Valproik kislota (umumiy va erkin)
Kod:15004|CPT:80164, 80165|LOINC:4086-5, 4087-3
| Kabi | Valproik kislota, umumiy Valproik kislota, erkin |
|---|
Tahlil ma'lumotlari
Tadqiqot usuli
- Immunoanaliz
- Suyuq xromatografiya va tandem mass-spektrometriya (LC-MS/MS)
Kutilayotgan natija topshirish vaqti
1–2 kun
Maxsus tayyorlik
- Children younger than 1 year: withhold food for 30–40 minutes before the blood draw.
- Children 1–5 years: avoid food for 2–3 hours before specimen collection.
- Do not eat for 2–3 hours prior to collection; water is allowed.
- Refrain from smoking for 30 minutes before specimen collection.
Qanday foydalanish
Valproik kislota (umumiy va erkin) bo‘yicha tekshiruv valproat (valproik kislota; divalproeks natriy) uchun terapevtik dori monitoringida qo‘llanadi: samarali konsentratsiya va dozalash jadvalini belgilash, rioyani baholash va toksiklikni minimallashtirish maqsadida. U tipik absans, mioklonik va umumlashgan tonik–klonik tutqanoq kabi generallashgan epilepsiyalar hamda qisman (fokal) va aralash tutqanoq turlarida qo‘llanadi. Umumiy va erkin dori miqdorini o‘lchash oqsillarga bog‘lanish yoki metabolizm o‘zgarganda fraksiyalar o‘rtasidagi nomuvofiqlik paydo bo‘lishi mumkin bo‘lgan holatlarda foydalidir. Test, shuningdek, dozani oshirib yuborishga gumon bo‘lganda baholashga, homiladorlik va boshqa fiziologik o‘zgarishlar davrida monitoringga, hamda birga qo‘llaniladigan antiepileptik dorilar boshlangan yoki to‘xtatilganda dozani sozlashga xizmat qiladi. Talqin uchun odatda bir xil vaqtda olingan eng past konsentratsiya davridagi (trough) namuna afzal hisoblanadi.
Cheklovlar
Valproik kislota asosan GABA transaminazani ingibitsiya qilish orqali ingibitor neyrotransmissiyani kuchaytiradi, natijada markaziy gamma-aminobutirik kislota (GABA) darajasi oshadi va neyron qo‘zg‘aluvchanligi pasayadi. U epilepsiyaning bir nechta fenotiplarida faol va, shuningdek, bipolyar buzilish, migren profilaktikasi hamda boshqa nevrologik va psixiatrik holatlarda qo‘llanadi. Og‘iz orqali qabul qilingandan so‘ng so‘rilish tez va deyarli to‘liq. Oqsillarga bog‘lanish yuqori va terapevtik diapazonda to‘yinadigan xususiyatga ega. Biotransformatsiya jigarda kon’yugatsiya va mitoxondrial beta-oksidlanish orqali sodir bo‘ladi. Terapevtik monitoring samaradorlik va xavfsizlikni yaxshilaydi, chunki farmakokinetika nochiziqli va dozaga bog‘liq nojo‘ya ta’sirlar — masalan, vazn ortishi, ko‘ngil aynishi, tremor, bosh aylanishi, pankreatit, gepatotoksiklik va markaziy asab tizimi depressiyasi — ekspozitsiya ortishi bilan kuchayadi; og‘ir toksiklik va koma kam uchraydi, biroq katta dozani oshirib yuborishda yuz berishi mumkin. Namunalarni olish strategiyasi davolovchi shifokor tomonidan belgilanadi; odatda bir xil vaqtda olingan trough darajalari olinadi, ayrim vaziyatlarda juft trough/pik o‘lchovlari qo‘llanilishi mumkin.
| O'lchov birligi | mcg/mL |
|---|---|
| Referens oraliq | — |
| Ko'rsatmalar | Underlying hepatic, renal, or gastrointestinal disease that can modify valproic acid pharmacokinetics, Verification of adherence when accuracy of dosing is uncertain, Suspected acute valproic acid intoxication (central nervous system depression, disorientation, somnolence, tachycardia, pulmonary edema, pancreatitis, or hepatic injury), After therapy is initiated, when steady state is reached (approximately five half-lives), Infants younger than 1 year with rapid weight change (monitor every 1–3 months), Ongoing surveillance during stable seizure control (1–2 times per year), Therapeutic monitoring during pregnancy (at confirmation, 8–10 weeks, then every 2 months, at 34–36 weeks, and twice within 8 weeks postpartum; more frequently if seizures persist), Following the addition or discontinuation of other antiepileptic drugs in combination regimens |
Natija og'ishlarining mumkin sabablari
Oshgan daraja
- hepatic impairment
Namunangiz talablari
| Namunangiz | Zardob |
|---|---|
| Container | Oltin/yo'lbars qopqoqli probirka (SST, gel ajratgich) |
| Saqlash tayyorlik | Xona harorati, Sovutilgan, Muzlatilgan |
References
AMA, Division of Drugs and Toxicology. Drug Evaluations Subscription. Chicago, IL: American Medical Association; Fall 1992.
Smirnova OY, Sitnikov IY, Savinov SV. Therapeutic drug monitoring as a key factor in the proper approach to treatment of epilepsy and seizure syndromes.
Sokolov AV. Therapeutic drug monitoring. Quality Clinical Practice. 2002;(1):78-88.
Problems of Forensic Science. 2007;LXXII:416-432. Toxicological analysis of valproic acid in blood by FPIA in comparison to GC-MS.
Lacy CF. Drug Information Handbook. Lexi-Comp, Inc.; 2002.
Hirschfeld R. Safety and tolerability of oral loading divalproex sodium in acutely manic bipolar patients. Journal of Clinical Psychiatry. 1999;60:815-818.
Lagace DC, O'Brien WT, Gurvich N, Nachtigal MW, Klein PS. Valproic acid: How it works. Or not. Clinical Neuroscience Research. 2004;4:215-225.