5/25/2018 FARMACOLOGIEPlan deLectie1CaideAdministrareaMedicamentelor -slidepdf.

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DISCIPLINA DE FARMACOLOGIE
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CE ESTE FARMACOLOGIA?

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 ADMINISTRAREA

• ORALA
• SUBLINGUALA
• RECTALA
• PARENTERALA
• INHALATORIE
• LOCALA

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1. ADMINISTRAREA ORALA

• Caracteristici:
a) Locul de absorbtie:

- intestinul
- stomacul
b) Factorii care influenteaza absorbtia

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DUPA ABSORBTIE (INTESTIN, STOMAC)

VENA PORTA
“
EFECTUL
PRIMULUI
PASAJ ”   FICAT

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 “CICLUL HEPATO-ENTERO-HEPATIC”  

FICAT

 VENA PORTA CAI BILIARE

INTESTIN DUODEN

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Factorii care influenteaza absorbtia

• viteza de evacuare gastrica

• tranzitul intestinal
• forma farmaceutica

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 AVANTAJE DEZAVANTAJE

 calea cea mai practica  efect terapeutic lent

pentru terapia (30-40’)
ambulatorie (comoda)  NU toate M se
 gr. de periculozitate   administreaza oral 
 costul M mai  

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INUTILIZABILA

 comatosi
 sindrom de varsatura
 convulsii
 psihotici

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2. ADMINISTRAREA SUBLINGUALA

 Avantajele administrarii sublinguale:

- viteza de absorbtie rapida
-- Utilizata in urgentele medicale
evita inactivarea M la “prim pasaj hepatic”  

 Conditii pentru administrarea sublinguala:

- doar
doar M
M ce
cu se dizolva
gust rapid=timp
si miros de stationare scurt
acceptabil

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3. ADMINISTRAREA RECTALA

• Absorbtie partiala si neregulata

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 AVANTAJE DEZAVANTAJE

 in sindrom de varsatura  Supuse partial

 in afectiuni genitale  “primului pasaj

(anexite, dismenoree) hepatic”  

 in cazul M iritante  Sunt degradate de
gastrice flora bacteriana a
colonului
 NU la bolnavi cu
afectiuni rectale
 NU in boala diareica

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4. ADMINISTRAREA PARENTERALA  
(INJECTABILA)
•  Administrarea M pe cai artificiale (provocate) cu
seringa!

ID IV IA IM
SC

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 AVANTAJE DEZAVANTAJE

 Absorbtie rapida si  Necesita instrumentar

completa steril si personal
medical calificat
 Permit admnistrarea M

neabsorbabile pe cale Posibilitatea
transmiterii pe aceste
orala cai a unor afectiuni
 Permit administrarea M grave
inactivate de sucul 

gastric, enzime Erorile

tehnicade
dedozaj/de
 Permit adminstrerea M administrare =>
la bolnavi ce nu accidente severe
coopereaza
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CONDITIILE PENTRU ADMINISTRAREA

PREPARATELOR INJECTABILE

SM trebuie sa fie:
 Sterile
 Apirogene
 Limpezi
 Neutre
 Izotonice

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a) CALEA INTRADERMICA

• cantitatea injectata foarte mica (0,1-0,2

ml)
• administrata pe fata anterioara a
antebratului

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b) CALEA SUBCUTANATA

• cantitatea injectata foarte mica (1-3 ml)

• administrata pe fata externa a coapsei,
regiunea deltoidiana

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c) CALEA INTRAVENOASA

• DIRECTA (5-20 ml)

• PERFUZIE I.V.

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 AVANTAJE DEZAVANTAJE

 Efect terapeutic  RISCANTA !

rapid  Soc anafilactic
  “platou terapeutic” 
   Decompensare cardiaca


Cant.
lichidemare de Embolie
gazoasa/grasoasa
INDICATII:  NU IV sol. Uleioase !
 URGENTE


SOC ANAFILACTIC
 CRIZA DE AB

  ARSURI

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d) CALEA INTRAARTERIALA

• Arteriopatie diabetica
• Neoplasme
• Radiologie

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e) CALEA INTRAMUSCULARA

• In cadranul sup.-ext. al fesei

sau 1/3 mijlocie a coapsei
• Efect terapeutic rapid (15-20’) 
• Permite administrarea de solutii
apoase, uleioase, preparate
retard

• Incidente
flegmoane,posibile:
intepare abcese,
de vas

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f) CALEA INTRACARDIACA

• Adrenalina 10 /00 in stop cardiac

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g) ADMINISTRAREA IN SEROASE 
(PLEURA, PERICARD, PERITONEU)

• DOAR IN SPITAL !!!

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5. ADMINISTRAREA INHALATORIE
• GENERALE: anestezice generale volatile
• LOCALE: bronhodilatatoare in flacoane
presurizate dozate

!!! Preparatele cortizonice inhalate:

NU provoaca efecte cortizonice sistemice
NU deprima functia CRS

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6. ADMINISTRAREA LOCALA
• cu efect local (dermatologie)
• cu efect sistemic

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LEGAREA M DE PROTEINELE PLASMATICE

 ADMINISTRARE=> ABSORBTIE=> SANGE (PP)

• SM LIBERA, ACTIVA
• SM LEGATA DE PP, INACTIVE
- ALBUMINE
- ALFA 1 GLICOPROTEINE
- GLOBULINE
SM = substanta medicamentoasa

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Cantitatea de SM legata de PP depinde de: 

• c% plasmatica a SM libere
• cantitatea de PP si locurile libere pe PP
Fixarea SM pe PP delimiteaza 3 grupe de SM: 
• puternic
• moderat
• slab
Legarea este REVERSIBILA, DINAMICA, SATURABILA,
NESPECIFICA
CONSECINTELE LEGARII SM PE PP 
BLOCHEAZA TEMPORAR EFECTUL SI IL PRELUNGESTE

• rezerva provizorie a SM
• favorizeaza absorbtia
• determina alergia medicamentoasa
• hipoproteinemiile (CIROZA) => intoxicatiile medicamentoase

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DISTRIBUTIA M IN ORGANISM
 ADMINISTRARE=>ABSORBTIE=>DISTRIBUTIE
• NEUNIFORMA
• UNIFORMA
• REDISTRIBUTIE

-• Poate fi in:
COMPARTIMENTUL VASCULAR (Vd mic)
- macromolecule
- complexe SM-PP
• COMPARTIMENTUL INTERSTITIAL (Vd mijlociu) 
• COMPARTIMENTUL INTRACELULAR (Vd mare)
• DEPUNEREA SM IN TESUTUL ADIPOS (Vd MARE)
•  Vd = volum de distributie

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 A. DISTRIBUTIA IN SNC

BARIERA HEMATO-ENCEFALICA:
 BARIERA HEMATO-LICHIDIANA
 BARIERA LICHIDO-TISULARA
 BARIERA HEMATO-TISULARA

Distributia in SNC: 
Neuniforma
Permeabilitate crescuta in bolile inflamatorii
Permeabilitate crescuta la NN
Numar redus de receptori la varstnici

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B. DISTRIBUTIA PRIN PLACENTA

bariera placentara
• Difuziune pasiva
• Difuzia este posibila deoarece: PLACENTA
- suprafata mare
- grasime redusa
- vascularizatie bogata

• Depinde de perioada sarcinii:

- trimestrul I
- trimestrul II
- trimestrul III
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• SE EVITA ADMINISTRAREA M LA FEMEIA

GRAVIDA FARA CONSULT MEDICAL
• ZIUA 15-60 DE SARCINA (ETAPA
ORGANOGENEZEI) = TERATOGEN
• DZ, HTA, EPILEPSIE  NU SE INTRERUPE BRUSC,
CI SE AJUSTEAZA DOZA
• FEMEIA GRAVIDA:
- M cat mai putine
- doze cat mai mici
- durata cat mai scurta
- NU M recent introduse in terapeutica

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