Li-Biguanides ke lithethefatsi tse etselitsoeng ho theola tsoekere ea mali. Sesebelisoa se fumaneha ka mokhoa oa matlapa.
Li sebelisoa hangata khafetsa ka mofuta oa lefu la tsoekere la mofuta oa 2, e le papatso.
E le karolo ea monotherapy, lithethefatsi tsa hypoglycemic ha li fuoe hangata. Hangata sena se etsahala maemong a 5-10%.
Li-Biguanides li kenyelletsa litlhare tse latelang:
- Bagomet,
- Avandamet
- Metfogamma,
- Glucophage,
- Metformin Acre
- Siofor 500.
Ha joale, naheng ea Russia, le lefats'e ho pota, "Biguanides" e sebelisoa haholo bakeng sa karolo ea methylbiguanide, ke hore, metformin:
- glucophage
- Siofor
- metpho-gamma,
- dianormet
- glyformin le ba bang.
Metformin e arohana ho tloha ho hora le halofo ho isa ho tse tharo. Setlhare se hlahisoa matlapeng a 850 le 500 mg.
Litekanyetso tsa kalafo ke 1-2 g ka letsatsi.
U ka ja ho fihlela ho 3 g ka letsatsi la lefu la tsoekere.
Butylbiguanide derivatives:
- silubin
- buformin
- Adebite.
Ka kopo elelloa hore li-Biguanides li sebelisoa ka mokhoa o fokolang, ka lebaka la litlamorao tse mpe, e leng gysric dyspepsia.
Hona joale lingaka ha li khothaletse ho sebelisa li-derivatives tsa phenylbiguanide, hobane ho netefalitsoe hore li lebisa ho bokelleng maling a motho:
- pyruvate
- lactate
Ketso ea lithethefatsi
Bo-rasaense ba pakile hore litlamorao tse fokotsang tsoekere tsa metformin ho lefu la tsoekere li amahanngoa le phello e tobileng ea lithethefatsi ho pompo le synthesis. Phello e fokotsang tsoekere ea metformin e amahanngoa le ba tsamaisang glucose seleng.
Boholo ba ba tsamaisang tsoekere bo eketseha ka lebaka la ho pepesetsoa li-biguanides. Sena se bonahala ka ho tsamaisoa ha tsoekere e ntlafalitsoeng ho fetela membrane ea sele.
Phello ena e hlalosa phello ea liketso tsa "insulin" tsa 'mele le tsa insulin tse tsoang ka ntle. Lithethefatsi li sebetsa le ka har'a membrane ea mitochondrial.
Biguanides inhibit gluconeogeneis, ka hona ba kenya letsoho keketseho ea litaba tsa:
- lactate
- pyruvate,
- Alanine
Lintho tsena ke li-glucose tse tlang pele ho gluconeogeneis.
Palo ea ba tsamaisang tsoekere e eketseha tlasa ts'ebetso ea metformin ka membrane ea plasma. E mabapi le:
- GLUT-4,
- GLUT-2,
- GLUT-1.
Ho tsamaisa lintho tsa moea ho potlakisa:
- ka mesifa e boreleli ea vascular
- endothelium
- mesifa ea pelo.
Sena se hlalosa ho fokotseha ha ho ba teng ha insulin bathong ba nang le mofuta oa 2 lefu la tsoekere ka tlas'a tšusumetso ea metformin. Keketseho ea kutlo ea insulin ha e tsamaisane le keketseho ea secretion ea eona ke manyeme.
Khahlano le semelo sa ho fokotseha ha insulin, boemo ba mantlha bo bonts'ang insulin maling le bona boa fokotseha. Keketseho ea kutlo ea insulin ha e tsamaisane le keketseho ea secretion ea eona ke manyeme, joalo ka ha ho sebelisoa sulfonylureas.
Ha u phekola metformin bathong, ho fokotsa boima ba 'mele ho bonoa, empa ha ho phekoloa ka li-sulfonylurea agents le insulin, litlamorao tse ka ba teng. Ho feta moo, metformin e thusa ho theola serame lipids.
Litlamorao
Litlamorao tse kholo tse tsoang ts'ebelisong ea metformin li lokela ho hlokomeloa, mochine o tjena:
- lets'ollo, ho nyekeloa, ho hlatsa;
- tatso ea tšepe e molomong;
- ho hloka botsitso ka mpeng;
- ho fokotseha le ho felloa ke takatso ea lijo, ho fihlela ho hloea lijo;
- lactic acidosis.
Litlamorao le liketso tse bonts'itsoeng, joalo ka molao, li tloha kapele ka sekhahla se theohileng. Tlhaselo ea lets'ollo ke letšoao la ho emisa ho nka metformin.
Haeba u nka Metformin 200-3000 mg ka letsatsi nako e telele, joale u tla lokela ho hopola hore ho koaloa ha pampitšana ea gastrointestinal ho tla fokotseha:
- Li-vithamine tsa B,
- folic acid.
Hoa hlokahala ho rarolla molemong o mong le o mong bothata ba ho khethoa ha livithamini tse eketsehileng.
Ho bohlokoa ho boloka likhalase tsa mali li le tlasa taolo, 'me u hlahlobe sena bonyane habeli ka selemo. Sena ke sa bohlokoa ka lebaka la bokhoni ba metformin ba ho ntlafatsa gasecolic ea anaerobic ka mpeng e nyane le ho thibela glycogenolysis ka har'a sebete.
Haeba motho a e-na le litletlebo tsa bohloko ba mesifa le tatso ea tšepe molomong, ho bohlokoa ho ithuta boemo ba lactate. Haeba litaba tsa eona tsa mali li eketsehile, ketso ea kalafo e nang le metformin e lokela ho emisoa.
Haeba ho sa khonehe ho ithuta sekhahla sa lactate maling, joale metformin e hlakotsoe ho fihlela maemo a tloaelehileng, joale menyetla eohle ea tsamaiso ea eona e hlahlojoe.
Li-contraindication tse ka sehloohong
Ho na le li-contraindication tse ikhethang mabapi le ts'ebeliso ea metformin:
- lefu la tsoekere la ketoacidosis, hammoho le komisi le maemo a mang a lefu la tsoekere;
- ts'ebetso e sa sebetseng ea renal, ho eketseha ha creatinine maling maling a fetang 1.5 mmol / l;
- maemo a hypoxic a genesis efe kapa efe (angina pectoris, ho se potoloha ha mali, 4 FC, angina pectoris, infarction ea myocardial);
- ho hloleha ho phefumoloha;
- e tebileng discirculatory encephalopathy,
- maqeba
- phokolo ea mali
- mafu a tšoaetsanoang a tšoaetsanoang, mafu a ho buoa
- joala
- ho hloleha ha sebete;
- boimana
- matšoao a nalane ea lactic acidosis.
Ts'ebetsong ea ho holisoa ha sebete, biguanides e khethoa ha hepatomegaly e amoheloa ka lebaka la lefu la hepatostatosis ea lefu la tsoekere.
Ka mathata a tšoaetsanoang a allergic le dystrophic a sebete, litlamorao tsa biguanides ho hepatic parenchyma li ka tlalehoa, tse hlahisitsoeng ka:
- ponahalo ea cholestasis, ka linako tse ling ho fihla ho jaundice e bonahalang,
- liphetoho litlhahlobong tsa sebete sa hau.
Ho hepatitis e sa khaotseng e sa feleng, lithethefatsi li lokela ho sebelisoa ka hloko.
Ho fapana le lintho tse tsoang ho sulfonylurea, li-biguanides ha li na phello e tobileng ts'ebetsong ea hematopoietic ea moko le lesapo. Leha ho le joalo, li kopantsoe ka:
- mafu a liphio a khothalletsang ho fokotseha ha moea o fokang ka nakoana
- polokeho ea slag ea naetrojene
- khaello ea mali haholo, ka lebaka la kotsi ea lactacidemia.
Batho ba baholo ba kulang ba hloka ho fana ka litlhare ka hloko, hobane sena se tsamaisana le ts'okelo ea lactic acidosis. Sena se sebetsa ho bakuli ba etsang mosebetsi o boima oa 'mele.
Ho na le lithethefatsi, tseo tšebeliso ea tsona kalafong ea li-greatuanides li eketsang mochine oa lactic acidosis, ke tsena:
- fructose
- teturam
- antihistamines
- salicylates,
- barbiturates.
