编号 9 (2013)

The article discusses the current position of beta-blockers in the treatment of arterial hypertension. The experience of clinical studies that used bisoprolol is analyzed.

Current concepts of the pathogenesis and course of osteoporosis (OP), primarily spine OP, are considered. Clinical manifestations of OS, methods of diagnosis, including densitometry are presented. The problem of choice of most effective drugs for the treatment and prevention of OP is discussed. The feasibility of the use of drug Fosavance containing original alendronate 70 mg and 2800 IU of vitamin D 3, with combined antiresorptive and anabolic action is justified for this purpose. High efficiency of Fosavance is confirmed by the results of large clinical trials.

The article presents data concerning rivaroxaban, a first factor Xa inhibitor that was approved for clinical use. Pharmacodynamics and pharmacokinetics of the drug, drug interactions, and clinical aspects of the application are discussed. The results of large randomized phase III ROCKET-AF study which evaluated the effectiveness of rivaroxaban compared with warfarin are analyzed. Based on the results of this study, rivaroxaban has been registered in Russia as an alternative to warfarin for the prevention of thromboembolic complications in patients with atrial fibrillation.

The article considers the etiology, pathogenesis and clinical manifestations of vascular cognitive impairment. Relationship between cerebrovascular disease and poststroke cognitive disorders is discussed in detail. Criteria for the differential diagnosis of neurodegenerative and vascular cognitive disorders are presented. Current data on the pathogenetic and symptomatic treatment of poststroke cognitive disorders are presented.

In our country, ATC/DDD methodology is still not commonly used for the estimation of consumption of medicines (drugs). Using ATC/ DDD methodology, frequency analysis and VEN-analysis, a retrospective study of 1,071 case reports of patients with a proven diagnosis of myocardial infarction (MI), including ST-elevated myocardial infarction (STEMI) - 590 (55,1 %) patients, non ST-segment elevation myocardial infarction - 481 (44,9 %) patients, was performed. All patients were treated in the State Institution “Cardiologic Dispensary" of Komi Republic from 2003 to 2010. When calculating DDD/100 bed-days, it was revealed that the level of consumption of antiplatelets and anticoagulants exceed 100 DDD/100 bed-days. Nitrates with consumption level of 86,3 DDD/100 bed days occupy the 3 rd place, angiotensin converting enzyme inhibitors with 69,9 DDD/100 bed-days occupy 4 th place, and β-blockers - 42,8 DDD/100 bed-days - 5 th place. According to the level of consumption, diuretics and anti-thrombotic drugs are behind them. These groups of drugs accounted for 90 % of the total drug consumption according to the analysis of DU-90 % for groups of medicines. VEN-analysis in the structure of these groups of drugs revealed that vital drugs classified as V category accounted for 77,4 %, and the essential drugs (category E) - 22.6 %. Statins belonging to the V category were not included in the DU-90 % group. N category drugs were not appointed. Thus, the ATC/DDD-methodology allows to objectively assess the pharmacological support, significantly extends the capabilities of its analysis and can be used for adjustments in strategy and tactics for the management of patients with acute coronary syndrome in order to improve the quality of medical care

The article presents the data on peripheral autonomic pharmacodynamics of nitroglycerin, estimated by rhythmocardiography in patients with angina pectoris III-IV functional classes. Enhancement of humoral and sympathetic influence in the sinus node under the influence of nitroglycerin through inhibition of parasympathetic regulation was revealed, and more pronounced effect was observed in patients with angina pectoris III-IV functional classes without concomitant hypertension.

Based on the clinical, psychological and electrophysiological examinations of patients with acute and chronic cerebrovascular disease, efficacy and favorable tolerability of treatment with Mildronate (meldonium) is demonstrated. The drug reduces the severity of neurological disorders, improves psychological functions of patients. The biochemical basis for the therapeutic action of Mildronate includes antioxidant activity: the drug reduces oxidative damage of lipoprotein structures, restores the activity of the endogenous antioxidant system. Using single-photon emission computed tomography, it was established that Mildronate increases cerebral perfusion in areas of its decline, which are attributable to cerebral infarcts on magnetic resonance imaging.