Funso: Kodi Ndingagwiritse Ntchito Methadone?
Methadone - sikuti mankhwala osokoneza bongo amalephera?
Limeneli ndi funso limene ndimazoloŵera kumva kuchokera kwa odwala ndi mabanja omwe akudwala matendawa pamene ndikuwauza kuti dokotala wawo walamula Methadone kuti amve ululu. Ngakhale zili choncho kuti methadone imagwiritsidwa ntchito pochiza matenda obwera chifukwa cha mankhwala, methadone ndi mankhwala othandiza kwambiri kuti athetse ululu wambiri .
Morphine watenga mutu wa Gold Standard kuti awononge kupweteka , opioid ena onse amafanizidwa ndi chifukwa cha mphamvu zake, zosavuta za kayendedwe ndi mtengo wotsika. Ngati morphine ndi yabwino kwambiri, n'chifukwa chiyani tingagwiritse ntchito methadone?
Yankho:
Ngati titi tiyambe kuyerekeza methadone ndi morphine, tiyenera kuyamba ndi mfundo zoyambirira za ululu. Ululu ukhoza kugawidwa mu mitundu iwiri ya kufotokozera za thupi: zosautsa komanso zokhudzana ndi ubongo. Kupweteka kwachilombo kaŵirikaŵiri kumayambitsidwa ndi kuvulala kwa minofu (kupweteka kwa m'mimba) kapena kuvulala kwa ziwalo za mkati (ululu wa visceral). Kupweteka kwa mtima kumayamba chifukwa cha kuvulala kapena kupwetekedwa ndi mitsempha m'katikati mwa mitsempha yamkati kapena m'thupi.
Timadalitsidwa ndi opiate receptors mu ubongo wathu womwe umalola matupi athu kuyankha mankhwala opweteka a opioid. Ambiri mwa mapulogalamuwa amagawidwa m'mapatala ndi m'matawuni a delta ndipo peresenti yaing'ono ndi NMDA. Kupweteka kwapadera kumaphatikizidwa kwambiri ndi ma receptors ndi ululu wa m'magazi ndi madera a NMDA ; Morphine imangomangirira kumalo ovomerezeka okha, pamene methadone imamangiriza ku mu, delta ndi NMDA.
Morphine ali ndi ntchito yabwino yothetsera ululu wosiyanasiyana, koma chifukwa chakuti amatha kumanga 100% ya opiate receptors, methadone akhoza kuchita bwino kwambiri.
Opiate Toxicity ndi zotsatira zoyipa
Ophika, monga morphine, amatulutsa metabolites pamene agwidwa mu thupi. Mankhwalawa amatha kumanga thupi ndipo amachititsa zizindikiro za poizoni.
Opiate poizoni ndiye kuti ndi owonjezera kwambiri opiate omwe amatsogolera poizoni m'thupi ndipo amachititsa zizindikiro monga kusazengereza, kukhumudwa, kusokonezeka ndi kutaya mtima.
Methadone sichimabala metabolites ndipo sichikhala ndi "denga," kapena mlingo waukulu kwambiri. Methadone imakhalanso yosavuta kuwonetsa chiwindi, ndipo kusowa kwake kwa metabolites kumapanga chisamaliro chabwino cha mankhwala opweteka kwa odwala ambiri omwe ali ndi chiwindi ntchito kapena kulephereka kwadzidzidzi.
Zotsatira zoyipa za opiates zimaphatikizapo kudzimbidwa, kunyoza ndi kusanza, kugona, kuyabwa, kusokonezeka ndi kupuma kwa kupuma (kupuma kupuma). Odwala ambiri awonetsa kuchepa kwa zotsatira zovuta mutatha kusintha kwa methadone kuchokera ku opiate ina.
Zopindulitsa Zambiri za Methadone
Choncho methadone imathandiza kwambiri kuposa morphine pochiza ululu ndipo nthawi zambiri imayambitsa mavuto ochepa, koma uthenga wabwino sumaima pamenepo. Phindu lina la methadone ndilokhalokhalokha. Nusu ya moyo ndi nthawi yofunikira kuti theka la kuchuluka kwa mankhwala likhale lokhazikika kapena lochotsedwa ndi njira zowonongeka. Chifukwa cha moyo wautaliwu, methadone imatha kupweteka kwa maola 8 mpaka 10, pomwe nthawi zonse kumasulidwa kwa morphine kumachepetsa kupweteka kwa maola awiri kapena 4.
Izi zimasulira ku dosing yochepa kwa wodwalayo, kawiri kawiri kapena katatu patsiku.
Ndipo potsiriza, koma osachepera, methadone ndi yotsika mtengo kwambiri. Mwezi wokhazikika wa methadone umawononga ndalama zokwana madola 8, pamene morphine iwononga ndalama zokwana $ 100. Mafuta ena, monga Oxycontin ndi Fentanyl, amawononga kwambiri.
Zosokoneza Kugwiritsa Ntchito Methadone
Kodi ndatsimikiza kuti methadone ndi mankhwala opweteka kwambiri ? Ngati ndi choncho, mungadzifunse kuti n'chifukwa chiyani siigwiritsidwe ntchito nthawi zambiri. Ndapempha funso lomweli kwa madokotala angapo, ndipo ndapeza kuti kupitirira kunyalanyaza kuti methadone imanyamula, madokotala ambiri samangokhalira kuwafotokozera.
Chifukwa cha hafu ya moyo wa methadone, imayamba pang'onopang'ono m'thupi ndipo imatenga masiku asanu ndi asanu ndi asanu ndi awiri (7) kuti mipingo ikhale yolimba. Panthawiyi, wodwala ayenera kuyang'anitsitsa mosamala zizindikiro za poizoni. Izi sizimakhala zovuta kwa odwala omwe ali ndi chithandizo cholandirira kapena kuchipatala , chifukwa amatsatiridwa kale ndipo nthawi zambiri amakhala ndi mwayi wopita kwa anamwino ndi madokotala maola 24 pa tsiku. Ofesi ya udokotala sakhala ndi mphamvu yoyang'anira odwala kwambiri, omwe angakhale mbali yawo yotsutsana nayo.
Zina zolepheretsa ndi maphunziro a udokotala komanso kusakayika kwa odwala. Methadone imadziwikabe ngati mankhwala osokoneza bongo. Kunyada kumeneku kumachotsedwa pang'onopang'ono pamene madokotala akupitiriza kuphunzitsa anzao phindu lake ndipo anthu akuwona odwala ambiri akupeza mpumulo chifukwa cha izo.
Zotsatira:
Ayonrinde OT, Bridge DT. Kubwezeretsedwa kwa methadone kwa kasamaliro ka ululu wa khansa. Med J Aust 2000; 173: 536-40.
Davis MP, Walsh D. Methadone kuti athandizidwe ndi matenda a khansa: kafukufuku wa pharmacokinetics, pharmacodynamics, kuyanjana kwa mankhwala ndi ndondomeko za kayendedwe ka mankhwala. Thandizani Care Cancer 2001; 9: 73-83.
Toobs JD, Kral, LA. Kuchiza kwa Methadone kwa Mavuto Owawa. Am Phys Physician 2005; 71: 1353-8.