SPECIAL PHARMACOLOGY

1.Pathways of transmission of afferent impulses from receptors to the central nervous system.
Classification of drugs acting on the afferent part of the nervous system. Localization of
action of drugs affecting the afferent part of the nervous system. Astringent and enveloping
drugs. Definition. Mechanism of action. Therapeutic use

2. Local anesthetics. Classification, mechanism of action. Comparative characteristic, use in different types of
anesthesia. Side effects.

3. Adsorbent drugs. Definition. Mechanism of action. Therapeutic use. Irritant drugs. Definition. Mechanism of
distracting and trophic action. Therapeutic use
Decrease afferent innervations
MOA-Adsorb chemical substances on its surface
USE-poisoning, flatulence, decrease irritating effects of other drugs
Side effects-constipation, diarrhea, dark feces

4. Anatomical and physiological characteristic of efferent innervation. Concept of synapses, mediators and
receptors, their subdivision and localization. M-cholinergic agonists (M-cholinomimetic agents). Mechanism of
action, main effects, therapeutic use.
CHOLINERGIC AGENTS • THEY are medicinal substances that block or facilitate the
transmission of impulses in the cholinergic synapses.
They are divided into 2 groups:
• stimulating (exciting) cholinergic receptors (cholinoreceptor agonists) CHOLINOMIMETICS;
• blocking (depressing) these receptors (cholinoreceptor antagonists) CHOLINOBLOCKERS
1. Synapses
A synapse is the junction where a neuron communicates with another cell.
• Types:
o Chemical Synapse → Uses neurotransmitters (most common).
o Electrical Synapse → Direct ion flow via gap junctions (rapid transmission).
• Localization: Found in the central nervous system (CNS), autonomic nervous system
(ANS), and neuromuscular junctions.
2. Mediators (Neurotransmitters)
Mediators are chemical messengers that transmit signals across synapses.
• Classification:
o Excitatory (e.g., glutamate, acetylcholine) → Enhance signal transmission.
o Inhibitory (e.g., GABA, glycine) → Suppress neural activity.
o Neuromodulators (e.g., dopamine, serotonin, histamine) → Regulate neural
circuits.
• Localization: Found at synaptic terminals, stored in vesicles, released upon stimulation.
3. Receptors
Receptors are specialized proteins that bind neurotransmitters to initiate cellular responses.
5. Biosynthesis and breakdown of acetylcholine. M-, N-cholinomimetic agents (direct and indirect
[anticholinesterase] agents). Classification, mechanisms of action, pharmacological effects, comparative
characteristics and therapeutic use.
6.Clinic of acute poisoning with muscarine and anticholinesterase agents. Emergency measures.
7. M-cholinergic antagonists (M-cholinoblockers). Classification, pharmacological effects, comparative
characteristics, therapeutic use.

8. Clinic of acute poisoning with M-anticholinergics (M-cholino blockers). Emergency measures.

9. Drugs affecting the activity of N-cholinergic receptors, classification. N-cholinergic

agonists (N-cholinomimetic agents). Medical and biological problems of tobacco
smoking
10. Ganglionic blockers (N-cholinergic blocking agents). Pharmacological characteristics, therapeutic use.
11. Neuromuscular blockers (peripheral muscle relaxants, Nm-anticholinergics). Definition, classification,
sequence of development of the main effect, use, medical assistance in case of overdose.

overdose : Transfusion of donor blood

12.Adrenoreceptors, definition, classification, location in the body, physiological role.
Classification of agents that affect the activity of adrenoreceptors. -adrenergic agonists,
mechanism of action, main effects, therapeutic use.
13. ,-adrenergic agonists. Definition. Mechanism of action. Effects on the heart, vascular
tone, smooth muscles, metabolism. Therapeutic use. Side effects. Contraindications.
14. -adrenergic agonists. Definition. Classification. Mechanism of action. Main effects. Therapeutic use. Side
effects.

15. -adrenoblockers. Definition. Classification. Mechanism of action. Effect on the cardiovascular system,
smooth muscles. Therapeutic use. Side effects.

16. -adrenoblockers. Definition. Classification. Mechanism of action. Effect on the heart, blood vessels, smooth
muscles, metabolism, CNS. Therapeutic use. Side effects.
17. ,-adrenoblockers. Definition. Key aspects of action and use of labetalol. Side effects.

18. Adrenergic neuron blockers (sympatholytic). Localization and mechanism of action. Main effects.
Therapeutic use. Side effects.
SYMPATHOLYTICS
• RESERPINE stimulates NE secretion and inhibits its uptake => reduces
sympathetic, decreasing peripheral vascular resistance and BP
• It slows HR and reduces cardiac output , causes sedation and state of
indifference
 • It is USED in hypertension (but not a preferred drug), psychotic states
(but not a preferred drug).
• ADVERSE EFFECTS: depression, bradycardia, orthostatic hypotension,
nasal congestion, increased gastric acid secretion, diarrhea.

19. Drugs for inhalation anesthesia. Definition. Classification. Mechanisms of action. Stages and levels of
anesthesia. Side effects. Comparative characteristic of drugs for inhalation anesthesia.

20. Drugs for non-inhalation anesthesia. Definition. Mechanisms of action. Comparative

characteristic. Side effects.
 21. Ethyl alcohol. Effect on the central nervous system, local action on the skin and
mucous membranes. Antimicrobial properties. Application. Ethyl alcohol poisoning. First
aid measures
Ethanol is a substance of the narcotic type of action (resorptive effect) with antiseptic action in
topical application.
Symptoms: • loss of consciousness • acute respiratory failure (obturational aspiration type) • BP
decreases, thready pulse • cyanotic face • vomiting, may be involuntary urination and defecation
• hypotension of muscles • hypothermia • areflexion • violation of the contractility of the heart •
possible respiratory depression.

Therapy: • gastric lavage (when severe coma, after intubation of the trachea) • forced diuresis •
administration of sodium bicarbonate (when acidosis) • intravenous administration of solutions
of glucose, B and C groups vitamins • warming the patient • in severe cases, extracorporeal
detoxification (hemodialysis)
22. Hypnotics (sleeping pills), classification, principles of action and rules of administration.
Poisoning with sleeping pills, clinical picture and treatment.

23. Analgesics, definition, classification, comparative characteristics of groups.

Pharmacological characteristic of non-narcotic analgesics (analgesics-antipyretics),
therapeutic use.

1. Rheumatic diseases (rheumatoid arthritis, gouty and psoriatic arthritis, ankylosing

spondylitis, etc.) (1–11);
2. Non-rheumatic diseases of the musculoskeletal system (osteoarthritis, myositis,
tendovaginitis, trauma, etc.);
3. Moderate pain syndrome of various etiologies (headache and toothache, postoperative
pain, algodismenorea) (12–14);
4. Neurological diseases (neuralgia, radiculitis, etc.) (12–14);
5. ↑ body temperature >38,5 °C (1,3,13,15);
6. Prevention of "white" (arterial) thrombi formation (1).
24. Narcotic analgesics, definition, classification, mechanism of action, comparative
characteristics, indications for use.

25. Anticonvulsants, definition, classification. Pharmacological characteristics of

antiepileptic drugs. Principles of epilepsy therapy. Help with status epilepticus

Epileptic status is an emergency characterized by a series of recurrent episodes of

epilepsy, in the interval between which the patient is unconscious. Diazepam to be given
intravenously, and in the absence of effect – non-inhalational anesthetics are given
(propofol, thiopental).
26. Antiparkinsonian drugs. Definition. Classification. Effect on impulse transmission in
neurons of the extrapyramidal system. Therapeutic use. Side effects.
27. Psychotropic drugs, definition, classification. Pharmacological characteristic of
psychomotor stimulants (psychostimulants).
Psychotropic drugs are substances that affect mental processes, altering mood,
perception, behavior, or consciousness. They are classified into several categories based
on their effects on neurotransmitters and mental states. The main classes include:
• Antidepressants (e.g., SSRIs, MAOIs) – used to treat depression and anxiety.
• Antipsychotics – help manage schizophrenia and other psychotic disorders.
• Anxiolytics – reduce anxiety and promote relaxation.
• Mood stabilizers – used for bipolar disorder.
• Hypnotics – aid in sleep disorders.

28. Antipsychotics (neuroleptics), definition, classification, mechanism of action, main

effects and therapeutic use in various medical areas. Side effects of neuroleptics and the
mechanism of their development
 29. Anxiolytics (tranquilizers), definition, classification, pharmacodynamics, use, side
effects. Difference between anxiolytics and neuroleptics.

• Anxiolytics (also called antianxiety drugs) are primarily used to reduce anxiety and
promote relaxation. They often work by enhancing the effects of GABA, a
neurotransmitter that calms the nervous system.

• Neuroleptics (also known as antipsychotics) are used to manage psychotic disorders

such as schizophrenia and bipolar disorder. They primarily block dopamine receptors to
reduce symptoms like hallucinations and delusions. Examples include haloperidol and
risperidone

30. Sedatives, pharmacodynamics, therapeutic use. Bromism, clinical picture, treatment of

bromism

31. Normothymic (anti-manic) agents, principles of action, effects, therapeutic use.

Normothymic agents, also known as mood stabilizers, are used to manage mania and bipolar
disorder by stabilizing mood fluctuations. Their primary goal is to prevent manic episodes and
maintain emotional balance.
Principles of Action
These drugs work by:
• Modulating neurotransmitter activity, particularly dopamine, serotonin, and glutamate.
• Regulating ion channels in neurons, affecting excitability.
• Reducing excessive neuronal firing that contributes to manic symptoms.
Effects
• Mood stabilization – prevents extreme mood swings.
• Reduction of manic symptoms – controls hyperactivity, impulsivity, and agitation.
• Neuroprotective properties – may help preserve brain function over time.
Therapeutic Use
• Lithium – the most well-known mood stabilizer, effective in treating acute mania and
preventing relapse.
• Valproate (Valproic Acid) – used for rapid-cycling bipolar disorder and mixed episodes.
• Carbamazepine & Oxcarbazepine – anticonvulsants with mood-stabilizing effects.
• Lamotrigine – primarily used for bipolar depression rather than acute mania.
• Atypical Antipsychotics – such as quetiapine and olanzapine, which help manage manic
symptoms.
32. Antidepressants, definition, classification by mechanism of action, main effects,
therapeutic use. Side effects of antidepressants.

33. Psychometabolic stimulants (nootropics), mechanism of action, main effects, therapeutic

use, difference from psychomotor stimulants (psychostimulants)
34. Analeptics. Effect on the central nervous system, respiration and blood circulation.
Therapeutic use. Side effects. Respiratory stimulants. Definition, classification, mechanisms of
action. Routes and methods of administration. Therapeutic use

35. Antitussives, classification, mechanism of action, rules of use, possible

complications.
36. Expectorants, definition, classification, indications and rules of use.

37. Principles of pharmacotherapy of bronchial asthma (prevention and treatment of

exacerbation
38.Drugs used for the treatment of bronchial asthma and bronchospasm relief, classification,
pharmacodynamics, prescribing rules.

39.Principles of pharmacotherapy of pulmonary edema.

40. Principles of pharmacotherapy of heart failure.

1. Neurohormonal Modulation
• ACE inhibitors (ACEIs) & Angiotensin receptor blockers (ARBs) – Reduce afterload
and improve cardiac output.
• Beta-blockers – Decrease heart rate and myocardial oxygen demand.
• Mineralocorticoid receptor antagonists (MRAs) – Help prevent fluid retention and
fibrosis.
• Angiotensin receptor-neprilysin inhibitors (ARNIs) – Enhance vasodilation and
natriuresis.
2. Symptom Relief
• Diuretics – Reduce fluid overload and congestion.
• Digoxin – Improves contractility and controls heart rate in atrial fibrillation.
• Ivabradine – Slows heart rate in patients with sinus rhythm.
3. Advanced Therapies
• Sodium–glucose cotransporter 2 (SGLT2) inhibitors – Show benefits in heart failure
management.
• Vasodilators & Inotropes – Used in acute heart failure cases.
41. Cardiotonic (inotropic) agents, definition, classification. Characteristics and use of non-
glycoside cardiotonic agents.

NON GLYCOSIDIC AGENTS:

42. Cardiac glycosides. Sources. Classification. Mechanism of cardiotonic action.
Pharmacodynamics. Influence on blood circulation in heart failure.

43. Comparative characteristics of cardiac glycosides. Therapeutic use. Dosing principles. Side
effects. Intoxication with cardiac glycosides. Prophylaxis and intoxication treatment
44. Antiarrhythmic agents, definition, classification. Agents for tachyarrhythmias, classification,
pharmacodynamics, use for arrhythmias of different genesis

CLASS 3 AND 4 – TACHYARRHYTHMIAS

Treatment of bradyarrhythmia: muscarinic antagonists (eliminate the influence of the vagus
nerve); ß1-agonists (dobutamine, dopamine).
45. Agents for treatment bradyarrhythmia, principles of action, treatment depending on the
genesis and severity of arrhythmias.

1. Mild or Asymptomatic Bradyarrhythmia

• Often requires no treatment unless symptoms develop.
• Monitoring for progression is key.
2. Symptomatic Bradyarrhythmia
• Atropine: First-line drug that blocks vagal influence, increasing heart rate.
• Dopamine & Epinephrine: Used if atropine is ineffective, stimulating beta receptors.
 • Isoproterenol: A beta-agonist that enhances heart rate in certain cases.
3. Severe or Life-Threatening Bradyarrhythmia
• Transcutaneous pacing: Temporary measure for unstable patients.
• Transvenous pacing: Used when drug therapy fails.
• Permanent pacemaker: Indicated for chronic conduction disorders
46. Principles of pharmacotherapy of ischemic heart disease

1. Reducing Myocardial Oxygen Demand

• Beta-blockers – Lower heart rate and contractility.
• Calcium channel blockers – Reduce vascular resistance and myocardial workload.
• Nitrates – Dilate blood vessels to decrease preload and afterload.
2. Enhancing Myocardial Oxygen Supply
• Antiplatelet agents (Aspirin, Clopidogrel) – Prevent clot formation.
• Statins – Lower cholesterol and improve endothelial function.
• Revascularization procedures – Such as PCI or CABG in severe cases.
3. Preventing Disease Progression
• ACE inhibitors & ARBs – Improve vascular health and reduce cardiac remodeling.
• SGLT2 inhibitors – Emerging role in cardiovascular protection.
• Lifestyle modifications – Diet, exercise, and smoking cessation.
47. Antianginal drugs. Classification. Organic nitrates and nitrate-like agents, classification,
pharmacodynamics, rules of use. Stop of angina pectoris attack.

48. Antianginal properties of calcium channel blockers, beta-adrenoblockers and other

antianginal agents
49. Principles of pharmacotherapy of myocardial infarction.

50. Principles of pharmacotherapy of arterial hypertension

51. Antihypertensive drugs. Definition. Classification. Mechanism of action of neurotropic
hypotensive drugs of central and peripheral action.

52. Mechanism of hypotensive action of myotropic vasodilators, calcium channel blockers,

potassium channel activators. Therapeutic use. Side effects.

1. Myotropic Vasodilators
• Act directly on vascular smooth muscle to induce relaxation.
• Reduce vascular resistance, leading to lower blood pressure.
• Examples: Papaverine, Drotaverine.
2. Calcium Channel Blockers (CCBs)
• Inhibit L-type calcium channels, preventing calcium influx into smooth muscle.
• Dihydropyridines (e.g., Amlodipine, Nifedipine) primarily cause vasodilation.
• Non-dihydropyridines (e.g., Verapamil, Diltiazem) also affect cardiac conduction.
3. Potassium Channel Activators
• Open ATP-sensitive potassium channels, leading to hyperpolarization of vascular
smooth muscle.
• This reduces intracellular calcium, causing vasodilation.
• Example: Minoxidil.
Therapeutic Use
• Hypertension – All three classes help lower blood pressure.
• Angina – CCBs improve coronary blood flow.
• Heart failure – Some vasodilators assist in reducing cardiac workload.
Side Effects
• Myotropic Vasodilators – Hypotension, dizziness.
• CCBs – Peripheral edema, bradycardia (non-dihydropyridines).
• Potassium Channel Activators – Reflex tachycardia, fluid retention
53. Antihypertensive drugs affecting the renin-angiotensin system (ACE inhibitors, AT1-
receptor blockers, renin inhibitors). Mechanism of action. Therapeutic use. Side effects.

54. Combined use of antihypertensive drugs with different localization and mechanism of action.
Side effects of hypotensive drugs, their prevention and relief.
1. Common Drug Combinations
• ACE Inhibitors or ARBs + Calcium Channel Blockers (CCBs) – Reduces vascular
resistance while preventing fluid retention.
• ACE Inhibitors or ARBs + Diuretics – Enhances sodium excretion and vasodilation.
• Beta-Blockers + Diuretics – Lowers cardiac output and reduces fluid overload.
• Triple Therapy (ARB/CCB/Diuretic) – Used in resistant hypertension.
Side Effects of Hypotensive Drugs
Each class of antihypertensive drugs has potential side effects:
• ACE Inhibitors & ARBs – Cough, hyperkalemia.
• CCBs – Peripheral edema, headache.
• Diuretics – Electrolyte imbalances, dehydration.
• Beta-Blockers – Fatigue, bradycardia.
• Potassium Channel Activators – Reflex tachycardia

55. Diuretics. Definition. Classification. Mechanism of action of diuretics. Therapeutic use. Side
effects

MOA-Inhibit reabsorption of sodium and chloride at specific nephron sites increased water
excretion - Some also affect potassium, calcium, bicarbonate handling
SE- Hypokalemia (1-7,9), - hypocalcemia (1-3), - hypochloremic alkalosis (1-7), - hyponatremia
(1-8), - hypervolemia (8), - metabolic acidosis (9), - hypercalcemia (4-7), - hyperuricemia,
hyperglycemia (1-4), - ototoxicity, (1-3).
56. Comparative characteristic different group of diuretics and application
Loop diuretics:* Most potent, used in severe fluid overload and hypercalcemia.-
*Thiazides:* First line for hypertension, mild edema; less potent than loop.-
*Potassium-sparing:* Used with other diuretics to prevent K loss or in hyperaldosteronism.-
*Osmotic:* For rapid fluid removal in brain edema, kidney protection.-
*Carbonic anhydrase inhibitors:* Rarely used as diuretics; mainly glaucoma and altitude
sickness.
57. Hypolipidemic (antiatherosclerotic) agents, pharmacodynamics and application.

58. Uterine drugs. Classification. Drugs increasing myometrial tone and enhancing rhythmic
uterine contractions, application. Side effects. Drugs decreasing the tone of myometrium and
cervix
59. Drugs increasing and decreasing appetite. Mechanism of action. Therapeutic use. Side
effects.
1. Appetite Stimulants
These drugs increase hunger by acting on neurotransmitters and hormones that regulate food
intake.
• Megestrol Acetate – A synthetic progestin that enhances appetite, often used in cancer or
HIV/AIDS patients.
• Mirtazapine – An antidepressant that increases appetite as a side effect.
• Dronabinol – A cannabinoid that stimulates hunger, especially in patients with anorexia.
• Corticosteroids – Influence the hypothalamic-pituitary-adrenal axis to boost appetite.
Mechanism of Action
• Stimulate neuropeptide Y, a hunger-promoting neurotransmitter.
• Modulate hormonal pathways involved in metabolism.
• Reduce inflammatory cytokines, improving nutritional status.
Therapeutic Use
• Cancer-related cachexia – Helps patients regain weight.
• Anorexia & malnutrition – Supports recovery.
• Chronic illnesses – Used in HIV/AIDS and other wasting conditions.
Side Effects
• Weight gain, fluid retention, and hormonal imbalances.
• Mood swings, hypertension, and gastrointestinal issues.
2. Appetite Suppressants
These drugs reduce hunger by acting on the central nervous system.
• Phentermine – A stimulant that decreases appetite.
• Orlistat – Blocks fat absorption, reducing caloric intake.
• Liraglutide – A GLP-1 agonist that promotes satiety.
• Bupropion/Naltrexone – Modulates dopamine pathways to curb cravings.
Mechanism of Action
• Increase satiety hormones like GLP-1.
• Reduce hunger signals in the brain.
• Block fat absorption, lowering calorie intake.
Therapeutic Use
• Obesity management – Helps with weight loss.
• Metabolic disorders – Supports diabetes treatment.
• Binge eating disorder – Reduces compulsive eating.
Side Effects
• Insomnia, tachycardia, and gastrointestinal discomfort.
• Mood changes, hypertension, and digestive issues.
60. Vomiting and antiemetic drugs. Mechanism of action. Therapeutic use.

61. Principles of pharmacotherapy of gastric and duodenal ulcers.

1. Acid Suppression
• Proton Pump Inhibitors (PPIs) – Omeprazole, Pantoprazole; block acid secretion.
• H2-Receptor Antagonists – Ranitidine, Famotidine; reduce acid production.
2. Mucosal Protection
• Sucralfate – Forms a protective barrier over ulcers.
• Bismuth Compounds – Enhance mucosal defense and have antibacterial effects.
• Misoprostol – A prostaglandin analog that protects against NSAID-induced ulcers.
3. H. pylori Eradication
• Triple Therapy – PPI + Clarithromycin + Amoxicillin/Metronidazole.
• Quadruple Therapy – PPI + Bismuth + Metronidazole + Tetracycline.
4. NSAID-Induced Ulcers
• Discontinuation or substitution of NSAIDs.
• PPIs or Misoprostol for prevention.
62. Agents reducing the activity of acid-peptic factor. Classification and pharmacological
characteristics. Antacid drugs. Helicobacter pylori eradication
63. Gastric cytoprotective drugs. Definition. Mechanisms of action. Therapeutic use.
Gastric cytoprotective drugs are medications that protect the gastric mucosa from damage
without directly reducing acid secretion. They enhance mucosal defense mechanisms, making
the stomach lining more resistant to irritants.
1. Sucralfate (Venter) 2. Bismuth tricalcium dicitrate (De-nol) 3. Misoprostol (Saitotec)
Mechanisms of Action
These drugs work through various pathways:
• Mucosal Barrier Enhancement – Sucralfate forms a protective coating over ulcers.
• Prostaglandin Analog Action – Misoprostol increases mucus and bicarbonate secretion.
• Bismuth Compounds – Strengthen mucosal defenses and have antibacterial properties.
Therapeutic Use
• Peptic Ulcer Disease – Helps heal ulcers and prevent recurrence.
• NSAID-Induced Gastric Injury – Protects against drug-induced mucosal damage.
• Gastroesophageal Reflux Disease (GERD) – Supports mucosal integrity.
64. Drugs used in the disoders of excretory function of the pancreas. Therapeutic use. Principles
of pathogenetic therapy of pancreatitis.

65. Hepatoprotective agents. Definition. Classification. Comparative characteristics. Therapeutic

use.
66. Drugs affecting the motility of the gastrointestinal tract. Mechanism of action. Therapeutic
use. Side effects. Treatment in an attack of biliary pain
These drugs regulate smooth muscle contractions in the digestive tract, either stimulating or
inhibiting movement.
Mechanism of Action
• Prokinetics – Enhance motility by stimulating dopamine (D2) antagonism or serotonin
(5-HT4) agonism (e.g., Metoclopramide, Domperidone).
• Antispasmodics – Reduce excessive contractions by blocking muscarinic receptors
(e.g., Hyoscine, Dicyclomine).
• Laxatives – Increase intestinal movement via osmotic or stimulant effects (e.g.,
Bisacodyl, Lactulose).
• Opioid Antagonists – Prevent opioid-induced constipation by blocking mu-opioid
receptors (e.g., Methylnaltrexone).
Therapeutic Use
• Gastroparesis – Prokinetics improve gastric emptying.
• Irritable Bowel Syndrome (IBS) – Antispasmodics relieve cramps.
• Constipation – Laxatives promote bowel movements.
• Diarrhea – Opioid agonists (e.g., Loperamide) slow motility.
Side Effects
• Prokinetics – Extrapyramidal symptoms, diarrhea.
• Antispasmodics – Dry mouth, blurred vision.
• Laxatives – Electrolyte imbalance, dependency.
• Opioid Antagonists – Withdrawal symptoms.
Treatment of Biliary Pain
• Antispasmodics (e.g., Hyoscine, Drotaverine) relax bile duct muscles.
• NSAIDs (e.g., Diclofenac) reduce inflammation.
• Opioids (e.g., Morphine) for severe pain, though they may worsen biliary spasm.
67. Laxatives. Definition. Classification. Localization of action and rate of onset of laxative
effect. Comparative characteristics, indications, main side effects. Contraindications.
68. Antidiarrheal agents. Definition. Classification. Comparative characteristics of drugs of this
group. Rules of using and indications. The main side effects. Contraindications.

69. Drugs used in anemia. Classification. Preparations for the treatment of iron-deficiency
anemias. Features of application. Side effects. Symptoms of overdose.
70. Drugs for the treatment of megaloblastic anemias. Features of application. Anemia of chronic
diseases. Principles of therapy.

1. Vitamin B12 Therapy

• Cyanocobalamin or Hydroxocobalamin (IM or oral) replenishes B12 levels.
• High-dose oral B12 (1000-2000 µg) can be effective in some cases.
• Parenteral B12 is preferred for neurological symptoms.
2. Folate Therapy
• Folic Acid (oral or IV) corrects folate deficiency.
• Dietary folate intake should be increased.
Features of Application
• Oral vs. Parenteral: IM B12 bypasses absorption issues, while oral therapy is
convenient.
 • Monitoring: Regular blood tests ensure adequate response.
• Neurological Symptoms: Require aggressive B12 therapy.
Anemia of Chronic Diseases (ACD)
ACD is linked to chronic inflammation, infections, or malignancies, causing impaired iron
utilization.
Principles of Therapy
• Treat Underlying Disease: Managing the primary condition improves anemia.
• Iron Therapy: IV iron is preferred over oral iron in severe cases.
• Erythropoiesis-Stimulating Agents (ESAs): Used in chronic kidney disease.
• Anti-inflammatory Treatment: Helps reduce cytokine-mediated anemia
71. Drugs affecting leukopoiesis. Principles of pharmacotherapy of leukopenia
72. Classification of agents affecting the processes of haemostasis. Haemostatic agents.
Definition. Classification. Mechanism of action. Therapeutic use. Main side effects.

73. Antiplatelet agents. Classification. Mechanism of action. Pharmacological effects.

Pharmacokinetic features of agents of this group. Therapeutic use. Main side effects.
Contraindications.

74. Anticoagulants. Definition. Classification. Direct-acting anticoagulants. Classification.

Pharmacological characterization. Therapeutic use.
75. Anticoagulants of indirect action. Pharmacological characteristics. Therapeutic use.

76. Fibrinolytic agents. Classification. Mechanism of action. Pharmacological effects.

Therapeutic use. Main side effects. Contraindications.

77. Hypothalamic and pituitary preparations, their purpose and use.

78. Hormonal preparations of thyroid and parathyroid glands, pharmacodynamics, application.
Antithyroid agents, mechanism of action, uses.

79. Insulin preparations. Mechanism of action of insulin. Influence on metabolic processes.

Principles of insulin dosing in the treatment of diabetes mellitus. Comparative characteristics of
insulin preparations. Treatment of hypoglycaemic coma.
80. Synthetic hypoglycaemic drugs. Classification. Mechanisms of action. Comparative
characteristics. Therapeutic use. Side effects.

81. Preparations of adrenal cortex hormones. Classification. Effect of glucocorticoids on

metabolic processes. Anti-inflammatory, immunosuppressive and anti-allergic effects.
Comparative characteristics of glucocorticoid preparations. Therapeutic use. Side effects.
Inhibitors of corticosteroid synthesis.

82. Preparations of female sex hormones and their antagonists. Oral contraceptives.
83. Drugs affecting calcium metabolism and bone tissue metabolism.
1. Calcium Supplements – Calcium carbonate, calcium citrate.
2. Vitamin D Analogues – Cholecalciferol, calcitriol.
3. Bisphosphonates – Alendronate, zoledronic acid (inhibit bone resorption).
4. Parathyroid Hormone (PTH) Analogues – Teriparatide (stimulates bone formation).
5. Calcitonin – Reduces bone resorption.
6. Selective Estrogen Receptor Modulators (SERMs) – Raloxifene (mimics estrogen
effects on bone).
7. RANKL Inhibitors – Denosumab (prevents osteoclast activation).
Mechanism of Action
• Calcium & Vitamin D – Enhance calcium absorption and bone mineralization.
• Bisphosphonates – Inhibit osteoclast-mediated bone resorption.
• PTH Analogues – Stimulate osteoblast activity for bone formation.
• Calcitonin – Suppresses osteoclast function, reducing calcium release.
• SERMs – Maintain bone density by mimicking estrogen effects.
• RANKL Inhibitors – Block osteoclast differentiation, reducing bone loss.
Therapeutic Use
• Osteoporosis – Bisphosphonates, SERMs, PTH analogues.
• Hypercalcemia – Calcitonin, bisphosphonates.
• Rickets & Osteomalacia – Vitamin D supplements.
• Paget’s Disease – Bisphosphonates.
• Bone Metastases – RANKL inhibitors.
Side Effects
• Bisphosphonates – Esophageal irritation, osteonecrosis of the jaw.
• Vitamin D Excess – Hypercalcemia, kidney stones.
• Calcitonin – Nausea, flushing.
• SERMs – Increased risk of thromboembolism.
• RANKL Inhibitors – Hypocalcemia, infections.
84. Androgenic drugs and their antagonists, pharmacodynamics, use. Anabolic steroids,
influence on metabolic processes, application, side effects.

85. Preparations of water-soluble vitamins. Influence on metabolic processes, nervous and

cardiovascular system, gastrointestinal tract, haematopoiesis, tissue regeneration. Therapeutic
use. Side effects

86. Preparations of fat-soluble vitamins. Influence on metabolic processes, tissues, organs and
systems. Therapeutic use. Side effects. Poisoning with vitamins A and D. Medical assistance
measures.

Vitamin A Toxicity
• Causes: Overconsumption of supplements or liver-rich foods.
• Symptoms:
o Acute toxicity: Nausea, dizziness, headache, blurred vision.
 o Chronic toxicity: Liver damage, bone pain, dry skin, birth defects (if taken during
pregnancy).
• Treatment: Discontinuation of vitamin A intake, supportive care.
Vitamin D Toxicity
• Causes: Excessive supplement use (not from sun exposure).
• Symptoms:
o Hypercalcemia (high calcium levels): Weakness, vomiting, frequent urination.
o Kidney damage: Kidney stones, renal failure.
o Bone pain and cardiovascular issues.
• Treatment: Stopping vitamin D intake, IV fluids, medications like corticosteroids or
bisphosphonates to lower calcium levels
87. Nonsteroidal anti-inflammatory drugs. Classification. Mechanism of action. Effect on
cyclooxygenase activity, prostaglandin synthesis. Therapeutic use. Side effects.

88. Classification of anti-allergic drugs. Drugs inhibiting the release of allergy mediators. Drugs
for the treatment of anaphylactic shock.
1. Antihistamines – Block histamine receptors (e.g., Loratadine, Cetirizine).
2. Mast Cell Stabilizers – Prevent histamine release (e.g., Cromolyn Sodium).
3. Corticosteroids – Suppress inflammation (e.g., Prednisolone, Hydrocortisone).
4. Leukotriene Receptor Antagonists – Reduce airway inflammation (e.g., Montelukast).
5. Immunomodulators – Target immune pathways (e.g., Omalizumab).
Drugs Inhibiting the Release of Allergy Mediators
These drugs prevent the excessive release of mediators like histamine, prostaglandins, and
leukotrienes:
• Mast Cell Stabilizers – Cromolyn, Nedocromil.
• Corticosteroids – Reduce cytokine production.
• Leukotriene Inhibitors – Montelukast, Zafirlukast.
Drugs for Anaphylactic Shock
Anaphylactic shock is a life-threatening allergic reaction requiring immediate treatment:
• Epinephrine – First-line treatment to reverse airway constriction and hypotension.
• Antihistamines – Diphenhydramine, Ranitidine (supportive therapy).
• Corticosteroids – Prevent late-phase reactions.
 • IV Fluids & Vasopressors – Maintain blood pressure in severe cases.
89. Antihistamines. Classification. Mechanisms of action. Therapeutic use. Side effects.
Contraindications.

90. Principles of pharmacotherapy of rheumatic diseases. Baseline antirheumatic agents.

Principles of Pharmacotherapy
1. Disease Modification – Slowing disease progression with DMARDs (Disease-
Modifying Antirheumatic Drugs).
2. Inflammation Control – Using NSAIDs and corticosteroids to reduce swelling and
pain.
3. Symptom Relief – Managing pain and stiffness with analgesics.
4. Immune Modulation – Targeting immune pathways with biologic agents.
Baseline Antirheumatic Agents
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Ibuprofen, Naproxen, Diclofenac – Reduce inflammation and pain.
• COX-2 Inhibitors (Celecoxib) – Lower gastrointestinal side effects.
2. Corticosteroids
• Prednisolone, Dexamethasone – Suppress immune response and inflammation.
• Used for acute flares but long-term use has side effects.
3. Conventional DMARDs
• Methotrexate – First-line treatment for RA.
• Sulfasalazine, Leflunomide – Alternative DMARDs for inflammatory arthritis.
• Hydroxychloroquine – Used in lupus and mild RA.
4. Biologic DMARDs
• TNF Inhibitors (Infliximab, Etanercept, Adalimumab) – Block inflammatory
cytokines.
• IL-6 Inhibitors (Tocilizumab) – Reduce immune-mediated inflammation.
• B-cell Therapy (Rituximab) – Targets immune cells involved in RA.
5. Targeted Synthetic DMARDs
• JAK Inhibitors (Tofacitinib, Baricitinib) – Modulate immune signaling pathways.
Side Effects & Monitoring
• NSAIDs – Risk of gastrointestinal ulcers and kidney damage.
• Corticosteroids – Long-term use may cause osteoporosis and diabetes.
91. Immunosuppressants. Definition. Mechanisms of action. Therapeutic use. Side effects.
Immunomodulators (immunostimulants).

1. Selectively binds to the growth factor of the endothelial vessels and neutralizes it → violation
of an giogenesis, ↓ vascularization and depression of growth of the tumor (1) 2. Blocks human
epidermal growth factor receptor type 2 (HER-2) on tumor cells → ↓ division of malignant cells
(2) 3. ↓ level of circulating CD20 + B-lymphocytes (3) 4. Blocks epidermal growth factor
receptor (EGFR)

92. Anti-gout drugs. Mechanism of action. Indications and contraindications for use. Drugs used
in acute attacks of gout (colchicine, indomethacin, diclofenac sodium). Mechanism of action.
Side effects.

1.Complete rest 2. Elevated position of affected limbs 3. In acute inflammation — cold (soak
limbs in cold water). After pain relief – warming. 4. Increased fluid consumption (alkaline
mineral water)
93. Antiseptic and disinfectants, definition, classification, principle of action, application.

94. Chemotherapeutic agents. Definition. Classification. Principles of chemotherapy

Chemotherapeutic agents are medicinal substances suppressing the vital functions of pathogens
of infectious diseases or tumor cells.
Principles of rational chemotherapy.
The choice of the drug should be carried out taking into account:
1) Diagnosis (therapy can be empirical and etiotropic);
2) The spectrum of drugs activity (it is preferable to administer narrow-spectrum antibiotics);
3) The state of the patient's organism taking into account his age, pregnancy and concomitant
diseases;
4) Toxicity of drugs, their side effects;
5) Localization of the infection (the substance should reach the focus of infection);
6) Route of administration (In severe cases, drugs are administered parenterally);
7) The possibility of combining drugs in order to enhance the pharmacological effect and
prevention of the development of resistance of microorganisms to antibiotics;
8) Drugs cost.
95. Principles of pharmacotherapy of community-acquired pneumonia.
1. Antibiotic Therapy
• Mild CAP (Outpatient):
o First-line: Amoxicillin or Doxycycline.
o Alternative: Macrolides (Azithromycin, Clarithromycin) if atypical pathogens are
suspected.
• Moderate to Severe CAP (Hospitalized Patients):
o Beta-lactam + Macrolide (e.g., Ceftriaxone + Azithromycin).
o Respiratory Fluoroquinolones (Levofloxacin, Moxifloxacin) as monotherapy.
• Severe CAP (ICU Admission):
o Beta-lactam + Macrolide or Fluoroquinolone.
o MRSA or Pseudomonas Coverage if risk factors exist.
2. Supportive Therapy
• Oxygen Therapy – For hypoxia.
• Antipyretics & Analgesics – Fever and pain management.
• IV Fluids – Maintain hydration in severe cases.
96. Penicillins. Preparations of natural and semi-synthetic penicillins. Mechanism and spectrum
of antimicrobial action. Therapeutic use. Side effects.
97. Cephalosporins. Mechanism and spectrum of antimicrobial action. Comparative
characteristics of drugs of different generations. Therapeutic use. Side effects.

98. Carbapenems and monobactams. Mechanism and spectrum of action. Indications. Side
effects
99. Macrolides and azalides. Mechanism, nature and spectrum of antimicrobial action.
Indications. Side effects.

100. Tetracyclines. Polymyxins. Mechanism, nature and spectrum of antimicrobial action.

Indications. Side effects.
101. Lincosamides (lincomycin and clindamycin). Chloramphenicol. Mechanism, nature and
spectrum of antimicrobial action. Therapeutic use. Side effects
102. Aminoglycosides. Glycopeptides (vancomycin). Mechanism, nature and spectrum of
antimicrobial action. Therapeutic use. Side effects.

103. Amphenicols, steroid structure antibiotics, oxazolidinones and streptogramins.

Classification. Mechanism and spectrum of action. Indications. Main side effects.
Contraindications
104. Glycopeptides. Classification. Mechanism and spectrum of action. Indications. Main side
effects. Contraindications

105. Sulfonamides. Mechanism, nature and spectrum of antimicrobial action. Comparative

characteristics. Combined preparations. Therapeutic use. Side effects and their prevention.

106. Fluoroquinolones. Mechanism of action, spectrum of antimicrobial activity. Therapeutic

use. Side effects.
107. Derivatives of 8-oxyquinolines, nitrofurans and nitroimidazole derivatives. Mechanism of
action, spectrum of antimicrobial activity. Therapeutic use. Side effects.

108. Antituberculosis drugs. Mechanism and antimicrobial spectrum. Comparative

characteristics. Key aspects of therapeutic use. Side effects. Principles of pharmacotherapy of
tuberculosis.

109. Antifungal drugs, definition, classification, pharmacokinetic features, spectrum of action,

therapeutic use, side effects.
110. Antiviral drugs, definition, classification, mechanisms of action, use based on viral infection
localization

111. Antimalarial drugs. Action on various forms of the malarial plasmodium. Principles of
application. Side effects.

112. Drugs used for the treatment of amoebiasis, classification, mechanism of action, therapeutic
use, side effects.

113. Drugs used for the treatment of trichomoniasis, giardiasis (lambliasis), toxoplasmosis,
leishmaniasis, pneumocystosis, trypanosomiasis. Clinical features of the disease, localization of
the pathogen and principles of pharmacotherapy
114. Antihelminthics drugs, classification. Drugs used for the treatment of intestinal
nematodoses, cestodoses and trematodoses: properties, features of application, side effects.
General characteristic of drugs used for the treatment of extraintestinal helminthiases

115. Antineoplastic (anticancer) drugs. Classification. Mechanisms of action. Spectrum of

antineoplastic activity. Complications that arise when using, their prevention and treatment.
Immunodepressive properties of cytostatics. The concept of targeted antineoplastic drugs.