Mankhwala "Kortef": malangizo ntchito, zizindikiro, contraindications, mlingo ndemanga

Glucocorticosteroids (GCS) amatchedwa mankhwala kupanga, amene analogues mahomoni amkati opangidwa ndi kotekisi adrenal. GCS ali pa thupi zosiyanasiyana za mankhwalawa: odana ndi yotupa ndi zakupha chikumbumtima, immunosuppressive, odana ndi poizoni ndi antishock.

Today mankhwala msika wa Russia ndi mndandanda lonse la mankhwala amenewa. Mmodzi wa iwo ndi "Kortef". Malangizo ntchito amalimbikitsa kutenga ndi chiwerengero cha matenda.

Kapangidwe ndi Kaonekedwe

medicament The cholinga cha utsogoleli m'kamwa. Waukulu yogwira chigawo "Kortef" kukonzekera (malangizo ali ndi mfundo imeneyi) ndi hydrocortisone - ndi timadzi opangidwa ndi zopangitsa kwa adrenal. Ntchito zokhudza zonse ndipo m'deralo ntchito mu mapangidwe mankhwala hydrocortisone achilengedwe kapena esters ake.

Mu mankhwala "Kortef" timadzi umenewu uli kuchuluka kwa 10 mg. Monga zinthu zina protrude monga kashiamu stearate, wowuma chimanga, sucrose, lactose, mafuta mchere ndi asidi sorbic.

Mawonekedwe chachikulu umene akufuna kuti ogula 'Kortef "- mapiritsi. Malangizo ntchito, ogwira ntchito zaumoyo weniweni ndi odwala kuti dzuwa mkulu wa mankhwala. Mapiritsi a mawonekedwe zozungulira ndi mzere padziko ndi embossed pa izo zaikidwa «CORTEF10» mmatumba mu mbale zinada galasi (chilichonse odzaza ndi zidutswa 100). Kugula mankhwala yekha mankhwala dokotala.

pharmacodynamics

Monga tanena kale, mankhwala ali ndi mndandanda wa zotsatira za thupi: odana ndi yotupa ndi antishock, zakupha chikumbumtima ndi odana ndi matupi awo sagwirizana, odana ndi poizoni, immunosuppressive ndi antimetabolite. Kufotokozera za mankhwala (malangizo Buku) lili ndi mfundo za misa njira imene mankhwala kumakhudzanso. Iwo kumabwezera mmbuyo amasulidwe owayimira yotupa ndipo kwambiri kubweza amasulidwe cytokines (interferon, interleukins) kuchokera macrophages ndi lymphocytes.

Komanso, "Kortef" kumapangitsa yosungirako glycogen mu chiwindi, kumaonjezera kuchuluka kwa shuga uli mu magazi, madzimadzi kubweza ndi excreted Na + ndipo K + ukuwonjezeka. Ndi okhudzidwa mwachindunji medicament ndi amachepetsa yopanga histamine (nkhoswe, T. E. Mkhalapakati wofunikila mtundu yomweyo thupi lawo siligwirizana).

Komanso, yokonza Kortef "malangizo ntchito monga ananena kudzera amachepetsa chiwerengero cha infiltrates ma (zinthu selo magazi ndi lymph) ndi yosatheka yotupa foci locomotor ntchito leukocytes ndi lymphocytes amathandiza kuchepetsa permeability capillary. Mankhwala kumabwezera mmbuyo kaphatikizidwe ndi kumawonjezera mlingo wa kusokonezeka mapuloteni.

"Kortef" amakhudza pituitary ndi limaleka kutulutsa corticotropin (ACTH), popanda zomwe zikhoza kusiya kwathunthu kugwira ntchito kwa kotekisi adrenal.

Medicine "Kortef": malangizo, ntchito

Akatswiri Mlendo kuti patsogolo pathu mankhwala ntchito zosiyanasiyana za mankhwala. Izo ntchito kuchotsa wodwalayo poizoni, zoopsa, zilonda zamoto, cardiogenic, mantha ntchito pa nthawi imene muyezo antishock mankhwala anabweretsa palibe chifukwa. Tiyeni tikambirane mfundo zimenezi mwatsatanetsatane.

siyana kotero, momwe odwala Kwalamulidwa "Kortef"?

Malangizo ntchito, malongosoledwe mankhwala anabweretsa ogula mfundo zokhuza kuthekera ntchito zake endocrinology. Apa, mankhwala adzakhala ochiza matenda monga insufficiency wa adrenal kotekisi kugwira ntchito, thyroiditis (subacute mawonekedwe), adrenal hyperplasia (titadziwa authunthu), hypercalcemia, amene anaonekera pa maziko a malignancies.

Komanso, Rheumatology "Kortef" motsimikiza kumaonekera mankhwalawa bursitis, nyamakazi (gout, psoriatic rheumatoid), ankylosing spondylitis, nonspecific tenosynovitis. zotsatira zabwino akwaniritsa, odwala wochotsa "Kortef" mu zokhudza zonse lupus erythematosus, pachimake enaake ophwanya matenda a mtima, polymyositis, epicondylitis.

Pali zizindikiro ntchito "Kortefa" ndi m'munda wa khungu. Apa mankhwala othandiza pa matenda a pemphigus, mycosis fungoides, herpetiformis, ndi dermatitis exfoliative. Komanso Kwalamulidwa kwa psoriasis kwambiri, seborrheic dermatitis, erythema multiforme katundu otaya.

Allergists mankhwala "Kortef" ndi matenda seramu, matupi awo sagwirizana rhinitis chiyambi, ndi atypical ndipo kulankhula dermatitis, bronchial mphumu hypersensitivity munthu mankhwala.

Akatswiri-ophthalmologists monga mchitidwe woika "Kortefa" ndi chiwerengero cha matenda. The medicament ndi mogwira zilonda corneal ndi conjunctivitis chiyambi matupi awo sagwirizana ndi keratitis ndi iritis, iridocyclitis pamene, neuritis, uevite, etc. Mu munda wa Oncology GCS "Kortef" zotchulidwa mu khansa, mu ubongo - .. zingapo sclerosis.

Nanga ntchito "Kortef"? Malangizo ntchito kakunena kuti uzipereke odwala ake pulmonology (symptomatic sarcoidosis, fulminant m'mapapo mwanga TB, kukhumba chibayo) ndi hematology (thrombocytopenia sekondale, aplastic magazi m'thupi kapena hemolytic, erythroblastopenia).

Mapulogalamu ndi dosing

The medicament "Kortef" cholinga cha utsogoleli m'kamwa. Komabe, chifukwa chosindikiza lyophilizate wa njira "Solu-Kortef" malangizo Buku akulangiza kutumikiridwa intramuscularly, m'nsinga (bolus kapena kulowetsedwa) ndi thumba periarticular.

Koma makonzedwe m'kamwa, mlingo woyambilira zingasiyane mg ndi 20 240 tsiku malingana ndi matenda matenda ndi zovuta alili. Mlingo mulingo woyenera pa nkhani iliyonse amusankha ndi kutsitsa poyamba anavomerezedwa zing'onozing'ono zomwe zingatipatse zotsatira ankafuna.

Mu zikhalidwe pachimake ndi chithandizo mwadzidzidzi analimbikitsa mtsempha mankhwala kasamalidwe "Solu-Kortef". Malangizo ntchito limafotokoza zotsatirazi muyezo chiwembu. Yankho loyamba 100 mg (mlingo woyambilira) kutumikiridwa oposa theka miniti. Buku yotsatira ya mankhwala mu 500 mg ayenera kuperekedwa mkati mphindi 10. Komanso, aliyense maola 2-6, ndondomeko ayenera mobwerezabwereza, popanda kuiwala mosalekeza kuwunika alili.

Tiyenera kukumbukira kuti pamafunika mlingo waukulu, "Sol-Kortef" okhawo nthawi olimba wodwalayo, koma salinso kuposa masiku 3.

V / mamita "Kortef" kutumikiridwa mu buku la 125-250 mg / tsiku. Phindu mankhwala akuwonetseredwa pambuyo maola 6-25 pambuyo ndondomeko ndi ukhoza kwa masiku angapo masabata angapo.

Ngati ndi kotheka, "Kortef" jakisoni anali kwapakati pa-articular kapena periarticular mu thumba. Mlingo ochiza mfundo zazikulu (phewa, bondo, m'chiuno) ndi 25-50 mg, koma zinthu pachimake ndi angafikire 100 mg. Chifukwa mafupa wocheperako (elbows, woimbayo phalanges) adzakhala okwanira jekeseni buku la 10-20 mg, anapanga 1 nthawi. Bwerezaninso analimbikitsa pa masabata 1-3 (zina pamafunika ndi zambiri - masiku 3-5).

Ambiri, ndi nkhani mankhwala "Kortef" Mlingo ndi yoyendetsa likhoza kusankha dokotala amachitira. Mwadzidzidzi kusiya mankhwala si zofunika, mwina mkulu wa kumwa. Akamaliza mankhwala kumachitika mwa pang'onopang'ono kuchepetsa mlingo.

Contraindications ntchito "Kortefa"

Pali mndandanda wa matenda ndi zinthu chamoyo, pamene sankaloledwa kutenga pansi kulingalira ndi mankhwala. Izi parasitic ndi matenda matenda a chiyambi tizilombo mafangasi toyambitsa (anasamutsa m'mbuyomu posachedwapa, zikuchitika pa nthawi).

Musati am'sankhe, ngati wodwalayo ali anapezeka ndi psychosis mu gawo pachimake, decompensated shuga kapena anthu akuvutika hypothyroidism, hyperthyroidism, matenda oopsa, chironda chachikulu matenda m'mimba ndi matenda dermatological, chironda chachikulu kapena uthunthu opatsirana.

Pali mndandanda wa contraindications kwa intraarticular jekeseni "Solu-Kortef" mankhwala. Musati mankhwala, ndipo chiwerengero cha mavuto ndi dongosolo la mtima, kuphatikizapo mbiri posachedwapa infarction m'mnyewa wamtima.

Kwa mlingo umodzi, ngakhale kwa "ofunika" zosowa contraindication kuti ntchito ndi munthu hypersensitivity kwa zigawo mankhwala.

zotsatira osafunika

Zifukwa zingapo zimadalira pafupipafupi ndi chinyezimiro cha mavuto, mndandanda wa muli mankhwala kuti "Kortef" malangizo Buku. Zizindikiro, mlingo, nthawi kumene zotchulidwa dokotala kupezeka ziyenela kuyan'anidwa ndithu. Ena kufunika amadziwikanso Ufumuyo kusunga kayendedwe circadian wa kopita (kusinthasintha mphamvu ya njira zosiyanasiyana kwachilengedwenso kugwirizana ndi kusintha kwa usana ndi usiku).

Dongosolo endocrine poyankha kulandira "Kortefa" akhoza kuyankha kuchepa kudziwa shuga ndi chitukuko cha matenda a shuga steroid chikhalidwe, ogwira ntchito za yimitsira adrenal. Pali mwayi kukhala syndrome Cushing a, zizindikiro zazikulu zimene ziri kachigawo woboola pakati mawonekedwe a nkhope, kunenepa, pituitary mtundu wa kuwonjezeka chiwerengero cha magazi, myasthenia gravis, matenda osiyanasiyana a msambo mu akazi.

Chisoni pa mundawo m'mimba zingakhale zizindikiro monga kunyansidwa ndi kusanza, kapamba, ndipo zosiyanasiyana steroid ulceration pa mundawo m'mimba, magazi, ndi perforation a (GI) makoma ake, erosive esophagitis.

Kuchokera mbali ya zochita mtima chokhwima kuti "Kortef" (wosuta akutsimikiza mfundo imeneyi) ndi arrhythmia, bradycardia, thrombosis, kuwonjezeka zizindikiro magazi. Motsutsa likhale ndi pachimake ndi subacute mawonekedwe a "Kortef" infarction m'mnyewa wamtima zingachititse kufala kwa necrosis, chopinga wa mapangidwe minofu yovulazidwa, tingayambe chophukacho wa minofu mtima.

Nthawi zambiri kukhumudwa kugwiritsa ntchito "Kortefa" njira imodzi kapena wina akhoza kukhala zosiyanasiyana ziwalo ndi kachitidwe ka thupi la munthu. mawonetseredwe zotheka a dongosolo chapakati mantha ndi ziwalo kwenikweni, matenda a kagayidwe ndi dongosolo minofu ndi mafupa. Iwo angasonyeze zosiyanasiyana thupi lawo siligwirizana. Mfundo yonse ali mu medicament ntchito "Kortef" malangizo.

Mimba ndi mkaka wa m'mawere

Mu nthawi ya gestation ndi mwana yoyamwitsa mosamalitsa limaletsa medicament "Kortef" malangizo Buku. Kufotokozera (pamaso pa mitundu ina ya mankhwala benzyl mowa odziwikiratu), mankhwala lili zokhudza mavuto mwina ntchito "Kortefa" m'masiku otsiriza monga kulephera kwa ntchito adrenal, boma la breathlessness imfa.

Ana, amai amene ali woyembekezera kuumirizidwa kutenga hydrocortisone, ayenera kuyang'aniridwa pafupi ogwira ntchito zachipatala ncholinga kudziwika oyambirira a zizindikiro za insufficiency adrenal.

Kodi muyenera kulabadira?

Mu mankhwala ndi ntchito mankhwala "Kortef" wogwiritsa Phunziro pankhaniyi analimbikitsa zakudya Kuchepetsa mchere wambiri. Komanso, thupi liyenera kumlandira mapuloteni chokwanira. Komanso nthawi imeneyi ndi zosavomerezeka kugwira mtundu uliwonse wa katemera. M'pofunika kuchita polojekiti kopitirira magawo magazi, anthu ambiri shuga m'magazi ndi clotting ake. N'kofunikanso kuti aziona mkodzo linanena bungwe ndi kulemera kwa wodwalayo.

Ngati chilichonse nkhawa, anthu akukumana Inde achire ndi "Kortefa" ayenera kuwonjezera mlingo wa corticosteroids. Ponena za odwala matenda TB, amene ali gawo yogwira azitenga "Kortef" yekha limodzi ndi mankhwala chogwirizana anawalozera kwa chithandizo cha matenda chachikulu. Mu TB zikuchitika mu mawonekedwe zobisika, kapena m'kati unakhota tuberculin likuyesetsa madokotala ayenera kwambiri kuwunika mmene alili ndi mankhwala chemoprophylaxis ngati ndikofunika kutero.

Ngati poika mankhwala amayamba kukula kwa sekondale adrenal insufficiency, n'zotheka matenda zinthu mwa pang'onopang'ono kuchepetsa mlingo. Pambuyo mankhwala udzatha, ngakhale kwa miyezi ingapo Tingaone mtundu uwu kulephera. mavuto amene anachitika nthawi ino ali ndi chidziwitso cha resumption wa kopita GCS.

Koma matenda yosavuta nsungu diso, pa "Kortef" (wosuta, ntchito, akatswiri enieni ali m'nkhani), ndipo corticosteroids ina ayenera kugwiritsidwa ntchito mosamala kwambiri, chifukwa n'zotheka chitukuko cha perforation corneal.

ogwira ntchito zachipatala ayenera kudziwa mfundo yakuti pa mankhwala "Kortefom" matenda ena opatsirana kungakhale asymptomatic, mu mawonekedwe zobisika, ndipo ndi osiyana a mwamphamvu. Ndi kukula Mlingo wa corticosteroids ntchito kumachititsa kukhala matenda zobisika. E. Mothandizidwa "Kortefa" snizhet kukana matenda, amachepetsa luso localize gwero la matenda.

Amene amapatsidwa immunosuppressive Mlingo "Kortefa" kapena corticosteroids ina analimbikitsa osati amakhudzana ndi anthu amene ali ndi katsabola kapena chikuku. Ngati anzanu otere chichitike, muyenera kudziwitsa dokotala awo amachitira nthawi yomweyo.

SCS kungakhale chifukwa matenda a m'maganizo, kapena kulimbikitsa alipo mawonetseredwe psychotic, kuchuluka Kusakhazikika maganizo.

Pali zambiri kuti odwala ena pa maziko a "Kortefa" (kapena corticosteroids zina) anayamba sarcoma Kaposi a. Komabe, pambuyo kulipira medicament anati chikhululukiro matenda.

Chifukwa chakuti mavuto pambuyo kutenga mankhwala ndi mwachindunji amadalira nthawi ndi mlingo mlingo, kusankha kuyamba njira mankhwala, anakhala ndi Mlingo kololeka dokotala zimatengera pamene mumayesto ubwino ankaimbidwa mtima wake ndi mavuto angathe mankhwala.

Mogwirizana ndi mankhwala ena

Choncho, tinakambirana zimene tingati "Kortef". Malangizo ntchito, zizindikiro ndi contraindications ndi zotsatira zake zoyipa za mankhwala nazonso ankaona. Mpaka kuona kuti anthu aluso poika mankhwala odwala ayenera kudziwa kuti hydrocortisone ali anachitira ndi zosiyanasiyana zinthu, ndipo mankhwala awa akhoza kuwononga kwambiri m'thupi.

Choyamba, hydrocortisone pharmaceutically atakwatirana ndi mankhwala ena ndi kugwirizana pofuna akhoza kupanga insolubles. Chachiwiri, kumaonjezera kawopsedwe wa glycosides mtima, chifukwa angathe hypokalemia, kenako pali chiopsezo cha kuchuluka kwa arrhythmia.

Ndi nawo mwachindunji "Kortefa" (makamaka, chigawo waukulu) kumawonjezera mlingo wa excretion asidi acetylsalicylic (ASA) ndiponso mlingo okhutitsidwa amachepetsa magazi.

Ntchito hydrocortisone pa maziko a katemera moyo HIV lingachititse kutsegula kwa mavairasi ndi chitukuko cha matenda.

Paracetamol mu tandem ndi "Kortefom" kungakhale hepatotoxic. Pa makonzedwe yaitali kumaonjezera ndende ya kupatsidwa folic acid mu thupi. Pa Mlingo mkulu hydrocortisone amachepetsa mphamvu ya somatropin (zikule timadzi).

Komanso, waukulu yogwira pophika amachepetsa mphamvu ya mankhwala hypoglycemic koma kumawonjezera zotsatira anticoagulant wa zotumphukira coumarin. "Kortef" limaleka zotsatira vitamini D pa mayamwidwe ndondomeko ya Ca ₂ + mu lumen wa matumbo. Mothandizidwa hydrocortisone kumawonjezera kawopsedwe wa cyclosporine ndi ketoconazole.

Pamaso pa zinthu monga ephedrine, theophylline, rifampicin, barbiturates mphamvu iliyonse akangofika GCS zotsatira amachepetsa. Ziphuphu zakumaso ndi chitukuko cha hirsutism (kukula kwambiri a osachiritsika - okhwima ndi mdima - tsitsi akazi chitsanzo mwamuna) poyambirira pa phwando pamodzi ndi mankhwala ena hydrocortisone steroid m'thupi (anabolic mankhwala, estrogens m'kamwa kulera).

Maganizo a ogula za mankhwala "Kortef"

"Kortef" n'zovuta mankhwala alibe maganizo olakwika. Ngakhale zabwino zambiri. Kufotokozera mankhwala "Kortef" (ndemanga za ogwira ntchito zachipatala amatsimikizira izi) amalola kuti mudziwe m'mene yotakata ukulu, kotero mndandanda ndi yaitali ndi chowawa zochitika. Kuweruza ndi ndemanga odwala okha, munthu mwamsanga omasulidwa ku zowawa, chifukwa mu bwino khalidwe la moyo, koma wina wachititsa zambiri olakwika, ndi maganizo odwala analibe mphamvu iliyonse.

Izi mankhwala zoipa kapena zabwino - n'chochepa kwambiri funso chida monga "Kortef". Chinthu chachikulu apa - kudalira zinachitikira ndi akatswiri a dokotala kupezeka ndiponso kutsatira malangizo ake onse.