Is buprenorphine mune ramangwana rekusingaperi rinorwadza here?
Pamusoro pemaonero anokosha, dambudziko reopioid uye kurwadziwa kusingaperi kunopesana zvakananga. Kunyange zvazvo CDC inotaura kuti "uchapupu huripo kwenguva refu hupioid therapy yehutano husingagumi kunze kwekupedzisira kwekuchengetedza hupenyu hunoramba huripo, uine huwandu hwehupupuriro hwokuti uone hupfumi hunopesana nehupi hupi hupioid therapy," chokwadi chinoramba chiripo kuti opioids ndiyo kupindira kukuru kwekurapa kusarwa kusingaperi.
Kunyange zvazvo vatarisi vekutarisira vanhu vakuru vanogona kupa maoooid yekutambudzika kusingaperi, havadi kuita izvi nokuda kwekutya kuderedza mwoyo kana kuvimba. Vanazhinji vanachiremba vokutanga vanoona tarisiro yekupa varwere opioid kwenguva yakareba zvakare inonetsa uye nokukurumidzira vanotumira varwere ivavo kunyanzvi dzematambudziko.
Pasinei nekusava nehanya nekuchibata, kurwadziwa kusingaperi kunowedzera kuwedzera. Muna 2010, 31 muzana yeAmerica vakaona kurwadziwa kusingaperi, uko kunotsanangurwa sehutwa hunopedza makore anopfuura matatu kusvika matanhatu. Nemhaka yekuti huzhinji hwevanhu vane marwadzo asingagumi anowanikwa kune vanachiremba vekuchengetedza, zvinenge zvichibudirira kana tine nzira yakachengeteka uye inobudirira kune opioid-mamwe mishonga ayo vanachiremba vanozonzwa vakasununguka kurondedzera. Imwe mishonga inonzi buprenorphine inogona rimwe zuva kubatsirana nemutemo uyu.
Chii Chinonzi Buprenorphine?
Buprenorphine ndeyekirasi yemishonga inonzi opioid partial agonist-antagonists.
Mukuwedzera pane imwe mishonga inobatanidza buprenorphine uye naloxone (Suboxone), buprenorphine inoshandiswa seanpioid substitution therapy kurapa kuvimba kweopioid (kuvimba ne heroin kana kuti narcotics yemishonga). Iyi mishonga inoshanda nekudzivirira zviratidzo zvekudzoka kana munhu anodarika opioid anorega kutora opioid.
Buprenorphine inonzi semisynthetic opioid derivative ye opium alkaloid thebaine, inowanika mu opium poppy ( Papaver somniferum ). Zvakatora makumi emakore kuti vatsvakurudzi vashandise mushonga uyu, uye kune vakawanda vakundikana kuedza kusati kwaitika kambani yeChirungu yemishonga yakagadzira muna 1966. Pakazosvika 1978, kuumbwa kwakasimba kwebuprenorphine kwakatangwa, kuteverwa neshanduro dzinyorwa (dzinoshandiswa pasi pemutauro) iteration muna 1982. Muna 1985, buprenorphine yakaunzwa muUnited States seanopiyoid analgesic.
Iyo Inoshanda Sei
Buprenorphine ine nzira dzakananga dzekuita dzinoita kuti zvive zvisingakanganisi kwete chete kubata kurapa kweopioid asi zvichida kurwadziwa kusingaperi, zvakare.
Kutanga, buprenorphine ine hukama hwepamusoro huri pakati pe μ-opioid receptor, iyo inokonzera kuponeswa kunorwadza. Uyezve, buprenorphine ine purogiramu inononoka yokuparadzanisa kubva mu-μ-opioid receptor, zvinoreva kuti inoramba yakabatanidzwa kwenguva yakareba kune yakagamuchirwa, uye yakaramba ichiita.
Chechipiri, kunyange zvazvo buprenorphine inofarira i-μ-opioid receptor chaizvo, inoshanda sechinhu chinokonzera μ-opioid receptor agonist, zvinoreva kuti kunyange buprenorphine ichidzivirira kubvisa opioid, zviito zvayo hazvina simba kupfuura opioid.
Chechitatu, buprenorphine inokwana κ-opioid receptor antagonist.
Kushandurwa kwe-κ-opioid receptor kunoguma muhuputi hweputi uye hwepfungwa dzeopioid. Mune mamwe mazwi, buprenorphine haingakuiti "yakakwirira."
Administration
Sezvambotaurwa, iyoxone inowanzobatanidzwa ne buprenorphine muchimiro cheSuboxone. Naloxone isha-acting, opioid receptor anopikisana. Kana yakabatanidzwa mumadhekai akakwana ane buprenorphine, naloxone inogona kukonzera ngozi ine opioid migumisiro-kusanganisira kuora mwoyo, kudengenyeka, uye hypotension-pasina kuderedza marwadzo, kana kupora kurwadziwa. Uyezve, kuwedzerwa kwaivaxone ku buprenorphine kunoshandiswa sechidzivisa kushandisa zvinodhaka.
Maererano neNIH:
Buprenorphine inouya sehwendefa rinonyora pasi. Kubatanidzwa kwebuprenorphine uye naloxone kunouya sehwendefa rinonyanya kushandiswa (Zubsolv) uye sefirimu inonyanya kushandiswa (Suboxone) kutora pasi pemirimi uye se buccal [cheek] film (Bunavail) kushandisa pakati pegamu nematama.
Buprenorphine inouyawo mune transdermal patch, kuumbwa kwakanyanyisa, uye, munguva pfupi yapfuura, shanduro yemitauro yakawanda. Muna December 2017, yakaziviswa kuti FDA yaive ichiongorora zvitsva zvinyorwa zvinoshandiswa pakurapa kurwadziwa kwakanyanya.
Migumisiro Yechiri
Kunyange zvazvo zvisingasviki seypioid, zvose buprenorphine uye Suboxone zvinogona kuva nemigumisiro yakaipa kusanganisira zvinotevera:
- Kutambudzika shure
- Chiratidzo chakasvibiswa
- Constipation
- Dambudziko nehope
- Mouth numbness
- Headache
- Dumbu remarwadzo
- Mutauro unorwadza
Mamwe matambudziko makuru, zvakadai sekutambudzika kufema kana kuvhara muromo kana rurimi, zvinoda kurapwa nokukurumidza. Zvakakosha, kusanganisa buprenorphine nedzimwe mishonga se benzodiazepines zvinogona kuuraya.
Buprenorphine for Chronic Pain
Mukuongorora kwakarongeka kwakabudiswa munaDisemba 2017, Aiyer uye vanyori vanyori vakaongorora kubatsira kwebuprenorphine kune vatungamiri vemarwadzo asingagumi. Vatsvakurudzi vakatsvaga 25 miedzo yakarongedzwa yakawanda inosanganisira zvishanu buprenorphine formulation:
- Intravenous buprenorphine
- Sublingual buprenorphine
- Sublingual buprenorphine / naloxone (Suboxone)
- Buccal buprenorphine
- Transdermal buprenorphine
Kakawanda, vatsvakurudzi vakawana kuti zvidzidzo zve14 kubva pa25 zvakaratidza kuti buprenorphine mune zvinyorwa zvose zvaibatsira pakurapa kusarwa kusingaperi. Kunyanya zvakanyanya, zvidzidzo 10 kubva ku15 zvakaratidza kuti transdermal buprenorphine yakanga iri kubudirira, uye zvikamu zviviri zvezvitatu zvakaratidza kuti buccal buprenorphine yaive yakashanda. Chimwe chete chezvidzidzo zvitanhatu zvakaratidza kuti zvinyorwa zvisinganzwisisiki kana intravenous buprenorphine zvaibatsira pakurapa marwadzo asingagumi. Zvinonyanya kukosha, hapana migumisiro yakakomba yakaipisisa yakataurwa mune imwe yezvidzidzo, izvo zvinoratidza kuti buprenorphine yakachengeteka.
Muna 2014, Cote uye vanyori vanyori vakabudisa kurongeka kwakarongeka kuongorora kushanda kwebumbiro rekunyora buprenorphine pakurapa kurwadziwa kusingaperi. Kunyange zvazvo huwandu hwezvidzidzo dzavakaongorora dzaive hunocherechedza uye hwakaderera, vatsvakurudzi vakawana kuti mabhuku ekunyora buprenorphine aibudirira mukurapa kurwadziwa kusingaperi. Zvinonzwisisika, Cote uye vanyori vanyori vakanyora urongwa hunotevera hwezvinobatsira zvebuprenorphine:
- Kuwedzera kwekuita muhutano hweuropathy nemhaka yehuwandu hwehuwandu hwemasvomhu.
- Kusununguka kwekushandisa kune vakwegura uye muhutachiona husina maturo nekuda kwehuwandu hwehupenyu hwehafu yeupenyu uye metabolites.
- Kusapindira kwekuzvidzivirira kwepamusoro kufananidzwa ne morphine uye fentanyl zvichienderana nehuwandu hwehuwandu hunobva kune zvakananga uye chipatara.
- Kuchengetedza kwepfungwa yekufema kunetseka kana kushandiswa pasina imwe nheyo yenheyo yezvinokonzera kushungurudzika, zvichida nokuti basa rekutanga rekubudisa anorgesia rinogona kuva rakaderera kupfuura iro rekupera mweya.
- Zvishoma zvishoma ku hypogonadism, sezvakaratidzwa mune chirongwa chekuchengetedza.
- Pashoma kukura kwekushivirira, zvichida kuburikidza nekupikisana kwep kappa kana opioid-receptor-like (ORL-1) agonism.
- Antihyperalgesic effect, zvichida nemhaka yekupikisa kappa kana kuti ORL-1 agonism.
- Kuora mwoyo kunokonzerwa nevarwere vasingateereri kurwara.
Zvinofadza, inofungidzirwa kuti nekuda kwekuvhara kwayo, buprenorphine inogona kukwanisa kubatsira vanhu vane maopioid-induced hyperalgesia.
Mune imwe nyaya inonzi "Kuongorora kwakakwana kweapioid-induced hyperalgesia," Lee uye vanyori-vanyori maopioid-induced hyperlagesia sezvinotevera:
Opioid-induced hyperalgesia (OIH) inotsanangurwa sehutano hwekudzivirira hutachiona hunokonzerwa nekuonekwa kune opioid. Mamiriro acho akaonekwa nehutano hunoita apo murwere anogamuchira opioid yekurapa marwadzo angangodaro anowedzera kunetseka kune zvimwe zvinorwadza zvinokuvadza. Mhando yekutambudzika inowanikwa inogona kunge yakangofanana nekurwadziwa kwepasi kana kuti inogona kusiyanisa neyopakutanga kunorwadza. OIH inoratidzika kunge yakasiyana, inogadziriswa, uye inoyevedza inogona kutsanangura kurasikirwa kweapioid efficacy mune vamwe varwere.
Nemaziso, kurwadziwa kwepascpp is the painful sharpness resulting from damaging to the body part. Zvinotendesa kuti buprenorphine ine antinociceptive properties.
Muchikamu che2014 chakabudiswa muAnesthesiology , Chen uye vanyori vanyori vanyora zvinotevera:
Buprenorphine yakaratidzwa kuti inodzokorora hyperalgesia inokonzerwa neopioid kuburikidza ne 'buprenorphine-induced antinociception.' Uyezve, buprenorphine inopikisa κ-receptor uye inogona kukwikwidza nemigumisiro yepinal dynorphin, inogumira κ-receptor agonist. Nemhaka yokuti spinal dynorphin inowedzera mushure mekuonekwa kweopioid uye inobatsira kuOIH, kukwikwidzana kunoitwa buprenorphine panzvimbo ye-κ-receptor kusungira kunogona kuderedza kusvibiswa kwepinal dynorphin zvichiita kuti inopera OIH.
Kunyora Buprenorphine
Kusvikira zvishoma, muUnited States, buprenorphine inenge isati yashandiswa kurapa kurwadziwa kusingaperi. Suboxone inorayirwa kure-label kune mishonga yekurwadziwa kusingaperi. Uyezve, transdermal buprenorphine patch inowanikwa pakurapa kurwadziwa kwakanyanya kuUnited States.
Zvisinei, hapana maonero ekubvumirana pamusoro pekubudirira kwekushandisa buprenorphine nokuda kwechinangwa ichi. Pari zvino, zvidzidzo zvishomanana kuongorora kuitika kwebuprenorphine pane kurwadziwa kusingaperi zvakasiyana zvikuru munzira dzavo, uye saka zvakaoma kuenzanisa.
Pamberi pemutemo we buprenorphine yekurapa marwadzo asingagumi unova chiito chekuita-uchapupu, nyaya dzakasiyana-siyana dzinoda kugadziriswa. Semuenzaniso, zvidzidzo zvemazuva ano zvinoshandisa maitiro akasiyana-siyana ekurwadziwa paanoongorora kushanda nekudaro kugovera kusanzwisiswa kuongororwa. Pain scale scales muongororo yekuongorora buprenorphine yaizofanira kuenzaniswa. Uyezve, kugadzirisa maitiro uye nzira yehutungamiri yaizofanira kuongororwa nenzira dzakasiyana-siyana dzekutambudzika kusingaperi.
Kana mishonga ye buprenorphine yekutambudzika kusingaperi yakambove yakava uchapupu-yakagadziriswa, vanachiremba vekuchengetedza kwepamusoro vaizogadziriswa kuti vaite basa iri. Muna 2000, US Drug Addiction Treatment Act yakaita kuti zvive zvepamutemo kune vanachiremba vekuchengetedza vana kuti vape chirwere chekupikira maopioid vachishandisa Schedule III, IV, uye V zvinodhaka. Muna 2002, FDA yakabvumira kurapwa kwevarwere ne buprenorphine, ichifananidza seHurumende III zvinodhaka.
Zvose izvo chiremba mukuru wekuchengetedza unofanirwa kuita kuti akwanise kuronga buprenorphine mumugariro wevarwere kunze kwekupedzisa maawa masere ekudzidzisa. Kunyange zvakadaro, vashomanana ndivo vanoita basa rekuchengeta vanove vakakodzera kugovera buprenorphine.
Kunyange zvazvo vanachiremba vakawanda vekuchengetedza kwepamusoro vangangodaro vachinetseka pane zvinoratidzwa, hazvirevi kuti zvakakura zvekufungidzira kuti vanachiremba vanonyanya kutarisira rimwe zuva vanobata marwadzo asingagumi mukurapa kwekunze kushandisa buprenorphine. Mukuwedzera kune vekuchirapa vanachiremba vane simba rekupa buprenorphine, CDC inewo mirayiridzo munzvimbo yekurapa vanachiremba kuti vararame kurwadziwa kwenguva refu neopioid.
Zvinonyanya kukosha, maCDC anorayira kuti vanachiremba vanonyanya kutarisira vanoronga maopioids ekurwadziwa kusingaperi apo apo maitiro asina opioid haakwanisi, uye kupa maopioids pamutengo wakaderera zvikuru unogona. Muchirevo ichi, buprenorphine inogona kuonekwa seypioid alternative.
> Sources:
> Aiyer R, et al. Kurapa Kwemarwadzo Akashata Nezvipembenene Buprenorphine Formulations: Ongororo Yakarongeka yeKliniki Dzidzo. Anesthesia & Analgesia. 2017. [epub mberi kwekunyora]
> Chen KY, Chen L, Mao J. Buprenorphine-Naloxone Therapy muPauin Management. Anesthesiology. 2014; 120 (5): 1262-74.
> Cote J, Montgomery L. Sublingual Buprenorphine seAntgesic in Chronic Chronic Pain: A Reviewatic Review. Pain Medicine. 2014; 15: 1171-1178.
> Dowell D, Haegerich TM, Chou R. CDC Guideline yekutsanangura maOpioid for Chronic Pain - United States, 2016. MMWR. 2016; 65 (1): 1-49.
> Lee M, et al. Kuongorora Kwakakwana kweOpioid-Inonzi Hyperalgesia. Pain Physician. 2011; 14 (2): 145-61.