ʻO ka pilina ma waena o ke kumu lāʻau a me ka pharmacodynamics

Hoʻopili ka hana a ke ʻano o ka GCS me ko lākou hiki ke launa pū me nā ʻenekela i loko o ka cytoplasm o ke kō: ʻo ka steroid - receptor complex is penetrates the cellus nucleus, bind to DNA, e pili ana i ka lawe ʻana i kahi ʻano o nā genes, kahi e alakaʻi ai i ka hoʻololi o ka synt synt o ka protein, enzymes, fatty acid. Hoʻopilikia ka GCS i nā ʻano minamina a pau, loaʻa kahi hopena anti-inflammatory, anti-allergic, anti-shock a me immunosuppressive.

ʻO ka hana o ka hopena anti-inflammatory o corticosteroids e hoʻopau i nā phases a pau o ka mumū. Ma ka hoʻomau ʻana i nā membrane a me nā hana i hoʻopili ʻia, incl. lysis, nā lāʻau lapaʻau anti-inflammatory o ka pale ʻana i ka hoʻokuʻu ʻana o nā enzymes proteolytic mai o ka lāe, ke kālai ʻia i ka hana ʻana o nā ʻāpana kūwau o ka oxygen a me nā lipid peroxides i nā membranes. I ka hoʻomaka ʻana o ka mumū, hoʻoweliweli ka corticosteroids i nā moku liʻiliʻi a hoʻemi i ka hana o ka hyaluronidase, a laila hoʻokaʻawale i ke ʻano o ka hakakā, pale i ka hoʻopili ʻana o nā neutrophils a me nā monocytes i ka endotheli vascular, e kaupalena i ko lākou komo ʻana i nā ʻili, a hoʻemi i ka hana o nā macrophages a me nā fibroblasts.

I ka hoʻokō ʻana o ka hopena anti-inflammatory, ka hana koʻikoʻi e hana i ka hiki o GCS e pale i ka synthesis a hoʻokuʻu i nā mea hoʻoponopono nīnū (PG, histamine, serotonin, bradykinin, etc.). Ke hoʻonāukiuki nei lākou i ka hoʻopili ʻana o ka lipocortins, inhibitors o ka phosopisote o ka phospholipase A2, a hoʻohaʻahaʻa i ka hoʻokumu ʻana o COX-2 i ke kaʻe o ka mumū. Ke alakaʻi nei kēia i kahi hoʻokuʻu palena o ka arachidonic acid mai ka phospholipids o nā membran cell a me kahi hoʻohaʻahaʻa i ka hoʻokumu o nā metabolites (PG, leukotrienes a me ka platelet activing factor).

Hiki i ka GCS ke kāohi i ka hana proliferation, no ka mea kaupalena lākou i ka komo ʻana o nā monocytes i loko o ka ʻōpala palipē, pale i ko lākou komo ʻana i kēia hōʻeha ʻana, pale i ka kāpili ʻana o ka mucopolysaccharides, nā kāpena a hoʻoneʻe i nā ʻōnaehana o ka lymphopoiesis. Me ka hoʻonāukiuki ʻana o nā genesis infectious o corticosteroids, hāʻawi ʻia i ka hopena o ka hopena immunosuppressive, pono e hui pū me ka lāʻau antimicrobial.

ʻO ka hopena immunosuppressive o GCS ma muli o ka hōʻemi ʻana i ka helu a me nā hana o ka T-lymphocytes e neʻe nei i ke koko, he hōʻemi i nā hana o nā immunoglobulins a me ka hopena o nā T-helpers ma B-lymphocytes, heʻano i ka hōʻuluʻulu ʻia i loko o ke koko, i ka hoʻomohala ʻana o nā ʻano hōʻuluʻulu o ka neʻe ʻana a me ka helu o nā interleukins . ^ E Ha yM.

ʻO ka hopena antiallergic o corticosteroids ma muli o ka emi ʻana o ka helu o nā basophils neʻe, ka pale hewa ʻana o ka launa ʻana o nā ʻĀina Fc i loaʻa i ka pūnaehana mast me nā Fc o IgE a me ka māhele C3 o ka hoʻohui, kahi e pale ai i ka hōʻailona mai ke komo ʻana i ka pūliki me ka hoʻopiʻi ʻia ʻana e ke kahe ʻana o ka hoʻokuʻu ʻana i ka histamine, heparin, a me serotonin mai nā ʻano hoʻonaninani. a me nā mea hoʻomehana allergy o kahi ʻano koke a pale i kā lākou hopena ma nā cell effector.

ʻO ka hopena antishock ma muli o ke komo ʻana o GCS i ka hoʻoponopono ʻana i ka leo vascular, ma ko lākou ʻano mua, ka mālamalama o nā kīʻaha koko i ka catecholamines e hoʻonui, e alakaʻi ana i ka hoʻoliʻiliʻi o ka hoʻokahe, ke hoʻololi ʻana i ka paʻakai-paʻakai, ʻo ka sodium a me ka wai e mālama ʻia, hoʻonui ʻia ka plasma a hoʻemi ka hypovolemia.

Hilahila a me nā hopena ʻaoʻao

ʻO kēia pūʻulu o nā lāʻau lapaʻau pinepine pinepine i nā hopena hopena: ke pani ʻana i ka hoʻohālikelike o ke kino, hoʻomaikaʻi i ka maʻi ʻeha a me nā maʻi ʻeha o ka gastrointestinal. Me ka hoʻohana ʻana i ka manawa lōʻihi, hiki ke hoʻonui i ke kaʻi o ke koko, ka hiki ʻana o ka diabetes steroid, edema, nāwaliwali o ka naʻau, ka myocardial dystrophy, Myenko-Cush's syndrome, hiki i ka adrenal atrophy.

I kekahi manawa ke lawe i nā lāʻau lapaʻau, aia kahi wīwī, insomnia, hoʻonui ʻia ke kaila intracranial, psychosis. Me ka hoʻohana ʻana i ka ʻōnaehana ʻana o ka corticosteroids, hoʻopau ʻia ka iwi a me ka pāuna o ka calcium-phosphorus i ka hopena, a hiki i ka hopena o ke osteoporosis a me nā hana o ka lua.

Nā Hoʻohui

• Hypersensitivity.
• ʻO nā maʻi koʻikoʻi.
• Nā maʻi maʻi maʻi fungal.
• ʻO ka maʻi pākēnē.
• SIDI
• He maʻi ulia, ka huhū ʻōpū.
• ʻO nā hiʻohiʻona koʻikoʻi o ke hypertension.
• ʻO ka maʻi Itsenko-Cush.
• Jade
• Sypilis
• Naʻi maʻi mellitus.
• Osteoporosis.
• Kahawai
• Haumakua.
• Nā maʻi āpau.
• Nā keiki ʻōpio.

• Hoʻokomo (bacterial, viral, fungal) lesi o ka ʻili a me nā membous membous.
• ʻO nā Tumors o ka ʻili.
• ʻO ka hōʻino ʻana i ka kūʻokoʻa o ka ʻili a me nā membrane mucous.
• Nā keiki ʻōpio.

Hoʻohui

Hoʻonui ka GCS i ka hopena bronchodilating o β-adrenostimulants a me theophylline, e hōʻemi i ka hopena hypoglycemic o ka insulin a me nā ʻaina antidiabetic waha, nā hana anticoagulant o nā Coumarins (kūlike nā anticoagulants).

ʻO Diphenin, ephedrine, fenobarbital, rifampicin a me nā lāʻau lapaʻau'ē aʻe e koi ai i ka helu o nā microsomal ate enzyme e hoʻopau i ka T1 / 2 GCS. ʻO ka hormone ulu a me nā antacids e hōʻemi ana i ka laweʻana o corticosteroids. Ke hui pū me ka glycosides cardiac a me diuretics, piʻi nui ka loaʻa o ka arrhythmias a me ka hypokalemia, i hui pū ʻia me nā NSAID, nui ka hopena o ka hōʻeha o ka gastrointestinal a me ka loaʻa ʻana o ke koko gastrointestinal i hoʻonui.

Ka hana o ka hana a me nā hopena koʻikoʻi pharmacodynamic

Hoʻopau ka Glucocorticoids i nā membrane cell i loko o ka cytoplasm a hoʻopaʻa pū ʻia i nā receptors glucocorticoid kūikawā. ʻO ka hopena i hoʻohālikelike ʻia i komo i ka inti a me ka hoʻoulu ʻana i ka hoʻokumu o i-RNA, e alakaʻi ana i ke kāpili ʻana o kekahi o nā ʻōnaehana hoʻoponopono. He nui o nā huahana biologically ikaika (catecholamines, nā mea hoʻopihapiha i nā ʻoihana) hiki ke hoʻōla i ka paila o ka glucocorticoid-receptor, ma laila e hōʻemi ai i ka hana o nā glucocorticoids. ʻO nā hopena nui ka hopena o ka glucocorticoids.

• Pilikia i ka ʻōnaehana pale.

- Ka hopena anti-inflammatory (ka nui me nā ʻano maʻi a me ka pale ʻana o ka maʻi) ma muli o ke ʻano o ka synta o ka PG, RT a me nā cytokines, i ka hoʻemi mākaʻi o ka capillary, i hoʻemi ka chemotaxis o nā mea maʻi immunocompetent a me ka pale ʻana i ka hana fibroblast.

- Ka mālama ʻana i ka pale o ke kelepona, hoʻāla i ka autoimmune i ka wā o ka hoʻololi ʻana i ke kino, hōʻemi ʻia ka hana o T-lymphocytes, macrophages, eosinophils.

• Ka hopena ma ka kaila metabol-electrolyte.

- Lolo i ke kino o ka sodium a me nā wai wai (hoʻonui hou i ka reabsorption i ka distal renule tubule), hoʻoneʻe ikaika i nā papa paʻakai (no ka lāʻau me nā hana mineralocorticoid), hoʻonui i ke kaumaha o ke kino.

- Ke emi ʻana o ka loaʻa ʻana o nā calcium kaluna me ka meaʻai, ka hoʻēmi ʻana i kā lākou ʻike i ka iwi iwi (osteoporosis), a me ka hoʻonui ʻana o ka ʻokiʻoki i ka urinary.

• Ka hopena ma nā kaʻina metabola.

- No ka lipid metabolism - ka lawe hou ʻana o ka kiko adipose (hoʻonui i ka hoʻoneʻe ʻana o ka momona i ka maka, ʻāʻī, ke poʻohiwi ʻāʻī, ka ʻōpū), hypercholesterolemia.

- No ka lolo ka hoʻoliʻi kaola - hoʻoulu ai i ka gluconeogenesis i loko o ka puʻuwai, kahi e hoʻemi nei i ka pae pono o nā membranes no ka glucose (hiki i ka ulu ʻana o ka maʻi diabetes).

- No ka protein metabolism - ka hoʻoulu ʻana o ka anabolism i loko o nā pōpoki a me nā hana catabolic i nā kiko o kekahi, nā kaila o nā mea o nā globulins i ke koko koko.

• Ke hopena i ka CVS - ka hoʻonui ʻia o ke koko (neʻe hypertension) ma muli o ka paʻa ʻana o ke kahe i loko o ke kino, ke piʻi ʻana o ke kūwaho a me ka ʻike ʻana o ka adrenoreceptors i loko o ka puʻuwai a me nā koko, a me ka hoʻonui i ka hopena pressor o ka angiotensin II.

• Ka hopena ma ka ʻōnaehana kelepona hypothalamus-pituitary-adrenal - inhibition ma muli o ke ʻano o ka paipai maikaʻi ʻole.

• Ka hopena o ke koko - lymphocytopenia, monocytopenia a me eosinopenia, i ka manawa like o ka glucocorticoids hoʻoulu i ka hoʻomaʻamaʻa ʻana o nā ʻāpana koko wīwī, hoʻonui i ka huina o nā neutrophils a me nā platelets (nā hoʻololi i ka pūnao o ka palena o ke koko i ʻike ʻia i loko o nā hola 6-12 ma hope o ka hoʻokele ʻana a hoʻomau i ka hoʻohana mau ʻana i kēia mau lāʻau no ka wai he mau pule).

ʻO Glucocorticoids no ka hoʻohana ʻana i ka lawelawe hoʻopulepule i ka palupalu i ka wai, maikaʻi i nā momona a me nā ʻano wai ʻē aʻe. Ka neʻe lākou i loko o ke koko i loko o kahi kūlana i hoʻopaʻa ʻia i ka protein (paʻa ʻole). ʻO nā hua lāʻau injectable o nā glucocorticoids ko lākou mau mea wai hoʻonaninani a me nā paʻakai (succinates, hemisuccinates, phosphates), e alakaʻi ana i kahi wikiwiki wikiwiki o ka hana. Ke hoʻomohala nei ka hopena o ka hoʻopiʻi liʻiliʻi o ka crystalline o ka glucocorticoids, akā hiki ke lōʻihi i ka 0.5-1 mau mahina, ua hoʻohana ʻia no nā inikini intraarticular.

Hoʻopili maikaʻi ʻia nā Glucocorticoids no ka hoʻoponopono waha i nā ahe, C_tah i loko o ke koko, ua hoʻomaopopo ʻia ma hope o nā hola 0.5-1.5. Ua hoʻolōʻihi ka meaʻai i ka heʻe ʻana, akā ʻaʻole i pili i ka bioavailability o nā lāʻau lapaʻau (tab. 27-15).

KANAʻINA ʻO KA Glucocorticoids E METHOD O KA ʻ OFPAʻU

1. Glucocorticoids no ka hoʻohana topical:

A) no ke noi ʻana i ka ʻili (i ke ʻano o ka poni, kaʻaila, ka emulsion, pauku):

- ka aciumide fluocinolone (sinaflan, flucinar)

- paleka i ka flumethasone (lorinden)

- betamethasone (celestoderm B, celeston)

B) no ka hoʻokomo 'ana i loko o ka maka a me / a i ʻole ke pepeiao, ma ke ʻano o kahi aila ʻoniʻoni.

- betamethasone n (betamethasone dipropionate, etc.) B) no ka hana inhalation:

- kūlohelohe (waiʻohea, hoʻoluhi)

- fluticasone propionate (flixotide)

D) no ka hoʻokele intraarticular:

D) no ka hoʻokomo ʻana i ka kiko periarticular:

ʻO nā hopena hopena

ʻO Glucocorticoids kahi mana kū'ē i ke koʻikoʻi, ka hopena anti-shock. Piʻi nui ko lākou koko me ke koʻikoʻi, nā hōʻeha, ke koko, a me nā kūlana pīhoihoi. ʻO ka hoʻonui ʻana i ko lākou haʻahaʻa ma lalo o kēia mau ʻano, ʻo ia kekahi o nā hana o ka hoʻohālikelike o ke kino i ke kaumaha, lilo koko, hakakā me ka haʻalulu a me nā hopena o nā trauma. Hoʻokomo ka Glucocorticoids i ke kahe o ke koko ʻōhumu, hoʻonui i ka ʻike ʻana i ka myocardium a me nā pā vascular i catecholamines, a pale i ka desensitization o nā mea nānā aku i catecholamines i ko lākou kiʻekiʻe kiʻekiʻe. Eia kekahi, hoʻonāukiuki hoʻi ka glucocorticoids i ka erythropoiesis i loko o ka ʻōpū o ka iwi, ka mea e hoʻopuka i ka nui o ka hou o ke kahe o ke koko.

Ka hopena pili i ka hoʻoponopono metabolism |