No 7 (2017)

Effective relief of chronic intense pain is still a serious problem. The article analyzes the main changes in the federal regulatory and legal framework that expand the rights of medical workers in administration and prescription of narcotic drugs (ND) and psychotropic substances (PS). The authors emphasize that in order to carry out adequate analgesic therapy with the use of ND and PS it is necessary to make changes in some formulations of the legislative base, emphasizing the necessity of using these medicines for medical purposes when indicated. Attention is drawn to the fact that the organizational accessibility of the ND PS depends not only on federal normative legal acts, but also on the quality of their implementation in the field. The need for timely initiation of adequate analgesic therapy is emphasized; the tactics of choosing opioid analgesics (OA) and their dosage forms, as well as the main rules for their appointment are described. The impact of the duration of the effect of various dosage forms of OA on the development of opioid tolerance and hyperalgesia, and the growth of the narcogenic potential are explained. It is concluded that in order to conduct adequate analgesic therapy and improve its quality, it is extremely necessary to increase the level of administration of ND, but using the drugs with relatively low narcogenic potential and a relatively low risk of their non-medical use.

The «PANDA» trial was aimed to the evaluation of renal function in patients with acute nonspecific low back pain against the background of therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). The study included 407patients who have received one of four NSAIDs: meloxicam (15 mg/day), etoricoxib (60 mg/day), nimesulide (200 mg/day) or celecoxib (200 mg/day) for 14 days. At five visits, blood pressure, glomerular filtration rate (GFR), and blood cystatin-C values were monitored. According to the results of the observation, there were no clinically significant changes in the level of systolic and diastolic blood pressure, GFR and cystatin-C concentrations between the onset of therapy and the completion of the study in all groups of patients, regardless of the NSAID taken. Statistically Significant differences in all indicators studied were noted in the group of patients with history of hypertension and diabetes mellitus compared to patients without these diseases.

The levels of stable metabolites of nitric oxide (NO) in the serum and urine of patients with ankylosing spondylitis (ASA) have been determined. The study included 93 patients with a confirmed ASA and a group of healthy donors (n=35). Thirty patients with ASA were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), 33 - with NSAIDs and prospidin, 30 - with NSAIDs and methotrexate. The concentrations of stable metabolites of NO in serum and urine were determined before treatment and 3, 6, 12 months after initiation of therapy. The clinical value of levels of stable metabolites of NO in blood serum and urine in patients with ASA was evaluated depending on the clinical features of the disease and during the application of background therapy. It has been established that the level of stable metabolites of NO serves as an additional criterion for the activity of the disease and the effectiveness of therapy.

Treatment of osteoarthritis (OA) is targeted both at the symptoms of the disease (reducing pain, inflammation, improving the functional state), and at slowing of the progression and improving the quality of life of patients. Symptomatic effects are achieved by a combination of non-pharmacological and pharmacological treatments provided by numerous recommendations. Currently, there is sufficient evidence that symptomatic slow release preparations have anti-inflammatory, analgesic and structure-modifying effects.

The quality of life was assessed in 120 female patients with osteoarthrosis of joints of the hands receiving chondroitin sulfate, glucosamine sulfate, diacerein and aceclofenac during 18-month follow-up. It was revealed that therapy with repeated courses of diacerein and chondroitin sulfate improves the quality of life of patients with osteoarthrosis of joints of the hands according to the physical health scales, and chondroitin sulfate - according to the psychological health scales.

Cerebrovascular diseases are one of the main causes of mortality and disability of patients. According to statistical data, mortality from cerebrovascular diseases reaches 11-12% in economically developed countries. Rheological and biochemical characteristics of the blood have a critically importance in the development of cerebrovascular pathology, since microcirculation disorders are often detected with an increase in the functional activity of platelets, blood viscosity, latent signs of disseminated intravascular coagulation. One of the risk factors for cerebrovascular disease is the activation of the vascular-platelet phase of hemostasis and the violation of the rheological properties of the blood - an increase in blood clotting ability, which can lead to dangerous consequences for the human body, thrombosis. In this regard, in order to prevent the activation of intravascular thrombosis, the use of antiplatelet agents is pathogenetically justified. Antiplatelets are a complex and very important class o drugs that requires special attention both in the choice of a particular agent and in the period of its use. Dipyridamole refers to pyrimidine derivatives, it is an effective antiplatelet drug with vasodilating properties. A complex mechanism of action of dipyridamole due to its antiaggregatory properties due to the inhibition of the reactivity of the platelets, the drug improves microcirculation by reducing platelets aggregation and increasing their deformability, angioprotective properties - enhances the synthesis of endothelial growth factor and angiogenesis.. Dipyridamole also has vasodilating effect, it is important to note selectively directed vasodilatory effect on small vessels due to inhibition of the capture of adenosine and the suppression of the production of phosphodiesterase.