Savremena farmakoterapija i jatrogena patologija

During the past few decades, the pharmaceutical industry has developed into a powerful human activity highly influencing modern medicine. Thousands of synthetic therapeuticals have been developed, and these formulations enabled the successful treatment of many diseases, some of which were considered incurable. An increase in drug consumption followed the development of the pharmaceutical industry and the introduction of synthetic drugs. The widespread use of new medicals enabled the collection of data confirming their effectiveness, but also more and more data concerning side and unwanted effects were reported. Frequent side/unwanted effect reports gave rise to development of iatrogenic pathology, a new branch of clinical pathology. The knowledge of the possible unwanted effects of drugs on macro organisms did not enable the effective withdrawal of such formulations from the market. At the beginning, the reports concerning unwanted effects were not verealed. Consequently some potentially harmful formulations were used for years without methodical analyses of their side/unwanted effects. Some potentially dangerous formulations are still on the market such as drugs containing ulcerogenic, hepatotoxic, nephrotoxic substances as well as those inducing bone marrow aplasia. The administration of these potentially dangerous formulations is understandable in the case of clear therapeutic indications allowing no alternatives. In these cases the risk of harmful side effects is greatly overwhelmed by the risk from the primary disease. Otherwise the administration of the potentially harmful drug is unjustified, especially if the indication is not a disease. Many potentially harmful drugs are formulated for use in healthy animals, recommended as growth, laying and milk stimulators, those allowing higher speed and strength in sport and racing horses, estrus inducers and suppressors. The misuse or maluse medication is highly present in sport horses daily treated with vitamin and mineral supplements, analgesics, corticosteroid and anabolic steroids. Unwanted effects of such treatments are evident sometimes shortly after application and sometimes later, influencing reproduction. The same problem is present in small animals.Farmaceutska industrija je poslednjih godina izrasla u jednu od najmoćnijih industrijskih grana bez koje se savremena medicina danas ne može da zamisli. Hiljade lekova, uglavnom sintetičkog karaktera, omogućile su manje ili više uspešno lečenje najvećeg broja oboljenja, čak i onih koja su doskora smatrana neizlečivim. Uporedo sa razvojem farmaceutske industrije i sintezom novih lekova, rasla je potrošnja lekova, koju su, pored potvrde o njihovoj efikasnosti pratile i sve češće informacije o neželjenim dejstvima, na čijoj je osnovi izrasla nova oblast kliničke patologije - takozvana jatrogena patologija. Saznanje o štetnim efektima nije omogućilo efikasno povlačenje takvih lekova iz upotrebe. U početku su, naime, informacije o neželjenim dejstvima prikrivane, zbog čega su neki lekovi godinama korišćeni bez ozbiljnih analiza o štetama koje su izazvali. Mnogi od njih se pri tome još uvek koriste. Tako se danas na tržištu još uvek nalazi na desetine lekova koji mogu da izazovu oštećenje jetre, bubrega, kostne srži, ulceracija na sluzokožama želuca i creva i tako dalje. U slučaju jasnih terapijskih indikacija kod oboljenja za čije lečenje ne postoje manje opasne alternative njihova primena je razumljiva. U takvim situacijama se svesno ulazi u rizik od neželjenih efekata, ukoliko se proceni da je on manji od rizika koji nosi osnovna bolest. U svim drugim slučajevima njihovo dalje korišćenje bi bilo besmisleno, posebno ukoliko indikacija za njihovu primenu nije bolest. Mnogi potencijalno štetni „lekovi" se, naime, preporučuju za podsticanje rasta, povećanje produkcije mleka, mesa ili jaja, veću brzinu ili uzdržljivost kod sportskih konja, za indukciju ili supresiju estrusa - dakle za primenu kod zdravih životinja. Ovo se u prvom redu odnosi na sportske konje kod kojih se svakodnevno koriste ogromne količine lekova: vitamina i minerala, analgetika, kortikosteroida i anabolika. Neželjeni efekti takvog tretmana su očigledni -nekada neposredno nakon aplikacije, a nekada i mnogo kasnije, u priplodu. Isto se odnosi na male životinje