Gluconorm: cov lus qhia rau kev siv: nqe thiab tshuaj xyuas cov neeg mob ntshav qab zib txog cov tshuaj kho ntshav qab zib

Tus kws kuaj mob endocrinologist tau kuaj pom - lub xeev muaj mob ntsig txog ntshav qab zib. Lub cev hnyav zuj zus tas li, cov zaub mov hauv lub cev tsis ua hauj lwm, zoo, qab zib taug kev (hypoglycemic syndrome). Hauv ntej, kev lom zem. Thaum koj zom ib qho kev noj zaub mov, qab zib nce, zoo, cov tsos mob uas koj paub heev tshwm sim. Yuav pib nrog, txhawm rau txo qis kuv lub siab, Kuv tau xaj qhov tshuaj no thaum noj su ib hnub ib zaug rau 1 ntsiav tshuaj, tab sis qee qhov tsis muaj kev cuam tshuam, zoo, tsuas yog. Kuv tau mus rau lwm tus kws kho mob, kws kho mob Siofor 850, coj nws tus kheej. Qhov cuam tshuam ua rau thawj hnub ntawm kev txais tos tau yooj yim dua, thaum yav tsaus ntuj kuv xav noj tsawg dua. Tom qab 2 lub lim tiam ntawm kev kho mob, qhov hnyav nce poob los ntawm 1.5 kg. Yog lawm, thiab kuv lub siab zoo dua.

Twb tau ib xyoos txij thaum kuv tau kuaj pom tus mob ntshav qab zib hom 2, tom qab ntawd tus kws kho mob tau hais kom kuv noj zaub mov nruj thiab txhaws qa. Peb noj tshuaj rau txog ib hlis, tab sis tam sim no piam thaj tsis nce siab dua 6-7. Nws tsuas yog qhov ntxim nyiam tias cov khoom noj yuav tsum tau ua tom qab. Txawm hais tias kev noj qab haus huv tseem kim dua, tau kawg.

Cov lus qhia luv luv

200 lab ... Nws tsim nyog nco cov duab no, vim yog qhov no yog qhov tau kwv yees ntau tus naj npawb ntawm cov neeg mob ntshav qab zib hnub no. Thiab raws li kev kwv yees ntawm cov kws tshawb fawb (thiab tsis yog qhov xav tau ntau tshaj plaws), los ntawm 2030 peb yuav tsum cia siab tias yuav muaj kev nce rau hauv daim duab no los ntawm tsawg kawg ib thiab ib nrab zaug. Ob qhov tseem ceeb pathological dag ntawm lub hauv paus pib ntawm cov ntshav qab zib: insulin tsis kam thiab pancreatic tsis txaus rau kev tsim cov tshuaj insulin endogenous. Txo txoj kev pheej hmoo ntawm cov teeb meem vascular (qhov muag tsis pom kev, mob plawv thiab hlab ntsha tawg, txhais ceg txiav), koj yuav tsum tau tuav koj txhais tes tas li ntawm cov mem tes (lossis theej, ntawm lub ntsuas kub) txhawm rau kom paub tseeb tias saib xyuas cov ntshav qabzib ntau ntxiv. Hauv qhov no, txoj kev kho mob nruj kho yog ib txoj hauv kev tseem ceeb hauv kev kho mob ntshav qab zib. Raws li txoj cai, tshuaj tua kab mob kev kho mob yog pib nrog monotherapy, uas siv ob qho metformin lossis sulfonylureas (glibenclamide glyclazide, glimepiride). Nyob rau hauv lub neej yav tom ntej, nrog kev pom meej tsis meej hauv cov kab ke biochemical, kev sib txuas ntawm cov tshuaj tau pib los yog cov tshuaj insulin txuas nrog. Ntxiv mus: txij li Txij li thaum muaj ntshav qab zib yog suav tias yog ib qho kev mob tshwm sim, txawm tias pib kho mob monotherapy, sai dua lossis tom qab, ntxiv cov tshuaj ntxiv nrog ib lossis ob pawg txheej txheem ntawm Mashkovsky siv phau ntawv yuav xav tau.

Feem ntau cov tshuaj tiv thaiv kab mob ua ke hauv kev soj ntsuam xyaum yog metformin + glibenclamide. Cov tshuaj gluconorm yog tsis muaj dab tsi ntau dua qhov no muaj zog hypoglycemic ob-tivthaiv ligament. Metformin biguanide txo qis ntshav qabzib los ntawm kev txo qis rau kev cuam tshuam rau cov tshuaj insulin hauv cov nqaij nruab nrog cev thiab ua kom cov ntshav qabzib ntau ntxiv los ntawm cov ntaub so ntswg. Cov tshuaj no inhibits qhov nqus ntawm cov carbohydrates hauv cov hnyuv thiab cuam tshuam nrog cov synthesis ntawm qabzib los ntawm lub siab. Metformin kuj tseem txhim kho cov duab lipid ntawm cov ntshav, txo qib ntawm cov "roj" phem. Glibenclamide, nyeg, yog cev nqaij cov nqaij ntawm sulfonylurea. Nws txhawb kev tso tawm cov tshuaj insulin los ntawm kev nce siab ntawm kev mob hlwb ntawm pancreatic cells-hlwb rau cov kua nplaum thiab qhov kev paub txog kev ua si ntawm insulin nrog lub hom phiaj hlwb.

Gluconorm feem ntau yog siv rau khoom noj ntawm qhov koob tshuaj pom zoo nrog tus kws kho mob (nws tuaj yeem yog tus kheej hauv txhua kis). Raws li kev coj noj coj ua, lawv "pib" los ntawm ib ntsiav tshuaj thiab tom qab ntawd hloov kho qhov tshuaj nyob rau txhua 1-2 lub lis piam, xam nrog theem ntawm cov piam thaj hauv cov ntshav, thaum tsis tshaj li qhov muaj peev xwm nyob rau txhua hnub pib ntawm 5 ntsiav tshuaj.

Kws Tshuaj

Gluconorm ® yog kev sib xyaw ua ke ntawm ob lub qhov ncauj hypoglycemic ntawm ntau yam pharmacological pawg: metformin thiab glibenclamide.

Metformin belongs rau cov pab pawg ntawm biguanides thiab txo cov ntshav qabzib los ntawm kev nce qhov kev hnov ​​mob ntawm cov ntaub so ntswg mus rau kev ua haujlwm ntawm insulin thiab txhim kho kev qabzib zoo ntxiv. Txo kev nqus ntawm carbohydrates nyob rau hauv lub plab zom mov thiab inhibits gluconeogenesis nyob rau hauv daim siab. Cov tshuaj kuj tseem muaj txiaj ntsig zoo rau cov lipid profile ntawm cov ntshav, txo qis theem ntawm cov roj (cholesterol) tag nrho. LDL thiab triglycerides. Tsis ua rau muaj kev tsis haum ntshav.

Glibenclamide belongs rau cov pab pawg ntawm sulfonylurea derivatives ntawm lub cim thib ob. Nws stimulates insulin secretion los ntawm kev txo qis ntawm qhov pib ntawm pancreatic cell-cell glucose voos, nce insulin rhiab heev thiab nws cov lus qhia rau lub hlwb phiaj, nce insulin tso tawm, txhim kho cov nyhuv ntawm insulin rau cov leeg thiab lub siab ua kom lub cev, thiab inhibits lipolysis hauv adipose nqaij. Kev ua nyob rau theem ob ntawm insulin secretion.

Cov Tshuaj Pharmacokinetics

Thaum muab tshuaj, nqus ntawm lub plab zom mov yog 48-84%. Lub sijhawm mus txog C_max - 1-2 teev V_d - 9-10 litres. Kev sib txuas lus nrog cov protein ntshav yog 95%.

Yuav luag txhua qhov ua tiav nyob hauv daim siab nrog rau kev tsim ntawm ob lub cev tsis ua haujlwm, ib qho yog tawm los ntawm lub raum, thiab lwm qhov los ntawm txoj hnyuv. T_1/2 - txij 3 txog 10-16 teev

Tom qab lub qhov ncauj tswj hwm, nws yog nqus tau los ntawm lub plab zom mov kom txaus, 20-30% ntawm qhov koob tshuaj yog pom hauv cov quav. Kev tsis raug cai txog kev nyab xeeb yog los ntawm 50 txog 60%. Nrog kev noj ib txhij, kev nqus ntawm metformin yog txo thiab qeeb. Nws faib sai sai hauv cov ntaub so ntswg, kev xyaum tsis khi rau cov ntshav protein.

Nws yog metabolized mus rau ib tug kawm ntawv uas tsis muaj zog thiab tawm los ntawm ob lub raum. T_1/2 kwv yees li 9-12 teev

Daim ntawv tso tawm

Zaj duab xis-ntsiav tshuaj ntawm cov xim dawb lossis yuav luag xim dawb, puag ncig, biconvex, thaum tawg ntawm dawb mus dawb nrog lub greyish zas.

Cov zam: microcrystalline cellulose - 100 mg, pob kws hmoov txhuv - 20 mg, colloidal silicon dioxide - 20 mg, gelatin - 10 mg, glycerol - 10 mg, magnesium stearate - 7 mg, purified talc - 15 mg, croscarmellose sodium - 30 mg, sodium carboxymethyl hmoov txhuv nplej siab - 18.3 mg, cellacephate - 2 mg, diethyl phthalate - 0.2 mg.

10 Pcs. - hlwv (4) - pob khoom los ntawm cardboard.
20 Pcs. - hlwv (2) - pob khoom los ntawm cardboard.

Cov tshuaj siv yog noj ntawm qhov ncauj, nrog noj mov. Qhov ntau thiab tsawg ntawm cov tshuaj tau txiav txim los ntawm tus kws kho mob tshwj xeeb rau txhua tus neeg mob, nyob ntawm seb cov ntshav nyob ntawm seb ntau npaum li cas.

Feem ntau cov tshuaj pib yog 1 tab. (400 mg / 2.5 mg) / hnub. Txhua 1-2 lub lis piam tom qab pib kho, qhov tshuaj ntawm cov tshuaj tau kho raws li qib ntshav cov ntshav nyob hauv lub cev. Thaum hloov cov kev sib txuas ua ke dhau los nrog metformin thiab glybeklamide, 1-2 ntsiav tshuaj yog kws kho. Gluconorm nyob ntawm seb koob tshuaj dhau los ntawm txhua qhov.

Qhov siab tshaj plaws niaj hnub noj yog 5 ntsiav tshuaj.

Noj ntau dhau

Kev noj tshuaj ntau dhau lossis muaj qhov muaj pheej hmoo tuaj yeem cuam tshuam kev loj hlob ntawm cov kab mob lactic acidosis, zoo li Metforminum yog ib feem ntawm kev npaj. Thaum cov tsos mob ntawm tus kab mob lactic acid tshwm sim (ntuav, mob plab, feem ntau tsis muaj zog, mob leeg), koj yuav tsum tsum tsis txhob noj cov tshuaj no. Lactic acidosis yog kev mob uas yuav tsum tau txais kev kho mob xwm txheej ceev, kev kho mob ntawm cov kab mob lactic acidosis yuav tsum tau ua nyob hauv tsev kho mob. Qhov kev kho mob uas zoo tshaj plaws yog hemodialysis.

Kev noj tshuaj ntau dhau kuj tuaj yeem ua rau kev txhim kho ntawm cov ntshav qog nqaij hlav vim muaj cov glibenclamide hauv kev npaj. Cov tsos mob ntawm tus mob ntshav qab zib: tshaib plab, tawm hws ntau dhau, tsis muaj zog, palpitations, pallor ntawm daim tawv nqaij, tawv nqaij ntawm lub qhov ncauj ntawm lub qhov ntswg, tshee tshee, kev ntxhov siab, mob taub hau, mob taub hau, mob taub hau, pw tsaug zog, ib qho kev ntshai, tsis muaj kev sib koom tes ntawm kev txav mus los, ib ntus ntawm cov leeg mob. Nrog rau kev nce qib ntawm hypoglycemia, cov neeg mob yuav plam lawv tus kheej kev tswj hwm thiab kev nco qab.

Nrog cov ntshav qog ntshav qab zib tsawg lossis mob ntshav qab zib, dextrose (piam thaj) lossis kua qab zib yog noj ntawm qhov ncauj. Thaum muaj mob ntshav nce hlwb ntau (qhov tsis nco qab lawm), 40% dextrose (qabzib) tov lossis tso ntshav qabzib, v / m, s / c raug siv iv. Tom qab nws rov qab nco qab, tus neeg mob yuav tsum tau muab cov zaub mov nplua nuj nyob hauv cov khoom noj kom hnyav kom tsis txhob muaj kev rov qab txhim kho ntawm hypoglycemia.

Kev sib txuam

ACE inhibitors (captopril, enalapril), histamine H blockers txhim kho cov nyhuv hypoglycemic ntawm cov tshuaj₂receptors (cimetidine), antifungal agents (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), fibrates (clofibrate, bezafibrat), tshuaj tiv thaiv kab mob ntsws (ethionamide), salicytates, anticoagulant antagon MAO, sulfonamides ntev ntev, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubular secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, lwm tus cov tshuaj hypoglycemic (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), cov tshuaj tiv thaiv kab mob (phenytoin), qeeb calcium calcium blockers, carbonic anhydrase inhibitors (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide, triazene diazenterine , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, iodine-muaj cov thyroid hormones, lithium ntsev, hauv kev txhaj tshuaj ntau - nicotinic acid, chlorpromazine, tshuaj tiv thaiv qhov ncauj thiab estrogens.

Zis acidifying tshuaj (ammonium chloride, calcium chloride, ascorbic acid nyob rau hauv cov koob tshuaj loj) txhim kho cov nyhuv los ntawm kev txo qis ntawm kev sib cais thiab nce kev rov kho dua ntawm glibenclamide.

Ethanol tsub kom muaj feem ntau ntawm cov kab mob lactic acidosis.

Metformin Txo C_max thiab T_1/2 furosemide los ntawm 31% thiab 42.3%, feem.

Furosemide nce C_max metformin los ntawm 22%.

Nifedipine nce ntxiv kev nqus, C_max ua kom qis qis dua ntawm kev siv tshuaj metformin.

Cov tshuaj Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren thiab vancomycin) zais cia hauv cov tubules sib tw rau cov tshuab thauj tubular thiab tuaj yeem nce C nrog kev kho mob ntev_max 60% metformin.

Sab sij huam

Ntawm ib feem ntawm cov khoom noj metabolism carbohydrate: hypoglycemia yog ua tau.

Los ntawm lub plab zom mov thiab daim siab: tsis tshua muaj - xeev siab, ntuav, mob plab, poob qab los noj mov, "nws yog xim hlau" saj hauv lub qhov ncauj, qee qhov - cholestatic jaundice, nce kev ua haujlwm ntawm daim siab enzymes, kab mob siab.

Los ntawm cov kab mob hemopoietic: tsis tshua muaj - leukopenia, thrombocytopenia, erythrocytopenia, tsis tshua muaj tshwm sim - agranulocytosis, hemolytic lossis megaloblastic anemia, pancytopenia.

Los ntawm ib sab ntawm lub hauv nruab nrab lub paj hlwb: mob taub hau, kiv taub hau, qaug zog, qaug zog, tsis tshua muaj - paresis, mob rhiab.

Kev ua xua thiab immunopathological: tsis tshua muaj - urticaria, erythema, tawv nqaij khaus, kub ib ce, mob pob txaws, mob ntshav qab zib.

Dermatological tshua: tsis tshua muaj - photosensitivity.

Los ntawm sab ntawm cov metabolism: lactic acidosis.

Lwm yam: muaj kev cuam tshuam los ntawm dej cawv tsis txaus ntseeg tom qab haus dej, qhia los ntawm cov teeb meem ntawm cov ntshav ncig thiab ua pa ntawm lub cev (tsis xws li cov tshuaj tiv thaiv: ntuav, hnov ​​qhov kub ntawm lub ntsej muag thiab lub cev sab saud, tachycardia, kiv taub hau, mob taub hau).

Ntshav qab zib Hom 2 rau cov neeg laus:

• nrog rau kev ua tsis tau zoo ntawm kev kho kev noj haus, kev tawm dag zog thiab kev kho mob yav dhau los nrog metformin lossis glibenclamide,
• los hloov cov kev kho mob yav dhau los nrog ob yam tshuaj (metformin thiab glibenclamide) hauv cov neeg mob uas muaj ntshav khov thiab tswj ntshav qabzib.

Cov Yuav Tsum Muaj

• ntshav qab zib hom 1
• ketoacidosis, mob ntshav qab zib precoma, mob ntshav qab zib coma,
• qog ntshav,
• mob raum tsis zoo,
• mob uas tuaj yeem ua rau lub raum hloov pauv (lub cev qhuav dej, ua mob hnyav, ua rau poob siab),
• mob los yog mob mus ntev nrog cov nqaij mos hypoxia (mob plawv lossis ua pa tsis ua haujlwm, tsis ntev los no myocardial infarction, poob siab),
• daim siab ua hauj lwm
• porphyria
• siv cov miconazole kom nruj,
• cov kab mob sib kis, kev phais mob loj, kev raug mob, kub hnyiab thiab lwm yam mob uas yuav tsum muaj kev kho mob,
• cawv ntev, qaug cawv qaug cawv,
• lactic acidosis (suav nrog keeb kwm),
• siv tsawg kawg 48 teev ua ntej thiab nyob rau hauv 48 teev tom qab ua kev tshawb fawb radioisotope lossis xoo hluav taws xob nrog kev qhia ntawm iodine-muaj qhov sib piv nruab nrab,
• ua raws li kev noj haus kom tsis txhob muaj calories ntau tsawg (tsawg dua 1000 calories / hnub),
• cev xeeb tub
• lub sij hawm pub niam mis,
• cov tshuaj tiv thaiv kab mob rau metformin, glibenclamide lossis lwm yam sulfonylurea derivatives, thiab cov txuam nrog cov tshuaj tiv thaiv kab mob.

Nws tsis pom zoo kom siv cov tshuaj rau cov neeg laus dua 60 xyoo uas ua haujlwm lub cev hnyav, uas cuam tshuam nrog kev pheej hmoo ntawm kev tsim mob lactic acidosis hauv lawv.

Nrog ceev faj: febrile syndrome, adrenal tsis txaus, hypofunction ntawm anterior pituitary, mob qog nrog kev ua haujlwm tsis taus.

Cev xeeb tub thiab lactation

Thaum cev xeeb tub, kev siv ntawm gluconorm yog contraindicated. Thaum npaj lub cev xeeb tub, nrog rau kev muaj cev xeeb tub thaum lub sijhawm noj cov tshuaj Gluconorm, cov tshuaj yuav tsum tau txiav tawm thiab kev kho mob insulin yuav tsum tau kho.

Gluconorm ® yog qhov sib txuam hauv kev pub niam mis, vim tias metformin kis mus rau hauv niam mis. Hauv qhov no, koj yuav tsum hloov mus rau kev siv tshuaj insulin lossis txwv kev pub niam mis.

Cov lus qhia tshwj xeeb

Kev phais mob thiab kev raug mob loj, kev kub nyhiab, kev kis mob nrog febrile syndrome yuav tsum tsis siv tshuaj ntxiv thiab teem caij rau tshuaj insulin.

Nws yog ib qho tsim nyog yuav tau soj ntsuam cov qib ntawm cov piam thaj hauv cov ntshav ntawm lub plab khoob thiab tom qab noj mov.

Cov neeg mob yuav tsum ceeb toom qhia txog kev pheej hmoo yuav muaj ntshav qab zib tsawg nyob rau hauv muaj ethanol, NSAIDs, thiab tshaib plab.

Ib qho kev hloov kho koob tshuaj yog qhov tsim nyog rau kev tawm dag zog lub cev thiab lub siab, hloov kev noj zaub mov.

Thaum kho, nws tsis pom zoo kom haus cawv.

48 teev ua ntej kev phais lossis iv kev tswj hwm ntawm iodine-muaj radiopaque tus neeg sawv cev, gluconorm tswj hwm yuav tsum tsis ua haujlwm ntxiv. Gluconorm kev kho mob yog pom zoo kom rov ua dua tom qab 48 teev.

Cuam tshuam rau kev muaj peev xwm tsav tsheb thiab tswj cov tshuab

Thaum lub sijhawm kho mob, yuav tsum tau saib xyuas thaum tsav tsheb thiab koom nrog lwm yam kev phom sij uas yuav tsum muaj kev mloog zoo thiab ceev ntawm cov kev tiv thaiv psychomotor.