Ingabe kufanele sazi kahle ngemithi yokulwa nokugabha?

Cishe uzizwa unesicanucanu futhi uhlanza ngezinye izikhathi, akunjalo? Akumnandi neze. Ngakho-ke namuhla sizokhuluma ngohlobo lomuthi olungasiza ekulawuleni nasekumiseni lezi zinto njengokucanucanu nokuhlanza . Lezi yizinto esizibiza ngokuthi imithi yokulwa nokugabha . Ake sibone ukuthi ziyini lezi, zisebenza kanjani, nokuthi zisetshenziswa nini.

Ziyini lezi zidakamizwa zokulwa nokugabha?

Kalula nje, "imithi yokulwa nokugabha" yimithi enikezwa ukuvimbela isicanucanu nokuhlanza, noma ukwelapha uma kwenzeka. "I-Anti-`` isho "ngokumelene." Igama elithi "-emetic" livela egameni elithi "emesis". Kwezokwelapha, igama elithi "(emesis)`` liphinde lisetshenziswe ekuhlanzeni. Ngakho-ke, le yimithi enikezwa ukuvimbela ukuhlanza.

Kunezinhlobo eziningana zemithi ethi "Antiemetic", okuyizinhlobo ezahlukene zemithi ethi "amakilasi emithi". Eminye yayo ungayithola ekhemisi ngaphandle kwemithi kadokotela (ebizwa ngokuthi "imithi ethengiswa ngaphandle kwemithi kadokotela" noma ethi "OTC"). Kodwa eminye yayo ingathathwa kuphela ngemithi kadokotela (imithi kadokotela ). Njengoba kunezimbangela eziningi zesicanucanu nokuhlanza, kunemithi ethi "Antiemetic" ethile efanele imbangela ngayinye.

Ngidinga nini umuthi wokulwa nokuhlanza?

Manje cishe ucabanga ukuthi, 'Pho ngingawudinga nini umuthi onjengalona?'

Ukuhlanza empeleni ngezinye izikhathi kuyindlela yokuzivikela emzimbeni wethu. Cabanga ngakho, uma udla ukudla okonakele, noma uma unesifo sesisu (umkhuhlane wesisu), kungcono ukuhlanza bese ususa ubuthi emzimbeni wakho.

Kodwa-ke, uma ukuhlanza kukhulu noma kwenzeka njalo, kungaholela ezinkingeni ezinkulu zempilo. Isibonelo:

• Ukuphuka kwamathambo kungenzeka, ikakhulukazi kwasebekhulile.
• Ukuphelelwa amanzi emzimbeni kusho ukulahlekelwa amanzi emzimbeni.
• Ukuqhuma komphimbo, okwaziwa nangokuthi i-Boerhaave's syndrome.
• Ukulahlekelwa yisifiso sokudla .
• Ukushoda kokudla okunempilo (`Ukungondleki kahle`).
• Izinguquko zengqondo.
• I-enamel yamazinyo iyaguga.
• Amanxeba okuhlinzwa angavulwa kabusha (`Ukuvulwa kabusha kwamanxeba okuhlinzwa`).

Ngenxa yezinto ezinjengalezi, odokotela ngezinye izikhathi banikeza lo muthi "wokulwa nokugabha" ukuze kuvinjelwe ukuhlanza noma kumiswe ukuhlanza osekuqalile kakade.

Usizo ngesicanucanu esiqhubekayo nokuhlanza

Uma unesicanucanu esikhulu noma eside kanye nokuhlanza, udokotela wakho angase akunike umuthi "wokulwa nokugabha". Ake sibheke ezinye izibonelo.

• Isicanucanu nokuhlanza okubangelwa imisebe kanye ne-chemotherapy: Isicanucanu kanye/noma ukuhlanza kuyimiphumela emibi evamile ye-chemotherapy. Ukwelashwa ngemisebe ebuchosheni, emathunjini, noma esibindini nakho kungabangela le miphumela emibi. Ngenxa yalesi sizathu, odokotela batusa ukuthi uthathe umuthi wokulwa nokugabha ngenkathi uphathwa i-chemotherapy noma i-radiation therapy. Lokhu kungenxa yokuthi isicanucanu nokuhlanza ngokweqile kungaba yingozi kakhulu kumuntu onomdlavuza.
• Isicanucanu nokuhlanza ngesikhathi sokukhulelwa (okwaziwa nangokuthi 'ukucasuka kwasekuseni'): Abanye odokotela batusa imithi yokulwa nokugabha ethengiswa ngaphandle kwemithi kadokotela. Ngokufanayo, ngemithi 'ye-hyperemesis gravidarum', odokotela batusa imithi yokulwa nokugabha ethengiswa ngaphandle kwemithi kadokotela noma imithi 'ye-antiemetics' kadokotela.

Into ebaluleke kakhulu ukukhuluma nodokotela wakho mayelana nokuthi uzoyisebenzisa nini futhi kanjani le mithi `(Antiemetic)`. Ngezinye izikhathi, ikakhulukazi ezimweni ezifana ne-`(CINV)`, kungadingeka usebenzise `(Antiemetic)` engaphezu kweyodwa. Uma unesicanucanu nokuhlanza ngesikhathi sokukhulelwa , kufanele nakanjani ukhulume nodokotela ngaphambi kokuthatha noma yimuphi umuthi ekhemisi.

Ikhambi lokucanuzela nokuhlanza okungazelelwe

Ngezinye izikhathi, lapho isicanucanu nokuhlanza cishe kuzokwenzeka, odokotela banikeza lo muthi "wokulwa nokugabha" ukuze bawuvimbele. Cabanga ngale ndlela.

Imithi eminingi, njengemithi yokubulala izinzwa (esetshenziswa ekubulaleni izinzwa) kanye nama-opioid , ingabangela isicanucanu nokuhlanza njengomphumela ongemuhle. Odokotela basebenzisa le mithi ezintweni ezifana nokuhlinzwa. Ngakho-ke, ukuze bavimbele isicanucanu nokuhlanza ngemva kokuhlinzwa (isicanucanu nokuhlanza ngemva kokuhlinzwa - i-PONV), bazokunikeza umuthi wokulwa nokugabha.

I-Vertigo kanye nokucasuka kokunyakaza nakho kungabangela isicanucanu nokuhlanza. Uma uzoba sesimweni lapho kungenzeka ukuthi ubhekane nalezi zimpawu (isibonelo, ohambweni olude, njengasebhasini noma emkhunjini), udokotela wakho angancoma ukuthi uthathe umuthi wokudambisa ukucasuka.

Ngaphandle kwalokhu, kungase kube nezinye izimo lapho udokotela angakunikeza khona umuthi "wokulwa nokugabha".

Yimiphi imithi ekhona yokuqeda ukuhlanza?

Manje ake sibone ukuthi yiziphi izinhlobo zemithi yokulwa nokugabha etholakalayo. Kunezinhlobo eziyisikhombisa zemithi "elwa nokugabha". Kunezinhlobo eziningana zemithi esigabeni ngasinye.

1. Izitha ze-Serotonin

Lolu uhlobo oluvame ukusetshenziswa kakhulu lwe-"Antiemetic" olunikezwa ngqo ukwelapha isicanucanu nokuhlanza. Izibonelo zalokhu yilezi:

• `I-Granisetron (Kytril®)`
• `Ondansetron (Zofran®)`
• `I-Palonosetron (i-Aloxi®)`

Lo muthi uvunyelwe yi-US Food and Drug Administration ( FDA ) ukuvimbela okulandelayo:

• `CINV` (isicanucanu nokuhlanza okubangelwa ukwelashwa komdlavuza) kanye nesicanucanu nokuhlanza okubangelwa ukwelashwa ngemisebe.
• `PONV` (lokho kusho isicanucanu nokuhlanza ngemva kokuhlinzwa).

Kodwa-ke, ngezinye izikhathi odokotela banikeza le mithi kwezinye izimo. Lokhu kubizwa ngokuthi ukusetshenziswa 'okungekho ku-label', okusho ukuthi isetshenziselwa ezinye izinjongo ngaphandle kwalezo ezivunyiwe yi-FDA.

2. Ama-antihistamine

Ama-antihistamine, ikakhulukazi lawo avimba i-histamine 1 (H1) receptor, asetshenziswa kakhulu odokotela ukulawula izimpawu ezihlobene nokungezwani komzimba. Kodwa-ke, amanye awo avunyelwe yi-FDA ukuvimbela nokwelapha isicanucanu nokuhlanza okubangelwa ukuguliswa ukunyakaza kanye nesiyezi. Ngezinye izikhathi, odokotela bangase bawanikeze ama-antihistamine angekho ohlwini lwemithi uma amanye ama-antiemetics esicanucanu nokuhlanza ngesikhathi sokukhulelwa engasebenzi. Nazi ezinye izinhlobo zama-antihistamine okuhlanza:

• Amaphilisi okuhlafuna e-`Dimenhydrinate` (`Dramamine®`)
• Ama-capsule noma amaphilisi e-Diphenhydramine (i-Benadryl®)
• I-Vitamin B6 ene-'Doxylamine succinate' – Lena yindlela yokuqala yokwelapha isicanucanu nokuhlanza ngesikhathi sokukhulelwa.
• `I-Meclizine (i-Antivert®, i-Bonine®, i-Dramamine-N®)`
• `I-Promethazine (i-Phenergan®)`

Imithi efana ne-diphenhydramine kanye ne-dimenhydrinate ingasiza futhi ekuvimbeleni i-PONV (isicanucanu nokuhlanza ngemva kokuhlinzwa), kodwa ngokuvamile akuyona imithi yokuqala yalokhu.

3. Ama-Glucocorticoids

Ama-Glucocorticoids (noma ama-Corticosteroids) ayizinhlobo zemithi odokotela abayisebenzisayo ikakhulukazi ngenxa yezakhiwo zabo zokulwa nokungezwani komzimba kanye nokulwa nokuvuvukala. Kodwa-ke, amanye ama-Glucocorticoids nawo asebenza njengemithi yokulwa nokugabha.

I-Dexamethasone (i-Baycadron Elixer®, i-Decadron®, i-Zema-Pak®, kanye neminye imikhiqizo) iyi-glucocorticoid eyinhloko esetshenziswa odokotela ukuvimbela i-CINV (isicanucanu esibangelwa ukwelashwa komdlavuza) kanye ne-PONV (isicanucanu esilandela ukuhlinzwa).

Odokotela ngezinye izikhathi banikeza i-`(Glucocorticoid)` kanye nezinye izinhlobo ze-`(Antiemetic)` ukuvimbela isicanucanu nokuhlanza. Kodwa ngokungafani nezinye izinhlobo ze-`(Antiemetic)`, i-`(Glucocorticoids)` ayikwazi ukwelapha isicanucanu nokuhlanza uma sekuqalile. Okusho ukuthi, inikezwa kuphela ukuvimbela.

4. Imithi yokulwa ne-cholinergic

Ama-anticholinergics (aziwa nangokuthi ama-antimuscarinics) uhlobo lomuthi ovimba ukusebenza kwekhemikhali ebizwa ngokuthi i-acetylcholine (i-neurotransmitter). Angasiza ekwelapheni izimo ezahlukahlukene (njengokungalawuleki komchamo kanye ne-COPD), futhi angasiza nasekucasukeni nasekuhlanzeni.

I-Scopolamine (Maldemar, Scopace, Transderm Scop®) umuthi oyinhloko wokulwa ne-cholinergic osetshenziselwa ukuhlanza. Odokotela bawusebenzisela:

• Vimbela i-'PONV' (ukuhlanza ngemva kokuhlinzwa).
• Ukuvimbela noma ukwelapha isicanucanu esibangelwa "ukugula kokunyakaza" (ukuhlanza ngenkathi usohambweni).

5. Abaphikisi be-Neurokinin-1 receptor

Ama-receptor antagonist e-Neurokinin-1 (NK-1) asebenza ngokuvimba into yemvelo ebuchosheni bakho ebizwa ngokuthi i-neurokinin ebangela isicanucanu nokuhlanza. Le mithi iyasebenza kakhulu ekwelapheni i-CINV (isicanucanu esibangelwa umdlavuza) kanye ne-PONV (isicanucanu esilandela ukuhlinzwa). Futhi inezakhiwo zokulwa nokukhathazeka (i-anxiolytic) kanye ne-antidepressant.

Imithi ekulesi sigaba yile:

• `I-Aprepitant (i-Aponvie®, i-Emend®` kanye ne-`Cinvanti®)`
• `Fosaprepitant (Emend®` futhi `Focinvez®)`
• Inhlanganisela ethi `Netupitant` kanye nethi `palonosetron` (`Akynzeo®)`
• `I-Rolapitant (i-Varubi®)`

6. Abaphikisi be-Dopamine

Ama-dopamine antagonists uhlobo lomuthi ovimba izinhlobo ezithile zamaseli ebuchosheni bakho ukuthi angaqhumi. Ayindlela eyinhloko yokwelapha ezinye izimo zempilo yengqondo kanye nezimpawu, ikakhulukazi i-psychosis kanye ne-schizophrenia . Kodwa-ke, ezinye zalezi zinhlobo zingasiza nasekucasukeni nasekuhlanzeni.

Kunezinhlobo eziningana zezidakamizwa ze-dopamine ezisetshenziselwa ukuhlanza:

• `I-Amisulpride (i-Barhemsys®)`
• "I-Chlorpromazine (Thorazine®)"
• `I-Droperidol (I-Inapsine®)`
• `I-Haloperidol (Haldol®)`
• `Metoclopramide (Reglan®, Gimoti®)`
• "I-Olanzapine (i-Zyprexa®, i-Lybalvi®, i-Symbyax®)"
• `I-Prochlorperazine (Compro®)`

Ama-dopamine antagonists ayindlela ehlukile ye-'CINV' (ukuhlanza okubangelwa umdlavuza) lapho eminye imithi '(Antiemetic)' ingasebenzi. Ingasiza futhi ekuvimbeleni i-'PONV' (ukuhlanza ngemva kokuhlinzwa).

7. Ama-Cannabinoid

Ama-cannabinoid ayisigaba samakhemikhali atholakala esitshalweni se-cannabis (insangu). Anamathela kuma-receptor e-cannabinoid ebuchosheni bakho, ohlelweni lokugaya ukudla, kanye namaseli omzimba.

Ama-cannabinoid akhiqizwayo ama-molecule aklanyelwe ukulingisa imiphumela ye-tetrahydrocannabinol (THC). Okwamanje kunezinhlobo ezimbili zama-cannabinoids okwenziwa emakethe angasetshenziswa njengemithi yokulwa nokugabha:

• `I-Dronabinol (Marinol®)`
• `Nabilone (Cesamet®)`

Lezi zivunyelwe yi-FDA kwi-CINV (ukuhlanza okubangelwa ukwelashwa komdlavuza), futhi kufanele zisetshenziswe kuphela uma imithi yokulwa nokugabha yesigaba sokuqala yehlulekile.

Ama-cannabinoids uhlobo olusha lwemithi yokulwa nokuqunjelwa. Abacwaningi basafunda futhi bacwaninga ukuthi asebenza kanjani.

Siwuthola kanjani lo muthi? (Izindlela zokusebenzisa)

Imithi eminingi "yokulwa nokugabha" itholakala ngezindlela ezingaphezu kweyodwa. Ingase ibukeke kanje:

• Amaphilisi okuphuza, okusho amaphilisi agwinywayo noma ahlafunwayo.
• Izixazululo ze-IV (ezifakwa emthanjeni), okuyimithi ewuketshezi efakwa emthanjeni.
• Imijovo emisipheni yakho (esicutshini).
• Amabala esikhumba (transdermal) – Lokhu kungokwe-Scopolamine (i-anticholinergic).
• Amaphilisi e-rectal (ama-suppository).

Ingabe le mithi ingabangela imiphumela emibi?

Imiphumela emibi engenzeka ngohlobo ngalunye lwe-`(Antiemetic)` iyahlukahluka. Udokotela wakho uzokutshela ngale miphumela emibi ngaphambi kokuba uqale ukuthatha umuthi. Ungesabi ukubuza imibuzo nokwabelana ngemicabango yakho. Uma unemiphumela emibi ekhathazayo ngemuva kokuqala i-`(Antiemetic)`, khuluma nodokotela wakho.

Nazi ezinye zemiphumela emibi evame kakhulu (kodwa hhayi yonke) engenzeka ngohlobo ngalunye lwe-"Antiemetic":

• Izitha ze-Serotonin: Ikhanda elibuhlungu, isiyezi, kanye nokuqunjelwa.
• Ama-Antihistamine: Ukulala.
• Ama-Glucocorticoids: Ukungalali, ukucasuka, kanye nokushintsha kwemizwelo.
• Imithi Yokulwa Nezinso: Umlomo owomile, ukushintsha kombono, kanye nokozela.
• Ama-NK-1 receptor antagonists: Angabangela ikhanda elibuhlungu, isiyezi, futhi kwabanye abantu, ukusabela okukhulu kokungezwani komzimba (i-anaphylaxis).
• Izitha ze-Dopamine: isiyezi, ikhanda elibuhlungu, nezinkinga zokunyakaza, njenge-dystonia (ukufinyela kwemisipha okungahleliwe) kanye ne-tardive dyskinesia (ukunyakaza komzimba okungahleliwe, ikakhulukazi kobuso nomlomo).
• Ama-cannabinoid:I-Vertigo, umfutho wegazi ophansi, kanye ne-dysphoria (umuzwa wokungakhululeki okukhulu noma ukunganeliseki).

Kulungile yini ukuthatha lo muthi uma ngikhulelwe?

Uma uhlushwa isicanucanu nokuhlanza ngesikhathi sokukhulelwa, kufanele ukhulume nodokotela wakho wezifo zabesifazane (Ob/Gyn) noma omunye udokotela. Bavame ukuncoma ukuthi wenze izinguquko ekudleni okudlayo noma izikhathi ozidla ngazo. Uma lokho kungasizi, bangase bakunikeze imithi.

Izifundo eziningi zikhombisile ukuthi eminye imithi yokulwa nokuqunjelwa ngokuvamile iphephile ukuyisebenzisa ngesikhathi sokukhulelwa. Kodwa-ke, ulwazi lokuphepha kwabanye luyaphikisana noma lulinganiselwe. Wena nodokotela wakho nizonquma ndawonye ukuthi yini engcono kakhulu kuwe.

Uma nje uthola ukuthi ukhulelwe, bona udokotela ukuze akuxoxele ngemithi oyithathayo. Futhi, kufanele nakanjani ukhulume nodokotela ngaphambi kokuqala noma yimiphi imithi emisha ngesikhathi sokukhulelwa.

Wenzani uma uphuthelwa umthamo wemithi?

Uma uphuthelwa umthamo womuthi "wokulwa nokugabha", ikakhulukazi uma kungumuthi ovimbela isicanucanu nokuhlanza ongaqhubeka, njenge-"CINV," khuluma nodokotela wakho. Uzokweluleka ngalokho okufanele ukwenze.

Yimuphi umyalezo esifuna ukuwuthatha ekhaya kulesi sihloko?

Akekho othanda ukuzwa isicanucanu nokuhlanza. Ngezinye izikhathi, lezi zikhathi ezingajabulisi ziyadingeka emizimbeni yethu. Kodwa ngezinye izikhathi, zingaba yingozi enkulu. Ngenhlanhla, imithi yokulwa nokugabha ingasiza ekuvimbeleni kanye/noma ekwelapheni isicanucanu nokuhlanza, kungakhathaliseki ukuthi kusenesikhathi noma kuyaqhubeka. Kunezinketho eziningana ongakhetha kuzo. Ngokubambisana, wena nodokotela wakho nizonquma ukuthi yikuphi okungcono kakhulu kuwe. Ngakho-ke, uma unale nkinga, ungesabi ukukhuluma nodokotela, kulungile?

'Imithi yokulwa nokuqunjelwa, isicanucanu, ukuhlanza, imithi yokulwa nokuqunjelwa, imiphumela emibi, ukukhulelwa, ukwelashwa komdlavuza