Cov Tshuaj> Lisinopril - ratiopharm (ntsiav tshuaj)

Lisinopril ratiopharm yog ib cov tshuaj rau txo kev mob ntshav siab thiab kho lub plawv thiab lub raum tsis ua haujlwm. Raws li kev kho mob sai-sai, cov tshuaj yuav siv tau rau cov mob myocardial infarction (tsis pub dhau rau lub lis piam, raug hemodynamic ruaj ntseg ntawm tus neeg mob). Kev poob hauv ntshav siab tshwm sim nyob rau hauv ib teev thiab ib nrab tom qab noj cov tshuaj thiab nce mus txog nws cov nyhuv siab tom qab rau rau cuaj teev.

Hauv kev kho mob ntshav siab, kev pib ntawm lisinopril ratiopharm yog 10 mg. Cov tshuaj yog noj txhua hnub, ib zaug thiab tib lub sij hawm yam tsis tau hais txog kev noj zaub mov. Ntxiv mus, cov koob tshuaj tau raug kho ib zaug txhua ob lossis plaub lub lis piam nrog cov koob tshuaj ntawm 5-10 mg.

Hauv kev kho mob ntawm cov mob myocardial infarction, cov tshuaj tau tawm hauv thawj 24-7 teev tom qab kev kuaj mob ntawm cov tsos mob tshwm sim, qhia tias systolic ntshav siab qhov ntsuas tsis yog tsawg dua 100 hli Hg. Qhov tshuaj thawj zaug yog 5 mg nrog nce ntxiv rau 10 mg rau hnub thib peb ntawm kev tswj hwm.

Hauv raum tsis ua haujlwm, qhov ntau npaum ntawm cov tshuaj raug xaiv raws li cov cim creatinine tshem tawm.

Tsis pom zoo contraindications rau kev siv cov tshuaj no yog menyuam yaus, cev xeeb tub, angioedema thiab Quincke's edema. Tsis pom zoo teem caij thaum lactation. Thaum noj cov tshuaj diuretics, noj cov tshuaj yuav nrog cov ntshav siab ntau dhau los, thiab kev sib xyaw nrog cov tshuaj tiv thaiv kab mob tuaj yeem ua rau txo qis cov ntshav qabzib thiab kev txhim kho hypoglycemic poob siab.

Daim ntawv teev cov kev mob tshwm sim thaum noj Lisinopril yog qhov nws kim heev. Ntawm ib feem ntawm cov ntshav hematopoietic, yuav muaj kev tsis zoo hauv hemoglobin thiab hematocrit, nyob rau ib feem ntawm cov leeg hlwb - mob taub hau, kiv taub hau, pw tsaug zog ntxhov siab, asthenia, qaug zog, nyob rau ib feem ntawm cov hlab plawv - hypotension thiab lwm cov teeb meem orthostatic. Yog tias pom tias muaj cov kev mob tshwm sim, yuav tsum kuaj xyuas ntshav siab, tsis tu ncua, nrog tshuaj xyuas cov qib creatinine thiab ntshav electrolyte concentration.

Pharmacological cov yam ntxwv ntawm cov tshuaj Lisinopril-ratiopharm

Lisinopril (N-N- (15) -1-carboxy-3-phenylpropyl-L-lysyl-L-proline) yog cov tshuaj tiv thaiv ACE. Nws nplov qhov tsim ntawm angiotensin II, uas muaj cov nyhuv vasoconstrictor. Txo cov leeg ntshav systolic thiab cov ntshav siab ntsig txog ntshav siab, tiv thaiv hlab plawv thiab txhim kho cov ntshav ncig hauv lub raum. Hauv feem ntau cov neeg mob, cov nyhuv antihypertensive manifests nws tus kheej 1-2 teev tom qab lub qhov ncauj tswj hwm ntawm cov tshuaj, qhov siab tshaj plaws - kwv yees li 6 hours9 teev. Ntsoos ntsoos mob los tsis tshwm sim.
Qhov nqus ntawm cov tshuaj tom qab kev tswj hwm ntawm qhov ncauj yog kwv yees li 25-50%. Kev noj ib txhij tsis cuam tshuam rau kev nqus. Qhov siab tshaj plaws hauv cov ntshav ntshav tau mus txog tom qab li 6-7 teev. Lisinopril me ntsis khi rau cov ntshav protein. Nws tsis yog metabolized, cia hauv cov zis hloov pauv. Ib nrab-lub neej yog 12 teev .Txoj kev ua haujlwm tsis zoo rau lub raum, qhov kev tawm ntawm lisinopril raug txo kom tsawg raws li kev pom ntawm kev ua haujlwm tsis zoo. Hauv cov neeg mob laus (tshaj 65 xyoo), zoo li hauv lub plawv tsis ua haujlwm, kev tshem tawm ntawm lub pob zeb lisinopril tsawg dua.
Cov tshuaj yog tawm thaum lub sij hawm hemodialysis.

Kev siv cov tshuaj lisinopril-ratiopharm

AH (kev mob ntshav siab)
Raws li txoj cai, thawj koob tshuaj hauv kev kho mob kub siab (kub siab) yog 5 mg / hnub hauv ib koob (thaum sawv ntxov). Yog tias thaum tib lub sijhawm cov ntshav siab nws tsis rov qab ua li qub, cov koob tshuaj tau nce ntxiv rau 10-20 mg (nyob ntawm tus neeg mob cov lus teb) ib hnub ib zaug thaum sawv ntxov. Cov koob tshuaj pom zoo feem ntau yog 10-20 mg, thiab qhov ntau tshaj yog 40 mg / hnub.
Mob plawv nres
Thawj koob tshuaj yog 2.5 mg (1/2 t ntawm 5 mg ntsiav tshuaj). Cov koob tshuaj yog maj mam nce ntxiv nyob ntawm tus neeg cov tshuaj tiv thaiv. Cov tshuaj tua kab mob pom zoo kom noj tshuaj yog 20 mg / hnub hauv ib koob.
Siv nrog ceev faj hauv cov neeg mob uas noj / tau siv tshuaj diuretics. Yog tias nws tsis tuaj yeem txwv tsis pub siv cov tshuaj diuretics ua ntej, nws raug pom zoo tias lisinopril noj nrog kev siv tshuaj tsawg kawg nkaus los ntawm kev tswj cov ntshav siab thiab lub raum ua haujlwm.
Mob myocardial infarction nrog ST ntu ntu
Kev kho yuav tsum tau pib hauv thawj 24 teev txij li pib ntawm cov tsos mob ntawm myocardial infarction (hauv qhov tsis muaj arterial hypotension). Thawj koob tshuaj yog 5 mg / hnub, lub hom phiaj koob tshuaj yog 10 mg / hnub hauv ib koob. Cov neeg mob systolic siab tsis siab tshaj 120 hli RT. Kos duab. Ua ntej thiab thaum kho, nyob rau thawj 3 hnub tom qab myocardial infarction, kev kho mob yog pib ntawm koob tshuaj 2.5 mg. Nrog ib theem ntawm systolic ntshav siab hauv qab 100 hli RT. Kos duab. Kev siv tshuaj kho yuav tsum tsis pub ntau tshaj 5 mg rau ib hnub (tuaj yeem txo rau 2.5 mg).
Yog tias tom qab noj lisinopril ntawm koob tshuaj 2.5 mg, qib systolic ntshav siab qis dua 90 hli Hg. Kos duab., Tshuaj yuav tsum tau muab tso tseg. Lub sijhawm pom zoo ntawm kev siv rau myocardial infarction yog 6 lub lis piam.
Tus mob leeg me nyuam (theem pib) hauv cov neeg mob uas muaj ntshav qab zib hom 2 mellitus
Qhov tshuaj thawj zaug yog 10 mg 1 zaug nyob rau ib hnub, qhov siab tshaj plaws yog 20 mg 1 zaug nyob rau ib hnub.
Thaum muaj ntshav qab zib insulin-tiv thaiv kab mob (vim tias tseem muaj peev xwm txhim kho hyperkalemia), kev kho mob nrog lisinipril yuav tsum tau pib nrog cov koob tshuaj qis raws li lub rooj thiab ua raws kev saib xyuas ntawm tus kws kho mob.
Lub raum tsis ua hauj lwm thiab creatinine tshem tawm 30-80 ml / min: Thawj qhov hno yog 2.5 mg ib hnub ib zaug thaum sawv ntxov. Kev kho mob koob tshuaj (5-10 mg ib hnub twg) nyob ntawm tus neeg teb ntawm tus neeg mob. Tsis pub tshaj qhov siab tshaj qhov niaj hnub noj 20 mg.
Lub raum tsis ua haujlwm thiab cov creatinine tshem tawm tsawg dua 30 ml / min: Qhov pom zoo kom pib siv tshuaj yog 2.5 mg. Qhov koob tshuaj txhua hnub yog txiav txim siab ib tus zuj zus, nyob ntawm qhov kev nkag siab, nws raug nquahu kom nce lub sijhawm ntawm cov koob tshuaj (1 zaug hauv 2 hnub).

Cov tshuaj tiv thaiv tsis haum rau kev siv tshuaj Lisinopril-ratiopharm

Hypersensitivity rau lisinopril lossis lwm qhov sib xyaw ntawm cov tshuaj, angioedema, suav nrog kev siv ACE inhibitors hauv keeb kwm, idiopathic thiab mob muaj keeb Quincke edema, mob plawv, poob siab, mob myocardial infarction nyob rau hauv lub xub ntiag ntawm arterial hypotension (systolic ntshav qis dua 90 hli Hg). , lub sijhawm cev xeeb tub thiab lactation, lub hnub nyoog txog 12 xyoo.

Phiv cov tshuaj lisinopril-ratiopharm

kev mob plawv: arterial hypotension (tshwj xeeb tshaj yog tom qab siv thawj zaug ntawm cov tshuaj los ntawm cov neeg mob nrog sodium tsis txaus, lub cev qhuav dej, lub plawv tsis ua haujlwm), orthostatic tshua, nrog rau kiv taub hau, tsis muaj zog, tsis pom kev, tsis nco qab. Muaj cov ntawv ceeb toom sib txawv ntawm kev txhim kho tachycardia, mob plawv dhia tsis tuaj yeem, mob ntawm pob tw, thiab mob stroke.
Hematopoietic thiab lymphatic systems: tsis tshua muaj - thrombocytopenia, leukopenia, neutropenia, agranulocytosis, hemolytic anemia, lymphadenopathy, autoimmune kab mob.
Genitourinary system: lub raum khiav tsis zoo, muaj qee kis - mob raum tsis zoo. Hauv cov neeg mob uas lub raum mob hlab ntsha hlwb thiab hauv cov neeg mob ib txhij tau txais cov tshuaj diuretics, kev nce rau cov ntshav creatinine thiab urea nitrogen rau hauv cov ntshav cov ntshav tuaj yeem pom, muaj cov ntawv ceeb toom cais ntawm uremia, oliguria, anuria, tsis tshua muaj mob - impotence, gynecomastia.
Kab mob ua pa: hnoos qhuav thiab mob ntsws, qee zaum sinusitis, rhinitis, bronchospasm, glossitis thiab lub qhov ncauj qhuav, muaj cov ntawv ceeb toom sib txawv ntawm kev mob ntsws eosinophilic.
GIT: xeev siab, ntuav, mob epigastric thiab dyspepsia, tsis nco qab, mob plab, quav tawv, raws plab. Hauv cov xwm txheej cais - cholestasis, kev ua si ntawm hepatic transaminases thiab cov ntsiab lus bilirubin vim yog lub siab ua haujlwm tsis zoo nrog kev puas tsuaj thiab necrosis ntawm hepatocytes. Muaj cov ntaub ntawv hais txog kev mob pancreatitis, kab mob siab (hepatocellular lossis cholestatic).
Daim tawv nqaij, kev ua xua thiab lub cev tiv thaiv kab mob: kev hnov mob ntawm tshav kub, yaug ntawm daim tawv nqaij, khaus, qee qhov - angioedema ntawm daim di ncauj, ntsej muag thiab / lossis nqua, tawm hws ntau dhau, lom ua rau daim tawv nqaij tsis haum, Stevens-Jones syndrome, polymorphic alopecia. Cov tawv nqaij ua xua tuaj yeem nrog kub taub hau, myalgia, mob pob txaws / mob caj dab, mob vasculitis, muaj tshuaj tiv thaiv zoo, nce ntxiv ESR, eosinophilia, leukocytosis, photophobia.
CNS: mob taub hau, qaug zog, kiv taub hau, nyuaj siab, pw tsaug zog, sib luag tes taw, tsis txaus, tsis meej pem, tsis meej pem, tsis pom kev thiab tsis pom tseeb, asthenia.
Kev ntsuas ntsuas: nce cov ntshiab si creatinine thiab urea nitrogen, hyperkalemia, qee zaum nce bilirubin concentration, hyponatremia.

Cov lus qhia tshwj xeeb rau kev siv cov tshuaj Lisinopril-ratiopharm

Hauv cov kab mob myocardial infarction nrog ntu nce ST lisinopril tuaj yeem kho rau txhua tus neeg mob nyob rau hauv qhov tsis muaj contraindications, tshwj xeeb tshaj yog rau cov neeg mob uas lub plawv tsis ua haujlwm thaum ntxov ntawm tus kab mob, nrog rau kev txiav tawm ntawm cov leeg ntshav ntawm sab laug ventricle, nrog rau kev mob ntshav siab (arterial hypertension), thiab ntshav qab zib mellitus.
Hauv cov neeg mob hypovolemia, sodium tsis txaus vim kev siv tshuaj diuretics, tsis muaj ntsev ntau, vim ntuav, raws plab, tom qab lim ntshav, qhov kev txhim kho ntawm dheev hypotension cia li mob ceev, mob raum tsis ua haujlwm. Hauv cov xwm txheej zoo li no, nws raug nquahu kom them nyiaj rau qhov ua kua dej thiab ntsev ua ntej kho nrog lisinopril thiab muab kev saib xyuas mob txaus.
Nrog ceev faj (noj mus rau hauv tus account cov txiaj ntsig / txaus sib piv), cov tshuaj yog raug rau cov neeg mob uas muaj ob leeg lub raum mob ntshav siab los yog lub raum lub raum mob hlab ntsha, nrog rau cov neeg mob tsis ua haujlwm lub raum, mob siab, hematopoiesis, kab mob autoimmune, mob hnyav aortic, mitral stenosis, obstructive hypertrophic cardiomyopathy. Txhua yam ntawm cov mob no yuav tsum tau muaj kev saib xyuas tas li thiab tshuaj xyuas lub chaw kuaj ntsuas.
Muaj cov ntawv ceeb toom ntawm cov neeg mob cholestatic jaundice vam meej mus rau fulminant necrosis. Yog hais tias tus neeg mob txhim kho jaundice lossis ua rau nce siab hauv daim siab ntau dhau los, kev siv tshuaj yuav tsum tsis ua ntxiv.
Hauv thawj cov tshuaj hu ua aldosteronism, thaum kho kev ua xua, kev siv tshuaj ACE inhibitors tsis pom zoo.
Hauv cov neeg laus cov neeg mob, kev tiv thaiv zoo mus rau lisinopril tuaj yeem pom nrog kev siv cov koob tshuaj ib txwm siv.
Nrog kev ceev faj, lisinopril yog tshuaj rau cov neeg mob uas muaj ntau dua ntawm creatinine hauv cov ntshav (nce txog 150-180 micromol / l).
Txij li thaum lisinopril-ratiopharm tsis yog biotransformed hauv daim siab, nws yuav yog cov tshuaj ntawm kev xaiv ntawm lwm cov tshuaj tiv thaiv ACE rau cov neeg mob uas lub siab tsis zoo.
Lub sijhawm ntawm cev xeeb tub thiab lactation. Kev siv cov tshuaj yog contraindicated heev hauv thawj peb lub hlis thaum cev xeeb tub. Hauv lub sijhawm xyoo II thiab III, kev kho mob nrog lisinopril kuj tseem tsis pom zoo (yog tias kev siv tshuaj yog qhov tsim nyog kiag li nyob rau xyoo II, kev soj ntsuam ultrasound ntawm kev ntsuas cov haujlwm ua haujlwm tau pom zoo). Cov menyuam mos uas lawv niam coj lisinopril yuav tsum tau soj ntsuam kev txhim kho ntawm kev ua kom yuag, oliguria, hyperkalemia. Kev siv cov tshuaj thaum lactation tsis pom zoo.
Cawv rau ntawm kev muaj peev xwm tsav lub tsheb thiab ua haujlwm nrog cov tshuab. Thaum pib ntawm kev kho mob, kev txhim kho ntawm txoj hlab ntshav ntawm txoj kev mob ntshav yog qhov ua tau, uas tuaj yeem cuam tshuam lub peev xwm tsav tsheb thiab ua haujlwm nrog cov teeb meem muaj peev xwm txaus ntshai.

Kev sib cuam tshuam yeeb tshuaj Lisinopril-ratiopharm

Cawv, diuretics thiab lwm cov tshuaj tiv thaiv kev tiv thaiv (blockers ntawm α- thiab β-adrenergic receptors, calcium antagonists, thiab lwm yam) potentiate hypotensive nyhuv ntawm lisinopril.
Nrog rau kev siv ua ke nrog cov tshuaj potassium-sparing diuretics (spironolactone, amiloride, triamteren), hyperkalemia yuav tshwm sim, yog li ntawd, thaum siv cov tshuaj no, nws yog ib qho tsim nyog los tswj kev xav ntawm cov potassium hauv cov ntshav ntshav. Hyperkalemia tseem muaj peev xwm nrog kev siv cyclosporine tib si, kev npaj poov tshuaj, cov khoom noj muaj tshuaj muaj cov potassium, uas yog qhov tshwj xeeb tseem ceeb hauv cov ntshav qab zib mellitus, lub raum tsis ua haujlwm.
NSAIDs (tshwj xeeb yog indomethacin), sodium chloride txo cov nyhuv antihypertensive ntawm lisinopril.
Thaum siv nrog lithium npaj, nws yog ib qho ua tau kom ncua kev tshem tawm ntawm cov roj ntsha lithium tawm ntawm lub cev thiab, raws li, muaj kev pheej hmoo ntawm nws cov nyhuv ua kom mob siab. Nws yog ib qho tsim nyog yuav tsum soj ntsuam qib theem ntawm cov roj ntsha lithium hauv cov ntshav.
Cov hlwb pob txha muaj kev tiv thaiv kab mob, nrog rau lisinopril, ua rau muaj kev pheej hmoo ntawm neutropenia thiab / lossis agranulocytosis.
Allopurinol, cytostatics, immunosuppressants, corticosteroids, procainamide nrog rau kev siv ua ke nrog lisinopril tuaj yeem ua rau kev loj hlob ntawm leukopenia.
Estrogens, sympathomimetics txo cov txiaj ntsig antihypertensive zoo ntawm lisinopril.
Lisinopril-ratiopharm tuaj yeem siv tib lub sijhawm nrog glyceryl trinitrate, uas yog tswj hwm iv lossis transdermally.
Kev ceeb toom yog tshaj tawm rau cov neeg mob uas muaj tus kab mob myocardial infarction rau 6-12 teev tom qab kev saib xyuas ntawm streptokinase (kev pheej hmoo ntawm hypotension).
Lisinopril-ratiopharm pab txoj kev ua rau qaug cawv.
Tshuaj, tshuaj loog, hypnotics, tricyclic antidepressants txhim kho cov nyhuv hypotensive.
Thaum lub sijhawm lim ntshav nrog lisinopril txoj kev kho, muaj qhov muaj kev pheej hmoo ntawm kev phiv tshuaj yog tias polyacrylonitrile hlau sulfonate high-flow membranes tau siv (piv txwv li AN69).
Kev siv tshuaj hypoglycemic qhov ncauj (piv txwv, urea sulfonyl derivatives - metformin, biguanides - glibenclamide) thiab insulin thaum siv nrog ACE inhibitors tuaj yeem txhim kho hypotensive, tshwj xeeb tshaj yog thaum pib kho.
Noj tshuaj antacids tuaj yeem txo cov nyhuv antihypertensive.

Kev noj tshuaj ntau dhau Lisinopril-ratiopharm, cov tsos mob thiab kev kho mob

Ib qho kev txo qis hauv cov ntshav siab nrog kev tsis hnov qab ntawm qhov tseem ceeb hauv cov plab hnyuv siab raum, poob siab, tsis txaus ntseeg hauv cov ntshav electrolytes, mob raum tsis ua haujlwm, tachycardia, bradycardia, kiv taub hau, ntxhov siab thiab hnoos. Nws yog ib qho tsim nyog kom tsum tsis txhob siv cov tshuaj. Rau intoxication, pais plab lavage yog pom zoo. Nrog arterial hypotension, tus neeg mob yuav tsum muab tso rau ntawm nws sab nraub qaum nrog nws ob txhais ceg tsa ceg. Txog kev kho tus mob ntshav siab, tso ntshav tawm ntawm lub cev kev daws teeb meem thiab / lossis ntshav hloov ntshav tau qhia. Yog tias tsim nyog, iv siv tshuaj angiotensin. Lisinopril tuaj yeem raug tshem tawm los ntawm hemodialysis (polyacrylonitrile hlau sulfonate high-flow membranes xws li AN69 tsis tuaj yeem siv). Nyob rau hauv kev mob ntawm txoj sia tiv thaiv kev mob caj dab, yuav tsum siv tshuaj antihistamines. Yog tias qhov chaw kho mob tau nrog los ntawm kev mob ntawm tus nplaig, lub ntsej muag, thiab lub ntsej muag, nws yog qhov yuav tsum tau pib kho sai nrog s / c tswj hwm ntawm 0.3-0.5 ml ntawm epinephrine tov (1: 1000), intubation lossis laryngotomy yog qhia kom paub meej txog kev ua pa ntawm lub cev Cov. Thaum bradycardia mob tsawv tom qab kho, nws yog qhov tsim nyog los ua hluav taws xob txhawb nqa. Nws yog ib qho tsim nyog los soj ntsuam cov ntsuas tseem ceeb ntawm cov haujlwm tseem ceeb, kev saib xyuas ntawm cov ntshiab electrolytes thiab creatinine.

Dosage daim ntawv

Qhov yooj yim lub cev thiab tshuaj:

5 mg dawb puag ncig biconvex ntsiav tshuaj, nrog kev ceeb toom rau rhuav ntawm ib sab,

10 mg ntsiav tshuaj: lub teeb xim liab, tsis muaj xim tsis yog xim, dotted, round biconvex, nrog kev nqis siab rau kev ua txhaum ntawm ib sab,

20 mg ntsiav tshuaj ntawm grey-liab xim tsis muaj xim tsis sib xws, dotted, round biconvex, nrog kev nqis siab rau kev ua txhaum ntawm ib sab.

Cov chaw muag tshuaj

Lisinopril yog peptidyl dipeptidase inhibitor. Nws tshem tawm ACE (ACE), uas yog lub hauv paus rau kev hloov pauv ntawm angiotensin I rau hauv vasoconstrictive peptide, angiotensin II, txhawb cov kev zais ntawm aldosterone los ntawm adrenal cortex. ACE kev tsuj tawm ua rau muaj kev txo qis ntawm cov tshuaj angiotensin II, uas ua rau txo qis vasoconstrictor kev ua si thiab kev tso pa zais ntawm aldosterone. Txo cov aldosterone zais cia tsawg tuaj yeem ua rau kom cov ntshiab poov tshuaj ntau ntxiv. Lisinopril txo qis ntshav siab feem ntau vim yog inhibition of renin-angiotensin-. Txawm li cas los xij, lisinopril muaj cov nyhuv antihypertensive txawm tias nyob hauv cov neeg mob uas tsis muaj qib qis qis. ACE zoo tib yam rau kinase II, ib qho enzyme uas txhawb txoj kev tawg ntawm bradykinin.

Tawm tsam keeb kwm yav dhau los ntawm qhov kev txiav txim ntawm cov tshuaj, ib qho kev txo qis ntawm arterial systolic thiab diastolic siab tshwm sim.

Nws tau pom tias tag nrho cov teeb meem kev tsis haum nyob rau hauv cov neeg mob uas tau txais siab lossis qis ntawm lisinopril zoo ib yam li muaj xwm thiab ntau zaus.

Nws tau tshaj tawm tias nyob rau hauv cov neeg mob uas tau txais lisinopril, muaj qhov txo qis ntxiv ntawm kev tso zis ntawm albumin hauv cov zis, qhia tias ACE inhibitory nyhuv ntawm lisinopril ua rau txo qis microalbuminuria los ntawm kev cuam tshuam ncaj qha rau cov nqaij mos raum ntxiv rau nws lub peev xwm txo ntshav siab.

Txoj kev kho nrog lisinopril tsis cuam tshuam rau kev tswj ntshav qabzib, raws li pom los ntawm nws cov txiaj ntsig tsis txaus ntseeg nyob rau theem ntawm glycosylated hemoglobin (HbA ₁ c) c)

Nws tau tsim tsa uas lisinopril ua lub luag haujlwm zoo rau hauv kev rov ua kom txoj haujlwm ntawm endothelium uas puas lawm hauv cov neeg mob hyperglycemia.

Lisinopril yog qhov ncauj ACE inhibitor uas tsis muaj sulfhydryl.

Tom qab noj cov lisinopril, qhov kev xav ntau tshaj plaws hauv cov ntshav cov ntshav tau mus txog tom qab 7:00, txawm hais tias nyob rau hauv cov neeg mob uas muaj myocardial infarction muaj kev cuam tshuam rau kev ncua sij hawm me ntsis kom mus txog cov ntsiab lus siab. Raws li kev tso zis hauv cov zis, qhov nruab nrab ntawm kev nqus ntawm lisinopril nyob rau hauv thaj tsam yog kwv yees li 25% ntawm qhov txawv txav ntawm cov neeg mob sib txawv hauv 6-60% ntawm txhua qhov kev kawm tau kawm (5-80 mg). Hauv cov neeg mob uas lub plawv tsis ua hauj lwm, txo qis hauv bioavailability yog li 16%.

Noj mov tsis cuam tshuam rau kev nqus ntawm cov tshuaj

Lisinopril tsis khi rau cov ntshav muaj protein ntau, tshwj tsis yog rau lub plawv mob ua kom muaj cov leeg mob hlwb ntau dhau (ACE).

Lisinopril tsis yog metabolized thiab ua rau tsis hloov pauv ntawm cov zis. Kev tshem tawm ib nrab-lub neej nyob rau hauv cov neeg mob noj ntau yam tshuaj yog 12.6 teev. Kev tshem ntawm lisinopril hauv cov tib neeg noj qab haus huv yog 50 ml / min. Yog tias muaj mob ntawm lub raum tsis ua haujlwm, qhov kev tawm ntawm lisinopril yog txo qis hauv kev faib ua feem ntawm kev tsis haum ntawm kev ua haujlwm. Qhov kev txo qis hauv cov ntshav ua rau pom tseeb tau ncua ntev lub sij hawm davhlau ya nyob twg thiab tsis cuam tshuam nrog kev txuam nrog tshuaj. Qeb kawg zaum no qhia txog kev sib khi rau ACE thiab tsis yog ib qho koob tshuaj sib npaug.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo

Hauv cov neeg mob qog mob ntshav siab, lub siab ua haujlwm tsis txaus ua rau muaj qhov txo qis ntawm lisinopril (li 30% tom qab kev txiav txim hauv cov zis), ntxiv rau qhov nce ntxiv (kwv yees li 50%) piv nrog cov neeg tuaj yeem noj qab haus huv vim muaj kev tshem tawm hauv kev tshem tawm.

Lub raum khiav tsis zoo

Lub raum ua haujlwm tsis zoo txo qhov kev tshem tawm ntawm lisinopril, uas yog tawm los ntawm lub raum, tab sis qhov kev txo qis no yog qhov tseem ceeb hauv thaj chaw tsuas yog thaum glomerular pom kev qis dua 30 ml / min. Nrog rau qhov nruab nrab thiab me me ntawm lub raum ua puas (kev tsim kho lub peev xwm ntawm 30-80 ml / min), qhov nruab nrab ntawm AUC nce tsuas yog 13%, thaum muaj qhov hnyav ntawm lub raum puas tsuaj (creatinine tshem ntawm 5-30 ml / min), qhov nruab nrab AUC ntawm 4 5 zaug. Lisinopril tuaj yeem tshem tawm los ntawm lim ntshav. Thaum lub sij hawm hemodialysis, lub sijhawm uas yog 4:00, qhov kev sib xyaw ntawm lisinopril hauv cov ntshav txo qis rau thaj tsam li ntawm 60% nrog kev lim ntshav ntawm 40 thiab 55 ml / min.

Cov neeg mob lub plawv tsis ua haujlwm nrog lisinopril ntau dua piv rau cov neeg ua haujlwm noj qab haus huv (qhov nruab nrab AUC nce li ntawm 125%), tab sis raws li cov nyiaj ntawm lisinopril kuaj pom hauv cov zis, muaj qhov txo qis ntawm kev nqus ntawm kwv yees li 16% piv rau cov neeg tuaj yeem noj qab haus huv.

Cov neeg laus cov neeg mob

Cov neeg laus muaj qib siab dua ntawm cov tshuaj hauv ntshav thiab qhov siab dua / teev nkhaus (nce ntxiv txog 60%) piv nrog cov neeg mob hluas.

Cov kws kho mob cov keeb kwm ntawm lisinopril tau kawm nyob rau hauv 29 cov menyuam yaus mob ntshav ncig los ntawm 6 mus rau 16 xyoo, nrog GFR saum toj no 30 ml / min / 1.73 m 2. Tom qab siv lisinopril nyob rau hauv ib koob ntawm 0.1-0.2 mg / kg, qhov sib luag ntawm cov ntshav plasma tau mus txog li ntawm 6:00, thiab cov degree ntawm kev nqus mus rau lub hauv paus tawm hauv cov zis yog 28%. Cov ntaub ntawv no tau zoo sib xws rau cov laus tau tshawb pom yav dhau los.

AUC thiab C ntsuas _max hauv cov menyuam yaus nws zoo sib xws rau cov neeg laus tau saib.

Lub plawv tsis ua hauj lwm (kev kho mob yam ntxwv).

Mob myocardial infarction (kev kho mob ncua luv (6 lub lim tiam) rau cov neeg mob hemodynamically tsis pub dhau 24 teev tom qab mob myocardial infarction).

Teeb meem ntawm ob lub raum hauv ntshav qab zib mellitus (kho mob raum nyob rau hauv cov neeg mob ntshav siab hom II mob ntshav qab zib mellitus thiab thawj zaug mob nephropathy).

Cov Yuav Tsum Muaj

Kev siv tshuaj tiv thaiv kab mob rau lisinopril, lwm yam tshuaj, lossis lwm yam tshuaj tiv thaiv ACE.
Keeb kwm ntawm kev mob hlwb (suav nrog tom qab siv ACE inhibitors, idiopathic thiab roj ntsha Quincke edema).
Aortic lossis mitral stenosis lossis hypertrophic cardiomyopathy nrog mob ntshav nrog ntau yam.
Biliary raum leeg txoj hlab ntsha hlwb los yog leeg ntshav ntawm ib raum.
Mob myocardial infarction nrog tsis khov kho hemodynamics.
Cardiogenic poob siab.
Cov neeg mob uas muaj cov ntshiab creatinine ≥ 220 μmol / L.
Kev siv lub tshuaj ib leeg thiab siab-dhau ntawm daim nyias nyias polyacrylonitrile sodium-2-methylosulfonate (piv txwv li AN 69) thaum raug lim ntshav sai sai.
Kev siv tib lub sij hawm ntawm aliskiren-muaj cov tshuaj hauv cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR 2).
Thawj Hyperaldosteronism.
Cov poj niam cev xeeb tub lossis cov poj niam npaj yuav xeeb tub (saib "Siv thaum cev xeeb tub lossis lactation").

Kev sib cuam tshuam nrog lwm yam tshuaj thiab lwm yam kev sib cuam tshuam

Kev tshuaj ntsuab. Nrog rau kev siv tshuaj loog ib txhij hauv cov neeg mob, lisinopril twb tau noj lawm - cov nyhuv antihypertensive feem ntau yog ob npaug. Thaum pib ntawm kev sib xyaw ntawm lisinopril nrog diuretics, cov neeg mob yuav hnov zoo li txo ntshav siab ntau nrog lisinopril. Tseem muaj kev txhim kho cov tsos mob ntawm lub ntsej muag nrog cov lisinopril tuaj yeem txo qis yog tias cov tshuaj diuretics raug txiav ua ntej pib lisinopril kev kho mob thiab nce ntxiv hauv cov kua dej los yog ntsev, nrog rau kev kho qis ntawm ACE inhibitors thaum pib.

Cov khoom noj muaj cov poov tshuaj muaj yees, potassium-sparing diuretics los yog muaj potassium. Qee tus neeg mob yuav pib muaj mob hyperkalemia. Qhov tseeb uas ua rau muaj kev pheej hmoo ntawm hyperkalemia muaj xws li lub raum tsis ua haujlwm, mob ntshav qab zib mellitus, kev siv cov pa-tshuaj ua ke ntawm cov tshuaj tua kab mob (xws li spironolactone, triamteren, amiloride), cov poov tshuaj muaj zaub mov ntxiv, thiab ntsev hloov nrog cov poov tshuaj. Kev siv cov poov tshuaj muaj poov tshuaj, potassium-sparing diuretics los yog muaj ntsev ntxiv ntsev tuaj yeem ua rau muaj qhov nce siab ntau ntxiv, tshwj xeeb tshaj yog rau cov neeg mob uas tsis zoo lub raum kev ua haujlwm.

Hauv qhov no, kev sib txuam ntawm cov tshuaj no tuaj yeem tsuas yog ua tib zoo saib xyuas los ntawm tus kws kho mob thiab nrog kev soj ntsuam cov tshuaj poov tshuaj ntau ntau ntxiv thiab lub raum kev ua haujlwm.

Thaum noj tshuaj lisinopril tiv thaiv cov keeb kwm ntawm kev noj qab haus huv li diuretics, hypokalemia tshwm sim los ntawm lawv cov kev ua kom tsawg tuaj yeem ua kom tsis muaj zog.

Kev npaj lithium. Kev rov ua tau ntxiv nyob rau hauv cov roj ntsha lithium concentration thiab cov tshuaj lom tau qhia nrog kev siv tib lub sijhawm ntawm lithium thiab ACE inhibitors. Kev siv tib lub sijhawm thiazide diuretics tuaj yeem ua rau muaj kev pheej hmoo ntawm lithium intoxication thiab txhim kho kev ua kom muaj tshuaj lom. Kev siv ua ke ntawm lisinopril thiab lithium tsis pom zoo, txawm li cas los xij, yog tias kev sib txuam no yog qhov tsim nyog, qib ntawm cov lithium concentration hauv cov ntshav yuav tsum tau ua tib zoo saib.

Nonsteroidal anti-inflammatory tshuaj (NSAIDs), suav nrog cov tshuaj acetylsalicylic acid ≥ 3 g / hnub.

Lwm cov tshuaj tiv thaiv kabmob (beta-blockers, alpha-blockers, calcium antagonists). Siv tib lub sijhawm siv cov tshuaj no tuaj yeem txhim kho cov nyhuv hypotensive ntawm lisinopril. Kev siv yooj yim nrog nitroglycerin, lwm yam nitrates lossis lwm yam vasodilators kuj yuav txo tau cov ntshav siab ntxiv.

Tricyclic antidepressants / tshuaj tiv thaiv mob / tshuaj loog. Kev siv tshuaj loog ib txhij, tricyclic antidepressants, thiab tshuaj tiv thaiv kev tiv thaiv nrog ACE inhibitors yuav ua rau muaj qhov nce ntawm hypotensive nyhuv ntawm tom kawg.

Cov tshuaj Sympathomimetic. Sympathomimetic tshuaj tej zaum yuav txo cov nyhuv tshuaj tiv thaiv ACE inhibitors. Vim li no, nws yog qhov yuav tsum tau saib xyuas tus neeg mob ntshav siab ntau dua txhawm rau txhawm rau tsim kom muaj seb cov txiaj ntsig xav tau tau ua tiav.

Tshuaj tiv thaiv kab mob kev nkeeg. Kev siv tshuaj ACE inhibitors thiab cov tshuaj tiv thaiv kab mob ntshav siab ib txhij (insulin, tshuaj tiv thaiv kab mob hauv lub qhov ncauj) tuaj yeem txhim kho cov txiaj ntsig ntawm kev txo qis ntshav qab zib nrog kev pheej hmoo ntawm hypoglycemia. Cov nyhuv no feem ntau tshwm sim nyob rau thawj lub lim tiam ntawm kev siv tshuaj sib xyaw thiab hauv cov neeg mob raum tsis ua haujlwm.

Acetylsalicylic acid, tshuaj thrombolytic, beta-blockers, nitrates. Lisinopril tuaj yeem siv ib txhij nrog acetylsalicylic acid (hauv koob tshuaj), cov tshuaj thrombolytic, beta-blockers thiab / lossis nitrates nyob rau hauv kev saib xyuas ntawm tus kws kho mob.

Npaj kub. Cov tshuaj tiv thaiv kab mob hauv lub cev (cov tsos mob ntawm vasodilation, suav nrog kub taub hau, xeev siab, kiv taub hau, thiab mob ntshav txhaws, uas tuaj yeem ua rau mob hnyav) tom qab txhaj tshuaj kub (piv txwv li, sodium ib zaug) muaj ntau dua rau cov neeg mob kho nrog ACE inhibitors.

Ob chav thaiv ntawm renin-angiotensin-. Nws tau pom tias qhov ob zaug thaiv ntawm renin-angiotensin- (RAAS) nrog kev siv ACE inhibitors tib lub sijhawm, angiotensin II receptor antagonists lossis aliskiren yog tus cwj pwm los ntawm ntau dua qhov tshwm sim tsis zoo xws li arterial hypotension, hyperkalemia, lub raum tsis ua haujlwm (suav nrog mob raum tsis ua haujlwm) piv nrog kev siv cov tshuaj monotherapy.

Allopurinol, cytostatics, immunosuppressants, corticosteroids, procainamide. Nrog rau kev siv ua ke nrog lisinopril, leukopenia tuaj yeem ua rau.

Cov tshuaj uas tua cov pob txha ua haujlwm. Nrog rau kev siv ua ke nrog lisinopril, lawv nce neutropenia thiab / lossis agranulocytosis.

Estrogens. Nrog rau kev sib tham tib lub sijhawm, nws muaj peev xwm txo cov nyhuv hypotensive ntawm lisinopril vim cov kua dej tau ceev hauv lub cev.

Lisinopril yuav tsum siv nrog ceev faj hauv cov neeg mob uas muaj tus kab mob myocardial infarction tsis pub dhau 6-12 teev tom qab kev saib xyuas ntawm streptokinase (kev pheej hmoo ntawm kev txhim kho arterial hypotension).

Cov tshuaj, tshuaj loog, dej cawv, pw tsaug zog hauv kev sib xyaw ua ke nrog lisinopril ua rau muaj kev nce siab hauv cov nyhuv hypotensive.

Daim ntawv thov nta

Cov tsos mob arterial hypotension tsis tshua pom muaj hauv cov neeg mob uas tsis tshua mob txoj kev mob ntshav siab. Hauv cov neeg mob uas lub plawv tsis ua hauj lwm, nrog lossis tsis mob raum tsis ua hauj lwm, pom muaj tsos mob ntawm txoj hlab ntsha hypotension.

Qhov ntxim nyiam ntawm txoj kev mob ntshav khov yog qhov siab dua rau cov neeg mob uas lub plawv tsis ua haujlwm loj noj ntau ntawm lub voj diuretics, muaj hyponatremia lossis lub raum tsis ua haujlwm ntawm lub cev ua haujlwm, thaum lub sijhawm lim ntshav, zawv plab lossis ntuav, zoo li hauv kev mob loj ntawm renin-dependent arterial hypertension.

Thaum arterial hypotension tshwm sim, tus neeg mob yuav tsum muab tso rau ntawm nws sab nraub qaum, thiab yog tias tsim nyog, kev tso ntshav qab ntsev yog tsim nyog.

Kev hloov pauv ntawm cov hlab ntsha tsis yog qhov sib txuam rau txoj kev siv tshuaj ntxiv, feem ntau nws tuaj yeem tswj tau yooj yim tom qab cov ntshav siab tau nce ntxiv tom qab nce siab hauv cov dej ntim hauv lub cev.

Hauv qee cov neeg mob uas lub plawv tsis ua haujlwm, muaj ntshav siab lossis ntshav qis, ib qho kev txo qis ntxiv ntawm cov ntshav ntshav hauv lub cev yuav tshwm sim thaum kho nrog lisinopril. Cov nyhuv no yog qhov kwv yees tau thiab, raws li txoj cai, tsis tas yuav tsum tsis lis kev kho mob lisinopril. Yog hais tias arterial hypotension dhau los ua cov tsos mob, nws yuav tsim nyog los txo qhov koob tshuaj lossis tsum tsis txhob noj cov lisinopril.

Arterial hypotension hauv kev mob siab myocardial infarction. Hauv kev mob siab myocardial infarction hauv cov neeg mob uas muaj hemodynamics ruaj khov, kev kho mob nrog lisinopril yuav tsum tau nqa tawm hauv thawj 24 teev kom tiv thaiv kev ua haujlwm ntawm chav sab laug ntawm lub plawv thiab lub plawv tsis ua haujlwm, zoo li txo qis tuag. Hauv kev mob myocardial infarction, kev kho mob nrog lisinopril tsis tuaj yeem pib yog tias muaj kev pheej hmoo ntxiv ntawm cov ntshav tsis zoo tom qab kho nrog vasodilators. Qhov no siv rau cov neeg mob systolic ntshav siab ntawm 100 hli RT. Kos duab. lossis tsawg dua, lossis cov neeg mob uas tau tsim muaj kev poob siab cardiogenic. Hauv thawj 3 hnub tom qab myocardial infarction, koob tshuaj yuav tsum raug txo yog tias systolic siab tsis tshaj 120 hli Hg. Kos duab. Yog hais tias systolic cov ntshav siab sib npaug lossis tsawg dua 100 hli Hg.

Hauv cov neeg mob nrog hypovolemia, sodium tsis muaj nyob rau hauv kev sib txuas nrog kev siv cov tshuaj diuretics, tsis pub ntsev ntsev, los ntawm ntuav, raws plab, tom qab lim ntshav, txoj kev txhim kho ntawm txoj hlab ntsha hauv ntshav sai sai, mob raum tsis ua haujlwm. Hauv cov xwm txheej zoo li no, nws raug nquahu kom them nyiaj rau qhov ua kua dej thiab ntsev ua ntej kho nrog lisinopril thiab muab kev saib xyuas mob. Nrog rau kev ceev faj (muab cov txiaj ntsig / qhov phom sij sib piv), cov tshuaj yuav tsum tau muab rau cov neeg mob tom qab hloov raum, thiab ntxiv rau cov neeg mob nrog lub raum tsis ua haujlwm, mob siab, qaug zog hematopoiesis, kab mob autoimmune. Txhua yam teeb meem raug mob thaum siv cov lisinopril yuav tsum muaj kev saib xyuas kev noj qab haus huv thiab kev kuaj mob.

Aortic thiab mitral valve stenosis / hypertrophic cardiomyopathy. Zoo ib yam li lwm tus ACE inhibitors, lisinopril tsis pom zoo rau cov neeg mob uas muaj mitral stenosis lossis teeb meem nyuaj ntawm cov ntshav tawm ntawm sab laug ventricle (nrog aortic stenosis lossis hypertrophic cardiomyopathy).

Lub raum khiav tsis zoo. Hauv cov neeg mob uas lub raum lub raum tsis ua haujlwm (creatinine tshem tawm)

Hauv cov neeg mob nrog lub plawv tsis ua hauj lwm arterial hypotension, tshwm sim thaum pib kho mob nrog ACE inhibitors, tuaj yeem ua rau lub raum khiav tsis zoo. Hauv cov xwm txheej zoo li no, kev txhim kho ntawm lub raum tsis ua haujlwm, feem ntau thim rov qab, tau tshaj tawm.

Hauv qee cov neeg mob nrog Ob leeg lub raum artery stenosis los yog ib lub raum lub raum artery stenosis ACE inhibitors nce qib urea thiab ntshiab si creatinine, raws li txoj cai, cov teebmeem no ploj tom qab tso tseg cov tshuaj. Qhov ntxim nyiam ntawm cov kev tshwm sim yog qhov tshwj xeeb tshaj yog nyob hauv cov neeg mob uas lub raum tsis ua haujlwm.

Lub xub ntiag ntawm kev kho tus mob ntshav siab nce siab yuav ua rau muaj kev pheej hmoo ntawm cov ntshav khov ntau heev thiab lub raum tsis ua haujlwm.

Hauv qee cov neeg mob Ag tsis muaj mob raum pom tseeb, kev siv lisinopril, tshwj xeeb tshaj yog thaum noj cov tshuaj diuretics, ua rau muaj kev nce qib ntawm urea hauv cov ntshav thiab creatinine nyob rau hauv cov ntshav cov ntshav, cov kev hloov pauv no, raws li txoj cai, yog qhov tsis tseem ceeb thiab kev hloov chaw. Qhov ntxim nyiam ntawm lawv qhov tshwm sim ntau dua hauv cov neeg mob uas lub raum tsis ua haujlwm. Nyob rau hauv cov xwm txheej zoo li no, nws yuav tsim nyog los txo cov koob tshuaj thiab / lossis tsum tsis siv tshuaj diuretics thiab / lossis lisinopril.

Hauv cov kab mob myocardial infarction nws yog txwv tsis pub siv lisinopril nyob rau hauv cov neeg mob uas muaj kev tsis zoo hauv lub raum (cov ntshav dej creatinine> 177 μmol / L thiab proteinuria> 500 mg / 24 h). Yog tias lub raum tsis zoo ua haujlwm thaum lub sijhawm kho mob lisinopril (ntshiab siininine 266 μmol / L lossis ob zaug piv rau qib pib), kev txiav tsis siv nws yuav tsum tau txiav txim siab.

Kev tsis haum tshuaj / mob hlwb. Tsis tshua muaj kev qhia txog angioedema ntawm lub ntsej muag, nqua, daim di ncauj, tus nplaig, glottis thiab / lossis lub suab nrov hauv cov neeg mob kho nrog ACE inhibitors, suav nrog lisinopril. Angioneurotic edema tuaj yeem tshwm sim tau txhua lub sijhawm thaum kho mob. Hauv cov xwm txheej zoo li no, cov tshuaj yuav tsum tau nres tam sim ntawd, kev kho tsim nyog yuav tsum tau pib thiab kev soj ntsuam cov neeg mob yuav tsum tsim kom ntseeg tau tias cov tsos mob ploj mus kom tas. Nyob rau hauv cov xwm txheej uas qhov chaw mob edema nyob hauv thaj chaw ntawm tus nplaig, tsis ua rau lub ntsws ua tsis taus pa, tus neeg mob yuav xav tau kev soj ntsuam mus ntev, txij li kev kho nrog antihistamines thiab GCS tej zaum yuav tsis muaj txhij txhua.

Cov mob ib leeg xwb uas tshaj los ntawm caj pas mob hlwb los ntawm tus caj pas lossis tus nplaig tau tshaj tawm.

Hauv cov neeg mob uas muaj keeb kwm mob hlwb tsis yog cuam tshuam nrog kev siv tshuaj tiv thaiv ACE, qhov kev pheej hmoo ntawm kev tsim cov tshuaj tiv thaiv mob hlwb los teb rau kev siv tshuaj hauv pawg no yuav muaj ntau ntxiv.

ACE cov tshuaj tiv thaiv kab mob tuaj yeem ua rau mob caj dab ntau dua rau cov neeg mob ntawm cov haiv neeg Negroid ntau dua li cov neeg mob ntawm haiv neeg Caucasian.

Kev phiv tshuaj anaphylactoid rau cov neeg mob ua rau mob hemodialysis. Anaphylactoid tshua tau tshaj tawm nyob rau hauv cov neeg mob ua rau mob hemodialysis siv high-flow membranes (piv txwv li AN 69) thiab tau kho ib txhij nrog ACE inhibitors. Cov neeg mob no yuav tsum raug hais kom hloov dialysis membranes rau daim nyias nyias ntawm lwm yam sib txawv lossis siv cov tshuaj tiv thaiv kabmob ntawm lwm chav kawm sib txawv.

Lub siab xav. Cov neeg mob siv tshuaj ACE inhibitors thaum lub zog txoj kev kho mob (piv txwv, Hymenoptera lom) muaj kev phiv tshuaj anaphylactoid ruaj khov. Cov kev cuam tshuam no raug zam nyob hauv tib cov neeg mob los ntawm kev ncua ib ntus tsis siv ACE inhibitors, tab sis tom qab tsis saib xyuas qhov rov siv tshuaj, cov tshuaj tiv thaiv tau rov qab los.

Daim siab ua haujlwm. Tsis tshua muaj heev, ACE inhibitors tau cuam tshuam nrog cov tsos mob uas pib nrog mob cholestatic jaundice thiab maj mam hloov mus rau necrosis thiab (qee zaum) tuag. Tus txheej txheem ntawm cov tsos mob no tseem tsis tau pom. Cov neeg mob uas tau tsim muaj lub ntsej muag daj thaum lub sijhawm saib xyuas ntawm lisinopril lossis tau pom tias nce siab hauv daim siab lub siab yuav tsum tsis txhob noj cov tshuaj thiab muab kev kho mob tsim nyog.

Neutropenia / agranulocytosis. Cov neeg mob neutropenia / agranulocytosis, thrombocytopenia, thiab ntshav liab tau qhia tawm hauv cov neeg mob uas tau txais ACE inhibitors. Hauv cov neeg mob uas lub raum ua haujlwm tsis tu ncua thiab nyob rau qhov tsis muaj lwm yam teeb meem ntxiv, neutropenia yog tsawg. Tom qab siv ceev xwmphem ACE inhibitor, neutropenia thiab agranulocytosis thim rov qab. Nws yog ib qho tsim nyog yuav tsum tau sau tshuaj lisinopril nrog kev ceev faj rau cov neeg mob collagenosis, zoo li thaum cov neeg mob tau txais kev kho mob, thaum kho nrog allopurinol lossis procainamide, lossis nrog kev sib txuam ntawm cov kev cuam tshuam no, tshwj xeeb tshaj yog tiv thaiv keeb kwm ntawm qhov tsis ua haujlwm lub raum. Qee tus neeg mob no kis tau tus kab mob hnyav heev uas tsis yog ib txwm zoo rau kev siv tshuaj tua kab mob ntau ntxiv. Thaum siv cov tshuaj hauv cov neeg mob li ntawd, nws raug nquahu kom saib xyuas lub sijhawm ntawm cov leukocytes hauv cov ntshav ntau ntau thiab qhia cov neeg mob kom qhia tias muaj kab mob dab tsi.

Hnoos. Tom qab siv ACE inhibitors, hnoos yuav tshwm sim. Feem ntau hnoos yog qhov tsis zoo thiab nres tom qab tsis ua hauj lwm ntawm kev kho. Kev hnoos los ntawm ACE inhibitors yuav tsum raug txiav txim siab nyob rau hauv kev sib txawv ntawm kev kuaj mob hnoos ua ib qho ntawm cov kev xaiv tau.

Kev phais / tshuaj loog Hauv cov neeg mob uas tau phais mob lossis tso tshuaj loog nrog cov neeg sawv cev uas ua rau lub siab ntsws, lisinopril tuaj yeem thaiv kev tsim cov tshuaj angiotensin II tom qab kev lees paub ntawm renin. Yog tias pom cov hlab ntsha hypotension pom vim tias lub tshuab no, nws yog ib qho tsim nyog yuav tau rov ua kom ntim ntawm cov ntshav ncig.

Hyperkalemia Ntau qhov xwm txheej ntawm cov ntshiab poov tshuaj ntau ntau hauv cov neeg mob uas tau kho nrog ACE inhibitors, suav nrog lisinopril, tau tshaj tawm. Cov neeg mob uas muaj pheej hmoo loj los ua mob hyperkalemia yog cov uas lub raum tsis ua haujlwm, mob ntshav qab zib, lossis cov neeg uas siv cov tshuaj ntxiv poov tshuaj, potassium-sparing diuretics, lossis cov tshuaj ntsev ntxiv, lossis cov uas noj lwm yam tshuaj uas muaj cov poov tshuaj poov tshuaj ntau ntxiv. (Xws li heparin).

Cov neeg mob ntshav qab zib. Hauv cov neeg mob ntshav qab zib noj tshuaj tiv thaiv kab mob hauv qhov ncauj los yog insulin, ceev faj glycemic yuav tsum tau ua thaum thawj lub hlis ntawm kev kho mob nrog ACE inhibitors.

Anaphylactoid kev tsis haum tshuaj uas tshwm sim thaum lub sij hawm apheresis ntawm tsawg lipoproteins (LDL). Hauv apheresis nrog dextrin sulfate, kev siv ACE inhibitors tuaj yeem ua rau anaphylactic uas tuaj yeem tuag taus. Cov tsos mob no tuaj yeem zam los ntawm kev tu ncua ib ntus nrog kev kho mob ACE inhibitors ua ntej txhua lub hnoos qeev lossis hloov ACE inhibitors nrog lwm cov tshuaj.

Kev ntxub ntxaug lwm haiv neeg. Cov tshuaj tiv thaiv ACE tuaj yeem ua rau mob siab ntxiv rau cov neeg mob uas muaj cov xim tawv dub (Cov haiv neeg Negroid) dua li cov neeg mob ntawm haiv neeg Caucasian. Tsis tas li, hauv pawg no cov neeg mob, cov nyhuv hypotensive ntawm lisinopril yog qhov tsawg tshaj tawm vim tias qhov muaj peev xwm ntawm qhov qis qis qis ua haujlwm.

Lithium. Feem ntau, kev siv tib lub sijhawm ntawm lithium thiab lisinopril tsis pom zoo.

Ob chav thaiv ntawm renin-angiotensin- (RAAS). Nws tau tshaj tawm tias kev siv ACE inhibitors tib lub sijhawm, angiotensin II receptor blockers lossis aliskiren ua rau muaj kev pheej hmoo ntawm hypotension, hyperkalemia, ua rau lub raum tsis ua haujlwm (suav nrog mob raum tsis ua haujlwm). Yog li no, ob zaug thaiv RAAS los ntawm kev siv tshuaj ua ke ntawm ACE inhibitors, angiotensin II receptor blockers, lossis aliskiren tsis pom zoo.

Thaum muaj kev xav tau tshwj xeeb rau kev siv txoj kev kho ob zaug, nws yuav tsum ua raws li kev saib xyuas ntawm tus kws tshaj lij thiab kuaj xyuas lub raum tsis ua haujlwm, qib ntshav thiab ntshav siab. Cov neeg mob ntshav qab zib nephropathy tsis pom zoo siv ACE inhibitors thiab angiotensin II receptor blockers ib txhij.

Kev Proteinuria Cais cais tawm ntawm kev txhim kho ntawm cov proteinuria hauv cov neeg mob tau tshaj tawm, tshwj xeeb tshaj yog txo qis lub raum lossis tom qab noj cov lisinopril ntau kawg. Thaum kuaj mob cov proteinuria ntau (ntau dua 1 g / hnub), lisinopril yuav tsum tsuas yog siv tom qab tshuaj xyuas cov txiaj ntsig kho muaj txiaj ntsig zoo thiab muaj peev xwm muaj kev pheej hmoo thiab nrog kev soj ntsuam tas li ntawm cov kev kuaj mob thiab biochemical.

Siv thaum cev xeeb tub thiab lactation

Cev xeeb tub Cov tshuaj yog contraindicated rau hauv cov poj niam cev xeeb tub lossis cov poj niam uas npaj npaj cev xeeb tub. Yog tias kev xeeb tub yog paub tseeb thaum kho nrog cov tshuaj, nws txoj kev siv yuav tsum nres tam sim ntawd thiab, yog tias tsim nyog, hloov nrog lwm cov tshuaj pom zoo rau kev siv los ntawm cov poj niam cev xeeb tub.

Nws paub tias ncua ntev raug rau ACE inhibitors thaum lub sij hawm thib ob thiab thib peb lub cev xeeb tub ntawm cev xeeb tub qhov tshwm sim ntawm fetotoxicity (txo lub raum kev ua haujlwm, oligohydramnios, ncua ossification ntawm pob txha taub hau) thiab neonatal toxicity (lub raum tsis ua hauj lwm, mob ntshav ncig, hyperkalemia). Tus raug ACE inhibitors thaum lub hlis thib ob ntawm cev xeeb tub, nws raug pom zoo los saib xyuas lub raum thiab cranial pob txha muaj nuj nqi siv ultrasound.

Cov menyuam mos uas lawv niam tau noj cov tshuaj lisinopril yuav tsum ua tib zoo soj ntsuam mob ntshav liab, ntshav liab, thiab hyperkalemia.

Kev pub niam mis. Vim tias tsis muaj cov ntaub ntawv qhia txog qhov tseem yuav tau siv lisinopril thaum pub mis, noj tshuaj lisinopril thaum pub mis niam tsis pom zoo. Nyob rau lub sijhawm no, nws raug nquahu kom siv lwm txoj kev kho, daim ntawv nyab xeeb ntawm kev kawm tau zoo dua, tshwj xeeb tshaj yog tias cov menyuam yug lossis menyuam tsis tau yug ntxov.

Tsuas tshuaj thiab tswj hwm

Lisinopril yuav tsum noj qhov ncauj 1 zaug nyob rau ib hnub. Zoo li lwm yam tshuaj uas yuav tsum tau noj ib hnub ib zaug, lisinopril yuav tsum noj txhua hnub nyob rau tib lub sijhawm. Noj mov tsis cuam tshuam rau kev nqus ntawm cov tshuaj ntsiav lisinopril. Cov koob tshuaj yuav tsum tau txiav txim siab ib tus zuj zus raws li cov ntaub ntawv kuaj mob ntawm tus neeg mob thiab ntsuas ntshav siab.

Lisinopril tuaj yeem siv ob qho tib si li monotherapy thiab hauv kev sib xyaw nrog lwm cov chav kawm ntawm cov tshuaj antihypertensive.

Thawj koob tshuaj rau cov neeg mob ntshav siab yog 10 mg. Cov neeg mob uas muaj lub zog renin-angiotensin-aldosterone tshwj xeeb (tshwj xeeb, nrog kev kho mob ntshav siab, nce ntxiv cov kua qab ntsev (sodium chloride) los ntawm lub cev thiab / lossis txo qis cov kua dej intercellular, lub plawv tsis ua hauj lwm los yog mob ntshav tsis txaus) yuav muaj kev txo ntshav siab ntau dua tom qab noj thawj zaug koob tshuaj. Rau cov neeg mob zoo li no, koob tshuaj pom zoo yog 2.5-5 mg, kev pib kho mob yuav tsum muaj nyob rau hauv kev saib xyuas ntawm kws kho mob. Txo qhov tshuaj tiv thaiv thaum xub pib kuj tseem pom zoo ua ntej muaj mob raum (saib Cov Lus 1 hauv qab).

Qhov pom zoo kom noj tshuaj yog 20 mg ib hnub ib zaug. Yog tias lub sijhawm teem sijhawm ntawm cov tshuaj no tsis muaj kev pab kho mob txaus hauv 2-4 lub lis piam tom qab noj tshuaj hauv qhov teev tshwj xeeb, nws tuaj yeem nce ntxiv. Qhov siab tshaj plaws siv nyob rau hauv kev tswj cov kab mob mus ntev ntev yog 80 mg rau ib hnub.

Cov neeg mob uas noj tshuaj kho.

Cov tsos mob ntawm txoj hlab ntsha tuaj yeem tshwm sim tom qab pib kho nrog lisinopril. Qhov no muaj feem ntau rau cov neeg mob uas siv tshuaj diuretics thaum kho nrog lisinopril.

Koob xaiv rau cov neeg mob lub raum tsis ua hauj lwm.

Qhov ntau npaum li cas rau cov neeg mob raum tsis ua haujlwm yuav tsum yog los ntawm QC, koob tshuaj txij nkawm yog nyob ntawm qhov chaw kho mob cov lus teb thiab raug xaiv los ntawm kev ntsuas tsis tu ncua ntawm kev ua haujlwm raum, poov tshuaj thiab sodium ntau nyob hauv cov ntshav, raws li qhia hauv qab no. 1.

Kem 1. Xaiv cov tshuaj rau cov neeg mob raum tsis ua hauj lwm zoo.