Bo co thc tp BV A KHOA C HU

PHN I:

TNG QUAN V C S THC TP

1. Bnh vin a Khoa c Hu : - Tn Bnh Vin: Bnh vin a Khoa c Hu. - a Ch: Thi trn ng Thanh, c Hu, Long An. - Tng s cc khoa lm sng, a khoa, chuyn khoa:

Ni Khoa:
A2: Tim Mch A4: Truyn Nhim A5: Lao - Bnh Nhim Phi A7: Ni Thn Kinh A10: Y Hc C Truyn A12: Hi Sc Cp Cu

Ngoi Khoa:
B2: Ngoi Tit Niu B8: Khoa Rng Hm Mt B9: Tai Mi Hng B11: Khoa Sn C1: Khoa Khm Bnh C9: Khoa Chun on Hnh nh C10: Khoa Dc C11: Trang B

Trang - 1

2. Khoa Dc Bnh Vin:

V tr: - Khoa Dc l khoa chuyn mn rt quan trng khng th thiu c, cc khoa khc c th thiu c nhng thiu khoa Dc th khng tr thnh bnh vin. Khoa Dc chu s ch o trc tip ca gim c bnh vin.

Chc nng: - Thc hin cng tc chuyn mn k thut v Dc, nghin cu khoa Dc, tham gia hun luyn v bi dng cn b. - Qun l thuc men, ha cht, y c v cc ch chuyn mn v Dc trong ton bnh vin. - Tng hp nghin cu, xut cc vn v cng tc Dc trong ton bnh vin m bo thng tin, t vn v s dng thuc, kim tra theo di vic s dng thuc an ton, hp l trong ton bnh vin.

Nhim v: - m bo cung cp thuc men, ha cht, y c y kp thi p ng yu cu cn iu tr. - T chc cp pht thuc, ha cht, y c. - T chc pha ch sn xut thuc theo ch trng v phng hng ca b y t.

PHN II: KT QU THC TP

1. Cng tc cung ng thuc:
D tr: c 2 cp

- D tr thng 5: thuc khoa Dc c cc duyt xong lnh thuc. - D tr cui nm vo thng 11: d tr hng cho nm sau. Bn kho d tr mt ln na duyt mi cp pht.
D tr b sung: do kho d tr u thu nh thuc v bo him thuc hng tm

thn mt nm d tr mt ln.

Cch tnh d tr: - Tn kho ti thiu = s lng s dng trung bnh /ngy x s ngy ti thiu. - S lng s dng = s lng s dng trung bnh /ngy x 30 ngy + tn kho ti thiu. - D tr = s lng s dng - tn kho trong k. VD: D tr thuc Seduxen 5mg s dng trong mt thng. S ngy ti thiu 7 ngy, tn kho trong k l 432 vin Tn kho ti thiu = 600 x 7 = 4200 vin S lng s dng = 600 x 30 + 4200 = 22200 vin D tr = 22200 432 = 21768 vin

Bng d tr S T T 1 2 Tn thuc Nng Hm lng Normodipin Vin Richter 5mg SAT 100UI ng Hungary n v Nc sn xut S lng u k 0.00 Nhp Xut Tn 300.00 BV175 (BHYT) (Khoa dc) Bng d tr mua thuc hng tm thn thng 10/2009 STT Tn thuc Nng Hm lng 1 2 3 4 5 6 Lexomil 6mg Phenobarbittal 100mg Phenobarbittal 200mg Seduxen 5mg Ketamin 500mg Durogeric Ming .. Ngi lp d tr .. 100 .. Vin L 4980 110000 114980 109.895 5085 8 8 200.000 500 Vin Vin ng 492 552 1800 2352 492 1540 0 812 3.000 3000 200 n v Tn Nhp 2008 2009 Tng cng Xut 2009 Tn D tr n 2010 9/2009 Duyt Ghi ch S lng Cng ty Ghi ch

330.00 321.00 9.00

Biopharco.VN 114.00 400.00 429.00 85.00 200.00 BV 175

Gim c

Bng d tr thuc c A - B ( d tr b sung ) STT Tn thuc Nng Hm lng 1 Isorvet 0,1% (Isorosbide diniteat) . Th trng n v ng 15 200 215 195 20 200 200 n v Tn Nhp 2005 2006 Tng cng Xut 2006 Tn 2006 D tr 2007 Duyt Ghi ch

.. Ch nhim kho Ngy thng nm C quan duyt d tr

Ngi lp d tr

Nhp: theo ha n c du hp php. Xut: theo n thuc + phiu lnh thuc. Tn: s lng d tr cn li sau khi xut.

Th kho Ngy thng ghi s 01/01/00 01/12/09 01/12/09 000054 000057 Chng t S hiu u k Bn cho bnh nhn Bn cho bnh nhn 55.000,05 5.000,05 55.000,05 2,0 2,0 37,0 35,0 33,0 Din gii n gi Nhp Xut Tn

01/12/09 01/12/09 02/12/09

000074 000093 000032

Bn cho bnh nhn Bn cho bnh nhn Mua t cng ty CTTNHHDP TH ,s H: 10795

55.000,05 55.000,05 55.000,00 100,0

2,0 2,0

31,0 29,0 129,0

Nhn xt: khi gp s c xy ra thuc phn ng c hi hay thuc km cht lng th chng ta d dng thu hi thuc v hn ch c gy hi nh vo ngy thng, chng t, s hiu v bn cho ai. 2. T chc, qun l cp pht thuc: Quy trnh cp pht : + Chun b cp pht ng gi cc thnh phm ra chai l. + Nhn v kim tra phiu c ch k ca Bc s v thuc ph hp l hp l, ngc li th khng hp l tr li bnh nhn. + Chun b cp pht: Thc hin Ba kim tra: - Th thc n, phiu lnh thuc, liu dng, cch dng. - Nhn thuc. - Cht lng thuc bng cm quan Ba i chiu:
-

Tn thuc n, phiu vi nhn thuc. Nng , hm lng thuc n, phiu vi s thuc c giao. S lng, s khon trn n, phiu vi thuc chun b giao cho khch hng.

n thuc : Tn tuiGii tnh .. n v Chn on .. Tn thuc 1 Sng tra..chiu ti ..s lng . Ghi ch Tn thuc 2 Sng tra..chiu ti ..s lng . Ghi ch Ch k Bc s

Phiu lnh thuc : H v tn ..Tui.. n v . Chn on STT Tn thuc, hm lng n v S lng

Ngi nhn

Ngy ..thng .nm BS khm bnh

3. Quy ch Dc chnh : + T chc kim tra : Kho Dc v phng k hoch tng hp phi hp kim tra v cng tc Dc bnh vin + Ni dung kim tra : S dng thuc an ton, hp l, cc n thuc, t trc, cp cu ti cc khoa + Lch kim tra : Kim tra nh k 6 thng 12 thng v t xut + Kim tra : Quy ch qun l thuc, quy ch k n thuc, quy ch thuc gy nghin 4. T chc pha ch sn xut theo ch trng v phng hng ca b y t : A. Pha ch thuc tim : Yu cu v khun Quy trnh tun theo 1 chiu, khp kn: Cn ( Hot cht, T dc, Dung mi )

Ha tan hoc trn u

Lc

ng gi

Quy trnh v sinh chung chun b pha ch :

a. Chun b thng v trang b dng c pha ch : + Dng 50ml cn 900 t dit khun thng pha ch, trng li 2 ln bng nc ct. Ct nc vo thng pha ch, vo can m bo s lng cht lng, ct xong phi y np kn . + Tit khun qun, o, m, khu trang, h thng lc, nt cao su, nilon ra bng nc ct nhit 1200C t 5 20 pht trong ni hp. + Chun b chai x l t tiu chun

+ V sinh cc phng hp, phng sy, phng tin pha ch. + V sinh cc loi my mc: ni hp, ni ct, t sy i vi t sy phi dng gc bng git sch lau theo mt chiu bn trong. + Phng pha ch v tin pha ch dng nc ct ( trng thng pha ch trn ) ha cloramin B 5%lau tng (ngang u tr xung ), cnh ca, nn nh, dng cn 960lau bn, gh pha ch, cc ca knh, ca nhm C ra dp dng trong phng pha ch, dp i trong nh. b. Pha ch: Bt n t ngoi t nht 30 pht tit khun cn phng. Ngi pha ch tm ra v sinh c nhn, mang trang phc pha ch tit khun, mang dp ring ca phng pha ch. Dng cn 700 tit khun tay. Lp h thng lc, dng cn 960 t tit khun cc chu dng trong pha ch. Tin hnh pha ch theo tng quy trnh ring. Pha ch xong phi v sinh sp xp dng c gn, sy dng c, nt 600 - 700C trong vng 3h. Chiu ngy cui tun xng hi formol phng pha ch .
Quy trnh x l chai dch truyn qua s dng:

a. Chai mi thu mua v: - Ra bn ngoi cho sch ct. Khui m nt chai. Ngm nc x phng, thm khong 100g cloramin B (tn dng nc x phng c )trong 24 h.Co nhn, trng ra chai bng nc my. Ngm chai trong acid HCl 10% hoc H2SO4 5% trong 24 h.Trng chai trong v ngoi 2 ln bng nc ct hoc nc x l qua my lc nc ri trng trong bng nc ct pha tim, dc sch. Sy 1600C trong 2h. b. Chai mi thu v cc khoa ca bnh vin v: - i vi cc chai dung dch Nacl 0,9% -10%.ti nc cho b, co nhn, m nt. Sau ngm trong dung dch HCl 10% hoc H2SO4 5% trong 24h.Trng chai trong v ngoi 2 ln bng nc ct hoc nc x l qua my lc nc ri trng trong bng nc ct pha tim, dc sch. Sy 1600C trong 2h.
Qui trnh s dng ni hp Semco:

- Kim tra ni hp vn vi nc x ra ngoi 5 pht cho ht r st, trc khi cho vo ni. Cp nc vo ni hi n vch quy nh. Ring ni s 3 va n ch full. ng cu dao in, bt cng tc my (n bo bt sng ). n th t cc nt off;.slow.exh. Khi c chung reo hoc 15 pht tnh t khi n th 2STERILIZING bt sng, tc cng tc my cp cu dao in. Vn van x ht nc trong ni, ni dn ca ni, m t t ca ni hp (ngi m lun ng pha sau cnh ca). Kim tra bng keo th nhit nu chuyn mu en l c. Ngi hp phi thng xuyn c mt, lun i dp v thng bo cho cp trn khi c hin tng bt thng.

Ni Hp Semco
Quy trnh s dng ni ct nc ct:

- Kim tra ni hp vn vi nc x loi r st ra trong 5 pht. Kha van x ni ca ni nc ct. M vi cp nc vo ni n vch quy nh. y cu dao in cho ni ct hot ng. B 2 lt nc ct u ri hng vo thng, can. Ngi ct phi thng xuyn c mt, lun i dp phng in git, bo co cho cp trn khi c hin tng bt thng. Khi nc yu hi bc ra nhiu th m van thm nc lm lnh. Nu cn c th tt cu dao kha vi nc li, ch nc mh ct tip. Khi ngng ct: Cp cu dao in, kha vi nc lm lnh, m van x ht nc trong ni bo v snh nhit v ni ct.

Ni Ct Nc Ct Mt s thuc pha tim :

Dch truyn NaCl 0,9%

Dung dch dng ngoi NaCl 0.9%

B. Pha ch thuc theo n: Ni quy trong phng pha ch theo n: Thn trng, t m, chnh xc, gn gng, sch s, ngn np. Danh mc thucdng ngoi: Cn ASA Cn salicylic 20%

Cn benzoic 20%

Cn BSI 2% Hn dch long no lu hunh 10% Dung dch oxy gi 3% Dung dch acid boric Cn Iod 5% Cn Iod 10% Cn Iod 1% Cn Iod 0,1% Cn long no 10% Dung dch glycerin borat 3% Thuc 1% Xanh methylen 1%

 Dung dch natrisalicylic 5% Dung dch berberin 1% Dung dch berberin 2% Dung dch Na.Bi.Ca 5% Dung dch acid tricloacetic 33% Cn acid boric 2% Dung dch lugol 3% Dung dch NaCl 0,9% Dung dch formoldehyd 2% Dung dch acid citric 50% Dung dch acid citric 20% Dung dch acid acetic 30% Dung dch novocain 5% Dung dch novocain 0,5% Dung dch novocain 0,25%

Cn 700 Cn 900 Cn 500

Bt talc methol 1% M acid salicylic 2%

 M acid salicylic 5% M km oxyd 10%

Dung dch AgNo3 1%

C. Quy trnh pha ch 1 s dung dch: Dung dch xanh methylen 1% Cng thc : Xanh methylen 1% . 10g Nc ct Phn tch cng thc: Xanh methylen: bt kt tinh mu xanh xm, khng mi bn vng kh tri tan trong khong 30 pht /100p cn, ch phm c phn ng trung tnh. Nc ct l dung mi. K thut pha ch: Chun b: ha cht, dng c. Pha ch: Cn xanh methylen. Ha tan xanh methylen trong khong 800 - 900ml nc ct thm nc v, khuy u tan ht. Lc phu c lt bng gn. Cng dng: St trng vt thng, lm sn se nim mc. Bo qun nhn Trong chai, l kn. Dn nhn thnh phm dng ngoi. Tiu chun kim tra cht lng: theo TCCS. Cm quan: dung dch trong sut, mu xanh l m.
Dung dch oxy gi 10tt(3%)

.v 1000ml

Cng thc:

Oxygi 50% ..600ml Nc ct ..v10000ml

Phn tch cng thc: Nc oxy gi 50% l cht lng trong sut, khng mu, n da, mi hi c bit, c phn ng acid nh, ch phm ny b thy phn di tc dng ca nh sng, khng kh, nhit . Nc ct l dung mi. K thut pha ch : Chun b: ha cht, dung mi . Pha ch: ong oxy gi 50%. Cho oxy gi 50% vo can, thm 8000ml nc ct vo, lc k thm nc ct v, lc k u. Dng phu lc c lt bng gn. Cng dng v cch dng : St trng vt thng dng trng ph khoa, gii phu, dng ngoi lm thuc cm mu (trong nha khoa). Bo qun nhn : Trong chai, l nt kn ni thong mt, trnh nh sng. Dn nhn thnh phm dng ngoi. Tiu chun khim tra cht lng : Theo TCCS Cm quan : dung dch trong sut khng mu, mi c bt Cn IOD 5% Cng thc:

Cn Iod 10% .500ml Cn 700 ..v 1000ml

Phn tch cng thc: Cn Iod 10% l cn m pha ch cn Iod 5% ha tan trong cn 700 Cn 700 l dung mi K thut pha ch: Chun b : ha cht, dung c. Pha ch: ong cn Iod 10% cho vo cc c chn ,cho tip khong 1/4 Lng cn 700 khuy u thm cn 700 v khuy tan Cng dng : dng theo chuyn khoa B5, B8 Bo qun nhn: Trong chai thy tinh mu, nt kn trnh nh sng Dn nhn thnh phm dng ngoi, bng B(c) Tiu chun kim tra cht ln: theo TCCS Cm quan : cht lng trong sut, mu m, mi Iod. Dung dch Acid boric 3% Cng thc: Acid Boric 30g Nc ct v 1000ml

Phn tch cng thc: Acid Boric : bt kt tinh mu trng, khng mu, t tan trong nc, d tan trong nc si nng, ethanol 960, glycerin 85% Nc ct l dung mi K thut pha ch : Chun b : Ha cht, dng c Pha ch :cn Acid Boric ha tan trong nc ct un nng 70 0 - 800 thm nc ct nng va , khuy u ngui hoc cn nng lc qua bng gn Cng dng v cch dng: St trng dit nm. Ra cc vt thng bn ngoi Bo qun - nhn: Trong chai l nt kn Dn nh thnh phm dng ngoi Tiu chun kim tra cht lng : Theo TCCS Cm quan : dung dch trong sut, khng mu, c phn ng hi acid.

5. Danh Mc Thuc Thit Yu ang S Dng Trong Bnh Vin :

1. Thuc gy t, m: STT Tn thuc ng dng, hm lng Tuyn s dng Dng bo ch 1 2 3 4 5 6 7 8 9 10 Atropine sulfate Diazepam Bupivacaine Fentanyl Halothane Ketamine Oxygen dc dng Thiopental Morphine(clohydrat) Promethazine (hydcloride) 11 12 13 14 15 Ethyl clorid Lidocaine(hydrocloride) Procain(hydrocloride) Etomidat Isosluran tim tim tim tim ng h hp tim ng h hp tim tim Tim Ung Dd phun ti ch tim tim tim ng h hp A + + + + + + + + + + + + + + + + B + + + + + + + + + + + + + + + + C + + + + D -

16 17 18 19 20

Midazodam Pethidin Propofal Sevosluran Sutentanil

tim tim tim tim tim

+ + + + +

+ + + + +

+ + -

2. Thuc gim au, h st, nhm chng vim, cc bnh xng khp STT Tn thuc ng dng ,hm lng Tuyn s dng Dng bo ch 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Acetylsalicylic acid Acemetacin Celecoxib Diclofenac Etodolac Ibuprofen Aceclofenac Meloxicam Lexoprosen Nabumeton Naproxen Netopam(hydroclorid) Tenocicam Paracetamol Piroxicam Ung Ung Ung Ung Ung Ung Ung Ung Ung Ung Ung /t Tim/ung Tim/ung Ung /thuc t Tim/ung A + + + + + + + + + + + + + + + B + + + + + + + + + + + + + + + C + + + + + + D + + + + + -

16 17 18

Morphine(clohydrate) Pethidine(hydrocloride) Allopurinol

Tim Tim Ung

+ + +

+ + +

3. Thuc chng d ng v dng trong cc trng hp qu mn STT Tn thuc ng dng ,hm lng Tuyn s dng Dng bo ch 1 2 3 4 5 6 7 8 9 10 11 12 13 Alimemazine Acrivastatin Antazolin Cetirizin Dexamethason Desloratadin Dexclorpheniramin Diphenhydramin Dinethinden Ebastin Levocetirizin Cinnarizin Iexotenadin Ung Ung Ung/tim Ung Ung Ung Ung Tim Ung Ung Ung Ung Ung A + + + + + + + + + + + + + B + + + + + + + + + + + + + C + + + + + + + + D + + + + -

14 15 16 17 18

Hydrocortison Mazipredone Methylprednisolon Prednisolon Promethazine (hydrocloride)

Tim Tim Tim Ung Ung

+ + + + +

+ + + + +

19

Epinephrine (adrenaline)

Tim

20

Chlorpheniramin (hydrogen maleate) 4. Thuc gii c

Ung

STT Tn thuc

ng dng ,hm lng Tuyn s dng Dng bo ch A + + + + + + + + + + + + B + + + + + + + + + + + + C + + + + + + D + + + -

1 2 3 4 5 6 7 8 9 10 11 12

Atropine(sulfate) Acetycystein Bretylium tosilat Calci gluconat Dantrolen Dimencaprol Hydroxocobalamine Methionine Naloxon(hydrochloride) Natri calci edetat Natri thiosulfate Penicilamin

Tim Tim Tim Tim Ung Tim Tim Ung Tim Tim Tim Tim/ung

13 14 15 16 17 18 19 20

Pralidoxime iod Xanh methylen ng sulfat Ephedrin(hydroclorid) Flumazenic Naltrexon Than hot Edetat natri calci

Tim Tim Ung Tim Tim Ung Ung tim

+ + + + + + + +

+ + + + + + + +

+ + + + +

+ + -

5. Thuc chng ng kinh STT Tn thuc ng dng ,hm lng Tuyn s dng Dng bo ch 1 Acid valproic (mui Natri) 2 3 4 5 6 7 Carbamazepin Cidbapendin Diazepam Magnesi sulfat Oxcarbazepin Phenobarbital (mui natri) 8 Phenytoin Ung Ung Tim Tim Ung Tim Ung Ung + + + + + + + + + + + + + + + + + + Ung A + B C D -

(mui Natri) 9 10 11 12 13 Pregabalin Volproat magnesi Valproid acid Valpromid Volproat natri Ung Ung Ung ung ung + + + + + + + + + + + + + + -

6. Thuc tr k sinh trng, chng nhim khun STT Tn thuc ng dng ,hm lng Tuyn s dng Dng bo ch 1 2 3 4 5 6 7 Albendazol Mebendazol Niclosamid Metriforate Praziquantel Amoxicilin Ampicilin(mui natri) Ung Ung Ung Ung Ung Ung Tim A + + + + + + + B + + + + + + + C + + + + D + + + + -

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Benzyl penicilin Cefaclor Cefalexin Cefazolin Cefixim Cefotaxim Cefradine Ceftriaxone Cefuroxime Cloxacilin Procaine benzylpenicilin Amikacin Gentamicine Tobramycin Chloramphenicol Vacomycin Erythromycin Ofloxacin Doxycycline Dason Isoniazid Nystatin

tim Ung Ung tim Ung tim Tim Tim Ung Ung tim tim tim Tim Ung Tim Ung Ung Ung Ung Ung Ung

+ + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + +

+ + + + + + + +

7. Thuc tr au na u

STT Tn thuc

ng dng ,hm lng Tuyn s dng Dng bo ch A + + + + + + B + + + + + + C + + + D -

1 2 3 4 5 6

Ergotamine(tartrat) Propranolol(hydroclorid) Donepezil Ilunarizin Sumatriptan Dihydro ergotamin mesylat

Ung/tim Ung Ung Ung Ung/tim Tim

8. Thuc chng ung th STT Tn thuc ng dng, hm lng Tuyn s dng Dng bo ch 1 2 3 4 5 L asparaaginase Bleomycin Carboplatin Cisplatin Cytarabin Tim Tim Tim Tim Tim A + + + + + B C D -

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Dactinomycin Etoposid Fluorouracil Hydroxycarbamid Ifosfamid Mercaptopurin Methotrexat Mitomycin Procarbazin Tamoxifen Vinblastin(sulfat) Vincristin(sulfat) Calci folinat Filgrastim Ondansetron

Tim Tim /ung Tim Ung Tim Ung Tim/ung Tim ung Ung Tim Tim Tim Tim tim

+ + + + + + + + + + + + + + +

9. Thuc tim mch STT Tn thuc ng dng ,hm lng Tuyn s dng Dng bo ch 1 2 3 Atenolol Diltiazem Glyceryl tinitrat Ung Ung Ung A + + + B + + + C + + D -

Isosorbid(Dinitrat Hoc Mononitrat)

Ung

5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Amlodipin Captopril Enalapril Hydroclorothiazid Methyldopa Nifedipin Lidocain(hydroclorid) Propranolol(hydroclorid) Verapamil(hydroclorid) Heptaminal(hydroclorid) Digoxin Dobutamin Dopamin(hydroclorid) Epinephrin(adrenalin) Atorvastatin Fenofibrat Simvastatin

Ung Ung Ung Ung Ung Ung Tim Ung Ung Ung Ung Tim Tim Tim Ung Ung Ung

+ + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + -

+ + + + + + + + + + -

+ +

10. Thuc ngoi da STT Tn thuc ng dng ,hm lngTuyn s dng Dng bo ch A B C D

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Acitretin Amoralfon Azelaid acid Capsaicin Acid benzoic v acid salicylic Cn A.S.A Cn BSI Clotrimazol Ketoconazol Miconazol Neomycin va Bacitracin Povidon iod Betamethason (Valesat) Fluocinalon acetonid Hydrocortison(acetat) Acid salicylic Benzyl bezoat Diethylphtalat Km oxyd

Ung Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi Dng ngoi

+ + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + -

+ + + + + + + + + + + + + -

11. Thuc ng tiu ha

STT Tn thuc

ng dng ,hm lng Tuyn s dng Dng bo ch A + + + + + + + + + + + + + + B + + + + + + + + + + + + + C + + + + + + + + + D + + + + + -

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Cimetidin Famotidin Omeprazol Pantoprazol Ranitidin Metoclopramid Alverin(citrat) Bisacodyl Magnesi sulfat Oresol Attapulgite Loperamid Diosmin Hyoscin butylbromid

Ung Ung Ung Tim /ung Ung Tim /ung Ung Ung Ung Ung Ung Ung Ung Ung

12. Thuc dng cho tai mi hng, mt STT Tn thuc ng dng ,hm lngTuyn s dng Dng bo ch 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Aciclovir Argyrol Cloramphenicol Gentamicin Neomycin(sulfat) Ofloxacin Tetracyclin (hydroclorid) Hydrocortison Tetracain(hydroclorid) Acetazolamid Pilocarpin Timolol Nc oxy gi Naphazolin Sulfarin Xylometazolin Sulfacetamid natri Tra mt Nh mt Nh mt Nh mt Nh mt Nh mt Tra mt Tra mt Nh mt Ung Nh mt Nh mt Dng ngoi Nh mi Nh mi Nh mi Nh mt A + + + + + + + + + + + + + + + + + B + + + + + + + + + + + + + + + C + + + + + + + + + + D + + + + + + + + +

13. Thuc chng ri lon tm thn STT Tn thuc ng dng ,hm lngTuyn s dng Dng bo ch 1 2 3 4 5 6 7 8 9 Diazepam Haloperidol Levomepromazin Risperdon Sulpirid Amitriptylin(hydroclorid) Acidvalproic Carbamazepin Clomipramin Ung Ung /tim Ung Ung Ung /tim Ung Ung Ung Ung A + + + + + + + + + B + + + + + + + C + D -

Tuyn s dng : + Tuyn A : Bnh vin hng 1,2 + Tuyn B : Bnh vin hng 3 v khng hn + Tuyn C : c s y t c Bc s ( phng khm, yt c quan, trng hc, trm y t x) + Tuyn D : C s y t khng c Bc s

Bnh vin 175 - Khoa B6

Danh Mc thuc t trc cp cu STT Tn thuc, Nng , hm n v lng, dng bo ch. S lng Ghi ch

Thuc gy nghin v diatepam tim 1 2 Seduxen 10mg Dolargan 100mg ng ng 04 04 Diatepam

Dch truyn 1 2 3 Glucose 5% - 500ml Natri clorid 0,9% 500ml Ringer lactaat 500ml Chai Chai chai 04 05 04

Thuc hng thn 1 Seduxen 5mg vin 20

Thuc tim 1 2 Adona 25 mg Ampicillin 1g ng L 05 05

Thuc vin 1 2 .. Adalat 10mg Amoxicilin 500mg . nang Vin 05 20 .. Nh git

Danh Mc thuc t trc khoa Dc STT Tn thuc, nng , hm n v lng Thuc gy nghin 1 2 Dolargan 100mg Fentanyl 0,1mg 12mg Thuc Hng Thn 1 Diatepam (seduxen)10mg ng 05 ng ng 05 10 Dolcontral S lng Ghi ch Hn dng

Thuc chng sc tim mch cm mu v cc thuc khc 1 2 Adalat 10mg Cimetidin 300mg Thuc khng sinh 1 2 Amikacin 500mg Metronidazol 500mg/200ml Dch truyn 1 2 Acid Glutamic 1% Dy tryn dch Chai B 05 30 L chai 10 10 nang ng 10 10

Dng c - s sch 1 2 .... Bnh cu ha Danh mc thuc Ci Ci . 04 01 .. . .

Bng danh mc gm ..khon Ghi ch : + Thng xuyn kim tra hn dng, tuyt i khng c thuc ht hn. + i vi thuc trc 3 thng trc khi thuc ht hn.

+ Cc kptrc nht v bn giao y theo danh mc. Nhn xt Ngy ..thng nm Ch nhim khoa Dc

6. Thuc ng y:

Tn cc dc liu : - Ng gia b - Thn khc - Trch t - Cc hoa - Lin nhc - Thng trut - Bin u - Mch nha - Y d - i hi - Lin kiu - Si h - To nhn - Vin ch - Tho quyt minh - Xuyn khung - Sinh a - Ich ch nhn - Tiu hi - Hong cm - an b - Bch thc - Bch linh - Bch ch - Tm sen - Bnh vi - Hong lin - Chi t - Xa tin t - Hong k - Cam tho bc - Ngu tt - H th - Mn kinh t - Da cn

- K t - ng quy - trng - c hot - Cu khng - Thch cao - Qua lu - Sn th - Hoi sn - ng sm - trng - Trn b - A giao - inh hng - Thc a - Mch mn - C tranh - Sn tra

- i to - Bn h - Ct cnh - Thng nh - Bch b - i hi - Kim anh - Sa nhn - Ba kch - Tc on - Thin nin kin - Mc hng - Huyn sm

 Mt S Toa Thuc ng Y :

1. Tr suy nhc thn kinh - suy nhc c th ( 5 thang ) ng sm...............................15g Hong k................................20g ng quy.............................15g Bch trut...............................15g To nhn sao .........................12g B t nhn..............................12g K t......................................10g Sinh a..................................15g Vin tr..................................0,4g Ht sen...................................12g H th .................................15g Ba kch...................................12g Chch tho.............................0,8g i to...................................15g an sm.................................12g Long nhn..............................10g

2. Suy nhc c th ( 5 thang ) ng sm........................... 12g Bch linh........................... 12g Bch trut.......................... 12g Cam tho........................... 7g Xuyn khung..................... 12g ng quy........................ 12g Thc a............................ 12g Bch tht......................... 12g Trn b............................... 10g 3. Tr hi chng tht lng hng ( 5 thang ) c hot............................ 10g Khng hot...................... 10g Ngu tt............................. 15g Huyt gic......................... 20g Ba kch.............................. 12g Ngc dung......................... 12g Dm dng hot................ 12g Thin nin kin.................. 3g ng quy........................ 12g Thc a............................ 12g

Mc qua............................. 12g 4. Suy nhc c th - Ung th thc qun ( 5 thang ) ng quy........................ 1g Xuyn khung..................... 10g Bch tht......................... 12g Sinh a............................. 15g ng sm........................... 12g Bch linh........................... 10g Bch trut.......................... 12g C ngt.............................. 0,4g an sm............................. 10g Ngu tt............................. 10g Bn chi lin....................... 10g Tc on............................ 10g To nhn............................ 10g Vin ch............................. 10g K t................................. 10g B ct toi......................... 15g trng............................ 10g i to............................... 10g Bch hoa x thit tho...... 18g

6. Bo qun thuc men: PHIU THEO DI CHT LNG THUC Tn n v ch qun Tn n v Phiu theo di cht lng thuc Tn thuc (nng ,hm lng ).. n v tnh Ni sn xut Ngy Ngy S Ngun S S hng kim nhp lng, phiu phiu v qui KN nhp cch /giao S Hn Nhn l dng xt sn cht xut lng Phn loi cht lng Din bin cht lng lu kho(Ngy kim /tnh trng cht lng Ghi ch

Cch sp xp bo qun thuc

Phi tin hnh phn loi ngay khi nhp thuc vo kho - Hng nhp trc, bn ngoi, xut trc (FIFO) - Sp xp trong kho phi m bo: Ba d: D thy d ly d kim tra Nm chng : Chng m nng - mi chut cn trng Chng nhm ln Chng chy n Chng thuc qu hn dng Chng v - h hao mt mt Thuc bo qun nhit thng ,mt ,thng thong .mt s thuc c bit cn bo qun nht 80C n 150C , m khng qu 70%. 7. Hng dn s dng thuc: Thuc khng sinh Gentamicin - Ch nh : Nhim trng h hp, tit niu, tiu ha, xng, m mm vim mng no, vim mng bng, nhim khun huyt . - Chng ch nh : Mn cm, tn thng chc nng thn, ph n c thai nhc c. - Dng dng: ng tim: 40mg/2ml; 80mg/2ml Thuc nhmt ,kem ,m 0,1% -0,3% - Cch dng v liu dng A: - Chc nng thn bnh thng : IM 3mg/kg/ngy x 3ln - Tn thng chc nng thn : IM 1mg/kg/ngy x 3ln

E: 2mg/kg/ngy x 3 ln - Mt ngy ung 3 ln, sng, tra, ti. Nc ung dng vi thuc tt nht nc un si ngui. Phi Hp Thuc Trong iu Tr:
TOA THUC - 1

Chn on : 1. Amoxicillin Sng 2

Vim d dy 500mg tra 0 250mg tra 0

Tui 31

Gii tnh : Nam

vin ung chiu 2 vin ung chiu 2 vin ung chiu 1 ti 0 s lng 20 Ngy 2/12/2009 Ch k Bc s ti 0 s lng 28 ti 0 s lng 28

2. Metronidazol Sng 2

3. Omeprazol 20mg Sng 1 tra 0

Nhn xt : Amoxicilin l thuc khng vim, tr vim d dy Metronidazoll thuc khng vim dng phi hp thuc tng kh nng dit khun. Omeprazol tr lot d dy tin trin. Cc thuc iu tr ph hp vi bnh n .
TOA THUC - 2

Chn on : au khp vai 1. Diclophenac Sng 1 50mg

Tui 42

Gii tnh :N

vin ung chiu 1 vin ung chiu 1 ti 0 s lng 14 ti 0 s lng 14

tra 0

2. Omeprazol 20mg Sng 1 3. Bephazym Sng 1 tra 1 tra 0

vin ung chiu 1 vin ung chiu 1 vin ung chiu 1 ti 0 s lng 21 Ngy 2/12/2009 Ch k Bc s ti 0 s lng 21 ti 0 s lng 21

4. Prednisolon 5mg Sng 1 tra 1

5. Dorotyl 250mg Sng 1 tra 1

Nhn xt : Diclophenac iu tr au nhc khp c tc dng ph lot d dy cho nn phi hp Omeprazol v Bephazym lm gim kh nng b lot d dy. Prednisolon iu tr au nhc khp, Dorotyl gim au nhc khp . Cc thuc iu tr ph hp vi bnh n .
TOA THUC - 3

Chn on : Tng huyt p 1. Enahexal 10mg Sng 1 tra 0 vin ung chiu 0 vin ung chiu 1 vin ung chiu 0 ti 0 s lng 15 ti 0 s lng 30 ti 0 s lng 15

2. Nitromint 2,6mg Sng 1 tra 0

3. Aspirin 81mg Sng 0 4. Rutin C Sng 0 tra 1

vin ung tra 1 chiu 0 ti 0 s lng 15 Ngy 2/12/2009 Ch k Bc s

Nhn xt : Enahexal iu tr huyt p, Nitromint d phng cn au tht ngc, h tr iu tr suy tim. Aspirin nga huyt khi tnh mch, ng mch. RutinC ngn nga cao huyt p. Cc thuc iu tr hp l vi bnh n.
D ng thuc, phn ng c hi ca thuc ADR cha c s liu thng k

Cc thuc gy d ng thng gp: Khng sinh, thuc h st, gim au Vaccin, huyt thanh, thuc chng vim.

- Nh: mn , ni m ay, nga th ngng thuc hoc dng khng sinh histamin H1. - Nng: Nga, ban ph ton thn, kh th, ri lon tiu ha, ri lon tim mch sc phn v c th gy t vong th ngng dng thuc.
-

Phn ng c hi ca ADR: l do dng sai thuc, dng sai liu, dng liu cao sai v ng s dng.

Mt vi trng hp bnh nhn b d ng thuc Bnh nhn ung Paracetamol 650mg b ni m ay, ng mn . Cch khc phc: phi cho bnh nhn ngng ung paracetamol 650mg thay vo cho ung Acetylcystein.

PHN III:

KT LUN
Trong thi gian thc tp em nhn c s hng dn rt tn tnh ca thy c v nhng cn b y t ti bnh vin. Em c iu kin thc tp nhng iu mnh hc trng. Qua em bit cch sp xp thuc hp l, d ly, d kim tra v cch bo qun thuc trnh h hng, ht hn dng v khng b mi mt, nm mc. Pha ch mt s dung dch dng ngoi nh: cn 50%, 70%, 90%; dd AgNo3 1%, dd xanh Methylen 1%... Em cng c hng dn cp pht thuc cho bnh nhn, lp bo co v d tr, bo co xut - nhp - tn ti nh thuc ca bnh vin. ng thi nng cao hiu bit v chuyn mn v cch s dng thuc An Ton - Hp L - Hiu Qu.