Fentanyl: malangizo ogwiritsira ntchito

Mankhwalawa amapezeka mu mtundu wofikira Mlingo wokhala ndi zinthu zina zothandiza, zomwe zimatchedwa transdermal achire dongosolokomanso mawonekedwe jakisoni yankho.

Mitundu yotulutsidwa kwa Fentanyl:

• Yankho la jakisoni - 50 ml, 50 mcg / ml.
• Transdermal achire dongosolo, malo olumikizirana ndi 4.2 cm 2 / 8.4 cm 2 / 16.8 cm 2 / 25.2 cm 2 / 33.6 cm 2. Zinthu zomwe zimagwira zimamasulidwa pamlingo wa 12.5 / 25/50/75/1700 μg / h. Pamtunda wakunja kwa zigamba, zolemba zofiirira ndi Fentanyl 12.5 μg / ora / Fentanyl 25 μg / ola / Fentanyl 50 μg / ola / Fentanyl 75 μg / ola / Fentanyl 100 μg / ola. 1 TTC ili ndi 1.38 mg / 2.75 mg / 5.5 mg / 8.25 mg / 11 mg ya chinthu chogwira ntchito. Katoni imodzi yamakatoni ili ndi matumba 5 osasinthika kutentha.

Zotsatira za pharmacological

Fentanyl ndi narcotic analgesic. Mlingo wa 100 mcg (0.1 mg) (2 ml), wofanana ndi 10 mg analgesic ntchito morphine kapena 75 mg meperidine.

Njira zazikulu zochizira ndi analgesia ndi sedation. Mukamamwa mankhwalawa, ziyenera kukumbukiridwa kuti kusintha kwa kupuma komanso kuchepa kwamapapo kwa alveolar kumatha kupitilira nthawi yayitali kuposa mphamvu ya analgesic. Ndi mlingo wowonjezereka, pali kuchepa pulmonary kagayidwe. Mlingo waukulu ungayambitse ziphuphu. Fentanyl ikamatengedwa ndimatsuka pang'ono kuposa morphine ndi meperidine.

Pharmacodynamics ndi Pharmacokinetics

Pharmacokinetics tikhoza kufotokozeredwa monga mtundu wokhala ndi magawo atatu:

• nthawi yogawa mphindi 1.7
• kugawa nthawi mphindi 13,
• kuthetsa theka la moyo wa mphindi 219.

Kuchulukitsa kwa fentanyl ndi 4 l / kg. Kuchulukitsa kwa mapuloteni a plasma kumachepa ndikukula kwa ionization wa mankhwala. Kusintha kwa pH kungakhudze kugawa kwake pakati plasma ndidongosolo lamkati lamanjenje. Zogwira ntchito zimadziunjikira mu minofu ya mafupa ndi minofu ya adipose, pambuyo pake imatulutsidwa pang'ono m'magazi. Fentanyl imasinthidwa makamaka m'chiwindi, imawonetsa pafupipafupi. Pafupifupi 75% ya mtsempha wa magazi amamuyamwa mkodzo mu mawonekedwe a metabolites. Osakwana 10% amachotsa mkodzo osasinthika. Pafupifupi 9% ya mankhwalawa amathandizidwa mu ndowe monga metabolites.

Mankhwalawa amayamba kuchita nthawi yomweyo pambuyo pakupanga kwamitsempha. Komabe, pazipita zotsatira za analgesic zimadziwika mkati mwa mphindi zochepa. Kutalika kwa zotsatira za analgesic kumachokera pa mphindi 30 mpaka ola limodzi mutatha kulowetsedwa mpaka 100 mcg (0 mg) (2 ml). Pambuyo pamitsempha, makonzedwe a chinthu chogwira ntchito amawonedwa kuchokera kwa mphindi zisanu ndi ziwiri mpaka zisanu ndi zitatu, ndipo nthawi yayitali ndi pafupifupi maola awiri.

Zisonyezero zogwiritsa ntchito fentanyl

• zotsatira za analgesic za nthawi yochepa muubwino opaleshoni at kukonzekerakulowetsa ndi kukonza mu nthawi yantchito,
• ntchito ngati wamphamvu mankhwala opwetekaZowonjezera pa opaleshoni wamba
• kuphatikiza ndi antipsychoticmonga Droperidol pogwiritsa ntchito mankhwala opangira zida, komanso othandizira opaleshoni yayikulu ndi yam'deralo,
• ntchito monga zokongoletsa kwa odwala omwe ali pachiwopsezo chachikulu, pochita opaleshoni yovuta, mwachitsanzo, pamtima.

Komanso, zikuwonetsa kugwiritsa ntchito fentanyl zamitsempha ndi njira zamatsengapomwe mankhwalawa amagwiritsidwa ntchito ngati mankhwala opha ululu.

Contraindication

• odwala ndi hypersensitivity kuti kukonzekera kwa opioid,
• odwala ndi mphumu ya bronchial,
• odwala ndimankhwala osokoneza bongo,
• odwala akuvutika ndi zovuta zakumapeto,
• nthawi ntchito za obstetric,
• odwala ndi kulephera kupuma,
• odwala okayikiridwa matumbo kutsekeka.

Zotsatira zoyipa

Mankhwalawa nthawi zina amatha kupangitsa kuti pakhale zovuta zingapo:

• kukula kwa kudalira mankhwala ndi kugwiritsa ntchito kwambiri mankhwala,
• kwambiri kupuma matenda,
• antihypertensive zotsatira,
• bradycardia,
• kufinya kwakanthawi kochepa,
• zolimbitsa bronchoconstriction.

Malangizo ogwiritsa ntchito fentanyl

Malinga ndi malangizo a Fentanyl, mankhwalawa ayenera kuyikidwa kokha ndi akatswiri azachipatala omwe amadziwa bwino malamulo ogwiritsira ntchito opioid wamphamvu pochiza ululu wosachiritsika.

Chifukwa cha chiwopsezo cha kupuma, fentanyl imangoperekedwa kuti izigwiritsidwa ntchito mwa odwala omwe amalekerera bwino mankhwalawa. Mukamagwiritsa ntchito mankhwalawa, ndikofunikira kuti muchepetse kugwiritsa ntchito mankhwala ena osokoneza bongo mpaka momwe mungathere.

Chidziwitso: Odwala amatengedwa ngati opioid osagonjetsedwa ngati adatenga kale 60 mg. Morphine patsiku, 30 mg Oxycodone patsiku, 8 mg Hydromorphone tsiku ndi tsiku kapena zina opioids kwa sabata kapena kupitilira.

M'pofunika kufotokoza kuchuluka kwa mankhwalawa kwa wodwala aliyense payekhapayekha, poganizira mbiri yakale yoyendetsera analgesics munthawi ya chithandizo ndi chiopsezo cha odwala kuti azidalira mankhwala.

Pakupereka mtundu uliwonse wa mankhwalawa, katswiri ayenera kuwunika mosamala momwe wodwalayo agwirira ntchito kupuma, makamaka pa maola 24-72 oyambira atangoyamba kumene chithandizo, pamene seramu yozungulirapo kuchokera pachiwopsezo choyambirira chikhala pazokwanira zake.

Mlingo

Pokonzekera wodwala wamkulu: iv - 0,05-0.1 mg (wophatikizidwa ndi 2,5-5 mg wa droperidol) pafupifupi mphindi khumi ndi zisanu asanayambitse opaleshoni. Pa opaleshoni ya opaleshoni: iv - 0,05-0.2 mg kwa theka lililonse la ola.

Pokonzekera opareshoni, ana: 0,002 mg / kg thupi. Pa opaleshoni ya opaleshoni: i / v - 0.01-0.15 mg / kg kapena i / m 0.15-0.25 mg / kg. Kuti mukhalebe opaleshoni yopanga opaleshoni: i / m - pa 0.001-0.002 mg / kg.

Chigamba chimayikidwa kwa maola makumi awiri ndi limodzi pamalo achitetezo a khungu. Nthawi yomweyo, ndikofunikira kuti khungu lomwe limayikidwa pakhungu likhale ndi tsitsi lochepera ndipo lisakhale ndi mawonekedwe owoneka osakwiyitsa.

Malangizo apadera

Fentanyl mu mawonekedwe a TTC iyenera kuyikidwa pamalo osalimba, osakwiya, komanso osapsa mtima pakhungu ndi malo osalala, mwachitsanzo, pachifuwa, kumbuyo kapena pamphumi. Ana aang'ono ndi anthu omwe kuwonongeka kwazidziwitsondikofunikira kuyika chigamba kumbuyo chakumanzere kuti muchepetse mwayi wa chigambacho. Tsitsi pamalo ofunsira liyenera kuchotsedwa musanagwiritse ntchito kachitidwe, ndipo sikulimbikitsidwa kugwiritsa ntchito lezala pa izi. Kanthu komwe khungu limayikidwapo liyenera kutsukidwa musanagwiritse ntchito ndi madzi ofunda popanda kuwonjezera zitsulo.

Fentanyl mu mawonekedwe a TTS iyenera kugwiritsidwa ntchito mukangochotsa chigamba pachikwama chomata. Simungathe kugwiritsa ntchito mankhwalawo ngati mapake ake ali ndi zizindikiro zakuphwanya ndi kukhumudwa.

Chigoba chilichonse kuchokera paphukusi chimayenera kusinthidwa pasanathe maola makumi awiri ndi awiri. Kutsatira chigamba chotsatira, muyenera kugwiritsa ntchito chikopa chatsopano. Ngati pali zovuta ndi zomatira m'mphepete pa chigamba, mutha kuyikapo gulu kuti lithandizike.

Sizoletsedwa: kugwiritsa ntchito magwero otentha, mwachitsanzo, mapepala otenthetsera kapena zofunda zamagetsi, komanso kuwongolera zotenthetsera magetsi ndi nyale zofukizira kumalo okonzera chigamba, kuyatsa dzuwa, kutenga malo osambira, ma batu otentha ndi mabedi otenthetsera madzi.

Bongo

Mankhwala osokoneza bongo owopsa amatha kuwonekera ngati:

• kupuma
• kugona
• kugwera stuporkapena kwa ndani
• kuphipha kwamisempha
• bradycardia
• hypotension.

Nthawi zina, bongo wa Fentanyl amatha kupha.

Malangizo apadera

Fentanyl pa Wikipedia. Gwiritsani ntchito ngati mankhwala

Kuphatikiza pa mitundu iyi ya kutulutsira Mlingo, pali milandu yodziwika pamene Fentanyl idagwiritsidwa ntchito ndi mautumiki apadera mwanjira yamagesi kuthana ndi zigawenga. Mukamamasula omwe anagwidwa ndi zigawenga pa nthawi ya nyimbo Nord-Ost, ntchito zapaderazi zimagwiritsa ntchito nyimbo potengera zomwe zimachokera fentanyl. Chifukwa cha kukhudzana ndi pompopompo, anthu mkati mwanyumbayo anali ndi zizindikiro monga kusokonezeka, nseru, kufuna kusanza, komanso kupundula ziwalo. Malinga ndi akatswiri, zotsatira zoyipa zoterezi sizingakwiyitse.

Kuchita ndi mankhwala ena

Kuchita ndi Antidepressants

Kugwiritsa ntchito nthawi yomweyo kwa Fentanyl ndi othandizira ena omwe amakhudza dongosolo lamanjenje lamkati, kuphatikizira kusuntha, hypnotics, tranquilizer, anesthetics, and opioids, zitha kuwonjezera ngozi yokhala ndi vuto la kupuma, kusinkhidwa kwambiri, kupuma komanso kufa. Mankhwala ophatikizika ndi mankhwala aliwonse omwe ali pamwambawa akagwiritsidwa ntchito, mlingo wa imodzi kapena uyenera kuchepetsedwa.

CYP3A4 Inhibitors

Chifukwa chakuti isoenzyme CYP3A4 imagwira ntchito yofunika kwambiri mu metabolism ya fentanyl, mankhwala omwe amalepheretsa ntchito ya CYP3A4 angayambitse kuchepa kwa chidziwitso cha fentanyl, zomwe zimaphatikizapo kuwonjezeka kwa kuphatikizira kwazinthu mu plasma ndikuwonjezera nthawi yayitali ya zotsatira za mankhwala opioid. Zotsatirazi zitha kutchulidwa kwambiri pogwiritsa ntchito 3A4 inhibitors.

Zolozera CYP3A4

Inducers a CYP450 3A4 angayambitse kagayidwe ka Fentanyl, komwe kungapangitse kuchuluka kwa mankhwalawa, kuchepa kwa kugwiritsidwa ntchito kwa plasma, kusagwira bwino ntchito, kapena, chitukuko cha matenda obwera chifukwa cha wodwala yemwe amayamba kugwiritsa ntchito mankhwala osokoneza bongo.

Monoamine Oxidase Inhibitors

Kugwirizana kwa Fentanyl ndi monoamine oxidase inhibitors sikumveka bwino, kotero, kugwiritsa ntchito mankhwala osokoneza bongo kumatsutsana kwambiri.

Fentanyl Analogs

• Dolforin - kuphatikiza pazogwira ntchito, kapangidwe ka TTC kameneka ndi mowa wa lauryl ndi polima ya acrylic,
• Durogezik Matrix- kapangidwe ka mankhwala akuphatikiza ndi pololymer wa polyethylene terephthalate ndi ethylene vinyl acetate, polyacrylate ndi yogwira ntchito,
• Lunaldin - mankhwala a analgesic okhala ndi fentanyl,
• Fendivia - mankhwala osokoneza bongo, mawonekedwe ake omwe ali ofanana ndi mankhwala ofotokozedwawo,
• Fentadol - TTS ndi zomwe zili yogwira fentanyl.

Ndemanga za Fentanyl

Ndemanga pa Fentanyl ndi mankhwala osiyanasiyana. Kwenikweni, odwala sangathe kuunika mokwanira mphamvu ya mankhwalawo chifukwa cha kuopsa kwa matenda omwe awonetsedwa. Pazonse, akatswiri amamuyerekezera Fentanyl kwambiri, chifukwa chidachi chimapereka chithandizo chamtengo wapatali pakuchiza matenda ambiri, komanso chimathandizira odwala kuchotsa ululu panthawi ya chithandizo ndi pambuyo pake.

Mtengo wa Fentanyl

Mtengo wa mankhwalawa ndiwokwera kwambiri, koma zotsatira za analgesic zomwe zachitika ndi mtengo wake. M'mafakitala ena, mutha kugula yankho la ma intravenous and intramuscular management kuchokera ku ma ruble 2,290.

Maphunziro: Anamaliza maphunziro awo ku Rivne State Basic Medical College ndi digiri ku Pharmacy. Anamaliza maphunziro ake ku Vinnitsa State Medical University. M.I. Pirogov ndi gulu lozindikira kutengera izi.

Zokumana nazo: Kuyambira 2003 mpaka 2013, amagwira ntchito monga mfesi ya zamankhwala komanso manijala wa khemisi. Anapatsidwa makalata komanso kusiyanasiyana kwa zaka zambiri akugwira ntchito molimbika. Zolemba pamitu yachipatala zidasindikizidwa m'mabuku azofalitsa (manyuzipepala) komanso pazamasamba osiyanasiyana pa intaneti.

Masana abwino, ndingagule kuti Durogezik kapena Fentanyl, kodi ndikofunikira?

Mlingo ndi makonzedwe

Madokotala okhawo omwe ali ndi chidziwitso komanso chidziwitso pakugwiritsa ntchito mankhwala opioid wamphamvu omwe ali ndi mphamvu yayikulu amatha kutsata mankhwalawa akamagwiritsidwa ntchito pochiza ululu wosachiritsika.

Popeza pali mwayi wopondereza kupuma, mankhwalawa amangoperekedwa kwa okhawo omwe ali ndi mwayi wololera mankhwala otere. Pogwiritsa ntchito Fentanyl, pamafunika kuti muchepetse kugwiritsa ntchito mankhwala ena oletsa ululu.

Anthu omwe amalimbana ndi zovuta za opioids ndi anthu omwe amathandizidwa tsiku lililonse ndi 60 mg ya morphine, 30 mg ya oxycodone, komanso 8 mg ya hydromorphone, kapena mankhwala ena a opioid masiku 7 kapena kupitilira.

Kusankhidwa kwa magawo kwa wodwala aliyense kumachitika payekhapayekha, poganizira mbiri yomwe ilipo yogwiritsidwa ntchito ndi analgesics panthawi ya mankhwala, komanso zochitika zowopsa pakuwonekera kwa mankhwala osokoneza bongo mwa munthu.

Pambuyo poika gawo lililonse la mankhwala, dokotala amayenera kuyang'anira momwe wodwalayo amayankhira, mwachitsanzo, kukakamiza kupuma, makamaka pakumatha maola 24-72 kuyambira chiyambi cha maphunzirowa, mankhwalawa akafika pazambiri zake mkati mwa seramu.

Kukula kwa magawo.

Pokonzekera munthu wamkulu pochita opareshoni, 0,05-0.1 mg wa mankhwalawa amaperekedwa kudzera mu minyewa ya mankhwala ophatikizira a droperidol (2.5-5 mg). Izi zimafunikira pafupifupi mphindi 15 musanakhazikitse opaleshoni. Monga opaleshoni ya opaleshoni: 0,05-0.2 mg ya thunthu limaperekedwa kudzera mu mphindi 30 zilizonse.

Pankhani yokonzekeretsa mwana opaleshoni, 0,002 mg / kg ya mankhwalawa iyenera kuperekedwa. Pa opaleshoni ya opaleshoni, muyezo wa iv wa 0,01-0.15 mg / kg kapena jekeseni ya iv ya 0.15-0.25 mg / kg pamafunika. Kuti mupeze opaleshoni ya opaleshoni, makonzedwe a intramuscular of 0.001-0.002 mg / kg ya mankhwala ndi ofunika.

Chigoba chikuyenera kuyikidwira kwa malo a khungu (maola atatu). Chofunikira pakuchitsa ndi kuchuluka kwa tsitsi pamalo operekera chithandizo, komanso ngati palibe chizindikiro choonekera cha mkwiyo.

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Kuchita ndi mankhwala ena

Kuphatikiza ndi antidepressants.

Kuphatikiza ndi mankhwala ena omwe amakhudza kugwira ntchito kwa mtima wamanjenje (kuphatikiza ma tranquilizer, ma hypnotics kapena ma sedenti, opioids ndi mankhwala ochititsa dzanzi) kungayambitse kuwonjezeka kwa vuto la kuperewera kwa dongosolo la kupuma, kukula kwa mphamvu yakutsitsimutsa komanso kupweteka. Pogwiritsa ntchito nthawi imodzi ndi njira zili pamwambazi, kukula kwa mulingo wa imodzi kuyenera kuchepetsedwa.

Mankhwala omwe amachepetsa ntchito ya CYP3A4.

Chifukwa chakuti CYP3A4 isoenzyme ndi gawo lofunikira la kagayidwe kamankhwala, mankhwala omwe amachepetsa ntchito yake amatha kuchepa mphamvu za kupezeka kwa Fentanyl, chifukwa chomwe mfundo zake mkati mwa kuchuluka kwa plasma ndi kutalika kwa zotsatira za opioid zimapitilira. Zotsatira zomwezi zimatha kukhala zowonjezereka ngati zimaphatikizidwa ndi 3A4 inhibitors.

Zinthu zomwe zimayambitsa ntchito ya CYP3A4.

Zomwe zimayambitsa CYP450 3A4 zimatha kuyambitsa kagayidwe kamankhwala, chifukwa chomwe chilolezo chake chikuwonjezeka, ndipo mulingo mkati mwa plasma, mosiyana, umachepa.Zotsatira zake, pali kuchepa kwa kugwiritsa ntchito mankhwala osokoneza bongo kapena kupezeka kotheka kwa anthu omwe amayamba kukhala osokoneza bongo.

Kuphatikiza ndi IMAO.

Kuphatikiza kwa mankhwalawa ndi MAOI sikunaphunzire mpaka pano, ndichifukwa chake kugwiritsa ntchito zinthu izi ndizovomerezeka.

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Mlingo ndi makonzedwe

Fentanyl yankho lake limapangidwira makonzedwe amkati kapena mu mnofu.

Mukupweteka kwambiri, mankhwalawa amaperekedwa pa mlingo wa 25-100 intg m'mitsempha kapena intramuscularly (monga njira yokhayo kapena imodzi ndi antipsychotic).

Pa kusindikiza, Fentanyl imayendetsedwa ndi intramuscularly pa mlingo wa 50-100 beforeg mphindi 30 asanayambe opareshoni.

Pa mankhwala oyamba a mankhwalawa, mankhwalawa amathandizidwa ndi michere ya 100-200. Kenako, mphindi 10-30 zilizonse, 50-150 μg yowonjezera imayendetsedwa kuti ikhalebe yofunikira ya analgesia (kuphatikiza ndi droperidol).

Mukamayendetsa neuroleptanalgesia kwinaku mukupumira mozungulira (mwachitsanzo, nthawi yayitali kwambiri komanso kugwira ntchito kwakanthawi), pomwe minyewa yopumula imagwiritsidwa ntchito, Fentanyl imayendetsedwa pambuyo pa mlingo wa neuroleptic wa 50 μg pa 10-20 kg yolemera. Pankhaniyi, kupuma kwamwadzidzidzi kuyenera kuyang'aniridwa ndikukonzekera kuyamwa kwadzidzidzi komanso mpweya wabwino wamakina uyenera kusungidwa. Mlingo wapamwamba wa Fentanyl (50-100 mcg / kg) amagwiritsidwa ntchito pokhapokha ngati atsegulidwe mtima.

Kwa analgesia wowonjezera pakanthawi kochita opaleshoni yam'magazi, mankhwalawa amathandizidwa kudzera mwamitsempha kapena ma intramuscularly pa mlingo wa 25-50 micrograms (nthawi zambiri amaphatikizidwa ndi antipsychotic). Ngati ndi kotheka, jakisoni wa Fentanyl amabwerezedwa mphindi 20-30 zilizonse.

Ana ndi mankhwala mankhwala zotsatirazi Mlingo:

• kukonzekera opaleshoni: 2 mcg / kg,
• Opaleshoni yayikulu: 150-250 mcg / kg pamitsempha kapena 10-150 mcg / kg kudzera m'mitsempha,
• kukonza pafupipafupi opaleshoni: 2 mcg / kg intramuscularly kapena 1-2 mcg / kg kudzera.

Neuroleptanalgesia

Fentanyl ndi syntgesic yopanga yochokera ku 4-aminopiperidine. Kapangidwe kamakemikolo ndi kofanana ndi promedol. Ili ndi mphamvu, koma yochepa (yokhala ndi kayendetsedwe kamodzi) ka analgesic.

Pambuyo pokonzekera mtsempha wa magazi, mphamvu yake imayamba pambuyo pa mphindi 1-3 ndipo imakhala mphindi 15-30. Pambuyo mu makonzedwe a mu mnofu, mphamvu yake kwambiri imachitika pakapita mphindi 3 mpaka 10.

Pokonzekera mankhwala opaleshoni (premedication), fentanyl imaperekedwa pa mlingo wa 0,05-0.1 mg (1-2 ml ya 0.005% solution) mu intramuscularly theka la ola musanachite opareshoni.

Pochita opaleshoni yam'deralo, fentanyl (nthawi zambiri yophatikiza ndi antipsychotic) imagwiritsidwa ntchito ngati analgesic yowonjezera. 0.5-1 ml ya yankho la 0.005% ya fentanyl imayendetsedwa kudzera m'mitsempha kapena mu mnofu (ngati n`koyenera, mankhwalawa amatha kubwerezedwa mphindi 20 mpaka 20 zilizonse.

Fentanyl ikhoza kugwiritsidwa ntchito pochepetsa kupweteka kwambiri mu myocardial infarction, angina pectoris, infarction ya pulmonary, impso ndi hepatic colic. Yambitsani intramuscularly kapena kudzera m'mitsempha 0,5-1-2 ml ya yankho la 0.005%. Fentanyl nthawi zambiri amagwiritsidwa ntchito pazinthu izi kuphatikiza ndi antipsychotic mankhwala.

Jakisoni wa Fentanyl amabwerezedwanso pambuyo pa mphindi 20 mpaka 40, ndipo atatha opaleshoni pambuyo pa maola 3-6.

Mukamagwiritsa ntchito fentanyl, makamaka ndi kuyambitsa mwachangu mu mtsempha, kupuma kwamatenda ndikotheka, komwe kumatha kuthetsedwa ndi kukhazikitsa kwa lexone.

Kwa ntchito yayifupi yopanda patsekeke, pakugwiritsa ntchito minofu yopumula sikofunikira ndipo neuroleptanalgesia ikuchitika ndikusungabe kupuma kwapang'onopang'ono, fentanyl imayendetsedwa pamlingo wa 1 ml ya yankho la 0.005% pamtunda uliwonse wa 10 mpaka 20 wa thupi. Pankhaniyi, ndikofunikira kuyang'anira kuyenera kwa kupuma kosinthika. Ndikofunikira kuti mutha kuchita, ngati kuli kotheka, kuyamwa kwa trachea ndi makina olimbitsa mpweya wam'mapapo. Pazinthu zosowa kwa makina mpweya wabwino, kugwiritsa ntchito fentanyl kwa neuroleptanalgesia sikuvomerezeka.

Kukwiya kwa magalimoto, kuphipha komanso minyewa ya chifuwa ndi miyendo, bronchio spasm, hypotension, sinus bradycardia ikawonedwe. Bradycardia imachotsedwa ndi atropine (0.5-1 ml ya yankho la 0.1%).

Odwala omwe amathandizidwa ndi insulin, corticosteroids ndi antihypertensive mankhwala amawayendetsa pakadontho kakang'ono.

Kuledzera komanso kupweteka kwa thupi (kudalira kwakuthupi) kumatha kukhala fentanyl.

Ndi kulumikizana mwachisawawa, fentanyl imalowa m'magazi kudzera pakhungu, kotero chisamaliro chowonjezereka chikuyenera kuthandizidwa pogwira ntchito ndi mankhwalawa. Zomwezo zimalimbikitsidwa pofufuza zinthu zosadziwika zomwe zimafanana ndi fentanyl.

Sinthani ya Neuroleptanalgesia |Mimba komanso kuyamwa

Pa nthawi yobereka, Fentanyl imagwiritsidwa ntchito pokhapokha ngati phindu lomwe mayi akuyembekezera limaposa chiwopsezo cha mwana wosabadwa ndi wakhanda.

Mankhwalawa amadutsa mkaka wa m'mawere, chifukwa chake, pogwiritsa ntchito Fentanyl, kuyamwitsa kuyenera kuyimitsidwa.

Amayi amiseche yakugwiritsa ntchito mankhwala ayenera kusankha mosamala njira zakulera.

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito munthawi yomweyo Fentanyl ndi ma antihistamines omwe ali ndi mphamvu yosintha ndi Mowa, chiopsezo cha zotsatira zoyipa chikukula.

Benzodiazepines imachulukitsa wodwala kuchoka ku neuroleptanalgesia, ma beta-blockers angachepetse pafupipafupi komanso kuopsa kwa zovuta zomwe zimachitika mukagwiritsa ntchito Fentanyl pochita opaleshoni yamtima, koma zimawonjezera mwayi wa bradycardia.

Pogwiritsa ntchito munthawi yomweyo ndi monoamine oxidase inhibitors, chiopsezo cha zovuta zowonjezereka chimawonjezereka, ndimankhwala a antihypertensive, zotsatira zake zimatha.

Kuphatikizidwa ndi kupuma kwa minofu, kukhazikika kwa minofu kumalepheretsedwa kapena kutha, kupumula kwa minofu ndi ntchito ya vagolytic kumachepetsa chiopsezo cha hypotension ndi bradycardia, ndipo kumatha kukulitsa chiwopsezo cha matenda oopsa, tachycardia, kupuma minofu komwe kulibe ntchito ya vagolytic, musachepetse chiopsezo cha hypotension ndi bradycardia, ndikuwonjezera mwayi wowopsa. zoyipa zimachitika mu mtima.

Fentanyl iyenera kugwiritsidwa ntchito mosamala pakuyang'ana komwe mapiritsi akugona, ma antipsychotic ndi mankhwala kwa opaleshoni wamba pofuna kupewa kukakamira zochitika zapakati pa kupuma komanso kuponderezana kwakukulu kwa dongosolo lamanjenje. Dinitrogen oxide imawonjezera kuuma kwa minofu, ndipo ma tridclic antidepressants amachititsa mwayi woponderezera kupuma.

Mankhwala sayenera kugwiritsidwa ntchito limodzi ndi narcotic analgesics kuchokera ku gulu la opioid receptor antagonist agonists (tramadol, nalbuphine ndi butorphanol) ndi gawo la agonists (buprenorphine), popeza pali ngozi yakufooka kwa analgesia.

Ndi chithandizo chofanana ndi mankhwala a antihypertensive, glucocorticosteroids ndi insulin, Fentanyl iyenera kugwiritsidwa ntchito mu Mlingo wochepetsedwa. Zotsatira za analgesic ndi zotsatira zoyipa za opioid agonists ena (promedol, morphine) muzochitika zamankhwala othandizira amaphatikizidwa ndi zochita ndi zotsatira za Fentanyl.

Fentanyl analogues ndi: Dolforin, Lunaldin, Fentadol Matrix, Fentadol Reservoir, Fendivia.

Mtengo wa fentanyl m'masitolo ogulitsa mankhwala

Mankhwalawa sangagulidwe m'maketo ogulitsa mankhwala, chifukwa amangopezeka ku zipatala. Komabe, zimadziwika kuti mtengo wa Fentanyl umachokera ku 90-100 ma ruble pachilichonse cha mankhwala omwe ali ndi ma 5 ampoules a jekeseni wa 50 μg / ml.

Kodi mwapeza cholakwika m'mawuwo? Sankhani ndikusindikiza Ctrl + Lowani.

Mimba komanso kuyamwa

Palibe zosakwanira pakugwiritsa ntchito fentanyl mwa amayi apakati. Fentanyl amadutsa chikhazikitso m'mimba moyambirira. Kafukufuku wazinyama wawonetsa kukhalapo kwa kawopsedwe kaziberekedwe, koma tanthauzo la zomwe anthu adalandira sizikudziwika. Kugwiritsa ntchito fentanyl nthawi yayitali kumabweretsa chitukuko cha akhanda, zomwe zitha kukhala zowopsa kwa moyo ngati atasiyidwa. Ngati mukufunika kumwa ma opioids nthawi yayitali mu amayi apakati, muyenera kumuchenjeza wodwalayo za chiwopsezo chokhala ndi matenda omwe amayamba kumene mwa ana, ndikuwonetsetsa kuti chithandizo choyenera chilipo.

Kugwiritsa ntchito fentanyl (iv kapena iv) pakubala (kuphatikiza gawo la cesarean) sikulimbikitsidwa, chifukwa fentanyl amadutsa chikhodzodzo, komanso chifukwa malo opumira a mwana wosabadwayo amakhudzidwa kwambiri ndi opiates. Pankhani ya kusankha kugwiritsa ntchito fentanyl, mankhwala okonzekera kugwiritsa ntchito ndi ofunika.

Fentanyl imachotsedwa mkaka wa m'mawere ndipo imayambitsa kudwala / kupuma kwa ana, motero muyenera kukana kudya pakatha maola 24 mutatha kugwiritsa ntchito mankhwalawa. Kuopsa / phindu la kuyamwitsa mutagwiritsa ntchito fentanyl liyenera kuganiziridwanso.

Njira zopewera kupewa ngozi

Fentanyl iyenera kugwiritsidwa ntchito ndi anthu odziwa ntchito kwambiri. Fentanyl iyenera kukhazikitsidwa ndi akatswiri okhawo omwe amadziwa malamulo oyendetsera analgesic opioid mankhwala a nthawi yayitali, kuzindikira ndikuchotsa hypoventilation, kuphatikizapo chithandizo ndi opioid receptor antagonists ngati pakufunika.

Fentanyl, monga ma opioid analgesics ena, amatha kukhala ozunza onse ngati agwiritsidwa ntchito molingana ndi mawonekedwe oti agwiritse ntchito, komanso akapeza mwayi wovomerezeka ndi mankhwalawo. Ngozi izi ziyenera kukumbukiridwa popereka mankhwala, kupereka komanso kufalitsa mankhwala ngati pali nkhawa yokhudza kugwiritsidwa ntchito molakwika, kuzunza komanso kuphwanya malamulo ena.

Odwala omwe ali ndi chiopsezo chowonjezeka cha opioid amaphatikiza odwala omwe ali ndi mbiri ya mabanja osokoneza bongo (kuphatikiza mankhwala osokoneza bongo kapena mowa) kapena mavuto ena amisala (mwachitsanzo, kukhumudwa kwambiri). Musanalembe opioid analgesics kwa wodwala, kuchuluka kwa zoopsa zamatenda zomwe zimadalira opioid ziyenera kuyesedwa. Odwala onse omwe amalandira ma opioid amayenera kuyang'aniridwa ndi zizindikiro zosagwiritsidwa ntchito molakwika, kuzunza, komanso kukulitsa kudalira. Odwala omwe ali pachiwopsezo chowonjezereka cha opioid amalangizidwa kuti achoke pakukonzekera kosintha kwa opioid; odwala awa amafunikira kuwunikira kosalekeza kwa zizindikiro za kuvutitsidwa kwa opioid.

Zovuta zokhudzana ndi kuzunzidwa, kudalira komanso kugwiritsa ntchito mosayenera siziyenera kukhala chifukwa chakulephera kwa mankhwalawa.

Komabe, odwala onse omwe amalandira opioid analgesics amafunikira kuwunikira mosamala za zizindikiro zakusuta ndikuzunza, popeza pali chiwopsezo cha kusuta, kuphatikizapo kugwiritsa ntchito bwino opioid analgesics.

Kuchulukitsa mlingo wa fentanyl chifukwa chowerengera molakwika mukachotsa wodwala kuchokera ku mtundu wina wa analgesic kungayambitse chifuwa chachikulu pa mlingo woyamba.

Fentanyl sayenera kugwiritsidwa ntchito pochepetsa kupweteka kwakanthawi komanso kofatsa.

Kugwiritsa ntchito mankhwala munthawi yomweyo komwe kumakhudza dongosolo lamanjenje kumafuna kuwunikira ndi kuwunika kwapadera.

Kugwiritsa ntchito fentanyl kumatha kuyambitsa kupuma, komwe kumadalira mlingo ndipo kumatha kuyimitsidwa ndikuyambitsa wina wotsutsa - naloxone. Kukhazikitsidwa kwa Mlingo wowonjezera wa naloxone kungakhale kofunikira, chifukwa kupuma kwamtunduwu kumatha kukhala nthawi yayitali kuposa nthawi yotsutsana naye. Kupsinjika kwa mtima ndi chimodzi mwazovuta zowopsa zamankhwala omwe amapezeka ndi opioid receptor agonists, kuphatikizapo fentanyl. Chiwopsezo chachikulu cha kupuma kwamankhwala chimawonedwa mwa okalamba komanso ofooka, nthawi zambiri atatha kugwiritsa ntchito muyeso waukulu kwa odwala omwe sanalandire chithandizo cha opioid kapena m'malo omwe ma opioids amawayikidwa pamodzi ndi mankhwala ena omwe amapondereza kupuma. Matenda opumira omwe amayambitsidwa ndi ma opioid amawonetsedwa ndi kuchepa kwamphamvu kwa kupuma komanso kuchepa kwa kupuma, komwe kumanenedweratu pakupuma "kosayenera" (kupuma kwakukuru kumasokonezedwa ndi kupumira kwakanthawi). Kusungika kwa kaboni dayokiti chifukwa cha kupuma kumatha kupangitsa kuti mphamvu za osokoneza bongo zizisintha. Pankhaniyi, mankhwala osokoneza bongo ochulukirapo omwe ali ndi mankhwala osokoneza bongo ndi ma opioid ndi owopsa kwambiri.

Analgesia yozama imatsatiridwa ndi kupuma kwakukulu, komwe kumatha kupitilira kapena kubwezeretsanso pambuyo pake. Pachifukwa ichi, kuwunika odwala mosamala ndikofunikira, komanso kupezeka kwa zida zofunika komanso mdani wina wofuna kutenganso chiyembekezo. Hyperventilation pa opaleshoni angasinthe wodwalayo poyankha CO₂ ndikupangitsa kupsinjika kwa kupuma kwa nthawi ya postoperative.

Fentanyl iyenera kuthandizidwa mosamala kwambiri kwa odwala omwe ali ndi vuto la m'mapapo kapena matenda am'mapapo mwanga, komanso kwa odwala omwe ali ndi kuchepa kwakukulu kwa zotsalira zam'mapapo, hypoxia, hypercapnia, kapena omwe kale anali ndi kupuma. Mwa odwalawa, ngakhale njira zochizira za fentanyl zimatha kuponderezera kupuma mpaka ntchito. Kwa gulu ili la odwala, njira zina zosagwiritsa ntchito opioid ziyenera kuganiziridwanso, ndipo ma opioids ayenera kuyikidwa kokha moyang'aniridwa ndi achipatala komanso pamankhwala ochepa kwambiri.

Kuvulala kumutu komanso kuwonjezereka kwa nkhawa ya intracranial

Fentanyl sayenera kulembedwa kwa odwala omwe amatha chidwi kwambiri ndi zovuta za kuchuluka kwa CO okwera.₂. Gulu ili la odwala limaphatikizapo omwe ali ndi zizindikiro zowonjezera kukhudzika kwa intracranial, kusokonezeka kwa chikumbumtima, kapena chikomokere. Opioids amatha kusokoneza kuyesa kwa matenda omwe ali ndi odwala ovulala muubongo. Fentanyl iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi chotupa muubongo.

Kuuma kwa minyewa, kuphatikiza minofu ya pectoral, ndikotheka, komwe kungapewedwe potsatira njira izi: kukhazikika pang'onopang'ono, kutsika ndi benzodiazepines, komanso kugwiritsa ntchito minofu yolumikizira minofu.

Kupezeka kwa mayendedwe a myoclonic a chikhalidwe chosakhala cha khunyu ndi kotheka. Bradycardia, mpaka kumangidwa kwa mtima, imatha kuchitika ngati wodwala alandila kuchuluka kwa anticholinergics kapena pamene fentanyl imagwiritsidwa ntchito limodzi ndi othandizira minofu omwe alibe ntchito ya vagolytic. Bradycardia ikhoza kuyimitsidwa ndikuyambitsa atropine.

Pogwiritsa ntchito fentanyl nthawi yayitali, kulekerera komanso kudalira mankhwala kumatha.

Ma opioids amatha kuyambitsa hypotension, makamaka kwa odwala omwe ali ndi hypovolemia. Njira zoyenera ziyenera kuchitidwa kuti magazi azithamanga.

Pewani jakisoni wofulumira wa mankhwala opioid mwa odwala omwe ali ndi vuto losinthika:

Odwala omwe akhala akuchita opioid mankhwala kwakanthawi kochepa kapena omwe amadalira opioid angafunikire kuchuluka kwa fentanyl.

Kuchepetsa mlingo kumalimbikitsa odwala okalamba ndi ofooka.

Kugwiritsa ntchito fentanyl kumafuna kuchenjeza odwala omwe ali ndi mikhalidwe iyi: hypothyroidism yosasinthika, matenda am'mapapo, kuchepa kwamphamvu, uchidakwa, chiwindi kapena impso. Odwala oterewa amafunikiranso kuwunika kwa nthawi yayitali.

Pogwiritsa ntchito fentanyl limodzi ndi ma antipsychotic (monga droperidol), ndikofunikira kulingalira kusiyana kwakutali kwa nthawi ya mankhwalawa. Ndi kugwiritsidwa ntchito kwawo munthawi yomweyo, chiopsezo cha hypotension chikuwonjezeka. Ma antipsychotic amatha kuyambitsa ma extrapyramidal omwe amatha kuwongolera pogwiritsa ntchito mankhwala a antiparkinsonia.

Monga ma opioids ena, chifukwa cha zotsatira zake za anticholinergic, kugwiritsa ntchito fentanyl kumatha kubweretsa kuwonjezeka kwa kukakamiza kwa bile duct ndipo, kawirikawiri, kupindika kwa sphincter ya Oddi kumatha kuwonedwa.

Odwala a myasthenia gravis, muyenera kuganizira mozama kugwiritsa ntchito anticholinergics ndi mankhwala omwe amaletsa kufalitsa kwa mitsempha isanachitike komanso nthawi ya opaleshoni, yomwe imaphatikizapo kulowetsedwa kwa fentanyl.

Kugwiritsa ntchito fentanyl panthawi yobereka kumatha kubweretsa kupsinjika kwa mwana wakhanda.

Kuyanjana ndi Mowa ndi Mankhwala Osokoneza bongo

Fentanyl ikhoza kukhala ndi chowonjezera pakukakamiza kwa ntchito yamagulu amanjenje ikaperekedwa motsutsana ndi maziko a mowa, ma opioids ena kapena mankhwala osaloledwa omwe ali ndi vuto lofananalo ndi dongosolo lamkati lamanjenje.

Gwiritsani ntchito ana. Chitetezo cha fentanyl sichinatsimikizidwe mwa ana ochepera zaka ziwiri. Fentanyl imatha kuperekedwa kwa ana azaka zopitilira 2 ndi omwe kupirira kwa opioid kwawonetsedwa.

Analgesia mwa ana omwe amasungika kupuma mokhazikika ayenera kugwiritsidwa ntchito ngati njira yolumikizira mankhwala osokoneza bongo kapena ngati cholumikizira kutsata (kapena ngati gawo la njira ya sedation / analgesia), pokhapokha ngati anthu oyenerera ndi zida zilipo pothandizidwa kupuma. Kukhazikika kwa fentanyl, makamaka kwa ana, kungayambitse mankhwala osokoneza bongo.

Gwiritsani ntchito mwa okalamba. Zomwe zimapezeka pofufuza zamkati mwa fentanyl zimapereka lingaliro kuti odwala okalamba amatha kuchepa kwa mankhwalawo ndikuwonjezera theka la mankhwalawo, komanso, odwala oterowo amatha kukhala osamala ndi fentanyl kuposa odwala achinyamata. Odwala okalamba amafunikira kuwunikira mosamala kuti adziwe zizindikiro za fentanyl yochulukirapo, yomwe ingafune kuchepetsa fentanyl.

Chenjezo liyenera kugwiritsidwa ntchito pophatikiza fentanyl ndi mankhwala omwe amakhudza dongosolo la serotonergic neurotransmitter.

Kuphatikiza ndi mankhwala a serotonergic, monga kusankha serotonin reuptake inhibitors, serotonin ndi norepinephrine reuptake inhibitors, komanso mankhwala omwe amakhudza kagayidwe ka serotonin (kuphatikizapo monoamine oxidase inhibitors), angayambitse ngozi ya serotonin.

Kukula kwa serotonin syndrome kumatha kuchitika pogwiritsa ntchito mankhwala osokoneza.

Kuwonetsedwa kwamankhwala kwa serotonin syndrome kungaphatikizepo zizindikiro zotsatirazi:

- kusintha kwa mtima wamaganizidwe (kuda nkhawa, kukomoka,

- kusokonezeka kwa dongosolo la ziwonetsero zamagetsi (tachycardia, kuchuluka kwa kuthamanga kwa magazi, hyperthermia),

- mitsempha yamatumbo (hyperreflexia, kusokonezeka kwa mgwirizano, kukhazikika kwa minofu),

zizindikiro zam'matumbo (mwachitsanzo, nseru, kusanza, kutsekula m'mimba).

Ngati chitukuko cha serotonin syndrome chikuwaka, kugwiritsa ntchito fentanyl kuyenera kuyimitsidwa nthawi yomweyo.

Kukopa pa kuyendetsa magalimoto ndi njira zina zowopsa. Kuyendetsa galimoto ndikuchita zina zomwe zingakhale zovulaza ndizotheka kokha ngati nthawi yokwanira yatha kuchokera pakugwiritsa ntchito mankhwalawa.