Drug therapy
The main principles of conservative treatment of patients HOZANK is life and continuity of care, differential treatment based nosology and disease stage, multimodality treatment using all the options for therapeutic effects (Pharmacotherapy, spa treatment, physical therapy, diet, physiotherapy, etc.).
History of treatment of patients HOZANK can be divided into 3 phases. Initially, based on the available at that time, ideas about the pathogenesis of these diseases, priority is the appointment of antispasmodics. However, subsequent observations have shown not only by their low efficiency, but in many cases, especially in severe stages of arterial insufficiency, a clear deterioration of the affected limb. In the future the main direction of treatment began to consider the normalization of blood rheology, particularly aggregation activity of erythrocytes and platelets. Currently, along with the direction of increasing attention is paid to the metabolic aspects of these diseases.
With today's core positions of conservative therapy of patients HOZANK should be considered:
1) improvement of microcirculation,
2) suppression of the overproduction of cytokines and free radicals
3) increasing the antioxidant activity of blood,
4) immunotherapy,
5) the normalization of lipid metabolism,
6) stimulation of development of collaterals.
Implementation of these recommendations (except the last two) can quite quickly get a clinical effect and why, along with routine treatment, they are the basis of intensive care of these patients carried out if necessary. Microcirculation improvement achieved lower aggregation of red blood cells and platelets, increasing the plastic properties of erythrocytes and leukocytes, decreased adhesion of platelets and leukocytes to the vascular wall, as well as lower hematocrit and blood viscosity. Suppression of overproduction of neutrophils and platelets of various biologically active substances that damage the endothelium and contributing to both local thrombosis and atherogenesis, is essential in severe stages of arterial insufficiency. It also has been linked to inhibition of free radicals and the need to improve the antioxidant properties of blood.
Implementation of all these areas of treatment has now become possible thanks to the emergence of new effective drugs, possessing, as a rule, multicomponent effects. Some of them useful in more detail.
First of all, it should be noted brand viagra pentoxifylline. The drug is used in the treatment of patients with peripheral vascular disease for 25 years. Apart from a pronounced effect on platelet hemostasis, it helps to reduce erythrocyte aggregation and to enhance their plastic properties, increases levels of cAMP in the tissues, and also has prostatsiklinstimuliruyuschey activity. It inhibits the anti-inflammatory effect of various cytokines (IL1 and TNF), as well as superoxide production, which is essential for the treatment of severe stages of arterial insufficiency.
Pentoxifylline is more effective at a dose of 1200 mg / day. The drug, despite the high dose was well tolerated by the gradual absorption in the gastrointestinal tract that does not generate its highest concentrations in the blood. Good tolerability of pentoxifylline is also noted for a long time (several years) use.
An important advantage is preserving the therapeutic efficacy, which reduces platelet aggregation and blood viscosity, as well as improving the elastic properties of red blood cells throughout the course of treatment. Clinically, patients with intermittent claudication is manifested by gradual and steady increase in painless walking distance in most patients.
Promising in the treatment of peripheral artery disease is a systemic enzyme, ie oral application specifically designed mixtures of hydrolytic enzymes from plants and animals. Of these, the most famous are the drugs Wobenzym and flogenzim. Their high efficacy in the treatment of peripheral artery disease is associated with increased fibrinolysis, the destruction of deposits of fibrin, inhibiting platelet aggregation, reduction of elasticity of red blood cells, the optimization of the inflammatory process, an analgesic effect (due to the destruction of inflammatory mediators - serotonin, histamine, bradykinin, etc.), the impact on immunegenesis - immunomodulatory action associated with the effect of enzymes on the production and removal of cytokines, blocking of excessive formation, inactivation and removal of "dangerous" cytokines, reduction and even the splitting of immune complexes. There is also activation of phagocytosis and a decrease in dyslipoproteinemia. In other words, there is a physiological modulation of host defense reactions. Extremely important is the almost complete safety of these drugs. The above mechanisms of action of systemic enzyme determine its effectiveness not only in lesions of blood vessels, but also in venous pathology, in particular in the treatment of thrombophlebitis and post-thrombotic disease, as confirmed by our data.
To effective treatment of patients HOZANK also applies tanakan. Its main active principle - an extract of Ginkgo biloba. Therapeutic effect of the drug due to the influence of derivatives terpene acid, proanthocyanidins and glikozidflavinov. Mechanisms of action Tanakan are the following: 1) reducing the aggregation of red blood cells and platelets, and 2) resistance trombotsatarnomu factor aggregation, and 3) inhibition of what else will help of Viagra free radicals ("retention effect"), which protects the structural and functional integrity of cell membranes, and 4) a positive effect on the nervous transmission 5) the anti-edema effect, and 6) improvement of energy metabolism (increased glucose uptake and oxygen, ATP synthesis, the removal of lactate).
As platelet disaggregants widely used aspirin at a daily dose of 100 - 325 mg. Its negative properties, unlike other non-steroidal anti-inflammatory drugs is a dose-dependent inhibition of synthesis of the most powerful of all known natural antiplatelet agents - prostacyclin. It is this justified the use of small doses of the drug, not inhibits the synthesis of prostacyclin in the vascular wall.
Large doses of aspirin inhibit not only platelet cyclooxygenase (antiaggregatory effect), but also vessels, leading to a decrease in the synthesis of prostacyclin. This negative property Aspirin leveled his small doses.
Indicated deficiencies does not have a drug ticlopidine, which is a potent antiaggregatory agent [5]. The drug inhibits ADP-induced platelet aggregation and aggregation induced by collagen, reduces platelet adhesion to the vascular wall (especially in the area of atherosclerotic plaque), normalizes erythrocyte deformability. Ulcerogenic action of ticlopidine is less pronounced than that of aspirin. The drug can be used as monotherapy. Along with HOZANK he was appointed for the prevention of stroke and myocardial infarction, particularly in patients with intermittent claudication. Tiklid has a pronounced therapeutic effect in diabetic angiopathy.
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