Biguanides ali m'gulu la guanidines, lomwe limathandiza kwambiri matenda ashuga. Kupatula apo, gulu ili la mankhwala limatsitsa kuchuluka kwa shuga m'magazi.
Othandizira awa ndi: L-butylbiguanide (Buformin), N, N-dimethylbiguanide (Metformin), Phenethylbiguanide (Fenformin).
Kusiyana kwa kapangidwe kotsika kwa ma gluuanides omwe ali mu shuga kumapangidwa ndi thupi ndi kuchuluka kwa kuchuluka. Koma zotsatira za guanidine zimachokera ku metabolism zimafanana nthawi zambiri.
Komabe, othandizira a antihyperglycemic sagwiritsidwa ntchito ngati monotherapy. Monga lamulo, izi zimachitika mu 5-10% ya milandu.
Kodi agogo amagwira ntchito bwanji?
Momwe mankhwalawa amakhudzira thupi samvetsetsa kwathunthu, ngakhale atakhala maphunziro angapo. Koma zidalembedwa kuti guanidine zotumphukira zamagazi zimachepetsa shuga ya mtundu 2, makamaka ngati wodwalayo ali ndi vuto la kunenepa kwambiri.
Biguanides ali ndi "kusunga insulini-kusunga", motero pakapita nthawi kufunika kwa kayendetsedwe ka mahomoni amthupi kumachepa. Komanso mankhwalawa amachepetsa gluconeogeneis ochulukitsidwa ndi mapuloteni.
Kuphatikiza apo, zinthu ngati izi zimapangitsa kuti shuga ayambe kutuluka ndikusintha shuga kukhala lactate. Chifukwa chodziwikiratu ndi zomwe zimachokera ku guanidine, njira yolembera zinthu monga:
- mafuta
- vitamini B 12№
- ma amino acid;
- D-xylose.
Pali lingaliro kuti pakupangika kwa kupuma kwa minofu, mapangidwe a ATP amachepetsa, omwe amachepetsa njira zosiyanasiyana za metabolic momwe mphamvu zimatha (mwachitsanzo, gluconeogenesis). Mwina, momwe limagwirira ntchito za biguanides ndi momwe zimawakhudzira kagayidwe ka lipid.
Zinapezekanso kuti mankhwalawa m'magulu odwala matenda ashuga omwe amadalira insulin omwe ali ndi kulemera kwakukulu amathandizira kuchepa kwamphamvu kwa thupi.
Koma zoterezi zimadziwika pokhapokha pakuyamba chithandizo, zinthu zina sizikumidwa m'matumbo, ndipo chilimbikitso cha wodwalayo chimachepa.
Mlingo ndi makonzedwe
Gulu la Biguanides limaphatikizapo mankhwala omwe ali ndi dzina lotsatira:
- Siofor 1000 / 850/500;
- Bagomet;
- Metformin Acre;
- Avandamet;
- Glucophage;
- Metfogamma.
Masiku ano, zotuluka za methylbiguanide ndizogwiritsidwa ntchito kwambiri, zomwe ndi metformin. Izi ndi monga Gliformin, Glucofag, Dianormet ndi zinthu zina.
Njira yogwiritsira ntchito ma Biguanides ambiri ndi chimodzimodzi. Poyamba, Mlingo wocheperako umasankhidwa, koma ndi kulolera bwino umachulukitsidwa tsiku lililonse la 2-4. Komanso, polyhexamethylene biguanide ayenera kuledzera atatha kudya, zomwe zingalepheretse kukula kwa zoyipa kuchokera m'mimba thirakiti.
Gulu la Biguanides lomwe limagwiritsidwa ntchito pochiza matenda osagwiritsa ntchito insulin limakhala ndi zotsatirapo zochizira kwa maola khumi ndi awiri. Chifukwa chake, mlingo wa tsiku ndi tsiku uyenera kugawidwa mu 2 Mlingo.
Kumayambiriro kwa zamankhwala, Metformin 850, Siofor ndi zina zotero, zimatengedwa ndi kuchuluka kwa 500 mg kamodzi (madzulo). Pakatha sabata, pokhapokha ngati wodwala alibe mavuto am'mimba, kuchuluka kwa tsiku lililonse kumawonjezeredwa mpaka 850 mg kapena wodwala akamamwa owonjezera 500 mg m'mawa.
Ngati mukukumana ndi zovuta, mlingo uyenera kuchepetsedwa, ndipo pakapita kanthawi muyesenso kuonjezera. Pazitali kwambiri pazinthu zomwe zimachitika m'thupi zimachitika pakatha miyezi iwiri ya chithandizo.
Kuthandizira Mlingo - mpaka 2000 mg patsiku. Kuchuluka kovomerezeka ndi 3000 mg patsiku, koma kwa achinyamata okha. Mlingo woyenera kwambiri wa okalamba sioposa 1000 mg.
Polyhexamethylene biguanide ikhoza kuphatikizidwa ndi secretogens (sulfonylureas ndi dongo), insulin ndi glitazones. Chifukwa chake, makampani opanga mankhwala amapanga zokonzekera zophatikizika zomwe zimakhala ndi hypoglycemic pamtengo wotsika, womwe umachepetsa chiopsezo cha zotsatirapo:
- Glucovans (metformin ndi glibenclamide);
- Glibomet.
Ngati mutenga mankhwala ophatikizika, ndiye kuti kuchuluka kwa shuga m'magazi kumatanthauza pakatha maola awiri, ndipo zotsatira zake zimakhala mpaka maola 12.
Mankhwalawa amatengedwa ndi piritsi limodzi patsiku ndikuwonjezereka kwa mapiritsi 2 tsiku lililonse.
Zochita Zosiyana ndi Zopikisana
Polyhexamethylene biguanide ndi zinthu zina kuchokera pagululi zimatha kuyambitsa zinthu zingapo zoyipa. Zodziwika kwambiri zimaphatikizapo zolephera pakudya m'mimba, kusadya bwino, kupezeka kwa kukoma kwa zitsulo mkamwa komanso kukulira kwa lactic acidosis.
Chizindikiro choletsa kudya kwa zinthu kuchokera mndandanda wa guanidine ndikuwukira m'mimba. Komabe, ndikusintha kwa mlingo, zotsatira zoyipa zambiri zimatha.
Metformin imatsutsana pazochitika zotsatirazi:
- kulephera kupuma;
- matenda a shuga;
- mavuto a chiwindi
- sitiroko;
- mimba
- matenda pachimake;
- discirculatory encephalopathy;
- kukanika kwa aimpso, pamene mulingo wa creatinine m'mwazi ndi woposa 1.5 mmol / l.
Komanso, mankhwalawa sangatengedwe ndi matenda a shuga, kuphatikizapo ketoacidosis ndipo, ngati pali mbiri ya lactic acidosis. Kuphatikiza apo, mankhwalawa amaphatikizidwa mu hypoxic zinthu (vuto la mtima, angina pectoris, magazi osayenda bwino).
Metformin sigwirizana ndi mowa. Ndipo ngati chiwindi chikukulitsidwa, ndiye kuti mankhwalawa amalembedwa pokhapokha ngati hepatomegaly imachitika motsutsana ndi maziko a matenda a shuga a hepatostatosis.
Pankhani ya zotupa za chiwindi, zam'mimba kapena zotupa, ma biguanides amatha kusokoneza hepatic parenchyma. Zotsatira zake, zowoneka mu kusintha kwa mayeso ogwira ntchito. Cholestasis imatha kukhalanso, ndi zizindikiro zomveka za jaundice.
Poyerekeza ndi mankhwala a sulfonylurea, mankhwalawa ochokera ku mitundu yambiri ya guanidine samatha kuyambitsa impso ndi m'mafupa. Ngakhale, amaphatikizidwa chifukwa cha kuchepa kwa magazi m'thupi, kusungidwa, poizoni wa nayitrogeni komanso pamaso pa matenda a impso omwe amachititsa kuchepa kwa kusefukira kwa glomerular.
Komanso, ngati chithandizo chokhala ndi biguanides chikuphatikizidwa ndi fructose, antihistamines, barbiturates, teturam ndi salicylates, izi zimakulitsa lactic acidosis.
Phunziro pazokhudza matenda a shuga limaperekedwa mu kanema munkhaniyi.
