LUNALDIN (LUNALDIN) malangizo ogwiritsira ntchito

- chifukwa cha chiwopsezo cha kupuma koopsa m'moyo, kugwiritsa ntchito Lunaldine kumatsutsana mwa odwala omwe sanalandire chithandizo cha opioid kale,

- mikhalidwe yodziwika ndi kupuma kwambiri kapena matenda oopsa a m'mapapo,

- wazaka mpaka 18

- Hypersensitivity to the yogwira thunthu kapena aliyense wa iwo opeza.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Lunaldin amayenera kugwiritsidwa ntchito pokhapokha ngati odwala omwe amawaganizira kuti ndi ololera opioid, amagwiritsidwa ntchito kupweteka kosalekeza chifukwa cha khansa. Odwala amaonedwa ngati opioid wololera ngati atenga osachepera 60 mg a morphine patsiku, 25 ofg ya fentanyl pa ola limodzi, kapena mlingo wofanana wa analgesic wa opioid wina kwa sabata limodzi kapena kupitilira apo.

Mapiritsi ang'onoang'ono amaikidwa pansi pa lilime mozama momwe angathere. Mapiritsi sayenera kumeza, kutafuna ndi kusungunuka, mankhwalawa ayenera kupasuka kwathunthu kumagawo. Odwala amalangizidwa kuti asadye kapena kumwa mpaka piritsi lawolawo litasungunuka kwathunthu.

Odwala omwe ali ndi pakamwa youma, asanatenge Lunaldin angagwiritse ntchito madzi kuti athetse mankhwalawa.

Mlingo woyenera umatsimikiziridwa kwa wodwala aliyense payekhapokha posankhidwa ndi kuwonjezeka kwapang'onopang'ono kwa mlingo. Posankha mlingo, mapiritsi okhala ndi zinthu zosiyanasiyana zogwiritsidwa ntchito angagwiritsidwe ntchito. Mlingo woyambirira uyenera kukhala 100 μg, pakukonzekera masinthidwe amayamba kuwonjezeka pang'onopang'ono m'malo ofunikira. Munthawi ya kumwa mankhwala, odwala ayenera kuyang'aniridwa mosamala mpaka mlingo woyenera utakwaniritsidwa, i.e., mpaka zotsatira zoyenera za analgesic zitheke.

Zotsatira za pharmacological

Lunaldin ndiwofotokozera, wogwira ntchito mwachidule, wofulumira komanso wofulumira. Zotsatira zazikulu zochizira ndi mankhwala a ululu komanso sedation. Ntchito ya analgesic ndiyokwera pafupifupi nthawi 100 kuposa ya morphine. Lunaldin amathandizira pakatikati kwamanjenje, kupuma ndi matumbo, monga opioid analgesics, yomwe imadziwika ndi mankhwala a mkalasiyi.

Zotsatira zoyipa

Mukamagwiritsa ntchito Lunaldine, munthu ayenera kuyembekezera zosokoneza zina za ma opioid, kuchuluka kwa izi, monga lamulo, kumayamba kuchepa ngati ntchito yayitali. Zovuta zazikulu zomwe zimachitika chifukwa chogwiritsa ntchito opioid ndi kupuma kwamatenda (zomwe zingayambitse kumangidwa kwa kupuma), kuchepa kwa magazi, komanso mantha.

Kuchokera pakupuma dongosolo: pafupipafupi - kupsinjika, kupindika, mpaka kumangidwa.

Kuchokera kwamankhwala amanjenje ndi ziwalo zam'maganizo: kawirikawiri - kupweteka mutu, kugona, nthawi zambiri - kukhumudwa kwa chapakati chamanjenje (kuphatikizapo pambuyo pa opaleshoni), kukhumudwa kwamchiberekero yamanjenje, kutsekemera, kupsinjika, kuzindikira kwamaso. , pafupipafupi osakhazikitsidwa - chisokonezo, chisangalalo, kuyerekezera zinthu zina, kupweteka kwa mutu, kuchepa kwa magazi mkati.

Kuchokera pamimba yodyetsera: pafupipafupi - nseru, kusanza, kusalankhula kocheperako, kuzungulira kwa kupindika kwa Oddi, kuchepa kwa madzi akumimba, kudzimbidwa, colic (mwa odwala omwe anali ndi mbiri yawo).

Malangizo apadera

Chifukwa cha zovuta zoyipa zomwe zingachitike mu chithandizo cha ma opioid monga Lunaldin, odwala ndi omwe akuwasamalira ayenera kuzindikira bwino kufunika kotenga Lunaldin molondola, komanso kudziwa zomwe ayenera kuchita akakhala ndi vuto la bongo.

Musanayambe chithandizo ndi Lunaldin, ndikofunikira kukhazikika pakumwa mankhwala opioid omwe amagwiritsidwa ntchito pochepetsa ululu womwe ukupitilira.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu:

Lunaldin atha kusokoneza mphamvu yakuchita ntchito zowopsa, monga kuyendetsa galimoto kapena kugwiritsa ntchito makina.

Odwala ayenera kulangizidwa kuti apewe kuyendetsa ndi kugwiritsa ntchito makina, monga chizungulire, kugona, kapena kuwonongeka kwamaso kumachitika ndikutenga Lunaldin.

Kuchita

Dinitrogen oxide imawonjezera kukhazikika kwa minofu, ma tridclic antidepressants, opiates, sedative ndi hypnotics (Ps), phenothiazines, mankhwala osokoneza bongo (tranquilizer), mankhwala othandizira opaleshoni, zotumphukira minofu, zoyipa (kupsinjika kwa CNS, hypoventilation, ochepa hypotension, bradycardia, kupuma pakati pakukakamiza ndi ena).

Imawonjezera mphamvu ya antihypertensive mankhwala. Beta-blockers imatha kuchepetsa pafupipafupi komanso kuopsa kwa vuto la kupanikizika kochitidwa opaleshoni yamtima (kuphatikizapo sternotomy), koma kuonjezera ngozi ya bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone amachepetsa mphamvu ya analgesic ya Lunaldin ndikuchotsa mphamvu yake yoletsa kupuma.

Kutulutsa mafomu ndi kapangidwe kake

Amapezeka mu mawonekedwe a sublingual (kusungunuka pansi pa lilime) mapiritsi a mitundu yosiyanasiyana (mcg) ndi mawonekedwe:

• 100 - wozungulira
• 200 - ovoid,
• 300 - patatu,
• 400 - rhombic
• 600 - semicircular (yooneka ngati D,)
• 800 - kapisozi.

Piritsi limodzi limakhala ndi ntchito - fentanyl citron micronized ndi othandizira.

Pharmacokinetics

Mankhwalawa ali ndi mphamvu yotchedwa hydrophobicity, kotero, imakamizidwa mofulumira mkatikati mwa pakamwa kuposa momwe amathandizira kugaya chakudya. Kuchokera kudera laling'ono, limalowa mkati mwa mphindi 30. Bioavailability ndi 70%. Chiwonetsero chachikulu cha magazi a fentanyl chimafika ndikuyamba kwa mankhwala a 100-800 μg pambuyo pa mphindi 8-10.

Kuchuluka kwa fentanyl (80-85%) kumalumikizana ndi mapuloteni a plasma, omwe amachititsa kuti pakhale nthawi yochepa. Kuchulukitsa kwa kaperekedwe ka mankhwalawa mlingano ndi 3-6 l / kg.

Kupanga kwakukulu kwa fentanyl kumachitika mothandizidwa ndi hepatic michere. Njira yayikulu yochotsera thupi ndi mkodzo (85%) ndi bile (15%).

Kutalika kwa theka la chinthu kuchokera mthupi kumachokera ku maola 3 mpaka 12,5.

Zizindikiro zogwiritsidwa ntchito ndi Lunaldin

Chizindikiro chachikulu chogwiritsidwa ntchito ndi Lunaldin ndi pharmacotherapy ya chizindikiro cha ululu kwa odwala khansa omwe amalandira chithandizo chokhazikika cha opioid.

Chizindikiro chachikulu chogwiritsidwa ntchito ndi Lunaldin ndi pharmacotherapy ya chizindikiro cha ululu kwa odwala khansa omwe amalandira chithandizo chokhazikika cha opioid.

Ndi chisamaliro

Kusamala kowonjezereka kumafunikira pakupereka Lunaldin kwa odwala omwe amakonda kutsata intracranial owonjezera wa CO₂ m'magazi:

• kuchuluka kwazovuta zamkati,
• chikomokere
• kudziwa zolakwika
• neoplasms ya ubongo.

Makamaka kusamala pakugwiritsira ntchito mankhwalawa kuyenera kuchitika pochiza anthu omwe ali ndi vuto la mutu, mawonekedwe a bradycardia ndi tachycardia. Odwala okalamba komanso ofooka, kumwa mankhwalawa kungayambitse kuchuluka kwa theka la moyo ndikuwonjezera chidwi cha zosakaniza. Mu gululi la odwala, ndikofunikira kuwona mawonetseredwe a zizindikiro za kuledzera ndikusintha mlingo kumatsikira.

Odwala omwe ali ndi vuto la impso komanso hepatic, mankhwalawa amatha kuyambitsa kuchuluka kwa fentanyl m'magazi (chifukwa cha kuchuluka kwake kwa bioavailability komanso kuletsa kuchotsedwa). Mankhwalawa ayenera kugwiritsidwa ntchito mosamala kwambiri odwala omwe ali ndi:

• Hypervolemia (kuchuluka kwa madzi a m'magazi),
• matenda oopsa
• kuwonongeka ndi kutupa kwa mucosa mkamwa.

Malangizo a Lunaldin

Gawani odwala omwe ali ndi kulolera kwa opioids, mutatenga 60 mg ya morphine pakamwa kapena 25 μg / h ya fentanyl. Kumwa mankhwalawa kumayamba ndi mlingo wa 100 mcg, pang'onopang'ono kuchuluka kwake. Ngati mkati mwa mphindi 15-30. mutatenga piritsi la 100 μg, ululu suuma, ndiye kuti mutenge piritsi lachiwiri lomwe limagwira ntchito yomweyo.

Gome limawonetsa njira zachitsanzo zoperekera muyeso wa Lunaldin, ngati mlingo woyamba sukubweretsa:

Kumwa mankhwalawa kumayamba ndi mlingo wa 100 mcg, pang'onopang'ono kuchuluka kwake.

Ngati mutamwa mlingo wambiri wa mankhwalawa, zotsatira za analgesic sizinachitike, ndiye kuti mlingo wapakatikati (100 mcg) ndi mankhwala. Mukamasankha mlingo pa gawo lodzikakamiza, musagwiritse ntchito mapiritsi oposa 2 omwe akumenyedwa kamodzi. Zotsatira za thupi la fentanyl mu mlingo woposa 800 mcg sizinawunikidwe.

Ndi mawonetseredwe amitundu yoposa inayi ya kupweteka kwambiri patsiku, kupitilira masiku opitilira 4 motsatana, kusintha kwa mankhwalawa kwa nthawi yayitali ya opioid mndandanda kumayikidwa. Mukasinthira kuchoka ku analgesic kupita ku imzake, kutumikiridwa mobwerezabwereza kwa mlingo kumachitika moyang'aniridwa ndi dokotala ndikuwunika kwa Laborator momwe wodwalayo alili.

Ndi kutha kwa kupweteka kwa paroxysmal, Lunaldin anasiya. Mankhwalawa amachotsedwa, pang'onopang'ono kuchepetsa mlingo, kuti asayambitse kuwoneka ngati achire.

Matumbo

Mankhwala amatha kukhala olepheretsa matumbo athu kuti ayambe kudzimbidwa. Kuphatikiza apo, zotsatirazi nthawi zambiri zimadziwika:

• kamwa yowuma
• kupweteka m'mimba,
• matumbo
• mavuto a dyspeptic
• matumbo,
• mawonekedwe a zilonda pamlomo wamkamwa,
• kuphwanya lamulo lakumeza,
• kukomoka.

Chomwe chimakhala chofala kwambiri ndikupanga mpweya wambiri, zomwe zimayambitsa kuphuka komanso kuphimba.

Pakati mantha dongosolo

Kuchokera pakati mantha dongosolo nthawi zambiri kumabuka:

• asthenia
• kukhumudwa
• kusowa tulo
• kuphwanya kukoma, masomphenya, malingaliro oyipa,
• kuyerekezera
• zamkhutu
• chisokonezo,
• zolota
• kusintha kwakuthwa,
• nkhawa zochulukirapo.

Vuto lodzilamulira tokha ndilofala.

Kuchokera pamtima

Zomwe zimachitika mu izi:

• kugwa kwam'maso,
• kumasuka kwamisempha ya makoma amitsempha yamagazi (vasodilation),
• mafunde
• khungu
• arrhythmia.

Pathological zimatha kuwonetsedwa ndi ochepa hypotension, kusokonekera kwa mtima, kuchepa kwa mtima (bradycardia) kapena kuwonjezeka kwa kugunda kwa mtima (tachycardia).

Thupi lawo siligwirizana ndi mankhwalawa limatha kudziwoneka ngati:

• mawonekedwe a khungu - zotupa, kuyabwa,
• redness ndi kutupa pamalo a jakisoni.

Odwala omwe ali ndi vuto la hypobiliary system, biliary colic, mkhutu wa bile wotuluka ungachitike. Ndi kugwiritsa ntchito nthawi yayitali, kuledzera, malingaliro komanso thupi (kudalira) kumatha. Zotsatira zoyipa za thupi zimatha kuyambitsa kugona komanso kuchepa kwa libido.

Zokhudza mphamvu pakuwongolera njira

Mankhwalawa amatha kusokoneza dongosolo lamanjenje lamkati komanso ziwalo zam'maganizo, motero munthawi ya chithandizo Lunaldin ayenera kukana kuyendetsa magalimoto, kugwira ntchito ndi machitidwe ndi ntchito zina zomwe zimafunikira chisamaliro, kuthamanga kwa kupanga zisankho komanso kuona.

Mankhwalawa amatha kusokoneza dongosolo lamkati lamanjenje komanso ziwalo zam'mano, chifukwa cha mankhwala ndi Lunaldin, muyenera kukana kuyendetsa magalimoto.

Gwiritsani ntchito pa nthawi yoyembekezera

Kumwa mankhwala kumafuna chisankho choyenera. Kutalika kwa nthawi yayitali ndi mankhwalawa panthawi yomwe mayi ali ndi pakati kumayambitsa kuchoka kwa wakhanda. Mankhwalawa amalowera mu chotchinga cha m'mimba, ndipo kugwiritsa ntchito kwake pakubadwa kwa mwana ndiwowopsa pakapuma kwa mwana wakhanda komanso wakhanda.

Mankhwalawa amapezeka mkaka wa m'mawere. Chifukwa chake, kubereka kwake pakamayamwa kumatha kuyambitsa kupuma kwa khanda. Mankhwala mu kuyamwitsa ndi nthawi yakhazikitsidwa pokhapokha ngati phindu lake limagwiritsidwa ntchito limaposa chiwopsezo cha mwana ndi mayi.

The ntchito aimpso kuwonongeka

Popeza njira yayikulu yogwiritsira ntchito mankhwala ndi ma metabolites ali ndi mkodzo, vuto laimpso, kuchepa kwa chimbudzi, kudzikundikira m'thupi, komanso kuwonjezeka kwa nthawi yochitapo kanthu. Odwala otere amafunikira kuwongolera kwa plasma ya mankhwala ndi kusintha kwa mlingo ndi kuwonjezeka kwa voliyumu yake.

Kugwiritsa ntchito kwa vuto la chiwindi

Mankhwalawa amachotsedwa ndi bile, motero, ndi matenda a chiwindi, kwa hepatic colic, nthawi yayitali ingagwiritsidwe ntchito, komwe, ngati dongosolo la mankhwala likatsatiridwa, lingayambitse bongo. Kwa odwala oterowo, mankhwalawa amayenera kumwedwa mosamala, kuwona kuchuluka ndi kuchuluka kwa mankhwalawa kwa adokotala, ndi kumayesedwa pafupipafupi.

Bongo

Pankhani ya bongo wa Lunaldin, mavuto obwera chifukwa cha kupsinjika ndi kupuma kumawonjezereka, mpaka kuima kwake. Thandizo loyamba la bongo ndi:

• kukonzanso ndi kuyeretsa kwamkamwa (malo ochepa) kuchokera kumanzere a phale,
• kuwunika kwa zokwanira odwala,
• kupuma movutikira, kuphatikiza makulitsidwe ndi mpweya wabwino,
• kusunga kutentha kwa thupi
• kuyambitsa kwamadzi kuti apange kutayika kwake.

Maantidote ku opioid analgesics ndi Naloxone. Koma zitha kugwiritsidwa ntchito pokhapokha kuthetsa bongo mwa anthu omwe sanagwiritse ntchito ma opioid kale.

Ndi hypotension yayikulu, mankhwala obwezeretsa m'madzi a m'magazi amaperekedwa kuti athetse magazi.

Maantidote ku opioid analgesics ndi Naloxone.

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

Mapiritsi ang'onoang'ono amtundu woyera, mawonekedwe ozungulira.

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

tabu. masentimita 200 mcg: ma 10 kapena 30 ma PC.
Reg. Ayi: 9476/10 ya 02.11.2010 - Pakatika

Mapiritsi ang'onoang'ono ndi oyera, ozungulira.

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

tabu. masentimita 300 mcg: ma 10 kapena 30 ma PC.
Reg. Ayi: 9476/10 ya 02.11.2010 - Pakatika

Mapiritsi ang'onoang'ono amtundu woyera, wopindika patali.

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

tabu. sublingual 400 mcg: ma 10 kapena 30 ma PC.
Reg. Ayi: 9476/10 ya 02.11.2010 - Pakatika

Mapiritsi ang'onoang'ono amtundu woyera, wopangidwa ndi diamondi.

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

tabu. masentimita 600 mcg: ma 10 kapena 30 ma PC.
Reg. Ayi: 9476/10 ya 02.11.2010 - Pakatika

Mapiritsi okhala ndi mitundu yoyera, "D-mawonekedwe".

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

tabu. sublingual 800 mcg: ma 10 kapena 30 ma PC.
Reg. Ayi: 9476/10 ya 02.11.2010 - Pakatika

Mapiritsi okhala ndi zinthu zoyera ndi zoyera, kapangidwe kake.

Othandizira: mannitol, microcrystalline colloidal cellulose (osakanikirana wa 98% microcrystalline cellulose ndi 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Ma PC 10 - matuza (1) - makatoni.
Ma PC 10 - matuza (3) - makatoni.

Mankhwala

Lunaldin ndiwofotokozera, wogwira ntchito mwachidule, wofulumira komanso wofulumira. Zotsatira zazikulu zochizira za Lunaldin ndi analgesic komanso sedative. Ntchito ya analgesic ya Lunaldin ndiyokwera kwambiri kuposa 100 ya morphine. Lunaldin amathandizira pakatikati kwamanjenje, kupuma ndi matumbo, monga opioid analgesics, yomwe imadziwika ndi mankhwala a mkalasiyi.

Zawonetsedwa kuti odwala omwe ali ndi khansa omwe ali ndi ululu omwe amalandila pafupipafupi kukonza kwa opioids, fentanyl imachepetsa kwambiri kupweteka kwamankhwala opweteka (mphindi 15 pambuyo pa utsogoleri), poyerekeza ndi placebo, yomwe imachepetsa kwambiri kufunika kwa mankhwala opweteketsa mwadzidzidzi. Chitetezo ndikuyenda bwino kwa fentanyl kudawunikiridwa mwa odwala omwe adalandira mankhwalawa nthawi yomweyo ululu utachitika. Kugwiritsa ntchito kwa prophylactic kwa fentanyl mu kunenedweratu kopweteka sikunaphunzire mu mayeso a chipatala. Lunaldin, monga onse μ-opioid receptor agonists, amachititsa zotsatira zotsalira za inhibitory pakumapeto. Chiwopsezo cha kupuma kwam'mimba ndizambiri mwa anthu omwe sanalandire ma opioid kale, poyerekeza ndi odwala omwe adakumana ndi ululu waukulu komanso omwe adalandira chithandizo cha nthawi yayitali ndi opioids.

Ma opioids nthawi zambiri amakulitsa kamvekedwe ka minofu yosalala ya kwamikodzo, zomwe zimapangitsa kuwonjezeka kwamkodzo kapena zovuta kukodza. Ma opioids amathandizira kamvekedwe ka minofu yosalala ya mmimba, kuchepetsa matumbo, komwe kungakhale chifukwa cha kukonza kwa fentanyl.

Gwiritsani ntchito pa nthawi yoyembekezera

Chitetezo cha Lunaldin panthawi yoyembekezera sichinakhazikitsidwe. Kuchira kwa nthawi yayitali panthawi yoyembekezera kumatha kuyambitsa "kusiya" kwa wakhanda. Lunaldin sayenera kugwiritsidwa ntchito pakubadwa kwa mwana (kuphatikiza gawo la cesarean), popeza imadutsana ndi chikhodzodzo ndipo imatha kuyambitsa kupsinjika kwa mwana wakhanda kapena khanda.Pakati pa pakati, Lunaldin angagwiritsidwe ntchito pokhapokha ngati phindu lomwe lingakhalepo kwa mayi limayambitsa chiwopsezo kwa mwana wosabadwayo.

Lunaldin amadutsa mkaka wa m'mawere ndipo amatha kukhala ndi mphamvu yosinthika ndikuletsa kupuma kwa ana oyamwitsa. Lunaldin angagwiritsidwe ntchito mwa amayi oyamwitsa pokhapokha ngati phindu la kumwa mankhwalawo limaposa chiwopsezo chomwe chimayambira mayi ndi mwana. Ndi bwino kusiya kuyamwitsa mukamamwa mankhwalawo.

Mlingo ndi makonzedwe

Lunaldin amayenera kugwiritsidwa ntchito pokhapokha ngati odwala omwe amawaganizira kuti ndi ololera opioid, amagwiritsidwa ntchito kupweteka kosalekeza chifukwa cha khansa. Odwala amaonedwa ngati opioid wololera ngati atenga osachepera 60 mg a morphine patsiku, 25 ofg ya fentanyl pa ola limodzi, kapena mlingo wofanana wa analgesic wa opioid wina kwa sabata limodzi kapena kupitilira apo.

Mapiritsi okhala ndi zigawo za Lunaldin amayikidwa mwachindunji pansi pa lilime mozama momwe angathere. Mapiritsi a Lunaldin sayenera kumeza, kutafuna ndi kusungunuka, mankhwalawa amayenera kupasuka kwathunthu kumagawo. Odwala amalangizidwa kuti asadye kapena kumwa mpaka piritsi lawolawo litasungunuka kwathunthu.

Odwala omwe ali ndi pakamwa youma, asanatenge Lunaldin angagwiritse ntchito madzi kuti athetse mankhwalawa.

Mulingo woyenera wa Lunaldin umatsimikiziridwa kwa wodwala aliyense payekhapokha posankhidwa ndi kuwonjezeka kwapang'onopang'ono kwa mlingo. Posankha mlingo, mapiritsi okhala ndi zinthu zosiyanasiyana zogwiritsidwa ntchito angagwiritsidwe ntchito. Mlingo woyambirira wa Lunaldin uyenera kukhala 100 μg, mu gawo la kuchepa kwa mankhwalawa umakulitsidwa pang'onopang'ono ngati kuli kofunikira m'njira zosiyanasiyana. Munthawi ya kumwa mankhwala, odwala ayenera kuyang'aniridwa mosamala mpaka mlingo woyenera utakwaniritsidwa, i.e., mpaka zotsatira zoyenera za analgesic zitheke.

Kusintha kochokera ku fentanyl komwe kumakhala zokonzekera ku Lunaldin sikuyenera kuchitika mwa kuchuluka kwa 1: 1 chifukwa cha mayamwidwe osiyanasiyana a kukonzekera. Ngati odwala akusintha kuchokera ku mankhwala ena okhala ndi fentanyl, kuyika kwa mankhwalawa pogwiritsa ntchito Lunaldine kuyenera kuchitidwa.

Malangizo omwe ali otsatirawa amalimbikitsidwa kuti asankhidwe kwa mlingo, ngakhale muzochitika zonse zomwe adokotala amafunika kuganizira za zomwe wodwala akufuna, zaka, komanso matenda omwe ali nawo.

Odwala onse ayenera kuyamba kulandira chithandizo piritsi limodzi la 100 mcg sublingual. Ngati mphamvu yokwanira ya analgesic siyikupezeka mkati mwa mphindi 15-30 mutatenga piritsi limodzi lokhazikika, mutha kutenga piritsi yachiwiri ya 100 μg. Ngati mutamwa mapiritsi awiri a 100 makilogalamu 100 osakwanira, musaganizire kuchuluka kwa mankhwalawa mu gawo lotsatira la ululu. Kuchulukitsa kwa mankhwalawa kuyenera kuchitika pang'onopang'ono mpaka kupumula kokwanira kwamapweteka Dosing titration iyenera kuyamba ndi piritsi limodzi lokhazikika. Piritsi lachiwiri lowonjezera laling'ono liyenera kutengedwa pambuyo pa mphindi 15-30 ngati chithandizo chokwanira cha ululu sichikwaniritsidwa. Mlingo wa piritsi yolumikizana yowonjezera uyenera kukulitsidwa kuchokera pa 100 mpaka 200 mcg kenako mlingo wa 400 mcg kapena kupitirira. Izi zikuwonetsedwa pachithunzichi. Pakusankha kwa kusankha kwa mankhwalawa, kulandira mapiritsi sayenera kupitirira mapiritsi awiri (2) akumvuto limodzi.
Mlingo (mcg) wa Mlingo woyamba (mcg) wowonjezera
mapiritsi okhala ndi mphamvu piritsi (lachiwiri) lamkati, zomwe
gawo la vuto lopweteka limayenera kutengedwa
15-30 mphindi pambuyo piritsi loyamba

100 100
200 100
300 100
400 200
600 200
800 -

Ngati kupweteka kokwanira kumakwaniritsidwa pamlingo wapamwamba, koma zotsatira zosayenerazi zimawoneka kuti ndizosavomerezeka, mlingo wapakati ungathe kutumikiridwa (pogwiritsa ntchito piritsi ya ma microgram 100). Mlingo wa zopitilira 800 osawunika pamayeso azachipatala. Kuchepetsa chiopsezo chotsatira chokhudzana ndi kumwa mankhwala opioid ndi kudziwa mulingo woyenera, kuyang'anira wodwala mosamala pakadutsa panjira ndikofunikira.

Atazindikira mulingo woyenera, womwe umatha kukhala piritsi limodzi, odwala amathandizidwa ndikukonzekera kumwa mankhwalawa ndikuchepetsa kugwiritsidwa ntchito kwa mankhwalawa mpaka anayi a Lunaldin patsiku.

Ngati machitidwe (anesthesia kapena kusintha kosiyanasiyana) muyezo wofanana wa Lunaldin asintha kwambiri, kusintha kwa mankhwalawa kungafunike kuti mulibe mlingo woyenera. Ngati zopweteka zopitilira zinayi zimawonedwa patsiku kwa masiku opitilira anayi, mulingo uyenera kusinthidwa.

opioids omwe akhala akuchita kwa nthawi yayitali amagwiritsidwa ntchito pochepetsa ululu wosalekeza. Ngati mankhwala opioid omwe akhala akuchita kwa nthawi yayitali m'malo mwake kapena mlingo wake utasinthidwa, mulingo wa Lunaldine uyenera kuwerengedwanso ndikuwapatsa gawo lina kuti asankhe wodwala woyenera.

Kubwereza kwakubwereza komanso kusankha kwa ma painkiller kuyenera kuchitika moyang'aniridwa ndi achipatala.

Ngati wodwalayo safunikiranso kumwa mankhwala opioid, mlingo wa Lunaldin uyenera kukumbukiridwa musanayambe kuchepa kwapang'onopang'ono mu mlingo wa opioids kuti muchepetse zovuta zomwe zingatheke chifukwa cha "kuchoka". Ngati odwala akupitiliza kumwa mankhwala a opioid kuchiza ululu wosapweteka, koma osafunikiranso chithandizo chothandizira kupweteka, Lunaldin akhoza kuyimitsidwa nthawi yomweyo.

Gwiritsani ntchito mwa ana ndi achinyamata

Lunaldin sayenera kugwiritsidwa ntchito mwa odwala omwe ali ndi zaka 18 chifukwa cha chitetezo chokwanira komanso chidziwitso chokwanira.

Gwiritsani ntchito odwala okalamba

Mlingo wosankhidwa uyenera kuchitika mosamala kwambiri. Odwala ayenera kuyang'aniridwa mosamala kuti awone ngati ali ndi vuto la fentanyl.

Gwiritsani ntchito odwala omwe ali ndi vuto laimpso kapena kwa chiwindi ntchito

Odwala omwe ali ndi vuto la chiwindi kapena matenda a impso amayenera kuyang'aniridwa mosamala kuti awone ngati ali ndi vuto la fentanyl poyipa yopereka mlingo wa Lunaldin.

Kuchita ndi mankhwala ena

Dinitrogen oxide imawonjezera kukhazikika kwa minofu, ma tridclic antidepressants, opiates, sedative ndi hypnotics (Ps), phenothiazines, mankhwala osokoneza bongo (tranquilizer), mankhwala othandizira opaleshoni, zotumphukira minofu, zoyipa (kupsinjika kwa CNS, hypoventilation, ochepa hypotension, bradycardia, kupuma pakati pakukakamiza ndi ena).

Imawonjezera mphamvu ya antihypertensive mankhwala. Beta-blockers imatha kuchepetsa pafupipafupi komanso kuopsa kwa vuto la kupanikizika kochitidwa opaleshoni yamtima (kuphatikizapo sternotomy), koma kuonjezera ngozi ya bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone amachepetsa mphamvu ya fentanyl ndikuchotsa mphamvu yake yopumira pakatikati.

Benzodiazepines imachulukitsa kumatulutsa kwa neuroleptanalgesia.

Ndikofunikira kuchepetsa mlingo wa fentanyl mukamagwiritsa ntchito insulin, glucocorticosteroids, antihypertensive mankhwala. Mao inhibitors amalimbikitsa chiopsezo cha zovuta zazikulu.

Zopuma zolimbitsa thupi zimaletsa kapena kuthetsa kusakhazikika kwa minofu, kupumula kwa minofu yokhala ndi m-anticholinergic zochita (kuphatikizapo pancuronium bromide) kumachepetsa chiopsezo cha bradycardia ndi hypotension (makamaka pamene beta-blockers ndi vasodilators ena amagwiritsidwa ntchito) ndipo zimawonjezera chiopsezo cha tachycardia ndi matenda oopsa, m-anticholinergic zochita (kuphatikizapo suxamethonium) sizichepetsa chiopsezo cha bradycardia ndi ochepa hypotension (makamaka motsutsana ndi mbiri yakale ya mtima) ndikukula chiopsezo cha mavuto akulu kuchokera ku mtima.

Mimba komanso kuyamwa

Chitetezo cha Lunaldin panthawi yoyembekezera sichinakhazikitsidwe. Kutenga nthawi yayitali pa nthawi ya pakati kumayambitsa matenda akhanda. Lunaldin sayenera kugwiritsidwa ntchito pakubala (kuphatikiza gawo la cesarean), popeza imadutsana ndi chikhazikitso ndipo imatha kubweretsa kupsinjika kwa mwana wakhanda kapena khanda.

Lunaldin angagwiritsidwe ntchito panthawi yomwe ali ndi pakati pokhapokha ngati phindu lomwe lingakhalepo kwa mayi limaposa chiopsezo cha mwana wosabadwayo.

Fentanyl imachotseredwa mkaka wa m'mawere ndipo imatha kuyambitsa kusokonezeka ndi kupuma kwa mwana wakhanda wakhanda. Chifukwa chake, fentanyl ingagwiritsidwe ntchito poyamwitsa pokhapokha phindu limapitilira chiwopsezo cha mayi ndi mwana.

Kuyanjana kwa mankhwala osokoneza bongo

Fentanyl imapangidwa ndi CYP3A4. Mankhwala omwe amalepheretsa ntchito ya CYP3A4, monga macrolide antibacterial (mwachitsanzo, erythromycin), azole antifungals (mwachitsanzo, ketoconazole, itraconazole), kapena proteinase inhibitors (mwachitsanzo, ritonavir), amatha kuwonjezera kukhudzana kwa fentanyl, potero, ndikuchepetsa kwake , kuwonjezera, kapena kuwonjezera nthawi ya mankhwala a opioid. Madzi a mphesa amadziwika kuti akuletsa CYP3A4. Fentanyl, motero, iyenera kugwiritsidwa ntchito mosamala odwala omwe atenga CYP3A4 inhibitors nthawi yomweyo.

The munthawi yomweyo mankhwala ena omwe amakhumudwitsa kwambiri chapakati mantha dongosolo, monga zina morphine zotumphukira (analgesics ndi antitussive mankhwala), mankhwala opha ululu, minyewa yopuma, antidepressants, H 1 histamine receptor blockers yokhala ndi mphamvu yosintha, barbiturates, tranquilizer (mwachitsanzo, benzodiazepines) , mapiritsi ogona, ma antipsychotic, clonidine ndi mankhwala ena okhudzana angapangitse kuti chiwonjezere cha inhibitory bwanji pa chapakati mantha dongosolo. Kupsinjika kwa kupsinjika, Hypotension ikhoza kudziwika.

Ethanol imapititsa patsogolo mphamvu ya sedphine ya morphine analgesics, kotero, munthawi yomweyo kugwiritsa ntchito zakumwa zoledzeretsa kapena mankhwala okhala ndi mowa Lunaldin sikulimbikitsidwa.

Fentanyl siyikulimbikitsidwa kuti igwiritsidwe ntchito kwa odwala omwe alandila ma MAO inhibitors m'masiku 14 apitawa, chifukwa kuwonjezeka kwa opioid analgesics ndi mao inhibitors akuwonedwa.

Kugwiritsa ntchito nthawi yomweyo kwa opioid receptor antagonists (kuphatikizapo naloxone) kapena gawo la opioid receptor agonists / antagonists (kuphatikiza buprenorphine, nalbuphine, pentazocine) silikulimbikitsidwa. Amayanjana kwambiri ndi ma opioid receptors omwe ali ndi ntchito zochepa kwambiri chifukwa chake amachepetsa pang'ono zotsatira za fentanyl ndipo zimatha kuyambitsa zizindikiro zobwera mwa odwala omwe amadalira opioid.

Maanticonvulsants, monga carbamazepine, phenytoin ndi hexamidine (primidone) amatha kukulitsa kagayidwe ka fentanyl m'chiwindi, ndikufulumizitsa kutuluka kwake kuchokera mthupi. Odwala omwe amalandila chithandizo ndi ma anticonvulsants angafunikire kuchuluka kwa fentanyl.