Ma'aikatan Glucocorticoid > Jiyya da rigakafin

Hanyar aiwatar da aikin GCS yana da alaƙa da ikon hulɗa da takamaiman masu karɓar ragi a cikin ƙwayar ƙwayar ƙwayar cuta: steroid - mai rikitarwa mai narkewa ya shiga cikin kwayar halitta, yana ɗaure zuwa DNA, yana ɗaukar fassarar ƙwayoyin halittar da yawa, wanda ke haifar da canji a cikin haɗin sunadarai, enzymes, nucleic acid. GCS yana shafar kowane nau'in metabolism, yana da ƙwarin anti-mai kumburi, ƙwanƙwasa ƙwayar cuta, anti-shock da immunosuppressive sakamako.

Hanyar anti-mai kumburi sakamako na corticosteroids shine murƙushe duk matakai na kumburi. Ta hanyar tsayar da membranes na salon salula da kuma sashin karkashin kasa, incl. lysis, steroidal anti-mai kumburi magungunan hana sakin proteolytic enzymes daga tantanin halitta, hana samuwar oxygen kyauta da lipid peroxides a cikin membranes. A cikin ƙwayar kumburi, corticosteroids yana hana ƙananan tasoshin ruwa da rage ayyukan hyaluronidase, ta haka yana hana matakan exudation, hana haɗewar abubuwan da ke tattare da lalatattun ƙwayoyin cuta zuwa ga jijiyoyin bugun jini, iyakance shigar su cikin kyallen, kuma rage ayyukan macrophages da fibroblasts.

A cikin aiwatar da tasirin anti-mai kumburi, an taka muhimmiyar rawa ta ikon GCS don hana rikice-rikice da ƙaddamar da masu shiga tsakani (PG, histamine, serotonin, bradykinin, da sauransu). Suna jawo aikin lipocortins, masu hana phosyholipase A2 biosynthesis, kuma suna rage haɓakar COX-2 a cikin ayyukan kumburi. Wannan yana haifar da ƙarancin fito da arachidonic acid daga phospholipids na membranes cell kuma zuwa raguwa da samuwar metabolites (PG, leukotrienes da factor platelet).

GCS na iya hana ci gaban yaduwa, saboda suna iyakance shigarwar monocytes cikin nama mai narkewa, suna hana shigarsu wannan lokacin na kumburi, da hana hadarin mucopolysaccharides, sunadarai da kuma hana aiwatar da cutar ta lymphopoiesis. Tare da kumburi da kwayoyin cuta na corticosteroids, wanda aka ba gaban tasirin rigakafi, yana da kyau a haɗaka tare da maganin antimicrobial.

Tasirin immunosuppressive na GCS shine saboda raguwa a cikin lamba da kuma aiki na T-lymphocytes da ke yawo a cikin jini, raguwa a cikin samar da immunoglobulins da kuma tasirin T-mataimaki akan B-lymphocytes, raguwa a cikin abubuwan da ke cikin jini, kirkirar hadaddun rigakafi da ƙarancin fitarwa na inhibition .

Sakamakon antiallergic na corticosteroids shine saboda raguwa a cikin yawan ƙwayoyin basophils, rikicewar hulɗa na masu karɓar Fc da ke kan saman sel na Mast tare da yankin Fc na IgE da haɗin C3 na haɗin gwiwa, wanda ke hana siginar shiga kwayar kuma yana tare da raguwa a cikin sakin ƙididdigar histamine, heparin, da seitiin da sauran masu ba da izini ga matsakanci na wani nau'in kai tsaye kuma suna hana tasirinsu akan kwayoyin halitta.

Tasirin antishock shine saboda halartar GCS a cikin ka'idar sautin jijiyoyin bugun gini, a kan asalinsu, hankalin jijiyoyin jini zuwa catecholamines yana ƙaruwa, wanda ke haifar da karuwa a cikin jini, canje-canje metabolism na ruwa, sodium da ruwa yana riƙewa, ƙarancin plasma yana ƙaruwa kuma hypovolemia yana raguwa.

Haƙuri da sakamako masu illa

Wannan rukunin kwayoyi kusan sau da yawa yana haifar da sakamako masu illa: dakatar da sake aiki na jiki, ƙwanƙwasawa na cututtukan ƙwayar cuta da cututtukan cututtukan gastrointestinal mai yiwuwa. Tare da amfani da tsawan lokaci, karuwa a cikin karfin jini, haɓakar ciwon sukari steroid, edema, rauni na tsoka, dystrophy na myocardial, Ciwon kansa na Hisenko-Cushing, ciwon adrenal yana yiwuwa.

Wani lokacin lokacin shan kwayoyi, akwai tashin hankali, rashin bacci, haɓaka matsin lamba na intracranial, psychosis. Tare da tsawan tsari na amfani da corticosteroids, zazzage kashi da alli-phosphorus metabolism, wanda hakan ke haifar da osteoporosis da kashin baya.

Contraindications

Rashin hankali.
Cututtukan fata.
Kwayoyin cuta ko cutar fungal.
Cutar tarin fuka.
Kanjamau
Ciwon mara, kumburin ciki.
Wani mummunan nau'in hauhawar jini.
Itsenko-Cushing's syndrome.
Jade
Syphilis
Ciwon sukari mellitus.
Osteoporosis
Ciki
Rashin shayarwa.
M psychoses.
Childrenaramin yara.

Lokacin da amfani da Topically:

Cututtuka (kwayan cuta, hoto ko bidiyo mai zagaya yanar gizo da sauri, cututtukan fata) raunuka na fata da kuma membranes na mucous.
Tumbin fata.
Take hakkin mutuncin fata da membran membranes.
Childrenaramin yara.

Haɗa kai

GCS yana haɓaka tasirin bronchodilating na β-adrenostimulants da theophylline, rage tasirin hypoglycemic na insulin da magungunan antidiabetic na oral, aikin anticoagulant na coumarins (kai tsaye anticoagulants).

Diphenin, ephedrine, phenobarbital, rifampicin da sauran magunguna waɗanda ke haifar da haifar da ƙwayoyin enzymes hanta microsomal suna rage T1 / 2 GCS. Harkokin haɓakar hormone da antacids suna rage shaye-shaye na corticosteroids. Lokacin da aka haɗu da cardiac glycosides da diuretics, haɗarin arrhythmias da hypokalemia yana ƙaruwa, lokacin da aka haɗu da NSAIDs, haɗarin lalacewar gastrointestinal da kuma faruwa na jijiyoyin jini yana ƙaruwa.

Hanyar aikin da babban tasirin magunguna

Glucocorticoids ya bazu a cikin membranes tantanin halitta zuwa cikin cytoplasm kuma yana ɗaukar takamaiman ga masu karɓa na glucocorticoid. Sakamakon aiki mai rikitarwa ya shiga tsakiya kuma yana haɓaka samuwar i-RNA, wanda ke haifar da haɗarin adadin sunadarai masu ƙayyade abubuwa. Yawancin abubuwa masu aiki na biologically (catecholamines, matsakanci na mai kara kumburi) sun sami damar hana rikice-rikice na glucocorticoid-mai karɓar, ta haka rage ayyukan glucocorticoids. Babban tasirin glucocorticoids sune kamar haka.

• Tasiri kan tsarin rigakafi.

- Tasirin anti-mai kumburi (akasarinsu tare da rashin lafiyan nau'ikan cututtukan kumburi) saboda rashi na PG, RT da cytokines, ragewar karfin iko, rage chemotaxis na sel da rigakafin aiki da hana ayyukan fibroblast.

- ressionarkewar rigakafin salula, halayen autoimmune yayin dasawar kwayoyin, rage aikin T-lymphocytes, macrophages, eosinophils.

• Tasiri kan aikin magudanar ruwa-na lantarki.

- jinkirta a cikin jikin sodium da ruwa ion (ƙara yawan reabsorption a cikin na nesa na koda na tubules), aiki kawar na ions potassium (ga kwayoyi tare da mineralocorticoid aiki), ƙara yawan jiki.

- decreasearin raguwa a cikin ɗimin alli na alli tare da abinci, raguwa a cikin abubuwan da ke cikin ƙashin ƙashi (osteoporosis), da kuma ƙaruwa a cikin urinary excretion.

• Tasiri kan tafiyar matakai na rayuwa.

- Domin samar da abinci mai narkewa - sake fasalin fatarar nama mai rauni (karin yawan kitse a fuska, wuya, wuyan kafada, ciki), hypercholesterolemia.

- Domin metabolism na metabolism - haɓakar gluconeogenesis a cikin hanta, raguwa cikin permeability na membranes cell don glucose (haɓakar ciwon sukari steroid yana yiwuwa).

- Don metabolism na furotin - haɓakar anabolism a cikin hanta da kuma tsarin catabolic a cikin wasu kyallen takarda, raguwa a cikin abubuwan da ke cikin globulins a cikin jini.

• Tasiri akan CVS - hauhawar hawan jini (hauhawar jini ta steroid) saboda riƙewar ruwa a cikin jiki, haɓakawa da ƙima da ƙwaƙwalwar adrenoreceptors a cikin zuciya da jijiyoyin jini, da haɓaka tasirin mai amfani na angiotensin II.

• Tasiri akan tsarin hypothalamus-pituitary-adrenal gland system - inhibition saboda mummunan tsarin aikin.

• Tasiri a cikin jini - lymphocytopenia, monocytopenia da eosinopenia, a lokaci guda glucocorticoids suna haɓaka yaduwar ƙwayoyin jan jini, ƙara yawan ƙwayoyin jini da fararen hular (canje-canje a cikin ƙwayoyin salula na jini yana bayyana a cikin 6-12 hours bayan gudanarwa kuma sun ci gaba da tsawaita amfani da waɗannan magungunan don makonni da yawa).

Glucocorticoids don amfani da tsari na zamani suna narkewa cikin ruwa, suna da kyau a fitsari da sauran abubuwan da ake samu na halitta. Suna kewaya cikin jini akasarinsu ne a cikin wata takin mai gina jiki (mara aiki). Hanyoyin da ake amfani dasu na glucocorticoids sune esters ko salts mai ruwa-ruwa (succinates, hemisuccinates, phosphates), wanda ke haifar da farawa da sauri. Sakamakon dakatarwar karamin kuzari na glucocorticoids yana haɓaka a hankali, amma zai iya ɗaukar har zuwa watanni 0,5-1, ana amfani dasu don injections na ciki.

Glucocorticoids don maganin baka yana da kyau daga narkewa, C_tah a cikin jini, an lura dashi bayan sa'o'i 0.5-1.5. Abinci yana rage jinkirin sha, amma baya tasiri akan bioavailability na kwayoyi (tab. 27-15).

CLASSIFICATION OF Glucocorticoids BY hanyar aikin

1. Glucocorticoids don amfani da Topical:

A) don aikace-aikace zuwa fata (a cikin nau'i na maganin shafawa, cream, emulsion, foda):

- Acetonide mai kyalli (sinaflan, mura)

- flumethasone pivalate (lorinden)

- betamethasone (jakar

B) domin sanya idanu a cikin ido da / ko kunne, a sifar maganin shafawa ido:

- betamethasone n (betamethasone dipropionate, da sauransu) B) don amfani da inhalation:

- ya gama gari (yayan, Becotide)

- Fluticasone propionate (flixotide)

D) don gudanarwar intraarticular:

D) don gabatarwa zuwa cikin kashin cikin:

Tasirin metabolism

Glucocorticoids suna da ƙarfin anti-stress, sakamako na anti-shock. Matsayin jininsu yana tashi sosai tare da damuwa, raunin da ya faru, zubar jini, da yanayin rawar jiki. Increasearuwar matakin su a ƙarƙashin waɗannan halayen yana ɗayan ɗayan hanyoyin da jikin mutum yake dacewa da damuwa ga damuwa, ɓacin jini, yaƙi da girgiza da kuma tasirin tashin hankali. Glucocorticoids yana haɓaka haɓakar jini na yau da kullun, ƙara haɓakar jijiyoyin myocardium da ganuwar jijiyoyin ga catecholamines, kuma suna hana isar masu karɓa zuwa catecholamines a babban matakinsu. Bugu da kari, glucocorticoids shima yana karfafa erythropoiesis a cikin kasusuwa kasusuwa, wanda ke taimakawa sosai cikin saurin sake maye gurbin jini.