Glucovans: malangizo ogwiritsira ntchito

Piritsi limodzi lachifundo 1

Mlingo wa 2.5 mg + 500 mg:

Zogwira ntchito: glibenclamide - 2,5 mg, metformin hydrochloride - 500 mg.

Core: croscarmellose sodium - 14.0 mg, povidone K 30 - 20,0 mg, selulosi

microcrystalline - 56,5 mg, magnesium stearate - 7.0 mg.

Phula: opadry OY-L-24808 pinki - 12.0 mg: lactose monohydrate - 36.0%,

15cP hypromellose - 28.0%, titanium dioxide - 24.39%, macrogol - 10.00%, oxide wachikasu - 1.30%, okusayidi wachitsulo - 0,3%, okusayidi wakuda - 0,10%, madzi oyeretsedwa - qs

Mlingo 5 mg + 500 mg:

Zogwira ntchito: glibenclamide - 5 mg, metformin hydrochloride - 500 mg.

Nucleus: croscarmellose sodium - 14.0 mg, povidone K 30 - 20,0 mg, microcrystalline cellulose - 54.0 mg, magnesium stearate - 7.0 mg.

Phula: Opadry 31-F-22700 chikasu - 12,0 mg: lactose monohydrate - 36.0%, hypromellose 15 cP - 28.0%, titanium dioxide - 20.42%, macrogol - 10,00%, utoto wa utoto wa pinki - 3.00%, iron oxide chikasu - 2.50%, red oxide ofiira - 0,08%, madzi oyeretsedwa - qs.

Mlingo wa 2.5 mg + 500 mg: mapiritsi okhala ndi biconvex, kapangidwe kake, utoto wokutidwa ndi mtundu wowala wa lalanje, wolembedwa "2,5" mbali imodzi.

Mlingo wa 5 mg + 500 mg: mapiritsi okhala ndi biconvex wokhala ndi kapisozi
chipolopolo chachikaso, cholembedwa ndi "5" mbali imodzi.

Zotsatira za pharmacological

Glucovans® ndi kuphatikiza kosakanikirana kwamankhwala awiri am'magazi a hypoglycemic pamagulu osiyanasiyana a pharmacological: metformin ndi glibenclamide.

Metformin ndi ya gulu la Biguanides ndipo amachepetsa zomwe zimakhala ndi basal ndi postprandial glucose m'magazi a m'magazi. Metformin simalimbikitsa kubisirana kwa insulin chifukwa chake siyambitsa hypoglycemia. Ili ndi njira zitatu:

- amachepetsa kupanga shuga ndi chiwindi poletsa gluconeogeneis ndi glycogenolysis,

- kumawonjezera kukhudzika kwa zotumphukira zolandilira ku insulin, kumwa ndi kugwiritsa ntchito shuga m'maselo a m'mitsempha,

- imachedwa mayamwidwe am'magazi m'mimba.

Metformin ndi glibenclamide zimakhala ndi njira zosiyanasiyana zochitira zinthu, koma zimathandizana wina ndi mnzake pogwira ntchito. Kuphatikizidwa kwa ma othandizira awiri a hypoglycemic kumathandizira pakuchepetsa shuga.

Pharmacokinetics

Glibenclamide. Mukamamwa pakamwa, mayamwidwe kuchokera m'matumbo am'mimba amaposa 95%. Glibenclamide, yomwe ndi gawo la mankhwalawa Glucovans ® imakhala micron. Kuchuluka kwa kuchuluka kwa plasma kumafikira pafupifupi maola 4, kuchuluka kwa magawidwe kuli pafupifupi malita 10. Kuyankhulana ndi mapuloteni a plasma ndi 99%. Imakhala ngati imaphatikizidwa kwathunthu m'chiwindi ndikupanga awiri osagwira metabolites, omwe

chofukufuku ndi impso (40%) komanso ndi bile (60%). Kutha kwa theka-moyo ndikuchokera maola 4 mpaka 11. Pambuyo pakukonzekera pakamwa, metformin imatengedwa kuchokera m'matumbo am'mimba kwathunthu, kuchuluka kwa ndende mu plasma kumafikiridwa mkati mwa maola 2,5. Pafupifupi 20-30% ya metformin imapukusidwa kudzera m'matumbo osasinthika. Mtheradi bioavailability kuchokera 50 mpaka 60%.

Metformin imagawidwa mwachangu mu minofu, sikuti imagwira mapuloteni a plasma. Amapangidwira pamlingo wofooka kwambiri ndikuwonetsa impso. Kuchotsa theka-moyo ndi pafupifupi maola 6.5. Ngati aimpso ntchito, aimpso chilolezo amachepetsa, monga creatinine chilolezo, pomwe kuwonongedwa theka moyo kumawonjezereka, zomwe zimabweretsa kuchuluka kwa metformin m'magazi a magazi. Kuphatikiza kwa metformin ndi glibenclamide mu mtundu womwewo wa mapangidwewo kuli ndi bioavailability yomweyo ngati mukumwa mapiritsi okhala ndi metformin kapena glibenclamide patokha. The bioavailability ya metformin kuphatikiza ndi glibenclamide sichikhudzidwa ndi chakudya, komanso bioavailability wa glibenclamide. Komabe, kuchuluka kwa mayamwa a glibenclamide kumawonjezera ndi chakudya.

Zizindikiro zogwiritsidwa ntchito

Type 2 shuga mwa akulu:

ndi kuperewera kwa mankhwala othandizira kudya, masewera olimbitsa thupi komanso monotherapy yapitayi ndi metformin kapena zotumphukira za sulfonylurea,

m'malo mankhwalawa m'mbuyomu ndimankhwala awiri (metformin ndi sulfonylurea derivative) mwa odwala omwe ali ndi khola komanso glycemia yokhazikika.

Contraindication

Hypersensitivity kuti metformin, glibenclamide kapena zotumphukira zina zotumphukira, komanso zinthu zina zothandizira, lembani matenda a shuga 1,

matenda ashuga a ketoacidosis, matenda a shuga, matenda ashuga, kulephera kwa impso kapena kuwonongeka kwaimpso (kulengedwa kwa chilolezo chosaposa 60 ml / min),

Mikhalidwe yovuta kwambiri yomwe ingayambitse kusintha kwa impso: kuchepa madzi m'thupi, kudwala kwambiri, kuopa, kuyambitsa matenda a iodine okhala ndi ayodini (onani "Maupangiri Apadera"),

matenda owopsa kapena osakhazikika omwe amayenda ndi minofu hypoxia: kulephera kwa mtima kapena kupuma, kulowetsedwa kwaposachedwa, kugwedezeka, kulephera kwa chiwindi, porphyria,

mimba, nthawi yoyamwitsa, kugwiritsa ntchito miconazole munthawi yomweyo, opaleshoni yayikulu,

uchidakwa wambiri, kuledzera kwambiri, lactic acidosis (kuphatikizapo mbiri yakale)

kutsatira zakudya zochepa zama calori (zosakwana 1000 calories / tsiku),

Sitikulimbikitsidwa kugwiritsa ntchito mankhwalawa mwa anthu opitirira zaka 60 omwe amagwira ntchito zolimbitsa thupi, zomwe zimagwirizanitsidwa ndi chiwopsezo chokhala ndi lactic acidosis mwa iwo.

Glucovans ® ilinso ndi lactose, chifukwa chake sagwiritsiridwa ntchito osavomerezeka kwa odwala omwe ali ndi matenda amtundu wothandizidwa ndi galactose tsankho, kuchepa kwa lactase kapena glucose-galactose malabsorption.

Mimba komanso kuyamwa

Kugwiritsa ntchito mankhwalawa kumapangidwa pakakhala pakati. Wodwalayo ayenera kuchenjezedwa kuti panthawi ya chithandizo ndi Glucovans ®, ndikofunikira kudziwitsa dokotala za mimba yomwe yakonzekereratu komanso momwe mayi adzakhalire. Pokonzekera kutenga pakati, komanso ngati mukukhala ndi pakati panthawi yomwe mukumwa mankhwalawa Glucovans ®, mankhwalawa ayenera kuyimitsidwa komanso chithandizo cha insulin. Glucovans ® imalekanitsidwa poyamwitsa, popeza palibe umboni wa kuthekera kwake kudutsa mkaka wa m'mawere.

Mlingo ndi makonzedwe

Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala aliyense payekha kwa wodwala aliyense, kutengera mlingo wa glycemia.

Mlingo woyambirira ndi piritsi limodzi la mankhwala Glucovans® 2.5 mg + 500 mg kapena Glucovans® 5 mg + 500 mg kamodzi pa tsiku. Popewa hypoglycemia, mlingo woyambayo sayenera kupitirira muyeso ya tsiku ndi tsiku ya glibenclamide (kapena mlingo wofanana wa mankhwala ena omwe kale anali kumwa sulfonylurea) kapena metformin, ngati agwiritsidwa ntchito ngati mankhwala oyambira. Ndikulimbikitsidwa kuti mlingo uonjezeke osapitirira 5 mg ya glibenclamide + 500 mg ya metformin patsiku lililonse pakapita milungu iwiri kapena kupitirira kuti magazi azitha kuyamwa.

Mothandizidwa ndi chithandizo cham'mbuyomu ndi metformin ndi glibenclamide: Mlingo woyambirira suyenera kupitirira tsiku ndi tsiku mlingo wa glibenclamide (kapena mlingo wofanana wa sulfonylurea kukonzekera) ndi metformin yomwe idatengedwa kale. Pakatha masabata awiri kapena angapo atayamba kumwa mankhwalawa, mankhwalawa amasinthidwa malinga ndi glycemia.

Pazipita tsiku lililonse mapiritsi 4 a mankhwala Glucovans® 5 mg + 500 mg kapena mapiritsi 6 a mankhwala Glucovans® 2.5 mg + 500 mg.

Mlingo wa miyeso umatengera cholinga cha munthu payekha:

Mlingo wa 2.5 mg + 500 mg ndi 5 mg + 500 mg

• Kamodzi patsiku, m'mawa nthawi ya chakudya cham'mawa, ndikupatsidwa piritsi limodzi patsiku.

Kawiri pa tsiku, m'mawa ndi madzulo, ndimapiritsi awiri kapena anayi patsiku.

Mlingo wa 2.5 mg + 500 mg

Katatu katatu patsiku, m'mawa, masana ndi madzulo, mapiritsi atatu, 5 kapena 6 patsiku.

Mlingo wa 5 mg + 500 mg

Katatu patsiku, m'mawa, masana ndi madzulo, mapiritsi atatu patsiku amawaika.

Mapiritsi ayenera kumwedwa ndi zakudya. Chakudya chilichonse chimayenera kutsagana ndi chakudya chokhala ndi chakudya chokwanira chomanga thupi kuti mupewe kuchitika kwa hypoglycemia.

Mlingo wa mankhwalawa amasankhidwa kutengera mtundu wa impso. Mlingo woyambayo sayenera kupitirira piritsi 1 la mankhwala Glucovans® 2.5 mg + 500 mg. Kuwunika pafupipafupi kwa impso ndikofunikira.

Glucovans ® siyikulimbikitsidwa kuti izigwiritsidwa ntchito mwa ana.

Bongo

Ngati bongo, kukula kwa hypoglycemia ndikotheka chifukwa cha kupezeka kwa sulfonylurea mu kapangidwe ka mankhwala (onani "Maupangiri Apadera").

Wofatsa komanso wofatsa zizindikiro za hypoglycemia popanda kutaya chikumbumtima komanso minyewa yake imatha kuwongoleredwa pakumwa shuga msanga. Ndikofunikira kuchita kusintha kwa mlingo ndi / kapena kusintha zakudya. Kupezeka kwa zovuta zamaganizidwe a hypoglycemic mwa odwala matenda a shuga, limodzi ndi chikomokere, paroxysm, kapena matenda ena amitsempha, amafunikira chithandizo chamankhwala mwadzidzidzi. Mothandizidwa kulowetsedwa kwa njira ya dextrose ndikofunikira msanga atazindikira kapena kukayikira kwa hypoglycemia, asanafike kuchipatala. Pambuyo podziwikanso, ndikofunikira kuti mupatse wodwalayo chakudya chambiri m'zakudya zamafuta ochepa (kuti mupewe kukonzanso kwa hypoglycemia).

Kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali kapena kupezeka kwa zinthu zoopsa zomwe zimayambitsa ngozi kungayambitse kukula kwa lactic acidosis, popeza metformin ndi gawo lamankhwala

Lactic acidosis ndi vuto lofunika mwachipatala, chithandizo cha lactic acidosis chikuyenera kuchitika kuchipatala. Njira yothandizira kwambiri pochotsa lactate ndi metformin ndi hemodialysis.

Plasma glibenclamide chilolezo chitha kuchuluka kwa odwala omwe ali ndi matenda a chiwindi. Popeza glibenclamide imagwira mwachangu mapuloteni amwazi, mankhwalawo samachotsedwa panthawi yoyimba.

Kuchita ndi mankhwala ena

Lactic acidosis ndi vuto lofunika mwachipatala, chithandizo cha lactic acidosis chikuyenera kuchitika kuchipatala. Njira yothandizira kwambiri pochotsa lactate ndi metformin ndi hemodialysis.

Plasma glibenclamide chilolezo chitha kuchuluka kwa odwala omwe ali ndi matenda a chiwindi. Popeza glibenclamide imagwira mwachangu mapuloteni amwazi, mankhwalawo samachotsedwa panthawi yoyimba.

Bozentan kuphatikiza ndi glibenclamide kumawonjezera chiopsezo cha hepatotoxicity. Ndikulimbikitsidwa kuti mupewe kumwa mankhwalawa nthawi imodzi. Mphamvu ya gloglycemic ya glibenclamide ingathenso kuchepa.

Zokhudzana ndi Metformin

Mowa: Chiwopsezo cha kukhala ndi lactic acidosis imachulukitsidwa ndi kuledzera kwakapena kwambiri, makamaka ngati mukufa ndi njala, kapena musadye kwambiri, kapena ngati chiwindi chikulephera. Pa mankhwalawa ndi Glucovans®, mowa ndi mankhwala okhala ndi mowa ziyenera kupewedwa.

Omwe amagwiritsidwa ntchito ndi othandizira onse a hypoglycemic

Chlorpromazine: Mlingo wambiri (100 mg / tsiku) umayambitsa kuchuluka kwa glycemia (kuchepetsa kutulutsa kwa insulin).

Chenjezo: muyenera kumuchenjeza wodwalayo za kufunika koyang'anira pawokha magazi, ngati pakufunika kutero,

Sinthani mlingo wa hypoglycemic wothandizila munthawi yomweyo kugwiritsa ntchito antipsychotic ndipo mutasiya kugwiritsa ntchito.

Glucocorticosteroids (GCS) ndi tetracosactide: kuwonjezeka kwa shuga m'magazi, nthawi zina limodzi ndi ketosis (GCS imayambitsa kutsika kwa kulekerera kwa glucose).

Chenjezo: wodwalayo ayenera kuchenjezedwa za kufunika koyang'anira mozungulira magazi, ngati pakufunika kutero, mlingo wa hypoglycemic wothandizila uyenera kusinthidwa panthawi yomwe akugwiritsa ntchito GCS komanso atasiya kugwiritsa ntchito.

Danazole ali ndi vuto la hyperglycemic. Ngati mankhwala a danazol akufunika ndipo omalizirawo atayimitsidwa, kusintha kwa mankhwala Glucovans® kumafunika motsogozedwa ndi glycemia.

Zr-adrenergic agonists: chifukwa cha kukondoweza kwa pr-adrenergic receptors kumawonjezera kuchuluka kwa shuga m'magazi.

Chenjezo: ndikofunikira kuchenjeza wodwalayo ndikukhazikitsa mphamvu ya zomwe zili m'magazi a shuga, kuthandizira insulin.

Ma diuretics: kuchuluka kwa shuga m'magazi.

Chenjezo: wodwalayo ayenera kuchenjezedwa za kufunika koyang'anira pawokha magazi, kusintha kwa mankhwala a hypoglycemic panthawi yomwe amagwiritsidwa ntchito munthawi yomweyo ndi okodzetsa ndipo atayimitsa kugwiritsa ntchito kungafunike.

Angiotensin-converting enzyme (ACE) inhibitors (Captopril, enalapril): kugwiritsa ntchito zoletsa za ACE kumathandizira kuchepetsa shuga. Ngati ndi kotheka, mlingo wa Glucovans® uyenera kusinthidwa munthawi yomweyo kugwiritsa ntchito ACE zoletsa ndipo mutasiya kugwiritsa ntchito.

Zokhudzana ndi Metformin

Diuretics: Lactic acidosis yomwe imachitika pamene Metformin imatengedwa ndi kulephera kwaimpso komwe kumachitika chifukwa cha diuretics, makamaka looptureure.

Omwe amagwiritsidwa ntchito ndi glibenclamide

Z-adrenergic blockers, clonidine, reserpine, guanethidine ndi sympathomimetics amapaka zina mwazizindikiro za hypoglycemia: palpitations ndi tachycardia, ambiri osasankha beta-blockers amawonjezera zovuta komanso zovuta za hypoglycemia. Wodwalayo ayenera kuchenjezedwa za kufunika koyang'anira pawokha shuga wa magazi, makamaka kumayambiriro kwa chithandizo.

Fluconazole: Kuwonjezeka kwa theka la moyo wa glibenclamide ndi kupezeka kwa mawonekedwe a hypoglycemia. Wodwalayo ayenera kuchenjezedwa za kufunika koyang'anira payekha shuga m'magazi, kungakhale kofunikira kusintha mlingo wa mankhwala a hypoglycemic munthawi yomweyo mukumwa mankhwala a fluconazole komanso atasiya kugwiritsa ntchito.

Omwe amagwiritsidwa ntchito ndi glibenclamide

Desmopressin: Glucovans® ingachepetse zotsatira zoyipa za desmopressin.

Mankhwala a antibacterial ochokera ku gulu la sulfonamides, fluoroquinolones, anticoagulants (coumarin derivatives), mao inhibitors, chloramphenicol, pentoxifylline, lipid-kuchepetsa mankhwala ochokera pagulu la fibrate, disopyramides - chiopsezo cha hypoglycemia wogwiritsa ntchito glibenclamide.

Zolemba zogwiritsira ntchito

Potengera momwe mankhwalawo amathandizira ndi Glucovans®, ndikofunikira kuyang'anitsitsa kuchuluka kwa glucose osala kudya ndikatha kudya.

Lactic acidosis ndizosowa kwambiri, koma zowopsa (kufa kwakukulu popanda chithandizo chadzidzidzi) zovuta zomwe zingachitike chifukwa cha kuchuluka kwa metformin. Milandu ya lactic acidosis mwa odwala omwe amachitidwa ndi metformin imachitika makamaka mwa odwala omwe ali ndi matenda osokoneza bongo omwe amalephera kwambiri aimpso.

Zina zokhudzana ndi chiwopsezo ziyenera kuganiziridwanso, monga matenda osokoneza bongo osagwiritsidwa bwino ntchito, ketosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri mowa, kulephera kwa chiwindi, komanso vuto lililonse lomwe lingakhale ndi hypoxia yayikulu.

Chiwopsezo chokhala ndi lactic acidosis iyenera kuganiziridwa ngati zizindikiro zosakhudzana ndi minyewa yokhala ndi minyewa yokhala ndi vuto la dyspeptic, ululu wam'mimba komanso malaise owoneka kwambiri. Woopsa milandu, kufupika kwa acidotic, hypoxia, hypothermia, ndi chikomokere zimachitika.

Diagnostic labotale magawo ndi: ochepa magazi pH, plasma lactate ndende pamwamba 5 mmol / l, kuchuluka anionic imeneyi ndi lactate / pyruvate chiŵerengero.

Popeza Glucovans® imakhala ndi glibenclamide, kumwa mankhwalawo kumayendera limodzi ndi chiopsezo cha hypoglycemia wodwala. Kuchepetsa pang'onopang'ono kwa mankhwala atangoyamba chithandizo kungalepheretse kupezeka kwa hypoglycemia. Chithandizo ichi chitha kuperekedwa kwa wodwala yemwe amatsatira chakudya chokhazikika (kuphatikizapo chakudya cham'mawa). Ndikofunikira kuti kudya zakudya zamafuta nthawi zonse, chifukwa chiopsezo cha kukhala ndi hypoglycemia chikuwonjezeka ndikudya mochedwa, kudya kosakwanira kapena koperewera kwa chakudya. Kukula kwa hypoglycemia nthawi zambiri kumatha kukhala ndi chakudya cha hypocaloric, mutachita masewera olimbitsa thupi mochulukirapo kapena kwa nthawi yayitali, ndi mowa, kapena kuphatikiza othandizira a hypoglycemic.

Chifukwa cha kubweza komwe kumachitika chifukwa cha hypoglycemia, thukuta, mantha, tachycardia, matenda oopsa, kutsekemera, angina pectoris ndi arrhythmia. Zizindikiro zomalizirazi zitha kupezeka ngati hypoglycemia imayamba pang'onopang'ono, pankhani ya kuchepa kwa magazi kapena mukumwa ma beta-blockers, clonidine, reserpine, guanethidine kapena sympathomimetics.

Zizindikiro zina za hypoglycemia mwa odwala omwe ali ndi matenda ashuga zimatha kuphatikizira kupweteka mutu, njala, nseru, kusanza, kutopa kwambiri, kusokonezeka kwa tulo, kukwiya, kupsinjika, kusokonezeka kwa ndende ndi psychomotor ndi paresthesia, chizungulire, kupuma, kukoka, kukayikira, kusazindikira, kupuma kosakhazikika, ndi bradycardia.

Kuwapatsa mankhwala mosamala, kusankha kwa mankhwala, ndi malangizo oyenera kwa wodwala ndikofunikira kuti achepetse vuto la hypoglycemia. Ngati wodwala wayambiranso vuto la hypoglycemia, lomwe lili loopsa kapena logwirizana ndi kusazindikira zizindikirazo, ayenera kuthandizanso pochira odwala ena.

Zomwe zimathandizira pakupanga hypoglycemia:

• Kugwiritsa ntchito nthawi yomweyo mowa, makamaka pakusala kudya,

• Kukana kapena (makamaka kwa odwala okalamba) kulephera kwa wodwalayo kulumikizana ndi adokotala ndikutsatira malangizo omwe afotokozedwa mu malangizo ogwiritsira ntchito,

• Zakudya zoperewera, zakudya zopanda zakudya, njala kapena kusintha kwa zakudya,

• Kusiyana pakati pa masewera olimbitsa thupi ndi kudya,

• Kulephera kwamphamvu kwa chiwindi,

• Mankhwala osokoneza bongo a Glucovans®,

• Matenda osankhidwa a endocrine: kuchepa kwa ntchito ya chithokomiro,

zotupa ndi ma adrenal,

• Imodzi munthawi yomweyo mankhwala.

Kulephera kwamkati ndi chiwindi

Pharmacokinetics ndi / kapena pharmacodynamics amatha kusiyanasiyana kwa odwala omwe ali ndi chiwindi cha hepatic kapena kuwonongeka kwambiri kwaimpso. Hypoglycemia yomwe imapezeka mwa odwalawa imatha kupitilira, momwemo chithandizo choyenera chiyenera kuyamba.

Magazi a Magazi

Pakachitika opaleshoni kapena chifukwa china chobowola matenda a shuga, tikulimbikitsidwa kuti kusinthidwa kwakanthawi kochepa ka mankhwala a insulin kuganiziridwe. Zizindikiro za hyperglycemia ndi kukodza pafupipafupi, ludzu lalikulu, khungu louma.

Maola 48 asanafike kuchitidwe opaleshoni kapena kukonzekera kwamkati wokhala ndi ayodini, mankhwala a Glucovans® ayenera kusiyidwa. Chithandizo chikulimbikitsidwa kuti chithandizidwenso pambuyo pa maola 48, ndipo pambuyo poti ntchito yaimpso yayesedwa ndikuvomerezeka ngati yovomerezeka.

Popeza metformin imachotsedwa impso, ndipo nthawi zambiri pambuyo pake, ndikofunikira kudziwa chidziwitso cha creatinine komanso / kapena mawonekedwe a serum creatinine: osachepera pachaka kwa odwala omwe ali ndi vuto laimpso, komanso kawiri pachaka odwala okalamba komanso odwala omwe ali ndi creatinine chilolezo pamwambo wapamwamba kwambiri.

Kusamalitsa kwakukulu kumalimbikitsidwa panthawi yomwe ntchito ya impso ingakhale yodwala, mwachitsanzo, odwala okalamba, kapena ngati mankhwala oyambitsa antihypertensive, kugwiritsa ntchito okodzetsa kapena mankhwala osapweteka a antiidal (NSAIDs).

Njira zina zopewera

Wodwalayo ayenera kudziwitsa dokotala za mawonekedwe a matenda a bronchopulmonary kapena matenda opatsirana.

Kukopa pa kuyendetsa galimoto ndikugwira ntchito ndi zinthu

Odwala ayenera kudziwitsidwa za chiopsezo cha hypoglycemia ndipo ayenera kuyang'anitsitsa chitetezo poyendetsa galimoto ndi magwiridwe antchito omwe amafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.