Imiphumela Yezokwelapha Kwabadala
Ukuguga kuyinqubo yemvelo yemvelo eyenzeka kuwo wonke umuntu. Njengoba umzimba uguga, izinguquko ezithweni zomzimba, ezicutshini, kanye nemisebenzi yomzimba zithinta ngqo indlela imithi esebenza ngayo. Ngakho-ke, ukunikeza ukwelashwa ngezidakamizwa kubantu abadala kudinga ukunakwa okukhethekile. Imithamo ephephile kubantu abadala abasebasha ingaba nemiphumela enamandla noma ehlala isikhathi eside kubantu abadala, kuyilapho eminye imithi ingase ingasebenzi kahle. Lesi sihloko sixoxa ngemiphumela yezokwelapha kubantu abadala, izici ezithonya impendulo yezidakamizwa, kanye nezimiso zokusetshenziswa kwemithi ephephile.
Izinguquko zomzimba kubantu asebekhulile kanye nomthelela wazo emithini
Imiphumela yezokwelapha iwumphumela wokuxhumana komuthi nomzimba kanye nama-receptor awo aqondiwe, athonywa yi-pharmacokinetics (indlela umzimba owucubungula ngayo umuthi) kanye ne-pharmacodynamics (indlela umuthi othinta ngayo umzimba). Kubantu abadala, zombili lezi zici zivame ukushintsha.
1. Izinguquko ze-Pharmacokinetic
a. Ukumuncwa (ukumuncwa kwezidakamizwa)
Ngokuvamile, ukumuncwa kwemithi ngomgudu wokugaya ukudla akuyehli kakhulu njalo kubantu abadala, kodwa kungashintsha ngenxa yokuncipha kokukhiqizwa kwe-asidi esiswini, ukukhishwa kwesisu kancane kancane, kanye nokwehla kokugeleza kwegazi kuya emgodini wokugaya ukudla. Nakuba lezi zinguquko zivame ukungabalulekile, ngaphansi kwezimo ezithile—isibonelo, kubantu abadala abanesifo sesisu, ukusetshenziswa kwe-antacid, noma izinkinga zokunyakaza—ukumuncwa kwemithi kungaba kancane noma kungazinzile. Lokhu kungathinta imithi edinga indawo ene-asidi ukuze imuncwe kahle.
b. Ukusatshalaliswa (ukusatshalaliswa kwezidakamizwa emzimbeni)
Ukwakheka komzimba wabantu abadala kuyashintsha: isisindo semisipha siyancipha, kuyilapho iphesenti lamafutha emzimbeni livame ukwanda. Ngaphezu kwalokho, okuqukethwe kwamanzi emzimbeni kuyancipha. Ngenxa yalokho:
– Imithi encibilika emanzini (ephinga amanzi) ivame ukuba nomthamo omncane wokusatshalaliswa ukuze ukuhlushwa egazini kube phezulu.
– Imithi encibilika emafutheni (i-lipophilic) ingagcinwa isikhathi eside ezicutshini zamafutha ukuze imiphumela yayo iqhubeke isikhathi eside.
Isibonelo, eminye imithi yokudambisa ebangela ukukhuluphala ngokweqile ingase ihlale isikhathi eside, okwandisa ingozi yokozela nokuwa isikhathi eside.
c. Ukwakheka kwe-metabolism (ukuwohloka kwezidakamizwa esibindini)
Ukusebenza kwesibindi kubantu abadala kungancipha ngenxa yokwehla kwesisindo sesibindi kanye nokugeleza kwegazi esithweni somzimba. Ukuguqulwa kwemithi, ikakhulukazi labo abadlula ku-metabolism yokuqala, kungancipha, okuholela emazingeni aphezulu egazini. Izidakamizwa eziguqulwa ngama-enzyme athile esibindi zingase zithole ukuguquguquka okukhulu ekuphenduleni kubantu abadala, ikakhulukazi uma kukhona isifo sesibindi noma kwenzeka ukusebenzisana nezinye izidakamizwa.
d. Ukukhishwa kwemithi (ukukhishwa kwemithi ngezinso)
Ukwehla kokusebenza kwezinso kungenye yezinguquko ezibaluleke kakhulu ekugugeni. Izinga lokuhlunga kwe-glomerular livame ukwehla ngokuguga, ngisho nakubantu abadala ababonakala bephilile. Ngenxa yokuthi imithi eminingi kanye nama-metabolites ayo akhishwa ngezinso, lokhu kwehla kungaholela ekuqongeleleni kwemithi emzimbeni futhi kwandise ingozi yobuthi. Ngakho-ke, ukulungiswa komthamo ngokusekelwe ekusebenzeni kwezinso kuvame ukudingeka.
2. Izinguquko ze-pharmacodynamic
I-pharmacodynamics kubantu asebekhulile nayo iyashintsha ngenxa yokuzwela okuhlukile kwama-receptor kanye nezimpendulo zesistimu yezitho. Isibonelo:
– Abantu abadala bazwela kakhulu ezidakamizweni ezisebenza ohlelweni lwezinzwa oluphakathi, njenge-benzodiazepines, ama-opioid, kanye ne-anticholinergics. Le miphumela ingafaka ukudideka, ukuphazamiseka kwengqondo, izinkinga zokulinganisela, ngisho nokuwa.
– Impendulo emithini yokwehlisa umfutho wegazi ingaba namandla kakhulu ngoba izindlela zokubuyisela umfutho wegazi (isib., i-baroreceptor reflex) zibuthakathaka. Ngenxa yalokho, ingozi yokwehla komfutho wegazi okubangelwa yi-orthostatic iyanda.
– Imithi ethinta ukujiya kwegazi ingandisa ingozi yokopha, ikakhulukazi uma ukusebenza kwezinso kuncipha noma uma kusetshenziswa eminye imithi esebenzisana nayo.
Izingozi ezikhethekile zokusetshenziswa kwezidakamizwa kubantu asebekhulile
1. I-Polpharmacy
I-Polypharmacy isho ukuthatha imithi eminingi ngesikhathi esisodwa—into evamile ngoba abantu abadala bavame ukuba nezifo eziningi ezingamahlalakhona ezifana nomfutho wegazi ophakeme, isifo sikashukela, isifo senhliziyo, ubuhlungu bamalunga, noma izinkinga zokulala. Uma kusetshenziswa imithi eminingi, kulapho ingozi yokuba:
- Ukusebenzisana kwezidakamizwa
- Imiphumela emibi ehlukaniswe ngezigaba
– Amaphutha ekuphuzeni imithi
- Ukungalandeli imithetho ngenxa yezindlela eziyinkimbinkimbi
I-Polypharmacy ingafaka nemithi ethengiswa ngaphandle kwemithi kadokotela, izithasiselo, noma imithi yamakhambi iziguli ezingayibiki njalo kubahlinzeki bezempilo. Kodwa-ke, le mikhiqizo ingasebenzisana nemithi kadokotela.
2. Imiphumela emibi "engavamile"
Kwabantu abadala asebekhulile, imiphumela emibi yemithi ayiveli njalo ngezindlela ezisobala. Isibonelo, ukutheleleka noma ukuphazamiseka kwe-metabolic kungabonakala njengokudideka noma ukwehla kokusebenza kwansuku zonke. Ngokufanayo, imiphumela emibi yemithi ingenzeka: izidakamizwa zokudambisa azigcini nje ngokubangela ukozela kodwa futhi zingabangela nokuphambana kwengqondo. Imithi yokwehlisa umfutho wegazi ayigcini nje ngokwehlisa umfutho wegazi kodwa futhi ingabangela nokuquleka lapho umile.
3. Ukwehla kwenani lezinto ezigciniwe zemvelo
Abantu abadala banekhono lomzimba elinciphile lokuzilungisa. Isibonelo, ukuphelelwa amanzi emzimbeni okuncane kungaholela ekuhlulekeni kwezinso ngokushesha, okubangela ukunqwabelana kwemithi ekhishwa yizinso. Izimo ezibucayi ezifana nesifo sohudo, umkhuhlane, noma ukudla okungondleki kahle kungashintsha ngokuzumayo izimpendulo zemithi.
4. Izinkinga zokuthobela imithetho kanye nokusetshenziswa
Ukuphazamiseka kokubona, ukuthuthumela, ukulahlekelwa yinkumbulo, kanye nobunzima bokuvula amaphakheji emithi kungaholela ekulinganisweni okungalungile. Amashejuli ayinkimbinkimbi (isib. ukuthatha imithi izikhathi ezingu-3-4 ngosuku) enza isimo sibe sibi nakakhulu.
Amaqembu ezidakamizwa adinga ukuqapha
Amaqembu amaningana ezidakamizwa avame ukubangela izinkinga kubantu asebekhulile:
1. Ama-Benzodiazepine namaphilisi okulala: kwandisa ingozi yokuwa, ukudideka, kanye nokuthembela.
2. Imithi yokulwa nokungezwani komzimba (isib. eminye imithi yokungezwani komzimba, imithi yesinyi, imithi ethile yokucindezeleka): ingabangela umlomo owomile, ukuqunjelwa, ukugcinwa komchamo, ukuphambana kwengqondo, kanye nokukhubazeka kokukhumbula.
3. Ama-NSAID (imithi elwa nokuvuvukala engeyona eye-steroidal): anengozi yokubangela ukopha esiswini, izinkinga zezinso, kanye nomfutho wegazi owandayo kanye nokwehluleka kwenhliziyo.
4. Ama-opioid: angabangela ukuqunjelwa okukhulu, ukozela, kanye nokucindezeleka kokuphefumula, ikakhulukazi uma kuhlanganiswa neminye imithi yokudambisa.
5. Ama-anticoagulant nama-antiplatelet: andisa ingozi yokopha, ngakho-ke ukuqapha nokulungisa umthamo kubalulekile.
6. Eminye imithi yesifo sikashukela: ingozi yokwehla kwe-hypoglycemia iphezulu, kanti ukwehla kwe-hypoglycemia kubantu asebekhulile kungaholela ekuweni noma ekulahlekelweni yingqondo.
Izimiso zokusebenzisa izidakamizwa ngokuphephile kubantu asebekhulile
Ukuze kuncishiswe izingozi, lezi zimiso ezilandelayo zivame ukusetshenziswa emitholampilo:
1. Qala phansi, hamba kancane
Ngenxa yokuthi i-metabolism kanye nokukhishwa kwayo kungahamba kancane, ukuqala ngomthamo ophansi kusiza ukugwema imiphumela emibi ngokweqile.
2. Ukuhlolwa kokusebenza kwezinso nesibindi
Umthamo osekelwe ekusebenzeni kwezinso ubalulekile emithini eminingi. Ukuqapha njalo kuyanconywa futhi ngokwelashwa kwesikhathi eside.
3. Buyekeza imithi njalo (ukubuyekezwa kwemithi)
Ekuhambeleni ngakunye, imithi esetshenzisiwe idinga ukuhlolwa: ukuthi isadingeka yini, ukuthi ikhona yini imithi ephindaphindwayo, nokuthi ngabe ikhona yini imithi engamiswa (ingakhishwa kudokotela).
4. Gwema izidakamizwa eziyingozi kakhulu uma kukhona ezinye izindlela.
Iziqondiso eziningana ezifana nezindinganiso ze-Beers zisiza ekutholeni izidakamizwa okufanele zigwenywe noma zisetshenziswe ngokuqapha kubantu asebekhulile.
5. Naka ukusebenzisana kwezidakamizwa kanye nezithasiselo.
Izisebenzi zezempilo kudingeka zibuze ngayo yonke imikhiqizo esetshenziswa yiziguli, okuhlanganisa izithasiselo kanye nemithi yamakhambi.
6. Yenza kube lula uhlelo lokudla
Uma kungenzeka, sebenzisa inhlanganisela yomthamo owodwa ngosuku noma engaguquki ukuze uthuthukise ukuthobela imithetho, kuyilapho ucabangela ukuphepha.
7. Imfundo yesiguli kanye nomndeni
Ukuqonda ukuthi ungayithatha kanjani imithi, imiphumela emibi okufanele uyiqaphele, nokuthi kufanele ufune nini usizo lwezokwelapha kungasiza ekuvimbeleni izehlakalo ezingafuneki.
Isiphetho
Imiphumela yemithi kubantu asebekhulile ithonywa izinguquko zomzimba ezithinta ukumuncwa kwemithi, ukusatshalaliswa kwayo, ukwakheka kwayo emzimbeni, kanye nokukhishwa kwayo, kanye nezinguquko ekuzweleni komzimba ngemithi. Izimo ezifana ne-polypharmacy, ukwehla kokusebenza kwezinso, kanye nokuncipha kokugcinwa kwayo emzimbeni kwandisa ingozi yemiphumela emibi, ngezinye izikhathi eba nezimpawu ezingavamile. Ngakho-ke, izimiso zokusetshenziswa kwemithi ephephile kubantu asebekhulile zidinga indlela yomuntu ngamunye, ukuqapha njalo, kanye nemfundo eyanele. Ngezinyathelo ezifanele, ukwelashwa ngemithi kungahlala kusebenza ngenkathi kunciphisa izingozi, ngaleyo ndlela kugcinwe ikhwalithi yokuphila kubantu asebekhulile.
Uma ungathanda, ngingahlela lesi sihloko ngokwezidingo zakho ezithile—isibonelo, iphepha lasekolishi (elinezingcaphuno), ukuze kufundiswe iziguli, noma ukuze kugxilwe eqenjini elithile lezidakamizwa.
