Kubva pakurwisa-inflammatories kune maopioid uye anti-depressants nezvimwe, marudzi mazhinji emishonga anorayirwa kumarwadzo shure uye mumutsipa. Zvizhinji zvinopa humwe humwe hutano hwekubata marwadzo, asi kukanganisa kusingafadzi, uye kunyange nengozi, migumisiro yakaipa inosarudzwa ipapo.
Iyi nyaya inofanidza miviri yakadai yemishonga - COX-2 inhibitors uye opioids.
Cox-2 Inhibitors - Celebrex, Vioxx uye Bextra
Cox-2 inhibitors inoratidziro ye-non-steroidal anti-inflammatory (NSAID) mishonga inoshandiswa pakurwadziwa kwakanyanya, maitiro akawanda earthritis uyewo kumarwa kwemwedzi.
Dzinopesana nezvinodhaka zvakadai seAspirin, Aleve, Motrin uye zvakadai pakuti izvo zvavanoita zvinonyanya kutarisirwa.
Masayendisiti navanachiremba vanoziva kuti kurwadziwa kunokonzerwa nezvinhu zvinonzi prostaglandins. Prostaglandins, zvakare, inobudiswa mumuviri nemaviri enzymes akabatana (rimwe nerimwe rine zvisizvo zvakasiyana-siyana), iko COX-1 uye COX-2. Nyanzvi dziri mumunda dzinozivawo kuti prostaglandin inonyanya kukonzera kurwadziwa, kuzvimba uye kuputika chaizvoizvo zvinongogadzirwa ne COX-2 enzyme.
Mhedzisiro huru pakati pemishonga yemasikirwo isiri-steroidal anti-inflammatory pain (ie, maitiro akasiyana-siyana emaNSAID) uye COX-2 inhibitors ndeyokuti apo NSAID inodzivisa zviito zveEXX-1 uye COX-2 enzymes, COX-2 inhibitors, sezvinoreva zita racho, kudzivisa chete COX-2s.
Dambudziko racho rakanyanya COX-2 inhibitor rakabviswa pamusika. Izvi ndezvikonzero nekuti vakawanikwa kuwedzera njodzi yehutano hwemwoyo (kushungurudzika kwemwoyo uye kurohwa) pawakashandiswa kwekufamba kwenguva.
Vioxx (zita rinonzi rofecoxib) uye Bextra (zita rinowanzozivikanwa valdecoxib) rakabviswa pamusika kumavambo a2000. Vioxx yakagadzirwa naMerck, uye Bextra yakagadzirwa naPfizer.
Iyo inobva pane imwe Pfizer's COX-2 inhibitor, Celebrex (zita rinowanzoreva celecoxib.)
Sezvo mishonga chete yezvikamu zvitatu zve COX-2 inhibitor inoramba iri pamusika weU.S., Celebrix uye celecoxib iye zvino anouya ne "black box warning", iyo ndiyo yakagadzirirwa kumira yakakwana kuti ikupei kumibvunzo isina mubvunzo yekuchengeteka kwechirwere .
Vanachiremba vanorayira Celebrex vave vakarayirwa neRDA kuti vakupei Mishonga yeMishonga, iyo inowedzera huwandu hwehuwandu uye huwandu hwemashoko.
Kana uri kushamisika kuti chii chaunogona kutora kunze kweCelebrex, kuongororwa kwegore ra2013 kwakawana kuti pane zvose zvisingasarudze NSAIDs, naproxen (Aleve) inogona kunge inokonzera ngozi shoma yemwoyo kune varwere. Vanyori vanoongorora vanokurudzira kuti chero chipi cheNSAID chamunoshandisa, kuti iwe uite saizvozvo muzana rakaderera pane rinogona, uye kwenguva yakareba nguva yakawanda inogoneka.
Cherechedza kuti dzimwe mhando dzeNSAIDS, iyo iyo inodzivisa zvose COX-1 uye COX-2 enzyme, inogona kuwedzera kungozi yekurwadziwa kwepfungwa kana kurohwa, pamwe chete. Nekudaro, muna 2015, FDA yakaraira mazwi pamusoro peESAID mabhokisi ose (kusanganisira Celebrex, iyo chete inosara COX-2 inhibitor) inoshandiswa kuratidza kutsvaga kutsva kwakawana kushaya kwemwoyo kunogona kuitika kunyange masvondo mushure mokutanga rudzi urwu rwemishonga, uye kuti kana iwe uchingoshandisa mushonga wacho, yakakwirira iyo ngozi inogona kuva.
Opioids Kubva Kumusoro Kana Mutsipa
Opioid iklasi yemishonga inorwadza iyo ine simba rokusunungura runyararo rwakasimba. Opioids inowanzoshandiswa pakurwadziwa kwakanyanya, asi dzimwe nguva vanachiremba vanovataurira sevanotanga kurapa mutsara pakurwadziwa kwakanyanya.
Dambudziko nderokuti, urwu hwemarwadzo anononoka hunyengeri, zvinoreva kuti vanouya nekugona kukanganisa.
Vamwe varwere vanovaka kuvhiringidzika, izvo zvinogona kutungamirira pakuzvidzivirira kwemuviri, uye pakupedzisira zvizere zvinopindwa muropa.
Mimwe mishonga yemaopioid yakachena narcotics, asi dzimwe dzakavhenganiswa nehutachiona husingadyiki hunoita kuti tibvise zvakadai seTyelnol. Opioids inogadzirirwa sechinguvana-kuita, uye sekuita kwenguva refu.
Kunyange zvazvo kushandiswa kweapioid yemarwadzo emutsipa uye kumashure kwakapararira, uchapupu hahuna kukodzera kutsigira tsika iyi. Kuongororwa muBrithani Medical Journal kunozivisa kuti opioid ndiyo ndiyo mishonga inowanzosarudzwa muUnited States.
Izvozvo zvakati, munyori wekudzokorora anotaura, maopioids haaratidzi kubatsira kubatsira vanhu kudzoka kuzoshanda chero ipi zvayo kupfuura imwe mhando yekurapa kwekurwadziwa shure, uye havavandudzi migumisiro yekutarisirwa kwepamusoro kunorwadza kwakanyanya.
Kana kurwadziwa kwako kumashure kusingaperi, opioid ingasakwanisa kukuitira chero zvachose. Munyori wekudzokorora akawana uchapupu hushoma hwokuti hunoshanda nekuda kwechinangwa ichi.
Pamwe nechinjodzi chekudhakwa, maopioids anouya nemamwe madambudziko anosanganisira kuvhiringidzika, kusagadzikana kwepabonde uye kuora mwoyo, kungotaura mazita mashoma.
Opioids inowanzoswededzwa pamakambani ekutsvaga anotsausa. Chimwe chinonzi opioid, OxyContin, chakaitwa se "nhamba yakachengeteka" nevamiriri vekambani mumushandirapamwe unobudirira wokudhinda. Asi vatungamiri vePurdue Pharma, vadzidzisi veOxyContin, vakazobvumirwa mumatare kuti izvo zviti zvaive zvenhema uye zvinotsausa.
COX-2 Inhibitors vs Opioids - Funga Usati Watora
Paunofunga kana unorayirwa mishonga inorwadza, funga nezvezvinetso zvose zvinogona kuitika kubva pakuzvitora. Iwe unogona kunge urikukuvadza chirwere chemwoyo kana kurohwa, kana kurarama nekudhakwa kwe (kazhinji kunodhura) mishonga inorwadza.
Yeuka, kazhinji kuchinja muviri wako kunogona kubatsira nekunzwa kurwadziwa, kudzokerazve kurasikirwa basa nekuvandudza hupenyu hwehupenyu. Vashoma vanoshanyirwa nechiremba wepanyama vangave zvose zvaunoda kuti uwane hupenyu hwako.
> Kwakabva:
> Deyo, R., et. al. Opioids for low back pain. Clinical Review. State of the Art Review. Jan 2015. http://www.bmj.com/content/350/bmj.g6380
> Nissen, S., et. al., Cardiovascular Safety yaCelecoxib. N Engl J Med. Nov 2016. http://www.jwatch.org/na42802/2016/11/14/cardiovascular-safety-celecoxib
> Pawlosky, N. Mwoyo wehutano Ndeipi NSAID dzose dzakafanana? Unogona here Pharm J. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676195/
Vioxx uye Cox-2 Inhibitors
Cox-2 inhibitors seVixx, Celebrex naBextra vane rudzi rweNSAID, kana kuti kwete-steroidal anti-inflammatory drugs. Izvo zvakagadzirwa muma1990 pakupindura migumisiro yeNSAIDS .
Nemhaka yokuti vari mumhuri imwe yemishonga, zvose Cox-2 inhibitors inofamba nenzira yakafanana nenzira yakafanana. Nokudaro, varwere vanotora Vioxx kana Bextra neCelebrex vanogona kunge vari pangozi yekurwadziwa kwemoyo.
Kunyange zvazvo vasiri Cox-2 inhibitors, dzimwe NSAID dzinokonzera njodzi dzinokonzerwa naMotrin, Naprosyn, Voltaren uye Mobic.
Opioids
Opioids inoshandiswa pakuenzanisa kunorwadza kwakanyanya. Mukuwedzera kumarwadzo asingadzoki shure, maopioid anowanikwawo mumamiriro ekurwadziwa kwekenza, kurwadziwa kwepfungwa uye mamwe mamiriro.
Opioids inorwadza zvakanyanya; morphine ndiyo muenzaniso unonyatsozivikanwa weopioid, kunyange zvazvo kune zvidimbu zvakasiyana-siyana zvichibva pakuita-unyoro kusvika kune simba. Mienzaniso inosanganisira OxyContin, codeine, Darvon uye Vicodin.
Opioids ine mimwe migumisiro yakaipa, kusanganisira kuvepo kwe:
- kupumha kuora mwoyo
- kuvimbiswa
- dambudziko rekuchengetedza uye kusvuta
Kunyanya kunetseka kweapioid semishonga inorwadza inogona kukanganisa uye kuvimba. Kutsvakurudza kunoratidza kuti OxyContin, kunyanya, i "gedhi" yekudhakwa kune mamwe madhiragi akaoma. Dzimwe nguva, varwere vangangorambwa mishonga nokuti zvinokurudzira hazvisi kunzwisiswa, uye zvinogona kuonekwa seyakakosha morphine (kana mamwe opioid) kuvhiringidzwa.
Mhedzisiro
Kana zvakanyatsogadziriswa , zvakanakira kutora opioid yekutambudzika zvakasimba kudarika zvinowanzobatana. Opioids inobatsira chaizvo kupora kurwadziwa. Uye vatsvakurudzi vazhinji, masangano anodzora mumishonga, uye vanachiremba vanofunga kuti opioids inofanirwa kuongorora kurapwa kwehupenyu husingaperi. Asi sekusarudzo ipi neipi yehutano, shanda nachiremba wako nevamwe vadzidzisi vehutano kuti vawane chakanakisisa iwe.
Kunobva:
Mibvunzo uye Mhinduro.FDA Zvigadziriswa Zvisarudzo zveCOC-2 Selective uye Zvisarudzo Zvisiri-Steroidal Anti-inflammatory drugs (NSAIDs). FDA. April 7, 2005.
Brasseur, L. Kudzokorora kwezvino ma pharmacologic kurapa marwadzo. Zvinodhaka. 1997.
Cicero, TJ, Inciardi, JA, Munoz, A. Maitiro ekudzvinyirirwa kweOxycontin nedzimwe mhirizhonga yeOpioid muUnited States 2002-2004 JPain Gumiguru 2005.
Grau, LE, Dasgupta, N., Harvey, AP, Irwin, K., Givens, A., Kinzley, ML, Heimer, R .. Kusashandiswa kweipioid: OxyContin "drug gate"? AmJ Murairo May-June 2007.