funds that increase blood coagulation (hemostatic) coagulants

According to the classification, this group of drugs is divided into direct and indirect coagulants, but sometimes they are divided from another principle:

1) for local applications (thrombin, hemostatic sponge, fibrino film, etc.)

2) for systemic use (fibrinogen, vikasol).

Thrombinum; dry powder in AMP. OU, 1, which corresponds to 125 units. Activity; in 10 ml bottles) - direct action coagulant for local application. Being a natural component of blood coagulation system, causes the effect of in vitro and in vivo.

Before use, powder is dissolved in saline. Usually, the powder in the ampoule is a mixture of thromboplastin, calcium and prothrombin.

Apply only locally. Prescribed patients with bleeding from small vessels and parenchymal organs (operations on the liver, kidney, lungs, brain), bleeding from gums. It is used locally in the form of a hemostatic sponge thrombin, a hemistatic sponge, a hematic sponge, or simply applying a tampon impregnated with a thrombin solution.

Sometimes, especially in pediatrics, thrombin is used inward (the contents of the ampoule are dissolved in 50 ml of sodium chloride or 50 ml of a 5% amben solution, assign 1 tablespoon 2-3 times a day) with gastric bleeding or inhalation when bleeding from the respiratory tract.

Fibrinogen (Fibrinogenum; in vials of 1, 0 and 2, 0 dry porous mass) - used for systemic exposure. Also get from the blood plasma of donors. According to the influence of trombin, fibrinogen turns into fibrin forming blood clots.

Fibrinogen is used as an ambulance. It is especially effective when it is a shortage of massive bleeding (placenta detachment, Hypieces of Afibrinogenemia, in surgical, obstetric, gynecological and oncological practice).

It is usually prescribed to Vienna, sometimes locally in the form of a film applied to a bleeding surface.

Before use, the preparation is dissolved in 250 or 500 ml of heated water for injections. Intravenously introduced drip or slowly inkjet.

Vikasol (Vicasolum; in Tab, 0, 015 and in AMP. 1 ml of 1% solution) indirect coagulant, synthetic water-soluble analogue of vitamin K, which activates the formation of fibrino thrombus formation. Denote as vitamin K3. The pharmacological effect is not Vikasol itself, but the vitamins of K1 and K2 resulting from it, so the effect develops after 12-24 hours, intravenous administration - After 30 minutes, with intramuscular - after 2-3 hours.

These vitamins are necessary for synthesis in the liver Prothrombin (II factor), proof (VII factor), as well as IX and X factors.

Indications for use: with an excessive decrease in the prothrombin index, with pronounced to-vitamin failure, due to:

1) bleeding from parenchymal organs;

2) the procedure for replaced blood transfusion, if we overflow (child) canned blood;

as well as:

3) long-term use of vitamin K - aspirin and NSPID antagonists (disturbing platelet aggregation);

4) long-term use of antibiotics wide spectrum actions (leftomycetin, ampicillin, tetracycline, aminoglycosides, fluoroquinolones);

5) the use of sulfonamides;

6) the prevention of hemorrhagic diseases of newborns;

7) long-term diarrhea in children;

8) fibrosis;

9) in pregnant women, especially in suffering tuberculosis and epilepsy and receiving appropriate treatment;

10) overdose of anticoagulants of indirect action;

11) jaundice, hepatitis, as well as after injuries, bleeding (hemorrhoids, ulcer, radiation disease);

12) preparation for surgical operation and in the postoperative period.

Effects can be weakened while simultaneously assigning Vikasol antagonists: aspirin, NSAIDs, PASK, indirect anticoagulants of the neodythicumarine group.

Side Effects: Hemolysis of Erythrocytes with intravenous administration.

Phytomenadinum; 1 ml for intravenous administration, as well as capsules containing 0, 1 ml of 10% oily solution, which corresponds to 0, 01 of the preparation). Unlike natural vitamin K1 (trans-compound) is a synthetic preparation. Represents a racemic form (a mixture of trans- and cisomers), and according to biological activity, it retains all properties of vitamin K1. Quickly absorbed and supports the peak concentration to eight hours.

Indications for use: hemorrhagic syndrome with hypoprotromubinemia caused by a decrease in the functions of the liver (hepatitis, liver cirrhosis), with ulcerative colitis, under the overdose of anticoagulants, with long-term use of high doses of high-spectrum antibiotics and sulfonamides; Before heavy operations to reduce bleeding.

Side Effects: Phenomena of hypercoagulation when non-compliance with the dosing mode.

Of the means relating to direct-acting coagulants, drugs are also used:

1) Protombian complex (VI, VII, IX, X factors);

2) Antigemophilic Globulin (VIII Factor).

Agapova Olga Mikhailovna, teacher of pharmacology and wedge. Farmakology, with 1 Kvalif. Categories, Gay Medical College, 2013.

Drugs affecting blood system.

The blood system performs the most important functions:

Provides transportation of oxygen from the lungs to other organs and tissues, carbon dioxide from tissues into lungs through red blood cells.

Provides homeostasis --- constancy of the inner medium in liquid media.

Performs a trophic function: in the delivery of nutrient substrates to organs and tissues.

Protective function from xenobiotics, antigens, infectious agents.

Blood plasma proteins, leukocytes, antibodies protect the organism from "aliens".

Classification medicinesaffecting blood system.

Funds affecting blood formation:

1. Gears. Eripopopoese stimulating evaluations.

2. Drugs. Harvesting, stimulating leukeopeep.

Funds affecting blood clotting processes :

1. Used blood clotting:

Anticoagulants direct and indirect action.

Fibrinolities (thrombolytics).

Antiagregants.

2. Funds that increase blood clotting:

Direct and indirect coagulants.

Fibrinolysis funds. Fibrinolysis inhibitors.

Stimulants of platelet aggregation.

Angioprotectors. Vascular permeability means.

Medicinal plants with a hemostatic effect.

Plasmo-substituting means of functional purpose:

-- Disintellation solutions.

Solutions with hemodynamic effect.

Solutions governing water-salt balanis.

Solutions for parenteral nutrition.

Classification of medicines affecting blood system.

Drugs affecting erythropoes:

Reducing the level of hemoglobin and a decrease in the number of circulating erythrocytes are signs of anemia. The hemoglobin includes a bustlant iron, which has acceptative properties - - bind to oxygen in the lungs and carbon dioxide in the tissues. Erythrocytes, red blood cells are oxygen carriers in tissues and organs and transport carbon dioxide from tissues into lungs. With a lack of iron and vitamins involved in blood state breeding, iron deficiency anemia develops (hypochromic anemia). With a lack of folic acid (vitamin B9), Vitamin B12 develops B12-Foliyephic-quiet anemia (hyperchromic anemia). Patients suffering from anemia experience chronic hypoxia. Treatment of anemia is substantive therapy: apply iron and vitamins. Factors predisposing anemia:

Blood loss, an alimentary pregnancy, the reception of contraceptive, anti-fragile agents; Preparations that depress the blood-making disease of the stomach and 12-rosewind, exhaustion, decay of forces, vegetarianism.

Treatment of iron deficiency anemia is carried out by iron preparations, vitamin vehicles and other biological active substances.

Combined gland and vitamin drugs:

Ferroplex, sorbifer Durules, Ferrofolgammma, Tardeferon.

Ferroplex. List B (Sylnodeus.)Ferroplex..

Release form: 1). Here, contains 50 mg of iron sulfate and 30mg ascorbic acid. Inside, not chewing in1-2 Dr. in the day after eating. Children from 4 to 12 years old 1 dragee 3 times a day. Course treatment month and more.

Vitamin C contributes to the best absorption of iron in the body.

Sorbifer Duruless. List B.Sorbifeer Duroles..

Release form: 1). Tablets in the shell, contain 320mg sulfate iron, corresponds to 100mgFE.(ІІ) and 60mg ascorbic acid. In the first time of 1stab.1-2Reza per day, sometimes increasing the dose to 3-4tlease, drinking 1/2-channel water, not chewing for 3-4 months before replenishing the iron depot in the body. For prevention of anemia 1 Table 1 times a day.

Ferroofolgamma. List B.Ferrofolgamma..

Release form: 1). Capsules. Approach inside 2-3 times a day. Design: iron sulfate 37mg, folic acid 5mg, vitamin B12--100mg, vitamin C - 100mg black and red iron oxide.

All components are involved in the ripening of red blood cells. It is also used for the treatment of VIT.V12-Foliological deficient anemia.

Tartiferon. List B.Tardiferonum.

Release form: 1).

Indications:Hypocrous anemia of various origin.

Iron preparations: Ferrum-Lek, Ferlam.

Ferrum-Lek. List B.

Ferrum- lek..

Release form: 1). Black coloring of 2 ml, contains 100mgsugrath iron for in / venical injection!

2). Black coloring of 2 ml.three-axle iron with maltose for intramuscular. Injection!

Quickly fills the lack of iron in the body after injecting administration.

Indications: Hypochromic anemia of various origin, insufficiency of suction and poor tolerance of iron preparations used orally.

Ferlam.

Basic side effects:Dyspepsic disorders, irritation of mucous membranes by the gastrointestinal tract (therefore, should not be chewed, and most drugs are produced by pharmacy in dragee, capsules, pills in shells), ulcerative damage to esophagus, allergic reactions, headache, dizziness, weakness, boost , diarrhea, abdominal pain, excitability or depression, sleep disorder (drowsiness), violation of the functions of the liver and kidneys.

Common contraindications:Sharp i. chronic diseases Liver, hemo-chromatosis, hemosiderosis (excess iron content in the body), blood diseases associated with impaired iron absorption mechanism, liver and kidney damage.

Precautions in iron-containing drug therapy:

It is impossible to use simultaneously with tetracycles, calcium preparations, aluminum, magnesium, cholesterol, milk products - is a complex of iron with medicinal substances and iron loses the ability to be absorbed into the blood. Comply with the maximum possible time interval between the reception of drugs (except tetracycline) and iron preparations.

For warning side Effects Iron preparations and dosage correction should conduct blood tests on hemoglobin.

It is necessary to apply drugs according to the method of administration. Ferrum-Lek for VN / MUM. INCLUDING NOT IS NOT IS IN / NEW and vice versa! Hemostimulin should be sized with a solution of diluted acid for better iron absorption.

Overdose by iron preparations: Vomiting and diarrhea with blood admixture, hyperthermia, sweating, acidosis, weak pulse, decreased blood pressure, heartbeat, liver damage, coagulopathy, renal failure, muscle cramps and coma can manifest themselves after 6-12 hours.

Urgent Care: It is necessary to rinse the stomach, inside raw eggs, milk for binding iron ions in the gastrointestinal tract; Deferoxamine and symptomatic therapy are introduced.

Vitamin preparations: cyanocobalamin, folic acid.

Cianocobalamin. Analogue "Oxycobalamin". Common list.

CY.anocobalaminum.

Release form: 1). The crisp of the raspberry color of 1 ml, contains 30mkg, 200mkg and 500 mk for subcutaneous and ext / mph.

2). Tablets in the shell of 0.00005grams and folic acid. 3) .0.005% Solution 1ml (oxycobalamin).

Indications:Iron deficiency and B12-folio-productive anemia, anemia caused by the action of drugs and toxic substances, liver disease and peripheral nervous system: neuritis, neuralgia, diabetes mellitus, psoriasis, nephropathy, pernicious anemia, sclerosis, psoriasis.

Side effects: Allergic reactions, excitation, pain in the heart area, tachycardia.

Contraindications:Increased sensitivity, angina, thromboembolia. You can not mix vitamins B12 and B1, B2 (destruction of the drug) in one syringe.

Folic acid. Vitamin RR. List of shared.

Acidum Folicum.

Release form: 1). Position and tablets of 0.001g.

Indications:The same thing that in vitamin preparations B12; leukopenia for ioniziru-journey radiation, taking sulfanimamides, radiotherapy, alimentary insufficiency.

Side effects:Allergic reactions, urticaria.

Contraindications:Increased sensitivity.

Drugs, stimulating leukeopoese.

Preparations used to increase the number of leukocytes are used mainly during leukopenia. Leukopenia --- quantitative content of leukocytes below normal.

Lekukax. List B.

Leucomax.

Release form: 1). Poster for injections.

P:Leukopenia caused by radioactive irradiation, radiation disease.

ETC:Increased sensitivity.

Garnocite. List B.

Granocitum.

Release form: 1).

Drugs affecting blood clotting.

In the body there are 3 systems affecting the blood system: 1.Anticoagulant or antoslifier.

2. Clearing or thromb-forming system.

3.Fibrinolytic or thrombolytic system.

By pharmacological action can be divided into the following groups:

1) funds that prevent blood coagulation (antiagregants, anticoagulants, fibrinolytic agents) are used for diseases accompanied by thrombosis;

2) Means contributing to blood coagulation (hemostatic, coagulants, antifibrinolytic agents) are used for bleeding, hemorogs.

Antiagregants.

These are means that reduce platelet aggregation. The aggregation (adhesion) of platelets contributes to blood clotting.

Preparations:

Acetylsalicylic acid (acidum acetylsalicylicum) or aspirin of tablets of 0.05, 0.1, 0.325 and 0.5 g inside 1 time per day, preferably in the form of pills with intestinal coating. It has anti-inflammatory, analgesic and antipyretic effect - is currently widely used as an antiarrheant.

Dipyridamol (Dipyridamolum) or Kuraltil - Tablets covered with shell, and dragee 0.025, 0.05 and 0.075 g inside 3-4 times a day 1 hour before meals. In patients with stress angina, it is possible to attack the angina disease due to the condemning syndrome.

Preparations are used to prevent myocardial infarction and ischemic stroke, as well as during peripheral arterial diseases.

Anticoagulants.

These are funds inhibiting blood coagulation. In some diseases of vessels (atherosclerosis, varicose expansion veins, etc.) are created favorable conditions for the formation of thromboms in the worst of vessels. This can lead to severe blood circulation disorders, myocardial infarction, stroke, etc. To prevent these states, anticoagulants are used, which are direct and indirect effects.

1. Direct effect anticoagulants (have an antoslude action directly in the blood).

Preparations:

Heparinum - 5 ml bottles (1 ml - 5000, 10,000 and 20,000 units). Apply 5000 - 20,000 units in Vienna and subcutaneously.

Heparin has its effect on blood clotting factors only after the formation of a complex with antithrombin III, however, the process of inactivating the coagulation factors under the action of one antithrombin III flows very slowly. Heparin causes changes in the antitrombin III molecule, which leads to the acceleration of this process of about 1000 times.

Used for the prevention and treatment of pulmonary deep veins and thrombosis of the pulmonary artery, during angina and myocardial infarction, to prevent peripheral arterial thrombosis, during the prosthetics of the heart valves.

When intravenous administration, the action occurs immediately and lasts 2-6 hours. When subcutaneously administration, heparin begins to act after 1-2 hours, the duration of action is 8-12 hours (prescribed 2-3 times a day).

Side effects: bleeding, with prolonged use (more than 3 months) osteoporosis may develop, rarely hypercalemia.

The low molecular weight heparinaceans, as well as heparin, act on coagulation factors in a complex with antithrombin III, but differ from heparin the following properties:

It is better absorbed with subcutaneous administration (low molecular weight heparins - about 90%, standard heparin - 20%);

Acts longer, which allows them to be introduced 1-2 times a day;

Retained thrombocytopenia;

Less danger of osteoporosis.

In domestic practice used the following drugs low molecular weight heparins - anoxaparin-sodium (kleksan), obverse calcium (fractionyparin), Dalteparin - sodium (fragmin), Revision-sodium (CLIVARINE).

Used for the prevention and treatment of deep vein thrombosis (especially after surgery), to prevent the thromboembolism of the pulmonary artery, as well as during angina and myocardial infarction, obstetric practice. It is introduced only subcutaneously. Dosage in Me (international units).

Side effects: bleeding, in the first days of treatment there is a moderate thrombocytopenia, can cause allergic reactions.

Antithrombin IIINEsome for the manifestation of anticoagulant action of heparin, as well as low molecular weight heparins. Used in hereditary deficiency antithrombin III, administered intravenously.

Sodium citrate (Natrii Citras) is a sterile 4% solution for the conservation of donor blood.

2. Anticoagulants of indirect effects (reduce the synthesis of the coagulant factor - prothrombin in the liver).

Preparations:

Neodicumarinum - tablets of 0.1 g 3 times a day with a gradual decrease in the dose, because Cumulates.

Phenylin (phenylinum) - Tablets 0.03 g 3 - 4 times a day, followed by a decrease in the dose.

It is used for long-term prevention and treatment of thrombosis and thromboembolism (deep veins thrombosis, pulmonary artery thromboembolism, myocardial infarction, heart valve prosthetics), in surgical practice to prevent thrombosis in the postoperative period. Preparations are injected inside. Treatment is carried out under the obligatory control of the level of prothrombin in the blood plasma.

Side effects: bleeding (for prevention, vitamin K drugs should be administered, allergic reactions, diarrhea, liver dysfunction, skin necrosis, penetrate the placenta and can have a teratogenic effect, so they are contraindicated during pregnancy. Phenylin, in addition to the listed side effects, can cause inhibition of blood formation.

Hemostatics.

Funds that increase blood coagulation are used to stop bleeding, so they are referred to hemostatic means (Hemostatic) or antighemorgic means. This group includes:

1. Preparations of blood coagulation factors - the need for such preparations occurs with the insufficiency of one or more blood coagulation factors.

Hemophil M and cryoprecipitate blood plasma preparations containing the clutch factor VIII.

Preparations of factor VIII are administered intravenously in hereditary (hemophilia a) and the acquisitive failure of factor VIII.

Adverse reactions: Tachycardia, arterial hypotension, shortness of breath. Allergic reactions are possible - urticaria, an increase in body temperature, anaphylactic shock, as well as hemolysis of erythrocytes.

All preparations of coagulation factors obtained from blood plasma have a significant drawback - the possibility of transfer viral infections (HIV, hepatitis).

To stop bleeding, a thrombin preparation (Trombinum) is used - this is a natural blood coagulation factor is obtained from the blood plasma of donors, produced in ampoules containing 0.001 g of dry matter (dissolved before use of 0.9% sodium chloride solution), as well as hemostatic sponges (collagen , gelatin). Apply these drugs to stop bleeding from small capillaries and parenchymal organs.

In addition, to stop the uterine, pulmonary, kidney, intestinal and other bleeding, drugs of medicinal plants are used - the leaves of nettle, the grass of the yarrow, the grass of the peppercarce, the grass of the sweating, Cara of Kalina, Arnica flowers, the Lagochilus intoxicating. Apply medicinal plants in the form of infusions, tinctures and extracts inside and locally.

2. Vitamin K preparations are used for bleeding and other hemorrhagic complications caused by a disadvantage of this vitamin in the body. Vitamin K is necessary for the synthesis of prothrombin and other coagulation factors in the liver.

Preparations:

Vikasol (Vicasolum) is a synthetic substitute for vitamin K. Ampules 1% solution of 1 ml for intramuscular administration, tablets of 0.015 g 2 times a day.

3. Also during bleeding use drugs:

Calcii chloridum - has an anti-inflammatory effect, stabilizes vessels. Available in a 10% solution in ampoules of 10 ml administered intravenously slowly.

Calcium Gluconate (Calcii Gluconas) - produced in the form of a 10% solution in ampoules of 10 ml administered intravenously and intramuscularly. Inside in tablets of 0.5 g