Sandostatin: chisonyezo chogwiritsidwa ntchito ndi kapamba

Kufotokozera kogwirizana ndi 05.08.2015

Dzina lachi Latin: Sandostatin
Code ya ATX: H01CB02
Chithandizo: Octreotide
Wopanga: Novartis Pharma (Switzerland)

1 ml ya yankho la iv and s / c ili ndi 50, 100 kapena 500 μg ya yogwira ntchito octreotide.

1 vial ya ma microspheres pokonzekera kuyimitsidwa kwa i / m makonzedwe a Sandostatin Lar ali ndi 10 mg ya yogwira mawonekedwe mu mawonekedwe octreotide acetate.

Mlingo ndi makonzedwe

Sandostatin amawonetsedwa kwa odwala pambuyo pancreatic opaleshoni yachulukitsa ya kapamba. Mankhwalawa amachepetsa ululu, chifukwa kuchepa kwa mapangidwe a ma enzyme kumalepheretsa chiwonongeko cha minofu ya limba.

Mu mtundu wa kapamba, Sandostatin imathandizira odwala, amathandizira kuchepetsa kuchuluka kwa khunyu. Sandostatin mu ampoules imaperekedwa kwa odwala subcutaneally, intramuscularly, kudzera mu kulowetsedwa katatu patsiku. Madontho amapangidwa pakati pa chakudya ndi pogona. Kukhazikitsidwa kwa Sandostatin kumachitika ola limodzi isanachitike opareshoni ndipo mkati mwa masiku 7 atatha. Mlingowo umaperekedwa ndi dokotala aliyense payekha, kutengera mtundu wa matendawa. Mankhwalawa amayamba kuchita mphindi 5 atayamba kulowetsedwa.

Zotsatira zoyipa

Ndi chithandizo cha Sandrostatin, mavuto amtsogolo amatha kuchitika. Kuchokera m'mimba, m'mimba, kusanza, kusokonezeka kwa tulo, kuponderezana, cholecystitis, mawonekedwe amiyala m'mitsempha ya biliary, kuwonjezereka kwa zomwe zili ndi bilirubin ndi michere ya chiwindi m'magazi, komanso kupweteka pamimba. Matenda a mtima, mantha ndi endocrine:

hypothyroidism (kusakwanira kwa chithokomiro pantchito),
kagayidwe kachakudya kagayidwe kachakudya koyipa m'thupi,
bradycardia (kuthamanga kwa mtima),
kukomoka mtima,
mutu.

Ndi tsankho la zigawo za Sandostatin, matupi athu sagwirizana zimatha kuchitika.

Kuchita ndi mankhwala ena

Mosamala, Sandostatin iyenera kugwiritsidwa ntchito molumikizana ndi beta-blockers ndi mankhwala a diuretic. Mukaphatikizidwa ndi cyclosporine, zotsatira zake zomaliza zimachepa. Sandostatin yokhala ndi insulin imayikidwa mosamala. Poterepa, ndikofunikira kuwongolera zomwe zili m'magazi. Sandostatin amachepetsa kuyamwa kwa cimetidine. Kugwirizana kwa mowa sikuloledwa. Mankhwalawa alibe mphamvu pa kuyendetsa galimoto.

Kupanga ndi mawonekedwe a kumasulidwa

Mankhwala omwe amagwiritsidwa ntchito ndi octreotide, omwe ndi analogue yopanga ya mahomoni somatostatin. Mankhwalawa amasulidwa ngati njira yothetsera jakisoni (ma ampoules) kapena ma lyophilisate, pomwe njira imakonzedwa.

Mphepete imodzi yokhala ndi voliyumu ya 1 ml ili ndi mlingo wa 0,05-0.1 mg wa zomwe zimagwira. Kuphatikiza pa yankho lomalizidwa, mankhwalawa amapangidwa ngati ufa, womwe umasungunulidwa musanagwiritse ntchito pochita ndende.

Kutulutsa mawonekedwe ndi kapangidwe kake

Njira ya kutulutsidwa kwa Sandostatin ndi njira yothetsera kulowetsedwa kwamkati ndi kosuntha: kopanda utoto, wowonekera (m'mapiritsi a 1 ml, pamakatoni a 5 kapena 10 ampoules).

Muli 1 ml ya yankho:

ntchito yogwira: octreotide (monga peptide yaulere) - 50, 100 kapena 500 μg,
zina zowonjezera: sodium bicarbonate, lactic acid, mannitol, kaboni dioksidi, madzi a jekeseni.

Mankhwala

Zomwe zimagwira mu Sandostatin ndi octreotide - ma octapeptide, ma analogue achilengedwe mahomoni somatostatin, omwe ali ndi zotulukapo zofananira zamankhwala, koma nthawi yayitali.

Octreotide imachepetsa kubisika kwa kukula kwa mahomoni (GH), onse a m'matumbo amawonjezeka komanso akuwonjezeka chifukwa cha insulin hypoglycemia, zochitika zolimbitsa thupi, komanso kukhudzana ndi arginine. Sandostatin imalepheretsanso kubisika kwa insulin, serotonin, gastrin ndi glucagon, kuchuluka kwa matenda a m'magazi kapena chifukwa cha chakudya. Imachepetsa katulutsidwe wa glucagon ndi insulin yolimbikitsidwa ndi arginine, komanso chinsinsi cha thyrotropin choyambitsidwa ndi thyroliberin.

Mosiyana ndi somatostatin, octreotide imachepetsa kubisala kwa GR mokulira kuposa katulutsidwe ka insulin. Mankhwala samatsogolera ku hypersecretion yotsatira ya mahomoni (mwachitsanzo, kukula kwa mahomoni mwa odwala omwe ali ndi acomegaly). Ndi acromegaly, Sandostatin imachepetsa plasma yambiri ya GH ndi kukula kwa insulin (IGF-1). Mu 90% ya odwala, pali kuchepa kwa kuchuluka kwa GH ndi 50%, pomwe GH yomwe ili pansi pa 5 ng / ml ikhoza kukwaniritsidwa pafupifupi 50% ya milandu. Odwala ambiri okhala ndi acomegaly, mankhwalawa amachepetsa kutupa kwa minofu yofewa, kuuma kwa mutu komanso hyperhidrosis, paresthesia ndi ululu wolumikizana. Ndi ma pituitary adenomas akulu, Sandostatin amatha kuchepetsa kukula kwa chotupa.

Octreotide ikhoza kupititsa patsogolo matendawa chifukwa chosakwanira (mankhwalawa artery embolism, opaleshoni, chemotherapy, kuphatikizapo 5-fluorouracil ndi streptozotocin) ya chotupa cham'mimba cha chotupa cha m'mimba ndi kapamba. Chifukwa chake, ndi zotupa za carcinoid, Sandostatin amachepetsa kuopsa kwa m'mimba komanso kumverera kwa nkhope yake, komwe kumachitika nthawi zambiri limodzi ndi kuchepa kwa plasma ndende ya serotonin ndi chimbudzi cha 5-hydroxyindoleacetic acid mkodzo. Ndi zotupa za VIP zokhala ndi hyperproduction of the vasoactive matumbo peptide (VIP), mankhwalawa nthawi zambiri amachepetsa kutsegula m'mimba kwambiri, chifukwa, amakula bwino moyo wa wodwalayo. Nthawi yomweyo, zosokoneza zomwe zimachitika mu ma elekitirodi a electrolyte (mwachitsanzo, hypokalemia) zimachepetsedwa, zomwe zimapangitsa kuletsa utsogoleri wama elexandrita ndi zam'madzi. Mwa odwala ena, Sandostatin amachedwetsa ndipo ngakhale amachepetsa chotupacho, amachepetsa kukula kwake, komanso kukula kwa metastases ya chiwindi. Kusintha kwamankhwala, monga lamulo, kumayendetsedwa ndi kuchepa kapena kufalikira kwa plasma ndende ya VIP.

Ndi glucagonomas, octreotide imachepetsa kusamukira kwa erythema. Mu shuga mellitus, mankhwalawa samakhudza kwambiri kuopsa kwa hyperglycemia, kotero kufunika kwa othandizira a hypoglycemic kapena insulin nthawi zambiri kumakhala kosasinthika. Chifukwa cha kuchepa kwa m'mimba, kuwonjezeka kwa thupi ndikotheka. Ndipo ngakhale kuchepa kwa kuchuluka kwa ma glucagon mchikakamizo cha Sandostatin kumakhala kwakanthawi, chilengedwe chimakhala chokhazikika munthawi yonse yomwa mankhwalawa.

Mu gastrinomas / Zollinger-Ellison syndrome, kugwiritsa ntchito octreotide ngati mankhwala amodzi kapena kuphatikiza ndi histamine H blockers₂-receptors kapena proton pump inhibitors angayambitse kuchepa kwa hypersecretion ya hydrochloric acid m'mimba, kuchepa kwa ndende ya gastrin m'magazi am'magazi komanso kuopsa kwa kutentha ndi kutsegula m'mimba.

Odwala omwe ali ndi insulinomas, Sandostatin amathandiza kuchepetsa kuchuluka kwa insulin yogwiritsira ntchito m'magazi (izi zimatha kukhala kwakanthawi kochepa, mpaka maola 2). Pamaso pa zotupa zotheka kugwira ntchito, mankhwalawa amatha kubwezeretsa ndikukhalanso ndi standardoglycemia nthawi ya preoperative. Ndi zotupa zosavomerezeka komanso zotupa, kayendedwe ka glycemic kamatha kusintha popanda kuchepa nthawi yayitali pakulimbikitsa kuchuluka kwa insulin m'magazi.

Odwala omwe ali ndi zotupa zosowa zomwe zimakulitsa kukula kwa mahomoni akumasuka (somatoliberinomas), Sandostatin amachepetsa kuuma kwa zizindikiro za acomegaly, popeza zimalepheretsa kubisalira kwa kukula kwa mahomoni akumasamba ndikumakulitsa kwa hormone yokha. M'tsogolomu, kuchepa kwa pituitary hypertrophy ndikothekanso.

Mukamatuluka magazi kuchokera m'mitsempha ya varicose ya esophagus ndi m'mimba mwa odwala omwe ali ndi vuto lodana ndi kuperewera kwa khosi, kuwonjezera kwa octreotide ku chithandizo chamankhwala (mwachitsanzo, sclerotherapy) kungalepheretse kutaya magazi komanso kupewa kutayiranso magazi, kuchepetsa magazi ndi kupititsa patsogolo masiku asanu. Amakhulupirira kuti limagwirira ntchito ya Sandostatin ndi chifukwa chakuchepa kwa magazi a ziwalo chifukwa cha kuponderezedwa kwa mahomoni osokoneza bongo monga glucagon ndi VIP.

Odwala omwe akuwonetsedwa kuti akuchitidwa opaleshoni ya pancreatic, Sandostatin, yemwe amagwiritsidwa ntchito pambuyo pa opareshoni, amachepetsa zomwe zimachitika chifukwa chaoperative (mwachitsanzo, postoperative acute pancreatitis, fancula ya pancreatic, sepsis, abscesses.

Ndi makina ochotsetsa m'mimba mwa omwe ali ndi Acquired Immunodeficiency Syndrome (AIDS), Sandostatin kwathunthu kapena pang'ono pang'onopang'ono, pafupifupi 30% ya milandu pamene kutsegula m'mimba sikungathe kuthandizidwa ndi antidiarrheal ndi / kapena antimicrobial therapy.

Pharmacokinetics

Pambuyo pothandizidwa ndi subcutaneous, octreotide imathamanga mwachangu komanso kwathunthu. Kuchuluka kwa plasma ndende kumafika pafupifupi mphindi 30.

Ndi mapuloteni a plasma omwe amamanga 65%. Kulumikizana ndi maselo amwazi ndikosapeweka kwambiri. Kugawa voliyumu - 0,27 l / kg. Chilolezo chonse ndi 160 ml / min.

Pambuyo pokonza jakisoni, theka la moyo (T_½) - mphindi 100 Kuchotsedwa kwa mankhwalawa pambuyo pokonzekera mtsempha wa magazi kumachitika m'magawo awiri, T_½ ndi 10 ndi 90 mphindi, motsatana. Mankhwala ochulukirapo amawachotsa ndowe, pafupifupi 32% - ndi mkodzo osasinthika.

Zizindikiro zogwiritsidwa ntchito

acromegaly: kusakwanira kwa radiation / opaleshoni yothandizira kuti athe kuwongolera mawonetseredwe akuluakulu amatenda ndikuchepa kwa GR (kukula kwa mahomoni) ndi IGF-1 (insulin-like grow factor) mu plasma, ngati wodwala akana kuthandizira kapena ngati pali zotsutsana pazomwe zimayambitsa, yochepa Chithandizo pakati pa njira zamankhwala othandizira poizoniyu mpaka pomwe mphamvu zake zitheke,
Kubisa zotupa za endocrine pamimba (m'mimba thirakiti) ndi kapamba (pofuna kuwongolera chizindikiro): ma VIP, glucagonomas, zotupa za carcinoid, insulinomas (zochizira mankhwalawa komanso chifukwa cha hypoglycemia munthawi ya ntchito), somatoliberin , yomwe imadziwika ndi hyperproduction of releasing factor GR), gastrinomas / Zollinger - Ellison syndrome (nthawi zambiri imagwiritsidwa ntchito ndi histamine H blockers₂ma receptors ndi proton pump zoletsa). Tiyenera kukumbukira kuti Sandostatin si mankhwala antitumor, ndipo kugwiritsa ntchito sikupereka chithandizo cha gulu ili la odwala.
kutsekeka m'mimba mwa odwala Edzi (kuwongolera zizindikiro),
zovuta pambuyo pancreatic opaleshoni (kupewa),
Kutuluka kwa magazi kuchokera m'mitsempha ya varicose yam'mimba komanso kum'mero kwa chiwindi (pamodzi ndi njira zina zochiritsira (mwachitsanzo, endoscopic sclerotherapy) kuti muchepe magazi komanso kuti musabwerenso.

Contraindication

Mtheradi wotsutsana ndi mankhwalawa ndi kupezeka kwa Hypersensitivity pamagawo a mankhwala.

Malinga ndi malangizo, Sandostatin iyenera kugwiritsidwa ntchito mosamala pazotsatirazi:

cholelithiasis
matenda ashuga
mimba
nthawi yoyamwitsa.

Kuchiritsa katundu

Mtengo: kuchokera 1750 mpaka 1875 rubles.

Mankhwalawa ali ndi mphamvu ya antithyroid m'thupi, pomwe kupanga mahomoni monga TSH ndi STH kumachepetsedwa, zomwe zimapangitsa kuwonetsa kwa antispasmodic effect. Sandostatin imakhudzana ndimatumbo am'mimba - imachepetsa kuyendetsa ndi kupanga madzi a m'mimba. Mothandizidwa ndi mankhwalawa, kuletsa kwachulukidwe katulutsidwe ka serototin ndi mahomoni okula (kupanga komwe kumachitika mwachindunji ndi endocrine system), komanso ma peptides, kumawonedwa.

Mankhwalawa amakhudza kaphatikizidwe wa kukula kwa mahomoni ngati insulin hypoglycemia imalephera kutulutsa shuga, gastrin, ma peptides ena, komanso insulin. Octreotide imathetsa ntchito yopanga thyrotropin mothandizidwa ndi thyroliberin. Pambuyo poyang'anira yankho pansi pa khungu, mahyper hypersecretion sanalembedwe.

Mwa anthu omwe ali ndi acromegaly, mankhwalawa amachepetsa osati chisonyezo cha kukula kwa mahomoni, komanso somatomedin A m'magazi. Kuchitidwa achire othandizira amatha kusintha kukula kwa mahomoni mu 50% ya odwala.

Odwala omwe ali ndi zotupa zama carcinoid, kuopsa kwa zizindikiritso kumachepetsedwa, mankhwalawa amawongolera kuchuluka kwa serotonin, m'mimba ndimatayala, ndipo "kutentha kwamphamvu" kumatha.

Mu pathologies yodziwika ndi katulutsidwe kakang'ono ka vasoactive matumbo am'mimba, kutenga octreiotide kumapangitsa kukhala bwino, ndipo electrolyte bwino imabweranso yachilendo ndi chithandizo. Ndizofunikira kudziwa kuti nthawi zambiri matendawa amayenda, kuchuluka kwa neoplasm kumachepa, chiopsezo chofalitsa metastases ku chiwindi chimachepa.

Anthu omwe akuvutika ndi matenda otseguka m'mimba amawona kuchepa kwakukulu komwe kumayambira kumbuyo kwa mankhwalawa ndi octreotide. Chifukwa cha izi, ndikotheka kusintha kulemera kwa thupi, kuchepetsa kuchuluka kwa glucagon m'thupi. Sandostatin nthawi zambiri imalimbikitsidwa kuti igwiritsidwe ntchito limodzi ndi H2 receptor blockers, komanso ma proton pump inhibitors, omwe amathandizanso pakuwonekera kwa kuwonongeka kwa zizindikiro zosiyanasiyana komanso kuchuluka kwa gastrin (kuchepa kumawonedwa).

Mothandizidwa ndi mankhwalawa, kuchepa kwa insulin yogwira inshuwaransi kwalembedwa mwa anthu omwe amapezeka ndi insulinoma (zotsatira zabwino zimawonedwa patatha maola 2). Anthu omwe ali ndi opaleshoni yodziwika amatha kudziwa kukonzanso kwa standardoglycemia atachitidwa opaleshoni.

Pogwiritsa ntchito kwambiri kukula kwa timadzi tating'onoting'ono tomwe timapanga, kuchepa kwakali kwa zizindikiro za acromegaly kumadziwika. Izi zimatheka chifukwa choletsa kupanga kwa mahomoni okula, komanso kutulutsa kwake. Pambuyo pake, kuchuluka kwa hypertrophied pituitary gland kumachepa.

Ndi mankhwala a Sandostatin, ulesi umathetsedwa, mutu womwe umawonongeka kale, zizindikiro za hyperhidrosis, kupweteka m'mafupa ndi mafupa, komanso zotumphukira za neuropathy zimatha pang'ono pang'ono.

Zotsatira zoyipa ndi bongo

Mankhwala, kukula kwam'mimba, kupweteka mseru, kutsegula m'mimba, kusilira, kuwonjezeka kwa microsomal enymes, steatorrhea, alopecia sikuwonetsedwa. Maphunziro owopsa a hepatitis, hyperbilirubinemia, kuwonjezeka kwa index ya GGT.

Pambuyo pa chithandizo chambiri, kulekerera kwa glucose kumatha kuchepa, zovuta za kapamba, hypoglycemia, kukula kwa cholelithiasis, kuwonetsa matupi awo, komanso kupezeka kwa hyperglycemia kosatha.

Ndizotheka kuti kumverera koyaka, kuwonetsa kuwawa kwakumalo, kutupira pamalo a jekeseni.

Kupweteka m'mimba
Kukula kwa "mafunde"
Mbale wamiseru
Kutsitsa kwa mtima
Matumbo am'mimba.

Syndrome Syndrome zimasonyezedwa.

F-Synthesis, Russia

Mtengo kuyambira 616 mpaka 23800 rub.

Octreotide ndi mankhwala ofanana ndi Sandostatin, omwe ali ndi vuto longa somatostatin mthupi. Amawonetsedwa pochiza komanso kupewa mitundu ina ya endocrine pathologies. Zimapangidwa m'njira yothetsera jakisoni.

Ubwino:

Itha kuikidwa kwa kapamba omwe amapezeka atachitidwa opaleshoni
Zimalepheretsa chitukuko cha postoperative sepsis
Amachotsa kutsegula m'mimba mwa Edzi.

Chuma:

Hyperbilirubinemia imatha kuchitika pakumwa
Sangaphatikizidwe ndi mowa.
Yoperekedwa ndi mankhwala.

Zambiri Zamankhwala

Sandostatin ndi analogue yopanga ya somatostatin. Mu thupi la munthu, timadzi tating'onoting'ono timene timapangidwa m'magawo awiri: hypothalamus ndi mabwalo am'mphepete mwa kapamba. Chamoyo choterechi chimakhala ndi cholepheretsa kupanga ma mahomoni ambiri nthawi imodzi: thyrotropin ndi kukula kwa mahomoni, komanso zimachepetsa kubisika kwa insulin, cholecystokinin, gastrin, glucagon.

Chofunikira cha mankhwalawa Sandostatin ndi octreotide, ma analogue opanga mahomoni amadziwika ndi nthawi yayitali kuposa zachilengedwe somatostatin.

Sandostatin imapangidwa ngati njira yothetsera jakisoni kapena lyophilisate pakukonzekera kwake. Mphepete imodzi yokhala ndi voliyumu ya 1 ml ikhoza kukhala ndi mlingo wa 0,05 mg kapena 0,5 mg pazomwe zimagwira ntchito.

Mndandanda wazisonyezo zogwiritsidwa ntchito

Malinga ndi malangizo a mankhwalawa, kugwiritsa ntchito Sandostatin kumayendetsedwa ndi wopanga pazotsatirazi:

Acromegaly.
Endocrine timadzi timene timatulutsa kapamba ndi matumbo (Zollinger-Ellison syndrome, zotupa za carcinoid pamaso pa carcinoid syndrome, VIPoma, insulinoma, ndi zina).
Kutulutsa magazi kuchokera kumitsempha ya varicose yam'mero (monga gawo la chithandizo chokwanira).
Kupewa mavuto.

Yang'anani! Sandostatin ilibe mankhwala a antitumor ndipo sangathe kugwiritsidwa ntchito ngati monotherapy pa ma oncological pathologies awa.

Kuchita ndi mankhwala ena

Popeza Sandostatin imakhala yokhudza thupi la wodwalayo, kugwiritsa ntchito kwake kungafune kusintha kwa mankhwalawa kwa mankhwala ena omwe wodwalayo akulandira.

Chifukwa cha kuthekera kwa timadzi timene timakhudza kugunda kwa mtima komanso kamvekedwe ka mtima, kukonza ma antiarrhythmics (beta blockers) ndi othandizira antihypertensive (calcium blockers, diuretics, etc.) nthawi zambiri zimafunika.

Kugwiritsa ntchito bromocriptine limodzi ndi Sandostatin kumabweretsa kusintha kwa bioavailability wa ergot alkaloid. Koma pokhudzana ndi mankhwala ena a ergot, zotsatira zake ndizosiyana kotheratu: kuphatikiza kwa Cyclosporin ndi Sandostatin kumapangitsa kuchepa kwa mayamwidwe a cytostatic.

Pamafunikanso kusintha kwa mankhwalawa omwe amachepetsa shuga m'magazi, ndipo ngati wodwala alandira insulin yovomerezeka, ndiye kuti afunika kumuyambiranso.

Sandostatin imayambitsa kuwonongeka kwa mayamwidwe a cimetidine ndipo amachepetsa index ya metabolic ya mankhwala omwe amatsitsidwa ndi dongosolo la cytochrome.

Pancreatitis ndi chithandizo chake

Pancreatitis (kutupa kwa kapamba) kumachitika chifukwa cha kuperewera kwa zakudya m'thupi, kumwa mowa ndi khofi wambiri, kugwiritsa ntchito mankhwala ena, matenda amtundu wamatsenga, komanso mavuto ena angapo. Mfundoyi imakhala ndi mitundu iwiri yosiyanasiyana: kupweteka komanso kupweteka, chithandizo chomwe chimasiyana kwambiri.

Chinsinsi cha kapamba ndi chiwonongeko cha kapamba ndi michere yamagaya, yomwe imapanganso. Mwachizolowezi, kukula kwa zovuta zoterezi kumalumikizidwa ndi kutsekeka kwa kutulutsa kwa timadzi ta kapamba tomwe timayendetsa matumbo kulowa m'matumbo ang'onoang'ono, komwe kumabweretsa kuchuluka kwa michere mkati mwa lobules yomwe imatulutsa, kukhazikitsidwa kwa mapuloteni asanakwane komanso kudziwononga tokha.

Sandostatin imakhumudwitsa kwambiri ntchito zachinsinsi za kapamba, chifukwa chake, madokotala ochita opaleshoni nthawi zambiri amawapereka kwa odwala oopsa omwe amachitidwa opaleshoni yapachimbudzi.

Izi zimakuthandizani kuti muchepetse zizindikiro za ululu, chifukwa kuchepa kwa kapangidwe ka michere ya m'mimba kumachepetsa njira yowonongera ziwalo za zomwe zikukhudzidwa.

Pankhani ya pancreatitis pachimake, kuchuluka kwa zowonongeka ndikokulirapo, odwala oterowo amafunikira kuchipatala msanga kuchipatala cha opaleshoni chifukwa chankhanza, mwamphamvu, komanso nthawi zambiri. Ngati matendawa ndi ofatsa, komanso nthawi yochulukirapo komanso kuzindikira kwake matendawa, ndiye kuti tikulankhula za matenda kapamba. Itha kuyamba kwa zaka ndi makumi, popeza njira yotupa imakhudzanso malo ocheperako kapamba. Nthawi yomweyo, matenda a kapamba, kuwonongeka kwa ziphuphu kumachitika ngakhale popanda kudziwikiratu.

Ngakhale kuti kugwiritsa ntchito kwa Sandostatin chifukwa cha pancreatitis yayitali sikufotokozedwa pazomwe zikugwiritsidwa ntchito, nthawi zina amaloleza odwala panthawi yowonjezereka. Njira yothandizirana chotereyi imalola wodwalayo kumva kuti ali ndi mpumulo, koma sizikuwakhudza pafupipafupi komanso nthawi yayitali. Komabe, madokotala ambiri safuna kugwiritsa ntchito Sandostatin pochiza odwala osadwala, chifukwa pamafunika kusankha koyenera kwa mankhwalawa ndipo ali ndi zotsutsana zingapo komanso zoyipa.

Mankhwala

Sandostatin ndi mankhwala omwe amafunikira ndipo ayenera kuwunikidwa bwino. Musanayambe maphunziro, ndikofunikira kuti mupange mayeso angapo a magazi, ndikuwunikanso zam'mimba ndi kapamba. M'tsogolomu, mayesowa adzafunika kubwerezedwa kuti athe kuwunika momwe Sandostatin amakhudzira thupi.

Sandostatin amaperekedwa mwachisawawa, kudzera m'mitsempha kapena ngati kulowetsedwa kwamitsempha katatu patsiku, amaloledwa kuchepetsa mankhwalawa ndi madzi a jakisoni, koma osagwirizana ndi yankho la shuga. Kuyambitsa kuyenera kuyikidwa pakati pa chakudya, komanso asanagone, potero kumachepetsa mwayi wokhala ndi zovuta zina.

Mlingo wa mankhwalawa amasankhidwa mosiyanasiyana, kutengera matendawa ndi kuopsa kwa njira yake.

Kutalika kwa chithandizo ndi Sandostatin zimatengera nosology ndipo zimatha kuyambira masiku 5 mpaka 7 mpaka miyezi ingapo. Pofuna kupewa zovuta odwala omwe ali ndi vuto lalikulu la kapamba omwe amachitidwa opaleshoni, Sandostatin amamuika ola limodzi asanayambe opareshoni ndipo asanadutse masiku asanu ndi awiri.

Kanemayo amakamba za pamachitidwe a Sandostatin:

Malangizo apadera

Kubwezera sikumachitika kawirikawiri pochiza odwala omwe ali ndi gastroentero-pancreatic endocrine neoplasms.

Ndi anapezeka pituitary neoplasms, kuyang'anira odwala moyenera kumafunika kuti adziwe kukula kwa chotupa ndikuchepetsa minda yowoneka.

Odwala omwe apezeka ndi matenda insulinomas kuchuluka kwakukulu komanso nthawi yayitali hypoglycemia. Ndi kukhazikitsidwa kwa Sandostatin pakati pazakudya, komanso nthawi yogona, ndikotheka kuchepetsa zovuta zoyipa kuchokera kugaya chakudya.

Ndi chithandizo chachitali cha acromegaly, kuyesedwa kwa ultrasound kwa vutoli kumakhazikitsidwa chikhodzodzo pa nthawi yanthawi yofufuza matenda a ndulu. Sitikulimbikitsidwa kupereka jakisoni pakanthawi kochepa m'malo omwewo.

Sandostatin yoyamwitsa komanso kubereka imayikidwa malinga ndi zikuwonetseratu.

Ndi makonzedwe ang'onoang'ono a Mlingo wocheperako, kusinthasintha kwakukulu kwa shuga kungapeweke. Pa chithandizo, kuyang'anira shuga wamagazi nthawi zonse kumafunika.

Sandostatin LAR sangathe kutumikiridwa kudzera m'mitsempha, imayendetsedwa kwambiri intramuscularly (makamaka gluteus maximus). Ngati kulowa mu mtsempha wamagazi, m'malo mwa singano ndi jekeseni wofunikira ndikofunikira.

Mankhwala omwe amathandizira zilonda zam'mimba

Limodzi mwa gulu lodziwika bwino komanso logwiritsidwa ntchito nthawi yayitali ndi ma antacid. Mankhwalawa amaphatikiza alkalizing othandizira omwe amachepetsa asidi am'mimba kwambiri. Izi zimaphatikizapo sodium bicarbonate, kapena soda. Ubwino wa mankhwalawa wagona posachedwa kwa asidi, zovuta zimakhala pakulimbikitsa kusintha kwa zamchere m'thupi chifukwa chogwiritsa ntchito koloko yosagwira.

Calcium carbonate ndi mankhwala amphamvu kuposa mankhwala omwe afotokozedwa pamwambapa, koma amakhalanso ndi zomwezi. Kulandira chithandizo kwa nthawi yayitali kumayambitsa kudzimbidwa komanso kubisala kwachiwiri.

Mankhwala a Antacid a zilonda zam'mimba amakhalanso ndi magnesium oxide, trisilrate wa magnesium, aluminium hydroxide. Zinthu izi zimakhala ndi kuyamwa komanso mphamvu yodziwitsa. Zinthu za alkalizing zili mu mankhwala monga Vicalin, Bellgin, Bekarbon, Vikair, Almagel, Fosfalugel, Maaloks.

Kuthamanga kwa mankhwalawa ndikuchepetsa kutentha kwa mtima ndi kupweteka, kuwonekera chifukwa chakuchepa kwa acidity pazomwe zili m'mimba. Zotsatira za mankhwalawa zimadalira luso lawo la kusakanikirana ndipo limatenga mphindi 20 mpaka 60. Mankhwala amatengedwa bwino pakadontho kakang'ono mpaka katatu pa tsiku musanadye komanso usiku. Kuperekera zizindikiro za matenda, ma antacid amachepetsa kufooka kwa zilonda ndipo samakhudza zomwe zimayambitsa matendawa.

Gastric secretion blockers

Mankhwala olimbana ndi zilonda zam'mimba za gululi ali ndi cimetidine. Imalepheretsa mitsempha ya mitsempha ndi maunyolo omwe amachititsa kuti pakhale hydrochloric acid. Kutengera cimetidine, Ranitidine, Nizotidine, Famotidine ndi ma analogues ena ambiri amapangidwa.

Mothandizidwa ndi mankhwalawa, mapangidwe a pepsin ndi hydrochloric acid amathandizidwa modalirika, ndipo kupweteka ndi m'mimba kukokana zimathetsedwa. Kuchitikaku kumayambira atangomwa mankhwalawa, kupweteka kumatha pambuyo masiku 5, kusanza ndi kutentha kwamtima - patatha sabata. Zilonda zam'mimba zimayamba kuchira pakatha milungu 6, zomwe zimathamanga kwambiri kuposa kugwiritsa ntchito mankhwala ena. Zotsatira zoyipa ndizochepa.

Pharmacological gulu katulutsidwe blockers

Mankhwalawa a zilonda zam'mimba ali ndi vuto losakhazikika. Kuphatikiza pa kutsekereza katulutsidwe, zimakhudza machitidwe ena ndi ziwalo. Mankhwala amathandizanso pochiza zilonda zam'mimba. Mankhwala azitsamba achilengedwe ndi mabulosi a belladonna, omwe ali ndi atropine. Izi sizimangochepetsa kupanga hydrochloric acid, komanso zimachepetsa ntchito zam'mimba. Dongosolo la Belladonna ndi gawo la zokonzekera monga Bellalgin, Bellastesin, Bekarbon.

Pulifillin, komanso metacin, yotalikilidwa ndi masamba oundana ndi chipale chofewa, ilibe ntchito kwenikweni. Amachepetsa kukokana kwa m'mimba ndikuchepetsa kutulutsa kwake.

Gastrocepin kapena pirenzepine amathandiza kupewa kubwezeretsanso zilonda zam'mimba. Izi ndi zothandiza, chifukwa kwa nthawi yayitali amachepetsa katulutsidwe wa asidi, alibe mphamvu pa ntchito ya chapamimba.

Kupangika kwa asidi mu maselo otsekereza kumalepheretsedwa ndikuchira kwatsopano kwa zilonda zam'mimba - Omeprazole. Zimapanga zotsatira zosatha, zimagwiritsidwa ntchito pokonzanso mankhwala. Mankhwala atsopano a mahomoni "Sandostatin", "Octreotide", komanso diuretic "Diakarb" amathandizira kuchepa kwa chinsinsi.

Zilonda zam'mimba: mankhwala ndi cytoprotective mankhwala

Gululi limaphatikizapo mankhwala omwe amateteza maselo a m'mimba. Zimagwira kwambiri zilonda zam'mimba, pamene chitetezo cham'mimba zimachepa kwambiri. Pali mitundu yambiri yamitundu ya cytoprotectoral. Zina mwazo zimathandizira kukulitsa kubereka kwa ntchofu. Awa ndi mankhwala otengera mizu ya licorice (ma granles a Flacarbin, ma extracts, manyowa a licorice, mapiritsi a Likvirshpon) ndi Medicus rhizomes (kukonzekera kwa Vikalin ndi Vikair). Ena amachulukitsa zoteteza za ntchofu. Uku ndikuganiza kuchokera pamizu ya elecampane (mapiritsi a Alantoin), msuzi wa kabichi yaiwisi.

Ndi zilonda zakuya kwambiri, kutuluka magazi mwadzidzidzi, mankhwala a zilonda zam'mimba akuwonetsedwa - othandizira kupanga mafilimu (mankhwala "Ulkogant", "Carafate", "Keal").

Kukonzekera kwa Bismuth

Mankhwala othandizira zilonda zam'mimba zochokera pachinthu ichi ali ndi mphamvu yophatikiza. Amabisa zolakwika za mucosa, ndikupanga cholepheretsa. Kuphatikiza apo, amalepheretsa ma acid pamimba, kupha ma virus omwe amayambitsa zilonda zam'mimba (Helicobacter pylori). Chithandizo chogwira mtima kwambiri ndi De-nol.

Muzochita zamankhwala, pali matenda omwe amafunikira kutsindikidwa kwa ntchito zina za thupi: chinsinsi cha ma enzymes, mahomoni. Izi ndizofunikira kwa moyo wathunthu kapena nthawi ya opaleshoni kuti ichiritse bwino pakatha nthawi yothandizira. Milandu yachipatala yotereyi imaphatikizapo acromegaly, khansa, kapangidwe ka endocrine, kusatheka kwa njira zakale zamankhwala (chithandizo cha radiation, chithandizo cha opereshoni).

Malangizo ogwiritsira ntchito Octreotide

Mankhwalawa amatanthauza ma analogues opangidwa kapena zinthu zina zachilengedwe zamathupi a munthu. Mankhwala omwe amagwira ntchito m'malo mwa somatostatin, ali ndi mphamvu imodzimodzi ya mankhwala, koma amakhalanso ndi mphamvu. Mankhwala Octreotide amalepheretsa kupanga mahomoni okula, insulin, serotonin, glucagon, gastrin, omwe amapangidwa mopambanitsa chifukwa cha matenda kapena atatha kudya.

Mlingo ndi makonzedwe

Mankhwala ndiwothandizika kupondereza kupanga mahomoni, chifukwa chake, kusintha kwayekha muyezo kapena mankhwala popanda malangizo a dokotala saloledwa. Kugwiritsa ntchito molakwika mankhwalawa kumabweretsa kukula kwa matenda oyambitsidwa, kapena kupangika kwatsopano chifukwa cha kusakwanira kwa mahomoni. Mlingo ndi mawonekedwe a jakisoni amaperekedwa chifukwa chodziwitsa matenda omwe ali ndi vutoli. Mitundu ya Depot ndi Long imayendetsedwa kokha intramuscularly.

Mlingo wachitsanzo pa matenda osiyanasiyana ndi awa:

octreotide pancreatitis (pachimake) - 100 mcg katatu pa tsiku kwa masiku 5 mosazindikira (s / c) (n`zotheka kukulitsa mlingo mpaka 1200 mcg / tsiku ndi jakisoni mu mtsempha (iv),
kusiya zilonda zam'mimba - 25-50 mcg / ola iv kwa masiku 5,
kusiya venous (varicose) magazi am'minye - 25-50 mcg / ola iv kwa masiku 5,
Mlingo wa prophylactic nthawi ya opareshoni - 100-200 mcg s / c 1-2 mawola angapo asanachitike opaleshoni, 100-200 s / c katatu kapena tsiku - atachitidwa opaleshoni kwa masiku 5-7,
acromegaly kapena gastroenteropancreotic zotupa - 50-100 mcg 1-2 jakisoni tsiku lililonse.

Kuyanjana kwa mankhwala

Mankhwala amachepetsa kuyamwa kwa cimetidine ndikuchepetsa kuyamwa kwa cyclosporine. Kufanana ndi okodzetsa, beta-blockers, insulin, mankhwala a hypoglycemic, blockers a "slowly" calcium calcium, kusintha kwa mankhwala kumafunika. The bioavailability wa bromocriptine ikuchulukirachulukira. Mankhwala omwe ali pansi pa kagayidwe ka michere ya cytochrome P450 dongosolo amamuika motsogozedwa ndi katswiri.

Bongo

Mankhwalawa, mankhwala osokoneza bongo amatha kuonekera momwe zizindikiro zimawonekera: nseru, kufooka kwa nkhope, kumva kupweteka m'mimba, kutsika kwamtima, kuwonda. Ngati chimodzi mwazizindikirozi chikuchitika, siyani chithandizo ndipo dokotala.

Malo osungira

Sungani mankhwalawo mufiriji kutentha kwa + 2 ... + 8ºC.Osamasula mankhwalawo. Khala kutali ndi dzuwa.

Tsiku lotha ntchito

Kutalika kwa yosungirako - zaka 3.

Kupanga ndi mawonekedwe a kumasulidwa

Chithandizo chogwira ntchito ndi okreotide. Fomu yotulutsayo ndi ma ampoules okhala ndi yankho la subcutaneous ndi intravenous makonzedwe ndi ma microspheres opanga kuyimitsidwa kwa makonzedwe a intramuscularly.

Mimba komanso kuyamwa

Pa nthawi yoyembekezera komanso yoyamwitsa, mankhwalawa saikidwa mankhwala.

Gwiritsani ntchito paubwana

Palibe chidziwitso pakugwiritsa ntchito mankhwalawa kwa ana.

Terms a Tchuthi cha Pharmacy

Mankhwala, mankhwala amagulitsidwa ndi mankhwala.

Pansi pa zilonda zam'mimba amadziwika kuti amapanga chilema kukhoma kwa chiwalo. Komanso, zoyipa zimakhudza makamaka mucous nembanemba. Musanagule mankhwala azilonda zam'mimba, muyenera kudziwa pang'ono zamatendawa.

Zilonda zamitundu mitundu

Malinga ndi kuya kwa chotupa, zilonda ndizapamwamba, zimangokhudza mucous membrane, komanso mwakuya, zimagwira mbali zam'mimba ndi minyewa yam'mimba. Ndi kuwonongedwa kwa makoma a chiwalo, akunena za kupangika kwake. Poterepa, zomwe zili m'mimba zimathiridwa m'mimba. Popeza matendawa amatenga nthawi yayitali, oyandikana nawo amatha kumamatira kukhoma kwa chofotokozedwacho kuchokera kunja, ndipo zilonda zam'mimba zimatha kufalikira. Mofananamo, tikulankhula za zilonda zolowa, kulowa.

Mankhwala omwe amathandizira zilonda zam'mimba

Gastric secretion blockers

Pharmacological gulu katulutsidwe blockers

Pulifillin, komanso metacin, yotalikilidwa ndi masamba oundana ndi chipale chofewa, ilibe ntchito kwenikweni. Amachepetsa kukokana kwa m'mimba ndikuchepetsa kutulutsa kwake.

Zilonda zam'mimba: mankhwala ndi cytoprotective mankhwala

Ndi zilonda zakuya kwambiri, kutuluka magazi mwadzidzidzi, mankhwala a zilonda zam'mimba akuwonetsedwa - othandizira kupanga mafilimu (mankhwala "Ulkogant", "Carafate", "Keal").

Kukonzekera kwa Bismuth

Malangizo ogwiritsira ntchito Octreotide

Kupanga ndi mawonekedwe a kumasulidwa

Octreotide imapezeka pokhapokha njira zothetsera makulidwe a intramuscular and subcutaneous. Kuchuluka kwa ma ampoules ndi 1 ndi 5 ml. Mlingo umasiyana ndende ya yogwira mankhwala pa 1 ml ya yankho: 50, 100, 300, 600 mcg. Madzimadzi alibe mtundu komanso wopanda fungo. Mankhwalawa amaperekedwa m'mabokosi atsekedwa. Octreotide-Depot ndi Octreotide-Long ali lyophilized ufa wa kulowetsedwa (mwanjira zina, wothinikizidwa ndi piritsi) wathunthu ndi zosungunulira, kuyimitsanso kuyimitsidwa, syringe yapadera ndi singano ya intramuscular.

Kugonjera pakukonzekera

Madzi a jakisoni

Octreotide-Depot imakhala ndi pololymer ya dl-lactic ndi glycolic acid, polysorbate-80, madzi a jekeseni, D-mannitol, mchere wa sodium wa carboxymethyl cellulose. Kwa mankhwala Octreotide-Long, carmellose sodium, D-mannitol amagwiritsidwa ntchito. Kusiyana kwa mitundu itatu ya mankhwalawa ndi:

kuthamanga
Kutalika kwa zinthu zomwe zimagwira mkati mwa thupi,
mayendedwe amakhudzidwe.

Pharmacodynamics ndi pharmacokinetics

Mankhwalawa adapangidwa kuti apondereze kubisika kwa mahomoni omwe amapangidwa kwambiri ndi thupi la wodwalayo chifukwa cha matenda a pathologies komanso atatha kudya. Izi zikugwira ntchito kwa glucagon, insulin, gastrin, serotonin, insulin. Octreotide imachepetsa kupanga mahomoni okula omwe amayamba chifukwa cholimbikira thupi, arginine, kapena insulin hypoglycemia. Thyrotropin secretion imaponderezedwanso.

Mankhwalawa amagwiritsidwa ntchito pochepetsa chiopsezo cha njira zogwirira ntchito pambuyo pochita opaleshoni ya kapamba (pancreatic fistula, pancreatitis pachimake atachitidwa opaleshoni, sepsis, abscesses). Octreotide imagwiritsidwa ntchito, limodzi ndi mankhwala ena, kuti magazi asiye kutuluka ndipo zimayambiranso ndi mitsempha ya m'mimba ndi m'mimba mwa odwala omwe ali ndi vuto la chidwi.

Ndi subcutaneous makonzedwe, mankhwalawa amatengeka mwachangu: kuchuluka pazogwira zomwe zimachitika pambuyo pa mphindi 30. Thupi limalumikiza mapuloteni am'madzi ndi 65%. Mankhwalawa amachotsedwa m'thupi pambuyo pa mphindi 100 ndikuwongolera. Ndi jakisoni wamkati, kutulutsa kwa octreotide kuchokera mthupi kumachitika m'magawo awiri: pambuyo pa mphindi 10 ndi 90. Kuchuluka kwa zinthu kumachotsedwa m'matumbo, 32% imachotsedwa ndipo impso sizinasinthidwe.

Zizindikiro zogwiritsa ntchito Octreotide

Mankhwalawa cholinga chake ndikupondereza chinsinsi cha mahomoni okhala ndi mndandanda wambiri wa matenda. Kuphatikiza apo, mankhwalawa amagwiritsidwa ntchito poletsa zovuta m'mimba. Chipangizocho chikuvomerezedwa kuti chigwiritsidwe ntchito limodzi ndi mitundu yodziwika ya mankhwala (mwachitsanzo, endoscopic sclerotherapy). Mayendedwe akulu ogwiritsira ntchito Octreotide:

pachimake kapamba
kusiya magazi ndi zilonda zam'mimba za duodenum ndi m'mimba,
kupewa ndi kuyimitsa mitsempha ya varicose ndi matenda a chiwindi.
mankhwalawa komanso kupewa zovuta zam'mimba pambuyo pakuchita opaleshoni,
acromegaly, ndi kulephera kwa ma dopamine agonists, kulephera kuchitira opareshoni, kulandira mankhwala a radiation,
m'mimba endocrine zotupa za gastroenteropancreatic dongosolo,
glucagonoma
gastrinoma
Refractory (chitetezo) kutsegula m'mimba mwa odwala Edzi.

Mlingo ndi makonzedwe

Mlingo wachitsanzo pa matenda osiyanasiyana ndi awa:

octreotide pancreatitis (pachimake) - 100 mcg katatu pa tsiku kwa masiku 5 mosazindikira (s / c) (n`zotheka kukulitsa mlingo mpaka 1200 mcg / tsiku ndi jakisoni mu mtsempha (iv),
kusiya zilonda zam'mimba - 25-50 mcg / ola iv kwa masiku 5,
kusiya venous (varicose) magazi am'minye - 25-50 mcg / ola iv kwa masiku 5,
Mlingo wa prophylactic nthawi ya opareshoni - 100-200 mcg s / c 1-2 mawola angapo asanachitike opaleshoni, 100-200 s / c katatu kapena tsiku - atachitidwa opaleshoni kwa masiku 5-7,
acromegaly kapena gastroenteropancreotic zotupa - 50-100 mcg 1-2 jakisoni tsiku lililonse.

Kuyanjana kwa mankhwala

Zotsatira zoyipa

Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumayambitsa kupangidwa kwa miyala mu ndulu. Kuphatikiza pazomwe zimachitika ndi alopecia mukamagwiritsa ntchito mankhwalawa, machitidwe osiyanasiyana osiyanasiyana amachitika. Maonekedwe awo amadalira kuwonda kwa matendawa, momwe wodwalayo alili, komanso mogwirizana ndi mankhwala. Chisamaliro chimayenera kuthandizidwa ku zakudya chifukwa cha kusintha kwa katemera wa insulin ndi mahomoni ena. Zotsatira zoyipa:

kukomoka
kusanza, kusanza, kutulutsa, kutsegula m'mimba, kutsegula m'mimba, kuwawa, kupweteka kwa msana,
kutsekeka m'mimba (kawirikawiri)
pachimake chiwindi popanda cholestasis,
arrhasmia,
bradycardia
hyperbilirubinemia,
hyperglycemia
kulolerana kwa shuga,
kukulitsa kwa hypoglycemia,
kuyabwa, kuyaka, redness, kutupa kwa pakhungu kapena minofu pamalo a jekeseni.

Bongo

Kugwiritsa ntchito mankhwala Octreotide ochulukitsa kumayambitsa kuchepa kwakanthaŵi kwa kugunda kwa mtima, kumva kuthamanga kwa magazi kumutu ndi kumaso. Payokha, bongo wambiri umatha kuwonekera pakuphwanya kugwirira kwa m'mimba thirakiti: nseru, matenda am'mimba, matumbo opanda kanthu (njala yadzidzidzi), kupweteka kwam'mimba. Vutoli limathandizidwa mosamala, sizitanthauza kuti discontinuation ya mankhwala (kupatula milandu yovuta).

Zolemba za Octreotide

Mankhwala othandizira amaloledwa kulolerana ndi othandizira kapena kuthekera kwake. Ma Analogs amapezekanso pamankhwala, chifukwa mwakutero kugwiritsa ntchito kwawo kwaulere m'malo mwa Octreotide ndizosatheka. Kumbukirani kuti kusintha kwamankhwala kumachitika kokha ndi katswiri malinga ndi momwe wodwalayo amathandizira. Zofanizira zazikulu za Octreotide:

Sandostatin - analogue ya ufa yopanga njira zothetsera jakisoni wa iv ndi SC, chinthu chomwe chimagwira ndi octreotide, momwe thupi limafanana,
Somatostatin - mankhwala ozikidwa pazinthu zopanda mafuta zomwe zimalepheretsa kupanga mahomoni okula, choletsa serotonin, ma peptides ena,
Diferelin, analogue for subcutaneous management based on triptorelin acetate, ntchito mankhwalawa abala akazi, IVF kupondereza mahomoni omwewo ndi zinthu pakakhala kotheka kugwiritsa ntchito octreotide,
Mankhwala a Sermorelin - amagwiritsidwa ntchito kuti azindikire kukonzanso komanso magwiridwe antchito a kukula kwamafuta (kufufuzira kuchuluka kwa kuperewera kwa mahomoni mwa ana otupa).

Chifukwa cha kuthekera pakupanga, mankhwalawa ndi okwera mtengo (ma analogu sasiyana kwambiri mumtengo ndipo ali ndi malingaliro awo ogwiritsira ntchito). Mtengo wapakati pama pharmacies ku Moscow ndi ruble 1300. Mtengo umasiyanasiyana kutengera mtundu wa mankhwala, kuchuluka kwake, dziko lomwe akupanga. M'madera, mankhwala nthawi zina amakhala okwera mtengo 15-30% chifukwa chakuchepa kwake. Mtengo wapakati ku Moscow ndi likulu: