Lunaldin shine mataki na uku na "tsaka-tsakin raunin azaba" na WHO. Waɗannan su ne mafi girman ikon narkewa masu narkewa waɗanda aka yi amfani da su don rage zafin ciwo.
Sunan kasa da kasa mai zaman kansa
Fentanyl.
Lunaldin shine mataki na uku na "tsaka-tsakin raunin azaba" na WHO.
ATX
Lambar ATX - N02AB03 - Fentanil.
Saki siffofin da abun da ke ciki
Akwai shi a cikin nau'ikan yar yar yare (don rushewa a ƙarƙashin harshe) alluna daban-daban (mcg) da tsari:
- 100 - zagaye;
- 200 - tsallake;
- 300 - triangular;
- 400 - rhombic;
- 600 - semicircular (D-dimbin yawa);
- 800 - kwanson ruwa.
Tabletaya daga cikin kwamfutar hannu ya ƙunshi abu mai aiki - fentanyl citron micronized da abubuwan taimako.
Lunaldin
Magungunan yana cikin rukunin oplogid analgesics. Abubuwan da ke toshe masu karɓa na µ-opioid, waɗanda ke haifar da supraspinal (µ1 - nunawa ga tsarin gudanar da kwakwalwa) da kashin baya (µ2-tasiri akan jijiyoyin ƙwayar jijiya) analgesia (rage raɗaɗin jin zafi tare da taimakon magunguna).
Abun ya shiga tsakani tare da kirar adenylate cyclase (AC) da adoposin monophosphate na cyclic (cAMP), waɗanda ke aika da sigina a tsakanin jijiyoyin jijiyoyin jijiya. Fentanyl yana shafar polarization na membranes, aikin tashoshin ion, wanda ke haifar da raguwa a cikin sakin matsakanci na jin zafi.
Tunda masu karɓar ra'ayoyi suna cikin gida ba kawai a cikin kwakwalwa da kashin baya ba, har ma da gabobin na gefe, magungunan:
- yana hana aikin cibiyar numfashi;
- yana ƙara sautin jijiyoyin jiki mai santsi na tsarin urinary, haɓakawa ko hana hayar urination;
- yana haifar da spasm na biliary fili;
- yana kara sautin jijiya mai santsi a cikin jijiyar ciki, yana rage motsin hanji;
- dilates tasoshin yanki;
- yana tsokanar ciwon zuciya da bradycardia.
Wannan hanyar ta haifar da amfani da miyagun ƙwayoyi a cikin farfadowa na yanayin cututtukan cuta, tare da raɗaɗi mai zafi da ba za a iya jurewa ba.
Pharmacokinetics
A miyagun ƙwayoyi yana da shelar hydrophobicity, saboda haka yana tunawa da sauri a cikin rami na baka fiye da narkewa kamar jijiyoyin. Daga cikin yankin sublingual, an kwashe shi a cikin minti 30. Bioavailability ne 70%. Matsakaicin taro a cikin jinin fentanyl ya haɗu tare da gabatarwar 100-800 μg na miyagun ƙwayoyi bayan minti 22-24.
Babban adadin fentanyl (80-85%) yana ɗaukar nauyin furotin na plasma, wanda ke haifar da sakamako na ɗan gajeren lokaci. Ofarar da rarraba magungunan a cikin daidaita shine 3-6 l / kg.
Babban biotransformation na fentanyl yana faruwa a ƙarƙashin rinjayar enzymes hepatic. Babban hanyar cirewa daga jiki shine tare da fitsari (85%) da bile (15%).
Matsakaicin rabin rayuwa na wani abu daga jiki shine daga awanni 3 zuwa 12.5.
Alamu don amfanin Lunaldin
Babban nuni ga amfani da Lunaldin shine magani na magani na alamomin raɗaɗi a cikin marasa lafiya na ciwon daji da ke karɓar maganin opioid na yau da kullun.
Babban nuni ga amfani da Lunaldin shine magani na magani na alamomin raɗaɗi a cikin marasa lafiya na ciwon daji da ke karɓar maganin opioid na yau da kullun.
Contraindications
An sanya maganin a cikin:
- yanayi tare da matsanancin ciwon ciki;
- cutar huhu;
- kulawa ta lokaci guda na magani tare da masu hana monoamine oxidase (MAO) ko kuma gudanarwarsa na tsawon ƙasa da makonni 2 bayan ƙarshen maganin;
- shan magungunan gauraye - masu adawa da karɓar rayayyun masu karɓa na opioid;
- shekarun haƙuri har zuwa shekaru 18;
- rashin lafiyan dauki ga abubuwanda aka gyara;
- rashin maganin opioid na farko.
Tare da kulawa
Ana buƙatar ƙarin taka tsantsan yayin rubuta Lunaldin ga marasa lafiya da ke cikin matsanancin bayyanar intracranial na wuce haddi na CO₂ a cikin jini:
- pressureara yawan matsa lamba na intracranial;
- coma;
- hankali mai ruhi;
- neoplasms na kwakwalwa.
Musamman kiyayewa game da amfani da miyagun ƙwayoyi ya kamata a lura da shi a cikin lura da mutanen da ke da raunin kai, alamun bradycardia da tachycardia. A cikin tsofaffi da marasa lafiya marasa lafiya, shan magani na iya haifar da karuwa a cikin rabin rayuwar da kuma kara yawan jin daɗin abubuwan da ke ciki. A cikin wannan rukuni na marasa lafiya, ya zama dole a lura da bayyanar alamun alamun maye kuma daidaita kashi a ƙasa.
A cikin marasa lafiya tare da na koda da hepatic karancin, magani zai iya haifar da karuwa a cikin adadin fentanyl a cikin jini (saboda karuwa a cikin bioavailability da hanawa na kawar). Dole ne a yi amfani da maganin tare da taka tsantsan a cikin marasa lafiya da:
- hypervolemia (karuwa a cikin ƙwayar plasma a cikin jini);
- hauhawar jini
- lalacewa da kumburi da bakin mucosa.
Yin karatun hanyoyin Lunaldin
Sanya marasa lafiya tare da ingantaccen haƙuri game da opioids, shan 60 mg na morphine ta magana ko 25 μg / h na fentanyl. Shan miyagun ƙwayoyi yana farawa da adadin 100 mcg, a hankali yana ƙaruwa da adadinsa. Idan cikin minti 15-30. bayan ɗaukar kwamfutar hannu microgram 100, zafin bai tsaya ba, to sai a ɗauki kwamfutar hannu ta biyu tare da adadin adadin abubuwan aiki.
Teburin yana nuna hanyoyi na misalai na zakka na Lunaldin, idan kashi na farko baya kawo nutsuwa:
| Kashi na farko (mcg) | Kashi na biyu (mcg) |
| 100 | 100 |
| 200 | 100 |
| 300 | 100 |
| 400 | 200 |
| 600 | 200 |
| 800 | - |
Shan miyagun ƙwayoyi yana farawa da adadin 100 mcg, a hankali yana ƙaruwa da adadinsa.
Idan bayan shan matsakaicin maganin warkewa, ba a sami sakamako na farfadowa ba, to an wajabta maganin matsakaici (100 mcg). Lokacin zabar wani kashi a matakin titration, kada kuyi amfani da allunan 2 sama da rauni guda ɗaya na jin zafi. Abubuwan da zasu shafi jikin fentanyl a cikin sashi na 800 mcg ba a kimanta su ba.
Tare da bayyanar da abubuwa sama da huɗu na matsanancin azaba a kowace rana, da za a iya ɗaukar fiye da kwanaki 4 a jere, ana tsara takaddar magunguna na jerin hanyoyin opioid na tsawan aiki. Lokacin yin sauyawa daga wani analgesic zuwa wani, ana sake maimaita jerin abubuwan kashi ɗaya a ƙarƙashin kulawar likita da kuma ƙididdigar gwaje-gwaje na yanayin haƙuri.
Tare da dakatar da ciwo na paroxysmal, Lunaldin ya daina aiki. An soke maganin, a hankali ragewa sashi don kar ya haifar da bayyanar cututtukan cirewa.
Tare da ciwon sukari
Tare da Lunaldin analgesia, ana ba da shawarar marasa lafiya da ciwon sukari don amfani da haɗe-haɗe tare da Propofol da Diazepam.
An zaɓi adadin kwayoyi daban-daban.
Side effects
A yayin jiyya, ana haifar da sakamako masu illa ga wasu lokuta:
- gajiya;
- nutsuwa
- ciwon kai da farin ciki;
- hyperhidrosis;
- tashin zuciya
Tare da lokuta daban-daban, ana nuna tasirin mummunar abubuwa daga tsarin daban-daban na jikin da a ciki ake karbar masu karɓa.
Gastrointestinal fili
Magunguna na iya samun sakamako mai hana motsa jiki cikin motsi na hanji kuma yana haifar da maƙarƙashiya. Bugu da kari, ana yawan lura da mai zuwa:
- bushe bakin
- zafi a ciki;
- rarrabuwar kawuna;
- rikicewar dyspeptic;
- toshewar hanji;
- bayyanar ulcers a kan mucosa na baka;
- take hakkin aikin hadiye;
- anorexia.
Commonarancin na yau da kullun shine haɓakar iskar gas, yana haifar da ɓarna da ƙanshi.
Tsarin juyayi na tsakiya
Daga tsakiya juyayi tsarin sau da yawa tashi:
- asthenia;
- Damuwa
- rashin bacci
- take hakkin dandano, hangen nesa, tsinkaye mara kyau;
- hallucinations;
- delirium;
- rikicewar hankali;
- natsuwa;
- canji mai sauƙin yanayi;
- kara damuwa.
Rashin fahimtar kai ba ya zama ruwan dare gama gari.
Daga tsarin urinary
Sakamakon Lunaldin akan masu karɓar ƙwayar urinary yana kara sautin jijiyoyi masu santsi, wanda ke tattare da rikicewar urination - karuwa ko jinkirta fitowar fitowar fitsari, spasm na mafitsara, oliguria.
Daga tsarin numfashi
Sau da yawa lura:
- rashin lafiyar numfashi;
- hanci mai gudu;
- pharyngitis.
Commonlyarancin yau da kullun, ƙwayar hanji, ƙwanƙwasawa na huhu, kamawar numfashi, hawan jini.
Daga tsarin zuciya
A pathological dauki na iya zama:
- rushewar orthostatic;
- shakatawa na tsokoki na ganuwar jijiyoyin jini (vasodilation);
- tides;
- jan fuska;
- arrhythmia.
Halin ƙwaƙwalwar ƙwayar jijiyoyin jiki na iya bayyana kansu a matsayin jijiyoyin jini, rashin ƙarfi na kwanciyar hankali, ƙonewar zuciya (bradycardia) ko karuwa a cikin zuciya (tachycardia).
Cutar Al'aura
Cutar rashin lafiyan ga miyagun ƙwayoyi na iya faruwa ta hanyar:
- bayyanar fata - kurji, itching;
- jan ciki da kumburi a wurin allurar.
A cikin marasa lafiya waɗanda ke da matsala na tsarin hypobiliary, ana iya lura da biliary colic, cin zarafin zubar da ƙwayar cuta. Tare da yin amfani da tsawan lokaci, jaraba, jarabar tunani da ta jiki (dogaro) na iya haɓaka. Tasirin mummuna akan jikin mutum na iya haifar da lalatawar jima'i da raguwar libido.
Tasiri kan ikon sarrafa abubuwan inji
Magungunan za su iya shafar tsarin jijiyoyi na tsakiya da gabobin jijiyoyi, don haka a lokacin jiyya Lunaldin ya kamata ya ƙi hawa motoci, aiki tare da kayan aiki da ayyukan mai buƙatar da ke buƙatar hankali, saurin yanke shawara da kuma iyawar gani.
Magungunan za su iya yin tasiri ga tsarin juyayi na tsakiya da gabobin azanci, sabili da haka, a yayin lokacin tare da Lunaldin, ya kamata ku ƙi fitar da motocin.
Umarni na musamman
Tare da tsawan magani tare da maganin opioid, za a lura da umarnin da aka bayar a cikin umarnin don maganin. Ya kamata a sanar da mutanen da ke kula da mara lafiya a kan halayen tasirin miyagun ƙwayoyi akan tsarin daban-daban da kuma yiwuwar yawan shan ruwa. Yakamata su iya bada taimako na farko idan akwai alamun maye.
Yi amfani da tsufa
A cikin mutanen da suka manyan shekaru (saboda raguwa a cikin adadin metabolic da kawar da miyagun ƙwayoyi) za'a iya lura da alamun maye. Sabili da haka, lokacin titin kashi na miyagun ƙwayoyi, wajibi ne don la'akari da yanayin jikin mutum da halaye na shekaru.
Aiki yara
Ba a sanya shi ga yara 'yan ƙasa da shekaru 18 ba, kodayake a ƙasashen waje, don kula da cututtukan ƙwaƙwalwar ƙwayar cuta, an yarda da amfani da fentanyl daga shekara 1.
Yi amfani da lokacin daukar ciki da lactation
Shan magani yana buƙatar yanke shawara daidai. Dogaro da jiyya tare da miyagun ƙwayoyi a lokacin daukar ciki na iya haifar da cirewa a cikin jariri. Magungunan yana shiga katangar mahaifa, kuma amfani da shi lokacin haihuwa yana da haɗari ga ayyukan fitsari da tayi.
Ana samun maganin a cikin madarar nono. Saboda haka, alƙawarin sa yayin shayarwa na iya haifar da gazawar rashin lafiyar jariri. Magunguna a cikin lactation da lokacin haihuwa yana wajabta ne kawai lokacin da amfanin amfaninsa ya wuce haɗari ga jariri da uwa.
Aikace-aikacen aiki mara kyau
Tunda babban hanyar da ake bayarwa na maganin da kuma metabolites dinsa yana tare da fitsari, idan akwai matsala na aikin dangi, jinkirtawa a cikin aikin nasa, tarawa cikin jiki, da kuma karuwa a lokacin aiki. Irin waɗannan marasa lafiya suna buƙatar sarrafa abun cikin ƙwayar plasma na miyagun ƙwayoyi da daidaita sashi tare da karuwa a cikin girma.
Amfani don aikin hanta mai rauni
An cire magungunan tare da bile, sabili da haka, tare da cututtukan hanta, hepatic colic, ɗaukar tsawaita kayan zai iya faruwa, wanda, idan aka bi jadawalin gudanar da miyagun ƙwayoyi, zai iya haifar da yawan abin sha. Ga irin waɗannan marasa lafiya, ya kamata a ɗauka magunguna tare da taka tsantsan, lura da mita da sashi wanda likita ke ƙididdigewa, da kuma gudanar da gwaje gwaje na yau da kullun.
Yawan damuwa
Idan batun Lunaldin ya wuce gona da iri, sakamakon tashin hankali da nakasawar numfashi yana kara tabarbarewa, har zuwa matakinsa. Taimako na farko game da yawan zubar da jini sune:
- bita da tsarkakewa daga bakin bakin ciki (sararin samaniya) daga ragowar kwamfutar hannu;
- kimantawa da wadatar haƙuri;
- taimako na numfashi, har zuwa lokacin shiga ciki da tilasta samun iska a huhun;
- kula da zafin jiki;
- gabatarwar ruwa don gyarawa don asarar ta.
Maganin rigakafin cututtukan opioid shine Naloxone. Amma ana iya amfani da shi kawai don kawar da yawan shan ruwa a cikin mutanen da basu da amfani da opioids a baya.
Tare da mummunan tashin hankali, ana gudanar da magungunan musanyawa na plasma don daidaita yanayin karfin jini.
Maganin rigakafin cututtukan opioid shine Naloxone.
Yin hulɗa tare da wasu kwayoyi
Magungunan yana metabolized ta enzymes hanta, don haka magungunan da ke shafar ayyukan su (Erythromycin, Ritonavir, Itraconazole) suna haɓaka ƙwayoyin halittar maganin kuma suna haifar da tsawaita sakamako.
Haɗin kai tare da wasu ƙididdigar ƙwaƙwalwa, magungunan ƙwayoyin cuta, magungunan bacci da abubuwan kwantar da hankula suna haifar da karuwa a cikin sakamako mai hanawa da kuma annashuwa, aikin nakasasshe, raguwar hauhawar jini. Sabili da haka, ana amfani da haɗin su tare da taka tsantsan.
Ba'a ba da shawarar shan antagonists / agonists na masu karɓa na opioid a lokaci guda kamar maganin ba, saboda a cikin marasa lafiya waɗanda suka daɗe suna shan wannan magani, wannan haɗin yana haifar da alamun cirewa.
Amfani da barasa
Ethyl barasa yana inganta tasirin magani, saboda haka ba a bada shawarar hada magungunan tare da giya ba.
Analogs
Lunaldin's analogues sune:
- Dolforin;
- Fentavera;
- Matrifen;
- Fendivia
- Carfentanil.
Magunguna kan bar sharuɗan
Da takardar sayan magani.
Zan iya saya ba tare da takardar sayan magani ba?
A'a.
Farashin Lunaldin
A cikin Russia, magani yana biyan kuɗi daga 4000 rubles. don allunan 10 Na 100, 4500 rub. don kunshin No. 200 da 5000 rubles. na lamba 300.
Yanayin ajiya na miyagun ƙwayoyi
An hada magungunan a cikin jerin A, kuma dole ne a adana shi a cikin rufaffiyar minista, nesa da yara a yawan zafin jiki na ɗakin.
Ranar karewa
Bai wuce shekaru 3 ba.
An adana magungunan don bai wuce shekaru 3 ba.
Mai masana'anta
"Sadauki Stockholm AB", Sweden.
Ra'ayoyi game da Lunaldin
Tatyana Ivanova, dan shekara 45, Pskov: "Kyakkyawan shiri. Ya taimaka sosai bayan aikin. Jin raunin yana da ƙarfi sosai kuma babu abin da ya taimaka. Abin da Lunaldin ya yi shi ne kawai ya cece ni daga azaba."
Mikhail Prokopchuk, dan shekara 48, emerovo: "Ina aiki a matsayin mai maganin maye a cikin karamin asibiti. A al'adata, yawanci dole ne inyi amfani da maganin sa maye tare da Lunaldin .. Kyakkyawan magani wanda ya tabbatar da amincinsa da tasiri a aikace. Ciwan ya tsaya da sauri, kuma babu wasu sakamako masu illa, banda tashin zuciya. "
Ekaterina Filippova, mai shekara 36, Kostroma: “Mahaifiyata ta sha wahala sosai daga ciwon kansa. Har zuwa ranar karshe, magungunan Lunaldin ne kawai suka kubutar da mu. Babu bukatar allura, kwaya a karkashin harshen, kuma zafin ya warke.
