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Lekarstvenno the caused diseases of a respiratory organs

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Lekarstvenno the caused diseases of a respiratory organs
General principles of treatment

Lekarstvenno the caused diseases — the diseases developing owing to side effect of various medicines.
Side effect of medicines — the undesirable effects arising at use of medicines in the doses recommended for prevention and treatment of diseases. Toxic effect of medicines — undesirable effects, the caused medicines in the doses exceeding therapeutic.
The diseases connected with toxic effects medicines and reception by mistake of other substance are not included into RODS group.

Epidemiology

Epidemiological researches on prevalence of RODS in Russia were not conducted. In the researches conducted in the USA it is shown that about 25% of all hospitalization are connected from RODS. At the same time the share of defeats of a respiratory organs in structure of RODS makes up to 10% (according to various authors from 5% (at ambulatory patients) to 15% (in the conditions of a hospital).

Classification

Allocate the caused diseases of a respiratory organs following lekarstvenno:
• bronchial asthma;
• pulmonary eosinophilic infiltration;
• medicinal system lupus erythematosus;
• not cardiogenic fluid lungs;
• obliterating bronchiolitis;
• pleural exudate;
• fibroziruyushchy alveolitis.

Etiology and patogenenez

Medicines which use most often leads to defeat of a respiratory organs

Group of medicines

Representatives

Antimicrobic

Amphotericinum In, an isoniazid, nitrofurans, streptomycin, Sulfasalazinum, tetracycline, Ethambutolum

Neurotropic

Anxiolytics, carbamazepine, sedative medicines, Trazodonum, chlordiazepoxide

Antiinflammatory

Acetylsalicylic acid, metamizole sodium

Antineoplastic

Busulfan, Bleomycinum, gemtsitabin, Melphalanum, Mercaptopurinum, a methotrexate, Procarbazinum, Tamoxifenum, fludarabin, hlorambutsit, etopozid

Immunotropnye

Azathioprinum, colony stimulating factor, Interlaken, interferon, Penicillaminum, gold salts, factor of a necrosis of tumors, cyclosporine

Kardiotropnye

Amiodaronum, anticoagulants, b-adrenoblockers, gidralazin, Hydrochlorthiazidum, Dipiridamolum, inhibitors of an angiotensin-converting enzyme, protamin sulfate, tokainid, flekainid

Narcotic

Cocaine, methylphenidate, narcotic analgetics

Other medicines

Anorexigenic medicines, Bromocriptinum, dantrolen, mineral oils, tryptophane

Side effects of medicines can be divided into two groups conditionally:
• connected with direct pharmacological effect of medicines (typical side effects);
• the reactions of an organism to medicines caused by feature, including an originality of psychological reactions of the patient (paradoxical side effects). They are unexpected and often quite heavy.
Risk factors of emergence of side reactions:
• children's and advanced age;
• duration of reception and a dose (dependence on a dose and duration of reception is characteristic of typical side effects);
• hereditary predisposition;
• associated diseases.

Clinical signs and symptoms of an illness

The clinical manifestations characteristic of all lekarstvenno the caused diseases of a respiratory organs:
• cough — dry or with department of a phlegm;
• asthma;
• thorax pain.
Clinical criteria of disease severity at the majority of RODS are: expressiveness of intoxication and respiratory insufficiency.

The diagnosis and the recommended clinical trials

Characteristic feature of RODS — existence of interrelation between emergence of symptoms and reception of a certain medicine (however the fibroziruyushchy alveolitis against reception of Amiodaronum and antineoplastic medicines can develop in several years after the beginning of pharmacotherapy).

The main mechanisms of injury of lungs in case of use of various medicines

medicines

Target cells

Damage mediators

Possible side effects

Colchicine

Macrophages

Neutral proteases

Increase in permeability of an epithelium

Amphotericinum

Neutrophils

Increase
aggregations
neutrophils

Damage of an endothelium

Nitrofurantoin

Lymphocytes

Autoantibodies to albumine

Immune complex deposition in lungs

Penicillaminum

Lymphocytes

Autoantibodies to a basal membrane of balls

Immune complex deposition in lungs and kidneys

Amiodaronum gold Salt Nitrofurantoin

Lymphocytes

Activation
blastogenesis
lymphocytes

Autologichesky cytotoxicity

Gold salts

Lymphocytes

Release of lymphokines

Damage of a parenchyma of lungs

Gold Salt Penicillaminum

Fibroblasts

Disturbance of an exchange of collagen

Disturbance of a reparation of a pulmonary matrix

Heroin Terbutalin

System of a complement

Complement activation

Aggregation of neutrophils with damage of an endothelium

Nitrofurantoin

Extracellular matrix

Production of oxidizers

Damage of a membrane of an endothelium

Diagnostic minimum

Clinical blood test

At many RODS reveal the increased maintenance of eosinophils which quantity correlates with weight of process:
• 5 — 15% — an easy current;
• 15 — 30% — a medium-weight current;
• > 30% — a heavy current.

The visualizing research methods

The changes characteristic of certain forms lekarstvenno of the caused diseases of a respiratory organs come to light. Expressiveness of changes correlates with weight of process.

Research of function of external respiration

Depending on a form lekarstvenno of the caused diseases of a respiratory organs changes of function of external respiration on restrictive (decrease in the general capacity of lungs, OFV1/FZhEL> 80%), obstructive (OFV1/FZhEL <80% come to light at the safe pulmonary volumes) or to the mixed type.



 
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