Glibenclamide: litlhaloso tsa lithethefatsi, litlhahlobo le litaelo

Lithethefatsi tsa molomo. Mehloli ea sulfonylureas.

Khoutu ea ATX: A10VB01.

Glibenclamide e fokotsa bongata ba glucose maling. Keketseho ea mahloriso a insulin le ho fokotseha ha tsoekere ho etsahala butle butle. E ama hantle mekhoa ea metabolic. Ts'ebetso e nts'etsapele lihora tse peli kamora tsamaiso, e fihla hofihlella ka mor'a lihora tse 7-8 mme e nka lihora tse 8-12.

Ho sebelisana le lithethefatsi tse ling

E ntlafatsa phello ea li-anticoagulants tse sa tobang.
Li-urine acidifying agents (ammonium chloride, calcium chloride, ascorbic acid ka tekanyetso e kholo) li matlafatsa phello ea glibenclamide.

Antifungal systemic mokgwa (azole derivatives), fluoroquinolones, tetracyclines, chloramphenicol, H2-blockers, beta-blockers, Ace inhibitors, nonsteroidal antiinflammatory lithethefatsi, monoamine dihydrobenzophenanthridine inhibitors, clofibrate, bezafibrate, probenecid, acetaminophen, li ethionamide, anabolic steroid, pentoxifylline, allopurmnol , cyclophosphamide, reserpine, sulfonamides, insulin e thusa ho nts'etsapele hypoglycemia.
Li-Barbiturates, phenothiazines, diazoxide, glucocorticoid le lihomone tsa qoqotho, estrogens, gestagens, glucagon, lithethefatsi tsa adrenomimetic, salate ea lithium, melemo ea nicotinic acid, rifampicin le saluretics li fokolisa phello ea hypoglycemic.

Contraindication

Glibenclamide e hanyetsanoe maemong a latelang:

• lefu la tsoekere le itšetlehileng ka lefu la tsoekere (mofuta oa 1), ho kenyeletsoa ho bana le lilemong tsa bocha.
• lefu la tsoekere ketoacidosis,
• lefu la tsoekere kapa leta,
• ho tlosoa ha makhopho
• hyperosmolar coma,
• ho hloleha ho matla ha renal kapa ho ba le sebete (boleng ba tumello ea tumello ea creatinine ka tlase ho 30 ml / min),
• ho chesa haholo
• likotsi tse ngata tse ngata
• mehato ea ho buoa
• mala,
• paresis ea mala
• malabsorption ea lijo le kholo ea hypoglycemia,
• leukopenia
• eketsa kutloisiso ea motho ka mong lithethefatsi, hammoho le lithethefatsi tse ling tsa sulfa le sulfonylureas,
• ho ima le ho nyekeloa
• lilemo ho isa ho lilemo tse 14.

Basali ba rerileng ho ima, hammoho le ho ba le ngoana, ba lokela ho fetohela insulin kapa ba emise ho anyesa letsoele ka botlalo.

Tekanyetso le tsamaiso

Glibenclamide e lokela ho hlatsuoa ka metsi a manyane. Ngaka e beha qeto ea tekanyetso ea pele le boholo ba lithethefatsi bakeng sa kalafo ea tlhokomelo bakeng sa mokuli ka mong, ho ipapisitse le liphetho tsa tlhahlobo ea boemo ba tsoekere moriring le mali. Ke litaelo tse joalo bakeng sa ts'ebeliso eo Glibenclamide e e hlokang.

Tekanyetso ea pele ea moriana ke halofo ea letlapa (2,5 mg) hang ka letsatsi. Haeba ho hlokahala, tekanyetso ea letsatsi le letsatsi e ka eketsoa ka ho lekola nako eohle tsoekere e maling. Keketseho ea litekanyetso e lokela ho etsoa butle butle ka nako ea matsatsi a 'maloa ka 2,5 mg, ho fihlela tekanyetso e sebetsang ea kalafo e fihlelleha.

Tekanyo e phahameng e ka ba matlapa a 3 ka letsatsi (15 mg). Ho eketsa bongata bona ha ho ntlafatse phello ea hypoglycemic.

Haeba tekanyetso e fihla ho matlapa a mabeli ka letsatsi, joale a nooa ka nako ea hoseng pele ho lijo. Haeba u hloka ho sebelisa boholo ba lithethefatsi, ho ka ba molemo ho li etsa ka litekanyetso tse peli, mme karo-karolelano e lokela ho ba 2: 1 (hoseng le mantsiboea).

Bakuli ba tsofetseng ba lokela ho qala kalafo ka tekanyetso ea halofo e lateloang ke ho eketseha ha eona ka karohano ea beke e le seng ho feta 2,5 mg ka letsatsi.

Haeba boima ba 'mele oa motho kapa tsela eo a phelang ka eona e fetoha, tekanyetso e tlameha ho fetoloa. Hape khalemelo e lokela ho etsoa haeba ho na le lintho tse eketsang kotsi ea ho ba le hyper- kapa hypoglycemia.

Ka tšebeliso e feteletseng ea sethethefatsi sena, hypoglycemia e qala. Matšoao a hae:

1. ho fufuleloa ho eketsehileng
2. ho tšoenyeha
3. tachycardia le khatello e phahameng ea mali, bohloko bo ka pelong, arrhythmia,
4. hlooho e bohloko
5. takatso e matla ea ho ja, ho hlatsa, ho nyekeloa,
6. ho otsela, ho hloka thahasello,
7. mabifi le matšoenyeho
8. khatello ea maikutlo,
9. khatello ea maikutlo, ho ferekana kelellong,
10. paresis, thothomelo,
11. phetoho ea kutloisiso
12. ho tsitsipana ha genesis e bohareng.

Maemong a mang, lipontšong tsa eona, hypoglycemia e tšoana le stroke. Ho ka ba le komello.

Phekolo ea overdose

Ka tekanyo e fokolang ea hypoglycemia e bonolo, e ka emisoa ke tšebeliso ea tšohanyetso ea lik'habohaedreite (lisakere tsa tsoekere, tee e tsoekere kapa lero la litholoana). Ka hona, batho ba nang le lefu la tsoekere ba lokela ho lula ba nkile 20 gg ea tsoekere (likotoana tse 'ne tsa tsoekere).

Li-sweeteners ha li na phello ea kalafo e nang le hypoglycemia. Haeba boemo ba mokuli bo le bobe haholo, o lokela ho kena sepetlele. Etsa bonnete ba hore u leka ho susumetsa ho hlatsa le ho fana ka mokelikeli (metsi kapa lemonade e nang le sodium sulfate le khabone e hlahisitsoeng), le lithethefatsi tsa hypoglycemic.

Litla-morao

Ho tloha ka lehlakoreng la metabolism e ka ba:

hypoglycemia, hangata ea mantsiboea, e tsamaea le:

• hlooho e bohloko
• tlala
• ho nyekeloa
• khathatso ea boroko
• bosiu
• ho tšoenyeha
• ho thothomela
• secretion ea mofufutso o thata o thellisang,
• tachycardia
• ferekanya letsoalo
• ho ikutloa o khathetse
• mathata a puo le a pono

Ka linako tse ling ho ka ba le ho tsitsipana le ho akheha, hammoho le:

1. kutloisiso e eketsehileng ea joala,
2. boima ba 'mele
3. dyslipidemia, bokella lithane tsa adipose,
4. ka tšebeliso ea nako e telele, nts'etsopele ea hypofunction ea tšoelesa ea qoqotho e khoneha.

Ho tsoa ts'ebetsong ea tšilo ea lijo:

• ho nyekeloa, ho hlatsa,
• ho sithabela, ho hlonama le ho utloa bohloko ba ka mpeng,
• marulelo, letsoalo la pelo, lets'ollo,
• takatso e eketsehileng kapa e fokotsehileng,
• maemong a sa tloaelehang, ts'ebetso ea sebete e ka khathatsoa, ​​hepatitis, cholestatic jaundice, porphyria e ka nts'etsapele.

Ho tsoa ho sheropoietic system:

1. ka seoelo ho ka ba le lefu la ho ruruha ha methapo ea mali kapa la hemolytic,
2. leukopenia
3. agranulocytosis,
4. pancytopenia
5. eosinophilia
6. thrombocytopenia.

• erythema multiforme, photosensitivity kapa dermatitis ea exfoliative ha e hlahe,
• li-cross-allergy ho li-agents tse kang thiazide, sulfonamides kapa sulfonylureas li ka hlaha.

Litla-morao tse ling:

Patlo e sa lekanang ea li-hormone tsa antidiuretic, e tsamaeang le:

• ho tsekela
• ho ruruha ha sefahleho
• matsoho le maqaqailana
• khatello ea maikutlo
• lethargy
• cramps
• stupor
• coma
• bothata ba bolulo (ba nakoana).

Haeba ho na le karabelo e sa rateheng kapa liketsahalo tse sa tloaelehang, ka hona o lokela ho buisana le ngaka ea hau mabapi le kalafo e eketsehileng ka lithethefatsi tsena, ka nako ena Glibenclamide e tla tlameha ho chechisoa.

Likarolo tsa ts'ebeliso

Ngaka e lokela ho lula e ela hloko karabelo ea mokuli ea lithethefatsi sehlopheng sena. Glibenclamide e lokela ho sebelisoa kamehla ka tekanyo e khothalelitsoeng le ka nako e hlalositsoeng hantle ea letsatsi. Ena ke litaelo tse tobileng tsa tšebeliso, ho seng joalo Glibenclamide ha e khothalletsoe.

Ngaka e lekola litekanyetso, phetisetso e nepahetseng ea kamohelo nakong ea motšehare le nako ea ts'ebeliso, ho ipapisitsoe le kemiso ea letsatsi le letsatsi ea mokuli.

E le hore lithethefatsi li lebise ho tsoekere e nepahetseng ea mali, ho bohlokoa ho latela mokhoa o khethehileng oa ho ja le ho sebelisa moriana, ho ikoetlisa le ho theola boima ba 'mele ha ho hlokahala. Sena sohle e lokela ho ba litaelo tsa tšebeliso.

Mokuli o lokela ho leka ho fokotsa nako e sebelisitsoeng letsatsing le ho fokotsa lijo tse mafura a mangata.

Litlhoko-hloko le liphoso ha u sebelisa lithethefatsi

Khetho ea pele e lokela ho tla pele ho tlhahlobo ea ngaka kamehla, u ke ke ua sebelisa moriana nako e telele ho feta nako e khothalelitsoeng. Glibenclamide le analogue li lokela ho sebelisoa ka hloko ha ho ka ba le lefu la ho fokola ka mpeng, bothata ba ho hlonepha ha joala, joala, mafu a qoqotho (hyper- kapa hypothyroidism), ts'ebetsong ea ho se sebetse hantle ha sebete, le ho bakuli ba tsofetseng.

Ka monotherapy ka lilemo tse fetang tse hlano, khanyetso ea bobeli e ka hlaha.

Tebello ea laboratori

Nakong ea kalafo ka glibenclamide, ho hlokahala hore u lule u shebile khatello ea mali maling (ha lethal dose le ntse le khethoa, sena se lokela ho etsoa makhetlo a 'maloa ka beke), hammoho le boemo ba hemoglobin (bonyane hanngoe ka likhoeli tse tharo), sebaka se nang le sena se bohlokoa le glucose ka har'a moroto. Sena se tla etsa hore ho khonehe ho lemoha ho hanyetsa ha mantlha kapa ho bohareng ba sethethefatsi sena ka nako.

O boetse o lokela ho lekola boemo ba mali a potoloho (haholo-holo litaba tsa lisele tse tšoeu tsa mali le liplatelete), hammoho le tšebetso ea sebete.

Kotsi ea hypoglycemia qalong ea kalafo ea lithethefatsi

Mehatong ea pele ea kalafo, menyetla ea ho ba le boemo bona ea eketseha, haholo-holo haeba ho se ho jeoe lijo tse sa jelloeng kapa tse jeoang khafetsa. Lintho tse kenyang letsoho kholisong ea hypoglycemia:

1. ho se khone kapa ho se rate ha bakuli, haholo-holo maqheku, ho sebelisana le ngaka le ho nka Glibenclamide kapa analogue,
2. khaello ea phepo e nepahetseng, tloaelo ea ho ja ka tsela e sa tloaelehang kapa lijo tse haellang,
3. ho se leka-lekane pakeng tsa tšebeliso ea lik'habohaedreite le ho ikoetlisa,
4. Liphoso lijong
5. ho nwa jwala, haholoholo ha ho na le khaello ea phepo e nepahetseng.
6. mosebetsi o sa sebetseng oa renal,
7. ho se sebetse hantle ha sebete,
8. lithethefatsi tse ngata
9. maloetse a sa lefelloeng ea tsamaiso ea endocrine e amang metabolism ea carbohydrate, hammoho le hypoglycemia, ho kenyelletsa le ho hloka pituitari le adrenocortical, ts'ebetso ea thyroid e senyehileng.
10. tšebeliso e tšoanang ea lithethefatsi tse ling.

Lithethefatsi tse tšoanang li sebetsa:

• gliclazide (matlapa a 30mg),
• gliclazide (80 mg ka ngoe),
• gliclazide maxpharma,
• diadeon
• diabeteson MV,
• glurenorm.

Glibenclamide ke ea sehlopha sa baemeli ba hypoglycemic bakeng sa tsamaiso ea molomo. E na le mochine o thata oa ts'ebetso, o kenyang phello e eketsehileng ea "pancreatic" le "pancreatic".

Mofumahali

Kamora ho tsamaisoa ka molomo, ho kenngoa ka mokhoa o potlakileng le o sebetsang oa glibenclamide ka pampiring ea litlama ho etsahala. Litlhahlobo tsa tokollo ea in vitro li bonts'itse hore motsoako o sebetsang oa Glibenclamide o lokolla hoo e ka bang karolo ea 63% ea palo ea ntho e sebetsang nakong ea metsotso e 15, 72% nakong ea metsotso e 60. Ka nako e ts'oanang, ho ja ho ka lebisa ho fokotseha ha khatello ea eona ea mali ea mali ha e bapisoa le tšebeliso ea mpa e se nang letho. Ho tlangoa ha glibenclamide le albin ho plasma ea mali ho feta 98%. Sebeteng, glibenclamide e batla e fetotsoe ka ho felletseng e le li-metabolites tse peli tse ka sehloohong: 4-trans-hydroxy-glibenclamide le 3-cis-hydroxy-glibenclamide. Li-metabolites tse peli li epolloa ka tekanyo e tšoanang ka liphio le sebete. Bonyane halofo ea bophelo ba glibenclamide e tsoang plasma ea mali ke lihora tse 1.5-3,5. Nako ea ketso, leha ho le joalo, ha e tsamaellane le halofo ea bophelo ho tsoa ho lero la mali. Ho bakuli ba sa sebetseng hantle ke sebete, ho pepesetsoa ha plasma ho fokotsehile. Ka ho hloleha ho leka-lekanya ha (rereineine clearance ea 30 ml / min), ts'oarello ea glibenclamide le metabolites tse peli tsa mantlha li lula li sa fetohe, ka ho hloleha ho matla ha renal, ho khoneha.

Mokhoa oa ho sebelisa: litekanyetso le kalafo

Tekanyetso e itšetlehile ka lilemo, botebo ba nako ea lefu la tsoekere, khatello ea tsoekere ea mali le lihora tse peli kamora ho ja. Tekanyetso e tloaelehileng ea letsatsi le letsatsi e tloha ho 2,5 ho isa ho 15 mg. Khafetsa ea tsamaiso ke makhetlo a 1-3 ka letsatsi bakeng sa metsotso e 20-30 pele ho lijo. Melemo ea lipalo tse fetang 15 mg / ka letsatsi ha e ekehe botebo ba phello ea hypoglycemic. Tekanyetso ea pele ho bakuli ba tsofetseng ke 1 mg / letsatsi.

Ha u nkela lithethefatsi tsa hypoglycemic mofuta o tšoanang, li khethoa ho latela morero o fanoeng ka holimo, 'me sethethefatsi se fetileng se felisoa hang-hang. Ha o fetoha ho tloha ho biguanides, tekanyetso ea pele ea letsatsi le letsatsi ke 2,5 mg, haeba ho hlokahala, tekanyetso ea letsatsi le letsatsi e eketsoa matsatsi a mang le a tšeletseng a6,5 ka 2,5 mg ho fihlela phello e fumanehang. Ha ho se na matseliso nakong ea libeke tse 4-6, ho a hlokahala hore u nke qeto ka phekolo e kopaneng.

Litlamorao

Hypoglycemia (e khahlanong le regimen ea dosing le lijo tse sa lekaneng), boima ba 'mele, feberu, arthralgia, proteinuria, ho kula (ho ruruha ha letlalo, ho hlohlona), dyspepsia (ho nyekeloa ke pelo, lets'ollo, maikutlo a boima ho epigastrium), mathata a methapo ea kutlo (paresis, mafu a kutloisiso) , hemopoiesis (hypoplastic kapa hemolytic anemia, leukopenia, agranulocytosis, pancytopenia, eosinophilia, thrombocytopenia), ts'ebetso ea sebete e sa sebetseng (cholestasis), porphyria ea morao-rao, liphetoho tsa tatso, polyuria, foto ensibilizatsiya, hlooho e opang, mokhathala, ho fokola, ho tsekela.

Bongata. Matšoao: hypoglycemia (tlala, ho ruruha, bofokoli bo matla, ho akheha, ho thothomela, ho tšoenyeha, ho opeloa ke hlooho, ho tsekela, ho hloka boroko, ho teneha, khatello ea maikutlo, edema ea mokokotlo, puo e sa sebetseng hantle le pono, ho hloka kelello).

Phekolo: haeba mokuli a hlokahalletse, nka tsoekere kahare, a lahlehetsoe ke kelello - kenya iv dextrose (iv bolus - 50% dextrose tharollo, joale infusion ea 10% tharollo), 1-2 mg glucagon s / c, i / m kapa iv, diazoxide 30 mg iv bakeng sa metsotso e 30, ho lekola khatello ea tsoekere nako le nako metsotso e 15, hammoho le ho khetholla pH, urea nitrogen, creatinine le li-elektrone maling. Kamora ho hlaphoheloa kelellong, ho bohlokoa ho fa mokuli lijo tse nang le lik'habohaedreite tse bonolo tse tsoang habonolo (molemong oa ho qoba tsoelopele ea hypoglycemia). Ka lefu la mokokotlo la mokokotlo, mannitol le dexamethasone.

Litaelo tse khethehileng

Hoa hlokahala hore nako le nako u lekole boemo ba tsoekere maling maling ka mpeng e se nang letho le ka mor'a ho ja, khalase ea letsatsi le letsatsi ea litaba tsa tsoekere maling le moriring.

Tabeng ea mehato ea ho buuoa kapa ho bola ha lefu la tsoekere, monyetla oa ho sebelisa litokisetso tsa insulin o lokela ho nahaneloa.

Bakuli ba lokela ho hlokomelisoa ka kotsi e eketsehang ea hypoglycemia maemong a ho ja ka mokhoa oa ethanol (ho kenyelletsa le nts'etsopele ea maikutlo a kang a discriram: bohloko ba ka mpeng, ho nyekeloa ke pelo, ho hlatsa, hlooho e bohloko), li-NSAIDs le tlala.

Nakong ea kalafo, ha ho khothalletsoe hore u lule letsatsing nako e telele.

Phetoho ea tekanyetso ea hlokahala bakeng sa ho fetella hoa mmele le maikutlo, phetoho ea lijo.

Lipontšo tsa kliniki tsa hypoglycemia li ka koaloa ha ho nkuoa li-beta-blockers, clonidine, reserpine, guanethidine.

Nakong ea kalafo, tlhokomelo e lokela ho nkuoa ha ho khannoa likoloi le ho etsa lintho tse ling tse ka bang kotsi tse hlokang ho tsepamisa mohopolo le ho potlakisa karabelo ea psychomotor.

Lipotso, likarabo, litlhahlobo mabapi le lithethefatsi Glibenclamide

Tlhahisoleseling e fanoeng e reretsoe litsebi tsa bongaka le tsa meriana. Tlhahisoleseling e nepahetseng ka ho fetelletseng ka lithethefatsi e fumaneha litaelong tse tlamelletsoeng ke moqapi. Ha ho na tlhahisoleseling e thathamisitsoeng leqepheng lena kapa leha e le efe ea sebaka sa rona sa marang-rang e ka sebeletsang e le sebaka sa boipiletso ba motho ho setsebi.

Bongata

Phekolo: ente ea kahare ea 40 - 100 ml ea tharollo ea glucose ea 20% le / kapa (le maemong ao ho ke keng ha khoneha ho qhekella ha methapo ea kutlo.) Bakeng sa thibelo ea ho boelana hape kamora ho hlaphoheloa kelellong lihora tse 24 ho isa ho tse 48, lik'habohaedreite li fanoa ka molomo (habeli ho isa ho tse 30 carbohydrate hanghang le lihora tse ling le tse ling tse peli ho isa ho tse tharo) kapa ts'ebetso ea tsoekere e telele e etsoa ka nako e telele (5 ho isa ho 20%). Hoa khoneha ho tsamaisa glucagon ea intramuscularly 1 ml ka mor'a lihora tse ling le tse ling tse 48.Ho lekola kamehla tsoekere ea mali bonyane lihora tse 48 kamora ho fela ha boemo bo matla ba hypoglycemic. Maemong moo, moo ho nang le tekanyo e phahameng ea ho tahoa (joalo ka ha ho e-na le sepheo sa ho ipolaea), ho lahleheloa ke tsebo ho phehella, ts'ebetso ea nako e telele ea tsoekere ea 5-10% e etsoa, ​​khatello e lakatsehang ea tsoekere maling e lokela ho ba 200 mg / dl. Kamora metsotso e 20, ho hlahisoa tharollo ea glucose ea 40% hoa khoneha. Haeba setšoantšo sa kliniki se sa fetohe, ho hlokahala hore u batle lisosa tse ling tsa ho lahleheloa ke kelello, ho feta moo, tsamaisa kalafo bakeng sa lefu la mokokotlo la mokokotlo (dexamethasone, sorbitol), leihlo le matla la mokuli le kalafo. Ka chefo e matla, e ka etsoa hammoho le mehato e boletsoeng ka holimo, le mehato e akaretsang ea ho felisa chefo (gastric lavage, ho hlatsa ho hlatsa), le ho fana ka litlhare tse sebetsang. Glibenclamide ha e hlahisoe ke hemodialysis.

Maemo a polokelo

Boloka ka mocheso o sa feteng 25 ° C hole le bana.

Foromo ea tokollo:
Glibenclamide - matlapa.
Matlapa a 30 ka har'a likotlolo.

Letlapa le le lengGlibenclamide e na le 5 mg glibenclamide.
Baeti: lactose monohydrate, starch ea litapole, sodium ea croscarmellose, povidone 25, magnesium stearate, colloidal silicon dioxide, indigo carmine E 132.