Sanovasc - (Sanovasc)

1. Kufotokozera za mankhwalawa
2. Mndandanda wazofananira ndi mitengo
3. Ndemanga
4. Malangizo ovomerezeka ogwiritsa ntchito

Kufotokozera za mankhwalawa

Sanovask - NSAIDs. Imakhala ndi zotsutsana ndi kutupa, ma analgesic ndi antipyretic zotsatira, komanso imalepheretsa kuphatikiza kwa mapulateleti. Kupanga kwamachitidwe kumalumikizidwa ndi kulepheretsa kwa ntchito ya COX - puloteni yofunika kwambiri ya metabolism ya arachidonic acid, yomwe ili patsogolo pa prostaglandins, yomwe imagwira gawo lalikulu pathogenesis ya kutupa, kupweteka ndi kutentha thupi. Kutsika kwa zomwe zili mu ma prostaglandins (makamaka E 1) pakatikati pa thermoregulation kumabweretsa kuchepa kwa kutentha kwa thupi chifukwa cha kuchuluka kwa mitsempha ya magazi pakhungu komanso thukuta lomwe likuwonjezeka. Mphamvu ya analgesic imachitika chifukwa cha zonse zapakati komanso zotumphukira. Amachepetsa kusakanikirana, kuphatikizika kwa mapulateleti ndi thrombosis poletsa kaphatikizidwe ka thromboxane A 2 m'mapulateleti.

Imachepetsa kufa ndi chiopsezo chokhala ndi myocardial infaration ndi angina osakhazikika. Kugwiritsa ntchito yoyambirira kupewa matenda a mtima dongosolo ndi yachiwiri kupewa myocardial infarction. Mlingo wa tsiku lililonse wa 6 g kapena kuposerapo, umalepheretsa kaphatikizidwe ka prothrombin mu chiwindi ndikuwonjezera nthawi ya prothrombin. Kuchulukitsa kwa plasma fibrinolytic ntchito ndikuchepetsa kuchuluka kwa mavitamini obwera chifukwa cha vitamini K (II, VII, IX, X). Zimawonjezera zovuta za hemorrhagic panthawi yopangira opaleshoni, zimawonjezera chiopsezo chotaya magazi munthawi ya mankhwala ndi anticoagulants. Imathandizira kuchulukitsidwa kwa uric acid (imasokoneza kuyambiranso kwa impso), koma yayikulu. Blockade ya COX-1 m'mimba mucosa kumabweretsa zoletsa gastroprotective prostaglandins, zomwe zingayambitse zilonda zam'mimba mucous ndi magazi pambuyo pake.

Kutulutsa mawonekedwe, ma CD ndi kapangidwe kake

Mapiritsiwa amaphatikizidwa ndi enteric film membrane wa oyera kapena pafupifupi oyera, ozungulira, biconvex, pamtanda wopingasa - pakati pazotuwa zoyera kapena pafupifupi zoyera komanso mtambo woonda.

Othandizira: lactose monohydrate - 31,5 mg, cellcrystalline cellulose - 16,3 mg, colloidal silicon dioxide - 1,7 mg, sodium carboxymethyl wowuma - 0,5 mg.

Mapangidwe a Shell: kopolymer wa methaconic acid ndi ethyl acrylate 1: 1 - 3.35 mg, povidone K17 - 0.56 mg, talc - 0,75 mg, macrogol 4000 - 0,34 mg.

Ma PC 10 - matumba otumphukira (3) - mapaketi a makatoni.
Ma PC 10 - matumba a matuza (6) - mapaketi a makatoni.
Ma PC 10 - mapepala otumphukira (9) - mapaketi a makatoni.
30 ma PC - zitini za polima (1) - mapaketi a makatoni.
Ma PC 60. - zitini za polima (1) - mapaketi a makatoni.

Mapiritsiwa amaphatikizidwa ndi enteric film membrane wa oyera kapena pafupifupi oyera, ozungulira, biconvex, pamtanda wopingasa - pakati pazotuwa zoyera kapena pafupifupi zoyera komanso mtambo woonda.

Othandizira: lactose monohydrate - 47.25 mg, cellcrystalline cellulose - 24.4 mg, colloidal silicon dioxide - 2.6 mg, sodium carboxymethyl wowuma - 0,75 mg.

Mapangidwe a Shell: kopolymer wa methaconic acid ndi ethyl acrylate 1: 1 - 6.7 mg, povidone K17 - 1.12 mg, talc - 1.5 mg, macrogol 4000 - 0.68 mg.

Ma PC 10 - matumba otumphukira (3) - mapaketi a makatoni.
Ma PC 10 - matumba a matuza (6) - mapaketi a makatoni.
Ma PC 10 - mapepala otumphukira (9) - mapaketi a makatoni.
30 ma PC - zitini za polima (1) - mapaketi a makatoni.
Ma PC 60. - zitini za polima (1) - mapaketi a makatoni.

Mapiritsiwa amaphatikizidwa ndi enteric film membrane wa oyera kapena pafupifupi oyera, ozungulira, biconvex, pamtanda wopingasa - pakati pazotuwa zoyera kapena pafupifupi zoyera komanso mtambo woonda.

Othandizira: lactose monohydrate - 63 mg, cellcrystalline cellulose - 32.6 mg, colloidal silicon dioxide - 3,4 mg, sodium carboxymethyl wowuma - 1 mg.

Mapangidwe a Shell: kopolymer wa methaconic acid ndi ethyl acrylate 1: 1 - 10.05 mg, povidone K17 - 1.68 mg, talc - 2.25 mg, macrogol 4000 - 1.02 mg.

Ma PC 10 - matumba otumphukira (3) - mapaketi a makatoni.
Ma PC 10 - matumba a matuza (6) - mapaketi a makatoni.
Ma PC 10 - mapepala otumphukira (9) - mapaketi a makatoni.
30 ma PC - zitini za polima (1) - mapaketi a makatoni.
Ma PC 60. - zitini za polima (1) - mapaketi a makatoni.

Zotsatira za pharmacological

NSAIDs. Imakhala ndi zotsutsana ndi kutupa, ma analgesic ndi antipyretic zotsatira, komanso imalepheretsa kuphatikiza kwa mapulateleti. Kupanga kwamachitidwe kumalumikizidwa ndi kulepheretsa kwa ntchito ya COX - puloteni yofunika kwambiri ya metabolism ya arachidonic acid, yomwe ili patsogolo pa prostaglandins, yomwe imagwira gawo lalikulu pathogenesis ya kutupa, kupweteka ndi kutentha thupi. Kutsika kwa zomwe zili mu ma prostaglandins (makamaka E 1) pakatikati pa thermoregulation kumabweretsa kuchepa kwa kutentha kwa thupi chifukwa cha kuchuluka kwa mitsempha ya magazi pakhungu komanso thukuta lomwe likuwonjezeka. Mphamvu ya analgesic imachitika chifukwa cha zonse zapakati komanso zotumphukira. Amachepetsa kusakanikirana, kuphatikizika kwa mapulateleti ndi thrombosis poletsa kaphatikizidwe ka thromboxane A 2 m'mapulateleti.

Imachepetsa kufa ndi chiopsezo chokhala ndi myocardial infaration ndi angina osakhazikika. Kugwiritsa ntchito yoyambirira kupewa matenda a mtima dongosolo ndi yachiwiri kupewa myocardial infarction. Mlingo wa tsiku lililonse wa 6 g kapena kuposerapo, umalepheretsa kaphatikizidwe ka prothrombin mu chiwindi ndikuwonjezera nthawi ya prothrombin. Kuchulukitsa kwa plasma fibrinolytic ntchito ndikuchepetsa kuchuluka kwa mavitamini obwera chifukwa cha vitamini K (II, VII, IX, X). Zimawonjezera zovuta za hemorrhagic panthawi yopangira opaleshoni, zimawonjezera chiopsezo chotaya magazi munthawi ya mankhwala ndi anticoagulants. Imathandizira kuchulukitsidwa kwa uric acid (imasokoneza kuyambiranso kwa impso), koma yayikulu. Blockade ya COX-1 m'mimba mucosa kumabweretsa zoletsa gastroprotective prostaglandins, zomwe zingayambitse zilonda zam'mimba mucous ndi magazi pambuyo pake.

Pharmacokinetics

Ikamamwa pakamwa, imatengedwa mwachangu kuchokera kumimba yamatumbo ang'ono ndikuchepera pamimba. Kupezeka kwa chakudya m'mimba kwambiri kumasintha mayamwidwe a acetylsalicylic acid.

Zimapukusidwa mu chiwindi ndi hydrolysis ndikupanga salicylic acid, ndikutsatira ndi kuphatikizika ndi glycine kapena glucuronide. Masautso a salicylates m'magazi amwazi amasiyana.

Pafupifupi 80% ya salicylic acid imamangiriza mapuloteni a plasma. Ma salicylates amalowerera mosavuta mu zimakhala zambiri komanso madzi amthupi, kuphatikiza mu cerebrospinal, peritoneal and synovial fluid. Pazocheperako, ma salicylates amapezeka mu minofu yaubongo, kutsata - mu bile, thukuta, ndowe. Imalowa mwachangu kudzera mu chotchinga chachikulu, chochepa chomwe chimapukusidwa mkaka wa m'mawere.

Mwa makanda, ma salicylates amatha kuthana ndi bilirubin kuyanjana ndi albumin ndikuthandizira kukulitsa bilirubin encephalopathy.

Kulowa mkati molumikizira kwamkamwa kumathandizira kwambiri pamaso pa hyperemia ndi edema ndikuchepetsa gawo lakukula kwa kutupa.

Acidosis ikachitika, ambiri mwa michere imasandulika kukhala asidi wopanda ionized, yemwe amalowa bwino mkati mwake, kuphatikizapo kupita ku ubongo.

Imafufutidwa makamaka ndi kubisala mwachangu m'matumbu a impso osasinthika (60%) komanso mu mawonekedwe a metabolites. Kuchulukitsa kwa salicylate kosasinthika kumadalira pH ya mkodzo (kusintha kwamkodzo kwamkodzo, kuchepa kwa mchere wama-salicylates kumawonjezeka, kubwezeretsanso kwawo kumakulirakulira, ndipo chimbudzi chimakulanso kwambiri). T 1/2 acetylsalicylic acid pafupifupi mphindi 15. T 1/2 ya salicylate ikamagwiritsidwa ntchito ngati mulingo wocheperako ndi maola awiri ndi atatu, ndipo Mlingo wowonjezereka ukhoza kuwonjezeka mpaka maola 15-30. Mwa ana obadwa kumene, kuchotsa kwa salicylate kumayamba pang'onopang'ono kuposa akuluakulu.

Zizindikiro zamankhwala

Rheumatism, nyamakazi yokhala ndi nyamakazi, matenda opatsirana komanso matendawo, matenda opatsirana komanso otupa, kupweteka kwapafupipafupi kwamitundu yosiyanasiyana (kuphatikizapo neuralgia, myalgia, mutu), kupewa thrombosis ndi embolism , kupewa ngozi za cerebrovascular malinga ndi mtundu wa ischemic.

Mu matenda immunology ndi allergology: mu kukula pang'onopang'ono Mlingo wa "aspirin" wokhalitsa komanso mapangidwe okhazikika a NSAIDs mwa odwala omwe ali ndi "Asipirin" mphumu ndi "aspirin triad".

Zotsatira zoyipa

Kuchokera pamimba: kukhumudwa, kusanza, kuperewera, kupweteka kwam'mimba, kutsegula m'mimba, kawirikawiri - kumachitika zilonda zam'mimba komanso zotupa, magazi ochokera m'matumbo, kuwonongeka kwa chiwindi.

Kuchokera kumbali ya chapakati mantha dongosolo: ntchito kwa nthawi yayitali, chizungulire, kupweteka kwa mutu, kusinthika kwowona, tinnitus, aseptic meningitis ndikotheka.

Kuchokera ku hemopoietic dongosolo: kawirikawiri - thrombocytopenia, kuchepa magazi.

Kuchokera pamagazi othandizira magazi: kawirikawiri - hemorrhagic syndrome, kutalika kwa nthawi ya magazi.

Kuchokera kwamikodzo dongosolo: kawirikawiri - kusokonezeka kwa impso, ndi ntchito yayitali - kupweteka kwambiri kwaimpso, nephrotic syndrome.

Zotsatira zoyipa: kawirikawiri - zotupa pakhungu, edema ya Quincke, bronchospasm, "aspirin triad" (kuphatikiza mphumu ya bronchial, polyposis ya mphuno ndi paranasal sinuses komanso tsankho la acetylsalicylic acid ndi mankhwala a pyrazolone.

Zina: nthawi zina - Matenda a Reye, omwe amagwiritsidwa ntchito kwa nthawi yayitali - Zizindikiro zowonjezereka za kulephera kwa mtima.

Mimba komanso kuyamwa

Contraindised mu I ndi III trimesters a mimba. Mu II trimester yokhala ndi pakati, kuvomereza kamodzi ndikotheka malinga ndi mawonekedwe okhwima.

Imakhala ndi teratogenic athari: ikagwiritsidwa ntchito mu trimester yoyamba, imayambitsa kukulitsa kwa palate yapamwamba, mu trimester yachitatu imayambitsa kulepheretsa kwa ntchito (inhibition of prostaglandin synthesis), kutsekeka msanga kwa ductus arteriosus mu fetus, pulmonary vascular hyperplasia ndi kufalikira kwa magazi mu pulmonary.

Acetylsalicylic acid imachotseredwa mkaka wa m'mawere, zomwe zimapangitsa kuti magazi azituluka kwa mwana chifukwa cha kupindika kwa zinthu za m'magazi, chifukwa chake amayi sayenera kugwiritsa ntchito acetylsalicylic acid panthawi yotsekera.

Malangizo apadera

Amagwiritsidwa ntchito mosamala odwala omwe ali ndi matenda a chiwindi ndi impso, ndi mphumu ya bronchial, zilonda zam'mimba komanso zotupa ndi magazi ochokera m'matumbo am'mimba mu anamnesis, ndi magazi ochulukirapo kapena munthawi yomweyo.

Acetylsalicylic acid ngakhale yaying'ono Mlingo amachepetsa excretion wa uric acid mthupi, zomwe zingayambitse kugwidwa kwamatenda kwa gout mwa odwala otenga msanga. Nthawi yayitali pochita mankhwala komanso / kapena kugwiritsa ntchito acetylsalicylic acid mu milingo yayikulu, kuyang'aniridwa kwachipatala ndikuwunika pafupipafupi kuchuluka kwa hemoglobin kumafunika.

Kugwiritsa ntchito acetylsalicylic acid monga anti-yotupa wothandizira tsiku lililonse la 5-8 g ndizochepa chifukwa chakuwoneka bwino kwa zotsatira zoyipa m'mimba.

Musana opaleshoni, kuti muchepetse magazi munthawi ya opaleshoni komanso munthawi yothandizira, muyenera kusiya kumwa salicylates kwa masiku 5-7.

Pakupatsirana kwa nthawi yayitali, kuyezetsa magazi komanso kuyeseza magazi kochita zamatsenga kuyenera kuchitidwa.

Kugwiritsidwa ntchito kwa acetylsalicylic acid mu ana oponderezedwa kumatsutsana, chifukwa panjira ya kachilombo ka ana mothandizidwa ndi acetylsalicylic acid, chiopsezo chokhala ndi matenda a Reye chikuwonjezeka. Zizindikiro za Reye's syndrome zimaphatikizapo kusanza kwa nthawi yayitali, encephalopathy, komanso chiwindi.

Kutalika kwa mankhwalawa (popanda kufunsa dokotala) sikuyenera kupitirira masiku 7 mutagwiritsidwa ntchito ngati analgesic komanso masiku opitilira 3 ngati antipyretic.

Pa chithandizo, wodwala ayenera kupewa kumwa mowa.

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito munthawi yomweyo ma antacid okhala ndi magnesium ndi / kapena aluminium hydroxide, chepetsani ndikuchepetsa kuyamwa kwa acetylsalicylic acid.

Pogwiritsa ntchito munthawi yomweyo calcium yotseka, mankhwala omwe amachepetsa calcium kapena kuwonjezera kuchuluka kwa calcium kuchokera mthupi, chiopsezo chotaya magazi chikuwonjezeka.

Pogwiritsa ntchito munthawi yomweyo ndi acetylsalicylic acid, zotsatira za heparin ndi anticoagulants, hypoglycemic othandizira a sulfonylureas, insulin, methotrexate, phenytoin, valproic acid imatheka.

Pogwiritsa ntchito munthawi yomweyo ndi corticosteroids, chiopsezo cha ulcerogenic kanthu ndi kupezeka kwa magazi m'mimba kumawonjezeka.

Pogwiritsa ntchito munthawi yomweyo, mphamvu ya okodzetsa (spironolactone, furosemide) imachepetsedwa.

Pogwiritsa ntchito munthawi yomweyo ma NSAID ena, chiopsezo cha mavuto amabwera. Acetylsalicylic acid imatha kuchepetsa plasma wozungulira indomethacin, piroxicam.

Ikagwiritsidwa ntchito nthawi yomweyo ndi kukonzekera kwa golide, acetylsalicylic acid imatha kuyambitsa chiwindi.

Pogwiritsa ntchito munthawi yomweyo, mphamvu ya ma uricosuric othandizira amachepetsa (kuphatikizapo phenenecid, sulfinpyrazone, benzbromarone).

Ndi munthawi yomweyo kugwiritsa ntchito acetylsalicylic acid ndi sodium alendronate, kukula kwa esophagitis yayikulu ndikotheka.

Pogwiritsa ntchito munthawi yomweyo griseofulvin, kuphwanya mayamwidwe a acetylsalicylic acid ndikotheka.

Mlandu wa kuyamwa kwa iris hemorrhage akufotokozedwa pamene akutenga kachilombo ka ginkgo biloba motsutsana ndi chiyambi chogwiritsa ntchito acetylsalicylic acid nthawi ya 325 mg / tsiku. Amakhulupirira kuti izi zitha kukhala chifukwa chowonjezera zoletsa mphamvu ya kuphatikizika kwa mapulosi.

Pogwiritsa ntchito munthawi yomweyo dipyridamole, kuwonjezeka kwa C max kwa salicylate m'madzi a m'magazi ndi AUC ndikotheka.

Pogwiritsa ntchito munthawi yomweyo asidi acetylsalicylic acid, makulidwe a digoxin, barbiturates ndi mchere wa lithiamu mukuwonjezeka kwa madzi am'magazi.

Ndi munthawi yomweyo kugwiritsa ntchito salicylates waukulu Mlingo wa carbonic anhydrase zoletsa, salicylate kuledzera ndi kotheka.

Acetylsalicylic acid mu Mlingo wochepera 300 mg / tsiku ali ndi chidwi chambiri pa mphamvu ya capopril ndi enalapril. Mukamagwiritsa ntchito acetylsalicylic acid mu Mlingo wambiri, kuchepa kwa mphamvu ya capopril ndi enalapril ndikotheka.

Ndi munthawi yomweyo kugwiritsa ntchito khofi wambiri kumawonjezera mayamwidwe, plasma ndende ndi bioavailability wa acetylsalicylic acid.

Ndi munthawi yomweyo kugwiritsa ntchito metoprolol kumatha kuwonjezera C max salicylate m'madzi a m'magazi.

Mukamagwiritsa ntchito pentazocine poyambira kugwiritsa ntchito mankhwala acetylsalicylic kwa nthawi yayitali, pamakhala ngozi yoti impso zingayambike.

Ndi munthawi yomweyo kugwiritsa ntchito phenylbutazone kumachepetsa uricosuria chifukwa acetylsalicylic acid.

Ndi munthawi yomweyo kugwiritsa ntchito Mowa kumapangitsa zotsatira za acetylsalicylic acid pamimba.

Gulu la Nosological (ICD-10)

Mankhwala

Makina amachitidwe a acetylsalicylic acid (ASA) amachokera pazolepheretsa za COX-1, chifukwa chomwe kaphatikizidwe ka PG, prostacyclins ndi Tx ndi kotsekedwa. Amachepetsa kusakanikirana, kuphatikizika kwa mapulateleti, ndi thrombosis mwa kupondereza kaphatikizidwe ka TxA2 m'mapulateleti. Imawonjezera ntchito ya fibrinolytic ya plasma yamagazi ndikuchepetsa kuchuluka kwa mavitamini a K-amadalira a vitamini K (II, VII, IX, X). Mphamvu ya antiplatelet imatchulidwa kwambiri m'mapulateleti, chifukwa satha kupanga COX. Mphamvu ya antiplatelet imayamba kugwiritsidwa ntchito ngati mulingo wochepa wa mankhwalawa ndikupitilira kwa masiku 7 mutatha kamodzi. Izi zimatha ASA ntchito popewa komanso kuchiza infarction ya mtima, matenda a mtima, zovuta za mitsempha ya varicose. ASA imakhalanso ndi anti-yotupa, analgesic, antipyretic.

Contraindication

Hypersensitivity ku acetylsalicylic acid, okonda mapangidwe a mankhwala ndi NSAID ena,

zotupa ndi zotupa zam'mimba (mu gawo lachiwopsezo),

Mphumu ya bronchial yomwe imapangidwa ndi ma salicylates ndi ma NSAID ena,

kuphatikiza kwa mphumu ya bronchial, polyposis ya mphuno ndi zolakwika zamkati ndi tsankho kwa ASA,

kuphatikiza methotrexate muyezo wa 15 mg / sabata kapena kupitirira,

kulephera kwambiri kwaimpso (Cl creatinine osakwana 30 ml / min),

kulephera kwambiri kwa chiwindi (kalasi B komanso pamwambamwamba pa Mwana-Pugh),

aakulu mtima kulephera III - IV gulu lothandiza malinga ndi gulu NYHA,

lactose tsankho, kufupika kwa lactase, shuga / galactose malabsorption syndrome (mankhwalawa ali ndi lactose monohydrate),

pakati (Ine ndi oyambira atatu),

nthawi yoyamwitsa,

wazaka 18.

Ndi chisamaliro: gout, hyperuricemia, chapamimba ndi duodenal ulcer kapena mbiri yokhudza kutulutsa magazi m'mimba (kulephera kwa impso), kulephera kwa impso (creatinine Cl woposa 30 ml / min), kusokonezeka kwa CVD (kuphatikizapo kuperewera kwa mtima, hypovolemia, opaleshoni yayikulu kulowererapo, sepsis kapena milandu yotaya magazi kwambiri - chiwopsezo cha matenda a impso ndi kulephera kwa impso), kulephera kwa chiwindi (m'munsi mwa B pa kuchuluka kwa Mwana), mphumu ya bronchial, matenda opatsirana kupuma, hay fever, mphuno ya mphuno, ziwengo zamankhwala, kuphatikizapo NSAIDs, analgesics, anti-yotupa, antirheumatic agents, kuperewera kwa glucose-6-phosphate dehydrogenase (ASA imatha kuyambitsa hemolysis ndi hemolytic anemia, zinthu zomwe zingakulitse chiopsezo cha hemolysis ndi mlingo waukulu wa mankhwala, kutentha thupi komanso matenda opha ziwopsezo), mimba (II trimester), othandizira opaleshoni yolowerera (kuphatikiza ang'ono, mwachitsanzo, kupaka dzino), munthawi yomweyo makonzedwe a methotrexate osakwana 15 mg / sabata, anticoagulants, thrombolytic kapena antiplatelet agents ndi njira, NSAIDs ndi salicylic asidi ofanana nawo mlingo waukulu, digoxin, hypoglycemic wothandizira ntchito m'kamwa (sulfonylurea zotumphukira) ndi insulin, asidi valproic, mowa (makamaka mowa), SSRIs, ibuprofen (cm. "mogwirizana").

Zotsatira zoyipa

Kuchokera m'mimba: Nthawi zambiri - nseru, kutentha mtima, kusanza, kupweteka pamimba, kawirikawiri - zilonda zam'mimba, osowa - zilonda zam'mimba ndi zotupa za m'mimba, kutaya kwa m'mimba, kuchepa kwa chiwindi kwa nthawi yayitali.

Kuchokera kumbali yamanjenje yapakati: chizungulire, kusowa kwa makutu, tinnitus, chomwe chingakhale chizindikiro cha mankhwala osokoneza bongo (onani "bongo").

Kuchokera ku hemopoietic system: kuchuluka kwa magazi a perioperative (intra- ndi postoperative), hematomas (mikwingwirima), mphuno, magazi amkamwa, magazi ochokera ku genitourinary thirakiti. Pali malipoti amilandu yayikulu yotaya magazi, monga magazi am'mimba komanso magazi a m'matumbo (makamaka odwala omwe ali ndi vuto losakanikirana ndi magazi omwe sanathe kufikira kuthamanga kwa magazi komanso / kapena kulandira chithandizo chofanana ndi mankhwala a anticoagulant), omwe nthawi zina amatha kukhala oopsa . Kuchepetsa magazi kumatha kubweretsa kukula kwa magazi m'thupi kapena matenda a posthemorrhagic / iron akusowa (mwachitsanzo, chifukwa cha kutuluka kwa zamatsenga) ndi zizindikiro zogwirizana ndi zamankhwala ndi zasayansi (asthenia, pallor, hypoperfusion). Pali malipoti a milandu ya hemolysis ndi hemolytic anemia mwa odwala kwambiri glucose-6-phosphate dehydrogenase.

Zotsatira zoyipa: zotupa pakhungu, kuyabwa, urticaria, edema ya Quincke, rhinitis, kutupa kwa mucous nembanemba, bronchospasm, cardiorespiratory stress syndrome, komanso kuvutikanso kwakukulu, kuphatikiza anaphylactic.

Kuchokera pamikodzo: Pali malipoti amilandu olephera aimpso komanso kulephera kwa impso.

Kuchita

Ndi kugwiritsa ntchito nthawi yomweyo ASA imathandizira zotsatira za mankhwala omwe ali pansipa. Ngati ndi kotheka, nthawi yomweyo ASA yokhala ndi ndalama zomwe zalembedwayi iyenera kuganizira kufunika kochepetsa mlingo wawo:

- methotrexate - chifukwa cha kuchepa kwa chilolezo cha impso ndi kuchoka kwake pakulankhulana ndi mapuloteni,

- anticoagulants, thrombolytic and antiplatelet agents (ticlopidine) - pamakhala chiwopsezo chowonjezereka cha magazi chifukwa cha synergism yayikulu yamankhwala omwe amagwiritsidwa ntchito,

- mankhwala osokoneza bongo a anticoagulant, thrombolytic kapena antiplatelet effect, - pali kuwonjezeka kwa zomwe zimawononga pa mucosa wam'mimba,

- SSRIs - imatha kubweretsa chiwopsezo chowonjezeka magazi kuchokera kumtunda wapamwamba wam'mimba (synergism ndi ASA),

- digoxin - chifukwa cha kuchepa kwa impso zake, zomwe zimayambitsa bongo.

- hypoglycemic othandizira pakamwa makonzedwe (sulfonylurea zotumphukira) ndi insulin chifukwa cha hypoglycemic katundu wa ASA palokha waukulu komanso kusamutsidwa kwa zotumphukira sulfonylurea kuchokera mgwirizano ndi mapuloteni a plasma,

- Valproic acid - kawopsedwe wake amakula chifukwa chakuchoka kwawo polumikizana ndi mapuloteni amadzi a m'magazi,

- NSAIDs ndi salicylic acid zotumphukira mu Mlingo waukulu - chiwopsezo cha ulcerogenic zotsatira ndi magazi kuchokera m'mimba chifukwa chogwirizana,

- ibuprofen - pali malingaliro okana za kulepheretsa kusintha kwa thromboxanesynthetase chifukwa cha zochita za ASA, zomwe zimapangitsa kutsika kwa mtima ndi zotsatira za ASA,

- Mowa - kuwonjezeka kwa kuwonongeka kwa mucosa wam'mimba komanso kutalika kwa nthawi yotuluka magazi chifukwa chakuwonjezera mphamvu kwa zotsatira za ASA ndi Mowa.

The munthawi yomweyo dongosolo la ASA Mlingo wambiri amatha kufooketsa mphamvu ya mankhwala omwe alembedwa pansipa. Ngati ndi kotheka, nthawi yomweyo kutumikiridwa kwa ASA ndi ndalama zomwe zalembedwa kuyenera kuganizira kufunika kosintha kwa mlingo:

- diuretics iliyonse - pali kuchepa kwa GFR chifukwa chakuchepa kwa kapangidwe ka GHG mu impso,

- ACE zoletsa - pali kuchepa kwa mlingo wa GFR chifukwa cha kuletsa kwa ma GHG ndi vasodilating, motero, kufooka kwa zotsatira za hypotensive. Kutsika kwamankhwala ku GFR kumawonedwa ndi mlingo wa ASA wopitilira 160 mg. Kuphatikiza apo, pali kuchepa kwamphamvu mu mtima waopositi wa ACE woperekedwa kwa odwala pochiza mtima. Izi zimawonekeranso pakagwiritsidwa ntchito molumikizana ndi ASA pamiyeso yayikulu,

- mankhwala osokoneza bongo a uricosuric kanthu (benzbromaron, probenecid) - kuchepa kwa uricosuric zotsatira chifukwa cha mpikisano wothana ndi aimpso aular urinal acid excretion,

- systemic corticosteroids (kupatula hydrocortisone yomwe imagwiritsidwa ntchito m'malo mwa chithandizo cha matenda a Addison) - pali kuwonjezeka kwa kuchulukitsidwa kwa salicylates ndipo, chifukwa chake, kufooka kwa zochita zawo.

Mlingo ndi makonzedwe

Mkati osatafuna, kumwa madzi ambiri, makamaka musanadye. Mapiritsi amatengedwa 1 nthawi patsiku.

Kutalika kwa mankhwala kumatsimikiziridwa ndi adokotala.

Kupewera koyambirira kwa kulowetsedwa kwachimake myocardial pamaso pa zinthu zoopsa. 50-100 mg / tsiku.

Kupewa kubwerezanso kwa myocardial infarction, kusakhazikika komanso kukhazikika kwa angina pectoris. 50-100 mg / tsiku.

Angina wosakhazikika (ndi kukayikira komwe kumayambitsa kupweteka kwamnyewa wamtima). Mlingo woyambirira wa 100 mg (piritsi loyamba liyenera kutafunidwa mwachangu) uyenera kutengedwa ndi wodwalayo posachedwa pakukayikirana kuti chitukuko cha kulowerera kwaposachedwa. M'masiku 30 otsatira chitukuko cha kulowetsedwa kwa myocardial, mlingo wa 200-300 mg / tsiku uyenera kusamalidwa. Pambuyo masiku 30, chithandizo choyenera chikuyenera kuperekedwa kuti tipewe kubwerezanso kwa myocardial infarction.

Kupewa kwa stroko komanso kuchepa kwa ngozi yamisala. 75-100 mg / tsiku.

Kupewa kwa thromboembolism pambuyo pakuchita opaleshoni ndikulowerera kwa mtima kosafunikira. 50-100 mg / tsiku.

Kupewa kwa DVT ndi pulmonary embolism ndi nthambi zake. 100-200 mg / tsiku.

Fomu ya Mlingo:

mapiritsi okhala ndi kanthu

Piritsi limodzi lili:

acetylsalicylic acid - 50.00 mg, 75.00 mg kapena 100.00 mg.

Zabwino (pakati):

lactose monohydrate - 31.50 mg, 47.25 mg kapena 63.00 mg, cellcrystalline cellulose - 16.30 mg, 24.40 mg kapena 32.60 mg, colloidal silicon dioxide - 1.70 mg, 2.60 mg kapena 3.40 mg; sodium carboxymethyl wowuma 0,50 mg, 0.75 mg kapena 1.00 mg.

Othandizira (chipolopolo):

Copolymer wa methaconic acid ndi ethyl acrylate 1: 1 - 3.35 mg, 6.70 mg kapena 10,05 mg, povidone K17 - 0.56 mg, 1.12 mg kapena 1.68 mg, talc - 0,75 mg, 1 , 50 mg kapena 2.25 mg, macrogol 4000 - 0.34 mg, 0.68 mg kapena 1.02 mg.

Zozungulira, mapiritsi a biconvex, filimu yophimba ya enteric, yoyera kapena yoyera. Pamtanda: pakati pake ndi koyera kapena pafupifupi koyera komanso mzere woonda.

Bongo

Zitha kukhala ndi zotsatirapo zoopsa, makamaka kwa okalamba ndi ana.

Matenda a salicylism amakula mukamamwa ASA pa mlingo woposa 100 mg / kg / tsiku kwa masiku opitilira 2 chifukwa chogwiritsa ntchito mankhwala oopsa monga gawo la zosayenera pakugwiritsidwa ntchito poizoni (poyizoni woperewera) kapena mwangozi kapena mwanjira yopereka mankhwala oopsa kwa wamkulu kapena mwana (poyizoni wazakudya) .

Wocheperako pang'ono mwamphamvu (limodzi mlingo wosakwana 150 mg / kg)

Zizindikiro chizungulire, tinnitus, kuchepa kwa makutu, kuchuluka thukuta, kusanza ndi mutu, kusokonezeka kwa mutu, chisokonezo, tachypnea, Hyperventilation, kupuma kwa alkalosis.

Chithandizo: gastric lavage, mobwerezabwereza makonzedwe a adamulowetsa kaboni, anakakamiza zamchere diuresis, kubwezeretsa madzi-electrolyte bwino ndi KShchS.

Digiri Yapakatikati ndi yolemetsa (mlingo umodzi wa 150-300 mg / kg - zolimba, kuposa 300 mg / kg - poyizoni woopsa)

Zizindikiro kupuma alkalosis ndi compensatory metabolic acidosis, hyperpyrexia, hyperventilation, non-cardiogenic pulmonary edema, kupuma, kupindika, asphyxia, kumbali ya CCC - mtima arrhythmias, wolemba kuchepa kwa kuthamanga kwa magazi, kulepheretsa zochitika zamtima, pamagawo a mphamvu ya madzi kuchokera pamanja mpaka kukula kwa aimpso kulephera, yodziwika ndi hypokalemia, hypernatremia, kuphwanya shuga kagayidwe - hyperglycemia, hypoglycemia (makamaka ana), etoatsidoz, tinnitus, ugonthi, m'mimba kukha mwazi hematological matenda - ndi chopinga wa loitanirana kupatsidwa zinthu za m'mwazi kuti coagulopathy, ndi px kutambasuka, hypoprothrombinemia, ubongo matenda - poizoni encephalopathy ndi kupondereza dongosolo chapakati mantha (kusinza, chisokonezo, chikomokere, kupweteka).

Chithandizo: kuchipatala msanga m'madipatimenti apadera othandizira chithandizo chamankhwala - chifuwa cham'mimba, kubwerezabwereza kwa makala ophatikizidwa, kukakamizidwa kwa zamkati, hemodialysis, kubwezeretsanso kwa hydrolyte bwino komanso acid-base balance, dalili.

Wopanga

Wopanga / bungwe lolandila madandaulo a ogula: OJSC Irbit Chemical Farm. 623856, Russia, dera la Sverdlovsk, Irbit, st. Kirova, 172.

Tel./fax: (34355) 3-60-90.

Adilesi Yopanga: Sverdlovsk Region, Irbit, ul. Karl Marx, 124-a.

Bungwe lalamulo lomwe lidatchulidwa kuti chikalata chovomerezeka: OAO Aveksima. 125284, Russia, Moscow, chiyembekezo cha Leningradsky, 31A, p. 1.

Zizindikiro zogwiritsidwa ntchito

Mu matenda immunology ndi allergology: mu kukula pang'onopang'ono Mlingo wa "aspirin" wokhalitsa komanso mapangidwe okhazikika a NSAIDs odwala omwe ali ndi "asipirini" mphumu ndi "aspirin triad"

Feverish syndrome mu matenda opatsirana komanso kutupa.

Ululu wamankhwala (wamavuto osiyanasiyana): mutu (kuphatikizira omwe amagwirizana ndi vuto lochotsa mowa), migraine, mano, neuralgia, lumbago, radicular radicular syndrome, myalgia, arthralgia, algodismenorea.

Monga antiplatelet mankhwala (Mlingo mpaka 300 mg / tsiku): matenda a mtima, kupezeka kwa zinthu zingapo zomwe zingayambitse matenda a mtima, kupweteka kwa mtima misoza sitiroko amuna, ma cell ma cell opatsirana (kupewa ndi kuchiza matenda a thromboembolism), balloon coronary angioplasty and stent layilation (kuchepetsa chiopsezo cha kubwezeretsanso stenosis ndi chithandizo cha stratation yachiwiri ya mtsempha wamagazi), ndi ma atheros klerotic zotupa za coronary artery (matenda a Kawasaki), aortoarteritis (matenda a Takayasu), mavuvu ya mitsempha ya mtima ndi matenda atria, mitral valve prolapse (kupewa thromboembolism), pulmonary embolism, pulmonary infarction, pachimake thrombophlebitis,

Rheumatism, nyamakazi yamatenda am'mimba, matenda opha ziwongo, pericarditis, rheumatic chorea - sagwiritsidwa ntchito pano ..

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mapiritsi a mankhwalawa amatengedwa pakamwa, ndi matenda a febrile ndi ululu kwa akulu - Kutalika kwa chithandizo sikuyenera kupitilira masabata awiri.

Kusintha rheological katundu wamagazi - 0,15-0.25 g / tsiku kwa miyezi ingapo.

Mapiritsi okhala ndi ASA mu Mlingo pamwambapa 325 mg (400-500 mg) adapangidwa kuti agwiritsidwe ntchito ngati mankhwala a analgesic komanso odana ndi kutupa, mu Mlingo wa 50-75-100-300-325 mg mu akulu, makamaka ngati mankhwala a antiplatelet.

Ndi kulowetsedwa kwa myocardial, komanso kupewa kwachiwiri kwa odwala pambuyo poyambira, 40-325 mg kamodzi patsiku (nthawi zambiri 160 mg). Monga zoletsa za kuphatikiza kwa maselo oundana - 300-325 mg / tsiku kwa nthawi yayitali.Ndi kusokonezeka kwa mphamvu ya cerebrovascular in men, ubongo wa thromboembolism - 325 mg / tsiku ndi kuwonjezeka pang'onopang'ono mpaka 1 1 / tsiku, kupewa kupewa kuyambiranso - 125-300 mg / tsiku. Pofuna kupewa thrombosis kapena kungosintha kwa minyewa ya m'mimba, 325 mg maola 7 aliwonse kudzera mu chubu cham'mimba, ndiye kuti 325 mg pamlomo katatu katatu patsiku (nthawi zambiri amaphatikizidwa ndi dipyridamole, yemwe amathetsedwa pakatha sabata, akupitilira chithandizo chanthawi yayitali.

Ndi rheumatism yogwira imalembedwa (pakadali pano yopanda mankhwala) tsiku lililonse la 5-8 g kwa achikulire ndi 100-125 mg / kg kwa achinyamata (zaka 15-18), pafupipafupi kugwiritsa ntchito 4-5 pa tsiku. Pambuyo pa chithandizo cha milungu iwiri kapena itatu, ana amachepetsa mlingo mpaka 60-70 mg / kg / tsiku, chithandizo chachikulire chimapitilizidwa ndi mlingo womwewo, nthawi yayitali imakhala mpaka masabata 6. Kuletsa kumachitika pang'onopang'ono mkati mwa masabata 1-2.

Mafunso, mayankho, ndemanga pa mankhwala Sanovask

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

Kupanga ndi mawonekedwe a kumasulidwa

Mapiritsi - 1 piritsi:

• Zinthu zothandizira: acetylsalicylic acid 50 mg,
• Othandizira: Omwe amathandizira: lactose monohydrate - 31,5 mg, cellcrystalline cellulose - 16,3 mg, colloidal silicon dioxide - 1.7 mg, sodium carboxymethyl - 0,5 mg,
• kapangidwe kazinthu ka shell: Copolymer wa methaconic acid ndi ethyl acrylate 1: 1 - 3.35 mg, povidone K17 - 0.56 mg, talc - 0,75 mg, macrogol 4000 - 0,34 mg.

Mapiritsi 30 pacake.

Mapiritsiwa amaphatikizidwa ndi enteric film membrane wa oyera kapena pafupifupi oyera, ozungulira, biconvex, pamtanda wopingasa - pakati pazotuwa zoyera kapena pafupifupi zoyera komanso mtambo woonda.

NSAIDs. Imakhala ndi zotsutsana ndi kutupa, ma analgesic ndi antipyretic zotsatira, komanso imalepheretsa kuphatikiza kwa mapulateleti. Kupanga kwamachitidwe kumalumikizidwa ndi kulepheretsa kwa ntchito ya COX - puloteni yofunika kwambiri ya metabolism ya arachidonic acid, yomwe ili patsogolo pa prostaglandins, yomwe imagwira gawo lalikulu pathogenesis ya kutupa, kupweteka ndi kutentha thupi. Kutsika kwa zomwe zili mu ma prostaglandins (makamaka E1) pakatikati pa thermoregulation kumabweretsa kuchepa kwa kutentha kwa thupi chifukwa cha kuchuluka kwa mitsempha ya magazi pakhungu komanso thukuta lomwe likuwonjezeka. Mphamvu ya analgesic imachitika chifukwa cha zonse zapakati komanso zotumphukira. Amachepetsa kusakanikirana, kuphatikizika kwa mapulateleti ndi thrombosis poletsa kaphatikizidwe ka thromboxane A2 mu mapulosi.

Imachepetsa kufa ndi chiopsezo chokhala ndi myocardial infaration ndi angina osakhazikika. Kugwiritsa ntchito yoyambirira kupewa matenda a mtima dongosolo ndi yachiwiri kupewa myocardial infarction. Mlingo wa tsiku lililonse wa 6 g kapena kuposerapo, umalepheretsa kaphatikizidwe ka prothrombin mu chiwindi ndikuwonjezera nthawi ya prothrombin. Kuchulukitsa kwa plasma fibrinolytic ntchito ndikuchepetsa kuchuluka kwa mavitamini obwera chifukwa cha vitamini K (II, VII, IX, X). Zimawonjezera zovuta za hemorrhagic panthawi yopangira opaleshoni, zimawonjezera chiopsezo chotaya magazi munthawi ya mankhwala ndi anticoagulants. Imathandizira kuchulukitsidwa kwa uric acid (imasokoneza kuyambiranso kwa impso), koma yayikulu. Blockade ya COX-1 m'mimba mucosa kumabweretsa zoletsa gastroprotective prostaglandins, zomwe zingayambitse zilonda zam'mimba mucous ndi magazi pambuyo pake.

Ikamamwa pakamwa, imatengedwa mwachangu kuchokera kumimba yamatumbo ang'ono ndikuchepera pamimba. Kupezeka kwa chakudya m'mimba kwambiri kumasintha mayamwidwe a acetylsalicylic acid.

Zimapukusidwa mu chiwindi ndi hydrolysis ndikupanga salicylic acid, ndikutsatira ndi kuphatikizika ndi glycine kapena glucuronide. Masautso a salicylates m'magazi amwazi amasiyana.

Pafupifupi 80% ya salicylic acid imamangiriza mapuloteni a plasma. Ma salicylates amalowerera mosavuta mu zimakhala zambiri komanso madzi amthupi, kuphatikiza mu cerebrospinal, peritoneal and synovial fluid. Pazocheperako, ma salicylates amapezeka mu minofu yaubongo, kutsata - mu bile, thukuta, ndowe. Imalowa mwachangu kudzera mu chotchinga chachikulu, chochepa chomwe chimapukusidwa mkaka wa m'mawere.

Mwa makanda, ma salicylates amatha kuthana ndi bilirubin kuyanjana ndi albumin ndikuthandizira kukulitsa bilirubin encephalopathy.

Kulowa mkati molumikizira kwamkamwa kumathandizira kwambiri pamaso pa hyperemia ndi edema ndikuchepetsa gawo lakukula kwa kutupa.

Acidosis ikachitika, ambiri mwa michere imasandulika kukhala asidi wopanda ionized, yemwe amalowa bwino mkati mwake, kuphatikizapo kupita ku ubongo.

Imafufutidwa makamaka ndi kubisala mwachangu m'matumbu a impso osasinthika (60%) komanso mu mawonekedwe a metabolites. Kuchulukitsa kwa salicylate kosasinthika kumadalira pH ya mkodzo (kusintha kwamkodzo kwamkodzo, kuchepa kwa mchere wama-salicylates kumawonjezeka, kubwezeretsanso kwawo kumakulirakulira, ndipo chimbudzi chimakulanso kwambiri). T1 / 2 ya acetylsalicylic acid pafupifupi mphindi 15. T1 / 2 ya salicylate ikagwiritsidwa ntchito muyezo wocheperako ndi maola 2-3, ndi kuchuluka kwa mankhwalawa kumatha kuwonjezeka mpaka maola 15-30.

Ntchito Sanovask mu pakati ndi ana

Contraindised mu I ndi III trimesters a mimba. Mu II trimester yokhala ndi pakati, kuvomereza kamodzi ndikotheka malinga ndi mawonekedwe okhwima.

Imakhala ndi teratogenic athari: ikagwiritsidwa ntchito mu trimester yoyamba, imayambitsa kukulitsa kwa palate yapamwamba, mu trimester yachitatu imayambitsa kulepheretsa kwa ntchito (inhibition of prostaglandin synthesis), kutsekeka msanga kwa ductus arteriosus mu fetus, pulmonary vascular hyperplasia ndi kufalikira kwa magazi mu pulmonary.

Acetylsalicylic acid imachotseredwa mkaka wa m'mawere, zomwe zimapangitsa kuti magazi azituluka kwa mwana chifukwa cha kupindika kwa zinthu za m'magazi, chifukwa chake amayi sayenera kugwiritsa ntchito acetylsalicylic acid panthawi yotsekera.

Contrindication: Ana a zaka (mpaka zaka 15 - chiopsezo cha Reye syndrome mu ana omwe ali ndi matenda oopsa).

Mlingo Sanovask

Aliyense. Kwa akuluakulu, mlingo umodzi umasiyana 40 mg mpaka 1 g, tsiku lililonse - kuchokera ku 150 mg mpaka 8 g, pafupipafupi kugwiritsa ntchito - 2-6 nthawi / tsiku.

Kugwiritsa ntchito acetylsalicylic acid monga anti-yotupa wothandizira tsiku lililonse la 5-8 g ndizochepa chifukwa chakuwoneka bwino kwa zotsatira zoyipa m'mimba.

Musana opaleshoni, kuti muchepetse magazi munthawi ya opaleshoni komanso munthawi yothandizira, muyenera kusiya kumwa salicylates kwa masiku 5-7.

Pakupatsirana kwa nthawi yayitali, kuyezetsa magazi komanso kuyeseza magazi kochita zamatsenga kuyenera kuchitidwa.

Kugwiritsidwa ntchito kwa acetylsalicylic acid mu ana oponderezedwa kumatsutsana, chifukwa panjira ya kachilombo ka ana mothandizidwa ndi acetylsalicylic acid, chiopsezo chokhala ndi matenda a Reye chikuwonjezeka. Zizindikiro za Reye's syndrome zimaphatikizapo kusanza kwa nthawi yayitali, encephalopathy, komanso chiwindi.

Kutalika kwa mankhwalawa (popanda kufunsa dokotala) sikuyenera kupitirira masiku 7 mutagwiritsidwa ntchito ngati analgesic komanso masiku opitilira 3 ngati antipyretic.

Pa chithandizo, wodwala ayenera kupewa kumwa mowa.

Mimba komanso kuyamwa

Mimba

Kugwiritsa ntchito milingo yayikulu ya salicylates m'miyezi itatu yoyambirira ya kubereka kumalumikizidwa ndi kuchuluka kwa zolakwika za fetal (kufinya kwamkati, zolakwika zamtima). Kukhazikitsidwa kwa salicylates mu trimester yoyamba ya mimba kumatsutsana.

Munthawi yachiwiri ya mimba, ma salicylates amatha kuikidwa poganizira kuwunika kovomerezeka ndi mapindu a mayi ndi mwana wosabadwayo, makamaka pamlingo wosaposa 150 mg / tsiku komanso kwa nthawi yochepa.

Mu trimester yomaliza yamimba, ma salicylates omwe ali ndi mlingo waukulu (wopitilira 300 mg / tsiku) amalepheretsa kugwira ntchito, kutsekeka msanga kwa ductus arteriosus mu mwana wosabadwayo, kuchuluka kwa magazi m'mayi ndi mwana wosabadwayo, komanso kuyang'anira asanabadwe kungayambitse kukha magazi kwakanthawi, makamaka ana akhanda. Kukhazikitsidwa kwa salicylates mu trimester yomaliza yam'mimba imatsutsana.

Gwiritsani ntchito pokonza mkaka

Ma salicylates ndi ma metabolites awo ochepa amapita mkaka wa m'mawere. Mwadzidzidzi kudya kwa salicylates pa mkaka wa m`mawere sikuyenda limodzi ndi zovuta mu mwana ndipo sikutanthauza kuti kuyamwa yoyamwitsa. Komabe, pogwiritsa ntchito mankhwalawa kwa nthawi yayitali kapena kupatsidwa mlingo waukulu, kuyamwitsa kuyenera kuyimitsidwa nthawi yomweyo.