Glibenclamide: Kufotokozera za mankhwala, ndemanga ndi malangizo

Mankhwala a Oral hypoglycemic. Zothandiza kuchokera ku sulfonylureas.

Nambala ya ATX: A10VB01.

Glibenclamide imachepetsa kuchuluka kwa shuga m'magazi. Kuwonjezeka kwa plasma insulin ndende ndikuchepa kwa glucose kumachitika pang'onopang'ono. Mosangalatsa zimakhudza kagayidwe kachakudya. Mchitidwewu umayamba patatha maola awiri pambuyo pa utsogoleri, umafika patadutsa maola 7-8 ndipo umatha maola 8-12.

Kuchita ndi mankhwala ena

Imawonjezera zotsatira za anticoagulants.
Mphamvu ya urine acidifying agents (ammonium chloride, calcium chloride, ascorbic acid mumadontho akuluakulu) imathandizira zotsatira za glibenclamide.

Antifungal zokhudza zonse njira (azole zotumphukira), fluoroquinolones, tetracyclines, chloramphenicol, H2-blockers, beta-blockers, Ace zoletsa, nonsteroidal antiinflammatory mankhwala, monoamine oxidase zoletsa, clofibrate, bezafibrate, probenecid acetaminophen, ethionamide, anabolic mankhwala, pentoxifylline, allopurmnol , cyclophosphamide, reserpine, sulfonamides, insulin imathandizira pakukula kwa hypoglycemia.
Ma Barbiturates, phenothiazines, diazoxide, glucocorticoid ndi mahomoni a chithokomiro, estrogens, gestagens, glucagon, mankhwala a adrenomimetic, mchere wa lithiamu, zotumphukira za asidi a nicotinic, rifampicin ndi saluretics zimafooketsa mphamvu ya hypoglycemic.

Contraindication

Glibenclamide imaphatikizidwa mu milandu yotsatirayi:

• insellinus wodwala matenda a shuga (mtundu 1), kuphatikiza ana ndi achinyamata.
• matenda ashuga ketoacidosis,
• matenda a shuga kapena chikomokere,
• kuchotsedwa kwa kapamba
• hyperosmolar chikomokere,
• kuperewera kwambiri kwaimpso kapena chiwindi (mawonekedwe a creatinine chilolezo chochepera 30 ml / min),
• kuwotcha kwakukulu
• kuvulala kwambiri zingapo
• othandizira opaleshoni
• matumbo
• paresis am'mimba
• Malabsorption chakudya ndi kukula kwa hypoglycemia,
• leukopenia
• kuchuluka kwa chidwi cha munthu pa mankhwalawo, komanso mankhwala ena a sulfa ndi sulfonylureas,
• mimba ndi mkaka wa m`mawere
• zaka mpaka 14.

Amayi omwe akukonzekera kutenga pakati, komanso kubereka mwana, ayenera kusinthana ndi insulin kapena kusiya kuyamwitsa.

Mlingo ndi makonzedwe

Glibenclamide iyenera kutsukidwa ndi madzi pang'ono. Dokotalayo ndi amene amadziwa kuchuluka kwa mankhwalawa komanso kuchuluka kwa mankhwalawa kuti akonze wodwala aliyense payekhapayekha, potengera zotsatira za kusanthula kwa kuchuluka kwa shuga mu mkodzo ndi magazi. Ndiwo malangizo omwe mungagwiritse ntchito omwe Glibenclamide imafunikira.

Mlingo woyambirira wa mankhwalawa ndi theka la piritsi (2.5 mg) kamodzi patsiku. Ngati ndi kotheka, mlingo wa tsiku ndi tsiku ungathe kuwonjezereka poonetsetsa kuchuluka kwa shuga m'magazi. Kuchulukitsa kwa mankhwalawa kuyenera kuchitika pang'onopang'ono ndi masiku angapo ndi 2,5 mg, mpaka mlingo wothandizidwa nawo utakwaniritsidwa.

Mlingo waukulu kwambiri ungakhale mapiritsi atatu patsiku (15 mg). Kuchulukitsa kuchuluka kumeneku sikukweza mphamvu ya hypoglycemic.

Ngati mankhwalawa ali mapiritsi 2 patsiku, ndiye kuti amamwa kamodzi m'mawa asanadye. Ngati mukufuna kugwiritsa ntchito kuchuluka kwa mankhwalawa, ndiye kuti ndibwino kuti muzichita mwanjira ziwiri, ndipo chiyezo chake chikhale 2: 1 (m'mawa ndi madzulo).

Okalamba odwala ayenera kuyamba kulandira chithandizo cha mankhwala ndi theka la mankhwala omwe amawonjezeredwa ndi kuwonjezeka kwa sabata limodzi osaposa 2.5 mg patsiku.

Ngati kulemera kwa thupi la munthu kapena moyo wake zasintha, mlingo umayenera kusintha. Komanso, kuwongolera kuyenera kuchitika ngati pali zinthu zomwe zimawonjezera mwayi wokhala ndi hyper- kapena hypoglycemia.

Ndi bongo wa mankhwalawa, hypoglycemia imayamba. Zizindikiro zake:

1. kutuluka thukuta kwambiri
2. nkhawa
3. tachycardia ndi kuthamanga kwa magazi, kupweteka mumtima, arrhythmia,
4. mutu
5. kudya kwambiri, kusanza, nseru,
6. kugona, kusasamala,
7. kupsa mtima ndi nkhawa
8. kusokonezeka ndende,
9. nkhawa, kusokonezeka kwa chikumbumtima,
10. paresis, kugwedezeka,
11. kusintha kwamvekedwe
12. kupweteka kwa chapakati genesis.

Nthawi zina, m'mawonekedwe ake, hypoglycemia imafanana ndi stroke. Akomoka kumayamba.

Mankhwala osokoneza bongo

Ndi hypoglycemia yofatsa mpaka yolimbitsa, itha kuyimitsidwa pang'onopang'ono kudya zakudya zamagulu (magawo a shuga, tiyi wokoma kapena madzi a zipatso). Chifukwa chake, odwala matenda ashuga ayenera kunyamula pafupifupi 20 g shuga (zidutswa zinayi za shuga).

Zokomera sizikhala ndi zochizira komanso hypoglycemia. Ngati wodwalayo ali ndi vuto lalikulu, ndiye kuti ayenera kupita kuchipatala. Onetsetsani kuti mwayambitsa kusanza ndikupereka madzi (madzi kapena mandimu okhala ndi sodium sulfate ndi mpweya wothandizidwa), kuphatikizapo mankhwala a hypoglycemic.

Zotsatira zoyipa

Kuchokera kumbali ya metabolism kungakhale:

hypoglycemia, nthawi zambiri usiku, limodzi ndi:

• mutu
• njala
• nseru
• kugona kusokonezedwa
• zolota
• nkhawa
• kunjenjemera
• kubisa thukuta lozizira kwambiri,
• tachycardia
• kusokonezeka kwa chikumbumtima
• kutopa
• malankhulidwe ndi masomphenya

Nthawi zina pamakhala kupsinjika ndi chikomokere, komanso:

1. kuchuluka kwa chidwi ndi mowa,
2. kunenepa
3. dyslipidemia, kudzikundikira kwa minofu ya adipose,
4. kugwiritsa ntchito nthawi yayitali, kukula kwa hypofunction ya chithokomiro.

Kuchokera m'mimba:

• kusanza, kusanza,
• kuwonda, kusasangalala komanso kumva kupweteka m'mimba,
• ulemu, kutentha pa chifuwa, kutsegula m'mimba,
• kuchuluka kapena kuchepa kudya,
• Nthawi zina, chiwindi chimatha kusokonezeka, hepatitis, cholestatic jaundice, porphyria imayamba.

Kuchokera ku hemopoietic system:

1. kawirikawiri sipangakhale magazi aplasiki kapena hemolytic anemia,
2. leukopenia
3. agranulocytosis,
4. pancytopenia
5. eosinophilia
6. thrombocytopenia.

• erythema multiforme, photosensitivity kapena exfoliative dermatitis sakonda kukhala,
• mtanda-ziwengo kwa othandizira ngati thiazide, sulfonamides kapena sulfonylureas angachitike.

Zotsatira zina zoyipa:

Kusakwanira katemera wa antiidiuretic mahomoni, limodzi ndi:

• chizungulire
• kutupa kwa nkhope
• manja ndi matako
• kukhumudwa
• ulesi
• kukokana
• stupor
• chikomokere
• matenda osakhalitsa (osakhalitsa).

Ngati pali zovuta zina zomwe sizinachitike kapena zochitika zachilendo, ndiye kuti muyenera kufunsa dokotala wanu kuti mupeze chithandizo china ndi mankhwalawa, pano, Glibenclamide iyenera kuikidwanso.

Zolemba zogwiritsira ntchito

Dokotala amayenera kudziwa nthawi zonse zomwe wodwalayo adakumana ndi mankhwala omwe ali mgululi. Glibenclamide iyenera kugwiritsidwa ntchito nthawi zonse pokhapokha mulingo wovomerezeka. Awa ndi malangizo enieni ogwiritsira ntchito, mwanjira ina Glibenclamide sikulimbikitsidwa.

Dokotala ndi amene amawerengera kuchuluka kwa mankhwalawo, kagawidwe koyenera pakati pa tsiku ndi nthawi yogwiritsira ntchito, kutengera njira ya wodwala tsiku lililonse.

Kuti mankhwalawa athe kutsogola shuga wokwanira wamagazi, ndikofunikira kutsatira zakudya zapadera limodzi ndi kumwa mankhwalawo, kuchita zolimbitsa thupi komanso kuchepetsa thupi, ngati pakufunika. Zonsezi zizikhala ngati malangizo ogwiritsira ntchito.

Wodwala ayenera kuyesa kuchepetsa nthawi yomwe imagwiritsidwa ntchito padzuwa ndikuchepetsa kuchuluka kwa zakudya zamafuta.

Njira zopewera komanso zolakwika mukamamwa mankhwalawo

Kukhazikitsidwa koyamba kuyenera kutsatiridwa ndi kufunsa kwa dokotala, simungagwiritse ntchito mankhwalawa kwa nthawi yayitali kuposa nthawi yomwe mwalimbikitsa. Glibenclamide ndi analogi ayenera kugwiritsidwa ntchito mosamala vuto la febrile syndrome, kusakwanira kwa adrenal, uchidakwa, matenda a chithokomiro (hyper- kapena hypothyroidism), vuto la chiwindi, komanso odwala okalamba.

Ndi monotherapy kwa zaka zoposa zisanu, kukana kwachiwiri kumayamba.

Kuyang'anira ma labotale

Mankhwalawa ndi glibenclamide, muyenera kuyang'anira kuchuluka kwa magazi m'magazi (pamene mankhwalawa akusankhidwa, izi ziyenera kuchitidwa kangapo pa sabata), komanso mulingo wa glycated hemoglobin (osachepera miyezi itatu iliyonse), malo omwe izi ndizofunikira komanso glucose mkodzo. Izi zipangitsa kuti kuzindikira koyamba kapena kwachiwiri kukana mankhwalawa nthawi.

Muyeneranso kuwunika momwe magazi alowerera (makamaka zomwe zili m'maselo oyera a magazi ndi mapulateleti) komanso ntchito ya chiwindi.

Kuopsa kwa hypoglycemia kumayambiriro kwa mankhwala

Pa magawo oyambirira a mankhwalawa, chiopsezo chotenga matendawa chimawonjezeka, makamaka ngati zakudya sizinadulidwe kapena zakudya zosakhazikika zimachitika. Zomwe zimathandizira pakupanga hypoglycemia:

1. kulephera kapena kusafuna kwa odwala, makamaka okalamba, kuti azigwirizana ndi dokotala ndikutenga Glibenclamide kapena fanizo lake,
2. kuperewera kwa zakudya m'thupi, kudya mosazolowereka kapena kudya chakudya,
3. kusasamala pakati pa chakudya ndi zochita zolimbitsa thupi,
4. zolakwa zakudya
5. kumwa mowa, makamaka ngati pali vuto la kuperewera kwa m'thupi,
6. kuwonongeka kwaimpso,
7. kukanika kwambiri kwa chiwindi,
8. mankhwala osokoneza bongo
9. matenda osawerengeka a endocrine system yomwe imakhudza kagayidwe kazakudya, komanso kuphatikiza kwa hypoglycemia, kuphatikiza kusowa pituitary ndi adrenocortical, kuwonongeka kwa chithokomiro.
10. kugwiritsa ntchito mankhwala enanso munthawi yomweyo.

Mankhwala ofanana:

• gliclazide (mapiritsi 30mg),
• gliclazide (80 mg aliyense),
• gliclazide maxpharma,
• diadeon
• matenda ashuga MV,
• glugorm.

Glibenclamide ndi gulu la othandizira pakamwa. Ili ndi njira yovuta yogwiritsira ntchito, yomwe imakhala yowonjezera-pancreatic ndi pancreatic.

Pharmacokinetics

Pambuyo pakamwa, kutulutsa mwachangu komanso kokwanira kwa glibenclamide mu mankhwala azitsamba kumachitika. Mayeso omasulidwa a in vitro adawonetsa kuti chophatikizira Glibenclamide chimatulutsa pafupifupi 63% ya kuchuluka kwa zinthu zogwira ntchito mkati mphindi 15, 72% mkati mwa mphindi 60. Nthawi yomweyo, kudya kumatha kuyambitsa kuchepa kwa kuchuluka kwake m'madzi am'magazi poyerekeza ndi kugwiritsidwa ntchito pamimba yopanda kanthu. Kumangika kwa glibenclamide ndi albhamuin m'madzi am'magazi ndi oposa 98%. Mu chiwindi, glibenclamide pafupifupi imasinthidwa kukhala zigawo zazikulu ziwiri: 4-trans-hydroxy-glibenclamide ndi 3-cis-hydroxy-glibenclamide. Ma metabolites awiri amachotsedwa pamlingo womwewo kudzera impso ndi chiwindi. Hafu yapakati ya moyo wa glibenclamide kuchokera m'madzi a m'magazi ndi ma 1.5-3,5 maola. Kutalika kwa chochita, komabe, sikugwirizana ndi theka la moyo kuchokera ku madzi a m'magazi. Odwala omwe ali ndi chiwindi chochepa, plasma excretion imachepetsedwa. Ndi kulephera kwapakati kwakhungu (creatinine chilolezo cha 30 ml / min), mawonekedwe a glibenclamide ndi ziwiri zazikulu metabolites amakhalabe osasinthika, ndi kulephera kwambiri kwaimpso, kukondoweza ndikotheka.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mlingo umatengera zaka, kuopsa kwa njira ya matenda ashuga, kuchuluka kwa shuga m'magazi ndi maola awiri mutatha kudya. Wapakati tsiku lililonse mlingo kuyambira 2,5 mpaka 15 mg. Pafupipafupi kayendetsedwe kake katatu pa tsiku kwa mphindi 20-30 musanadye. Mlingo wa zopitilira 15 mg / tsiku usakulitse zovuta za hypoglycemic. Mlingo woyamba mwa odwala okalamba ndi 1 mg / tsiku.

Mukasinthira mankhwala a hypoglycemic ndi mtundu wofananawo, amapatsidwa mankhwala malinga ndi zomwe zaperekedwa pamwambapa, ndipo mankhwala am'mbuyowo amathetsedwa nthawi yomweyo. Mukamasintha kuchokera ku Biguanides, mlingo woyambirira wa tsiku ndi tsiku ndi 2,5 mg, ngati kuli kotheka, mlingo wa tsiku ndi tsiku umakulitsidwa tsiku lililonse la 5-6 ndi 2.5 mg mpaka kulipidwa. Popeza kulibe chindapusa mkati mwa masabata a 4-6, ndikofunikira kusankha pazamankhwala omwe amaphatikiza.

Zotsatira zoyipa

Hypoglycemia (kuphwanya malamulo a dosing komanso kudya mokwanira), kunenepa kwambiri, kutentha thupi, matenda a m'mimba, matendawo, khungu: kuyabwa, epigastrium , hemopoiesis (hypoplastic kapena hemolytic anemia, leukopenia, agranulocytosis, pancytopenia, eosinophilia, thrombocytopenia), chiwindi ntchito (cholestasis), mochedwa cutaneous porphyria, kusintha kwa kukoma, polyuria, chithunzi ensibilizatsiya, kupweteka kwa mutu, kutopa, kufooka, chizungulire.

Bongo. Zizindikiro: hypoglycemia (njala, thukuta, kufooka kwambiri, kugona, kunjenjemera, nkhawa, kupweteka mutu, chizungulire, kusowa tulo, kusakhazikika, kukhumudwa, matenda osokoneza bongo), kusowa kwa kulankhula komanso kuwona, kusokonezeka kwa chikumbumtima), kuperewera kwa ubongo.

Chithandizo: ngati wodwalayo akudziwa, tengani shuga mkati, ndikutha kuzindikira - jekesani iv dextrose (iv bolus - 50% dextrose solution, ndiye kulowetsedwa kwa 10% yankho), 1-2 mg glucagon s / c, i / m kapena iv, diazoxide 30 mg iv kwa mphindi 30, kuyang'anira kuchuluka kwa glucose mphindi 15 zilizonse, komanso kudziwa pH, urea nayitrogeni, creatinine, ndi ma elekitirodi pamagazi. Pambuyo podziwikanso, ndikofunikira kuti mupatse wodwalayo chakudya chambiri m'zakudya zamafuta ochepa (kuti mupewe kukonzanso kwa hypoglycemia). Ndi matenda edema, mannitol ndi dexamethasone.

Malangizo apadera

Ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya, kupindika kwa tsiku ndi tsiku m'magazi ndi mkodzo.

Pankhani ya chithandizo cha opaleshoni kapena kuwonongeka kwa matenda ashuga, mwayi wogwiritsa ntchito insulin uyenera kuganiziridwanso.

Odwala ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia pazochitika za ethanol (kuphatikizapo kukula kwa disulfiram-like): kupweteka kwam'mimba, nseru, kusanza, kupweteka mutu, NSAIDs, ndi njala.

Pa chithandizo, sikulimbikitsidwa kuti mukhale padzuwa nthawi yayitali.

Kusintha kwa mlingo ndikofunikira pakulimbitsa thupi ndi malingaliro, kusintha kwa zakudya.

Mawonetseredwe azachipatala a hypoglycemia amatha kutsekedwa mukatenga beta-blockers, clonidine, reserpine, guanethidine.

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.

Mafunso, mayankho, ndemanga pa mankhwala Glibenclamide

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe amaphatikizidwa ndi zomwe amapanga ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.

Bongo

Chithandizo: jekeseni wa mtsempha wama 40 - 100 ml ya njira ya 20% ya shuga ndi / kapena (ndipo pachitika kuti catheterization yamitsempha singatheke) jakisoni wamitsempha kapena wofundira wa 1-2 ml ya glucagon. Pofuna kupewa kubwereranso pambuyo pozindikira kwa maola 24 mpaka 48, chakudya chimaperekedwa pakamwa nthawi yomweyo (20 mpaka 30 chakudya nthawi yomweyo ndipo 2 mpaka 3 maola) kapena kulowetsedwa kwa shuga kwa nthawi yayitali kumachitika (5 mpaka 20%). Ndizotheka kutumikirira glucagon wa intramuscularly maola 48 aliwonse maola 48 aliwonse.Kuwunikira pafupipafupi shuga kwa maola osachepera 48 atatha vuto lalikulu la hypoglycemic. Milandu yomwe, pamaso pa kuchuluka kwambiri kwa kuledzera (monga momwe amadzifunira kudzipha), kusokonezeka kwa chikumbumtima kumapitirira, kulowetsedwa kwa shuga wa 5-10% kumachitika, kufunafuna kwa shuga m'magazi kuyenera kukhala pafupifupi 200 mg / dl. Pambuyo mphindi 20, kubwezeretsanso njira ya shuga 40% ndikotheka. Ngati chithunzi cha chipatala sichisintha, ndikofunikira kuyang'ana zina zomwe zimapangitsa kuti musakhale ndi chikumbumtima, kuwonjezera pa kuchitira chithandizo cha matenda a ubongo edema (dexamethasone, sorbitol), kuwunika kwambiri wodwalayo komanso kuchira. Poizoni wakupha, amatha kuchitika pamodzi ndi njira zomwe zatchulidwazi, komanso njira zothetsera poizoni (chapamimba cham'mimba, kusanza), komanso kukupatsirani makala oyambitsa. Glibenclamide siinafotokozedwe ndi hemodialysis.

Malo osungira

Sungani pa kutentha kosaposa 25 ° C kuchokera kwa ana.

Kutulutsa Fomu:
Glibenclamide - mapiritsi.
30 mapiritsi m'mbale.

Piritsi 1Glibenclamide ili ndi glibenclamide 5 mg.
Omwe amathandizira: lactose monohydrate, wowuma wa mbatata, croscarmellose sodium, povidone 25, magnesium stearate, colloidal silicon dioxide, indigo carmine E 132.