Malangizo a Durogezik ogwiritsa ntchito, contraindication, mavuto, ndemanga

Durogezic dongosolo lomwe lili ndi fentanyl depot limapangidwa kuti lithandizire kwa nthawi yayitali kupweteka kwapweteka makamaka kwa odwala khansa. Zotsatira zake zazikulu wopanikiza ndi sedative. Fentanyl wa synthetic amalumikizana ndi ma opioid receptors. Zimalepheretsa kufalikira kwa mphamvu panjira zowawa mpaka thalamus ndi hypothalamus. Ndi yolimba (nthawi 100) ya analgesic kuposa morphine.

Kutalika konse kwa chigamba maola 72. Kuchuluka kwazinthu zomwe zimatulutsidwa mu kayendedwe kazinthu zimatengera gawo la chigamba ndipo ndi 25, 50, 75 kapena 100 μg pa ola limodzi.

Kuphatikiza apo, mankhwalawa amalepheretsa malo opumira, amasangalatsa malo osanza, komanso amachepetsa kugunda kwa mtima. Pafupifupi kulibe magazi. Kuchulukitsa kamvekedwe ka sphincter, kumachepetsa kuyenda kwamatumbo komanso magazi aimpso. Amayambitsa chisangalalo ndikuthandizira kugona.

Pharmacokinetics

Fentanyl imamasulidwa mosalekeza. Pambuyo pakugwiritsira ntchito, ndende yake ya plasma imachulukanso kuposa maola 12-24, kenako imakhala yokhazikika kwa maola 48 otsala. Mlingo wa ndende ndiwofanana ndi kukula kwa chigamba. Kuzunza kwofananira kumathandizidwa ndi kugwiritsa ntchito mobwerezabwereza ma TTS ofanana.

Pambuyo pochotsa TTC, ndende imachepa pang'onopang'ono. T1 / 2 ndi avareji ya maola 17. Pang'onopang'ono zimasowa m'madzi a m'magazi, popeza kuyamwa kwa fentanyl pakhungu kumapitirirabe. Odwala ofooka, chilolezo chimachepetsedwa ndipo T1 / 2 amatalika. Metabolism imachitika m'chiwindi, impso, matumbo. 75% ya mankhwala omwe amapezeka mu mkodzo, 9% ndi ndowe.

Zizindikiro zogwiritsidwa ntchito

• kupweteka kwa khansa
• kupweteka kwa neuropathic (ndi matenda ashuga polyneuropathy, syringomyeliamitsempha yovulala multiple sclerosis),
• phantom ululu, zowawa ndi nyamakazi ndi arthrosis.

Contraindication

• kupweteka kwa postoperative
• kuponderezedwa pakatikati pa kupuma,
• pseudomembranous colitischifukwa chotenga maantibayotiki (cephalosporins, penicillin, lincosamides),
• kutsekula m'mimba,
• mimba
• kuwonongeka kwa khungu pamalo ogwiritsira ntchito,
• wazaka 18.

Mosamala, mankhwalawa amadziwitsa nthawi zotupa za muubongo, matenda a m'mapapokuchuluka kwazovuta zam'mimba, kuvulala kwamitsempha yamaubongo, aimpso ndi kulephera kwa chiwindi, matenda a ndulu, hypothyroidism, Prostatic hyperplasiazovuta zazikulu, kuchepa kwa urethra, uchidakwa, malingaliro ofuna kudzipha mwa wodwala, akutenga insulin, Mao zoletsa, GKSantihypertensive mankhwala.

Zotsatira zoyipa

• kugona kukhumudwa, kuyerekezera, kuda nkhawa, kupweteka mutu, kusokoneza, zochepa euphoria, kusowa tulo, amnesia, paresthesia,
• makupalatkupuma bronchospasm, kupuma movutikira,
• nseru kudzimbidwa, Biliary colicpakamwa kowuma nthawi zambiri kutsegula m'mimba,
• bradycardia kapena tachycardia, matenda oopsa kapena hypotensionkusungika kwamikodzo
• kudalira kwakuthupi ndi kwamaganizidwe,
• zimachitika m'deralo mu mawonekedwe a zotupa, kuyabwa ndi Hyperemiakudutsa tsiku kuchokera kuchotsedwa kwa TTC.

Ngati mwadzidzidzi kutha kwa mankhwala kumayamba "Odziletsa matenda": nseru, kusanza, kuzizira, kutsegula m'mimba, nkhawa. Zizindikiro sizitchulidwa pang'ono ngati mlingo umachepetsedwa pang'onopang'ono.

Durogezik, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Patch ya analgesic ya Durogezik imagwiritsidwa ntchito mopepuka, imagwiritsidwa ntchito pamwamba pa khungu la thupi kapena mikono mchigawo chapamwamba. Malowa azikhala ndi chopendekera pang'ono, chomwe chimadulidwa musanayambe ntchito. Musanayambe kugwiritsa ntchito chigamba, khungu liyenera kukhala louma, osagwiritsa ntchito sopo, mafuta kapena mafuta odzola.

Chigoba chimathiriridwa nthawi yomweyo chikachotsedwa phukusi, chimakanikizidwa ndi manja anu ndi malo osungirako zaka 30. - Mphepete zimayenera kukhudzana ndi khungu. Dongosolo latsopanoli limakhala ndi gawo lina pakhungu. Odwala omwe sanamwe ma opioids, mlingo wotsika kwambiri ndi 25 μg / h. Mukamachoka Promedola Mlingowu umagwiritsidwanso ntchito. Mukasintha kuchokera ku mankhwala ena a narcotic, zosowa za tsiku ndi tsiku za analgesics zamankhwala am'mbuyo zimawerengedwa. Nthawi zonsezi zimapangidwa ndi adokotala.

Pambuyo pa ntchito yoyamba, kugwiritsidwa ntchito kwa zinthu zomwe zimagwira pang'onopang'ono kumawonjezeka kuposa maola 12-18, motero, wodwalayo amafunikira analgesics. Ngati patsiku la 3 wodwalayo akufunikirabe zoonjezera zowonjezera, ndiye kuti mlingo wotsatira wa TTC ukuwonjezeka ndi 25 μg / h. TTS ikayimitsidwa, kuchuluka kwa mankhwalawa kumachepa pang'onopang'ono, kotero ma opioids ena amawayikira ndi kuchuluka pang'onopang'ono kwa mlingo.

Durogezik matrix Mosiyana ndi chigamba chosungiramo, chimaphatikizanso zigawo - zomatira komanso zomanga thupi za fentanyl. Chifukwa chake, ndichoperewera, chosinthika, chodabwitsa komanso chosavuta kugwiritsa ntchito. Kuphatikiza apo, yasintha zinthu zomatira. Kusapezeka kwa chosungira ndi fentanyl komanso kuphatikiza kwa magwiridwe antchito kumawonjezera chitetezo cha mankhwalawa, chifukwa ngati chigamba chiwonongeka, kumasulidwa kosalamulirika kwa mankhwalawo komanso bongo wake ndizosatheka. Imapezeka m'mitundu ingapo ndi mphamvu zosiyanasiyana. Mukamagwiritsa ntchito kufalitsa kwamkati, 12,5, 25, 50, 75 kapena 100 μg ya chinthu chilichonse pa ola limodzi chimamasulidwa. Monga mukuwonera, mulingo wambiri ndiwofalikira, womwe umathandizira kusankha kwamankhwala.

Bongo

Kuwonetsedwa bradypnea ndi ziphuphukukhumudwa kwa malo opumira, bradycardia, kuuma kwa minofu, kutsitsa magazi. TTC imachotsedwa ngati kuli kofunikira - mpweya wabwino, othandizira makonda naloxone. Chithandizo cha Zizindikiro: kuyambitsa opuma minofu, atropine ndi bradycardia.

Kuchita

Kuopsa kwa hypoventilation, kusinkhasinkha kwambiri komanso kuchepa kwa kuthamanga kwa magazi mukamagwiritsa ntchito mankhwala kumachulukitsa, zomwe zimapangitsa kuti ntchito yamanjenje yayikulu iyambe: opioid analgesics, omata, sedative komansomankhwala azinyumba, phenothiazines, antihistamines, minofu yapakati yopuma.

Kuwonjezeka kwa ndende ya plasma ndi kutalika kwa chigamba kumadziwika CYP3A4 zoletsa (ritonavir, Ketoconazole, troleandomycin, chindwana, itraconazole, Nelfinavir, Amiodarone, Verapamil, Nefadozone, diltiazem).

Durogezik amalimbikitsa zotsatira zake antihypertensive mankhwala.

Kuchepetsa mphamvu ya analgesic ya mankhwala buprenorphine, pentazocine, nalbuphine, naltrexone, naloxone.

Zopumitsira minofu Chotsani minofu. Zolimbitsa thupi zolimbitsa thupi ndi ntchito ya vagolytic zimachepetsa chiopsezo cha bradycardia ndi hypotension, zochitika zosagwirizana ndi vagolytic zimawonjezera chiopsezo cha CCC.

Mlingo wa fentanyl uyenera kuchepetsedwa akagwiritsidwa ntchito ndi GKS, insulin ndi antihypertensive mankhwala.

Kutulutsa mawonekedwe ndi kapangidwe kake

Durogesic imapangidwa ngati mawonekedwe a transdermal Therapeutic system (TTC): chigamba chachikatikati chamakona ozunguliridwa, translucent, hermetically losindikizidwa, lomwe limakhala ndi ma gel osawoneka bwino, ma crystalline particles ndi ma Bubulo amlengo amaloledwa mu gel, zolemba pa chipolopolo chakunja: pinki, 0,025 mg / h, 0,05 mg / h - wobiriwira wopepuka, 0,075 mg / h - wabuluu, 0,1 mg / h - imvi (1 pc. M'matumba a zinthu zophatikizika, matumba 5 m'bokosi lamatoni).

Zomwe zili mu 1 system zikuphatikiza:

• Mphamvu yogwira: fentanyl - 2,5 mg, 5 mg, 7.5 mg kapena 10 mg,
• Zothandiza: hydroxyethyl cellulose, ethyl mowa, madzi oyeretsedwa.

Kamangidwe ka zigawo za chigamba:

• Katundu wakunja: kopolymer wa ethylene vinyl acetate ndi polyester,
• Reservoir: ethanol (0.1 ml / 10 cm 2) ndi fentanyl (2,5 mg / 10 cm 2) ngati madzi amadzimadzi a hydroxyethyl cellulose,
• Kutulutsa nembanemba: ethylene vinyl acetate (imayang'anira kuchuluka kwa zotulutsa)
• Silicone yomatira yosanjikiza ndi filimu yotulutsa yoteteza: polyester ndi fluorocarbon diacrylate.

Mlingo ndi makonzedwe

Dokotala amasankha mlingo wa Durogezik payekhapayekha malinga ndi momwe wodwalayo alili komanso kuwunika pafupipafupi kusintha pambuyo pakugwiritsa ntchito TTC.

Chigamba chimayikidwa pachithunzi cha khungu lamanja kapena thunthu. Pakugwiritsa ntchito, muyenera kusankha malo okhala ndi tsitsi lalitali kwambiri. Musanagwiritse ntchito, tsitsi pamalo ogwiritsira ntchito liyenera kudulidwa (osameta). Ngati kuli kofunika kutsuka khungu musanayambe kugwiritsa ntchito, musagwiritse ntchito sopo, mafuta, mafuta odzola kapena njira zina, kuti musayambitse mkwiyo pakhungu kapena kusintha kwa malo ake. Musanagwiritse ntchito, khungu liyenera kukhala louma kwathunthu.

Durogezik imapukutidwa mutangochotsa m'thumba losindikizidwa, ndikulikoka ndi manja ndi masekondi 30 pamalo oikapo. Muyenera kuwonetsetsa kuti chigambacho chimagwera bwino pakhungu, makamaka pozungulira.

Durogezik idapangidwa kuti izigwiritsidwa ntchito mosalekeza kwa maola makumi awiri ndi awiri. Dongosolo latsopanoli limatha kukakamizidwa kudera lina la khungu pokhapokha litachotsa kale shuga. Pamalo amodzi pakhungu, khungu limatha kupangika ndi masiku angapo.

Pakugwiritsa ntchito koyamba, Mlingo (kukula kwa kachitidwe) umasankhidwa malinga ndi momwe wodwalayo alili, kugwiritsidwa ntchito koyambirira kwa opioid analgesics komanso kuchuluka kwa kulekerera. Ngati palibe ma opioids omwe adafotokozedwapo kale, chigamba cha 25 μg / h chikuyenera kugwiritsidwa ntchito ngati gawo loyambirira. Mlingo womwewo umaperekedwa ngati wodwalayo adalandira Promedol kale.

Odwala omwe ali ndi kulolera kwa opioid, akasintha kuchokera ku mitundu ya opioid kapena ya pakamwa kupita ku Durogesic, mlingo umawerengeredwa potengera kufunika kwa maola 24 a analgesia.

Kuti musinthe bwino kuchoka pa mankhwala kupita kwina, chithandizo cha analgesic choyambirira chimayenera kuchotsedwa pang'onopang'ono mutatha kugwiritsa ntchito Mlingo woyamba wa Durogezik.

Ngati kupweteka kokwanira sikumachitika mutatha kugwiritsa ntchito koyamba mankhwalawa, pakatha masiku atatu mlingo ungathe kuwonjezereka ndi 25 /g / h, komabe, vuto la wodwalayo komanso kufunika kwowonjezera mpumulo wamisala kuyenera kukumbukiridwa (mulingo wakumwa wa morphine wa 90 mg / tsiku pafupifupi wofanana ndi 25 μg / h Durogesic) . Kuti mukwaniritse mlingo woposa 100 μg / h, ma TTC angapo amatha kugwiritsidwa ntchito nthawi imodzi.

Ngati "kuphulika" kupweteka kumachitika, odwala angafunike Mlingo wowonjezera wa analgesics. Odwala ena atha kufunafuna njira zina kapena zowonjezera pakugwiritsira ntchito opioid analgesics akamagwiritsa ntchito Mlingo wopitilira 300 mcg / h.

Malangizo apadera

Odwala omwe adayamba kudwala kwambiri ayenera kuyang'aniridwa ndi achipatala kwa tsiku limodzi atachotsedwa ku Durogezik.

Mankhwalawa, omwe ali ndi ntchito isanayambe komanso itatha, ayenera kusungidwa kuti ana asawafikire.

Chigamba sichingawonongeke mwanjira iliyonse ndikugawika pawiri kapena kudula, chifukwa izi zimapangitsa kuti fentanyl isamasulidwe.

Ngati kuli kofunikira kusiya kugwiritsa ntchito Durogezik, m'malo mwake ndi ma opioid ena ayenera kuchitika pang'onopang'ono kuti mupewe kukula kwa matenda omwe achire.

Mankhwalawa angakhudze ntchito zamaganizidwe ndi thupi poyenera kuchita ntchito zoopsa, monga kuyendetsa galimoto kapena kugwira ntchito ndi makina. Pa mankhwala, munthu ayenera kupewa kuyendetsa magalimoto ndikugwirira ntchito zoopsa zomwe zimafunikira chidwi chachikulu komanso kuthamanga kwa zochitika zama psychomotor kuchokera kwa wodwala.

Mukatha kugwiritsa ntchito, chigambacho chizikulungika ndi mbali yomata pakatikati ndikubwerera kwa dokotala kuti ziwonongeke m'njira yoyenera. Mapulogalamu osagwiritsidwa ntchito amayeneranso kubwezedwa kwa dokotala kuti atayike.

• Ndi yogwira - Durogezik Matrix, Lunaldin, Fendivia,
• Mwa makina ochitira - Bupranal, Ultiva, Prosidol, Dipidolor, Morphine, Palexia, Nopan, Promedol, Scanan, Fentanyl ndi ena opioid narcotic analgesics.

Malangizo ogwiritsira ntchito Durogesic: njira ndi mlingo

Durogezik imagwiritsidwa ntchito mopitirira. TTS iyenera kuyikika pakhungu lowuma, lathyathyathya la mikono yakumtunda kapena thunthu. Kugwiritsa ntchito, tikulimbikitsidwa kusankha malo okhala ndi tsitsi lalitali kwambiri. Tsitsi pamalo ofunsira liyenera kudulidwa (osameta). Ngati malo ogwiritsira ntchito amafunika kutsukidwa musanagwiritse ntchito Durogezik, izi ziyenera kuchitika ndi madzi oyera popanda kugwiritsa ntchito sopo, mafuta ambiri, mafuta kapena njira zina, chifukwa zimatha kubweretsa mkwiyo pakhungu kapena kusintha kwa malo ake.

Sungunulani chigamba cha Durogezik mutachichotsa kachikwama kosindikizidwa. TTS patsamba lofunsira liyenera kukanikizidwa mwamphamvu ndi chikwani chanu masekondi 30. Muyenera kuwonetsetsa kuti chigambacho chimagwera bwino pakhungu, makamaka pozungulira.

Durogezik idapangidwa kuti igwiritsidwe ntchito kwa maola 72. Dongosolo latsopanoli limatha kukakamizidwa kudera lina pakhungu pambuyo pochotsa chigamba chomwe kale chinali ndi shuga. TTS imatha kuthiridwa m'thupi lomwelo pakangotha ​​masiku angapo.

Mlingo wa mankhwalawa amasankhidwa payekha malinga ndi momwe wodwalayo alili (ziyenera kuwunikidwanso pambuyo pa kugwiritsa ntchito TTC iliyonse).

Mukamagwiritsa ntchito Durogezic kwa nthawi yoyamba, kukula kwa dongosolo (mlingo) kumasankhidwa potengera momwe amagwiritsidwira ntchito opioid analgesics, mkhalidwe wa wodwalayo komanso kuchuluka kwa kulekerera. Odwala omwe sanamwe ma opioids m'mbuyomu, mlingo wotsikitsitsa umafotokozedwa ngati mlingo woyambirira - 0,025 mg / h. Mlingo womwewo umagwiritsidwa ntchito kwa odwala omwe alandila Promedol kale.

Mukamasintha mitundu ya ma opioid kapena ya pakamwa kupita ku Durogesic mwa odwala omwe amalekerera opioid, mlingo umawerengeredwa payekhapayekha.

Kuyesa koyambirira kwa mphamvu ya analgesic yamankhwala sikungachitike pochitika patadutsa maola 24 mutatha kugwiritsa ntchito, chifukwa cha kuwonjezeka kwapang'onopang'ono kwa ndende ya fentanyl mu seramu.

Kuti musinthe bwino kuchoka pa mankhwala kupita kwina, chithandizo cha analgesic choyambirira chimayenera kuchotsedwa pang'onopang'ono mutatha kugwiritsa ntchito koyamba kwa Durogesic.

Ngati kupweteka kokwanira pambuyo pophika koyamba kwa mankhwalawa sikukwaniritsidwa, patatha masiku atatu, mutha kuchuluka. Komanso, kuwonjezeka kwa mankhwalawa masiku atatu aliwonse nkotheka. Nthawi imodzi, mlingo umakulitsidwa ndi 0,025 mg / h, komabe, mkhalidwe wa wodwalayo komanso kufunika kwa analgesia yowonjezereka kuyenera kukumbukiridwa (mlingo wapakamwa wapakamwa wa 90 mg wa morphine pafupifupi wofanana ndi Durogesic mlingo wa 0,025 mg / h). Kuti mukwaniritse mlingo wopitilira 0.1 mg / h, ma TTC angapo amatha kugwiritsidwa ntchito nthawi imodzi. Nthawi ndi nthawi, pakumva kupweteka pakumveka, odwala angafunenso kuwonjezerera kwa analgesics osakhalitsa. Odwala ena, akamagwiritsa ntchito mlingo wa Durogesic pamtunda wa 0.3 mg / h, angafunikire njira zowonjezera kapena njira zina zoyendetsera opioid analgesics.

Mimba komanso kuyamwa

Zambiri pakugwiritsa ntchito Durogesic mwa amayi apakati zimawonedwa ngati zosakwanira. Siyenera kuyikidwa pa nthawi yomwe muli ndi pakati, pokhapokha ngati pakufunika thandizo mwachangu.

Kugwiritsa ntchito mankhwalawa pakubadwa kwa ana kumatsutsana, chifukwa fentanyl imathetsa chotchinga komanso imatha kuyambitsa choletsa kupuma khanda.

Fentanyl imapezeka mkaka wa m'mawere, imatha kusuntha ndipo imayambitsa mavuto kupuma mwa ana. Pankhani imeneyi, sikulimbikitsidwa kuti mugwiritse ntchito pa mkaka wa mkaka.

Kuyanjana kwa mankhwala

Pogwiritsa ntchito nthawi yomweyo Durogezic ndi mankhwala ena, zotsatirazi zingachitike:

• Mankhwala ena omwe amakhumudwitsa dongosolo lamanjenje, kuphatikizira ma opioid, hypnotics ndi sedative, phenothiazines, mankhwala opha ululu, kupuma kwa minofu, othandizira, ma antihistamines omwe ali ndi zotsatira zoyipa, zakumwa zoledzeretsa: chiwopsezo chowonjezereka ndikukula kwa hypoventilation, kutsitsa ochepa kupanikizika, kusinkhidwa kwambiri (palimodzi kwa odwala kumafuna kuwunika momwe wodwalayo alili),
• Zoyeserera za Cytochrome P Inhibitors₄₅₀ CYP3A4 (ritonavir): kuwonjezeka kwa kuchuluka kwa fentanyl mu plasma, komwe kumawonjezera mwayi wolimbikitsa kapena kutalikitsa njira zochizira komanso kupezeka kwa zotsatira zoyipa (kuphatikiza sikumalimbikitsa),
• Nitrous oxide: minofu yowuma,
• Buprenorphine: kuchepa kwa zotsatira za Durogesic,
• Monoamine oxidase inhibitors: chiwopsezo chowonjezereka cha zovuta zovuta.

Mukaphatikizidwa ndi insulin, glucocorticosteroids ndi antihypertensive mankhwala, ndikofunikira kuchepetsa mlingo wa fentanyl.

Mafanizo a Durogezik ndi awa: Lunaldin, Fendivia, Dolforin, Fentadol Reservoir, Fentadol Matrix, Dolforin, Durogezik Matrix.

Ndemanga za Durogezik

Kwenikweni, maukondewa amapereka ndemanga zabwino za Durogezik. Odwala amafotokozera kuti azitha kugwiritsa ntchito mosavuta komanso mogwira mtima komanso nthawi yayitali (mankhwalawa amatha mpaka masiku atatu) kupumula kwa zovuta zopweteka, zomwe zimapangitsa kuti pakhale kusintha kwakukulu. Njira iyi ya analgesia ndiyovomerezeka m'maganizo kwa odwala ambiri poyerekeza ndi jakisoni wa opweteka.

Odwala omwe kale amatenga morphine pakamwa amazindikira kuti Durogezic imalekerera bwino. Amakuthandizaninso kuti muthane ndi kudzimbidwa, komwe nthawi zambiri kumachitika kumwa mankhwala okhala ndi morphine. Komabe, mankhwalawa amakhalanso ndi mavuto, omwe nthawi zambiri mseru ndi kusanza zimatchulidwa, padera, kudzimbidwa. Khansa ya m'mimba imatha yokha pakapita masiku 5-7, koma nthawi zina odwala amayenera kutenga antiemetics muyezo waukulu. Kudalira kwamalingaliro sikumayamba ndi kugwiritsa ntchito mankhwalawa. Nthawi zina, ntchito ya Dyurogezik itatha, thupi lawo limakumana ndi vuto la hyperemia, lomwe limangokhala lokha kapena mutamwa ma antihistamines.

Malangizo ogwiritsira ntchito Durogezik (njira ndi Mlingo)

Mlingo wa Durogezik amasankhidwa payekha malinga ndi momwe wodwalayo alili.

Mlingo woyambirira (kukula kwa kachitidwe) koyamba kogwiritsa ntchito amasankhidwa potengera opioid analgesics, momwe wodwalayo alili komanso kuchuluka kwa kulekerera.

Odwala omwe sanamwe mankhwala a opioid analgesics, mlingo wotsika kwambiri wa 25 μg / h umagwiritsidwa ntchito ngati mlingo woyambirira. Ngati wodwalayo adalandira kale Promedol, Durogesic ndi mankhwala omwewo.

Kusintha kochokera ku mitundu ya makolo kapena ya pakamwa ya opioid analgesics kupita ku Durogesic kwa odwala omwe ali ndi kulolera kwa opioids kuyenera kuchitika motere:

• Muwerenge zomwe zimafunikira kwa maola 24 a analgesia.
• Sinthani kuchuluka kumeneku kukhala kofanana ndi kamvekedwe ka morphine malinga ndi tebulo 1. Mlingo wonse wamkamwa ndi IM wa opioid analgesics omwe akuwonetsedwa pagome ndi ofanana mu analgesic kwambiri mpaka 10 mg IM morphine.
• Sankhani mtundu wa morphine wofunikira wa maola 24 wodwala komanso mlingo wofanana wa Durogesic.

Kusankha Mlingo ndi kukonza mankhwalawa

TTS Durogezik imayenera kusinthidwa ndi yatsopano maola aliwonse a 72. Mlingo umayikidwa kutengera kukwaniritsidwa kwa kupweteka kofunikira.

Ngati mankhwala opaleshoni sangathe pambuyo poti mugwiritse ntchito koyamba mankhwalawa, ndiye kuti patatha masiku atatu, mutha kuchuluka. Kenako mlingo akhoza kuchuluka ndi imeneyi kwa masiku atatu. Nthawi zambiri, mlingo umakulitsidwa ndi 25 mcg / h panthawi.

Kuti mukwaniritse mlingo wopitilira 100 μg / h, ma TTC angapo amatha kugwiritsidwa ntchito kwathunthu.

Odwala nthawi zina amafunika Mlingo wowonjezera wa analgesics wamkanthawi kochepa pamene "kuphulika" kumawonekera. Odwala ena amafunikira njira zowonjezera kapena zowonjezera pakugwiritsira ntchito opioid analgesics akamagwiritsa ntchito mlingo wa Durogesic wopitilira 300 mcg / h.

Zotsatira zoyipa

Kugwiritsa ntchito mankhwala Durogezik kungayambitse zotsatirazi:

• Pakati ndi zotumphukira mantha dongosolo: mutu, kugona, nkhawa, chisokonezo, kuyerekezera zinthu zina, kugona, kukhumudwa, nthawi zina paresthesia, euphoria, amnesia, kusowa tulo, kugwedezeka, phokoso.
• Mtima dongosolo: kutsitsa magazi, bradycardia, matenda oopsa, tachycardia.
• Matumbo a pakamwa: mkamwa youma, nseru, kudzimbidwa, kusanza, colic (mwa odwala omwe anali ndi mbiri yawo), nthawi zina - kutsegula m'mimba.
• Njira yothandizira kupuma: bronchospasm, hypoventilation ndi kupuma kwapafupipafupi (ndi mankhwala osokoneza bongo), mwadzidzidzi - kufupika.
• Zomwe zimachitika mdera lanu: erythema, zotupa pakhungu ndikuyiyamwa pamalo ogwiritsira ntchito.
• Zina: kutuluka thukuta, kusungika kwamkodzo, kuwuma kwakanthawi kwa minofu (kuphatikiza pectoral), kuyabwa, kulolerana, komanso kudalira kwamalingaliro ndi thupi, nthawi zina, kusowa pogonana, asthenia ndi matenda achire.

Kutulutsa mawonekedwe Durogezik, ma CD ndikuphatikizira ndi mankhwala.

Transdermal Therapeutic system (TTC) yokhala ndi malo olumikizana ndi 10 cm2 komanso kutulutsa kwa fentanyl kwa 25 μg / h ndi cholembera chamkati chokhala ndi makona ozunguliridwa, omwe ali ndi khungu loonekera, cholembedwa "25 μg / h" ndi pinki kunja kwa chigamba. 1 TTC fentanyl 2,5 mg
Omwe amathandizira: hydroxyethyl cellulose, ethanol, madzi oyeretsedwa.
Kuphatikizika kwa chipolopolo chakunja choteteza TTC: copolymer wa polyester ndi ethylene vinyl acetate.
Zomwe zimapangidwa ndi chosungira zomwe zimagwiritsa ntchito: madzi am'madzi otengera hydroxyethyl cellulose.
Mapangidwe a nembanemba wamasamba a TTT, kuwongolera kutulutsa kwa fentanyl: ethylene vinyl acetate.
Zomwe zimapangidwa ndi filimu yoteteza yochotsa: silicone yomatira yosanja yokhala ndi filimu ya fluorocarbon diacrylate ndi polyester.
1 pc - matumba (5) - mapaketi a makatoni.
Transdermal Therapeutic system (TTC) yokhala ndi malo olumikizirana 20 cm2 komanso fentanyl yotulutsa 50 μg / h, ndi cholembera chamkati chamakona chopingasa, chomwe chili ndi galasi yowoneka bwino, kunja kwa chigamba pamakhala cholembera chobiriwira "50 μg / h". 1 TTC fentanyl 5 mg
Omwe amathandizira: hydroxyethyl cellulose, ethanol, madzi oyeretsedwa.
Kuphatikizika kwa chipolopolo chakunja choteteza TTC: copolymer wa polyester ndi ethylene vinyl acetate.
Zomwe zimapangidwa ndi chosungira zomwe zimagwiritsa ntchito: madzi am'madzi otengera hydroxyethyl cellulose.
Mapangidwe a nembanemba wamasamba a TTT, kuwongolera kutulutsa kwa fentanyl: ethylene vinyl acetate.
Zomwe zimapangidwa ndi filimu yoteteza yochotsa: silicone yomatira yosanja yokhala ndi filimu ya fluorocarbon diacrylate ndi polyester.
1 pc - matumba (5) - mapaketi a makatoni.
Transdermal Therapeutic system (TTC) yokhala ndi malo olumikizana ndi 30 cm2 komanso kutulutsa kwa fentanyl kwa 75 μg / h, ndi cholembera chamkati chamkati chomwe chimakhala ndi ngodya zozungulira, chokhala ndi gelala yowoneka bwino, mawu oti "75 μg / h" ndi amtambo kunja kwa chigamba. 1 TTS fentanyl 7.5 mg
Omwe amathandizira: hydroxyethyl cellulose, ethanol, madzi oyeretsedwa.
Kuphatikizika kwa chipolopolo chakunja choteteza TTC: copolymer wa polyester ndi ethylene vinyl acetate.
Zomwe zimapangidwa ndi chosungira zomwe zimagwiritsa ntchito: madzi am'madzi otengera hydroxyethyl cellulose.
Mapangidwe a nembanemba wamasamba a TTT, kuwongolera kutulutsa kwa fentanyl: ethylene vinyl acetate.
Zomwe zimapangidwa ndi filimu yoteteza yochotsa: silicone yomatira yosanja yokhala ndi filimu ya fluorocarbon diacrylate ndi polyester.
1 pc - matumba (5) - mapaketi a makatoni.
Transdermal achire system (TTS) yolumikizana ndi 40 cm2 komanso kutulutsa fentanyl kwa 100 μg / h, ndi cholembera chamkati chamkati chomwe chimakhala ndi ngodya zozungulira, chokhala ndi khungu loonekera, kunja kwa chigamba pamakhala mawu olembedwa “100 μg / h”. 1 TTC fentanyl 10 mg
Omwe amathandizira: hydroxyethyl cellulose, ethanol, madzi oyeretsedwa.
Kuphatikizika kwa chipolopolo chakunja choteteza TTC: copolymer wa polyester ndi ethylene vinyl acetate.
Zomwe zimapangidwa ndi chosungira zomwe zimagwiritsa ntchito: madzi am'madzi otengera hydroxyethyl cellulose.
Mapangidwe a nembanemba wamasamba a TTT, kuwongolera kutulutsa kwa fentanyl: ethylene vinyl acetate.
Zomwe zimapangidwa ndi filimu yoteteza yochotsa: silicone yomatira yosanja yokhala ndi filimu ya fluorocarbon diacrylate ndi polyester.
1 pc - matumba (5) - mapaketi a makatoni.

Kufotokozera kwa mankhwalawa kumatengera malangizo ovomerezeka omwe angagwiritsidwe ntchito.

Pharmacological kanthu Durogezik

An opioid analgesic yogwiritsa ntchito transdermal. Fentanyl ndi analgesic yopanga yomwe imagwirizana kwambiri ndi ma-opioid receptors. Ili ndi mndandanda II wa mankhwala osokoneza bongo, mankhwala a psychotropic ndi omwe amatsogolera, ovomerezedwa ndi Lamulo la Boma la Russian Federation Namba 681 ya 06/30/98. Ikuwonjezera ntchito ya machitidwe oletsa kupanikizika, kumawonjezera kuchepa kwa mphamvu ya kupweteka. Zimasokoneza kutumiza kwa zokoka m'mayendedwe apadera komanso osakhala achindunji kupita ku gawo la thalamus, hypothalamus, ndi amygdala.
Zotsatira zazikulu zochizira za mankhwalawa ndi analgesic komanso sedative. Chiwerengero chogwira ntchito kwambiri cha analgesic cha fentanyl mu plasma mwa odwala omwe sanagwiritse ntchito opioid analgesics ndi 0,3-1,5 ng / ml. Kutalika konse kwa mankhwalawa ndi maola makumi awiri ndi awiri
Imakhala ndi zokhumudwitsa kumalo opumira, imachepetsa kugunda kwa mtima, imasangalatsa malo a mitsempha ya vagus ndi malo osanza. Kuchulukitsa kamvekedwe ka minofu yosalala ya biliary thirakiti, ma sphincters (kuphatikiza urethra, chikhodzodzo, kupindika kwa Oddi), amachepetsa kuyenda kwamatumbo, kumapangitsa mayamwidwe am'madzi kuchokera m'mimba. Pafupifupi mphamvu ya magazi, imachepetsa magazi. M'magazi mumachulukitsa zomwe zili ndi amylase ndi lipase.
Zimalimbikitsa kuyamba kugona. Zimayambitsa kukokoloka.
Mlingo wa chitukuko cha kudalira kwa mankhwala ndi kulolera kwa analgesic zotsatira zimadziwika ndi kusiyana kwakukulu kwa anthu.

Mlingo ndi njira ya mankhwala.

Mlingo wa Durogezic uyenera kusankhidwa payekha malinga ndi momwe wodwalayo alili komanso kukwanira kwake atagwiritsidwa ntchito ndi TTC.
Mlingo woyambirira (kukula kwa kachitidwe) koyamba kogwiritsa ntchito amasankhidwa potengera opioid analgesics, kuchuluka kwa kulolerana komanso momwe wodwalayo alili.
Odwala omwe sanatengepo opioid analgesics, mlingo wotsika kwambiri wa Durogesic, 25 μg / h, amagwiritsidwa ntchito ngati mlingo woyambirira. Mankhwala amapatsidwa mlingo womwewo ngati wodwalayo alandila promedol.
Kusintha kochokera pakamwa kapena potengera mitundu ya opioid analgesics kupita ku Durogesic mwa odwala omwe ali ndi kulolera kwa opioids ayenera kuchitika m'njira zotsatirazi.
1. Werengani kuwerengera kwa maola 24 aposowa kwa analgesia.
2. Sinthani kuchuluka kumeneku kukhala kofanana ndi kamvekedwe kamlomo ka morphine malinga ndi tebulo 1. Mlingo wonse wa IM ndi pakamwa wa opioid analgesics omwe aperekedwa pagome lino ndi ofanana mu analgesic athari kwa 10 mg IM morphine.
3. Pa tebulo lachiwiri, pezani mlingo wa morphine wofunikira wa maola 24 wodwala komanso mlingo wofanana wa Durogesic.
Gome 1. Samutsani mlingo wofanana wa analgesic dzina la mankhwalawa Molingana ndi analgesic mlingo (mg) i / m * pakamwa Morphine 10 30 (mothandizidwa pafupipafupi) ** 60 (ndi kayendetsedwe kamodzi) Omnopon 45 - Hydromorphone 1.5 7.5 Methadone 10 20 Oxycodone 15 30 Levorphanol 2 4 Oxymorphone 1 10 (rectally) Diamorphine 5 60 Petidine 75 - Codeine 130 200 Buprenorphine 0.3 0.8 (sublingual)

* Mlingo woyamwa motere umalimbikitsidwa ndikusintha kuchokera kwa makolo kupita ku njira yolankhulira.

** Chiwerengero cha mphamvu ya zochita za morphine munjira / njira yolankhulirana ya makonzedwe, ofanana ndi 1: 3, zimatengera zovuta zamankhwala zomwe zimapezeka pochiza odwala omwe ali ndi ululu wambiri.
Tebulo 2. Mlingo wovomerezeka wa Durogesic (kutengera mlingo wa tsiku ndi tsiku wa morphine) Oral tsiku lililonse morphine (mg / tsiku) Mlingo wa Durogesic (μg / h) 2013-03-20

Dzinalo Lopanda Padziko Lonse

Nthawi zambiri dokotala amalembera kalata yofunsira mankhwala m'Chilatini. Phentanylum (fentanyl) - dzina la yogwira mankhwala.

Durogezik ndi amodzi mwa mankhwala omwe ali ndi zotsatira za analgesic komanso sedative.

N02AB03 - code for anatomical and achire mankhwala gulu.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa amapangidwa mwa mawonekedwe a chigamba chamkati ndi ma gel oonekera omwe ali momwemo.

Kapangidwe ka mankhwala kumaphatikizira fentanyl. Mlingo wa kumasulidwa kwa chinthu cha psychotropic ndi 25 μg / h ndi 50 μg / h.

Mankhwalawa amapangidwa mwa mawonekedwe a chigamba chamkati ndi ma gel oonekera omwe ali momwemo.

Ndi chisamaliro

Sitikulimbikitsidwa kugwiritsa ntchito chigamba cha transdermal nthawi zingapo:

1. Pamaso pa matenda am'mapapo.
2. Pankhani yowonjezereka kwa anzawo.
3. Ndi kuchepa kwa kuthamanga kwa magazi.
4. Ndi aimpso kulephera kapena kwa chiwindi kukanika.
   Durogesic imagwiritsidwa ntchito kupweteka kwa neuropathic komwe kumachitika ndi ma sclerosis ambiri komanso matenda ashuga polyneuropathy (kusintha kwawoneka mu minyewa yamitsempha).
   Mankhwalawa amapatsidwa mankhwala opweteka kwambiri pamaso pa chotupa cha khansa.
   Durogezik tikulimbikitsidwa vuto la phantom ululu matenda a musculoskeletal system.
   Durogesic ali osavomerezeka kuti agwiritsidwe ntchito pamaso pa matenda am'mapapo.
   Chigamba sichimagwiritsidwa ntchito ngati chiwopsezo chowonjezeka cha mkati.
   Durogezik simalimbikitsidwa kuti muchepetse kuthamanga kwa magazi.
   
   
   
   
   

Kumata

Choyenereracho chiyenera kuyikidwacho pouma pakhungu la thunthu kapena pamapewa. Ndikofunikira choyamba kumeta tsitsi pakhungu. Simungagwiritse ntchito zodzoladzola zingapo musanagwiritse ntchito chigamba kuti mupewe kugunda kapena kuchepetsa mphamvu ya mankhwala.

Sikulimbikitsidwa kumata chigamba pamalo omwewo pakhungu, osayang'anira nthawi yayitali (osapitilira masiku 5-7).

Gwiritsani ntchito panthawi yoyembekezera komanso mkaka wa m`mawere

Kugwiritsa ntchito kwachigamba kwamankhwala kumapangitsa akazi apakati. Kugwiritsa ntchito mankhwala pa nthawi yoyamwitsa kungayambitse kuletsa kupuma kwa mwana.

Kugwiritsa ntchito kwachigamba kwamankhwala kumapangitsa akazi apakati.

Kuyenderana ndi mowa

Sikulimbikitsidwa kumwa mowa panthawi yanthawi ya mankhwala a opioid.

Sikulimbikitsidwa kumwa mowa panthawi yanthawi ya mankhwala a opioid.

Fentadol Matrix ndi Fendivia ali ndi fentanyl.