Njira zamakono zochizira matenda a shuga zimaphatikizapo kugwiritsa ntchito mankhwala ochiritsira omwe ali m'magulu osiyanasiyana pochizira.
Mpaka pano, mitundu isanu ndi umodzi yamankhwala ochepetsa shuga aonekera mu pharmacology.
Mankhwala ochepetsa shuga amagwiritsidwa ntchito pokhapokha ngati wodwala ali ndi mtundu wachiwiri wa matenda a shuga, omwe samadalira insulin.
Mankhwala onse ali m'gulu lotsatira lamankhwala:
- Biguanides.
- Glinidam.
- Glitazone.
- Alfa glucosidase zoletsa.
- Zoletsa za DPP-4.
- Sulfonamides.
- Kuphatikizidwa.
Gulu la Biguanides limaphatikizapo mankhwala amodzi - Metformin. Chida ichi chakhala chikugwiritsidwa ntchito kuyambira 1994. Chida chake ndi chomwe chimagwiritsidwa ntchito kwambiri kuchepetsa shuga mthupi.
Glitazones imaphatikizapo mankhwala amodzi - Pioglitazone. Mankhwalawa amathandizira kukulitsa gawo la khungu la zotumphukira maselo kuti apange insulin komanso amachepetsa kuchuluka kwa mafuta kagayidwe.
Ma alpha-glucosidase ma inhibitors amalepheretsa kugaya kwa chakudya, kupewa kutulutsa shuga m'magazi a m'magazi.
Ma DPP-4 ma inhibitors amalepheretsa kuwonongeka kwa glucagon-polypetide 1 (GLP-1) ndikuletsa enzyme DPP-4.
Sulfanilamides amagwiritsidwa ntchito ngati mankhwala ochepetsa shuga ndipo ndiwodziwika kwambiri. Kuchita kwa mankhwala a gululi kumatengera kukondoweza kwa insulin yopanga ma cell a pancreatic. Pakadali pano, magulu anayi a sulfonamides apangidwa.
Mankhwala osakanikirana ndi othandizira omwe ali ndi mitundu yambiri yogwira popanga.
Ma glinids amaphatikiza mankhwala awiri pakupanga kwawo - Repaglinide ndi Nateglinide. Mankhwalawa ali ndi mphamvu yosangalatsa pa maselo a beta a pancreatic minofu.
Kuphatikiza pa kutsitsa shuga, ma dothi okhala ndi zinthu zina:
- sizimathandizira kulemera;
- mukamagwiritsa ntchito mankhwala a gululi odwala, mwayi wa hypoglycemia umachepetsa kangapo poyerekeza ndi sulfonamides.
Monga mankhwala aliwonse, ndalama za gulu ladongo zimakhala ndi zovuta zingapo:
- mukagwiritsidwa ntchito, pali mwayi wopanga hypoglycemia;
- osavomerezeka kugwiritsa ntchito mankhwala ngati wodwala ali ndi matenda ena a chiwindi.
Mankhwala a Clinid nthawi zambiri amagwiritsidwa ntchito ngati poyambira othandizira odwala matenda a shuga 2.
Zizindikiro ndi contraindication ogwiritsa ntchito dongo
Chizindikiro chachikulu chakugwiritsa ntchito dongo ndicho kupezeka kwa mtundu wachiwiri wa matenda a shuga wodwala pakadalibe ntchito yochokera pakulandidwa kwa zakudya ndi zolimbitsa thupi.
Mankhwala omwe ali mgululi amagwiritsidwa ntchito kuti achepetse shuga m'thupi la wodwalayo.
Monga mankhwala aliwonse, mankhwala a gulu ladongo amakhala ndi zotsutsana zingapo kuti agwiritse ntchito.
Zoyambitsa matope pakugwiritsa ntchito dongo ndi izi:
- Kukhalapo kwa hypersensitivity.
- Kupezeka kwa matenda amtundu wa 1 wodwala.
- Kukula mu thupi la zinthu zofunika insulin mankhwala.
- Kukhalapo kwa zovuta kwambiri pakugwira ntchito kwa impso ndi chiwindi.
- Nthawi ya bere ndi nthawi yoyamwitsa.
Sitikulimbikitsidwa kupaka mankhwala opatsirana a glinids kwa odwala a ana ndi achinyamata ochepera zaka 18, kuwonjezera apo, sikulimbikitsidwa kuti mugwiritse ntchito mankhwala ochizira matenda a shuga kwa odwala azaka zopitilira 75.
Zotsatira zoyipa zomwe zimagwiritsidwa ntchito pogwiritsa ntchito mankhwalawa ndi:
- kusokonezeka kwa kugwira ntchito kwam'mimba thirakiti, kuwonetseredwa ndi kusanza ndi malingaliro a mseru;
- Nthawi zina, thupi limakumana ndi mawonekedwe a khungu lotupa
- nthawi zina pamakhala kuchuluka kwapang'onopang'ono kwa ntchito ya transamylase.
Nthawi zina, pamakhala kuwonongeka kooneka, komwe kumatsatana ndi kusinthasintha kwa shuga mumthupi.
Limagwirira ntchito dongo
Ma glinides ndi othandizira popanga insulin. Mankhwalawa amasiyana ndi sulfonamides osati mwapangidwe, komanso mankhwala. Glinids adapangidwa ngati mankhwala omwe amathandizira kubwezeretsa ndikuwonjezera kuchuluka kwa insulin ya pancreatic hormone yopangidwa ndi maselo a beta.
Ma glinids amayenera kumwedwa kokha pakudya, izi zimakupatsani mwayi wowonjezera zakudya zopatsa mphamvu poyerekeza ndi zakudya mukamamwa sulfonamides.
Meglitinides ali ndi theka lalifupi, lomwe limachepetsa mwayi wokhala ndi boma la hypoglycemic.
Pakadali pano, meglitinides akuphatikiza mankhwala awiri - Nateglinide ndi Repaglinide.
Limagwirira a zochita za mankhwala amatengera mphamvu yake pa njira zotsamira za ATP zotengera za beta-cell. Izi zimabweretsa kutsika kwa nembanemba ndi kutsegulidwa kwa njira za calcium. Pambuyo kukhudzana ndi minyewa ya pancreatic, mankhwalawa amathandizira kuchuluka kwa calcium ion m'maselo kuchokera kumalo ophatikizana.
Kuwonjezeka kwa kuchuluka kwa calcium mu cell kumapangitsa ntchito ya insulin.
Kulumikizana komwe limapangidwa ndi meglitinides ndi ma cell receptors sikokhazikika, chifukwa chake, zovuta zomwe zimapangidwa zimakhala nthawi yayifupi.
Kukonzekera kwa Clinid, komwe kumalowetsedwa m'thupi, kumakhala ndi magazi okwanira ola limodzi pambuyo pa kuperekedwa. The bioavailability mankhwala pafupifupi 56%.
The munthawi yomweyo kuperekedwa kwa mankhwala ndi chakudya sizikhudza kwambiri nthawi kuti afike pazomwe zimapangitsa kuti azigwira ntchito m'magazi, ndipo pazomwe zimapangitsa kuti ambiri azigwira bwino ntchito zimachepetsedwa ndi 20%. Glinides amatha kuphatikiza mapuloteni am'madzi a plasma, omwe amamanga 98%.
Hafu ya moyo wa mankhwala kuchokera mthupi pafupifupi ola limodzi.
Kuchotsa kwa dongo kukonzekera kumachitika makamaka ndi ndowe. Mwanjira imeneyi, pafupifupi 90% ya ma metabolites omwe amapangidwa nthawi ya metabolism amachotsedwa. Kuphatikiza apo, kuchotsedwa kwa mankhwalawa kumachitika pang'ono kudzera mu mkodzo wamkati.
Zoyipa zamtunduwu wa mankhwalawa ndizofunikira zamitundu yambiri tsiku lonse komanso mtengo wokwera wa mankhwalawa.
Kugwiritsa ntchito mankhwala a Starlix
Starlix ndi mankhwala omwe amatengedwa musanadye chakudya panthawi ya mankhwala a matenda a shuga 2. The pakati pakati kumwa mankhwala ndi chakudya sayenera upambana 0.5 maola.
Pogwiritsa ntchito mankhwalawa monotherapy, mlingo umodzi wa 120 mg umalimbikitsidwa. Mankhwala ayenera kumwedwa katatu patsiku. Mankhwala ayenera kumwedwa musanadye kadzutsa, nkhomaliro komanso chakudya chamadzulo.
Ngati mankhwalawa amathandizira kuti mankhwalawa asalole kuti mupeze zomwe mungafune, muyezo umodzi utha kuwonjezeka mpaka 180 mg.
Kusintha kwa mankhwalawa kwa mankhwalawa kumachitika pafupipafupi malinga ndi zotsatira za kafukufuku wa zasayansi wa Zizindikiro za HbA1c ndi zizindikiro za glycemia ola limodzi kapena awiri mutatha kudya.
Starlix ikhoza, ngati pakufunika, igwiritsidwe ntchito ngati mankhwala othandizira odwala matenda a shuga 2. Mankhwalawa amatha kugwiritsidwa ntchito molumikizana ndi metformin.
Mukamagwiritsa ntchito Starlix molumikizana ndi Metformin, mlingo umodzi womwe umagwiritsidwa ntchito uyenera kukhala wa 120 mg katatu patsiku. Mankhwala pa zovuta mankhwala kumwa pamaso chakudya.
Zikachitika kuti nthawi yonse ya mankhwalawa itakwana, kuchuluka kwa HbA1c kumayandikira chidziwitso chotsimikizika mwakuthupi, mankhwala a Starlix atha kuchepetsedwa mpaka kufika pa 60 mg katatu patsiku mwakufuna kwa dokotala.
Kugwiritsa ntchito mankhwala Novonorm
Mankhwala a Novonorm ndi mankhwala, omwe amaphatikizanso repaglinide mu mlingo wa 0,5, 1 kapena 2 mg monga chinthu chachikulu chogwiritsa ntchito.
Mlingo woyambirira wa mankhwala a shuga ayenera kukhala 0,5 mg pazomwe zimagwira.
Kukula kwa Mlingo kumaloledwa masiku osakwana 7 mpaka 14 atayamba kugwiritsa ntchito mankhwala.
Ngati kulephera kwa chiwindi kwa wodwala matenda a shuga kwapezeka, HbA1c imayang'aniridwa pafupipafupi kuposa masabata awiri.
Mankhwala amaloledwa kugwiritsidwa ntchito pazotsatira zazikuluzikulu:
- Mlingo umodzi wa mankhwalawa uyenera kukhala 4 mg yogwira mankhwala.
- Mlingo wa tsiku lililonse wa mankhwalawa sayenera kupitilira 16 mg.
Nthawi yoyenera kumwa mankhwalawa ndi mphindi 15 musanadye, koma ndikothekanso kumwa mankhwalawa kwa mphindi 30 musanadye chakudya kapena musanayambe.
Ngati chakudya chidadulidwa ndi odwala, ndiye mankhwalawo sayenera kumwedwa.
Pakukhazikitsa chakudya chowonjezera, mankhwalawa amayeneranso kugwiritsidwa ntchito.
Kusiyanitsa kwakukulu pakati pa Starlix ndi Novonorm ndikuti chomaliza chimatha kuchepetsa kwambiri kuchuluka kwa shuga osati mutatha kudya, komanso pakati pa zakudya. Izi ndichifukwa cha kuthekera kwa gawo lomwe limagwira nawo gawo la SUR receptor ndikupanga mgwirizano wolimba ndi izo.
Tizindikire kuti Starlix sakonda kubweretsa mawonekedwe a dziko la hypoglycemic poyerekeza ndi Novonorm.
Zotsatira zoyipa ndi kusamala
Pambuyo pakamwa, makonzedwe a gulu la glinid amalimbikitsa njira zoyambira zotulutsira insulin m'matumbo a beta a pancreatic minofu yokhudza zochitika za mtundu uwu wa mankhwala. Kugwiritsa ntchito mankhwalawa kuphwanya malangizo ogwiritsira ntchito kapena malingaliro omwe amachokera kwa endocrinologist amatha kupangitsa mtundu wachiwiri wa matenda a shuga, omwe ndi matenda a insulin-Independent endocrine omwe ali ndi matenda a hypoglycemia.
Kusintha koteroko mthupi kumafunika kugwiritsa ntchito mankhwala musanadye.
Kutengera malamulo onse ndi malingaliro omwe mukamagwiritsa ntchito mankhwala amtundu wa dongo, sizimayambitsa dziko la hypoglycemic.
Mankhwalawa ndi othandiza kwambiri ngati agwiritsidwa ntchito koyambirira kwa matenda ashuga a 2. Magawo oyamba amakula matendawa amasiyanitsidwa ndikuti nthawi imeneyi magwiridwe antchito a maselo a pancreatic, omwe amachititsa kuti insulini isungidwe, amasungidwa.
Kuthekera kotenga gawo la hypoglycemic mthupi la wodwala wokhala ndi matenda amtundu wa 2 pafupifupi kuli kofanana ndi pafupipafupi kwa hypoglycemia ndikugwiritsa ntchito mankhwala a sulfonylurea omwe amakhala nawo kwakanthawi kochepa.
Pogwiritsa ntchito kukonzekera kwa dongo, chisamaliro chapadera chimayenera kuthandizidwa ngati wodwala walephera chiwindi. Izi ndichifukwa choti metabolism yayikulu ya mankhwala imachitika m'maselo a chiwindi. Mankhwala onse omwe ali mgululi amalumikizana ndi cytochrome P-350, omwe amatanthauza magawo a dongosolo la chiwindi.
Chenjezo liyenera kuchitika mukamagwiritsa ntchito mankhwala osokoneza bongo omwe ndi osatheka kuwongolera bwino glycemia m'thupi. Zochitika zoterezi zimatha kukhala kukulitsa kwa matenda mthupi, zoopsa, pakhungu. Izi zikachitika, mankhwala ayenera kusiyidwa ndikuyamba kugwiritsa ntchito mankhwala a insulin.
Zambiri zokhudzana ndi mankhwalawa omwe amagwiritsidwa ntchito pochiza matenda a shuga zafotokozedwa muvidiyoyi.
