Currently, certain changes are taking place in the public health system of Ukraine. The country's parliament adopted in the first reading the draft law "On Compulsory Social and Medical Insurance" and the draft new version of the law "On Medicines". It can be assumed that after the introduction of the relevant laws, the role of the pharmacist (hereinafter, the term “pharmacist” (from the English pharmacist) means pharmacists and pharmacists) in the public health system will increase significantly. In particular, the draft law "On Medicines" provides for the introduction of Good Pharmaceutical (Pharmacy) Practice standards into the daily practice of pharmacies.

There are active discussions that the activities of a pharmacist should not be limited to the sale of medicines and other medical products. Practice shows that many patients go to a pharmacy in order to get the necessary advice from a pharmacist regarding the choice and use of a drug. So far, in our country, the functional duties and powers of a pharmacist have not been fixed at the legislative level. Meanwhile, the world community has developed recommendations regarding the activities of the pharmacist in the public health system. He was directly involved in their development. Andrey Meshkovsky, a Russian pharmacist who worked for several decades in the WHO Secretariat on behalf of the USSR Ministry of Health, who kindly agreed to express the WHO's official point of view on the role of the pharmacist in public health on the pages of the APTEKA Weekly.

— What place does the development of recommendations in the field of pharmacy occupy in WHO activities?

- Significant enough. Currently, the main directions of WHO are the development of standards for quality, efficacy, safety, rational use of medicines, as well as carrying out activities aimed at expanding access of low-income populations to vital medicines, developing recommendations for the implementation of national policy in the field of providing the population with medicines . Since 1992, the WHO Regional Office for Europe (Copenhagen, Denmark) has been running a Special Pharmaceutical Program for the countries of Central and Eastern Europe, the purpose of which is to provide assistance to the countries of the former socialist camp and the USSR.

- What prompted the WHO experts to start developing recommendations on the scope of the pharmacist in the public health system?

— WHO experts showed an active interest in the role of a pharmacist in the public health system in the second half of the 1980s. Obviously, the appeal to this problem was caused by the concern of many workers in pharmacies regarding their place in the medical care system. This concern was primarily due to the tendency in industrialized countries to consider the pharmacist almost exclusively as a seller of medicines, since the pharmaceutical manufacturers assumed the functions associated with their manufacture and, to a large extent, informing doctors about them. These trends do not appear to be in the interests of either pharmacists or society as a whole. Underestimation of the importance of the work of pharmacists inevitably leads to insufficient use of their potential and professional knowledge, and also forces these specialists to pursue only economic interests (sell more, sell the most expensive medicines, etc.).

— Why did the WHO start addressing this issue only in the 80s, after almost 40 years of its existence?

- This is due to several reasons. First, the scope of WHO's activities in relation to medicines has expanded gradually. Secondly, it was only in the 1980s that the necessary conditions were created for discussing this problem at the international level. It was during this period that the narrowing of the traditional sphere of activity of pharmacists - the manufacture of medicines according to extemporaneous recipes - became especially noticeable in many countries. In fact, by that time, the production of medicines had almost completely begun to be carried out in industrial production. The sphere of drug sales has undergone significant changes: in some countries (Japan, the USA), the practice of dispensing them by doctors has become firmly established; increased sales in the general distribution network (for example, in supermarkets); the sale of medicines by mail has become more popular, in recent years - via the Internet. The wholesale distribution of medicines is increasingly being carried out by businessmen who do not have a pharmaceutical education. Using the imperfection of the legislation, in many countries numerous intermediaries, who do not have a pharmaceutical education, have appeared between manufacturers and retail pharmacies.

At the same time, other areas of activity in the pharmaceutical sector became more complicated, such as the development and production of drugs, their quality control, supply, distribution, selection and rational use of drugs, state regulation of the pharmaceutical market, etc. There was a problem of falsified drugs, which required a certain reorientation of the quality control system. In those areas of activity where specialists with medical, chemical, economic education traditionally dominated, there was a need for workers with a pharmaceutical education. Thus, a situation arose when, on the one hand, the knowledge of pharmacists remained unclaimed, and on the other hand, pharmacists were not sufficiently involved in new areas of activity.

— How did you manage to attract the attention of the world medical community to this problem?

- The initiator was a professional association - the International Pharmaceutical Federation (FIP - Federation International Pharmaceutique), which has been cooperating with WHO for a long time as a non-governmental organization, which actively supported its drug program. The success of this initiative was facilitated by the strengthening of links between FIP and the WHO Secretariat in the 1980s. By this time, the practice of regular meetings of the WHO Director-General with the leadership of FIP had been established. WHO headquarters staff have been repeatedly invited to attend meetings of the FIP Council. By the way, I also happened to take part in these meetings.

It should be noted that by the mid-1980s, the need to revise the personnel structure was ripe in all areas of healthcare. In 1985, the WHO Expert Committee for Health for All by the Year 2000 called for a redefinition of the roles and functions of all categories of health workers.

— These are the final reports of WHO meetings, the 1994 World Health Assembly Resolution (WHA 47.12) and the Good Pharmaceutical Practice (GPP) guidelines. By this time, WHO meetings have been held on this issue:

• European Regional Meeting "The Role of the Pharmacist in Retail and Hospital Pharmacy", Madrid (Spain), 1988

• First (Global) Meeting "Content of Pharmacy and Functions of Pharmacists", New Delhi (India), 1988

• Second Meeting "Quality Pharmaceutical Services - Benefits for the State and Society", Tokyo (Japan), 1993

• Third Meeting "Training Future Pharmacists: Curriculum Development", Vancouver (Canada), 1997

• Fourth meeting "The role of the pharmacist in self-medication", The Hague (Netherlands), 1998

It is necessary to at least briefly characterize each of the documents that were adopted at these meetings.

conclusions European regional meeting "The role of the pharmacist in retail and hospital pharmacy" can be represented as follows:

• doctors and pharmacists should work together; common approaches to the choice of medicines are needed; A pharmacist is a doctor's consultant, he takes part in the choice of medicines and gives recommendations on their rational use.

• pharmacists play a leading role in providing information and advice to the patient regarding the use of medicines; pharmacists should inform patients about possible side effects of medicines

• pharmacists should promote healthy lifestyles.

First (global) meeting "Content of pharmacy and functions of pharmacists". The participants confirmed the conclusions of the Madrid meeting regarding the role of the pharmacist in the retail and hospital pharmacy and made recommendations regarding the scope of activities of pharmacists beyond the pharmacy chain. In their opinion:

• the unit of the Ministry of Health responsible for the pharmaceutical service should have the same importance as other units

• pharmacists with experience should be involved in the development of drug legislation

• drug procurement, storage and distribution should be managed by pharmacists, not physicians. Pharmacists, having undergone appropriate training, should head national control and analytical laboratories; they can be involved in registration and post-registration quality control of medicines, participation in clinical trials, etc.

• pharmacists should be members of the “team of health workers”, together with other specialists, participate in scientific research, training of medical personnel, dissemination of information, and the work of international organizations.

The second meeting "Quality Pharmaceutical Services - Benefits for the State and Society". The concept of pharmaceutical care was formulated, according to which the main thing in the work of a pharmacist should be the interests of the patient. The participants of the meeting proposed to provide pharmaceutical care both for each patient and for the entire population. This implies:

• providing patients with reliable and objective information about drugs;

• participation of pharmacists in the development of draft laws and regulations related to providing the population with medicines

• development of guidelines and criteria for compiling forms

• development of drug distribution systems.

Third meeting "Training future pharmacists: curriculum development". An important outcome of the meeting is the compilation of modern requirements for a pharmacist, called the “pharmacist of 7 stars”:

* health worker, team member

* able to make responsible decisions

* communication specialist - an intermediary between the doctor and the patient

*ready to lead in the public interest

* leader capable of managing resources and information

*ready to learn for life

* a mentor involved in the training of young pharmacists.

An analysis of these requirements indicates that the emphasis is not on the need to obtain deeper specialized knowledge in the field of pharmacy, but on the improvement of personal qualities, which, along with acquired professional skills, will allow a specialist to take a worthy place among public health workers.

The meeting participants noted the need to make appropriate changes to the curricula for training specialists in this field. In their opinion, the implementation of these tasks requires the cooperation of all interested parties (institutions, organizations and enterprises), including at the international level.

Fourth meeting "The role of the pharmacist in self-medication". By the time of this meeting, the concept of pharmaceutical care discussed at the Tokyo meeting had been further developed in the Good Pharmaceutical Practice (GPP) rules. The key issue of the meeting - the provision of assistance by pharmacists to people who expressed a desire to be treated on their own - was considered by the participants of the meeting as part of the GPP. It was noted that in many countries there has been a trend towards an increase in the number of patients who prefer self-medication.

The duty of the pharmacist, according to the recommendations of the meeting participants, is to establish a trusting relationship with the patient and recommend high-quality medicines to him, as well as interact with other healthcare professionals, government and public organizations, representatives of the pharmaceutical industry, etc.

The participants of the Fourth meeting suggested that pharmacists put into practice the principles of GPP.

World Health Assembly (WHA) Resolution "The Role of the Pharmacist in Supporting the Revised WHO Medicines Strategy". The conclusions of the Tokyo meeting (1993) were submitted in 1994 to the discussion of the highest international forum in the field of health - the World Health Assembly. The preamble to the Assembly Resolution (WHA 47.12 of 10 May 1994) contains the important conclusion that "the pharmacist can play a key role in the public health system". The WHA Resolution substantiates the need for the participation of pharmacists in the development of relevant regulations and rules governing work in the pharmaceutical field.

Member countries were asked to define the role of pharmacists in the implementation of the National Drug Policy as part of the Health for All strategy; make full use of the knowledge of pharmacists at all levels of the health system, especially in the development of the National Drug Policy.

— What are the fundamental principles of Good Pharmaceutical Practice that underlie the work of pharmacies?

— The GPP rules apply to the retail sale of medicines and are a way to implement the concept of pharmaceutical care. At the same time, the main activities of the pharmacist should be the dispensing of medicines and medical products of good quality, as well as the provision of information about medicines. An integral part of the work of the pharmacist should be to promote the rational prescribing of high-quality medicines and their correct use.

Thus, the pharmacist should be able to influence decisions regarding the use of medicines. Relationships with healthcare professionals, in particular with physicians, should be partnership based, based on mutual trust, especially in matters relating to pharmacotherapy.

Introduction

Despite the fact that any market (including the pharmaceutical one) lives according to certain rules aimed at increasing profits, in pharmaceuticals, as one of the most important sections of medical science, the first place is given to protecting the health of patients. The economic component is certainly important, but it should not come to the fore.

A pharmacist is, first of all, a medical consultant who will help you understand a wide range of medicines, dietary supplements, medical products and pharmaceutical cosmetics, provide competent advice and prevent possible errors in treatment. This function of a pharmaceutical specialist is especially important in the fast pace of modern life. Today, people would rather go straight to the pharmacy than sit in line to see a doctor. In addition, many therapists in district clinics sometimes do not have time to follow the latest pharmaceutical market or prescribe drugs that are actively promoted by medical representatives of pharmaceutical companies, which is not always appropriate and affordable for patients.

In this regard, an even greater responsibility for the health of people who come to them falls on the shoulders of the pharmacy staff. And even if the buyer who comes to the pharmacy knows which drug group he needs, he often lacks specific professional knowledge (for example, about contraindications or about the regimen), and the help of a pharmacy specialist will be very useful to him.

Often, pharmacists and pharmacists have to take on other roles - a cashier, a packer, and even a psychologist, given that patients who are nervous and upset by their illness come to the pharmacy, who need to be reassured, convinced of the successful outcome of the treatment, and encouraged.

The role of the pharmaceutical worker in the health care system

The active interest of the world community in the role of the pharmacist in the health care system manifested itself in the second half of the 1980s. It was during this period that the narrowing of the traditional sphere of activity of pharmacists, the manufacture of medicines according to extemporaneous recipes, became especially noticeable in many countries. In fact, by that time, the production of drugs had almost completely begun to be carried out in industrial production. The scope of drug sales has undergone significant changes: in some countries (Japan, the USA), the practice of dispensing drugs by doctors has firmly established itself; increased sales in the general distribution network (for example, in supermarkets); The sale of medicines by mail has become more popular, and in recent years, via the Internet. The wholesale distribution of drugs is increasingly being carried out by businessmen who do not have a pharmaceutical education.

At the same time, other areas of activity in the pharmaceutical sector became more complicated, such as the development and production of drugs, their quality control, supply, distribution, selection and rational use of drugs, state regulation of the pharmaceutical market, etc. There was a problem of falsified drugs, which required a certain reorientation of the quality control system. In those areas of activity where specialists with medical, chemical, economic education traditionally dominated, there was a need for workers with a pharmaceutical education. Thus, a situation arose when, on the one hand, the knowledge of pharmacists remained unclaimed, and on the other hand, pharmacists were not sufficiently involved in new areas of activity. Underestimation of the importance of the work of pharmacists inevitably leads to insufficient use of their potential and professional knowledge, and also forces these specialists to pursue only economic interests (sell more, sell the most expensive medicines, etc.).

It should be noted that by the mid-1980s, the need to revise the personnel structure was ripe in all areas of healthcare. In 1985, the WHO Expert Committee for Health for All by the Year 2000 called for a redefinition of the roles and functions of all categories of health workers.

In 1988, in Madrid (Spain), the European Regional Meeting "The Role of the Pharmacist in Retail and Hospital Pharmacy" was held, the participants of which came to the following conclusions:

* doctors and pharmacists should work together; common approaches to the choice of drugs are needed; a pharmacist is a doctor's consultant, he takes part in the choice of drugs and gives recommendations on their rational use;

* pharmacists play a leading role in providing information and advice to the patient regarding the use of drugs; pharmacists should inform patients about the possible side effects of drugs;

* pharmacists should contribute to the promotion of a healthy lifestyle.

At the meeting of the IFF "Quality Pharmaceutical Services - Benefits for the State and Society" (Tokyo, 1993), the concept of pharmaceutical care was formulated, according to which the interests of the patient should be the main thing in the work of a pharmacist. The participants of the meeting proposed to provide pharmaceutical care both for each patient and for the entire population. This implies:

* providing patients with reliable and objective information about drugs;

* participation of pharmacists in the development of draft laws and regulations relating to the provision of drugs to the population;

* development of guidelines and criteria for compiling forms;

* development of drug distribution systems.

During the 3rd Annual Meeting of the European Forum of Pharmaceutical Associations and WHO, held in May 1994 in Copenhagen (Denmark), with the aim of improving the efficiency of health systems, the following principles were adopted:

* Medicines cannot be considered solely as a commodity;

* the supply of medicines to the population should be carried out only through pharmacies;

* at all stages of drug distribution, it is necessary to exercise control by professionals;

* the duty of the pharmacist is to be guided by strict ethical rules and standards of professional conduct and to exercise personal control over the distribution of medicines among the population;

* pharmacist must be free from economic influence to carry out their activities by non-pharmacists;

* special pharmaceutical education gives the pharmacist the exclusive right to:

Personally responsible for the sale of pharmaceutical products on the market;

The ability to guarantee, in the interests of maintaining the health and safety of the population, adequate control over the quality, storage, safety and supply of medicines to the population;

Manage a pharmacy.

The WHO/WAP Guidelines for Good Pharmacy Practice in Community and Hospital Pharmacies can be seen as a set of professional objectives for national pharmaceutical associations and governments.

According to the Guidelines, the main task of pharmacy practice is to provide medicines, other medical products and health care services, as well as to help people and society in their best use.

Good Pharmacy Practices (GPP) The WHO requires that:

* the first task facing the pharmacist was the well-being of the patient, regardless of his location;

* the main activity of the pharmacy was to provide patients with medicines and other medical products, relevant information, advice, as well as to record side effects from the use of drugs;

* an integral part of the pharmacist's activity was the promotion of rational and economical prescription and proper use of drugs;

* each element of the pharmacy service was focused on an individual, was clearly defined and effectively communicated to each participant.

“Pharmacy care provided by pharmacists is focused on optimizing patient outcomes and is the foundation for the efficient, rational and safe use of medicines. This guide is a timely and accessible resource for pharmacists, educators and students worldwide to develop patient-centered services and skills to meet the needs of local patients,” said Ton Hoek, Secretary General and Chief Executive Officer of the International Pharmaceutical Federation .

Job responsibilities of a pharmacist and pharmacist in a pharmacy:

Carries out the reception of prescriptions and requirements of medical organizations, the release of medicines and medical products.

It manufactures medicines, checks their quality by the simplest methods of intra-pharmacy control.

Participates in the acceptance of goods, their distribution to storage areas, ensures the conditions for the storage of medicines and medical products in accordance with their physical and chemical properties and the current storage rules.

Provides advisory assistance to packers in the packaging of medicines.

Carries out sanitary-educational and informational work among the population about medicines and medical products, their use and storage at home.

Provides first aid in emergencies.

Moreover, in their work pharmacists should be guided not only by their own ethical standards and moral qualities, but also legislative acts, decrees and orders of the government that regulate the activities of pharmaceutical specialists. For example: the Federal Law "On Medicines", the Law of the Russian Federation "On the Protection of Consumer Rights", the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" and many others.

Pharmacists and pharmacists should remember that their place of work - a pharmacy - is not only a special specialized organization of the healthcare system, but also a kind of trade institution. And here a conflict of interests is often inevitable - commercial benefits and satisfaction of the true needs of buyers. To prevent it, specialists must always strike a balance and remember that the main task is to preserve the health of patients.

For many years, cardiovascular diseases have been one of the most common not only in Ukraine, but also in the world. Unfortunately, many of us, having crossed a certain age limit, are faced with one or another malfunction in the cardiovascular system. What are the reasons for such a significant prevalence of this group of pathologies? There are many reasons and they are very diverse - starting with such global ones as population aging, an unfavorable ecological situation, more individual ones - a hereditary predisposition, and those that can be corrected - a sedentary lifestyle, an unbalanced diet, bad habits, frequent stress, etc. It is sad that despite Despite the significant progress of medicine in this direction, cardiovascular diseases continue to hold a significant share among the causes of death in Europe. At the same time, Ukraine ranks first among European countries in this sad indicator (Nichols M. et al., 2012). In such conditions, prevention becomes, without exaggeration, of great importance, and you should not think that if you did not have time to take care of prevention before the first bells appear, indicating a malfunction of the cardiovascular system, then it is too late to do anything - quite the contrary! This is just the case when it is not too late to take care of your health and longevity. Many of us miss the first bells of the disease past our ears, often out of ignorance. What should a pharmacist pay attention to? What is the role of the pharmacist in the context of cardiovascular disease prevention?

Arterial hypertension. The magnitude of blood pressure depends on the intensity of the work of the heart, but no less important role in this case belongs to the smallest arteries that regulate pressure due to the ability to relax if it is necessary to reduce pressure, or shrink if it is necessary to increase it. Blood pressure over 140/90 is considered a sign of hypertension. A decrease in the elasticity of the vascular wall, which is the main factor leading to an increase in blood pressure, also leads to the development of atherosclerosis (Kosarev V.V., Babanov S.A., 2012). Arterial hypertension increases the risk of stroke, myocardial infarction, vascular damage, atherosclerosis, and thrombosis.

Arrhythmia. Arrhythmia (violation of the frequency, rhythm and sequence of contractions of the heart) can occur under the influence of a wide range of factors, including metabolic disorders. Arrhythmia can lead to an acute hemodynamic disorder, and with sufficient duration and lack of emergency care, to death (Gromova O.I. et al., 2012).

Cardiac ischemia. This condition occurs when the heart does not receive oxygen in the required amount, for example, when the vessels that feed the heart become clogged with atherosclerotic plaques or a blood clot forms and the volume of blood entering the heart decreases - the heart begins to “suffocate”. Ischemic heart disease can manifest itself in the form of angina pectoris, myocardial infarction, heart failure and sudden death (Tumarenko A.V., Skvortsov V.V., 2013).

Angina. It is the most common manifestation of coronary heart disease. The main symptoms of angina pectoris are sharp pain, which has a pressing, squeezing character and can radiate to the left arm and shoulder, under the shoulder blade, to the lower jaw. Attacks of angina pectoris occur during physical exertion, emotional overstrain, sudden hypothermia or overheating of the body, after taking heavy or spicy food, drinking alcohol.

Myocardial infarction. This condition also develops due to a lack of oxygen and insufficient blood supply, however, in this case, not only the contractile function of the heart muscle is disturbed, but cells begin to die. A heart attack manifests itself in the form of severe retrosternal pain in the left side of the chest, behind the sternum, sometimes in the upper abdomen or under the shoulder blade. The pain is noted for more than 30 minutes and is not stopped by nitroglycerin. Sometimes, instead of pain, there is a burning sensation and moderate pressure, weakness and shortness of breath are possible.

Heart failure. This is a condition where the heart is unable to pump enough blood through the body to meet its oxygen and nutrient needs. As a rule, heart failure develops as a complication of diseases that damage the heart muscle (for example, myocardial infarction).

Medical prevention

An attentive reader, of course, noted the key role of thrombosis and atherosclerosis in the formation of most of the above diseases or their further development and chronicity. Moreover, both of these processes - thrombus formation and the development of atherosclerosis - are closely interrelated, which makes it justified to conduct long-term antithrombotic therapy in order to prevent cardiovascular complications in any manifestations of atherothrombosis. It is important to remember that in the absence of adequate therapy on a regular basis, a characteristic feature of atherothrombosis manifests itself, namely: steady progression and development of a systemic lesion (Tolpygina S.N. et al., 2012). At the same time, the leading role in the prevention of complications of atherosclerosis and thrombosis belongs to antiplatelet agents - drugs that inhibit platelet aggregation.

The most commonly used antiplatelet agent is acetylsalicylic acid, which is used for this purpose in relatively low doses. Acetylsalicylic acid, acting on cyclooxygenase, reduces the level of protaglandins, in particular thromboxane A, which causes platelet aggregation. In addition, this drug fights inflammation processes, which are also involved in the development of atherothrombosis. Thus, antiplatelet agents, primarily acetylsalicylic acid, are indicated for people with coronary heart disease, as well as those at an increased risk of its development.

However, it should be borne in mind that the use of acetylsalicylic acid is associated with a significant likelihood of developing a wide range of adverse reactions, which primarily concern the gastrointestinal tract, such as gastric bleeding. Thus, when prescribing this drug, it is important to take measures to minimize the dosage of acetylsalicylic acid in order to accordingly reduce the risk of adverse effects.

One of these approaches, which have become widespread in medical practice, is the use of potassium and magnesium preparations (for example, PANANGIN) along with acetylsalicylic acid. This is due to the fact that magnesium potentiates the properties of acetylsalicylic acid, which allows you to reduce its daily dose, and thus reduce the likelihood of side effects, including such as gastric bleeding (Trisvetova E.L., 2014; Kotova O.V. , Ryabokon I.V., 2012). In addition, potassium and magnesium deficiency plays an important role in the development of various disorders in the cardiovascular system, including in the context of thrombosis. Thus, it has been proven that magnesium deficiency leads to thrombosis, while patients who have had myocardial infarction and thromboembolism are most at risk. It is also noteworthy that the acute phase of ischemic myocardial infarction is characterized by a significant decrease in the level of magnesium in the blood serum - up to 55% of the norm! At the same time, against the background of the development of myocardial infarction and the deterioration of the patient's condition, magnesium deficiency is also steadily increasing (Yessenova I.I., 2011). In addition, potassium-magnesium deficiency can manifest itself in the development of cardiac arrhythmia, which is difficult to treat (Kosarev V.V., Babanov S.A., 2012). Also, potassium deficiency is known to be associated with an increase in blood pressure (D'Elia L. et al., 2011) and may exacerbate the undesirable effects of certain drugs (Kotova O.V., Ryabokon I.V., 2012).

All these effects of potassium and magnesium are well known to cardiologists, which is confirmed by the structure of prescribing drugs. So, according to the data of "RxTest - Monitoring of drug prescriptions", PANANGIN - a magnesium and potassium drug - is most often prescribed in combination with an acetylsalicylic acid drug. The second position is held by a diuretic, which is also pathogenetically justified, since the use of the latter is associated with increased excretion of magnesium and potassium.

And this is not surprising, because doctors in practice made sure that potassium and magnesium preparations have a wide range of positive effects on the activity of the cardiovascular system. This is of particular importance in the context of prevention, given that almost half of the population, and among patients at risk of developing cardiovascular diseases - more than 80% have a deficiency of these macronutrients important for the functioning of the body (Trisvetova E.L., 2014) .

PANANGIN - we replenish the deficiency of potassium and magnesium with ...

Arrhythmias. Potassium deficiency can lead to the development of cardiac arrhythmia, and the correction of its level is also important in the prevention of stroke (Kotova O.V., Ryabokon I.V., 2012). In turn, magnesium is involved in ensuring normal contractile activity of the heart and stabilizing its rhythm. Magnesium deficiency can also be manifested by arrhythmias. An important effect of magnesium in this case is also its potassium-sparing properties (Trisvetova E.L., 2014).

arterial hypertension. Potassium deficiency is associated with increased blood pressure, and low magnesium levels are inversely related to blood pressure levels. When magnesium deficiency is replenished, there is a decrease in tone and pressure in the vessels. Magnesium and potassium help to reduce the level of lipids in the blood, the risk of thrombosis and atherosclerosis (Kotova O.V., Ryabokon I.V., 2012).

Angina. With angina pectoris, almost 40% of patients have magnesium deficiency. Magnesium in combination with traditional treatment improves myocardial function and vasodilatory function of the endothelium, reduces the severity of angina attacks and reduces heart rate (Trisvetova E.L., 2014).

Myocardial infarction. The decrease in magnesium levels, which is noted during the development of myocardial infarction, stimulates the entry of calcium into the cell and exacerbates ischemia or metabolic disorders. Prolonged and aggravated calcium overload of the cell leads to its subsequent damage.

Heart failure. D Magnesium deficiency in patients with heart failure is noted in almost 40% of cases. At the same time, the use of magnesium along with traditional therapy can improve the survival rate and general condition of patients (Trisvetova E.L., 2014).

NB! The levels of magnesium and potassium in the body are interdependent, since a deficiency of one negatively affects the level of the other and vice versa. Magnesium prevents the loss of potassium, while the magnesium content depends on the concentration of potassium (Postnikova S.L. et al., 2007). This makes it expedient to use drugs such as PANANGIN containing both magnesium and potassium.

PANANGIN is an over-the-counter drug designed to replenish the missing reserves of potassium and magnesium and, thereby, help to avoid the development of the pathology of the cardiovascular system associated with their deficiency. PANANGIN will be relevant for a pharmacy visitor who:

• acquires antiplatelet agents, such as acetylsalicylic acid, if the doctor has forgotten to prescribe potassium and magnesium preparations or the patient doubts their need. In this case, potassium and magnesium in PANANGIN, potentiating the properties of acetylsalicylic acid, will help reduce its dose and the likelihood of side effects, as well as help fight atherosclerosis, high blood pressure and the risk of arrhythmia;
• takes diuretics (except for potassium-sparing ones). In this case, there may be an increased "washout" of essential macronutrients such as magnesium and potassium, and since diuretics are usually prescribed to lower blood pressure, it would be advisable to prevent at least the opposite effect associated with a deficiency of potassium and magnesium, and possibly improve the condition by compensating for the previously existing deficit;
• applies to older people. Thus, it is known that more than 80% of people over the age of 70 have magnesium deficiency, as well as an increased risk of developing cardiovascular diseases (Trisvetova E.L., 2014);
• is overweight or obese, since these factors are also associated with an increased likelihood of deficiency of these macronutrients and the development of cardiovascular diseases.

Thus, the use of magnesium and potassium as part of PANANGIN can reduce blood pressure in patients with arterial hypertension, reduce the risk of arrhythmia, thrombosis, improve myocardial contractility, and prevent the development of heart failure. PANANGIN will be relevant for people who care about their health and strive to provide all the conditions for the normal functioning of the cardiovascular system.

PANANGIN : doctors trust and pharmacists recommend!

Press Service of the Weekly APTEKA

List of used literature on the site http://www.site

INFORMATION FOR THE PROFESSIONAL ACTIVITIES OF MEDICAL AND PHARMACEUTICAL WORKERS

Panangin (PANANGIN). Ingredients: magnesium aspartate, potassium aspartate. Dosage form. Film-coated tablets. pharmacological group. Minerals. Magnesium preparations. ATC code. A12C C30. Indications. Additional therapy for chronic heart diseases (with heart failure, in the post-infarction period), cardiac arrhythmias, especially with ventricular arrhythmias. Additional therapy in the treatment of digitalis preparations. As a supplement to increase magnesium and potassium levels from food. Contraindications. Hypersensitivity to the active substances or any of the excipients of the drug. Acute and chronic renal failure, Addison's disease, 3rd degree AV block, cardiogenic shock (blood pressure<90 мм рт. ст.). Побочные эффекты. Со стороны желудочно-кишечного тракта: при применении в высоких дозах возможно повышение частоты дефекации. По некоторым данным, возможны тошнота, рвота и боль в животе. Производитель.ОАО «Гедеон Рихтер»/Gedeon Richter Plc. Н-1103, Будапешт, ул. Демреи, 19–21, Венгрия/H-1103, Budapest, Gyomroi ut. 19–21, Hungary. Р.с. № UA/7315/01/01 с 10.08.2012 по 10.08.2017.

List of used literature

• Gromova O.I., Aleksandrova S.A., Makarenko V.N. et al. (2012) Modern predictors of life-threatening arrhythmias. Creative. cardiology, 2:30–46.
• Esenova I.I. (2011) Focus on magnesium preparations. Ration. pharmacoter. in Cardiology, 7(4): 487–491.
• Kosarev V.V., Babanov S.A. (2012) Panangin in the treatment and prevention of cardiovascular diseases. RMJ (Russian Medical Journal), 34: 1660–1664.
• Kotova O.V., Ryabokon I.V. (2012) Pathogenetic role of potassium and magnesium deficiency in the development of neurological diseases. (RMJ) Russian medical journal, 29: 1493.
• Postnikova S.L., Kasatova T.B., Vereshchagina G.S. et al. (2007) Magnesium and cardiovascular disease. (RMJ) Russian Medical Journal, 20: 1498–1500.
• Tolpygina S.N., Martsevich S.Yu., Khoseva E.N. et al. (2012) Efficacy and safety of acetylsalicylic acid in primary and secondary prevention of cardiovascular diseases. Ration. pharmacoter. in Cardiology, 8(2): 205–210.
• Trisvetova E.L. (2014) Magnesium deficiency and cardiovascular disease: time to act. Ration. pharmacoter. in Cardiology, 10(1): 99–105.
• Tumarenko A.V., Skvortsov V.V. (2013) Promising issues in the pharmacotherapy of coronary heart disease. (RMJ) Russian Medical Journal, 17: 891–896.
• D'Elia L., Barba G., Cappuccio F.P. et al. (2011) Association of habitual potassium intake, stroke and cardiovascular disease: a meta-analysis of prospective studies.
• Ration. pharmacoter. in Cardiology, 7(3): 371–381.
• Nichols M., Townsend N., Luengo-Fernandez R. et al. (2012) European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.

The whole history of medicine is characterized by a close partnership between the doctor and the pharmacist. This tandem is largely preserved to this day. Therefore, the pharmacy cannot be viewed as a simple retail business, as it is done in the consumer goods market. Although in the Rx market the choice of a drug for the treatment of a disease is made by the doctor, the pharmacist has a significant influence on which drug will be ultimately used. The pharmacy and its employees influence the consumption of medicines in three main ways: 1) the formation of the assortment;

2) a proposal to replace an analogue drug in the absence of a prescribed medicinal product; 3) implementation of consulting and information activities.

Assortment formation. Each pharmacy forms its own assortment. This process is based mainly on economic arguments - as a trade enterprise, the pharmacy seeks to extract the maximum profit from its activities and cares little that its assortment contains all the medicines necessary for the treatment of all diseases. The main feature of the pharmacy compared to most retailers is a huge range of products. Moreover, many of these products have analogues both in the form of the same drug produced by another company under a different trade name, and in the form of another drug that is similar in its pharmacological activity. And if the replacement of one drug by another in the second case can not be done in all cases, then in the first it is almost a common practice. This situation creates greater freedom for the pharmacy in the formation of its range. A pharmacy may not include in the list of purchased drugs any drug that is not included in the third or fourth hundred commodity items of its range, and at the same time will not feel this loss. For an excluded drug, such a decision greatly increases the likelihood of replacement. Therefore, the manufacturer must take into account that the risk of non-inclusion of almost every single drug in the pharmacy's purchasing list is very high, and only the targeted work of the marketing departments of the manufacturer with pharmacies can be guaranteed to prevent this.

Drug replacement. In accordance with the law, pharmacy workers are allowed to carry out generic substitution of medicines that are not on sale. Generic is the replacement of a drug with its analogue - a drug with the same active ingredient, in an adequate form and dosage, to be used instead of the drug being replaced. There are three generic replacement systems in the world.

Full generic replacement system. Allows the pharmacist, without any restrictions, if necessary, to issue its synonym instead of the prescribed drug.

The system of prohibiting notes in the recipe. A prescription form may include a field, if marked by a doctor, the pharmacist is not authorized to dispense any drug other than the one prescribed. In all other cases (i.e. if the field is left blank), the pharmacist has the right to a replacement. It is easy to understand that under this system it is the permissibility of substitution that is the norm.

The system of permissive notes in the recipe. In this case, a specific field must be completed by the doctor to allow the substitution. Normal (no mark) is its ban. The permissive labeling system most severely restricts the pharmacist's right to substitute.

In addition, in a number of countries, the practice of issuing a prescription with an INN is widespread. In this case, the pharmacist actually transfers the right not even to replace, but to choose this drug from all available synonyms.

In modern Russia, in fact, there is a system of full generic replacement, which gives the widest possible powers to pharmacy workers. Meanwhile, it is known that this system causes increased risks associated with side effects from unequal exposure of patients to different drugs with the same active substance. In some cases, these differences can be quite significant. For example, according to studies, therapeutically equivalent doses of synonyms of the well-known ACE inhibitor enalapril present on the Russian market gave a threefold (!) spread of values: from 12 to 36.6 mg per day for different drugs (ALO. Yudin et al., 2008). When the choice of a specific drug from a number of synonyms is carried out by a doctor, he consciously takes into account such differences. If the choice is made by a pharmacist who does not have experience in medical work with drugs, he is guided only by the data on the content of the active substance indicated on the package and, therefore, can make serious mistakes. Similarly, the pharmacist may not know the clinical difference between the action of different synonyms, the greater or lesser degree of side effects.

At the same time, the recommendations of pharmacy workers are very effective. According to surveys of the Financial Academy (now the State Financial University under the Government of the Russian Federation), in Moscow pharmacies in the late 90s, the buyer in about 45% of cases agreed with the generic replacement offered to him by the pharmacist / pharmacist (A.Yu. Yudanov et al., 2008 ).

In addition to generic, there is also a therapeutic substitution. In this case, the drug is replaced by a drug used for the same disease, but with a different active ingredient. In fact, in this case, the method of treatment changes, the choice of which, as you know, is the exclusive prerogative of the doctor. Therefore, pharmacists are prohibited from therapeutic substitution of prescription drugs.

Advisory activity. The professional level of pharmacy workers in Russia is extremely high. About 20% of the total number of employees (including cleaners, drivers and cashiers, etc.) in pharmacies are specialists with specialized higher education. And the employees of the first (prescription) table, according to the law, can only be pharmacists. High professional training of pharmacists allows them to perform the function of adapting doctor's prescriptions to the actual choice of drugs, as well as helping in the selection of OTC drugs. The advisory activity of a pharmacist is of the greatest importance for the OTC market. It is when choosing an over-the-counter drug that the pharmacist compensates with his help for the patient's lack of information about the properties of the drug. Up to half of pharmacy visitors turn to the pharmacist for advice, which indicates the extremely important role of the pharmacist in the choice of medicines.

In addition to consulting customers, pharmacists often inform doctors about the availability of drugs, the appearance of their analogues (synonyms) and other receipts.

The role of the pharmacist has recently been increasing, because economic conditions have changed. The solution of issues in the choice and acquisition of drugs is in the sphere of doctor-pharmacist-patient relations. Doctors do not have time to keep track of the updated range of drugs, they are conservative, they use an average of 20-30 drugs in daily practice. The responsibility of people for their health is increasing, a healthy lifestyle is in vogue, the role of self-medication is increasing. The patient today is a literate, demanding consumer, less likely to turn to doctors, more often to a pharmacist, or self-medicate, the pharmacist is the most accessible member of the healthcare team. Pharmacists have extensive knowledge about drug use. Pharmacists can make recommendations for possible solutions to problems or send, if necessary, to a doctor. Pharmacists can make responsible decisions.

The pharmacy is the most appropriate place to promote healthy lifestyles and inform about risk factors. In Russia, there is a concept of pharmaceutical service - the rules of good pharmacy practice. This program exists in other states: health promotion and disease prevention, safe, effective and economic treatment, identification and solution of problems related to the use of drugs.

Impact on prescribing and drug use

Currently, the main source of information about drugs in the medical practice of a doctor is a medical representative - a representative of the manufacturer.

The main activity is aimed at promoting drugs on the market. In some municipalities, it is forbidden to communicate with medical representatives during the work of a doctor, this is due to the fact that doctors do not promote a certain manufacturer. This is stated in Order No. 1175n, where all drugs are prescribed and assigned by INN, trade and grouping name. When dispensing an over-the-counter drug, a pharmacy visitor carefully approaches the choice of drugs through qualified advice from a pharmacist. The pharmacist must provide information about the product, its properties and advice to the buyer.

Qualifications of pharmaceutical workers. Confirmation of professional competence

A pharmacist, who is a specialist in ensuring the effectiveness and safety of drugs, obliges the state to organize a system for regulating the maintenance and confirmation of the level of professional qualifications of pharmacists.

In modern conditions, pharmacists undergo continuous education, continuous professional development and lifelong learning.

Continuing education is a process designed to enhance the professional development of pharmacists. Continuing professional development is the duty of the pharmacist to systematically support the development and expansion of his knowledge in order to guarantee his continued competence in the course of his work.

Lifelong learning - actions to increase the level of knowledge in professional fields.

After graduation, during the first year, an internship is obligatory - during the year the pharmacist works, receives a salary, a year later he receives a specialist certificate. Then, if desired, postgraduate studies, the defense of a candidate, doctoral studies - the defense of a doctoral dissertation.

1 time in 5 years mandatory advanced training (for pharmacists and pharmacists) and accreditation of a specialist - a document of a single standard form confirming the compliance of the level of preparation of a pharmaceutical worker with educational standards 1 time in 5 years.

To obtain qualification categories: second, first and highest, a specialist submits an application to the certification commission of the Ministry of Health of the Choi and a report for the last year of work. Qualification categories are required to receive bonuses to the official salary in municipal and state pharmacies.

The program of state guarantees of free provision of medical care to citizens