Biguanides ndi mankhwala omwe amapangidwa kuti achepetse magazi. Chidachi chimapezeka ngati mapiritsi.
Amagwiritsidwa ntchito, nthawi zambiri, ndi mtundu 2 shuga mellitus, monga othandizira.
Monga gawo la monotherapy, mankhwala a hypoglycemic amalembedwa kawirikawiri. Nthawi zambiri izi zimachitika mu 5-10% ya milandu.
Biguanides akuphatikiza ndi mankhwala otsatirawa:
- Bagomet,
- Avandamet
- Metfogamma,
- Chikwanje,
- Metformin Acre
- Siofor 500.
Pakadali pano, ku Russia, komanso padziko lonse lapansi, a Biguanides amagwiritsidwa ntchito, makamaka, methylbiguanide zotumphukira, ndiye metformin:
- glucophage
- Siofor
- metpho-gamma,
- dianormet
- glyformin ndi ena.
Metformin imasokoneza kuchokera ola limodzi ndi theka mpaka maola atatu. Mankhwalawa amapangidwa m'mapiritsi a 850 ndi 500 mg.
Mankhwala othandizira ndi 1-2 ga patsiku.
Mutha kudya mpaka 3 g patsiku la matenda ashuga.
Mabukhu a Butylbiguanide:
- silubin
- buformin
- Adebite.
Chonde dziwani kuti biguanides imagwiritsidwa ntchito pang'ono, chifukwa cha zovuta zoyipa, zomwe ndi gastric dyspepsia.
Tsopano madokotala salimbikitsa kugwiritsa ntchito zinthu zina za phenylbiguanide, chifukwa zimatsimikiziridwa kuti zimayambitsa kuchuluka kwa magazi a munthu:
- pyruvate
- lactate
Zochita zamankhwala
Asayansi atsimikizira kuti kuchepa kwa shuga kwa metformin mu shuga kumayenderana ndi zotsatira zake za mankhwalawa pa dziwe komanso kaphatikizidwe. Mphamvu yotsitsa shuga ya metformin imalumikizidwa ndi anthu onyamula shuga mu cell.
Kuchuluka kwa anthu onyamula glucose kumawonjezeka chifukwa cha kukhudzana ndi ma biguanides. Izi zimawonetsedwa pakupitilira kwa glucose komwe kudutsa membrane wa khungu.
Izi zimathandizira kudziwa zomwe zimachitika chifukwa cha insulin komanso insulin yomwe imachokera kunja. Mankhwalawa amathandizanso pamatumbo a mitochondrial.
Biguanides akuletsa gluconeogenesis, potero amathandiza pakuwonjezeka pazomwe zili:
- lactate
- chimbudzi,
- Alanine
Zinthu izi ndizatsogola zam'magazi mu gawo la gluconeogeneis.
Kuchuluka kwa anthu onyamula glucose kumawonjezeka mothandizidwa ndi metformin m'matumbo a plasma. Zokhudza:
- GLUT-4,
- GLUT-2,
- GLUT-1.
Kuyendetsa glucose kumathandizira:
- minofu yosalala
- endothelium
- minofu ya mtima.
Izi zikufotokozera kuchepa kwa kukana kwa insulini mwa anthu omwe ali ndi mtundu wa matenda a shuga 2 mellitus motsogozedwa ndi metformin. Kuwonjezeka kwa chidwi cha insulin sikumayendetsedwa ndi kuwonjezeka kwa chinsinsi chake ndi kapamba.
Potengera maziko a kuchepa kwa insulin, kuchuluka kwake komwe kumawonetsa insulin m'magazi kumatsikanso. Kuwonjezeka kwa chidwi cha insulin sikumayendetsedwa ndi kuwonjezeka kwa chinsinsi chake ndi kapamba, monga momwe mukugwiritsira ntchito sulfonylureas.
Pochiza ndi metformin mwa anthu, kuwonda kumawonedwa, koma pochiza ndi othandizira a sulfonylurea ndi insulin, zotsatirapo zake zingakhale. Kuphatikiza apo, metformin imathandizira kuchepetsa ma seramu lipids.
Zotsatira zoyipa
Zotsatira zoyipa zakugwiritsa ntchito metformin ziyenera kudziwika, limagwirira ndi motere:
- matenda am'mimba, nseru, kusanza;
- kulawa kwazitsulo mkamwa;
- kusapeza bwino pamimba;
- kuchepa ndi kusowa kwa chilakiko, mpaka chakudya chakudya;
- lactic acidosis.
Zotsatira zoyipa ndi zochita, monga lamulo, zimachoka mwachangu ndi kuchepa kwa mulingo. Kuwopsa kwa matenda otsegula m'mimba ndikuwonetsa kuti musiye kumwa metformin.
Ngati mutenga Metformin 200-3000 mg patsiku kwa nthawi yayitali, ndiye kuti muyenera kukumbukira kuti mayamwidwe am'mimba amachepa:
- Mavitamini B,
- folic acid.
Ndikofunikira kuthetsa vuto lililonse ili ndi mavitamini owonjezera.
Ndikofunikira kuti magazi azisungunuka, ndikuwonetsetsa kawiri pachaka. Izi ndizofunikira chifukwa kupatsidwa mphamvu ya metformin kuti imalimbikitse anaerobic glycolysis m'matumbo ang'onoang'ono ndikuletsa glycogenolysis m'chiwindi.
Ngati munthu ali ndi zodandaula za kupweteka kwa minofu ndi kakomedwe kachitsulo mkamwa, ndikofunikira kuti muphunzire kuchuluka kwa lactate. Ngati magazi ake ndiwonjezereka, ndiye kuti zochizira ndi metformin ziyenera kuyimitsidwa.
Ngati sizotheka kuphunzira kuchuluka kwa lactate m'magazi, ndiye kuti metformin imathetsedwa mpaka mawonekedwewo atakhazikika, ndiye kuti mwayi wonse woyendetsedwa ndi iye umawunikiridwa.
Kuphwanya kwakukulu
Pali zotsutsana mwanjira yogwiritsira ntchito metformin:
- matenda ashuga ketoacidosis, komanso chikomokere ndi zina zikhalidwe za anthu odwala matenda ashuga;
- kuwonongeka kwaimpso, kuwonjezeka kwa creatinine m'magazi oposa 1.5 mmol / l;
- Hypoxic zikhalidwe za genesis iliyonse (angina pectoris, kufalikira kwazigawo, 4 FC, angina pectoris, infarction ya myocardial);
- kulephera kupuma;
- kwambiri discirculatory encephalopathy,
- mikwingwirima
- kuchepa magazi
- matenda opatsirana pachimake, matenda opatsirana;
- mowa
- kulephera kwa chiwindi;
- mimba
- zikuwonetsa mbiri ya lactic acidosis.
Mukakulitsa chiwindi, biguanides amalembedwa pamene hepatomegaly imadziwika chifukwa cha matenda ashuga hepatostatosis.
Ndi matenda obwera chifukwa cha kukomoka kwa chiwindi, komanso zovuta za chiwopsezo cha hepatic parenchyma zitha kulembedwa, zomwe zafotokozedwa motere:
- kuwoneka kwa cholestasis, nthawi zina mpaka jaundice wowoneka,
- kusintha kwa magwiridwe antchito a chiwindi.
Mukupweteka kwambiri kwa chiwindi, mankhwala ayenera kugwiritsidwa ntchito mosamala.
Mosiyana ndi zotumphukira za sulfonylurea, ma biguanides sakhala ndi chiwopsezo mwachindunji pa hematopoietic ntchito ya mafuta a m'mafupa ndi impso. Komabe, amatsutsana mu:
- matenda a impso omwe amathandizira kuchepa kwa kusefera kwa glomerular
- posungira nitrogenous slag
- kuchepa magazi kwambiri, chifukwa choopsa cha lactacidemia.
Okalamba odwala amafunika kupereka mankhwala mosamala, chifukwa izi zimagwirizanitsidwa ndi kuopseza kwa lactic acidosis. Izi zimagwira ntchito kwa odwala omwe amagwira ntchito zolimbitsa thupi kwambiri.
Pali mankhwala osokoneza bongo, omwe ntchito pa mankhwalawa amagwiritsa ntchito mankhwala a lactic acidosis, awa ndi awa:
- fructose
- teturam
- antihistamines
- salicylates,
- barbiturates.
