I-Baeta ngumenzeli we-hypoglycemic enzelwe ukulawula ushukela wegazi ohlotsheni 2 sikashukela. I-Exenatide ihlukaniswa njenge-amino acid amidopeptides. Njengomlinganiso we-incretin mimetic, wehlisa ukugaya, uthuthukisa umsebenzi wamaseli e-b. Ukusuka ku-insulin yendabuko, umuthi uhlukaniswa ngamakhono wemithi kanye nezindleko.
Ngubani okhonjiswa i-exenatide
Umuthi unqunyelwe abanesifo sikashukela ngohlobo lwesibili lwesifo (ngaphandle kwezingane nabesifazane abakhulelwe). Uma ukwelashwa ngeMetformin nezinye izidakamizwa ze-hypoglycemic kunganikeli imiphumela efiselekayo, iBayete ichazwe njengekhambi elingeziwe. Imijovo nayo isetshenziswa njenge-monotherapy. Okubaluleke ngokukhethekile kwisifo sikashukela esingancikileli i-insulin yikhono lomuthi ukulawula isifiso sokudla nesisindo somzimba.
Khipha ifomu
I-Baeta yisisombululo ngaphandle kombala nephunga. I-1 ml yesakhi esisebenzayo se-exetanide iqukethe ama-250 mcg. Indima yezithako ezingeziwe yi-acetic acid, i-sodium acetate trihydrate, i-matacresol, i-mannitol nezinye izimbongi.
Umuthi ukhishwa esibayeni esisodwa sesirinji - i-analogue yesizukulwane esisha se-insulin. Umthamo wezokwelapha esibayeni esinjalo ungu-1,2 noma u-2,4 ml (kwiphakeji ngalinye - isipanji esisodwa).
Ngomuthi weBayet, i-Exenatide kuphela engenza njenge-analogue.
Amathuba we-Pharmacodynamic
Kwenzekani ngeBayeta ngemuva kokuphathwa ngokungachemile? Indlela yokusebenza yesidakamizwa ilula. Ama-incretins, omelele kuwo yi-exenatide (isakhi esisebenzayo somuthi), akhuphula ukukhiqizwa kwe-insulin futhi avimbele ukukhiqizwa kwe-glucose analog kwesibindi.
I-Exenatide Baeta isiza abanesifo sikashukela ukulawula ushukela kanje:
- Ngamanani aphezulu we-glucometer, isidakamizwa senza kusebenze ukukhiqizwa kwe-insulin parenchyma kumaseli e-b-cell.
- Lapho nje izinga loshukela wegazi lisondela ngokujwayelekile, ukukhululeka kwe-hormone kuyeka.
- Esimweni sohlobo lwesifo sikashukela esingaxhomekeli i-insulin, ngemuva kokwejeta kweBaeta, ukukhiqizwa kwe-insulin akubonwa imizuzu eyi-10 yokuqala. Umuthi ubuyisela impendulo ye-insulin kuzo zombili izigaba zayo.
Yehlisa ukugaya ukudla, icindezela isifiso sokudla nesisu samathumbu (kuze kufike ukuqunjelwa).
Izici ze-Pharmacokinetic
Umuthi udonswa kanjani, usatshalaliswa, udonswe futhi ucishwe kanjani?
- Ngemuva komjovo, isakhi esisebenzayo i-exenatide sisakazeka ngokushesha ngohlelo lokujikeleza kwegazi futhi senze umphumela wokwelapha. Ngomthamo we-10 μg wamanani aphakathi nendawo, ufinyelela ngemuva kwamahora ama-2. Indawo yomjovo (ithanga, i-forearm noma isisu) ayithinti isilinganiso sokungena nokusebenza kahle.
- Umuthi ufakwa emzimbeni wokugaya ukudla, ohlelweni lokujikeleza kanye namanyikwe. Amandla ayo ekhemisi awa ngokuya ngomthamo.
- Izinso zisusa iBayetu ngamahora ayi-10. Kwi-pathologies ye-renal, ukulungiswa kwamthamo akudingeki, ngoba ukusulwa kwento esebenzayo kulesi sigaba seziguli kusondele kwesejwayelekile.
- Njengoba umuthi udonswa yizinso, i-hepatic pathologies ayikuguquki okuqukethwe kwe-exenatide ku-plasma yegazi.
Izici ezihlobene nobudala azithinti indlela yokusebenza kwesakhi esisebenzayo, ngenxa yalokho, ebudaleni, ukulungiswa kwamthamo akudingeki. Ebuntwaneni (kuze kube iminyaka eyi-12), umphumela we-exenatide awuzange ufundwe. Esikhathini sobusha (iminyaka eyi-12-18) kulabo abathola umthamo we-5 μg wesifo sikashukela, ukusabela kufana nabantu abadala.
Abesilisa nabesifazane baphendula ngokulingana ekwelashweni kweBayeta. Kwakungekho mehluko phakathi kwabamele izinhlanga ezahlukahlukene, okusho ukuthi ukulungiswa kwamthamo ngokwezindlela ezinjalo akudingekile kulezi zigaba zabanesifo sikashukela.
I-Baeta ngesikhathi sokukhulelwa
Ngesikhathi sokukhulelwa nokuqunjelwa, imijovo ye-Bajeta iyaphulwa, ngoba izingxenye ezisebenzayo zithinta kabi ukwakheka kwengane. Ikakhulu, ukusetshenziswa kwe-Bajeta kungavusa uhlobo oluthile lwesifo sikashukela esincike kumntwana.
Ukuthuthuka, umzimba wengane uthatha umsebenzi we-insulin synthesis. Ama-pancreas we-fetus alawula ama-glycemic indices kuwo womntwana nakunina. Ngakho-ke, lapho uhlela ukukhulelwa, kufanele uhlolwe futhi uthole izeluleko eziningiliziwe zokusebenzisa izidakamizwa eziphephile ezimweni ezintsha.
Contraindication
Isisekelo se-contraindication ukuthatha ikhambi le-Bayet ukungatheleleki komuntu ngamunye kwezingxenye ezisebenzayo zefomula. Umuthi awubekelwe abanesifo sikashukela ngohlobo lwesifo sokuqala, kanye nangesikhathi sikashukela se-ketoacidosis. Umuthi awusebenzi ezigulini ezine-pathologies yesisu, amathumbu, izinso kanye ne-gastroparesis.
I-Bayeta nayo ayikhonjiswanga izingane, ngoba izinga lokusebenza ngempumelelo nokuphepha kwemithi yezingane alizange lihlolwe. Ngokuphendula okungezwani nezinto ezithako ze-metabolite, awukho umuthi obekiwe.
Imiphumela emibi
IByeta kuyaqabukela ibangele imiphumela engafuneki. Uma isetshenziswa njenge-monotherapy, izehlakalo ze-hypoglycemic syndrome cishe zingama-5% (uma ziqhathaniswa ne-1% placebo).
Iningi lalawa macala libonakala ngamandla aphansi. Uma bevela, khona-ke, kungenzeka kakhulu, uma izincomo zezokwelashwa zingalandelwa, umuthi uphelelwe isikhathi, noma uma ugcinwe ngokungalungile.
Kuyaqabukela, i-Baeta ibangela ukukhuphuka kwe-pathology yezinso kanye nokwanda kwe-creatinine. Ezimweni zomtholampilo, imininingwane nge-nephrotoxicity ye-exenatide ayiqoshwa, ngaphandle kweziqephu ngazinye ze-pancreatitis ye-acute. Isifo sikashukela kufanele saziswe ngezimpawu zalesi sifo (ubuhlungu besisu obukhulu, obuqhubekayo besisu).
Ukulimala kokuqala kungahle kuhambisane nobuthakathaka, ukwethuka, kwezinye izimo - ukushaqeka kwe-angioedema ne-anaphylactic. Uma imiphumela emibi ikhonjwa, inkambo yokwelashwa imisiwe bese kuboniswana nodokotela ovumayo nge-endocrinologist.
Njengoba yonke izidakamizwa esekelwe kumaprotheni nama-peptides ingavusa ukukhuluphala, amasosha omzimba esithako esisebenzayo angakhiqizwa ngesikhathi sokwelashwa kweBayeta, i-titer yawo iyancipha ngokuhamba kwesikhathi futhi ihlala iphansi. Ukuba khona kwama-antibodies akuthinti imvamisa nezinhlobo zemiphumela emibi eqoshiwe.
Isifo sikashukela kufanele sixwayiswe ngokuthi imijovo yeBayeta izosiza ekulahlekelweni kwesifiso sokudla kanye nokwehla kwesisindo. Lokhu kusabela komzimba akudingi ukulungiswa okujwayelekile.
Isiqondisi Sesicelo
I-Bayetu isetshenziswa ngohlobo lwe-monotherapy, ukwengeza ukudla okune-carb ephansi kanye nemithwalo yemisipha, ukuvumela ukuthi ulawule isilinganiso sikashukela. Ekwelashweni okuhlanganisiwe, imijovo ihlanganiswa namatafula e-Metformin, i-thiazolidinedione, i-sulfonylureas, kanye nezinhlanganisela zawo ukufeza ukulawulwa okuhle kwe-glycemic.
Uhlobo lokwelashwa lakhiwa udokotela. Umuthi ugawulwa ngaphansi kwesikhumba esiswini, okhalweni, engalweni. Esigabeni sokuqala sesifundo sokwelashwa, kuthathwa isilinganiso okungenani esingu-5 mcg ekuseni nakusihlwa. Umuthi kufanele uphuzwe kungakapheli ihora ngaphambi kokudla. Ngemuva kokudla, imijovo ayinconywa. Ngemuva kwenyanga, kanye nokujwayela okujwayelekile, okujwayelekile kungaphindwa kabili. Ngalesi kulungiswa, ngeke kube nemiphumela emibi.
Uma isikhathi somjovo siphuthelwa, umjovo olandelayo wenziwa ngaphandle kokushintsha umthamo. Akunconyelwe ukuthi kufakwe isixazululo emthanjeni noma emisipha. Uma i-Byeta isetshenziswa ekwelapheni okuyinkimbinkimbi nokutholwa kwe-sulfonylurea, inqubo evamile iyancishiswa ukunciphisa ubungozi bemiphumela emibi noma ukweqisa ngokweqile.
Udokotela kumele azise onesifo sikashukela ngemithetho yokusebenzisa ipeni yesirinji. Ukuqonda inqubo kuzokusiza uthole isifundo sevidiyo kule vidiyo.
Izimpawu ze-overdose
Ngokuzihlola ngokwakho nangemithi yokuthathwa komthamo, kungaqalwa i-overdose. Ungasibona lesi simo ngezimpawu eziyimpawu: ukuntuleka kwesifiso sokudla, ushintsho kokuncamelayo kokunambitheka, ukuphazamiseka kwesifo sokudansa, ushintsho kusigqi sokusilela. Isistimu yezinzwa isibonisa ukudakwa ngekhanda, ukulahleka kokuxhumana, kanye nokuwohloka kwekhwalithi yokulala.
Kepha imvamisa izimpawu zivela esikhunjeni: ukuqubuka, ukuvuvukala, ukulunywa endaweni yomjovo. Ukuqina kwezimpawu kunesilinganiso, ukwelashwa kuyizimpawu. Imvamisa, ezimeni ezinjalo, umthamo unqunywa yiBayeta, ngezinkinga ezibucayi, zonke izidakamizwa zemiphumela efanayo efanayo ziyakhanselwa.
Imiphumela Yokulapha Inhlanganisela
Lapho ukhetha irejimeni yokwelashwa kweBayeta, udokotela wokuqala we-endocrinologist kufanele aziswe ngayo yonke imishanguzo ethathwa yisifo sikashukela ngalesi sikhathi. Kunakwa ukubhekelwa kakhulu kumathebulethi aphuzwa ngomlomo futhi amukelwa emgodini wokugaya ukudla. Njengoba umuthi ubambezela ukuphuma kwe-gastric, kuyadingeka ukuthatha eminye imishanguzo amahora ama-2 ngaphambi kwemijovo yeBaeta.
Ngokulashwa okuhambisanayo ngokusho kwesikimu esithi "i-Baeta plus Digoxin" ukusebenza kwezokwelapha kuyaphela. Iziguli ezinokweqile ezisebenzisa iLisinopril kufanele futhi zibekezelele isikhathi sesikhathi phakathi komjovo kanye namathebulethi. Ama-inhibitors we-HMG-CoA reductase awaguquki ukwakheka kwamafutha egazi (low and high density lipids, triglycerol, cholesterol isamba) ngesikhathi sokwelashwa okuhlangene.
Ukusetshenziswa kwe-Baeta ngemuva kokwelashwa kwe-insulin, kanye namalungiselelo we-D-phenylalanine, meglitinide noma i-b-glucosidase inhibitors, akufundwanga. Eminye imishanguzo ingadala imiphumela emibi uma ihlanganiswa neBayeta, futhi ngudokotela kuphela ongabheka wonke ama-nuances wokusebenzisana kwabo.
Izimo zokugcina zamapeni wesirinji
YeBayeta, imiyalo yokusebenzisa ichaza ngokuningiliziwe yonke imibandela yesitoreji sayo. Ngekhithi losizo lokuqala, udinga ukukhetha indawo eyomile, emnyama futhi epholile enombuso wokushisa wama-2-8 degrees. Uma ukuqina kuphukile futhi nepeni yesirinji yayivele isebenza, kufanele ishiywe ekushiseni kwegumbi (kufika kuma-degree angama-25).
Impilo yamashalofu yomuthi onjalo ayisekho inyanga. Ukutholakala kwezingane kwikhabithi yemithi kumele kube nomkhawulo. Lapho ugcina emaphakeji esiqandisini, i-Baete akufanele iqandwe.
Ungashiyi ipeni lesirinji nenalithi enamathiselwe isikhathi sokusetshenziswa. Ngemuva kwenqubo, inaliti iyasuswa, futhi ngaphambi komjovo olandelayo, kufakwa okusha. Ukunaka izimo zokugcina zomuthi kunciphisa umphumela wazo wokwelapha. Uma isixazululo esicacile sinamafu, kuvela amachashaza kuyo, umuthi uguqula umbala, umuthi kufanele uchithulwe.
Bayikhipha ekhemisi i-Bajetu ngencwadi kadokotela. Umuthi kumele usetshenziswe kungakapheli iminyaka emibili kusukela onyakeni okhishwe ebhokisini. Umuthi ophelelwe yisikhathi awunakusetshenziswa - ngaphezu kokusebenza kancane, ubungozi bokungaphenduki okuhle buyanda. Izinga lomuthi nalo lincike ekuthobeleni imigomo yokubeka.
I-Baeta: ukubuyekezwa esithangamini
Izinkundla ezithintekayo zidingida ngenkuthalo ukuthi kungenzeka yini ukulungiswa kwesisindo ngosizo lweBayeta. Akukhona nje kuphela abanesifo sikashukela aba nesifiso somuthi.
Imiyalo ekhethekile
I-Baeta ingumuthi okhiqizwa njenge-analogue yokwenziwa ye-glucagon-peptide-1 yomzimba womuntu, kepha isikhathi saso sibonisa isikhathi eside kakhulu. Inani layo labanesifo sikashukela likhona ngqo eqinisweni lokuthi lisebenza njengehomoni yomuntu. Ngaphezu kokulungiswa kwesisindo nokulawulwa kwe-glycemic, i-glycosylated hemoglobin ithuthuka ngo-1-1.8%.
Kuzo zonke izinzuzo zalo eziningi, ngokuqhathanisa ezinye izindlela, i-Baeta ayinabo ubunzima. Ifomu lokukhishwa lomuthi lifaka kuphela imijovo engenasisekelo, i-analogue yethebhulethi ayikakhiwa. Ingxenye yesithathu yabantu abanesifo sikashukela abesebenzisa umuthi isikhathi eside banezikhalazo zezimpawu ezihamba kancane zokuthi baphenduke kabi.
Lapho i-metabolite isikiwe, izinga le-GLP-1 lingagxuma ngezikhathi ezithile, futhi ngalo amathuba we-hypoglycemia. I-Baeta njenge-ejenti ye-metabolic izibonakalise ekwelashweni okuyinkimbinkimbi nezinye izidakamizwa ze-hypoglycemic.
Ividiyo ikhombisa imiyalo yezinyathelo ngezinyathelo yokusetshenziswa kwamapeni wesirinji yesizukulwane esisha.
