Kulephera kwamtima kosalekeza, ndikotheka kugwiritsa ntchito lisinopril nthawi imodzi ndi okodzetsa komanso / kapena mtima glycosides. Ngati ndi kotheka, mlingo wa diuretic uyenera kuchepetsedwa musanatenge lisinopril. Mlingo woyambirira ndi 2,5 mg 1 nthawi / tsiku, m'tsogolomu umakulitsidwa pang'onopang'ono (ndi 2,5 mg m'masiku 3-5) mpaka 5-10 mg / tsiku. Mlingo waukulu kwambiri ndi 20 mg / tsiku.
Mu pachimake m`mnyewa wamtima infarction (monga gawo la mankhwala mu maola 24 oyambirira, odwala khola hemodynamic magawo) mankhwala 5 mg yoyamba 24 hours, ndiye 5 mg tsiku lililonse, 10 mg pambuyo masiku awiri ndipo 10 mg kamodzi patsiku. Odwala omwe ali ndi kupweteka kwambiri myocardial infarction, mankhwalawa amagwiritsidwa ntchito kwa milungu 6. Kumayambiriro kwa mankhwalawa kapena masiku oyamba atatu pambuyo panjira yolakwika, odwala omwe ali ndi vuto lochepa kwambiri la magazi (120 mm Hg kapena kutsika) ndi mankhwala a 2 mg. Pangachitike ochepa ochepa hypotension (systolic magazi m'munsimu kapena wofanana ndi 100 mm Hg), tsiku lililonse 5 mg imatha kuchepetsedwa kwakanthawi mpaka 2,5 mg. Ngati kuchuluka kwa nthawi yayitali kwa hypotension (magazi a systolic m'munsi mwa 90 mm Hg kwa ola limodzi), Irume iyenera kusiyidwa.
Mu matenda a diabetes a nephropathy odwala omwe ali ndi vuto la matenda a shuga 1 mellitus (wodalira insulin), Iramed ® imayikidwa pa 10 mg 1 nthawi / tsiku. Ngati ndi kotheka, mlingowo ungathe kuwonjezeka mpaka 20 mg / tsiku kuti mukwaniritse kuchuluka kwa kuthamanga kwa magazi m'munsi mwa 75 mm Hg. m'malo okhala. Odwala omwe ali ndi matenda a shuga 2 a mellitus (osadalira insulini), mlingo ndi womwewo kuti akwaniritse kuthamanga kwa magazi a diastolic pansi pa 90 mm Hg. m'malo okhala.
Zotsatira zoyipa
Nthawi zambiri: chizungulire, kupweteka mutu, kutopa, kutsegula m'mimba, kutsokomola, nseru.
Kuchokera pamtima dongosolo: kuchepa kwamphamvu kwa kuthamanga kwa magazi, kupweteka pachifuwa, osawerengeka - orthostatic hypotension, tachycardia, bradycardia, Zizindikiro zoyipa za kulephera kwa mtima, kuvulala kwa AV, kupunduka kwa mtima.
Kuchokera kumbali ya chapakati mantha dongosolo ndi zotumphukira mantha dongosolo: kusinthasintha mphamvu, chisokonezo, paresthesia, kugona, kugwedezeka mwamphamvu minofu ya miyendo ndi milomo, kawirikawiri - asthenic syndrome.
Kuchokera pamimba yodyetsera: mkamwa youma, kukomoka, kukomoka, kusintha kwa m'mimba, kupweteka kwam'mimba, kapamba, hepatocellular kapena cholestatic, jaundice, hepatitis, kuchuluka kwa hepatic transaminases, hyperbilirubinemia.
Kuchokera kupuma dongosolo: dyspnea, bronchospasm.
Dermatological zimachitika: kuchuluka thukuta, kuyabwa khungu, alopecia, photosensitivity.
Kuchokera ku ziwalo za hemopoietic: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, kuchepa kwa magazi (kuchepa kwa hematocrit, hemoglobin, erythrocytopenia).
Kuchokera kumbali ya kagayidwe: hyperkalemia, hyponatremia, hyperuricemia, kuchuluka kwa creatinine m'magazi.
Kuchokera kwamikodzo dongosolo: kuwonongeka kwa impso, oliguria, anuria, uremia, proteinemia.
Thupi lawo siligwirizana: urticaria, angioedema ya nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx, zotupa pakhungu, kuyabwa, kutentha thupi, zotsatira zabwino za antiinuclear antibody, kuchuluka kwa ESR, eosinophilia, leukocytosis, nthawi zina - interstitial angioeurotic.
Zina: arthralgia / nyamakazi, myalgia, vasculitis, kuchepa kwa potency.
Zizindikiro: kuchepa kwamphamvu kwa magazi, pakamwa pouma, kugona, kwamikodzo, kudzimbidwa, nkhawa, kuchuluka kwa kusokonekera.
Chithandizo: chizindikiro cha mankhwala, kuphatikizira kwa mchere wamkati, ndipo ngati kuli koyenera, kugwiritsa ntchito mankhwala a vasopressor motsogozedwa ndi kuthamanga kwa magazi komanso kupatula kwa magazi. Mwina ntchito hemodialysis.
Ndi munthawi yomweyo kugwiritsa ntchito kwa Irume ndi potaziyamu wotsekemera okodzetsa (spironolactone, triamteren, amiloride), kukonzekera kwa potaziyamu, mchere wotsekemera wokhala ndi potaziyamu, chiopsezo chokhala ndi vuto la matenda a impso.
Pogwiritsa ntchito munthawi yomweyo ya Irume ndi okodzetsa, kuchepa kwakukulu kwa magazi kumadziwika.
Ndi kugwiritsa ntchito nthawi yomweyo kwa Irume ndi mankhwala ena a antihypertensive, zotsatira zowonjezera zimadziwika.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi NSAIDs, estrogens, adrenostimulants, antihypertensive zotsatira za lisinopril amachepetsa.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi lifiyamu, mafuta a lithiamu ochokera mthupi amachepetsa.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi maantacid ndi colestyramine, kuyamwa kwa lisinopril kuchokera m'mimba thirakiti kumachepetsedwa.
Ethanol imawonjezera mphamvu ya mankhwalawa.
Tiyenera kukumbukira kuti kuchepa kwakukulu kwa kuthamanga kwa magazi kumachitika ndi kuchepa kwamadzi am'mimba chifukwa cha diuretic mankhwala, kutsika kwa mchere mu chakudya, panthawi ya dialysis ndi odwala omwe akutsekula m'mimba kapena kusanza. Odwala omwe ali ndi vuto la mtima limodzi ndi kulephera kwaimpso nthawi yomweyo kapena popanda izi, matendawa amatha kupezeka, omwe amapezeka kwambiri kwa odwala omwe ali ndi vuto lalikulu la mtima, chifukwa chogwiritsa ntchito milingo yayikulu ya diuretic, hyponatremia, kapena vuto laimpso. Odwala otere, chithandizo chiyenera kuyambitsidwa ndi kuyang'aniridwa ndi dokotala (mosamala, sankhani mankhwalawa ndi mankhwala okodzetsa). Njira yofananira iyenera kutsatiridwa posankha Irume kwa odwala omwe ali ndi matenda amitsempha yamagazi, kuchepa kwa magazi, komwe kuchepa kwambiri kwa magazi kungayambitse kuphwanya kwa myocardial kapena stroke.
Pankhani ya kukhazikika kwa kuchepa kwa magazi, wodwalayo ayenera kupatsidwa mwayi wowonekera ndipo ngati kuli kotheka, iv 0.9% sodium chloride solution. Kuchepa kwakanthawi kwa hypotensive si kuphwanya kumwa potsatira mlingo wotsatira wa mankhwalawa.
Mukamagwiritsa ntchito Irume mwa odwala ena omwe ali ndi vuto la mtima losalephera, koma ndi magazi abwinobwino kapena otsika magazi, kuchepa kwa magazi kumatha kuchitika, zomwe nthawi zambiri sizikhala chifukwa chosiya kulandira chithandizo. Ngati ochepa hypotension amakhala chizindikiro, ndikofunikira kuchepetsa mlingo wa mankhwalawo kapena kusiya kumwa mankhwala ndi Irume.
Mu infanoctional yokhala ndi myocardial infarction, kugwiritsa ntchito mankhwala okhazikika (thrombolytics, acetylsalicylic acid, beta-blockers) akuwonetsedwa. Irumed ® ikhoza kugwiritsidwa ntchito molumikizana ndi on / kumayambitsa kapena kugwiritsa ntchito transdermal system ya nitroglycerin.
Iramed ® sayenera kulembedwa kwa odwala omwe ali ndi vuto lalikulu la infracity, omwe ali pachiwopsezo chowonjezereka cha hemodynamics atagwiritsidwa ntchito ndi vasodilators: kwa odwala omwe ali ndi magazi a systolic a 100 mm Hg. kapena wotsika, kapena ndi mantha a cardiogenic.
Odwala omwe ali ndi vuto la mtima wosakhazikika, kuchepa kwamphamvu kwa magazi atayamba kulandira chithandizo ndi ACE zoletsa kungayambitse kuwonongeka kwa impso. Milandu ya chitukuko chaimpso kulephera amadziwika. Odwala omwe ali ndi vuto limodzi la impso a stenosis kapena artery stenosis ya impso imodzi yothandizidwa ndi zoletsa za ACE, panali kuwonjezeka kwa seramu urea ndi creatinine, yemwe amasinthidwa pambuyo posiya chithandizo (chofala kwambiri kwa odwala omwe ali ndi vuto la aimpso).
Lisinopril sinafotokozeredwe kuchepa kwamitsempha yamagazi m'magazi omwe ali ndi kuwonongeka kwambiri kwaimpso ndi serum creatinine yoposa 177 mmol / l kapena proteinuria yoposa 500 mg / tsiku. Ngati vuto la impso likukula ndikugwiritsa ntchito mankhwalawa (zomwe zili mu seramu creatinine ndizoposa 265 mmol / l kapena kuwonjezeka kawiri poyerekeza ndi chidziwitso chisanachitike chithandizo), kufunikira kwa chithandizo chokwanira ndi Iramed ® kuyenera kuwunikiridwa.
Odwala omwe amatenga ma inhibitors a ACE, kuphatikizapo lisinopril, samakonda kukhala ndi angioedema a nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx, ndipo kukula kwake ndikotheka nthawi iliyonse panthawi yamankhwala. Pankhaniyi, chithandizo ndi Irume chiyenera kuyimitsidwa posachedwa ndipo wodwalayo ayenera kuyang'aniridwa mpaka zizindikirocho zikuyambiranso. Komabe, ngati vuto la edema limangopezeka pankhope pokha komanso milomo yake komanso momwe limakhalira nthawi zambiri popanda kuthandizira, antihistamines ingathe kutumikiridwa.
Ndi kufalikira kwa angioedema ku lilime, epiglottis kapena larynx, kutsekeka kwa mpweya mu njira kumatha kuchitika, motero, chithandizo choyenera chikuyenera kuchitika nthawi yomweyo (0.3-0.5 ml 1: 1000 epinephrine solution s / c) ndi / kapena njira zowonetsetsa kuti panthawiyi pakhale mpweya. Zidadziwika kuti odwala a mpikisano wothamanga wa Negroid amatenga zoletsa za ACE, angioedema amakula kwambiri kuposa odwala mafuko ena. Odwala omwe ali ndi mbiri ya angioedema yomwe siyinkagwirizanidwe ndi chithandizo cham'mbuyomu ndi ACE inhibitors, chiopsezo cha chitukuko chake panthawi ya chithandizo ndi Iramed chitha kuchuluka.
Odwala atenga zoletsa za ACE, panthawi yofunitsitsa poizoni wa hymenoptera (mavu, njuchi, nyerere), anaphylactoid zimachitika kwambiri. Izi zitha kupewedwa ndikusiya kwakanthawi chithandizo ndi ACE inhibitor musanalole chilichonse.
Tiyenera kukumbukira kuti odwala omwe akutenga ma inhibitors a ACE ndipo akutsatira hemodialysis amagwiritsa ntchito ma membala anthawi zonse a dialysis (mwachitsanzo, AN69), anaphylactic angamve. Zikatero, ndikofunikira kuganizira za mtundu wina wa membrane wa dialysis kapena mankhwala ena a antihypertensive.
Mukamagwiritsa ntchito zoletsa za ACE, kutsokomola kumadziwika (kouma, nthawi yayitali, komwe kumazimiririka atasiya kulandira chithandizo ndi ACE inhibitor). Pozindikira kuti pali chifuwa, kutsokomola komwe kumachitika chifukwa chogwiritsa ntchito ACE inhibitor kuyenera kuganiziridwanso.
Mukamagwiritsa ntchito mankhwala omwe amachepetsa kuthamanga kwa magazi kwa odwala omwe amachitidwa opaleshoni yayikulu kapena nthawi ya opaleshoni yambiri, lisinopril imatha kuletsa mapangidwe a angiotensin II, pambuyo pake pomvera kupukusira kwa renin. Kutsika kwakukulu kwa kuthamanga kwa magazi, komwe kumawonedwa ngati chifukwa cha njirayi, kungathetsedwe ndikuwonjezeka kwa bcc. Opaleshoni isanachitike (kuphatikizapo opaleshoni yamano), dokotala wa opaleshoni / opaleshoni ayenera kudziwitsidwa za kugwiritsidwa ntchito kwa ACE inhibitor.
Nthawi zina, Hyperkalemia adadziwika. Zomwe zimayambitsa kukula kwa hyperkalemia zimaphatikizapo kulephera kwa aimpso, matenda a shuga komanso kugwiritsa ntchito munthawi yomweyo potaziyamu (spironolactone, triamteren kapena amiloride), kukonzekera kwa potaziyamu kapena m'malo a mchere omwe ali ndi potaziyamu, makamaka kwa odwala omwe ali ndi vuto laimpso. Ngati ndi kotheka, kugwiritsa ntchito mitunduyi kuyenera kuwunika kawirikawiri mulingo wa potaziyamu mu seramu yamagazi.
Odwala omwe ali pachiwopsezo cha kukhala ndi hypotension yokhala ndi vuto (pamchere wopanda mchere kapena wopanda mchere) ndi / wopanda hyponatremia, komanso mwa odwala omwe analandira kuchuluka kwa okodzetsa, zinthu zomwe zili pamwambapa ziyenera kulipiridwira musanachitike chithandizo (kutaya madzi ndi mchere). M'pofunika kuwongolera mphamvu ya mankhwalawa koyambirira kwa mankhwalawa Iromed ® pa phindu la kuthamanga kwa magazi.
Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu
Palibe chidziwitso chokhudzana ndi Irume, wogwiritsidwa ntchito pochiritsa Mlingo, pa kuyendetsa magalimoto ndi maginito, koma ayenera kukumbukira kuti chizungulire chingachitike. Chifukwa chake, munthawi yamankhwala, odwala ayenera kusamala poyendetsa magalimoto ndi ntchito yomwe ikufunika kuti ichitike chidwi komanso kuthamanga kwa zochitika zama psychomotor.
Kutulutsidwa mawonekedwe Irume, mankhwala ma CD ndi zikuchokera.
Mapiritsiwo ndi oyera, ozungulira, a biconvex, okhala ndi notch mbali imodzi.
1 tabu
lisinopril (mu mawonekedwe a dihydrate)
5 mg
Omwe amathandizira: mannitol, calcium phosphate dihydrate, wowuma chimanga, pregelatinized starch, colloidal silicon dioxide, magnesium stearate.
30 ma PC - matuza (1) - mapaketi a makatoni.
Mapiritsiwo ndi oyera, wozungulira, wozungulira, wozungulira.
1 tabu
lisinopril (mu mawonekedwe a dihydrate)
5 mg
Omwe amathandizira: mannitol, calcium phosphate dihydrate, wowuma chimanga, pregelatinized starch, colloidal silicon dioxide, magnesium stearate.
30 ma PC - matuza (1) - mapaketi a makatoni.
Mapiritsiwo ndi opepuka wachikaso, utoto, wozungulira, wozungulira, woopsa mbali imodzi.
1 tabu
lisinopril (mu mawonekedwe a dihydrate)
10 mg
Omwe amathandizira: mannitol, calcium phosphate dihydrate, wowonda wa chimanga, wowuma wa chimanga, utoto wachikasu wachitsulo (E172), colloidal silicon dioxide, magnesium stearate.
30 ma PC - matuza (1) - mapaketi a makatoni.
Mapiritsi okhala ndi pichesi, ozungulira, osalala, okhala ndi chiopsezo mbali imodzi.
1 tabu
lisinopril (mu mawonekedwe a dihydrate)
20 mg
Omwe amathandizira: mannitol, calcium phosphate dihydrate, wowonda wa chimanga, wowuma wa chimanga, utoto wachikasu wachikasu (E172), utoto wofiira wa chitsulo (E172), colloidal silicon dioxide, magnesium stearate.
30 ma PC - matuza (1) - mapaketi a makatoni.
Kufotokozera kwa mankhwalawa kumatengera malangizo ovomerezeka omwe angagwiritsidwe ntchito.
Pharmacological zochita Irume
ACE inhibitor. Mankhwala a antihypertensive. Kupanga kwamachitidwe kumalumikizidwa ndi kulepheretsa kwa ntchito ya ACE, yomwe imayambitsa kuponderezedwa kwa mapangidwe a angiotensin II kuchokera ku angiotensin I ndikuchepetsa mwachindunji kutulutsidwa kwa aldosterone. Amachepetsa kuchepa kwa bradykinin ndikuwonjezera kaphatikizidwe ka prostaglandins.
Amachepetsa OPSS, kuthamanga kwa magazi, kutsitsa, kupanikizika m'mapapo m'mimba, kumapangitsa kuchuluka kwa magazi kwa mphindi ndikuwonjezera kulolera kwa odwala omwe ali ndi vuto la mtima. Lisinopril ali ndi vuto losakhazikika, pomwe amakulitsa mitsempha kwambiri kuposa mitsempha. Zotsatira zina zimafotokozedwa ndi kuthana ndi machitidwe a minye renin-angiotensin. Amasintha magazi kupita ku ischemic myocardium. Pogwiritsa ntchito nthawi yayitali, hypertrophy ya myocardium ndi makhoma amitsempha ya mtundu wotsalira amachepa.
Kugwiritsa ntchito zoletsa za ACE mwa odwala omwe ali ndi vuto losatha la mtima kumabweretsa kukulira kwa chiyembekezo cha moyo, mwa odwala omwe akhala akuvutika ndi matenda amiseche, popanda chiwonetsero chamankhwala chakulephera kwa mtima, kupita pang'onopang'ono pang'onopang'ono kumanzere kwamitsempha yamanja.
Kukhazikika kwa chochitika kumadziwika pambuyo pa ola limodzi mutatha kumwa mankhwalawa, kuchuluka kwake kumadziwika pambuyo pa maola 6-7, nthawi yochitapo kanthu ndi maola 24. Ndi ochepa matenda oopsa, zotsatira zake zimawonedwa m'masiku oyamba pambuyo pa kuyamba kwa mankhwalawa, zotsatira zokhazikika zimayamba pambuyo pa miyezi 1-2.
Ndi kusiyiratu kwakumwa kwa mankhwalawo, kuchuluka kwakukulu kwa magazi sikunawonedwe. Kuphatikiza pakuchepetsa kuthamanga kwa magazi, lisinopril imachepetsa albuminuria. Odwala omwe ali ndi hyperglycemia, zimathandizanso kuti mawonekedwe a glomerular endothelium awonongeke. Lisinopril sichikhudzanso kuchuluka kwa shuga m'magazi a shuga ndipo sikuti kumawonjezera kuchuluka kwa hypoglycemia.
Pharmacokinetics wa mankhwala.
Mutatha kumwa mankhwalawo mkati, pafupifupi 25% ya lisinopril imayamwa kuchokera m'mimba. Kudya sizikhudzana ndi mayamwa. Mafuta ndi pafupifupi 30%. Bioavailability ndi 29%. Cmax mu plasma imatheka pambuyo pafupifupi maola 6-8.
Osagwira m'mapuloteni a plasma. Lisinopril amalowa pang'ono mu BBB, kudzera mu chotchinga chachikulu.
T1 / 2 - maola 12. Lisinopril samapangidwira ndipo amachotsa mkodzo osasinthika.
Zisonyezero zogwiritsidwa ntchito:
- matenda oopsa (monga monotherapy kapena kuphatikiza mankhwala ena a antihypertensive),
- Kulephera kwamtima kosalekeza (monga gawo limodzi la mankhwala ochiritsira odwala omwe amatenga digito ndi / kapena okodzetsa),
- chithandizo choyambirira cha kupweteka kwamkati myocardial infarction (monga gawo limodzi la mankhwala ophatikizira mu maola 24 oyambirira kwa odwala omwe ali ndi magawo a hemodynamic magawo, kuti azitha kutsata izi ndikuletsa kukomoka kwamitsempha yama mtima komanso kukomoka kwa mtima),
- diabetesic nephropathy (kuti achepetse albuminuria odwala omwe amadalira insulin omwe ali ndi magazi abwinobwino komanso odwala osagwirizana ndi insulin omwe amadwala matenda oopsa a arterial).
Mlingo ndi njira ya mankhwala.
Mankhwala ndi mankhwala pakamwa. Kudya sikukhudzana ndi mayamwidwe, chifukwa chake mankhwalawa amatha kumwedwa musanadye chakudya, kapena mutatha kudya. Pafupipafupi oyang'anira ndi nthawi imodzi / tsiku (pafupifupi nthawi imodzi).
Mankhwalawa ofunika matenda oopsa, tikulimbikitsidwa kupereka mankhwala koyamba 10 mg. Mlingo wokonza ndi 20 mg / tsiku. Mlingo wambiri watsiku ndi tsiku ndi 40 mg. Kuti muchite bwino mokwanira, maphunzirowa atafunsidwa kwa milungu iwiri kapena itatu (izi ziyenera kuganiziridwa pakukulitsa mlingo). Ngati kugwiritsa ntchito mankhwalawa muyezo waukulu sikuyambitsa vuto lokwanira, ndiye kuti mankhwala ena othandizira amatha.
Kwa odwala omwe amathandizira okodzetsa, mankhwalawa okodzetsa ayenera kusiyidwa masiku atatu asanafike mankhwala. Kwa odwala omwe sizingatheke kusiya mankhwala okodzetsa, Iramed imayikidwa koyamba mlingo wa 5 mg / tsiku.
Pankhani ya kukonzanso kwamitsempha yamagazi kapena zinthu zina ndi kuchuluka kwa dongosolo la renin-angiotensin-aldosterone, Irume amamuika muyeso wa 2,5-5 mg / tsiku motsogozedwa ndi kuthamanga kwa magazi, ntchito ya impso, potaziyamu wambiri mu seramu yamagazi. Mlingo wokonza umakhazikitsidwa kutengera kuthamanga kwa magazi.
Odwala omwe ali ndi vuto la impso komanso odwala hemodialysis, mlingo woyambayo umakhazikitsidwa kutengera QC. Mlingo wokonza umatsimikizika malinga ndi kuthamanga kwa magazi (motsogozedwa ndi ntchito yaimpso, potaziyamu ndi magawo a sodium m'magazi).
QC
Koyamba tsiku lililonse
30-70 ml / mphindi
5-10 mg
10-30 ml / mphindi
2,5-5 mg
2013-03-20
Zopikisana
- mbiri ya angioedema (kuphatikiza kugwiritsa ntchito zoletsa za ACE),
- cholowa cha edincke's edema,
- zaka mpaka 18 - (kuchita bwino ndi chitetezo sizinakhazikitsidwe),
- mimba
- Hypersensitivity kuti lisinopril ndi zoletsa zina za ACE,
Ndi kusamala Mankhwala ayenera kutumikiridwa kwa kungʻambika stenosis, hypertrophic cardiomyopathy, aimpso mtsempha wamagazi, stenosis limodzi ndi azotemia, pambuyo pambuyo kupatsirana kwa impso, chachikulu hyperaldosteronism, ochepa hypotension, mafupa hypoplasia, hyponatremia pakudya kopanda mchere kapena wopanda mchere), Hyperkalemia, mikhalidwe yoyendetsedwa ndi kuchepa kwa magazi ozungulira (kuphatikiza matenda otsegula m'mimba, kusanza), matenda a minofu yolumikizidwa (kuphatikizapo a systemic lupus erythematosus, scleroderma), matenda a shuga, gout, hyperuricemia, IHD, kuchepa kwa magazi m'thupi, okalamba.
Malangizo ogwiritsira ntchito
Mankhwala ndi mankhwala pakamwa. Kudya sikukhudzana ndi mayamwidwe, chifukwa chake mankhwalawa amatha kumwedwa musanadye chakudya, kapena mutatha kudya. Kuchulukitsidwa kovomerezeka kamodzi pa tsiku (pafupifupi nthawi imodzi).
At Chithandizo cha matenda oopsa Mlingo woyambirira wa 10 mg tikulimbikitsidwa. Pulogalamu yayikulu yokonza ndi 20-40 mg wa patsiku. Mlingo wapamwamba tsiku lililonse ndi 80 mg.
Odwala omwe amatenga diuretics, mlingo umasankhidwa payekhapayekha, kupatsidwa kuti odwala oterewa amatha kukhala ndi hyponatremia kapena kuchepetsedwa magazi, zomwe zingayambitse kukulitsa kwa hypotension. Kuchiza ndi okodzetsa kuyenera kutha kusiyidwa masiku atatu isanayambike mankhwalawa ndipo ngati kuli koyenera, muyambirenso posankha mtundu wa Irume malinga ndi momwe mukudwala. Kwa odwala omwe sizingatheke kusiya mankhwala okodzetsa, Iramed imayikidwa koyamba mlingo wa 5 mg / tsiku, ndikuwonjezeranso malinga ndi mankhwalawa komanso kulekerera kwa mankhwalawa. Ngati ndi kotheka, chithandizo ndi okodzetsa chitha kuyambiranso.
Kugwiritsira ntchito kwa Irume pa mimba komanso mkaka wa m`mawere
Kugwiritsiridwa ntchito kwa Irume pa nthawi ya pakati kumapangidwa. Lisinopril amadutsa chotchinga.
Mimba ikachitika, chithandizo chokhala ndi Iromed chikuyenera kuimitsidwa pokhapokha, pokhapokha ngati phindu la mayiyo likupereka chiwopsezo kwa mwana wosabadwayo (wodwalayo ayenera kudziwitsidwa za chiopsezo cha mwana wosabadwayo). Kulandila kwa zoletsa za ACE mu II ndi III trimesters ya mimba kungayambitse imfa ya mwana wosabadwayo komanso wakhanda. Mu akhanda, chigaza hypoplasia, oligohydramnios, kusintha kwa mafupa a chigaza ndi nkhope, kuphipha kwam'mapapo, komanso kukula kwa impso. Kwa ana akhanda ndi akhanda omwe amayi awo adatengedwa ndi ma inhibitors a ACE pa nthawi ya pakati, tikulimbikitsidwa kuti kuwunikira mosamala kumachitika kuti mupeze kuchepa kwa magazi, oliguria, hyperkalemia.
Palibe chidziwitso pakulowerera kwa lisinopril mkaka wa m'mawere. Pa chithandizo ndi Irume, ndikofunikira kusiya kuyamwitsa.
Irume ndi choletsa ACE. Mankhwala a antihypertensive. Kupanga kwamachitidwe kumalumikizidwa ndi kulepheretsa kwa ntchito ya ACE, yomwe imayambitsa kuponderezedwa kwa mapangidwe a angiotensin II kuchokera ku angiotensin I ndikuchepetsa mwachindunji kutulutsidwa kwa aldosterone. Amachepetsa kuchepa kwa bradykinin ndikuwonjezera kaphatikizidwe ka prostaglandins.
Amachepetsa OPSS, kuthamanga kwa magazi, kutsitsa, kupanikizika m'mapapo m'mimba, kumapangitsa kuchuluka kwa magazi kwa mphindi ndikuwonjezera kulolera kwa odwala omwe ali ndi vuto la mtima. Lisinopril ali ndi vuto losakhazikika, pomwe amakulitsa mitsempha kwambiri kuposa mitsempha. Zotsatira zina zimafotokozedwa ndi kuthana ndi machitidwe a minye renin-angiotensin. Amasintha magazi kupita ku ischemic myocardium. Pogwiritsa ntchito nthawi yayitali, hypertrophy ya myocardium ndi makhoma amitsempha ya mtundu wotsalira amachepa.
Kugwiritsa ntchito zoletsa za ACE mu odwala omwe ali ndi vuto la mtima kumayambitsa kuchuluka kwa moyo, mwa odwala pambuyo podzikweza, popanda mawonekedwe a mtima kulephera, kupita pang'onopang'ono kwa vuto lakumanzere kwamitsempha.
Kukhazikika kwa chochitika kumadziwika pambuyo pa ola limodzi mutatha kumwa mankhwalawa, mphamvu yayikulu imawonedwa pambuyo pa maola 6-7, nthawi yochitapo kanthu ndi maola 24. Ndi matenda oopsa, zotsatira zake zimadziwika m'masiku oyamba pambuyo pa kuyamba kwa mankhwalawa, zotsatira zokhazikika zimayamba pambuyo pa miyezi 1-2.
Zotsatira zoyipa
Kuchokera pamtima: kuchepa kwa kuthamanga kwa magazi, kupweteka pachifuwa, orthostatic hypotension, tachycardia, bradycardia, zizindikiro zowipira za kuchepa kwa mtima, kusokonekera kwa AV conduction, kulowetsedwa kwa myocardial.
Kuchokera m'mimba: kupweteka kwam'mimba, pakamwa kowuma, dyspepsia, anorexia, kusintha kwa kapamba, kapamba, hepatocellular kapena cholestatic hepatitis, jaundice, kuchuluka kwa hepatic transaminases, hyperbilirubinemia.
Kuchokera kumbali yamanjenje yapakati: kulumikizana kwamphamvu, chisokonezo, paresthesia, kugona, kupindika kwa minofu ya miyendo ndi milomo, asthenic syndrome, chisokonezo.
Kuchokera pakapumidwe: dyspnea, bronchospasm, ziphuphu.
Pa khungu: urticaria, thukuta, kusowa tsitsi, kupenyerera.
Kuchokera ku ziwalo za hemopoietic: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, kuchepa magazi (kuchepa hematocrit, erythrocytopenia).
Kuchokera ku genitourinary system: uremia, oliguria / anuria, mkhutu waimpso, kulephera kwaimpso, kutsika kwa potency.
Zotsatira zoyipa: angioedema ya nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx, zotupa pakhungu, kuyabwa, kutentha, zotsatira zabwino za antiinuclear antibody, kuchuluka kwa ESR, eosinophilia, leukocytosis.
Zina: Hyperkalemia, hyponatremia, hyperuricemia, arthralgia, myalgia.
Odwala ambiri, zotsatira zoyipa zinali zofewa komanso zosakhalitsa.
Tiyenera kukumbukira kuti kuchepa kwakukulu kwa kuthamanga kwa magazi kumachitika ndi kuchepa kwamadzi am'mimba chifukwa cha diuretic mankhwala, kutsika kwa mchere mu chakudya, panthawi ya dialysis ndi odwala omwe akutsekula m'mimba kapena kusanza. Odwala omwe ali ndi vuto la mtima limodzi ndi kulephera kwaimpso nthawi yomweyo kapena popanda izi, matendawa amatha kupezeka, omwe amapezeka kwambiri kwa odwala omwe ali ndi vuto lalikulu la mtima, chifukwa chogwiritsa ntchito milingo yayikulu ya diuretic, hyponatremia, kapena vuto laimpso. Odwala otere, chithandizo chiyenera kuyambitsidwa ndi kuyang'aniridwa ndi dokotala (mosamala, sankhani mankhwalawa ndi mankhwala okodzetsa). Njira yofananira iyenera kutsatiridwa posankha Irume kwa odwala omwe ali ndi matenda amitsempha yamagazi, kuchepa kwa magazi, komwe kuchepa kwambiri kwa magazi kungayambitse kuphwanya kwa myocardial kapena stroke.
Pankhani ya kukhazikika kwa kuchepa kwa magazi, wodwalayo ayenera kupatsidwa mwayi wowonekera ndipo ngati kuli kotheka, iv 0.9% sodium chloride solution. Kuchepa kwakanthawi kwa hypotensive si kuphwanya kumwa potsatira mlingo wotsatira wa mankhwalawa.
Mukamagwiritsa ntchito Irume mwa odwala ena omwe ali ndi vuto la mtima losalephera, koma ndi magazi abwinobwino kapena otsika magazi, kuchepa kwa magazi kumatha kuchitika, zomwe nthawi zambiri sizikhala chifukwa chosiya kulandira chithandizo. Ngati ochepa hypotension amakhala chizindikiro, ndikofunikira kuchepetsa mlingo wa mankhwalawo kapena kusiya kumwa mankhwala ndi Irume.
Mu infanoctional yokhala ndi myocardial infarction, kugwiritsa ntchito mankhwala okhazikika (thrombolytics, acetylsalicylic acid, beta-blockers) akuwonetsedwa. Iramed ikhoza kugwiritsidwa ntchito molumikizana ndi intravenous administration kapena kugwiritsa ntchito transdermal nitroglycerin system.
Odwala omwe ali ndi vuto la mtima wosakhazikika, kuchepa kwamphamvu kwa magazi atayamba kulandira chithandizo ndi ACE zoletsa kungayambitse kuwonongeka kwa impso. Milandu yokhudzana ndi kulephera kwa aimpso pachaka mukamamwa ma ACE zoletsa tawonedwa. Odwala omwe ali ndi vuto limodzi la impso a stenosis kapena artery stenosis ya impso imodzi yothandizidwa ndi zoletsa za ACE, panali kuwonjezeka kwa seramu urea ndi creatinine, yemwe amasinthidwa pambuyo posiya chithandizo (chofala kwambiri kwa odwala omwe ali ndi vuto la aimpso).
Odwala omwe amatenga ma inhibitors a ACE, kuphatikizapo lisinopril, samakonda kukhala ndi angioedema a nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx, ndipo kukula kwake ndikotheka nthawi iliyonse panthawi yamankhwala. Pankhaniyi, chithandizo ndi Irume chiyenera kuyimitsidwa posachedwa ndipo wodwalayo ayenera kuyang'aniridwa mpaka zizindikirocho zikuyambiranso. Komabe, ngati vuto la edema limangopezeka pankhope pokha komanso milomo yake komanso momwe limakhalira nthawi zambiri popanda kuthandizira, antihistamines ingathe kutumikiridwa.
Ndi kufalikira kwa angioedema ku lilime, epiglottis kapena larynx, kutsekeka kwa mpweya kungachitike, chifukwa chake, chithandizo choyenera ndi / kapena njira ziyenera kutengedwa kuti zitsimikizire kuti msewu ndiwotsekedwa. Zidadziwika kuti odwala a mpikisano wothamanga wa Negroid amatenga zoletsa za ACE, angioedema amakula kwambiri kuposa odwala mafuko ena. Odwala omwe ali ndi mbiri ya angioedema yomwe siyinkagwirizanidwe ndi chithandizo cham'mbuyomu ndi ACE inhibitors, chiopsezo cha chitukuko chake panthawi ya chithandizo ndi Iramed chitha kuchuluka.
Odwala omwe atenga ma zoletsa a ACE, panthawi yoletsa kukomoka (mavu, njuchi, nyerere ndi hymenoptera), anaphylactoid angayambitse kwambiri. Izi zitha kupewedwa ndikusiya kwakanthawi chithandizo ndi ACE inhibitor musanalole chilichonse.
Tiyenera kukumbukira kuti odwala omwe akutenga ma AID zoletsa komanso akutsitsa hemodialysis pogwiritsa ntchito michere yambiri ya dialysis, zimapangitsa kuti anaphylactic atenge. Zikatero, ndikofunikira kuganizira za mtundu wina wa membrane wa dialysis kapena mankhwala ena a antihypertensive.
Mukamagwiritsa ntchito zoletsa za ACE, kutsokomola kumadziwika (kouma, nthawi yayitali, komwe kumazimiririka atasiya kulandira chithandizo ndi ACE inhibitor). Pozindikira kuti pali chifuwa, kutsokomola komwe kumachitika chifukwa chogwiritsa ntchito ACE inhibitor kuyenera kuganiziridwanso.
Mukamagwiritsa ntchito mankhwala omwe amachepetsa kuthamanga kwa magazi kwa odwala omwe amachitidwa opaleshoni yayikulu kapena nthawi ya opaleshoni yambiri, lisinopril imatha kuletsa mapangidwe a angiotensin II, pambuyo pake pomvera kupukusira kwa renin. Kutsika kwakukulu kwa kuthamanga kwa magazi, komwe kumawerengedwa ngati chifukwa cha njirayi, kumatha kuthetsedwa pakuwonjezeka kwa kuchuluka kwa magazi.
Nthawi zina, Hyperkalemia adadziwika. Zomwe zimayambitsa kukula kwa hyperkalemia zimaphatikizapo kulephera kwa aimpso, matenda a shuga komanso kugwiritsa ntchito munthawi yomweyo potaziyamu (spironolactone, triamteren kapena amiloride), kukonzekera kwa potaziyamu kapena m'malo a mchere omwe ali ndi potaziyamu, makamaka kwa odwala omwe ali ndi vuto laimpso. Ngati ndi kotheka, kugwiritsa ntchito mitunduyi kuyenera kuwunika kawirikawiri mulingo wa potaziyamu mu seramu yamagazi.
Odwala omwe ali pachiwopsezo chokhala ndi hypotension yokhala ndi mchere wambiri (wopanda mchere kapena wopanda mchere) komanso mwa odwala omwe analandira kuchuluka kwa okodzetsa, zomwe zili pamwambapa ziyenera kulipiridwenso musanalandire chithandizo (kutayika kwa madzi ndi mchere).
Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu
Palibe chidziwitso chokhudzana ndi Irume, chomwe chimagwiritsidwa ntchito pochiritsa Mlingo, pakuyendetsa magalimoto ndi maginito, koma muyenera kukumbukira kuti chizungulire nchotheka.
Zizindikiro kuchepa kwa magazi.
Chithandizo: ndikofunikira kusanza komanso / kapena kutsuka m'mimba, mtsogolomo, chithandizo chamankhwala chimachitika ndicholinga chofuna kuchotsa madzi m'thupi komanso kusokonezeka kwa mchere wamchere. Ndi ochepa hypotension, yankho la isotonic liyenera kuperekedwa, vasopressors ndi mankhwala. Mwina ntchito hemodialysis.Zizindikiro kuchepa kwa magazi.
Chithandizo: ndikofunikira kusanza komanso / kapena kutsuka m'mimba, mtsogolomo, chithandizo chamankhwala chimachitika ndicholinga chofuna kuchotsa madzi m'thupi komanso kusokonezeka kwa mchere wamchere. Ndi ochepa hypotension, yankho la isotonic liyenera kuperekedwa, vasopressors ndi mankhwala. Mwina ntchito hemodialysis.
Ndi munthawi yomweyo kugwiritsa ntchito kwa Irume ndi potaziyamu wotsekemera okodzetsa (spironolactone, triamteren, amiloride), kukonzekera kwa potaziyamu, mchere wotsekemera wokhala ndi potaziyamu, chiopsezo chokhala ndi vuto la matenda a impso.
Pogwiritsa ntchito munthawi yomweyo ya Irume ndi okodzetsa, kuchepa kwakukulu kwa magazi kumadziwika.
Ndi kugwiritsa ntchito nthawi yomweyo kwa Irume ndi mankhwala ena a antihypertensive, zotsatira zowonjezera zimadziwika.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi NSAIDs, estrogens, mphamvu ya antihypertensive ya lisinopril yafupika.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi lifiyamu, mafuta a lithiamu ochokera mthupi amachepetsa.
Pogwiritsa ntchito nthawi yomweyo ya Irume ndi maantacid ndi colestyramine, kuyamwa kwa lisinopril m'mimba kumachepetsa.
Panalibe kuyanjana kwakukulu kwa pharmacokinetic pazochitika pomwe lisinopril imagwiritsidwa ntchito ndi propranolol, digoxin, kapena hydrochlorothiazide.
Mankhwalawa amayenera kusungidwa pamatenthedwe mpaka 25 ° C. Tsiku lotha ntchito: zaka zitatu.
Mankhwala Irmed: malangizo ntchito
Irume ndi hypotensive othandizira omwe amagwiritsidwa ntchito pochiza matenda oopsa komanso zina za mtima ndi mitsempha yamagazi yokhudzana ndi kuchuluka kwa mitsempha. Ngati mugwiritsidwa ntchito molakwika, imatha kukubweretserani mavuto, chifukwa mumatha kuyamba kumwa mankhwala mwachilolezo ch dokotala.
Dzinalo Lopanda Padziko Lonse
Lisinopril - dzina la yogwira mankhwala.
Irume ndi mankhwala ogwiritsidwa ntchito pochotsa matenda oopsa komanso zina mwa mtima ndi m'mitsempha yamagazi.
С09АА03 - code for gulu la anatomical-achire-mankhwala.
Kutulutsa mafomu ndi kapangidwe kake
Mankhwalawa ali ndi mawonekedwe apiritsi yotulutsidwa. Piritsi lililonse limaphatikizapo:
- lisinopril dihydrate (10 kapena 20 mg),
- mannitol
- wowuma mbatata
- calcium phosphate dihydrate,
- chitsulo
- silicon dioksidi madzi,
- pregelatinized mbatata wowuma
- magnesium wakuba.
Mapiritsi amaperekedwa m'maselo a ma polymeric 30, omwe amawaika m'makatoni ndikunyamula malangizo.
Zomwe zimayikidwa
Zisonyezo zakusankhidwa kwa Irume ndi:
- matenda oopsa (monga othandizira okhawo othandizira kapena osakaniza mankhwala ena),
- Kulephera kwamtima kosalekeza (kuphatikiza ndi diuretics kapena mtima glycosides),
- kupewa ndi kuchiza infrction ya myocardial (tsiku loyamba la mankhwalawa limaperekedwa kuti likhale ndi magawo a hemodynamic komanso kupewa mtima wodwala)
- kuwonongeka kwa matenda ashuga a m'matumbo (kuchepetsa kuchuluka kwa albumin komwe kumachitika mkodzo mwa anthu omwe ali ndi matenda amtundu wa 2 ndi mtundu wa 2).
Gulu la Nosological (ICD-10)
| Mapiritsi | 1 tabu. |
| ntchito: |
| lisinopril dihydrate (malinga ndi lisinopril anhydrous) | 10/20 mg |
| oyenera (10 mg): mannitol, calcium phosphate dihydrate, wowuma chimanga, pregelatinized wowuma, utoto wachikasu chitsulo oxide (E172), colloidal silicon dioxide, magnesium stearate |
| odzola (20 mg): mannitol, calcium phosphate dihydrate, wowuma chimanga, pregelatinized wowuma, wachikasu chitsulo oxide utoto (E172), utoto wofiira wa okusayidi (E172), colloidal silicon dioxide, magnesium stearate |
Mlingo ndi makonzedwe
Mkati musanadye kapena musanadye, 1 nthawi patsiku, makamaka nthawi imodzi.
Chofunikira pa matenda oopsa. Mlingo woyambirira ndi 10 mg kamodzi patsiku, mlingo wokonza ndi 20 mg / tsiku, ndipo pazokwanira ndi 40 mg / tsiku.
Kuti muchite bwino pakukhudzidwa, pang'onopang'ono milungu iwiri ya mankhwalawa ndi mankhwala ingafunike (izi ziyenera kukumbukiridwa pakukweza mlingo). Ngati kugwiritsa ntchito mankhwalawa muyezo waukulu sikuyambitsa vuto lokwanira, ndiye kuti mankhwala ena othandizira amatha.
Odwala omwe adalandira diuretics m'mbuyomu, ndikofunikira kuti alembetse pakadutsa masiku awiri isanayambike mankhwalawa. Ngati ndizosatheka kuletsa kukodzetsa, mlingo woyambirira wa lisinopril sayenera kupitirira 5 mg / tsiku.
Pankhani ya kukonzanso kwamitsempha yamagazi kapena zinthu zina ndi RAAS yowonjezera. Mankhwala Iramed ® anafotokozera koyamba mlingo wa 2,5-5 mg / tsiku motsogozedwa magazi, impso ntchito, potaziyamu ndende mu magazi seramu.
Mlingo wokonza umakhazikitsidwa kutengera kuthamanga kwa magazi.
Odwala aimpso kulephera ndi odwala hemodialysis, Mlingo woyambirira umakhazikitsidwa kutengera mlingo wa Clin wa creatinine. Mlingo wokonza umatsimikizika malinga ndi kuthamanga kwa magazi (motsogozedwa ndi ntchito yaimpso, potaziyamu ndi magawo a sodium m'magazi).
Mlingo wa kulephera kwa impso. Mlingo amatsimikiza kutengera mtundu wa Cl wa creatinine, monga akuwonetsera patebulopo.
| Cl creatinine, ml / mphindi | Mlingo woyamba, mg / tsiku |
| 30–70 | 5–10 |
| 10–30 | 2,5–5 |
| milungu |
Kumayambiriro kwa mankhwalawa kapena masiku oyamba atatu pambuyo panjira yodwala kwambiri odwala omwe ali ndi kuthamanga kwa magazi (120 mmHg kapena kutsika), mlingo wocheperako wa 2.5 mg uyenera kutumikiridwa. Pakakhala kuchepa kwa kuthamanga kwa magazi (SBP ≤100 mm Hg), tsiku lililonse mlingo wa 5 mg ukhoza, ngati pakufunika, utachepetsedwa kwakanthawi mpaka 2,5 mg. Pankhani ya kuchepa kwakanthawi kwa kuthamanga kwa magazi (CAD mmHg zoposa ola limodzi), chithandizo cha mankhwala iyenera kusiyidwa.
Matenda a shuga. Odwala omwe ali ndi matenda osokoneza bongo omwe amadalira shuga, 10 mg ya lisinopril amagwiritsidwa ntchito kamodzi patsiku. Ngati ndi kotheka, mlingowo umatha kuwonjezeka mpaka 20 mg kamodzi patsiku kuti akwaniritse mfundo za dAD pansi pa 75 mm Hg. m'malo okhala.
Odwala omwe ali ndi matenda a shuga omwe amadalira insulin - mlingo womwewo umagwiritsidwa ntchito kukwaniritsa mfundo za dAD pansi pa 90 mm Hg. m'malo okhala.
Wopanga
BELUPO, mankhwala ndi zodzikongoletsera dd, Republic of Croatia. 48000, Koprivnitsa, st. Danica, 5.
Oimira ofesi ya BELUPO, mankhwala ndi zodzikongoletsera dd, Republic of Croatia ku Russia (adilesi ya zodandaula): 119330, Moscow, 38 Lomonosovsky pr-t, apt. 71-72.
Tele. ((495) 933-72-13, fakisi: (495) 933-72-15.
