Cardiomagnyl Forte: malangizo ogwiritsira ntchito

Chifukwa cha kuchuluka kwa matenda amtima, kugwiritsa ntchito Cardiomagnyl nthawi zina ndikofunikira. Mankhwalawa amathandizira magazi pampu yamtima, amakhudza mawonekedwe a mamasukidwe akayendedwe ndipo amaletsa mapangidwe a maphuphu.

Cardiomagnyl akuwonetsedwa ngati prophlaxis yoyamba pamaso pazinthu zina zoyipa, zomwe zimaphatikizapo kunenepa kwambiri komanso matenda ashuga, kusuta ndi kuthamanga kwa magazi, komanso kukalamba, ndi zina zotere. opaleshoni ya mtima inachitidwa.

Kutulutsa Fomu

Makampaniwa amapanga mankhwalawa m'njira yam'mapiritsi, momwe zimasonyezera cholinga cha mankhwalawa. Amayikidwa m'mabotolo amtundu wamagalasi a bulauni a zidutswa 30 kapena 100. Zinthu zazikulu za mankhwalawa ndi:

• acetylsalicylic acid (aspirin),
• magnesium hydroxide,
• kukhuthala
• talcum ufa
• magnesium

Zotsatira za pharmacological ndi pharmacokinetics

Acetylsalicylic acid (ASA), yomwe ndi gawo la Cardiomagnyl, imakhala ndi njira zingapo zolimbana ndi kuphatikizana kwa ma platelet, kuphatikizapo kuletsa kwa enzyme ya COX-1. Kuphatikiza apo, mankhwalawa ndi a analgesic, amathandizira njira zotupa komanso antipyretic. Acid imatha kukhala ndi vuto pa mucosa wam'mimba; magnesium hydroxide imawonjezeredwa pakupanga kwa Cardiomagnyl kuti iwongole.

Ma pharmacokinetics a mankhwalawo ndiotetezeka kwathunthu kwa thupi la munthu.

Mafuta ndi mayamwidwe kuchokera m'mimba thirakiti limachitika mwachangu kwambiri komanso pafupifupi. T1 / 2 ASA ndi mphindi 15; chifukwa cha hydrolysis, amasintha kukhala 100 peresenti ya bioavaidwe salicylic acid. Mchitidwewo umachitika m'magazi am'magazi, m'mimba ndi chiwindi.

T1 / 2 ya salicylic acid wokhala ndi milingo yaying'ono ya Cardiomagnyl pafupifupi maola atatu. Ngati njira za enzyme zikukwanira, mtengo wa chisonyezo umakwera kwambiri.

Malangizo: Momwe mungatenge Cardiomagnyl

Popewa kubwerezanso kwa magazi kuundana ndi CVS yamitundu yosiyanasiyana, nchotheka kupaka mlingo wa tsiku ndi tsiku wa 150 mg pa nthawi yoyamba ya chithandizo, pakapita kanthawi, kuchepetsa mlingo kukhala 75.

Kupangira Cardiomagnyl Forte ndi mulingo woyenera

Mapiritsi a Cardiomagnyl Forte amapezeka pa mlingo 1 piritsi / tsiku. omwe ali ndi matenda a mtima. Umu ndiye chikhalidwe choyambirira, chomwe chimatsitsidwa pambuyo pake.

Momwe mungamwe?

Mapiritsi ayenera kutsukidwa ndi kapu ya madzi oyera kapena madzi ena aliwonse. Nthawi zambiri zimamezedwa zonse, nthawi zina zimaphwanyidwa kapena kudula pakati musanagwiritse ntchito. Mutha kutafuna.

Nthawi yatsiku yotenga Cardiomagnyl

M'malangizo a wopanga, simudzapeza yankho la funso: mankhwalawa amayenera kuledzera m'mawa, madzulo kapena usiku. Dokotala akuyenera kupereka njira yovomerezeka. Nthawi zambiri, upangiri wa dokotala umakhudzanso njira zamadzulo zomwe zimamwa mankhwalawo. Pali zinthu zambiri zomwe zikusonyeza kuti ola limodzi mukatha kudya chakudya chamadzulo ndiye nthawi yabwino kugwiritsa ntchito mankhwala ochepetsa magazi.

Kutalika kwa ntchito

Ngati kuwopsa kwa matenda amtima ndiwokwera, kugwiritsa ntchito mankhwalawa ndikolembedwera pafupipafupi. Kutsiliza kumatha kukhudzidwa pokhapokha ngati pali zotsutsana. Wodwala ndi dokotala wothandiza wodwalayo ayenera kuwunika kuchuluka kwa magazi ndi kuchuluka kwa magazi. Makhalidwe awo othandizira athandizira kudziwa kutalika kwa mankhwalawa.

Tiyeni tiyesetse mayeso kuti tidziwe momwe mtima wanu uliri.

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Mlingo

Ndi mitundu yosiyanasiyana ya matenda a mtima, madokotala nthawi zambiri amapereka mankhwala a Cardiomagnyl tsiku lililonse kumayambiriro kwa 150 mg. Ngati chithandizo chikufunika mu regimen yokonza, mlingo umatheka. Mu pachimake myocardial infarction komanso chidwi ndi angina pectoris, mlingo wa tsiku ndi tsiku umatha kuphatikizidwa mpaka 450 mg. Onani dokotala ndipo atenge Cardiomagnyl ndi chiyambi cha zizindikiro zoyambira.

Contraindication

Nthawi zina, magazi omwe amachepetsa magazi amawagwiritsa ntchito. Izi zimawonedwa matenda am'mimba ndi zina zotaya magazi motalika, kuphatikizapo omwe amayamba chifukwa cha kuchepa kwa vitamini K, matenda a hemorrhagic diathesis ndi thrombocytopenia. Osagwiritsa ntchito mankhwala Cardiomagnyl odwala bronchial mphumu. Pamaso pa kufalikira kwa vuto lakukokoloka ndi chiwonetsero cha magazi m'matumbo am'mimba, mankhwalawa sayenera kuphatikizidwa mpaka pano.

Dokotala sayenera kufotokozera Cardiomagnyl ngati wodwala ali ndi vuto lotchedwa glucose-6-phosphate dehydrogenase komanso ngati CC yatchulidwa Kodi pali vuto lotani pogwiritsa ntchito mankhwalawa panthawi yomwe muli ndi pakati komanso poyamwitsa?

Ngati sacilates alowa mthupi la mayi woyembekezera woyamba trosester waukulu Mlingo, kuwonjezeka mavuto ndi kukula kwa mwana wosabadwayo. Izi zikachitika mu III trimester, ntchito imaletsa. Asanakhazikitsidwe, mphamvu yakumaso yotseka, Mlingo woposa 300 mg / tsiku umatulutsa magazi. Zodabwitsazi zimawonedwa ponse pa mayi ndi mwana wosabadwayo. Zoopsa kwambiri ndi waukulu Mlingo wa mankhwala, omwe amagwiritsidwa ntchito pafupi ndi kubala kwa mwana. Amatha kubowola m'matumbo amkati.

Zochita Zosiyanasiyana

Zotsatira zoyipa nthawi zambiri zimawoneka ngati chifuwa. Nthawi zambiri, odwala amadandaula za urticaria kapena edincke's edema. Nthawi zina, anaphylactic zimachitika. Zotsatira zoyipa zomwe zimapezeka m'mimba zimapezeka:

Mitsempha yamagazi m'mitsempha yamagazi

• kutentha kwa mtima (pafupipafupi kuposa mawonekedwe ena),
• kusanza ndi mseru
• kupweteka ndi kuchuluka kwa kutupa kwa chapamimba mucosa ndi duodenum 12,
• magazi m'matumbo am'mimba,
• kuchuluka kwa michere ya chiwindi,
• prick anditisatitis,
• zovuta
• esophagitis, etc.

Matumbo nthawi zina amakwiya, kusokonekera kwamatumbo komwe kumayang'aniridwa kumawonedwa. Mu kupuma kwamphamvu, kupezeka kwa mawonekedwe a spasmodic mokhudzana ndi bronchus. Mu hematopoietic dongosolo, kusokonezeka mu njira yowonjezereka magazi ndikotheka. Zotsatira zoyipa zimawonedwa nthawi zambiri. Chomwe chimakonda kwambiri ndi kuchepa magazi. Zotsatira zoyipa ndizina:

• mawonetseredwe a agranulocytosis,
• kulumikizana kwa neutropenia
• wodwala ali ndi eosinophilia.

Mwakuyendetsa kwa Cardiomagnyl m'malo ovuta, zovuta zoyipa zimatha kuchitika, zomwe zimatha kudziwoneka ngati mutu, tinnitus, kugona komanso chizungulire. Zotsatira zosasangalatsa kwambiri ziyenera kuonedwa ngati kukha magazi kwa hemorrhage.

Kodi mankhwalawo amagwirizana bwanji ndi mankhwala ena?

Cardiomagnyl imawonjezera mphamvu yakuchiritsa ya anticoagulants, methotrexate, mankhwala okhala ndi hypoglycemic katundu, acetazolamide, ndi zina.

Cardiomagnyl imakhala ndi vuto linalake pakukumana kwa zigawo za ma antacid ndi colestyramine. Sipangaphatikizidwe kuphatikiza NSAIDs ndi Cardiomagnyl. Cardiomagnyl kuphatikiza ndi Probenecid ndizovuta, chifukwa pali kufooka kwa zochizira zamankhwala onse awiri.

Mankhwala ofanana: omwe ali bwino

Pali zithunzi zambiri za Cardiomagnyl. Amasiyana onse mu code ya ATC komanso kapangidwe kazinthuzo komanso momwe amasulidwira. Mwa otchuka kwambiri komanso apafupi ndi makina amachitidwe angadziwike:

Zofananira zambiri za Cardiomagnyl zimasiyana pamtengo wovomerezeka kwambiri (kuchokera ma ruble 8). Acekardol, Fazostabil, Tromboass sakhala ndi kusiyana kwakukulu pakugwiritsira ntchito pulogalamuyi, popeza kuti gawo lalikulu la ntchito ndi ASA, komabe ndi momwe ziliri. Mwachitsanzo, Acecardol ndikofunikira kudya musanadye, ndipo Cardiomagnyl itatha. Mankhwalawa amasiyana ndi mankhwala omwe amapezeka ndi mawonekedwe ena osagwirizana ndi magnesium hydroxide yoteteza mucosa.

Mu Tromboass mulibe magnesium hydroxide, zotsatira zoyipa zimachepetsedwa ndi kukhalapo kwa membrane wapadera wotetezedwa m'matumbo a membrane woteteza. Malinga ndi madotolo ndi odwala, Tromboass ndi Phazostabil adalemba zoyipa zochepa.

Aspirin Cardio, wopangidwa ndi Bayer AG, mosiyana ndi Cardiomagnyl, amakhalanso ndi nembanemba yomwe imasungunuka m'mimba.

Kafukufuku wapadera wathandizira kukhazikitsa: Cardiomagnyl ndiyothandiza kwambiri kuposa mitundu yonse ya entuble soluble komanso imakhudza kuponderezana kwa kuphatikizana kwa mapulosi.

Monga momwe amagawidwira mu pharmacy, malamulo osungira

Mankhwala ndi ma analogu amawerengedwa ndi ma pharmacies popanda mankhwala. Ndikofunikira kuyang'anira tsiku lotha ntchito. Ndizofanana ndi zaka zitatu. Zogula ziyenera kusungidwa kutentha mpaka madigiri 25, kupewa dzuwa.

Ndemanga za Cardiomagnyl pakukula kwa maukonde apadziko lonse ndizabwino, koma palinso kuyesa koyipa komwe kumakhudzana makamaka ndi zomwe odwala amachita ndi njira yolakwika yoyendetsera. Mu ndemanga zopanda pake, mtengo wokwera wa mankhwalawo komanso kupezeka kwa zoyipa zingapo zimayankhulidwa nthawi zambiri.

Mutha kupereka ndemanga zingapo kuchokera pagawo lodziwika bwino ndi ochezeka:

• Sofya Ivakina, wazaka 35. Kwa nthawi yayitali amatenga Cardiomagnyl wolembedwa ndi adokotala, koma adalimbika mtengo. Chipatala adalangiza kuti chisinthidwe ndi analogue yotsika mtengo ya Trombo ass. Ndi m'mimba adasiya kuvutitsa mavuto komanso zachuma.
• Petr Tukin, wazaka 45. Ndimatenga cardiomagnyl kwa zaka zopitilira 3 usiku ola limodzi nditatha kudya chakudya. Ndimakondwera kwambiri ndi zotsatira zake.
• Vera Garina, wazaka 60. Kudya kwa Cardiomagnyl mwanjira ina kumagwirizana ndi mafupa. Ndimasiya kumwa kukonzekeretsa mtima, mafupa anga amasiya kuwawa. Ndiyambira, sindikudziwa kuti ndidziyike pati.
• Leon Izyumin, wazaka 55. Ntchito otsika mtengo. Sindinakonde kugwira bwino ntchito kwawo. Tsopano ndimangotenga miyala ya Cardiomagnyl. Zotsatira zake sizingakhale zabwinoko, kuphatikiza kuthamanga kwa magazi ndi shuga m'magazi.
• Sasha Gulina, wazaka 48. Ngati mtengo wa Cardiomagnyl ukadakhala wocheperako, zonse zindigwirizana. Mankhwala ndi abwino kwambiri. Pondilimbikitsidwa ndi dokotala, ndinasinthira piritsi tsiku lililonse mpaka theka la piritsi. Palibe zoyipa zomwe zimawonedwa.
• Anatoly Petrov, wazaka 67. Ndimalola Cardiomagnyl kwa zaka zingapo. Ndimamva bwino, kuphatikiza popeza kuyambira pachiyambi ndakhala ndikugwiritsa ntchito Ginkgo biloba forte limodzi. Pokonzekera kwachiwiri, zida zolimbitsa khoma zilipo.
• Dina Anisimova, wazaka 55. Ndi m'mimba mwanga, adotolo, osaganizira zovuta, adapereka Cardiomagnyl, potero amawonjezera vutoli. Ndinasinthira ku Acecardol munthawi, tsopano zonse zili bwino. Ndikupangira aliyense amene ali ndi vuto la m'mimba kuti asinthane ndi analogue ya Cardiomagnyl, yomwe ili ndi chipolopolo chosungunuka.

Mankhwala

Acetylsalicylic acid ndi analgesic, odana ndi kutupa ndi antipyretic ndi antiplatelet. Katundu wa antiaggregant amawonjezera nthawi ya magazi.

Kuphatikizika kwakukulu kwa zamankhwala ndizoletsa za mapangidwe a ma prostaglandins ndi thromboxane. Mphamvu ya analgesic ndizowonjezera zomwe zimayambika chifukwa cha kuletsa kwa cycloo oxygenase enzyme. Mphamvu yotsutsa-yotupa imalumikizidwa ndi kuchepa kwa magazi komwe kumachitika chifukwa cha chopinga cha PGE2.

Acetylsalicylic acid mosavomerezeka amalepheretsa kuphatikiza kwa prostaglandins G / H, kutengera kwake kwa maplatini kumatenga nthawi yayitali kuposa asidi acetylsalicylic acid. Mphamvu ya acetylsalicylic acid pa thromboxane biosynthesis m'mapulateleti komanso pakukhetsa magazi kwa nthawi yayitali imatha kwa nthawi yayitali mankhwala atasiya. Chochitikacho chimayima pokhapokha pakuwonekera kwa maselo atsopano m'magazi amwazi.

Salicylic acid (yogwira metabolite ya acetylsalicylic acid) imakhala ndi anti-yotupa, imakhudzanso kupuma, dziko la acid-base balance ndi mucosa. Ma salicylates amathandizira kupuma, makamaka pokhudza mwachindunji mafupa. Ma salicylates amakhudza molunjika m'mimba mwa kuletsa vasodilator wake ndi cytoprotective prostaglandins ndikuwonjezera chiopsezo cha zilonda zam'mimba.

Mafuta Mutatenga acetylsalicylic acid, imakamizidwa mwachangu kuchokera kugaya chakudya. Pambuyo makonzedwe, mayamwidwe osakhala ionized mawonekedwe acetylsalicylic acid amapezeka m'mimba ndi matumbo. Kuchuluka kwa mayamwidwe kumachepa ndi kudya komanso kwa odwala omwe ali ndi vuto la migraine, kumawonjezera - mwa odwala achlorhydria kapena odwala omwe atenga ma polysorbates kapena ma antacid. Kuzindikira kwakukulu mu seramu yamagazi kumatheka pambuyo pa maola 1-2.

Kugawa. Kumangiriza kwa acetylsalicylic acid ku mapuloteni a plasma ndi 80-90%. Voliyumu yogawa kwa akuluakulu ndi kulemera kwa thupi la 170 ml / kg. Ndi kuwonjezeka kwa ndende ya plasma, malo omwe amapangira mapuloteni amakhuta, zomwe zimapangitsa kuti chiwonetsero chiziwonjezereka. Ma salicylates amamangilira kwambiri mapuloteni a plasma ndipo amafalikira thupi lonse. Ma salicylates amadutsa mkaka wa m'mawere ndipo amatha kudutsa chotchinga.

Kupenda. Acetylsalicylic acid ndi hydrolyzed kwa yogwira metabolite - salicylic acid khoma la m'mimba. Pambuyo pa mayamwidwe, acetylsalicylic acid amasinthidwa mwachangu kukhala salicylic acid, koma amakhala ochulukirapo m'madzi a m'magazi mkati mwa mphindi 20 zoyambirira atamwa.

Pomaliza Salicylic acid imapangidwa m'chiwindi. Chifukwa chake, kuchuluka kwa kuchuluka kwa salicylate m'madzi a m'magazi kumawonjezera kuchuluka kwa mkati mwa mkati. Pa mlingo wa 325 mg wa acetylsalicylic acid, kuchotseraku kumachitika ndi kutenga gawo loyambira la kinetics. Kutha kwa theka la moyo kumapangitsa maola 2-3. Ndi mlingo waukulu wa acetylsalicylic acid, theka la moyo limawonjezeka mpaka maola 15-30. Salicylic acid imapukusidwanso osasinthika mkodzo. Kutulutsa kwa salicylic acid kumadalira mlingo wa mkodzo ndi pH. Pafupifupi 30% ya salicylic acid imachotsedwa mkodzo ngati mkodzo umakhala wamchere, 2% yokha ngati ndi acidic. Kupukusira kwa impso kumachitika chifukwa cha kusinthasintha kwa kusefukira kwa thupi, katulutsidwe katulutsidwe ka impso tubules ndi kungoyambiranso chiberekero.

Pachimake komanso matenda a mtima.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Contraindication pa ntchito imodzi.

Methotrexate. Kugwiritsa ntchito acetylsalicylic acid ndi methotrexate mu Mlingo wa 15 mg / sabata kapena zowonjezereka kumawonjezera kawopsedwe wa methotrexate (kuchepa kwa impact clearance ya methotrexate ndi othandizira-kutulutsa komanso kusamukira kwa methotrexate ndi salicylates chifukwa cha mapuloteni a plasma).

ACE zoletsa. ACE zoletsa kuphatikiza ndi waukulu Mlingo wa acetylsalicylic acid amachititsa kuchepa glomerular kusefera chifukwa chopinga wa vasodilatory mphamvu ya prostaglandins ndi kuchepa kwa antihypertensive kwenikweni.

Acetazolamide. Mwina kuwonjezeka kwa kuchuluka kwa acetazolamide kungayambitse kulowa kwa ma salicylates kuchokera m'madzi am'magazi kulowa m'matumbo ndikuyambitsa kuwonongeka kwa acetazolamide (kutopa, kufooka, kugona, kusokonezeka, hyperchloremic metabolic acidosis) komanso kuwopsa kwa salicylates (kusanza, tachycardia, hyperpnoea.

Probenecid, sulfinpyrazone. Mankhwala osokoneza bongo a phenenecid ndi michere yambiri (> 500 mg) amagwiritsidwa ntchito, mphamvu iliyonse ya metabolism imachepetsedwa ndipo chimbudzi cha uric acid chitha kuchepa.

Kuphatikiza kugwiritsidwa ntchito mosamala.

Methotrexate. Pamene acetylsalicylic acid ndi methotrexate amagwiritsidwa ntchito Mlingo wochepera 15 mg / sabata, hematological kawopsedwe wa methotrexate ukuwonjezeka (kuchepa kwa impso chilolezo cha methotrexate ndi othandizira-kutulutsa komanso kusungidwa kwa methotrexate ndi salicylates chifukwa cha mapuloteni a plasma).

Clopidogrel, ticlopidine. Kuphatikizidwa kwa clopidogrel ndi acetylsalicylic acid kumatha kukhala ndi synergistic. Kugwiritsa ntchito koteroko kumachitika mosamala, chifukwa izi zimawonjezera ngozi yotulutsa magazi.

Maanticoagulants (warfarin, fenprokumon). Kuchepa kwa kupanga kwa thrombin ndikotheka, kumapangitsa kusakhudzana ndi kuchepa kwa mapulogilamu (Vitag K antagonist) ndikuwonjezera magazi.

Abciximab, tirofiban, eptifibatide. Ndikotheka kuletsa glycoprotein IIb / IIIa zolandilira m'mapulateleti, zomwe zimapangitsa kuti magazi azituluka kwambiri.

Heparin. Kuchepa kwa kupanga kwa thrombin ndikotheka, kumapangitsa kusokoneza kwina kwamathandizo othandizira, omwe amatsogolera magazi.

Ngati zinthu ziwiri kapena zingapo zakumwambazi zimagwiritsidwa ntchito limodzi ndi acetylsalicylic acid, izi zingapangitse kuti pakhale mgwirizano wokhudzana ndi zoletsa zam'magazi, chifukwa, zimawonjezera hemorrhagic diathesis.

NSAIDs ndi COX-2 zoletsa (celecoxib). Kugwiritsidwa ntchito kophatikizana kumawonjezera chiopsezo cha kukhumudwa m'matumbo, ndipo kungayambitse magazi m'matumbo.

Ibuprofen. Kugwiritsa ntchito nthawi yomweyo ibuprofen kumalepheretsa kusakanikirana kwa mapulateni chifukwa cha zochita za acetylsalicylic acid. Chithandizo cha ibuprofen odwala omwe ali ndi chiopsezo chowonekera cha mtima ndi mtima wake amatha kuchepetsa kuchuluka kwa mtima wa acetylsalicylic acid.

Odwala omwe amatenga acetylsalicylic acid kamodzi patsiku kuti ateteze matenda amtima komanso kumwa ibuprofen nthawi ndi nthawi ayenera kumwa acetylsalicylic acid osachepera 2:00 asanadye ibuprofen.

Furosemide. Kuletsa proximal tubular kufooka kwa furosemide ndikotheka, komwe kumayambitsa kuchepa kwa okodzetsa a furosemide.

Quinidine. Zowonjezera m'mapulateleti ndizotheka, zomwe zimapangitsa kuti magazi azituluka nthawi yayitali.

Spironolactone. Mphamvu yosinthidwa ya renin ndiyotheka, yomwe imapangitsa kutsika kwa spironolactone.

Kusankha serotonin reuptake zoletsa. Kugwiritsidwa ntchito kophatikizana kumawonjezera chiopsezo cha kukhumudwa m'matumbo, ndipo kungayambitse magazi m'matumbo.

Vomerezani Pogwiritsa ntchito munthawi yomweyo ndi valproate, acetylsalicylic acid imachotsa kugwirizana kwake ndi mapuloteni a plasma, ndikuwonjezera kawopsedwe kazinthu zam'mbuyo (zoletsa zamkati mwa dongosolo lamanjenje, m'mimba thirakiti).

Systemic glucocorticosteroids (kuphatikiza hydrocortisone, yomwe imagwiritsidwa ntchito pochotsa matenda a Addison) imachepetsa mulingo wama salicylates m'magazi ndikuwonjezera chiopsezo cha mankhwala osokoneza bongo atatha kulandira chithandizo.

Mankhwala osokoneza bongo. Kugwiritsa ntchito pamodzi mankhwala acetylsalicylic acid ndi mankhwala antidiabetic kumawonjezera chiopsezo cha hypoglycemia.

Maantacid. Kuwonjezeka kwa chilolezo cha impso ndi kuchepa kwa impso (chifukwa cha kuchuluka kwa mkodzo wa mkodzo) ndikotheka, komwe kumayambitsa kuchepa kwa zotsatira za acetylsalicylic acid.

Katemera wa chikuku. Kugwirizana kumawonjezera ngozi ya matenda a Reye.

Ginkgo biloba. Kugwiritsa ntchito pamodzi ndi ginkgo biloba kumalepheretsa kuphatikiza kwa maselo ambiri, zomwe zimapangitsa kuti magazi azituluka.

Digoxin. Pogwiritsa ntchito munthawi yomweyo ndi digoxin, kugundika kwamapazi m'magazi kumaonjezera chifukwa cha kuchepa kwa impso.

Mowa zimapangitsa kuwonongeka kwa mucous nembanemba am'mimba ndipo kumatenga nthawi yotuluka magazi chifukwa cha synergism ya acetylsalicylic acid ndi mowa.

Zolemba ntchito

Cardiomagnyl Forte amagwiritsidwa ntchito mosamala potsatira izi:

• Hypersensitivity kwa analgesic, odana ndi kutupa, anti-rheumatic mankhwala, komanso pamaso pa chifuwa cha zinthu zina.
• zilonda zam'mimba, kuphatikizapo mbiri yokhala ndi zilonda zam'mimba kapena zilonda zam'mimba
• kugwiritsa ntchito munthawi yomweyo ma anticoagulants,
• Odwala omwe ali ndi vuto la impso kapena odwala mkhutu wamatenda oyenda mtima (mwachitsanzo, mtima wamitsempha, matenda a mtima wosakhazikika, hypovolemia, opaleshoni yayikulu, sepsis, kapena magazi akulu), chifukwa acetylsalicylic acid ingakulenso chiopsezo cha vuto laimpso ,
• Odwala omwe ali ndi vuto lalikulu la shuga-6-phosphate dehydrogenase, acetylsalicylic acid angayambitse hemolysis kapena hemolytic anemia. Makamaka pakakhala zinthu zomwe zingakulitse chiwopsezo cha hemolysis, mwachitsanzo, kuchuluka kwa mankhwala, kutentha thupi kapena matenda opweteka,
• chiwindi ntchito.

Ibuprofen akhoza kuchepetsa zoletsa zotsatira za acetylsalicylic acid pa kuphatikiza kwa maselo ambiri. Pankhani yogwiritsa ntchito Cardiomagnyl Forte, wodwalayo ayenera kufunsa dokotala asanagwiritse ntchito mankhwala opha ibuprofen.

Acetylsalicylic acid ungayambitse kukula kwa bronchospasm kapena kuukira kwa mphumu ya bronchial kapena hypersensitivity reaction. Zowopsa zimaphatikizidwa ndi mbiri ya mphumu, hay fever, polyposis kapena matenda opumira kwambiri, matupi awo osokoneza (mwachitsanzo, kusintha kwa khungu, kuyabwa, urticaria) kuzinthu zina za m'mbiri.

Kudzera mwa kuletsa kwa kuchuluka kwa acetylsalicylic acid pa kuphatikizika kwa maselo ambiri, komwe kumapitilira masiku angapo pambuyo pa utsogoleri, kugwiritsa ntchito mankhwala okhala ndi acetylsalicylic acid kumatha kukulitsa mwayi / kulimbitsa magazi panthawi ya opaleshoni (kuphatikizapo maopaleshoni ang'onoang'ono, monga kuchotsa mano).

Ndi milingo yaying'ono ya acetylsalicylic acid, uric acid excretion ikhoza kuchepetsedwa. Izi zimatha kudzetsa matenda a gout mwa odwala omwe atengeka mosavuta.

Osagwiritsa ntchito mankhwala omwe ali ndi acetylsalicylic acid kwa ana ndi achinyamata omwe ali ndi vuto la kupuma kwamatenda oyamba ndi ma virus (ARVI), yomwe imayendera limodzi kapena osayenda ndi kuwonjezeka kwa kutentha kwa thupi, osafunsa dokotala. Kwa matenda ena a virus, makamaka fuluwenza A, fuluwenza B ndi nthomba, pali chiopsezo chotenga matenda a Reye, omwe ndi matenda osowa kwambiri koma owopsa omwe amafunika chithandizo chamankhwala mwachangu. Chiwopsezocho chitha kupitilizidwa ngati acetylsalicylic acid amagwiritsidwa ntchito ngati mankhwala ophatikizira, koma ubale wa causal sunatsimikizidwe pankhaniyi. Ngati izi zimaphatikizidwa ndi kusanza kosalekeza, izi zitha kukhala chiwonetsero cha matenda a Reye.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Kuponderezedwa kwa kaphatikizidwe ka prostaglandin kungasokoneze kwambiri kubereka komanso / kapena fetal / intrauterine. Kafukufuku wopezeka wa genemiological akuwonetsa kuti ali ndi vuto la kusokonezeka padera ndi vuto la fetal pambuyo pogwiritsa ntchito ma prostaglandin synthesis inhibitors m'mimba yoyambirira. Chiwopsezocho chikuwonjezeka kutengera kuchuluka kwa mankhwalawa komanso nthawi yayitali. Malinga ndi zomwe zilipo, ubale pakati pa kumwa acetylsalicylic acid ndi chiwopsezo chowonjezereka cholakwika sichinatsimikizidwe.

Zomwe zilipo za matenda obwera chifukwa cha kusinthika sizimagwirizana, komabe, chiwopsezo cha gastroschisis sichitha kuphatikizidwa ndikugwiritsa ntchito acetylsalicylic acid. Zotsatira za kafukufuku woyembekezeredwa wazotsatira zam'mimba zoyambirira (miyezi ya 1-4) ndi kutenga nawo gawo kwa mabanja pafupifupi 14800 a akazi sizimawonetsa kulumikizana kulikonse ndi chiopsezo chowonjezeka cha kusokonekera.

Kafukufuku wazinyama amawonetsa kawopsedwe obeleka.

Nthawi ya I ndi II trimester ya mimba, kukonzekera komwe kumakhala ndi acetylsalicylic acid sikuyenera kutumikiridwa popanda chidziwitso chokwanira chachipatala. Mwa amayi omwe akuyembekezeredwa kuti ali ndi pakati kapena nthawi yoyamba komanso yachiwiri ya kubereka, mlingo wa mankhwala okhala ndi acetylsalicylic acid uyenera kukhala wochepa kwambiri, ndipo nthawi yayitali ya chithandizo iyenera kukhala yochepa kwambiri.

Mu III trimester ya mimba, onse a prostaglandin synthesis inhibitors angakhudze mwana wosabadwayo motere:

• Kuopsa kwa mtima ndi mtima (ndi kutsekeka msanga kwa ductus arteriosus ndi pulmonary matenda oopsa)
• aimpso ntchito ndi zotheka kukula kwa aimpso kulephera ndi oligohydroamniosis,

Prostaglandin synthesis inhibitors imatha kukhudza mkazi ndi mwana kumapeto kwa mimba motere:

• kuthekera kwakukweza nthawi ya magazi, mphamvu ya antiplatelet yomwe imatha kuchitika ngakhale utadwala kwambiri
• chopinga wa uterine contractions, zomwe zingayambitse kuchepa kapena kuwonjezeka kwa nthawi yayitali.

Ngakhale izi, acetylsalicylic acid imaphatikizidwa mu trimester yachitatu ya mimba.

Ma salicylates ndi ma metabolites awo amapita mkaka wa m'mawere ochepa.

Popeza palibe zovuta zoyipa za mankhwala kwa mwana zomwe zimapezeka ndi amayi atatenga mkaka, sizoyenera kusokoneza kuyamwitsa. Komabe, ngati mukugwiritsidwa ntchito pafupipafupi kapena mukugwiritsa ntchito Mlingo wambiri wa yoyamwitsa, ndikofunikira kusiya.

Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa zinthu zina.Zosakhudzidwa.

Mlingo ndi makonzedwe

Mulingo woyamwa wabwino ndi 150 mg (piritsi 1) patsiku.

Mapiritsiwo amamezedwa lonse, kutsukidwa ndi madzi ngati kuli kofunikira. Kuonetsetsa kuti zikupezeka mwachangu, piritsi limatha kutafunidwa kapena kusungunuka m'madzi.

Kuwonongeka kwa chiwindi. Mankhwala sayenera kugwiritsidwa ntchito mwa odwala omwe ali ndi vuto la chiwindi. Kusintha kwa Mlingo kungafunike kwa odwala omwe ali ndi vuto la chiwindi.

Matenda aimpso. Mankhwala sayenera kugwiritsidwa ntchito pochiza odwala omwe amalephera kwambiri aimpso

Malinga ndi zowonetsa (onani. Gawo " Mlingo ndi makonzedwe ») Osagwiritsa ntchito Cardiomagnyl Forte mwa ana.

Kugwiritsa ntchito acetylsalicylic acid mwa ana osakwana zaka 15 kumatha kuyambitsa zovuta zoyipa (kuphatikiza ndi matenda a Reye's, chimodzi mwazizindikiro zomwe kumakhala kusanza kosalekeza).

Bongo

Chowopsa

Mlingo wowopsa. Akuluakulu 300 mg / kg thupi.

Poizoni wa salicylate amatha kubisika, chifukwa zizindikiro ndi mawonekedwe ake sizikudziwika. Kuledzera kwapakati kwamphamvu chifukwa cha salicylates, kapena salicylism kumachitika, ngati lamulo, pokhapokha Mlingo waukulu waukulu.

Zizindikiro za poyizoni woopsa (chifukwa cha kugwiritsa ntchito mankhwalawa kwa nthawi yayitali) ndi chizungulire, ugonthi, kuchuluka kwa thukuta, kutentha thupi, kupuma, tinthitosis, kuchepa kwam'madzi, mutu, chisokonezo, mseru komanso kusanza.

Kuledzera kwa pachimake kumawonetsedwa ndi kusintha kwamankhwala mu acid-base, komwe kumatha kusiyanasiyana kutengera zaka komanso kuopsa kwa kuledzera. Kuwonetsedwa kwake pafupipafupi mwa ana ndi metabolic acidosis. Kuopsa kwa vutoli sikungowerengeredwa pokhapokha chifukwa cha kuchuluka kwa ma salicylates m'madzi a m'magazi. Kuyamwa kwa acetylsalicylic acid kumatha kuchepetsedwa chifukwa chachedwa kutulutsidwa kwa m'mimba, kupangika kwa calculi m'mimba, kapena kukonzekera kumayendetsedwa ngati mapiritsi obwera.

Zizindikiro za poizoni woopsa komanso wa pachimake (chifukwa cha mankhwala osokoneza bongo): hypoglycemia (makamaka mwa ana), encephalopathy, chikomokere, hypotension, edema yam'mimba, kupweteka kwa mtima, edagulopathy, edema ya mtima, kusokonezeka kwa mtima.

Odwala omwe amakhala ndi vuto losagwiritsa ntchito mankhwala osokoneza bongo kapena osokoneza bongo, komanso odwala okalamba kapena ana.

Chithandizo.Pankhani ya mankhwala osokoneza bongo owonjezera, kupweteka kwam'mimba komanso kugwiritsa ntchito makala oyambitsa ndikofunikira. Ngati mukukayikira kuti mupeze mlingo waukulu kuposa 120 mg / kg thupi, ikonzani kaboni pafupipafupi.

Miyezo ya salumili ya Serum iyenera kuwerengedwa pafupifupi 2:00 iliyonse mutatha kumwa, mpaka mulingo wa salicylate umachepetsedwa ndipo mulingo wa acid-base umabwezeretseka.

Nthawi ya Prothrombin ndi / kapena MNI (International Normalized Index) iyenera kuyang'aniridwa, makamaka ngati magazi akuwakayikira.

Ndikofunikira kubwezeretsa bwino kwamagetsi ndi ma electrolyte. Njira zothandiza pochotsa salicylate ku madzi a m'magazi ndi zamchere ndi diodiisysis. Hemodialysis ikuyenera kugwiritsidwa ntchito ngati muledzera kwambiri, chifukwa njirayi imathandizira kwambiri kuchulukitsa kwa salicylates ndikubwezeretsanso acid-base ndi miyeso yamchere yamchere.

Kudzera mu zovuta za pathophysiological za poizoni wa salicylate, mawonetsedwe ndi zizindikiro / zotsatira zoyesa zingaphatikizeponso:

Mawonekedwe ndi Zizindikiro

zotsatira zoyesa

njira zochizira

Kuledzeretsa pang'ono kapena pang'ono

Kutumphukira kwa m'mimba, kubwereza mobwerezabwereza kukonzanso kaboni, kukakamizidwa zamchere

Tachypnea, hyperventilation, alkalosis ya kupuma

Kubwezeretsa kwa electrolyte ndi acid-base balance

Hyperhidrosis (thukuta kwambiri)

Kuledzera pang'ono kapena koopsa

Kutumphukira kwa m'mimba, kubwereza mobwerezabwereza kaboni

Kupuma alkalosis ndi compensatory metabolic acidosis

Kubwezeretsa kwa electrolyte ndi acid-base balance

Kubwezeretsa kwa electrolyte ndi acid-base balance

Kupuma: Hyperventilation, osakhala cardiogenic m'mapapo, kulephera kupuma, asphyxia

Mtima: dysarrhythmias, ochepa hypotension, kulephera kwa mtima

Mwachitsanzo, kusintha kwa kuthamanga kwa magazi, ECG

Kutayika kwa madzimadzi ndi kuchepa kwa madzi m'magetsi, oliguria, kulephera kwa impso

Mwachitsanzo, hypokalemia, hypernatremia, hyponatremia, kusintha kwa impso

Kubwezeretsa kwa electrolyte ndi acid-base balance

Kuchepetsa shuga kagayidwe, ketoacidosis

Hyperglycemia, hypoglycemia (makamaka ana). Kuchulukitsa kwa ketone

Tinnitus, ugonthi

Mimba: Kutaya magazi kwa GI

Hematologic: zoletsa zam'magazi, coagulopathy

Mwachitsanzo, kuchuluka kwa PT, hypoprothrombinemia

Neurological: poizoni wa poizoni wowopsa komanso kupsinjika kwa mitsempha yokhudzana ndi mantha monga chiwopsezo, chisokonezo, chikomokere, komanso kugwidwa.

Dzinalo Lopanda Padziko Lonse

INN ya mankhwalawa ndi Acetylsalicylic acid + Magnesium hydroxide.

Cardiomagnyl Forte ndi mankhwala osakanikirana kuchokera pagulu la mankhwala omwe si a antiidal anti-yotupa omwe amadziwika kuti ndi antiplatelet.

Khodi ya anatomical ndi achire mankhwala a magulu: B01AC30.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa amapezeka ngati mapiritsi oyera. Amakhala ozungulira komanso ali pachiwopsezo mbali imodzi.

Zomwe mapiritsiwo akuphatikizira zimagwira ntchito monga izi:

• 150 mg acetylsalicylic acid
• 30.39 mg wa magnesium hydroxide.

Zina ndizabwino:

• wowuma chimanga
• cellcrystalline mapadi,
• magnesium wakuba,
• wowuma mbatata
• hypopellose,
• propylene glycol (macrogol),
• talcum ufa.

Mankhwalawa amapezeka ngati mapiritsi oyera. Amakhala ozungulira komanso ali pachiwopsezo mbali imodzi.

Zotsatira za pharmacological

Acetylsalicylic acid imakhala ndi zotsatira za NSAIDs zonse, monga:

1. Antiaggregant.
2. Anti-kutupa.
3. Mankhwala opweteka.
4. Antipyretic.

Zotsatira zazikuluzikulu za chinthuchi ndi kuchepa kwa kuphatikizika kwa mafuta a m'magazi (gluing), komwe kumapangitsa kuti magazi achepe.

Makina a acetylsalicylic acid ndi kupondereza kupanga kwa cycloo oxygenase enzyme. Zotsatira zake, kapangidwe ka thromboxane m'mapulateleti amasokoneza. Asidiyu amatithandizanso kupuma komanso mafupa amagwira ntchito.

Acetylsalicylic acid imasokoneza mucosa wa m'mimba. Magnesium hydroxide imathandiza kupewa kukhumudwa m'matumbo. Magnesium imawonjezeredwa pokonzekera iyi chifukwa cha katundu wake wa antacid (kulowererapo kwa hydrochloric acid ndikuyika makhoma am'mimba ndi membrane woteteza).

Pharmacokinetics

Acetylsalicylic acid ali ndi mayamwidwe ambiri. Pambuyo pakukonzekera pakamwa, imalowa mwachangu m'mimba ndikuyandikira ndende yake yambiri ya plasma pambuyo pa maola 1-2. Mukamamwa mankhwala ndi chakudya, mayamwidwe amachepetsa. The bioavailability wa asidi ndi 80-90%. Imagawidwa mthupi lonse, imadutsa mkaka wa m'mawere ndikudutsa placenta.

Kagayidwe koyamba kumachitika m'mimba.

Kagayidwe koyamba kumachitika m'mimba. Potere, ma salicylates amapangidwa. Kuphatikizanso kwa metabolism kumachitika m'chiwindi. Ma salicylates amathandizidwa ndi impso zosasinthika.

Magnesium hydroxide imakhala ndi mayamwidwe otsika komanso otsika a bioavailability (25-30%). Imadutsa mkaka wa m'mawere yaying'ono ndikudutsa moyipa mwa chotchinga. Magnesium amachotsedwa m'thupi makamaka ndi ndowe.

Ndi chiyani?

Mankhwalawa amalembera matenda otsatirawa:

1. Pachimake komanso matenda a mtima a coronary (matenda a mtima).
2. Angina pectoris.
3. Supombosis.

Mankhwalawa amalembera matenda a mtima.
Mankhwalawa amalembera angina osakhazikika.
Mankhwalawa amalembera thrombosis.

Mankhwalawa nthawi zambiri amagwiritsidwa ntchito popewa thromboembolism (atachitidwa opaleshoni), kulephera kwa mtima, kuphwanya mkati mwa mtima, ndi ngozi ya mtima. Odwala omwe ali ndi matenda a shuga, matenda oopsa, matenda oopsa, komanso anthu amene amasuta pambuyo pa zaka 50, amafunikanso kupewa.

Kodi mutenge Cardiomagnyl Forte?

Mankhwalawa amatengedwa pakamwa ndi madzi pang'ono. Piritsi imatha kugawidwa m'magawo awiri (mothandizidwa ndi zoopsa) kapena kuphwanyidwa kuti iperekedwe mwachangu.

Pofuna kuchepetsa kukhudzika kwa matenda a mtima, mapiritsi 1 patsiku (150 mg ya acetylsalicylic acid) ndi mankhwala. Mlingo woyamba. Kenako imachepetsedwa ndi 2 times.

Pambuyo pakuchita opaleshoni ya mtima, 75 mg (theka la piritsi) kapena 150 mg amatengedwa mwakufuna kwa dokotala.

Pofuna kupewa matenda a mtima (myocardial infarction, thrombosis) tengani piritsi limodzi patsiku.

Kumwa mankhwala a shuga

Odwala omwe ali ndi matenda ashuga ali ndi chiopsezo chowonjezereka kwamaso am'magazi komanso kukula kwa thrombosis. Pofuna kupewa, theka la piritsi limayikidwa tsiku lililonse.

Odwala omwe ali ndi matenda ashuga ali ndi chiopsezo chowonjezereka kwamaso am'magazi komanso kukula kwa thrombosis. Pofuna kupewa, theka la piritsi limayikidwa tsiku lililonse.

Hematopoietic ziwalo

Njira yozungulira imakhala ndi chiopsezo chotukuka:

• kuchepa magazi
• thrombocytopenia
• neutropenia
• agranulocytosis,
• eosinophilia.

Mukamwa mankhwalawa, zotsatira zoyipa monga esophagitis zimatha kuchitika.
Zotsatira zoyipa monga nseru ndi kusanza zitha kuchitika chifukwa chomwa mankhwalawo.
Kutenga mankhwalawa, zotsatira zoyipa zimatha ngati bronchospasm.
Mwa kumwa mankhwalawa, zotsatira zoyipa ngati m'mimba zimatha.
Mwa kumwa mankhwalawa, zotsatira zoyipa ngati stomatitis zimatha kuchitika.
Zotsatira zoyipa ngati eosinophilia zimatha kuledzera.
Mwa kumwa mankhwalawa, zotsatira zoyipa ngati urticaria zimatha kuchitika.

Nthawi zina thupi limakhala ndi izi:

• Edincke's edema,
• Khungu
• urticaria
• kuphipha kwa bronchi.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwala amavomerezedwa kuti azigwiritsidwa ntchito mu 2nd trimester yam'mimba pakulimbikitsidwa ndi katswiri. Dotolo atha kukulemberani mankhwalawa pamene phindu kwa mayi likuwonjezera chiwopsezo kwa mwana wosabadwayo.

Mu trimester yoyamba ya mimba, Cardiomagnyl imatha kuyambitsa kusokonezeka kwa fetal. Ndi zoletsedwa kugwiritsa ntchito mankhwalawa mu 3 trimester. Imaletsa ntchito ndipo imawonjezera mwayi wotaya magazi kwa mayi ndi mwana.

Ma salicylates amadutsa mkaka wa m'mawere ochepa. Pa yoyamwitsa, mankhwalawa amatengedwa mosamala (mlingo umodzi umaloledwa ngati pakufunika). Kugwiritsa ntchito mapiritsi nthawi yayitali kumatha kuwononga mwana.

The ntchito aimpso kuwonongeka

Popeza chimbudzi cha salicylates chimachitika ndi impso, pamaso pa kulephera kwa impso, mankhwalawa ayenera kumwedwa mosamala. Ndi kuvulala kwambiri kwa impso, dokotala akhoza kuletsa kumwa mankhwalawa.

Popeza chimbudzi cha salicylates chimachitika ndi impso, pamaso pa kulephera kwa impso, mankhwalawa ayenera kumwedwa mosamala.

Kuchita ndi mankhwala ena

Mankhwalawa ali osavomerezeka kuti agwiritsidwe ntchito limodzi ndi ma NSAID ena. Kugwirizana kumeneku kumabweretsa ntchito yochulukirapo ya mankhwala ndikuwonjezera zoyipa.

Cardiomagnyl imathandizanso kuti:

• anticoagulants
• Acetazolamide
• Methotrexate
• othandizira a hypoglycemic.

Pali kuchepa mu kuchitako kwa okodzetsa monga Furosemide ndi Spironolactone. Ndi munthawi yomweyo makonzedwe a Colestiramine ndi ma antacid, kuchuluka kwa mayankho a Cardiomagnyl kumachepa. Kuchepetsa mphamvu kumachitikanso kumaphatikizidwa ndi probenecid.

Kuyenderana ndi mowa

Kumwa mowa panthawi ya mankhwala kumaletsedwa. Mowa umawonjezera kukwiya kwa mapiritsi pamatumbo am'mimba. Izi zimawonjezera chiopsezo cha mavuto.

Mankhwala otchuka omwe ali ndi vuto lofananalo ndi Aspirin Cardio, Thrombital, Acekardol, Magnikor, Thrombo-Ass.

Cardiomagnyl | Malangizo ntchito malangizo a Aspirin Cardio Thrombital Forte malangizo a Thrombo ACC

Ndemanga za Cardiomagnyl Fort

Igor, wazaka 43, Krasnoyarsk.

Ndakhala ndikugwira ntchito yamtima wazaka zoposa 10. Ndimawerengera cardiomagnylum kwa odwala ambiri. Ili ndi zotulukapo zachangu, zili ndi mtengo wotsika mtengo komanso zochepa zoyipa. Mankhwala ndi ofunikira kupewa matenda a mtima ndi matenda a mtima.

Alexandra, wazaka 35, Vladimir.

Ndimapereka mankhwala kwa odwala pambuyo zaka 40 zothandizira kupewa matenda a mtima. Odwala onse amalekerera bwino. Machitidwe anga, sindinawone zotsatira zoyipa. Koma ndikukulangizani kuti musatenge nokha komanso mosasamala.

Victor, wazaka 46, Zheleznogorsk.

Cardiomagnyl ndi yosavuta kugwiritsa ntchito, yotsika mtengo komanso yotetezeka. Ndikupangira mankhwalawa odwala omwe ali ndi matenda a mtima, matenda a arteriosulinosis, mitsempha ya varicose ndi thromboembolism. Nthawi zambiri ndimalemba kuti ndizodziteteza.

Anastasia, wazaka 58, Ryazan.

Nthawi zonse ndimamwa mapiritsiwa pambuyo pa vuto la mtima pakulimbikitsidwa ndi dokotala. Mankhwala amalekeredwa bwino, osakhala ndi mavuto. Kuyambira pachiyambire phwando ine nthawi yomweyo ndinamva bwino.

Daria, wazaka 36, ​​mzinda wa St.

Ndimamwa mankhwalawa monga momwe adanenera adotolo kuti athandizire mitsempha ya varicose. Mankhwalawa amachepetsa magazi komanso kupewa magazi. Ndinkakhala ndi ululu, miyendo yolemera komanso kukokana usiku. Njira yabwino!

A Gregory, azaka 47, ku Moscow.

Ndinadwala mtima 2 zapitazo. Tsopano ndikumwa mapiritsiwa kupewa. Amakhala bwino komanso alibe mavuto. Ndinasiyanso kupweteka mutu pafupipafupi.