Kuchokera ku anti-inflammatories kupita ku opioids ndi anti-depressants ndi zina zambiri, mitundu yambiri ya mankhwala imalangizidwa chifukwa cha kupweteka kumbuyo ndi kumutu. Ambiri amapereka zosowa zowawa zina, koma kuthekera kosautsa, komanso ngakhale zoopsa, zimayambira pamenepo.
Nkhaniyi ikufanizira mankhwala awiriwa - COX-2 inhibitors ndi opioids.
Mavitamini a Cox-2 - Celebrex, Vioxx ndi Bextra
Mankhwala a Cox-2 ndi mtundu wa mankhwala osagwiritsidwa ntchito poletsa kupweteka (NSAID) omwe amagwiritsidwa ntchito popweteka kwambiri, nyamakazi zosiyanasiyana komanso kupweteka kwa msambo.
Zimasiyana ndi mankhwala monga aspirin, Aleve, Motrin ndi zina zotero zomwe zochita zawo zimakhudzidwa kwambiri.
Asayansi ndi madokotala amadziwa kuti ululu umachitika chifukwa cha zinthu zotchedwa prostaglandins. Prostaglandins, inenso, imapangidwa m'thupi ndi michere iwiri yowonjezera (iliyonse ili ndi zotsatira zosiyana), zomwe ndi COX-1 ndi COX-2. Akatswiri amtunduwu amadziwanso kuti prostaglandin makamaka imayambitsa kupweteka, kutupa ndi kutupa zimangotulutsidwa ndi mankhwala a COX-2.
Kusiyana kwakukulu pakati pa mankhwala osamva kupweteka kwambiri (kupatulapo mitundu yosiyanasiyana ya NSAID) ndi COX-2 inhibitors ndi kuti pamene ma NSAID amaletsa zochita za COX-1 ndi COX-2 michere, COX-2 inhibitors, monga dzina limatanthawuzira, khalani chete COX-2s.
Vutoli ndilopoperatu mankhwala a COX-2 achotsedwa pamsika. Ichi ndi chifukwa chakuti anapezeka kuti akuwonjezera chiopsezo cha zochitika za mtima (zamtima ndi zikwapu) zikagwiritsidwa ntchito patapita nthawi.
Vioxx (dzina loti rofecoxib) ndi Bextra (dzina lotchuka valdecoxib) adachotsedwa kumsika kumayambiriro kwa zaka za 2000. Vioxx anapangidwa ndi Merck, ndipo Bextra anapangidwa ndi Pfizer.
Imene imasiya masamba ena a Pfizer a COX-2 inhibitor, Celebrex (dzina lachibadwa celecoxib.)
Monga mankhwala okhawo atatu a COX-2 omwe amatayika pa msika wa US, Celebrix ndi celecoxib tsopano amabwera ndi "chenjezo la bokosi lakuda," lomwe liri chizindikiro chodziwika bwino kuti chikuchenjezeni ku zovuta zokhudzana ndi chitetezo cha mankhwala .
Madokotala omwe amapereka Celebrex aphunzitsidwa ndi FDA kuti akupatseni malangizo a ma ARV, omwe amawunikira mauthenga owopsa ndi mlingo.
Ngati mukudabwa kuti ndi chiyani chomwe mungatenge kupatula Celebrex, ndemanga ya 2013 inapeza kuti zonsezi sizinasankhidwe, naproxen (Aleve) mwachiwonekere imayambitsa vuto la mtima kwa odwala. Olemba ovomerezeka amalangiza kuti zonse zomwe mumagwiritsa ntchito ndi NSAID, kuti muchite zimenezi pamtingo wotsikirapo, ndipo nthawi yaying'ono ingatheke.
Dziwani kuti mitundu ina ya NSAIDS, mtundu womwe umaletsa ma volimoni awiri a COX-1 ndi COX-2, ingapangitse chiopsezo cha matenda a mtima kapena kupwetekedwa mtima. Ndipotu, mu 2015, a FDA adalamula mawu pa malembo onse a NSAID (kuphatikizapo Celebrex, kokha kokha COX-2 inhibitor) kuti asinthidwe kuti awonetse kufufuza kwatsopano komwe kunapeza kupweteka kwa mtima ngakhale masabata atayamba mankhwalawa, kuti ngati mutagwiritsira ntchito mankhwalawa, chiwopsezo chikhoza kukhala chachikulu.
Opioids for Back or Meck Pain
Opioid ndi kalasi ya mankhwala opweteka omwe amatha kupereka mpumulo wamphamvu kwambiri. Ma opioids amagwiritsidwa ntchito popweteka kwambiri, koma madokotala nthawi zina amapereka mankhwala oyamba omwe amachititsa ululu wowawa.
Vuto ndilo, mtundu uwu wa kupweteka kumathandizira ndi mankhwala osokoneza bongo, omwe amatanthauza kuti amabwera ndi kuthekera kwauchidakwa.
Odwala ena amapanga kulekerera, zomwe zingachititse kuti munthu azidalira thupi, ndipo pamapeto pake amatha kuledzera.
Mankhwala ena a opioid ndiwo mankhwala osokoneza bongo, pamene ena akuphatikizidwa ndi kuchepetsa kupweteka kwambiri monga Tyelnol. Opioids amachitidwa ngati ochepa, ndipo akhala akuchita nthawi yaitali.
Ngakhale kugwiritsidwa ntchito kwa opioid kwa ululu ndi kupweteka kumbuyo kuli kufalikira, umboni siwunikira kuthandizira izi. Buku lina la British Medical Journal linanena kuti ma opioid tsopano ndi mankhwala omwe amaperekedwa kwambiri ku United States.
Izi zanenedwa kuti, opioids samawoneka kuti amathandiza anthu kubwerera kukagwira ntchito mofulumira kuposa mitundu ina ya mankhwala opweteka kumbuyo, komanso samapanga zotsatira za chisamaliro chachikulu cha ululu wammbuyo.
Ngati kupweteka kwanu kumbuyo kulibe, opioids sangakhoze kukuchitirani kanthu kali konse. Wolemba wobwereza anapeza umboni wochepa wosonyeza kuti amagwira ntchito imeneyi.
Pogwiritsa ntchito chiopsezo chotere, opioids amabwera ndi zotsatira zina monga kudzimbidwa, kusagonana ndi kuvutika maganizo, kutchula owerengeka chabe.
Opioid imayambanso kuyambitsa malonda omwe amachititsa kusocheretsa. Mtundu umodzi wa opioid, OxyContin, unayesedwa ngati "zotetezeka" zowonongeka ndi oimira kampani mu ntchito yapadera yofalitsira. Koma akuluakulu apamwamba a Purdue Pharma, opanga OxyContin, pambuyo pake adavomereza kukhoti kuti zonenazo zinali zabodza komanso zonyenga.
COX-2 Inhibitors vs Opioids - Ganizani Musanatenge
Mukamaganizira kapena kuuzidwa mankhwala opweteka, ganizirani za mavuto omwe angakhalepo chifukwa chowutenga. Mutha kukhala kuopsa kwa matenda a mtima kapena kukwapulidwa, kapena kukhala ndi chizoloŵezi cha mankhwala opweteka (nthawi zambiri).
Kumbukirani, nthawi zambiri kusuntha thupi lanu kungakuthandizeni ndi kupweteka kumbuyo, kubwezeretsanso ntchito komanso kusintha moyo wanu. Kupitako kangapo ndi wodwala zakuthupi kungakhale zonse zomwe mukufunikira kuti mutenge moyo wanu.
> Chitsime:
> Deyo, R., ndi. al. Opioids chifukwa cha kupweteka kochepa. Kupititsa kuchipatala. State of the Art Review. Jan 2015. http://www.bmj.com/content/350/bmj.g6380
> Nissen, S., ndi. Al., Mtima wa Mtima wa Celecoxib. N Engl J Med. Nov 2016. http://www.jwatch.org/na42802/2016/11/14/cardiovascular-safety-celecoxib
> Pawlosky, N. Mavuto a mtima Amagulu onse a NSAID ali ofanana? Kodi Pharm J. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676195/
Vioxx ndi Cox-2 Inhibitors
Ma cox-2 inhibitors monga Vioxx, Celebrex ndi Bextra ndi mtundu wa NSAID, kapena mankhwala osagwiritsidwa ntchito poletsa kutupa. Zinachitika m'ma 1990s chifukwa cha zotsatira za NSAIDS .
Chifukwa chakuti ali m'banja lomweli la mankhwala, onse omwe amachititsa kuti mankhwala a Cox-2 azikhala mofanana kwambiri. Choncho, odwala omwe amagwiritsa ntchito Vioxx kapena Bextra ndi Celebrex angakhalebe pachiopsezo cha mtima.
Ngakhale kuti sizili zotetezera Cox-2, ma NSAID ena omwe amachititsa ngozizi ndi Motrin, Naprosyn, Voltaren ndi Mobic.
Opioids
Ma opioids amagwiritsidwa ntchito mopweteka kwambiri. Kuwonjezera pa ululu wopweteka kwambiri, opioids amathandizidwanso mukamamva ululu wa khansa, ululu wa mitsempha ndi zina.
Opioid ndikumva kupweteka kwakukulu; Morphine ndi chitsanzo chabwino kwambiri cha opioid, ngakhale kuti pali mitundu yambiri yochokera kuchitidwe wofatsa mpaka wamphamvu. Zitsanzo ndi OxyContin, codeine, Darvon ndi Vicodin.
Opioids ali ndi zotsatira zambiri, kuphatikizapo kuthekera kwa:
- kupsinjika maganizo
- kudzimbidwa
- chiopsezo chodalira komanso kuledzera
Chosavuta chodziwika bwino cha opioids monga mankhwala opweteka ndizokhoza kuledzera ndi kudalira. Kafukufuku amasonyeza kuti OxyContin, makamaka, ndi "chipata" chakumwa mankhwala osokoneza bongo. Nthawi zina, odwala akhoza kukanidwa mankhwalawa chifukwa choti sakumvetsetsa, ndipo amawoneka kuti akhoza kukhala a morphine (kapena ena opioid).
Zotsatira
Mukamagwiritsidwa ntchito bwino , phindu la kutenga opioid za ululu ndi lamphamvu kusiyana ndi zoopsa. Opioids ndi othandiza kwambiri popuma kupweteka. Ndipo ofufuza ambiri, mabungwe olamulira a zamankhwala, ndi madokotala amakhulupirira kuti opioids ndi ofunika kudziŵa chithandizo cha kupweteka kosatha. Koma monga ndi chisankho chilichonse chamankhwala, gwiritsani ntchito ndi dokotala ndi anthu ena ogwira ntchito zaumoyo kuti mupeze njira yabwino kwa inu.
Chitsime:
Mafunso ndi Mayankho.FDA Zochita Zowonetsera Zokakamiza za COX-2 Zosankha ndi Zosasankha Zopanda Kuvulaza (NSAIDs). FDA. April 7, 2005.
Brasseur, L. Kukambitsirana za mankhwala apakono omwe amachititsa ululu. Mankhwala. 1997.
Cicero, TJ, Inciardi, JA, Munoz, A. Makhalidwe ogwiritsira ntchito Oxycontin ndi zina zotere za opioid ku United States 2002-2004 JPain Oct. 2005.
Grau, LE, Dasgupta, N., Harvey, AP, Irwin, K., Givens, A., Kinzley, ML, Heimer, .. Kugwiritsa ntchito opioids: Kodi OxyContin ndi "chipata" mankhwala? AmJ Addict May-June 2007.