Eyona >> Ulwazi Lweziyobisi >> Uluhlu lweeopioid: Ukusetyenziswa, iimveliso eziqhelekileyo kunye nolwazi ngokhuseleko

Uluhlu lweeopioid: Ukusetyenziswa, iimveliso eziqhelekileyo kunye nolwazi ngokhuseleko

Ulwazi lweziyobisi iOpioids isebenza ngokuthintela imiqondiso eya kwingqondo ebhalisa iintlungu. Funda ngakumbi malunga nokusetyenziswa kwe-opioid kunye nokhuseleko apha.

Ulawulo lwezinhlungu sisihloko esifumana ingqalelo enkulu kumzi mveliso wanamhlanje wezempilo. Esinye sezizathu eziqhelekileyo zokuba abantu baye kwindawo ekuthengiswa kuyo iziyobisi kukufumana iyeza lentlungu. Iziyobisi ezithomalalisa iintlungu kuthiwa zii-analgesics. Ama-analgesics ayafumaneka ekhawuntareni nangemigqaliselo. Ke, uyazi njani ukuba yeyiphi i-analgesic efanelekileyo eyakho intlungu? Lo ngumbuzo obalulekileyo wokulawula iintlungu ngokufanelekileyo.

Ngentlungu ebukhali-emva kotyando okanye ukwenzakala okubuhlungu, umzekelo-iiopioid zezona zilungileyo zokuthomalalisa iintlungu. Ukuba ukhe waphula ithambo okanye wasusa amazinyo obulumko, unokuqhelana neopioid ezithile ezinje ngePercocet, Lortab, okanye iTylenol # 3. Kule nqaku, siza kuqwalasela iinkcukacha ezibalulekileyo malunga neyeza ze-opioid-kuquka iipropati zabo, amagama egama eliqhelekileyo kunye nokusetyenziswa okukhuselekileyo.

Uluhlu lweeopioid
Igama lesiqhelo	Amagama eBrand	Ixabiso eliphakathi lemali	Ugcino olulodwa	Funda nzulu
Ikhowudi ye-Acetaminophen # 3	Itylenol # 3	$ 13.92 ngeepilisi ezingama-20, 300-30 mg	Fumana amatikiti	Funda nzulu
IBuprenorphine	IBuprenex, iSubutex, iButrans, iBelbuca	$ 52.48 nge-10, iipilisi ze-8 mg	Fumana amatikiti	Funda nzulu
Fentanyl	Actiq, Abstral, Duragesic, Fentora, Subsys	$ 149 nge-10, 25 mcg / hr patches	Fumana amatikiti	Funda nzulu
IHydrocodone-acetaminophen	INorco, iLortab, iLorcet, iXodol, iHycet	$ 14.73 nge-12, 5-325 mg iipilisi	Fumana amatikiti	Funda nzulu
I-hydrocodone bitartrate	IZohydro ER, iHysingla ER	$ 283 nge-30, 10 mg njengezingxobo	Fumana amatikiti	Funda nzulu
I-Hydrocodone-homatropine	IHydodan, iHydromet	$ 37.52 ngeedola ezingama-30, 5-1.5 mg	Fumana amatikiti (tablet) Fumana amatikiti (ulwelo)	Funda nzulu
IHydromorphone	UDilaudid, Exalgo	$ 21.15 nge-30, 2 iipilisi mg	Fumana amatikiti	Funda nzulu
Imeperidine	Idemerol	$ 3.90 nge-1mL ye-50 mg / mL	Fumana amatikiti	Funda nzulu
Imethadone	Dolophine, Methadose, Diskets	$ 42.84 nge-90, 10 iipilisi mg	Fumana amatikiti	Funda nzulu
I-Morphine (ukukhutshwa okude)	IKadian, iMelika iyaqhubeka, iMorphabond	$ 74.26 nge-60, 15 iipilisi mg	Fumana amatikiti	Funda nzulu
I-morphine sulfate (ukukhutshwa kwangoko)	Roxanol (ayisebenzi)	$ 41.37 nge-60, 15 iipilisi mg	Fumana amatikiti (tablet) Fumana amatikiti (ulwelo)	Funda nzulu
Ioksijodone-acetaminophen	IPercocet, Endocet, Roxicet, Xartemis XR	$ 14.10 nge-12, 5-325 mg iipilisi	Fumana amatikiti	Funda nzulu
Ioksijini-aspirin	IPercodan, i-Endodan	$ 264 nge-120, 4.83-325 mg iipilisi	Fumana amatikiti	Funda nzulu
I-Oxycodone (ukukhutshwa kwangoko)	Oxaydo, Roxicodone	$ 118 nge-120, 10 iipilisi mg	Fumana amatikiti	Funda nzulu
I-Oxycodone (ukukhutshwa okwandisiweyo)	I-Oxycontin, i-Xtampza ER	Iidola ezingama-316 nge-60, iipilisi ezili-10 mg	Fumana amatikiti	Funda nzulu
ITapentadol	INucynta, iNucynta ER	Iidola ezingama-274.57 nge-30, iipilisi ezingama-50 mg	Fumana amatikiti	Funda nzulu
I-Tramadol	Ultram	$ 47.14 nge-60, 50 iipilisi mg	Fumana amatikiti	Funda nzulu

Ezinye iiopioids

Codeine sulphate
I-Duramorph (inaliti morphine)
IHydrocodone-ibuprofen
Ifowuni yefowuni
I-Oxycodone kunye ne-naloxone (Targiniq ER)
I-Tramadol-acetaminophen (i-Ultracet)

Apha ngezantsi kukho amayeza ambalwa opioid asetyenziselwa ukunyanga iimeko ngaphandle kweentlungu:

I-opium tincture yesifo sohudo
I-Loperamide (Imodium) yokuhambisa
I-Diphenoxylate-atropine (Lomotil) yesifo sohudo
I-Hydrocodone-chlorpheniramine (iVituz) yokukhwehlela
I-Buprenorphine-naloxone (i-Suboxone, iZubsolv) yesifo sokusetyenziswa kwe-opioid

Yintoni iiopioids?

Iiopioids ziludidi lweziyobisi ezisetyenziselwa ukunciphisa iintlungu eziphakathi. Ii-opioids zikwabizwa ngokuba zii-narcotic. Igama elithi narcotic lisetyenziswa ngabantu abathile ukubhekisa kwiziyobisi ezingekho mthethweni, kodwa ke ngobuchwephesha kubhekiswa kwiiopioids. Iiopioids zisemthethweni xa kuthengwa amayeza akhutshwe ngokungqinelana nemithetho yomanyano kunye neyaseburhulumenteni.

Iiopioids ziyenzeka ngokwendalo; i-opium, i-morphine, kunye ne-codeine zivela kwi-Asia opium poppy plant. Iiopioids zokwenza izinto zitshintshiwe kwilebhu. Oku kubandakanya i-oxycodone, i-hydrocodone, i-fentanyl, kunye nezinye ezininzi.

Zisebenza njani iiopioid?

Kukho ii-opioid zendalo ezifumaneka emzimbeni wethu ezibizwa ngokuba zii-endorphins. I-Endorphins ibopha kwaye isebenze ii-receptors ezithile kwinkqubo yeemvakalelo. Ngokudibeneyo, ii-receptors ezahlukeneyo zibizwa ngokuba zii-opioid receptors. Xa zenziwe zasebenza, ii-receptors zivimba imiqondiso yokuya kwingqondo ebhalisa iintlungu. Ukongeza kwintlungu ethomalalisayo, oku kunokudala imvakalelo yokuzola kunye nolonwabo.

Imeko eqhelekileyo apho ii-endorphins zenza lo mphumo ngexesha lokuzilolonga. Amachiza e-opioid alingisa ii-endorphins zomzimba ngokwenza ii-opioid receptors ziye kwinqanaba elingaphezulu. Ezinye iziyobisi ze-opioid zinefuthe lazo ngokukhawuleza. Ezi zisetyenziselwa ukunyanga iintlungu zokuqaqamba (iintlungu eziqatha ezihlala ixesha elifutshane).

Iiopioids ezandisiweyo ezikhutshiweyo zisebenza kancinci kodwa ixesha elide. Ezi zihlala zisetyenziselwa ukunceda amanqaku aphantsi entlungu imini nobusuku ngelixa kuncitshiswa ukusetyenziswa kweeopioid ezikhutshwa kwangoko, ezinokuthi zibe ngumkhwa.

Zisetyenziselwa ntoni ii-opioids?

IiOpioids zisetyenziselwa ukunyanga iintlungu ezilinganayo. Ezi meko zonyango zilandelayo zinxulunyaniswa nokusetyenziswa kweopioid:

Umhlaza onje Ileukemia , umhlaza wedlala lobudoda , umhlaza wamathumbu , umhlaza webele , kunye nabanye
Unonophelo lonyango
Ingxaki yeseli yokugula
Isifo samathambo (kubandakanya i-psoriatic arthritis, i-rheumatoid arthritis, kunye ne-osteoarthritis)
Ukuphazamiseka kokusebenzisa iOpioid
ISciatica
Intlungu yasemva koqhaqho
Amatye eentso
Intloko ye-Migraine
Ubuhlungu beMusculoskeletal (njenge iintlungu ezisezantsi )
Iiopioid ngeedosi ezincinci zidityaniswe nezinye izithako zokunyanga ukukhohlela okanye urhudo .

Ngubani onokuthatha iiopioids?

Iintsana, abantwana kunye nolutsha

Iiopioids zimiselwe abantwana kunye nolutsha ukuba zinciphise iintlungu emva kotyando. Ayizizo zonke ii-opioid ezifanelekileyo kweli qela leminyaka. I-Fentanyl, morphine, kunye ne-methadone zisetyenziswa kuyo yonke iminyaka. I-Oxycodone kunye ne-hydromorphone ayiboniswanga ukuba isetyenziswe kubantwana abangaphantsi kweenyanga ezi-6 ubudala. IHydrocodone ayiboniswanga ukuba isetyenziswe kwizigulana ezingaphantsi kweminyaka emi-2 ubudala.

Ngo-2017, i-FDA ndibeke isithintelo ekusetyenzisweni kwekhowudi kunye ne-tramadol ebantwaneni , ngenxa yeengxaki zokuphefumla. Ngokukodwa, i-codeine akufuneki isetyenziswe kubantwana abangaphantsi kweminyaka eyi-12, kwaye i-tramadol akufuneki isetyenziswe kubantwana abangaphantsi kweminyaka eli-18. I-Meperidine ayikhuthazwa ukuba isetyenziswe kwizigulana zabantwana ngenxa yokuqokelelwa kwemetabolite enetyhefu enokubangela ityhefu ekubanjweni, ngakumbi kwabo banezintso ezingasebenzi kakuhle.

Abantu abadala

Iiopioids zikhuselekile ukuba zingasetyenziswa kubantu abadala ukuba zithathwa ixesha elifutshane kwaye njengoko kumiselwe ngumboneleli wezempilo. Iziphumo ebezona zixhaphakileyo ziziphumo zoxinzelelo lwe-CNS, ezibandakanya ukozela, ukuthomalalisa, kunye nokuphazamiseka kwengqondo. Ezinye izigulana zinokufumana ukukhubazeka kwememori okanye ukudideka. Bonke abantu abasebenzisa ii-opioid kufuneka baqonde umngcipheko wendalo wokuxhomekeka kwe-opioid, umlutha kunye nokugqithisa. Le micimbi iyanda xa ii-opioid zisetyenziswa gwenxa.

Abadala

Ukusetyenziswa kwe-opioid kufuneka kuthintelwe xa kunokwenzeka kubemi be-geriatric. Ukusebenzisa ii-opioids kubantu abadala kwandisa kakhulu umngcipheko wokuwa, njengoko kunokubangela i-ataxia, ukungasebenzi kakuhle kwengqondo kunye ne-syncope. Ukuba azikho ezinye iindlela ezikhuselekileyo ezikhoyo, ii-opioid zinokumiselwa kwelonaqondo lisezantsi elisebenzayo- ngesiqhelo i-25% ukuya kwi-50% yedosi yabantu abadala- ize ilungelelaniswe ngokunyamezelana.

Izilwanyana zasekhaya

Iiopioid ezimbini zinemvume ye-FDA yokusetyenziswa kwizilwanyana; i-buprenorphine ivunyiwe ukuba isetyenziswe kwiikati, ngelixa i-butorphanol ivunyiwe ukuba isetyenziswe kwiikati, izinja kunye namahashe. Oogqirha bezilwanyana ngokufuthi bayalela i-opioids ‘off-label’ ukuba isetyenziswe kwizilwanyana zasekhaya. Umzekelo, i-hydrocodone isetyenziselwa ukunyanga iintlungu kunye nokukhohlela ezinjeni. I-Tramadol ihlala imiselwe ukuphatha iintlungu ezinjeni nasezikati.

Ngaba iiopioids zikhuselekile?

Zonke ii-opioid zithwala umngcipheko wokuba likhoboka le-opioid, uxhatshazo kunye nokusetyenziswa gwenxa. IZiko leLizwe kuThintelo lweziyobisi iingxelo ukuba ngaphezulu kwezigidi ezi-2 zaseMelika zisebenzisa kakubi i-opioids kwaye ngaphezulu kwe-90 ye-opioid overdose yokufa kwenzeka eMelika mihla le. Ukusetyenziswa gwenxa kwe-opioid kunye nokumisela ngaphezulu yeyona ngxaki iphambili yezempilo yoluntu ebizwa ngokuba yi ubhubhane we-opioid . Ukunciphisa umngcipheko wokuphathwa gadalala kwe-opioid, iU.S.Ukutya kunye noLawulo lweeDrug (i-FDA) ithathe amanyathelo amaninzi okukhokela abaguli kunye nabasemagunyeni ekusebenziseni kwabo ngokukhuselekileyo.

Ngo-2016, i-FDA yabhengeza imfuno entsha ukuba ii-opioid ezikhutshwa kwangoko zibandakanya isilumkiso sebhokisi emnyama kwileyibhile yabo, echaza umngcipheko wokusetyenziswa gwenxa kunye nokusetyenziswa gwenxa, okunokubangela ukuba likhoboka, ukugqithisa nokufa.

Kwakuloo nyaka, i-FDA yafuna isilumkiso sebhokisi emnyama yeeopioid ezichaza umngcipheko wokusebenzisa iiopioids kunye nezinye iinkqubo zokudakumba zenkqubo ye-nervous, kubandakanya ne-benzodiazepines. Ezi zigaba zibini zahlukeneyo zamachiza, xa zithathiwe kunye, zinokubangela isidumbu, uxinzelelo lokuphefumla, isiqaqa kunye nokufa.

Ngo-2020, i-FDA yafuna oko ilebheli yeeopioid zibandakanya ingcebiso ukuthetha nengcali yezempilo malunga nokusetyenziswa kwe-naloxone-iyeza elisetyenziselwa ukunyanga i-opioid overdose.

Ukusetyenziswa kwexesha elide kweeopioids ngu akusaphakanyiswa ukuba ubuhlungu obungapheliyo ngaphandle kweentlungu ezinxulumene nomhlaza. Ngapha koko, ukusetyenziswa kwexesha elide kweeopioid kunokwenza ezinye iintlobo zentlungu engapheliyo kwaye kubeke abaguli emngciphekweni omkhulu wokuxhomekeka kwe-opioid.

Xa isetyenziswe ngokufanelekileyo, ukusetyenziswa kwexesha elifutshane kwezonyango kwe-opioids kunokukhuseleka kwaye kunqabile kunikeze ukuxhomekeka. Ukuthintela ukugqithisa, hlala ulawula ii-opioids njengoko kuyalelwe kwileyibhile yephakheji.

Ukhumbula iOpioid

Nasiphi na isiyobisi esithengisiweyo sinokukhunjulwa ukuba umenzi okanye abasemagunyeni abalawulayo bayazi ukuba inokuba nesiphene okanye ibe yingozi. Apha ngezantsi kukho iinkumbulo zakutshanje ezinikezelwe kwimveliso yeopioid:

I-Hospira, Inc. Ukhumbule inaliti yabo ye-hydromorphone Nge-13 ka-Epreli 2020, ngenxa yokubanakho kweebhotile zeglasi ezingenanto okanye eziqhekekileyo. Zonke iimveliso ezichaphazelekayo ziphelelwe lixesha.

Alvogen ukhumbule ii-patent ze-fentanyl transdermal patches ngenxa yokulahlekiswa kwemveliso ngoJulayi 2019. Inani elincinci leebhokisi ezinemibhalo yefentanyl yamandla angalunganga. Zonke iimveliso ezichaphazelekayo ziphelelwe lixesha.

Iinkonzo ze-PharMEDium, LLC Ukhumbule inaliti yabo ye-hydromorphone ngenxa yobukho besulfite-ulwazi lokulebhelisha kwimveliso lubanga ukuba imveliso ayinasulfite. Ukuboniswa kwe-sulfite kunokubangela iimpendulo ezibi kakhulu kwizigulana ezine-sulfite allergies. Zonke iimveliso ezichaphazelekayo ziphelelwe lixesha.

Izithintelo zeopioids

Iiopioids kufuneka zithintelwe kwizigulana ezinembali yokusebenzisa iziyobisi okanye ukusetyenziswa gwenxa kweziyobisi njengoko zinokubangela imikhwa.

Sebenzisa ulumkiso olugqithisileyo xa uthatha naliphi na ichiza le-opioid ukuba ukhe waba neempendulo ezibukhali kwi-opioid. Kuqhelekile ukuba ii-opioids zibangele ukukhutshwa kwe-histamine, kukhokelela kurhawuzelelo. Le ayisiyonyani yokwenyani. Ukunyanga okwenyani kwiiarhente ze-opioid kubandakanya i-anaphylaxis okanye i-angioedema. Ngenxa yokufana kubume beekhemikhali zabo, kunokwenzeka ukuba ube namava okuwela umnqamlezo kunye neopioid ngaphandle kwegosa lokoqobo.

Iiopioid akufuneki zisetyenziswe kwizigulana ezinemeko yokuphefumla njengoko uxinzelelo lokuphefumla lunokuba mandundu ziiopioids.

Iiopioid akufuneki zisetyenziswe kwizigulana ezinesithintelo esaziwayo okanye esisolwayo sesisu (GI), kubandakanya ileus ekhubazekileyo, njengoko iiopioid zinokunciphisa ngokubonakalayo ukuhambisa kwendlela ye-GI.

Izigulana ezinesibindi okanye isifo sezintso kufuneka zijongwe ngokusondeleyo ngelixa zikwi-opioids. Iidosi zabo kusenokwenzeka ukuba kufuneka zihlengahlengiswe ukunqanda amanqanaba ayingozi kuxinzelelo lwe-CNS.

Ngaba unokuthatha i-opioids ngelixa ukhulelwe okanye uncelisa?

Amaziko oLawulo lweNtsholongwane kunye noThintelo (CDC) acebisa ngokuchasene nokusetyenziswa kwe-opioid ngelixa ukhulelwe okanye uncancisa ukuba ezinye iindlela ezikhuselekileyo zinokwenzeka. Ukongeza emngciphekweni wokusetyenziswa gwenxa (okunokubangela ukwenzakala kumama), ukusetyenziswa ixesha elide kweeopioid ngexesha lokukhulelwa okanye xa ukuncancisa kunokonzakalisa umntwana. Iiopioid zinqumla i-placenta, ke ii-neonates zichazwa kwiziphumo zazo. Ngokwe-CDC, oku kunokubangela ukuzalwa kwangaphambi kokuzalwa, ukukhula okungalunganga kosana olungekazalwa, kunye neziphene zokuzalwa (kubandakanya iziphene ze-neural tube, glaucoma, iziphene zesisu, kunye neziphene zentliziyo). Kuqhelekile ukuba iintsana zivezwe kwii-opioid ngexesha lokukhulelwa ukuze zikhule ukuxhomekeka kwentsana kunye nokurhoxa.

Iimpawu zokurhoxiswa kwe-opioid kubandakanya ukugabha, urhudo, ukusilela ukutyeba, ukukhala okuphezulu, iipateni zokulala ezingaqhelekanga, ukucaphuka, ukungasebenzi kakuhle, kunye neenyikima. Le meko inokusongela ubomi ngaphandle konyango lwakwangoko. Ubunzima buxhomekeke kwidosi yoomama kunye nobuninzi.

Ngaba izinto ezilawulwa ziiopioid?

Ngenxa yokuba benokubakho gadalala kunye nokusetyenziswa gwenxa, ii-opioids zihlelwa njengezinto ezilawulwayo yi-Arhente yokuNyanzeliswa kweziyobisi e-US (i-DEA) Phantse zonke ii-opioid zidweliswe njengezinto ezilawulwa kwiShedyuli II. Iziyobisi ezikolu luhlu zezona zilawulwa kakhulu kuwo onke amayeza amiselweyo. Kukho okwahlukileyo okumbalwa, njenge-buprenorphine, tramadol, kunye ne-acetaminophen-codeine. Ezi zizinto ezilawulwayo kodwa zinezithintelo ezimbalwa ekusebenziseni kwazo. Inkqubo yokucwangciswa, kunye neziyobisi ezithile ezinikezelwe kwishedyuli nganye, zinokwahluka phakathi kwamazwe ngokwemiqathango kaRhulumente yeZinto ezilawulwayo.

Iziphumo eziqhelekileyo ze-opioids

Kukho iziphumo ebezingalindelekanga ezininzi eziqhelekileyo kuwo onke amayeza e-opioid. Uninzi lwezi ziphumo zingalunganga zoxinzelelo lwe-CNS. Ezi ziphumo bezingalindelekanga zinokunyuswa zizinye izinto ezibangela ukudakumba kwe-CNS, njenge-benzodiazepines, utywala, kunye neebarbiturates. Oku kubandakanya:

Ukozela
Ukudideka
Ukuphazamiseka kokulala
Ukuphazamiseka kwengqondo
IDyspnea (ubunzima bokuphefumla)

Amayeza e-opioid nawo anciphisa isantya sesisu. Oku kubangela iziphumo ebezingalindelekanga ezinje:

Isihlunu / ukugabha
Ukuqunjelwa

Iiopioids zibangela ukukhutshwa kwe-histamine, enokubangela:

Pruritus (ukurhawuzelela)
Irhashalala
Ukuhluza

Ukuba uthabathe iyeza le-opioid ixesha elide, akufuneki uyeke ngequbuliso njengoko unokufumana iimpawu zokurhoxa. Ugqirha wakho kufuneka akhokele isicatshulwa esicothayo sokuyeka iyeza ngokukhuselekileyo.

Ixabisa malini iiopioids?

Uninzi lwe-opioids lufumaneka ngokubanzi kwixabiso elifikelelekayo, elingaphantsi kwe- $ 20 nge Ikhuphoni elilodwa . Ezinye ii-opioid eziqhelekileyo kolu luhlu lwamaxabiso zibandakanya i-tramadol, i-oxycodone, iipilisi ze-buprenorphine, kunye ne-generic Percocet, Lortab, kunye neTylenol # 3. Ezinye ii-opioid zibiza kakhulu.

Umzekelo, i-oxymorphone ihlala ixabisa ngaphezulu kwe- $ 500 ye-generic (okanye i- $ 111.81 ene-singleCare coupon). Ezinye ii-opioid-ezinjengeNucynta -zithengiswa kuphela phantsi kwegama lophawu, nto leyo ebenza babize kakhulu (iNucynta ijikeleze i- $ 274 kunikezelo lweentsuku ezingama-30 kwiivenkile ezininzi ezithengisa izinto).

Izicwangciso ze-inshurensi zihlala zidwelisa uninzi lweeopioid eziqhelekileyo kwiNqanaba 1, elilelona xabiso liphantsi kakhulu kumachiza amiselweyo.

Izicwangciso zeinshurensi zihlala zinciphisa umda wobungakanani beziyobisi ze-opioid abaza kuzigubungela ngexesha elithile. Oogqirha banokungenisa ifom yesigunyaziso sangaphambili kwinkampani yeinshurensi ukuba isigulana sifuna idosi ephezulu kunokuba isicwangciso sivumela ngokwesiqhelo. Umzekelo, iiplani ezininzi zeinshurensi ziya kugubungela kuphela unikezelo lweentsuku ezisi-7 okokuqala xa umxhamli efumana iyeza le-opioid ngelixa besebenzisa isicwangciso sabo sezempilo.

Eminye imida yokugubungela inokusebenza ngokuxhomekeke kwimeko yokuphathwa. Umzekelo, i-methadone igutyungelwe sisicwangciso sezonyango hayi ngokufihla ikhemesti ukuba isetyenziselwa unyango lweziyobisi, endaweni yeentlungu.

Ngaphambi kokuba ugcwalise iyeza lakho le-opioid, jonga kwi-SingleCare Ukuqinisekisa ukuba uhlawula elona xabiso liphantsi.