[The use of antidepressants for the treatment of chronic pain: a focus on elderly patients.]

A possible tool to improve the efficacy and safety of managing elderly and senile patients with chronic pain may be the use of adjuvant analgesics, in particular, antidepressants. Available clinical data indicate the possibility of using antidepressants as an alternative to opioid analgesics and non-steroidal anti-inflammatory drugs. The review includes the analysis of the comparative characteristics and peculiarities of prescribing tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors as painkillers in elderly patients. Recommendations are given on the use of various representatives of the antidepressant group in elderly patients with various types of pain, aimed at minimizing possible adverse drug reactions and improving the quality of life of this category of patients.

Features of the choice and the use of antiepileptic drugs as analgesics in elderly.

High prevalence of chronic pain in elderly results in active search of new approaches for the effective and safe management of this category of patients. Antiepileptic drugs may provide analgesic affect in different types of chronic pain (mainly, in neuropathic pain). Variety of antiepileptics used as analgesics have variable efficacy and safety profile in elderly. «Old¼ antiepileptics (phenobarbital, clonazepam, ethosuximide, carbamazepine, phenytoin, valproate, etc.) and «new¼ (gabapentin, pregabalin, oxcarbazepine, lamotrigine, levetiracetam, topiramate, zonisamide, tiagabine) are considered in this review with insights on pharmacokinetic features of these drugs in elderly, profile of side effects, parameters of analgesic efficacy.

[Rational treatment of patients with functional dyspepsia].

Functional dyspepsia is one of the most common functional disorders of the gastrointestinal tract, which resulted from impaired motor skills, visceral hypersensitivity, increased mucosal permeability, disorders of the autonomic nervous system, etc. There is no specific therapy for this disease, which often leads to the irrational use of various groups of drugs. Drug therapy is recommended only during periods of symptoms. The main options of pharmacotherapy include the use of proton pump inhibitors, phytotherapeutic drugs, eradication therapy of Helicobacter pylori. Against the background of possible motor disorders, prokinetics are also one of the possible treatment options, but cisapride has long been withdrawn from sale due to cardiotoxicity, the use of domperidone and metoclopramide is limited due to side effects, especially with long-term therapy, so currently the only prokinetic that can be used in everyday clinical practice is itopride. In refractory cases, tricyclic antidepressants and psychotherapeutic approaches are another effective treatment option.

[Symptomatic slow-acting drugs in the treatment of osteoarthritis: focus on glucosamine preparations]. / Simptomaticheskie lekarstvennye sredstva zamedlennogo deistviya pri lechenii osteoartrita: fokus na preparaty glyukozamina.

The article discusses the place of symptomatic slow-acting drugs in current guidelines for the treatment of osteoarthritis. Special emphasis is put ot glucosamine preparations, the attitude towards which, until recently, was ambiguous. The results of experimental and clinical studies demonstrating the advantages of crystalline glucosamine sulfate over preparations/food additives of glucosamine hydrochloride are presented. The differences in the pharmacodynamics and pharmacokinetics of glucosamine sulfate and glucosamine hydrochloride, which may be the reason for the ineffectiveness of the latter in clinical trials, are discussed.

Prevalence and risk factors of potentially prescribing omissions in elderly and senile patients: clinical practice in Russian hospitals.

A retrospective pharmacoepidemiological study (included data from medical records of 401 patients ≥65 years of age who received treatment in hospitals) was aimed to measure prevalence of potentially prescribing omissions (PPOs) among older people using Screening Tool to Alert doctors to Right Treatment 2 (START-2) criteria (2015) and to investigate associated risk factors. Statistical analysis includes methods of parametric and nonparametric statistics. We compared patients who had PPOs with those had not PPOs. It was found that hypertension, diabetes mellitus and high levels of concomitant diseases were more characteristic for people with PPOs, and they received more medications. There were no significantly differences in terms of age and gender. Polypharmacy was observed in 36,7% of patients. Using the START-2 criteria, 633 episodes of PPOs were indicated (67,3% of patients). 94,7% PPOs were mainly associated with under-use of statins, aspirin, b-blockers and angiotensin-converting enzyme inhibitors. Multivariate analyses revealed strong association of PPOs prevalence with the number of prescribed medications and comorbidities, especially, ischaemic heart disease and hypertension. Cardiovascular medications were the most common among PPOs.

[Muramyldipeptide - based compounds in current medicine: focus on glucosaminylmuramyl dipeptide].

The role of immune mechanisms in the pathogenesis of almost all human diseases shown in recent decades, increase in antibiotic resistance and secondary immunodeficiency, aging of the population and widespread use of immunosuppressive drugs and procedures suggest a wider use of immunomodulators in current clinical practice, but the use of most of them limits the lack of knowledge. The most promising compounds for the development as immunomodulating agents and adjuvants for a wide range of vaccines are low molecular weight fragments of peptidoglycan - muramylpeptides. The article describes the mechanisms of action of muramylpeptides, their biological effects and properties of medicines developed on their basis. Special emphasis is placed to glucosaminylmuramyl dipeptide registered in the Russian Federation under the trade name Likopid, which is currently the best - studied drug in its group. The results of Likopid studies when used as a prophylactic and therapeutic agent for infections of various localization in adults and children, for oncological diseases and complications of chemotherapy and radiation therapy, psoriasis, atopic and other diseases are presented. It is emphasized that in diseases associated with human papillomavirus and plaque psoriasis, according to current criteria of evidence - based medicine, Likopid should be classified as drug with level A efficacy (high efficiency in 80-100% of patients). High safety of Likopid in adults and children, including newborns, is noted.

Methods of Pharmacological Treatment of Chronic Thromboembolic Pulmonary Hypertension Current Approaches to the Patients Management.

In this paper we have discussed epidemiology, pathogenesis, and approaches to treatment of chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a unique potentially curable form of pulmonary hypertension. The gold standard of CTEPH treatment is pulmonary thromboendarterectomy. However, about 40% of patients with CTEPH are inoperable due to distal surgically inaccessible lesions of the pulmonary vasculature, severe hemodynamic impairments, or other contraindications. In addition, nearly half of patients have persistent or recurrent pulmonary hypertension following surgery. Current guidelines support the use of pharmacotherapy in these patients. In the article we have presented results of main clinical studies of targeted drugs therapy (endothelin receptor antagonists, prostanoids, phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators) of patients with CTEPH. The only drug that has demonstrated robust clinical efficacy in terms of improvment hemodynamic parameters, exercise capacity and patients' quality of life is the stimulator of the soluble guanylate cyclase riociguat. The efficacy and safety of riociguat have been investigated in short-term and long-term studies with follow-up up to 6 years. Results of these studies have constituted the basis forits approval by the regulatory authorities of more than 50 countries for the treatment of inoperable CTEPH and persistent or recurrent CTEPH after pulmonary thromboendarterectomy. In the European Union, USA and many other countries, riociguat is the only pharmacological agent approved for these indications.

[The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate]. / Intranazal'nye glyukokortikosteroidy v terapii rinosinusita: fokus na mometazona furoat.

The authors discuss the mechanism of action, effectiveness, and safety of intranasal glucocorticosteroids (inGCS) used to treat acute, recurrent and chronic rhinosinusitis (RS). The last version of the European guidelines concerning the application of inGCS assigns the highest level of evidence-Ia and the highest strength of recommendations-A to these medications when applied for the treatment of acute and polypoid rhinosinusitis. Moreover, they acquire the status of the agents of choice for the therapy of chronic RS without polyps. Mometasone furoate is one of the best explored preparations of this group of medicines. It is possessed of favourable pharmacodynamic and pharmacokinetic properties when prescribed for local application. The new mometasone furoate preparation in the form of an intranasal spray Dezrinit produced by "Teva" Ltd. was registered in the Russian Federation. In a comparative randomized clinical trial (RCT), the preparation was shown to be an equivalent to the Nasonex spray.

[Enoxaparin is a low-molecular-weight heparin with a complex chemical structure and various non-anticoagulant properties]. / Énoksaparin - nizkomolekuliarnyi geparin so slozhnoi khimicheskoi strukturoi i raznoobraznymi neantikoaguliantnymi svoistvami.

The paper discusses the non-anticoagulant properties of unfractionated heparin and enoxaparin and their relation to their chemical structures. It is emphasized that enoxaparin has multiple, often interrelated, non-anticoagulant effects that can complement its antithrombotic activity and enhance the efficiency of therapy in patients receiving the drug for various indications. The realization of these effects requires the complex structure with the standard distribution of molecular weight (Mw) (average Mw, about 4500 Da, as well as Mw of less than 2000 Da (<20%), 2000 to 8000 Da (>68%), and more than 8000 Da (<18%), and with the standard content of 1.6-anhidro rings (15-25%), which is determined by the source of raw materials and by the production technology of the original drug and cannot be fully reproduced when designing its bioanalogues.

[Linex forte in the prevention and treatment of gastrointestinal diseases].

The paper discusses the properties of Lactobacillus acidophilus (LA-5) and Bifidobacterium animals subsp. lactis (BB-12) that are active ingredients of linex forte, as well as the results of their experimental and clinical studies in gastroenterology. It states dosing recommendations for the drug to treat gastrointestinal tract diseases in adults and children.

[Role of probiotics in the prevention and treatment of diarrhea of various genesis: focus on linex].

The paper gives an update on the role of the microbiota in the maintenance of human health and in the pathogenesis of diseases. There is evidence for the efficacy and safety of probiotics in the treatment and prevention of diarrhea of various genesis. The place of linex in the therapy of diarrhea syndrome is discussed on the basis of the results of clinical trials.

[The influence of ciprofloxacin and pefloxacin on blood coagulation and the anticoagulant effect of heparin]. / Vliianie tsiprofloksatsina i pefloksatsina na svertyvaemost' krovi i antikoaguliantnyi éffekt geparina.

At a single intravenous administration to rabbits ciprofloxacin (10 and 20 mg/kg) and pefloxacin (40 mg/kg) increased the blood coagulability. Administered in a dose of 20 mg/kg pefloxacin exerted no effect on the parameter. Ciprofloxacin (20 mg/kg) and pefloxacin (40 mg/kg) decreased the anticoagulant effect of heparin (100 U/kg).

[Interaction of quinidine, lidocaine, tricaine and pyromecaine with heparin]. / Issledovanie vzaimodeistviia khinidina, lidokaina, trikaina i piromekaina s geparinom.

In the experiments on rabbits it was shown that quinidine administered intravenously in a dose of 5 mg/kg exerts no effect on the blood coagulability but decreases the degree and duration of the anticoagulant effect of heparin. Lidocaine, trimecaine and pyromecaine at the same dose alter neither the blood coagulability nor the anticoagulant effect of heparin.

[Comparative evaluation of the anticoagulant activity of the sodium and calcium salts of heparin, isolated from swine intestinal mucosa]. / Sravnitel'naia otsenka antikoaguliantnoi aktivnosti natrievoi i kal'tsievoi solei heparina, vydelennogo iz slizistoi obolochki kishechnika svinei.

During in vitro experiments it was shown that at intravenous administration to rabbits and dogs in a dose of 100 IU/kg the anticoagulant effect of mucosal heparin sodium was greater than that of heparin calcium. At subcutaneous administration to rabbits in a dose of 750 IU/kg calcium heparin exhibited a stable and even anticoagulant effect for 12 hours. Mucosal sodium heparin administered subcutaneously caused marked peaks of hypocoagulation and rebound effect. At subcutaneous injection sodium heparin action duration was 10 hours.

[Interaction of the calcium salt of heparin with specific antagonists and ethacizine]. / Izuchenie vzaimodeistviia kal'tsievoi soli geparina so spetsificheskimi antagonistami i étatsizinom.

Protamine sulfate was shown to bind calcium heparinate isolated from the pig intestinal mucosa during in vitro experiments in 0.6:1 ration and during experiments on rabbits and dogs in 1.5:1 ratio. 2,5-ionen neutralizes the anticoagulant effect of calcium heparinate during in vitro and animal experiments in 0.6:1 ratio. Neutralization of calcium heparinate requires by approximately 30% more specific antagonists than neutralization of the same amount of sodium heparinate. Ethacizine was found in experiments on rabbits to decrease the anticoagulant effect of calcium heparinate to the same degree as does sodium heparinate.

[Influence of isoptin on the anticoagulant effect of the sodium and calcium salts of heparin]. / Vliianie izoptina na antikoaguliantnyi éffekt natrievoi i kal'tsievoi solei geparina.

It was found that in buffer medium isoptin at concentrations of 0.025-0.0015 mg/ml failed to interact with heparin calcium. In experiments on rabbits isoptin (0.05-0.1 mg/kg) was shown to exert no effect on the time of whole blood coagulation, the time of recalcification and thrombin time and to produce no changes in the anticoagulant effect of heparin calcium but to increase the effect of heparin sodium.