Momwe mungagwiritsire ntchito Fendivia?

Kufotokozera za mtundu wa kipimo

Chojambula chamkati chamkati chomwe chimakhala ndi zozungulira m'mphepete mwa filimu yoteteza chowonekera. Kanema woteteza ndi wamkulu kuposa chigamba. Chiwopsezo chauchimo chimagawa filimu yoteteza yochotsedwayo magawo awiri.

Zolemba zotsatirazi zimayikidwa patchalitchi posindikiza mitundu:

1) Fendivia ™ 12,5 μg / h - chigamba (18 ± 0.5) mm mulitali, (24 ± 0.5) mm kutalika: "Fentanyl 12.5 μg / ora" - chisindikizo cha bulauni,

2) Fendivia ™ 25 μg / h - chigamba (24.6 ± 0.5) mm mulitali, (37 ± 0.5) mm kutalika: "Fentanyl 25 μg / ola" - kusindikiza kofiira,

3) Fendivia ™ 50 μg / h - chigamba (34 ± 0.5) mm mulitali, (51.3 ± 0.5) mm kutalika: "Fentanyl 50 μg / ora" - chisindikizo chobiriwira,

4) Fendivia ™ 75 μg / h - chigamba (42 ± 0.5) mm mulitali, (61.7 ± 0.5) mm kutalika: "Fentanyl 75 μg / ola" - kusindikiza kwakuda kwamtambo,

5) Fendivia ™ 100 μg / h - chigamba (49 ± 0.5) mm mulitali, (70 ± 0.5) mm kutalika: "Fentanyl 100 μg / ora" - imvi.

Zizindikiro zogwiritsidwa ntchito

Kuvulala - ululu wowopsa komanso wolimbitsa thupi (angina pectoris, kulowerera m'mitsempha, kupweteka kwa odwala a khansa, kuvulala, kupweteka kwa ntchito), kukonzekera mitundu yosiyanasiyana ya opaleshoni yophatikizana ndi droperidol, antipsychotic chifuwa ndi m'mimba, ziwiya zazikulu, mu neurosurgery, ndi gynecological, orthopedic ndi ntchito zina).

TTS ndi matenda opweteka kwambiri opweteka kwambiri komanso okhazikika: kupweteka koyambitsidwa ndi khansa, kupweteka kwa mtundu wina, kumafuna analgesia ndi narcotic analgesics (mwachitsanzo, neuropathy, nyamakazi, matenda a Varicella zoster, etc.).

Contraindication

Hypersensitivity, kukhumudwa kwambiri kwa kupuma kwapakati.

TTS - ululu wammbuyo kapena wa postoperative (kuthekera kwa kusankha kwakwanira kwa mankhwalawa kwakanthawi kochepa, komwe kumatha kuyambitsa khungu lowopsa kapena loopsa), kukwiya, kupweteka kapena kuwonongeka kwa khungu (pamalo ofunsira), kutsekula m'mimba ndi pseudomembranous colitis yoyambitsidwa ndi cephalosporins, lincosamides, penicillin, dyspepsia wa poizoni, kupuma kwambiri, kupsinjika, msambo, zaka zosakwana 18.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mu / mu, mu / m. Akuluakulu pakukonzekera opaleshoni kwa mphindi 10-15 isanayambike - iv, 0,05-0.1 mg wa fentanyl ndi 2,5-5 mg wa droperidol.

Kwa opaleshoni yayikulu - iv, 0,4-0.6 mg, kukhalabe ndi opaleshoni - iv, 0,05-0.2 mg pakatha mphindi 20-30, pakulimbikitsa kupweteka pambuyo pa opaleshoni - iv - 0,05-0.1 mg, ngati kuli kotheka, akubwerezedwa Mlingo pambuyo 1 kapena 2 maola

Kutonthoza kupweteka ndi myocardial infarction - 0,5 mg limodzi ndi 5 mg ya droperidol (kwa mphindi 3).

Ana pakukonzekera opareshoni - 2 μg / kg, kwa opaleshoni yofikira - 10-150 μg / kg iv kapena 150-250 μg / kg iv, poisamalira anesthesia - 1-2 μg / kg iv 2 mcg / kg v / m. Kwa ana ochepera zaka ziwiri, Mlingo sanakhazikitsidwe.

Chigoba chimayikidwa kwanuko kwa maola makumi asanu ndi awiri (7) pakhungu losasunthika (losakwiya, lopanda tsitsi, kutsukidwa ndi madzi oyera ngati pakufunika kutero, osagwiritsa ntchito zitsulo ndi zouma bwino) ndikukanikizidwa mwamphamvu (njira zina). Mlingo amasankhidwa payekha. Kwa odwala omwe sanamwe opiates kale, mlingo woyambirira ndi 25 μg / h, ndi kulekerera kwa opiates mukasinthira kulandira chithandizo cha fentanyl, mlingo woyambirira amawerengedwa molingana ndi matebulo ofanana, kutengera kufunika kwa tsiku ndi tsiku kwa analgesics, ngati mlingo wopitilira 300 μg / h ukugwiritsidwa ntchito, wowonjezera kapena njira zina zoyendetsera.

Zotsatira za pharmacological

Narcotic analgesic, opiate receptor agonist (makamaka ma receptors) a chapakati mantha dongosolo, msana ndi zotumphukira zimakhala. Ikuwonjezera ntchito ya machitidwe oletsa kupanikizika, kumawonjezera kuchepa kwa mphamvu ya kupweteka.

Zotsatira zazikulu zochizira za mankhwalawa ndi analgesic komanso sedative. Imakhumudwitsa malo opumira, imachepetsa kugunda kwa mtima, imasangalatsa malo a n.vagus ndi malo osanza, imakulitsa mamvekedwe a minofu yosalala ya thirakiti la biliary, sphincters (kuphatikiza ndi urethra, chikhodzodzo ndi zotupa za Oddi), zimathandizira mayamwidwe am'madzi kuchokera m'mimba. Amachepetsa kuthamanga kwa magazi, matumbo a m'mimba komanso magazi aimpso. M'magazi kumawonjezera kuchuluka kwa amylase ndi lipase, kumachepetsa kuchuluka kwa STH, catecholamines, ADH, cortisol, prolactin.

Imalimbikitsa kukonzekera kugona (makamaka pokhudzana ndi kuchotsa ululu). Zimayambitsa kukokoloka. Mlingo wa chitukuko cha kudalira kwa mankhwala ndi kulolerana kwa zotsatira za analgesic kumakhala ndi kusiyana kwakukulu pamunthu payekha.

Mosiyana ndi ma analgesics ena a opioid, samayambitsa machitidwe a histamine.

Mulingo woyenera kwambiri wa analgesic ndi i.v. makonzedwe amayamba pambuyo pa mphindi 3-5, ndi i / m - pambuyo pa mphindi 20-30, nthawi ya mankhwalawo limodzi ndi maulamuliro a i / v mpaka 100 mcg ndi 0.5-1 h, ndi kuyang'anira kwa i / m monga Mlingo wowonjezera - maola 1-2, mukamagwiritsa ntchito TTS - maola 72

Zotsatira zoyipa

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

Kuchokera kwamitsempha yamanjenje ndi ziwalo zam'maganizo: pafupipafupi - kupweteka mutu, kugona, kuphatikizira akhanda), kawirikawiri - kukhumudwa kwa dongosolo lamanjenje lamkati (kuphatikiza pa opaleshoni), kukhumudwa kwa pakati pa dongosolo lamanjenje, kutsekeka, kukomoka, kawirikawiri - Kuzindikira kowoneka bwino, diplopia, maloto owoneka bwino, kuiwalika, kusasunthika - kusokonezeka, kukondwerera, kuwonera, kupweteka mutu, kulowetserera matenda oopsa.

Kuchokera pamimba yogaya chakudya: pafupipafupi - nseru, kusanza, kawirikawiri - kukomoka, kupindika kwa Oddi, kuchepa kwa zotupa, kudzimbidwa, colic (odwala omwe anali ndi mbiri yawo).

Kuchokera ku CCC: pafupipafupi - bradycardia, kutsitsa magazi, nthawi zambiri - kuletsa zochitika za CCC, mpaka kumangidwa kwa mtima.

Kuchokera kwamikodzo dongosolo: kuphipha kwa ma ureters, kusungika kwamikodzo.

Thupi lawo siligwirizana - kawirikawiri - matupa a khungu, laryngospasm, kuzizira, pruritus, bronchospasm.

Zomwe zimachitika mdelalo (mukamagwiritsa ntchito chigamba): kuyabwa, zotupa, khungu lake (kusowa mkati mwa maola 24 mutachotsa chigamba), ndikuyaka.

Zina: kukanika kwakanthawi kwa minofu (kuphatikiza minofu ya chifuwa), thukuta lochulukirapo, kudalira mankhwala, matenda amkati, kupweteka kwam'mimba, kutseguka, rhinitis, kusisita, kupumira kwa thukuta, thukuta, kudwala, kusanza, kusanza, mantha kusakwiya, kunjenjemera, ana opukusidwa, kufooka wamba), kulolerana.

Malangizo apadera

Mankhwalawa ayenera kugwiritsidwa ntchito ndi okhawo omwe ali ndi chipatala chofunikira kwambiri. Munthawi ya ntchito, wodwala amafunikira kuwunikidwa mosamala.

Odwala omwe amachepetsa thupi panthawi yayitali akamagwira ntchito kapenanso kugwiritsa ntchito fentanyl, kuwonjezeka kwa nthawi yake kungachitike.

Imawonjezera ntchito ya plasma amylase ndi lipase chifukwa cha kuphipha kwa sphincter ya Oddi ndikuwonjezera kukakamiza mu dongosolo la biliary (kuphunzira kwa ma enzymes awa kuyenera kuchitika mwina maola angapo asanagwiritse ntchito fentanyl, kapena maola a 24 atatha kuyendetsa).

Kafukufuku wa radionuclide amachepetsa kuwona kwa hepatobiliary thirakiti chifukwa cha kuphipha kwa sphincter ya Oddi.

Ngati ndi kotheka, poika mankhwala pa mkaka wa m`mawere ayenera kusiya kuyamwitsa.

Kugwiritsa ntchito kachiwongola osavomerezeka chifukwa cha ululu wammbuyo kapena wa postoperative (chifukwa cha kuthekera kosankha mlingo kwakanthawi kothandizira komanso chiwopsezo cha hypoventilation), mwa amayi omwe ali ndi zaka zobereka ndipo amafunikira kusamala mu matenda am'mapapo. COPD (mwina kupsinjika pakati pa kupuma), chikumbumtima chovulala, chikomokere, zotupa muubongo, bradyarrhythmias, chiwindi ndi impso, muukalamba ndi ubwana.

Mukamagwiritsa ntchito chigamba, tikulimbikitsidwa kuti musayang'ane mwachangu ndi magetsi ochokera kunja (kutentha pads, saunas, malo osambira dzuwa, ndi zina zambiri).

Pa chithandizo, simuyenera kuchita nawo zinthu zoopsa zomwe zimafuna kuwonjezereka komanso kuthamanga kwa zochitika zama psychomotor.

Kuchita

Dinitrogen oxide imathandizira kukhazikika kwa minofu, ma tridclic antidepressants, opiates, sedative ndi hypnotics, phenothiazines, mankhwala a anxiolytic (tranquilizer), mankhwala opaleshoni ya minofu, zotumphukira za minofu, othandizira ma antihistamines, omwe ali ndi zotsatira zoyambitsa komanso zina za phenol, ethanol. Kupsinjika kwa CNS, hypoventilation, ochepa hypotension, bradycardia, kupuma pakati kukakamira, etc.).

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

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

Benzodiazepines imachulukitsa kumatulutsa kwa neuroleptanalgesia.

Ndikofunikira kuchepetsa mlingo wa fentanyl mukugwiritsa ntchito insulin, corticosteroids, antihypertensive mankhwala.

Mao inhibitors amalimbikitsa chiopsezo cha zovuta zazikulu.

Zopuma zolimbitsa thupi zimaletsa kapena kuthetsa kusakhazikika kwa minofu, kupumula kwa minofu yokhala ndi m-anticholinergic zochita (kuphatikizapo pancuronium bromide) kumachepetsa chiopsezo cha bradycardia ndi hypotension (makamaka pamene beta-blockers ndi vasodilators ena amagwiritsidwa ntchito) ndipo zimawonjezera chiopsezo cha tachycardia, matenda oopsa a myorrheal omwe alibe m-anticholinergic shughuli (kuphatikiza suxamethonium) samachepetsa chiopsezo cha bradycardia ndi hypotension yakale (makamaka motsutsana ndi mbiri yakale ya mtima) ndikuchulukitsa chiopsezo chovuta kwambiri Zotsatira wanthawi zonse ku CCC lapansi.

Mankhwala

Fendivia ™ ndi chigamba cha transdermal chomwe chimapereka kupitiliza kwachilengedwe kwa fentanyl kwa maola 72. Fentanyl ndi opioid analgesic yothandizirana makamaka ndi ma opiate μ receptors a chapakati mantha dongosolo, msana, ndi ziwalo zotumphukira. Ikuwonjezera ntchito ya machitidwe oletsa kupanikizika, kumawonjezera kuchepa kwa mphamvu ya kupweteka. Fendivia ya mankhwalawa makamaka imakhala ndi zotsatira za analgesic komanso sedative. Fentanyl imakhumudwitsa malo opumira, imachepetsa kugunda kwa mtima, imakondweretsa malo n.vagus ndi malo osanza, kumawonjezera mamvekedwe a minofu yosalala ya biliary tra, sphincters (kuphatikizapo urethra, chikhodzodzo ndi sphincter ya Oddi), imakonza kuyamwa kwamadzi kuchokera m'mimba. Amachepetsa kuthamanga kwa magazi, matumbo a m'mimba komanso magazi aimpso. M'magazi kumawonjezera kuchuluka kwa amylase ndi lipase, kumachepetsa kuchuluka kwa STH, catecholamines, ACTH, cortisol, prolactin. Imalimbikitsa kukonzekera kugona (makamaka pokhudzana ndi kuchotsa ululu). Zimayambitsa kukokoloka. Mlingo wa chitukuko cha kudalira kwa mankhwala ndi kulolerana kwa zotsatira za analgesic kumakhala ndi kusiyana kwakukulu pamunthu payekha. Kawirikawiri sizimayambitsa kusintha kwa histamine.

Pharmacokinetics

Njira yochepetsetsa ya analgesic ya fentanyl mu seramu yamagazi mwa odwala omwe sanagwiritse ntchito opioid analgesics ndi 0.3-11.5 / ml. Pafupipafupi pazinthu zosafunikira zoterezi zimawonjezeka ndi kuchuluka kwa fentanyl m'magazi a seramu pamwamba pa 2 ng / ml. Ndi kukula kwa kulolerana, onse osachepera ogwira analgesic ndende ya fentanyl amawonjezeka komanso ndende komwe kumachitika zosafunika.

Zogulitsa. Pambuyo pa ntchito yoyamba ya chigawo cha transdermal, kuchuluka kwa fentanyl mu seramu yamagazi kumawonjezeka pang'onopang'ono, nthawi zambiri kumakhala pakati pa maola 12 ndi 24, kenako kumakhala kosasintha kwa maola onse a 72. Pakugwiritsa ntchito kwachiwiri kwa maola 72 phukusi lapa transdermal, kudzipereka kosalekeza kwa fentanyl mu seramu yamagazi kumatheka, komwe kumakhalabe pakutsatira kwa chigamba chofanana. Kuchuluka kwa fentanyl m'mwazi ndikofanana ndi kukula kwa chigamba cha transdermal. Mafuta a fentanyl amatha kusiyanasiyana pang'ono kutengera malo omwe angagwiritsidwe ntchito. Kuponyera kwapang'onopang'ono kwa fentanyl (pafupifupi 25%) kunawonedwa m'maphunziro omwe adachitika ndi odzipereka athanzi panthawi yoika chigamba pachifuwa poyerekeza ndikugwiritsa ntchito dzanja lam'mbuyo ndi kumbuyo.

Kugawa. Fentanyl imamangidwa ndi mapuloteni a plasma ndi 84%, imadutsa BBB, placenta, ndikulowetsa mkaka wa m'mawere.

Kupenda. Fentanyl ili ndi chingwe cha michere ya biotransfform ndipo imapangidwa makamaka m'chiwindi ndi ma enzymes CYP3A4. Metabolite yayikulu ya fentanyl ndi norfentanil, yomwe siikugwira ntchito.

Kuswana. Pambuyo pochotsa chigamba cha transdermal, kuchuluka kwa fentanyl mu seramu yamagazi kumachepa pang'onopang'ono. T_1/2 fentanyl atatha kugwiritsa ntchito chigamba cha transdermal ndi maola 17 (maola 13 mpaka 22) mwa akulu ndi maola 22-25 mwa ana. The kuyamwa kwa fentanyl kuchokera pakhungu kumabweretsa pang'onopang'ono kuchotsa kwa mankhwala kuchokera magazi seramu kuyerekeza ndi iv makonzedwe. Pafupifupi 75% ya fentanyl imachotsedwa mu mkodzo, makamaka mawonekedwe a metabolites, osakwana 10% sasintha, pafupifupi 9% imachotsedwa mu ndowe, makamaka mu mawonekedwe a metabolites.

Magulu Opatsa Odwala

Kuchepa kwa chiwindi kapena impso kungayambitse kuchuluka kwa serum fentanyl. Okalamba, ofooka, kapena ofooka, kuchepa kwa chilolezo cha fentanyl ndikotheka, komwe kumatha kuyambitsa T_1/2 fentanyl.

Ana. Kutengera ndi kulemera kwa thupi, chilolezo (l / h / kg) ndichabwino kwambiri kwa ana kuyambira 2 mpaka 5 ndi 25% mwapamwamba mwa ana kuyambira wazaka 6 mpaka 10 poyerekeza ndi ana azaka 11 mpaka 16 omwe ali ndi zaka 11 chilolezo chomwecho ngati akulu.

Mimba komanso kuyamwa

Chitetezo cha ma transdermal patches ndi fentanyl panthawi yapakati sichinakhazikitsidwe. Kafukufuku wazinyama adakhazikitsa kawopsedwe kena kobereka.

Fentanyl iyenera kugwiritsidwa ntchito pokhapokha ngati pakufunika kutero. Kugwiritsira ntchito nthawi yayitali panthawi yoyembekezera kungayambitse kuti akhanda akhazikike. Osati kawirikawiri, panali zomwe zimawonetsa kuti akhanda omwe amayi awo akhanda amayamba kugwiritsa ntchito fentanyl ndi fentanyl panthawi yapakati.

Fentanyl sayenera kugwiritsidwa ntchito pamene akugwira ntchito komanso pakubala (kuphatikizapo gawo la cesarean), mongaimadutsa mwa placenta ndipo imatha kuyambitsa kupsinjika kwa mwana wosabadwa kapena wakhanda.

Fentanyl imachotsedwa mkaka wa m'mawere ndipo imatha kuyambitsa kusokonezeka ndi kupsinjika kwa mwana wakhanda loyamwa. Chifukwa chake, ngati kuli kotheka, kuikidwa kwa mankhwala Fendivia ™ pa mkaka wa m`mawere kuyenera kuyamwa kuyamwa

Mlingo ndi makonzedwe

Patch ya transdermal imatulutsa fentanyl mkati mwa maola 72. Mtengo wotulutsira fentanyl ndi 12.5, 25, 50, 75 ndi 100 μg / h, womwe ndi pafupifupi 0.3, 0.6, 1.2, 1.8 ndi 2.4 mg / tsiku, motero.

Mlingo wofunikira wa fentanyl umasankhidwa payekhapayekha, poganizira momwe wodwalayo alili, ndipo amayenera kuwunikiridwa pafupipafupi. Mlingo wothandiza wotsika kwambiri uyenera kugwiritsidwa ntchito.

Kusankha koyambirira

Mlingo woyambirira wa fentanyl umakhazikitsidwa malinga ndi kuchuluka kwa kudya kwa opioid m'mbuyomu, komanso kuganizira momwe zingathekere kulolerana, kugwiritsa ntchito mankhwala osokoneza bongo, thanzi komanso thanzi la wodwala, i.e. kukula kwa thupi, zaka komanso kutopa, kuopsa kwa matendawa.

Akuluakulu adathandizidwa ndi opioids m'mbuyomu

Kusamutsa odwala omwe adalandira ma opioid kuchokera pakamwa kapena paulamuliro wa opioids kupita nawo ku chigawo cha transdermal, tebulo 1 liyenera kugwiritsidwa ntchito Ngati kuli koyenera, mlingowo ungasinthidwe kutsika pansi kapena kupitilira kwa 12,5 kapena 25 μg / h kuti musankhe Mlingo wothandiza wotsikirapo kwambiri malinga ndi kuyankha kwa wodwalayo komanso kufunika kwa kupumula kowonjezereka.

Akuluakulu omwe sanalandiridwepo ndi ma opioid kale

Monga lamulo, transdermal management sikulimbikitsidwa kwa odwala omwe sanalandire opioids kale. Njira zina zakakhazikitsire (pakamwa, mwa makolo) ziyenera kuganiziridwa. Popewa kumwa mopitirira muyeso kwa odwala omwe sanalandire ma opioid kale, tikulimbikitsidwa kuti ma doioids otsika atulutsidwe mwachangu alembe (kuphatikizapo morphine, hydromorphone, oxycodone, tramadol ndi codeine), mlingo womwe umayenera kusankhidwa kuti ugwirizane ndi chigawo cha transdermal chothandizira kupweteka pa mlingo wa 12,5 kapena 25 mcg / h. Pambuyo pake, odwala amatha kusinthana ndi kugwiritsa ntchito mankhwalawa Fendivia ™.

M'magawo a opioid omwe sanayenere kugwiritsidwa ntchito komanso kugwiritsa ntchito chigamba cha transdermal imadziwika kuti ndiyo njira yokhayo yothandizira, kugwiritsa ntchito Fendivia ™ kuyenera kuyambitsidwa ndi mlingo wochepa wa 12,5 μg / h. Zikatero, kuyang'anira wodwala ndikofunikira.

Pali chiopsezo cha kupuma kwakanthawi kapena koopsa kwa moyo ngakhale mlingo wochepa wa 12.5 μg / h wa Fendivia ™ umagwiritsidwa ntchito kwa odwala omwe sanalandire opioids kale.

Kusintha kuchokera ku kutenga ma opioid ena

Wodwala akangotuluka pakamwa kapena mwaukazitape wa opioid analgesics kupita ku chithandizo cha fentanyl, mlingo woyambira wa Fendivia ™ amawerengedwa motere.

1) Chiwerengero cha opioid analgesics chofunikira cha wodwalayo maola 24 apitawo (mg / tsiku) chiyenera kutsimikiziridwa.

2) Chuma chomwe chimalandilidwa chimayenera kusinthidwa kupita kwa kamwa yoyenera ya tsiku ndi tsiku ya morphine (mg / tsiku) pogwiritsa ntchito gome 1.

3) Mlingo woyenera wa fentanyl umatsimikiziridwa pogwiritsa ntchito matebulo 2 ndi 3.

Mapiritsi 2 ndi 3 sayenera kugwiritsidwa ntchito kusinthira kuchokera ku chigamba cha transdermal kupita ku opioids ena kuti musamwe mankhwala okwanira. Izi zimatha kuyambitsa bongo.

Gome la kutembenuka - coefficients posinthira mlingo wa tsiku ndi tsiku wa mankhwala omwe amagwiritsidwa ntchito kale kukhala wofanana ndi analgesic tsiku lililonse pamlomo wa morphine (mg / tsiku la opioid × mgwirizano = ofanana ndi analgesic tsiku lililonse Mlomo wa morphine)

ndi Ntchito ya morphine ya pakamwa kapena intramuscularly imachitika chifukwa cha zovuta zomwe zimachitika kwa odwala omwe ali ndi ululu wammbuyo.

b Kutengera ndi maphunziro omwe ali ndi i / m kasitomala wa opioid analgesics omwe atchulidwa pamwambapa, anachitika kuti akhazikitse ntchito yawo yofanana ndi morphine. Mlingo wa pakamwa makonzedwe ndi Mlingo womwe akutsimikiziridwa pakusintha kuchokera kwa makolo kupita ku njira yolankhulira yamankhwala.

Mlingo woyambira wa Fendivia ™ malingana ndi mtundu wakumwa wa morphine wa tsiku ndi tsiku (kwa odwala akuluakulu osakhazikika bwino omwe akufuna kulandira mankhwala opioid: chiŵerengero cha kusintha kuchokera ku morphine woperekedwa pakamwa ndikugwiritsira ntchito fentanyl ndi 150: 1)

Mlingo woyambira wa Fendivia ™ malingana ndi mtundu wakumwa wa morphine wa tsiku ndi tsiku (kwa anthu akuluakulu omwe ali ndi mankhwala othandizira opioid wokhazikika: chiyerekezo cha kusintha kwa morphine wothandizidwa pakamwa ndi fentanyl ndi 100: 1)

Kuyesa koyambirira kwa zotsatira zoyenera za mankhwala a Fendivia ™ kutha kuchitika palibe kale kuposa maola 24 mutatha kugwiritsa ntchito. Kuchepetsa kumeneku kuli chifukwa chakuti kuwonjezeka kwa kuchuluka kwa fentanyl mu seramu yamagazi 24 mawola 24 atatha kugwiritsa ntchito chigamba cha transdermal pang'onopang'ono. Chifukwa chake, mukasinthana ndi mankhwala kupita kwina, chithandizo cha analgesic choyambirira chiyenera kusiyidwa pang'onopang'ono mutatha kugwiritsa ntchito koyamba mlingo wa Fendivia ™ mpaka mphamvu yake ikhazikike.

Kusankha kwa Mlingo ndi Therapy Yokonza

Chigoba cha transdermal chizisinthidwa china chatsopano maola 72 aliwonse.

Mlingo amasankhidwa payekha mpaka mulingo woyenera kwambiri wa mulingo wa analgesia ndi kulekerera kwa mankhwala Fendivia ™ akwaniritsidwa. Nthawi zambiri, nthawi 1, mlingo umawonjezeka ndi 12,5 kapena 25 mcg / h. Komabe, mukasintha mlingo, ndikofunikira kuganizira za momwe wodwalayo alili komanso kufunika kwa analgesia wowonjezera (mulingo wamkamwa wa morphine 45 ndi 90 mg / tsiku ali ofanana ndi Mlingo wa 12,5 ndi 25 μg / h wa Fendivia ™, motero). Pambuyo kuwonjezera kuchuluka, wodwalayo angafunike mpaka masiku 6 kuti akwaniritse analgesia yokhazikika.

Pachifukwa ichi, mutachulukitsa mlingo, ndikofunikira kugwiritsa ntchito chigamba cha transdermal cha kuchuluka kwa nthawi zosachepera 2 kwa maola 72. Pambuyo pokhapokha, kuwonjezeka kwa mlingo wotsatira ndikotheka ngati kupumula kwa ululu sikokwanira.

Kuti mupeze mlingo wopitilira 100 mcg / h, zigawo zingapo za transdermal zitha kugwiritsidwa ntchito nthawi imodzi. Ngati kupweteka kwapang'onopang'ono kumachitika, odwala nthawi zina angafunike Mlingo wowonjezera wa analgesics. Ngati mulingo wa Fendivia ™ uposa 300 mcg / h, muyenera kuigwiritsa ntchito njira zowonjezera kapena njira zina zothandizira ululu kapena njira zina zoyendetsera opioid analgesics.

Kumayambiriro kwa chithandizo chamankhwala, ngati mugwiritsa ntchito mlingo woyambirira wa mankhwalawa, kuchepa kwa mphamvu kwambiri, mphamvuyo ikhoza kutha pambuyo pa maola 48 ndi chigamba cha mlingo womwewo, ndipo pambuyo pa maola makumi awiri ndi awiri mlingowo ungathe kuchuluka.

Ngati kuli kofunika kusintha kachilomboka kupita mpaka maola 72 (mwachitsanzo, ngati chigambacho chitasungunulidwa), chigawo cha mulingo womwewo uyenera kukakamizidwa kudera lina la khungu. Zoterezi zimatha kubweretsa kuchuluka kwa fentanyl m'madzi a m'magazi, chifukwa chake wodwalayo ayenera kuyang'aniridwa mosamala.

Posintha kuchokera ku chithandizo chanthawi yayitali ndi morphine kukhala chigamba cha transdermal chokhala ndi fentanyl, matenda achire angachitike ngakhale atakhala ndi analgesic kwenikweni. Zizindikiro zochoka pakachitika, tikulimbikitsidwa kuti odwala apatsidwe morphine wamfupi pamiyeso yotsika.

Kuchotsa kwa Fendivia ™

Ngati kuli kofunikira kusokoneza kugwiritsa ntchito chigamba cha transdermal, ndiye kuti ma opioids ena aliwonse ayenera kusintha m'malo pang'onopang'ono, kuyambira mlingo wotsika ndikuwonjezera pang'onopang'ono. Izi ndichifukwa choti zomwe zili mu fentanyl mu seramu yamagazi pambuyo pochotsa chigawo cha transdermal zimachepa pang'onopang'ono. Osachepera maola 20 amafunikira kuti achepetse seramu fentanyl ndi 50 %. Pali lamulo lambiri: kuchotsera kwa analgesia ndi opioid analgesics kuyenera kuchitidwa pang'onopang'ono kuti muchepetse zizindikiro zodzipatula (kusanza, kusanza, kutsegula m'mimba, kuda nkhawa komanso minyewa ya minyewa).

Gwiritsani ntchito odwala okalamba

Odwala okalamba ayenera kupendedwa mosamala ndikuwonetsetsa. Ngati ndi kotheka, mlingo wa Fendivia ™ uyenera kuchepetsedwa (onani "Malangizo Apadera"). Odwala okalamba omwe sanalandirepo ma opioid kale, Fendivia ™ iyenera kugwiritsidwa ntchito pokhapokha ngati phindu likulipira chiwopsezo. Monga mlingo woyambirira, ndi 12,5 mcg / h yekhayo amene ayenera kugwiritsidwa ntchito.

Gwiritsani ntchito odwala omwe ali ndi vuto la chiwindi ndi impso

Odwala omwe ali ndi vuto la chiwindi ndi impso ayenera kuwunikidwa bwino ndi kuwunikira ngati akuwonetsa fentanyl ndipo ngati pakufunika kutero, mlingo wa Fendivia ™ uyenera kuchepetsedwa (onani "Malangizo Apadera").

Odwala omwe ali ndi vuto la chiwindi ndi impso omwe sanalandirepo ma opioid kale, Fendivia ™ iyenera kugwiritsidwa ntchito pokhapokha ngati phindu likulipira chiwopsezo. Monga mlingo woyambirira, ndi 12,5 mcg / h yekhayo amene ayenera kugwiritsidwa ntchito.

Gwiritsani ntchito mwa odwala omwe ali ndi malungo / motsogozedwa ndi mphamvu zakunja kutentha

Odwala omwe ali ndi malungo angafunike kusintha kwa fentanyl (onani "Malangizo Apadera").

Gwiritsani ntchito mwa ana a zaka 16 kapena kupitirira

Mlingo wa ana opitirira zaka 16 ndiwofanana ndi njira ya akulu.

Gwiritsani ntchito ana kuyambira zaka ziwiri mpaka 16

Fendivia ™ mankhwala ayenera kugwiritsidwa ntchito mwa ana okhawo omwe alandila kale morphine pakamwa osachepera 30 mg / tsiku. Mukasintha kuchokera pakamwa kapena pa makina a opioid analgesics kupita ku chigawo cha transdermal ndi fentanyl mwa ana, mlingo woyambirira amawerengedwa pogwiritsa ntchito matebulo 1 ndi 4.

Mulingo woyambira wa Fendivia ™ wa ana azaka ziwiri mpaka 16 zakubadwa, kutengera mtundu wa morphine wa tsiku lililonse

Kusintha kwa Mlingo wa fentanyl wopitilira 25 mcg / h sikusiyana kwa ana ndi akulu (onani tebulo 2).

b M'mayeso azachipatala, malire omwe adawonetsedwa pamankhwala a morphine tsiku lililonse adagwiritsidwa ntchito kuwerengera kusintha kwa wodwala kupita ku Fendivia ™.

M'maphunziro awiri aana, kuchuluka kwa patch ya transdermal kunawerengeredwa mosamala: kuyambira 30 mpaka 44 mg / tsiku la morphine, pakamwa kapena kuchuluka kofanana ndi ma analgesics ena a opioid, adasinthidwa ndi chigamba chimodzi cha transdermal pa mlingo wa 12,5 μg / h. Njira yosinthira ana imagwiritsidwa ntchito pokhapokha m'malo mwa morphine wamlomo (kapena ofanana nawo) ndi chigamba cha transdermal. Malowa sangagwiritsidwe ntchito kusinthira kuchokera ku fentanyl kupita ku ma analgesics ena a opioid, chifukwa pamenepa vuto limatha kuchitika.

Mphamvu ya analgesic ya muyezo woyamba wa chigamba cha transdermal ndi fentanyl sichimafika pamlingo woyenera kwambiri panthawi ya maola 24. Chifukwa chake, m'maola 12 oyamba mutasintha mankhwala Fendivia ™, wodwalayo ayenera kulandira Mlingo woyamba wa analgesics. Maola 12 otsatira, odwala ayenera kupatsidwa ma analgesics potengera zosowa zamankhwala.

Popeza kuchuluka kwa fentanyl m'magazi kumafika pakufunika kwake pambuyo pa maola 12-24, ndikofunikira kuti aziwonetsetsa odwala pazovuta, zomwe zingaphatikizepo kupsinjika kwa maola osachepera 48 mutayamba chithandizo cha transdermal patch kapena mutatha kuchuluka (onani "Malangizo apadera" )

Mlingo wosankha ndi kusamalira mankhwala a ana kuyambira zaka ziwiri mpaka 16

Patch ya transdermal iyenera m'malo mwake ndi yatsopano maora aliwonse a 72. Mlingo umasankhidwa payekhapayekha mpaka mulingo woyenera wa mulingo wa analgesia ndi kulekerera kwa mankhwala Fendivia ™ akwaniritsidwa. Ngati analgesic zotsatira za Fendivia ™ sizokwanira, morphine kapena wina wosakhalitsa wa opioid analgesic ayenera kukhazikitsidwa. Kutengera ndi kufunikira kowonjezera kwa opaleshoni ndi kuuma kwa kupweteka kwa mwana, kuwonjezeka kwa mlingo ndikotheka. Kusintha kwa Mlingo kuyenera kuchitika pang'onopang'ono, mukuwonjezera kwa 12.5 mcg / h. Mlingo sayenera kuchulukitsa kopitilira kamodzi pa maola makumi awiri ndi awiri.

Chigoba cha transdermal chikuyenera kupakidwa pachitseko cha khungu losakhwima la thunthu kapena phewa. Msana wapamwamba ndiye malo abwino kwambiri ogwiritsira ntchito chigamba cha transdermal mwa ana aang'ono. Ndi kugwiritsa ntchito, mwayi wodzichotsa wekha wa chigamba cha ana amachepetsa.

Kugwiritsa ntchito, tikulimbikitsidwa kusankha malo okhala ndi tsitsi lochepera (makamaka popanda tsitsi). Musanagwiritse ntchito tsitsi pamalo ogwiritsira ntchito ayenera kudulidwa (osameta). Ngati tsamba logwiritsira ntchito liyenera kutsukidwa musanayambe kugwiritsa ntchito chigamba cha transdermal, izi ziyenera kuchitika ndi madzi oyera. Osagwiritsa ntchito sopo, mafuta odzola, mafuta, mowa kapena njira zina, monga zimatha kuyambitsa khungu kapena kusintha malo. Pamaso ntchito, khungu liyenera kukhala louma.

Popeza chigamba cha transdermal chimatetezedwa ndi filimu yoteteza kunja kwa madzi, sichitha kuchotsedwa pakungosamba kwakanthawi kochepa.

Chigoba cha transdermal chimachotsedwa pamtengo pokhomeka gawo lozunguliridwa pafupi ndi nsonga ya muvi ndikang'amba mosamala zinthuzo.

Chigoba cha transdermal chiyenera kugwiritsidwa ntchito atachotsedwa phukusi, osakhudza mbali yake yomatira. Pambuyo pochotsa filimu yoteteza, chigamba cha transdermal chimayenera kukanikizidwa mwamphamvu ndi chikhatho cha dzanja kupita kumalo ogwiritsira ntchito masekondi 30. Onetsetsani kuti chigamba cha transdermal chimamangiririka pakhungu, makamaka kuzungulira m'mphepete. Zowonjezera zina zamkaka zingafunike. Kenako muzisamba m'manja ndi madzi oyera.

Chigoba chikuyenera kuvalidwa mosalekeza kwa maola makumi asanu ndi awiri, chitatha icho chimasinthidwa ndi chigamba chatsopano cha transdermal. Patch yatsopano ya transdermal iyenera kuyikidwa nthawi zonse kumalo ena pakhungu, osalanda malo omwe adagwiritsidwa ntchito kale. Pamalo omwe mungagwiritse ntchito, chigamba cha transdermal sichitha kugwiritsidwanso ntchito kale osati masiku 7.

Yang'anani chigamba cha transdermal musanagwiritse ntchito.

Patch ya transdermal sayenera kugawidwa kapena kudula (onani "Maupangiri Apadera").

Bongo

Mankhwala ochulukirapo a fentanyl amadziwonetsera okha momwe amawonjezekera pazotsatira zake zamankhwala, zowopsa kwambiri ndizo kupsinjika kwa kupuma.

Zizindikiro ulesi, chikomokere, kukhumudwa kwa malo opumira ndi Cheyne-Stokes kupuma komanso / kapena cyanosis. Zizindikiro zina zimaphatikizapo hypothermia, kuchepa kwa minofu, bradycardia, ochepa hypotension. Zizindikiro za poizoni zimaphatikizira kupindika kwambiri, ataxia, miosis, kupsinjika, ndi kupuma.

Chithandizo: Kuchotsa kwa chigamba cha transdermal, makonzedwe a wodwala winawake - naloxone, zotsatira za thupi kapena zonena kwa wodwalayo, chisonyezo komanso chothandizira pantchito zofunika kuchita (kuphatikiza minyewa yopuma, kupuma mokwanira, ndi bradycardia - makonzedwe a atropine, ndi kuchepa kwamphamvu kwa magazi - kukonzanso kwa BCC )

Mlingo woyambira wokhazikitsidwa ndi akuluakulu ndi 0.4-22 mg iv naloxone. Ngati ndi kotheka, mutha kupatsanso mlingo womwewo pakatha mphindi ziwiri zilizonse kapena kupereka mankhwala a 2 mg a naloxone osungunuka mu 500 ml ya 0,9% sodium chloride solution kapena 5% dextrose solution (0.004 mg / ml). Mlingo wa makonzedwe uyenera kusinthidwa poganizira zam'mbuyomu infusions ndi wodwalayo poyankha.

Ngati mtsempha wa intravenous ukulephera, ndiye kuti lexone ikhoza kutumikiridwa kudzera m'mitsempha kapena s.c. Pambuyo pa i / m kapena s / c makonzedwe a naloxone, kuyambirako kumayamba kuchepa poyerekeza ndi kayendetsedwe ka i / v. Intramuscular makonzedwe amapereka kwa nthawi yayitali kuposa mtsempha wamagazi.

Matenda opatsirana chifukwa cha mankhwala osokoneza bongo amatha kupitilira nthawi yayitali poyerekeza ndi wotsutsana ndi opioid. Kuchotsa zotsatira za analgesic kumatha kubweretsa kuwonjezeka kwa kupweteka kwambiri komanso kutulutsidwa kwa makatekisolamu. Ngati ndi kotheka, wodwalayo ayenera kulandira chithandizo.

Fomu ya Mlingo:

transdermal achire dongosolo (TTC)

Chithandizo:
Fendivia ™ 12,5 μg / hr: TTC iliyonse imakhala ndi 1.38 mg ya fentanyl mu chigamba 4.2 cm and ndikutulutsa fentanyl pamlingo wa 12.5 μg / hr.
Fendivia ™ 25 μg / hr: TTC iliyonse imakhala ndi 2.75 mg ya fentanyl mumatumba a 8.4 cm² ndipo imapereka fentanyl pamlingo wa 25 μg / hr.
Fendivia ™ 50 μg / hr: TTC iliyonse imakhala ndi 5.50 mg ya fentanyl mumatumba a 16.8 cm² ndikutulutsa fentanyl pamlingo wa 50 μg / hr.
Fendivia ™ 75 μg / hr: TTC iliyonse imakhala ndi 8.25 mg ya fentanyl mumkati wa 25.2 cm² ndikutulutsa fentanyl pamlingo wa 75 μg / hr.
Fendivia ™ 100 μg / hr: TTC iliyonse imakhala ndi 11.00 mg ya fentanyl mu chigamba cha 33.6 cm² ndikutulutsa fentanyl pamlingo wa 100 μg / hr.
Othandizira:
1) Makanema oteteza kunja:
- filimu ya polyethylene terephthalate,
2) Malo osungira:
- silicone zomatira wosanjikiza,
- dimethicone (E 900),
3) Ma Microresores omwe ali ndi ntchito:
- dipropylene glycol,
- hyprolose (E 463),
4) Kutulutsa nembanemba:
- ethylene ndi vinyl acetate Copolymer,
5) Zosakaniza khungu
- silicone zomatira wosanjikiza,
- dimethicone (E 900),
6) Kanema wochotsa:
- filimu ya polyester yokhala ndi polima yokhala ndi polymer.

Chojambula chamkati chamkati chomwe chimakhala ndi zozungulira m'mphepete mwa filimu yoteteza chowonekera. Kanema woteteza ndi wamkulu kuposa chigamba. Chiwopsezo chauchimo chimagawa filimu yoteteza yochotsedwayo magawo awiri.
Zolemba zotsatirazi zimayikidwa patchalitchi posindikiza mitundu:
1) Fendivia ™ 12,5 μg / ola, chigamba 18 ± 0.5 mm mulifupi, 24 ± 0.5 mm kutalika:
- "Fentanyl 12,5 μg / ora" - zofiirira,
2) Fendivia ™ 25 μg / h, chigamba 24.6 ± 0.5 mm mulifupi, 37 ± 0.5 mm kutalika:
- "Fentanyl 25 μg / ora" - kusindikiza kofiira,
3) Fendivia ™ 50 μg / h, chigamba 34 ± 0.5 mm mulifupi, 51.3 ± 0.5 mm kutalika:
- "Fentanyl 50 μg / ora" - kusindikiza kobiriwira,
4) Fendivia ™ 75 mcg / h, chigamba 42 ± 0.5 mm mulifupi, 61.7 ± 0.5 mm kutalika:
- "Fentanyl 75 μg / ora" - kusindikiza kwakuda,
5) Fendivia ™ 100 μg / ola, chigamba 49 ± 0.5 mm mulifupi, 70 ± 0.5 mm kutalika:
- "Fentanyl 100 μg / ora" - imvi.

Mankhwala

Mankhwala
Fendivia ™ ndi chigamba cha transdermal chomwe chimapereka fentanyl mosalekeza kwa maola makumi awiri ndi awiri. Fentanyl ndi opioid analgesic yothandizirana makamaka ndi opiate μ receptors of the central mantha system (CNS), msana, ndi ziwalo zotumphukira. Ikuwonjezera ntchito ya machitidwe oletsa kupanikizika, kumawonjezera kuchepa kwa mphamvu ya kupweteka. Fendivia ya mankhwalawa makamaka imakhala ndi zotsatira za analgesic komanso sedative. Fentanyl imakhumudwitsa malo opumira, imachepetsa kugunda kwa mtima, imakondweretsa malo n. vagus ndi malo osanza, kumawonjezera mamvekedwe a minofu yosalala ya biliary thirakiti, ma sphincters (kuphatikiza ndi urethra, chikhodzodzo ndi zotupa za Oddi), zimathandizira kuyamwa kwa madzi kuchokera m'matumbo am'mimba (GIT). Amachepetsa kuthamanga kwa magazi (BP), matumbo a m'mimba komanso magazi a impso.
M'magazi, zimawonjezera kuchuluka kwa amylase ndi lipase, kumachepetsa kuchuluka kwa mahomoni a kukula, catecholamines, adrenocorticotropic timadzi, cortisol, prolactin. Imalimbikitsa kukonzekera kugona (makamaka pokhudzana ndi kuchotsa ululu). Zimayambitsa kukokoloka. Mlingo wa chitukuko cha kudalira kwa mankhwala ndi kulolerana kwa zotsatira za analgesic kumakhala ndi kusiyana kwakukulu pamunthu payekha. Mosiyana ndi ma analgesics ena a opioid, zimayambitsa kwambiri kuchepa kwa histamine.

Pharmacokinetics
Pulogalamu yothandiza kwambiri ya analgesic ya fentanyl mu seramu yamagazi mwa odwala omwe sanagwiritse ntchito opioid analgesics ndi 0,3-1,5 ng / ml. Pafupipafupi pazinthu zosafunikira zoterezi zimawonjezeka ndi kuchuluka kwa fentanyl m'magazi a seramu pamwamba pa 2 ng / ml. Ndi kukula kwa kulolerana, onse osachepera ogwira analgesic ndende ya fentanyl amawonjezeka komanso ndende komwe kumachitika zosafunika.
Cholinga: ntchito yoyamba ya chigawo cha transdermal, kuchuluka kwa fentanyl mu seramu yamagazi kumawonjezeka pang'onopang'ono, nthawi zambiri kumakhala pakati pa maola 12 ndi 24, kenako kumakhala kosasintha kwa maola onse a 72. Pakugwiritsa ntchito kwachiwiri kwa maola 72 phukusi lapa transdermal, kudzipereka kosalekeza kwa fentanyl mu seramu yamagazi kumatheka, komwe kumakhalabe pakutsatira kwa chigamba chofanana. Kuchuluka kwa fentanyl m'mwazi ndikofanana ndi kukula kwa chigamba cha transdermal. Mafuta a fentanyl amatha kusiyanasiyana pang'ono kutengera malo omwe angagwiritsidwe ntchito. Kuyamwa kwapang'onopang'ono kwa fentanyl (pafupifupi 25%) kunawonedwa m'maphunziro omwe adachitika ndi odzipereka athanzi panthawi yoika chigamba pachifuwa poyerekeza ndi ntchito yomwe ili pamanja ndi kumbuyo.
Kugawa: fentanyl imamangiriza mapuloteni a plasma ndi 84%, imadutsa chotchinga ndi magazi, chotchinga, ndi mkaka wa m'mawere.
Metabolism: fentanyl imakhala ndi chingwe cha biotransfform kinetics ndipo imapangidwa makamaka m'chiwindi kudzera mu michere ya CYP3A4. Metabolite yayikulu ya fentanyl ndi norfentanil, yomwe siikugwira ntchito.
Kuchotsa: atachotsa chigamba cha transdermal, kuchuluka kwa fentanyl mu seramu yamagazi kumachepa pang'onopang'ono. Hafu ya moyo wa fentanyl atatha kugwiritsa ntchito chigamba cha transdermal ndi maola 17 (maola 13 mpaka 22) mwa akulu ndi maola 22-25 mwa ana. The kuyamwa kwa fentanyl kuchokera pakhungu limayambitsa pang'onopang'ono kuchotsa kwa mankhwala kuchokera ku seramu yamagazi poyerekeza ndi mtsempha wamitsempha.
Pafupifupi 75% ya fentanyl imachotsedwa mu mkodzo, makamaka mawonekedwe a metabolites, ochepera 10% - osasinthika. Pafupifupi 9% amachotseredwa ndowe, makamaka mu ma metabolites.
Magulu Opatsa Odwala
Kuchepa kwa chiwindi kapena impso kungayambitse kuchuluka kwa serum fentanyl. Okalamba odwala, ofooka kapena ofooka, kuchepa kwa chidziwitso cha fentanyl ndikotheka, komwe kumatha kubweretsa moyo wautali wa fentanyl.
Ana
Kutengera kulemera kwa thupi, chilolezo (l / h / kg) ndichopepuka ndi 85% mwa ana azaka 2 mpaka 5 ndi 25% mwapamwamba mwa ana azaka 6 mpaka 10 poyerekeza ndi ana azaka 11 mpaka 10 Zaka 16 omwe ali ndi chilolezo chofanana ndi akulu.

Gwiritsani ntchito pa nthawi ya pakati komanso poyamwitsa

Mimba
Chitetezo cha ma transdermal patches ndi fentanyl panthawi yapakati sichinakhazikitsidwe. Kafukufuku wazinyama adakhazikitsa kawopsedwe kena kobereka.
Fentanyl iyenera kugwiritsidwa ntchito pokhapokha ngati pakufunika kutero. Kugwiritsa ntchito nthawi yayitali panthawi yoyembekezera kumatha kuyambitsa "achire achire" mwa akhanda. Nthawi zambiri, kukhalapo kwa zizindikiro za "kusiya" kumadziwika mwa makanda omwe amayi awo amakhala akugwiritsa ntchito fentanyl ndi fentanyl panthawi yapakati.
Fentanyl sayenera kugwiritsidwa ntchito pamene akugwira ntchito komanso pakubala (kuphatikizapo gawo la cesarean), monga imadutsa mwa placenta ndipo imatha kuyambitsa kupsinjika kwa mwana wosabadwa kapena wakhanda.
Kuyamwitsa
Fentanyl imachotsedwa mkaka wa m'mawere ndipo imatha kuyambitsa kusokonezeka ndi kupsinjika kwa mwana wakhanda loyamwa. Chifukwa chake, ngati kuli kotheka, kuikidwa kwa mankhwala Fendivia ™ pa mkaka wa m`mawere kuyenera kuyamwitsa kuyamwa (kwanthawi yonse yogwiritsira ntchito komanso osachepera maola makumi asanu ndi awiri atatha kugwiritsa ntchito komaliza).

Zotsatira zoyipa

Chitetezo cha transdermal patches ndi fentanyl chinayesedwa mu 1565 akuluakulu ndi ana 289 omwe adatenga nawo gawo 11 maphunziro azachipatala pakugwiritsira ntchito mankhwalawa pochiza matenda opweteka a oncological komanso osagwirizana ndi oncological. Odwala awa adalandira pafupifupi gawo limodzi la chigamba cha transdermal ndi fentanyl, pambuyo pake chitetezo cha mankhwala chidawunikidwa. Kutengera ndi zomwe zaphatikizidwa zotetezedwa kuchokera ku mayeso azachipatala, zochitika zoyipa kwambiri (zomwe zimachitika pafupipafupi 10%) zinali nseru (35.7%), kusanza (23.2%), kudzimbidwa (23.1 %), kugona. (15.0%), chizungulire (13.1%) ndi mutu (11.8%).
Zotsatira zoyipa zimagawidwa malinga ndi zomwe zimachitika pafupipafupi:
Nthawi zambiri (> 1/10)
Mafupipafupi (> 1/100, 1/1000, 1 / 10,000,

Kutulutsa mafomu ndi kapangidwe kake

Mankhwala amafunsidwa ngati njira yothetsera jakisoni (kutumikiridwa kudzera m'mitsempha ndi intramuscularly). Pakugulitsa mutha kupeza chigamba cha transdermal. Fentanyl amagwira ntchito ngati othandizira. Mitundu yosiyanasiyana ya mankhwalawa imaperekedwa. Mlingo wa zomwe zimagwiritsidwa ntchito zimatha kukhala zosiyanasiyana (mg): 1.38, 2.75, 5.5, 8.25, 11. Kuchuluka kwa kumasulidwa kwa fentanyl kumasiyananso (μg / h): 12.5, 25, 50, 75, 100.

Chigamba chidakutidwa ndi filimu yoteteza, chomwe chili ndi zinthu zina:

Ndi chisamaliro

Zilolezo zingapo pakugwiritsa ntchito zalembedwa:

• kuchuluka kwazovuta zamkati,
• matenda a m'mapapo
• bradyarrhythmia
• kuvulala kwa ubongo kapena kutupa,
• kuthamanga kwa magazi
• colic m'chiwindi, impso,
• kapangidwe ka calculi mu ndulu,
• Matenda a chithokomiro (hypothyroidism),
• kupweteka kwam'mimba kwa etiology yosadziwika,
• chomera chamchiberekero chamitsempha,
• kuwonjezeka kwa kutentha kwa thupi kwakanthawi, komwe kumabweretsa kutentha kwambiri (mwachitsanzo, poyendera sauna),
• mowa kapena mankhwala osokoneza bongo,
• kuchepa kwa mphamvu ya urethra,
• ambiri zovuta mkhalidwe wodwala.

Wopanga

LTS Lohmann Therapy System AG. Lohmannstrasse 2, D-56626, Andernach, Germany. LTS Lohmann Therapie-Systeme AG. Lohmannstrasse, 2, D-56626 Andernach, Germany.

Wogwirizira satifiketi yakulembetsa: Takeda Pharma A / S. Dubendal Alle 10, 2630 Taastrup, Denmark. Takeda Pharma A / S. Dybendal Alle 10, 2630 Taastrup, Denmark.

Zodandaula za ogula ziyenera kutumizidwa kwa: Takeda Pharmaceuticals LLC. 119048, Moscow, st. Usacheva, 2, p. 1.

Tele. ((495) 933-55-11, fakisi: (495) 502-16-25.

Momwe mungagwiritsire ntchito Fendivia

Mlingo wa gawo yogwira umatsimikiziridwa payekhapayekha. Kuchuluka kwa fentanyl kumatengera momwe wodwalayo alili, kupezeka / kusakhalapo kwa chidziwitso ndi kugwiritsidwa ntchito koyambirira kwa narcotic analgesics. Mukamagwiritsa ntchito chigamba, nsalu yakunja imatsukidwa ndikuuma. Zidole siziyenera kugwiritsidwa ntchito, madzi oyera ndi okwanira. Khungu sayenera kupunduka.

Mlingo woyamba ndi 12,5 kapena 25 mg. Kenako imakulitsidwa ndi chigamba chilichonse chatsopano. Kuchuluka kwa fentanyl tsiku lililonse ndi 300 mg. Ngati ndi kotheka kuwonjezera mlingo, lingalirani ndalama zamadzimadzi. Kuti mupewe zizindikiro zakuti muchoke, ndikofunikira kuti muchepetse kuchuluka kwa zinthu zomwe zimagwira pang'onopang'ono.

Momwe mungasinthire

Kutalika kwa kugwiritsa ntchito chigamba chimodzi ndi maola 72. Pambuyo pake, m'malo mwake amapangidwa. Ngati achire akakhala ofowoka, mankhwalawo amasinthidwa patatha maola 48. Komanso, chigamba chotsatira chimayikidwa m'malo atsopano. Ngati izi sizikumbukiridwa, kuchuluka kwa fentanyl kumachuluka. Pochotsa chigamba, ayenera kupindidwa ndi zomata mkati ndi kutaya.

Ndi matenda a shuga, mankhwalawa amatha kugwiritsidwa ntchito, koma monga momwe adanenera.

Matumbo

Kuchepetsa mphuno kumatsatiridwa ndi kusanza, kupweteka kwam'mimba, kusokonezeka kwa chopondapo, kutsika kwa chimbudzi, kupweteka kwa pakamwa pakamwa. Zizindikiro za matumbo otsekemera samachitika kawirikawiri.

Kutenga Fendivia kumatha kuwapangitsa kuti asakhale ndi chidwi chofuna kudya.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwalawa amapangidwa ngati mawonekedwe a transdermal achire system (TTC): chithunzi chowongolera chamkati chokhala ndi mbali zokutira papulogalamu yotchinga yowonekera, yomwe ndi yayikulu kuposa chigamba, filimu yoteteza imagawika m'magawo awiri ndi incusoidalidal, patches 12.5 / 25/50 / 75/100 μg / h ali ndi kutalika kwa 24/37 / 51.3 / 61.7 / 70 mm (± 0,5 mm uliwonse) ndi m'lifupi mwake 18 / 24.6 / 34/42/49 mm (± 0,5 mm iliyonse), motengera, zilembo zotsatirazi zimayikidwa kumtunda ndi kusindikiza kwa utoto (kutengera mtundu wa kutulutsa kwa chinthu): 12.5 μg / h - brown Fentanyl 12,5 μg / ora, 25 μg / h - Fentanyl 25 μg / maola ofiira, 50 μg / h - Fentanyl 50 μg / wobiriwira wa ora, 75 μg / h - Fentanyl 75 μg / ola kuwala , 100 μg / h - imvi Fentanyl 100 μg / ola lililonse TTS imayikidwa mu thumba losungika losungika la aluminiyumu, pepala ndi polyacrylonitrile (PAN), pabokosi la makatoni 5 ndi malangizo ogwiritsira ntchito Fendivia.

Kupanga kwa chigamba chimodzi (TTC):

• yogwira pophika: fentanyl, zomwe zili mu 1 TTC ndi: 1.38, 2.75, 5.5, 8.25 kapena 11 mg mu chigamba chokhala ndi chiwopsezo cha 12,5, 25, 50, 75 ndi 100 μg / h ndi ndi malo olumikizirana a 4.2, 8.4, 16.8, 25.2 ndi 33.6 cm², motsatana
• Filimu yochotseka: filimu ya polyester yokhala ndi polima yokhala ndi polymer;
• Kanema woteteza kunja: filimu ya polyethylene terephthalate (PET film),
• mathanki ang'onoang'ono, kuphatikiza yogwira: hyprolose (E463), dipropylene glycol,
• reservoir / khungu-zomatira khungu: dimethicone (E900), silicone zomatira wosanjikiza,
• kumasula membrane: kopolymer wa vinyl acetate ndi ethylene.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwala ndi mankhwala, koma monga chomaliza. Amagwiritsidwa ntchito pazifukwa zaumoyo, pomwe maubwino amakhala ochulukirapo kuposa kuvulaza komwe kungachitike. Ndi chithandizo chamankhwala panthawi yoyembekezera, pamakhala mwayi woti mwana akhanda atabadwa.

Popeza kuti mankhwalawa amalowa mkaka wa mayi komanso kudzera mu placenta, chiopsezo chokhala ndi zovuta zoyipa mwa mwana ndichokwera kwambiri.

Gwiritsani ntchito mu ukalamba

Pa mankhwala, njira yochotseredwa kwa fentanyl imayamba kuchepa. Izi zimabweretsa kukulira pang'onopang'ono kwa kupsinjika kwake. Pazifukwa izi, mlingo uyenera kuwunikiranso. Mankhwalawa amavomerezedwa kuti azigwiritsidwa ntchito pokhapokha ngati phindu liposa kuvulaza. Mankhwalawa amayenera kuyamba ndi mlingo wa 12,5 mg.

Mukakalamba, mankhwalawa amavomerezedwa kuti azigwiritsidwa ntchito pokhapokha ngati phindu liposa kuvulaza.

Ndemanga za Fendivia

Kufufuza kwa ogula komanso akatswiri amakupatsani mwayi wambiri pazokhudza mankhwalawa.

Danilov I.I., oncologist, wazaka 49, Vladivostok

Chida chimagwira ntchito yake - chimachotsa kupweteka. Zoyipa zake zimaphatikizanso kuthamanga kwambiri, chifukwa fentonil imatulutsidwa pang'onopang'ono: choyamba imalowa mkati mwa mawonekedwe akunja ndipo pambuyo pake mumagazi. Ngakhale mawonekedwe ake, mankhwalawa amathanso kukhala owopsa chifukwa cha kusokonekera kwa chitetezo chathupi (anaphylactoid reaction).

Verilova A.A., dokotala wa opaleshoni, wazaka 53, St.

Ndimagwiritsa ntchito mankhwalawa moyenera chifukwa cha mawonekedwe osokoneza. Amachita pang'onopang'ono. Kuphatikiza apo, mtengo wake ndi wokwera. Ngati tilingalira zake zazikulu, ndiye kuti chida ichi sichabwino poyerekeza ndi mitundu ina.

Fentanyl zigamba m'malo mwa mapiritsi

Eugene, wazaka 33, Penza

Mankhwalawa ndi owopsa, monga ma opiates ambiri. Nthawi yayitali atangoyamba kumene chithandizo, adasiya kuthandiza. Ndidawerenga za kuthekera kwa kulekerera kwa chinthu chomwe chimagwira, koma sindinkaganiza kuti analcic ya narcotic ikhoza kusiya ntchito yake mwachangu. Ndidasinthira ku analogi.

Veronika, wazaka 39, Moscow

Ndi oncology, imathandizira bwino. Zotsatira zake ndizakanthawi kochepa, pambuyo pake ndikofunikira kusintha pang'ono, lomwe ndi vuto, chifukwa lingagwiritsidwe ntchito nthawi yopitilira 1 mkati mwa maola 48. Pazifukwa izi, adotolo adatumiza mankhwala ena.

Fendivia, malangizo ogwiritsira ntchito: njira ndi mlingo

Fendivia chigamba chimagwiritsidwa ntchito transdermally.

Fentanyl imamasulidwa pamlingo wa 12.5, 25, 50, 75 kapena 100 μg / h, womwe ndi pafupifupi 0.3, 0.6, 1.2, 1.8 kapena 2.4 mg patsiku, motsatana.

Mlingo umakhazikitsidwa payekhapayekha, kutengera momwe wodwalayo alili, ndipo amayenera kuwunikira pafupipafupi mukamagwiritsa ntchito. M'pofunika kugwiritsa ntchito osachepera ogwira mlingo.

Chigamba chomwe chili ndi fentanyl chikulimbikitsidwa kuti chiike pansi, osawonongeka pakhungu la phewa kapena thunthu. Ana aang'ono ayenera kumamatira kumbuyo kwawo kuti achepetse kudzimana.

Tsamba logwiritsira ntchito liyenera kusankhidwa ndi tsitsi locheperako. Musanagwiritse ntchito TTS, tsitsi lomwe limapezeka patsamba lofunsiralo likufunika kudulidwa (popanda kumetedwa). Ngati kuli kofunika kutsuka malo ogwiritsira ntchito musanayambe gluing chigamba, izi ziyenera kuchitidwa ndi madzi oyera. Kugwiritsa ntchito mafuta odzola, sopo, mowa, mafuta kapena zinthu zina sizikulimbikitsidwa, chifukwa zimatha kubweretsa mkwiyo pakhungu kapena kusintha kwa zinthu zake. Pamaso pa ndondomeko, khungu liyenera kukhala louma. Popeza chigamba chidakutidwa ndi filimu yoteteza madzi, simungachichotse ndi shawa lalifupi.

Mukangochotsa chigamba pachikwama chosungika ndikuchotsa filimu yoteteza, chiikeni pakhungu popanda kukhudza mbali yomata ndikulimbikira motsutsana ndi malo ogwiritsira ntchito ndi dzanja lanu kwa masekondi 30. TTS iyenera kukhala yolimba pakhungu, makamaka kuzungulira m'mphepete, ngati kuli koyenera, ikonzanso, kenako ndikusamba m'manja ndi madzi oyera.

Fendivia adapangidwa kuti azigwiritsa ntchito kwa maola makumi awiri ndi awiri. Patch yatsopano nthawi zonse imayenera kuyikidwa kudera lina pakhungu, osagwiritsa ntchito malo omwe adagwiritsapo kale ntchito. Bokosani chigamba pamalo omwewo sichitha kubwerezabwereza kuposa masiku 7.

Mlingo woyambirira umakhazikitsidwa poganizira kuchuluka kwa kudya kwa opioid munthawi yam'mbuyomu chithandizo cha Fendivia, chiopsezo chokhala ndi kulolerana, chithandizo chamankhwala ena, thanzi la wodwalayo komanso momwe alili, zaka, kulemera kwa thupi, kuchuluka kwa kutopa ndi kuopsa kwa chotupa.

Odwala omwe sanalandiridwepo ndi ma opioid samalimbikitsidwa chifukwa cha kugwiritsa ntchito kwawo, pakadali pano, muyenera kugwiritsa ntchito mankhwala osokoneza pakamwa komanso mwaubwino. Pofuna kupewa bongo, ayenera kugwiritsa ntchito mankhwala ochepetsa mphamvu ya mankhwala opatsirana posachedwa (kuphatikizapo tramadol, oxycodone, hydromorphone, morphine, ndi codeine). Mlingo wa mankhwalawa achikulire umayenera kuti ukhale wofanana nawo m'njira yofanana ndi Fendivia ya 12.5 / 25 mcg / h analgesic. Mtsogolomo, odwala amatha kusintha kusintha kwa kugwiritsa ntchito chigamba cha transdermal.

Potengera pakumwa ma opioid pamlomo kapena kuphwanya, ndipo kugwiritsa ntchito TTC kumadziwika kuti ndi njira yokhayo yothandizira, ndikofunikira kuyamba kulandira chithandizo chamankhwala ochepa kwambiri - 12,5 μg / h.

Mukasinthira kugwiritsa ntchito chigamba cha transdermal, kwa wodwala yemwe adagwiritsa ntchito opioid yapakamwa m'mbuyomu, ndikofunikira kukhazikitsa kuchuluka kwa omwe adalandira opioid analgesics kale, omwe amafunikira maola 24 omaliza (mg / tsiku). Mlingo wotsatira uyenera kusinthidwa kukhala mulingo wofanana wa tsiku ndi tsiku wa morphine (mg / tsiku) pogwiritsa ntchito zoyenera zonse.

Mlingo wofanana wa morphine umakhazikitsidwa ndikuchulukitsa mlingo wa opioid analgesics pazinthu zotsatirazi (zomwe kale ntchito opioid mu mg / tsiku la x mg) mgonero womwe umagwiritsidwa ntchito kuyambiranso mlingo wa tsiku ndi tsiku pamlomo / makulidwe a makolo:

• morphine - 1 a / 3,
• fentanyl - - / 300,
• codeine - 0,15 / 0,23 b,
• diamorphine - 0,5 / 6 b,
• ketobemidone - 1/3,
• hydromorphone - 4/20 b,
• levorphanol - 7.5 / 15 b,
• oxycodone - 1.5 / 3,
• pethidine - - / 0,4 b,
• tramadol - 0.25 / 0.3,
• tapentadol - 0,4 / -,
• methadone - 1.5 / 3 b.

A - ntchito ya morphine analandira pakamwa kapena intramuscularly (IM) pamaziko a odwala omwe akudwala ululu.

b - malinga ndi zotsatira za kafukufuku wopezeka ndi jakisoni waminyewa iliyonse ya mankhwalawa kuti adziwe ntchito zomwe akuyerekeza poyerekeza ndi morphine, Mlingo wamlomo ndi mankhwala omwe amalimbikitsidwa kusintha kwa njira yoyendetsera pakamwa.

Mlingo woyenera wa fentanyl umakhazikitsidwa kutengera mlingo wa morphine wakumwa tsiku lililonse.

Kwa odwala akuluakulu okhazikika omwe ali ndi vuto la opioid, omwe ali ndi kusintha kwa mankhwala a morphine tsiku ndi tsiku kupita kwa mlingo wa transentermal fentanyl akulimbikitsidwa ndi gawo la kusintha kwa 150 ÷ ​​1 morphine (mg / tsiku) - fentanyl (μg / h):

• zosakwana 90 - 12.5,
• 90–134 – 25,
• 135–224 – 50,
• 225–314 – 75,
• 315–404 – 100,
• 405–494 – 125,
• 495–584 – 150,
• 585–674 – 175,
• 675–764 – 200,
• 765–854 – 225,
• 855–944 – 250,
• 945–1034 – 275,
• 1035–1124 – 300.

Kwa odwala achikulire omwe amamwa mankhwala okhazikika omwe ali ndi opioids, kusintha kwa mankhwalawa tsiku lililonse kumakhala mlingo wa transentermal fentanyl tikulimbikitsidwa ndi gawo la kusintha kwa 100 ÷ 1 morphine (mg / tsiku) - fentanyl (μg / h):

• zosakwana 44 - 12.5,
• 45–89 – 25,
• 90–149 – 50,
• 150–209 – 75,
• 210–269 – 100,
• 270–329 – 125,
• 330–389 – 150,
• 390–449 – 175,
• 450–509 – 200,
• 510–569 – 225,
• 570–629 – 250,
• 630–689 – 275,
• 690–749 – 300.

Kuyesa koyambirira kwa zotsatira zoyenera za Fendivia sikuyenera kuchitika pasanathe maola 24 mutatha kugwiritsa ntchito. Chomwe chimapangitsa izi kuchepa ndikuwonjezereka pang'onopang'ono kwa kuchuluka kwa fentanyl mu seramu yamagazi mu maola 24 atatha kugwiritsa ntchito chigamba. Zotsatira zake, pakusintha kuchokera ku mankhwala a analgesic kupita kwina, chithandizo cham'mbuyomu chiyenera kuyimitsidwa pang'onopang'ono, pambuyo pa kugwiritsidwa ntchito koyamba kwa fentanyl mpaka kukhazikika kwa mphamvu yake ya analgesic.

TTC iyenera kusinthidwa ndi yatsopano maola 72 aliwonse. The titration wa yokonza mlingo ikuchitika payekha mpaka mulingo wokwanira wa analgesia, akwaniritsa kulolerana kwa mankhwalawa. Monga lamulo, mlingo umatha kuwonjezeka nthawi ndi 12,5 kapena 25 μg / h, kutengera mtundu wa wodwalayo komanso kufunika kwa analgesia wowonjezera (kamvekedwe kamlomo kamtundu wa 45 ndi 90 mg / tsiku pafupifupi kofanana ndi Fendivia pa Mlingo wa 12,5 ndi 25 μg / h, motsatana). Khola la analgesia lingachitike patatha masiku 6 mutachulukitsa mlingo. Chifukwa chake, mutasintha mankhwalawa, muyenera kugwiritsa ntchito mlingo wowonjezera osachepera 2 kwa maola 72, ndipo pokhapokha ngati kuli koyenera, muwonjezere.

Kuti mukwaniritse mlingo wopitilira 100 μg / h, kugwiritsa ntchito munthawi yomweyo mapulaneti angapo amaloledwa. Pakumva ululu wambiri, zingakhale zofunikira kupereka mankhwala owonjezera a analgesics osakhalitsa. Mukamagwiritsa ntchito Fendivia muyezo wopitilira 300 μg / h, ndikofunikira kulingalira momwe mungagwiritsire ntchito njira zowonjezera / zosakanikira kapena njira zoperekera opioid analgesics.

Kumayambiriro kwa maphunzirowa, ngati kuchepa kwakukulu kwa analgesic pambuyo kugwiritsa ntchito koyamba kwa mankhwalawa, pambuyo pa maola 48 patch ingathe kusinthidwa ndi imodzimodzi, ndipo pambuyo pa maola makumi awiri ndi awiri mlingowo ungathe kuchuluka.

Ngati chigamba chayamba kusokonekera kapena ngati pakufunika kuisintha pazifukwa zina maola 72 asanadutse, chigamba chokhala ndi mlingo wofananikacho chitha kukakamizidwa kudera lina la khungu. Pankhaniyi, mkhalidwe wa wodwala uyenera kuyang'aniridwa mosamala, chifukwa choopsa cha kuchuluka kwa plasma ndende ya mankhwalawa.

Poyerekeza ndi kusintha kwa kusintha kwa nthawi yayitali ndi morphine kuthandizidwa ndi transdermal chigamba, matenda achire angayambike, ngakhale atakhala ndi analgesic kwenikweni. Ngati matendawa amachitika, tikulimbikitsidwa kuti mupitirize kupereka ma morphine osakhalitsa pamankhwala ochepa.

Ngati pakufunika kusokoneza chithandizo ndi transdermal chigamba, ayenera m'malo ndi ma opioids ena pang'onopang'ono, kuyambira mlingo wotsika, chifukwa kuchepa kwapang'onopang'ono kwa serum fentanyl mutachotsa chigamba ndikuwopseza kuti uchoka. Kuchepetsa kuchuluka kwa fentanyl m'mwazi ndi 50%, pamafunika maola osachepera 17.

Mu ana ndi achinyamata a zaka 2-16, Fendivia ingagwiritsidwe ntchito pokhapokha ngati odwala atenga kale pamlomo morphine ofanana (mlingo wa osachepera 30 mg / tsiku). Posintha kuchokera pakamwa / paubwino wa opioid analgesics kukhala chigamba chokhala ndi fentanyl, mlingo woyambirira wa ana amawerengeredwa kutengera mlingo wakumwa wamkamwa tsiku lililonse wa morphine. Fendivia pa mlingo wa 12,5 ndi 25 μg / h ali wofanana ndi morphine pakamwa Mlingo wa 30- 44 ndi 45-134 mg / tsiku, motero. Kusintha kwa ana kugwiritsa ntchito fentanyl mu Mlingo wopitirira 25 μg / h sikusiyana ndi zomwe zimachitika mwa anthu akuluakulu.

Ndi chigoba chimodzi cha 12,5 μg / h, morphine yokha imatha kusinthidwa pakamwa pa 30-44 mg / tsiku kapena ma analgesics a opioid ofanana. Chiwembuchi sichingagwiritsidwe ntchito kusamutsa ana kuti azigwiritsa ntchito fentanyl kupita ku ma analgesics ena a opioid chifukwa chotheka cha bongo.

Popeza analgesic zotsatira zoyambira za patch pa maola 24 oyamba sinafike pamlingo wokwanira, atasinthira kulandira chithandizo cha Fendivia, ana ayenera kulandira analgesics am'mbuyomu. Maola 12 otsatira, ma analgesics omwe amagwiritsidwa ntchito kale angagwiritsidwe ntchito pakafunika kuthandizidwa. Mlingo umayikidwa payekhapayekha, mankhwala atangoyamba, chigamba chake chimayenera kusinthidwa ndi china chatsopano maola 72 aliwonse. Ngati mukufuna kuwonjezera mlingo, kukonzanso kwake mwa ana kumachitika pang'onopang'ono, mukuwonjezeka kwa 12,5 μg / h, popanda kuwonjezeka pafupipafupi kuposa nthawi imodzi mu maola 72. Pankhani ya kusakwanira kwa analgesic kanthu, kugwiritsa ntchito morphine kapena wina wosakhalitsa wa opioid analgesic ndikotheka.

Mimba komanso kuyamwa

Zomwe zimatsimikizira chitetezo cha Fendivia pa nthawi yoyembekezera sizipezeka. Pakuphunzira kwa nyama, poizoni wina woonekera adawululidwa. Kugwiritsidwa ntchito kwa nthawi yayitali pogwiritsira ntchito fentanyl pakati pa fentanyl kumatha kubweretsa kuwonekera kwa akhanda. Malipoti apadera adalembedwa za zomwe zilipo kale za matendawa kwa akhanda omwe amayi awo amagwiritsa ntchito TTC nthawi yonse yomwe ali ndi pakati.

Kugwiritsa ntchito fentanyl panthawi yoyembekezera kumaloledwa pokhapokha mwadzidzidzi. Fendivia siyikulimbikitsidwa kuti mugwiritse ntchito pakubala ndi pakubala (kuphatikizapo gawo la cesarean), popeza mankhwalawa amalowera mchikhodzodzo ndipo angayambitse kupsinjika kwa mwana wakhanda / wakhanda.

Mankhwalawa amadziwika mkaka wa m'mawere ndipo amatha kuyambitsa kupuma komanso kukhazikika kwa mwana woyamwa. Paziphatikizo, ngati pakufunika kugwiritsa ntchito Fendivia panthawi yotseka, ndikofunikira kusokoneza yoyamwitsa (nthawi yonse yogwiritsira ntchito, komanso kwa maola osachepera 72 mutatha kugwiritsa ntchito komaliza).

Gwiritsani ntchito paubwana

Kugwiritsidwa ntchito kwa TTC mwa ana osaposa zaka 2 kumatsutsana, chifukwa palibe deta yotsimikizira chitetezo ndi kuwoneka bwino kwa mankhwalawa. Achinyamata opitirira zaka 16 amalimbikitsidwa kuti azilandira mtundu wina wa dosing wofanana ndi wa achikulire.

Fendivia sayenera kuperekedwa kwa ana azaka zopitilira 2 omwe sanalandire chithandizo ndi opioid analgesics. Kugwiritsa ntchito mankhwalawa ndizotheka pokhapokha ngati ana ali ndi kulolera kwa opioid. Chonde dziwani kuti kuwopsa kwa kupsinjika kwakuopsa / koopsa komwe kumakhalapo ngakhale mutayamwa bwanji. Ndikulimbikitsidwa kuwunikira odwala kuti akwaniritse zovuta zoyipa kwa maola osachepera 48 atatha kulandira chithandizo kapena atakulitsa Mlingo.

Posankha malo ogwiritsira ntchito, chisamaliro chiyenera kutengedwa ndikuyang'anira mosamala momwe chigambacho chimapukusira kuti chisagwidwe ndi mwana mwangozi.

Ndi chiwindi ntchito

Popeza kusintha kwa metabolism kwa fentanyl kumachitika m'chiwindi, pamaso pa kuphwanya kwa chiwindi ntchito, kuchepa kwa kuchuluka kwa kutulutsa kwake kumatheka.

Chifukwa cha chiwopsezo chowonjezereka ndi zovuta zomwe zilipo pachiwindi, odwala ayenera kuyang'aniridwa pakumwa. Ngati ndi kotheka, kuchepetsa kuchuluka kwa fentanyl kungafunike.

Mlingo woyambirira wa Fendivia sayenera kupitirira 12,5 mcg / h.

Kuyanjana kwa mankhwala

• zotumphukira za barbituric acid: chiopsezo cha kupuma kwamphamvu chikukulitsidwa, kuphatikiza uku kumatsutsana,
• inhibitors of cytochrome P450 3A4 (CYP3A4) - nefazodone, nelfinavir, erythromycin, voriconazole, fluconazole, clarithromycin, ketoconazole, ritonavir, itraconazole, cimetidine, verapamil, amiodarone, kuchuluka kwa kuchuluka kwa magazi kuchitanso, komanso kumawonjezera mwayi wosinthika, kuphatikizapo kupuma kwambiri. Pamafunika kuwunika wodwala, ndipo ngati pakufunika kutero, muchepetse kuchuluka kwa fentanyl kapena kuimitsa kugwiritsa ntchito, komanso osayang'anira mosamala, pewani kuphatikiza mankhwalawa. Nthawi yocheperako pakati pa kuleka kwa mankhwala ndi CYP3A4 zoletsa ndi kugwiritsa ntchito koyamba kuyenera kukhala kosachepera maola 48,
• CYP3A4 inducers - phenobarbital, carbamazepine, rifampicin, phenytoin: kuchuluka kwa fentanyl mu plasma kumachepa ndipo mphamvu yake yochizira imafooka, chifukwa chomwe kusintha kwa mlingo kungapangidwire. Kuphatikiza uku kumafuna chisamaliro chapadera. Ngati chithandizo chothandizirana ndi CYP3A4 inducer chathetsedwa, pangafunikire kuchepetsa kuchuluka kwa fentanyl ndikuwunika wodwalayo,
• CNS suppressants - anesthetics, opioids ena, hypnotics ndi kusunthasuntha, phenothiazine zotumphukira, minofu omasuka, tranquilizer, mowa, antihistamines ndi zopatsa mphamvu: zowonjezera zotheka zimatha kukhala, hypotension, hypoventilation, sedation / coma yayikulu ikhoza kuchitika, mosamala kuwunika kwa momwe zinthu ziliri
• mankhwala a serotonergic - kusankha serotonin reuptake inhibitors (SSRIs), kusankha serotonin ndi noradrenaline reuptake inhibitors (SSRIs), MAO inhibitors: kuphatikiza uku sikulimbikitsidwa chifukwa choopseza kukhala ndi serotonin syndrome. Kuphatikizidwa ndi MAO, kuwonjezeka kwa zotsatira za narcotic analgesics ndikothekanso,
• nalbuphine, buprenorphine, pentazocine: mphamvu ya analgesic yayamba kufooka, kulekeka kwa matendawa kumachitika mwa odwala omwe akudalira opioid, kuphatikiza sikokwanira,
• minofu yotsitsimutsa yogwira ntchito ya vagolytic (kuphatikizapo pancuronium bromide): chiwopsezo cha kuchepa kwa hypotial ndi bradycardia yafupika (makamaka mukamagwiritsa ntchito beta-blockers ndi vasodilators ena) ndikuwopseza kuwopsa kwa matenda oopsa komanso tachycardia ikukulitsidwa,
• kupuma minofu komwe sikuwonetsa ntchito ya vagolytic (succinylcholine): chiwopsezo cha zovuta zazikulu kuchokera ku CCC chikukulitsidwa, chiwopsezo cha bradycardia ndi hypotension ya arterial (makamaka ndi mbiri yofooka yamtima) sichitha.