Eplerenone, Piritsi Yamlomo

Zamkati

• Machenjezo ofunikira
• Kodi eplerenone ndi chiyani?
• Chifukwa chimagwiritsidwa ntchito
• Momwe imagwirira ntchito
• Zotsatira za Eplerenone
• Zotsatira zofala kwambiri
• Zotsatira zoyipa
• Eplerenone amatha kulumikizana ndi mankhwala ena
• Maantibayotiki
• Mankhwala osokoneza bongo
• Mankhwala osokoneza bongo
• Mankhwala ochepetsa mphamvu ya kachilombo ka HIV
• Mankhwala othamanga magazi
• Mankhwala okhazikika okhazikika
• Mankhwala opweteka
• Mankhwala okhudzana ndi potaziyamu
• Zowonjezera potaziyamu
• Machenjezo a Eplerenone
• Chenjezo la ziwengo
• Chenjezo lothandizira chakudya
• Machenjezo kwa anthu omwe ali ndi matenda ena
• Machenjezo kwa magulu ena
• Momwe mungatenge eplerenone
• Mitundu ya mankhwala ndi mphamvu
• Mlingo wa kuthamanga kwa magazi
• Mlingo wa kulephera kwa mtima mutadwala mtima
• Mlingo waukulu (wazaka 65 kapena kupitirira)
• Maganizo apadera
• Tengani monga mwalamulidwa
• Zofunikira pakumwa eplerenone
• Zonse
• Yosungirako
• Zowonjezeranso
• Kuyenda
• Kudziyang'anira pawokha
• Kuwunika kuchipatala
• Ndalama zobisika
• Chilolezo chisanachitike
• Kodi pali njira zina?

Mfundo zazikulu za eplerenone

1. Piritsi la Eplerenone pakamwa limapezeka ngati mankhwala achibadwa komanso mankhwala osokoneza bongo. Dzinalo: Inspra.
2. Eplerenone imangobwera ngati piritsi lomwe mumamwa.
3. Eplerenone oral tablet imagwiritsidwa ntchito kuchiza matenda oopsa (kuthamanga kwa magazi), komanso kulephera kwa mtima mutadwala matenda a mtima.

Machenjezo ofunikira

• Chenjezo la potaziyamu: Mankhwalawa amatha kukweza potaziyamu m'magazi anu. Dokotala wanu amayang'ana kuchuluka kwa potaziyamu wanu mukamamwa eplerenone. Simuyenera kumwa mankhwalawa ngati:
  • ali ndi potaziyamu wambiri
  • tengani magazi omwe amakhudza potaziyamu wanu
  • tengani zowonjezera potaziyamu
  • osagwira bwino impso

Kodi eplerenone ndi chiyani?

Eplerenone ndi mankhwala omwe mumalandira. Zimabwera ngati piritsi lokamwa.

Piritsi ya Eplerenone yamlomo imapezeka ngati mankhwala otchedwa Inspra. Ikupezekanso ngati mankhwala achibadwa. Mankhwala achibadwa nthawi zambiri amakhala otsika poyerekeza ndi mtundu wamaina. Nthawi zina, sangapezeke mwamphamvu iliyonse kapena mawonekedwe aliwonse monga mankhwala omwe amadziwika ndi dzina.

Eplerenone itha kutengedwa ngati gawo limodzi la mankhwala osakaniza. Izi zikutanthauza kuti mungafunike kumwa mankhwala ena.

Chifukwa chimagwiritsidwa ntchito

Eplerenone amagwiritsidwa ntchito pochiza kuthamanga kwa magazi. Mankhwala omwe amachepetsa kuthamanga kwa magazi amachepetsa mwayi wokhala ndi stroke kapena matenda amtima.

Eplerenone imagwiritsidwanso ntchito kuthandizira kuchira kwa mtima pambuyo povutika ndi mtima.

Momwe imagwirira ntchito

Eplerenone ndi gulu la mankhwala otchedwa aldosterone antagonists. Gulu la mankhwala ndi gulu la mankhwala omwe amagwiranso ntchito chimodzimodzi. Mankhwalawa amagwiritsidwa ntchito pochiza zofananira.

Eplerenone imagwira ntchito posokoneza zochitika za steroid mthupi lanu lotchedwa aldosterone. Aldosterone imathandizira kukulitsa kuchuluka kwa sodium ndi madzi omwe mumasunga. Kuwonjezeka kwa sodium ndi madzi kumatha kuyambitsa kuthamanga kwa magazi, komwe kumayambitsanso mtima.

Eplerenone imatseka kuthekera kwa aldosterone kowonjezera kuchuluka kwa sodium ndi madzi m'thupi lanu. Amalola madzi ambiri ndi sodium kuchoka m'thupi lanu.

Zotsatira za Eplerenone

Eplerenone piritsi yamlomo imatha kuyambitsa tulo komanso mavuto ena.

Zotsatira zofala kwambiri

Zotsatira zoyipa zomwe zimatha kuchitika ndi eplerenone ndi monga:

• chizungulire
• kutsegula m'mimba
• kukhosomola
• Zizindikiro zonga chimfine, monga kutentha thupi ndi kupweteka kwa thupi
• kutopa
• gynecomastia (kukula kwa mawere mwa amuna)

Ngati zotsatirazi ndizochepa, zimatha kutha masiku angapo kapena milungu ingapo. Ngati ali ovuta kwambiri kapena osapita, lankhulani ndi dokotala kapena wamankhwala.

Zotsatira zoyipa

Itanani dokotala wanu nthawi yomweyo ngati muli ndi zovuta zina. Itanani 911 ngati zizindikiro zanu zikuwopseza moyo kapena ngati mukuganiza kuti mukukumana ndi vuto lachipatala. Zotsatira zoyipa komanso zizindikilo zake zimatha kukhala izi:

• Mavuto a impso. Zizindikiro zimatha kuphatikiza:
  • kusowa kwa madzi m'thupi
  • kutopa
  • kutupa kwa miyendo yanu
  • chisokonezo
  • kuchepa pokodza
  • Hyperkalemia (potaziyamu wambiri m'magazi anu. Zizindikiro zake ndi monga:
    • kufooka kwa minofu
    • kutopa
    • kugunda kwamtima kosasintha
    • kumva kulira
    • nseru

Chodzikanira: Cholinga chathu ndikukupatsani chidziwitso chofunikira kwambiri komanso chaposachedwa. Komabe, chifukwa mankhwala amakhudza munthu aliyense mosiyanasiyana, sitingatsimikizire kuti izi zimaphatikizaponso zovuta zonse zomwe zingachitike. Izi sizilowa m'malo mwa upangiri wa zamankhwala. Nthawi zonse muzikambirana mavuto omwe angakhalepo ndi othandizira azaumoyo omwe amadziwa mbiri yanu yazachipatala.

Eplerenone amatha kulumikizana ndi mankhwala ena

Pulogalamu yamlomo ya Eplerenone imatha kulumikizana ndi mankhwala ena, mavitamini, kapena zitsamba zomwe mwina mukumwa. Kulumikizana ndi pamene chinthu chimasintha momwe mankhwala amagwirira ntchito. Izi zitha kukhala zowononga kapena kuletsa mankhwalawa kuti asagwire ntchito bwino.

Pofuna kupewa kuyanjana, dokotala ayenera kuyang'anira mankhwala anu onse mosamala. Onetsetsani kuuza dokotala wanu za mankhwala onse, mavitamini, kapena zitsamba zomwe mukumwa. Kuti mudziwe momwe mankhwalawa angagwirizane ndi china chake chomwe mumatenga, lankhulani ndi dokotala kapena wamankhwala.

Zitsanzo za mankhwala omwe angayambitse kuyanjana ndi eplerenone alembedwa pansipa.

Maantibayotiki

Kutenga maantibayotiki ndi eplerenone kumatha kukulitsa kuchuluka kwa eplerenone mthupi lanu. Izi zitha kuyambitsa zovuta zina. Zitsanzo za mankhwalawa ndi monga:

• chithuchithu
• erythromycin

Mankhwala osokoneza bongo

Kutenga nefazodone ndi eplerenone imatha kukulitsa milingo ya eplerenone mthupi lanu. Izi zitha kuyambitsa zovuta zina.

Mankhwala osokoneza bongo

Kutenga mankhwala osokoneza bongo ndi eplerenone kumatha kukulitsa kuchuluka kwa eplerenone mthupi lanu. Izi zitha kuyambitsa zovuta zina. Zitsanzo za mankhwalawa ndi monga:

• chithu
• ketoconazole
• fluconazole

Mankhwala ochepetsa mphamvu ya kachilombo ka HIV

Kutenga eplerenone ndi mankhwala otchedwa antiretrovirals kumatha kukulitsa kuchuluka kwa eplerenone mthupi lanu. Izi zitha kuyambitsa zovuta zina. Zitsanzo za mankhwalawa ndi monga:

• alireza
• mwambo
• alireza

Mankhwala othamanga magazi

Kutenga eplerenone ndi mankhwala ochizira kuthamanga kwa magazi kumatha kukulitsa chiopsezo chokhala ndi potaziyamu wambiri wamavuto komanso impso. Zitsanzo za mankhwalawa ndi monga:

• angiotensin receptor blockers, monga:
  • kondwani
  • eprosartan
  • alirezatalischi
  • alireza
  • alireza
  • alireza
  • alirezatalischi
  • alireza
  • angiotensin-converting enzyme (ACE) inhibitors, monga:
    • alireza
    • kapita
    • chikodil
    • zochita
    • kutchilimy
    • kutchfuneralhome
    • perindopril
    • quinapril
    • chithu
    • kutchfuneral

Mankhwala okhazikika okhazikika

Kutenga lifiyamu ndi eplerenone imatha kuwonjezera zotsatira za mankhwalawa. Izi zitha kuyambitsa zovuta zina.

Mankhwala opweteka

Mankhwala ena opweteka omwe amatchedwa nonsteroidal anti-inflammatory drug (NSAIDs) ndi COX-2 inhibitors amatha kukhudza kuthamanga kwa magazi kutsitsa ndikuwonjezera potaziyamu akamamwa ndi eplerenone. Zitsanzo za mankhwalawa ndi monga:

• celecoxib, choletsa COX-2
• NSAID monga:
  • diclofenac
  • ibuprofen
  • indomethacin
  • ketoprofen
  • ketorolac
  • meloxicam
  • nabumetone
  • naproxen
  • magwire
  • ibuprofen
  • naproxen

Mankhwala okhudzana ndi potaziyamu

Mankhwala otchedwa potassium-sparing diuretics amatha kukulitsa potaziyamu mthupi lanu mukamamwa ndi eplerenone. Zitsanzo za mankhwalawa ndi monga:

• spironolactone
• amiloride
• alireza

Zowonjezera potaziyamu

Zowonjezera potaziyamu zimatha kuwonjezera potaziyamu mthupi lanu mukamamwa ndi eplerenone.

Chodzikanira: Cholinga chathu ndikukupatsani chidziwitso chofunikira kwambiri komanso chaposachedwa. Komabe, chifukwa mankhwala amagwirira ntchito mosiyanasiyana mwa munthu aliyense, sitingatsimikizire kuti izi zikuphatikizira kulumikizana kulikonse kotheka. Izi sizilowa m'malo mwa upangiri wa zamankhwala. Nthawi zonse lankhulani ndi omwe amakuthandizani pa zaumoyo momwe mungachitire ndi mankhwala, mavitamini, zitsamba ndi zowonjezera, komanso mankhwala omwe mumamwa.

Machenjezo a Eplerenone

Mankhwalawa amabwera ndi machenjezo angapo.

Chenjezo la ziwengo

Eplerenone imatha kuyambitsa vuto lalikulu. Zizindikiro zake ndi izi:

• kuvuta kupuma
• kutupa pakhosi kapena lilime
• ming'oma

Mukakhala ndi zizindikilozi, itanani 911 kapena pitani kuchipinda chadzidzidzi chapafupi.

Musatengerenso mankhwalawa ngati munakhalapo ndi vuto linalake. Kutenganso kumatha kukhala koopsa (kuyambitsa imfa).

Chenjezo lothandizira chakudya

Kudya zipatso zamphesa kapena kumwa madzi amphesa kumatha kukulitsa kuchuluka kwa eplerenone mthupi lanu. Pewani kumwa zipatso za manyumwa mukamamwa mankhwalawa.

Machenjezo kwa anthu omwe ali ndi matenda ena

Kwa anthu omwe ali ndi vuto la impso: Mutha kukhala ndi chiopsezo chowonjezeka cha potaziyamu m'magazi anu. Dokotala wanu amayang'anira impso zanu ndi milingo ya potaziyamu kuti awonetsetse kuti zili bwino kuti mupitirize kumwa eplerenone.

Kwa anthu omwe ali ndi matenda ashuga: Simuyenera kugwiritsa ntchito eplerenone ngati muli ndi matenda ashuga komanso muli ndi mapuloteni mkodzo wanu. Kuchita izi kudzakuyika pachiwopsezo chachikulu chotenga hyperkalemia (potaziyamu wambiri). Zizindikiro za hyperkalemia ndi monga:

• kufooka kwa minofu
• kutopa
• kumva kulira
• nseru

Kwa anthu omwe ali ndi kuthamanga kwa magazi: Ngati muli ndi kuthamanga kwa magazi, simuyenera kumwa mankhwalawa ngati muli ndi zina. Uzani dokotala wanu ngati muli ndi mavuto a impso, matenda ashuga komanso mapuloteni mumkodzo wanu, kapena ngati mumamwa potaziyamu.

Machenjezo kwa magulu ena

Kwa amayi apakati: Kafukufuku wazinyama sanawonetse chiopsezo kwa mwana wosabadwa pamene mayi amamwa mankhwalawo. Komabe, maphunziro a nyama samaneneratu nthawi zonse momwe anthu angayankhire. Komanso, sipanakhale maphunziro okwanira omwe anachitidwa mwa anthu kuti asonyeze ngati mankhwalawa atha kubweretsa chiopsezo kwa mwana wosabadwa.

Mankhwalawa ayenera kugwiritsidwa ntchito pokhapokha ngati pakufunika kutero. Lankhulani ndi dokotala ngati muli ndi pakati kapena mukukonzekera kutenga pakati.

Kwa amayi omwe akuyamwitsa: Sidziwika ngati eplerenone imadutsa mkaka wa m'mawere. Ngati zingatero, zitha kubweretsa zovuta kwa mwana yemwe akuyamwitsa. Inu ndi dokotala mungafunike kusankha ngati mungamwe eplerenone kapena kuyamwitsa.

Kwa okalamba: Okalamba amatha kugwiritsa ntchito mankhwala pang'onopang'ono. Mlingo wachikulire wabwinobwino ungapangitse kuchuluka kwa mankhwalawa kukhala okwera kuposa thupi lanu. Ngati ndinu wamkulu, mungafunike mlingo wocheperako kapena mulingo wina wa mulingo.

Kwa ana: Eplerenone sanaphunzirepo ngati chithandizo cha kulephera kwa mtima kwa anthu ochepera zaka 18. Chifukwa cha kuthamanga kwa magazi, eplerenone idapezeka kuti siyothandiza ana.

Momwe mungatenge eplerenone

Mlingo wodziwa izi ndi wa piritsi la eplerenone. Mlingo ndi mafomu onse omwe sangakhale nawo sangaphatikizidwe pano. Mlingo wanu, mawonekedwe anu, komanso kuti mumatenga kangati zimadalira:

• zaka zanu
• matenda omwe akuchiritsidwa
• kuopsa kwa matenda anu
• Matenda ena omwe muli nawo
• momwe mumachitira ndi mankhwala oyamba

Mitundu ya mankhwala ndi mphamvu

Zowonjezera: Eplerenone

• Mawonekedwe: piritsi yamlomo
• Mphamvu: 25 mg, 50 mg

Mtundu: Kulimbikitsa

• Mawonekedwe: piritsi yamlomo
• Mphamvu: 25 mg, 50 mg

Mlingo wa kuthamanga kwa magazi

Mlingo wa akulu (zaka 18 mpaka 64 zaka)

• Mlingo woyambira: 50 mg amatengedwa kamodzi patsiku.
• Mlingo ukuwonjezeka: Ngati kuli kotheka, dokotala wanu akhoza kuwonjezera mlingo wanu ku 50 mg wotengedwa kawiri patsiku.

Mlingo wa ana (zaka 0-17 zaka)

Palibe malingaliro amtundu wa anthu ochepera zaka 18.

Mlingo waukulu (wazaka 65 kapena kupitirira)

Okalamba amatha kugwiritsa ntchito mankhwala pang'onopang'ono. Mlingo wachikulire wabwinobwino ungapangitse kuchuluka kwa mankhwalawa kukhala okwera kuposa thupi lanu. Ngati ndinu wamkulu, mungafunike mlingo wocheperako kapena mulingo wina wa mulingo.

Mlingo wa kulephera kwa mtima mutadwala mtima

Mlingo wa akulu (zaka 18-64 zaka)

• Mlingo woyambira: 25 mg amatengedwa kamodzi patsiku.
• Mlingo ukuwonjezeka: Ngati kuli kotheka, dokotala wanu akhoza kuwonjezera mlingo wanu ku 50 mg wotengedwa kamodzi patsiku.

Mlingo wa ana (zaka 0-17 zaka)

Eplerenone sanaphunzirepo ana omwe ali ndi vuto la mtima ndipo sayenera kugwiritsidwa ntchito kwa anthu ochepera zaka 18.

Mlingo waukulu (wazaka 65 kapena kupitirira)

Okalamba amatha kugwiritsa ntchito mankhwala pang'onopang'ono. Mlingo wachikulire wabwinobwino ungapangitse kuchuluka kwa mankhwalawa kukhala okwera kuposa thupi lanu. Ngati ndinu wamkulu, mungafunike mlingo wotsika kapena ndandanda ina.

Maganizo apadera

Kwa anthu omwe ali ndi vuto la impso: Dokotala wanu akhoza kuyimitsa chithandizo chanu ndi eplerenone ngati ntchito yanu ya impso ili yovuta. Komanso, kugwiritsa ntchito mankhwalawa kumakulitsa chiopsezo chokhala ndi potaziyamu wambiri m'magazi anu.

Chodzikanira: Cholinga chathu ndikukupatsani chidziwitso chofunikira kwambiri komanso chaposachedwa. Komabe, chifukwa mankhwala osokoneza bongo amakhudza munthu aliyense mosiyanasiyana, sitingatsimikizire kuti mndandandawu umaphatikizira miyezo yonse yotheka. Izi sizilowa m'malo mwa upangiri wa zamankhwala. Nthawi zonse lankhulani ndi dokotala kapena wamankhwala za mlingo woyenera kwa inu.

Tengani monga mwalamulidwa

Eplerenone imagwiritsidwa ntchito pochiza kwa nthawi yayitali. Zimabwera ndi zoopsa zazikulu ngati simukuzitenga monga mwalamulo.

Mukasiya kumwa mankhwalawa kapena osamwa konse: Ngati simumamwa mankhwalawa, kuthamanga kwa magazi kwanu kumakhala kochuluka. Izi ziwonjezera chiopsezo chanu chodwala matenda a sitiroko kapena a mtima.

Mukasiya kumwa mankhwalawa mwadzidzidzi, kuthamanga kwa magazi kwanu kumatha (kuwonjezeka mwadzidzidzi). Izi zitha kukulitsa chiopsezo chodwala matenda amtima kapena sitiroko. Osasiya kumwa eplerenone osalankhula ndi dokotala.

Ngati mwaphonya Mlingo kapena osazitenga nthawi yake: Mwina simungathe kuyendetsa bwino magazi. Izi zitha kuwonjezera chiopsezo chanu chodwala matenda amtima kapena sitiroko.

Ngati mutenga zochuluka kwambiri:Ngati mutenga zochuluka kwambiri: Mutha kukhala ndimankhwala owopsa mthupi lanu. Kutenga eplerenone yambiri kumatha kubweretsa kutsika kwa magazi. Zitha kupanganso kuchuluka kwa potaziyamu wamagazi, ndizizindikiro zomwe zimaphatikizapo:

• kufooka kwa minofu
• kutopa
• kugunda kwamtima kosasintha
• kumva kulira
• nseru

Ngati mukuganiza kuti mwamwa kwambiri mankhwalawa, itanani dokotala wanu kapena funsani malangizo kuchokera ku American Association of Poison Control Center ku 1-800-222-1222 kapena kudzera pa chida chawo pa intaneti. Koma ngati matenda anu akukulira, itanani 911 kapena pitani kuchipatala chapafupi pomwepo.

Zomwe muyenera kuchita mukaphonya mlingo: Mukaiwala kumwa mankhwala anu, tengani mwamsanga mukamakumbukira. Ngati kwangotsala maola ochepa kuti nthawi ya mlingo wanu wotsatira ifike, dikirani ndikungotenga gawo limodzi panthawiyo.

Osayesa konse kutenga mwa kumwa miyezo iwiri nthawi imodzi. Izi zitha kuyambitsa zovuta zina.

Momwe mungadziwire ngati mankhwalawa akugwira ntchito: Mudzadziwa ngati eplerenone ikugwira ntchito mukamayang'ana kuthamanga kwa magazi kwanu. Ngati kuthamanga kwa magazi kwanu kuli pansi kapena pansi pa cholinga chomwe dokotala wakupangirani, mankhwalawa akugwira ntchito.

Zofunikira pakumwa eplerenone

Kumbukirani izi ngati dokotala akukulemberani eplerenone.

Zonse

• Eplerenone itha kumwa kapena popanda chakudya.
• Mutha kudula kapena kuphwanya phale.

Yosungirako

• Sungani eplerenone kutentha kwapakati pakati pa 68 ° F mpaka 77 ° F (20 ° C mpaka 25 ° C).
• Osamaundana eplerenone.
• Sungani mankhwalawa kutali ndi kuwala.
• Musasunge mankhwalawa m'malo onyowa kapena onyowa, monga mabafa.

Zowonjezeranso

Mankhwala a mankhwalawa amakonzanso. Simuyenera kusowa mankhwala atsopano kuti mudzazidwenso. Dokotala wanu adzalemba kuchuluka kwa mafuta obwezerezedwanso pamankhwala anu.

Kuyenda

Mukamayenda ndi mankhwala anu:

• Nthawi zonse muzinyamula mankhwala anu. Mukamauluka, musayikenso m'thumba lofufuzidwa. Sungani m'thumba lanu.
• Osadandaula za makina a X-ray pabwalo la ndege. Sangathe kuvulaza mankhwala anu.
• Mungafunike kuwonetsa ogwira ntchito ku eyapoti chizindikiro cha mankhwala anu. Nthawi zonse muzinyamula chidebe choyambirira cholembedwa ndi mankhwala.
• Musayike mankhwalawa m'galimoto yamagolovu amgalimoto yanu kapena siyani m'galimoto. Onetsetsani kuti musachite izi nyengo ikatentha kapena kuzizira kwambiri.

Kudziyang'anira pawokha

Muyenera kukawona kuthamanga kwa magazi kwanu. Ngati ndi choncho, muyenera kulemba chipika ndi tsiku, nthawi yatsiku, komanso kuwerengetsa kwa magazi anu. Bweretsani chipika ichi nanu kwa madokotala.

Ngati dokotala akukufunsani kuti muyang'ane kuthamanga kwa magazi kwanu, muyenera kugula zowunikira magazi.

Kuwunika kuchipatala

Mukamalandira chithandizo cha eplerenone, dokotala angafunikire kuwunika zotsatirazi kuti awone ngati mankhwalawa akugwira ntchito kapena ali otetezeka kuti mupitirize kumwa:

• kuthamanga kwa magazi
• chiwindi chimagwira
• ntchito ya impso
• potaziyamu wamagazi

Ndalama zobisika

Ngati dokotala akukufunsani kuti muwone kuthamanga kwa magazi kwanu, mufunika kuwunika magazi. Izi zimapezeka kuma pharmacies ambiri.

Chilolezo chisanachitike

Makampani ambiri a inshuwaransi amafuna chilolezo choyambirira cha mankhwalawa. Izi zikutanthauza kuti dokotala wanu adzafunika kuvomerezedwa ndi kampani yanu ya inshuwaransi kampani yanu ya inshuwaransi isanakulipireni mankhwalawo.

Kodi pali njira zina?

Palinso mankhwala ena omwe amapezeka kuti athetse vuto lanu. Ena akhoza kukuyenererani kuposa ena. Lankhulani ndi dokotala wanu za mankhwala ena omwe angakuthandizeni.

Chodzikanira: Healthaline yayesetsa kwambiri kuti zidziwitso zonse zikhale zolondola, zomveka bwino, komanso zaposachedwa. Komabe, nkhaniyi sikuyenera kugwiritsidwa ntchito m'malo mwa chidziwitso ndi ukadaulo wa akatswiri pazachipatala. Muyenera kufunsa adotolo kapena akatswiri azaumoyo musanamwe mankhwala aliwonse. Zambiri zamankhwala zomwe zili pano zitha kusintha ndipo sizingapangidwe kuti zigwiritse ntchito, mayendedwe, zodzitetezera, machenjezo, kulumikizana ndi mankhwala, kusokonezeka, kapena zovuta zina. Kusapezeka kwa machenjezo kapena zidziwitso za mankhwala omwe apatsidwa sikuwonetsa kuti kuphatikiza mankhwala kapena mankhwalawa ndiwotetezeka, ogwira ntchito, komanso oyenera kwa odwala onse kapena ntchito zina zilizonse.