Yini i-biguanides: umphumela weqembu lezidakamizwa sikashukela

AmaBiguanides izidakamizwa ezenzelwe ukwehlisa ushukela wegazi. Ithuluzi liyatholakala ngesimo samathebulethi.

Zisetshenziselwa, kaningi, ngohlobo lwe-2 yesifo sikashukela, njengesijobelelo.

Njengengxenye ye-monotherapy, izidakamizwa ze-hypoglycemic zichazwa kuyaqabukela. Imvamisa lokhu kwenzeka emaphesenti angama-5- 10%.

AmaBiguanides afaka lezi zidakamizwa ezilandelayo:

• I-Bagomet,
• Avandamet
• I-Metfogamma,
• I-Glucophage,
• I-Metformin Acre
• Siofor 500.

Okwamanje, eRussia, kanye nasemhlabeni wonke, ama-Biguanides asetshenziswa, ingxenye enkulu, i-methylbiguanide derivatives, okungukuthi, metformin:

1. glucophage
2. Siofor
3. i-metpho-gamma,
4. dianormet
5. glyformin nabanye.

I-Metformin ihlukana kusuka ehoreni elilodwa nesigamu kuya emahoreni amathathu. Umuthi ukhiqizwa ezibhebheni ze-850 no-500 mg.

Imithamo yokwelapha ingu-1-2 g ngosuku.

Ungadla kuze kufike ku-3 g ngosuku lwesifo sikashukela.

Okuphuma ku-Butylbiguanide:

• i-silubin
• buformin
• Adebite.

Uyacelwa ukuthi uqaphele ukuthi ama-biguanides asetshenziswa kuphela, ngenxa yemiphumela emibi kakhulu, okungukuthi i-gysric dyspepsia.

Manje odokotela abancomi ukusebenzisa okuphuma ku-phenylbiguanide, ngoba kufakazelwa ukuthi kuholela ekuqongeleleni egazini lomuntu:

• i-pyruvate
• lactate

Isenzo sezidakamizwa

Ososayensi baveze ukuthi imiphumela enciphisa ushukela we-metformin kushukela ihlotshaniswa nomphumela othize wesidakamizwa echibini nasekwenzeni. Umphumela wehlisela ushukela we-metformin uhlotshaniswa nabathutha i-glucose esitokisini.

Umthamo wezinto zokuhambisa ushukela ukhuphuka ngenxa yokuchayeka kuma-Biguanides. Lokhu kubonakaliswa kuthuthukiso lweglucose oluthuthukisiwe kuwo wonke ulwelwesi lweseli.

Lo mphumela uchaza umphumela ezenzweni zombili i-insulin yomzimba ne-insulin evela ngaphandle. Izidakamizwa nazo zisebenza kulwelwesi lwe-mitochondrial.

I-Biguanides inhibit gluconeogenesis, ngalokho banegalelo ekwandeni kokuqukethwe kwe:

1. lactate
2. i-pyruvate,
3. Alanine

Lezi zinto zingaphambili kwe-glucose kumongo we-gluconeogeneis.

Umthamo wezinto zokuhambisa ushukela ukhuphuka ngaphansi kwesenzo se-metformin kulwelwesi lwe-plasma. Imayelana:

• I-GLUT-4,
• I-GLUT-2,
• I-GLUT-1.

Ukuhamba kwe-glucose kuyashesha:

1. kwimisipha ebushelelezi yemisipha
2. endothelium
3. izicubu zenhliziyo.

Lokhu kuchaza ukwehla kokungazweli kwe-insulin kubantu abanesifo sikashukela sohlobo 2 ngaphansi kwethonya le-metformin. Ukwanda kokuzwela kwe-insulin akuhambisani nokwenyuka kokuqanjwa kwayo ngamanyikwe.

Ngokuphikisana nesizinda sokwehla kokumelana ne-insulin, izinga eliyisisekelo elibonisa i-insulin egazini nalo liyancipha. Ukwanda kokuzwela kwe-insulin akuhambisani nokwenyuka kokuklanywa kwayo ngamanyikwe, njengalapho kusetshenziswa ama-sulfonylureas.

Lapho welapha nge-metformin kubantu, ukwehla kwesisindo kuyabonakala, kepha uma welapha ama-sulfonylurea agents kanye ne-insulin, umphumela ophikisayo ungaba. Ngaphezu kwalokho, i-metformin isiza ukwehlisa i-serum lipids.

Imiphumela emibi

Imiphumela emiphumela emqoka evela ekusetshenzisweni kwe-metformin kufanele ibonwe, indlela esebenza ngayo yile elandelayo:

• isifo sohudo, isicanucanu, ukugabha;
• ukunambitheka kwensimbi emlonyeni;
• ukungakhululeki esiswini;
• ukuncipha nokulahlekelwa yinhliziyo yokudla, kuze kufike ekuphambukeni ukudla;
• i-lactic acidosis.

Imiphumela emibi ebonisiwe nezenzo, njengomthetho, zisuka ngokushesha zinokwehla ngomthamo. Ukuhlaselwa yisifo sohudo kuwuphawu lokumisa ukuthatha i-metformin.

Uma uthatha i-Metformin 200-3000 mg ngosuku isikhathi eside, khona-ke kuzodingeka ukhumbule ukuthi ukumuncwa kwamapheshana esiswini kuzokwehla:

1. Amavithamini we-B,
2. i-folic acid.

Kuyadingeka ukuxazulula esimweni ngasinye inkinga yokuqokwa okwengeziwe kwamavithamini.

Kubalulekile ukugcina okuqukethwe kwe-lactate okuqukethwe kungaphansi kokulawulwa, futhi kuhlole lokhu okungenani kabili ngonyaka. Lokhu kubalulekile kunikezwe amandla e-metformin okukhulisa i-anaerobic glycolysis emathunjini amancane nasekuvimbeleni i-glycogenolysis esibindini.

Uma umuntu enezikhalazo zobuhlungu bemisipha nokunambitheka kwensimbi emlonyeni, kubalulekile ukutadisha izinga le-lactate. Uma okuqukethwe igazi layo lenyuke, khona-ke izindlela zokwelashwa nge-metformin kufanele zime.

Uma kungenakwenzeka ukutadisha izinga le-lactate egazini, khona-ke i-metformin ikhanseliwe kuze kube yilapho isimo sivamile, khona-ke wonke amathuba okuphathwa kwayo ayahlolwa.

I-contraindication esemqoka

Kunemikhawulo ethile yokusetshenziswa kwe-metformin:

1. i-ketoacidosis yesifo sikashukela, kanye nethonya nezinye izimo zemvelaphi yesifo sikashukela;
2. umsebenzi wokuphazamiseka wezinso, ukwanda kwe-creatinine egazini ngaphezu kwe-1.5 mmol / l;
3. izimo ze-hypoxic zanoma iluphi uhlobo lwe-genesis (i-angina pectoris, ukwehluleka kokujikeleza, i-4 FC, i-angina pectoris, infarction ye-myocardial);
4. ukwehluleka ukuphefumula;
5. i-encephalopathy enamandla
6. imivimbo
7. i-anemia
8. izifo ezithathelwanayo ezihlasela kakhulu, izifo zokuhlinzwa;
9. utshwala
10. ukwehluleka kwesibindi;
11. ukukhulelwa
12. izinkomba zomlando we-lactic acidosis.

Ngenqubo yokwanda kwesibindi, ama-biguanides anqunywa lapho i-hepatomegaly ibonwa njengomphumela we-hepatostatosis yesifo sikashukela.

Ngokuphazamiseka okungapheli kwe-allergic and dystrophic kwesibindi, umphumela wama-Biguanides ku-hepatic parenchyma ungaqoshwa, okuvezwa ku:

• ukubonakala kwe-cholestasis, kwesinye isikhathi kufika kuma-jaundice abonakalayo,
• ushintsho ekuhlolweni kwesibindi okusebenzayo.

E-hepatitis ephikelelayo engapheli, izidakamizwa kufanele zisetshenziswe ngokuqapha.

Ngokungafani nokususelwa kwe-sulfonylurea, ama-biguanides awanawo umphumela oqondile onobuthi emsebenzini we-hematopoietic womongo wamathambo nezinso. Kodwa-ke, zifakwe ku-contraindised ku:

• izifo zezinso ezikhuthaza ukwehla kokuhlunga kwe-glomerular
• ukugcinwa kwe-nitrogenous slag
• anemia kakhulu, ngenxa yengozi ye-lactacidemia.

Abantu abagulayo abagulayo kudingeka banikeze izidakamizwa ngokucophelela, ngoba lokhu kuhlotshaniswa nosongo lwe-lactic acidosis. Lokhu kusebenza kulezi ziguli ezisebenza kakhulu ngokomzimba.

Kukhona izidakamizwa, ukusetshenziswa kwayo ekwelapheni i-Biguanides kwandisa ukusebenza kwe-lactic acidosis, yilezi:

• i-fructose
• teturam
• ama-antihistamines
• ama-salicylates,
• ama-barbiturates.