Ukunyangwa kwe-Gold-standard standard for the disease of Parkinson's (PD) yonyango lonyango . Cishe zonke iilwimi ezikhoyo ziyakwandisa izinga le-dopamine kwingqondo. Indlela eyafumana ngayo amayeza anikezela le feat ininzi enokuyenza nokusebenza kwayo kunye nemiphumo emibi.
I-Levodopa ekuThatheni iiMpawu zeMoto
I-Levodopa yinkqubo yokuqala yezilwanyana ze-PD-brain cells zisebenzisa i-levodopa njengebhloko yokwakha ukwenza i-dopamine.
I-Levodopa isebenza ngokuqhelekileyo impawu zeemoto, ukukwenza uzive uncinci, uhamba kunye kwaye uguquke. Ngelishwa, ayiphilisi iPD kwaye ayikwazi ukuyeka inkqubo yesifo esezantsi.
I-Levodopa nayo ineempembelelo. Ezi ziphumo, nangona kunjalo, zinokupheliswa ngokuhlanganisa i-levodopa namanye amayeza. Ngokomzekelo, omnye umphumo osisigxina se-levodopa xa isetyenziselwa yedwa isisongela-umphumo we-dopamine kakhulu ejikelezayo kwigazi lomzimba endaweni yengqondo. Ukukhusela isicupunu kunye nokuphucula inani levodopa elifikelela kwingqondo, i-levodopa idlalwa ngenye uhlobo lweziyobisi ebizwa ngokuba yi- dopa decarboxylase inhibitor (DDI). I-DDI ibimbela ukuguqulwa kwe-levodopa kwi-dopamine kwigazi lomzimba ngokuvumela i-levodopa ngaphezulu ukuba ifinyelele ingqondo kunye nokukhusela isicaphulelo.
Ifomu eqhelekileyo yeDDI esetyenziswa kumazwe amaninzi i-carbidopa. Ukuhlanganiswa kwe-levodopa kunye ne-carbidopa kuyaziwa ngegama leshishini iSinemet.
Kwamazwe amaninzi amayeza e-carbidopa / levodopa anqunywe njengeqhekeza-inombolo (inombolo ephezulu) inani le-carbidopa kwipilisi nganye, kunye ne-denominator (inombolo ephantsi) inani levodopa. Ngokomzekelo, ukuhlanganiswa kwe-25/100 kwenziwe ngama-milligram ama-carbidopa kunye ne-100 milligram ye-levodopa.
I-Carbidopa / levodopa nayo iyafumaneka kwi-formulation-release release formation eyaziwayo njengeSinemet CR. Ukuqulunqwa kwe-Sinemet ukulawulwa okulawulwayo kuvumela ixesha lokukhululwa kwe-levodopa kwi-bloodstream, elinceda ekugqibeleni ukuphela kwee-do-wear-off-off variations, kunye nokuphazamiseka kokulala ebusuku.
Ezinye izidakamizwa zeDopamine
Nangona i-levodopa iphatha kakuhle iimpawu zesifo se-Parkinson , eso sifo sisaqhubeka kwaye siba sibi nakwixesha. Isifo sika-Parkinson sonakalisa amangqamuzana ebuchopho enza i-dopamine okanye eguqulela i-levodopa kwi-dopamine. Njengoko eso sifo siyaqhubeka, kunzima kakhulu ukukhuthaza ukuveliswa kwengqondo ye-dopamine . Ngoko ke, sidinga iindlela ezongezelelweyo zokugcina ingqondo ye-dopamine ephakamileyo ngokwaneleyo ukwenzela ukuxhasa ukusetyenziswa kweemoto eziqhelekileyo.
Ekubeni iiseli zokuvelisa i-dopamine zonakaliswe sisifo kufuneka sijolise kwezinye iiseli ezingenakuvelisa i-dopamine kodwa sisebenzise ukusebenzisa i-dopamine ekhoyo ngokuthe ngempumelelo. Iiklasi ezimbini zamachiza zinokukwenza oku:
- amayeza achukumisa ngokukodwa iiseli ezisisebenzisa i-dopamine-"i-dopamine agonists"
- amayeza avimbela ukuphazamiseka kwe-dopamine emzimbeni, ngoko ke ukwandisa amanqanaba afumaneka kwingqondo-"COMT and MAO inhibitors"
I-Dopamine Agonist kwiiNgxaki zePasinson
Kukho ii-agonists ezimbalwa ezifana ne-dopamine:
- (Mirapex) iPramipexole
- (Qeqesha) iRopinirole
- (Neupro) iRotigotine
Zonke ezi zonyango zifanisa imiphumo ye-dopamine kwi-receptors ekhethiweyo ye-dopamine, eziyi-cell eziphucula imiphumo ye-dopamine kwingqondo.
La mayeza angenza iziphumo ezinjengezondlo, uxinzelelo lwegazi oluphantsi, kunye nokuphazamiseka kwengqondo ngoko kufuneka ziqalwe njengendlela ephantsi kakhulu, kwaye yanda ngokunyuka phantsi kolawulo lwe-neurologist yomntu.
I-COMT Inhibitors kunye ne-MAO Inhibitors
I-COMT (i-catechol-O-methyltransferase) inhibitors kunye ne-MAO-B (i-monoamine oxidase uhlobo B) i-inhibitors isebenza ukuvimba ukuphazamiseka nokungasebenzi kwe-dopamine emzimbeni nasengqondweni.
Ukuba i-COMT ivaliwe okanye ivalwe, umzekelo, i-levodopa eninzi inokufikelela kwinkqubo yokulawula imoto. I-COMT inhibitors eziqhelekileyo zikhona (Tasmar) tolcapone kunye (Comtan) entacapone. I-COMT inhibitors inceda kakhulu abantu abaneemoto eziguqukayo.
Kodwa njengamachiza amaninzi, i-COMT ne-MAOI inhibitors baneempembelelo. Ngokomzekelo, amahlanu ukuya kweyeshumi kwizigulane ezithatha i-COMT inhibitor zenza uhudo. Oku kudla ukuba itywala kufuneka imiswe. Amabini amabini ukuya kweethathu abantu abathatha i-tolcapone baba neengxaki ezinzulu zesibindi ezifuna ukuvavanya ngokusondeleyo kokusebenza kwesibindi xa kusenziwa isigqirha okanye ukuphela kokusetyenziswa kweziyobisi ngokupheleleyo. I-Entacapone ayinayo iingxaki zetyhefu zesibindi.
I-MAO-B inhibitors, njenge-Eldepryl selegiline kunye (Azilect) i-rasagiline, inqanda i-enzyme i-MAO-B ukuba ingaphuli i-dopamine kwingqondo ngokwayo.
Selegiline isetyenziswe ngokuyinhloko ukukhusela okanye ukugqithisa ukuphela kwe-dose motor. Imiphumo yayo imnene kakhulu. Selegiline wayekholelwa ukuba enze njengesichengechunge se-neuroprotective ekhusela umonakalo omkhulu kwi-dopamine neurons kwingqondo. Kuvela ukuba le mphulo ye-neuroprotective ye-selegiline incinci okanye ayikho.
I-Rasagiline, ngakolunye uhlangothi, ikhangeleka ukuba iyathembise ngakumbi ngokubhekiselele kwimpembelelo ye-neuroprotective ingaba i-jury isaphuma kule miphumo ebalulekileyo yeziyobisi. I-Rasagiline isetyenziswa kakhulu kwi-Parkinson yokuqala kunye neyokulinganisela ukunciphisa ukuhamba kweemoto. Ubungqina obuninzi bokusebenza kwe-rasagiline kwaye ukhuseleko luyimfuneko.
Okukwintsusa
Ngelixa i-levodopa yiphilisi engcono yokuphatha iingxaki ze-Parkinson zesifo, ngamanye amaxesha amanye amayeza afana ne-dopamine agonists okanye i-MAO inhibitors ingaqaliswa kuqala, ingakumbi ukuba iimpawu zomntu zincinci. Ezi zonyango ziyakongezwa kwakhona kwiyeza levodopa ukulawula ukunyuka kweemoto.
Iindaba ezilungileyo kukuba ngelixa isifo sika-Parkinson asiphilwanga, zikho iindlela zokujamelana nesi sifo kwaye uphucule wakho okanye umntanakho osebenzayo imihla ngemihla kunye nomgangatho wobomi.
Imithombo:
I-American Society of Health-System Pharmacy, iLevodopa neCarbidopa
Connolly, BS, Lang, AE (2014). Unyango lwe-Pharmacological ye-Parkinson isifo: ukuhlaziywa. JAMA , Apr 23-30; 311 (16): 1670-83.
R. Pahwa kunye ne-KE Lyons (abaHleli), iNcwadana yezifo zikaPasinson ; I-4 Edition, eNew York, Abashicileli bezeMpilo kwi-Informa, ngo-2007.