Umbuzo: Kungani ngingasebenzisa i-Methadone?
I-Methadone - akusiyo yini ukuthi izidakamizwa ze-heroine izilutha?
Lona umbuzo engijwayele ukuzwa kusuka ezigulini ezinomsoco nemindeni lapho ngibatshela ukuthi udokotela wabo ucele i-Methadone ubuhlungu. Nakuba kuyiqiniso ukuthi i-methadone isetshenziselwa ukuphatha izimpawu zokuqeda izidakamizwa, i-methadone nayo imithi ephumelelayo kakhulu yokwelapha ubuhlungu obunembile .
UMorphine uzuze isihloko seGold Standard yokulawula ubuhlungu , i-opioid bonke abanye baqhathaniswa nekhono layo, kulula ukuphatha kanye nezindleko eziphansi. Uma i-morphine inkulu kakhulu, kungani singasebenzisa i-methadone?
Impendulo:
Uma sizoqala ukuqhathanisa i-methadone ne-morphine, kudingeka siqale ngezimiso eziyisisekelo zobuhlungu. Ubuhlungu bungahlukaniswa ngezinhlobo ezimbili zokuchazwa kwemvelo: i-nociceptive neuropathic. Ubuhlungu obuningi bokudla buvame ukubangelwa ukulimala kwezicubu (ubuhlungu obukhulu) noma ukulimala ezitho zangaphakathi (ubuhlungu be-visceral). Ubuhlungu be-neuropathic bubangelwa ukulimala noma ukuhlambalaza izinzwa ngaphakathi kwesimiso sezinzwa zomphakathi noma emzimbeni womzimba.
Sibusiswe nge-opiate receptors ebuchosheni bethu obuvumela imizimba yethu ukuba isabele emithini yemilenze ye-opioid. Iningi lala ma-receptors lihlukaniswa kuma-receiver nama-delta kanti amaphesenti amancane yi-NMDA. Ubuhlungu obunamaphutha abuzwa ngokuyinhloko yi-receptors kanye nobuhlungu be-neuropathic yi-delta nama-receptors we-NMDA ; i-morphine ibopha ku-receptors kuphela, kuyilapho i-methadone ibophezela ku-mu, delta ne-NMDA.
UMorphine unomsebenzi omuhle wokuphatha izinhlobo eziningi zobuhlungu, kodwa ngenxa yokukwazi ukubopha 100% we-opiate receptors, i-methadone ingayenza kangcono nakakhulu.
Opiate Toxicity kanye nemiphumela emibi
Ama-opiates, afana ne-morphine, akhiqiza i-metabolites uma ephukile emzimbeni. Lezi zimetabolite zingakha emzimbeni futhi zibangele izimpawu ze-opiate toxicity.
I-opiate toxicity ngokuyinhloko i-overdose ye-opiate eholele emazingeni anobuthi emzimbeni futhi ibangele izimpawu ezifana nokungazitholi, ukucubungula, ukuzamazama nokuzamazama.
I-Methadone ayikhiqizi i-metabolites ngakho-ke ayinawo "ugwayi," noma isisindo esiphezulu. I-Methadone nayo ilula ukugubha isibindi, futhi ukuntuleka kwayo kwemetabolites kwenza kube yimpumelelo enkulu imithi yobuhlungu yeziguli eziningi ezinciphile isibindi umsebenzi noma ukwehluleka kwenqunu.
Imiphumela emibi evamile yama-opiates ihlanganisa ukugcoba, ukucabangela nokuhlanza, ukulala, ukushaya, ukudideka nokucindezeleka kokuphefumula (ukuphefumula kanzima). Iziguli eziningi ziye zabika ukwehla kwezimpikiswano ezimbi ngemva kokushintshela ku-methadone kusuka kwenye i-opiate.
Izinzuzo Ezengeziwe ze-Methadone
Ngakho i-methadone iyasebenza kakhulu kune-morphine ekwelapheni ubuhlungu futhi ngokuvamile ibangela imiphumela embi kakhulu , kodwa izindaba ezinhle azimi lapho. Enye inzuzo ye-methadone iyinxenye yokuphila kwayo. I-half-life is the time required for half the substance of a drug to be metabolized or eliminated by processes of nature. Ngenxa yalesi sigaba sokuphila esingeziwe, i-methadone inomphumela wokunciphisa ubuhlungu wamahora angu-8 kuya kwangu-10, kanti ukukhishwa kwe-morphine okungavamile kokukhipha ngaphandle kukhulula kuphela ubuhlungu amahora amabili kuya kwangu-4.
Lokhu kuhumusha ekungeneni okuncane kwesiguli, ngokuvamile izikhathi ezimbili noma kathathu ngosuku.
Futhi ekugcineni, kodwa okungenani, i-methadone iyasebenza kakhulu. Ukunikezwa ngenyanga kwe-methadone kubiza cishe amaRandi ayi-8, kuyilapho i-morphine izovame ukubiza ngaphezulu kwezingu-100. Amanye ama-opiate, afana no-Oxycontin no-Fentanyl, azobiza ngaphezulu.
Izithiyo zokusetshenziswa kweMethadone
Ngabe uqinisekisile ukuthi i-methadone ingumuthi omkhulu wobuhlungu ? Uma kunjalo, ungase uzithole uzibuza ukuthi kungani kungasetshenzisiwe kaningi. Ngiye ngabuza umbuzo ofanayo odokotela abaningi, futhi ngithole ukuthi ngaphezu kwenhlamba ukuthi i-methadone ithwala, odokotela abaningi abajabule ukuyibeka.
Ngenxa ye-half-life extension ye-methadone, yakha kancane kancane emzimbeni futhi ingathatha izinsuku ezinhlanu kuya kwezingu-7 ukuze amazinga azinze. Phakathi nalesi sikhathi, isiguli sidinga ukuqapha eduze izibonakaliso zobuthi. Ngokuvamile akuyona inkinga yeziguli ezinakekelwa nge-palliative noma esibhedlela , ngoba sezivele zilandelwa eduze futhi ngokuvamile zikwazi ukuthola abahlengikazi nodokotela amahora angu-24 ngosuku. Ihhovisi elivamile lodokotela alinayo ikhono lokuqapha iziguli eziseduze, okungenzeka kube yingxenye yokungabaza ukuyibeka.
Ezinye izithiyo kukhona imfundo yezokwelapha kanye nokwehluleka kwesiguli. I-Methadone isaziwa kabanzi ngokuthi yizidakamizwa ezilutha izidakamizwa. Leyo nhlanhla isuswa kancane kancane njengoba odokotela beqhubeka befundisa ontanga yabo ngezinzuzo zayo futhi umphakathi ubona iziguli eziningi zithola ukukhululeka ngenxa yalo.
Imithombo:
I-Ayonrinde OT, i-Bridge DT. Ukubuyiswa kwemethadone yokuphathwa kobuhlungu bomdlavuza. I-Med J Aust 2000; 173: 536-40.
I-Davis MP, uWalsh D. Methadone ngokusizwa ubuhlungu bomdlavuza: ukubuyekezwa kwe-pharmacokinetics, i-pharmacodynamics, ukusebenzisana kwezidakamizwa kanye nezinhlelo zokuphatha. Care Cancer 2001; 9: 73-83.
I-Toobs JD, Kral, LA. Ukwelashwa kwe-Methadone yezizwe zobuhlungu. Am Fam Physician 2005; 71: 1353-8.