The main aspects of drug therapy

Successes of classical pharmacology and particularly the success of clinical pharmacology in collaboration with the Clinical Pharmacy greatly expanded knowledge of the therapeutic efficacy of medicines. This allows make better use of them for the treatment of various diseases with the requirements of modern pharmacotherapy: minimum dose of the drug substance to achieve optimum therapeutic effect without the side effects. This formulated in general terms the basic "social order" Health with medicines for therapeutic or prophylactic purposes experts (Clinicians and pharmacists) may perform in extreme close, only if the following conditions are met:

• Proper assessment of the effectiveness of drugs, its indications and contraindications, The exact dosage and possible interactions with other drugs.
• Match therapeutic effect of the drug etiology and symptomatology of a pathological condition, which is achieved by removing the cause of the disease (эtiotropnaya therapy) or normalization of physiological disorders, underlying disease (patogeneticheskaya therapy). Unfortunately, Specialist does not always have the possibility of strict selection of drugs, taking into account the nature of the etiology and pathogenesis of the disease. Often there is a need to work on those or other symptoms, that requires the use of symptomatic drugs (simptomaticheskaya therapy).
• Allowance for compensatory and adaptive mechanisms, available in any pathological process, as well as conditions, promoting recovery.
• Taking into account the many factors, affecting the complex and delicate mechanisms of interaction with the drug by the body. For Example, composition and properties of the drug component, the nature of the carrier, type of formulation, condition of the body, concomitant diseases and other, which can be caused not only by the bioavailability and efficacy of medicines, but also their side effects.

In each case, you must take into account the principle of action of the drug, the ability of its absorption by the body: processes of absorption from the injection site, Distribution and biotransformation in the body - metabolism, the mechanism of interaction of physiological and biophysical processes in cells, tissues, agencies, the interaction of other drugs, time and way of excretion.

• The optimal combination of general and specific principles of drug therapy and clinical nutrition.
• Accounting aspects of clinical chronopharmacology, ʙioritmologii, and sex, age, environmental performance, and other factors, affecting the effectiveness of drugs in the treatment and prevention of diseases.
• Finally, optimal use of drugs in medical practice requires, to drug therapy was strictly individualized and selective, since it is based on the rule: "Treat the patient, not a disease ". Individual drug therapy should be considered as the highest level and more complex integrated therapy, which is caused by a genetic reaction to a particular patient to a particular medicine. Individualized therapy provides clinical diagnosis, clear understanding of the pathogenesis of the disease, ability to carry medication on the clinical evidence and taking into account, if necessary, in a combination of other treatments.

These conditions provide optimal drug therapy, the interaction of drugs at all stages of promotion of drugs to the consumer, from the stage of preparation and finishing phase of the optimal use of. To address the potential interaction processes in the last stage – the most difficult task, since the therapeutic effects of drugs, and especially their pharmacokinetic and pharmacodynamic parameters, It affects a variety of factors, including biochemical and physiological affects, occurring in the body under the influence of drugs.

The rate of development, severity, duration, and sometimes the nature of the therapeutic effects of drugs depends on their concentrations or doses in the body. Some differences in the pharmacological effects of drugs due to the influence of sex hormones on metabolism, as well as their interactions c receptors.

The intensity and duration of action of hypnotics, analgesic, antihypertensive, antihistamines, hormonal and other drugs affect the body daily biorhythms. The most extensively studied circadian rhythms in drug action, which depend on the circadian processes, in the body (in particular, known circadian rhythms in the secretion of hormones, activity of microsomal enzymes, etc..). So, glucocorticoid drugs are most effective when they are administered in 8 hours, insulin - in 8-13 hours, allergic reactions to drugs are more likely to occur in 21-24 o'clock. At the same time of day are most effective antihistamines. The sensitivity of the organism to drug varies depending on the age, the functional state of organs and systems. There's also an individual's sensitivity to substances, due to genetic factors. Genetic characteristics of functioning of various enzyme systems can lead to slow the biotransformation of drugs in this regard to enhance their therapeutic actions or manifestation of toxic effects with drugs at therapeutic doses.

Accelerating biotransformation resulting in increased enzyme activity leads to the weakening of the therapeutic effect. Besides, disruption of the normal course of biochemical reactions in the body can lead to toxic effects like unusual idiosyncrasy.

With the simultaneous use of two or more drugs in the interaction can be observed changes in their therapeutic action, manifested in the form of synergies, antagonism or sinergoantagonizma. The latter type of interaction is expressed in, that there is mutual reinforcement effects alone, a combination of drugs and the simultaneous weakening of other.

The basis of the interaction of drugs can have different pharmacokinetic processes: change in the rate and extent of absorption in the gastrointestinal tract depending on the increase or decrease in pH of the contents of the stomach and duodenum through the use of antacid preparations and other; acceleration or slowing gastric emptying or intestinal motility by use of laxatives or astringents, and so on. d.

Some drugs may affect the degree of interaction of other drugs c plasma proteins, thereby changing their active concentration. Especially substantially similar to the interaction of drugs, well binding protein and having a small therapeutic breadth Actions (antykoahulyantov, cardiac glycosides and others.). At the heart of the interaction of certain drugs is an impact on their metabolism through induction of enzymes, involved in the biotransformation.

The occurrence of adverse reactions during drug interactions (the weakening of the therapeutic effect, increased side effects, appearance of new toxic effects, etc..) It can be designated as the incompatible drugs.

Repeated application of drugs in the same dosage can vary their action in the direction of strengthening, and reducing. Increased therapeutic or side effect of drugs may be caused by accumulation of substances in the body or caused by the effects of (cumulation). Reducing the therapeutic effect with repeated use of drugs called habituation, or tolerance. Long-term use of certain drugs, having psychotropic activity, may cause the development of dependence syndrome.