samwvera nervis nevralgiis mkurnaloba: karbamazepini ... - GPC
samwvera nervis nevralgiis mkurnaloba: karbamazepini ... - GPC
samwvera nervis nevralgiis mkurnaloba: karbamazepini ... - GPC
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gamoyenebis instruqcia<br />
produqtis savaWro saxelwodeba: <strong>karbamazepini</strong> LPH<br />
produqtis arapatentirebuli, generiuli saxelwodeba: <strong>karbamazepini</strong><br />
gamoSvebis forma: 200mg-iani tableti<br />
produqtis Semcveloba: 1 tableti Seicavs 200mg karbamazepins.<br />
Cvenebebi:<br />
epilefsia, parcialuri gulyrebi, kompleqsur simptomatologiasTan erTad<br />
(fsiqomotoruli gulyrebi), parcialuri gulyrebi minimaluri simptomatologiiT<br />
(fokaluri gulyrebi) upiratesad fokaluri genezis generalizebuli tonurklonuri<br />
krunCxvebi (disociaciuri grand mali, ZilSi ganviTarebuli grand mali),<br />
epilefsiis Sereuli formebi.<br />
mcire gulyrebis dros preparatis efeqturoba mcirea. <strong>karbamazepini</strong>s daniSvnam<br />
atipuri absensebis dros SesaZloa gamoiwvios epileptiuri Setevebis gaxSireba.<br />
<strong>samwvera</strong> <strong>nervis</strong> <strong>nevralgiis</strong> <strong>mkurnaloba</strong>: <strong>karbamazepini</strong> iniSneba <strong>samwvera</strong> <strong>nervis</strong><br />
<strong>nevralgiis</strong> manifestaciis pirvel periodSi, tkivilis sindromis kupirebis mizniT.<br />
efeqturia agreTve glosofaringealuri <strong>nevralgiis</strong> drosac.<br />
mwvave maniakaluri mdgomareobis da maniakalur-depresiuli moSlilobis <strong>mkurnaloba</strong><br />
– <strong>karbamazepini</strong> SeiZleba gamoyenebul iqnes rogorc monoTerapiis saxiT, aseve<br />
liTiumis preparatebTan erTad im pacientebSi romelTac am preparatis mimarT<br />
aReniSnebaT rezistentoba an im kontingentSi, romelTac ar gaaCniaT tolerantoba<br />
Cveulebrivi antimaniakaluri Terapiis mimarT.<br />
alkoholuri abstinenciis dros ganviTarebuli gulyrebi – mxolod stacionarul<br />
pirobebSi (konvulsiis zRurbli qveiTdeba, riTac krunCxvis ganviTarebis riski<br />
mcirdeba).<br />
diabetur nevropaTiasTan asocirebuli nevralgiuri tkivilis <strong>mkurnaloba</strong>.<br />
uSaqro diabetis dros – antidiurezuli efeqtis gamo. igi dadebiTad moqmedebs<br />
neorohormonuli warmoSobis poliuriasa da polidifsiaze.<br />
miRebis wesi da dozireba<br />
dozirebis reJimis SerCeva xdeba individualurad. sawyisi peroralur doza<br />
mozrdilebSi, 12 wlis da 12 welze ufros mozardebSi Seadgens 200mg orjer<br />
dReSi (dReSi 400mg). aucileblobis SemTxvevaSi klinikuri efeqtis gaTvaliswinebiT<br />
dozas zrdian araumetes 200mg/dReRameSi 3-4 miRebis saxiT erTkviriani intervalis<br />
Semdeg. 12-15 wlis mozardebSi driuri doza ar unda arematebodes 1000mg-s, xolo<br />
15 wlis da ufros mozardebSi - 1200mg dReRameSi. 1600mg-mde odenobiT doza<br />
gamoiyeneba mxolod mozrdilebSi iSviaT SemTvxvevebSi. SemanarCunebel dozas<br />
Seadgens Cveulebriv 600-1200mg/dReRameSi, rac dReSi unda iyos ganawilebuli<br />
ramodenime miRebaze. mkurnalobis xangrZlivoba damokidebulia Cvenebebeze,<br />
mkurnalobis efeqturobaze, Terapiis Sedegad organizmis reaqciaze.<br />
6-12 wlamde bavSvebSi iniSneba 100mg 2 calkeuli miRebis saxiT, aucileblobis<br />
SemTxvevaSi da preparatis mimarT tolerantobis gaTvaliswinebiT dozas zrdian<br />
araumetes 100mg/dReRameSi 3-4 miRebis saxiT erTkviriani intervalis Semdeg.<br />
Cveulebriv dRiuri doza ar unda aWarbebdes 100mg-s dReRameSi. SemanarCunebel<br />
doza Seadgens 400-800mg/dReRameSi. 6 wlamde asakis bavSvebSi – 10-20mg/kg dReSi<br />
orjer pirvel dRes, SemdgomSi dozas zrdian 100mg/dReRameSi erTkviriani<br />
intervalis Semdeg optimaluri efeqtis miRebamde, SemanarCunebel dozas Cveulebriv<br />
Seadgens 35mg/kg dReRameSi.<br />
SigniT miRebisas mozrdilebSi, 15 wlis da ufrosi asakis mozardebSi maqsimalur<br />
dozas Seadgens - 1.2g/dReRameSi.
epilefsiis mkurnalobis mizniT krbamazepini SeiZleba gmaoyenebul iqnes<br />
monoTerapiis saxiT an sxva antikonvulsantebTan erTad. im SemTxvevaSi Tu igi<br />
iniSneba sxva arsebul antikonvulsantur Terapiastan erTad, misi damateba unda<br />
moxdes TandaTanobiT, arsebuli Antikonvulsantis doza unda iyos tandaTan<br />
Semcirebuli, garada fenitoinisa, romlis doza piriqiT unda gaizardos.<br />
<strong>samwvera</strong> <strong>nervis</strong> nevralgia: glosofaringealuri nevralgia.<br />
sawyisi doza: 100mg dReSi orjer, (dReSi 200mg). es dRiuri doza SeiZleba<br />
gaizardos 200mg-mde dReSi, 12 saaTSi erTxel tkivilis kupirebis mizniT 100mg<br />
damatebebiTi dozis saxiT. ar gadaaWarboT 1200mg dReSi.<br />
SemanarCunebeli doza: tkivilis kontroli miiRweva 400-800mg dRiuri doziT<br />
(zogjer 200mg sakmarisia).<br />
mwvave maniakaluri mdgomareobis da maniakalur-depresiuli moSliloba<br />
sawyisi doza unda iyos dabali, 200-400mg dReSi. saWiroebis SemTxvevaSi<br />
SesaZlebelia dozis gazrda maqimum 1600mg dReSi, mravaljeradi miRebis saxiT.<br />
SemanarCunebeli doza – 400-600mg dReSi.<br />
mwvave Sizofreniis dros rekomendirebulia <strong>karbamazepini</strong>s Setavseba neiroloptiuri<br />
medikamantebtan erTad. agreTve manikalur depresiuli sidromis dros saTanado<br />
prevenciuli zomebis miRebis Semdeg <strong>karbamazepini</strong> SesaZlebelia miRebul iqnes<br />
liTiumTan erTad.<br />
ukuCvenebebi<br />
− hipermgrZnobeloba <strong>karbamazepini</strong>s ar romelime sxva tricikluri<br />
antidepresantis mimarT (amitriptilini, desipramini, imipramini,<br />
protriptilini, nitriptilini da sxva)<br />
− antrioventrikuluri blokada an anamnezSi Zvlis tvinis daTrgunvis<br />
precendenti<br />
− mao-s inhibitorebis erTdrouli gamoyeneba. <strong>karbamazepini</strong>s daniSvnamde<br />
mao-s inihibitorebis miReba unda Sewyvetil iqnes aranakleb 14 dRiT<br />
adre Tu ki amis saSualebas iZleva pacientis klinikuri mdgomareoba.<br />
specialuri miTiTebani da gafrTxilebebi<br />
<strong>karbamazepini</strong>T mkurnalobis dawyebamde aucilebelia pacientis avadmyofobis<br />
istoriis detaluri Seswavla da saguldagulo samedicino inspeqtireba.<br />
gansakuTrebuli sifrTxiliT <strong>karbamazepini</strong> unda iyos gamoyenebuli atipuri absensis<br />
SetevebiT mimdinare Sereuli tipis gulyrebis dros, mas Semdeg rac dafiqsirda<br />
<strong>karbamazepini</strong>T mkurnalobis periodSi generalizebuli krunCxvebis ganviTareba.<br />
hematologiuri daavadebebis, RviZlis funqciuri ukmarisobis, kardialuri, renaluri<br />
ukmarisobis, natriumis cvlis deficitis dros <strong>karbamazepini</strong>s gamoyeneba unda moxdes<br />
mas Semdeg, rac Sefasdeba preparatis SesaZlo sargebelsa da risks Soris<br />
Tandafardoba, da mxolod saTanado prevenciuli RonisZiebebis Catarebis Semdeg.<br />
pacientebSi hepato-renuli darRvevebiT, an im SemTxvevaSi Tu romelime medikamentis<br />
mimarT manifestirebuli hematologiuri gverdiTi movlenebis ganviTarebis<br />
precendeti arsebobs, aucilebelia SesaZlo risksa da sargeblbels Soris<br />
Tanafardobis dadgena. mkurnalobis dawyebamde aucileblad unda gakeTdes sisxlis<br />
saerTo analizi da RviZlis funqciuri gamokvleva.<br />
sisxlis analizi unda keTdebodes yovelkvireulad mkurnalobis pirveli Tvis<br />
ganmavlobaSi. periodulad unda sruldebodes RviZlis testirebac. kanis alergiuli<br />
reaqciebis gaCenisa da RviZlis sakontrolo testebis maCveneblebis cvlilebis<br />
SemTxvevaSi kabramazepiniT <strong>mkurnaloba</strong> dauyovebliv unda Sewydes.
SedarebiT iSviaTad aRiniSneba araprogresuli an talRiseburad mimidinare<br />
asimptomuri leikopenia, rac ar qmnis mkurnalobis Sewyvetis aucileblobas. magram<br />
progresuli leikopeniis an klinikuri gamovlinebebis TandarTvis SemTxvevaSi<br />
(rogoricaa cxeleba, angina) <strong>mkurnaloba</strong> dauyovnebliv unda Sewydes.<br />
pacientma aucileblad unda Seatyobinos mkurnal eqims arasasurveli<br />
hemotologiuri (rogoricaa: cxeleba, angina, piridan sisxldena) da hepatitTan<br />
dakavSirebuli (Zilianoba, umadoba, gulisreva, siyviTle) simptomebis ganviTarebis<br />
Sesaxeb.<br />
pacientebi, romelTac aReniSnebaT <strong>karbamazepini</strong>s gamoyenebis periodSi Zilianoba da<br />
Tavbrusxveva, unda gafrTxilebuli iyvenen imis Sesaxeb rom arsebobs riski<br />
avtomobilis marTvisa da teqnikur mowyobilobebTan muSaobis dros, agreTve iseTi<br />
saqmianobis dros, romelic moiTxovs yuradRebis koncentrirebasa da normaluri<br />
refleqsebis arsebobas.<br />
anamnezSi hematologiuri gverdiTi efeqtebis SemTxvevaSi <strong>karbamazepini</strong>T mkurnalobis<br />
periodSi arsebobs hemotologiuri simptomebis gauaresebis riski. <strong>karbamazepini</strong>s<br />
zomieri antiqolinergiuli aqtivobis gamo saWiroa gansakuTrebuli sifrTxile<br />
maRali TvalSida wnevis mqone pacientebSi, amitom aRniSnuli pacientebi<br />
eqvemdebarebian mkacr samedicino monitorings.<br />
sxva triciklur warmoebulebTan urTierTqmedebis gamo <strong>karbamazepini</strong>s daniSvnam<br />
SeiZleba gamoiwvios gviani fsiqozis gaaqtiveba, da xanSiSesul pacientebSi ki<br />
SfoTva da mentaluri konfuzia (deriliumi).<br />
im SemTxvevaSi, rodesac arsebobs <strong>karbamazepini</strong>s mkurnalobis Sewyvetis<br />
aucilebloba, sxva antiepileptiur saSualebaze gadasvla unda moxdes diazepamis<br />
fonze.<br />
sxva medikamentebTan urTierTqmedeba da urTierTqmedebis sxva formebi<br />
<strong>karbamazepini</strong> metabolizdeba RviZlis citoqromebis mier (P450, kerzod ki P45003A4).<br />
is medikamentebi romlebic axdenen enzimebis metabolizmis stimulacias an<br />
inhibirebas karbamazepinTan erTdrouli gamoyenebis dros SesaZloa gamoiwvion<br />
karbmazepinis plazmis donis cvlileba, riTac izrdeba gverdiTi movlenebis<br />
ganviTarebi riski.<br />
<strong>karbamazepini</strong>s plazmis doneze moqmedi agentebi<br />
CYP 3A4-is inhibitorebi axdenen <strong>karbamazepini</strong>s metabolizmis daTrgunvas, es ki<br />
saboloo jamSi iwvevs <strong>karbamazepini</strong>s plazmis donis Semcirebas. medikamantebi,<br />
romlebic iwvevn <strong>karbamazepini</strong>s donis momatebas sisxlis plazmaSi:<br />
cimetidini, danazoli, dilTiazemi, makrolidebi, eriTromicini, troleandomicini,<br />
klariTromicini, fluoqsetini, loratadini, terfenadini, isoniazidi, niacinamidi,<br />
nikotinamidi, propoqsipeni, ketakonazoli, itrakonazoli, valproati.<br />
medikamentebi, romlebic iwveven <strong>karbamazepini</strong>s metabolizmis gaZlierebas<br />
CYP 3A4-is induqtorebi zrdian <strong>karbamazepini</strong>s metabolizmis siCqares:<br />
cisplatini, doqsorubicini, rifampini, fenobarbitali, fenitoini, primidoni,<br />
Teofilini.<br />
<strong>karbamazepini</strong> Tavismxriv iwvevs Semdegi preparatebis plazmuri donis Semcirebas:<br />
paracetamoli: hepatotoqsiurobis riski<br />
aminofilini, Terofilini – karbamazepinTan erTdrouli gamoyenebis dros SesaZloa<br />
gamoiwvion RviZlSi qsantinebis metabolizmis gaZliereba.<br />
kumarinisa da indadionis warmoebuli antikoagulantebi – antikoagulanturi efeqti<br />
SesaZloa daqveiTdes RviZlis inducirebis gamo:
alprozolami, klonmazepami, klozapini, doqsiciklini, etosuqcimidi, galoperidoli,<br />
hormonaluri kontraceptivebi, fenitoini.<br />
liTiumTan erTdroulma gamoyenebam SesaZloa gamoiwvios nevrologiuri gverdiTi<br />
efeqtebis gamovlinebis riskis gazrda.<br />
karbamazepinma SesaZloa gamoiwvios kontraceptivebis usafrTxoebis daqveiTeba.<br />
<strong>karbamazepini</strong> aqveiTebs alkoholis mimarT pacientTa tolerantobas. mkurnalobis<br />
periodSi ar aris rekomendirebuli alkoholis miReba.<br />
orsuloba da laqtacia<br />
orsulobis dros <strong>karbamazepini</strong>s gamoyeneba ukiduresad sariskoa, vinaidan igi iwvevs<br />
nayofis dazianebas. epidemiologiuri kvlevebiT dadginda, rom orsulobis dros<br />
<strong>karbamazepini</strong>s gamoyenebis Sedegad viTardeba nayofis Tandayolili anomaliebi– maT<br />
Soris spina bifida. aqedan gamomdinare <strong>karbamazepini</strong>s daniSvna orsulebSi<br />
(gansakuTrebiT pirvel trimestrSi) rekomendirebuli mxolod im SemTxvevaSi TuU<br />
potenciuri Terapiuli sargebeli awonasworebs preparatis nayofis mimarT zianis<br />
miyenebis risks. im SemTxvevaSo Tu miRebulia gadawyvetileba orsulobis periodSi<br />
misi daniSvnis Sesaxeb, mkacrad rekomendirebulia misi daniSvna monoTerapiis saxiT.<br />
laqtaciis periodSi <strong>karbamazepini</strong>s gamoyeneba unda Sewydes, vinaidan igi<br />
eqskretirdeba dedis rZeSi.<br />
avtomobilis marTva da teqnikur xelsawyoebTan muSaoba<br />
pacientebi, romelTac aReniSnebaT <strong>karbamazepini</strong>s gamoyenebis periodSi Zilianoba da<br />
Tavbrusxveva, unda gafrTxilebuli iyvenen imis Sesaxeb rom arsebobs riski<br />
avtomobilis marTvisa da teqnikur mowyobilobebTan muSaobis dros, agreTve iseTi<br />
saqmianobis dros, romelic moiTxovs yuradRebis koncentrirebasa da normaluri<br />
refleqsebis arsebobas.<br />
gverdiTi efeqtebi<br />
gverdiTi movlenebis ganviTareba damokidebulia preparatis dozaze. gverdiTi<br />
efeqtebis ganviTrebis sixSire metia mkurnalobis dasawyisSi da kombinirebuli<br />
mkurnalobis dros.<br />
dozisa da mkurnalobis meTodis mkacrad dacvis SemTxvevaSi medikamenti maRali<br />
tolerantobiT xasiaTdeba.<br />
yvelaze xSirad gverdiTi efeqtebi vlindeba mkurnalobis sawyis fazaSi, esenia:<br />
Tavbrusxveva, Zilianoba, barbaci, gulisreva, Rebineba.<br />
sisxlmbadi sistema: aplastiuri anemia, agrnaulocitozi, pancitopenia, Zvlis tvinis<br />
daTrgunva, leikopenia, eozinofilia, porfiria.<br />
kanis reaqciebi: gamonayari, urtikaria, toqsiuri epidermuli nekrolizi (Lyell’s<br />
sindromi), stivens-jonsonis sindromi, kanis pigmentaciis cvlileba, eqsfoliatiuri<br />
dermatiti, multiformuli da kvanZovani eriTema, purpura, ganvrcobili lupus<br />
eriTematozis gauareseba. iSviaTad alopecia, oflianoba.<br />
centraluri nevruli sistema: sedacia, Zilianoba, cnobierebis darRvevebi,<br />
Tavbrusxveva, siarulisa da moZraobis moSlilobani (cerebraluri ataqsia).<br />
zogierT SemTxvevaSi vlindeba Tavis tkivili. xanSiSesul pacientebSi SeiZleba<br />
gaviTardes SfoTva da dezorientacia. iSviaTad uneblie moZraobebi (nistagmi) da<br />
calkeul SemTxvevebSi ki metyvelebis, mgrZnoblobis moSlilobani, aseve kunTovani<br />
asTenia, <strong>nervis</strong> anTeba (periferiuli nevriti), rogorc qveda kidurebis paralizis<br />
gamovlineba (paresTeziebi). agreTve iSviaT SemTxvevebSi aRiricxeba mxedvelobis<br />
dabindva, mxedvelobiTi halucianaciebi.
aseve SesaZlebelia izolirebulad ganviTardes fsiqikuri simptomebi rogoricaa:<br />
halucinaciebi, depresiuli mdgomareobebi, agresiuli qceva, azrovnebiTi procesebis<br />
Seferxeba, daqveiTebuli iniciativa, faruli fsiqozis aqtivacia.<br />
agreTve aRwerilia xanSiSesul paciebtebSi an cerebraluri dazianebebis dros<br />
SemTxvevebi, rodesac viTardeba pirisa da saxis uneblie moZraobebi, kunTovani<br />
diskineziuri moSlilobani.<br />
ofTalmologiuri simptomebi: izolirebuli koniuqitviti, mxedvelobis gardamavali<br />
moSliloba. glaukomis dros TvalSida wneva periodulad aucileblad unda<br />
gakontroldes.<br />
saWmlis momnelebeli sistema: mkurnalobis sawyis etapze SesaZlebelia ganviTardes:<br />
umadoba, piris simSrale, gulisreva, Rebineba, diarea an yabzoba. aRwerilia muclis<br />
tkivilis, piris Rrusa da xaxis anTebis (stomatiti, glositi, gingivitis)<br />
calkeuli SemTxvevebi. aRniSnuli simptomebi spontanurad qreba mkurnalobis<br />
dasrulebidan an dozis Semcirebidan 8-14 dRis Semdeg.<br />
aRniSnuli fenomenis Tavidan acileba SesaZlebelia mkurnalobis TandaTanobiT<br />
dawyebiT, progresulad mzardi dozebis miRebiT.<br />
zogjer adgili aqvs RviZlis testebis cvlielebebs, iSviaTad viTardeba hepatitis,<br />
sxvadasxva formis SedarebiT izolirebuli RviZlis qsovilis anTebiTi procesebi<br />
(qolestaturi, hepatocelularuli, granulomatozuri da Sereuli hepatitebi,<br />
pankeatitebi).<br />
gulsisxlZarRvTa sistema: ganskauTrebiT xanSiSesul pacientebSi, an gulis<br />
ukmarisobis dros, iSviaTad SeiZleba ganviTardes: bradikardia, riTmis darRvevebi,<br />
iSemiuri kardiopaTiis gauareseba. calkeul SemTxvevebSi - gulis doneze<br />
gamtareblobis darRvevebi (atrio-ventrikuluri blokada cnobierebis dakargviT),<br />
arteriuli wnevis momateba an daqveiTeba. arteriuli wnevis daqveiTeba aRiniSneba<br />
gansakuTrebiT im SemTxvevaSi Tu <strong>karbamazepini</strong>s maRali dozebi gamoiyeneba.<br />
sasunTqi sistema: respiratoruli hipermgrZnobelobis niSnebi – cxeleba, dispnoe,<br />
filtvebSi Segubeba, filtvis fibrozi.<br />
Zvlovan-kunTovani sistema: iSviaTad viTardeba saxsrebisa da kunTebis tkivili<br />
(arTralgia, mialgia), kunTovani krunCxvebi.<br />
metabolizmi: antidiurezuli moqmedebis gamo karbamazepinma SeiZleba gamoiwvios<br />
hiponatriemia RebinebiT, Tavis tkiviliT da dezorientaciiT. iSviaT SemTxvevebSi<br />
viTardeba SeSupeba da wonis momateba. ukiduresad iSviaTad viTardeba ginekomastia<br />
da galaqtorea. aseve dafiqsirebulia plazmaSi kacliumis donis daqveiTebis<br />
SemTxvevebi.<br />
Sard-sasqeso sistema: iSviaTad aRiniSneba proteinuria, hematuria, oliguria, rac<br />
preparatis antidiurezuli moqmedebiT ganpirobebuli Tirkmlis ukmarisobis<br />
gamovlinebaa, agreTve SesaZlebelia ganviTardes dizuria, polakiuria, rac<br />
Sesabamisad TirkmlebSi Sardis Seferxebis gamovlinebaa.<br />
calkeul SemTxvevebSi - seqsualuri darRvevebi, rogoricaa libidos daqveiTeba da<br />
impotencia.<br />
gansakuTrebuli gafrTxilebani<br />
gansakuTrebuli yuradReba unda mieqcies kanis alergiul reaqciebs, hematologiur<br />
da hepatotoqsiur reaqciebs. mkurnalobis xangrZlivi kursis SemTxvevaSi imisaTvis,<br />
rom aRniSnuli darRvevebi ganisazRvros adreul stadiaze, rekomendirebulia<br />
periodulad Catardes saTanado laboratoriuli gamokvlevebi - sisxlisa da<br />
RviZlis funqcionaluri mdgomareobis dasadgenad. agreTve aucilebelia<br />
<strong>karbamazepini</strong>s da sxva antiepileptiuri medikamantebis sisxlSi donis perioduli<br />
gansazRvra kombinirebuli mkurnalobis SemTxvevaSi. sisxlis saerTo analizi da
RviZlis funqcionaluri gamokvlevebi unda Catardes mkurnalobis dawyebamde,<br />
mkurnalobis pirveli Tvis ganmavlobaSi yovel kviras, SemdgomSi ki TveSi erTxel.<br />
mkurnalobis pirveli 6 Tvis gasvlis Semdeg, aucilebelia yovelwliurad 2-4<br />
gamokvlevis Catareba.<br />
Tu gverdiTi efeqtebi imdenad mZimea rom dadga mkurnalobis Sewyvetis<br />
aucileblobis sakiTxi, aseT SemTvxveaSi mkurnalobis Sewyevta unda moxdes<br />
samedicino zedamxedvelobis qveS da gaTvaliswinebul unda iqnes pacientisTvis<br />
SesaZlo riski (krunCxvebis ganviTareba, epileptiuri statusi).<br />
Cveulebriv rekomendirebulia mkurnalobis Sewyveta TandaTanobiT, sxva<br />
antiepileptiuri saSulaebis Canacvlebis fonze.<br />
hiperdozireba<br />
niSnebi da simptomebi: hiperdozirebis pirveli niSnebi da simptomebi vlindeba<br />
Sewovidan 1-3 saaTis ganmavlobaSi. arsebuli simptomatikidan, rogorc wesi,<br />
nervkunTovani darRvevebi yvelaze ufro mkveTrad aris gamoxatuli.<br />
kardiovaskularuli simptomebi Cveulebriv ufro naklebad aris gamoxatuli, xolo<br />
mZime kardialuri garTulebani viTardeba mxolod ukiduresad maRali dozis (
sunTqvis daTrgunva: gaixsnas haeris gzebi, saWiroebis SemTxvevaSi mimarTeT<br />
endotraqeul intubacias, oqsigenacia.<br />
arteriuli wnevis daqveiTeba: plazmis Semcvlelebis Seyvana.<br />
krunCxvebi: diazepamis da barbituratebis miReba.<br />
diazepamma da barbituratebma SeiZleba gamoiwvios sasunTqi sistemis daTrgunvis<br />
gauareseba (gansakuTrebiT bavSvebSi), agreTve gamoiwvion arteriuli wnevis<br />
daqvieiTeba da komis ganviTareba. barbituratebis gamoyeneba ar SeiZleba im<br />
SemTxvevaSi Tu pacients didi raodenobiT aqvs miRebuli iseTi medikamenti romelic<br />
Trgunavs momoaminoqsidazas an uaxloes xanSi Catarda aseTi medikamentiT<br />
<strong>mkurnaloba</strong>.
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