Zizindikiro zogwiritsa ntchito Diuver ndi malangizo atsatanetsatane

Diuver ndi imodzi mwamphamvu kwambiri okodzetsa kwambiri. Mlingo wochepetsetsa wa mankhwalawa (mpaka 5 mg) amachepetsa kuthamanga kwa magazi, pomwe ali ndi kukayikira pang'ono, chifukwa chake amagwiritsidwa ntchito pochiza matenda oopsa. Malinga ndi kafukufuku, Diuver amatha kuchepetsa kuthamanga kwa magazi mu 60% ya odwala. Mankhwalawa akhoza kuphatikizidwa ndi mankhwala a antihypertensive ochokera m'magulu onse. Pa mlingo wa 5-20 mg, Diuver's diuretic athari imakonzedwa kwambiri, chifukwa chake, mlingo waukulu umagwiritsidwa ntchito pothandiza edema, kuphatikizapo kulephera kwa mtima.

Zowonetsa Diuver

Mankhwala ndi a gulu la loop okodzetsa. Malo ochitapo mankhwalawa ndi gawo lakukwera la nephron loop, lomwe limatchedwa kuti loop la Henle pambuyo pa wasayansi yemwe adazipeza. Mu chiuno cha impso, kupatsanso mkodzo m'magazi a potaziyamu ndi sodium kolorayidi kumachitika. Nthawi zambiri, pafupifupi kotala limodzi la sodium kulowa mkodzo woyamba limakomoka. Liop diuretics imalepheretsa kusunthaku, chifukwa cha ntchito yawo, kuchuluka kwa mapangidwe a mkodzo kumawonjezeka, kukodza kumachitika pafupipafupi, kuchuluka kwa madzi amkati amachepetsa, ndipo nthawi yomweyo, kupanikizika kumachepa.

Mu Diover ya mankhwala, chinthu chogwira ntchito ndi torasemide. Mwa zina zodulira mafuta ovomerezeka mu Russian Federation, anali omaliza kulowa nawo machitidwe azachipatala, kuzungulira zaka za zana la 20.

Kuchokera pamapangidwe ochitapo kanthu zikuwonekeratu zomwe Diuver amathandizira:

1. Nthawi zambiri, amawerengedwa edema, kuphatikizira iwo omwe adayamba chifukwa cha kulephera mtima, matenda osakhazikika a impso ndi mapapu. Edema yomwe imapanga nephrotic syndrome imatha kuchepetsedwa kokha ndi loop diuretics.
2. Chizindikiro chachiwiri chogwiritsira ntchito mankhwalawa ndi matenda oopsa. Diuver nthawi zambiri amalimbikitsidwa kwa odwala omwe kukwera kwa kupanikizika kumatha kuyambitsidwa ndi zifukwa zingapo nthawi imodzi: kusokonezeka kwa kayendetsedwe ka kayendedwe ka kukakamiza, vasospasm, chidwi chamthupi chamchere kwambiri.
3. Diuver amagwiritsidwa ntchito ngati pakufunika, okakamiza diuresis, mwachitsanzo, poizoni wa mankhwala osokoneza bongo. Popewa kuchepa kwamadzi, wodwalayo amapaka jekeseni ndi mchere.

Mapiritsi a Diuver ndi kufanana kwawo kwathunthu ndi zina mwa zotupa zamphamvu kwambiri, motero nthawi zambiri zimalembedwa kwa odwala omwe alibe chithandizo chokwanira: okalamba, odwala ndi mtima, matenda a shuga komanso matenda ena a metabolic, kuphatikizapo dyslipidemia. Ngati kupanikizika sikukwera kwambiri kuposa kwazonse, kumatha kuchepetsedwa mosavuta pokonzekera, mwachitsanzo, thiazide-like diuretics kapena ACE inhibitors.

Kodi mankhwalawo amagwira ntchito bwanji?

Maziko ochititsa chidwi a Diuver ndimapangidwe ovuta omwe madokotala amawatcha "katatu":

1. Diuver imalepheretsa kugwiritsanso ntchito sodium, potero kuthandiza kuchepetsa masitolo amadzimadzi m'thupi. Mosiyana ndi ma looptiki ena opaka, mphamvu ya Diuver iyi sikutiyesa yayikulu.
2. Mankhwala amalimbikitsa kuchulukitsidwa kwa calcium kuchokera ku minofu ya makoma amitsempha, chifukwa cha momwe chidwi chawo cha katekisimu amachepa. Mwakutero, izi zimabweretsa kupumula kwa makhoma a mitsempha yamagazi, kutsitsa kuthamanga.
3. Katundu wapadera wa Diuver ndi kuchepa kwa ntchito ya RAAS pressure regulation system, yomwe imalongosoleredwa ndi mgwirizano wa torasemide ku zochitika za angiotensin II receptors. Chifukwa cha izi, kupindika kwa zotengera kumalephereka, kukula kwa zotsatira zomwe zimachitika chifukwa cha matenda oopsa kumachepetsedwa: hypertrophy ya myocardial ndi makoma amitsempha.

Diuver ali ndi bioavailability wokwanira: Zoposa 80% zamafuta zomwe zimagwira zimalowa m'magazi. Komanso, kuchuluka kwa bioavailability kumadalira pang'ono mawonekedwe a chimbudzi cha odwala. Malangizo ogwiritsira ntchito amakulolani kuudya musanadye kapena mutatha kudya, popeza chakudya sichimakhudza mayamwidwe a torasemide. Chifukwa cha izi, zochita za Diuver ndizodziwikiratu. Mapiritsi amatha kumwedwa nthawi yabwino ndipo nthawi yomweyo onetsetsani kuti achita zinthu mwachangu.

Matenda olembetsa magazi komanso kukakamizidwa kukhala zinthu zakale - zaulere

Matenda a mtima komanso mikwingwirima ndizomwe zimayambitsa pafupifupi 70% ya imfa zonse padziko lapansi. Anthu asanu ndi awiri mwa anthu khumi amafa chifukwa chotseka mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chakumapeto kowopsa ndichofanana - kuthamanga kwa magazi chifukwa cha matenda oopsa.

Ndikotheka komanso kofunikira kuti muchepetse kukakamizidwa, osatero ayi. Koma izi sizichiritsa matendawa, koma zimangothandiza kuthana ndi kafukufuku, osati zomwe zimayambitsa matendawa.

• Matenda a kukakamizidwa - 97%
• Kuthetsa kwa mitsempha thrombosis - 80%
• Kuthetsa kwa kugunda kwamtima kwamphamvu - 99%
• Kuchotsa mutu - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku - 97%

Pharmacokinetics aku Torasemide:

Kutulutsa mawonekedwe ndi mlingo

Diuver amapangidwa ndi kampani yopanga mankhwala ku Croatia Pliva Hrvatsk, yomwe ndi imodzi mwa magawo a Teva. Ku Russia, mankhwalawa ndi otchuka kwambiri. Malinga ndi kafukufuku wotsatsa malonda mu 2013, pakafunika kukhazikitsa torasemide, 90% ya amtima wokonda mtima amakonda Duver.

Mapiritsi alibe makola amakanema, kapangidwe kake ndi:

• torasemide;
• lactose;
• wowuma;
• sodium wowuma glycolate;
• silika;
• magnesium wakuba.

Mankhwalawa ali ndi Mlingo 2 wokha - 5 ndi 10 mg, koma mapiritsiwa ali ndi notch, yomwe imawalola kuti agawidwe pakati. Zosunga ma paketi ndi Mtengo Wotsatsira:

Kwa matenda oopsa, malangizowa akutsimikizira kuti ayambe kulandira mankhwala a 2 mg mg tsiku lililonse. Pankhaniyi, kupanikizika kumachepa pang'onopang'ono popanda okodzetsa mwamphamvu. Diuver amatchulidwa kwa nthawi yayitali. Zotsatira zoyambirira zitha kuyembekezeredwa kale sabata yoyamba ya chithandizo, zotsatira zoyambira zimayamba pambuyo pa miyezi itatu yoyendetsa. Kutsitsa kwapakati pakumatenga Diuver ndi 17/12 (kutsika kumatsika ndi 17, kutsika ndi 12 mmHg), kwa odwala oopsa omwe amakhala ndi chidwi chambiri cha okodzetsa - mpaka 27/2. Ndiwosakwanira, mulingo ungathe kuwirikiza, koma mphamvu ya hypotensive imachulukitsa pang'ono, ndipo mkodzo wothira ukhoza kutseguka. Poyerekeza ndi ndemanga za madotolo, ndichinthu chanzeru kugwiritsa ntchito mankhwala ophatikiza: Muli muyezo wochepetsetsa komanso mankhwala ena kuti akakamizike.

Ndi edema, chithandizo chimayamba ndi 5 mg, mlingo ungathe kukwezedwa pang'onopang'ono mpaka 20 mg. Ndi edema yayikulu, chomwe chimayambitsa kukhala nephrotic syndrome, adokotala amatha kuwonjezera mlingo mpaka 40, ndipo nthawi zina mpaka 200 mg. Pa mlingo wa 5-20 mg, mankhwalawa amatha kutumikiridwa kwa nthawi yayitali, pamlingo wapamwamba - mpaka edema itatha.

Momwe angatenge

Malangizowa amapereka mtundu umodzi wokha wa Diuver, ngakhale atamwa mankhwala. Malinga ndi ndemanga, madokotala amatha kukupatsirani mankhwalawa kawiri pa tsiku ngati mlingo wake uli wokwera kapena zovuta zake sizikwanira tsiku lonse. Ngati ndi kotheka, piritsi limatha kugawidwa pakati ndikuphwanyidwa.

Nthawi yabwino kudya Diuver imakhala m'mawa mutatha kadzutsa. Pankhaniyi, piritsi limodzi lidzakhala lokwanira kuchepa koyerekeza kwa tsiku limodzi, ndipo kusinthasintha kwachilengedwe kumakhalabe: lidzakhala lokwera m'mawa, pomwe piritsi silinayambe kugwira ntchito mwamphamvu, komanso madzulo, pomwe mphamvu yotsekemera ya mankhwalawa itatha.

Ngati mankhwalawo akuphatikizidwa ndi kukodza pafupipafupi ndipo samakulolani kuti mukhale ndi moyo wokhazikika, phwando likhoza kusunthidwa mpaka madzulo. Pogwiritsa ntchito Diuver yamadzulo, ndikofunikira kuthana ndi kuthinitsidwa kwa m'mawa, chifukwa itha kukhala yopyola muyeso wamba.

Malangizo kwa odwala omwe amatenga mapiritsi a Diuver:

Diuver ikhoza kulepheretsa chidwi cha anthu, motero, ikamatengedwa, kuyendetsa galimoto ndi ntchito yofunika kwambiri osafunikira.

Zotsatira zoyipa

Zotsatira zoyipa zambiri za Diuver ndizokhudzana ndi kugunda kwake. Popeza kuti kutulutsa mkodzo mwachindunji kumatengera mlingo wa mankhwalawa, kusakhudzidwa kosayenera kumawonekera nthawi zambiri mukamamwa kwambiri.

Zotsatira zoyipa:

• Hyponatremia. Ngati mumanyalanyaza malangizo a momwe mungagwiritsire ntchito, kuchepa kwa sodium, kuchepa kwamadzi mu thupi ndikotheka. Vutoli ladzala ndi hypotension mpaka kugwedezeka, kuchepa kwa mkodzo, kutsekeka kwamitsempha yamagazi ndimagazi, komanso matenda a chiwindi - ndi encephalopathy. Nthawi yomweyo, kuchuluka kwa potaziyamu ndi hydrogen kumawonjezeka, hypochloremic alkalosis ikhoza kukulira - kuwonjezeka kwa magazi pH;
• Hypokalemia imachitika ndikamadya osakwanira a potaziyamu. Zimayambitsa kupweteka, makamaka kwa odwala oopsa omwe amalembedwa mtima mtima glycosides;
• Matenda a Magnesium amadzaza ndi arrhythmias, calcium - minofu kukokana;
• Zotsatira zoyipa za kumva. Pakhoza kukhala phokoso kapena kutonthola m'makutu, kuwonongeka kwa makutu, kuphatikiza chizungulire champhamvu. Kukula kwa zotsatirazi kumakhala kwabwino kwambiri ndi kasungidwe ka torasemide, komanso mukamamwa pamodzi ndi ethacosterone acid (Diuver group analog). Monga lamulo, atachotsa mapiritsi a Diuver, kumva kumabwezeretseka pakokha;
• Matenda a metabolism. Malangizowo akuwonetsa kuti kuchuluka kwa uric acid m'magazi, kukula kwa gout, kapena kufalikira pakukula kwa matenda omwe alipo;
• Hyperglycemia, yomwe ingayambitse matenda ashuga ngati wodwalayo ali ndi vuto lakelo;
• Kuchuluka kwa cholesterol;
• Thupi lawo siligwirizana;
• Matenda am'mimba;
• Photosensitivity - kukulitsa chidwi cha khungu mpaka dzuwa.

Kukula kwa zotsatira zoyipa m'malangizo ogwiritsira ntchito sikuwonetsedwa, komabe, ndikudziwika kuti mwa amayi ndi apamwamba.

Contraindication

M'magulu angapo a odwala matenda oopsa, malangizo ogwiritsira ntchito Diuver amaletsa kayendetsedwe kake. Milandu yambiri imakhudzana ndi kuperewera kwa sodium ndi madzi am'mimba chifukwa chokhudza mapindikidwe a mapiritsi.

Mapiritsi a Diuver sagwirizana bwino ndi mowa. Ethanol ndi okodzetsa, chifukwa chake, pakudya zochuluka pamodzi ndi torasemide, wodwalayo amatha kutaya madzi m'thupi kwambiri, omwe amayamba chifukwa cha kusazindikira, kugwedezeka kolimba, komanso kugwa. Contraindication imaphatikizapo kumwa pafupipafupi mowa waukulu, chifukwa wodwalayo amatha kukumana ndi zovuta, makamaka kusalinganika kwa electrolyte.

Analogs ndi choloweza

Ufulu wa mankhwala oyamba omwe ali ndi yogwira mankhwala torasemide ndi wa kampani yaku America Roche, imatchedwa Demadex. Palibe ku Europe kapena ku Russia Demadex sanalembetsedwe. Diuver ndi ma fanizo ake okhala ndi torasemide ndi ma Demadex a zamagetsi.

Mwa fanizo la Diuver ku Russia, mankhwala awa adalembetsedwa:

Ngati mutayika mapiritsi awa potchuka, Diuver adzayenera kupereka malo oyamba, kutsatiridwa ndi Britomar, Torasemid kuchokera ku North Star, Trigrim ndi Lotonel pamalire ambiri.

Mwa analogues, malo apadera amakhala ndi Trigrim ndi Torasemide a kampani ya Ozone. Mankhwalawa ndi okhawo omwe ali ndi Mlingo wa 2,5 mg, chifukwa chake amatengedwa mosavuta ndi matenda oopsa, ophatikizidwa ndi mankhwala ena a antihypertensive.

Britomar amayima padera. Amasiyana mosiyanasiyana ndi mankhwala ena mumtundu wa kumasulidwa. Mapiritsi a Britomar amakhala ndi mphamvu yayitali. Malinga ndi odwala, zimakhudza kwambiri mapangidwe a mkodzo, chifukwa chake ndizosavuta kulekerera. Malinga ndi kafukufuku, mphamvu ya kukodzetsa kwa mankhwalawa yachedwa, mapangidwe a mkodzo apamwamba kwambiri amapezeka pakatha maola 6 atatha kuyamwa, kufunsa kwamkodzo kumakhala kofooka, koma kuchuluka kwa mkodzo wa tsiku ndi tsiku ndi chimodzimodzi ndi kwa Diuver. Amakhulupirira kuti torasemide yotalikilapo imakhala yovuta kuyambitsa hypoglycemia ndipo imakhala yotetezeka ku impso. Komabe, pali umboni kuti zotetezera za torsemide wamba pamtima ndizolimba kuposa nthawi yayitali.

Yerekezerani ndi mankhwala ofanana

Omwe ali pafupi kwambiri ndi Diuver malinga ndi momwe angachitire ndi loop diuretics furosemide (choyambirira ndi Lasix, generics Furosemide) ndi ethacosterone acid (1 mankhwala amalembetsedwa ku Russian Federation - Uregit).

Kusiyanitsa kofunikira kwa mankhwalawa:

1. Bioavailability wa torasemide ndiwokwera kwambiri kuposa furosemide. Kuphatikiza apo, zotsatira za torasemide mwa odwala osiyanasiyana ndizofanana, ndipo zotsatira za furosemide nthawi zambiri zimatengera umunthu payekha ndipo zimasiyana kwambiri.
2. Kuchita kwa furosemide ndi ethaconic acid kumathamanga, koma kufupikitsa, chifukwa chake amafunika kutengedwa katatu patsiku.
3. Furosemide sangathe kulowa m'malo mwa Diuver pakanthawi kochepa kochotsa matenda oopsa, koma amathana mwachangu ndi zovuta zamankhwala oopsa. Ndi kumwa kamodzi, imayamba kugwira ntchito pambuyo pa theka la ola, ndi makina othandizira - pambuyo pa mphindi 10.
4. Ngakhale a Lasix kapena Uregit omwe ali ndi zotsatira zapatatu mu Diuver. Kuchepetsa kupanikizika ndi thandizo lawo kumatheka pokhapokha kuchotsa madziwo.
5. Diuver sakonda kuyambitsa zovuta kuposa Lasix (pafupipafupi, ndi 0.3 ndi 4.2%).
6. Ma diuretics olimba komanso othamanga amakhala ndi mphamvu yopitikitsanso - kuchotsa madzi mwachangu, kenako kudzikundikira kwake. Mukamagwiritsa ntchito Diuver, izi zimakhalapo.
7. Ndikosayenera kusintha Diuver ndi analogi yamagulu pakadwala matenda a mtima, chifukwa amaloledwa ndi odwala oterowo. Pafupipafupi kogonekedwa mobwerezabwereza chifukwa cha kulephera kwa mtima mwa iwo omwe akutenga torasemide ndi 17%, mwa omwe amamwa furosemide - 32%.

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