Kusan shekaru 50, likitoci suna yin amfani da magungunan sulfanilamide don bi da mellitus type 2 na sukari, duk da cewa tsarinsu na rage sukari na ɗauka yana da wahala.
Shirye-shiryen rukunin sulfonamide sun shafi yawancin beta na ƙwayar cuta, ta haka ne ya inganta babban da samar da insulin.
Shirye-shiryen Sulfanilamide suna da extraaramin illa. Tare da wannan, kyakkyawan saka idanu na glycemic na dogon lokaci yayin jiyya tare da sulfonamides:
- yana rage yawan samarda glucose ta hanta;
- haɓakar amsa insulin asirin kayan abinci;
- yana inganta tasirin insulin akan tsokoki da ƙwayoyin adipose.
An rarraba Sulfanilamides zuwa magungunan ƙarni na farko (ba a amfani da su a halin yanzu a Rasha) da magunguna na ƙarni na biyu, jerin sune kamar haka:
- glipizide
- gliclazide
- glycidone
- glibenclamide,
kasancewa babban rukuni na lura da ciwon sukari.
Shirye-shiryen gulimepiride na sulfonamide, saboda halayensa na musamman, yana nufin abubuwa masu rage sukari ne na ƙarni na uku.
Hanyar aikin
Hanyar aiwatarwa na magungunan rukunilamide rukuni, wanda ke taimakawa rage matakan sukari, ya danganta ne da haɓakar ƙwayar insulin, wanda tashoshin tasirin potassium na ATP ke sarrafawa a cikin ƙwayar plasma na ƙwayar beta.
ATP-mai kula da tashoshi mai mahimmanci sun ƙunshi ƙananan ƙananan 2. Ofaya daga cikin waɗannan ƙananan abubuwan ya ƙunshi mai karɓa na sulfonamide, ɗayan kuma ya ƙunshi tashar kai tsaye. A cikin marasa lafiya da ke da nau'in ciwon sukari na 2 na sukari, wanda a cikin shi ake kiyaye aikin beta sel zuwa wani gwargwado, mai karɓar yana ɗaure sulfonamide, wanda ke kaiwa zuwa ƙulli tashar tasirin potassium mai ƙwaƙwalwar ATP.
Sakamakon haka, potassium yana tarawa a cikin sel na beta, wanda daga baya aka yanke shi, wanda ya fi dacewa da ƙaddamar da adadin kuzari a cikin tantanin beta. Increaseara yawan adadin alli a cikin ƙwayoyin beta suna kunna jigilar kwayar insulin zuwa ƙwayoyin cytoplasmic daga cikin abin da suka haɗu, kuma sararin samaniya yana cike da insulin.
Ya kamata a lura cewa yawan motsa insulin ta hanyar sirri ba ya dogara da matakin glucose a cikin jini, kuma karuwa a cikin yawan ƙwayar insulin plasma yana haifar da raguwa a cikin postprandial da azumi glycemia.
A wannan yanayin, sulfanilamide secretogens-HbA1 suna da tasirin rage yawan sukari, raguwar sukari yana faruwa da 1-2%. Lokacin da aka magance shi da magungunan marasa sulfanelamide, ana rage sukari da kashi 0-1-1. Wannan ya faru ne saboda ƙarshen saurin ƙarshe.
Magungunan Sulfanilamide da alama suna da wasu ƙarin tasirin-ƙwaƙwalwar ƙwayar ƙwayar cuta a kan kyallen takaddun insulin-ins da hanta. Koyaya, ainihin hanyoyin aiwatar da aikin da ke taimakawa raguwar hauhawar jini ba a kafa su ba har yau.
Yana yiwuwa sulpinlamide hyperstimulation na ɓoye ƙwayar hormone-insulin a cikin tsarin hanta hanta yana inganta tasirin insulin akan hanta kuma yana rage yawan azumi.
Normalization na glycemia yana rage yawan guba na glucose kuma don haka yana ƙaruwa da hankalin insulin wanda yake kan ƙirar insulin-dogara da kasusuwa (adipose, tsoka).
Sulfanilamide gliclazide a cikin nau'in 2 na ciwon sukari mellitus ya dawo da damuwa ta farko (minti na 3-5) na ɓoye insulin, wanda, bi da bi, yana inganta tashin hankali na lokaci na biyu (1-2 a awa), halayyar nau'in ciwon sukari na 2 na 2.
Magungunan magani na magunguna sulfa sun bambanta a matsayin matsayin adsorption, metabolism da excretion rate. Magunguna a jerin mutanen na biyu da na uku ba su da kariyar plasma masu aiki, wanda ke bambanta su da kwayoyi a jerin mutanen farkon.
Dukkanin shirye-shiryen sulfanilamide kusan kusan kyallen takan dauke su. Koyaya, farawa daga aikinsu da tsawon lokacinsa yana dogara ne akan halayen likitanci na mutum, wanda aka ƙaddara ta hanyar maganin.
Yawancin magungunan sulfa suna da ɗan gajeren rabin rayuwa, waɗanda ke ɗaukar awoyi 4-10. Tunda yawancin sulfonamides suna da tasiri yayin ɗauka sau biyu, duk da ɗan gajeren rabin rayuwa daga hanyoyin jini, ana tsammani a cikin ƙwayoyin beta a matakin nama, kawarwarsu tana ƙasa da jini.
Magungunan Glyclazide sulfanilamide yana samuwa yanzu a cikin tsari na tsawan lokaci kuma yana ba da cikakkiyar kulawa sosai a cikin plasma na 24 hours (diabeton MB). Manyan jerin magungunan sulfa suna karyewa a hanta, hanjin su kuma ya rage kadan daga cikin kodan sannan kuma a wani bangare na hanji.
Sashi da magani regimens
Yawancin lokaci, jiyya tare da sulfonamides yana farawa da mafi ƙarancin kashi kuma yana ƙaruwa tare da tazara tsakanin kwanaki 4-7 har sai an sami sakamako da ake so. Marasa lafiya waɗanda ke da alaƙa da abin da ake ci, da waɗanda ke neman rage nauyi, na iya rage yawan sinadarin sulfonamides ko kuma barin su baki ɗaya.
Koyaya, akwai shaidar cewa amfani da ƙaramin ƙwayar sulfonamides yana ba da damar dogon lokaci don kula da kyakkyawan glucose.
Yawancin marasa lafiya suna cimma matakan glycemic ɗin da suke so yayin amfani da 1/3, 1/2 na matsakaicin adadin. Amma idan a lokacin jiyya tare da sulfonamides da ake buƙata taro a glucose bai faru ba, to ana haɗuwa da magungunan tare da wakilai marasa insulin hypoglycemic ko tare da insulin.
Lokacin zabar sulfonamides, dole ne a yi la'akari da abubuwa da yawa:
- farawa da tsawon lokacin aiki;
- karfi;
- yanayin metabolism;
- m halayen.
Hanyar aiwatar da aikin sulfonamide ya dogara da matsayin matsayin kusancinta da mai karɓar sulfonamide. A wannan batun, ana gane glyclazide, glimepiride, glibenclamide a matsayin mafi inganci da aiki.
Abin lura ne cewa magungunan sulfanilamide suna shafar aikin tashoshi na alli a cikin tsokoki da tasoshin, wanda ke shafar tsarin aikin vasodilation. Har yanzu dai ba a san ko wannan tsari yana da muhimmanci ba.
Idan babu isasshen tasiri na magungunan da aka haɗa a cikin jerin abubuwan sulfonamides, zaku iya amfani da haɗin haɗin su tare da kowane abu mai rage sukari. Banda shi shine sirrin-meglitinides, wanda shima ya daure wa masu karbar na sulfonamide.
Haɗin magani tare da kwayoyi waɗanda aka haɗa a cikin jerin abubuwan sulfonamides na aikin haɗin gwiwa an haɗa su da kwayoyi waɗanda ke da tsarin da ya bambanta da sulfanilamides.
Haɗin magungunan sulfonamide tare da metformin ya zama abin baratacce, tunda ƙarshen baya tasiri kan ɓoye insulin na hormone, amma yana ƙara haɓaka hanta zuwa gare shi, sakamakon haka, sakamakon rage sukari na sulfonamides yana ƙaruwa.
Haɗin kwayoyi masu kama da juna suna da matukar dacewa a cikin lura da ciwon sukari na 2. Tare da haɗakar magungunan sulfa tare da inhibitors na alpha glucosidase, ƙarancin glucose ya fito daga ƙananan hanji bayan cin abinci, don haka glycemia postprandial ya ragu.
Glitazones yana haɓaka jijiyar hanji da sauran ƙwayoyin da suke dogaro da insulin zuwa cikin insulin-hormone, wanda ke ƙarfafa tsarin aikin sulfanilamide-wanda ke motsa insulin. Idan muka yi la'akari da haɗakar magungunan da aka haɗa a cikin jerin sulfonamides tare da insulin, to, ra'ayoyin likitocin a cikin wannan al'amari suna da tabbas.
A bangare guda, idan ya zama dole a rubuto insulin, ana zaton cewa ajiyar ajikin ta ta lalace, daga nan ne yanke hukuncin cewa kara magani tare da kwayar sulfonamide ba shi da tushe.
A lokaci guda, idan mai haƙuri wanda ko da yake yana ɓoye insulin zuwa ɗan ƙaramin ƙin yin amfani da sulfanilamide, wannan zai buƙaci ƙaruwa mafi girma a kashi na insulin.
Ganin wannan gaskiyar, tsarin sarrafa kansa na metabolism ta hanyar insulin kwayoyin halitta yafi dacewa fiye da sauran hanyoyin insulin. Ko da tare da iyakataccen wadataccen sel na sel, watsi da tsarin kula da kai ba shi da ma'ana.
Jerin magungunan sulfonamide na mutanen ƙarni na shahararrun shahararrun mutane a Rasha:
- glycidone;
- gliclazide MV;
- glipizide;
- glimepiride;
- glibenclamide.
Alamu
Lokacin ɗaukar sulfonamides, matakin HbA1c ya kamata ya ragu tsakanin 1-2%. Magungunan Sulfanilamide, kamar sauran magunguna masu rage sukari, sun fi tasiri a cikin marasa lafiya da ke da ƙarancin ƙwayar ƙwayar cutar glycemic fiye da waɗanda marasa lafiyar waɗanda alamomin su ke kusanci da al'ada (HbA1c 7%).
Shirye-shiryen da suka fi dacewa na sulfanilamide don marasa lafiya da ke dauke da nau'in ciwon sukari na 2 na sukari, wanda ke da rashi bayyanar insulin, amma, har yanzu, kantinan insulin a cikin kwayoyin beta ba su gama aiki ba kuma sun isa su karfafa sulfonamides.
Jerin rukuni na marasa lafiya tare da kyakkyawan sakamako:
- Ciwon sukari ya bunkasa bayan shekaru 30.
- Tsawon lokacin cutar ba ta wuce shekaru 5 ba.
- Azumi na hauhawar jini kasa da 17 mmol / L.
- Patientswararrun marasa lafiya da masu kiba.
- Marasa lafiya da ke bin shawarar masanin abinci, tare da babban aiki na zahiri.
- Marasa lafiya ba tare da cikakken rashi insulin ba.
Hudu na marasa lafiya waɗanda aka fara gano su da nau'in ciwon sukari na 2 na sukari ba su da amsa ga jiyya tare da sulfonamides. A gare su, wajibi ne don zaɓar sauran ingantattun magunguna masu rage ƙwayar sukari.
A cikin ragowar marasa lafiya waɗanda suka amsa da kyau don magani, 3-4% sun rasa hankalinsu don maganin sulfonamides a cikin shekara guda (tachyphylaxis, na biyu mai tsayayya).
Da farko dai, wannan yana faruwa ne sakamakon raguwar ɓoyewar ƙwayoyin beta kuma saboda yawan kiba (karuwa a jure insulin).
Sakamakon magani mara kyau ana iya haifar dashi ba kawai ga dalilai na sama ba, har ma da sauran dalilai:
- ƙananan aiki na jiki;
- rashin biyayya
- danniya
- cututtukan cikin zuciya (bugun jini, bugun zuciya, kamuwa da cuta);
- alƙawarin da kwayoyi waɗanda ke rage tasirin sulfonamides.
A cikin wasu marasa lafiya da ke dauke da nau'in ciwon sukari na 2 na masu ciwon sukari, yayin jiyya tare da sulfonamides (glibenclamide), an lura da "laps syndrome", mai kama da cutar ta Somogy a nau'in 1 masu ciwon sukari.
Sauya glibenclamide tare da magani tare da rage tasirin hypoglycemic sakamako (glimepiride) rama don ciwon sukari mellitus.
Yana yiwuwa rashin lafiyar hyctglycemia tare da yin amfani da glibenclamide yana tsokanar cutar asuba a cikin waɗannan marasa lafiya, wanda ke tilasta likita ya ƙara yawan ƙwayoyi zuwa matsakaici. Kuma yawan bacci na dare a cikin wannan yanayin yana tsananta kuma yana haifar da mummunar zubar da cutar siga da safe da yamma.
Wannan shine ma'anar "looping syndrome" a cikin lura da nau'in ciwon sukari na 2 na ƙwayar cuta tare da magungunan sulfonamide. A yau, metformin (biguanide) shine magani na farko don ƙwayar cuta ta farko da ta kamu da nau'in cutar sukari guda 2.
Sulfanilamides galibi ana wajabta masa rashin magani tare da wannan magani. Idan mai haƙuri ya sami rashin haƙuri don shirye-shiryen metformin ko ya ƙi shi saboda wasu dalilai, ana iya amfani da sulfonamides a cikin nau'in ciwon sukari na 2 na mellitus a matsayin maganin basal.
Contraindications
Shirye-shiryen Sulfanilamide suna contraindicated a cikin lokuta na rashin hankali a gare su, da kuma a cikin ketoacidosis na masu ciwon sukari, wanda ke haɗuwa tare da coma ko ba tare da shi ba. Idan yanayin ya haɓaka saboda lura da nau'in ciwon sukari na 2 na ƙwayar cuta tare da kwayoyi a cikin jerin sulfonamides, to ya kamata a soke su kuma ya kamata a rubuta insulin DKA.
A cikin wasu gwaje-gwaje na asibiti waɗanda ba su cika cikakkun ka'idojin binciken kimiyya ba, an sami haɗarin haɗarin mace-mace daga cututtukan zuciya da suka haɓaka tare da maganin sulfonamide.
Amma a cikin binciken da za a yi a gaba game da masanan kimiyyar Birtaniyya, ba a tabbatar da wannan gaskiyar ba. Saboda haka, a yau ba a tabbatar da haɗarin cututtukan zuciya ba sakamakon magungunan sulfa.
Mahimmanci! Mafi rikitarwa mai rikitarwa wanda zai iya haɓaka tare da maganin sulfanilamide shine hypoglycemia da nau'ikansa masu tsauri. Saboda haka, yakamata a sanar da marasa lafiya game da yiwuwar wannan yanayin!
Hypoglycemia yana da wuya a bincika tsofaffi da marasa lafiya na beta-blocker. Halin da ke tattare da shi lokacin shan sulfonamides sune:
- Rashin jin daɗin marasa lafiya tare da alamun rashin abinci mai gina jiki.
- Marasa lafiya da ke fama da wahala, nakuda ko kuma gazawar hanta.
- Marasa lafiya tare da ƙayyadadden ƙuntatawa na yawan caloric.
- Marasa lafiya bayan shan barasa.
- Mutanen da ke fama da ciwon sukari bayan matsanancin ƙoƙarin jiki.
Marasa lafiya a cikin matsananciyar damuwa, bayan rauni, kamuwa da cuta, ko tiyata, na iya rasa ikon sarrafa glycemic tare da shirye-shiryen sulfanilamide. A wannan yanayin, akwai buƙatar buƙatar ƙarin allurai na insulin, aƙalla azaman na ɗan lokaci. Amma haɗarin haɓakar hypoglycemia, har ma da haɗarin cewa za a sami ƙwayar cutar haihuwar jini, yana ƙaruwa.
