Antihypertensive Therapy a Matenda a shuga

Njira yachikhalidwe yothandizira odwala omwe ali ndi matenda oopsa ndiyo kukhazikitsidwa kwa monotherapy ndimankhwala othana ndi antihypertensive omwe ali ndi gawo lodziwikiratu mpaka pazothandiza kwambiri, ndiye kuti lachiwiri ndi lachitatu ndi mankhwala. Komabe, njirayi ndi yayitali komanso siigwira ntchito nthawi zonse. Pokonza njira yodziwira matenda azachipatala, zinaonekeratu kuti monotherapy imangothandiza mu 50% ya odwala komanso pokhapokha magazi amawonjezeka. Nthawi zambiri, njira zingapo za pathogenetic zimagona pakupanga matenda oopsa, chifukwa chake ma monotherapy sangakhudze zonse zomwe zimayambitsa kuthamanga kwa magazi mwa wodwala aliyense.

Kuphatikiza apo, kukwaniritsa zofunika kwa kuthamanga kwa magazi (140/90 mm RT. Art. "W />
Kapangidwira ka mankhwala a antihypertensive kwa odwala matenda a shuga omwe ali ndi vuto la kuthamanga kwa magazi> 140/90 mm RT. Art.

Mayeso azachipatala a Multicenter amawonetsa kuti mankhwala 2 mpaka 4 am'magulu osiyanasiyana amafunikira kuti akwaniritse kuthamanga kwa magazi.

Ubwino wophatikiza matenda olembetsa magazi asanafike monotherapy ndizodziwikiratu:
• Kuphatikiza chithandizo kumakupatsani mwayi wogwiritsa ntchito njira zingapo zopangira matenda oopsa, zomwe zimapangitsa,
• kuphatikiza mankhwala amalola kugwiritsa ntchito mankhwala osachepera mankhwala osapereka nsembe antihypertensive,
• kuphatikiza kwina kwa mankhwalawa kumachotsa (kapena kufooketsa) zoyipa zamagawo amunthu.

Malinga ndi malingaliro ochokera mu 2003 a VII Joint United States Committee for the Prevention and Treatment of Arterial Hypertension (JNC 7), chithandizo chophatikiza chimayenera kuperekedwa kwa wodwala aliyense amene magazi ake akupitilira 20/10 mmHg. Art. mfundo zofunika, i.e. 140/90 mmHg. Art. Odwala opanda matenda a shuga ndi 130/80 mm RT. Art. odwala matenda ashuga.

Njira yakusankhidwa kwa mankhwala a antihypertensive kwa odwala matenda a shuga imaperekedwa.

Njira zamankhwala othandizira odwala matenda a shuga

Monotherapy imatheka pokhapokha kuwonjezeka kwakukulu kwa kuthamanga kwa magazi> 130/80 mm RT. Art

Cholinga chachikulu pakuperekera odwala omwe ali ndi matenda ashuga ndi kupewa kutukuka kapena kupitirira msanga kwa zovuta zamavuto amtunduwu (DN, DR, kuwonongeka kwa ziwiya zamtima, bongo, ndi mitsempha ina yayikulu). Ndizosatsutsika kuti zomwe zimatsogolera zikuwonetsedwa.

Ma adducins ndi mapuloteni a cytoskeleton a khungu. Amaganiza kuti, mbali inayi, mauctuctins amapatsira ma cell mkati mwa khungu, ndipo, akalumikizana ndi mapuloteni ena a cytoskeletal, amayendetsa ma ion kudzera mu membrane wa cell. Mwa anthu, ma aducins onse amapangidwa nthawi ziwiri.

Kutulutsa mafomu ndi kapangidwe kake

Mapiritsiwo ali ndi utoto woyera, fungo lapadera, mawonekedwe osalala. Mwa blockers, mankhwalawa akuwoneka kuti amatha kuchepetsa mtima kukana komanso kutulutsa mphamvu m'makoma a mitsempha.

The yogwira mankhwala ali kuchuluka 25 mg.

Kutulutsa mawonekedwe - mapiritsi, 25 mg, 10 ma PC. Kulongedza contour, khungu, yokhala ndi malangizo ogwiritsa ntchito. 20 ma PC. mapiritsi amatayikidwa mumtsuko woyikidwa mu katoni.

Mankhwala amapangidwa pa mlingo wa 12,5 mg ndi 50 mg. Mankhwalawa ali ndi gulu la sulfhydryl lomwe limalepheretsa kuwonongeka kwa myocardium.

Mankhwalawa ali ndi gulu la sulfhydryl lomwe limalepheretsa kuwonongeka kwa myocardium.

Zotsatira za pharmacological

Mankhwalawa amathetsa ntchito ya ACE, chifukwa chake, kuchuluka kwa kusintha kwa enzyme I kupita ku angiotensin II, komwe kumatanthauza vasoconstrictor athari, kumachepa.

Mu adrenal cortex, kupanga aldosterone kumawonjezeka. Mankhwala amakhudza kinin-kallikrein dongosolo, kusunga bradykinin.

Pharmacokinetics

Mutagwiritsa ntchito limodzi mlingo wa mankhwala othandizira, 75% ya mankhwalawo amachotsedwa pamimba. Kudya kumakhudza mayamwidwe a mankhwalawa, kuchepetsa zotsatira zake ndi 40%.

Mu madzi a m'magazi, mankhwalawa amamangidwa kumapuloteni (albumin) ndipo amamuchotsa mkaka wa m'mawere.

Mutagwiritsa ntchito limodzi mlingo wa mankhwala othandizira, 75% ya mankhwalawo amachotsedwa pamimba.Mu madzi a m'magazi, mankhwalawo amamangidwa ndi mapuloteni (albumin).
Mankhwala amaphulika m'maselo a chiwindi.

Mankhwala amaphulika m'maselo a chiwindi, ndikupanga zotsatirazi:

osagwirizana ndi zinthu zomwe zikugwira,
cysteine disulfide.

Zinthu zowola sizikugwira ntchito. Hafu ya moyo wa mankhwala sichidutsa 3 hours. Ndi kulephera kwa aimpso, mankhwalawa amadziunjikira m'thupi, chifukwa chake, kuchuluka kwa urea ndi creatinine m'magazi a seramu kumawonjezeka.

Zomwe Captopril zimathandizira 25

Wothandizira mankhwala amasonyezedwa matenda monga:

matenda oopsa (monga gawo la mankhwala osakanikirana),
kusintha kwa ntchito yamanzere kwamitsempha chifukwa cha kufooka kwa mtima,
matenda ashuga nephropathy,
kulephera kwa mtima.

Malangizo ogwiritsira ntchito othandizira achire amasonyeza kuti anti-ischemic, mtima wa blocker. Mankhwalawa amagwiritsidwa ntchito popereka chisamaliro chadzidzidzi pakuwonjezera kuthamanga kwa magazi pamalo oyambira.

Mankhwalawa amagwiritsidwa ntchito popereka chisamaliro chadzidzidzi pakuwonjezera kuthamanga kwa magazi pamalo oyambira.

Kuchuluka kwake kumachepa bwanji

ACE zoletsa mpaka 150 mg patsiku, ogwiritsidwa ntchito pazachikhalidwe limodzi ndi mtima glycosides ndi diuretic, amachepetsa kufa ndi 40%.

Mlingo woyambira wa 6.25 mg pang'onopang'ono umakwera mpaka 25 mg 2-3 kawiri pa tsiku. Poletsa kutsika kwa magazi, kuchuluka kwa mankhwala omwe amwedwa kumachitika masiku angapo (kuchuluka kwa mankhwalawa ndikololedwa kwa magazi a systolic pamtunda wa 90 mm Hg komanso osapitirira 1 nthawi sabata).

Zigawo zikuluzikulu za mankhwalawa zimachepetsa kuthamanga kwa magazi, koma zimayambitsa kukulitsa zotsatira zoyipa, mpaka kumayambiriro kwa myocardial kapena stroke.

Contraindication

Mankhwala sanakhazikitsidwe ngati mudziwe za matenda monga:

anaphylactic mantha (mbiri),
kuwonongeka kwaimpso,
magazi akulu a nayitrogeni
opaleshoni yama impso
kuchepa kwa machitidwe a mapaundi,
mitral valavu stenosis,
chiwindi
matenda a chiwindi
ochepa hypotension,
Cardiogenic mantha ndi myocardial infarction.

Mankhwala sanakhazikitsidwe ngati chidziwitso cha kufooka kwa impso chikuwoneka m'mbiri yamankhwala.

Hypotension ndi chiwonetsero choyambirira cha kukanika kwaimpso sikuti ndi zotsutsana kwathunthu chifukwa cha kuperekedwa kwa mankhwala.

Ndi myocardial infaration

Mankhwala wolembedwa koyambirira, amakhala ndi zotsatirazi:

amachepetsa nkhawa pamtima,
amachepetsa chiopsezo cha fibrosis,
sinamwino endothelial function,
imayendetsa ma receptor a peptide omwe amapanga mitsempha yamagazi.

Mankhwalawa aledzera moyang'aniridwa ndi kuthamanga kwa magazi kwa masabata asanu. Mutamwa mankhwalawo, nsonga za antihypertensive zimawonedwa pambuyo pa maola 3-5.

Mlingo woyambirira wa mankhwalawa ndi 6.25 mg.

Mankhwalawa amatchulidwa 3-16 patatha pachimake myocardial infarction. Pambuyo pa maola awiri, mlingo wa ACE inhibitors umakulitsidwa mpaka 12,5 mg ndi kumwa 3 katatu patsiku.

Mankhwalawa ndiwotalikirapo, ochitika mothandizidwa ndi kuthamanga kwa magazi (kuthamanga kwa magazi a wodwala sayenera kugwa pansi pa 100 mm Hg. Art.).

Captopril, yoperekedwa koyambirira, imathandiza kuchepetsa kupsinjika kwa mtima.

Pakanikizidwa

Mlingo woyambirira wa mankhwalawa 25 mg 2 kawiri pa tsiku. Ngati pakufunika thandizo, kuchuluka kwa mankhwalawa kumawonjezereka kwa masiku 14-28 mpaka zotsatira zamankhwala zimatheka.

Ndi matenda oopsa a digiri ya I-II, chithandizo chikuchitika pogwiritsa ntchito ACE zoletsa pa 25 mg 2 kawiri pa tsiku. Kuchuluka kwa tsiku lililonse kwa mankhwalawa ndi 100 mg.

Pa matenda oopsa kwambiri, mlingo wa 30 mg katatu patsiku umaloledwa. Mukamapereka mankhwala, ngozi ya kutsika kwa magazi imawonjezeka ngati wodwala akudwala kwambiri mtima, amakhala ndi magazi ochepa.

Kulephera kwa mtima kosatha

Zochizira kulephera kwa mtima, mankhwalawa amalimbikitsidwa ngati mankhwala omwe ali ndi diuretics alibe matenda. Mlingo woyambirira ndi 6.25 mg katatu patsiku.

Kuchuluka kwa mankhwalawa sikudutsa 25 mg katatu pa tsiku.

Mulingo waukulu wa blocker ndi 150 mg patsiku.

Ndi matenda ashuga nephropathy

Mu vuto laimpso, lomwe limayamba mwa wodwala matenda a shuga, ndi creatinine chilolezo cha 30 ml / mphindi, mankhwala ndi mankhwala a 75-100 mg / tsiku.

Mankhwalawa aledzera pakukakamiza kwa ola limodzi asanadye.

Zimatenga nthawi yayitali bwanji

Kupanikizika kumacheperachepera maola 1-1,5 mutatha kugwiritsa ntchito mlingo umodzi wa mankhwalawa. Kupitiliza kwakanthawi kachipatala kumachitika pakatha masabata 8 mutatha kugwiritsa ntchito mankhwala a antihypertensive.

Mlingo wa Captopril 25 watsimikiza.

Matumbo

Mukamagwiritsa ntchito mankhwalawa, mutha kukumana ndi zovuta monga:

nseru
kusowa kwa chakudya
kusintha kwa kukoma
kupweteka kwa epigastric
kudzimbidwa
chiwindi
kutupa kwa kapamba,
kuphwanya kapangidwe ka bile,
Khungu
kupweteka mu hypochondrium yoyenera.

Hematopoietic ziwalo

Zomwe zimachitika mutagwiritsa ntchito mankhwalawa zimawerengedwa kuti ndi:

kuchepa magazi
kuchuluka kwa magazi
magawo ochepa a neutrophils m'magazi.

Mulingo waukulu wa mankhwalawa kwa anthu opitilira 65 umayambitsa kuchepa kwa maselo oyera a magazi, kuwonjezereka kwa matenda oyamba ndi mafangasi, omwe ndi oopsa kwambiri kwa odwala omwe ali ndi matenda a autoimmune.

Pakati mantha dongosolo

Pa mankhwala, mawonekedwe a machitidwe amodzimodzi:

chizungulire
kutopa
kuphwanya mgwirizano
kusintha kwa khungu.

Mwa odwala okalamba, kuwonongeka kwa mawonekedwe, kugona, kupweteka mutu, kuzindikira, kapena kuwonongeka kwa orthostatic ndizotheka.

Pa chithandizo, chizungulire chimadziwika.

Kuchokera kwamikodzo

Zosakwanira zimachitika mthupi monga:

kuwonongeka kwaimpso,
polyuria
kuchuluka kwa mapuloteni mumkodzo,
kuchuluka sclerotic njira mu zimakhala za kwamikodzo chiwalo.

Odwala omwe amalephera kupweteka aimpso, chiopsezo chokhala ndi microalbuminuria chikuchulukitsa, kuchuluka kwa creatinine kumawonjezeka kuposa 30% kuchokera pamlingo woyamba. Odwala ena, aimpso ochepa mphamvu ntchito, ischemic nephropathy amakhala.

Kuchokera ku kupuma

Pa mankhwala, mawonekedwe a machitidwe amodzimodzi:

bronchospasm,
chifuwa chowuma,
kugwedezeka kwamphamvu ndi mawu
zilonda zapakhosi
kupuma movutikira atagona.
laryngeal stenosis,
pulmonary edema.

Makanda obadwa kumene amakhala ndi vuto la oliguria ndi mitsempha.

Captopril ikhoza kuyambitsa chifuwa chowuma, chopweteka.

Pa khungu

Mukamagwiritsa ntchito choletsa ACE, wodwala amatha kukumana ndi zovuta monga:

kulowetsedwa mapepala oyenda,
kuyabwa kowawa
mabala a pinki.

Mawonekedwe amtundu wa pakhungu amachitika pakadutsa mphindi zochepa atamwa mankhwalawo, Zizindikiro zimayambiranso pambuyo pa kumwa mankhwala.

Kutupa kumachitika motsutsana ndi msana wa edema yodontha, kutentha kumawonekera, khungu limalimbikira, lomwe limasunthika bwino, fossa siliwongola kwa nthawi yayitali ndikukanikiza ndi chala.

Kuchokera ku genitourinary system

Mankhwala atagwiritsidwa ntchito kwa nthawi yayitali amatha kubweretsa kusabereka, kuwonongeka kwa impso.

Mawonetsedwe pawokha atatha kumwa mankhwalawa amakhala ndi mtima wa edema ndi urticaria. Kukula kwa anaphylactoid zimachitika limodzi ndi maonekedwe a kuyabwa kwa chapamwamba ndi m'munsi malekezero, nkhope, pakamwa patsekeke, kutsatsa wosanjikiza chapamwamba kupuma thirakiti ndi m'mimba thirakiti.

Mawonetsedwe pawokha atatha kumwa mankhwalawa amadziwika ndi mawonekedwe a kukhathamira.

Wodwala ali ndi izi:

aphonia,
kupuma mwamphamvu
kutsutsika
zotsatira zakupha.

Mankhwala

Captopril ndi angiotensin kutembenuza enzyme (ACE) inhibitor yomwe imalepheretsa kutembenuka kwa angiotensin I kuti angiotensin II, zomwe zimapangitsa kuchepa kwa kutulutsa kwa aldosterone. Izi zimabweretsa kutsika kwathunthu kwamitsempha yamagazi kukana, kuthamanga kwa magazi (BP), positi - ndikukweza pamtima.

Ntchito ya kukonzanso kwa plasma sikukhudza zotsatira zama hypotensive. Kutsika kwa kuthamanga kwa magazi kumachitika pang'onopang'ono komanso m'munsi mwa mahomoni, omwe amafotokozedwa ndi zomwe zimachitika mu minofu renin-angiotensin.

Kugwiritsidwa ntchito kwa nthawi yayitali kwa Captopril kumachepetsa kuopsa kwa myocardial hypertrophy, komanso makoma a mitsempha yotulutsa.

Komanso, mankhwalawa ali ndi zotsatirazi mthupi:

timapitilira magazi ndi aimpso,
Imachepetsa kuphatikizika kwa masamba
amachulukitsa magazi ku ischemic myocardium,
Amathandizira kuchepetsa kuchuluka kwa ayoni a sodium odwala omwe ali ndi vuto la mtima,
amachepetsa kuchepa kwa bradykinin ndikuwonjezera kapangidwe ka prostaglandin.

Captopril imayendetsa mitsempha kwakukulu kwambiri kuposa mitsempha.

Mosiyana ndi kugwiritsa ntchito vasodilators mwachindunji (minoxidil, hydrazine, etc.), kuchepa kwa kuthamanga kwa magazi pambuyo potenga captopril sikumawonetsera kuwonetsa tachycardia ndikuchepetsa kufunikira kwa myocardium pakupereka kwa oxygen. Pakulephera kwa mtima, mlingo wokwanira wa mankhwalawo sukusokoneza kuchuluka kwa magazi.

Pambuyo pakukonzekera pakamwa, kuchepa kwambiri kwa kuthamanga kwa magazi kumawonedwa pambuyo pa maola 1-1,5. Kutalika kwa hypotensive zotsatira kumadalira mlingo ndikufika pamtengo wokwanira bwino masabata angapo.

Malangizo ogwiritsira ntchito Captopril: njira ndi mlingo

Mapiritsi a Captopril amatengedwa pakamwa 1 ola limodzi asanadye.

Dokotala amamulembera tsiku lililonse mlingo uliwonse malinga ndi momwe matenda akuwonekera.

Mlingo wothandizidwa ndi matenda osakhazikika a mtima (osakanikirana ndi mankhwala), pakalibe vuto logwiritsa ntchito okodzetsa: koyamba mlingo wa 6.25 mg katatu patsiku. Mlingo umasinthidwa kukhala pafupifupi muyeso wokonza - 25 mg 2-3 patsiku, pang'onopang'ono, masabata awiri kapena kuposerapo. Ngati pakufunika kuwonjezera mlingo, kuchuluka kumapangidwa nthawi 1 m'masabata awiri,

Mlingo woyenera wa Captopril wothinikizidwa ndi matenda oopsa: koyamba mlingo wa 25 mg kawiri pa tsiku. Ngati achire mphamvu sikokwanira, mlingo tikulimbikitsidwa kuti ziwonjezeke pang'onopang'ono, nthawi 1 m'milungu 2-4. Mankhwala okonza njira yovomerezeka ya matenda oopsa ndi 25 mg kawiri pa tsiku, koma osapitirira 50 mg, chifukwa chaukali - 50 mg katatu patsiku.

Mlingo wambiri watsiku ndi tsiku ndi 150 mg.

Mlingo wa tsiku ndi tsiku wa odwala omwe ali ndi vuto la impso amalimbikitsidwa. / 1.73 m 2) - mlingo woyambirira wa 12,5-25 mg wa patsiku. Ngati ndi kotheka, kuwonjezereka kumapangidwa kwa nthawi yayitali, koma mankhwalawa amagwiritsidwa ntchito tsiku lililonse mosagwirizana ndi masiku onse.

Kwa odwala okalamba, mlingo umasankhidwa mosiyanasiyana, chithandizo chimalimbikitsidwa kuti muyambire ndi 6.25 mg 2 kawiri pa tsiku ndikuyesera kuti mulibe mlingo.

Ngati ndi kotheka, owonjezera othandizira okodzetsa, kupukusa okodzetsa m'malo motulutsa thiazide.

Zotsatira zoyipa

Kugwiritsidwa ntchito kwa captopril kumatha kuyambitsa mavuto:

Kuchokera pamtima dongosolo: kuchepa kwakukulu kwa kuthamanga kwa magazi, hypotension ya orthostatic, zotumphukira edema, tachycardia,
Kuchokera m'mimba thirakiti, kapamba, chiwindi: mkamwa wouma, kusokonekera kwamkamwa, kuchepa kwa chidwi, nseru, stomatitis, kawirikawiri - kupweteka kwam'mimba, kutsegula m'mimba, hyperbilirubinemia, kuchuluka kwa michere ya chiwindi, hepatitis,
Kuchokera kwamikodzo dongosolo: kuwonongeka kwa impso (kuchuluka kwa creatinine ndi urea m'magazi), proteinuria,
Kuchokera kwamanjenje: kugona, chizungulire, kumva kutopa, kupweteka mutu, paresthesia, ataxia, asthenia, kusawona bwino,
Kuchokera ku hemopoietic dongosolo: kawirikawiri - kuchepa magazi, neutropenia, agranulocytosis, thrombocytopenia,
Kuchokera pakapumidwe: bronchospasm, chifuwa chowuma (chosakhalitsa), pulmonary edema,
Laborator Zizindikiro: hyponatremia, hyperkalemia, acidosis, odwala matenda a shuga - hypoglycemia (omwe ali ndi pakamwa hypoglycemic wothandizila ndi insulin)
Dermatological zimachitika: kuchuluka photosensitivity, kuyabwa, zotupa khungu, kawirikawiri maculopapular, nthawi zambiri owopsa kapena vesicular,
Thupi lawo siligwirizana ndi immunopathological: angioedema ya mucous nembanemba mkamwa, lilime, larynx ndi pharynx, milomo, nkhope ndi miyendo, kawirikawiri - matumbo edema, lymphadenopathy, matenda a seramu, kawirikawiri, kupezeka kwa antiinodar antibodies m'magazi,
Zina: paresthesia.

Malangizo apadera

Ndi nthawi yoika mankhwalawa pakumwa mankhwalawa, ndikofunikira kuyang'anira ntchito yaimpso.

Chithandizo cha odwala omwe ali ndi vuto la mtima kwambiri chikuyenera kuchitika moyang'aniridwa ndi achipatala.

Mosamala, makamaka motsutsana ndi maziko a vuto la impso, Captopril imayikidwa limodzi ndi immunosuppressants (kuphatikizapo cyclophosphamide, azathioprine), allopurinol kapena procainamide, odwala a systemic vasculitis kapena kuvulaza ma processic minofu. Pofuna kupewa zovuta zazikulu, musanayambe kugwiritsa ntchito, m'miyezi itatu yoyambirira (nthawi imodzi mu masabata awiri) komanso nthawi yonse yogwiritsira ntchito mankhwalawa, ndikofunikira kuwongolera chithunzi cha magazi oyipa.

Odwala omwe ali ndi mbiri yodwala matenda a impso, captopril imawonjezera mwayi wokhala ndi proteinuria, chifukwa chake, m'gulu ili la odwala, kuchuluka kwa mapuloteni mkodzo kuyenera kuyang'aniridwa miyezi isanu ndi iwiri (1 nthawi m'masabata 4), ndipo ngati zikuwonjezereka, nkhani yokhudza kusiya mankhwala iyenera kuyankhidwa .

Chiwopsezo chokhala ndi vuto la impso limapezeka mwa odwala omwe ali ndi aimpso a stenosis, ndikuwonjezereka kwa kuchuluka kwa creatinine kapena urea m'magazi, ndikofunikira kuti muchepetse mulingo kapena kuti muyiyetse.

Pofuna kupewa kukhazikika kwa anaphylactoid mwa odwala omwe akutenga Captopril, tikulimbikitsidwa kuti dialysis nembanemba yokhala ndi vuto lalikulu (kuphatikizapo AN69) isagwiritsidwe ntchito hemodialysis.

Chiwopsezo chokhala ndi vuto lokhala ndi mankhwalawa chifukwa chogwiritsa ntchito mankhwalawa chitha kuchepetsedwa, ngati asanayambitse chithandizo (masiku 4-7), mlingo umachepetsedwa kwambiri kapena kugwiritsa ntchito okodzetsa kumayimitsidwa.

Ngati pali vuto lochita kuledzera pakumwa mankhwala, wodwalayo amalimbikitsidwa kuti ayime kaye ndikuwakweza miyendo.

Ndi wowopsa ochepa hypotension, wodwalayo ayenera kupereka mankhwala a isotonic sodium kolorayidi.

Ndi chitukuko cha angioedema, mankhwalawa ayenera kusiyidwa ndipo dokotala ayenera kuthandizidwa mwachangu. Kwa edema yokhala ndi zotupa pa nkhope, kawirikawiri, chithandizo chapadera sichofunikira, kupatula kumwa ma antihistamines kuti muchepetse kuwonongeka kwa zizindikiro. Ngati pali chiopsezo chotenga mpweya wabwino (chotupa cha lilime, pharynx kapena larynx), 0,5 ml ya epinephrine (adrenaline) uyenera kuthandizidwa mosasamala muyezo wa 1: 1000.

Kugwiritsidwa ntchito kwa captopril kumatha kuyambitsa chizungulire, makamaka kumayambiriro kwa chithandizo, chifukwa chake odwala amalangizidwa kuti asayendetse magalimoto ndi maginito, komanso zochitika zoopsa zomwe zimafuna kuyang'aniridwa komanso kuthamanga kwa zochitika zama psychomotor.

Kuyanjana kwa mankhwala osokoneza bongo

Ntchito ya antihypertensive ya captopril imatha kupangidwa ndi vasodilators (minoxidil) ndi okodzetsa.

Kuphatikizika ndi clonidine, estrogens, indomethacin ndi mankhwala ena osagwiritsa ntchito mankhwala a antiidal omwe amathandizira kuchepetsa kuperewera kwa mankhwalawa.

Pogwiritsa ntchito nthawi yomweyo mawu oti:

Potaziyamu yosawononga okodzetsa ndi kukonzekera kwa potaziyamu kungayambitse hyperkalemia,
Kukonzekera kwa golide (sodium aurothiomalate) ndi ma inhibitors osintha a angiotensin kumayambitsa zovuta zingapo, kuphatikizapo nseru, kusanza, kutupira nkhope, kutsitsa magazi,
Procainamide ndi allopurinol zimayambitsa chiopsezo chotenga matenda a Stevens-Johnson ndi / kapena neutropenia,
Mchere wa Lithium umakulitsa zinthu za seramu lifiyamu,
Cyclophosphacin, azathioprine ndi ma immunosuppressants ena amawonjezera mwayi wamavuto obisika,
Wothandizidwa ndi insulin ndi pakamwa amalimbikitsa chiopsezo cha hypoglycemia.

Ma analogi a Captopril akuphatikizapo: Capoten, Captopril-STI, Captopril-AKOS, Captopril Sandoz, Captopres, Alkadil.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

M'tsogolo mayi, chithandizo cha matenda oopsa chimachitika pogwiritsa ntchito mankhwala Methyldopa.

Oletsa sikuti amatchulidwa, chifukwa akuyimba:

Kulephera kwa impso mwana wakhanda,
kupindika miyendo ndi nkhope
kukula kwa mapapo,
Imfa ya mwana wosabadwa.

Mankhwala mu mkaka wa m'mawere amakhala ndi zotsatira zoyipa pa thanzi la mwana.

Kuyenderana ndi mowa

Mankhwalawa sangatengedwe nthawi imodzi ndi zakumwa zomwe zimakhala ndi ethyl mowa, kuti mupewe kukulitsa zovuta.

Pankhani ya poizoni wa Captopril, wodwalayo amayamba kuwonongeka.

Bongo

Pothetsa poyizoni ndi ACE inhibitor, wodwalayo amakula:

hypotension
myocardial infaration
sitiroko
thromboembolism
kulephera kwa aimpso
kuwonongeka kwamawonekedwe.

Mankhwala, tikulimbikitsidwa kuyeretsa matumbo, mankhwala jekeseni wa mankhwala a vasoconstrictor. Mankhwala, njira za colloidal, mankhwala Dopamine ndi Norepinephril amagwiritsidwa ntchito.

Kuchita ndi mankhwala ena

Kuphatikizana kwa mankhwalawa ndi vasodilator kumapangitsa kuwonjezeka kwa hypotensive.

Kugwiritsa ntchito kwa ACE inhibitor yokhala ndi mankhwala osapweteka a antiidal kapena Clonidine kumapangitsa kuchepa kwa mphamvu ya mankhwalawa.

Kugwiritsa ntchito mankhwala osokoneza bongo kumayambitsa bongo wa potaziyamu.

Chenjezo liyenera kuchitidwa nthawi yomweyo kugwiritsa ntchito mchere wa lithiamu ndi wothandizirana ndi hypotensive, popeza kuchuluka kwa ma cell omwe amapezeka mu seramu ya magazi kumawonjezeka.

Kugwiritsidwa ntchito kwa Captopril ndi mankhwala osokoneza bongo omwe amaletsa kutupa kumapangitsa kuti mankhwalawa athe kuchepa.

Odwala omwe akutenga Allopurinol ndi choletsa ACE ali pachiwopsezo chokhala ndi chizindikiro cha Stevens-Johnson.

Monga cholowa m'malo mwa mankhwala othandizira, gwiritsani ntchito:

Inhibitor ya kampani Sandoz (Germany) ili ndi 6.25 mg yogwira mankhwala piritsi limodzi. Mankhwalawa amagwiritsidwa ntchito pochiza matenda osokoneza bongo, kulephera kwa mtima, matenda a shuga.

Alkadil amatha kukhala ngati cholowa m'malo mwa mankhwalawa ndipo ndiwothandiza. Mankhwalawa amalembedwa chifukwa cha kulephera kwa muyezo.

Angiopril ali ndi vuto lofananalo ndi ACE inhibitor. Mankhwalawa amalembedwa kuti ayambe kugwira ntchito ya mtima, pambuyo pofufuza m'mitsempha, ndi albuminuria osapitirira 30 mg / tsiku.

Captopril malangizoCapoten malangizoBerlipril malangizo

Mutha kusintha mankhwalawa ndi mankhwala monga Kapoten. Mankhwala amatengedwa monga adanenera dokotala ola limodzi musanadye.

Ndemanga za Captopril 25

Vasily, wazaka 67, Voronezh

Ndimadwala matenda othamanga magazi. Chaka chatha, panali vuto lalikulu kwambiri la matenda oopsa. Kupsinjika sikunatayike ndi kalikonse, ngakhale jakisoni wakuchipatala sichinakhale chosavuta. Ndinakumbukira mankhwalawa, ndikuyika piritsi la 25 mg pansi pa lilime langa, ndipo patatha mphindi 30 kupanikizika kunachepa. Nthawi zonse ndimasunga mankhwalawo mu kabati ya mankhwala.

Margarita, wazaka 55, Cheboksary

Usiku, kupanikizika kunali 230 mpaka 115. Ndidayika mapiritsi awiri a mankhwalawo pansi pa lilime langa, kenako usiku wina 2. M'mawa, kukakamiza kudatsika mpaka 160 pa 100. Dokotala adapereka jekeseni wambiri ndipo zovuta zake zidabweranso. Ndikhulupirira kuti ndibwino kugwiritsa ntchito mankhwala oyamba a Kapoten pamankhwala.

Tamara, wazaka 57, Derbent

Ndimatenga inhibitor ya ACE kwa zaka 15, piritsi limodzi 0,25 mg kamodzi patsiku. Zochita za tsiku ndi tsiku zasintha, ntchito zamagalimoto zachepa, motero ndimamwa mapiritsi awiri a mankhwalawa patsiku. Palibe mavuto. Mankhwala ndi othandiza.

Mlingo

Piritsi limodzi lili

ntchito yogwira - capopril 25 mg

zokopa: lactose monohydrate, microcrystalline cellulose, magnesium kapena calcium stearate, silicon dioxide, colloidal anhydrous

Mapiritsiwo ndi oyera pamtundu, wooneka ngati cylindrical, wokhala ndi chamfer mbali zonse ziwiri, wokhala ndi notch wozungulira mbali imodzi komanso wolemba "G" mbali inayo.

Mankhwala

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, imathamanga mwachangu komanso kwathunthu kuchokera kumimba. Kudya munthawi yomweyo kumachepetsa mayamwidwe ndi 30-55%. Kuzungulira kwakukulu (Cmax) m'madzi a m'magazi kumachitika pambuyo pa mphindi 30-90. Mu plasma, imagwira mapuloteni ndi 25-30%. Imagawidwa mthupi lonse komanso minyewa yonse, imawoloka chikhodzodzo, kupita mkaka wa m'mawere, ndipo chotchinga mu magazi sichidutsa. Zimapangidwa m'chiwindi ndikupanga kapangidwe ka Captopril disulfide dimer ndi Captopril cysteine disulfide. Kutha kwa theka la moyo kumapangitsa maola 2-3. 40-50% imachotsedwa impso sizinasinthidwe, zina zonse mu mawonekedwe a metabolites.

Mankhwala

Captopril imakhala ndi hypotensive, vasodilating, mtima ndi zotsatira. Imalepheretsa ntchito ya eniotensin-yotembenuza enzyme, yomwe imayambitsa kuchepa kwa kusintha kwa angiotensin I kupita ku angiotensin II (imakhala ndi vasoconstrictor athari, imalimbikitsa kutulutsidwa kwa aldosterone) komanso imalepheretsa kuyambitsa kwa maimidwe opatsirana amkati mpweya - bradykinin ndi prostoglandin E2. Imawonjezera ntchito ya kallikrein-kinin system, imawonjezera kutulutsa kwa zinthu zotheka zomwe zimakhala ndi natriuretic ndi vasodilating, ndikuwongolera magazi aimpso. Kuchepetsa kwathunthu zotumphukira mtima kukana, chisanachitike ndi pambuyo pa mtima, kuthamanga mu bwalo yaying'ono ndi m'mapapo mwanga, kumawonjezera kutulutsa kwa mtima.

Zizindikiro zogwiritsidwa ntchito

ochepa matenda oopsa (kuphatikiza mono-ndi kuphatikiza mankhwala)

Kulephera kwamtima kosalekeza (monga gawo la kuphatikiza

kukanika kwa yamanzere yamkati pamene khazikika

odwala pambuyo myocardial infarction

matenda a shuga a nephropathy a shuga

Mlingo ndi makonzedwe

Mankhwala amatengedwa pakamwa, mosasamala kanthu za kudya.

Mlingo woyambirira wa 25-50 mg 2 kawiri pa tsiku, ngati kuli kotheka, mlingo umodzi umachulukitsidwa mpaka 100-150 mg 2 kawiri pa tsiku, pakapita masabata a 2-4. Kukonza mlingo wa 25 mg katatu patsiku. Mlingo wambiri watsiku ndi tsiku ndi 150 mg.

Kulephera kwamtima kosalekeza

Mlingo woyamba wa 6.25 -12,5 mg katatu patsiku, kenako ndikuwonjezeka masabata awiri aliwonse, mpaka muyeso wa 25 mg katatu pa tsiku kapena mpaka 50 mg katatu pa tsiku. Mlingo wambiri watsiku ndi tsiku ndi 150 mg.

Kuvulala kwamanzere kwamanzere

Chithandizo chimayamba pakanthawi kuyambira 3 mpaka 16 mpaka tsiku lachiberekero chamkati. Mlingo woyamba wa Captopril ndi 6.25 mg / tsiku patsiku loyamba. Kenako, tsiku lotsatira, limachulukitsa mpaka 12,5 mg katatu patsiku kwa masiku awiri ndi kuwonjezeka pang'onopang'ono mpaka 25-50 mg ya Captopril katatu patsiku. Mlingowu umatheka pang'onopang'ono milungu ingapo. Muzochitika za Hypotension, monga kulephera kwa mtima, mlingo wa okodzetsa komanso / kapena ma Vasodilators ena onga amatha kuchepetsedwa kuti akwaniritse mlingo wokhazikika boma.

Mlingo wambiri watsiku ndi tsiku ndi 150 mg.

Matenda a shuga ndi nephropathy okhala ndi matenda a shuga

Mlingo woyambirira ndi 6.25 mg / tsiku. Ngati ndi kotheka, onjezani mlingo kukhala 75-100 mg / tsiku (mu Mlingo wa 2-3). Pankhani ya shuga wodalira insulin wokhala ndi microalbuminuria (kumasulidwa kwa albumin 30-300 mg patsiku), mlingo ndi 50 mg kawiri patsiku. Ndi chilolezo chokwanira cha mapuloteni opitilira 500 mg patsiku, mankhwalawa amagwira ntchito pa 25 mg katatu patsiku.

Mu vuto laimpso

Mlingo woyambirira wa 6.25 mg katatu patsiku, ndikutsatira. Mlingo waukulu kwambiri umatengera chilolezo cha creatinine.