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Psychotonic drugs.

Psychostimulants- This psychotropic drugs, having a stimulating effect on the central nervous system, capable of quickly mobilizing the body’s functional and energy reserves, increasing physical and mental performance.

The first psychostimulants were alkaloids of tea leaves and coffee beans, purine derivatives - caffeine, theophylline, theobromine, which were used in the form of drinks. In the 19th century they were allocated to pure form and synthesized. They are weak psychostimulants.

The first representative of powerful psychostimulants derived from phenylalkynamine was phenamine (amphetamine), it was synthesized in 1910 as an adrenaline substitute, but it did not live up to expectations. Later it was studied that when using phenamine, it increases physical activity, fatigue is relieved, mood improves, a feeling of increased strength, long time the need for sleep and food intake decreases. The effect occurs quickly, and is especially striking against the background of existing fatigue. The effect is achieved through the rapid and complete use of the body's reserve capabilities; it is similar to euphoria; control over the maximum permissible work is suppressed. In sports it is doping. The most dangerous is the systematic use of drugs in this group (phenamine, pervitin, meridil), which leads to insomnia, exhaustion nervous system and loss of strength. Currently, phenylalkine derivatives are not used due to the rapid development of mental dependence on them.

Classification:

1. Phenylalkyl sydnonimine derivatives:

Sidnocarb (Mesocarb)

2. Xanthine derivatives:

Caffeine – sodium benzoate

3. Benzimidazole derivatives:

Bemitil (Bemaktor)

Features of the action of sydnonimine derivatives (sydnocarb):

By chemical structure and the mechanism of action is similar to phenamine, but is less toxic and in therapeutic doses has a less pronounced psychostimulating effect. The effect develops gradually, the action is longer than that of phenamine and is not accompanied by pronounced euphoria and motor excitement.

Mechanism of action: they are indirect adrenergic agonists. Activate adrenergic transmission nerve impulses at all levels: from higher departments CNS to executive bodies. They displace norepinephrine and dopamine from mobilization pool 2, the concentration of mediators in the synaptic cleft increases, and the effect on postsynaptic receptors increases. Also affects chromophin cells medulla adrenal glands, increase the release of adrenaline into the blood. Effects:

1. Psychostimulating effect: when taking sydnocarb against the background of mental fatigue, signs of fatigue are weakened, drowsiness disappears, mood improves, mild euphoria, determination and desire to work appear. The duration of storing events in short-term memory increases, translation into long term memory information is improving little. Stereotyped work that does not require deep understanding is performed better. Attention is scattered, patience decreases, and the number of errors in work increases. Increasing the dose leads to increased euphoria, racing thoughts, difficulty concentrating, and an inability to perform creative work.

When used in persons with mental disorders and in case of an overdose of the drug in healthy people, they increase crazy ideas, agitation, delusions, hallucinations, antisocial behavior worsens.

2. Promotion physical activity: the pace of work performed increases, the maximum volume of it increases less. A typical “doping” effect is observed.

Mental control over the safe load limit is weakened. This can lead to complete exhaustion.

3. Anorexigenic effect: increases basal metabolism, blood glucose levels and reduces the feeling of hunger, suppresses appetite. This is due to the stimulation of the satiety center in the hypothalamus and suppression of the appetite center. Their systematic use leads to weight loss.

4. Peripheral effects: occur with increasing doses - tachycardia, vasoconstriction and increased pressure, hyperglycemia - contraindicated in atherosclerosis, hypertension, thyrotoxicosis and diabetes mellitus.

Features of the action of xanthine derivatives (caffeine):

In therapeutic doses it is inferior to sidnocarb and phenamine in terms of psychostimulating activity. In high doses it causes activation comparable to sidnocarb mental activity, excitement, insomnia, elements of euphoria. On physical performance has little effect. Caffeine sodium benzoate is similar in action to caffeine, but is more soluble in water and is eliminated from the body faster.

1. Psychostimulating effect: has a direct, and not mediated by other structures, effect on the cerebral cortex. Eliminates drowsiness, fatigue, appears cheerfulness, increases mental and physical performance. The effect of caffeine depends on the dose and type of high nervous activity. Caffeine restores the balance between the processes of inhibition and excitation. In small doses the psychostimulating effect predominates, in large doses it can lead to exhaustion nerve cells and CNS depression.

2. Increases metabolism, enhances the secretion of adrenaline by the adrenal glands, increases blood sugar.

3. Effect on vasomotor and respiratory centers medulla oblongata: in relatively high doses excites these centers. Stimulates cardiovascular functions vascular system and breathing (analeptic effect). Due to direct action on the myocardium and increased secretion of adrenaline, the frequency and strength of heart contractions moderately increases (cardiostimulating effect).

4. Effect on vascular tone: twofold. A direct effect on vascular smooth muscle leads to their dilation. By stimulating the vasomotor center, it constricts blood vessels. Depending on the predominance of one effect or another, different vascular areas respond to caffeine differently. Normal pressure does not change, may sometimes increase. Dilates the vessels of the heart, kidneys, transversely striated muscles, narrows cerebral vessels, tones the veins.

5. Increases secretion gastric juice. Therefore, it is contraindicated for people with stomach ulcers.

6. Has an antispasmodic effect on the bronchi, bile and urinary tract. Increases diuresis to a small extent (more pronounced with theophylline).

A cup of coffee contains a single dose of caffeine (100 – 150 mg). Excessive consumption of tea and coffee can lead to addiction and dependence (theism). Taking large doses causes poisoning, which is characterized by agitation, confusion of thoughts, increased blood pressure, tachycardia and unpleasant sensations in the heart area.

Indications for the use of caffeine and sydnocarb:

1. Asthenic conditions with mental illness, after suffering from intoxication, neuroinfections, brain injuries. Sidnocarb is prescribed. Use for a short period of time (2 – 3 weeks) due to the possibility of addiction. Doses are selected individually.

2. To weaken the side effects sedative effect(drowsiness, decreased performance, depression) during treatment with anticonvulsants, antihistamines, tranquilizers. Caffeine is prescribed in small doses in the morning, in short courses.

3. Hypotension of various origins (trauma, intoxication, infectious diseases) to restore the tone of the vasomotor center and to increase tone venous vessels when blood is deposited in dilated veins and its venous return to the heart falls. Caffeine is used parenterally - 10% solution, 1-2 ml subcutaneously every 2 to 3 hours.

4. For a one-time increase in performance, physical endurance in emergency conditions, when it is necessary to perform work in short term, at night, at a very high pace, or perform a maximum volume load. Sidnocarb is prescribed once at a dose of 0.02 - 0.03 before work or in the middle, followed by rest. Repeated use within 24 hours is dangerous, as it gives a paradoxical effect and complications. Can be prescribed in short cycles of 2-3 days, subject to rest at night. Caffeine is less effective, but can replace sydnocarb. Prescribed in pure form at 0.05 - 0.15 2 - 3 times a day or in the form of drinks and chocolate.

Features of the action of benzimidazole derivatives (bemityl):

1. Increases efficiency, reduces muscle weakness, feeling tired, quickly restores performance after exercise. (actoprotective effect). The activating effect on mental and physical performance is comparable to that of sydnocarb under normal conditions and superior to it under unfavorable conditions (hypoxia and hyperthermia).

2. Reduces the body’s need for oxygen and increases resistance to hypoxia – antihypoxic effect; weaken the processes of peroxidation - antioxidant effect, reduce heat production.

3. Eliminates mental inhibition, improves mental activity, the learning process, and has a psychostimulating and anti-asthenic effect.

4. Positive effect on cerebral vessels.

5. Immunostimulating effect.

6. Stimulates reparative processes in the liver after damage and intoxication.

7. Adaptogenic effect – accelerates the body’s adaptation to hypoxia, hyper- and hypothermia and others adverse effects environment.

Application:

1. Asthenic conditions with neurasthenia, somatic diseases, after traumas suffered, intoxications, infections, after transferred operations, when overworked.

2. Included complex therapy progressive muscular dystrophies, epilepsy, disorders cerebral circulation.

3. As part of complex therapy viral hepatitis and toxic liver damage.

4. To improve immunity in patients who often suffer from respiratory diseases viral infections, recurrent erysipelas, pyoderma. For prevention infectious diseases during the epidemic.

5. Healthy people in order to improve performance, prevent fatigue, quick recovery performance after exercise, to accelerate adaptation to unfavorable conditions environment.

Apply after meals at 0.25 - 0.5 2 times a day in 5-day courses with a 2-day break between them. The average number of courses is 2 - 3. For prevention - once a day, 0.25.

Side effects:

Irritant effect on the gastrointestinal tract when taken on an empty stomach, there are discomfort in the stomach and liver, nausea, vomiting, allergic reactions.

Nootropics

Nootropics have an effect primarily on higher brain functions: they improve and restore memory, learning, and mental activity in case of impairment; increase the brain's resistance to adverse influences.

They do not have a pronounced psychostimulating or sedative effect. Stimulates the transfer of information between the hemispheres of the brain, improves energy and plastic processes in brain tissue. Nootropics are characterized by low toxicity and good tolerance by patients of different age categories.

Classification:

1. Pyrrolidone derivatives (racetams):

Piracetam (Nootropil, Lucetam, combination drug - Phezam)

Fenotropil

2. GABA derivatives:

Pantogam

Picamilon

Aminalon

Phenibut

Hopanthenic acid (Pantocalcin, Pantogam)

3. Drugs of other groups:

Pyritinol (Encephabol)

Acefen (Meclofenoxate, Centrophenoxine)

Gliatilin (Cerepro)

Cerebrolysin

Cortexin ( combination drug with glycine)

Noopept

Vinpotropil

4. Herbal preparations:

Memoplant – based on ginkgo biloba

Bilobil

Tanakan

Mechanism of action:

The main effect of the drugs is to improve energy and plastic metabolism in nerve tissue: activate the utilization of glucose by the brain, the synthesis of ATP, RNA, proteins, membrane phospholipids.

The drugs of the group have the following effects:

1. Antihypoxic – increases the brain’s resistance to oxygen deficiency.

2. Antioxidant – block the damaging effects of active oxygen radicals.

3. Nootropic – improves memory and learning processes, mental activity. They increase concentration, reduce time and the number of errors when solving problems, improve long-term memory and the ability to perceive information. The effect appears 2 – 3 months after the start of treatment.

4. Cerebroprotective effect – increasing the brain’s resistance to adverse effects (hypoxia, overheating, cooling, stress)

5. Restorative effect - activation recovery processes in the damaged brain after traumatic brain injury, stroke, neuroinfection, intoxication with neurotropic poisons.

Application:

1. Impaired memory, attention, thinking after traumatic brain injury, stroke, intoxication, status epilepticus, asthenic conditions, chronic fatigue, some mental illnesses, and chronic circulatory disorders. Piracetam is the most effective. Course from 2 – 3 weeks to 2 – 6 months. In mild cases against the background chronic disorder for cerebral circulation, picamilon, acephen, and pyritinol are prescribed. At frequent attacks epilepsy and pulmonary cranial - brain injuries- pantogam.

2. To remove from comatose state after brain injuries and intoxications, relief of withdrawal and delirious syndromes in alcoholism and drug addiction, with acute poisoning morphine, barbiturates, alcohol. Piracetam is used intravenously or intramuscularly - a 20% solution, after improvement they switch to oral therapy.

3. For children who are behind in mental development, delayed speech development, poor learning ability, mental retardation. In geriatrics - to improve memory and maintain performance, with senile dementia– piracetam, pantogam, pyritinol, acephen.

4. Healthy people exposed to unfavorable factors, including stressful situations. As a preventive measure to protect the brain and maintain mental performance, piracetam is prescribed in a dose of up to 1.2 once or repeatedly in therapeutic doses of 0.4 3-4 times a day, as well as acephen 0.1 - 0.3 2 - 3 times a day. day.

Side effect:

Rarely occurs when taking piracetam. long-term treatment: dyspeptic disorders, hyperactivation - irritability and sleep disturbance.

Pyritinol often causes insomnia, irritability, and increased excitability.

Acefen sometimes aggravates mental disorders in patients with paranoid and hallucinatory symptoms.

Pantogam and picamilon essential side effects they don't call.

Related information.

CENTRAL NERVOUS SYSTEM STIMULANTS

Stimulants are conventionally divided into 4 large groups:

1. PSYCHOSTIMULANTS

a) psychomotor:

Phenamine;

Sidnocarb.

b) psychometabolic (nootropics):

Nootropil (piracetam);

Cerebrolysin;

Gamalon et al.

2. ANALEPTICA

a) direct action:

Bemegrid;

Etimizole, etc.

b) reflex action:

Tsititon et al.

c) mixed action:

Cordiamin et al.

3. SPINAL CORD STIMULATORS

Strychnine;

Sekurenin et al.

4. GENERAL TONIZERS (ADAPTOGENS)

A) plant origin:

Preparations of ginseng, eleutherococcus, aralia, golden root, maral root, Bittner's balm, etc.

b) animal origin:

Pantocrinus et al.

PSYCHOSTIMULANTS and NOOTROPICS

PSYCHOSTIMULANTS

Psychostimulants (or psychotonics, psychoanaleptics, psychomotor stimulants) increase mood, the ability to perceive external stimuli, and psychomotor activity. They reduce the feeling of fatigue, increase physical and mental performance (especially when tired), and temporarily reduce the need for sleep (drugs that invigorate a tired body are called “doping” - from English to dope - to give drugs).

Unlike CNS depressants, stimulants have less important, since they lack selectivity of action. In addition, stimulation of the central nervous system is accompanied by its subsequent inhibition.

CLASSIFICATION OF PSYCHOSTIMULANTS

1) Drugs acting directly on the central nervous system:

a) stimulating primarily the cerebral cortex (xanthine alkaloids, phenamine, sydnocarb, methylphenamine, meridol, etc.);

b) stimulating mainly medulla(bark<зол, кордиамин, бемегрид, камфора, двуокись углерода);

c) stimulating primarily the spinal cord (strychnine).

2) Drugs that act on the central nervous system reflexively (lobeline, veratrum, nicotine).

It should be remembered that this division is conditional and when used in large doses they can stimulate the central nervous system as a whole.

A typical representative of psychostimulants is PHENAMIN (amphetamine sulfate; tablet of 0.005; drops in the nose, in the eye 1% solution). Chemically it is a phenylalkylamine, that is, similar in structure to adrenaline and norepinephrine.

THE MECHANISM OF ACTION is associated with the ability to release NORADRENALINE and DOPAMINE from presynaptic endings. In addition, phenamine reduces the reuptake of norepinephrine and dopamine.

Phenamine stimulates the ascending activating reticular formation of the brain stem.

PHARMACOLOGICAL EFFECTS

INFLUENCE ON THE CNS

Powerful central nervous system stimulant. It increases mental and physical performance, improves mood, causes euphoria, insomnia, tremors, and anxiety. In therapeutic doses, it has an awakening effect, eliminates fatigue, and increases physical capabilities. Stimulates the respiratory center and in this regard acts as an analeptic.

INFLUENCE ON THE CARDIOVASCULAR SYSTEM

Increases both systolic and diastolic blood pressure. Tachyphylaxis is known in relation to the hypertensive effect of phenamine.

SMOOTH MUSCLE

Phenamine increases the tone of the bladder sphincter and relaxes the bronchial muscles, but only at high doses. Phenamine reduces appetite (on the hypothalamus), has some anticonvulsant effect (for Petit mal).

ADVERSE REACTIONS

An undesirable effect is stimulation of the sympathetic nervous system (tachycardia, anxiety, headache, tremor, agitation, confusion, paranoid psychosis, angina attacks).

The drug causes drug dependence, mainly mental, and accumulates. Tolerance may develop.

INDICATIONS FOR USE:

1) neurotic subdepression;

2) for narcolepsy, for catalepsy, to prevent pathological drowsiness (narcolepsy);

3) obesity;

4) as an analeptic for poisoning with narcotic analgesics.

Pyridrol and Meridol are similar to phenamine in their effect on the central nervous system. They do not have unwanted peripheral adrenomimetic effects.

In addition to phenamine, the group of phenylalkyl synnonimines also includes the active psychostimulant drug sydnocarb (mesocarb). This is an original domestic drug, slightly different in chemical structure from phenamine. In Russian clinics, sydnocarb is currently the main psychostimulant. Compared to phenamine, it is significantly less toxic and does not exhibit a pronounced peripheral sympathomimetic effect. The psychostimulating effect develops gradually, but it is longer lasting and is not accompanied by euphoria and motor excitement. As a rule, there is no tachycardia and a sharp increase in blood pressure. After the effect of the drug, the patient does not experience general weakness and drowsiness. The drug is used for various types of asthenia, occurring with lethargy and lethargy, apathy, decreased performance, hypochondriasis, and increased drowsiness.

The drug is used as a psychostimulant for asthenic and neurasthenic disorders in patients who have suffered intoxication, infection and brain injury, and in some forms of psychosis.

In addition, sydnocarb is used to relieve asthenic manifestations after the use of neuroleptics, tranquilizers, as well as in the treatment of patients with alcoholism (relief of asthenoneurotic reactions during the period of “alcohol withdrawal”, to reduce the phenomenon of withdrawal).

Sidnocarb is also used in the treatment of children with mental retardation, accompanied by adynamia, aspontaneity, lethargy, lethargy, and asthenia.

Side effects. In case of an overdose, increased irritability, anxiety, and decreased appetite are possible. In patients with psychosis, delusions and hallucinations may increase. Sometimes there is a moderate rise in blood pressure.

The drug is available in tablets of 0.005; 0.01; 0.025.

The industry also produces the combined drug Sidnogluton, containing 0.025 sydnocarb and 0.1 glutamic acid. The latter potentiates the psychostimulating effect of sydnocarb.

Drugs that primarily stimulate the cerebral cortex include XANTHINE ALKALOIDS (purine derivatives; metalxanthines), a typical representative of which is CAFFEINE.

Xanthine alkaloids are found in several plants grown throughout the world. Three natural xanthine alkaloids are found in these plants: caffeine, theobromine, theophylline, which are purine bases. When heated with nitric acid, they form a yellow precipitate, hence the term xanthines (Greek - xanthos - yellow). Caffeine is found in tea leaves (Thea sinensis - 2%), coffee seeds (Coffea arabica - 1-2%), cocoa seeds (Theobroma acuminata), etc.

PHARMACOLOGICAL EFFECTS

Caffeine has the most pronounced effect on the central nervous system, followed by theophylline and theobromine. The effect of caffeine on higher nervous activity depends on the dose and type of nervous system. In small doses, caffeine increases the activity of the cortex, in large doses it inhibits it. In small doses, it helps speed up the thinking process and makes it clearer, brings clarity to the train of thought, reduces drowsiness, fatigue and gives the ability to perform intellectually complex tasks. It reduces reaction time, increases motor activity and strengthens conditioned reflexes. These effects can be observed after 1-2 cups of coffee. One cup contains about 1500 mg of caffeine.

Higher doses cause increased excitability, confusion, insomnia, headache, and tremors. Theophylline in large doses can even cause seizures.

MEDULLA

High doses directly stimulate the respiratory, vasomotor and vagus nerve centers. This leads to increased breathing (faster and deeper), increased blood pressure, and tachycardia. True, in large doses, tachycardia and arrhythmias occur, that is, its peripheral effect predominates (cardiac output increases).

SPINAL CORD

Very large doses increase reflex excitability of the spinal cord and can lead to clonic convulsions.

BLOOD VESSELS

Xanthines have a myotropic effect on blood vessels, but this vasodilating effect is short-lived. It should not be used to treat peripheral vascular disease.

Xanthines have ambiguous effects on different vascular areas. The latter helps with migraines. Caffeine has a weak myotropic antispasmodic effect on smooth muscle organs (bronchi, bile ducts). This is of great importance for the clinic. It has long been known that theophylline eliminates bronchospasm during anaphylactic shock, stimulates skeletal muscles, increases their metabolism, and eliminates their fatigue.

Caffeine increases BASIC METABOLISM. Increases glycogenolysis, causing hyperglycemia. Increases lipolysis, releases adrenaline from the adrenal medulla.

Xanthines increase diuresis. Theophylline is the strongest in this regard, followed by theobromine and caffeine.

Xanthines increase the volume, acidity and pepsin content of gastric juice.

THE MECHANISM OF ACTION is associated with two directions:

1) xanthines inhibit cyclic nucleotide phosphodiesterase and prevent the transition of cAMP to 5-AMP;

2) cause changes in the distribution of calcium at the level of intracellular processes.

ADVERSE REACTIONS

1) Confusion, tremor, headache, insomnia. Ringing in the ears, headache, tachycardia, shortness of breath, arrhythmias. For these reactions, sedatives should be prescribed.

2) Kspntins are contraindicated in patients with peptic ulcers and gastritis.

3) To xanthines, addiction develops, to a greater extent - mental dependence, which, however, is not dangerous.

INDICATIONS FOR USE

To stimulate mental activity. With fatigue, with symptoms of asthenia, with migraine, hypotension. For absent-mindedness, impaired attention, exhaustion.

Caffeine is part of many combination drugs with non-narcotic and narcotic analgesics: citramon, Panadol extra, solpadeine, as well as with ergot alkaloids - the drug caffeamine.

NOOTROPICS, NOOTROPICS

The term is derived from the Greek - noos - thinking, tropos - desire, affinity. Agents that have a special effect on the higher integrative functions of the brain, stimulating memory, learning, and improving mental activity.

Improving mental and mental activity is the main effect of this group of drugs. This manifests itself in mental deficiency associated with organic brain damage.

Mechanisms of action of nootropic drugs at the neurophysiological level: influence on transchannel and other types of polysynaptically evoked potentials recorded on the EEG.

The direction of action of nootropic drugs indicates their pronounced influence on the integrative activity of the brain and the processes of information transmission in the brain. Probably, under the influence of nootropics, various brain formations and information transmission processes in the brain are tuned to the theta rhythm. The ability of nootropic drugs to improve learning and memory processes is based on the process of increasing the level of spatial synchronization of brain biopotentials.

It should be noted that these drugs do not affect the higher nervous system of healthy animals and the psyche of a healthy person. They normally do not change many behavioral reactions, conditioned reflexes, bioelectrical activity of the brain, and motor activity.

The pharmacotherapeutic effect of nootropics at the molecular level in pathological conditions is based on their beneficial effect on neurometabolism and brain energy. Therefore, this group of drugs is also called psychometabolic stimulants. The main nootropics used in practice mimic the metabolic effects of aminobutyric acid (GABA).

The first drug synthesized abroad in the late 60s in the research laboratory of UCB (Belgium) was called NOOTROPIL. In our country there is an analogue - PIRACETAM (Piracetamum; in the table, 0.2; in an amp. 20% solution, 5 ml; capsules - 0.4). It is a classic nootropic drug, therefore it is most often used by doctors of various specialties.

PHARMACOLOGICAL EFFECTS

Piracetam (nootropil) is a cyclic derivative of GABA. Nootropics improve the metabolism of brain cells and, above all, the metabolism of glucose and oxygen in them, increase the resistance of cells to hypoxia, improve blood supply to the brain, and communication between the hemispheres. Nootropics increase memory and reduce fatigue. But the effects appear gradually, not immediately after administration. Piracetam has anticonvulsant activity, and in recent years its immunomodulatory effects and immunopotentiating effects have also been described.

INDICATIONS FOR USE:

In conditions after a concussion;

In mentally retarded children with varying degrees of mental retardation; in children with memory, attention, and speech disorders;

For old people, elderly people, in geriatrics to improve memory and mood;

For chronic treatment of drug addicts, alcoholics;

In patients after a stroke;

Nootropics are indicated for enuresis in young children.

In addition, it is prescribed to potentiate the effects of immunostimulants.

AMINALONE is a GABA drug. Obtained synthetically. GABA is an inhibitory neurotransmitter that plays an important role in the metabolic processes of nervous tissue. The drug stimulates tissue respiration, activates Krebs cycle enzymes, and improves the utilization of glucose by neurons.

Indications for use: vascular diseases of the brain, mental retardation in children.

Side effects of nootropics: brain stimulation can lead to irritability, sleep disturbances, mood disorders, anxiety in children, increased blood pressure, and sexual excitability. Therefore, they are used in courses (2-3 weeks).

In recent years, the group of nootropic drugs has expanded significantly. This includes the Hungarian drug Cavinton (Gedeon Rihter), Cerebrolysin, etc.

CAVINTON (table. 0.005; amp. 0.5% solution, 2 ml). Ethyl ester of apovincamic acid (a preparation of Vinca minor alkaloid).

Cavinton has the following effects:

1) dilates brain vessels;

2) increases cerebral blood flow, improves oxygen supply to the brain;

3) improves glucose utilization by neurons, promotes the accumulation of cAMP and ATP;

4) reduces platelet aggregation;

5) increases the content of catecholamines in the central nervous system.

It is used primarily in neurology for:

1) neurological and mental disorders associated with cerebrovascular accidents (stroke, trauma, sclerosis);

2) memory disorders;

3) dizziness;

4) aphasia;

5) hypertensive encephalopathy;

6) atherosclerosis of retinal vessels, i.e. in ophthalmology, etc.;

7) decreased hearing of toxic origin.

Nootropics, the list of drugs of which today is represented by a wide range of drugs, date back to 1963. At that time, Belgian clinicians and pharmacologists managed to synthesize and use in medical practice the first drug from the group of nootropics - Piracetam.

Numerous studies have proven clinical improvements in patients of various groups with constant use of Piracetam, including increased memory and facilitation of learning processes.

In 1972, the term “nootropics” was coined to designate a class of drugs designed to improve the integrative functionality of the brain. In modern neurology, nootropic drugs are an integral part of the treatment of various disorders in children and adults.

Characteristics of the pharmaceutical group

Nootropics(from Greek noos - mind, thoughts and tropos - vector, direction) are widely used in neurological practice to positively influence the higher integrative functions of the brain. With the help of drugs, they correct some behavioral reactions in people and adults, increase resistance to stressful situations, learning ability, and chronic hypoxia. Other functions of the drugs are:

maintaining the energy structure of a neuron (nerve cell);

improving the functionality of the central nervous system;

activation of the plastic functionality of the central nervous system;

providing a pronounced neuroprotective effect;

normalization and stabilization of the cell membrane;

minimizes the need of nerve cells for oxygen.

The nootropic effect can be primary with a direct effect on neurons and secondary with an improvement in general cerebral circulation. There are two main groups of nootropics:

true (improvement of mnestic functions of the brain and nervous system);

combined action (combination of several functions simultaneously).

Synonyms of the pharmacological group of nootropics are cerebroprotectors, neuroregulators, neuroanabolics, eutotrophic, neurometabolic drugs. All terms reflect the general effect of the drugs - the ability to stimulate metabolic processes in the nervous structures of the human body.

Mechanism of action

Nootropic drugs directly affect the whole range of functional abilities of the brain, promoting their active activity. Thanks to adequate therapy, concentration improves and interactions between the right and left hemispheres are facilitated. It has been proven that the drugs rejuvenate the body and prolong the life of patients with a burdened clinical neurological history.

The biogenic origin of the drug significantly affects all processes of intracellular metabolism, stimulating protein synthesis, excretion of excess glucose, and ATP formation. The following mechanisms and effects of influence are distinguished:

membrane stabilizing effect;

antioxidant;

antihypoxic;

neuroprotective.

There is a significant increase in the brain's resistance to the negative effects of exogenous and endogenous factors. The effectiveness of the drugs is enhanced by the simultaneous use of angioprotectors and psychostimulants. The main category of patients who are prescribed nootropics are children and the elderly.

Main indications for use

Typical indications for prescribing nootropic drugs are the following conditions:

psychoorganic syndrome (dystrophic changes in nervous tissue of any origin);

alcoholism with withdrawal syndrome;

drug addiction;

neuroleptic syndrome (as a combination therapy);

neurotic or organic asthenia;

cerebrovascular insufficiency;

sickle cell anemia;

ophthalmological pathologies (complex therapy).

Neurogenic urinary disorders are treated with the help of nootropics. Nootropic drugs are a necessary measure for Parkinson's disease, ischemia, cerebral palsy, and epileptic seizures.

Contraindications and side effects

Nootropic drugs can be prescribed with relative contraindications at the discretion of the attending physician. Absolute contraindications include acute or chronic renal failure, pregnancy and lactation, complicated liver diseases, acute hemorrhagic stroke, hypersensitivity, severe psychomotor agitation. Side effects of the drug include the following conditions:

sleep disturbance, insomnia;

dyspeptic disorders;

increased excitability:

anxiety syndrome, panic attacks;

hypotension;

increased effect on hepatic or renal function;

convulsive syndrome, epileptic seizures;

loss of coordination, unsteadiness of gait;

redness of the face, feeling of heat;

severe iosinophilia;

hallucinations and confusion;

thrombophlebitis, febrile syndrome.

While taking the drug, allergic rashes on the body such as urticaria, itching, burning on the skin, mainly in the neck, face, and back are possible. If any discomfort occurs, it is recommended to stop treatment or adjust the daily dosage. Cases of drug overdose have not been registered.

Basic nootropic drugs

Which ones are better in the treatment of neurological diseases? The use of nootropic drugs can be combined or independent. Typically, nootropics are used as stand-alone therapy for minor disorders. The following drugs with proven effectiveness are widely used in neurological practice:

Nootropic drugs for the treatment of serious neurological disorders are used in adult neurological practice. When used as complex therapy, the likelihood of a decrease or increase in the activity of other drugs is taken into account.

The best nootropics for children

In pediatric practice, nootropics are used to treat mental retardation, to improve attention, speech development, and poor performance at school. Children's nootropic drugs have been widely used since 1952. The main reasons for prescribing are the following conditions in children of different ages:

cerebrovascular disease;

hypoxic syndrome in cerebral palsy:

poor speech development;

intellectual disability;

encephalopathy.

It has been proven that in childhood the tolerability of nootropic drugs is much better than in adults. The main medications for children are the following:

Piracetam(Nootropil, Cerebril, Lucetam, Oykamid).


Suitable for use in children over 1 year of age, available in tablets, ampoules, and capsules. Not prescribed for children with increased emotional excitability. The active substance has a beneficial effect on the brain, increases sensitivity to intellectual stress, stabilizes concentration, and promotes learning.

Pantogam.


An anticonvulsant drug suitable for children from the first days of life. It is sold from pharmacies in the form of syrups and tablets. It is used to treat cerebral palsy, improve the condition of autism, and schizophrenia. Pantogam is used for children with neurogenic or stress urinary incontinence. Also, with constant use, the child’s emotional background is normalized, especially with delayed mental and speech development. The likelihood of developing side effects is also reduced: drowsiness, allergic reactions, dyspeptic disorders.

Picamilon.

The drug, intended to dilate blood vessels in the brain, is an analogue of Piracetam in terms of active substance and effectiveness. Has a mild tranquilizing effect. It is sold from pharmacies in the form of injections for intravenous and intramuscular administration, in tablets. In pediatrics, it is prescribed to children from 3 years of age. The nootropic drug is especially effective under high emotional stress and increased physical and mental activity.

Phenibut.


The product belongs to the latest generation of drugs. Prescribed to children to stimulate the normal functioning of the nervous system, increase mental and intellectual activity, while helping to cope with overload. The drug has a low degree of toxicity and is suitable for children over 2 years of age. The main side effects include nausea, increased drowsiness, and dizziness. Available from pharmacy chains in the form of powder and tablets.

Pyritinol.


The drug is intended for the effect of mild sedation. Necessary for the treatment of depressive syndrome in adolescents, vegetative-vascular dystonia, and excessive fatigue. It is a complex drug for mental and mental retardation. Not recommended for use in children under 12 months. Despite its high activity, the drug has a number of side effects: loss of taste, dyspnea, polymyositis, nausea and dizziness.

Cinnarizine(Vertisin, Disiron, Cyrizin, Balcinnarzin, Cinnarone).


It is used in pediatrics to treat children over 12 years of age, but recently it has been used in children from 1 year of age. The drug has many side effects, from typical nausea to epileptic attacks, renal and liver dysfunction, and arterial hypotension. The effectiveness of the drug has not been proven. The drug is available in the form of capsules and tablets.

Semax.


The drug is widely used in pediatric practice due to its high efficiency and convenient pharmacological form. The drug eliminates excessive moodiness and emotional excitability. Side effects include dizziness, nausea, and irritation of the nasal mucosa. Used in children with delayed speech development and sleep disturbances.

Glycine.


The active ingredient is aminoacetic acid. The drug is well tolerated by young children and is effective against excessive emotional arousal. With long-term use, performance and learning ability are activated, night sleep is regulated, and concentration of attention increases. Glycine is suitable for treating children of any age.

Gammalon.


New from Japan, is a follower of Piracetam. A similar composition of Gammalon is contained in Aminalon, but the price of the drug is much lower. If the cost of a Japanese nootropic reaches 2,500 rubles. per package, then Aminalon costs 100-150 rubles. per package. The effectiveness of both drugs has not been studied or proven. The price and quality of the Japanese product is more of a marketing ploy.

Experts have different opinions about the effectiveness of nootropics in children. Some consider drugs to be indispensable tools in the treatment of any neurogenic disorders and psycho-emotional disorders. Others doubt the effectiveness of nootropic drugs due to the lack of clinical data for use in childhood. Basically, nootropic drugs are used for “calming” as an adjuvant treatment to basic treatment. All drugs are dispensed from pharmacy chains without a prescription.

List of the best nootropics

Which drugs are best to take in a specific clinical situation should be decided by the attending physician. Today, there are several of the most effective drugs that have found wide application in both pediatrics and adult practice for the treatment of diseases of a neurogenic nature:

Piracetam;

Nootropil;

• Cerebrolysin;

  Vinpocetine;

  Biotredin;

  Aminalon;

  Biotredin.

The effect of constant use of modern nootropic drugs begins only after a few months. As an independent drug, nootropics are used to prevent neurological diseases, decreased performance in adults, and impaired concentration.

Combined products

Among nootropics, there are drugs with a combined composition. Such products include two or more active components, which to one degree or another enhance or reduce the effect of each other. The main drugs in the series are:

Gamalate B6 (composed of pyridoxine hydrochloride, magnesium glutamate hydrobromide);

Omaron, Fezam, Evryza, Noozom (Piracetam and Cinnarizine, auxiliary components);

Neuronorm (active ingredients Piracetam and Cinnarizine);

Olatropil (Piracetam and GABA);

Thiocetam (Piracetam and Thiotriazolin).

All products are similar in effectiveness to Piracetam. Combination drugs are used for severe problems; similarly to popular drugs, they are used in monotherapy and in combination with other drugs.

All medications, despite the absence of side effects, require a doctor's prescription. Only on the basis of medical examination data can an accurate diagnosis be established, which will determine further adequate treatment.

• Piracetam (Nootropil)

Hello, dear friends!

Still, thoughts about laser vision correction do not leave me alone. I can’t even believe that you can get rid of eye problems once and for all, break your glasses, flush your lenses down the toilet and live a full life.

“But this is still an operation, an intervention in the body. Think 100 times!” - Mom warns me.

“The correction costs money. What if it doesn’t help? - the husband is being miserly.

“Perhaps all sorts of exercises, drops, vitamins would be better?” - whispers a cautious inner voice.

My dears, my dears!!! Where does this pessimism come from? Read this interesting article, you will learn that the history of laser vision correction goes back 30 years, and during this time the technique of performing the operation has been perfected. Do you also have doubts, dear readers? So, you should also study the information from this article.

Apparently, the issue of the safety of operations to restore vision occupies one of the main places in the minds of Russians.

Laser correction, the most popular method of correcting myopia, farsightedness and astigmatism, is the subject of a lot of articles and studies, and is discussed by visitors to numerous forums and blogs. And among adequate and truthful information, various kinds of conjectures and judgments often slip through, which truly frighten the inexperienced reader seeking the truth.

What you won’t learn from the messages of well-meaning online visitors: it’s harmful and painful, and during correction they remove a layer of the cornea, but the problem ITSELF is not eliminated, and you will have to walk around with a blindfold for several months, and laser correction cannot be done on nulliparous women, and vision then falls again... Horror, Horror, I want to close my eyes and, exhaling, say: “No-no, I won’t let you cut my eyes, it’s better to look like that!”

Cut your eyes! Where did this even come from? And who came up with horror stories about bandages, the lack of statistics on laser corrections and other misconceptions? It’s difficult to answer this question, but in order to establish the truth once and for all, let’s turn to an irrefutable source: the history of the issue.

Radial keratotomy

So, the first method of vision correction called “radial keratotomy” appeared back in the 30s. last century. Its essence was that incisions were applied to the cornea of ​​the eye (from the pupil to the periphery of the cornea), which subsequently grew together.

As a result, the shape of the cornea changed and vision improved. However, these first vision correction operations were accompanied by many serious complications (one of them was clouding of the cornea, leading to loss of vision).

The accuracy and stability of the result of such vision correction also left much to be desired, since the speed of healing depends on the individual speed of regeneration of the cells of each person’s body - some can boast that their wounds heal instantly, while others are forced to walk with a bandage for weeks due to for the slightest scratch...

And besides this, the surgeon’s instruments were often far from micron precision. It was this method that gave rise to many rumors and prejudices that frighten people of the 21st century.

This method received a new life in the 70s, when it was improved by the famous ophthalmic surgeon Svyatoslav Fedorov. New diamond instruments and microscopes have already appeared, allowing the radial keratotomy method to move to a qualitatively new level.

However, this technique still required a long period of rehabilitation, and was often accompanied by complications; the patient could lose vision from accidental stress during any load. Well, the question of the predictability of the result and the accuracy of its execution still remained open.

Few managed to obtain the desired “unit”. This is where the roots of many prejudices about laser vision correction come from. Therefore, attempts to find another way to restore good vision were not abandoned.

The history of the excimer laser, actively used in modern ophthalmology, begins in 1976. Then the attention of medical scientists was attracted by the developments of IBM Corporation. IBM specialists used a laser beam to engrave the surface of computer chips. This procedure required truly jewelry precision (down to microns). Therefore, this know-how seriously interested doctors.

As a result of the research, doctors have established that the safety of using a laser beam and the ability to control it in depth and diameter of the impact zone is of particular importance in such a delicate area as refractive surgery. And the triumphant march of laser vision correction technology began.

In 1985, the first laser vision correction using the PRK technique was performed. As with radial keratotomy, the cornea of ​​the eye was directly exposed. But the principle of influence was completely different. No notching was required. The shape of the cornea changed under the influence of a laser, which evaporated tissue from its surface and formed a new surface.

High accuracy made it possible to achieve good predictability of the result and a significant reduction in the side effects of vision correction. But for the patient, the period of restoration of the surface layer (2-4 days) was extremely unpleasant, and adaptation ended only after 3-4 weeks. But, despite this, the patients were very satisfied, because the acquired excellent vision made it possible to very quickly forget about these unpleasant sensations.

Lasik technique

The most popular Lasik technique today appeared in 1989. Its main advantage was that the superficial layers of the cornea were not affected, and the evaporation of corneal tissue occurred from the middle layers.

This method of laser correction has become a real revolution in refractive surgery, and today LASIK allows vision correction to be carried out under local anesthesia in a few minutes, significantly reducing the recovery period.

During correction, using a special device - a microkeratome, the surface layer of the cornea with a thickness of 130-150 microns is bent, after which the laser evaporates part of the cornea and the flap is placed in place. Restoration of the epithelium along the edge of the flap occurs within a few hours after correction, and it is securely fixed; the patient immediately notices a significant improvement in vision. Its sharpness is finally restored within a few days.

LASIK technology underwent multi-stage clinical trials before it began to be used in ophthalmology centers and clinics. Long-term observations of patients have shown that the excimer laser does not cause any disorders, since the impact occurs only on one of the refractive media - the cornea, and the depth of impact is strictly limited.

Today, medical centers and clinics in 45 countries work with it. Over the past 10 years, about 5 million vision corrections using the Lasik technique have been performed worldwide. In the USA and Japan, the procedure for restoring vision using laser vision correction has long gone beyond the confines of specialized clinics.

Often small laser correction centers can be seen in the territories of large shopping and entertainment complexes, next to dental and cosmetology offices and beauty salons. The patient undergoes a vision diagnosis, and then, according to the data obtained during the examination, the doctor makes a correction.

In addition, the US government, as part of the National Armed Forces Improvement Program, year after year pays for laser vision correction for military personnel of all ranks and branches of the military.

The high level of safety of the procedure and advanced laser installations of the latest generation have made the laser correction procedure simple and accessible to everyone. Of course, we must not forget that, like any medical method, laser correction has some contraindications and limitations. It is not recommended for people suffering from:

• HIV infection
• tuberculosis
• diabetes
• some skin and eye diseases
• pregnant women
• nursing mothers

But for those who can restore their vision using this technology, the correction becomes a real salvation. After all, it is an incomparable pleasure to look and see the world around us bright and clear every day.

Among the thousands of people who have undergone laser vision correction, there is not a single one who would at least once regret their decision to give up glasses and contact lenses. Former patients of ophthalmologists often admit that only after laser correction did they begin to feel like full-fledged people.

It's so nice to not care about the fact that you might not see something. Having made the correction, they persuade all their visually impaired friends to do this feat. And they, in turn, then wonder why they were so poorly persuaded and could not be convinced earlier?

The truth about laser correction is that it really helps get rid of nearsightedness, farsightedness and astigmatism. Today it is the most reliable and perfect way to restore vision, allowing you to forget about glasses and contact lenses once and for all!

http://excimerclinic.ru/press/true/

Day of laser vision correction surgery through the patient's eyes

DAY OF OPERATION. This is how one patient describes LASIK laser vision correction surgery.

9.30 This morning I find myself away from cosmetics and perfumes, which is mandatory for eye surgery. I have not been wearing contact lenses for two weeks now so that my eye returns to its normal state before the operation.

10.00 After a light breakfast, I leave the house accompanied by my husband. During the operation he will wait for me and then take me home.

11.00 ARRIVAL at the clinic
"Good morning, how are you?" They greet me warmly at the reception. Yesterday I wrote a statement of consent to the operation. I have no more questions, and I am invited to the reception department.

11.10 Brief eye examination. The doctor checks my eyes one last time before surgery.

11.20 In the preparation room I receive a cap and shoe covers that I need to wear during the operation. Then they put some local anesthetic medicine in my eye and disinfect the skin around my eyes. "How are you feeling?" the nurse asks me. She offers me a sedative for any possible nervousness.

11.30-11.50 OPERATION
I go to the operating room and lie down on the bed. The doctor opens my eyes and instills eye drops into me again.

11.45 I feel a brief pressure, it becomes dark, the eye is treated with a microkeratome knife. Then it becomes light again and I can hear the laser working on my eye. I do not feel anything.

11.50 Having finished the work, the doctor asks me: “Are you feeling well?” I feel good and can already get up. The doctor checks the result of the operation using a special lamp - he is happy with everything.

11.55 I can leave the operating room and change clothes. Then I sit on the sofa in the clinic lobby and relax. Laser eye surgery is over. A polite nurse offers me coffee.

12.15 The operated eyes are checked again. Everything is fine! I am given antibiotic eye drops and some simple advice.

12.20 WE ARE LEAVING

"Bye see you tomorrow!" — the receptionist says goodbye to me after she has scheduled my follow-up visit for the next day.

http://www.cvz.ru/laser-correction/operation-laser/den-operacii-glazami-pacienta/

Laser vision correction is a harmless and effective technology for correcting farsightedness, myopia and astigmatism. The correction process helps improve vision and eliminates the need to wear glasses.

Previously, people suffering from farsightedness and myopia had the only way to improve their vision - wearing glasses. In 1939, ophthalmic surgeon Sato from Japan laid the foundations for such a surgical intervention as radial keratotomy (during the procedure, incisions are made on the cornea). However, complications arose and the development of the methodology stopped. Only in the 1970s did the doctor Stanislav Fedorov improve his surgical technique. During this period, the first experimental laser was created, and the first correction operation using a laser was carried out in 1985 in Berlin. This technology for restoring the ability to see clearly was immediately recognized by leading experts in the world. Thanks to the list of advantages, this method is widely used today in 53 countries around the world.

Technology

There are many intervention methods in medical practice. Let's look at some of them in more detail.

Photorefractive keratectomy– the method was first used in the 1980s and involves exposing the upper corneal layers to an excimer laser. There is no effect on the internal structures of the eye. The recovery process is quite long.

Laser assisted keratomileusis (LASIK)– during surgical manipulation, specially designed medical devices (microkeratomes) are used. This equipment provides the ability to lift the upper corneal layers. This frees up the middle layers for laser therapy. Advantages: painless procedure, short rehabilitation period.

L laser epitheliokeratectomy (LASEK)– the epithelial layer is preserved and an epithelial flap is applied to the surface of the cornea.

The results of surgical intervention depend not only on the chosen method, but also on the experience and qualifications of the doctor. You can obtain additional information directly about this procedure by following the link http://medbooking.com/services/category/lazernaja-korrekcija-zrenija.

The correction technique is selected for each patient individually, taking into account the characteristics of the body, indications and contraindications. The selection of the method is carried out by an ophthalmologist. A link to the Internet portal http://medbooking.com/services/category/konsulytacija-okulista will help you in selecting a qualified specialist. The website provides information on how you can consult an ophthalmologist and make an appointment with an experienced doctor. This portal presents to your attention the widest database of specialists in this field.

The benefits of using a laser to restore vision

• Accuracy and reliability. The first correction was carried out long before today, so we can say with confidence that the technique is effective and reliable.
• Wide range of applications. There are no age restrictions, the technology allows you to eliminate various eye diseases.
• Speed ​​of implementation. The duration of the procedure is from 15 to 20 minutes. The laser effect is applied only for 50 seconds, after which the patient is left under the supervision of a doctor for several hours and sent home.
• Painless. Local anesthesia is used - special drops are simply placed in the eyes.
• No hospitalization. Treatment can also be carried out on an outpatient basis. The person is discharged home the same day. This procedure is more of a cosmetic one, so in the absence of complications, which are very unlikely, you won’t even need a sick leave.
• The postoperative stage is reduced to a minimum. The client begins to see perfectly immediately after the manipulations are performed; vigilance is finally restored within eight days.
• Predictability of results. Thanks to diagnostic measures, the attending physician has the opportunity to predict the future acceptable outcome of the intervention. Studies and observations have shown that no cases of visual impairment were found.
• Use of the latest, modern equipment in work allows the operation to be carried out quickly.

Contraindications to laser therapy

• in acute form.
• Cataract (even if it is at an early stage).
• Myopia that progresses.
• Infectious diseases in severe form.
• Previously undergone surgery for retinal detachment.
• Iridocyclitis.
• Glaucoma.
• Inflammatory diseases that affect the visual system.
• Endocrine and other general pathologies.
• Psychological disorders.