Diuretics: mndandanda wa mankhwala, limagwirira ntchito

Mankhwala a diuretic amakhudza ntchito ya impso ndikuthandizira njira ya mkodzo.

Limagwirira ntchito zochita ambiri okodzetsa, makamaka ngati potaziyamu wothandiza kukodzetsa, zimatengera luso lotha kubwezeretsa mayiyo mu impso, makamaka mu aimpso tubules, ma elekitiroma.

Kuwonjezeka kwa kuchuluka kwa ma electrolyte otulutsidwa kumachitika nthawi yomweyo ndi kutulutsidwa kwa madzi ena amadzimadzi.

Diuretic yoyamba idawoneka m'zaka za zana la 19, pomwe mankhwala a zebury amapezeka, omwe amagwiritsidwa ntchito kwambiri pochiza syphilis. Koma pokhudzana ndi matendawa, mankhwalawa sanali ogwira ntchito, koma mphamvu yake yokhudza kukodzetsa thupi anazindikira.

Pambuyo kanthawi, kukonzekera kwa mercury kunasinthidwa ndi mankhwala oopsa.

Posakhalitsa, kusintha kwa kapangidwe ka zida zamagetsi kunapangitsa kuti pakhale mankhwala amphamvu kwambiri a diuretic, omwe ali ndi gulu lawo.

Kodi okodzetsa ndi chiyani?

Mankhwala a diuretic nthawi zambiri amagwiritsidwa ntchito ku:

• ndi kulephera kwa mtima,
• ndi edema,
• onetsetsani kuti mkodzo watuluka, vuto laimpso
• kuthamanga kwa magazi,
• poizoni, chotsani poizoni.

Dziwani kuti ma diuretics amagwiritsidwa ntchito kwambiri pochita matenda oopsa komanso kulephera kwa mtima. Matendawa amaphatikizidwa ndi kuchepa kwa mchere wa thupi. Mankhwala a diuretic amachotsa kudziunjikira kwambiri kwa zinthu motero amachepetsa kutupa.

Ndi kuthamanga kwa magazi, sodium owonjezera amakhudza kamvekedwe ka minofu, komwe kamayamba kuchepera komanso mgwirizano. Mankhwala a diuretic omwe amagwiritsidwa ntchito ngati antihypertensives amatsuka sodium kunja kwa thupi ndikulimbikitsa vasodilation, omwe amachepetsa kuthamanga kwa magazi.

Poizoni, ena mwa poizoni amatsitsidwa ndi impso. Kupititsa patsogolo njirayi, ma diuretics amagwiritsidwanso ntchito. Muzipatala, njira iyi imatchedwa "kukakamiza diuresis."

Choyamba, njira zambiri zothetsera zimaperekedwa kwa odwala, pambuyo pake, kugwiritsidwa ntchito kothandiza kwambiri kwamitsempha, komwe kumachotsa madzimadzi m'thupi, komanso ndi poyizoni.

Ma diuretics ndi gulu lawo

Mwa matenda osiyanasiyana, okodzetsa enieni amaperekedwa omwe ali ndi njira yosiyana yochitira.

1. Mankhwala osokoneza bongo omwe amakhudza kugwira ntchito kwa aimpso tubule epithelium, mndandanda: Triamteren Amiloride, Ethaconic acid, Torasemide, Bumetamide, Flurosemide, Indapamide, Clopamide, Metolazone, Chlortalidone, Methclothiazide, Bendroflumethiozide, Hydrochlorazolezid.
2. Osmotic diuretics: Monitol.
3. Potazium-yosungirako diuretics: Veroshpiron (Spironolactone) amatanthauza okonda za mineralocorticoid receptors.

Gulu la okodzetsa mwa kugwiritsa ntchito bwino kwa sodium kuchokera mthupi:

• Zosagwira - chotsani 5% sodium.
• Kuchita kwapakatikati - sodium 10% imachotsedwa.
• Yothandiza kwambiri - chotsani sodium yoposa 15%.

Limagwirira a zochita za okodzetsa

Makina a zochita zama diuretics amatha kuphunziridwa ndi chitsanzo cha zotsatira zawo zamankhwala. Mwachitsanzo, kuchepa kwa kuthamanga kwa magazi kumachitika chifukwa cha machitidwe awiri:

1. Kutsika kwa sodium ndende.
2. Zokhudza mwachindunji mtsempha wamagazi.

Chifukwa chake, matenda oopsa oopsa amatha kuimitsidwa ndi kuchepa kwa magazi ndi kukonzanso kwakutalika kwa kamvekedwe ka mtima.

Kutsika kwa kuchepa kwa okosijeni m'matumbo a mtima mukamagwiritsa ntchito okodzetsa kumalumikizidwa ndi:

• ndi nkhawa yama cell a myocardial,
• ndi kuchulukitsa kwam'mimba mu impso,
• ndi kuchepa kwa zomatira zam'magazi,
• ndi kuchepa kwa katundu kumanzere kwamitseko yamanzere.

Ma diuretics ena, mwachitsanzo, Mannitol, samangowonjezera kuchuluka kwamadzi am'mimba nthawi ya edema, komanso amatha kuwonjezera kukakamiza kwa osmolar kuthamanga kwamadzimadzi.

Ma diuretics, chifukwa cha zomwe ali, amatha kupumula minofu yosalala ya mitsempha, bronchi, ndi ma ducts a bile, ali ndi mphamvu ya antispasmodic.

Zisonyezero zoika ma diuretics

Chizindikiro chofunikira cha kuperekera okodzetsa ndi matenda oopsa, makamaka izi zimagwira ntchito kwa odwala okalamba. Mankhwala a diuretic amaperekedwa kuti asungidwe sodium. Izi ndi monga ascites, matenda a impso ndi kulephera mtima.

Ndi mafupa, wodwala amamuika thiazide diuretics. Mankhwala osokoneza bongo a Potaziyamu amawonetsedwa pobadwa nako Liddle syndrome (kuchotsedwa kwa potaziyamu yambiri komanso positi wa sodium).

Loop okodzetsa zimakhudzanso aimpso ntchito, zotchulidwa kuti intraocular anzawo, glaucoma, mtima edema, matenda enaake.

Zochizira komanso kupewa matenda oopsa oopsa, madokotala amatenga mankhwala a thiazide, omwe muyezo wocheperako amakhala ndi mwayi wofatsa kwa odwala omwe ali ndi matenda oopsa. Zatsimikizika kuti thiazide diuretics mu prophylactic Mlingo imachepetsa chiopsezo cha stroke.

Kutenga mankhwalawa muyezo waukulu osavomerezeka, imakhala yofala ndi kukula kwa hypokalemia.

Pofuna kupewa izi, thiazide diuretics imatha kuphatikizidwa ndi potaziyamu yosasamala okodzetsa.

Pochizira okodzetsa, mankhwala othandizira ndi othandizira amadziwika. Mu yogwira gawo, Mlingo wamphamvu wokhala ndi ma diuretics (Furosemide) akuwonetsedwa. Ndi mankhwala othandizira kukonza, kugwiritsa ntchito okodzetsa pafupipafupi.

Contraindication pa ntchito okodzetsa

Odwala omwe decompensated matenda enaake a chiwindi, hypokalemia, kugwiritsa ntchito okodzetsa ndi zotsutsana. Liopture ya loop sinafotokozedwe kwa odwala omwe amalolera kulandira mankhwala ena a sulfanilamide (hypoglycemic and antibacterial mankhwala).

Kwa anthu omwe ali ndi kupuma komanso kupweteka kwambiri kwaimpso, okodzetsedwa amatsutsana. Ma diuretics a gulu la thiazide (Methiclothiazide, Bendroflumethiozide, Cycl litšoantšoazide, Hydrochlorothiazide) amatsutsana mu mtundu 2 wa shuga, chifukwa wodwalayo angakulitse kwambiri shuga m'magazi.

Ventricular arrhythmias amathanso kutsutsana pakusankhidwa kwa okodzetsa.

Kwa odwala omwe amatenga mchere wa lithiamu ndi mtima glycosides, okodzetsa ziwalo amatumizidwa mosamala kwambiri.

Osmotic diuretics sinafotokozeredwe kulephera kwa mtima.

Zotsatira zoyipa

Ma diuretics pamndandanda wa thiazide amatha kuwonjezera kuchuluka kwa uric acid. Pachifukwachi, odwala omwe apezeka kuti ali ndi gout akhoza kukhala akuipiraipira.

Ma diuretics a gulu la thiazide (hydrochlorothiazide, hypothiazide) atha kubweretsa zotsatira zosasangalatsa. Ngati mulingo woyenera wosankhidwa kapena wodwala akulekerera, zotsatirapo zake zitha kuwoneka:

• mutu
• kutsegula m'mimba ndikotheka
• nseru
• kufooka
• kamwa yowuma
• kugona

Kusasiyanitsa kwa ayoni kumaphatikizapo:

1. Anachepetsa libido mwa amuna,
2. chifuwa
3. kuchuluka kwa shuga m'magazi,
4. chigoba minofu kukokana
5. kufooka kwa minofu
6. arrhythmia.

Zotsatira zoyipa za furosemide:

• kutsika kwa potaziyamu, magnesium, calcium,
• chizungulire
• nseru
• kamwa yowuma
• kukodza pafupipafupi.

Kusintha kwa kusinthana kwa ion, kuchuluka kwa uric acid, shuga, calcium ukuwonjezeka, zomwe zimaphatikizapo:

• paresthesia
• zotupa pakhungu,
• kusamva.

Zotsatira zoyipa za aldosterone adani zimaphatikizapo:

1. zotupa pakhungu,
2. gynecomastia
3. kukokana
4. mutu
5. kusanza, kusanza.

Amayi omwe sanasankhe molakwika ndi kumwa molakwika akuti:

Chithandizo cha ochepa matenda oopsa mu shuga. Zodzikongoletsera

Ma diuretics (okodzetsa) ndi amodzi mwa magulu ofunikira kwambiri a antihypertensives chifukwa chogwira ntchito kwambiri, kulolerana kwabwino pamtengo wotsika kapena wotsika mtengo. Pakadali pano, ndi matenda oopsa a arterial, makamaka thiazide (hypothiazide, hydrochlorothiside, etc.) ndi thiazide-like (indapamide, chlortalidone, xipamide) okodzetsa amagwiritsidwa ntchito, zomwe zimagwirizanitsidwa ndi kuwonjezeka kwapadera mumkodzo wa sodium.

Loop diuretics (furosemide, etc.) siigwiritsidwa ntchito kwa nthawi yayitali pochita matenda oopsa, koma amawonetsedwa kwa odwala omwe amachepetsa mphamvu yaimpso m'malo mwa thiazide diuretics. Potaziyamu yosawononga okodzetsa (triamteren, etc.) ataya kwambiri kufunika kwa mankhwalawa.

Mpaka posachedwa, thiazide diuretics yochizira matenda oopsa a shuga a 2 mtundu akhala akugwiritsidwa ntchito pang'ono chifukwa chokhoza kuchepetsa mphamvu zama cell insulin, kuchuluka kwa glucose, komanso cholesterol ndi triglycerides m'magazi.

Komabe, zidapezeka kuti zotsatirazi zimachitika pokhapokha ngati pali kugwiritsa ntchito mankhwala yayitali nthawi yayitali, ndipo Mlingo wocheperako samakhudza kagayidwe kazakudya ndi lipid metabolism. Liureide ngati Thiazide ndi thiazide samachotsa sodium kokha, komanso potaziyamu, komanso magnesium kuchokera m'thupi.

Kuchulukitsidwa kwa zakudya zamafuta a potaziyamu ndi magnesium (zipatso zatsopano ndi zouma ndi zipatso, masamba, mbatata yophika, oatmeal ndi buckwheat, etc.) kumalepheretsa kuti thupi liwonongeke ndi mcherewu. Mukatenga mapiritsi a thiazide osakanikirana ndi potaziyamu (triampur, triamco), zotayika za potaziyamu ndizochepa.

Thiazide-ngati diuretics, yomwe imakhudza pang'ono kagayidwe kazakudya ndi lipid metabolism, amalimbikitsidwa kuphatikiza matenda oopsa komanso mtundu wa 2 matenda a shuga, ngakhale kuti utsogoleri wa insulin ungakulitse kufunika kwa insulini. Mankhwala oyamba kusankha ndi indapamide retard (arifon), amene amatengedwa kamodzi patsiku.

Popeza kusungidwa kwa Na ndi zamadzimadzi ndi vuto la hypervolemia zomwe zimapangitsa gawo lalikulu la matenda oopsa a matenda amtundu wa 1 ndi mtundu wa 2 shuga, kugwiritsa ntchito ma diuretics kuphatikiza kuthamanga kwa magazi ndi koyenera. Komabe, si magulu onse a diuretic omwe ali otetezeka komanso ogwira ntchito kwa odwala matenda ashuga.

Gulu la okodzetsa

Thiazide diuretics Mankhwalawa amagwira makamaka pama cell a distal opukusidwa kuchokera mkati, pomwe amaletsa kukodzetsa kumachitika patatha maola 1-2 pambuyo pakukonzekera pakamwa ndikuchitika, monga lamulo, maola 12-18 (hypothiazide) mpaka maola 24 (chlortalidone). Thiazide diuretics ndi amphamvu kwambiri potaziyamu-okodzetsa.

Limagwirira a diabetic zotsatira za thiazides ndi chifukwa kutchulidwa potaziyamu owonjezera mphamvu ya mankhwalawa. Kuwonongeka kwa extracellular ndi intracellular potaziyamu mu β-maselo a kapamba motsogozedwa ndi thiazides kumayambitsa kubisala insulin katulutsidwe ndi hyperglycemia. The kwambiri diuretic amachotsa potaziyamu, ndi kukhathamiritsa yake matenda ashuga.

Pakufufuza kwatsatanetsatane kwa thiazide diuretics, zidapezeka kuti mphamvu ya potaziyamu yowonjezera ya thiazides imangodalira mlingo wachilengedwe. Kudalira kwa potaziyamu pochotsa zotsatira za hypothiazide (mankhwala ogwiritsidwa ntchito kwambiri a thiazide ku Russia) amaperekedwa.

Chifukwa chake, ndi mlingo wa hypothiazide wa 12,5 mg / tsiku kapena mochepera, mphamvu yake ya potaziyamu siyothandiza.Ngati mphamvu ya potaziyamu-yochotsa mphamvu ya thiazides imatengera mlingo wa mankhwalawa, ndiye kuti diabetogenic zotsatira za ma diuretics (okhudzana mwachindunji ndi kuchuluka kwa potaziyamu) ayeneranso kukhala oledzera, i.e., kukhala okwanira pa mlingo waukulu wa mankhwala komanso ochepa.

Zowonadi, maphunziro ochulukirapo awonetsa kuti kuchuluka kwa thiazide komwe kumakhala kocheperako, sikuchepetsa mphamvu ya kagayidwe kazachilengedwe. Ndi kipimo cha hypothiazide pamtunda wa 50 mg / tsiku, chiwopsezo cha matenda a shuga 2 chafika pa 7% (kafukufuku wa MRFIT), ndi mlingo wa 25 mg kapena kuchepera, palibe kuchuluka kwakukulu pachiwopsezo cha matenda a matenda a shuga 2 (SHEP, TOMHS).

Pakufufuza kwakukulu kwa anthu ambiri ARIC, komwe kunaphatikizapo anthu opitilira 12,000 opanda matenda a shuga, zinawonetsedwa kuti kutenga thiazide diuretics pa mlingo wa 12.5-25 mg / tsiku kwa zaka 6 siziphatikizidwa ndi chiwopsezo chowonjezeka cha matenda a shuga 2 (OP = 0.91) .

Chifukwa chake, maphunziro olamulidwa ndi multicenter atsimikizira kuti chiopsezo chokhala ndi matenda a shuga a 2 de novo omwe amagwiritsidwa ntchito kwa nthawi yayitali a thiazide diuretics ndi ochepa kwambiri pamene mlingo wawo sunapamwamba kuposa 25 mg / tsiku.

Zotsatira za thiazide diuretics pa lipid metabolism zimatengera nthawi ya mankhwalawo komanso pocheperako pang'ono pa mlingo wake. Chifukwa chake, mutatenga thiazides kwa miyezi 3-12. mulingo wa cholesterol wa seramu ukuwonjezeka ndi 5-7%.

Nthawi yomweyo, mayesero azachipatala omwe amayang'aniridwa ndi placebo omwe amawonetsa kuti kugwiritsa ntchito mankhwala kwa nthawi yayitali (kwa zaka 3-5) kwenikweni sikukhudza kagayidwe ka lipid. Mu maphunziro a HAPPHY ndi EWPHE, hypercholesterolemia yoyambira idadziwika (mulingo wa OX woposa 6.5 mmol / L).

Chifukwa chake, palibe umboni wotsimikiza kuti thiazide diuretics sangathe kupatsidwa kwa anthu omwe ali ndi dyslipidemia, ngati pakufunika kuchepetsa magazi.

Pamaso pa matenda a zamitsempha, mfundo zakuchiritsa matenda oopsa ndizosiyana, chifukwa chophwanya kagayidwe kazachilengedwe. Chifukwa chake, ndi matenda oopsa komanso mtundu wina wa matenda ashuga a 2, ndikofunikira kuti poyambapo kuchitira mankhwala a antihypertensive ophatikizidwa.

Pakadali pano, kuphatikiza komwe kumakhazikitsidwa pakugwiritsa ntchito angiotensin II ndi ACE inhibitors kumawerengedwa ngati koyenera kwambiri. Ndikofunika kuphatikiza mankhwalawa ndi beta-blockers ndi okodzetsa. Zotsatira zabwino zimaperekedwa ndi kuphatikiza kwa ACE inhibitors ndi antagonists a calcium.

Mwa anthu omwe ali ndi matenda ashuga, kupanikizika kumawonjezeka chifukwa chowonjezeka pamagazi. Kuphatikiza apo, odwala omwe ali mgululi amatha kugwidwa ndi mchere, motero amapatsidwa mankhwala osiyanasiyana okodzetsa:

• thiazide - chlortalidone ndi hypothiazide,
• thiazide-indapamide,
• loopback - lasix ndi furosemide,
• potaziyamu-kuteteza - veroshpiron.

Ma diuretics amatha kupititsa patsogolo ntchito ya ACE inhibitor, chifukwa chomwe amagwiritsidwa ntchito kwambiri ndi madokotala pochiza matenda osokoneza bongo. Koma, monga mankhwala aliwonse, ali ndi malire pakugwiritsa ntchito.

Tizoid diuretics ya matenda a shuga a 2 amayikidwa mosamala, popeza kuchuluka kwakukulu kumathandizira kuti magazi a wodwala akhale ndi cholesterol komanso shuga. Ndi kulephera kwa impso, kupezeka kwa matenda ashuga, mankhwala amatha kuletsa impso. Komanso kutsutsana kwa tizoid okodzetsa ndimatumbo.

Liureide ngati diazone sikuti nthawi zambiri amalembedwa ndi ACE zoletsa. Mtunduwu umakhala ndi zonyozeka zochepa, pomwe sizikuwakhudza impso komanso osathandizira pakufuma kwa potaziyamu.

Loop diuretics mu matenda oopsa, kuphatikiza ndi matenda a shuga a 2, sagwiritsiridwa ntchito kwambiri ndi madokotala chifukwa chokondweretsedwa ndi mphamvu ya diureis ndi potaziyamu. Komabe, mwayi wawo ndi kuphatikiza bwino kwambiri ndi ACE zoletsa, zomwe ndizofunikira kwambiri pakulephera kwa impso. Ndipo kubwezeretsanso kwa potaziyamu mutatenga Lasix ndi Furosemide kumabwezedwanso chifukwa chowonjezera potaziyamu.

Veroshpiron wa mankhwala osokoneza bongo omwe nthawi zina amapezeka kuti amathandizira matenda oopsa, koma ayenera kukumbukira kuti ngati kulephera kwa impso, kugwiritsidwa ntchito kumatsutsana.

Mankhwala Oletsedwa

Ndi mapiritsi ati a antihypertgency omwe ali ovuta kwa odwala matenda ashuga? Zoletsa, zowononga okodzetsa a shuga zimaphatikizapo Hypothiazide (a thiazide diuretic). Mapiritsiwa amatha kuwonjezera shuga wamagazi ndi kuchuluka kwa cholesterol. Pamaso kulephera kwa aimpso, wodwala amatha kuwonongeka pakugwira ntchito kwa chiwalo. Odwala omwe ali ndi matenda oopsa amathiridwa okodzetsa a magulu ena.

Mankhwala Atenolol (β1-adenoblocker) a matenda a shuga a mtundu 1 ndi 2 amachititsa kuchuluka kapena kuchepa kwa matenda a glycemia.

Mochenjera, amalembera kuwonongeka kwa impso, mtima. Ndi nephropathy, Atenolol ingayambitse kuchepa kwambiri kwa magazi.

Mankhwalawa amasokoneza kagayidwe kachakudya kagayidwe kachakudya, kamakhala ndi zotsatira zoyipa zingapo kuchokera ku mantha, m'mimba, mtima. Poyerekeza ndi kumbuyo kwa kutenga Atenolol mu mtundu 2 wa matenda a shuga, kuthamanga kwambiri kwa magazi kumawonedwa.

Izi zimadzetsa kuwonongeka kwakukuru m'moyo wabwino. Kumwa mankhwalawa kumapangitsa kuti vutoli lizindikire kuchuluka kwa shuga m'magazi.

Odwala omwe amadalira insulin, Atenolol amatha kuyambitsa hypoglycemia chifukwa cha kuwonongeka kwa glucose kwa chiwindi, ndikupanga insulin. Zimakhala zovuta kwa dokotala kuti azindikire molondola, chifukwa zizindikiritso zake sizimatchulidwa.

Kuphatikiza apo, Atenolol imachepetsa chidwi cha minofu ya thupi kupita ku insulin, yomwe imayambitsa kuwonongeka kwa odwala omwe ali ndi matenda a shuga a 2, kusayerekezeka pamlingo wa cholesterol yoyipa komanso yopindulitsa, ndikuthandizira ku hyperglycemia.

Kulandila kwa Atenolol sikungayime mwadzidzidzi; ndikofunikira kufunsa dokotala za momwe adasinthira ndikusamutsira njira zina. Kafukufuku wa sayansi akuwonetsa kuti kugwiritsa ntchito nthawi yayitali kwa Atenolol odwala omwe ali ndi matenda oopsa pang'onopang'ono kumayambitsa kukula kwa mtundu wa 2 matenda a shuga, chifukwa chidwi cha minofu kupita ku insulin chimachepa.

Njira ina ya Atenolol ndi Nebilet, β-blocker yemwe samakhudza metabolism ndipo amakhala ndi tanthauzo la vasodilating.

Mapiritsi a matenda oopsa mu shuga mellitus ayenera kusankhidwa ndi kuikidwa ndi dokotala kuganizira za munthu wodwala, kupezeka kwa ma contraindication, kuopsa kwa matenda. Sitikulimbikitsidwa kugwiritsa ntchito β-blockers (Atenolol), malupu okodzetsa, chifukwa mankhwalawa amakhudza kayendedwe ka metabolic, amathandizira kuchuluka kwa glycemia ndi cholephera kuperewera kwa cholesterol.

Mndandanda wamankhwala othandizira amaphatikizapo sartans, thiazide-like diuretics (Indapamide), ACE inhibitors.

Zithandizo za anthu ndi njira

Kodi okakamiza nthawi zambiri amafunsa dokotala. Ma diuretics ndi okodzetsa amtundu wina wochita ndi kutanthauzira kukodzetsa kwenikweni. Tsoka ilo, onsewa ali ndi zovuta komanso kugwiritsa ntchito kwawo popanda malangizo a dokotala ndizowopsa paumoyo. Kodi okodzetsa ndi chiyani?

Gulu la mitundu - mitundu ya ma diuretics

Ma diuretics amalimbikitsa zochitika za ACE zoletsa, motero, amapatsidwa mankhwala osokoneza bongo. Liazide-like diuretics imakhala yofatsa mu mtundu wachiwiri wa matenda osokoneza bongo, imakhala yochepa kwambiri pazotsatira za potaziyamu, kuchuluka kwa glucose ndi lipids m'magazi, ndipo osasokoneza kugwira ntchito kwa impso.

Gululi limaphatikizapo Indapamide ndi Arefon Retard. Mankhwala ali ndi nephroprotective kwambiri pa gawo lililonse la ziwalo.

Indapamide imalimbikitsa vasodilation, imathandizira kupanga mapulatini osakanikirana, chifukwa chotenga mankhwalawa a matenda a shuga a 2, kuchuluka kwa magazi ndi kuchepa kwa magazi.

Mu mankhwalawa achire, indapamide imangoyambitsa hypotensive zotsatira popanda kuwonjezera mkodzo.Malo ofunikira kwambiri ku Indapamide ndi mtima ndi minofu yaimpso.

Kuchiza ndi Indapamide sikukhudza kagayidwe kachakudya mthupi, chifukwa chake sikukweza kuchuluka kwa glucose, lipoproteins wotsika kwambiri m'magazi. Indapamide imatenga mwachangu mawonekedwe awo am'mimba, koma izi sizimachepetsa kugwira ntchito kwake, kudya pang'ono kumachepetsa kuyamwa.

Kugwira ntchito kwa nthawi yayitali kumatha kuchepetsa kuchuluka kwa mankhwalawa. Chithandizo chamankhwala chimatheka pomaliza sabata yoyamba kumwa mapiritsi. Ndikofunikira kumwa kapisozi imodzi patsiku.

Ndi magome ati okodzetsa omwe ndingamwe kumwa kuthamanga kwa magazi kwa matenda ashuga?

Mapiritsi a diuretic amalembedwa kuthamanga kwa magazi (matenda oopsa) mu mtundu 2 wa shuga. Dokotala wopezekapo amayenera kusankha mankhwalawa, makamaka kuopsa kwa matendawa, kupezeka kwa kuwonongeka kwa minyewa, komanso kuponderezana.

Furosemide ndi Lasix amalembedwa kuti atupire kwambiri kuphatikiza ndi ACE inhibitors. Komanso, odwala omwe ali ndi vuto la aimpso, kugwira ntchito kwa chiwalo chokhudzidwayo kumakhala bwino. Mankhwala amatsukidwa kuchokera potaziyamu wa thupi, motero muyenera kuphatikiza mankhwala okhala ndi potaziyamu (Asparkam).

Veroshpiron samatulutsa potaziyamu m'thupi la wodwalayo, koma amaletsedwa kuti agwiritse ntchito kulephera kwa aimpso. Ndi matenda a shuga, chithandizo chamankhwala ngati amenewo chimaperekedwa mankhwala osamveka.

Hypertension imatha kuthandizidwa pogwiritsa ntchito njira zina za shuga pokhapokha kuyang'aniridwa ndi dokotala. Chifukwa si zitsamba zonse zomwe zili zothandizanso chimodzimodzi komanso zotetezeka kwathunthu.

Mankhwala azitsamba ndi a nthawi yayitali, nthawi zina zimatenga miyezi ingapo mpaka miyezi isanu ndi umodzi kuti muchiritse. Komabe, kudya zitsamba ndi chindapusa kuyenera kusinthidwa ndi zosokoneza, zomwe zimayenera kukhala masiku osachepera asanu ndi awiri kapena khumi.

Kuphatikiza pa mankhwala a zovuta pakukakamizidwa pamaso pa matenda a shuga 2, zakudya zapadera ziyenera kutsatiridwa.

Momwe mungasankhe mapiritsi a diuretic

Pa matenda ndi machitidwe osiyanasiyana, gulu lina la okakamiza limasankhidwa:

• Saluretics - okodzetsa, chotsani potaziyamu ndi magnesium, ndikuyambitsa okodzetsa:
  • loopback - furosemide, bumetanide, torasemide, lasix, ethaconic acid
  • sulfonamides - chlortalidone, clopamide (nthawi zambiri chlortalidone, clopamide imagwiritsidwa ntchito limodzi ndi beta-adenoblockers, omwe ali ndi antihypertensive mankhwala), indapamide - mankhwala oopsa
  • thiazide - cyclformazide, hypothiazide
  • carbonic anhydrase zoletsa - acetazolamide, diacarb
• Potaziyamu wolekerera okodzetsa - gwiritsani ntchito polumikizira, kuteteza kutaya kwa potaziyamu - amiloride, spironolactone, triamteren, veroshpiron, eplerenone
• Osmotic diuretics imalepheretsa kuyamwa kwamadzi chifukwa cha kusiyana kwa kupanikizika kwa osmotic mu tubules - mannitol, urea (intravenous makonzedwe).

Zomwe madokotala atakulemberani:

• Matenda oopsa a magazi (kuthamanga kwa magazi) - thiazides ndi indapamide
• Nephrotic syndrome ndi kulephera kwa mtima ndizodzikongoletsa zina. Poyerekeza ndi malembedwe a mtima kulephera, kutupa kwamiyendo kwambiri ndikukhazikitsa kwa furosemide kapena lasix.
• Matenda a shuga, matenda a metabolic - indapamide
• Kuchuluka kwa adrenal secretion ya aldosterone - spironolactone
• Osteoporosis - Thiazides

Zochita zama diuretics zitha kugawidwa mu:

Pofika nthawi

Ntchito yayitali (mpaka masiku 4)Eplerenone, Veroshpiron, Chlortalidone Nthawi yapakatikati (mpaka maola 14)Diacarb, Clopamide, Triamteren, Hypothiazide, Indapamide Kuchita zinthu mwachidule (mpaka maola 8)Mafuta, Furosemide, Lasix, Torasemide, Ethacrine acid

Zojambula zotuluka m'miyendo

Mafuta opaka m'mimba amathandizira kuchuluka kwa impso ndi impso, motero, ndi madzi. Amayambitsa kukhathamira kwamphamvu, kopita patsogolo mwachangu, koma kwakanthawi kochepa (osapitirira maola 6), chifukwa chake nthawi zambiri amagwiritsidwa ntchito popereka chithandizo chadzidzidzi.Kulephera kwa mtima kosatha ndi edema yayikulu, kugwiritsa ntchito kwawo ndikotheka pazosankha zazifupi.

Ma diuretics awa ndi othandiza pakhungu la impso, koma mosiyana ndi ena. Koma popeza mukumwa mankhwala opaka m'miyendo, pamakhala kuwonongeka kwa magnesium ndi potaziyamu m'thupi, izi zimayipa ntchito ya mtima.

Pachimake aimpso kulephera ndi anuria, kwambiri chiwindi kulephera, hypersensitivity, pachimake glomerulonephritis, kutsekeka kwa kwamikodzo thirakiti ndi Calculator (onani impso miyala), kapamba, urethral stenosis. , kuphwanya kagayidwe ka madzi.

Zotsatira zoyipa: tachycardia, kutsika kwa kupanikizika, kugwa, kufooka, kusokonezeka, kupweteka mutu, kugona, chizungulire, kusamva bwino ndi masomphenya, pakamwa pouma, nseru, kusanza, ludzu, kufooka kwa chakudya, kufalikira kwamkodzo, kuchepa kwamikodzo potency, hematuria, interstitial nephritis, khungu loyenda, kutentha thupi, photosensitivity, erythema, dermatitis, anaphylactic mantha, miyendo kukokana, kufooka kwa minofu, ndi zina zambiri.

Furosemide 40 mg. Ma PC 50. 20-30 rub.Lasix 40 mg. Ma PC 45. 50 rub Trigrim 10 mg. 30 ma PC 500 rub. 5 mg 30 ma PC 270 rub.Diuver 10 mg 20 ma PC 450 rub., 5 mg 20 ma PC. 320 rub

Sulfanamide okodzetsa

Izi zimaphatikizapo Indapamide - mankhwala omwe amachepetsa kuthamanga kwa magazi (diuretic, vasodilator), omwe ali pafupi ndi mankhwala ku thiazides. Zotsatira zakuchizira zimachitika pakatha milungu iwiri ya utsogoleri, kuchuluka kumatheka pambuyo pa miyezi iwiri iwiri ndipo kumatenga mpaka miyezi iwiri.

Kulephera chiwindi, hypersensitivity, ana osaposa zaka 18, azimayi pa mkaka wa m`mawere, kuyamwa kwa lactose, mosamala pa nthawi yoyembekezera, ndikuphwanya magazi-electrolyte metabolism, hyperurathyroidism.

Zotsatira zoyipa: kugwa kwa magazi, palpitations, arrhythmia, kusintha kwa ECG, kutsokomola, sinusitis, pharyngitis, chizungulire, kugona, kupweteka kwa mutu, mantha, kugona, nkhawa, kudzimbidwa kapena kutsegula m'mimba, mseru, kusanza, kamwa yowuma, kapamba, nocturia, polyuria, urticaria, kuyabwa kwa khungu, ndi zina zambiri.

Indapamide: Akuter-Sanovel, Arindal, Arifon, Indap, Indipam, Indiaur, Ionik, Ipres-Long, Lorvas, Retapres, Tenzar, komanso:

Arifon 2,5 mg 30 ma PC 450 rub

Indap 2,5 mg 30 ma PC 100 rub

Acriptamide 2,5 mg 30 ma PC 50 rub

Indapamide 2,5 mg 30 ma PC 100 rub

Ravel 1.5 mg 30 ma PC 200 rub.

Thiazide okodzetsa

Momwe mungagwiritsire ntchito zochita za thiazide diuretics ndi ma distal tubules a impso. Zimatengera kuti mankhwalawa amalepheretsa kuyamwa kwa sodium ions, ndikutsatira madzi limodzi ndi gradient yothamanga. Zotsatira zake, sodium amachotsedwera limodzi ndi madzi ochulukirapo.

Monga lamulo, thiazide diuretics amawonetsa okodzetsa mphamvu ya mphamvu yapakatikati. Mankhwala ena m'gululi amatha kutulutsa mitsempha yamagazi.

• Chifukwa chakuchepa kwa kufinya kwa khoma la mtima, mankhwala a thiazide diuretic amagwiritsidwa ntchito kwambiri pakupanga mankhwalawa kwa matenda oopsa.
• Kutha kuchotsa edema yakunja ndi yamkati kumapangitsa mankhwalawa kukhala othandizira pochotsa kulephera kwa mtima.
• Amagwiritsidwanso ntchito pa edema yolumikizidwa ndi cirrhosis ndi nephrotic syndrome.

Mankhwalawa amatengeka mwachangu ndikuyamba kuchita pambuyo theka la ola kapena ola limodzi pambuyo pa kuwongolera. Kutalika kwa zochita zawo ndi pafupifupi maola 12, omwe amakupatsani mwayi woti muzitha kugwiritsa ntchito mankhwala osokoneza bongo kamodzi patsiku ngati othandizira ena komanso mpaka kawiri pochotsa edema ya mtima. Ubwino wa mtundu uwu wa diuretic ndikuti samasokoneza kuchuluka kwa acid-base magazi.

Zambiri za kutenga thiazide diuretics:

• Zitha kusokoneza potaziyamu ndi magnesium (wokhala ndi mankhwala osakhalitsa)
• Onjezerani kuchuluka kwa uric acid (osafunikira kwa gout)
• Kuchulukitsa shuga (osafunika kwa shuga)

Kukonzekera kwa Thiazide: Gigroton, Hypothiazide, Dichlothiazide, Oxodoline, Cyclomethazide.

25 mg 20 ma PC. 100 rub

100 mg 20 ma PC. 120 rub

25 mg 20 ma PC. 50 rub

100 mg 20 ma PC. 70 rub

Kuchepetsa potaziyamu poteteza

Monga thiazide kukonzekera, potaziyamu wocheperako okodzetsa ndi saluretics ndipo amagwira ntchito pamlingo wa distal tubules. Mfundo yogwirira ntchito ndi yofanana ndi thiazides (kuphwanya mayankho a sodium) ndi kutayika kwake pamodzi ndi madzi (Amiloride, Triampur).

Spironolactone imakumana ndi aldosterone (mahomoni a adrenal omwe amalepheretsa sodium ndi madzi). Komabe, mphamvu ya potaziyamu yosalekerera okodzetsa imakhala yofooka ndipo imakula pang'onopang'ono (mpaka masiku 2-5 kuyambira chiyambi cha mankhwala).

• Zotsatira zake, mankhwala osokoneza bongo a potaziyamu sayenera kukhala odziimira pawokha ndipo nthawi zambiri amalembedwa ngati okodzetsa ena, mwachitsanzo, ndi hyperaldosteronism yachiwiri, kulephera kwa mtima kugonjetsedwa ndi chithandizo choyambira, nephrotic syndrome, cirrhosis.
• Komanso, gululi limakhala mankhwala osankha osalolera ku mankhwala omwe amatsuka potaziyamu pochiza matenda a mtima, monga myocarditis, omwe ali ndi edematous syndrome.
• Akaphatikizidwa ndi loopt kapena thiazide diuretics, mankhwala osokoneza bongo a potaziyamu amateteza kutayika kwakukulu kwa potaziyamu mumkodzo.
• Primary hyperaldosteronism (chotupa cha adrenal gland) imafunanso kukhazikitsidwa kwa deta ya diuretic (veroshpiron). Mankhwalawa ndi oyenera odwala omwe ali ndi matenda a shuga komanso gout.

Othandizira oteteza potaziyamu: Spironolactone (Veroshpiron), Amiloride, Triamteren (Triampur).

Ma diuretics otchuka ndi makina awo ochitapo kanthu pa thupi

Ma diuretics omwe amakhudza ntchito ya aimpso tubules amalepheretsa sodium kulowa mthupi kachiwiri ndikufinya mkodzo. Ma diuretics a sing'anga ogwira ntchito a Methiclothiazide Bendroflumethiosos, Cyclaniseazide amachititsa kuti ikhale yovuta kuyamwa chlorine, komanso osati sodium. Chifukwa cha izi, amatchedwanso saluretics, kutanthauza "mchere".

Thiazide-ngati diuretics (Hypothiazide) amalembera makamaka edema, matenda a impso, kapena kulephera mtima. Hypothiazide imakonda kwambiri ngati othandizira ena.

Mankhwalawa amachotsa sodium yambiri ndikuchepetsa kupanikizika m'mitsempha. Kuphatikiza apo, mankhwala a thiazide amawonjezera mphamvu ya mankhwala, momwe amagwirira ntchito omwe cholinga chake ndi kutsitsa magazi.

Popereka kuchuluka kwa mankhwalawa, mankhwalawa amayamba kuchulukana popanda kutsitsa magazi. Hypothiazide imafotokozedwanso kwa matenda a shuga insipidus ndi urolithiasis.

Zinthu zomwe zimapangidwa pokonzekera zimachepetsa kuchuluka kwa calcium ion ndikuletsa mapangidwe amchere mu impso.

Ma diuretics othandiza kwambiri amaphatikizapo Furosemide (Lasix). Mothandizidwa ndi mtsempha wa magazi mankhwalawa, zimachitika pambuyo pa mphindi 10. Mankhwala ndi oyenera

• Kulephera kwamkati kwamanzere kwamtima, motsatana ndi mapapu a edema,
• zotumphukira edema,
• ochepa matenda oopsa
• kuchotsa kwa poizoni.

Ethacrinic acid (Ureghit) ili pafupi ndi Lasix, koma imakhala nthawi yayitali.

Monitol wodziwika bwino kwambiri amathandizira kudzera m'mitsempha. Mankhwala amathandizira kuthamanga kwa osmotic ya plasma ndi kutsika kwa intracranial ndi intraocular anzawo. Chifukwa chake, mankhwalawa amagwira ntchito kwambiri mu oliguria, yomwe imayambitsa kupsa, zoopsa kapena kuchepa kwa magazi.

Aldosterone antagonists (Aldactone, Veroshpiron) amaletsa kuyamwa kwa sodium ions ndikulepheretsa chinsinsi cha magnesium ndi potaziyamu.Mankhwala a gululi amawonetsedwa ndi edema, matenda oopsa komanso kusokonekera mtima. Potaziyamu yosasamala okodzetsa kwenikweni simalowa nembanemba.

Ma diuretics ndi matenda ashuga a 2

Tcherani khutu! Tiyenera kukumbukira kuti ndi mtundu wachiwiri wa matenda ashuga, wothandizila wina wokhawo amene angagwiritsidwe ntchito, ndiko kuti, kuperekera mankhwala osokoneza bongo osaganizira matendawa kapena kudziyambitsa nokha kungapangitse zotsatira zoyipa m'thupi.

Thiazide diuretics ya mtundu 2 matenda a shuga amachepetsa makamaka kuthana ndi magazi, ndi edema komanso pochizira matenda amtima.

OWERENGA ATHANDIZA!

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

Komanso thiazide diuretics amagwiritsidwa ntchito pofuna kuchiza odwala ambiri omwe ali ndi matenda oopsa omwe amakhala nthawi yayitali.

Mankhwalawa amachepetsa chidwi cha maselo kupita ku insulin ya mahomoni, zomwe zimapangitsa kuti magazi azikhala ndi glucose, triglycerides ndi cholesterol. Izi zimayika ziletso zazikulu pakugwiritsira ntchito izi diuretics mu mtundu 2 wa shuga.

Komabe, kafukufuku waposachedwa wazachipatala wakugwiritsira ntchito okodzetsa a shuga a 2 akuwonetsa kuti zotsatirapo zoyipa izi zimawonedwa pafupipafupi ndi mankhwala. Pa Mlingo wotsika, zotsatira zoyipa sizimachitika.

Zofunika! Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, popereka mankhwala a thiazide okodzetsa, odwala ayenera kudya masamba ndi zipatso zambiri momwe angathere. Izi zikuthandizira kuthetsa kutaya kwakukulu kwa potaziyamu, sodium, ndi magnesium. Kuphatikiza apo, chiopsezo chochepetsera chidwi cha thupi kwa insulin iyenera kuganiziridwa.

Ndi mtundu wachiwiri wa matenda a shuga a mellitus, mankhwala omwe amagwiritsidwa ntchito kwambiri ndi Indapamide, kapena, Arifon yake yochokera. Onse awiri a Indapamide ndi Arifon alibe phindu lililonse pakubadwa kwa chakudya ndi lipid metabolism, komwe ndikofunikira kwambiri kwa matenda ashuga a 2.

Zododometsa zina za matenda a shuga a 2 zimalembedwa kochepa kwambiri pokhapokha ngati pali zina:

1. malupu otupa a mtundu 2 a shuga amagwiritsidwa ntchito kamodzi pokhapokha ngati pakufunika kukwaniritsa kuthamanga kwa magazi,
2. kuphatikiza thiazide komanso kuphatikiza potaziyamu - posafunikira kuchepetsa kutayika kwa potaziyamu.

Odwala omwe ali ndi vuto la shuga m'magazi ayenera kumvetsetsa kuti kutenga diuretic iliyonse kungayambitse vuto lalikulu - kuchepa kwa chidwi cha insulin. Komanso, mankhwalawa owonjezera matenda oopsa sangatenge nthawi yayitali.

Mndandanda wa antihypertensive mankhwala a 2 shuga

Mankhwala a antihypertensive a mtundu wachiwiri wa matenda osokoneza bongo amasankhidwa payekhapayekha, chifukwa cha momwe impso imagwirira ntchito, komanso momwe zimayambira pamafuta amafuta ndi chakudya chamagulu. Matenda oopsa a arterial amaperekera 80% ya iwo omwe ali ndi vuto la hyperglycemia. Matenda amawonjezera kugwira ntchito kwa ziwalo zamkati, kusokoneza njira zachilengedwe za kagayidwe.

Mawonekedwe

Chithandizo cha mapiritsi opanikizika kwa odwala matenda ashuga ndiwovuta chifukwa chosatheka, kuwonetsera komwe kumachitika chifukwa cha kukanika kwa kagayidwe kazakudya.

Kusankha kwa mankhwalawa kwa matenda oopsa ndi hyperglycemia kumatengera ndi mikhalidwe:

• Kuchita bwino, zotsatira zoyipa zochepa,
• Cardio ndi nephroprotective effect (kuteteza mtima ndi impso),
• Zosagwirizana ndi kuchuluka kwa lipids ndi shuga m'magazi.

Mankhwala ochita mwachangu

Ngati mumakonda kudumpha mwadzidzidzi mu kuthamanga kwa magazi, aliyense payekha mankhwala oyenera a matenda oopsa a shuga ayenera kukhala pafupi.

Ngati chithandizo chadzidzidzi chikufunika, gwiritsani ntchito njira yomwe thupi lake limapitilira maola opitilira 6. Zinthu zogwira ntchito zomwe ndi gawo limodzi la mayina wamba azachipatala:

Mankhwala othandizira pakachitidwe

Kuwerenga pafupipafupi pamtunda wa 130/80 mm Hg. Art. chifukwa odwala matenda ashuga ali ndi zovuta za michere, kukula kwa atherosulinosis, kupitilira kwa matenda a shuga angiopathies. Pankhaniyi, kugwiritsa ntchito mankhwala osokoneza bongo nthawi zonse kumalimbikitsidwa, pomwe nthawi yomweyo kumatsata zakudya zamchere komanso zopatsa mphamvu. Zotsatira zamankhwala othinana ndi matenda ashuga ayenera kukhala osalala. Dontho la kuthamanga kwa magazi kutsatiridwa ndi kudumpha kumawonongetsa ngakhale dongosolo lamtima wamunthu wathanzi.

Mndandanda wa mankhwala ku Europe

Mankhwala otsatirawa ndiofala ku Europe:

• Lozol generic: indapamide
• Thalitone generic: chlorthalidone
• Zaroxolyn generic: metolazone
• Aquatensen generic: methyclothiazide
• Aquazide h
• Diuril generic: chlorothiazide
• Diuril sodium generic: chlorothiazide
• Enduron generic: methyclothiazide
• Esidrix generic: hydrochlorothiazide
• Microzide generic: hydrochlorothiazide
• Mykrox generic: metolazone
• Naturetin generic: bendroflumethiazide
• Saluron generic: hydroflumethiazide
• Renese generic: polythiazide

Malinga ndi kafukufuku wina wakunja, mankhwalawa amagwiritsidwanso ntchito:

• metolazone
• hydroflumthiazide,
• benzthiazide
• polythiazide
• methicothiazide,
• bendroflumethiazide,
• trichlorumbwaazide,
• quinetasone
• thienyl acid, etc.

Mndandanda wa mankhwala ku Russia ndi Belarus

• Acriptamide
• Acriptamide retard
• Akuter-Sanovel
• Arindap
• Arifon
• Arifon Pewani
• Vero-Indapamide
• Indapamide
• Indapamide Long Richter
• Indapamide MV Stad
• Kubweza kwa Indapamide
• Indapamide Retard-OBL
• Indapamide Retard Teva
• Indapamide Sandoz
• Indapamide-OBL
• Indapamide Werth
• Indapamide teva
• Zododometsa
• Indapsan
• Indap
• Indipam
• India
• Inspra
• Ionik
• Jonik Retard
• Ipres Long
• Lorvas
• Lorvas SR
• Pamid
• RavelSR
• Kubwereza
• SR-Indamed
• Tenzar

Mndandanda wamankhwala omwe ali ndi yogwira ntchito (Hydrochlorothiazidum) :

• Hydrochlorothiazide
• Hydrochlorothiazide
• Hydrochlorothiazide-ATS
• Hypothiazide

Chifukwa chakuti mankhwalawa amagwiritsidwa ntchito kwambiri pochiza matenda oopsa, mndandandawu sakhala wathunthu, koma uli ndi mayina apamwamba a malonda pazinthu izi.

Thiazide okodzetsa owonjezera matenda oopsa

Thiazide diuretics zakhala zikugwiritsidwa ntchito mosalekeza pakubweza matenda oopsa kuyambira pomwe adawonekera pamsika. Gulu lapadera la okodzetsa awa ndi mwala wofunikira pakubera matenda oopsa. Mankhwala ochepa omwe amagwiritsidwa ntchito pochiza matenda aliwonse amatha kunyadira nthawi yayitali kugwiritsa ntchito, ndipo izi zikuwonetsa kuyesetsa ndi chitetezo cha mankhwala awa. Mwachitsanzo hydrochlorothiazide ndi diuretic wodziwika bwino kwambiri mdziko lapansi pochiza matenda oopsa. Thiazide diuretics amachepetsa kuopsa kwa kufa, kuwonongeka, kupindika kwa mtima ndi kuchepa kwa mtima mu matenda oopsa.

Malangizo ambiri azachipatala othandizira odwala matenda oopsa amaganizira za kugwiritsa ntchito thiazide diuretics. Amagwiritsidwa ntchito ngati mankhwala oyambira ku USA (JNC VII) ndipo akulimbikitsidwa kuti azigwiritsidwa ntchito ku Europe (ESC / ESH). Komabe, mchaka cha 2011, National Institutes of Health ku United Kingdom (NICE) idalimbikitsa ma calcium blockers (BCCs) ngati mankhwala oyambira mzitsogozo zawo pochiza matenda oopsa. Komabe, amazindikiranso kuti thiazide diuretics imatha kugwiritsidwa ntchito ngati mankhwala oyambira ngati CCL yatsutsidwa, ngati wodwala ali ndi edema kapena ali pachiwopsezo chachikulu cha kulephera kwa mtima. Thiazide diuretics inasinthidwa ku Australia ndi angiotensin-converting enzyme inhibitors (ACE inhibitors) chifukwa cha chizolowezi chawo chowonjezera chiopsezo cha matenda ashuga a 2.

Liazide diuretics yama edema ochokera kumachitidwe osiyanasiyana

Thiazide diuretics amagwiritsidwa ntchito mochizira mitundu iyi ya edema:

• Edema wachikhalidwe chamtima,

Komabe, ziyenera kukumbukiridwa kuti zovuta kwambiri kulephera kwa mtima (CHF), ma loop diuretics amathandiza kwambiri.

• Edema wa hepatic koyambira (ndi matenda amitsempha),
• Edema wa chiyambi,

Komabe, sizothandiza pakukanika kwa impso - ndi kuchepa kwa kusefera kwa glomerular osakwana mamililita 30 mpaka 40 kwa mphindi. Chosiyana ndi ichi metolazone ndi indapamide chifukwa cha malo ena owonjezera mu proximal tubules.

• Edema wothandizirana kwa nthawi yayitali wa glucocorticoids.

Thiazide okodzetsa ndi mafupa

Izi zimaphatikizidwanso ndi kashiamu wabwino komanso kuchepa kwa ma fractures kwa odwala omwe ali ndi mafupa. Njira zomwe zimapangidwira kuti izi zitheke motere: thiazide diuretics imathandizira kusiyanitsa kwa mafupa am'magazi ndi mapangidwe a minofu ya mafupa. Chifukwa cha izi chepetsa kuchepa kwa mafupa .

Chifukwa chokhoza kusunga calcium mthupi, thiazide diuretics imagwiritsidwa ntchito pochiza:

• Matenda A mano
• Hypocalcemia,
• Nephrolithiasis,
• Poyizoni wa Bromide

Carbonic anhydrase inhibitors

Gulu la mankhwalawa limaphatikizapo Diacarb. Nthawi zambiri, michere ya carbonic anhydrase imalimbikitsa kupangidwa kwa kaboni kaboni m'm impso kuchokera m'madzi ndi kaboni dayoksidi, yomwe imabwezeretsa magazi m'malo amchere. Poletsa enzyme, Diakarb amalimbikitsa kutulutsa kwa sodium mu mkodzo, womwe umatunga madzi limodzi nawo. Nthawi yomweyo ndi mkodzo, kuchuluka kwa potaziyamu kumakhalanso kutayika. Diacarb imapereka mphamvu yofooka, yomwe imayamba msanga (pambuyo ola limodzi ngati itamwa mapiritsi, itatha theka la ola ndi kulowetsedwa kwa mtsempha). Kutalika kwa kuchitapo kanthu kuli pafupifupi maola 10 (maola 4 ndi makulidwe a makolo).

Mankhwalawa amagwiritsidwa ntchito:

• intracranial matenda oopsa
• kuchuluka kwachulukidwe ka magazi
• poizoni ndi salicylates ndi barbiturates kwa zamchere mkodzo
• mankhwalawa cytostatics
• ndi gout

Pharmacokinetics of thiazide okodzetsa

Thiazide okodzetsa, kupatula ndipo chlortalidone amazilowetsa bwino m'matumbo am'mimba (GIT) ndipo amapikika kwambiri mu chiwindi. Chlortiazide chifukwa chosamveka bwino m'matumbo am'mimba, imayikidwa mu milingo yayikulu ndipo ndiyomwe imayimira gulu la thiazide diuretics, lomwe itha kuperekedwera makolo .

Machitidwe chlortalidone amabwera pang'onopang'ono chifukwa cha kuyamwa pang'onopang'ono. Ma diuretics amenewa amamangirira mwachindunji kumapuloteni amadzi a m'magazi ndiye chifukwa chake amagwera mabulangete osati mwa kusefera, koma kudzera anion zoyendera makina .

Kuchita mankhwala osokoneza bongo a thiazide diuretics

Thiazide diuretics imawonjezera mphamvu ya kupukusa okodzetsa, vitamini D, mtima glycosides, diazoxide, kukonzekera kwa lithiamu, mankhwala ochititsa dzanzi. Ndipo zochita za insulin, shuga wochepetsera zochokera ku sulfanylurea, anticoagulants, uricosuric othandizira mankhwalawa zimafooketsa thiazide okodzetsa.

Ma thiazide okodzetsa oopsa kwambiri kuphatikiza ndi quinidine chifukwa chakuti motsutsana ndi maziko a hypokalemia (chimodzi mwazotsatira za thiazide diuretics, zomwe tikambirana pansipa), quinidine imatha kuyambitsa moyo wamantha.

Zotsatira za thiazide diuretics zimachepetsedwa zikaphatikizidwa ndi mankhwala osapweteka a antiidal (NSAIDs) ndi lipid-kuchepetsa ma ion-exchange cationic resins.

Ndi kuphatikiza kwa thiazide diuretics ndi glucocorticoids, chiopsezo cha hypokalemia chikuwonjezeka.

Limagwirira ntchito ya thiazide okodzetsa

Mamembala a kalasi iyi ya okodzetsa ndi zotengera za benzothiadiazine. Mawu akuti "thiazide" amagwiritsidwanso ntchito pa mankhwalawa omwe ali ndi vuto lofanana ndi lopanda mankhwala a thiazide. Mwachitsanzo, chlortalidone ndi metolazone. Zothandizira zoterezi zimatchedwa thiazide-diuretics.

Benzothiadiazine - makina a gulu la mamolekyulu a thiazide diuretics

Kupanga kwa thiazide diuretics pochepetsa kuthamanga kwa magazi sikumveka bwino. Ndi kukhazikitsidwa kwa thiazides, kupanikizika kumachepa chifukwa cha kuchuluka kwa diuresis, kutsika kwama voliyumu ya plasma ndi kuchepa kwa kutulutsa kwamtima. Chosangalatsa ndichakuti pogwiritsa ntchito mosalekeza thiazide diuretics, kuchepetsa kukakamiza kumapangidwanso pakuchepetsa kukana kwaziphuphu (i.e., chifukwa vasodilation). Zomwe zimapangidwira kuti zikwaniritse izi sizikudziwika. Thiazide diuretics imawongolera kuthamanga kwa magazi mwa gawo mwa kuletsa kubwezeretsanso kwa Na, K, ndi Cl.

Mosiyana ndi loop diuretics, thiazide diuretics kuonjezera calcium mu distal tubules a nephron. Ndi kuchepa kwa kuchuluka kwa sodium mu ma epithelial cell a tubule, thiazides mosazindikira amawonjezera zochitika za anti-anti wa N-Ca.

Antiporter ndi mapuloteni am'mizere mumitsempha yama cell omwe amatsitsa zinthu kudzera mwa umuna.

Izi zimathandizira kusamutsidwa kwa Ca kuchokera ku maselo a epithelial kupita ku minyewa yokhala ndi impso. Yokha, kayendedwe ka Ca amachepetsa kuchuluka kwa Ca, komwe kumapangitsa Ca kuti ipangike kwambiri kuchokera ku kuwala kwa masubu m'maselo a epithelial kudzera mu njira zosankha za Ca zosankha (TRPV5). Mwanjira ina, kuchepa kwa ndende ya Ca mu cell kumawonjezera mphamvu chifukwa chobwezeretsanso kuchokera ku chimbudzi cha nephron.

Liazide diuretics imakulitsanso Ca reabsorption ndi limagwirira momwe Na ndi Ca wobwezeretsanso mu proximal tubules amakhudzidwa poyankha kuchepa kwa ndende ya Na. Gawo la izi limachitika chifukwa cha kuchuluka kwa mahomoni a parathyroid.

Mphamvu ya okodzetsa a thiazide diuretics ndi yocheperako poyerekeza ndi ya loop diuretics, imayamba pang'onopang'ono, koma yayitali.

Contraindication pakugwiritsa ntchito thiazide diuretics

Thiazide okodzetsa ali otsutsana kwathunthu m'matenda otsatirawa:

• Hypotension
• Thupi lawo siligwirizana mankhwala.
• Kulephera kwina
• Chithandizo cha Lithium,
• Hypokalemia
• Zitha kukulitsa shuga.

Liazide diuretics amachepetsa chilolezo cha uric acid, chifukwa amapikisana nawo pa transporter yomweyo, momwemonso onjezerani kuchuluka kwa uric acid m'magazi . Chifukwa chake, ayenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi gout kapena hyperuricemia.

Kugwiritsa ntchito mosalekeza kwa thiazide diuretics zingayambitse hyperklycemia . Thiazide okodzetsa amatha kutaya kwa potaziyamu ndi thupi tikusunga zomwe CA.

Liazide diuretics imatha kuchepetsa kuchulukitsa kwaachulukidwe ndikuwononga mwana wosabadwayo, motero iyenera kupewa pakakhala pakati .

Zotsatira zoyipa za thiazide diuretics

Thiazide okodzetsa amayambitsa zotsatirazi:

• Hyperglycemia,
• Hyperuricemia
• Hypokalemia (kachitidwe ka kakulidwe kake kamafotokozedwera pansipa),
• Hyponatremia,
• Hypomagnesemia,
• Hypocalciuria,
• Hyperuricemia, ngakhale gout ndiyosowa. Amayi ali ndi chiopsezo chocheperako kuposa abambo
• Matumbo am'mimba thirakiti: nseru, anorexia, kutsegula m'mimba, cholecystitis, kapamba, kupweteka kwam'mimba, kudzimbidwa,
• Hyperlipidemia. Kuwonjezeka kwa cholesterol ya plasma ndi 5-15% ndi kuwonjezeka kwa milingo yotsika kwambiri ya lipoproteins (VLDL) ndi triglycerides (TG). Mwambiri, chiopsezo chotenga matenda a atherosulinosis ndi ochepa,
• Mavuto a chapakati mantha dongosolo (CNS): kufooka, xanthopsia, kuchuluka kutopa, paresthesia. Osowa
• Kusabala kumayamba mwa amuna 10% chifukwa kuchepa kwamadzi mu thupi,
• Thupi lawo siligwirizana. Kupanda ziwengo kumawonedwa ndi gulu la sulfonamide,
• Photosensitization ndi dermatitis sichioneka kawirikawiri, ndipo kawirikawiri thrombocytopenia, hemolytic anemia ndi pachimake necrotizing pancreatitis.

Njira za hypokalemia

Thiazide diuretics amadziwika kuti amayambitsa hypokalemia.Pali njira zingapo zothandizira kupangira hypokalemia mutatenga thiazide diuretics (i., Kutsitsa kuchuluka kwa potaziyamu m'madzi a m'magazi):

Kutsegulira kwa renin-angiotensin-aldosterone chifukwa cha diuretic hypovolemia: thupi limayankha kuchepa kwambiri kwamadzimadzi m'thupi ndipo limayamba kupanga zambiri za aldosterone, zomwe zimapangitsa kagayidwe ka Na / K, komwe kumayambitsa kutayika kwa potaziyamu. Pazifukwa izi, zoletsa za ACE zomwe zimalepheretsa angiotensin 2 zimagwiritsidwa ntchito limodzi ndi thiazide diuretics kuti athane ndi hypokalemia. Kuphatikizidwa koyenera kwa milingo kungakwaniritse cholinga ichi.

Kuchepa kwa kuchuluka kwa K mumkodzo pakuwonjezeka kwa mkodzo kumawonjezera mphamvu ya K kuchokera m'maselo kupita kumkodzo. Potaziyamu amatayika kudzera munjira zam potaziyamu monga ROMK. Izi zimachitika kudzera mukuyambitsa kwanyengo.

Ma diuretics ndi gulu lakale la mankhwala omwe amagwiritsidwa ntchito pochiza matenda oopsa (AH). Amadziwika kwambiri ku USA ndi mayiko ena olankhula Chingerezi. Kupita patsogolo kochititsa chidwi kochizira matenda oopsa kwawonetsedwa m'mayeso akulu mosasamala momwe okodzetsa anali maziko kapena othandizira ofunika kwazaka zambiri za antihypertensive therapy. Malingaliro okhudza okodzetsa pakadali pano ndiwosangalatsa. Akatswiri ambiri akupitilizabe kuziganizira, kuphatikizapo mankhwala a antihypertensive a mzere woyamba. Ena amawona okodzetsa ngati amodzi mwa magulu ofanana a antihypertensive mankhwala. Ndipo ena amatengera njira za dzulo. Pamodzi ndi maubwino osakayika - kutanthauzira kwa hypotensive zotsatira, kukonzekera kwa dosing, mtengo wotsika, ambiri okodzetsa ambiri amakhalanso ndi zovuta zingapo zomwe zimakhudzana ndi kusokonekera kwa electrolyte bwino, lipid ndi carbohydrate metabolism ndi activation ya CAS.

Magulu atatu a okodzetsa amadziwika kuti amasiyana mu kapangidwe ka mankhwala ndi kutulutsa kwina kanthu mu nephron:

• thiazide
• matembenukidwe
• potaziyamu wothandiza okodzetsa.

The pharmacological zotsatira za thiazide ndi thiazide-ngati okodzetsa amadziwika pamlingo wa distal tubules loure diuretics - pamlingo kukwera chiuno Henle, potaziyamu woteteza - kwambiri madipatimenti akutali distal tubules.

Ma diuretics onse, kupatula spironolactone, "amagwira ntchito" moyang'anizana ndi nephron lumen. Popeza ma diuretics amayendayenda m'magazi mu mawonekedwe ophatikizika ndi mapuloteni, samadutsa mu fayilo ya glomerular, koma kufikira malo awo ochitapo kanthu pobisa mwachangu magawo ofananirana ndi nephron ndi epithelium. Kulephera kwa aimpso epithelium kuti akhazikitse gawo limodzi kapena gulu lina la okakamiza munthawi zina zam'magazi (mwachitsanzo, ndi acidosis) ndikofunikira kwambiri ndikusankha kusankha kwawo.

Ubwino ndi zovuta zamankhwala

Kugwiritsa ntchito mankhwala othandizira matenda oopsa kwakhala kwodziwika kwa zaka zopitilira 70, munthawi imeneyi magwiridwe antchito ndi mawonekedwe amiseche amamveka bwino. Phindu la thiazide diuretics ndi monga:

• ntchito wamba
• kusintha kwakanthawi (30 - 60 Mphindi),
• mbiri yayitali (mpaka maola 11),
• sayambitsa alkalization kapena acidization wamagazi,
• muthane ndi matenda amitsempha yamagazi.

Zoyipa zazikulu zogwiritsa ntchito okodzetsa a gululi ndi:

• hypokalemia ndi hypomagnesemia, zomwe zimayambitsa chisokonezo mumiyeso ya contractions,
• kusunga uric acid ndi kuchulukitsa kwa gout,
• kuchuluka kwa shuga m'magazi ndi kuwonongeka kwa matenda ashuga,
• nseru, kutsegula m'mimba, kufooka wamba,
• kapamba
• zovuta zamitsempha.

Zisonyezero zakudikirira

Thiazide diuretics angagwiritsidwe ntchito matenda otere:

• edema yokhala ndi vuto lozungulira, matenda amchiwindi, matenda a impso,
• matenda oopsa komanso achiwiri
• glaucoma
• matenda ashuga
• kusungunuka kwa madzi nthawi yanenepa kwambiri, musanachitike kusamba,
• kutupa kwa miyendo ndi thrombosis,
• kudzikundikira kwa oxalates mu impso.

Onani vidiyo yokhudza zochita za okodzetsa kapena makina okodzetsa:

Zotsatira zoyipa

Kumwa mankhwala okodzetsa kumatha kuyambitsa kufooka kowonjezereka, chizungulire, khungu mumaso, nseru ndi m'mimba, kupweteka kwam'mimba, kuchepa kwa mawonekedwe, mapulatini amachepetsa, maselo oyera a magazi, kuchuluka kwa uric acid, calcium.

Mu sabata yoyamba yogwiritsira ntchito thiazides, kuthamanga kwa magwiridwe antchito ndikuwunika chidwi sikungakhale kovutikira, chifukwa chake sikulimbikitsidwa kuyendetsa magalimoto kapena kugwira ntchito ndi zovuta kupanga.

Pofuna kupewa kutayika kwambiri kwa potaziyamu, mankhwala omwe ali ndi zomwe zimayikidwa nthawi imodzi - Panangin, Asparkam, Potaziyamu Normin, Caliposis. Zakudyazi ziyenera kuphatikizapo kuchuluka kwamasamba, zipatso ndi misuzi kuchokera kwa iwo, uchi, ma apricots owuma, mtedza ndi mandimu ndizothandiza.

Ubwino ndi kuvulaza kwa okodzetsa

Makhalidwe abwino okonzanso amagwiritsidwa ntchito ndi othamanga (ndipo inu ndi ine sitimasiyana, zitachitika izi). Kutenga diuretics pamaso pa mpikisano, ndizosavuta komanso mwachangu kuti tichotse kulemera "kowonjezera". Amayi amagwiritsanso ntchito mankhwalawa kuchepetsa thupi. Omanga thupi amalimbitsa thupi kuti adyetse madzi ndi minofu kuti aziwoneka bwino kwambiri.

Koma, monga mu chilichonse, pamakhala ndalama ziwiri ndipo, limodzi ndi maubwino, okodzetsa akhoza kukhala oyipa:

• Pamodzinso ndi mkodzo, sikuti mchere wa sodium wokha womwe umachotsedwa m'thupi, komanso zinthu zofunikira, mwachitsanzo, potaziyamu, kusowa kwake komwe kumabweretsa kufooka komanso kuchepa mphamvu,
• Kuchoka kwachilengedwe kwa calcium kumachedwetsedwa, zomwe zimapangitsa kuti mchere ukhale,
• Kuyamwa mwachangu kumatha kubweretsa chisokonezo cha tulo,
• Ma diuretics amawonjezera cholesterol "yoyipa" m'magazi,
• Mankhwala osokoneza bongo amatha kuyambitsa kubereka mwa amuna.

Kuti mupewe mavuto omwe amabwera chifukwa cha okodzetsa thupi, ndikukulangizani kuti musamadzimvere, koma pitani kwa dokotala ndikuwona momwe okodzetsa ali oyenera, momwe mungagwiritsire ntchito, omwe mungathe kuphatikiza kuti mupeze zotsatira zabwino popanda zovuta.

Kodi thiazide diuretics amagwira ntchito bwanji?

Liazide diuretics imakhudzanso mkati mwa epithelium ikalumikiza ma distal tubules a nephron. Ma sodium cato amakhala ndi ntchito yayikulu ya osmotic, yomwe imatsogolera pakupanga edema, kuphatikizapo matenda oopsa ("sodium amakoka madzi limodzi ndi iyo"). Thiazide ndi thiazide-ngati diuretics inhibit (chipika) mapuloteni - njira, zomwe ndi mlatho woyendetsa anyezi wa sodium ndi chlorine. Pachifukwa ichi, dzina lawo lachiwiri ndi la saluretics ("mchere wopereka"). Kuchuluka kwa sodium kumachepa, osmolarity ya plasma amachepetsa - edema regraine ndipo kupanikizika kwapakati pamagazi kumachepa.

Kuphatikiza pa ntchito ya natriuretic, thiazide diuretics amatha kuletsa enzyme ya carbonic anhydrase. Izi zimawonetsedwa ndi kuchepa kwa zomwe zili phosphate anions ndi bicarbonate. Kugwiritsa ntchito mankhwala kwa nthawi yayitali kwa thiazide diuretic gulu kumabweretsa mpumulo wa gawo la minofu ya arterioles (bedi loukitsa). Chifukwa chake, akatswiri a mtima amagwiritsa ntchito ma diaztics ngati thiazide pochiza matenda oopsa osakanikirana ndi mankhwala oyamba a antihypertensive.

Zotsatira za calcium reabsorption (kulowereranso m'magazi) zimapangitsa kuti mankhwalawa akhale opambana ndi mafupa a concomitant, calcium nephrolithiasis. Amakhulupirira kuti njira zomwe zimayendetsa calcium calcium zimachepetsa kukonzanso kwa mtima.

Zochitika zoyipa zomwe zimalepheretsa kugwiritsa ntchito mankhwala zimagwirizana ndi uricemic effect (kuchuluka kwa uric acid), zotsatira za kagayidwe kazakudya (hyperglycemia).Kusintha kwa kapangidwe ka seramu lipid ndikotheka (kuchuluka kwa osalimba a lipoproteins ndi cholesterol kumawonjezeka).

Liazide-ngati diuretics imakhala ndi mfundo zofananira, kuphatikiza kulepheretsa ntchito ya michere ya michere. Zotsalira zomwezi ndizofanana. Kusiyana kwagona pakusiyana kwa kapangidwe ka mankhwala, magwiridwe antchito ndi ofanana.

ACE zoletsa

Pakukhazikika pang'onopang'ono kwa mawonekedwe a matenda oopsa, ma blocker a angiotensin (ACE) amagwiritsidwa ntchito, omwe amathandizira kapangidwe ka angiotensin. Pochepetsa kuchuluka kwa angiotensin, tiziwalo timene timatulutsa adrenal timatulutsa aldosterone yochepa, yomwe imasunga sodium ndi madzi m'thupi. Vasodilation imachitika, madzi ochulukirapo ndi mchere amachotsedwa, zotsatira za hypotonic zimawonekera.

Zinthu zogwira zomwe zimatchinga ACE:

• Enalapril
• Perindopril,
• Quinapril,
• Fosinopril
• Kalamazoo,
• Ramipril.

Zoyipa za zoletsa ndizoleza kuzengereza kwa potaziyamu ndikuwachedwa kugwira ntchito. Zotsatira zakugwiritsidwazo siziwunikiridwa pasanathe milungu iwiri atasankhidwa.

Angiotensin Receptor blockers (ARBs)

Amaletsa kaphatikizidwe ka renin, kamene kamapangitsa kusintha kwa angiotensin, komwe kumayambitsa kuchepa kwa makoma amitsempha yamagazi. Ma ARB amadziwika ngati tsankho kwa ACE inhibitors likhazikitsidwa. Makina awo amomwe amapangira zamankhwala amodzi ndizosiyana, koma cholinga ndi chimodzimodzi - kuchepetsa zotsatira za angiotensin ndi aldosterone.

Gululi limatchedwa sartani kumapeto kwa mayina a zinthu zomwe zimagwira ntchito:

Ma diuretics amakhala ndi hypotonic yofatsa, imayikidwa limodzi ndi mankhwalawa pogwiritsa ntchito mapiritsi ena oopsa a shuga.

1. Ma loop diuretics (furosemide, lax) amaphatikiza bwino ndi zoletsa za ACE, sizimakhudza kuchuluka kwa shuga, lipids, ndipo ndi oyenera kuti pakanthawi kochepa ayendetse kufafaniza thukuta lalikulu. Kugwiritsidwa ntchito kosalamulirika kumayambitsa kuthamangitsidwa kwa potaziyamu, komwe kungapangitse kuwonjezeka kwa hypokalemia ndi mtima arrhythmia.
2. Chifukwa cha kufatsa kwambiri kwa okodzetsa, thiazide-diuretics (indapamide) sikukhumudwitsa kuchuluka kwa glucose, acid acid, potaziyamu, ndipo sikukhudza magwiridwe antchito a impso.
3. Thiazide diuretics (hypothiazide) Mlingo watsiku ndi tsiku woposa 50 mg amatha kuwonjezera shuga ndi cholesterol. Mankhwala amawayang'anira mosamala mulingo wocheperako chifukwa chakuchepa kwa impso ndi gout.
4. Zinthu zoteteza potaziyamu (Veroshpiron) sizikulimbikitsidwa kuti mugwiritse ntchito mtundu wa shuga wachiwiri, limodzi ndi vuto laimpso.

Beta blockers

Mankhwala angapo omwe amaletsa kukondoweza kwa adrenoreceptors ndi adrenaline ndi norepinephrine amawerengedwa makamaka pochizira ischemia, mtima, kulephera kwa mtima. Ndi hyperglycemia, mapiritsi a matenda oopsa amasankhidwa ndi zina zowonjezera vasodilating:

Otsutsa a calcium

Calcium calcium blockers - gulu la mankhwala omwe amachepetsa kuchuluka kwa calcium ion. Pumulani ndikukula makoma amitsempha yamagazi, mitsempha, maselo osalala. Magulu omwe agawidwa m'magulu:

1. Verapamil, diltiazem. Kukhudza ntchito ya myocardium ndi maselo amtima, chepetsani kugunda kwa mtima. Kugwiritsa ntchito pamodzi ndi beta-blockers kumatsutsana.
2. Amachokera ku dihydropyridine - nifedipine, verapamil, nimodipine, amlodipine. Amatsitsimula makoma a minofu yosalala, kumawonjezera kugunda kwa mtima.

Ma calcium antagonists samasokoneza chakudya chamafuta, lipid metabolism. Mukagwiritsidwa ntchito ngati mankhwala opondera, mtundu wachiwiri wa matenda ashuga ndiwabwino, koma uli ndi zotsutsana zingapo. Nifedipine imatsutsana mu angina pectoris, kulephera kwa mtima ndi impso, koyenera kupumula kumodzi. Amlodipine imatha kutupa.Verapamil imakhudzidwa ndi impso, koma imatha kuyambitsa bronchodilators.

Zochita payekha

Mankhwala a antihypertensive amaphatikizidwa wina ndi mnzake, osankhidwa poganizira matenda ophatikizana, mankhwala omwe amatengedwa. Hypertension, limodzi ndi matenda ashuga a intracellular kagayidwe, amachititsa zosiyanasiyana zoyipa zimachitika.

Musanagwiritse ntchito, muyenera kuphunzira mndandanda wazotsatira zoyipa, njira zowathetsera.

Mukamatenga, mphamvu zamagazi zimawonedwa. Nthawi yomweyo, mulingo wa glycated hemoglobin, cholesterol, triglycerides, glucose othamanga komanso mukatha kudya amayang'aniridwa. Kupatuka kosayenera pamlingo wovomerezeka kumafuna kuti pakhale mankhwala.

Zojambula zotuluka m'miyendo

Mankhwala atatu amatchedwa loop diuretics - furosemide, ethacosterone acid ndi bumetanide. Loop diuretics imakhala ndi mphamvu kwambiri pa saluretic chifukwa cha blockade ya Ma2 + / K + / Cl-co-transport panjira yomwe ikukwera. Chizindikiro chachikulu cha kusankhidwa kwawo mu matenda oopsa ndi onga aimpso kulephera momwe thiazide okodzetsa satha. Kukhazikitsidwa kwa ziwopsezo za ziwopsezo kwa odwala omwe ali ndi vuto losakanikirana kwa matenda oopsa sizitanthauza chifukwa cha nthawi yochepa yochita ndi kawopsedwe. Zotsatira zonse zoyipa za thiazide diuretics sizachilendo mu loure okodzetsa, omwe amakhalanso ndi zotsatira za ototoxic.

Mankhwala odziwika kwambiri kuchokera ku gulu la loop diuretics ndi mangochinos Ili ndi zochita zamphamvu, koma zazifupi (maora 4-6), choncho ziyenera kutengedwa kawiri patsiku. Mu matenda oopsa ndi aimpso kulephera, mlingo wa furosemide umasankhidwa payekha, molingana ndi lamulo la kuchuluka msambo (40, 80, 160, 320 mg).

Potaziyamu-yosasamala okodzetsa

Gulu la mankhwalawa ndi spironolactone (Veroshpiron) amiloride ndi kopambana kukhala ndi phindu lothandiza pa matenda oopsa. Triamteren ndi amiloride ndi zoletsa mwachindunji za potaziyamu secretion mu distal tubules ndipo ali ndi ofooka kwambiri okodzetsa komanso osokoneza bongo. Amagwiritsidwa ntchito limodzi ndi thiazide diuretics popewa hypokalemia. Madokotala amadziwa bwino mankhwalawa wopambana (kuphatikiza 25 mg ya hypothiazide ndi 50 mg ya triamteren). Chodziwika bwino ndi mankhwala a moduretic, okhala ndi 50 mg ya hypothiazide ndi 5 mg ya amiloride. Triamteren ndi amiloride amatsutsana mu kulephera kwaimpso chifukwa cha chiwopsezo cha hyperkalemia. Amadziwika kuti kuphatikiza kwa triamteren ndi indomethacin kungayambitse kusinthanso kwachembere. Mukamachitira ndi amiloride, zotsatira zoyipa monga mseru, khungu, komanso zotupa pakhungu nthawi zina zimachitika.

Limagwirira a zochita za spironolactone wagona mu mpikisano wotsutsana ndi aldosterone, mawonekedwe ake analogue omwe ali. Mlingo wokwanira wokwanira zana (100 mg patsiku) spironolactone ali ndi diuretic komanso hypotensive. Komabe, spironolactone ilibe tanthauzo lodziyimira payekha pakuthandizira matenda oopsa, chifukwa nthawi yayitali kayendetsedwe kake kamakhala limodzi ndi chitukuko cha zotsatira zoyipa za mahomoni (gynecomastia mwa amuna ndi amenorrhea mwa akazi). Mukamamwa Mlingo wotsikirapo (50 mg patsiku), mavuto ambiri amachepetsa, komabe, onse okodzetsa ndi antihypertensive zotsatira zake amakhala ofooka.

Ndi ma diuretics ati omwe amagwiritsidwa ntchito masiku ano kuchiza odwala matenda oopsa?

Mankhwala akuluakulu a gululi pochiza matenda oopsa ndi thiazides ndi thiazide-ngati diuretics. Mankhwala omwe amagwiritsidwa ntchito kwambiri akuphatikiza hydrochlorothiazide, chlortalidone ndi indapamide (Arifon retard).

Liazide diuretics imatha kugwiritsidwa ntchito m'magulu osiyanasiyana odwala, onse omwe ali ndi zovuta AH. Matenda omwe mungagwiritse ntchito okodzetsa makamaka:

• Kulephera kwa mtima
• Matenda a shuga
• Systolic matenda oopsa
• Kupewa Kukwazidwa Mikwingwirima
• Zotsatira
• Cerebrovascular matenda
• Ukalamba
• Mtundu wakuda

Kugwiritsa ntchito thiazides kumawerengedwa kuti ndiwotsutsana kokha mimba ndi hypokalemia . Muyenera kusamala mukamagwiritsidwa ntchito odwala omwe ali ndi gout, dyslipidemia, matenda a shuga komanso kulephera kwambiri kwaimpso.

Ndi mankhwala ati ochokera pagululi omwe ali abwino kwambiri?

Chidwi chachikulu mu antihypertensive diuretic, chokhala ndi mphamvu yofooka yotsitsa komanso tanthauzo lotchedwa vasoprotective, tsopanoimamveka komanso ndiyenera - Arifon Pewani (indapamide). Zovuta za metabolism zokhudzana ndi thiazide diuretics sizikhudzanso Arifon-retard, omwe mlingo wochepetsedwa mpaka 1.5 mg suwonjezera magawo a lipid ndi carbohydrate metabolism motero amakhala bwino posankha diuretic. Kwa odwala omwe ali ndi matenda oopsa oopsa limodzi ndi matenda a shuga, kugwiritsa ntchito Arifon-retard pophatikiza chithandizo ndikofunikira, chifukwa chotsika kwambiri kwa kutsika kwa kuthamanga kwa magazi (130/80) komanso kusalolera m'thupi.

Mpaka pano, palibe gulu la okodzetsa lotere, lomwe lingaganizire mbali zonse zamankhwala awa. Chifukwa chake, magulu akhoza kugawidwa ndi:

• kapangidwe ka mankhwala
• chochitikacho
• limagwirira ntchito
• mphamvu ya kuchitapo kanthu
• kusintha maonekedwe,
• nthawi yayitali
• mavuto.

Gulu loyambirira la okodzetsa lidakhazikitsidwa pakusiyana pakupanga mankhwala. Ndipo panali kuyesa kutulutsa mitundu ya okodzetsa kutengera mtundu wawo wama impso. Komabe, ena okodzetsa amakhala ndi mphamvu yowonjezera. Kuyesa kugawa ma diuretics kutengera gawo lomwe nephron yomwe amakhudzidwa ilinso yopanda phindu, popeza mankhwala osmotic, ethacrine acid, furosemide, Xanthines ndi ena satenga gawo limodzi la nephron, koma panthawi yonseyi. Pazokhudzana ndi mawonekedwe a okodzetsa otere, gulu lomwe limagwirira ntchito limakhala lanzeru kwambiri.

Pochiza wodwala, kuchokera ku malo azaumoyo, gulu la okodzetsa malinga ndi nthawi yowonekera, kuchuluka kwa kuyambiranso, komanso mphamvu yakuchitidwayi sikofunikira.

Kukonzekera ndi kugwiritsa ntchito kwawo

Chithandizo chachikulu pakati pa thiazide diuretics ndi chlortiazide (hydrochlorothiazide). Mankhwala onga a Thiazide akuphatikiza Chlortalidone, Indapamide, Xipamide. Mpaka pano, mankhwala ambiri a analog ("jini") nawonso adalembetsedwa.

Zisonyezero zogwiritsira ntchito saluretics:

• Chithandizo cha edematous syndrome ndi nephrotic syndrome. Kuchita bwino ndikochepa. Kugwiritsa ntchito ndikomveka ngati gawo la awiri-, nthawi zina magawo atatu a mankhwala a diuretic. Kuperewera kwa zochitika pakusintha kwa nephrotic kumafotokozedwanso ndi njira ina: hypoproteinemia ndi oncotically edema. Liazide diuretics iyenera kukhala yokhala ndi lingaliro chifukwa cha kusuntha kwa ma electrolyte - hypokalemia, hyponatremia.
• Edema yokhala ndi kuwonongeka kwa chiwindi. Therapy monga gawo limodzi la mankhwala a diuretic.
• Matenda oopsa. Ndizoyenera kugwiritsa ntchito ngati monotherapy, makamaka ndi maphunziro ofatsa (2 digiri). Kusankha komwe kumakondwera ndi mankhwala ngati thiazide pochiza matenda oopsa kumachitika ndi akatswiri a mtima chifukwa cha nthawi yayitali, kuthamanga kwapanthawi yothamanga. Regimen yotsika kwambiri imapereka chiwongolero choyenera cha kuthamanga kwa magazi.
• Kulephera kwamtima kosalekeza malinga ndi malingaliro a European and Russian a mtima amafunikira kusankha ma saluretics. Chlortalidone imakhala ndi antihypertensive masiku atatu. Indapamide ndi thiazide diuretics ndi othandiza kwa maola 24. Amachepetsa nawonso vuto la hyperkalemia. Izi zimakuthandizani kuti muzigwiritsa ntchito tsiku lililonse, kapenanso zochepa.Kuphatikiza apo, kumasuka kwa maselo osalala a minyewa kumathandizira kugwiritsa ntchito mankhwala osokoneza bongo komanso kulephera kwa mtima.

Zotsatira zoyipa ndi contraindication

Zotsatira zoyipa zomwe zimayambitsa mankhwala m'gululi zimagwirizanitsidwa ndi kusokonezeka kwa metabolic ndi electrolyte chifukwa cha magwiridwe antchito.

1. Hypokalemia ndi mtundu wake wa arrhythmogenic mpaka asystole. Pamafunika mankhwala kusiya ndi kukonza seramu potaziyamu.
2. Hyponatremia.
3. Kusintha kwa atherogenic mu plasma ndi chizolowezi cha thrombosis. Kukhazikitsidwa potenga ma statins.
4. Hyperuricemia ndi chitukuko cha gouty nyamakazi kapena kuwonongeka kwa impso. Kuletsa mankhwala
5. Kuchepetsa kagayidwe kazakudya, makamaka akamagwiritsa ntchito limodzi ndi beta-blockers.

Zotsatira zoyipa za mankhwala, mndandanda wa zotsutsana umapangidwa motere:

• Matenda a gouty, nephropathy,
• hypokalemia
• yachepetsedwa sodium
• Mimba (kugwiritsa ntchito Indapamide monga mankhwala osaphunzitsidwa bwino omwe ali ndi mphamvu kwambiri pa mwana wosabadwayo makamaka osafunikira), pomwe mukumwa Hypothiazide monga gawo limodzi la mankhwala osakanikirana (opanda ACE inhibitors),
• thupi lawo siligwirizana.

Thiazides ndi makina awo ochitira

Liazide diuretics imadziwika ngati mankhwala olimbitsa pang'ono, mphamvu zake zimachitika pambuyo pafupifupi maola 1-3 ndipo zimatha kwa maola 12. Limagwirira ntchito ya thiazide okodzetsa umalimbana tubules a impso, chifukwa chomwe pali kusiyanitsidwa kuyamwa kwa sodium ndi chlorine ndi kuchuluka kwawo chimbudzi pamodzi ndi mkodzo. Kuphatikiza apo, thiazide-ngati diuretic amatsitsa potulutsa mkodzo wa calcium ndikuchepetsa mapangidwe a uric acid.

Zisonyezo zogwiritsa ntchito thiazide diuretics

Thiazide diuretics amagwiritsidwa ntchito pochiza matenda awa:

• Kutupa, komwe kanapangidwa chifukwa cha matenda a impso, omwe amadziwika ndi kuphwanya kwamchere wamchere. Komabe, mphamvu ya thiazide diuretics yochizira matendawa ndi yotsika, chifukwa chake amalembedwa ndi ma diuretics ena (diopture yoleketsa bwino).
• Edema yoyambitsidwa ndi matenda amitsempha. Nthawi zambiri amagwiritsidwa ntchito molumikizana ndi ma diuretics ena.
• Kuthamanga kwa magazi.
• Kulephera kwamtima komanso kosatha.

Zogwira ntchito

Thiazide diuretics amagwiritsidwa ntchito pochiza matenda ambiri. Nthawi zambiri, mumagwiritsidwa ntchito mankhwala, zigawo zikuluzikulu zomwe ndi hydrochlorothiazide ndi chlortiazide. Amayamba kugwira ntchito patatha maola ochepa, ndipo zomwe amapanga mwamphamvu kwambiri zimawonedwa patatha maola 3-4 atatha kutsata. Zochitazo zimatha pafupifupi maola 11-13.

"Hydrochlorothiazide"

Ndi ya yachiwiri okodzetsa ndipo imagwiritsidwa ntchito pochiza kuthamanga kwa magazi, kulephera kwa mtima, cirrhosis komanso kupewa miyala. Mankhwala amapangidwa ngati mapiritsi omwe amayenera kudya mukatha kudya m'mawa. Pochiza kuthamanga kwa magazi, madokotala amalimbikitsa kumwa piritsi limodzi kamodzi patsiku. Pankhani ya edema, muyenera kumwa mapiritsi a 1-4. Ili ndi zotsatirapo zingapo zoyipa, monga mseru komanso kusanza, kukokana, arrhythmias, komanso khungu lawo siligwirizana. Madokotala salimbikitsa kumwa "Hydrochlorothiazide" panthawi yoyembekezera komanso poyamwitsa, komanso anthu okalamba. Ndikofunika kudziwa kuti mukamagwiritsa ntchito mankhwala, simuyenera kukhala padzuwa nthawi yayitali, chifukwa mankhwalawa amachititsa khungu kuzindikira mphamvu zakuthambo.

Gwiritsani ntchito mankhwala pochiza kuthamanga kwa magazi. Imwani mankhwalawa tikulimbikitsidwa m'mawa, ngakhale kudya, piritsi 1 1 patsiku.Indapamide imayambitsa zovuta izi: kupweteka mutu, kukwiya msanga, kukhumudwa, kutopa, kupsinjika. Pakakhala bongo, wodwalayo amatha kusanza, kusanza, kupweteka mutu komanso chizungulire, kutopa ndi kusokonezeka. Kuti muchepetse zizindikiro za mankhwala osokoneza bongo, muyenera kutsuka m'mimba yanu ndi kumwa njira yofunikira ya makala ophatikizidwa. Simuyenera kumwa mankhwalawa panthawi yoyembekezera komanso poyamwitsa.

Ndi thiazide yemwe amagwira ntchito kwa nthawi yayitali, njira yogwiritsira ntchito yomwe ikufuna kuthana ndi potaziyamu ndi magnesium mumkodzo. Amagwiritsidwa ntchito kuti achepetse kupsinjika ndikuchepetsa kutupa kwa mitundu yosiyanasiyana. Zochizira puffness, tikulimbikitsidwa kugwiritsa ntchito mankhwala 1-2 mapiritsi 1 kamodzi patsiku. Pambuyo poti kutupira kumachoka pang'onopang'ono, mlingo umayenera kuchepetsedwa. Imwani mankhwala ochepetsera kupanikizika kuyenera kukhala piritsi limodzi kamodzi patsiku. "Clopamide" imakhala ndi zoyipa zingapo: kutsika kwa kuchuluka kwa sodium ndi potaziyamu m'magazi, kusanza, kupweteka, chifuwa. Amaloledwa kugwiritsidwa ntchito panthawi yoyembekezera komanso poyamwitsa, koma muyenera kumwa mankhwalawo mosamala ndipo pokhapokha zotsatira zomwe zikuyembekezereka zikupita patsogolo chiwopsezo cha matenda opatsirana m'mimba mwa mwana.

Ma diuretics, kapena okodzetsa, ndi zinthu zomwe zimachulukitsa chimbudzi cha mkodzo kuchokera mthupi ndikuchepetsa madzi amkati ndi minyewa ya m'mimba. Kuwonjezeka kwa kukodza komwe kumachitika chifukwa cha okodzetsa kumalumikizidwa ndi kuthana kwawo kwa impso, komwe makamaka kumalepheretsa kubwezeretsanso kwa ayoni a sodium mu renal tubules, komwe kumayendetsedwa ndi kuchepa kwa kubwezeretsanso kwamadzi. Udindo wocheperako umaseweredwa ndikuwonjezera kusefedwa mu glomeruli.

Ma diuretics amayimiriridwa makamaka ndi magulu otsatirawa:

a) diuretics "kuzungulira" ndikugwira gawo lozungulira loko la Henle,

b) poteteza mphamvu zake potaziyamu,

Ma diuretics amakhudzanso mapangidwe a mkodzo, zomwe zimatengera mphamvu zawo, mapangidwe ake ndi kutulutsa kwake (magawo osiyanasiyana a nephron).

Zowonjezera zamphamvu kwambiri zomwe zilipo ndi "loopback". Mwa kapangidwe kawo kamakina, ndizomwe zimachokera ku sulfamoylanthranilic ndi dichlorophenoxyacetic acids (furosemide, bumetanide, ethacosterone acid, etc.). Ma dioptesi a loop amagwira ntchito kudera lonse lokwera kwambiri la nephron (Henle loop) ndikuletsa kwambiri kubwezeretsanso kwa chlorine ndi sodium ions, ndipo kumasulidwa kwa potaziyamu ayoni kumakulanso.

Ma diuretics othandiza kwambiri amaphatikiza thiazides - zotumphukira za benzothiadiazine (hydrochlorothiazide, cyclopentiazide, etc.). Zotsatira zake zimayamba makamaka m'chigawo cha nephron, pomwe kubwezeretsanso kwa masenti (sodium ndi potaziyamu) kumatsekedwa. Amadziwika ndi hypokalemia, nthawi zina owopsa.

Onse ziwalo zopatsa thupi ndi benzothiadiazines amagwiritsidwa ntchito pochiza matenda oopsa komanso kulephera kwa mtima. Kuchulukitsa diuresis, amachepetsa BCC, motero, mtima wake wobwerera kumtima ndi katundu pa myocardium, kuchepetsa kuchulukana m'mapapu. Thiazides, kuphatikiza apo, imapumitsa khoma lamitsempha yama cell: ma metabolic omwe amapezeka mu cell membrane a arterioles amasintha, makamaka, kuchuluka kwa ayodini amachepetsa, komwe kumayambitsa kuchepa kwa kutupa ndi kuchepa kwa zotumphukira zamitsempha. Mothandizidwa ndi thiazides, kukonzanso kwa mtima kwamasinthidwe, kusintha kwa makina a vasoconstrictor zinthu (adrenaline, ndi zina zotere) kumatsika komanso kukhumudwitsidwa komwe kukuchitika ndi ganglion yolepheretsa mankhwala.

Potaziyamu yosawononga ma diuretics imakulitsanso kutulutsa kwa ayoni a sodium, koma nthawi yomweyo kuchepetsa kutulutsa kwa ayoni a potaziyamu. Amakhala ngati gawo la distal m'malo omwe sodium ndi potaziyamu ions amasinthana.Mwakulimba ndi kutalika kwa zotulukazo, amakhala otsika kwambiri ku "kuzungulira", koma osayambitsa hypokalemia. Oyimira gulu lalikulu la mankhwalawa - spironolactone, triamteren - amasiyana pamapangidwe ochitapo kanthu. Spironolactone imatsutsana ndi aldosterone, ndipo ntchito zake zochizira ndizapamwamba, ndizokwera kwambiri komanso kupanga mu thupi la aldosterone. Triamteren sikuti akutsutsana ndi aldosterone, mothandizidwa ndi mankhwalawa, kuchuluka kwa ziwalo za epithelial cell za distal tubules mosamala kumachepera ma sodium ions, omalizirawa amakhalabe mu lumen a tubule ndikusunga madzi, zomwe zimapangitsa kuti mkodzo lizitulutsa.

Kukonzekera kwa gulu la osmodiuretic ndi lokhalo lomwe silimaletsa kukodza. Zosefera, zimachulukitsa kuthamanga kwa "mkodzo woyamba" (glomerular filtrate), womwe umalepheretsa kubwezeretsanso kwa madzi mu proximal tubules. Mankhwala othandiza kwambiri osmotic diuretics (mannitol, etc.) amagwiritsidwa ntchito poyambitsa kukakamiza poizoni wambiri (barbiturates, salicylates, etc.), kulephera kwaimpso, komanso kulephera kwa mtima kwapanja kwa odwala omwe amachepetsa mafupa. Monga othandizira amadzimadzi, amadzipangira mankhwala a edema.

Kugwiritsa ntchito kaboni anhydrase inhibitors (onani Enzymes ndi antifermenta) monga okodzetsa kumachitika chifukwa cha kuletsa kwa ntchito yaimbirayi impso (makamaka mu proximal renal tubules). Zotsatira zake, mapangidwe ndi kudzipatula kwake kwa carbonic acid kumachepa, kusinthidwanso kwa ma bicarbonate ion ndi Na + ions mwa tubular epithelium kumachepa, chifukwa chake madzi am'madzi amachulukanso. Nthawi yomweyo, mkodzo pH umadzuka ndikuwumiriza, poyankha kuchedwa kwa H + ion, umachulukitsa katulutsidwe ka K + ions. Kuphatikiza apo, kuchuluka kwa ammonium ndi chlorine kumachepetsedwa, hyperchloremic acidosis imayamba, pomwe mankhwalawo amasiya kuchita.

Osmotic

Mfundo yogwiritsira ntchito osmotic diuretics ndikuti amawonjezera kuthamanga kwa osmotic m'madzi am'magazi, chifukwa chake, kuchokera ku minofu yomwe yatupa, madzimadzi amachotsedwa ndipo kuchuluka kwa magazi komwe kumazungulira kumawonjezeka.

Izi zimachepetsa kubwezeretsanso kwa sodium ndi chlorine. Mukamapereka mankhwala okodzetsa awa, chisamaliro chimayenera kulipidwa chifukwa cha matenda oyambitsidwa ndi anthu, chifukwa amatha kukhala ndi vuto loyipa matenda a chiwindi ndi impso.

Madokotala saletsa mwangozi odwala kuti azisankha okha diuretics pawokha: gulu lirilonse la mankhwala a diuretic ali ndi mawonekedwe owonetsa, zotsutsana zake ndi zoyipa zake. Kugwiritsa ntchito mphamvu zamankhwala kumapangitsa kuti potaziyamuyu achotsedwe kapena kuphatikizika kwa chinthu, kuchepa madzi, kupweteka mutu kwambiri, vuto la matenda oopsa. Ndi mankhwala ochulukirapo okodzetsa, mankhwala othamanga amatha kulephera.

Zamasamba

• palpable diuretic zotsatira,
• "Zofewa" pa impso, mtima, mtsempha wamagazi,
• chotsani madzi owonjezera, kutsuka chikhodzodzo ndi impso,
• onetsetsani kuti ndiwofatsa,
• kukhutitsa thupi ndi zinthu zofunikira: mchere wamankhwala, mavitamini, zinthu zogwiritsa ntchito pazogwiritsa ntchito,
• choyenera kugwiritsidwa ntchito kwanthawi yayitali (maphunziro).

Zisonyezero zogwiritsa ntchito malupu okodzetsa: kapangidwe kake ndi contraindication

Chizindikiro chofunikira cha kuperekera okodzetsa ndi matenda oopsa, makamaka izi zimagwira ntchito kwa odwala okalamba. Mankhwala a diuretic amaperekedwa kuti asungidwe sodium.

Ndi mafupa, wodwala amamuika thiazide diuretics. Mankhwala osokoneza bongo a Potaziyamu amawonetsedwa pobadwa nako Liddle syndrome (kuchotsedwa kwa potaziyamu yambiri komanso positi wa sodium).

Loop okodzetsa zimakhudzanso aimpso ntchito, zotchulidwa kuti intraocular anzawo, glaucoma, mtima edema, matenda enaake.

Zochizira komanso kupewa matenda oopsa oopsa, madokotala amatenga mankhwala a thiazide, omwe muyezo wocheperako amakhala ndi mwayi wofatsa kwa odwala omwe ali ndi matenda oopsa. Zatsimikizika kuti thiazide diuretics mu prophylactic Mlingo imachepetsa chiopsezo cha stroke.

Kutenga mankhwalawa muyezo waukulu osavomerezeka, imakhala yofala ndi kukula kwa hypokalemia.

Pochizira okodzetsa, mankhwala othandizira ndi othandizira amadziwika. Mu yogwira gawo, Mlingo wamphamvu wokhala ndi ma diuretics (Furosemide) akuwonetsedwa. Ndi mankhwala othandizira kukonza, kugwiritsa ntchito okodzetsa pafupipafupi.

Odwala omwe decompensated matenda enaake a chiwindi, hypokalemia, kugwiritsa ntchito okodzetsa ndi zotsutsana. Liopture ya loop sinafotokozedwe kwa odwala omwe amalolera kulandira mankhwala ena a sulfanilamide (hypoglycemic and antibacterial mankhwala).

Kwa anthu omwe ali ndi kupuma komanso kupweteka kwambiri kwaimpso, okodzetsedwa amatsutsana. Ma diuretics a gulu la thiazide (Methiclothiazide, Bendroflumethiozide, Cycl litšoantšoazide, Hydrochlorothiazide) amatsutsana mu mtundu 2 wa shuga, chifukwa wodwalayo angakulitse kwambiri shuga m'magazi.

Ventricular arrhythmias amathanso kutsutsana pakusankhidwa kwa okodzetsa.

Kwa odwala omwe amatenga mchere wa lithiamu ndi mtima glycosides, okodzetsa ziwalo amatumizidwa mosamala kwambiri.

Pochizira okodzetsa, mankhwala othandizira ndi othandizira amadziwika. Mu yogwira gawo, Mlingo wamphamvu wokhala ndi ma diuretics (Furosemide) akuwonetsedwa. Ndi mankhwala othandizira kukonza, kugwiritsa ntchito okodzetsa pafupipafupi.

Mankhwala a diuretic amakhudza ntchito ya impso ndikuthandizira njira ya mkodzo.

Limagwirira ntchito zochita ambiri okodzetsa, makamaka ngati potaziyamu wothandiza kukodzetsa, zimatengera luso lotha kubwezeretsa mayiyo mu impso, makamaka mu aimpso tubules, ma elekitiroma.

Kuwonjezeka kwa kuchuluka kwa ma electrolyte otulutsidwa kumachitika nthawi yomweyo ndi kutulutsidwa kwa madzi ena amadzimadzi.

Diuretic yoyamba idawoneka m'zaka za zana la 19, pomwe mankhwala a zebury amapezeka, omwe amagwiritsidwa ntchito kwambiri pochiza syphilis. Koma pokhudzana ndi matendawa, mankhwalawa sanali ogwira ntchito, koma mphamvu yake yokhudza kukodzetsa thupi anazindikira.

Pambuyo kanthawi, kukonzekera kwa mercury kunasinthidwa ndi mankhwala oopsa.

Posakhalitsa, kusintha kwa kapangidwe ka zida zamagetsi kunapangitsa kuti pakhale mankhwala amphamvu kwambiri a diuretic, omwe ali ndi gulu lawo.

Ma diuretics amathandizira pa matenda ndi matenda omwe amayenda ndi madzi posungira:

• nephrotic syndrome
• matenda a mafupa
• kutalika kwa malekezero a pansi ndi kulephera mtima,
• kuthamanga kwa magazi (matenda oopsa),
• katulutsidwe kwambiri ka mankhwala a aldosterone,
• glaucoma
• matenda a impso ndi chiwindi,
• kulephera kwamtima,
• kutupa kwa minofu.

Dziwani zamomwe zimayambitsa khansa yotsitsimutsa a cell mwa azimayi komanso malamulo a chithandizo cha maphunziro.

Malangizo ogwiritsira ntchito njira ya Fulonephrol ya urological afotokozedwa patsamba lino.

Posankha mankhwala okodzetsa, madokotala amaganizira zofooka zake. Chithandizo chilichonse chimakhala ndi mndandanda womwe umaphatikizidwa (zomwe zikuwonetsedwa mu malangizo). Si onse ma diuretics opangira omwe amalembedwera panthawi yapakati:

• zaka za ana
• kuyamwa
• mimba
• Hypersensitivity kuti phytoextracts kapena zigawo zina zopanga okodzetsa,
• matenda ashuga
• kwambiri mawonekedwe a aimpso Kulephera.

Musanaganize za momwe angapangire mankhwala ngati thiazide, ndikofunikira kumvetsetsa zomwe thiazide diuretics ndi.

Mwachidule, ili ndi gulu lazopanga zomanga thupi zazitali kwambiri.

Thiazide okodzetsa amakhala ponseponse chifukwa chogwira ntchito bwino pochiza matenda oopsa komanso kulephera kwa mtima. Ubwino wa thiazide ndi thiazide-okodzetsa ena poyerekeza ndi ena okodzetsa sakhala malire pazoletsa kugwiritsa ntchito mchere ndi chakudya.

Kuphatikiza apo, ma diuretics a thiazide (thiazide-like) akupulumutsa calcium, motero mankhwalawa adzakhala chisankho cha Nambala 1 pochiza matenda oopsa komanso kulephera kwa mtima kwa odwala omwe ali ndi mafupa.

Thiazide-mtundu diuretics amagwiritsidwa ntchito potupa, kuthamanga kwa magazi, matenda a mtima.

• Kutupa, komwe kanapangidwa chifukwa cha matenda a impso, omwe amadziwika ndi kuphwanya kwamchere wamchere. Komabe, mphamvu ya thiazide diuretics yochizira matendawa ndi yotsika, chifukwa chake amalembedwa ndi ma diuretics ena (diopture yoleketsa bwino).
• Edema yoyambitsidwa ndi matenda amitsempha. Nthawi zambiri amagwiritsidwa ntchito molumikizana ndi ma diuretics ena.
• Kuthamanga kwa magazi.
• Kulephera kwamtima komanso kosatha.

Nthawi zambiri, mankhwala a gululi amagwiritsidwa ntchito pochiza matenda amkodzo ndi kwamikodzo. Mankhwalawa amagwira ntchito molimbitsa mphamvu, momwe amadziwonekera pakapita ola limodzi mpaka maola atatu, ndipo nthawiyo imafikira pafupifupi theka la tsiku.

Makina a kuchitapo kanthu ndikulepheretsa kubwezeretsanso kwa sodium ndi madzi mu proximal a reubu tubules, chifukwa chomwe amachotsedwa pamkodzo pamlingo wothamanga. Kuphatikiza apo, thiazide okodzetsa amachepetsa ma calcium, komanso kuchuluka kwake komanso kuchuluka kwa mapangidwe a uric acid mu impso.

Ma diuretics amtunduwu akuwonetsedwa m'mikhalidwe yotsatirayi:

• edematous syndrome
• matenda oopsa oopsa, omwe saimitsidwa mwa njira wamba, kuchepetsa ziwopsezo,
• pachimake komanso matenda a mtima olephera.

Mankhwala akuluakulu a gululi amaonedwa kuti ndi chlortiazide ndi hydrochlorothiazide, ndiko kuyamba kwa kugwira ntchito komwe kumachitika m'maola oyamba, ndipo zotsatira zake zimakhala kwa maola ambiri.

Zotsatira zoyipa zimaphatikizapo kusokonezeka pang'ono kwa metabolic, kuphatikiza kusintha kwa kagayidwe kazinthu zina ndi mavitamini. Komanso, hypokalemia (kuchepa kwa kuchuluka kwa potaziyamu m'magazi) nthawi zina imapezeka kuchokera kumbali yotsatizana, pomwe mankhwala amasiya kwakanthawi ndipo mankhwala omwe ali ndi zomwe zili pamwamba pazinthuzi (panangin, asparkum) ndi omwe amapatsidwa.

Mutha kuzindikira kuchepa pafupipafupi kwa mulingo wa sodium mu plasma, komanso kuwonjezereka kwa kuchuluka kwa uric acid. Yotsirizirayi, imayambitsa nyamakazi yamafupa, komanso imakhudzanso minyewa ya m'mimba. Atasiya kugwiritsa ntchito mankhwalawa, thupi lonse limagwira.

Ngati odwala pamodzi ndi okodzetsa amatenga beta-blockers, ndiye kuti vuto lina lingayambitse matenda a shuga.

Mwa zosokoneza, zotsatirazi ziyenera kudziwika:

• yotupa yolowa matenda
• matenda osokoneza bongo a impso,
• kutsika kwa potaziyamu ndi sodium m'madzi am'magazi,
• mimba ndi nthawi yoyamwitsa,
• thupi lawo siligwirizana kapena tsankho kwa chilichonse cha mankhwala.

Masiku ano, mankhwala aliwonse ali ndi gawo lililonse la mankhwalawa, lomwe mungagule ndi ndalama zochepa osalandira mankhwala a dokotala. Komabe, ndikofunikira kuti kukhazikitsidwa kwa mankhwalawa ndi okhazikitsidwa ndi dokotala woyenera, ndikuwonetsa kuchuluka kwa mlingo, pafupipafupi komanso nthawi yayitali. Chotsatira, tikufotokozerani mwachidule za mankhwala akuluakulu ochokera pagululi.

Kukonzekera kwa gululi kumakhudzanso diuretic chifukwa cholepheretsa kubwezeretsanso mankhwala a sodium m'chiuno cha Henle, komwe ndi bondo lake lokwera.Pankhaniyi, kuwonjezereka kwa excretion ya calcium, bicarbonates, magnesium ndi phosphates kumachitika.

Ma loop diuretics amakhalanso ndi vuto lowonjezereka chifukwa cha kusintha kwa mapangidwe a ma prostaglandins ndi impso. Kuchita izi kumachepetsa kukakamiza kwa mtima kumanzere kwamtima komanso kumathandiza kuchepetsa mapafu.

Pakati pa mankhwalawa, furosemide loop diuretic imagwiritsidwa ntchito kwambiri.

Loop diuretics amachita mwanjira yoti yogwira mankhwala amachotsa sodium ayoni ndi madzi kudzera impso. Nthawi zambiri amagwiritsidwa ntchito ngati thandizo mwachangu, chifukwa nthawi zambiri zimachitika pasanathe maola 6.

Kugwiritsa ntchito kwa nthawi yayitali kapena kosalamulirika kumayambitsa kukodzetsa kwa mafuta kumatha kubweretsa mavuto mu mtima chifukwa chotayika kwa magnesium ndi potaziyamu. Itha kugwiritsidwa ntchito ngati vuto la impso.

Mwa zina zotsutsana, zinthu zotsatirazi zitha kudziwika:

• myocardial infaration
• pachimake aimpso kulephera
• kulephera kwambiri kwa chiwindi
• kapamba
• miyala ya impso
• gout
• urethral stenosis,
• Hypersensitivity
• matenda aortic stenosis,
• zosokoneza pamiyeso yamagetsi yamagetsi,
• kuthamanga kwa magazi (kuzungulira kwamitsempha kumatha kutsitsa magazi).

Zamkatimu:

• kuthetsa kupusa,
• mpumulo wa kulephera kwa mtima,
• kutulutsa mkodzo chifukwa cha matenda a impso komanso kukokoloka kwa ntchito,
• Chithandizo cha kuthamanga kwa magazi
• Kuchotsa poizoni ndi ziphe.

Zotsatira zoyipa ndi contraindication.

Zamkatimu:

• Edema wa impso ndi mtima wachokera kuchotsa madzi owonjezera.
• Hepatic osakwanira kuti muchepetse kuledzera ndikusintha kwamchere wamchere.
• Urolithiasis kuchotsa calcium yambiri ndikuletsa miyala ya impso.
• Nephrogenic (shuga insipidus) shuga kuti asinthe kusintha kwazogwirizana ndi kufalitsidwa kwamadzi.
• Hypertension monga gawo la zovuta mankhwala okhala ndi antihypertensive mankhwala kuti achulukitse komanso kuwonjezera nthawiyo.
• Kufunika kotalikitsa zotsatira za mankhwala ozungulira.

Chifukwa cha kuchuluka kwa diuresis komanso kusintha kwa madzi amchere wamchere, kukonzekera kwa thiazide kumagwiritsidwa ntchito poizoni ndi kuledzera ndi mchere wazitsulo.

• Matenda a mafupa omwe amaphatikizidwa ndi kuphwanya kagayidwe ka uric acid.
• Kusintha kwa kagayidwe kamchere wamchere, komanso kuchuluka kwa uric acid.
• Ukalamba, kutenga pakati komanso kuyamwa. Kuchiza ndi ma diuretics amtunduwu sikokwanira kwa mwana.
• Kuperewera kwa impso ndi chiwindi kumagwira ntchito pachimake.
• Asthenic syndrome.
• Antihypertensive syndrome.
• Matenda a adrenal gland ndi mkodzo wamafuta ntchito.

Contraindative pakutenga thiazide diuretics zikutanthauza kuti muyenera kukwaniritsa okodzetsa munjira zina, nthawi zambiri oboola ndi osmotic amagwiritsidwa ntchito.

Mankhwala omwe amalimbitsa luso lawo losefera amatchedwa loop diuretics.

Mankhwalawa amalimbikitsa kupumula kwa minyewa yosalala, kuwonjezera magazi othamanga, kupititsa patsogolo kupanga kwa ma prostaglandins E2 ndi I2 m'maselo am'mitsempha, ndikuwonjezera kusefukira kwa glomerular.

Chifukwa cha njira zonsezi, kuwonjezeka kwa diuretic zotsatira kumawonedwa.

Mankhwala amalimbikitsidwa kuti apezeke ndi matenda ndi njira zina monga:

1. Mtima, chiwindi ndi impso edema. Amawonetsedwa atazindikira matendawa.
2. Kulephera kwa impso. Njira zimapatsidwa kuthekera kosintha kwa magazi a impso ndikuthandizira kuthamanga kwa mkodzo mu anuria.
3. Hypercalcemia. Yambitsani chimbudzi cha calcium mu thupi.
4. Matenda oopsa, koma pokhapokha ngati wodwala walephera mtima.Mwazinthu zina zonse, kusankhidwa kwa thiazide diuretics kumawerengedwa kuti ndi koyenera.

Amagwiritsidwanso ntchito kuti athandize kukakamiza okakamiza poizoni, komanso popereka thandizo mwadzidzidzi pofufuza edema kapena ubongo.

• kuyimitsa mkodzo kulowa mu chikhodzodzo,
• kutentha kwa mtima
• Mankhwala osokoneza bongo a gulu la sulfonamide,
• mimba ndi mkaka wa m`mawere.

Maphikidwe othandiza

Ndalama zomwe zimachokera ku zitsamba za matenda oopsa komanso matenda a shuga 2 zimagwira bwino kwambiri.

Mankhwala othandizira kwambiri odwala matenda ashuga ndi okodzetsa. Tithokoze, njira yopanga kukodza kwamkodzo m'thupi imapangidwa, zomwe zimapangitsa kuwonjezeka kwamizere, komanso kutulutsidwa kwamphamvu kwa thupi la munthu kuchokera kumadzi ndi mchere wambiri.

Chifukwa chake, dongosolo lonse la magazi limatsitsidwa, kuthamanga kwa magazi kumachepa ndipo mitsempha yomweyo ya magazi ndi yopapatiza.

Mavuto osinthana

Kuphwanya mapuloteni kagayidwe komwe kumalumikizidwa ndi kuchepa kwa potaziyamu, zomwe zimayambitsa kuphwanya kwa nayitrogeni bwino. Amakula nthawi zambiri mwa ana ndi okalamba omwe amakhala ndi mapuloteni ochepa muzakudya. Kuti muthane ndi vutoli, ndikofunikira kulemeretsa zakudya zamapuloteni ndikupereka mankhwala a anabolic.

Mukamagwiritsa ntchito thiazide ndi loop diuretics m'magazi, kuchuluka kwa cholesterol, beta-lipoproteins, triglycerides kumawonjezeka. Chifukwa chake, popanga diuretics, lipids mu zakudya iyenera kukhala yochepa, ndipo ngati kuli kotheka, ma diuretics ayenera kuphatikizidwa ndi angiotensin-converting enzyme inhibitors (ACE inhibitors).

Thiazide diuretic mankhwala amatha kuyambitsa kuchuluka kwa shuga m'magazi (hyperglycemia), makamaka kwa odwala matenda a shuga kapena kunenepa kwambiri. Pofuna kupewa izi, kuletsa zakudya zamafuta ochepa azakudya (shuga), kugwiritsa ntchito ACE zoletsa ndi potaziyamu ndikofunikira.

Mu anthu omwe ali ndi matenda oopsa komanso opuwala purine metabolism, kuchuluka kwa uric acid m'magazi kungakhale kwakukulu (hyperuricemia). Makamaka kukhathamira kwa kuphatikizana kwamtunduwu ndi mankhwala a thiazide okodzetsa. Mankhwalawa, zakudya zopatsa mphamvu za purine, allopurinol, zimayikidwa, okodzetsa amaphatikizidwa ndi ACE inhibitors.

Pankhani yogwiritsa ntchito mankhwala ochuluka okodzetsa kwa nthawi yayitali, ntchito ya impso imatha kusokonezeka ndi kukula kwa azotemia (kuwonjezereka kwa kuchuluka kwa zinyalala za nayitrogeni m'magazi). Muzochitika izi, ndikofunikira kuyang'anira pafupipafupi zizindikiro za azotemia.

Kulekerera kwa diuretic ndikosowa. Amadziwika kwambiri ndi thiazide ndi loop diuretics, makamaka mwa odwala omwe ali ndi ziwopsezo kuti sulfonamides. Thupi lawo siligwirizana likhoza kukhala ndi zotupa pakhungu, vasculitis, photosensitivity, malungo, chiwindi ndi impso.

Chithandizo cha matupi awo sagwirizana zimachitika molingana ndi chizolowezi chogwiritsidwa ntchito ndi antihistamines ndi prednisone.

Kugwiritsa ntchito kaboni ya anhydrase inhibitors kungakhale limodzi ndi kuwonongeka kwa mitsempha. Mutu, kusowa tulo, paresthesia, kugona.

Ndi mtsempha wa magazi a ethacrine acid, kuwonongeka koopsa m'makutu kumatha kuchitika.

Pafupifupi magulu onse a mankhwala a diuretic amawonjezera chiopsezo chokhala ndi urolithiasis.

• Hypovolemia,
• hypokalemia (imawonjezera kwambiri kuwopsa kwa mtima wama glycosides),
• hyponatremia,
• Hyperuricemia (ingayambitse kuukira kwa gout),
• hypocalcemia,
• hyperglycemia
• Hypomagnesemia - kuchepa kwa magnesium kumawoneka ngati chifukwa cha pseudogout (chondrocalcinosis),
• chizungulire
• kukomoka
• hypotension.

Chifukwa chiyani gwiritsani ntchito diuretics a shuga

Nthawi zambiri, mitundu yosiyanasiyana ya mankhwala a diuretic imayikidwa kuti ichiritse matenda oopsa. Koma madokotala amalimbikitsanso mankhwalawa chifukwa cha matenda a kutupa komanso miyendo. Ndipo sizodabwitsa, chifukwa matendawa amatha kuwonetsa kukhalapo kwa kulephera kwa mtima.

Mu shuga mellitus, ma diuttics omwe amafunsidwa ayenera kugwiritsidwa ntchito mosamala kwambiri, chifukwa si onse okodzetsa omwe ali oyenera kuchita izi kapena chamoyo chimenecho. Chifukwa chake, ndikofunikira kupita kukakambirana ndi katswiri wazachipatala yemwe angakuwuzeni kuti ndi mankhwala ati omwe mungathe kumwa omwe ali ndi matenda ashuga.

Monga mukudziwa, diuretic mankhwala a shuga amatha kukhala osiyanasiyana. Mwachitsanzo, mankhwala osokoneza bongo a potaziyamu ndi masoka otayirira siabwino kuti muchiritse bwino matenda oopsa mu shuga mellitus.

Ndikofunikira kudziwa kuti gawoli ndiloyenera kugwiritsidwa ntchito kamodzi, ndiye kuti, kuti tichotse mwachangu kumverera kowawa komwe kumawonekera. Omwe amasankhidwa pang'ono pakadali pano ndi okakamira potaziyamu, popeza m'nthawi yamakono awa amawoneka kuti ndi achikale komanso opatsidwa zovuta zambiri zoyipa.

Othandizira ngati a Thiazide ndi thiazide

Othandizira a Thiazide ndi thiazide amadziwika kuti ndi otchuka kwambiri pochiza matenda osokoneza bongo, komanso matenda oopsa. Amaganizika okodzetsa okodzetsa am'matenda amtundu wachiwiri amatha kumwedwa pang'ono.

Izi zikuphatikizapo Poithiazide ndi Dichlothiazide. Zoyipa zawo zimakhala chifukwa chakuchepetsa mphamvu ya maselo kupita ku insulin yomwe imaperekedwa.

Nthawi zambiri, izi zimachitika chifukwa chogwiritsa ntchito kwambiri mankhwalawa. Zowonadi, milandu yotereyi imatha kuchitika m'mbuyomu m'njira zoyipa zosiyanasiyana.

Mankhwala okhala ndi diazitrate ngati Thiazide amatha kutengedwa ndi odwala omwe ali ndi matenda osokoneza bongo popanda mantha apadera. Magenge monga indapamide ndi zinthu zofatsa kwambiri.

Pogwiritsa ntchito zinthuzi, mutha kuchotsa potaziyamu, sodium, magnesium m'thupi. Chifukwa chake, ndi chithandizo, odwala omwe ali ndi matenda ashuga ayenera kudya zakudya zomwe zanenedwa pamwambapa.

Izi ndi phala la buckwheat, oatmeal, Zipatso, mtedza, ndipo, zipatso zatsopano.

Ndi matenda ashuga, mankhwala wowerengeka azitha kugwiritsidwanso ntchito. Komabe, musanagwiritse ntchito mwachindunji, ndikofunikira kufunsa dokotala kuti mupeze yankho lenileni ndikuwunika kuti agwirizane ndi mankhwala othandizira.

Wodwala wodwala matenda a shuga ayenera kuyang'aniridwa ngati akuwapatsa chithandizo cha matenda omwe amagwirizana, chifukwa kufunika kwa insulin pankhaniyi kumatha kusiyanasiyana mchikakamizo cha mankhwala omwe amakhudza kagayidwe kazachilengedwe (corticosteroids, salicylates).

Beta-adrenergic blockers imasokoneza kutulutsa kwa shuga chiwindi pakukonzekera kwa hypoglycemia, yomwe imapangidwira kudzera mwa beta2-adrenergic receptors, ndikuchepetsa zizindikiro za hypoglycemia, kupatula kutuluka thukuta. Chifukwa chake, hypoglycemia yomwe imayambitsidwa ndi insulin imakulitsidwa ndipo imayamba kuchepa.

Pankhaniyi, ngati wodwala wodwala matenda a shuga afunika kukhazikitsa beta-adrenergic receptor, mtima wa beta-1-blockers, mwachitsanzo, atenolol, uyenera kugwiritsidwa ntchito. Mankhwala a Sympatolytic amathanso kutulutsa zotsatira za insulin.

Liazide diuretics imatha kupangitsa kukula kwa matenda a shuga, motero, mwachilengedwe, kukonza kwa matenda oopsa mu shuga mellitus kumafunikira chisamaliro chapadera.Zochita za sulfonylurea zotumphukira zimakonzedwa ndi waukulu Mlingo wa sulufilamides, ndipo ena a iwo amawonjezera mulingo wa butamide waulere, mwina chifukwa cha mpikisano wolumikizana ndi mapuloteni a plasma.

Monoamine oxidase inhibitors amatha kutulutsa zotsatira za mankhwala a hypoglycemic, komanso mwina insulin. Amatha kuchepetsa kudya, motero amasintha kufunika kwa insulin. Ndizotheka kuyanjana ndi ethanol ndikupanga hypoglycemia, ma anticoagulants chifukwa cha mpikisano wa michere ya chiwindi, etc.

Otsata a hepatic microsomal michere imathandizira kagayidwe ka sulfonylurea zotumphukira zimapukusidwa mu chiwindi, mwachitsanzo, butamide. Kutalikirana kwawo ndi kulumikizana ndi mapuloteni a plasma kumachitika ndi munthawi yomweyo ndimankhwala okhala ndi clofibrate, ena omwe si a antiidal a antiidal and anti sodiumon sideson.

Mlingo waukulu wa acetylsalicylic acid amakhala ndi vuto la hypoglycemic. Zitsanzo zonsezi zikuwonetsa kuti mwayi wokhudzana ndi kugwiritsa ntchito mankhwala osokoneza bongo pochiza odwala matenda ashuga ndiwowona.

Pharmacokinetics ya mankhwala osokoneza bongo

Matenda a impso ophatikizira matenda a shuga amaphatikizidwa ndi kusintha kwa mankhwala ena ambiri. Kuchepetsa kwa penicillin panthawi ya makonzedwe a intramuscular kumachepetsa kwambiri odwala okalamba omwe ali ndi matenda osokoneza bongo kuposa anthu omwe ali m'gulu loyang'anira.

Izi zimapangitsa kuchepa kwa mankhwala ambiri m'magazi. Kuchepa mayamwidwe mwina chifukwa cha matenda ashuga microangiopathy. Kusintha kofananako pakuphatikizidwa kwa mankhwalawa sikukutalikiranso ndipo sikungakhale ndi zotsatirapo zosafunikira.

Matenda opatsirana chifukwa cha mankhwala osokoneza bongo

Pambuyo pobweretsa thiazide okodzetsa m'machitidwe azachipatala, zidapezeka kuti, pogwiritsa ntchito nthawi yayitali, zimachulukitsa hyperglycemia mwa odwala omwe ali ndi matenda osokoneza bongo, ndipo pambuyo pake zidapezeka kuti kulekerera kwa glucose kumavulaza mwa ena athanzi. Ndi chithandizo chotenga nthawi yayitali, amalimbikitsa odwala omwe ali ndi vuto la glucose.

Makina a izi sakhazikitsidwe mokwanira. Amapereka lingaliro la kulumikizidwa ndi kuchepa kwa potaziyamu. Atamaliza kulandira chithandizo, kuchuluka kwa shuga kumabweranso koyambirira, kupatula odwala omwe anali ndi vutoli asanalandire chithandizo.

Chiwopsezo cha kukhala ndi matenda ashuga chiyenera kuganiziridwanso pochiza odwala omwe ali ndi matenda ochepa oletsa kuchepa kwa magazi, chifukwa mwayi wokhala nthenda yachiwiri yoopsa kwambiri mosakayikira umachepetsa phindu la hypotensive zotsatira za thiazide diuretics.

Potaziyamu-yosasamala okodzetsa

Kuti muchepetse kuthamanga kwa magazi (BP), okodzetsa a shuga amadziwika. Amayikidwa ngati pali katundu wambiri pamtima (CVS) kapena ngati pali kuphwanya kwa mkodzo ndi impso.

Gulu lalikulu lazachipatala limakhazikitsidwa pamapangidwe, momwe kusankha kwa mankhwala omwe ali pachiwonetsero cha matenda kumakhazikitsidwa.

Pankhani ya matenda a shuga a mellitus (DM), mankhwalawa amaperekedwanso kuti athandizidwe, chifukwa chake okodzetsa amalembedwa ndi adokotala okhawo malinga ndi mankhwala omwe ali pamndandandawo. Amakhala ndi mavuto ambiri.

Kusankha kwa mankhwala ochepetsa kuthamanga kwa magazi mu shuga kuyenera kutengera chithunzi cha matendawa, thanzi la wodwalayo, zaka zake ndi cholinga chogwiritsa ntchito. Dokotala amawona chomwe chimayambitsa kuchuluka kwa madzimadzi ndipo, pamaziko a izi, diuretic imalembedwa.

Mtundu woyamba wa matenda ashuga, kukondera kumapangidwa pa gulu la thiazide la mankhwala ochepa. Ena mwa mankhwalawa amasokoneza kagayidwe ka glucose, kamayenera kuganiziridwa mukamamwa. Kutsika kwamphamvu kwa kuthamanga kwa magazi kumachitika pogwiritsa ntchito dioptureure.

Mitundu ya ma diuretics

Matenda aliwonse amafunikira chithandizo ndi mankhwala enaake omwe amachitika mwachindunji pazomwe zimayambitsa matendawa. Mankhwala a diuretic ali ndi njira ina yochitira. Malinga ndi izi, aliyense okodzetsa aliyense ndi wa gulu linalake:

• mankhwala omwe amakhudza kugwira ntchito kwa impso tubules ndi monga: "Chlortalidone", "Clopamide", "cyclumbazide",
• okodzetsa ndi osmotic zotsatira (mwachitsanzo, "Monitol"),
• potaziyamu wambiri woteteza mankhwala: Veroshpiron.

Komanso, ma diuretics onse amagawidwa m'magulu molingana ndi mphamvu ya sodium excretion:

• yatulutsa bwino kwambiri kuchokera pa 15% ndi kupitirira,
• ndi mphamvu yokwanira 5-10%,
• kuchotsa 5% kapena kuchepera thupi.

Aliyense diuretic ali ndi cholinga chake. Ma diuretics osagwira bwino ntchito amathandizira thupi kuphatikiza ndi mankhwala ena. M'maphunziro, zidapezeka kuti kuchuluka kwa mapuloteni mumkodzo, kukwera kwake kudzakhala ndi matenda oopsa.

Magulu a okodzetsa

Ma diuretics amagawika m'magulu molingana ndi momwe amakopera thupi:

1. Loopback - chotsani madzi owonjezera pakanthawi kochepa. Izi ndi monga: "Furosemide", "Ethaconic acid" ndi ena.
2. Thiazide diuretics - nthawi zambiri amagwiritsidwa ntchito pa matenda ashuga ndipo amawerengedwa ngati amodzi mwa mankhwala othandiza kwambiri. Chepetsani kupsinjika ndikuthandizira kuthetsa kutupira. Izi ndi monga: "Hypothiazide", "Indapamide", "Dichlothiazide".
3. Osmotic diuretics - chotsani madzi mu nthawi yochepa kwambiri. Kugwiritsidwa ntchito pangozi zadzidzidzi. Choletsedwa kuti chigwiritsike ntchito kwa nthawi yayitali. Izi ndi monga: Urea, Mannitol, Potaziyamu Acetate.
4. Potaziyamu woletsa kukodzetsa kumachepetsa kuwonongeka kwa electrolyte bwino, kumathandizira kuwonetsa kwa potaziyamu ndi sodium kuchokera m'thupi. Izi zikuphatikiza: Triamteren, Spironolactone.

Zotsatira zoyipa zimachitika chifukwa chogwiritsa ntchito diuretics pochiza matenda a shuga kwa nthawi yayitali. Chifukwa chake, kuti mugwiritse ntchito bwino mankhwalawa moyenera, dokotala amayenera kupereka mankhwala pambuyo polemba mayeso onse ofunikira.

Diuretic yotere imagwiritsidwa ntchito kwambiri pothandizira matenda a shuga mellitus, omwe ali m'gulu la thiazide kapena thiazoid. Ma diuretics omwe ali a thiazide ones (Dichlothiazide, Poithiazide) ndipo amatengedwa ku matenda oopsa ndi mtundu 1 wa matenda a shuga amakhala othandiza kwambiri pa Mlingo wochepa.

Nthawi zambiri, diuretics imagwiritsidwa ntchito limodzi ndi mankhwala ena.

A diuretic monga Hypothiazide nthawi zambiri amagwiritsidwa ntchito popanga zovuta za matenda a shuga ndi kuthamanga kwa magazi. Chimodzi mwazinthu zoyipa ndizopanga mankhwala, zomwe zimakhudza kusinthana kwa shuga ndi cholesterol.

Zolembera zamagetsi amtundu wachiwiri za shuga sizikulimbikitsidwa pamiyeso yambiri. Ma diuretics omwe ali m'gulu la thiazide ali ndi malo omwe amasokoneza kupanga insulin ndikuwonjezera kuchuluka kwa shuga.

Mankhwala a diuretic a shuga, a gulu la potaziyamu kapena loop, saloledwa. Kusiyira limodzi ndi makonzedwe a nthawi imodzi panthawi yadzidzidzi.

Ma diuretics ndi ma antihypertensives othandiza kwambiri. Amapanga kuchuluka kwa mkodzo mthupi la munthu, zomwe zimapangitsa kuti njira zochulukirapo zotulutsira madzi ndikumasulidwa kwamphamvu kwa thupi kumchere ndi madzi owopsa. Chifukwa chake, kutsitsa kwazinthu zozungulira, vasoconstriction ndi kutsitsa kukakamiza kumachitika.

Ma diuretics nthawi zambiri amathandizidwa pochiza matenda oopsa, koma nthawi zina amatengedwanso ndi odwala omwe ali ndi vuto la chiwindi ndipo anthu omwe ali ndi vuto la kutupa m'miyendo (ichi chikhoza kukhala chimodzi mwazizindikiro zosadziwika za kulephera kwa mtima).

Koma kwa anthu omwe ali ndi matenda ashuga, ma diuretics amayenera kugwiritsidwa ntchito mosamala kwambiri, moyang'aniridwa ndi dokotala, ndipo kumbukirani kuti si onse okodzetsa omwe ali oyenera kwa iwo.

Loop ndi potaziyamu woleketsa okodzetsa sizingakhale zoyenera kuchitira kwathunthu matenda oopsa mu shuga mellitus, koma angagwiritsidwe ntchito kamodzi, popereka chithandizo chamankhwala chopweteka.

Odziwika kwambiri pantchito zochotsa matenda ashuga masiku ano ndi ma thiazide ndi thiazide ngati diuretics. Thiazide diuretics, monga dichlothiazide ndi poithiazide, amagwiritsidwa ntchito mwanjira zochepa pochizira matenda oopsa a matenda a shuga II mellitus.

Chowonadi ndi chakuti amachepetsa chidwi cha maselo kuti apange insulin. Nthawi zambiri izi zimachitika pokhazikika ndikugwiritsa ntchito mankhwalawa, koma nthawi zina zimachitika m'mbuyomu, momwe zimakhalira.

Mankhwala othandizira odwala matenda a shuga amakhazikitsidwa makamaka kuti achepetse matenda oopsa, kuchepetsa kutupa ndi kuchiritsa mtima. Tiyenera kudziwa kuti si onse othandiza othandizira odwala matenda ashuga omwe angagwiritsidwe ntchito, zomwe zikutanthauza kuti mankhwala omwe amadzipaka okha kapena kuikidwa mankhwala okodzetsa, osaganizira nthenda yayikuluyi, ikhoza kuvulaza thupi.

Zochizira odwala ambiri omwe ali ndi matenda oopsa kwa nthawi yayitali, mankhwala a thiazide okodze amagwiritsidwa ntchito, zomwe zimapangitsa kuti thupi lizitayika kwambiri. Nthawi yomweyo, amachepetsa kwambiri chidwi cha maselo kuti apange insulini, zomwe zikutanthauza kuti kuchuluka kwa magazi a triglycerides, glucose ndi cholesterol azikula, zomwe zidzalepheretsa kugwiritsa ntchito izi diuretics kwa matenda a shuga a 2.

Komabe, kafukufuku waposachedwa wogwiritsa ntchito ma diuretics mu shuga mellitus adazindikira kuti zotsatirazi zoyipa zimawonedwa nthawi zambiri ndi Mlingo waukulu wa mankhwala. Zotsatira zotsika - zoyipa siziri kuwonetsedwa.

Kuphatikiza apo, odwala omwe ali ndi matenda a shuga a mtundu wa 2, akamamwa mankhwala a thiazide, amalimbikitsidwa kuti adye zipatso zambiri komanso masamba ambiri, omwe ayenera kulipira kutayika kwa magnesium, sodium ndi potaziyamu.

Chiwopsezo chochepetsera chidwi cha maselo ku insulin iyenera kukumbukiridwanso. Pa chithandizo cha matenda oopsa, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi pafupipafupi ndipo, ngati pakufunika, muwonjezere kuchuluka kwake.

Ampoules

Jekeseni wa mankhwala okodzetsa nthawi zambiri amalembedwa mozama, pakakhala koyenera kuti zotsatira zake zichitike mwachangu kapena wodwala atalephera kumwa mapiritsi. Mankhwala osankhidwa ndi:

1. Jekeseni wothandizila umagwiritsidwa ntchito intravenous ndi mu mnofu makonzedwe. Mlingo umatha kuyambira 0,1 mpaka 1.5 mg, jekeseni wotsatira ukhoza kuchitika, ndikuwonetsetsa kuti pakhale maola 4-6. Mankhwalawa ayenera kukhala masiku atatu kapena anayi.
2. Ethaconic acid. Njira ya jakisoni wa mankhwalawa imapangidwa kuti apangidwe mtsempha, mlingo ndi 50 mg. Kukhazikika kwa njira zochizira kungayembekezeredwe pambuyo pa mphindi 30, kumatha kwa maola 8.
3. Furosemide. Njira yothetsera vutoli ingagwiritsidwe ntchito pokonzekera ma intramuscular and intravenous, pomwe mlingo umachokera ku 20 mpaka 40 mg. Zotsatira zimachitika pakapita mphindi zochepa ndipo zimatha kwa maola 8.
4. Lasix. Imaperekedwa kudzera m'mitsempha kapena intramuscularly. Ndi kuchuluka kwa kuthamanga kwa magazi, mankhwalawa amatha kumwa kawiri patsiku.

Zokhudzana ndi zovuta za mankhwala omwe angathe kubayidwa ndi gululi, zimawoneka ngati zopweteka zomwe zimachitika chifukwa cha kuyambitsa kwa mankhwala komanso kuthekera kwakudziyendetsa pakokha.

Chonde dziwani kuti mtundu wa mankhwalawo ndi mlingo wake uyenera kutumizidwa ndi dokotala, mukuganizira za zomwe wodwalayo ali, ndi kuopsa kwa matendawa.

Kutalika kwambiri kwazitali kwambiri ndi kukokoloka - 2 nthawi yayitali kuposa furosemide (chifukwa chake, ndiye abwino kwambiri pagulu lachifumu lophimba zochizira matenda oopsa).

Mphamvu yododometsa kwambiri imafotokozedwa ndikuti ndikumaloza kwa gawo la Henle komwe chochuluka cha sodium, ndipo chifukwa chake madzi, amabwezedwanso. Loop okodzetsa mwa magawidwe yogwira amalowa ndikuwunikira kwa tubule yotsimikizika ndikupikisana ndi uric acid chifukwa cha chimbudzi, chomwe chimayambitsa kuchedwa kwake ndi hypercuricemia.

Zopopera za loop zina zimakhala ndi yachiwiri. Mphamvu yachiwiri ya gulu la mankhwalawa ndiwowonjezereka pakupanga ma prostaglandins, omwe amachititsa kuti vasodilation ikhale bwino ndikuwongoletsa magazi kwa impso.

• dyslipidemia,
• kuchuluka serum creatinine ndende,
• hypocalcemia,
• zotupa.

Ototoxicity (kuwonongeka kwa khutu) ndi vuto lalikulu koma losowa kwambiri loop diuretics. Tinnitus ndi chizungulire zitha kuchitika, koma muzoopsa zimatha kubweretsanso ugonthi.

Popeza ma loop diuretics monga furosemide, torasemide ndi bumetanide ali ndi mankhwala okhala ndi sulufule (onani chithunzichi mu kapangidwe ka mankhwala opangidwa ndi chiuno chotsekemera kwa chithunzi), pali chiopsezo choti odwala omwe ali ndi chidwi ndi sulufiline amatha kukhala ndi chidwi ndi ziwalo zotentha.

Kuwopsa kumeneku kukuwoneka paziwongola dzanja. Komabe, kwenikweni, chiopsezo cha kukhudzidwanso mosadziwika sichikudziwika, ndipo pali zinthu zina zomwe zimatsutsana kupezeka kwa kusinthaku.

Kafukufuku wina adapeza kuti 10 peresenti yokha ya odwala omwe sagwirizana ndi mankhwala a sulfonamide ndi omwe amawombana ndi loop diuretics. Komabe, sizikudziwikabe kuti izi ndi zowona kapena ayi.

Ethaconic acid ndi mankhwala okhawo m'gulu lino la okodzetsa omwe si sulfanilamide. Komabe, ili ndi zovuta zomwe zimakhudzana ndi poizoni m'mimba.

Loop diuretics ikaphatikizidwa ndi aminoglycoside antibayotiki imachulukitsa chiopsezo cha ototoxicity (ugonthi wosasinthika), anticoagulants amawonjezera ngozi ya magazi, mtima glycosides amawonjezera ngozi ya arrhythmias,

mankhwala antidiabetesic gulu la sulfonylurea zotumphukira - kuonjezera ngozi ya hypoglycemia, NSAIDs - kuchepetsa zotsatira za chomaliza. Ma loop okodze amawonjezera mphamvu ya kukonzekera kwa propranolol ndi lifiyamu.

Ophatikizira okodzetsa

Ophatikizira okodzetsa nthawi imodzi amakhala ndi mphamvu yolera komanso kuchepetsa magazi. Ubwino wawukulu wa mankhwalawa ndikuti zotsatira zake zimachitika pambuyo pa maola 1-3 pambuyo pa 6 ndi 9.

Ma diuretics ophatikizidwa odziwika bwino ndi awa: Amirtid Mite, Triamtezid, Diazid, Isobar. Kugwiritsidwa ntchito kwa toxosis pa nthawi ya pakati, kuthamanga kwa magazi komanso kulephera kwamtima.

Gululi lalingaliroli lingaganizidwe pa chitsanzo cha Apo-Triazide. Mankhwalawa ali ndi thiazide diuretic - hydrochlorothiazide ndi potaziyamu wotetezera diuretic - triampteren. Chifukwa cha kuphatikiza uku, mphamvu yothandiza kukodzetsa thupi imatheka ndipo palibe chifukwa chowonjezera potaziyamu.

Mankhwala ophatikizika nthawi zambiri amaphatikiza zinthu ziwiri kapena zingapo zogwira ntchito kuti mphamvu zakezo zizigwirira ntchito limodzi, ndikuchepetsa mavuto.Mwachitsanzo, mankhwalawa Apo-Azid ali ndi ziwonetsero ziwiri - potaziyamu woteteza potampumine (kupewa kutayika kwa izi) ndi thiazide diuretic hydrochlorothiazide (kuwonjezera mphamvu ya mankhwala).

Ma diuretics amagwiritsidwa ntchito kwambiri pochiza kuthamanga kwa magazi pochepetsa kuchuluka kwa madzi omwe amayenderera m'matumbo. Kugawidwa kwa diuretics kumatenga mankhwala omwe ali osiyana mosiyanasiyana, mfundo zofunikira ndi katundu.

Sikulimbikitsidwa kuti muwatenge popanda kutsatira mankhwala a dotolo, chifukwa izi zitha kuvulaza thanzi. Kusankhidwa kwa diuretic kumatsimikiziridwa ndi momwe wodwalayo alili komanso momwe akumvera ndi zigawo za mankhwala. Thiazide diuretics ndizofala kwambiri.

Lure okodzetsa

Ma diuretics opepuka amagwiritsidwa ntchito kwambiri mu matenda a gynecology ndi ana polimbana ndi kutukusira kwa manja ndi mapazi mwa amayi apakati, ndi mawonekedwe a kuthamanga kwa magazi kwa ana komanso kwa achikulire. Poyamba, ngati diuretic yofewa, mankhwala osmotic amatha kugwiritsidwa ntchito, chifukwa tanthauzo lawo lalikulu limakhala lofuna kuchotsa madzimadzi mu minofu ya edematous. Ana ndi okalamba nthawi zambiri amapatsidwa mankhwala ochepetsa mphamvu ya potaziyamu ngati diuretic yofooka, yomwe nthawi zambiri imakhala yokwanira ngati pakufunika kuchepetsa kuthamanga kwa magazi ndi mwana ndi 10-20 mm. Mwa okalamba, chifukwa cha kusintha komwe kumachitika mwa njira zamankhwala amitundu mitundu, zomwe m'njira zonse zimakhudzana ndi okodzetsa pang'ono, amatha kupereka zotsatira zabwino.

Dziwani kuti ndibwino kukonda mtundu wa mankhwala omwe amapezeka m'magulu a "mapapo" ndipo osakhala ndi zotsatila zosiyanasiyana za mapulani a mahomoni, omwe ndi ofunikira kwambiri makamaka kwa ana ang'ono ndi amayi apakati. Komanso, ma infusions osiyanasiyana azitsamba amatha kuphatikizidwa ndi kuwala okodzetsa.

Ma diuretics amphamvu

Mosiyana ndi ma diuretics opepuka, omwe mankhwalawa wowerengeka amagwiritsidwa ntchito kwa nthawi yayitali, mankhwala opanga okodzetsa analengedwa posachedwa, koma ali ponseponse pochiza matenda osiyanasiyana.

Mpaka pano, okodzetsa amphamvu kwambiri ndi mankhwala:

Lasix itha kugwiritsidwa ntchito mwa makolo ndi pakamwa. Ubwino wosatsutsika wa chida ichi ndikuyamba mwachangu zotsatira zabwino pambuyo pakugwiritsa ntchito. Mwachitsanzo, ngati Lasix idatengedwa pakamwa, ndiye kuti kusintha kumachitika mkati mwa ola limodzi, komanso kuyang'anira makolo patangopita mphindi zochepa. Nthawi yomweyo, kutalika kwa diuretic iyi kutengedwa pakamwa mpaka maola 8, ndipo pakaperekedwa kudzera m'mitsempha - atatu okha.

Mphamvu ya diuretic ya mankhwala ena amphamvu a okodzetsa - Spironolactone, yogwiritsidwa ntchito pa edema yamaukidwe osiyanasiyana, kuphatikizapo mtima wa edema, imachitika tsiku lachitatu kumwa mankhwalawa. Komabe, nthawi ino imatha kuchepetsedwa kwambiri mwa kusankha Flurosemide kapena Hypothiazide ndi Spironolactone.

Kuchepetsa kumapezeka ngati ufa wouma ndipo kumawerengedwa kuti ndi amodzi mwa othandizira kwambiri othandizira mu edema ya ubongo, mapapu, mtima ndi poyizoni ndi barbiturates.

Ophatikizira okodzetsa

Zophatikiza zama diuretics zimaphatikizapo:

1. Vero-Triamtezid,
2. Diazide
3. Diursan
4. Diursan Mite
5. Isobar
6. Lazilactone
7. Moduretic
8. Thialoride
9. Triam Co
10. Triampur compositum,
11. Chikwawa,
12. Triamtel
13. Fureis compositum,
14. Furo Aldopur
15. Ecodurex
16. Aldactone Saltucin,
17. Amyloside
18. Amyloretiki,
19. Amiloride + Hydrochlorothiazide,
20. Amitrid,
21. Amitrid Mite
22. Apo triazide.

Zonsezi zophatikizira m'mimba zonse zimakhala ndi mphamvu komanso zododometsa.Ubwino wa mankhwala ophatikizika ndikuthamanga kwa kuyambika kwa kusintha kwamphamvu mutatha kumwa nawo (kuyambira 1 mpaka 3 maola) ndikukhalabe ndi zotsatira zabwino kwa maola 7 mpaka 9.

Ophatikizira okodzetsa amaphatikizidwa makamaka pakhungu loperewera, toxosis m'milungu yotsiriza ya kutenga pakati, chiwindi cirrhosis, nephrotic syndrome, kulephera kwa mtima, komanso chifukwa cha matenda oopsa.

Kashiamu wopanda diuretic

Mapiritsi osagwiritsa ntchito calcium diuretic amaperekedwa kwa odwala omwe ali ndi kuthamanga kwa magazi kuphatikiza mafupa. Ichi ndi gawo lofunikira poletsa kupitilira kwa mafupa kwa odwala, ndipo chifukwa chake, kuwoneka kwa ma fractures atsopano. Loop ndi potaziyamu-yosalekerera okodzetsa amakuyamwa calcium, pomwe thiazide okodzetsa, m'malo mwake, amachepetsa ma supion a calcium mu mkodzo. Ndiye chifukwa chake thiazide-ngati ndi thiazide diuretics okha ndi omwe amapatsidwa odwala omwe ali ndi mafupa. Komabe, ma diuretics opulumutsa calcium ndi ofunikira osati kokha kwa anthu omwe ali ndi vuto la mafupa, komanso kwa anthu ena omwe ali pachiwopsezo chachikulu cha kukulira kuvulala kwa ORA, mwachitsanzo, anthu okalamba. Kafukufuku akuwonetsa kuti anthu omwe amatenga mankhwala okodzetsa ngati thiazide pochiza matenda oopsa sangathe kukumana ndi zovuta kuposa omwe adalembedwa mitundu ina ya okodzetsa.

Koma, ngakhale atafotokozeredwa phindu la diuretic, calcium, kusungidwa, amathanso kuponderezedwa m'magulu ena a odwala, chifukwa kudya kwawo kumalumikizidwa ndi kuchuluka kwa magnesium ndi potaziyamu kuchokera m'thupi, zomwe zikutanthauza kuti odwala omwe ali ndi hyperuricemia, gout, hypokalemia ndi ena sangathe kulembedwa.

Antihypertensive okodzetsa

Njira yodalirika yoperekera matenda oopsa kwa odwala ndi kugwiritsa ntchito ma okodzetsa ena. Ndipo sikuti zangokhala kuti onse okodzetsa amatha kuchepetsa kukakamiza, nthawi zina osagwiritsidwa bwino ntchito mpaka mankhwala omwe ali odziwika kwambiri pochiza matenda oopsa, komanso kuti chithandizo chamankhwala othandizira antioxypertensive chikufanizidwa, mwachitsanzo, ndi ma blockers a B , zimapatsa wodwala nthawi 9-15 mtengo wotsika mtengo, zomwe ndizofunikira, chifukwa chakuti gulu la anthu omwe akudwala matenda oopsa ndi omwe amapuma pantchito, omwe chuma chawo nthawi zambiri sichimawalola kulipira mtengo wokwera Fulakesi chithandizo.

Mukamamwa mankhwala okodzetsa, mphamvu ya hypotensive imatheka chifukwa chakuti poyambira chithandizo pamakhala kuchepa kwa magazi ndi mtima wake (kutulutsa kwa sodium chloride kumatha), ndipo ngakhale pakatha miyezi ingapo magazi atuluka bwino, mitsempha ya magazi pofika nthawi imeneyi imachepetsa kukana kwina, potero kuthandiza antihypertensive zotsatira akwaniritsidwa pa mankhwala.

Zinthu zosangalatsa pamutuwu!

Ma diuretics ndi mankhwala omwe amapanga diuretic. Mankhwala odziwika komanso omwe amagwiritsidwa ntchito nthawi zambiri ndi magulu awiri a diuretic - thiazide ndi thiazide-ngati diuretics. Ntchito yogwiritsira ntchito mankhwalawa nthawi zambiri imangotengera matenda a impso ndi kwamkodzo, koma amagwiritsidwanso ntchito kukonza zolimbitsa asidi ndi madzi osankhidwa a electrolyte. M'zaka zaposachedwa, apeza ntchito yawo mu mtima ndi cholinga chochepetsa kuthamanga kwa magazi ndi kuchepetsa katundu pamtima.

Makina ochitira, zikuwonetsa kugwiritsa ntchito thiazide diuretics.

Nthawi zambiri, mankhwala a gululi amagwiritsidwa ntchito pochiza matenda amkodzo ndi kwamikodzo. Mankhwalawa amagwira ntchito molimbitsa mphamvu, momwe amadziwonekera pakapita ola limodzi mpaka maola atatu, ndipo nthawiyo imafikira pafupifupi theka la tsiku.Makina a kuchitapo kanthu ndikulepheretsa kubwezeretsanso kwa sodium ndi madzi mu proximal a reubu tubules, chifukwa chomwe amachotsedwa pamkodzo pamlingo wothamanga. Kuphatikiza apo, thiazide okodzetsa amachepetsa ma calcium, komanso kuchuluka kwake komanso kuchuluka kwa mapangidwe a uric acid mu impso.

Ma diuretics amtunduwu akuwonetsedwa m'mikhalidwe yotsatirayi:

• edematous syndrome
• matenda oopsa oopsa, omwe saimitsidwa mwa njira wamba, kuchepetsa ziwopsezo,
• pachimake komanso matenda a mtima olephera.

Mankhwala akuluakulu a gululi amaonedwa kuti ndi chlortiazide ndi hydrochlorothiazide, ndikoyambira kwa kugwira ntchito komwe kumachitika m'maola oyamba, ndipo zotsatira zawo zimakhala mpaka maola 12 mpaka 13.

Zotsatira zoyipa ndi contraindication.

Zotsatira zoyipa zimaphatikizapo kusokonezeka pang'ono kwa metabolic, kuphatikiza kusintha kwa kagayidwe kazinthu zina ndi mavitamini. Komanso, hypokalemia (kuchepa kwa kuchuluka kwa potaziyamu m'magazi) nthawi zina imapezeka kuchokera kumbali yotsatizana, pomwe mankhwala amasiya kwakanthawi ndipo mankhwala omwe ali ndi zomwe zili pamwamba pazinthuzi (panangin, asparkum) ndi omwe amapatsidwa. Mutha kuzindikira kuchepa pafupipafupi kwa mulingo wa sodium mu plasma, komanso kuwonjezereka kwa kuchuluka kwa uric acid. Yotsirizirayi, imayambitsa nyamakazi yamafupa, komanso imakhudzanso minyewa ya m'mimba. Atasiya kugwiritsa ntchito mankhwalawa, thupi lonse limagwira.

Ngati odwala pamodzi ndi okodzetsa amatenga beta-blockers, ndiye kuti vuto lina lingayambitse matenda a shuga.

Mwa zosokoneza, zotsatirazi ziyenera kudziwika:

• yotupa yolowa matenda
• matenda osokoneza bongo a impso,
• kutsika kwa potaziyamu ndi sodium m'madzi am'magazi,
• mimba ndi nthawi yoyamwitsa,
• thupi lawo siligwirizana kapena tsankho kwa chilichonse cha mankhwala.

Masiku ano, mankhwala aliwonse ali ndi gawo lililonse la mankhwalawa, lomwe mungagule ndi ndalama zochepa osalandira mankhwala a dokotala. Komabe, ndikofunikira kuti kukhazikitsidwa kwa mankhwalawa ndi okhazikitsidwa ndi dokotala woyenera, ndikuwonetsa kuchuluka kwa mlingo, pafupipafupi komanso nthawi yayitali. Chotsatira, tikufotokozerani mwachidule za mankhwala akuluakulu ochokera pagululi.

Mpaka pano, thiazide diuretics imaphatikizapo hydrochlorothiazide, indapamide, chlortalidone, ndi clopamide. Tikukufotokozerani zoyamba ziwiri mwatsatanetsatane.

Madokotala amapereka mankhwala awa kwa odwala omwe ali ndi edema komanso matenda oopsa, ngati sakhala m'magulu a azimayi oyembekezera, amayi oyamwitsa, komanso anthu okalamba. Amagwiritsidwa ntchito mwachangu kwa odwala omwe ali ndi vuto la mtima ndi chiwindi, omwe ali ndi chiyembekezo cha urolithiasis. Ndi matenda oopsa, mlingo wa tsiku ndi tsiku umakhala piritsi limodzi, limodzi ndi edema yayikulu, mlingo uwu umatha kufikira mapiritsi anayi patsiku. Zotsatira zoyipa, kusanza, kusanza, kusokonezeka thupi, matupi athu amatha kusiyanitsidwa, koma tiyenera kunena kuti ndizosowa kwambiri. Pa nthawi yomwe mukumwa mankhwalawa, ndikofunikira kuti pasakhale kowala mwachindunji, chifukwa mankhwalawa amachititsa chidwi cha khungu la munthu ku radiation ya ultraviolet.

Njira iyi imagwiritsidwa ntchito pa matenda oopsa. Amamwa m'mawa kamodzi patsiku. Zotsatira zoyipa zimaphatikizapo kufooka, kutopa, kupweteka mutu, kukhumudwa, kukokana m'mimba. Osatenga amayi oyembekezera komanso oyamwitsa. Ngati mankhwala osokoneza bongo a mankhwala, nseru, kusanza, chizungulire ngakhalenso kukhala ndi vuto lofooka. Pankhaniyi, muyenera kuyitanira ambulansi ndipo nthawi yomweyo mumamwa makala oyambitsa ndikuyesera kutsuka m'mimba mwanu.

Ma diuretics, kapena okodzetsa, ndi gulu lalikulu kwambiri la mankhwala omwe amachepetsa mphamvu ya timadzi tambiri timatumbo tathupi tathupi ndi minofu powonjezera kutulutsa mkodzo kuchokera mthupi. Kukonzekera kwa gululi kumagwiritsidwa ntchito kwambiri pochiza matenda osiyanasiyana, ndipo kuchuluka kwa mitundu yawo kumachuluka chaka chilichonse.

Gulu la mankhwala

Pali mitundu ingapo yamagulu a mankhwala a diuretic. Mwina zolondola kwambiri ndi izi gulu la mayiko othandizira okodzetsa pamakina ochitira :

• thiazide okodzeya,
• ma diuretics omwe si a thiazide omwe amakhudza gawo lozungulira la Heine,
• potaziyamu wothandiza okodzetsa,
• zida zodulira
• kuphatikiza kwa okodzetsa ndi potaziyamu wothandiza.

Palinso gulu la okodzetsa kutengera kuchuluka kwa kuwonekera kwa zotsatira zake, kutalika kwa chochitikacho ndi mphamvu zake, kapangidwe kazinthu zina ndi mankhwala, etc.

Zopanda-thiazide diuretics

Chigawo ichi chimatchedwanso thiazide-diuretics. Woimira wake wodziwika kwambiri ndi indapamide. Ili ndi mphamvu yofanana ndi thiazide diuretics, ndipo imagwiritsidwa ntchito pochiza matenda oopsa oopsa. Patsamba lamankhwala osokoneza bongo, indapamide ikhoza kupezeka pansi pa mayina Indap, Indopres, Acriptamide, Retapres, Arifon, Pamid, Arindap.

Kuphatikiza pa indapamide, chlortalidone (Oxodoline) imagwiranso ntchito pano.