Ịṅụbiga mmanya ókè nke Colchicine na Gloriosa Lily Poison: Gịnị kpatara ịṅụ ọgwụ mgbochi gout maka ọkụ ọkụ na-egbu egbu¶

(Colchicine)Colcrys, Mitigare, Gloperba) - alkaloid mgbochi mkpali nke narị afọ nke edepụtara maka nnukwu gout flares, familial Mediterranean fever (FMF), na pericarditis - nwere otu n'ime windo ọgwụgwọ kachasị dị warara, nke na-enweghị mgbaghara na ọgwụ niile. N'adịghị ka ibuprofen ma ọ bụ acetaminophen, ebe onye ọrịa nwere ike na-eche n'ụzọ na-ezighị ezi na ha nwere ike ị na-enwekwu njuaka nke ọgwụ mgbe nhụjuanya nnukwu-ụkwụ gout mgbu na-adịghị mma, ** ilo naanị 10 ka 20 ọkọlọtọ colchicine mbadamba 0.6-milligram 0.6-milligram (6 ruo 12 milligrams ngụkọta, ma ọ bụ karịa 0.15 milligrams kwa ụbọchị na-emekọrịta ihe na ọgwụ nje kwa ụbọchị). clarithromycin - na-ebute oke egwu, nsi ọtụtụ akụkụ biphasic na-enweghị ọgwụ mgbochi azụmahịa zuru ebe niile. Nsi na-egbu egbu na-eme mgbe ndị na-eri nri ma ọ bụ ụmụaka na-eri tubers, bulbs, ma ọ bụ akwụkwọ nke ** Flame Lily (Gloriosa superba*** ma ọ bụ ** Crocus mgbụsị akwụkwọ (Colchicum autumnale***, ma ọ bụ mgbe etinyere ya podophyllin (podofilox) A na-eloda resin wart dị n'elu ma ọ bụ tinye ya na mpaghara akpụkpọ ahụ sara mbara. Ọ bụrụ na onye ọ bụla na-ewere colchicine karịa mbadamba 3 edebere (1.8 mg) nke colchicine n'ime awa 24, ma ọ bụ tinye osisi * Colchicum * ma ọ bụ * Gloriosa *, kpọọ mpaghara gị. nọmba mberede ozugbo - ** ọbụlagodi ma ọ bụrụ na ọ dị ha mma nke ukwuu maka awa ole na ole mbụ ***. Maka ihe mberede toxicological na hematological metụtara, kpọtụrụ nri ero ọhịa na iri ihe ọkụkụ na-egbu egbu, neutropenic ahụ ọkụ na ụmị ọkpụkpụ suppression, na nsị nri, nnukwu gastroenteritis, na akpịrị ịkpọ nkụ.

Nsi Colchicine bụ ihe kpochapụrụ ** "oge nkwụsịtụ-bọmbụ" toxin ** yiri amatoxin Death Cap mushrooms na paraquat: mgbe 2-na-12-hour mgbaàmà na-adịghị egbu oge na-aghọ aghụghọ, Phase 1 na-eti ihe mgbawa, ọgbụgbọ-dị ka afọ ọsịsa ọbara na hypovolemic ujo, sochiri na ** 24 ruo 72 awa, na-enweghị ike iku ume iku ume (Phase) (ARDS), imeju/akụrụ arụ ọrụ, na ụmị ọkpụkpụ zuru ezu aplasia (sel ọbara ọcha na platelet efu)**.

Mee nke a ugbu a¶

1. ** Kpọọ nọmba mberede mpaghara gị na njikwa nsi ozugbo ma ọ bụrụ na onye ọ bụla loro ihe karịrị mbadamba colchicine 3 (1.8 mg) n'otu ụbọchị, ma ọ bụ ego ọ bụla nke ụbịa Crocus / Gloriosa Lily. Kingdom, 000 na Australia (ozi nsi 13 11 26), ma ọ bụ lelee akwụkwọ ndekọ aha anyị nọmba mberede. Echerela ka afọ mgbu ma ọ bụ vomiting malite; ozugbo colchicine na-amịkọrọ n'ime eriri afọ wee kee ya n'ime mkpụrụ ndụ nke ahụ, a pụghị ịchọta ya n'ọbara.
2. **Gaa na ngalaba mberede n'ime awa 1 ruo 2 mbụ maka unyi arụrụ ọrụ mberede (Multidose Activated CharcoalN'ihi na colchicine na-enweta ọtụtụ ihe enterohepatic recirculation (imeju na-etinyekwa colchicine n'ime bile, nke na-atụgharị azụ n'ime eriri afọ obere ka a na-emegharị ya ọzọ), ụlọ ọgwụ na-aṅụ mmanya ** na-agbanye unyi ugboro ugboro kwa awa 2 ruo 4 ** ọnyà colchicine n'ime eriri afọ ma bụrụ nke na-eme ka ọkpụkpụ na-eme ka ọ ghara ịdị irè.
3. ** Kwụsị ịṅụ colchicine ozugbo ma ọ bụrụ na enyere gị ọgwụ nje macrolide ọ bụla.clarithromycin ma ọ bụ erythromycinantifungal (itraconazole, ketoconazole), ọgwụ obi (verapamil, diltiazem), ma ọ bụ cyclosporine - ma ọ bụ ọ bụrụ na ị na-aṅụ ihe ọṅụṅụ mkpụrụ osisi grepu.** Ọgwụ ndị a na-egbochi ya CYP3A4 enzyme na P-glycoprotein mgbapụta efflux nke na-ekpochapụ colchicine, na-atụgharị ọgwụ gout 2-ọgwụ nkịtị ka ọ bụrụ ọgwụ ngafe n'ime okpukpu iri na-egbu egbu.
4. ** Ọ bụrụ na ọgbụgbọ siri ike na afọ ọsịsa mmiri/ọbara amalitelarị oge nke mbụ, malite ngbanwe mmiri na-eme ihe ike mgbe ị na-eche ụgbọ ihe mberede - na enyela ọgwụ mgbochi afọ ọsịsa (loperamide / Imodium()cholera-like gastroenteritis). Inye loperamide ma ọ bụ bismuth subsalicylate ọnyà colchicine na-adịghị etinye n'ime eriri afọ nke mere na nsị na-abanyekwa n'ọbara.
5. ** Ọ bụrụ na mmiri mmiri podophyllin (podofilox) wart wụsara na mberede na nnukwu akpụkpọ anụ ma ọ bụ akpụkpọ anụ mucous, saa anụ ahụ ozugbo ma jiri ncha na mmiri na-asọ asọ saa ya nke ọma.
6. Weta karama mkpụrụ ọgwụ colchicine (ka ndị dọkịta nwee ike gụọ ọgwụ ndị na-efu efu wee gbakọọ kpọmkwem mg/kg dose) ma ọ bụ foto / ihe nlele nke bọlbụ osisi ma ọ bụ ifuru . Ịmara ma onye ọrịa ọ̀ riri ahụ < 0.5 mg/kg, 0.5 to 0.8 mg/kg, ma ọ bụ > 0.8 mg/kg ozugbo na-agwa ndị otu nlekọta ahụike kpọmkwem amụma ịlanarị onye ọrịa yana ihe ICU chọrọ.

Osisi mkpebi: colchicine, Gloriosa lily, na podophyllin nsi nsi¶

flowchart TD
    A["Ngwọta Colchicine a na-enyo enyo, Gloriosa Lily / Mgbụsị akwụkwọ Crocus Ingestion, ma ọ bụ mkpughe Podophyllin"] --> B{"Gbakọọ dose Colchicine ingested (na mg/kg nke arọ ahụ) ma ọ bụ lelee Mmekọrịta ọgwụ."}
    B -->|"Ọgwụ gout nkịtị + Clarithromycin / Verapamil / Cyclosporine + afọ ọsịsa ọhụrụ / vomiting"| C["IATROGENIC COLCHICINE TOXICITY: Kwụsị ọgwụ abụọ ahụ wee gaa ER ozugbo"]
    B -->|"Ịṅụbiga mmanya ókè <0.5 mg/kg (dịka, 7 ruo 30 mg na okenye 70-kg)"| D["Ihe ize ndụ dị ukwuu: Ụgbọ njem EMS ozugbo maka eriri afọ (ma ọ bụrụ na <1 hr) + Unyi arụ ọrụ Multidose"]
    B -->|"Ịṅụbiga mmanya ókè 0.5 ruo 0.8 mg / kg (35 ruo 56 mg na 70-kg okenye)"| E["Nsi na-eyi ndụ dị oke egwu: na-atụ anya ujo GI siri ike + Aplasia ụmị ọkpụkpụ (10% ruo 50% anwụ)"]
    B -->|"Ịṅụbiga mmanya ókè> 0.8 mg / kg (> 56 mg na 70-kg okenye) ma ọ bụ Gloriosa tuber dum."| F["ỌKWU NDỊ NA-ECHICHE (na-eru nso 80% ruo 100% ọnwụ): Mbufe ICU / ECMO ozugbo."]
    C --> G["Oge 1 (awa 2 ruo 24): Mweghachi nke Crystalloid IV na-eme ihe ike maka ọgbụgbọ-dị ka mfu mmiri mmiri GI"]
    D --> G
    E --> G
    F --> G
    G --> H["Usoro 2 (Ụbọchị 1 ruo 7): Nkwado obi ICU (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) maka Neutropenia"]

Kedu ka colchicine na podophyllin si egbu mkpụrụ ndụ: igbachi mkpịsị mkpịsị mitotic¶

Iji ghọta ihe kpatara nsị colchicine ji yie nke mbụ dị ka nsị nri siri ike, mgbe ahụ dị ka nnukwu nkụchi obi, na ụbọchị ise ka e mesịrị dị ka nnukwu ọrịa radieshon ma ọ bụ leukemia chemotherapy toxicity, nyochaa otú molekul si arụ ọrụ n'ime mmadụ ọ bụla cell.

Microtubule depolymerization na njide nkewa cell na metaphase¶

Selụ ọ bụla dị ndụ n'ime ahụ mmadụ nwere skeleton dị n'ime ya na usoro okporo ụzọ nke tubes protein nwere oghere a na-akpọ microtubules, gbakọtara site na ngọngọ ụlọ a na-akpọ ** alpha-tubulin na beta-tubulin dimers **. Microtubules na-arụ ọrụ abụọ dị mkpa:

1. ** Spindle Mitotic n'oge nkewa sel (mitosis):** Mgbe ọ bụla cell stem dị n'ime eriri afọ gị, ụmị ọkpụkpụ, ma ọ bụ ntutu isi na-ekewa iji dochie mkpụrụ ndụ ochie, microtubules na-etolite obere eriri (mkpụrụ osisi mitotic) nke na-adọpụ chromosomes oyiri n'ime sel ọhụrụ abụọ.
2. ** Ụgbọ njem intracellular na myocardial contractility n'ime sel ndị na-abụghị nkewa: ** N'ime mkpụrụ ndụ akwara obi (cardiomyocytes), axon akwara, na mkpụrụ ndụ imeju, microtubules na-arụ ọrụ dị ka eriri ebufe na-ebufe mitochondria, channels calcium, na neurotransmitter vesicles gafee cell.

** Colchicine ** (yana ** podophyllotoxin ** sitere na osisi Mayapple / wart resin, na vinca alkaloids eji na chemotherapy cancer) jikọtara ya na nso nso a na-apụghị ịgbagha agbagha na beta-tubulin dimers soluble, na-eme ka njedebe na-eto eto nke microtubule wee gbasaa ma gbazee (**)

• ** N'ime anụ ahụ na-ekesa ngwa ngwa (mucosa mucosa na ụmị ọkpụkpụ):** cell cell ọ bụla na-ekewa na-akwụsị kpamkpam n'etiti nkewa sel (** njide metaphase**) ma na-anwụ anwụ cell.apoptosis). N'ihi na mkpụrụ ndụ ndị dị n'ime obere eriri afọ gị na-edochi onwe ha kwa awa 24 ruo 48, eriri afọ ahụ dum na-apụ n'anya n'ụbọchị nke mbụ (** Phase 1 cholera-dị ka afọ ọsịsa**). N'ihi na mkpụrụ ndụ ọbara ọcha na platelet dị na ụmị ọkpụkpụ gị na-edochi onwe ha kwa ụbọchị 3 ruo 5, usoro ahụ ji alụso ọrịa ọgụ na usoro mgbochi ọbara na-apụ n'anya n'ụbọchị 3 ruo 7 (** Phase 2 pancytopenia na sepsis**).
• ** N'ime akwara obi na mkpụrụ ndụ akwara: *** Mgbasa netwọk microtubule n'ime mkpụrụ ndụ akwara obi na-akpaghasị njikwa calcium sarcoplasmic na njem ike mitochondrial, na-akpata ** ihe ịtụnanya myocardial kpọmkwem, ujo cardiogenic refractory, ngọngọ obi zuru oke, na asystole mberede ** na awa 24 ruo 72.

Ihe kpatara hemodialysis na hemoperfusion enweghị ike iwepụ colchicine n'ahụ¶

N'adịghị ka caffeine, lithium, ma ọ bụ salicylates (aspirin), nke na-agbaze na plasma mmiri nke ọbara, ebe igwe dialysis nwere ike wepụ ha, colchicine na-abanye n'ọbara na-agbapụ n'ọbara n'ime awa 1 ruo 3 wee kpọchie ya na protein tubulin ** miri emi n'ime anụ ahụ siri ike , na-eke oke nkesa ( ** oke nkesa).Vd = 2 to 12 L/kg, ruo 21 l/kg n'imebiga ihe ókè). N'ihi na ihe na-erughị pasenti 1 ruo 2 nke colchicine ahụ na-anọgide na-ese n'elu n'ọbara, ** hemodialysis, hemofiltration, na unyi hemoperfusion abaghị uru kpamkpam n'iwepụ colchicine ** (ọ bụ ezie na a ka na-eji dialysis na-akwado ndị ọrịa akụrụ na-adaba na Phase 2). Nke a bụ ya mere ** mmetọ nke eriri afọ na Multidose Activated Charcoal** tupu na n'oge imegharị ihe nke enterohepatic dị oke egwu.

Iwu igbu egbu nke dabere na ibu (Bismuth & Baud classification)¶

Na toxicology nke ụlọ ọgwụ (nke Bismuth, Baud na ndị ọrụ ibe ya guzobere na Paris Poison Control Center), a na-ebu amụma nlanarị onye ọrịa mgbe oke ọgwụ colchicine gachara n'ụzọ ziri ezi site n'ịgbakọ dose milligram ingested kewara site na ịdị arọ ahụ onye ọrịa na kilogram.mg/kg):

Usoro ọgwụgwọ atọ dị iche iche nke nsi Colchicine na Gloriosa Lily¶

Nsi Colchicine na-aga n'usoro usoro ọgwụgwọ atọ n'usoro n'ime ụbọchị 10 ruo 14:

Nkeji 1: Usoro eriri afọ & Hypovolemic (awa 2 ruo 24 mgbe ntinyechara)¶

• Window latent nke awa 2 ruo 12 na-eduhie eduhie:** N'ime awa 2 ruo 6 nke mbụ mgbe ilochara oke ọgwụ colchicine ma ọ bụ rie nri * Gloriosa * / * Colchicum * bulbs, onye ọrịa ahụ na-enwe mmetụta ** zuru oke*** (ma ewezuga obere ọkụ n'ọnụ na akpịrị na ahịhịa ndụ). Aghọgbula gị ịnọrọ n'ụlọ n'oge windo dị jụụ.
• ** Ihe mgbawa "Cholera-dị ka" Gastroenteritis (awa 6 ruo 24):** Ka eriri afọ crypt mitosis na-akwụsị na mkpụrụ ndụ mucosal slough, onye ọrịa na-amalite ime ihe ike, ọgbụgbọ na-adịghị agwụ agwụ, ọgbụgbọ, na-egbu mgbu na-egbu mgbu nke afọ, na ** nnukwu afọ ọsịsa na-aga n'ihu, mmiri mmiri na ọbara "mmiri osikapa.
• ** Hypovolemic Shock na Electrolyte Collapse: *** Mfu mmiri na-esi na eriri afọ nwere ike gafere ** 5 ruo 10 lita (1.3 ruo 2.6 galọn) n'ime awa 24, na-akpata nnukwu ujo hypovolemic, prerenal nnukwu mmerụ ahụ akụrụ, metabolic lactic acidosis, hypokalemia, hyponatremia, hypocalcytemia. reactive spike na ọbara ọcha ọnụ ọgụgụ n'elu 20,000 / mcL tupu ụmị ọkpụkpụ daa).

Nkeji 2: Ọdịda nke akụkụ ahụ dị iche iche, Shock Cardiogenic, na Ụmị ọkpụkpụ Aplasia Oge (Ụbọchị 1 ruo 7)¶

Dị nnọọ ka vomiting na afọ ọsịsa na-egosi na ọ na-ebelata ihe dị ka awa 24 ruo 36, onye ọrịa na-abanye na nkeji nke abụọ na-egbu egbu:

1. ** Refractory Cardiogenic Shock na Arrhythmias (awa 24 ruo 72 - Isi Ihe Na-akpata Ọnwụ):**
2. Mbibi tubulin ozugbo n'ime myocytes nke obi na-akpata nkụda obi biventricular.left ventricular ejection fraction dropping below 15% to 20%), nnukwu hypotension nke na-akwụsị ịzaghachi na mmiri IV na vasopressors, sinus bradycardia, ngọngọ obi atrioventricular zuru ezu, tachycardia ventricular, na mberede asystolic obi njide.
3. ** Ụmị ọkpụkpụ zuru ezu Aplasia / Pancytopenia (Ụbọchị 3 ruo 7):**
4. N'etiti ụbọchị 3 na ụbọchị 7, ọnụọgụ neutrophil zuru oke nke onye ọrịa na-agbada na ** efu (efu).agranulocytosis*** na platelet na-agbada n'okpuru 10,000 ruo 20,000 / mcL (severe thrombocytopenia).
5. N'ihi na eriri eriri afọ ahụ ewepụla ihe mgbochi ya megide nje bacteria n'otu oge ahụ anụ ahụ enweghị mkpụrụ ndụ ọbara ọcha efu, nje bacteria Gram-negative.E. coli, * Klebsiella *, * Pseudomonas *) na-agbanye ozugbo site na eriri afọ banye n'ọbara, na-eme ka ** fulminant neutropenic septic shock na Disseminated Intravascular Coagulation (DIC)**.
6. ** Ọrịa nhụsianya iku ume (ARDS), Rhabdomyolysis, na ahụ mkpọnwụ na-agbago:**
7. Ọkpụkpụ capillary na ngụgụ na-akpata edema na-abụghị cardiogenic pulmonary edema (ARDS) chọrọ ikuku ventilashion.
8. Ọkpụkpụ skeletal ozugbo na mmebi microtubule axonal na-akpata nnukwu ** myoneuropathy** (adịghị ike akwara dị nso na-eṅomi ọrịa Guillain-Barré, creatine kinase dị elu. rhabdomyolysis, na mfu nke mmeghachi omume), n'akụkụ nnukwu mmerụ ahụ imeju, pancreatitis, na ahụ kpọnwụrụ akpọnwụ.

Nkeji 3: mgbake & ngụkọta oge alopecia (Ụbọchị 7 ruo izu 3+)¶

Ọ bụrụ na onye ọrịa ahụ lanarịrị nsogbu obi na septic nke Phase 2 na ICU:

• Leukocytosis na-eweghachi: mkpụrụ ndụ ụmị ọkpụkpụ malitegharịa na-ekewa gburugburu ụbọchị 7 ruo 10, na-eme ka ọnụ ọgụgụ sel ọcha maliteghachi nke ọma.
• ** Ọnwụ ntutu zuru oke, dị egwu (Total AlopeciaN'ihe dị ka ụbọchị 7 ruo 14, n'ihi na mkpụrụ ndụ matrix nke ntutu na-ekesa ngwa ngwa dị ka ndị na-agwọ ọrịa chemotherapy, ** ntutu isi niile, nku anya na ntutu anụ ahụ na-adaba n'ụkwụ *** (ọ na-emecha na-etolite kpamkpam karịa ọnwa 3 ruo 6). Neuromyopathy adịghị ike nwere ike were izu ma ọ bụ ọnwa nke nhazigharị anụ ahụ iji dozie.

Mmekọrịta ọgwụ na-egbu egbu: Otu ọgwụ gout 2-ọgwụ nkịtị na-esi aghọ ịdoụbiga mmanya ókè na-egbu egbu¶

Ihe karịrị ọkara nke nde ọgwụ colchicine na-egbu egbu n'ụlọọgwụ esiteghị na ụma emebiga ihe ókè; ha na-eme na ndị ọrịa na-ewere mbadamba colchicine 0.6-mg nke a na-enyekarị ha bụ ndị a na-enye otu oge ọgwụ nje ma ọ bụ mkpụrụ obi obi, ma ọ bụ ndị nwere akụrụ na-adịghị ala ala ma ọ bụ ọrịa imeju.

Nke CYP3A4 na P-glycoprotein (P-gp) ọnyà mkpochapụ¶

Dị ka ọ na-adịkarị, mkpụrụ ndụ mmadụ na-echebe onwe ha pụọ ​​na colchicine site na iji nfuli abụọ dị ndụ:

1. ** P-glycoproteinP-gp / ABCB1):** Ihe mgbapụta efflux cellular na-arụ ọrụ n'elu sel eriri afọ, biliary canaliculi imeju, na tubules akụrụ nke ** na-agbapụta colchicine nke ọma n'ime sel n'ime stool na mmamịrị.
2. ** Cytochrome P450 3A4 (CYP3A4):** Enzyme imeju nke demethylates na inactivates colchicine.

Ụdị ihe ọkụkụ dị ka: Gloriosa Superba (ọkụ Lily) na Colchicum Autumnale (Mgbụsị akwụkwọ Crocus)¶

Osisi ịchọ mma na nke ọhịa abụọ toro n'ọtụtụ ebe nwere nnukwu mkpokọta eke nke colchicine dị ọcha ma na-ebute ọtụtụ nsị na-egbu egbu kwa afọ n'etiti ndị na-elekọta ubi, ndị na-eri galik ọhịa, na ụmụaka:

1. * Colchicum autumnale * (Mgbụsị akwụkwọ Crocus / Meadow Saffron / ụmụ nwanyị gba ọtọ)¶

• ** Garlic ọhịa (Allium ursinum / Ramps) Ọnyà nri: *** N'oge opupu ihe ubi, * Colchicum autumnale * na-eziga akwụkwọ ndụ akwụkwọ ndụ na-acha akwụkwọ ndụ akwụkwọ ndụ na-egbuke egbuke site na bulbs n'okpuru ala na ahịhịa Europe na North America - na-etokarị ** nri na-esote galik anụ ọhịa.Allium ursinum / galik bear)** ma ọ bụ ramps. Ndị na-azụ anụ na-atụtụ akwụkwọ galik ọhịa maka pesto ma ọ bụ ofe na-akpachapụ anya na-ekpokọta akwụkwọ Colchicum yana galik.
• Otu esi agwa ha iche: Igwepịa akwụkwọ galik ọhịa a na-eri eri na-ewepụta isi galik na-adịghị mma**, akwụkwọ ya na-etokwa n'osisi ya n'otu n'otu; Akwụkwọ Colchicum autumnale na-egbu egbu nwere isi galik ZERO, sie ike, wee kechie ibe ya nke ọma n'ọbọ gbakọtara na ala. Iri obere akwụkwọ Colchicum ma ọ bụ ifuru na-ebuga ọgwụ colchicine na-egbu egbu. (Rịba ama: * Colchicum autumnale * dịkwa iche na ezigbo nri nri ** Saffron [Crocus sativus]**, nke bụ nke ezinụlọ iris Iridaceae ma nwee ihe mkparị 3, ebe nsi Colchicum bụ nke Colchicaceae ma nwere stamen 6).

2. Gloriosa superba (ọkụ lily / ebube Lily / ịrị elu Lily)¶

• ** Ụtọ Poteto / Yam / Ginger Tuber Trap: *** Gloriosa superba * bụ osisi vine na-arị elu na-ekpo ọkụ nke nwere ọkụ na-acha uhie uhie na-acha odo odo na-etolite n'ofe Eshia, Africa, Australia, yana dị ka osisi ịchọ mma na US na Europe. N'okpuru ala, ọ na-eto ụdị V ma ọ bụ L-anụ ahụ ** n'okpuru ala tubers *** nke dị ka ** poteto dị ụtọ, ji, akpu, ma ọ bụ mgbọrọgwụ ginger ***.
• ** Oke egbu egbu:** Otu mkpụrụ osisi Gloriosa superba nke dị gram iri abụọ ruo 50 nwere ** 60 ruo 150 milligrams nke pure colchicine na gloriosin* - zuru ezu igbu ndị okenye abụọ ruo atọ. Onye ọ bụla nke na-esi nri na mberede rie tuber Gloriosa ga-achọ mmetọ afọ nke ụlọ ọgwụ ozugbo tupu afọ nke mbụ amalite.

Podophyllin (Podofilox / Mayapple) Nsi: ihe ize ndụ wart-resin dị n'elu¶

** Podophyllin *** bụ resin osisi gbadoro anya nke ewepụtara na mgbọrọgwụ nke ** American Mayapple (Podophyllum peltatum*, nwere nsi microtubule na-arụ ọrụ ** podophyllotoxin (podofilox / Condylox). Edere ya ka ọ bụrụ 0.5% ngwọta / gel ma ọ bụ gbakọta dị ka 10% na 25% benzoin tincture iji kpochapụ waatị genital.condyloma acuminata) na waatị osisi.

• ** Otu nsi si eme: *** nwata na-eloda karama wart na-ewepụ ihe mberede, na-eri mkpụrụ osisi Mayapple na-acha akwụkwọ ndụ akwụkwọ ndụ na-achaghị acha / mgbọrọgwụ n'ime ọhịa, ma ọ bụ ** itinye 10% ruo 25% podophyllin resin gafee nnukwu, raw, na-agba ọbara genital ma ọ bụ perianal warts na ịghara ịsacha ya mgbe awa 1 ruo 4 gafere.
• ** Ntugharị akwara ozi pụrụ iche n'akụkụ ọdịda ụmị ọkpụkpụ:** Dị ka colchicine, podophyllin na-akpọchi spindle mitotic ma na-ebute vomiting/afọ ọsịsa siri ike nke 1 nke na-esote usoro nke abụọ ** ụmị ọkpụkpụ pancytopenia, ọdịda imeju, na ujo. Na mgbakwunye, podophyllin na-agafe ihe mgbochi ụbụrụ ọbara nke ukwuu karịa colchicine, na-eme ka ** nnukwu ụbụrụ ụbụrụ ụbụrụ ụbụrụ ụbụrụ (mgbagwoju anya, mgbagwoju anya anya, lethargy, coma, seizures) n'ime awa 6 ruo 24 **, na-esote nnukwu ** sensorimotor peripheral neuropathy (ọnụọgụ/ụkwụ na-egbu mgbu)

Nlekọta ụlọ ọgwụ ICU nke Colchicine na Podophyllin toxicity¶

1. ** Ngwunye afọ ntanye ozugbo (n'ime nkeji 60) yana unyi arụ ọrụ Multidose (MDAC):**
2. N'ihi na ọnwụ n'elu 0.5 ruo 0.8 mg / kg dị elu nke ukwuu na dialysis na-ada ada, ndị dọkịta na-arụ ọrụ n'oge nasogastric aspiration / lavage ma ọ bụrụ na onye ọrịa rutere n'ime 1 hour ingestion na inye ** activated unyi (50 g na mbụ, na-esote 25 g ọ bụla 2 ruo 4 awa)** n'akụkụ IV ondanherontic receptive.
3. ** Mweghachi Hemodynamic Early ike ike na VA-ECMO:**
4. Nnukwu mgbanwe mmiri crystalloid (0.9% normal saline ma ọ bụ Ringer's lactate) na-eduzi echocardiography n'akụkụ akwa n'oge oge nke 1, na-agbanwe ngwa ngwa na ** norepinephrine / epinephrine infusions ** na mmalite ** Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) ** ma ọ bụrụ na refractory cardiogenic ujo na-amalite na Phase 2 (VA-ECMO echekwala ọtụtụ ndị ọrịa na-abanye n'ime ha ruo mgbe mkgyocardial . emegharịrị 5 ruo 7 ụbọchị mgbe e mesịrị).
5. ** Ihe na-akpali akpali nke granulocyte nke mbụ (G-CSF / Filgrastim) na Neutropenic Sepsis kpachara anya: ***
6. Tupu ma ọ bụ ozugbo ọnụ ọgụgụ sel ọbara ọcha malitere ịdaba n'ụbọchị 2 ruo 3, ndị ọkà mmụta ọbara na ndị na-ahụ maka toxicologists na-enye subcutaneous ma ọ bụ intravenous kwa ụbọchị **filgrastim (G-CSF, 5 mcg / kg / ụbọchị) *** iji kpalite mkpụrụ ndụ ụmị ọkpụkpụ na-adị ndụ ma belata oge nke neutropenia na-egbu egbu, jikọtara ya na ọgwụ nje na-egbu egbu.cefepime, piperacillin-tazobactam, ma ọ bụ meropenem) na mmịnye platelet.
7. ** Investigation Colchicine-Specific Fab Antibody Fragments:** Na họrọ European toxicology centers (France), nnwale ** colchicine-kpọmkwem ovine Fab iberibe ** (nke ahaziri ya na Digibind/DigiFab eji maka digoxin overdose) ewepụtala colchicine nke ọma n'ime anụ ahụ na ujo na recardirine. ogbugba ndu iji ọmịiko.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911 na ** US Control Poison Control na 1-800-222-1222** (Canada: 1-844-POISON-X). Nchịkwa nri na ọgwụ na US (FDA) Colcrys (Colchicine) Safety Labeling na-enye iwu siri ike ** 1.8 mg kacha 3 mbadamba nnukwu gout flare okpu (1.2 mg sochiri 0.6 mg 1 hour mgbe e mesịrị)** ma na-ebu contraindications nke igbe ojii megide ijikọ colchicine CYP3A4/P-gp ihe mgbochi (clarithromycin, ritonavir/Paxlovid, cyclosporine) n'ime ndị ọrịa nwere ọrịa akụrụ ma ọ bụ imeju.
• United Kingdom: Kpọọ 999 ozugbo maka ihe ọ bụla a na-enyo enyo nke colchicine ma ọ bụ * Colchicum* ịdoụbiga mmanya ókè. The UK Medicines and Healthcare Product Regulatory Agency (MHRA) na National Poisons Information Service (NPIS / TOXBASE) na-ekewa ọgwụ mgbochi colchicine ọ bụla nke ebumnobi ma ọ bụ nke mberede dị ka ihe mberede ahụike na-eyi ndụ egwu chọrọ nnabata ụlọ ọgwụ ozugbo, Multidose Activated Charcoal, na opekempe 24-hour obi/ma ọ bụrụ na nchọpụta biochemical ọbụlagodi.
• European Union: Kpọọ 112. European Alliance of Associations for Rheumatology (EULAR) ntuziaka gout na French Poison Control / European Association of Poisons Centers and Clinical Toxicologists (EAPCCT) protocols na-eduzi nchịkọta colchicine dị ala, mwepu macrolide siri ike, na mbido ICU / VA-ECMO maka ingestions> = 0.5 mg/k
• Australia na New Zealand: Kpọọ 000 na Australia (ozi nsi 13 11 26) ma ọ bụ 111 na New Zealand (0800 764 766). Nlekọta ngwa ahịa ọgwụgwọ (TGA) na Medsafe NZ na-adọ aka ná ntị nke ọma megide "nara ruo mgbe afọ ọsịsa" gout dosing.
• India na Asia-Pacific: Kpọọ 112 na India, 995 na Singapore, 119 na Japan na South Korea, ma ọ bụ 999 na Malaysia na Hong Kong. Na India na Sri Lanka, Gloriosa superba (Karthigai Kilangu / Niyagala) nsi tuber bụ ihe a ma ama na-akpata nnukwu pancytopenia na-egbu egbu na ujo cardiogenic chọrọ ntugharị ụlọ ọgwụ ozugbo. Lelee akwụkwọ ndekọ aha anyị nọmba mberede mba ụwa.

Ajụjụ a na-ajụkarị¶

Kedu ọnụọgụ ọgwụ colchicine kacha mma ị ga-ewere maka nnukwu ọgụ gout?¶

FDA nke oge a na ntuziaka rheumatology nke mba ụwa (dabere na nnwale ụlọ ọgwụ AGREE) gosipụtara na oke nchekwa na ịdị irè maka oke ọkụ gout n'ime okenye nwere akụrụ na imeju bụ mbadamba 0.6-milligram abụọ (1.2 mg) were na akara izizi nke ọkụ, sochiri naanị otu 0.6-milligram ọzọ - mbadamba mbadamba 0.6 mg mgbe e mesịrị, mbadamba 0.1 mg. (1.8 mg). Ị ga-akwụsị ma chere opekata mpe awa iri asaa na abụọ tupu ị were usoro ọkụ ọkụ ọzọ. Ịṅụ ọgwụ 6, 10, ma ọ bụ 15 n'otu ụbọchị anaghị eme ka mgbu gout kwụsị ngwa ngwa ma nwee ike ịkpata nsị nke ọtụtụ akụkụ ahụ.

Gịnị mere ndị dọkịta n’oge gara aga ji gwa ndị ọrịa gout ka ha nọgide na-aṅụ colchicine kwa awa ruo mgbe ha nwere afọ ọsịsa, gịnịkwa mere e ji kwụsị ya?¶

Ruo ọtụtụ iri afọ tupu emee ọmụmụ ihe gbasara dose nke oge a, ndị dọkịta enweghị ihe ọzọ dị mma na-egbochi mkpasu iwe ma dabere na iwu nke narị afọ nke 19 nke inye mbadamba colchicine 1 kwa elekere ruo mgbe onye ọrịa malitere ọsịsa na vomiting siri ike. Ndị ọkà mmụta ọgwụ na-ahụ maka ọgwụ na-emecha chọpụta na afọ ọsịsa nke colchicine na-akpata abụghị mmetụta na-adịghị njọ - ọ bụ kpọmkwem ihe ịrịba ama na ọgwụ ahụ emerụla ma gbuo mkpụrụ ndụ sel ndị na-ekesa n'ime obere eriri afọ gị, yana na dose nke na-akpata afọ ọsịsa na-adaba kpọmkwem na dose nke na-akpata ọdịda ụmị ọkpụkpụ na nkụda mmụọ na-egbu egbu.

Kedu ihe kpatara o ji dị ize ndụ ịṅụ ọgwụ nje clarithromycin ma ọ bụ COVID-19 Paxlovid mgbe ị na-ewere colchicine kwa ụbọchị?¶

Ahụ gị na-adabere na mgbapụta cellular nke a na-akpọ P-glycoprotein na enzyme imeju a na-akpọ CYP3A4 iji wepụ colchicine n'ime sel gị n'ime bile na mmamịrị ka ọ ghara ịmalite. Clarithromycin (Biaxin), erythromycin, ọgwụ antifungal dị ka itraconazole, yana akụkụ ritonavir nke COVID-19 Paxlovid mechiri kpamkpam ma P-glycoprotein na CYP3A4. Ọ bụrụ na ị na-aga n'ihu na-aṅụ ọgwụ colchicine 1 ma ọ bụ 2 kwa ụbọchị mgbe ị na-ewere clarithromycin ma ọ bụ Paxlovid, ọnyà colchicine dị n'ime obi gị na ụmị ọkpụkpụ na ọkwa 3 ruo 4 ugboro nkịtị, na-ebute nsị na-egbu egbu n'ime ụbọchị.

Ọ bụrụ na mmadụ loro ọgwụ colchicine extra colchicine awa 3 gara aga ma ọ ka na-enwe mmetụta 100% nkịtị, ha apụọla n'ihe egwu?¶

Mba - windo na-enweghị mgbaàmà bụ ọnyà kacha dị ize ndụ na nsị colchicine. Colchicine na-ewe awa 2 ruo 12 iji mebie spindles microtubule n'ime nkewa sel eriri afọ, yabụ onye ọrịa ọ bụla na-enwe mmetụta zuru oke maka ọtụtụ awa mbụ mgbe ilochara ọgwụ na-egbu egbu. Ichere n'ụlọ ruo mgbe ọgbụgbọ siri ike na afọ ọsịsa ọbara na-amalite pụtara na nsi ahapụlarị eriri afọ wee kpọchie ya n'ime akwara obi na ụmị ọkpụkpụ, ebe dialysis enweghị ike iru ya. Ịga ụlọ mberede ahụ n'oge dị jụụ nke mbụ 1 ruo 2 awa maka unyi na-arụ ọrụ nwere ike ịzọpụta ndụ onye ọrịa.

Kedu ka ndị mmadụ si enweta nsi na mberede site na ụbịa Crocus ma ọ bụ osisi Gloriosa Lily?¶

N'oge opupu ihe ubi, mgbụsị akwụkwọ crocus na-egbu egbu (Colchicum autumnale) na-epulite na ala ahịhịa dị mmiri mmiri n'akụkụ galik ọhịa oriri (Allium ursinum / ramps); Ndị na-eri anụ ndị na-adịghị anụ akwụkwọ ọ bụla maka isi galik na-agwakọta akwụkwọ Colchicum na mberede n'ime pesto ma ọ bụ ofe galik ọhịa. N'ebe okpomọkụ na ebe okpomọkụ (na n'ụlọ ndị nwere lilies na-arị elu), tubers nke Flame Lily (Gloriosa superba) dị ka obere poteto dị ụtọ, ji, ma ọ bụ mgbọrọgwụ ginger, na iri ọbụna ọkara tuber na-enye nnukwu ọgwụ colchicine na-egbu egbu.

Isi mmalite na nduzi ọchịchị¶

• ** Nchịkwa nri na ọgwụ ọjọọ US (FDA, United States): *** Nkọwapụta Ozi na Ntuziaka Ọgwụ maka Colcrys (Colchicine, USP) Mbadamba ụrọ * na * Nkwukọrịta Nchekwa Ọgwụ FDA: Mmekọrịta Ọgwụ na-egbu egbu n'etiti Colchicine na P-Glycoprotein / Strong CYP3A4 Inhibitors (Critosporine)
• ** Terkeltaub RA et al. (Arthritis & Rheumatism, The AGREE Trial):*** Dị elu Versus Obere Dosing of Oral Colchicine for Early Acute Gout Flare: Mpụta iri abụọ na anọ nke Multicenter mbụ, Randomized, Double-kpuru, Placebo-Controlled, Parallel-Group, Dose.Comparidyson Colchicine*
• ** Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ et al. (Klinical Toxicology):*** Nsi Colchicine: Akụkụ gbara ọchịchịrị nke ọgwụ oge ochie* (Bismuth/Baud arọ dabere mg/kg stratification ọnwụ, 3-phase clinical progression, enterohepatic recirculation, Multidose Activated Charcoal, na G-CSF/VA-ECMO nlekọta kpụ ọkụ n'ọnụ).
• ** Ọgwụ na ngwaahịa nlekọta ahụike Regulatory Agency (MHRA) & National Poisons Information Service (NPIS, United Kingdom):** * Mmelite nchekwa ọgwụ: Colchicine - Ndekọ ọgwụgwọ dị warara nke ukwuu na ihe ize ndụ nke ịdoụbiga mmanya ókè.
• ** Òtù Ahụ Ike Ụwa (WHO) & Ntuziaka Ụlọ Ọrụ nsi: ** * Nlekọta ụlọ ọgwụ nke nsị osisi: Colchicum autumnale (Autumn Crocus), Gloriosa superba (flame Lily), na Podophyllum peltatum (Podophyllin Resin)*.

Ntuziaka emetụtara¶

• Iri ero anụ ọhịa, amatoxin, na iri ihe ọkụkụ na-egbu egbu
• Ahụ ọkụ Neutropenic, ọrịa chemotherapy, na ihe mberede ahụike oncologic
• Ahụhụ akụrụ dị oke njọ, rhabdomyolysis, na nhụsianya mmamịrị gbara ọchịchịrị
• Nsi nri, nnukwu gastroenteritis, na akpịrị ịkpọ nkụ
• Nsi enyemaka mbụ na ikpughe nsi