Ukwelashwa okujwayelekile kwegolide kwezifo zikaParkinson (PD) kuyindlela yokwelashwa . Cishe yonke imithi etholakalayo yenza ukwandisa izinga le-dopamine ebuchosheni. Indlela umuthi onikeziwe owenza ngayo lokhu kuhambisana nokusebenza kwawo nemiphumela emibi.
I-Levodopa ekuphatheni iziMpawu
I-Levodopa iyimithi yokuqala ye-PD-ubuchopho amaseli asebenzisa i-levodopa njengesakhi sokwakha ukwenza i-dopamine engaphezulu.
I-Levodopa isebenza ngezibonakaliso ezivame ukuhamba ngezimoto, okwenza ube nomuzwa ongenamandla, ohamba phambili futhi oguquguqukayo. Ngeshwa, ayiphululi i-PD futhi ayikwazi ukumisa inqubo yesifo esiyisisekelo ngokwayo.
I-Levodopa nayo inemiphumela emibi. Kodwa lemiphumela emibi ingasuswa ngokuhlanganisa i-levodopa neminye imithi. Isibonelo, umphumela owodwa omkhulu we-levodopa uma isetshenziselwa yedwa kuyisiphithiphithi-umphumela we-dopamine kakhulu ojikeleza emzimbeni wegazi esikhundleni somqondo. Ukuvimbela isicuphososi nokuthuthukisa inani levodopa elifinyelela ebuchosheni, i-levodopa ivame ukunikezwa ngolunye uhlobo lwezidakamizwa olubizwa ngokuthi i- dopa decarboxylase inhibitor (DDI). I-DDI ivimbela ukuguqulwa kwe-levodopa ukuba i-dopamine emzimbeni wegazi lomzimba ngaleyo ndlela ivumela i-levodopa ngaphezulu ukuba ifinyelele ebuchosheni nokuvimbela isicanucanu.
Ifomu ejwayelekile kakhulu yeDDI elisetshenziswe emazweni amaningi yi-carbidopa. Ukuhlanganiswa kwe-levodopa ne-carbidopa kuyaziwa ngegama lokuhweba iSinemet.
Emazweni amaningi amazinga omthamo we-carbidopa / levodopa anqunywe njengengxenyana-i-numerator (inombolo ephezulu) ingumuthi we-carbidopa kuthebhulethi ngayinye, ne-denominator (inombolo engezansi) inani levodopa. Isibonelo, inhlanganisela ye-25/100 iqukethe ama-milligram angu-25 we-carbidopa nama-milligram angu-100 we-levodopa.
I-Carbidopa / levodopa itholakale nokubunjwa okukhulunywe ngokulawulwa okubizwa ngokuthi iSinemet CR. Ukubunjwa okulawulwayo kweSinemet kuvumela isikhathi sokukhululwa kancane kwe-levodopa engxenyeni yegazi, esiza ukugudluza ukuguqulwa kwesilinganiso sokuphela kwesilinganiso, kanye nokuphazamiseka kokulala ebusuku.
Ezinye izidakamizwa zeDopamine
Nakuba i-levodopa ithatha ngokuphumelelayo izimpawu zesifo sikaParkinson , lesi sifo nokho siyaqhubeka futhi siba sibi kakhulu ngokuhamba kwesikhathi. Isifo sikaParkinson sonakalisa amangqamuzana obuchopho enza i-dopamine noma okuguqula i-levodopa ukuba i-dopamine. Njengoba lesi sifo sithuthuka, kuba nzima ngokwengeziwe ukugqugquzela ubuchopho ukukhiqiza i-dopamine . Ngakho-ke, sidinga izindlela ezihlukile zokugcina amazinga e-brain dopamine aphezulu ngokwanele ukusekela ukusebenza okuvamile kwemoto.
Njengoba amangqamuzana okukhiqiza i-dopamine abonakaliswa yisifo esifanele sibheke amanye amangqamuzana angase akhiqize i-dopamine kodwa azame ukusebenzisa i-dopamine ekhona ngokuphumelelayo. Izigaba ezimbili zemithi zingenza lokhu:
- imithi ekhuthaza ngokuqondile amaseli asebenzisa i-dopamine-"i-dopamine agonists"
- imithi evimbela ukuwohloka kwe-dopamine emzimbeni futhi ngaleyo ndlela ukwandise amazinga atholakele ebuchosheni-i- "COMT and MAO inhibitors"
I-Dopamine Agonists eziguleni zikaPasinson
Kunezinhlobo ezimbalwa ze-dopamine agonists njenge:
- (Mirapex) I-Pramipexole
- (Vuselela) Ropinirole
- (Neupro) i-Rotigotine
Zonke lezi mithi zilinganisa imiphumela ye-dopamine kuma-receptors akhethiwe, awamaseli akhuthaza imiphumela ye-dopamine ebuchosheni.
Le mithi ingenza imiphumela emibi njengesizungu, ukucindezela kwegazi okuphansi, nokuphazanyiswa kwengqondo ukuze kuqalwe njengesilinganiso esincane kakhulu, futhi kancane kancane kwanda ngaphansi kokuqondiswa kwesifo sezinzwa zomuntu.
I-COMT Inhibitors nama-MAO Inhibitors
I-COMT (i-catechol-O-methyltransferase) inhibitors kanye ne-MAO-B (i-monoamine oxidase uhlobo B) inhibitors isebenza ukuvimbela ukuwohloka nokusetshenziswa kwe-dopamine emzimbeni nasebuchosheni.
Uma i-COMT ivinjiwe noma ivinjelwe, isibonelo, i-levodopa engaphezulu ingafinyelela ohlelweni lokulawula isithuthuthu. I-COMT inhibitors evamile kakhulu (Tasmar) i-tecone futhi (i-Comtan) i-entacapone. I-COMT inhibitors ibasiza kakhulu abantu abanezimoto eziguqukayo.
Kodwa njengemithi eminingi, i-COMT ne-MAOI inhibitors banemiphumela emibi. Ngokwesibonelo, amaphesenti amahlanu kuya kwayishumi weziguli ezithatha isishibithi se-COMT zidala isifo sohudo. Ngokuvamile kusho ukuthi isidakamizwa kufanele simiswe. Amaphesenti amabili kuya kwamatsatfu abantu abathwala i-tropone bakhula izinkinga ezinkulu zesibindi ezidinga ukuqapha okuqaphele kokusebenza kwesibindi uma kusetshenziswa izidakamizwa noma ukuyeka ukusetshenziswa kwezidakamizwa ngokuphelele. I-Entacapone ayinayo lezinkinga zobuthi zesibindi.
I-MAO-B inhibitors, njenge-Eldepryl selegiline no-Azilect) i-rasagiline, ivimbela i-enzyme i-MAO-B ukuthi ingaphuli i-dopamine ebuchosheni ngokwayo.
I-Selegiline isetshenziselwa ngokuyinhloko ukuvimbela noma ukubhebhezela ukushintsha kwezimoto ukuphela kokuphela. Imiphumela yayo ibuhlungu kakhulu. U-Selegiline wayekholelwa ukuthi abe yisisetshenziswa sokuvimbela ukuvimbela umonakalo we-dopamine neurons ebuchosheni. Kuvela ukuthi le mphumela ye-neuroprotective ye-selegiline incane noma ayikho.
I-Rasagiline, ngakolunye uhlangothi, ibukeka ibe yithembisayo kakhulu ngokuqondene nemiphumela yayo engase ibe neuroprotective nakuba ijaji lisekhona kulo mphumela obalulekile walesi sidakamizwa. I-Rasagiline isetshenziswe ikakhulukazi eParkinson yokuqala nokulinganisa ukunciphisa ukushintsha kwezimoto. Ubufakazi obengeziwe bokusebenza nokuphepha kwe-rasagiline kuyadingeka.
Ngaphansi
Nakuba i-levodopa ingumuthi omuhle kakhulu wokuphatha izinkinga zemoto zesifo sikaParkinson, ngezinye izikhathi ezinye izidakamizwa ezifana ne-dopamine agonists noma i-MAO inhibitors zingaqala kuqala, ikakhulukazi uma izimpawu zomuntu zinomusa. Le mithi ingabuye yengezwe kwi-levodopa yokwelashwa ukuphatha ukushintsha kwezimoto.
Izindaba ezinhle ukuthi ngenkathi isifo sikaParkinson singelapheki, kunezindlela zokubhekana nalesi sifo futhi uthuthukise ukusebenza komsebenzi wakho wansuku zonke kanye nekhwalithi yokuphila.
Imithombo:
I-American Society of Health-System Pharmacists, i- Levodopa neCarbidopa
I-Connolly, i-BS, i-Lang, i-AE (2014). Ukwelashwa kwamaphilisi we-Parkinson isifo: ukubuyekezwa. I-JAMA , Apr 23-30; 311 (16): 1670-83.
R. Pahwa kanye no-KE Lyons (Abahleli), Isibhuku Sezifo ZasePasinson ; I-4th Edition, eNew York, Abashicileli bezeMpilo e-Informa, ka-2007.