Ukuvavanya iOpioid Best and Non-Opioid Drug Options
I-Analgesics yinkalo yeziyobisi ezisetyenziselwa ukunciphisa i-analgesia (intlungu). Basebenza ngokuthintela iimpawu zentlungu kwiingqondo okanye ukuphazamisa ukuchazwa kwengqondo kwezo zibonakaliso. Ii-Analgesics zikwahlula ngokubanzi njengokuba kungekho i-opioid (engekho i-narcotic) okanye i-opioid (i-narcotic).
I-Opioid Analgesics
Ama-analgesics angenayo i-opioid adilizwe kwiintlobo zintathu: i- acetaminophen , izidakamizwa ezichasayo ezingabhubhisiyo (i-NSAID) kunye ne-COX-2 inhibitors.
Ngethuba elowo luneendlela ezahlukeneyo zesenzo, zisebenza ngokuthintela uhlobo lwe-enzyme ebizwa ngokuba yi-cyclooxygenase, okanye i-COX. Kukho iintlobo ezimbini ezahlukeneyo ze-enzyme, i-COX-1 kunye ne-COX-2, ezo zombini zinoxanduva lokubangela ukuvuvukala nentlungu ngenxa yokulimala.
Kuzo zintathu iintlobo ze-non-opioids iintlungu zokuhluthwa:
- I-Acetaminophen (eyaziwa nangokuthi i-paracetamol) iphakathi kwezona zinto ziqhelekileyo ezichazwe kwi-analgesics kwi-world namhlanje. Ngelixa abantu baya kudla ukuyiqonda ngamagama egqabha iTylenol, isithako esisebenzayo siqulethwe kumakhulu angaphezu kwama-cold-counter-counter-counter-counter-counter-cure, I-Acetaminophen inikeza zombini i-analgesic kunye ne-antipyretic (ukukhulelwa komkhuhlane) kodwa ayiphathi kakubi. Ngoxa i-action yayo ingacaciswanga kakuhle, kubonakala ngathi ikhusela umsebenzi we-COX kwingqondo kunye nenkqubo ye-nervous central kuphela. Isiphumo salo esona siphumo sonyango esibangelwa ngokugqithiseleyo. Ngokutsho kwe-US Food and Drug Administration (i-FDA), i-acetaminophen namhlanje iyona nto ibangela ukuhluleka kwesibindi e-US, ngokukodwa phakathi kwezidakwa ezinxilisayo okanye abantu abazisebenzisa ngokuzenzekelayo iziyobisi ze-opioid ezine-acetaminophen.
- Izidakamizwa ezichasene nezidakamizwa (i-NSAID) ziyi-klasi yezidakamizwa eziquka ezo nkcukacha njenge-Advil (ibuprofen), i-Aleve (naproxen), ne-Bayer (i-aspirin). Njengoko i-acetaminophen, ii-NSAID zifumaneka kwiifom ezininzi ezahlukeneyo kubandakanya iipilisi, i-syrups, kunye nee-patches. Nangona kunjalo, ngokungafani ne-acetaminophen, ii-NSAID ziyakuthi zivimbele i-COX-1 kunye ne-COX-2 kungekhona kwinkqubo yesantya ephakathi kodwa kwezinye iindawo zomzimba, ngokunjalo. Olu nyathelo olwandisiweyo lunceda, inxalenye, kwizilwanyana 'izidakamizwa, ezichasayo kunye nezixhobo zokulwa ne-antipyretic. Nangona kunjalo, le ndlela inokunciphisa iindleko ezikhuselekileyo i-COX enokwakheka kwesisu. Ngenxa yoko, imiphumo emibi efana nokuhlengahlengiswa, isicupunu, kunye nezilonda akuqhelekanga. Ngaphandle kwe-aspirin, ii-NSAID zinokunyusa kakhulu umngcipheko wokuhlaselwa kwintliziyo kunye nokubethelwa kwabantu abanembali yesifo senhliziyo.
- I-COX-2 inhibitors yi-subset ye-NSAID enamhlanje iquka esinye sezidakamizwa ezivunyiweyo ze-FDA, iCelebrex (celecoxib) . Njengalo negama, i-COX-2 inhibitors icima kuphela i-COX-2 enzyme, ukunciphisa intlungu kunye nokuvuvukala ngaphandle kokubangela iziphumo zecala lomzimba. Nangona kunjalo, njengeklasi yeziyobisi, bayaziwa ngokunyusa umngcipheko wokuhlaselwa kwentliziyo ngama-40 ekhulwini. Ngenxa yoko, i-Vioxx eyayisakuba yintandokazi (rofecoxib) yayisuswa ngokuzithandela kwimarike yase-US ngo-2005, ilandelwa kungekudala emva kokubulawa kweminye i-COX-2 inhibitors. Ingxenye yayo, i-Celebrex ihlala enye yezilwanyana ezithengisa kakhulu kwi-portfolio ye-Pfizer.
IiOpioid Analgesics
I-analgesics ye-opioid uhlobo lonyango olusebenza ngokubophezela kwiimvume zokufumana i-opioid ezifumaneka kuyo yonke inkqubo yeentlanzi kunye neendlela zesisu. Ezi zamukeli azilawuli kuphela imisebenzi ethile ye- somatic ezinjengeentlungu , nazo zinoxanduva lokubangela impembelelo yengqondo (ingqondo) edibana nabantu abanezilwanyana ze-opioid.
Iziyobisi ze-opioid zisetyenziselwa ukuxilwa kweentlungu, i-anesthesia, kunye nokunyanga umlutha we-opiate. Azinxulumene nobutywala bombutho okanye kubangele nayiphi na imiphumo emibi ehambelana ne-NSAID.
Nangona ikhuselekile xa isetyenziswe njengoko kuchaziwe, i-opioids ingabangela ubuthongo, isisonguluko, ukuqhenqa, i-hypoventilation (ukuphefumla okungapheliyo) kunye nokunyamezela kwezinye.
Oku kunjalo ngokukodwa kubantu abadala asebekhulile kule miphumo.
Ngaphezu koko, ukusetyenziswa kwexesha elide kunxulumene nomngcipheko wokunyamezela izidakamizwa (apho isicatshulwa siphumelela khona), ukuxhomekeka (umlutha) kunye nokuhoxiswa. Ngenxa yoko, izidakamizwa ezininzi ze-opioid zilawulwa yizinto ezifuna umyalelo wegqirha. Ngokweengxelo ezivela kumaZiko okuLawulwa kweNtsholongwane kunye nokuPhepha, izigidi ezininzi zaseMelika zizilwelwe ze-opioid.
Kukho iintlobo ezintathu zeentlobo zamachiza opioid ezisetyenziselwa ukuphatha intlungu:
- I-opiate alkaloids zihlobo lweziyobisi ezifunyenwe ziimveliso ezifumaneka kwintlobo ye-opium poppy uPapaver somniferum . Izixhobo eziphambili ze-psychoactive ezitholakala kwi-opium ziquka i- morphine kunye ne-codeine. Bobabini benza ngokuthe ngqo kwi-system ye-nervous system ukuze banciphise intlungu. Ukulala, ukukhawuleza, ukuhlanza nokuqhawulwa yimiphumo emibi. Nangona i-morphine yaziwa ngokuba yingozi kakhulu, ikhodiyine nayo inakho ukukhupha impawu xa isetyenziswe. I-Codeine nayo yodwa i-opioid ifakwe kwiindlela ezininzi zokulungisa amanxeba (ngokuqhelekileyo ukukhwehlela ama-syrups aququzelelwe nge-NSAID).
- I-opioid enemihla ngemihla yilezi zinto ezihlanganiswe kwi-opioid yemvelo kwaye zibandakanya ezo zonyango njenge- Oxycontin (oxycodone) kunye ne- Vicodin (i-hydrocodone) . I-Oxycodone isetyenziselwa ukunyanga intlungu enzima (kubandakanywa nomhlaza okanye intlungu emva kokuhlinzwa) kwaye ithathwa njengomlutha omkhulu. Ngenxa yaloo nto, i-hydrocodone ixhatshazwa ngaphezu kweyiphi na into e-opioid e-US, ngokwembiko ka-2014 evela kwiSizwe soLuntu sokuSetyenziswa kakubi kweziyobisi. Ezi ziyobisi ezinamandla zingasetyenziselwa ngokukhuseleka ukuphucula intlungu yesikhashana, kodwa, njengemithi yeShedyuli II, kufuna ukulawulwa kwonyango olusondeleyo.
- I-opioid epheleleyo yenziwe yenziwe ngokupheleleyo kwibhabhi ukwenza umsebenzi othile wokubopha i-opiates. Ziquka i-methadone kunye ne-buprenorphine (isetyenziselwa ukuphatha umlutha we-opiate) kunye ne- tramadol (isetyenziswe rhoqo kwiintlungu zentsebenzo). Nangona zibhekwa njengezilonda ezincinci kunezinye iziyobisi ze-opioid, abantu bayaziwa ukuba bahlakulele ukuxhomekeka xa kusetyenziswa ixesha elide.
ILizwi
Ama-Analgesics angaba luncedo kakhulu ekulawuleni ubuhlungu be-arthritis kwaye asetyenziswe ngokukhuselekileyo xa kuthathwe njengoko kuchaziwe. Nangona oogqirha baninzi baya kugxila kwiiyobisi ezingekho ii-opioid zonyango, kukho iimeko apho kunzima khona, ubuhlungu obukhulu bufuna imithi ephezulu ye- opioid . Oku kuya kuba yinkxaso-futshane yexesha elifutshane ukuphepha naluphi na umngcipheko wokuxhomekeka.
Ngelo xesha, akusacaci ukuba i-opioid ye-dose ephantsi kangakanani xa ifaniswa namanye amayeza angekho opioid. Ngaloo ndlela, ukuba unesifo esibi, isifo se-arthritis esingapheliyo, qwalasela intlanganiso kunye neengcali zolawulo lweentlungu onokukuthetha ngeendlela ezipheleleyo zokonyango lwezonyango, zombini utywala kunye nokungenawo amayeza.
> Imithombo:
> Amacandelo okuLawula nokuLawula izifo. "Izimpawu ezibalulekileyo: Ukuhluka phakathi kwamanye amazwe ekuBhaliseni i-Opioid Pains Relievers kunye neBenzodiazepines-United States, 2012." MMWR . 2014; 63 (26); 563-568.
> Cicero, J .; Ellis, M .; Surratt, H. et al. "Izinto ezichaphazela ukukhethwa kwe-hydrocodone kunye ne-oxycodone njenge-opioid eyinqobo kubashushu beziyobisi abafuna unyango e-United States." IPHEPHA. 2013; 154 (12): 2639. INGXELO: 10.1016 / j.pain.2013.07.025.
> Isizwe seSizwe sokuSetyenziswa kakubi kweziyobisi. "I-America's Addiction to Opioids: IHeroin kunye neMigomo yokuLawula kakubi." EWashington, DC; kukhutshwa ngoMeyi 14, 2014.
> Yoon, E .; Babar, A .; Choudhary, M. et al. "I-Acetaminophen-Yenza i-Hepatotoxicity: i-Update Comprehensive". Umbhalo we-clinical and hepatology . 2016; 4 (2): 131-42. INGXELO: 10.14218 / JCTH.2015.00052.