Maphunziro a Ma ARV Ototoxic
Ototoxicity amatanthauza kuwonongeka kwa mankhwala komwe kumakhudza khutu lamkati. Zowonongeka zikhoza kukhala zamuyaya kapena zazing'ono, zopangitsa kumva kutayika kapena kusokonezeka maganizo. Ngakhale mankhwala atengedwa kuti apindule, mankhwala onse amakhala ndi zotsatira zomwe muyenera kuzidziwa musanatenge. Kumva kutayika komwe kumakhudzana ndi kudya mankhwala ototoxic ndi chifukwa chimodzi chomwe dokotala wanu angakulereni kumwa mankhwala mogwirizana ndi moyo wachisokonezo.
Kumva kutaya nthawi zambiri kumagwirizanitsidwa ndi magulu asanu ndi limodzi a mankhwala. Zotsatirazi zikhoza kugwirizanitsidwa ndi kuwonongeka kwakumvetsera kwamuyaya:
- Aminoglycoside maantibayotiki
- Platinum-based chemotherapy
Mankhwala omwe amachititsa kuti amve kuchepa kwafupipafupi:
- Loop diuretics
- Quinine
- Salicylates
- Vinca alkaloids
Mankhwala ambiri omwe tatchula pamwambawa akhoza kuvulaza impso (nephrotoxic) ndipo amafuna dokotala kuti awonetse magazi anu nthawi zonse kuti ayese ntchito ya impso. Mukawona kusintha kulikonse mukumva kwanu, nthawi zonse muyenera kupeza thandizo kuchokera kwa dokotala wanu.
Kuopsa kwa Ototoxicity
Kufala kwa ototoxicity sikunatchulidwe bwino, komabe kuwonongeka kosakhalitsa ndi kosatha ku ototoxicity kumadziwika. Mankhwala ena amadziwa zambiri kuposa ena ndipo adzafotokozedwa m'magawo awo. Mofananamo palibe kumvetsetsa kochuluka pa momwe mungapewere ototoxicity kuti zisadzachitike.
Mankhwala ena omwe ali ndi chiopsezo chowonjezeka cha ototoxicity monga mankhwala ena ophera maantibayotiki adzafuna ntchito ya magazi kudziwika kuti "nsonga ndi chigwa". Nthendayi ndi mlingo wa mankhwala pamene iyenera kukhala pamtendere wambiri m'magazi. Chidebe ndi mlingo wa mankhwala pamene ziyenera kukhala zovuta kwambiri.
Pamene kuyang'anitsitsa izi kungathandize kukhalabe ndi zotsatira zochizira, sizikutitsimikizira kuti simudzakhala ndi vuto la ototoxicity.
Zinthu zina zomwe zingapangitse ototoxicity ndi izi:
- mlingo, kutalika kwa chithandizo, ndi ndalama zonse zomwe analandira
- impso kulephera
- kutenga mankhwala ena ototoxic panthawi yomweyo
- chibadwa cha mtundu wa ototoxicity
Zizindikiro zokhudzana ndi Ototoxicity
Zizindikiro zokhudzana ndi ototoxicity zimadalira kwambiri mbali ya khutu lamkati lomwe lawonongeka. Kuwonongeka kwa khutu lamkati kukhoza kuchitika kwa cochlea yako (yotchedwa cochleotoxicity) kapena zovuta zanu zovala (zotchedwa vestibulotoxicity). Pazochitika zonsezi, zizindikiro zonse zimakhudzana ndi maselo osokonezeka.
Ngati nkhuku yanu yowonongeka, kumva kwanu sikudzatha. Kuchuluka kwa vutoli kumagwirizana molingana ndi kuwonongeka kumene kumachititsa kuti thupi likhale lofewa pofuna kuthetsa kutaya kwa kumva . Kutaya kumvetsera kungakhudze kumodzi kapena onse awiri.
Ngati ototoxicity imakhudza zovuta zowonongeka, kulingalira kwanu kumakhudzidwa. Mofanana ndi kuwonongeka kwa nkhuku yanu, kuwonongeka kungakhudze khutu limodzi kapena makutu onse awiri. Ngati kuwonongeka kumakhudza khutu limodzi pang'onopang'ono, simungathe kuwona zizindikiro zilizonse. Komabe ngati kuwonongeka kukuchitika mofulumira ku khutu limodzi, mungakumanepo:
- vutolo
- kusanza
- kuyenda kosayendetsa maso (nystagmus)
Zizindikiro zomwe zimachitika mofulumira zingakuchititseni kuti mukhale ogona mpaka zizindikiro zikuyendetsa pang'onopang'ono. Ngati kuwonongeka kumachitika kumbali zonse ziwiri za khutu lanu, mukhoza kuwona:
- mutu
- kumvetsera kwa khutu
- Kusayenerera kumakhudza mphamvu yoyenda
- masomphenya olakwika omwe amapezeka jerky (oscillopsia)
- kusagwirizana kwa kutsogolera mutu
- kuyenda ndi chikhalidwe chachikulu
- zovuta kuyenda mumdima
- kusakhazikika
- kumutu
- kutopa
Ngati kuwonongeka kwa chovala chanu ndi chovuta, oscillopsia ndi zovuta kuyenda usiku sizingakhale bwino. Zizindikiro zina zikhoza kusintha pakapita nthawi. Powonongeka kwakukulu, mukhoza kupumula kuchokera ku zizindikiro zambiri zokhudzana ndi kuchuluka kwa thupi chifukwa thupi lanu limatha kusintha.
Aminoglycoside Antibiotics
Ma antibiotic aminoglycoside ndi gulu lofunika kwambiri la mankhwala opatsirana magazi ndi amkodzo komanso chifuwa chachikulu cha TB. Mankhwalawa ndi awa:
- gentamicin
- tobramycin
- streptomycin
Mankhwala ophera aminoglycoside ali ndi chiwopsezo cha pafupifupi 20 peresenti ya vuto lakumva komanso pafupifupi 15 peresenti ya ngozi yolimbana ndi mavuto. Kuopsa kwa mavuto okhudzana ndi ototoxicity kumawonjezeka ngati mutenga mankhwala otchedwa diasitic (monga Lasix) kapena vancomycin (antibiotic) panthawi yomweyo.
Loop Diuretics
Loop diuretics amachititsa kuchuluka kwa mkodzo kupanga. Izi zimathandizira kufooka mtima kwa mtima, kuthamanga kwa magazi, komanso kusokonezeka kwa impso. Mankhwala amodzi ndi awa:
- Lasix (furosemide)
- Bumex (chimanga)
Mankhwala otsegula m'mimba amakhala ndi chiopsezo chotere cha ototoxicity koma amatha kukhala ochuluka mwa anthu asanu ndi mmodzi mwa anthu 100 aliwonse omwe amagwiritsa ntchito mankhwalawa. Kawirikawiri amaganiza kuti amapezeka pa mlingo waukulu kwambiri omwe amachititsa kuti magazi azikhala ndi ma milligita pafupifupi 50 (mg) pa lita imodzi.
Platinum-Based Chemotherapy
Cisplatin ndi Carboplatin ndi awiri mwa mankhwala akuluakulu a mankhwala (anti-neoplastics) omwe ali ototoxic. Amagwiritsidwa ntchito kwambiri pochiza khansa zosiyanasiyana kuphatikizapo:
- khwangwala & testicular khansara
- khansara ya chikhodzodzo
- khansa ya m'mapapo
- mutu ndi khansa za khansa
Quinine
Quinine amagwiritsidwa ntchito pochiza malungo ndi miyendo ya mwendo. Kuchiza kwa nthawi yaitali ndi quinine kumapangitsa kuti pakhale chiopsezo cha 20 peresenti, chomwe chimapangitsa kuti munthu asamve zambiri pamutu, zomwe nthawi zambiri zimawoneka ngati zakhala zosatha ngati kumva kutayika kumene kumakhala kovuta. Quinine imayambanso kumva kumva kutayika komwe kumayambitsidwa ndi matenda otchedwa cinchonism :
- osamva
- vutolo
- kumalira mu makutu anu
- mutu
- kutaya masomphenya
- kunyoza
Salicylates
Ma salicylates monga aspirin ali ndi chiopsezo cha ototoxicity pa mlingo waukulu ndipo amatha kumva kutayika kwa decibel 30, zomwe ndizofanana ndi kung'ung'udza. Komabe, zowonongeka zingakhale zochepa kwambiri monga tinsitini zochepa pamatenda otsika a aspirin. Amuna achikulire makamaka amawoneka kuti ali pachiopsezo chokumva kutayika kokhudzana ndi ntchito ya aspirin. Chiopsezo chikhoza kukhala kuyambira 12 mpaka 33 peresenti potsata kuchuluka kwa ntchito.
Vinca Alkaloids
Vincristine ndi mankhwala ochizira matenda oopsa a khansa ya m'magazi (ALL), Hodgkin lymphoma, ndi khansa zina. Mankhwalawa makamaka amagwiritsidwa ntchito ndi chiopsezo chachikulu chochititsa kupweteka kwa kumva pamene akugwiritsidwa ntchito mosavuta ndi aminoglycoside antibiotics.
Kuzindikira Kutayika Kumva Kugwirizana kwa Ototoxicity
Musanayambe kuchipatala ndi mankhwala omwe ali pangozi ya ototoxicity, muyenera kuwona katswiri wa zamagetsi kuti awonetsere mawu oyambirira. Dokotala wanu atsimikiza ngati kafukufuku wokonzedwa nthawi zonse adzafunika kuchitidwa kapena kudzifufuza nokha kumvetsera kwanu. Ngakhale izi sizilepheretsa kumva kutayika kwokhudzana ndi ototoxicity, zidzakuthandizani kuzindikira mavuto oyambirira.
Kuchiza Ototoxicity Related Hearing Loss
Palibe pakalipano mankhwala aliwonse omwe angapezeke kuti asinthe kuwonongeka kosatha kwa khutu lamkati. Ngati mumakhala ndi vuto limodzi lakumvetsera, mutha kumva bwino thandizo la kumva. Ngati muli ndi vuto lakumva kwamuyaya kwa makutu onse awiri, ndiye adokotala angakulimbikitseni mapiritsi a cochlear . Kukonzekera kawirikawiri ndikochiza chithandizo ngati mukudwala matenda osakhalitsa kapena osatha.
> Zotsatira:
> Chilankhulo cha American-Language-Hearing Association. (2017). Mankhwala Ototoxic (Mmene Mankhwala Amawathandizira). http://www.asha.org/public/hearing/Otootoxic-Medications/
> Boldenberg, D, Goldstein, BJ. (2011). Buku Lopereka Buku la Otolaryngology Mutu ndi Opaleshoni Yamakono. A Thiem Medical Publishers. New York, NY.
> Merck Manual. (2017). Ototoxicity Yophatikiza Mankhwala. http://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/drug-induced-ototoxicity
> Rybak, LP & Brenner, MJ. (2015). Otolaryngology ya Cumming: Ottoxic and Auditory Ototoxicity. http://www.clinicalkey.com (Kulembetsa Kuyenera Kuyenera)
> Association of Disorder Association. (2017). Ototoxicity. http://vestibular.org/ototoxicity