Lunaldin ndi gawo lachitatu la "makwerero othandizira kupweteka" a WHO. Awa ndi ma analgesics amphamvu kwambiri a narcotic omwe amagwiritsidwa ntchito pochepetsa kupweteka kwambiri.
Dzinalo Losayenerana
Fentanyl.
Lunaldin ndi gawo lachitatu la "makwerero othandizira kupweteka" a WHO.
ATX
Code ya ATX - N02AB03 - Fentanil.
Kutulutsa mafomu ndi kapangidwe kake
Amapezeka mu mawonekedwe a sublingual (kusungunuka pansi pa lilime) mapiritsi a mitundu yosiyanasiyana (mcg) ndi mawonekedwe:
- 100 - wozungulira;
- 200 - ovoid;
- 300 - patatu;
- 400 - rhombic;
- 600 - semicircular (D-mawonekedwe);
- 800 - kapisozi.
Piritsi limodzi lili ndi chinthu chomwe chimagwira - fentanyl citron micronized ndi othandizira.
Pharmacological zochita za Lunaldin
Mankhwalawa ndi a gulu la opioid analgesics. Thupi limalepheretsa µ-opioid receptors, yomwe imayambitsa ma supraspinal (µ1 -kuwonetsedwa kwa magawo olamulira a ubongo) ndi msana (µ2-kukopa kwa kayendetsedwe kazinthu zam'mimba) analgesia (kuchepetsa kupweteka kwa mothandizidwa ndi mankhwala opangira mankhwala).
Thupi limasokoneza kaphatikizidwe ka adenylate cyclase (AC) ndi cyclic adenosine monophosphate (cAMP), yomwe imafikitsa zizindikilo pakati pa ma synapses a mafupa amitsempha. Fentanyl imakhudza polarization wa nembanemba, ntchito ya njira za ion, zomwe zimayambitsa kuchepa kumasulidwa kwa oyimira pakati opweteka.
Popeza µ ma receptor amapezeka osati muubongo ndi msana, komanso ziwalo zotumphukira, mankhwalawo:
- amalepheretsa kugwira ntchito kwa kupuma;
- kumawonjezera mamvekedwe a minofu yosalala ya kwamikodzo dongosolo, kuwonjezeka kapena kuletsa kukodza;
- amachititsa kuphipha kwamitsempha yamavuto;
- kumawonjezera mamvekedwe a minofu yosalala ya m'mimba, kuchepetsa matumbo;
- dilates zotumphukira ziwiya;
- kumakwiyitsa hypotension ndi bradycardia.
Njira imeneyi inachititsa kuti mankhwalawa agwiritsidwe ntchito mu analgesic mankhwala am'magazi, limodzi ndi kupweteka kwambiri komanso kosaletseka.
Pharmacokinetics
Mankhwalawa ali ndi mphamvu yotchedwa hydrophobicity, kotero, imakamizidwa mofulumira mkatikati mwa pakamwa kuposa momwe amathandizira kugaya chakudya. Kuchokera kudera laling'ono, limalowa mkati mwa mphindi 30. Bioavailability ndi 70%. Chiwonetsero chachikulu cha magazi a fentanyl chimafika ndikuyamba kwa mankhwala a 100-800 μg pambuyo pa mphindi 8-10.
Kuchuluka kwa fentanyl (80-85%) kumalumikizana ndi mapuloteni a plasma, omwe amachititsa kuti pakhale nthawi yochepa. Kuchulukitsa kwa kaperekedwe ka mankhwalawa munthawi zonse ndi 3-6 l / kg.
Kupanga kwakukulu kwa fentanyl kumachitika mothandizidwa ndi hepatic michere. Njira yayikulu yochotsera thupi ndi mkodzo (85%) ndi bile (15%).
Kutalika kwa theka la chinthu kuchokera mthupi kumachokera ku maola 3 mpaka 12,5.
Zisonyezero pakugwiritsa ntchito Lunaldin
Chizindikiro chachikulu chogwiritsidwa ntchito ndi Lunaldin ndi pharmacotherapy ya chizindikiro cha ululu kwa odwala khansa omwe amalandira chithandizo chokhazikika cha opioid.
Chizindikiro chachikulu chogwiritsidwa ntchito ndi Lunaldin ndi pharmacotherapy ya chizindikiro cha ululu kwa odwala khansa omwe amalandira chithandizo chokhazikika cha opioid.
Contraindication
Mankhwala ndi contraindised mu:
- machitidwe omwe amaphatikizidwa ndi kupuma kwambiri;
- matenda a m'mapapo;
- munthawi yomweyo kugwiritsa ntchito mankhwala omwe ali ndi ma monoamine oxidase (MAO) blockers kapena makonzedwe ake kwa nthawi yochepera masabata awiri atatha chithandizo;
- kumwa mankhwala osakanikirana - otsutsana ndi agonists a opioid receptors;
- wodwala mpaka zaka 18;
- thupi lawo siligwirizana ndi zigawo zikuluzikulu;
- kusowa kwa opioid isanachitike.
Ndi chisamaliro
Kusamala kowonjezereka kumafunikira pakupereka Lunaldin kwa odwala omwe amakonda kutsata intracranial owonjezera wa CO₂ m'magazi:
- kuchuluka kwachuma chamkati;
- chikomokere;
- kuzindikira kolakwika;
- neoplasms ya ubongo.
Makamaka kusamala pakugwiritsira ntchito mankhwalawa kuyenera kuchitika pochiza anthu omwe ali ndi vuto la kumutu, kuwonetsa kwa bradycardia ndi tachycardia. Odwala okalamba komanso ofooka, kumwa mankhwalawa kungayambitse kuchuluka kwa theka la moyo ndikuwonjezera chidwi cha zosakaniza. Mu gululi la odwala, ndikofunikira kuyang'ana mawonetseredwe a zizindikiro za kuledzera ndikusintha mlingo kumatsikira.
Odwala omwe ali ndi vuto la impso komanso hepatic, mankhwalawa amatha kuyambitsa kuchuluka kwa fentanyl m'magazi (chifukwa cha kuchuluka kwake kwa bioavailability komanso kuletsa kuchotsedwa). Mankhwalawa ayenera kugwiritsidwa ntchito mosamala kwambiri odwala omwe ali ndi:
- Hypervolemia (kuchuluka kwa kuchuluka kwa plasma m'magazi);
- matenda oopsa
- kuwonongeka ndi kutupa kwa mucosa mkamwa.
Malamulo a Lunaldin
Gawani odwala omwe ali ndi kupirira kwa opioids, mutatenga 60 mg ya morphine pakamwa kapena 25 μg / h ya fentanyl. Kumwa mankhwalawa kumayamba ndi mlingo wa 100 mcg, pang'onopang'ono kuchuluka kwake. Ngati mkati mwa mphindi 15-30. mutatenga piritsi la ma virus 100, kupweteka sikumatha, ndiye kuti mutenge piritsi lachiwiri lokhala ndi zinthu zomwezo.
Gome limawonetsa njira zachitsanzo za kaperekedwe ka mankhwala a Lunaldin, ngati mlingo woyamba sukubweretsa:
| Mlingo woyamba (mcg) | Mlingo wachiwiri (mcg) |
| 100 | 100 |
| 200 | 100 |
| 300 | 100 |
| 400 | 200 |
| 600 | 200 |
| 800 | - |
Kumwa mankhwalawa kumayamba ndi mlingo wa 100 mcg, pang'onopang'ono kuchuluka kwake.
Ngati mutamwa mlingo wambiri wa mankhwalawa, zotsatira za analgesic sizinachitike, ndiye kuti mlingo wapakatikati (100 mcg) ndi mankhwala. Mukamasankha mlingo pa gawo lodzikakamiza, musagwiritse ntchito mapiritsi oposa 2 omwe akumenyedwa kamodzi. Zotsatira za thupi la fentanyl mu mlingo wa zopitilira 800 osazindikiridwa.
Ndi mawonetseredwe amitundu yoposa inayi ya kupweteka kwambiri patsiku, kupitilira masiku 4 otsatizana, kusintha kwa mankhwalawa kwa nthawi yayitali ya opioid mndandanda kumayikidwa. Mukasinthira kuchoka ku analgesic kupita ku imzake, kutumikiridwa mobwerezabwereza kwa mankhwala kumachitika moyang'aniridwa ndi dokotala ndikuwunika kwa Laborator komwe akudwala.
Ndi kutha kwa kupweteka kwa paroxysmal, Lunaldin anasiya. Mankhwalawa amachotsedwa, pang'onopang'ono kuchepetsa mlingo kuti asayambitse kuwoneka ngati achire.
Ndi matenda ashuga
Ndi Lunaldin analgesia, odwala matenda a shuga amalimbikitsidwa kuti azigwiritsa ntchito Propofol ndi Diazepam.
Mlingo wa mankhwala amasankhidwa payekha.
Zotsatira zoyipa
Pa chithandizo, zotsatirazi zoyipa zimawonetsedwa nthawi zambiri:
- kutopa;
- kugona
- mutu ndi chizungulire;
- hyperhidrosis;
- nseru
Ndi maulendo osiyanasiyana, zoyipa zimawonekera kuchokera kuma kachitidwe osiyanasiyana amthupi momwe ma μ receptors amapangidwira.
Matumbo
Mankhwala amatha kukhala olepheretsa matumbo athu kuti ayambe kudzimbidwa. Kuphatikiza apo, zotsatirazi nthawi zambiri zimadziwika:
- kamwa yowuma
- kupweteka m'mimba;
- zovuta za defecation;
- mavuto a dyspeptic;
- matumbo kutsekereza;
- mawonekedwe a zilonda pakamwa;
- kuphwanya machitidwe a kumeza;
- kukomoka.
Chomwe chimakhala chofala kwambiri ndikupanga mpweya wambiri, zomwe zimayambitsa kuphuka komanso kuphimba.
Pakati mantha dongosolo
Kuchokera pakati mantha dongosolo nthawi zambiri kumabuka:
- asthenia;
- Kukhumudwa
- kusowa tulo
- kuphwanya kulawa, masomphenya, kuzindikira kwamwano;
- kuyerekezera;
- delirium;
- chisokonezo cha chikumbumtima;
- zolota;
- Kusintha kwakuthwa;
- nkhawa zochulukirapo.
Vuto lodzilamulira tokha ndilofala.
Kuchokera kwamikodzo
Zotsatira za Lunaldin pamikodzo yamkodzo dongosolo limakulitsa kamvekedwe ka minofu yosalala, yomwe imayendera limodzi ndi vuto la kukodza - kuchuluka kapena kuchepa kwa mkodzo, kuphipha kwa chikhodzodzo, oliguria.
Kuchokera ku kupuma
Nthawi zambiri:
- kupsinjika;
- mphuno zam'mimba;
- pharyngitis.
Pafupipafupi, mphumu ya bronchial, kuchepa kwamapapo, kumangidwa kwa kupuma, hemoptysis.
Kuchokera pamtima
Zomwe zimachitika mu izi:
- kugwa kwa orthostatic;
- kupuma kwamisempha ya makoma amitsempha yamagazi (vasodilation);
- mafunde;
- mawonekedwe ofiira
- arrhythmia.
Pathological zimatha kuwonetsedwa ndi ochepa hypotension, kusokonekera kwa mtima, kuchepa kwa mtima (bradycardia) kapena kuwonjezeka kwa kugunda kwa mtima (tachycardia).
Matupi omaliza
Thupi lawo siligwirizana ndi mankhwalawa lingachitike mwanjira ya:
- mawonekedwe a khungu - zotupa, kuyabwa;
- redness ndi kutupa pamalo a jakisoni.
Odwala omwe ali ndi vuto la hypobiliary system, biliary colic, kuphwanya kutuluka kwa ndulu, titha kuzindikira. Ndi kugwiritsa ntchito nthawi yayitali, kuledzera, malingaliro komanso thupi (kudalira) kumatha. Zotsatira zoyipa za thupi zimatha kuyambitsa kugona komanso kuchepa kwa libido.
Zokhudza mphamvu pakuwongolera njira
Mankhwalawa amatha kusokoneza dongosolo lamkati la manjenje ndi ziwalo zamavuto, motero munthawi ya chithandizo Lunaldin ayenera kukana kuyendetsa magalimoto, kugwira ntchito ndi machitidwe ndi ntchito zina zomwe zimafunikira chisamaliro, kuthamanga kwa kupanga zisankho komanso kuona.
Mankhwalawa amatha kusokoneza dongosolo lamkati lamanjenje komanso ziwalo zam'maganizo, motero, munthawi yamankhwala ndi Lunaldin, muyenera kukana kuyendetsa magalimoto.
Malangizo apadera
Ndi chithandizo cha nthawi yayitali ndi opioid analgesics, malangizo omwe aperekedwa mu malangizo a mankhwalawa amayenera kuonedwa. Anthu omwe akusamalira wodwala ayenera kulangizidwa pa zomwe zimachitika chifukwa cha mankhwalawa machitidwe osiyanasiyana ndi kuthekera kwa bongo. Ayenera kupereka chithandizo choyamba ngati pali vuto la kuledzera.
Gwiritsani ntchito mu ukalamba
Mwa anthu okalamba (chifukwa cha kuchepa kwa kuchuluka kwa kagayidwe kachakudya ndi kuchotsedwa kwa mankhwalawa), zizindikiro za kuledzera zitha kudziwika. Chifukwa chake, popereka mlingo wa mankhwalawa, ndikofunikira kuganizira za thupi ndi zaka zake.
Kupatsa ana
Sichiloledwa kwa ana ochepera zaka 18, ngakhale ali kunja, pochiza matenda opweteka kwambiri, fentanyl imaloledwa kugwiritsidwa ntchito kuyambira chaka chimodzi.
Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere
Kumwa mankhwala kumafuna chisankho choyenera. Kutenga nthawi yayitali ndi mankhwalawa panthawi yapakati kumapangitsa kuti mwana akhanda. Mankhwalawa amalowera mu zotchinga za m'mimba, ndipo kugwiritsa ntchito kwake pakubadwa kwa ana ndiwowopsa pantchito yopuma ya mwana wosabadwa ndi wakhanda.
Mankhwalawa amapezeka mkaka wa m'mawere. Chifukwa chake, kubereka kwake pakamayamwa kumatha kuyambitsa kupuma kwa khanda. Mankhwala mu kuyamwitsa ndi nthawi yakhazikitsidwa pokhapokha pokhapokha ngati phindu lake limagwiritsidwa ntchito limaposa chiwopsezo cha mwana ndi mayi.
The ntchito aimpso kuwonongeka
Popeza njira yayikulu yogwiritsira ntchito mankhwala ndi ma metabolites ali ndi mkodzo, vuto laimpso, kuchepa kwa chimbudzi, kudzikundikira m'thupi, komanso kuwonjezeka kwa nthawi yochitapo kanthu. Odwala otere amafunikira kuwongolera kwa plasma ya mankhwala ndi kusintha kwa mlingo ndi kuwonjezeka kwa voliyumu yake.
Gwiritsani ntchito ntchito yolakwika ya chiwindi
Mankhwalawa amachotsedwa ndi bile, motero, ndi matenda a chiwindi, kwa hepatic colic, nthawi yayitali ingagwiritsidwe ntchito, komwe, ngati dongosolo la mankhwala likatsatiridwa, lingayambitse bongo. Kwa odwala oterowo, mankhwalawa amayenera kumwedwa mosamala, kuwona kuchuluka ndi kuchuluka kwa mankhwalawa omwe adokotala amawerengedwa, ndikuwunika.
Bongo
Pankhani ya bongo wa Lunaldin, mavuto obwera chifukwa cha kupsinjika ndi kupuma kumawonjezereka, mpaka kuima kwake. Thandizo loyamba la bongo ndi:
- kukonzanso ndi kuyeretsa kwamkamwa patsekemera (gawo laling'ono) kuchokera kuzinthu zotsalira za piritsi;
- kuwunika kwa kukwana wodwala;
- mpumulo, kufikira makulidwe ndi kukakamiza mpweya wabwino;
- kusunga kutentha kwa thupi;
- kuyambitsa kwamadzi kuti apange kutayika kwake.
Katemera wa opioid analgesics ndi Naloxone. Koma zitha kugwiritsidwa ntchito pokhapokha kuthetsa bongo mwa anthu omwe sanagwiritse ntchito ma opioid kale.
Ndi hypotension yayikulu, mankhwala obwezeretsa m'madzi a m'magazi amaperekedwa kuti athetse magazi.
Katemera wa opioid analgesics ndi Naloxone.
Kuchita ndi mankhwala ena
Mankhwala zimapukusidwa ndi michere chiwindi, kotero mankhwala omwe amakhudza ntchito yawo (Erythromycin, Ritonavir, Itraconazole) kumawonjezera bioavailability wa mankhwala ndikubweretsa kuchuluka kwa zotsatira.
Kuphatikizika ndi ma analgesics ena, ma antipsychotic, mapiritsi ogona ndi zinthu zina zomwe zimapangitsa kuti magazi azikhala ochepa komanso osangalatsa, kupuma kwamphamvu, kutsika kwamphamvu kwa magazi. Chifukwa chake, kuphatikiza kwawo kumagwiritsidwa ntchito mosamala kwambiri.
Sitikulimbikitsidwa kumwa antagonists / agonists a opioid receptors nthawi yomweyo ndi mankhwalawo, chifukwa mwa odwala omwe amamwa mankhwalawa kwa nthawi yayitali, kuphatikiza kumeneku kumayambitsa zizindikiro za kusiya.
Kuyenderana ndi mowa
Mowa wa Ethyl umathandizira kusunthika kwa mankhwalawa, kotero kuphatikiza mankhwalawa ndi zakumwa sizikulimbikitsidwa.
Analogi
Mafanizo a Lunaldin ndi:
- Dolforin;
- Fentavera;
- Matrifen;
- Fendivia
- Carfentanil.
Kupita kwina mankhwala
Ndi mankhwala.
Kodi ndingagule popanda kulandira mankhwala?
Ayi.
Mtengo wa Lunaldin
Ku Russia, mankhwala amtengo amachokera ku ma ruble 4000. mapiritsi 10 No. 100, 4500 rub. kwa ma CD No. ruble 200 ndi 5000. owerengedwa 300.
Zosungidwa zamankhwala
Mankhwalawa akuphatikizidwa pamndandanda A, ndipo uyenera kusungidwa mu kabati yotsekedwa, kutali ndi ana kufiriira.
Tsiku lotha ntchito
Osapitirira zaka zitatu.
Mankhwalawa amasungidwa osaposa zaka zitatu.
Wopanga
"Recipharm Stockholm AB", Sweden.
Ndemanga za Lunaldin
A Tatyana Ivanova, wazaka 45, a Pskov: "Kukonzekera bwino kwambiri. Kunandithandizanso pambuyo pa opaleshoni. Kupwetekaku kunali kwamphamvu kwambiri ndipo palibe chomwe chinathandiza. Mankhwala a Lunaldin okha ndiwo adandipulumutsa ku chizunzo."
Mikhail Prokopchuk, wazaka 48, emerovo: "Ndimagwira ntchito yothandizira kuchipatala chaching'ono. Machitidwe anga, nthawi zambiri ndimagwiritsa ntchito mankhwala opha ululu ndi Lunaldin. Mankhwala abwino omwe atsimikizira kutetezeka ndi kuchita kwake bwino. "
Ekaterina Filippova, wazaka 36, Kostroma: "Amayi anga anali ndi ululu wambiri ku kansa ya colorectal. Mpaka tsiku lomaliza, mapiritsi a a Lunaldin okha ndi omwe adatipulumutsa. Palibe chifukwa chobayira, piritsi pansi pa lilime, ndipo ululu udachepera."
