Pharmacodynamics muMitambo yeMishonga yeKliniki
Pharmacodynamics ibazi re pharmacology rinoongorora migumisiro yemishonga mumuviri. Chinangwa chayo chinosanganisira nzira dzekushanda kwemishonga, hukama huripo pakati pehuwandu hwemishonga nemigumisiro yekiriniki, uye zvinhu zvinopesvedzera mhinduro yemurwere. Mukurapa kwemishonga, kunzwisisa pharmacodynamics hakusi kungofungidzira chete asiwo kunoshanda sehwaro hwakakosha hwekuita sarudzo dzekurapa: kusarudza mishonga yakakodzera, kuona zvinangwa zvekurapa, kutarisa kushanda kwayo, uye kudzivirira nekugadzirisa migumisiro yakaipa. Chinyorwa chino chinokurukura basa re pharmacodynamics mukurapa kwemishonga, kusanganisira kushandiswa kwayo kuzvirwere zvakasiyana-siyana zvevarwere.
Pfungwa huru dze pharmacodynamics
Pharmacodynamics inotanga nemubvunzo mukuru: mishonga inogadzira sei mhedzisiro yayo? Kazhinji, mishonga inoshanda nekubatana nezvinangwa zvehupenyu zvakaita semareceptors, maenzymes, nzira dzeion, kana zvinotakura. Kudyidzana uku kunogona kukonzera mhinduro dzinodiwa dzemuviri (mhedzisiro yekurapa) kana mhinduro dzisingadiwe (mhedzisiro). Padanho rekiriniki, pharmacodynamics inobatsira kuvhara musiyano uripo pakati pe "dose inopihwa" uye "mhedzisiro inoonekwa," senge kudzikisa BP, kugadzirisa zviratidzo zvekurwadziwa, kana kudzora shuga yeropa.
Hukama hwemushonga-kuwanda kwemushonga hunowanzo ratidzwa uchishandisa nzira yemushonga-mhinduro. Zviyero zviviri zvakakosha zvinoshandiswa kazhinji zvinoti kushanda zvakanaka (kukwanisa kwemushonga kugadzira mhedzisiro yakanyanya) uye simba (chiyero kana huwandu hunodiwa kuti ugadzire mhedzisiro chaiyo). Mukiriniki yemishonga, kunzwisisa uku kunobatsira, semuenzaniso, pakusarudza pakati pesimba mbiri dzinoshanda zvakaenzana asi dzakasiyana dzemushonga, kana pakuona kana mushonga wakasimba zvakakwana kumurwere ane chirwere chakakomba.
MaReceptors uye nzira dzekuita kwemishonga
Mishonga mizhinji inoshanda kuburikidza nemareceptors. Mareceptors anogona kuva mapuroteni emukati (semuenzaniso, adrenergic receptors), mareceptor emukati memasero (semuenzaniso, masteroid receptors), kana zvimwe zvinangwa zvakaita semaenzymes (semuenzaniso, ACE inhibitors). Pharmacodynamics inodzidza mhando dzekudyidzana kwemishonga nemareceptors, akadai se:
1. MaAgonists, kureva mishonga inomutsa mareceptors uye inoburitsa mhinduro (muenzaniso: salbutamol se β2 agonist yebronchodilation).
2. Mishonga inorwisa, kureva mishonga inodzivisa kushanda kwereceptor (muenzaniso: propranolol se β antagonist yekuderedza kurova kwemoyo).
3. Zvikamu zve agonist, zvinoshandisa ma receptors asi zvine simba shoma pane agonists yakazara.
4. Maagonists anopindirana, anoderedza basa rekutanga remugamuchiri pasi pemamwe mamiriro ezvinhu.
Mukurapa, kunzwisisa mhando idzi dzekudyidzana kunobatsira varapi vemishonga kufanotaura mhedzisiro yemishonga kana ikashandiswa pamwe chete. Semuenzaniso, kupa mushonga unopesana nemurwere kunogona kuderedza kushanda kwemushonga unoshanda pamwe chete, kana kuti mushonga wechikamu cheagonist unogona "kutsiva" mushonga wakazara uye kuderedza mhedzisiro yese. Izvi zvakakosha zvikuru kuvarwere vane mishonga yakaoma, senge avo vane chirwere chemwoyo, asthma, kana zvirwere zvepfungwa.
Nhamba yekurapa, kushanda kwayo, uye kuchengetedzeka
Imwe pfungwa inokosha mu pharmacodynamics i therapeutic index, iyo iri pakati pe dose inoshanda ne dose ine chepfu. Mishonga ine chidimbu chekurapa chakamanikana (semuenzaniso, warfarin, digoxin, lithium, phenytoin) inoda kutariswa zvakanyanya nekuti shanduko diki muhuwandu hwemishonga inogona kukonzera chepfu kana kutadza kurapwa. Mukurapa kwemishonga, izvi zvine chekuita nechirongwa cheTherapeutic Drug Monitoring (TDM) uye kuongororwa kwezviratidzo zvekiriniki zvevarwere.
Nyanzvi dzemishonga hadzingotaridzi huwandu hwemishonga chete asiwo dzinohubatanidza nemhinduro dzevarwere. Semuenzaniso, huwandu hwewarfarin hahuyerwi zvakananga, asi mhedzisiro yavo yemishonga inotariswa uchishandisa INR. Izvi zvinoratidza kuti pharmacodynamics inowanzoonekwa kuburikidza nezviratidzo zvekiriniki kana biomarkers, kwete chete kuwanda kwemishonga muropa.
Kusiyana kwemhinduro dzevarwere
Havasi varwere vese vanopindura mishonga nenzira imwe chete. Kusiyana kwemhinduro kunogona kukonzerwa nezvinhu zvakaita sezera, majini, zvimwe zvirwere, kusashivirira, kunzwa kwereceptor, uye kudyidzana kwemishonga. Pharmacodynamics inobatsira kutsanangura kuti nei varwere vaviri vari pamushonga mumwe chete vachigona kuwana mhedzisiro yakasiyana: mumwe anovandudzika, mumwe haadaro, kana kutowana migumisiro yakaipa.
Semuenzaniso, varwere vakwegura vanowanzo nzwa zvakanyanya kune mimwe mishonga, yakadai se benzodiazepines, antipsychotics, kana antihypertensive pressure. Shanduko idzi hadzisi nguva dzose dzine chekuita ne pharmacokinetics (kunyudzwa, kugoverwa, kushandiswa kwemetabolism, uye kubviswa kwemishonga), asiwo nekuchinja kwe pharmacodynamic, senge ma receptor responses mu central nervous system uye cardiovascular system. Nokudaro, musimboti wekuti "tanga pasi, enda zvishoma nezvishoma" unoshandiswa zvakanyanya mukiriniki yemishonga, kunyanya muvanhu vakwegura.
Kudyidzana kwemishonga kubva pamaonero e pharmacodynamic
Kudyidzana kwemishonga hakungoitiki chete padanho re pharmacokinetic, asiwo padanho re pharmacodynamic. Kudyidzana kwemishonga kunoitika kana mishonga miviri iine mhedzisiro inosimbisana (synergistic) kana inopedza simba (agonistic) pachinangwa chimwe chete kana system yemuviri. Mienzaniso inowanzoonekwa mukiriniki inosanganisira:
– Njodzi yekubuda ropa inowedzera kana mishonga inorwisa ropa (warfarin) ikashandiswa pamwe chete nemishonga inorwisa maplatelet (aspirin, clopidogrel) kana NSAIDs. Izvi zvinonyanya kukonzerwa nemhedzisiro yemishonga inopindirana inokanganisa hemostasis.
– Kuora mwoyo uye kunyaradza kufema zvinowedzerwa kana mishonga yeopioid ikashandiswa pamwe chete nebenzodiazepines kana mimwe mishonga yekunyaradza.
– Hyperkalemia inogona kuitika kana mishonga inodzivirira ACE/ARB ikashandiswa pamwe chete ne spironolactone kana potassium supplements.
Varapi vemishonga vanofanirwa kuona musanganiswa une njodzi, kuongorora zvavanoda pakurapa, uye kupa mazano akadai sekugadzirisa dose, kusarudza dzimwe nzira, kana kutarisa zvimwe zvinhu.
Kushivirira, kusanzwa kushushikana, uye kuvimba nezvinhu
Kana munhu akashandisa mushonga kwenguva refu, mhinduro yemushonga inogona kudzikira nekuda kwekushivirira kana kusanzwa kwereceptor. Semuenzaniso, kushandisa mimwe mishonga inobvisa kudzimbika kwemushonga kunogona kukonzera kuzara kwemushonga, nepo kushandisa nitrate kwenguva refu kunogona kuderedza mhinduro yekurwisa anginal pasina nguva isina nitrate. Nemaopioid, kutsungirira mhedzisiro yekurwadziwa kunogona kuitika, zvichida kugadziriswa kwemishonga yemurwere kana nzira dzekutenderera opioid.
Pharmacodynamics inobatanidzwawo nenjodzi yekusada kushandisa zvinodhaka kana kurega kushandisa zvinodhaka, kunyanya nebenzodiazepines, opioids, nemimwe mishonga yepsychotropic. Mumabasa ekiriniki emishonga, varapi vemishonga vanoita basa rekudzidzisa varwere, kuderedza kuronga, uye kutarisa zviratidzo zvekushandisa zvinodhaka zvisina kunaka.
Pharmacodynamics mukusarudza kurapwa uye kutarisa kwekiriniki
Kushandiswa kwemishonga inorapa ropa kunoonekwa mukusarudza kurapwa zvichibva pazvinangwa zvekurapa. Semuenzaniso, muBP, mishonga inogona kuderedza BP kuburikidza nenzira dzakasiyana: mishonga inobvisa mvura mumuviri inoderedza vhoriyamu, mishonga inodzivirira ACE inogadzirisa renin-angiotensin system, uye mishonga inovhara calcium channel inokonzera kuyerera kweropa mumuviri. Nyanzvi dzemishonga dzinofunga nezvehupenyu hwemurwere: angave ane chirwere cheshuga, itsvo dzakakundikana, kana chirwere chemwoyo; zvinangwa zveBP yavo ndezvipi; uye njodzi yemigumisiro yakadai se hyperkalemia kana edema.
Muchirwere cheshuga, kusarudzwa kwemishonga hakungotarise chete kudzikiswa kweHbA1c asiwo zvimwe zvinokonzera pharmacodynamic zvakaita sengozi ye hypoglycemia, kukanganisa huremu hwemuviri, uye kuchengetedzwa kwemwoyo kana itsvo. Panguva imwecheteyo, muzvirwere, mishonga inorwisa mabhakitiriya inova yakakosha: mimwe mishonga inorwisa mabhakitiriya inoenderana nenguva, mimwe inoenderana nehuwandu, uye mimwe inopesvedzerwa neAUC/MIC. Ruzivo urwu runobatsira kugadzira nzira yekurapa ine musoro, kusanganisira nguva yekurapa uye nguva yekurapa.
Basa revanorapa mishonga yekurapa uye kushandira pamwe kwevashandi pamwe chete
Mukati mechikwata chehutano, varapi vemishonga vanoshanda senyanzvi dzemishonga, vachiona kuti kurapwa kwakachengeteka uye kunoshanda. Pharmacodynamics inoshanda sechishandiso chekuongorora kana zvinangwa zvekurapa zviri kuzadzikiswa, kana migumisiro inogona kutsanangurwa nenzira dzemishonga, uye kana kusanganiswa kwemishonga kwakakodzera. Varapi vemishonga vanobatsirawo kuburikidza nekudzidzisa varwere, semuenzaniso, kutsanangura kuti nei mishonga ichifanira kutorwa nguva dzose kuti irambe ichishanda zvakanaka, kana kuti nei mimwe mishonga isingafaniri kumiswa kamwe kamwe.
Kushanda pamwe chete navanachiremba nevanamukoti kunodiwa kuti zvirongwa zvekurapa zvienderane. Kana kurapwa kwakundikana, pharmacodynamics inobatsira kuona kana chikonzero chacho chiri chidiki zvakanyanya, kuramba mushonga (kumishonga inorwisa mabhakitiriya), kana kuti mushonga usina kukodzera mamiriro emurwere. Saizvozvowo, kana migumisiro yakaipa ikaitika, kunzwisisa pharmacodynamics kunobatsira kusiyanisa migumisiro inofungidzirwa (inoenderana nedosi) kubva kune migumisiro isinganzwisisike.
Penutup
Pharmacodynamics ihwaro hwakakosha mumabasa ekurapa emishonga nekuti inotsanangura hukama huripo pakati pemishonga, zvinangwa zvehupenyu, uye mhinduro dzevarwere kukiriniki. Nekunzwisisa nzira dzekuita kwemishonga, ma curve emhinduro yemushonga, ma index ekurapa, kusiyana kwemhinduro, uye kudyidzana kwemishonga, varapi vemishonga vanogona kupa mazano ekurapa akanyatsojeka uye akachengeteka. Pakati pekuoma kuri kuwedzera kwevarwere uye nzira dzemishonga, kushandiswa nguva dzose kwemishonga kuchavandudza mhando yekurapwa, kuderedza njodzi, uye kutsigira kuwanikwa kwemhedzisiro yakanaka yekiriniki.
