Organic nitrates - nkà mmụta ọgwụ, mejupụtara

Organic nitrates - nkà mmụta ọgwụ, mejupụtara

Nitroglycerin bụ otu n'ime nitrate otu (ester nke nitric acid na glycerol). Ruo ogologo oge, a kwenyere na omume ya na-adabere na mmụba nke ọbara ọgbụgba n'ihi kpọmkwem myotropic coronary dilating action. Otú ọ dị, catheterization nke sinus nke akwara obi na ndị ọrịa nwere angina gosiri na nchịkwa sublingual nke nitroglycerin fọrọ nke nta ka ọ ghara ime ka ọbara na-erugharị ọbara dị elu, ọ bụ ezie na nnukwu arịa na-agbasa. Otú ọ dị, nitroglycerin, nke a na-enye ozugbo n'ime akwara akwara nke aka ekpe, n'ọtụtụ ndị ọrịa na-amụba ọbara ọgbụgba nke akwara obi, ma ọ dịghị ewepụ angina na-akpata mmega ahụ. Ntinye nitroglycerin na-esote n'ime akwara nyere mmetụta achọrọ. Site na data ndị a ọ na-esote na mmetụta antianginal nke nitroglycerin na-ejikọta ya na mmetụta extracardiac ya. Isi ihe kpatara mkpochapụ ọgụ nke angina pectoris bụ mbelata nke venous na arterial pressure na nitroglycerin na, yabụ, mbelata nke nlọghachi venous na iguzogide nrugharị ọbara na, n'ihi nke a, mbelata tupu na mgbe ibu. obi. N'aka nke ya, nke a na-eduga n'ịbelata ọrụ nke obi na mkpa ya maka oxygen. N'okpuru ọnọdụ ndị a, ọkwa dị ugbu a nke inye ọbara na ikuku oxygen na-aghọ nke zuru oke ma wepụ ọnọdụ hypoxia. Dabere na mmetụta nke arịa ndị ahụ na nitroglycerin, a na-ahazi ha n'usoro a: veins> arterioles> arterioles na sphincters capillary. N'ihe gbasara usoro izu ike nke akwara dị nro, nitroglycerin egosila na ọ na-eme ihe n'otu aka ahụ na ihe ntụrụndụ endothelial (NO). N'ime ahụ, a na-ahapụ nitric oxide site na nitroglycerin (na nitrates ndị ọzọ), site na nke a na-emepụta S-nitrosothiols. Ngwakọta ndị a na-arụ ọrụ cytosolic guanylate cyclase soluble. Nke ikpeazụ na-ebute mbelata nke ọdịnaya nke ion Ca2 + cytosolic efu, nke na-eduga na izu ike nke akwara dị nro. Nitroglycerin na-eme ka ọbara na-enye aka na mpaghara ischemic nke myocardium. Nke a bụ n'ihi ọtụtụ mmetụta. Ya mere, mbelata nke esemokwu diastolic nke mgbidi ventricular na-eme ka ọbara na-enye aka na akụkụ subendocardial nke myocardium. Mgbasawanye nke nnukwu arịa akwara na-arụ ọrụ dị mma. Karịsịa mma bụ mgbasawanye ha na saịtị nke mgbachi. Tụkwasị na nke ahụ, a chọpụtara na nitroglycerin na-eme ka mgbasa ozi dịkwuo mma, ma na-egbochikwa njikọ dị n'etiti ntụgharị uche nke na-eme ka mbelata nke arịa akwara. Nke ikpeazụ na-ebute mbelata nke ọdịnaya nke ion Ca2 + cytosolic efu, nke na-eduga na izu ike nke akwara dị nro. Nitroglycerin na-eme ka ọbara na-enye aka na mpaghara ischemic nke myocardium. Nke a bụ n'ihi ọtụtụ mmetụta. Ya mere, mbelata nke esemokwu diastolic nke mgbidi ventricular na-eme ka ọbara na-enye aka na akụkụ subendocardial nke myocardium. Mgbasawanye nke nnukwu arịa akwara na-arụ ọrụ dị mma. Karịsịa mma bụ mgbasawanye ha na saịtị nke mgbachi. Tụkwasị na nke ahụ, a chọpụtara na nitroglycerin na-eme ka mgbasa ozi dịkwuo mma, ma na-egbochikwa njikọ dị n'etiti ntụgharị uche nke na-eme ka mbelata nke arịa akwara. Nke ikpeazụ na-ebute mbelata nke ọdịnaya nke ion Ca2 + cytosolic efu, nke na-eduga na izu ike nke akwara dị nro. Nitroglycerin na-eme ka ọbara na-enye aka na mpaghara ischemic nke myocardium. Nke a bụ n'ihi ọtụtụ mmetụta. Ya mere, mbelata nke esemokwu diastolic nke mgbidi ventricular na-eme ka ọbara na-enye aka na akụkụ subendocardial nke myocardium. Mgbasawanye nke nnukwu arịa akwara na-arụ ọrụ dị mma. Karịsịa mma bụ mgbasawanye ha na saịtị nke mgbachi. Tụkwasị na nke ahụ, a chọpụtara na nitroglycerin na-eme ka mgbasa ozi dịkwuo mma, ma na-egbochikwa njikọ dị n'etiti ntụgharị uche nke na-eme ka mbelata nke arịa akwara. Nke a bụ n'ihi ọtụtụ mmetụta. Ya mere, mbelata nke esemokwu diastolic nke mgbidi ventricular na-eme ka ọbara na-enye aka na akụkụ subendocardial nke myocardium. Mgbasawanye nke nnukwu arịa akwara na-arụ ọrụ dị mma. Karịsịa mma bụ mgbasawanye ha na saịtị nke mgbachi. Tụkwasị na nke ahụ, a chọpụtara na nitroglycerin na-eme ka mgbasa ozi dịkwuo mma, ma na-egbochikwa njikọ dị n'etiti ntụgharị uche nke na-eme ka mbelata nke arịa akwara. Nke a bụ n'ihi ọtụtụ mmetụta. Ya mere, mbelata nke esemokwu diastolic nke mgbidi ventricular na-eme ka ọbara na-enye aka na akụkụ subendocardial nke myocardium. Mgbasawanye nke nnukwu arịa akwara na-arụ ọrụ dị mma. Karịsịa mma bụ mgbasawanye ha na saịtị nke mgbachi. Tụkwasị na nke ahụ, a chọpụtara na nitroglycerin na-eme ka mgbasa ozi dịkwuo mma, ma na-egbochikwa njikọ dị n'etiti ntụgharị uche nke na-eme ka mbelata nke arịa akwara.

C01DA Organic nitrates

Nitrates, ma ọ bụ nitrovasodilators (NVD), bụ otu ọgwụ (PM) nwere akụrụngwa vasodilating na iche na nhazi kemịkal. A na-ejikọta ha site na usoro a na-ejikarị eme ihe: n'ihi mgbanwe kemịkalụ mgbagwoju anya, nitrates na-agbanwe ghọọ nitric oxide (NO), ihe bụ ihe analog nke ihe a na-akpọ endothelial-based relaxing factor. Ọ DỊGHỊ na-eme ka guanylate cyclase rụọ ọrụ, na-eme ka e guzobe cyclic guanosine monophosphate, nke nwere ike ime ka mkpụrụ ndụ akwara dị nro dị nro.

Site na oke vasodilating mmetụta, nitrates nwere ike ime ka dizziness, adịghị ike, na ọgbụgbọ. Site na mbelata ọbara mgbali elu, ọnọdụ collaptoid nwere ike ime. N'okwu nke ikpeazụ, onye ọrịa kwesịrị ibu ụzọ tọgbọrọ ya, ekwesịrị inye ụkwụ ya elu. Usoro a na-ebelata mmetụta vasodilating nke nitrates na ihe fọrọ nke nta ka ọ bụrụ mgbe niile na-eduga ná mmụba na ọnọdụ ahụ. Ndakpọ na nzaghachi maka oriri nitrate na-emekarị na ndị ọrịa na-ebubughị nitrates, ma ọ bụ n'ọnọdụ ebe ndị ọrịa nwere ogologo ezumike na ịṅụ nitrates. N'ọnọdụ ndị a na-adịghị ahụkebe, ọgwụ nwere ike ịkpata methemoglobinemia, mana mmetụta a ga-ekwe omume naanị mgbe ejiri ya na doses okpukpu iri karịa nke ọgwụgwọ.

Ụzọ bụ isi nke igbochi mmepe nke ndidi na nitrates bụ nchịkwa oge ha:

Ọtụtụ contraindications na nhọpụta nke nitrates bụ ikwu. Ekwesịrị iji nlezianya mee ihe na ndị nwere ọbara mgbali elu, Otú ọ dị, na ndị ọrịa nwere hemodynamics kwụsiri ike, ọ dịghị oke ọbara mgbali elu n'okpuru nke a na-apụghị ịkọwapụta nitrates. N'ime ndị ọrịa nwere ọnọdụ hemodynamics na-akwụghị ọtọ, dịka ọmụmaatụ, nwere infarction myocardial, mgbagwoju anya site na ujo cardiogenic, nnukwu ọdịda ventricular aka ekpe, wdg. ekwesịrị iji nlezianya na-eji ọgwụ eme ihe. A machibidoro iji nitrates mee ihe ma ọ bụrụ na mmụba intracranial na-abawanye, ọbara ọgbụgba n'ụbụrụ, yana nwekwara ike ime ka ọnọdụ ndị ọrịa nwere nnukwu valvụ mitral prolapse dịkwuo njọ ma na-abawanye ogo regurgitation n'ime ha. Na hypertrophic cardiomyopathy obstructive, ojiji nke nitrates nwere ike ịbawanye ogo nke ihe mgbochi ma mee ka ọnọdụ ndị ọrịa dịkwuo njọ,

  • Nhọpụta nke nitrates n'ụzọ dị otú ahụ na-emepụta mmetụta na ehihie (ya bụ, mgbe ndị ọrịa nwere ike exertional angina nwere mkpa maka ọgwụ ọjọọ) ma ghara ịmepụta mmetụta n'abalị (mgbe ọ dịghị mkpa maka ọgwụ na ndị ọrịa na-arịa ọrịa). angina kwụsiri ike). 

Ịnagide nitrates nwere ike ịmalite ngwa ngwa mgbe ụfọdụ, n'ime ụbọchị ma ọ bụ ọbụna awa. A na-ahụ nke a n'ọnọdụ ebe a na-edobe otu ịta ọgwụ ọjọọ ruo ogologo oge. Dịka ọmụmaatụ, mgbe mgbe na nchịkwa intravenous nke nitrates na ngalaba nlekọta kpụ ọkụ n'ọnụ, ihe ịrịba ama mbụ nke ike ọgwụgwụ nke mmetụta na-apụta ugbua 10-12 awa mgbe mmalite nchịkwa. Ihe riri ahụ na nitrates nwere ike gbanwee, ma mgbe a kwụsịrị ọgwụ ahụ, a na-eweghachikarị uche na ya n'ime ụbọchị ole na ole. Ọ bụrụ na ntinye nke nitrate n'ime ọbara na-agbanwe n'ụbọchị na oge a na-emepụta n'oge nke nitrate na-anọghị n'ime ahụ ma ọ bụ dị na obere ntinye uche (a na-akpọ oge a oge na-adịghị na nitrate), mgbe ahụ n'oge. N'oge a, mmetụta nke nitrate nwere oge iji gbakee, na ebe obibi adịghị etolite ma ọ bụ na-eto eto ruo ntakịrị. E gosiputara na ọ bụrụ na n'ụbọchị, oge na-adịghị arụ ọrụ nke nitrate bụ awa 6-8, mgbe ahụ ihe ize ndụ nke ịmalite ịṅụ ọgwụ ọjọọ dị ntakịrị. Ụkpụrụ nke igbochi mmepe nke nitrates riri ahụ dabeere na ụkpụrụ a - usoro nke ha na-eji oge.

Usoro n'ozuzu nke nitrates bụ nhazi nke NO n'ime ahụ, nke na-ekpebi ọrụ ọgwụ nke ọgwụ. Otú ọ dị, enwere ike ịhụ ọdịiche dị ịrịba ama na ịdị irè n'etiti ọgwụ dị iche iche dị na otu a, nke bụ n'ihi ọtụtụ ihe kpatara ya.

  • Na mgbakwunye na nitrate, nye iwu ọgwụ ọzọ nke nwere ikike ime ka ọrụ nitrates nwee ike. Enwere ike nweta nke a site n'ịdepụta ndị a na-akpọ ndị na-enye onyinye nke SH-groups (onye nnọchiteanya kachasị mfe bụ methionine) ma ọ bụ ACE inhibitors - captopril, enalapril, wdg.

Mgbe ị na-eji nitrates, a na-ahụ vasodilation (karịsịa arịa nke akwa venous), nke na-eduga na ntinye ọbara na veins na mbelata nke a na-akpọ preload na obi, yana mbelata njedebe diastolic mgbali. na ventricle aka ekpe na mbelata nke ikuku oxygen myocardial. Nke a na-akọwa ọnụnọ nke anti-ischemic na mgbochi anginal mmetụta na NVD na ndị ọrịa nwere ọrịa obi obi (CHD). Ụfọdụ ọrụ na-arụ na omume a bụ mmetụta NVD na-agbasa ozugbo na akwara akwara. Mmetụta vasodilating nke NVD na-akọwa irè ha na ndị ọrịa nwere nkụchi obi.

  • Kagbuo nitrate ma nye ya ọgwụ antianginal nwere usoro omume dị iche (ọ bụghị nke otu NVD). Ekwesịrị ịkwụsị nitrate nke nta nke nta (n'ime ụbọchị 2-3, ka ọ ghara ịkpata ọrịa nkwụsị. Ọ ga-eburu n'uche na nhọpụta nke otu nitrate kama nke ọzọ (dịka ọmụmaatụ, ọgwụ ID ma ọ bụ IMN kama ọgwụ NG). ) enweghị ike idozi nsogbu ahụ, ebe ọ bụ na ịṅụ ọgwụ ọjọọ na-emepụta ọgwụ niile dị n'ìgwè a. Mgbe ụbọchị ole na ole nke nkwụsịtụ, a na-eweghachikarị mmetụta nke nitrates, enwere ike ịde ya ọzọ, ma n'ụzọ dị otú a iji belata ihe ize ndụ nke ịṅụ ọgwụ ọjọọ na opekempe. .

Nke mbụ, bioavailability (ya bụ, izu oke nke ntinye ọgwụ na-abanye na mgbasa ozi sistemu) nke nkwadebe NVD dị iche iche na ụdị usoro onunu dị iche iche dị iche iche.

Ná nkezi, riri ahụ na nitrates bụ ndị ọzọ akpọ, ogologo na mgbe niile nọgidere na-enwe ịta nke ọgwụ ọjọọ n'ime ọbara. Ya mere, mgbe ị na-eji ụdị ọgwụgwọ transdermal nke nitrates na-edobe mkpokọta ọgwụ otu ụbọchị niile, ihe iri ahụ nwere ike ịmalite ngwa ngwa. A na-ahụkwa otu ọnọdụ ahụ mgbe ị na-agbalị ịnweta mmetụta nitrate na-adịgide adịgide n'ụbọchị niile mgbe ị na-ewere ụdị usoro ọgwụgwọ nke obere oge ma ọ bụ nitrates na-eme ogologo oge ọtụtụ ugboro n'ụbọchị.

Ojiji nke nitrates na angina na-adabere ozugbo na klas ọrụ ya. Site na angina pectoris I FC, mgbe mwakpo na-eme amụma, yana oke mgbatị ahụ, ọ dịghị mkpa maka ọgwụgwọ mgbe niile. Kenye nitrates na-eme mkpụmkpụ tupu ihe omume ndị nwere ike ibute ọgụ angina, bụ isi tupu mgbatị ahụ. Maka nke a, ụdị aerosol NG na ID dị ezigbo mma, na-enwe mmetụta ngwa ngwa, akpọpụta na obere mkpụmkpụ.

Mmetụta mmetụta nke nitrates na-ejikọta ya na ikike ha nwere ime ka vasodilation. Ọtụtụ mgbe ha na-egosipụta site na isi ọwụwa, mgbe ụfọdụ ọ na-esiwanye ike. Na nri mbụ nke nitrates, isi ọwụwa na-apụta n'ọtụtụ ndị ọrịa, na-eri ya mgbe niile na-apụ n'anya kpamkpam ma ọ bụ ike ya na-ebelata nke ukwuu. Otú ọ dị, na ụfọdụ ndị ọrịa, na-eji nitrates eme ihe mgbe nile, ike isi ọwụwa adịghị ebelata (dịka iwu, ndị ọrịa dị otú ahụ nwere akụkọ ihe mere eme nke mmerụ isi); N'ọnọdụ ndị a, a ga-ahapụrịrị oriri nitrates.

  • Jiri nwayọ mụbaa dose nke ọgwụ. Dị ka a na-achị, ịba ụba nke nitrate na-enyere aka iweghachi mmetụta ahụ. Otú ọ dị, nke a na-edugakarị na mmepe nke ịṅụ ọgwụ ọjọọ na mmụba mmanye na dose nke ọgwụ mgbe obere oge gasịrị.

Ọ bụrụ na ọ gaghị ekwe omume ịtụle ịdị irè nke ọgwụgwọ na ọgwụ antianginal site na iji ule mmega ahụ, a na-atụ aro ka iji usoro nyocha na-apụtaghị ìhè. Ọgwụ nitrates dị irè na nkezi na-ebute mbelata nke ọbara mgbali systolic (SBP) na izu ike site na 15-25 mm Hg. Art. Ọ bụrụ na SBP na-ebelata ka ọ dị ntakịrị, mgbe ahụ mmetụta nke ọgwụ na-abụkarị ezughị oke, ma ọ bụrụ na ọ dị ukwuu, mgbe ahụ, ihe ize ndụ nke mmetụta na-abawanye. N'ịtụle SBP tupu ị were ọgwụ ahụ, ọ dị mkpa ịmegharị otu usoro ahụ n'oge a na-atụ anya ka ọ rụọ ọrụ ya (mgbe ejiri ụdị usoro ọgwụgwọ ogologo oge, ọ na-emekarị mgbe awa 2-3 gachara) ma nyochaa ịdị njọ nke ọgwụ ahụ. mmetụta.

N'okpuru riri ahụ, ma ọ bụ ndidi, anyị na-aghọta ike ọgwụgwụ nke mmetụta ọgwụ ọjọọ na-eji mgbe niile. Ogo mmepe nke nitrates riri ahụ dịgasị iche iche na ndị ọrịa dị iche iche. Yabụ, site na iji mbadamba ụrọ nke isosorbide dinitrate (nitrosorbide) 10-20 mg 4 r / ụbọchị maka otu ọnwa, enweghị mmetụta zuru oke na-apụta na 10-15% nke ndị ọrịa nwere angina pectoris kwụsiri ike (mmepe nke ahụ riri ahụ zuru oke). Na 60-70% nke ndị ọrịa, mmetụta nke ọgwụ na-ebelata nke ukwuu, mana ọ na-anọgide na-ahụ maka ahụike (mmepe nke riri ahụ). Na 10-15% nke ndị ọrịa, mmetụta nke ọgwụ na-anọgide na-agbanweghị (ọ dịghị riri ahụ).

Nke atọ, usoro nke NO guzobe na ngwa nke dị iche iche HPD dị iche. Ya mere, a chọrọ ọnụnọ nke otu sulfhydryl (SH-groups) maka ịmepụta NO mgbe ị na-eji ID, IMN, na NG. Site na oriri nitrates mgbe niile, ihe nchekwa nke otu SH na-ebelata, n'ihi nke mmetụta ọgwụ nwere ike ịda mbà. Nke a bụ otu (ma ọ bụghị naanị) usoro maka mmepe nke nitrate ndidi. Maka nhazi nke NO mgbe ị na-eji molsidomine, ọnụnọ nke SH-groups adịghị mkpa, ya mere, mmepe nke ndidi na ọgwụ a nwere ike ọ gaghị adị ka a na-akpọ nitrates organic.

Site na angina pectoris IV FC, a na-achọ nri nitrates mgbe niile iji hụ na mmetụta ọ na-enwe kwa ụbọchị. Maka nke a, ọ kachasị mma ịkọwa nitrates nke ọrụ ogologo oge 2 r / ụbọchị - n'ụtụtụ na mgbede. Ekwesịrị ịgbaso otu ụkpụrụ nke idepụta nitrates ma ọ bụrụ na angina adịghị akwụsi ike.

N'ime nitrates organic, a na-eji ọgwụ atọ eme ihe ugbu a na ụlọ ọgwụ: nitroglycerin (NG), isosorbide dinitrate (ID), na isosorbide mononitrate (IMN), nke bụ metabolite eke nke ID. 

Iji weghachi uche na nitrates, ị ga-:

  • Ojiji nke ọgwụ ọjọọ bụ episodic, naanị n'ọnọdụ ebe onye ọrịa nwere mkpa maka ha. Maka ndị ọrịa nwere angina kwụsiri ike, usoro a gụnyere iji ọgwụ eme ihe ozugbo tupu ọnọdụ ndị nwere ike ibute ọgụ, ọkachasị tupu mgbatị ahụ a na-atụ anya ya. A na-akpọ usoro a na-ewere nitrates sporadic. Ọ dị mma ma dị irè naanị maka ndị ọrịa nwere angina dị nro (Klas ọrụ I ma ọ bụ II - FC). Maka iji nitrates eme ihe mgbe ụfọdụ, ọgwụ ndị na-enye ngwa ngwa, nke a na-akpọ na obere mmetụta, dị ka ụdị sublingual ma ọ bụ buccal doses, dị nnọọ mma. Aerosols nke NG na ID dị mma maka ebumnuche ndị a.

Mgbe ị na-edepụta nitrates nye ndị ọrịa nwere angina pectoris kwụsiri ike, enwere mmụba na ndidi mmega ahụ, mbelata ugboro ole ọgụ angina, yana mbelata mkpa NG iji kwụsị ọgụ angina. Ọ ka mma ịjụ ọrụ nke nitrates (yana ọgwụ ndị ọzọ na-egbochi anginal) site na iji ule na-emega ahụ na igwe na-agba ọsọ ma ọ bụ ergometer igwe. Nnwale dị otú ahụ, nke a na-eme megide ndabere nke omume nke ọgwụ nitrates dị irè, na-ekpughe mmụba nke ogologo oge nke ibu na ọrụ a na-arụ n'oge ya, yana mbelata ihe ịrịba ama nke ischemia myocardial.

Site na angina pectoris II FC, a na-edekwa nitrates tupu mgbatị ahụ echere n'ụdị usoro onunu ogwu na-adị mkpụmkpụ. Agbanyeghị, ọ bụrụ na ndị ọrịa dị otú ahụ na-emega ahụ nke ọma nke ọma, ọgụ angina na-emekarị. N'ọnọdụ ndị dị otú ahụ, ọ ka mma ịnye ọgwụ ndị na-eme ogologo oge na-adị ogologo oge na nke dị ogologo oge maka oge dum nke mmega ahụ. Ọ bụrụ na ọgụ angina na-eme naanị mgbe ị na-eje ije ma ghara ime oge fọdụrụnụ, mgbe ahụ, ọ bụ ihe ezi uche dị na ya ịkọwapụta nitrates ogologo oge ogologo oge na ọkara otu awa tupu ịpụ.

Iri ụfọdụ ọgwụ n'otu oge yana nitrates nwere ike inye aka gbochie mmepe nke riri ahụ. Ndị na-egbochi ACE, ndị na-enye ndị otu SH, diuretics nwere ike inwe mmetụta dị otú ahụ.

Nke abuo, mmetụta nke NVD na-adabere ọ bụghị nanị na ntinye ọgwụ n'ime ọbara, kamakwa na ọnụego mgbanwe ya. Ya mere, usoro onunu ogwu nke NVD, nke na-enye mmụba dị ukwuu na ntinye ọgwụ n'ime ọbara (dịka ọmụmaatụ, mbadamba NG maka ịre n'okpuru ire na ikuku), n'ihe banyere ịdị njọ nke mmetụta, dị elu karịa ụdị usoro onunu ogwu. nke na-enye mmụba nwayọọ nwayọọ na ntinye ọgwụ n'ime ọbara (ihe atụ kpochapụrụ bụ ihe a na-akpọ transdermal doseji ụdị nitrates).

A na-egosi ojiji nke nitrates maka glaucoma mepere emepe, ebe ọ bụ na ha nwere ike ibelata nrụgide intraocular. Site na glaucoma na-emechi akụkụ, nitrates anaghị emetụta nrụgide intraocular, Otú ọ dị, n'agbanyeghị ụdị ọrịa a, a pụghị iwere ha dị ka contraindicated.

Ogo isi ọwụwa, n'ụkpụrụ, anaghị adabere n'ụdị ọgwụ sitere na otu nitrate. Otú ọ dị, o doro anya na e nwere ụfọdụ ndabere nke isi ọwụwa na usoro onunu ogwu eji - ịdị njọ nke isi ọwụwa na iji isosorbide dinitrate nke ọkara oge (nitrosorbide), nke e nyere 3 r / ụbọchị, dị nnọọ ukwuu karịa iji isosorbide mononitrate. nke ogologo oge (olicard), nke enyere 1 r / ụbọchị.

Nitroglycerin na-agbasakwa arịa ụbụrụ, akụkụ ahụ dị n'ime, na retina. N'ịbụ onye antispasmodic nke myotropic edinam, ọ na-ebelata ụda nke ire ụtọ mọzụlụ nke esịtidem akụkụ (digestive tract, bronchioles, wdg). N'ime mmetụta ndị na-adịghị mma, ọ nwere ike ime ka tachycardia reflex (mmeghachi omume na-akwụ ụgwọ nke metụtara mbelata ọbara mgbali), isi ọwụwa, dizziness. A na-akpọpụta ihe ndị a karịsịa mgbe usoro ọgwụgwọ mbụ gasịrị. Ike isi ọwụwa na-ebelata ma ọ kwụsịkwa ime. A na-eji nitrates agwọ ihe fọrọ nke nta ka ọ bụrụ ụdị ọrịa akwara obi niile. Ọnụnọ nke akpọrọ antianginal na ọrụ antiischemic na-eme ka o kwe omume iji ọgwụ ndị a nke ọma maka mgbochi na enyemaka nke ọgụ angina na ndị ọrịa nwere angina pectoris kwụsiri ike. Mgbe a na-ewere ha, mmega ahụ na-abawanye nke ukwuu. na-ebelata ọnụ ọgụgụ nke ọgụ angina. N'ozuzu, mmetụta antianginal nke nitrates na angina kwụsiri ike dị ka ịdị irè nke ọgwụ antianginal nke otu ndị ọzọ (calcium antagonists, β-blockers). Otú ọ dị, ekwesịrị iburu n'obi na ịdị irè nke nitrates na angina pectoris na-adabere n'ụzọ dị ukwuu na nke ọgwụ, na ụdị dose na usoro onunu ogwu, nakwa na atụmatụ nke ojiji. A na-ejikwa nitrates dị ka ọgwụ antianginal na-agwọ ọrịa angina pectoris na-adịghị akwụsi ike, vasospastic angina pectoris. N'ụdị usoro onunu ogwu, a na-enyekarị nitrates maka nnukwu ọrịa myocardial infarction (MI). N'ozuzu, mmetụta antianginal nke nitrates na angina kwụsiri ike dị ka ịdị irè nke ọgwụ antianginal nke otu ndị ọzọ (calcium antagonists, β-blockers). Otú ọ dị, ekwesịrị iburu n'obi na ịdị irè nke nitrates na angina pectoris na-adabere n'ụzọ dị ukwuu na nke ọgwụ, na ụdị dose na usoro onunu ogwu, nakwa na atụmatụ nke ojiji. A na-ejikwa nitrates dị ka ọgwụ antianginal na-agwọ ọrịa angina pectoris na-adịghị akwụsi ike, vasospastic angina pectoris. N'ụdị usoro onunu ogwu, a na-enyekarị nitrates maka nnukwu ọrịa myocardial infarction (MI). N'ozuzu, mmetụta antianginal nke nitrates na angina kwụsiri ike dị ka ịdị irè nke ọgwụ antianginal nke otu ndị ọzọ (calcium antagonists, β-blockers). Otú ọ dị, ekwesịrị iburu n'obi na ịdị irè nke nitrates na angina pectoris na-adabere n'ụzọ dị ukwuu na nke ọgwụ, na ụdị dose na usoro onunu ogwu, nakwa na atụmatụ nke ojiji. A na-ejikwa nitrates dị ka ọgwụ antianginal na-agwọ ọrịa angina pectoris na-adịghị akwụsi ike, vasospastic angina pectoris. N'ụdị usoro onunu ogwu, a na-enyekarị nitrates maka nnukwu ọrịa myocardial infarction (MI). yana site na atụmatụ nke ngwa ya. A na-ejikwa nitrates dị ka ọgwụ antianginal na-agwọ ọrịa angina pectoris na-adịghị akwụsi ike, vasospastic angina pectoris. N'ụdị usoro onunu ogwu, a na-enyekarị nitrates maka nnukwu ọrịa myocardial infarction (MI). yana site na atụmatụ nke ngwa ya. A na-ejikwa nitrates dị ka ọgwụ antianginal na-agwọ ọrịa angina pectoris na-adịghị akwụsi ike, vasospastic angina pectoris. N'ụdị usoro onunu ogwu, a na-enyekarị nitrates maka nnukwu ọrịa myocardial infarction (MI).

Site na angina pectoris III FC, ekwesịrị ịdepụta nitrates n'ụzọ iji hụ na a na-eme ọgwụ n'ụbọchị. Maka nke a, nitrates na-eme ogologo oge na-adaba adaba, na-enye mmetụta na-adịgide adịgide ruo awa 10-12, nke na-adịgide n'ime oge niile nke mmega ahụ.

  Isosorbide dinitrate
A. Nitroglycerin otu: sublingual - mbadamba nkume NG; mmanya nitroglycerin ngwọta; Votchala tụlee (nwere nitroglycerin na menthol na ha mejupụtara); ịgba - Nitrospray, wdg.
Enwere ike kewaa ha n'ime ndị zuru oke: hypersensitivity na nitrates, hypotension arterial siri ike, hypovolemia, ọdịda ventricular aka ekpe na obere LV end-diastolic mgbali, constrictive pericarditis, hemorrhagic stroke (ruo ọnwa 6); na ndị ikwu: orthostatic arterial hypotension, hypertrophic cardiomyopathy na mwepu traktị na-apụ apụ, stenosis siri ike nke aortic orifice ma ọ bụ aka ekpe atrioventricular orifice, ụba intracranial mgbali, encephalopathy, glaucoma-mmechi glaucoma na elu intraocular mgbali, anaemia. 0.25-1.0 min / 1-2 h
  dị mkpa
  40-240 mg / ụbọchị
  0.4 mg (inhalation otu)
Na nnukwu myocardial infarction ma ọ bụ nnukwu aka ekpe ventricular ọdịda, a na-ewere Isoket-spray naanị n'okpuru nchịkwa ọbara mgbali, ọnụọgụ obi na n'okpuru nlekọta ahụike. Na mmalite nke 1-3 doses na etiti oge nke 30 sekọnd, ọ bụrụ na enweghị mmetụta n'ime nkeji 10 - mgbakwunye ọzọ (naanị n'okpuru nlekọta ahụike).
Dị ka oge ọrụ si dị, a na-ekewa nitrates n'ime nkwadebe (mbadamba, aerosols) nke obere ihe (ruo 1 awa); Mbadamba ụrọ nkịtị nke ọrụ ogologo oge na-agafeghị oke (site na awa 1 ruo 6) na mbadamba pụrụ iche, capsules, yana patches na nitroglycerin nke ọrụ ogologo oge (site na awa 6 ruo 16).

Nitrocore     

Na antianginal mmetụta nke nitrates na IHD, ike dilating mmetụta na akwara obi arịa na hemodynamic mgbanwe na-eme n'ihi ntụrụndụ nke dum usoro nke peripheral arịa, gụnyere dilatation nke capacitive veins, na-ekere òkè, nke mbụ niile. Ihe a niile na-eduga na mbelata nke systolic ikpeazụ na nrụgide distolic na ventricle ekpe (LV); Mgbochi akwara dị n'akụkụ na-ebelata, nke na-ebelata ibu LV na njupụta ya, ma na-eme ka ọbara na-erugharị na myocardial subendocardial, nke na-enwe mmetụta nke ischemia. Nitrates na-akpata vasodilation nke arterioles na veins, nke na-etolite ntọala maka mmụba mgbaàmà nke angina exertional n'ihi ọrụ nke ọgwụ ndị a na-arụ ọrụ, nitric oxide (NO), na site na ibelata ibu ibu [9, 10].

Aspirin nwere ike belata isi ọwụwa, ma ọ pụkwara iduga n'ịkwụsị ọgwụgwọ na ọbụna ịjụ ịṅụ nitrates.

  Isosorbide mononitrate  
8. Kryzhanovsky S.A., Vititnova M.B. Ọgwụ maka ọgwụgwọ ọrịa obi obi (isi, ụlọ ọgwụ na ọgwụ na-egosi na-egosi). nkuzi 2, akụkụ 1. Organic nitrates na ọnọdụ ha na ọgwụ ọgwụ nke ọrịa obi obi. Onye na-agwọ ọrịa, 2011, 3: 38-54 .
  20 mg 
5. Kimch A, Amsterdam E et al. Mmụba mmega ahụ na-abawanye mgbe ịgbasa ọnụ nitroglycerin: usoro ọgwụgwọ ọhụrụ na mgbe emechara na angina pectoris. Mgbasa, 1983, 67:124-127 .
Mmekọrịta ọgwụ nke nitrates. N'ụzọ bụ isi, ha bụ pharmacodynamic na okike, ha na-agụnye ịba ụba nke vasodilation nke ndị na-emegide calcium kpatara (nifedipine, amlodipine, felodipine, wdg), ndị na-egbochi ACE.

  40-120 mg
usoro nke ime ihe na pharmacological mmetụta

14. Lupanov V.P. Nitrates. N'akwụkwọ:. Rational pharmacotherapy nke ọrịa obi: ntuziaka maka ndị ọkachamara. Compendium n'okpuru gen. ed. E.I. Chazova, Yu.A. Karpov. Ederede nke abụọ. ziri ezi na mgbakwunye M.: Litterra, 2015, isi 10: 106-122 .
Efox ogologo
  15 min / 4-6 h
   20-80 mg / ụbọchị
 0.3-1.5 mg sublingually maka ọgụ angina 1.25-3.75 mg sublingually.   

Ndị ọrịa nwere angina pectoris II FC kwụsiri ike (ya na ọgụ angina pectoris na-adịghị adịkarị na obere oge nke ischemia myocardial n'oge ehihie) nwere ike inye obere nitrates tupu ọnọdụ ndị nwere ike ibute ọgụ angina. Tinyere ụdị mmetụta dị mkpirikpi, enwere ike iji ụdị ihe eme ogologo oge dị ogologo.

   Tebụl 2. Ụdị ọgwụ nke organic nitrates na akwadoro doses   
  Nitroglycerin
  15 min / 8 h
Monocinque
Ndị ọrịa na-arụ ọrụ nke klas I (FC). Mwakpo nke angina pectoris na-adịkarị obere ma na-enwe nnukwu ibu, dị ka a na-achị, ọ dịghị mkpa ịṅụ ọgwụ antianginal mgbe niile. A na-enye nitrates naanị obere oge n'ụdị usoro onunu ogwu nke na-enye nsonaazụ ngwa ngwa na nke akpọpụtara: mbadamba, capsules, NT na ID aerosols. Ekwesịrị iwere ụdị ndị dị otú ahụ 5-10 nkeji tupu mgbatị ahụ a na-atụ anya ya, nke na-ebutekarị ọgụ nke angina pectoris.

1. Murrell W. Nitro-glycerine dị ka ihe ngwọta maka angina pectoris. Lancet, 1879; 1:80-81.
  Kaadị 40, 60,120
9. Munzel T, Steven S, Daiber A. Organic nitrates: melite na usoro n'okpuru vasodilation, ndidi na endothelial dysfunction. Vascul Pharmacol, 2014, 63 (3): 105-113.
Nitrates nwere ikike naanị igbochi na ịkwụsị ọgụ angina na ọ naghị emetụta usoro IHD n'onwe ya ( egosipụtabeghị mmetụta nitrates na prognosis nke ndị ọrịa nwere IHD). Ya mere, ndị ọrịa nwere IHD, na mgbakwunye na nitrates, kwesịrị ịṅụ ọtụtụ ọgwụ ndị ọzọ: b-blockers, statins, aspirin, IHD inhibitors.

Isosorbide dinitrate n'ụdị ịgba (Isoket-spray) maka ịgbasa na mucosa ọnụ, n'elu ime ntì na-eji nke ọma kwụsị ọgụ angina tupu nrụgide anụ ahụ ma ọ bụ nke mmetụta uche, nke na-ebutekarị angina pectoris [12]. Iji mee nke a, ịkwesịrị ịgbanye ikuku aerosol n'ọnụ gị ma jide ume gị. Ọgwụ dị na vials iko 15 ml nwere 300 doses nke 1.25 mg ID. Ọ bụrụ na mgbe ịgba ọgwụ mbụ ahụ gasịrị, ọgụ mgbu na-aga n'ihu, mgbe ahụ, ọ ga-ekwe omume ịmegharị ntụtụ ahụ na nkeji 30 otu ugboro ma ọ bụ ugboro abụọ ka ị na-ejide ume. Ọ bụrụ na ọgụ mgbu ahụ, nke ụdị ọgụ angina, na-aga n'ihu, mgbe ahụ ị nwere ike ikwugharị injection nke aerosol na nkeji nke 30 sekọnd otu ugboro ma ọ bụ abụọ ọzọ ka ị na-ejide ume gị.

 Tebụl 3. Nitrates na ọgwụ ndị dị ka nitrate na angina kwụsiri ike     
Ọnụnọ nke ọgụ angina na enweghị contraindications bụ ihe ngosi maka nhọpụta nke nitrates. N'ụzọ dị mwute, nitrates na-eji na-emeso angina pectoris enweghị ike kpamkpam gwọọ ọrịa, ma ha na-agbanwe physiological ọnọdụ na myocardium na ukwuu ikwado ọrụ nke ọrịa obi.

10-30

Ekwesiri iburu n'uche na mgbe ị na-ewere nitrates na ụdị phosphodiesterase ụdị 5 inhibitors (PDE-5) (sildenafil, vardenafil, tadalafil, wdg), edepụtara n'ihe metụtara erectile dysfunction ma ọ bụ maka ọgwụgwọ ọbara mgbali elu nke akpa ume, hypotension arterial na-achịkwaghị achịkwa na ọdịdị ahụ. Myocardial ischemia n'ihi mbelata nke ukwuu na-erugharị ọbara na akwara akwara stenotic. Sildenafil na-ebelata ọbara mgbali site na 8.4/5.5 mm Hg. Art. na ọtụtụ ihe ndị ọzọ mgbe a na-ejikọta ya na nitrates. N'ihe banyere nchịkwa n'amaghị ama nke nchikota PDE-5 inhibitor na nitrate, ụgbọ ihe mberede nwere ike ịchọ α-adrenergic agonists ma ọ bụ ọbụna norepinephrine. E kwesịghị iji a1-adrenergic blockers (prazosin) na-enye nitrates. N'ime ụmụ nwoke nwere ọrịa prostate, na-ewere tamsulosin (ihe mgbochi nke a1A- na a1B-adrenergic receptors), nitrates nwere ike inye iwu. Site na ịkpachara anya, ekwesịrị ịdepụta nitrates nye ndị ọrịa nwere oke regurgitation mitral.

3. Abrams J. Otu esi eji nitrates. Ọgwụgwọ Cardiovasc Ther, 2002, 16 (6): 511-514.
  Denitration + nhazi glucuronide
2. Thadani U, Lipicky RJ. Nitrates ọnụ dị mkpụmkpụ na nke na-adị ogologo oge maka angina pectoris kwụsiri ike. Ọgwụgwọ Cardiovasc Ther, 1994, 8 (4): 611-623.
Olikard retard
  50-70 l / min 
30-80
(ọnụ ọnụ)
B. Isosorbide dinitrate otu: Isoket spray na ndị ọzọ
Pektrol
egosi maka ojiji nke isosorbide dinitrate spray: enyemaka nke angina ọgụ, mgbochi nke angina ọgụ, nnukwu myocardial infarction, nnukwu myocardial infarction. ọdịda ventricular aka ekpe.

N'ime ndị ọrịa nwere angina pectoris mgbe myocardial infarction gasịrị, a na-ejikarị nitrates na ndị na-egbochi ACE, nke na-egbochi mmepe nke ndidi.

  Kaadị 20 Na-
  egosi
  Ogologo oge ọrụ
12. Silber S. Nitrates: gịnị kpatara na olee otu a ga-esi jiri ha mee ihe taa? Ọnọdụ ugbu a nke uru ụlọ ọgwụ nke nitroglycerin, isosorbide dinitrate, isosorbide -5-mononitrate. Eur J Clin Pharmacol, 1990, 38 (1): 35-51.
  8 mg 1-2 r / ụbọchị.
  Enwere ike iji nitrates
n'ụdị aerosols dị ka ndị isi antianginal na ndị ọrịa nwere angina dị nro (I-II FC). Iji Isoket-spray n'ụdị aerosol na-enye gị ohere ịme ngwa ngwa mmalite nke ihe na-arụ ọrụ ma belata oge iji belata ọgụ ma e jiri ya tụnyere mbadamba sublingual.

  Uzo esi ewepu
  otu dose nke
Iso Mac retard  
Unstable angina (UA) . A na-ewere iji nitrates na NS dị ka usoro ọgwụgwọ a na-anabatakarị. Ntinye nke NG n'ime ala n'ọtụtụ ọnọdụ na-akwụsị nke ọma ma gbochie angina ezumike.
  Dị ka achọrọ
Ọnụnọ nke a na-akpọ antianginal na antiischemic edinam na-enye ohere ịga nke ọma ojiji nke mkpụmkpụ-eme Isoket-spray nitrate maka mgbochi na enyemaka nke angina ọgụ na ndị ọrịa na-kwụsi ike na akwara obi ọrịa. Mgbe ị na-eji Isoket-spray, nnabata onye ọrịa na-emega ahụ na-abawanye nke ukwuu, ọnụ ọgụgụ ọgụ angina na-ebelata, na ndụ ndụ na-akawanye mma.

Usoro bioavailability nke sistemu,%
I. nitrates organic na-eme mkpụmkpụ maka enyemaka nke ọgụ angina:

Pharmacokinetics

  Nitroglycerin (mbadamba sublingual, capsules)
6. Olbinskaya L.I., Sizova Zh.M., Ushakova A.V. Ntụle arụmọrụ, nchekwa, mmetụta cardiohemodynamic nke isosorbide dinitrate aerosol na mbadamba nitroglycerin sublingual. Ter. akwụkwọ akụkọ, 1998, 3: 69-72 .
  Isosorbide-5-mononitrate (ọnụ) 
  100
7. Blizzard V.I. Akwụkwọ ntuziaka ụlọ ọgwụ ọgwụ nke ọgwụ obi. M., LLC "Ụlọ Ọrụ Ozi ahụike", 2005: 198-203.
  10-40 mg
Mgbe ị na-edepụta ọgwụ na usoro hemodynamic nke omume, karịsịa nitrates, na ndị agadi agadi, ekwesịrị ịhụ iwu ndị a: malite ọgwụgwọ na obere doses, jiri nlezianya nyochaa mmetụta ndị na-adịghị mma, na-atụle mgbe niile ịgbanwe ọgwụ ahụ ma ọ bụrụ na anabataghị ya nke ọma ma ghara ịdị irè. .

  Dilasidome retard
20-30
  dị ala

  Enweghị
isi mmalite: Council Medical, No. 8, 2015
  5–10 min/1-2 h
  0.11 l/min
Nitrospray nitrates
na-eji n'ụdị dị iche iche nke ọrịa obi:

  Ọgwụ, ụdị usoro onunu ogwu
  4-12 mg / ụbọchị
  Isosorbide dinitrate (mbadamba sublingual)
Ugbu a, a na-eji ọgwụ atọ nke otu a: nitroglycerin (NG), isosorbide dinitrate (ID) na isosorbide-5-mononitrate (ISM), nke bụ eke. metabolite nke ID.

Monocinque retard
  2 ma ọ bụ 3 ugboro n'ụbọchị
  Long-eme
  1-3 sprays n'ime ọnụ (dose 1.25 ID)
Isiokwu na-atụle na nkà mmụta ọgwụ nke nitrates na ebe ha na mgbagwoju ọgwụgwọ nke ọrịa obi obi. E gosipụtara usoro omume nke nitrates organic, ọkachasị nfe dị mkpụmkpụ nke isosorbide dinitrate (ID). A na-enyocha ihe ngosi na contraindications maka ojiji ya n'ụdị dị iche iche nke IHD.
  Otu ugboro 
  n'ụbọchị  

  Corvaton, Sidnopharm
Dilasidome

Nitrates na-eme mkpụmkpụ maka enyemaka nke ọgụ angina . Onye na-anọchite anya otu nitrates organic a bụ nitroglycerin .. Ọgwụ ahụ nwere mmetụta antispasmodic myotropic ma na-eme ka uru ahụ nke arịa akwara dị jụụ ozugbo. A na-arụ ọrụ ụfọdụ na nke a site na mmetụta mgbochi etiti na ụda ọmịiko. Mmetụta antianginal nke NG bụkwa n'ihi nhazigharị nke hemodynamics jikọtara ya na mmetụta izugbe na arịa ọbara, izu ike nke uru ahụ dị nro nke arịa dị n'akụkụ, karịsịa na mgbatị vein. N'okpuru mmetụta nke NG, venous ọbara na-eruba n'obi na-ebelata, nrụgide na atrium ziri ezi, usoro akwara pulmonary na-ebelata, na mgbochi vaskụla mpụta na-ebelatakwa. Mwepu myocardial na-apụtakwa, esemokwu ya na nguzogide nchụpụ ọbara na-ebelata, ọchịchọ oxygen myocardial na ụgwọ ike na-ebelata. Site na mbelata ischemia, mkpali mgbu sitere na nlebara anya nke ischemic na-apụ n'anya nke nta nke nta ma ọrịa mgbu kwụsị. Ọ bụ ikike nke NG ịkwụsị ọgụ angina ma gbochie ihe omume ha na-eme ka ọ bụrụ akụkụ dị mkpa nke ọgwụgwọ ndị ọrịa nwere ọrịa akwara obi [11].

  1.5–2 min/10–30 min
0–10
    6.4 mg
  1, 2, 3, and 5 mg 
  40–120 mg/ day
intravenous ID infusion (isoket 0.1%) dị irè na NS karịa ọgwụ ọnụ.

Maka ọgwụgwọ kwesịrị ekwesị na nitrates, ọ dị mkpa ịmata kpọmkwem nchoputa, detuo ọnụnọ nke myocardial ischemia na angina pectoris dị ka ngosipụta ya, ma guzobe atụmatụ nke ọnọdụ ya [4, 7].

Isoket Spray na ndị ọrịa nwere angina pectoris nwere ike were prophylactically n'ọnọdụ ebe enwere ihe mere ị ga-eji na-atụ anya ọgụ angina, dịka ọmụmaatụ, n'oge mmega ahụ mgbe nri gasịrị, nchekasị mmetụta uche, mmekọahụ, ma ọ bụrụ na ịpụ n'èzí na ihu igwe oyi, na angina pectoris. nke na-eme na nnukwu ibu na ọkara.
  Ogologo oge
  dị obere ihe dịka 60 min / 10-12 h   N'oge ọgwụgwọ nitrate   ,  
mmanya nwere ike ịkpasu ma ọ bụ mee ka ọbara mgbali   elu dịkwuo elu. ịbanye n'ime ahụ, a na-amata nitrates, na-etinye ya na akpụkpọ anụ mucous nke ọnụ ma ọ bụ n'ime eriri afọ, maka iji akpụkpọ anụ na eriri afọ ( Table 1) .





). Site usoro onunu ogwu ụdị: mbadamba, capsules, sprays, ointments, patches, ngwọta, wdg The ala systemic bioavailability nke NG mgbe a na-ewere ọnụ na n'otu oge ahụ ezi absorption site akpụkpọ na mucous membranes nke NG capsules na-akọwa ihe mere na-adịbeghị anya depot- (ma ọ bụ retard-) mbadamba NG ma ọ bụ capsules.

  1.25 mg (inhalation otu)
  ugboro abụọ n'ụbọchị
Mmetụta na-eme ka o sie ike iji nitrates (isi ọwụwa, palpitations, dizziness) nke reflex sinus tachycardia na-eme na nitrates na-eme mkpụmkpụ. Hypotension bụ nke kacha njọ na isi ọwụwa bụ mmetụta dị na nitrates na-emekarị.

Iso Mak 20 Nitrosorbide
11. Mazur N.A. Ọrụ nke nitrates na ọgwụgwọ ndị ọrịa obi dịka ụkpụrụ nke ọgwụ na-egosi na-egosi na ndụmọdụ maka ngwa ha bara uru. Ọrịa obi, 2005, 8: 92-96 .
  Mbadamba ụrọ nke nitroglycerin ogologo oge (ọnụ)
ọtụtụ ndị ọrịa chọrọ ka nitrates mee naanị maka obere oge (nke a metụtara ndị ọrịa nwere angina pectoris nke 1st ma ọ bụ nke abụọ na-arụ ọrụ nke klaasị), mgbe ha na-enye onwe ha oke nrụgide (dịka ọmụmaatụ, gaa ọrụ ma ọ bụ ọrụ). site na ọrụ). Ọ bụ maka ndị ọrịa dị otú ahụ ka ụdị aerosol nke nitrates dị mma.

Site na angina pectoris IV FC (mgbe ọgụ angina nwere ike ime n'abalị), ekwesịrị inye nitrates n'ụzọ iji hụ na ọ na-emetụta ụbọchị dum. Iji mee nke a, ọ ka mma ịnye nitrates ogologo oge 2 r / ụbọchị n'ụtụtụ na mgbede. Ebe ọ bụ na ọgụ angina nwekwara ike ime n'abalị, a ga-edepụta nitrates iji hụ na mmetụta ha na-eme gburugburu elekere, na, dịka iwu, yana ọgwụ ndị ọzọ antianginal, bụ isi na b-blockers.

Ọgwụ mbụ maka ọgwụgwọ angina pectoris bụ nitrates - ọgwụ sitere na otu nitrovasodilators. N'afọ 1879, Dr. W. Murrell bipụtara n'akwụkwọ akụkọ Bekee "Lancet" nsonaazụ nke iji 1% mmanya ngwọta nitroglycerin iji kwụsị ọgụ angina na igbochi ha tupu mgbatị ahụ [1]. Ruo ọbịbịa nke b-blockers na calcium channel blockers (calcium antagonists), nitrates bụ nanị ndị nnọchiteanya nke antianginal na ngwa agha nke dọkịta obi. N'agbanyeghị ọgwụ ndị ọzọ dị irè na-apụta n'oge na-adịbeghị anya, nitrates ka na-anọ n'ọnọdụ siri ike na ọgwụgwọ ndị ọrịa nwere ụdị ọgwụgwọ dị iche iche nke ọrịa akwara obi [2-4].

   Isiokwu 1. Pharmacokinetic parameters nke atọ isi organic nitrates   
B. Isosorbide-5-mononitrate otu: Mono Mac; Efoks na ndị ọzọ.

  Isosorbide 5- na 2- mononitrates
  Plasma ọkara ndụ
ndị ọrịa nwere angina pectoris III-IV FC siri ike (na ọgụ nke angina pectoris ugboro ugboro na ngosipụta nke ischemia myocardial na-enweghị mgbu n'ehihie na n'abalị) kwesịrị inye ọgwụ nitrates mgbe niile; na ndị ọrịa dị otú ahụ, ọ dị mkpa ịgbalịsi ike ịnọgide na-enwe mmetụta n'ụbọchị. Maka nke a, nitrates na-eme ogologo oge dị mma, na-enye mmetụta na-adịgide adịgide 10-12 awa.

Isosorbide dinitrate (Isoket) na-efe efe. Otu dose nke ngwọta ọgwụ nwere 1.25 mg nke ISDN. Mgbe ịgbasa na mucosa ọnụ, mmetụta ahụ na-apụta mgbe nkeji 1-3 ga-adịru 90-120 nkeji. Otu esi eji: weta Isoket-spray nso n'ọnụ gị, jide karama ahụ kwụ ọtọ. Were ume miri emi, kupụ ume. Na-esote - fesa dose 1 (pịa sprayer) n'ime ọnụ (nke a nwere ike ime ka ire ọkụ dị ntakịrị). Mgbe ị were 1 dose, mechie ọnụ gị ma kuo ume n'imi maka 30 sekọnd. Oge ọ bụla ị pịa sprayer, a ga-efesa nha nha nha nke ihe ngwọta n'ụdị obere mmiri. Ọgwụ ahụ na-abanye ngwa ngwa site na akpụkpọ anụ mucous nke ọnụ wee banye n'ọbara n'ime ihe nke sekọnd. Isoket-spray enweghị freon, ọ dịghị njọ na gburugburu ebe obibi. Uru ọzọ bụ nghọta nke karama ahụ, nke na-enye gị ohere ịhụ mkpa ọ dị maka nnọchi n'oge.

Monosan
  Isosorbide-5-mononitrate ogologo oge (ọnụ)
  Kardiket-spray
  dị ala
  40-90 min
Sapropterin bụ ihe na-emekọ ihe na njikọ nke nitric oxide. A na-atụ aro ka ị kpachara anya n'otu oge iji sapropterin nwere ọgwụ na vasodilators niile, nke a na-ejikọta ya na nitric oxide (NO), gụnyere NO na-enye onyinye - nitroglycerin, IDN, IMN, wdg.

Nitrates na ọgwụgwọ ndị ọrịa nwere ọrịa obi obi: lekwasị anya na isosorbide dinitrate
  Isosorbide dinitrate         
  6.5-13 mg 2-4 r / ụbọchị
Nhazi nke nitrates organic [8]:

     75

4. Aronov D.M., Lupanov V.P. Ojiji dị iche iche nke nitrates na ọrịa obi na-adabere n'ụdị na ogo ọrịa ahụ. Ọrịa obi, 2006, 1: 74-82 .
Nhazi nke nitrates nke oge a sitere na usoro ọgwụ ha (organic nitrates, sydnonimines), oge nke ime ihe (obere ime, ogologo oge, ogologo oge). A na-emepụta nitrates n'ụdị ọgwụ dị iche iche (maka intravenous, oral, transdermal, buccal Administration), nke na-agbasawanye ohere nke ojiji ha ma n'ọnọdụ siri ike nke ọrịa obi na ọnọdụ mberede.
13. Thadani U. Ihe ịma aka na ọgwụgwọ nitrate na ntachi obi nitrate: mgbasawanye, mgbochi, na akwụkwọ akụkọ gbasara ahụike. Amer J Cardiovasc Ọgwụ, 2014, 14 (4): 287-301.
A na-egosi Pharmacodynamics nke nitrates na tebụl 3 .
10. Lupanov V.P. Nitrates. Ntuziaka maka ọrịa obi na mpịakọta anọ. Ed. acad. Chazova E.I. Ed. " Omume", 2014, 4: 688-703 .
  Ihe na-arụ ọrụ
  40-120 mg / ụbọchị
 (efere buccal na goms)
 mmalite/oge ọrụ
Isoket-spray ejiriwo nke ọma na-agwọ ụdị ọrịa dị iche iche nke ọrịa obi. Ọ nwere mmetụta antianginal akpọpụtara, ma ọ bụrụ na a na-enye ya n'ụzọ zuru oke, ma na-eme ka ndụ ndị ọrịa dịkwuo mma nke angina na-egbochi mmega ahụ nke ukwuu.

Ịnagide nitrates na-adabere na usoro ọgwụ na oge ọgwụgwọ, ọ na-ebelata irè ọgwụgwọ ma gbasaa ọ bụghị naanị na mmetụta antianginal na hemodynamic, kamakwa na mmetụta antiaggregation. Enwere ike igbochi ndidi (riri ahụ) dị ka otu n'ime nsogbu ndị nwere ike igbochi site n'ịgbanwe usoro onunu na oge nchịkwa, yana site na iji ọgwụ na-ewepụta ngwa ngwa. Ebe obibi bụ ihe na-agbanwe agbanwe. Ọ bụrụ na nitrate na-apụ n'ahụ, mgbe ahụ, a na-eweghachite uche na ya ngwa ngwa. Ọ pụtakwara na ọ bụrụ na a na-edepụta nitrates na-eme ogologo oge ọ bụghị mgbe niile, mana n'ụzọ dị otú a na n'ụbọchị a na-emepụta oge (awa 7-10) mgbe ọgwụ ahụ adịghị n'ime ahụ, mgbe ahụ, ịṅụ ọgwụ ọjọọ na ha adịghị etolite. ma ọ bụ na-etolite ruo n'ókè dị nta karịa n'ọnọdụ ndị ahụ mgbe a na-ewere ha na-aga n'ihu.

 Ihe mgbagwoju anya nke nitrates na-eme ogologo oge bụ mmebi nke nkwụsị nke endothelial na-akawanye njọ, ya mere a na-emekarị omume nke iwu iwu nitrates ogologo oge dị ka ọgwụ ndị mbụ na ndị ọrịa nwere angina na-arụ ọrụ kwesịrị ka a gbanwee [14].

  1 oge kwa ụbọchị 
Mmetụta nitrates na àgwà ndụ.Ogo nke ndụ bụ ihe ngosi dị mkpa nke na-agụnye ọdịmma anụ ahụ, mmekọrịta mmadụ na ibe ya na nke uche nke onye ọrịa ma na-egosipụta ikike anụ ahụ, mmekọrịta mmadụ na ibe ya, nghọta na mmekọahụ. Ọrụ ozugbo na-emeziwanye ndụ ndụ bụ ikpochapụ ọrịa mgbu, gbanwee ọrụ moto, ọnọdụ uche-mmetụta uche, wdg; ebumnuche ogologo oge bụ ịbawanye ndụ ma belata ugboro ole ụlọ ọgwụ. N'ọtụtụ ndị ọrịa nwere angina kwụsiri ike, n'ihi ọgụ na-aga n'ihu na-eduga na mgbochi dị ịrịba ama na ndụ kwa ụbọchị, ịdị mma nke ndụ na-ebelata n'ihi enweghị ike, ụra zuru oke, mmega ahụ na-ebelata, na ọnụnọ nke nsogbu uche. Mmetụta nke nitrates na prognosis na ndị ọrịa nwere ọrịa akwara obi ewepụtabeghị nke ọma.

  4-5 awa Tebụl 2
na-egosi ụdị isi nke nitrates organic na usoro akwadoro.   Mwepu nke Plasma   2.5-10 mg

Ngosipụta maka ojiji na usoro onunu ogwu

  0.3-0.6 mg
  Denitration (80%) + nhazi nke glucuronide (20%)
  Nitrong-forte 
  Nitroglycerin akpụkpọ anụ
  metabolites na-arụ ọrụ
  otu ugboro n'ụbọchị.

V.P. LUPANOV, MD, Prọfesọ, Research Institute of Clinical Cardiology aha ya bụ N.N. A.L. Myasnikov Russian Cardiological Research and Production Complex nke Ministry of Health of Russia

  0.5-2.0 sentimita (1 inch = 2.54 cm)
  0.2-0.8 mg / h (10 mg / day) 
Nitrate maka infarction myocardial ka egosiri maka ihe ịrịba ama na-adịgide adịgide nke ischemia myocardial na kwa maka nkụda mmụọ nke ụdị nkụda mmụọ.
  Isosorbide dinitrate
A. Isosorbide dinitrate otu: mbadamba maka iji sublingual: Iso Mak 5 mg na ndị ọzọ; Mbadamba ụrọ maka nchịkwa ọnụ: Nitrosorbide, Isodinit, wdg.
Otú ọ dị, e kwesịghị idepụta nitrates maka ọbara mgbali systolic <90 mm Hg. Art. ma ọ bụ mgbe ọ na-ebelata karịa 30 mm Hg. Art. site na mbido mbụ, bradycardia siri ike (HR <50 beats / min) ma ọ bụ tachycardia (HR> 100-110 beats / min).

  Ọgwụ Nitroglycerin a
  na-emekarị
  30 min/5-7 h
ọgwụgwọ nitrate nwere ike ịda n'ụfọdụ ndị ọrịa n'ihi nguzogide nitric oxide ma ọ bụ nnabata nitrate.

   Ngwa akpụkpọ sublingual mmetụta nke
   nitrates

  Nitroglycerin (aerosol, n'okpuru ire) 
  Isosorbide-5-mononitrate
II. Nitrates organic na-eme mkpụmkpụ:
  4
  l / min dị mkpụmkpụ
iji kwụsị ọgụ nke angina pectoris ma ọ bụ tupu nrụgide anụ ahụ ma ọ bụ nke mmetụta uche nke nwere ike ibute ọgụ, ịkwesịrị ịgbanye n'ọnụ 1-3 ugboro na nkeji nke 30 sekọnd. n'etiti sprays megide backdrop nke ijide ume gị. Enwere ike ịbawanye otu dose nke 3 sprays maka enyemaka nke mbuso agha naanị na nkwenye ngwa ngwa nke dọkịta.

30-10
Isosorbide dinitrate (5 mg sublingually) na-enyere aka ịkwụsị ọgụ angina maka ihe dị ka elekere 1 n'ihi eziokwu ahụ bụ na dinitrate ga-agbanwerịrị ka ọ bụrụ mononitrate n'ime imeju iji nwee mmetụta antianginal (mgbe ihe dị ka nkeji 3-4 gasịrị). nke bụ karịa, karịa mgbe ị na-ewere NG). Mgbe nchịkwa ọnụ gasịrị, mmetụta hemodynamic na antianginal na-adịgide ruo ọtụtụ awa, nke na-enye nchebe ogologo oge megide angina karịa mgbe nchịkwa NG sublingual.

 

  Ihe dị ka 60 min / 10-16 h
  Isosorbide dinitrate (aerosol, Isoket-spray)
Mmetụta ọgwụgwọ nke nitrates na angina pectoris na-adabere n'ụzọ dị ukwuu nke ọgwụ, na ụdị dose na usoro onunu ogwu, yana na atụmatụ nke nchịkwa ya. 11, 12]. Enwere nitrates organic maka ọnọdụ ahụike ọ bụla. Ụdị nitrates dị iche iche na-eme ka o kwe omume n'ọnọdụ ọ bụla ịhọrọ usoro ọgwụgwọ onye ọ bụla. Nke a, n'otu aka ahụ, na-enye gị ohere ịbawanye uru ọgwụgwọ nke nitrates, na n'aka nke ọzọ, belata ihe ize ndụ nke mmetụta ndị dị na ya.
Mono Mac Depot
  2 min / 20-30 min
  Isosorbide dinitrate ogologo oge (ọnụ)
  ugboro 3 n'ụbọchị.
Contraindications na ojiji nke nitrates


  50-100 mg  na-   eme ogologo oge
nitrates na-eme ngwa ngwa ka bụ ụzọ na-enweghị atụ nke ịkwụsị ọgụ angina. Ha nwere ike ịnye mmetụta dị mkpụmkpụ, mana ọ bụ nke a pụrụ ịdabere na ya [5-7]. Uru nke nitrates na-eme mkpụmkpụ bụ ikike ọ bụghị naanị igbochi, kamakwa ịkwụsị ọgụ angina amalitelarị. Nitrates kere nso nso a n'ụdị aerosols nwere ma nitroglycerin ma ọ bụ isosorbide dinitrate (Isoket-spray). Uru nke nitrate aerosols bụ dose nke ziri ezi, ichekwa ngwaahịa ọgwụ nke ọma, yana ịdị mfe iji.

   mgbe ejiri ọnụ Nitromint
 na-eme ogologo   oge 1-3 ugboro n'ime nkeji iri na ise

A na-aghọta ndidi (ma ọ bụ ahụ riri ahụ) dị ka mbelata nke ogologo oge na ịdị njọ nke mmetụta nke nitrates na iji ha eme ihe mgbe niile ma ọ bụ mkpa iji ọtụtụ doses iji nweta otu mmetụta ahụ mgbe ị na-ejigide nlezianya dị elu n'ọbara. A na-ewere ihe kpatara ọdịdị nke ntachi obi na nitrates dị ka: mbelata nguzobe nke nitric oxide (NO), osooso nke inactivation ya n'ihi mmụba nke ọrụ phosphodiesterases, na mmụba nke nhazi endothelin. 1, nke nwere mmetụta vasoconstrictive [13]. A na-ejikọta echiche oge gboo na mbelata intracellular na ntinye nke sulfhydride (SH-groups) dị mkpa maka mmezu nke mmetụta nke NO.

  Otutu nnabata
  30 min / 8-24 h (chọrọ oge elekere 12)
  1,2- na 1,3-glycerol dinitrate
  Nitroglycerin n'ụdị ude 2%, akpụkpọ anụ.

Ewebatara nitrates Organic n'ime omume ụlọ ọgwụ na narị afọ nke 19. N'afọ 1879, Dr. Murrel bipụtara otu isiokwu, bụ́ onye tụrụ aro ka e jiri nitroglycerin mee ihe iji kpochapụ ọgụ angina.

N'iburu n'uche mmụba dị ukwuu nke ọrịa obi, mkpa nke ọgwụ ndị a na-atụle dị nnọọ elu taa. Ruo ugbu a, a na-ewere nitroglycerin na ọgwụ ndị ọzọ emepụtara na ndabere ya, yana ọgwụ ndị dị ha nso, isosorbide mono- na dinitrate, bụ ọgwụ antianginal kacha dị irè.

organic okwu bụ lime mmiri starch nitrate

Mmetụta antianginal nke nitrates organic na-ejikọta ya na mmụba nke ikuku oxygen na akwara obi na, n'otu oge ahụ, na mbelata mkpa ya.

Usoro nke ime ihe

N'agbanyeghị ahụmịhe ogologo oge dị otú ahụ, usoro nke antianginal na vasodilating mmetụta nke nitrates eguzobewo n'oge na-adịbeghị anya. Ọ mejupụtara na myotropic na neurotropic mmetụta nke isi components.

Mgbe etinyere ya, NO otu na-ekewapụ na nitrate molecule, nke yiri ihe na-enye izu ike endothelial. Ọ na-arụ ọrụ guanylate cyclase, nke na-eduga na mmụba nke cyclic guanosine monophosphate cyclic, nchịkọta nke na-enyere aka na mmepe nke myosin dephosphorylation na mbelata ntinye nke calcium ion n'ime sel, na-eme ka izu ike nke ezigbo uru nke anụ ahụ. mgbidi vaskụla. A pụkwara ịhụ nke a na urinary, akụkụ okuku ume, tract digestive. Na-emetụta akụkụ ụbụrụ nke ụbụrụ, nitrates na-enye aka na nkwụsị nke akụkụ etiti nke reflexes nke akwara ọbara, na ike ọgwụgwụ nke njikwa ọmịiko nke usoro obi obi.

A maara na starch bụ ihe na-emepụta ihe. A naghị agụnye mmiri lime na nitrate ọlaọcha.

Mmetụta antianginal nke nitrates

Maka ịdị irè nke antianginal, ọ bụghị naanị obere oge na mgbasawanye nke arịa ọbara na mmụba ọbara na-esi na ha dị mkpa, kamakwa mwepu hemodynamic nke akwara obi, nke na-eduga n'ịkụda obi na mkpa oxygen ya. N'ihi mgbasawanye nke vein, nlọghachi nke venous ọbara na akụkụ ahụ dị oke (mbelata nke ibu ibu, nrụgide n'ime ventricles, esemokwu nke mgbidi ha), na mgbasawanye akwara na-ebelata ọkwa nke mmepụta obi obi (mbelata ibu n'azụ, mmepụta obi obi. nguzogide, mmefu ike na oriri oxygen myocardial).

nkwadebe nitrate organic

Mmetụta dị mma na trophism myocardial

Na mgbakwunye, organic nitrates nwere mmetụta bara uru na trophism myocardial, ọrụ nke enzymes iku ume, electrolyte metabolism, na-abawanye nkwụsi ike eletriki nke akwara obi, na-egbochi mmepe nke arrhythmias. Ihe dị oke mkpa bụkwa ihe onwunwe nke ihe ndị a iji belata nrụgide, n'ihi nke a na-eji ha eme ihe ma ọ bụrụ na enweghi ike nke ventricle aka ekpe.

Ọgwụ

Ngwakọta ọgwụ dị nso na nitrates organic (sodium nitroprusside, nitrites, molidomine) nwekwara mmetụta nitroxidergic.

Ha nwere ndịiche ama ama na mpaghara pharmacokinetic na egosi maka ojiji (nitroglycerin na-eji tumadi iji kpochapụ ọgụ angina, ọgwụ ndị ọzọ iji gbochie mmepe ha). Oghom mmeghachi omume nke onye ọgwụ na ngwaahịa bụ tumadi n'ihi na usoro nke edinam nkịtị ka dum Atiya nke ọgwụ ndị a, ya mere yiri nnọọ.

mmetụta nke organic nitrates

Nhazi nke organic nitrates

Ọgwụ niile dị otú ahụ dabara na ngalaba anọ:

  • nkwadebe nke nitroglycerin;
  • ọgwụ dabere na isosorbide dinitrate;
  • nkwadebe nke isosorbide mononitrate;
  • ọgwụ ndị dị ka nitrate.

Ọgwụ dabere na nitroglycerin na-arụ ọrụ ogologo oge. Ndị a gụnyere: Sustonit, Sustak, Nitrong, Trinitrolong, Nitroderm.

Ọgwụ dabere na isosorbide dinitrate nwere obere oge ime ihe.

Otu nitrates organic na-agụnye ọgwụ ndị dị ka Iso-Mik, Nitrosorbide na Isodinit.

A na-eji ọgwụ ndị dabere na isosorbide mononitrate bụ ịdị irè ogologo oge, na ndepụta ha gụnyere ọgwụ ndị dị ka Monocinque Retard, Mono Mac Depot.

mmetụta nke organic nitrates

Ọgwụ dị ka nitrate gụnyere Molidomin, Amylnitrite na sodium nitroprusside.

Kedu otu esi eji nitrates organic na ọbara mgbali elu?

A na-ejikọta mmetụta antianginal nke organic nitrates

Ọgwụgwọ hypotension arterial

Ihe dị oke mkpa na ụlọ ọgwụ bụ mbelata nrụgide karịa 15 mm Hg. Art. site n'ọkwa ntinye. Ọrịa ahụ bụ n'ihi mmetụta vasodilating nke a na-akpọ nitrates. Site na mbelata ọbara mgbali elu, ọ ga-ekwe omume ibelata ọbara na akụkụ ahụ niile, gụnyere obi. Iji gbochie mmepe nke hypotension siri ike, a na-atụ aro iji nitroglycerin na ọdụ ma ọ bụ ịgha ụgha na ụkwụ weliri elu.

Inweta ihe a n'ọnọdụ kwụ ọtọ nwere ike ịkpasu nkụda mmụọ na ike ọgwụgwụ nke mmetụta antianginal, ebe ọ bụ na mbelata nke ukwuu nke nrịba ọbara na-enye aka na-ebelata ọbara ọgbụgba. N'ọnọdụ ndị dị otú ahụ, ọrịa ohi nwere ike ime, nke bụ mmụba nke ischemia nke akwara obi, karịsịa na ndị ọrịa nwere stenosing atherosclerosis nke arịa ọbara ọbara.

Mbelata nke nrụgide siri ike nwere ike kpasuo nkwadebe nke nitrates organic dabere na sodium nitroprusside, nke a na-eji intravenously na mmepe nke ọgba aghara ọbara mgbali elu, edema akpa ume, preeclampsia, dissecting aortic aneurysm, eclampsia yana hypotension na-achịkwa n'oge ịwa ahụ.

Contraindications

Mmeghachi omume ọjọọ a na-ebute ihe mgbochi dị otú ahụ na ojiji nitroglycerin na nitrates organic ndị ọzọ, dị ka hypotension arterial na nrụgide systolic na-erughị 90 mm Hg. Art., na diastolic - ihe na-erughị 60 mm Hg. nka.; ujo, ida.

otu organic nitrates

mmekọrịta ọgwụ ọjọọ

A na-eme ka ikike nke nitrates organic belata ọbara mgbali elu ma ọ bụrụ na ejikọtara ya na vasodilators ndị ọzọ, ihe ọṅụṅụ na-aba n'anya, na ọgwụ analgesics narcotic. Iche iche, ọ dị mkpa iburu n'obi na ha na-adabaghị na sildenafil ("Viagra"). Ọgwụ a na-arụkwa ọrụ site na nitric oxide, na enwere ike nke mmetụta vasodilating na nnukwu hypotension na ọbụna ọnwụ.

Mmetụta nke organic nitrates

Nitrates nwere ike ịkpata mmetụta ọjọọ ndị a:

  1. orthostatic ọdịda. Ọtụtụ mgbe, mmetụta a na-akpalite nitroglycerin. Usoro nke ọnọdụ ọrịa a na-ejikọta ya na mbelata nke nlọghachi azụ na obi, nke na-ebelata ọkwa nke ọbara na ụbụrụ mgbe ị na-ewere ọnọdụ kwụ ọtọ. Ya mere, mgbe ịṅụchara ọgwụ ahụ, onye ọrịa ahụ ga-eji nwayọọ nwayọọ mee ya.
  2. Tachycardia, nke bụ isi mmetụta nke organic nitrates ma nwee mmetụta baroreflex, nke bụ iji belata njikwa parasympathetic nke obi mgbagha na nzaghachi na ntụrụndụ nke mgbidi vaskụla. A na-akpọkarị tachycardia mgbe ụfọdụ site na iji nitrates gwọọ onwe ya. N'ihe banyere iji ọgwụ ọjọọ eme ihe n'otu oge na-akpata bradycardia: ndị na-egbochi ọwa calcium sitere na ụdị phenylalkylamines ("Verapamil"), β-blockers na dihydropyridines ("Amlodipine", "Nicardipine", wdg) - a na-agbatị akara ngosi akụkụ a.
  3. Bradycardia, nke bụ mmetụta na-adịghị ahụkebe nke na-eme mgbe ụfọdụ site na intravenous injections nke nitroglycerin megide ndabere nke mbelata nrụgide siri ike. Isi ihe kpatara ọnọdụ pathological a bụ ịbawanye ụda nke akwara vagus. Enwere ike iji Atropine dozie ihe a.
  4. Isi ọwụwa bụ ihe mgbaàmà na-emekarị mgbe ọ nwụsịrị nitrates organic. Mmeghachi omume a nwere ike ịdịru site na nkeji 20 ruo ọtụtụ awa, na-esonyere ya na dizziness, nwee agwa na-akụda mmụọ, ọkachasị na ndị ọrịa nwere atherosclerosis nke ụbụrụ. Cephalgia jikọtara ya na mmetụta ọjọọ nke nitrates organic na hemodynamics cerebral. Ihe si na ya pụta bụ mbelata nke ọbara na-eru n'ụbụrụ, agụụ oxygen nke ụbụrụ, mmụba nke nrụgide intracranial, mgbasawanye nke mgbidi nke veins n'ime okpokoro isi, nke na-akpata mgbu.
  5. Mmụba nrụgide intraocular, nke bụ ihe mgbaàmà akụkụ na-adịghị adịgide adịgide nke nitrates. N'akụkụ a, a na-ewere glaucoma dị ka ihe mgbochi maka ojiji ha.

nhazi nitrates organic

Usoro ọgwụgwọ

A na-eji "Nitroglycerin" mee ihe dị ka ndị a:

  • capsules na 1% mmanụ ngwọta na dose nke 0.001 na 0.0005 g;
  • mbadamba nkume 0,0005 g;
  • aerosol maka iji sublingual - 0.0004 g;
  • mmanya mmanya - 1-2 tụlee kwa shuga.

Iji gbochie ọgụ angina, a na-eji mbadamba ọnụ na-eme ogologo oge - "Nitrong", "Nitrogranu-long", "Sustak forte". Ndepụta nke nitrates organic buru oke ibu. Mgbe ịṅụchara ọgwụ ndị a, ọrụ nke isi ihe na-amalite mgbe nkeji 120 gachara ma dị ihe dị ka awa 6. A na-ejikwa ego ndị a dị ka usoro ọgwụgwọ transdermal si dị - patches pụrụ iche ("Deponit"), nke a na-etinye na akpụkpọ ahụ maka awa 12 (patch na-ewepụta 0.0005 g nke ihe kwa ụbọchị).

organic nitrates ndepụta

A na-enye Isosorbide dinitrate sublingually, omume ya na-etolite mgbe nkeji 3-5 gachara, yana nchịkwa ọnụ - mgbe nkeji 15-30 gachara. Usoro onunu ogwu bụ otu mbadamba otu ugboro, a na-ekpebi ojiji ọzọ site na usoro ọgwụgwọ nke ọkachamara guzobere. N'agbanyeghị ojiji a na-ejikarị ọgwụ a eme ihe na omume ahụike nke oge a, ọ kachasị mma ijikọta nlekọta ya na dọkịta, n'ihi mmetụta a na-akpọkarị na mmeghachi omume n'akụkụ.


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