Kufufuza Njira Zapamwamba Zopangira Opioid ndi Zosagwiritsa Ntchito Mankhwala Osakaniza Opioid
Mankhwalawa ndi mankhwala omwe amagwiritsidwa ntchito kuthetsa analgesia (ululu). Zimagwira ntchito poletsa zizindikiro zopweteka ku ubongo kapena kusokoneza kutanthauzira kwa ubongo. Zizindikirozi zimagululidwa mosiyanasiyana monga osakhala opioid (osati mankhwala osokoneza bongo) kapena opioid (mankhwala osokoneza bongo) omwe amathandiza kupweteka.
Osati Opioid Analgesics
Mankhwala osagwiritsa ntchito opioid akuphwanyidwa m'magulu atatu: acetaminophen , mankhwala osagwiritsidwa ntchito poletsa kutupa (NSAIDs) , ndi COX-2 inhibitors.
Ngakhale kuti aliyense ali ndi njira yosiyana, amagwira ntchito poletsa mtundu wa enzyme wotchedwa cyclooxygenase, kapena COX. Pali mitundu iwiri yosiyanasiyana ya enzyme iyi, COX-1 ndi COX-2, zonsezi zomwe zimayambitsa kuyimba ndi ululu poyankha kuvulala.
Pa mitundu itatu ya zowawa zopanda opioids:
- Acetaminophen (yemwenso amadziwika kuti paracetamol) ndi imodzi mwa zilembo zowonjezereka zomwe zimagwiritsidwa ntchito kwambiri padziko lapansi lero. Ngakhale kuti nthawi zambiri anthu amazindikira kuti ndi ma tylenol, mayendedwe othandizirawa amakhala m'madera ambirimbiri ozizira, chimfine, ndi chimfine. Acetaminophen amapereka onse analgesic ndi antipyretic (kutentha thupi) koma samachiza kutupa. Ngakhale kuti kayendedwe kake sikamvetsetsedwa bwino, zikuwoneka kuti zimalepheretsa ntchito ya COX mu ubongo ndi pakatikati zamagazi okha. Mbali yake yaikulu ndi chiwindi cha chiwindi chomwe chimayambira makamaka chifukwa chogwiritsa ntchito mopitirira muyeso. Malingana ndi US Food and Drug Administration (FDA), masiku ano acetaminophen ndi amene amachititsa kuti vuto la chiwindi likhale lopweteka kwambiri ku US, makamaka pakati pa anthu omwe amamwa mowa mwauchidakwa kapena anthu omwe amasangalala ndi mankhwala opioid omwe ali ndi acetaminophen.
- Mankhwala otsutsana ndi kutupa (nonsteroidal anti-inflammatory drugs (NSAIDs) ndi gulu la mankhwala lomwe limaphatikizapo mankhwala monga Advil (ibuprofen), Aleve (naproxen), ndi aspirin ya Bayer. Mofanana ndi acetaminophen, NSAIDs imapezeka m'njira zambiri kuphatikizapo mapiritsi, syrups, ndi mapepala. Komabe, mosiyana ndi acetaminophen, ma NSAID amaletsa COX-1 ndi COX-2 osati m'chigawo chapakati cha mitsempha koma mbali zina za thupi. Kuwonjezeka kumeneku kumathandizira, mwa zina, mankhwalawa 'analgesic, anti-inflammatory, ndi antipyretic zotsatira. Komabe, njira yomweyi ingachepetse chitetezo chomwe COX ili nayo pamimba. Zotsatira zake, zowonongeka monga kunyoza, mseru, ndi zilonda si zachilendo. Kupatula aspirin, NSAIDs imatha kuonjezera kwambiri chiopsezo cha mtima ndi kupweteka kwa anthu omwe ali ndi mbiri ya matenda a mtima.
- COX-2 inhibitors ndi gawo la NSAID zomwe lero zimaphatikizapo mankhwala amodzi okha a FDA, Celebrex (celecoxib) . Malingana ndi dzinali, COX-2 inhibitors imatsutsa kokha mapuloteni a COX-2, kuchepetsa kupweteka ndi kutupa popanda kuchititsa m'mimba zotsatirapo za m'mimba. Komabe, monga kalasi ya mankhwala, amadziwika kuti amachititsa chiopsezo cha mtima ndi 40 peresenti. Chifukwa chake, Vioxx yemwe kale anali wotchuka (rofecoxib) adachotsedwa modzipereka ku msika wa US mu 2005, atangotengedwa ndi kuphedwa kwa ziwalo zina za COX-2. Celebrex ndi imodzi mwa mankhwala ogulitsidwa kwambiri pa Pfizer pharmaceutical portfolio.
Opioid Analgesics
Mankhwala otchedwa opioid analgesics ndi mtundu wa mankhwala omwe amagwira ntchito pomangirira ma opioid receptors omwe amakhala mu dongosolo lonse la mantha ndi m'mimba. Zokometsera izi sizikutanthauza kuti zimakhala zovuta monga zowawa , komanso zimayambitsa mavuto omwe amachititsa anthu kugwirizana ndi mankhwala opioid.
Mankhwala opioid amagwiritsidwa ntchito pamagulu pofuna kupweteka, kupweteka kwa magazi, komanso kuchiza opiate. Iwo sagwirizanitsidwa ndi dothi la mankhwala kapena amachititsa zotsatira zina zomwe zimagwirizanitsidwa ndi NSAIDs.
Ngakhale mutagwiritsidwa ntchito monga momwe mwalembedwera, ma opioids angayambe kugona, kunyoza, kudzimbidwa, hypoventilation (kupuma mopanda nzeru), ndi kupatsa ena.
Izi ndizoona makamaka kwa okalamba omwe ali ovuta ku zotsatirazi.
Komanso, kugwiritsira ntchito nthawi yaitali kumagwirizanitsidwa ndi chiopsezo cha kusamalidwa kwa mankhwala (komwe mankhwalawa amatha pang'onopang'ono), kudalira (kuledzera), ndi kuchotsa. Chifukwa chake, mankhwala ambiri a opioid amalamulidwa ndi zinthu zofuna mankhwala a dokotala. Malinga ndi lipoti la Centers for Disease Control and Prevention, anthu ambiri a ku America amamwa mankhwala opioid.
Pali mitundu itatu yambiri ya mankhwala opioid ogwiritsira ntchito ululu:
- Opiate alkaloid ndi mtundu wa mankhwala omwe amachokera ku mankhwala omwe amapezeka ku opium poppy chomera Papaver somniferum . Mankhwala omwe amapezeka mu opiamu amaphatikizapo morphine ndi codeine. Zonsezi zimagwira ntchito mwachindunji dongosolo la mitsempha lochepetsera kumva ululu. Kugona, kumutu, kusanza, ndi kudzimbidwa ndi zotsatira zofala. Ngakhale kuti morphine imadziwika kwambiri, codeine imakhalanso ndi zizindikiro zowonongeka ngati iwonongeke kwambiri. Codeine nayenso ndi opioid yokha yomwe ikuphatikizidwa mu njira zambiri zothandizira (makamaka chifuwa cha mankhwala omwe amapangidwa ndi NSAID).
- Ma opioids omwe sagwiritsidwa ntchito ndi omwe amapangidwa kuchokera ku ma opioid komanso amaphatikizapo mankhwala monga Oxycontin (oxycodone) ndi Vicodin (hydrocodone) . Oxycodone amagwiritsidwa ntchito pochiza kupweteka kwambiri (kuphatikizapo khansara kapena ululu wopita opaleshoni) ndipo amaonedwa kuti ndi wovuta kwambiri. Chifukwa chake, hydrocodone imagwiritsidwa ntchito molakwa kuposa mankhwala ena opioid ku US, malinga ndi lipoti la 2014 kuchokera ku National Institute of Drug Abuse. Mankhwala amphamvuwa angagwiritsidwe ntchito mosamala pofuna kupuma kwafupipafupi, koma monga mankhwala a Pulogalamu Yachiwiri, amafunika kuyang'anitsitsa kuchipatala.
- Ma opioids opangidwa ndi mavitaminiwa amapangidwa kwathunthu mu labu kuti agwire ntchito yothandizana ndi opiates. Amaphatikizapo methadone ndi buprenorphine (omwe amagwiritsidwa ntchito pochizira opiate) komanso tramadol (yogwiritsidwa ntchito kawirikawiri pamapweteka apambuyo). Ngakhale kuti akuwoneka kuti ndi ochepa kwambiri kuposa mankhwala ena a opioid, anthu amadziwika kukhala ndi chidaliro ngati agwiritsidwa ntchito kwa nthawi yaitali.
Mawu Ochokera
Malingaliro amatha kukhala othandiza kwambiri kuthetsa ululu wa nyamakazi ndipo amagwiritsa ntchito mosamala ngati atengedwa malinga ndi lamulo. Ngakhale madokotala ambiri adzalingalira za mankhwala osagwiritsa ntchito opioid kuti athe kuchiritsidwa, pangakhale mikhalidwe yovuta kwambiri, yowawa kwambiri ingafunike mankhwala amphamvu opioid . Izi zikanangokhala chithandizo champhindi kochepa kuti muteteze chiopsezo chilichonse chodalira.
Pa nthawi yomweyi, sizikuwonekeratu kuti ma opioids amatha bwanji poyerekeza ndi njira zina zopanda opioid. Choncho, ngati muli ndi ululu waukulu wamagazi, ganizirani zokambirana ndi katswiri wothandizira kupwetekedwa mtima yemwe angakuuzeni kudzera muzomwe mungasankhire mankhwala, mankhwala komanso osagwiritsa ntchito mankhwala.
> Zotsatira:
> Zolinga za Kuletsa ndi Kuteteza Matenda. "Zizindikiro Zofunikira: Kusiyanasiyana pakati pa mayiko pofotokoza za opioid Pains Relievers ndi Benzodiazepines-United States, 2012." MMWR . 2014; 63 (26); 563-568.
> Cicero, J .; Ellis, M .; Surratt, H. et al. "Zinthu zomwe zimakhudza mtundu wa hydrocodone ndi oxycodone monga opioids oyambirira omwe amazunza anthu ambiri akufuna thandizo ku United States." PAIN. 2013; 154 (12): 2639. DOI: 10.1016 / j.pain.2013.07.025.
> Institute of National Drug Abuse. "America's Addiction to Opioids: Heroin ndi Mankhwala Ogwiritsa Ntchito Mankhwala Osokoneza Bongo." Washington, DC; adatulutsidwa pa May 14, 2014.
> Yoon, E .; Babar, A .; Choudhary, M. et al. "Acetaminophen-Inachititsa Hepatotoxicity: Chidziwitso Chokwanira.". Journal of hepatology ndi matembenuzidwe . 2016; 4 (2): 131-42. DOI: 10.14218 / JCTH.2015.00052.