Ukususela kwiintsholongwane ezichasene ne-opioids kunye nabachasayo kunye nokunye, ezininzi iintlobo zemithi zichazwe ngenxa yentlungu nentsimbi. Uninzi lunika ubuncinane ubuncwane bolawulo lweentlungu, kodwa unokuba luncedo olungathandekiyo, kwaye nokuba lunobungozi, iziphumo zecala zigqitywa khona.
Eli nqaku lifanisa amachiza anjalo - i-COX-2 inhibitors kunye ne-opioids.
I-Cox-2 Inhibitors - i-Celebrex, iVixx kunye ne-Bextra
Ii-cox-2 inhibitors zihlobo lwe-non-steroidal anti-inflammatory (NSAID) ezisetyenziselwa ubuhlungu obukhulu, iintlobo ezininzi ze-arthritis kunye nobuhlungu besisu.
Ahluke kwiziyobisi ezifana ne-aspirin, i-Aleve, i-Motrin kunye nezinto ezinje ekuthi isenzo sabo sijoliswe ngakumbi.
Izazinzulu kunye noogqirha bayazi ukuba intlungu ibangelwa yizinto ezibizwa ngokuba yi-prostaglandins. I-Prostaglandins, kwakhona, iveliswa emzimbeni ngama-enzyme edibeneyo (ngasinye sinemiphumo eyahlukileyo), okuyi-COX-1 kunye ne-COX-2. Iingcali ezisentsimini ziyazi ukuba i-prostaglandin ngokufanelekileyo ixanduva lweentlungu, ukuvuvukala nokuvuvukala kuveliswa kuphela yi-enzyme ye-COX-2.
Uhlobo oluphambili phakathi kweemveli zengqondo ezingenakuvuthayo zentlungu (oko kukuthi, iindlela ezahlukeneyo ze-NSAID) kunye ne-COX-2 inhibitors kukuba ngelixa i-NSAID inqanda izenzo ze-COX-1 kunye ne-COX-2 enzymes, i-COX-2 inhibitors, njengoko igama lithetha, khuphela kuphela i-COX-2.
Ingxaki ininzi i-COX-2 inhibitors ithathelwe emakethe. Oku kungenxa yokuba bafunyenwe ukunyusa umngcipheko weemeko zentliziyo (ukuhlaselwa yintliziyo kunye nokubetha) xa kusetyenziswa ixesha elide.
I-Vioxx (igama eliqhelekileyo elithi rofecoxib) kunye neBextra (igama eliqhelekileyo i-valdecoxib) laxothwa kwiimarike ekuqaleni kwawo-2000. UVoxx wenziwa nguMerck, kunye noBextra wenziwa nguPfizer.
Okushiya enye i-Pfizer enye ye-COX-2 inhibitor, i-Celebrex (igama eliqhelekileyo celecoxib.)
Njengoko kuphela isilwanyana se-COX-2 inhibitors esele kwimarike yase-US, i-Celebrix kunye ne-celecoxib ngoku iza ne "bhokisi ebomnyama isilumkiso," yile ilebula eyenzelwe ukukhangela ngokwaneleyo ukuba ikuqaphele iphrofayili ekhusekileyo yokhuseleko .
Oogqirha abayalela iCelebrex baye bafundiswa yi-FDA ukukunika iNcwadana yeMithi, inomngcipheko kunye nolwazi lwe-dosage.
Ukuba uzibuza into enye ongayithatha ngaphandle kweCelebrex, ukuhlaziywa kuka-2013 kufumanise ukuba kuzo zonke ii-NSAID ezingakhethi, i-naproxen (i-Aleve) ibonakala ibangela ubuncinci besifo sengqondo kubagulane. Ababhali bokuhlaziya batusa ukuba nayiphi na i-NSAID oyisebenzisayo, ukuba wenze njalo kumlinganiselo ongezantsi kakhulu, kunye nexesha elincinci lexesha elinokwenzeka.
Qaphela ukuba ezinye iintlobo ze-NSAIDS, uhlobo oluvimbela zombini i-COX-1 kunye ne-COX-2 enzymes, lunokwandisa umngcipheko wokuhlaselwa kwentliziyo okanye ukubetha, ngokunjalo. Enyanisweni, ngo-2015, i-FDA yalela ukuba amagama kuwo onke amabhokisi ebhokisi e-NSAID (kuquka i-Celebrex, kuphela i-COX-2 inhibitor eseleyo kuphela) ihlaziywe ukubonisa uphando olutsha olufumene ukuhlaselwa kwentliziyo lunokuvela emva kweeveki emva kokuqala olu hlobo lwesilonda, kwaye ukuba ixesha elide usisebenzisa le nkunkuma, iphakamileyo ingozi.
I-opioids ye-Back or neck Pain
I-opioid yiklasi yeentlungu zentlungu ekwazi ukunikela ngokukhululeka okukhulu. I-opioids isetyenziselwa ukuxilwa kabuhlungu, kodwa ngamanye amaxesha oogqirha bawabeka njengonyango lokuqala lwezentlungu.
Ingxaki kukuba, le nxalenye yeentlungu ezixoxwa yi-narcotic, nto leyo ithetha ukuba ziza nezixhobo zokulutha.
Ezinye izigulane zakha ukunyamezela, oku kunokukhokelela ekuxhomekeke emzimbeni, kwaye ekugqibeleni kuzaliswe umlutha ogcweleyo.
Amanye amayeza e-opioid ahlambulukileyo ngama-narcotics, ngelixa amanye axutywe kunye neentlungu ezininzi ezinomlutha ezifana neTyelnol. I-opioids zenziwe njengendlela emfutshane, kwaye zisebenza ixesha elide.
Nangona ukusetyenziswa kwe-opioids yentlungu nentlungu emva kwandile, ubungqina abukho imfuneko yokuxhasa lo mkhuba. Ukuhlaziywa kwiBritish Medical Journal ibikela ukuba ii-opioids ngoku zizidakamizwa eziqhelekileyo eziqhelekileyo eMelika.
Oko kwathiwa, iimbono zokubhaliweyo zombhali, i-opioids ayibonakali ekuncedeni abantu babuyele emsebenzini ukuba basebenze nantoni na ngakumbi kunezinye iintlobo zonyango lwentlungu, okanye abaphuculanga iziphumo zokunyamekela okuphambili kwintlungu emva.
Ukuba intlungu yakho yangemuva ayinasiphelo, i-opioids ayinakukwenza nantoni na. Umbhali wokuhlaziya ufumene ubungqina obuncinane bokuthi basebenzela le njongo.
Kanye nomngcipheko wokulutha, i-opioids iza nezinye iziphumo ezibandakanya ukuzithemba, ukungasebenzi kwezesondo nokuxinezeleka, ukubiza nje ezimbalwa.
I-opioids nazo zixhomekeke kwimikhankaso yokuthengisa elahlekisa. Olunye uhlobo lwe-opioid, i-OxyContin, lwalukhutshwe njenge-"ekhuselekileyo" yokuhlambalaza ngabameli beenkampani kwiphulo lokuthengisa. Kodwa abaphathi abakhulu be-Purdue Pharma, abenzi be-OxyContin, kamva bavunyelwa enkundleni ukuba abo babango babunenkohliso kwaye badukisa.
I-COX-2 Inhibitors vs Opioids - Cinga ngaphambi kokuba uthathe
Xa uqwalasela okanye umiselwe imithi yentlungu, cinga ngeengxaki zonke ezinokuthi zivele ngokuzithatha. Unokuba usengozini yokuhlaselwa yintliziyo okanye ukubetha, okanye uhlala nomlutha (ovuthiweyo).
Khumbula, ngokuqhelekileyo ukuthutha umzimba wakho kunokunceda ngeentlungu, ukuphinda uphinde ulahleke umsebenzi kunye nokuphucula umgangatho wobomi. Ukutyelela ezimbalwa kunye nomgulana ongokwenyama kungakho konke okufunayo ukubuyisela umgangatho wobomi.
> Umthombo:
> Deyo, R., et. al. I-opioids yeentlungu ezisezantsi. Uhlolo lweKlinikhi. I-State of Art Review. Jan 2015. http://www.bmj.com/content/350/bmj.g6380
> Nissen, S., kunye. al., ukhuseleko lwe-Cardiovascular Safety of Celecoxib. N Engl J Med. Novemba 2016. http://www.jwatch.org/na42802/2016/11/14/cardiovascular-safety-celecoxib
> I-Pawlosky, N. Ingozi ye-cardiovascular Ingaba zonke i-NSAID zifana? Ngaba uFarm J. Matshi 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676195/
Vioxx kunye ne-Cox-2 Inhibitors
I-Cox-2 inhibitors njengeVixx, i-Celebrex kunye ne-Bextra zihlobo lwe-NSAID, okanye izidakamizwa ezingekho-steroidal ezichasayo. Ziye zaphuhliswa kuma-1990 ngokuphendula kwimiphumo emibi ye-NSAIDS .
Ngenxa yokuba bahlala kwintsapho efanayo yonyango, zonke i-Cox-2 inhibitors ziziphatha ngendlela enhle ngendlela efanayo. Ngoko ke, izigulane ezithatha indawo yeVixx okanye iBextra neCelebrex zisenokuba yingozi yokuhlaselwa yintliziyo.
Nangona bengenayo i-Cox-2 inhibitors, ezinye i-NSAID ezenza iingozi zinoMotrin, i-Naprosyn, i-Voltaren kunye ne-Mobic.
Opioids
I-opioids isetyenziselwa ukuthotyelwa intlungu. Ukongeza kwintlungu engapheliyo, i-opioids nayo ilawulwa kwiimeko zesifo somhlaza, intlungu yesifo kunye nezinye iimeko.
I-opioids yinkxwaleko enamandla kakhulu; i-morphine ngumzekelo owaziwa kakhulu we-opioids, nangona kukho ngokwenene iindidi ezinokuqala ukususela kumsebenzi onobubele. Imizekelo ibandakanya i-OxyContin, ikhowudi, iDarvon kunye noVicodin.
I-Opioids ineempembelelo eziliqela, kubandakanywa nokuba:
- ukudandatheka
- ukuqothulwa
- umngcipheko wokuxhomekeka kunye nokulutha
Iyona nto ibonakalayo engafanelekanga yeopioids njengemithi yeentlungu iyakwazi ukuxhatshazwa nokuxhomekeka. Uphando lubonisa ukuba i-OxyContin, ngokukodwa, "isango" lokuxilisa kwezinye iziyobisi ezinzima. Ngamanye amaxesha, izigulana zingenakuphikiswa loo mayeza ngenxa yokuba izizathu zabo ziqondwa kakuhle, kwaye ziyakubonakala zikhona njenge-morphine (okanye ezinye i-opioid) eziluthayo.
Isiphumo
Xa ilawulwa ngokufanelekileyo , iinzuzo zokuthatha i-opioids ngentlungu inamandla kunomngcipheko ochaphazelekayo. I-opioids iyasebenza ngokukhululeka kwintlungu. Kwaye abaninzi abaphandi, amabhunga olawulo kwiyeza, kunye noogqirha banomuvo wokuthi ii-opioids zifanelekile ukuqwalasela unyango lwentlungu engapheliyo. Kodwa njengawo nawuphi na ukhetho lokunakekelwa kwempilo, sebenza kunye nogqirha kunye nabanye abaqeqeshi bezempilo ukuze bafumane inketho engcono kuwe.
Umthombo:
Imibuzo kunye nezimpendulo.Iziganeko zokuLawula i-APDA ze-COX-2 ezikhethiweyo kunye nee-Non-Steroidal Anti-inflammatory drugs (NSAIDs). FDA. NgoAprili 7, 2005.
Brasseur, L. Ukuhlaziywa kwonyango lwangoku kwi-pharmacologic yentlungu. Zi yobisi. 1997.
Cicero, TJ, Inciardi, JA, Munoz, A. Imizila yokusetyenziswa kakubi kwe-Oxycontin kunye nezinye i-opioid analgesics e-United States 2002-2004 JPain Oktobha 2005.
Grau, LE, Dasgupta, N., Harvey, AP, Irwin, K., Givens, A., Kinzley, ML, Heimer, R .. Ukusetyenziswa kakubi kwe-opioids: i-OxyContin "isango"? AmJ Addict ngoMeyi-Juni 2007.