LUNALDIN (LUNALDIN) litaelo bakeng sa tšebeliso

- ka lebaka la kotsi ea ho tepella maikutlo ho ka behang bophelo kotsing, tšebeliso ea Lunaldine e tšoaelitsoe ho bakuli ba sa kang ba amohela kalafo ea opioid,

- maemo a khetholloang ke khatello e matla ea ho hema kapa lefu le matla la pulmonary,

- lilemo ho isa ho 18

- Hypersensitivity ho ntho e sebetsang kapa ho mang kapa mang oa fantisi.

Mokhoa oa ho sebelisa: litekanyetso le kalafo

Lunaldin e lokela ho fuoa feela bakuli ba nkoang ba le mamello ho phekolo ea opioid, e sebelisetsoang bohloko bo sa feleng bo hlahisoang ke mofetše. Bakuli ba nkuoa ba le mamello ea opioid haeba ba nka bonyane 60 mg ea morphine ka letsatsi ka molomo, 25 μg ea fentanyl ka hora ka kotloloho kapa tekanyetso e lekanang ea "opioid" e ngoe bakeng sa beke kapa ho feta.

Matlapa a sublingual a beoa ka tlasa leleme ka kotloloho ka moo ho ka khonehang. Matlapa ha a lokela ho metsoa, ​​ho hlafuna le ho qhibiliha, lithethefatsi ha lia lokela ho qhibiliha ka botlalo sebakeng se sublingual. Bakuli ba eletsoa hore ba se ke ba ja kapa ba e-noa ho fihlela letlapa le leng le felletseng le felisitsoe ka botlalo.

Bakuli ba nang le molomo o omileng, pele ba nka Lunaldin ba ka sebelisa metsi ho nosetsa mucosa ea molomo.

Tekanyetso e nepahetseng e ikemiselitsoe ho mokuli e mong le e mong ka khetho ka keketseho ea butle-butle ea lethal dose. Ho khetha tekanyetso, matlapa a nang le lintho tse fapaneng tse sebetsang a ka sebelisoa. Tekanyetso ea pele e lokela ho ba 100 μg, ts'ebetsong ea titration butle-butle e hlokahala ka mokhoa o hlokahalang lethathamong la litekanyetso tse teng. Nakong ea tekanyetso ea lethal dose, bakuli ba lokela ho hlahlojoa ka hloko ho fihlela tekanyo e nepahetseng e fihlella, i.e., ho fihlela phello e nepahetseng ea analgesic e fihlella.

Ketso ea pharmacological

Lunaldin ke "analgesic" e sebetsang hantle, e etsang lintho ka potlako, ebile e sebetsa ka potlako. Litlamorao tse ka sehloohong tsa kalafo ke meriana ea bohloko le ho nyefoloa. Ts'ebetso ea analgesic e phahame makhetlo a 100 ho feta ea morphine. Lunaldin e na le phello e tloaelehileng tsamaisong ea methapo e bohareng, lits'ebetso tsa matšoafo le tsa ka mpeng, tloaelo ea li-analgesics tsa opioid, e leng tloaelo bakeng sa lithethefatsi tsa sehlopha sena.

Litlamorao

Ha u sebelisa Lunaldine, motho o lokela ho lebella karabelo e sa rateheng joalo ka li-opioids, botebo ba liphetoho tsena, joalo ka molao, bo batla bo fokotseha ka tšebeliso e telele. Litlamorao tse mpe tse ka bang tse mpe tse amanang le ts'ebeliso ea opioid ke khatello ea maikutlo (e ka lebisang ho ho ts'oaroa hoa moea), ho fokotseha ha khatello ea mali le ho ts'oha.

Ho tsoa ts'ebetsong ea phefumoloho: khafetsa - khatello ea maikutlo, phepelo ea maikutlo, ho fihlela ho ts'oaroa phefumoloho.

Ho tsoa tsamaisong ea methapo ea kutlo le litho tsa kutlo: hangata - hlooho ea hlooho, ho otsela, hangata - khatello ea maikutlo ea methapo (ho kenyeletsa kamora ho buuoa), ho tsitsipana hoa kelello ea methapo e kholo ea methapo, ho soetseha, ho tsitsipana, pono e fifalitsoeng ea pono, diplopia, litoro tse hlakileng, tahlehelo ea mohopolo. , khafetsa e sa thehoang - pherekano, euphoria, hallucinations, hlooho e bohloko, intracranial hypertension.

Ho tsoa ho ts'ebetso ea tšilo ea lijo: hangata khafetsa - ho nyekeloa, ho hlatsa, hangata ho thefuleha, spasm ea sphincter ea Oddi, ho fokotseha ha sefutho, ho senyeha, colic ea biliary (ho bakuli ba neng ba na le nalane ea bona).

Litaelo tse khethehileng

Ka lebaka la litlamorao tse mpe tse ka bang teng nakong ea kalafo ka li-opioid tse kang Lunaldin, bakuli le bahlokomeli ba lokela ho lemoha ka botlalo bohlokoa ba ho nka Lunaldin ka nepo, hape ba tsebe hore na ke mehato efe e lokelang ho nkuoa ha ho hlaha matšoao a overdose.

Pele o qala kalafo le Lunaldin, ho bohlokoa ho tsitsisa tsamaiso ea lithethefatsi tse telele tsa opioid tse sebelisitsoeng ho kokobetsa bohloko bo sa feleng.

Tšusumetso ho bokhoni ba ho khanna makoloi le mekhoa ea ho laola:

Lunaldin e ka ama hampe matla a ho etsa ts'ebetso e kotsi, joalo ka ho khanna koloi kapa ho sebelisa mochine.

Bakuli ba lokela ho eletsoa hore ba khaotse ho khanna le ho sebelisa mochine oa ts'ebetso, joalo ka ho tsekela, ho otsela kapa ho senyeha hoa pono ho ka etsahala ha o ntse o nka Lunaldin.

Tšebelisano

Dinitrogen oxide e ntlafatsa ho ruruha ha mesifa, li-antidepressants tsa triceclic, opiates, sedative le hypnotics (Ps), phenothiazines, lithethefatsi tse amanang le khatello ea kelello (li-tranquilizer), lithethefatsi bakeng sa ts'oaetso e akaretsang, ho hlasimolohileng ha mesifa ea ho phomola, li-antihistamine tse nang le litlamorao tse ling hape litla-morao (khatello ea maikutlo ea CNS, hypoventilation, hypotension ea methapo, bradycardia, khatello ea phepelo ea setsi le ba bang).

E ntlafatsa phello ea lithethefatsi tse antihypertensive. Beta-blockers e ka fokotsa khafetsa le ho teba ha karabelo ea khatello ea pelo ha ho etsoa opereishene ea pelo (ho kenyeletsoa le sternotomy), empa ho eketsa kotsi ea bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone e fokotsa phello ea analgesic ea Lunaldin le ho felisa phello ea eona e thibelang setsi sa phefumoloho.

Lokolla liforomo le sebopeho

E fumaneha ka mokhoa oa sublingual (bakeng sa ho felisoa tlasa leleme) matlapa a litekanyetso tse fapaneng (mcg) le mofuta:

• 100 - ho pota
• 200 - ovoid,
• 300 - tharo,
• 400 - rhombic
• 600 - semicircular (e bōpehileng joaloka sebopeho),
• 800 - capular.

Letlapa le le leng le na le ntho e sebetsang - fentanyl citron micronised le likarolo tse thusang.

Mofumahali

Setlhare se na le hydrophobicity e boletsoeng, ka hona e kenella ka potlako kahare ho mothamo oa molomo ho feta tselaneng ea tšilo ea lijo. Ho tloha sebakeng se sekametseng, e ananeloa nakong ea metsotso e 30. Bioavailability ke 70%. Pherekano e phahameng maling a fentanyl e fihla ka mor'a ho hlahisoa ha lithethefatsi tsa 100-800 drugg kamora metsotso e 8-10.

Karolo e kholo ea fentanyl (80-85%) e kopana le liprotheine tsa plasma, tse bakang phello ea eona ea nakoana. Bophahamo ba karolelano ea lithethefatsi ka ho lekana ke 3-6 l / kg.

Mokhoa o ka sehloohong oa biotransformation oa fentanyl o hlaha tlasa tšusumetso ea li-enzymes tsa hepatic. Mokhoa o ka sehloohong oa ho pepesa 'mele o tsoa ho urine (85%) le bile (15%).

Nako ea bophelo ea ntho e tsoang 'meleng e tsoa lihora tse 3 ho isa ho tse 12,5.

Matšoao a ts'ebeliso ea Lunaldin

Tšoaetso e kholo ea ts'ebeliso ea Lunaldin ke pharmacotherapy ea letšoao la bohloko ho bakuli ba mofets'e ba fumanang kalafo ea opioid e tloaelehileng.

Tšoaetso e kholo ea ts'ebeliso ea Lunaldin ke pharmacotherapy ea letšoao la bohloko ho bakuli ba mofets'e ba fumanang kalafo ea opioid e tloaelehileng.

Ka tlhokomelo

Ho hlokahala tlhokomeliso e eketsehileng ha ho laela Lunaldin ho bakuli ba tloaetseng ho bonts'a maikutlo a tebileng a ho feta a COac maling:

• Keketseho e kenang ea hare-hare,
• coma
• letsoalo le foufetseng
• neoplasms ea boko.

Boemo ba ts'ebetso ea ts'ebeliso ea lithethefatsi ka ho khetheha bo lokela ho bonoa ha ho phekoloa batho ba nang le likotsi tsa hlooho, lipontšo tsa bradycardia le tachycardia. Ho bakuli ba tsofetseng le ba holofetseng, ho nwa meriana ho ka baka keketseho ea halofo ea bophelo le ho eketsa kutloisiso ea metsoako ea metsoako. Sehlopheng sena sa bakuli, ho a hlokahala ho sheba lipontšo tsa matšoao a tahi mme o lokise lethal dose tlase.

Ho bakuli ba nang le ho fokola ha renal le hepatic, meriana e ka baka keketseho ea palo ea fentanyl maling (ka lebaka la keketseho ea eona le bioavailability le thibelo ea ho tlosoa). Moriana o tlameha ho sebelisoa ka hloko e kholo ho bakuli ba nang le:

• hypervolemia (eketseha molumo oa plasma maling),
• khatello ea mali
• ho senya le ho ruruha ha mucosa ea molomo.

Regimen regimen Lunaldin

Abela bakuli ba nang le mamello ea li-opioids ka nako e telele, ba nka 60 mg ea morphine ka molomo kapa 25 μg / h ea fentanyl. Ho nka moriana ho qala ka lethal dose ea 100 mcg, butle-butle e eketsa palo ea eona. Haeba nakong ea metsotso e 15-30. kamora ho nka letlapa la 100 μg, bohloko ha bo emise, ebe o nka letlapa la bobeli ka tekanyo e lekanang ea lintho tse sebetsang.

Tafole e bonts'a mekhoa e behang mohlala ea ho fana ka tekanyetso ea Lunaldin, haeba tekanyetso ea pele e sa tlise liphallelo:

Ho nka moriana ho qala ka lethal dose ea 100 mcg, butle-butle e eketsa palo ea eona.

Haeba kamora ho nka tekanyetso ea kalafo e phahameng ka ho fetisisa, phello ea analgesic ha ea ka ea fumanoa, joale ho fanoa ka tekanyo e mahareng (100 mcg). Ha u khetha tekanyetso sethaleng, u se ke ua sebelisa matlapa a fetang a mabeli ka tlhaselo e le 'ngoe ea bohloko. Litlamorao ho 'mele oa fentanyl ho litekanyetso tsa li-mcg tse fetang 800 ha li so hlahlojoe.

Ka ponts'o ea likarolo tse fetang tse 'ne tsa bohloko bo boholo ka letsatsi, tse fetang matsatsi a 4 ka tatellano, ho fanoa ka phetoho ea litekanyetso tsa lithethefatsi tsa letoto la li-opioid tsa nako e telele. Ha ho tloha ho analgesic e 'ngoe ho ea ho e' ngoe, karolo e pheta-phetoang ea lethal dose e etsoa tlasa tlhokomelo ea ngaka le tlhahlobo ea laboratori ea boemo ba mokuli.

Ka ho felisoa ha bohloko ba paroxysmal, takatso ea Lunaldin e emisitsoe. Moriana o felisitsoe, butle-butle o fokotsa litekanyetso, e le hore li se ke tsa baka ponahalo ea lefu la ho tlohela.

Phekolo ea ka mpeng

Ho sebelisa litlhare ho ka ba le phello e thibelang ho sebetsa ha ka mpeng le ho baka ho sokela. Ntle le moo, ho latela lintlha tse latelang:

• molomo o omileng
• bohloko ka mpeng,
• matsoele
• mathata a dyspeptic
• bowel,
• ponahalo ea liso ka mpeng ea molomo,
• tlolo ea ketso ea ho koenya,
• anorexia.

Se sa tloaelehang ke ho etsoa ha khase e ngata, e bakang ho thunya le ho boreleli.

Tsamaiso ea methapo e bohareng

Ho tloha ho tsamaiso ea methapo e bohareng hangata ho hlaha:

• asthenia
• khatello ea maikutlo
• ho hloka boroko
• tlolo ea tatso, pono, pono e hlakileng,
• hallucinations
• bosaoana
• pherekano,
• bosiu
• phetoho e bohale ea maikutlo
• ho tšoenyeha ho eketsehileng.

Ho itšehla thajana ha hoa tloaeleha.

Ho tsoa ho tsamaiso ea methapo ea pelo

Karabelo ea pathological e ka ba:

• orthostatic fall,
• boikhathollo ba mesifa ea marako a methapo ea mali (vasodilation),
• maqhubu
• bofubelu ba sefahleho
• arrhythmia.

Boitšoaro ba methapo ea kutlo bo ka bonahatsoa ke khatello ea methapo ea pelo, mokokotlo oa mokokotlo oa pelo, morethetho oa pelo (bradycardia) kapa keketseho ea sekhahla sa pelo (tachycardia).

Karabelo e kulang ea lithethefatsi e ka iponahatsa e le ka tsela ea:

• matšoao a letlalo - lekhopho, ho hlohlona,
• redness le ho ruruha sebakeng sa ente.

Ho bakuli ba nang le mathata a "hypobiliary system", "biliary colic" e ka fokolisang leqhubu la bile le ka ba teng. Ka tšebeliso ea nako e telele, ho lemalla, ho lemalla kelellong le 'meleng (ho itšetleha) ho ka hlaha. Tšusumetso e mpe 'meleng e ka baka mathata a thobalano mme ea fokotsa libido.

Tšusumetso ho bokhoni ba taolo ea methapo

Moriana o ka ama hampe methapo ea methapo ea kutlo le litho tsa kutlo, ka hona nakong ea kalafo Lunaldin o lokela ho hana ho khanna makoloi, ho sebetsa ka mekhoa le lits'ebetso tse hlokang ho tsotelloa, lebelo la ho etsa liqeto le pono ea mahlo.

Moriana o ka ama hampe tsamaiso ea methapo le methapo ea kutlo, ka hona, nakong ea kalafo le Lunaldin, o lokela ho hana ho khanna likoloi.

Sebelisa nakong ea bokhachane le pelehi

Ho nka moriana ho hloka qeto e leka-lekaneng. Ho phekoloa ka nako e telele le sethethefatsi nakong ea kemolo ho ka etsa hore lesea le tlohe. Moriana o kenella ka har'a sethopo, 'me tšebeliso ea oona nakong ea tlhaho ea ngoana e kotsi mesebetsing ea ho hema ea lesea le le sa tsoa hlaha.

Setlhare se fumanoa lebeseng. Ka hona, ho beoa ha eona nakong ea ho anyesa ho ka lebisa ho se atleheng ha lesea. Moriana o kopaneng le nako ea boitšisinyo e fanoa feela ha melemo ea ts'ebeliso ea ona e feta likotsi ho lesea le mme.

Kopo ea ts'ebetso ea renal e senyehileng

Kaha mokhoa o ka sehloohong oa phello ea moriana le metabolite ea oona o na le moroto, haeba ts'ebetso ea mokokotlo e sa sebetse hantle, ho lieha ho pepeseha ha eona, ho bokellana ha mmele, le ho eketseha ha nako ea ts'ebetso ho ka hlokomeloa. Bakuli ba joalo ba hloka taolo ea dikahare tsa plasma ea lithethefatsi le litekanyetso ka keketseho ea bophahamo ba eona.

Sebelisa bakeng sa ts'ebetso ea sebete e sa sebetseng

Moriana o qhekelloa ka bile, ka hona, ka lefu la sebete, hepatic colic, ketso ea nako e telele ea ntho e ka hlaha, eo, haeba kemiso ea ts'ebetso ea moriana e lateloang e ka baka tšebeliso e feteletseng. Bakeng sa bakuli ba joalo, moriana o lokela ho nooa ka hloko, o shebe khafetsa le litekanyetso li beiloe ke ngaka, le ho hlahlojoa khafetsa.

Bongata

Haeba ho na le ts'oaetso e feteletseng ea Lunaldin, litlamorao tsa khatello ea maikutlo le khatello ea maikutlo ea phefumoloho li eketseha ho fihlela li emisa. Thuso ea pele bakeng sa overdose ke:

• ntlafatso le bohloeki ba molomo oa eona (sebaka se ka thoko) ho tsoa maseleng a letlapa,
• Tlhahlobo ea ho lekana ha mokuli,
• phomolo ea ho hema, ho kenyelletsa ho kenella hare le moea o qobelloang,
• ho boloka mocheso wa mmele
• kenyelletso ea mokelikeli ho etsa joalo bakeng sa tahlehelo ea eona.

Antidote ho opioid analgesics ke Naloxone. Empa e ka sebelisoa feela ho tlosa tšebeliso e feteletseng ho batho ba neng ba sa sebelise li-opioid tsa nakong e fetileng.

Ka hypotension e matla, ho sebelisoa meriana e meng ea plasma ho etsa hore khatello ea mali e fokotsehe.

Antidote ho opioid analgesics ke Naloxone.

Fomu ea tokollo, sebopeho le sephutheloana

Matlapa a potolohileng a mebala e tšoeu, sebopeho se chitja.

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

tab. sublingual 200 mcg: li-pcs tse 10 kapa 30.
Reg. Che: 9476/10 ea 02.11.2010 - E felile

Matlapa a sublingual a tšoeu, oval.

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

tab. sublingual 300 mcg: li-pcs tse 10 kapa 30.
Reg. Che: 9476/10 ea 02.11.2010 - E felile

Matlapa a nang le likarolo tse mmaloa a 'mala o mosoeu, a likhutlo li tharo ka sebopeho.

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

tab. sublingual 400 mcg: li-pcs tse 10 kapa 30.
Reg. Che: 9476/10 ea 02.11.2010 - E felile

Matlapa a ka tlung a mmala o mosoeu, a bopehileng joaloka daemane.

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

tab. sublingual 600 mcg: li-pcs tse 10 kapa 30.
Reg. Che: 9476/10 ea 02.11.2010 - E felile

Matlapa a ka tlung a mmala o mosoeu, "sebopeho sa D".

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

tab. sublingual 800 mcg: li-pcs tse 10 kapa 30.
Reg. Che: 9476/10 ea 02.11.2010 - E felile

Matlapa a ka tlung a tšoeu, a bopehile joaloka kapu.

Baeti: mannitol, microcrystalline colloidal cellulose (motsoako oa cellulose ea 98% le li-silicon tsa 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

Li-pcs tse 10 - marang-rang (1) - Mabokose a karete.
Li-pcs tse 10 - marang-rang (3) - Mabokose a likarete.

Pharadodynamics

Lunaldin ke "analgesic" e sebetsang hantle, e etsang lintho ka potlako, ebile e sebetsa ka potlako. Litlamorao tse ka sehloohong tsa kalafo ea Lunaldin ke li-analgesic ebile li le sedative. Ts'ebetso ea analgesic ea Lunaldin e phahame makhetlo a 100 ho feta ea morphine. Lunaldin e na le phello e tloaelehileng tsamaisong ea methapo e bohareng, lits'ebetso tsa matšoafo le tsa ka mpeng, tloaelo ea li-analgesics tsa opioid, e leng tloaelo bakeng sa lithethefatsi tsa sehlopha sena.

Ho bontšitsoe hore ho bakuli ba nang le mofetše ba nang le bohloko ba fumanang li-opioids khafetsa, fentanyl e fokotsa haholo matla a tlhaselo ea bohloko (metsotso e 15 kamora ts'ebetso), ha e bapisoa le placebo, e fokotsang haholo tlhoko ea meriana ea bohloko ea tšohanyetso. Tšireletseho le katleho ea fentanyl e ile ea hlahlojoa ho bakuli ba amohelang moriana hanghang ha bohloko bo hlaha. Ts'ebeliso ea prophylactic ea fentanyl maemong a boletsoeng esale pele ea bohloko ha e so ithutoe litekong tsa bongaka. Lunaldin, joalo ka li-agonists tsohle tsa μ-opioid receptor, li baka phello e thibelang litekanyetso ho setsi sa ho hema. Kotsi ea khatello ea maikutlo ea ho hema e phahame ho batho ba e-so ka ba amohela li-opioid pele, ha ba bapisoa le bakuli ba kileng ba ba le bohloko bo boholo mme ba fumaneng kalafo ea nako e telele ka li-opioids.

Li-opioids hangata li eketsa molumo oa mesifa e boreleli ea pampiri ea urine, e leng ho eketsang khafetsa ha ho ntša urine kapa ho thata ho ntša. Li-opioids li eketsa molumo oa mesifa e boreleli ea tšilo ea lijo, li fokotsa ho se sebetse hantle ka mpeng, e ka bang ka lebaka la phetoho ea fentanyl.

Sebelisa nakong ea bokhachane

Tšireletseho ea Lunaldin nakong ea kemolo ha e so theoe. Phekolo ea nako e telele nakong ea kemolo e ka baka matšoao a "ho khaola" ho ngoana ea sa tsoa hlaha. Lunaldin ha ea lokela ho sebelisoa nakong ea tlhaho ea masea (ho kenyeletsoa karolo ea cesarean), kaha e tšela sethala 'me e ka baka khatello ea maikutlo ka popelong kapa leseeng. Ka nako ea kemaro, Lunaldin e ka sebelisoa feela haeba phaello e ka ba teng ho mme ho feta kotsi e ka bang teng ho lesea.

Lunaldin o fetela lebeseng 'me a ka ba le phello e matla ea ho baka le ho thibela ho hema ho bana ba anyesitsoeng. Lunaldin e ka sebelisoa ho basali ba anyesang ha feela melemo ea ho sebelisa moriana e feta kotsi e ka bang teng ho mme le ngoana. Ho kgothaletswa ho emisa ho anyesa ha o ntse o sebelisa moriana.

Tekanyetso le tsamaiso

Lunaldin e lokela ho fuoa feela bakuli ba nkoang ba le mamello ho phekolo ea opioid, e sebelisetsoang bohloko bo sa feleng bo hlahisoang ke mofetše. Bakuli ba nkuoa ba le mamello ea opioid haeba ba nka bonyane 60 mg ea morphine ka letsatsi ka molomo, 25 μg ea fentanyl ka hora ka kotloloho kapa tekanyetso e lekanang ea "opioid" e ngoe bakeng sa beke kapa ho feta.

Matlapa a sublingual a Lunaldin a beoa ka kotloloho tlasa leleme ka botebo kamoo ho ka khonehang. Matlapa a Lunaldin ha aa lokela ho metsoa, ​​ho hlafuna le ho qhibiliha, lithethefatsi ha lia lokela ho qhibiliha ka botlalo sebakeng se sublingual. Bakuli ba eletsoa hore ba se ke ba ja kapa ba e-noa ho fihlela letlapa le leng le felletseng le felisitsoe ka botlalo.

Bakuli ba nang le molomo o omileng, pele ba nka Lunaldin ba ka sebelisa metsi ho nosetsa mucosa ea molomo.

Tekanyo e nepahetseng ea Lunaldin e ikemiselitse ho mokuli e mong le e mong ka khetho ka ho eketseha ha tekanyetso ea butle-butle. Ho khetha tekanyetso, matlapa a nang le lintho tse fapaneng tse sebetsang a ka sebelisoa. Tekanyetso ea pele ea Lunaldin e lokela ho ba 100 μg, ts'ebetsong ea ho kenyelletsa butle-butle e ntse e eketseha ha ho hlokahala lethathamong la litekanyetso tse teng. Nakong ea tekanyetso ea lethal dose, bakuli ba lokela ho hlahlojoa ka hloko ho fihlela tekanyo e nepahetseng e fihlella, i.e., ho fihlela phello e nepahetseng ea analgesic e fihlella.

Phetoho e tsoang litokisetsong tse ling tse nang le fentanyl e eang Lunaldin ha ea lokela ho etsoa ka karolelano ea 1: 1 ka lebaka la lintlha tse fapaneng tsa tlhahlobo ea litokisetso. Haeba bakuli ba tloha lithethefatsing tse ling tse nang le fentanyl, ho lokela ho etsoa ka litekanyetso tsa litekanyetso ka Lunaldine.

Mokhoa o latelang o khothaletsoa khetho ea litekanyetso, le ha maemong ohle ngaka e eang e lokela ho nahanela litlhoko tsa bongaka tsa bakuli, lilemo, le mafu a kopaneng.

Bakuli bohle ba lokela ho qala kalafo ka pilisi e le 'ngoe ea 100 mcg sublingual. Haeba phello e lekaneng ea li-analgesic e sa fihlelletsoe nakong ea metsotso e 15-30 ka mor'a ho nka pente e le 'ngoe e lekanang, o ka nka letlapa la bobeli la 100 μg. Haeba kamora ho nka matlapa a mabeli a li-microgram tse 100 tsa liphallelo tse lekaneng tse sa fihlelleheng, nahana ka ho eketsa tekanyetso ho fihlela tekanyetso e latelang ea moriana ketsahalong e tlang ea bohloko. Ho eketsa tekanyetso ho lokela ho etsoa butle butle ho fihlela phomolo e lekaneng ea bohloko e fihlelleha. Dosing titration e lokela ho qala ka pilisi e le 'ngoe e ikhethileng. Letlapa la bobeli le tlatsetsang le nang le bothata le lokela ho nkuoa kamora metsotso e 15-30 haeba ho sa fihlellehe liphallelo tse lekaneng tsa bohloko. Tekanyetso ea letlapa le kopaneng la sublingual e lokela ho eketsoa ho tloha ho 100 ho isa ho 200 mcg ebe o kenyelletsa lethal dose ea 400 mcg kapa ho feta. Sena se bontšoa setšoantšong se ka tlase. Boemong ba khetho ea litekanyetso, titration ha ea lokela ho sebelisa litafole tse fetang tse peli (2) ketsahalong e le 'ngoe ea bohloko.
Dose (mcg) ea Dose ea pele (mcg) ea tlatsetso
matlapa a sublingual letlapeng la (sub) la sublingual, leo ho lona
Ketsahalo ea ho hlaseloa ha bohloko e hloka ho nkuoa
Metsotso e 15-30 ka mor'a pilisi ea pele

100 100
200 100
300 100
400 200
600 200
800 -

Haeba liphallelo tse lekaneng tsa bohloko li fumaneha ka tekanyetso e phahameng, empa litlamorao tse sa lakatseheng li nkoa li sa amohelehe, ho ka fanoa ka tekanyo e mahareng (ho sebelisa selefouno e 100 cm ea sublingual). Melemo ea li-mcg tse fetang 800 ha e so hlahlojoe litekong tsa bongaka. Ho fokotsa kotsi ea karabelo e mpe e amanang le ho sebelisa lithethefatsi tsa opioid le ho fumana lethal dose e nepahetseng, tlhahlobo ea tlhokomelo ea bongaka e hlokolosi ea boemo ba mokuli nakong ea tekanyetso ea tekanyetso e hlokahala.

Kamora ho fumana tekanyetso e nepahetseng, e ka fetang piritsi e le 'ngoe, bakuli ba fumana kalafo ea tlhokomelo ba sebelisa tekanyetso e khethiloeng mme ba fokotsa ts'ebeliso ea lithethefatsi ho isa tekanyong ea litekanyetso tse' ne tsa Lunaldin ka letsatsi.

Haeba karabelo (anesthesia kapa litla-morao tse mpe) tekong e ts'oanang ea Lunaldin e fetoha haholo, ho ka hlokahala tokiso ea tekanyetso ho boloka tekanyo e nepahetseng. Haeba likarolo tse fetang tse 'ne tsa bohloko li bonoa ka letsatsi ka matsatsi a fetang a mane a latellanang, tekanyetso e lokela ho lokisoa.

li-opioid tsa nako e telele tse sebelisetsoang ho imolla bohloko bo sa feleng. Haeba moriana oa opioid ea sebetseng ka nako e telele o nkeloa sebaka kapa lethalamo la lona le fetotsoe, lethal dose ea Lunaldine le lokela ho baloa le ho fuoa lipilisi bakeng sa ho khetha moriana o loketseng hantle.

Khetho e pheta-phetoang ea titration le lethal dose ea li-painkiller e lokela ho etsoa ka tlasa tlhokomelo ea bongaka.

Haeba mokuli a sa hlole a hloka ho sebelisa lithethefatsi tsa opioid, tekanyo ea Lunaldin e lokela ho tsotelloa pele ho qala phokotseho ea butle-butle ea lethal dose ea li-opioids ho fokotsa litlamorao tse ka bang teng tsa "ho tlosoa". Haeba bakuli ba ntse ba tsoela pele ho nka meriana ea opioid khafetsa ho phekola bohloko bo sa feleng, empa ba sa hloke kalafo bakeng sa litlhaselo tsa bohloko, Lunaldin a ka emisoa hanghang.

Sebelisa ho bana le lilemong tsa bocha

Lunaldin ha ea lokela ho sebelisoa ho bakuli ba ka tlase ho lilemo tse 18 ka lebaka la polokeho e sa lekaneng le data e sebetsang.

Sebelisa ho bakuli ba tsofetseng

Tekanyetso ea tekanyetso e lokela ho etsoa ka hloko e kholo. Bakuli ba lokela ho hlahlojoa ka hloko bakeng sa matšoao a ho ba le chefo ea fentanyl.

Sebelisa ho bakuli ba nang le bothata ba ho ruruha ba renal kapa hepatic

Bakuli ba nang le ts'oaetso ea sefuba kapa ts'ebetso ea liphio ba lokela ho beoa leihlo ka hloko bakeng sa matšoao a ho ba le chefo ea fentanyl sethaleng sa ho fuoa lethaliti la Lunaldin.

Ho sebelisana le lithethefatsi tse ling

Dinitrogen oxide e ntlafatsa ho ruruha ha mesifa, li-antidepressants tsa triceclic, opiates, sedative le hypnotics (Ps), phenothiazines, lithethefatsi tse amanang le khatello ea kelello (li-tranquilizer), lithethefatsi bakeng sa ts'oaetso e akaretsang, ho hlasimolohileng ha mesifa ea ho phomola, li-antihistamine tse nang le litlamorao tse ling hape litla-morao (khatello ea maikutlo ea CNS, hypoventilation, hypotension ea methapo, bradycardia, khatello ea phepelo ea setsi le ba bang).

E ntlafatsa phello ea lithethefatsi tse antihypertensive. Beta-blockers e ka fokotsa khafetsa le ho teba ha karabelo ea khatello ea pelo ha ho etsoa opereishene ea pelo (ho kenyeletsoa le sternotomy), empa ho eketsa kotsi ea bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone e fokotsa phello ea analgesic ea fentanyl le ho felisa phello ea eona e thibelang setsi sa phefumoloho.

Li-benzodiazepines li lelefatsa ho ntšoa ha neuroleptanalgesia.

Hoa hlokahala ho fokotsa tekanyo ea fentanyl ha u ntse u sebelisa insulin, glucocorticosteroids, lithethefatsi tsa antihypertensive. Li-inhibitors tsa MAO li eketsa kotsi ea mathata a tebileng.

Boikoetliso ba mesifa bo thibela kapa ho tlosa ho thatafala ha mesifa, ho phomola mesifa ka tšebetso ea m-anticholinergic (ho kenyeletsa le pancuronium bromide) ho fokotsa kotsi ea bradycardia le hypotension (haholoholo ha ho sebelisoa beta-blockers le li-vasodilator tse ling) mme ho ka eketsa kotsi ea tachycardia le khatello ea mali, ketsahalo ea m-anticholinergic (ho kenyelletsa le suxamethonium) ha e fokotse kotsi ea ho ba le bradycardia le hypotension ea arterial (haholo-holo khahlano le nalane ea nalane e boima ea pelo) le ho eketseha kotsi ea litlamorao tse matla tse tsoang tsamaisong ea pelo le pelo.

Bokhachane le pelehi

Tšireletseho ea Lunaldin nakong ea kemolo ha e so theoe. Phekolo ea nako e telele nakong ea boimana e ka baka matšoao a ho tlohela ho lesea. Lunaldin ha ea lokela ho sebelisoa nakong ea tlhaho ea ngoana (ho kenyeletsoa karolo ea cesarean), kaha e tšela sebaka sa polasetiki mme e ka baka khatello ea maikutlo ka popelong kapa leseeng.

Lunaldin e ka sebelisoa nakong ea bokhachane ha feela phaello e ka ba teng ho mme e feta kotsi e ka bang teng ho lesea.

Fentanyl e pepesoa lebeseng la matsoele 'me e ka baka ho nyekeloa le khatello ea maikutlo ho lesea le anyesitsoeng. Ka hona, fentanyl e ka sebelisoa nakong ea ho anyesa feela haeba phaello e feta haholo kotsi e ka bang teng ho mme le lesea.

Ho sebelisana le lithethefatsi

Fentanyl e hlahisitsoe ke CYP3A4. Lithethefatsi tse thibelang ts'ebetso ea CYP3A4, joalo ka lithibela-mafu tsa macrolide (mohlala, erythromycin), azole antifungals (e.g. ketoconazole, itraconazole), kapa protease inhibitors (jk. ntlafatsa, kapa eketsa nako ea moriana oa opioid. Jusi ea grapefruit e tsejoa ho thibela CYP3A4. Fentanyl, ka hona, e lokela ho sebelisoa ka hloko ho bakuli ba nkang li-inhibitors tsa CYP3A4 ka nako e le 'ngoe.

Tsamaiso e ts'oanang ea lithethefatsi tse ling tse nang le phello e nyahamisang tsamaisong ea methapo e kholo, joalo ka lithethefatsi tse ling tsa morphine (li-analgesics le lithibela-mafu), lithethefatsi bakeng sa anesthesia, mesifa ea ho phomola, li-antidepressants, li-1 1 histamine li-receptor blockers tse nang le tšusumetso, li-barbiturates, tranquilizer (mohlala, benzodiazepines) , lipilisi tsa ho robala, li-antipsychotic, clonidine le metsoako e amanang le tsona li ka lebisa ho eketseheng ha phello ea thibelo ea methapo ea kutlo. Ho sithabela maikutlo, "khatello ea maikutlo" ho ka lemohuoa.

Ethanol e ntlafatsa phello ea sedative ea morphine analgesics, kahoo tšebeliso e tšoanang ea lino tse tahang kapa lithethefatsi tse nang le joala le Lunaldin ha e khothalletsoe.

Fentanyl ha e khothalletsoe hore e sebelisoe ho bakuli ba fumaneng li-inhibitors tsa MAO matsatsing a 14 a fetileng, hobane phello e ntseng e eketseha ea li-analgesics tsa opioid tse nang le li-inhibitors tsa MAO li hlokometsoe.

Ts'ebeliso e ts'oanang ea lihanyetsi tsa opioid receptor antagonists (ho kenyelletsa le naloxone) kapa karolo e fokolang ea opioid receptor agonists / antagonists (ho kenyelletsa buprenorphine, nalbuphine, pentazocine) ha e khothalletsoe. Li na le tšebelisano e phahameng bakeng sa li-receptor tsa opioid tse nang le ts'ebetso e tlase haholo, ka hona, ka tsela e itseng li fokotsa phello ea analgesic ea fentanyl mme li ka baka matšoao a ho tlohela ho bakuli ba itšetlehileng ka opioid.

Li-anticonvulsants, joalo ka carbamazepine, phenytoin le hexamidine (primidone) li ka eketsa metabolism ea fentanyl sebeteng, ea potlakisa ho tsoa ha eona ho tsoa 'meleng. Bakuli ba fumanang kalafo ka li-anticonvulsants tsena ba ka hloka tekanyetso e phahameng ea fentanyl.