LUNALDIN (LUNALDIN) cov lus qhia rau siv

- vim tias muaj kev pheej hmoo ntawm kev phom sij tuag taus, kev siv Lunaldine yog contraindicated nyob rau hauv cov neeg mob uas tsis tau txais kev kho mob opioid yav dhau los,

- tej yam mob uas tau muaj los ntawm kev ua pa nyuaj siab lossis txoj hlab ntsws hnyav,

- muaj hnub nyoog txog 18 xyoo

- Kev ua haujlwm tsis haum rau cov tshuaj yeeb dej caw lossis rau ib yam ntawm cov tsis nyiam.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Lunaldin yuav tsum raug kho tsuas yog rau cov neeg mob uas suav tias yog ua siab ntev rau kev kho opioid, siv rau qhov mob tas mus li los ntawm mob cancer. Cov neeg mob tau txiav txim siab opioid tiv thaiv yog tias lawv noj tsawg kawg 60 mg ntawm morphine ib hnub twg qhov ncauj, 25 μg fentanyl ib teev percutaneously lossis sib npaug analgesic koob ntawm lwm opioid rau ib lub lis piam lossis ntau dua.

Sublingual ntsiav tshuaj tso ncaj qha rau hauv tus nplaig li tob tau. Cov ntsiav tshuaj yuav tsum tsis txhob nqos, zom thiab yaj, cov tshuaj yuav tsum yaj tag hauv thaj av sublingual. Cov neeg mob tau hais kom tsis txhob noj mov lossis haus dej haus kom txog thaum cov tshuaj sublingual yog tag nrho.

Cov neeg mob uas tau ntsib lub qhov ncauj qhuav, ua ntej noj Lunaldin tuaj yeem siv dej kom ntub dej ntawm lub qhov ncauj qhov ntswg.

Cov koob tshuaj zoo tshaj plaws tau txiav txim rau txhua tus neeg mob ib tus zuj zus los ntawm kev xaiv nrog kev nce qib hauv koob. Txhawm rau xaiv cov koob tshuaj, cov ntsiav tshuaj uas muaj cov tshuaj sib txawv txav tuaj yeem siv tau. Thawj koob tshuaj yuav tsum yog 100 μg, nyob rau hauv cov txheej txheem ntawm titration nws tau maj mam nce ntxiv raws li qhov tsim nyog ntawm cov koob tshuaj uas twb muaj lawm. Thaum lub sijhawm ua haujlwm ntawm lub koob tshuaj, cov neeg mob yuav tsum tau saib xyuas kom txog rau thaum pom kev noj tshuaj tau ua tiav, i.e., kom txog rau thaum tsim nyog tshuaj loog tiav.

Pharmacological kev txiav txim

Lunaldin yog qhov ua tau zoo, ua yeeb yam luv luv, nrawm μ-opioid analgesic. Qhov tseem ceeb hauv kev kho mob yog kev kho mob thiab kev ua kom loog. Kev ua kom loog yog kwv yees li 100 npaug ntawm cov morphine. Lunaldin muaj cov nyhuv cuam tshuam rau lub nruab nrab lub paj hlwb, ua pa ntawm lub plab thiab lub plab hnyuv, ua haujlwm ntawm opioid analgesics, uas ib txwm muaj rau cov tshuaj hauv chav kawm no.

Sab sij huam

Thaum siv Lunaldine, ib qho yuav tsum xav tias qhov kev xav tsis haum ntawm opioids, kev siv ntawm cov tshuaj tiv thaiv no, raws li txoj cai, nyhav dhau los ntawm kev siv ntev. Cov kev mob tshwm sim loj tshaj plaws uas cuam tshuam nrog kev siv tshuaj opioid yog kev ua pa nyuaj (uas tuaj yeem ua rau ntes tau pa), txo ntshav siab, thiab poob siab.

Los ntawm cov txheej txheem ua pa: ntau zaus - ua pa nyuaj, hypoventilation, mus txog rau kev ua pa.

Los ntawm cov leeg hlwb thiab cov khoom hauv lub cev: ntau dua - mob taub hau, tsaug zog, tsawg dua - kev nyuaj siab ntawm lub hauv nruab nrab lub paj hlwb (suav nrog tom qab phais mob), ua rau muaj kev ntxhov siab ntawm lub hauv nruab nrab ntawm cov hlab ntsha, delirium, convulsions, plooj pom kev pom, diplopia, npau suav tiag tiag, nco ploj. , zaus tsis tsim - ua haujlwm tsis meej pem, zoo siab, txhaws ntswg, mob taub hau, mob ntshav siab.

Los ntawm lub plab zom mov: ntau zaus - xeev siab, ntuav, tsis tshua muaj ntau lub sij hawm zoo, muaj qhov hnoos qeev ntawm Oddi, qeeb qeeb ntawm lub plab zom mov, cem quav, biliary colic (hauv cov neeg mob uas muaj keeb kwm ntawm lawv).

Cov lus qhia tshwj xeeb

Vim tias muaj cov kev mob tshwm sim loj heev uas yuav tshwm sim thaum kho nrog opioids xws li Lunaldin, cov neeg mob thiab cov neeg saib xyuas yuav tsum lees paub qhov tseem ceeb ntawm kev noj Lunaldin kom raug, thiab tseem paub tias yuav ua li cas thaum noj tshuaj ntau dhau tshwm sim.

Ua ntej pib kho nrog Lunaldin, nws yog ib qho tseem ceeb kom ruaj khov tswj hwm ntawm cov tshuaj opioid ntev siv los daws qhov mob tas li.

Cuam tshuam rau lub peev xwm tsav tsheb thiab tswj cov tswv yim:

Lunaldin tuaj yeem cuam tshuam tsis zoo rau lub peev xwm los ua haujlwm tsis zoo, xws li tsav tsheb lossis siv tshuab.

Cov neeg mob yuav tsum raug qhia kom tsis txhob tsav tsheb thiab kev siv lub tshuab ua haujlwm, xws li kiv taub hau, tsaug zog, lossis pom kev tsis zoo yuav tshwm sim thaum noj Lunaldin.

Kev sib txuam

Dinitrogen oxide ua rau cov leeg ua kom muaj zog, tricyclic antidepressants, opiates, sedatives thiab hypnotics (Ps), phenothiazines, anxiolytic tshuaj (tshuaj loog), tshuaj rau cov tshuaj loog dav dav, cov leeg kho kom zoo, cov tshuaj tiv thaiv antihistamines nrog lwm yam sedative thiab muaj cov nyhuv sedative thiab sedative. phiv (CNS kev nyuaj siab, hypoventilation, hlab ntsha hypotension, bradycardia, chaw ua pa ntawm lub cev thiab lwm tus).

Txhim kho cov nyhuv ntawm antihypertensive tshuaj. Beta-blockers tuaj yeem txo qhov tsawg zaus thiab qhov hnyav ntawm cov kev tsis haum siab hauv kev phais mob plawv (suav nrog sternotomy), tab sis nce ntawm kev pheej hmoo ntawm bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone txo cov nyhuv analgesic ntawm Lunaldin thiab tshem tawm nws cov nyhuv inhibitory rau hauv lub chaw ua pa.

Tso cov ntaub ntawv thiab cov nyob ua ke

Muaj nyob hauv daim ntawv sublingual (rau kev xaus nyob hauv tus nplaig) ntsiav tshuaj ntawm qhov sib txawv (mcg) thiab daim ntawv:

• 100 - npawv
• 200 - ovoid,
• 300 - voos peb,
• 400 - rhombic
• 600 - semicircular (D-zoo li),
• 800 - tsiav tshuaj.

Ib ntsiav tshuaj muaj cov tshuaj nquag - fentanyl citron micronized thiab cov ntu ua haujlwm pabcuam.

Cov Tshuaj Pharmacokinetics

Cov tshuaj muaj cov cim tawm hydrophobicity, yog li nws yog nqus sai dua ntawm lub qhov ncauj kab noj hniav ntau dua li ntawm cov hnyuv. Los ntawm sublingual cheeb tsam, nws yog nqus hauv 30 feeb. Bioavailability yog 70%. Qhov siab tshaj plaws nyob rau hauv cov ntshav ntawm fentanyl nce mus txog nrog kev qhia ntawm 100-800 μg ntawm cov tshuaj tom qab 22-24 feeb.

Qhov ntau dua ntawm fentanyl (80-85%) khi rau cov protein ntshav, uas ua rau nws lub cev muaj zog. Qhov ntim ntawm qhov faib tawm ntawm cov tshuaj hauv qhov sib npaug yog 3-6 l / kg.

Lub ntsiab biotransformation ntawm fentanyl tshwm sim nyob rau hauv kev cuam tshuam ntawm hepatic enzymes. Qhov tseem ceeb ntawm txoj kev nthuav tawm ntawm lub cev yog qhov mob tso zis (85%) thiab cov kua tsib (15%).

Ib nrab-lub neej ntawm ib yam khoom los ntawm lub cev yog los ntawm 3 txog 12,5 teev.

Cov lus qhia rau kev siv Lunaldin

Cov cim tseem ceeb rau kev siv Lunaldin yog kev kho tshuaj ntawm kev mob tshwm sim hauv cov neeg mob cancer tau txais kev kho opioid tsis tu ncua.

Cov cim tseem ceeb rau kev siv Lunaldin yog kev kho tshuaj ntawm kev mob tshwm sim hauv cov neeg mob cancer tau txais kev kho opioid tsis tu ncua.

Nrog saib xyuas

Yuav tsum tau ceeb toom ntau ntxiv thaum sau ntawv Lunaldin rau cov neeg mob uas ntxim rau qhov cuam tshuam ntau tshaj ntawm CO₂ hauv cov ntshav:

• nce siab intracranial,
• coma
• qhov muag plooj
• neoplasms ntawm lub paj hlwb.

Tshwj xeeb kev ceev faj ntawm kev siv cov tshuaj yuav tsum tau pom nyob rau hauv kev kho mob ntawm cov neeg muaj mob taub hau, tshwm sim ntawm bradycardia thiab tachycardia. Hauv cov neeg laus thiab cov neeg mob debilitated, noj cov tshuaj yuav ua rau muaj kev nce ntxiv hauv ib nrab-lub neej thiab muaj kev nkag siab zoo ntxiv rau cov khoom xyaw. Hauv pawg neeg mob no, nws yog ib qho tsim nyog yuav tau soj ntsuam qhov tsos mob ntawm kev qaug cawv thiab kho qhov koob tshuaj hauv qab.

Hauv cov neeg mob uas lub raum thiab mob hepatic tsis txaus, ib yam tshuaj yuav ua rau muaj ntau npaum li cas ntawm fentanyl hauv cov ntshav (vim tias nws cov bioavailability thiab inhibition ntawm kev tshem tawm). Cov tshuaj yuav tsum tau siv nrog ceev faj nyob rau hauv cov neeg mob nrog:

• hypervolemia (nce ntshav ntau ntau hauv cov ntshav),
• ntshav siab
• kev puas tsuaj thiab o ntawm lub qhov ncauj mucosa.

Dosing regimen ntawm Lunaldin

Muab rau cov neeg mob uas tau tsim nrog kev kam rau ua opioids, noj 60 mg ntawm morphine ntawm qhov ncauj lossis 25 μg / h ntawm fentanyl. Kev noj tshuaj pib nrog koob tshuaj 100 mcg, maj mam nce nws ntau. Yog tias hauv 15-30 feeb. tom qab noj ib ntsiav tshuaj ntawm 100 μg, qhov mob tsis nres, tom qab ntawd noj ib lub tshuaj thib ob nrog tib cov tshuaj uas muaj ntau yam.

Cov lus qhia txog cov qauv kev piv txwv rau titrating ib koob tshuaj Lunaldin, yog tias thawj koob tsis nqa tshuaj tuaj:

Kev noj tshuaj pib nrog koob tshuaj 100 mcg, maj mam nce nws ntau.

Yog tias tom qab siv ntau tshaj qhov kev kho mob, cov nyhuv ua kom loog tsis tiav, tom qab ntawd ib qho tshuaj nruab nrab (100 mcg) yog tau kho. Thaum xaiv cov koob tshuaj ntawm qib titration, tsis txhob siv ntau dua 2 ntsiav tshuaj nrog ib qho kev tawm tsam ntawm qhov mob. Qhov cuam tshuam rau lub cev ntawm fentanyl hauv ntau npaum li 800 mcg tseem tsis tau soj ntsuam.

Nrog cov kev ua kom pom ntau dua plaub ntu ntawm kev mob hnyav ib hnub, ua kom ntev dua 4 hnub sib law liag, kev kho tshuaj ntau dua ntawm cov tshuaj opioid ntev ntev tau raug kho. Thaum hloov los ntawm ib qho ua kom tsis haum rau lwm qhov, ib qho kev rov ua dua ntawm cov koob tshuaj yog ua tiav los ntawm kev saib xyuas ntawm tus kws kho mob thiab kuaj ntsuas ntawm tus neeg mob lub sijhawm.

Nrog rau qhov kev tso tawm ntawm mob paroxysmal, Lunaldin kev ua kom tsawg yog nres. Cov tshuaj raug muab tso tseg, maj mam txo qhov tsuas tshuaj, yog li kom tsis txhob ua rau pom qhov tshwm sim ntawm kev tshem tawm tus mob.

Lub plab zom mov

Cov tshuaj noj tuaj yeem muaj qhov cuam tshuam ua kom lub plab hnyuv thiab ua kom quav tawv. Ib qho ntxiv, cov hauv qab no feem ntau sau tseg:

• qhov ncauj qhuav
• mob hauv plab,
• plob tsis so tswj
• dyspeptic mob
• ob leeg plob tsis so tswj,
• cov tsos ntawm cov mob rau ntawm lub qhov ncauj mucosa,
• ua txhaum cai ntawm kev ua ntawm kev nqos,
• kev tsis nco qab.

Tsawg dua li qhov muaj roj tsim ntau dhau, ua rau tsam plab thiab pom kev.

Nruab nrab hauv lub paj hlwb

Los ntawm lub hauv nruab nrab lub paj hlwb feem ntau tshwm sim:

• asthenia
• kev nyuaj siab
• insomnia
• ua txhaum ntawm saj, lub zeem muag, kev pom zoo,
• lus txhais
• dev paus
• tsis meej pem,
• npau suav phem,
• qhov hloov pauv ntau dua ntawm cov mus ob peb vas,
• muaj kev ntxhov siab ntau dua.

Kev pom tus kheej tsis tshua pom tshwm sim tsawg.

Los ntawm cov hlab plawv system

Cov tshwm sim pathological yuav:

• orthostatic cev qhuav dej,
• leeg kev so ntawm cov phab ntsa ntawm cov hlab ntsha (vasodilation),
• dej ntas
• ntsej muag liab
• arrhythmia.

Mob lub cev tuaj yeem pom los ntawm txoj hlab ntshav liab txoj hlab ntshav siab, tsis hnov ​​qab myocardial contractility, mob ntshav tawm ntawm lub plawv (bradycardia) lossis nce siab hauv plawv (tachycardia).

Kev tsis haum tshuaj rau qhov tshuaj muaj peev xwm tshwm sim nws tus kheej hauv daim ntawv ntawm:

• tawv nqaij ua pob - ua pob, khaus,
• liab thiab o ntawm thaj chaw txhaj tshuaj.

Hauv cov neeg mob uas muaj teeb meem ntawm cov kab mob hypobiliary, biliary colic, ua haujlwm tsis pom kev bile tawm yuav tshwm sim. Ntev nrog kev siv, kev quav yeeb quav tshuaj, kev mob hlwb thiab kev quav lub cev (dependence) yuav tshwm sim. Qhov tshwm sim tsis zoo ntawm lub cev tuaj yeem ua rau kev sib daj sib deev thiab txo qis libido.

Cuam tshuam rau lub peev xwm los tswj cov tshuab

Cov tshuaj tuaj yeem cuam tshuam rau lub hauv nruab nrab lub paj hlwb thiab cov kab mob hauv nruab siab, yog li thaum lub sijhawm kho Lunaldin yuav tsum tsis kam tsav tsheb, ua haujlwm nrog cov tshuab thiab cov haujlwm ua haujlwm uas yuav tsum muaj kev saib xyuas, nrawm ntawm kev txiav txim siab thiab pom tseeb.

Cov tshuaj tuaj yeem cuam tshuam rau lub hauv nruab nrab lub paj hlwb thiab cov plab hnyuv siab raum, yog li ntawd, thaum kho nrog Lunaldin, koj yuav tsum tsis kam tsav tsheb.

Siv thaum cev xeeb tub thiab lactation

Kev noj tshuaj yuav tsum muaj kev txiav txim siab kom sib luag. Kev kho ntev ntev nrog cov tshuaj thaum cev xeeb tub yuav ua rau tshem tawm hauv tus menyuam mos. Cov tshuaj nkag mus rau hauv qhov chaw tiv thaiv, thiab nws siv thaum lub sijhawm yug menyuam yog qhov txaus ntshai rau kev ua pa ntawm cov menyuam hauv plab thiab cov menyuam tshiab.

Cov tshuaj muaj nyob hauv niam mis. Yog li, nws cov sijhawm teem sijhawm pub mis niam tuaj yeem ua rau kev ua pa ntawm tus menyuam tsis ua haujlwm. Cov tshuaj nyob rau hauv lub lactation thiab lub sijhawm cev xeeb tub yog kws kho tsuas yog thaum cov txiaj ntsig ntawm nws siv ntau tshaj qhov txaus ntshai rau tus menyuam thiab leej niam.

Daim ntawv thov rau lub raum khiav tsis zoo

Txij li txoj hauv kev tseem ceeb ntawm kev tshem tawm cov tshuaj thiab nws cov metabolites yog nrog cov zis, yog tias lub raum ua haujlwm tsis zoo, ncua sij hawm hauv nws cov kev tshem tawm, tsub zuj zuj hauv lub cev, thiab nce siab hauv lub sijhawm txiav txim siab yuav tau sau tseg. Cov neeg mob zoo li no xav tau kev tswj hwm lub plasma cov ntsiab lus ntawm cov tshuaj thiab kev hloov kho tshuaj nrog kev nce ntxiv hauv nws cov ntawv.

Daim ntawv thov rau lub siab ua haujlwm tsis zoo

Cov tshuaj yog tawm nrog cov kua tsib, yog li ntawd, nrog daim siab pathology, hepatic colic, lub sijhawm ua haujlwm ntev ntawm cov tshuaj yuav tshwm sim, uas, yog tias lub sijhawm tswj hwm ntawm cov tshuaj yog ua raws, tuaj yeem ua rau muaj kev noj tshuaj ntau dua. Rau cov neeg mob zoo li no, cov tshuaj yuav tsum tau ua nrog ceev faj, soj ntsuam cov zaus thiab ntau npaum li cas los ntawm tus kws kho mob, thiab tau kuaj mob tas li.

Noj ntau dhau

Nyob rau hauv cov ntaub ntawv ntawm kev noj tshuaj ntau ntawm Lunaldin, qhov tshwm sim ntawm kev ua siab ntsws thiab lub ntsws ua pa nyuaj dua, txog nws qhov chaw nres. Thawj cov kev pab rau haus luam yeeb yog:

• kev hloov kho thiab kev ua kom huv huv ntawm lub qhov ncauj (qhov chaw sublingual) los ntawm cov seem ntawm cov ntsiav tshuaj,
• kev soj ntsuam ntawm tus neeg mob kom txaus,
• kev pab ua pa, suav nrog kev ua kom tawm thiab yuam kev ua pa,
• tswj lub cev kub
• kev qhia ntawm cov kua dej ua rau nws poob.

Cov tshuaj tiv thaiv rau opioid analgesics yog Naloxone. Tab sis nws tsuas yog siv los tshem tawm kev siv ntau dhau ntawm cov neeg uas tsis tau siv yav dhau los ua opioids.

Nrog rau qhov mob ntshav khov (hypotension), cov tshuaj hloov ntshav yog muab rau cov ntshav nce siab.

Cov tshuaj tiv thaiv rau opioid analgesics yog Naloxone.

Tso tawm daim ntawv, muaj pes tsawg leeg thiab ntim khoom

Sublingual ntsiav tshuaj ntawm cov xim dawb, puag ncig puab.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

tab. sublingual 200 mcg: 10 lossis 30 pcs.
Reg. Tsis Muaj: 9476/10 ntawm 02.11.2010 - Tas sijhawm

Sublingual ntsiav tshuaj yog dawb, oval.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

tab. sublingual 300 mcg: 10 lossis 30 pcs.
Reg. Tsis Muaj: 9476/10 ntawm 02.11.2010 - Tas sijhawm

Sublingual ntsiav tshuaj ntawm cov xim dawb, daim duab peb sab hauv duab.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

tab. sublingual 400 mcg: 10 lossis 30 pcs.
Reg. Tsis Muaj: 9476/10 ntawm 02.11.2010 - Tas sijhawm

Sublingual ntsiav tshuaj ntawm cov xim dawb, pob zeb diamond-puab.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

tab. sublingual 600 mcg: 10 lossis 30 pcs.
Reg. Tsis Muaj: 9476/10 ntawm 02.11.2010 - Tas sijhawm

Sublingual ntsiav tshuaj ntawm cov xim dawb, "D-puab" daim ntawv.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

tab. sublingual 800 mcg: 10 lossis 30 pcs.
Reg. Tsis Muaj: 9476/10 ntawm 02.11.2010 - Tas sijhawm

Sublingual ntsiav tshuaj yog dawb, tsiav tshuaj-puab.

Cov muaj tswv yim: mannitol, microcrystalline colloidal cellulose (sib tov ntawm 98% microcrystalline cellulose thiab 2% colloidal anhydrous silicon), croscarmellose sodium, magnesium stearate.

10 Pcs - hlwv (1) - thawv ntawv thawv.
10 Pcs - hlwv (3) - thawv ntawv thawv.

Cov Tshuaj Hauv Tshuaj

Lunaldin yog qhov ua tau zoo, ua yeeb yam luv luv, nrawm μ-opioid analgesic. Cov kev kho mob tseem ceeb ntawm Lunaldin yog analgesic thiab sedative. Lunaldin qhov kev ua kom loog yog kwv yees li 100 zaus ntau dua li ntawm morphine. Lunaldin muaj cov nyhuv cuam tshuam rau lub nruab nrab lub paj hlwb, ua pa ntawm lub plab thiab lub plab hnyuv, ua haujlwm ntawm opioid analgesics, uas ib txwm muaj rau cov tshuaj hauv chav kawm no.

Nws tau pom tias hauv cov neeg mob qog nqaij hlav uas muaj mob tau txais kev saib xyuas tas li ntawm cov tshuaj opioids, fentanyl ua rau txo qhov hnyav ntawm qhov mob nres (15 feeb tom qab tswj hwm), piv nrog cov placebo, uas txo qis qhov xav tau tshuaj kho mob thaum muaj xwm txheej ceev. Qhov kev nyab xeeb thiab kev ua tau zoo ntawm fentanyl tau raug soj ntsuam hauv cov neeg mob uas tau txais cov tshuaj tam sim ntawd thaum hnov ​​mob. Txoj kev siv prophylactic ntawm fentanyl hauv kev kwv yees mob ntawm kev mob tsis tau kawm hauv kev sim ntsuas. Lunaldin, zoo li txhua yam μ-opioid receptor agonists, ua rau muaj kev cuam tshuam ntau ntxiv rau txoj kev ua pa ntawm lub chaw ua pa. Txoj kev pheej hmoo ntawm lub ntsws ua pa nyuaj dua rau cov neeg uas tsis tau txais tshuaj opioids, piv nrog cov neeg mob uas yav dhau los ua rau mob hnyav thiab tus uas tau txais kev kho ntev nrog opioids.

Cov tshuaj opioids feem ntau ua rau lub suab nrov ntawm cov nqaij leeg ntawm qhov mob txeeb zig, ua rau nce mus ntev npaum li cas tso zis lossis nyuaj rau tso zis. Cov tshuaj opioids nce lub suab ntawm cov nqaij ntshiv ntawm cov hnyuv, txo lub plab hnyuv, uas tuaj yeem yog vim kho cov nyhuv ntawm fentanyl.

Siv thaum cev xeeb tub

Lunaldin kev nyab xeeb thaum cev xeeb tub tseem tsis tau tsim. Kev kho ntev ntev thaum cev xeeb tub tuaj yeem ua rau "tshem tawm" cov tsos mob hauv tus menyuam mos. Lunaldin yuav tsum tsis txhob siv thaum yug menyuam (suav nrog rau kev phais menyuam), vim nws hla tus txiv neej thiab tuaj yeem ua rau mob ntsws ua rau muaj menyuam hauv plab lossis menyuam yug tshiab. Thaum cev xeeb tub, Lunaldin tuaj yeem siv tsuas yog muaj txiaj ntsig rau tus niam tshaj qhov muaj feem yuav ua rau muaj menyuam hauv plab.

Lunaldin dhau mus rau hauv niam cov kua mis thiab yuav muaj qhov ua kom loog loj thiab thaiv kev ua pa ntawm cov menyuam uas noj niam mis. Lunaldin tuaj yeem siv rau hauv kev pub mis pojniam tsuas yog tias qhov txiaj ntsig ntawm kev siv tshuaj ntau dhau qhov kev pheej hmoo rau leej niam thiab tus menyuam. Nws raug nquahu kom tsum tsis pub noj niam mis thaum noj cov tshuaj.

Tsuas tshuaj thiab tswj hwm

Lunaldin yuav tsum raug kho tsuas yog rau cov neeg mob uas suav tias yog ua siab ntev rau kev kho opioid, siv rau qhov mob tas mus li los ntawm mob cancer. Cov neeg mob tau txiav txim siab opioid tiv thaiv yog tias lawv noj tsawg kawg 60 mg ntawm morphine ib hnub twg qhov ncauj, 25 μg fentanyl ib teev percutaneously lossis sib npaug analgesic koob ntawm lwm opioid rau ib lub lis piam lossis ntau dua.

Lunaldin sublingual ntsiav tshuaj muab tso ncaj qha rau hauv qab tus nplaig li tob tau. Lunaldin ntsiav tshuaj yuav tsum tsis txhob nqos, zom thiab yaj, cov tshuaj yuav tsum yaj tag hauv thaj av sublingual. Cov neeg mob tau hais kom tsis txhob noj mov lossis haus dej haus kom txog thaum cov tshuaj sublingual yog tag nrho.

Cov neeg mob uas tau ntsib lub qhov ncauj qhuav, ua ntej noj Lunaldin tuaj yeem siv dej kom ntub dej ntawm lub qhov ncauj qhov ntswg.

Cov koob tshuaj zoo ntawm Lunaldin yog txiav txim rau txhua tus neeg mob ib tus zuj zus los ntawm kev xaiv nrog kev nce qib hauv koob. Txhawm rau xaiv cov koob tshuaj, cov ntsiav tshuaj uas muaj cov tshuaj sib txawv txav tuaj yeem siv tau. Thawj koob tshuaj Lunaldin yuav tsum yog 100 μg, nyob rau hauv cov txheej txheem ntawm titration nws tau maj mam nce ntxiv raws li qhov tsim nyog ntawm cov koob tshuaj uas twb muaj lawm. Thaum lub sijhawm ua haujlwm ntawm lub koob tshuaj, cov neeg mob yuav tsum tau saib xyuas kom txog rau thaum pom kev noj tshuaj tau ua tiav, i.e., kom txog rau thaum tsim nyog tshuaj loog tiav.

Kev hloov pauv los ntawm lwm yam fentanyl-uas muaj kev npaj rau Lunaldin yuav tsum tsis txhob ua nyob rau hauv 1: 1 piv vim qhov sib txawv nqus ntawm kev npaj. Yog tias cov neeg mob tau hloov los ntawm lwm cov tshuaj fentanyl uas muaj cov tshuaj, kev tshaj tawm koob tshuaj uas siv Lunaldine yuav tsum ua.

Cov kev cai nram qab no raug pom zoo rau kev xaiv koob tshuaj, txawm hais tias txhua tus neeg mob tus kws kho mob yuav tsum coj mus rau hauv tus neeg mob cov kev xav tau, hnub nyoog, thiab cov kab mob sib kis.

Txhua tus neeg mob yuav tsum pib kho nrog ib qho 100 mcg sublingual ntsiav tshuaj. Yog tias qhov ua kom zoo txaus ua kom tiav tsis tiav hauv 15-30 feeb tom qab noj ib ntsiav tshuaj ntau, koj tuaj yeem nqa ib ntsiav tshuaj thib ob ntawm 100 μg. Yog tias tom qab noj 2 ntsiav tshuaj ntawm 100 micrograms qhov mob txaus kom hnov ​​mob tsis tiav, txiav txim siab nce qhov koob tshuaj rau lwm cov tshuaj tom ntej ntawm qhov mob tom ntej. Ua kom nce lub koob tshuaj yuav tsum tau nqa tawm maj mam txog thaum ua kom mob txaus. Kev noj tshuaj feem ntau yuav tsum tau pib nrog ib cov ntsiav tshuaj nkaus xwb. Qhov thib ob ntxiv sublingual ntsiav tshuaj yuav tsum tau noj tom qab 15-30 feeb yog tias qhov mob txaus kho tsis tiav. Cov koob tshuaj ntawm ib qho tshuaj ntxiv sublingual yuav tsum tau nce los ntawm 100 mus rau 200 mcg thiab tom qab ntawd mus rau ib koob ntawm 400 mcg lossis ntau dua. Qhov no qhia hauv daim duab hauv qab no. Ntawm qib xaiv cov koob tshuaj, titration yuav tsum tsis txhob siv ntau tshaj ob (2) ntsiav tshuaj zoo ib zaug hauv qhov mob.
Koob (mcg) ntawm thawj koob (mcg) ntawm ntxiv
sublingual ntsiav tshuaj nyob rau (thib ob) sublingual ntsiav tshuaj, uas nyob rau hauv cov ntaub ntawv ntawm
ntu ntawm qhov mob nres yuav tsum tau ua
15-30 feeb tom qab thawj zaug tshuaj

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Yog tias qhov mob hnyav tau ua tiav ntawm kev txhaj tshuaj ntau dua, tab sis cov txiaj ntsig tsis tsim nyog pom tau tias qhov tsis lees txais, ib qho tshuaj nruab nrab tuaj yeem kho tau (siv 100 microgram sublingual ntsiav tshuaj). Cov koob tshuaj ntau dua 800 mcg tseem tsis tau soj ntsuam hauv kev sim tshuaj. Txo txoj kev pheej hmoo ntawm qhov tshwm sim tsis zoo uas cuam tshuam nrog kev noj tshuaj opioid thiab txiav txim siab pom zoo tshaj plaws, kev saib xyuas kev kho mob ntawm tus neeg mob lub sijhawm thaum txhaj koob tshuaj yog tsim nyog.

Tom qab txiav txim siab qhov zoo tshaj plaws ntawm lub koob tshuaj, uas tuaj yeem ua tau ntau dua ib ntsiav tshuaj, cov neeg mob tau txais kev saib xyuas kev kho mob uas siv cov koob tshuaj uas tau xaiv thiab txwv kev siv tshuaj ntau tshaj plaub zaug ntawm Lunaldin ib hnub.

Yog tias qhov tshuaj tiv thaiv (tshuaj loog los sis qhov tshwm sim tsis zoo) rau qhov zoo sib xws ntawm Lunaldin hloov pauv ntau, kev hloov kho koob yuav raug tswj hwm kev noj tshuaj kom zoo dua. Yog tias ntau tshaj plaub ntu kev mob siab pom ib hnub rau ntau dua plaub hnub sib law liag, cov tshuaj yuav tsum raug kho.

opioids ntev ntev siv los daws qhov mob tas li. Yog tias kev hloov pauv tshuaj opioid ntev ntev los yog hloov nws qhov kev hloov pauv, qhov koob tshuaj Lunaldine yuav tsum rov ntsuas dua thiab ua kom zoo dua los xaiv qhov zoo tshaj plaws rau tus neeg mob.

Rov ua dua ib feem kaum thiab kev xaiv koob tshuaj ntawm cov tshuaj pleev yuav tsum ua raws li kev saib xyuas mob.

Yog hais tias tus neeg mob tsis tas yuav siv tshuaj opioid lawm, koob tshuaj Lunaldin yuav tsum raug coj mus rau hauv tus account ua ntej pib txo cov tshuaj opioids kom txo qis qhov tshwm sim ntawm "tshem tawm". Yog tias cov neeg mob pheej noj tshuaj opioid tas li los kho tus mob ntev, tab sis tsis tas yuav kho tus mob, Lunaldin tuaj yeem nres tam sim ntawd.

Siv rau hauv cov menyuam yaus thiab cov hluas

Lunaldin yuav tsum tsis txhob siv rau hauv cov neeg mob hnub nyoog qis dua 18 xyoo vim tsis muaj ntaub ntawv kev nyab xeeb thiab ua tau zoo.

Siv rau cov neeg mob laus

Kev noj tshuaj feem ntau yuav tsum tau ua nrog ceev faj heev. Cov neeg mob yuav tsum tau ua tib zoo saib rau cov cim ntawm fentanyl lom.

Siv rau hauv cov neeg mob uas lub raum lossis lub cev muaj zog

Cov neeg mob uas muaj lub siab lossis lub raum tsis ua haujlwm yuav tsum tau ua tib zoo saib rau cov cim ntawm fentanyl toxicity ntawm theem ntawm titration ntawm ib koob tshuaj Lunaldin.

Kev sib cuam tshuam nrog lwm yam tshuaj

Dinitrogen oxide ua rau cov leeg ua kom muaj zog, tricyclic antidepressants, opiates, sedatives thiab hypnotics (Ps), phenothiazines, anxiolytic tshuaj (tshuaj loog), tshuaj rau cov tshuaj loog dav dav, cov leeg kho kom zoo, cov tshuaj tiv thaiv antihistamines nrog lwm yam sedative thiab muaj cov nyhuv sedative thiab sedative. phiv (CNS kev nyuaj siab, hypoventilation, hlab ntsha hypotension, bradycardia, chaw ua pa ntawm lub cev thiab lwm tus).

Txhim kho cov nyhuv ntawm antihypertensive tshuaj. Beta-blockers tuaj yeem txo qhov tsawg zaus thiab qhov hnyav ntawm cov kev tsis haum siab hauv kev phais mob plawv (suav nrog sternotomy), tab sis nce ntawm kev pheej hmoo ntawm bradycardia.

Buprenorphine, nalbuphine, pentazocine, naloxone, naltrexone txo cov nyhuv analgesic ntawm fentanyl thiab tshem tawm nws cov nyhuv inhibitory rau hauv lub chaw ua pa.

Benzodiazepines rub tawm ntev ntxiv ntawm kev tso tawm neuroleptanalgesia.

Nws yog qhov tsim nyog los txo cov koob tshuaj fentanyl thaum siv tshuaj insulin, glucocorticosteroids, antihypertensive tshuaj. MAO inhibitors nce ntxiv ntawm kev pheej hmoo ntawm cov teeb meem loj.

Cov leeg ua kom cov leeg ua kom tsis txhob muaj zog lossis ua kom cov leeg ua kom nruj, qhov ua kom cov leeg ua si nrog m-anticholinergic kev ua si (suav nrog pancuronium bromide) txo txoj kev pheej hmoo ntawm bradycardia thiab mob ntshav siab (tshwj xeeb tshaj yog thaum beta-blockers thiab lwm yam vasodilators siv) thiab yuav ua rau muaj kev pheej hmoo ntawm tachycardia thiab ntshav siab, m-anticholinergic kev ua si (suav nrog suxamethonium) tsis txo qhov kev pheej hmoo ntawm bradycardia thiab arterial hypotension (tshwj xeeb yog tiv thaiv cov keeb kwm ntawm lub nra keeb kwm yav dhau los) thiab nce ntxiv kev pheej hmoo ntawm kev phiv loj los ntawm cov kab mob plawv.

Cev xeeb tub thiab lactation

Kev nyab xeeb ntawm Lunaldin thaum cev xeeb tub tsis tau tsim tsa. Lub sijhawm ntev kho thaum cev xeeb tub tuaj yeem ua rau cov tsos mob tshem tawm ntawm tus menyuam mos. Lunaldin yuav tsum tsis txhob siv thaum yug menyuam (suav nrog rau kev phais menyuam), vim nws hla tawm lub tsho me nyuam thiab tuaj yeem ua rau mob ntsws ua pa rau hauv tus menyuam lossis menyuam mos.

Lunaldin tuaj yeem siv rau lub sijhawm cev xeeb tub nkaus xwb yog tias muaj txiaj ntsig zoo rau leej niam outweighs qhov kev pheej hmoo rau tus menyuam hauv plab.

Fentanyl ua rau cov kua mis tawm thiab yuav ua rau mob ntsws thiab ua pa nyuaj hauv tus menyuam noj niam mis. Yog li, fentanyl tuaj yeem siv rau lub sijhawm pub niam mis nkaus xwb yog tias cov txiaj ntsig zoo tshaj qhov muaj peev xwm ua rau tus niam thiab tus menyuam mob.

Yeeb tshuaj sib cuam tshuam

Fentanyl kho los ntawm CYP3A4. Cov tshuaj uas tiv thaiv kev ua haujlwm ntawm CYP3A4, xws li cov tshuaj tua kab mob macrolide (e.g., erythromycin), azole antifungals (e.g., ketoconazole, itraconazole), lossis protease inhibitors (e.g., ritonavir), tuaj yeem ua kom muaj kev lom zem ntxiv ntawm fentanyl, yog li nws txo qis thiab nws cov kab ke. , txhim kho, lossis nce lub sijhawm ntawm cov tshuaj opioid. Cov kua txiv kab ntxwv uas paub txog inhibit CYP3A4. Fentanyl, yog li, yuav tsum tau siv nrog ceev faj hauv cov neeg mob noj CYP3A4 inhibitors tib lub sijhawm.

Tib txhij tswj hwm ntawm lwm cov tshuaj uas muaj qhov cuam tshuam ntawm lub hauv nruab nrab cov hlab ntsha, xws li lwm yam tshuaj morphine (tshuaj loog thiab tshuaj tiv thaiv), tshuaj rau tshuaj loog, mob leeg, txo tshuaj, H 1 histamine receptor blockers nrog cov nyhuv sedative, barbiturates, tranquilizers (piv txwv li, benzodiazepines) , kev noj tshuaj tsaug zog, tshuaj tiv thaiv kev ntxhov siab, clonidine thiab cov tshuaj sib txuas tuaj yeem ua rau kom muaj kev cuam tshuam ntau dua ntawm cov nyhuv inhibitory hauv nruab nrab lub paj hlwb. Kev ua pa nyuaj siab, hypotension yuav tau sau tseg.

Ethanol txhim kho cov nyhuv sedative ntawm morphine analgesics, yog li kev siv dej cawv ib txhij los yog cov tshuaj muaj cawv nrog cov tshuaj Lunaldin tsis pom zoo.

Fentanyl tsis pom zoo rau siv rau hauv cov neeg mob tau txais MAO inhibitors dhau 14 hnub dhau los, txij li ib qho kev nce ntawm cov nyhuv ntawm opioid analgesics nrog MAO inhibitors tau pom.

Kev siv tib lub sijhawm opioid receptor antagonists (suav nrog naloxone) lossis ib feem opioid receptor agonists / antagonists (suav nrog buprenorphine, nalbuphine, pentazocine) tsis pom zoo. Lawv muaj qhov sib thooj siab siab rau opioid receptors nrog cov kev ua haujlwm tsis tshua muaj txiaj ntsig thiab yog li ntawd qee qhov txo qis kev ua haujlwm ntawm fentanyl thiab tej zaum yuav ua rau cov tsos mob tshem tawm hauv cov neeg mob opioid-dependant.

Cov tshuaj anticonvulsants, xws li carbamazepine, phenytoin, thiab hexamidine (primidone) tuaj yeem nce cov metabolism ntawm fentanyl hauv daim siab, ua kom nrawm dua nws cov kev tawm ntawm lub cev. Cov neeg mob tau txais kev kho mob nrog cov tshuaj anticonvulsants no yuav tsum tau txhaj tshuaj fentanyl ntau dua.