Kodi buprenorphine ndi tsogolo la mankhwala opweteka osatha?
Pa mtengo wamtengo wapatali, vuto la opioid ndi ululu wopweteka limatsutsidwa mwachindunji. Ngakhale kuti CDC imanena kuti "umboni wathanzi wa opioid wa nthawi yaitali wopanda ululu woperewera ndi chisamaliro cha mapeto a moyo umakhalabe wosakwanira, popanda umboni wochuluka wodalirika kuti upeze phindu la nthawi yaitali popanda mankhwala opioid," zenizeni kuti opioids ndi Njira yaikulu yothandizira kupweteka kosatha.
Ngakhale opereka chithandizo chapadera angapereke opioids kuti azimva ululu wosaneneka, iwo akukayikira kuchita zimenezo poopa kuwonjezera pa matenda odwala kapena kudalira. Madokotala ambiri omwe amatha kuchipatala amapeza chiyembekezo chopatsa odwala ma opioids kwa nthawi yaitali molimbikitsana ndipo mofulumira amatumiza odwalawa kupita ku akatswiri ovutika.
Ngakhale kuti sakufuna kuchiza, chisoni chochuluka chikuwonjezeka mobwerezabwereza. Mu 2010, anthu 31 pa anthu 100 aliwonse a ku America adamva kupweteka kosalekeza, komwe kumatanthawuza kuti ululu wopitirira miyezi itatu kapena isanu ndi umodzi. Chifukwa chakuti anthu ambiri omwe amamva kupweteka kosalekeza amapita kwa madokotala oyang'anira chisamaliro, zingakhale zopambana ngati titakhala ndi njira yodalirika komanso yothandiza kwa opioids-mankhwala ena omwe madokotalawa amamva bwino. Mankhwala otchedwa buprenorphine amatha tsiku lina kuthandizira ndalamazi.
Kodi Buprenorphine N'chiyani?
Buprenorphine ndi gulu la mankhwala otchedwa opioid osakaniza agonist-antagonists.
Kuwonjezera pa mankhwala ena omwe amaphatikizana ndi buprenorphine ndi naloxone (Suboxone), buprenorphine imagwiritsidwa ntchito ngati mankhwala opioid m'malo ochizira opioid (kudalira heroin kapena mankhwala osokoneza bongo). Mankhwalawa amagwira ntchito poletsa zizindikiro zowononga ngati munthu wodalira opioids amasiya kumwa opioids.
Buprenorphine ndizochokera ku opium alkaloid thebaine, yomwe imapezeka mu opium poppy ( Papaver somniferum ). Zinatenga zaka zambiri kuti ochita kafukufuku apangitse mankhwalawa, ndipo ambiri analephera kuyesa kampani ina ya Chingerezi itayipanga mu 1966. Pofika m'chaka cha 1978, buperrenaline inayamba kufotokozedwa mwatsatanetsatane, motsogoleredwa ndi zilembo zinayi (zolembedwa pansi pa lilime) iteration mu 1982. Mu 1985, buprenorphine inayambika ku United States ngati opioid analgesic.
Momwe Ikugwirira Ntchito
Buprenorphine ili ndi njira zenizeni zowonetsera zomwe zimapangitsa kuti zikhale zosavuta kokha kuchiza opioid kudalira koma mwina kupweteka kosalekeza, nayenso.
Choyamba, buprenorphine ili ndi mgwirizano wapamwamba wa μ-opioid receptor, yomwe imayambitsa kupuma kowawa. Komanso, buprenorphine imakhala yochepa pang'onopang'ono ya kusokonezeka kuchokera ku μ-opioid receptor, kutanthauza kuti imakhala yokhala nthawi yaitali kwa receptor, ndipo ili ndi zotsatira zake.
Chachiwiri, ngakhale buprenorphine imakonda kwambiri μ-opioid receptor, imangokhala ngati μ-opioid receptor agonist, zomwe zikutanthauza kuti ngakhale buprenorphine imalepheretsa opioid kuchoka, zochita zake sizowona bwino kuposa opioid.
Chachitatu, buprenorphine ndi wotsutsa wothandizira ochioid opioid.
Kuyambitsa zotsatira za κ-opioid receptor zotsatira za euphoric ndi psychotic za opioids. M'mawu ena, buprenorphine sichidzakupangitsani kukhala "okwera."
Ulamuliro
Monga tanenera kale, nalxone nthawi zambiri imakhala ndi buprenorphine monga mawonekedwe a Suboxone. Naloxone ndi wotsutsana ndi opioid receptor antagonist. Ngati mankhwalawa ali otsika kwambiri ndi buprenorphine, naloxone ikhoza kuthana ndi zotsatira zoopsa za opioid-kuphatikizapo kupuma, kupuma, ndi hypotension-popanda kuchepetsa kupweteka, kapena kupumula kwa ululu. Kuwonjezera apo, Kuwonjezera kwa naloxone kwa buprenorphine kumateteza ngati kugwiritsa ntchito mankhwala osokoneza bongo.
Malinga ndi NIH:
Buprenorphine imabwera ngati piritsi yolembera. Kuphatikizana kwa buprenorphine ndi naloxone kumabwera ngati piritsi yowonjezera (Zubsolv) komanso filimu yowonetsera (Suboxone) kuti ikhale pansi pa lilime komanso filimu [cheek] yomwe imagwiritsidwa ntchito pakati pa chingamu ndi tsaya.
Buprenorphine imabweranso mu chigawo chosinthika, kufotokozera mwachinyengo, ndipo, posachedwa, kupopera kwaling'ono. Mu December 2017, adalengezedwa kuti a FDA akuwongolera kutsogolo kwatsopano kuti athetse ululu waukulu.
Zotsatira Zotsatira
Ngakhale kuti si opioids, onse buprenorphine ndi Suboxone akhoza kukhala ndi zotsatira zoipa monga zotsatirazi:
- Ululu wammbuyo
- Masomphenya obisika
- Kutsekedwa
- Zovuta ndi kugona
- Chifuwa champhuno
- Mutu
- Kupweteka kwa m'mimba
- Kuwawa kwa malirime
Zotsatira zowopsa kwambiri, monga kupuma kupuma kapena kutupa kwa pakamwa kapena lilime, zimafuna chithandizo chamankhwala mwamsanga. Chofunika kwambiri, kusakaniza buprenorphine ndi mankhwala ena monga benzodiazepines akhoza kupha.
Buprenorphine for Chronic Pain
Mu ndondomeko yowonongeka yomwe inalembedwa mu December 2017, Aiyer ndi olemba anzawo anafufuza momwe buprenorphine ikuyendera kuti azisamalira kupweteka kosatha. Ofufuzawa anafufuza mayesero 25 omwe amachititsa kuti asagwiritsidwe ntchito:
- Intravenous buprenorphine
- Buprenorphine yamagulu
- Buloliyumu buprenorphine / naloxone (Suboxone)
- Buccal buprenorphine
- Transdermal buprenorphine
Kafukufukuyu, anapeza kuti maphunziro 14 mwa 25 amachititsa kuti buprenorphine m'chilankhulo chilichonse chikhale chothandiza kuchiza matenda aakulu. Zowonjezereka, maphunziro khumi mwa khumi ndi asanu (15) adawonetsa kuti transdermal buprenorphine inali yothandiza, ndipo maphunziro awiri mwa atatu adasonyeza kuti buccal buprenorphine inali yogwira mtima. Kafukufuku mmodzi yekha mwa asanu ndi limodzi adasonyezeratu kuti ubongo kapena mankhwala osagwiritsidwa ntchito molakwika amathandiza kwambiri kuchiza matenda aakulu. Chofunika kwambiri, palibe zotsatira zoyipa zomwe zinawonetsedwa mu maphunziro alionse, omwe amasonyeza kuti buprenorphine ndi yotetezeka.
Mu 2014, olemba mabuku ndi olemba anzawo adafalitsa ndondomeko yowonongeka yowona bwino za buprenorphine yeniyeni kuti athetse ululu wosatha. Ngakhale kuti maphunziro ambiri omwe adawafufuza anali osamalitsa komanso otsika kwambiri, ochita kafukufukuwo anapeza kuti buprenorphine yovomerezeka inali yogwira mtima pochiza kupweteka kosatha. Zowoneka kuti, Cote ndi olemba anzawo analemba mndandanda wa zotsatirazi za buprenorphine:
- Kuwonjezeka kowonjezereka mu ululu wa ubongo chifukwa cha mbiri yake yapadera ya mankhwala.
- Kusagwiritsidwa ntchito kwa okalamba ndi kuwonongeka kwa chiwindi chifukwa cha kuchepa kwake kwa hafu ya moyo ndi metabolites.
- Kuchulukanso kochepa poyerekeza ndi morphine ndi fentanyl pogwiritsa ntchito umboni wochepa wochokera kuzinthu zozizwitsa komanso zamaganizo.
- Kutentha kwapopopu ya kupuma kwapweteka pamene kugwiritsidwa ntchito popanda njira zina zamkati zamanjenje zosokoneza maganizo, mwinamwake chifukwa choti ntchito yoyamba yopanga analgesia ikhoza kukhala yochepa kuposa ya kupuma kwa maganizo.
- Zotsatira zochepa pa hypogonadism, monga momwe zasonyezedwera mu chithandizo chokonza.
- Zochepa zochepa zolekerera, mwinamwake kupyolera kutsutsana ndi kappa kapenanso opioid-receptor-like (ORL-1) agonism.
- Kuchuluka kwa antihyperalgesic, mwina chifukwa cha kutsutsana kwa kappa kapena ORL-1 agonism.
- Zomwe zimachititsa kuti odwala asamangodalira mankhwala ochiritsira.
Chochititsa chidwi, zimaganiziridwa kuti chifukwa cha zida zake, buprenorphine ikhoza kuthandiza anthu omwe ali ndi hyperalgesia.
M'nkhani yomwe ili ndi mutu wakuti "Kufufuza mozama za hyperalgesia ya opioid," Lee ndi olemba omwe amachititsa opioid-hyduced malingaliro monga awa:
Hyperalgesia (OIH) yotchedwa opioid-oduced hyperalgesia (OIH) imatanthauzidwa ngati mkhalidwe wothandizira kupweteka chifukwa cha opioid. Matendawa amadziwika ndi zovuta zomwe munthu wodwala kulandira opioid kuchiza kupweteka amatha kukhala ndi vuto linalake lopweteketsa. Mtundu wa ululu umene umakumana nawo ukhoza kukhala wosiyana ndi ululu womwe umakhalapo kapena ungakhale wosiyana ndi ululu wapachiyambi. OIH ikuwoneka ngati chinthu chodziwika bwino, chotsimikizika, komanso chodziwika chomwe chikhoza kufotokozera kuwonongeka kwa opioid mphamvu kwa odwala ena.
Zindikirani, ululu wopweteka kwambiri ndi ululu wakuthwa chifukwa cha kuwonongeka kwa gawo la thupi. Zikugodometsedwa kuti buprenorphine ili ndi zizindikiro zamagetsi.
M'nkhani ya 2014 yomwe inafalitsidwa mu Anesthesiology , Chen ndi alembi ena analemba izi:
Buprenorphine yasonyezedwa kuti isinthe hyperalgesia chifukwa cha opioids kupyolera mu 'antinciception' yotchedwa buprenorphine. ' Komanso, buprenorphine ndi wotsutsana ndi κ-receptor ndipo akhoza kupikisana ndi zotsatira za spinal dynorphin, agonist wokhala ndi κ-receptor. Chifukwa chakuti spinal dynorphin ikuwonjezeka pambuyo poonekera kwa opioid ndipo imapangitsa OIH, zotsatira za mpikisano wa buprenorphine pa tsamba la κ-receptor kumanga zingachepetse zotsatira za msana wam'mimba chifukwa cha kuchepa kwa OIH.
Kufotokozera Buprenorphine
Ku United States, buprenorphine imagwiritsidwa kale ntchito pochizira kupweteka kosatha. Suboxone inalembedwa kuchokapo-lemba pofuna kuchiza kupweteka kosatha. Komanso, transdermal buprenorphine chikwama chilipo kuti athe kuchiritsidwa kwambiri ku United States.
Komabe, palibe lingaliro lovomerezana pazothandiza kugwiritsa ntchito buprenorphine pachifukwa ichi. Pakalipano, kafukufuku wowerengeka omwe akuwona zotsatira za buprenorphine pa ululu wopitirira ndizosiyana kwambiri ndi njira zawo, ndipo zimakhala zovuta kufanizitsana.
Bungwe la buprenorphine lisanayambe kulandira kupweteka kwanthawi yaitali limakhala umboni wozikidwa pa umboni, nkhani zosiyanasiyana ziyenera kuthetsedwa. Mwachitsanzo, kafukufuku wamakono amagwiritsira ntchito miyeso yosiyanasiyana ya ululu pofufuza momwe ntchito ikuyendera ndikupereka kusanthula kosagwirizana. Mavuto a zowawa pamaphunziro pofufuza buprenorphine ayenera kukhala ovomerezeka. Kuwonjezera pamenepo, njira zowonetsera njira ndi kayendetsedwe ka kayendetsedwe ka kayendedwe kazitsulo ziyenera kuyesedwa pa zochitika zosiyanasiyana za ululu wosatha.
Ngati mankhwala a buprenorphine omwe amamva kupweteka kosaneneka amayamba kukhala owonetsetsa umboni, madokotala oyambilira amatha kusamalidwa chifukwa chochita zimenezi. M'chaka cha 2000, lamulo la mankhwala opatsirana pogwiritsa ntchito mankhwala osokoneza bongo la United States linapereka lamulo loti madokotala apite kuchipatala athandizidwe pogwiritsira ntchito mankhwala a odwala III, IV, ndi V. Mu 2002, chipani cha FDA chinachiza chithandizo chamagulu ndi buprenorphine, kuchiwonetsa ngati mankhwala a Pulogalamu III.
Zonse zomwe dokotala woyang'anira chisamaliro amayenera kuchita kuti athe kulamula buprenorphine mu malo omwe ali odwala ndi kumaliza maola asanu ndi atatu. Komabe, ochepa omwe amapereka chithandizo chapamwamba akhala oyenera kulandira buprenorphine.
Ngakhale kuti madokotala ambiri osamalidwa amatha kusokoneza malingaliro awo, sizingakhale zazikulu zedi kuganiza kuti madokotala oyamwitsa amatha kusamalira kupweteka kosatha kumagwiritsa ntchito buprenorphine. Kuwonjezera pa chisamaliro chapadera madokotala omwe ali ndi mphamvu zotumizira buprenorphine, CDC imakhalanso ndi malo ogwiritsira ntchito madokotala oyamwitsa kusamalira kupweteka kosatha ndi opioids.
Momwemonso, malangizo a CDC amavomereza kuti madokotala oyang'anira chisamaliro amapereka opioids kwa ululu wosapitirira kokha ngati mankhwala osagwiritsidwa ntchito opioid sali okwanira, ndi kupereka opioids pa mlingo wotsika kwambiri. M'nkhaniyi, buprenorphine ikhoza kutengedwa ngati njira ya opioid.
> Zotsatira:
> Aiyer R, et al. Chithandizo cha Kuvutika Kwambiri Ndi Buprenorphine Zosiyanasiyana Zolemba: Kufufuza Kwambiri pa Zomwe Amaphunziro Amaphunziro Opaleshoni. Anesthesia & Analgesia. 2017. [epub patsogolo pa kusindikiza]
> Chen KY, Chen L, Mao J. Buprenorphine-Naloxone Therapy mu Ulonda Wowawa. Anesthesiology. 2014; 120 (5): 1262-74.
> Cote J, Montgomery L. Buprenorphine Yophiphiritsira monga Analgesic in Chronic Pain: A Review Review. Kupweteka kwa mankhwala. 2014; 15: 1171-1178.
> Dowell D, Haegerich TM, Chou R. CDC Guide ya Kufotokozera Opioids kwa Matenda Ovuta - United States, 2016. MMWR. 2016; 65 (1): 1-49.
> Lee M, et al. Kubwereza Kwambiri kwa Hyperalgesia Yopanda Opioid. Pain Physician. 2011; 14 (2): 145-61.