Carbonic anhydrase inhibitors: mechanism ntawm qhov kev txiav txim ntawm qhov muag dauv rau glaucoma

Carbonic anhydrase inhibitors yog diuretics, uas yog tsis siv raws li diuretics los yog mochegonki. Hais rau cov tshuaj yog glaucoma. Cia peb xav txog nyob rau hauv ntau yam nrov tshaj plaws sawv daws yuav.

Acetazolamide (Acetazolamide)

Nws muaj diuretic zog. Nres carbonic anhydrase raum proximal tubules thiaj li reabsorption ntawm K, Na thiab dej (diuresis ua ib qho kev nce), nws leads mus rau ib tug txo nyob rau hauv lub BCC thiab metabolic acidosis. Carbonic anhydrase depresses lub ciliary lub cev thiab ua rau yus mus rau ib tug txos ntawm lub intraocular siab, thiab kuj thiaj li tso pa tawm ntawm aqueous lom zem nyob rau hauv lub hlwb ua rau antiepileptic kev ua si. Nws muaj zoo haum los ntawm tus mob huam, Cmax nyob rau hauv cov ntshav nyob rau hauv ob teev. Nyhuv yuav kav mus txog 12 teev. 40-60% txo IOP thiab thiaj li muaj ntau lawm ntawm intraocular kua.

Indications & ntau npaum

Lub ntsiab indications: ocular tawg, glaucoma. Nyob rau hauv glaucoma, lub sab hauv muab rau 0.125-0.25 g 1-3 lub sij hawm ib hnub twg, txhua txhua hnub rau 5 hnub, tom qab uas xav tau ib tug ob-hnub so.

Sab los: xeev siab, tsis qab los noj mov, raws plab, ua xua, impaired kev txiav txim zoo ntawm kov, paraesthesia, tinnitus, nkees nkees. Tag nrho cov no yuav ua rau muaj mob carbonic anhydrase inhibitors. Npaj kuj contraindications. Qhov no ntev li rhiab heev (rau sulfonamides xws li), Addison tus kab mob, tiv rau acidosis, mob siab tus kab mob thiab lub raum kab mob, cev xeeb tub, mob ntshav qab zib mellitus, uremia.

Pab txwv: pulmonary embolism, pulmonary emphysema (tejzaum nws ua acidosis).

Cov tshuaj: Ntsiav tshuaj ua nyob rau hauv teb chaws Poland Polpharma "Diakarb" rau 0.5 g

Dorzolamide (dorzolamide)

Cheeb carbonic anhydrase isoenzyme II Kev ua (Xa reversible co tshuaj tiv thaiv ntawm cov pa roj carbon dioxide thiab carbonic acid lub cev qhuav dej) qhov muag ciliary lub cev. Pa intraocular dej yog txo los ntawm 50%, slows cia lub tsim ntawm bicarbonate ions, thiab cov thiaj li thauj ntawm dej thiab sodium. Txo los ntawm 38% ntawm zus tau tej cov intraocular kua uas tsis cuam tshuam rau outflow. Nws penetrates mus rau hauv lub ceev ceev feem ntau los ntawm lub povtseg, cornea los yog sclera. Cov absorbed rau hauv lub mauj vascular txaj ntawm lub qhov muag mucosal (yuav tshwm sim diuretic thiab lwm yam teebmeem raug sulfonamides). Tom qab lub substance tau txais mus rau hauv cov ntshav, sai penetrates mus rau hauv cov ntshav liab, uas muaj loj nyiaj ntawm cov carbonic anhydrase II. Dorzolamide 33% bound rau ntshav proteins. Qhov siab tshaj plaws hypotensive nyhuv manifests tom qab instillation los ntawm ib tug 2 teev thiab khw muag khoom noj nws 12 teev. Thaum backfilling mus rau 2 lub sij hawm ntawm 9-21% tauj ib hnub txo intraocular siab thaum instilled li 3 lub sij hawm ib hnub twg - mus 14-24%. Yuav txo tau ntawm intraocular siab los ntawm kev siv ib tug 2% tshuaj yuav ua tau nyiaj pab ntau tshaj 4,5-6,1 mm hg. Ib tug tov ntawm 3% yuav tsis zoo vim hais tias nws yuav sai sai ntxuav tawm ntawm lub conjunctival kab noj hniav raws li nws ua rau muaj zog tearing. Nyob rau hauv nrog lub sij hawm timolol muaj ib tug ntxiv pronounced nyhuv los ntawm 13 mus 21%. Tsawg heev ntxim rau cov ntshav siab thiab lub plawv dhia muaj carbonic anhydrase inhibitors. Diuretics no pab pawg neeg yog tsis siv rau cov npaj lub hom phiaj. Nyob rau qhov no tom qab.

Indications & ntau npaum

Indications: thawj thiab qhib-angle glaucoma, ocular tawg. Cov tshuaj no yog qhia los ntawm 1 drop 2-3 zaug ib hnub twg.

Sab los: paresthesia, poob phaus, kev nyuaj siab, daim tawv nqaij ua pob ua xyua, aplasticheskayaanemiya, agranulocytosis, nkees, mob taub hau, tshuaj lom epidermal necrolysis, ntsim saj nyob rau hauv lub qhov ncauj, xeev siab, nce nyob rau hauv lub thickness ntawm lub cornea, iridocyclitis, blepharitis, keratitis, conjunctivitis, photophobia, qhov muag plooj tsis pom kev, khaus thiab tingling nov ntawm nqaij tawv nyob rau hauv lub ob lub qhov muag, tsis xis nyob, Stevens - Johnson syndrome, hlawv, los kua muag.

Lub carbonic anhydrase inhibitor (qhov muag dauv) muaj cov nram qab contraindications: ntev rhiab heev (rau sulfonamides xws li), thaum yau, mob siab tus kab mob thiab lub raum kab mob, cev xeeb tub thiab pub niam mis.

Kev npaj: eyedrops "Trusopt" muaj 1 ml ntawm 20 mg dorzolamide hydrochloride tshuaj. vials - 5 ml. Nws yuav ua nyob rau hauv lub Netherlands los ntawm Merck Ntse & Dohme.

Carbonic anhydrase inhibitors: Brinzolamide (brinzolamide)

Lub blocker ntawm carbonic anhydrase muaj lub peev xwm thaum ua ntawv thov topically rau tseem ceeb yuav txo tau thiab tswj IOP. Brinzolamide muaj siab selectivity rau carbonic anhydrase II, thiab feem ntau tsim lub cev zog zoo txeem mus rau hauv lub qhov muag. Thaum muab piv nrog dorzolamide thiab atsetozolamidom nws pom tias brinzolamide - lub feem ntau hwj chim tshuaj pab pawg neeg ntawm carbonic anhydrase inhibitors. Muaj pov thawj hais tias cov tshuaj pleev los yog tso dej raws leeg thawj coj ntawm brinzolamide leads mus rau ib txoj kev txhim kho ntawm lub optic disk. Thiab nws thiaj li los ntawm ib tug nruab nrab ntawm 20% IOP. Nws tsis ua hauj lwm tag nrho cov carbonic anhydrase inhibitors. Lub mechanism ntawm qhov kev txiav txim tshwj xeeb los ntawm brinzolamide.

Indications thiab ntau npaum

Indications: ocular tawg, qhib-angle glaucoma. Siv 2 lub sij hawm ib hnub twg rau ib tug nco.

Sab los: saj perversion, txawv teb chaws lub cev nov ntawm nqaij tawv, qhov muag plooj tsis pom kev raws li qhov instillation (lub sij hawm) thiab ib tug burning nov ntawm nqaij tawv. Kis zos zoo dua dorzolamide.

Contraindications: ntev rhiab heev mus rau yeeb tshuaj (rau sulfonamides xws li), cov me nyuam uas muaj hnub nyoog, cev xeeb tub thiab pub niam mis.

Kev npaj: eyedrops "Azopt" muaj 1 ml ntawm ib ncua kev kawm ntawm 10 mg brinzolamide. Peev Xwm vials ntawm 5 ml. Ua nyob rau hauv lub teb chaws USA los ntawm Alcon.

Yuav ua li cas lwm tus yog carbonic anhydrase inhibitors?

prostaglandin derivatives

Latanoprost (latanoprost) - prostaglandin receptor xim agonist. Tsub kom outflow ntawm intraocular kua los ntawm lub uvea, uas ua rau yus mus rau ib tug txos ntawm intraocular siab. Feem nyob rau zus tau tej cov aqueous lom zem yuav tsis pab. Yuav hloov qhov luaj li cas ntawm cov menyuam kawm ntawv, tab sis tsuas yog me ntsis. Thaum backfilling penetrates rau hauv daim ntawv ntawm isopropyl ether ntawm lub cornea thiab muaj hydrolyzed mus rau lub xeev ntawm ib tug biologically active acid, uas yuav tsum tau hais tseg nyob rau hauv thawj 4 teev nyob rau hauv intraocular kua thiab nyob rau hauv ntshav nyob rau hauv thawj teev. 0,16l / kg - volume ntawm tis. Ob teev tom qab tas li ntawd tiav lub siab tshaj plaws nyob rau hauv concentration lub aqueous lom zem, tom qab uas nws yog muab faib rau cov pib ntawm pem hauv ntej ya, i.e. tawv muag thiab lub conjunctiva, thiab ces nkag mus rau rau hauv lub posterior ya (nyob rau hauv me me). Lub active daim ntawv nyob rau hauv cov ntaub so ntswg ntawm lub qhov muag yog xyaum tsis metabolized, mas nyob rau hauv lub siab biotransformation. Advantageously, metabolites yog tas nyob hauv cov zis. Cia saib ib co ntawm cov carbonic anhydrase inhibitors.

Unoprostone (unoprostone)

Isopropyl unoprostone yog ib tug derivative ntawm ib tug docosanoid sai txo intraocular siab (IOP) siv qhov tseeb pharmacologic mechanism. Yog tsis muaj kev hloov lub sij hawm zus tau tej cov intraocular kua, tswj nws outflow. Kev tshawb fawb pom tau hais tias, muab piv nrog 0.5% timolol maleate, isopropyl unoprostone muaj ntsis zoo ib los yog zoo dua kev ua si kom tsis txhob muaj IOP. Cov tshuaj tsis cuam tshuam rau cov kev pab thiab tsis ua rau yuav txo tau ntawm cov ntshav khiav tsis zoo hauv lub ocular ntaub so ntswg, miosis los yog mydriasis; corneal lwm ncua sij hawm kuj tsis kuaj. Tom qab tshuaj pleev unchanged isotropy unoprostone twb tsis kuaj nyob rau hauv ntshav.

carbonic anhydrase inhibitors rau glaucoma yuav tsum tau tshuaj xwb los ntawm ib tug kws kho mob, nws tus kheej-tshuaj yog tsis tau tso cai.