"Phenytoin": mirayiridzo kushandiswa, analogs, Kuronga

Chii chinoumba mushonga akadai "Phenytoin" Mirayiridzo kushandiswa, analogs ndivo vamiririri pamwe chete vachishingaira chirungiso zvichakurukurwa pazasi.

Chemical zvivako uye chimiro

"Phenytoin" pamwe chete vachishingaira chirungiso ane Anti-tsviyo mushonga. It rinobva hydantoin, pedyo chaizvo kune barbituric asidhi (mu kwemakemikari kwavo mamiriro).

The fuma iri mubvunzo kunobatanidzwa pamazita mishonga zvinokosha nokuda WHO, uyewo mazita mishonga zvinokosha.

Phenytoin (mirayiridzo kushandiswa kwezvinodhaka pamwe rokuti achapiwa kumiririrwa hereinafter) akanga synthesized muna 1908 gore. Uye bedzi 1937-mü anticonvulsant ehupfumi ayo pazvakawanikwa.

fuma uyu upfu (crystalline) ane chena ruvara rwuri kushanda insoluble mumvura. remubatanidzwa Izvi zvinogona zvazvichanyungudutswa 1% mhinduro kubva caustic alkali.

Pari kusunungura zvokuudzwa mapiritsi "Phenytoin" uyewo zvinoreva kuti parenteral yaitonga.

pharmacology

Sei mushonga "Phenytoin"? Mirayiridzo dzokushandisa kunoratidza kuti ane anticonvulsant mumiririri, antiarrhythmic, antiepileptic uye tsandanyama relaxant zvivako.

Anticonvulsant basa rokugadzirira iri nani kumusoro. Zvisinei, kugadzwa kwake haakonzeri hope uye lethargy.

Phenytoin inonzi inoshanda bio-yemagetsi stabilizer. Kana kutora matunhu mishonga yacho fuma, zvinogona kutungamirira murombo Kufambisa kufamba kwevanhu.

Vaiona zvinoreva zvaanopa simba ari CNS, anowedzera excitability chikumbaridzozve, ine antiarrhythmic chiito pamusoro mwoyo, uye kunoderedza mwero ndima pulses ose ari chinogumbura danda bazi uye Purkinje fibers.

The mashandiro kuita zvinodhaka

Zvichienderana sei mishonga "Phenytoin"? Instruction inoti kuti nheyo rawo muviri haisi aizvinzwisisa. Zvisinei, vanamazvikokota vanoti kuti chinokosha chinoratidza chokushandisa ichi kukwanisa kwayo kudzikamisa membranes (neuronal) synaptic kwokubatana masero etsinga uye muviri.

Nokuda akadaro anokonzerwa, mushonga anogona kukutadzisa kupararira neuronal excitation uyewo kuderedza nezvokubvuta basa.

Features mari

The mushonga chinoshamisa "Phenytoin"? Mirayiridzo dzokushandisa inoshuma kuti chacho vanoshingaira fuma kunokanganisa autonomic ganglia, musana uye uropi, mwoyo, kusanganisira ayo conductive ezvinhu, peripheral tsinga uye anotsvedzerera tsandanyama pamusoro intestinal uye mwoyo midziyo.

Kugamuchira mushonga uyu kunoderedza yavaibvisa wevasungwa munguva Tutsinga tunofambisa mashoko utwu, aivabatsira kuti chokufambisa kuti yavaibvisa ions kubva mumasero, uye kuderera intracellular karusiyamu masangano.

Zvinofanira kucherechedzwa kuti vaiona mushonga kunokanganisa mukushanda fibroblasts, masero glial, uye kwemakemikari anobudiswa. Zvakanzi zvekare yakawanikwa kugona rayo mhanyisa ronda kuporesa, kudzvinyirira basa receptors (glutamate), kuvandudza wedzerai reokisijeni kuti masero, nyama uye nhengo mumamiriro ezvinhu ose hypoxia uye zvinokachidza chepfu.

The mushonga pa kuchirapa mishonga ine mwero toning uye anonyaradza uye haisi muropa.

kinetics

Ko phenytoin fuma wefodya? Mirayiridzo dzokushandisa (rudzi kusunungurwa chete zita zvinodhaka kwave ainzi apa) rinoti dzaiita zvokutaurwa yaitonga rokuti uyu mushonga nokururamisira nyore kunyura nedare murwere. Zvisinei, kuti pharmacokinetic parameters vaiona rinoreva dzingasiyana zvinooneka munyika dzakasiyana mumapoka varwere.

The soro wevasungwa zvinodhaka muropa kunokwanisika mumaawa 5-14 (maawa anosvika 28 nokuti pahwendefa Pfungwa). Kuvhiringidzwa nomumukanwa kwokubatsira zvinodhaka riri akacherechedza pashure inenge awa, uye pashure intravenous Kutarisirwa - pashure maminitsi mashoma.

Vanenge 80% yezviri nhumbi inobatanidzwa ropa mapuroteni eplasma. Vanhu vane chirwere cheitsvo, mwero inogona kusvika 43%.

Maererano mirayiridzo mari zvakarurama nokukurumidza chinokunda ropa-uropi nokuidzivirira. Muchiitiko chino, zviri akaparadzirwa zvinenge zvose munyama uye nhengo.

About 5% kubva phenytoin iri outputted pedyo neitsvo. Panyaya yeimwe yasara kuti rinoita muna chiropa uye dzikwanise akaneta paraoksifenily uye glucuronides, iyo zvino kubuda mumuviri pamwechete bile.

Ndingatarira kushandisa mishonga "Phenytoin"? Kushandiswa kwezvinodhaka ichi kunoratidzwa ne pentobarbital, mavhitaminzi D uye K, uyewo mamwe protivoepileptikami. Chete muchiitiko ichi achava kubudirira sezvinobvira.

umboo

Mune zvimwe zviitiko, kushandisa zvinodhaka pamwe kushingaira chirungiso, sezvo phenytoin? Mirayiridzo kushandiswa (mahwendefa uye mhinduro vanofanira kuvakurudzira chiremba ruzivo chete) inoratidza zvinotevera zvairatidza:

• pfari;
• nguva pashure pokuvhiyiwa uye kunotevera (kuzvidzivirira zvinodhaka);
• ventricular uye supraventricular arrhythmia, iyo kunokonzerwa ane ovhadhozi pamusoro antidepressants uye cardiac glycosides;
• chinzvimbo epilepticus pamwe haasaruri pfari yakaoma uye tonic-clonic pfari;
• Meniere kuti urwere;
• trigeminal neuralgia, kusanganisira kuramba carbamazepine;
• maronda colitis kana kutsamwa bowel syndrome (mu ineffectiveness mamwe kurapa);
• vachivavhiringidza repfungwa pezvakaitwa, chirwere chepfungwa, maitiro asina kutsarukana;
• strabismus uye yemaziso;
• zvemamiriro patsva muitiro (kutsva, mazino caries, ulceration uye scleroderma);
• relapsing fivha uye hypothalamic syndrome.

Contraindications

mishonga Viewed arege kushandiswa kana:

• cachexia kana leukopenia;
• lactation;
• chakakomba chiropa uye chirwere cheitsvo;
• mwoyo kukundikana, AV-blockade pamusoro 2nd kana 3rd dhigirii, bradycardia;
• hypersensitivity kuti basa zvinhu;
• porphyria;
• urwere pakati Morgagni-Adams-Stokes;
• pamuviri.

Uyewo, kungwarira varwere cheshuga mellitus, udhakwa, kana lupus erythematosus kana hyperthermia.

Medicine "Phenytoin": mirayiridzo kushandiswa

The chipimo chemushonga zvinodhaka anosarudzwa nomumwe zvichienderana murwere zera uye chirwere.

Kana zvipusha zvirwere dose kunofanira kakawanda kudzika kupfuura netsviyo. Medicine piritsi muchimiro wakatorwa chete panguva kudya.

The daily dose varwere mukuru yaiva pamahwendefa 1-3 (akakamurwa 2-3 mishonga). Kana zvakakodzera, nhamba iyi inogona ngazviwedzerwe kusvika 4 Mahwendefa rimwe zuva.

The kunonyanyisa chipimo chemushonga kurapwa pazuva iri 8 Mahwendefa. Muchiitiko chino, pane imwe nguva murwere anogona chete kutora 3 Mahwendefa.

In pakurapa vana pasi 5 makore vakamirapo ¼ piritsi kaviri pazuva. Kids 5-8 Makore - ari zvakaenzana, asi 3 kana 4 kanomwe pazuva.

Vana vanenge zera 8, Zvinokurudzirwa kupa Mahwendefa 1-2 muna 2 yakakamurwa mishonga.

Ya kurapwa pamwe chokushandisa ichi kunorondedzerwa bedzi nyanzvi.

Zviito ne-hunhu

Mishonga phenytoin kungaita zvinotevera sadikanwa Migumisiro:

• Skin chisimbwa, okuvhurumuka morbilliform (vanofanira kumisa mushonga kusimbisa zviratidzo).
• Zvakakomba neutachiona (kashoma kuitika), fivha, zvakadzama ganda kwemakomo, Stevens-Johnson urwere, erythema angioedema, hepatitis.
• Gingival hyperplasia isiri yekenza, macrocytosis, osteomalacia, megaplasticheskaya kupererwa neropa, thrombocytopenia, pancytopenia, hirsutism, haemolytic kupererwa neropa, lymphadenopathy.
• Dose-nemataundi kusagadzikana epfungwa, ziso, miromo uye anopenya fibrillation, kufunganya, ataxia, dzungu, tremor, kushaya hope, kushatirwa, kutsinga dzinouya neuropathy (yokuvamba pamwe kwenguva refu refu mishonga).
• Hypertrichosis, coarsening chiso chake features, hyperpigmentation, uremu, chearthritis.

Zvinofanira kucherechedzwa kuti kana kugamuchira dose wokutanga, murwere anogona kuva zvinotevera divi Migumisiro gastrointestinal zvirwere, pakukwirira chiropa makemikari, kuda kurutsa, dyspepsia, gastralgia uye gastritis. The chidzoke akadai anokonzerwa zvingadziviswa kana ukawana mapiritsi chete panguva kudya.

zviitiko ovhadhozi

Pokushandisa vaiona zvinodhaka pane mukuru mishonga kuti mazhinji kwenguva kungaita kuti pave ataxia, nystagmus, hyperkinesis, kutsinga dzinouya neuropathy, uye diplopia. Uyewo, murwere anogona kuratidza pfuma pfari, hyperglycemia, uye vadhakwa.

Zvinofanira kucherechedzwa kuti fuma iyi hapana chaicho mushonga. Zvipatara yaifanira maererano richiratidzwa zviratidzo.

chaicho mashoko

Of Mari haigoni payakakurudzirwa kukanzura varwere nepfari, sezvo izvi zvingaita kukura syndrome. Kana uchida kuramba kuzvigamuchira (somuenzaniso, nezvimwe zvinhu kana hypersensitivity), unofanira kushandisa Anti-nepfari mishonga imwe mhando.

Treatment rinoreva ndakatendeka inobata remafuta akawandisa, bilirubin, alkaline phosphatase, chiropa makemikari, shuga, serum calcium kemikari thyroxine.

Sezvataurwa pamusoro apa, phenytoin fuma rinoita ari chiropa, zvisinei panguva kugamuchirwa kwayo zvinoda kutarisirwa kuti vanhu vane chiropa kukundikana.

Kana munhu kare Zvakacherechedzwa hypersensitivity kune hydantoin anticonvulsants, ipapo fuma Zvinogonekawo chisimbwa.

Panguva kurapwa, murwere hakubvumidzwi kutyaira motokari uye kuita basa ngozi.

Analogs uye nhoroondo

Chii chinogona kutsiva antiepileptic zvinodhaka "Phenytoin"? Analogues kuti mumiriri ichi zvine chete rinoita chirungiso. Mishonga iyi zvinosanganisira zvinotevera: "Difenin", "diphenylhydantoin" uye "Dilantin".

Wongororo Vazhinji varwere pasi kufunga zvakanaka. Vanoti mushonga ari Kutamiswa zvikuru nyore. Uyezve, ine zvishoma uye asingauyi chisanyanya anticonvulsant ehupfumi kunyange pashure nehurumende refu.

Tinofanirawo kuziva kuti pane zvakawanda zvakanaka wongororo kuti motokari iyi, iyo akasiya varwere akarikunda ari kunzwisisa mishonga.