Mlingo wa Glucose ndi Administration

Chlorpropamide (Chlorpropamidum)

N- (para-Chlorobenzenesulfonyl) -N - propylurea.
White crystalline ufa; wopanda fungo komanso wopanda. Sipangokhala mowa, benzene, acetone.
Kapangidwe kake kali pafupi ndi butamide, mosiyana ndi maumboni kuti m'malo mwa benzene nyukiliya imakhala ndi atomu ya Cl m'malo mwa gulu la CH3 ndipo m'malo mwa gulu la butyl (C 4 H 9) ku N 'ili ndi gulu la propyl (C 3 H 7).

Zotsatira zoyipa

Thupi lawo siligwirizana, leukopenia (kuchepa kwa kuchuluka kwa leukocytes m'mwazi), thrombocytopenia (kuchepa kwa kuchuluka kwa ma protein m'magazi), agranulocytosis (kuchepa kwakukulu kwa chiwerengero cha granulocytes m'magazi), kutsekula m'mimba (kutsegula m'mimba), cholestatic jaundice (chikasu cham'maso kwa khungu ndi zotupa za khungu. kusayenda kwa bile mu biliary thirakiti.

Contraindication

Zabwino (kutayika kwathunthu kwa chikumbumtima - gawo loyambirira la chitukuko cha chikomokere, chodziwika ndikusungidwa kwa kupweteka komanso kuwonongeka) ndi chikomokere (kutaya kwathunthu kwa chikumbumtima, chodziwika ndi kusakhalapo kwathunthu kwa kachitidwe ka thupi pazosangalatsa zakunja) zikhalidwe, ketoacidosis (acidization chifukwa chazinthu zambiri za matupi a ketone m'magazi - pakati kagayidwe kazakudya), ana ndi achinyamata, mimba ndi mkaka wa m`mawere, pachimake matenda opatsirana, mkhutu aimpso, leukopenia, thrombocyte ndi granulocytopenia (malingaliro kuchepa kwamapulatifomu ndi ma granulocytes m'mwazi), kuchitapo kanthu kwa opaleshoni, matupi awo sagwirizana ndi sulfonamides.
Mtheradi contraindication ndi jaundice ndi kuphwanya chiwindi ntchito.

Chlorpropamide - mawonekedwe ndi mawonekedwe a ntchito

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Chithandizo cha matenda a shuga a mtundu wachiwiri chimaphatikizapo kuperekera mankhwala ochepetsa shuga a magulu osiyanasiyana.

Izi zimaphatikizapo zochokera ku sulfonylurea.

M'modzi mwa oimira gululi ndi chlorpopamide.

Zambiri pazamankhwala

Chlorpropamide ndichinthu chogwira ntchito chomwe ndi cha m'badwo woyamba wa sulfonylurea. Gulu lake la mankhwala ndi la hypoglycemic popanga othandizira. Chlorpropamide siisungunuka m'madzi, koma, m'malo mwake, imasungunuka mu mowa.

Mosiyana ndi mibadwo ina ya sulfonylurea yotuluka, chlorpropamide imachitika posachedwa. Kuti mukwaniritse mulingo woyenera wa glycemia, umagwiritsidwa ntchito waukulu.

Zotsatira zoyipa za kumwa mankhwalawa zimatchulidwa kwambiri kuyerekeza ndi Glibenclamide ndi ena oimira m'badwo wachiwiri. Kugwiritsa ntchito mosakwanira kupanga mahomoni (insulin) komanso kuchepa kwa minofu yomwe imayamba kugwira ntchito. Kuchiza ndi chlorpropamide kumathandizira odwala omwe ali ndi matenda a shuga osafunikira komanso / kapena odwala matenda amtundu wa 2.

Chlorpropamide ndi dzina lodziwika bwino ngati mankhwala. Amapanga maziko a mankhwalawo (ndi gawo lina). Amapezeka m'mapiritsi.

Zotsatira za pharmacological

Mankhwalawa ali ndi vuto la hypoglycemic. Katunduyo amamangiriridwa ku njira za potaziyamu, kumalimbikitsa kubisalira kwa insulin. Mu minofu ndi ziwalo zomwe zimatengedwa ndi insulin, kuchuluka kwa ma cell receptors kumawonjezeka.

Pamaso pa insulin ya insulin, kuchuluka kwa shuga kumachepa. Ili ndi ntchito yotsutsana. Chifukwa chachinsinsi cha insulin, kulemera kumachitika.

Kutumiza glycemia sikudalira shuga. Chlorpropamide, monga sulfonylureas, imakhala ndi ngozi za hypoglycemia, koma pang'ono.

Akaphatikizidwa ndi othandizira ena a hypoglycemic (biguanides, thiazolidatediones, onani kuyanjana ndi mankhwala ena), Mlingo wotsiriza umachepetsedwa.

Pharmacokinetics

Pambuyo polowa m'matumbo am'mimba, chlorpropamide imatenga bwino. Pakatha ola limodzi, chinthucho chili m'magazi, ndende yake yambiri - pambuyo pa maola 2-4. Plasma mapuloteni omangira> 90%.

Mankhwalawa amagwira ntchito tsiku lonse ngati agwiritsidwa ntchito kamodzi. Kutha kwa theka-moyo kuli pafupifupi maola makumi atatu ndi limodzi. Imapakidwa makamaka mumkodzo (mpaka 90%).

Zizindikiro ndi contraindication

Zizindikiro zogwiritsidwa ntchito ndi shuga osadalira insulin, komanso insipidus ya shuga. Chlorpropamide adayikidwa panthawi yomwe mankhwala amathandizira pakudya, othandizira olimbitsa thupi sanabweretse zotsatira zoyenera pakuwonetsa zizindikiro.

Mwa zina zotsutsana ndi kugwiritsa ntchito mankhwalawa ndi monga:

• Hypersensitivity kuti chlorpropamide,
• Mtundu woyamba wa shuga
• Hypersensitivity ena sulfonylureas,
• kagayidwe ndi kukondera kwa acidosis,
• matenda a chithokomiro,
• ketoacidosis
• chiwindi ndi vuto la impso,
• matenda opatsirana pachimake
• Mimba / mkaka,
• kholo ndi kwa ndani
• zaka za ana
• kulephera mobwerezabwereza kwa chlorpropamide mankhwala,
• zinthu pambuyo pancreatic resection.

Mlingo ndi makonzedwe

Mlingo umakhazikitsidwa ndi adokotala potengera njira ya matenda ashuga komanso kupuma kwa glycemia. Mukakwaniritsa chindapusa chokhazikika mwa wodwala, chitha kuchepetsedwa. Monga lamulo, ndi matenda a shuga a mtundu 2, chizolowezi cha tsiku lililonse ndi 250-500 mg. Ndi matenda a shuga insipidus - 125 mg patsiku. Mukasamutsidwa kupita ku mankhwala ena, kusintha kwa mankhwalawo kumafunikira.

Malangizo ogwiritsira ntchito chlorpropamide amawonetsa kugwiritsa ntchito mankhwala theka la ola musanadye. Ndikofunikira kudya izi nthawi imodzi. Ngati Mlingo umapereka mapiritsi ochepera 2, ndiye kuti phwando limachitika m'mawa.

Kanema kuchokera kwa katswiri wokhudza matenda ashuga komanso momwe mungathanire:

Zolemba zogwiritsira ntchito

Musanakonzekere kukhala ndi pakati, muyenera kusiya chlorpropamide. Kuwongolera matenda a shuga a mtundu wachiwiri ndi insulin kumawerengedwa kuti ndiwo njira yabwino kwambiri. Panthawi ya mkaka, amatsatira mfundo zomwezo.

Kutumiza kwa mankhwalawa amapangidwa kuchokera hafu ya piritsi patsiku, ndiye kuti imayikidwa piritsi loyamba. Odwala omwe ali ndi vuto laimpso / kwa chiwindi ntchito amafunika kusintha kwa mlingo. Popereka mankhwala kwa anthu achikulire, zaka zawo zimawaganiziridwa.

Mukalipira ngongoleyo, muyenera kuchepetsa mankhwalawa. Kuwongolera kumachitidwanso ndikusintha kwa thupi, katundu, kusunthira kwina.

Chifukwa cha kusowa kwa chidziwitso cha chitetezo cha mankhwalawa, mankhwalawa saikidwa kwa ana. Ngati mukuvulala, musanayambe kugwira ntchito, munthawi ya matenda opatsirana, wodwalayo amasamutsidwa kwakanthawi insulin.

Osagwiritsa ntchito ndi Bozetan. Pali umboni kuti zidakhudza odwala omwe adalandira chlorpropamide. Adanenanso kuwonjezeka kwa hepatic indices (ma enzyme). Malinga ndi momwe mankhwalawa amagwiritsidwira ntchito, mankhwalawo amadzimadzi amadzimadzi am'maselo amachepetsa. Izi zimaphatikizira kudzikundikira kwawo, zomwe zimawabweretsa poizoni.

Kuchita ndi mankhwala ena

Pogwiritsa ntchito nthawi yomweyo chlorpropamide ndi mankhwala ena, zotsatira zake zitha kuchepa kapena kuwonjezeka. Kufunsidwa koyenera musanamwe mankhwala ena.

Kuwonjezeka kanthu mankhwala kumachitika pamene coadministered ndi insulin, mankhwala ena hypoglycemic, biguanides, coumarin ofanana nawo, phenylbutazone, mankhwala tetracycline, Mao zoletsa, fibrates, salicylates, miconazole, streroidami, mwamuna mahomoni, cytostatics, sulfonamides, opangidwa kuchokera quinolone, clofibrate, sulfinpyrazone.

Mankhwala otsatirawa amachepetsa mphamvu ya chlorpropamide: barbiturates, diuretics, adrenostimulants, estrogens, mapiritsi akulera, Mlingo waukulu wa nicotinic acid, diazoxide, mahomoni a chithokomiro, phenytoin, glucocorticosteroids, sympathomimetics, phenothiazine.

Chlorpropamide ndi othandizira a hypoglycemic omwe amatanthauza zoyamba za m'badwo wa sulfonylurea. Poyerekeza ndi otsatira ake, imachepetsa shuga ndikuchepetsa kwake. Pakadali pano, mankhwalawa sagwiritsidwa ntchito.

Mapiritsi othandizira kubereka a shuga

Njira zina zimatha kukhala ndi vuto la shuga. Dziwani zambiri zamomwe mungakhalire ndi njira zakulera zakutsogolo kwa amayi omwe ali ndi matenda ashuga.

Mkazi yemwe ali ndi matenda ashuga amakumananso ndi mavuto omwe azimayi ambiri amakumana nawo, monga kusankha njira yakulera. Komabe, mosiyana ndi azimayi omwe alibe matenda ashuga, ayenera kuganizira momwe njira zakulera zomwe angasankhe zimakhudzira shuga wake wamagazi.

Matenda a shuga ndi mapiritsi olembera

M'mbuyomu, mapiritsi oteteza kubereka sanalimbikitsidwe kwa amayi omwe ali ndi matenda ashuga chifukwa cha kusintha kwa mahomoni komwe chithandizo chitha kubweretsa. Mlingo waukulu wamahomoni umatha kukhala ndi chidwi chachikulu ndi shuga m'magazi, zomwe zimapangitsa kuti zikhale zovuta kuti azimayi azisamalira matenda awo ashuga. Komabe, kafukufuku wazopangidwe zatsopano kwapangitsa kuti mitundu yamagetsi ikhale yopepuka. Mapiritsi atsopano, monga kukonzekera pakamwa Jess, ndi otetezeka kwa amayi ambiri, osati ndi matenda a shuga okha. Ngati mulibe luso logwiritsa ntchito njira zakulera izi, werengani ndemanga za adotolo za mapiritsi. Amayi omwe ali ndi matenda ashuga omwe amasankha kugwiritsa ntchito mapiritsi oletsa kubereka ayenera kumwa mlingo wochepetsetsa wothana ndi vuto la matenda ashuga.

Koma, amayi omwe amamwa mapiritsi a kulera ayenera kukumbukira kuti chiwopsezo chowonjezeka cha myocardial kapena stroko mwa amayi omwe amagwiritsa ntchito njira yolerera. Popeza anthu omwe ali ndi matenda a shuga amakhalanso ndi chiopsezo chowonjezeka cha matenda a mtima, azimayi ayenera kufunsa dokotala.

Matenda a shuga ndi njira zina zakulera

Mapiritsi othandizira kubereka si njira yokhayo yogwiritsira ntchito mahomoni kuti mupewe kutenga pakati. Palinso majakisoni, zimadzala, mphete ndi mitengo.

Majakisoni akukhala chisankho chodziwika bwino chifukwa jakisoni imodzi ya depot medroxyprogesterone acetate (Depo-Provera) imaletsa kutenga pakati mpaka miyezi itatu. Pogwiritsa ntchito njirayi, azimayi akuyenera kuganiza zakulera kangapo pachaka. Komabe, popeza jakisoni amagwiritsa ntchito progestin ya mahomoni, pamakhala zovuta zina monga kunenepa kwambiri, kukula kwa tsitsi losafunikira, chizungulire, kupweteka kwa mutu, komanso nkhawa.

Ngati simukufuna kubaya jakisoni miyezi itatu iliyonse, mutha kuyeserera kulowetsedwa. Ichi ndi ndodo yaying'ono yolingana ndi pulasitiki yomwe imakwanira pansi pa khungu la nkhope yanu. Chikhazikikacho chikakhala, chimatulutsa progestin, mahomoni ofanana ndi jakisoni.

Chipangizo chinanso chophatikizidwa ndi gulu la kulera ndi mphete ya ukazi, yomwe imavalidwa masiku 21. Mpheteyi imayikidwa m'chigawo chapamwamba cha nyini, ikakhala m'malo, simukumva. Mphete imangopereka progestin, komanso estrogen, zomwe zikutanthauza kuti azimayi omwe amagwiritsa ntchito amatha kukumana ndi zovuta zomwe zimafanana kwambiri ndi njira zakulera za piritsi.

Pomaliza, pali chigamba choletsa kulera. Monga ma plasters ena a mankhwala, mwachitsanzo, omwe amakakuthandizani kuti musiye kusuta, chigamba cha kulera chimagwira ntchito mukamayikidwa pakhungu. Chigamba chimatulutsa estrogen ndi progestin sabata imodzi, kenako chimasinthidwa ndi china chatsopano, izi zimachitika kwa masabata atatu motsatizana. Chigamba sichimavalidwa sabata lachinayi (nthawi yakusamba), kenako kuzungulira kumabwereza. Ndiponso, zoyipa zimatha kukhala zofanana ndi mapiritsi oteteza kubala kapena mphete zachikazi, kuphatikiza pamakhala kukhumudwitsa komwe kumakhala pakhungu lomwe mukugwiritsa ntchito chigambacho.

Monga mapiritsi oteteza kubereka, mitundu ina ya njira zakulera za mahomoni zimakhudzanso shuga yanu yamagazi. Ngati mungagwiritse ntchito imodzi mwanjira izi, mungafunike kusintha mtundu wa mankhwala anu a shuga.

Matenda a shuga ndi zida za intrauterine

Zipangizo za Intrauterine (IUDs) ndi zida zomwe zimayikidwa mu chiberekero. IUD imakhalapobe kwanthawi kwakanthawi mpaka adotolo atachichotsa. Pazifukwa zomwe madokotala samamvetsetsa bwino, IUD imalepheretsa dzira losauthira kuti lisayikidwe kukhoma la chiberekero ndipo limathandizira kupewa kutenga pakati. Ngakhale IUD ndi njira yothandiza kwambiri yakulera, imodzi mwazovuta zakugwiritsa ntchito ndi matenda am'kati mwa chiberekero.

Amayi omwe ali ndi matenda a shuga ali pachiwopsezo chachikulu chotenga matenda chifukwa cha matenda awo, chifukwa chake mtundu uwu wa kubereka sungakhale chisankho chabwino kwambiri ngati muli ndi matenda ashuga.

Matenda a shuga ndi zotchinga njira zakulera

Ndi nkhawa za matenda opatsirana pogonana, njira zotchinga zikufalikira kwambiri pakati pa azimayi. Poteteza umuna kuti usafike m'chiberekero, chiopsezo cha kutenga pakati, komanso kufalikira kwa matenda, chimachepa.

Kwa azimayi ambiri, njira zotchinga zimakhala njira yoletsa kubereka, ndipo makondomu ndi zithunzi zamkati sizikhudza shuga. Ndikofunikira, komabe, kumvetsetsa kuti njira zotchinga ndizowonongeka kwambiri kuposa mapiritsi ndipo ziyenera kugwiritsidwa ntchito moyenera, pogonana. Kuphatikiza apo, azimayi omwe ali ndi matenda ashuga amatha kukhala ndi chiopsezo chachikulu chotenga matenda a yisiti mukamagwiritsa ntchito diaphragm.

Matenda A shuga ndi Kuchepetsa

Pomaliza, mwina njira yotetezeka kwambiri yolerera, ndi njira yolera yotsekera pogwiritsa ntchito opaleshoni yotchedwa tubal ligation. Iyi ndiye njira yokhayo yolerera ngati mayi akuchitidwa opaleshoni. Kudalirika kwa njirayi ndikwabwino Pro, ndipo kungokhala kokhazikika kumatha “kutsutsana” ngati simuli wotsimikiza kuti simumafuna ana.

Mfundo ina yomwe imakondera njirayi kwa amayi omwe ali ndi matenda ashuga ndikuti kukhathamiritsa sikukhudza kuchuluka kwa shuga kwa mkazi. Komabe, opaleshoniyo ilibe ngozi, kuphatikiza matenda ndi zovuta zina.

Chilichonse chomwe mungasankhe, njira yodalirika yolerera ndiyofunika kwa amayi omwe ali ndi matenda ashuga, popeza kuti kukhala ndi pakati osakonzekera kumalumikizidwa ndi chiopsezo ku thanzi la mayi ndi mwana. Kukhala ndi udindo wokhudzana ndi kubereka kumakupatsani mpando woyendetsa.

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Kugwiritsa

Mlingo umayikidwa payekhapayekha, poganizira zomwe zimayimira glycemia ndi glucosuria. Mlingo woyambirira ndi 250 mg / tsiku, kwa okalamba odwala - 100-125 mg / tsiku, nthawi yogwiritsira ntchito ndi masiku 3-5. Kenako, kutengera mphamvu, pang'onopang'ono mlingo umachepetsedwa kapena kuwonjezeka ndi 50-125 mg ndi gawo la masiku 3-5. Mlingo wambiri watsiku ndi tsiku ndi 500 mg.

Mulingo woyenera wokonza ndi 100-500 mg / tsiku, kutengera momwe wodwalayo alili, pafupipafupi makonzedwe ake ndi 1 r / tsiku panthawi ya kadzutsa. Mukasankha othandizira ena a hypoglycemic ndi chlorpropamide, mankhwala omwe kale adagwiritsidwa ntchito ayenera kusiyidwa ndipo chlorpropamide iyenera kukhazikitsidwa ndi 250 mg / tsiku.

Kugwiritsa ntchito mankhwalawa kwakanthawi kumatha kubweretsa kuchepa kwa chidwi cha othandizira pakamwa.Pamene chlorpropamide ikawonjezeredwa pamankhwala ambuyomu a insulin (munthawi yomwe mlingo wa insulin wa tsiku ndi tsiku sunapitirire 40), mlingo wa insulin nthawi zambiri umachepetsedwa ndi 50%.

Zotsatira zoyipa

- hypoglycemia ya zovuta zosiyanasiyana, mpaka kukomoka,
- Matenda a dyspeptic (mseru, kusanza, kumva kudzaza m'mimba),
- khungu AR (redness, urticaria),
- nthawi zina - leukopenia, agranulocytosis,
- osowa - - jaundice wopewera, thrombocytopenia, magazi aplasic.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati. Mu shuga wambiri wokhala ndi hyperglycemia komanso glucosuria, amayamba ndi 0,5 g kamodzi patsiku, m'mawa, mphindi 30 asanadye.

Mwa mitundu yofatsa ya shuga - kuchokera pa mlingo wa 0,25 ga, osagwira pakadutsa sabata 1, mlingowo ukuwonjezeka mpaka 0,5 g, ndipo nthawi zina mpaka 0,75 g. Ndi matenda a glycemia komanso kuthetsa glucosuria, mlingo umachepetsedwa ndi 0.125 g milungu iwiri iliyonse. Popeza mphamvu ya 0,75 ga, makonzedwe ena ndi osatheka.

Ndi matenda a shuga a insipidus - 0.1-0.15 g / tsiku.

Malangizo apadera

Kuwunikira pafupipafupi shuga a magazi ndikatha kudya glycosylated Hb, glycemia tsiku lililonse ndi glucosuria ndikofunikira.

Zovulala, chithandizo cha opaleshoni, matenda opatsirana, panthawi yoyembekezera, kusunthidwa kwakanthawi kwa wodwala kupita ku insulin kumasonyezedwa.

Odwala ayenera kuchenjezedwa za kuthekera kwa kuchitapo kwa hypoglycemic, makamaka pakakhala matenda opatsirana kapena nthawi ya vuto loipa.

Zizindikiro za hypoglycemia zimatha kusungunuka kapena kusowa kwa okalamba omwe ali ndi vuto lauronomic kapena nthawi yomweyo kulandira beta-blockers, clonidine, reserpine, guanethidine kapena ena achifundo.

Ngati kuli kofunikira kusamutsa wodwala kuchokera ku insulin mankhwala kupita kumlomo wa chlorpropamide, jakisoni wa insulin akhoza kuyimitsidwa mwadzidzidzi, ndipo ngati wodwalayo alandila zoposa 40 PIECES / tsiku, ndiye kuti mankhwalawa ndi chlorpropamide angayambike ndi kuchepa kwa 50% ya mlingo wa insulin m'masiku ochepa.

Mukamalipira shuga mellitus, kuchepa kwa insulin kumawonjezera (mwina kuchepetsa kufunika kwa mankhwalawo).

Kuwongolera kwa dose kumachitika ndikusintha kwa thupi la wodwalayo, momwe amakhalira, chifukwa chiopsezo chowonjezera cha hypoglycemia.

Munthawi yamankhwala, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafuna kuti chidwi ndi kuthamanga kwa ma psychomotor kuchitike.

Mafunso, mayankho, ndemanga pa Chlorpropamide

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe amaphatikizidwa ndi zomwe amapanga ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.

Pharmacology

Imalimbikitsa kutulutsidwa kwa insulin m'maselo a pancreatic beta ndikuwonjezera kuchuluka kwa insulin zolandila mu ziwalo zomwe mukufuna. Ili ndi ntchito yotsutsana.

Imayamwa bwino m'mimba, imapezeka m'magazi mkati mwa ola lathunthu mutatha kuperekera. C_max akwaniritsidwa mu maola 2-4_1/2 - Maola 36. Amatulutsidwa ndi impso (80-90% ya mlingo) kwa maola 96, kuphatikiza 20-30% osasinthika. Hypoglycemic zotsatira pambuyo limodzi mlingo kumatha maola 24.

Bongo

Chithandizo: hypoglycemia wolimbitsa - kumeza shuga mkati, kusintha kwa mankhwala kapena zakudya. Mwa mawonekedwe owopsa (osowa kwambiri) okhala ndi chikomokere komanso kupweteka - kukhazikitsidwa kwa njira ya glucose yolumikizira 50% ndi kulowetsedwa kwa 10% shuga (kukhalabe ndi shuga m'magazi pamwamba pa 100 mg / dl), kuwunika mosamala kuchuluka kwa shuga m'magazi a 24- 48 h

Mayina amalonda

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