Drugs from the antispasmodic group are among the most popular and are often prescribed by specialists in various fields. Most often, they stop the pain syndrome, but they can also be used for etiotropic therapy, and in situations where spasm is characteristic of this disease, but does not play a role in the mechanism of its development, and even to prepare patients for certain procedures. Antispasmodics are usually sold without a prescription, so many patients use them themselves, and this is fraught with complications and side effects.
Pain syndrome, both acute and chronic, is based on dysfunction of smooth muscle cells. In the pathology of the internal organs, in which there is a layer of such cells, pain develops due to excessive contraction of smooth muscle cells. Pain symptoms can develop without organic damage, say, to the stomach or intestines, and therefore patients often use antispasmodics without medical prescription. Therefore, at the reception, you need to ask the patient in detail not only about what worries him, but also about the medicines that he takes.
Of course, an important factor in taking antispasmodics for pain is that they have an analgesic effect by relieving spasm of smooth muscles, but they do not "erasure" symptoms of organ damage and do not complicate the diagnosis. But uncontrolled intake of this group of drugs can have side effects that are undesirable for the patient.
General indications for which antispasmodics are most often prescribed relate to the elimination of spasms of the gastrointestinal tract, the removal of colic, the elimination of hypertonicity, and the treatment of diseases of the cardiovascular system.
Some types of antispasmodics and their uses
According to the mechanism of their action, all antispasmodics are divided into non-selective (phosphodiesterase inhibitors) and selective (M-anticholinergics, calcium and sodium channel blockers).
Phosphodiesterase inhibitors are effective due to the fact that the PDE IV enzyme is present in the smooth muscle cells of the entire intestine, in the cells of the urinary and biliary tract, and therefore the blockade of its activity has an antispasmodic effect. They are actively used for acute colicky pains, urolithiasis, irritable bowel syndrome, as well as increased blood pressure and regional blood flow disorders.
Contraindications to the appointment of phosphodiesterase inhibitors are severe hepatic, cardiac or renal failure, cardiogenic shock, and some other conditions.
Among the disadvantages of non-selective antispasmodics, it should be noted the likelihood of serious side effects (such as dizziness, tachycardia, nausea, diarrhea, allergies, and others); lack of selectivity.
M-cholinolytics are used most often to relieve pain in diseases the upper gastrointestinal tract, since it is here that there is the highest density of the corresponding m-cholinergic receptors. Their scope – these are abdominal pains caused by pylorospasm, biliary dyskinesia, dysfunction of the sphincter of Oddi.
Antiholinolytics are contraindicated in tachyarrhythmias, glaucoma, organic stenosis of the gastrointestinal tract, benign prostatic hyperplasia, as they have undesirable side effects.
Sodium channel blockers act on the basis of reducing the permeability of the cell membrane for extracellular sodium and indirectly suppressing the release of potassium from it, due to this action spasm is eliminated.
Calcium channel blockers (very complex and diverse, found in skeletal muscles, atrioventricular tracts, vascular smooth muscle cells, myofibrils of the myocardium and other places) inhibit the penetration of calcium ions into cells and have a pronounced vasodilating effect.
Selective antispasmodics are a very large and heterogeneous group of drugs, most often indicated for the effect on the cardiovascular system, since very high dosages are required to relieve pain in the gastrointestinal tract, which is unacceptable.
Contraindications and warnings for the use of antispasmodics
The use of antispasmodics is contraindicated in tuberculosis, certain pathologies of the large intestine and microbial diseases of the intestine, certain types of colitis, Crohn's disease, and a number of other diseases.
An overdose of an antispasmodic can be expressed by allergic manifestations, dyspeptic disorders, excitation of the central nervous system or, conversely, a slowdown in the psychomotor reaction, a violation of cardiovascular activity.
Prescription of antispasmodics is possible only according to indications, taking into account the clinical pharmacology of the drug of each group, in accordance with the recommendations for use. The breadth of their application requires the doctor to constantly take into account the characteristics and properties of different groups of antispasmodics, their tolerance, in order to avoid not only underestimation, but also overestimation of their therapeutic capabilities.
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