"Phenytoin": cov lus qhia rau kev siv, analogs, Muaj pes tsawg leeg

Yuav ua li cas yuav muab xws li ib tug yeeb tshuaj raws li "Phenytoin" Cov lus qhia rau kev siv, analogs yog cov neeg ua hauj nrog cov tib yam kom nquag plias khoom sib ua zaub mov yuav tsum hais hauv qab no.

Tshuaj zog thiab cov hauv daim ntawv ntawm

"Phenytoin" nrog rau cov tib yam kom nquag plias khoom sib ua zaub mov yog ib tug anti-epileptic tshuaj. Nws yog ib tug derivative ntawm hydantoin, heev ze rau lub barbituric acid (nyob rau hauv lawv cov tshuaj qauv).

Cov tshuaj yeeb dej caw nyob rau hauv lo lus nug yog muaj nyob rau hauv daim ntawv teev cov tseem ceeb cov tshuaj los ntawm LEEJ TWG, raws li zoo raws li ib daim ntawv teev qhov tseem ceeb cov tshuaj.

Phenytoin (cov lus qhia rau kev siv ntawm cov tshuaj nrog cov tivthaiv yuav raug sawv cev hereinafter) twb tsim nyob rau hauv 1908 xyoo. Thiab tsuas mus rau xyoo 1937-th nws anticonvulsant zog nyob sab.

Qhov no tshuaj yog ib hmoov (crystalline) ntawm ib tug dawb xim uas yog suab insoluble nyob rau hauv cov dej. Qhov no compound tej zaum yuav ua neej nyob hauv ib tug 1% tshuaj ntawm caustic alkali.

Tam sim no tso qhov ncauj ntsiav tshuaj "Phenytoin" raws li txhais tau tias rau parenteral thawj coj.

pharmacology

Yuav ua li cas puas cov tshuaj "Phenytoin"? Cov lus qhia rau kev siv ntawd hais tias nws muaj anticonvulsant neeg sawv cev, antiarrhythmic, antiepileptic thiab nqaij relaxant zog.

Anticonvulsant kev ua ntawm kev npaj no yog theej siab. Txawm li cas los, nws lub sij hawm tsis ua koj nkees nkees thiab nkees.

Phenytoin hu ua zoo bio-hluav taws xob stabilizer. Thaum noj siab koob tshuaj ntawm cov tshuaj yeeb dej caw, nws yuav ua tau rau cov neeg pluag kom sib haum ntawm tib neeg lub cev.

Xam tias yog txhais tau tias activates Cns, tsub kom excitability chaw pib, muaj ib tug antiarrhythmic txiav txim rau hauv lub plawv, thiab kuj thiaj li tus nqi ntawm tso cai ntawm lub pulses ntawm lub beam ceg thaiv thiab Purkinje fibers.

Lub mechanism ntawm qhov kev txiav txim ntawm cov tshuaj

Based on dab tsi ua rau cov tshuaj "Phenytoin"? Instruction hais tias lub hauv paus ntsiab lus ntawm nws cov nyhuv rau tib neeg lub cev yog tseem tsis to taub. Txawm li cas los, cov kws txawj hais lus cam uas siv feature ntawm qhov cuab tam yog nws muaj peev xwm mus rau stabilize week (neuronal) synaptic kev sib txuas ntawm cov hlab hlwb thiab lub cev.

Tshuav nqi rau zoo li no los, cov tshuaj yuav pab tau txwv cov kis ntawm neuronal excitation li zoo raws li kom tsis txhob qaug dab peg kev ua si.

nta nyiaj

Lub zoo kawg li kho "Phenytoin"? Cov lus qhia rau kev siv qhia tias nws active tshuaj muaj feem xyuam rau cov autonomic ganglia, txha caj qaum thiab lub hlwb cov ntaub so ntswg, lub plawv, nrog rau nws cov conductive system, peripheral qab haus huv thiab du nqaij ntawm lub plab hnyuv thiab lub plawv hlab ntsha.

Tau txais cov tshuaj no thiaj sodium concentration nyob rau hauv neurons, pab txhawb cov thauj ntawm sodium ions ntawm cov hlwb, thiab tseem txo intracellular calcium taw.

Nws yuav tsum tau muab sau tseg kuj tau hais tias pom tau hais tias cov tshuaj muaj feem xyuam rau lub lag luam ntawm fibroblasts, glial hlwb, thiab endocrine. Nws twb tseem pheej nrhiav tau nws muaj peev xwm leeb lub qhov txhab kho, mus suppress cov kev ua ntawm receptors (glutamate), txhim kho mov ntawm oxygen mus rau lub hlwb, ntaub so ntswg thiab kabmob nyob rau hauv tej yam kev mob ntawm hypoxia thiab toxins lom.

Noj cov tshuaj ntawm tshuaj txhaj koob tshuaj, nws muaj ib tug me me nruj thiab soothing, thiab uas tsis yog-hom.

kinetics

Tsis phenytoin yam khoom uas yog absorbed? Cov lus qhia rau kev siv (ib daim ntawv ntawm kev tso tawm ntawm lub tib lub npe tshuaj tau muaj npe saum toj no) hais tias lub qhov ncauj thawj coj ntawm cov tshuaj tivthaiv ntawm no haum yooj yim absorbed los ntawm lub cev ntawm tus neeg mob. Txawm li cas los, lub pharmacokinetic tsis xam tau tias yog txhais tau tias tej zaum yuav txawv muaj nuj nqis nyob rau hauv sib txawv pab pawg ntawm cov neeg mob.

Qhov siab tshaj plaws concentration ntawm cov tshuaj nyob rau hauv cov ntshav yog tiav tsis pub dhau 5-14 teev (mus txog 28 teev rau cov ntsiav tshuaj formulation). Cov nyhuv ntawm qhov ncauj thawj coj ntawm cov tshuaj yog cai tom qab txog ib teev, thiab tom qab tso dej thawj coj - tom qab ob peb feeb.

Yuav luag 80% ntawm lub active tshuaj yog txuam nrog cov ntshav ntshav proteins. Cov neeg uas muaj mob raum, tus nqi yuav ncav cuag 43%.

Raws li cov lus qhia ntawm cov nyiaj haum sai sai overcomes lub ntshav-hlwb barrier. Nyob rau hauv cov ntaub ntawv no, nws yog faib nyob rau hauv yuav luag tag nrho cov ntaub so ntswg thiab kabmob.

Hais txog 5% ntawm cov phenytoin yog outputted los ntawm ob lub raum. Nrog rau kev hwm mus rau seem uas tebchaw, nws yog metabolized nyob rau hauv daim siab thiab hloov dua siab tshiab rau hauv tsaug zog paraoksifenily thiab glucuronides, uas ces mam li tawm hauv lub cev ua ke nrog lub bile.

Yuav ua li cas kuv yuav tsum tau siv cov tshuaj "Phenytoin"? Kev siv cov tshuaj no yog muaj nrog pentobarbital, vitamins D thiab K, raws li zoo li lwm yam protivoepileptikami. Tsuas yog nyob rau hauv cov ntaub ntawv no nws yuav tsum tau raws li zoo raws li sai tau.

zaj lus tim khawv

Nyob rau hauv tej rooj plaub, siv yeeb tshuaj muaj tus nquag muaj, raws li phenytoin? Cov lus qhia rau kev siv (ntsiav tshuaj thiab tshuaj yuav tsum pom zoo kom tsuas kws kho mob) qhia cov nram qab no indications:

• qaug dab peg;
• lub sij hawm tom qab kev phais thiab kev poob plig (raws li ib tug tiv thaiv kev yeeb tshuaj);
• ventricular thiab supraventricular arrhythmia, uas yog tshwm sim los ntawm ib tug overdose ntawm antidepressants thiab mob glycosides;
• raws li txoj cai epilepticus nrog ib nrab complex qaug dab peg thiab tonic-clonic qaug dab peg;
• Meniere lub syndrome;
• trigeminal neuralgia, nrog rau cov kuj mus carbamazepine;
• ulcerative mob plab los yog chim siab plob tsis so tswj syndrome (nyob rau hauv ineffectiveness lwm txoj kev kho);
• teeb ntawm kev xav dab, puas siab puas ntsws, tus cwj pwm mob;
• strabismus thiab glaucoma;
• txawv txav lwm cov txheej txheem (kub nyhiab, kev kho hniav caries, ulceration thiab scleroderma);
• relapsing ua npaws thiab hypothalamic syndrome.

Contraindications

Saib cov tshuaj tej zaum tsis yuav siv thaum:

• cachexia los yog leukopenia;
• lactation;
• mob loj heev siab thiab raum kab mob;
• lub plawv tsis ua hauj lwm, AV-blockade ntawm 2 los yog 3 degree, bradycardia;
• npau taws me ntsis rau active tshuaj;
• porphyria;
• syndrome ntawm Morgagni-Adams-Stokes;
• cev xeeb tub.

Tsis tas li ntawd, ceev faj nyob rau hauv cov neeg mob uas mob ntshav qab zib mellitus, alcoholism, thaum lupus erythematosus los yog hyperthermia.

Tshuaj "Phenytoin": cov lus qhia rau kev siv

Cov tshuaj ntawm cov tshuaj yog xaiv ib lub zuj zus nyob rau hauv tus neeg mob lub hnub nyoog thiab tus kab mob.

Thaum epileptic kab mob tshuaj yuav tsum tau ob peb lub sij hawm tsawg dua nyob rau hauv qaug dab peg. Tshuaj nyob rau hauv cov ntsiav tshuaj daim ntawv coj xwb thaum lub sij hawm noj mov.

Lub hnub koob tshuaj rau cov neeg laus cov neeg mob nqi 1-3 ntsiav tshuaj (muab faib mus rau hauv 2-3 koob tshuaj). Yog hais tias tsim nyog, qhov no xov tooj yuav muab ntau zog li 4 ntsiav tshuaj ib hnub twg.

Qhov siab tshaj plaws ntau npaum cov tshuaj ib hnub twg yog 8 ntsiav tshuaj. Nyob rau hauv cov ntaub ntawv no, ib lub sij hawm rau tus neeg mob tsuas nqa tau 3 ntsiav tshuaj.

Nyob rau hauv cov kev kho mob ntawm cov me nyuam hnub nyoog 5 xyoos lawv tsa ¼ ntsiav tshuaj ib hnub ob zaug. Cov me nyuam 5-8 xyoo - nyob rau hauv tib lub npaum li cas, tab sis 3 los yog 4 lub sij hawm ib hnub twg.

Cov me nyuam uas tau hu tus muaj hnub nyoog ntawm 8, nws yog pom zoo rau muab 1-2 ntsiav tshuaj nyob rau hauv 2 faib koob tshuaj.

Lub caij ntawm kev kho mob nrog rau qhov no lub cuab tam yog txhais los ntawm ib tug tshwj xeeb.

Kev nqis tes ua los ntawm-cim

Tshuaj phenytoin tej zaum yuav ua raws li nram no undesirable los:

• Daim tawv nqaij ua xua, tawm pob morbilliform (yuav tsum tau nres cov tshuaj los pab txo cov tsos mob).
• Kev fab loj (tshwm sim tsis tshua), kub taub hau, nws kim heev pob, Stevens-Johnson syndrome, erythema, angioedema, kab mob siab.
• Gingival hyperplasia, macrocytosis, osteomalacia, megaplasticheskaya anemia, thrombocytopenia, pancytopenia, hirsutism, haemolytic anemia, lymphadenopathy.
• Koob-dependent mob ntawm lub hauv paus poob siab system, qhov muag, daim di ncauj thiab tawv muag daj fibrillation, ntxhov siab vim, ataxia, kiv taub hau, co, insomnia, txob taus, piav thoob hlo neuropathy (tshwm sim nrog heev siab koob tshuaj).
• Hypertrichosis, coarsening ntawm lub ntsej muag nta, hyperpigmentation, poob phaus, mob caj dab.

Nws yuav tsum tau muab sau tseg tias thaum uas tau txais cov tshuaj thawj zaug, tus neeg mob tej zaum yuav tsim nram qab no tshwm sim los ntawm gastrointestinal mob, nce ntawm daim siab enzymes, xeev siab, dyspepsia, gastralgia thiab gastritis. Lub rov tshwm sim ntawm zoo li no los yuav tsum tau zam hais tias koj noj tshuaj xwb thaum lub sij hawm noj mov.

tus neeg mob ntawm overdose

Daim ntawv thov ntawm qhov suav hais tias cov tshuaj nyob rau high school koob tshuaj rau heev sij hawm yuav ua rau txoj kev loj hlob ntawm ataxia, nystagmus, hyperkinesis, piav thoob hlo neuropathy, thiab diplopia. Tsis tas li ntawd, ib tug neeg mob tej zaum yuav tshwm sim tau qaug dab peg tau, hyperglycemia, thiab stupor.

Nws yuav tsum tau muab sau tseg tias yam khoom uas yuav tsis muaj ib yam tshuaj. Therapy yuav tsum tau nqa tawm raws li cov manifested cov tsos mob.

Cov ntaub ntawv

Ntawm cov nyiaj yuav tsis tau dheev rho cov neeg mob uas tau qaug dab peg, raws li qhov no yuav ua rau txoj kev loj hlob ntawm lub syndrome. Yog hais tias koj xav mus tsis kam txais yuav nws (piv txwv li, kev ua xua los yog npau taws me ntsis), koj yuav tsum tau siv anti-qaug dab peg tshuaj ntawm lwm yam.

Kev kho mob txhais tau hais tias pom tau hais tias muaj feem xyuam rau cov roj cholesterol, bilirubin, alkaline phosphatase, daim siab enzymes, qabzib, ntshiab calcium thiab tshuaj thyroxine.

Raws li hais saum toj no, phenytoin yam khoom uas yog metabolized nyob rau hauv lub siab, txawm li cas los thaum lub sij hawm nws txais tos yuav tsum tau kev pab tshwj xeeb rau cov neeg uas muaj lub siab tsis ua hauj lwm.

Yog hais tias ib tug neeg tau yav tas los tau cai meem kev txhawj xeeb rau hydantoin anticonvulsants, ces tus tshuaj no kuj tau kev tsis haum tshuaj.

Thaum lub sij hawm kev kho mob, tus neeg mob yog txwv tsis pub tsav tsheb ib lub tsheb thiab ua tej hauj lwm.

Analogs thiab xyuas

Yuav ua li cas yuav hloov tau lub antiepileptic tshuaj "Phenytoin"? Analogues ntawm no neeg sawv cev muaj qhov tib active ingredient. Cov tshuaj xws li cov nram qab no: "Difenin", "diphenylhydantoin" thiab "Dilantin".

Feem ntau cov kev xyuas txog cov neeg mob nyob rau hauv saib xyuas yog kev ncaj ncees. Lawv cam tias cov tshuaj yog kis yooj yim heev. Nyob rau hauv tas li ntawd, nws muaj ib tug me me npaum li cas thiab tsis plam nws anticonvulsant zog txawm tom qab heev thawj coj.

Peb kuj yuav tsum nco ntsoov hais tias muaj yog ib tug ntau ntawm zoo xyuas rau cov tsheb no, uas tshuav cov neeg mob uas coj nws nyob rau hauv lub complex txoj kev kho.