ʻO ka lāʻau Tio-Lipon-Novopharm: kuhikuhi i ka hoʻohana

IKOAAIKAU
Kauoha Kuhina
ka mālama olakino o Ukraine
12.11.13№ 968
Palapala hoʻopaʻa inoa
№UA/13320/01/01

NA ININA
no ka hoʻohana lāʻau ʻana i ka lāʻau

TIO-LIPON - NOVOFARM
(TIO-LIPON-NOVOFARM)

Kūkulu:
mea waiwai: thioctic acid,
ʻO ka 1 ml mau hoʻonā i loaʻa i ka 30 mg o ka thioctic (a-lipoic) acid,
nā mea hoʻohālikelike : meglumine, macrogol 300, wai no ka hoʻonāʻau.
Pākuʻi helu. Nā hopena no ka infusion.
ʻĀpana Pharmacotherapeutic. ʻO ke ʻano hana i ka ʻōnaehana hana a me ka hana kaʻina. PBX code A 16A X 01.
Nā hiʻohiʻona maʻi.
Nā Hōʻike.Kāohi a me ka mālama ʻana i ka polyneuropathy maʻi, nā mākaʻi hoʻoholika, nā maʻi o ka ate (hepatitis, cirrhosis, hoʻonaninani momona), me ka hoʻōkiu (me ka laʻa: nā ʻuhū, ka paʻakai o nā metala kaumaha).
Nā Hoʻohui

ʻO ka hypersensitivity i ka thioctic (α-lipoic) acid a i nā mea'ē aʻe o nā lāʻau lapaʻau,

kūlana e hiki ai ke alakaʻi i ka acidosis lactic,

ka hopena nui o ka paʻi a me ka hana ate.

ʻLoe a me ke kākele.Hoʻohana ʻia ka lāʻau ma ke ʻano o ka infusion drip intravenous ma hope o ka hoʻoinu ʻana i ka hopena o ka 0.9% sodium chloride.
Ua kuhikuhi ʻia ka poʻe ʻōpio i hoʻokahi lā 20 ml o kahi hoʻonā i 250 ml o 0.9% hopena sodium klorida (e like me 600 mg o ka thioctic (a-lipoic) waʻai i kēlā me kēia lā). I nā pilikia koʻikoʻi, hoʻonui ka nui o kēlā me kēia lā i 900-1200 mg / lā.
Ke hoʻokō nei ka hoʻokele hoʻonāʻana - ʻaʻole i wikiwiki ka 50 mg o ka thioctic (a-lipoic) acid (kahi e pili ana i ka 1.7 ml o ka hopena no ka infusion) i kēlā me kēia mau minuke, ʻo ka lōʻihi o ka infusion ma kahi o 30 mau minuke.
Pono e hoʻohana pono ʻia ka hopena o ka infusion no ka mea e hoʻohana ana i nā peke pale pale māmā.
Hoʻopilikia a me ka polyneuropathy maʻi. I ka hoʻomaka ʻana o ka papa hana o ka hoʻomaʻamaʻa ʻia, ʻo Tio-Lipon-Novofarm e mālama ʻia i ka intravenously no 1-2 mau wiki. ʻO ka manawa aʻe, huli lākou i ka mālama mālamaʻana me nā hana ʻai i nā wai thioctic (a-lipoic) no ka hoʻoponopono waha ma kahi maʻi o 600 mg i kēlā me kēia lā.
Maʻi maʻi. Ua kau ʻia ka lāʻau lapaʻau i loko o kahi kaona o 600-1200 mg o ka thioctic (a-lipoic) acid i kēlā me kēia lā, e like me ka paʻakikī o ke kūlana o ka mea maʻi a me nā hōʻike o ka wahi hana o ka hana mahele o ka puʻuwai.
No ka prophylaxis polyneuropathy maʻi maʻi, hoʻōho o ka maʻi, ʻehaʻeha, make ke ʻano o ka lāʻau lapaʻau ʻokoʻa, e pili ana i: makahiki, nui ke kino o ka mea maʻi a me ka pohihihi o ka maʻi. Pono e hoʻomaka i ka hoʻōla me kahi kinapo o 10 ml o kahi hopena i loko o 250 ml o kahi hopena o ka sodium chloride 0.9% (e like me 300 mg o ka thioctic (a-lipoic) waikawa) i kēlā me kēia lā.
Nā Hōʻailona huhū
Mai ka pūnao a me ka hoʻonaninani naʻauao: ka loli a ʻae ʻole paha i ka hoʻāʻo ʻana o ka ʻono, me ka hoʻokele wikiwiki, mau manaʻo i ke kaumaha i loko o ke poʻo, hoʻonui ʻia ke kaila intracranial, ʻāwili wela, hoʻonui ʻia ka puʻukū, ʻoluʻolu ke ea. I kekahi mau pilikia, ma hope o ka hoʻokele intravenous, ʻeha, hōʻeha, nā koi, ka diplopia, a me ka ʻike maka ʻana i ʻike ʻia. I ka nui o nā hihia, hele kūʻokoʻa kēia mau hōʻike āpau.
Mai ke koko koko: aia nā hemorrhages petechial i nā membous mucous, ka ʻili, ka thrombocytopathy, platelet dysfunction, hypocoagulation, hemorrhagic rash (purpura), thrombophlebitis.
Mai ka hāliʻi ʻana o ka huina: i kekahi mau ala, me ka hoʻokele wikiwiki ʻana i ka lāʻau lapaʻau, ʻūhā, ka luaʻi, ka ʻōpū ʻana o ka ʻōpū, ʻeha o ka ʻōpū, ka mea i hala me ke kūʻokoʻa.
Mai ka ʻaoʻao o ka metabolism: ma muli o ka hoʻonui ʻana o ka glucose, e emi paha ke kō o ke kō, e hōʻeha paha i nā hōʻailona o ka hypoglycemia like ʻole, e like me ka dizz, ka hoʻomaʻamaʻa nui, ʻeha, a me ka ʻike maka ʻana.
Mai ka pūnaehana cardiovascular: me ka hoʻonaninani wikiwiki ʻana, hiki ke ʻike ʻia ka ʻeha ma ka ʻāina o ka puʻuwai, ka tachycardia, ka mea ke kaʻawale kūʻokoʻa.
Allergic hopena pili: i ka pūnaewele hōʻeha, ka hopena o ka urticaria a me ka hoʻomohalaʻana o ka eczema, rashes petechial, itching, dermatitis, luhi - kūloko o ka maʻi o ka ʻōnaehana ma mua o ka pīhoihoi anaphylactic.
Nā kūloko kūloko: i kekahi manawa - i ka poʻe maʻi me ka hypersensitivity, hiki ke hōʻā ʻia kahi mea hōʻeha ma kahi wahi maʻi ʻo Tio-Lipon-Novofarm.
Ke keu.Inā loaʻa kahi overdose, nausea, luaʻi, hiki ke hele o ke poʻo. Hiki i ka ʻōmole maʻi toxicological lapaʻau, ma ka hoʻomaka ʻana o ka mālama ʻana, e hōʻeha i ka hoʻomau ʻia a psychopotor a me ka stupor e pili ana i nā hopena e like me nā kuʻi epileptic generalized a me ka hoʻomohala ʻana i ka acidact lactic. ʻO ka wehewehe ʻana i nā hopena kīnā i ka waʻawa nui o ka waika thioctic (a-lipoic), e like me ka hypoglycemia, pīhoihoi, rhabdomyolysis, ʻehaʻīlio a me nā ʻōpū palaualelo, kōlolisis, hōʻaiʻe puʻu intravascular (DIC), pale i ka hana o ka lolo a me nā pilikia o ka ʻōpū (multi-organ failed), i loaʻa.
Therapeutic kaʻina ma ka hihia o ka hoʻohālikelike.
Inā he kānalua o ka hoʻōla nui i ka wai thioctic (a-lipoic), pono koke ke kūkulu ʻia i ka mea maʻi i loko o ka hale hau a hoʻomaka i ka hoʻohana ʻana i nā ʻano lāʻau maʻamau i ʻōlelo ʻia i ka hihia o nā mea make (ʻo ia hoʻi, ka hoʻoulu ʻana i ka luaʻi, ka gastric gastage, ka hoʻohana ʻana o ka uluna i hoʻolaʻa ʻia, etc.). Pono e mālama ʻia nā hopena o ke kuʻuna epileptic maʻamau, lactic acidosis a me nā hopena e hoʻoweliweli hou aku nei i ke ola e like me nā kumu o ke kuʻuna o ka maʻi kūlohelohe a hilinaʻi ma nā hōʻailona. ʻO ka hoʻohana ʻana o ka hemodialysis, hemoperfusion a me nā hana filtration no ka wikiwiki o ka hoʻopau ʻana i ka thioctic (a-lipoic) waikina, ʻaʻole i hōʻoia i ka hōʻoiaʻike pono i ka loaʻa pono.
Hoʻohana i ka wā hāpai a ʻo ka umauma.ʻAʻole hoʻolako ʻia ka hoʻohana ʻana o ka wai thioctic (a-lipoic) i ka wā hapai ma muli o ka loaʻa ʻole o nā ʻike lapaʻau pono. ʻAʻohe ʻikepili ma ka komo ʻana o ka asi thioctic (a-lipoic) i loko o ka waiū waiu, no laila, ʻaʻole pono ia e hoʻohana i ka wā o ka hānai wahine.
E na keiki. ʻAʻole i hāʻawi ʻia ʻo Tio-Lipon-Novofarm i nā keiki a me nā ʻōpio ma muli o ka nele o nāʻike lapaʻau me ka lāʻau lapaʻau ma kēia ʻano maʻi.
Nā hiʻohiʻona o ka noi.I ka mālamaʻana i nā maʻi maʻi me ka maʻi maʻamau, pono nui ka kontrol glycemic. I kekahi mau hihia, pono ia e hoʻoponopono i ka hopena o nā ʻaina hypoglycemic e pale i ka hypoglycemia.
I ka wā e mālama ai i ka polyneuropathy, ma muli o ke kaʻina hana o ka hoʻoulu ʻana, hiki i ka manawa pōkole ke piʻi i ka naʻau, ka hele ʻana me ka paresthesia me ka manaʻo ʻana o nā "nā meaʻalolo manuahi."
ʻO ka inu mau ka mea e pilikia ai ka polyneuropathy a hōʻemi paha i ka hopena o Tio-Lipon-Novopharm. No laila, ua kauoha ʻia e hōʻole i ka inu ʻawaʻawa i ka wā i mālama ʻia ai ka lāʻau lapaʻau. ʻAʻole pono ke kau ʻia ʻo Tio-Lipon-Novofarm me ka hoʻomākaukau ʻana i nā metala (hoʻomākaukau ʻana o ka hao, magnesium, calcium), a me nā huahana pānaʻi me nā kalima.
ʻO ka photosensitive ka lāʻau lapaʻau, no laila pono e hoʻokaʻawale i nā hue mai ka pale i ka manawa mua ma mua o ka hoʻohana.
Pono e pale ʻia nā hoʻonāpili infusion mai ka lā ma o ka uhi ʻana iā lākou me nā ʻāpana pale māmā. Ma lalo o kēia mau kūlana, ua kūpono ka hoʻonā ʻana o ka infusion ua hoʻomākaukau ʻia no ka lōʻihi o 6 mau hola.
ʻO ka hiki ke hoʻokaumaha i ka hopena o ka hopena i ka wā e holo a hana paha me nā hana ʻē aʻe. ʻAʻole hopena ka lāʻau lapaʻau i ka hopena o ka hopena i ka wā o ka hoʻokele a hana pū me nā mīkini ʻē aʻe, akā inā loaʻa nā hōʻailona o nā hopena ʻaoʻao o ka lāʻau (e ʻike i nā "hōʻino hewa"), pono ia e pale i kēia ʻano hana.
Hoʻopili me nā lāʻau lapaʻau a me nā ʻano ʻē aʻe ʻē aʻe. Hoʻokomo ʻia ka wai Thioctic (a-lipoic) me nā mea paʻakikī ionik (no ka laʻana, cisplatin), no laila hiki i ka lāʻau ke hōʻemi i ka hopena o cisplatin.
Me nā molekula gula (no ka laʻana, me ka hopena o ka levulose), ka hua a thioctic (a-lipoic) i hoʻopiha nui ʻia.
Thioctic (a-lipoic) waikawa he mea kila kai, no laila ʻaʻole hiki ke hoʻohana pū ʻia me nā metala (hao, hana hoʻomākaukau magnesium).
Hiki i ka hoʻōho Thioctic (a-lipoic) ke hoʻonui i ka hopena hoʻohaʻahaʻa i ke kō i ka hopena o ka insulin a / a i ʻole nā ​​lāʻau lapaʻau antidiabetic, no laila, i ka hoʻomaka ʻana o ka mālama ʻana me ka wai thioctic (a-lipoic), mākaʻikaʻi mau i nā pae koko koko i hōʻike ʻia. No ka pale ʻana i ka hoʻomaka ʻana o nā hōʻailona o ka hypoglycemia i kekahi mau mea, pono paha e hoʻohaʻahaʻa i ka nui o ka insulin a / a i ʻole nā ​​mea hoʻāno antidiabetic waha.
ʻO nā waiwai Pharmacological.
Lapaʻau lāʻau ʻO ka wai Thioctic (a-lipoic) ka waiwai i hoʻohuihui ʻia i loko o ke kino a ke kau nei i ka mana o kahi coenzyme i ka decarboxylation oxidative o nā waikona a-keto, ka mea nui i ka hana o ka hoʻokō ʻana o ka ikehu i loko o ka pūloli. Kōkua i ka hoʻemi ʻana i ke kō koko a hoʻonui i ka nui o ka glycogen i loko o ka ate. A nele a hoʻonāukiuki metabolism o ka thioctic (a-lipoic) waikawa ma muli o ka hoʻopaleha a i ʻole ka hōʻuluʻulu nui ʻana o kekahi mau huahana decay (no ka laʻana, nā kino ketone) alakaʻi i ka hana hōʻino o ka glycolysis aerobic. Hiki i ka acid Thioctic (a-lipoic) i loko o nā mea hana ikaika ʻelua physiologically (i hana ʻia a hoʻemi ʻia) me nā hopena antitoxic a me antioxidant. Hoʻopilikia ka Thioctic (a-lipoic) i ka metabolism o ka kolamu, e komo i ka hoʻoponopono o ka lipid me ka ʻaila metabolism, hoʻomaikaʻi i ka hana ate (ma muli o hepatoprotective, antioxidant, detoxification effects). Thioctic (a-lipoic) waikawa e like me nā huahana pharmacological i nā huaora B.
Lapaʻau lāʻau Thioctic (a-lipoic) acid iʻa i nā loli nui i ka wā o ka hele mua ma o ka ate. He mea nui ka laha o ka interindividual ma ka loaʻa ʻana o ka ʻōnaehana no ka thioctic (a-lipoic) acid i nānā ʻia. Ua hoʻohālikelike ʻia nā pōpoki ma kahi nui o ke ʻano o ka metabolites. Kūkulu ʻia ke ʻano o nā metabolites ma muli o ka hoʻopihapiha o ke kūleʻa o ka ʻaoʻao a me ke konugation. ʻO ka hapalua ola o ka thioctic (a-lipoic) waikawa mai ka serum koko he 10-20 mau minuke.
Nā hiʻohiʻona lāʻau.
Nā pilikino pilikino a me nā huahana: wīwī ʻeleʻele ʻeleʻele a iʻa kūloko hoʻi paha.
Lauluu. Hoʻohālikelike ka hopena o ka lāʻau thioctic (a-lipoic) me ka kūlohelohe o ka glucose, kū like a Ringer a me nā hāmeʻe e hiki ai ke pane pū me nā pūʻulu SH-a i ʻole nā ​​disulfide.
ʻO ka lā kau. 2 makahiki
Nā kūlana mālama. E kūʻai ma ke kāpili kūlohelohe i kahi mahana ʻaʻole iʻoi aku ma mua o 25 ° C. Mai mālama i nā keiki.
Ma muli o ka manaʻo i ka mālama thioctic (a-lipoic) i ka kukui, pono e mālama i nā kīʻaha ma nā pepa pepa a hiki i ka hoʻohana koke ʻia.
ʻOhiʻohi. 10 ml a 20 mau ml paha i loko o nā hue, 5 mau pahu i loko o nā pahu pale blister, 1 a i ʻole 2 mau lole pale polū i loko o kahi pahu pahu.
Māhele ʻāina. Ma ke kumu.
Mea hana ʻOihana ʻoihana "Novopharm-Biosynthesis".
Kahua. Ukraine, 11700, Zhytomyr wahi, Novograd-Volynsky, st. Zhytomyr, 38.
ʻO ka lā o ka loiloi hope.

Sposib zastosuvannya that dozi

Hoʻohana ʻia ka lāʻau lapaʻau ma ka hulahula o ka hoʻopihapiha kūloko o ka infusion o 0.9% o ka sodium chloride.

ʻO ka Doroslim uane 1 ka manawa no ka doba 20 ml rosin ma ka 250 ml o 0.9% ka waiela waiatini mākaʻi (e like me 600 mg o ka waikawa (a-lipoic acid) ma doba). I loko o ka lāʻau o nā pōpoki nui, e hoʻohui wau i kahi maʻi a hiki i ka 900-1200 mg / dob.

No ka lawelawe lawelawe intravenously ma mua o 50 mg o ka waikole (a-lipoic acid) (ʻo ia kahi 1.7 ml o ka uku no ka infusion) no ka nui o ke kālā, ʻaʻole i emi ka manawa o ka infusion ma mua o 30 mau manawa.

Hoʻomau ʻole nā ​​mākaukau no ka slz rozschin infusion i lawe ʻia ma ke ala, me nā makana lanakila a pau.

Hoʻopilikia a me ka polyneuropathy maʻi. Ma ka cob, ua paʻa ke kaʻina o Tіo-Lіpon-Novofarm ma loko, e hoʻonui ana i 1-2 mau manawa. Pono ke hoʻololi i Nadal i ka pidtrimuyuyu therapy me nā puka lіkarskimi tіoktovoi (a-lіpopovo) waikawa a no ka hoʻokūkū waha ma kahi maʻa o 600 mg no kēlā dob.

Hoʻopau i ka ʻai. Ua hoʻomaopopo ʻia ka lāʻau lapaʻau ma kahi o 600-1200 mg o ka waikawa (a-lipoic acid) no ka hoʻomaʻamaʻa hou ʻia, maʻi nui ka mea maʻi, a aia kekahi mākaʻi a me nā ʻōnaehana o ka lua o ka pūʻulu hana o ka ate.

No ka prophylaxis Hoʻopau i ka polyneuropathy maʻi, hele i ka hoʻohuihui o ka maʻi, nā maʻi o ka puʻuwai, pono ke hoʻoponopono ʻia ke ʻano i ka lāʻau lapaʻau ʻokoʻa, ka ʻano o ke ʻano: ka maʻi, ke kaumaha a me ke kaupaona ʻana o ka pae paʻakikī. E hoʻoponopono i ka pono no ka pāpaʻi cob o 10 ml no 250 ml 0.9% no ka sodium chloride (like me 300 mg o ka waikawa (a-lipoic acid)).

Hōʻike

Mai ka ʻaoʻao o ka ʻōnaehana hoʻonā a a me kēlā ʻelele: Zmina abo smacked smakovyh vidchuttіv, me kahi shyvdkomnogo Ua hōʻike iā vlvdchuttya uuloko i ke poʻo, ka pidvyshennya kūwāwa kūloko kūloko, tide, pidvisthennuyu pitlivist, paʻakikī i ka hanu. I ka ʻohe nui o ka hāʻule ʻana o ka haki, hōʻea ka poʻomanaʻo o ka holo ʻana, ka paʻa ʻana, ka judomis, diplopia, he zora paʻa ʻole. Loaʻa aʻe nā vipadkiv us_kazan_ e hōʻike iā lākou iho.

Mai ka ʻaoʻao o ka ʻōnaehana koko: hemorrhages petechial i nā membrane mucous, ka ʻili, thrombocytopathy, hana i ka hana thrombocyte, hypocoagulation, hemorrhagic visipa (ʻulaʻula), thrombophlebitis i hoʻoiho ʻia.

Mai ka ʻaoʻao ʻaoʻao o ka mauʻu lau: ma okremich vipadka, me kahi lāʻau kūloko o shvidkuyu e lawelawe ana, nausea, bluing, ʻeha, ʻehaʻeha, a me ka yelp i hoʻoneʻe kūʻokoʻa.

3 aoao obmіnu rechovin: ma muli o ka hoʻonui ʻana o ka glucose i hoʻonui ʻia, hiki iā mākou ke hōʻemi i ke kiʻekiʻe o ka pauku o ke kō i loko o ke koko, e hiki ai iā mākou keʻike i nā hōʻailona o nā hōʻailona, ​​e like me ka pani ʻana, ke kiʻekiʻe nui ʻana, hōʻeha a me ke anuanu.

Mai ka ʻaoʻao o ka ʻōnaehana moku: me kahi moho shvidkuyu i hoʻokomo ʻia e hiki ke wikiwiki i ka naʻau dilyantsya, tachikardiya, scho e hele kūʻokoʻa.

Nā Hoʻolaha Alerika: i ka mahina i hala, ua hiki iā mākou ke lanakila i ka pūnāwai a me ka lūlū a me ka makahiki, ka aila, dermatitis, dermatitis, a me nā mea hoʻohālikelike alaka i ka anaphylactic shock.

Ho‘ouna: Inodi - i ka mea maʻi me ka ʻike maoli i ka hapanui o ka manawa, i ʻoi aku ka ikaika o ka Lonu-Novofarm.

Kiʻihi

I ka hihia o ka overdose, e pā ana i ka paluhaluhi, bluing, ʻeha. Hiki i ka ʻike i ka maʻi toxicological koʻikoʻi ma ka cob o ka hopena o ka hopohopo motor psychic, akā pono ka hoʻomaʻamaʻa i ia ʻano lapaʻau, e like me nā mea kuʻunaʻi ākea a me ka hoʻomohala ʻana i ka lactic acidosis. Buli otrimanі Moʻolako ia іntoksikatsіynih naslіdkіv luakini nā māhele tіoktovoї (ka-lіpoєvoї)ʻakika gіpoglіkemіya yak, kŰia, rabdomіolіz, GOSTR necrosis skeletal m'yazіv, gemolіz, disemіnovane vnutrіshnosudinne zgortannya (FEP), prignіchennya funktsії poo mozk i rozladi vnutrіshnіh organіv (multiorganna nedostatnіst )

Hele mai ka Therapeutic ma ka Intoxication.

Inā aia he hopena koʻikoʻi o ka huʻapapa, pono ke mālama ʻia i ka maʻi ma ka hale āpau ma ka hale, a pono pono e kāpae iā lākou e pono ke mālama i kā lākou mālama ola olakino.Pēlā nō, hoʻomohala nui i ka lula, ka lactic acidosis a me ka hoʻohālikelike ʻana a hiki ke hoʻoweliweli ʻia i ke ola, e hana ʻia ma kahi maʻi ʻole a hōʻike ʻia ka hōʻailona koʻikoʻi. ʻO ka hoʻomohala ʻana o ka hemodialysis, hemoperfusion a me nā hana filtration o ka wikiwiki wikiwiki i ka hoʻopuka ʻana i nā waikawa (a-lipoic acid) a me nā dosi ʻaʻole i lawe mai i kahi hana.

Zastosuvannya i ka wā vag_nostnost abo yearvannya umauma

ʻO ka loaʻa ʻana o ka waikawa (a-lipo) waikawa a me ka hola o ka hana ma ke ʻano o ka ʻike ʻole o ka ʻikepili. Tuhua e pili ana i ka komo ʻana o ka waikona (a-lipo) waikiko i ka umauma, pau ka waiu, no laila, ʻaʻole i ʻōlelo ʻia ka paʻakikī o ka umauma i ka makahiki mua.

ʻAʻole kōkua ʻo Tio-Lіpon-Novofarm e hānau i nā keiki ma o ka loaʻa ʻana o nā hoʻokolohua lapaʻau no ka hoʻomākaukau ʻana i kahi ʻano o nā maʻi.

ʻO nā hiʻohiʻona zastosuvannya

I ka loaʻa ʻana o nā maʻi maʻi ma ka maʻi chukrovia maʻi, ʻo ka nui o ka mālama ʻana i ka glikemії. I ka pau o nā mea pōʻino, pono ʻoe e hoʻoponopono wikiwiki i nā hewa o nā mea hōʻemi haʻahaʻa i ke kumu o ka loaʻa o ka gogoglіkemії.

No ka hapalua hola o ka polieneuropathy, nui nā hana hou i ka hoʻoponopono hou ʻana, kahi lihi ʻoi aku ka nui, a laila makemake wau e nānā pono i kekahi mau manawa me ka "goosebump".

ʻO ka inuʻana i ka waiʻona wai ka mea i ulu ai ka polyneuropathy a hiki ke hōʻemi i ka make o Tio-Lippon-Novopharm. Ke kauoha ʻia nei e mālama i ka inu ʻawa a inu ʻawa i ka inu ʻawaʻawa. ʻAʻole hōʻike koke ka inoa o Tio-Lіpon-Novofarm me nā lāʻau lapaʻau, pono ia e lawe i ka metala (hoʻomākaukau ʻana zaliza, magnesium, calcium), akā pū kekahi me nā huahana wai, pono e lawe i ka calcium.

Hoʻomaʻamaʻa ʻia ka lāʻau lapaʻau, ʻo ia ka ipu o ka hoʻopihapiha no ka hoʻopihapiha ʻana i ka tilka me ka kali ʻole i mua o nā mea lanakila

Інфузійні розчини slіd e hopu i nā ʻano hiamoe a pau, me ke kōkua o nā ʻāpana pilikino. I kēia mau noʻonoʻo ʻana o ka hoʻomākaukau, ua nalowale ka infusion rozchin i kahi lā aʻe i ʻoi aku he 6 mau makahiki.

Vz зmodiya me іnshimi lіkarskimi zaboba e іnshі vidi vzakmodiiy

ʻO Tioktova (a-lіpoєva) waikika ka mea hou a me nā mea i hoʻopili wale ai me ka pa alima (no ka laʻana, me cisplatin), no laila hiki i ka lāʻau ke hoʻohaʻahaʻa i ka hopena o cisplatin.

Me nā molekula o ka kukama (no ka laʻana, me ke kumu o ka levulose) th_oktova (a-lіpoєva) waikō e hoʻomālamalama au i ka spoluki pūlū koʻikoʻi.

ʻO Tioktova (a-lіpoпva) ka waila he chelator kila, no laila, ʻaʻole hiki ke hoʻokaʻawale i nā metala i hoʻokahi manawa (hoʻomākaukau zaliza, magnіyu).

Hiki ke hāʻawi i ka waikole Tioktova (a-lipo) i kahi hopena o ka insulin a me / a me nā haʻahaʻa protibiotic haʻahaʻa loa, ka nui o ka cob o i-uric acid (a-lipo) nānā mau, hōʻike. No ka loaʻa mai o nā hōʻailona o ka hypoglycaemia ma nā vipads okimich, pono ʻoe e loaʻa i kahi haʻahaʻa o ka waha a me / a i ʻole antidiabetic waha.

ʻO nā luna lāʻau lapaʻau

Lapaʻau lāʻau. ʻO ka waika Tioktova (a-lіpoєva) ka waikawa ов cystic acid, ka mea i hoʻokaʻawale ʻia i loko o ke kino a me ka hana o ka coenzyme i ka decarboxylation oxidative o nā waikawa a-keto, a he mea nui ka hana o ka coenzyme i ke kaʻina hana o ka ikehu i ka mea hoʻomanawanui. ʻO ka pīpī i ka hoʻololi o ke kō i loko o ke koko a me ka hoʻonui ʻana i ke kōpaʻa koko i loko o ke akea. Ma kahi hiki ʻole ke hoʻohaʻahaʻa pono i ka nui o ka waikawa (a-lipo) waikawa a me nā mea momona laʻa a me ka hōʻiliʻili nui ʻana o kekahi mau huahana i ka hoʻoili (no ka laʻana, he ʻano kupa ketone) alakaʻi i ka luku ʻana o ka glycol aerobic. Hiki ke loaʻa ka wai momona Tіoktova (a-lіpoєva) i loko o nā papa hana ʻelua physiologically (ʻo oxidized a renewed), kahi e kapa ʻia nei ʻo antitoxic a me antioxidant. Hoʻokomo ka Tioktova (kahi a-lipoic) i ka hoʻololi ʻana o ka cholesterol, e mālama i ka lipid maʻamau a me ka metabolism, ke hana polyphenol o ka ate (hepatoprotective, antioxidant, hana antioxidant). Ua kūpono kēia waikū Tіoktova (a-lіpoєva) waikawa no ka mana lāʻau lapaʻau a hiki i ka hui V.

Lapaʻau lāʻau. ʻIke ʻia ka Tіoktova (kahi--lіpoєva) waiwai koʻikoʻi i ka wā o ke kaina mua ma o ka umu. E hoʻolōʻihi i ka mea nui o ka nui o ka awelika ma ka loaʻa ʻana o ka waikawa (a-lipo) waikawa. Nui loa ia i ka loaʻa ʻana o ka nirkas ma viglyad metabolites. Apono i ka metabolism i loko o ka hopena o ka hopena o ka oxidation o ka lancing lateral a me ka conjugate. ʻO ka manawa kahi o ka hoʻoneʻe (a-lipo) waikawa a me ke kō kōle koko e lilo i 10-20 hvilin.

Umovi zberigannya

Zberalala i loko o ka hoʻopiha mua ma ka mahana o 25 ° С. ʻAʻole hiki iā Zberalala ke hiki i nā keiki.

I zvіyazku zim, scho tіoktova (a-lіpoєva) waikiki i kū i ka dііv svіtla, nā kīʻaha іlіd zberіgati ma nā kālele kālele i luna ʻole i kālai ʻole ʻia.

10 ml a 20 ml paha kūwaha, 5 mau pānaʻi i kēlā me kēia ʻanā, a me nā pahu i haki ʻia, 1 pahu kāhea.

E hoʻokuʻu i ke ʻano a me ka ʻano

Nā palapala kiko o ka hoʻokuʻu a thiolipone:

• nā pihi i uhi ʻia nā kiʻi: he melemele a he melemele paha ka pōpō me ke aniani ʻōmaʻomaʻo, ʻālamalama ke kumu kala, he 300 mg kēlā me kēia pōkā, biconvex, 600 mg kēlā me kahi pāholo, ma kahi ʻaoʻao me kahi kīwī (ma kahi kāwele kāleka 1 ʻeleʻele mau kīʻaha, i he pahu o 30 a 50 papa paha, i loko o kahi ʻāpana pepa no nā kākela o 1-3, i kahi pā 10 o nā pcs.)
• hoʻokūkū i ka hoʻomākaukau ʻana o kahi hopena no ka hoʻokō intravenous: i ka ʻalohi, ka uhi ʻono-melemele (i loko o kahi ʻeke pepa o 10 ampoules a i ʻole nā ​​ʻāpana lā 1-2 o ka 5 mau ampoules).

Ka hoʻohālikelike ʻana o 1 papa papa o ka thiolipone:

• mea ikaika: thioctic acid (lipoic acid) - 300 a 600 mg paha,
• ʻO nā mea kōkua (300/600 mg): calcium stearate monohala - 5 / 8.2 mg, lactose monohala (paʻū waiʻa) - 91.5 / 80.6 mg, sodium stearyl fumarate - 5 / 8.2 mg, hypromellose - 5 / 8.2 mg, sodium carboxymethyl starch (primogel) - 17,5 / 28.7 mg, colloidal silicon dioxide - 7.5 / 12.3 mg, cellulose microcrystalline - 50/41 mg, magnesium stearate - 5 / 8.2 mg hoʻolaʻa mololiium - 13.5 / 24.6 mg,
• ʻāhiu (300/600 mg): Opadry II (hypromellose - 3.4 / 4.1 mg, macrogol 4000 –1.1 / 1.3 mg, monoholate lactose - 3 / 3.6 mg) - 10/12 mg, nā pua puaʻa - 2.5 / 3 mg, titanium dioxide (E 171) - 2 / 2.4 mg, alumini varnish e pili ana i ka quinoline melemele (E 104) - 0.4 / 0.48 mg, alumini varnish e pili ana i ka indigo carmine ( E 132) - 0,05 / 0,06 mg, alumini varnish e pili ana i ka lumana melemele laumula (E 110) - 0,05 / 0.06 mg.

ʻO ka hoʻonohonoho ʻana o 1 ml Tiolipon:

• mea ikaika: thioctic acid (lipoic acid) - 30 mg,
• nā mea kōkua: propylene glycol, ethylene diamine, wai no ka hoʻonāukiuki.

Lapaʻau lāʻau

ʻO ka waikawa Thioctic (alpha-lipoic acid) kahi antogenxidant endogenous (hoʻopili i nā radical manuahi), i hoʻokumu ʻia i loko o ke kino i ka wā o ka decarboxylation oxidative o nā waika alpha-keto.

He maʻi hypolipidemic, hepatoprotective, hypoglycemic a me hypocholesterolemic hopena.

Me he mea lālani ʻo nā pākuʻi multienzyme mitochondrial, komo i loko o ka decarboxylation oxidative o nā alpha-keto acid a me ka pyruvic acid. Hāʻawi ia i ka hoʻonui ʻana o ka glycogen i loko o ka palupalu a me ka hoʻemi ʻana o ke kao o ka glucose i loko o ke koko, a me ka lanakila ʻana nō hoʻi i ke kūleʻa ʻana i ka insulin.

Ma ke ʻano o ka hana biochemical, kokoke ka lipoic acid i nā huaora B. Pono ia no ka pālea a me ka lipid metabolism, hoʻoulu i ka hana metabolism, hoʻomaikaʻi i ka hana ate a me nā neʻe trophic.

Lapaʻau lāʻau

• hoʻokō paʻa: C_max (ka uha nui) ʻo 0.025-0038 mg / ml, ka manawa e hiki ai ke lōʻihi, ʻo ia ka 10-11 mau minuke, ʻo ka wahi ma lalo o ka pihi ʻike-ana i ka manawa o ka 0.005 mg / ml,
• hoʻopuka waha: ka lipoic acid ka piha a paʻa koke mai ka gastrointestinal tract, ʻoiai e hoʻemi ana ka ʻalo ʻana mai ka lawe ʻana i ka lāʻau me ka meaʻai. ʻO ka manawa e hiki ai ke lōʻihi loa o ka piʻi ʻana mai 40 a 60 mau minuke.

ʻO Bioavailability ʻo 30%. He ʻano hopena mua ka Lipoic acid ma loko o ka puʻu. A ma muli o ke kaila oxidation kaulike a me ka conjugation, loaʻa ke hoʻokumu i nā metabolites.

ʻO ka nui o ka hoʻolaha e like me 450 ml / kg. Hoʻopiliʻia nā Thioctic acid a me nā metabolites i nā keiki (80-90%). Hōʻea ka hapalua-ola-20 a 20 mau minuke. ʻO ka huakaʻi holoʻokoʻa plasma he 10-15 ml / min.

Nā Hoʻohui

• lactase kakali, lactose intolerance, glucose-galactose malabsorption (nā papa),
• hapai a me lactation,
• makahiki i 18 makahiki
• ka molaki ʻana o kēlā me kēia mea o ka lāʻau.

Kuhi (thiolipone i kuhikuhi ʻia ma lalo o ka mākaʻi o kekahi kauka):

• ʻāhiʻi mellitus (nā papa),
• ka waiʻona maʻi (papa).

Nā ʻōkuhi no ka hoʻohana ʻana iā Thiolipone: ka ʻaea a me ka helu ʻana

Lawe ʻia ʻo Thiolipone me ka liʻiliʻi me ka liʻiliʻi o ka wai, me ka ʻoka ʻole.

Lawe ʻia nā papa he hoʻokahi i ka lā ma kahi ʻōpū ʻole, ma kahi o 30 mau minuke ma mua o ka ʻai mua.

ʻO 600 mg ka lā maʻamau e 600 mg.

ʻO ka liʻiliʻi loa o ka papa he 3 mau mahina (ma kekahi mau manawa, makemake ʻia ke ʻano lōʻihi.)

Hoʻolaha kaʻi ʻana

E lawelawe ʻia ʻo Thiolipon. I ka wā ma mua, pono e hoʻokaʻawale ʻia ka ʻike i loko o ka hopena isotonic sodium chloride.

I nā hōʻike koʻikoʻi o ka maʻi, e lawelawe ʻia ʻo 300-600 mg hoʻokahi manawa i ka lā i ke ʻano o ka infra infip infusion (no nā minuke 50).

Hoʻololi ʻia ka lōʻihi o ka hoʻohana ʻana mai 2 a 4 mau pule. Ma hope o ka pau ʻana o kēia manawa, neʻe ka mea maʻi i ka waha waha o ka lāʻau (300-600 mg i kēlā me kēia lā) me kahi papa no ka liʻiliʻi o 3 mau mahina.

Nā hopena hopena

Hiki i nā hopena ʻino: hypoglycemia (pili i ka hoʻoliʻi ʻana i ka glucose) maikaʻi, nā hopena alereno (e komo ana i ka urticaria, ka pīhoihoi anaphylactic).

He mau koi ʻē aʻe:

• nā poli: dyspepsia, me ka ʻōpū, ka luaʻi, ke kaumaha,
• ʻoi aku ka hoʻonāukiō: kaʻai ʻole - ka ʻāhewa, diplopia, hemorrhages pinpoint i ka ʻāʻī a me nā membula mucous, thrombocytopathy, hemorrhagic rash, thrombophlebitis, me ka wikiwiki wikiwiki o ka hopena - i hoʻonui ʻia ke keʻena intracranial (ke ʻano o ke kaumaha ʻana i ke poʻo), paʻakikī ka hanu (ʻaʻole ʻo ʻia ke ʻano hoʻohui ʻia).

Nā ʻōlelo kikoʻī

ʻO nā mea maʻi me ka maʻi maʻi e koi mau ana ka mālama ʻana i ke kaohi o ke koko, ʻoi aku hoʻi i nā hoʻomaka mua o ka lāʻau. I kekahi mau hihia, hiki i ke kauka ke hōʻemi i ka nui o ka lāʻau lapaʻau insulin / waha hypoglycemic e pale i ka hypoglycemia.

I ka wā mālama, pono ʻoe e pale i ka inu ʻona, ʻo ka mea i ka manawa like me ka nāwaliwali o ka hopena therapeutic o ka thioctic acid.

Pono e hoʻokaʻawale ʻia nā Ampoule me ka neʻe mai ka pale hoʻokaʻa ma mua o ka hoʻohana ʻana, ka mea i pili me ka photosensitivity o ka mea ikaika. I ka wā o ka infusion, ua haʻi ʻia e pale i ka wai o ka hopena mai ka mālamalama (hiki i ka hoʻohana ʻana i nā peke pale pale pale, alumini foil). ʻO ka lōʻihi loa o ka mālama ʻana i ka hopena i hoʻomākaukau ʻia he 6 mau hola.

Hoʻohui nūhou

• cisplatin: kahi kuhi o kona hana pono (cisplatin i lawe ʻia ma hope o kaʻaina awakea a i ʻole i ke ahiahi),
• Hoʻomoe a mika / hao, a me nā huahana waiʻai no ka calcium ma loko o ia mau mea: no ka mea, ua hui ka thioctic acid me nā mea paʻakikī ionic, ʻo ia ka manawa i ʻōlelo ʻia no ka hoʻohana ʻana i kēia mau lāʻau i ke ahiahi a i ke ahiahi paha.
• waiʻona (ethanol): kahi hōʻemi o ka hana therapeutic o Thiolipon,
• Nā hana insulin a me nā waha hypoglycemic waha: hoʻonui i kā lākou hana.

Ke ʻano o ka noi

Ka lāʻau Thiolipone manaʻo ia e hoʻomākaukau no ka hoʻonā ʻana no ka infusion ma hope o ka hoʻoilina mua ʻana ma ka hopena isotonic sodium chloride.
I nā hopena hoʻopiʻi o ka maʻi diabetes a i ʻole mea inu ʻawaʻawa, 300-600 mg 1 manawa i kēlā me kēia lā e lawelawe ʻia ʻo ka infusion drip infip. Pono e hoʻokomo ʻia ka infusion intusion i loko o 50 mau minuke.
Pono ʻia ka lāʻau lapaʻau no ka hoʻohana ʻana ma loko o nā hebedoma 2-4.
A laila hiki iā ʻoe ke hoʻomau i ka lawe ʻana i ka lāʻau i loko ma kahi o 300-600 mg i ka lā. ʻO ka palena liʻiliʻi o ka mālamaʻana me nā papa he 3 mau mahina.

Hoʻopili pū me nā lāʻau ʻē aʻe

Alpha - lipoic acid (ma ke ʻano he hopena no ka infusion) e hōʻemi i ka hopena o cisplatin. Me ka hoʻohana like ʻana me ka insulin a me nā mea hoʻohana ʻē aʻe hypoglycemic agents, ua ʻike ʻia kahi hoʻonui o ka hopena hypoglycemic. Hoʻopau paʻakikī ka hoʻohuihui Alpha-lipoic paʻakikī i nā pūpū paʻakikī me ka mololi gula (no ka laʻana, he hopena o ka levulose), no laila, ʻaʻole hoʻohālikelike ʻia me ka hopena glucose, hoʻonā a Ringer, a me nā pūhui (me kā lākou nā hana a lākou) e kū pū me nā pūʻulu disulfide a me SH. . ^ E Ha yM.

ʻĀpana Pharmacological

ʻO nā mea e hoʻopilikia i ka ʻōnaehana hana a me ka hana metabolic. Waihona ATS 16A X 01.

Kāohi a me ka mālama ʻana i ka polyneuropathy maʻi, nā wai hoʻōlaʻai, nā maʻi o ka ate (hepatitis, cirrhosis, hoʻēmi momona), me ka hoʻōla (me ka laʻi, nā hāmama, ka paʻakai o nā metala kaumaha).

Nā hopena maikaʻiʻole

Mai ka pūnao a me ka hoʻonaninani naʻauao: ka loli a ʻae ʻole paha i ka hoʻowalewale o ka ʻono, me ka hoʻokele wikiwiki, me ka manaʻo i ke kaumaha i ke poʻo, hoʻonui i ke kaila intracranial, ʻāwili wela, hoʻonui ʻia ka puʻu ʻana, hiki i ka pōkole o ka hanu. I kekahi mau pilikia, ma hope o ka hoʻokele ʻana, a me ka hōʻeha, ka ʻeha, ka hoʻopaʻapaʻa, ka diplopia, a me ka nānā ʻana i ka ʻike. I ka nui o nā hihia, hele kūʻokoʻa kēia mau hōʻike āpau.

Kekahi koko: aia nā hemorrhages petechial i nā membous mucous, ka ʻili, ka thrombocytopathy, ka hana o ke kīʻaha lēwa, hypocoagulation, hemorrhagic rash (purpura), thrombophlebitis.

Mai ka hāliʻi ʻana o ka huina: i kekahi mau ala, me ka hoʻokele wikiwiki o ka lāʻau, nausea, ka luaʻi, ka ʻeha ʻana o ka ʻōpū, ka ʻōpū o ka ʻōpū, kahi i hele kūʻokoʻa ʻole ʻia.

3 ʻaoʻao o ka metabolism: ma muli o ka hoʻomaikaʻi ʻia o ka glucose ka nui, e emi ka nui o ke kō o ke koko, e hōʻeha paha i nā hōʻailona o ka hypoglycemia like ʻole, e like me ka leʻalā, kahe loa, hōʻehaʻeha, a me ke kuhihewa hoʻi.

Mai ka pūnaehana cardiovascular: me ka hoʻokele wikiwiki, ʻeha ma ka ʻāina o ka puʻuwai, e loaʻa paha ka tachycardia, hele kūʻokoʻa.

Allergic hopena pili : i ka pūnaewele hōʻeha, ka hopena o ka urticaria a me ka hoʻomohalaʻana o ka eczema, rash petechial, itching, dermatitis, kahi liʻiliʻi - nā maʻi kūloko o ka systemic a ma mua o ka pīhoihoi anaphylactic.

Nā kūloko kūloko: i kekahi manawa - nā maʻi me ka hypersensitivity ma ka wahi i hoʻolaha ʻia ʻo Tio-Lipon-Novofarm e ʻike i kahi ʻano wela.

Ke keu

Inā loaʻa kahi overdose, nausea, luaʻi, hiki ke hele o ke poʻo. ʻO ka ʻōlelo a ka maʻi toxicological lapaʻau ma ka hoʻomaka ʻana o ka hana e hōʻeha i ka psychomotor agitation a i ʻole eclipse a pili pū me nā hopena e like me nā mea kuʻuna ākea a me ka hoʻomohala ʻana i ka acidact lactic.

Therapeutic kaʻina ma ka hihia o ka hoʻohālikelike.

Inā he kānalua o ka hoʻōla nui i ka wai thioctic (a-lipoic), pono koke ke kūkulu ʻia i ka mea maʻi i loko o ka hale hau a hoʻomaka i ka hana ʻana i nā ʻōnaehana maʻamau i kuhikuhi ʻia i ka hihia o ka ʻawaʻawa (ʻo ia hoʻi, ka hoʻoulu ʻana o ka luaʻi, ka gastric lavage, intake o ka charcoal activated, etc.). Pono e mālama ʻia nā hopena o ke kuʻuna epileptic maʻamau, lactic acidosis a me nā hopena e hoʻoweliweli hou aku nei i ke ola e like me nā kumu o ke kuʻuna o ka maʻi kūlohelohe a hilinaʻi ma nā hōʻailona. ʻO ka hoʻohana ʻana o ka hemodialysis, hemoperfusion a me nā hana filtration no ka wikiwiki o ka haʻalele ʻana i ka thioctic (a-lipoic) waikina, ʻaʻole i lawe mai i nā pōmaikaʻi kūʻiʻo.

Hoʻohana i ka wā hāpai a me ka lactation

ʻAʻole hoʻolako ʻia ka hoʻohana ʻana o ka wai thioctic (a-lipoic) i ka wā hapai ma muli o ka loaʻa ʻole o nā ʻike lapaʻau pono. ʻAʻohe ʻikepili ma ka komo ʻana o ka asi thioctic (a-lipoic) i loko o ka waiū waiu, no laila, ʻaʻole pono ia e hoʻohana i ka wā o ka hānai wahine.

ʻAʻole ʻōlelo ʻia ʻo Tio-lipon-Novofarm no nā keiki a me nā ʻōpio ma muli o ka nele o nāʻike lapaʻau me ka lāʻau lapaʻau ma kēia ʻano maʻi.

Nā hiʻohiʻona noi

I ka mālamaʻana i nā maʻi maʻi me ka maʻi maʻamau, pono nui ka kontrol glycemic. I kekahi mau hihia, pono ia e hoʻoponopono i ke ʻano o nā ʻaihue hypoglycemic e pale i ka hypoglycemia.

I ka wā e mālama ai i ka polyneuropathy, ma muli o ke kaʻina hana o ka hoʻoulu ʻana, hiki i ka manawa pōkole ke hōʻoki ʻia i ka naʻau, ka hele ʻana me ka paresthesia me ka manaʻo ʻana o nā "koloi manuahi."

ʻO ka inu mauʻana i ka waiʻona he hopena pilikia no ka polyneuropathy a hiki ke hōʻemi i ka hopena o Tio-lipon-Novopharm.

Photoensitive ka lāʻau, no laila e hoʻokaʻawale ʻia nā kīkī mai ka pēpē ma mua wale nō o ka hoʻohana ʻana.

Pono e pale ʻia nā hoʻonāpili infusion mai ka lā ma o ka uhi ʻana iā lākou me nā ʻāpana pale māmā. Ma lalo o kēia mau kūlana, ua kū mau ka hoʻonā infusion i hoʻomākaukau ʻia no ka lōʻihi o 6:00.

ʻO nā waiwai Pharmacological

Lapaʻau lāʻau Thioctic (a-lipoic) waikona he mea ia i hoʻohuʻāʻa ʻia i loko o ke kino a ke hoʻokō nei i ka mea o ka coenzyme i ka decarboxylation oxidative o nā a-keto acid, ke hana i ka hana koʻikoʻi i ke kaʻina hana o ka ikehu i loko o ka pūloli.

Lapaʻau lāʻau Thioctic (a-lipoic) acid iʻa i nā loli nui i ka wā o ka hele mua ma o ka ate. He mea nui ka laha o ka interindividual ma ka loaʻa ʻana o ka ʻōnaehana no ka thioctic (a-lipoic) acid i nānā ʻia. Ua hoʻohālikelike ʻia nā pōpoki ma kahi nui o ke ʻano o ka metabolites. ʻO ke ʻano o nā metabolites ka hopena mai ka ʻaoʻao kaulahao oxidation a me ka conjugation. ʻO ka hapalua ola o ka thioctic (a-lipoic) waikawa mai ka serum koko he 10-20 mau minuke.

Nā kūlana mālama

E mālama ma ke kāpili kumu i ka mahana ma mua o 25 ° C. E mālama pono ʻole i nā keiki.

Ma muli o ka manaʻo o ke aniani thioctic (a-lipoic) i ka hana o ka kukui, pono e mālama i nā kīʻaha ma loko o ka pepa kalepa a hiki i ka hoʻohana koke ʻia.

10 ml a he 20 ml paha i loko o nā hue, 5 mau pahu i loko o nā pahu pale blister, 1 a i ʻole 2 mau mea hoʻonā i loko o kahi kīpē o ka pepa.