No 7 (2015)

The review article presents a systematic information about the mechanisms of action and efficacy of synthetic human parathyroid hormone апаlogгу - teriparatide - in men and women with osteoporotic bone fractures. The results of experimental and clinical studies have confirmed the anabolic effect of this drug on bone metabolism, as well as its ability to increase bone mineral density (BMD) and reduce the risk of recurrent osteoporotic fractures, even in patients with very low BMD and several previous low-energy bone fractures. Literature data for the positive effects of teriparatide therapy on the processes of reparative regeneration of bone after fractures are separately analyzed. As a result, it is concluded that this drug has a particular importance for the examined cohort of patients usually treated by orthopedist-traumatologist, since it is able to simultaneously optimize the existing processes of bone union and to prevent repeated bone fractures in patients with osteoporosis.

Treatment of patients with chronic daily headache (CDH) is one of the most difficult problems in neurological practice. The combination of drug and non-drug therapies - the basis of the modern approach to the treatment of CDH. In our country, pharmacotherapy of headaches often involves the appointment of neurometabolic and vasodilator drugs, and non-drug therapy includes massage, physiotherapy and manual therapy. In world practice, these methods do not have evidence of efficiency and are not recommended for the treatment of CDH. The article deals with modern and effective methods of treatment of patients with CDH. The results of own authors’ observation of 62 patients (6 men and 56 women) with CDH aged from 23 to 78 years (mean age, 47.19±11.79 years) are presented, the analysis of the inefficiency of prior treatment is performed. Clinical case has demonstrated the effective treatment of patient suffering from CDH using behavioral therapy and antidepressant duloxetine. The data on the efficacy of duloxetine in CDH are discussed. It is emphasized that duloksetin is an effective and well tolerated drug for the treatment of patients with CDH and comorbid illnesses such as anxiety and depressive disorders, chronic nonspecific lower back pain, and fibromyalgia.

The article is devoted to pharmacological preconditioning before carotid endarterectomy in patients with chronic cerebrovascular insufficiency. The study was based on the results of surgical treatment of 80 patients with hemodynamically significant unilateral and bilateral carotid stenosis. Half of these patients underwent surgery immediately, and others - after pharmacological preconditioning with drug Actovegin at a dose of 1200 mg/day for 1.5 months. It was shown that preoperative preparation before surgery increases cerebral perfusion as determined by single photon emission computed tomography, and significantly improves the results of surgical treatment. There was significant difference in cognitive function of patients of these groups 7 days and 6 months after surgery. Such an improvement in cognitive functions correlated with fewer asymptomatic cerebral ischemic foci in different brain regions. The positive role of pharmacological preconditioning with drug Actovegin in the surgical treatment of stenoses of precerebral arteries, contributing to a more complete recovery of cognitive functions, was noted.

The article presents the data on the state of the hypothalamic-pituitary-adrenal axis (HPAA) in patients with a first psychotic episode (FPE) during antipsychotic treatment. The cortisol and dehydroepiandrosterone sulfate levels in 33 patients (17 men and 16 women; mean age 28.6±1.5 years) with PES in the process of treatment with olanzapine were assessed. The control group included 34 mental and somatically healthy people (14 women and 20 men; mean age - 34.6±6.8 years). Evaluation of hormonal parameters was performed in dynamics (baseline, at 3-4 and 6-8 weeks of therapy) depending on gender, severity of psychopathology and efficacy of treatment. The findings suggest involvement of HPAA in pathophysiological and therapeutic processes in patients with FPE. Hormonal predictors of efficacy of treatment of PES using olanzapine are presented.

Modern pharmacotherapy opens wide opportunities to influence the various clinical manifestations of ankylosing spondylitis (AS). Along with the traditional treatment regimens, new classes of drugs that can improve the condition of patients and slow the progression of the disease emerge. The introduction of tumor necrosis factor α (TNF-α) inhibitors into clinical practice can be considered as a great progress in the treatment of AS. Wide application of genetically engineered biological agents in clinical practice does not preclude the search for other available therapeutic approaches, associated with less severe immunosuppression, good tolerability, a lower cost.

The article considers the modern principles of management of patients with Alzheimer's disease. Medical and drug-free methods used in the treatment of cognitive, emotional and behavioral disorders are discussed. The data on the effectiveness of the basic symptomatic therapy: N-methyl D-aspartate receptor antagonists, acetylcholine esterase inhibitors as monotherapy and in combination with choline alfoscerate - are presented. Some of the issues of the use and effectiveness of cognitive-motor training, psychosocial support to patients with cognitive impairment, their relatives and caregivers are highlighted.

Bisphosphonates are the most common drugs used for the treatment of osteoporosis. The article examines the pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of alendronates from the perspective of evidence-based medicine. The feasibility of the application of alendronate 70 mg once a week, which significantly improves patients' adherence to treatment, is demonstrated.