Buku la Mankhwala Osokoneza bongo

Oral hypoglycemic wothandizira, lotuluka la phenylalanine. Mu mankhwala ndi mankhwala amasiyana ndi ena othandizira a hypoglycemic. Imabwezeretsa kubisalira koyambirira kwa insulin, komwe kumapangitsa kutsika kwa glucose wa m'magazi komanso kuchuluka kwa hemoglobin (HbA1c).

Mothandizidwa ndi nateglinide yomwe idatengedwa musanadye, gawo loyambirira (kapena loyamba) la insulin katulutsidwe limabwezeretseka. Makina azinthu izi ndizogwiritsa ntchito mwachangu komanso zosinthika kwa nateglinide ndi njira za K + ATP zotengera ma pancreatic β-cell. Kusankhidwa kwa nateglinide pokhudzana ndi njira za K + ATP zomwe zimadalira ma pancreatic β-cell ndizokwana 300 kupatula izi pokhudzana ndi njira ya mtima ndi mitsempha yamagazi.

Nateglinide, mosiyana ndi othandizira ena am'magazi a hypoglycemic, amachititsa kubisalira kwa insulin m'mphindi 15 zoyambirira mutatha kudya, chifukwa chomwe kusinthasintha kwa m'mimba mwa m'magazi a "glucose" kumachitika. Mu maola otsatira a 3-4, kuchuluka kwa insulin kumabwereranso kuzomwe zimakhazikitsidwa, motero, ndizotheka kupewa chitukuko cha postprandial hyperinsulinemia, chomwe chingapangitse kuchepa kwa hypoglycemia.

Katulutsidwe wa insulin ndi ma pancreatic β-maselo oyambitsidwa ndi nateglinide kumadalira kuchuluka kwa kuchuluka kwa glucose m'magazi, ndiko kuti, pamene kuchuluka kwa glucose kumachepa, insulin secretion imachepa. Momwemonso, kumiza nthawi yomweyo kapena kulowetsedwa kwa shuga kumapangitsa kuwonjezeka kwa insulin.

Tengani mkati. Ndi monotherapy - 120-180 mg katatu kapena tsiku. Pochita kuphatikiza mankhwala - 60-120 mg katatu kapena tsiku.

Zotsatira zoyipa

Mwinanso: Zizindikiro zikuwonetsa kukula kwa hypoglycemia - kutuluka thukuta, kunjenjemera, chizungulire, kulimbitsa chilakolako, palpitations, nseru, kufooka, malaise (nthawi zambiri izi zimachitika modekha ndikumayimitsidwa mosavuta ndikumwa chakudya).

Pafupipafupi: ntchito yowonjezera ya hepatic michere m'magazi (nthawi zambiri imakhala yofatsa komanso yochepa), yotupa, kuyabwa, urticaria.

Type 2 matenda a shuga a mellitus (osadalira insulini) - osagwiritsa ntchito mankhwalawa pakudya komanso machitidwe olimbitsa thupi (mu mawonekedwe a monotherapy kapena kuphatikiza mankhwala ena a hypoglycemic).

Malangizo apadera

Chiwopsezo cha kukhala ndi hypoglycemia pamene mukumwa nateglinide (monga mankhwala ena a hypoglycemic) ndiwokwera kwambiri kwa okalamba omwe ali ndi kuchepa kwa thupi, pamaso pa adrenal kapena pituitary insuffence. Kutsika kwa glucose m'magazi kungayambike chifukwa chomwa mowa, kuchuluka kwa zochita zolimbitsa thupi, komanso kugwiritsa ntchito munthawi yomweyo mankhwala ena a hypoglycemic.

Kugwiritsa ntchito nthawi yomweyo kwa beta-blockers kungatchinjirize kuwonetsa kwa hypoglycemia.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Odwala omwe amagwira ntchito ndi makina ndi magalimoto oyendetsa ayenera kusamala kuti apewe hypoglycemia.

Zizindikiro zogwiritsidwa ntchito

Nateglinide imawonetsedwa ngati monotherapy yotsitsa kuchuluka kwa shuga m'magazi a odwala omwe ali ndi mtundu wa 2 shuga mellitus (osagwirizana ndi insulin-amadalira matenda osokoneza bongo) omwe samadya mokwanira ndikuchita masewera olimbitsa thupi kuti athe kuwongolera glycemia wawo komanso omwe sanalandire chithandizo kwa nthawi yayitali ndi othandizira ena a hypoglycemic.

Nateglinide imasonyezedwanso kuti ikhale yothandizira kuphatikiza ndi metformin mwa odwala omwe sangathe kuwongolera glycemia motsutsana ndi metformin (osavomerezeka m'malo mwa metformin ndi nateglinide).

Mankhwala

Pharmacokinetics

Mafuta Pambuyo pakulowetsa musanadye chakudya, nateglinide imalowerera msanga, Cmax mu plasma imatheka pafupifupi pakati pa ola limodzi. Pamene nateglinide idalembedwa kwa odwala omwe ali ndi matenda a shuga 2 mu Mlingo wa 60 mpaka 240 mg katatu pa tsiku kwa sabata limodzi, kudalira kwathunthu kwa AUC ndi ndi Cmax kuchokera ku mlingo. Tmax mwa odwalawa sanali odalira mlingo. Mtheradi bioavailability pafupifupi 73%. Mukamadya kapena mutatha kudya, mayamwidwe a nateglinide (AUC) sanasinthe, koma kuchepa kwa mayamwidwe kumawonedwa, kumadziwika ndi kuchepa kwa Cmax komanso kuwonjezereka kwa Tmax. Mukamatenga nateglinide pamimba yopanda kanthu, ma profasma a plasma omwe amakhala ndi mapiri angapo. Izi sizimawonedwa pakudya nateglinide musanadye.

Kugawa. Malinga ndi malipoti, ndi pa / pakukhazikitsa nateglinide, kuchuluka kwa magawidwe mu gawo lofanana mwa munthu wathanzi kuli pafupifupi malita 10. Nateglinide imamangiriza mpaka 98% ndi mapuloteni a seramu, makamaka okhala ndi albumin, mpaka ochepera - okhala ndi cy1-acid glycoprotein. Kuchulukitsa kwa mapuloteni a plasma sikudalira kuchuluka kwa zinthu zomwe zimakhala m'mipatalayi kuyambira 0,10 mpaka 10 μg / ml.

Kupenda. Pamaso chimbudzi, nateglinide imapangidwa ndi gawo la ogwiritsa ntchito ambiri oxidase dongosolo. Njira yayikulu ya metabolic ndi hydroxylation, kutsatira kumanga kwa glucuronide. Ma metabolites ofunikira amakhala ofooka kwambiri mu hypoglycemic zotsatira kuposa nateglinide. Metabolite yaying'ono - isoprene - imafanana ndi mphamvu pazigawo zoyambirira za nateglinide. Malinga ndi kafukufuku wa in vitro, nateglinide imapangidwa makamaka ndi kutengapo gawo kwa cytochrome P450: CYP2C9 isoenzyme (70%) ndi CYP3A4 (30%).

Kuswana. Nateglinide ndi metabolites yake imafulumira komanso kupukusa pambuyo pakamwa. Pakupita maola 6, pafupifupi 75% ya mlingo wa nateglinide wolembedwa ndi carbon 14C wapezeka mkodzo. 83% ya 14C-nateglinide imafukusidwa ndi impso, 10% - kudzera m'mimba. Pafupifupi 16% ya nateglinide yolembedwa ndi 14C yatsimikizika kuti sasintha mkodzo. M'maphunziro onse odzipereka aumoyo komanso odwala omwe ali ndi matenda a shuga 2, kuchuluka kwa nateglinide mu plasma kumachepa kwambiri, nthawi yayikulu ya T1 / 2 inali maola 1.5. Malinga ndi theka lalifupi lofanizira, palibe kuwerengeka kwachilendo kwa nateglinide komwe kumawonetsedwa ndi Mlingo wambiri mpaka 240 mg 3 pa tsiku kwa masiku 7.

Kuchita ndi mankhwala ena

Kafukufuku wa in vitro metabolism awonetsa kuti nateglinide imapangidwa makamaka pogwiritsa ntchito cytochrome P450: CYP2C9 isoenzymes (70%) ndipo, mpaka pang'ono, CYP3A4 (30%). Nateglinide ndi choletsa choletsa cha CYP2C9 isoenzyme mu vivo, monga akuwonetsera ndi kulepheretsa kwa vitro metabolism ya tolbutamide. Zotsatira za metabolic za CYP3A4 zoletsa sizinadziwike pazoyesa za vitro.

Gliburide. Mu kafukufuku wosasinthika, mankhwala ambiri osokoneza bongo, odwala matenda amtundu wa 2 adayikidwa nateglinide 120 mg katatu tsiku lililonse musanadye tsiku limodzi limodzi ndi 10 mg ya glyburide. Panalibe zosintha za chipatala za mankhwala a zinthu zonse ziwiri.

Metformin. Pofotokoza odwala 2 omwe ali ndi matenda a shuga 2 mg 3 mg tsiku katatu musanadye mothandizidwa ndi metformin 500 mg katatu patsiku, panalibe zosintha zachipatala zamankhwala onse awiriwa.

Digoxin. Pamene 120 mg ya nateglinide adalembedwa kuti azigwira bwino ntchito odzipereka katatu pa tsiku musanadye, osakaniza limodzi mlingo wa 1 mg wa digoxin, panalibe zosintha zachipatala zamankhwala onse awiriwa.

Warfarin. Pamene odzipereka athanzi adalembedwa 120 mg ya nateglinide katatu pa tsiku musanadye kwa masiku 4 osakanikirana ndi mlingo umodzi wa 30 mg wa warfarin patsiku lachiwiri, sizinasinthe mu pharmacokinetics ya zinthu zonsezi, PV nayonso sinasinthe.

Diclofenac. M'mawa ndi masana, 120 mg ya nateglinide osakanikirana ndi mlingo umodzi wa 75 mg wa diclofenac sizinachititse kuti pakhale kusintha kwakukulu mu pharmacokinetics ya zinthu zonsezi modzipereka.

Ambiri mwa nateglinide (98%) ali ndi mapuloteni a plasma, makamaka a albumin. Maphunziro a in vitro akusamutsidwa ndi zinthu zokhala ndi milingo yambiri yomangiriza, monga furosemide, propranolol, Captopril, nicardipine, pravastatin, glyburide, warfarin, phenytoin, acetylsalicylic acid, tolbutamide ndi metformin, sizinathandize pa kuchuluka kwa kumanga kwa nateglinide kwa plasma. Nateglinide sinakhudzenso mapuloteni a plasma omwe amamangidwa ndi propranolol, glyburide, nicardipine, phenytoin, acetylsalicylic acid ndi tolbutamide mu vitro. Komabe, m zikhalidwe za chipatala zazing'ono zimasiyana.

Mankhwala ena, kuphatikiza NSAIDs, salicylates, Mao inhibitors komanso osagwiritsa ntchito beta-blockers amatha kupititsa patsogolo hypoglycemic zotsatira za nateglinide ndi othandizira ena a hypoglycemic.

Mankhwala ena, kuphatikizapo thiazide diuretics, corticosteroids, analogi ya chithokomiro, sympathomimetics, amatha kuchepetsa kuchuluka kwa hypoglycemic ya nateglinide ndi othandizira ena pakamwa. Mankhwalawa akaperekedwa kapena kufooka kwa wodwala amene amalandila nateglinide, ndikofunikira kuyang'anira kuchuluka kwa glycemia.

Kuyanjana kwa chakudya. The pharmacokinetics of nateglinide sizimadalira kapangidwe kazakudya (mapuloteni, mafuta kapena kaboni). Komabe, Cmax imachepetsedwa kwambiri mukamamwa nateglinide Mphindi 10 musanatenge chakudya chamadzimadzi. Nateglinide ilibe vuto lililonse pamimba yopanda kanthu mwa anthu athanzi, monga akuwonetsera mayeso a acetaminophen.

Njira zopewera kugwiritsa ntchito

Hypoglycemia. Onse othandizira a hypoglycemic amatha kupangitsa hypoglycemia. Pafupipafupi hypoglycemia zimatengera kuopsa kwa matenda ashuga, kayendedwe ka glycemia ndi machitidwe ena a wodwala. Okalamba komanso a senile odwala, odwala omwe ali ndi vuto la kuchepa kwa zakudya, odwala omwe ali ndi adrenal kapena pituitary insufficiency ndi omwe amatha kupezeka ndi hypoglycemic zotsatira za mankhwalawa. Chiwopsezo cha hypoglycemia chitha kukulira komanso kuchita masewera olimbitsa thupi mwamphamvu, kumwa mowa, osakwanira zama calorie (munthawi yayitali kapena mwangozi), kapena mukaphatikizidwa ndi othandizira ena pakamwa. Zingakhale zovuta kudziwa hypoglycemia mwa odwala omwe ali ndi vuto la neuronomic (visceral) ndi / kapena mukamamwa beta-blockers. Kuchepetsa chiopsezo cha hypoglycemia, nateglinide ndi mankhwala musanadye, wodwala amene amadumphira chakudya amayeneranso kudumpha nateglinide yotsatira.

Zokhudza chiwindi. Nateglinide iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi matenda achiwindi kapena oopsa, popeza momwe amagwiritsidwira ntchito mwa odwala otere sanafufuzidwe.

Kuwonongeka kwa glycemic control. Kuchepetsa kwakanthawi kwamayendedwe a glycemic kumatha kuchitika ndi malungo, matenda, zoopsa, ndi opareshoni. Milandu iyi, m'malo mwa nateglinide, chithandizo cha insulin ndi chofunikira. Kuperewera kwachiwiri kapena kuchepa kwa mphamvu ya nateglinide kumatha kuchitika patapita nthawi.

Zoyeserera zasayansi. Kuyankha kwa mankhwalawa kuyenera kuwunikidwa nthawi ndi nthawi ndende ya glucose ndi HbA1c.

Kufotokozera za mankhwalawa

Nateglinide - Wothandizira pakamwa wa hypoglycemic, zotengera za phenylalanine. Mu mankhwala ndi mankhwala amasiyana ndi ena othandizira a hypoglycemic. Kubwezeretsanso katulutsidwe koyambirira ka insulin, komwe kumapangitsa kutsika kwa glucose wa m'magazi komanso kuchuluka kwa hemoglobin (HbA 1c).

Mndandanda wazofananira

Kutulutsa Fomu (mwa kutchuka)	Mtengo, pakani.
Nateglinide
Nateglinide * (Nateglinide *)
Starlix

Mlendo wina adanenapo za tsiku lotha ntchito

Zimatenga nthawi yayitali bwanji kuti munthu atenge Nateglinide kuti amve kusintha kwa mkhalidwe wa wodwalayo?
Ochita kafukufukuwo nthawi zambiri atatha tsiku limodzi adasintha. Koma izi sizingafanane ndi nthawi yomwe musinthe. Funsani dokotala wanu kuti mupeze mankhwalawa kwa nthawi yayitali bwanji. Gome ili pansipa likuwonetsa zotsatira za kafukufuku pa zoyambira kuchitapo kanthu.

Mamembala

Tsiku 1

Alendo atatu adafotokoza zaka za odwala

Mamembala	%
Zaka 46-60	1

33.3%

30-55 wazaka

33.3%

> Zaka 60

Zolemba zosangalatsa

Momwe mungasankhire analog yoyenera
Mu pharmacology, mankhwala nthawi zambiri amagawidwa m'magulumagulu ndi ma analogi. Kapangidwe kazofananira kameneka kamaphatikizira amodzi kapena angapo amomwe omwewo omwe ali ndi mphamvu yothandizira thupi. Ndi ma analogi amatanthauza mankhwala okhala ndi zinthu zosiyanasiyana zogwira ntchito, koma zochizira matenda omwewo.

Kusiyana pakati pa matenda a ma virus ndi bakiteriya
Matenda opatsirana amayambitsidwa ndi ma virus, mabakiteriya, bowa ndi protozoa. Njira ya matenda oyambitsidwa ndi ma virus ndi ma bacteria nthawi zambiri imakhala yofanana. Komabe, kusiyanitsa chomwe chimayambitsa matendawa kumatanthauza kusankha njira yoyenera yomwe ingathandize kuthana ndi vuto losachedwa kudwala ndipo sizivulaza mwana.

Chifuwa ndi chomwe chimayambitsa chimfine pafupipafupi
Anthu ena amadziwa vuto lomwe mwana nthawi zambiri amakhala nalo kwa chimfine. Makolo amamutengera kwa madotolo, kukamuyeza mayeso, kugwiritsa ntchito mankhwala osokoneza bongo, ndipo monga chotulukapo chake, mwana amalembetsa kale ndi dotolo wa ana monga nthawi zambiri amadwala. Zoyambitsa zenizeni za kupuma pafupipafupi sizidziwika.

Urology: mankhwalawa a chlamydial urethritis
Chlamydial urethritis nthawi zambiri imapezeka pochita urologist. Amayamba chifukwa cha majeremusi a Chlamidia trachomatis, omwe ali ndi mphamvu ya mabakiteriya komanso mavairasi, omwe nthawi zambiri amafunikira njira yothandizira antibacterial. Imatha kuyambitsa kutupa kosakhudzana ndi urethra mwa amuna ndi akazi.

Zizindikiro ndi contraindication ntchito, bongo

Nateglenide imagwiritsidwa ntchito ngati wodwala ali ndi mtundu wachiwiri wa insulin wodalira matenda osagwirizana ndi inshuwaransi popanda kusintha kosiyanasiyana mukamagwiritsa ntchito mankhwala othandizira pakudya komanso machitidwe olimbitsa thupi.

Mankhwalawa angagwiritsidwe ntchito pa matenda a monotherapy komanso ngati mankhwala osokoneza bongo.

Nthawi zambiri, mankhwalawa amagwiritsidwa ntchito limodzi ndi Metformin.

Mukamagwiritsa ntchito mankhwalawa, pali zotsutsana zingapo zomwe zimagwiritsidwa ntchito. Zomwe zili pakati pa contraindication ogwiritsa ntchito Nateglinide ndi awa:

kukhalapo kwa matenda amtundu wa 1 wodwala,
kukhalapo kwa wodwala matenda a shuga mellitus zizindikiro za chitukuko cha matenda ashuga ketoacidosis,
Kuzindikira kwamphamvu matenda a chiwindi,
nthawi ya bere ndi nthawi yoyamwitsa,
ubwana wa wodwala matenda ashuga,
kukhalapo kwa chidwi cha ziwonetsero zomwe zimaphatikizidwa ndi kapangidwe kake ka mankhwala.

Kutengera kapangidwe kazomwe mankhwala amapangira thupi, zitha kuganiziridwa kuti chotsatira chachikulu cha kuphwanya kwa mankhwala othandizira pochizira matenda a shuga ndiko kukula kwa hypoglycemia mwa wodwalayo, komwe kumatha kuwonekera pang'onopang'ono kusiyanasiyana kutengera kukula kwa mankhwala osokoneza bongo panthawi yamankhwala.

Kusankhidwa kwa njira yochizira matenda osokoneza bongo kumadalira kuchuluka kwa mawonekedwe.

Pomwe mukukhalabe wodwalayo ndikusazindikira mawonekedwe a mitsempha, ndikofunikira kuti mutenge glucose kapena shuga mkati ndikusintha kudya.

Ndi kukula kwambiri mawonekedwe a hypoglycemic boma, momwe muli chitukuko cha chikomokere, tikulimbikitsidwa kuchita intravenous shuga njira.

Njira ya hemodialysis ndi njira yabwino, popeza Nateglitin amakhala ndi zomanga kwambiri m'mapuloteni a plasma.

Malangizo ogwiritsira ntchito mankhwalawa

Kumwa mankhwala osokoneza bongo ali mkati.

Pankhani ya monotherapy, muyeso wa 120-180 mg katatu patsiku ndi mankhwala.

Ngati Nateglinide imagwiritsidwa ntchito ngati imodzi mwazinthu zovuta kwambiri zochizira, mulingo woyenera panthawi ya mankhwalawa umachokera pa 60 mpaka 120 mg katatu patsiku.

Pogwiritsa ntchito mankhwalawa, wodwalayo amatha kukulitsa zovuta zina mthupi.

Zotsatira zoyipa mukamamwa mankhwalawa zimawonetsedwa poyenda zotsatirazi ndi ziwalo za thupi la wodwala:

Kuphwanya kwamanjenje ndi ziwalo zamagetsi.
Zosokoneza pakugwira ntchito kwa kupuma kwamphamvu.
Kulephera m'matumbo am'mimba.
Kusokonezeka kwa kagayidwe kachakudya.

Kuphatikiza apo, mavuto amabwera omwe amakhudza zomwe zimachitika mthupi.

Ngati pali kusokonezeka kwa kayendedwe ka mitsempha, wodwalayo amakhala ndi chizungulire.

Zovuta mu kupuma zimawonekera mwa kuwonekera kwa kupuma kwa wodwala, kukula kwa zizindikiro za bronchitis, ndi mawonekedwe a chifuwa.

Pakachitika zovuta zomwe zimakhudza kugwira ntchito kwa m'mimba, wodwalayo amawoneka ngati akutsegula m'mimba komanso akumva mseru.

Zotsatira zoyipa za kusokonezeka kwa kagayidwe kachakudya ndi kakulidwe ka matenda a hypoglycemic m'thupi la wodwalayo, komanso m'mavuto akulu kwambiri a glycemic coma.

Kukula kwa dziko la hypoglycemic pogwiritsa ntchito Nateglinide pa mankhwala ndizosowa kwambiri.

Khansa ya m'mimba ndi kutsegula m'mimba monga zotsatira zoyipa za mankhwalawa zimawonekeranso kawirikawiri, nthawi zambiri zotsatirazi zimadza mwa munthu pogwiritsa ntchito zovuta za mtundu 2 za matenda a shuga ngati Metformin ndi imodzi mwazinthu zothandizira.

Nthawi zina, mukamatenga Netelinid wodwala yemwe ali ndi matenda osokoneza bongo, mawonekedwe a ululu wammbuyo amadziwika kuti ndiwotsatira.

Kuphatikiza apo, mikhalidwe yonga chimfine imatha kukula m'thupi la wodwalayo.

Mndandanda wa mankhwalawa, kusunga ndi mtengo wa mankhwalawo

Mankhwalawa amayenera kusungidwa m'malo amdima. Kutentha kosungiramo mankhwalawa kuyenera kukhala kosiyanasiyana mpaka 15 mpaka 30 digiri Celsius.

Alumali moyo wa mankhwala ndi zaka ziwiri. Ikatha nthawi yosungirako, mankhwalawo amaletsedwa kugwiritsa ntchito mankhwalawa. Katundu womalizira ayenera kubwezerezedwanso.

Malo osungira mankhwalawa sayenera kupezeka kwa ana.
Mpaka pano, makampani opanga zamankhwala amatulutsa mitundu yambiri ya mankhwala omwe ali ndi vuto lofanana ndi thupi la wodwala wokhala ndi matenda a shuga a 2.

Mankhwala omwe ali ndi vuto lofanana ndi awa: