Umbuzo: Kutheni ndingasebenzisa iMethadone?
I-Methadone - akunjalo ukuba izidakamizwa ze-heroine zilutha?
Lo ngumbuzo ndiqhele ukuba ndivalele kwizigulane ezinobomi kunye neentsapho xa ndibaxelela ukuba ugqirha wabo ucele i-Methadone ngentlungu. Nangona kuyi nyaniso ukuba i-methadone isetyenziselwa ukunyanga iimpawu zokurhoxiswa kweengxabano, i-methadone nayo yonyango elisebenzayo kakhulu ukuphatha intlungu enzima.
UMorphine ufumene isihloko seGold Standard ukulawula ubuhlungu , i-opioid bonke abanye bafaniswa kunye nokusebenza kwayo, ukukhululeka kolawulo kunye neendleko eziphantsi. Ukuba i-morphine inkulu kakhulu, kutheni sisenokusebenzisa i-methadone?
Impendulo:
Ukuba siza kuqalisa ukuthelekisa i-methadone kunye ne-morphine, kufuneka siqale ngemigaqo ephambili yentlungu. Ubuhlungu bunokwahlula zibe zimbini iintlobo zeenkcazelo zemizimba: i-nociceptive neuropathic. Iintlungu zesifo se-nociceptive ngokuvamile zibangelwa yingozi yesikhumba (ubuhlungu be-somatic) okanye ukulimala kwizitho zangaphakathi (intlungu ye-visceral). Intlungu ye-neuropathic ibangelwa ukulimala okanye ukuhlambalaza iimbilini kwiinkqubo zesantya okanye kwi-body of peripheral.
Siyintsikelelo nge-opiate receptors kwiibongo zethu ezivumela imizimba yethu ukuba iphendule kwiimithi zentlungu ye-opioid. Uninzi lwaba mamkeli luhlelwa kwii-receptors kunye ne-delta kunye neepesenti ezincinci yi-NMDA. Iintlungu ze-nociceptive zixhaswa ngokubanzi ngama-receptors kunye neentlungu ze-neuropathic nge-delta kunye ne- NMDA receptors ; i-morphine ibopha kwi-receptors kuphela, ngelixa i-methadone ibopha kwi-delta, ne-NMDA.
UMorphine unomsebenzi omuhle wokunyanga iintlobo ezininzi zeentlungu, kodwa ngenxa yokukwazi ukubopha kwi-100% ye-opiate receptors, i-methadone inokukwenza okungcono.
Ukupheliswa kweTyxicity and Effects Side
Ama-opiates, afana ne-morphine, avelise i-metabolites xa ephukile ngaphakathi emzimbeni. Ezi metabolites zinokwakha emzimbeni kwaye zibangele iimpawu ze-opiate toxicity.
I-opiate inetyity ngokugqithiseleyo i-overdose ye-opiate ekhokelela kumazinga anobuthi emzimbeni kwaye ibangela izibonakaliso ezifana nokungazinzi, ukuhlambalaza, ukuxubha kunye nokunyaniseka.
I-Methadone ayivelisi i-metabolites kwaye ngenxa yoko ayinayo "idilesi," okanye i-dose ephezulu. I-Methadone nayo ilula ukuyilungisa ngesibindi, kwaye ukungabikho kwayo kweemetabolites kwenza kube yinto ekhethekileyo yonyango lwezonyango ezininzi kwizigulane ezinciphise isibindi umsebenzi okanye ukungaphumeleli komntu.
Iziphumo eziqhelekileyo zemiba ye-opiates zibandakanya ukuzithemba, ukugabisa isisu kunye nokuhlanza, ukulala, ukugubha, ukudideka nokudandatheka okuphefumulayo (ukuphefumula ubunzima). Izigulane ezininzi ziye zachaza ukwehla kweempembelelo ezimbi emva kokutshintsha kwi-methadone kwenye i-opiate.
Uncedo olungakumbi lweMethadone
Ngoko i-methadone iphumelele ngakumbi kune-morphine ekuphatheni ubuhlungu kwaye ibangela imiphumo embi engaphantsi, kodwa iindaba ezilungileyo aziyeki apho. Enye inzuzo ye-methadone yimizuzu yesibini eyongezelelweyo. Isiqingatha-nobomi ixesha elifunekayo ukuba isiqingatha ubuninzi besilwanyana sibe sisetyenziswe okanye sichithwe ngeenkqubo eziqhelekileyo ze-biological. Ngenxa yalolu hlobo lwesigamu-ubomi, i-methadone inefuthe lokunciphisa intlungu yeeyure eziyi-8 ukuya kwe-10, ngelixa i-morphine yokukhululwa engaphelelwanga rhoqo ikhupha intlungu ngeeyure ezi-2 ukuya kwii-4.
Oku kuguqulela kwi-dosing engaphantsi kwesigulane, ngokuqhelekileyo emibini okanye kathathu ngosuku.
Kwaye ekugqibeleni, kodwa kungabi ncinane, i-methadone ixabisa kakhulu. Ukubonelelwa kweenyanga eziqhelekileyo ngeendleko ze-methadone malunga ne-$ 8, ngelixa i-morphine iya kuhlawula i-$ 100. Amanye ama-opiates, afana ne-Oxycontin kunye neFentanyl, aya kubiza ngaphezulu.
Izithintelo zokusetyenziswa kweMethadone
Ingaba ndiqinisekile ukuba i-methadone yipilisi enkulu yeentlungu ? Ukuba kunjalo, unokuzibuza ukuba kutheni kungasetyenziswanga rhoqo. Ndiyicelile umbuzo ofanayo kumagqirha amaninzi, kwaye ndifumene ukuba ngaphaya kwesihlamba sokuba i-methadone ithwala, oogqirha abaninzi abanakho ukukhululeka ukuyibeka.
Ngenxa ye-half-life-length ye-methadone, iyakhula ngokukhawuleza emzimbeni kwaye ingathatha iintsuku ezi-5 ukuya kwezi-7 kumanqanaba okuzinzisa. Ngeli xesha, isigulane kufuneka ihlolwe ngokusondeleyo kwimpawu zetyhefu. Ngokuqhelekileyo akuyiyo ingxaki kwizigulane ezinonophelo zokunyamezela okanye ukunyamekela , ngenxa yokuba sele zilandelwa ngokusondeleyo kwaye ngokuqhelekileyo ziyafikelela kumongikazi kunye noogqirha iiyure ezingama-24 ngosuku. Iofisi yoogqirha engasenalo ikhono lokubeka iliso kwizigulane ezikufutshane, ezinokuthi zibe yinxalenye yokungabaza ukuyibeka.
Ezinye izithintelo zemfundo yonyango kunye nokungafuni kwesigulane. I-Methadone isaziwa ngokubanzi njengesiza sezilwabisi ezidakamizwa. Ukuba intshutshiso ihlanjululwa ngokukhawuleza njengoko nje oogqirha baqhubeka befundisa oontanga babo kwiintlobo zayo kwaye uluntu lubona izigulane ezininzi zifumana uncedo ngenxa yalo.
Imithombo:
I-Ayonrinde OT, iBridge Bridge. Ukubuyiselwa kwakhona kwemethadone yokulawulwa kweentlungu zomhlaza. Med J Aust 2000; 173: 536-40.
I-Davis iPhalamende, uWalsh D. Methadone ukwenzela uxolo lomhlaza: ukuhlaziywa kwe-pharmacokinetics, i-pharmacodynamics, ukusebenzisana kwezidakamizwa kunye neenkqubo zokulawula. Inkxaso yeCancer Care 2001; 9: 73-83.
Toobs JD, Kral, LA. Ukwelashwa kweMethadone yeZizwe zobuhlungu. U-Fam Famician 2005; 71: 1353-8.