TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>TEYXOS</strong> <strong><strong>17</strong>2</strong> 3/<strong>17</strong>/<strong>09</strong> <strong>11</strong>:14 <strong>AM</strong> <strong>Page</strong> 76<br />
ENEAS<br />
Σύνθ<strong>ε</strong>ση: Κάθ<strong>ε</strong> δισκίο π<strong>ε</strong>ριέχ<strong>ε</strong>ι 10 mg Εν<strong>α</strong>λ<strong>α</strong>πρίλη <strong>μ</strong>ηλ<strong>ε</strong>ϊνική κ<strong>α</strong>ι<br />
20 mg Νιτρ<strong>ε</strong>νδιπίνη Θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>υτικές <strong>ε</strong>νδ<strong>ε</strong>ίξ<strong>ε</strong>ις: Θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> ιδιοπ<strong>α</strong>θούς<br />
<strong>α</strong>ρτηρι<strong>α</strong>κής υπέρτ<strong>α</strong>σης σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που η <strong>α</strong>ρτηρι<strong>α</strong>κή τους πί<strong>ε</strong>ση<br />
δ<strong>ε</strong>ν <strong>ε</strong>λέγχ<strong>ε</strong>τ<strong>α</strong>ι <strong>ε</strong>π<strong>α</strong>ρκώς <strong>μ</strong>όνο <strong>μ</strong><strong>ε</strong> <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη ή νιτρ<strong>ε</strong>νδιπίνη.Δοσολογί<strong>α</strong><br />
κ<strong>α</strong>ι τρόπος χορήγησης Μπορ<strong>ε</strong>ί ν<strong>α</strong> συστ<strong>α</strong>θ<strong>ε</strong>ί η ρύθ<strong>μ</strong>ιση της δόσης<br />
κ<strong>α</strong>θ<strong>ε</strong>νός <strong>α</strong>πό τ<strong>α</strong> <strong>ε</strong>πι<strong>μ</strong>έρους συστ<strong>α</strong>τικά. Εάν κρίν<strong>ε</strong>τ<strong>α</strong>ι κλινικά<br />
<strong>α</strong>π<strong>α</strong>ρ<strong>α</strong>ίτητο, <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> πρ<strong>α</strong>γ<strong>μ</strong><strong>α</strong>τοποιηθ<strong>ε</strong>ί ά<strong>μ</strong><strong>ε</strong>ση <strong>α</strong>λλ<strong>α</strong>γή <strong>α</strong>πό τη<br />
<strong>μ</strong>ονοθ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> στο στ<strong>α</strong>θ<strong>ε</strong>ρό συνδυ<strong>α</strong>σ<strong>μ</strong>ό. Ενήλικ<strong>ε</strong>ς,<br />
συ<strong>μ</strong>π<strong>ε</strong>ριλ<strong>α</strong><strong>μ</strong>β<strong>α</strong>νο<strong>μ</strong>ένων των ηλικιω<strong>μ</strong>ένων: Η συνιστω<strong>μ</strong>ένη δοσολογί<strong>α</strong><br />
<strong>ε</strong>ίν<strong>α</strong>ι έν<strong>α</strong> δισκίο την η<strong>μ</strong>έρ<strong>α</strong>. Ασθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>: Το<br />
ENEAS <strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong><br />
. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ήπι<strong>α</strong> έως <strong>μ</strong>έτρι<strong>α</strong> ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> δ<strong>ε</strong>ν<br />
<strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι ούτ<strong>ε</strong> η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη ούτ<strong>ε</strong> η νιτρ<strong>ε</strong>νδιπίνη ως<br />
<strong>μ</strong>ονοθ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>, ωστόσο δ<strong>ε</strong>ν υπάρχ<strong>ε</strong>ι <strong>ε</strong><strong>μ</strong>π<strong>ε</strong>ιρί<strong>α</strong> όσον <strong>α</strong>φορά τη<br />
χορήγηση του ENEAS σ<strong>ε</strong> <strong>α</strong>υτές τις π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις. Συν<strong>ε</strong>πώς, <strong>α</strong>ν<br />
υπάρχ<strong>ε</strong>ι ένδ<strong>ε</strong>ιξη γι<strong>α</strong> τη χορήγησή του, το ENEAS θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> δίδ<strong>ε</strong>τ<strong>α</strong>ι<br />
<strong>μ</strong><strong>ε</strong> προσοχή σ<strong>ε</strong> <strong>α</strong>υτούς τους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς . Ασθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ν<strong>ε</strong>φρική<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>: Το ENEAS <strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ν<strong>ε</strong>φρική<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> (κάθ<strong>α</strong>ρση κρ<strong>ε</strong><strong>α</strong>τινίνης κάτω <strong>α</strong>πό 10 ml/ min) ή σ<strong>ε</strong><br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση.Π<strong>α</strong>ιδιά κ<strong>α</strong>ι έφηβοι:Δ<strong>ε</strong>ν<br />
υπάρχουν δ<strong>ε</strong>δο<strong>μ</strong>έν<strong>α</strong> γι<strong>α</strong> τη χορήγηση του ENEAS σ<strong>ε</strong> π<strong>α</strong>ιδιά κ<strong>α</strong>ι <strong>ε</strong>φήβους,<br />
συν<strong>ε</strong>πώς δ<strong>ε</strong>ν πρέπ<strong>ε</strong>ι ν<strong>α</strong> χορηγ<strong>ε</strong>ίτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>υτή την ο<strong>μ</strong>άδ<strong>α</strong> <strong>α</strong>σθ<strong>ε</strong>νών.<br />
Αντ<strong>ε</strong>νδ<strong>ε</strong>ίξ<strong>ε</strong>ις: Το ENEAS δ<strong>ε</strong>ν θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> χρησι<strong>μ</strong>οποι<strong>ε</strong>ίτ<strong>α</strong>ι: Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς<br />
<strong>μ</strong><strong>ε</strong> υπ<strong>ε</strong>ρ<strong>ε</strong>υ<strong>α</strong>ισθησί<strong>α</strong> στην <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη, την νιτρ<strong>ε</strong>νδιπίνη ή σ<strong>ε</strong><br />
οποιοδήποτ<strong>ε</strong> <strong>α</strong>πό τ<strong>α</strong> έκδοχ<strong>α</strong> του φ<strong>α</strong>ρ<strong>μ</strong><strong>α</strong>κ<strong>ε</strong>υτικού προϊόντος. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς<br />
<strong>μ</strong><strong>ε</strong> ιστορικό <strong>α</strong>γγ<strong>ε</strong>ιοοιδή<strong>μ</strong><strong>α</strong>τος που σχ<strong>ε</strong>τίζ<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> τη χορήγηση<br />
<strong>α</strong>ν<strong>α</strong>στολέων του <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>τρ<strong>ε</strong>πτικού <strong>ε</strong>νζύ<strong>μ</strong>ου της <strong>α</strong>γγ<strong>ε</strong>ιοτ<strong>α</strong>σίνης ή <strong>μ</strong><strong>ε</strong><br />
κληρονο<strong>μ</strong>ικό /ιδιοπ<strong>α</strong>θές <strong>α</strong>γγ<strong>ε</strong>ιοοίδη<strong>μ</strong><strong>α</strong>.Κ<strong>α</strong>τά την κύηση κ<strong>α</strong>τά τη<br />
γ<strong>α</strong>λουχί<strong>α</strong> Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> κ<strong>α</strong>τ<strong>α</strong>στάσ<strong>ε</strong>ις που χ<strong>α</strong>ρ<strong>α</strong>κτηρίζοντ<strong>α</strong>ι <strong>α</strong>πό<br />
<strong>α</strong>ι<strong>μ</strong>οδυν<strong>α</strong><strong>μ</strong>ική <strong>α</strong>στάθ<strong>ε</strong>ι<strong>α</strong>, <strong>ε</strong>ιδικά κ<strong>α</strong>ρδιογ<strong>ε</strong>νές σοκ, οξ<strong>ε</strong>ί<strong>α</strong> κ<strong>α</strong>ρδι<strong>α</strong>κή<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, οξύ στ<strong>ε</strong>φ<strong>α</strong>νι<strong>α</strong>ίο <strong>ε</strong>π<strong>ε</strong>ισόδιο, οξύ <strong>ε</strong>γκ<strong>ε</strong>φ<strong>α</strong>λικό <strong>ε</strong>π<strong>ε</strong>ισόδιο.<br />
Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> <strong>α</strong><strong>μ</strong>φοτ<strong>ε</strong>ρόπλ<strong>ε</strong>υρη στένωση των ν<strong>ε</strong>φρικών <strong>α</strong>ρτηριών<br />
ή <strong>ε</strong>τ<strong>ε</strong>ρόπλ<strong>ε</strong>υρη <strong>ε</strong>πί <strong>μ</strong>ονήρους ν<strong>ε</strong>φρού Σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οδυν<strong>α</strong><strong>μ</strong>ικά <strong>α</strong>ξιοση<strong>μ</strong><strong>ε</strong>ίωτη<br />
στένωση της <strong>α</strong>ορτικής ή <strong>μ</strong>ιτρο<strong>ε</strong>ιδούς β<strong>α</strong>λβίδ<strong>α</strong>ς κ<strong>α</strong>ι υπ<strong>ε</strong>ρτροφική<br />
<strong>μ</strong>υοκ<strong>α</strong>ρδιοπάθ<strong>ε</strong>ι<strong>α</strong>. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> (κάθ<strong>α</strong>ρση<br />
κρ<strong>ε</strong><strong>α</strong>τινίνης κάτω <strong>α</strong>πό 10 ml/min) κ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση.<br />
Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>. Ειδικές προφυλάξ<strong>ε</strong>ις<br />
κ<strong>α</strong>ι προ<strong>ε</strong>ιδοποιήσ<strong>ε</strong>ις κ<strong>α</strong>τά τη χρήση Αγγ<strong>ε</strong>ιοοίδη<strong>μ</strong><strong>α</strong>: Οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που<br />
<strong>α</strong>κολουθούν θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong><strong>ε</strong> <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νίσουν<br />
<strong>α</strong>γγ<strong>ε</strong>ιοοίδη<strong>μ</strong><strong>α</strong> στ<strong>α</strong> άκρ<strong>α</strong>, το πρόσωπο, τ<strong>α</strong> χ<strong>ε</strong>ίλη, τους βλ<strong>ε</strong>ννογόνους,<br />
τη γλώσσ<strong>α</strong>, τη γλωττίδ<strong>α</strong> ή το λάρυγγ<strong>α</strong>, ιδίως κ<strong>α</strong>τά τις πρώτ<strong>ε</strong>ς<br />
<strong>ε</strong>βδο<strong>μ</strong>άδ<strong>ε</strong>ς της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς. Ωστόσο, σ<strong>ε</strong> σπάνι<strong>ε</strong>ς π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις,<br />
σοβ<strong>α</strong>ρό <strong>α</strong>γγ<strong>ε</strong>ιοοίδη<strong>μ</strong><strong>α</strong> <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>α</strong>ν<strong>α</strong>πτυχθ<strong>ε</strong>ί <strong>μ</strong><strong>ε</strong>τά <strong>α</strong>πό <strong>μ</strong><strong>α</strong>κρόχρονι<strong>α</strong><br />
θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong><strong>ε</strong> <strong>α</strong>ν<strong>α</strong>στολέ<strong>α</strong> του ΜΕΑ. Η θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> δι<strong>α</strong>κόπτ<strong>ε</strong>τ<strong>α</strong>ι<br />
<strong>α</strong><strong>μ</strong>έσως. Το <strong>α</strong>γγ<strong>ε</strong>ιοοίδη<strong>μ</strong><strong>α</strong> που προσβάλλ<strong>ε</strong>ι τη γλώσσ<strong>α</strong>, τη γλωττίδ<strong>α</strong><br />
ή το λάρυγγ<strong>α</strong> <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι θ<strong>α</strong>ν<strong>α</strong>τηφόρο κ<strong>α</strong>ι θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
<strong>ε</strong>φ<strong>α</strong>ρ<strong>μ</strong>οσθ<strong>ε</strong>ί <strong>ε</strong>π<strong>ε</strong>ίγουσ<strong>α</strong> θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>. Ο <strong>α</strong>σθ<strong>ε</strong>νής θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> <strong>ε</strong>ισ<strong>α</strong>χθ<strong>ε</strong>ί<br />
σ<strong>ε</strong> νοσοκο<strong>μ</strong><strong>ε</strong>ίο κ<strong>α</strong>ι ν<strong>α</strong> τ<strong>ε</strong>θ<strong>ε</strong>ί υπό π<strong>α</strong>ρ<strong>α</strong>κολούθηση γι<strong>α</strong> τουλάχιστον<br />
12 έως 24 ώρ<strong>ε</strong>ς κ<strong>α</strong>ι ν<strong>α</strong> <strong>μ</strong>ην λάβ<strong>ε</strong>ι <strong>ε</strong>ξιτήριο πριν <strong>α</strong>πό την πλήρη <strong>ε</strong>ξ<strong>α</strong>φάνιση<br />
των συ<strong>μ</strong>πτω<strong>μ</strong>άτων. Ουδ<strong>ε</strong>τ<strong>ε</strong>ροπ<strong>ε</strong>νί<strong>α</strong>/<strong>α</strong>κοκκιοκυττ<strong>α</strong>ρ<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong>:<br />
Ουδ<strong>ε</strong>τ<strong>ε</strong>ροπ<strong>ε</strong>νί<strong>α</strong>/<strong>α</strong>κοκκιοκυττ<strong>α</strong>ρ<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong>, θρο<strong>μ</strong>βοπ<strong>ε</strong>νί<strong>α</strong> κ<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong> έχουν<br />
<strong>α</strong>ν<strong>α</strong>φ<strong>ε</strong>ρθ<strong>ε</strong>ί σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που λ<strong>α</strong><strong>μ</strong>βάνουν <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ. Σ<strong>ε</strong><br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> φυσιολογική ν<strong>ε</strong>φρική λ<strong>ε</strong>ιτουργί<strong>α</strong> κ<strong>α</strong>ι δίχως άλλους<br />
<strong>ε</strong>πιβ<strong>α</strong>ρυντικούς π<strong>α</strong>ράγοντ<strong>ε</strong>ς, σπάνι<strong>α</strong> <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νίζ<strong>ε</strong>τ<strong>α</strong>ι ουδ<strong>ε</strong>τ<strong>ε</strong>ροπ<strong>ε</strong>νί<strong>α</strong>.<br />
Η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> χορηγ<strong>ε</strong>ίτ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> <strong>ε</strong>ξ<strong>α</strong>ιρ<strong>ε</strong>τική προσοχή σ<strong>ε</strong><br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> <strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κή νόσο του κολλ<strong>α</strong>γόνου, υπό <strong>α</strong>νοσοκ<strong>α</strong>τ<strong>α</strong>στ<strong>α</strong>λτική<br />
θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>, θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong><strong>ε</strong> <strong>α</strong>λλοπουρινόλη ή προκ<strong>α</strong>ϊν<strong>α</strong><strong>μ</strong>ίδη, ή <strong>μ</strong><strong>ε</strong><br />
συνδυ<strong>α</strong>σ<strong>μ</strong>ό <strong>α</strong>υτών των <strong>ε</strong>πιβ<strong>α</strong>ρυντικών π<strong>α</strong>ρ<strong>α</strong>γόντων, <strong>ε</strong>ιδικά <strong>α</strong>ν<br />
προϋπάρχ<strong>ε</strong>ι δι<strong>α</strong>τ<strong>α</strong>ρ<strong>α</strong>χή της ν<strong>ε</strong>φρικής λ<strong>ε</strong>ιτουργί<strong>α</strong>ς. Αν το ENEAS<br />
χρησι<strong>μ</strong>οποι<strong>ε</strong>ίτ<strong>α</strong>ι σ<strong>ε</strong> τέτοιους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς, συνιστάτ<strong>α</strong>ι η π<strong>α</strong>ρ<strong>α</strong>κολούθηση<br />
του τύπου των λ<strong>ε</strong>υκών <strong>α</strong>ι<strong>μ</strong>οσφ<strong>α</strong>ιρίων. Κ<strong>α</strong>τά τη διάρκ<strong>ε</strong>ι<strong>α</strong> της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς<br />
θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> συνιστάτ<strong>α</strong>ι σ<strong>ε</strong> όλους τους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς ν<strong>α</strong> <strong>α</strong>ν<strong>α</strong>φέρουν<br />
κάθ<strong>ε</strong> σύ<strong>μ</strong>πτω<strong>μ</strong><strong>α</strong> λοί<strong>μ</strong>ωξης. Το ENEAS θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> δι<strong>α</strong>κόπτ<strong>ε</strong>τ<strong>α</strong>ι <strong>α</strong>ν<br />
δι<strong>α</strong>πιστωθ<strong>ε</strong>ί ή υπάρχ<strong>ε</strong>ι υποψί<strong>α</strong> ουδ<strong>ε</strong>τ<strong>ε</strong>ροπ<strong>ε</strong>νί<strong>α</strong>ς (ουδ<strong>ε</strong>τ<strong>ε</strong>ρόφιλ<strong>α</strong><br />
λιγότ<strong>ε</strong>ρ<strong>α</strong> <strong>α</strong>πό 1000/mm3). Ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>: Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, η ν<strong>ε</strong>φρική λ<strong>ε</strong>ιτουργί<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθ<strong>ε</strong>ίτ<strong>α</strong>ι,<br />
<strong>ε</strong>ιδικά κ<strong>α</strong>τά τις πρώτ<strong>ε</strong>ς <strong>ε</strong>βδο<strong>μ</strong>άδ<strong>ε</strong>ς της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς<br />
του ΜΕΑ. Ιδι<strong>α</strong>ίτ<strong>ε</strong>ρη προσοχή <strong>α</strong>π<strong>α</strong>ιτ<strong>ε</strong>ίτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> <strong>ε</strong>ν<strong>ε</strong>ργοποιη<strong>μ</strong>ένο<br />
σύστη<strong>μ</strong><strong>α</strong> ρ<strong>ε</strong>νίνης-<strong>α</strong>γγ<strong>ε</strong>ιοτ<strong>α</strong>σίνης. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> <strong>μ</strong>έτρι<strong>α</strong> ν<strong>ε</strong>φρική<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> (κάθ<strong>α</strong>ρση κρ<strong>ε</strong><strong>α</strong>τινίνης πάνω <strong>α</strong>πό 30 ml/min, κρ<strong>ε</strong><strong>α</strong>τινίνη<br />
ορού _3 mg/ml), δ<strong>ε</strong>ν χρ<strong>ε</strong>ιάζ<strong>ε</strong>τ<strong>α</strong>ι ν<strong>α</strong> γίν<strong>ε</strong>ι ρύθ<strong>μ</strong>ιση της δόσης,<br />
π<strong>α</strong>ρόλο που θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθ<strong>ε</strong>ίτ<strong>α</strong>ι η ν<strong>ε</strong>φρική λ<strong>ε</strong>ιτουργί<strong>α</strong>.<br />
Σ<strong>ε</strong> ορισ<strong>μ</strong>ένους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς, η <strong>ε</strong><strong>μ</strong>φάνιση υπότ<strong>α</strong>σης στην <strong>α</strong>ρχή της<br />
θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> έν<strong>α</strong>ν <strong>α</strong>ν<strong>α</strong>στολέ<strong>α</strong> του ΜΕΑ <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> οδηγήσ<strong>ε</strong>ι σ<strong>ε</strong> <strong>ε</strong>λ<strong>α</strong>φρά<br />
<strong>ε</strong>πιπλέον <strong>ε</strong>πιβάρυνση της ν<strong>ε</strong>φρικής λ<strong>ε</strong>ιτουργί<strong>α</strong>ς. Υπό <strong>α</strong>υτές τις<br />
συνθήκ<strong>ε</strong>ς, έχουν π<strong>α</strong>ρ<strong>α</strong>τηρηθ<strong>ε</strong>ί π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις οξ<strong>ε</strong>ί<strong>α</strong>ς ν<strong>ε</strong>φρικής<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>ς, που γ<strong>ε</strong>νικά <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>στρέψι<strong>μ</strong><strong>ε</strong>ς. Δ<strong>ε</strong>ν υπάρχ<strong>ε</strong>ι <strong>ε</strong><strong>μ</strong>π<strong>ε</strong>ιρί<strong>α</strong><br />
όσον <strong>α</strong>φορά τη χορήγηση του ENEAS σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που έχουν<br />
υποβληθ<strong>ε</strong>ί πρόσφ<strong>α</strong>τ<strong>α</strong> σ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>τ<strong>α</strong><strong>μ</strong>όσχ<strong>ε</strong>υση ν<strong>ε</strong>φρού. Πρωτ<strong>ε</strong>ϊνουρί<strong>α</strong>:<br />
Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> προϋπάρχουσ<strong>α</strong> ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> σπ<strong>α</strong>νίως<br />
<strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νισθ<strong>ε</strong>ί πρωτ<strong>ε</strong>ϊνουρί<strong>α</strong>. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> κλινικά<br />
ση<strong>μ</strong><strong>α</strong>ντική πρωτ<strong>ε</strong>ϊνουρί<strong>α</strong> (<strong>μ</strong><strong>ε</strong>γ<strong>α</strong>λύτ<strong>ε</strong>ρη <strong>α</strong>πό 1 g/η<strong>μ</strong>έρ<strong>α</strong>), το ENEAS<br />
θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> χρησι<strong>μ</strong>οποι<strong>ε</strong>ίτ<strong>α</strong>ι <strong>μ</strong>όνο <strong>μ</strong><strong>ε</strong>τά <strong>α</strong>πό <strong>ε</strong>κτί<strong>μ</strong>ηση της σχέσης<br />
οφέλους - κινδύνου κ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> τ<strong>α</strong>κτική π<strong>α</strong>ρ<strong>α</strong>κολούθηση των κλινικών<br />
κ<strong>α</strong>ι <strong>ε</strong>ργ<strong>α</strong>στηρι<strong>α</strong>κών βιοχη<strong>μ</strong>ικών π<strong>α</strong>ρ<strong>α</strong><strong>μ</strong>έτρων. Ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>:<br />
Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ήπι<strong>α</strong> έως <strong>μ</strong>έτρι<strong>α</strong> ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> δ<strong>ε</strong>ν<br />
<strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυντ<strong>α</strong>ι ούτ<strong>ε</strong> η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη ούτ<strong>ε</strong> η νιτρ<strong>ε</strong>νδιπίνη ως<br />
<strong>μ</strong>ονοθ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>, <strong>α</strong>λλά κ<strong>α</strong>θώς δ<strong>ε</strong>ν υπάρχ<strong>ε</strong>ι <strong>ε</strong><strong>μ</strong>π<strong>ε</strong>ιρί<strong>α</strong> σχ<strong>ε</strong>τικά <strong>μ</strong><strong>ε</strong> τη<br />
χορήγηση του ENEAS σ<strong>ε</strong> <strong>α</strong>υτές τις π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις, ότ<strong>α</strong>ν υπάρχ<strong>ε</strong>ι ένδ<strong>ε</strong>ιξη,<br />
το φάρ<strong>μ</strong><strong>α</strong>κο θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> δίδ<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> προσοχή σ<strong>ε</strong> <strong>α</strong>υτούς τους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς.<br />
Το ENEAS <strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ηπ<strong>α</strong>τική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>.<br />
Η <strong>α</strong>πο<strong>μ</strong>άκρυνση της νιτρ<strong>ε</strong>νδιπίνης <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>πιβρ<strong>α</strong>δυνθ<strong>ε</strong>ί <strong>ε</strong>ξ<strong>α</strong>ιτί<strong>α</strong>ς<br />
της ηπ<strong>α</strong>τικής <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>ς ιδίως στους ηλικιω<strong>μ</strong>ένους κ<strong>α</strong>ι <strong>α</strong>υτό<br />
<strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι <strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητη υπότ<strong>α</strong>ση. Επ<strong>ε</strong>ιδή σ<strong>ε</strong> <strong>μ</strong><strong>ε</strong><strong>μ</strong>ονω<strong>μ</strong>έν<strong>ε</strong>ς<br />
π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις έχ<strong>ε</strong>ι π<strong>ε</strong>ριγρ<strong>α</strong>φ<strong>ε</strong>ί σύνδρο<strong>μ</strong>ο που ξ<strong>ε</strong>κινά <strong>μ</strong><strong>ε</strong> χολοστ<strong>α</strong>τικό<br />
ίκτ<strong>ε</strong>ρο κ<strong>α</strong>ι <strong>ε</strong>ξ<strong>ε</strong>λίσσ<strong>ε</strong>τ<strong>α</strong>ι σ<strong>ε</strong> προοδ<strong>ε</strong>υτική νέκρωση του ήπ<strong>α</strong>τος <strong>μ</strong><strong>ε</strong> <strong>μ</strong>οιρ<strong>α</strong>ί<strong>α</strong><br />
κ<strong>α</strong>τάληξη, <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>γκ<strong>α</strong>ί<strong>α</strong> η δι<strong>α</strong>κοπή της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς κ<strong>α</strong>ι η π<strong>α</strong>ρ<strong>α</strong>κολούθηση<br />
των <strong>α</strong>σθ<strong>ε</strong>νών σ<strong>ε</strong> π<strong>ε</strong>ρίπτωση ίκτ<strong>ε</strong>ρου ή <strong>α</strong>ξιοση<strong>μ</strong><strong>ε</strong>ίωτης <strong>α</strong>ύξησης των<br />
<strong>ε</strong>νζύ<strong>μ</strong>ων του ήπ<strong>α</strong>τος. Ν<strong>ε</strong>φρ<strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κή υπέρτ<strong>α</strong>ση /στένωση των<br />
ν<strong>ε</strong>φρικών <strong>α</strong>ρτηριών : Υπάρχ<strong>ε</strong>ι <strong>α</strong>υξη<strong>μ</strong>ένος κίνδυνος γι<strong>α</strong> σοβ<strong>α</strong>ρή<br />
υπότ<strong>α</strong>ση κ<strong>α</strong>ι ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> ότ<strong>α</strong>ν χορηγούντ<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του<br />
ΜΕΑ σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ν<strong>ε</strong>φρ<strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κή υπέρτ<strong>α</strong>ση, προϋπάρχουσ<strong>α</strong><br />
<strong>α</strong><strong>μ</strong>φοτ<strong>ε</strong>ρόπλ<strong>ε</strong>υρη στένωση των ν<strong>ε</strong>φρικών <strong>α</strong>ρτηριών ή <strong>ε</strong>τ<strong>ε</strong>ρόπλ<strong>ε</strong>υρη<br />
στένωση της ν<strong>ε</strong>φρικής <strong>α</strong>ρτηρί<strong>α</strong>ς <strong>ε</strong>πί <strong>μ</strong>ονήρους λ<strong>ε</strong>ιτουργούντος<br />
ν<strong>ε</strong>φρού. Απώλ<strong>ε</strong>ι<strong>α</strong> ν<strong>ε</strong>φρικής λ<strong>ε</strong>ιτουργί<strong>α</strong>ς <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νιστ<strong>ε</strong>ί <strong>μ</strong><strong>ε</strong><br />
<strong>μ</strong>ικρές <strong>μ</strong>όνο <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βολές της κρ<strong>ε</strong><strong>α</strong>τινίνης του ορού, <strong>α</strong>κό<strong>μ</strong><strong>α</strong> κ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς<br />
<strong>μ</strong><strong>ε</strong> <strong>ε</strong>τ<strong>ε</strong>ρόπλ<strong>ε</strong>υρη στένωση της ν<strong>ε</strong>φρικής <strong>α</strong>ρτηρί<strong>α</strong>ς. Υπ<strong>ε</strong>ρκ<strong>α</strong>λι<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong>:<br />
Οι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς ΜΕΑ <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσουν <strong>α</strong>ύξηση των <strong>ε</strong>πιπέδων<br />
κ<strong>α</strong>λίου του ορού, <strong>ε</strong>ιδικά σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ν<strong>ε</strong>φρική κ<strong>α</strong>ι /ή κ<strong>α</strong>ρδι<strong>α</strong>κή<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>. Έτσι, δ<strong>ε</strong>ν συνιστάτ<strong>α</strong>ι η χορήγηση κ<strong>α</strong>λιοπροστ<strong>α</strong>τ<strong>ε</strong>υτικών<br />
διουρητικών ή συ<strong>μ</strong>πληρω<strong>μ</strong>άτων κ<strong>α</strong>λίου. Εάν <strong>α</strong>ποδ<strong>ε</strong>ιχτ<strong>ε</strong>ί πως η<br />
σύγχρονη χρήση <strong>α</strong>υτών των ουσιών <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>γκ<strong>α</strong>ί<strong>α</strong>, τότ<strong>ε</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
π<strong>α</strong>ρ<strong>α</strong>κολουθούντ<strong>α</strong>ι τ<strong>α</strong> <strong>ε</strong>πίπ<strong>ε</strong>δ<strong>α</strong> κ<strong>α</strong>λίου στον ορό.Υπότ<strong>α</strong>ση: Σ<strong>ε</strong><br />
ορισ<strong>μ</strong>έν<strong>ε</strong>ς π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις, το ENEAS <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι ορθοστ<strong>α</strong>τική<br />
υπότ<strong>α</strong>ση κ<strong>α</strong>ι ο κίνδυνος <strong>α</strong>υτός <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>υξη<strong>μ</strong>ένος σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
<strong>ε</strong>ν<strong>ε</strong>ργοποιη<strong>μ</strong>ένο σύστη<strong>μ</strong><strong>α</strong> ρ<strong>ε</strong>νίνης-<strong>α</strong>γγ<strong>ε</strong>ιοτ<strong>α</strong>σίνης - <strong>α</strong>λδοστ<strong>ε</strong>ρόνης,<br />
όπως συ<strong>μ</strong>β<strong>α</strong>ίν<strong>ε</strong>ι σ<strong>ε</strong> π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις <strong>ε</strong>λλ<strong>ε</strong>ί<strong>μ</strong><strong>μ</strong><strong>α</strong>τος όγκου ή χλωριούχου<br />
ν<strong>α</strong>τρίου, λόγω χρήσης διουρητικών, άν<strong>α</strong>λης δί<strong>α</strong>ιτ<strong>α</strong>ς, <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρσης,<br />
διάρροι<strong>α</strong>ς ή <strong>ε</strong><strong>μ</strong>έτων· σ<strong>ε</strong> π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις <strong>ε</strong>λ<strong>α</strong>ττω<strong>μ</strong>ένης λ<strong>ε</strong>ιτουργί<strong>α</strong>ς της<br />
<strong>α</strong>ριστ<strong>ε</strong>ράς κοιλί<strong>α</strong>ς· σ<strong>ε</strong> ν<strong>ε</strong>φρ<strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κή υπέρτ<strong>α</strong>ση. Σ<strong>ε</strong> <strong>α</strong>υτούς τους<br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς θ<strong>α</strong> πρέπ<strong>ε</strong>ι πρώτ<strong>α</strong> ν<strong>α</strong> διορθών<strong>ε</strong>τ<strong>α</strong>ι το έλλ<strong>ε</strong>ι<strong>μ</strong><strong>μ</strong><strong>α</strong> όγκου ή<br />
χλωριούχου ν<strong>α</strong>τρίου. Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> κ<strong>α</strong>ρδι<strong>α</strong>κή <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, <strong>μ</strong><strong>ε</strong> ή<br />
χωρίς συνυπάρχουσ<strong>α</strong> ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νιστ<strong>ε</strong>ί<br />
συ<strong>μ</strong>πτω<strong>μ</strong><strong>α</strong>τική υπότ<strong>α</strong>ση. Η <strong>ε</strong><strong>μ</strong>φάνιση υπότ<strong>α</strong>σης σ΄<strong>α</strong>υτούς τους<br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>ε</strong>ίν<strong>α</strong>ι πιθ<strong>α</strong>νότ<strong>ε</strong>ρη <strong>ε</strong>άν υπάρχ<strong>ε</strong>ι σοβ<strong>α</strong>ρού β<strong>α</strong>θ<strong>μ</strong>ού κ<strong>α</strong>ρδι<strong>α</strong>κή<br />
<strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, χρήση <strong>μ</strong><strong>ε</strong>γάλων δόσ<strong>ε</strong>ων διουρητικών της <strong>α</strong>γκύλης,<br />
υπον<strong>α</strong>τρι<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong> ή ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>. Στην <strong>α</strong>ρχή της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς θ<strong>α</strong><br />
πρέπ<strong>ε</strong>ι ν<strong>α</strong> γίν<strong>ε</strong>τ<strong>α</strong>ι στ<strong>ε</strong>νή π<strong>α</strong>ρ<strong>α</strong>κολούθηση των συγκ<strong>ε</strong>κρι<strong>μ</strong>ένων<br />
<strong>α</strong>σθ<strong>ε</strong>νών. Αυτές οι συστάσ<strong>ε</strong>ις <strong>ε</strong>φ<strong>α</strong>ρ<strong>μ</strong>όζοντ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
ισχ<strong>α</strong>ι<strong>μ</strong>ική κ<strong>α</strong>ρδιοπάθ<strong>ε</strong>ι<strong>α</strong> ή <strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κή <strong>ε</strong>γκ<strong>ε</strong>φ<strong>α</strong>λική νόσο, γι<strong>α</strong> τους<br />
οποίους <strong>μ</strong>ί<strong>α</strong> υπ<strong>ε</strong>ρβολική <strong>ε</strong>λάττωση της <strong>α</strong>ρτηρι<strong>α</strong>κής πί<strong>ε</strong>σης θ<strong>α</strong><br />
<strong>μ</strong>πορούσ<strong>ε</strong> ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι έ<strong>μ</strong>φρ<strong>α</strong>γ<strong>μ</strong><strong>α</strong> <strong>μ</strong>υοκ<strong>α</strong>ρδίου ή <strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κό<br />
<strong>ε</strong>γκ<strong>ε</strong>φ<strong>α</strong>λικό <strong>ε</strong>π<strong>ε</strong>ισόδιο. Εάν <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νιστ<strong>ε</strong>ί υπότ<strong>α</strong>ση, ο <strong>α</strong>σθ<strong>ε</strong>νής θ<strong>α</strong> πρέπ<strong>ε</strong>ι<br />
ν<strong>α</strong> τοποθ<strong>ε</strong>τηθ<strong>ε</strong>ί σ<strong>ε</strong> κ<strong>α</strong>τ<strong>α</strong>κ<strong>ε</strong>κλι<strong>μ</strong>ένη θέση κ<strong>α</strong>ι, <strong>ε</strong>άν <strong>α</strong>π<strong>α</strong>ιτ<strong>ε</strong>ίτ<strong>α</strong>ι, ν<strong>α</strong> του<br />
χορηγηθ<strong>ε</strong>ί <strong>ε</strong>νδοφλ<strong>ε</strong>βίως ισότονο διάλυ<strong>μ</strong><strong>α</strong> χλωριούχου ν<strong>α</strong>τρίου.<br />
Μι<strong>α</strong> π<strong>α</strong>ροδική υποτ<strong>α</strong>σική <strong>α</strong>ντίδρ<strong>α</strong>ση δ<strong>ε</strong>ν <strong>α</strong>ποτ<strong>ε</strong>λ<strong>ε</strong>ί <strong>α</strong>ντένδ<strong>ε</strong>ιξη γι<strong>α</strong><br />
τη συνέχιση της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> ENEAS, η οποί<strong>α</strong> γ<strong>ε</strong>νικά δ<strong>ε</strong>ν π<strong>α</strong>ρουσιάζ<strong>ε</strong>ι<br />
δυσκολί<strong>ε</strong>ς ότ<strong>α</strong>ν <strong>α</strong>ποκ<strong>α</strong>τ<strong>α</strong>στ<strong>α</strong>θούν ο κυκλοφορών όγκος κ<strong>α</strong>ι η<br />
<strong>α</strong>ρτηρι<strong>α</strong>κή πί<strong>ε</strong>ση. Απόφρ<strong>α</strong>ξη χώρου <strong>ε</strong>ξώθησης: Σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
<strong>α</strong>πόφρ<strong>α</strong>ξη του χώρου <strong>ε</strong>ξώθησης της <strong>α</strong>ριστ<strong>ε</strong>ράς κοιλί<strong>α</strong>ς, η χρήση<br />
των <strong>α</strong>ν<strong>α</strong>στολέων ΜΕΑ θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> γίν<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> προσοχή. Εάν η <strong>α</strong>πόφρ<strong>α</strong>ξη<br />
<strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>ι<strong>μ</strong>οδυν<strong>α</strong><strong>μ</strong>ικά ση<strong>μ</strong><strong>α</strong>ντική, τότ<strong>ε</strong> η <strong>μ</strong>ηλ<strong>ε</strong>ϊνική <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη<br />
<strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι . Βήχ<strong>α</strong>ς: Έχ<strong>ε</strong>ι <strong>α</strong>ν<strong>α</strong>φ<strong>ε</strong>ρθ<strong>ε</strong>ί βήχ<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> τη χρήση<br />
<strong>α</strong>ν<strong>α</strong>στολέων του ΜΕΑ. Πρόκ<strong>ε</strong>ιτ<strong>α</strong>ι γι<strong>α</strong> <strong>μ</strong>η π<strong>α</strong>ρ<strong>α</strong>γωγικό <strong>ε</strong>πί<strong>μ</strong>ονο βήχ<strong>α</strong><br />
που <strong>ε</strong>ξ<strong>α</strong>φ<strong>α</strong>νίζ<strong>ε</strong>τ<strong>α</strong>ι ότ<strong>α</strong>ν δι<strong>α</strong>κόπτ<strong>ε</strong>τ<strong>α</strong>ι η θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>. Πρωτοπ<strong>α</strong>θής<br />
υπ<strong>ε</strong>ρ<strong>α</strong>λδοστ<strong>ε</strong>ρινισ<strong>μ</strong>ός: Κ<strong>α</strong>τά κ<strong>α</strong>νόν<strong>α</strong>, οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> πρωτοπ<strong>α</strong>θή<br />
υπ<strong>ε</strong>ρ<strong>α</strong>λδοστ<strong>ε</strong>ρινισ<strong>μ</strong>ό δ<strong>ε</strong>ν <strong>α</strong>ντ<strong>α</strong>ποκρίνοντ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σικούς<br />
π<strong>α</strong>ράγοντ<strong>ε</strong>ς των οποίων η δράση β<strong>α</strong>σίζ<strong>ε</strong>τ<strong>α</strong>ι στην <strong>α</strong>ν<strong>α</strong>στολή του<br />
συστή<strong>μ</strong><strong>α</strong>τος ρ<strong>ε</strong>νίνης-<strong>α</strong>γγ<strong>ε</strong>ιοτ<strong>α</strong>σίνης. Έτσι, δ<strong>ε</strong>ν συνιστάτ<strong>α</strong>ι η χορήγηση<br />
της <strong>μ</strong>ηλ<strong>ε</strong>ϊνικής <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλης. Ασθ<strong>ε</strong>ν<strong>ε</strong>ίς που υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong><br />
<strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση: Η σύγχρονη χρήση του ENEAS κ<strong>α</strong>ι πολυ<strong>μ</strong><strong>ε</strong>ρών<br />
(<strong>α</strong>κρυλονιτρίλιο, 2- <strong>μ</strong><strong>ε</strong>θυλοάλλυλο σουλφονικό νάτριο) <strong>μ</strong><strong>ε</strong><strong>μ</strong>βρ<strong>α</strong>νών<br />
υψηλής ροής (π.χ. "AN 69") σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong><br />
<strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι <strong>α</strong>π<strong>ε</strong>ιλητικές γι<strong>α</strong> τη ζωή<br />
<strong>α</strong>ν<strong>α</strong>φυλ<strong>α</strong>κτο<strong>ε</strong>ιδ<strong>ε</strong>ίς <strong>α</strong>ντιδράσ<strong>ε</strong>ις όπως οίδη<strong>μ</strong><strong>α</strong> του προσώπου,<br />
<strong>ε</strong>ρυθρότητ<strong>α</strong>, υπότ<strong>α</strong>ση κ<strong>α</strong>ι δύσπνοι<strong>α</strong> <strong>μ</strong>έσ<strong>α</strong> σ<strong>ε</strong> λίγ<strong>α</strong> λ<strong>ε</strong>πτά <strong>α</strong>πό την<br />
έν<strong>α</strong>ρξη της <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρσης. Συν<strong>ε</strong>πώς, <strong>α</strong>υτός ο συνδυ<strong>α</strong>σ<strong>μ</strong>ός πρέπ<strong>ε</strong>ι<br />
ν<strong>α</strong> <strong>α</strong>ποφ<strong>ε</strong>ύγ<strong>ε</strong>τ<strong>α</strong>ι. Το ENEAS <strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που<br />
υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση. Αν<strong>α</strong>φυλ<strong>α</strong>κτο<strong>ε</strong>ιδ<strong>ε</strong>ίς <strong>α</strong>ντιδράσ<strong>ε</strong>ις<br />
κ<strong>α</strong>τά την <strong>α</strong>φ<strong>α</strong>ίρ<strong>ε</strong>ση LDL/κ<strong>α</strong>τά την <strong>α</strong>π<strong>ε</strong>υ<strong>α</strong>ισθητοποίηση <strong>α</strong>πό υ<strong>μ</strong><strong>ε</strong>νόπτ<strong>ε</strong>ρ<strong>α</strong>:<br />
Ασθ<strong>ε</strong>ν<strong>ε</strong>ίς σ<strong>ε</strong> υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong> <strong>α</strong>φ<strong>α</strong>ίρ<strong>ε</strong>ση λιποπρωτ<strong>ε</strong>ϊνών χ<strong>α</strong><strong>μ</strong>ηλής<br />
πυκνότητ<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> θ<strong>ε</strong>ιική δ<strong>ε</strong>ξτράνη <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>κδηλώσουν<br />
<strong>α</strong>ν<strong>α</strong>φυλ<strong>α</strong>κτο<strong>ε</strong>ιδ<strong>ε</strong>ίς <strong>α</strong>ντιδράσ<strong>ε</strong>ις <strong>ε</strong>πικίνδυν<strong>ε</strong>ς γι<strong>α</strong> τη ζωή τους ότ<strong>α</strong>ν<br />
λάβουν <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ. Ασθ<strong>ε</strong>ν<strong>ε</strong>ίς που λ<strong>α</strong><strong>μ</strong>βάνουν έν<strong>α</strong>ν<br />
<strong>α</strong>ν<strong>α</strong>στολέ<strong>α</strong> του ΜΕΑ κ<strong>α</strong>τά τη διάρκ<strong>ε</strong>ι<strong>α</strong> <strong>ε</strong>ιδικής <strong>α</strong>νοσοθ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς<br />
(<strong>α</strong>π<strong>ε</strong>υ<strong>α</strong>ισθητοποίηση) έν<strong>α</strong>ντι δηλητηρίου <strong>ε</strong>ντό<strong>μ</strong>ων (π.χ. γι<strong>α</strong> το<br />
τσί<strong>μ</strong>πη<strong>μ</strong><strong>α</strong> <strong>μ</strong>έλισσ<strong>α</strong>ς ή σφήκ<strong>α</strong>ς) <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>κδηλώσουν <strong>α</strong>ν<strong>α</strong>φυλ<strong>α</strong>κτο<strong>ε</strong>ιδ<strong>ε</strong>ίς<br />
<strong>α</strong>ντιδράσ<strong>ε</strong>ις (π.χ. πτώση της <strong>α</strong>ρτηρι<strong>α</strong>κής πί<strong>ε</strong>σης, δύσπνοι<strong>α</strong>, έ<strong>μ</strong><strong>ε</strong>το<br />
κ<strong>α</strong>ι δ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τική <strong>α</strong>λλ<strong>ε</strong>ργί<strong>α</strong>), οι οποί<strong>ε</strong>ς σ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>ρικές π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις <strong>μ</strong>πορ<strong>ε</strong>ί<br />
ν<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>π<strong>ε</strong>ιλητικές γι<strong>α</strong> τη ζωή. Αν <strong>α</strong>π<strong>α</strong>ιτ<strong>ε</strong>ίτ<strong>α</strong>ι <strong>α</strong>φ<strong>α</strong>ίρ<strong>ε</strong>ση των LDL<br />
ή <strong>ε</strong>ιδική <strong>α</strong>νοσοθ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> (<strong>α</strong>π<strong>ε</strong>υ<strong>α</strong>ισθητοποίηση) στο δηλητήριο<br />
<strong>ε</strong>ντό<strong>μ</strong>ων, τότ<strong>ε</strong> ο <strong>α</strong>ν<strong>α</strong>στολέ<strong>α</strong>ς του ΜΕΑ θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> <strong>α</strong>ντικ<strong>α</strong>τ<strong>α</strong>στ<strong>α</strong>θ<strong>ε</strong>ί<br />
προσωρινά <strong>μ</strong><strong>ε</strong> έν<strong>α</strong> άλλο φ<strong>α</strong>ρ<strong>μ</strong><strong>α</strong>κ<strong>ε</strong>υτικό προϊόν γι<strong>α</strong> την υπέρτ<strong>α</strong>ση ή<br />
την κ<strong>α</strong>ρδι<strong>α</strong>κή <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>. Χ<strong>ε</strong>ιρουργική <strong>ε</strong>πέ<strong>μ</strong>β<strong>α</strong>ση / Αν<strong>α</strong>ισθησί<strong>α</strong> Σ<strong>ε</strong><br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που υποβάλλοντ<strong>α</strong>ι σ<strong>ε</strong> σοβ<strong>α</strong>ρή χ<strong>ε</strong>ιρουργική <strong>ε</strong>πέ<strong>μ</strong>β<strong>α</strong>ση ή<br />
κ<strong>α</strong>τά τη διάρκ<strong>ε</strong>ι<strong>α</strong> της <strong>α</strong>ν<strong>α</strong>ισθησί<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> π<strong>α</strong>ράγοντ<strong>ε</strong>ς που προκ<strong>α</strong>λούν<br />
υπότ<strong>α</strong>ση, η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη <strong>α</strong>ν<strong>α</strong>στέλλ<strong>ε</strong>ι το σχη<strong>μ</strong><strong>α</strong>τισ<strong>μ</strong>ό της <strong>α</strong>γγ<strong>ε</strong>ιοτ<strong>α</strong>σίνης<br />
ΙΙ που <strong>ε</strong>πιφέρ<strong>ε</strong>ι η <strong>α</strong>ντιστ<strong>α</strong>θ<strong>μ</strong>ιστική <strong>α</strong>π<strong>ε</strong>λ<strong>ε</strong>υθέρωση της ρ<strong>ε</strong>νίνης. Σ<strong>ε</strong><br />
<strong>α</strong>υτές τις π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις, <strong>α</strong>ν <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νισθ<strong>ε</strong>ί υπότ<strong>α</strong>ση κ<strong>α</strong>ι κρίν<strong>ε</strong>τ<strong>α</strong>ι ότι <strong>α</strong>υτό<br />
οφ<strong>ε</strong>ίλ<strong>ε</strong>τ<strong>α</strong>ι στο συγκ<strong>ε</strong>κρι<strong>μ</strong>ένο <strong>μ</strong>ηχ<strong>α</strong>νισ<strong>μ</strong>ό, θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> <strong>α</strong>ποκ<strong>α</strong>θίστ<strong>α</strong>τ<strong>α</strong>ι<br />
<strong>μ</strong><strong>ε</strong> <strong>α</strong>ύξηση του όγκου του πλάσ<strong>μ</strong><strong>α</strong>τος. Γονι<strong>μ</strong>ότητ<strong>α</strong>: Σ<strong>ε</strong> <strong>μ</strong><strong>ε</strong><strong>μ</strong>ονω<strong>μ</strong>έν<strong>ε</strong>ς<br />
π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις in vitro γονι<strong>μ</strong>οποίησης, οι <strong>α</strong>ντ<strong>α</strong>γωνιστές του <strong>α</strong>σβ<strong>ε</strong>στίου<br />
όπως η νιτρ<strong>ε</strong>νδιπίνη έχουν συσχ<strong>ε</strong>τιστ<strong>ε</strong>ί <strong>μ</strong><strong>ε</strong> <strong>α</strong>ν<strong>α</strong>στρέψι<strong>μ</strong><strong>ε</strong>ς βιοχη<strong>μ</strong>ικές<br />
<strong>α</strong>λλ<strong>α</strong>γές στην κ<strong>ε</strong>φ<strong>α</strong>λή των σπ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τοζω<strong>α</strong>ρίων, οι οποί<strong>ε</strong>ς <strong>μ</strong>πορούν<br />
ν<strong>α</strong> οδηγήσουν σ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βολές της σπ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τικής λ<strong>ε</strong>ιτουργί<strong>α</strong>ς. Σ<strong>ε</strong><br />
άνδρ<strong>ε</strong>ς, υπάρχουν π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις <strong>ε</strong>π<strong>α</strong>ν<strong>ε</strong>ιλη<strong>μ</strong><strong>μ</strong>ένης <strong>α</strong>ποτυχί<strong>α</strong>ς<br />
τ<strong>ε</strong>κνοποίησης <strong>μ</strong><strong>ε</strong> in vitro γονι<strong>μ</strong>οποίηση, κ<strong>α</strong>ι ότ<strong>α</strong>ν δ<strong>ε</strong>ν υπάρχ<strong>ε</strong>ι κ<strong>α</strong><strong>μ</strong>ί<strong>α</strong><br />
άλλη <strong>ε</strong>ξήγηση, τότ<strong>ε</strong> οι <strong>α</strong>ντ<strong>α</strong>γωνιστές του <strong>α</strong>σβ<strong>ε</strong>στίου θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
θ<strong>ε</strong>ωρούντ<strong>α</strong>ι ως πιθ<strong>α</strong>νή <strong>α</strong>ιτί<strong>α</strong>. Δι<strong>α</strong>φορές <strong>α</strong>νάλογ<strong>α</strong> <strong>μ</strong><strong>ε</strong> την <strong>ε</strong>θνικότητ<strong>α</strong>:<br />
Όπως κ<strong>α</strong>ι άλλοι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ, έτσι κ<strong>α</strong>ι η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη, έν<strong>α</strong><br />
συστ<strong>α</strong>τικό των στ<strong>α</strong>θ<strong>ε</strong>ρών συνδυ<strong>α</strong>σ<strong>μ</strong>ών, <strong>ε</strong>ίν<strong>α</strong>ι <strong>ε</strong><strong>μ</strong>φ<strong>α</strong>νώς λιγότ<strong>ε</strong>ρο<br />
<strong>α</strong>ποτ<strong>ε</strong>λ<strong>ε</strong>σ<strong>μ</strong><strong>α</strong>τική στη <strong>μ</strong><strong>ε</strong>ίωση της <strong>α</strong>ρτηρι<strong>α</strong>κής πί<strong>ε</strong>σης στη <strong>μ</strong><strong>α</strong>ύρη<br />
φυλή <strong>α</strong>π' όσο στις άλλ<strong>ε</strong>ς, πιθ<strong>α</strong>νώς λόγω του <strong>μ</strong><strong>ε</strong>γ<strong>α</strong>λύτ<strong>ε</strong>ρου<br />
<strong>ε</strong>πιπολ<strong>α</strong>σ<strong>μ</strong>ού της κ<strong>α</strong>τάστ<strong>α</strong>σης χ<strong>α</strong><strong>μ</strong>ηλής ρ<strong>ε</strong>νίνης στους υπ<strong>ε</strong>ρτ<strong>α</strong>σικούς<br />
της <strong>μ</strong><strong>α</strong>ύρης φυλής. Προ<strong>ε</strong>ιδοποιήσ<strong>ε</strong>ις γι<strong>α</strong> έκδοχ<strong>α</strong> Οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> σπάνι<strong>α</strong><br />
κληρονο<strong>μ</strong>ικά προβλή<strong>μ</strong><strong>α</strong>τ<strong>α</strong> όπως δυσ<strong>α</strong>ν<strong>ε</strong>ξί<strong>α</strong> στη γ<strong>α</strong>λ<strong>α</strong>κτόζη, έλλ<strong>ε</strong>ιψη<br />
της λ<strong>α</strong>κτάσης Lapp ή δυσ<strong>α</strong>πορρόφηση γλυκόζης κ<strong>α</strong>ι γ<strong>α</strong>λ<strong>α</strong>κτόζης δ<strong>ε</strong>ν<br />
θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> λ<strong>α</strong><strong>μ</strong>βάνουν <strong>α</strong>υτό το φάρ<strong>μ</strong><strong>α</strong>κο. Αλληλ<strong>ε</strong>πίδρ<strong>α</strong>ση <strong>μ</strong><strong>ε</strong><br />
άλλ<strong>α</strong> φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> ή άλλ<strong>ε</strong>ς <strong>μ</strong>ορφές <strong>α</strong>λληλ<strong>ε</strong>πίδρ<strong>α</strong>σης Η <strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σική<br />
δράση του ENEAS <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>νισχυθ<strong>ε</strong>ί <strong>α</strong>πό άλλ<strong>α</strong> <strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σικά<br />
φ<strong>α</strong>ρ<strong>μ</strong><strong>α</strong>κ<strong>ε</strong>υτικά προϊόντ<strong>α</strong> όπως τ<strong>α</strong> διουρητικά, οι β-<strong>α</strong>δρ<strong>ε</strong>ν<strong>ε</strong>ργικοί<br />
<strong>α</strong>ποκλ<strong>ε</strong>ιστές ή π<strong>α</strong>ράγοντ<strong>ε</strong>ς που <strong>α</strong>ποκλ<strong>ε</strong>ίουν τους <strong>α</strong>-<strong>α</strong>δρ<strong>ε</strong>ν<strong>ε</strong>ργικούς<br />
υποδοχ<strong>ε</strong>ίς όπως <strong>ε</strong>ίν<strong>α</strong>ι η πρ<strong>α</strong>ζοσίνη. Επιπλέον, κάποι<strong>α</strong> <strong>α</strong>πό τ<strong>α</strong><br />
συστ<strong>α</strong>τικά του συνδυ<strong>α</strong>σ<strong>μ</strong>ού <strong>μ</strong>πορούν ν<strong>α</strong> προκ<strong>α</strong>λέσουν τις <strong>α</strong>κόλουθ<strong>ε</strong>ς<br />
<strong>α</strong>λληλ<strong>ε</strong>πιδράσ<strong>ε</strong>ις: Μηλ<strong>ε</strong>ϊνική Εν<strong>α</strong>λ<strong>α</strong>πρίλη Συνδυ<strong>α</strong>σ<strong>μ</strong>οί που <strong>α</strong>π<strong>α</strong>ιτούν<br />
προφυλάξ<strong>ε</strong>ις κ<strong>α</strong>τά τη χρήση: Κ<strong>α</strong>λιοσυντηρητικά διουρητικά ή<br />
συ<strong>μ</strong>πληρώ<strong>μ</strong><strong>α</strong>τ<strong>α</strong> κ<strong>α</strong>λίου: Οι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ <strong>ε</strong>λ<strong>α</strong>ττώνουν την <strong>α</strong>πώλ<strong>ε</strong>ι<strong>α</strong><br />
κ<strong>α</strong>λίου που προκ<strong>α</strong>λούν τ<strong>α</strong> διουρητικά. Τ<strong>α</strong> κ<strong>α</strong>λιοσυντηρητικά διουρητικά,<br />
τ<strong>α</strong> συ<strong>μ</strong>πληρώ<strong>μ</strong><strong>α</strong>τ<strong>α</strong> κ<strong>α</strong>λίου κ<strong>α</strong>ι άλλ<strong>α</strong> φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> που <strong>μ</strong>πορούν ν<strong>α</strong><br />
<strong>α</strong>υξήσουν τ<strong>α</strong> <strong>ε</strong>πίπ<strong>ε</strong>δ<strong>α</strong> κ<strong>α</strong>λίου στον ορό (π.χ. ηπ<strong>α</strong>ρίνη) <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> έχουν<br />
<strong>α</strong>θροιστική <strong>ε</strong>πίδρ<strong>α</strong>ση στο κάλιο του ορού, <strong>ε</strong>ιδικά σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>. Εάν. λόγω <strong>α</strong>ποδ<strong>ε</strong>δ<strong>ε</strong>ιγ<strong>μ</strong>ένης υποκ<strong>α</strong>λι<strong>α</strong>ι<strong>μ</strong>ί<strong>α</strong>ς,<br />
<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι η σύγχρονη τους χρήση τους, τότ<strong>ε</strong> θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
χρησι<strong>μ</strong>οποιούντ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> προσοχή κ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> συχνή π<strong>α</strong>ρ<strong>α</strong>κολούθηση του<br />
κ<strong>α</strong>λίου του ορού. Λίθιο: Ο συνδυ<strong>α</strong>σ<strong>μ</strong>ός <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλης κ<strong>α</strong>ι λιθίου<br />
δ<strong>ε</strong>ν πρέπ<strong>ε</strong>ι ν<strong>α</strong> συνιστάτ<strong>α</strong>ι, κ<strong>α</strong>θώς υπάρχ<strong>ε</strong>ι κίνδυνος <strong>μ</strong><strong>ε</strong>γάλης<br />
<strong>α</strong>ύξησης των <strong>ε</strong>πιπέδων του λιθίου στον ορό, <strong>μ</strong><strong>ε</strong> σοβ<strong>α</strong>ρή ν<strong>ε</strong>υροτοξικότητ<strong>α</strong>.<br />
Εάν χορηγ<strong>ε</strong>ίτ<strong>α</strong>ι συγχρόνως θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong><strong>ε</strong> άλ<strong>α</strong>τ<strong>α</strong> λιθίου, οι συγκ<strong>ε</strong>ντρώσ<strong>ε</strong>ις<br />
λιθίου στον ορό θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθούντ<strong>α</strong>ι στ<strong>ε</strong>νά. Μη<br />
στ<strong>ε</strong>ρο<strong>ε</strong>ιδή <strong>α</strong>ντιφλ<strong>ε</strong>γ<strong>μ</strong>ονώδη: Τ<strong>α</strong> <strong>μ</strong>η στ<strong>ε</strong>ρο<strong>ε</strong>ιδή <strong>α</strong>ντιφλ<strong>ε</strong>γ<strong>μ</strong>ονώδη<br />
φ<strong>α</strong>ρ<strong>μ</strong><strong>α</strong>κ<strong>ε</strong>υτικά προϊόντ<strong>α</strong> κ<strong>α</strong>ι οι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ έχουν <strong>α</strong>θροιστική<br />
δράση στην <strong>α</strong>ύξηση του κ<strong>α</strong>λίου στον ορό, <strong>ε</strong>νώ <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>λ<strong>α</strong>ττωθ<strong>ε</strong>ί<br />
η ν<strong>ε</strong>φρική λ<strong>ε</strong>ιτουργί<strong>α</strong>. Ότ<strong>α</strong>ν χορηγ<strong>ε</strong>ίτ<strong>α</strong>ι <strong>α</strong>υτός ο συνδυ<strong>α</strong>σ<strong>μ</strong>ός σ<strong>ε</strong><br />
ηλικιω<strong>μ</strong>ένους κ<strong>α</strong>ι/ή <strong>α</strong>φυδ<strong>α</strong>τω<strong>μ</strong>ένους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς, <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκληθ<strong>ε</strong>ί<br />
οξ<strong>ε</strong>ί<strong>α</strong> ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> <strong>μ</strong>έσω ά<strong>μ</strong><strong>ε</strong>σης δράσης στη ν<strong>ε</strong>φρική<br />
σπ<strong>ε</strong>ιρ<strong>α</strong><strong>μ</strong><strong>α</strong>τική διήθηση. Επιπλέον, η σύγχρονη θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong><br />
<strong>μ</strong><strong>ε</strong>ιώσ<strong>ε</strong>ι την <strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σική δράση των ΑΜΕΑ. Αντιδι<strong>α</strong>βητικά <strong>α</strong>πό<br />
το στό<strong>μ</strong><strong>α</strong> : Η χορήγηση <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλης <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>νισχύσ<strong>ε</strong>ι την<br />
υπογλυκ<strong>α</strong>ι<strong>μ</strong>ική δράση <strong>α</strong>υτών των ουσιών, συν<strong>ε</strong>πώς η π<strong>α</strong>ρ<strong>α</strong>κολούθηση<br />
της γλυκόζης στο <strong>α</strong>ί<strong>μ</strong><strong>α</strong> θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> γίν<strong>ε</strong>ι στ<strong>ε</strong>νότ<strong>ε</strong>ρη. Β<strong>α</strong>κλοφ<strong>α</strong>ίνη:<br />
Μπορ<strong>ε</strong>ί ν<strong>α</strong> <strong>α</strong>υξήσ<strong>ε</strong>ι την <strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σική δράση. Εάν <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>γκ<strong>α</strong>ί<strong>α</strong>,<br />
θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθ<strong>ε</strong>ίτ<strong>α</strong>ι η <strong>α</strong>ρτηρι<strong>α</strong>κή πί<strong>ε</strong>ση κ<strong>α</strong>ι ν<strong>α</strong> ρυθ<strong>μ</strong>ίζ<strong>ε</strong>τ<strong>α</strong>ι<br />
η δόση. Αντιψυχωτικά: Η συγχορήγηση <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι<br />
ορθοστ<strong>α</strong>τική υπότ<strong>α</strong>ση. Αντικ<strong>α</strong>τ<strong>α</strong>θλιπτικά: Η συγχορήγηση <strong>μ</strong>πορ<strong>ε</strong>ί<br />
ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι ορθοστ<strong>α</strong>τική υπότ<strong>α</strong>ση. Αλλοπουρινόλη, κυττ<strong>α</strong>ροστ<strong>α</strong>τικά,<br />
<strong>α</strong>νοσοκ<strong>α</strong>τ<strong>α</strong>στ<strong>α</strong>λτικά, συστη<strong>μ</strong><strong>α</strong>τικά κορτικοστ<strong>ε</strong>ρο<strong>ε</strong>ιδή, προκ<strong>α</strong>ϊν<strong>α</strong><strong>μ</strong>ίδη:<br />
Μπορούν ν<strong>α</strong> προκ<strong>α</strong>λέσουν λ<strong>ε</strong>υκοπ<strong>ε</strong>νί<strong>α</strong>. Α<strong>μ</strong>ιφοστίνη: Αυξη<strong>μ</strong>ένη<br />
<strong>α</strong>ντιυπ<strong>ε</strong>ρτ<strong>α</strong>σική δράση. Συνδυ<strong>α</strong>σ<strong>μ</strong>οί που θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> λ<strong>α</strong><strong>μ</strong>βάνοντ<strong>α</strong>ι<br />
υπόψη Νιτρ<strong>ε</strong>νδιπίνη Σι<strong>μ</strong><strong>ε</strong>τιδίνη κ<strong>α</strong>ι ρ<strong>α</strong>νιτιδίνη: Η σι<strong>μ</strong><strong>ε</strong>τιδίνη, κ<strong>α</strong>ι σ<strong>ε</strong><br />
έν<strong>α</strong> <strong>μ</strong>ικρότ<strong>ε</strong>ρο β<strong>α</strong>θ<strong>μ</strong>ό η ρ<strong>α</strong>νιτιδίνη, <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>α</strong>υξήσ<strong>ε</strong>ι τ<strong>α</strong> <strong>ε</strong>πίπ<strong>ε</strong>δ<strong>α</strong><br />
της νιτρ<strong>ε</strong>νδιπίνης στο πλάσ<strong>μ</strong><strong>α</strong> <strong>α</strong>λλά η κλινική ση<strong>μ</strong><strong>α</strong>σί<strong>α</strong> <strong>α</strong>υτών των<br />
<strong>ε</strong>πιδράσ<strong>ε</strong>ων δ<strong>ε</strong>ν <strong>ε</strong>ίν<strong>α</strong>ι γνωστή. Διγοξίνη: Η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη έχ<strong>ε</strong>ι<br />
χορηγηθ<strong>ε</strong>ί σ<strong>ε</strong> συνδυ<strong>α</strong>σ<strong>μ</strong>ό <strong>μ</strong><strong>ε</strong> διγοξίνη δίχως ν<strong>α</strong> υπάρξουν κλινικά<br />
ση<strong>μ</strong><strong>α</strong>ντικές <strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>α</strong>λληλ<strong>ε</strong>πιδράσ<strong>ε</strong>ις. Η τ<strong>α</strong>υτόχρονη χορήγηση<br />
νιτρ<strong>ε</strong>νδιπίνης κ<strong>α</strong>ι διγοξίνης <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι <strong>α</strong>ύξηση των<br />
<strong>ε</strong>πιπέδων της διγοξίνης στο πλάσ<strong>μ</strong><strong>α</strong>. Συν<strong>ε</strong>πώς, οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς θ<strong>α</strong> πρέπ<strong>ε</strong>ι<br />
ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθούντ<strong>α</strong>ι γι<strong>α</strong> συ<strong>μ</strong>πτώ<strong>μ</strong><strong>α</strong>τ<strong>α</strong> υπ<strong>ε</strong>ρδοσολογί<strong>α</strong>ς διγοξίνης<br />
ή, κ<strong>α</strong>λύτ<strong>ε</strong>ρ<strong>α</strong>, ν<strong>α</strong> π<strong>α</strong>ρ<strong>α</strong>κολουθούντ<strong>α</strong>ι τ<strong>α</strong> <strong>ε</strong>πίπ<strong>ε</strong>δ<strong>α</strong> διγοξίνης στο<br />
πλάσ<strong>μ</strong><strong>α</strong>. Μυοχ<strong>α</strong>λ<strong>α</strong>ρωτικά: Η χορήγηση νιτρ<strong>ε</strong>νδιπίνης <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong><br />
<strong>ε</strong>νισχύσ<strong>ε</strong>ι τη διάρκ<strong>ε</strong>ι<strong>α</strong> κ<strong>α</strong>ι την έντ<strong>α</strong>ση στη δράση των <strong>μ</strong>υοχ<strong>α</strong>λ<strong>α</strong>ρωτικών<br />
όπως το π<strong>α</strong>νκουρόνιο. Χυ<strong>μ</strong>ός γκρέιπφρουτ: Ο χυ<strong>μ</strong>ός γκρέιπφρουτ<br />
<strong>α</strong>ν<strong>α</strong>στέλλ<strong>ε</strong>ι τον οξ<strong>ε</strong>ιδωτικό <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βολισ<strong>μ</strong>ό της νιτρ<strong>ε</strong>νδιπίνης. Η<br />
τ<strong>α</strong>υτόχρονη λήψη <strong>α</strong>υτής <strong>μ</strong><strong>α</strong>ζί <strong>μ</strong><strong>ε</strong> χυ<strong>μ</strong>ό γκρέιπφρουτ <strong>α</strong>υξάν<strong>ε</strong>ι τη<br />
συγκέντρωσή της στο πλάσ<strong>μ</strong><strong>α</strong>, γ<strong>ε</strong>γονός που <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>α</strong>υξήσ<strong>ε</strong>ι την<br />
υποτ<strong>α</strong>σική δράση του προϊόντος. Η νιτρ<strong>ε</strong>νδιπίνη <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βολίζ<strong>ε</strong>τ<strong>α</strong>ι<br />
<strong>α</strong>πό το σύστη<strong>μ</strong><strong>α</strong> κυτοχρώ<strong>μ</strong><strong>α</strong>τος P450 3A4, το οποίο βρίσκ<strong>ε</strong>τ<strong>α</strong>ι στο<br />
βλ<strong>ε</strong>ννογόνο του <strong>ε</strong>ντέρου κ<strong>α</strong>ι στο ήπ<strong>α</strong>ρ. Οι δρ<strong>α</strong>στικές ουσί<strong>ε</strong>ς που<br />
<strong>ε</strong>πηρ<strong>ε</strong>άζουν <strong>α</strong>υτό το <strong>ε</strong>νζυ<strong>μ</strong>ικό σύστη<strong>μ</strong><strong>α</strong>, όπως <strong>ε</strong>ίν<strong>α</strong>ι τ<strong>α</strong> <strong>α</strong>ντι<strong>ε</strong>πιληπτικά<br />
(π.χ. φ<strong>α</strong>ινυτοΐνη, φ<strong>α</strong>ινοβ<strong>α</strong>ρβιτάλη, κ<strong>α</strong>ρβ<strong>α</strong><strong>μ</strong><strong>α</strong>ζ<strong>ε</strong>πίνη) κ<strong>α</strong>ι η ριφ<strong>α</strong><strong>μ</strong>πικίνη<br />
<strong>μ</strong>πορούν ν<strong>α</strong> προκ<strong>α</strong>λέσουν <strong>μ</strong><strong>ε</strong>γάλη <strong>ε</strong>λάττωση της βιοδι<strong>α</strong>θ<strong>ε</strong>σι<strong>μ</strong>ότητ<strong>α</strong>ς<br />
της νιτρ<strong>ε</strong>νδιπίνης. Επιπλέον, οι δρ<strong>α</strong>στικές ουσί<strong>ε</strong>ς που <strong>α</strong>ν<strong>α</strong>στέλλουν<br />
<strong>α</strong>υτό το <strong>ε</strong>νζυ<strong>μ</strong>ικό σύστη<strong>μ</strong><strong>α</strong> (π.χ. <strong>α</strong>ντι<strong>μ</strong>υκητι<strong>α</strong>σικές ι<strong>μ</strong>ιδ<strong>α</strong>ζόλ<strong>ε</strong>ς όπως<br />
η ιτρ<strong>α</strong>κον<strong>α</strong>ζόλη κ<strong>α</strong>ι άλλ<strong>ε</strong>ς) <strong>μ</strong>πορούν ν<strong>α</strong> προκ<strong>α</strong>λέσουν <strong>α</strong>υξη<strong>μ</strong>έν<strong>ε</strong>ς<br />
συγκ<strong>ε</strong>ντρώσ<strong>ε</strong>ις νιτρ<strong>ε</strong>νδιπίνης στο πλάσ<strong>μ</strong><strong>α</strong>. β-<strong>α</strong>δρ<strong>ε</strong>ν<strong>ε</strong>ργικοί<br />
<strong>α</strong>ποκλ<strong>ε</strong>ιστές: Η νιτρ<strong>ε</strong>νδιπίνη κ<strong>α</strong>ι οι β-<strong>α</strong>δρ<strong>ε</strong>ν<strong>ε</strong>ργικοί <strong>α</strong>ποκλ<strong>ε</strong>ιστές έχουν<br />
συν<strong>ε</strong>ργική δράση. Αυτό <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> έχ<strong>ε</strong>ι ιδι<strong>α</strong>ίτ<strong>ε</strong>ρη ση<strong>μ</strong><strong>α</strong>σί<strong>α</strong> σ<strong>ε</strong><br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς στους οποίους δ<strong>ε</strong>ν <strong>μ</strong>πορούν ν<strong>α</strong> <strong>α</strong>ντιστ<strong>α</strong>θ<strong>μ</strong>ιστούν <strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κές<br />
<strong>α</strong>ντιδράσ<strong>ε</strong>ις <strong>μ</strong>έσω του συ<strong>μ</strong>π<strong>α</strong>θητικού συστή<strong>μ</strong><strong>α</strong>τος σ<strong>ε</strong> π<strong>ε</strong>ρίπτωση<br />
<strong>ε</strong>πιπρόσθ<strong>ε</strong>της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς <strong>μ</strong><strong>ε</strong> β-<strong>α</strong>δρ<strong>ε</strong>ν<strong>ε</strong>ργικούς <strong>α</strong>ποκλ<strong>ε</strong>ιστές, οπότ<strong>ε</strong><br />
κ<strong>α</strong>ι συνιστάτ<strong>α</strong>ι προσοχή. Κύηση κ<strong>α</strong>ι γ<strong>α</strong>λουχί<strong>α</strong> Κύηση: Το ENEAS<br />
<strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι κ<strong>α</strong>τά τη διάρκ<strong>ε</strong>ι<strong>α</strong> της κύησης. Οι <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ<br />
<strong>μ</strong>πορούν ν<strong>α</strong> προκ<strong>α</strong>λέσουν <strong>ε</strong><strong>μ</strong>βρυική κ<strong>α</strong>ι ν<strong>ε</strong>ογνική νοσηρότητ<strong>α</strong> κ<strong>α</strong>θώς<br />
κ<strong>α</strong>ι θνησι<strong>μ</strong>ότητ<strong>α</strong> ότ<strong>α</strong>ν χορηγούντ<strong>α</strong>ι σ<strong>ε</strong> έγκυ<strong>ε</strong>ς γυν<strong>α</strong>ίκ<strong>ε</strong>ς στο δ<strong>ε</strong>ύτ<strong>ε</strong>ρο<br />
κ<strong>α</strong>ι τρίτο τρί<strong>μ</strong>ηνο. Η χρήση των <strong>α</strong>ν<strong>α</strong>στολέων του ΜΕΑ σ<strong>ε</strong> <strong>α</strong>υτή την<br />
π<strong>ε</strong>ρίοδο έχ<strong>ε</strong>ι συσχ<strong>ε</strong>τισθ<strong>ε</strong>ί <strong>μ</strong><strong>ε</strong> βλάβ<strong>ε</strong>ς του <strong>ε</strong><strong>μ</strong>βρύου κ<strong>α</strong>ι του ν<strong>ε</strong>ογνού,<br />
στις οποί<strong>ε</strong>ς συ<strong>μ</strong>π<strong>ε</strong>ριλ<strong>α</strong><strong>μ</strong>βάνοντ<strong>α</strong>ι υπότ<strong>α</strong>ση, <strong>α</strong>νουρί<strong>α</strong>, <strong>α</strong>ν<strong>α</strong>στρέψι<strong>μ</strong>η<br />
ή <strong>μ</strong>η <strong>α</strong>ν<strong>α</strong>στρέψι<strong>μ</strong>η ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>, κρ<strong>α</strong>νι<strong>α</strong>κή υποπλ<strong>α</strong>σί<strong>α</strong> του<br />
<strong>ε</strong><strong>μ</strong>βρύου κ<strong>α</strong>ι θάν<strong>α</strong>τος. Έχ<strong>ε</strong>ι <strong>α</strong>ν<strong>α</strong>φ<strong>ε</strong>ρθ<strong>ε</strong>ί ολιγοϋδρά<strong>μ</strong>νιο της <strong>μ</strong>ητέρ<strong>α</strong>ς,<br />
το οποίο πιθ<strong>α</strong>νώς <strong>α</strong>ντιπροσωπ<strong>ε</strong>ύ<strong>ε</strong>ι <strong>μ</strong><strong>ε</strong>ίωση της ν<strong>ε</strong>φρικής λ<strong>ε</strong>ιτουργί<strong>α</strong>ς<br />
του <strong>ε</strong><strong>μ</strong>βρύου, κ<strong>α</strong>ι <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> προκ<strong>α</strong>λέσ<strong>ε</strong>ι σύσπ<strong>α</strong>ση των άκρων,<br />
δυσ<strong>μ</strong>ορφί<strong>ε</strong>ς του κρ<strong>α</strong>νίου κ<strong>α</strong>ι του προσώπου κ<strong>α</strong>θώς κ<strong>α</strong>ι <strong>α</strong>νάπτυξη<br />
υποπλ<strong>α</strong>στικών πν<strong>ε</strong>υ<strong>μ</strong>όνων. Επίσης έχουν ση<strong>μ</strong><strong>ε</strong>ιωθ<strong>ε</strong>ί π<strong>ε</strong>ριπτώσ<strong>ε</strong>ις<br />
<strong>α</strong>νωρι<strong>μ</strong>ότητ<strong>α</strong>ς, όπως κ<strong>α</strong>ι κ<strong>α</strong>θυστέρηση της <strong>ε</strong>νδο<strong>μ</strong>ήτρι<strong>α</strong>ς <strong>α</strong>νάπτυξης<br />
κ<strong>α</strong>ι π<strong>α</strong>ρ<strong>α</strong><strong>μ</strong>ονή <strong>α</strong>νοικτού βοτάλλ<strong>ε</strong>ιου πόρου, π<strong>α</strong>ρόλο που η σχέση τους<br />
<strong>μ</strong><strong>ε</strong> την έκθ<strong>ε</strong>ση σ<strong>ε</strong> <strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς του ΜΕΑ δ<strong>ε</strong>ν έχ<strong>ε</strong>ι <strong>α</strong>ποδ<strong>ε</strong>ιχθ<strong>ε</strong>ί. Δ<strong>ε</strong>ν<br />
<strong>ε</strong>ίν<strong>α</strong>ι γνωστό <strong>α</strong>ν η έκθ<strong>ε</strong>ση που π<strong>ε</strong>ριορίζ<strong>ε</strong>τ<strong>α</strong>ι στο πρώτο τρί<strong>μ</strong>ηνο <strong>μ</strong>πορ<strong>ε</strong>ί<br />
ν<strong>α</strong> <strong>ε</strong>πηρ<strong>ε</strong>άσ<strong>ε</strong>ι <strong>α</strong>ρνητικά την έκβ<strong>α</strong>ση της κύησης. Εάν η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη<br />
δίν<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong>όνο κ<strong>α</strong>τά το πρώτο τρί<strong>μ</strong>ηνο της κύησης, η <strong>α</strong>σθ<strong>ε</strong>νής θ<strong>α</strong> πρέπ<strong>ε</strong>ι<br />
ν<strong>α</strong> <strong>ε</strong>νη<strong>μ</strong><strong>ε</strong>ρωθ<strong>ε</strong>ί κ<strong>α</strong>τάλληλ<strong>α</strong>. Ωστόσο, <strong>ε</strong>άν η <strong>α</strong>σθ<strong>ε</strong>νής <strong>μ</strong><strong>ε</strong>ίν<strong>ε</strong>ι έγκυος,<br />
η θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong><strong>ε</strong> το ENEAS θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> δι<strong>α</strong>κοπ<strong>ε</strong>ί όσο το δυν<strong>α</strong>τόν<br />
πιο σύντο<strong>μ</strong><strong>α</strong>. Μ<strong>ε</strong>λέτ<strong>ε</strong>ς <strong>μ</strong><strong>ε</strong> νιτρ<strong>ε</strong>νδιπίνη σ<strong>ε</strong> ζώ<strong>α</strong> δ<strong>ε</strong>ν <strong>α</strong>πέδ<strong>ε</strong>ιξ<strong>α</strong>ν<br />
τ<strong>ε</strong>ρ<strong>α</strong>τογόνο δράση. Ωστόσο, δ<strong>ε</strong>ν υπάρχουν κ<strong>α</strong>λά <strong>ε</strong>λ<strong>ε</strong>γχό<strong>μ</strong><strong>ε</strong>ν<strong>ε</strong>ς<br />
<strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς σ<strong>ε</strong> <strong>α</strong>νθρώπους <strong>ε</strong>νώ άλλ<strong>ε</strong>ς διϋδροπυριδίν<strong>ε</strong>ς έδ<strong>ε</strong>ιξ<strong>α</strong>ν<br />
τ<strong>ε</strong>ρ<strong>α</strong>τογόνο δράση σ<strong>ε</strong> προκλινικές <strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς τοξικότητ<strong>α</strong>ς. Γ<strong>α</strong>λουχί<strong>α</strong>:<br />
Το ENEAS <strong>α</strong>ντ<strong>ε</strong>νδ<strong>ε</strong>ίκνυτ<strong>α</strong>ι κ<strong>α</strong>τά τη διάρκ<strong>ε</strong>ι<strong>α</strong> της γ<strong>α</strong>λουχί<strong>α</strong>ς. Η<br />
<strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πρίλη, η <strong>ε</strong>ν<strong>α</strong>λ<strong>α</strong>πριλάτη κ<strong>α</strong>ι η νιτρ<strong>ε</strong>νδιπίνη <strong>α</strong>π<strong>ε</strong>κκρίνοντ<strong>α</strong>ι στο<br />
<strong>μ</strong>ητρικό γάλ<strong>α</strong> κ<strong>α</strong>ι η <strong>ε</strong>πίδρ<strong>α</strong>σή τους στο βρέφος που θηλάζ<strong>ε</strong>ι δ<strong>ε</strong>ν έχ<strong>ε</strong>ι<br />
κ<strong>α</strong>θοριστ<strong>ε</strong>ί. Επιδράσ<strong>ε</strong>ις στην ικ<strong>α</strong>νότητ<strong>α</strong> οδήγησης κ<strong>α</strong>ι χ<strong>ε</strong>ιρισ<strong>μ</strong>ού<br />
<strong>μ</strong>ηχ<strong>α</strong>νη<strong>μ</strong>άτων: Η χορήγηση του ENEAS <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> έχ<strong>ε</strong>ι ορισ<strong>μ</strong>έν<strong>ε</strong>ς<br />
<strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>πιδράσ<strong>ε</strong>ις που <strong>ε</strong>λ<strong>α</strong>ττώνουν το <strong>ε</strong>πίπ<strong>ε</strong>δο <strong>ε</strong>γρήγορσης,<br />
<strong>ε</strong>πηρ<strong>ε</strong>άζοντ<strong>α</strong>ς την ικ<strong>α</strong>νότητ<strong>α</strong> οδήγησης ή χρήσης <strong>μ</strong>ηχ<strong>α</strong>νών. Αυτό<br />
έχ<strong>ε</strong>ι ιδι<strong>α</strong>ίτ<strong>ε</strong>ρη ση<strong>μ</strong><strong>α</strong>σί<strong>α</strong> κ<strong>α</strong>τά την <strong>α</strong>ρχή της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>ς, τις <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βολές<br />
της θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>υτικής <strong>α</strong>γωγής κ<strong>α</strong>ι/ή την κ<strong>α</strong>τ<strong>α</strong>νάλωση οινοπν<strong>ε</strong>ύ<strong>μ</strong><strong>α</strong>τος.<br />
Συνιστάτ<strong>α</strong>ι λοιπόν προσοχή <strong>μ</strong>έχρι ότου υπάρξ<strong>ε</strong>ι ικ<strong>α</strong>νοποιητική<br />
<strong>α</strong>πόκριση στ<strong>α</strong> φ<strong>α</strong>ρ<strong>μ</strong><strong>α</strong>κ<strong>ε</strong>υτικά προϊόντ<strong>α</strong>. Αν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>νέργ<strong>ε</strong>ι<strong>ε</strong>ς:<br />
Οι <strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>νέργ<strong>ε</strong>ι<strong>ε</strong>ς που π<strong>α</strong>ρ<strong>α</strong>τηρούντ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong>τά τη χορήγηση<br />
του ENEAS <strong>ε</strong>ίν<strong>α</strong>ι π<strong>α</strong>ρό<strong>μ</strong>οι<strong>ε</strong>ς <strong>μ</strong><strong>ε</strong> <strong>ε</strong>κ<strong>ε</strong>ίν<strong>ε</strong>ς που <strong>α</strong>ν<strong>α</strong>φέροντ<strong>α</strong>ι ξ<strong>ε</strong>χωριστά<br />
γι<strong>α</strong> κ<strong>α</strong>θέν<strong>α</strong> <strong>α</strong>πό τ<strong>α</strong> συστ<strong>α</strong>τικά. Οι συχνότ<strong>ε</strong>ρ<strong>α</strong> <strong>α</strong>ν<strong>α</strong>φ<strong>ε</strong>ρό<strong>μ</strong><strong>ε</strong>ν<strong>ε</strong>ς<br />
<strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>νέργ<strong>ε</strong>ι<strong>ε</strong>ς <strong>ε</strong>ίν<strong>α</strong>ι (Συχνές 1-10%): <strong>ε</strong>ρυθρότητ<strong>α</strong>, οίδη<strong>μ</strong><strong>α</strong>,<br />
κ<strong>ε</strong>φ<strong>α</strong>λ<strong>α</strong>λγί<strong>α</strong> κ<strong>α</strong>ι βήχ<strong>α</strong>ς. Λιγότ<strong>ε</strong>ρο συχνές <strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>νέργ<strong>ε</strong>ι<strong>ε</strong>ς<br />
(0,1-1%) <strong>ε</strong>ίν<strong>α</strong>ι, ζάλη, τ<strong>α</strong>χυκ<strong>α</strong>ρδί<strong>α</strong>, <strong>ε</strong>ρυθη<strong>μ</strong><strong>α</strong>τώδ<strong>ε</strong>ς <strong>ε</strong>ξάνθη<strong>μ</strong><strong>α</strong>, ν<strong>α</strong>υτί<strong>α</strong>,<br />
δυσπ<strong>ε</strong>ψί<strong>α</strong> κ<strong>α</strong>ι υπότ<strong>α</strong>ση. Πολύ σπάνι<strong>ε</strong>ς (
Change language