Othandizira a Glucocorticoid > Chithandizo ndi kupewa

Kapangidwe kake ka GCS kamalumikizidwa ndi kuthekera kwawo kuthana ndi ma receptor enaake mu cytoplasm ya cell: steroid - receptor tata imalowa mkati mwa cell nucleus, imamangiriza ku DNA, zomwe zimakhudza kusintha kwa mitundu yosiyanasiyana ya majini, zomwe zimabweretsa kusintha kwa kapangidwe ka mapuloteni, ma enzyme, ma acid. GCS imakhudza mitundu yonse ya kagayidwe, imakhala ndi anti-yotupa, anti-allergic, anti-shock ndi immunosuppression.

Limagwirira a odana ndi yotupa zotsatira za corticosteroids ndi kupondereza magawo onse a kutupa. Mwa kukhazikika kwa zimimba za ma cell ndi ma subcellular,, incl. lysis, mankhwala a antiidal a kutupa amateteza kutulutsidwa kwa ma enzymes a proteinolytic mu cell, kuletsa mapangidwe a okosijeni a okosijeni aulere ndi lipid peroxides mu nembanemba. Pakuwala, corticosteroids amachititsa ziwiya zazing'ono ndikuchepetsa ntchito ya hyaluronidase, potero kuletsa gawo la kukwiya, kuletsa kudziphatikiza kwa neutrophils ndi monocytes ku vasot endumheli, kutsitsa malowedwe awo mu minofu, ndikuchepetsa ntchito ya macrophages ndi ma fibroblasts.

Pakhazikitsa ntchito yotsutsa-kutupa, gawo lofunikira limachitika ndi kuthekera kwa GCS poletsa kaphatikizidwe ndi kumasulidwa kwa oyimira pakati otupa (PG, histamine, serotonin, bradykinin, ndi zina). Amayambitsa kapangidwe ka lipocortins, zoletsa za phospholipase A2 biosynthesis, ndikuchepetsa mapangidwe a COX-2 poyang'ana kutupa. Izi zimapangitsa kuti amasulidwe ochepa a arachidonic acid kuchokera ku ma phospholipids a membrane wam'mimba ndikuchepa kwamapangidwe ake a metabolites (PG, leukotrienes ndi platelet activation factor).

GCS ikhoza kuletsa kuchuluka, chifukwa amaletsa kulowa kwa monocytes mu minofu yovulazidwa, kuletsa kutenga nawo gawo kwakutupa, kuletsa kaphatikizidwe ka mucopolysaccharides, mapuloteni ndikuletsa njira za lymphopoiesis. Ndi kutupa kwa genesis yopatsirana ya corticosteroids, chifukwa cha kupezeka kwa immunosuppressive, ndikofunika kuphatikiza ndi antimicrobial mankhwala.

Mphamvu ya immunosuppressive ya GCS imatheka chifukwa cha kuchepa kwa kuchuluka ndi ntchito za T-lymphocyte zomwe zikuzungulira m'magazi, kuchepa kwa kupanga ma immunoglobulins ndi zotsatira za othandizira a T pa B-lymphocyte, kuchepa kwa zomwe zimakwanira m'magazi, kupangika kwa chitetezo chokwanira cha chitetezo cha mthupi ndi kuphatikizika kwa ma protein ambiri. .

Mphamvu yakale ya corticosteroids imayamba chifukwa cha kuchepa kwa kuchuluka kwa ma basophil ozungulira, kuphwanya kwa mgwirizano wa Fc receptors womwe uli pamtunda wa maselo am'mimba ndi Fc dera la IgE ndi gawo la C3 lolumikizira, lomwe limalepheretsa chizindikirochi kulowa cell ndipo chikuyenda ndi kuchepa kwa kumasulidwa kwa histamine, heparin, ndi seroton ndi ena oletsa matupi a ziwonetsero za mtundu wina ndipo amalepheretsa kusintha kwawo pama cell.

Zotsatira zakutsutsana ndi chifukwa cha kutenga nawo gawo kwa GCS pakuwongolera kamvekedwe ka mtima, motsutsana ndi kumbuyo kwawo, chidwi cha mitsempha yamagazi kupita ku catecholamines imawonjezereka, zomwe zimabweretsa kuwonjezeka kwa kuthamanga kwa magazi, kusintha kwa mchere wamchere, sodium ndi madzi zimasungidwa, kuchuluka kwa plasma ndi hypovolemia kumachepa.

Kulekerera ndi mavuto

Gulu la mankhwalawa nthawi zambiri limayambitsa mavuto: kuponderezanso mphamvu za thupi, kuchulukitsa kwa matenda opatsirana a m'matumbo ndi matenda amkamwa ndikotheka. Ndi kugwiritsa ntchito nthawi yayitali, kuchuluka kwa kuthamanga kwa magazi, kukula kwa matenda a shuga a steroid, edema, kufooka kwa minofu, myocardial dystrophy, matenda a Itsenko-Cushing's, adrenal atrophy ndikotheka.

Nthawi zina mukamamwa mankhwalawa, pamakhala kusokonezeka, kusowa tulo, kuchuluka kwa mavuto obisika, psychosis. Ndi kugwiritsa ntchito nthawi yayitali corticosteroids, kaphatikizidwe ka mafupa ndi calcium-phosphorous zimatha kusokonekera, zomwe pamapeto pake zimayambitsa matenda a mafupa komanso ziwongo.

Contraindication

Hypersensitivity.
Matenda owopsa.
Matenda a fungal ndi fungal.
Chifuwa chachikulu.
Edzi
Zilonda zam'mimba, kukhetsa m'mimba.
Mitundu ikuluikulu ya matenda oopsa.
Itsenko-Cushing's syndrome.
Yade
Syphilis
Matenda a shuga.
Matendawa
Mimba
Kuyamwitsa.
Psychoses pachimake.
Ana aang'ono.

Mukamagwiritsa ntchito:

Zilonda zopatsirana (bacteria, viral, fungal) pakhungu ndi mucous nembanemba.
Thupi lakhungu.
Kuphwanya umphumphu wa khungu ndi mucous nembanemba.
Ana aang'ono.

Kuchita

GCS imalimbikitsa bronchodilating zotsatira za β-adrenostimulants ndi theophylline, amachepetsa mphamvu ya insulin ndi mkamwa antidiabetesic othandizira, anticoagulant ntchito ya coumarins (yosalunjika anticoagulants).

Diphenin, ephedrine, phenobarbital, rifampicin ndi mankhwala ena omwe amachititsa kuti michere ya chiwindi yama microsomal ifupikitse T1 / 2 GCS. Kukula kwa mahomoni ndi ma antacid amachepetsa kuyamwa kwa corticosteroids. Akaphatikizidwa ndi mtima glycosides ndi okodzetsa, chiopsezo cha arrhythmias ndi hypokalemia chimawonjezeka, akaphatikizidwa ndi NSAIDs, chiopsezo cha kuwonongeka kwa m'mimba komanso kupezeka kwa magazi m'mimba kumawonjezeka.

Limagwirira ntchito ndi waukulu pharmacodynamic zotsatira

Glucocorticoids imasokoneza ma membrane am'mimba mu cytoplasm ndikumangirira ku glucocorticoid receptors enieni. Zomwe zimapangidwira zovuta zimalowa mu nucleus ndikuthandizira kupangidwa kwa i-RNA, komwe kumabweretsa kuphatikizidwa kwa mapuloteni angapo owongolera. Zinthu zingapo zogwira ntchito yogwiritsa ntchito kwachilengedwe (ma catecholamines, ma mediator otupa) zimatha kuyambitsa zovuta za glucocorticoid-receptor, potero zimachepetsa ntchito ya glucocorticoids. Zotsatira zazikulu za glucocorticoids zili motere.

• Zowononga chitetezo chathupi.

- Anti-yotupa zotsatira (makamaka ndi matupi awo sagwirizana ndi kutupa) chifukwa cha kusokonekera kwa PG, RT ndi ma cytokines, kutsika kwa kuvomerezedwa kwa capillary, kuchepa kwa chemotaxis yama cell a immunocompetent ndi kuletsa ntchito ya fibroblast.

- Kuponderezedwa kwa chitetezo chokwanira kwa ma cell, ma autoimmune zimachitika pakapangidwa kazinthu, kuchepa kwa ntchito ya T-lymphocyte, macrophages, eosinophils.

• Zotsatira pamadzi-electrolyte metabolism.

- Kuchepetsa thupi la sodium ndi ayoni amadzi (kuchuluka kubwezeretsanso mu distal aimp tubules), kuyamwa kwathanzi kwam potaziyamu (mankhwala omwe ali ndi mineralocorticoid ntchito), kukulitsa thupi.

- Kuchepa kwa mayamwidwe amchere a calcium ndi chakudya, kuchepa kwa zomwe zili m'matumbo am'mafupa (mafupa), komanso kuwonjezeka kwa kwamikodzo.

• Zowononga zochita za metabolic.

- Kwa lipid kagayidwe - kugawa mafuta a adipose minofu (kuchuluka kwa mafuta kumaso, khosi, lamba, phewa), hypercholesterolemia.

- Kwa kagayidwe kazakudya - kukondoweza kwa gluconeogenesis m'chiwindi, kuchepa kwa kupezeka kwa ma membrane am' cell a glucose (kukula kwa matenda a shuga a steroid ndikotheka).

- Kwa kagayidwe kazakudya mapuloteni - kukondoweza kwa anabolism mu chiwindi ndi njira za catabolic mu minofu ina, kuchepa kwa zomwe ma globulins amapezeka m'magazi.

• Zotsatira za CVS - kuthamanga kwa magazi (kuthamanga kwa magazi) chifukwa cha kusungunuka kwa madzi m'thupi, kuchuluka kwa kachulukidwe ndi chidwi cha adrenoreceptors mu mtima ndi m'mitsempha yamagazi, komanso kuchuluka kwa Pressor a angiotensin II.

• Zotsatira pa hypothalamus-pituitary-adrenal gland system - zoletsa chifukwa cha mayankho olakwika a mayankho.

• Kukhudzidwa kwa magazi - lymphocytopenia, monocytopenia ndi eosinopenia, nthawi yomweyo glucocorticoids amalimbikitsa kuchuluka kwa maselo ofiira amwazi, kuonjezera kuchuluka kwa ma neutrophils ndi mapulateleti (kusintha kwa ma cell a magazi kumawonekera mkati mwamaola 6 mpaka 6 pambuyo pa kukhazikitsidwa ndikupitilira nthawi yayitali kugwiritsa ntchito mankhwalawa masabata angapo).

Glucocorticoids yogwiritsidwa ntchito kwazinthu samasungunuka bwino m'madzi, yabwino m'mafuta ndi zina zowonjezera zachilengedwe. Zimayenda m'magazi makamaka mu boma. Mitundu yovomerezeka ya glucocorticoids ndi masisiti osungunuka ndi madzi kapena mchere (zothandiza, hemisuccinates, phosphates), zomwe zimapangitsa kuti ayambe kugwira ntchito mwachangu. Zotsatira zamayimidwe ocheperako a glucocorticoids amakula pang'onopang'ono, koma amatha mpaka miyezi 0.5-1, amagwiritsidwa ntchito jakisoni wa intraarticular.

Glucocorticoids pakakonzedwe kamlomo imayamwa bwino kuchokera m'mimba, C_mosamala m'magazi, zimadziwika pambuyo pa maola 0,5-1.5. Chakudya chimachepetsa mayamwidwe, koma sizikhudzanso kukhudzana kwa mankhwala a bioavailability (tsamba 27 mpaka 15).

KUSUNGA KWA Glucocorticoids Yolembedwa ndi MeTHOD OF APPLICATION

1. Glucocorticoids ogwiritsira ntchito apakhungu:

A) kugwiritsa ntchito pakhungu (monga mafuta, kirimu, emulsion, ufa):

- fluocinolone acetonide (sinaflan, flucinar)

- flumethasone pivalate (lorinden)

- betamethasone (celestoderm B, celeston)

B) kuti azilowetsa m'maso ndi / kapena khutu, ngati mawonekedwe amafuta amaso:

- betamethasone n (betamethasone dipropionate, etc.) B) pakugwiritsa ntchito inhalation:

- beclomethasone (beclometh, becotide)

- fluticasone propionate (flixotide)

D) makonzedwe a intraarticular:

D) yoyambitsa kuyambitsa minofu ya periarticular:

Zotsatira zaabolism

Glucocorticoids ali ndi anti-nkhawa, odana ndi nkhawa. Mwazi wawo umakwera kwambiri ndikapanikizika, kuvulala, magazi, komanso manjenje. Kuwonjezeka kwa milingo imeneyi munthawi imodzi ndi imodzi mwazinthu zomwe zimapangitsa kuti thupi lizisinthasintha, kutaya magazi, kulimbana ndi kugwedezeka ndi zotsatira za kuvutika. Glucocorticoids imachulukitsa magazi mwatsatanetsatane, imawonjezera chidwi cha myocardium ndi makoma amitsempha kuti ma katecholamine, komanso kupewa desensitization of receptors kuti azikhala pa Catecholamines pamlingo wawo waukulu. Kuphatikiza apo, glucocorticoids imathandizanso erythropoiesis m'mphepete mwa mafupa, zomwe zimathandizira kuti magazi abwererenso mwachangu.