{"id":2070,"date":"2012-09-12T08:10:47","date_gmt":"2012-09-12T07:10:47","guid":{"rendered":"http:\/\/www.zdravstvena.info\/vsznj\/?p=2070"},"modified":"2012-09-12T09:14:18","modified_gmt":"2012-09-12T08:14:18","slug":"farmakologija-zapiski-2012-1-del","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/vsznj\/farmakologija-zapiski-2012-1-del\/","title":{"rendered":"Farmakologija zapiski 2012 1.del"},"content":{"rendered":"

\"\"Zgodovinski okvir farmakologije? Na\u0161tej in opi\u0161i zgodovinska obdobja?<\/h1>\n

1. Obdobje: obdobje uporabe naravnih snovi:<\/p>\n

– iz prazgodovine do 20. Stoletja<\/p>\n

– alkohol, atropin, marihuana:<\/p>\n

2. Obdobje: obdobje sinteznih u\u010dinkovin:<\/p>\n

– 20. Stoletje<\/p>\n

3. doba biotehnologije:<\/p>\n

– od konca 20. Stoletja dalje.<\/p>\n

<\/p>\n

2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na\u0161tej 3 klju\u010dne zakone na podro\u010dju zdravil v RS?<\/h1>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zakon o zdravilih ( 99. Podzakonskih aktov)<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zakon o zdravstveni dejavnosti<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zakon o lekarni\u0161ki dejavnosti.<\/p>\n

3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Opi\u0161i pot do novega zdravila?<\/h1>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Prvo je potrebno bolezen raziskati. Ko ugotovijo vzrok bolezni; na\u010drtujejo kako bi bolezen prepre\u010dili.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Potrebna je sinteza, \u00a0ter izolacija snovi. Kemi\u010dno testiranje \u2013 5000 molekul.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Predklini\u010dno testiranje farmakolo\u0161ke u\u010dinkovine. Ugotavljamo embrio \u2013 toksi\u010dnost, mutagenost molekul na \u017eival. Traja do 6 let.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Razvoj farmacevtskih oblik, stabilnost.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 KLINI\u010cNO TESTIRANJE =<\/p>\n

FazaI, majhno \u0161tevilo zdravil ljudi; grobo odmerjanje; ves \u010das se spremlja toksi\u010dnost in organizem.<\/p>\n

Faza II. Ve\u010dje \u0161tevilo bolnikov (20-30) do 3 leta v ve\u010djih bolni\u0161nicah.<\/p>\n

Faza III. Na bolnikih, veliko \u0161t. Klini\u010dna u\u010dinkovitost.<\/p>\n

 <\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pridobitev dovoljenja za promet po centraliziranem postopku.<\/em><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spremljanje KVU (kakovost, varnost, u\u010dinkovitost)<\/em><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Faza IV. Ugotavlja se KVU.<\/em><\/p>\n

4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vrste zdravil glede na izdelovalca!<\/h1>\n

INOVATIVNA ZDRAVILA: originalna zdravila; izdelana v industriji; so klini\u010dno testirana; skozi vse faze poti do novega zdravila.<\/p>\n

GENERI\u010cNA ZDRAVILA: zelo podobno inovativnem; cenej\u0161a od inovativnih zdravil; enaka kakovost; varnost in u\u010dinkovitost. Ne delajo klini\u010dnih \u0161tudij \u2013 se ne izvaja na ljudeh.<\/p>\n

MAGISTRALNA ZDRAVILA: narejena za to\u010dno dolo\u010denega bolnika, po receptih, ki ga pripi\u0161e zdravnik. Izdelujejo ga lekarne.<\/p>\n

GALENSKA ZDRAVILA: so zdravila izdelana v lekarnah ali galenskih laboratorijih; v malih serijah. Enostavnej\u0161e izdelave.<\/p>\n

BIOLO\u0160KA ZDRAVILA: biolo\u0161ki organizmi; po kemi\u010dni zgradbi so proteini.<\/p>\n

BIOLO\u0160KO PODOBNA ZDRAVILA: ni nobenega kopiranja. Vse faze v celoti izvedemo.<\/p>\n

 <\/p>\n

5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Razvr\u0161\u010danje zdravil!<\/h1>\n

Zdravila:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na RECEPT: Rp ->\u00a0 navadni zdravni\u0161ki recepti (zeleni in beli)<\/p>\n

\u00e8 Posebni zdravni\u0161ki recept<\/p>\n

\u00e8 Obnovljivi recept<\/p>\n

\u00e8 H \u2013 bolni\u0161ni\u010dni recept<\/p>\n

\u00e8 ZZ \u2013 zdravstvena organizacija<\/p>\n

 <\/p>\n

 <\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Brez RECEPTA:\u00a0\u00a0 -> izdajanje v lekarnah in specializiranih prodajalnah.<\/p>\n

\u00e8 Izdajanje samo v lekarnah.<\/p>\n

 <\/p>\n

6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sestavni deli recepta?<\/h1>\n

\u00e8\u00a0\u00a0 Administrativni del recepta:<\/p>\n

    \n
  1. Podatki o uporabniku zdravila:<\/li>\n<\/ol>\n

    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ime, priimek, naslov uporabnika zdravila<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 mesec, leto rojstva, spol uporabnika.<\/p>\n

      \n
    1. Podatki o zdravniku:<\/li>\n<\/ol>\n

      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Osebna \u0161tevilka zdravnika<\/p>\n

      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lastnoro\u010dni podpis, osebni \u017eig<\/p>\n

      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Telefonska \u0161tevilka zdravnika.<\/p>\n

      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u017dig z imenom in naslovom ustanove.<\/p>\n

        \n
      1. Podatki o pla\u010dniku zdravila<\/li>\n
      2. Drugi potrebni podatki.<\/li>\n<\/ol>\n

         <\/p>\n

        \u00e8\u00a0\u00a0 Strokovni del recepta:<\/p>\n

          \n
        1. Lastni\u0161ko in splo\u0161no ime zdravila<\/li>\n
        2. Farmacevtsko obliko in jakost zdravila<\/li>\n
        3. Koli\u010dino zdravila<\/li>\n
        4. Odmerjanje in na\u010din uporabe zdravila<\/li>\n
        5. Datum predpisa recepta<\/li>\n<\/ol>\n

          7. \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Kdaj je ogla\u0161evanje zdravil prepovedano?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0 Kadar imamo zdravilo brez dovoljenja za promet<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0 Medicinski pripomo\u010dki, ki niso vpisani v register<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila, ki se izdajajo le na recept<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila, ki vsebujejo psihotropne ali narkoti\u010dne snovi<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila pri: spolni PB, raku, tumorjih, diabetes<\/p>\n

          8. Kdaj je ogla\u0161evanje zdravil zavajajo\u010de?<\/h1>\n

          – kadar se napoveduje zdravljenje, pa ga ni!<\/p>\n

          9. Kompetence MS pri dajanju zdravil?<\/h1>\n

          – poznavanje skupin zdravil, njihovih imen.<\/p>\n

          – Preverjanje 6 P (identitete paciente, zdravila).<\/p>\n

          – Spremljanje delovanja zdravila pri pacientu.<\/p>\n

          – Prepoznavanje suma na \u017eelene u\u010dinke in interakcije pri pacientu.<\/p>\n

          – V primeru nejasnosti -> posvetovanje z zdravnikom ali farmacevtom.<\/p>\n

          – Dokumentiranje vseh aktivnosti.<\/p>\n

           <\/p>\n

          FARMAKOKINETIKA 2. POGLAVJE<\/strong><\/p>\n

          1. Kaj je farmakokinetika?<\/h1>\n

          Opisuje gibanje zdravila po telesu in nam pove kako telo deluje na zdravilo.<\/p>\n

          2. Na\u010dini delovanja zdravil?<\/h1>\n

          \u00e8 Sistemsko delovanje:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Natan\u010dno se na\u010drtuje spro\u0161\u010danje u\u010dinkovine iz farmacevtske oblike<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Deluje po sitemu ADME: absorpcija \u2013 u\u010dinkovine, prehod v krvni obtok. Distribucija \u2013 porazdelitev po tkivih in organih. Metabolizem \u2013 presnova. Ekskrecija \u2013 izlo\u010danje u\u010dinkovine.<\/p>\n

          \u00e8 Lokalno delovanje:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spro\u0161\u010danje u\u010dinkovine iz farmacevtske oblike<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lokalno delovanje<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odstranjevanje ( lokalni metabolizem; fizikalno \u2013 kemijski razpad; fizi\u010dno \u2013 mehansko odstranjevanje.<\/p>\n

          3. Poti aplikacije zdravil ?<\/h1>\n

          \u00e8 POVR\u0160INSKO \u2013 na ko\u017eo ali sluznico.<\/p>\n

          Na\u010dini:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nazalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vaginalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rektalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Inhalacijsko<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oralno<\/p>\n

          \u00e8 ENTERALNO \u2013 preko prebavnega trakta;<\/p>\n

          Na\u010dini:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Peroralno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rektalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gastri\u010dno<\/p>\n

           <\/p>\n

          \u00e8 PARENTERALNO –\u00a0 mimo prebavnega trakta<\/p>\n

          Na\u010dini:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intravensko<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intramuskularno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intradermalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Subkutano<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sublingualno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Transdermalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bukalno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Inhalacijsko<\/p>\n

          \u00e8 DRUGO:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Epiduralno<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intravitrealno<\/p>\n

          4. Katere vrste peroralnih farmacevtskih oblik pozna\u0161?<\/h1>\n

          \u00e8 \u00a0TEKO\u010cE P.O. :<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raztopine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Suspenzije<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Emulzije<\/p>\n

          \u00e8 TRDNE P.O. :<\/p>\n

          Tablete:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Filmsko oblo\u017eene<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ogrodne<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Orodisperzibilne<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u017dve\u010dljive<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0160ume\u010de<\/p>\n

          \u00e8 Kapsule:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Trde<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mehke<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Papirnate<\/p>\n

          5. Na\u010dini spro\u0161\u010danja peroralnih farmacevtskih oblik!<\/h1>\n

          \u00e8 S takoj\u0161nim spro\u0161\u010danjem<\/p>\n

          \u00e8 S prirejenim spro\u0161\u010danjem:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Z zadr\u017eanim spro\u0161\u010danjem<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S podalj\u0161anim spro\u0161\u010danjem<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S pulzirajo\u010dim spro\u0161\u010danjem<\/p>\n

           <\/p>\n

          6. Farmakokineti\u010dni procesi?<\/h1>\n

          – A\u00a0\u00a0 absorbcija<\/p>\n

          – D\u00a0\u00a0 distribucija<\/p>\n

          – M metabolizem<\/p>\n

          – E\u00a0\u00a0 ekskrecija<\/p>\n

          7. Absorpcija?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vsrkavanje; prehod \u010dez biolo\u0161ke membrane<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 u\u010dinkovina preide z mesta aplikacije, v krvni obtok in se porazdeli na mesto delovanja.<\/p>\n

          8. Kaj vpliva na absorpcijo?<\/h1>\n

          \u00e8 FIZIOLO\u0160KI DEJAVNIKI<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stopnja prekrvavljenosti<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Celokupna povr\u0161ina, s katere poteka absorpcija<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010cas dospetja u\u010dinkovine na mesto absorpcije in trajanje zadr\u017eevanja na mestu absorpcije<\/p>\n

          \u00e8 FIZIKALNO KEMIJSKI DEJAVNIKI:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Topnost u\u010dinkovine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kemijska stabilnost<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Velikost molekule<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stopnja ionizacije<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mehanizem absorpcije<\/p>\n

          9. Fizikalno \u2013 kemijski dejavniki?<\/h1>\n

          \u00e8 Topnost v vodi:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Potrebna za raztapljanje v prebavne sokove in v krvi.<\/p>\n

          \u00e8 Topnost v lipidih:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Potrebna za prehod skozi biolo\u0161ke membrane<\/p>\n

          \u00e8 Stopnja ionizacije \u2013 \u0161ibke baze ali kisline . pH:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dja stopnja ionizacije,<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolj\u0161a topnost v vosi,<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slab\u0161e prehajanje biolo\u0161kih membran.<\/p>\n

          \u00e8 Velikost molekul:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dje, ko so molekule; po\u010dasnej\u0161a je absorpcija.<\/p>\n

          \u00e8 Pasivna difuzija: poteka v smeri konc. Gradienta<\/p>\n

          \u00e8 Aktivni transport: poteka s pomo\u010djo transp. Proteinov.<\/p>\n

          10. Distribucija zdr. u\u010dinkovine v telesu!<\/h1>\n

          \u00e8 Porazdelitev zdr. u\u010dinkovine po telesu.<\/p>\n

          Model porazdelitve u\u010dinkovine v telesu:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V krvi<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ekstracelularna<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intracelularna<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V tkivih<\/p>\n

          11. Dejavniki, ki vplivajo na distribucijo u\u010dinkovine v posameznih organih!<\/h1>\n

          \u00e8 Vpliv na hitrost:<\/p>\n

          Prepustnost membran:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kapilare<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Krvno mo\u017eganska bariera<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Placenta<\/p>\n

          Prekrvavljenost:<\/p>\n

          \u00e8 Vpliv na obseg<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Topnost v lipidih<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pH \u2013 pKa<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vezava na plazemske proteine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vezava na tkivne proteine<\/p>\n

          12. Vezava na plazemske proteine!<\/h1>\n

          \u00e8 Tekmovanje u\u010dinkovin na vezavna mesta:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izpodrivanje vezavne u\u010dinkovine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dji dele\u017e nevezane u\u010dinkovine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mo\u010dnej\u0161e delovanje ve\u010dja mo\u017enost ne\u017eelenih u\u010dinkovin.<\/p>\n

          13. Vezava na plazemske beljakovine!<\/h1>\n

          \u00e8 Poznamo dve vrsti plazemskih beljakovin:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Albumini<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Globulini, glikoproteini, lipoproteini<\/p>\n

          14. Metabolizem ali biotransformacija?<\/h1>\n

          \u00e8 Namen:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pove\u010dati topnost u\u010dinkovine v vodi<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zmanj\u0161ati farmakolo\u0161ko u\u010dinkovitost<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Omogo\u010diti izlo\u010danje u\u010dinkovine iz telesa<\/p>\n

          \u00e8 Kje poteka metabolizem?<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Jetra<\/p>\n

          \u00e8 Poznamo 3 faze metabolizma:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 I faza:\u00a0\u00a0\u00a0 oksidacija, redukcija, hidroliza<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 II faza: Konjugacija:<\/p>\n

          Glukuronidacija, aciliranje, z \u017eveplovo kislini, z aminokislinami (glicin)<\/p>\n

          \u00e8 III faza izlo\u010danje z \u017eol\u010dem.<\/p>\n

          15. Enterohepati\u010dno kro\u017eenje \u2013 efekt prvega prehoda<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010drevesne bakterije cepijo konjugat in se izlo\u010dijo z blatom iz telesa.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 En del konjugata gre ponovno skozi jetra, \u010drevesje in po krvenm obtoku.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nekaj u\u010dinkovine se izlo\u010di z urinom.<\/p>\n

          16. Ekskrecija \u2013 izlo\u010danje zdravilne u\u010dinkovine!<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi ledvica z urinom<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi jetra, \u017eol\u010d se izlo\u010di z blatom<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi ko\u017eo z znojem<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi usta s slino<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi plju\u010da z izdihanim zrakom<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skozi mle\u010dne \u017eleze z mlekom<\/p>\n

          17. Kaj je KLIRENS?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Je volumen krvi, iz katerega se (ireverzibilno); nepovratno odstrani u\u010dinkovina v \u010dasovni enoti<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pomeni kak\u0161na koli\u010dina zdravila se o\u010disti iz plazme v dolo\u010deni \u010dasovni enoti.<\/p>\n

          18. Izlo\u010danje skozi ledvice!<\/h1>\n

          3 procesi:<\/p>\n

          \u00e8 GLOMERULARNA filtracija \u2013 majhne molekule<\/p>\n

          \u00e8 TUBULARNA reabsorpcija \u2013 pasivni proces; prena\u0161alci proteini; lipofilne u\u010dinkovine.<\/p>\n

          \u00e8 TUBULARNA sekrecija<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0najpomembnej\u0161i aktivni proces; \u0161ibki elektroliti.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Majhne molekule \u2013 nevezane na proteine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Aktivni transport \u2013 neodvisen od vezane na proteine. Prena\u0161a amione in katione neglede na koncentrirani gradient. Tekmovanje in izpodrivanje!<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pasiven transport glede na konc. Gradient. Za neionizirane, lipofilne molekule. Pomemben vpliv pH urina.<\/p>\n

          FARMAKOFINAMIKA 3. POGLAVJE<\/strong><\/p>\n

          1.\u00a0\u00a0\u00a0\u00a0 Kaj je farmakodinamika?<\/h1>\n

          Opisuje mo\u010d, vpliv zdravila na telo. Razlaga mehanizme, preko katerih zdravila delujejo na organizem, to pomeni, kaj zdravilo naredi v telesu, da se to odrazi kot terapevtski u\u010dinek.<\/p>\n

          2.\u00a0\u00a0\u00a0\u00a0 Kako vplivajo zdravila na telo?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stimulirajo<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zavirajo<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Delujejo toksi\u010dno (uni\u010dujo\u010de)<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dra\u017eijo<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nadome\u0161\u010dajo manjkajo\u010de snovi<\/p>\n

          3.\u00a0\u00a0\u00a0\u00a0 Na kak\u0161en na\u010din delujejo zdravila?<\/h1>\n

          \u00e8 Poru\u0161ijo celi\u010dno membrano<\/p>\n

          \u00e8 Vstopajo v kemijsko reakcijo<\/p>\n

          \u00e8 Fizikalno delovanje<\/p>\n

          \u00e8 Interakcija z:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Encimi<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Strukturnimi proteini<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prena\u0161alnimi proteini<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ionskimi kanal\u010dki<\/p>\n

          \u00e8 vezava na receptorje kot ligandi za:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 hormonske receptorje<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 nevromodularne oz. nevrotransmiterske receptorje.<\/p>\n

          4.\u00a0\u00a0\u00a0\u00a0 Katere so tar\u010dne molekule z delovanje zdravil?<\/h1>\n

          \u00e8 Encimi: so proteini, ve\u010dinoma globularni, vsebujejo koencime, kofaktorje<\/p>\n

          \u00e8 Receptorji: velika proteinska molekula; posebno vezavno mesto na celici ali znotraj celice.<\/p>\n

          \u00e8 Ionski kanal\u010dki: transmembranski proteini.<\/p>\n

          \u00e8 Transportni sistemi: prena\u0161alne molekule.<\/p>\n

          5.\u00a0\u00a0\u00a0\u00a0 Kaj so encimi?<\/h1>\n

          \u00e8 So proteini, beljakovine.<\/p>\n

          \u00e8 Katalizirajo \u2013 pospe\u0161ujejo kemijske reakcije v organizmu.<\/p>\n

          \u00e8 Encimi pretvarjajo:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Substrat <-> produkt; sami se pri tem ne spreminjajo.<\/p>\n

          \u00e8 Encimska inhibicija: snovi, ki zavirajo delovanje encima:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 REVERZIBILNO<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 IREVERZIBILNO<\/p>\n

          Snovi, ki zavirajo ekspresijo gena in zmanj\u0161ajo tvorbo encima.<\/p>\n

          \u00e8 Encimska indukcija:<\/p>\n

          Snovi, ki vzpodbujajo, pospe\u0161ujejo, ekspresijo encimskega gena in pove\u010dajo tvorbo encima.<\/p>\n

          6.\u00a0\u00a0\u00a0\u00a0 Reverzibilna inhibicija encimov?<\/h1>\n

          \u00e8 KOMPETITIVNA \u2013 vezana na aktivno mesto; enako kot substrat; nikoli isto\u010dasno; struturna podobnost<\/p>\n

          \u00e8 NEKOMPETITIVNA –\u00a0 vezana na drugo mesto; strukturne spremembe encima; obi\u010dajno ireverzibilne. Strukturna razli\u010dnost.<\/p>\n

          \u00e8 INKOMPETITIVNA –\u00a0 vezana na kompleks encim\/substrat; vedno isto\u010dasno; strukturna razli\u010dnost.<\/p>\n

          7.\u00a0\u00a0\u00a0\u00a0 Receptorji?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dolo\u010dajo kvantitativno razmerje med odmerkom in farmakolo\u0161kim u\u010dinkom u\u010dinkovine.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So vklju\u010deni v kem. sporo\u010danje med celicami in znotraj celice.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Posredujejo delovanje farmakolo\u0161kih agonistov in antagonistov.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Receptorji so odgovorni za selektivnost delovanja zdravil.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Model delovanja \u00bbKLJU\u010c \u2013 KLJU\u010cAVNICA\u00ab<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Velika molekula<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mesto vezave zdravila.<\/p>\n

          8.\u00a0\u00a0\u00a0\u00a0 Receptorji kot posredniki?<\/h1>\n

          Kak\u0161ne celice poznamo:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nevrotransmiterji<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hormoni<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila<\/p>\n

           <\/p>\n

          \u00e8 Preko \u017eiv\u010dnega sistema se ve\u017eejo nevrotransmiterji na receptor.<\/p>\n

          \u00e8 Preko endokrinega sistema se hormoni ve\u017eejo na receptor.<\/p>\n

          9.\u00a0\u00a0\u00a0\u00a0 Kje se nahajajo receptorji?<\/h1>\n

          Nahajajo se na:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na povr\u0161ini celice<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V celi\u010dni membrani<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V celici (jedro)<\/p>\n

          10. Na kak\u0161en na\u010din delujejo zdravila?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spojine, ki se ve\u017eejo na receptorje, imenovani LIGANDI.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0160tevilni celi\u010dni procesi ne bi potekali tako, kot potekajo, brez naravnih celi\u010dnih ligandov.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Receptor lahko reagira, ali pa bo blokiran \u010de se zdravilo ve\u017ee na receptor in se ni\u010d ne zgodi.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kadar je u\u010dinkovina sposobna stimulirati receptor, ji re\u010demo agonist in posnema delovanje naravnega endogenega prena\u0161alca.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kadar pa u\u010dinkovina receptorjev blokira, ji re\u010demo antagonist in taka spojina blokira delovanje naravnega prena\u0161alca.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u010dinek, ki ga opazimo kot rezultat delovanja antagonista, je pogosto nasproten u\u010dinek, ki ga opazimo pri stimulaciji receptorja. Kadar u\u010dinkovina deluje kot antagonisti, prepre\u010duje naravni spojini vezavo na receptor.<\/p>\n

          11. \u00a0Ligandi?<\/h1>\n

          Kateri so?<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hormoni<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nevrotransmiterji<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila: afiniteta vezave, intrinzi\u010dna aktivnost<\/p>\n

          –<\/p>\n

          \u00e8 Afiniteta vezave \u2013 je opredeljena kot stopnja vezave u\u010dinkovine na receptor; ve\u010dja kot je afiniteta, mo\u010dnej\u0161a je vezava.<\/p>\n

          \u00e8 Intrinzi\u010dna aktivnost\/ u\u010dinkovitost- je sposobnost u\u010dinkovine da povzro\u010di u\u010dinek na receptorju.<\/p>\n

          \u00e8 Ligandi so relativno selektivni<\/p>\n

          \u00e8 Adaptacija na zdravilo, prilagoditev organizma!<\/p>\n

          12. \u00a0Katere snovi potujejo skozi ionske kanal\u010dke?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ioni<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Molekule<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ligandi<\/p>\n

          13. Razmerje med koncentracijo\/odmerkom in u\u010dinkovitostjo zdravila?<\/h1>\n

          Je odnos med koncentracijo\/odmerkom u\u010dinkovine in u\u010dinkom, ki ga izzove. Lahko ga izmerimo in matemati\u010dno opi\u0161emo.<\/p>\n

          14. \u00a0Na kak\u0161en na\u010din merimo u\u010dinkovitost zdravila?<\/h1>\n

          Na:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Molekularnem nivoju<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Celi\u010dnem nivoju<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nivoju organa ali tkiva<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nivoju organizma<\/p>\n

          15. \u00a0Kaj je terapevtsko okno, kaj nam pove?<\/h1>\n

          Je razpon med minimalno efektivno koncentracijo, pri kateri dose\u017eemo minimalni u\u010dinek in maksimalno sprejemljivo koncentracijo, med kareto toksi\u010dni u\u010dinki prevladajo nad terapevtskimi.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dje kot je terapevtsko okno, bolj je zdravilo zdravo.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nam pove, kako varno je zdravilo.<\/p>\n

          16. Kaj nam pove terapevtski indeks?<\/h1>\n

          TI = TD50 <\/sub>\/ED50<\/sub><\/p>\n

          TD50 <\/sub>= odmerek, ki je toksi\u010den za 50 % populacije<\/p>\n

          ED50<\/sub> = odmerek ki je u\u010dinkovit za 50% populacije.<\/p>\n

           <\/p>\n

          \u00e8 Majhen terapevtski indeks: 2 \u2013 3 \u2013 majhna razlika med u\u010dinkovitim in toksi\u010dnim odmerkom \u2013 zahteva spremljanje plazemskih koncentracij u\u010dinkovine!<\/p>\n

          MEC = minimalna efektiva koncentracija.<\/p>\n

           <\/p>\n

           <\/p>\n

          NE\u017dELENE REAKCIJE ZDRAVIL 4. POGLAVJE<\/strong><\/p>\n

           <\/p>\n

          1.\u00a0\u00a0\u00a0\u00a0 Definicija: kaj je ne\u017eeleni u\u010dinek zdravila?<\/h1>\n

          Je \u0161kodljiva in nenamerna reakcija, do katere lahko pride pri odmerkih, ki se pri ljudeh ali pri \u017eivalih obi\u010dajno uporabljajo za prepre\u010devanje, diagnosticiranje ali zdravljenje bolezni ali za ponovno vzpostavitev, izbolj\u0161anje ali spremembo fiziolo\u0161ke funkcije.<\/p>\n

          2.\u00a0\u00a0\u00a0\u00a0 Definicija: nepri\u010dakovani ne\u017eeleni u\u010dinek zdravila?<\/h1>\n

          Je ne\u017eeleni \u0161kodljivi u\u010dinek, \u010digar narava, resnost ali posledice niso v skladu s povzetkom glavnih zna\u010dilnosti zdravila.<\/p>\n

           <\/p>\n

          3.\u00a0\u00a0\u00a0\u00a0 Resni ne\u017eeleni u\u010dinek zdravila?<\/h1>\n

          Za uporabo v humani medicini je vsaka ne\u017eelena reakcija, ki ima za posledico smrt, neposredno \u017eivljenjsko ogro\u017eenost, zahteva stacionarno bolni\u0161ni\u010dno obravnavo ali podalj\u0161anje obstoje\u010de bolni\u0161ni\u010dne obravnave, ima za posledico dolgotrajno ali izrazito nezmo\u017enost nesposobnost ali prirojeno anomalijo ali okvaro ob rojstvu.<\/p>\n

          4.\u00a0\u00a0\u00a0\u00a0 Kaj je klini\u010dna preizku\u0161nja?<\/h1>\n

          \u00e8 Je raziskava na ljudeh;<\/p>\n

          \u00e8 Namen je odkriti ali potrditi klini\u010dne, farmakolo\u0161ke ali druge farmakodinamske in farmakokineti\u010dne u\u010dinke zdravila.<\/p>\n

          \u00e8 Namen je tudi odkriti \u0161kodljive ne\u017eelene u\u010dinke!<\/p>\n

          \u00e8 Preu\u010duje absorpcijo, porazdelitev, presnovo in izlo\u010danje zdravila<\/p>\n

          \u00e8 S ciljem doka\u017eemo njegovo varnost in u\u010dinkovitost.<\/p>\n

          5.\u00a0\u00a0\u00a0\u00a0 Vrste ne\u017eelenih u\u010dinkov zdravil?<\/h1>\n

          \u00e8 Ne\u017eeleni u\u010dinek:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Je u\u010dinek zdravila glede na njegovo delovanje na drugih mestih v telesu ( poleg terapevtskega)<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Je napovedljiv<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Njegova jakost je obi\u010dajno odvisna od odmerka<\/p>\n

          \u00e8 ALERGIJSKE REAKCIJE:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Niso napovedljive<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Niso odvisne od odmerka<\/p>\n

          \u00e8 IDIOSINKRATSKE REAKCIJE:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pojavijo se redko<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prizadenejo majhen del populacije<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odvisne so od genetske konstitucije posameznika.<\/p>\n

          6.\u00a0\u00a0\u00a0\u00a0 Tipi alergijskih reakcij?<\/h1>\n

          \u00e8 Tip I: ANAFILAKSIJA (npr: anafilakti\u010dni \u0161ok)<\/p>\n

          \u00e8 Tip II. : CITOTOKSI\u010cNA REAKCIJA ( npr:. vezava na krvne celice, tvorba protiteles, ob ponovnem stiku liza celic in anemija)<\/p>\n

          \u00e8 Tip III.: SERUMSKA BOLEZEN (reakcija protitelo \u2013 antigen povzro\u010di precipitacijo netopnih kompleksov v tkivih, vnetna reakcija)<\/p>\n

          \u00e8 Tip IV.: ZAKASNJENA ALERGIJSAK REAKCIJA ( reakcija med zdravilom in T \u2013 limfociti, npr:. fotosenzitivne reakcije).<\/p>\n

          7.\u00a0\u00a0\u00a0\u00a0 Kaj je teratogenost?<\/h1>\n

          \u00e8 Je lastnost neke snovi, oziroma dejavnika (npr:. sevanje), da povzro\u010di struktura, funkcijske , presnovne in vedenjske nepravilnosti pri zarodku, \u010de je nose\u010dnica izpostavljena takemu dejavniku.<\/p>\n

          \u00e8 Najmo\u010dnej\u0161i vpliv v prvem tromese\u010dju \u2013 ORGANOGENEZA.<\/p>\n

          8.\u00a0\u00a0\u00a0\u00a0 Kaj je kancerogenost?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 je lastnost neke snovi, oz. dejavnika, da povzro\u010di rakava obolenja.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 najmo\u010dnej\u0161i vpliv v prvem tromese\u010dju \u2013 obdobje ORGANOGENEZA.<\/p>\n

          9.\u00a0\u00a0\u00a0\u00a0 Kaj je mutagenost?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Je lastnost neke snovi, oziroma dejavnika, da povzro\u010di okvaro dednega materiala.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Najmo\u010dnej\u0161i vpliv ima v prvem tromese\u010dju \u2013 obdobje ORGANOGENEZE.<\/p>\n

          10. \u00a0Kaj je farmakovigilanca?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Je proces ugotavljanja, vrednotenja in odzivanja na nova spoznanja o ne\u017eelenih u\u010dinkih in drugih varnostnih vidikih zdravila, ko je zdravilo \u017ee na tr\u017ei\u0161\u010du.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Imetniki dovoljenja za promet z zdravili morajo imeti odgovorno osebo za farmakovigilanco, ki je neprestano dosegljiva<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Interna klinika \u2013 UKC Ljubljana center za zastrupitve.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na podlagi podatkov o varnosti zdravila in oceni razmerja med koristjo in tveganjem lahko JAZMP:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odvzame dovoljenje za promet<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Za\u010dasno odvzame dovoljenje<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prepove prodajo<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uvede spremembe dovoljenja za promet.<\/p>\n

          INTERAKCIJE PRI ZDRAVILIH 5. POGLAVJE<\/strong><\/p>\n

          1.\u00a0\u00a0\u00a0\u00a0 Kaj je interakcija?<\/h1>\n

          Pomeni medsebojno delovanje. Nastopi po aplikaciji zdravila.<\/p>\n

          2.\u00a0\u00a0\u00a0\u00a0 \u00a0Vpliv interakcij na delovanje zdravila?<\/h1>\n

          \u00e8 Pove\u010danje u\u010dinka:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adicija (vsota)<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sinergija (> vsota)<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Potenciranje<\/p>\n

          \u00e8 Zmanj\u0161anje u\u010dinka:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antagonizem<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nevtralizacija<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izni\u010denje<\/p>\n

          3.\u00a0\u00a0\u00a0\u00a0 Katere vrste interakcij pozna\u0161?<\/h1>\n

          \u00e8 Fizikalno kemijske<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pred aplikacijo \u2013 inkopatibilnost<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po aplikaciji \u2013 interakcija<\/p>\n

          \u00e8 Farmakokineti\u010dna<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ADME<\/p>\n

          \u00e8 Farmakodinami\u010dna<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na mestu delovanja; na receptorju.<\/p>\n

          4.\u00a0\u00a0\u00a0\u00a0 Fizikalno \u2013 kemijske reakcije?<\/h1>\n

          \u00e8 Kemijske reakcije:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pred aplikacijo: razpad u\u010dinkovine od vplivom kisika, vlage, svetlobe.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po aplikaciji: pri terapiji Fe obvezno zraven tudi vitamin c!<\/p>\n

          \u00e8 Fizikalni vpliv:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uporaba steklene brizge<\/p>\n

          5.\u00a0\u00a0\u00a0\u00a0 Farmakokineti\u010dne interakcije?<\/h1>\n

          \u00e8 ABSORPCIJA se: upo\u010dasni, zakasni, ovira, prepre\u010di, pospe\u0161i.<\/p>\n

           <\/p>\n

          Po kak\u0161nih mehanizmih potekajo interakcije pri absorpciji?<\/p>\n

          Tvorba netopnih kompleksov ali kelatov:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dvovalentni in trivalentni kationi, holestiramin:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zmanj\u0161a se absorpcija tetraciklinov, fosfatov!<\/p>\n

           <\/p>\n

          Sprememba \u017eelod\u010dnega pH:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antacidi: zmanj\u0161a se absorpcija ketoketokonazola.<\/p>\n

          Sprememba motilitete:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Metoklopramid \u2013 zmanj\u0161a se abs. Digoksina<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pove\u010da se abs. Paracetamola, etanola.<\/p>\n

          Sprememba sluznece prebavil.<\/p>\n

           <\/p>\n

          \u00e8 \u00a0DISTRIBUCIJA:<\/p>\n

          Vezava na plazemske beljakovine:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izpodrivanje z vezavnih mest (tabela)<\/p>\n

          Aktivni transport na mesto delovanja:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do zaviranja aktivnega transporta.<\/p>\n

           <\/p>\n

          Vezava v tkivih:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do izpodrivanja z vezavnih mest v tkivih.<\/p>\n

           <\/p>\n

          Izpodrivanje v vezavnih mest plazemskih beljakovin (tabela):<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Varfarin \u2013 antikoagulant. Ve\u017ee se na mesto, prepre\u010di strjevanje krvi.<\/p>\n

           <\/p>\n

          <\/p>\n

          \u00e8 METABOLIZEM<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Inhibicijska: plazemska konc. U\u010dinkoveine nara\u0161\u010da in s tem tudi konc. Metabolita.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indukcija: konc. Metabolita pada in s tem pada tudi plazemska konc. U\u010dinkovine.<\/p>\n

           <\/p>\n

          \u00e8 EKSKRECIJA<\/p>\n

           <\/p>\n

          Imamo lahko:<\/p>\n

          Vpliv na glomerularno filtracijo:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sprememba pretoka krvi skozi ledvice<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vezava na beljakovine plazme.<\/p>\n

           <\/p>\n

          Vpliv na tubularni sistem:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Probenecid \u2013 zmanj\u0161ana eks. Penicilina.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kinidin \u2013 zmanj\u0161ana eks. Digoksina<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Propafenon \u2013 zmanj\u0161ana eks. Digoksina.<\/p>\n

           <\/p>\n

          Spremembe pretoka urina in pH urina.<\/p>\n

           <\/p>\n

          6.\u00a0\u00a0\u00a0\u00a0 Farmakodinamske interakcije?<\/h1>\n

          \u00e8 Receptorske:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Agonisti<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antagonisti: kompetitivni, nekompetitivni<\/p>\n

          \u00e8 Nereceptorske:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sprememba ionskega okolja<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Podoben u\u010dinek na dolo\u010den organ<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Refleksna adaptacija organizma.<\/p>\n

          7.\u00a0\u00a0\u00a0\u00a0 Na\u0161tej vsaj 5 tveganih situacij za nastanek interakcij?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 polifarmacija<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Starostniki<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odpoved ledvic, srca, astma<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u010dinkovine z velikim obsegom metabolizma prvega prehoda.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u010dinkovine z visoko intrinzi\u010dno toksi\u010dnostjo<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uporaba visokih odmerkov<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dolo\u010dene skupine zdravil.<\/p>\n

          8.\u00a0\u00a0\u00a0\u00a0 Na\u0161tej vsaj 5 razredov u\u010dinkovin z visokim tveganjem za interakcijo?<\/h1>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiaritmiki<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antikoagulanti<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kontraceptivi<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiepileptiki<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Beta blokatorji<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antimikotiki<\/p>\n

           <\/p>\n

          9.\u00a0\u00a0\u00a0\u00a0 Ali lahko zdravilo vzamemo skupaj s sokom grenivke?<\/h1>\n

          Ne ne smemo!<\/p>\n

          Razlaga: pride do inhibicije encimov v steni prebavil (ne v jetrih) s tem se zmanj\u0161a efekt prehoda; pove\u010da se plazemska konc. Nekaterih u\u010dinkovin. Zavira se metabolizem.<\/p>\n

           <\/p>\n

          Kaj se zgodi, \u010de zdravilo vseeno vzamemo skupaj s sokom grenivke?<\/p>\n

          Zdravila, ki so ob\u010dutljiva na grenivko?<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ca \u2013 antagonisti<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Benzodiazepini<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Psihotropne u\u010dinkovine<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Statini<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Inhibitorji fosfodiesteraze tipa 5.<\/p>\n

           <\/p>\n

          Trajanje vpliva: pribli\u017eno 3 dni<\/p>\n

          10. Interakcije s \u0161entjan\u017eevko?<\/h1>\n

          Pride do indukcije encimov. Pove\u010duje se delovanje zdravila. Delovanje obratno kot pri soku grenivke.<\/p>\n

          \u00e8 Farmakokineti\u010dne interakcije:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indukcija encimov v jetrih<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indukcija glikoproteina P<\/p>\n

          \u00e8 Farmakodinami\u010dne interakcije:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vpliv na prevzem serotonina in drugih nevrotransmiterjev<\/p>\n

          Razredi u\u010dinkovin pri interakciji s \u0161entjan\u017eevko:<\/p>\n

          \u00e8 Zni\u017eana plazemska koncentracija:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 HIV proteazni inhibitorji<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 HIV inhibitorji: ne \u2013 nukleozidne reverzne transkript.<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ciklosporin<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Varfamin<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Digoxin<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Teofilin<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antikonvulzivni ( fenobarbiton)<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Peroralni kontraceptivi<\/p>\n

          \u00e8 Pove\u010dani serotoninergi\u010dni u\u010dinki:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SSRi in podobne u\u010dinkovine<\/p>\n

           <\/p>\n

          11. \u00a0Interakcij zdravil s hrano in alkoholom?<\/h1>\n

          \u00e8 Inhibitorji monoaminooksidaze (MAOi) \u2013 delujejo na ta na\u010din, da upo\u010dasnijo presnovo (metabolizem) kateholaminov in aminov \u2013 tiramina v hrani (izdelki iz kvasa, rde\u010de vino) \u2013 pove\u010da se tiamin v plazmi in lahko pride do hipertenzivne krize!<\/p>\n

          \u00e8 Etanol:<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko se pove\u010da ali zmanj\u0161a delovanje u\u010dinkovine,<\/p>\n

          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vpliva na absorbcijo, distribucijo, metabozizem, izlo\u010danje; na\u010din delovanja, lahko deluje sinergisti\u010dno ali potencira delovanje.<\/p>\n

           <\/p>\n

          SPLO\u0160NI DEL: 6. Poglavje<\/p>\n

          VPLIV STANJA ORGANIZMA NA DELOVANJE ZDRAVIL<\/span><\/strong><\/p>\n

           <\/p>\n

            \n
          1. 1. <\/strong>Prehajanje zdravil preko placente?<\/span><\/strong><\/li>\n<\/ol>\n

            Je odvisno od:<\/p>\n

            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fizikalno \u2013 kemijskih lastnosti u\u010dinkovine:<\/p>\n

              \n
            • Velikost molekule<\/li>\n
            • Topnost molekule<\/li>\n
            • Stopnje ionizacije<\/li>\n
            • Afiniteta za plazemske proteine.<\/li>\n<\/ul>\n

              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odmerka zdravil (vpliv na koncentracijski gradient)<\/p>\n

               <\/p>\n

                \n
              1. 2. <\/strong>Kaj vpliva na absorpcijo zdravil v nose\u010dnosti?<\/span><\/strong><\/li>\n<\/ol>\n

                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prvo tromese\u010dje (obdobje organogeneze, najve\u010dje tveganje)<\/p>\n

                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Drugo in tretje tromese\u010dje (glede na toksi\u010dnost u\u010dinkovine)<\/p>\n

                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Upo\u010dasnjena peristaltika in praznjenje \u017eelodca \u2013 vpliv na koli\u010dino absorbirane u\u010dinkovine<\/p>\n

                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zmanj\u0161ano izlo\u010danje \u017eelod\u010dne kisline \u2013 vpliv na absorpcijo kislih u\u010dinkovin<\/p>\n

                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dji volumen porazdelitve \u2013 ni\u017eja koncentracija u\u010dinkovine.<\/p>\n

                 <\/p>\n

                  \n
                1. 3. <\/strong>Na\u0161tej vsaj 5 dejavnikov, ki vplivajo na prehajanje zdravil v mleko?<\/span><\/strong><\/li>\n<\/ol>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Velikost molekule,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Topnost v vodi,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Topnost v lipidih,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Afiniteta za plazemske proteine,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odmerek zdravila pri materi,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Koli\u010dina popitega mleka,<\/p>\n

                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010casovni interval med jemanjem\/absorpcijo zdravila in hranjenjem otroka.<\/p>\n

                   <\/p>\n

                    \n
                  1. 4. <\/strong>Zna\u010dilnosti in vpliv na FK in FD pri dojen\u010dku, otroku?<\/span><\/strong><\/li>\n<\/ol>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po\u010dasnej\u0161a peristaltika in praznjenje \u017eelodca<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manj\u0161a aktivnost in koncentracija prebavnih sokov<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka koncentracija \u017eelod\u010dne kisline<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka mi\u0161i\u010dna masa<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tanka ko\u017ea<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nepopolno razvita krvno \u2013 mo\u017eganska bariera<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dji dele\u017e telesnih teko\u010din<\/p>\n

                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manj\u0161i dele\u017e telesnih ma\u0161\u010dob<\/p>\n

                     <\/p>\n

                      \n
                    1. 5. <\/strong>Kaj vpliva na absorpcijo zdravil pri dojen\u010dku, otroku ter kako?<\/span><\/strong><\/li>\n<\/ol>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po\u010dasnej\u0161a peristaltika in praznjenje \u017eelodca \u2192 dalj\u0161e zadr\u017eevanje na mestu absorpcije, ve\u010dja stopnja absorpcije, vi\u0161je plazemske koncentracije.<\/p>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manj\u0161a aktivnost in koncentracija prebavnih sokov \u2192 manj\u0161a koli\u010dina \u017eol\u010da, slab\u0161a absorpcija v ma\u0161\u010dobah topnih u\u010dinkovin.<\/p>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka koncentracija \u017eelod\u010dne kisline \u2192 slab\u0161a biolo\u0161ka uporabnost kislih u\u010dinkovin.<\/p>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slab\u0161a periferna perfuzija \u2192 slab\u0161a absorpcija parenteralno apliciranih u\u010dinkovin.<\/p>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka mi\u0161i\u010dna masa \u2192 manj\u0161a hitrost absorpcije z mesta aplikacije.<\/p>\n

                       <\/p>\n

                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tanka ko\u017ea \u2192 Ve\u010dja hitrost in obseg absorpcije preko ko\u017ee.<\/p>\n

                       <\/p>\n

                       <\/p>\n

                        \n
                      1. 6. <\/strong>Kaj vpliva na distribucijo zdravil pri dojen\u010dku, otroku ter kako?<\/span><\/strong><\/li>\n<\/ol>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka koncentracija plazemskih beljakovin \u2192 ve\u010dji dele\u017e nevezane u\u010dinkovine v plazmi, ve\u010dja u\u010dinkovitost in toksi\u010dnost.<\/p>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nepopolno razvita krvno \u2013 mo\u017eganska bariera \u2192 la\u017eji prehod u\u010dinkovin v mo\u017egane, tveganje za mo\u017eganske po\u0161kodbe.<\/p>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dji dele\u017e telesnih teko\u010din \u2192 ni\u017eja koncentracija u\u010dinkovine na mestu delovanja.<\/p>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manj\u0161i dele\u017e telesnih ma\u0161\u010dob \u2192 manj\u0161a koli\u010dina v ma\u0161\u010dobah vezane u\u010dinkovine, kraj\u0161i \u010das delovanja in\u00a0 ve\u010dja u\u010dinkovitost.<\/p>\n

                         <\/p>\n

                          \n
                        1. 7. <\/strong>Kaj vpliva na metobolizem in izlo\u010danje zdravil pri dojen\u010dku, otroku ter kako?<\/span><\/strong><\/li>\n<\/ol>\n

                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka aktivnost mikrosomalnih encimov in nizka konjugacijska sposobnost \u2192 nizek hepati\u010dni klirens, po\u010dasnej\u0161e izlo\u010danje u\u010dinkovine, dalj\u0161i razpolovni \u010das.<\/p>\n

                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizka hitrost glomerularne filtracije in obseg pretoka krvi skozi ledvice \u2192 nizek renalni klirens, po\u010dasnej\u0161e izlo\u010danje, dalj\u0161i razpolovni \u010das.<\/p>\n

                          <\/span><\/p>\n

                          <\/span><\/p>\n

                            \n
                          1. 8. <\/strong>Kaj je pomembno pri odmerjanju zdravil pri otrocih?<\/span><\/strong><\/li>\n<\/ol>\n

                            Potrebno je upo\u0161tevati prera\u010dun odmerkov glede na:<\/p>\n

                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Starost \u2192 Youngovo pravilo<\/p>\n

                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Telesno te\u017eo \u2192 Clarkeovo pravilo telesne te\u017ee<\/p>\n

                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Telesno povr\u0161ino \u2192 Clarkeovo pravilo telesne povr\u0161ine<\/p>\n

                             <\/p>\n

                              \n
                            1. 9. <\/strong>Vpliv spola na FK in FD?<\/span><\/strong><\/li>\n<\/ol>\n

                              Absorpcija:<\/span><\/strong><\/p>\n

                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manj\u0161a koli\u010dina \u017eelod\u010dne alkoholne dehidrogenaze pri \u017eenskah <\/strong>\u2192 vi\u0161je plazemske koncentracije, ve\u010dje tveganje za intoksikacijo.<\/p>\n

                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dja kislost \u017eelodca, po\u010dasnej\u0161e praznjenje:<\/p>\n

                              \u2192 dalj\u0161i \u010das zadr\u017eevanja na mestu aborpcije, ve\u010dji obseg absorpcije.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2192 ve\u010dje tveganje za \u017eelod\u010dno toksi\u010dnost u\u010dinkovin.<\/p>\n

                              Distribucija:<\/span><\/strong><\/p>\n

                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dji dele\u017e ma\u0161\u010dob pri \u017eenskah \u2192 ni\u017eje plazemske koncentracije, dalj\u0161e delovanje.<\/p>\n

                              Metabolizem:<\/span><\/strong><\/p>\n

                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dja aktivnost CYP pri \u017eenskah za 40% \u2192 hitrej\u0161i metabolizem, kraj\u0161i \u010das delovanja, hitrej\u0161e nastajanje ev. Toksi\u010dnih metabolitov.<\/p>\n

                               <\/p>\n

                                \n
                              1. 10. <\/strong>Vpliv bolezni na prehajanje zdravil?<\/span><\/strong><\/li>\n<\/ol>\n

                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u017delod\u010dne bolezni, bruhanje, diareja \u2192 sprememba hitrosti in obsega absorpcije<\/p>\n

                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vnetne bolezni prebavne sluznice \u2192 sprememba obsega in hitrosti absorpcije<\/p>\n

                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolezni obto\u010dil in srca \u2192 vplivajo na prekrvavljenost.<\/p>\n

                                 <\/p>\n

                                  \n
                                1. 11. <\/strong>Vpliv diete na prehajanje zdravil?<\/span><\/strong><\/li>\n<\/ol>\n

                                   <\/p>\n

                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prisotnost hrane v \u017eelodcu \u2192 lahko upo\u010dasni hitrost in obseg absorpcije, podalj\u0161a delovanje.<\/p>\n

                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prisotnost dvovalentnih ionov \u2192 tvorba kelatov in oviranje absorpcije<\/p>\n

                                  SPLO\u0160NI DEL: 7. Poglavje<\/p>\n

                                  OSNOVE TOKSIKOLOGIJE<\/span><\/strong><\/p>\n

                                    \n
                                  1. 1. <\/strong>Splo\u0161na pomo\u010d pri zastrupitvah?<\/span><\/strong><\/li>\n<\/ol>\n

                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dina strupov pride v telo po peroralni poti \u2192 ukrepi za zmanj\u0161evanje absorpcije iz prebavil:<\/p>\n

                                    – izzovemo bruhanje (emetiki)<\/p>\n

                                    – pospe\u0161evanje izlo\u010danja (odvajala)<\/p>\n

                                    – adsorpcija (adsorbenti)<\/p>\n

                                     <\/p>\n

                                      \n
                                    1. 2. <\/strong>Kak\u0161ni so splo\u0161ni ukrepi pri zastrupitvah?<\/span><\/strong><\/li>\n<\/ol>\n

                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Emetiki (ipekakuana, alkaloid emetin \u2013 dra\u017ei kemoreceptorski center za bruhanje v meduli; kontraidikacija pri zau\u017eitvju korozivnih substanc (bencin, pralni pra\u0161ek, kisline)!<\/p>\n

                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adsorbenti (aktivno oglje, lahko se da po bruhanje, ne skupaj z ipekakuano)<\/p>\n

                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odvajala: – osmotska (pove\u010dajo \u010drevesni volumen \u2192 refleks praznjenja (npr. sorbitol)<\/p>\n

                                      -anorganske soli (pogojno).<\/p>\n

                                       <\/p>\n

                                        \n
                                      1. 3. <\/strong>Kaj so antidoti?<\/span><\/strong><\/li>\n<\/ol>\n

                                         <\/p>\n

                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kovine: izpodrivajo esencialne elemente z njihovih vezavnih mest; kopi\u010dijo se v mo\u017eganih, ledvicah, ko\u017ei, kosteh, krvi. Antidoti so kelirajo\u010de snovi \u2013 netopni kelati ve\u017eejo metalne ione.<\/p>\n

                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Metanol: primes etilnega alkohola<\/p>\n

                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cianidi<\/p>\n

                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Organofosfati.<\/p>\n

                                         <\/p>\n

                                          \n
                                        1. 4. <\/strong>Katera so \u017eivljenja ogro\u017eajo\u010da stanja pri klini\u010dnem predoziranju ter kako ukrepamo v takem primeru?<\/span><\/strong><\/li>\n<\/ol>\n

                                          <\/span><\/strong><\/p>\n

                                          Stanja: kr\u010di, sr\u010dne aritmije, cirkulatorni \u0161ok, nezavest, obstrukcija dihalnih poti, prekinitev dihanja.<\/p>\n

                                           <\/p>\n

                                          Splo\u0161ni ukrepi:<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Identifikacija u\u010dinkovine, ki je povzro\u010dila stanje.<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ukrepi za zmanj\u0161evanje absorpcije (bruhanje).<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hemodializa za odstranjevanje u\u010dinkovine in toksi\u010dnih metabolitov.<\/p>\n

                                           <\/p>\n

                                           <\/p>\n

                                          SPECIALNI DEL: 8. Poglavje<\/p>\n

                                          AVTONOMNI \u017dIV\u010cNI SISTEM IN VAZOAKTIVNE SNOVI<\/span><\/strong><\/p>\n


                                          \n<\/span><\/strong><\/p>\n

                                          Avtonomni oziroma periferni \u017eiv\u010dni sistem sestavljajo:<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Motori\u010dni \u017eivci<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Senzori\u010dni \u017eivci.<\/p>\n

                                          Motori\u010dne \u017eivce delimo na:<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Somatski \u017eiv\u010dni sistem (z vplivom na\u0161e volje)<\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avtonomni \u017eiv\u010dni sistem (brez vpliva na\u0161e volje).<\/p>\n

                                           <\/p>\n

                                          Avtonomni \u017eiv\u010dni sistem delimo na 2 dela:<\/span><\/strong><\/p>\n

                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Simpati\u010dni \u017eiv\u010dni sistem oziroma Adrenergi\u010dni sistem, delimo na:<\/span><\/p>\n

                                            \n
                                          • Alfa receptorji: alfa 1 in alfa 2<\/li>\n
                                          • Beta receptorji: beta 1 in beta 2.<\/li>\n<\/ul>\n

                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Parasimpati\u010dni \u017eiv\u010dni sistem oziroma Holinergi\u010dni sistem, delimo na:<\/span><\/p>\n

                                              \n
                                            • Muskarinski receptorji<\/li>\n
                                            • Nikotinski receptorji.<\/li>\n<\/ul>\n

                                               <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                                              Tar\u010dni organ<\/strong><\/td>\nU\u010dinki parasimpatika<\/strong><\/td>\nU\u010dinki simpatika<\/strong><\/td>\n<\/tr>\n
                                              Oko (iris)<\/strong><\/td>\nStimulacija konstriktornih mi\u0161ic; konstrikcija zenice<\/td>\nStimulacija dilatornih mi\u0161ic; dilatacija zenice<\/td>\n<\/tr>\n
                                              \u017dleze (nazalne, solzne, slinavke, \u017eelod\u010dne)<\/strong><\/td>\nStimulacija sekretorne aktivnosti<\/td>\nInhibicija sekretornih aktivnosti; vazokonstrikcija krvnih \u017eil, ki oskrbujejo \u017eleze<\/td>\n<\/tr>\n
                                              Znojnice<\/strong><\/td>\nNi u\u010dinka<\/td>\nStimulacija obilnega znojenja<\/td>\n<\/tr>\n
                                              Sredica suprarenalke<\/strong><\/td>\nNi u\u010dinka<\/td>\nStimulacija celic sredice k izlo\u010danju adrenalina in noradrenalina<\/td>\n<\/tr>\n
                                              Sr\u010dna mi\u0161ica <\/strong><\/td>\nZni\u017eevanje hitrosti bitja srca<\/td>\nPospe\u0161evanje hitrosti in jakosti sr\u010dnega utripa<\/td>\n<\/tr>\n
                                              Srce: koronarne \u017eile<\/strong><\/td>\nKonstrikcija koronarnih \u017eil<\/td>\nVazodilatacija<\/td>\n<\/tr>\n
                                              Mehur\/se\u010dnica<\/strong><\/td>\nKontrakcija gladkih mi\u0161ic stene mehurja; relaksacija uretralnega sfinktra; promocija mokrenja<\/td>\nRelaksacija gladkih mi\u0161ic v steni mehurja; konstrikcija uretralnega sfinktra; inhibicija mokrenja<\/td>\n<\/tr>\n
                                              Plju\u010da<\/strong><\/td>\nKonstrikcija bronhiolov<\/td>\nDilatacija bronhiolov, blaga kontrakcija krvnih \u017eil<\/td>\n<\/tr>\n
                                              Prebavila<\/strong><\/td>\nPospe\u0161evanje motilitete (peristaltike) in koli\u010dine izlo\u010dkov prebavnih organov; relaksacija sfinktrov in olaj\u0161anje prehoda hrane skozi prebavni trakt.<\/td>\nZmanj\u0161evanje aktivnosti \u017elez in mi\u0161ic prebavil in konstrikcija sfinktrov<\/td>\n<\/tr>\n
                                              Jetra<\/strong><\/td>\nNi u\u010dinka<\/td>\nAdrenalin stimulira spro\u0161\u010danje glukoze iz jeter v krvi<\/td>\n<\/tr>\n
                                              \u017dol\u010dnik<\/strong><\/td>\nDra\u017eenje (\u017eol\u010dnik se skr\u010di in spro\u0161\u010da \u017eol\u010d)<\/td>\nInhibicija (\u017eol\u010dnik je spro\u0161\u010den)<\/td>\n<\/tr>\n
                                              Ledvica<\/strong><\/td>\nNi u\u010dinka<\/td>\nVazokonstrikcija; zmanj\u0161evanje izlo\u010danja urina; promocija tvorbe renina.<\/td>\n<\/tr>\n
                                              Krvne \u017eile<\/strong><\/td>\nMalo ali ni\u010d efekta<\/td>\nKonstrikcija ve\u010dine \u017eil; pove\u010danje krvnega tlaka<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                                               <\/p>\n

                                                \n
                                              1. 1. <\/strong>Kaj se zgodi z nevrotransmiterjem – noradrenalinom, ko se le – ta sprosti v sinapso?<\/span><\/strong><\/li>\n<\/ol>\n

                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Povzro\u010di serijo celi\u010dnih dogodkov, ki lahko povzro\u010dijo vezavo na postsinapti\u010dne receptorje.<\/p>\n

                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do ponovnega privzema.<\/p>\n

                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do MAO inhibitorjev<\/p>\n

                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do encima COMT.<\/p>\n

                                                 <\/p>\n

                                                  \n
                                                1. 2. <\/strong>Na\u0161tej nevrotransmiterje ter receptorje adrenergi\u010dnega sistem!<\/span><\/strong><\/li>\n<\/ol>\n

                                                   <\/p>\n

                                                  Adrenergi\u010dni oziroma simpati\u010dni \u017eiv\u010dni sistem, je aktiven kadar je telo v begu, boju, akciji.<\/p>\n

                                                   <\/p>\n

                                                  Nevrotransmiterji so:<\/span><\/strong><\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noradrenalin<\/strong> (spro\u0161\u010danje iz \u017eiv\u010dnih kon\u010di\u010dev)<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adrenalin<\/strong> (spro\u0161\u010danje v kri iz nadledvi\u010dne \u017eleze, ko je ta vzdra\u017eena s simpati\u010dnimi \u017eiv\u010dnimi vlakni)<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dopamin<\/strong> (spro\u0161\u010danje v mo\u017eganih, ledvicah, GIT).<\/p>\n

                                                  Receptorji so:<\/span><\/strong><\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alfa 1\u2192 vazokonstrikcija \u017eil (kr\u010denje \u017eil), zmanj\u0161evanje motilitete in sekrecija GIT, glikogenoliza, znojenje, kurja polt.<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alfa 2 \u2192 neg. povratna zveza; zmanj\u0161evanje spro\u0161\u010danja noradrenalina<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Beta 1\u2192 pove\u010da se sr\u010dni utrip, lipoliza, spro\u0161\u010danje renina, zmanj\u0161a se motiliteta in sekrecija GIT; \u0161irjenje \u017eil.<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Beta 2 \u2192 relaksacija gladkih mi\u0161ic bronhijev, uterusa, krvnih \u017eil skeletnih mi\u0161ic, glikogenoliza.<\/p>\n

                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dopaminergi\u010dni \u2192za izbolj\u0161anje simptomov Parkinsonove bolezni.<\/p>\n

                                                   <\/p>\n

                                                    \n
                                                  1. 3. <\/strong>Alfa 1 receptorji?<\/span><\/strong><\/li>\n<\/ol>\n

                                                    So alfa mimetiki.<\/p>\n

                                                    Njihova klini\u010dna uporaba:<\/span><\/p>\n

                                                    – hipotenzija<\/strong> (urgentna)<\/p>\n

                                                    – nazalni dekongestivi<\/strong> (za zmanj\u0161evanje izlo\u010danje sluzi, za zmanj\u0161evanje krvavitve, za zmanj\u0161evanje edema),<\/p>\n

                                                    – rde\u010de o\u010di<\/strong>.<\/p>\n

                                                     <\/p>\n

                                                    Selektivni direktni agonisti:<\/span><\/strong><\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Metoksamin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nafazolin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fenilefrin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oksimetazolin.<\/p>\n

                                                     <\/p>\n

                                                    Neselektivni simpatomimetiki:<\/span><\/strong><\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noradrenalin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Psevdoefedrin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Metaraminol<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adrenalin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Efedrin<\/p>\n

                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dopamin.<\/p>\n

                                                     <\/p>\n

                                                     <\/p>\n

                                                      \n
                                                    1. 4. <\/strong>Beta receptorji?<\/span><\/strong><\/li>\n<\/ol>\n

                                                      Beta 1 receptorji \u2192 beta mimetiki. Predstavnik:<\/span><\/strong> dobutamin.<\/p>\n

                                                      Klini\u010dna uporaba:<\/span><\/strong><\/p>\n

                                                      Pozitivno inotropno pri:<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cirkulatornem \u0161oku,<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sr\u010dnem zastoju,<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hipotenziji.<\/p>\n

                                                       <\/p>\n

                                                      Beta 2 receptorji \u2192 beta 2 mimetiki. Predstavniki:<\/span><\/strong> Fenoterol, Salbutamol, Salmeterol.<\/p>\n

                                                      Klini\u010dna uporaba:<\/span><\/strong><\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 KOPB,<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cirkulatorni \u0161ok,<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prezgodnji porod,<\/p>\n

                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Periferna vaskularna bolezen.<\/p>\n

                                                       <\/p>\n

                                                        \n
                                                      1. 5. <\/strong>Alfa 1: alfa antagonisti?<\/span><\/strong><\/li>\n<\/ol>\n

                                                        Klini\u010dna uporaba:<\/span><\/strong><\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Periferna vazodilatacija (nadzor hipertenzije, periferna vaskularna bolezen, tumor sredice suprarenalke)<\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Retencija urina<\/p>\n

                                                        Predstavniki:<\/span><\/strong><\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fenoksibenzamin,<\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fentolamin,<\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prazosin,<\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Doksazosin,<\/p>\n

                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tetrazosin.<\/p>\n

                                                         <\/p>\n

                                                          \n
                                                        1. 6. <\/strong>Beta 1: beta blokatorji?<\/span><\/strong><\/li>\n<\/ol>\n

                                                          Klini\u010dna uporaba:<\/span><\/strong><\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolezen srca,<\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hipertenzija,<\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Profilaksa migrene (prepre\u010devanje),<\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Situacijska anksioznost,<\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tirotoksikoza.<\/p>\n

                                                          Predstavniki:<\/span><\/strong><\/p>\n

                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neselektivni beta blokatorji:<\/span><\/p>\n

                                                            \n
                                                          • Alprenolol<\/li>\n
                                                          • Karvedilol<\/li>\n
                                                          • Nadolol<\/li>\n
                                                          • Oksprenolol<\/li>\n
                                                          • Pindolol<\/li>\n
                                                          • Propranolol<\/li>\n
                                                          • Sotalol<\/li>\n
                                                          • Timolol.<\/li>\n<\/ul>\n

                                                             <\/p>\n

                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kardioselektivni beta blokatorji:<\/span><\/p>\n

                                                              \n
                                                            • Atenolol,<\/li>\n
                                                            • Bisoprolol,<\/li>\n
                                                            • Metoprolol.<\/li>\n<\/ul>\n

                                                              7. N<\/strong><\/strong>a\u0161tej nevrotransmiterje ter receptorje holinergi\u010dnega sistema!<\/span><\/strong><\/p>\n

                                                              Holinergi\u010dni oziroma parasimpati\u010dni \u017eiv\u010dni sistem je aktiven, ko telo po\u010diva in se obnavlja.<\/p>\n

                                                               <\/p>\n

                                                              Nevrotransmiterji:<\/span><\/strong><\/p>\n

                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Acetilhotlin: simpati\u010dni predgangljiski, parasimpati\u010dni predgangljiski, parasimpati\u010dni efektorni, simpati\u010dni efektorni (supraprenalka), somatski (hotni) \u017eiv\u010dni sistem.<\/p>\n

                                                              Receptorji:<\/span><\/strong><\/p>\n

                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Muskarinski<\/p>\n

                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nikotinski.<\/p>\n

                                                               <\/p>\n

                                                                \n
                                                              1. 8. <\/strong>Mehanizem holinergi\u010dnega delovanja?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                Ko se acetilholin sprosti v sinapso pride do:<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Depolarizacije \u017eiv\u010dnega vlakna<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Acetilholinesteraze<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ponovnega prevzema<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vezave na postsinapti\u010dne receptorje\u2192 aktivacija citoplazemskega sekundarnega prena\u0161alca \u2192 serija intracelularnih dogodkov, obnova in po\u010ditek.<\/p>\n

                                                                 <\/p>\n

                                                                Nikotinski receptorji:<\/span><\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pove\u010da se tonus;<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pride do aktivnosti C\u017dS, sredice suprarenalke, nevromuskalarni stik skeletnih mi\u0161ic.<\/p>\n

                                                                Muskarinski receptorji:<\/span><\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odgovorni za prebavo in organe.<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u017dS (M1),<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Periferni efektorni organi (srce, M2),<\/p>\n

                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Visceralne gladke mi\u0161ice, eksokrine \u017eleze (M3).<\/p>\n

                                                                 <\/p>\n

                                                                 <\/p>\n

                                                                  \n
                                                                1. 9. <\/strong>Vrste in uporaba muskarinskih receptorjev?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                  Vrste:<\/span><\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Acetilholin<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Karbahol<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pilokarpin,<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cisaprid.<\/p>\n

                                                                  Klini\u010dna uporaba:<\/span><\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Midriaza (za \u0161irjenje zenic),<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Glavkom,<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Konstipacija, zmanj\u0161ana motiliteta GIT,<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Urinarna retencija,<\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tahikardija<\/p>\n

                                                                  Stimulacija muskarinskih receptorjev:<\/span><\/p>\n

                                                                  –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Miastenia gravis.<\/p>\n

                                                                   <\/p>\n

                                                                    \n
                                                                  1. 10. <\/strong>Uporaba nikotinskih receptorjev?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                    Za stimulacijo nikotinskih receptorjev.<\/p>\n

                                                                    Klini\u010dna uporaba:<\/p>\n

                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje mi\u0161i\u010dne slabosti (bolezen motori\u010dnih nevronov, bolezni z izgubo mi\u0161ic),<\/p>\n

                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odvajanje od kajenja.<\/p>\n

                                                                     <\/p>\n

                                                                      \n
                                                                    1. 11. <\/strong>Muskarinski antagonisti?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                      Klini\u010dna uporaba:<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antispazmodiki (zmanj\u0161ujejo motiliteto prebavil),<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Protiulkusno delovanje (zmanj\u0161ujejo izlo\u010danje prebavnih sokov),<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiemetiki (centralno pomirjanje),<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Midriatiki (za \u0161irjenje zenic),<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiasmatiki (zmanj\u0161ujejo izlo\u010danje bronhialnega sekreta, bronhodilatacija),<\/p>\n

                                                                      –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Enureza, inkontinenca, pogosto mokrenje.<\/p>\n

                                                                       <\/p>\n

                                                                       <\/p>\n

                                                                        \n
                                                                      1. 12. <\/strong>Histamin in antihistaminiki, kak\u0161ne vrste receptorjev histamina poznamo in kje so?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H1: gladke mi\u0161ice, eksokrine \u017eleze, respiratorni trakt.<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H2: parietalne celice \u017eelodca.<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oba tipa: C\u017dS, sr\u010dna mi\u0161ica.<\/p>\n

                                                                        Histamin deluje kot nevrotransmiter v imunskem sistemu.<\/p>\n

                                                                        Prisotnost histamina v telesu:<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Plju\u010da,<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ko\u017ea,<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mukoza GIT,<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mastociti,<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bazifilci,<\/p>\n

                                                                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Trombociti.<\/p>\n

                                                                         <\/p>\n

                                                                          \n
                                                                        1. 13. <\/strong>Klini\u010dni pomen antihistaminikov?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                          U\u010dinkovine:<\/p>\n

                                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Astemizol,<\/p>\n

                                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cetirizin,<\/p>\n

                                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Loratadin<\/p>\n

                                                                          Ne\u017eeleni stranski u\u010dinki:<\/p>\n

                                                                          –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zaspanost (ker se nahajajo v C\u017dS).<\/p>\n

                                                                           <\/p>\n

                                                                          SPECIALNI DEL: 9. Poglavje<\/span><\/p>\n

                                                                          <\/span><\/strong><\/p>\n

                                                                          CENTRALNI \u017dIV\u010cNI SISTEM<\/span><\/strong><\/p>\n


                                                                          \n<\/span><\/strong><\/p>\n

                                                                          Osrednji oziroma centralni \u017eiv\u010dni sistem sestavljajo mo\u017egani in hrbtenja\u010da.<\/p>\n

                                                                            \n
                                                                          1. 1. <\/strong>Na\u0161tej nevrotransmiterje v mo\u017eganih!<\/span><\/strong><\/li>\n<\/ol>\n

                                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Serotonin,<\/p>\n

                                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 GABA,<\/p>\n

                                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Acetilholin,<\/p>\n

                                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dopamin,<\/p>\n

                                                                            –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noradrenalin.<\/p>\n

                                                                             <\/p>\n

                                                                              \n
                                                                            1. 2. <\/strong>Skupine zdravil, ki vplivajo na centralni \u017eiv\u010dni sistem:<\/span><\/strong><\/li>\n<\/ol>\n

                                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antipsihotiki,<\/p>\n

                                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Anksiolitiki in hipnotiki,<\/p>\n

                                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antidepresivi in stabilizatorji razpolo\u017eenja,<\/p>\n

                                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiparkinsoniki,<\/p>\n

                                                                              –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antikonvulzivi.<\/p>\n

                                                                               <\/p>\n

                                                                                \n
                                                                              1. 3. <\/strong>Antipsihotiki, delovanje, predstavniki, skupine ter ne\u017eeleni stranski u\u010dinki?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                                Delovanje:<\/span><\/strong><\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Blokirajo dopaminske receptorje v mezolimbi\u010dni poti (center mo\u017eganov).<\/p>\n

                                                                                Skupine:<\/span><\/strong><\/p>\n

                                                                                Receptorji na katere antipsihotiki delujejo:<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dopaminski,<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Muskarinski,<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Histaminski H1,<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Serotoninski,<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alfa 1, adrenergi\u010dni.<\/p>\n

                                                                                Predstavniki:<\/span><\/strong><\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prazine, rispedal.<\/p>\n

                                                                                Ne\u017eeleni stranski u\u010dinki:<\/span><\/strong><\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ekstrapiramidalni u\u010dinki (z zdravili povzro\u010deni parkinsonizem) \u2192 antimuskarinska zdravila: tremor, rigidnost, ote\u017eeno gibanje, distoni\u010dne reakcije (pa\u010denje obraza, trd vrat, spasti\u010dnost okon\u010din), nemir, tardivna diskinezija z nehotenimi gibi, nevrolepti\u010dni maligni sindrom (urgenca!)<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hipotenzija (zaradi blokade alfa receptorjev), aritmija<\/p>\n

                                                                                –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sedacija<\/p>\n

                                                                                 <\/p>\n

                                                                                  \n
                                                                                1. 4. <\/strong>Ali lahko damo antipsihotik in antiemetik skupaj? <\/span><\/strong><\/li>\n<\/ol>\n

                                                                                  Ne. Pomislimo na mo\u017enost interakcije, ker obe zdravili delujeta na C\u017dS. Pokli\u010demo zdravnika.<\/p>\n

                                                                                   <\/p>\n

                                                                                    \n
                                                                                  1. 5. <\/strong>Anksiolitiki in psihotiki, mehanizem delovanja, predstavniki?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                                    Mehanizem delovanja:<\/span><\/strong><\/p>\n

                                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 GABA: glavni inhibitorni nevrotransmiter v mo\u017eganih<\/p>\n

                                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Anksiolitiki: pove\u010dajo mo\u010d GABA, jakost, trajanje delovanja GABA.<\/p>\n

                                                                                    Vrste anksiolitikov:<\/p>\n

                                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Barbiturati: uporablja se ga predvsem kot antiepileptika.<\/p>\n

                                                                                    Delovanje: sedacija C\u017dS, vezana na GABA receptorje.<\/p>\n

                                                                                    Ne\u017eeleni u\u010dinki: zaspanost, odvisnost, sedacija.<\/p>\n

                                                                                    Predstavnik: Fenobarbiton.<\/p>\n

                                                                                    Interakcije: toksi\u010dnost barbituratov pove\u010dajo: antihistaminiki, alkohol,<\/p>\n

                                                                                    analgetiki, anestetiki, pomirjevala.<\/p>\n

                                                                                     <\/p>\n

                                                                                    –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Benzodiazepini: sedacija C\u017dS, vezava na receptorje.<\/p>\n

                                                                                    Ne\u017eeleni u\u010dinki: zaspanost, odvisnost, sedacija.<\/p>\n

                                                                                    Predstavnik: Apaurin<\/p>\n

                                                                                    Interakcije: s tistimi zdravili, ki tudi centralno pomirjajo, se pravi<\/p>\n

                                                                                    tistimi, ki prav tako delujejo na C\u017dS.<\/p>\n

                                                                                     <\/p>\n

                                                                                      \n
                                                                                    1. 6. <\/strong>Kaj naredimo v primeru, da pacientu apliciramo Apaurin, potem pa en dan zavohamo zadah po alkoholu?<\/span><\/strong><\/li>\n<\/ol>\n

                                                                                      Pomislimo na mo\u017enost interakcije. Pomislimo na mo\u017enost sedativnega delovanja. Pokli\u010demo zdravnika.<\/p>\n","protected":false},"excerpt":{"rendered":"

                                                                                      Zgodovinski okvir farmakologije? Na\u0161tej in opi\u0161i zgodovinska obdobja? 1. Obdobje: obdobje uporabe naravnih snovi: – iz prazgodovine do 20. Stoletja – alkohol, atropin, marihuana: 2. Obdobje: obdobje sinteznih u\u010dinkovin: – 20. Stoletje 3. doba biotehnologije: – od konca 20. Stoletja dalje.<\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[705],"tags":[1785,706,1784,1783],"class_list":["post-2070","post","type-post","status-publish","format-standard","hentry","category-2letnik-farmakologija","tag-farma","tag-farmakologija","tag-gradivo-za-farmakologijo","tag-zapiski-za-farmakologijo"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/2070","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=2070"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/2070\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=2070"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=2070"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=2070"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}