Amiodarone

Yogwira mtima, koma yoopsa kwambiri

Amiodarone (Cordarone, Pacerone) ndi yogwira mtima kwambiri, ndipo ndithudi mankhwala osokoneza bongo omwe ndi opambana kwambiri. Ngati dokotala akufuna kuti mutenge mankhwalawa kuti mukhale ndi mtima wokhala ndi mtima , mumayenera kumvetsetsa zovuta zowonjezereka.

• Werengani za mankhwala osokoneza bongo.

Zochitika Zachilendo za Amiodarone

Amiodarone ali ndi makhalidwe angapo omwe amachititsa kuti ikhale yapadera pakati pa mankhwala osokoneza bongo - ngakhale pakati pa mankhwala ambiri.

Choyamba, pamene atengedwa pakamwa, amiodarone amatenga masabata kuti apindule kwambiri, ndi chifukwa chosazolowereka. Ngakhale kuti mankhwala ambiri amapezeka m'magazi kwa kanthawi mpaka atagwiritsidwa ntchito mophatikizapo mankhwala kapena osakanizidwa, amiodarone amasungidwa mu matupi a thupi. Zotsatira zowonongeka za mankhwalawa sizingatheke mpaka minofu imakhala yokhutira mokwanira ndi amiodarone. Choncho mankhwalawa ayenera "kusungidwa" asanakhale opambana kwambiri. Chizolowezi cha "loading" regimen cha amiodarone chikanakhala kugwiritsa ntchito mlingo waukulu wa mlungu umodzi kapena awiri, ndipo yesani mlingo pa mwezi wotsatira kapena kotero. Si zachilendo kupatsa anthu 1200 kapena 1600 mg tsiku ndi tsiku, kenako, kuti akhalebe ndi 100 kapena 200 mg tsiku (pamlomo).

Amiodarone imatha kuperekedwanso mwachangu pamene mankhwala a arrhythmia ndi ofunika kwambiri, ndipo zotsatira zake zimayenda mofulumira kwambiri ndi njira iyi. Komabe, kusinthika kwa mankhwala oyenera m'thupi kumayenera kuchitidwa mosamala, chifukwa chakuti mankhwala osokoneza bongo amatha kukhala "olemedwa" kwa nthawi yaitali.

Chachiwiri, amiodarone imasiya thupi kwambiri, pang'onopang'ono. Sichidasokonezedwa ndi chiwindi kapena impso. (Amiodarone imagwiritsidwa ntchito mophiphiritsira ku chiwindi ndi deethylamiodarone, yomwe ili ndi mankhwala ofanana ndi amagazi ndi a poizoni monga amiodarone, omwe amakhalanso m'thupi kwa nthawi yayitali.) Kwa mbali zambiri, amiodarone ndi metabolites ake amachotsedwa thupi maselo a amiodarone amatayika - monga maselo a khungu, kapena maselo ochokera m'matumbo a m'mimba, omwe amakhetsedwa ndi mamiliyoni tsiku lililonse.

Izi, mwachiwonekere, ndizozitali, pang'onopang'ono.

Choncho, ngati zatsimikizirika kuti ndi bwino kuimitsa amiodarone (chifukwa cha zotsatira zake, mwachitsanzo) mankhwalawa amakhalabe mu thupi muyezo woyerekeza kwa nthawi yayitali pambuyo poti mlingo womaliza watengedwa. "Hafu ya moyo" ya amiodarone, mosiyana ndi mankhwala ena ambiri, imayesedwa mu masabata mmalo mwa maola.

Chachitatu, chifukwa amiodarone imasungidwa m'matenda osiyanasiyana m'thupi, ikhoza kubweretsa zotsatira zokhudzana ndi ziwalo zosiyanasiyana. Zina mwa zotsatirazi zingatenge miyezi kapena zaka kuti zikhalepo, kotero aliyense amene amamwa mankhwalawa ayenera kukhala maso nthawi zonse.

Chachinai, amiodarone amagwira ntchito m'njira zosiyanasiyana, mosiyana ndi mankhwala ambiri. Amagwiritsidwa ntchito m'magulu awiri a mankhwala osokoneza bongo (Kalasi Woyamba ndi Gawo III, zomwe zili zoyenera). Zimakhala ngati beta blocker komanso calcium blocker . Amachepetsa mitsempha ya mitsempha, ndipo nthawi zambiri amachititsa "kuletsa" zotsatira za mahomoni a chithokomiro. Zonsezi zimapangitsa kuti athe kuthana ndi arrhythmias, ndipo mwina chifukwa cha amiodarone yodabwitsa kwambiri.

Zovuta za Amiodarone

Zotsatira za mankhwala a amiodarone nthawi zambiri amatenga masabata kapena miyezi (kapena ngakhale zaka) kukula, kotero aliyense amene amamwa mankhwalawa ayenera kukhala tcheru ngati mankhwalawa akugwiritsidwa ntchito.

Kuonjezera apo, zotsatira zake za amidodarone zimakhala zachilendo kwambiri kwa mankhwala osokoneza bongo - kapena mankhwala alionse okhudza mankhwalawa. Pazifukwazi, pamene amiodarone atangoyamba kugwiritsidwa ntchito kuchipatala, zinatenga zaka zopitirira khumi kuti madokotala adziwe kuti zizindikiro zambiri zachilendo zomwe anali kuziwona zinali chifukwa cha amiodarone. Mpaka lero, madokotala nthawi zambiri samalephera kuyang'anitsitsa odwala awo kutenga amiodarone nthawi yaitali, komanso mwakhama, kuzindikira kuti mankhwalawa akubweretsa mavuto.

• Werengani mbiri yachilendo ya amiodarone .

Nazi zina mwa zotsatira zosiyana kwambiri zomwe zingaoneke ndi amiodarone:

• Amiodarone kaŵirikaŵiri imayambitsa ma depositi kupanga maso, omwe nthawi zambiri amatsogolera ku "halo-masomphenya," pamene kuyang'ana nyali zowala usiku kuli ngati kuyang'ana mwezi pamadzulo usiku.
• Amiodarone ingayambitse kusokoneza (ndipo mwinamwake kosatha) kutuluka kwa khungu lakuda buluu, makamaka kumadera a dzuwa.
• Amiodarone kawirikawiri imathandiza khungu kuti liziwotcha dzuwa, kotero kuti ngakhale kutentha pang'ono kungachititse kuti kutentha kwa dzuwa kukhale koopsa.
• Amiodarone ingayambitse matenda a chithokomiro, onse otchedwa hypothyroidism (otsika chithokomiro) ndi hyperthyroidism (kutentha kwa chithokomiro.) Matenda a chithokomiro amavuta kwambiri ndi amiodarone, ndipo akhoza kukhala ovuta kuzindikira ndi kuchiritsa mosavuta. Pachifukwa ichi, odwala omwe amamwa mankhwalawa ayenera kuyang'anitsitsa chithokomiro chawo nthawi zonse. Werengani zambiri zokhudza amiodarone ndi chithokomiro.
• Amiodarone ingayambitse chiwindi, kotero kuti mapuloteni a chiwindi ayenera kuyang'aniridwa nthawi ndi nthawi.
• Amiodarone ingayambitse mtundu wambiri wa asidi reflux disorder .
• Mbali yowopsya kwambiri ya amiodarone ndi poizoni wa poizoni. Izi zingatenge mitundu yosiyanasiyana. Kungatenge mawonekedwe a matenda a mapapu amphamvu omwe amachititsa odwala kudwala kwambiri, amafuna chisamaliro chokwanira, ndipo nthawi zambiri amatha kufa. Kapena, zingayambitse zina zowonongeka, pang'onopang'ono, zosazindikirika, "kuuma" kwa mapapo omwe dokotala ndi wodwala angathe kuziganizira kufikira kuopsa, mwinamwake kusokonezeka kwa mapapo kumapiri. Werengani zambiri za amiodarone poizoni poizoni.

Kodi Amiodarone Iyenera Kugwiritsidwa Ntchito Liti?

Chifukwa cha zovuta komanso zoopsa za kugwiritsa ntchito amidodarone, mankhwalawa ayenera kugwiritsidwa ntchito mwa anthu omwe arrmthmias ali oopsya moyo kapena osokoneza moyo, komanso palibe mankhwala ena othandiza. Ngakhale zili zovuta, komabe amiodarone ndi yodabwitsa kwambiri, ndipo yathandiza kubwezeretsa zikwi zambiri za anthu zomwe zimalepheretsa arrhythmias kukhala ndi moyo wamba.

Mawu Ochokera

Pogwiritsidwa ntchito moyenera, amiodarone ikhoza kukhala phindu lalikulu kwa anthu omwe ali ndi arrhythmias mtima wamtima. Koma chifukwa cha mphamvu zake zowononga, ntchito yake iyenera kukhala yochepa. Dokotala aliyense yemwe amalembetsa kuti amododarone amuthandiza wodwala wake kukambirana mosamala za mavuto omwe angadzachitike ndi mankhwalawa, ndipo ayenera kudzipereka kukhala wothandizana nawo nthawi yaitali, ndikuwongolera mosamala zotsatira zatsopano, malinga ngati mankhwala odabwitsa awa akugwiritsidwa ntchito.

> Zotsatira:

> Goldschlager N, Epstein AE, Naccarelli GV, et al. Buku lothandizira odwala omwe amachiza odwala ndi amiodarone: 2007. Heart Rhythm 2007; 4: 1250.

> Vassallo P, Trohman RG. Kufotokozera Amiodarone: Umboni Wowonongeka wa Zochitika Zachilendo. JAMA 2007; 298: 1312.