Amiodarone

Amiodarone

I-Amiodarone igqama njengomuthi onamandla odokotela abawunikeza ukwelapha nokuvimbela ukushaya kwenhliziyo okungajwayelekile okuyingozi, ikakhulukazi ezigulini ezinezimo zenhliziyo ezimbi. Lo muthi usiza ukubuyisela isigqi senhliziyo esivamile futhi unciphisa ingozi ye-arrhythmias esongela ukuphila. Ukuqonda indlela yokusebenzisa i-amiodarone ngendlela efanele, kanye nemiphumela engemihle engase ibe khona kanye nezinyathelo zokuphepha ezidingekayo, kusiza iziguli zenze izinqumo ezinolwazi mayelana nohlelo lwazo lokwelashwa kwenhliziyo.

Iyini i-Amiodarone?

I-Amiodarone umuthi onamandla wokunqanda ukungezwani komzimba osesigabeni sesigaba sesi-III semithi elwa nokuvuvukala. I-US Food and Drug Administration (FDA) igunyaze ngokukhethekile lo muthi ukuze welaphe izigqi zenhliziyo ezingavamile ezisongela ukuphila, ikakhulukazi i-fibrillation ye-ventricular kanye ne-tachycardia ye-ventricular engazinzile.

Izici ezibalulekile zomuthi zihlanganisa:

• Kuthatha imizuzu engu-1-30 ukuqala ukusebenza lapho unikezwa ngomthambo
• Inengxenye yempilo ende esukela ezinsukwini eziyi-15 kuye kweziyi-142
• Ibonisa i-bioavailability eguquguqukayo phakathi kuka-35% no-65%
• Icutshungulwa ngokuyinhloko yisibindi
• Ifinyelela ukuhlushwa okuphezulu emahoreni angama-3-7 ngemuva kokuphathwa

Ukusetshenziswa kwe-Amiodarone

I-FDA igunyaze i-amiodarone yokwelapha izimo ezimbalwa ezithile:

• I-Ventricular Fibrillation: Isimo esinzima lapho inhliziyo ishaya khona ngendlela exakile
• I-Tachycardia ye-ventricular: Isigqi senhliziyo esisheshayo esiyingozi esiqala emagumbini aphansi enhliziyo
• I-Hemodynamically Unstable Arrhythmias Evamile: Ukushaya kwenhliziyo okungajwayelekile okuthinta ukugeleza kwegazi
• Izifo ezisongela ukuphila zesigqi senhliziyo: Ikakhulukazi lezo ezithinta ama-ventricles

Odokotela bangase futhi banikeze i-amiodarone ngezinjongo ezingekho ilebula, kuhlanganise nokuphathwa kwe-atrial fibrillation kanye ne-supraventricular tachycardia. 

Ungayisebenzisa kanjani ithebhulethi ye-Amiodarone

Iziguli ngokuvamile zithola imithamo yazo yokuqala ye-amiodarone esibhedlela lapho odokotela bengakwazi ukuqapha ngokucophelela izimpendulo zesigqi senhliziyo.

Lapho uthatha amaphilisi e-amiodarone, iziguli kufanele zilandele lezi ziqondiso ezibalulekile:

• Thatha ithebhulethi ngengilazi yamanzi egcwele
• Gcina ukungaguquguquki ekukuthatheni ngokudla noma ngaphandle kokudla
• Landela ngokuqinile isimiso somthamo esinqunyiwe
• Gcina amaphilisi ekamelweni lokushisa, kude nomswakama nokukhanya
• Ungalokothi uyeke ukuphuza imithi ngaphandle kwesiqondiso sezokwelapha
• Yazisa bonke odokotela mayelana nokusetshenziswa kwethebhulethi i-amiodarone

Iziguli ezinenkinga yokugaya ukudla zingadinga ukuhlukanisa imithamo ephezulu futhi ziyiphuze kanye nokudla.

Imiphumela Emibi Yethebhulethi ye-Amiodarone

Imiphumela engemihle evamile iziguli ezingase zibe nayo ihlanganisa:

• I-nausea kanye nokuhlanza
• Isiyezi noma ikhanda elikhanyayo
• Ukuzwela ukukhanya kwelanga
• Ukuqhaqhazela kwezandla
• Ukukhathala okungajwayelekile
• Ukulahlekelwa kwesifiso
• ukuqunjelwa

Imiphumela emibi kakhulu ihlanganisa:

• Izinkinga zamaphaphu: Ukuphelelwa umoya, ukukhwehlela, ubuhlungu besifuba, noma imfiva
• Ukulimala Kwesibindi: Ukuphuzi kwesikhumba/amehlo, umchamo omnyama, ubuhlungu besisu
• Izinguquko Zombono: Umbono ophundlekile, ukubona ama-halo ezungeze izibani
• Izinkinga ze-Thyroid: Ukushintsha kwesisindo, ukushisa noma ukungabekezelelani amakhaza, ukujuluka ngokweqile
• Izinguquko zesigqi senhliziyo: Ukushaya kwenhliziyo okusheshayo noma okungajwayelekile, ubuhlungu besifuba
• Izinkinga Zesikhumba: Umbala oluhlaza-mpunga wesikhumba esichayeke elangeni
• Izinkinga Zezinzwa: Ukuba ndikindiki noma ukushoshozela kwezandla/ ezinyaweni, ubuthakathaka bemisipha

Ukuqapha

Ukucatshangelwa kokuphepha kudlala indima ebalulekile lapho uthatha amaphilisi e-amiodarone, njengoba lo muthi uphethe ileveli yesixwayiso esibucayi kakhulu se-FDA. 

• Izidingo Ezibalulekile Zokuqapha:
  • Ukuhlolwa kwamehlo njalo ukuhlola izinguquko zombono
  • Ukuhlolwa kwegazi njalo ukuqapha ukusebenza kwesibindi kanye ne-thyroid
  • Ama-X-ray esifuba ukuhlola impilo yamaphaphu
  • Ukuqapha isigqi senhliziyo, ikakhulukazi ngesikhathi sokulungiswa komthamo
  • Ukuhlola umfutho wegazi okuvamile
• Izimo Zesistimu: Iziguli ezinezimo ezithile zezokwelapha zidinga ukunakwa okukhethekile lapho zithatha i-amiodarone. Iziguli ezinezimo zenhliziyo ezinzima, i-bradycardia, noma ezinenhliziyo evimbekile kufanele ziwugweme lo muthi. Labo abanesifo sesibindi bangase badinge imithamo encishisiwe, kuyilapho abantu abanezinkinga zezinso bangase bathole ukuphuma kancane kwezidakamizwa ohlelweni lwabo. 
• Ukucabangela Ukudla: Iziguli kufanele zigweme ijusi ye-grapefruit njengoba ingakhuphula ukugxila kwemithi emzimbeni. 
• Ukuvezwa kwelanga: Ukuvikela ilanga kuba okubalulekile njengoba umuthi ukhulisa ukuzwela ukukhanya kwelanga futhi ungabangela ukuguquguquka kwesikhumba okuluhlaza okwesibhakabhaka ezindaweni ezisobala.
• Ukukhulelwa Nokuncelisa: Abesifazane abakhulelwe akufanele baphuze i-amiodarone ngoba ingalimaza umbungu okhulayo. Ngokufanayo, ibele Akunconywa ngenkathi uthatha i-amiodarone.

Isebenza kanjani ithebhulethi ye-Amiodarone

Njengemithi ye-antiarrhythmic yekilasi lesi-III, isenzo esiyinhloko se-amiodarone sihlanganisa ukuvimba iziteshi ze-potassium kumaseli enhliziyo. Lokhu kuvinjelwa kwandisa isikhathi amangqamuzana enhliziyo asithathayo ukuze alulame phakathi kwamasignali kagesi, okuvimbela ngempumelelo isigqi senhliziyo esisheshayo noma esinesiphithiphithi ukuthi singathuthuki.

Okwenza i-amiodarone ihluke ubuningi bayo bomsebenzi. Ngokungafani neminye imithi yesigqi senhliziyo, ithinta iziteshi eziningi ngasikhathi sinye:

• Imiphumela Yesiteshi Se-Potassium: Yandisa amandla okwenza inhliziyo
• Umthelela wesiteshi sesodium: Inciphisa ukuhamba kukagesi
• Umthelela wesiteshi seCalcium: Kuthinta ukufinyela kwemisipha yenhliziyo
• Imiphumela ye-Beta-receptor: Yehlisa ukusabela kwenhliziyo ekukhuthazeni

Ngingathatha I-Amiodarone Ngeminye Imithi?

Ukusebenzisana kwemithi kubonisa ukucatshangelwa okubalulekile ezigulini ezithatha amaphilisi e-amiodarone. 

Ukusebenzisana kwemithi ebalulekile okudinga ukuqapha ngokucophelela kuhlanganisa:

• Imithi ye-Antifungal efana i-ketoconazole kanye ne-fluconazole
• Imithi elwa namagciwane, okuhlanganisa i-ritonavir ne-indinavir
• Abancisha igazi bayathanda warfarin, okungandisa izingozi zokopha
• Imithi yokwehlisa i-cholesterol (ama-statins), kufaka phakathi i-simvastatin ne-atorvastatin
• Corticosteroids
• I-Cyclosporine (umuthi wokucindezela izivikeli mzimba)
• I-Digoxin, edinga ukuncishiswa komthamo ngo-50% uma isetshenziswa ne-amiodarone
• I-Fentanyl, esetshenziselwa izinhlobo ezithile zobuhlungu
• Imithi yenhliziyo efana ne-beta-blockers (metoprolol, atenolol) kanye ne-calcium channel blockers (verapamil, diltiazem)
• Lidocaine
• I-Sofosbuvir (umuthi osetshenziselwa i-hepatitis)
• John's wort herbal supplement

Ulwazi Lomthamo

Uhlelo olujwayelekile lokudosa ngomlomo lulandela indlela yezigaba ezintathu:

• Iyalayisha Isigaba
  • Umthamo wokuqala: 800 kuya ku-1600 mg nsuku zonke
  • Ubude besikhathi: 1 kuya ku-3 amaviki
  • Ihlukaniswe ngemithamo eminingi ngokudla
• Isigaba Sokulungisa
  • Yehliselwa ku-600-800 mg ngosuku
  • Isikhathi: Inyanga e-1
  • Kuqashwe ukusebenza kahle
• Isigaba Sokulungisa
  • Umthamo ojwayelekile: 400 mg ngosuku
  • Kungase kudinge ukulungiswa ngokusekelwe empendulweni
  • Ukuqapha njalo kuyaqhubeka

Nge-arrhythmias ye-ventricular esongela ukuphila, odokotela bangase baqale ukwelashwa ngokuphathwa komthambo endaweni yesibhedlela. 

Isiphetho

I-Amiodarone ime njengomuthi obalulekile ezigulini ezinezinkinga ezisongela ukuphila zesigqi senhliziyo. Lesi sidakamizwa esinamandla se-antiarrhythmic sisiza iziguli ukuthi ziphinde zibe nesigqi senhliziyo esivamile lapho ezinye izindlela zokwelapha zingaphumeleli. Odokotela bayayazisa i-amiodarone ngekhono layo eliyingqayizivele lokusebenza ngokusebenzisa imigudu eminingi enhliziyweni, okuyenza isebenze ngokukhethekile ezimweni ezinzima zenhliziyo ezimelana nokwelashwa okujwayelekile.

Ukuhlolwa njalo kwezokwelapha, ukunaka ngokucophelela izimiso zomthamo, nokuqwashisa ngemiphumela engemihle engase ibe khona kusiza ukuqinisekisa imiphumela engcono kakhulu. Iziguli eziqonda indima yazo enqubweni yokwelashwa futhi zigcine ukuxhumana okuvulekile nethimba lazo lokunakekelwa kwezempilo zithola imiphumela engcono kakhulu ngalo muthi onamandla.

Imibuzo Evame Ukubuzwa

1. Ingabe i-amiodarone iphephile ukusebenzisa?

Odokotela babheka i-amiodarone ephephile uma inqunywe ngendlela efanele futhi iqashwe njalo. Umuthi udinga ukuqondisa ngokucophelela ngokuhlolwa kwegazi okuvamile, i-X-ray yesifuba, nokuhlolwa kwamehlo ukuze kuqinisekiswe ukuphepha kwesiguli. Nakuba inezixwayiso ezingathi sína, ukugada okufanele kwezokwelapha kusiza ukuphatha izingozi ezingaba khona ngempumelelo.

2. Yimuphi umphumela ovame kakhulu we-amiodarone?

Imiphumela emibi kakhulu ye-amiodarone ihlanganisa:

• I-Corneal microdeposits (ithinta ngaphezu kwe-90% yeziguli)
• I-nausea nezinkinga zokugaya ukudla
• Ukuzwela ukukhanya kwelanga
• Ukuzamazama kanye nezinkinga zokuxhumanisa

3. Ubani okufanele agweme i-amiodarone?

Abantu abathile akufanele bathathe i-amiodarone, okuhlanganisa:

• Abesifazane abakhulelwe noma abancelisayo
• Iziguli ezinenhliziyo eqine kakhulu ngaphandle kwe-a i-pacemaker
• Abantu abangezwani ne-iodine
• Abantu abanezinkinga ezinzima ze-thyroid

4. Ingabe i-amiodarone iphephile ezinso?

Nakuba i-amiodarone ithinta ngokuyinhloko isibindi namaphaphu, ezinye iziguli zingase zithole imiphumela ehlobene nezinso. Odokotela baqapha ukusebenza kwezinso ngesikhathi sokwelashwa, nakuba ubuthi obubalulekile bezinso bungavamile. Iziguli ezinezinkinga zezinso ezikhona zingase zidinge ukulungiswa komthamo.

5. Nini ukusebenzisa i-amiodarone?

Odokotela banquma i-amiodarone ye-arrhythmias ye-ventricular esongela ukuphila kanye nezinye izifo ezinzima zesigqi senhliziyo. Isebenza njengomuthi obalulekile lapho ezinye izindlela zokwelapha zibonakala zingasebenzi noma zingafaneleki.

6. Uyini umehluko phakathi kwe-amiodarone ne-adenosine?

I-Amiodarone isebenza njengokwelashwa kwesikhathi eside kwe-arrhythmias ehlukahlukene, kuyilapho i-adenosine inikeza ukuguqulwa okusheshayo, okufushane kwezinhlobo ezithile ze-tachycardia ye-supraventricular. I-Adenosine ikhombisa ukusebenza kahle ku-70-85% weziguli zokuphatha okunamandla, kanti i-amiodarone inikeza ukulawulwa kwesigqi okuqhubekayo.

7. Ingabe i-amiodarone isetshenziselwa i-BP?

Nakuba inganqunyelwe ngokuyinhloko ukulawula ukucindezeleka kwegazi, i-amiodarone ingase ithinte ukushaya kwegazi njengomphumela wesibili. Inhloso eyinhloko yomuthi wukulawula isigqi senhliziyo kunokulawula umfutho wegazi.