Cov tshuaj Lunaldin: cov lus qhia rau kev siv

Pin
Send
Share
Send

Lunaldin yog theem thib peb ntawm "theem ntaiv ntawm kev kho mob" ntawm WHO. Cov no yog cov tshuaj hloog muaj zog tshaj plaws uas siv los daws qhov mob hnyav.

Lub Npe Tsis Yog Neeg Tsis Muaj Npe

Fentanyl.

Lunaldin yog theem thib peb ntawm "theem ntaiv ntawm kev kho mob" ntawm WHO.

ATX

ATX Code - N02AB03 - Fentanil.

Tso cov ntawv thiab cov nyob ua ke

Muaj nyob hauv daim ntawv sublingual (rau kev xaus nyob hauv tus nplaig) ntsiav tshuaj ntawm qhov sib txawv (mcg) thiab daim ntawv:

  • 100 - puag ncig;
  • 200 - ovoid;
  • 300 - daim duab peb sab;
  • 400 - rhombic;
  • 600 - semicircular (D-zoo li);
  • 800 - tsiav tshuaj.

Ib ntsiav tshuaj muaj cov tshuaj nquag - fentanyl citron micronized thiab cov ntu ua haujlwm pabcuam.

Pharmacological kev txiav txim ntawm Lunaldin

Cov tshuaj yog zwm rau pab pawg ntawm opioid analgesics. Cov tshuaj thaiv cov kabmob µ-opioid receptors, uas ua rau supraspinal (µ1-qhia txog kev tswj hwm lub hlwb) thiab pob txha caj qaum (-2-cuam tshuam rau cov kev tswj hwm ntawm tus txha caj qaum) analgesia (txo qhov mob rhiab heev nrog kev pab ntawm kws tshuaj).

Cov tshuaj cuam tshuam nrog kev sib txuas ntawm adenylate cyclase (AC) thiab cyclic adenosine monophosphate (cAMP), uas xa cov paib ntawm synapses ntawm cov leeg. Fentanyl cuam tshuam lub polarization ntawm daim nyias nyias, cov kev ua haujlwm ntawm cov channel ion, uas ua rau txo qis hauv kev tso tawm ntawm qhov mob mediators.

Vim tias ors cov chaw txais mob yog ib cheeb tsam tsis yog rau hauv lub hlwb thiab tus txha nqaj qaum xwb, tab sis kuj nyob hauv nruab nrog cev, kev siv tshuaj:

  • inhibits txoj haujlwm ntawm lub chaw ua pa;
  • nce lub suab nrov ntawm cov leeg ua haujlwm ntawm cov kab mob tso zis, nce ntxiv lossis tiv thaiv kom txhob tso zis;
  • ua rau spasm ntawm biliary huam;
  • nce suab nrov ntawm cov leeg nqaij ua haujlwm ntawm cov hnyuv plab, txo qis plab hnyuv;
  • dilates peripheral hlab ntsha;
  • provokes kev hypotension thiab bradycardia.
Cov tshuaj thaiv qhov ua haujlwm ntawm lub chaw ua pa.
Cov tshuaj ua kom haum siab ntawm cov hlab ntsha.
Cov tshuaj ntxiv ua rau lub suab nrov ntawm cov nqaij leeg du ntawm cov zis.
Cov tshuaj muab tshuaj ua rau muaj qhov txha caj qaum.

Qhov txheej txheem no ua rau muaj kev siv cov tshuaj nyob rau hauv analgesic txoj kev kho ntawm pathological tej yam kev mob, nrog los ntawm mob siab thiab intolerable.

Cov Tshuaj Pharmacokinetics

Cov tshuaj muaj cov cim tawm hydrophobicity, yog li nws yog nqus sai dua nyob rau hauv lub qhov ncauj kab noj hniav ntau dua li ntawm cov hnyuv. Los ntawm sublingual cheeb tsam, nws yog nqus hauv 30 feeb. Bioavailability yog 70%. Qhov siab tshaj plaws nyob rau hauv cov ntshav ntawm fentanyl nce mus txog nrog kev qhia ntawm 100-800 μg ntawm cov tshuaj tom qab 22-24 feeb.

Qhov ntau dua ntawm fentanyl (80-85%) khi rau cov protein ntshav, uas ua rau nws lub cev muaj zog. Qhov ntim ntawm qhov faib tawm ntawm cov tshuaj hauv qhov sib npaug yog 3-6 l / kg.

Lub ntsiab biotransformation ntawm fentanyl tshwm sim nyob rau hauv kev cuam tshuam ntawm hepatic enzymes. Qhov tseem ceeb ntawm kev nthuav tawm ntawm lub cev yog qhov mob tso zis (85%) thiab cov kua tsib (15%).

Ib nrab-lub neej ntawm ib yam khoom los ntawm lub cev yog los ntawm 3 txog 12,5 teev.

Kev qhia rau kev siv Lunaldin

Cov cim tseem ceeb rau kev siv Lunaldin yog kev kho tshuaj ntawm kev mob tshwm sim hauv cov neeg mob cancer tau txais kev kho opioid tsis tu ncua.

Cov cim tseem ceeb rau kev siv Lunaldin yog kev kho tshuaj ntawm kev mob tshwm sim hauv cov neeg mob cancer tau txais kev kho opioid tsis tu ncua.

Cov Yuav Tsum Muaj

Cov tshuaj yog contraindicated nyob rau hauv:

  • cov mob nrog kev nyuaj siab loj ntawm txoj hlab ua pa;
  • obstructive pulmonary mob;
  • kev sib xyaw ua ke ntawm cov tshuaj nrog cov tshuaj monoamine oxidase (MAO) blockers lossis nws txoj kev tswj hwm rau tsawg dua 2 lub lis piam tom qab kawg ntawm kev kho;
  • noj cov tshuaj sib xyaw - antagonists thiab agonists ntawm opioid receptors;
  • tus neeg mob lub hnub nyoog txog 18 xyoo;
  • kev tsis haum tshuaj rau cov khoom xyaw;
  • tsis muaj kev kho mob ua ntej opioid.

Nrog saib xyuas

Yuav tsum tau ceeb toom ntau ntxiv thaum sau ntawv Lunaldin rau cov neeg mob uas ntxim rau qhov cuam tshuam ntau tshaj ntawm CO of hauv cov ntshav:

  • nce siab intracranial;
  • coma;
  • qhov muag plooj;
  • neoplasms ntawm lub paj hlwb.

Tshwj xeeb kev ceev faj ntawm kev siv cov tshuaj yuav tsum tau pom nyob rau hauv kev kho mob ntawm cov neeg muaj mob taub hau, tshwm sim ntawm bradycardia thiab tachycardia. Hauv cov neeg laus thiab cov neeg mob debilitated, noj cov tshuaj yuav ua rau muaj kev nce ntxiv hauv ib nrab-lub neej thiab muaj kev nkag siab zoo ntxiv rau cov khoom xyaw. Hauv pawg neeg mob no, nws yog ib qho tsim nyog yuav tau soj ntsuam qhov tsos mob ntawm kev qaug cawv thiab kho qhov koob tshuaj hauv qab.

Yuav tsum muaj kev ceeb toom ntau ntxiv thaum teem Lunaldin rau cov neeg mob uas nquag plooj plooj.
Yuav tsum tau ceev faj ntau ntxiv thaum teem sijhawm Lunaldin rau cov neeg mob uas yuav mob hlwb.
Yuav tsum tau muaj kev ceeb toom ntau ntxiv thaum teem Lunaldin rau cov neeg mob nws tsis nco qab lawm.
Yuav tsum tau ceev faj ntau ntxiv thaum xaiv Lunaldin rau cov neeg mob uas nquag ua haujlwm txhawm rau txhawm rau nce siab.

Hauv cov neeg mob uas lub raum thiab hepatic tsis txaus, ib qho tshuaj yuav ua rau muaj qhov muaj peev xwm ntau ntxiv ntawm fentanyl hauv cov ntshav (vim tias qhov nce ntawm nws cov bioavailability thiab inhibition ntawm kev tshem tawm). Cov tshuaj yuav tsum tau siv nrog ceev faj nyob rau hauv cov neeg mob nrog:

  • hypervolemia (nce ntxiv hauv ntshav ntim hauv cov ntshav);
  • ntshav siab
  • kev puas tsuaj thiab o ntawm lub qhov ncauj mucosa.

Noj tshuaj ntau dua Lunaldina

Muab rau cov neeg mob uas tau tsim nrog kev kam rau ua opioids, noj 60 mg ntawm morphine ntawm qhov ncauj lossis 25 μg / h ntawm fentanyl. Kev noj tshuaj pib nrog koob tshuaj 100 mcg, maj mam nce nws ntau npaum li cas. Yog tias hauv 15-30 feeb. tom qab noj 100 ntsiav tshuaj microgram, qhov mob tsis tso tseg, tom qab ntawd noj ib lub tshuaj thib ob nrog tib lub tshuaj.

Cov lus qhia txog cov qauv kev ua kom zoo tshaj plaws rau titration ntawm ib koob tshuaj Lunaldin, yog tias thawj koob tsis nqa tshuaj tuaj:

Thawj koob tshuaj (mcg)Koob thib ob (mcg)
100100
200100
300100
400200
600200
800-

Kev noj tshuaj pib nrog koob tshuaj 100 mcg, maj mam nce nws ntau npaum li cas.

Yog tias tom qab siv ntau tshaj qhov kev kho mob, cov nyhuv ua kom loog tsis tiav, tom qab ntawd ib qho tshuaj nruab nrab (100 mcg) yog tau kho. Thaum xaiv cov koob tshuaj ntawm qib titration, tsis txhob siv ntau dua 2 ntsiav tshuaj nrog ib qho kev tawm tsam ntawm qhov mob. Qhov cuam tshuam rau lub cev ntawm fentanyl hauv ntau npaum li 800 mcg tseem tsis tau soj ntsuam.

Nrog cov kev ua kom pom ntau dua plaub ntu ntawm kev mob hnyav ib hnub, dhau mus ntev dua 4 hnub sib law liag, kev kho kom haum rau cov tshuaj ntawm ib qho kev txiav txim siab ntev opioid series tau raug kho. Thaum hloov los ntawm ib qho ua kom tsis haum rau lwm qhov, ib qho kev rov ua dua ntawm cov koob tshuaj yog ua tiav los ntawm kev saib xyuas ntawm tus kws kho mob thiab kuaj ntsuas ntawm tus neeg mob.

Nrog rau kev tsis ua tiav ntawm paroxysmal mob, Lunaldin txuas mus ntxiv. Cov tshuaj raug muab tso tseg, maj mam muab cov tshuaj txo kom tsis txhob ua rau qhov tsos ntawm kev tshem tawm tus mob.

Nrog ntshav qab zib

Nrog Lunaldin analgesia, cov neeg mob ntshav qab zib tau pom zoo kom siv nws qhov kev siv ua ke nrog Propofol thiab Diazepam.

Cov koob tshuaj ntawm cov tshuaj yog xaiv tus kheej.

Sab sij huam

Thaum kho, cov kev mob tshwm sim hauv qab no feem ntau nthuav qhia:

  • kev nkees;
  • tsaug zog
  • mob taub hau thiab kiv taub hau;
  • hyperhidrosis;
  • xeev siab

Nrog ntau zaus, cov kev tsis zoo tshwm sim los ntawm cov kab ke ntawm lub cev uas cov which txais hauv zos.

Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm mob taub hau yog feem ntau tshwm sim.
Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm kev qaug zog yog feem ntau manifested.
Thaum kho nrog tshuaj, ib cov kev phiv nyob rau hauv daim ntawv ntawm hyperhidrosis feem ntau tshwm sim.
Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm xeev siab yog tshwm sim feem ntau.
Hauv kev kho nrog cov tshuaj, ib sab phiv feem ntau pom nyob rau hauv daim ntawv ntawm cov rog rog muaj zog.

Kev kho mob txoj hnyuv

Cov tshuaj noj tuaj yeem muaj qhov cuam tshuam ua kom lub plab hnyuv thiab ua kom quav tawv. Ib qho ntxiv, cov hauv qab no feem ntau sau tseg:

  • qhov ncauj qhuav
  • mob hauv plab;
  • tso quav;
  • mob dyspeptic;
  • ob leeg hnyuv;
  • qhov kev tshwm sim ntawm mob rau ntawm lub qhov ncauj mucosa;
  • ua txhaum cai ntawm kev ua ntawm kev nqos;
  • kev tsis nco qab.

Tsawg dua li qhov muaj roj tsim ntau dhau, ua rau tsam plab thiab pom kev.

Nruab nrab hauv lub paj hlwb

Los ntawm lub hauv nruab nrab lub paj hlwb feem ntau tshwm sim:

  • asthenia;
  • Kev Nyuaj Siab
  • insomnia
  • ua txhaum ntawm saj, lub zeem muag, kev paub;
  • ua kom pom tseeb;
  • delirium;
  • tsis meej pem txog txoj kev nco qab;
  • npau suav phem;
  • qhov kev hloov pauv ruaj khov hauv kev xav;
  • muaj kev ntxhov siab ntau dua.

Kev pom tus kheej tsis tshua pom tshwm sim tsawg.

Thaum kho nrog tshuaj, ib qho tshwm sim feem ntau tshwm sim los ntawm kev hloov pauv ntawm kev saj.
Hauv kev kho nrog cov tshuaj, ib sab phiv feem ntau pom nyob rau hauv daim ntawv ntawm kev hloov pauv siab hauv lub siab.
Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm kev nyuaj siab yog feem ntau manifested.
Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm anorexia yog feem ntau manifested.
Thaum kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm dyspeptic mob feem ntau tshwm sim.
Thaum kho nrog tshuaj, ib qho tshwm sim yog feem ntau qhia nyob rau hauv daim ntawv ntawm qhov mob hauv plab.
Thaum kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm npau suav phem feem ntau manifested.

Los ntawm cov kab mob zis

Cov nyhuv ntawm Lunaldin ntawm cov kab mob tso zis rau lub suab tawm ntawm cov leeg du, uas yog nrog cov lus tsis txaus tawm ntawm cov zis - nce lossis qeeb tso zis tawm, spasm ntawm lub zais zis, oliguria.

Los ntawm lub tshuab ua pa

Feem ntau sau tseg:

  • kev kho mob ntsws;
  • los ntswg;
  • pharyngitis.

Tsawg tsawg dua, mob ntsws asthma, hypoventilation ntawm lub ntsws, ntes pa, hemoptysis.

Los ntawm cov hlab plawv system

Cov tshwm sim pathological yuav:

  • orthostatic cev qhuav dej;
  • leeg kev so ntawm cov phab ntsa ntawm cov hlab ntsha (vasodilation);
  • dej ntas;
  • ntsej muag liab;
  • arrhythmia.

Cov kev mob tshwm sim hauv lub cev tuaj yeem pom lawv tus kheej li txoj hlab ntshav hauv lub plawv tsis txaus, ua tsis tiav myocardial contractility, mob ntshav siab ntawm lub plawv (bradycardia) lossis nce siab hauv lub plawv (tachycardia).

Thaum kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm lub ntsej muag liab yog feem ntau manifested.
Thaum kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm arrhythmia yog feem ntau manifested.
Thaum kho nrog tshuaj, ib qho kev tshwm sim feem ntau tshwm sim los ntawm kev ua pa ntawm txoj pa.
Thaum kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm pharyngitis yog feem ntau manifested.
Thaum kho nrog cov tshuaj, cov kev mob tshwm sim hauv cov qauv ntawm qhov ntswg los ntswg feem ntau tshwm sim.
Thaum kho nrog cov tshuaj, ib qho kev phiv feem ntau qhia tau nws tus kheej hauv daim ntawv ntawm kev nce lossis qeeb hauv cov zis.
Thaum lub sij hawm kho nrog cov tshuaj, ib sab phiv nyob rau hauv daim ntawv ntawm tawm pob yog feem ntau tshwm sim.

Kev ua xua

Kev tsis haum tshuaj rau qhov tshuaj tshwm sim nyob rau hauv daim ntawv ntawm:

  • tawv nqaij ua pob - ua pob, khaus;
  • liab thiab o ntawm thaj chaw txhaj tshuaj.

Hauv cov neeg mob uas muaj teeb meem ntawm cov kab mob hypobiliary, biliary colic, qhov kev ua txhaum ntawm qhov tawm ntawm cov kua tsib, tuaj yeem sau tseg. Ntev nrog kev siv, kev quav yeeb quav tshuaj, kev quav yeeb quav tshuaj thiab mob ib ce (vam khom) yuav tshwm sim. Qhov tshwm sim tsis zoo ntawm lub cev tuaj yeem ua rau kev sib deev tsis txaus ntseeg thiab txo qis hauv libido.

Cuam tshuam rau lub peev xwm los tswj cov tshuab

Cov tshuaj tuaj yeem cuam tshuam loj heev rau lub hauv nruab nrab lub paj hlwb thiab lub siab ntawm cov plab hnyuv siab raum, yog li thaum lub sijhawm kho mob Lunaldin yuav tsum tsis kam tsav tsheb, ua haujlwm nrog cov tshuab thiab cov haujlwm ua haujlwm uas yuav tsum muaj kev saib xyuas, nrawm ntawm kev txiav txim siab thiab pom tseeb.

Cov tshuaj tuaj yeem cuam tshuam rau lub hauv nruab nrab lub paj hlwb thiab cov plab hnyuv siab raum, yog li ntawd, thaum lub sijhawm kho nrog Lunaldin, koj yuav tsum tsis kam tsav lub tsheb.

Cov lus qhia tshwj xeeb

Nrog kev kho mob ntev nrog opioid analgesics, cov lus qhia hauv cov lus qhia rau cov tshuaj yuav tsum pom. Cov neeg tu tus neeg mob yuav tsum tau qhia txog tus yam ntxwv ntawm cov nyhuv ntawm cov tshuaj ntawm ntau cov kab ke thiab qhov muaj peev xwm noj ntau dhau. Lawv yuav tsum muaj peev xwm muab kev pabcuam ua ntej thaum muaj cov paib.

Siv rau lub sijhawm qub

Hauv cov tib neeg ntawm cov xyoo dhau los (vim tias txo qis hauv metabolic tus nqi thiab tshem tawm cov tshuaj), cov cim ntawm intoxication tej zaum yuav raug sau tseg. Yog li no, thaum ua kev pom zoo rau ib koob tshuaj, nws yog ib qho tsim nyog yuav tsum coj mus rau hauv lub xeev ntawm lub cev thiab yam ntxwv ntawm lub hnub nyoog.

Txiag tej menyuam

Nws tsis yog qhov tsim tawm rau cov menyuam yaus hnub nyoog qis dua 18 xyoo, txawm hais tias txawv teb chaws, rau kev kho mob los ntawm tus mob ntev, fentanyl raug tso cai siv txij thaum 1 xyoos.

Siv thaum cev xeeb tub thiab lactation

Kev noj tshuaj yuav tsum muaj kev txiav txim siab kom zoo. Kev kho ntev ntev nrog cov tshuaj thaum cev xeeb tub yuav ua rau tshem tawm hauv tus menyuam mos. Cov tshuaj nkag mus rau hauv qhov chaw tiv thaiv, thiab nws siv thaum lub sijhawm yug menyuam yog qhov txaus ntshai rau kev ua pa ntawm cov menyuam hauv plab thiab cov menyuam tshiab.

Cov tshuaj muaj nyob hauv niam mis. Yog li, nws cov sijhawm teem sijhawm pub mis niam tuaj yeem ua rau kev ua pa ntawm tus menyuam tsis ua haujlwm.
Cov tshuaj tsis tau sau tseg rau cov menyuam yaus hnub nyoog qis dua 18 xyoo.
Txij li txoj hauv kev tseem ceeb ntawm kev tshem tawm cov tshuaj thiab nws cov metabolites yog nrog cov zis, yog tias lub raum ua haujlwm tsis zoo, ncua sij hawm hauv nws cov kev tshem tawm, tsub zuj zuj hauv lub cev, thiab kev nce qib hauv lub sijhawm yuav tau sau tseg.
Cov tshuaj yog tawm nrog cov kua tsib, yog li ntawd, nrog daim siab pathology, hepatic colic tuaj yeem sau tseg.

Cov tshuaj muaj nyob hauv niam mis. Yog li, nws cov sijhawm teem sijhawm pub mis niam tuaj yeem ua rau kev ua pa ntawm tus menyuam tsis ua haujlwm. Cov tshuaj nyob rau hauv lub lactation thiab lub sijhawm cev xeeb tub yog kws kho tsuas yog thaum cov txiaj ntsig ntawm nws siv ntau tshaj qhov txaus ntshai rau tus menyuam thiab leej niam.

Daim ntawv thov rau lub raum khiav tsis zoo

Txij li txoj hauv kev tseem ceeb ntawm kev tshem tawm cov tshuaj thiab nws cov metabolites yog nrog cov zis, yog tias lub raum ua haujlwm tsis zoo, ncua sij hawm hauv nws cov kev tshem tawm, tsub zuj zuj hauv lub cev, thiab kev nce qib hauv lub sijhawm yuav tau sau tseg. Cov neeg mob zoo li no xav tau kev tswj hwm lub plasma cov ntsiab lus ntawm cov tshuaj thiab muab hloov kho nrog qhov nce hauv nws qhov ntim.

Siv rau lub siab ua haujlwm tsis zoo

Cov tshuaj yog tawm nrog cov kua tsib, yog li ntawd, nrog daim siab pathology, hepatic colic, lub sijhawm ua haujlwm ntev ntawm cov tshuaj yuav tshwm sim, uas, yog tias lub sijhawm tswj hwm ntawm cov tshuaj yog ua raws, tuaj yeem ua rau muaj kev noj tshuaj ntau dua. Rau cov neeg mob zoo li no, cov tshuaj yuav tsum tau ua nrog ceev faj, soj ntsuam cov zaus thiab ntau npaum li cas los ntawm tus kws kho mob, thiab tau kuaj mob tas li.

Noj ntau dhau

Nyob rau hauv kev tshwm sim ntawm kev noj haus ntau ntawm Lunaldin, qhov tshwm sim ntawm kev ua haujlwm siab thiab lub ntsws txoj kev nyuaj siab ntev dua, txog qhov nws nres. Thawj cov kev pab rau haus luam yeeb yog:

  • kev txhim kho thiab kev ua kom huv huv ntawm lub qhov ncauj (qhov chaw sublingual) los ntawm cov seem ntawm cov ntsiav tshuaj;
  • kev soj ntsuam ntawm tus neeg mob kom txaus;
  • nyem ntawm kev ua pa, mus txog kev tawm tsam thiab yuam qhov cua ntawm lub ntsws;
  • tswj lub cev kub;
  • kev qhia ntawm cov kua dej ua rau nws poob.

Cov tshuaj tiv thaiv rau opioid analgesics yog Naloxone. Tab sis nws tsuas yog siv los tshem tawm kev siv ntau dhau ntawm cov neeg uas tsis tau siv yav dhau los ua opioids.

Nrog rau qhov mob ntshav khov (hypotension), ntshav hloov ntshav tshuaj yog tswj hwm kom ntshav siab.

Cov tshuaj tiv thaiv rau opioid analgesics yog Naloxone.

Kev cuam tshuam nrog lwm yam tshuaj

Cov tshuaj yog metabolized los ntawm daim siab enzymes, yog li cov tshuaj uas cuam tshuam rau lawv cov kev ua (Erythromycin, Ritonavir, Itraconazole) nce cov bioavailability ntawm cov tshuaj thiab ua rau lub sijhawm ntev ntawm cov nyhuv.

Kev sib xyaw nrog lwm cov tshuaj loog, tshuaj tiv thaiv kev mob hlwb, tshuaj noj pw tsaug zog thiab sedative ua rau muaj kev nce siab hauv cov tshuaj tiv thaiv thiab so ib ce, ua rau lub ntsws ua tsis taus pa, ua rau ntshav nce siab. Yog li ntawd, lawv kev sib xyaw ua ke yog siv nrog ceev faj.

Nws tsis pom zoo kom noj cov tshuaj thaiv kab mob / agonists ntawm opioid receptors tib lub sij hawm li cov tshuaj, vim tias hauv cov neeg mob uas tau noj cov tshuaj no ntev, qhov sib xyaw no ua rau cov tsos mob tshem tawm.

Cawv tau zoo

Kev haus cawv Ethyl txhim kho lub zog sedative siv tau, yog li sib txuas cov tshuaj nrog cov cawv cawv tsis pom zoo.

Analogs

Lunaldin cov analogues yog:

  • Dolforin;
  • Fentavera;
  • Matrifen;
  • Faib haujlwm
  • Carfentanil.
Cov tshuaj yooj yim ntawm opioid analgesics. Feem 1

Cov ntsiab lus ntawm lub tsev muag tshuaj tawm

Los ntawm tshuaj.

Kuv puas yuav tau yam tsis muaj daim ntawv yuav tshuaj?

Tsis yog.

Nqe rau Lunaldin

Hauv Lavxias, ib yam tshuaj raug nqi ntawm 4000 rubles. rau 10 ntsiav tshuaj No. 100, 4500 rub. rau ntim No. 200 thiab 5000 rubles. rau tus lej 300.

Cia rau cov neeg mob rau cov tshuaj

Cov tshuaj yog nyob rau Daim Ntawv A, thiab nws yuav tsum muab khaws cia rau hauv lub txee kaw, kom deb ntawm menyuam yaus ntawm chav tsev kub.

Hnub tas sij hawm

Tsis ntev tshaj 3 xyoos.

Cov tshuaj yuav cia tsis pub dhau 3 xyoos.

Chaw tsim tshuaj paus

"Recipharm Stockholm AB", Sweden.

Xyuas txog Lunaldin

Tatyana Ivanova, 45 xyoo, Pskov: "Kev npaj zoo. Nws tau pab zoo tom qab kev ua haujlwm. Cov kev mob tau dhau lawm thiab tsis muaj dab tsi pab. Tsuas yog noj Lunaldin cawm kuv ntawm kev tsim txom."

Mikhail Prokopchuk, 48 xyoo, emerovo: “Kuv ua haujlwm ua tus tshuaj loog hauv lub tsev kho mob me. Hauv kuv kev coj ua, kuv feem ntau yuav tsum tau siv tshuaj loog nrog Lunaldin. "

Ekaterina Filippova, hnub nyoog 36 xyoo, Kostroma: "Kuv niam tau mob hnyav los ntawm mob caj dab mob hnyuv. Txog hnub kawg, tsuas yog cov tshuaj Lunaldin thiaj li cawm tau peb xwb.

Pin
Send
Share
Send