Waukulu >> Zambiri Zamankhwala >> Angiotensin II receptor blockers (ARBs): Ntchito, zopangidwa wamba, komanso zidziwitso zachitetezo

Angiotensin II receptor blockers (ARBs): Ntchito, zopangidwa wamba, komanso zidziwitso zachitetezo

Angiotensin II receptor blockers (ARBs): Ntchito, zopangidwa wamba, komanso zidziwitso zachitetezoDrug Info Angiotensin II receptor blockers (ARBs) amathandizira kuthamanga kwa magazi komanso kulephera kwa mtima. Dziwani zambiri za mitundu ya ma ARB ndi chitetezo chawo pano.

Mndandanda wama ARB | Kodi ma ARB ndi chiyani? | Momwe amagwirira ntchito | Ntchito | Ndani angamwe ma ARB? | Chitetezo | Zotsatira zoyipa | Mtengo

Kuthamanga kwa magazi ndichizolowezi chamankhwala chomwe chimakhudza mazana mazana mamiliyoni aku America. Angiotensin II receptor blockers (ARBs) ndi gulu la mankhwala omwe amagwiritsidwa ntchito kuti achepetse kuthamanga kwa magazi ndipo ndi amodzi mwamankhwala oyamba omwe madotolo amapereka. Ndizothandiza kwambiri ndipo akhala akugwiritsidwa ntchito pochizira matenda oopsa (kuthamanga kwa magazi) kwazaka zambiri. Ma ARB amagwiritsidwanso ntchito kuthana ndi mitundu ina yamatenda amtima. Nkhaniyi ipereka chiwonetsero cha mankhwalawa. Tilemba mayina osiyanasiyana ndi generic, kupereka zambiri pamtengo wake, kufotokoza momwe mankhwalawo amagwirira ntchito, ndikulemba momwe amagwiritsidwira ntchito komanso chitetezo.



Mndandanda wa ma ARB
Dzina Brand (dzina generic) Avereji ya ndalama Kusungidwa kwa SingleCare Dziwani zambiri
Kuukira (candesartan) $ 127 pa 30, mapiritsi a 16 mg Pezani makuponi a makandulo Zambiri za Candesartan
Avapro (irbesartan) $ 104 pa 30, mapiritsi a 300 mg Pezani makuponi a irbesartan Zambiri za Irbesartan
Benicar (olmesartan) $ 182 pa 30, mapiritsi a 20 mg Pezani ma coupon a Olmesartan Zambiri za Olmesartan
Cozaar (losartan) $ 98 pa 30, 50 mg mapiritsi Pezani makuponi a losartan Zambiri za ku Losartan
Diovan (valsartan) $ 234 pa 30, mapiritsi 320 mg Pezani ma coupons a valsartan Zambiri za Valsartan
Micardis (telmisartan) $ 170 pa 30, mapiritsi a 20 mg Pezani ma coupon a telmisartan Zambiri za Telmisartanicardis

Ma ARB ena

  • Edarbi (azilsartan)
  • Teveten (eprosartan)

Ma ARB nthawi zambiri amaphatikizidwa ndi mankhwala ena ochepetsa kuthamanga kwa magazi - monga diuretic kapena calcium channel blocker - kuti achepetse kuchuluka kwa mapiritsi omwe odwala amamwa patsiku. M'munsimu muli zitsanzo:



  • Exforge (valsartan ndi amlodipine)
  • Avalide (irbesartan ndi hydrochlorothiazide)
  • Azor (olmesartan ndi amlodipine)
  • Twynsta (telmisartan ndi amlodipine)
  • Hyzaar (losartan ndi hydrochlorothiazide)
  • Diovan HCT (valsartan ndi hydrochlorothiazide)
  • Benicar HCT (olmesartan ndi hydrochlorothiazide)
  • Micardis HCT (telmisartan ndi hydrochlorothiazide)

Kodi angiotensin II receptor blockers (ARBs) ndi chiyani?

Angiotensin II receptor blockers - kapena ma ARB mwachidule - Ndi gulu la mankhwala omwe amagwiritsidwa ntchito pochiza kuthamanga kwa magazi. Ngakhale ma ARB onse ndi FDA ovomerezeka kuti athetse kuthamanga kwa magazi, ma ARB ena ali ndi chilolezo cha FDA chogwiritsa ntchito m'malo ena azachipatala monga kulephera kwa mtima, matenda a impso okhudzana ndi matenda ashuga, kapena kupewa zochitika zamtima. Ma ARB amalembedwa kwambiri ndipo akhala akugwiritsidwa ntchito kuyambira zaka za m'ma 1990.

Kodi ma ARB amagwira ntchito bwanji?

Thupi limayendetsa kuthamanga kwa magazi ndi kuchuluka kwake pogwiritsa ntchito netiweki yolumikizirana yotchedwa renin-angiotensin-aldosterone system (RAAS). Njirayi imalola impso kutumizira zikwangwani m'magazi ndi ziwalo zina. Impso zimapanga puloteni yotchedwa renin. Puloteni iyi imagwiritsidwa ntchito kupanga angiotensin II, mahomoni omwe amauza mitsempha ya magazi, ma gland, ndi ma adrenal gland kuti aziwonjezera kuthamanga kwa magazi komanso kuchuluka kwa magazi.



Apa ndipomwe ma ARB amabwera. Mankhwalawa amaletsa zovuta za angiotensin II kuti hormone iyi isathe kulumikizana ndi ziwalo zina. Chifukwa chake, ma ARB amaletsa kukwera kwa kuthamanga kwa magazi ndi kuchuluka kwa magazi.

Ma ARB ndi ofanana kwambiri ndi gulu lina lamankhwala am'magazi. Angiotensin-yotembenuza ma enzyme inhibitors, kapena ACE inhibitors mwachidule, imasokonezanso dongosolo la RAAS. Komabe, zoletsa za ACE zimawononga kulumikizana koyambirira kwa chiwonetserochi, ndikusokoneza kulumikizana kwina. Ma ARB amalowererapo pambuyo pake ndikuphwanya zikwangwani zomwe zimafanana kwambiri ndi kuthamanga kwa magazi. Pachifukwa ichi, ma ARB amayambitsa zovuta zochepa poyerekeza ndi zoletsa za ACE.

Kodi ma ARB amagwiritsidwa ntchito bwanji?

Ma ARB onse ndi ovomerezeka ndi FDA matenda oopsa . Ma ARB ena monga losartan, candesartan, ndi valsartan nawonso ndi FDA omwe amavomerezedwa ndi matenda amtima otchedwa congestive kulephera kwa mtima . Ma ARB apadera ali ndi zisonyezo zina zovomerezedwa ndi FDA kuphatikiza:



  • Kupewa zochitika za CV kwa odwala omwe ali ndi vuto lamanjenje lamanzere pambuyo poti m'mnyewa wamtima infarction (matenda amtima)
  • Matenda a impso omwe amayamba chifukwa cha matenda ashuga (proteinuria / microalbuminuria)
  • Kumanzere kwamitsempha yamagazi

Tchati chili pansipa chikufotokozera mwachidule zovomerezeka ndi FDA za ma ARB ena:

Zikuonetsa Ma ARB ovomerezeka kuti agwiritsidwe ntchito
Matenda oopsa Ma ARB onse
Mtima kulephera Otsatira
Kumanzere kwamitsempha yamagazi Losartan, losartan-hydrochlorothiazide
Mnyewa wamtima infarction Zamgululi
Matenda a impso omwe amabwera chifukwa cha matenda ashuga Losartan, irbesartan

Ma ARB amagwiritsidwa ntchito ngati chizindikiro pazochitika zina zamankhwala monga:

  • Matenda a Atrial
  • Matenda a impso (CKD)
  • Scleroderma
  • Migraine kupewa

Ma ARB osiyanasiyana amakhala ndi zinthu zosiyana pang'ono. Pachifukwa ichi, ma ARBS ena ndi othandiza pazinthu zina zamankhwala. Mwachitsanzo, candesartan ali adawonetsa kuyesetsa kupewa migraine chifukwa cha lipophilic yake.



Ngakhale ma ARB ambiri atha kugwiritsidwa ntchito pachikhalidwe china, ma ARB ena atha kukhala ofunikira kutengera mawonekedwe a wodwala. Mwachitsanzo, losartan ndi ARB yosankha mwa odwala omwe ali ndi hyperuricemia, pomwe candesartan, olmesartan, ndi valsartan zitha kukulitsa vuto ili. Ma ARB ena amatha kusankhidwa kuposa ena pazovuta zina zamankhwala. Losartan ndiye njira yoyamba kwa odwala omwe ali ndi chiopsezo chachikulu cha sitiroko. Pamapeto pake, zili ndi nzeru za dokotala kuti adziwe ARB yabwino kwambiri kwa wodwala wina.

Ndani angamwe ma ARB?

Makanda, ana, ndi achinyamata

Ma ARB ambiri ndi otetezeka komanso othandiza kuchiza matenda oopsa mwa ana. Losartan, valsartan, ndi olmesartan ali ndi chilolezo cha FDA chogwiritsa ntchito ana opitilira zaka zisanu ndi chimodzi, pomwe candesartan ili ndi chilolezo chogwiritsa ntchito ana opitilira chaka chimodzi. Malinga ndi National Kidney Foundation, mankhwalawa Atha kukhala othandizira kuti achepetse kupita patsogolo kwa CKD mwa ana. Ma ARB ena adasankhidwa kuti azilembedwa mwa ana, ngakhale anali ndi zocheperako zothandizira chitetezo komanso kuchita bwino pakati pa anthuwa. Kugwiritsa ntchito ma ARB mosamala komanso moyenera kwa ana kumafunikira kusintha kwa mlingo kutengera msinkhu komanso kulemera.



Akuluakulu

Ma ARB nthawi zambiri amaonedwa kuti ndi otetezeka komanso ogwira ntchito kwa akulu. Zotsatira zoyipa kwambiri ndizochepa ndipo zimatha kukhala ndi chizungulire, kupweteka mutu, kutsokomola, ndi kugona. Odwala ena amatha kukhala ndi zovuta zina. Ndikofunika kufunsa wothandizira zaumoyo pazovuta zomwe zingachitike kuti chithandizo chisinthidwe moyenera.

Okalamba

Ma ARB amakhalanso otetezeka komanso ogwira ntchito kwa odwala okalamba monga momwe aliri kwa odwala achichepere. Okalamba ndi omwe amakhala odwala ambiri omwe amalandila mankhwala aimpso, ndipo ma ARB atha kupereka phindu lochepetsera kukula kwa matenda a impso. Chotsatira chofunikira kwambiri mwa odwala okalamba omwe amamwa ma ARB adakulitsidwa ndi potaziyamu wa seramu (hyperkalemia). Kuyang'anitsitsa potaziyamu ya seramu kumalimbikitsidwa kwa odwalawa chifukwa chiwopsezo cha hyperkalemia chimakula ndi ukalamba komanso kuchuluka kwa comorbidities.



Wodwala wolumala chiwindi

Odwala omwe ali ndi matenda a chiwindi omwe amamwa ma ARB angafunike kuyamba pamlingo wotsika. Mlingo woyambira wa losartan ndi 25 mg kwa odwala omwe ali ndi vuto la chiwindi; imeneyo ndi theka la mlingo woyenera woyambira. Phukusili amalowetsa candesartan amalimbikitsanso kuti azigwiritsa ntchito theka la mlingo woyenera wa odwala matenda a chiwindi. Chifukwa ma ARB amachotsedwa m'thupi ndi chiwindi, ndikofunikira kuyambira pamlingo wochepa ndikuwonjezera mosamala chithandizo mwa odwalawa.

Kodi ma ARB ndi otetezeka?

ARB amakumbukira

Ogulitsa angapo a valsartan, losartan, ndi zinthu zopangidwa ndi irbesartan adakumbukiridwa chifukwa cha zonyansa za NMBA. Amakumbukira adayamba pakati pa 2018 ndikupitilira mpaka Seputembara 2019. Zosungidwa zakale za zosintha ndikusindikiza zolengeza zokhudzana ndi zokumbukira izi zimayikidwa pa intaneti ndi a FDA, komanso a mndandanda wathunthu za zinthu zonse zomwe zikukumbukiridwa mosalekeza zamankhwala a ARB. Ogulitsa omwe akhudzidwa ndikukumbukiraku akuphatikizira, koma samangokhala ku, Teva, Macleods, Mylan, Torrent, Aurobindo, Solco Healthcare, Prinston, ndi Camber Pharmaceuticals. Wosunga mankhwala anu amatha kukuthandizani ndi mafunso kapena nkhawa zokhudzana ndi anakumbukira mankhwala.



Zoletsa ku ARB

Musamwe mankhwala aliwonse a ARB ngati pali hypersensitivity pazomwe zimaphatikizidwa.

Ma ARB ayenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi kusamvana kwama electrolyte kuphatikiza otsika sodium (hyponatremia) ndi potaziyamu wambiri (hyperkalemia). Ma ARB atha kukulitsa kusamvana kumeneku ndi Kuchepetsa kusungidwa kwa sodium pa ma tubules oyandikira ndi akutali a impso, ndi by Kuchepetsa kutulutsa kwa potaziyamu panjira yotolera .

Odwala omwe ali ndi matenda amitsempha, otchedwa renal artery stenosis (RAS), mu impso zonse, kapena odwala omwe ali ndi impso imodzi yogwira ntchito komanso omwe amapezeka ndi RAS, sayenera kumwa ma ARB. Ma ARB amakhudza kufalikira kwa magazi mu impso, zomwe zimatha kutsitsa kusefukira kwa glomerular kwa odwala omwe ali ndi matenda aimpso. Izi zitha kukulitsa impso kugwira ntchito ndikubweretsa impso kulephera.

Momwemonso, kuchepa kwa voliyumu kuyenera kukonzedwa kwa odwala asanayambe mankhwala ndi ARB. Wodwala akadzaza voliyumu, kuchuluka kwa kusefera kwa impso kumadalira kwambiri angiotensin II, motero ma ARB amatha kupititsa patsogolo ntchito ya impso atatengedwa mdziko lino.

Ma ARB sayenera kutengedwa ndi odwala omwe akugwiritsa ntchito ACE inhibitors kapena Direct renin-inhibitors (DRI) monga Zamgululi (aliskiren). Mitundu itatu yonse yamankhwala imagwira ntchito pa renin-angiotensin system ndipo kuwasonkhanitsa pamodzi kumawonjezera chiopsezo cha impso, hyperkalemia, ndi hypotension. Onetsetsani kuti dokotala akudziwa mankhwala onse omwe mukumwa kuti mupewe kuyanjana ndi mankhwala osokoneza bongo.

Kodi mungamwe ma ARB pamene muli ndi pakati kapena mukuyamwitsa?

Lekani kumwa ARB mukangokayikira kuti mungakhale ndi pakati ndipo kambiranani ndi dokotala nthawi yomweyo. Ma ARB ayenera kupewedwa panthawi yapakati komanso yoyamwitsa ngati kuli kotheka. Mankhwala onse a ARB amakhala ndi chenjezo labokosi lakuda pazakuwonongeka kapena kuwonongeka kwa mwana wosabadwa ma ARB akagwiritsidwa ntchito ali ndi pakati.

Kodi ma ARB amayang'aniridwa?

Ayi, angiotensin II omwe amatsutsana nawo samayang'anira zinthu.

Zotsatira zoyipa za ARB

Otsatirawa ndi mbali wamba yomwe imatha kuchitika mukamamwa ma ARB. Uwu si mndandanda wathunthu, chifukwa umangokhudza zovuta zomwe zimafalikira kuma ARB onse. Zowonjezera zoyipa zimatha kukhala zodziwika bwino pamankhwala ena aliwonse mkalasi. Ngati mukukumana ndi zovuta kapena zosafunikira, funsani dokotala kapena wamankhwala kuti mumve zambiri ndi upangiri.

  • Mutu
  • Kutsekula m'mimba
  • Tsokomola
  • Matenda apamwamba opuma (URI)
  • Potaziyamu wapamwamba (hyperkalemia)
  • Kutengeka
  • Chizungulire
  • Kutopa
  • Asthenia (kufooka kapena kusowa kwa mphamvu)
  • Kupweteka kwa minofu

Ma ARB amadziwika kuti amachititsa zotsatira zoyipa zotchedwa angioedema. Komabe, zotsatirazi sizodziwika kwambiri m'ma ARB poyerekeza ndi ACE inhibitors. Izi zimakhulupirira kuti zimayambitsidwa ndi bradykinin, peputayidi ya vasodilating yomwe ingayambitse kutupa ndi kutupa. Ma ARB samawonjezera bradykinin pamlingo wofanana ndi ACE inhibitors.

Kodi ma ARB amawononga ndalama zingati?

Mankhwala ambiri m'kalasiyi amapezeka ngati ma generic pamtengo wotsika kuposa mnzake wamayina. Mwachitsanzo, Benicar itha kuwononga $ 300 patsiku la 30. Mtundu wa generic, olmesartan, umapezeka pamunsi ochepera $ 5 ndi Coupon ya SingleCare. Ngakhale ma ARB ambiri odziwika amawononga ndalama zoposa $ 200, mitundu ya generic imawononga ndalama zosakwana $ 30 kudzera pa SingleCare.

Ma ARB amapezeka ndi Medicare ambiri komanso mapulani a inshuwaransi, ngakhale ma ARB ena atha kusankhidwa kuposa ena. Mwachitsanzo, losartan amadziwika kuti ndi gawo limodzi - kapena mankhwala okonda kugwiritsa ntchito mankhwala osokoneza bongo pomwe mankhwala ena osakaniza monga candesartan-hydrochlorothiazide sangaphimbidwe konse. Kuphatikiza apo, dongosolo lanu la inshuwaransi limatha kudziwa kufotokozera kutengera matenda omwe akuwonetsedwa pamankhwala a wodwalayo. Matenda oopsa kwambiri ndi omwe amadziwika kuti ndi othandiza.

Ngakhale dongosolo la inshuwaransi likuphimba mankhwala anu, mwina zingakhale zotsika mtengo kugwiritsa ntchito Coupon ya SingleCare .

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