Desmopressin - cov lus qhia rau kev siv

Kev piav qhia cuam tshuam rau 30.07.2015

• Lub npe Latin: Ntshaw-chim
• ATX Code: H01BA02
• Tus qauv tshuaj lom neeg: C₄₆H₆₄N₁₄O₁₂Qha₂
• CAS Code: 16679-58-6

Tshuaj lom neeg thaj chaw

Desmopressin yog ib qho hluavtaws analogue vasopressin antidiuretic hormone, uas yog feem ntau ua los ntawm lobe tom qab pituitary caj pasCov. Cov tshuaj tau txais los ntawm kev hloov kho tshiab ntawm cov roj ntsha. vasopressin:1-cysteine ​​deamination thiab hloov chaw 8-l-argininetam sim no nyob rau hauv cov thawj molecule rau 8-D-arginine.

Lub cuab yeej tsis tshua muaj txiaj ntsig rau ntawm cov leeg du ntawm lub txaj viav vias thiab cov plab hnyuv siab raum, tab sis nws anti-duretic siv qhia ntau zog.

Pharmacodynamics thiab pharmacokinetics

Cov tshuaj activates Vasopressin V2 Txais Tosuas nyob hauv epithelial ntaub so ntswg convoluted tubules thiab hauv Ascending loops ntawm Henle, qhov no ua rau muaj qhov nce ntxiv hauv cov txheej txheem ntawm kev rov tso dej mus rau hauv cov hlab ntshav, txhawb kev tawm tsam 8 coagulation yam.

Lub tshuaj tiv thaiv kev ua haujlwm ntawm cov tshuaj yog tiav nrog subcutaneous, tso ntshav tshuaj thiab txheej txheem tshuaj, nrog instillation tshuaj kho mob hauv lub qhov ntswg.

Ib nrab-lub neej ntawm hluavtaws hormone = 75 feeb. Txawm li cas los xij, qhov siab txaus ntawm lub zog tuaj yeem tshawb pom hauv lub cev li ntawm 8-20 teev, tom qab kev tswj hwm. Cov tsos mob tau muaj pov thawj polyuria ploj tom qab 2-3 zaug kev siv ntawm cov khoom. Kev tswjfwm Intravenous yog qhov kev ua tau zoo dua li kev tswj hwm sab hauv.

Hauv cov neeg mob nrog hemophilia thiab von Willebrandt kab mob tom qab txhaj ib zaug ntawm 0.4 μg ntawm cov tshuaj rau 1 kg ntawm qhov hnyav, 8 coagulation taunce 3-4 zaug. Cov nyhuv ntawm cov tshuaj pib tshwm sim tom qab ib nrab ib teev thiab nce mus txog nws tus nqi ntau kawg hauv ib nrab thiab ib nrab - 2 teev.

Tsis tas li, thaum siv cov tshuaj, kev nce siab ntawm ntshav plasma tseem pom plasminogentab sis tib lub sij hawm qib fibrinolysis tseem zoo li qub.

Cov tshuaj yog metabolized hauv cov nqaij hauv lub siab. Cleavage tshwm sim disulfide choj koom nrog enzyme transhydrogenasesCov. Cov tshuaj nrog zis nws raug hloov pauv tsis hloov pauv lossis hom tshuaj tsis muaj zog. Desmopressin muaj tshuaj lom tsawg, tsis muaj teratogenic lossis mutagenic zog.

Daim ntawv tso tawm

Cov tshuaj yog tsim nyob rau hauv ntau version. Ua ntej koj xaiv daim ntawv, koj yuav tsum sab laj nrog koj tus kws kho mob kom nrhiav tau qhov tsim nyog rau kev kho mob.

Kev daws rau kev txhaj tshuaj yog muab cov tshuaj intramuscularly, intravenously, subcutaneously.

Cov tshuaj muaj nyob rau hauv daim ntawv dawb, puag ncig ntsiav tshuaj. Ntawm ib sab yog ntawv sau “D1” lossis “D2”. On thib ob sib faib sawb. Ntxiv nrog rau cov nquag tivthaiv, desmopressin, cov muaj pes tsawg leeg suav nrog magnesium stearate, cov hmoov txhuv nplej siab, povidone-K30, lactose monohydrate.

Cov tshuaj muaj nyob rau hauv daim ntawv dawb, puag ncig ntsiav tshuaj.

Nasal tee yog kua tsis muaj kob. Excipients yog chlorobutanol, sodium tshuaj dawb, dej, hydrochloric acid. Muab koob tshuaj 0.1 mg rau 1 ml.

Nws yog cov kua ntshiab. Ntim hauv lub raj mis tshwj xeeb nrog cov tshuaj dispenser. Excipients yog poov tshuaj sorbate, dej, hydrochloric acid, sodium tshuaj dawb.

Cov Tshuaj Pharmacokinetics

Ib nrab-lub neej ntawm cov khoom neeg tsim dag yog 75 feeb. Tab sis tib lub sijhawm, cov tshuaj hauv cov khoom muaj txiaj ntsig zoo tuaj yeem pom hauv lub cev rau 8-20 teev tom qab siv. Nws tau raug qhia tias cov cim ntawm polyuria ploj tom qab 2-3 kev siv tshuaj yaj yeeb. Hauv qhov no, kev txhaj tshuaj rau hauv lub cev yog qhov muaj txiaj ntsig zoo dua kev tswj hwm hauv kev saib xyuas.

Hauv cov neeg muaj kab mob von Willebrand, nrog rau hemophilia nrog kev tswj hwm ib leeg ntawm 0.4 μg / kg ntawm cov tshuaj, nce ntxiv ntawm 3-4 zaug qib 8 ntawm cov ntshav sib xyaw. Cov tshuaj pib ua tom qab 30 feeb txij lub sijhawm ntawm nws siv thiab nce mus txog qhov siab tshaj plaws tom qab 1.5-2 teev.

Tib lub sijhawm, kev siv cov tshuaj ua rau lub plasma qhov tseem ceeb nce ntawm plasminogen, txawm hais tias fibrinolysis cov ntsuas tseem nyob li qub.

Cov tshuaj undergoes metabolism hauv daim siab mob siab. Tus choj disulfide yog muab pov tseg los ntawm transhydrogenase enzyme.

Kev nqhis ntawm cov tshuaj tsis hloov pauv lossis cov khoom siv hauv lub cev tsis ua rau lub cev tshwm sim nrog zis.

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Cov Yuav Tsum Muaj

• polydipsia ntawm lub siab ntsws los yog yug me nyuam,
• lub xub ntiag ntawm anuria,
• ntshav hypoosmolality,
• kev tuav dej hauv lub cev,
• muaj lub plawv tsis ua hauj lwm nrog qhov xav tau tshuaj diuretic,
• kev tsis haum tshuaj rau cov tshuaj.

Nws yog txwv tsis pub tswj cov tshuaj qhov ntswg nrog Ville Willebrand-Dian kab mob ntawm subtype 2b, thiab ib qho ntxiv nrog cov tsis khov tsis khov

Tsuas tshuaj thiab tswj hwm

Cov ntsiav tshuaj yuav tsum tau noj ntawm qhov ncauj, tom qab ob peb teev tom qab noj mov (nrog lawv siv ua ke, ua kom tsis muaj zog ntawm cov tshuaj uas muaj zog, uas yuav ua rau txo qis hauv nws cov hauj lwm zoo). Kev pab ntau thiab tsawg thiab sijhawm ntawm kev kho yog xaiv los ntawm kws kho mob.

Cov neeg mob ntshav qab zib mellitus yam thaum xub thawj yuav tsum noj 0.1 mg ntawm cov tshuaj 1-3 zaug ib hnub. Tom qab qhov no, nws yog qhov yuav tsum tau xaiv ib tus zuj zus xaiv ib feem, coj mus rau hauv tus account cov txiaj ntsig uas siv tau los ntawm cov ntsiav tshuaj, thiab lawv lub siab ntev los ntawm tus neeg mob. Qhov nruab nrab, qhov tsuas tshuaj yog 0.1-0.2 mg, noj 1-3 zaug ib hnub.

Qhov loj ntawm qhov ntau tshaj plaws tau pub rau qhov ncauj ntawm cov tshuaj ib hnub yog 1.2 mg.

Nrog kev tawm tsam thaum hmo ntuj, lawv feem ntau noj 0.2 mg ntawm cov khoom hauv sab thaum hmo ntuj. Yog tias cov nyhuv ua tsis tiav, qhov muaj feem nrog ob npaug rau 0.4 mg. Thaum ua kev kho mob, koj yuav tsum tau txwv tsis pub haus dej rau hauv ib nrab hnub ntawm ib hnub. Qhov nruab nrab, kev kho mob tsis tu ncua kav 90 hnub. Kev txiav txim siab daim duab hauv chaw kuaj mob, tus kws kho mob tuaj yeem ncua sijhawm ntxiv (feem ntau, ua ntej ncua kev kho mob, cov tshuaj tau muab ncua tseg rau 7 hnub, thiab tom qab ntawd, coj mus rau hauv tus lej tau txais cov ntaub ntawv xov xwm soj ntsuam tom qab tshem tawm tshuaj, lawv txiav txim siab tias tus neeg mob yuav tsum tau kawm txuas ntxiv).

Cov neeg loj, nrog polyuria hmo ntuj hom, feem ntau yuav tsum noj 0.1 mg ntawm tshuaj rau qhov ncauj thaum hmo ntuj. Thaum tsis muaj cov tshuaj kho tau, nws muaj peev xwm ua ob npaug koob - txog 0.2 mg. Raws li kev saib xyuas ntawm kws kho mob, ntau npaum li cas los txuas ntxiv yog tsim nyog. Thaum tsis muaj cov cim qhia ntawm kev txhim kho tom qab 1 lub hlis ntawm kev siv tshuaj, kev kho yuav tsum tau tsum tsis ua mus ntxiv.

Intranasal cov tshuaj tsuag yog siv rau hauv qee qhov 10-40 mcg / hnub, uas tau muab faib rau ntau txoj kev siv. Cov menyuam yaus hnub nyoog tsawg kawg yog 3 hlis thiab qhov ntau kawg ntawm 12 xyoo yuav tsum kho cov tshuaj txhua hnub, uas yog nyob hauv thaj tsam ntawm 5-30 micrograms.

Kev noj tshuaj ntawm Desmopressin rau iv, s / c, thiab tseem / m hno yog 1-4 mcg / hnub (rau cov laus). Cov menyuam yaus raug tso cai rau li 0.4-2 micrograms ntawm cov tshuaj ib hnub.

Yog tias tsis muaj tshwm sim tom qab 1 lub lim tiam ntawm kev kho mob, nws yog ib qho tsim nyog yuav tau hloov kho qhov tshuaj txhua hnub. Txhawm rau xaiv cov kev kho mob tsim nyog qee zaum nws yuav siv sij hawm ntau heev - hauv ob peb lub lis piam.

50 kg nrog von Willebrand Kab Mob lossis Mild Hemophilia A. | Ntshav Phau Ntawv Ntshav "lub hom phiaj =" _ dawb paug "rel =" noopener noreferrer "> 41,, ,,,,,

Noj ntau dhau

Kev raug lom nrog cov tshuaj feem ntau ua rau cov kua dej nyob hauv lub cev thiab txhim kho cov tsos mob ntawm tus mob hyponatremia.

Hauv cov xwm txheej no, nws yuav tsum tswj hwm cov tshuaj isotonic lossis hypertonic tov ntawm sodium chloride, nrog rau yuav tsum muab tshuaj diuretic (furosemide) rau tus neeg mob.

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Kev sib cuam tshuam nrog lwm yam tshuaj

Kev sib xyaw nrog dopamine, tshwj xeeb tshaj yog thaum muab tshuaj ntau, tuaj yeem ua rau lub zog nias.

Indomethacin cuam tshuam qhov sib zog ntawm kev siv tshuaj ntsuab uas tsim los ntawm Desmopressin.

Kev sib xyaw ua ke ntawm cov tshuaj nrog lithium carbonate ua rau txo qis hauv nws cov tshuaj tiv thaiv kev tiv thaiv.

Kev saib xyuas yuav tsum tau ua los ua ke cov tshuaj nrog cov tshuaj uas ua rau muaj kev phom sij ntau tshaj tawm ntawm cov tshuaj tiv thaiv antidiuretic: xws li carbamazepine nrog chlorpromazine, phenylephrine nrog tricyclics, thiab epinephrine. Xws li kev sib xyaw ua ke tuaj yeem ua rau muaj txiaj ntsig ntawm vasopressor nyhuv ntawm cov tshuaj.

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Daim ntawv thov rau cov menyuam yaus

Kev ua haujlwm txhua hnub rau cov menyuam yaus uas tsis tau muaj 12 xyoos yuav tsum tau hloov kho.

Hauv cov menyuam mos mus txog 1 xyoos ntawm lub hnub nyoog, kev qaug cawv nrog ib yam khoom tuaj yeem ua rau txoj kev loj hlob ntawm qaug dab peg - hauv kev sib txuas nrog qhov ua rau khaus ntawm cov tshuaj ntawm NS.

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Cov tshuaj yeeb yaj kiab ntawm cov khoom siv yog npaj Vazomirin, Minirin thiab Emosint nrog Presinex, thiab ntxiv rau Adiuretin, Desmopressin acetate, Nourem nrog Nativa, Apo-Desmopressin thiab Adiuretin SD.

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Desmopressin tau txais kev tshuaj xyuas zoo nyob rau hauv kev kho mob nocturnal enuresis hauv menyuam yaus, txawm hais tias nws raug sau tseg tias cov kev cuam tshuam ntawm nws siv tsis txhim kho tam sim ntawd, tab sis tom qab ob peb lub lis piam. Nyob rau tib lub sijhawm, cov lus tshaj tawm hais tias cov tshuaj kho tau zoo txaus.

Kuj tseem muaj kev tshuaj xyuas txog kev ua haujlwm zoo ntawm cov tshuaj hauv ntshav qab zib ntawm qhov tsis muaj piam thaj - nws txoj kev siv txhim kho tus neeg mob tus mob, txo cov tsos mob ntawm tus kab mob.

Mechanism ntawm kev ua

Cov tshuaj ua haujlwm nquag yog hloov kho ntawm ib lub zog ntawm cov tshuaj hormones vasopressin. Thaum cov tshuaj nkag mus rau hauv lub cev, cov tshuaj tshwj xeeb tau qhib, vim tias cov txheej txheem ntawm cov dej rov ua kom tau zoo dua. Cov ntshav coagulation zoo tuaj.

Hauv cov neeg mob hemophilia, cov tshuaj nce ntxiv ntawm coagulation 8 los ntawm 3-4 zaug. Muaj ntau ntxiv rau ntawm plasminogen nyob rau hauv cov ntshav ntshav.

Kev tswj fwm tso cai rau koj kom ua tiav cov nyhuv.

Cov tshuaj txhim kho cov ntshav coagulation.

Nrog saib xyuas

Thaum muaj kev ua txhaum ntawm cov dej-electrolyte sib npaug, fibrosis ntawm lub zais zis, cov kab mob ntawm cov hlab plawv system lossis lub raum, kev pheej hmoo ntawm kev mob siab intracranial, yuav tsum ceev faj thaum siv tshuaj kho. Ib tug txheeb ze sib cog lus pom tau tias muaj hnub nyoog tshaj 65 xyoos.

Cov koob tshuaj thiab ntau npaum li cas yog nyob ntawm tus kabmob, tus yam ntxwv ntawm tus neeg mob. Lawv yuav tsum raug xaiv ua ke nrog tus kws kho mob. Koj yuav tsum paub koj tus kheej nrog cov lus qhia rau siv.

Qhov muab tshuaj rau thawj lub qhov ntswg, cov tshuaj tsuag nws txawv ntawm 10 txog 40 mcg ib hnub. Nws yuav tsum noj ob peb zaug. Cov me nyuam 12 xyoos rov hauv yuav tau hloov kho. Rau lawv, ib koob tshuaj 5 txog 30 micrograms yog xaiv thaum nruab hnub.

Nrog cov lus qhia ntawm kev txhaj tshuaj rau cov neeg laus, ntau npaum yog los ntawm 1 txog 4 micrograms ib kilogram ntawm lub cev hnyav. Hauv thaum yau, 0.4-2 micrograms yuav tsum tau tswj hwm.

Yog tias txoj kev kho tsis nqa cov nyhuv uas xav tau nyob rau hauv ib lub lis piam, cov koob tshuaj yuav tau hloov kho.

Yog tias txoj kev kho tsis nqa cov nyhuv uas xav tau nyob rau hauv ib lub lis piam, cov koob tshuaj yuav tau hloov kho.

Sab sij huam

Kiv taub hau, mob taub hau, yuav tsis meej pem yog ua tau. Tsis tshua muaj ntau, cov neeg mob poob mus rau hauv coma. Lub cev hnyav tuaj yeem nce ntxiv, rhinitis yuav tshwm sim. Hauv qee tus neeg mob, cov kab mob plab ntawm lub qhov ntswg tau o. Ntuav, xeev siab, thiab mob plab yog tau.

Ntshav siab tuaj yeem nce lossis poob qis. Qee zaum oliguria, kub tso xim, kev fab tshuaj tshwm sim. Mob Hyponatremia yuav tshwm sim. Thaum siv kev txhaj tshuaj, qhov mob tuaj yeem pom nyob ntawm thaj chaw txhaj tshuaj.

Yog tias cov tshuaj raug siv los kho menyuam yaus hnub nyoog qis dua 12 hli, mob tau qaug dab peg.

Kev ntsuas rau siv

Kev siv ntawm Desmopressin yog qhia rau kev kuaj mob thiab kho cov mob ntshav qab zib nruab nrab insipidus.

Ib qho ntxiv, tseem qhia cais rau ntau npaum:

• ntsiav tshuaj: cov menyuam yaus hnub nyoog dhau 5 xyoos - thawj tus mob nocturnal enuresis, cov neeg laus - kev kho mob ntawm nocturnal polyuria,
• cov pa tshuaj txau qhov ntswg thiab txau qhov ntswg: kev kuaj mob rau lub peev xwm concentration ntawm lub raum,
• qhov ntswg ntshav tawm: mob polyuria ntawm nruab nrab caj hlav, los ntawm kab mob lossis kev phais mob ntawm lub hauv nruab nrab ntawm cov leeg hlwb, poob plig.

Cawv tau zoo

Kev haus dej haus cawv thaum siv tshuaj kho tsis pom zoo, vim tias nws ua rau cov tshuaj siv tshuaj tsawg dua.

Cov tshuaj muaj pes tsawg tus txhais ua lus ntau. Cov qauv tshuaj yog cov ntsiav tshuaj Minirin, Nativa, Adiuretin, Tshuaj txau Presayneks, Vasomirin. Desmopressin Acetate kuj tseem siv. Muaj lwm cov tshuaj ntsiav, ntsiav tshuaj thiab cov kev daws teeb meem nrog cov yam ntxwv antidiuretic. Tej zaum siv cov tshuaj kho mob rau pej xeem.

Minirin yog qhov piv txwv ntawm Desmopressin.

Tsuas tshuaj thiab tswj hwm

Cov ntsiav tshuaj tau noj ntawm qhov ncauj, qee lub sijhawm tom qab noj mov.

• central diabetes insipidus: thawj koob tshuaj yog 0.1 mg 1-3 zaug ib hnub rau cov menyuam yaus thiab cov neeg laus. Tom ntej, cov koob tshuaj yog xaiv noj rau hauv tus account cov tib neeg cov lus teb tshuaj, nws tuaj yeem nyob ntawm 0.2 mg txog 1.2 mg ib hnub,
• thawj nocturnal enuresis: thawj koob tshuaj yog 0.2 mg thaum mus pw, thaum tsis muaj tshuaj kho kom txaus, nws tuaj yeem nce ntxiv rau 0.4 mg. Nws yog ib qho tsim nyog yuav tau txwv tsis pub haus dej thaum yav tsaus ntuj. Txoj kev kawm no kav 90 hnub. Tom qab 7 hnub so, ntsiav tshuaj tuaj yeem rov ua dua tshiab raws li cov pov thawj hauv tsev kho mob,
• nocturnal polyuria rau cov neeg laus: qhov pib koob yog 0.1 mg thaum mus pw, thaum tsis muaj qhov xav tau ntawm txoj cai, nws tau nce txhua txhua hnub 0.1 hnub los ntawm 0.1 mg txog thaum ib koob tau tiav uas muab cov txiaj ntsig zoo.

Thaum tsis muaj qhov tshuaj ntsuam mob txaus tom qab 30 hnub ntawm kev kho mob, cov tshuaj yuav tsum tsis ua ntxiv.

Ua kom cov tshuaj txau qhov ntswg

Cov tshuaj txau siv los ntawm kev tswj hwm hauv intranasal, ib qho nias ntawm lub koob tshuaj sib haum tau sib xyaw 0.01 mg ntawm cov tshuaj.

Hauv kev kho cov menyuam yaus, tus txheej txheem yuav tsum tau ua raws li kev saib xyuas ntawm cov neeg laus.

Cov koob tshuaj zoo tshaj plaws yog txiav txim siab los ntawm tus neeg xaiv.

• nruab nrab ntshav qab zib insipidus: cov neeg laus - 0.01-0.04 mg, menyuam yaus - 0.01-0.02 mg ib hnub. Cov txheej txheem yog nqa tawm ib zaug lossis faib cov koob tshuaj raws li 2-3 koob,
• kuaj raum: cov laus - 0.04 mg, menyuam yaus hnub nyoog tshaj 1 xyoos - 0.01-0.02 mg, menyuam yaus hnub nyoog qis dua 1 xyoos - 0.01 mg. Tom qab kev tswj hwm, tus neeg mob yuav tsum tso lub zais zis, tom qab 8 teev tom qab, 2 lub sijhawm tso zis rau coj los kawm nws osmolality. Qhov ntim tag nrho ntawm cov kua dej uas tus neeg mob haus thaum kuaj (1 teev ua ntej kev kawm thiab thaum 8 teev tom ntej) yuav tsum tsis pub ntau tshaj 500 ml. Yog tias qhov ntsuas osmolality qis dua 800 mOsm / kg hauv cov neeg laus thiab 600 mOsm / kg hauv cov menyuam yaus raug kuaj, qhov ntsuas tau rov ua dua. Thaum paub tseeb tias qhov ua txhaum ntawm cov peev xim concentration ntawm ob lub raum, yuav tsum tau tshuaj xyuas ntxiv.

Nas ob tee

Ncos yog thov intranasally, los ntawm instillation rau hauv lub qhov ntswg qhov kev taug mus rau lub qhov ntswg septum nrog me ntsis tipping ntawm lub taub hau rov qab thiab nws inclination mus rau sab.

Qhov tshwm sim ntawm kev kho kom zoo tshwm sim tsis pub dhau 30 feeb tom qab instillation ntawm cov tshuaj.

• mob ntshav qab zib insipidus ntawm lub hauv paus chiv keeb: cov laus - 0.01-0.04 mg (2-8 tee), cov menyuam - 0.005-0.02 mg (1-4 tee) ib hnub. Cov tshuaj raug muab ib zaug ib zaug, lossis cov tshuaj txhua hnub tau muab faib ua 2-3 koob. Tus kws kho mob sau cov tshuaj thiab lub sijhawm ncua ntawm kev tswj hwm ib tus zuj zus, suav txog tus neeg mob lub siab xav siv tshuaj,
• mob hauv nruab nrab daim ntawv ntawm nruab nrab polyuria: 0.01 mg txhua. Diuresis thiab haus dej kom tsawg yuav tsum tau ntsuas ntawm cov xuaj moos sib nrug kom txog thaum ua tiav tiav. Nyob rau hauv 3-5 teev, saib xyuas cov osmolarity plasma thiab zis, cov concentration ntawm sodium hauv cov ntshav,
• kev kawm txog kev muaj peev xwm nyob hauv lub raum: cov neeg laus - 0.015 mg, menyuam hnub nyoog qis dua 1 xyoos - 0.01-0.015 mg. Tom qab instillation ntawm cov tshuaj, zis zais cia yog yuav tsum tau. Tom qab ntawd cov zis mus kuaj tau los txiav txim siab osmolarity, cov txheej txheem tau rov ua dua 4 zaug nrog lwm tus ntawm 1 teev. Yog tias qhov nqhis dej tshwm sim, nws raug tso cai kom tsis pub ntau tshaj 200 ml ntawm cov kua rau tag nrho lub sijhawm (1 teev ua ntej kev kawm thiab hauv 8 teev tom ntej) ntawm txoj kev tshawb no.

Cov lus qhia tshwj xeeb

Desmopressin yuav tsum tsis txhob siv rau hauv cov neeg mob nrog concomitant pathologies lossis thaum noj tshuaj uas tuaj yeem ua rau kom cov kua dej hauv lub cev thiab cov roj ntsha tsis zoo.

Cov neeg mob nrog thawj lub sijhawm nocturnal enuresis 1 teev ua ntej thiab hauv 8 teev tom qab siv cov tshuaj yuav tsum txo cov kua dej tsawg - qhov no yuav txo qhov kev pheej hmoo ntawm phiv.

Kev siv ntawm Desmopressin rau kev kho mob nocturnal enuresis hauv cov menyuam yaus thiab cov tub ntxhais hluas ua rau muaj kev pheej hmoo ntawm kev ua mob rau lub hlwb.

Cov neeg mob polyuria los ntawm 2.8 txog 3 litres thiab theem pib ntshav plasma sodium tsawg kawg yog qhov muaj feem yuav muaj kev phiv.

Nrog rau kev ceev faj, nws raug nquahu kom siv cov tshuaj hauv cov neeg mob hnub nyoog 65 xyoos vim tias qhov pheej hmoo ntawm cov kua dej tau ceev, kev txhim kho hyponatremia thiab lwm yam cuam tshuam tsis zoo. Tus neeg mob yuav tsum tau txais kev tswj hwm hauv lub xeev thiab tsis tu ncua (ua ntej kev kho mob, tom qab peb hnub ntawm kev kho thiab txhua qhov kev nce siab) kev txiav txim siab txog qib uas muaj sodium siab hauv cov ntshav ntshav.

Yog tias muaj kub ib ce, kis kab mob rau lub plab los yog mob ncauj plab, kev siv cov tshuaj yuav tsum tau muab txuas mus ntxiv.

Txhawm rau tiv thaiv hyponatremia, kev kawm ntau dhau los raug pom zoo los txiav txim siab txog qib sodium ntawm ntshav ntshav, tshwj xeeb tshaj yog thaum sib xyaw cov ntsiav tshuaj nrog tricyclic antidepressants, xaiv serotonin inhibitors, chlorpromazine, carbamazepine, lwm yam tshuaj uas ua rau tsis muaj qhov sib luag ntawm cov tshuaj tiv thaiv kab mob antidiuretic, thiab ua ke nrog cov tshuaj tsis haum tshuaj tiv thaiv kab mob ( NSAIDs).

Kev kuaj mob thiab kev kho mob ntawm txoj kev tso zis tsis txaus ntseeg, mob hnoos thiab / lossis dysuria, mob txeeb zig, zais zis lossis mob qog, mob ntshav qab zib mellitus, polydipsia, thiab haus dej cawv yuav tsum tau nqa tawm ua ntej siv Desmopressin.

Hauv cov menyuam yaus hnub nyoog qis dua 1 xyoos, ib qho kev ntsuam xyuas los txiav txim siab lub peev xwm ntawm lub raum yuav tsum tau nqa tawm hauv tsev kho mob nkaus xwb.

Tom qab nqa tawm kev kuaj mob, tus neeg mob tau tso cai rau cov kua dej hauv lub ntim uas muab nqhis dej kom tsis nqhis.

Kev siv tshuaj tsuag tsis tuaj yeem raug rau cov menyuam yaus yog tias qhov koob tshuaj uas xav tau kev kho mob qis dua 0.01 mg.

Kev kawm txog kev muaj peev xwm ntawm lub raum nrog rau tee hauv cov menyuam yaus hnub nyoog qis dua 1 xyoos yuav tsum tau nqa tawm hauv qee qhov tshwj xeeb, txij li thaum lub hnub nyoog no lub peev xwm ntawm lub raum tsawg dua. Cov txheej txheem yuav tsum tau ua los ntawm tus kws kho mob hlwb. Tshaj koob tshuaj hauv cov menyuam yaus tuaj yeem ua rau lub plab tsis zoo, uas yog nrog txoj kev loj hlob ntawm qaug dab peg. Thaum lub sij hawm tso zis, yuav tsum ua kom tiav ib qho kev tsis haum cov kua dej.

Txij li thaum muaj mob rhinitis ntau heev, qhov nqus ntawm cov tee yog qhov tsis zoo, nws raug nquahu kom siv cov tshuaj sab hauv.

Nrog rau cov ntshav qab zib insipidus ntawm lub hauv paus pib, kev saib xyuas thaj chaw ntawm desmopressin ntau qhov kev pheej hmoo ntawm kev tsim muaj tus mob hyponatremia.

Yeeb tshuaj sib cuam tshuam

Nrog tib lub sijhawm siv Desmopressin:

• indomethacin tuaj yeem ua rau nce ntxiv hauv kev nqis tes ua ntawm desmopressin yam tsis nce nws lub sijhawm,
• tetracycline, glibutide, norepinephrine, lithium npaj txo cov nyhuv antidiuretic ntawm cov tshuaj,
• cov neeg ua haujlwm siab txhim kho lawv cov nyhuv,
• xaiv serotonin inhibitors, tricyclic antidepressants, carbamazepine, chlorpromazine tuaj yeem ua rau cov tsos mob ua tsis tiav ntawm cov tshuaj tiv thaiv antidiuretic, nce ntxiv antidiuretic nyhuv ntawm desmopressin, muaj kev pheej hmoo ntawm cov kua dej thiab kev txhim kho hyponatremia,
• NSAIDs ua rau muaj kev pheej hmoo ntawm cov dej cia hauv lub cev, qhov tshwm sim ntawm hyponatremia,
• dimethicone txo qis kev nqus ntawm cov tshuaj,
• loperamide thiab lwm yam tshuaj uas qeeb peristalsis tuaj yeem nce plasma ntau ntau ntawm desmopressin los ntawm 3 zaug thiab ua rau muaj kev pheej hmoo ntawm cov kua dej tawm thiab cov ntshav hyponatremia.

Cov tshuaj tiv thaiv ntawm Desmopressin yog: cov ntsiav tshuaj - Minirin, Nativa, Nourem, tshuaj tsuag - Apo-Desmopressin, Presineks, Minirin, Vasomirin.

Kev sib txuam

Concomitant siv, tshwj xeeb tshaj yog nyob rau hauv cov tshuaj loj, nrog dopamine tuaj yeem txhim kho cov nyhuv nias.

Indomethacin tuaj yeem cuam tshuam qhov sib zog ntawm Desmopressin raug rau lub cev.

Thaum noj tshuaj nrog lithium carbonate, nws cov nyhuv tshuaj tiv thaiv kab mob tsis muaj zog.

Nrog kev ceev faj, cov tshuaj yuav tsum ua ke nrog cov tshuaj uas ua rau muaj kev tso tawm ntau dua. antidiuretic hormone: chlorpromazine, carbamazepine, tricyclic antidepressants, phenylephrine, epinephrineCov. Qhov kev sib xyaw ua ke no tuaj yeem ua rau qhov kev nce siab ntawm vasopressor kev txiav txim ntawm Desmopressin.

Pharmacological kev txiav txim

Desmopressin yog ib qho tshuaj pleev ib ce ntawm cov tshuaj hormones ntuj arginine-vasopressin nrog cov nyhuv antidiuretic.

Piv nrog vasopressin, nws tsis tshua muaj qhov cuam tshuam rau cov leeg nqaij ntawm cov hlab ntsha thiab cov plab hnyuv siab raum, uas yog vim qhov hloov ntawm cov qauv ntawm desmopressin molecule piv nrog lub ntuj vasopressin molecule - deamination ntawm 1-cysteine ​​thiab hloov ntawm 8-L-arginine nrog D-arginine.

Nce permeability ntawm epithelium ntawm qhov distal seem ntawm cov tub ntxhais txoj kev tub nkeeg rau dej thiab ua rau nws ntau dua reabsorption. Kev siv ntawm Desmopressin hauv nruab nrab ntshav qab zib insipidus ua rau txo qis cov zis tso tawm thiab ib qho kev nce hauv osmolality ntawm cov zis thiab txo qis osmolality ntawm ntshav ntshav. Qhov no ua rau muaj kev txo qis hauv lub tso tawm ntawm txoj kev tso zis ntau ntxiv thiab txo qis nocturnal polyuria.

Qhov siab tshaj plaws ntawm cov tshuaj tiv thaiv kab mob tshwm sim thaum noj ntawm qhov ncauj - tom qab 4-7 teev. Cov tshuaj tiv thaiv kev tiv thaiv thaum noj ntawm qhov ncauj ntawm 0.1-0.2 mg - ntev txog 8 teev, ntawm ib koob ntawm 0.4 mg - txog 12 teev.

Kev thau plaub

• Nug tus kws kho mob hlwb lus nug
• Yuav cov tshuaj
• Saib cov tsev

Cov ntaub ntawv pharmacological

Cov chaw tsim tshuaj paus tsim cov tshuaj nyob rau ntau hom chaw muag tshuaj, ntawm cov uas:

1. Nasal tee, uas yog kua dej ntshiab, tsis muaj kob. Ntim hauv cov taub dej me me, ib qho twg muaj 5 ml ntawm yeeb tshuaj.
2. Nasal tsuag "Desmopressin". Nws yog cov kua ntshiab ntshiab tsis muaj xim. Ntim hauv hwj ua los ntawm cov iav tsaus nti thiab nruab nrog tshwj xeeb ntaus ntawv rau txau. Txhua lub raj ntim tau 50 koob tshuaj.
3. Ntsiav tshuaj Lawv yog cov dawb hauv cov xim, ntawm ib sab yog qhov pheej hmoo. Ntim hauv polyethylene ntim ntawm 28, 30, 90 pieces, lossis hauv cov hlwv pob 10, 30 pieces.

Cov lus qhia siv rau "Desmopressin" analogues tsis qhia. Peb yuav xav txog lawv hauv qab no.

Tus nquag ua hauj lwm hauv ntsiav tshuaj thiab tshuaj txau qhov ntswg yog desmopressin acetate, hauv kev tso tawm - desmopressin. Hauv kev tsim cov ntsiav tshuaj, cov khoom ua haujlwm pabcuam xws li magnesium stearate, cov hmoov txhuv nplej siab, povidone-K30, lactose monohydrate siv.

Ntu cov khoom siv hauv cov tshuaj tsuag yog: dej lim, hydrochloric acid, sodium chloride, potassium sorbate.

Raws li cov khoom sib ntxiv hauv kev tsim cov tee raug siv: dej lim dej, hydrochloric acid, sodium chloride, chlorobutanol.

Kev sib piv ntawm Desmopressin ntsiav tshuaj thiab tshuaj tsuag tsis yog qhov nyuaj rau kev tuaj tos, tab sis tus kws kho mob koom nrog yuav tsum ua qhov no.

Cov kev xav tsis zoo los ntawm kev siv cov tshuaj

Tawm tsam keeb kwm yav dhau los ntawm kev siv tee, tshuaj tsuag thiab Desmopressin ntsiav tshuaj, tus neeg mob yuav muaj ntau yam kev cuam tshuam tsis zoo, hauv kev sib txuas nrog uas nws pom zoo kom nruj rau cov koob tshuaj uas kws kho mob tau hais tseg. Feem ntau cov kev kho mob nrog tshuaj tshwm sim:

• Qhov mob ntawm qhov chaw txhaj tshuaj.
• Ua txhaum ntawm lacrimation.
• Kev ua xua rau pom kev ua xua.
• Lub nthwv dej.
• Ua xua tshwm sim ntawm daim tawv nqaij.
• Algodismenorea.
• Kev mob plab hnyuv.
• Ntuav
• Mob plab.
• Xeev siab
• O rau lub keeb kwm yav dhau los ntawm cov kua dej ceev cia hauv lub cev.
• Kev Hyponatremia.
• Oliguria.
• Nce lossis txo qis hauv cov ntshav siab yog tias cov tshuaj noj sai sai tso ntshav nrog.
• Cov pob txha mos nyob rau hauv lub qhov ntswg kab noj hniav.
• Hypoosmolality.
• Rhinitis.
• Qhov hnyav nce.
• Tsis nco qab.
• Tsis meej pem.
• Kiv taub hau.
• Mob taub Hau.
• Coma

Yog tias muaj qhov tsis zoo tshwm sim, nws yog ib qho tseem ceeb qhia rau koj tus kws kho mob. Qhov no muaj tseeb los ntawm cov lus qhia rau siv. Cov tshuaj tiv thaiv ntawm Desmopressin muaj cov kev mob tshwm sim zoo ib yam.

Siv cov tshuaj: yuav ua li cas nws thiaj

Kev kho mob thiab kev noj tshuaj rau txhua tus neeg mob yog tus kheej txiav txim los ntawm tus kws kho mob.

Thaum siv cov tshuaj intranasal ntawm cov tshuaj, kev tswj hwm txog li 40 mgk ntawm cov tshuaj ib hnub yog qhia. Qhov koob tshuaj yuav tsum muab faib ua ob peb daim ntawv thov. Hauv kev kho cov menyuam yaus, yuav tsum tau txhaj tshuaj kom haum, txij li txog 3 μg ib hnub siv feem ntau.

Yog tias kev siv tshuaj ntawm cov tshuaj yog tshuaj ua kom zoo, intravenously, subcutaneously, ces cov neeg laus cov neeg mob yuav tsum siv li 4 4g ib hnub, cov menyuam yaus - txog 2 μg.

Thaum tsis siv tshuaj kho thaum lub limtiam kev siv cov tshuaj, koj yuav tsum sab laj tus kws kho mob txhawm rau kho qhov tshuaj. Nws yuav siv sijhawm ntev txog li ob peb asthiv txhawm rau kom xaiv txoj kev kho mob zoo.

Cia rau cov mob rau cov tshuaj

Khaws cov tshuaj rau hauv qhov chaw uas tsis ncav cuag rau cov menyuam yaus, qhov kub uas tsis pub tshaj 30 degrees.

Khaws cov tshuaj cia kom deb ntawm cov menyuam yaus.

Cev xeeb tub thiab lactation

Kev kawm paub txaus thiab tswj hwm kev nyab xeeb ntawm desmopressin thaum cev xeeb tub thiab lactation tsis tau ua. Yog tias nws yuav tsum tau siv cov tshuaj desmopressin hauv pawg no ntawm cov neeg mob, cov txiaj ntsig ntawm kev kho mob rau leej niam thiab qhov muaj feem yuav ua rau muaj menyuam hauv plab lossis menyuam yaus yuav tsum tau ntsuas kom hnyav.

Kev Npaj Muaj DESMOPRESSIN (DESMOPRESSIN)

• APO-DESMOPRESSINE (tshuaj tsuag hauv qhov ntswg). 10 mcg / 1 koob tshuaj: fl. 2.5 ml (25 koob) lossis 5 ml (50 koob) • EMOSINT (EMOSINT) daws d / txhaj. 4 μg / 0.5 ml: amp. 10 pcs. • MINIRIN® (MINIRIN) tab. sublingual 120 mcg: 10, 30 lossis 100 pcs. • MINIRIN® (MINIRIN) tab. 200 mcg: 30 pcs. • MINIRIN® (MINIRIN) tab.

100 mcg: 30 pcs. • Cov tshuaj EMOSINT (EMOSINT) rau kev txhaj tshuaj. 40 mcg / 1 ml: amp. 10 pcs. 50 koob tshuaj dosing. • MINIRIN® ntaus ntawv (MINIRIN) tshuaj txau qhov ntswg. 10 mcg / 1 koob tshuaj: fl. 2.5 ml (25 koob) lossis 5 ml (50 koob) • MINIRIN® (MINIRIN) tab.

sublingual 240 mcg: 10, 30 lossis 100 units • PRESINEX (txau tshuaj rau qhov ntswg). 10 mcg / 1 koob tshuaj: fl. 60 koob • Tshuaj EMOSINT (EMOSINT) daws d / txhaj. 20 mcg / 1 ml: amp. 10 Pcs. • DESMOPRESSIN (hnoos qeev) 100 mcg / 1 ml: vial. 5 ml

• MINIRIN® (MINIRIN) tab.

sublingual 60 mcg: 10, 30, lossis 100 pcs.