danarTi # damtkicebulia saqarTvelos Sromis, janmrTelobisa ... - GPC
danarTi # damtkicebulia saqarTvelos Sromis, janmrTelobisa ... - GPC
danarTi # damtkicebulia saqarTvelos Sromis, janmrTelobisa ... - GPC
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<strong>danarTi</strong> #<br />
<strong>damtkicebulia</strong><br />
<strong>saqarTvelos</strong> <strong>Sromis</strong>, <strong>janmrTelobisa</strong> da<br />
socialuri dacvis saministros<br />
wamlis saagentos ufrosis<br />
200 wlis---------------------------------------<br />
#-------------------------------- brZaneba<br />
plesidreqsi<br />
Plecidrex<br />
gamoyenebis instruqcia<br />
wamlis forma:<br />
tableti<br />
Semadgenloba:<br />
3,4,5-meTilrezerpatis trimeToqsibenzoati (rezerpini). rezerpiniraufolfias<br />
sufTa alkaloidi, 1,4-dihidrazinoftalazinis sulfati<br />
(dihidralazinis sulfati). dihidralazini – ftalaginis warmoebuli.<br />
6-qlor-3-4-dihidro-2 H – 1,2,4-benzoTiadiazini – 7-sulfonamidi – 1,1 –<br />
dioqsidi (hidroqlorTiazidi), romelic sulfonamidis warmoebulia.<br />
TiToeuli tableti Seicavs 0,1 mg rezerpins, 10 mg dihidralazinis<br />
sulfats da 10 mg qlorTiazids.<br />
farmakoTerapiuli jgufi:<br />
hipotenziuri saSualeba.<br />
farmakologiuri Tvisebebi:<br />
plesidreqsi warmoadgens kombinirebul preparats. igi Seicavs 3<br />
komponents, romlebic ganapirobeben preparatis moqmedebis meqanizms.<br />
rezerpini iwvevs cns-sa da simpaTikur nervul daboloebebSi arsebuli<br />
kateqolaminebis gamofitvas da amave dros sakmaod xangrZlivi drois<br />
ganmavlobaSi Trgunavs kateqolaminebis deponirebis process. amis Sedegad<br />
mcirdeba simpaTikuri nervuli sistemis tonusis aqtivoba SenarCunebulia,<br />
rac iwvevs arteriuli wnevis daqveiTebas, pulsis gaiSviaTebas da<br />
sedaciur efeqts cns-is mxriv. misi moqmedebis maqsimaluri efeqti<br />
aRiniSneba mxolod 2-3 kviris Semdeg.<br />
dihidralazini arteriolebze uSualo zemoqmedebiT iwvevs periferul<br />
vazodilatacias da arteriuli wnevis Semcirebas. misi ZiriTadi moqmedeba<br />
dakavSirebulia sisxlZarRvTa periferiuli winaaRmdegobis SemcirebasTan<br />
Tavis tvinsa da TirkmelebSi. preparatis xangrZlivad moqmedebisas<br />
TirkmelebSi sisxlmimoqceva ar mcirdeba. dihidralazini avlens<br />
hipotenziur moqmedebas da ar iwvevs orTostatul hipotenzias.<br />
hidroqlorTiazidi Trgunavs Na + -s aqtiur rearbsorbcias, ZiriTadaT<br />
Tirkmelebis distalur milakebSi, ris Sedegadac adgili aqvs Na + -is, Cl - -<br />
1
is da wylis gamoyofas organizmidan. K + -s da Mg + -s eqskrecia<br />
TirkmelebiT izrdeba da damokidebulia dozaze. amave dros, Ca ++ -s<br />
reabsorbcia matulobs. preparatis diurezuli efeqti vlindeba<br />
daaxloebiT 6 sT-is Semdeg da SenarCunebulia 12 sT-is ganmavlobaSi. doza<br />
12,5 mg sakmarisia raTa miRweul iqnas maqsimaluri diurezuli efeqti.<br />
amasTan erTad, kaliumisa da natriumis gamoyofa damokidebulia dozaze.<br />
preparatis moqmedebisas adgili aqvs gulis sistoluri moculobis,<br />
eqstraceluluri siTxis da plazmis moculobis Semcirebas, xolo<br />
xangrZlivi mkurnalobisas – periferiul sisxlZarRvTa winaaRmdegobis<br />
daqveiTebas. eqsperimentulad dadgenilia preparatis mier adrenalinisa da<br />
da angiotenzin II-is vazokonstriqtoruli moqmedebis prevencia<br />
sisxlZarRvTa gluv kunTovan elementebze.<br />
Cveneba:<br />
preparati gamoiyeneba arteriuli hipertenziis samkurnalod.<br />
miRebis wesi da dozireba:<br />
doza dgindeba individualurad. mkurnaloba iwyeba mcire doziT, romelsac<br />
SemdgomSi TandaTan zrdian. dReRamuri doza ar unda aRematebodes 5<br />
tablets (0,5 mg rezerpini, 50 mg dihidralazini, 50 mg<br />
hidroqlorTiazidi). dReRamuri doza rekomendebulia gaiyos 2-3 miRebaze.<br />
mkurnalobis efeqtis SesanarCuneblad rekomendebulia minimaluri efeqturi<br />
dozis gamoyeneba. dReSi saSualod miiReba 1-3 tableti Wamis dros wylis<br />
miyolebiT.<br />
winaaRmdegCveneba:<br />
preparatis SemadgenlobaSi Semavali romelime komponentis mimarT<br />
momatebuli mgrZnobeloba.<br />
gamoxatuli depresia, parkinsonis daavadeba, epilefsia,<br />
eleqtrokonvulsiuri Terapia, feoqromocitoba, mao-s inhibitorebis<br />
gamoyeneba, kuWis wyluli, araspecifikuri wylulovani koliti,<br />
gamoxatuli taqikardia, anuria, Tirkmelebisa da RviZlis funqciis mZime<br />
formis dazianeba, refraqteruli hipokaliemia da simptomaturi<br />
hiperurikemia.<br />
sifrTxilea saWiro:<br />
preparati sifrTxiliT iniSneba gulis ukmarisobis, miokardiumis<br />
infarqtis gadatanis SemTxvevaSi, aseve koronaruli an cerebruli<br />
aTeroskleoziT Sepyrobil pacientebSi. saWiroa Tavidan aviciloT<br />
arteriuli wnevis mkveTri daqveiTeba. Tirkmelebis ukmarisobisas<br />
(kreatininis klirensi naklebia 30 ml/wT-Si an SratSi kreatininis<br />
raodenoba metia 2,5 mg/100 ml=221 mkmol/l) saWiroa preparatis miRebebs<br />
Soris intervalis gazrda, raTa Tavidan iqnas acilebuli misi sisxlSi<br />
dagroveba. preparati satransporto saSualebis marTvis dros amcirebs<br />
swrafi reaqciis unars.<br />
igi sifrTxiliT iniSneba: kuWisa da 12-goja nawlavis wylulovani<br />
daavadebis dros, eroziuli gastritis, naRvl-kenWovani daavadebis,<br />
2
sinusuri bradikardiis, atrioventrikuluri gamtarobis darRvevisas,<br />
depresiuli mdgomareobiT Sepyrobil pacientebSi. misi miReba unda<br />
Sewydes eleqtrokonvulsiuri Terapiis Catarebamde 7 dRiT adre.<br />
rezerpinis miReba dauSvebelia Tuki pacienti gegmavs operacias, vinaidan<br />
SesaZlebelia narkozis fonze arteriuli wnevis Zlieri daqveiTeba.<br />
gadaudebeli operaciis SemTxvevaSi saWiroa atropinis winaswari Seyvana,<br />
raTa Tavidan aviciloT mZime bradikardiis ganviTareba. RviZlis<br />
ukmarisobiT Sepyrobil pacientebSi rekomendebulia dozis Semcireba an<br />
preparatis miRebebs Soris intervalis gazrda. Zalian iSviaTad<br />
mosalodnelia mgluras msgavsi sindromis ganiTareba. im SemTxvevaSi Tuki<br />
gamovlindeba arTralgia (iSviaTad cxelebasTan erTad da kanze<br />
gamonayaris saxiT) aucilebelia preparatis miRebis dauyovnebliv<br />
Sewyveta.<br />
mkurnalobis procesSi mosalodnelia eleqtrolituri balansis darRveva,<br />
kerZod hipokaliemiis ganviTareba. amitom rekomendebulia SratSi<br />
regularulad eleqtrolitebis koncentraciis Semowmeba, gansakuTrebiT<br />
pacientebSi, romlebic iyeneben saTiTuras preparatebs. amave dros, ar<br />
aris mizanSewonili mkacri umarilo dietis dacva. am SemTxvevaSi, Tuki<br />
aRiniSneba hipokaliemia (magaliTad kunTebis sisuste, ariTmia), ekg-is<br />
cvlileba, an Tuki organizmidan damatebiT gamoiyofa kaliumi (Rebinebis,<br />
diareis, sakvebis arasakmarisad miRebis, nefrozis, RviZlis cirozis,<br />
hiperaldosteronizmis, kortikosteroiduli saSualebebiT mkurnalobis<br />
SemTxvevaSi) aucilebelia eqimis meTvalyureobis qveS damatebiT kaliumis<br />
Seyvana. pacientebSi, romlebsac SedarebiT maRal dozebSi miRebuli aqvT<br />
Tiazidebi, SesaZlebelia adgili hqondes hipomagniemias, rac gamoixateba –<br />
nervuli agznebadobiT, kunTebis krunCxvebiT da ariTmiiT. xandazmul<br />
pacientebSi, romlebsac aReniSnebaT qronikuli daavadebebi, aseve RviZlis<br />
ciroziT Sepyrobil pacientebSi arsebobs wyal-eleqtrolituri balansis<br />
darRvevisadmi midrekileba. calkeul SemTxvevebSi Tiazidebis gamoyenebisas<br />
aRiniSneba hiponatriemia, romlis Tanmxlebia nevrologiuri simptomebi<br />
(gulisreva, sisuste, orientaciis progresirebadi darRveva, apaTia).<br />
xandazmul da RviZlis ciroziT daavadebul pacientebSi rekomendebulia<br />
sisxlSi eleqtrolitebis donis xSiri Semowmeba. Tiazidebs SeswevT<br />
sisxlis SratSi SardmJavas donis momatebisa da podagris Setevis<br />
ganviTarebis unari. hiperlipidemiiT Sepyrobil pacientebSi<br />
rekomendebulia SratSi lipidebis donis regularuli gansazRvra.<br />
lipidebis donis momatebisas sisxlSi SeiZleba dadges Tiazidebis<br />
Semdgomi gamoyenebis mizanSewonilobis sakiTxi. Tiazidebi cvlian<br />
glukozis mimarT tolerantobas, Tumca Saqriani diabetis ganviTarebis<br />
movlenebs iSviaTad aqvs adgili maTi gamoyenebisas.<br />
orsulobisa da laqtaciis periodi:<br />
orsulobis I trimestrSi preparati iniSneba mxolod aucileblobis<br />
SemTxvevaSi. Tuki preparati iniSneba mSobiarobamde, maSin axalSobilebSi<br />
mosalodnelia cxviris lorwovani garsis SeSupeba da anoreqsiis<br />
ganviTareba. amitom orsulobis III trimestrSi preparatis gamoyeneba ar<br />
3
aris rekomendebuli. vinaidan preparati aRwevs dedis rZeSi, eqimi wyvets<br />
misi miRebis da/an gamoyenebis Sewyvetis sakiTxs.<br />
gverdiTi movlenebi:<br />
preparatis gamoyenebisas mosalodnelia gadaRlilobis SegrZneba,<br />
cnobierebis darRveva, Tavbrusxveva, Tavis tkivili da Zilis darRveva,<br />
aseve depresiuli da gangaSis mdgomareoba.<br />
kuW-nawlavis traqtis mxriv: gulisreva, Rebineba da diarea, agreTve<br />
cxviris lorwovani garsis SeSupeba, potenciis daqveiTeba da<br />
eriTematozuri gamonayari. preparatis maRali doziT gamoyenebam<br />
SesaZlebelia gamoiwvios orTostatuli hipotenzia. agreTve mis<br />
SemadgenlobaSi Semavali komponentebidan gamomdinare SesaZlebelia<br />
ganviTardes:<br />
mxedvelobis daqveiTeba, piris Rrus simSrale, kuWis wyluli, SeSupeba,<br />
potenciis daqveiTeba da eakulaciis darRveva, galaqtorea da<br />
ginekomasTia. maRali doziT miRebisas: gulis riTmis darRveva da<br />
parkinsonizmi. dihidralazinis Semcvelobis gamo SesaZloa ganviTardes<br />
taqikardia, gulis friali, stenokardia, zogjer RviZlis dazianeba<br />
simptomebiT, romlebic damaxasiaTebelia virusuli hepatitisaTvis.<br />
calkeul SemTxvevebSi kanze gamonayari da sisxlis suraTis cvlileba<br />
(anemia, leikopenia, Trombocitopenia). Zalian iSviaTad periferiuli<br />
nevriti da glomerulonefriti. amasTan erTad SesaZlebelia adgili<br />
hqondes iseT gverdiT movlenebs, rogoricaa;<br />
urtikaria da kanze sxva saxis gamonayari, fotosensibilizacia, Zalian<br />
iSviaTad nekrozuli vaskuliti, Trombocitopenia. calkeul SemTxvevebSi<br />
leikopenia, agranulocitozi, anemia, Zalian iSviaTad Zvlis tvinis<br />
funqciis daTrgunva, hipokaliemia, hiponatrieamia, hipomagniemia,<br />
hipoqloremiuli alkalozi da hiperkalciemia. im SemTxvevaSi, rodesac<br />
aRiniSneba hipokalciemia, aucilebelia diferenciuli diagnostikis<br />
Catareba (magaliTad hiperparaTireozis gamosaricxad). iSviaTad aRiniSneba<br />
RviZlis Sida qolestazi an siyviTle, pankreatiti, hiperurikemia,<br />
hiperglikemia, glukozuria an Saqriani diabetiT gamowveuli nivTierebaTa<br />
cvlis procesebis darRveva, sisxlSi lipidebis donis momateba,<br />
filtvebis SeSupeba.<br />
urTierTqmedeba sxva samkurnalo saSualebebTan:<br />
plesidreqsis hipotenziuri efeqti Zlierdeba misi sxva antihipertenziul<br />
samkurnalo saSualebebTan erTdrouli gamoyenebis SemTxvevaSi<br />
(guanetidini, meTildopa, beta blokatorebi, vazodilatatorebi, kalciumis<br />
antagonistebi, amf-is inhibitorebi). preparati aZlierebs alkoholis<br />
centralur moqmedebas, agreTve tkivilgamayuCebeli preparatebis,<br />
antihistaminuri da fsiqotropuli samkurnalo saSualebebis (tricikluri<br />
antidepresantebis) efeqts. igi aseve aZlierebs adrenalinis da sxva<br />
simpatomimeturi saSualebebis (sifrTxilea saWiro xvelebis sawinaaRmdego<br />
saSualebebis, Tvalisa da cxviris wveTebis gamoyenebisas) moqmedebas.<br />
amasTanave mosalodnelia Semdegi urTierTqmedebis ganviTareba, rac<br />
damokidebulia preparatSi Semaval komponentebze: rezerpinisa da<br />
4
antiariTmiuli, an sagule glikozidebis erTdroulma gamoyenebam<br />
SesaZlebelia gamoiwvios sinusur bradikardia. rezerpini agreTve amcirebs<br />
levodopas aqtivobas. dihidralazinisa da diazoqsidis erTdroulma<br />
gamoyenebam SesaZlebelia gamoiwvios gamoxatuli hipotenzia.<br />
vinaidan Tiaziduri jgufis diurezuli samkurnalo saSualebebi zrdian<br />
sisxlSi liTiumis dones, saWiroa sifrTxile im pacientebSi, romlebic<br />
iReben liTiums da hidroqlorTiazids erTdoulad. Tiazidebi aZliereben<br />
kurares warmoebulebis, Tiazidebis hipokaliemiur moqmedebas, romelic<br />
SesaZloa gaZlierdes amfotericinis, kortikosteroidebisa da<br />
karbenoqsilinis erTdrouli gamoyenebisas.<br />
aucileblobis SemTxvevaSi saWiroa insulinisa da peroraluri<br />
antidiabeturi samkurnalo saSualebebis dozebis koreqcia.<br />
Tiazidebisa da arasteroiduli anTebis sawinaaRmdego saSualebebis<br />
(magaliTad indometacinis) erTdroulma gamoyenebam SesaZlebelia<br />
gamoiwvios Tiazidebis diurezuli da hipotenziuri moqmedebis Semcireba.<br />
arsebobs calkeuli SemTxvevebi Tirkmelebis funqciis darRvevis Sesaxeb.<br />
Warbi dozireba:<br />
Warbi dozirebis SemTxvevaSi aRiniSneba: Tavis tkivili, Tavbrusxveva,<br />
Zilianoba, gonebis dabindva, koma, eqstrapiramiduli moSlilobebi,<br />
krunCxvebi, paresTeziebi da miozi, aseve gulisreva, Rebineba, diarea.<br />
aRiniSneba taqikardia da hipotenzia gonebis dagargviT, zogjer<br />
miokardiumis iSemiiT – stenokardiiTa da gulis riTmis darRveviT,<br />
sunTqvis daTrgunva, kunTebis sisuste, wvivis kunTebis krunCxvebi,<br />
oliguria.<br />
mkurnaloba:<br />
saWiroa xelovnuri Rebinebis gamowveva an kuWis amirecxva da gaaqtivebuli<br />
naxSiris miReba. orTostatuli hipotenziis arsebobis SemTxvevaSi<br />
aucilebelia pacientis horizontalur mdgomareobaSi moTavseba da plazmis<br />
Semcvlelebis Seyvana, eleqtrolitebis balansis koreqcia. Tuki aRiniSneba<br />
diarea, saWiroa antiqolinerguli saSualebebis daniSvna. krunCxvebis an<br />
epilefsiis arsebobisas saWiroa SeviyvanoT antikonvulsiuri saSualebebi,<br />
magaliTad diazepami. sunTqvis daTrgunvis SemTxvevaSi saWiroa xelovnuri<br />
sunTqvis Catareba. vinaidan rezerpins gaaCnia xangrZlivi moqmedeba,<br />
pacientis mdgomareobas akvirdebian 72 sT-is ganmavlobaSi.<br />
Senaxvis pirobebi:<br />
preparati inaxeba mSral, bnel, gril (30 0 C temperaturaze qveviT),<br />
bavSvebisagan dacul adgilas.<br />
gamoSvebis forma:<br />
tableti #10; 10X10 SefuTvaSi.<br />
mwarmoebeli firma:<br />
“Pletico”, indoeTi<br />
5
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