Mankhwala> Lisinopril - ratiopharm (mapiritsi)

Lisinopril ratiophar ndi mankhwala ochepetsa matenda oopsa komanso kuchitira mtima ndi impso. Ngati chithandizo chanthawi yochepa, mankhwalawa amatha kugwiritsidwa ntchito pachimake cha myocardial infarction (osapitirira masabata asanu ndi limodzi, kutengera kukhazikika kwa hemodynamic kwa wodwala). Kuchepa kwa kuthamanga kwa magazi kumachitika pakatha ola limodzi ndi theka mutatha kumwa mankhwalawo ndikufika pazomwe zimachitika pambuyo pa maola asanu ndi limodzi mpaka asanu ndi anayi.

Mankhwalawa matenda oopsa, Mlingo woyambirira wa lisinopril ratiopharm ndi 10 mg. Mankhwalawa amamwetsa tsiku lililonse, kamodzi komanso nthawi yomweyo osanenapo chakudya. Kupitilira apo, mlingo umasinthidwa kamodzi pakatha milungu iwiri kapena inayi ndi mlingo wa 5-10 mg.

Mankhwalawa pachimake myocardial infarction, mankhwalawa mankhwala woyamba 24-2 maola pambuyo kuzindikira matenda, malinga ndi systolic magazi chiwonetsero chotsitsa si 100 mm Hg. Mlingo woyambirira ndi 5 mg ndi kuchuluka kwa 10 mg patsiku lachitatu la makonzedwe.

Pakulephera kwa impso, Mlingo wa mankhwalawa umasankhidwa malinga ndi zizindikiro za creatinine chilolezo.

Milandu yolakwika yogwiritsa ntchito mankhwalawa ndi ubwana, mimba, angioedema ndi edema ya Quincke. Kukhazikitsidwa panthawi yanthawi yovomerezeka sikulimbikitsa. Mukumwa mankhwala okodzetsa, kumwa mankhwalawa kumatha kutsagana ndi kuchepa kwambiri kwa magazi, komanso kuphatikiza ndi mankhwala opatsirana pogwiritsira ntchito mankhwala osokoneza bongo kungayambitse kuchepa kwamphamvu kwa glucose komanso kukulira kwa hypoglycemic.

Mndandanda wazotsatira zoyipa mukamatenga Lisinopril ndizowonjezera. Pa gawo la hematopoietic dongosolo, pakhoza kukhala kuwonongeka mu hemoglobin ndi hematocrit, mbali yamanjenje - mutu, chizungulire, kusokonezeka kwa kugona, asthenia, kutopa kokwanira, mbali yamtima dongosolo - hypotension ndi zina orthostatic. Ngati mwazindikira zotsatira zoyipa, kuyang'anira kuthamanga kwa magazi kumafunika, komanso kuwunika kwa levelinine ndi plasma electrolyte.

Pharmacological zimatha mankhwala Lisinopril-ratiopharm

Lisinopril (N-N- (15) -1-carboxy-3-phenylpropyl-L-lysyl-L-proline) ndi choletsa ACE. Imalepheretsa mapangidwe a angiotensin II, omwe ali ndi vasoconstrictor. Kuchepetsa ochepa systolic ndi diastolic magazi, aimpso kukana ndipo bwino magazi mu impso. Odwala ambiri, antihypertensive zotsatira zimawonekera kwa maola 1-2 pambuyo pakumwa pakamwa, mankhwalawa - pafupifupi maola 8-9. Kukhazikika kwa achire zotsatira kumachitika pambuyo pa masabata 3-4. Kuchotsa matenda sikukula.
The mayamwidwe mankhwala pambuyo m`kamwa makonzedwe pafupifupi 25-50%. Kudya nthawi imodzi sikukhudza kuyamwa. Kuchuluka kwambiri kwa plasma ya magazi kumachitika pambuyo pa maola pafupifupi 6.7. Lisinopril amangiriza pang'ono mapuloteni a plasma. Sipakapukusika, mumatulutsa mkodzo osasinthika. Kutha kwa theka-moyo ndi maora 12. Ngati vuto laimpso likulephera, kuphipha kwa lisinopril kumachepetsedwa molingana ndi kuchuluka kwa magwiridwe antchito. Odwala okalamba (zaka zopitilira 65), komanso kulephera kwa mtima, chilolezo cha impso cha lisinopril chimachepetsedwa.
Mankhwala amachotsedwa pa hemodialysis.

Kugwiritsa ntchito mankhwala lisinopril-ratiopharm

AH (ochepa matenda oopsa)
Monga lamulo, mlingo woyambirira wa mankhwalawa matenda oopsa (matenda oopsa) ndi 5 mg / tsiku limodzi mlingo (m'mawa). Ngati nthawi yomweyo kuthamanga kwa magazi sikufalikira, mankhwalawa amawonjezeka mpaka 10-20 mg (kutengera mayankho azachipatala a wodwalayo) kamodzi patsiku m'mawa. Mlingo wovomerezeka nthawi zambiri umakhala wa 10-20 mg, ndipo pazomwe umakhala 40 mg / tsiku.
Kulephera kwamtima kosalekeza
Mlingo woyamba ndi 2,5 mg (1/2 t ya piritsi ya 5 mg). Mlingo pang'onopang'ono umachulukitsidwa kutengera munthu. Cholinga chomwe achire ndi achire ndi 20 mg / tsiku limodzi.
Gwiritsani ntchito mosamala odwala omwe atenga / okodzetsa. Ngati ndizosatheka kuyimitsa kugwiritsa ntchito ma diuretics pasadakhale, tikulimbikitsidwa kuti lisinopril imatengedwa ndi Mlingo wochepa kwambiri motsogozedwa ndi kuthamanga kwa magazi ndi ntchito yaimpso.
Pachimake myocardial infarction ndi ST gawo kukweza
Kuchiza kuyenera kuyambitsidwa kwa maola 24 oyambirira kuchokera pachiwonetsero cha kulowetsedwa kwa myocardial (osagwirizana ndi ochepa hypotension). Mlingo woyambirira ndi 5 mg / tsiku, mlingo womwe mukufuna ndi 10 mg / tsiku limodzi. Odwala omwe ali ndi systolic anzawo osaposa 120 mm RT. Art. Asanayambe komanso atagwiritsa ntchito mankhwalawa, masiku oyamba atatu pambuyo panjira yolowerera, mankhwala amayamba pa 2,5 mg. Ndi mulingo wa magazi a systolic pansi pa 100 mm RT. Art. mlingo achire sayenera upambana 5 mg patsiku (angathe kuchepetsedwa mpaka 2.5 mg).
Ngati mutatha kutenga lisinopril pa 2,5 mg, mulingo wa magazi a systolic uli pansipa 90 mm Hg. Art., Mankhwalawa ayenera kuthetsedwa. Kutalika kovomerezeka kwa ntchito yam'mnyewa wamtima ndi masabata 6.
Nephropathy (gawo loyambirira) mwa odwala omwe ali ndi mtundu II matenda a shuga
Mlingo woyambirira ndi 10 mg 1 nthawi patsiku, mlingo waukulu ndi 20 mg 1 nthawi patsiku.
Pankhani ya matenda a shuga omwe amadalira insulin (chifukwa chokhala ndi vuto la hyperkalemia), chithandizo cha lisinipril ziyenera kuyamba ndi milingo yotsika molingana ndi tebulo ndikuchitika moyang'aniridwa ndi dokotala.
Kulephera kwa renal ndi chilolezo cha creatinine 30-80 ml / min: Mlingo woyamba ndi 2,5 mg kamodzi tsiku lililonse m'mawa. The achire mlingo (5-10 mg wa patsiku) zimatengera yankho la wodwalayo. Osapitilira muyeso ya 20 mg ya tsiku lililonse.
Kulephera kwa renal ndi chilolezo cha creatinine zosakwana 30 ml / min: Mlingo woyambira wothandiza ndi 2.5 mg. Mlingo wa tsiku ndi tsiku umatsimikiziridwa payekhapayekha, kutengera momwe mukumvera, ndikofunikira kuti pakukweza magawo apakati pa Mlingo wa mankhwala (nthawi 1 m'masiku awiri).

Contraindication kugwiritsa ntchito mankhwala Lisinopril-ratiopharm

Hypersensitivity to lisinopril kapena zigawo zina za mankhwalawo, angioedema, kuphatikizapo kuphatikizidwa ndi kugwiritsa ntchito zoletsa za ACE m'mbiri, idiopathic ndi cholowa cha Quincke edema, cardiogenic shock, infaration yokhala ndi myocardial yokhazikika pamaso pa arterial hypotension (kuthamanga kwa magazi m'munsi mwa 90 mm Hg). , nthawi yoyembekezera komanso kuyamwa, zaka mpaka zaka 12.

Zotsatira zoyipa za mankhwala lisinopril-ratiopharm

mtima: ochepa hypotension (makamaka pambuyo kugwiritsa ntchito koyamba mlingo wa mankhwala odwala ndi sodium kuchepa, kuchepa kwa madzi m'thupi, mtima kulephera), orthostatic zimachitika, limodzi ndi chizungulire, kufooka, kusawona bwino, kusazindikira. Pali malipoti osiyana a chitukuko cha tachycardia, mtima arrhythmias, kupweteka kwa sternum, ndi stroke.
Magulu a hememopoic ndi ma lymphatic: kawirikawiri - thrombocytopenia, leukopenia, neutropenia, agranulocytosis, hemolytic anemia, lymphadenopathy, matenda a autoimmune.
Dongosolo la genitourinary: aimpso kuwonongeka ntchito, nthawi zina - pachimake aimpso kulephera. Odwala a impso artery stenosis komanso odwala omwe ali ndi vuto lokodzetsa, kuwonjezereka kwa seramu ya creatinine ndi urea nayitrogeni mu seramu yamagazi kumatha kuchitika, pali malipoti apadera a uremia, oliguria, anuria, osowa kwambiri - kusabala, gynecomastia.
Machitidwe opatsirana: chifuwa chowuma ndi bronchitis, nthawi zina sinusitis, rhinitis, bronchospasm, glossitis ndi pakamwa lowuma, pali malipoti osiyana a chibayo cha eosinophilic.
GIT: nseru, kusanza, kupweteka kwa epigastric ndi dyspepsia, anorexia, dysgeusia, kudzimbidwa, kutsegula m'mimba. Nthawi zina - cholestasis, kuchuluka kwa hepatic transaminases ndi bilirubin wambiri chifukwa chiwindi ntchito kuwonongeka ndi necrosis a hepatocytes. Pali malipoti a kapamba, hepatitis (hepatocellular kapena cholestatic).
Khungu, matupi awo sagwirizana ndi immunopathological: kumverera kutentha, kuzizira kwa khungu, kuyabwa, nthawi zina - angioedema milomo, nkhope ndi / kapena miyendo, thukuta kwambiri, vuto la poermal necrolysis, matenda a Stevens-Jones, polymorphic alopecia. Khungu limakhudzana ndi khungu, myalgia, arthralgia / nyamakazi, vasculitis, chinthu chabwino cha antinuclear, kuchuluka kwa ESR, eosinophilia, leukocytosis, Photophobia.
CNS: mutu, kutopa, chizungulire, kukhumudwa, kusokonezeka kwa tulo, paresthesia, kusalingalira bwino, kusokoneza, kusokoneza, tinnitus ndikuchepetsa maonedwe acuity, asthenia.
Zizindikiro zasayansi: kuchuluka kwa seramu creatinine ndi urea nayitrogeni, hyperkalemia, nthawi zina kuwonjezeka kwa bilirubin ndende, hyponatremia.

Malangizo apadera ogwiritsira ntchito mankhwala a Lisinopril-ratiopharm

Mu pachimake myocardial infarction ndi gawo kukweza ST lisinopril imatha kuperekedwa kwa odwala onse posakhala ndi contraindication, makamaka kwa odwala omwe ali ndi vuto la mtima m'magawo oyamba a matenda, ndi gawo lochepetsedwa la epistion yotsala, ndi matenda oopsa (matenda oopsa), komanso matenda ashuga.
Odwala ndi hypovolemia, kuchepa kwa sodium chifukwa chogwiritsa ntchito okodzetsa, chakudya chopanda mchere, chifukwa cha kusanza, kutsegula m'mimba, atatha kufooka kwa thupi, kukulira kwa hypotension yoopsa kwambiri, kulephera kwaimpso. Zikatero, ndikofunika kulipiritsa kutayika kwa madzimadzi ndi mchere musanalandire chithandizo ndi lisinopril ndikuwunika kuyang'aniridwa kokwanira kuchipatala.
Mosamala (poganizira phindu / chiopsezo), mankhwalawa amalembedwa kwa odwala omwe ali ndi vuto limodzi laimpso, kapena aimpso aimpso, komanso odwala omwe ali ndi vuto laimpso, chiwindi, hematopoiesis, matenda a autoimmune, aortic, mitral stenosis, hypertrophic cardiomyopathy. Zonsezi zochitika zamatenda zimafunikira kuyang'aniridwa kwachipatala pafupipafupi ndikuwunika magawo a labotale.
Pali malipoti amilandu ya cholestatic jaundice yomwe ikukwanira mpaka necrosis. Wodwala akayamba jaundice kapena kuchuluka kwakukulu kwa michere ya chiwindi, kugwiritsa ntchito mankhwalawa kuyenera kutha.
Mu chachikulu aldosteronism, munthawi ya chithandizo cha matupi awo sagwirizana, kugwiritsa ntchito ACE zoletsa sikulimbikitsidwa.
Mu odwala okalamba, chidwi cha lisinopril chitha kuonedwa ndikugwiritsa ntchito Mlingo wa mankhwala.
Mosamala, lisinopril imalembedwa kwa odwala omwe ali ndi kuchuluka kwa creatinine m'magazi (mpaka 150-180 micromol / l).
Popeza lisinopril-ratiopharm siinapangidwe biotransform mu chiwindi, ikhoza kukhala mankhwala osankhidwa pakati pazinthu zina za ACE zoletsa kwa odwala omwe ali ndi vuto la chiwindi.
Nthawi ya pakati ndi kuyamwa. Kugwiritsa ntchito mankhwalawa kumatsutsana koyamba mu trimester yoyamba ya kutenga pakati. Mu II ndi III trimester, chithandizo ndi lisinopril sichikulimbikitsidwanso (ngati kugwiritsa ntchito mankhwalawa ndikofunikira mu II trimester, kuwunikira kwa ma ultrasound a ma functional function kumalimbikitsa). Makanda omwe amayi awo adatenga lisinopril amayenera kuwunikidwa kuti apange hypotension, oliguria, hyperkalemia. Kugwiritsa ntchito mankhwalawa pa mkaka wa m'mawere sikulimbikitsidwa.
Kukopa pa kuyendetsa galimoto ndikugwira ntchito ndi zinthu. Kumayambiriro kwa mankhwalawa, kukhazikika kwa ochepa hypotension ndikotheka, komwe kumatha kukhudza kuyendetsa magalimoto ndikugwira ntchito ndi njira zoopsa.

Zochita ndi mankhwala Lisinopril-ratiopharm

Mowa, diuretics ndi othandizira ena a antihypertensive (blockers of α- ndi β-adrenergic receptors, calcium antagonists, etc.) atha kutulutsa mphamvu ya lisinopril.
Pogwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu (spironolactone, amiloride, triamteren), hyperkalemia ikhoza kukhala, chifukwa chake, mukamagwiritsa ntchito mankhwalawa, ndikofunikira kuthana ndi potaziyamu m'magazi a m'magazi. Hyperkalemia ndiyothekanso kugwiritsa ntchito nthawi imodzi ya cyclosporine, kukonzekera kwa potaziyamu, zina zowonjezera zomwe zili ndi potaziyamu, zomwe ndizofunikira kwambiri m'matenda a shuga, kulephera kwaimpso.
NSAIDs (makamaka indomethacin), sodium kolorayidi amachepetsa antihypertensive mphamvu ya lisinopril.
Mukamagwiritsa ntchito kukonzekera kwa lithiamu, ndizotheka kuchedwetsa kuchotsedwa kwa lithiamu m'thupi ndipo, chifukwa chake, kuonjezera chiopsezo cha poizoni. Ndikofunikira kuyang'anira nthawi zonse mulingo wa lifiyamu m'magazi.
Mafupa opondereza mafupa, pamodzi ndi lisinopril, amawonjezera chiopsezo cha neutropenia ndi / kapena agranulocytosis.
Allopurinol, cytostatics, immunosuppressants, corticosteroids, procainamide wogwiritsidwa ntchito munthawi yomweyo ndi lisinopril angayambitse kukula kwa leukopenia.
Estrogens, sympathomimetics amachepetsa mphamvu ya antihypertensive ya lisinopril.
Lisinopril-ratiopharm angagwiritsidwe ntchito nthawi imodzi ndi glyceryl trinitrate, yomwe imayendetsedwa iv kapena transdermally.
Chenjezo limaperekedwa kwa odwala omwe ali ndi vuto lalikulu la infracation ya 6-12 mawola atatha kutsata streptokinase (chiwopsezo cha hypotension).
Lisinopril-ratiopharm imathandizira mawonetseredwe a kuledzera.
Mankhwala osokoneza bongo, ma anesthetics, ma hypnotics, antidepressants a triceclic amalimbikitsa kwambiri hypotensive.
Pa dialysis ndi lisinopril mankhwala, pamakhala chiopsezo cha anaphylactic reaction ngati polyacrylonitrile zitsulo sulfonate zotumphukira zazitali zimagwiritsidwa ntchito (mwachitsanzo, AN69).
Kukonzekera kwa pakamwa kwa Hypoglycemic (mwachitsanzo, zotumphukira za urea sulfonyl - metformin, biguanides - glibenclamide) ndi insulin mukamagwiritsidwa ntchito ndi ACE inhibitors imatha kupititsa patsogolo hypotensive zotsatira, makamaka kumayambiriro kwa chithandizo.
Kumwa maantacid okhala kumatha kuchepetsa mphamvu ya antihypertensive.

Mankhwala osokoneza bongo a Lisinopril-ratiopharm, zizindikiro ndi chithandizo

Kuchepa kwambiri kwa kuthamanga kwa magazi ndi kufooka kwa mafungo ofunikira, mantha, kusowa kwa magazi m'magazi amagetsi, kupweteka kwa impso, tachycardia, bradycardia, chizungulire, nkhawa komanso kutsokomola. Ndikofunikira kusiya kugwiritsa ntchito mankhwalawa. Kwa kuledzera, phokoso lam'mimba limalimbikitsidwa. Ndi wowongoletsa ochepa, wodwalayo ayenera kumuyika kumbuyo ndi miyendo yake. Pokonza kuthamanga kwa magazi, kukhazikika kwa njira yothandizira pathupi ndi / kapena cholowa m'malo mwa plasma. Ngati ndi kotheka, iv imaperekedwa ndi angiotensin. Lisinopril akhoza kuchotseredwa ndi hemodialysis (polyacrylonitrile zitsulo sulfonate zotumphukira zotulutsa monga AN69 sizingagwiritsidwe ntchito). Pankhani ya angioedema yoopsa moyo, kugwiritsa ntchito antihistamines ndikofunikira. Ngati matenda azachipatala aphatikizidwa ndi kutukusira kwa lilime, glottis, ndi larynx, ndikofunikira kuyambitsa chithandizo mwachangu ndi s / c makonzedwe a 0.3-0.5 ml ya epinephrine solution (1: 1000), intubation kapena laryngotomy akuwonetsedwa kuti awonetsetse kuti patuluka pa airway . Bradycardia ikapitilira chithandizo, ndikofunikira kuyambitsa kukoka kwa magetsi. Ndikofunikira kuyang'anira nthawi zonse zowonetsa za ntchito zofunika, kuchuluka kwa ma seramu electrolyte ndi creatinine.

Mlingo

Zoyambira zathupi komanso mankhwala:

Mapiritsi a 5 mg oyera a biconvex, okhala ndi mphako wosweka mbali imodzi,

Mapiritsi 10 mg: pinki yopepuka, yopanda mawonekedwe, yokhala ndi biconvex, yopanda mbali imodzi,

20 mg mapiritsi amtundu wofiirira wopanda mtundu umodzi, wopanda, wokhala ndi biconvex, wokhala ndi notch yophwanya mbali imodzi.

Mankhwala

Lisinopril ndi peptidyl dipeptidase inhibitor. Imapondereza ACE (ACE), chomwe ndi chothandizira pa kutembenuka kwa angiotensin I kukhala vasoconstrictive peptide, angiotensin II, yomwe imalimbikitsa kubisalira kwa aldosterone ndi adrenal cortex. Kuponderezedwa kwa ACE kumabweretsa kuchepa kwa kuchuluka kwa angiotensin II, komwe kumabweretsa kuchepa kwa ntchito ya vasoconstrictor ndi secretion ya aldosterone. Kuchepa kwa aldosterone secretion kungayambitse kuchuluka kwa seramu potaziyamu. Lisinopril amachepetsa kuthamanga kwa magazi makamaka chifukwa chopinga cha renin-angiotensin-. Komabe, lisinopril imakhala ndi antihypertensive kwambiri ngakhale kwa odwala omwe ali ndi ziwengo zochepa. ACE ndi ofanana ndi kinase II, enzyme yomwe imalimbikitsa kuphwanya kwa bradykinin.

Potengera momwe mankhwalawo amathandizira, kuchepa kwakanthawi kwamankhwala kosakanikirana ndi diastolic kumachitika.

Zinawonetsedwa kuti mawonekedwe onse amomwe odwala amakumana nawo omwe amalandiridwa kwambiri kapena otsika kwambiri a lisinopril anali ofanana muchikhalidwe komanso pafupipafupi.

Zinanenedwa kuti mwa odwala omwe amalandila lisinopril, panali kuchepa kwakukulu kwa kuchuluka kwa albumin mkodzo, kuwonetsa kuti ACE inhibitory zotsatira za lisinopril kudapangitsa kutsika kwa microalbuminuria mwa kukhudza mwachindunji minyewa ya impso kuphatikiza kuthekera kwake kutsitsa magazi.

Mankhwalawa a lisinopril sanakhudze kuwongolera kwa shuga wamagazi, monga zikuwonekera ndi kuchepa kwake pamlingo wa glycosylated hemoglobin (HbA ₁ c)

Zinakhazikitsidwa kuti lisinopril imathandizira kubwezeretsa ntchito ya endothelium yowonongeka kwa odwala omwe ali ndi hyperglycemia.

Lisinopril ndi choletsa pakamwa cha ACE chomwe mulibe sulfhydryl.

Pambuyo pa kutenga lisinopril, kuchuluka kwakukulu mu seramu yamagazi kumafikira pambuyo pa 7:00, ngakhale odwala omwe ali ndi infralate ya myocardial infarction amakhala ndi chizolowezi chachedwa pang'ono kufikira zolumikizira. Kutengera kupukusika kwa mkodzo, kuchuluka kwa mayamwidwe a lisinopril m'gululi kuli pafupifupi 25% ya kusiyana kosiyanasiyana kwa odwala mu 6,60% ya mankhwala onse omwe amaphunzira (5-80 mg). Odwala omwe ali ndi vuto la mtima, bioavailability amachepetsa pafupifupi 16%.

Kudya sizikhudzana ndi mayamwa

Lisinopril samangiriza mapuloteni a plasma, kupatula ma angiotensin omwe amasinthira enzyme (ACE).

Lisinopril samapangidwira ndipo amachotsa mkodzo. Kuchotsa theka-moyo mwa odwala kutenga Mlingo wambiri ndi maola 12,6. Kuvomerezeka kwa lisinopril mwa anthu athanzi ndi 50 ml / min. Panthawi ya kuphwanya impso, mawonekedwe a lisinopril amachepetsedwa molingana ndi kuchuluka kwa magwiridwe antchito. Kutsika kwa seramu ndende kumawonetsa gawo lalitali ndipo silikugwirizana ndi kuchuluka kwa mankhwala. Gawo lomaliza ili likuwonetsa kuti likugwirizana kwambiri ndi ACE ndipo sikuti ndi kuchuluka kwake.

Odwala omwe ali ndi vuto la chiwindi

Odwala omwe ali ndi vuto la matenda amisempha, chiwindi chimagwira ntchito zomwe zimapangitsa kuti magazi azisungidwa (pafupifupi 30% pambuyo pakutsimikiza mu mkodzo), komanso kuwonjezeka (pafupifupi 50%) poyerekeza ndi odzipereka athanzi chifukwa cha kuchepa kwa chilolezo.

Matenda aimpso

Kuwonongeka kwa impso kumachepetsa kuchotsedwa kwa lisinopril, komwe kumatsitsidwa ndi impso, koma kuchepa kumeneku ndikofunikira pokhapokha ngati kusefera kwa glomerular kutsika kuposa 30 ml / min. Pokhala ndi kuwonongeka kwapakati komanso kofatsa kwa kuwonongeka kwa impso (creatinine chilolezo cha 30-80 ml / min), AUC wamba imangokulira ndi 13%, pomwe chiwopsezo chachikulu cha kuwonongeka kwa impso (creatinine chilolezo cha 5-30 ml / min), AUC ya 4 Kasanu. Lisinopril amatha kuthetsedwa ndi dialysis. Pa hemodialysis, nthawi yake 4:00, kuchuluka kwa lisinopril mu plasma kumachepera pafupifupi 60% ndi dialysis chilolezo chapakati pa 40 ndi 55 ml / min.

Odwala omwe ali ndi vuto la mtima amakhala ndi chiwonetsero chazovuta kwambiri poyerekeza ndi odzipereka athanzi (kuchuluka kwa AUC okwanira 125%), koma potengera kuchuluka kwa lisinopril omwe apezeka mu mkodzo, kuchepa kwa mayankho pafupifupi 16% poyerekeza ndi odzipereka athanzi.

Odwala okalamba

Odwala okalamba amakhala ndi mankhwalawa okwera kwambiri m'magazi ndi kupendekera kwapamwamba / koloko (kuwonjezeka pafupifupi 60%) poyerekeza ndi odwala achichepere.

Mbiri ya pharmacokinetic ya lisinopril idaphunziridwa mwa ana 29 okhala ndi matenda oopsa kuyambira 6 mpaka 16, pomwe GFR ili pamwamba pa 30 ml / mphindi / 1.73 m 2. Pambuyo pakugwiritsa ntchito lisinopril mu mulingo wa 0,1-0.2 mg / kg, ndende yolingana mu plasma yamagazi idafika mkati mwa 6:00, ndipo kuchuluka kwa kuyamwa kumunsi kotsitsidwa mu mkodzo kunali 28%. Zomwezi zinali zofanana ndi zomwe zimawonedwa kale mwa akulu.

Zizindikiro za AUC ndi C _max mwa ana anali ofanana ndi omwe amawonera akulu.

Kulephera kwa mtima (chithandizo chamankhwala).

Pachimake m`mnyewa wamtima infarction (yochepa mankhwala (6 milungu) kwa hemodynamically khola wodwala pasanathe maola 24 pambuyo pachimake myocardial infarction.

Zovuta za impso mu matenda a shuga mellitus (chithandizo cha matenda a impso mu matenda oopsa omwe ali ndi mtundu II matenda a shuga ndi matenda oyamba ndi nephropathy).

Contraindication

Hypersensitivity to lisinopril, zida zina za mankhwalawo, kapena zoletsa zina za ACE.
Mbiri ya angioedema (kuphatikiza kugwiritsa ntchito ACE zoletsa, idiopathic ndi cholowa cha Quincke edema).
Aortic kapena mitral stenosis kapena hypertrophic cardiomyopathy yokhala ndi kusokonezeka kwakukulu kwa hemodynamic.
Biliary aimpso stenosis kapena artery stenosis a impso imodzi.
Pachimake myocardial infarction ndi wosakhazikika hemodynamics.
Cardiogenic mantha.
Odwala omwe ali ndi serum creatinine ≥ 220 μmol / L.
Kugwiritsa ntchito munthawi yomweyo kugwiritsa ntchito mankhwalawa komanso kupukutira kwapakati pa polyacrylonitrile sodium-2-methylosulfonate (mwachitsanzo AN 69) pa dialysis yofulumira.
Kugwiritsa ntchito munthawi yomweyo mankhwala a aliskiren okhala ndi odwala omwe ali ndi matenda osokoneza bongo kapena matenda a impso (GFR 2).
Hyperaldosteronism yoyamba.
Amayi oyembekezera kapena amayi oyembekezera akukonzekera kukhala ndi pakati (onani "Gwiritsani ntchito panthawi yomwe muli ndi pakati kapena mkaka wa m'mawere").

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Zodzikongoletsera. Pogwiritsa ntchito munthawi yomweyo mankhwala okodzetsa odwala, lisinopril imayamba kale kutengedwa - antihypertensive effect imakonda kuphatikizidwa. Kumayambiriro kophatikizana kwa lisinopril ndi okodzetsa, odwala amatha kumverera kuchepa kwambiri kwa kuthamanga kwa magazi ndi lisinopril. Kuthekera kwa kukhala ndi vuto lokhazikika kwa hypotension kwa lisinopril kumatha kuchepetsedwa ngati mankhwala othandizira amachotsedwa musanayambe mankhwala a lisinopril komanso kuwonjezeka kwa madzimadzi kapena voliyumu yamchere, komanso kumwa mankhwala ochepetsa a ACE poyambira.

Zakudya za potaziyamu, zowonjezera potaziyamu kapena zosunga potaziyamu. Odwala ena atha kukhala ndi hyperkalemia. Zinthu zomwe zimawonjezera chiopsezo cha hyperkalemia zimaphatikizaponso kulephera kwa impso, matenda a shuga, kugwiritsa ntchito nthawi imodzi yamankhwala oteteza potaziyamu (monga spironolactone, triamteren, amiloride), zakudya zophatikiza ndi potaziyamu, komanso m'malo amchere. Kugwiritsira ntchito kwa potaziyamu okhala ndi zowonjezera pazakudya, potaziyamu-osasamala othandizira kapena mchere wa potaziyamu kungapangitse kuwonjezeka kwakukulu kwa milingo ya potaziyamu, makamaka kwa odwala omwe ali ndi vuto laimpso.

Pankhaniyi, kuphatikiza kwa mankhwalawa kungathe kutumizidwa pokhapokha kuwunikidwa mosamala ndi dokotala ndikuwunika pafupipafupi kuchuluka kwa seramu potaziyamu ndi ntchito ya impso.

Ngakhale kutenga lisinopril motsutsana ndi potaziyamu wofanana ndi okodzetsa, hypokalemia yoyambitsidwa chifukwa cha kudya ingafooke.

Kukonzekera kwa Lithium. Kuwonjezereka kosinthika kwa seramu lifiyamu ndikuwonetsa poizoni kunanenedwa ndikugwiritsa ntchito munthawi yomweyo kugwiritsa ntchito lifiyamu ndi ACE zoletsa. Kugwiritsira ntchito nthawi yomweyo kwa thiazide diuretics kungakulitse chiopsezo cha kuledzera wa lithiamu ndikuwonjezera kawopsedwe omwe alipo. Kugwiritsa ntchito munthawi yomweyo kwa lisinopril ndi lifiyamu sikofunikira.

Mankhwala osokoneza bongo a nonsteroidal (NSAIDs), kuphatikizapo acetylsalicylic acid ≥ 3 g / tsiku.

Mankhwala ena a antihypertensive (beta-blockers, alpha-blockers, calcium antagonists). Kugwiritsa ntchito munthawi yomweyo mankhwalawa kumathandizanso kuti hypinotril ikhale yovuta. Kugwiritsa ntchito limodzi ndi nitroglycerin, ma nitrate ena kapena ma vasodilator ena atha kuchepetsa kuthamanga kwa magazi.

Tricyclic antidepressants / antipsychotic / anesthetics. Kugwiritsa ntchito nthawi imodzi kwamankhwala osokoneza bongo, ma antidepressants atatu ndi antipsychotic mankhwala omwe ali ndi ACE inhibitors kungayambitse kuwonjezeka kwa hypotensive zotsatira zomaliza.

Mankhwala a Sympathomimetic. Mankhwala a Sympathomimetic angachepetse antihypertensive zotsatira za ACE zoletsa. Pachifukwa ichi, ndikofunikira kuyang'anitsitsa kuthamanga kwa magazi a wodwalayo kuti atsimikizire ngati njira yothandizidwa idakwaniritsidwa.

Mankhwala osokoneza bongo. Kugwiritsa ntchito pamodzi kwa ACE zoletsa komanso mankhwala antidiabetesic (insulin, pakamwa hypoglycemic othandizira) kumathandizanso kuchepetsa kutsika kwa magazi ndi chiopsezo cha hypoglycemia. Izi zimachitika kawirikawiri m'milungu yoyambirira yophatikiza mankhwala ndi odwala omwe ali ndi vuto la impso.

Acetylsalicylic acid, mankhwala a thrombolytic, beta-blockers, nitrate. Lisinopril angagwiritsidwe ntchito nthawi imodzi ndi acetylsalicylic acid (mu mtima Mlingo), mankhwala a thrombolytic, beta-blockers ndi / kapena nitrate moyang'aniridwa ndi dokotala.

Kukonzekera kwa golide. Zotsatira za Nitritoid (Zizindikiro za vasodilation, kuphatikizapo kutentha kwa moto, nseru, chizungulire, ndi matenda ochepa) zomwe zimatha kukhala zovuta kwambiri) atabayidwa kukonzekera golide (mwachitsanzo, sodium kamodzi) anali ochulukirapo kwa odwala omwe amathandizidwa ndi ACE inhibitors.

Ma blockade apawiri a renin-angiotensin-. Zawonetsedwa kuti magawo awiri a renin-angiotensin- (RAAS) omwe amagwiritsidwa ntchito munthawi yomweyo a ACE inhibitors, angiotensin II receptor antagonists kapena aliskiren amadziwika ndi zochitika zambiri zosagwirizana ndi zovuta monga arterial hypotension, hyperkalemia, kuwonongeka kwaimpso ntchito kugwiritsa ntchito monotherapy.

Allopurinol, cytostatics, immunosuppressants, corticosteroids, procainamide. Pogwiritsa ntchito munthawi yomweyo ndi lisinopril, leukopenia imatha kutsogolera.

Mankhwala omwe amachepetsa mafupa. Pogwiritsa ntchito munthawi yomweyo ndi lisinopril, zimawonjezera chiopsezo cha neutropenia ndi / kapena agranulocytosis.

Ma estrogens. Ndi kupangika panthawi imodzi, ndizotheka kuchepetsa kufooka kwa thupi chifukwa cha kusungunuka kwa madzi mthupi.

Lisinopril ayenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto lalikulu la infracity infarction mkati mwa maola 6 mpaka 6 atayang'aniridwa ndi streptokinase (chiwopsezo cha kukhala ochepa hypotension).

Mankhwala osokoneza bongo, mankhwala osokoneza bongo, zakumwa zoledzeretsa, mapiritsi ogona osakanikirana ndi lisinopril amachititsa kuwonjezeka kwa hypotensive.

Zolemba zogwiritsira ntchito

Zizindikiro ochepa ochepa hypotension Nthawi zambiri zimawonetsedwa mwa odwala omwe alibe zovuta zamankhwala oopsa. Odwala omwe ali ndi vuto la mtima, kapena kulephera kwa aimpso, amadziwika kwambiri.

The mwayi wokhala ochepa ochepa hypotension ndi apamwamba mu odwala kwambiri mtima kulephera kutenga waukulu Mlingo wokodzetsa okodzetsa, amakhala ndi vuto la impso kapena kuwonongeka kwa impso, komanso nthawi yodwala matenda oopsa, kutsegula m'mimba kapena kusanza, komanso mwa mitundu yoopsa yamankhwala omata.

Pakachitika matenda oopsa, wodwala amayenera kumuyika kumbuyo kwake, ndipo ngati ndi kotheka, kulowetsedwa kwa mchere kumafunika.

Kutsika kwakanthawi kochepa kwa magazi sikukulepheretsa kugwiritsa ntchito mankhwalawa, nthawi zambiri kumatha kuperekedwa mosavuta magazi atawonjezeka pambuyo pokuwonjezeka kwa kuchuluka kwa madzimadzi m'thupi.

Odwala ena omwe ali ndi vuto la mtima, okhala ndi magazi abwinobwino kapena otsika, kuchepa kwamphamvu kwa kuthamanga kwa magazi kumatha kuchitika pakumwa mankhwala a lisinopril. Izi zimanenedweratu ndipo, monga lamulo, sizikufuna kuti discontinuation ya lisinopril chithandizo. Ngati ochepa hypotension akhala chizindikiro, kungakhale kofunikira kuti muchepetse mankhwalawo kapena musiye kumwa mankhwala osokoneza bongo.

Arterial hypotension mu pachimake myocardial infarction. Mu kulowetsedwa pachimake kwa odwala omwe ali ndi hemodynamics yokhazikika, chithandizo ndi lisinopril ziyenera kuchitika mu maola 24 oyambirira kuti muchepetse kusokonezeka kwa chipinda chamanzere cha mtima komanso kulephera kwa mtima, komanso kuchepetsa imfa. Mu infalction yovuta ya pachimake, chithandizo cha lisinopril sichingayambike ngati pali chiwopsezo chowonjezereka cha hemodynamic mutatha chithandizo ndi vasodilators. Izi zikugwira ntchito kwa odwala omwe ali ndi systolic magazi a 100 mm RT. Art. kapena ochepa, kapena odwala omwe adayamba kudwala mtima. M'masiku atatu oyamba atatha kulowetsedwa ndi myocardial, mlingo uyenera kuchepetsedwa ngati kupanikizika kwa systolic sikupitirira 120 mm Hg. Art. Ngati magazi a systolic ndi ofanana kapena osakwana 100 mm Hg.

Mu odwala hypovolemia, sodium akusowa okhudzana ndi kugwiritsa ntchito okodzetsa, chakudya chopanda mchere, kudzera pakusanza, kutsekula m'mimba, pambuyo pa dialysis, kukulira kwadzidzidzi kwakanthawi kambiri kwamankhwala ochepa, kulephera kwaimpso. Zikatero, ndikofunika kulipiritsa kutayika kwa madzi ndi mchere musanalandire chithandizo ndi lisinopril ndikupereka kuyang'aniridwa kwachipatala. Mosamala kwambiri (poganizira phindu / chiopsezo), mankhwalawa amayenera kutumizidwa kwa odwala pambuyo pakuwonjezeka kwa impso, komanso kwa odwala omwe ali ndi vuto aimpso ntchito, chiwindi, mkhutu hematopoiesis, autoimmune matenda. Zosankha zonse za mankhwalawa pogwiritsa ntchito lisinopril zimafunikira kuyang'aniridwa kwachipatala ndikuwunika ma labotale.

Aortic ndi mitral valve stenosis / hypertrophic cardiomyopathy. Monga zoletsa zina za ACE, lisinopril siyikulimbikitsidwa kwa odwala omwe ali ndi mitral stenosis kapena kuvuta kutuluka kwa magazi kuchokera kumanzere kwamitsempha yamagazi (ndi aortic stenosis kapena hypertrophic cardiomyopathy).

Matenda aimpso. Odwala ndi mkhutu aimpso ntchito (creatinine chilolezo

Odwala kulephera kwa mtima ochepa hypotension, kumachitika kumayambiriro kwa mankhwala ndi ACE zoletsa, kungayambitse matenda aimpso. Zikatero, kukula kwa impso kulephera, komwe kumatha kusintha, akuti.

Odwala ena Mgwirizano wamitsempha wamagazi wamanjenje kapena stereosis ya impso imodzi Ma inhibitors a ACE amalimbikitsa kuchuluka kwa urea ndi serum creatinine, monga lamulo, zotsatirazi zimatha pambuyo poyimitsa mankhwalawa. Kuchepa kwa zochitika ngati izi kumakhala kwambiri makamaka kwa odwala omwe ali ndi vuto la impso.

Kupezeka kwa kukonzanso kwamitsempha yamagazi kumapangitsa kuti chiwopsezo chachikulu cha matenda obanika komanso aimpso chilephereke.

Mwa odwala ena Ag popanda matenda a impso owoneka bwino, kugwiritsa ntchito lisinopril, makamaka mukamakodzetsa, kumabweretsa kuwonjezeka kwa urea m'magazi ndi creatinine mu seramu yamagazi, kusintha kumeneku, monga lamulo, ndikosafunikira komanso kosakhalitsa. Kuthamanga kwa kupezeka kwawo kumakhala kwakukulu kwa odwala omwe ali ndi vuto laimpso. Zikatero, zitha kukhala zofunikira kuti muchepetse muyezo komanso / kapena siyani kumwa okodzetsa ndi / kapena lisinopril.

Mu pachimake myocardial infarction ndizoletsedwa kugwiritsa ntchito lisinopril mwa odwala omwe amalephera kuwonongeka kwa impso (serum creatinine> 177 μmol / L ndi proteinuria> 500 mg / 24 h). Ngati vuto la impso likukula pakhungu la lisinopril (serum creatinine> 265 μmol / L kapena kawiri poyerekeza ndi gawo loyambirira), kuleka kugwiritsa ntchito kwake kuyenera kuganiziridwanso.

Hypersensitivity / angioedema. Osadziwika kwambiri angioedema a nkhope, miyendo, milomo, lilime, glottis ndi / kapena larynx mwa odwala omwe ali ndi ACE zoletsa, kuphatikizapo lisinopril. Edema ya Angioneurotic imatha kuchitika nthawi iliyonse panthawi yamankhwala. Zikatero, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo, chithandizo choyenera chiyenera kuyambitsidwa ndikuwunika kwa wodwala kuyenera kukhazikitsidwa kuti zitsimikizire kuti zizindikiratu. Muzochitika zomwe edema imapezeka kudera la lilime, sikuti imayambitsa kupuma, wodwalayo angafunike kuwunika kwa nthawi yayitali, popeza chithandizo cha antihistamines ndi corticosteroids chingakhale chosakwanira.

Milandu yoyipa imodzi chifukwa cha angioedema a larynx kapena lilime adanenedwa.

Odwala omwe ali ndi mbiri ya angioedema yomwe sikugwirizana ndi ntchito ya ACE inhibitor, chiopsezo chokhala ndi angioedema poyankha kugwiritsa ntchito mankhwala m'gulu lino chitha kuchuluka.

ACE inhibitors angayambitse kutchulidwa kwa angioedema kwambiri kwa odwala a liwiro la Negroid kuposa odwala mpikisano wa ku Caucasian.

Anaphylactoid zimachitika odwala akudwala hemodialysis. Zotsatira za anaphylactoid zidanenedwa kwa odwala omwe akudwala hemodialysis omwe amagwiritsa ntchito ma membrane otaya kwambiri (mwachitsanzo AN 69) ndipo amathandizidwa nthawi yomweyo ndi ACE inhibitors. Odwala awa amafunsidwa kuti asinthe ma membrane a dialysis kuti akhale ndi ziwalo zamtundu wina kapena kuti agwiritse ntchito antihypertensive mankhwala a gulu lina.

Kukakamiza. Odwala omwe atenga ma inhibitors a ACE pa desensitization mankhwala (mwachitsanzo, poyizoni wa Hymenoptera) amakhala ndi anaphylactoid zimachitika. Izi zimapewedwa mwa omwewo mwa kusiya kwakanthawi kogwiritsa ntchito zilembo za ACE, koma atagwiritsanso ntchito mankhwalawa mosamala, zotsatira zake zidabwezeretseka.

Kulephera kwa chiwindi. Osowa kwambiri, ACE inhibitors adalumikizidwa ndi matenda omwe amayamba ndi cholestatic jaundice ndipo amapita patsogolo ku necrosis komanso (nthawi zina) kufa. Makina amtunduwu sanadziwika. Odwala omwe apanga matenda a jaundice pakayendetsedwe ka lisinopril kapena awona kuwonjezeka kwakukulu kwa michere ya chiwindi ayenera kusiya kumwa mankhwalawa ndikupereka chithandizo choyenera chamankhwala.

Neutropenia / agranulocytosis. Milandu ya neutropenia / agranulocytosis, thrombocytopenia, ndi kuchepa kwa magazi imanenedwa mwa odwala omwe adalandira zoletsa za ACE. Odwala omwe ali ndi vuto lanthete komanso chifukwa chosagwirizana ndi zinthu zina, neutropenia sichachilendo. Pambuyo poyimitsa ACE inhibitor, neutropenia ndi agranulocytosis zimatha kusintha. Ndikofunikira kupangira lisinopril mosamala kwambiri kwa odwala omwe ali ndi collagenosis, komanso odwala akamalandira chithandizo cha immunosuppression, akapatsidwa mankhwala ndi allopurinol kapena procainamide, kapenanso ndi kuphatikizika kwa zinthu izi zovuta, makamaka motsutsana ndi maziko a ntchito yaimpso. Ena mwa odwalawa amakhala ndi matenda oopsa omwe samathandiza nthawi zonse pakulimbana ndi maantibayotiki. Mukamagwiritsa ntchito mankhwalawa odwala, tikulimbikitsidwa kuyang'anira kuchuluka kwa leukocytes m'magazi ndi kuwalangiza odwala kuti afotokoze chizindikiro chilichonse chodwala.

Kutsokomola. Mutatha kugwiritsa ntchito zoletsa za ACE, kutsokomola kumatha kuchitika. Nthawi zambiri chifuwa chimakhala chisabereka ndipo chimasiya kuyimitsa mankhwala. Chifuwa choyambitsidwa ndi ACE inhibitors chiyenera kuganiziridwanso mosiyanitsa kutsokomola monga njira imodzi yomwe ingatheke.

Opaleshoni / Opaleshoni Odwala omwe amachitidwa opareshoni kapena opaleshoni yothandizira yomwe imayambitsa hypotension, lisinopril imatha kuletsa mapangidwe a angiotensin II pambuyo pobwezeretsa kutulutsa kwa renin. Ngati ochepa hypotension imawonedwa chifukwa cha njirayi, ndikofunikira kubwezeretsa kuchuluka kozungulira magazi.

Hyperkalemia Zovuta zingapo za kuchuluka kwa seramu potaziyamu mwa odwala omwe amathandizidwa ndi ACE inhibitors, kuphatikizapo lisinopril, adanenedwapo. Odwala omwe ali pachiwopsezo chachikulu chotenga hyperkalemia ndi omwe ali ndi vuto la impso, matenda ashuga, kapena omwe akugwiritsa ntchito mankhwala othandizira a potaziyamu, kapena poteteza mchere wa potaziyamu, kapena omwe amamwa mankhwala ena omwe amalimbikitsa seramu potaziyamu (mwachitsanzo heparin).

Odwala omwe ali ndi matenda ashuga. Odwala omwe ali ndi matenda ashuga omwe amamwa mankhwala othana ndi shuga kapena mankhwala a insulin, kuwongolera glycemic mosamala kuyenera kuchitidwa mwezi woyamba wa mankhwala ndi ACE zoletsa.

Kutengeka kwa anaphylactoid komwe kumachitika pakakhala kupindika kwa otsika osalimba a lipoproteins (LDL). Mu apheresis ndi dextrin sulfate, kugwiritsidwa ntchito kwa ACE inhibitors kumatha kuyambitsa zotsatira za anaphylactic zomwe zingakhale zowopsa m'moyo. Zizindikiro izi zitha kupewedwa ndikuchotsera kwakanthawi chithandizo ndi zoletsa za ACE pamaso pa apheresis iliyonse kapena mwa kusintha zoletsa za ACE ndi mankhwala ena.

Kuyanjana ndi mitundu. ACE inhibitors angayambitse kutchulidwa kwambiri kwa angioedema mwa odwala omwe ali ndi khungu lakuda (Negroid mbio) kuposa odwala mpikisano wa ku Caucasian. Komanso, pagulu ili la odwala, zotsatira za hypinotril sizitchulidwa kwenikweni chifukwa cha kuchuluka kwa zigawo zotsika za renin.

Lithium. Mwambiri, munthawi yomweyo kugwiritsa ntchito lifiyamu ndi lisinopril sikulimbikitsidwa.

Blockade iwiri ya renin-angiotensin- (RAAS). Zinanenedwa kuti kugwiritsa ntchito pamodzi kwa ACE zoletsa, angiotensin II receptor blockers kapena aliskiren kumawonjezera chiopsezo cha hypotension, hyperkalemia, kusokonezeka kwa impso (kuphatikizapo kuperewera kwaimpso). Chifukwa chake, kuphatikiza kawiri kwa RAAS ndi kuphatikiza kwa ACE zoletsa, angiotensin II receptor blockers, kapena aliskiren sikulimbikitsidwa.

Ngati pakufunika kugwiritsa ntchito mankhwala a blockade pawiri, uyenera kuchitika moyang'aniridwa ndi katswiri ndikuyang'ana pafupipafupi ntchito ya impso, milingo yama electrolyte ndi kuthamanga kwa magazi. Odwala omwe ali ndi matenda ashuga a nephropathy samalimbikitsidwa kugwiritsa ntchito ACE zoletsa ndi angiotensin II receptor blockers nthawi imodzi.

Proteinuria Nkhani zokhazokha za kukhazikika kwa proteinuria mu odwala zanenedwa, makamaka ndi kuchepetsedwa kwaimpso kapena mutatha kutenga waukulu Mlingo wa lisinopril. Pankhani ya proteinuria yofunika kwambiri (yoposa 1 g / tsiku), lisinopril iyenera kugwiritsidwa ntchito pokhapokha pofufuza phindu lazithandizo ndi chiwopsezo chowunikira komanso kuwunika pafupipafupi magawo a matenda ndi zamankhwala osiyanasiyana.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mimba Mankhwalawa amatsutsana mwa amayi apakati kapena amayi omwe akukonzekera kutenga pakati. Ngati kutenga pakati kumatsimikiziridwa pakumwa mankhwalawa, kugwiritsa ntchito kwake kuyenera kuyimitsidwa nthawi yomweyo, ndipo ngati kuli koyenera, ndikusinthidwa ndi mankhwala ena ovomerezeka ogwiritsira ntchito amayi apakati.

Amadziwika kuti kukhudzana kwa nthawi yayitali ndi ma inhibitors a ACE panthawi yachiwiri komanso yachitatu ya mimba kumapangitsa kuti thupi lizionekera kwambiri (kuchepa kwa impso, oligohydramnios, kuchepa kwa khungu la chifuwa) komanso neonatal toxicity (kufooka kwa impso, kuchepa kwa thupi, hyperkalemia. Pankhani yokhala ndi ma inhibitors a ACE panthawi yachiwiri ya mimba, tikulimbikitsidwa kuwunika ntchito zaimpso ndi cranial pogwiritsa ntchito ultrasound.

Makanda omwe amayi awo atenga lisinopril amayenera kuwunika mosamala kuti asachite kunjenjemera, oliguria, ndi hyperkalemia.

Kuyamwitsa. Popeza palibe chidziwitso chokhudza kugwiritsa ntchito lisinopril pa nthawi yoyamwitsa, kutenga lisinopril panthawi yoyamwitsa sikulimbikitsidwa. Munthawi imeneyi, ndikofunikira kugwiritsa ntchito njira zina zochiritsira, njira yachitetezo yomwe imaphunziridwa bwino, makamaka ngati mwana wakhanda kapena asanabadwe adadyetsedwa.

Mlingo ndi makonzedwe

Lisinopril ayenera kumwedwa pakamwa nthawi imodzi patsiku. Monga mankhwala ena omwe amayenera kumwa kamodzi patsiku, lisinopril iyenera kumwa tsiku lililonse nthawi yomweyo. Kudya sikumakhudza kuyamwa kwa mapiritsi a lisinopril. Mlingo uyenera kutsimikiziridwa payekha malinga ndi kuchuluka kwa manambala a wodwala ndi zizindikiro zamagazi.

Lisinopril angagwiritsidwe ntchito ngati monotherapy komanso kuphatikiza magulu ena a antihypertensive mankhwala.

Mlingo woyamba wa odwala matenda oopsa ndi 10 mg. Odwala omwe ali ndi dongosolo la renin-angiotensin-aldosterone kwambiri (makamaka, lophatikizanso matenda oopsa, kuchuluka kwa mchere (sodium chloride) kuchokera mthupi ndipo / kapena kuchepa kwamadzi am'magazi, kukomoka kwa mtima kapena matenda oopsa a m'magazi) amathanso kuchepa kwambiri ndi kuthamanga kwa magazi atatenga koyamba Mlingo. Kwa odwala oterewa, mlingo woyenera ndi 2,5-5 mg, kuyamba kwa chithandizo kuyenera kuchitika moyang'aniridwa ndi dokotala. Kuchepetsa mlingo woyambirira kumalimbikitsidwanso pamaso pa kulephera kwa impso (onani Gome 1 m'munsimu).

Mankhwala othandizira ndi 20 mg kamodzi patsiku. Ngati kupezeka kwa mankhwalawa sikupereka chithandizo chokwanira mkati mwa masabata 2-4 mutamwa mankhwalawo, mutha kuchuluka. Mlingo wapamwamba womwe umagwiritsidwa ntchito poyesedwa nthawi yayitali anali mayeso 80 mg tsiku lililonse.

Odwala omwe amatenga okodzetsa.

Zizindikiro zamitsempha tokha zimatha kutha atayamba kulandira chithandizo ndi lisinopril. Izi ndizotheka kwa odwala omwe amatenga diuretics akagwiritsidwa ntchito ndi lisinopril.

Mlingo kusankha kwa odwala aimpso.

Mlingo wa odwala omwe ali ndi vuto la aimpso uyenera kukhazikitsidwa ndi QC, mlingo wokonzanso umadalira mayankho azachipatala ndipo amasankhidwa ndikuwonetsa pafupipafupi zizindikiro za ntchito ya aimpso, potaziyamu ndi sodium m'magazi, monga zikuwonetsera pansipa. 1.

Gome 1. Kusankhidwa kwa odwala omwe ali ndi vuto la impso.