Fentanyl yog ib qho hluavtaws opioid analgesic. Nyob rau hauv nws cov qauv tshuaj, xws li ib yam khoom zoo ib yam li promedol. Thaum siv ib zaug, nws muaj zog heev, tab sis luv luv.
Thaum kev phais siv tshuaj loog hauv zos, fentanyl tuaj yeem siv los ua ib qho mob ntxiv (feem ntau ua ke nrog tshuaj tua kab mob).
Tshuaj raws li cov tshuaj no tau muab rau cov neeg mob txhawm rau txo qhov mob hnyav hauv myocardial infarction, pulmonary infarction, angina pectoris, nrog rau lub siab thiab lub raum colic. Kev npaj Fentanyl feem ntau yog siv rau hauv cov hlab ntsha lossis intramuscularly rau cov mob no.
Txawm li cas los xij, rau qee yam kab mob, cov tshuaj uas tau hais tseg yog siv sab nraud. Ib qho tshuaj tua kab mob zoo li no yog fentanyl thaj. kev phiv ntawm qhov noCov tshuaj, cov lus qhia rau kev siv, analogues thiab lwm yam ntaub ntawv tau tham hauv qab no.
Suab, ntim thiab muaj pes tsawg leeg
Fentanyl thaj yog ib qho kev kho mob ntawm lub cev. Cov tshuaj loog rau kev siv sab nraud zoo li cas? Qhov no yog ib lub pob tshab, daim duab plaub nrog cov npoo npoo uas muaj cov ntaub thaiv npog tshem tau (halved los ntawm kev txiav sinusoidal) uas loj dua li thaj tsam nws tus kheej.
Fentanyl tau ntim rau hauv lub hnab ntim cua sov ua los ntawm cov ntawv, txhuas thiab polyacrylonitrile. Muaj tsib lub hnab hauv ib lub thawv ntawv, nrog rau cov lus qhia ntxaws txog kev siv.
Cov tshuaj muaj pes tsawg leeg hauv nqe lus nug suav nrog xws li cov khoom xyaw nquag xws li fentanyl. Raws li rau txheej tiv thaiv tshem tau, nws yog polyester zaj duab xis nrog fluorine-muaj polymer txheej.
Nws ua haujlwm li cas?
Lub fentanyl transdermal thaj yog ib qho tshuaj pleev ib ce uas muab kev xa khoom ntawm tus neeg sawv cev rau 72 teev.
Fentanyl yog ib qho tshuaj tua kab mob opioid uas cuam tshuam nrog opioid μ-receptors hauv CNS, cov ntaub so ntswg thiab txha caj qaum. Cov tshuaj no muaj peev xwm ua kom muaj kev ua haujlwm ntawm cov kab mob antinociceptive thiab nce qhov mob. Yog li, cov tshuaj fentanyl-raws li cov lus nug muaj cov nyhuv sedative thiab analgesic.
Lwm yam khoom ntawm teeb meem
Txawm hais tias qhov tseeb tias fentanyl thaj yog siv sab nraud, nws yuav tsum raug coj mus rau hauv tus account tias cov tshuaj nquag. Cov tshuaj no tuaj yeem ua rau muaj kev ntxhov siab ntawm qhov chaw ua pa, ua rau lub plawv dhia qeeb, ua rau lub chaw ntuav thiab n.vagus chaw, ua kom cov leeg nqaij du (tsuas yog cov leeg nqaij ntawm biliary ib ntsuj av thiab sphincters), thiab txhim kho kev nqus. dej los ntawm lub digestive ib ntsuj av. Tsis tas li ntawd, cov khoom no tuaj yeem txo cov ntshav siab, lub raum ntshav khiav thiab cov hnyuv motility. Hauv plasma, fentanyl nce qhov concentration ntawm lipase thiab amylase, txo cov concentration ntawm kev loj hlob hormone, ACTH, catecholamines, cortisol thiab prolactin.
Nws tsis tuaj yeem hais tias cov khoom hauv nqe lus nug ua rau muaj kev zoo siab thiab pib pw tsaug zog (vim tshem tawm qhov mob).
Tus nqi ntawm kev txhim kho ntawm kev kam rau ua rau kev ua xua thiab tshuaj dependence muaj qhov sib txawv ntawm tus kheej. Piv nrog rau lwm cov tshuaj kho mob opioid, fentanyl tsis tshua muaj peev xwm ua rau cov tshuaj tiv thaiv histamine.
Pharmacokinetic nta
Dab tsi yog cov tshuaj pharmacokinetic ntawm cov tshuaj tua kab mob fentanyl? Qhov tsawg kawg nkaus ua tau zoo ntawm cov ntshav ntshav siab hauv cov neeg opioid-naive yog kwv yees li 0.3-1.5 ng / mL.
Tom qab thawj zaug siv cov tshuaj, qhov concentration ntawm nws cov tshuaj nquag hauv plasma nce maj mam thiab theem tawm ntawm 12 thiab 24 teev. Cov txiaj ntsig tau khaws cia rau 72 teev tom ntej.
Raws li cov lus qhia, qhov concentration ntawm fentanyl hauv tus neeg mob cov ntshav yog proportional rau qhov loj ntawm thaj. Kev nqus ntawm cov khoom no tuaj yeemtxawv nyob ntawm qhov chaw thov. Cov kev tshawb fawb tau pom tias txo qis fentanyl nqus tau tshwm sim thaum lub thaj tso rau ntawm lub hauv siab (piv rau sab nraub qaum thiab caj npab).
Cov kws tshaj lij qhia tias fentanyl tuaj yeem hla cov placenta, BBB thiab mus rau hauv cov kua mis. Cov khoom no khi rau plasma proteins los ntawm 84%. Nws kuj tseem muaj cov kinetics ntawm kev hloov pauv roj ntsha thiab yog metabolized hauv lub siab los ntawm CYP3A4 enzymes.
Tom qab tshem tawm thaj ua rau lo lus nug, nws cov ntshav cov ntshav qis zuj zus. Ib nrab-lub neej ntawm fentanyl tom qab thov yog 17 teev. Cov tshuaj no tawm nrog rau cov zis thiab cov kua tsib.
Tshuaj kho mob tshwj xeeb
Impaired raum thiab siab ua haujlwm tuaj yeem nce qib fentanyl hauv cov ntshav.
Nyob rau hauv cov neeg laus, nrog rau cov neeg mob uas tsis muaj zog lossis tsis noj zaub mov zoo, kev siv cov tshuaj no yuav ua rau txo qis ntawm kev tshem tawm ntawm fentanyl. Nyob rau hauv cov ntaub ntawv no, ib nrab-lub neej ntawm cov active tshuaj yog ua tau.
Tshuaj kho mob
Fentanyl thaj yog siv rau dab tsi? Cov lus qhia rau kev siv cov tshuaj no yog qhov mob ntev ntawm qhov muaj zog thiab nruab nrab, xav tau kev kho mob nrog tshuaj tua kab mob (opioid). Feem ntau, xws li cov tshuaj sab nraud yog muab rau:
- mob cancer;
- mob syndromes ntawm lub hauv paus chiv keeb uas tsis yog oncological yuav tsum tau rov tshuaj looganalgesics (piv txwv li, rau mob neuropathic, mob caj dab thiab arthrosis, mob phantom tom qab txiav caj dab).
txwv tsis pub siv
Ua ntej siv fentanyl thaj, cov lus qhia uas tau teev tseg saum toj no, koj yuav tsum nyeem cov contraindications. Cov no suav nrog cov xeev hauv qab no:
- mob hnyav CNS;
- mob ua pa nyuaj siab;
- tshuaj lom dyspepsia;
- khaus, puas lossis irradiated ntawm daim tawv nqaij hauv thaj chaw thov;
- mob plab hauv pseudomembranous colitis vim lincosamides, cephalosporins thiab penicillins;
- hnub nyoog yau;
- mob plab tom qab;
- kev siv ib txhij ntawm MAO inhibitors, nrog rau kev siv tshuaj tsis pub dhau ob lub lis piam tom qab lawv tshem tawm;
- siab rhiab heev rau cov tshuaj nquag lossis cov khoom pabcuam ntawm cov tshuaj.
Nrog kev ceev faj, cov tshuaj hauv nqe lus nug yog siv rau cov kab mob ntsws ntev, mob qog nqaij hlav, intracranial siab, arterial hypotension, mob hlwb raug mob, cholelithiasis, bradyarrhythmias, tshuaj dependence, siab / raum tsis ua hauj lwm, hypothyroidism, raum / hepatic colic, phais kab mob ntawm lub plab kab mob ntawm qhov mob hnyav (ua ntej kuaj mob), haus dej cawv, mob hnyav, BPH, urethral strictures, hyperthermia, kev xav tua tus kheej, kev siv tib lub sijhawm ntawm corticosteroids, insulin, antihypertensive.nyiaj txiag, nrog rau cov neeg laus, cov neeg mob uas tsis muaj zog thiab tsis muaj zaub mov noj.
KOJ
Fentanyl transdermal thaj ua rau thaj tso tawm lawv cov khoom xyaw nquag hauv 72 teev. Tib lub sijhawm, nws qhov kev tso tawm yog los ntawm 12.5 txog 100 mcg / h.
Cov tshuaj yuav tsum tau kho ntawm fentanyl yog xaiv los ntawm tus kheej thiab yuav tsum tau soj ntsuam tom qab siv txhua qhov thaj.
Qhov kev xaiv ntawm thawj koob tshuaj yog nyob ntawm theem ntawm kev siv opioid analgesics nyob rau lub sijhawm dhau los, suav nrog kev txhim kho ntawm kev ua siab ntev, qhov hnyav ntawm tus kab mob, kev kho mob sib xyaw thiab cov xwm txheej ntawm tus neeg mob.
Yog tias qhov xwm txheej ntawm cov tshuaj tiv thaiv ntawm tus neeg mob lub cev rau cov tshuaj opioids tsis nkag siab tag nrho, ces thawj koob tshuaj ntawm tus neeg sawv cev yuav tsum tsis txhob siab dua 25 mcg / h.
Yuav ua li cas hloov los ntawm lwm yam tshuaj tiv thaiv opioid?
Siv ib qho tshuaj tiv thaiv kab mob (fentanyl) rau oncology tom qab lwm qhov ncauj lossis parenteral opioid analgesics yuav tsum tau siv nrog ceev faj heev. Nws yuav tsum tau nco ntsoov tias thawj koob tshuaj nrog fentanyl yog xam nyob rau hauv ib txoj kev tshwj xeeb. Rau kev noj tshuaj kom raug, nrog tus kws kho mob tham.
Kev ntsuas qhov siab tshaj plaws ntawm cov tshuaj analgesic hauv nqe lus nug tuaj yeem ua tiav ib hnub tom qab daim ntawv thov. Qhov kev txwv no cuam tshuam nrog kev maj mam nce hauv cov concentration ntawm fentanyl hauv cov ntshav hauv thawj 24 teev.
Kev saib xyuas
Raws li cov lus qhia rau kev siv, fentanyl thaj yuav tsum tau hloov nrog ib qho tshiabtom qab 72 teev. Qhov ntau npaum ntawm cov tshuaj raug xaiv ib tus zuj zus mus txog rau thaum cov tshuaj loog yuav tsum tau ua tiav. Yog tias tom qab 48-72 teev tom qab daim ntawv thov muaj qhov pom ntawm qhov txo qis hauv cov nyhuv analgesic, tom qab ntawd lub thaj hloov pauv tom qab ob hnub.
Kev kho mob nres
Yog tias kev kho mob nrog cov tshuaj hloov pauv yuav tsum tau txiav tawm, nws hloov nrog lwm cov tshuaj opioids yuav tsum tau ua kom maj mam (los ntawm cov koob tshuaj qis mus rau qhov nce qeeb). Nws yuav tsum tau borne nyob rau hauv lub siab hais tias cov ntsiab lus ntawm fentanyl nyob rau hauv cov ntshav tom qab tshem tawm ntawm lub thaj yog txo qis linearly (hauv 17 teev).
Yuav ua li cas siv Fentanyl thaj
Cov tshuaj hauv nqe lus nug yog siv transdermally. Lub thaj yog muab tso rau ntawm qhov chaw tiaj tus ntawm cov tawv nqaij uas tsis muaj irradiated thiab tsis zoo (ntawm lub cev lossis lub xub pwg). Rau qhov chaw ntawm daim ntawv thov, nws yog ntshaw kom xaiv cov cheeb tsam nrog tsawg kawg ntawm cov plaub hau. Ua ntej muab lub thaj rau ntawm cov plaub hau ntawm lub cev, lawv yuav tsum tau txiav tawm (tab sis tsis shaved!).
Yog tias qhov chaw ntawm daim tawv nqaij yuav tsum tau ntxuav ua ntej siv cov tshuaj, nws yog qhov zoo dua los ua qhov no nrog cov dej zoo tib yam (tsis siv xab npum, roj, tshuaj pleev ib ce, cawv lossis lwm yam khoom uas tuaj yeem ua rau khaus lossis hloov pauv. cov khoom ntawm daim tawv nqaij). Cov npog yuav tsum qhuav tag ua ntej thov.
Vim qhov tseeb tias fentanyl thaj thaj, uas yog contraindicated saum toj no, muaj ib tug tiv thaiv waterproof sab nrauv zaj duab xis, nws muaj peev xwm muab tso rau ua ntej ib tug luv luv da dej.
Cov tshuaj hauv nqe lus nug yuav tsum raug sivtam sim ntawd tom qab muab nws tawm ntawm lub ntim. Tom qab tshem tawm cov yeeb yaj kiab tiv thaiv, thaj chaw transdermal yog nias kom nruj rau hauv daim ntawv thov thiab khaws cia rau hauv lub xeev no li ntawm 30 vib nas this. Tom qab ntawd, xyuas kom meej tias thaj chaw adheres rau ntawm daim tawv nqaij, nrog rau ntawm cov npoo. Yog tias xav tau, lawv yuav tsum tau kho ntxiv ntawm cov nyiaj.
Lub sijhawm ntawm fentanyl thaj yog 72 teev. Yog li ntawd, cov tshuaj yuav tsum tau hnav tsis tu ncua nyob rau lub sijhawm teev tseg, thiab tom qab ntawd hloov nrog ib qho tshiab. Qhov thib ob transdermal thaj yuav tsum tau siv rau thaj chaw sib txawv yam tsis tau npog thaj tsam ntawm daim ntawv thov dhau los.
Fentanyl tsis pom zoo rau kev sib cais thiab txiav.
Side effects
Thaum siv cov tshuaj fentanyl rau qhov mob hauv nraub qaum thiab lwm qhov hauv lub cev, ib tus yuav tsum paub txog cov kev mob tshwm sim. Cov tshuaj no yuav ua rau muaj kev phiv hauv qab no:
- ua pa nyuaj siab, hais lus tsis meej, tsaug zog, palpitations, hypersomnia, bradycardia, mob taub hau, arrhythmia, kiv taub hau;
- tsis meej pem, tachycardia, kev nyuaj siab, dyspnea, pharyngitis, ntxhov siab vim, ntuav, tshee, rhinitis;
- hnov lus tsis txaus ntseeg, arterial hypotension, anorexia nervosa, delirium, vasodilation, tsis muaj leeg nqaij contractions, yawning, hypoesthesia;
- euphoria, laryngospasm, amnesia, arterial hypertension, insomnia, mob plab, ntxhov siab, plab hnyuv, tshee, cem quav;
- paresthesia, xeev siab, amblyopia, xerostomia, asthenia, dyspepsia, kev sib deev tsis zoo, ataxia,hypoventilation, myoclonic convulsions, hiccups;
- hemoptysis, pruritus, obstructive pulmonary kab mob, raws plab, exudation, mob flatulence, anaphylactic shock, pob liab liab, anaphylactic tshua, tawm hws, tso zis, anaphylactoid tshua, ureteral spasm, ua pob liab vog;
- Hloov pauv ntawm daim tawv nqaij, microfissures, kab mob urinary, petechial yaig, tawv nqaij tawv, eschar, erythema, oliguria, zais zis mob;
- conjunctivitis, malaise, nkees, cov tsos mob xws li mob khaub thuas, o thiab txias.
Kev siv lub sijhawm ntev ntawm fentanyl thaj rau qhov mob nraub qaum thiab lwm qhov hauv lub cev tuaj yeem txhim kho kev puas siab puas ntsws thiab lub cev, kev ua siab ntev, thiab lub sijhawm luv luv.
Kev Sib Tham Tshuaj
Thaum siv tus neeg sawv cev hauv nqe lus nug, qhov sib npaug ntawm kev noj barbituric acid derivatives yuav tsum raug cais tawm, txwv tsis pub tom kawg tuaj yeem ua rau muaj kev nyuaj siab ua pa.
Kev siv lwm yam tshuaj uas ua rau lub hauv siab hauv nruab siab (opioids, tranquilizers, anxiolytics, tshuaj loog, cov leeg nqaij so, phenothiazine derivatives, thiab lwm yam) tuaj yeem ua rau hypoventilation, hypotension, tob sedation lossis coma.
Tseem ceeb kom paub
tshuaj raws li Fentanyl tau sau tseg ua ib feem ntawm kev tswj kev mob nyuaj, raug rau kev sib raug zoo, kev kho mob thiab kev soj ntsuam ntawm tus neeg mob tus mob.
Nrog kev txhim kho ntawm cov kev mob tshwm sim hnyav, tus neeg mob yuav tsumnyob rau hauv kev saib xyuas ntawm cov kws tshwj xeeb rau ib hnub tom qab tshem tawm thaj.
Cov khoom siv tsis siv thiab siv cov khoom siv hloov pauv uas muaj fentanyl yuav tsum tau khaws cia kom deb ntawm cov menyuam yaus.
Cov neeg ua npaws xav tau kev saib xyuas zoo los ntawm kws kho mob (kho tshuaj fentanyl yog tias tsim nyog).
Fentanyl thaj analogues
Analogues ntawm cov tshuaj hauv nqe lus nug ("Fendivia") yog cov tshuaj xws li "Fentanyl M Sandoz", "Lunaldin", "Fentadol Matrix", "Dyurogesic Matrix", "Fentadol Reservoir", "Fentanyl", " Dolforin". Nws yuav tsum nco ntsoov tias nws muaj peev xwm hloov cov cuab yeej tseem ceeb nrog cov zoo sib xws tsuas yog tom qab sab laj nrog kws kho mob.
