Ukuhlola Izinketho Zezidakamizwa Ezingcono Nezingekho Opioid
Ama-analgesics ayingxenye yezidakamizwa ezisetshenziselwa ukunciphisa i-analgesia (ubuhlungu). Basebenza ngokuvimbela izimpawu zobuhlungu ebuchosheni noma ukuphazamisa ukuchazwa kwengqondo kwalezo zimpawu. Ama-analgesics ahlukaniswe ngokubanzi njengokungabi yi-opioid (okungenayo i-narcotic) noma i-opioid (narcotic) yokunciphisa ubuhlungu.
Ama-Analgesics angewona ama-opioid
Ama-analgesics angenayo i-opioid ahlehlisiwe abe yizigaba ezintathu: i- acetaminophen , izidakamizwa ezingezona ukuvuvukala (non-steroidal anti-inflammatory drugs) (NSAIDs) , ne-COX-2 inhibitors.
Ngenkathi ngayinye inendlela yokwenza okuhlukile, isebenza ngokuvimbela uhlobo lwe-enzyme eyaziwa njenge-cyclooxygenase, noma i-COX. Kukhona izinhlobo ezimbili ezahlukene ze-enzyme, i-COX-1 ne-COX-2, kokubili okungukuthi ibangela ukuvuvukala nobuhlungu ekuphenduleni ukulimala.
Kulezi zinhlobo ezintathu ze-non-opioids ubuhlungu bokunciphisa ubuhlungu:
- I-Acetaminophen (eyaziwa nangokuthi i-paracetamol) iphakathi kwe-analgesics ejwayelekile kunazo zonke emhlabeni jikelele. Ngenkathi abantu bezovame ukuyiqaphela ngamagama e-Tylenol amagama, isithako esisebenzayo sitholakala emakhulwini angaphezu kwe-counter-the-counter, okuyisibindi nesifo samagciwane. I-Acetaminophen inikeza kokubili imiphumela ye-analgesic ne-antipyretic (ukuphefumula komkhuhlane) kodwa ayiphathi ukuvuvukala. Ngenkathi isenzo saso sesingaqondakali kahle, kubonakala sengathi sivimbela umsebenzi we-COX ebuchosheni nasesimisweni sezinzwa kuphela. Umthelela walo oqakatheke kakhulu ubuthi obunobuthi obubangelwa ngokuyinhloko ngokweqile. Ngokusho kwe-US Food and Drug Administration (FDA), i-acetaminophen namuhla yiyona imbangela eholela ekuhlulekeni kwesibindi e-US, ikakhulukazi phakathi kwezidakamizwa ezingapheliyo noma abantu abazisebenzisa ngokuzilibazisa izidakamizwa ezine-opioid equkethe i-acetaminophen.
- Izidakamizwa ezingezona ukuvuvukala (ama-NSAID) ziyizigaba zezidakamizwa ezihlanganisa lezo zinto njengo-Advil (ibuprofen), i-Aleve (naproxen), ne-Bayer (i-aspirin). Njenge-acetaminophen, ama-NSAID atholakalayo emafenjini amaningi ahlukahlukene ahlanganisa amaphilisi, ama-syrups, nama-patches. Kodwa-ke, ngokungafani ne-acetaminophen, ama-NSAID avimbela ngokuqondile i-COX-1 ne-COX-2 hhayi nje kwisistimu yezinzwa zomphakathi kodwa nezinye izingxenye zomzimba, futhi. Lesi sinyathelo esandisiwe senza, ngokwengxenye, izidakamizwa 'ze-analgesic, anti-inflammatory, kanye ne-antipyretic. Kodwa-ke, le ndlela efanayo inganciphisa izinzuzo zokuvikela i-COX enesibonda esiswini. Ngenxa yalokho, imiphumela emibi njenge-indigestion, i-nausea, nezilonda akuvamile. Ngaphandle kwe-aspirin, ama-NSAID angathuthukisa kakhulu ingozi yokuhlasela kwenhliziyo nokushaya kabuhlungu kubantu abanomlando wesifo senhliziyo.
- I-COX-2 inhibitors yi-subset ye-NSAID enamhlanje ehlanganisa isidakamizwa esisodwa esivunyelwe i-FDA, i- Celebrex (celecoxib) . Njengalolo gama, i-COX-2 inhibitors igxila kuphela enzyme ye-COX-2, ukunciphisa ubuhlungu nokuvuvukala ngaphandle kokubangela imiphumela emibi yemigubho. Kodwa-ke, njengeklasi yezidakamizwa, bayaziwa ukuthi bandise ingozi yokuhlaselwa yinhliziyo ngamaphesenti angu-40. Ngenxa yalokho, i-Vioxx eyake isithandwa kakhulu (i-rofecoxib) ihoxiswe ngokuzithandela emakethe yase-US ngonyaka ka-2005, ilandelwa ngemva nje kokubulawa kweminye i-COX-2 inhibitors. I-Celebrex iyisinye sezidakamizwa ezithengiswa kakhulu kwi-portfolio ye-pharmaceutical portfolio.
Ama-opioid Analgesics
I-analgesics yama-opioid uhlobo lomuthi osebenza ngokubopha ama-receptor opioid atholakale kuyo yonke isimiso sezinzwa kanye nomgudu wamathumbu. Lezi zitholampilo azilawuli nje kuphela imisebenzi ethile ye- somatic njengobunzima , futhi banesibopho sokubangela imiphumela yokuguqula ingqondo (abantu) abahlobanisa nezidakamizwa ze-opioid.
Izidakamizwa ze-opioid ziyasetshenziselwa imithi ukuphumula ubuhlungu, i-anesthesia, nokuphatha umlutha we-opiate. Azihlotshaniswa nobuthi obunobungozi noma zibangela noma yimiphi imiphumela emibi ehlotshaniswa nama-NSAID.
Ngenkathi iphephile uma isetshenziswe njengoba kuchazwe, i-opioids ingabangela ukulala, isicashu, ukuqothulwa, i-hypoventilation (ukuphefumula okungavamile), kanye nokuthokoza kwabanye.
Lokhu kuyiqiniso ikakhulu kubantu abadala asebekhulile kule miphumela.
Ngaphezu kwalokho, ukusetshenziswa kwesikhathi eside kuhlotshaniswa nengozi yokubekezelelana kwezidakamizwa (lapho umuthi kancane kancane ulahlekelwa khona umphumela), ukuxhomeka (ukulimala) nokuhoxiswa. Ngenxa yalokho, izidakamizwa eziningi ze-opioid zilawulwa izinto ezidinga umuthi odokotela. Ngokombiko ovela kwiCenters for Disease Control and Prevention, abaningi baseMelika abadakamizwa izidakamizwa ze-opioid.
Kunezigaba ezintathu ezibanzi zemithi e-opioid esetshenziselwa ukuphatha ubuhlungu:
- I-opiate alkaloids yilezi zidakamizwa ezithatha izidakamizwa ezitholakala ku-opium poppy plant uPapaver somniferum . Ama-compact psychoactive atholakala ku-opium afaka i- morphine ne-codeine. Bobabili benza ngokuqondile ohlelweni lwezinzwa zomphakathi ukuze kunciphise ukuzwa kobuhlungu. Ukulala, ukukhanya okulula, ukuhlanza nokuqothulwa yimiphumela emibi ejwayelekile. Nakuba i-morphine eyaziwa ukuthi iyilutha kakhulu, i-codeine nayo inamandla okubamba izimpawu uma kukhishwa ngokweqile. I-Codeine iyona kuphela i-opioid ehlanganiswe ezinkampweni eziningi ezingaphezulu kwe-counter (ngokuvamile ukukhwehlela ama-syrups ahlelwe nge-NSAID).
- Ama-opioid enziwe ngamakhemikhali angama-opioid futhi ahlanganisa izidakamizwa ezifana ne- Oxycontin (oxycodone) ne- Vicodin (i-hydrocodone) . I-oxycodone isetshenziselwa ukwelapha ubuhlungu obunzima (okufaka umdlavuza noma ubuhlungu bokuthutha) futhi kubhekwa njengomlutha omkhulu. Ngokwengxenye yayo, i-hydrocodone ihlukunyezwa ngaphezu kwanoma imuphi omunye umuthi we-opioid e-US, ngokusho kombiko we-2014 ovela kuNational Institute of Drug Abuse. Lezi zidakamizwa ezinamandla zingasetshenziswa ngokuphepha ukuze zithole ukuphumula okwesikhashana kodwa, njengemithi yesiHlelo II, zidinga ukunakekelwa okusheshayo kwezokwelapha.
- Ama-opioid ngokugcwele awenziwe ngokuphelele ebhodini ukwenza umsebenzi othile wokubophezela njenge-opiates zemvelo. Zihlanganisa i-methadone ne-buprenorphine (ejwayele ukusetshenziselwa ukwelapha izidakamizwa ze-opiate) kanye ne- tramadol (esetshenziselwa njalo ubuhlungu be-post-operative). Nakuba bebhekwa njengomlutha omncane kunezinye izidakamizwa ze-opioid, abantu bayaziwa ukuthuthukisa ukuxhomeka uma kusetshenziselwa isikhathi eside.
Izwi elivela
Ama-analgesics angaphumelela kakhulu ekulawuleni ubuhlungu be-arthritis futhi asetshenziswe ngokuphepha uma kuthathwa njengokushiwo. Nakuba odokotela abaningi bezogxila emithini engekho opioid yokwelapha, kungase kube nezimo lapho ubuhlungu obunzima, obukhulu bungadinga khona imithi e-opioid eqinile . Lokhu kungaba kuphela ukusizwa okwesikhashana ukugwema noma iyiphi ingozi yokuthembela.
Ngesikhathi esifanayo, kusacacile ukuthi ama-opioid amancane aphansi kangakanani uma kuqhathaniswa namanye ama-non-opioid for therapy. Njengalokhu, uma unesifo esibi kakhulu, ubuhlungu be-arthritis, ungacabangi ukuhlangana nomchwepheshe wezobuhlungu ongakhuluma nawe ngokusebenzisa izinketho zakho zokwelapha ngokugcwele, kokubili imithi kanye nemithi.
> Imithombo:
> Amasevisi Okulawula Nokuvimbela Izifo. "Izimpawu ze-Vital: Ukuhluka phakathi kwamazwe ekuBhaleni kwama-opioid Pain Relievers ne-Benzodiazepines-United States, 2012." I-MMWR . 2014; 63 (26); 563-568.
> Cicero, J .; Ellis, M .; USrratt, H. et al. "Izinto ezithonya ukukhethwa kwe-hydrocodone ne-oxycodone njenge-opioid eyinhloko kulabo abaxhaphaza izidakamizwa abafuna ukwelashwa e-United States." I-PAIN. 2013; 154 (12): 2639. I-DOI: 10.1016 / j.pain.2013.07.025.
> Isikhungo seNational on Abuse Abuse. "Ukunakekelwa Kwezilwane Ze-Opioids yaseMelika: I-Heroin ne-Prescription Yokudakwa Kwezidakamizwa." Washington, DC; ikhishwe ngoMeyi 14, 2014.
> Yoon, E .; I-Babar, A .; Choudhary, M. et al. "I-Acetaminophen-Induced Hepatotoxicity: Isibuyekezo Esizwakalayo.". I-Journal ye-hepatology yemitholampilo nokuhumusha . 2016; 4 (2): 131-42. I-DOI: 10.14218 / JCTH.2015.00052.