{"id":10319,"date":"2020-04-23T05:02:54","date_gmt":"2020-04-23T02:02:54","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/fenobarbital\/"},"modified":"2025-02-10T15:37:16","modified_gmt":"2025-02-10T13:37:16","slug":"fenobarbital","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/fenobarbital\/","title":{"rendered":"\u0424\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b"},"content":{"rendered":"

Informa\u0163ii generale \u015fi recomand\u0103ri pentru testare<\/em><\/strong><\/span><\/p>\n

In practica medical\u0103 curent\u0103 este recunoscut\u0103 din ce in ce mai mult importan\u0163a determin\u0103rii periodice a nivelului in sange al multora din medicamentele administrate, fie datorit\u0103 poten\u0163ialului crescut de reac\u0163ii adverse, fie complian\u0163ei reduse a pacien\u0163ilor.<\/span><\/p>\n

Monitorizarea terapeutic\u0103 a unui medicament (Therapeutic Drug Monitoring, TDM) are drept scop men\u0163inerea concentra\u0163iei acestuia in intervalul terapeutic<\/strong>, definit ca acel interval de valori ale nivelului in ser, plasm\u0103 sau sange integral in care medicamentul respectiv isi exercit\u0103 efectele clinice cu reac\u0163ii adverse minime pentru majoritatea pacien\u0163ilor.<\/span><\/p>\n

Conceptul de TDM se refer\u0103 astfel la m\u0103surarea concentra\u0163iei medicamentelor pentru a optimiza si adapta tratamentul la nivel individual (terapie personalizat\u0103). Pentru realizarea acestei \u0163inte terapeutice este important s\u0103 se cunoasc\u0103 pentru medicamentele administrate date legate de:<\/span><\/p>\n

-farmacocinetic\u0103<\/span>: studiaz\u0103 efectele medicamentului asupra organismului (rela\u0163ia doz\u0103-efect);<\/span><\/p>\n

-farmacodinamic\u0103<\/span>: studiaz\u0103 efectele organismului asupra medicamentelor (absorb\u0163ie, distribu\u0163ie etc);\u00a0<\/em><\/strong><\/span><\/p>\n

-farmacogenetic\u0103<\/span>: studiaz\u0103 modelul genetic al metaboliz\u0103rii medicamentelor luand in considerare varia\u0163iile individuale.\u00a0<\/em><\/strong><\/span><\/p>\n

Pentru a ob\u0163ine rezultate pentru concentra\u0163iile medicamentoase cu utilitate clinic\u0103 este important ca proba s\u0103 fie recoltat\u0103 in asa numita \u201esteady state\u201d<\/strong> (stare de echilibru) in care rata de medicament ce p\u0103trunde in organism este egal\u0103 cu cea eliminat\u0103. Atunci cand o doz\u0103 fix\u0103 de medicament este administrat\u0103 la intervale de timp regulate, acesta se va acumula in organism in cursul fazei de absorb\u0163ie pan\u0103 este atins\u0103 starea de echilibru; perioada de timp necesar\u0103 pentru a se ajunge la steady state<\/em> depinde de\u00a0 timpul de injum\u0103t\u0103\u0163ire al medicamentului (T1\/2<\/sub>)<\/strong>, adic\u0103 timpul in care concentra\u0163ia medicamentului in sange se reduce la jum\u0103tate. La randul s\u0103u T1\/2 <\/sub>depinde de rata de metabolizare si excre\u0163ie. In condi\u0163iile unei distribu\u0163ii rapide si uniforme a medicamentului in organism (cinetic\u0103 de ordinul I), precum si in absen\u0163a unei doze de inc\u0103rcare, este nevoie de un interval de timp echivalent cu cel pu\u0163in 5 T1\/2<\/sub>\u00a0 pentru a ob\u0163ine steady state<\/em> (vezi fig. 20.3.1<\/em>)1;2;4<\/sup>.<\/span>\u00a0\"-\"<\/a><\/span><\/p>\n

\"-\"<\/a><\/p>\n

Fig 20.3.1 Ob\u0163inerea\u00a0\u201e<\/strong>steady state\u201d<\/strong><\/p>\n

Acest proces poate fi rezumat astfel:<\/span><\/p>\n

k\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 k = constanta de dispari\u0163ie a lui D<\/span><\/span><\/p>\n

D\u2192E\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D = concentra\u0163ia medicamentului\u00a0 E = forma excretat\u0103 a medicamentului<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 k = constanta de dispari\u0163ie a lui D<\/span><\/p>\n

\u04231\/2<\/sub> = 0.693\/k<\/span><\/p>\n

Asa cum reiese din ecua\u0163ie, T1\/2 <\/sub>este o constant\u0103\u00a0\u00a0<\/sub>si nu depinde de concentra\u0163ia medicamentului. Daca T1\/2 <\/sub>este cunoscut se poate calcula modul de imp\u0103r\u0163ire a dozelor si intervalul de timp la care trebuie administrate pentru a se atinge nivelul terapeutic.<\/span><\/p>\n

Totusi, unele medicamente sunt metabolizate printr-un alt tip de cinetic\u0103 decat cea de ordinul I, suferind mai intai o metabolizare in ficat, urmat\u0103 de o distribu\u0163e multicompartimental\u0103 in organism (medicamentul are o anumit\u0103 rat\u0103 de distribu\u0163ie plasmatic\u0103\u00a0 si o rat\u0103 diferit\u0103 de distribu\u0163ie tisular\u0103). In aceste cazuri timpul necesar pentru a atinge steady state <\/em>poate s\u0103 fie diferit de echivalentul a 5 T1\/2<\/sub> .<\/span><\/p>\n

Cu excep\u0163ia urgen\u0163elor medicale, in cazurile in care se modific\u0103 dozele administrate si se adaug\u0103 sau se scot medicamente asociate, se va astepta ob\u0163inerea unei noi st\u0103ri de echilibru inainte de recoltarea probei pentru monitorizarea terapeutic\u0103. Intr-un mod similar, se va astepta aceeasi perioad\u0103 de timp pan\u0103 cand un medicament aflat in steady state <\/em>se va elimina din organism la intreruperea administr\u0103rii2<\/sup>.<\/span><\/p>\n

Odat\u0103 atins\u0103 starea de echilibru probele de sange pot fi recoltate in dou\u0103 momente diferite:<\/span><\/p>\n

\u2013 in momentul nivelului maxim (peak samples<\/em>): la 2-3 ore dup\u0103 administrarea unei doze orale, la 30-60 minute dup\u0103 o doza administrat\u0103 intravenos, la 2-4 ore dupa o doz\u0103 administrat\u0103 intramuscular sau la 1-1 si \u00bd ore dup\u0103 o doza administrat\u0103 intranazal;<\/span><\/p>\n

\u2013 in momentul nivelului minim (trough samples<\/em>): imediat inaintea administr\u0103rii urm\u0103toarei doze; acest moment este recomandat in majoritatea cazurilor.<\/span><\/p>\n

Monitorizarea terapeutic\u0103 a medicamentelor este indicat\u0103 in special in urm\u0103toarele situa\u0163ii:<\/span><\/p>\n

\u2022 perturbarea rela\u0163iei doz\u0103-efect;<\/span><\/div>\n
\u2022 esec in ob\u0163inerea efectului terapeutic sau suspectarea unei intoxica\u0163ii;<\/span><\/div>\n
\u2022 efect imposibil sau foarte greu de confirmat clinic (de exemplu in cazul imunosupresoarelor);<\/span><\/div>\n
\u2022 interval terapeutic ingust (de exemplu in cazul glicozidelor);<\/span><\/div>\n
\u2022 complian\u0163a redus\u0103 a pacien\u0163ilor (persoane varstnice sau cu boli psihice);<\/span><\/div>\n
\u2022 prezen\u0163a unor afec\u0163iuni care afecteaz\u0103 absorb\u0163ia, distribu\u0163ia, metabolizarea si excre\u0163ia medicamentelor;<\/span><\/div>\n
\u2022 administrarea simultana de medicamente care prezinta aceeasi cale de eliminare;<\/span><\/div>\n
\u2022 copii si persoane varstnice la care este afectat volumul de distributie: redus in cazul varstnicilor si crescut la copii.<\/span><\/div>\n

Clasele de medicamente pentru care se recomand\u0103 in mod special TDM sunt urm\u0103toarele:<\/span><\/p>\n

    \n
  • glicozide cardiace: digoxin, digitoxin;<\/span><\/li>\n
  • antiaritmice:\u00a0 amiodarona, flecainida, procainamida, chinidina;<\/span><\/li>\n
  • antiastmatice: teofilina;<\/span><\/li>\n
  • antibiotice: aminoglicozide, vancomicina;<\/span><\/li>\n
  • antivirale: medicamentele pentru infec\u0163ia HIV, ganciclovir;<\/span><\/li>\n
  • anticonvulsivante: fenobarbital, carbamazepin, fenitoin, acid valproic, gabapentin, primidona, lamotrigin;<\/span><\/li>\n
  • medicamente psihotrope: litiu, antidepresive triciclice, neuroleptice;<\/span><\/li>\n
  • imunosupresoare: ciclosporina, tacrolimus, sirolimus, everolimus, acid micofenolic, azatioprina;<\/span><\/li>\n
  • citostatice: methotrexat1;2<\/sup>.<\/span><\/li>\n<\/ul>\n

    In tabelul de mai jos sunt precizate pentru anumite medicamente T1\/2<\/sub>, intervalul de timp necesar pentru a se ajunge la steady state<\/em>, tipul de prob\u0103 pentru TDM si stabilitatea acesteia, intervalul terapeutic1;4<\/sup>:<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    MEDICAMENT<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    \u04231\/2<\/sub><\/strong>\u00a0<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    T p\u00e2n\u0103 la steady state<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Tip prob\u0103<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Stabilitate prob\u0103<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Metoda de determinare<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Interval terapeutic<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0414\u0438\u0433\u043e\u043a\u0441\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    36-48 h<\/span><\/p>\n<\/td>\n

    		\n

    7-10 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    ECLIA<\/span><\/p>\n<\/td>\n

    		\n

    0.9-2 ng\/mL<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Amiodarona<\/span><\/p>\n<\/td>\n

    		\n

    26-107 zile<\/span><\/p>\n<\/td>\n

    		Nu se aplica<\/span><\/td>\n\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    0.5-2 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Flecainida<\/span><\/p>\n<\/td>\n

    		\n

    12-27 ore<\/span><\/p>\n<\/td>\n

    		\n

    3-6 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    0.2-0.8 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Teofilina<\/span><\/p>\n<\/td>\n

    		7-11 ore (adult)<\/span><\/p>\n

    \u00a0<\/span>1-8 ore (copil)<\/span><\/td>\n

    		\n

    15-55 ore (adult)<\/span><\/p>\n

    5-40 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    < 1 an:<\/span><\/div>\n
    5-10 mg\/L<\/span><\/div>\n
    <\/div>\n
    <\/div>\n
    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2265 1 an:\u00a0\u00a0\u00a0<\/span><\/div>\n
    8-20 mg\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u0412\u0430\u043d\u043a\u043e\u043c\u0438\u0446\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n
    3-8 <\/span><\/div>\n
    or<\/span>e<\/span><\/div>\n<\/td>\n
    		\n

    1-2 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    FPIA<\/span><\/p>\n<\/td>\n

    		\n

    5 \u2013 10 \u00b5g\/mL<\/span><\/p>\n

    \u00a0<\/span><\/td>\n<\/tr>\n

    \n

    Carbamazepin<\/span><\/p>\n<\/td>\n

    		\n

    14-47 ore (adult)<\/span><\/p>\n

    8-19 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    7-12 zile (adult)<\/span><\/p>\n

    2-4 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    4-10 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0412\u0430\u043b\u044c\u043f\u0440\u043e\u0435\u0432\u0430\u044f \u043a\u0438\u0441\u043b\u043e\u0442\u0430<\/a><\/span><\/p>\n<\/td>\n

    		\n

    9-16 ore (adult)<\/span><\/p>\n

    7-13 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    2-4 zile (adult)<\/span><\/p>\n

    2-4 zile (copil)<\/span><\/p>\n<\/td>\n

    		\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n
    7 zile <\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		CEDIA<\/span><\/td>\n50-100 mg\/L<\/span><\/td>\n<\/tr>\n
    \n

    \u0422\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442<\/span><\/p>\n<\/td>\n

    		\n

    19-23 ore<\/span><\/p>\n<\/td>\n

    		\n

    5 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    1-10 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Etosuximid<\/span><\/p>\n<\/td>\n

    		\n

    50-60 ore (adult)<\/span><\/p>\n

    30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    8-12 zile (adult)<\/span><\/p>\n

    6-10 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    40-100 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0424\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b<\/strong><\/a><\/span><\/p>\n<\/td>\n

    		\n

    81-117 ore (adult)<\/strong><\/span><\/p>\n

    40-70 ore (copil)<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    17-24 zile (adult)<\/strong><\/span><\/p>\n

    8-15 zile (copil)<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/strong><\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/strong><\/span><\/div>\n
    la 2-8\u00b0C<\/strong><\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    10-40 mg\/L<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0424\u0435\u043d\u0438\u0442\u043e\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    18-22 ore (adult)<\/span><\/p>\n

    7-29 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    4-8 zile (adult)<\/span><\/p>\n

    2-5 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    <14 ani:<\/span><\/div>\n
    10-20 mg\/L<\/span><\/div>\n
    <\/div>\n
    <\/div>\n
    >14 ani:<\/span><\/div>\n
    6-14 mg\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u0413\u0430\u0431\u0430\u043f\u0435\u043d\u0442\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    5-7 ore (adult)<\/span><\/p>\n

    4-6 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    1-2 zile (adult)<\/span><\/p>\n

    1-2 zile (copil)<\/span><\/p>\n<\/td>\n

    		\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n
    7 zile <\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		HPLC<\/span><\/td>\n2 \u2013 10 \u00b5g\/mL<\/span><\/td>\n<\/tr>\n
    \u041b\u0430\u043c\u043e\u0442\u0440\u0438\u0434\u0436\u0438\u043d<\/span><\/td>\n\n

    15-30 ore (adult)<\/span><\/p>\n

    30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    3-10 zile (adult)<\/span><\/p>\n

    3-10 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    <14 ani:<\/span><\/div>\n
    5-15 mg\/L<\/span><\/div>\n
    <\/div>\n
    <\/div>\n
    >14 ani:<\/span><\/div>\n
    1-5 mg\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u041f\u0440\u0438\u043c\u0438\u0434\u043e\u043d<\/span><\/p>\n<\/td>\n

    		\n

    3-7 ore (adult)<\/span><\/p>\n

    4-6 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    16-60 ore (adult)<\/span><\/p>\n

    20-30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		HPLC<\/span><\/td>\n\n

    5-15 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Amitriptilina<\/span><\/p>\n<\/td>\n

    		\n

    8-51 ore<\/span><\/p>\n<\/td>\n

    		2-6 zile<\/span><\/td>\n\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n
    7 zile <\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		LC-MS\/MS<\/span><\/td>\n50-300 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    \u041b\u0438\u0442\u0438\u0439<\/span><\/p>\n<\/td>\n

    		\n

    14-30 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-7 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    8 ore<\/em> la temperatura camerei<\/span><\/p>\n

    24 ore<\/em> la 2-8\u00b0C<\/span><\/p>\n

    6 luni<\/em> la -18\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    ISE<\/span><\/p>\n<\/td>\n

    		\n

    Mania acut\u0103: 0.6-1.2 mmol\/L<\/span><\/p>\n

    \u2022 Protec\u0163ie impotriva viitoarelor episoade la pacien\u0163ii cu afec\u0163iune bipolar\u0103: <\/span><\/div>\n
    0.8-1.0 mmol\/L<\/span><\/div>\n

    \u2022 Depresie: 0.5-1.5 mmol\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Clomipramin<\/span><\/p>\n<\/td>\n

    		\n

    12-36 ore<\/span><\/p>\n<\/td>\n

    		3 saptamani<\/span><\/td>\n\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    90-250 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Clozapina<\/span><\/p>\n<\/td>\n

    		4-66 ore<\/span><\/td>\nNu se aplica<\/span><\/td>\n\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/td>\n

    		LC-MS\/MS<\/span><\/td>\n\n

    350-600 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Olanzapin<\/span><\/p>\n<\/td>\n

    		\n

    21-54 ore (adult \u226465 ani);<\/span><\/p>\n

    32-81 ore (adult >65 ani)<\/span><\/p>\n<\/td>\n

    		\n

    7 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		7 zile<\/span><\/p>\n

    \u00a0la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		LC-MS\/MS<\/span><\/td>\n\u00a010-80 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    Doxepin<\/span><\/p>\n<\/td>\n

    		\n

    8-25 ore<\/span><\/p>\n<\/td>\n

    		\n

    2.5-5 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    20-150 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Imipramin<\/span><\/p>\n<\/td>\n

    		\n

    6-20 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-5 zile<\/span><\/p>\n<\/td>\n

    		\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/td>\n\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/td>\n

    		LC-MS\/MS<\/span><\/td>\n45-150 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    Maprotilin<\/span><\/p>\n<\/td>\n

    		\n

    36-105 ore<\/span><\/p>\n<\/td>\n

    		14 zile<\/span><\/td>\n\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		7 zile la 2-8\u00b0C<\/span><\/td>\nLC-MS\/MS<\/span><\/td>\n125-200 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    Trimipramin<\/span><\/p>\n<\/td>\n

    		\n

    16-39 ore<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplica<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    150-350 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Haloperidol<\/span><\/p>\n<\/td>\n

    		\n

    41-41 ore (lactat);<\/span><\/p>\n

    14-28 zile (decanoat)<\/span><\/p>\n<\/td>\n

    		\n

    3-9 zile (lactat);<\/span><\/p>\n

    nu se aplica<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		7 zile\u00a0la 2-8\u00b0C<\/span><\/td>\nLC-MS\/MS<\/span><\/td>\n5-16 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    Risperidon<\/span><\/p>\n<\/td>\n

    		\n

    3 ore (fast metabolizer risperidon); 21 ore (fast metabolizer9-hidroxi-risperidon); 20 ore (slow metabolizer risperidon); 30 ore (slow metabolizer 9-hidroxi-risperidon);<\/span><\/p>\n<\/td>\n

    		\n

    1 zi (fast metabolizer risperidon); 5-6 zile\u00a0 (fast metabolizer9-hidroxi-risperidon); 5 zile (slow metabolizer risperidon); nu se aplica (slow metabolizer 9-hidroxi-risperidon).<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    7 zile<\/span><\/p>\n

    la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    10-120 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Ciclosporina A<\/span><\/p>\n<\/td>\n

    		\n

    6-27 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-6 zile<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		\n

    5 zile<\/span><\/p>\n

    la -20\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    Intervalul terapeutic variaz\u0103 \u00een func\u0163ie de tipul transplantului si perioada de timp de la transplant.<\/span><\/p>\n

    Pentru afec\u0163iuni dermatologice \u015fi reumatologice:<100 \u00b5g\/L<\/span><\/p>\n

    Pentru sindrom nefrotic: <\/span><\/div>\n
    60-160 \u00b5g\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    Tacrolimus<\/span><\/p>\n<\/td>\n

    		\n

    4-35 ore (adult)<\/span><\/p>\n

    4-12 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    2-6 zile (adult)<\/span><\/p>\n

    \u00a0<\/span><\/p>\n

    Nu se aplic\u0103 la copil<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		5 zile la -20\u00b0C<\/span><\/td>\n\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n
    \u2013 \u00een primele 2 luni de la transplant:<\/span><\/div>\n
    15-20 \u00b5g\/L<\/span><\/div>\n
    <\/div>\n
    \u2013 dup\u0103\u00a02 luni de la transplant:<\/span><\/div>\n
    8-15 \u00b5g\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \u0421\u0438\u0440\u043e\u043b\u0438\u043c\u0443\u0441 \u0432 \u043a\u0440\u043e\u0432\u0438<\/span><\/td>\n\n

    46-78 ore<\/span><\/p>\n<\/td>\n

    		\n

    5-7 zile<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		\n
    5 zile <\/span><\/div>\n
    la -20\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		4-20 \u00b5g\/L<\/span><\/td>\n<\/tr>\n
    \n

    Acid micofenolic<\/span><\/p>\n<\/td>\n

    		\n

    8-18 ore (adult)<\/span><\/p>\n

    variabil la copil<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile <\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		1-3.5 \u00b5g\/mL<\/span><\/td>\n<\/tr>\n
    \n

    Methotrexat<\/span><\/p>\n<\/td>\n

    		\n

    Cinetic\u0103 bifazic\u0103<\/span><\/p>\n<\/td>\n

    		-<\/span><\/td>\n\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n

    \u00a0<\/span><\/td>\n

    		\n
    7 zile <\/span><\/div>\n
    la 2-8\u00b0C protejat de lumin\u0103<\/span><\/div>\n<\/td>\n
    		FPIA<\/span><\/td>\nSe asociaz\u0103 cu un risc crescut de toxicitate:<\/span><\/p>\n

    \u2013 valorile > 5-10\u00a0 \u00b5mol\/L la 24 h de la admistrare<\/span><\/p>\n

    \u2013 valorile > 0.5-1\u00a0 \u00b5mol\/L la 48 h de la administrare<\/span><\/p>\n

    \u2013 valorile > 0.2\u00a0 \u00b5mol\/L la 72 h de la administrare<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    ECLIA = metoda imunochimic\u0103 cu detec\u0163ie prin chemiluminiscen\u0163\u0103<\/span><\/p>\n

    HPLC = cromatografie de lichide sub inalt\u0103 presiune<\/span><\/p>\n

    LC-MS\/MS = cromatografie de lichide cuplat\u0103 cu spectrometrie de mas\u0103<\/span><\/p>\n

    FPIA = fluorescent polarization immunoassay (metoda imunochimic\u0103 cu detec\u0163ie prin fluorescen\u0163\u0103 polarizat\u0103)<\/span><\/p>\n

    CEDIA = cloned enzyme donor immunoassay (metoda imunoenzimatic\u0103 care utilizeaz\u0103 tehnologia ADN-ului recombinant)<\/span><\/p>\n

    ISE = ion selective electrode (metoda potentiometric\u0103)<\/span><\/p>\n

    Anticonvulsivante<\/span><\/strong><\/span><\/p>\n

    Sunt medicamente utile in tratamentul epilepsiei, in special pentru crizele grand mal<\/em>, petit mal<\/em>, psihomotorii, precum si in unele afec\u0163iuni cum ar fi tic douloureux<\/em> (nevralgia de trigemen). Desi mecanismul de ac\u0163iune al acestor medicamente nu a fost elucidat, se pare c\u0103 toate, posibil cu excep\u0163ia fenobarbitalului, blocheaz\u0103 influxul de sodiu in neuronii a c\u0103ror membran\u0103 este afectat\u0103. In plus, unele medicamente si in special fenitoinul blocheaz\u0103 de asemenea influxul secundar de calciu in aceste celule. Fenobarbitalul si, posibil, fenitoinul stabilizeaz\u0103 membrana neuronilor afecta\u0163i.<\/span><\/p>\n

    Multe din anticonvulsivante exercit\u0103 efect asupra convulsiilor grand mal<\/em>, ins\u0103 sunt ineficace asupra celor de tip petit mal<\/em>. Doar etosuximidul si acidul valproic au un efect terpeutic in aceste condi\u0163ii.<\/span><\/p>\n

    In concluzie, desi mecanismul de ac\u0163iune al anticonvulsivantelor pare s\u0103 fie similar, acestea difer\u0103 in ceea ce priveste specificitatea2<\/sup>.<\/span><\/p>\n

    \u0424\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b<\/strong><\/span><\/p>\n

    Este un medicament cu ac\u0163iune deprimant\u0103 asupra sistemului nervos central care s-a dovedit a fi eficace in controlul convulsiilor generalizate si par\u0163iale. Se administreaz\u0103 frecvent in asociere cu fenitoinul sau cu acidul valproic.<\/span><\/p>\n

    Dozele zilnice de fenobarbital variaz\u0103 intre 60 mg si 300 mg la adult si intre 3 si 6 mg\/kg corp la copil. Absorb\u0163ia sa este lenta, dar completa cu o biodisponibilitate ce se apropie de 100%. Se leag\u0103 intr-un procent de ~50% de proteinele plasmatice si are un volum de distribu\u0163ie de 0.5 L\/kg; timpul mediu de injum\u0103t\u0103\u0163ire este de 96 ore, f\u0103r\u0103 metaboli\u0163i activi cunoscu\u0163i. Sedarea apare frecvent la concentra\u0163ii terapeutice ale fenobarbitalului in primele 2-3 s\u0103pt\u0103mani de tratament, dar acest efect dispare in timp.<\/span><\/p>\n

    Toxicitatea indus\u0103 de supradozare se caracterizeaz\u0103 prin depresie SNC, inclusiv a centrilor respiratori. La concentra\u0163ii serice >40 mg\/L apar simptome usoare precum ataxie, nistagmus, astenie, pierderea aten\u0163iei; simptomele devin severe la nivele >60 mg\/L; toxicitatea poate fi letal\u0103 la valori >100 mg\/L.<\/span><\/p>\n

    Nu este cunoscut\u0103 nici o interac\u0163iune medicamentoas\u0103 care s\u0103 afecteze semnificativ farmacocinetic\u0103 fenobarbitalul; in schimb acesta perturb\u0103 farmacocinetica altor medicamente datorit\u0103 inducerii sintezei enzimelor asociate citocromului hepatic P4503<\/sup><\/span>.<\/p>\n

    \u00a0<\/span><\/p>\n

    \u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

    1. Laborator Synevo. Referin\u0163e specifice tehnologiei de lucru utilizate. 2010. Ref Type: Catalog.<\/span><\/div>\n
    2. Matthew R. Pincus, Naif Z. Abraham. Toxicology and Therapeutic Drug Monitoring. In Henry\u2019s Clinical Diagnosis and Management by Laboratory Methods, Saunders-Elsevier, 21st Edition, 2007, 308-320.<\/span><\/div>\n
    3.\u00a0\u00a0Mayo Clinic\/Mayo Medical LaboratoriesTest Catalogs and Guides. Phenobarbital, Serum. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/div>\n
    4. Quest Diagnostics. Therapeutic Drug Monitoring. Drug Half-Life, Steady State, and Recommended Sample Collection Time. www.questdiagnostics.com. Ref Type: Internet Communication.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

    \u0412 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u043e\u0439 \u043f\u0440\u0430\u043a\u0442\u0438\u043a\u0435 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u0430 \u0432 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435 \u043a\u0440\u043e\u0432\u0438 \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0435\u0442\u0441\u044f \u0434\u043b\u044f \u043f\u043e\u0434\u0431\u043e\u0440\u0430 \u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430, \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e\u0439 \u0434\u043b\u044f \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u043b\u0435\u0447\u0435\u043d\u0438\u044f, \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u043e\u0442\u0440\u0430\u0432\u043b\u0435\u043d\u0438\u0439, \u043f\u0440\u0435\u0434\u0443\u043f\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u044f \u0432\u043e\u0437\u043d\u0438\u043a\u043d\u043e\u0432\u0435\u043d\u0438\u044f \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u0445 \u044d\u0444\u0444\u0435\u043a\u0442\u043e\u0432 \u043f\u0440\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u0438, \u0430 \u0442\u0430\u043a\u0436\u0435 \u0434\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0434\u043e\u0431\u0440\u043e\u0441\u043e\u0432\u0435\u0441\u0442\u043d\u043e\u0441\u0442\u0438 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043f\u0440\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u0438 (\u043a\u043e\u043c\u043f\u043b\u0430\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438).<\/p>\n

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    \u0421\u0438\u043c\u043f\u0442\u043e\u043c\u0430\u043c\u0438 \u043e\u0442\u0440\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u043e\u043c \u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u0441\u0435\u0434\u0430\u0446\u0438\u044f, \u0430\u0442\u0430\u043a\u0441\u0438\u044f, \u043d\u0438\u0441\u0442\u0430\u0433\u043c, \u0433\u0438\u043f\u0435\u0440\u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u0438 \u0440\u0430\u0437\u0434\u0440\u0430\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u044c (\u0443 \u0434\u0435\u0442\u0435\u0439), \u0441\u043f\u0443\u0442\u0430\u043d\u043d\u043e\u0441\u0442\u044c \u0441\u043e\u0437\u043d\u0430\u043d\u0438\u044f \u0438 \u043f\u0441\u0438\u0445\u043e\u043c\u043e\u0442\u043e\u0440\u043d\u043e\u0435 \u0432\u043e\u0437\u0431\u0443\u0436\u0434\u0435\u043d\u0438\u0435 (\u0443 \u043f\u043e\u0436\u0438\u043b\u044b\u0445 \u043b\u044e\u0434\u0435\u0439). \u0411\u043e\u043b\u0435\u0435 \u0442\u043e\u0433\u043e, \u0441\u0435\u0434\u0430\u0446\u0438\u044f \u043d\u0430\u0431\u043b\u044e\u0434\u0430\u0435\u0442\u0441\u044f \u0443 \u0432\u0441\u0435\u0445 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u0432 \u043d\u0430\u0447\u0430\u043b\u044c\u043d\u043e\u043c \u043f\u0435\u0440\u0438\u043e\u0434\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u044f. \u0412\u043b\u0438\u044f\u043d\u0438\u0435 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u0430 \u043d\u0430 \u0446\u0435\u043d\u0442\u0440\u0430\u043b\u044c\u043d\u0443\u044e \u043d\u0435\u0440\u0432\u043d\u0443\u044e \u0441\u0438\u0441\u0442\u0435\u043c\u0443 \u0438 \u0443\u0433\u043d\u0435\u0442\u0435\u043d\u0438\u0435 \u0434\u044b\u0445\u0430\u043d\u0438\u044f \u0443\u0441\u0438\u043b\u0438\u0432\u0430\u0435\u0442\u0441\u044f \u043f\u0440\u0438 \u043e\u0434\u043d\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u043c \u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0438 \u0441 \u0434\u0440\u0443\u0433\u0438\u043c\u0438 \u0441\u0435\u0434\u0430\u0442\u0438\u0432\u043d\u044b\u043c\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430\u043c\u0438.<\/p>\n

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    \u0424\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0437\u0438\u0440\u0443\u0435\u0442\u0441\u044f \u043c\u0438\u043a\u0440\u043e\u0441\u043e\u043c\u0430\u043b\u044c\u043d\u044b\u043c\u0438 \u0444\u0435\u0440\u043c\u0435\u043d\u0442\u0430\u043c\u0438 \u043f\u0435\u0447\u0435\u043d\u0438, \u0430 \u0434\u043e 25 % \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432\u044b\u0432\u043e\u0434\u0438\u0442\u0441\u044f \u0438\u0437 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0430 \u043f\u043e\u0447\u043a\u0430\u043c\u0438. \u041f\u0440\u0435\u043f\u0430\u0440\u0430\u0442 \u043f\u0440\u043e\u0442\u0438\u0432\u043e\u043f\u043e\u043a\u0430\u0437\u0430\u043d \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430\u043c, \u0441\u0442\u0440\u0430\u0434\u0430\u044e\u0449\u0438\u043c \u043f\u0435\u0447\u0435\u043d\u043e\u0447\u043d\u043e\u0439 \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u044c\u044e (\u0442.\u043a. \u044d\u0442\u043e \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442 \u043f\u0435\u0440\u0438\u043e\u0434 \u043f\u043e\u043b\u0443\u0432\u044b\u0432\u0435\u0434\u0435\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430) \u0438 \u043f\u043e\u0440\u0444\u0438\u0440\u0438\u0435\u0439.<\/p>\n

    \u041a\u043b\u0438\u0440\u0435\u043d\u0441 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u0430 \u0441\u043d\u0438\u0436\u0430\u0435\u0442\u0441\u044f \u0441 \u0443\u0432\u0435\u043b\u0438\u0447\u0435\u043d\u0438\u0435\u043c \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430, \u044d\u0442\u043e \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0441\u0432\u044f\u0437\u0430\u043d\u043e \u0441\u043e \u0441\u043d\u0438\u0436\u0435\u043d\u0438\u0435\u043c \u0438\u043d\u0430\u043a\u0442\u0438\u0432\u0438\u0440\u0443\u044e\u0449\u0435\u0439 \u0444\u0443\u043d\u043a\u0446\u0438\u0438 \u043f\u0435\u0447\u0435\u043d\u0438 \u0438 \u0443\u043c\u0435\u043d\u044c\u0448\u0435\u043d\u0438\u0435\u043c \u0444\u0438\u043b\u044c\u0442\u0440\u0443\u044e\u0449\u0435\u0439 \u0441\u043f\u043e\u0441\u043e\u0431\u043d\u043e\u0441\u0442\u0438 \u043f\u043e\u0447\u0435\u043a. \u0422\u0430\u043a\u0438\u043c \u043e\u0431\u0440\u0430\u0437\u043e\u043c, \u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0442\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u044d\u0444\u0444\u0435\u043a\u0442 \u0443 \u043f\u043e\u0436\u0438\u043b\u044b\u0445 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0434\u043e\u0441\u0442\u0438\u0433\u043d\u0443\u0442 \u043f\u0440\u0438 \u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0438 \u043c\u0435\u043d\u044c\u0448\u0438\u0445 \u0434\u043e\u0437 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430.<\/p>\n

    \u041d\u0430\u0438\u0431\u043e\u043b\u0435\u0435 \u0447\u0430\u0441\u0442\u044b\u043c\u0438 \u043f\u0440\u043e\u044f\u0432\u043b\u0435\u043d\u0438\u044f\u043c\u0438 \u043f\u0435\u0440\u0435\u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0438 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u0430 \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c \u0441\u043e\u043d\u043b\u0438\u0432\u043e\u0441\u0442\u044c, \u0433\u043e\u043b\u043e\u0432\u043d\u0430\u044f \u0431\u043e\u043b\u044c, \u0434\u0435\u043f\u0440\u0435\u0441\u0441\u0438\u044f, \u0433\u043e\u043b\u043e\u0432\u043e\u043a\u0440\u0443\u0436\u0435\u043d\u0438\u0435, \u0442\u043e\u0448\u043d\u043e\u0442\u0430, \u0433\u0438\u043f\u0435\u0440\u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c (\u0443 \u0434\u0435\u0442\u0435\u0439). \u0414\u0440\u0443\u0433\u0438\u043c\u0438 \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u043c\u0438 \u044d\u0444\u0444\u0435\u043a\u0442\u0430\u043c\u0438 \u0442\u0435\u0440\u0430\u043f\u0438\u0438 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u043e\u043c \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c \u0441\u0443\u0434\u043e\u0440\u043e\u0433\u0438, \u0431\u043e\u043b\u0438 \u0432 \u0440\u043e\u0442\u043e\u0432\u043e\u0439 \u043f\u043e\u043b\u043e\u0441\u0442\u0438 \u0438 \u0433\u043e\u0440\u043b\u0435, \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u043e\u0442\u043e\u0447\u0438\u0432\u043e\u0441\u0442\u044c, \u0437\u0430\u0442\u0440\u0443\u0434\u043d\u0435\u043d\u0438\u044f \u043f\u0440\u0438 \u0434\u044b\u0445\u0430\u043d\u0438\u0438, \u0433\u043b\u043e\u0442\u0430\u043d\u0438\u0438, \u0432\u044b\u0440\u0430\u0436\u0435\u043d\u043d\u0430\u044f \u0441\u044b\u043f\u044c, \u043d\u0435\u043e\u0431\u044a\u044f\u0441\u043d\u0438\u043c\u0430\u044f \u043b\u0438\u0445\u043e\u0440\u0430\u0434\u043a\u0430.<\/p>\n

    \u041f\u0440\u0435\u043f\u0430\u0440\u0430\u0442 \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0435\u0442\u0441\u044f \u0441 \u043e\u0441\u0442\u043e\u0440\u043e\u0436\u043d\u043e\u0441\u0442\u044c\u044e \u043f\u0440\u0438 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0438 \u0444\u0443\u043d\u043a\u0446\u0438\u0438 \u043f\u0435\u0447\u0435\u043d\u0438, \u043f\u043e\u0447\u0435\u043a, \u0434\u0435\u043f\u0440\u0435\u0441\u0441\u0438\u0438, \u0432\u044b\u0440\u0430\u0436\u0435\u043d\u043d\u044b\u0445 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f\u0445 \u0434\u044b\u0445\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0441\u0438\u0441\u0442\u0435\u043c\u044b.<\/p>\n

    \u0414\u043b\u044f \u0447\u0435\u0433\u043e \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/p>\n

      \n
    1. \u0414\u043b\u044f \u043f\u043e\u0434\u0431\u043e\u0440\u0430 \u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430, \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e\u0439 \u0434\u043b\u044f \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u043b\u0435\u0447\u0435\u043d\u0438\u044f;<\/li>\n
    2. \u0434\u043b\u044f \u043f\u0440\u0435\u0434\u0443\u043f\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u044f \u0432\u043e\u0437\u043d\u0438\u043a\u043d\u043e\u0432\u0435\u043d\u0438\u044f \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u0445 \u044d\u0444\u0444\u0435\u043a\u0442\u043e\u0432 \u0432 \u0445\u043e\u0434\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u044f;<\/li>\n
    3. \u0434\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u043e\u0442\u0440\u0430\u0432\u043b\u0435\u043d\u0438\u0439 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u043e\u043c.<\/li>\n<\/ol>\n

      \u041a\u043e\u0433\u0434\u0430 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/p>\n

        \n
      • \u041f\u0440\u0438 \u043c\u043e\u043d\u0438\u0442\u043e\u0440\u0438\u043d\u0433\u0435 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 \u043f\u0435\u0440\u0438\u043e\u0434\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u044f (\u0447\u0435\u0440\u0435\u0437 1\u20132 \u0447\u0430\u0441\u0430 \u043f\u043e\u0441\u043b\u0435 \u043d\u0430\u0447\u0430\u043b\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u044f, \u043a\u0430\u0436\u0434\u044b\u0435 3-4 \u043d\u0435\u0434\u0435\u043b\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f, \u043f\u043e\u0441\u043b\u0435 \u043a\u0430\u0436\u0434\u043e\u0439 \u0441\u043c\u0435\u043d\u044b \u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430, \u043f\u043e\u0441\u043b\u0435 \u0434\u043e\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u043a \u0442\u0435\u0440\u0430\u043f\u0438\u0438 \u0434\u0440\u0443\u0433\u0438\u0445 \u043f\u0440\u043e\u0442\u0438\u0432\u043e\u0441\u0443\u0434\u043e\u0440\u043e\u0436\u043d\u044b\u0445 \u0441\u0440\u0435\u0434\u0441\u0442\u0432);<\/li>\n
      • \u043f\u0440\u0438 \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u0438 \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u0445 \u044d\u0444\u0444\u0435\u043a\u0442\u043e\u0432, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u044b\u0445 \u0441 \u043f\u0440\u0438\u0435\u043c\u043e\u043c \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430;<\/li>\n
      • \u043f\u0440\u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u043d\u0430 \u043e\u0442\u0440\u0430\u0432\u043b\u0435\u043d\u0438\u0435 \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u043e\u043c;<\/li>\n
      • \u043f\u0440\u0438 \u043f\u043b\u0430\u043d\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0438 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u043d\u0430 \u0444\u043e\u043d\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0441\u0443\u0434\u043e\u0440\u043e\u0436\u043d\u043e\u0433\u043e \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430.<\/li>\n<\/ul>\n

        \u0427\u0442\u043e \u043e\u0437\u043d\u0430\u0447\u0430\u044e\u0442 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b?<\/p>\n

        \u0420\u0435\u0444\u0435\u0440\u0435\u043d\u0441\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f: 10 \u2013 40 \u043c\u043a\u0433\/\u043c\u043b.<\/p>\n

        \u0423 \u0431\u043e\u043b\u044c\u0448\u0438\u043d\u0441\u0442\u0432\u0430 \u043b\u044e\u0434\u0435\u0439 \u043e\u0442\u043c\u0435\u0447\u0430\u0435\u0442\u0441\u044f \u043e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u044b\u0439 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u044d\u0444\u0444\u0435\u043a\u0442 \u043e\u0442 \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0444\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b\u043e\u043c \u043f\u0440\u0438 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432 \u043f\u043b\u0430\u0437\u043c\u0435 \u043a\u0440\u043e\u0432\u0438 \u043e\u0442 10 \u0434\u043e 35 \u043c\u043a\u0433\/\u043c\u043b. \u0412 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u0445 \u0441\u043b\u0443\u0447\u0430\u044f\u0445 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u0430\u044f \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043c\u0435\u043d\u044c\u0448\u0435 10 \u043c\u043a\u0433\/\u043c\u043b, \u0430 \u0432 \u043e\u0442\u0434\u0435\u043b\u044c\u043d\u044b\u0445 \u043d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u044f\u0445 \u0437\u0430\u0440\u0435\u0433\u0438\u0441\u0442\u0440\u0438\u0440\u043e\u0432\u0430\u043d\u044b \u043f\u0440\u0438\u0437\u043d\u0430\u043a\u0438 \u043e\u0442\u0440\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u043c \u043f\u0440\u0438 \u0443\u0440\u043e\u0432\u043d\u0435 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u0435\u0433\u043e \u0432 \u043f\u043b\u0430\u0437\u043c\u0435 \u043a\u0440\u043e\u0432\u0438 \u0432 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u0445 10 \u2013 35 \u043c\u043a\u0433\/\u043c\u043b. \u041f\u043e\u044d\u0442\u043e\u043c\u0443 \u0434\u0430\u043d\u043d\u044b\u0435 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u044b\u0445 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0439 \u0434\u043e\u043b\u0436\u043d\u044b \u043e\u0446\u0435\u043d\u0438\u0432\u0430\u0442\u044c\u0441\u044f \u0432 \u0441\u043e\u0432\u043e\u043a\u0443\u043f\u043d\u043e\u0441\u0442\u0438 \u0441 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u043c \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435\u043c.<\/p>\n

        \u041a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u044c\u043d\u043e \u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u0438\u0442\u044c\u0441\u044f \u043a \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044e?<\/strong><\/p>\n

          \n
        • \u0414\u0435\u0442\u044f\u043c \u0432 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0435 \u0434\u043e 1 \u0433\u043e\u0434\u0430 \u043d\u0435 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0442\u044c \u043f\u0438\u0449\u0443 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 30-40 \u043c\u0438\u043d\u0443\u0442 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/li>\n
        • \u041d\u0435 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0442\u044c \u043f\u0438\u0449\u0443 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 2-3 \u0447\u0430\u0441\u043e\u0432 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f, \u043c\u043e\u0436\u043d\u043e \u043f\u0438\u0442\u044c \u0447\u0438\u0441\u0442\u0443\u044e \u043d\u0435\u0433\u0430\u0437\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u0443\u044e \u0432\u043e\u0434\u0443.<\/li>\n
        • \u041d\u0435 \u043a\u0443\u0440\u0438\u0442\u044c \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 30 \u043c\u0438\u043d\u0443\u0442 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/li>\n<\/ul>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[984],"product_tag":[],"class_list":{"0":"post-10319","1":"product","2":"type-product","3":"status-publish","5":"product_cat-monitorizare-terapeutica-medicamente-tdm","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10319","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10319"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10319"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10319"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10319"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}