STARI PATOLOGICE PRODUSE DE MED.

Stari patologice in domeniul cardiovascular

STARE PATOLOGICA MEDICAMENTE CU RISC

Insuficienta cardiaca
-Deprimarea miocardului - chinina, procainamida, beta-blocante, verapamil

-Lezarea miocardului - daunorubicina, doxorubicina, emetina

-Retentie hidrosalina
Aritmii ectopice
Bradicardie, bloc AV
- glucocorticoizi, aldosteron, carbenoxolon, fnilbutazona
- digitalice, chinidina, encainida, flecainida, amiodarona,
amine simpatomimetice, levodopa, antidepresive triciclice,
litiu, neuroleptice fenotiazinice, emetina, daunorubicina,
doxorubicina, lincomicina
- Blocante beta-adrenergice, verapamil, digitalice

hTA severa, colaps - guanetidina, prazosin, chinidina, procainamida, fenitoina,

propanolol, clorpromazina, antidepresive ciclice, levodopa

HTA - amine simpatomimetice vasoconstrictoare, ergotamina,

vasopresina, anorexigene, estrogeni, contraceptive orale,
aldosteron, carbenoxolona, glucocorticoizi.
Vasoconstrictie periferica - ergotamina, dopamina, blocante beta-adrenergice
Stari patologice ale sangelui

STARE MEDICAMENTE CU RISC

PATOLOGICA
Aplazie cloramfenicol, peniciline, streptomicina, sulfamide, fenitoina, acid
medulara acetilsalicilic, fenacetina, aminofenazona, fenilbutazona, oxifenbutazona,
acetazolamida, tolbutamida, clorpropamida, tioamide antitiroidiene
Agranulocitoza ag. alchilanti, antimetaboliti citotoxici, cloramfenicol, peniciline,
streptomicina, sulfamide, fenitoina, acid acetilsalicilic, aminofenazona,
metamizol, fenilbutazona, aur, fenindiona, acetazolamida, acid etacrinic,
carbutamida, clorpropamida, tolbutamida, mepacrina, chinina, barbiturice,
Anemie melfalan, cloramfenicol, tetracicline, peniciline, streptomicina, sulfamide,
aplastica fenitoina, trimetadiona, acid acetilsalicilic, aminofenazona, fenilbutazona,
aur, acetazolamida, tolbutamida
Anemie metotrexat, trimetoprim, pirimetamina, triamteren, cicloserina, izoniazida,
magaloblastica fenitoina, primidona, barbiturice, alcool, mestranol, contraceptive orale,
colchicina, neomicina, metformin
Anemie plumb, izoniazida, pirazinamida, cicloserina, cloramfenicol, alcool,
hipocroma anticoagulante, acid acetilsalicilic
Anemie Penicilina, cefalotina, rifampicina, izoniazida, sulfamide, clorpromazina,
hemolitica levodopa, metildopa, chinina, chinidina
Trombocitopenie Ag. alchilanti, cloramfenicol, peniciline, streptomicina, rifampicina,

Disfunctie Acid acetilsalicilic, AINS, sulfinpirazona, acid valproic, neuroleptice

plachetara fenotiazinice, carbenicilina, ticarcilina, benzilpenicilina, latamoxaf
Stari patologice renale
STARE MEDICAMENTE CU RISC
PATOLOGICA
Nefropatie tubulara Antibiotice aminogliozidice, cefalosporine, rifampicina, amfotericina B,
cisplatina, litiu, paracetamol
Nefropatie AINS, metoxifluran, sulfamide, unele peniciline, rifampicina, cefalotina,
interstitiala acuta prod. iodati de contrast
Nefropatie Penicilamina, trimetadiona, probececid, saruri de aur, saruri de mercur,
glomerulara cronica litiu, perclorat
Nefropatie Fenacetina, acid acetilsalicilic, fenazona
interstitiala cronica
si necroza papilara
Insuf. renala acuta antiHTA, diuretice, captopril, enalapril, opioide

Cristalurii Sulfamide, ampicilina, primidona, mercaptopurina

Diabet insipid Litiu, vitamine D, metoxifluran, dextropropoxifen

nefrogen
Retentie de lichide Corticosteroizi, carbenoxolona, steroizi androgeni si anabolizanti,
(edeme) estrogeni, fenilbutazona, indometacina, clonidina
Hiperkalimie Spironolactona, triamteren, amilorid, captopril, enalapril

Hipokaliemie Corticosteroizi, diuretice, carbenoxolona, amfotericina B, gentamicina,

tetraciclina
 Stari patologice gastrointestinale
STARE MEDICAMENTE CU RISC
PATOLOGICA

Greata si voma Tetracicline, eritromicina, citotoxice anticanceroase, opioide, levodopa,

bromocriptina, aminofilina, digitalice, estrogeni, sulfat feros

Gastrita hiperacida, Glucocorticoizi, aspirina, fenilbutazona, AINS

ulceratii, ulcer gastric
sau duodenal

Diaree, enterita, colita Purgative iriante, antibiotice - peniciline, tetracicline, cloramfenicol,

lincomicina, clindamicina-, rezerpina, metildopa, guanetidina, digitalice

Constipatie Opioide, codeina, atropina, anticolinergice, antiacide (carbonat de calciu,

hidroxid de aluminiu), vinblastina, vincristina

Malabsorbtie Colestiramina, purgative, colchicina, fluorouracil, fenobarbital,

primidona, fenitoina, metformina, buformina
Stari patologice hepatice
STARE MEDICAMENTE CU RISC
PATOLOGICA
Hepatita acuta paracetamol, fenacetina, fenilbutazona, AINS, acid valproic, IMAO,
metildopa, sulfamide, izoniazida, pirazinamida, etionamida, rifampicina,
eritromicina, troleandomicina, mercaptopurina
Hepatita cronica halotan, clorpromazina, metildopa, oxifenisatina, azatioprina, metotrexat
activa
Steatoza hepatica tetracicline

Ciroza metotrexat, vitamina A (supradozare cronica)

Icter colestatic steroizi anabolizanti, metiltestosteron, contraceptive orale,

clorpromazina, eritromicina, trolendomicina
Litiaza biliara estrogeni, contraceptive hormonale orale

Tumori hepatice estrogeni, contraceptive hormonale orale, steroizi androgeni si

anabolizanti
 Stari patologice ale ap. respirator
STARE MEDICAMENTE CU RISC
PATOLOGICA

Astm bronsic acid acetilsalicilic, AINS, peniciline, cefalosporine, eritromicina,

streptomicina, neomicina, tetracicline, griseofulvina, sulfamide, ioduri,
fier, dextran, beta-blocante (propranolol), parasimpatomimetice, IMAO
Pneumonie bleomicina, clorambucil, ciclofasfamida, melfalan, metotrexat,
interstitiala, alveolita, azatioprina, nitrofurantoina, sulfasalazina, metisergida, amiodarona,
fibroza pulmonara acebutolol, fenofibrat, saruri de aur, penicilamina
Eozinofilie pulmonara izoniazida, sulfonamide, nitrofuratoina, peniciline,
streptomicina,metotrexat, acid acetilsalicilic, carbamazepina, fenofibrat

Limfadenopatie nitrofurantoina, fenilbutazona, fenitoina

LED cu determinari izoniazida, sulfonamide, griseofulvina, peniciline, streptomicina,

pulmonare tetracicline, hidralazine procainamida, metildopa, chinidina, metisergida,
fenitoina, carbamazepina, fenotiazine, fenilbutazona
Poliarterita sistemica penicilina, tetracicline, griseofulvina, busulfan, hidralazina, chinidina,
cu determinari fenilbutazona, compusi de aur, fenotiazine, ioduri, tioamide antitiroidiene
pulmonare
Endocrinopatii medicamentoase
 In conditii de supradozare; reversibile.
 Glucocorticoizii: sindrom Cushingoid
 Insulina si antidiabeticele orale: r. hipoglicemiante
 Hormonii tiroidieni: hipertiroidism
 Diazoxidul: hiperglicemie
 Cafeina, teofilina, beta-adrenergicele: hiperglicemie
 Amfetaminele, disopiramida, perhexilina, tiabendazolul,
pentamidina: hipoglicemie
 Beta-blocantele (neselective: propranolol): hipoglicemie
 Hormoni steroizi sexuali: tulburari de menstruatie
 Neurolepticele fenotiazinice: tulburari de menstruatie, impotenta
sexuala
 Antidepresivele, antiHTA simpatolitice, cimetidina: disfunctii
sexuale
Stari patologice psihice si neurologice
induse de med.

 Barbiturice: stare confuzionala

 Antiparkinsonienele anticolinergice, antidepresive triciclice,
antipsihotice: perturbari ale memoriei si atentiei, dezorientare,
anxietate, halucinatii
 Neuroleptice fenotiazinice (rezerpina, haloperidol): sindrom depresiv
 Levodopa: halucinatii
 Amfetaminele: depresie, schizofrenie, paranoia
 Glucocorticoizii: dispozitie maniacala
 Contraceptive hormonale orale: depresie
Stari patologice oftalmice, ORL si ale
cavitatii orale produse de med.
STARE PATOLOGICA MEDICAMENTE CU RISC

Cresterea presiunii Glucocorticozi, anticolinergice, antidepresive triciclice

intraoculare
Depozite corneene Clorpromazina, tioridazina, fenotiazine, clorochina si
derivati
Miopie Fenotiazine

Opacitati ale Glucocorticoizi, clorpromazina, tioridazina

cristalinului
Cataracta Glucocorticoizi, miotice

Retinopatie pigmentara Glucocorticoizi, clorpromazina, tioridazina

Nevrita optica Fenotiazine, cloramfenicol, digitalice

Ototoxicitatea unor antibiotice
aminoglicozidice
ANTIBIOTIC FRECVENTA R. TOXICITATEA TOXICITATEA
OTOTOXICE VESTIBULARA AUDITIVA

Streptomicina 1% +++ + (adulti)

++ (copii)
Kanamicina 1% ++ +++

Gentamicina 2% +++ +

Tobramicina 1% ++ ++

Amikacina 3% ++ +++

Neomicina Interzisa pt. uz ++ ++++

sistemic!
Stari patologice ale muschilor,
articulatiilor, oaselor si tes. conjunctiv
produse de med.

 Mialgii, crampe musculare, miopatie acuta

 Glucocoticoizii, carbenoxolona, corticotrofina: crampe musculare
 Diuretice: dureri musculare
 Amine simpatomimetice beta2-adrenergice: tremor al extremitatilor
 Antiepileptice (fenobarbital, fenitoina): osteomalacie, rahitism
Reactii cutanate produse de med.
R. CUTANATA MEDICAMENTE CU RISC
PATOLOGICA
Acnee Glucocorticoizi, steroizi androgeni, anabolizanti, contraceptive
hormonale orale, litiu, bromuri, fenobarbital, fenitoina, etc.
Alopecie Citotoxice (ciclofosfamida), compusi de aur, heparina,contraceptive
hormonale orale, retinol (supradozare)
Eritem polimorf, Peniciline, sulfamide, barbiturice, fenitoina, fenilbutazona, sulindac
sindrom
Eczeme Antibiotice, sulfamide, procaina, antihistaminice, lanolina,
conservanti si vehicule
Fotosensibilizare Sulfamide antibacteriene, sulfamide antidiabetice, tiazide,
tetracicline, griseofulvina, fenotiazine, clordiazepoxid, acid nalidixic,
contraceptive hormonale orale, antiseptice, psoraleni
Lupus eritematos Hidralazine, sulfamide, procainamida, fenitoina, izoniazida,
nitrofurantoina
Pigmentare Progestative, contraceptive hormonale orale, corticotrofina, fier,
cutanata carbamida,fier, compusi de aur, clorpromazina, amiodarona
Urticarie, prurit, Peniciline, rifampicina, antibiotice, sulfamide, acid acetilsalicilic,
edem angioneurotic morfina, barbiturice, codeina, captopril, enalapril
Intoxicatii acute medicamentoase la om
 Substante incriminate:
 Asociatii medicamentoase
 Tranchilizante benzodiazepinice
 Barbiturice
 Antidepresive
 Neuroleptice fenotizinice

 Tratamentul intoxicatiilor:
 Provocarea vomei (exc. S. caustice, excitante SNC, comatosi)
 Spalaturi gastrice (exc. S. caustice, excitante SNC)
 Purgative
 Spalaturi cu apa (toxicitate cutanata, oculara)
 Diuretice: manitol
 Alcalinizarea urinii: fenobarbital, salicilati, s acide.
 Acidifierea urinii: amfetamina, imipramina, s. bazice.
 Epurarea extrarenala (dializa): in insuf. renala
 Sustinerea fctiilor vitale: respiratie, circulatie
 Antidoturi specifice
Antidoturi
SUBSTANTA TOXICA ANTIDOT

Barbiturice, Bemegrida (ahypnon), fiole de 50mg – i.v. lent 50mg

anestezice generale initial →200mg
Pimaclona (kariona) fiole de 15mg si 50mg - (i.m./i.v.)
50-100mg
Benzodiazepine Flumazenil fiole 0,5 mg, 1 mg – i.v. 0,2 mg
Toxice convulsivante Fenobarbital fiole 200mg – i.m. 50-200mg
Diazepam fiole 10mg – i.m./i.v. 2-20mg
Blocante beta- Atropina, izoprenalina
adrenergice
Opiacee, codeina Nalorfina, naloxona
Paracetamol Acetilcisteina, metionina

Atropina si Pilocarpina
parasimpatolitice
Toxice organofosforice Atropina, obidoxima (toxogonin)
Fenotiazine, Trihexifenidil
butirofenone,
metoclopramida
Dependenta - intoxicatie cronica
 Dependenta psihica
 Toleranta
 Dependenta fizica
 Psihotoxicitatea

 Med. cu potential de dependenta:

 morfina
 heroina & opiode
 amfetamine
 cocaina
 alcoolul
 barbituricele & hipnoticele, tranchilizantele
 lisergida (LSD)
 canabinoidele
 nicotina
 cafeina
CONCLUZII
 Medicamentele, desi sunt utilizate pentru profilaxia, tratamentul sau
diagnosticul bolilor sunt in general produse cu risc pentru sanatate.
 Se apreciaza raportul intre risc si beneficiu.
 Recomandarea si supravegherea de catre medicul terapeut.
 Combaterea reclamei exagerate a medicamentelor.
 Combaterea abuzului de medicamente (automedicatia).
 Atentie la segmentul vârstnic al populaţiei expus excesiv polimedicaţiei
(recomandate de specialişti de diverse specialităţi) şi efectelor
interferenţelor medicamentoase în condiţiile deficienţelor funcţionale
consecutive afecţiunii de bază sau comorbidităţilor.
 În plus, la această grupă de vârstă se întâlnesc cele mai frecvente
abateri de la prescripţia medicală (prin incapacitate de
autoadministrare corectă sau/şi complianţă redusă) ca şi tendinţa
accentuată spre automedicaţie.
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