Pa kukakamizidwa mankhwala Enap ndi malangizo kwa mankhwala

Matenda oopsa a arterial ndi matenda omwe amadziwika ndi kuwonjezeka kwa kupsinjika ndi kuwonongeka kwa ziwalo zolimbana ndi chidwi. Choyambitsa chimodzi cha matenda sichinafotokozedwe, chifukwa chake, muzochita zamankhwala, mankhwalawa amagwiritsidwa ntchito omwe cholinga chake ndi kuthana ndi zolumikizana za pathogenesis. Enap ndi mankhwala amakono oyambira mu mzere woyamba omwe amagwiritsidwa ntchito kwambiri ndi odwala chifukwa cha chitetezo, kugwiritsa ntchito bwino komanso mosavuta.

Malangizo ogwiritsira ntchito mankhwalawa

"Enap" ndi dzina lenileni la mankhwala, omwe amagwira ntchito omwe ali enalapril - zochokera ku maleic acid. Chida chimenecho ndi cha gulu la zoletsa (kutsitsa) angiotensin-kutembenuza enzyme (ACE inhibitor), kachitidwe ka kamene kamapangidwa patebulopo.

Kuphatikiza apo, mankhwalawa ali ndi mphamvu ya antifibrillatory ndipo amalepheretsa kukonzanso kwa myocardial (kukonzanso) pambuyo pa kugunda kwa mtima, ndi zodwala zatsopano kapena zopezedwa.

"Enap" imapezeka mu mawonekedwe a piritsi yokhala ndi mulingo wosiyanasiyana wa chinthu chogwira ntchito komanso kuphatikiza ndi njira zina zogwiritsidwa ntchito mosavuta, kuti mukwaniritse zolinga zochizira.

Gulu la ACE inhibitor ndi la mzere woyamba wa mankhwala ochizira matenda oopsa. "Enap" ndi nthumwi ya kalasi yachiwiri yokhala ndi mphamvu yayitali (maola oposa 24) ndipo imayikidwa kamodzi patsiku.

Chida chimagwiritsidwa ntchito pochiza:

• matenda oopsa a arterial - kuwonjezereka kosalekeza kwa zizindikiro popanda chifukwa chodziwika (zinthu zoopsa zokha zimaperekedwa),
• Cohn's syndrome ndi hyperaldosteronism yoyamba - endocrine pathologies omwe amadziwika ndi kuphatikizika kwa aldosterone,
• matenda a shuga - nephropathy - kuphwanya kwa kusefera kwa matumbo a kagayidwe kachakudya,
• Kulephera kwa mtima kosatha - mankhwalawa amathandizira mphamvu ya ejection osakhudza pafupipafupi,
• yachiwiri matenda oopsa okhala ndi zofooka zopindika,
• matenda a impso ndi gulu la matenda omwe amadziwika ndi njira yayitali yopitilira komanso kuchepa kwa kusefukira kwa glomerular.

"Enap" - njira yoyendetsera matenda oopsa, omwe amayamba kugwira ntchito 1 ora litatha. Mankhwalawa sagwiritsidwa ntchito kuletsa mavuto obwera chifukwa cha matenda.

Mlingo ndi makonzedwe

Mankhwala amapezeka mu mawonekedwe a mapiritsi okhala ndi magawo osiyanasiyana a yogwira - Enalaprilat (2.5-5-10-20 mg). Zinthu zothandiza: magnesium stearate, wowuma chimanga, sodium bicarbonate, chikasu ndi chofiira chitsulo okusayidi (utoto wa mapiritsi 20 mg), talc ndi lactose monohydrate.

Mankhwalawa amapangidwira pakamwa pakamwa kamodzi patsiku popanda kumangiriza kudya. Kusankhidwa kwa mlingo ndi regimen zimagwirizanitsidwa ndi adokotala.

Enap - mapiritsi a 5mg ndi osalala, ozungulira mawonekedwe ndi chopindika. Mtundu - oyera, opanda zoipitsa zina, mbali imodzi - kugawa Mzere.

Mankhwalawa amapezeka pabokosi lamakatoni: mapiritsi 20 okhala ndi matuza a zidutswa 10.

Mlingo wothandiziridwa ukupezeka patebulopo.

Mulingo woyenera kwambiri wa 40 mg ndi mapiritsi 8, owonjezera omwe amatsatana ndi zizindikiro za bongo (hyperkalemia, orthostatic hypotension, ndi ena).

Mlingo 10 mg

Mapiritsi okhala ndi muyezo wa enalaprilat 10 mg - wofiirira-wofiirira komanso wazungu. M'mphepete mwa kukonzekera akuwonetsedwa, mbali imodzi ya nkhope pali gawo logawanitsa.

Cholinga cha Enap 10 mg pamatenda osiyanasiyana chimaperekedwa pagome.

Enap HL ndi H

Chithandizo cha ochepa matenda oopsa zimaphatikizanso kusankha mankhwala osakaniza. Kuphatikiza kopambana kwambiri kwa ACE inhibitors ndi diuretics kumaganiziridwa.

KRKA imatulutsa Enap N ndi Enap HL, omwe amakhala ndi mankhwala a enalaprilat ndi hydrochlorothiazide (mankhwala a mtundu wa thiazide kuchokera ku gulu la okodzetsa).

Fomu yotulutsidwa imawonetsedwa pagome.

Kukhazikitsidwa kwa regimen ya kuvomereza kumadalira kuuma kwa matenda ndi kukhalapo kwa matenda oyanjana. Ambiri achire mlingo ndi piritsi 1 patsiku.

Kuphatikiza kwa ma inhibitors a ACE omwe ali ndi diuretics amadziwika kuti ndi othandiza kwambiri pa matenda othandizira okalamba.

Contraindication

"Enap" amatanthauza gulu la zoletsa zoletsa za ACE zomwe zimagwira pama cell a thupi lonse. Kugwiritsa ntchito mankhwalawa ndizochepa kwa odwala omwe:

• thupi lawo siligwirizana ndi yogwiritsa ntchito mankhwala othandizira komanso othandizira (kuphatikizapo oyimira ena a gululi),
• mbiri ya kugwedezeka kwa anaphylactic kapena edio ya angioedema Quincke,
• matenda ashuga nephropathy (CKD 3 komanso magawo ena),
• Mimba (metabolites yogwira mankhwala imalowa mu zotchinga za hematoplacental ndi kusokoneza kayendedwe ka magazi pakati pa mayi ndi mwana),
• ana osakwana zaka 6
• kulephera kwa chiwindi
• Hyperkalemia yoyambitsidwa ndi rhabdomyolysis, CKD, kuvulala kapena kuvulala.

Kukonzekera ndi kuphatikizidwa kwa hydrochlorothiazide kusokoneza kagayidwe kachakudya, chifukwa chake, amatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo.

Zotsatira zoyipa

Zotsatira zosayenera kumwa mankhwalawa zimachitika chifukwa cha kagayidwe kazigawo, potaziyamu, kutsika kwa magazi komanso kuphwanya kwa bradykinin.

Zotsatira zoyipa kwambiri poika "Enap" zimaperekedwa pagome.

Zizindikiro zodziwika bwino zimaphatikizapo kufooka, chizungulire, kupweteka kwa minofu, komanso kusokonezeka kwa kugona. Zotsatira zoyipa ndizosowa (kupatula chifuwa) ndipo zimasinthidwa ndi kusintha kwa mlingo ndi kusankha kwa wogwirizira.

Odwala omwe ali ndi vuto lambiri laimpso amafunika kuwunika mosamala kuchuluka kwa potaziyamu chifukwa cha chiopsezo cha kuledzera ndi mtima womangidwa m'mtima.

Analogs omwe akupezeka pamsika waku Russia

Enalapril ndi chinthu chotchuka chomwe chimagwiritsidwa ntchito pochiza matenda oopsa ndipo chimapezeka pansi pa mayina osiyanasiyana ogulitsa.

Kukonzekera komwe kumapangidwanso ku Russia:

• Burlipril (Germany),
• Ednit (Hungary),
• Renec ndi mankhwala oyamba,
• Enam (India),
• Brumipril (Belgium) amapezeka m'mabotolo,
• Enalapril Hexal (Germany),
• Enapharm (Russia).

Kusankhidwa kwa chida kumadalira momwe munthu akumvera komanso kuthekera kwachuma. Pankhani ya kukonzekera kwa mankhwala, kusankha kwa olowa mmalo kuchokera ku gulu la ACE inhibitor kapena mankhwala ena othandizira oyamba amathandizika.

Chithandizo cha matenda ochepa Kugwiritsa ntchito moyenera, nthawi yochitapo kanthu, kugwira ntchito bwino komanso chitetezo ndizofunikira zazikulu zamankhwala. Kukhazikitsidwa kwa regimen ndi muyeso wa mankhwalawa kumachitika ndi adotolo ndikumuwongolera pambuyo masiku 10-12.

Zotsatira zotsatirazi zinagwiritsidwa ntchito kukonzekera.

Kutulutsa Fomu

Mapiritsi a Enap amapangidwa omwe ali ndi mitundu yosiyanasiyana ya mankhwala othandizira.

• Njira Enani 2.5 mg - Awa ndi miyala yoyera kapena yoyera, biconvex, yozungulira, yokhala ndi bevel. Atadzaza matuza a ma PC 10.
• Njira Enani 5 mg - Awa ndi miyala yoyera kapena yoyera, yopyapyala, yokhala ndi chamfer ndi chiopsezo. Atadzaza matuza a ma PC 10.
• Njira Enani 10 mg - Awa ndi miyala yofiirira, yofiirira, yokhala ndi bevel ndi notch. Pakhoza kukhala zoyera ndi zotulutsa mkati komanso piritsi. Atadzaza matuza a ma PC 10.
• Njira Enani 20 mg - Awa ndi miyala ya lalanje-lalanje, yosalala, yokhala ndi chamfer komanso chiopsezo. Pakhoza kukhala matanga azoyera ndi zofiirira-burgundy wamkati mkati ndi piritsi. Atadzaza matuza a ma PC 10.

Mumapaketi a makatoni - 2, 3, 6 matuza.

Zotsatira za pharmacological

Kuvala ndi mankhwala oopsa. Makina a zochita za enalapril amachokera pazolepheretsa za ntchito ya ACE, zomwe zimapangitsa kutsika kwa kupanga kwa angiotensin II.

Thunthu la enalapril limachokera ku ma amino acid: L-Alanine ndi L-proline. Katunduyo atamwa pakamwa, amadzidzutsa kuti enalaprilat, choletsa ACE. Mothandizidwa ndi iye, kupanga angiotensin I angiotensin II kumachepa, chifukwa cha kuchepa kwa madzi a plasma, kuwonjezeka kwa ntchito ya plasma renin ndi kuchepa kwa secretion ya aldosterone kumadziwika. Popeza ACE ndi ofanana ndi kininase II, enalapril amatha kuletsa kuwonongeka kwa bradykinin (iyi ndi peptide yomwe imatulutsa vasopressor athari). Pakadali pano, sizikudziwika kuti tanthauzo la izi ndi chiyani mu kapangidwe ka zinthu.

Mphamvu ya antihypertensive yogwira ntchito imaphatikizidwa makamaka ndi kulepheretsa ntchito ya RAAS, yomwe imagwira ntchito yofunika pakayendetsedwe ka malamulo kuthamanga kwa magazi. Koma ngakhale mwa anthu omwe ali ndi kuthamanga kwambiri kwa magazi komanso kutsitsimuka kwa renin, antihypertensive zotsatira za enalapril amadziwika.

Mutatha kugwiritsa ntchito mankhwalawa, kuthamanga kwa magazi kumachepa mosasamala kanthu komwe thupi la munthu lili, pomwe kugunda kwa mtima sikukula kwambiri.

Kukula Hypotatic orthostatic hypotension limachitika pokha nthawi zina. Nthawi zina, kuti muchepetse kuthamanga kwa nkhawa, zimatenga milungu ingapo kumwa mankhwalawo. Ndi kusiyiratu kwakumwa kwa mankhwalawo, palibe kuwuka kwa magazi.

Kuletsa kwakukulu kwa ntchito ya ACE, monga lamulo, kumadziwika pakatha maola 2-4 atatha kumwa piritsi. Mphamvu ya antihypertensive nthawi zambiri imamveka ola limodzi mutatha kumwa mankhwala mkati, mphamvu zambiri zimachitika pambuyo pa maola 4-6. Kutalika kwa zochita zimatengera mlingo wa mankhwalawa. Ngati wodwala atenga Mlingo wa Enap wovomerezeka ndi dokotala, hemodynamic ndi antihypertensive kwenikweni zimakhalapo kwa maola osachepera 24.

Mwa anthu omwe akudwala matenda oopsa, ndi kuchepa kwa kuthamanga kwa magazi, kuchepa kwa zotumphukira zamitsempha komanso kuwonjezeka kwamatidwe amtima kumadziwika. Komabe, palibe kusintha kwakukulu pamlingo wamtima. Kutuluka kwa magazi kwamkati kumachuluka, kusintha kwa kusefukira kwa glomerular sikumawonedwa. Koma pali kuwonjezeka kwa chiwonetserochi mwa anthu omwe ali otsika kwambiri osasinthika.

Mwa anthu akuvutika matenda ashuga nephropathy ndi osakhala ndi matenda ashuga, mukumwa mankhwala a enalapril amachepetsa albuminuria /proteinuria ndi kuthetsedwa kwa IgG ndi impso.

Odwala omwe ali ndi vuto la mtima panthawi yothandizidwa ndi diuretics ndi mtima glycosides komanso kugwiritsa ntchito enalapril amachepetsa kuthamanga kwa magazi, kuthamanga kwa mtima, kukula kwa mtima, komanso kuchepa kwa kugunda kwa mtima (monga lamulo, mwa anthu omwe ali ndi vuto la mtima cholephera ichi chikuwonjezereka).

Pali kuchepa kwa kupanikizika kwa mapapu am'mapapo. Pogwiritsa ntchito mapiritsi nthawi yayitali, enalapril imakulitsa kulolerana kwa katundu wambiri, kumachepetsa zovuta zowonekera kulephera kwa mtima. Mu anthu omwe ali ndi CHF wofatsa pang'ono, mankhwalawa amachepetsa kufalikira kwa matendawa, komanso amachepetsa kukula kwa kuchepa kwamitsempha yamanzere yamanzere.

Mwa anthu omwe ali ndi vuto lamanzere lamanzere, Enap imachepetsa kuthekera kwa zotsatira zazikulu za ischemic (kuchuluka kwa mawonekedwe kumachepa myocardial infarationamachepetsa kuchuluka kwa zipatala chifukwa cha angina pectoris).

Pharmacokinetics ndi pharmacodynamics

Pambuyo kutenga enalapril kuyamwa mwachangu kumawonedwa - kuchuluka kwa mayamwidwe kuli pafupifupi 60%. The kuchuluka kwa enalapril m'magazi amati 1 ora pambuyo ntchito, kudya kudya sikukuchitika mayamwidwe. Thupi limapakidwa hydrolyzed, pomwe enalaprilat, ACE inhibitor, imapangidwa. Kwambiri ndende ya enalaprilat okhazikika 3-4 mawola pakamwa. Pogwiritsa ntchito enalapril mobwerezabwereza, theka la moyo ndi maola 11.

Enalapril sichiri biotransformed mthupi, kupatula kutembenuka kwa chinthu kukhala enalaprilat.

Kwenikweni akuwonetsa impso. Mu mkodzo, enalaprilat pa mlingo wa 40% ndi enalapril osasinthika pa 20% atsimikiza.

Zizindikiro zogwiritsa ntchito Enap

Zizindikiro zotsatirazi zaku Enap zimatsimikiziridwa:

• matenda oopsa,
• CHF (pophatikiza chithandizo)
• pofuna kupewa chiwonetsero chachikulu cha kulephera kwa mtima mwa odwala omwe akupezeka ndi omwe akupezeka asymptomatic lamanzere yamitsempha yamagazi kukanika (pophatikiza chithandizo)
• kuchepetsa pafupipafupi mawonekedwe myocardial infaration,
• kuti muchepetse kuchuluka kwa zipatala za anthu okhala ndi angina wosakhazikika.

Kuchokera pa mapiritsi omwe Enap, komanso ngati ndi oyenera kugwiritsa ntchito chilichonse, wodwalayo ayenera kufunsa dokotala.

Zotsatira zoyipa

Pa chithandizo, zotsatirapo zoyipa zitha kudziwika (zoyipa m'gulu lililonse zimaperekedwa motsatizana ndi zowonjezereka):

• hematopoiesis: kuchepa magazi, neutropeniakuchepa kwa hematocrit ndipo hemoglobin, agranulocytosis, thrombocytopeniahemopoiesis zoletsa, pancytopenia, autoimmune matenda, lymphadenopathy,
• kagayidwe: hypoglycemia,
• dongosolo lamanjenje: kukhumudwamutu, chikumbumtima kugona, kusowa tulo, paresthesia, kukwiya kwakukulu, vertigo, zosokoneza kugona,
• mtima ndi mitsempha yamagazi: chizungulire, kuchepa kwa magazi, kupweteka pachifuwa, angina pectoris, mtima arrhythmias, palpitations, sitirokokapena kulowerera m'matumbo, matenda a Raynaud,
• ziwalo zam'malingaliro: Kusintha kwa kukoma, kumverera kwa tinnitus, kuwona kwamaso,
• chimbudzi: kutsegula m'mimba, nseru, chisangalalo, kupweteka m'mimba, kutsekeka m'matumbo, kudzimbidwa, kusanza, kapamba, dyspepsia, kukomokamucous pakamwa mucosa, zilonda zam'mimba, kusokonezeka kwa ndulu ndi chiwindi, chiwindi, hepatic necrosis, glossitischolestasis stomatitiszilonda zam'mimba
• kupuma dongosolo: chifuwa, zilonda zam'mimba, kupsinjika, kupindika, kupuma movutikira, allergic alveolitischibayo, chibayo,
• khungu zotupa, mawonetseredwe a hypersensitivity, angioedema, thukuta kwambiri, kuyamwa alopecia, urticariaerythema multiforme, erythroderma, exfoliative dermatitis, epidermal poizoni necrolysis, pemphigus,
• genitourinary dongosolo: kuwonongeka kwa impso, proteinuria, kulephera kwaimpso, kusabala, gynecomastiaoliguria
• musculoskeletal system: minofu kukokana,
• zochitira kafukufuku wa labotale: hyperkalemia, kuchuluka kwa serum creatinine, hyponatremia, kuchuluka kwa urea m'magazi, ntchito ya chiwindi michere, kuchuluka kwa bilirubin m'magazi,
• mawonetsedwe ena: vuto la kusakwanira kwa chitetezo cha ADH, malungomyalgia, myositis, nyamakazi, vasculitis, serositis, leukocytosis, Kuchuluka kwa ESR, kusintha kwatsatanetsatane.

Tsegulani mapiritsi, malangizo ogwiritsira ntchito (njira ndi Mlingo)

Malangizo omwe amagwiritsidwa ntchito pakugwiritsa ntchito Enap amapereka kuti odwala amwe mankhwalawa pakamwa, mosasamala za kudya. Ndikulimbikitsidwa kumwa mankhwalawa nthawi yomweyo masana ndimadzi pang'ono.

At ochepa matenda oopsa Poyamba, mankhwalawa amadziwitsidwa muyezo wa 5 mpaka 20 mg kamodzi patsiku, mlingo umadalira kuopsa kwa matenda oopsa. Pankhani ya matenda oopsa, mlingo wa 5 mg kapena 10 mg patsiku umalimbikitsidwa pang'ono.

Mwa anthu omwe ali ndi activation yayikulu ya RAAS, kuthamanga kwa magazi kumatha kuchepa kwambiri. Pankhaniyi, tikulimbikitsidwa kugwiritsa ntchito mankhwala ochepa - 5 mg patsiku, kuchitira chithandizo moyang'aniridwa ndi katswiri.

Musanamwe mankhwalawa, muyenera kuganizira kuti chithandizo cham'mbuyomu chokhala ndi Mlingo waukulu wa mankhwala okodzetsa zimatha kutha kuchepa mphamvu ndipo umatha kukhala pachiwopsezo cha matenda ena oyamba koyambirira koyambirira. Pankhaniyi, tikulimbikitsidwa kugwiritsa ntchito mlingo wosaposa 5 mg pa tsiku. Ndikofunikira kuyimitsa kudya kwa okodzetsa masiku 2-34 masiku a Enap asanayambe. Pankhani ya chithandizo, ndikofunikira kuwunika momwe impso ikuwonera, zomwe zili potaziyamu m'magazi.

Mlingo wokonza ndi 20 mg kamodzi tsiku lililonse. Ngati pali chosowa chotere, ndiye kuti mlingo wa tsiku ndi tsiku umakulitsidwa mpaka 40 mg, mlingo umatsimikiziridwa payekhapayekha.

Ndi CHF, komanso kufooka kwamitsempha yamagazi, mankhwala oyamba ndi 2.5 mg wa mankhwala patsiku. Nthawi zina, ma diuretics, beta-blockers, ndi mtima glycosides amalembedwa nthawi yomweyo zochizira kulephera kwa mtima.

Pambuyo kukonza ochepa matenda oopsa Mlingo umatha kuwonjezeka pang'onopang'ono - mwa 2,5-55 mg tsiku lililonse la 3-4, kubweretsa gawo lokonza - 20 mg patsiku. Mlingo wapamwamba kwambiri ndi 40 mg patsiku.

Popeza munthawi ya chithandizo pamakhala mwayi woti mukulitse matenda a impso komanso owopsa, ndikofunikira kuyang'anitsitsa mosamala Zizindikiro za kupsinjika ndi ntchito yaimpso nthawi yamankhwala. Palibe chifukwa chothanirana ndi mankhwalawo ngati hypotension ikukula mutatha kugwiritsa ntchito koyamba mlingo.

Anthu omwe ali ndi matenda a impso amafunika kuwonjezera kuchuluka pakati pa kugwiritsa ntchito mapiritsi kapena kuchepetsa mlingo wa mankhwalawa.

Akuluakulu amalangizidwa kuti agwiritse ntchito mlingo woyamba wa 1.25 mg wa Enap, chifukwa kuchuluka kwa ma enalapril kumachepetsedwa.

Bongo

Ngati bongo umachitika, ndiye kuti pafupifupi maola 6, kuchepa kwa magazi kumadziwika. Kugwa kumatha, kuchuluka kwa ma electrolyte kumatha kusokonezeka, komanso bongo, kusokonekera kwa magazi, kulephera kwa impso, bradycardia chizungulire, tachycardia, kukokana, palpitations.

Mukakhala ndi bongo wambiri, muyenera kumuyika pamalo oyimirira, pomwe mutu umayenera kukhala wofanana ndi thupi. Ngati bongo ndi wofatsa, muyenera kutsuka m'mimba, perekani kaboni yodziyambitsa. Amachitidwa mu milandu yayikulu ya Enap mu / poyambitsa yankho la 0.9% sodium kolorayidi, titha kumayesedwa kutenga malo amkati mwa plasma, makatekolamaini.

Enalaprilat Itha kuchotsedwa m'thupi ndi hemodialysis, kuchuluka kwa kuchotseredwa ndi 62 ml pa mphindi.

Anthu omwe ali ndi brady Cardia amakhala opanga pacemaker. Pankhani ya bongo, kuwunika mosamala serum electrolyte okhutira ndi ndende creatinine.

Kuchita

Ndi blockade iwiri ya RAAS, ndiye kuti, pakakhala munthawi yomweyo makina a ACE zoletsa, angiotensin II receptor antagonists kapena aliskiren, chiwopsezo chikuwonjezeka ochepa hypotension. Ngati ndi kotheka, kuphatikiza koteroko kuyenera kuyang'anira ntchito ya impso, kusamala kwa magazi, kuthamanga kwa magazi.

Amakanizidwa kuphatikiza enalapril ndi aliskiren anthu omwe ali ndi matenda ashuga komanso matenda a impso.

ACE inhibitors amachepetsa kuchepa kwa potaziyamu mothandizidwa ndi okodzetsa. Pogwiritsa ntchito enalapril ndi potaziyamu woleketsa zinthu zina, mankhwala okhala ndi potaziyamu, komanso m'malo mwa potaziyamu, hyperkalemia ikhoza kukhala. Ndi kuphatikiza uku, ndikofunikira kuwongolera serum potaziyamu

Ndi mankhwala a diuretic am'mbuyomu, BCC imatha kuchepa ndipo mwayi wocheperako mkati mwa kutenga enalapril ukuwonjezeka. Izi zimatha kuchepetsedwa ndikuchotsa okodzetsa, kuwonjezera kuchuluka kwa tsiku ndi tsiku kwamadzi ndi mchere, komanso kuchepetsa kuchuluka kwa enalapril.

Pogwiritsa ntchito munthawi yomweyo enalapril alpha-blockers, beta-blockers, methyldopa, BKK, othandizira achifwamba nitroglycerin kapena nitrate ena, kuchepa kowonjezereka kwa magazi kungakhale kotheka.

Mukamamwa limodzi ndi kukonzekera kwa lifiyamu, kumawonekera kwakanthawi pang'onopang'ono kwa lithiamu ndende, komanso kuledzera kwa lithiamu. Mukamatenga thiazide diuretics, kuwonjezeka kwa seramu lithiamu ndende ndikotheka. Kuphatikiza koteroko sikulimbikitsidwa; ngati kuli kofunikira, kuwunikira mosamala kwa seramu lifiyamu ndikofunikira.

Mukamamwa pamodzi ndi enalapril, mankhwala angapo opha maantibayotiki, ma antidepressants opitilira muyeso amatha kuchepa magazi.

Mukamamwa pamodzi ndi Enap NSAIDs, mphamvu ya antihypertensive imatha kuchepa. Kuwonongeka kwa ntchito ya renth kumathandizidwanso, makamaka kwa odwala omwe ali ndi matenda a impso. Zotsatira zake ndizosintha.

Mukatengedwa nthawi yomweyo ndi Enap wothandizapo ndi insulin zotsatira za hypoglycemic zitha kutsegulidwa ndipo chiopsezo cha hypoglycemia chikuwonjezeka.

Mphamvu ya antihypertensive ya mankhwala imathandizira Mowa.

Sympathomimetics amachepetsa antihypertensive zotsatira za ACE zoletsa.

Enalapril amachepetsa mphamvu ya mankhwala, omwe akuphatikiza theofylline.

Mukamamwa pamodzi ndi enaposuppressants, cytostatics, allopurinol kuthekera kwa leukopenia kumakulanso. Anthu omwe ali ndi vuto laimpso akamatenga allopurinol ndi zoletsa za ACE zimawonjezera ngozi chifuwa.

Kutenga enalapril ndi cyclosporine nthawi imodzi kumabweretsa kuwonjezeka kwa hyperkalemia.

Mukamamwa maantacid okhala, ma bioavailability a ACE zoletsa amachepetsa.

Malangizo apadera

Pambuyo kudya kwa mankhwala a Enap koyamba, ochepa hypotension angayambe. Ndi hypotension yayikulu, wodwalayo ayenera kuyikidwa mbali, ngati kuli kotheka, yambitsani yankho la 0.9% Sodium chloride.

Wodwala atakhazikika, chithandizo chitha kupitilizidwa.

Enap siyikulimbikitsidwa kwa anthu omwe ali ndi vuto la impso.

Osowa kwambiri, matenda oyambira nawo cholestatic jaundice ndi chiwindipambuyo pake imayamba chiwindi necrosis. Wodwala akayamba kudwala matenda a jaundice, siyani chithandizo mwachangu ndi kukaonana ndi katswiri.

Pali mafotokozedwe amilandu ya neutropenia kapena agranulocytosis mwa anthu omwe amagwiritsa ntchito ACE zoletsa.

Mosamala, muyenera kugwiritsa ntchito mankhwalawa kwa anthu omwe ali ndi matenda opatsirana minofu, ngati angalandire chithandizo chamankhwala othandizira odwala procainamide, allopurinol. Pakadali pano, matenda oyambitsidwa ndi matenda osachiritsika amatha. maantibayotiki. Ngati enap amatengedwa ndi odwala oterowo, kuwunika kwa nthawi yayitali kuchuluka kwa leukocytes m'magazi ndikofunikira.

Pali mwayi wa angioedema mwa anthu omwe amalandira enap. Pazizindikiro zoyambirira za vutoli, kusiya kwa mankhwalawo ndi kupita kwa dokotala ndikofunikira. Chiwopsezo chowonjezereka chotengera matendawa chinadziwika mu odwala omwe ali ndi mbiri ya angioedema.

Mukumwa mankhwalawa nthawi zina, chitukuko cha anaphylactoid zimachitika mwa anthu omwe adakhudzidwa ndi poizoni wa hymenoptera adadziwika.

Mukumwa mankhwalawa, odwala amatha kubereka osabereka chifuwa chowumakusowa pambuyo kuletsa kwa enalapril.

Akatswiri ayenera kuchenjezedwa kuti wodwala akutenga Enap asanachite opareshoni ndi ambiri opaleshoni.

Ndikofunikira kuyendetsa mosamala ndikuchita zinthu zina zomwe zimafunikira chidwi nthawi ya chithandizo ndi Enap.

Pangani ma analogi

Envulopu za Enap zikugulitsidwa - mankhwala Enani R, Burlipril, Bagopril, Vazolapril, Renipril, Woitana, Ednit, Enalapril ndi ena

Enalapril kapena Enap - ndibwino?

Ogwiritsa ntchito omwe amapatsidwa mankhwala okhala ndi enalapril omwe amagwira ntchito nthawi zambiri amakhala ndi chidwi chofuna kudziwa ngati mapiritsi a enalapril ndi enap ndi chinthu chomwecho, ndipo pali kusiyana kotani pakati pawo? M'malo mwake, mankhwala othandizira omwe amapezeka m'mankhwala onse awiriwa ndi ofanana. Momwemo, amatulutsa zomwe zimakhudza thupi. Kusiyanitsa kokha ndi dziko lomwe mudachokera.

Pa mimba ndi mkaka wa m`mawere

Simungathe kumwa Enap mu amayi apakati mu trimester yoyamba, komanso miyezi yotsatira ya kutenga pakati. Masiku ano, ngozi yokhala ndi zotsatira za teratogenic sikutha. Ngati mimba yatsimikiziridwa, pamenepa, mankhwalawa ayenera kuthetsedwa nthawi yomweyo.

Ngati mzimayi watenga zoletsa za ACE pa nthawi yoyembekezera, ndikofunikira kuti nthawi zina azisanthula kuti awone kuchuluka kwa madzi amniotic, mawonekedwe a mafupa a chigaza ndi impso za mwana wosabadwayo. The yogwira thunthu anatsimikiza mu mkaka wa m`mawere, chifukwa mkaka wa m`mawere ayenera kuyimitsidwa.

Onetsani ndemanga

Kuunika kwa Enap, kuwunika kwa madotolo zakuchita bwino kwake kuli kwabwino kwambiri. Akatswiri amavomereza kuti kugwiritsa ntchito bwino mankhwalawa, wodwalayo amatha kusintha moyo wabwino kwambiri. Kuphatikiza apo, munthawi ya chithandizo, njira zosiyanasiyana zimawonekera. Ogwiritsa ntchito nthawi zambiri amati akuda nkhawa ndi chifuwa chowuma, etc. Ndikofunika kukumbukira kuti ngati vutoli likuipiraipira, muyenera kulankhulana ndi dokotala yemwe amasintha mlingo wake kapena kukupatsani mankhwala ena.

Njira yamachitidwe

Chimodzi mwazinthu zabwino za Enap ndikuthamanga kwa momwe zimakhudzira thupi la wodwalayo. Pafupifupi mukamamwa mankhwalawa, imayamba kukhala ndi mphamvu yokhudza thupi.

Choyamba, mankhwalawa amayambitsa dongosolo la angiotensin, potero amawonjezera kuchuluka kwa kupanga kwa renin. Zimathandizanso kuchepetsa aldosterone, yomwe ingayambitse zizindikiro za matenda oopsa.

Komanso, chifukwa chogwiritsa ntchito Enap pafupipafupi, kupanga chinthu monga bradykinin kumayendetsedwa. Izi zimapangitsa kuti magazi azithamanga komanso kuthandizira kutsika kwamitsempha yamagazi.

Madokotala ambiri amalimbikitsa kugwiritsa ntchito Enap kwa odwala omwe ali ndi vuto lalikulu la matenda oopsa. Mwakutero, kumwa mapiritsi kumakulitsa kuchulukana kwa mitsempha yamagazi ndikuchulukitsa kuthamanga kwa magazi mpaka mumtima.

Odwala ambiri, Enap amayamba kuchita zinthu ngati ola limodzi atatha kumwa mankhwalawo. Komabe, zabwino zonse zimakhala zowonekera pokhapokha maola 5-6.

Kodi ndikamwa mankhwalawa ndimamwa mankhwala ati?

Poyamba, muyenera kusankha pazomwe zikuwonetsa kuthamanga kwa magazi ndi bwino kugwiritsa ntchito mapiritsi. Akatswiri amalangiza achikulire omwe akufuna kuchepetsa kuthamanga kwa magazi kuti amwe mankhwalawo. Pa kuthamanga kwa magazi, simungathe kumwa "Enap", chifukwa izi zimangokulitsa thanzi lanu.

Kuonjezera phindu la mankhwalawa, ndikofunikira kusiya zizolowezi zoyipa. Chifukwa chake, munthawi yonse ya chithandizo, muyenera kusiya kusuta ndi kumwa mowa.

Ndingatenge nthawi yayitali bwanji?

Kutalika kwa maphunzirowa kumatsimikiziridwa ndi dokotala yemwe adapereka "Enapa" yochizira matenda oopsa. Nthawi zambiri, mapiritsi amagwiritsidwa ntchito osaposa sabata kuti athetse zizindikiro za kuthamanga kwa magazi. Ngati munthawi imeneyi matendawa samazimiririka, maphunzirowo amawonjezeranso masiku ena asanu.

Analogs ndi choloweza

Anthu omwe sayenera kugwiritsa ntchito Enap pochiza matenda othamanga magazi amalangizidwa kumwa zakumwa za mankhwalawa.

Mwa mitundu yapamwamba kwambiri ndi iyi:

• Burlipril. Chida ichi chimawerengedwa kuti ndi mankhwala othandiza kwambiri omwe amatha kuthana ndi matenda oopsa. Zomwe zimapangidwa ndi Berlipril zimaphatikizapo gawo la enalaprilat, lomwe limathandizira kupanga bradykinin ndikufinya makhoma amitsempha yamagazi. M'masiku ochepa, osaposa 5 mg ya mankhwalawa amatengedwa tsiku lililonse. Kupitilira masiku 10, mlingo umakulitsidwa pang'onopang'ono mpaka 30 mg.
• Renetek. Amapangidwa kuchokera ku enalapril maleate, omwe amasintha kayendedwe ka magazi ndi ntchito yamtima. Kugwiritsidwa ntchito kwa "Renitek" mkati mwa sabata kungathandize kuchepetsa kuthamanga kwa magazi kuzungulira bwino. Kuti muthane ndi matenda oopsa, osachepera 10 mg ya mankhwalawa aledzera tsiku lililonse.
• "Renipril." Mankhwalawa adapangidwira kuti abwezeretse kupuma, kusintha magazi, kuchepa mitsempha yamagazi ndikuchepetsa katundu pamtima. "Renipril" waledzera tsiku lililonse pa 15 mg patsiku.

Pomaliza

Kuthamanga kwa magazi kumayendera limodzi ndi zizindikiro zosasangalatsa zomwe mukufuna kuti muchotse msanga. Nthawi zambiri amagwiritsa ntchito Enap ndi mankhwala ena ofanana ndi awa.Musanagwiritse ntchito mapiritsi ngati amenewa, muyenera kudziwa mawonekedwe awo, momwe amagwirira ntchito pa thupi, ma contraindication ndi mawonekedwe ogwiritsira ntchito mankhwalawa matenda oopsa.

Malangizo ochepetsa kupanikizika popanda mapiritsi: kanema

Akatswiri amalimbikitsa kuti athane ndi matenda oopsa kwambiri. Ngati m'magawo oyamba kuthamanga kwa magazi kungasinthidwe ndi njira zamakhalidwe, ndiye kuti matenda oopsa a 2nd ndi 3 digiri phytotherapy adzakhala chakudya chowonjezera chabwino chomwe chimawonjezera mphamvu ya mankhwala. Zachidziwikire, zotsatira za mankhwalawa ndizothandiza munthu payekha, koma kuwunika kwa azitsamba ndi othandizira omwe ali ndi mankhwala osokoneza bongo akuwonetsa kuti chithandizo ndi mphatso zachilengedwe zimachulukitsa mwayi wokhala ndi matenda oopsa.

Ndani amakupatsani mankhwala?

Hypertension ndi vuto lodziwika bwino la akatswiri othandizira, akatswiri a mtima, ma endocrinologists, ndi ma nephrologists. Kuthamanga kwa magazi ndi mnzake wa shuga komanso matenda a metabolic, chofunikira kwambiri pakupezeka kwa matenda a mtima ndi mitsempha ya magazi. Ngakhale kuwonjezeka pang'ono kwa kupsinjika pamwamba pa chandamale ndi koopsa, makamaka kwa odwala omwe ali ndi vuto la mtima. Pazovuta zakuposa kwa 180/110, chiopsezo chowonongeka pamtima, ubongo, ndi impso zimachulukitsa kawiri.

Hypertension ndi matenda osachiritsika, motero odwala ayenera kumwa mankhwala tsiku lililonse pamoyo wawo wonse. Pa kukakamizidwa kuti muyambe kumwa mapiritsi zimadalira matenda oyamba. Kwa anthu ambiri, 140/90 imawerengedwa kuti ndi gawo lovuta. Kwa odwala matenda ashuga, ndi ochepa - 130/80, omwe amakupatsani mwayi woteteza chiwalo chimodzi chovuta kwambiri mwa odwala - impso. Pakulephera kwa impso, ndikofunika kuti kupanikizika kukhale pang'ono, kotero mapiritsi amayamba kumwa, kuyambira pamlingo wa 125/75.

Monga lamulo, mapiritsi a Enap amawonetsedwa kumayambiriro kwa matendawa, atadziwika kuti magazi azithamanga. Mankhwala amakupatsani mwayi wochepetsera kuchuluka kwapamwamba, systolic, kukakamizidwa ndi 20, komanso kutsika, diastolic, mwa magawo khumi. Kuchepetsa kumeneku kumapangitsa kuti matendawa akhale achilendo mu 47% ya odwala. Zachidziwikire, tikulankhula za zizindikiro zapakatikati. Kwa odwala omwe sanafike pa chandamale, mankhwala ena owonjezera a antihypertensive amaperekedwa.

Malinga ndi malangizo, mapiritsi a Enap amagwiritsidwa ntchito pazotsatirazi:

1. Chizindikiro chachikulu cha ntchito ya Enap ndi matenda oopsa, ndiko kuti, kukakamizidwa kwakukulu. Enalapril imawerengedwa kuti ndi imodzi mwazomwe mungagwiritse ntchito matenda oopsa, chifukwa chake, m'mayesero ambiri azachipatala, mankhwala atsopano amafananizidwa mogwirizana ndi mphamvu yake. Zinapezeka kuti kuchuluka kwa kuchepetsa nkhawa mukamalandira mankhwala a Enap kuli chimodzimodzi ngati mukumwa mankhwala ena a antihypertensive omwe amaphatikiza omwe amakono kwambiri. Pakadali pano, palibe mankhwala omwe ali othandiza kuposa ena. Madokotala, posankha mapiritsi ena kuti akakamizike, amatsogozedwa makamaka ndi katundu wawo wowonjezera komanso kuchuluka kwa chitetezo kwa wodwala wina.
2. Enap imakhala ndi zotsatira za mtima, motero, imayikidwa matenda a mtima: kuzindikirika kwa mtima kulephera, chiopsezo chachikulu chakulephera kwa odwala amanzere amitsempha yamagazi. Malinga ndi akatswiri a zamtima, kugwiritsa ntchito kwa Enap ndi kufananizidwa ndi gulu mwa odwala oterowo kumachepetsa kufa, kuchepetsa kuchuluka kwa zipatala, kuchepetsa kuchepa kwa matendawa, ndipo nthawi zina kumathandizanso kulolerana zolimbitsa thupi komanso kuchepetsa kuwonongeka kwa zizindikiro. Chiwopsezo cha kufa mwa odwala omwe amachepetsa kukakamizidwa ndi Enap kapena kuphatikiza kwa Enap ndi okodzetsa ndi 11% kutsika kuposa omwe amangogwiritsa ntchito diuretics pokhapokha kuwongolera matenda oopsa. Pakulephera kwa mtima, mankhwalawa nthawi zambiri amatchulidwa muyezo waukulu, pafupipafupi.
3. Enap ali ndi anti-atherosranceotic katundu, motero amalimbikitsidwa kwa coronary ischemia. Kugwiritsidwa ntchito kwake m'matumbo a mtima kumapangitsa kuchepetsa 30% pachiwopsezo cha stroke, komanso 21% ya kufa.

Kodi mankhwalawa amagwira ntchito bwanji?

Zomwe zimagwiritsidwa ntchito ndi mapiritsi a Enap ndi enalapril maleate. Mwanjira yake yoyambirira, ilibe mankhwala chifukwa chake, amatanthauza za mankhwala opanga mankhwala. Enalapril imalowetsedwa m'magazi ndipo imasamutsidwa ku chiwindi ndi iyo, pomwe imasinthidwa kukhala enalaprilat, chinthu chokhala ndi katundu wotchedwa antihypertensive. Pafupifupi 65% ya enalapril imalowa m'magazi, 60% yake yomwe imalowa m'chiwindi imasinthidwa kukhala enalaprilat. Chifukwa chake, kuchuluka kwantchito yonse ya mankhwalawa pafupifupi 40%. Izi ndizotsatira zabwino. Mwachitsanzo, ku lisinopril, omwe akugwirabe ntchito piritsi ndipo safuna kulowerera kwa chiwindi, chiwerengerochi ndi 25%.

Mlingo ndi kuchuluka kwa mayamwidwe a enalapril ndikusintha kwake kukhala enalaprilat sikudalira chidzalo cha m'mimba thirakiti, chifukwa chake simungadandaule, imwani mankhwalawa musanadye kapena pambuyo pake. M'magawo onse awiriwa, kuchuluka kwa yogwira ntchito m'magazi kudzawerengedwa pambuyo pa maola 4 kuyambira nthawi ya makonzedwe.

Kuvala sikuti ndi mankhwala othamangira mwachangu, ndikosayenera kumwa kuti muchepetse vuto lalikulu kwambiri. Koma kuvomereza pafupipafupi, kumawonetsa kukhazikika komwe kutchulidwa. Malinga ndi ndemanga ya odwala omwe amamwa mankhwalawo, kukakamiza kwa Enap ndikosowa kwenikweni. Kuti mapiritsi azitha kugwira ntchito mwamphamvu, ayenera kumakhala oledzera kwa masiku osachepera atatu popanda zosokoneza panthawi imodzimodzi.

Pafupifupi 2/3 ya enalapril imapukusidwa mkodzo, 1/3 - yokhala ndi ndowe. Ndi kulephera kwa aimpso, chindapusa chimatha kukhala chovuta, kuchuluka kwa enalapril m'magazi kumawonjezeka, kotero odwala angafunikire kuchepetsa kuchuluka kwa muyezo.

Malinga ndi gulu lauphatikizidwe wa zam'magulu, mankhwalawa amakhala a ACE zoletsa. Idapangidwa mu 1980 ndipo idakhala yachiwiri pagulu lake pambuyo pa Captopril. Ntchito ya uvuni imafotokozedwa mwatsatanetsatane mu malangizo ogwiritsira ntchito. Cholinga chake ndi kuponderezera dongosolo la kupanikizika - RAAS. Mankhwalawa amaletsa enzyme yotembenuza angiotensin, yomwe imafunika kuti pakhale mapangidwe a angiotensin II - mahomoni omwe amapanga mitsempha yamagazi. Kubisa kwa ACE kumabweretsa mpumulo wa minofu ya ziwiya zotumphukira komanso kuchepa kwa mavuto. Kuphatikiza pa hypotensive zotsatira, Enap imakhudzanso kaphatikizidwe ka aldosterone, mahomoni antidiuretic, adrenaline, potaziyamu ndi renin m'magazi, chifukwa chake, mankhwalawa ali ndi zinthu zambiri zomwe zimathandiza kwa odwala oopsa, osawerengera kuchepa kwa kukakamizidwa:

1. Hypertension imapangitsa kuti mbali yamanzere (chipinda chachikulu chamtima) igwire ntchito kwambiri, zomwe nthawi zambiri zimapangitsa kuti ikukulidwe. Kufooka, kutayika kwa khoma lamtima kumawonjezera mwayi wokhala ndi kupindika komanso kulephera kwa mtima katatu, kugunda kwa mtima katatu. Mapiritsi olowa sangangolepheretsa kupitirira kumanzere kwamitsempha yamagazi pang'ono, komanso kumayambitsa kukhumudwa kwake, ndipo izi zimawonekera ngakhale kwa odwala okalamba oopsa.
2. Pakati pamagulu onse amankhwala osokoneza bongo opanikizika, Enap ndi zoletsa zina za ACE zili ndi tanthauzo lambiri la nephroprotective. Ndi glomerulonephritis, matenda a shuga a nephropathy nthawi iliyonse, mankhwalawa amachedwa kukula kwa kuwonongeka kwa impso. Kutalika kwa nthawi yayitali (kuwunikira kunali kupitirira zaka 15) chithandizo cha enalapril chimalepheretsa nephropathy mu matenda ashuga omwe ali ndi microalbuminuria.
3. Njira zofananira monga momwe amapitira kumanzere ventricle (kupumula, kuchepetsedwa), pamene Enap imagwiritsidwa ntchito, imapezeka m'matumbo onse. Zotsatira zake, ntchito za endothelium zimabwezeretsedwa pang'onopang'ono, zotengera zimakhala zolimba komanso zowonjezereka.
4. Kusamba kwa azimayi nthawi zambiri kumabweretsa kuoneka ngati matenda oopsa kapena kuchuluka kwa zomwe zilipo. Chomwe chimapangitsa izi ndi kuchepa kwa estrogen, komwe kumabweretsa kuwonjezeka kwa ntchito ya ACE. Ma inhibitors a ACE ali ndi vuto lofanana ndi estrogen pa RAAS, chifukwa chake, amagwiritsidwa ntchito kwambiri azimayi a postmenopausal. Malinga ndi ndemanga, mapiritsi a Enap omwe ali m'gulu lino la odwala samangochepetsa kuthamanga kwa magazi komanso amaloledwa mosavuta, komanso amafooketsa kusintha kwa thupi: kuchepetsa kutopa ndi kusangalala, kuonjezera libido, kusintha kusintha, kuchotsa kutentha ndi thukuta.
5. Matenda a m'mapapo angayambitse matenda a m'mapapo. Kulowa mu odwala otere kumatha kuchepetsa kupanikizika kwa m'mapapo, kuonjezera kupirira, komanso kupewa mtima. Kupitilira milungu 8 yolamulira, kutsika kwakukulu kumapanikizika ndi magawo 6 (kuchokera 40.6 mpaka 34.7).

Momwe angatenge

Malangizo ogwiritsira ntchito Enap sikuwonetsa kuti atenge liti: m'mawa kapena madzulo, mapiritsi awa. Madokotala nthawi zambiri amapereka mankhwala a m'mawa kuti mankhwalawa azikwanira zolimbitsa thupi, kupsinjika ndi zina. Komabe, pali umboni kuti pakutha kwa tsiku mphamvu ya enalapril ikuipiraipira. Ngakhale kuti kuchepa kwa vutoli kumawonedwa ngati kosafunikira (okwera 20%), odwala ena amatha kuwonjezera kukakamiza m'mawa.

Dziyang'anireni: kuyeza kukakamiza m'mawa asanamwe mapiritsi. Ngati ili pamwamba pamlingo womwe mukufuna, muyenera kusintha mankhwalawo, chifukwa matenda oopsa m'mawa kwambiri ndi owopsa kwambiri pokhudzana ndi kukula kwa zovuta m'matumbo ndi pamtima. Pankhaniyi, kulandiridwa kwa Enap kuyenera kukonzedwanso kwa nthawi yamadzulo kapena masana. Njira yachiwiri ndikusintha kuchokera ku Enap kupita ku Enap-N.

Kufalikira kwamankhwala ndikofunikira pakuwongolera matenda oopsa. Kuvala kumakhala kuledzera tsiku lililonse, kupewa zosokoneza. Mankhwalawa amadziunjikira m'thupi kwa masiku angapo mphamvu yake isanakwane. Chifukwa chake, kudutsa kamodzi kumatha kuyambitsa kutalika (mpaka masiku atatu), koma nthawi zambiri kumangowonjezera kukakamizidwa. Osangokhala zofunikira pafupipafupi, komanso nthawi yomweyo yovomerezedwa. Malinga ndi kafukufuku, Enap imapereka zotsatira zabwino kwambiri kwa odwala omwe amamwa mapiritsi pa alamu yoletsa, kupewa kupewa kupatuka pa dongosolo kwa ola limodzi.

Malinga ndi malangizo, makonzedwe a Enap amayamba ndi mlingo woyambirira, womwe umatsimikiziridwa ndi adokotala, poganizira kuchuluka kwa kupsinjika ndi kukhalapo kwa matenda ena. Nthawi zambiri, 5 kapena 10 mg amatengedwa ngati mlingo woyambirira. Pambuyo piritsi loyamba, kuthamanga kwa magazi kumayeza kangapo patsiku, ndipo zotsatira zake zimalembedwa. Ngati mulingo wothinikizidwa (140/90 kapena kutsika) sukufikiridwa kapena pali kupanikizika, kuchuluka kwa mankhwalawa kumawonjezeka pang'ono pakatha masiku anayi. Nthawi zambiri zimatenga pafupifupi mwezi kuti musankhe mtundu. Enap ali ndi mitundu yambiri yosankha. Kuphatikiza apo, mapiritsi onse, kuyambira ndi 5 mg, ali ndi notch, ndiye kuti, amatha kugawidwa pakati. Chifukwa cha mankhwalawa, mutha kusankha molondola momwe mungathere.

Kwa odwala ambiri, mtengo wochizira matenda oopsa ndiwofunika, ndipo nthawi zina umakhala wosankha. Enap amatanthauza mankhwala okwera mtengo, ngakhale atamwa mankhwala okwanira. Mtengo wapakati wamaphunziro a pamwezi owerengedwa malinga ndi kuwunika kwa wodwala ndi ma ruble 180 Ma inhibitors ena a ACE siokwera mtengo kwambiri, mwachitsanzo, ma perindopril a opanga omwewo (Perinev) adzagula ma ruble 270.

Mtengo wa Enap umawononga ndalama zingati:

Zotsatira zoyipa

Malinga ndi zotsatira za kafukufuku wazachipatala, asayansi amawunika kulekerera kwa Enap ndikwabwino. Komabe, kukokomeza kwa mankhwalawa kumadzetsa mavuto ena, choncho chithandizo chiyenera kuyambitsidwa mosamala kwambiri. Mapiritsi oyamba samayenera kutengedwa ngati thupi lili ndi vuto lam'mimba chifukwa cha kutsegula m'mimba, kusanza, kudya mosakwanira kwa madzi ndi mchere. Pakati pa sabata, katundu wambiri, pokhala kutentha, kuyendetsa galimoto, kugwira ntchito kutalika sikuloledwa.

Zotsatira zoyipa za Enap malinga ndi malangizo:

Yerekezerani ndi mankhwala ofanana

Mitundu ya mankhwala a ACE inhibitors sakhala ofanana kwenikweni. Modabwitsa, mphamvu ya zinthuzi pathupi lake imafanana. Kapangidwe ka ntchito, ndandanda ya zosayenera zochita ndipo ngakhale contraindication ali pafupi kwambiri kwa iwo. Kuchita bwino kwa antihypertensive kumawerengedwa ndi asayansi chimodzimodzi.

Komabe, zosiyana zina mu ACE inhibitors zikadalipo:

1. Choyamba, mlingo ndi wosiyana. Mukasintha kuchokera ku Enap kupita pa analogue yamagulu, mlingo umayenera kusankhidwa mwatsopano, kuyambira wocheperako.
2. Captopril imayenera kuledzera pamimba yopanda kanthu, ndi mankhwala ena onse kuchokera pagululi - osasamala nthawi yakudya.
3. Ma enalapril otchuka kwambiri, Captopril, lisinopril, perindopril amathandizidwa makamaka kudzera mu impso, chifukwa chake, ndi kulephera kwaimpso, pamakhala chiopsezo cha bongo. Mu mawonekedwe a trandolapril ndi ramipril, impso zimakhudzidwa pang'ono, mpaka 67% ya chinthucho imapangidwa mu chiwindi.
4. Ma Ahibuluzi ambiri a ACE, kuphatikizapo enalapril, ndi mankhwala osokoneza bongo. Amagwira ntchito kwambiri m'matenda a chiwindi komanso m'mimba. Captopril ndi lisinopril poyamba amagwira ntchito, mphamvu zawo sizidalira mkhalidwe wam'mimba wamagetsi.

Mukamasankha mankhwala ena, dokotala samalingalira izi zokha, komanso kupezeka kwa mankhwalawo. Ngati Enap yakupangidwira ndipo imalekeredwa bwino, sikulimbikitsidwa kuti musinthe ngati mapiritsi ena. Ngati Enap sapereka chiwongolero chokhazikika, wothandizira wina antihypertgency amawonjezeredwa ku regimen yothandizira.

Chifukwa chiyani kuthamanga kwa magazi ndi koopsa?

Ndi kuwonjezeka kwa kuthamanga kwa magazi, mtima umagwira kuposa zofunikira, ndipo chifukwa cha kuyesetsa kwambiri, minofu imakula. Momwemonso, minofu ya omanga thupi imakula mosalekeza. Mumtima kukulira kuthamanga, chipindacho chimakulirakulira ndikuthiramo lamanzere lamanzere, chifukwa cha imfa yam'mimba, kufa kwa myocardial.

Kuchita kwa mankhwala motsutsana ndi kukakamiza kumatsitsimutsa minofu yosalala, kumapereka magazi kwaulere kudzera m'mitsempha, yomwe imatsitsa gawo lamanzere ndikuyenda bwino kwa magazi mu mtima.Zotsatira zake, kagayidwe kachakudya kamayenda bwino, palibenso mikhalidwe ya arrhythmias, ndipo maselo am myocardial samavutika.

Chifukwa chake mankhwala a kukakamiza kwa Enap on the body. Kuzungulira kwa magazi kukukhazikitsidwa osati mumtima, koma ziwalo zonse. Ndi kugwiritsa ntchito mankhwalawa pafupipafupi, kuthamanga kwa magazi kumaonekera, komanso thanzi la anthu omwe ali ndi matenda a mtima ndi mitsempha ya magazi.

Mapiritsi amatengedwa pakamwa ndi madzi. Mchitidwewu umatha tsiku. Palibe chowonjezera, chifukwa chake sipadzakhala mavuto kuchokera kufulumira kwa Enap. Enap imapangidwa m'mapiritsi a 2,5 mg (oyera, biconvex, ozungulira), 5 mg (yoyera, yopyapyala, cylindrical), 10 mg (red-brown, flat-cylindrical), 20 mg (lalanje opepuka, lathyathyathya-cylindrical). Mapiritsi amadzaza zidutswa 10. pachotupa, mapaketi okhala ndi makatoni amakhala ndi matuza 2-6. Chofunikira chachikulu ndi enalapril, zina zowonjezera ndi wowuma wa chimanga, lactose monohydrate, sodium hydrogen carbonate, magnesium stearate, talc, hyprolase, ndi utoto.

Kodi ma enisa amalembedwa liti?

Mapiritsi azowunikira akuwonetsedwa motere:

• kuphatikiza mankhwala a mtima kulephera kwina,
• ndi matenda oopsa,
• Kuchepetsa chiopsezo cha myocardial infarction,
• kukonza momwe odwala osakhazikika angina pectoris, omwe amalola kuchedwa kuchipatala,
• kuphatikiza mankhwala asymptomatic lamanzere yamitsempha yamagazi kuletsa kwambiri mtima.

Mukakhala kuti simungathe kutenga Enap

Zambiri pamakonzedwe a E amapezeka mu malangizo ogwiritsira ntchito kupanikizika, kwa nthawi yayitali bwanji, pa mlingo wanji, ndi zina zotere. Komabe, wodwalayo safunika kuwerenga malangizo - dokotala sangakulembeni mankhwala ngati pali zotsutsana zotsatirazi:

• Hypersensitivity kuti enalapril ndi ena magawo mapiritsi,
• zaka zazing'ono
• mimba ndi chiwindi B,
• porphyria
• angioedema,
• lactose tsankho,
• kumwa aliskiren ndi matenda a impso kapena matenda a shuga.

Mosamala, mapiritsi ochokera ku Enap amakakamizidwa amalembedwa:

• odwala hyperkalemia, aimpso mtsempha wamagazi, matenda a shuga,
• ndi ischemic matenda, kulephera kwa impso, matenda a minofu yolumikizana,
• Pambuyo pochotsa impso,
• ndi hematopoiesis woponderezedwa, matenda amitsempha.

Dokotala sangalimbikitse mankhwalawa kwa anthu omwe akudwala hemodialysis, kumwa ma immunosuppressants ndi okodzetsa, kutsatira zakudya zopanda mchere, ngati zikuwonetsedwa.

Momwe mungamwe mapiritsi opanikizika

Enap imafotokozedwa kukwezedwa kwa mitundu yosiyanasiyana, poganizira momwe wodwalayo alili, zaka, ndi zovuta zina. Chithandizo cha matenda oopsa amayamba ndi kudya kwa 5-10 mg ya mankhwalawa patsiku.

Matenda oopsa amtundu wa mankhwalawa amathandizidwa ndi 5 mg mg. Tiyenera kukumbukira kuti mwa odwala ena kutsikirako kumatha kuchepa kwambiri, ayenera kuyamba ndi yaying'ono ya mankhwalawa - 5 mg patsiku. Dokotala wopezekapo amayenera kuwunika wodwalayo.

Musanamwe mapiritsi, muyenera kuganizira kuti ngati ma diuretics mu milingo yayikulu idatengedwa kale, izi zingayambitse kuchepa kwa madzi ndikuwonjezera kukakamiza kwa mpunga kumayambiriro kwa mankhwalawa pogwiritsa ntchito Enap. Pankhaniyi, yambani kulandira chithandizo chamankhwala osachepera 5 mg patsiku. L

Ngati okodzetsa aletsedwa masiku awiri kutatsala nthawi ya Enap. Pa mankhwala, muyenera kuwunika nthawi ndi nthawi momwe impso imagwirira ntchito, komanso kuyesa zotsatira za potaziyamu m'magazi. Mlingo wokhazikika wokhazikika ndi 20 mg Enapa patsiku, ngati kuli kotheka, muyezo ungathe kuwonjezeredwa ndi dokotala, mukuganizira momwe wodwalayo alili.

Odwala matenda a mtima kulephera, monga pamaso pa kumanzere kwamitsempha yamagazi, mapiritsi a kuthamanga kwa magazi amapatsidwa mlingo wa 2,5 mg patsiku. Nthawi zina, pochiza kulephera kwa mtima, okodzetsa, mtima glycosides ndi beta-blockers amalembedwa limodzi.

Momwe kupanikizika kukhazikika, mlingo wa mankhwalawa ukhoza kuchuluka - tsiku lililonse la 3-4 ndi 2,5-5 mg, mpaka atakwanira kukonzanso (20 mg). Kuchuluka kwa enalapril patsiku ndi 40 mg.

Madokotala amakumbukira kuti pochizira pamakhala chiopsezo cha kulephera kwa impso komanso kutsika kwakanthawi, motero amayang'anitsitsa momwe wodwalayo amapanikizika ndi momwe impso ikugwirira ntchito.

Ngati kupanikizika kumatsika kwambiri pambuyo pakuyamba kudya kwa Enap, sikofunikira kuletsa mankhwalawo, zotsatira zake zimadutsa. Odwala omwe ali ndi matenda a impso amafunika kuchepetsa kuchuluka kapena kuwonjezera nthawi pakati pa mapiritsi. Anthu a Elap amawayikira Enap pa 1.25 mg poyamba, popeza kuchoka kwa Enalapril m'thupi mwa iwo kumayamba pang'onopang'ono.

Enap ndi zotsatira zake zoyipa

Monga mankhwala ena a antihypertensive, Enap imatha kuyambitsa mavuto osiyanasiyana mwa anthu. Izi ndi zotsatira zomwe mungakumane nazo kuti mutsike:

• kuchokera hematopoietic dongosolo: hemoglobin kuchepa ndi kuchepa magazi motsutsana maziko ake, neutropenia, agranulocytosis, chopinga cha hematopoietic ntchito, lymphadenopathy, chiwonetsero cha matenda a autoimmune, thrombocytopenia,
• kuchokera kumbali ya kagayidwe: hypoglycemia,
• mu ntchito yamanjenje: kupweteka mutu, kusokonezeka, kukhumudwa, kugona pakati pa tsiku ndi mavuto ndi kugona tulo usiku, kusangalala kwambiri,
• mkhalidwe wamtima ndi m'mitsempha yamagazi: kuchepa kwakukulu kwa kuthamanga kwa magazi, chizungulire, kupweteka kwa msana, angina pectoris, kulephera kwa kugunda kwa mtima, matenda a Raynaud, chiwopsezo cha kugwidwa ndi matenda a myocardial kapena
• Kuchokera ziwalo zam'maganizo: tinnitus, masomphenya osalala, kusintha kukoma,
• m'mimba: kukhumudwa ndi m'mimba kupweteka kusanachitike, kuphwanya m'mimba ndi kutsegula m'mimba, kutsekeka kwamatumbo ndi kudzimbidwa, dyspepsia, kapamba, zilonda zam'mimba, hepatitis, kupweteka kwa mucous mkamwa, kusagwira bwino kwa chiwindi, glossitis, cholestasis, hepatic necrosis, zilonda zam'mimba, stomatitis
• mu kupuma dongosolo: zilonda zapakhosi ndi chifuwa, kufinya, kupindika, kupumira komanso kupindika kwa bronchi, chibayo, rhinitis,
• pakhungu: hypersensitivity, zidzolo, angioedema, thukuta kwambiri, urticaria, kusowa kwa tsitsi, erythroderma, pemphigus, poizoni woopsa,
• Kuchokera ku genitourinary system: kulephera kwa impso, kusabala, oliguria, kulephera kwa impso, gynecomastia,
• mu masculoskeletal system: minofu kukokana,
• mu mayeso a labotale: kuchuluka kwa potaziyamu, sodium ndi creatinine m'magazi, kuchuluka kwa michere ya chiwindi, kuchuluka kwa bilirubin ndi urea m'magazi, kuchuluka kwa ESR,
• mawonetseredwe ena ndi: leukocytosis, nyamakazi, vasculitis, malungo, serositis, myalgia, photosensitivity, myositis.

Kupanga kuyanjana ndi mankhwala ena

Asanapereke mankhwala kwa Enap kwa wodwala, dokotala ayenera kudziwa zomwe mankhwalawo amamwa kuti asayambitse zotsatira zoyipa, chifukwa si mankhwala onse omwe amaphatikizidwa ndi enalapril.

Amadziwika kuti pankhani yokhazikitsidwa pakayendetsedwe ka ACE zoletsa, angiotensin II okana, kutsekeka kwapawiri kwa RAAS kumachitika, komwe kungayambitse kuwonongeka kwa hyperial hypotension (kugwa kwakali mu kukakamiza). Ngati chithandizo choterechi nchofunikira malinga ndi dokotala, muyenera kuwongolera ntchito ya impso, kuthamanga kwa magazi, kusamala kwa madzi mthupi.

Sizoletsedwa kumwa enalapril ndi aliskiren nthawi yomweyo kwa odwala omwe ali ndi matenda a impso, matenda a shuga.

Mothandizidwa ndi ACE inhibitors, kutayika kwa potaziyamu chifukwa chotenga diuretics kumachepetsedwa. Mukalandira chithandizo cha enalapril ndi potaziyamu woleketsa okodzetsa, m'malo mwa potaziyamu pamakhala chiwopsezo cha kukhala ndi hyperkalemia. Mu chithandizo chotere, ndikofunikira kuwongolera kuchuluka kwa potaziyamu mu seramu yamagazi.

Ngati mankhwala a diuretic adachitidwa musanayambe chithandizo cha Enap, chiopsezo chotsika kwambiri chamapanikizidwe chimakulitsidwa. Vutoli limatha kukhazikika ngati ma diuretics adatsitsidwa masiku angapo asadalandire Enap, kuphatikiza kugwiritsa ntchito madzi tsiku lililonse ndi mchere, kuchepetsa pang'ono mapiritsi olimbikitsidwa pamavuto (Enalapril).

Ndikofunikira kulingalira kuti kayendetsedwe ka nthawi yomweyo a Enap ndi Adrenergic blocking agents, BKK, nitroglycerin, ganglion blocking agents, nitrate zimatha kutsitsa kwambiri magazi. Chifukwa chake, ndikofunikira kuti muwunikenso mawonekedwe a mankhwalawa, muyezo komanso dongosolo la kumwa mankhwalawa.

Ngati Enap yatengedwa motsutsana ndi maziko a kukonzekera kwa lithiamu, kuwonjezeka kwa ndende ya lithiamu m'magazi kwapezeka, kuledzera kwa lithiamu ndikotheka. Liazide diuretics imachulukanso kuchuluka kwa seramu lifiyamu. Chifukwa chake, sikulimbikitsidwa kugwiritsira ntchito limodzi mankhwalawa, ndipo ngati kuli kofunikira, ndikofunikira kuwongolera kuchuluka kwa lithiamu mu seramu yamagazi.

Ngati mankhwala oletsa kupweteka, ma triceclic antidepressants, antipsychotic mankhwala amatengedwa motsutsana ndi maziko a Enap, izi zitha kuchepetsa kuthamanga kwa magazi. Ngati Enap itengedwa motsutsana ndi maziko a NSAIDs, siziwonetsa zonse, kuwonjezera apo, impso zimavutika. Pambuyo kukonza mankhwalawa, matendawo amabwerera mwakale.