Ndemanga ya zotumphukira za sulfonylurea

Popanda insulin yokwanira, amapitilira kuwonjezeka kwake. Zothandiza kuchokera ku sulfonylureas ndi amodzi mwa mankhwala omwe amachulukitsa chinsinsi cha timadzi tating'onoting'ono komanso timagulu tomwe timapangidwa mankhwala opangira hypoglycemic.

Amadziwika ndi kutchulidwa kochulukirapo poyerekeza ndi ena oyika matebulo okhala ndi zotsatira zofananira.

Mwachidule ndi mankhwala a gululi

Sulfonylurea derivatives (PSM) ndi gulu la mankhwala omwe amapangidwa pofuna kuchiza matenda ashuga. Kuphatikiza pa hypoglycemic, ali ndi vuto la hypocholesterolemic.

Gulu la mankhwala kuyambira kukhazikitsidwa:

1. M'badwo woyamba yoyimiriridwa ndi chlorpropamide, Tolbutamide. Masiku ano sizigwiritsidwa ntchito. Amadziwika ndi kufupikirako, kuti akwaniritse zomwe adalembedwera zochuluka.
2. Mbadwo wachiwiri ndi Glibenclamide, Glipizide, Gliclazide, Glimepiride. Ali ndi mawonekedwe owonetsa zochepa za zoyipa, amapatsidwa mankhwala ochepa.

Mothandizidwa ndi gulu la mankhwala, kubwezera kwabwino shuga sikungachitike. Izi zimakuthandizani kuti muchepetse komanso muchepetse kukula kwa zovuta.

Phwando la PSM limapereka:

• kuchepa kwa shuga wama chiwindi;
• kukondoweza kwa anc-cell kusinthitsa kukhudzidwa kwa shuga;
• kuchuluka kwa chidwi cha minofu kumadzi;
• Kuletsa kubisala kwa somatostatin, komwe kumachepetsa insulin.

Mndandanda wa kukonzekera kwa PSM: Glibamide, Maninil, Glibenclamide, Teva, Amaril, Glisitol, Glemaz, Glisitol, Tolinase, Glibetik, Gliclada, Meglimid, Glidiab, Diabeteson, Diazid, Reklid, Oziklid. Glibenez, Minidab, Movogleck.

Njira yamachitidwe

Gawo lalikulu limakhudza zolandila zenizeni ndikuziletsa. Pali kukhumudwa kwa ma membala a β-cell, ndipo chifukwa chake, kutsegulidwa kwa njira za calcium. Pambuyo pa izi, Ca ions amalowa m'maselo a beta.

Zotsatira zake ndi kutulutsidwa kwa timadzi tam'mimba tomwe timatulutsa ndikuchokera m'magazi. Zotsatira za PSM sizimayima paliponse pama glucose. Pachifukwa ichi, vuto la hypoglycemic limachitika nthawi zambiri.

Mankhwala amatengeka m'matumbo am'mimba, mphamvu zawo zimayamba maola awiri atatha kutsata. Wopangidwira m'chiwindi, kuchotsera kupatula Glycvidon kudzera impso.

Hafu ya moyo ndi nthawi ya zochita za aliyense pagululi ndizosiyana. Kumangiriza kwa mapuloteni a plasma - kuchokera ku 94 mpaka 99%. Njira yochotsera, kutengera mankhwalawo, ndi aimpso, aimpso, ndi kwa chiwindi. Mafuta a yogwira mankhwala amachepetsa limodzi ndi chakudya.

Zisonyezero zakudikirira

Zomwe zimachokera ku sulfonylureas zimalembedwa mtundu wa matenda ashuga a 2 m'mikhalidwe yotere:

• kupanga insulin yokwanira;
• ndi kuchepa kwa chidwi cha mahomoni a minofu;
• ndi kusachita bwino kwa mankhwala othandizira.

Contraindication ndi zoyipa

Contraindication sulfonylurea zotumphukira zimaphatikizapo:

• Mtundu woyamba wa shuga;
• kukanika kwa chiwindi;
• mimba
• kuyamwitsa;
• kukanika kwa impso;
• ketoacidosis;
• othandizira opaleshoni;
• Hypersensitivity kuti sulfonamides ndi othandiza mbali;
• tsankho ku PSM;
• kuchepa magazi
• pachimake matenda njira;
• wazaka 18.

Mankhwala samapangidwira kuchuluka kwa shuga osala kuposa 14 mmol / L. Komanso, musagwiritse ntchito insulin tsiku lililonse pamagulu opitilira 40. Osavomerezeka kwa odwala omwe ali ndi matenda ashuga 2 kwambiri pakakhala kuchepa kwa β-cell.

Molekyulu ya Biguanide

Glycvidone imatha kuperekedwa kwa anthu omwe ali ndi vuto la impso. Kuchotsa kwake kumachitika (pafupifupi 95%) kudzera m'matumbo. Kugwiritsa ntchito PSM kumatha kupanga kukana. Kuti muchepetse zochitika zoterezi, zimatha kuphatikizidwa ndi insulin ndi biguanides.

Gulu la mankhwala nthawi zambiri limaloledwa. Mwa zina zoyipa, hypoglycemia imachitika pafupipafupi, hypoglycemia imawonedwa pokhapokha mwa 5%. Komanso, munthawi ya mankhwala, kuwonda kumawonedwa. Izi zimachitika chifukwa cha kubisika kwa insulin.

Zotsatira zotsatirazi ndizochepa:

• mavuto a dyspeptic;
• kulawa kwazitsulo mkamwa;
• hyponatremia;
• hemolytic anemia;
• aimpso kuwonongeka;
• thupi lawo siligwirizana;
• kuphwanya chiwindi;
• leukopenia ndi thrombocytopenia;
• cholestatic jaundice.

Mlingo ndi makonzedwe

Mlingo wa PSM ndi wodwala. Amatsimikiza kuganizira kuwunika kwa boma la kagayidwe.

Ndikofunika kuti ndiyambe kugwiritsa ntchito mankhwala ndi PSM okhala ndi ofooka, ndipo pakalibe kutero, sinthani ku mankhwala amphamvu. Glibenclamide ili ndi mphamvu yochepetsera shuga kuposa ena am'kamwa otulutsa magazi.

Kumwa mankhwala omwe mwalandira kuchokera pagululi kumayamba ndi Mlingo wochepa. Kupitilira milungu iwiri, imayamba kuwonjezeka. PSM itha kutumikiridwa ndi insulin ndi ena oikidwa ndi hypoglycemic othandizira.

Mlingo muzochitika zotere umachepetsedwa, ndikusankhidwa kwambiri. Pakaperekedwe chipukuta mokhazikika, kubwerera ku njira yanthawi zonse yochizira kumachitika. Ngati insulin ikuchepera 10 mayunitsi / tsiku, dokotala amasintha wodwala kuti atenge mankhwala a sulfonylurea.

Type 2 shuga

Mlingo wa mankhwala enaake akuwonetsedwa mu malangizo omwe angagwiritsidwe ntchito. M'badwo ndi mawonekedwe a mankhwalawo pawokha (mankhwala othandizira) amawaganizira. Mlingo watsiku ndi tsiku wa chlorpropamide (m'badwo woyamba) - 0,75 g, Tolbutamide - 2 g (m'badwo wa 2), Glycvidona (m'badwo wa 2) - mpaka 0.12 g, Glibenclamide (m'badwo wa 2) - 0,02 g. Mlingo woyambirira umachepetsedwa.

Ndalama zonse za gulu la PSM zimatengedwa theka la ola kapena ola limodzi asanadye. Izi zimathandiza kuyamwa bwino kwa mankhwalawa, chifukwa chake, kutsika kwa postprandial glycemia. Ngati pali zovuta zakumwa za dyspeptic, PSM imatengedwa mukatha kudya.

Njira zopewera kupewa ngozi

Kwa anthu okalamba, chiopsezo chokhala ndi hypoglycemia ndichokwera kwambiri. Kwa gulu ili la odwala, mankhwala omwe ali ndi nthawi yochepa kwambiri amayikidwa kuti athetse mavuto osafunikira.

Ndikulimbikitsidwa kuti musiyane ndi mankhwala omwe akhala akuchita kwa nthawi yayitali (Glibenclamide) ndikusintha kukhala osankha pang'ono (Glycvidone, Glyclazide).

Kutenga mankhwala a sulfonylurea kumayambitsa chiopsezo cha hypoglycemia. Pa chithandizo, ndikofunikira kuyang'anira kuchuluka kwa shuga. Ndikulimbikitsidwa kuti mutsatire dongosolo la mankhwala lomwe dokotala wakhazikitsa.

Ndi kupatuka kwake, kuchuluka kwa glucose kumasintha. Pankhani ya chitukuko cha matenda ena panthawi ya chithandizo cha PSM, ndikofunikira kudziwitsa dokotala.

Munthawi ya chithandizo, zizindikiro zotsatirazi zimayang'aniridwa:

• msuzi wa mkodzo;
• glycosylated hemoglobin;
• shuga
• mulingo wa lipid;
• kuyesa kwa chiwindi.

Sikulimbikitsidwa kuti musinthe mlingo, musinthane ndi mankhwala ena, siyani chithandizo popanda kufunsa. Ndikofunikira kugwiritsa ntchito mankhwala panthawi yoyenera.

Kuonjezera mlingo womwe umayikidwa kungayambitse hypoglycemia. Kuti athetse, wodwalayo amatenga 25 g shuga. Zofanana ndi izi zofanana ndi zomwe zimachitika kuti kuchuluka kwa mankhwalawa kumawonekera kwa dokotala.

Mu hypoglycemia yayikulu, yomwe imayendera limodzi ndi kusazindikira, ndikofunikira kupita kuchipatala.

Glucose imayendetsedwa kudzera m'mitsempha. Mungafunike majekeseni owonjezera a glucagon mu / m, mu / mu. Pambuyo pa thandizo loyamba, muyenera kuyang'anira momwe zinthu ziliri masiku angapo ndi shuga wambiri.

Kanema pamitundu 2 ya matenda ashuga:

Kuchita kwa PSM ndi mankhwala ena

Mukumwa mankhwala ena, kuyanjana kwawo ndi zotumphukira za sulfonylurea kumawerengedwa. Mahomoni a anabolic, antidepressants, beta-blockers, sulfonamides, clofibrate, mahomoni achimuna, coumarins, mankhwala a tetracycline, miconazole, salicylates, mankhwala ena a hypoglycemic ndi insulin imakulitsa mphamvu ya hypoglycemic.

PSM imachepetsa mphamvu ya corticosteroids, barbiturates, glucagon, laxatives, estrogens ndi gestagen, nicotinic acid, chlorpromazine, phenothiazine, diuretics, mahomoni a chithokomiro, isoniazid, thiazides.