Verapamil mishonga yakasimba inoshandiswa kurapa chirwere chemwoyo. Nokuti inoderedza midziyo yeropa yemwoyo nemuviri zvose, ine mishonga yakawanda yemakiriniki. Asi kunze kwekushandiswa kwakawanda, mibare yako ye verapamil inofanira kunyatsoongororwa nokuti iyi mishonga inokonzera ngozi yehutachiona uye inogona kuva nemigumisiro yakaipisisa. Semuenzaniso, kuisa njodzi kwepiritsi imwe nemwana kunogona kuuraya.
Mechanism of Action
Verapamil i-calcium-channel blocker (anopikisa) iyo inoderedza kupinda kwe calcium ions kuburikidza neL-type calcium chiteshi chiri mumoyo masero uye masero masero anonyatsoshandiswa mumasipiramu epasi.
Verapamil ine zvakawanda physologic madhara:
- Vasodilation yezvose coronary (mwoyo) uye peripheral arteries and arterioles
- Kuderedza chibvumirano chemwoyo
- Kushungurudzika sinus node basa
- Yakaderedza atrioventricular node conduction
Pamusoro pemigumisiro yepamusoro, verapamil inopindirawo simba re metabolism remasikirini emwoyo, kuwedzera mwoyo kuvimba pamakinehydrates panzvimbo yekusunungura mafuta acids. Uyezve, verapamil inhibits pancreatic kubudisa insulin. Izvozvo zviviri zvinosvibisa zvinoshandiswa zvinonyanya kutaurwa mumamiriro ezvinhu ekutyisidzika apo muviri unoda goroidhadhi.
Metabolism
Verapamil inonyatsopindira kuburikidza nehutachiviri hwemimba uye inoparadzira zvakaperera mumuviri wose (90 muzana protein yakasungwa).
Pamusoro pokutanga-kudarika mastabilism, verapamil inoputsika nechiropa ichiita sechigadzirwa chemasabolite. Hafu yeupenyu hweVerapamil inenge maawa masere.
Clinical Uses
Nemhaka yemigumisiro yadzo pamwoyo nemuviri mhuka (ropa mudziyo), verapamil ine zvishandiswa zvakawanda. Heano mamwe emashoko anoshandiswa:
- Angina (yakasimba, isina kugadzikana uye Prinzmetal)
- Supraventricular tachycardia
- Raynaud's phenomenon
- Migraine prophylaxis
- Cluster headache prophylaxis
- Kuipa kana kukanganisa kuwedzera kwehutano
Verapamil ikirasi-IV inopesana nemishonga. Pasati vanachiremba vakashandisa verapamil kurapa arrhythmias, propranolol uye digoxin vaiwanzoshandiswa.
Migumisiro yakaipa uye Kubatana kweMishonga
Kunyange zvazvo zvisingawanzovi pasi pekuvhara kwepedyo kwechirwere chemapurisa, verapamil chepfu inogara iri kunetseka. Pamusoro pemigumisiro yaro yakaipa, verapamil inogonawo kusangana nemarudzi akawanda emishonga.
Kubudirira kunowanzoitika kwakanyanya kwerepamil kuvhara. Mune vamwe vanhu, verapamil inogona kukonzera utsi, kuchena-musoro, uye hypotension. Muzviitiko zvekudarika, verapamil inopindira rwiyo rwemoyo uye rinogona kutungamirira pakurasika kwehupenyu.
Heano zvimwe zvekushandisa kwezvinodhaka-zvinodhaka izvo verapamil inowedzera:
- Verapamil inoshandisa ne beta-blockers, nitrate uye diuretics yeropa yepamusoro inogona kuita kuti ropa rako rive pasi pangozi (hypotension).
- Verapamil inogona kuwedzera mhizha yemasimoni, iyo inoshandiswa kurapa high cholesterol, uye mitemo inogona kukonzera rhabdomyolysis kana kuputsika kwemisumbu inoputika neitsvo.
- Verapamil inoshandiswa nemagetsi e cytochrome P450 uye kushandiswa kwemishonga yemishonga yakafanana na amiodarone (imwe inorwarisa) inovhiringidza P450 inotungamirira kune chirwere chinosvibisa. Uyezve, mazai emuzambiringa anogadzirisawo p450 system uye inogona kuwedzera kuvhara ropa.
Ndapota ramba uchifunga kuti kana uchishandiswa sewakarondedzerwa uye nenzira yakachengeteka, verapamil inogona kubatsira zvikuru kune avo vanorida. Mashoko aya ari munyaya ino haafaniri kutyisidzira iwe kubva kushandisa verapamil paunorayirwa. Zvisinei, iwe unofanira kunyatsoteerera mazano ako emagetsi paunenge uchishandisa izvi, kana zvimwe, mishonga.
Kana iwe kana munhu waunoda ari kutora verapamil, zvakakosha kuti iwe uri kunyatsoongororwa nekugadza kwako chirwere chemapirini. Ita zvigadziro zvekuongorora nguva dzose pamwe nemudzidzisi wako uye iva nechokwadi chekuudza chiremba wako nezvekupi kuchinja kwemishonga yemishonga kusanganisira chero kushandiswa kwemishonga yemishonga.
Uyezve, kana iwe uchinzwa matambudziko anorwadza angangodaro anokonzerwa neshoko rakadai sokupera kana kupererwa kwenguva pfupi kwekuziva, kumbira rubatsiro rwekukurumidzira.
Sources:
Lynch, T uye Price, A. "Migumisiro yeCytochrome P450 Metabolism Pamishonga Yezvinodhaka, Kubatana, uye Kuipa Kwakaipa" American Family Physician. 2007.
Mosby's Drug Reference yeZviviro zveUtano, Rwechipiri . Elsevier. 2010.
Tomaszewski CA, Benowitz NL. Chitsauko 40. Calcium Channel Antagonists. Mu: Olson KR. eds. Kutyisa uye Kuwedzerwa Kwemishonga, 6e . New York, NY: McGraw-Hill; 2012.