Ho hlahloba lits'ebetso tse ntle ka ho fetisisa tsa Opioid le tse seng tsa Opioid
Li-analgesics ke sehlopha sa lithethefatsi tse sebelisetsoang ho fokotsa analgesia (bohloko). Ba sebetsa ka ho thibela boitsebiso ba bohloko boko kapa ho kena-kenana le tlhaloso ea boko ba lipontšo tseo. Li-analgesics li arotsoe ka hohle-hohle e le li-non-opioid (e seng lithethefatsi) kapa li-opioid (narcotic) tse fokolang bohloko.
Li-non-opioid Analgesics
Li-analgesics tseo e seng tsa opioid li arotsoe ka likarolo tse tharo: acetaminophen , li-anti-inflammatory nonsteroidal (NSAIDs) , le li-inhibitors tsa COX-2.
Le hoja e 'ngoe le e' ngoe e na le mekhoa e fapaneng ea liketso, e sebetsa ka ho thibela mofuta oa enzyme e tsejoang e le cyclooxygenase, kapa COX. Ho na le mefuta e 'meli e fapaneng ea enzyme ena, COX-1 le COX-2, tseo ka bobeli li ikarabellang bakeng sa ho baka ho ruruha le bohloko ho arabela kotsi.
Har'a mefuta e meraro ea li-non-opioids bohloko bo fokolang:
- Acetaminophen (eo hape e tsejoang e le paracetamol) ke e 'ngoe ea li-analgesics tse holimo ka ho fetisisa lefatšeng ka bophara kajeno. Le hoja batho ba atisa ho e tseba ka lebitso la Tylenol, motsoako o sebetsang o fumaneha ho makholo a mangata a ho feta, a li-sinus le a meriana ea mafu a sefuba. Acetaminophen e fana ka liphello tse peli tsa analgesic le antipyretic (fever relieving) empa ha e tšoara ho ruruha. Le hoja mekhoa ea eona ea liketso e sa utloisisoe hantle, e bonahala e thibela mosebetsi oa COX bokong le tsamaisong ea methapo feela. Sepheo sa lona se ka sehloohong ke ho chefo ha sebete ho bakoang haholo ke ho tlōla tekano. Ho ea ka US Food and Drug Administration (FDA), kajeno acetaminophen ke sesosa se ka sehloohong sa ho hloleha ha sebete sebakeng United States, haholo-holo har'a lino tse tahang tse sa foleng kapa batho ba ithabisang ba sebelisa lithethefatsi tsa opioid tse nang le acetaminophen.
- Lithethefatsi tse seng khahlanong le ho ruruha (NSAIDs) ke sehlopha sa lithethefatsi se akarelletsang likarolo tse kang Advil (ibuprofen), Aleve (naproxen), le Bayer (aspirin). Joaloka ka acetaminophen, li-NSAID li fumaneha ka litsela tse sa tšoaneng tse akarelletsang lipilisi, li-syrups le li-patches. Leha ho le joalo, ho fapana le acetaminophen, li-NSAID li thibela COX-1 le COX-2 hore e se ke ea sebelisoa tsamaisong ea methapo feela empa le likarolo tse ling tsa 'mele. Ketso ena e atolositsoeng e tlatsetsa litsing tse ling tsa 'lithethefatsi, li-anti-inflammatory, le antipyretic. Leha ho le joalo, mokhoa ona o ka fokotsa melemo e sireletsang eo COX e nang le eona ka kamoreng ea mpa. Ka lebaka leo, litla-morao tse kang indigestion, nausea, le ulcers li tloaelehile. Ntle ho aspirin, li-NSAID li ka eketsa kotsi ea lefu la pelo le ts'oaetso ho batho ba nang le histori ea lefu la pelo.
- COX-2 inhibitors ke karoloana ea li-NSAID tseo kajeno li kenyang lithethefatsi tse le 'ngoe feela tse amohelehang ka FDA, Celebrex (celecoxib) . Ho latela lebitso lena, COX-2 inhibitors e thibela feela enzyme ea COX-2, ho fokotsa bohloko le ho ruruha ntle le ho etsa hore litla-morao tsa moriana li bake litholoana. Leha ho le joalo, e le sehlopha sa lithethefatsi, li tsebahala ho eketsa kotsi ea lefu la pelo ka karolo ea 40 lekholong. Ka lebaka leo, Vioxx eo pele e neng e tsebahala (rofecoxib) o ile a tlosoa ka boithatelo 'marakeng oa US ka 2005, ka morao ka mor'a ho bolaoa ke li-COX-2 tse thibelang likokoana-hloko. Celebrex e ntse e le e 'ngoe ea lithethefatsi tse rekisoang haholo Pfizer pharmaceutical portfolio.
Opioid Analgesics
Li-analgesics tsa opioid ke mofuta oa lithethefatsi tse sebetsang ka ho tlamella li-receiptor receptors tse fumanehang tsamaisong eohle ea methapo le matšoao a meno. Li-receptor tsena ha li laole feela mesebetsi e itseng ea somatic e kang bohloko , li boetse li na le boikarabelo ba ho baka liphello tsa kelello (liphetoho tsa kelello) batho ba amahanngoa le lithethefatsi tsa opioid.
Lithethefatsi tsa opioid li sebelisoa ka meriana bakeng sa phomolo ea bohloko, anesthesia, le ho phekola ho lemala ha opiate. Ha li kopane le chefo ea liphatsa kapa li baka sesosa leha e le sefe sa litla-morao tse amanang le li-NSAID.
Le hoja e sireletsehile ha e sebelisoa joalokaha ho laetsoe, li-opioids li ka bakela ho otsela, ho nyekeloa ke pelo, ho itšireletsa, hypoventilation (ho phefumoloha ho sa tloaelehang) le ho thaba ho ba bang.
Sena ke 'nete haholo-holo ho batho ba hōlileng ba atisang ho ba le liphello tsena.
Ho feta moo, tšebeliso ea nako e telele e amahanngoa le kotsi ea ho mamelloa ke lithethefatsi (moo meriana e senyehang butle-butle e felloa ke matla), ho itšetleha (ho lemala) le ho tlohela. Ka lebaka leo, lithethefatsi tse ngata tsa opioid li laoloa ke lintho tse hlokang ngaka ea ngaka. Ho ea ka tlaleho e tsoang ho Li-Centers for Control and Prevention, Maamerika a limilione tse peli a lemalla lithethefatsi tsa opioid.
Ho na le likarolo tse tharo tse kholo tsa lithethefatsi tsa opioid tse sebelisetsoang ho phekola bohloko:
- Li-opiate alkaloids ke mofuta oa lithethefatsi tse fumanoeng metsoako ka tlhaho e fumanehang ho opium poppy semela Papaver somniferum . Lik'hemik'hale tsa psychoactive tse fumanehang ho opium li akarelletsa morphine le codeine. Ka bobeli li sebetsa ka ho toba tsamaisong ea methapo e meholo ho theola maikutlo a bohloko. Ho otsela, bohlooho bo bobebe, ho hlatsa le ho patoa ke litla-morao tse tloaelehileng. Le hoja morphine e tsejoa e le motho ea lemalang haholo, codeine e boetse e na le bokhoni ba ho tsoa matšoao a ho tlohela haeba e feteletsoe haholo. Codeine ke oona feela opioid e kenyelletsoang meriana e mengata ka ho fetisisa (e tloaelehileng ea ho khohlela e entsoeng ka NSAID).
- Li-opioid tse nang le lik'hemik'hale tse ling li entsoe ka li-opioid tsa tlhaho 'me li akarelletsa lithethefatsi tse kang Oxycontin (oxycodone) le Vicodin (hydrocodone) . Oxycodone e sebelisetsoa ho tšoara bohloko bo tebileng (ho kenyeletsa kankere kapa bohloko ba ka mor'a ho buuoa) 'me ho nkoa e le motho ea lemalang haholo. Karolo ea hydrocodone e sebelisoa hampe ho feta lithethefatsi leha e le life tsa opioid US, ho ea ka tlaleho ea 2014 ea National Institute of Drug Abuse. Lithethefatsi tsena tse matla li ka sebelisoa ka mokhoa o sireletsehileng bakeng sa phomolo ea nakoana, empa, joaloka lithethefatsi tsa Schedule II, li hloka tlhokomelo e haufi ea bongaka.
- Li-opioide tse feletseng li entsoe ka ho feletseng ka laborateng ho etsa mosebetsi o itseng oa li-receptor joaloka li-opiate tsa tlhaho. Li akarelletsa methadone le buprenorphine (e atisang ho sebelisoa ho phekola ho lemala ha opiate) hammoho le tramadol (e sebelisoang khafetsa bakeng sa bohloko bo bakoang ke post-operative). Le hoja ba nkoa ba lemalloa haholo ho feta lithethefatsi tse ling tsa opioid, batho ba tsejoa hore ba hlaolele ho itšetleha ha ba sebelisoa nako e telele.
Lentsoe le Tsoang ho
Li-analgesics li ka ba tse atlehang haholo ho laola bohloko ba ramatiki 'me li sebelisitsoe ka mokhoa o sireletsehileng haeba li nkiloe joalokaha li laetsoe. Le hoja lingaka tse ngata li tla lebisa tlhokomelo ho lithethefatsi tseo e seng tsa opioid bakeng sa kalafo, ho ka 'na ha e-ba le maemo ao bohloko bo matla, bo boima bo ka' nang ba hloka meriana e matla ea opioid . Sena se ne se tla ba feela phomolo ea nakoana ho qoba kotsi leha e le efe ea ho itšetleha.
Ka nako e ts'oanang, ha hoa hlaka hore na opioids ea tekanyo e tlase e sebetsa hakae ha e bapisoa le mefuta e meng ea phekolo ea mofuta o sa opioid. Ka lebaka leo, haeba u e-na le bohloko bo matla bo sa phekoleheng ba ramatiki, ak'u nahane ka ho kopana le setsebi sa ho laola bohloko bo ka u buisang ka mekhoa ea hau ea phekolo ea meriana, ka bobeli meriana le e seng meriana.
> Mehloli:
> Litsi tsa Tlhokomelo le Thibelo ea Maloetse. "Matšoao a Bohlokoa: Phapang har'a Linaha Tse Ngotseng ea Lihlahisoa Tsa Mafura a Opioid le Benzodiazepines-United States, 2012." MMWR . 2014; 63 (26); 563-568.
> Cicero, J .; Ellis, M .; Surratt, H. et al. "Lintho tse susumetsang khetho ea hydrocodone le oxycodone e le li-opioid tse ka sehloohong tse hlekefetsang batho ba batlang phekolo United States." PAIN. 2013; 154 (12): 2639. DOI: 10.1016 / j.pain.2013.07.025.
> Mokhatlo oa Sechaba oa Tlhekefetso ea Meriana. "Ho Lemalla ha Li-opioids Amerika: Heroin le Prescription ea Tlhekefetso ea Meriana." Washington, DC; e hlahisitsoeng ka la 14 May, 2014.
> Yoon, E .; Babar, A .; Choudhary, M. et al. "Acetaminophen-E entsoe ka Hepatotoxicity: Phetoho e Phethahetseng.". Journal ea hepatology ea bongaka le ea ho fetolela . 2016; 4 (2): 131-42. NA: 10.14218 / JCTH.2015.00052.