"Phenytoin": tilmaamaha loo isticmaalo, analogs, Curiska

Maxay ka dhigan tahay daroogo kale Tilmaamaha "phenytoin" loo isticmaalo, analogs yihiin wakiilada la qayb ka mid ah oo firfircoon waa la hoos ku soo bandhigi doonaa.

guryaha Kiimikada iyo qaab

"Phenytoin" la qayb ka mid ah oo firfircoon waa dawo anti-suuxdin. Waa derivative ah hydantoin, aad ugu dhow in ay acid ah barbituric (in qaab-dhismeedka kiimikada ay).

walax ee su'aasha ku jira liiska daawooyinka lagama maarmaanka ah by WHO, iyo sidoo kale liiska daawooyinka lagama maarmaanka ah.

Phenytoin (tilmaamaha isticmaalka daroogada leh qayb ka matali doono oran) waxaa ku dhexsameeysmo 1908 sano. Oo kaliya by 1937-mu hantida anticonvulsant laga helay.

walax Tani waa budo (crystalline) midabka cad oo ficil ahaan waa beelaya in biyaha. Xarunta Tani waxaa loo kala diri karaa in xal 1% of alkali dhamayta ah.

Currently sii daayo kiniinka afka "phenytoin" iyo sidoo kale ka dhigan tahay maamulka parenteral.

Farmashiiste

Sidee daroogada "phenytoin"? Tilmaamaha loogu isticmaalo waxay muujinaysaa in uu leeyahay wakiilka anticonvulsant, antiarrhythmic, guryaha relaxant antiepileptic iyo muruqa.

dhaqdhaqaaqa Anticonvulsant ee diyaarinta this waa halkii sare. Si kastaba ha ahaatee, uu ballan ma keenaan hurdo iyo feejignaan xumo.

Phenytoin yeedhay stabilizer bio-koronto wax ku ool ah. Marka qaadasho sare oo ah walaxda, waxay keeni kartaa in isuduwidda saboolka ah ee dhaqdhaqaaqa aadanaha.

Waxaa loo tixgeliyaa hab shidaa yimaada habdhiska dhimirka, waxay kordhisaa marinka excitability, ayaa tallaabo ah antiarrhythmic on wadnaha, iyo sidoo kale waxa ay yaraynaysaa heerka of maris ah digir of block laan ku jirase aad iyo macdantaa Purkinje.

hab ay of tallaabo daroogada

Iyada oo ku saleysan waxa ay saamayn daawo "phenytoin"? Waxbarashada sheegayaa in mabda 'ee ay saamaynta on jidhka bini'aadamka waxaa weli si buuxda u fahamsan yahay. Si kastaba ha ahaatee, khubarada ku doodaya in feature ee aasaasiga ah ee qalab this tahay awooddiisa ah inuu dejiyo xuubka (neuronal) xidhiidhada synaptic of unugyada dareenka iyo jidhka.

Ugu wacan tahay saamaynta sida, daroogada u xadidi karnaa fiditaanka of excitation neuronal iyo sidoo kale si loo yareeyo dhaqdhaqaaqa qalalka.

Features lacag

daawo la taaban karo "phenytoin"? Tilmaamaha loogu isticmaalo ayaa sheegay in ay walax firfircoon saamayn ku ganglia ku autonomic, laf-dhabarta iyo maskaxda, wadnaha, oo ay ku jiraan nidaamka tabinta, dareemayaasha durugsan iyo muruqa siman of weelashii xiidmaha iyo wadnaha.

Qaadashada daroogada Tani waxa ay yaraynaysaa fiirsashada sodium ee neurons, fududeeyo gaadiidka ee udhigo sodium ka unugyada, iyo sidoo kale hoos u dhaqdhaqaaqa calcium intracellular.

Waa in la sidoo kale lagu xusay in daawada loo arkaa saameeyaa hawlaha fibroblasts, unugyada glial, iyo hormoonada jidhka. Waxaa sidoo kale laga helay ay awoodda si loo dardar-bogsashada dhaawaca, si loo xakameeyo dhaqdhaqaaqa ee receptors (glutamate), loo hagaajiyo sahayda Ogsijiinta unugyada, unugyada iyo xubnaha in shuruudaha hypoxia iyo sunta lagu sumoobo.

Daawada at qiyaasood daweynta ayaa toning dhexdhexaad ah iyo xasiliyaa oo aan la qabatimo.

kinetics

Ha walax phenytoin nuugo? Tilmaamaha loogu isticmaalo (nooc ka mid ah in la sii daayo of daroogada magac isku mid kor ku xusan ayaa loo magacaabay) dhigayaa in maamulka afka of qayb daroogada of this ee si sahlan ee jidhku u nuugo bukaanka. Si kastaba ha ahaatee, oo xuduudaheedu pharmacokinetic tixgeliyo hab ku kala duwanaan karaan la taaban karo in kooxaha kala duwan ee bukaanka.

tirada ugu badan ee daroogada ah ee dhiigga waxaa lagu gaarayaa 5-14 saacadood (ilaa 28 saacadood samaynta looxa) gudahood. Saamaynta maamulka afka ee daroogada ayaa lagu arkay saacad kadib, iyo ka dib markii maamulka xididka - dhowr daqiiqo ka dib.

Ku dhawaad 80% oo ah walaxda firfircoon waxa uu la xidhiidhaa borotiinada plasma dhiigga. Dadka qaba cudurka kelyaha, heerka ay gaari karaan 43%.

Sida laga soo xigtay tilmaamaha lacagtaas si dhakhso guulaysta ah caqabad dhiig-maskaxda. Xaaladdan oo kale, waxaa loo qaybiyey ku dhowaad dhammaan unugyada iyo xubnaha.

About 5% phenytoin waxaa outputted by kelyaha. Marka la eego in ay xeryahooda ka harsan tahay, waxaa metabolized beerka iyo beddelay paraoksifenily aan firfircooneyn iyo glucuronides, taas oo markaa ah jidhka ka wada bile ah.

Sidee baan u isticmaalaa daawada "phenytoin"? Isticmaalka daroogada this lagu muujiyay la pentobarbital, vitamins D iyo K, iyo sidoo kale protivoepileptikami kale. Kaliya kiiskan uu u noqon doonaa sida wax ku ool ah sida ugu macquulsan.

maragga

Xaaladaha qaarkood, daroogooyinka u isticmaalaan la qayb firfircoon, sida phenytoin? Tilmaamaha loogu isticmaalo (kiniin iyo xal waa in ku talinaynaa dhakhtar khibrad leh oo keliya) waxay muujinaysaa ka muujinaya soo socda:

• qalalka,
• xilliga qalliinka iyo trauma (sida daroogada ka hortag ah) ka dib;
• ventricular iyo arrhythmia supraventricular, kaas oo uu sababay badinta ah murugada iyo glycosides wadnaha;
• xaaladda epilepticus la qalal adag qayb iyo qalal tonic clonic-;
• Meniere ee syndrome,
• neuralgia trigeminal, oo ay ku jiraan iska caabin ah ay u carbamazepine;
• ulcerös kolit ama caro syndrome mindhicirka (in waxtardarradoodu therapy kale);
• rabshooyin ah hababka fikirka, xanuunada maskaxda, cudurada dabeecadda;
• strabismus iyo glaucoma,
• habka aan caadi ahayn cusboonaysiinta (gubasho, suus ilkaha, ulceration iyo scleroderma);
• noqoshada qandho iyo hypothalamic syndrome.

sababo

daawo viewed laga yaabaa in aan la isticmaali karaa marka:

• cachexia ama leukopenia;
• nuujinta,
• beerka daran iyo cudur kalyaha ah,
• wadnaha oo shaqadiisa gaba, AV-Go'doominta of 2aad ama 3aad degree, bradycardia;
• diidmo in walxaha firfircoon;
• porfyri;
• syndrome ee Morgagni-Adams-Stokes,
• uurka.

Sidoo kale, digniin bukaanka qaba diabetes mellitus, Khamriga, marka lupus erythematosus ama hyperthermia.

Daawo "phenytoin": tilmaamaha loo isticmaalo

qiyaasta daawada waxaa si gaar ah loo doortay ku xiran da'da qofka bukaanka ah iyo cudur.

Marka cudurada suuxdin dose waa in ay dhowr jeer ka hooseeya ee qalalka. Dawo ah kiniin oo la qaato oo kaliya inta lagu guda jiro cuntada.

Qiyaasta maalin kasta bukaanada qaangaarka ka dhigan tahay in 1-3 kiniiniyada (qaybsan 2-3 qaadasho). Haddii loo baahdo, tirada this la soo kordhin karaa ilaa 4 kiniin maalin.

qiyaasta ugu badan ee daawada maalin kasta waa 8 kiniin. Xaaladdan oo kale, mar bukaanka qaadan kartaa oo kaliya 3 kaniini.

In lagu daweeyo carruurta ka yar 5 sano inay doortaan kiniin ¼ laba jeer maalintii. Kids 5-8 sano - in tiro la mid ah, laakiin 3 ama 4 jeer maalintii.

Caruurta gaadhay da'da of 8, waxaa lagu talinayaa in la siiyo 1-2 kaniini oo 2 qaadasho kala qaybsan.

Muddada aad daawada la qalab this waxaa lagu qeexaa oo keliya by takhasus u leh.

Waxqabadka by-qof

Daawooyinka phenytoin keeni karaan dhibaatooyinka soo socda aan loo baahnayn:

• Xasaasiyadda maqaarka, morbilliform finan (waa in ay joojiyaan daroogada loo khafiifiyo calaamadaha).
• Dareen-celinta xasaasiyadda daran (dhif dhacaan), qandho, Mandheera maqaarka ballaaran, Stevens-Johnson syndrome, anjioedema erythema, hepatitis.
• kelyaha ciridka, macrocytosis, osteomalacia, anemia megaplasticheskaya, Torombositobiiniya, pancytopenia, hirsutism, anemia haemolytic, Lymphadenopathy.
• xanuunada Qiyaasta ku tiirsan of habdhiska dhexe, indhaha, dibnaha iyo kaaha aamba, walaaca, ataxia, dawakhaad, gariirka, hurdo la'aan, caro, neuropathy ku dareen (dhaca la qaadasho sare dheer).
• Hypertrichosis, coarsening of sifooyinka wajiga, hyperpigmentation, miisaanka oo yaraada, arthritis.

Sidoo kale waa in la ogaadaa in marka la helo qiyaasta hore, bukaanka waxaa laga yaabaa in la horumariyo dhibaatooyinka soo socda ka mid ah cudurada caloosha, sare u qaadis ah ensaymes beerka, lalabo, dyspepsia, gastralgia iyo gastritis. ah ee saamaynta sida la baajin karin haddii aad qaadato kiniinka oo kaliya inta lagu guda jiro cuntada.

xaaladood oo badinta

Codsiga of daroogada loo arkaa at qiyaasood sare muddo sii dheeraaday waxay keeni kartaa in horumarka ataxia, nystagmus, hyperkinesis, neuropathy dareenka, iyo diplopia. Sidoo kale, bukaanka waxaa laga yaabaa mariyo faa'iido qalalka, hyperglycemia, iyo maskax hurudda.

Waa in la ogaadaa in walax this jiro daawo gaar ah. Therapy Waa in la fuliyo sida ay calaamado u muuqday.

macluumaad gaar ah

Lacagtaas oo jir- oo aan la joojin kartaa bukaanka qaba qalalka, maadaama ay tani waxay keeni kartaa horumarinta syndrome ah. Haddii aad doonayso in aad diido inaad tan aqbashaan (tusaale ahaan, xasaasiyad ama diidmo), waa in aad isticmaasho daawada anti-qabashada nooc kale.

Daaweynta macnaheedu tixgeliyo saamayn ku kolestaroolka, bilirubin, phosphatase xumadoodu, falgalka beerka, glucose, calcium serum iyo tyroksiini hormone.

Sida kor ku xusan, walax phenytoin waxaa metabolized beerka, si kastaba ha ahaatee inta ay soo dhaweynta waxay u baahan tahay daryeel gaar ah la siiyo dadka qaba beerka.

Haddii qof ayaa hore u la arkay diidmo in anticonvulsants hydantoin, ka dibna maalkiisa sidoo kale waa suurto gal xasaasiyadda.

Inta lagu jiro daaweynta, bukaanku waa ka mamnuuc in la wado baabuur oo uu ku sameeyo shaqo halis ah.

Analogs iyo dib u eegis

Maxaa bedeli karaa daroogada antiepileptic "phenytoin"? Analogues wakiilka this ku jira qayb ka mid ah oo firfircoon. Daawooyinka waxaa ka mid ah kuwan soo socda: "Difenin", "diphenylhydantoin" iyo "Dilantin".

dib u eegista Inta badan bukaanka hoos tixgelin waa cadaalad ah. Waxay ku doodayaan in daroogada waxaa loo wareejiyey si sahal ah. Intaa waxaa dheer, waxa ay leedahay qadar yar oo aan waayi guryaha ay anticonvulsant xitaa ka dib markii maamulka daba dheeraaday.

Sidoo kale waa in Waxaan la soco in ay jirto wax badan oo dib u eegista wanaagsan gaari this, kaas oo ka tagay bukaanada ku qaatay in therapy isku dhafan.