Anticholinergic tshuaj: daim ntawv teev. Lub mechanism ntawm qhov kev txiav txim ntawm lub anticholinergic tshuaj

Anticholinergic tshuaj - yog cov tshuaj uas thaiv qhov kev txiav txim ntawm lub ntuj neurotransmitter - acetylcholine - mus cholinergic receptors. Nyob rau hauv txawv teb chaws cov ntaub ntawv, qhov no pab pawg neeg ntawm cov tshuaj hu ua "delirianty" vim lub peev xwm los ua fem.

Ib me ntsis ntawm cov keeb kwm tseeb

Nyuam qhuav pib, nyob rau hauv nruab nrab-xyoo pua 20th, tshuaj anticholinergic txiav txim siv rau cov kev kho mob ntawm tus kab mob obstructive koj muaj teebmeem kev kab mob thiab mob hawb pob, tab sis lawv hloov los ntawm ntau niaj hnub tshuaj muaj tsawg tej kev phiv. Nrog rau txoj kev loj hlob ntawm pharmacology, zaum twb tau los tsim xws holinoblokatory uas tsis muaj tib lub loj loj daim ntawv teev cov kev phiv. Ntau npaum cov ntaub ntawv tau raug zoo, thiab nyob rau hauv kho xyaum pulmonary kab mob dua thov anticholinergics. Lub mechanism ntawm qhov kev txiav txim ntawm no pab pawg neeg ntawm cov tshuaj yog theej nyuab, tab sis nws yog ua tau los piav qhia txog lub ntsiab mus.

Yuav ua li cas holinoblokatory?

Lub ntsiab kev txiav txim ntawm lub anticholinergic tshuaj no yog thaiv cov hlab cholinergic receptors thiab cov impossibility ntawm influencing lawv neurotransmitter - acetylcholine. Piv txwv li, nyob rau hauv lub bronchi sim receptors nyob rau hauv lub tus mob.

kev faib tshuaj

Nyob ntawm seb uas receptors yog los ntawm anticholinergic tshuaj, daim ntawv no yuav muab faib mus rau hauv pab pawg:

• M-holinoblokatory (atropine, scopolamine, ipratropium bromide).
• H holinoblokatory (pentamine, tubocurarine).

Nyob rau hauv lub selectivity ntawm kev txiav txim:

• Central, los yog uas tsis yog-xim (atropine, pirenzepine, platifillin).
• Peripheral los yog xim (ipratropium bromide).

M-holinoblokatory

Lub ntsiab tus neeg sawv cev ntawm no pab pawg neeg ntawm cov tshuaj yog atropine. Atropine - ib tug alkaloid, uas yog muaj nyob rau hauv ib co nroj tsuag xws li cov nightshade, henbane thiab datura. Qhov tseem hais feature ntawm atropine - antispasmodic. Tawm tsam tom qab ntawm qhov kev txiav txim txo leeg laus cov hnyuv, zais zis thiab bronchus.

Atropine yog tshuaj hais lus, subcutaneously thiab intravenously. Nws ntev ntawm kev txiav txim yog hais txog 6 sij hawm thiab siv atropine mob ntev nce mus rau xya hnub.

Pharmacological los ntawm atropine:

• Dilated tub kawm ntawv ntawm ob lub qhov muag vim lub stimulating nyhuv on ncig nqaij ntawm lub iris - lub iris nqaij so kom txaus, ntsig txog, tus tub ntxhais kawm ceev. Qhov siab tshaj plaws cov nyhuv tshwm sim nyob rau 30-40 feeb tom qab instillation.
• Tuag tes tuag taw ntawm kev pab - lub lens yog ncav us txog thiab flattened, anticholinergic tshuaj tuned qhov muag rau deb tsis pom kev.
• Nce lub plawv dhia
• Qoj ntawm tus nqaij nyob rau hauv lub bronchi, mob huam, urinary zis.
• Txo nrog secretion qog, xws li bronchial, digestive thiab hws.

Kev siv cov atropine

• Nyob rau hauv Ophthalmology: txoj kev tshawb no ntawm lub fundus, lub ntsiab txhais ntawm refractive kev ua yuam kev.
• Nyob rau hauv Cardiology, atropine yog siv rau bradycardia.
• Nyob rau hauv pulmonology siv anticholinergic tshuaj nyob rau hauv mob hawb pob.
• Gastroenterology: pais plab rwj thiab duodenal rwj, gastritis giperatsidnom (los ntawm kev txo pais plab acid secretion digestive qog). Cov tshuaj no yuav siv tau nyob rau hauv cov ntaub ntawv ntawm plab hnyuv Colic.
• Lub anesthetists atropine siv raws li premedication ua ntej ntau yam phais cov txheej txheem.

Tshwm sim los ntawm atropine.

Yus muaj los ntawm dryness ntawm lub qhov ncauj thiab lub caj pas, photophobia, impaired nyob ze tsis pom kev, cem quav, teeb meem nyob rau hauv tso zis.

Atropine yog kiag li txhob siv nyob rau hauv glaucoma vim cov nyhuv uas muaj zog intraocular siab. Txhob anticholinergic tshuaj rau urinary incontinence, raws li so kom txaus rau cov nqaij ntshiv ntawm lub zais zis. Anticholinergics yuav tsum tau leej xaiv ntawm dosing. Nyob rau hauv excess koob tshuaj los lom kab mob, uas yog yus muaj los ntawm lub cev muaj zog thiab lub siab ntsws arousal, mydriasis, txhaws qa, teeb meem nqos, yuav sawv nyob rau hauv kub. Nyob rau hauv loj dua lom neeg mob pib mus poob lawv orientation nyob rau hauv qhov chaw, tsis paub txog cov neeg nyob ib ncig ntawm lawv, tau qhia hallucinations thiab delusions. Tej zaum tsim qaug dab peg uas mus rau hauv ib lub coma, tab sis vim yog tuag tes tuag taw ntawm lub pa chaw, txoj kev tuag tshwm sim sai heev. Feem ntau cov rhiab ntau ntau koob tshuaj ntawm cov me nyuam - lawv tuag koob tshuaj yog 6-10 mg.

Scopolamine structurally zoo xws li cov atropine, tab sis nyob rau hauv sib piv rau nws muab feem ntau inhibitory los rau lub hauv paus poob siab system, kuj ua ib tug sedative. Qhov no tej khoom vaj tse yog siv nyob rau hauv txoj kev xyaum ntawm cov tshuaj - scopolamine yog siv nyob rau hauv ib tug ntau yam ntawm mob ntawm lub vestibular system - kiv taub hau, impaired moj yam thiab tshuav nyiaj li cas, los mus tiv thaiv cov kev loj hlob ntawm lub hiav txwv thiab cua kev mob kev nkeeg.

Anticholinergic tshuaj muaj nyob rau hauv lub "Aeron," ib tug yeeb tshuaj uas yog feem ntau siv ua ntej lub tom ntej mus ncig ua si nyob rau hauv dav hlau thiab ships. Action ntsiav tshuaj ntev txog 6 teev. Muaj netabletirovannaya daim ntawv - transdermal kho system - plaster, uas yog glued rau lub pob ntseg thiab kev faib tawm cov tshuaj tshaj 72 teev. Cov anticholinergic tshuaj - antidepressants, nyob rau hauv heev tshaj tus neeg mob pab rau sai sai tsa tus dab ntawm cov neeg mob uas muaj nyob rau hauv mob kev nyuaj siab.

Ipratropium bromide ( "Atrovent") - ib tug hlab ntsws qhib. Thaum nqus tau pa siv suab tsis absorbed rau hauv cov ntshav thiab twb tsis muaj mauj teebmeem. Vim lub blockade ntawm cholinergic receptors ntawm tus nqaij ntshiv ntawm lub bronchi ua rau lawv expansion. Cov anticholinergics muaj raws li ib tug tshuaj rau ib tug aerosol tshuaj txau, los yog ib tug taub txua thiab yog zoo nyob rau hauv bronchial hawb pob thiab COPD. Sab los - xeev siab thiab lub qhov ncauj qhuav.

Tiotropium bromide - anticholinergic tshuaj rau cov khoom uas zoo sib xws rau ipratropium bromide. Nws yuav ua nyob rau hauv daim ntawv ntawm cov hmoov rau nqus tau pa. Ib tug txawv feature ntawm cov tshuaj no yog hais tias nws yog ntau lasting feem rau cholinergic receptors, yog li ntawd, yog zoo tshaj dua li ipratropium bromide. Nws yog siv nyob rau hauv cov neeg mob uas COPD.

Platifillin - Araneus alkaloid. Tsis zoo li lwm yam anticholinergics, platifillin tau dilate cov hlab ntsha. Vim li no cov khoom, muaj yog ib tug me ntsis txo nyob rau hauv cov ntshav siab. Cov tshuaj no yog tso tawm rau hauv ib tug tov thiab qhov quav suppositories. Thov nrog chua nyob rau hauv tus nqaij ntshiv ntawm hauv nruab nrog cev, daim siab thiab lub raum Colic, mob hawb pob, raws li zoo raws li mob tshwm sim los ntawm spasm mob pais plab rwj thiab duodenal rwj. Nyob rau hauv ophthalmological xyaum platifillin siv nyob rau hauv daim ntawv ntawm qhov muag dauv rau dilated cov menyuam kawm ntawv.

Pirenzepine - preferentially blocks lub plab hlwb uas tsim histamine. Los ntawm kev txo histamine tso tawm thiaj li qee ntawm hydrochloric acid. Lub ib txwm kho koob, tshuaj no muaj zoo tsis ntxim rau cov tub kawm ntawv thiab lub plawv dhia, ces cia li pirenzepine yog coj lus rau cov kev kho mob ntawm pais plab rwj thiab duodenal rwj.

H holinoblokatory (ganglionic)

Lub mechanism ntawm qhov kev txiav txim yog hais tias lub anticholinergic ua hauj lawm ntawm no pab pawg neeg thaiv cov hlab qhov sympathetic innervation thiab parasympathetic paj ntawm ntshav txo lub tso pa tawm ntawm adrenaline thiab noradrenaline, inhibit excitation ntawm cov pa thiab vasomotor chaw. Ntxiv mus, ntau dua qhov lub yam ntxwv ntawm lub sympathetic los yog parasympathetic innervations, qhov ntau manifest locking kev txiav txim.

Piv txwv li, tus nqi ntawm cov tub kawm ntawv uas muaj zog parasympathetic innervation influences - feem ntau yog cov menyuam kawm ntawv feem ntau roj. Nyob rau hauv cov ntaub ntawv no, holinoblokatory yuav cuam tshuam rau parasympathetic tshee system - raws li ib tug tshwm sim ntawm cov tub kawm ntawv yog dilated. Zoo tag nrho cov ntawm cov hlab ntsha nyob rau hauv tus ntawm lub sympathetic lub paj hlwb - tshuaj tshem tawm nws cov cawv thiab dilate cov hlab ntsha, vim uas lub siab yog txo.

H holinoblokatory muaj bronchodilatory nyhuv thiab yog siv rau cov bronchial spasm, txo lub suab nrov ntawm lub zais zis, yog li no yuav raug muab tso rau ntawm anticholinergics nyuaj tso zis. Tsis tas li ntawd, cov tshuaj txo lub internal secretion qog, raws li zoo raws li qeeb tus mob huam kom. Nyob rau hauv kev kho mob xyaum, siv feem ntau hypotensive nyhuv, uas muaj cov anticholinergics. Daim ntawv teev cov kev phiv yog nws kim heev:

• Nyob rau hauv ib feem ntawm lub digestive ib ntsuj av tau: qhov ncauj qhuav thiab cem quav.
• Los ntawm cov pa system: hnoos, lub zos voos tej zaum yuav tau ntsib.
• Los ntawm cov CCC: arrhythmia, palpitations qhia. Cov tsos mob yog tsawg tsawg thiab yog yooj yim tshem tawm.
• Lwm yam los tej zaum yuav txo tau qhov muag pom acuity, txoj kev loj hlob ntawm lub mob hauv daim ntawv ntawm glaucoma, edema.

Contraindications rau kev siv ntawm anticholinergic tshuaj

• Npau taws me ntsis rau derivatives ntawm atropine thiab lwm yam ntawm cov kev npaj.
• Cev xeeb tub (tshwj xeeb tshaj yog 1 peb lub hlis).
• Lactation.
• Cov me nyuam uas muaj hnub nyoog (txheeb ze contraindication).
• Kiag li txhob siv cov tshuaj nyob rau hauv lub-kaw glaucoma nyob rau hauv cov neeg mob uas raum tsis ua hauj lwm yog tsim nyog los ua tib zoo saib xyuas hauv lub xeev ntawm cov ntshav thiab zis.