"I-Phenytoin": imiyalelo yokusetyenziswa, imifanekiso, uhlobo lokukhululwa

Yintoni into efana ne "Phenytoin" Imigaqo yokusetyenziswa, izifaniso zamachiza kunye nesithako esisebenzayo ziya kuboniswa ngezantsi.

Iimpawu zeMichiza kunye nendlela yokukhululwa

"I-Phenytoin" kunye nenxalenye efanayo esebenzayo yisisifo se-antiepileptic. Yimvelaphi ye-hydantoin, efana ne-asidi ye-barbituric (kwisakhiwo sayo semichiza).

Ixabiso eliqwalaselwe ngolu hlobo luluhlu lwamachiza abalulekileyo be-WHO, kunye nolwahlulo lwamachiza abalulekileyo.

I-Phenytoin (umyalelo wokusetyenziswa kweziyobisi ngale nxalenye iza kuboniswa ngezantsi) yahlanganiswa ngowe-1908. Kwaye ngo-1937 kwafunyanwa iipropati zayo ze-anticonbulsant.

Le nto ingumgubo (i-crystalline) yombala omhlophe, okwenziwe ngokungafihla emanzini. Eli qulunqa lingachithwa kuphela kwi-1% izisombululo ze-alkalis caustic.

Okwangoku, iipilisi zomlomo ziveliswa "iPhenytoin", kwakunye neendlela zokulawulwa kwabazali.

Pharmacology

Isilwanyana "Phenytoin" sisebenza njani? Imiyalelo yokusetyenziswa ibonisa ukuba esi sixhobo sine-anticonbulsant, antiarrhythmic, anti-epileptic kunye ne-miorelaksiruyuschimi.

Umsebenzi we-anticonvulsant weli chiza uphakeme kakhulu. Nangona kunjalo, ukuwamkela kwakhe akubanga kubuthwa nokugwenxa.

I-Phenytoin ibizwa ngokuba yi-biologo-electric stabilizer. Xa uthatha amanyathelo aphezulu e-substance, kunokukhokelela ekuphuculeni ukuhambelana koluntu.

Oku kuthetha ukuba kusebenze i-CNS, iphakamisa umda wokuzikhupha, inomthelela we-antiarrhythm entliziyweni, kwaye iyanciphisa umlinganiselo wesigxina se- pulses ngasemva kwengubo ye-His and Purkinje fibers.

Inkqubo yesenzo sonyango

Sisiphi isiseko sezenzo zesilwanyana "iPhenytoin"? Umyalelo uthi umgaqo wempembelelo yawo emzimbeni womntu awuzange ufundwe ngokupheleleyo. Nangona kunjalo, iingcaphephe zithi isakhiwo esisisiseko solu cwangciso siyakwazi ukuzinzisa i-membranes (neuronal) kunye ne-cell cell.

Ngenxa yempembelelo, ukuthatha isibisi kunokunciphisa ukusasazeka kwe-excursion ye-neuronal, kunye nokunciphisa umsebenzi odibeneyo.

Izixhobo zesixhobo

Yintoni ephawulekayo malunga neziyobisi "iPhenytoin"? Imiyalelo yokusetyenziswa ikwazisa ukuba isicatshulwa sayo esishukumisayo sichaphazela i-ganglia yokuzimela, izicubu zengqondo kunye nomthambo womthambo, intliziyo, kubandakanywa nendlela yokuqhuba, imizila yeembilini kunye nemithambo ye-intestinal ye-muscle neye-heart.

Ukungenisa kwesi sidakamizwa kunokunciphisa uxinzelelo lwe-sodium kwi-neurons, ukuququzelela ukuthuthwa kwee-sodium kwiiseli, kwaye kuncitshiswe nokunyuswa kwe-calcium ye-intracellular.

Kufuneka kwakhona kuqatshelwe ukuba izidakamizwa ezichaphazelekayo zichaphazela umsebenzi we-fibroblasts, i-neuroglia kunye neeseli ze-endocrine. Kwakhona, amandla ayo okukhawulezisa ukuphilisa amanxeba, ukuphelisa umsebenzi we-receptors (glutamate), ukuphucula ukunikezelwa kwe-oksijini kwiiseli, izicubu kunye nezitho kwiimeko ze-toxin yetyhefu kunye ne-hypoxia.

Ukuthatha isicatshulwa kwizidakamizwa zonyango kunemiphumo ehambelanayo ye-tonic kwaye idibanisa, kwaye ayiyi kubangela ukuhlala.

Kinetics

Ingaba i-phenytoin ingumzimba? Imiyalelo yokusetyenziswa (uhlobo lokukhululwa kwegama elifanayo linikezwe ngasentla) lithetha ukuba xa kuthathwa ngomlomo, eli candelo lithathwa kalula ngumzimba wesigulane. Nangona kunjalo, iiparamitha ze-pharmacokinetic ze-arhente ebandakanyekayo zingahluka kakhulu kwiqela ezahlukeneyo zezigulane.

Ingxininkulu enkulu yeziyobisi egazini ifumaneka kwiiyure ezingama-5 ukuya kwe-14 (ukuya kwiiyure ezingama-28 zefomati). Umphumo wokulawulwa komlomo weliza ligcinwa emva kweyure, kwaye emva kokulawulwa kwe-intravenous - emva kwemizuzu embalwa.

Ngokwenene i-80% yesicatshulwa esisebenzayo ibopha kwiiprotheni ze-plasma zegazi. Kubantu abanesifo sezintso, esi sibonakaliso singafikelela kuma-43%.

Ngokomyalelo, i-arhente eqwalaselwa ngokukhawuleza iwela umqobo wegazi. Kule meko, ihanjiswa phantse kuzo zonke iisculi kunye namalungu.

Phantse i-5% ye-phenytoin idityaniswe yizintso. Ngokubhekiselele kumxube oseleyo, ulungelelaniswa esibindi, uguqulwe kuma-paraxyphenyls angasebenziyo kunye ne-glucuronides, ephuma emzimbeni kunye ne-bile.

Ndingayisebenzisa njani iPhenytoin? Ukusetyenziswa kwesi sidakamizwa kuboniswa kunye ne phenobarbital, iiVithamini D kunye neK, kunye nezinye i-antiepileptics. Kule meko kuya kuba yinkqubela phambili.

Iinkcazo

Kwiimeko ziphi iziyobisi ezisetyenziselwa isithako esinomsebenzi njenge phenytoin? Izikhokelo zokusetyenziswa (amacwecwe kunye nesisombululo esifaneleke ukuba zinconywe ngugqirha onolwazi) zibonisa ezi zilandelayo:

• Ukuxhamla;
• Ixesha emva kokuhlinzwa kunye noxinzelelo (njengesichengululo seprophylactic);
• Ama-arhythmias angama-ventricular kunye neentsika ezibangelwa ukugqithiseleka kwezinto ezixhasayo kunye ne-carlyac glycosides;
• Isimo sokuhlutha kwesifo kunye nokuhlaselwa okuyingxubevange kunye ne-tonic-clonic seizures;
• I-Meniere's syndrome;
• I-Neuralgia ye-nerginal nerves, kuquka nokuchasana ne-carbamazepine;
• I-ulcerative colitis okanye i-IBS (ukuba olunye unyango alusebenzi);
• Ukuphazamiseka kweenkqubo zengqondo, ukuphazamiseka kwengqondo, iingxaki zokuziphatha;
• Strabismus kunye ne glaucoma;
• Inkqubo ephazamisayo yokuvuselelwa (ukutshisa, i-caries, izilonda kunye ne-scleroderma);
• Umkhuhlane okhoyo kunye ne- hypothalamic syndrome.

Ukungqinelana

Esi sidakamizwa akufanele sisetyenziswe xa:

• I-cachexia okanye i-leukopenia;
• Ulungelelaniso;
• Izifo ezintle kunye nesibindi;
• Ukungaphumeleli kwentliziyo, ukukhuselwa kwe-AV ye-2 okanye yesithathu degree, i-bradycardia;
• Ukunyanzeliswa komzimba kwisithako esisebenzayo;
• Porphyria;
• I-Morgagni-Adams-Stokes syndrome;
• Ukukhulelwa.

Kwakhona, kufuneka unyathelwe kwizigulane ezinesifo sikashukela, utywala, kunye ne-lupus erythematosus okanye i-hyperthermia.

Iyeza "iPhenytoin": imiyalelo yokusetyenziswa

Umyinge walesi sonyango ukhethwe ngabanye, kuxhomekeke kwiminyaka yesigulane kunye nesifo.

Kwizifo ezingenayo isifo, umthamo kufuneka ube ngamaxesha amaninzi kunesixa sokuhluthwa. Iyeza elinefomathi ithathwa kuphela ngexesha lokutya.

Umtya wemihla ngemihla yezigulane zabantu abadala ziipilisi ezi-1-3 (zahlula zibe ngama-2-3 amanani). Ukuba kuyimfuneko, le mali ingeniswa kwiipilisi ezine ngosuku.

Isilinganiso esiphezulu sesilwanyana ngemini iipilisi eziyi-8. Ngelo xesha, isiguli sinokuthatha iipilisi ezintathu kuphela.

Xa uphatha abantwana abangaphantsi kweminyaka emi-5 ubudala, zi-tablet ezi-2 ¼ ngosuku. Kubantwana beminyaka emi-5-8-ngokulinganayo, kodwa ama-3 okanye amaxesha amane ngosuku.

Abantwana asele bafikelele kwiminyaka eyi-8, kucetyiswa ukuba banike iipilisi ezi-1-2 kwii-2 ezahlukileyo.

Ubungakanani bonyango olunesi sidakamizwa lugqitywe kuphela yingcali.

Imiphumo emibi

Ukusebenzisa iziyobisi nge phenytoin kunokubangela iziphumo ezingathandekiyo ezilandelayo:

• Ukunyuka kwesibindi, ukugqithisa kwe-korepodobnaya (kuyimfuneko ukucima eso sigqirha de ukuba uphawu lupheliswe).
• Eyona ntshukumo eyingozi kakhulu (engabonakaliyo), umkhuhlane, i-skin rashes enkulu, i-Stevens-Johnson syndrome, i-angioedema edema ye-erythema, i-hepatitis.
• I-hyperplasia yezinsini, i-macrocytosis, i-osteomalacia, i-anemia ye-megaplastic, i-thrombocytopenia, i-pancytopenia, i-hirsutism, i-anemia ye-hemolytic, i-lymphadenopathy.
• Izidalwa ezixhomekeke kumzimbeni we-system central neervous, i-nystagmus, i-fibrillation yomlomo kunye neenkophe, ukuxhalaba, i-ataxia, ukuxakeka, ukuthuthumela, ukusabalalisa, ukunyusa ukonakala, ukuvuthwa kwe-neuropathy (ukukhula kunye nokuthatha ixesha elide kwamanani amaninzi).
• I-Hypertrichosis, iimpawu zobuso ezinamaqhina, ukuchithwa kwegazi, ukulahleka kwesisindo, i-polyarthritis.

Kufuneka kwakhona kuqatshelwe ukuba ngomlinganiselo wokuqala, isigulane sinakho ukuvelisa iziphumo ezilandelayo: izifo zesisu, isisindo se-enzyme esinyukayo, isicashu, i-dyspepsia, i-gastralgia kunye ne-gastritis. Ukubonakala kweziphumo ezinjalo kunokuphetshwa ukuba uthathe i pilisi kuphela ngexesha lokutya.

Iimeko zokugqithisa

Ukusetyenziswa kwesi sigulo kumayeza aphezulu ixesha elide kunokukhokelela ekuphuhliseni i-ataxia, i-nystagmus, i-hyperkinesia, i-sensory neuropathy kunye ne-diplopia. Kwakhona, isigulane sinokubonisa ukunyuka kwe-stroke, i-hyperglycemia kunye ne-soporus.

Kufuneka kuqatshelwa ngokukodwa ukuba le nto ayinayo i-antidote ethile. Unyango kufuneka lwenziwe ngokwempawu ezibonakalisiweyo.

Ulwazi oluKhethekileyo

I-arhente ejongene nayo ayinakupheliswa ngokukhawuleza izigulane zenyama, kuba oku kungabangela ukuphuhliswa kwesifo se-retrait syndrome. Ukuba kuyimfuneko ukunqanda ukuyithatha (umzekelo, nge-allergies okanye i-hypersensitivity), kufuneka i-antiticonbulsant drug of different types should be used.

Unyango kunye nesicatshulwa esicatshungulwayo sinempembelelo kwinqanaba le-cholesterol, i-bilirubin, i- alkaline phosphatase, i- enzyme yesibindi, i-glucose, i-calcium kwi-serum yegazi kunye ne-hormone ye-thyroxin.

Njengoko kuchazwe ngentla, into ye phenytoin ixiliswe kwisibindi, ngenxa yoko, ngexesha lolawulo lwayo, kunyamekelwa unyango olukhethekileyo kubantu abanokuphelelwa ngamandla.

Ukuba umntu uye wafumana uvelwano olukhulu kwi-hydantoin anticonvulsants, ngoko ke le nto inokuthi iyancipha.

Ngethuba lokunyanga, isiguli asivunyelwe ukuqhuba imoto, kunye nokwenza imisebenzi enobungozi.

Iingxoxo kunye nokuhlaziywa

Yintoni enokuthi ithathe indawo ye-antiepileptic drug "Phenytoin"? Ii-Analog ze-arhente ziqukethe into efanayo esebenzayo. La mayeza afaka oku okulandelayo: "I-Diphenin", "iDiphenylhydantoin" kunye ne "Dilantin".

Uninzi lweengxelo zezigulane zezidakamizwa zilungile. Bathetha ukuba le nkunkuma idluliselwa kalula. Ukongezelela, inenani elincinci kwaye alilahlekelwa iipropati zayo ze-anticonvulsant nangona kufakwa ixesha elide.

Kufuneka kwakhona kuqatshelwe ukuba kukho iimbono ezintle malunga nale nyeza ukuba izigulane ezithatha njengenxalenye yonyango oluyinkimbinkimbi.