Matenda a mahomoni

Kugawika kwa mankhwalawa: m'badwo woyamba komanso wachiwiri, ndipo m'badwo woyamba sugwiritsidwa ntchito masiku ano chifukwa cha kuchuluka kwa zovuta zoyipa, pomwe ma analogu aposachedwa amakhala ndi njira zabwino zochizira komanso zotsika za zizindikiro zoyipa.

Kapangidwe ndi kapangidwe ka zochita

Sulfonylurea zotumphukira, mankhwala omwe amangoyambitsa maselo a pancreatic athanzi okha. Makina awo amachitidwe ndikuyambitsa kutulutsa insulin ndi gland. Kuti tichite izi, ndikofunikira kutseka njira zomwe sizimalola calcium kulowa cell ndikuzilepheretsa kukhumudwa kwake. Talandira calcium, khungu limakhala losangalala ndikuyamba kupanga insulin, yomwe mu shuga mellitus imakhala yambiri m'magazi chifukwa cha kuchepetsedwa kwa chidwi cha insulin.

Mu matenda a shuga, shuga amalowa m'magazi ndi ziwalo, koma insulin yokwanira silingamwe. Mankhwala omwe ali ndi sulfonylurea mu kapangidwe kake amasiya kuyipa kwamizere iyi.

Chifukwa chake, zoyambitsa zazikulu zomwe zimaperekedwa ndi mankhwala opangidwa kuchokera ku sulfonylurea ndi:

• Kukondoweza kwa khungu la pancreatic
• Tetezani insulini ku ma enzymes ndi ma antibodies omwe amuphwanya,
• Yambitsani mapangidwe a receptor a insulin ndi chidwi cha maselo kwa icho,
• Amalepheretsa gluconeogeneis, ndiko kuti, kaphatikizidwe ka glucose kuchokera kuzinthu zina, komanso amachepetsa kuchuluka kwa matupi a ketone.
• Pewani kuwonongeka kwa mafuta,
• Mofananamo, kubisala kwa glucagon wa pancreatic ndi somatostatin ndi kotsekedwa,
• Wonjezerani thupi ndi zinc, chitsulo.

Mndandanda wamankhwala a m'badwo woyamba:

• Carbutamide
• Tolbutamide
• Chlorpropamide
• Tolazamide

Mankhwala a gululi amalangizidwa kuti azichiza matenda a shuga 2 okha, komwe kumapangitsa chidwi cha maselo a insulin. Pankhani ya matenda a shuga amtundu woyamba, kapamba sangathe kugwira ntchito zake zonse.

Zofunika! Itha kutumikiridwa ngati monotherapy, kapena kuphatikiza ndi mankhwala a magulu ena, koma ndizovomerezeka kuti utenge mankhwala angapo kuchokera pagulu lomwelo nthawi imodzi.

Amakhulupirira kuti matendawa ndi osalamulirika, popita nthawi yayitali, osagwiritsa ntchito mankhwala ena omwe ali ndi matenda ashuga, ndichizindikiro cha kuperekedwa kwa mankhwalawa omwe afotokozedwa m'nkhaniyi.

Contraindication ndi zoyipa

Chifukwa chakuti mankhwalawa amakonzedwa kudzera m'chiwindi komanso kumapitirira impso, chithandizo chamankhwala chimapangidwa mu matenda amkodzo komanso amisala pangozi.

Komanso, simungathe kupereka mankhwalawa:

• Ana ochepera zaka 18, popeza zotsatira za thupi laana sizinafotokozedwe bwino.
• Amayi oyembekezera komanso nthawi yotsira (monga izi zatsimikiziridwa kuti sizingachitike ndi mwana wakhanda),
• Mtundu woyamba wa shuga.

Mlingo ndi makonzedwe

Mankhwala amapezeka pamapiritsi, amatengedwa pakamwa. Mlingo umatengera mtundu wa mankhwala omwe waperekedwa, mawonekedwe ake ndi momwe wodwalayo alili, zotsatira za kusanthula kwake, matenda okhudzana ndi zina.

Njira zopewera kupewa ngozi

Ndikofunikira kwambiri kuwunikira nthawi ndi nthawi osati kungoyendetsa bwino maphunzirowa, komanso kusamala pochiza matenda a shuga kwa anthu omwe ali ndi matenda a chiwindi ndi impso. Chifukwa cha kuchepa kwa ntchito ya ziwalozi, kuchuluka kwa mankhwala omwe ali m'magazi kumatha kuwonjezeka ndikumayambitsa zotsatira zoyipa.

Amayi oyembekezera ayenera kusiya kugwiritsa ntchito gulu la data la othandizira a hypoglycemic ndikusintha insulin panthawi yakubala ndi kudyetsa mwana.

Kuphatikiza pa matenda ashuga, okalamba ndi odwala omwe ali ndi matenda osachiritsika ayenera kusamala kuti apereke gulu ili la mankhwalawa chifukwa choopsa kwambiri cha hypoglycemia komanso kuvuta kwa kukhazikitsa mlingo woyenera.

Kuchita kwa PSM ndi mankhwala ena

Ndikofunika kuwunika mosamala kuphatikiza kwa mankhwalawa ndi mankhwala ena, makamaka pofotokoza chithandizo cha matenda angapo okhalitsa.

Magulu ena a mankhwala amatha kupangitsa kuti zochita za sulfonylurea zotumphukira kapena mosemphanitsa, zilepheretse zomwe akuchita, zomwe zimafuna kuti azigwiritsidwa ntchito.

Kuti akhazikitse njira yolondola yothandizira mankhwalawa, ndikofunikira kuti endocrinologist iphunzire mosamala zomwe akatswiri ena adalemba komanso mndandanda wazomwe mankhwala omwe wodwala amatenga nthawi zonse.

Othandizira ena a hypoglycemic, kuphatikiza pazomwe zimachokera ku sulfonylurea, ndi magulu a mankhwala omwe amapangidwanso omwe amakhudzanso kuteteza kwa insulin.

“Dmitry, wazaka 67. Posachedwa, matenda a shuga adakula kwambiri, adagonekedwa kuchipatala ndimatenda a shuga komanso mtima, masomphenya. Dokotala adawonjezeranso glibenclamide ku metformin. Ndakhala ndikumwa kwa miyezi yopitilira itatu. Shuga wagwera, nseru ndi nkhawa pang'ono, koma osati mpaka kuletsa mankhwalawo. Ndili wokondwa kuti shuga yatha. "

“Andrey, wazaka 48. Ndadwala zaka zoposa zisanu. Kwa nthawi yayitali, ngakhale mlingo waukulu wa "metformin" unaleka kupititsa shuga pamlingo woyenera. Ndinayenera kuwonjezera glimepiride, zidakhala zosavuta. Shuga adagwa ndipo amakhalabe okwanira 7-7.5, osakhala ndi zotsatirapo zoyipa. Nthawi ndi nthawi ndimafufuza za matenda anga, ndimayesedwa ndipo ndimakakumana ndi dokotala, amene akuti ndikuchita bwino. ”

“Elena, wazaka 41. Ndakhala ndikudwala kwa nthawi yayitali, ndidayesa mankhwala ambiri nthawi imeneyi, koma nditasintha "glyclazide", kukhazikika kudafika. Mayeso onse adayamba kukhala abwinobwino, ndipo tsopano zakwanitsa kuchepetsa kuchuluka kwake komanso kukhala ndi glucose yachilendo pakudya ndi masewera olimbitsa thupi. ”

Mitundu yambiri ndi choloweza mmalo osiyanasiyana. Mitengo imachokera ku ma ruble 60-350 phukusi lililonse. Njira ya mankhwalawa imafuna ndalama zambiri komanso mitundu yambiri ya mankhwala. Kugulitsa ndi mankhwala okha. Asanakhazikitsidwe, endocrinologist amachita kufufuza mozama ndi mayeso, mayeso a labotale kuti akhazikitse kufunika kosankhidwa kwa zotengera za sulfonylurea.

M'magawo oyamba, matenda a shuga amatha kuyimitsidwa ndikudya mwamphamvu komanso masewera olimbitsa thupi. Ngati wodwala sangathe kuwongolera glucose motere, amamulembera mankhwala. Amayamba ndi mlingo wochepa, mkhalidwe wa wodwalayo ndikuwonetsetsa kwake kwa chithandizo kumayendera.

Ngati chithandizo chotere sichikuletsa matendawa, ndiye kuti dotolo amayamba kulandira mankhwala oopsa, "tolbutamide" ndi mankhwala ofananawo akuphatikizidwa m'gulu lawo. Asanaikidwe, ndikofunikira kudziwa mtundu wa kapamba, chiwindi ndi impso. Chifukwa chakuti kukondoweza kwambiri kwa insulin katulutsidwe kumayamba, kuphwanya magwiridwe antchito a maselo a beta ndikotheka. Kuphatikiza apo, ndikofunikira kuti ntchito ya ziwalo zomwe kagayidwe ka mankhwala zipitirire.

Limagwirira zake zochita sulfonylurea zotumphukira.

1. Limbikitsani maselo a beta a kapamba (omwe amasunga kuchuluka kwa insulin m'magazi, kuonetsetsa kuti amapanga insulin mwachangu) ndikuwonjezera chidwi chawo ndi glucose.

2. Limbikitsani zochita za insulini, pondani ntchito ya insulinase (enzyme yomwe imaphwanya insulin), kufooketsa kulumikizana kwa insulin ndi mapuloteni, kuchepetsa kumanga kwa insulin ndi ma antibodies.

3. Kuchulukitsa kuzindikira kwa minofu ndi ma adipose minofu yolandila kwa insulin, kuonjezera kuchuluka kwa zolandirira ma insulin.

4. Kupititsa patsogolo kagwiritsidwe ntchito ka glucose mu minofu ndi chiwindi poyambitsa insulin.

5. Kuletsa kutulutsa kwa glucose m'chiwindi, kuletsa glucoseo m'thupi kuchokera kumapuloteni, mafuta ndi zinthu zina zopanda mafuta), ketosis (kuchuluka kwa matupi a ketone) m'chiwindi.

6. Mu adipose minofu: ziletsa lipolysis (kuthyoka kwamafuta), ntchito ya kupanga triglyceride lipase (enzyme yomwe imaphwanya triglycerides kupita ku glycerol ndi mafuta achilengedwe omasuka), imathandizira mayamwidwe ndi oxidation wa glucose.

7. Pondani zochita za maselo a alpha a islets a Langerhans (ma alpha sec sec glucagon, insulin antagonist).

8. Kanikizani secattion somatostatin (somatostatin linalake ndipo tikulephera katemera wa insulin).

9. Kuchulukitsa zomwe zili m'madzi a m'magazi a zinc, iron, magnesium.

Amalepheretsa zotsatira za hypoglycemic.

• Niacin ndi zotumphukira zake, ma saluretics (thiazides), mankhwala othandizira,
• indomethacin, mahomoni a chithokomiro, glucocorticoids, sympathomimetics,
• barbiturates, estrogens, chlorpromazine, diazoxide, acetazolamide, rifampicin,
• isoniazid, mahomoni oletsa kubereka, mchere wa lithiamu, calcium blockers.

Sulfonylureas zochizira matenda amitundu iwiri

Sulfonylurea mankhwala limagwirira ntchito

Mankhwala onse m'gululi amagwira makamaka pamaselo a beta a kapamba.

• Mankhwalawa amapangidwa m'maselo a pancreatic (otchedwa SUR1 receptor) motero amalimbikitsa katemera wa insulin. Izi zimapangitsa kuti magazi azikhala ndi insulin yambiri, zomwe zimachepetsa shuga m'magazi.
• Izi ndizotheka pokhapokha ngati ma cell a pancreatic amatha kupanga ndikutulutsa insulini.
• Chifukwa chake, mankhwalawa sagwira ntchito ndipo samapereka mtundu wa matenda ashuga 1.
• Monga mukudziwa, ndi mtundu wachiwiri wa matenda ashuga, maselo a beta "atha" ndipo sangathe kutulutsa insulin pakapita nthawi. Pankhaniyi, zidzafunika kubwezeretsanso insulin mthupi mwa jakisoni wotsekemera, ndipo kugwiritsa ntchito sulfonylurea kumakhala kopanda ntchito.
• Kuphatikiza apo, kafukufuku wasonyeza kuti mankhwalawa amatha kukulitsa chidwi cha chiwindi, minofu ndi maselo amafuta kupita ku insulin.

Mankhwala a Sulfonylureas omwe amaperekedwa

Mankhwala osokoneza bongo amalimbikitsidwa ngati muli ndi matenda amtundu wa 2 ndipo simungagwiritse ntchito Metformin chifukwa cha zotsutsana kapena ngati muli ndi zovuta zina.

Komabe, pankhani iyi (makamaka ngati mukunenepa kwambiri kapena onenepa kwambiri), pakhoza kukhala mankhwala ena othandiza kuchokera ku gulu la DPP-4 inhibitors (Trajenta, Onglyza, Kombolyze, Januvia, Galvus) kapena SGLT-2 inhibitors (Forxiga, Attokana) - chifukwa musachulukitse kulemera, mosiyana ndi sulfonylureas.

Mu shuga mellitus, ngati mukumwa mankhwala a metformin, samalani zakudya zanu ndikuchita masewera olimbitsa thupi pafupipafupi, komabe mulingo wanu wamagazi uli pamilingo yovomerezeka, zotumphukira za sulfonylurea zingathenso kukhala gawo lotsatira la chithandizo.

Contraindication

Zotumphukira za Sulfonylurea siziyenera kugwiritsidwa ntchito motere:

• Hypersensitivity to sulfonylurea kapena maantibayotiki ochokera ku gulu la sulfonamide (ngati muli ndi vuto losagwirizana ndi maantibayotiki monga Bactrim, Biseptol, Trimesan, Uroprim - muyenera kudziwitsa dokotala)
• Mtundu woyamba wa shuga
• Ketoacidosis
• Matenda owopsa a hepatic komanso / kapena aimpso (kupatula glycidone, yemwe amachokera ku bile, choncho amatha kugwiritsidwa ntchito ngati pali kulephera kwa impso),
• Mimba komanso kuyamwa.

Mankhwalawa omwe ali pamwambapa sayenera kugwiritsidwanso ntchito ngati kufunika kwa insulin ya thupi kumawonjezeka - mwachitsanzo, ndi matenda oopsa kapena opaleshoni. Muzochitika izi, dokotala angalimbikitse kugwiritsa ntchito insulin kwakanthawi.

Zothandiza kuchokera ku sulfonylureas momwe angatenge

Mankhwala onse m'gululi amatengedwa pakamwa.

• Amayenera kumwedwa nthawi yochepa asanadye kapena zakudya.
• Glimepiride ndi Gliclazide kumasulidwa kosatha (mwachitsanzo, Diaprel MR) amatengedwa 1 nthawi tsiku lililonse m'mawa.
• Gliclazide imagwiritsidwa ntchito kawiri tsiku lililonse.
• Njira yogwiritsira ntchito glycidone ndi glipizide zimatengera mlingo womwe umalimbikitsa - Mlingo wocheperako ungathe kutumikiridwa koposa 2 kapena katatu patsiku.
• Nthawi zambiri, dokotalayo amalimbikitsa koyamba mlingo wa mankhwalawa, womwe umatha kuwonjezeredwa ngati phindu la mankhwalawo limakhala lofooka kwambiri (mwachitsanzo, ma shuga omwe adakali ochepa kwambiri).
• Ngati mukuyiwala kumwa mankhwalawa, musonjezere mlingo wotsatira. Izi zimaphatikizidwa ndi chiopsezo cha hypoglycemia.
• Osadzisilira. Mlingo umayikidwa kokha ndi omwe amakuthandizani pazaumoyo.

Ubwino wogwiritsa ntchito gululi:

• kuchepetsa shuga
• zotsatira zabwino pakubwezeretsanso kwa shuga - m'magazi ochepa a hemoglobin otsika ndi 1-2% (ofanana ndi metformin),
• Zotsatira zina za mankhwala omwe amaphatikizidwa ndi kuchuluka kwa minyewa ya insulin,
• njira yovomerezeka
• mtengo wololera.

Zotsatira zoyipa za Sulfonylurea Derivatives

Zotsatira zoyipa kwambiri ndi chiopsezo cha hypoglycemia. Chiwopsezo cha hypoglycemia chimawonjezeka ngati mumwa mankhwala owonjezera, monga acenocumarol kapena warfarin, maantibayotiki ena, aspirin, kapena mankhwala ena osapweteka a antiidal, monga ibuprofen.

Kuphatikiza apo, chiwopsezochi chikuwonjezeka pambuyo pokumana zolimbitsa thupi, kumwa moŵa komanso ngati kupezeka kwa matenda a chithokomiro kapena kudya kosayenera.

Chinanso choopsa chogwiritsa ntchito sulfonylurea ndi kuwonjezeka kwa thupi, komwe sikofunika kwenikweni pankhani ya matenda ashuga, chifukwa kumawonjezera kukana insulini.