Yuav ua li cas siv tshuaj yaj yeeb Fendivia?

Kev piav qhia ntawm daim ntawv tshuaj

Ib lub duab plaub sib dhos ua ke nrog cov npoo sib txuam ntawm cov ntawv ua kom tshem tawm pob tshab tiv thaiv zaj duab xis. Cov tiv thaiv zaj duab xis yog qhov loj dua lub thaj. Qhov kev phais ntshav siab tau faib cov yeeb yaj kiab tiv thaiv tshem tawm tau ua ob ntu.

Cov ntawv sau hauv qab no tau thov rau lub thaj siv cov xim luam ntawv:

1) Fendivia ™ 12.5 μg / h - thaj (18 ± 0.5) mm dav, (24 ± 0.5) mm ntev: "Fentanyl 12,5 μg / teev" - xim av foob,

2) Fendivia ™ 25 μg / h - thaj (24.6 ± 0.5) mm dav, (37 ± 0.5) mm ntev: "Fentanyl 25 μg / teev" - luam ntawv liab,

3) Fendivia ™ 50 μg / h - thaj (34 ± 0.5) mm dav, (51.3 ± 0.5) hli ntev: "Fentanyl 50 μg / teev" - ntsuab foob,

4) Fendivia ™ 75 μg / h - thaj (42 ± 0.5) mm dav, (61.7 ± 0.5) mm ntev: "Fentanyl 75 μg / teev" - lub teeb xiav luam ntawv,

5) Fendivia ™ 100 μg / h - thaj (49 ± 0.5) mm dav, (70 ± 0.5) mm ntev: "Fentanyl 100 μg / teev" - grey luam tawm.

Kev ntsuas rau siv

Kev hno - mob ntawm mob hnyav thiab mob nyhav (angina pectoris, myocardial infarction, mob mob rau cov neeg mob qog nqaij hlav, mob, mob tom qab), kev kho mob ua ntej rau ntau hom kev ua kom loog nyob rau hauv kev sib xyaw nrog droperidol, antipsychotics (suav nrog thaum lub sijhawm hloov khoom nruab nrog lub hauv siab thiab lub plab hauv plab, cov hlab ntsha loj, hauv neurosurgery, nrog cov kws kho mob (gynecological, orthopedic thiab lwm yam haujlwm).

TTS yog kev mob ntsws mob uas ua rau muaj mob nyhav thiab mob hnyav: mob tshwm sim los ntawm mob cancer, mob ntawm lwm cov keeb, xav kom tus mob analgesia nrog narcotic analgesics (piv txwv, neuropathy, mob caj dab, mob sib kis ntawm Varicella zoster, thiab lwm yam).

Cov Yuav Tsum Tau Ua

Hypersensitivity, qhov kev nyuaj siab hnyav ntawm qhov chaw ua pa.

TTS - mob hnyav lossis tom qab mob (qhov tsis haum ntawm kev xaiv tshuaj txaus rau lub sijhawm kho mob luv, uas tuaj yeem ua rau mob hnyav lossis tuag taus), tawv nqaij, tsis ua haujlwm lossis puas ntawm daim tawv nqaij (ntawm daim ntawv thov), raws plab nrog pseudomembranous colitis los ntawm cephalosporins, lincosamides, penicillins, mob ua paug dyspepsia, mob ntsws ua pa nyuaj, cev xeeb tub, lactation, hnub nyoog qis dua 18 xyoo.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Hauv / hauv, hauv / m. Cov neeg laus hauv kev npaj rau kev phais mob 10-15 feeb ua ntej pib - iv, 0.05-0.1 mg fentanyl nrog 2.5-5 mg ntawm droperidol.

Rau kev tso tshuaj kom tsaug zog - iv, 0.4-0.6 mg, txhawm rau tswj kev ua kom loog - iv, 0.05-0.2 mg txhua 20-30 feeb, rau kev kho mob tom qab phais mob - iv - 0.05-0.1 mg, yog tias tsim nyog, rov ua dua koob tshuaj tom qab 1 lossis 2 teev

Txog kev kho mob ntawm kev mob nrog myocardial infarction - 0.1 mg nrog rau 5 mg ntawm droperidol (rau 3 feeb).

Cov menyuam npaj rau kev phais mob - 2 μg / kg, rau kev tso tshuaj kom tsaug zog - 10-150 μg / kg iv lossis 150-250 μg / kg iv, rau kev saib xyuas kev ua kom loog - 1-2 μg / kg iv. 2 mcg / kg v / m. Cov me nyuam qis dua 2 xyoos tsis tau tsim koob tshuaj.

Lub thaj ua rau thaj chaw siv tau 72 teev ntawm thaj chaw tiaj ntawm daim tawv (tsis txhuam, muaj plaub hau tsawg, ntxuav nrog dej huv yog tias tsim nyog, tsis tas siv xab npum thiab ziab kom qhuav) thiab nias kom nruj (daim ntawv thov rau lwm qhov chaw). Cov koob tshuaj yog xaiv tau ib tus zuj zus. Rau cov neeg mob uas tsis tau noj tshuaj opiates yav tas los, qhov tshuaj tiv thaiv thawj zaug yog 25 μg / h, nrog kev zam rau opiates thaum hloov mus rau kev kho fentanyl, thawj qhov kev txiav txim raug suav raws li cov lus sib piv, raws li qhov xav tau niaj hnub siv tshuaj loog, yog tias ib koob ntau dua 300 μg / h siv, ntxiv lossis lwm txoj kev khiav ntawm lub luag haujlwm.

Pharmacological kev txiav txim

Narcotic analgesic, opiate receptor agonist (mas mu receptors) ntawm lub hauv nruab nrab lub paj hlwb, cov leeg nraub qaum thiab cov ntaub so ntswg. Tsub kom ntau ntxiv cov haujlwm ntawm cov tshuaj tiv thaiv antinociceptive, nce qhov pib ntawm kev hnov ​​mob mob.

Lub ntsiab kev kho mob ntawm cov tshuaj yog analgesic thiab sedative. Nws muaj qhov cuam tshuam ntawm lub chaw ua pa, maj mam ua lub plawv dhia, ua kom lub siab n.vagus thiab qhov chaw ntuav, nce lub suab ntawm cov leeg du ntawm cov hlab plab, txha caj qaum (nrog rau lub qhov zis, zais zis thiab sphincter ntawm Oddi), txhim kho kev nqus ntawm dej los ntawm lub plab zom mov. Txo cov ntshav siab, plab hnyuv thiab lub raum khiav ntshav. Hauv cov ntshav nce lub siab ntawm amylase thiab lipase, txo cov tshuaj ntawm STH, catecholamines, ADH, cortisol, prolactin.

Txhawb nqa qhov pib ntawm kev pw tsaug zog (feem ntau hauv kev txuas nrog kev tshem tawm ntawm kev mob). Ua rau euphoria. Tus nqi ntawm kev txhim kho ntawm kev quav tshuaj thiab thev taus rau analgesic muaj qhov tseem ceeb rau tib neeg sib txawv.

Tsis zoo li lwm yam opioid analgesics, nws tsis tshua muaj kev ua rau histamine tsis haum.

Qhov siab tshaj plaws ua kom haum nrog i.v. kev tswj hwm txhim kho tom qab 3-5 feeb, nrog i / m - tom qab 20-30 feeb, lub sijhawm siv tshuaj nrog ib tus i / v tswj hwm txog li 100 mcg yog 0.5-1 teev, nrog i / m tswj hwm raws li cov koob tshuaj ntxiv - 1-2 teev, thaum siv TTS - 72 teev

Sab sij huam

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 zaus - mob taub hau, tsaug zog (suav nrog cov menyuam tshiab), tsawg dua - kev nyuaj siab ntawm lub hauv nruab nrab lub paj hlwb (suav nrog tom qab phais mob), tsis meej pem ntxhov siab ntawm lub hauv nruab nrab lub paj hlwb, delirium, qaug dab peg, tsawg dua - kev pom kev plooj plooj, pom kev, muaj kev npau suav, nco tsis meej, tsis muaj qhov tseeb ntau zaus - tsis meej pem, pom kev zoo siab, hnov ​​dias ntsej muag, mob taub hau, mob ntshav siab.

Los ntawm lub plab zom mov: ntau zaus - xeev siab, ntuav, tsis tshua ntau zaus - maj mam, spasm ntawm tus kheej ntawm Oddi, qeeb qeeb ntawm lub plab zom mov, cem quav, biliary colic (hauv cov neeg mob uas muaj keeb kwm ntawm lawv).

Los ntawm CCC: ntau zaus - bradycardia, txo qis ntshav siab, tsawg dua - txwv tsis pub cuam tshuam ntawm CCC yam haujlwm, mus txog rau lub plawv dhia.

Los ntawm cov kab mob txeeb zis: spasm ntawm txoj hlab zis, tso zis cia.

Kev tsis haum tshuaj - tsawg dua - cov tawv nqaij ua xua, laryngospasm, ua daus no, mob pruritus, bronchospasm.

Cov tshuaj tiv thaiv hauv zos (thaum siv thaj ua rau thaj): khaus, tawm pob, yaug tawm ntawm daim tawv nqaij (ploj li 24 teev tom qab tshem lub thaj), hlawv.

Lwm yam: mob leeg lub cev tsis ntev (nrog rau lub hauv siab mob), tawm hws, kev quav yeeb tshuaj, tshem tawm cov tsos mob (mob vague, mob plab, mob plab, mob rwj, txham txha, txhaws qa, tawm hws, tsis nco qab haus huv, xeev siab, ntuav, ntov, nkees) txob taus, tshee, lub cev qiag, qhov tsis muaj zog dav dav), thev taus.

Cov lus qhia tshwj xeeb

Cov tshuaj yuav tsum tsuas yog siv los ntawm cov neeg ua haujlwm hauv cov tsev kho mob tshwj xeeb. Hauv sijhawm tom qab tas, tus neeg mob xav tau kev saib xyuas kom zoo.

Hauv cov neeg mob uas txo lub cev qhov hnyav thaum ua haujlwm ntev lossis thaum muaj qee zaus rov qab siv fentanyl, kev nce siab hauv lub sijhawm nws ua tau.

Nws nce qhov kev ua haujlwm ntawm ntshav amylase thiab lipase vim yog qhov teeb meem ntawm lub sphincter ntawm Oddi thiab nce siab nyob rau hauv biliary system (kev kawm txog cov enzymes no yuav tsum tau nqa tawm ob peb teev ua ntej kev siv fentanyl, lossis 24 teev tom qab nws tswj hwm).

Txoj kev tshawb radionuclide qeeb qeeb pom kev ua haujlwm ntawm tus mob hepatobiliary vim muaj qhov tsis sib xws ntawm cov txha caj qaum ntawm Oddi.

Yog tias tsim nyog, kev teem sij hawm tshuaj thaum lactation yuav tsum tsis pub mis niam.

Kev siv thaj ua rau tsis pom zoo rau mob hnyav lossis ntev tom qab mob (vim yog qhov tsis muaj peev xwm xaiv ib koob tshuaj rau lub sijhawm luv thiab kev pheej hmoo ntawm hypoventilation), hauv cov pojniam muaj hnub nyoog deev thiab xav kom ceev faj txog mob ntsws ntev, suav nrog COPD (tej zaum kev nyuaj siab ntawm lub chaw ua pa), ua rau tsis nco qab, hnov ​​qab, hlwb hlav, bradyarrhythmias, mob siab thiab lub raum tsis ua haujlwm, hauv qhov laus thiab menyuam yaus.

Thaum siv thaj ua rau thaj, nws raug nquahu kom tsis txhob muaj qhov sib kis ntawm cov khoom siv sab nraud ntawm cua sov (cua sov ncoo, saunas, da dej hnub, thiab lwm yam).

Thaum kho, koj yuav tsum tsis txhob koom rau hauv cov haujlwm uas yuav muaj kev phom sij uas xav tau kev saib xyuas ntau dua thiab nrawm dua cov kev puas hlwb.

Kev sib txuam

Dinitrogen oxide txhim kho cov leeg ua kom nruj, tricyclic antidepressants, opiates, sedatives thiab hypnotics, phenothiazines, yeeb tshuaj anxiolytic (tshuaj tiv thaiv kab mob), tshuaj rau cov tshuaj loog dav dav, peripheral leeg relaxants, antihistamines, uas muaj sedative cuam tshuam thiab lwm yam pov thawj, ethanol. CNS kev nyuaj siab, kev mob siab, kev mob ntshav tawm ntshav, kev npau taws, mob ntsws ua pa hauv lub cev, thiab lwm yam).

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, corticosteroids, antihypertensive tshuaj.

MAO inhibitors nce ntxiv ntawm kev pheej hmoo ntawm cov teeb meem loj.

Cov leeg ua kom cov leeg ua rau tiv thaiv lossis tshem tawm cov leeg ua kom nruj, cov leeg ua kom so nrog m-anticholinergic kev ua si (suav nrog pancuronium bromide) txo txoj kev pheej hmoo ntawm bradycardia thiab hypotension (tshwj xeeb tshaj yog thaum beta-blockers thiab lwm yam vasodilators siv) thiab tej zaum yuav muaj kev pheej hmoo ntawm tachycardia, myorrheal kub siab uas tsis muaj 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 qhov kev pheej hmoo loj full-time los ntawm lub CCC.

Cov Tshuaj Hauv Tshuaj

Fndanyl yog ib qho transdermal thaj uas muab cov khoom fentanyl txuas ntxiv mus rau 72 teev Fentanyl yog opioid analgesic nrog kev sib nkag siab tshwj xeeb rau opiate ors receptors ntawm lub nruab nrab lub paj hlwb, txha caj qaum, thiab peripheral cov ntaub so ntswg. Tsub kom ntau ntxiv cov haujlwm ntawm cov tshuaj tiv thaiv antinociceptive, nce qhov pib ntawm kev hnov ​​mob mob. Cov tshuaj Fendivia ™ feem ntau muaj kev ua kom loog thiab sedative. Fentanyl muaj qhov cuam tshuam uas ua rau lub chaw ua pa tsis txaus, ua rau lub plawv dhia tuaj, ua rau muaj lub siab xav n.vagus thiab qhov chaw ntuav, nce lub suab nrov ntawm cov nqaij ntshiab ntawm cov nplais plab, cov leeg txha caj qaum (suav nrog cov tso zis, tso zis thiab tso pa tawm ntawm Oddi), txhim kho kev nqus ntawm dej los ntawm cov hnyuv. Txo cov ntshav siab, plab hnyuv thiab lub raum khiav ntshav. Hauv cov ntshav nce lub siab ntawm amylase thiab lipase, txo cov tshuaj ntawm STH, catecholamines, ACTH, cortisol, prolactin. Txhawb nqa qhov pib ntawm kev pw tsaug zog (feem ntau hauv kev txuas nrog kev tshem tawm ntawm kev mob). Ua rau euphoria. Tus nqi ntawm kev txhim kho ntawm kev quav tshuaj thiab thev taus rau analgesic muaj qhov tseem ceeb rau tib neeg sib txawv. Tsis tshua muaj neeg ua rau cov tshuaj tiv thaiv histamine.

Cov Tshuaj Pharmacokinetics

Kev siv tshuaj loog tsawg tshaj plaws ntawm fentanyl hauv cov ntshav ntshav hauv cov neeg mob uas tsis tau siv yav dhau los ua opioid analgesics yog 0.3-1.5 ng / ml. Qhov ntau zaus tsis muaj kev cuam tshuam hauv cov neeg mob li no nce nrog kev fentanyl hauv cov ntshav ntshav saum toj 2 ng / ml. Nrog rau kev txhim kho kev ua siab ntev, ob qho tib si yam tsawg kawg nkaus analgesic concentration ntawm fentanyl ntau ntxiv thiab cov kev xav ntawm yam tsis xav tau tshwm sim.

Xuas. Tom qab thawj daim ntawv thov hloov kho thaj chaw, qhov kev xav ntawm fentanyl hauv cov ntshav cov ntshav nce siab zuj zus, feem ntau yog qib ntawm 12 thiab 24 teev, thiab tom qab ntawd tseem nyob ruaj khov rau lub sijhawm 72 teev. Los ntawm daim ntawv thov 72-teev thib ob ntawm thaj hloov transdermal, ib qho kev sib xyaw ua ke ntawm fentanyl hauv cov ntshav cov ntshav tau tiav, uas tseem nyob thaum cov ntawv thov tom qab ntawm lub thaj ntawm tib qho loj me. Qhov kev xav ntawm fentanyl hauv cov ntshav yog sib npaug rau qhov loj ntawm qhov hloov transdermal. Kev nqus ntawm fentanyl yuav txawv me ntsis nyob ntawm qhov chaw thov. Txoj kev nqus me ntsis ntawm fentanyl (kwv yees li 25%) tau pom nyob rau hauv cov kev tshawb fawb ua nrog cov neeg ua haujlwm noj qab haus huv thaum lub sijhawm thov thaj ntawm lub hauv siab piv rau daim ntawv thov ntawm sab caj npab thiab sab nraub qaum.

Kev xa Khoom. Fentanyl khi rau cov ntshav plasma ntau npaum li 84%, dhau los ntawm BBB, cov hnoos ntshav, thiab mus rau hauv niam mis.

Kev zom zaub mov. Fentanyl muaj cov kab ke tawm ntawm biotransformation tawm thiab yog feem ntau ua rau lub siab los ntawm cov enzymes CYP3A4. Lub ntsiab metabolite ntawm fentanyl yog norfentanil, uas tsis nquag.

Chaw Sau Ntawv. Tom qab tshem tawm thaj ua rau thaj chaw transdermal, cov tshuaj fentanyl hauv cov ntshav cov ntshav tsawg zuj zus. T_1/2 fentanyl tom qab thov daim ntawv hloov transdermal yog 17 teev (13-22 teev) rau cov laus thiab 22-25 teev hauv cov menyuam yaus. Kev txuas ntxiv nqus ntawm fentanyl los ntawm lub ntsej muag ntawm daim tawv nqaij ua rau qhov kev tshem tawm qis dua ntawm cov tshuaj los ntawm cov ntshav cov ntshav piv nrog kev tswj hwm iv. Kwv yees li 75% ntawm fentanyl yog cov tawm hauv cov zis, feem ntau hauv cov tshuaj metabolites, tsawg dua 10% yog tsis hloov, kwv yees li 9% yog tawm hauv cov quav, feem ntau yog hauv cov tshuaj metabolites.

Pab Pawg Neeg Tshwj Xeeb

Lub siab ua haujlwm lossis lub raum tsis zoo tuaj yeem ua rau nce siab ntxiv cov fentanyl concentration. Hauv cov neeg laus, debilitated, lossis debilitated cov neeg mob, txo qis fentanyl clearance yog ua tau, uas tuaj yeem ua rau kom ntev dua T_1/2 fentanyl.

Cov menyuam. Ua raws li lub cev qhov hnyav, kev tshem tawm (l / h / kg) yog 82% siab dua rau cov menyuam yaus ntawm 2 txog 5 xyoo thiab 25% ntau dua hauv cov menyuam ntawm 6 txog 10 xyoo piv rau cov menyuam hnub nyoog 11 txog 16 xyoo uas muaj qhov zoo li no clearance tib yam li cov neeg laus.

Cev xeeb tub thiab lactation

Qhov kev nyab xeeb ntawm kev hloov kab mob nrog cov fentanyl thaum cev xeeb tub tsis tau tsim. Cov kev tshawb fawb tsiaj tau teeb tsa qee qhov kev ua me nyuam yaus muaj tshuaj lom.

Fentanyl tsuas yog siv thaum cev xeeb tub yog tsim nyog kiag li. Siv sijhawm ntev heev thaum cev xeeb tub tuaj yeem ua rau tshem tawm cov tsos mob hauv cov menyuam mos. Tsis tshua muaj neeg, tau tshaj tawm cov tsos mob ntawm kev tshem tawm cov tsos mob hauv cov menyuam tshiab uas lawv niam pheej siv thaj ua rau hloov pauv nrog fentanyl thaum cev xeeb tub.

Fentanyl yuav tsum tsis txhob siv thaum lub zog thiab kev yug menyuam (suav nrog kev phais mob), raws linws hla dhau lub tsho me nyuam thiab tuaj yeem ua rau mob ntsws ua rau muaj menyuam lossis menyuam mos tshiab.

Fentanyl ua rau cov kua mis tawm thiab yuav ua rau mob sedative thiab mob ntsws ua pa rau tus menyuam noj leej niam mis. Yog li, yog tias tsim nyog, kev teem caij noj cov tshuaj Fendivia ™ thaum lactation yuav tsum tsis pub mis niam (rau tag nrho lub sijhawm ntawm kev siv thiab tsis pub tsawg dua 72 xuaj moos tom qab siv kawg).

Tsuas tshuaj thiab tswj hwm

Qhov hloov pauv hloov tso fentanyl hauv 72 teev. Qhov fentanyl tso tawm yog 12.5, 25, 50, 75 thiab 100 μg / h, uas yog kwv yees li 0.3, 0.6, 1.2, 1.8 thiab 2.4 mg / hnub, ntsig txog.

Cov koob tshuaj yuav tsum tau fentanyl raug xaiv ib tus zuj zus, suav txog tus neeg mob tus mob, thiab yuav tsum tau kuaj xyuas tsis tu ncua. Kev noj tshuaj qis qis yuav tsum siv.

Thawj zaug xaiv tshuaj

Thawj qhov kev siv ntawm fentanyl yog tsim nyob ntawm theem ntawm kev siv tshuaj opioid nyob rau lub sijhawm dhau los, nrog rau kev txiav txim siab txoj kev txhim kho ntawm kev mob siab rau, kev siv tshuaj yeeb, kev noj qab haus huv thiab kev kho mob ntawm tus neeg mob, i.e. lub cev loj, lub hnub nyoog thiab cov degree ntawm kev qaug, qhov hnyav ntawm tus kab mob.

Cov neeg laus tau kho tus mob opioids

Txhawm rau hloov cov neeg mob uas tau txais opioids yav dhau los los ntawm kev tswj hwm qhov ncauj lossis kev tswj hwm ntawm opioids rau hloov kho thaj, Daim Ntawv 1 yuav tsum tau siv.Yog tsim nyog, qhov tshuaj yuav tuaj yeem hloov kho rau sab hauv lossis qis dua los ntawm 12.5 lossis 25 μg / h kom xaiv qhov siv tshuaj qis kawg nkaus nyob ntawm tus neeg mob teb thiab xav tau ntxiv tshuaj kho mob.

Cov neeg laus tsis tau kho dua nrog opioids

Raws li txoj cai, kev tswj hwm hloov chaw tsis pom zoo rau cov neeg mob uas tsis tau txais tshuaj opioids yav dhau los. Lwm txoj hauv kev ntawm kev tswj hwm (qhov ncauj, niam txiv) yuav tsum raug txiav txim. Txhawm rau kom tsis txhob noj tshuaj ntau tshaj nyob rau hauv cov neeg mob uas tsis tau txais tshuaj opioids yav dhau los, nws raug nquahu tias tsawg kawg ntawm kev tso tshuaj opioids tam sim ntawd yuav tsum tau kho (suav nrog morphine, hydromorphone, oxygencodone, tramadol thiab codeine), cov koob tshuaj uas yuav tsum tau xaiv kom nws phim rau qhov hloov kho kom haum rau kev kho mob. ntawm qhov ntau npaum ntawm 12.5 lossis 25 mcg / h. Tom qab ntawd, cov neeg mob tuaj yeem hloov mus rau kev siv cov tshuaj Fendivia ™.

Hauv cov xwm txheej uas tsis muaj qhov ncauj ntawm opioids tsis tau thiab siv qhov hloov kho kom pom tau tias tsuas yog txoj hauv kev kho mob nkaus xwb, kev siv Fendivia ™ yuav tsum tau pib nrog kev siv tshuaj tsawg kawg 12.5 μg / h. Hauv cov xwm txheej zoo li no, yuav tsum muaj kev saib xyuas tshwj xeeb ntawm tus neeg mob.

Muaj kev pheej hmoo ntawm mob hnyav lossis tuag taus pa nyuaj siab txawm tias ntau npaum li 12.5 μg / h ntawm Fendivia ™ raug siv rau hauv cov neeg mob uas tsis tau txais tshuaj opioids yav dhau los.

Hloov los ntawm kev noj lwm cov opioids

Thaum tus neeg mob hloov los ntawm qhov ncauj lossis kev tswj hwm hauv chaw kho mob ntawm opioid analgesics mus rau kev kho fentanyl, thawj zaug tshuaj ntawm Fendivia ivia yog suav raws li cov hauv qab no.

1) Tus lej ntawm opioid analgesics xav tau los ntawm tus neeg mob dhau 24 teev (mg / hnub) yuav tsum tau txiav txim siab.

2) Qhov nyiaj tau txais yuav tsum pauv mus rau qhov tsim nyog noj tshuaj ntawm qhov ncauj txhua hnub ntawm morphine (mg / hnub) siv cov lus 1.

3) Cov koob tshuaj uas tsim nyog ntawm fentanyl raug txiav txim siab siv cov ntxhuav 2 thiab 3.

Cov ntxhuav 2 thiab 3 yuav tsum tsis txhob siv los hloov pauv hloov chaw rau lwm cov opioids kom tsis txhob muaj tshuaj ntau dhau. Qhov no tuaj yeem ua rau muaj kev txwv ntau dhau.

Cov lus hloov pauv - coefficients rau kev hloov pauv ntawm cov tshuaj txhua hnub ntawm cov tshuaj opioids yav dhau los rau qhov sib npaug analgesic niaj hnub noj tshuaj ntawm morphine (mg / hnub ntawm opioid e coefficient = sib npaug analgesic niaj hnub noj tshuaj ntawm morphine)

thiab Cov kev ua ntawm qhov ncauj lossis intramuscularly siv morphine yog raws li kev paub hauv cov neeg siv tshuaj hauv cov neeg mob uas muaj mob mob.

b Raws li cov kev tshawb fawb nrog ib tus kws kho mob i / m ntawm txhua qhov ntawm opioid analgesics uas teev saum toj no, ua los tsim lawv cov haujlwm kev ua haujlwm piv nrog morphine. Cov koob tshuaj rau kev tswj hwm ntawm qhov ncauj yog qhov koob tshuaj pom zoo thaum hloov los ntawm niam txiv mus rau qhov ncauj ntawm kev tswj hwm tshuaj.

Qhov pom zoo kom pib txhaj tshuaj ntawm Fendivia ™ nyob ntawm kev noj tshuaj ntawm lub cev txhua hnub ntawm morphine (rau cov neeg mob tsis tshua muaj neeg laus cov neeg mob uas xav tau hloov opioid: qhov sib piv ntawm kev hloov pauv los ntawm cov ncauj lus morphine rau kev hloov kho ntawm fentanyl yog 150: 1)

Qhov pom zoo kom pib txhaj tshuaj ntawm Fendivia ™ nyob ntawm qhov ncauj niaj hnub ntawm morphine (rau cov neeg laus cov neeg mob nyob ruaj khov, kev tiv thaiv zoo opioid txoj kev kho: qhov piv ntawm kev hloov pauv ntawm qhov ncauj siv morphine rau kev hloov kho ntawm fentanyl yog 100: 1)

Qhov kev ntsuas thawj zaug ntawm qhov siab tshaj plaws ua haujlwm ntawm cov tshuaj Fendivia ™ tuaj yeem nqa tawm tsis dhau 24 teev tom qab thov. Qhov kev txwv no yog vim qhov tseeb tias ib qho kev nce ntxiv ntawm fentanyl hauv cov ntshav cov ntshav hauv thawj 24 teev tom qab kev siv daim ntawv hloov transdermal tshwm sim maj. Yog li no, thaum hloov los ntawm ib cov tshuaj mus rau lwm qhov, cov tshuaj kho mob yav dhau los yuav tsum tau maj mam txiav tawm tom qab daim ntawv thov ntawm thawj koob tshuaj ntawm Fendivia ™ kom txog thaum nws cov nyhuv analgesic nyob ruaj khov.

Koob xaiv thiab kho kev kho

Thaj chaw transdermal yuav tsum hloov nrog lub tshiab txhua txhua 72 teev.

Cov koob tshuaj tau xaiv ib tus zuj zus kom txog qhov pom tau zoo ntawm theem ntawm kev ua kom loog thiab kev tiv taus tshuaj ntawm Fendivia ™ tau tiav. Feem ntau, thaum lub sijhawm 1, qhov koob tshuaj nce ntxiv 12,5 lossis 25 mcg / h. Txawm li cas los xij, thaum kho cov koob tshuaj, nws yog ib qho tsim nyog yuav tsum tau coj mus rau hauv tus neeg mob tus mob thiab qhov xav tau ntxiv analgesia (noj ntawm qhov ncauj ntawm morphine 45 thiab 90 mg / hnub yog kwv yees li ntawm cov koob tshuaj 12,5 thiab 25 μg / h ntawm cov tshuaj Fendivia respectively, feem). Tom qab nce qhov koob tshuaj, tus neeg mob yuav tsum siv sijhawm ntev txog 6 hnub kom ua tiav kev mob siab ruaj khov.

Vim li no, tom qab nce qhov koob tshuaj, nws yog qhov tsim nyog los siv qhov hloov pauv ntawm cov tshuaj ntau dua tsawg kawg 2 zaug rau 72 teev. Tsuas yog tom qab no, qhov tshuaj ntxiv yuav ua tau yog tias qhov mob nyem tsis txaus.

Txhawm rau kom tau txais koob tshuaj ntau dua 100 mcg / h, ntau daim ntawv hla chaw tuaj yeem siv tau ib txhij. Yog tias kev mob hla kev mob, cov neeg mob qee zaum xav tau ntxiv cov koob tshuaj luv luv ua kom loog. Yog tias qhov koob tshuaj ntawm Fendivia ™ tshaj li 300 mcg / h, yuav tsum tau txais kev pom zoo siv ntxiv lossis lwm txoj hauv kev kho mob lossis lwm txoj hauv kev ntawm kev tswj hwm opioid analgesics.

Tsuas yog thaum pib ntawm txoj kev kho, yog tias tom qab thov kev siv thawj zaug muaj qhov txo qhov mob nyhuv txig, qhov thaj tuaj yeem hloov tom qab 48 teev nrog ib thaj ntawm cov tshuaj tib, thiab tom qab 72 teev koob tshuaj tuaj yeem nce ntxiv.

Yog tias nws yog qhov yuav tsum tau hloov kho cov tawv nqaij transdermal ntev txog 72 teev (piv txwv li, yog tias cov ntaub ntawv tau xeb tawm), ib thaj ntawm tib cov tshuaj yuav tsum tau lo rau lwm thaj chaw ntawm daim tawv. Ib qho xwm txheej zoo sib xws tuaj yeem ua rau muaj qhov nce ntxiv ntawm fentanyl hauv cov ntshav ntshav, thiab yog li tus neeg mob xav tau kev saib xyuas ze.

Thaum hloov los ntawm kev kho mob mus ntev nrog morphine hloov mus rau ib qho kev hloov pauv nrog fentanyl, kev tshem tawm cov tsos mob yuav tshwm sim txawm hais tias siv tshuaj loog txaus siv. Thaum cov tsos mob tshem tawm tshwm sim, nws raug nquahu tias cov neeg mob tau txais morphine ua yeeb yam luv luv hauv kev txhaj tshuaj tsawg.

Discontinuation ntawm Fendivia ™

Yog tias nws yog qhov yuav tsum tau cuam tshuam los ntawm kev siv transdermal thaj, ces lwm yam opioids yuav tsum tau hloov maj mam pib, pib nrog kev siv tshuaj tsawg thiab maj mam nce ntxiv. Qhov no yog vim qhov tseeb hais tias cov ntsiab lus ntawm fentanyl nyob rau hauv cov ntshav cov ntshav tom qab tshem tawm ntawm thaj hloov transdermal poob qis. Tsawg kawg 20 teev yuav tsum ua kom txo tau cov ntshav fentanyl txog 50 %. Muaj ib txoj cai dav dav: tshem tawm qhov quav nrog opioid analgesics yuav tsum tau maj mam ua kom tsis txhob tshem tawm cov tsos mob (xeev siab, ntuav, raws plab, ntxhov siab thiab mob leeg).

Siv rau cov neeg mob laus

Cov neeg laus yuav tsum ua tib zoo ntsuam xyuas thiab saib xyuas. Yog tias tsim nyog, cov koob tshuaj ntawm Fendivia ™ yuav tsum tau txo qis (saib "Cov Lus Qhia Tshwj Xeeb"). Hauv cov neeg mob laus uas tsis tau txais tshuaj opioids yav dhau los, Fendivia ™ tsuas yog siv yog tias cov txiaj ntsig tshaj qhov txaus ntshai. Raws li kev siv thawj zaug, tsuas yog 12.5 mcg / h yuav tsum tau siv.

Siv rau hauv cov neeg mob uas muaj lub siab thiab lub raum tsis ua haujlwm

Cov neeg mob uas muaj lub siab thiab lub raum tsis ua haujlwm yuav tsum tau ua tib zoo soj ntsuam thiab saib xyuas cov cim ntawm kev noj haus ntau tshaj ntawm fentanyl thiab, yog tias tsim nyog, cov koob tshuaj Fendivia ™ yuav tsum tau txo qis (saib "Cov Lus Qhia Tshwj Xeeb").

Hauv cov neeg mob uas muaj lub siab thiab lub raum tsis ua haujlwm uas yav dhau los tsis tau txais opioids, Fendivia ™ yuav tsum tau siv yog tias cov txiaj ntsig zoo dua qhov txaus ntshai. Raws li kev siv thawj zaug, tsuas yog 12.5 mcg / h yuav tsum tau siv.

Siv rau hauv cov neeg mob kub taub hau / hauv qab ntawm cov khoom cua kub sab nraud

Cov neeg mob ua npaws tej zaum yuav tsum tau txhaj tshuaj fentanyl (saib "Cov Lus Qhia Tshwj Xeeb").

Siv rau hauv cov menyuam yaus hnub nyoog 16 xyoo thiab laus dua

Kev muab tshuaj rau cov menyuam muaj hnub nyoog 16 xyoos zoo ib yam li tshuaj noj rau lub sijhawm laus.

Siv rau hauv cov menyuam yaus txij li 2 txog 16 xyoos

Cov tshuaj Fendivia ™ tsuas yog siv rau cov menyuam yaus uas tau txais morphine sib npaug hauv qhov ntau npaum li 30 mg / hnub. Thaum hloov los ntawm kev tswj hwm qhov ncauj lossis kev tswj hwm ntawm opioid analgesics mus rau qhov hloov pauv nrog fentanyl hauv cov menyuam yaus, thawj koob tshuaj yog suav siv cov ntxhuav 1 thiab 4.

Qhov pom zoo kom pib txhaj koob tshuaj Fendivia ™ rau cov menyuam yaus hnub nyoog 2 txog 16 xyoo a, nyob ntawm seb txhua hnub noj ntau npaum li cas ntawm morphine b

Qhov Hloov Hloov ntawm cov tshuaj fentanyl ntau dua 25 mcg / h tsis txawv rau cov menyuam yaus thiab cov neeg laus (saib cov lus 2).

b Hauv kev sim kho mob, cov kev txwv tsis pub qhia qhov ncauj tshuaj morphine txhua hnub tau siv los laij cov hloov chaw ntawm tus neeg mob mus rau Fendivia ™.

Hauv ob txoj kev tshawb nrhiav hauv cov menyuam yaus, qhov xav tau qhov ntau ntawm cov hloov transdermal tau suav nrog kev ceev faj: ntawm 30 txog 44 mg / hnub ntawm morphine, qhov ncauj lossis qhov sib npaug ntawm lwm cov tshuaj opioid analgesics, tau hloov los ntawm ib qho transdermal thaj ntawm qhov tshuaj ntawm 12.5 μg / h. Qhov kev hloov pauv no rau cov menyuam yaus tsuas yog siv thaum hloov morphine ntawm qhov ncauj (lossis nws sib npaug) nrog cov kab sib hloov. Yuav siv tsis tau tus txheej txheem hloov los ntawm fentanyl mus rau lwm qhov opioid analgesics, vim tias qhov no ib qho kev noj ntau tshaj yuav tshwm sim.

Cov nyhuv ua kom tsis haum qhov tshuaj tiv thaiv thawj zaug ntawm qhov hloov pauv hloov pauv nrog fentanyl tsis ncav qib siab tshaj plaws thaum thawj 24 teev. Yog li ntawd, nyob rau thawj 12 teev tom qab hloov mus rau cov tshuaj Fendivia ™, tus neeg mob yuav tsum tau txais kev kho mob yav dhau los ntawm analgesics. Dhau 12 teev tom qab, cov neeg mob yuav tsum tau muab cov tshuaj loog rau raws li qhov xav tau kho mob.

Txij li theem ntawm fentanyl hauv cov ntshav nce mus txog nws qhov txiaj ntsig siab tshaj plaws tom qab 12-24 teev, nws raug nquahu kom soj ntsuam cov neeg mob rau cov kev mob tshwm sim, uas yuav suav nrog kev nyuaj siab mob ntsws tsawg kawg 48 teev tom qab pib hloov kho thaj ua rau thaj chaw kho lossis tom qab nce cov koob tshuaj (saib "Cov lus qhia tshwj xeeb" )

Koob xaiv thiab tu txoj kev kho hauv cov menyuam yaus txij 2 txog 16 xyoo

Qhov hloov pauv yuav tsum tau hloov nrog lub tshiab txhua txhua 72 teev. Cov koob tshuaj yog xaiv tau ib tus zuj zus kom txog qhov zoo tshaj plaws ntawm theem ntawm kev tso tshuaj tiv thaiv thiab thev taus ntawm cov tshuaj Fendivia ™ tau tiav. Yog tias qhov ua kom loog rau lub cev ntawm Fendivia ™ yog qhov tsis txaus, morphine lossis lwm qhov kev ua haujlwm luv luv opioid analgesic yuav tsum tau kho. Nyob ntawm qhov xav tau ntxiv rau kev ua kom loog thiab mob hnyav ntawm tus menyuam, ua rau muaj kev nce siab ntau ntxiv. Koob tshuaj yuav tsum tau nqa tawm maj, nyob rau hauv nce ntawm 12.5 mcg / h. Cov koob tshuaj yuav tsum tsis txhob nce ntau tshaj ib zaug txhua 72 teev.

Cov kab mob hloov pauv yuav tsum siv rau thaj chaw tiaj tiaj ntawm daim tawv nqaij sab nraud thiab txawv ntawm lub duav lossis xub pwg. Qaum sab nraub qaum yog qhov chaw zoo tshaj plaws rau kev thov daim tawv nqaij hloov chaw hauv cov menyuam yaus. Nrog rau daim ntawv thov no, qhov ntxim nyiam ntawm kev tshem tawm tus kheej ntawm thaj transdermal los ntawm cov menyuam yaus raug txo kom tsawg.

Rau kev thov, nws raug nquahu kom xaiv ib qho chaw nrog cov plaub hau tsawg kawg (zoo dua yog tias tsis muaj plaub hau). Ua ntej thov cov plaub hau ntawm qhov chaw thov yuav tsum txiav tawm (tsis txhob chais. Yog tias qhov chaw thov yuav tsum tau ntxuav ua ntej siv thaj chaw transdermal, qhov no yuav tsum tau ua nrog dej huv. Tsis txhob siv xab npum, tshuaj pleev, roj, dej cawv lossis lwm yam, txhais tau tias yog lawv tuaj yeem ua rau tawv nqaij tawv lossis hloov nws lub zog. Ua ntej daim ntawv thov, daim tawv nqaij yuav tsum qhuav kiag li.

Txij li cov kab mob transdermal muaj kev tiv thaiv los ntawm cov dej tsis muaj txheej txheem tiv thaiv zaj duab xis, nws tsis tuaj yeem muab tshem tawm thaum nyob ib ntus luv luv hauv da dej.

Qhov hloov pauv hloov tawm ntawm lub pob los ntawm dabtsi yog khoov ib feem tsis muaj ze ntawm qhov taw ntawm xub thiab ua tib zoo ntuag cov khoom ntim pob.

Hloov thaj chaw yuav tsum tau thov tam sim ntawd tom qab tshem tawm los ntawm lub pob, tsis tas kov nws cov nplaum sab. Tom qab tshem cov zaj duab xis tiv thaiv, thaj chaw hloov pauv yuav tsum tau muab nias kom khov nrog lub xib teg ntawm tes mus rau qhov chaw ntawm daim ntawv thov ntev li 30 vib nas this. Nco ntsoov tias daim tawv nqaij transdermal yog nruj rau daim tawv nqaij, tshwj xeeb tshaj yog nyob ib ncig ntawm cov npoo. Yuav tsum tau kho kho thaj ntxiv. Tom qab ntawd ntxuav koj txhais tes nrog dej huv.

Lub thaj yuav tsum hnav tas li rau 72 teev, tom qab ntawd nws yuav tsum tau hloov nrog thaj hloov tshiab. Daim npog hloov tshiab yuav tsum tau siv rau lwm thaj tsam ntawm daim tawv nqaij, tsis txhob sau rau qhov chaw ntawm daim ntawv thov dhau los. Nyob rau tib qhov chaw ntawm daim ntawv thov, thaj hloov pauv yuav tuaj yeem thov dua tsis muaj ntxov dua tom qab 7 hnub.

Soj ntsuam cov kab mob ua ntej hloov ua ntej siv.

Cov kab mob hloov pauv yuav tsum tsis txhob faib lossis txiav (saib "Cov Lus Qhia Tshwj Xeeb").

Noj ntau dhau

Kev overdose ntawm fentanyl ua tau nws tus kheej hauv daim ntawv ntawm kev nce hauv nws cov txiaj ntsig pharmacological, qhov hnyav tshaj plaws uas ua rau mob ntsws ua pa.

Cov tsos mob ua tsis taus pa, coma, kev nyuaj siab ntawm lub chaw ua pa nrog Cheyne-Stokes ua pa thiab / lossis cyanosis. Lwm cov tsos mob yuav suav nrog hypothermia, txo lub suab nqaij, bradycardia, arterial hypotension. Cov tsos mob ntawm kev mob toxicity suav nrog kev ua kom tsaug zog, ataxia, miosis, mob nriaj, thiab ua pa nyuaj siab.

Kev Kho Mob: kev tshem tawm ntawm thaj chaw hloov kho, kev tswj hwm ntawm ib qho tshwj xeeb antagonist - naloxone, lub cev lossis lub cev muaj kev cuam tshuam ntawm tus neeg mob, cov tsos mob thiab txhawb kev ua haujlwm tseem ceeb (nrog rau kev tswj hwm ntawm cov leeg mob, kev siv lub tshuab ua pa, nrog bradycardia - kev tswj hwm ntawm atropine, nrog lub cim txo cov ntshav siab - rov qab los ntawm BCC )

Qhov pom zoo kom pib noj rau cov neeg laus yog 0.4–2 mg iv naloxone. Yog tias tsim nyog, koj tuaj yeem muab koob tshuaj rau txhua 2-3 feeb los yog sau ntawv siv lub sijhawm ntev li 2 mg ntawm naloxone yaj hauv 500 ml ntawm 0.9% sodium chloride tov lossis 5% dextrose daws (0.004 mg / ml). Kev tswj hwm tus nqi yuav tsum tau muab kho kom zoo rau hauv qhov kev txiav txim siab ua ntej thiab ua rau tus neeg mob teb.

Yog tias kev ua kom zoo nkauj tsis tuaj yeem ua tau, ces naloxone yuav raug muab tshuaj rau cov tshuaj intramuscularly lossis s / c. Tom qab i / m lossis s / c tswj hwm ntawm naloxone, qhov pib ntawm kev ua yuav qeeb qeeb piv rau i / v tswj hwm. Kev tswj hwm intramuscular muab cov txiaj ntsig ntev dua li kev tswj hwm intravenous.

Kev ua pa nyuaj siab vim yog noj ntau tshaj yuav nyob ntev dua li cov nyhuv ntawm opioid antagonist. Tshem cov nyhuv analgesic tuaj yeem ua rau nce ntxiv ntawm kev mob hnyav thiab tso cov catecholamines tawm. Yog tias tsim nyog, tus neeg mob yuav tsum tau kho nyob hauv chav saib xyuas mob hnyav.

Daim ntawv noj tshuaj:

transdermal kev kho kab mob (TTC)

Yam tshuaj muaj sia:
Cov Fendivia ™ 12.5 μg / teev: Txhua TTC muaj 1.38 mg ntawm fentanyl hauv thaj 4.2 cm² thiab tso fentanyl ntawm tus nqi ntawm 12.5 μg / hr.
Fendivia ™ 25 μg / teev: Txhua TTC muaj 2.75 mg ntawm fentanyl hauv thaj ntawm 8.4 cm² thiab tso fentanyl ntawm tus nqi ntawm 25 μg / hr.
Fendivia ™ 50 μg / teev: Txhua TTC muaj 5.50 mg ntawm fentanyl hauv thaj ntawm 16,8 cm² thiab tso fentanyl ntawm tus nqi ntawm 50 μg / teev.
Fendivia ™ 75 μg / teev: Txhua TTC muaj 8,25 mg fentanyl hauv thaj ntawm 25,2 cm² thiab tso fentanyl ntawm tus nqi ntawm 75 μg / teev.
Fendivia ™ 100 μg / teev: Txhua TTC muaj 11.00 mg fentanyl hauv 33.6 cm² thaj thiab tso fentanyl ntawm tus nqi ntawm 100 μg / teev.
Cov muaj tswv yim:
1) Txheej tiv thaiv zaj duab xis:
- polyethylene terephthalate zaj duab xis,
2) txheej txheej pov tseg:
- silicone nplaum txheej,
- dimethicone (E 900),
3) Cov tshuaj me me uas muaj cov tshuaj nquag:
- dipropylene glycol,
- hyprolose (E 463),
4) Tso tawm membrane:
- ethylene thiab vinyl acetate copolymer,
5) Daim tawv-nplaum nplaum txheej:
- silicone nplaum txheej,
- dimethicone (E 900),
6) Tsiv tiv thaiv cov yeeb yaj kiab:
- ib qho lo lus polyester nrog fluorine-muaj polymer txheej.

Ib lub duab plaub sib dhos ua ke nrog cov npoo sib txuam ntawm cov ntawv ua kom tshem tawm pob tshab tiv thaiv zaj duab xis. Cov tiv thaiv zaj duab xis yog qhov loj dua lub thaj. Qhov kev phais ntshav siab tau faib cov yeeb yaj kiab tiv thaiv tshem tawm tau ua ob ntu.
Cov ntawv sau hauv qab no tau thov rau lub thaj siv cov xim luam ntawv:
1) Fendivia ™ 12.5 μg / teev, thaj 18 ± 0.5 hli dav, 24 ± 0.5 hli ntev:
- "Fentanyl 12,5 μg / teev" - xim av luam tawm,
2) Fendivia ™ 25 μg / h, thaj 24.6 ± 0.5 hli dav, 37 ± 0.5 hli ntev:
- "Fentanyl 25 μg / teev" - luam ntawv liab,
3) Fendivia ™ 50 μg / h, thaj 34 ± 0.5 hli dav, 51.3 ± 0.5 hli ntev:
- "Fentanyl 50 μg / teev" - cov ntawv luam tawm ntsuab,
4) Fendivia ™ 75 mcg / h, thaj 42 ± 0.5 hli dav, 61.7 ± 0.5 hli ntev:
- "Fentanyl 75 μg / teev" - luam tawm lub teeb xiav,
5) Fendivia ™ 100 μg / teev, thaj 49 ± 0.5 hli dav, 70 ± 0.5 hli ntev:
- “Fentanyl 100 μg / teev” - sau grey.

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj
Fendivia ™ yog qhov kev hloov kho kho mob uas muab cov khoom fentanyl txuas ntxiv mus rau 72 teev. Fentanyl yog opioid analgesic nrog kev sib nkag siab tsuas yog ua rau opiate ors receptors ntawm lub hauv nruab nrab cov hlab hlwb (CNS), tus txha nqaj qaum, thiab cov ntaub so ntswg. Tsub kom ntau ntxiv cov haujlwm ntawm cov tshuaj tiv thaiv antinociceptive, nce qhov pib ntawm kev hnov ​​mob mob. Cov tshuaj Fendivia ™ feem ntau muaj kev ua kom loog thiab sedative. Fentanyl muaj qhov cuam tshuam uas ua rau lub plawv ua pa, maj mam txo lub plawv dhia, ua rau muaj lub siab tsis txaus siab n. qhov chaw mos thiab ntuav qhov chaw, nce lub suab nrov ntawm cov nqaij ntshiv ntawm cov leeg txoj hnyuv, cov leeg txha caj qaum (suav nrog cov zis, zais zis thiab hnoos qeev ntawm Oddi), txhim kho qhov nqus ntawm cov dej hauv lub plab (GIT). Txo cov ntshav siab (BP), plab hnyuv thiab lub raum khiav ntshav.
Hauv cov ntshav, nws nce lub siab ntawm amylase thiab lipase, txo qhov concentration ntawm kev loj hlob hormone, catecholamines, adrenocorticotropic hormone, cortisol, prolactin. Txhawb nqa qhov pib ntawm kev pw tsaug zog (feem ntau hauv kev txuas nrog kev tshem tawm ntawm kev mob). Ua rau euphoria. Tus nqi ntawm kev txhim kho ntawm kev quav tshuaj thiab thev taus rau analgesic muaj qhov tseem ceeb rau tib neeg sib txawv. Tsis zoo li lwm yam tshuaj opioid ua kom loog, nws ua rau muaj kev tsis haum cov tshuaj histamine.

Cov Tshuaj Pharmacokinetics
Kev siv tshuaj loog tsawg kawg ntawm fentanyl hauv cov ntshav ntshav hauv cov neeg mob uas tsis tau siv yav dhau los ua opioid analgesics yog 0.3-1.5 ng / ml. Qhov ntau zaus tsis muaj kev cuam tshuam hauv cov neeg mob li no nce nrog kev fentanyl hauv cov ntshav ntshav saum toj 2 ng / ml. Nrog rau kev txhim kho kev ua siab ntev, ob qho tib si yam tsawg kawg nkaus analgesic concentration ntawm fentanyl ntau ntxiv thiab cov kev xav ntawm yam tsis xav tau tshwm sim.
Xuas: tom qab thawj daim ntawv thov hloov transdermal, cov concentration ntawm fentanyl hauv cov ntshav cov ntshav nce qeeb zuj zus, feem ntau yog qib ntawm 12 thiab 24 teev, thiab tom qab ntawd tseem nyob ruaj khov rau lub sijhawm 72 teev. Los ntawm daim ntawv thov 72-teev thib ob ntawm thaj hloov transdermal, ib qho kev sib xyaw ua ke ntawm fentanyl hauv cov ntshav cov ntshav tau tiav, uas tseem nyob thaum cov ntawv thov tom qab ntawm lub thaj ntawm tib qho loj me. Qhov kev xav ntawm fentanyl hauv cov ntshav yog sib npaug rau qhov loj ntawm qhov hloov transdermal. Kev nqus ntawm fentanyl yuav txawv me ntsis nyob ntawm qhov chaw thov. Kev nqus qis me ntsis ntawm fentanyl (kwv yees li 25%) tau pom hauv cov kev tshawb fawb nrog cov neeg ua haujlwm noj qab haus huv thaum lub cev thov thaj ntawm lub hauv siab piv rau daim ntawv thov ntawm sab caj npab thiab sab nraub qaum.
Faib: fentanyl khi rau cov ntshav plasma ntau npaum li 84%, hla cov ntshav tiv thaiv lub hlwb, cov leeg, thiab nkag mus rau hauv niam mis.
Kev lom zem hauv lub cev: fentanyl muaj linear biotransformation kinetics thiab metabolized feem ntau hauv daim siab los ntawm CzP3A4 enzymes. Lub ntsiab metabolite ntawm fentanyl yog norfentanil, uas tsis nquag.
Thim: tom qab tshem tawm thaj ua rau transdermal, cov concentration ntawm fentanyl hauv cov ntshav cov ntshav qis zuj zus. Ib nrab-lub neej ntawm fentanyl tom qab daim ntawv thov ntawm thaj chaw transdermal yog 17 teev (13-22 teev) hauv cov laus thiab 22-25 teev hauv cov menyuam yaus. Kev txuas ntxiv nqus ntawm fentanyl los ntawm daim tawv nqaij ua rau lub zog qeeb dua ntawm cov tshuaj los ntawm cov ntshav cov ntshav piv nrog kev tswj hwm tus quav.
Txog 75% ntawm fentanyl raug tawm hauv cov zis, feem ntau yog hauv cov qauv ntawm cov khoom noj khoom haus, tsawg dua 10% - tsis hloov pauv. Kwv yees li 9% yog nyob hauv cov quav, feem ntau yog hauv cov tshuaj metabolites.
Pab Pawg Neeg Tshwj Xeeb
Lub siab ua haujlwm lossis lub raum tsis zoo tuaj yeem ua rau nce siab ntxiv cov fentanyl concentration. Hauv cov neeg laus, debilitated lossis debilitated cov neeg mob, txo qis hauv kev tshem tawm ntawm fentanyl yog ua tau, uas tuaj yeem ua rau lub neej luv luv ntawm ib nrab ntawm lub neej fentanyl.
Cov menyuam
Ua raws li lub cev qhov hnyav, tshem tawm (l / h / kg) yog 82% siab dua rau cov menyuam hnub nyoog 2 txog 5 xyoos thiab 25% ntau dua rau cov menyuam hnub nyoog 6 txog 10 xyoo piv nrog cov menyuam hnub nyoog 11 txog 10 16 xyoo uas muaj kev ntshiab sib luag li cov laus.

Siv thaum cev xeeb tub thiab thaum pub niam mis

Cev xeeb tub
Qhov kev nyab xeeb ntawm kev hloov kab mob nrog cov fentanyl thaum cev xeeb tub tsis tau tsim. Cov kev tshawb fawb tsiaj tau teeb tsa qee qhov kev ua me nyuam yaus muaj tshuaj lom.
Fentanyl tsuas yog siv thaum cev xeeb tub yog tsim nyog kiag li. Kev siv ntev ntev thaum cev xeeb tub tuaj yeem ua rau "tshem tawm cov tsos mob" hauv cov menyuam mos. Tsis tshua muaj ntau, qhov pom ntawm cov tsos mob ntawm "tshem tawm cov tsos mob" tau qhia hauv cov menyuam tshiab uas lawv niam tau siv thaj los hloov pauv nrog fentanyl thaum cev xeeb tub.
Fentanyl yuav tsum tsis txhob siv thaum lub zog thiab kev yug menyuam (suav nrog kev phais mob), raws li nws hla dhau lub tsho me nyuam thiab tuaj yeem ua rau mob ntsws ua rau muaj menyuam lossis menyuam mos tshiab.
Kev pub niam mis
Fentanyl ua rau cov kua mis tawm thiab yuav ua rau mob sedative thiab mob ntsws ua pa rau tus menyuam noj leej niam mis. Yog li, yog tias tsim nyog, kev teem sijhawm tshuaj Fendivia ivia thaum lactation yuav tsum tsis pub mis niam (rau tag nrho lub sijhawm ntawm kev siv thiab tsawg kawg 72 teev tom qab siv kawg).

Sab sij huam

Kev nyab xeeb ntawm kev hloov kab mob nrog cov fentanyl tau soj ntsuam hauv 1565 cov neeg laus thiab 289 cov menyuam yaus uas koom nrog 11 cov kev tshawb fawb txog kev siv tshuaj rau kev kho mob rau kev kho mob ntev ntawm oncological thiab tsis-oncological genesis. Cov neeg mob no tau txais tsawg kawg ib qho kev hloov pauv ntawm fentanyl, tom qab ntawd qhov kev nyab xeeb ntawm cov tshuaj tau raug soj ntsuam. Raws li cov ntaub ntawv kev tiv thaiv kev nyab xeeb los ntawm kev soj ntsuam, kev tshwm sim ntau yam (nrog tsawg kawg ntawm 10%) yog xeev siab (35.7%), ntuav (23,2%), cem quav (23.1) %), tsaug zog (15.0%), kiv taub hau (13.1%) thiab mob taub hau (11,8%).
Cov kev mob tshwm sim tsis zoo yog suav raws qhov teeb meem ntau zaus:
Heev heev (> 1/10)
Nquag (> 1/100, 1/1000, 1 / 10,000,

Tso cov ntaub ntawv thiab cov nyob ua ke

Ib lub tshuaj tau npaj siab ua qhov kev daws teeb meem rau kev txhaj tshuaj (muab tshuaj rau hauv qhov txhab thiab tshuaj pleev ib ce). Ntawm kev muag koj tuaj yeem nrhiav ib thaj hloov pauv. Fentanyl ua raws li ib txoj kev sib txuas. Muaj ntau qhov sib txawv ntawm cov tshuaj. Qhov ntau npaum li cas ntawm cov tshuaj nquag yuav txawv (mg): 1.38, 2.75, 5.5, 8.25, 11. Qhov kev siv ntawm fentanyl kuj txawv (μg / h): 12.5, 25, 50, 75, 100.

Lub thaj yog them nrog zaj duab xis tiv thaiv, muaj lwm yam tshuaj nyob rau hauv muaj pes tsawg leeg:

Nrog saib xyuas

Ib tug xov tooj ntawm cov kev txwv tus kwv tij nyob rau kev siv raug sau tseg:

• nce siab intracranial,
• cov kab mob ntsws
• lub zog bradyarrhythmia
• mob hlwb lossis o,
• ntshav siab
• colic nyob rau hauv daim siab, ob lub raum,
• tsim ntawm lub laij lej nyob rau hauv lub gallbladder,
• cov thyroid mob (hypothyroidism),
• mob plab tsis paub meej etiology,
• benign prostatic nqaij hypertrophy,
• qhov nce hauv lub cev kub dhau ib lub sijhawm, uas ua rau muaj qhov kub ntxhov (piv txwv, thaum mus xyuas lub sauna),
• dej cawv lossis quav yeeb tshuaj,
• txo qis hauv qhov lumen ntawm lub qhov zis,
• kev mob hnyav rau tus neeg mob.

Chaw tsim tshuaj paus

LTS Lohmann Txoj Kev Kho Mob AG. Lohmannstrasse 2, D-56626, Andernach, Lub Tebchaws Yelemees. LTS Lohmann Kev Kho Mob-Systeme AG. Lohmannstrasse, 2, D-56626 Andernach, Lub Tebchaws Yelemees.

Daim ntawv pov thawj rau daim ntawv sau npe: Takeda Pharma A / S. Dubendal Alle 10, 2630 Taastrup, Tebchaws Denmark. Takeda Pharma A / S. Dybendal Alle 10, 2630 Taastrup, Tebchaws Denmark.

Kev thov cov neeg tau txais kev pab yuav tsum tau xa mus rau: Takeda Pharmaceuticals LLC. 119048, Moscow, st. Usacheva, 2, p. 1.

Xov Tooj: (495) 933-55-11, fev: (495) 502-16-25.

Yuav Siv Fendivia li cas

Qhov ntau npaum li cas ntawm cov kev ua ub ua no tau txiav txim siab ib tus zuj zus. Tus nqi ntawm fentanyl nyob ntawm tus mob ntawm tus neeg mob, qhov pom / tsis pom muaj kev paub txog thaum siv cov tshuaj analgesics thaum ntxov. Thaum siv thaj ua rau thaj, qhov kev txiav txim sab nraud sab nraud yog ntxuav thiab qhuav. Cov tshuaj ntxuav tes tsis tas yuav siv, cov dej huv yog txaus. Daim tawv nqaij yuav tsum tsis deformed.

Thawj koob tshuaj yog 12,5 lossis 25 mg. Tom qab ntawd nws tau nce nrog txhua thaj tshiab. Qhov ntau tshaj plaws txhua hnub nqi ntawm fentanyl yog 300 mg. Yog tias nws yog qhov tsim nyog yuav tau nce lub koob tshuaj, txiav txim siab nyiaj txiag hauv cov ntawv ua kua. Txhawm rau kom tsis txhob pom cov paib tawm, nws raug nquahu kom txo qis ntawm cov tshuaj nquag maj mam ua.

Yuav hloov pauv li cas

Lub sijhawm siv ntawm 1 thaj yog 72 teev. Tom qab ntawd, hloov chaw. Yog tias cov tshuaj ua kom tsis muaj zog, cov khoom yuav hloov pauv tom qab 48 teev. Ntxiv mus, thaj tom ntej tau muab ntsia rau hauv qhov chaw tshiab. Yog tias qhov kev pom zoo no tsis raug coj mus rau hauv tus account, qhov kev haum xeeb ntawm fentanyl nce. Nyob rau hauv txheej txheem ntawm tshem tawm thaj, nws yuav tsum tau muab tais nrog lo nplaum sab hauv thiab pov tseg.

Nrog mob ntshav qab zib, cov tshuaj yuav siv tau, tab sis raws li kws kho mob qhia.

Kev kho mob txoj hnyuv

Xeev siab ntuav ua raws li ntuav, mob plab, tso quav, ua kom tsis zom plab, zom cov leeg ntawm qhov ncauj. Cov tsos mob ntawm txoj hnyuv tsis tshua pom tshwm sim ntau.

Noj Fendivia tuaj yeem ua rau poob qab los noj mov.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Cov tshuaj yog tsim nyob rau hauv daim ntawv ntawm transdermal kho cov txheej txheem (TTC): cov lus pom qhov tseeb thom khwm nrog cov npoo sib npaug ntawm qhov tshem tawm cov pob tshab tiv thaiv zaj duab xis, uas yog qhov loj dua ntawm thaj, qhov tiv thaiv zaj duab xis tau muab faib ua ob ntu los ntawm qhov kev phais sinusoidal, thaj ua rau thaj 12.5 / 25/50 / 75/100 μg / h muaj qhov ntev ntawm 24/37 / 51.3 / 61.7 / 70 mm (± 0.5 mm txhua) thiab qhov dav ntawm 18 / 24.6 / 34/42/49 hli (± 0.5 hli txhua tus), feem, cov ntawv cim hauv qab no tau thov rau thaj chaw los ntawm cov xim luam ntawv (nyob ntawm seb qhov tso tawm ntawm cov tshuaj yeeb dej caw): 12.5 μg / h - xim av Fentanyl 12,5 μg / teev, 25 μg / h - Fentanyl 25 μg / teev liab, 50 μg / h - Fentanyl 50 μg / teev ntsuab, 75 μg / h - Fentanyl 75 μg / teev lub teeb ntsuab , 100 μg / h - grey Fentanyl 100 μg / teev txhua TTS raug ntim rau hauv lub hnab ntim khoom kub ntawm aluminium, ntawv thiab polyacrylonitrile (PAN), hauv cov thawv ntawv thawv 5 lub hnab thiab cov lus qhia rau kev siv Fendivia.

Muaj pes tsawg leeg rau 1 thaj (TTC):

• cov khoom sib xyaw: fentanyl, cov ntsiab lus ntawm uas hauv 1 TTC yog: 1.38, 2.75, 5.5, 8.25 lossis 11 mg hauv ib thaj nrog qhov tso tawm ntawm 12.5, 25, 50, 75 thiab 100 μg / h thiab nrog thaj chaw sib txuas ntawm 4.2, 8.4, 16.8, 25.2 thiab 33.6 cm², ua ntu zus
• tiv thaiv cov yeeb yaj kiab: polyester zaj duab xis nrog cov tshuaj fluorine muaj polymer txheej,
• zaj duab xis tiv thaiv sab nraud: polyethylene terephthalate zaj duab xis (PET zaj duab xis),
• cov chaw ntim dej micro, suav nrog cov nquag tivthaiv: hyprolose (E463), dipropylene glycol,
• ntim dej / tawv nqaij-nplaum txheej: dimethicone (E900), txheej kua nplaum kua nplaum,
• tso tawm membrane: ib daim ntawv theej ntawm vinyl acetate thiab ethylene.

Siv thaum cev xeeb tub thiab lactation

Cov tshuaj tau tshuaj, tab sis raws li qhov kawg. Nws yog siv rau kev noj qab haus huv, thaum cov txiaj ntsig muaj txiaj ntsig ntau dua li qhov muaj mob tshwm sim. Nrog rau kev kho mob thaum cev xeeb tub, muaj kev pheej hmoo ntawm kev nthuav dav hauv tus menyuam tom qab yug menyuam.

Qhia tias cov tshuaj no nkag mus rau niam lub mis thiab los ntawm qhov txwv tsis pub, qhov phom sij ntawm kev tshwm sim tsis zoo hauv tus menyuam yog qhov siab heev.

Siv rau lub sijhawm qub

Thaum kho, txheej txheem ntawm kev ua kom tsis muaj fentanyl qeeb. Qhov no ua rau kom muaj kev nce qib zuj zus hauv nws qhov kev xav. Vim li no, cov koob tshuaj yuav tsum tau tshuaj xyuas. Cov tshuaj tau pom zoo rau kev siv tsuas yog tias cov txiaj ntsig tau dhau qhov phom sij. Cov kev kho mob yuav tsum pib nrog ib koob tshuaj 12,5 mg.

Hauv cov laus, cov tshuaj pom zoo rau kev siv tsuas yog tias cov txiaj ntsig tau tshaj qhov phom sij.

Kev txheeb xyuas txog Fendivia

Kev soj ntsuam cov neeg tau txais kev pab thiab cov kws tshaj lij yuav tso cai rau koj los tawm tswv yim ntau ntxiv txog cov tshuaj no.

Danilov I.I., oncologist, 49 xyoo, Vladivostok

Lub cuab yeej ua tiav nws txoj haujlwm - tshem tawm qhov mob. Qhov tsis zoo suav nrog qhov kev nrawm qis ntawm kev nqis tes ua, txij li fentonil raug tso tawm maj: ua ntej nws nkag mus rau cov qauv ntawm qhov sib txig sab nraud thiab tsuas yog tom qab ntawd mus rau hauv cov ntshav. Txawm hais tias nws zoo li cas, qhov kev hais daws no tuaj yeem ua rau muaj kev phom sij vim muaj kev cuam tshuam ntawm lub cev tsis muaj zog (qhov tsis zoo tshwm sim tshwm sim).

Verilova A.A., kws phais neeg, hnub nyoog 53 xyoos, St. Petersburg

Kuv siv cov tshuaj ncua vim daim ntawv tsis haum. Nws ua qeeb. Ib qho ntxiv, tus nqi yog siab. Yog tias peb xav txog nws cov yam ntxwv tseem ceeb, tom qab ntawd qhov kev ua tau zoo ntawm lub cuab yeej no tsis qis dua rau analogues hauv lwm cov ntawv.

Fentanyl ua kom tsis txhob noj tshuaj

Eugene, hnub nyoog 33 xyoo, Penza

Cov tshuaj yog qhov txaus ntshai heev, zoo li feem ntau opiates. Qee lub sijhawm tom qab pib txoj kev kho, nws nres pab. Kuv nyeem txog txoj kev txhim kho tau ntawm lub siab ntev rau cov tshuaj nquag, tab sis tsis tau xav tias qhov tshuaj yeeb dej cawv tuaj yeem sai li sai tau kom ua tiav nws txoj haujlwm. Kuv yuav tsum pauv mus rau ib qho khoom noj tshiab.

Veronika, 39 xyoo, Moscow

Nrog oncology, nws pab tsis zoo. Cov nyhuv yog luv-nyob, tom qab uas nws yog qhov yuav tsum hloov pauv thaj ua ntej me ntsis, uas yog teebmeem, vim tias nws tuaj yeem thov tsis pub tshaj 1 zaug nyob hauv 48 teev. Vim li no, tus kws kho mob tau sau lwm yam tshuaj ntxiv.

Cov lus qhia me ntsis, cov lus qhia rau kev siv: kev ua thiab npaum li cas

Fendivia thaj yog siv transdermally.

Fentanyl tawm ntawm tus nqi ntawm 12.5, 25, 50, 75 lossis 100 μg / h, uas yog kwv yees li 0.3, 0.6, 1.2, 1.8 lossis 2.4 mg ib hnub, ntsig txog.

Cov koob tshuaj yog txiav txim siab ib tus zuj zus, nyob ntawm tus mob ntawm tus neeg mob, thiab yuav tsum tau soj ntsuam tsis tu ncua tom qab siv txhua zaus. Nws yog ib qho tsim nyog yuav tsum tau thov koob tshuaj tsawg kawg nkaus.

Ib daim npog uas muaj fentanyl raug pom zoo kom siv rau hauv daim tiaj tiaj, tsis muaj qhov kawg ntawm daim tawv nqaij ntawm lub xub pwg lossis pob tw. Cov menyuam me yuav tsum lo nws lub nraub qaum kom txo qhov kev pheej hmoo ntawm kev tshem tawm lawv tus kheej.

Lub xaib rau thov yuav tsum tau xaiv nrog cov plaub hau tsawg kawg. Ua ntej ua ntawv thov TTS, cov plaub hau nyob ntawm thaj chaw thov yuav tsum tau txiav tawm (tsis muaj shaving). Yog tias nws tsim nyog los ntxuav qhov chaw ntawm daim ntawv thov ua ntej gluing thaj, qhov no yuav tsum tau ua nrog dej huv. Tsis txhob siv cov tshuaj pleev ntau, xab npum, cawv, roj lossis lwm yam khoom lag luam tsis pom zoo, vim tias lawv tuaj yeem ua rau tawv nqaij lossis hloov pauv ntawm nws lub zog. Ua ntej cov txheej txheem, daim tawv nqaij yuav tsum tau qhuav kiag li. Txij li cov ntaub npog nrog zaj duab xis tsis muaj dej thaiv, koj tsis tuaj yeem tshem nws nrog da dej luv.

Tam sim ntawd tom qab tshem lub thaj los ntawm lub hnab ntim khoom kom sov thiab tshem tawm zaj duab xis tiv thaiv, thov nws rau ntawm daim tawv nqaij tsis txhob kov cov ntawv nplaum thiab nias khov kho tawm tsam daim ntawv thov nrog koj lub xib teg ntev li 30 vib nas this. TTS yuav tsum ua kom tawv nqaij zoo, tshwj xeeb ncig ncig, yog tias tsim nyog, kho nws ntxiv, thiab tom qab ntawd ntxuav koj txhais tes nrog dej huv.

Fendivia yog tsim rau kev siv tas mus li rau 72 teev. Ib thaj tshiab yuav tsum tau siv rau lwm qhov ntawm daim tawv nqaij, tsis tas siv ntawm qhov chaw ntawm daim ntawv thov dhau los. Lo cov kua nplaum rau ntawm qhov qub chaw tuaj yeem rov ua dua tsis tau ua ntej dhau 7 hnub.

Thawj koob tshuaj yog tsim los rau hauv kev txiav txim siab theem ntawm kev noj tshuaj opioid nyob rau lub sijhawm ua ntej Fendivia kev kho, qhov kev pheej hmoo ntawm kev ua siab ntev, concomitant kev kho mob nrog lwm cov tshuaj, kev noj qab haus huv feem ntau ntawm tus neeg mob thiab nws cov xwm txheej kho mob, i.e. lub hnub nyoog, lub cev nyhav, qib ntawm kev qaug thiab qhov mob ntawm lub qhov txhab.

Cov neeg mob uas tsis tau kho dua zaum kawg nrog cov tshuaj opioids tsis pom zoo hloov tus qauv ntawm lawv txoj kev siv, qhov no, koj yuav tsum tau siv lub qhov ncauj thiab kev tswj hwm tshuaj ntawm cov tshuaj. Txhawm rau tiv thaiv kev noj tshuaj ntau dhau, lawv yuav tsum siv cov tshuaj tiv thaiv opioids tsawg tsawg (suav nrog tramadol, oxygencodone, hydromorphone, morphine, thiab codeine). Cov koob tshuaj ntawm cov tshuaj rau cov neeg laus yuav tsum muaj feem raug suav nrog raws li qhov nws haum rau Fendivia cov 12.5 / 25 mcg / h cov nyhuv analgesic. Lub neej yav tom ntej, cov neeg mob tuaj yeem ua rau kev hloov mus rau kev siv daim ntawv hloov chaw.

Nyob rau hauv rooj plaub thaum tshuaj noj ntawm qhov ncauj ntawm opioids yog sib kis lossis tsis tsim nyog, thiab kev siv TTC raug lees paub tias tsuas yog txoj hauv kev kho mob, nws yog ib qho tsim nyog yuav tsum pib kho nrog kev siv tshuaj qis kawg nkaus - 12.5 μg / h.

Thaum hloov mus rau kev siv thaj chaw hloov pauv, rau tus neeg mob uas tau siv qhov ncauj / niam txiv opioids nyob rau lub sijhawm dhau los, nws yog qhov tsim nyog los tsim cov nyiaj yav dhau los tau txais opioid analgesics, uas nws xav tau hauv 24 teev dhau los (mg / hnub). Qhov koob tshuaj yuav tsum tau hloov mus rau qhov sib npaug ntawm qhov ncauj txhua hnub ntawm morphine (mg / hnub) siv cov coefficient uas tsim nyog.

Cov koob tshuaj sib npaug ntawm morphine yog tsim los ntawm sib ntxiv cov koob tshuaj opioid analgesics los ntawm cov ntsiab lus hauv qab no (yav dhau los siv opioid hauv mg / hnub × coefficient) siv los rov siv cov tshuaj txhua hnub rau kev tswj hwm qhov ncauj / niam txiv:

• morphine - 1 a / 3,
• fentanyl - - / 300,
• codeine - 0.15 / 0.23 b,
• diamorphine - 0.5 / 6 b,
• ketobemidone - 1/3,
• hydromorphone - 4/20 b,
• levorphanol - 7.5 / 15 b,
• oxygencodone - 1.5 / 3,
• pethidine - - / 0.4 b,
• tramadol - 0.25 / 0.3,
• tapentadol - 0.4 / -,
• tshuaj txiav yeeb - 1.5 / 3 b.

a - kev ua haujlwm ntawm morphine tau txais ntawm qhov ncauj lossis intramuscularly (IM) ntawm lub hauv paus ntawm kev tshawb nrhiav hauv cov neeg mob uas muaj mob mob.

b - raws li cov txiaj ntsig tau los ntawm kev tshawb fawb tau txais nrog kev txhaj tshuaj ib leeg ntawm cov tshuaj no los txiav txim rau lawv cov kev ua haujlwm sib piv nrog morphine, koob tshuaj qhov ncauj yog qhov koob tshuaj uas tau pom zoo thaum hloov los ntawm niam txiv mus rau qhov ncauj ntawm kev tswj hwm.

Qhov tsim nyog pib koob tshuaj fentanyl yog tsim raws li kev noj tshuaj ntawm qhov ncauj txhua hnub ntawm morphine.

Rau cov neeg laus hauv thaj chaw kho mob tsis tshua nyob ruaj khov uas xav tau hloov opioid, kev hloov pauv hauv qab no los ntawm kev noj tshuaj ntawm qhov ncauj niaj hnub mus rau qhov kev hloov pauv ntawm fentanyl pom zoo nrog kev hloov pauv ntawm 150 ÷ ​​1 morphine (mg / hnub) - fentanyl (/g / h):

• tsawg dua 90 - 12.5,
• 90–134 – 25,
• 135–224 – 50,
• 225–314 – 75,
• 315–404 – 100,
• 405–494 – 125,
• 495–584 – 150,
• 585–674 – 175,
• 675–764 – 200,
• 765–854 – 225,
• 855–944 – 250,
• 945–1034 – 275,
• 1035–1124 – 300.

Rau cov neeg mob cov neeg laus noj zoo tiv thaiv kev kho mob ruaj khov nrog opioids, kev hloov pauv hauv qab no los ntawm kev noj tshuaj ntawm qhov ncauj niaj hnub mus rau qhov kev hloov pauv ntawm fentanyl pom zoo nrog kev hloov pauv ntawm 100 ÷ 1 morphine (mg / hnub) - fentanyl (/g / h):

• tsawg dua 44 - 12,5,
• 45–89 – 25,
• 90–149 – 50,
• 150–209 – 75,
• 210–269 – 100,
• 270–329 – 125,
• 330–389 – 150,
• 390–449 – 175,
• 450–509 – 200,
• 510–569 – 225,
• 570–629 – 250,
• 630–689 – 275,
• 690–749 – 300.

Qhov kev ntsuas thawj zaug ntawm qhov siab tshaj plaws ua haujlwm ntawm Fendivia yuav tsum tau nqa tawm tsis pub dhau 24 teev tom qab thov. Qhov laj thawj rau qhov kev txwv no yog maj mam nce ntxiv ntawm qhov kev fentanyl hauv cov ntshav cov ntshav hauv thawj 24 teev tom qab thov lub thaj. Yog li ntawd, thaum lub sij hawm hloov los ntawm ib qho tshuaj analgesic mus rau lwm qhov, kev kho yav dhau los yuav tsum tau maj mam nres, tom qab daim ntawv thov ntawm thawj koob tshuaj fentanyl thiab kom txog thaum lub stabilization ntawm nws cov nyhuv analgesic.

TTC yuav tsum tau hloov nrog lub tshiab txhua txhua 72 teev. Kev them nyiaj ib feem kaum ntawm kev saib xyuas txij nkawm yog nqa tawm ntawm tus kheej kom txog rau thaum muaj kev ua kom tiav qhov tsis txaus siab, suav txog qhov ua siab ntev ntawm cov tshuaj. Raws li txoj cai, koob tshuaj tuaj yeem nce ntxiv nyob rau ib lub sijhawm los ntawm 12.5 lossis 25 μg / h, nyob ntawm tus neeg mob tus mob thiab qhov xav tau ntxiv analgesia (qhov ncauj morphine ntawm koob tshuaj ntawm 45 thiab 90 mg / hnub yog kwv yees li ntawm Fendivia ntawm koob tshuaj 12,5 thiab 25 μg / h, feem). Kev ua kom qhov ncauj ruaj khov tuaj yeem tshwm sim 6 hnub tom qab nce koob tshuaj. Yog li, tom qab kho cov koob tshuaj, nws yuav tsum siv ntau ntxiv thaj chaw tsawg kawg 2 zaug rau 72 teev, thiab tsuas yog tom qab ntawd, yog tias tsim nyog, ua rau nws nce ntxiv.

Txhawm rau kom ua tiav qhov koob tshuaj ntau tshaj 100 μg / h, kev siv tib lub sij hawm ntau plasters raug tso cai. Thaum kev daws teeb meem mob tshwm sim, nws yuav tsim nyog muab tshuaj ntxiv rau ua yeeb yam luv luv ua kom loog. Thaum siv Fendivia hauv ib qho tshuaj uas ntau tshaj 300 μg / teev, nws yog qhov yuav tsum tau txiav txim siab txog qhov siv ntxiv / lwm cov tshuaj pleev xim lossis cov hau kev ntawm kev tswj hwm opioid analgesics.

Thaum pib ntawm qhov pib ntawm txoj kev kho, yog tias muaj qhov kev txo qis tseem ceeb ntawm qhov ua kom loog tom qab thov kev noj tshuaj thawj zaug, tom qab 48 teev thaj ua rau thaj tuaj yeem hloov los ntawm ib qho zoo sib xws, thiab tom qab 72 teev koob tshuaj tuaj yeem nce ntxiv.

Yog tias thaj ua rau thaj tsis tuaj yeem lossis muaj qhov xav tau los hloov nws rau lwm qhov laj thawj ua ntej 72 teev dhau los, ib thaj nrog qhov koob tshuaj zoo ib yam tuaj yeem raug lo rau lwm thaj chaw ntawm daim tawv nqaij. Hauv qhov no, tus neeg mob yuav tsum tau ua tib zoo saib xyuas, vim tias qhov kev pheej hmoo ntawm kev nce ntxiv hauv plasma concentration ntawm cov tshuaj.

Tawm tsam ntawm keeb kwm yav dhau los ntawm kev hloov pauv los ntawm kev kho kom ntev nrog morphine mus kho nrog ib daim kab mob transdermal, tshem tawm cov tsos mob yuav tshwm sim, txawm tias muaj cov nyhuv ua kom loog tsis haum. Yog tias qhov kev tsis sib haum xeeb no tshwm sim, nws raug nquahu kom koj tswj hwm kev ua yeeb yam morphine luv luv hauv koob.

Yog tias nws yuav tsum tau cuam tshuam nrog kev kho mob nrog thaj hloov kho, nws yuav tsum tau hloov nrog lwm cov tshuaj opioids maj mam, pib nrog qhov kev siv tshuaj tsawg, vim hais tias qhov qeeb ntawm cov ntshiab fentanyl tom qab tshem lub thaj thiab qhov kev hem thawj ntawm kev rho tawm. Txhawm rau txo qis kev fentanyl hauv cov ntshav los ntawm 50%, tsawg kawg 17 teev yuav tsum.

Hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog 2-16 xyoo, Fendivia tuaj yeem siv rau hauv cov xwm txheej uas cov neeg mob tau noj morphine ntawm qhov ncauj ntau npaum li qhov sib npaug (ntawm koob tshuaj tsawg kawg 30 mg / hnub). Thaum hloov los ntawm kev siv qhov ncauj / niam txiv ntawm opioid analgesics rau thaj nrog fentanyl, thawj koob tshuaj rau cov menyuam yaus yog xam raws li kev noj tshuaj ntawm qhov ncauj txhua hnub ntawm morphine. Cov Fendivia ntawm koob tshuaj 12,5 thiab 25 μg / h yog sib npaug rau morphine ntawm qhov ncauj ntawm 30–44 thiab 454134 mg / hnub, ntsig txog. Kev hloov pauv ntawm cov menyuam yaus mus rau kev siv fentanyl hauv koob tshuaj ntau dua 25 μg / h tsis txawv qhov ntawd ntawm cov neeg laus cov neeg mob.

Nrog rau ib daim transdermal ntawm 12.5 μg / h, tsuas yog morphine tuaj yeem hloov thaum noj ntawm qhov ncauj ntawm 30–44 mg / hnub lossis lwm yam tshuaj opioid analgesics hauv qhov sib npaug. Cov txheej txheem no tsis tuaj yeem siv hloov chaw rau menyuam yaus los ntawm kev siv fentanyl mus rau lwm qhov opioid analgesics vim tias qhov tshwm sim yuav tshwm sim ntawm kev haus dej ntau dhau.

Txij li thaum siv tshuaj ua kom qhov mob pib ntawm lub thaj thaum thawj 24 teev tsis tau txog qib uas tsim nyog, tom qab hloov mus rau kev kho Fendivia, cov menyuam yuav tsum tau txais kev kho mob yav dhau los hauv lub qub. Dhau 12 teev tom ntej, yav tas los siv cov tshuaj loog siv tau thaum siv tshuaj kho mob. Cov koob tshuaj tau teeb tsa ib leeg zuj zus, tom qab pib kev kho mob, thaj yuav tsum tau hloov nrog lub zog tshiab txhua 72 teev. Yog tias koj xav nce cov koob tshuaj, nws txoj kev kho hauv cov menyuam yaus yog ua tiav maj, hauv kev nce ntxiv ntawm 12.5 μg / h, yam tsis nce ntau tshaj li 1 zaug hauv 72 teev. Thaum tsis muaj qhov ua haujlwm ntawm qhov tsis haum analgesic, ntxiv siv morphine lossis lwm qhov kev ua haujlwm luv luv opioid analgesic yog ua tau.

Cev xeeb tub thiab lactation

Cov ntaub ntawv qhia txog kev nyab xeeb ntawm Fendivia thaum cev xeeb tub tsis muaj. Hauv chav kawm ntawm kev tshawb fawb ntawm cov tsiaj, qee yam kev muaj kuab lom raug mob tshwm sim. Lub caij nyoog ntev siv ntawm kev hloov kab mob nrog cov fentanyl thaum cev xeeb tub tuaj yeem ua rau qhov tsos mob ntawm kev tshem tawm mob hauv cov menyuam mos. Cov ntaub ntawv sib cais tau sau tseg txog cov tsos mob uas twb muaj lawm ntawm tus mob no hauv cov menyuam tshiab uas nws niam tau siv TTC tas li thaum cev xeeb tub.

Kev siv fentanyl thaum cev xeeb tub pub tsuas yog thaum xwm txheej ceev. Fendivia tsis pom zoo rau siv thaum yug menyuam thiab yug menyuam (suav nrog los ntawm kev phais plab phais), vim tias cov tshuaj nkag mus rau hauv lub tsho me nyuam thiab tuaj yeem ua rau mob ntsws ua pa hauv lub menyuam / menyuam mos.

Cov tshuaj tau raug tshawb pom nyob rau hauv niam cov kua mis thiab tuaj yeem ua rau kev nyuaj siab ua pa thiab ua kom loog hauv cov menyuam noj niam mis. Hauv qhov txuas no, yog tias yuav tsum siv cov Fendivia thaum lactation, nws yog qhov tsim nyog los cuam tshuam kev pub mis niam (rau tag nrho lub sijhawm ntawm kev siv, nrog rau lub sijhawm tsawg kawg 72 teev tom qab daim ntawv thov kawg).

Siv rau thaum yau

Kev siv TTC rau cov menyuam yaus hnub nyoog qis dua 2 xyoos yog qhov sib kis, vim tias tsis muaj cov ntaub ntawv qhia txog kev nyab xeeb thiab kev ua haujlwm ntawm kev kho. Cov hluas uas muaj hnub nyoog tshaj 16 xyoos pom zoo kom noj dua kom zoo ib yam li ntawd rau cov neeg laus.

Cov lus tshaj tawm yuav tsum tsis txhob muab rau cov menyuam yaus tshaj 2 xyoos uas tsis tau txais kev kho mob opioid analgesics yav dhau los. Kev siv cov tshuaj muaj peev xwm tsuas yog muaj menyuam yaus muaj opioid kam rau ua. Thov nco ntsoov tias kev pheej hmoo ntawm kev mob hnyav / ua rau tuag taus ntawm kev nyuaj siab muaj nyob nrog txawm tias qhov koob tshuaj tau txais. Nws raug nquahu kom soj ntsuam cov neeg mob rau kev txhim kho cov kev mob tshwm sim tsawg kawg 48 teev tom qab pib kho lossis tom qab nce ntxiv dua.

Thaum xaiv qhov chaw ntawm daim ntawv thov, kev saib xyuas yuav tsum tau saib xyuas thiab ua tib zoo saib xyuas seb thaj ua rau thaj nplaum yog li cas kom tiv thaiv nws los ntawm kev nqos los ntawm tus menyuam.

Nrog lub siab ua haujlwm tsis zoo

Txij li thaum lub cev hloov pauv ntawm fentanyl tshwm sim hauv lub siab, nyob rau hauv qhov muaj qhov ua haujlwm tsis muaj zog hepatic, ib qho kev txo qis ntawm nws qhov kev tshem tawm yog qhov ua tau.

Vim tias qhov kev pheej hmoo ntawm kev muaj peev xwm noj ntau tshaj nrog cov kev ua haujlwm tsis zoo hauv lub siab, cov neeg mob yuav tsum tau saib xyuas lub sijhawm kho. Yog tias tsim nyog, yuav tsum txo qhov koob tshuaj fentanyl ntxiv.

Thawj koob tshuaj ntawm Fendivia yuav tsum tsis pub tshaj 12.5 mcg / h.

Yeeb tshuaj sib cuam tshuam

• derivatives ntawm barbituric acid: qhov kev pheej hmoo ntawm kev ua pa nyuaj siab yog aggravated, kev sib xyaw no yog contraindicated,
• cov tshuaj tiv thaiv ntawm cytochrome P450 3A4 (CYP3A4) - nefazodone, nelfinavir, erythromycin, voriconazole, fluconazole, clarithromycin, ketoconazole, ritonavir, itraconazole, cimetidine, verapamil, amiodarone, ntshav nce ntxiv lossis ntau ntxiv kev txiav txim, thiab tseem yuav ua rau muaj qhov tshwm sim tsis zoo ntxiv, suav nrog kev ua pa nyuaj siab. Nws yog qhov yuav tsum tau soj ntsuam tus neeg mob thiab, yog tias tsim nyog, txo qhov koob tshuaj fentanyl lossis txiav nws txoj kev siv, thiab thaum tsis ua tib zoo saib xyuas, zam kev sib xyaw tshuaj no. Lub sijhawm nruab nrab ntawm kev ncua ntawm kev kho nrog CYP3A4 inhibitors thiab thawj daim ntawv thov ntawm lub thaj yuav tsum yog tsawg kawg 48 teev,
• CYP3A4 inducers - phenobarbital, carbamazepine, rifampicin, phenytoin: cov tshuaj fentanyl hauv cov ntshav qis thiab nws txoj kev kho ua kom tsis muaj zog, vim tias qhov kev kho tshuaj yuav ua tau. Kev sib xyaw ua ke no yuav tsum tau txais kev saib xyuas tshwj xeeb. Yog tias concomitant kev kho mob nrog CYP3A4 inducer raug tso tseg, nws yuav tsim nyog los txo qhov koob tshuaj fentanyl thiab saib xyuas tus neeg mob,
• Cov tshuaj tiv thaiv CNS - kev siv tshuaj loog, lwm yam tshuaj opioids, hypnotics thiab sedatives, phenothiazine derivatives, cov leeg ua kom tsis txhob mob, lub cev qhuav dej cawv, cawv, antihistamines nrog cov ua kom zoo: ntxiv cov teebmeem sedative yuav tsim, hypotension, hypoventilation, nqus tau pw tsaug zog / tsis nco qab yuav tshwm sim, ceev faj soj ntsuam ntawm tus mob
• cov tshuaj serotonergic - xaiv cov serotonin reuptake inhibitors (SSRIs), xaiv serotonin thiab noradrenaline reuptake inhibitors (SSRIs), MAO inhibitors: qhov sib xyaw no tsis pom zoo vim tias muaj kev hem thawj ntawm kev tsim serotonin syndrome. Thaum muab los sib xyaw nrog MAO, qhov nce ntawm cov txiaj ntsig ntawm narcotic analgesics kuj ua tau,
• nalbuphine, buprenorphine, pentazocine: cov nyhuv analgesic tsis muaj zog, qhov tsos mob tshem tawm yuav tshwm sim rau cov neeg mob opioid dependence, kev sib xyaw tsis pom zoo,
• cov leeg ua kom so nrog vagolytic kev ua si (suav nrog pancuronium bromide): qhov kev pheej hmoo ntawm cov hlab ntsha hypotension thiab bradycardia yog txo qis (tshwj xeeb tshaj yog thaum siv beta-blockers thiab lwm yam vasodilators) thiab kev hem thawj ntawm kev mob ntshav siab thiab tachycardia yog aggravated,
• cov leeg ua kom lub cev tsis ua vagolytic kev ua haujlwm (succinylcholine): qhov kev pheej hmoo ntawm kev mob hnyav los ntawm CCC yog qhov kev ntshai, qhov kev pheej hmoo ntawm bradycardia thiab arterial hypotension (tshwj xeeb nrog cov keeb kwm tsis muaj zog) tsis txo.