Ministry of healthcare of the republic of uzbekistan




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MINISTRY OF HEALTHCARE OF THE REPUBLIC OF UZBEKISTAN

TASHKENT MEDICAL ACADEMY


"CONFIRM"

The pro-rector on study

Prof........................ Teshaev O.R.

«__» _________________ 2012

Department: PHARMACOLOGY

Subject: PHARMACOLOGY


Technology of training on practical employment

On a theme:


DRUGS AFFECTING THE FUNCTION OF THE RESPIRATORY ORGANS

(educational-methodical course book

for teachers and students of medical Universities)

Tashkent – 2012

Composers: the senior lecturer of department of pharmacology ТМА Makhsumov Sh. M.

the senior lecturer of department of pharmacology ТМА Zaytseva O. A.


Methodical working out is confirmed:

- At faculty meeting the report № from 20

Theme: DRUGS AFFECTING THE FUNCTION OF THE RESPIRATORY ORGANS
1. Location and equipment of the lessons


  • department of pharmacology;

  • drugs, annotations to the drugs, slides, tables;

  • slide projector

2. The duration of the study of themes

Hours – 2

3. Purposes

- To form a general idea about the means of influencing the function of respiratory organs, to their destination;

- Give a classification of drugs which affect the function of respiratory system;

- To give an idea about the basic effects of drugs which affect the function of respiratory system;

- Give an idea of ​​the mechanisms of action of drugs which affect the function of respiratory system;

- To give knowledge of side effects affecting the respiratory function;

- Build knowledge of indications and contraindications to the use of drugs which affect the function of respiratory system;

- Ability to analyze the effect of shape, the appointment of certain drugs based on the total pharmacodynamics of affecting the function of organs of respiration;

- To give knowledge of the elements of pharmacotherapy with examples from the private formula.

Tasks



Student should know:
- Classification of drugs which affect the function of respiratory system;

- Effect of certain drugs which affect the function of respiratory organs, the body;

- Mechanisms of action of plant and equipment that affect the respiratory function;

- Indications for use of drugs which affect the function of respiratory system;

- Side effects and complications caused by the means of influencing the function of the respiratory system.
Student should be able to:

Perform practical skills - perform tasks for the recipe (prescription to caffeine-sodium benzoate (tab, amp), nikethamide (cordiaminum) (amp, flac), phenoxdiazine (libexinum) (tab), codeine phosphate (powd), the infusion of herb Thermopsis, bromhexine (tab), aminophylline (euphylline) (tab, amp), atropine sulfate (amp), adrenaline hydrochloride (amp), ephedrine hydrochloride (amp), isoprenaline (isadrinum) (flac)).

4. Motivation
Drugs affecting the function of respiratory system, widely used in many fields of clinical medicine (therapy, pediatrics, critical care, allergy, etc.), so knowledge of that impact on respiratory function, the values ​​for the body to use as students in further study of private pharmacy and GP.

5. Intersubject and intrasubject connections


Teaching this topic is based on the knowledge bases of students of biochemistry, anatomy, histology, normal and pathological physiology of the respiratory system. Acquired during the course knowledge will be used during the passage of therapy, pediatrics, critical care, allergy, obstetrics and other clinical disciplines, as well as for further study by a private pharmacy.
6. The content of lessons

6.1. Theoretical part


RESPIRATION STIMULANTS

According to the direction of their action, respiratory stimu­lants are subdivided into the following groups:

- Drugs affecting the respiratory center directly

v Bemegride

v Caffeine

v Aethimizolum

- Reflex respiratory stimulants

v Cytiton

v Lobeline

- Drugs of the mixed type of action

v Nikethamide (cordiaminum)

v Carbon dioxide
Respiratory stimulants are used to treat mild intoxication with the opioid analgesics and carbon oxide as well as asphyxia of newborns. They are also used to improve the es­sential levels of lung ventilation in the postanesthetic period. In general, respiratory stimu­lants are used very rarely. Hypoxia is usually treated with assisted or artificial respiration.
ANTITUSSIVE DRUGS

There are two groups of antitussive drugs.

  • Centrally acting antitussives

- Opioid (narcotic) drugs

v Codeine

v Ethyl morphine

- Non-opioid (non-narcotic) drugs



v Glaucine

v Oxeladin (tusuprex)

  • Peripherally acting antitussives

v Phenoxdiazine (libexinum)

Centrally acting drugs that suppress the medullary cough center, are widely used in practical medicine.

Phenoxdiazine (libexinum) belongs to the group of peripherally acting anti­tussives. It has an anesthetic effect on the mucosa of the upper respiratory tract and also possesses broncholytic properties. It does not affect the CNS. Drug dependence to phenox­diazine does not develop. Phenoxdiazine is a non-opioid (non-narcotic) antitussive drug.

EXPECTORANTS

The use of this group of drugs is indicated to facilitate the expectoration of mucus produced by the bronchial glands. There are two types of expectorants: 1) reflex acting drugs, 2) directly acting drugs.

Reflex acting drugs include ipecacuanha and thermopsis (extracts and infusions). When these drugs are taken orally, alkaloids contained in these preparations (in thermopsis also saponines) cause irritation of the stomach receptors. This is followed by a reflex increase in the bronchial glands' secretion, increased activity of the ciliary epithelium and in­tensified contraction of the bronchial muscles. Sputum becomes more abundant, less viscous and expectorates more easily with cough.

When used in high doses, these drugs cause reflex vomiting, but this effect does not have a therapeutic use.

Directly acting drugs are those that can dilute the secretions (mucolytics).
DRUGS USED FOR THE TREATMENT OF BRONCHOSPASM

All drugs used for the treatment of bronchial asthma and other bronchospastic states can be classified into the following groups.

I • Bronchodilators (broncholytics).

β2-Adrenoceptor stimulators v Salbutamol v Fenoterol v Terbutaline

v Isoprenaline (isadrinum) v Orciprenaline v Epinephrine

M-cholinoceptor blockers v Atropine

v Metocinium (methacinum) v Ipratropium

Spasmolytics that have a myotropic effect v Theophylline v Aminophylline (euphylline)

II • Drugs producing anti-inflammatory and broncholytic effect.



Steroid anti-inflammatory drugs v Hydrocortisone v Dexamethasone v Triamcinolone v Beclometasone

Anti-allergic drugs v Cromoline v Ketotifen

Drugs affecting leukotriene system

- Inhibitors of the leukotrienes synthesis (5-lypooxygenase inhibitors) v Zileuton

- Blockers of leukotriene receptors v Zafirlukast v Montelukast
DRUGS USED IN ACUTE RESPIRATORY FAILURE

Pulmonary edema is one of the major causes of acute respiratory failure. It can de­velop in diseases of the cardiovascular system, in chemical lung injury, in some infec­tious diseases, kidney and liver pathology and in cases of brain edema.

Opioid analgesics such as morphine, fentanyl and talamonal are widely used for the treatment of pulmonary edema.

If pulmonary edema is caused by high arterial blood pressure, the main task is to lower it. Ganglioblockers (trepirium, azamethonium, benzohexonium), vasodilators of myotropic action (sodium nitroprusside) and α-adrenoblockers (for example, phentolamine, low doses of chlorpromazine, promethazine) are used for this purpose.

Another way to reduce pulmonary edema is by decreasing the circulating blood vol­ume with the help of some efficacious and quick-acting diuretics (furosemide, ethacrynic acid) that also possess a hypotensive effect.

Alveolar edema and the formation of foam in the alveolar lumen leads to the deve­lopment of a marked hypoxia that requires urgent medical assistance. Apart from the al­ready mentioned drugs, the so called anti-foaming agents may be helpful. One of them is ethanol, which, when inhaled, decreases the surface tension of foam bubbles and trans­forms them into a fluid that takes up less volume (thus freeing up respiratory alveolar surface).

The most frequently used treatments of pulmonary edema are glucocorticoids, which have an anti-inflammatory and immunosuppressive effects.

Oxygen therapy is the universal method of treatment for all cases of pulmonary ede­ma. Another treatment of pulmonary edema (in case of cardiac failure) are cardiac glycosides.

One of the manifestations of acute respiratory failure is acute respiratory distress syn­drome (ARDS)a disease of newborn infants. Usually in the lungs the special alveolar cells produce surface-active substances surfactants (phosphatidylcholines, sphingo­myelins), which decrease fluid surface tension and play an important role in maintaining the alveolar tissue elasticity. In newborn infants, an insufficiency of pulmonary surfac­tants may be the cause of respiratory distress syndrome. It manifests as the interstitial pulmonary edema and multiple atelectases. This syndrome is treated with drugs that substitute for the endogenous surfactant as well as controlled pulmonary ventilation. One of the drugs from the group of medicinal surfactants is colfosceril (exosurf pediatric).
Used in this lesson, new teaching technologies: interactive game "DAISY"

Method involves active participation in the lesson each student, teacher works with the entire group.

Purpose: Consolidation and repetition of material.

STEPS:


1. Advance on a large piece written pattern with groups of drugs, according to the classification of anti-TBdrugs.
2. Pre-drawn on thick paper and individually cut "petals". On their reverse side are written the names of drugs. "Petals" are attached to a wall or a board with adhesive tape in the shape of daisies before classes.
3. Each student will "tear off" tab and attach it to the appropriate item on the template.
4. The game is repeated until, until all the petals will not be "derailed".
5. Students together with the teacher evaluate the correctness of the job.
6. Summing up the results of the teacher.


RESPIRATION STIMULANTS

Drugs affecting the respiratory center directly


Reflex respiratory stimulants

Drugs of the mixed type of action

Bemegride

Caffeine

Aethimizolum


Cytiton

Lobeline


Nikethamide (cordiaminum)

Carbon dioxide

6.2.Analitical part

Situational problem:
1. When you stop breathing in deep anesthesia of surgical patients was introduced cytiton. However, breathing is not restored. Was the doctor wrong?

Response. The doctor did wrong. Cytiton tonic reflex respiratory center. The reflex excitability under anesthetics suppressed, hence the use of cytiton useless in this situation. Should be introduced analeptic, better - Aethimizolum.


2. In connection with a debilitating cough patient was scheduled antitussive tablets that the patient was taking pre-chewed. Some time later, the cough has decreased considerably, but the patient began to experience increasing "numbness" in the mouth.

Which drug a patient was assigned?

What kind of features of route of administration should warn patients to avoid side effects of this drug?

With what it involves?

Response. The patient was appointed Phenoxdiazine (libexinum) having local anesthetic effect. The patient should warn him to swallow pills, not chewing.
3. Prolonged use of extraordinary means in a patient with a prolonged chronic bronchitis appeared the following effects: runny nose, watery eyes and drooling, to reduce that he was appointed into the solution of calcium chloride, after which these symptoms became less pronounced.

What drug was used?

What is the mechanism of the observed side effects of medication?

Why after administration of calcium chloride to reduce the side effects of the drug used?

Response. The patient was appointed iodides, with continued designation of which may phenomenon hypersecretion of mucous glands, in which iodine is released and the time allocation of annoying them. Calcium chloride is assigned to the patient as a substance, sealing the cell membrane (due to calcium ions) and reducing the concentration of anions of iodine, chlorine anion superseded.
4. Patients with chronic gastritis hyperacid a treatment of acute catarrh of the upper airway difficult to separate sputum. As an expectorant herb infusion was appointed Thermopsis, causing aggravation of gastritis.

How can we explain this?

What is appropriate to appoint an expectorant in this case?

Response. Symptoms of gastritis in patients has increased due to local irritating action cytiton contained in the grass Thermopsis. In this case it is advisable to appoint expectorants direct action. (Trypsin, acetyl, etc.).


5. In order to restore respiratory function the patient was injected intravenously lobeline. Breathing quickened somewhat. To enhance the effect, lobeline entered again. After repeated injections the patient started vomiting, convulsions appeared, there was a danger of cardiac arrest.

Why have developed these side effects?

Response. An overdose of lobeline, which showed in its direct action on CNS arousal centers of the medulla oblongata (the gag, the center of the vagus nerves) and N-cholinergic neurons of the spinal cord.
6. Patient transported to hospital with a severe attack of asthma. From the introduction of atropine and isoprenaline (isadrinum) declined due to an after receiving tachycardia.

Why atropine and isoprenaline (isadrinum), along with a bronchodilator effect causes tachycardia? What should replace the drugs?

Response. Tachycardia after administration of atropine due to the fact that it reduces the effect of cholinergic vagus nerve on the heart, against this background that dominates the tone of the sympathetic innervation, and isoprenaline (isadrinum) beta1-adrenergic receptors stimulates the heart and causes rapid heart rate. In this situation, you can assign agents to stimulate beta1-adrenergic receptors (salbutamol, fenoterol, terbutaline, etc.) or glucocorticoids.
7. In a patient with heart failure, pulmonary edema there was a threat. At the same time blood pressure dropped to 80/60 mm Hg. Art ..

Can I apply this to the patient or others ganglioblockers?

What types of medications can be used to assist in this situation.

Response. In this case, or other ganglioblockers funds do not apply, since they only aggravate it developed hypotension. In this situation, you can use the cardiac glycosides, corticosteroids, use defoamers, oxygen therapy.


6.3. Practical part
Perform practical skills - perform tasks for the recipe (prescription to caffeine-sodium benzoate (tab, amp), nikethamide (cordiaminum) (amp, flac), phenoxdiazine (libexinum) (tab), codeine phosphate (powd), the infusion of herb Thermopsis, bromhexine (tab), aminophylline (euphylline) (tab, amp), atropine sulfate (amp), adrenaline hydrochloride (amp), ephedrine hydrochloride (amp), isoprenaline (isadrinum) (flac)).
1. Prescribing FOR SOLID DOSAGE FORMS

Purpose: Prescribing FOR SOLID DOSAGE FORMS

Steps:



Action

Has not executed

Completely correctly executed

1.

The indicating to the pharmacist (Recipe)

0

10

2.

Transfer of the basic and auxiliary medical products which are a part of the written out medicine, with the dose indicating

0

30

3.

The indicating to the pharmacist about preparation of the medicinal form (M.f)

0

20

4.

The indicating to the pharmacist about amount of a given out drug

0

10

5.

The indicating to the patient about a way of drug intake, the indication to application

0

30




In total

0

100

2. Prescribing FOR SOLUTION INJECTION

Purpose: Prescribing FOR SOLUTION INJECTION

Steps:




Action

Has not executed

Completely correctly executed

1.

The indicating to the pharmacist (Recipe)

0

10

2.

Transfer of the basic and auxiliary medical products which are a part of the written out medicine, with the dose indicating

0

30

3.

The indicating to the pharmacist about preparation of the medicinal form (M.f)

0

20

4.

The indicating to the pharmacist about amount of a given out drug

0

10

5.

The indicating to the patient about a way of drug intake, the indication to application

0

30




In total

0

100

3. Prescribing FOR SOLUTION FOR INTERNAL USE

Purpose: Prescribing FOR SOLUTION FOR INTERNAL USE.

Steps:




Action

Has not executed

Completely correctly executed

1.

The indicating to the pharmacist (Recipe)

0

10

2.

Transfer of the basic and auxiliary medical products which are a part of the written out medicine, with the dose indicating

0

30

3.

The indicating to the pharmacist about preparation of the medicinal form (M.f)

0

20

4.

The indicating to the pharmacist about amount of a given out drug

0

10

5.

The indicating to the patient about a way of drug intake, the indication to application

0

30




In total

0

100

7. Forms of control knowledge, skills and abilities

- oral;

- writing;



- experience the practical skills.
8. Criteria for evaluating the current control




Progress %

Ball

The level of student knowledge

1

96-100%

Excellent

“5”


Complete the correct answer to the questions on classification, pharmacokinetics, pharmacodynamics, indications and contraindications to drugs, their side effects. Sums up the results and make decisions, think creatively, independently analyzed. Situational problem resolves correctly, with a creative approach, with full justification for the answer.
Actively and creatively participate in interactive games, right to make informed decisions and summarize, analyze.
Recipes are written in accordance with the dosage form and with the correct indication of the dose and indication for use.
The correct spelling of all drugs of this pharmacological group with faithful indication of the form of release.

2

91-95%

Excellent

“5”


Complete the correct answer to the questions on classification, pharmacokinetics, pharmacodynamics, indications and contraindications to drugs, their side effects. Creative thinking, self-analyzing. Situational problem resolves correctly, with a creative approach, the rationale for the answer.
Actively and creatively participate in interactive games, correct decision maker.
Recipes are written in accordance with the dosage form is a grammatical error.
The correct spelling of all drugs of this pharmacological group with faithful indication of the form of release.

3

86- 90%

Excellent

“5”


The questions on classification, pharmacokinetics, pharmacodynamics, indications and contraindications to drugs, their side effects are covered in full, but there are 2.1 errors in the response. Independently analyzed. Inaccuracies in the solution of case problems, but with the right approach.
Actively involved in interactive games, make the right decisions.
Recipes are written in accordance with the dosage form, with the proper indication of indication for use, but there are 3.2 grammatical errors.
The correct spelling of all drugs of this pharmacological group, but there is a discrepancy in the forms of release.

4

81-85%

Good

“4”


The questions on classification, pharmacokinetics, pharmacodynamics, indications and contraindications to drugs, their side effects are covered in full, but is 2-3 inaccuracies, errors. Into practice, understand the essence of the issue, says confidently, has fine performances. Situational problems solved correctly, but not adequately support the answer.
Actively participating in interactive games, correctly makes the decisions.
Recipes are written in accordance with the dosage form, with the proper indication of indication for use, but there are 3.2 grammatical mistakes, errors in dose.
The correct spelling of all drugs of this pharmacological group, but is 2-3 errors in registration forms.

5

76-80%

Good

“4”


Correct, but incomplete coverage of the issue. The student knows the classification, the indications for the use of drugs, their side effects, the basic properties, but do not fully understand the mechanism of action and the development of side effects. Understands the issue, says confidently, has fine views. Actively involved in interactive games. On case studies give incomplete solutions.
Recipes are written in accordance with the dosage form, with the proper indication of the dose, but not all are testimony to the application.
The correct spelling of all drugs of this pharmacological group, but there are 4.3 errors in the title and registration forms.

6

71-75%

Good

“4”


Correct, but incomplete coverage of the issue. The student knows the classification, but not complete lists indications for the use of drugs, their side effects, the basic properties that do not fully understand the mechanism of action and the development of side effects. Understands the issue, says confidently, has fine views. On case studies give incomplete solutions.
Recipes are written in accordance with the dosage form, with the proper indication of the dose, but not all are indications for use, is 2-3 grammatical errors.
The correct spelling of all drugs of this pharmacological group, but there are 4.3 errors in the forms of release.

7

66-70%

Satisfactorily

“3”



The correct answer to half of the questions posed. The student knows the classification is not complete lists the indications for the use of drugs, basic properties, but poorly versed in the mechanism of action, entangled in side effects. Understands the issue, says confidently, has fine performances only on selected topics. Situational problems solved correctly, but there is no justification response.
Recipes are written with the correct indication of the dose, but not completely given testimony to the application and there is an error in specifying the form of release.
Proper transfer of drugs of this pharmacological group, but there are grammatical errors in writing the names of drugs and mistakes in the registration forms.

8

61-65%

Satisfactorily

“3”


The correct answer to half of the questions posed. Errors in classification errors in the testimony to the use of drugs, the properties are poorly versed in the mechanism of action, entangled in side effects. Says uncertainly, has fine performances only on selected topics. Mistakes in solving situational.
Recipes are written in accordance with the dosage form, but without the indications for use and there are errors in the indication of the dose.
The correct spelling of the drugs pharmacological symmetric group, but there are errors in the registration forms.

9

55-60%

Satisfactorily

“3”


Reply with errors on half the issues raised. Student makes mistakes in classification, the indications for use, the properties are poorly versed in the mechanism of action, entangled in side effects. Says uncertainly, has a partial view on the subject. Situational problems solved incorrectly. Recipes are written with grammatical mistakes, without instructions for use and there are errors in the indication of the dose.
Correct spelling of only half of the preparations of this pharmacological group, there are errors in the forms of release.

10

50-54%

Not satisfactorily

“2”


The correct answer is 1 / 3 of the questions. The student does not know the classification, the indications for use, poorly versed in the mechanism of action, entangled in side effects. Situational problems solved incorrectly by the wrong approach.
Recipes are written incorrectly, without instructions for use and there are errors in the indication of the dose. Correct spelling of less than half of drugs, there are errors in the forms of release.

11

46-49%

Not satisfactorily

“2”


The correct answer is 1 / 4 of the questions posed. The student does not know the classification, the indications for use, poorly versed in the mechanism of action, entangled in side effects. Situational problems solved incorrectly by the wrong approach.
Recipes are written incorrectly, without instructions for use and there are errors in the indication of the dose, grammatical errors.
Correct spelling of less than half of drugs, there are errors in the registration forms and grammatical errors.

12

41-45%

Not satisfactorily

“2”


Coverage of 1 / 5 of the questions correctly. The student does not know the classification does not fully transfer the products of this pharmacological group. Gives incomplete and partially incorrect answers to questions on the pharmacokinetics and pharmacodynamics of drugs. Half of the prescriptions written incorrectly, mistakes in dose formulations, and indications for use.
Writing less than half the drugs without a release form.

13

36-40%

Not satisfactorily

“2”


Lighting 1 / 10 of the questions in the wrong approach. Do not know the classification, the indications for use, confuses the basic properties of drugs. Practically does not understand the mechanism of action and side effects of drugs.
All recipes are written incorrectly with blunders.
The list of drugs of this pharmacological group is not given.

14

31-35%

Not satisfactorily

“2”


Questions not answers. Do not know the mechanisms of action, adverse effects, the basic properties of drugs. .
Can not write prescriptions for this section of pharmacology, since there is no logical link between the dosage form and by the introduction, does not know the indications for use.



9. Chronological map of lessons



Stages of training

Form of training

Duration (total 90)

1

Introduction to the session instructor (support themes)




5

2

Discussion topics practical training, assessment of baseline knowledge of students with new educational technologies (small groups, case studies, business games, slides, videos, etc.)

The survey, an explanation

25

3

Summing up the discussion




5

4

Providing students with visual aids (drugs, computer programs, diagrams, etc.) and giving explanations to them




10

5

Independent work of students in mastering skills

The study of drugs, prescriptions

15

6

Determine the degree of achievement on the basis of lessons mastered the theoretical knowledge and practical experience on the results and taking into account this assessment of the group

Oral questioning, written survey, tests, test results of practical work, discussion debate

25

7

Conclusion of the teacher on this lesson. Assessment of students' knowledge on a 100 point system and its announcement. Cottage set in the next class (a set of questions)

Information, questions for self-training

5

10. Control questions

1. What is the classification of stimulants of respiration?

2. What is the mechanism of action and indications for use of stimulants, breathing in each group?

3. What is the classification and mechanisms of action of antitussives?

4. What are the negative features of codeine?

5. What is the classification and the use of expectorants?

6. What determines the effectiveness of expectorants reflex action?

7. What is the mechanism of action of trypsin expectorant?

8. What is the classification of bronchodilators?

9. What is the reason bronchodilatory effect isoprenaline (isadrinum)?

10. What is the mechanism of action of atropine bronchodilator?

11. The mechanism of action of some bronchodilators is associated with stimulation of beta-blockers?

12. What is the mechanism of the bronchodilator aminophylline (euphylline)?

13. What chemicals are used to relieve asthma attacks?

14. What are the characteristics and application of cromoline sodium?

15. What principles should be followed by pharmacotherapy of pulmonary edema?

16. What is the reason the therapeutic effect of ethanol in pulmonary edema?

17. What is the reason the therapeutic effect of urea in pulmonary edema?

18. What is the reason for the therapeutic value ganglioblockers pulmonary edema?

19. To write prescriptions for: caffeine-sodium benzoate (tab, amp), nikethamide (cordiaminum) (amp, flac), phenoxdiazine (libexinum) (tab), codeine phosphate (powd), the infusion of herb Thermopsis, bromhexine (tab), aminophylline (euphylline) (tab, amp), atropine sulfate (amp), adrenaline hydrochloride (amp), ephedrine hydrochloride (amp), isoprenaline (isadrinum) (flac).

11. The recommended literature



Basic

1. Kharkevich D.A. Pharmacology. -M: Medicine, 2005, 2010.

2. Kharkevich D.A. The general recipe. - М: Medicine, 1982.

3. Kharkevich D.A.Management to a practical training on pharmacology. - М: Medicine,

1988.

4. Azizova S.S. Pharmacology. - Tashkent: Ibn-Sino, 2000, 2002, 2006.



Additional

5. Mashkovsky M.D.Drugs. Directory. - М: Medicine, 2001, 2005.

6. A directory of Vidal. - М, 2008, 2009.

7. Makhsumov M. N, Malikov M.M. Pharmakology. - Tashkent: Ibn-Sino, 1997.

8. Каcung B.G.Bazic and clinical pharmacology. - St.-Petersburg - Moscow. 1998.

9. Khakimov Z.Z., Azimov M.M., Zaytseva O.A., Radzhapova Sh.Z. The general recipe

Toshkent, 2005.
10. The general medical practice. Clinical references and a pharmacological directory. Under the editorship of I.P.Denisov. Yu.L. Shevchenko. F.G.Nazyrova. - М: GEOTAR-MEDIA, 2005.

11.://www.cibis.ru/catalogue/pharmacology_pharmacy_toxicology/a/sites/

52185.html;://medvedev-ma.narod.ru/farmakologia/0.htm;

12. http://max.1gb.ru/farm/;

13. //nmu-student.narod.ru/farmacology;

14. //shop.medicinform.net/showtov.asp?FND=&Cat_id=298696;

15. //www.ronl.ru/formakologiya/; ://www.evrocet.ru/cshop/book-18921;



16. //www.vsma.ac.ru/~pharm/; ://WWW.JEDI.RU/book-189216-115.html.






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