Malangizo pakugwiritsa ntchito mankhwala a Bayeta - malangizo apadera ndi kuwunika

Baeta ndi hypoglycemic wothandizira kupangira shuga m'magazi a 2 shuga. Exenatide imatchulidwa kuti amino acid amidopeptides. Monga incretin mimetic, imachepetsa chimbudzi, imakulitsa ntchito yama b-cell. Kuchokera ku insulin yachikhalidwe, mankhwalawa amasiyanitsidwa ndi kuthekera kwa pharmacological ndi mtengo wake.

Ndani akuwonetsedwa exenatide

Mankhwalawa amalembedwa kwa odwala matenda ashuga amtundu wachiwiri wa matenda (kupatula ana ndi amayi apakati). Ngati chithandizo cha Metformin ndi mankhwala ena a hypoglycemic sichimapereka zotsatira zomwe zikufunikira, Bayete imayikidwa ngati mankhwala owonjezera. Jakisoni amagwiritsidwanso ntchito ngati monotherapy. Chofunika kwambiri pamankhwala osokoneza bongo omwe amadalira insulin ndi kuthekera kwa mankhwalawa kuti athe kulola kudya komanso kulemera kwa thupi.

Kutulutsa Fomu

Baeta ndi yankho popanda mtundu ndi fungo. 1 ml ya yogwira gawo la exetanide ili ndi 250 mcg. Udindo wazowonjezera zosakaniza ndi acetic acid, sodium acetate trihydrate, matacresol, mannitol ndi zina zotulutsa.

Mankhwalawa amamasulidwa mu cholembera chimodzi - analogue ya mbadwo watsopano wa insulin. Kuchuluka kwa mankhwala mu cholembera chotere ndi 1.2 kapena 2.4 ml (phukusi lirilonse - syringe imodzi).

Mankhwala a Bayet, ndi Exenatide okha omwe angachite ngati analogue.

Kuthekera kwa Pharmacodynamic

Kodi chimachitika ndi chiyani ku Bayeta pambuyo pa kayendetsedwe ka magawoli? Magwiridwe ochita mankhwalawa ndi osavuta. Ma insretins, omwe akuimira omwe ndi exenatide (wogwira ntchito popanga mankhwala), amathandizira kupanga insulin ndikupangitsa kuti shuga asapangidwe ndi chiwindi.

Exenatide Baeta imathandizira odwala matenda ashuga kuwongolera shuga m'njira zotsatirazi:

1. Ndi mfundo zazikulu za glucometer, mankhwalawa amachititsa kuti insulin parenchyma ipangidwe.
2. Thupi la shuga litangofika mwabwinobwino, katulutsidwe ka timadzi tokha timayima.
3. Pankhani ya shuga osadalira insulini, Baeta atangokhala, kupanga kwa insulin sikuwoneka kwa mphindi 10 zoyambirira. Mankhwalawa amabwezeretsa kuyankha kwa insulin m'magawo onse awiri.

Imachepetsa kugaya chakudya, imachepetsa chilakolako chofuna kudya komanso matumbo (mpaka kudzimbidwa).

Zolemba za Pharmacokinetic

Kodi mankhwala amamwa bwanji, amagawidwa, amamwa bwanji?

• Pambuyo jakisoni, chigawo chogwira ntchito (exenatide) chimafalikira mwachangu kudzera mu ziwalo zamagazi ndikuchita chothandizira. Pa mlingo wa 10 μg wa mfundo zamtengo wapatali, umafika patatha maola awiri. Dongosolo la jakisoni (ntchafu, mkono wam'mbuyo kapena pamimba) silimakhudza kugunda kwa mayamwa komanso kugwira ntchito bwino.
• Mankhwalawa amaphatikizidwa m'matumbo am'mimba, magazi mthupi ndi kapamba. Mphamvu zake zamankhwala samadalira mlingo.
• Impso zimachotsa Bayetu maola 10. Mu aimpso a impso, kusintha kwa mankhwalawa sikofunikira, popeza chiwonetsero cha mankhwala omwe ali m'gulu ili la odwala ali pafupi kwambiri.
• Popeza mankhwalawa amuchotsa impso, ma hepatic pathologies sasintha zomwe zili exenatide m'magazi a m'magazi.

Zochitika zokhudzana ndi zaka sizimakhudza kayendedwe ka zomwe zimagwira ntchito, chifukwa chake, pakukula, kusintha kwa mankhwala sikofunikira. Mu ubwana (mpaka zaka 12), zotsatira za exenatide sizinaphunzire. Muubwana (zaka 12-18) mwa omwe amalandira mlingo wa 5 μg wa anthu odwala matenda ashuga, zomwe zimachitika anali ofanana ndi akulu.

Amuna ndi akazi amachitanso chimodzimodzi ndi chithandizo cha Bayeta. Palibe kusiyana komwe kunawoneka pakati pa oimira mafuko osiyanasiyana, zomwe zikutanthauza kuti kusintha kwa mlingo malinga ndi njira zotere sikofunikira pamagulu awa a odwala matenda ashuga.

Baeta panthawi yoyembekezera

Pa nthawi yoyembekezera komanso mkaka wa m'mawere, jekeseni la Bayeta limaphatikizidwa, chifukwa zinthu zomwe zimagwira zimakhudza kamangidwe ka mwana wosabadwayo. Makamaka, kugwiritsa ntchito Baeta kumatha kupangitsa mwana kudwala matenda a shuga omwe amadalira insulin.

Kukula, thupi la mwana limagwira ntchito ya insulin synthesis. Zikondamoyo za mwana wosabadwayo zimayang'anira zovuta za glycemic mwa mwana komanso mayi. Chifukwa chake, pamene mukukonzekera kukhala ndi pakati, muyenera kukayezetsa ndi kupeza upangiri mwatsatanetsatane wa kumwa mankhwala omwe ali otetezeka m'malo atsopano.

Contraindication

Maziko a contraindication kuti atenge mankhwala a Bayet ndi chitetezo cha munthu chogwira ntchito mwamawonekedwe. Mankhwalawa sanatchulidwe odwala matenda ashuga omwe ali ndi mtundu woyamba wa matenda, komanso munthawi ya matenda a shuga a ketoacidosis. Mankhwala siwothandiza kwa odwala omwe ali ndi matenda am'mimba, matumbo, impso, komanso gastroparesis.

Bayeta siziwonetsedwanso kwa ana, popeza kuchuluka kwa mphamvu ndi chitetezo cha mankhwala kwa ana sichinayesedwe. Ngati thupi lanu siligwirizana ndi zosakaniza za metabolite, mankhwalawa sanalembedwe.

Zotsatira zoyipa

Byeta nthawi zambiri samayambitsa zovuta zosafunikira. Ngati imagwiritsidwa ntchito ngati monotherapy, kuchuluka kwa hypoglycemic syndrome kuli pafupifupi 5% (poyerekeza ndi 1% placebo).

Zambiri mwa milanduzi zimadziwika ndi kuchepa kwambiri. Ngati zichitika, ndiye kuti, ngati malingaliro azachipatala sanatsatidwe, mankhwalawo atha, kapena ngati sanasungidwe bwino.

Ngakhale kawirikawiri, Baeta imapangitsa kukondoweza kwa matenda a impso komanso kuchuluka kwa creatinine. Muzochitika zamankhwala, chidziwitso cha nephrotoxicity cha exenatide sichinalembedwe, kupatula zigawo zaumwini wa pancreatitis yacute. Anthu odwala matenda ashuga ayenera kudziwitsidwa za zizindikiro za nthendayi (kupweteka kwambiri pamimba).

Jekeseni woyamba akhoza kutsagana ndi kufooka, kunjenjemera, nthawi zina, angioedema ndi anaphylactic mantha. Ngati zotsatira zoyipa zadziwika, njira yolandirayo imayimitsidwa ndipo adokotala amafunsira kwa endocrinologist.

Popeza mankhwala onse okhala ndi mapuloteni ndi ma peptides amatha kupangitsa kuti immungenicity, ma antibodies ophatikizika pophika atha kupangidwa nthawi ya Bayeta mankhwala, gawo lawo limatsika pakapita nthawi ndipo limakhalabe lotsika. Kukhalapo kwa ma antibodies sikumakhudza ma frequency ndi mitundu ya zovuta zoyipa.

Anthu odwala matenda ashuga ayenera kuchenjezedwa kuti jakisoni wa Byeta amathandizira kuti asakhale ndi chidwi komanso kuti achepetse thupi. Izi momwe thupi silitengera kukonzedwa kwawamba.

Buku Lothandizira

Bayetu amagwiritsidwa ntchito ngati monotherapy, kuthandizira zakudya zamafuta ochepa komanso minofu yamatumbo, kukulolani kuti mulamulire shuga. Mankhwala ophatikizidwa, majekesowa amaphatikizidwa ndi mapiritsi a Metformin, thiazolidatedione, sulfonylureas, komanso kuphatikiza kwawo kuti akwaniritse bwino kwambiri glycemic control.

Dongosolo la chithandizo likupangidwa ndi dokotala. Mankhwalawa amawadulira pansi pakhungu pamimba, m'chiuno, pamphumi. Pa gawo loyamba la maphunziro, mankhwalawa osachepera 5 mcg amaperekedwa m'mawa ndi madzulo. Mankhwalawa amayenera kumwa pasanathe ola limodzi asanadye. Mukatha kudya, jakisoni sililimbikitsidwa. Pakatha mwezi, ndikazolowera, chizolowezi chimatha kuchulukitsidwa. Ndi kukonzaku, palibe zotsatira zoyipa.

Ngati nthawi ya jakisoni yaphonya, jekeseni wotsatira amachitidwa popanda kusintha mlingo. Sitikulimbikitsidwa kubaya yankho mu mtsempha kapena minofu. Ngati Byeta adagwiritsidwa ntchito popanga mankhwala osokoneza bongo a sulfonylurea, chizolowezi chomaliza chimachepetsedwa kuti muchepetse chiopsezo cha zotsatira zoyipa kapena bongo.

Dokotala ayenera kudziwitsa wodwalayo za malamulo ogwiritsira ntchito cholembera. Kumvetsetsa njirayi kukuthandizani kuti muphunzitse kanema pa kanemayu.

Zizindikiro zosokoneza bongo

Ndi njira yodzilankhulira nokha komanso kuyesera kwa mlingo, mankhwala osokoneza bongo amatha. Mutha kuzindikira mkhalidwewo mwa zizindikiritso: kusowa chilumikizano, kusintha kwa zokonda, zovuta zakusokonekera, kusintha kwa mawonekedwe a kuchepa. Mchitidwe wamanjenje umayimira kuledzera ndikupweteka mutu, kusagwirizana, komanso kuwonongeka pakuloza.

Koma nthawi zambiri chizindikirochi chimapezeka pakhungu: totupa, kutupa, kuyamwa pamalo opaka jekeseni. Kukula kwa zizindikiro ndizodziletsa, mankhwalawa ndiwowonekera. Nthawi zambiri pamiyeso yotere, Mlingo wa Bajeta umamvekedwa bwino, ndikovuta kwambiri, mankhwala onse omwe ali ndi mawonekedwe ofananawo amathetsedwa.

Kuphatikiza Zotsatira za Therapy

Mukamasankha mtundu wa mankhwala a Bayeta, endocrinologist ayenera kudziwa za mankhwala onse omwe wodwala matendawa amatenga pakadali pano. Makamaka amapatsidwa chidwi ndi mapiritsi omwe amatengedwa pakamwa ndikuyamwa. Popeza mankhwalawa amachedwetsa m'mimba, mankhwala ena ayenera kumwedwa patatsala maola awiri kuti jakisoni isanachitike.

Ndi chithandizo chomwechi mogwirizana ndi chiwembu "Baeta kuphatikiza Digoxin", mphamvu ya mankhwala yomaliza imachepa. Odwala oopsa omwe amagwiritsa ntchito Lisinopril ayeneranso kupirira nthawi yayitali pakati pa jakisoni ndi mapiritsi. HMG-CoA reductase inhibitors sizisintha kapangidwe ka mafuta m'magazi (otsika komanso okwera kwambiri lipids, triglycerol, cholesterol yathunthu) pa mankhwala ogwirira ntchito.

Kugwiritsa ntchito Baeta kumbuyo kwa insulin mankhwala, komanso kukonzekera kwa D-phenylalanine, meglitinide kapena b-glucosidase inhibitors, sikunaphunzire. Mankhwala ena amatha kupweteketsa mtima akaphatikizidwa ndi Bayeta, ndipo ndi dokotala yekha amene angayang'ane zovuta zonse zomwe amachita.

Zosunga mu syringe pensulo

Kwa Bayeta, malangizo ogwiritsira ntchito amafotokozera mwatsatanetsatane mikhalidwe yonse yosungirako. Kuti mukhale ndi zida zothandizira, muyenera kusankha malo owuma, amdima komanso ozizira omwe ali ndi kutentha kwa madigiri 2-8. Ngati zolimba zidasokonekera ndipo cholembera chake chidayamba kugwira ntchito, ziyenera kusiyidwa ndi kutentha kwa firiji (mpaka madigiri 25).

Moyo wa alumali wa mankhwala oterowo suwapitilira mwezi umodzi. Kufikira kwa ana ku nduna yamankhwala kuyenera kukhala kochepa. Mukasunga ma CD mu firiji, Baete sayenera kuzizira.

Osasiya cholembera ndi singano yomwe imalumikizidwa nthawi yayitali. Pambuyo pa njirayi, singano imachotsedwa, ndipo jekeseni wotsatira, asanayikenso, amaikidwa watsopano. Kunyalanyaza mawonekedwe osungirako a mankhwalawa kumachepetsa kuchiritsa kwake. Ngati yankho lomveka likakhala lamtambo, ziphuphu zimatuluka, mankhwalawo amasintha mtundu, ndipo mankhwalawo ayenera kutayidwa.

Iwo amamasula mumtengo wa Baetu monga mankhwala. Mankhwalawa ayenera kugwiritsidwa ntchito patatha zaka ziwiri kuchokera chaka chamasulidwa. Mankhwala omwe atha ntchito sangathe kugwiritsidwa ntchito - kuwonjezera pazoyenda zochepa, chiopsezo chotsatira chazovuta chikuwonjezeka. Ubwino wamankhwala umatanthauzanso kutsatira momwe akusungira.

Malangizo apadera

Baeta ndi mankhwala omwe amapangidwa ngati cholumikizira chopanga cha glucagon-peptide-1 cha thupi la munthu, koma nthawi yake yowonekera ndiyotalikirapo. Ubwino wake kwa anthu odwala matenda ashuga umagona ndendende chifukwa chakuti umagwira ngati timunthu wa munthu. Kuphatikiza pa kuwongolera kunenepa komanso kuwongolera glycemic, hemoglobin ya glycosylated imakhala bwino ndi 1-1.8%.

Ndi zabwino zake zambiri, poyerekeza ndi njira zina, Baeta ilinso zovuta. Njira yotulutsira mankhwalawa imangotengera ma jakisoni amkati, mapiritsi a analogue sanapangidwe. Theka lachitatu la anthu odwala matenda ashuga omwe akhala akugwiritsa ntchito mankhwalawa kwa nthawi yayitali ali ndi zodandaula za mawonekedwe osakhalitsa a zovuta zoyipa.

Pamene metabolite ikalowedwa, mulingo wa GLP-1 umatha kudumphadumpha kangapo, ndipo mwina umakhala ndi hypoglycemia. Baeta monga metabolic othandizira yatsimikizira yokha mu chithandizo chovuta ndi mankhwala ena a hypoglycemic.

Kanemayo akuwonetsa malangizo a pang'onopang'ono ogwiritsira ntchito zolembera zatsopano za syringe.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

S / c pa ntchafu, pamimba kapena pamphumi. Mlingo woyamba wa Baeta ndi 5 mcg 2 kawiri pa tsiku nthawi iliyonse mkati mwa ola limodzi musanadye chakudya cham'mawa ndi chamadzulo. Simuyenera kupereka mankhwala mukatha kudya. Ngati jakisoni wasowa, chithandizo chimapitilizidwa popanda kusintha kwa mlingo.

Patatha mwezi umodzi chiyambire chithandizo, mlingo wa mankhwalawa ukhoza kuchuluka mpaka 10 mcg 2 pa tsiku.

Pogwiritsa ntchito munthawi yomweyo ndi metformin, thiazolinedione, kapena kuphatikiza kwa mankhwalawa awiri, mlingo wawo woyambirira sasintha. Akaphatikizidwa ndi kuphatikizika kwa sulfonylurea, kuchepetsedwa kwa mankhwala a sulfonylurea kungafunike kuti muchepetse chiopsezo cha hypoglycemia.

Zotsatira za pharmacological

Mphamvu yolimbikitsira incretin (glucagon-like peptide-1), yolimbikitsa kudzipatula kwa shuga m'magazi ndikutulutsa zina za hypoglycemic zotsatira za ma insretins (kukonza beta-cell ntchito, kupondereza kuperewera kwa glucagon ndikuchepetsa kuchepa kwa m'mimba atatha kulowa m'magazi ambiri kuchokera m'matumbo).

Mndandanda wa amino acid wa exenatide (yogwira mankhwala a Baeta) pang'ono umafanana ndi kuchuluka kwa glucagon ngati peptide-1, chifukwa chomwe chimamangilira ndikuyambitsa ma receptors ake mwa anthu, zomwe zimapangitsa kuti maselo azikhala ndi shuga komanso kutulutsa kwa insulin kuchokera ku ma cell a pancreatic beta komanso nawo cyclic AMP kapena njira zina zowonetsera ma intracellular. Imalimbikitsa kutulutsidwa kwa insulini kuchokera ku maselo a beta pamaso pa kutsika kwa glucose.

M'mikhalidwe ya hyperglycemic, imakulitsa katulutsidwe kamatenda a glucose omwe amapezeka m'matumbo a beta, omwe amasiya pamene kuchuluka kwa shuga m'magazi kumatsika ndikufikira mwachizolowezi, potero kumachepetsa chiwopsezo cha hypoglycemia.

Kuteteza kwa insulin panthawi yoyamba ya mphindi 10 (gawo loyamba la mayankho a insulin) kulibe odwala omwe ali ndi vuto la 2 shuga; Kuyamba Byeta kumabwezeretsa kapena kumakulitsa kwambiri magawo oyamba ndi achiwiri a kuyankha kwa insulin mwa odwala.

Poyerekeza ndi maziko a hyperglycemia, kuyang'anira Baeta kumachepetsa kubisalira kwa glucagon, pomwe mayankho abwinobwino a glucagon samasokonezedwa.

Kuyamba Byeta kumabweretsa kuchepa kwa chilimbikitso ndi kuchepa kwa chakudya, kuponderezana kwa m'mimba, komwe kumayambitsa kuchepa kwakumapeto kwake.

Zotsatira zoyipa

Mafupipafupi: Nthawi zambiri (kupitirira 10%), nthawi zambiri (kupitirira 1%, ochepera 10%), mwapang'onopang'ono (kuposa 0,1%, ochepera 1%), kawirikawiri (kuposa 0.01%, ochepera 0,1%), kawirikawiri kwambiri (osakwana 0.01%) .

Nthawi zambiri: nseru, kusanza, kutsegula m'mimba, hypoglycemia (kuphatikiza ndi metformin ndi

Nthawi zambiri: dyspepsia, kunjenjemera, chizungulire, kupweteka kwa mutu, kufooka chilala, kufooka, gastroesophageal Reflux, hyperhidrosis, khungu pakachitika jekeseni,

pafupipafupi: kupweteka kwam'mimba, kutulutsa, kuyereketsa, kudzimbidwa, kusokoneza chisangalalo, kusefukira.

Pafupipafupi: kugona, kuyabwa, kuyabwa, kuperewera kwa madzi (chifukwa cha mseru, kusanza, ndi / kapena kutsekula m'mimba), angioedema.

Zosowa kwambiri: mawonekedwe a anaphylactic.

Poyerekeza ndi zamankhwala, ma antibodies a ku Baete amawoneka, omwe, pomwepo, sasintha pafupipafupi komanso mtundu wazotsatira zoyipa.

Zimanenedwa za milandu ingapo ya nthawi yowonjezera magazi, osakonda kutsagana ndi magazi uku akugwiritsa ntchito warfarin.

Kuchita

Mukamagwiritsa ntchito mankhwala apakamwa omwe amafunika kuti ayamwa msanga m'mimba, muyenera kukumbukira kuti mankhwalawa amatha kuchepetsa m'mimba. Mankhwala osokoneza bongo omwe zochita zawo zimatengera kupendekera kwawo (kuphatikiza mankhwala opha maantibayotiki) akulimbikitsidwa kuti asagwiritsidwe ntchito ola limodzi ola limodzi la Baeta lisanayambike, ngati mankhwalawa amayenera kumwa ndi chakudya, ayenera kumwedwa nthawi yomwe chakudya zimayambitsidwa.

Kuchulukitsa Cmax ya digoxin ndi 17%, TCmax - ndi maola 2,5, pomwe AUC sasintha.

Kuchepetsa AUC ndi Cmax ya lovastatin ndi 40% ndi 28%, motero, kumawonjezera TCmax ndi maola 4.

Kuchulukitsa TCmax ya lisinopril ndi 2 maola (palibe kusintha kumatanthauza tsiku lililonse systolic ndi diastolic magazi amawonekera).

Ndi makonzedwe a warfarin mphindi 30 pambuyo pa Baeta, TCmax ya warfarin inachuluka pafupifupi maola 2, komabe, palibe vuto lililonse la Cmax kapena AUC.