Pyramil keu: nā ʻōlelo no ka hoʻohana ʻana

Manawa kuhikuhi
no ka hoʻohanaʻana i kahi lāʻau lapaʻau no ka hoʻohana lāʻau

E heluhelu pono i kēia mau ʻōkuhi ma mua o ka hoʻomaka ʻana i ka lawe / hoʻohana ʻana i kēia lāʻau lapaʻau.
• Mālama i ka manual, e koi hou paha.
• Inā he nīnau kāu, e nīnau aku i kāu kauka.
• Ua kuhikuhi ʻia kēia lāʻau lapaʻau iā ʻoe ponoʻī a ʻaʻole pono e kaʻana iā ʻoe i ka mea ʻē aʻe, no ka mea e hōʻeha ʻia iā lākou e like pū me ʻoe.

Nā palapala ʻano:

mea hoʻolaʻa kaha: ramipril - 2.50 / 5.00 / 10.00 mg, nā mea hoʻowalewale: microcrystalline cellulose - 296.10 / 293.60 / 289.00 mg, kūmole pregelatinized - 18.00 / 18.00 / 18.00 mg, kahapulu silika kahakaha - 32.00 / 32.00 / 32.00 mg, glycine ʻO ka hokeo - 3.00 / 3.00 / 3.00 mg, glyceryl dibehenate - 8.00 / 8.00 / 8,00 mg, ka hao kīpona hao wai melemele (E-172) 0.40 / - / - mg, hoʻoheheʻe ulaula pōpale hao (E-172) - / 0.40 / - mg.

‘:Lelo:

ʻO nā papa 2.5 mg: nā oblong, nā biconvex nā kukui aniani ke aniani me kahi pālahalaha, a me nā paepae i loaʻa ʻole i nā kala ʻeleʻele a i ʻole ka hopena ma kahi ʻaoʻao.
Nā papa ʻaina 5.0 mg: oblong, nā biconvex nā kukui aniani ʻulaʻula me kahi ʻili paʻakikī, me nā peha lohi a ʻoi ʻeleʻele a me ka pilikia ma kekahi ʻaoʻao.
10.0 mg tablet: oblong, biconvex papa o ke keʻokeʻo a ʻeleʻele paha keʻokeʻo me kahi ʻōwili a me ka hopena ma kahi ʻaoʻao.

ʻO nā waiwai Pharmacological

Lapaʻau lāʻau
Ua hopu koke ʻo Ramipril i ka gastrointestinal tract a hoʻopaʻa ʻia i ka hydrolysis i loko o ka ate e hana ai i ka metabolite ikaika o ka ramiprilat. ʻO Ramiprilat he lōlani hana lōʻihi o ka ACE - he enzyme e pili ana i ka hoʻololi ʻana o ka angiotensin I i ka angiotensin II.
Hoʻokomo ʻo Ramipril i ka hōʻemi o ka pae o ka angiotensin II i ka plasma, he hoʻonui i ka hana renin a me kahi hoʻohaʻahaʻa i ka hoʻokuʻu ʻana o ald testosterone.
Hōʻike i ka pae kininase II, hoʻopili i ka wāwahi o ka bradykinin, hoʻonui i ka synthesis o prostaglandins. Ma lalo o ka hopena o ka ramipril, e hoʻonui ana nā moku peripheral a me ka hōʻemi o ka huakaʻi pale ākea holoʻokoʻa (OPSS).
He maʻi haole
He hopena hypotensive i ke kūlana o ka mea maʻi "hoʻopunipuni" a "kū".
Hoʻemi ia i OPSS (ma hope o kaʻohi), ka ukiuki jamming i nā capillaries pulmonary me ka piʻi ʻole o ka uku uku i ka helu o ka naʻau (HR).
Hoʻonui i ke kahe koko a me ka renal i ke kahe ʻana me ka ʻole e hoʻopiʻi i ka helu filtration glomerular.
ʻO ka hoʻomaka ʻana o ka hopena hypotensive ʻo 1-2 mau hola ma hope o ke kauā ʻana, hoʻomohala ʻia ka hopena kiʻekiʻe 3-6 mau hola ma hope o ka hoʻokō ʻana. Hana ka hana i ka liʻiliʻi o 24 mau hola.
ʻO ka hemahema o ka puʻuwai a me nā puʻuwai hōʻeha ma muli o ka maʻi myocardial infarction
Ua hōʻemi ʻo Ramipril i ka OPSS a, ma ka hopena, ke piʻi o ke koko.
Hoʻonui i nā hopena cardiac a hoʻomanawanui. Me ka hoʻohana ʻana i ka lōʻihi, hāʻawi ia i ka loli hou ʻana o ka hypertrophy myocardial i nā poʻe maʻi me ka naʻau ʻole o ka papa hana noʻu a me II e like me ka helu ʻana o NYHA, hoʻomaikaʻi i ke kahe koko i ka ischemic myocardium.
Hoʻonui ʻo Ramipril i ke ola ʻana o nā poʻe maʻi me nā hōʻailona o ka neʻe ʻana a i ʻole ke kani ʻana i ka naʻau ma hope o ka myocardial infarction. Loaʻa ia i kahi hopena cardioprotective, pale i nā episode ischemic coronary, hōʻemi ka hopena o ka hoʻomohala ʻana i ka myocardial infarction a hōʻemi i ka lōʻihi o ka hoʻokipa.
ʻO ka maʻi nephropathy Diabetic a me kahi maʻi ʻole
I nā mea maʻi me ka maʻi nephropathy diabetes a nondiabetic, lawe i ka moe ramipril i ke emi ʻana o ka holomua o ka hiki ʻole o ka renal ka hoʻomaka ʻana a me ka hoʻomaka ʻana o ka hopena o ka renal me ka hopena, a no laila, e hōʻemi ana i ka pono no ka hemodialysis a i ʻole ka hoʻololi ʻana i ka peʻe. I nā hoʻomaka mua o ka maʻi diabetes a nondiabetic nephropathy, hoʻemi ka ramipril i ka nui o ka albuminuria.
ʻO nā maʻi i ka maʻi kiʻekiʻe o nā maʻi Cardiovascular
ma muli o ke kauā maʻi vaskular (hōʻike i ka maʻi ʻōpū coronary (CHD), e hoʻopau ana i ka maʻi ʻula o ka peripheral a i ʻole ka mōʻaukala o ka ʻeha), ka maʻi diabetes mellitus me ka liʻiliʻi o ka mea hou aku (microalbuminuria, hypertension arterial, hoʻonui i ka plasma o ka kolesterol "(OX). moloprotein cholesterol kiʻekiʻe-kiʻekiʻe (HDL-C), ulaula) i ka hoʻohui ʻana o ka ramipril i ka hanana maʻamau e hoʻemi nui i ka hōʻeha o ka myocardial infarction, ins lta a me ka make, mai mea'ōnaehana mānowai koko kumu.
Lapaʻau lāʻau
Ua hopu koke ʻia ʻo Ramipril i ka ʻeha gastrointestinal ma hope o ka hoʻoponopono waha. He kūʻokoʻa ʻole ka Absorption o ka inu kai.
Ma hope o ka hoʻopili ʻana, ka wikiwiki ramipril a kokoke loa i huli i ka metabolite ikaika o ka ramiprilat ma lalo o ka hana o ka ate esterase enzyme. ʻO Ramiprilat he 6 mau manawa hou aku ka nui o ka pale ʻana i ka ACE ma mua o ka ramipril. Ua ʻike ʻia hoʻi nā lāʻau lapaʻau hou ʻole i kūkulu ʻia.
I ka poʻe maʻi me ka hana renal impaired, ʻo ka loli i ka ramipril i ramiprilat i lalo i lalo o ka lōʻihi o ka esterase, no laila, ʻo ka nui o ka ramipril i loko o ke koko koko i loko o kēia mau maʻi ua hoʻonui.
Loaʻa ka ʻike kiʻekiʻe o ka ramipril i ka plasma i loko o hoʻokahi hola ma hope o ka hoʻokele ʻana, ʻo ramiprilat - i loko o he 2 mau hola ma hope o ka lawe ʻana i ka lāʻau.
ʻO ka bioavailability o ramipril he 60%. E kamaʻilio ka pilina me ka protein plasma e 73% no ka ramipril a me 56% no ramiprilat. Ma hope o ka lawe iā 5 mg, ʻo ka wehe ʻana i ka renal o ka ramipril he 10-55 ml / min, hōʻea ka extrarenal ma kahi 750 ml / min. No ka ramiprilat, ʻo kēia mau helu he 70-120 ml / min a ma kahi o ka 140 ml / min, kēlā. ʻO Ramipril a me ramiprilat ka mea nui loa i hoʻopā ʻia e nā keiki (40-60%). Me ka hana ʻole ʻana o ka māka, ke iho nei kā lākou haʻalele.
ʻO ka hapalua o ka ola ramiprilat me ka hoʻohana lōʻihi ʻana i kahi maʻa o 5-10 mg hoʻokahi manawa i ka lā he 13-17 hola.

Nā hōʻailona no ka hoʻohana ʻana

• nālākohu arterial,
• hōʻeha o ka puʻuwai kūpilikiʻi (ma ke ʻano he hui hoʻohui)
• nā mea maʻi a i ʻole ka maʻi diabetes nephropathy, preclinical a me nā haukapila i hōʻike ʻia, ʻoiai me ka proteinuria koʻikoʻi, ʻoiai inā hui pū ʻia me ka hypertension arterial a me ka hiki ʻana o microalbuminuria,
• ka hōʻemi ʻana o ka maʻi myocardial infarction, stroke, a i ʻole ka make cardiovascular i nā maʻi me nā maʻi nui o ka maʻi cardiovascular:
- i nā mea maʻi me ka maʻi ʻalani coronary paʻa, myocardial infarction me ka ʻole a ʻole o ka mōʻaukala o nā mea maʻi, me nā poʻe maʻi e hoʻomaʻamaʻa ana i ka maʻilani me ka coroliary transluminal percutanely, coronary artery bypass grafting.
- i nā mea maʻi me ka mōʻaukala o nā hōʻeha,
- i nā mea maʻi me nā ulia pōkole o nā mākilo peripheral,
- i nā mea maʻi me ka maʻi pākahi me ka liʻiliʻi o kahi mea hou aku e pili ana i ka maʻi (microalbuminuria, hypertension arterial, hoʻonui i ka holo ʻana o ka plasma o OX, ua hoʻoneʻe ʻia nā mea kūlohelohe i HDL-C, ka ulaula),
• ka puʻuwai paʻakikī i ulu ai i nā lā mua (mai 2 a hiki i 9 mau lā) ma hope o ka infiction myocardial koʻikoʻi.

Nā Hoʻohui

• hypersensitivity i ramipril, ʻokoʻa ACE e hoʻopaʻa ʻia a i ʻole nā ​​mea kōkua o ka lāʻau lapaʻau,
• hoʻohele a loaʻa paha i ka edema angioedema Quincke (me ka lawe ʻana i nā mea paʻa o ka ACE ma ka mōʻaukala),
• ka stodyosis hemodynamically koʻikoʻi o nā renal renderal (bilateral a i ʻole unilateral i ke ʻano o hoʻokahi keiki),
• kū'ē ka huhū,
• ka mea nui ka hyperaldosteronism,
• nā maʻi arterial koʻikoʻi (systolic blood pressure haʻahaʻa ma mua o 90 mm Hg) a i ʻole nā ​​kūlana me ka hemodynamics unstable.
• hāpai
• wā o ka umauma,
• makahiki a hiki i 18 mau makahiki (ʻaʻole i aʻo ʻia ka maikaʻi a me ka palekana o ka hoʻohana ʻana).
• ka hopena o ka renal maikaʻi (hoʻopili aku ka hana (CC) ma mua o 20 ml / min / 1.73 m²),
• hōʻeha paʻakikī ka maʻi (ʻaʻole ʻike no ka maʻi maʻi),
• ka hemodialysis a i ʻole hemofiltration me ka hoʻohana ʻana i kekahi membranes me kahi ʻaoʻao maikaʻi i hoʻopiʻi ʻia (nui nā memba polyacrylonitrile kiʻekiʻe (ke ʻano o ka hoʻoulu ʻana i ka hopena hypersensitivity).
• apheresis o nā lipoproteins haʻahaʻa haʻahaʻa e hoʻohana ana i ka dextran sulfate (ʻoi aʻe ka ulu ʻana o nā hopena hypersensitivity),
• hoʻohana ma ke ala koʻikoʻi o ka infarction myocardial: hōʻeha paʻa o ka puʻuwai koʻikoʻi (CHF) (NYHA papa IV papa hana), ka uka paʻa ʻole ʻana, nā hana hoʻoweliweli o ka arrhythmias cardiac, "pulmonary" puʻuwai,
• e like me nā mea ʻē aʻe ACE, ka hui pū ʻana o ka ramipril a me nā lāʻau lapaʻau e pili ana i ka aliskiren, ua contraindicated ma ka poʻe maʻi me ka maʻi mellitus a i ʻole ka hōʻemi a i ʻole ka hopena renal (CC ma mua o 60 ml / min / 1.73 m²).
• ka hoʻohana pinepine ʻana o ka antagonist reseptor II nāiotensin i nā maʻi me ka nephropathy maʻi,
• ka nephropathy, ka mea i mālama ʻia me ka glucocorticosteroids, nā lāʻau anti-inflammatory non-steroidal (NSAIDs), immunomodulators a / a me nā lāʻau hou o ka cytotoxic (ʻaʻole pono i nāʻike kulekele).
• hemodynamically nui aortic a mitral stenosis (pilikia o ka hoʻemi nui ʻana o ke kao koko e ukali ana i ka hana renal impaired (CC ma mua o 20 ml / min / 1.73 m²), hypertrophic obstruktive cardiomyopathy.

Me ka mālama pono

ʻO ka hoʻohana pū ʻana me nā lāʻau lapaʻau e pili ana i ka aliskiren, a i ʻole me kaiotropin II receptor antagonist, e alakaʻi ana i kahi pālua o ka ʻōnaehana renin-angiotensin-aldosterone (RAAS), hyperkalemia, hyponatremia (me ke ʻano o ke kuʻuna o ka diuretics a me nā ʻeke āpau me ke kaohi ʻana o ka paʻakai o ka paʻakai), diabetes mellitus (ʻeha o ka hyperkalemia), ke ake ʻole o ka puʻuwai ʻeha, keu a paʻa paha no nā lāʻau ʻē aʻe me kahi hopena antihypertensive ua lawe ʻia, ka coronary koʻikoʻi a me nā lesi cerebral. nā paʻakai (ʻo ka hopena o ka hoʻemi i ke kahe koko me ka hoʻemi nui ʻana i ke kahe koko), ka hemodynamically koʻikoʻi unilateral stenosis o ka renal artery (ma ke ʻano o ʻelua mau pūnaʻi), nā kūlana i hoʻohui ʻia e ka hapa o ka nui o ke koko (e pili ana i ke aniani, ka luaʻi), i ka hoʻohana like ʻana o ka hoʻomākaukau lithium, immunosuppressants a saluretics, maʻi maʻi hoʻohui (me ka systemic lupus erythematosus, scleroderma - nui ka hoʻonui ʻana o ka neutropenia a i ʻole agranulocytosis), desensitizing therapy, ʻoihana holomua (ma mua o 65 mau makahiki) (hoʻonui ika hopena o ka hoʻoneʻe o ka kōā wahī a me / a i ʻole a i ʻole nā ​​puʻuwai a me ke kaumaha ole o ka naʻau), ke ola ma hope o ka hoʻololi ʻana i ka huehue, ka huhū palupalu.

Hoʻohana i ka wā hāpai a i ka wā o ka umauma

Hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau Pyramil ® i ka wā hāpai a me ka hoʻoulu ʻana i ka maʻi, no ka mea hiki i ka hoʻohana ʻana i ka ramipril ke hopena i loko o ka pūpū: hoʻomohala ʻia o ka huehue o ka pūpū, hoʻemi i ke koko o ka pēpē a me nā keiki hou, nā māla hana kīnā ʻole, hyperkalemia, hypoplasia o nā iwi o ka ʻōpala, hypoplasia o nā māmā. ʻAʻohe o ka Pyramil ® i ka wahine e hoʻolālā ana i kahi hāpai. I ka hihia o ka hapai i ka wā o ka maʻi me ka lāʻau Pyramil ®, pono ʻoe e kāpae i ka lawe ʻana i ka lāʻau i ka wā e hiki ai a nānā i ka hoʻomohala ʻana o ka pūpū.
Pono nā wahine o nā makahiki reproduction e loaʻa ana i ka maʻi me nā ACE inhibitors e hoʻohana i ka contraceptives maikaʻi.
Inā hānau nā wahine o ka hānau keiki ʻana me ka hypertension arterial, a laila e hoʻomanaʻo ʻia i ka wā e hāpai ai, e hoʻoneʻe i ka mea maʻi i ka lāʻau hypotensive mai kekahi pūʻulu. I nā kūlana a pau, pono ke mālama ʻia ʻana o ka lāʻau lapaʻau.
ʻAʻohe mea hōʻike no ka excreted o ramipril ma ka umauma umauma.
Ua hōʻike ʻia nā haʻawina holoholona me nā hipa ʻokripril i ka waiū o nā ʻiole lactating. Ua hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau Pyramil ® i ka wā o ka hoʻoulu ʻana. Inā pono e kuhikuhi i ka lāʻau lapaʻau Pyramil ® i kahi makuahine hānai, pono e hoʻoholo ʻia ke kīnā o ka hooki ʻana i ka huhū umauma.

ʻLoe a me ke kākele

I loko, me ka nānā ʻole o ka meaʻai meaʻai, me ka ʻole o ka minamina, inu i ka wai nui (1/2 kīʻaha).
Koho ʻia ka lā ma ka mea e hopena ai ka hopena a me ke ahonui i ka lāʻau lapaʻau.
He maʻi haole
ʻO ka papa hoʻomaka ʻia o ka Pyramil ® no ka poʻe maʻi me ka ʻole o ka naʻau manaʻo ʻole e lawe nei i nā diuretics ʻo 2.5 mg i kēlā me kēia lā. Hiki ke hoʻonui mālie ʻia ka nui o kēlā me kēia mau hebedoma e pili ana i ka hopena a me ke ahonui. ʻO ka dosis kiʻekiʻe loa he 10 mg hoʻokahi i ka lā.
ʻO ka maʻamau, ʻo ka dosis mālama mālama he 2.5-5 mg hoʻokahi i kēlā me kēia lā.
I ka hana ʻole o ka hopena therapeutic ʻoluʻolu i ka wā e lawe ai i ka 10 mg i kēlā me kēia lā o ka lāʻau Pyramil®, hāʻawi ʻia ke koho ʻana i ka lāʻau lapaʻau hui pū ʻia.
Inā lawe ka mea maʻi i ka diuretics, pono lākou e hoʻōki e lawe iā lākou a hōʻemi paha i kā lākou dosis 2-3 lā ma mua o ka hoʻomaka ʻana o ka mālama ʻana me Pyramil ®. No kēlā mau mea maʻi, ʻo ka lāʻau i ʻōlelo ʻia e like me ka 1.25 mg (1/2 papa o 2.5 mg) hoʻokahi i ka lā.
Hoʻopau ʻole nā ​​puʻuwai naʻau
ʻO ka ʻōmole hoʻomaka mua o Pyramil ® ka 1.25 mg (1/2 papa o 2.5 mg) hoʻokahi i ka lā.
Hiki ke hoʻonui mālie ka hopena ma muli o ka hopena a me ka hoʻomanawanui, e pālua i kēlā me kēia 1-2 pule. Hiki ke lawe ʻia nā wai he 2,5 mg i kēlā me kēia lā a i ke kiʻekiʻe loa.
ʻO ka dosis kiʻekiʻe loa he 10 mg hoʻokahi i ka lā.
No ka poʻe maʻi e lawe ana i ka nui o nā diuretics, pono e hoʻemi ʻia kā lākou mau dosis ma mua o ka hoʻomaka ʻana i ka mālama ʻana me Pyramil ® e hōʻemi i ka hopena o ka ulu ʻana i ka hypotension arterial hypaticness.
No ka hōʻemi ʻana i ka hopena o myocardial infarction, stroke, a i ʻole ka make cardiovascular i nā maʻi me nā maʻi puʻuwai kiʻekiʻe.
No ke kau ʻana i ka hoʻomaka ʻana: 2.5 mg hoʻokahi i kēlā me kēia lā. Wahi a ka hoʻomanawanui, hiki ke pāpālua i ka make ma hope o ka 1 mau pule o ka mālama ʻana, a ma mua o 3 mau pule o ka hoʻōmi ʻana, e hoʻonui iā ia i ka maʻi mālama maʻamau o 10 mg hoʻokahi i ka lā.
ʻO ka nele o ka puʻuwai ma muli o ka maʻi myocardial infarction
Hoʻomaka ka mālamaʻana i nā lā 3-10 ma hope o ka maʻi myocardial hoʻonā.
ʻO ka paʻu mua o Pyramil ® ka 5 mg i kēlā me kēia lā (2,5 mg mau manawa i ke kakahiaka a i ke ahiahi), ma hope o ka lā ʻelua mau hua i hoʻonui ʻia ai ka nui o 5 mg ʻelua i ka lā.
Me ka hoʻomanawanui ʻole i ka make mua ʻana o 2.5 mg pālua i kēlā me kēia lā, pono e kuhikuhi ʻia ka nui o 1.25 mg (1/2 papa o 2.5 mg) ʻelua i ka lā hoʻokahi, a laila e hoʻonui ʻia ai ka nui i ka 2.5 mg a 5 mg papalua i kēlā me kēia lā. ʻO ka mālama mālama ʻia o Pyramil ® ka 2.5-5 mg pālua i kēlā me kēia lā. ʻO ka palena loa ʻo kēlā me kēia lā he 10 mg.
ʻO ka maʻi nephropathy maʻi Diabetic
ʻO ka ʻōmole hoʻomaka mua o Pyramil ® ka 1.25 mg (1/2 papa o 2.5 mg) hoʻokahi i ka lā.
Aia i ka hoʻomanawanui, hiki ke pāpālua ka hopena i nā manawa o 2-3 mau pule i kahi kūpono o 5 mg pākahi.
Inā lawe ka mea maʻi i ka diuretics, pono lākou e hoʻōki e lawe iā lākou a hoʻohaʻahaʻa paha i ka nui o nā lā 2-3 i mua o ka hoʻomaka ʻana o ka mālama ʻana me Pyramil ®, i kēia hihia ke kumu o ka lapaʻau mua ʻana o Pyramil ® ka 1.25 mg (1/2 papa o 2.5 mg) kahi. i ka la hou i.
ʻO ka maʻi me ka hana renal impaired
No ka poʻe maʻi me ka hana renal impaired (creanine clearance (CC) 20-50 ml / min / 1,73 m²), ʻo ka ʻōlelo muaʻi o ka Pyramil® i ʻōlelo ʻia ʻo 1,25 mg (1/2 papa o 2.5 mg) hoʻokahi i ka lā , ʻaʻole pono eʻoi aku ka nui o ka lāʻau ma ka 5 mg i kēlā me kēia lā. Ma kahi o ka maikaʻi ʻole o ka renal (CC ma lalo o 20 ml / min / 1.73 m²), ʻo ke ʻano o ka hoʻomaka mua ʻana o Pyramil ® ʻo 1,25 mg (1/2 papa o 2.5 mg) hoʻokahi i ka lā, inā pono, e hoʻonui ʻia ka pākē. a hiki i kahi 2.5 mg i kēlā me kēia lā.
ʻO nā mea maʻi me ka hana pūlima hemahema
I ka poʻe maʻi me ka pīhoihoi hana ʻino, hiki ke ʻike ʻia kahi hoʻonui a me ka nāwaliwali o ka hopena therapeutic o ka lāʻau Pyramil ®. Pono e hoʻomaka ʻia ka mālama ʻana ma lalo o ka mākaʻi ʻana o ke kauka me kahi kaʻe o 1.25 mg (1/2 papa o 2.5 mg). ʻAʻole pono nā kauā nui loa e ka 2.5 mg i kēlā me kēia lā.
Nā maʻi maʻi (ma lalo o 65 mau makahiki)
Pono e mālama ʻia ka lāʻau kiaʻi ma ke kau ʻana i ka lāʻau Pyramil ® i ka poʻe maʻi o nā ʻelemakule ʻehā inā he puʻupaʻa a he aʻe ʻole paha, a me ka hoʻopiʻi ʻana o nā naʻau a me / a me ke hoʻohana ʻana o ka diuretics.
Pono e koho ʻia ka pākēnū i kēlā me kēia mahele o ka pae kiʻekiʻe o ke koko. Hoʻemi ʻia ka lāʻau mua i ka 1.25 mg i kēlā me kēia lā.

Loaʻa ka hopena

Wahi a ka World Health Organization (WHO), ua ʻokaʻawale ʻia nā hopena makemake e like me kā lākou pinepine i ka neʻe ʻana e like me: pinepine pinepine (≥ 1/10), pinepine pinepine (≥1 / 100, mai ka ʻōnaehana cardiovascular
pinepine: ka hōʻailona o ka hoʻokahe nui ʻana i ke koko, ke aho ole o ka hoʻoponopono o ka vascular tone (orthostatic hypotension), syncope,
nuliuliu: hiolo orthostatic, ischemia myocardial, me ka hoʻomohala ʻana o ka hoʻouka kaua ʻana i ka angina pectoris a i ʻole myocardial infarction, kaʻi ʻana o cerebrovascular (ma muli o ke kao o ke kahe koko i loko o nā mea maʻi e hoʻoweliweli), tachycardia, arrhythmia, edema peripheral, palpitation, ka holo ʻana o ke koko i ka ʻili o ka maka.
jarang: ka hanana a hoʻonui ʻana paha i ka maʻi pōʻaiapili ma hope o ka stenotic vascular lesions, vasculitis,
ʻaʻole maopopo: ʻO ka maʻi o Raynaud.
Mai nā heʻano hemopoietic
nuliuliu: eosinophilia
jarang: ka leukopenia, a me ka neutropenia a me agranulocytosis (neutropenia a me agranulocytosis e hoʻi a mau aku a lele i ka wā e pau ana ka hana o ACE), anemia, thrombocytopenia, lymphadenopathy, hōʻemi i ka hemoglobin,
ʻaʻole maopopo: pale o ka iʻa hematopoiesis, pancytopenia, hemolytic anemia.
Mai ka pūnaehana pili ʻana
pinepine: nāwaliwali, nawaliwali,
nuliuliu: moemoeā a ʻehia, hopohopo, hopohopo, paresthesia, dizziness, hoʻomaha moe, hoʻomāhuʻewa, ʻeha hopohopo,
jarang: uhaki, hoʻokaʻawale, hilahila
ʻaʻole maopopo: ischemia cerebral, ka hoʻohui me ka neʻe a me ka haunaele panee o ka cerebral circulation, parosmia (paʻa ka ʻike ʻana i nā mea ʻala), ka hopena i ka hopena psychomotor, paʻa ka ʻike.
Mai nā naʻau kuikawa
nuliuliu: nā hiʻohiʻona ʻike, e komo pū ana me nā kiʻi blurry, ʻono hōʻono,
jarang: conjunctivitis, hoʻolohe i ka ʻike, tinnitus (sensation o ke kani, tinnitus).
Mai ka papa huhū
pinepine: "Ka pipi" maloʻo, bronchitis, sinusitis, pōkole o ka hanu,
nuliuliu: ʻO bronchospasm, me ka hoʻohui ʻana o ke ʻano o ka maʻi bronchial asthma, ʻoi aku ka ihu.
Mai ka pūnaehana hana ʻana
pinepine: nā hana ʻino i loko o ka ʻōpū a me ka puʻu, nā huina o ke kūwaha, hōʻeha i ka ʻōpū, ka ʻōpū, ka ʻōpū ʻana o ka ʻōpū, ka luaʻi, hoʻopuka,
nuliuliu: pancreatitis, hoʻonui i ka hana o ka "ati" transaminases a me konite plasma konohiki bilirubin, hoonui i ka hana Enzimrei pancreatic, ʻōpū o ka ʻōpū, ʻeha ka ʻōpū, gastritis, constipation, waha maloʻo.
jarang: ʻO ka ʻanuʻaka, ʻo ka huehue cholestatic, leshi hepatocellular,
ʻaʻole maopopo: stomatitis aphthous (kahi ulu kūpaʻa o ka wahaosa waha), ke ake ʻole o ka ate, cholestatic a cytolytic hepatitis, komo hoʻopono
Mai ka urinary tract
jarang: impalired 'ōpau hana, me ka hoʻomohala ʻana o ka hana ʻole o ka pale renal, ka hoʻonui ʻia ʻana o ka urine, hoʻonui proteinuria i mua i mua, hoʻonui i ka urea a me ka likone i loko o ke koko.
Ma ka ʻāpana o ka ʻili a me nā membrane membrane
pinepine: ka ʻiliʻili o nā kino, ma ke ʻano maculopapular,
nuliuliu: ka angioedema, a me ka momona (laryngeal edema e hiki ai i ke auwai i ke ala e hiki ai i ka make), ka ʻeha o ka ʻili, ka hyperhidrosis (hoʻonui nui aʻe),
jarang: dermatitis exfoliative, urticaria, onycholysis (exfoliation o ke kui mai ka paʻu palau o ka manamana lima),
loa loa: papahālea papahola,
ʻaʻole maopopo: ʻO nā mea lā i nā lākī epidermal toxic, Stevens-Johnson syndrome, erythema multiforme, pemphigus (cystic rash), ka ulu kino o ka psoriasis, dermatitis like psoriasis, pemphigoid a lichenoid exanthema a enanthema, alopecia.
Mai ka ʻōnaehana musculoskeletal
pinepine: huʻi ʻaʻalapa, myalgia,
nuliuliu: aolaila.
Mai ka ʻaoʻao o ka metabolism
pinepine: hoonui o ka kalima ma ke koko,
nuliuliu: anorexia, hoʻemi i ka momona,
ʻaʻole maopopo: hoʻemi i ka sodium i ke koko.
Mai ka pā kūlohelohe
ʻaʻole maopopo: nā anaphylactic a i ʻole anaphylactoid hopena, hoʻonui i ka ʻauhau o nā antibodies antinuclear.
ʻŌnaehana Endocrine
ʻaʻole maopopo: nā maʻi maʻi ʻole i ka ʻimi huna ʻana o ka hormone antidiuretic (SNA ADH).
Mai ka ʻōnaehana hana hānau
nuliuliu: ka maʻi lahilahi ma muli o ka hana erectile, hoʻemi ka libido,
ʻaʻole maopopo: kekekekikia.
ʻO nā maʻi maʻamau a me nā maʻi i ka pūnaewele injection
pinepine: ʻeha ka ʻōpū, luhi
nuliuliu: fiva
jarang: ʻaiaiaia.

Ke keu

Nā Hoʻomaka Ka nui o ka vasodilation peripheral me ka hoʻomohala ʻana o ka hoʻohaʻahaʻa pane i ke kahe koko (BP), hoʻomākeʻokeʻo, bradycardia, pālākō wai-electrolyte kaulike, pīhoihoi, kūleʻa o ka renal failed, stupor.
Lāʻau: i nā hihia maʻalahi o ka overdose: lavage gastric, hoʻokele o nā adsorbents, sodium sulfate (ʻoi aku hoʻi i loko o nā minuke 30 mau mua ma hope o ka lawelawe ʻana). Pono ka nānā o ka hana a nā mea ola pono. I ka nui o nā hihia koʻikoʻi - nā hana e kuhikuhi ana i ka hoʻopaʻa ʻana i ke koko: ke kōkō ʻana o ka mana o ka 0.9% hopena o ka sodium chloride, ka mea hoʻololi plasma, ka hoʻokomo ʻana i kahi pacemaker kūlohelohe me ka bradycardia paʻa-lāʻau, hemodialysis. Me kahi emi o ka hoʻokahe koko, ʻo ka hoʻomaka ʻana o nā agonists α-adrenergic (norepinephrine, dopamine) hiki ke hoʻohui ʻia i ka lāʻau e hoʻohou i ka nui o ke koko koko a hoʻihoʻi i ka kūpaʻa wai-electrolyte. Ma ka hihia o ka bradycardia, hōʻike ʻia ke koho ʻana i ka atropine a i ʻole hoʻokomo i kahi ʻonemeke pale kūlohelohe.
Pono e nānā pono pono ai i ke koko, hana pēpē a me nā electrolytes serum.
ʻAʻoheʻike i ka hoʻohana ʻana o ka diuresis hoʻokaumaha, nā hoʻololi i ka urine pH, hemofiltration a i ʻole dialysis e hoʻolōʻihi i ka lawe ʻana i ka ramipril mai ke kino. Hōʻike ʻia nā Hemodialysis i nā hihia o ka hoʻomohala ʻana o ka hana renal.

Hoʻopili pū me nā lāʻau ʻē aʻe

Hoʻohui hui like ʻole
ʻO ka hoʻohana ʻana i kekahi membranes ikaika loa me ke kūkaʻi hewa ʻole (no ka laʻana, he polyacryl-nitrile membranes) i ka wā he hemodialysis a hemofiltration paha, ka hoʻohana ʻana o ka dextran sulfate i ka wā apheresis o nā lipoproteins kūloko haʻahaʻa hiki ke alakaʻi i ka hōʻeha o ka hopena anaphylactic nui, inā pono e hana ʻia ka mea maʻi (ma ka hihia o plasmapheresis a me hemofiltration) a e hoʻihoʻi i ka mea maʻi i lawe i nā lāʻau antihypertensive.
E like me nā mea hoʻonaʻauao ACE ʻē aʻe, ʻo ka hoʻohana pū ʻana o ka ramipril me nā aliskiren a me nā lāʻau aliskiren e loaʻa ana i contraindicated i nā maʻi me ka maʻi mellitus a i ʻole ka hōʻemi a i ʻole ka hopena renal (CC ma mua o 60 ml / min / 1.73 m²).
Hoʻohana me ka hana me nā ACE inhibitors ke hoʻonui i ka hōʻeha o ka hoʻomohala ʻana i ka hana ʻole (me ka maikaʻi ʻole o ka hopena ʻole), hyperkalemia.
ʻO ka hoʻohana like ʻana o ka lāʻau a me ka diiotensin II receptor antagonist i loko o nā mea maʻi me ka nephropathy maʻi maʻi, ua contraindicated a ʻaʻole i ʻōlelo ʻia i nā maʻi ʻē aʻe.
Hoʻohana ʻia nā hui me ka mālama
Hoʻohana me paʻakai paʻakai, pā dieter-sparing (ma ke ʻano, amiloride, triamteren, spironolactone), a me nā lāʻau lapaʻau, ka hāʻawi ʻana i ka hoʻonui ʻana i kahi pāumama serum (komo i ka trimethoprim, tacrolimus, cyclosporine, angiotensin II receptor antagonist) hiki ke alakaʻi i ka nui o ka pā o serum (koi pono ka nānā ʻana i nā pae o ka serum potassium level).
ʻO ka lāʻau antihypertensive (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrates, antidepressants tricyclic, antipsychotics, nā pōpoki hiamoe, analgesics narcotic, nā māka no ka mea maʻamau a me nā kūloko. hoonui i ka hopena antihypertensive o ramipril.
Vasopressor sympathomimetics a me nā ʻano lāʻau ʻē aʻe e hoʻoiho ai i ka hopena antihypertensive (no ka laʻana, isoproterenol, dobutamine, dopamine, epinephrine) e hōʻemi i ka hopena antihypertensive o ka ramipril, a me ka nānā pinepine ʻana i ke kahe koko ke koi ʻia.
Hoʻohana me allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (glucocorticosteroids a me mineralocorticosteroids) a me nā ala ʻē aʻe e hiki ke hoʻopiʻi i nā ʻōlaʻi hematological, hoʻonui i ka nui o ka hoʻomohala ʻana i ka leukopenia.
ʻAʻole hoʻohana ʻia ka hoʻohana pinepine ʻana o ramipril me corticosteroids.
He māhu paʻakai pā alakaʻi i kahi hoʻonui i ka hoʻomohala o ka lithium i ka serum koko a me ka hoʻonui ʻana i nā hopena cardiac a me neurotoxic o lithium.
Hoʻonui ʻo Ramipril i ka hopena hypoglycemic nā mea lawelawe hypoglycemic (insulin, hypoglycemic agents no ka hoʻokūkū waha (sulfonylurea derivatives)) a hiki i ke kūkuluʻana i ka hypoglycemia. Pono ʻia ke kāohi o ka glucose.
Vildagliptin alakaʻi i kahi hoʻonui i ka ulu o ka angioedema.
Hoʻohana mua ka ramipril me mTOR (mammalian Target o Rapamycin - mea pani ʻia o rapamycin i loko o nā maʻi mammalian), no ka laʻana, me ka temsirolimus, hiki ke alakaʻi i ka nui o ka ulu ʻana o ka angioedema.
ʻO nā hui e noʻonoʻo
ʻO nā lāʻau anti-inflammatory nonsteroidal (NSAIDs) (no ka laʻana, acetylsalicylic acid (ʻoi aku ma mua o 3 g / lā), nā mākia cyclooxygenase-2 (COX2)) hiki ke hoʻonāwaliwali i ka hopena antihypertensive o ka ramipril, me ka hoʻopiʻi i ka hana renal impaired, i kekahi manawa ke alakaʻi nei i ka hiki ʻole o ka hana renal. Heparin hoʻonui i ka potassium serum.
ʻO Sodium Chloride e ho'ēmi i ka hopena o ramipril.
ʻAʻole pono e hoʻopau ethanol i ka wā o ka mālama ʻana me ka ramipril (ua hoʻonui ʻia ka hopena o ka hopena o ka eʻai o ka ethanol i loko o ka pūnaehana neʻe ma waena (CNS).
Kahukula hoʻonāwaliwali i ka hopena antihypertensive (paʻa ka wai).
Hoʻololi i ka maʻi maʻi me ka hoʻonui ʻana i ke ʻano o nā poʻomanaʻo pepeke. Hoʻopau ka ACE inhibitors, ʻo ia hoʻi me ka ramipril, e hoʻonui i ka hoʻomohala ʻana no ka hoʻomohala ʻana i ka anaphylactic a i ʻole ka hopena anaphylactoid i nā poʻomanaʻo pepeke.

Nā ʻōlelo kikoʻī

Ma mua o ka hoʻomaka ʻana i ka mālama ʻana me Pyramil ®, pono ia e hoʻopau i ka hyponatremia a me hypovolemia. I nā maʻi nā mea i lawe ma mua i nā diuretics, pono ia e kāpae iā lākou a hōʻemi paha i kā lākou dosis 2-3 lā ma mua o ka hoʻomaka ʻana e lawe i ka lāʻau lapaʻau Pyramil ®. Ma kēia hihia, pono e nānā pono ʻia ke kūlana o nā mea maʻi me ka puʻuwai naʻau maʻi ma muli o ka hiki ke hoʻomohala i ka decompensation i nā maʻi me ka nui o ka nui o ke koko lele.
Ma hope o ka lawe ʻana i ka hapa mua, me ka hoʻonui ʻana i ka maʻi o ka diuretic a me / a Pyramil®, pono nā mea maʻi ma lalo o ka mālama ʻana i nā maʻi no nā hola 8 ma muli o ka hiki ke hoʻomohala a i ka hypthension orthostatic.
ʻO ka hypotension arential he ʻōmole ia no ka hoʻomau ʻana i ka mālama ʻana me Pyramil ®, ʻoiai ke hoʻihoʻi ʻana i ka nui o ke kaila o ke koko a me ka hoʻohiolo ʻana i ke koko, ke lawe ʻana i nā kaila o ka lā nui i ka hopena ʻaʻole e hoʻonā i ka hypotension hypertension.
Ma ka hihia o ka hana pinepine o ka hypotension arterial nui, pono e hoʻemi ʻia ka nui o nā lāʻau a haʻalele paha i ka lāʻau. ʻO ka mea maʻi me ka hypertension arterial malignant a i ʻole ka hoʻopiʻi ʻana o ka puʻuwai naʻau, ʻoi loa ma ke ʻano o ke ake ʻana o ka infarction myocardial. wale no i kahi kahua o ka hale hoʻokipa.
I ka poʻe maʻi me ka puʻuwai puʻuwai paʻakikī, lawe i ka Pyramil ® hiki i kahi hōʻemi i ke kahe o ke koko, ka mea i kekahi mau hihia me ka oliguria a i ʻole azotemia a hiki i ka hoʻomohala ʻana o ka maikaʻi ʻole o ka maikaʻi ʻole.
ʻO ka poʻe maʻi me ka hana nui o RAAS e lawe nei i ka lāʻau lapaʻau no ka manawa mua a i ʻole ke kau kiʻekiʻe ma mua e kiaʻi mau i ka neʻe koko a me ka hana ʻana o ka maʻi, ʻoi loa ia i ka hoʻomaka ʻana o ka mālama ʻana, no ka mea, he nui ka maʻi o ka hōʻemi o ke kahe koko a me nā hana renal i hana ʻia ma muli o ke kaohi ʻana o ACE.
Pono e makaʻala loa i ka mālama ʻana o nā mea maʻi, no ka mea he mea ākea lākou i ka pale ʻana ACE.
Pono e mālama ʻia i ka wā mālama i ka wā o ka hoʻoikaika kino a me / a i ʻole ka wela o ka mahana ma muli o ka loaʻa o ka hoʻonui nui ʻana o ka luhilahi a me ka make wai me ka hoʻomohala ʻana i ka hypotension arterial ma ke ʻano o ka hoʻemi ʻana o ka nui o ke koko a me ka hoʻokaʻa ʻana i ka ʻike sodium i loko o ke koko.
Ma mua a i ka wā e mālama ai me ka Pyramil ®, pono ia e mālama pono i nā hana renal (creatinine, urea), pāmeʻa plasma, he helu koko āpau, hemoglobin, a me nā hōʻike hana lawelawe.
Me ka hoʻomohala ʻana o ka jaundice cholestatic a i ʻole ka mākaukau e hoʻonui i ka hana o nā “transaminases” “ʻokiʻoki”, pono ʻoe e hoʻōki i ka hana ʻana o ka ACE inhibitors.
ʻO ka pūʻulu pilikia no ka hyperkalemia e haku ʻia i nā mea maʻi me ka nele ʻole o ka maʻi, diabetes mellitus, a me nā mea e lawe ana i ka diuretics pākuhi-potassium, ka hoʻomākaukau ʻana i ka potassium a me nā paʻakai paʻakai pākana a me nā hana lāʻau e hoʻonui ai i ka momona o ka serum potassium (ma ka laʻana, heparin).
I ka poʻe maʻi me ka nui o ka ulu ʻana o ka ulu ʻana o ka neutropenia (me ka hana ʻole ʻole o ka hopena, nā maʻi ʻōnaehana o ka ʻili hoʻohui), i ka wā e lawelawe ana i ka lāʻau Pyramil®, he ʻano kūkākūkā koko nui ke nānā ʻia i hoʻokahi manawa i hoʻokahi mahina i ka mau mahina 3-6 mua o ka hōʻola ʻana, a me nā hōʻailona mua o ka maʻi. Inā ʻike ʻia ka neutropenia (ʻoi aku ka nui o nā neutrophils ma mua o 2000 / μl), pono e hoʻopau ʻia ka mālama ʻana me nā mea maʻi ACE.
I nā hanana ka hopena, i ka wā i mālama ʻia ai me ka inhibitor ACE, me ka ramipril, ka angioedema o ka maka, nā lālā, nā lehelehe, ka lehelehe, ka larynx a / a i ʻole pharynx i hoʻomaopopo ʻia. Inā loaʻa i ka edema hiki ke hoʻomohala koke i kēlā me kēia manawa o ka mālama ʻana, pono ʻoe e hoʻokaʻawale i ka lawe ʻana i ka lāʻau lapaʻau, e mālama i ka mālama olakino āpau a mālama i ka mālama pono ʻana i ka mea maʻi a hiki i nā hōʻailona holoʻokoʻa a mau loa.
I loko o nā mea maʻi e loaʻa ana i nā inhibitor ACE, ua nānā ʻia nā hihia o ka angededema o ka ʻōpū, ka mea i hōʻike ʻia e ka ʻeha o ka ʻōpū me ka ʻole ʻana o ka nausea a me ka luaʻi ʻana, a i kekahi mau kūlana angioedema o ka maka i nānā pū ʻia. Inā ulu ka mea maʻi i nā maʻi ma luna aʻe me ka mālama ʻana o nā inhibitor ACE, pono hoʻi i ka maʻi hopena ka manaʻo e hoʻomohala i ka angioedema intestinal i loko o lākou.
ʻO ka hoʻohana ʻana o ka inhibitions ACE, me ka ramipril, i nā mea maʻi e hana ana i ka hōʻemi ma ka hoʻohana ʻana i ka anesthesia aoao hiki ke alakaʻi i ka hoʻomohala ʻana o ka hypotension arterial.
Aāpai ʻia e oki i ka lawe ʻana i ka lāʻau Pyramil ® i hoʻokahi lā ma mua o ka hoʻomaʻamaʻa ʻana.
ʻO ka hoʻohana ʻana o nā membrane ikaika nui me ka pehu i hoʻopiʻi ʻole ʻia (ma ke ʻano, no ka polyacrylonitrile membranes) pono e ʻalo ʻia, no ka laʻana, no ka hemodialysis wikiwiki a i ka hemofiltration hui pū me ka pūlele ACE (ma muli o ka hiki ke kūleʻa o ka anaphylactoid i nā mea maʻi). I nā hihia pilikia, me ka apheresis o nā lipoproteins low density (LDL) me ka dextran sulfate a me ka hoʻokō ʻana i nā ACE inhibitors, e hoʻomohala ka hopena o ka anaphylactoid.
No laila, ʻaʻole pono kēia ʻano o nā ʻoihana i ka poʻe maʻi e loaʻa ana nā ACE inhibitors.
Hoʻopau ʻole nā ​​mea antihypertensive e kāohi iā RAAS i ka mālama ʻana i nā mea maʻi me ka hyperaldosteronism primer, no laila, ʻaʻole i aʻo ʻia ka hoʻohana ʻana o ka ramipril i nā hihia like ʻole.
E like me nā mea hoʻonaʻauao ACE ʻē aʻe, ʻo ka hoʻohana pū ʻana o ka ramipril me nā aliskiren a me nā lāʻau aliskiren e loaʻa ana i contraindicated i nā maʻi me ka maʻi mellitus a i ʻole ka hōʻemi a i ʻole ka hopena renal (CC ma mua o 60 ml / min / 1.73 m²).
ʻO ka hoʻohana like ʻana me nā lāʻau lapaʻau e pili ana i ka aliskiren, a i ʻole me ka angiotensin II receptor antagonist, e alakaʻi ana i kahi pālua ʻelua o ka RAAS, ʻaʻole ia i hoʻoluhi ʻia ma muli o ka hopena o ke kahe nui o ke kahe koko, i ka hoʻomohala ʻana i ka hana hyperkalemia a me nā hana ʻole i ke kīpapa i hoʻohālikelike ʻia me ka monotherapy.
ʻO ka hoʻohana like ʻana o nā antagonist o ka receptor naiotiotin II i nā mea maʻi me ka nephropathy maʻi maʻi, ua contraindicated (e ʻike i ka ʻāpana "Contraindications").

Hoʻokomo i ka hiki ke lawe i nā kaʻa, nā mīkini

ʻAʻohe ʻikepili i ka hopena maikaʻi o ka hoʻomākaukau ʻana o ka Pyramil ® i nā hana i manaʻo ʻia e hiki ai ke hoʻokele i nā kaʻa a hana paha me nā mīkini. Eia nō naʻe, ma muli o ka hopena o ka hopena o ka hopena, e like me ka hoʻohaʻahaʻa ʻana i ke koko a me ka pohihihi, ke kuhi ʻia e kaohi ʻana i ka hana ʻana i nā hana e hopohopo nei e koi ai i ka piʻi ʻana o ka manaʻo nui a me ka wikiwiki o ka hopena o ka psychomotor, me ka hoʻokele ʻana, ma hope iho o ka lawe ʻana i ka hopena mua, ka huli ʻana i kekahi lāʻau lapaʻau ʻē aʻe. ʻOiai e lawe ana i ka diuretics a me ka waiʻona.

ʻO nā mea mālama palekana

Hoʻololi ʻia ka mālama ʻana i nā maʻi e loaʻa ana i ka papa diuretic concomitant, ma muli o ka hiki ke nele o nā wai a me (a) nā electrolytes i loko o ke kino, a me ka nānā i ka hana o ka renal a me ka pae o ka potassium i ke koko.

ʻIkepili ma ramipril
Leka i pāpā ʻia ʻia nā ʻōnaehana renin-angiotensin-ald testosterone (RAAS)
ʻAʻole ke ʻano o ka hui ʻana o Pyramil® Extra a me aliskiren ma muli o ka nui o ka ulu o ka hypotension, hyperkalemia, a me nā loli i ka hana ʻoi. ʻO ka hoʻohana ʻana o Pyramil® Extra i hui pū me ka aliskiren ua contraindicated i ka poʻe maʻi me ka maʻi mellitus a i ʻole ka hopena ʻole (GFR 2) (e nānā i "Hoʻohui pono me nā lāʻau lapaʻau hou").
ʻO nā maʻi i ka hoʻonui ʻia ʻana o ka maʻi Arterial Hypotension
ʻO nā mea maʻi me ka hoʻonaninua koʻikoʻi o ka ʻōnaehana renin-angiotensin-aldosterone
ʻO ka poʻe maʻi me ka hoʻōho ikaika o RAAS i ka nui o ka mahuahua o ke kahe nui o ka hoʻokahe nui ʻana i ke koko a me nā hana renal impaired ma ke ʻano o ka pale ʻana o ACE, a ʻoi aku me ka hoʻokele mua o kahi ACE inhibitor (a i ʻole concomitant diuretic) a i ka hoʻonui ʻia ʻana.
Kuhi ʻia ka hoʻonā nui ʻana o RAAS, ka mea e koi ai i ka limahana o ke limahana olakino, ʻo ia hoʻi ka nānā ʻana i ke kaʻi koko, ke kali ʻia nei i nā ʻano koʻi o nā kānaka:
- nā mea maʻi me ka hypertension arterial koʻikoʻi,
- nā mea maʻi me ka puʻuwai naʻau decompensated,
- nā mea maʻi me nā maʻi hemodynamically koʻikoʻi o ka kahe a i ʻole ke kahe o ke koko mai ka ventricle hema (e.g., stenosis o ka aortic a mitral valve paha),
- nā mea maʻi me ka stenosis renal renal stenosis a he hana lua o ka hana,
- nā mea maʻi i loaʻa a i ʻole e kūkulu i ka hemahema o ka wai a (a i ʻole) electrolytes (me nā mea maʻi e lawe ana i nā diuretics),
- nā mea maʻi me ka cirrhosis a (a i ʻole) ascites.
- Nā maʻi maʻi e hana ana i ka hōʻeha hōʻeha a i ʻole Anesthesia me nā lāʻau lapaʻau e hoʻokau ana i ka hypotension.
Ma mua o ka hoʻomaka ʻana i ka mālama ʻana, pono e hoʻoponopono ʻia nā maʻi kau iho, hypovolemia, a i ʻole ka pau ʻana o ka electrolyte (akā naʻe, i nā mea maʻi me ka puʻuwai naʻau ʻole nā ​​mea hoʻoponopono a me nā mea ʻē aʻe o kēlā me kēia hana
- i nā mea maʻi me ka transient (transient) a i ʻole ka mauʻu naʻau paʻa ma hope o MI,
- i nā mea maʻi e hōʻemi ana i ka hoʻomohalaʻana i ka ischemia cardiac a i ʻole cerebral paha, a i nā hihia aʻeha o ka hypotension.
I ka hoʻomaka mua o ka mālama ʻana, pono ke nānā ʻia o ka maʻi lapaʻau kūikawā.
ʻO nā maʻi maʻi
Pono e emi iho nā ʻoi mua o ka hipa ramipril, me ko lākou piʻi pinepine ʻana, ma muli o ka nui o nā hopena kūpono ʻole. ʻAʻole ʻōlelo ʻia ʻo Amlodipine / ramipril i nā maʻi maʻi ʻelemakule a maʻi maʻi.
Nā mea lawelawe
Inā hiki, e ʻōlelo no e kāpae i nā inhibitor ACE i kahi lā ma mua o ka hoʻokō ʻana.
ʻO ka nānā ʻana me ka nānā ʻana i nā pēpē
Pono e loiloi ʻia ka hana o Renal i mua o ka wā o ka mālama ʻana a i ka wā e hoʻoponopono ʻia ai ka lāʻau, ʻoi aku hoʻi i nā pule mua o ka maʻi. Pono pono ka nānā kiaʻi ʻana i ka poʻe maʻi me ka hana renal impaired. Aia kahi hopena o ka hana renal impaired, ʻoi aku i nā mea maʻi me ka puʻuwai naʻau congestive a i ʻole ma hope o ke hoʻololi ʻana i ka maʻi.
I ka poʻe maʻi me ka hōʻeha kino ʻole (GFR

ʻLoe a me ke kākele

Nā ʻōpala
ʻAʻole pono e hoʻohana ʻia ʻo Pyramil® Hoʻomaka no ka hoʻomaka ʻana o ka lāʻau no ka hypertension arterial. Pono e koho ʻia nā ʻōmole o kēlā me kēia pae e like me ka pā o ka mea maʻi a me ka pae o ke kaohi koko.
Inā pono e hoʻololi i ka ʻōlelo, koho ʻia ka nui o ka dosimen no kēlā me kēia māhele o ka lāʻau i ka hoʻokaʻawale - ramipril a me amlodipine, a aia wale nō ma hope o ke hoʻoholo ʻana i nā inika pono, hiki ke hoʻololi ʻia ka lawelawe o nā mea kūʻokoʻa e ka luna o ka lāʻau Pyramil® Extra.
Palapala ʻia: hoʻokahi pahu kiʻe i kēlā me kēia lā. Ka helu momona pākahi o kēlā me kēia lā: hoʻokahi kapena o 10 mg / 10 mg.
Nā hui ahonui kūikawā
ʻO nā maʻi me ka hana pūlea lēwa: Hoʻololi ʻia ka hopena maikaʻi loa a me ka mālama mālama pono ʻia e ka ʻū ʻana i ka mahele o kēlā me kēia wahi o ka lāʻau (amlodipine a me ramipril) kahi kaʻawale.
Ua kāpae ʻia ʻo Ramipril i ka wā o ka dialysis, no laila pono e lawe ʻia ka lāʻau i kekahi mau hola ma hope o ka hemodialysis.
ʻAʻole ʻo ʻAnlodipine i hoʻopuka ʻia e ka dialysis. No ka poʻe maʻi i ka dialisis, ua kuhikuhi ʻia me ka mālama nui loa.
I ka wā o ka mālama ʻana me ka Pyramil® Extra, ka hana o ka pēpē a me ka pae o ka pāhana i loko o ke koko pono e nānā ʻia. Ma ka hihia o ka hana hoka ponoʻole, pono ia Pyramil® Extra e hōʻoki a hoʻololi ʻia e ka lawe ʻana i nā ʻāpana kūpono i nā māhele.
ʻO nā mea maʻi me ka pīhoihoi paʻa ʻole: ʻO ka palena loa o kēlā me kēia lā o ka ramipril he 2.5 mg. ʻAʻole hoʻohana ʻia ka lāʻau Pyramil® Hoʻonui i nā mea maʻi me nā hana heʻeha lēwa.
Nā maʻi maʻi: Hoʻomaopopo ʻia ka mālama ʻana e hoʻomaka me nā haʻahaʻa haʻahaʻa haʻahaʻa, e ukali ʻia e ka piʻi ʻana me ka mālama ʻana.
Nā keiki a me nā ʻōpio: palekana a me ka hana pono o Pyramil® Loaʻa i nā keiki ʻaʻole i hoʻokū ʻia. ʻAʻole hiki i ka hāʻawi ʻana i nā loiloi dosage.

Ke ʻano o ka noi
No ka lawelawe waha. Lawe i ka manawa like, me ka manaʻo o ka ʻono o ka meaʻai.

Nosological ʻano papa (ICD-10)

ʻO ka wehewehe ʻana i ke ʻano dosis

Nā papa ʻaina 5 mg: oblong, biconvex, ʻulaʻula kukui i ke kala me kahi pālahalaha, a me nā pā popo i loaʻa ʻole i nā kala ʻeleʻele a me ka notch ma kekahi ʻaoʻao.

Nā Kūlana, 10 mg: oblong, biconvex, keʻokeʻo a ʻokoʻa paha keʻokeʻo i ke kala me kahi pālahalaha a notch ma kekahi ʻaoʻao.

Lapaʻau lāʻau

Hoʻopili koke ʻia ʻo Ramipril i ka hana kūwili ʻana a hana i ka hydrolysis i loko o ka ate me ka hoʻokumu ʻia o ka metabolite kūlohelohe o ramiprilat. ʻO Ramiprilat he lōlani hana lōʻihi ACE, he enzyme e kolo ana i ka hoʻololi ʻana o ka angiotensin I i ka angiotensin II.

Hoʻokomo ʻo Ramipril i ka hōʻemi o ka pae o ka angiotensin II i ka plasma, he hoʻonui i ka hana renin a me kahi hoʻohaʻahaʻa i ka hoʻokuʻu ʻana o ald testosterone. Ke kāohi nei i ka pae o ka kinase II, ke pale aku i ka uha ʻana o ka bradykinin, hoʻonui i ka synthesis o PG. Ma lalo o ka hana a ramipril, hoʻonui ʻia nā moku peripheral a hoʻemi ʻia ʻo OPSS.

Loaʻa i kahi hopena hypotensive ke waiho hewa a kū ke kanaka maʻi. Hoʻemi i ka OPSS (ma hope o ka hoʻouka), ka ukiuki ʻana i ka pulillary pulima no ke koi ʻole o ka hoʻonui ʻana i ka helu o ka naʻau. Hoʻonui ka coronary a me ke kahe koko aʻai ʻole me ka hoʻopono ʻole i ka GFR.

ʻO ka hoʻomaka ʻana o ka hopena hypotensive ʻo 1-2 mau hola ma hope o ke kauā ʻana, e hoʻomohala ʻia ka hopena kiʻekiʻe 3-6 mau hola ma hope o ka nānā ʻana. Hana ka hana i ka liʻiliʻi o 24 mau hola.

Huli puʻuwai a me ka puʻuwai pu ʻole ma muli o ka maʻi myocardial infarction

Ua hōʻemi ʻo Ramipril i ka OPSS a hopena i ke koko. Hoʻonui i nā hopena cardiac a hoʻomanawanui. Me ka hoʻohana ʻana i ka lōʻihi, hāʻawi ia i ka hoʻoiho hou ʻana o ka maʻi hypocrophy myocardial i nā poʻe maʻi me ka naʻau ʻole o ka papa hana I me II e like me ka helu ʻana. NYHA, e hoʻomaikaʻi i ka hāʻawi koko i ka ischemic myocardium.

Hoʻonui ʻo Ramipril i ke ola ʻana o nā maʻi me nā hōʻailona o ka neʻe ʻana a i ʻole CHF ma hope o ka infococose myocardial. Loaʻa ia i kahi hopena cardioprotective, pale i nā episode ischemic coronary, hōʻemi ka hopena o ka hoʻomohala ʻana i ka myocardial infarction a hōʻemi i ka lōʻihi o ka hoʻokipa.

ʻO ka maʻi nephropathy maʻi Diabetic

I nā mea maʻi me ka maʻi nephropathy maʻi a me ka mea ʻole, ua hōʻai ʻo ramipril i ka nui o ka holomua o ka hiki ʻole o ka renal a me ka hoʻomaka ʻana o ka hope o ka papa o ka hana ʻana, a no laila e hōʻemi ai i ka pono o ka hemodialysis a i ʻole ka hoʻololi ʻana i ka pēpē. I nā hoʻomaka mua o ka maʻi diabetes a nondiabetic nephropathy, hoʻemi ka ramipril i ka nui o ka albuminuria.

I nā maʻi me ka maʻi nui o ka maʻi cardiovascular ma muli o nā maʻi vascular (ʻike ʻia me ka maʻi ʻalopona coronary, e pau ana i ka maʻi pākuʻi peripheral a i ʻole ka mōʻaukala o ke ahulau), ka maʻi diabetes mellitus me ka liʻiliʻi o ka mea hou aku i hoʻopilikia maʻi (microalbuminuria, hypertension arterial, hoʻonui i ka konsentrasi plasma o ka nui o ka kolesterol, a i emi ka plasma ka ʻike ʻana o ka HDL-C, ulaula) i ka hoʻohui ʻana o ka ramipril i ke ʻano maʻamau i hōʻemi nui ʻia i ka hoʻouka ʻana o myocardial infarction, stroke a me ka make lima. kumu hanana.

Lapaʻau lāʻau

Ua hopu koke ʻia ʻo Ramipril i ka ʻeha gastrointestinal ma hope o ka hoʻoponopono waha. He kūʻokoʻa ʻole ka Absorption o ka inu kai.

Ma hope o ka hoʻopili ʻana, ka ramipril wikiwiki a ʻokoʻa loa i huli i ka metabolite ikaika o ka ramiprilat ma lalo o ke ʻano o ka esterase enzyme i loko o ka ate. ʻO Ramiprilat he 6 mau manawa hou aku ka nui o ka pale ʻana i ka ACE ma mua o ka ramipril. Ua ʻike ʻia nā lāʻau lapaʻau hou ʻole i hiki ke hāmiʻi ʻia.

I ka poʻe maʻi me ka hana renal impaired, ʻo ka loli i ka ramipril i ramiprilat i lalo i lalo o ka lōʻihi o ka esterase, no laila, ʻo ka nui o ka ramipril i loko o ke koko koko i loko o kēia mau maʻi ua hoʻonui.

C_max Loaʻa ka ramipril i ka plasma i loko o hoʻokahi hola ma hope o ka hoʻokele ʻana, ramiprilata - i loko o 2-4 mau hola ma hope o ka lawe ʻana i ka lāʻau. ʻO ka bioavailability o ramipril he 60%. Ua hoʻokele ka paila protein Plasma 73% no ka ramipril a me 56% no ka ramiprilat. Ma hope o ka lawe iā 5 mg, ʻo ka wehe ʻana i ka renal o ka ramipril he 10-55 ml / min, hōʻea ʻo ka extrarenal ma kahi o 750 ml / min. No ka ramiprilat, ʻo kēia mau waiwai ka helu 70-1-1 ml / min a ma kahi o 140 ml / min, kēlā. ʻO Ramipril a me ramiprilat ka mea nui loa i hoʻopā ʻia e nā keiki (40-60%). Me ka hana ʻole ʻana o ka māka, ke iho nei kā lākou haʻalele.

T_1/2 ramiprilata me ka hoʻohana mau ʻana i kahi mahele o ka 5-10 mg 1 manawa i ka lā he 13-17 hola.

Nā hōʻikeʻike o ka lāʻau Pyramil ®

ka maʻi paʻakikī ʻana (ma ke ʻano he hui hoʻohui)

maʻi diabetes a me nā mea maʻi ʻole nephropathy, preclinical a me nā haukapila i hōʻike ʻia, kahi me ka proteinuria koʻikoʻi, keu i hui pū ʻia me ka hypertension arterial a me ka hiki ʻana o ka microalbuminuria,

ka hoʻemi ʻana o ka maʻi myocardial infarction, stroke, a cardiovascular mortal in the pasyente with a high risk of cardiovascular disease (nā maʻi me ka maʻi coronary artery maʻi, mōʻaukala o myocardial infarction a i ʻole ia, me nā mea maʻi me ka percutaneous transluminal corumary angioplasty, coronary artery bypass grafting, nā mea maʻi me ka stroke nā maʻi kīnāwai peripheral, diabetes mellitus me ka liʻiliʻi he keu hou loa (microalbuminuria, hypertension arterial, hoʻonui i ka plasma m huina naʻokoko nā hoʻohui like, ua hoʻemi wai koko nā hoʻohui like o ka LDL-HDL naʻokoko, momoku)

puʻuwai paʻakikī i ulu ai i nā lā mua (mai 2 a 9 mau lā) ma hope o ka hoʻonāʻana i kaʻu myocardial infarction.

ʻŌpū a me ka lactation

Hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau Pyramil ® i ka wā hāpai a me ka hoʻoulu ʻana i ka maʻi, no ka mea paha he hopena koʻikoʻi ma luna o ka pūpū: hoʻomohala i ka hanana ʻana o ka pūpū o ka pūpū, hoʻemi i ke koko o ka pēpē a me nā keiki hou, nā maʻi āpau i hala, hyperkalemia, hypoplasia o nā iwi o ka ʻōpala, hypoplasia o nā māmā. ʻAʻohe o ka Pyramil ® i ka wahine e hoʻolālā ana i kahi hāpai. I ka hopena o ka hapai i ka wā o ka hoʻoulu ʻana me ka Pyramil ®, pono ʻoe e kāpae i ka lawe ʻana i ka lāʻau i ka hiki koke aku a nānā i ka hoʻolālā ʻana o ka pūpū.

Pono nā wahine o nā makahiki reproduction e loaʻa ana i ka maʻi me nā ACE inhibitors e hoʻohana i ka contraceptives maikaʻi. Inā hānau nā wahine o ka hānau keiki ʻana me ka hypertension arterial, a laila e hoʻomanaʻo ʻia i ka wā e hāpai ai, e hoʻoneʻe i ka mea maʻi i ka lāʻau hypotensive mai kekahi pūʻulu. I nā kūlana a pau, pono ke mālama ʻia ʻana o ka lāʻau lapaʻau.

ʻAʻohe mea hōʻike no ka excreted o ramipril ma ka umauma umauma.

Ua hōʻike ʻia nā haʻawina holoholona me nā hipa ʻokripril i ka waiū o nā ʻiole lactating. Ua hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau Pyramil ® i ka wā o ka hoʻoulu ʻana. Inā pono e kuhikuhi i ka lāʻau lapaʻau Pyramil ® i kahi makuahine hānai, pono e hoʻoholo ʻia ke kīnā o ka hooki ʻana i ka huhū umauma.

Nā hopena hopena

Hāʻawi ʻia nā hopena kūpono ʻole e like me ka hoʻoili ʻana o ka WHO e like me kā lākou pinepine i ka neʻe ʻana e like me kēia: pinepine pinepine (> 1/10), pinepine (> 1/100, 1/1000, 1/10000, ke koko, pānā aʻōkōlohi i nā orthostatic o ke kani vascular (hypotension orthostatic) , nā kūlana syncopal, pinepine - - nā wili orthostatic, ischemia myocardial, me ka hoʻomohala ʻana o ka hoʻouka kaua ʻana o angina pectoris a me ka myocardial infarction, cerebrovascular accident (ma muli o kahi hāʻule nui o ke koko koko i ka poʻe maʻi i ka hopena), tachycardia, arrhythmia, peripheral edema, palpitation, flushing to ʻili o ka maka, ʻaʻole iki - ka hanana a i ʻole ka luhi ʻana i ka pilikia o ka lele i ke kāʻei o nā ulia stenotic vascular, vasculitis, ʻaʻole ʻike ka ʻike - ʻike ʻole i ka maʻi o Raynaud.

Mai nā ʻekopa hemopoietic: ka pinepine - eosinophilia, jarang - leukopenia, komo me ka neutropenia a me agranulocytosis (neutropenia a me agranulocytosis e hoʻi a mau i ka wā e oki ʻia ai nā inhibitor ACE), anemia, thrombocytopenia, lymphadenopathy, hoʻōla hemoglobin, ʻike pinepine ʻole - suppression of bone hemorropen, hemorropen hemag, hemorropenagia.

Mai ka ʻōnaehana hoʻonāukiuki: ka pinepine - nāwaliwali, hōʻeha o ka ʻeha, ka pinepine - ka hana o ka naʻau, ke kaumaha, ka hopohopo, paresthesia, ka hoʻonāukiuki, nā hopohopo hiamoe, ka ʻōpū, ka hopohopo holo kaʻa, ʻaʻole i loaʻa - haʻalulu, kūwili ʻole, hilahila, ʻike pinepine ʻole - cerebral ischemia, e komo me ka hōʻeha a me ka maʻi wā. ka puʻe ʻana o ka cerebral, parosmia (ka nānā ʻana o nā mea ʻala), nā hopena psychomotor impaired, ʻano paʻa.

Mai nā ʻike: pinepine - nā nānā ʻike, a me nā kiʻi hiʻona, hōʻole ʻole i ka nānā ʻana i nā mea ʻono, ʻaʻole liʻiliʻi - conjunctivitis, hoʻopuka hewa, tinnitus (sensation ke kani, tinnitus).

Mai ka papa hana hanu: pinepine - paʻū maloʻo, bronchitis, sinusitis, pōkole o ka hanu, pinepine - bronchospasm, me ka hoʻohui ʻana o ka ate bronchial, ʻoi aku ka ihu.

Mai ka pūnaehana hana ʻana: pinepine - nā māhina mau ʻana i loko o ka ʻōpū a me nā puʻu, nā huina o ke ake ʻana, ʻeha ʻole i loko o ka ʻōpū, ka dyspepsia, ka ʻōpū, ka luaʻi, ka luaʻi ʻana, ka pinepine - pancreatitis, ka hana nui o nā transaminases hepatic a me ka hoʻokūkū o ka bilirubin conjugated i loko o ke koko plasma, ka hoʻonui ʻana i ka hana o nā enzyme pancreatic, ka ʻōpū o ka ʻōpū ka ʻōpū, ka ʻeha i ka ʻōpū, gastritis, constipation, malo maloʻo, līlū o ka glossitis, jaundice cholestatic, lesi hepatocellular, ʻike pinepine ʻole - af ozny stomatitis (hoʻoʻino naoh o ku una i ka mucosa), huʻi ake e loaa, a cytolytic a me ka cholestatic hepatitis, me hoʻopono

Mai ka pā ʻīpī: lā ʻo ia - i ʻole ka hana ʻana o ka renal function, me ka hoʻomohala ʻana o ka hana ʻole o ka pilikia ʻole, ka hoʻonui ʻana o ka ʻohi i ka urine, ka hoʻonui ʻana aʻe i ka proteinuria i mua o ka wā, ka nui o ka piʻi ʻana o ka urea a me ka hana ʻana i loko o ke koko.

Mai ka ʻili a me ka membous. ka pinepine - kahi ʻōmole kino ka ʻili, kūwili maoli maculopapular, pinepine pinepine - ka edion angioneurotic, komo hōʻeha (hiki i ka laryngeal edema ke hōʻeha i ke ala ākea a hiki i ka make), ka ʻeha ʻili, ke ʻano hyperhidrosis (hoʻonui nui aʻe), ʻolua - dermatitis exfoliative, urticaria, onycholysis (peeling o ke kui mai nā palupalu palupalu o ka manamana), aneane ʻole - ka hoʻāʻo ʻana ka photosensitivity, ka ʻike pinepine ʻole - ke poʻomanaʻo epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus (cystic rash), ka ulu ʻana o ka psoriasis, dermatitis like-psoriasis, pemphigoid a i ʻole lichenoid exanthema a ena ena theme, alopecia.

Mai ka ʻōnaehana musculoskeletal: ka pinepine - nā ʻōpū o ka naʻau, myalgia, pinepine pinepine - arthralgia.

Mai ka ʻaoʻao o ka metabolism: ka pinepine - hoʻonui i ka paʻakai i ke koko, pinepine - - anorexia, hoʻemi i ka makemake, ʻaʻole ʻike ka ʻike - hoʻemi ʻia ka sodium i loko o ke koko.

Mai ka pānaʻi: frequency ike ole - anaphylactic a anaphylactoid reaksi, hoʻonui titer o nā antinuclear antibodies.

Mai ka hoʻonā endocrine: ka ʻike pinepine ʻole - ADHD secretion syndrome.

Mai ka ʻōpiopio: pinepine - nā maʻi luhi no ka neʻe ʻana i ka erectile, i hoʻokaʻawale i ka libido, ʻaʻole ʻike ka ʻike - gynecomastia.

ʻO nā maʻi maʻamau a me nā pilikia i ka pūnaewele hōʻola: pinepine - ʻehaʻeha, ʻeha, hele pinepine - maʻi, ʻaʻohe - asthenia.

Hoʻohui

ʻO ka hoʻohana ʻana i kekahi membranes ikaika loa me ka pehu i hoʻopiʻi maikaʻi ʻia (ma ka laʻana, inā pono ke polyacrylonitrile membranes) i ka wā hemodialysis a i ʻole hemofiltration, ke hoʻohana ʻana o dextran sulfate i ka wā LDL apheresis hiki ke alakaʻi i ka hopena o ka hopena anaphylactic koʻikoʻi, inā inā pono ke kanaka i kēia mau hana, pono nā ʻano like ʻole. a me hemofiltration) a e hoʻoneʻe i ka mea maʻi i nā lāʻau antihypertensive.

E like me nā mea hoʻonaʻauao ACE ʻē aʻe, ʻo ka hoʻohana pū ʻana o ka ramipril me nā aliskiren a me nā lāʻau aliskiren e loaʻa ana i contraindicated ma ka poʻe maʻi me ka maʻi mellitus a i ʻole ka hōʻemi a i ʻole ka hopena renal (Cl creatinine 2).

Hoʻohana me ka hana me nā mea hoʻohana a ACE inhibitors ka hoʻonui i ka ulu ʻana o ka pilikia o ka renal (me ka nui o ka maʻi), hyperkalemia. ʻO ka hoʻohana like ʻana o ka lāʻau a me ka ARA II i nā mea maʻi me ka nephropathy maʻi maʻi, ua contraindicated a ʻaʻole i ʻōlelo ʻia i nā poʻe maʻi ʻē aʻe.

Hoʻohana ʻia nā hui me ka mālama

ʻO ka hoʻohana like pū me ka paʻakai pālolo, pāpaʻi potassium-sparing (no ka laʻana, amiloride, triamteren, spironolactone), a me nā lāʻau lapaʻau e hoʻonui ai i ka pae o ka pāhana nui o ke kō (a me ka trimethoprim, tacrolimus, cyclosporine, ARA II) hiki ke alakaʻi i ka hoʻonui ʻana i ke kiʻekiʻe o ka paʻakai i ka serum o ke koko (e pili ana i ka trimethoprim, tacrolimus, cyclosporine, ARA II) hiki ke alakaʻi i ka hoʻonui ʻana i ke kiʻekiʻe o ka paʻakai ma ka serum o ke koko. ka mālama pinepine ʻana o ka paʻakai i loko o ka serum koko).

Nā lāʻau antihypertensive (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrates, tricyclic antidepressants, antipsychotics, hypnotics, narcotic analgesics, agents for general and local anesthesia ningkatkeun the antihypertensive effects of ramipri.

ʻO ka Vasopressor sympathomimetics a me nā lāʻau lapaʻau e hoʻoiho i nā hopena antihypertensive (e.g. isoproterenol, dobutamine, dopamine, epinephrine) e hōʻemi i ka hopena antihypertensive o ka ramipril, a me ka nānā pinepine ʻana i ke kahe koko e koi ʻia.

ʻO ka hoʻohana pū ʻana o allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (GCS a me mineralocorticosteroids) a me nā lāʻau lapaʻau ʻē aʻe e hiki ke hoʻopilikia i nā parameter hematological e hoʻonui i ka hōʻeha o ka hoʻomohala ʻana i ka leukopenia. ʻAʻole hoʻohana ʻia ka hoʻohana pinepine ʻana o ramipril me corticosteroids.

Lithium salts alakaʻi i ka hoʻonui i ka serum lithium konsentrate a me ka hoʻonui o cardio- a me neurotoxic hopena o lithium.

Hoʻonui ʻo Ramipril i ka hopena o nā aihue hypoglycemic (insulin, hypoglycemic agents no ka hoʻokūkū waha (sulfonylurea derivatives) a hiki i ka hoʻomohala ʻana o ka hypoglycemia.

Kūʻē ʻo Vildagliptin i ka hoʻonui i ka ulu ʻana o ka angioedema.

ʻO ka hoʻohana mua ʻana o ka ramipril me nā pale mTOR (mammalian target of rapamycin - ka hopena o ka rapamycin i loko o nā selamalia mamases), me ka hoʻohālike me ka temsirolimus, hiki ke alakaʻi i ka nui o ka hoʻomohala ʻana i ka angioedema.

ʻO nā hui e noʻonoʻo

ʻO NSAIDs (e.g. acetylsalicylic acid (ʻoi aku ma mua o 3 g / lā), hiki i nā mea hoʻohui COX2) hiki ke hoʻonāwaliwali i ka hopena antihypertensive o ka ramipril, a me ke kumu no ka hana ʻana i ka maʻi renal, i kekahi manawa ke alakaʻi nei i ka hana ʻole ʻole.

Hiki i ka Heparin ke hoʻonui i ka paʻakai serum.

ʻO Sodium chloride e hoʻonāwaliwali i ka hopena o ka ramipril.

ʻAʻole pono ke ʻoki ʻia ka Ethanol i ka wā o ka mālama ʻana me ka ramipril (ʻo ka hoʻonui ʻia ʻana o ka hopena o ka ethanol ma ka pūnaehana pīhoihoi koʻikoʻi). Hoʻokomo nā Estrogens i ka hopena antihypertensive (mālama i ka wai).

Hoʻololi i nā maʻi no ka hypersensitivity i nā poʻomanaʻo pepeke

Hoʻopau ka ACE inhibitors, ʻo ia hoʻi me ka ramipril, e hoʻonui i ka hoʻomohala ʻana no ka hoʻomohala ʻana i ka anaphylactic a i ʻole ka hopena anaphylactoid i nā poʻomanaʻo pepeke.

Ka hana lāʻau lapaʻau

Ma hope o ka lawelawe waha, ua mālama koke ʻia ka ramipril mai ka ʻeha o ka gastrointestinal: ʻike ʻia ka pihi plasma kiʻekiʻe o ka ramipril i loko o hoʻokahi hola. ʻO ka pae o ke kīnā ʻana e pili ana i ka 56% o ka nui i lawe ʻia a kūʻokoʻa ʻole i ka ʻaina o ka meaʻai. ʻO ka bioavailability o ka metabolite ikaika o ramiprilat ma hope o ke alakaʻi waha ʻana o 2.5 mg a me 5 mg ʻo 45%, ʻoi aku ka piʻi ʻana o nā paona 2 a 4 mau hola ma hope o ka hoʻokō ʻana.

Ka palekana o ka plasma paʻa o ka ramiprilat ma hope o hoʻokahi kaʻe o ka nui o ka nui o ka ramipril ua hele ma ka lā 4 o ka lā.

ʻO ka pilina o ka protein plasma e pili ana i ka 73% no ka ramipril a me 56% no ka ramiprilat.

Ua aneane piha ka Ramipril i ka ramiprilat, diketopiperazinovy ​​ester, diketopiperazinovy ​​acid a me nā glucuronides o ka ramipril a me ramiprilat.

Hoʻopuka o nā metabolites, ʻoiai ma o nā keiki. Nā hana Plasma o ramiprilat e lūlū ai i ka polyphase. Ma muli o kona hiki i ke kūpaʻa saturated i ka ACE a me ka neʻe wikiwiki ʻana mai ka enzyme, hōʻike ʻo ramiprilat i kahi lōʻihi elimination hapa loa i nā hoʻokaʻawale plasma. Ma hope o ka lawe pinepine ʻana i nā inikua o kēlā me kēia lā o ka ramipril, ʻo ka hapalua o nā ola o ka mālama ʻana o ka ramiprilat he 13-17 mau hola no nā inika o 5-10 mg a lōʻihi no nā haʻahaʻa haʻahaʻa o 1.25-2.5 mg. ʻO ka ʻokoʻa ma muli o ka hiki saturable o ka pāʻai e pili ana i ka pilina ramiprilat.

Hoʻokahi i ka wai waha hoʻokahi o 10 mg o ramipril, ʻaʻole i alakaʻi i ka ʻike maka ʻana o ka ramipril a i kāna metabolite hoʻi i ka waiū umauma. Eia naʻe, ʻaʻole i ʻike ʻia ka hopena o nā doses.

I nā mea maʻi me ka ʻōpū o ka renal, ua hōʻemi ʻia ka excretion o ramiprilat, ʻoiai ʻo ka hoʻomaʻamaʻa ʻana o ka hoʻomaʻamaʻa o ka ramiprilat e hoʻopili pololei ʻia me ka cleince creatinine. Ke alakaʻi kēia i ka hoʻonui i ka neʻe o ka plasma ramiprilat, e hoʻohaʻahaʻa me ka mea lohi ma mua o nā kumuhana me ka hana maʻamau maʻamau.

I ka poʻe maʻi me ka maʻi hepatic, ua lohi ka hoʻōla o ka ramipril ma ramiprilat ma muli o ka hana o ka hana hepatic esterases. Hōʻike kēia mau mea maʻi i nā kiʻekiʻe ramipril kiʻekiʻe. Eia nō naʻe, ua like ka pae ʻana o ka plasma ramiprilat i nā mea i nā mea maʻi me ka hana neʻe maʻamau.

ʻO Ramiprilat kahi metabolite ikaika o ramipril, ke kāohi i ka enzyme dipeptidyl carboxypeptidase I (ʻike ʻia hoʻi ʻo ka angiotensin-hoʻohuli o ka enzyme a kininase II). I loko o ka plasma a me ka ʻili, e hoʻopili kēia kaomi i ka hoʻololi ʻana o ka angiotensin I i kahi vasoconstrictor ikaika (vasoconstrictor) angiotensin II, a me ka wāwahi o ka vasodilator bradykinin ikaika. ʻO ka hōʻemi i ka hoʻokumuʻana o ka angiotensin II a ke kāohi nei i ka ʻakiʻi o ka bradykinin i alakaʻi i ka hoʻonui ʻia o nā kīʻaha koko. Mai ka hoʻoulu ʻana o ka angiotensin II i ka hoʻokuʻu ʻana o ka ald testosterone, ua hoʻemi ʻia ka huna ʻana o ka ald testosterone ma muli o ka ramiprilat. ʻO ka pane awelika o monotherapy me kahi ACE inhibitor i loko o nā mea maʻi o ka lāhui Negroid (ka mea maʻamau ma ka heluna kanaka me ka hypertension a me ka haʻahaʻa haʻahaʻa o renin) i haʻahaʻa ka hoʻohālikelike ʻia i nā ʻelele o nā lāhui ʻē aʻe.

Hōʻemi ʻo Ramipril i ka pale o ka vascular kūlā o peripheral (OPSS), ma ka hoʻomaʻamaʻa ʻole i ka hoʻololi ʻana i ke kahe koko o ka renal a me ka huina filtration glomerular.

I ka poʻe maʻi me ka hypertension arterial, lawe aku iā Pyramil® i ka emi o ke kahe koko i ka wā e waiho ana a kū ana, me ka loaʻa ʻole o ka uku uku i ka helu o ka puʻuwai (HR). I ka hapa nui o nā mea maʻi, ʻo ka hopena antihypertensive ma hope o ka lawelawe ʻana o ka waha ma kahi hoʻokahi i kū ʻia ma hope o nā hola 1-2. ʻO ka hopena kiʻekiʻe loa o ka nui pākahi maʻa mau ʻia ma hope o 3-6 mau hola a kū mau ʻo 24 mau hola.

ʻO ka hopena antihypertensive kiʻekiʻe me ka hoʻohana lōʻihi ʻana i ka ramipril ua nānā ʻia ma hope o 3-4 mau pule. Me ka hoʻomehana lōʻihi, hoʻomau ia no 2 mau makahiki.

Hōʻalo ka huhū ʻo ka ramipril ʻaʻole alakaʻi i ka piʻi wikiwiki a me ka nui o ke kahe koko.

Ma kahi o nā lāʻau maʻamau e pili ana i ka diuretics a me ka glycosides cardiac (e like me ka mea i kau ʻia ai e ke kauka), maikaʻi ʻo Pyramil i ka poʻe maʻi me nā puʻuwai naʻau II-IV e like me ka papa hana ʻana o NYHA (New York Cardiology Association).

Hōʻalo ka Pyramil i ka OPSS (hoʻemi i ka poha i ka naʻau), hoʻonui i ka hiki ke o ka ala venous a hoʻēmi i ke kiko piha o ka ventricle hema, kahi mea, e alakaʻi ai i ka hoʻoemi o ka preload ma ka puʻuwai. Ke lawe nei i ka ramipril, he nui ka hoʻonui ʻana i ka hoʻopuka o ka cardiac, hapa hapa ejection a me ka hoʻomaikaʻi ʻana i ka hoʻokau ʻana i ka hoʻohaʻomaʻi ʻana a me kahi hoʻomaikaʻi ʻana i ka index cardiac. Hoʻololi ʻo Ramipril i ka hoʻoulu ʻana iā neuroendocrine.

Ka helu ʻana o nā papa Pyramil

ʻO ka lāʻau lapaʻau e hana ʻia e nā hui mai Polani a me Switzerland. Loaʻa i nā palapala papa.

Palapala 1. ʻO ke kūmole o ka pāpū.

Nā hana hana i ka hana

ʻO ka hopena Pyramil ma muli o ke ʻano ikaika - ramipril. Ua kōkua nō ka:

1. Ke hoʻolōʻihi i ka hōʻailona o ka angiotensin i loko o ke koko a me nā kiko. ʻO kēia hormon kahi i loaʻa ka hopena vasoconstrictor a alakaʻi i kahi hoʻonui hoʻomehana.
2. Hoʻonui ia i ka paleʻana o ka ʻōnaehana hormonal i kuleana no ka hoʻonui ʻana i ke koko i loko o nā kiko a me nā kīʻaha.
3. Hoʻololi i ka hoʻokuʻu o norepinephrine, ka mea e hāʻawi ai i ka piʻi nui o ka puʻuwai puʻuwai. Eia kekahi, ʻo ka waiwai i loaʻa i kahi hopena vasoconstrictor a hōʻemi i ka hopena pressor.
4. Hoʻemi i ka hana aldosterone. Hoʻonui ka mineralocorticoid hormone i ka nui o ke koko kahe a hoʻonui i ke kaumaha.
5. Hoʻonui i ke kūʻē o ka bradykinin i ka pau. Loaʻa ka waiwai i ka hopena antihypertensive (hoʻemi i ke kaomi ʻana).
6. Hoʻopau i ka hoʻonui ʻana o nā kahe koko i loko o nā keiki.
7. Loaʻa iā ia kahi hopena restorative maikaʻi ma ka ventricle hema a me ka ʻōnaehana cardiovascular ma ke ao holoʻokoʻa.
8. Hoʻihoʻi hou i ka kiko myocardial ma o ka hoʻoulu ʻana i ke kāpili ʻana o ka nitric oxide.
9. Hoʻēmi i ka huina pale kūloko peripheral i nā hui a me nā ʻōnaehana organ.
10. Hoʻonui ka hāʻawi i ke koko i nā ʻĀina a me kā lākou ʻōnaehana.
11. Hoʻolālā ka hoʻonui ʻana i nā māka koko.

Nā ʻōkuhi no ka hoʻohana

Loaʻa i kēlā me kēia pūpū Pyramil ʻike ʻike.Ma mua o ka hoʻohana ʻana, pono e familiarize iā ʻoe iho me nā ʻōlelo a ka mea hana hana.

Ma keʻano pilikino, ʻo Pyramil, ka ʻōlelo pono no ka hoʻohana ʻana o ia i kahi papa inoa piha o nā hōʻike, ua pono no ka:

1. Hoʻonui ke koko.
2. Hoʻopau ʻole nā ​​naʻau paʻakikī.
3. Hoʻopokole / maʻiʻai ʻole ka maʻi diabetes.
4. I mea e pale ai i ka hopena o ka hoʻomohala ʻana i ka myocardial infarction a i ʻole nā ​​ʻano maʻi cardiovascular e hiki ai ke hoʻomau i ka make.
5. Me ka maʻi puʻuwai coronary, ʻo ia hoʻi ma hope o ka mālama ʻana i ka maʻi coronary maʻi.
6. Me ka poho.
7. Ke hoʻokaʻa a pani paha i nā moku koko nui.
8. Me ka maʻi paʻakikī i nā ʻano like ʻole.
9. ʻO ka lāʻau lapaʻau ma hope o ka myocardial infarction i ka hopena o kahi hanana nui o ka puʻuwai puʻuwai.

Loaʻa nā papa Pyramil i kahi ʻano biconvex oblong. Ma kekahi ʻaoʻao kahi pīpī - pilikia. Hoʻokomo nā papa i ka pā, e ʻae ʻia nā poloka pōkole ma ka lihilihi. Loaʻa ka Pyramil i loko o kēia mau heluʻi:

1. 2,5 mg Uhi ia me ka hua manu melemele heterogeneous i hoʻokomo ʻia.
2. 5 mg He mālamalama pinkish māmā.
3. 10 mg Hoʻohui ʻia lākou me ka keʻokeʻo a ʻokoʻa paha ke keʻokeʻo a ʻole i kahi splashes.

Hoʻokomo ʻia ka dosage Pyramil i nā hōʻailona no ka hoʻohana ʻana a me ke ahonui i kekahi mea maʻi maʻi.

ʻO nā hoʻopiʻi i hōʻeha ʻia e ke koko kiʻekiʻe

Papa 2. Papaʻana a hoʻoponopono i ka Pyramil.

ʻAʻole hiki ke kāʻili ʻia ka Pyramids a pono holoi ʻia me ka wai nui (ka hapa - 100 ml).

Nā hiʻohiʻona o ka hoʻohana

ʻO nā Pyramids, kahi ʻōlelo e loaʻa ai nā nui o nā palena, pono e hoʻohana me ka akahele. Nui kekahi mau ʻōlelo aʻo, ma waena o lākou:

1. E mālama pono ka hoʻohui ʻana i nā Pyramils ​​me nā diuretics. Manaʻo ʻia e hoʻohaʻahaʻa i ka nui a hoʻopau ʻole paha e lawe i ka lāʻau lapaʻau.
2. ʻO ka hoʻohana mua ʻana o Pyramil e hele mai ma lalo o ka mālamaʻana o kahi loea. ʻO ka manawa nānā ka mea nānā i 8 mau hola.
3. I ka hopena o ka puʻuwai paʻakikī, hiki i ka Pyramylls ke alakaʻi i kahi kahe o ke kahe o ke koko.
4. Me ka hana kiʻekiʻe o ka ʻōnaehana renin-angiotensin, ʻoi aku ia e nānā pono i ke kahe o ke koko a me ka hana hana.
5. Me ka hoʻonui kino kino a i ʻole ka ea kiʻekiʻe, pono pono e pale i ka dehydration. I ka hui pū me Pyramil, hiki iā ia ke hana i ka nui o ka pohō.
6. Ma mua o ka hoʻomaʻamaʻa, ʻaʻole i haʻalele ʻo Pyramil i 24 mau hola ma mua, etc.

Wahi a nā ʻikepili i loaʻa, ʻaʻohe maikaʻi o Pyramil i ka hiki ke hoʻokau i kahi kaʻa. Eia naʻe, ʻo nā hopena ʻokoʻa e like me ka nāwaliwali a me ka luhiluhi hiki ke hopena i ka palekana palekana.

I ka wā hāpai a hānai paha, lawe pio ʻo Pyramil. Hiki i kēia ke alakaʻi i ka hoʻouluʻana o kahi fetal a i ʻole hoʻi e kū mai ana i kahi nui o nā pathologies. Ke hoʻolālā nei i ka wā hāpai, pono ʻoe e hōʻole i ka lawe ʻana i ka lāʻau lapaʻau ma mua.

Palena ʻia nā Pyramids e lawe i:

• Nā poʻe ma lalo o 18
• me ka waha o Quincke,
• kōleʻa / lawelawe kōleʻa
• hypersensitivity i nā māhele o ka lāʻau lapaʻau,
• me nā ʻōmole glucose a i ʻole nā ​​lāʻau lapaʻau ʻole,
• me ka loaʻaʻole o ka hoʻemi nui o ke koko i ka mea maʻi (ma ka nui o nā maʻi hypotensive),
• me ka pīhoihoi cardiov, etc.

Nā kuikili a me nā likeʻina

Nui nā lāʻau lapaʻau e kahuli ai iā Pyramil, hiki ke hoʻokaʻawale i nā hui ʻelua.

1. Palapala like o Pyramil. Meola ua like ka like me ka like o ka mana ma ka mana, akā ʻokoʻa ʻia e ka inoa kālepa.
2. Nā ʻaloglelo Pyramil. ʻO ka hoʻomākaukau e ʻokoʻa i ka hoʻopili ʻana akā ua like nā hopena therapeutic like.

ʻO Pyramil, ka mea hiki ke loaʻa nā ʻieʻōlelo i nā ʻekena i like me ka hoʻohālikelike ʻana me:

ʻO ka Pyramil, nā mea hoʻohālike e loaʻa kahi hopena like, hiki ke hoʻololi ʻia e: