IClopidogrel, Ithebhulethi Yomlomo

-Delile

• Izithombe ezinhle kakhulu ze-clopidogrel
• Yini i-clopidogrel?
• Kungani kusetshenziswa
• Isebenza kanjani
• Imiphumela emibi yeClopidogrel
• Imiphumela emibi ejwayelekile
• Imiphumela emibi kakhulu
• IClopidogrel ingaxhumana neminye imithi
• Isidakamizwa sikashukela
• Izidakamizwa ze-acid esiswini (proton pump inhibitors)
• Izidakamizwa ezingezona ukuvuvukala (ama-NSAID)
• Abanciphisa igazi
• Izidakamizwa ezisetshenziselwa ukwelapha ukudangala
• Ama-salicylates (i-aspirin)
• Ama-opioid
• Ungayithatha kanjani i-clopidogrel
• Amafomu namandla
• Isilinganiso se-acute coronary syndrome
• Isikali sokuhlaselwa yinhliziyo muva nje, isifo sohlangothi sakamuva, noma isifo semithambo yegazi
• Izexwayiso zeClopidogrel
• Isexwayiso se-FDA: Isixwayiso somsebenzi wesibindi
  
• Isexwayiso esibi sokopha
• Isexwayiso ngokuhlinzwa noma ngenqubo
• Isexwayiso somzimba
• Ukusebenzisana kotshwala
• Izexwayiso zabantu abanezimo ezithile zempilo
• Izexwayiso kwamanye amaqembu
• Thatha njengoba kuqondisiwe
• Ukucatshangelwa okubalulekile kokuthatha i-clopidogrel
• Jikelele
• Isitoreji
• Ukuvakasha
• Ukuzilawula
• Ukuqapha komtholampilo
• Izindleko ezifihliwe
• Ukutholakala
• Ingabe zikhona ezinye izindlela?

Izithombe ezinhle kakhulu ze-clopidogrel

1. Ithebhulethi yomlomo yeClopidogrel iyatholakala njengezidakamizwa ezijwayelekile nezegama. Igama lomkhiqizo: I-Plavix.
2. IClopidogrel iza kuphela ngendlela yethebhulethi oyithatha ngomlomo.
3. I-Clopidogrel isetshenziselwa ukuvimbela isifo senhliziyo nesifo sohlangothi. Inqunyelwe abantu abake bahlaselwa yisifo senhliziyo noma isifo sohlangothi, noma abanesifo semithambo yegazi (ukungahambi kahle emilenzeni).

Yini i-clopidogrel?

Ithebhulethi yomlomo yeClopidogrel ngumuthi kadokotela otholakala njengomuthi wegama lomkhiqizo I-Plavix. Iphinde itholakale njengomuthi ojwayelekile. Imithi ejwayelekile ijwayele ukubiza imali encane kunohlobo lwamagama. Kwezinye izimo, kungenzeka zingatholakali ngawo wonke amandla noma amafomu njengomuthi wegama lomkhiqizo.

IClopidogrel iza kuphela ngendlela yethebhulethi oyithatha ngomlomo.

Kungani kusetshenziswa

IClopidogrel isetshenziselwa ukuvimbela amahlule egazi uma unezinhlungu esifubeni, isifo semithambo eseceleni (ukusakazeka kahle emilenzeni yakho), isifo senhliziyo, noma isifo sohlangothi.

Lesi sidakamizwa singasetshenziswa njengengxenye yokwelashwa okuhlanganayo. Lokho kusho ukuthi ungadinga ukuyithatha nezinye izidakamizwa. Udokotela wakho uzonquma ukuthi kufanele usebenzise lesi sidakamizwa nezinye izidakamizwa, njenge-aspirin.

Isebenza kanjani

I-Clopidogrel ingeyesigaba semithi ebizwa nge-platelet inhibitors noma i-thienopyridine class inhibitors ye-P2Y12 ADP platelet receptors. Isigaba semithi siyiqembu lemithi esebenza ngendlela efanayo. Le mithi ivame ukusetshenziselwa ukwelapha izimo ezifanayo.

Ama-platelet amangqamuzana egazi asiza igazi lakho ukuba livale ngokwejwayelekile. I-Clopidogrel isiza ukuvimbela ama-platelet ekuhlanganeni ndawonye. Lokhu kubayekisa ukwakha amahlule egazi.

Imiphumela emibi yeClopidogrel

Ithebhulethi yomlomo yeClopidogrel ingadala imiphumela emibi noma emibi. Uhlu olulandelayo luqukethe eminye yemiphumela emibi engase ivele ngenkathi uthatha i-clopidogrel. Lolu hlu alufaki yonke imiphumela emibi engaba khona.

Ngeminye imininingwane ngemiphumela engemihle ye-clopidogrel, noma amathiphu wokuthi ungabhekana kanjani nemiphumela emibi ekhathazayo, khuluma nodokotela wakho noma usokhemisi.

Imiphumela emibi ejwayelekile

Imiphumela emibi ejwayelekile engenzeka nge-clopidogrel ifaka:

• ukopha
• isikhumba esilumayo

Uma unesikhumba esilumayo, singahamba zingakapheli izinsuku ezimbalwa noma amasonto ambalwa. Uma kunzima kakhulu noma kungapheli, khuluma nodokotela wakho noma usokhemisi.

Imiphumela emibi kakhulu

Shayela udokotela wakho ngokushesha uma unemiphumela emibi kakhulu. Shayela u-911 uma izimpawu zakho zizizwa zisongela impilo noma uma ucabanga ukuthi unezimo eziphuthumayo zezokwelapha. Imiphumela emibi kanye nezimpawu zayo zingafaka okulandelayo:

• Ukopha okungathi sína, okusongela impilo. Izimpawu zingafaka:
  • ukopha okungachazeki noma ukopha okuhlala isikhathi eside
  • igazi emchameni wakho (umchamo obomvana, obomvu, noma onsundu)
  • indle ebomvu noma emnyama ebukeka njengetiyela
  • imihuzuko noma imihuzuko engachazeki eba nkulu
  • ukukhwehlela igazi noma amahlule egazi
  • uhlanza igazi noma uhlanza olubukeka njengezizathu zekhofi
• Inkinga yokuvala igazi ebizwa nge-thrombotic thrombocytopenic purpura (TTP). Lesi simo singenzeka ngemuva kokuthatha i-clopidogrel, noma ngabe usithatha kuphela isikhathi esingaphansi kwamasonto amabili. Ku-TTP, amahlule egazi akha emithanjeni yegazi noma yikuphi emzimbeni. Thola usizo lwezokwelapha ngokushesha uma unanoma iyiphi yalezi zimpawu:
  • amabala we-purplish (purpura) esikhunjeni sakho noma emlonyeni wakho (ulwelwesi lwamafinyila) ngenxa yokopha ngaphansi kwesikhumba
  • ukuphuzi kwesikhumba sakho noma okumhlophe kwamehlo akho (i-jaundice)
  • ukukhathala noma ubuthakathaka
  • isikhumba esibukeka sigqamile
  • imfiva
  • ukushaya kwenhliziyo okusheshayo noma ukuphefumula okuncane
  • ikhanda
  • ukukhuluma ulimi noma ukuqonda ulimi (aphasia)
  • ukudideka
  • ikhoma
  • unhlangothi
  • ukudlikiza
  • inani eliphansi lomchamo, noma umchamo obomvana noma onegazi kuwo
  • ubuhlungu besisu
  • isicanucanu, ukuhlanza, noma isifo sohudo
  • ukulahleka kombono

IClopidogrel ingaxhumana neminye imithi

Ithebhulethi yomlomo yeClopidogrel ingaxhumana neminye imithi eminingana. Ukuxhumana okuhlukile kungadala imiphumela ehlukile. Isibonelo, ezinye zingaphazamisa ukuthi usebenza kanjani umuthi, kanti ezinye zingadala imiphumela emibi eyengeziwe.

Ngezansi kunohlu lwemithi engasebenzisana ne-clopidogrel. Lolu hlu alunazo zonke izidakamizwa ezingasebenzisana ne-clopidogrel.

Ngaphambi kokuthatha i-clopidogrel, qiniseka ukuthi utshela udokotela kanye nosokhemisi mayelana nayo yonke imishanguzo kadokotela, i-counter-counter, nezinye izidakamizwa oziphuzayo. Batshele futhi nganoma yimaphi amavithamini, amakhambi, nezithako ozisebenzisayo. Ukwabelana ngalolu lwazi kungakusiza ugweme ukuhlangana okungenzeka.

Uma unemibuzo mayelana nokuhlangana kwezidakamizwa okungakuthinta, buza udokotela wakho noma usokhemisi.

Isidakamizwa sikashukela

Ezimweni eziningi, umabhebhana akufanele ithathwe nge-clopidogrel. Ukuthatha le mithi ndawonye kukhulisa inani le-repaglinide emzimbeni wakho, okungaholela emazingeni kashukela aphansi egazini. Uma kufanele uthathe le mithi ndawonye, ​​udokotela wakho uzokuphatha ngokucophelela umthamo wakho we-repaglinide.

Izidakamizwa ze-acid esiswini (proton pump inhibitors)

Akufanele uthathe i-clopidogrel ngezidakamizwa ezisetshenziselwa ukwelapha i-acid esiswini. Bangenza ukuthi i-clopidogrel ingasebenzi kahle. Izibonelo zale mithi zifaka:

• omeprazole
• esomeprazole

Izidakamizwa ezingezona ukuvuvukala (ama-NSAID)

Ukuthatha i-clopidogrel ngama-NSAID kungandisa ingozi yokuphuma kwegazi esiswini nasemathunjini akho. Izibonelo zale mithi zifaka:

• i-aspirin
• ibuprofen
• umabhebhana

Abanciphisa igazi

I-Warfarin futhi umsebenzi we-clopidogrel ukunciphisa igazi ngezindlela ezahlukene. Ukuzihlanganisa ndawonye kwandisa ingozi yokuphuma kwegazi.

Izidakamizwa ezisetshenziselwa ukwelapha ukudangala

Ukusebenzisa ama-anti-depressants athile nge-clopidogrel kungandisa ingozi yokuphuma kwegazi. Izibonelo zale mithi zifaka:

• i-serotonin reuptake inhibitors ekhethiwe (SSRIs)
• i-serotonin-norepinephrine reuptake inhibitors (SNRIs)

Ama-salicylates (i-aspirin)

Uma une-acute coronary syndrome, kufanele uthathe i-aspirin nge-clopidogrel. Kodwa-ke, akufanele uthathe le mithi ndawonye uma ngabe usanda kushaywa unhlangothi. Ukwenza kanjalo kwandisa ingozi yokuphuma kwegazi okukhulu.

Ama-opioid

Ukuthatha umuthi we-opioid nge-clopidogrel kungabambezela ukumuncwa futhi kwehlise inani le-clopidogrel emzimbeni wakho, kuyenze ingasebenzi kahle. Uma kufanele uthathe le mithi ndawonye, ​​udokotela wakho angakunikeza umuthi owengeziwe wokusiza ukuvimbela amahlule egazi ezimweni ezithile.

Izibonelo zama-opioid zifaka:

• ikhodi
• i-hydrocodone
• fentanyl
• morphine

Ungayithatha kanjani i-clopidogrel

Umthamo we-clopidogrel odokotela wakho okuyalelayo uzoncika ohlotsheni lwesimo osisebenzisayo ukwelapha umuthi.

Imvamisa, udokotela wakho uzokuqala ngomthamo ophansi futhi awulungise ngokuhamba kwesikhathi ukufinyelela umthamo okulungele wena. Ekugcineni bazonquma isilinganiso esincane kunazo zonke esihlinzeka ngomphumela oyifunayo.

Imininingwane elandelayo ichaza imithamo esetshenziswa kakhulu noma enconywayo. Kodwa-ke, qiniseka ukuthatha isilinganiso udokotela wakho akubekela sona. Udokotela wakho uzonquma isilinganiso esihle kakhulu ukuhlangabezana nezidingo zakho.

Amafomu namandla

Okujwayelekile: I-Clopidogrel

• Ifomu: ithebhulethi yomlomo
• Amandla: 75 mg no-300 mg

Umkhiqizo: I-Plavix

• Ifomu: ithebhulethi yomlomo
• Amandla: 75 mg no-300 mg

Isilinganiso se-acute coronary syndrome

Isilinganiso sabadala (abaneminyaka engu-18 nangaphezulu)

• Isilinganiso sokuqala sokuqala: 300 mg, kuthathwe kanye. Ukuqala ukwelashwa ngaphandle komthamo wokulayisha kuzobambezela imiphumela ngezinsuku ezimbalwa.
• Isilinganiso sesondlo: 75 mg, ithathwa kanye ngosuku.

Isilinganiso sengane (iminyaka engu-0 kuye kwengu-17)

Lesi sidakamizwa asikaze sifundwe ezinganeni futhi akufanele sisetshenziswe kubantu abangaphansi kweminyaka eyi-18.

Isikali sokuhlaselwa yinhliziyo muva nje, isifo sohlangothi sakamuva, noma isifo semithambo yegazi

Isilinganiso sabadala (abaneminyaka engu-18 nangaphezulu)

• Isilinganiso esivamile: Ama-75 mg athathwe kanye ngosuku.

Isilinganiso sengane (iminyaka engu-0 kuye kwengu-17)

Lesi sidakamizwa asikaze sifundwe ezinganeni futhi akufanele sisetshenziswe kubantu abangaphansi kweminyaka eyi-18.

Izexwayiso zeClopidogrel

Isexwayiso se-FDA: Isixwayiso somsebenzi wesibindi

• Lo muthi unesixwayiso se-Black Box. Lesi yisexwayiso esibi kakhulu esivela ku-Food and Drug Administration (FDA). Isexwayiso sebhokisi elimnyama sixwayisa odokotela neziguli ngemiphumela engaba yingozi.
• I-Clopidogrel idilizwe yisibindi sakho. Abanye abantu banokuhluka kofuzo ekusebenzeni kwe-enzyme eyodwa yesibindi, i-cytochrome p-450 2C19 (CYP2C19). Lokhu kunganciphisa ukuthi lo muthi wephulwe kanjani emzimbeni wakho futhi uwenze ungasebenzi futhi. Udokotela wakho angakuhlola ukuze abone ukuthi unalo mehluko wofuzo yini. Uma unayo, udokotela wakho uzokunika ezinye izindlela zokwelapha noma izidakamizwa esikhundleni se-clopidogrel.

Isexwayiso esibi sokopha

Lesi sidakamizwa singadala ukopha okukhulu futhi kwesinye isikhathi kubulale. IClopidogrel ingakwenza ube nomhuzuko futhi wophe kalula, ube namakhala okopha, futhi kuzothatha isikhathi eside kunokujwayelekile ukopha kuyeke. Kufanele utshele udokotela wakho nganoma yikuphi ukuphuma kwegazi okukhulu, okufana nalokhu:

• ukuphuma kwegazi okungaqondakali, okuhlala isikhathi eside, noma okweqile
• igazi emchameni noma esitulweni sakho

Isexwayiso ngokuhlinzwa noma ngenqubo

Ngaphambi kokuba kwenziwe noma yiziphi izinqubo, kufanele utshele odokotela bakho noma odokotela bamazinyo ukuthi uthatha i-clopidogrel. Ungadinga ukuyeka ukuthatha lesi sidakamizwa isikhashana ngaphambi kwenqubo yokuvimbela ukuphuma kwegazi. Udokotela wakho uzokwazisa ukuthi uyeke nini ukuthatha le mithi nokuthi kulungile yini ukuyiphuza futhi.

Isexwayiso somzimba

I-Clopidogrel ingadala ukusabela okweqile komzimba. Izimpawu zingafaka:

• inkinga yokuphefumula
• ukuvuvukala kobuso bakho, izindebe, ulimi, noma umphimbo

Ungaphinde uwuthathe lo muthi uma ngabe uke waba nokungezwani komzimba nawo. Akufanele futhi uthathe lesi sidakamizwa uma uxabana ne-thienopyridines (njenge-ticlopidine ne-clopidogrel). Ukuyithatha okwesibili ngemuva kokuphendula okweqile kungabulala.

Ukusebenzisana kotshwala

Utshwala bungandisa ingozi yokuphuma kwegazi ngenkathi uthatha lo muthi.

Izexwayiso zabantu abanezimo ezithile zempilo

Kubantu abanegazi elisebenzayo: Akufanele uthathe i-clopidogrel uma unegazi elisebenzayo (njengegazi lobuchopho) noma isimo sezokwelapha esibangela ukopha (njengesisu noma isilonda samathumbu). I-Clopidogrel ivimbela ukujiya futhi yenyuse ingozi yokuphuma kwegazi.

Kubantu abanokungezwani komzimba ne-thienopyridines: Uma uke waba nokusabela okweqile kunoma yiluphi uhlobo lwe-thienopyridine, akufanele uthathe i-clopidogrel.

Kubantu abanesifo sohlangothi sakamuva: Akufanele uthathe lesi sidakamizwa nge-aspirin uma usanda kuba nesifo sohlangothi. Kungakhuphula ingozi yakho yokopha okungathi sína.

Izexwayiso kwamanye amaqembu

Kwabesifazane abakhulelwe: Ucwaningo olwenziwe kwabesifazane abakhulelwe abathatha i-clopidogrel alukhombisanga ubungozi obengeziwe bokukhubazeka kokuzalwa noma ukukhulelwa kwesisu. Izifundo ze-clopidogrel ezilwaneni ezikhulelwe nazo azikhombisanga lezi zingozi.

Kodwa-ke, kunezingozi ezingaba khona kumama nakumbungu uma isifo senhliziyo noma isifo sohlangothi senzeka ngesikhathi sokukhulelwa. Ngakho-ke, inzuzo ye-clopidogrel ekuvimbeleni le micimbi yezempilo ingadlula noma iyiphi ingozi yomuthi lapho ukhulelwe.

Tshela udokotela wakho uma ukhulelwe noma uhlela ukukhulelwa. I-Clopidogrel kufanele isetshenziswe ngesikhathi sokukhulelwa kuphela uma inzuzo engaba khona iqinisekisa ubungozi obungaba khona.

Kwabesifazane abancelisayo: Akwaziwa ukuthi ngabe i-clopidogrel idlulela ebeleni lwebele. Uma kunjalo, kungadala imiphumela emibi enganeni enceliswa ibele. Wena nodokotela wakho kungadingeka ukuthi ninqume ukuthi uzothatha i-clopidogrel noma ukuncelisa ibele.

Okwezingane: Ukuphepha nokusebenza kwe-clopidogrel akukasungulwa ezinganeni ezingaphansi kweminyaka eyi-18.

Thatha njengoba kuqondisiwe

Ithebhulethi yomlomo yeClopidogrel isetshenziselwa ukwelashwa isikhathi eside. Kuza nezingozi ezinkulu uma ungayithathi njengokuyalelwe.

Uma uyeka ukuthatha lo muthi noma ungawuthathi nhlobo: Wandisa ingozi yokuhlaselwa yisifo senhliziyo noma isifo sohlangothi. Lezi zimo zingabulala.

Uma kufanele uyeke okwesikhashana ukuthatha i-clopidogrel, qala ukuyithatha futhi ngokushesha lapho udokotela ekutshela. Ukumisa lesi sidakamizwa kungakhuphula ubungozi bezimo zenhliziyo ezinkulu, isifo sohlangothi, noma ihlule legazi emilenzeni noma emaphashini.

Uma uphuthelwa imithamo noma ungaphuzi umuthi ngesikhathi: Imithi yakho kungenzeka ingasebenzi kahle noma ingayeka ukusebenza ngokuphelele. Ukuze lo muthi usebenze kahle, inani elithile lidinga ukuba semzimbeni wakho ngaso sonke isikhathi.

Uma uthatha kakhulu: Ungaba namazinga ayingozi omuthi emzimbeni wakho. Izimpawu zokweqisa izidakamizwa zalesi sidakamizwa zingafaka ukopha.

Uma ucabanga ukuthi uthathe kakhulu lo muthi, shayela udokotela wakho noma funa ukuholwa yi-American Association of Poison Control Centers ku-800-222-1222 noma ngethuluzi labo eliku-inthanethi. Kepha uma izimpawu zakho zinzima, shayela ku-911 noma uye egumbini lezimo eziphuthumayo eliseduze ngokushesha.

Okufanele ukwenze uma uphuthelwa umthamo: Uma uphuthelwa umthamo, thatha i-clopidogrel ngokushesha okukhulu lapho ukhumbula. Uma cishe sekuyisikhathi sedosi yakho elandelayo, weqa umthamo ongabanjwanga. Thatha umthamo owodwa kuphela ngesikhathi sakho esivamile. Ungathathi imithamo emibili ye-clopidogrel ngasikhathi sinye ngaphandle kokuthi udokotela wakho akutshele.

Ungasho kanjani ukuthi umuthi uyasebenza: Akufanele ube nokuhlaselwa yisifo senhliziyo noma isifo sohlangothi.

Ukucatshangelwa okubalulekile kokuthatha i-clopidogrel

Gcina lokhu kubheka engqondweni uma udokotela wakho ekuyalela ithebhulethi yomlomo ye-clopidogrel.

Jikelele

• Musa ukusika noma ukuchoboza ithebhulethi.

Isitoreji

• Gcina i-clopidogrel ekamelweni lokushisa eduze kwe-77 ° F (25 ° C). Ingagcinwa isikhathi esifushane ezingeni lokushisa eliphakathi kuka-59ºF no-86 ° F (15ºC no-30 ° C).
• Ungawugcini lo muthi ezindaweni ezinomswakama noma ezinomswakama, njengezindlu zangasese.

Ukuvakasha

Lapho uhamba nemithi yakho:

• Ngaso sonke isikhathi phatha imithi yakho. Lapho undiza, ungalokothi uwufake esikhwameni esihloliwe. Yigcine esikhwameni sakho sokuthwala.
• Ungakhathazeki ngemishini ye-X-ray yesikhumulo sezindiza. Ngeke zilimaze imithi yakho.
• Ungadinga ukukhombisa abasebenzi bezindiza ilebula lekhemisi lemithi yakho. Ngaso sonke isikhathi phatha isitsha sokuqala esinelebula kadokotela.
• Ungafaki lo muthi egumbini legilavu ​​lemoto yakho noma uwushiye emotweni. Qinisekisa ukugwema ukwenza lokhu lapho isimo sezulu sishisa kakhulu noma sibanda kakhulu.

Ukuzilawula

Udokotela wakho uzokufundisa wena namalungu omndeni wakho izimpawu zokuhlaselwa yisifo senhliziyo, ukushaywa unhlangothi, noma ukunqamuka kwegazi emilenzeni noma emaphashini. Uma unezimpawu zalezi zinkinga, kufanele uye egumbini lezimo eziphuthumayo noma ushayele u-911 khona manjalo.

Ukuqapha komtholampilo

Ngaphambi kokuqala ukwelashwa nge-clopidogrel, udokotela wakho angenza ukuhlolwa kofuzo ukuhlola uhlobo lwakho lwe-CYP2C19. Lokhu kuhlolwa kofuzo kuzosiza udokotela wakho anqume ukuthi kufanele yini uthathe i-clopidogrel. Amanye ama-genotypes anciphisa indlela i-clopidogrel ephuka ngayo. Uma unalolu hlobo lwe-genotype, lo muthi kungenzeka ungakusebenzeli.

Ukuze uqiniseke ukuthi umuthi wakho uyasebenza futhi uphephile kuwe, udokotela wakho uzohlola okulandelayo:

• ukubalwa kwegazi okuphelele (CBC)
• izimpawu zokopha

Izindleko ezifihliwe

Uma welashelwa i-acute coronary syndrome, kungadingeka ukuthi uthathe i-clopidogrel ne-aspirin. Udokotela wakho angakutshela okuningi.

Ukutholakala

Iningi lama-pharmacy ligcina uhlobo olujwayelekile lwe-clopidogrel. Kodwa-ke, akuwona wonke amasheya ekhemisi iPlavix, ifomu legama lomkhiqizo. Uma udokotela wakho ekuyala i-Plavix, lapho ugcwalisa incwadi kadokotela, qiniseka ukuthi ushayela phambili ukuze uqiniseke ukuthi ikhemisi lakho liyayiphatha.

Ingabe zikhona ezinye izindlela?

Kuneminye imithi etholakalayo yokwelapha isimo sakho. Ezinye zingakulungela kangcono kunabanye. Khuluma nodokotela wakho ngezinye izinketho zezidakamizwa ezingakusebenzela.

Ukuzikhulula: I-Healthline yenze yonke imizamo yokuqinisekisa ukuthi lonke ulwazi luyiqiniso, luphelele futhi lusesikhathini. Kodwa-ke, le ndatshana akufanele isetshenziswe njengokungena esikhundleni solwazi nobungoti bochwepheshe bezokunakekelwa kwezempilo onelayisense. Kufanele uhlale uthintana nodokotela wakho noma omunye uchwepheshe wezokunakekelwa kwempilo ngaphambi kokuthatha noma imuphi umuthi. Imininingwane yezidakamizwa equkethwe lapha ingashintsha futhi ayihloselwe ukumboza konke ukusetshenziswa okungaba khona, izinkomba, izixwayiso, izexwayiso, ukuxhumana kwezidakamizwa, ukungezwani komzimba, noma imiphumela emibi. Ukungabikho kwezixwayiso noma olunye ulwazi lomuthi othile awukhombisi ukuthi inhlanganisela yezidakamizwa noma yezidakamizwa iphephile, iyasebenza, noma ilungele zonke iziguli noma konke ukusetshenziswa okuthile.