Momwe mungagwiritsire ntchito mankhwala Glidiab MV?

Gliclazide ndi mankhwala amkamwa a hypoglycemic okhudzana ndi zotumphukira sulfonylureas M'badwo wachiwiri. Mchitidwe wa mankhwalawo umalimbana ndi kutsegula kwa ma cell a β kapambakupanga insulin, kuchuluka kwa zotumphukira kwa minofu yake, kumakulirakulira shuga insulin katulutsidwe zotsatira ndi kukondoweza kwa intracellular ntchito glycogen synthetase m'misempha minofu. Mankhwalawa amachepetsa nthawi kuyambira nthawi yomwe chakudya chimayambira mpaka pakuyamba kupanga insulinamachepetsa shuga wa postprandial, komanso kubwezeretsa choyambirira (choyambirira) pachimake insulin katulutsidwe (mosiyana ndi mankhwala ena sulfonylureasmakamaka ikugwira ntchito mu gawo lachiwiri).

Kuphatikiza pa kukhazikitsa kagayidwe kazachilengedwe gliclazide bwino kuyesapochepetsa kuphatikizika kwa mapulosi ndi Kutsatira, normalization wa mtima kukhathamiritsa, kubwezeretsa kwa zochita zathupi parietal fibrinolysis.

Mankhwala a Glidiab amachepetsa kukhudzika mtima adrenalineimalepheretsa mapangidwe atherosulinosis ndi microthrombosis. Imalepheretsa kupita patsogolo kwa zomwe sizowonjezera (kumbuyo) matenda ashuga retinopathy. Ndi chithandizo chakanthawi, kuchepa kwakukulu kumawonedwa proteinuriakukulira kumbuyomatenda ashuga nephropathy.

Kumwa mankhwalawa, chifukwa cha momwe amakhudzidwira koyambirira insulin katulutsidwe, sikhala limodzi ndi kunenepa kwambiri komanso imakondanso kuchepa kwa odwala onenepa ngati kuli koyenera zakudya mankhwala.

Oyang'anira pakamwa gliclazide kumabweretsa kuyamwa pafupifupi kwathunthu m'mimba. TCmax mu seramu magazi Maola 4 (mapiritsi MV - 6-12 maola). Kumangiriza kwa mapuloteni a plasma kuli pamlingo wa 90-95%. Kusintha kwa ma metabolic kumachitika m'chiwindi ndikutulutsa kwa zinthu zopanda ntchito kagayidwe. T1 / 2 ndi maola 8-11 (mapiritsi a MV - maola 16). Kulowetsa Fomu metabolites ikuchitika makamaka ndi impso (pafupifupi 70%), komanso matumbo (12%). Pafupifupi 1% gliclazide yachotsa mkodzo osasinthika.

Zizindikiro zogwiritsidwa ntchito

Glidiab akuwonetsedwa mtundu 2 shuga (NIDDM, shuga yosadalira insulin) yodziwika bwino zakudya mankhwala ndi kuphedwazolimbitsa thupi zovuta zovuta ngati sizikuyenda bwino m'mbuyomu.

Kugwiritsa ntchito Glidiab ndikutsutsana kwathunthu mu:

matenda ashuga ketoacidosis,
yoyamwitsa,
mtundu 1 shuga,
matenda a shugachikomokere,
kwambiri matenda a chiwindi/impso,
hyperosmolar coma,
leukopenia,
nyengo zopweteka, ndi kufunika kugwiritsa ntchito insulinkuphatikiza kuvulala, opareshonichachikulu amayaka,
paresis am'mimba,
wa mimba,
matumbo kutsekeka,
matenda ndi malabsorption chakudya ndikusintha hypoglycemia (kuphatikizapo matenda opatsirana)
zanga zokha Hypersensitivity kuti gliclazide kapena mankhwala ena
muubwana.

Zotsatira zoyipa

Zotsatira zoyipa komanso zoyipa kwambiri za Glidiab hypoglycemia, nthawi zambiri zimayamba chifukwa chophwanya mtundu wa mankhwala komanso zosakwanira zakudya mankhwala. Chizindikiro cha vutoli ndi chosiyanasiyana ndipo chimatha kudziwonetsa: mutunjala kutopamwadzidzidzi kufookakusasamala nkhawa, nkhanzakusakhazikika mayiko ovutakuchepa kwapang'onopang'ono, kulephera kulolera, kuwonongeka kwamawonekedwekusowa thandizo aphasiazovuta zamaganizidwe kunjenjemera, chizungulire, delirium, kulephera kudziletsa, spasmskulephera kudziwa Hypersomniakupuma kosakhazikika thukuta, bradycardia.

Zotsatira zachiwiri zofunikira kwambiri zothandizira kuphimba magazi ku Glidiab zimawonedwa ngati zovuta zoyipa kuchokera m'mimba, zomwe zimafotokozedwa dyspepsia (nserukupweteka kwa epigastric ndipo kutsegula m'mimba), kuphwanya malamulo hepatic ntchito (kuchuluka kwantchitochiwindi transaminase, cholestatic jaundice), kukomoka (ngati mutamwa mapiritsi ndi chakudya, kuuma kukomoka amachepetsa).

Zingakhalenso matupi awo sagwirizanamakamaka obwera urticaria, maculopapular zidzolo ndi Khungu.

Nthawi zina leukopenia, thrombocytopenia ndi kuchepa magazi.

Glidiab, malangizo ogwiritsira ntchito

Kusankhidwa kwa Mlingo wa mankhwala Glidiab amachitika payekhapayekha malinga ndi mawonetseredwe azachipatala NIDDM ndi msinkhu glycemia, yomwe imayeza pamimba yopanda kanthu, komanso pambuyo pa maola awiri mutatha kudya.

Poyamba, kudya kwa tsiku ndi tsiku piritsi la 1 Glidiab 80 mg kapena piritsi la 1st Glidiab MV 30 mg ndikulimbikitsidwa. Mlingo wamba watsiku ndi tsiku ndi 160 mg ndi 60 mg, ndipo kutalika kwake ndi 320 mg ndi 120 mg, motero, pamapiritsi ndi mapiritsi a MV. Mapiritsi achire a Glidiab 80 mg amatengedwa mphindi 30-60 musanadye kawiri m'maola 24 (m'mawa ndi madzulo). Mapiritsi MV 30 mg amasonyezedwa kuti amatengedwa kamodzi m'mawa uliwonse mukamadya kadzutsa. Kuchulukitsa Mlingo angathe kuchitidwa ndi imeneyi osachepera masiku 14.

Okalamba odwala ndi odwala omwe ali ndi matenda a impso (ndi CC 15-80 ml / min) safuna kusintha kwa mlingo.

Bongo

Pankhani ya bongo gliclazide chitukuko hypoglycemianthawi zina kufikirahypoglycemic chikomokere.

Ngati zizindikiro za bongo zimapangitsa wodwala kudziwa, ayenera kumwa nthawi yomweyo shuga yankho kapena shuga (dextrose) M'mawonekedwe a wodwalayo, kuwongolera kwa yankho kumasonyezedwa Dextrose (40%) kapena jakisoni wa IM Glucagon (1-2 mg). M'tsogolomo, ndi zovuta zina, wodwalayo ayenera kudya zakudya zokhala ndi zambiri chakudya, pofuna chenjezo kuyambiranso kwa hypoglycemia.

Kuchita

Kutsika kwa mphamvu ya hypoglycemic ya Glidiab kumawonedwa ngati kugwiritsidwa ntchito kwake ndi glucocorticoids, barbituratesamanditititita (Terbutaline, Epinephrine, Ritodrin, Clonidine, Salbutamol), olimbana ndi calcium, mchere wa lithiamu, nicotinic acid, thiazide okodzetsakaboni anhydrase zoletsa (Diacarb), Chlortalidone, Triamteren, Chlorpromazine, Furosemide, Asparaginase, Danazol, Baclofen, Diazoxide, Rifampicin, Morphine, Isoniazid, Glucagon, Phenytoin, mahomoni chithokomiro England estrogen (kuphatikiza kulera kwamlomo).

Kuwonjezeka kwa ntchito ya hypoglycemic ya Glidiab kumadziwika ndi kuphatikiza kwake pamodzi ndi mankhwala antifungal (Fluconazole, Miconazole), ACE zoletsa (Enalapril, Captopril), H2-blockers (Cimetidine)Bezafibrat, Clofibrate), NSAIDs (Indomethacin, Phenylbutazone, Diclofenac,, salicylates, anti-TB mankhwala (Ethionamide), anticoagulants osadziwika, β-blockersanabolic steroids CyclophosphamideMao zoletsa Chloramphenicol, Theofylline, Allopurinolyaitali sulfonamides, Fenfluramine, Pentoxifylline, Fluoxetine, Guanethidine, Reserpine, tubular secretion blockers, Kutulutsa, Bromocriptine, Pyridoxine, ethanol, komanso mankhwala ena a hypoglycemic (insulin, khwawa, acarbose).

Kulandila kwa Joidi kwa Glidiab ndi mtima glycosides kumawonjezera chiopsezo cha mapangidwe chamkati extrasystole.

Zotsatira za β-blockers, Reserpine, Clonidine, Guanethidine imatha kuzindikira zodwala matenda hypoglycemia.

Malangizo apadera

Chithandizo cha Glidiab chikuyenera kuthandizidwaotsika kalori zakudyandi kuphatikiza kochepa chakudya.

Kutembenuka kwakadyedwe, komanso kupsinjika kwamalingaliro ndi thupi kumafunikira kusintha kwa mlingo gliclazide.

Munthawi yonse ya zamankhwala, onetsetsani mulingo wa glycemiaKukhazikika pamimba yopanda kanthu ndikatha kudya.

At matenda a shugakomanso othandizira opaleshoni kugwiritsa ntchito kuyenera kuganiziridwa zokhala ndi insulin kukonzekera.

Wodwala ayenera kudziwitsidwa za kuthekera kwa mapangidwe hypoglycemia posala, kutenga NSAIDs ndi Muli okonzekera ethanol.

Makamaka ozindikira zotsatira za mankhwala a hypoglycemic ndi odwala okalamba, odwala ofooka, kapena omwe samalandira zakudya zamagulu komanso anthu omwe akudwala hypocorticism.

Muyenera kusamala mukamagwira ntchito yowopsa kapena yolondola, komanso poyendetsa galimoto, makamaka posankha mtundu wa mankhwalawa, chifukwa chakuwonjezereka kwa mapangidwe hypoglycemia.

Glemaz,
Amaril,
Kukongola,
Sinthani,
Glibetic,
Mdyerekezi,
Glianov,
Maninil,
Glibenclamide,
Diameprid,
Glimepiride,
Diapiride,
Glinova,
Meglimide,
Ziphuphu,
Guwa,
Eglim etc.

Glidia MV,
Diabeteson MR,
Gliklada,
Sinthani,
Gliclazide MR,
Diagnizide MR,
Gluktam,
Diabinax,
Glucostabil,
Zolemba,
Zamakolo,
Mdyerekezi,
Osiklid.

Zochitika za chithandizo cha Glidiab kwa odwala omwe ali m'gulu la ana a zaka sizokwanira kuti aziyang'anira ana.

Ndi mowa

Ngati mumamwa mowa mukumwa mankhwala a Glidiab, mutha kukumana nawodisulfiram ngati anachita (matenda) kuwonekera kupweteka kwam'mimba, nseru/kusanza, mutu.

Pa mimba ndi mkaka wa m`mawere

Gwiritsani ntchito pochiza Glidiab yoyamwitsa ndi wa mimba Zoletsedwa.

Ndemanga za Glidiab zomwe zimapezeka paukonde ndizochepa, koma zabwino kwambiri. Malinga ndi omwe odwala adalandira, mankhwalawa amalimbana ndi mawonekedwe owoneka bwino. shuga wosadalira insulin ndipo ili ndi zovuta zochepa zoyipa. Mwachilengedwe, mukamatenga Glidiab, muyenera kukhala oyenera chakudya ndikutsatira malangizowo zolimbitsa thupi.

Kutulutsa mawonekedwe ndi kapangidwe kake

Fomu ya kutulutsidwa kwa Glidiab MV ndi piritsi lokhala ndi masinthidwe osinthika: lathyathyathya-oyera, oyera ndi zonunkhira bwino kapena zoyera, atapakidwa, kuphatikiza ndi zovomerezeka (zidutswa 10 mmatumba, pamakatoni a makatoni atatu kapena 6).

Piritsi limodzi:

yogwira mankhwala: gliclazide - 30 mg,
othandizira: microcrystalline cellulose - 123 mg, hypromellose - 44 mg, magnesium stearate - 2 mg, colloidal silicon dioxide - 1 mg.

Pharmacokinetics

Gliclazide pambuyo pakamwa makonzedwe ali pafupifupi odziwidwa kwathunthu kuchokera m'mimba. Kuphatikizika kwa plasma kumawonjezeka pang'onopang'ono ndikufika pazokwanira mkati mwa maola 6-12. Kudya sikukhudza kuyamwa kwa chinthu.

Ndi gawo limodzi la Glidiab MV tsiku ndi tsiku, njira yothandizirana ya plasma ya gliclazide imaperekedwa kwa maola 24.

Plasma kumanga mapuloteni pafupifupi 95%.

Matenda a metabolism amapezeka m'chiwindi ndikupanga ma metabolites osagwira.

T_1/2 (theka-moyo) ndi pafupifupi maola 16. Amapukusidwa makamaka ndi impso mu mawonekedwe a metabolites, pafupifupi 1% ya chinthucho imatuluka osagwira mkodzo.

Contraindication

mtundu 1 shuga
matenda ashuga ketoacidosis,
matenda a shuga
zinthu zomwe zimayendetsedwa ndi malabsorption chakudya, kupezeka kwa hypoglycemia (matenda opatsirana),
hyperosmolar chikomokere,
paresis am'mimba
leukopenia
kukanika kwa hepatic / aimpso,
matumbo
kulowererapo kwakukulu kwa opaleshoni, kuvulala kwambiri, kuwotcha, ndi zina zomwe zimafuna chithandizo cha insulin,
kuphatikiza mankhwala ndi miconazole, danazole kapena phenylbutazone,
wazaka 18
Mimba ndi kuyamwa
tsankho lililonse pazigawo zina za mankhwalawo, komanso sulfonamides ndi zina za sulfonylurea.

Wachibale (Glidiab MV amalembedwa moyang'aniridwa ndi achipatala):

febrile syndrome
uchidakwa
zakudya zopanda thanzi / zosagwirizana,
pituitary / adrenal insuffidence,
matenda oopsa a mtima dongosolo (kuphatikizapo atherosulinosis, matenda a mtima),
aimpso / chiwindi kulephera,
hypopituitarism,
shuga-6-phosphate dehydrogenase akusowa,
kugwiritsa ntchito glucocorticosteroids nthawi yayitali,
matenda a chithokomiro, akupita ndikuphwanya ntchito yake,
ukalamba.

Malangizo ogwiritsira ntchito Glidiab MV: njira ndi mlingo

Glidiab MV amatengedwa pakamwa, nthawi imodzi patsiku la kadzutsa.

Mlingo wa mankhwalawa amasankhidwa ndi dokotala payekhapokha malinga ndi matenda omwe amawonetsa matendawa, kusala glucose komanso maola awiri mutatha kudya.

Mlingo woyamba wa tsiku lililonse ndi piritsi limodzi. M'tsogolomu, ngati kuli kotheka, onjezani mlingo ndi masabata osachepera awiri. Mulingo waukulu ndi mapiritsi 4 patsiku.

Ndikotheka kusintha kuchokera ku Glidiab kupita ku Glidiab MV tsiku lililonse mapiritsi a 4-5.

Mankhwalawa amatha kuphatikizidwa ndi ena othandizira a hypoglycemic: biguanides, insulin kapena alpha-glucosidase inhibitors.

Kuyanjana kwa mankhwala osokoneza bongo

Kuphatikiza komwe shuga wamagazi angachulukane (kufooketsa mphamvu ya gliclazide):

danazol: kuphatikiza sikumalimbikitsidwa, mankhwalawa ali ndi vuto la matenda ashuga, ngati sizingatheke kuisintha ndi mankhwala ena, kuchuluka kwa shuga m'magazi kuyenera kuyang'aniridwa, mlingo wa Glidiab MV ungasinthidwe ndi dokotala panthawi yophatikiza mankhwala komanso atatha.
chlorpromazine (muyezo wa tsiku ndi tsiku wa 100 mg): kuphatikiza kumafunikira kusamala, popeza kuwonjezeka kwa kuchuluka kwa shuga m'magazi ndi kuchepa kwa chinsinsi cha insulin, ngati sizingatheke m'malo mwake ndi mankhwala ena, kuchuluka kwa shuga m'magazi kuyenera kuwunikira kusintha kwa Glidiab MV,
tetracosactide ndi glucocorticosteroids (wamba / makonzedwe: intraarticular, rectal ndi kunja makonzedwe): kuphatikiza kumafunikira kusamala, popeza pali kuwonjezeka kwa kuchuluka kwa shuga wamagazi ndi chitukuko cha ketoacidosis, tikulimbikitsidwa kuti kuyang'anitsitsa kuchuluka kwa shuga wamagazi, makamaka kumayambiriro kwa mankhwala Mankhwala atamalizidwa ndi adokotala, muyezo wa Glidiab MV ungasinthidwe,
salbutamol, ritodrin, terbutaline (mtsempha wamkati): kuphatikiza kumafunikira kusamala,
anticoagulants (makamaka warfarin): kuchulukitsa kwa anticoagulants (kusintha kwa mankhwala kungafunike).

Kuphatikiza komwe chiwopsezo cha kukhala ndi hypoglycemia chimakulirakulira (kuchuluka kwa gliclazide):

miconazole (kachitidwe kapena kagwiritsidwe ntchito komwe kamakhala ngati kamisempha m'kamwa.): kaphatikizidwe kamakhala kotsutsana, chifukwa hypoglycemia imatha kukhala chikomokere,
phenylbutazone (kachitidwe ka makonzedwe): kuphatikiza sikumalimbikitsidwa, ngati sikotheka m'malo mwake ndi mankhwala ena, kuchuluka kwa shuga m'magazi kuyenera kuyang'aniridwa, panthawi yophatikizira mankhwala ndipo atamaliza adokotala amatha kusintha mlingo wa Glidiab MV,
ethanol: kuphatikiza sikumalimbikitsidwa, komwe kumalumikizidwa ndi kuchuluka kwa hypoglycemia komanso mwayi wokhala ndi vuto la hypoglycemic coma,
othandizira ena a hypoglycemic (insulin, alpha-glucosidase inhibitors, metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 agonists), mankhwala osagwiritsa ntchito mankhwala a anti-yotupa, fluconazole, beta-adrenergic blocking agents, neurotransmithibitors₂- histamine receptors, monoamine oxidase inhibitors, clarithromycin, sulfonamides: kuphatikiza kumafunikira kusamala.

Zofanizira za Glidiab MV ndi: Diabeteson MB, Diabefarm MV, Gliclazide Canon, Glidiab, Gliclada, Diabetalong, Diabinax, Diabefarm.

Makhalidwe wamba

Mankhwala "Glidiab MV 30" amatengedwa ngati analogue yaku Russia ya mankhwala achifalansa "Diabeteson MV". Amapangidwa ndi Akrikhin Chemical and Pharmaceutical Plant ku Moscow Region.

Mankhwalawa amatanthauza othandizira pakamwa a hypoglycemic omwe ali mu mawonekedwe a piritsi omwe amasulidwa. Mtundu wa kapangidwe kawo ndi loyera kapena kirimu, akhoza kukhala mabulangeti a marble. Mapiritsi amafanana ndi chamfersante athyathyathya.

Phukusi la ogula ndi paketi. Ikhoza kukhala ndi miyala 30 kapena 60, yokhazikitsidwa ndi mbale zamakanema.

Mosiyana ndi mankhwalawa "Diabeteson MV" okhala ndi mlingo wa 0,060 g wa gliclazide, mankhwalawa "Glidiab MV" ali ndi mphamvu yofanana yogwiritsidwa ntchito kawiri pawiri, yomwe ndi 0,030 g.

Zina zopanda piritsi zomwe zilipo ndi hydroxypropylmethyl cellulose, mamolekyulamu aerosilic, magnesium stearate, microcrystalline cellulose.

Palinso mankhwala "Glidiab" omwe amatulutsidwa mwachizolowezi cha zomwe zimagwira. Mlingo mu piritsi limodzi ndi 0.08 g wa gliclazide.

Zimagwira bwanji?

Malangizo ogwiritsira ntchito mankhwala a Glidiab MV amafotokoza mphamvu ya glyclazide, yomwe imalimbikitsa kuteteza kwa insulin m'maselo a β-cell omwe amapezeka m'mapapo.

Mothandizidwa ndi mapiritsi, ntchito ya insulin yobisa ya mamolekyulu a glucose imakulanso, ndipo minyewa yamkati mwapadera imakhudzidwa kwambiri ndi mahomoni a insulin.

Minth glycogen synthetase, kukhala intrate ya intracellular, imakhala yothandiza kwambiri. Pali kuchepa kwa gawo kuyambira pa kuyamba kudya mpaka kutulutsidwa kwa mahomoni. Insulin katulutsidwe amabwezeretsedwa ku nsonga zoyambirira, zomwe zimasiyanitsa gliclazide ndi ena am'mbuyomu sulfonylurea, zomwe zimachitika gawo lachiwiri. Mlingo wa gluprose wa postprandial umachepa.

Pali kusintha kwa ma microcirculation chifukwa cha kuphatikiza ndi kuphatikiza kwa maselo am'magazi, kusintha kwachulukidwe la khoma lamitsempha, kuchepa kwa kakulidwe ka microsrombotic ndi atherosulinosis, komanso kubwezeretsa zomwe zimachitika pakusintha kwachilengedwe kwa kuwundana kwa magazi. Kutheka kwa zomwe ma receptor amapanga m'mitsempha yamagazi kwa ma molekyulu a adrenaline amachepetsa.

Mankhwala amatha kuchepetsa matenda a shuga a retinopathy osagwirizana kwambiri. Kutalika kwa nthawi yayitali ndi mankhwalawa pokhudzana ndi kuwonongeka kwa matenda ashuga pazinthu za impso zomwe zimapangitsa kusefedwa kungachepetse kutulutsa kwa mapuloteni mumkodzo.

Mankhwalawa samachulukitsa kuchuluka kwa thupi, koma amachepetsa chifukwa cha zomwe zimachitika poyambira kutulutsa insulin. Sizipangitsa kuti insulinemia iwonjezeke.

Kodi chimagwiritsidwa ntchito ndi chiyani?

Madokotala amalimbikitsa kugwiritsa ntchito mankhwalawa ndi shuga wambiri wa digiri yachiwiri. Chithandizo chikuchitika ndi osakwanira zakudya ndi zolimbitsa thupi.

Kwa mankhwala a Glidiab MV, Zizindikirozi zimakhudzana ndi kupewa kufalikira m'matenda a matenda ashuga, omwe amadziwika ndi nephropathy, retinopathy, myocardial infarction komanso stroke.

Momwe mungagwiritsire ntchito

Mlingo wa mankhwalawa amasankhidwa wodwala aliyense payekhapayekha, poganizira mawonetseredwe a matendawa, kuchuluka kwa shuga ndi m'mimba yopanda kanthu ndi mphindi 120 mutatha kudya.

Mankhwala "Glidiab MV", malangizo omwe angagwiritsidwe ntchito amapereka mankhwala oyamba a 0,03 g, omwe ali ofanana ndi piritsi limodzi. Izi zimawonetsedwa kwa odwala okalamba atatha zaka 65. Mankhwalawa amagwiritsidwa ntchito pakumwa limodzi piritsi m'mawa.

Ngati ndi kotheka, mlingo umachulukidwa pakatha milungu iwiri iliyonse. Kutalika kwa tsiku limodzi kumaloledwa kutenga 0,2020 g, yomwe imagwirizana ndi mapiritsi 4.

Mankhwala "Glidiab MV" amagwiritsidwa ntchito m'malo mwa mankhwala a dzina lomweli ndikutulutsidwa, kudya mapiritsi a 1-4 patsiku.

Amaphatikizidwa ndi wothandizira wa hypoglycemic wozikidwa pa biguanide, alpha-glucosidase inhibitor wa mamolekyulu a insulin.

Ngati matenda aimpso ofooka ofooka kapena osakhazikika, pomwe kuchuluka kwa mankhwala a creatinine sikupitilira malita 0,080 pamphindi, mlingo wake suchepetsedwa.

Pomwe osatenga

Mapiritsi a Glidiab MV samalimbikitsidwa kuti azigwiritsidwa ntchito mu mawonekedwe oyamba a shuga mellitus, ndi kuwonjezeka kwa ma ketoni mu mkodzo, ndi gastric paresis, ndi hyperosmolar, diabetesica ndi precoma, opaleshoni yayikulu ndikuwotcha, njira zowopsa pamene insulin ikufunika chithandizo.

Contraindication kwambiri kuphwanya kwa hepatic kapena aimpso ntchito, matumbo kutsekeka, kusintha chakudya mayamwidwe, kukula kwa hypoglycemic boma.

Simungagwiritse ntchito mankhwalawa chifukwa cha chimfine, leukopenia, kutenga pakati, kuyamwitsa komanso kuleza mtima kwambiri pazomwe zimagwiritsidwa ntchito ndi mankhwala.

Muyenera kusamala mukamapereka mankhwalawa, kuyang'aniridwa kwapadera ndi kusankha kwa odwala omwe akudalira mowa komanso zovuta za chithokomiro.

Zochizira

Kwa mankhwala "Glidiab MV", malangizo ogwiritsira ntchito akuwonetsa kufunikira kwake kuphatikiza ndi zakudya zopatsa mphamvu zochepa, kuphatikizapo zakudya zamagulu ochepa. Kuwunika pafupipafupi kuchuluka kwa shuga m'magazi kuyambira m'mawa tisanayambe kudya ndikofunikira.

Ngati panali chithandizo cha opaleshoni kapena kuwonongeka kwa matenda ashuga, kuyambitsa insulin othandizira ndikotheka.

Pali machenjezo okhudza kupezeka kwa njira ya hypoglycemic ndikugwiritsa ntchito mowa wa ethyl, chinthu chosapweteka cha antiidal komanso kusowa kwa zakudya. Kumwa mowa kumatha kuyambitsa matenda a discriram, pomwe mutu ndi m'mimba zimapweteka, nseru ndi kusanza ndizotheka.

Mlingo wa mankhwalawa uyenera kusinthidwa pakukhumudwa kapena m'maganizo komanso pakudya kwakanthaŵi.
Makamaka makamaka pokhudzana ndi mankhwalawa ndi okalamba, odwala omwe alibe thanzi kapena zakudya zopanda pake, odwala ofooka omwe ali ndi vuto la kusakwanira kwa adrenal-pituitary system.

Pa magawo oyamba ogwiritsira ntchito mankhwalawa posankha mlingo, ngati pali chiyembekezo cha vuto la hypoglycemic, simuyenera kuchita zinthu zomwe zimafunikira chidwi chochulukirapo komanso kugwiritsidwa ntchito mwachangu kwa psychomotor.

Zotsatira zoyipa

Kwa Glidiab MV, malangizowa amaphatikizapo zokhudzana ndi kukhudzidwa kwa ziwalo zamkati za endocrine pakagwiridwe kake kolakwika pakugwiritsira ntchito piritsi komanso panthawi yoperewera zakudya zoyenera. Nthawi zambiri, kutsika kwa shuga m'magazi kumapangitsa kuti pakhale mutu, wotopa, wanjala, wopanda thandizo, nkhawa, kufooka pompopompo, kuchita zachiwawa, kusakhala ndi chidwi chambiri, komanso kukhumudwa. Komanso, pali kusintha kwamawonedwe owoneka, kunjenjemera, kusokonezeka kwa malingaliro, kupweteka kwa chizungulire, kuperewera kwa mpweya, kupuma kosakhazikika, ndi kuchepa kwa kugunda kwa mtima.

Matumbo osagwira ntchito m'thupi mwanjira ya malabsorption, nseru, kutsegula m'mimba, kusowa kwa chilimbikitso, kusokonekera kwa maselo a chiwindi, cholestatic jaundice, komanso kuchuluka kwa michere ya transaminase.

Njira zosafunikira mu hematopoietic system zimagwirizanitsidwa ndi kuchepa kwa hemoglobin, platinamu ndi leukocyte.

Mankhwalawa amatha kuyambitsa mawonekedwe a kuyamwa, urticaria, zotupa za maculopapular.

Kuyambitsa kowonjezera

Malangizo ogwiritsira ntchito mankhwala a Glidiab MV amachenjeza za mankhwala osokoneza bongo, omwe akuwonetsedwa ndi kuchepa kwa ndende yamagazi m'magazi am'magazi. Pogwiritsa ntchito mankhwala mopitilira muyeso, kukula kwa chikomokere kwa hypoglycemic ndikotheka.

Kuti athetse izi, munthu amaloledwa kudya ma hydrocarboni okhala ndi mafuta ambiri, mwachitsanzo, chidutswa cha shuga. Munthu akakhala kuti alibe chikumbumtima, 40% dextrose kapena glucose solution amadzipaka m'mitsempha, ndipo glucagon amadzipaka minofu yambiri 1 mg. Wodwala akamadzuka, amakakamizidwa kudya ma hydrocarbon oyamwa bwino kuti asadzabwerenso kuukira kwa hypoglycemic.

Kuphatikiza ndi mankhwala

Ntchito hypoglycemic wa medicament "Glidiab CF 30 mg wa" akhoza kumatheka mwa kuyambitsa kufanana angiotensin akatembenuka enzyme woletsa ndi Monoamine oxidase mtundu cholandilira blocker formations beta adrenozavisimyh ndi H2 gistaminozavisimyh zochokera cimetidine ndi flukonazolovyh mankhwala mikonazolovyh antifungal, si steroidal odana ndi yotupa wothandizila phenylbutazone, indomethacin, diclofenac.

Zotsatira zam'mapiritsi zimapangidwira ndi clofibrate ndi bezafibrate, anti-TB mankhwala kuchokera ku gulu la ethionamide, salicylates, anticoagulant osakanikirana a kapangidwe ka coumarin, anabolic steroids, cyclophosphamides, chloramphenicol, sulfonamides okhala ndi mphamvu yayitali.

Mankhwalawa amachepetsa shuga m'magazi pogwiritsa ntchito ma tubular blockers, ethyl mowa, acarbose, biguanide, insulin.

Kuchepetsa mphamvu ya mapiritsi a hypoglycemic kumachitika chifukwa cha barbiturates, mankhwala ozikidwa pa epinephrine, clonidine, terbutaline, rhytodrin, salbutamol, phenytoin, zoletsa za encyme ya carbonic anhydrase encyme monga acetazolamide, thiazide diuretics, mahomoni okhala ndi mankhwala ophatikizika a lithiamu.

Mamolekyu amowa a ethyl amatha kuchitika pa gliclazide ndikamachitika chinthu chofanana ndi disulfiram.

Yogwira magawo mapiritsi amachititsa kukhumudwa kosakonzekera komanso mawonekedwe amitsempha yamafupa amkati akaphatikizidwa ndi mtima glycosides.

Beta-blockers, clonidine, reserpine, guanethidine, mankhwala otsekemera a hypoglycemia.

Maganizo a odwala

Chofunikira sikuti ndi malangizo okhawo omwe angagwiritsidwe ntchito ndi mankhwala a Glidiab MV. Ndemanga zimakambirana zomwe odwala amaganiza pakugwiritsa ntchito mankhwalawa. Chida ichi chimathandiza odwala ambiri kuchepetsa kukhathamiritsa kwa glucose pamakhalidwe abwino, ndipo kuphatikiza ndi zakudya kumasintha njira yamoyo.

Anthu amadziwa kuti mawonekedwe abwino a mapiritsiwa ndiwogwiritsa ntchito mosavuta m'mawa. Masana, simungakumbukire kufunika kwa chithandizo.

Pa ndemanga za "Glidiab MV" pamatha kumveka zambiri komanso zoipa, zomwe zimagwirizanitsidwa ndi kusathandiza kwa chida ichi. Izi zimachitika kawirikawiri ngati mulingo wolakwika, pomwe mankhwala ochepa amaperekedwa.

Kupanga ndi mafomu omasulira

Yogwira: 0,03 g ya gliclazide
Othandizira: hypromellose, MCC, aerosil, E572.

Mapiritsi amtundu wamiyala yosalala yokhala ndi mbali zopindika, zoyera kapena zonona. Kuguba kotheka kwa kakhomako sikuti ndi vuto. Atakulungidwa mu zidutswa 10 m'matuza. M'matakata - 3 kapena 6 ma contour plates, ogwiritsa ntchito.

Kuchiritsa katundu

Mankhwala okhala ndi hypoglycemic malinga ndi glycazide, zotumphukira za m'badwo wachiwiri sulfonylurea. Imalimbikitsa kupanga insulin mthupi, imakulitsa chidwi cha minofu ndi insulin-chinsinsi cha glucose. Kubwezeretsanso bwino kwa insulin katulutsidwe, kusintha microcirculation, amachepetsa kuphatikiza m`mwazi, kubwezeretsa kufunika kwa mtima.

Kumwa mankhwalawa sikuthandizira kuti pakhale ndalama zowonjezera mapaundi, chifukwa zimakhudza mapangidwe apamwamba a insulin.

Njira yogwiritsira ntchito

Mankhwalawa amapangidwira chithandizo chokha cha achikulire. Mapiritsi a Glidiab MV, mogwirizana ndi malangizo ogwiritsira ntchito, amatengedwa kamodzi patsiku, amapezeka bwino kwambiri m'mawa ndi chakudya. Mapiritsiwo amametsedwa kwathunthu, sangathe kulumwa kapena kuphwanyidwa.

Ngati pazifukwa zinagalandiridwira, ndiye kuti kusinthanitsa ndi kuchotsedwaku ndikulimbikitsidwa. Piritsi loiwalika liyenera kuledzera m'mawa wotsatira. Mlingo wa mankhwalawa, monga mankhwala aliwonse a hypoglycemic, nthawi zonse amasankhidwa payekha kwa wodwala aliyense mogwirizana ndi umboni wake wa glucose wamagazi ndi hemoglobin.

Mlingo woyambirira woperekedwa ndi 30 mg tsiku lililonse. Pambuyo pake, ikhoza kusinthidwa kukhala 60, 90 ndi 120 mg. Amaloledwa kuonjezera tsiku lililonse mankhwala pokhapokha mwezi utatha mlingo woyamba. Chosiyana ndi zochitika pamene chithandizo choyambirira sichinapereke zotsatira zomwe zimayembekezeredwa, ndipo shuga ya glucose idatsalira pamlingo womwewo (mankhwala asanachitike). Panthawi imeneyi, mlingo umatha kuchuluka pambuyo - masiku 14.

HF yothandizira kukonza ndi 30-120 mg.

Ngati kuli kofunikira kusamutsa wodwala ndi Glidiab 80 mg ku mapiritsi okhala ndi nthawi yayitali (MV 30 mg), amachitika pambuyo poyang'ana kuchuluka kwa glucose pazowerengera 1: 1. Ngati wodwalayo adatenga kale mankhwala ena a hypoglycemic, ndiye kuti kusinthaku kuyenera kuchitika ndi mawerengeredwe a HF yam'mbuyomu ndi nthawi yochotsa. Palibe chifukwa chowonera nthawi yosinthira, SN yoyambirira ya Glidiab MV ndi 30 mg, pambuyo pake ikhoza kusinthidwa.

Ngati wodwala watenga mapiritsi ndi nthawi yayitali ya mankhwala othandizira, kupuma kuyenera kutengedwa kuti muchepetse zowonjezera. Pambuyo pa izi, mutha kuyamba kumwa kwa nthawi yayitali ndi mlingo wa 30 mg.

Kusintha kwa muyezo kwa odwala okalamba (65+) sikofunikira. Kwa anthu omwe ali pachiwopsezo, 30 mg ya CH imayikidwa.

Poletsa zovuta za matenda ashuga, mlingo wa tsiku ndi tsiku umatha kuwonjezeredwa mpaka mtengo wokwanira 120 mg monga njira inanso yazakudya ndi zolimbitsa thupi. Kulandila kumachitika mpaka zizindikiro zitasintha, poganizira kuopsa kwa hypoglycemia.

M'mimba, HB

Ndikosayenera kwambiri kuti azimayi azigwiritsa ntchito mankhwala amkamwa omwe amachepetsa shuga m'magazi panthawi yomwe amakhala ndi mwana, popeza palibe umboni wa chitetezo cha Glidiab MV.

Pokonzekera kutenga pakati kapena ngati zikuchitika motsutsana ndi mapiritsi a Glidiab MV, mankhwalawa ayenera kuthetsedwa ndipo mkazi ayenera kupatsidwa mankhwala a insulin.

Palibe zambiri zodalirika ngati chinthu chodalitsacho chitha kulowa mkaka wa m'mawere, chifukwa chake, ndikosayenera kwambiri kuphatikiza mankhwala a hypoglycemic ndi mkaka wa m`mawere. Panthawi yomwe mukumwa mapiritsi a HB, ayenera kuthetsedwa kuti asayambitse kuchepa kwa shuga m'magazi.

Kuchita mankhwala osokoneza bongo

Mankhwalawa ndi mapiritsi a Glidiab MV, kuthekera kwa gliclazide kuthana ndi zinthu za mankhwala ena kuyenera kukumbukiridwa.Oopsa kwambiri amatha kukhala osakanikirana ndi mankhwala omwe amathandizira zotsatira za gliclazide, popeza kuopseza kwa hypoglycemic coma kumachuluka kwambiri.

Ndi zoletsedwa kuphatikiza mankhwala a Glidiab MV ndi Miconazole (mwatsatanetsatane kapena kunja kwa mawonekedwe a gel), chifukwa izi zimapangitsa kuti pakhale kupweteka kwambiri, komwe kumatha kupha munthu.

Sizikulimbikitsidwa kuphatikiza mankhwalawa ndi phenylbutazone pazifukwa zomwezo. Iyenera kulowetsedwa ndi mankhwala ena odana ndi kutupa. Ngati ndizosatheka kuzimitsa, wodwalayo ayenera kudziwa zoopsa zomwe zingachitike komanso kufunikira kwa kuyang'anira shuga m'magazi.

Sizoletsedwa kuphatikiza ndi zakumwa kapena mankhwala osokoneza bongo a ethanol, popeza mowa umalimbikitsa kukula kwa hypa ya hypoglycemic.

Pali mankhwala angapo omwe amatha kutumizidwa mosamala limodzi ndi Glidiab MV. Mankhwalawa amaphatikizapo insulin, metformin, alpha-glucoside inhibitors, beta-blockers, sulfonamides, NSAIDs, etc. Ngati nkofunikira, kugwiritsa ntchito kwawo kuyenera kuyang'aniridwa mosamala ndi zizindikiro zosafunikira.

Danazol amakhala ndi matenda a shuga, amachepetsa mphamvu ya gliklidiza ndipo amathandizira kukulitsa kuchuluka kwa shuga m'magazi. Ngati sikutheka kusintha mankhwalawa ndi mankhwala ena, wodwalayo ayenera kuyang'anira kuchuluka kwa shuga, ngati kuli koyenera, mlingo wa Glidiab MV uyenera kusintha.

Chlorpromazine amachulukitsa shuga m'magazi ndipo amachepetsa kaphatikizidwe ka insulin. Kuwongolera kwa shuga kwa anthu odwala matenda ashuga ndikofunikira, kutsimikiza mtima kwa mlingo wa gliclazide ndi kuphatikiza kwa Glidiab MV munthawi ya mankhwala a Chlorpromazine ndipo atachotsedwa.

Mankhwala okhala ndi corticosteroids ndi njira iliyonse yogwiritsira ntchito (kunja, kwanuko, mtsempha kapena mkatikati) amalimbikitsa kuchuluka kwa glucose komanso amathandizira pakachitika ketoacidosis. Mukaphatikizidwa ndi mtundu uwu wa mankhwalawa, kuyang'anira shuga wamagazi nthawi zonse kumachitika ndipo ndikofunikira kudziwa mosamala Mlingo wabwino kwambiri panthawi yonseyi komanso pambuyo pa kutha kwa mahomoni.

Ndi maphunziro olumikizana ndi ma anticoagulants, ndizotheka kuwonjezera zochita zawo. Kusintha kwa Mlingo wofunikira.

Zotsatira zoyipa

Kutenga mapiritsi a Glidiab MV atha kutsagana ndi kusakhudzidwa kwakanthawi kwa thupi.

Monga mankhwala onse am'magulu a sulfonylurea, mankhwalawa amatha kupweteka kwambiri ngati mapiritsi atengedwa mosasamala komanso makamaka ndi zakudya zosadumphika. Zikatero, vuto limakhala limodzi ndi:

Mutu
Njala yadzaoneni
Kholingo, kusanza
Kutopa
Kusowa tulo kapena kugona
Mokwiyitsa
Chisangalalo
Kuletsa zochita
Zosokoneza
Kukhumudwa
Kusokonezeka kwa chikumbumtima, malankhulidwe ndi masomphenya
Chizungulire
Spasms
Kupuma kosapumira
Delirium
Muzovuta kwambiri, kusiya kugona ndi kufa pambuyo pake kumatha.

Komanso, wodwala amatha kukumana ndi zovuta zina:

Kuchulukitsa thukuta
Khungu kumata
Kukula kwa BP
Tachycardia
Arrhasmia
Angina pectoris.

Nthawi zina, kumwa mapiritsi kumayenderana ndi matenda osiyanasiyana a ziwalo zina:

M`mimba thirakiti: nseru, kusanza, kupweteka m'mimba, kutsegula m'mimba kapena kudzimbidwa. Popewa zinthu zosafunikira kapena kuchepetsa mphamvu, mapiritsi amalimbikitsidwa kuti amwe ndi chakudya.
Khungu: zotupa, kuyabwa, edema ya Quincke, erythema, zochita zamwano.
Hematopoietic ziwalo: kuchepa magazi, leukopenia, thrombocytopenia. Zoyenera ndizosakhalitsa: amangozipanga okha atatha kumwa mankhwala.
Chiwindi: kutsegula kwa ma enzymes, osowa - hepatitis. Ngati pali zizindikiro za cholestatic jaundice, ndiye kuti mankhwalawa ayenera kuthetsedwa.
Zambiri zamawonedwe: kuchepa kwa maonedwe owoneka (nthawi zambiri zimachitika kumayambiriro kwa maphunzirowa chifukwa cha kusintha kwa glucose).

Zotsatira zina zoyipa za sulfonylurea kukonzekera ndi izi:

Erythropenia
Anemia
Vasculitis
Hyponatremia
Agranulocytosis.

Migwirizano ndi magwiritsidwe akusungidwa

Glidiab ndi mankhwala omwe amalembedwa.

Sungani mapiritsi m'malo owuma, osagwira chinyontho ndi kuwala kwa dzuwa, pamtunda wa 25 25 º. Kutengera ndi izi, moyo wa alumali wa Glidiab ndi zaka 4, ndipo Glidiab MV ndi zaka ziwiri.

Kodi mwapeza cholakwika m'mawuwo? Sankhani ndikusindikiza Ctrl + Lowani.

Mfundo za mankhwalawa

Mankhwala ochiza matenda "okoma" a mtundu wachiwiri amapezeka mu mawonekedwe apiritsi, chinthu chachikulu chomwe chimagwiritsidwa ntchito pa mankhwala ndi glyclazide. Kuphatikizika kwa mapiritsiwa kumaphatikizanso zina zowonjezera - microcrystalline cellulose, magnesium stearate ndi zinthu zina.

Chidule "MV", chopezeka m'dzina la mankhwalawa, chikuyimira kumasulidwa. Ma Dokotala akuwunikira kuti izi zimakuthandizani kuti mumwe mankhwalawa kamodzi patsiku.

Chopanga chachikulu panthawi ya mayamwidwe amathandizira kulimbikitsa ntchito ya minofu ya glycogen synthetase komanso kupanga kwa insulin ya thupi m'thupi. Kuphatikiza apo, gawo lalikulu limasankha chinsinsi cha insulini, ndipo zimapangitsa kuti azikhala ndi chidwi chambiri.

Chosafunikanso kwambiri ndichakuti mapiritsi a Glidiab amathandizira kuchepetsa pakati pa kugwiritsa ntchito chakudya ndi kuyamba kwa insulin. Kudziwitsa za mankhwalawo kukuwonetsa kuti kugwiritsidwa ntchito kwa mankhwalawa kumatsitsa chidwi cha dziko la hyperglycemic, pomwe pakubwezeretsanso pachimake cha kupangika kwa mahomoni.

Zinthu zonsezi pamwambapa zimakhudza kagayidwe kazakudya ndi michere. Kugwiritsa ntchito mankhwala Glidiab kumachepetsa mwayi wokhala ndi kusintha kwa mitsempha ya mitsempha m'mitsempha yamagazi.

Chifukwa chachilendo cha mlingo, mlingo umodzi patsiku umatsimikizira wogwira ntchito pa plasma kwa maola 24.

Malangizo ogwiritsira ntchito mapiritsi

The abstract wa mankhwala Glidiab MB akuwonetsa kuti mankhwalawa amalimbikitsidwa pochiza matenda osokoneza bongo monga kuphatikiza ndi zakudya zama carb ochepa komanso zolimbitsa thupi zolimbitsa thupi.

Monga lamulo, mankhwala nthawi zonse amagwira ntchito ngati njira yokhayo yotsitsira shuga. Pokhapokha pokhapokha pakhoza kuvomerezedwa pazovuta za matenda. Mwachitsanzo, kuphatikiza ndi kukonzekera kochokera ku gulu la Biguanide.

Mlingo wa mankhwalawa umaperekedwa potengera shuga pamimba yopanda kanthu, komanso maola awiri mutatha kudya.

Pa Glidiab, malangizo ogwiritsira ntchito amapereka malangizo awa:

Mapiritsi akulimbikitsidwa kuti amwe kamodzi patsiku, nthawi yokwanira ndiye m'mawa musanadye.
Pafupifupi, mlingo patsiku ndi 80 mg, kuphatikiza kwa okalamba (opitilira 65).
Ngati achire zotsatira zake ndizosakwanira, ndizovomerezeka kuti pang'onopang'ono muwonjezere mlingo ndi masiku 14.
Mlingo wambiri patsiku soposa 320 mg.

Ngati wodwalayo wasokoneza ntchito ya chiwindi ndi impso, ndiye kuti kusintha kwa mankhwala a Glidiab MV sikofunikira.

Mtengo wa mankhwalawa, komwe kuchuluka kwa zinthu ndi 80 mg (mapiritsi 60 pa paketi iliyonse) ndi 134 ma ruble. Mtengo wa mapiritsi 60 mgulu la 30 mg ndi ma ruble a 130. Glidiab MB ndiyokwera mtengo kwambiri, mtengo wake ndi 60 ma PC. 80 mg iliyonse ndi ma ruble 185.

Mitu ya mankhwalawa

Muzochitika zingapo, Glidiab sakulangizidwa kuti apereke chifukwa cha kupezeka kwa ma contraindication, kuthekera kwakukulu pamavuto amkatikati mwa dongosolo lamanjenje ndi mtima.

Pankhaniyi, mankhwala ofanana amalimbikitsidwa. Zofanizira za Glidiab ndi: Fomu, Amaryl, Diabrex, Maninil, Glurenorm ndi mankhwala ena othandizira matenda a shuga.

Kusintha mankhwalawo ndi amodzi kapena mankhwala ena kuyenera kuchitika kokha ndi adokotala, palibe china.

Tiyeni tiganizire za fanizo mwatsatanetsatane:

Formetin ndi mankhwala omwe amalimbikitsidwa pochiza matenda amishuga amtundu wa 2 pomwe chithandizo chamankhwala sichitha konse. Nthawi zambiri amalimbikitsidwa kuphatikizidwa ndi mankhwala omwe amachokera ku sulfonylurea.
Mapiritsi a Maninil ali ndi chofunikira chachikulu chopanga glibenclamide, ndi zotumphukira za sulfonylurea. Mankhwala amalimbikitsa yogwira insulin, imapereka insulin yotulutsa shuga.
Glibenclamide imalembedwa mtundu wachiwiri wa matenda ashuga, pomwe sizingatheke kulipira chipangizochi kudzera mu zakudya komanso masewera. Mlingo womwe umapangidwira malinga ndi zomwe zikuwonetsa shuga, amatha kusiyanasiyana kuchokera ku 2.5 mpaka 15 mg. Kuchulukana kangapo patsiku.
Amaryl - wothandizira wa hypoglycemic, amapatsidwa mankhwala ochizira matenda amtundu wachiwiri ngati mankhwala okhawo kapena osakanikirana ndi insulin kapena metformin. Monga lamulo, chithandizo ndi mankhwalawa chimachitika nthawi yayitali.

Mankhwala Glidiab ndi ofanana nawo ndi othandiza kwambiri pochiza matenda "okoma". Komabe, limodzi ndi katundu wabwino, ali ndi zotsutsana ndi zoyipa. Chifukwa chake, kusankhidwa kuyenera kuchitidwa ndi adokotala okha.

Kumwa mapiritsi kumathandizira kuti thupi muchepetse kuchuluka kwa shuga ndikuwakhazikika pamlingo wofunikira. Koma, kuti athandize kugwiritsidwa ntchito bwino kwa mankhwalawa, wodwalayo ayenera kutsatira zakudya komanso masewera olimbitsa thupi kuti achulukitse mphamvu ya minofu yofewa.

Kodi mukuganiza bwanji pamenepa? Ndi mankhwala ati omwe adanenedwa ndi adotolo anu, ndipo munganene chiyani za izi molingana ndi zomwe mwakumana nazo?