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BRAZILIAN PEMPHIGUS.

Generalized different this form is endemic characterized spread such as south-west of Brazilian and surround of territories. Predominantly ill are young people before 30 ages. Damage mucous membrane oral cavity is not seen.

 

TREATMENT.

Possibility is treatment ill pemphigus discovery only 50 years after opening glucocorticoid and sytostatic. Before used glucocorticoid fatality end has 100%. In this tames glucocorticoid there is bases drug of treatment.

There are math arsenal synthetic glucocorticoid drug derivative cortisone or hydrocortisone (Prednisolone) including ftor synthetic drug (tryamsinolon, kenacort, polcortolon) and prolonged glucocorticoid (kenalog). By opinion learned is begin treatment pemphigus must of Prednisolone.

Treatment begin only in condition specialize hospital or department intensive therapy. 120 mg a day is adequately maximally doses of therapy it is allow getting positive therapeutic effects. Middle doses of Prednisolone have 60 mg (12 tabulate) or 2 ampoules (60 mg Prednisolone).

By use hormone therapy may be remember, that effective drugs increases if day doses of Prednisolone distribution by respective with physiology rhythm secretion glucocorticoid. Therefore maximal doses a day Prednisolone use in the morning what weakening negative influence drug on the function overkedney.

Exclusive impotent pole by corticosteroid therapy patients with pemphigus there is long tames use maximal doses drugs and tactics their lowering. Firstly maximal doses must save till beginning therapeutic effect such as not appear now eruption and epithelisation erosions. Term used maximal doses glucocorticoids compose by middle 10-15 days.

If about one week not therapeutic effect that day doses drug must be increase in 0.25% from firstly doses.

Decreases doses Prednisolone in the terms 1-2 years.

Merit attention methodic treatment ill pemphigus Prednisolone with combination Diprospane.

Diprospane there is corticosteroid’s drug prolonged action into the 1 ml close 5 mg betametazone dipropionaty and 2 mg betametazone dinatria phosphate. Action betametazone dinatria phosphate show firstly tames after introduction drug and disappears with urine every other or two day. By this tames graduation metabolizes betametazone dipropionaty and very slowly disappear (on the 10 day disappear about 40% drug).

Completely disappear of drug through 4-6 weeks. Diprospane has introduction intramuscular once in the 10 day. Usually firstly abolition injection drugs since having less therapeutic activity.

Before treatment maximal doses glucocorticoid ill need careful examined for discover according diseases and prescribe therapy such as:

Antihypertensive drug

 

Drugs decreasing stimulating influence on adrenergic innervations on cardiac- vascular system (neurotropic)     Central action Depression centrals of limbic-reticular complex Sedatives, tranquilizers, neuroleptics, hypnotic drugs
Depression tonus on vasomotor center Clophelinum, methyldopa (agonist of central a2 adrenoreceptor) and agonist L1 Moxonidine
  Peripheral action Ganglioblockers Benzohexonium, pentaminum, hygronium, trimetaphan
Symptholotics Reserpine, Ornidum, Octadinum
a-adrenoblockers Prezosinum, Terazosin, Doxazosin selective a1 Phentolamini hydrochloridum, Tropaphenum, Dihydroergotaminum, Dihydroergotoxinum non-selective a1, a2
b-adrenoblockers Anaprilinum, Nadolol, Timolol, Oxprenolol non-selective b1,b2 Metoprolol, Talinolol, Atenolol, Acebutalolum cardioselective b1
a-b adrenoblockers Labetalol
a-b1-b2 adrenoblockers Carvedilol
Drugs influencing on Rennin-angiotensis system Angiotensin-converting enzyme inhibitors Captopril, Enalapril, Ramipril
Angiotensin 2 antagonists losartan
Myotropic action   Action on ion-chan- nels Ca2+ channel blockers Diltiazem, Phenihydinum,
K+ channel activators Minoxidil, Diazoxidum
Other drugs Dibazolum, Magnesii sulfas
Diuretics (fluid-electrolytes metabolism) Spironolactone, Furosemidum, Hydrochlorothiazide

 



Glucocorticoid drugs influence on the fluid-electrolytes metabolism – repartition Na and K, number intracellular K increases and extacellular Na too. Number extracellular Na increases because of:

- increases reabsorbing Na in the kidneys;

- increases suck in Na in the digestive tract;

- increases intracellular K

Electrolyte Na is pull on the itself water and increase volume cerulean blood that promote increases pressure.

Influents on the hart-vascular system – looking increases pressure because of: - increase volume cerulean blood;

- increases is tonus of vascular since increases sensitive vascular ward from adrenaline.

 

Carbohydrate metabolism – looking hyperglycemia because of:

- increases gluconeogeneses;

- decreases activity insulin as glucocorticoid is antagonist, this developing exhaust pancreas gland and developing steroids diabetic;

- increases suck in glucoses in the digestive tract;

- more intensively appear glucoses in to blood from liver;

Prescribes is little doses antidiabetices drug (short action 4-6 hts)

Fatly metabolism – because of increases glucoses activation syntheses is trigluzerides and decreases metabolisms fat tissue.

Protein metabolism – increases disintegration protein and decreases their syntheses therefore looking osteoporoses and immunosuppressant since Ig’s composed from protein.

Anticoagulant drug – a) straight anticoagulant Heparin in the 1 ml contain 5000 UI, Calciparin introduction intravenous ones 2 hours on 400-600 UI/kg, Repivarin (Clivarin) syringe-tube on 0,25 ml under skin, Fragmin ampoule in the 1 ml contain 10 000 UI, Fraxiparin syringe-tube on 0,3 ml under skin.

b) not straight anticoagulant: Neodicumarinim tab on 0,05, 0,1; Phenylinum tab. on 0,3, Syncumar 0,002, 0,004, on 1-2 tab. a day.

 

However even be absent according diseases all patient used massive doses of glucocorticoid at the long tames need short curse prescribe following drugs: vitamins B gropes, Ascorbinum acid, drug of Kali and Calcium; by generalized eruption und erosive fireplaces on the skin prescribe antibiotic widely specter action.

All patients need in the foot product contain more math protein (cooked meat, fish, curd, eggs and milk products).

Parallels with this need limitation use fat, carbohydrates and salt.

Corticosteroid drug need use after eat.

Parallels with glucocorticoid use immunosuppressant: Methotrecsat, Azatioprin, Ciclophosphamid, Ciclosporin.

Note good therapeutic effect by simultaneous used glucocorticoid (30-60mg a day) and immunosuppressant (25-50 mg 1 a week). It is seen rapidly remission.

In the last years used now cytostatic Sandimmun from calculation 5-8 mg on the kilogram. Long tams used maximum doses sandimmun in the middle 14-20 days, then doses decreases till 2-2,5 mg on the 1 kg, in this doses drug may used 2-4 mounts.

Wide use inhibits proteases ( Kontrical, Aminocapron acid), vitamin Quercetinum on 1 tabulate (0,02) 3-5 a day, y-globulin;

Drug improve metabolism Parmidin, Anginin, Prodectin tab on 0,25 3 ones a day;

Drug by treatment hyper immunity condition – Batridenum tab. on 0,1 2-3 ones a day.

Drug activation is process regeneration of mucous membrane – Glycyrramum tab. on o,05 3-4 ones a day before eat 30 minutes, injection drugs vitamin B group.

Drug used by traumas and damages – Aethimizolum tab. 0,1 3 ones a day or 1,5% solution 4-5 ml under of skin and intramuscular.

External treatment is including used paint – Methylenum ruleum, Viride nitens, Fucorzinum. By erosion of mucous membrane irrigate Kali permanganate, Acid boricy and soda with adding 0,25-0,5% solution Novocainy.

 

 

 

 

 


Date: 2014-12-21; view: 1392


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