Gluconorm: malangizo ogwiritsira ntchito: mtengo ndi kuwunika kwa odwala matenda ashuga okhudza mapiritsi a shuga

The endocrinologist adapanga matenda - prediabetesic boma. Kulemera kumakula mosalekeza, kusokonezeka kwa metabolic, chabwino, kuyenda kwa shuga (hypoglycemic syndrome). Mwachidule, zosangalatsa. Mukaphwanya chakudya, shuga amadzuka, chabwino, Zizindikiro zodziwika bwino zimawonekera. Poyamba, kuti muchepetse kulakalaka kwanga, adandiuza kuti ndizipeza pakudya 1 kamodzi patsiku pa piritsi limodzi, koma mwanjira ina palibe zotsatira, chabwino, ayi. Ndinapita kwa dotolo wina, wotchulidwa Siofor 850, kuti ndikhale ndekha. Zomwe zimachitika patsiku loyamba kulandila zidakhala zosavuta, madzulo ndimafuna kudya zochepa. Pambuyo pa milungu iwiri ya chithandizo, kulemera kunachepa ndi 1.5 kg. Inde, ndipo ndikumva bwino.

Patha chaka chimodzi kuchokera pamene ndidapezeka ndi matenda a shuga a 2, pambuyo pake dokotala adandiuza kuti ndizidya zakudya zopatsa thanzi komanso gluconorm. Tidatenga kumwa kwa pafupifupi mwezi umodzi, koma tsopano glucose samakwera pamwamba 6-7. Ndi chisoni kuti zakudya ziyenera kutsatiridwa. Ngakhale thanzi ndizodula, inde.

Kufotokozera kwapfupi

200 miliyoni ... Ndikofunika kukumbukira chiwerengerochi, chifukwa awa ndiomwe akuyerekeza kuchuluka kwa anthu omwe akudwala matenda ashuga lero. Ndipo malingana ndi zoneneratu za asayansi (osati zowonjezera kwambiri), pofika chaka cha 2030 tiyenera kuyembekezera kuwonjezeka kwa chiwerengerochi nthawi zosachepera ndi theka. Pa muzu wa chitukuko cha matenda ashuga pali zinthu zazikulu ziwiri: insulin kukana ndi kuperewera kwa kapamba popanga amkati insulin. Kuti muchepetse chiopsezo chamavuto am'mitsempha (khungu, kugunda kwamtima ndi kukwapula, kudula mwendo), muyenera kuyang'ana dzanja lanu pafupipafupi (kapena, pamtunda) kuti muwonetsetse kuchuluka kwa misempha yamagazi. Pankhani imeneyi, kukulitsa kwa mankhwala ndi njira yofunika kwambiri pochizira matenda ashuga. Monga lamulo, chithandizo cha antidiabetesic chimayamba ndi monotherapy, chomwe chimagwiritsa ntchito metformin kapena sulfonylureas (glibenclamide glyclazide, glimepiride). Mtsogolomo, kuwonongeka koonekeratu pamitundu yachilengedwe, kuphatikiza kwa mankhwalawa kumayambitsa kapena jakisoni wa insulin wolumikizidwa. Komanso: Popeza matenda ashuga amawerengedwa ngati matenda opita patsogolo, ngakhale ndi chipambano choyambirira cha monotherapy, posakhalitsa, zowonjezera zamankhwala ndi gawo limodzi kapena awiri am'malo a buku la Mashkovsky adzafunika.

Kuphatikiza kofala kwambiri kwa matenda amtundu wa chifuwa ndi metformin + glibenclamide. Mafuta a gluconorm samangokhala chinthu china kuposa iyi ya hypoglycemic yolimba yamagawo awiri. Metformin biguanide imatsitsa glucose wamagazi pochepetsa mphamvu ya insulini mu zotumphukira za minofu ndikuthandizira kukoka kwa glucose ndi minofu. Izi zimalepheretsa kuyamwa kwa chakudya cham'mimba komanso zimasokoneza kapangidwe ka shuga ndi chiwindi. Metformin imathandizanso chithunzi cha magazi a lipid, ndikuchepetsa cholesterol "yoyipa". Glibenclamide, ndiye mnofu wa mnofu wa sulfonylurea. Zimapangitsa kuti amasulidwe a insulin pakukulitsa chidwi cha pancreatic β-cell ku glucose komanso kuchuluka kwa insulin komwe kumakhala ndi chandamale chandamale.

Gluconorm nthawi zambiri imagwiritsidwa ntchito ngati chakudya pamtengo womwe amavomerezana ndi adokotala (akhoza kukhala aliyense payekha). Mwachikhalidwe, "amayamba" piritsi limodzi ndikusintha mlingo uliwonse pakadutsa masabata awiri amodzi ndi gawo la glucose m'magazi, pomwe osapitirira muyeso wololeza wapiritsi tsiku lililonse.

Pharmacology

Gluconorm ® ndi kuphatikiza kosakanikirana kwamakamwa awiri a hypoglycemic omwe amagwira m'magulu osiyanasiyana a pharmacological: metformin ndi glibenclamide.

Metformin ili m'gulu la gluuanides ndipo amachepetsa shuga wa seramu mwakuwonjezera mphamvu ya zotumphukira mu zochita za insulin ndikuwonjezera kukweza kwa glucose. Amachepetsa kuyamwa kwa chakudya m'mimba ndipo amalepheretsa gluconeogeneis m'chiwindi. Mankhwalawa alinso ndi phindu pa mbiri ya lipid ya magazi, kutsitsa cholesterol yathunthu. LDL ndi triglycerides. Sichimayambitsa kukhudzana kwa hypoglycemic.

Glibenclamide ndi m'gulu la anthu am'badwo wotsatira wa sulfonylurea. Zimapangitsa secretion ya insulini pochepetsa kutsika kwa shuga wa glucose, kumakulitsa chidwi cha insulin komanso kumangika kwa ma cell omwe mukufuna, kumawonjezera kutulutsidwa kwa insulini, ndikuwonjezera mphamvu ya insulini pakukoka minofu ndi chiwindi cha glucose, ndikuletsa lipolysis mu minofu ya adipose. Machitidwe mu gawo lachiwiri la insulin katulutsidwe.

Pharmacokinetics

Mukaperekedwa, kuyamwa kuchokera m'matumbo am'mimba ndi 48-84%. Nthawi yoti mufikire C_max - Maora 1-2 V_d - 9-10 malita. Kuyankhulana ndi mapuloteni a plasma ndi 95%.

Imakhala ngati imaphatikizidwa kwathunthu m'chiwindi ndikupanga ma metabolites awiri osagwira ntchito, amodzi omwe amatsitsidwa ndi impso, ndipo ena ndi matumbo. T_1/2 - kuyambira 3 mpaka 10-16 maola

Pambuyo pakukonzekera pakamwa, imatengedwa kuchokera m'matumbo am'mimba mokwanira, 20-30% ya mankhwalawa imapezeka mu ndowe. Mtheradi bioavailability kuchokera 50 mpaka 60%. Ndi kuyamwa kwa munthawi yomweyo, kuyamwa kwa metformin kumachepetsedwa ndikuchedwa. Imagawidwa mwachangu mu minofu, sikuti imagwirizana ndi mapuloteni a plasma.

Amapangidwira pamlingo wofooka kwambiri ndikuwonetsa impso. T_1/2 pafupifupi maola 9-12

Kutulutsa Fomu

Mapiritsi okhala ndi utoto wamafuta oyera kapena pafupifupi oyera, ozungulira, a biconvex, pa nthawi yopuma yoyera mpaka yoyera yomwe imayera utoto.

Omwe amathandizira: cellcrystalline cellulose - 100 mg, cell wowuma - 20 mg, colloidal silicon dioxide - 20 mg, gelatin - 10 mg, glycerol - 10 mg, magnesium stearate - 7 mg, talc - 15 mg, croscarmellose sodium - 30 mg, sodium carboxymethyl wowuma - 18.3 mg, cellacephate - 2 mg, diethyl phthalate - 0,2 mg.

Ma PC 10 - matuza (4) - mapaketi a makatoni.
20 ma PC. - matuza (2) - mapaketi a makatoni.

Mankhwalawa amagwiritsidwa ntchito pakamwa, komanso zakudya. Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala aliyense payekha kwa wodwala aliyense, kutengera kuchuluka kwa shuga.

Nthawi zambiri mlingo woyambirira ndi 1 tabu. (400 mg / 2.5 mg) / tsiku. Pakadutsa milungu iwiri ndi inayi atayamba kumwa mankhwalawa, mankhwalawa amathandizidwa malinga ndi kuchuluka kwa shuga m'magazi. Mukamachotsa mankhwala ophatikizira am'mbuyomu ndi metformin ndi glybeklamide, mapiritsi 1-2 amapatsidwa. Gluconorm kutengera mtundu wapitawo wa chilichonse.

Pazipita tsiku lililonse mapiritsi 5.

Bongo

Mankhwala osokoneza bongo kapena kupezeka kwa zinthu zomwe zingachitike pachiwopsezo kungayambitse kukula kwa lactic acidosis, monga Metforminum ndi gawo lokonzekera. Zizindikiro za lactic acidosis zikawoneka (kusanza, kupweteka pamimba, kufooka, minofu kukokana), muyenera kusiya kumwa mankhwalawo. Lactic acidosis ndi vuto lofunika kuchipatala msanga, mankhwalawa a lactic acidosis ayenera kuchitika kuchipatala. Chithandizo chothandiza kwambiri ndi hemodialysis.

Mankhwala osokoneza bongo amathanso kukulitsa kukula kwa hypoglycemia chifukwa cha glibenclamide pokonzekera. Zizindikiro za hypoglycemia: Njala, thukuta kwambiri, kufooka, pakhungu, kutsekeka kwa pakamwa, kugwedezeka, nkhawa, kupweteka mutu, kugona, kusokonezeka kwa tulo, malingaliro a mantha, kusokonezeka kwa kayendedwe, kusokonezeka kwa minyewa kwakanthawi. Ndi kupita patsogolo kwa hypoglycemia, odwala amatha kulephera kudziletsa komanso kuzindikira.

Ndi hypoglycemia yofatsa kapena yolimbitsa thupi, shuga kapena njira ya shuga imatengedwa pakamwa. Pakachitika vuto lalikulu la hypoglycemia (kusowa kwa chikumbumtima), yankho la 40% dextrose (glucose) kapena glucagon wamkati, v / m, s / c amaperekedwa iv. Pambuyo pozindikira, wodwalayo ayenera kupatsidwa chakudya chamagulu owonjezera chakudya kuti asayambenso kukhudzana ndi hypoglycemia.

Kuchita

ACE inhibitors (Captopril, enalapril), histamine H blockers amalimbikitsa mphamvu ya hypoglycemic₂receptors (cimetidine), antifungal agents (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), fibrate (clofibrate, bezafibrat), anti-tuberculosis mankhwala (ethionamide), salicytates, anticoagulant antagonists Mao, sulfonamides wa nthawi yayitali, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubular secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, ena hypoglycemic mankhwala (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), antiepileptic mankhwala (phenytoin), wosakwiya calcium njira blockers, carbonic anhydrase inhibitors (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, mahomoni okhala ndi chithokomiro, mchere wa lithiamu, muyezo waukulu - nicotinic acid, chlorpromazine, kulera kwapakamwa komanso estrojeni.

Mankhwala a urine acidifying (ammonium chloride, calcium chloride, ascorbic acid mumadontho akuluakulu) amalimbikitsa zotsatira zake pochepetsa kusiyana kwake ndikuwonjezera kubwezeretsanso kwa glibenclamide.

Ethanol imawonjezera mwayi wa lactic acidosis.

Metformin Imachepetsa C_max ndi T_1/2 furosemide ndi 31% ndi 42.3%, motero.

Furosemide imachulukitsa C_max metformin ndi 22%.

Nifedipine imachulukitsa mayamwidwe, C_max Imachepetsa kuchotsedwa kwa metformin.

Mankhwala a Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren ndi vancomycin) omwe amatulutsidwa mu tubules kupikisanirana kachitidwe ka mayendedwe a tubular ndipo amatha kuonjezera C ndi chithandizo cha nthawi yayitali_max 60% metformin.

Zotsatira zoyipa

Pa gawo la kagayidwe kazakudya: hypoglycemia ndiyotheka.

Kuchokera m'mimba thirakiti ndi chiwindi: kawirikawiri - nseru, kusanza, kupweteka m'mimba, kusowa chilakolako cha chakudya, "kukomoka kwachitsulo" mkamwa, nthawi zina - cholestatic jaundice, kuchuluka kwa michere ya chiwindi, hepatitis.

Kuchokera ku hemopoietic dongosolo: kawirikawiri - leukopenia, thrombocytopenia, erythrocytopenia, kawirikawiri - agranulocytosis, hemolytic kapena megaloblastic anemia, pancytopenia.

Kuchokera kumbali ya dongosolo lamkati lamanjenje: mutu, chizungulire, kufooka, kutopa, kawirikawiri - paresis, zovuta zam'maganizo.

Thupi lawo siligwirizana ndi immunopathological: kawirikawiri - urticaria, erythema, kuyabwa khungu, kutentha thupi, arthralgia, proteinuria.

Dermatological zimachitika: kawirikawiri - photosensitivity.

Kuchokera kumbali ya kagayidwe: lactic acidosis.

Zina: pachimake kukomoka mowa pambuyo kumwa, zikuwonetsa zovuta za kuzungulira thupi ndi kupuma ziwalo (disulfiram-like: kusanza, kumva kutentha mu nkhope ndi thupi lakumaso, tachycardia, chizungulire, kupweteka kwa mutu).

Type 2 shuga mwa akulu:

• ndi kusachita bwino kwa mankhwala othandizira kudya, kuchita masewera olimbitsa thupi komanso chithandizo cham'mbuyomu ndi metformin kapena glibenclamide,
• kusintha mankhwala am'mbuyomu ndi mitundu iwiri ya mankhwala (metformin ndi glibenclamide) mwa odwala omwe ali ndi shuga komanso magazi mokhazikika.

Contraindication

• mtundu 1 shuga
• matenda ashuga ketoacidosis, matenda a shuga, matenda ashuga,
• achina,
• kuvulala kwambiri aimpso,
• Zovuta zomwe zingayambitse kusintha kwa impso (kuchepa madzi m'thupi, matenda akulu, mantha),
• matenda owopsa kapena osakhazikika omwe amatsatana ndi minofu hypoxia (mtima kapena kupuma, kulephera kwaposachedwa kwamkati, kugwedezeka),
• kulephera kwa chiwindi
• porphyria
• kugwiritsa ntchito miconazole,
• matenda opatsirana, njira zazikulu zopangira opaleshoni, kuvulala, kuwotcha kambiri ndi zina zofunika pa insulin.
• uchidakwa wambiri, kuledzera
• lactic acidosis (kuphatikizapo mbiri),
• gwiritsani ntchito kwa maola osachepera 48 isanachitike komanso mkati mwa maola 48 mutapanga maphunziro a radioisotope kapena x-ray ndikukhazikitsa ma iodine okhala ndi zosiyana pakati,
• kutsatira zakudya zochepa zama calori (zosakwana 1000 calories / tsiku),
• mimba
• nthawi yoyamwitsa,
• Hypersensitivity kuti metformin, glibenclamide kapena zina zotumphukira za sulfonylurea, komanso zinthu zothandiza.

Sitikulimbikitsidwa kugwiritsa ntchito mankhwalawa mwa anthu opitirira zaka 60 omwe amagwira ntchito zolimbitsa thupi, zomwe zimagwirizanitsidwa ndi chiwopsezo chokhala ndi lactic acidosis mwa iwo.

Mochenjera: febrile syndrome, adrenal insufficiency, hypofunction ya anterior pituitary, matenda a chithokomiro omwe ali ndi vuto la chithokomiro.

Mimba komanso kuyamwa

Pa nthawi ya pakati, kugwiritsa ntchito gluconorm kumapangidwa. Mukakonzekera kutenga pakati, komanso ngati muli ndi pakati pa nthawi yomwe mukumwa Gluconorm, mankhwalawa ayenera kusiyidwa ndipo mankhwala a insulin ayenera kuyikidwa.

Gluconorm ® imalekanitsidwa poyamwitsa, momwe metformin imadutsira mkaka wa m'mawere. Pankhaniyi, muyenera kusinthana ndi insulin kapena kusiya kuyamwitsa.

Malangizo apadera

Kuchitapo kwakukulu kwa maopareshoni ndi kuvulala, kuwotcha kwakukulu, matenda opatsirana omwe ali ndi febrile syndrome kungafune kuleka kwa mankhwalawo ndi kuikidwa kwa mankhwala a insulin.

Ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya.

Odwala ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia milandu ya ethanol, NSAIDs, ndi njala.

Kusintha kwa mlingo ndikofunikira pakulimbitsa thupi ndi malingaliro, kusintha kwa zakudya.

Pa mankhwala, osavomerezeka kumwa mowa.

Maola 48 asanafike opaleshoni kapena iv. Yoyamwa yokhala ndi ayodini wokhala ndi radiopaque, makonzedwe a gluconorm ayenera kusiyidwa. Chithandizo cha gluconorm chikulimbikitsidwa kuti chibwezeretsedwe pambuyo pa maola 48.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafuna kuti anthu azisamalira komanso azithamanga kwambiri.