Yaya ake amfani da miyagun ƙwayoyi Fentanyl?

Ana samun magungunan a cikin nau'in sashi mai taushi wanda ya ƙunshi abubuwa masu aiki da kayan taimako, wanda ake kira tsarin warkewa na transdermalkazalika a cikin tsari maganin allura.

Hanyoyin sakin Fentanyl:

Magani don allura - 50 ml, 50 mcg / ml.
Tsarin warkewa na Transdermal, yankin da za'a iya saduwa dashi shine 4.2 cm 2 / 8.4 cm 2 / 16.8 cm 2 / 25.2 cm 2 / 33.6 cm 2. An saki abu mai aiki a cikin adadin 12.5 / 25/50/75/100 μg / h. A saman farfajiyar, alamun launin ruwan kasa sune Fentanyl 12.5 μg / awa / Fentanyl 25 μg / awa / Fentanyl 50 μg / awa / Fentanyl 75 μg / awa / Fentanyl 100 μg / awa. 1 TTC ya ƙunshi 1.38 mg / 2.75 mg / 5.5 mg / 8.25 mg / 11 mg na abu mai aiki. Kunshin kwandon daya ya ƙunshi jaka 5 mai zafi-baƙin ƙarfe.

Aikin magunguna

Fentanyl ne narcotic analgesic. Kashi 100 mcg (0.1 mg) (2 ml), kusan daidai yake da aikin ƙididdigar ƙwaƙwalwa na 10 MG ƙwayar cuta ko 75mg ciwan meperidine.

Babban aikin warkewa shine analgesia da kwantar da hankali. Lokacin shan magani, ya kamata a haifa da hankali cewa canje-canje a cikin numfashi da kuma alveolar samun iska daga cikin huhu na iya šaukar tsawon lokaci fiye da aikin analgesic. Tare da kara yawan kwayoyi, akwai raguwa metabolism na huhu. Manyan allurai na iya haifar mayuka. Fentanyl lokacin da aka ɗauka yana da ƙarancin amai ƙwayar cuta da ciwan meperidine.

Pharmacodynamics da kuma Magunguna

Za a iya bayyana Pharmacokinetics a matsayin samfuri tare da matakai uku:

lokacin rarraba 1.7 minti
sake rarraba lokacin 13 mintuna,
kawar rabin rayuwa na mintuna 219.

Ofimar rarraba fentanyl shine 4 l / kg. Thearfin ƙarfin ƙwayar plasma yana raguwa tare da ƙara ionization na miyagun ƙwayoyi. Canje-canje a cikin pH na iya shafar rarraba shi tsakanin plasma datsarin juyayi na tsakiya. Aiki mai aiki yana tarawa a cikin kasusuwa da kasusuwa na tso adi, bayan haka a hankali aka sake shi a cikin jini. Fentanyl an canza shi sosai a cikin hanta, yana nuna babban mita. Kimanin kashi 75% na maganin cikin ciki an cire shi ne a cikin fitsari a cikin hanyar metabolites. Kasa da 10% an cire shi a cikin fitsari. Kusan 9% na kashi an fesa shi a cikin feces kamar metabolites.

Magungunan yana fara aiki kusan nan da nan bayan gudanarwar jijiya. Koyaya, an lura da matsakaicin aikin analgesic cikin aan mintuna. Matsayin da aka saba dashi na tasirin analgesic shine daga mintina 30 zuwa awa daya bayan wani kaso na ciki wanda yakai 100 mcg (0.1 mg) (2 ml). Bayan gudanarwar cikin mahaifa, ana lura da fara aikin da yake aiki daga mintuna bakwai zuwa takwas, kuma tsawon lokacin aikin shine kamar awanni biyu.

Alamu don amfani da fentanyl

don tasirin analgesic na ɗan gajeren lokaci cikin inganci maganin ciwan jiki a tsarawashigowa da tabbatarwa cikin zamani bayan aiki,
don amfani azaman ƙarfi maganin jin zafitoarin gaba ɗaya zuwa maganin hana haihuwa ko na gida
don hadewa tare da maganin tarikamar Saurab tare da prematication, kazalika da taimako gaba daya da maganin sa barci,
don amfani azaman m don marasa lafiya da babban haɗarin, lokacin aiwatar da hadaddun ayyuka, alal misali, akan zuciya.

Hakanan, alamomi don amfanin fentanyl sune jijiya da hanyoyin maganin orthopedicinda ake amfani da miyagun ƙwayoyi azaman maganin zafin azaman motsa jiki.

Contraindications

marasa lafiya da rashin kwanciyar hankali ga shirye-shiryen opioid,
marasa lafiya tare da asma,
marasa lafiya tare damiyagun ƙwayoyi,
marasa lafiya da ke fama da yanayi tare da bacin rai na cibiyar numfashi,
a lokacin Ayyukan mahaifa,
marasa lafiya tare da gazawar numfashi,
wadanda ake zargin marasa lafiya ne toshewar hanji.

Side effects

Wannan miyagun ƙwayoyi a wasu yanayi na iya tayar da bayyanar cututtuka daban-daban:

ci gaban dogara da miyagun ƙwayoyi tare da wuce kima amfani da miyagun ƙwayoyi,
mai mahimmanci rashin lafiyar jiki,
antihypertensive sakamako,
bradycardia,
gajeriyar tsokar jiki,
matsakaici bronchoconstriction.

Umarnin don amfani da fentanyl

Dangane da umarnin Fentanyl, yakamata likitan likitanci ya kamata ya wajabta maganin kawai wadanda suka kware game da ka'idojin amfani da opioids masu ƙarfi don magance ciwo mai raɗaɗi.

Saboda haɗarin ciwon ciki, an sanya fentanyl don amfani kawai a cikin marasa lafiya waɗanda ke jure wa irin waɗannan magunguna da kyau. Lokacin amfani da wannan magani, yana da mahimmanci don rage yawan amfani da wasu magungunan hana barci zuwa mafi ƙarancin yiwu.

Lura: Marasa lafiya ana ɗauka cewa opioid yana da juriya idan sun taɓa ɗaukar aƙalla 60 MG. Morphine kowace rana, 30 MG Oxycodone kowace rana, 8 MG Hydromorphone kullun ko wasu opioids har sati daya ko fiye.

Wajibi ne a tsara yadda ake amfani da magunguna ga kowane mai haƙuri daban-daban, la'akari da tarihin gudanarwar da ta gabata manazarci a lokacin jiyya da abubuwan haɗari ga marasa lafiya don haɓaka dogara da magunguna.

Lokacin rubuta kowane kashi na wannan magani, ƙwararren likita yakamata ya lura da abin da mai haƙuri ya ɗauka, musamman bacin rai, musamman awanni 24-72 na farko bayan farawar, lokacin da tarawar farko daga facin farko ya kai matsayinsa.

Sashi

A cikin shiri don aiki na mai haƙuri: iv - 0.05-0.1 MG (a haɗe tare da 2.5-5 MG na droperidol) kimanin mintina goma sha biyar kafin gabatarwar maganin tashin hankali. Don maganin sa barci: iv - 0.05-0.2 mg na kowane rabin sa'a.

A cikin shiri don tiyata, yara: 0.002 mg / kg nauyin jiki. Don maganin sa barci: i / v - 0.01-0.15 mg / kg ko i / m 0.15-0.25 mg / kg. Don kula da maganin sa barci: i / m - a 0.001-0.002 mg / kg.

Ana amfani da facin tsawan awanni 72 a saman ɗakin fata. A lokaci guda, yana da muhimmanci sosai farjin fata inda ake amfani da facin zama tare da ƙarancin gashi kuma basu da alamun bayyananniyar rashin damuwa.

Umarni na musamman

Fentanyl a cikin irin TTC dole ne a shafa shi a kan yanayin da ya dace, mara haushi, da ba a jika shi tare da ɗakin kwana, alal misali, a kirji, baya ko hannu. Kananan yara da mutane da rashin hankaliZai fi kyau a sanya maɓallin a ƙarshen baya don rage yiwuwar facin ana cire su ba bisa ƙa'ida ba. Dole ne a cire gashi a wurin aikace-aikacen kafin amfani da tsarin, kuma ba a ba da shawarar yin amfani da reza don wannan ba. Dole ne a tsabtace yankin da za a shafa abin da ke ciki kafin amfani da ruwan dumi ba tare da ƙarin sabulu ba.

Fentanyl a cikin nau'i na TTS ya kamata a yi amfani da shi nan da nan bayan cire facin daga jakar da aka rufe. Ba za ku iya amfani da miyagun ƙwayoyi ba idan kunshinsa yana da alamun keta da rashin damuwa.

Kowane faci daga kunshin dole ne a canza a cikin sa'o'i 72. Don amfani da facin gaba, dole ne a yi amfani da sabon fatar fata. Idan akwai matsaloli tare da manne gefen a kan facin, zaku iya amfani da taimakon band don gyarawa.

An haramtawa sosai: don amfani da matattarar zafi, alal misali, murfin murhu ko bargo, kamar yadda kuma za a jagoranci na’urar dumama da fitilun tanning zuwa wurin da za a gyara wurin, don shawo kan rana, ɗaukan wanka mai zafi, baho masu zafi da gadaje masu ruwa.

Yawan abin sama da ya kamata

Wani mummunar cutar yawan ƙwayoyi na iya bayyana kanta a cikin hanyar:

bacin rai
nutsuwa
fadawa cikin wawako ga wa
tsoka spasm
bradycardia
tashin hankali.

A lokuta da dama, yawan shan Fentanyl na iya zama mai mutuwa.

Umarni na musamman

Fentanyl akan Wikipedia. Yi amfani azaman wakili mai guba

Bayan waɗannan nau'ikan sakin magunguna, akwai sanannun lokuta lokacin da sabis na musamman suka yi amfani da Fentanyl ta hanyar gas don kawar da 'yan ta'adda. A yayin sakin wadanda aka kama daga hannun 'yan ta'adda a yayin da ake wa lakabi da Nord-Ost, musanman na musamman sun yi amfani da bayanin da ya danganci abubuwan da aka samo. fentanyl. Sakamakon bayyanar wannan cibiyar, mutanen da ke cikin ginin sun ga alamu kamar rashin damuwa, tashin zuciya, matsananciyar amayar amai, da kuma matsananciyar numfashi. A cewar masana, mummunan mutuwa irin wannan abun da ake ciki ba zai iya tsokani ba.

Yin hulɗa tare da wasu kwayoyi

Haɗi tare da Antidepressants

Yin amfani da Fentanyl na lokaci guda tare da wasu jami'ai waɗanda ke shafar tsarin juyayi na tsakiya, ciki har da maganin maye, maganin maye, kwantar da hankula, maganin motsa jiki na gaba ɗaya, da kuma opioids, na iya ƙara haɗarin lalata tsarin jijiyoyin jiki, ɓarna mai zurfi, ɓarna, ƙwayar cuta da mutuwa. Lokacin da ake amfani da magani tare da kowane daga cikin magungunan da ke sama, ana amfani da kashi ɗaya ko ya kamata a rage.

Masu hana CYP3A4

Sakamakon cewa isoenzyme CYP3A4 yana taka muhimmiyar rawa a cikin metabolism na fentanyl, kwayoyi waɗanda ke hana ayyukan CYP3A4 na iya haifar da raguwa game da fentanyl, wanda zai haifar da haɓaka yawan abubuwan a cikin ƙwayar plasma kuma ya ƙara tsawon lokacin tasirin magungunan opioid. Wadannan illolin na iya kasancewa da ma'ana tare da amfani da inhibitors na 3A4.

Likitocin CYP3A4

Inducers na CYP450 3A4 na iya haifar da metabolism na Fentanyl, wanda zai iya haifar da karɓar ƙwayar magani, raguwa a cikin tattarawar abu a cikin ƙwayar plasma, rashin tasiri ko, mai yiwuwa, haɓaka ciwo na cirewa a cikin haƙuri tare da shan kwayoyi masu zuwa ga miyagun ƙwayoyi.

Masu hana Monoamine Oxidase

Har yanzu ba a fahimci hulɗar da Fentanyl tare da hanawar ma'adinin oxidase, don haka yin amfani da magunguna a cikin hadaddun ya kaure sosai.

Fentanyl Analogs

Dolforin - ban da kayan aiki, abun da ke tattare da wannan TTC ya hada da barasa mai sa maye da kayan aikin polymer,
Matashin gidan Durogezik- abun da ke ciki na miyagun ƙwayoyi ya hada da copolymer na polyethylene terephthalate da ethylene vinyl acetate, polyacrylate da sinadaran aiki,
Lunaldin - wani kwayar cutar analgesic dauke da fentanyl,
Fendivia - maganin cutarwa, maganin abin da ya kusan kama da maganin da aka bayyana,
Fentadol - TTS tare da abun ciki na fentanyl mai aiki.

Fentanyl Reviews

Reviews on the miyagun ƙwayoyi Fentanyl sun bambanta. Ainihin, marassa lafiya ba sa iya nazarin tasirin maganin sosai saboda tsananin cututtukan da ke nuna shi. Gabaɗaya, masana sunyi ƙarancin Fentanyl sosai, tunda kayan aiki yana ba da taimako mai mahimmanci a cikin lura da cututtukan da yawa, kuma yana bawa marasa lafiya damar kawar da ciwo yayin jiyya da bayan shi.

Farashin Fentanyl

Farashin wannan magani yana da girma sosai, amma tasiri na tasiri wanda yake da shi an kashe shi da farashin. A cikin wasu kantin magunguna, zaku iya siyar da mafita don gudanarwar ciki da sarrafawa daga 2,290 rubles.

Ilimi: Ta yi karatun digiri a Kwalejin Kimiyya ta Kasa ta Rivne tare da digiri a fannin Kasuwanci. Ta yi karatun digiri a Jami'ar Likita ta Vinnitsa. M.I. Pirogov da kuma aikin horon dan adam dangane da shi.

Kwarewa: Daga 2003 zuwa 2013, ta yi aiki a matsayin mai kantin magani kuma manajan kantin sayar da kayayyaki na kantin magani. An ba ta haruffa da rarrabe har tsawon shekaru na aikin da ta yi. An buga labaran kan batutuwan likitanci a cikin mujallu na gida (jaridu) da kuma wasu hanyoyin yanar gizo da dama.

Ina maraice, a ina zan sayi Durogezik ko Fentanyl, shin ya zama dole?

Sashi da gudanarwa

Doctorswararrun likitoci ne kawai suna da ilimi da gogewa a cikin kula da ƙwayoyin opioid masu ƙarfi tare da tasiri mai ƙarfi na iya ba da magani lokacin da aka yi amfani da su don magance ciwo na kullum.

Tunda akwai yuwuwar murkushe ayyukan numfashi, ana wajabta maganin ne kawai ga waɗancan mutane waɗanda ke da kyakkyawan haƙuri ga irin waɗannan kwayoyi. Yayin amfani da Fentanyl, ana buƙatar rage girman amfani da wasu maganin hana haifuwa.

Mutanen da ke tsayayya da tasirin opioids mutane ne da aka yiwa allurar yau da kullun tare da aƙalla 60 mg na morphine, 30 mg na oxygencodone, haka kuma 8 mg na hydromorphone, ko wasu magunguna na opioid na kwana 7 ko mafi tsayi.

Zaɓin sassan ɓangaren kowane haƙuri yana gudana daban-daban, la'akari da tarihin data kasance game da amfani da analgesics yayin far, da abubuwan haɗari don bayyanar shan kwayoyi a cikin mutum.

Bayan alƙawarin kowane yanki na kwayoyi, likita yakamata ya lura da mai haƙuri a hankali, alal misali, dakatar da ayyukan numfashi, musamman a cikin awanni 24-72 na farko daga fara karatun, lokacin da maganin ya isa matsakaicin ƙwayar cuta a cikin ƙwayar magani.

Girma na sashi kashi.

Yayin shirye-shiryen balagaggu don aikin tiyata, ana gudanar da 0.05-0.1 MG na miyagun ƙwayoyi a cikin jijiya (a hade tare da droperidol (2.5-5 mg). Ana buƙatar wannan kamar mintina 15 kafin aikin maganin cutar sanƙara. A matsayin maganin tiyata: 0.05-0.2 MG na abu ana gudanar dashi cikin ciki kowane minti 30.

Game da shirya yaro don aikin tiyata, 0.002 mg / kg na miyagun ƙwayoyi ya kamata a gudanar dashi. Don maganin sa barci, ana buƙatar sashi na iv na 0.01-0.15 mg / kg ko allurar iv na 0.15-0.25 mg / kg ana buƙatar. Don kula da maganin sa barci, gudanarwar intramuscular na 0.001-0.002 mg / kg na miyagun ƙwayoyi ya zama dole.

Dole ne a yi amfani da facin a cikin farfajiyar (yankin ɗakin kwana) na awanni 72. Wani mahimmin yanayi na aikin shine mafi ƙarancin gashi a wurin da ake jiyya, haka nan kuma da rashin alamun alamun fushi na yanayin rashin lafiyar.

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Haɗi tare da wasu kwayoyi

Haɗuwa tare da maganin cututtukan fata.

Haɗuwa tare da wasu kwayoyi waɗanda ke shafar aikin aikin juyayi na tsakiya (ciki har da kwanciyar hankali, hypnotics ko sedative, opioids da kuma maganin motsa jiki na gaba ɗaya) na iya haifar da haɓaka da mummunar cutar tashin hankali na tsarin numfashi, haɓaka sakamako mai zurfi na jijiya mai narkewa da ƙwayar cuta, har ma da mutuwa. Tare da yin amfani da lokaci ɗaya tare da kowane ɗayan abubuwan da ke sama, ya kamata a rage girman sashi ɗaya daga cikinsu.

Magunguna waɗanda ke rage ayyukan CYP3A4.

Sakamakon cewa CYP3A4 isoenzyme muhimmin abu ne na metabolism na miyagun ƙwayoyi, kwayoyi waɗanda ke rage jinkirin ayyukanta na iya rage ƙimar Fentanyl, sakamakon abin da ƙimar sa a cikin haɓakar plasma ya ƙaru kuma tsawon lokacin sakamako opioid yana tsawaita. Abubuwa masu kama da wannan na iya zama da ƙarfi idan aka haɗu da masu hana 3A4 aiki.

Abubuwan da ke haifar da aikin CYP3A4.

Abubuwa waɗanda ke haifar da CYP450 3A4 suna iya haifar da aiwatar da metabolism na miyagun ƙwayoyi, saboda abin da karɓar sa ya karu, kuma matakin da ke cikin plasma, akasin haka, yana raguwa.Sakamakon haka, akwai rashin inganci na miyagun ƙwayoyi ko yiwuwar faruwar cutar a cikin mutanen da daga baya suka kamu da kwayoyi.

Haɗuwa da IMAO.

Haɗin magungunan tare da MAOI ba a yi nazarin isa ba, wanda shine dalilin da ya sa amfani da waɗannan abubuwan a lokaci guda an haramta shi gaba ɗaya.

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Sashi da gudanarwa

Maganin Fentanyl an yi niyya ne don gudanarwar jijiyoyin jini ko gudanarwa na ciki.

A cikin ciwo mai raɗaɗi, ana gudanar da miyagun ƙwayoyi a kashi 25-100 μg a cikin ciki ko intramuscularly (a matsayin hanya ɗaya ko kuma a lokaci guda tare da antipsychotics).

Don rigakafin, Fentanyl ana gudanar da shi ta intramuscularly a kashi 50-100 μg na mintina 30 kafin aikin.

Don maganin sa barci, ana gudanar da maganin ne a cikin 100gram 10000. Bayan haka, kowane minti 10-30, ana gudanar da ƙarin 50-150 μg don kula da matakin analgesia (a haɗe tare da droperidol).

Lokacin gudanar da aikin neuroleptanalgesia yayin riƙe numfashi maras kyau (alal misali, a yayin karin ƙwayar motsi da gajeren lokaci), lokacin da ba a yi amfani da abubuwan shakatawa na tsoka ba, ana gudanar da Fentanyl bayan maganin neuroleptik na 50 μg a kowace kilogiram 10-20 na nauyin jiki. A wannan halin, yakamata a kula da numfashi mara lafiyan kuma a kula da shirye-shiryen shigar da gaggawa gaggawa da injin na inji. Ana amfani da mafi yawan allurai na Fentanyl (50-100 mcg / kg) na musamman don tiyata na zuciya.

Additionalarin ƙarin analgesia yayin aiki a ƙarƙashin maganin hana haihuwa, ana gudanar da maganin a cikin jijiya ko intramuscularly a kashi 25-25 microgram (sau da yawa a hade tare da maganin ƙwayoyin cuta). Idan ya cancanta, ana maimaita allurar Fentanyl kowane minti 20-30.

An wajabta wa yara magani a cikin allurai masu zuwa:

shiri don tiyata: 2 mcg / kg,
na gaba daya na maganin sa barci: 150-250 mcg / kg intramuscularly ko 10-150 mcg / kg a ciki,
kiyaye maganin saurin gaba daya: 2 mcg / kg intramuscularly ko 1-2 mcg / kg a ciki.

Neuroleptanalgesia

Fentanyl wani kwaro ne na roba da aka samo daga 4-aminopiperidine. Tsarin sunadarai ya ɗan yi kama da promedol. Yana da ƙarfi, amma na ɗan gajeren lokaci (tare da tsari guda ɗaya) sakamako na tsinkaye.

Bayan gudanarwa na ciki, matsakaicin sakamako yana tasowa bayan mintuna 1-3 kuma yana ɗaukar mintuna 15-30. Bayan gudanarwar intramuscular, mafi girman tasirin yana faruwa a cikin minti 3-10.

Don shirye-shiryen miyagun ƙwayoyi don maganin tashin hankali (premedication), ana gudanar da fentanyl a cikin kashi 0.05-0.1 mg (1-2 ml na maganin 0.005%) intramuscularly rabin sa'a kafin tiyata.

A cikin ayyukan a karkashin maganin sa barci na gida, ana iya amfani da fentanyl (yawanci a haɗe tare da ƙwayar cuta) a matsayin ƙarin analgesic. 0.5-1 ml na 0.005% na maganin fentanyl ana gudanar dashi ta hanyar ciki ko cikin intramuscularly (idan ya cancanta, ana iya maimaita miyagun ƙwayoyi kowane minti 20-40).

Fentanyl za'a iya amfani dashi don rage zafin ciwo a cikin rauni na huhu, angina pectoris, infarction na huhu, na koda da na hepatic colic. Ceaddamar da intramuscularly ko cikin ciki 0,5-1-2 ml na 0.005% bayani. Ana amfani da Fentanyl sau da yawa don wannan dalilin a hade tare da magungunan antipsychotic.

Ana maimaita alluran Fentanyl bayan minti 20-40, kuma bayan tiyata bayan awanni 3-6.

Lokacin amfani da fentanyl, musamman tare da gabatarwar saurin shiga cikin jijiya, rashin damuwa na numfashi mai yiwuwa ne, wanda za'a iya kawar dashi ta hanyar jijiyar naloxone.

Don gajeriyar ayyukan mara jijiyoyi, lokacin da ba a buƙatar amfani da abubuwan shakatawa na tsoka kuma ana aiwatar da neuroleptanalgesia yayin da ake ci gaba da numfashi mara lafiyan, ana gudanar da fentanyl a cikin 1 ml na maganin 0.005% ga kowane nauyin 10 zuwa 20 na nauyin jiki. A wannan yanayin, wajibi ne a kula da isawar numfashi maras wata-wata. Yana da Dole a sami damar yin, idan ya cancanta, toshewar trachea da kuma yadda ake yin huhu a cikin huhu. Idan babu yanayi don yin iska, in ba a yarda da amfani da fentanyl don maganin neuroleptanalgesia ba.

Za'a iya lura da tashin hankali na motsa jiki, spasm da taurin tsokoki na kirji da wata gabar jiki, hanji na zuciya, hypotension, sinus bradycardia. Bradycardia an kawar dashi ta atropine (0.5-1 ml na maganin 0.1%).

Ana kula da marasa lafiyar da insulin, corticosteroids da magungunan antihypertensive a ƙananan allurai.

Cutar da jaraba da jaraba mai ban tsoro (dogaro da ilimin halittar jiki) na iya haɓaka fentanyl.

Tare da hulɗa mai rauni, fentanyl yana shiga cikin jini ta fata, don haka ya kamata a kara kulawa sosai lokacin aiki tare da miyagun ƙwayoyi. Ana bada shawarar iri ɗaya yayin nazarin abubuwan da ba a sani ba masu kama da fentanyl.

Neuroleptanalgesia edit |Haihuwa da lactation

A lokacin daukar ciki, ana amfani da Fentanyl ne kawai a cikin yanayi inda ake tsammanin fa'ida ga uwa sama da girman hadarin da tayi ga jariri da jariri.

Magungunan suna shiga cikin madara, sabili da haka, yayin amfani da Fentanyl, ya kamata a daina shayar da jarirai.

Matan mata masu haihuwa yayin amfani da miyagun ƙwayoyi ya kamata su zaɓi waɗanda ke da rigakafin a hankali.

Hulɗa da ƙwayoyi

Ta hanyar amfani da Fentanyl na lokaci guda tare da antihistamines tare da tasirin magani da ethanol, haɗarin tasirin sakamako yana ƙaruwa.

Benzodiazepines yana tsawaita fitar da mai haƙuri daga neuroleptanalgesia, masu hana beta iya rage mita da tsananin raunin haɓakawa yayin amfani da Fentanyl a cikin aikin tiyata, amma yana ƙaruwa da damar bradycardia.

Tare da yin amfani da lokaci ɗaya tare da hanawar monoamine oxidase, haɗarin rikitarwa mai yawa yana ƙaruwa, tare da magungunan antihypertensive, sakamakon ƙarshen yana ƙaruwa.

Lokacin da aka haɗu tare da shakatawa na tsoka, an hana ko kawar da tsauraran tsoka, shakatawa na tsoka tare da aikin vagolytic yana rage haɗarin hauhawar jini da bradycardia, kuma yana iya haɓaka haɗarin hauhawar jini, tachycardia, shakatawa na tsoka waɗanda ba su da aikin vagolytic, kada ku rage haɗarin hypotension da bradycardia, da haɓaka yiwuwar tsananin wahala mummunan halayen daga tsarin zuciya.

Ya kamata a yi amfani da Fentanyl tare da taka tsantsan game da tushen aikin kwayayen bacci, magungunan ƙwayoyin cuta da magunguna don maganin hana jijiyoyi don hana tashin hankali na ayyukan cibiyar numfashi, da kuma hana ƙwayar tsohuwar tsarin jijiya. Oxidit din Dinitrogen yana kara karfin taurin tsoka, kuma maganin tricyclic antidepressants yana kara yiwuwar dakatar da cibiyar numfashi.

Bai kamata a yi amfani da miyagun ƙwayoyi a haɗe tare da masu ba da narkewa ba daga rukunin opioid receptor antagonist agonists (tramadol, nalbuphine da butorphanol) da kuma agonists na yanki (buprenorphine), tun da akwai haɗarin rauni na analgesia.

Tare da kwantar da hankali tare da magungunan antihypertensive, glucocorticosteroids da insulin, dole ne a yi amfani da Fentanyl a cikin ragewar allurai. Tasirin analgesic da sakamako na sauran agonists na opioid (promedol, morphine) a cikin kewayon sashin warkewa an haɗe su tare da aiki da tasirin Fentanyl.

Fentanyl analogues sune: Dolforin, Lunaldin, Fentadol Matrix, Fentadol Reservoir, Fendivia.

Farashin fentanyl a cikin magunguna

Ba za a iya sayan maganin ba a cikin sarƙoƙi na kantin sayar da kayayyaki, tunda ana samun su ne kawai ga asibitoci. Koyaya, an san cewa farashin Fentanyl daga 90-100 rubles a kowane kunshin na miyagun ƙwayoyi wanda ya ƙunshi allurar ampoules guda 5 don sashi na 50 μg / ml.

An sami kuskure a cikin rubutun? Zaɓi shi kuma latsa Ctrl + Shigar.

Haihuwa da lactation

Babu isasshen bayanai game da amfani da fentanyl a cikin mata masu juna biyu. Fentanyl ya haife mahaifa a farkon ciki. Nazarin dabbobi sun nuna kasancewar ƙwayar haihuwar haihuwa, amma ba a san mahimmancin bayanan da aka karɓa ga ɗan adam ba. Yin amfani da fentanyl na dogon lokaci yayin daukar ciki na iya haifar da ci gaba da kawar da ciwo a cikin jarirai, wanda hakan na iya zama barazanar rayuwa idan ba a kula da shi ba. Idan kuna buƙatar shan opioids na dogon lokaci a cikin mata masu juna biyu, ya kamata ku gargadi mara lafiya game da haɗarin kamuwa da cututtukan cirewa a cikin jarirai, kuma ku tabbata cewa za a sami magani da ya dace.

Ba a bada shawarar amfani da fentanyl (iv ko iv) yayin haihuwa (ciki har da sashin cesarean), saboda fentanyl shine ya ketare mahaifa, kuma saboda cibiyar tayi ne tayiyuwa musamman opiates. Game da shawarar yanke hukunci game da amfani da fentanyl, maganin rigakafi da ake bukata zai zama dole.

Fentanyl an keɓe shi a cikin madara mai nono kuma yana iya haifar da tashin hankali / rashin numfashi a cikin yara, saboda haka dole ne ku ƙi ciyarwa a cikin sa'o'i 24 bayan sanya magani. Ya kamata a yi la’akari da rabo / amfanin rabo na shayarwa bayan amfani da fentanyl.

Kariya da aminci

Fentanyl ne kawai yakamata ayi amfani da shi sosai. Fentanyl yakamata kawai ya tsara ta kwararru waɗanda suke sane da ka'idoji don gudanar da maganin opioid na dogon lokaci, ganowa da cire hypoventilation, gami da magani tare da masu maganin opioid antagonists idan ya cancanta.

Fentanyl, kamar sauran masu binciken opioid, na iya zama batun cin zarafi duka biyu lokacin da aka yi amfani da shi daidai da alamun da ake amfani da su, da kuma lokacin samun damar yin amfani da miyagun ƙwayoyi. Wannan haɗarin yakamata ayi la'akari dashi yayin rubutawa, rubutawa da rarraba magunguna a cikin yanayi inda akwai damuwa game da rashin amfani, zagi da sauran keta hakki.

Marasa lafiya da ke da haɗarin cutar opioid sun haɗa da marasa lafiya da tarihin dangi na maye (gami da miyagun ƙwayoyi ko barasa) ko wasu rikice-rikice na kwakwalwa (misali, matsananciyar damuwa). Kafin a tsara bayanan analgesics na opioid ga mara haƙuri, ya kamata a tantance matsayin haɗarin asibiti na haɓakar dogara da opioid. Duk likitocin da ke karɓar opioids ya kamata a sa ido don alamun rashin amfani, zagi, da haɓaka dogaro. An shawarci marasa lafiya a cikin haɗarin cutar opioid da su bar su kan shirye-shiryen fitarwa na opioid; waɗannan marasa lafiya suna buƙatar ci gaba da lura da alamun cutar opioid.

Damuwa game da zagi, dogaro da amfani mara kyau bai kamata su zama tushen dalilin rashin nasarar maganin jin zafi da ya dace ba.

Koyaya, duk marasa lafiya da ke karɓar bayanan opioid suna buƙatar sa ido sosai game da alamun jaraba da cin zarafi, tunda akwai haɗarin jaraba, gami da amfani da magungunan opioid da suka dace.

Haɓaka adadin da aka ba da shawarar fentanyl a sakamakon ƙididdigar da ba daidai ba lokacin canja wurin haƙuri daga wata farfadowa na opioid zai iya haifar da mummunan adadin yawan zafin jiki akan kashi na farko.

Bai kamata a yi amfani da Fentanyl don sauƙaƙa gajeriyar tazara da taushi ba.

Yin amfani da magunguna a lokaci guda wanda ke shafar tsarin juyayi na tsakiya yana buƙatar ƙididdigar musamman da lura.

Amfani da fentanyl na iya haifar da bacin rai, wanda yake dogaro-kashi a cikin yanayi kuma za'a iya dakatar dashi ta gabatarwar wani takaddama mai karyatawa - naloxone. Gabatarwar ƙarin allurai naloxone na iya zama dole, saboda baƙin ciki na iya wuce tsawon lokacin aikin antagonist. Depressionwaƙwalwar numfashi shine ɗayan haɗari mafi haɗari na jiyya tare da agonists na opioid, ciki har da fentanyl. Ana lura da haɗarin mafi girma na rashin damuwa na numfashi a cikin tsofaffi da marasa lafiya marasa ƙarfi, yawanci bayan amfani da babban farawa ga marasa lafiya waɗanda ba su karɓi maganin opioid a baya ba ko a lokuta inda ake wajabta opioids a lokaci guda tare da wasu magunguna waɗanda ke dakatar da aikin numfashi. Nunawar numfashi wanda opioids ke haifarwa yana nunawa ta hanyar raunana tashin numfashi da kuma raguwa a cikin numfashi, yawanci ana bayyana shi ne a cikin "numfashi" na numfashi (numfashi mai zurfi yana katsewa koyaushe). Riƙewar Carbon dioxide saboda ɓacin rai yana iya inganta tasirin maganin opioids. Dangane da wannan, shan kwayoyi masu yalwa tare da kwantar da hankula da opioids yana da haɗari musamman.

Jinƙan ciki yana haɗuwa da matsanancin damuwa na numfashi, wanda zai iya tsayawa ko sake sakewa cikin lokacin aikin. A saboda wannan dalili, saka idanu na marasa lafiya a hankali ya zama dole, kazalika da kasancewar kayan aikin da suka wajaba da kuma takamaiman maganin adawa don sake farfadowa. Hyperventilation a lokacin tashin hankali na iya canza amsa haƙuri ga mai da hankali kan CO₂ kuma yana haifar da bacin rai a cikin bayan aikin.

Fentanyl ya kamata a wajabta shi sosai tare da taka tsantsan a cikin marasa lafiya da ke fama da cutar huhun hanji ko kuma cututtukan zuciya, haka kuma a cikin marasa lafiyar da ke da raguwa sosai a yawan huhun huhun, hypoxia, hypercapnia, ko kuma waɗanda suka taɓa fama da matsalar numfashi. A cikin waɗannan marasa lafiya, har ma da magungunan warkewa na fentanyl na yau da kullun na iya rage aikin numfashi har zuwa huhu. Don wannan rukuni na marasa lafiya, ya kamata a yi la'akari da madadin marasa maganin opioid, opioids ya kamata ne kawai a wajabta su a karkashin kulawa ta asibiti kuma a mafi ƙarancin tasiri.

Injuriesunƙun kai da haɓaka matsa lamba intracranial

Fentanyl bai kamata a rubuta shi ba ga marasa lafiya waɗanda zasu iya zama musamman kula da tasirin intracranial na matakan CO.₂. Wannan rukuni na marasa lafiya ya haɗa da waɗanda ke da alamun karuwar haɓakar intracranial, ƙarancin sani, ko ƙwayar cuta. Opioids na iya rikitar da kimanta yanayin asibiti na marasa lafiya da ke fama da rauni a kwakwalwa. Ya kamata a tsara Fentanyl tare da taka tsantsan ga marasa lafiya da ke da ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa.

Rigarfin ƙwayar tsoka, ciki har da tsokoki na pectoral, mai yiwuwa ne, wanda za'a iya guje masa ta hanyar ɗaukar matakan masu zuwa: gudanarwar jinkiri mai sauƙi, kwance kai tare da benzodiazepines, da kuma amfani da shakatawar tsoka.

Abun da ke faruwa na motsi na myoclonic na yanayin rashin cututtukan epileptogenic yana yiwuwa. Bradycardia, har zuwa kamawar zuciya, na iya faruwa idan mai haƙuri ya sami isasshen adadin maganin anticholinergics ko lokacin da ake amfani da fentanyl a hade tare da shakatawa na tsoka waɗanda basu da aikin vagolytic. Bradycardia zai iya tsayawa ta gabatarwar atropine.

Tare da yin amfani da fentanyl na tsawan lokaci, haƙuri da dogaro ga ƙwayoyi na iya haɓaka.

Opioids na iya haifar da hauhawar jini, musamman a cikin marasa lafiya da ke fama da hypovolemia. Dole ne a dauki matakan da suka wajaba don kula da tsayayyen jini.

Guji hanzarin ƙwayoyin inzali na magungunan opioid a cikin marasa lafiya tare da canzawar ƙwayar ƙwayar ƙwayar cuta: a cikin waɗannan marasa lafiya, raguwa na yau da kullun a matsin lamba na jijiya wani lokaci tare da raguwa na ɗan gajeren lokaci a cikin matsin ƙanshin ƙwaƙwalwar cerebral.

Marasa lafiya waɗanda ke kan jiyya opioid na dogon lokaci ko kuma waɗanda ke da dogaro na opioid na iya buƙatar ƙarin allurai na fentanyl.

Ana ba da shawarar rage ƙarfin kashi a cikin tsofaffi da marasa lafiya marasa ƙarfi.

Yin amfani da fentanyl yana buƙatar taka tsantsan a cikin marasa lafiya tare da waɗannan yanayi: hypothyroidism da ba a sarrafa shi ba, cutar huhu, rage ƙarancin abinci, buguwa, hanta mai rauni ko aikin koda. Irin waɗannan majinyata suna kuma buƙatar dogon sa ido na aikin bayan-ta-kwana.

Lokacin amfani da fentanyl tare da antipsychotics (kamar droperidol), yana da mahimmanci don la'akari da bambanci a cikin tsawon lokacin aikin waɗannan kwayoyi. Tare da yin amfani da su lokaci guda, haɗarin hypotension yana ƙaruwa. Antipsychotics na iya haifar da alamun extrapyramidal wanda za'a iya sarrafa shi ta hanyar amfani da magungunan antiparkinsonian.

Kamar yadda yake tare da sauran opioids, saboda tasirin maganin anticholinergic, amfanin fentanyl zai iya haifar da karuwa a cikin bututun bile kuma, a lokuta da ƙarancin yanayi, ana iya lura da kumburin sphincter na Oddi.

A cikin marasa lafiya tare da myasthenia gravis, ya kamata a hankali yin la'akari da amfani da wasu cututtukan anticholinergics da kwayoyi waɗanda ke toshewar jijiyoyin jini a gaba da kuma lokacin maganin motsa jiki na gaba daya, wanda ya haɗa da gudanarwar fentanyl.

Amfani da fentanyl yayin haihuwa yana iya haifar da rashin damuwa a cikin jariri.

Haɗi tare da Barasa da Miyagun Kwayoyi

Fentanyl na iya samun sakamako mai ƙarfi game da dakatar da aikin juyayi na tsakiya yayin da aka tsara shi akan asalin giya, wasu opioids ko magungunan ba bisa doka ba tare da irin wannan sakamako a cikin tsarin juyayi na tsakiya.

Yi amfani da yara. Ba a tabbatar da amincin fentanyl a cikin yara 'yan ƙasa da shekaru 2 ba. Fentanyl ne kawai za'a iya rubuta shi ga yara 'yan shekaru sama da 2 kuma wanda aka nuna wa opioid haƙuri.

Analgesia a cikin yara waɗanda ke riƙe da numfashi na bazata yakamata a yi amfani dasu azaman haɗin kai don matakan motsa jiki ko azaman haɗuwa ga aikin kwance (ko kuma wani ɓangare na dabarar shaƙatawa / analgesia), da a samar da cewa ƙwararrun ma'aikata da kayan aiki suna iya kasancewa don shigarwar cikin jijiyoyin jiki da nutsuwa ta wucin gadi. Gudanar da haɗari na fentanyl, musamman a cikin yara, na iya haifar da mummunar yawan ƙwayoyi.

Yi amfani da tsofaffi. Bayanan da aka samo yayin nazarin nazarin tsarin kulawa na fentanyl suna ba da shawarar cewa tsofaffi marasa lafiya na iya rage yarda da tsawan rabin rayuwar magani, kuma a ƙari, irin waɗannan marasa lafiya na iya zama masu hankali ga fentanyl fiye da marasa lafiya na matasa. Tsofaffi marasa lafiya suna buƙatar kulawa da hankali don gano alamun yiwuwar yawan ƙwayar fentanyl, wanda zai buƙaci raguwa a cikin yawan fentanyl.

Yakamata a yi taka tsantsan cikin haɗuwar amfani da fentanyl tare da kwayoyi waɗanda ke shafar tsarin serotonergic neurotransmitter.

Haɗin kai tare da magungunan serotonergic, kamar zaɓin serotonin reuptake inhibitors, serotonin da norepinephrine reuptake inhibitors, kazalika da kwayoyi waɗanda suka shafi metabolism na serotonin (gami da inhibitors na monoamine oxidase inhibitors), na iya haifar da cututtukan cututtukan ƙwayar cuta na serotonin.

Haɓaka ƙwayar cutar serotonin na iya faruwa tare da amfani da kwayoyi a cikin allurai da aka bada shawara.

Bayyanar asibiti game da ciwo na serotonin na iya haɗawa da alamu masu zuwa:

- canje-canje a cikin halin kwakwalwa (tashin hankali na damuwa, abubuwan son rai, nai),

- rikice-rikice na tsarin juyayi na kansa (tachycardia, hauhawar jini na labile, hauhawar jini),

- rikicewar neuromuscular (hyperreflexia, daidaitaccen daidaituwa, rashi tsoka),

alamun gastrointestinal (misali, tashin zuciya, amai, gudawa).

Idan ana zargin ci gaban serotonin ciwo, dole ne a dakatar da amfani da fentanyl nan da nan.

Tasiri kan iya tuƙin motoci da sauran hanyoyin haɗari. Tuki abin hawa da shiga cikin wasu ayyukan haɗari na iya yiwuwa ne kawai lokacin da isasshen lokacin da ya wuce bayan amfani da miyagun ƙwayoyi.