Iziyobisi ezinamandla ezinokutsha ngokukhawuleza
I-Corticosteroids okanye i-glucocorticoids, edlalwa ngokuba yi "steroids", ayeyicinga ukuba imangalisa. Ngowe-1948, kwi-Clinical Mayo eRochester, eMinnesota, izigulane zezigulane ze-arthritis zanikezelwa iilticticidide yansuku zonke. Iziphumo zazingqongqo kwaye uphuculo olunzulu kangaka, oogqirha bacinga ukuba "unyango" lwe-arthritis lafunyanwa.
Nangona kunjalo, njengoko ukusetshenziswa kwe-corticosteroids kwandiswe ngaphezu kweminyaka, kwavela iziphumo ezibi. Amanqanaba aphezulu anikezelwa ixesha elide elide liguqulela i-steroids "kwi-scars-oids." Izigulane zaxwayiswa ngeengxaki ezinokuthi, ukusetyenziswa kwe-corticosteroids kwaba yinto ekhuselekileyo, kwaye ezinye izigulane zaze zatshitshisa unyango ngenxa yokuba zinoyika.
Enyanisweni, i-corticosteroids iilisi ezinamandla ezinokubaluleka ukuba zilawulwa zizikhokelo ezifanelekileyo. Ukuqonda indlela abasebenza ngayo nendlela yokusetyenziswa ngokukhuselekileyo kubalulekile.
Sibanzi
I-Corticosteroids izidakamizwa ezihlobene ngokusondeleyo ne-cortisol, i-hormone eveliswa ngokwemvelo kwi-correl (adreal gland). Corticosteroids ziquka:
- I-Betamethasone (Celestone)
- Budesonide (Entocort EC)
- Cortisone (Cortone)
- Dexamethasone (iDadadron)
- Hydrocortisone (Cortef)
- I-Methylprednisolone (Medrol)
- I-Prednisolone (Ukuqhawula)
- IPrednisone (Deltasone)
- I-Triamcinolone (uKenacort, iKenalog)
Indima yeCortisol
I-Cortisol idlala indima ebalulekileyo ekulawuleni ityuwa kunye nokulinganisela kwamanzi emzimbeni kunye nokulawula i-carbohydrate, i-fat, kunye neprotein ye-metabolism. Xa umzimba ugxininiswa, i-pituitary gland kwisiseko seengqondo ikhupha i-ACTH (i-adrenocorticotropic hormone) eyenza i-adrenal glands ivelise i-cortisol.
I-cortisol eyongezelelweyo ivumela umzimba ukuba ubhekane neemeko ezixinzelelekileyo, ezifana nokusuleleka, ukuxhatshazwa, ukuhlinzwa okanye iingxaki zengqondo. Xa imeko yokuxinezeleka iphelile, ukuvelisa i-adrenal hormone kubuyela kwizinto eziqhelekileyo. Izilonda ze-adrenal zivame ukuvelisa ii-milligram ze-cortisol ngosuku, ngokusa kusasa, kodwa zivelise amaxesha amaninzi xa zifuneka.
Indlela yeCorticosteroids
I-Corticosteroids yenza isistim somzimba ngokukhusela ukuveliswa kwezinto ezibangela izenzo ezinokumangalisa kunye nokuvuvukala , njenge-prostaglandins. Nangona kunjalo, nazo ziphazamisa umsebenzi weeseli ezimhlophe zegazi ezonakalisa izidumbu zangaphandle kwaye zincede ukugcina isistim somzimba sisebenze ngokufanelekileyo. Ukuphazamisana nomsebenzi wamaseli omhlophe wegazi kuvelisa umphumo wecala lokukhusela okwandisiweyo kwintsholongwane.
Iinkcazo
I-Corticosteroids isetyenziswa kakhulu kwiimeko ezininzi. Ziyasetyenziswa ukulawula ukuvuvukala kwamalungu kunye nezitho kwizifo ezinjenge:
- Irheumatoid arthritis
- I-Lupus (i-Lupus Erythematosus)
- Ankylosing spondylitis
- I-arthritis yabantwana
- Isifo sesifo sesisu
- Dermatomyositis
- Polymyositis
- Izifo ezixubileyo zesifo
- Isifo seBehcet
- Polymyalgia rheumatica
- I-Scleroderma (i-systemic sclerosis)
- I-cell arteritis enkulu (i-temporal arteritis)
I-Corticosteroids ayisetyenziswanga ngokufanelekileyo kwinkqubo ye- osteoarthritis , nangona ngamanye amaxesha isetyenziswe njengejoza lendawo kwindawo echaphazelekayo.
Lawulo
I-Corticosteroids ixhaphake kwiindlela zazo zokwenza isicelo. Banganikwa:
- Ngomlomo
- Injected in vein or muscle
- Isetyenzisiwe kwindawo yesikhumba
- Ijojowe ngqo kumalungu axhamliweyo
Iziyobisi zeCorticosteroid nazo zingasetyenziswa njengezithako eziqulethwe apha:
- Iimveliso zamehlo (ukuphatha iimeko zamehlo ahlukahlukeneyo)
- Inhalers (ukunyanga isifo se-asthma okanye isifo se-bronchial)
- Ukuhla kwamanzi kunye nokuphalaza (ukuphatha iingxaki ezahlukeneyo zamanzi)
- Iifoloji ze-topical, i-ointments, njl. (Ukuphatha iingxaki ezahlukeneyo zesikhumba)
I-Corticosteroids ingasetyenziselwa kunye nezinye iziyobisi kwaye imiselwe ukusetyenziswa kwexesha elifutshane kunye nexesha elide. I-Prednisone (amagama e-brand Cortan, i-deltasone, i-Liquid Pred, i-Meticorten, i-Orasone, i-Panasol-S, i-Prednicen-M, kunye ne-Sterapred) iyona ndlela eqhelekileyo echanekileyo ye-corticosteroid ye-arthritis. Kwimizuzu emine ukuya kweyesihlanu ibe namandla njengekhostisol. Ngako oko, iiligrigram ezinhlanu ze-prednisone zilingana nomkhiqizo we-cortisol yemihla ngemihla. Kukho ezinye ii-corticosteroids ezikhoyo ezikhoyo ezahlukileyo kwi-potency kunye nesiqingatha sobomi.
Injecting vs. Oral Corticosteroids
Ukudubula kwe-steroid, okubizwa ngokuba yi-cortisone shot, i-corticosteroid injection, okanye unyango lwama-intra-articular ngumjovo we-steroid ngqo kwi-joint joint. Le ndlela ivumela oogqirha ukuba basebenzise iqondo eliphezulu le-corticosteroid ngqo kwisiza sokuvuvukala. Ekubeni ikwasekuhlaleni, lonke umzimba uyawusindisa ingxube ephezulu yeziyobisi.
Usulelo lwesayithi kwindawo yokujola isiphumo esisecaleni. Iijojo eziqhelekileyo kwi-joint joint zingenza umonakalo we-cartilage. Oogqirha basebenzisa le nyango ngokukhawuleza, emva kokunye okukhethwa kukho, baye bazama ukunciphisa inani leenjini ukwenzela kanye emva kweenyanga ezimbalwa kunye nembalwa ngokubambisana ngokubambisana.
Imiphumela
Impembelelo enamandla ye-corticosteroids inokubangela iziphumo ezibi kakhulu ezifana nezifo zeCushing, ukungasebenzi kwemigodi ye-adrenal okubangelwa ukugqithiswa kwe-cortisol. Uluhlu lweziphumo ezinobungozi lude kwaye lubandakanya:
- Ukwandisa ukondla kunye nokunyuka kwesisindo
- Iifosti zamanqatha esifubeni, ubuso, ngasemva, nesisu
- Ukugcinwa kwamanzi kunye neetyuwa ekukhohliseni kunye ne-edema
- Igazi elonyukayo
- Sikashukela
- Amanqaku amnyama kunye namabhakabhaka
- Ukunciphisa ukuphulukiswa kwamanxeba
- Osteoporosis
- Cataract
- Acne
- Ubuthakathaka obuthathaka
- Ukucocwa kwesikhumba
- Ukwanda kwamathuba okusuleleka kwintsholongwane
- Izilonda zesisu
- Ukwandisa ukujuluka
- Ukuhamba kweemvakalelo
- Iingxaki zeengqondo ezifana nokudandatheka
- Ukunciphisa i-Adrenal kunye neengxaki
Imiphumo emibi ingancitshiswa ngokulandela imiyalelo yesigqirha kunye nokuthatha i-dose esebenzayo. Kwakhona kubalulekile ukuphepha ukuzithethelela komthamo, mhlawumbi ngokungeza ngaphezulu okanye ukumisa amayeza ngaphandle kweshedyuli.
Ixesha elifutshane elijongene noTywala lwexesha elide
Xa isetyenziswe njengonyango lwexesha elifutshane, i-prednisone ivame ukumiselwa kwiqondo elimodareyithwayo kwaye liyancitshiswa okanye "lifakwe" kwixesha elilodwa okanye ezimbini zeveki. Injongo kukufikelela ekuphuculeni ngokukhawuleza kwiimpawu, kodwa ingasondelanga ixesha lokusetyenziswa kwe-corticosteroid.
Ixesha elide lonyango lugcinwe kwiimeko ezinzima zesifo se-rheumatoid okanye izifo ezihlobene. I dose ngokuqhelekileyo i-milligram ye-prednisone ibe yiminyaka emihlanu ukuya kweyesixhenxe neyesigamu ngosuku oluqhubekayo kwiinyanga okanye iminyaka.
I-dose ephezulu ye-dotero inikezelwa ngezihlandlo kwiimeko ezinqabile kakhulu, ezinzima kakhulu kwizifo ezivuthayo. Umthamo ophezulu uthathwa njengama-daily dose we-prednisone kwi-milligram enye nge kilogram yesisindo somzimba okanye malunga nee-milligram ezingama-60 ngosuku olunikezwa ngamanani ahlukeneyo. Kwiimeko ezinjalo, i-steroids "ifakwe" ngokukhawuleza.
Ukunciphisa iziphumo ezichaphazelekayo, i-corticosteroid efunekayo ephantsi kakhulu ifunekayo. Lelo liqondo elifanelekileyo.
Ukuyeka
I dose ye-corticosteroids kufuneka iyancitshiswe kancane ukwenzela ukuba izigulane ze-adrenal ziqalise ukuveliswa kwe-cortisol yemvelo. Ukuphelisa amayeza ngokukhawuleza kunokubangela i-adrenal crisis (imeko ebungozi yobomi obangelwa ngamanqanaba aneleyo e-cortisol) nangona oku kunqabile.
Kwiimeko apho i-corticosteroids ithathwa kwiqondo elingaphantsi ixesha elide, ukupakisha kunokuqhubeka kweenyanga okanye iminyaka. Ngamanye amaxesha, amanani ayancipha nge-milligram enye ngexesha elide lokuthintela ukuphazamiseka. Xa i-steroids ithathwa ixesha elifutshane, i-tapering iyanda ngokukhawuleza kwaye iyancipha kwi-dosage ingaba mkhulu.
Enye inkxalabo ekhoyo enxulumene nokunqanyulwa kwe-steroids yi-steroid ye-withdrawal syndrome, okanye isiphumo sokuhlawuleka, okuyiyo impendulo yomzimba ekugqibeleni ukususwa kweziyobisi. Impembelelo ephumayo ingakhokelela kumkhuhlane, intlungu yesisu, kunye nentlungu edibeneyo, okwenza kube nzima ukuba ugqirha uhlukanise phakathi kweempawu zokurhoxisa kunye nesifo sesifo ngokwaso.
Ukukhetha
Ngokutsho kwePill Book (iincwadi zeBantam), usebenzisa ii-milligram ze-prednisone njengesiseko sokuthelekisa, ixabiso elinganayo lezinye i-corticosteroids zezi:
- 0.6 mg-0.75 mg weBetamethasone
- 25 mg yeCortisone
- 0.75 mg yeDexamethasone
- 20 mg ye-Hydrocortisone
- 4 mg weMethylprednisolone
- 5 mg wePrednisolone
- 4 mg ye-Triamcinolone
I-Corticosteroid Converter ibalwa ama-dose alinganayo nee-corticosteroids ezahlukeneyo. Ithuluzi lokuguqula lula ukuyisebenzisa.
ILizwi
I-Corticosteroids ziinkunkuma ezinamandla ezinokuphucula iimpawu kwaye ziphumele iziphumo ezintle. Kukho iziphumo ezinokubambisana nokusetyenziswa kwazo ezingafanelekanga, nangona kunjalo. Amandla e-corticosteroids akufanele akwesatshwe, kodwa kufuneka ahlonishwe.
Imithombo:
I-Kelley's Bookbook yeRheumatology. I-ninth edition. Elsevier. I-Glucocorticoid Therapy Isahluko 60. Jacobs noBijlsma.
I-Duke University Medical Centre ye-Arthritis, uDavid S. Pisetsky MD
Sobel, Klein. IArthritis: Yintoni eyenza, iStartin Press; 1999.