Lisinoton® (Lisinoton®)

Fomu ya Mlingo - mapiritsi (ma PC 10. Pakunyamula matumba, matuza atatu mumakatoni, ma PC 14. Mu paketi yofikira, matuza awiri mu paketi yamakatoni, paketi iliyonse ilinso ndi malangizo ogwiritsa ntchito Lysinotone):

• Mlingo wa 5 mg: kuzungulira, lathyathyathya, oyera, ali ndi chiopsezo mbali zonse ziwiri,
• Mlingo wa 10 mg: ozungulira, biconvex, pinki wopepuka (mwina wopendekera), wokhala pachiwopsezo,
• Mlingo wa 20 mg: kuzungulira, biconvex, pinki (mwina woyenda), ndi chiwopsezo.

Piritsi 1:

• yogwira mankhwala: lisinopril (mu mawonekedwe a dihydrate) - 5, 10 kapena 20 mg,
• othandizira zigawo: croscarmellose sodium, calcium hydrogen phosphate dihydrate, magnesium stearate, mannitol, pregelatinized starch. Mapiritsi 10 mg mulinso ndi pinki pigment osakaniza PB-24823, 20 mg mapiritsi ali ndi pinki pigment osakaniza PB-24824.

Mankhwala

Mankhwala othandizira a lisinotone - lisinopril, ndi zoletsa ACE. Kupanga kwake kwake pakulimbitsa thupi kumafotokozedwa ndi kuthekera kuchepetsa mapangidwe a angiotensin II angiotensin II, komwe kumapangitsa kutsika kwachindunji kumasulidwa kwa aldosterone. Zotsatira zina za mankhwalawa zimachitika chifukwa cha momwe minyewa ya renin-angiotensin imapangidwira.

Lisinopril amachepetsa kuchepa kwa bradykinin, kumawonjezera kapangidwe ka prostaglandins. Imakulitsa mitsempha pamlingo wokulirapo kuposa mitsempha. Amachepetsa kuthamanga kwa magazi (BP), kuphatikizika kwamitsempha yamagazi kukana (OPSS), kupanikizika kwa m'mapapo m'mimba, kukweza. Kuchulukitsa kwa miniti ya magazi ndi kulolera pang'ono kwa nkhawa kwa odwala omwe ali ndi vuto la mtima.

Ndi chithandizo chotenga nthawi yayitali, lisinopril imasintha magazi kupita ku ischemic myocardium, imachepetsa hypertrophy ya myocardium ndi makhoma a mitsempha yamitsempha ya mtundu wotsalira.

Lysinotone imachulukitsa chiyembekezo cha moyo kwa odwala omwe ali ndi vuto losatha la mtima, komanso imachepetsa kupitilira kwa kusowa kwa mapindikidwe kumanzere kwa odwala pambuyo poyimitsidwa kwamtima posakhalitsa mawonetseredwe a mtima kulephera kwa mtima.

Pambuyo pa limodzi mlingo wa Lysinotone, mphamvu ya hypotensive imayamba pambuyo pa ola limodzi, imafikira pazokwanira maola 6, imatha kwa maola 24. Kutalika kwa zotsatirazi kumadaliranso mlingo wa mankhwalawa. Ndi ochepa matenda oopsa, momwe zimawonekera masiku oyambira atangoyamba kumene chithandizo, zotsatira zabwino zimayamba pambuyo pa miyezi 1-2.

Pankhani yakuchoka kwadzidzidzi kwa Lysinotone, kuwonjezeka kwakukulu kwa kuthamanga kwa magazi sikunawonedwe.

Lisinopril amachepetsa albinuria. Ndi hyperglycemia, zimathandizira kuti magwiridwe antchito owonongeka a glomerular endothelium. Zilibe gawo lililonse pamlingo wa glucose m'magazi a odwala matenda a shuga, motero, sizomwe zimayambitsa kuchuluka kwa zochitika za hypoglycemia.

Pharmacokinetics

Kamodzi m'matumbo am'mimba, lisinopril imalowa pafupifupi 30%. Kudya sizimakhudza kuchuluka kwa mayamwa a lysinotone.

Bioavailability ndi 29%. Kuzindikira kwakukulu kumafika mkati mwa maola 7 ndipo kumakhala 90 ng / ml.

Lisinopril sikugwirizana kwenikweni ndi mapuloteni a plasma. Amadutsa magazi-ubongo ndi zotchinga zina m'malo otsika.

Osati biotransformed Imayatsidwa osasinthika ndi impso. Kuchotsa theka moyo ndi maola 12.

Zizindikiro zogwiritsidwa ntchito

• Chithandizo cha pachimake myocardial infarction ndi hemodynamic magawo kumayambiriro kwa nthawi - kuti akhale hemodynamic magawo komanso kupewa kukula kwamanzere kwamitsempha yamagazi ndi mtima kulephera.
• monotherapy kapena kuphatikiza chithandizo cha matenda oopsa,
• kuphatikiza mankhwala a mtima kulephera (osakanikirana ndi okodzetsa ndi / kapena kukonzekera kwa digitalis).

Contraindication

• cholowa cha edincke's edema,
• mbiri ya angioedema (ngakhale atayambitsa),
• wazaka 18
• mimba ndi mkaka wa m`mawere
• Hypersensitivity gawo lililonse la mankhwala kapena zoletsa zina za ACE.

Mapiritsi a Lysinotone amagwiritsidwa ntchito mosamala potsatira milandu:

• kwambiri aimpso kuwonongeka, aimpso kulephera, stenosis ya impso imodzi ndi patsogolo azotemia kapena mayiko aimpso mtsempha wamagazi stenosis, zinthu pambuyo impso
• azotemia, hyperkalemia,
• machitidwe a Hypovolemic (kuphatikiza chifukwa cha kutsegula m'mimba kapena kusanza),
• kuletsa mafupa hematopoiesis,
• matenda a mtima, ochepa hypotension, hypertrophic insulin Cardiomyopathy, stenosis ya orortice orion, kukomoka kwa mtima,
• chachikulu hyperaldosteronism,
• autoimmune zokhudza matenda a minofu yolumikizira (kuphatikizapo scleroderma ndi systemic lupus erythematosus),
• matenda amisempha (kuphatikizapo kuperewera kwa mphamvu ya m'magazi),
• ukalamba
• Kutsatira zakudya zokhala ndi sodium ochepa.

Lisinoton, malangizo ogwiritsira ntchito: njira ndi mlingo

Mapiritsi a Lysinotone amawonetsedwa pakamwa.

Ndi ochepa matenda oopsa, ngati mankhwala amodzi, Lysinoton amatchulidwa 5 mg kamodzi patsiku. Ngati hypotensive zotsatira zake zili zosakwanira, mlingo umachulukitsidwa ndi 5 mg masiku onse awiri mpaka zotsatira zomwe mukufuna, koma osapitirira 40 mg patsiku (kuwonjezereka kwa mankhwalawa sikupangitsa kuchepa kwa magazi kwambiri). Kukonza tsiku lililonse mlingo pafupifupi 20 mg. Zotsatira zake zambiri zimakhazikika pambuyo pa milungu iwiri kapena itatu ya mankhwala, zomwe zimayenera kukumbukiridwa panthawi ya kumwa mankhwala. Ngakhale mutamwa mankhwalawa tsiku lililonse, kuthamanga kwa magazi sikuchepa mokwanira, lipatseni mankhwala ophatikiza.

Odwala omwe adalandira diuretics ayenera kuchotsedwa masiku 2-3 isanayambe kumwa Lysinotone. Ngati izi sizingatheke, mlingo woyambira wa lisinopril uyenera kukhala 5 mg. Pakupita maola ochepa (pafupifupi maola 6) atatha kumwa koyamba, wodwalayo ayenera kuyang'aniridwa mosamala ndi dokotala yemwe adzayang'ane njira yochepetsera kuthamanga kwa magazi (kuteteza kugonja kwakanenedwe).

Pankhani ya kukonzanso kwamitsempha yamagazi ndi zina zomwe zikuchulukitsidwa ndi ntchito ya renin-angiotensin-aldosterone system (RAAS), tikulimbikitsidwanso kuti ayambe kutenga Lisinoton moyang'aniridwa ndi dokotala (kuwongolera kuthamanga kwa magazi, ntchito yaimpso ndi seramu potaziyamu) pang'onopang'ono koyamba mlingo - 2.5-55 mg patsiku. Mlingo wokonza umatsimikiziridwa ndi zotsatira za kusuntha kwa kuthamanga kwa magazi.

Odwala omwe amalephera aimpso, muyeso woyamba wa Lysinotone umatsimikiziridwa kutengera chilolezo chaininine (CC). Mankhwala yokonza aikidwa mogwirizana ndi zovuta za kuyang'aniridwa kwa aimpso ndi seramu potaziyamu.

Mlingo woyambitsa wa odwala omwe ali ndi vuto la aimpso:

• KK 30-70 ml / mphindi - 5-10 mg,
• KK 10-30 ml / mphindi - 2.5-5 mg,
• QC

Kupanga ndi mawonekedwe a kumasulidwa

mumapaketi a matuza 10 kapena 14 ma PC, mu paketi ambiri makatoni 3 kapena 2, motsatana.

mumapaketi a matuza 10 kapena 14 ma PC, mu paketi ambiri makatoni 3 kapena 2, motsatana.

mumapaketi a matuza 10 kapena 14 ma PC, mu paketi ambiri makatoni 3 kapena 2, motsatana.

Kufotokozera za mtundu wa kipimo

Mapiritsi a 5 mg: mozungulira, mapiritsi a biconvex, okhala ndi notch, oyera.

Mapiritsi 10 mg: mozungulira, mapiritsi a biconvex, okhala ndi notch, pinki yowala.

20 mg mapiritsi: mozungulira, mapiritsi a biconvex, okhala ndi notch, pinki, kuguba kumaloledwa.

Zisonyezero za mankhwala Lysinoton ®

Matenda oopsa a arterial (mu monotherapy kapena kuphatikiza ena othandizira), matenda amtima wosakhazikika (monga gawo la mankhwala othandizira odwala omwe amatenga digito ndi / kapena okodzetsa), chithandizo choyambirira cha infarate ya myocardial infarction (mu maola 24 oyamba ndi hemodynamics yokhazikika ya kusamalira izi ndikuletsa kulephera kwamitsempha yamagetsi komanso kulephera kwa mtima).

Mimba komanso kuyamwa

Kugwiritsa ntchito kwa lisinopril pa nthawi ya pakati kumapangidwa. Mimba ikakhazikitsidwa, mankhwalawo amayenera kusiyidwa posachedwa. Kulandila kwa zoletsa za ACE mu II ndi III trimester ya mimba kumakhala ndi zovuta pa mwana wosabadwayo (kutchulidwa kwa kuchepa kwa kuthamanga kwa magazi, kulephera kwa impso, hyperkalemia, chigaza hypoplasia, kufa kwa intrauterine). Palibe zambiri pazotsatira zoyipa za mankhwalawa mwana wosabadwa ngati agwiritsidwa ntchito nthawi yoyamba. Kwa makanda ndi makanda omwe amakhala ndi intrauterine kukhudzana ndi ma inhibitors a ACE, tikulimbikitsidwa kuyang'anira mosamala kuti mupeze nthawi yake yomwe kuchepa kwa magazi, oliguria, hyperkalemia. Lisinopril amawoloka placenta. Palibe chidziwitso pakulowerera kwa lisinopril mkaka wa m'mawere. Kwa nthawi ya mankhwala ndi mankhwalawa, ndikofunikira kusiya kuyamwitsa.

Zotsatira zoyipa

Zotsatira zoyipa kwambiri ndizo chizungulire, kupweteka mutu (mu 5-6% ya odwala), kufooka, kutsegula m'mimba, kutsokomola (3%), mseru, kusanza, kupweteka kwa mtima, kupweteka pachifuwa, kupweteka pachifuwa (1-3%).

Zotsatira zina zoyipa (pafupipafupi kuthamanga kwa magazi, orthostatic hypotension ,impso ntchito.

Kuchokera kumbali yamanjenje yapakati: kutopa, kugona, kupindika kwa minofu ndi milomo.

Kuchokera ku hemopoietic system: leukopenia, neutropenia, agranulocytosis, thrombocytopenia ndizotheka, ndi chithandizo cha nthawi yayitali - kuchepa pang'ono kwa ndende ya hemoglobin ndi hematocrit, erythrocytopenia.

Zizindikiro zasayansi: Hyperkalemia, azotemia, hyperuricemia, hyperbilirubinemia, kuchuluka kwa michere ya "chiwindi", makamaka ngati pali mbiri yodwala matenda a impso, matenda a shuga komanso kukonzanso kwamitsempha yamagazi.

Osakumana ndi mavuto ochepa

Kuchokera pamtima: palpitations, tachycardia, myocardial infarction, cerebrovascular stroke mwa odwala omwe ali pachiwopsezo cha matendawa, chifukwa cha kuchepa kwa magazi.

Kuchokera m'mimba: pakamwa kowuma, anorexia, dyspepsia, kusintha kwa kakomedwe, kupweteka kwam'mimba, kapamba, hepatocellular kapena cholestatic jaundice, hepatitis.

Pa khungu: urticaria, thukuta, kuyabwa khungu, alopecia.

Kuchokera pamikodzo: aimpso ntchito, oliguria, anuria, pachimake aimpso kulephera, uremia, proteinuria.

Kuchokera kumbali yamanjenje yapakati: asthenic syndrome, kusinthasintha kwa mphamvu, chisokonezo.

Zina: myalgia, fever, kusokonezeka kwa fetal, kuchepa kwa potency.

Kuchita

Chisamaliro chofunikira chimafunikira mukamagwiritsa ntchito mankhwala omwe ali ndi potaziyamu wotsekemera okodzetsa (spironolactone, triamteren, amiloride), potaziyamu, mchere wokhala ndi potaziyamu (chiwopsezo cha kupanikizika kwa Hyperkalemia chikuwonjezeka, makamaka chifukwa cha vuto laimpso, chifukwa chake, amatha kuphatikizidwa pamodzi malinga ndi lingaliro la dokotala payekha kuwunika kuchuluka kwa seramu potaziyamu ndi ntchito ya impso).

Chenjezo litha kugwiritsidwa ntchito limodzi:

- ndi okodzetsa: Ndi makonzedwe owonjezera a okodzetsa kwa wodwala omwe akutenga Lisinoton, monga lamulo, antihypertensive yowonjezera imachitika - chiwopsezo cha kuchepa kwa magazi. Lisinopril amachepetsa kutulutsa kwa potaziyamu kuchokera m'thupi pakumwa mankhwala okodzetsa,

- ndi othandizira ena a antihypertensive (zowonjezera),

- ndi NSAIDs (indomethacin, etc.), estrogens, komanso adrenostimulants - kuchepa kwa mphamvu ya antihypertensive ya lisinopril,

- ndi lifiyamu (lithiamu excretion imatha kuchepa, motero, seramu lifiyamu iyenera kuyang'aniridwa pafupipafupi),

- ndi ma antacid ndi colestyramine - amachepetsa mayamwidwe m'mimba.

Mowa umawonjezera mphamvu ya mankhwalawo.

Mlingo ndi makonzedwe

Mkati. Ndi ochepa matenda oopsa, odwala osalandira mankhwala ena a antihypertensive amapatsidwa 5 mg kamodzi patsiku. Pakalibe kuchitika, mlingo umachulukitsidwa masiku awiri ndi atatu ndi 5 mg mpaka pa avareji achire a 2040 mg / tsiku (kukulitsa mlingo pamwamba pa 40 mg / tsiku nthawi zambiri sikuti kumabweretsa kuchepa kwa kuthamanga kwa magazi). Mulingo wamba wokonzanso tsiku lililonse ndi 20 mg. Mlingo wambiri watsiku ndi tsiku ndi 40 mg.

Kukula kwathunthu kumachitika pambuyo pa masabata 2-2 kuyambira pakuyambira kwa chithandizo, zomwe zimayenera kukumbukiridwa pakukweza mlingo. Ndi matenda osakwanira azaumoyo, ndizotheka kuphatikiza mankhwalawa ndi mankhwala ena a antihypertensive.

Ngati wodwalayo alandila chithandizo choyambirira ndi okodzetsa, ndiye kuti kumwa mankhwalawa kuyenera kuyimitsidwa masiku awiri asanafike ntchito ya lisinotone. Ngati izi sizingatheke, ndiye kuti mankhwalawa a Lysinotone sayenera kupitirira 5 mg / tsiku. Pankhaniyi, mutatenga mlingo woyamba, kuyang'anira kuchipatala kumalimbikitsidwa kwa maola angapo (mphamvu yayitali imatheka pambuyo pafupifupi maola 6), chifukwa kuchepa kwakukulu kwa magazi kungachitike.

Ndi matenda a renovascular Hypertension kapena zina machitidwe ndi kuchuluka kwa renin-angiotensin-aldosterone dongosolo, amathandizanso kupereka mankhwala ochepa a 2,5-5 mg tsiku lililonse, moyang'aniridwa ndi achipatala (kuwongolera kuthamanga kwa magazi, ntchito yaimpso, seramu potaziyamu ndende). Mlingo wokonza, popitiliza kuthandizira, uyenera kutsimikiziridwa kutengera mphamvu ya magazi.

Ndi kulephera kwa aimpso chifukwa chakuti lisinopril imachotsedwa kudzera mu impso, mlingo woyambirira uyenera kutsimikiziridwa malinga ndi chilolezo cha creatinine, ndiye, malinga ndi zomwe zimachitika, mlingo wokonzanso uyenera kukhazikitsidwa pansi pazoyang'anira kawirikawiri aimpso, potaziyamu, sodium m'magazi a magazi mankhwala a hemodialysis).

Ndi wolimbitsa ochepa matenda oopsa kukonzanso kwa nthawi yayitali ya 10-15 mg / tsiku akuwonetsedwa.

Kulephera kwa mtima kosatha - kuyamba ndi 2,5 mg 1 nthawi patsiku, kenako kuwonjezeka kwa mlingo wa 2,5 mg pambuyo masiku 3-5, monga momwe mungathandizire tsiku lililonse la 5-20 mg. Mlingo sayenera kupitirira 20 mg / tsiku.

Mwa okalamba, kutchulidwa kochulukirapo komanso kosatha kwa nthawi yayitali kumawonedwa, komwe kumalumikizidwa ndi kuchepa kwa kuchuluka kwa lisinopril (ndikulimbikitsidwa kuti muyambe kulandira mankhwala ndi 2.5 mg / tsiku).

Pachimake myocardial infarction (monga gawo la mankhwala osakanikirana). Patsiku loyamba - 5 mg pakamwa, ndiye 5 mg tsiku lililonse, 10 mg pambuyo masiku 2 ndi 10 mg kamodzi patsiku. Odwala omwe ali ndi kuphwanya kwakumwa kwa myocardial, mankhwala ayenera kugwiritsidwa ntchito kwa milungu 6.

Kumayambiriro kwa mankhwalawa kapena masiku oyamba atatu pambuyo panjira yodwala kwambiri odwala omwe ali ndi kuthamanga kwa magazi (120 mmHg kapena kuchepera), mlingo wocheperako wa 2.5 mg uyenera kutumikiridwa. Pankhani ya kuchepa kwa kuthamanga kwa magazi (SBP pansipa kapena ofanana ndi 100 mm Hg), mlingo wa tsiku lililonse wa 5 mg ukhoza, ngati pakufunika, uchepetse kwakanthawi mpaka 2,5 mg.Pankhani ya kuchepa kwakanthawi kwa kuthamanga kwa magazi (SBP pansi 90 mm Hg. Art. Kuposa ola limodzi), chithandizo ndi Lisinoton ziyenera kusiyidwa.

Bongo

Zizindikiro (zimachitika pakumwa mlingo umodzi wa 50 mg): kuchepa kwa magazi, pakamwa pouma, kugona, kukodyeka kwamkodzo, kudzimbidwa, nkhawa, kuchuluka kwa kusokonekera.

Chithandizo: symptomatic chithandizo, iv madzimadzi makonzedwe, magazi kuthamanga, madzi-electrolyte bwino ndi matenda a omaliza. Lysinotone ikhoza kupukusidwa ndi hemodialysis.

Malangizo apadera

Zizindikiro zapadera. Nthawi zambiri, kutsika kwamphamvu kwa kuthamanga kwa magazi kumachitika ndi kuchepa kwamphamvu kwamadzimadzi chifukwa cha kukodzetsa, kuchepa kwa mchere mu chakudya, kudzimbidwa, kutsegula m'mimba, kapena kusanza. Odwala omwe ali ndi vuto la mtima losalephera limodzi ndi kulephera kwaimpso kapena popanda iwo, kuchepa kwamphamvu kwa magazi kumatheka. Nthawi zambiri zimapezeka kwa odwala omwe ali ndi vuto lalikulu la mtima, chifukwa chogwiritsa ntchito kuchuluka kwa kukodzetsa, hyponatremia, kapena vuto laimpso. Odwala otere, chithandizo ndi Lisinotone ziyenera kuyamba kuyang'aniridwa ndi dokotala (mosamala, sankhani mankhwalawa ndi mankhwala okodzetsa). Malamulo omwewo ayenera kutsatiridwa popereka mankhwala odwala omwe ali ndi matenda a mtima komanso kuchepa kwa magazi m'magazi, komwe kuchepa kwambiri kwa magazi kumatha kubweretsa kuphwanyidwa kwa myocardial kapena stroke. Kuchepa kwakanthawi kwa hypotensive si kuphwanya kumwa potsatira mlingo wotsatira wa mankhwalawa. Mukamagwiritsa ntchito Lysinotone mwa odwala ena omwe ali ndi vuto la mtima losalephera, koma ndi vuto labwinobwino kapena lotsika magazi, kuchepa kwa magazi kumatha kuchitika, zomwe nthawi zambiri sizikhala chifukwa chosiya kulandira chithandizo. Musanayambe chithandizo ndi Lysinotone, ngati kuli kotheka, sinthani sodium ndende ndi / kapena mupangitse kuchuluka kwa madzi otayika, yang'anirani mosamala momwe magawo a Lysinotone amayambira. Pankhani ya stenosis ya aimpso mtsempha wamagazi (makamaka pokhudzana ndi stenosis ya impso imodzi), komanso ngati mukulephera kuzungulira chifukwa chosowa sodium komanso / kapena madzimadzi, kugwiritsa ntchito Lysinotone kungayambitse vuto la impso. Sizingasinthe pambuyo popewa mankhwala.

Mu pachimake myocardial infarction. Kugwiritsidwa ntchito kwa mankhwala othandizira (thrombolytics, acetylsalicylic acid, beta-blockers) akuwonetsedwa. Lysinotone angagwiritsidwe ntchito molumikizana ndi pa / kumayambitsa kapena kugwiritsa ntchito njira zochizira matenda a nitroglycerin.

Opaleshoni yopangira opaleshoni / opaleshoni wamba. Ndi njira zambiri zopangira opaleshoni, komanso kugwiritsa ntchito mankhwala ena omwe amachepetsa kuthamanga kwa magazi, lisinopril, kutsekereza mapangidwe a angiotensin II, kungayambitse kuchepa kosadziwika kwa kuthamanga kwa magazi.

Odwala okalamba mlingo womwewo umatsogolera kuchuluka kwa mankhwalawa m'magazi, chifukwa chake, chisamaliro chofunikira chimafunikira pakukhazikitsa mankhwalawa, ngakhale kuti palibe kusiyana mu antihypertensive zotsatira za Lysinotone pakati pa okalamba ndi achinyamata. Popeza chiopsezo cha agranulocytosis sichingathetsedwe, kuwunika kwa chithunzi cha magazi kumafunika. Mukamagwiritsa ntchito mankhwalawa pansi pa dialysis ndi membrane ya polyacrylonitrile, mankhwalawa amatha kuchitika, motero, tikulimbikitsidwa kuti mitundu ina ya membrane wa dialysis, kapena poika ma antihypertensive agents ena.

Palibe zambiri pazokhudzana ndi lisinopril, omwe amagwiritsidwa ntchito pochiritsa Mlingo, pa kuyendetsa magalimoto ndi maginito, komabe, ziyenera kukumbukiridwa kuti chizungulire nchotheka, motero muyenera kusamala.

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

Mapiritsiwo ndi ozungulira, biconvex, pinki wowala bwino, wokhala ndi mphako, wokhala ndi mainchesi 7 mm.

Othandizira: mannitol, calcium phosphate disubstituted dihydrate, pregelatinized chimanga wowuma, croscarmellose sodium, magnesium stearate, utoto (E172).

Ma PC 10 - matuza (2) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.

Zotsatira za pharmacological

ACE inhibitor ndi polypeptidase yomwe imathandizira kusintha kwa angiotensin I kuti angiotensin II. Angiotensin II imayambitsa vasoconstriction ndipo imathandizira kubisalira kwa aldosterone.

Kuponderezedwa kwa ACE kumabweretsa kuchepa kwa ntchito ya vasoconstrictor ndi kuchepa kwa secretion ya aldosterone. Zotsatira zake, kuchuluka pang'ono kwa seramu potaziyamu ndikotheka. Odwala omwe ali ndi matenda oopsa komanso matenda a impso wamba, kulandira lisinopril wokha kwa masabata opitilira 24, kuchuluka kwa serum potaziyamu kunali pafupifupi 0,1 meq / L. Komabe, pafupifupi 15% ya odwala adawonetsa kuwonjezeka kwa kuposa 0,5 meq / l ndipo pafupifupi 6% adawonetsa kuchepa kwaopitilira 0.5 meq / l. Pakufufuza komweko, odwala omwe amalandila lisinopril ndi hydrochlorothiazide kwa masabata opitilira 24 adawonetsa kuchepa kwapakati pa serum potaziyamu ya 0,1 meq / l, pafupifupi 4% yaiwo akuwonetsa kuwonjezeka kwa kuposa 0,5 meq / l, ndi pafupifupi 1.2% kutsika kwa oposa 0,5 meq / l.

ACE ndi ofanana ndi kininase, enzyme yomwe imawononga bradykinin. Udindo wamagulu okwera a bradykinin (omwe ali ndi katundu wa vasodilating) panthawi yamankhwala osakanikirana ndi lisinopril samamveka bwino ndipo amafunikira kuti apitirize kuphunzira. Ngakhale kuti mapangidwe amachepetsa kuthamanga kwa magazi panthawi ya chithandizo ndi lisinopril makamaka chifukwa cha kuletsa kwa renin-angiotensin-aldosterone dongosolo, lisinopril imakhalanso ndi vuto loti lingachitike kwa odwala omwe ali ndi matenda oopsa kwambiri. Ngakhale lisinopril imakhala ndi antihyperturant odwala mu mitundu yonse, odwala omwe ali ndi vuto loti azitha kusintha - oimira amtundu wakuda (anthuwa amadziwika ndi gawo lotsika la renin) amawonetsa kuyankha kotsika kwa monotherapy kuposa odwala amitundu ina. Kugwiritsa ntchito nthawi imodzi ya lisinopril ndi hydrochlorothiazide kumathandizanso kuthamanga kwa magazi mwa odwala - oyimira akuda ndi mitundu ina, chifukwa chomwe kusiyana kwazomwe zimachitika chifukwa cha kusiyana mafuko kumatha.

Kugwiritsanso ntchito kwa lisinopril kwa ochepa matenda oopsa kumayambitsa kuchepa kwa kuthamanga kwa magazi pafupifupi kumlingo womwewo ndi ma supine, osayambitsa tachycardia. Matenda amtundu wa orthostatic nthawi zambiri samawonedwa, ngakhale kuti kupezeka kwawo ndizotheka, makamaka ndi kusowa kwamadzi kapena kusowa kwa electrolyte. Akaphatikizidwa ndi thiazide diuretics, mphamvu ya antihypertensive yamankhwala imatchulidwa.

Odwala ambiri, kuyambika kwa antihypertensive kanthu kumawonedwa pambuyo pa ola limodzi atatha kumwa mankhwalawa kamodzi, mphamvu yayikulu imachitika pambuyo pa maola 7. Mphamvu ya antihypertgency imapitilira kwa maola 24 mutatha kumwa mankhwalawa tsiku lililonse. Malinga ndi kafukufuku wina, pafupifupi, mphamvu yake imakhala yokhazikika komanso yowonjezereka pakumwa mankhwala 20 mg kapena kupitilira pomwe mukumamwa Mlingo wocheperako. Komabe, ndi mankhwala onse omwe amaphunziridwa, pafupifupi antihypertensive zotsatira zake zinali zochepa kwambiri pambuyo pa maola 24 kuchokera pakukonzekera kuposa maola 6.

Odwala ena, kuti achepetse kuthamanga kwa magazi, pangafunike kumwa mankhwalawa pafupipafupi kwa milungu iwiri.

Mphamvu ya antihypertensive ya lisinopril siyimachepa nthawi yayitali. Kuchotsedwa kwadzidzidzi kwa mankhwalawa sikupangitsa kuti magazi azithamanga (mwakuyerekeza ndi kuthamanga kwa magazi musanalandire chithandizo).

Kuchepa kwa kuthamanga kwa magazi kumachitika mwachangu komanso kutchulidwa mukamamwa mankhwalawa.

Kuchita bwino kwa lisinopril komanso mayendedwe ake ofanana ndi ofanana kwa odwala achinyamata komanso okalamba.

Mlingo

Ndi ochepa matenda oopsa, mlingo woyambirira wa mankhwalawa kwa odwala omwe sanalandire mankhwala ena a antihypertensive ndi 5 mg 1 nthawi / tsiku m'mawa. M'tsogolomo, kutengera mphamvu ya kuthamanga kwa magazi, Mlingo wa kukonza mankhwalawa ndi 10-20 mg 1 nthawi / tsiku. Mulingo woyenera kwambiri wa antihypertensive ungatheke pambuyo pa masabata 2-4 kuyambira pomwe mankhwalawa amayamba. Kuchulukitsa mlingo wa oposa 40 mg / tsiku sikuti nthawi zonse kumabweretsa kuwonjezeka kwa zotsatira. Pankhaniyi, kuphatikiza mankhwalawa kumalimbikitsidwa ndikusinthidwa kwa okodzetsa ochepa mlingo (potero kukhathamiritsa kwa kuchitapo kanthu). Pazipita mlingo tsiku lililonse sayenera kupitirira 80 mg. Odwala omwe adalandira diuretics m'mbuyomu, ayenera kuchotsedwa masiku 2-3 asanayambe kugwiritsa ntchito lisinotone. Mlingo woyamba wa tsiku lililonse mu milandu sayenera kupitirira 5 mg / tsiku. Mutatenga mlingo woyamba, kuyan'aniridwa kwa adokotala kumalimbikitsidwa mpaka kukhazikika kwa kuthamanga kwa magazi kumatheka.

Pakulephera kwa mtima, mankhwalawa amagwiritsidwa ntchito ngati gawo la zovuta zovuta nthawi imodzi ndi okodzetsa komanso / kapena mtima glycosides. Mlingo woyamba wa Lysinotone ndi 2,5 mg / tsiku m'mawa, m'tsogolomu umakulitsidwa pang'onopang'ono mpaka 5-10 mg 1 nthawi / tsiku. Mlingo wapamwamba tsiku lililonse ndi 20 mg.

Zochizira matenda am'mimba otupa kwambiri, lisinotone iyenera kugwiritsidwa ntchito ngati cholumikizira chithandizo chokwanira (kuphatikiza pamodzi ndi chizindikiro cha nitrate). Odwala omwe ali ndi hemodynamics yokhazikika, chithandizo chitha kuyambitsidwa mwa maola 24 atangoyamba zizindikiro za vuto la mtima. Mlingo woyamba wa Lysinotone ndi 5 mg, ndiye 5 mg pambuyo pa maola 24, 10 mg pambuyo maola 48 kenako 10 mg / tsiku.

Kwa odwala omwe ali ndi vuto lochepa kwambiri la magazi (osakwana 120 mm Hg) poyambira chithandizo kapena masiku atatu atangoyamba matenda a mtima, mlingo ndi 2,5 mg. Pamaso pa ochepa hypotension (systolic magazi pansipa 100 mm Hg), mankhwalawa tsiku lililonse sayenera kupitirira 5 mg ndipo ngati kuli kotheka, akhoza kuchepetsedwa mpaka 2,5 mg. Ndi kulimbikira kwamankhwala ochepa (kuchuluka kwa magazi a systolic osakwana 90 mm Hg kwa ola lopitilira ola), mankhwalawa ndi lisinotone ayenera kusiyidwa.

Kutalika kwa chithandizo ndi masabata 6. Mlingo wochepetsetsa kwambiri ndi 5 mg / tsiku. Ngati pali zizindikiro za kulephera kwa mtima, chithandizo chiyenera kupitilizidwa.

Odwala ndi mkhutu aimpso ntchito, mlingo umatsimikiza kutengera QC.