Mubvunzo: Sei Ndingashandisa Methadone?
Methadone - haisi here kuti mishonga ye heroine inokanganisa?
Ndiyo mubvunzo wandakajaira kunzwa kubva kune vakomana nevarwere nemhuri apo ini ndichivaudza kuti chiremba wavo akaraira Methadone kuti awane marwadzo. Kunyange zvazvo ichokwadi kuti methadone inoshandiswa kurapa narcotic kurega zviratidzo, methadone inoshandawo mishonga inobatsira zvikuru kubata chirwere chinononoka.
Morphine akawana musoro weGold Standard yekudzivirira kurwadziwa , maopioid vamwe vose vanofananidzwa nekuda kwehutano hwavo, nyore nyore kwehutungamiri uye mari shoma. Kana morphine yakakura kwazvo, nei tingamboshandisa methadone?
Mhinduro:
Kana tichatanga kuenzanisa methadone ne morphine, tinofanira kutanga nemitemo yekutambudzika. Nhamo inogona kugoverwa kuva miviri miviri yekutsanangurwa kwepanyama: nociceptive uye neuropathic. Manzwiro echeciceptive anowanzokonzerwa nekukuvara kwepanyama (kurwadziwa kwepamusoro) kana kukuvadzwa kune nhengo dzomukati (kurwadziwa kwepisceral). Utano hwehutachiona hunokonzerwa nokukuvara kana kunyorera mitsipa mukati mehutano hwemagetsi kana muviri weropa.
Isu takakomborerwa neopiate receptors muhutano hwedu hunobvumira miviri yedu kuti ipindure pamarwadzo eopioid marwadzo. Ruzhinji rwezvikwata izvi zvinotarirwa mumu uye delta receptors uye mazana maduku ndeNMDA. Zvinorwadza zvinoshungurudza zvinonyanya kupindirana neve mu receptors uye marwadzo europathic ne delta uye NMDA receptors ; morphine inosunga kune mu receptors chete, apo methadone inosunga ku mu, delta uye NMDA.
Morphine anoita basa rakanaka kwazvo rokurapa marudzi mazhinji emarwadzo, asi nekuda kwekwanisiro yekusunga kune 100% yeopiate receptors, methadone inogona kuzviita zviri nani.
Opiate Toxicity uye Side Side Effects
Zviputi, zvakadai se morphine, inobereka metabolite kana ichinge yaputswa mukati memuviri. Iyi metabolite inogona kuvaka mumuviri uye inokonzera zviratidzo zve opiate chepfu.
Opiate toxicity inonyanya kudarika yeopiate inotungamirira kuhuwandu hwehupombwe mumuviri uye inokonzera zviratidzo zvakadai sokusazorora, kukanganisa, kudengenyeka uye kunetseka.
Methadone haina kubereka metabolites uye saka haina "denga," kana kuti inosvika mazamu. Methadone inowedzerawo kushandiswa kwechiropa nechiropa, uye kusakwanisa kwayo kwemasabolites kunoita kuti uve sarudzo yakanakisisa yemishonga inorwadza kuvarwere vakawanda vane kuora kwechiropa basa kana kukanganisa kwenhema.
Matambudziko anowanzoitwa maopiates anosanganisira kuvhiringidzika, kushungurudza uye kurutsira, kurara, kuchenesa, kuvhiringidzika uye kuora mwoyo kufema (kunetseka kufema). Varwere vakawanda vakataura kuti kuderera kwezvinhu zvinotambudza mushure mekushandura methadone kubva kune imwe opiate.
Zvimwe Zvipo zveMethadone
Saka methadone inoshanda kupfuura morphine pakurapa marwadzo uye zvinowanzokonzera migumisiro shoma shoma, asi mashoko akanaka haagumi ipapo. Imwe rubatsiro ye methadone ndiyo yakawedzerwa hafu yeupenyu. Hafu yeupenyu ndiyo nguva inotarisirwa kuti hafu yehuwandu hwemishonga inogona kushandiswa kana kushandiswa nehutano hwehupenyu. Nemhaka yeiyo yakawedzerwa hafu yehupenyu, methadone inobata marwadzo-kutapudza kwemaawa 8 kusvika ku10, asi nguva dzose kusunungurwa kusunungurwa morphine kunongoderedza marwadzo kwemaawa maviri kusvika mana.
Izvi zvinoshandura kuva kuderera kashoma kune murwere, kazhinji kaviri kana katatu pazuva.
Uye pakupedzisira, asi kwete zvishoma, methadone inodhura zvikuru. Mwedzi unowanikwa we methadone unodhura madhora 8, nepo morphine inowanzobhadhara $ 100. Mamwe maopiate, akadai seOxycontin naFentanyl, achatora zvakanyanya.
Zvipingamupinyi zvekushandisa Methadone
Ndine here iwe wakagutsikana kuti methadone inobatsira zvikuru kurapa ? Kana zvakadaro, unogona kuzviwana uchishamisika kuti nei usingashandisi kakawanda. Ndakabvunza mubvunzo iwoyo kune vanoverengeka vanachiremba, uye ndakaona kuti kunze kwekunyadziswa kwakaitwa methadone, vanachiremba vazhinji vanongova vakasununguka kuzvinyora.
Nemhaka yemethadone yakapetwa hafu yehupenyu, inowedzera zvishoma mumutumbi uye inogona kutora mazuva mashanu kusvika kune manomwe kuitira maitiro ekugadzikana. Munguva ino, murwere anoda kuongororwa zvakanyanya nezviratidzo zvehutu. Izvi hazvirevi dambudziko kune varwere vane hutano hwekuchengeta kana kutarisira , nokuti ivo vari kutotamiswa pamwe chete uye kazhinji vanokwanisa kuwana vanamukoti uye vanachiremba masikati nemaawa. Hofisi yechiremba chaiye haina simba rekucherechedza varwere vari pedyo, izvo zvingava chikamu chekuzeza kwavo kuitaura.
Zvimwe zvipingamupinyi zvikoro zvechiremba uye kusagadzikana kwevarwere. Methadone ichiri kuzivikanwa zvikuru sechirwere chemishonga inodhaka. Iko kushorwa kunononoka kubviswa apo vanachiremba vachipfuurira kudzidzisa vezera ravo pamigumisiro yaro uye vanhu vanowanzoona varwere vakawanda vachiwana zororo nemhaka yaro.
Sources:
Ayonrinde OT, Bridge DT. Kuwanazve kwemethadone kwekurwadziwa kwekenza. Med J Aust 2000; 173: 536-40.
Davis MP, Walsh D. Methadone nokuda kwekununurwa kwehutano hwekenza: kuongororwa kwe pharmacokinetics, pharmacodynamics, kushandiswa kwezvinodhaka uye zvigadzirwa zvehutungamiri. Kutsigira Care Care Cancer 2001; 9: 73-83.
Toobs JD, Kral, LA. Methadone Kuchirwa Kwemarwadzo Ekutambudzika. Ndiye Chiremba weNzara 2005; 71: 1353-8.