I-Angiotensin II receptor blockers (ARBs): Ukusetyenziswa, iimveliso eziqhelekileyo kunye nolwazi lokhuseleko
Ulwazi lweziyobisi I-Angiotensin II receptor blockers (ARBs) inyanga uxinzelelo lwegazi kunye nokusilela kwentliziyo. Funda ngakumbi malunga neentlobo zee-ARB kunye nokhuseleko lwazo apha.Uluhlu lweeARB | Yintoni ii-ARB? | Indlela abasebenza ngayo | Sebenzisa | Ngubani onokuthatha ii-ARB? | Ukhuseleko | Imiphumela | Iindleko
Uxinzelelo lwegazi oluphezulu yimeko eqhelekileyo yonyango echaphazela amakhulu ezigidi zabantu baseMelika. I-Angiotensin II receptor blockers (ARBs) ziludidi lwamachiza asetyenziselwa ukuthoba uxinzelelo lwegazi kwaye lolunye lweentlobo zokuqala zamachiza abaya kumiselwa ngoogqirha kule meko. Ziyasebenza kakhulu kwaye zisetyenziselwe ukunyanga uxinzelelo lwegazi (uxinzelelo lwegazi oluphezulu) amashumi eminyaka. Ii-ARBs zisetyenziselwa ukunyanga ezinye iintlobo zesifo sentliziyo ngokunjalo. Eli nqaku liza kunika isishwankathelo sale klasi yamayeza. Siza kudwelisa amagama ohlobo oluthile kunye nalawo enziwe afana nalawo aveliswe ngumenzi, sinike ulwazi ngeendleko zawo, sichaze ukuba zisebenza njani iziyobisi, kwaye sigubungele ukusetyenziswa kwazo kunye nokuqwalaselwa kokhuseleko.
Uluhlu lweeARBs | |||
---|---|---|---|
Igama lebrand (igama eliqhelekileyo) | Ixabiso eliphakathi lemali | Ugcino olulodwa | Funda nzulu |
Ukuhlaselwa (candesartan) | $ 127 nge-30, iipilisi ezili-16 mg | Fumana iikhuphoni zamakhandlela | Iinkcukacha zeCandesartan |
I-Avapro (irbesartan) | $ 104 nge-30, iipilisi ezingama-300 mg | Fumana amatikiti e-irbesartan | Iinkcukacha ze-Irbesartan |
IBenicar (olmesartan) | $ 182 nge-30, iipilisi ezingama-20 mg | Fumana amatikiti e-Olmesartan | Iinkcukacha zika-Olmesartan |
UCozaar (losartan) | Iidola ezingama-98 nge-30, iipilisi ezingama-50 mg | Fumana amatikiti e-losartan | Iinkcukacha zeLosartan |
UDiovan (valsartan) | Iidola ezingama-234 nge-30, iipilisi ezingama-320 mg | Fumana amatikiti evalsartan | Iinkcukacha zeValsartan |
IMicardis (itelmisartan) | $ 170 nge-30, iipilisi ezingama-20 mg | Fumana amatikiti etelmisartan | Iinkcukacha zeTelmisartanicardis |
Ezinye ii-ARBs
- Edarbi (azilsartan)
- UTeveten (eprosartan)
Ii-ARBs zihlala zidityaniswa nezinye iziyobisi ezichasene noxinzelelo lwegazi-ezinje nge-diuretic okanye i-calcium channel blocker-ukunciphisa inani lezigulana ezizithathayo ngosuku. Apha ngezantsi kukho imizekelo:
- Exforge (valsartan kunye neamlodipine)
- Avalide (irbesartan kunye nehydrochlorothiazide)
- Azor (olmesartan kunye neamlodipine)
- Twynsta (telmisartan kunye neamlodipine)
- IHyzaar (losartan kunye nehydrochlorothiazide)
- IDiovan HCT (valsartan kunye nehydrochlorothiazide)
- I-Benicar HCT (olmesartan kunye nehydrochlorothiazide)
- IMicardis HCT (telmisartan kunye nehydrochlorothiazide)
Yintoni ii-angiotensin II receptor blockers (ARBs)?
I-Angiotensin II receptor blockers - okanye ii-ARBs ngokufutshane - Ngaba iklasi yamayeza asetyenziselwa ukunyanga uxinzelelo lwegazi oluphezulu. Ngelixa zonke ii-ARBs zivunywa yi-FDA ukunyanga uxinzelelo lwegazi oluphezulu, ii-ARBs ezithile zinemvume ye-FDA yokusetyenziswa kwezinye iimeko zeklinikhi ezinje ngokusilela kwentliziyo, isifo sezintso esinxulumene nesifo seswekile, okanye uthintelo lweziganeko zentliziyo. Ii-ARBs ziqheleke kakhulu kwaye ziye zasetyenziswa ukusukela kwiminyaka yoo-1990.
Zisebenza njani ii-ARB?
Umzimba ulawula uxinzelelo lwegazi kunye nevolumu usebenzisa uthungelwano lonxibelelwano olubizwa ngokuba yi-renin-angiotensin-aldosterone system (RAAS). Le nkqubo ivumela izintso ukuba zithumele imiqondiso kwimithambo yegazi nakwamanye amalungu. Izintso zivelisa iprotein ebizwa ngokuba yi-renin. Le protein isetyenziselwa ukwenza i-angiotensin II, ihomoni exelela imithambo yegazi, idlala lobuchopho, kunye namadlala e-adrenal ukunyusa uxinzelelo lwegazi kunye nevolumu yegazi.
Kulapho ii-ARB zingena khona. La machiza athintela ifuthe le-angiotensin II ukuze le hormone ingakwazi ukunxibelelana namanye amalungu. Ke, ii-ARBs zithintela ukunyuka koxinzelelo lwegazi kunye nevolumu yegazi.
Ii-ARB zifana kakhulu nolunye udidi lwamayeza oxinzelelo lwegazi. I-Angiotensin-eguqula i-enzyme inhibitors, okanye i-ACE inhibitors ngokufutshane, iphazamisana nenkqubo yeRAAS. Nangona kunjalo, i-ACE inhibitors iyaphula unxibelelwano kwangethuba kumqondiso wecascade, iphazamisa imigca emininzi yonxibelelwano. Ii-ARBs ziphazamisa kamva kwi-Cascade kwaye zivimbe imiqondiso ejolise ngakumbi kuxinzelelo lwegazi. Ngesi sizathu, ii-ARBs zibangela iziphumo ezibi ezimbalwa xa kuthelekiswa ne-ACE inhibitors.
Zisetyenziselwa ntoni ii-ARB?
Zonke ii-ARBs zivunyiwe yi-FDA uxinzelelo lwegazi . Ezinye ii-ARBs ezinjenge-losartan, i-candesartan, kunye ne-valsartan nazo zivunyiwe yi-FDA kwisifo sentliziyo esithile esibizwa ngokuba yi-congestive ukumelwa yintliziyo . Ii-ARB ezithile zinezinye izinto ezivunyiweyo ze-FDA kubandakanya:
- Uthintelo lweziganeko zeCV kwizigulana ezinesifo sokungasebenzi kakuhle kwekhohlo kwasemva kokubeleka emva kwentliziyo (isifo sentliziyo)
- Isifo sezintso esibangelwa isifo seswekile (proteinuria / microalbuminuria)
- Ihypertrophy yasekhohlo ye-ventricular
Itshathi engezantsi ishwankathela izikhombisi ezivunyiweyo ze-FDA zee-ARB ezithile:
Uphawu | Ii-ARB zivunyiwe ukuba zisetyenziswe |
Uxinzelelo lwegazi | Zonke ii-ARBs |
Ukumelwa yintliziyo | I-Candesartan, valsartan |
Ihypertrophy yasekhohlo ye-ventricular | ILosartan, losartan-hydrochlorothiazide |
Imyocardial infarction | Valsartan |
Isifo sezintso esibangelwa sisifo seswekile | ILosartan, irbesartan |
Ii-ARB zisetyenziswa ngaphandle kwelebheli kwezinye iimeko zeklinikhi ezinje:
- I-fibrillation ye-Atriya
- Isifo sezintso esinganyangekiyo (CKD)
- Iscleroderma
- Migraine uthintelo
Ii-ARBs ezahlukeneyo zibonisa iipropathi ezahlukeneyo. Ngesi sizathu, ii-ARBS ezithile ziluncedo ngakumbi kwiimeko ezithile zonyango. Umzekelo, icandesartan inayo ubonakalise ukusebenza ngokuthintela i-migraine ngenxa yeepropati zayo.
Ngelixa ii-ARBs ezininzi zinokusetyenziselwa imeko ethile, ii-ARBs ezithile zinokufuneka ngokuxhomekeke kwiimpawu zesigulana. Umzekelo, i-losartan yi-ARB yokhetho kwizigulana ezine-hyperuricemia, ngelixa i-candesartan, i-olmesartan, kunye ne-valsartan zinokuyenza mandundu le meko. Ezinye ii-ARB zinokukhethwa ngaphezu kwezinye kwiimeko ezithile zeklinikhi. ILosartan lukhetho lodidi lokuqala kwizigulana ezixinzelelekileyo ezisemngciphekweni omkhulu wokubetha. Ekugqibeleni, kuxhomekeke kugqirha ukuba achonge eyona ARB yesigulana esithile.
Ngubani onokuthatha ii-ARB?
Iintsana, abantwana kunye nolutsha
Ii-ARBs ezininzi zikhuselekile kwaye ziyasebenza kunyango lwexinzelelo lwegazi ebantwaneni. ILosartan, i-valsartan, kunye ne-olmesartan banemvume ye-FDA yokusetyenziswa kubantwana abadala kuneminyaka emi-6, ngelixa i-candesartan inemvume yokusetyenziswa kubantwana abadala kunonyaka omnye. Ngokwe-National Kidney Foundation, la machiza banokuba ziiarhente ezikhethiweyo zokucothisa ukuqhubela phambili kwe-CKD ebantwaneni. Ezinye ii-ARBs zichazwe ngaphandle kwelebheli ebantwaneni, ngaphandle kwedatha encinci yokuxhasa ukhuseleko kunye nokusebenza kwaba bantu. Ukusetyenziswa okukhuselekileyo nokusebenzayo kwe-ARBs ebantwaneni kufuna uhlengahlengiso lwethamo ngokusekwe kubudala kunye nobunzima.
Abantu abadala
Ii-ARBs zithathwa ngokuba zikhuselekile kwaye ziyasebenza kubantu abadala. Iziphumo ebezingalindelekanga zixhaphakileyo zincinci kwaye zinokubandakanya ukuba nesiyezi, intloko ebuhlungu, ukukhohlela kunye nokozela. Abanye abaguli banokufumana iziphumo ebezingalindelekanga ezinganyamezelekiyo. Kubalulekile ukudibana nomboneleli wezempilo malunga neziphumo ebezingalindelekanga ukuze unyango luhlengahlengiswe ngokufanelekileyo.
Abadala
Ii-ARBs zikhuselekile kwaye ziyasebenza kwizigulana ezigugileyo njengoko zinjalo kwizigulana ezisencinci. Inani labantu abadala liba uninzi lwezigulana ezifumana unyango lwezintso endaweni yazo, kwaye ii-ARBs zinokubonelela ngesibonelelo esibalulekileyo ngokunciphisa ukuqhubela phambili kwesifo sezintso. Iziphumo ezibaluleke kakhulu ezichongiweyo kwizigulana ezindala ezithatha ii-ARBs zonyuswe i-serum potassium (hyperkalemia). Vala ukubeka esweni i-potassium ye-serum kucetyiswa esi sigulana njengobungozi bokwanda kwe-hyperkalemia kunye nobudala kunye nenani le-comorbidities.
Umonde onesiphene sesibindi
Izigulana ezinesifo sesibindi ezithatha ii-ARBs zisenokufuna ukuqala kwidosi esezantsi. Idosi yokuqala ye-losartan ngama-25 mg kwizigulana ezinokukhubazeka kwesibindi; Sisiqingatha sesiqingatha sokuqala esinconywayo sokuqala. Iphakheji ifaka i-candesartan ikwacebisa ukuba kusetyenziswe isiqingatha sedosi yesiqhelo yokuqalisa kwizigulana ezinesifo sesibindi. Ngenxa yokuba ii-ARBs zisuswa ikakhulu emzimbeni sisibindi, kubalulekile ukuqala kwidosi esezantsi kwaye unyuse ngononophelo unyango kwesi sigulana.
Ngaba ii-ARBs zikhuselekile?
IARB iyakhumbula
Abasasazi abaninzi be-valsartan, i-losartan, kunye neemveliso ezine-irbesartan bakhunjulwa ngenxa yokungcola kwe-NMBA. Ukukhumbula kwaqala phakathi ku-2018 kwaye kwaqhubeka ngo-Septemba ngo-2019 uhlaziyo kunye namaphepha eendaba malunga nokukhumbula oku kuthunyelwe kwi-intanethi yi-FDA, kunye ne uluhlu olubanzi Kuzo zonke iimveliso ezichaphazelekayo ekukhunjuleni okuqhubekayo kwamayeza e-ARB. Abasasazi abachaphazeleke zizikhumbuzo zibandakanya, kodwa azikhawulelwanga, Teva, Macleods, Mylan, Torrent, Aurobindo, Solco Healthcare, Prinston, and Camber Pharmaceuticals. Usokhemesti wakho unokunceda ngemibuzo okanye iinkxalabo ezinxulumene nayo wakhumbula amayeza.
Izithintelo zeARB
Musa ukuthatha naliphi na iyeza le-ARB ukuba kukho i-hypersensitivity kuyo nayiphi na into eyenziweyo.
Ii-ARBs kufuneka zisetyenziswe ngononophelo kwizigulana ezinokungalingani kwe-electrolyte kubandakanya isodiyam esezantsi (i-hyponatremia) kunye namanqanaba aphezulu e-potassium (hyperkalemia). Ii-ARBs zinokuzenza mandundu ngakumbi ezi kungalingani ngokuthi ukunciphisa ukugcinwa kwesodiyamu kwii-tubules ezi-proximal kunye ne-distal zezintso, nangokuthi ukunciphisa ukugcinwa kwe-potassium kwindawo yokuqokelela .
Izigulana ezinesifo semithambo, esaziwa njenge-renal artery stenosis (RAS), kwizintso zombini, okanye kwizigulana ezinezintso ezisebenzayo kunye nokuxilongwa kwe-RAS, akufuneki zithathe ii-ARBs. Ii-ARB zichaphazela ukujikeleza kwegazi kwizintso, ezinokwehlisa izinga lokuhluza i-glomerular kwizigulana ezinesifo esibi sezintso. Oku kunokuba nzima ekusebenzeni kwezintso kwaye kukhokelele ekusileleni kwezintso.
Kwangokunjalo, ukupheliswa kwevolumu kufuneka kulungiswe kwizigulana ngaphambi kokuqala unyango nge-ARB. Xa isigulana siphelelwe ngumthamo, izinga lokuhluza izintso lixhomekeke kakhulu kwi-angiotensin II, yiyo loo nto ii-ARBs zinokuqhubeka nokubeka esichengeni ukusebenza kwezintso xa zithathwa kweli lizwe.
Ii-ARBs akufuneki zithathwe zizigulana ezisebenzisa i-ACE inhibitors okanye i-renin-inhibitors ngqo (i-DRI) enje ITekturna (Aliskiren). Zonke ezi ntlobo zintathu zamayeza zisebenza kwinkqubo ye-renin-angiotensin kwaye uzithatha kunye zihlanganisa umngcipheko wokuphazamiseka kwezintso, i-hyperkalemia, kunye ne-hypotension. Qiniseka ukuba ugqirha wakho uyazi onke amayeza owasebenzisayo ukuthintela ukuhlangana kweziyobisi okunokuba yingozi.
Ngaba ungazithatha ii-ARBs ngelixa ukhulelwe okanye uncancisa?
Yeka ukuthatha i-ARB ngokukhawuleza ukuba ukrokrela ukuba ungakhulelwa kwaye qhagamshelana nogqirha wakho ngokukhawuleza. Ii-ARBs kufuneka zithintelwe ngexa lokukhulelwa kunye nokuncancisa ukuba kunokwenzeka. Onke amayeza e-ARB aqulathe isilumkiso sebhokisi emnyama malunga nokwenzakala okunokubakho okanye ukusweleka kwimveku engekazalwa xa kusetyenziswa ii-ARBs ngexesha lokukhulelwa.
Ngaba ii-ARBs zilawulwa zizinto?
Hayi, ii-angiotensin II receptor antagonists azilawulwa zizinto.
Iziphumo eziqhelekileyo ze-ARB
Oku kulandelayo licala eliqhelekileyo elinokuthi lenzeke ngelixa uthatha ii-ARBs. Olu ayilo luhlu olupheleleyo, kuba lubandakanya kuphela iziphumo ebezingalindelekanga eziqhelekileyo kuzo zonke ii-ARBs. Iziphumo ebezingalindelekanga ezongezelelekileyo zinokuba yinto eqhelekileyo kumachiza athile ngaphakathi kule klasi. Ukuba ufumana iziphumo ezibi okanye ezinganyamezelekiyo, nxibelelana nogqirha okanye usokhemesti ngolwazi oluthe kratya kunye nengcebiso.
- Intloko ebuhlungu
- Urhudo
- Khohlela
- Usulelo oluphezulu lokuphefumla (URI)
- I-potassium ephezulu (hyperkalemia)
- Uxinzelelo lwegazi
- Ukuba nesiyezi
- Ukudinwa
- I-Asthenia (ubuthathaka okanye ukungabikho kwamandla)
- Intlungu yemisipha
Ii-ARBs ziye zaziwa ukuba zibangela iziphumo ebezingalindelekanga ezinzima ezibizwa ngokuba yi-angioedema. Nangona kunjalo, le mpembelelo yecala ayiqhelekanga kakhulu kwii-ARB xa kuthelekiswa ne-ACE inhibitors. Esi siphumo sisecaleni sikholelwa ukuba sibangelwa yi-bradykinin, ipeptide ye-vasodilating enokubangela ukudumba kunye nokudumba. Ii-ARBs azonyusi i-bradykinin iye kwinqanaba elifanayo ne-ACE inhibitors.
Ixabisa malini iiARB?
Uninzi lweziyobisi ezikule klasi ziyafumaneka njenge-generic ngexabiso eliphantsi kunogxa wabo wegama lophawu. Umzekelo, IBenicar inokuxabisa ngaphezulu kwe- $ 300 kunikezelo lweentsuku ezingama-30. Inguqulelo yohlobo oluqhelekileyo, i-olmesartan, iyafumaneka ngaphantsi kwe- $ 5 nge Ikhuphoni elilodwa. Ngelixa uninzi lwamagama e-ARBs lubiza ngaphezulu kwe- $ 200, iinguqulelo zesiqhelo zihlala zibiza imali engaphantsi kwe- $ 30 nge-SingleCare.
Ii-ARBs zigutyungelwe luninzi lwezonyango kunye nezicwangciso zeinshurensi, nangona ezinye ii-ARB zinokukhethwa kunezinye. Umzekelo, i-losartan idweliswa njengonyango lwenqanaba 1 - okanye ukhetha iziyobisi-ngelixa ezinye iziyobisi ezidibeneyo njenge-candesartan-hydrochlorothiazide isenokungagutyungelwa kwaphela. Ukongeza, isicwangciso sakho seinshurensi sinokumisela isigubungelo ngokubhekisele ekuchongeni okuchazwe kummiselo wesigulana. Uxinzelelo lwexinzelelo sesona sifo sinokubakho kwisigunyaziso.
Nokuba isicwangciso seinshurensi siwagubungela amayeza akho, kunokuba yexabiso eliphantsi ukusebenzisa Ikhuphoni elilodwa .
Izixhobo:
- Isishwankathelo se-generic angiotensin receptor blockers , LOUSE. Usokhemesti
- Olunye uthintelo lonyango lwe-anti-migraine: I-ACE inhibitors, ii-ARBs, iicalcium block blockers, i-serotonin antagonists, kunye ne-NMDA receptor antagonists , Ukhetho lwangoku kunyango kwi-Neurology
- Ngaphezu kwe-100 yezigidi zaseMelika zinexinzelelo lwegazi Umbutho wentliziyo yaseMelika
- Ukhetho lokonyango olwahlukileyo nee-ARBs. Yeyiphi oyinike? Nini? Ngoba? , Ijenali yaseMelika yeziyobisi zentliziyo
- I-KDIGO 2021 izikhokelo zeklinikhi yokulawulwa koxinzelelo lwegazi kwizifo zezintso ezingapheliyo , Izintso zamazwe ngamazwe
- Ukusebenza kwe-angiotensin yokuguqula i-enzyme inhibitors kunye ne-angiotensin receptor blockers kunyango lothintelo lwe-episodic migraine kubantu abadala , Iingxelo zangoku zeNtlungu kunye neNtloko
- Ukusebenza kunye nokukhuseleka kwe-angiotensin II receptor blockade kwizigulana ezindala ezinesifo seswekile, Umbutho weSwekile yaseMelika
- I-Angiotensin receptor blockers iyasitshintsha isingqisho se-circadian soxinzelelo lwegazi ngokucinezela ukubuyiselwa kwakhona kwe-sodium tubular , Ijenali yaseMelika yePhysology
- Hyperkalemia enxulunyaniswa ne-angiotensin-eguqula i-enzyme inhibitors kunye ne-angiotensin receptor blockers , Unyango lweentliziyo
- I-Angiotensin II Receptor Blockers (ARB) -IinkcazoPearls
- I-Angiotensin-eguqula i-enzyme inhibitors kunye ne-receptor blockers kwintliziyo ukusilela kunye nesifo sezintso esinganyangekiyo -ehlisa iingxabano - Ijenali yentliziyo yaseIndiya