Majekeseni a Methylene Blue ndi Kulowetsa Mankhwala Kudzera Mumtsempha (IV)

Mabotolo awiri ang'onoang'ono okhala ndi madzi abuluu kwambiri angamaoneke ofanana akakhala patebulo. Ena ndi mankhwala a jakisoni opanda tizilombo toyambitsa matenda, opangidwa kuti alowetsedwe m'mitsempha. Enawo ndi mankhwala a m'botolo la chogwetsera madontho oti amwedwe, utoto wogwiritsidwa ntchito m'labotale, kapena chinthu chogwiritsidwa ntchito m'thanki la nsomba chomwe sichiyenera kulowetsedwa mumtsempha konse. Mtundu wake sukukuuzani chilichonse. Kapangidwe kake kamakuuzani zonse.

Iyi ndiyo mfundo yaikulu ya nkhaniyi: kudziwa kuti chinthu ndi mankhwala otani sikufanana ndi kudziwa kuti n'choyenera kubayidwa. Chosakaniza chamadzimadzi chingakhale ndi methylene blue yeniyeni yoyera kwambiri pa mayeso a mankhwala koma n'kukhalabe chosayenera kubayidwa, chifukwa majekeseni ayeneranso kukhala opanda tizilombo toyambitsa matenda, kukhala ndi poizoni wa mabakiteriya wochepa, kukhala ndi tinthu tochepa molingana ndi miyezo, ndiponso kuikidwa m'chotengera choyenera. Mukakumbukira kusiyana kumeneku, mfundo zina zonse za m'bukuli zimakhala zomveka.

Jakisoni wovomerezeka wopanda tizilombo toyambitsa matenda

Mankhwala omwe amagwiritsidwa ntchito ngati chitsanzo choyerekezera ndi ProvayBlue, jakisoni wa methylene blue woperekedwa ndi chilolezo cha dokotala, wovomerezeka pochiza methemoglobinemia yosakhala yobadwa nayo mwa akuluakulu ndi ana. Kuchuluka kwa mankhwala ake ndi 5 mg/mL (0.5%), kotchulidwa potengera methylene blue trihydrate, ndipo amagulitsidwa ngati 10 mg m'madzi a 2 mL ndi 50 mg m'madzi a 10 mL m'maampulu kapena m'mabotolo ang'onoang'ono a mlingo umodzi. Chinthu chokhacho chosagwira ntchito ngati mankhwala ndi Madzi Opangira Majekeseni, ndipo pH ya chosakanizacho ndi 3.0 mpaka 4.5, monga momwe lebulo laposachedwa la ProvayBlue pa DailyMed likufotokozera.

Panopa pali mankhwala angapo ofanana nawo opanda dzina lapadera la kampani omwe amatengera mankhwalawa, choncho ProvayBlue ndi dzina la mtundu wa mankhwala, osati jakisoni yekhayo wovomerezeka. Chenjezo limodzi: kungokhala ndi tsamba la mankhwala pa DailyMed sikutsimikizira pakokha kuti FDA yawavomereza. Pali jakisoni wa methylene blue wa 1% amene amagulitsidwa ndipo lebulo lake limanena kuti FDA sinatsimikize kuti ndi wotetezeka komanso wothandiza. Fufuzani ngati mankhwalawo ndi ovomerezeka, komanso ngati pali mawu osonyeza kuti ndi opanda tizilombo toyambitsa matenda ndiponso a mlingo umodzi, m'malo mongoganiza kuti botolo lililonse labuluu n'loyenera.

Mlingo wotchulidwa pa lebulo lovomerezeka uli ndi malire omveka. Akuluakulu ndi ana amapatsidwa 1 mg/kg kudzera mumtsempha kwa mphindi 5 mpaka 30, zomwe zikufanana ndi 0.2 mL/kg ya chosakaniza cha 5 mg/mL. Ngati methemoglobin ikadali yoposa 30% kapena zizindikiro zikupitirirabe, mlingo wina umodzi wa 1 mg/kg ungaperekedwe patadutsa ola limodzi. Ngati milingo iwiri siyathetsa vutolo, lebulo limalangiza njira zina zochizira m'malo mopereka methylene blue yowonjezera. Odwala omwe impso zawo zikugwira ntchito movutikira pang'ono mpaka kwambiri amapatsidwa mlingo umodzi wokha wa 1 mg/kg, chifukwa kuchuluka kwa mankhwala omwe thupi limakumana nawo kumakwera kwambiri pamene ntchito ya impso ikuchepa.

Kaperekedwe kake kalinso ndi malamulo ake. Mankhwalawa ndi oti alowetsedwe kudzera mumtsempha wokha ndipo sayenera kubayidwa pansi pa khungu. Chosakanizacho chili ndi zinthu zosungunuka zochepa poyerekeza ndi madzi a m'thupi, choncho chingachepetsedwe mphamvu posakanizidwa ndi 50 mL ya dextrose wa 5% kuti kuchepetse kupweteka pamalo omwe chikulowetsedwa, makamaka mwa ana, ndipo chosakaniza chochepetsedwa mphamvu chiyenera kugwiritsidwa ntchito nthawi yomweyo. Sichiyenera kuchepetsedwa mphamvu ndi zosakaniza za sodium chloride, chifukwa chloride imachepetsa kuthekera kwa methylene blue kusungunuka. Yang'anani chotengera chilichonse, gwiritsani ntchito zomwe zili mu ampulu kapena botolo la mlingo umodzi kamodzi kokha, ndipo tayani zotsalazo. Zisungidwe pa kutentha kwa m'chipinda, zotetezedwa ku kuwala, osaziika m'firiji kapena kuziziritsa mpaka kuundana.

Owerenga amene akufuna kudziwa zimene molekyuluyi imachita ikafika m'magazi angayambe ndi mmene methylene blue imagwirira ntchito m'thupi, yomwe imafotokoza ntchito ya mankhwalawa padera ndi mafunso a kapangidwe kake omwe akufotokozedwa pano.

Kulowetsa mankhwala pa ntchito zosatchulidwa pa lebulo kumagwiritsa ntchito molekyulu yomweyo pansi pa malamulo osiyana

Kupatula methemoglobinemia, nthawi zina akatswiri a zachipatala amapereka methylene blue kudzera mumtsempha pa mavuto monga vasoplegia pambuyo pa opaleshoni ya mtima kapena shoko yobwera chifukwa cha matenda aakulu oyambitsidwa ndi tizilombo, pomwe zotsatira zake pa kukhwinyata kwa mitsempha zikufufuzidwa. Njira zimenezi nthawi zambiri zimagwiritsa ntchito milingo yosiyana, kulowetsa mankhwala mosalekeza, kapena kuwapereka mobwerezabwereza, zomwe sizikugwirizana ndi dongosolo lovomerezeka la milingo iwiri. Izi zimapangitsa kuti zikhale ntchito zosatchulidwa pa lebulo: mankhwalawo angakhale jakisoni wovomerezeka, koma dongosolo lowapereka silili lovomerezeka ndi FDA. Umboni woyambirira wa mayesero okhudza vasoplegia ndi shoko yobwera chifukwa cha matenda aakulu oyambitsidwa ndi tizilombo ukusonyeza chifukwa chake ofufuza ali ndi chidwi, komanso chifukwa chake milingo ikufufuzidwabe m'malo mokhala yokhazikika.

Mankhwala okonzedwa posakaniza zinthu kuti alowetsedwe mumtsempha amawonjezera kusiyana kwina. Mankhwala okonzedwa motere angasiyane pa kuchuluka kwa mankhwala m'chosakaniza chomaliza, madzi ochepetsera mphamvu, chotengera, zinthu zina zowonjezera, ndi nthawi yomaliza yomwe angagwiritsidwe ntchito. Ndipo mankhwala okonzedwa posakaniza zinthu, monga gulu, savomerezedwa ndi FDA pa chitetezo kapena kuthandiza kwake, monga momwe FDA ikufotokozera mu mafunso ndi mayankho okhudza kukonza mankhwala posakaniza zinthu. Kaya syringe ili ndi mankhwala a dzina lapadera la kampani, opanda dzina lapadera, kapena okonzedwa posakaniza zinthu, molekyuluyi ili ndi zoopsa zomwezo zotchulidwa pa lebulo lovomerezeka, kuphatikizapo kugwirizana kwake ndi mankhwala okhudza serotonin, chiopsezo cha kuwonongeka kwa maselo ofiira a magazi, ndi kukhudzidwa ndi kuwala, zomwe zigawo zotsatirazi zikufotokoza.

Chifukwa chake mulingo wa khalidwe wokha supangitsa madzi kukhala oyenera kubayidwa

Apa ndi pamene chisokonezo chambiri chimachitika. Chosakaniza chamadzimadzi chogulitsidwa m'masitolo chingalengezedwe kuti chili ndi methylene blue wa mulingo wa USP, kusonyeza zotsatira za mayeso zoposa 98%, ndipo n'kukhalabe chosayenera kubayidwa. Mulingo wa khalidwe la mankhwala umafotokoza ufa wake: kuzindikira mankhwalawo, kuyeza kuchuluka kwake, zonyansa za zinthu za organic, zotsalira za zosungunulira, zitsulo, ndi mayeso ena ofanana. Jakisoni ayenera kudutsa mayeso amenewo komanso kukwaniritsa zofunikira zina za mankhwala olowetsedwa m'thupi osadutsa m'mimba, zomwe mulingo wa khalidwe wokha sufotokoza.

Mzere uliwonse umalepheretsa vuto losiyana. Madzi omwe ali ndi tizilombo angayambitse matenda m'magazi. Poizoni wa mabakiteriya akufa amakhalabe ngakhale atasefedwa mwachisawawa ndipo angayambitse kutentha kwambiri kwa thupi kapena shoko. Tinthu ndi zinthu zotuluka m'chosakaniza n'kukhala zolimba zingakakamire m'mitsempha yaing'ono. Chotengera chosayenera chingatulutse zinthu zake kulowa m'mankhwalawo kapena kulephera kukhala chotsekedwa bwino. Palibe chimodzi mwa zolakwikazi chomwe chimasintha mtundu wabuluu kapena nambala ya zotsatira za mayeso, ndipo ndicho chifukwa chake kungoyang'ana ndi maso kapena kuona peresenti ya kuyera sikungatsimikizire kuti mankhwala ndi oyenera kulowetsedwa m'mitsempha. Kuti muone zonse zomwe mayeso athunthu a kuyera amaphatikiza, onani mmene mulingo wa USP umatsimikizidwira.

Lamulo logwiritsira ntchito ndi lalifupi: musabaye methylene blue wopangidwa kuti agwiritsidwe ntchito m'kamwa, m'thanki la nsomba, kapena m'labotale, kaya kuyera kwake kotchulidwa ndi kotani. Kubaya kumafuna mankhwala opangidwa, oyesedwa, olembedwa pa lebulo, ndi kulamulidwa ndi dokotala kuti agwiritsidwe ntchito ngati jakisoni.

Mfundo za chitetezo zochokera pa lebulo lovomerezeka

Lebulo lovomerezeka limasonkhanitsa zoopsa zofunika kuzidziwa musanagwiritse ntchito mankhwalawa kudzera mumtsempha. Yoyamba ndi vuto la serotonin syndrome, lomwe lili ndi chenjezo lalikulu loikidwa m'bokosi: methylene blue imalepheretsa ntchito ya monoamine oxidase, choncho kuiphatikiza ndi mankhwala ochepetsa kukhumudwa omwe amakhudza serotonin, mankhwala ena a opioid, ndi mankhwala ogwirizana nawo kungayambitse vuto lalikulu kapena lakupha. Odwala amauzidwa kupewa mankhwala amenewa kwa maola 72 pambuyo pa mlingo womaliza, pokhapokha katswiri wa zachipatala ataona kuti kuwapereka limodzi sikungapeweke ndipo akuyang'anira wodwalayo mosamalitsa.

Yachiwiri ndi kusowa kwa glucose-6-phosphate dehydrogenase, komwe ndi chifukwa choletsa kugwiritsa ntchito mankhwalawa: odwala omwe ali ndi vutoli ali pachiwopsezo chachikulu cha kuwonongeka kwa maselo ofiira a magazi, ndipo mankhwalawo sangagwire ntchito chifukwa ntchito yake imadalira njira ya ma enzyme yomwe odwalawa alibe. Kusagwirizana kwambiri kwa thupi ndi methylene blue kapena utoto wina wa thiazine ndi chifukwa china choletsa kugwiritsa ntchito mankhwalawa.

Machenjezo enanso akuphatikiza kuvutika kwa ntchito ya impso komwe kumachulukitsa mankhwala omwe thupi lonse limakumana nawo, kuvulazidwa kwa mwana wosabadwa ngati mankhwalawo afika m'madzi omuzungulira m'chiberekero, komanso mndandanda wa zinthu zoyang'anira ana obadwa nthawi yake omwe anakumana ndi mankhwalawo. Palinso malipoti a kuvulazidwa koyambitsidwa ndi kuwala komwe kumafuna kutetezedwa ku kuwala. Zinthu ziwiri zachilendo poyang'anira odwala n'zofunika m'zipatala: mtundu wabuluu umapangitsa chipangizo choyezera mpweya wa okosijeni pogwiritsa ntchito kugunda kwa mtima kusonyeza manambala otsika molakwika, choncho kuyeza magazi a mumtsempha wonyamula magazi kuchokera kumtima n'kumene kumakondedwa; komanso ukhoza kusokoneza zida zoyang'anira kuya kwa kugonetsa ndi mankhwala ndi mayeso a mkodzo ogwiritsa ntchito utoto wabuluu. M'magulu a zidziwitso za chitetezo za odwala akuluakulu 31, mavuto aakulu anachitika mwa pafupifupi 3%, ndipo mavuto omwe anaoneka mwa osachepera 2% anaphatikiza mutu, nseru, kutsegula m'mimba, kuchepa kwa potaziyamu ndi maginiziyamu, kugwedezeka mwadzidzidzi kwa minofu, ndi zochitika zofanana ndi khunyu.

Palibe mwa zimenezi chomwe chili mkangano wovomereza kapena wotsutsa dongosolo lililonse logwiritsa ntchito mankhwalawa pa ntchito zosatchulidwa pa lebulo. Ndi chikumbutso chakuti zoopsa zimatsagana ndi molekyuluyi, kaya thumba lolowetsera mankhwalawo likuti chiyani.

Zoyenera kutsimikizira musanagwiritse ntchito kudzera mumtsempha (IV)

Ngati ndinu wodwala kapena wosamalira wodwala, tsimikizirani zinthu zinayi ndi gulu lopereka chithandizo: kuti mankhwalawo ndi jakisoni wopanda tizilombo toyambitsa matenda, wovomerezeka kapena wokonzedwa posakaniza zinthu kuti agwiritsidwe ntchito kudzera mumtsempha; kuti vuto lomwe akuchiza ndi mlingo zikutsatira dongosolo losankhidwa mosamala; kuti mankhwala okhudza serotonin ndi mkhalidwe wa G6PD zinawunikidwa; ndi kuti kuyang'anira kukuphatikiza kuyeza okosijeni kudzera m'mayeso a magazi m'malo mongodalira chipangizo choyezera okosijeni pogwiritsa ntchito kugunda kwa mtima chokha. Ngati wina akupereka lingaliro lobaya chosakaniza cha m'botolo la chogwetsera madontho chogulitsidwa m'masitolo kapena cha m'labotale, onani zimenezo ngati chifukwa choyimitsa nthawi yomweyo ndipo funsani gawo la mankhwala la chipatala m'malo mwake.

Kapangidwe ka mankhwala ndiyo mfundo yaikulu, ndipo lebulo ndilo mgwirizano. Gwirizanitsani madziwo ndi njira yoyenera yowaperekera, ndipo mtundu wabuluu sudzakhalanso gwero la chisokonezo.