No 6 (2013)

This review summarizes data on the effectiveness of lercanidipine. Lercanidipine is third-generation dihydropyridine calcium channel blocker, characterized by high vasoselectivity, long duration of action and a good antihypertensive efficacy. High lipophilicity of drug provides gradual and prolonged hypotensive effect of the drug. This reduces the risk of adverse side effects against the background of treatment with lercanidipine and increases compliance to the treatment with this drug. The review summarizes data on the hypotensive efficacy of lercanidipine and its organoprotective properties. The comparison of its efficacy with that of other groups of drugs is presented. The potentials for the use of this drug in elderly patients with arterial hypertension are discussed.

Anemia in patients with cardiovascular diseases is a serious problem both in terms of detection of pathogenetical link with underlying disease, and the management of these patients. Regardless of whether anemia is a true comorbidity or is associated with the pathogenesis of cardiac pathology, each case requires timely diagnosis of anemia, and verification of pathogenetical variant and the causes for its development, and adequate correction using antianemic drugs, mainly iron supplements.

The article presents the current understanding of the mechanisms of dysmenorrhea and main pharmacological approaches to relief of its symptoms, which include the use of non-steroidal anti-inflammatory drugs, estrogen-progestin preparations, antispasmodics and combination drugs. The data on the efficacy and safety of drugs traditionally used to relief of menstrual pain are presented. The alternative methods of treatment of dysmenorrhea are considered. The algorithm for choosing a drug for the treatment of dysmenorrhea in the counseling of patients at the pharmacies is suggested.

Community-acquired pneumonia (CAP) is a serious medical problem, associated with a high mortality in some categories of patients. Antibacterial treatment of CAP is not always effective, primarily due to resistance of pathogens, which dictates the need for search of additional (adjuvant) treatment. The prospects for the use of glucocorticosteroids, drotrecogin alpha, granulocyte-colony stimulating factor, statins, angiotensin-converting enzyme inhibitors, N-acetylcysteine in CAP are considered. It is emphasized that although the adjuvant therapy does not substitute for antibiotics, it can improve the prognosis in a number of pathological conditions (such as acute respiratory distress syndrome).

The article presents the pathogenetical features, main clinical manifestations, classification, diagnosis, and advanced algorithm of step therapy of gastroesophageal reflux disease (GERD). Much attention is paid to modern three-step algorithm for the treatment of GERD, according to which rational choice of drugs for its treatment is proposed. The schemes of treatment of GERD using modern proton pump inhibitor pantoprazole (Controloc) are considered.

The article discusses the problem of primary sclerosing cholangitis (PSC). Information on the pathogenesis, diagnosis, and treatment of PSC is presented. Particular attention is paid to the use of ursodeoxycholic acid (UDCA), hepatoprotector embeding in the membrane of hepatocytes that stabilizes the structure and protects liver cells from the damaging factors, inhibits the absorption of lipophilic bile acids in the intestine, induces the formation of bile enriched in bicarbonates (acid salts of carbonic acid), that results in increased passage of bile and stimulates the release of toxic bile acids in the intestine. Currently, UDCA may be considered as the primary drug in the treatment of PSC.

Chronic pancreatitis (CP) is one of the most urgent and investigated problems in gastroenterology. Despite the variety of the spectrum of etiologic, pathogenetic and provoking factors for CP, one of the leading causes of disease pathology is pathology of biliary tract. A key element in treatment of CP is the correction of exocrine pancreatic insufficiency; furthermore, characteristic feature of biliary pancreatitis that distinguishes it from other forms of pancreatitis, is a combination of exocrine pancreatic insufficiency with chronic biliary insufficiency. The use of modern mini-microspheric multienzyme preparations (Creon®) in combination with ursodeoxycholic acid significantly improves the clinical efficacy of replacement therapy.

The article discusses the problem of the treatment of hypertensive patients using optimal combinations of antihypertensive drugs. The results of numerous studies on the use of different groups of antihypertensive drugs, including β-blockers (bisoprolol), calcium channel blocker (amlodipine), and their combinations are analyzed.

Article is devoted to the treatment and prevention of nephropathy in patients with arterial hypertension (AH). The problems of the pathogenesis of hypertensive nephroangiosclerosis and significance of activation of angiotensin-aldosterone system in its development and progression are discussed. General principles for the use of ACE inhibitors in these patients are presented. Researches on one of the drugs of this group - ramipril - are discussed in detail. The features of the pharmacokinetics and pharmacodynamics of this drug are described. The results of studies proving the effectiveness of ramipril in the treatment of nephropathy in different categories of patients are described in detail.

Maintaining of physiological magnesium levels in the tissues is a fundamental condition determining human health. A numerous of experimental and clinical studies have suggested a relationship between magnesium deficiency and the risk of various diseases and pathological conditions. The combined effect of magnesium deficiency on the etiopathogenesis of comorbid diseases is of particular interest. Multi-center, observational study «Screening of magnesium levels in the blood plasma and red blood cells in a multi-field hospital settings» was focused on the evaluation of this impact. The primary objective of the study was to determine the frequency of magnesium deficiency in various categories of patients. Large-scale screening program for prevalence of magnesium deficiency included 2,000 patients 18-90 years old, for each of which information on 187 parameters was collected. The study was conducted in four centers with participation of patients from 6 cities: Vladimir, Ivanovo, Kemerovo, Kostroma, Moscow and Ufa, including those with cardiovascular, gastrointestinal, hematological, neurological diseases (150 patients), nephrological, urological, pul-monological, dermatological, gynecological and endocrinological abnormalities ( 150 patients). The study also included 500 healthy volunteers. Data on medical history diagnosis, demographics, anthropometric parameters, data of blood test (evaluation of magnesium levels in plasma and red blood cells), and urinalysis were registered. The study included patients admitted to the hospital for emergency care or for planned treatment. Low magnesium levels ( <0.8 mmol/L in plasma) was detected in 956 patients, while a high levels (> 1.3 mmol/L) - only in 70 patients, which indicates a high prevalence of magnesium deficiency It is shown that magnesium deficiency corresponds to significantly increased risk of conditions such as E66.3. Overweight, G47.8. Sleep disorders, R56.8. Cramps, H52. Myopia, I63.0. Ischemic cerebral infarction, I10. Essential primary hypertension, I34.1. Mitral valve prolapse, F43.0. Acute stress reaction, I20.0. Unstable angina, N94.3. Premenstrual syndrome, E11.7 E11.8. Insulin-dependent diabetes mellitus, I47.9. Paroxysmal tachycardia, etc. Data of analysis of pyridoxine level using structured questionnaire in patients showed that 47% of patients did not have any deficit, and severe deficit was found only in 16% of patients. Most severe pyridoxine deficiency corresponded to lower magnesium levels (correlation coefficient, r=-0,53). It is shown that the optimal serum magnesium level with the minimum risk of diagnoses studied, ranged 0.80 to 0.85 mmol/L. The plasma magnesium levels up to 0.80 mmol/L correspond to a statistically significant increased risk of the above and other pathologies. Results of the study support the use of medicines containing organic magnesium salts for the replenishment and prevention of its deficiency