Ukubuyekezwa kokutholwa kwe-sulfonylurea

Ngokukhiqizwa okunganele kwe-insulin, baphendukela ekwandeni kokuhlushwa kwayo. Izithako ze-sulfonylureas zingezemithi ekhulisa imfihlo ye-hormone futhi ingeyemithi yokwenziwa ye-hypoglycemic.

Zibonakaliswa ngumphumela omenyezelwe kakhulu uma uqhathaniswa namanye ama-ejenti etafuleni anomphumela ofanayo.

Kafushane ngemishanguzo yeqembu

Ama-Sulfonylurea derivatives (PSM) yiqembu lezidakamizwa ezenzelwe ukwelapha isifo sikashukela. Ngaphezu kwe-hypoglycemic, banomphumela we-hypocholesterolemic.

Ukuhlukaniswa kwezidakamizwa selokhu kwethulwa:

1. Isizukulwane sokuqala emelelwe yi-chlorpropamide, Tolbutamide. Namuhla azisetshenziswa. Bakhonjiswa ngesenzo esifushane, ukufeza umphumela ababekwe wona ngevolumu enkulu.
2. Isizukulwane sesibili yiGlibenclamide, Glipizide, Gliclazide, Glimepiride. Bakhombise ukubonakaliswa okuncane kwemiphumela emibi, kunqunywe ngenani elincane.

Ngosizo lweqembu lemithi, isinxephezelo esihle sesifo sikashukela singatholakala. Lokhu kukuvumela ukuthi uvikele futhi wehlise ijubane ukuthuthukiswa kwezinkinga.

Ukwemukelwa kwe-PSM kuhlinzeka:

• kunciphise ukukhiqizwa kweshukela;
• ukukhuthaza kwe-pancreatic β-cell ukuthuthukisa ukuzwela kwe-glucose;
• ukukhulisa ukuzwela kwezicubu kwehomoni;
• Ukuvimbela ukucasulwa kwe-somatostatin, okucindezela i-insulin.

Uhlu lwamalungiselelo we-PSM: Glibamide, Maninil, Glibenclamide, Teva, Amaril, Glisitol, Glemaz, Glisitol, Tolinase, Glibetik, Gliclada, Meglimid, Glidiab, Diabeteson, Diazid, Reklid, Oziklid. Glibenez, Minidab, Movogleck.

Indlela yokusebenza

Isakhi esiyinhloko sithinta ama-receptors wesiteshi esithile futhi siwavimbele. Kukhona ukudonswa kolwelwesi lwama-β-cell, futhi ngenxa yalokho, ukuvulwa kweziteshi ze-calcium. Ngemuva kwalokhu, amaCa ions angena kumaseli we-beta.

Umphumela uba ukukhishwa kwe-hormone emigqeni ye-intracellular kanye nokukhishwa kwayo egazini. Umphumela we-PSM uzimele we-glucose okuhlushwa Ngalesi sizathu, isimo se-hypoglycemic sivame ukwenzeka.

Imithi igxilwe emgodini wokugaya ukudla, umphumela wawo uqala amahora ama-2 ngemuva kokuphathwa. I-enzelwe esibindini, ekhishwe ngaphandle kwe-Glycvidon, ngokusebenzisa izinso.

Isikhathi sokuphila nesikhathi ubude besidakamizwa ngasinye eqenjini sehlukile. Ukuhlanganisa amaprotheni e-plasma - kusuka ku-94 kuye kuma-99%. Indlela yokuqothula, ngokuya ngomuthi, i-renal, renal-hepatic, ne-hepatic. Ukuvalwa kwento esebenzayo kuyancipha ngokudla okuhlanganisiwe.

Izinkomba zokuqokwa

Izinhlinzeko ze-sulfonylureas zinqunyelwe isifo sikashukela sohlobo 2 ezimeni ezinjalo:

• ukukhiqizwa okunganele kwe-insulin;
• ngokuncipha kokuzwela kwehomoni yezicubu;
• nokungasebenzi kahle kokulashwa kokudla.

Contraindication kanye nemiphumela emibi

Okuphathelene ne-Contraindication sulfonylurea kufaka lokhu:

• Uhlobo 1 sikashukela;
• ukungasebenzi kwesibindi;
• ukukhulelwa
• ukuncelisa;
• ukungasebenzi kwezinso;
• ketoacidosis;
• ukungenelela kokuhlinzwa;
• i-hypersensitivity to sulfonamides kanye nezinto ezisizayo;
• ukungabekezeleli i-PSM;
• i-anemia
• izinqubo zokutheleleka okunamandla;
• iminyaka engu-18.

Izidakamizwa azinqunyelwe amazinga aphezulu kashukela azila ukudla angaphezu kuka-14 mmol / L. Futhi, musa ukufaka isicelo sezidingo zansuku zonke ze-insulin zamayunithi angaphezu kwama-40. Akunconyelwe iziguli ezinesifo sikashukela esibi 2 lapho kukhona khona β-cell defence.

I-molecule yeBiguanide

I-Glycvidone ingabhekelwa kubantu abanokulimazeka okuthambile kokusebenza kwezinso. Ukukhishwa kwayo kwenziwa (cishe ama-95%) ngamathumbu. Ukusetshenziswa kwe-PSM kungakha ukumelana. Ukunciphisa izehlakalo ezinjalo, zingahlanganiswa ne-insulin ne-biguanides.

Iqembu lemithi livame ukubekezelelwa. Phakathi kwemiphumela emibi, i-hypoglycemia imvamisa, i-hypoglycemia ebukhali ibonwa emaphesenti angama-5 kuphela. Futhi, phakathi nokwelashwa, inzuzo yesisindo iyabonakala. Lokhu kungenxa yokuqashelwa kwe-insulin endulin.

Imiphumela elandelayo emibi ayivamile:

• ukuphazamiseka kwe-dyspeptic;
• ukunambitheka kwensimbi emlonyeni;
• i-hyponatremia;
• i-hemolytic anemia;
• umsebenzi wezinso ongonakalisiwe;
• ukungahambi kahle komzimba;
• ukwephulwa kwesibindi;
• i-leukopenia ne-thrombocytopenia;
• i-cholestatic jaundice.

Imithamo nokuphatha

Umthamo we-PSM unqunywe ngudokotela. Kunqunywa ukuthi kubhekwe ukuhlaziywa kwesimo se-metabolism.

Kungcono ukuqala ukwelashwa nge-PSM nababuthakathaka, kuthi uma ungekho umphumela, shintshela kwezidakamizwa ezinamandla. I-Glibenclamide inomphumela ophinda wehlise ushukela ukwedlula amanye ama-ejenti omlomo we-hypoglycemic.

Ukuthatha umuthi obekiwe kuleli qembu kuqalwa ngemithamo emincane. Ngaphezu kwamaviki amabili, ikhula kancane kancane. I-PSM ingabekwa nge-insulin kanye namanye ama-etafula ama-hypoglycemic.

Umthamo ezimweni ezinjalo uyancishiswa, kukhethwa okulungile kakhudlwana. Lapho isinxephezelo esimeme sesitholakala, ukubuyela kunqubo ejwayelekile yokwelashwa kwenzeka. Uma imfuneko ye-insulin ingaphansi kwama-unit ayi-10 / ngosuku, udokotela ushintsha isiguli ukuze sithathwe sulfonylurea.

Thayipha isifo sikashukela sesi-2

Umthamo wesidakamizwa esithile uboniswa kwimiyalo yokusebenzisa. Isizukulwane nezimpawu zomuthi uqobo (into esebenzayo) kuyabhekwa. Umthamo wansuku zonke we-chlorpropamide (isizukulwane sokuqala) - 0,75 g, iTolbutamide - 2 g (isizukulwane sesibili), iGlycvidona (isizukulwane sesibili) - kufinyelela ku-0.12 g, Glibenclamide (isizukulwane sesibili) - 0,02 g. Iziguli ezinokulimazeleka komzimba nomsebenzi we-hepatic, asebekhulile umthamo wokuqala uyancishiswa.

Zonke izimali zeqembu le-PSM zithathwa uhhafu wehora noma ihora ngaphambi kokudla. Lokhu kunikeza ukufakwa okungcono kwezidakamizwa futhi, ngenxa yalokho, ukwehla kwe-gracemia ye-postprandial. Uma kunokuphazamiseka okusobala kwe-dyspeptic, i-PSM ithathwa ngemuva kwezikhathi zokudla.

Ukuphepha kokuphepha

Kubantu asebekhulile, ingozi yokuba ne-hypoglycemia iphakeme kakhulu. Kulesi sigaba seziguli, izidakamizwa ezinesikhathi esifushane kakhulu zinqunyelwe ukuvikela imiphumela engathandeki.

Kunconywe ukulahla izidakamizwa ezisebenza isikhathi eside (i-Glibenclamide) bese ushintshela ku-short-acting (Glycvidone, Glyclazide).

Ukuthatha okuvela ku-sulfonylurea kudala izingozi ze-hypoglycemia. Ngesikhathi sokwelashwa, kuyadingeka ukubheka amazinga kashukela. Kunconywa ukuthi ulandele uhlelo lokwelashwa olusungulwe udokotela wakho.

Ngokuphambuka kwayo, inani le-glucose lingashintsha. Ezimweni zokwenziwa kwezinye izifo ngesikhathi sokwelashwa kwe-PSM, kuyadingeka ukwazisa udokotela.

Ngenkathi yokwelashwa, izinkomba ezilandelayo zigadiwe:

• izinga likashukela lomchamo;
• i-glycosylated hemoglobin;
• ushukela wegazi
• izinga le-lipid;
• ukuhlolwa kwesibindi.

Akunconyelwe ukuthi ushintshe umthamo, ushintshele kwesinye isidakamizwa, uyeke ukwelashwa ngaphandle kokubonisana. Kubalulekile ukusebenzisa umuthi ngesikhathi esibekiwe.

Ukweqa umthamo obekiwe kungaholela ku-hypoglycemia. Ukuyiqeda, isiguli sithatha i-25 g yeglucose. Isimo ngasinye esifanako uma kungenzeka sinyuke isilinganiso semithi sibikwa kudokotela.

Kwi-hypoglycemia enzima, ehambisana nokulahlekelwa ukwazi, kuyadingeka ukufuna usizo lodokotela.

I-glucose ilawulwa ngokuhlinzwa. Ungadinga imijovo eyengeziwe ye-glucagon ku / m, ngo / ku. Ngemuva kosizo lokuqala, uzodinga ukuqapha isimo izinsuku eziningana ngesilinganiso esoshukela ejwayelekile.

Ividiyo onhlobo lwesifo sikashukela sohlobo 2:

Ukusebenzisana kwe-PSM nezinye izidakamizwa

Ekuhambeni kokuthatha eminye imithi, ukuhambisana kwabo ne-sulfonylurea derivatives kuyabhekwa. Amahomoni we-anabolic, ama-antidepressants, ama-beta-blockers, ama-sulfonamides, ama-clofibrate, ama-hormone besilisa, ama-coumarins, izidakamizwa ze-tetracycline, i-miconazole, i-salicylates, nezinye izidakamizwa ze-hypoglycemic ne-insulin zikhulisa umphumela we-hypoglycemic.

I-PSM inciphisa imiphumela ye-corticosteroids, i-barbiturates, i-glucagon, i-laxatives, ama-estrogens kanye nama-gestagens, i-nicotinic acid, i-chlorpromazine, i-phenothiazine, i-diuretics, ama-hormone e-thyroid, isoniazid, i-thiazides.