1. Furosemid 1.1 Theo duoc thu: Furosemid l thuc li tiu dn cht sulfonamide, c xp vo nhm thuc li tiu quai.

C ch tc dng ch yu ca furosemid l c ch h thng ng vn chuyn Na+, K+, 2Cl - , on dy ca nhnh ln quai Henle, lm tng thi tr nhng cht in gii ny km theo tng bi xut nc. Cng c s tng o thi Ca++ v Mg++. Tc dng li tiu ca thuc mnh, do ko theo tc dng h huyt p, nhng thng yu. Dc ng hc Furosemid hp thu tt qua ng ung, tc dng li tiu xut hin nhanh sau 1/2 gi, t nng ti a sau 1 - 2 gi v duy tr tc dng t 4 - 6 gi. Tc dng chng tng huyt p ko di hn.. Vi ngi bnh ph nng, kh dng sinh hc ca thuc gim, c th do nh hng trc tip ca vic gim hp thu ng tiu ha. S hp thu ca furosemid c th ko di v c th gim bi thc n. Mt phn ba lng thuc hp thu c thi tr qua thn, phn cn li thi tr qua nc tiu, ch yu di dng khng chuyn ha, thuc thi tr hon ton trong 24 gi. Ch nh Ph phi cp; ph do tim, gan, thn v cc loi ph khc; tng huyt p khi c tn thng thn; tng calci huyt. Liu lng v cch dng

iu tr ph: Liu ung bt u thng dng l 40 mg/ngy. iu chnh liu nu thy cn thit ty theo p ng. Trng hp ph nh c th dng liu 20 mg/ngy hoc 40 mg cch nht. Mt vi trng hp c th tng liu ln 80 mg hoc hn na, chia lm 1 hoc 2 ln trong ngy. Trng hp nng, c th phi d liu tng dn ln ti 600 mg/ngy. Trong trng hp cp cu, hoc khi khng dng c ng ung, c th tim bp hoc tnh mch chm 20 - 40 mg hoc cn thit c th cao hn. Nu liu ln hn 50 mg th nn tim truyn tnh mch chm. cha ph phi, liu tim tnh mch chm ban u l 40 mg. Nu p ng cha tho ng trong vng mt gi, liu c th tng ln 80 mg, tim tnh mch chm. iu tr tng huyt p: Furosemid khng phi l thuc chnh iu tr bnh tng huyt p v c th phi hp vi cc thuc chng tng huyt p khc iu tr tng huyt p ngi c tn thng thn. Liu dng ng ung l 40 - 80 mg/ngy, dng n c hoc phi hp vi cc thuc h huyt p khc. 1.2 Theo tgn tc thuc v ch khi ch nh Tng tc thuc: Thn trng mc 2: Suy gan cc thuc li niu thi kali c th khi pht hn m gan, lm tng nhim kim chuyn ha, lm tng NH3. Khng c tng tc vi cc thuc trong n 1.3 Theo MARTINDALE 1.3.1Tc dng khng mong mun Hu ht cc tc dng ph ca furosemide xy ra vi liu lng cao. Cc tc dng KMM thng gp nht l s mt cn bng dch v cht in gii trong c hyponatraemia, h kali mu, v nhim kim hypochloraemic, c bit sau khi dng liu ln hoc dng ko di. Du hiu ca s mt cn bng in gii bao gm nhc u, h huyt p, au c bp,

kh ming, kht nc, yu km, th , bun ng, bn chn, thiu niu, ri lon nhp tim, v ri lon tiu ha. Furosemide lm tng bi tit canxi thn

Thn trng khi sd

Furosemide khng nn dng cho bnh nhn hn m kt hp vi bnh x gan Suy gan bnh nhn suy tim sung huyt v gan mn tnh, liu cao c th lm tng men gan. c bit thn trng v liu cho nhng bnh nhn ny trnh tc ng nghim trng n gan gy ra do gim huyt p h thng. Nh vi cc thiazide, furosemide nn trnh bnh nhn suy gan nng Tng tc Cc tng tc ca furosemide do nh hng ca n trn s cn bng dch th v cht in gii.. Furosemide c th tng dc tnh trn thn ca cc cephalosporin nh cefalotin v c th lm tng c tnh trn taica aminoglycoside v thuc c tai khc. S dng Furosemide l mt thuc li tiu mnh, c s dng trong iu tr ph n kt hp vi suy tim (), bao gm c ph phi, v cc ri lon thn v gan v c th c hiu qu nhng bnh nhn khng p ng vi thuc li tiu thiazide . N cng c s dng liu cao trong vic iu tr ca thiu niu do suy thn hoc suy. Furosemide cng c s dng trong iu tr tng huyt p (), hoc mt mnh hoc vi thuc h huyt p khc. Liu lng. Trong iu tr ph, thng thng liu ung ban u l 40 mg mt ln mi ngy, iu chnh khi cn thit theo phn ng. Trng hp nh c th p ng n 20 mg / ngy hoc 40 mg vo ngy thay th. Mt s bnh nhn c th cn liu 80 mg hoc nhiu hn hng ngy cho l mt hay hai liu hng ngy, hoc lin tc. Trng hp nng c th cn chnh dn liu n 600 mg / ngy. Trong trng hp khn cp hoc khi iu tr rng ming 20-50 mg furosemide c th c bng cch tim tnh mch chm, tim bp c th c a ra trong trng hp c bit nhng khng ph hp vi iu kin cp Trong khi iu tr tng huyt p, furosemide c cho liu ung 4-80 mg mi ngy, hoc mt mnh, hoc vi cc thuc h huyt p khc

C trng Ch n ung hn ch mui v thuc li tiu l tr ct chnh trong iu tr x gan c trng Spironolactone thng l thuc li tiu ca s la chn u tin, nhng furosemide c th c thm vo iu tr khi cn thit 2.kalium Ch : 1 mmol tng ng 75 mg kali clorid. Ch nh Kali clorid thng c la chn iu tr gim kali mu, v ion clorid cng cn iu chnh gim clo mu thng xy ra cng vi gim kali mu. Kali clorid c ch nh iu tr gim kali mu nng ngi bnh dng thuc li tiu thi kali. Kali clorid cn c dng phng gim kali mu nhng ngi c bit c nguy c gim kali mu (v d: ngi bnh dng digitalis b lon nhp tim nng, v gim kali mu lm tng c tnh ca glycosid tim). Kali clorid cng c th ch nh cho ngi b x gan c chc nng thn bnh thng, mt s trng thi a chy, k c do s dng thuc nhun trng di ngy, nn ko di, hi chng Bartter, bnh thn gy mt kali, v nhng ngi bnh (k c tr em) iu tr corticosteroid ko di. Liu lng v cch dng Ung mui kali phi ung vo ba n hoc sau ba n vi nhiu nc. Thuc nc phi pha long trc khi dng. Tim tnh mch: Phi pha long nng kali clorid vi mt th tch ln (1000 ml) ca dch thch hp truyn tnh mch, nng kali tt nht l 40 mmol trong mt lt, v khng vt qu 80 mmol trong mt lt. trnh tng kali mu trong khi truyn tnh mch, tc truyn

khng c nhanh, tc 10 mmol trong mt gi thng l an ton, khi lng nc tiu thi ra tha ng (trong iu tr cp cu, tc truyn l 20 mmol/gi). iu tr gim kali mu Ngi ln: Ung phng trong liu php li niu: 40 mmol/ngy kali clorid c th phng c gim kali huyt phn ln s ngi bnh dng thuc li niu di ngy. i vi ngi tng huyt p khng bin chng, khng ph, iu tr ngoi tr, thng khng cn b sung kali; tuy nhin, nu kali huyt thanh di 3 mmol/lt, nn dng 50 - 60 mmol kali/ngy. i vi ngi bnh ph (th d suy tim, x gan c trng) cho 40 - 80 mmol/ngy (thiu nh) hoc 100 - 120 mmol/ngy (thiu nng) km theo di cn thn kali huyt thanh. Tim truyn nh git tnh mch ngoi bin (kali huyt thanh nh hn 2,5 mmol/lt) tc truyn 10 - 20 mmol/gi; dnh tc nhanh hn 20 mmol/gi cho nhng trng hp cp cu; c th lp li cch 2 - 3 gi nu cn, nhng nng kali trong dch truyn khng c vt qu nng ti a 40 mmol/lt. Tng tc thuc Phi hp nguy him : mc 4: Thuc l tiu gi kali( spinorolacton): phi hp c nguy c dn n tng kali mu Khi dng kali clorid kt hp vi thuc li tiu thiazid (lm mt nhiu kali), c nguy c tng kali mu nu ngng thuc li tiu.

3.Verospiron(spinorolacton) Theo dc th

Spironolacton l cht i khng mineralocorticoid, tc dng qua vic c ch cnh tranh vi aldosteron v cc mineralocorticoid khc, lm tng bi tit natri v nc. Spironolacton lm gim bi tit cc ion kali, amoni (NH4+) v H+. C tc dng li tiu v chng tng huyt p u qua c ch . Spironolacton bt u tc dng tng i chm, cn phi 2 hoc 3 ngy mi t tc dng ti a v thuc gim tc dng chm trong 2 - 3 ngy khi ngng thuc. V vy khng dng spironolacton khi cn gy bi niu nhanh. S tng bi tit magnesi v kali ca cc thuc li tiu thiazid v li tiu quai (furosemid) s b gim khi dng ng thi vi spironolacton. V spironolacton l cht i khng cnh tranh vi aldosteron, liu dng cn thit c iu chnh theo p ng iu tr. Tng aldosteron tin pht him gp. Tng aldosteron th pht xy ra trong ph th pht do x gan, hi chng thn h v suy tim sung huyt ko di v sau khi iu tr vi thuc li tiu thng thng. Tc dng li tiu c tng cng khi dng phi hp vi cc thuc li tiu thng thng, spironolacton khng gy tng acid uric huyt hoc tng glucose huyt, nh xy ra khi dng thuc li tiu thiazid liu cao.

Ch nh
C trng do x gan. Ph gan, ph thn, ph tim khi cc thuc cha ph khc km tc dng, c bit khi c nghi ng chng tng aldosteron. Tng huyt p, khi cch iu tr khc km tc dng hoc khng thch hp.

Tc dng khng mong mun (ADR)

Cc phn ng khng lin quan n liu dng trong ngy v thi gian iu tr. Nguy c phn ng c hi thp khi dng liu thp hn 100 mg. Thng thng nht l to v n ng do tng nng prolactin nhng thng hi phc sau iu tr. Tng kali huyt lun phi c xem xt nhng ngi gim chc nng thn. Nguy c ny thp khi dng liu di 100 mg/ngy ngi c chc nng thn bnh thng, vi iu kin khng dng thm kali v phi kim sot vic nhn kali qua n ung khng theo ch .

Liu lng v cch dng

Ngi ln: Li tiu khi ph khng tr do x gan, hi chng thn h, suy tim sung huyt, c bit nghi ng c tng aldosteron, thng phi hp vi furosemid, cc thiazid hoc cc thuc li tiu tng t: Liu ban u l ung 25 - 200 mg/ngy, chia 2 - 4 ln, dng t nht 5 ngy, liu duy tr l 75 - 400 mg/ngy, chia 2 - 4 ln.

Chng tng huyt p: Liu ban u ung 50 - 100 mg/ngy, chia 2 - 4 ln, dng t nht 2 tun; liu duy tr iu chnh theo tng ngi bnh. Nhng hin nay t c dng iu tr tng huyt p.

Tng tc thuc
S dng ng thi spironolacton vi cc cht c ch enzym chuyn (ACE - 1) c th dn ti ''tng kali huyt" nng, e da tnh mng, c bit ngi c suy thn.

Theo Martindal

Tng tc Tng nguy c hyperkalaemia nu spironolactone c dng vi cc cht b sung kali .

Hyperkalaemia c th xy ra bnh nhn cng c cc cht c ch ACE, thuc i khng th th angiotensin II, NSAIDs, ciclosporin, hoc trilostane. bnh nhn dng spironolactone vi NSAID hoc ciclosporin nguy c c thn cng c th tng ln.

S dng
Spironolactone, mt steroid c cu trc tng t nh l ca hormone aldosterone adrenocortical t nhin, cht i khng cnh tranh ca aldosterone ng ln xa. N hot ng nh mt cht li tiu tng bi tit nc natri, gim bi tit kali. N cng c s dng cho ph kt hp vi bnh x gan (c hoc khng c c trng,), hi chng thn h. N thng c dng vi cc thiazide, furosemide, hoc thuc li tiu tng t, bo tn kali trong nhng ngi c nguy c b h kali mu. Trong khi iu tr ph, spironolactone thng c a ra liu ung ban u l 100 mg / ngy, sau iu chnh khi cn thit, mt s bnh nhn c th cn liu ln n 400 mg / ngy. Trong x gan c trng gan v ph n, bnh nhn c natri niu / t l kali ln hn 1 c th c cho mt liu ban u l 100 mg mi ngy trong khi bnh nhn spironolactone vi mt t l nh hn 1 c th c cho dng liu ban u l 200-400 mg / ngy . 4. CIPROBAY (CIPROFLOXACINE)

Theo dc th
Ciprofloxacin l thuc khng sinh nhm quinolon. Ciprofloxacin c tc dng tt vi cc vi khun khng li khng sinh thuc cc nhm khc (aminoglycosid, cephalosporin, tetracyclin, penicilin...) v c coi l mt trong nhng thuc c tc dng mnh nht trong nhm fluoroquinolon. Ciprofloxacin hp thu nhanh v d dng ng tiu ha. Khi c thc n v cc thuc chng toan, hp thu thuc b chm li nhng khng b nh hng mt cch ng k.

Ch nh
Ciprofloxacin ch c ch nh cho cc nhim khun nng m cc thuc khng sinh thng thng khng tc dng trnh pht trin cc vi khun khng cipofloxacin: Vim ng tit niu trn v di; vim tuyn tin lit; vim xng - ty; vim rut vi khun nng; nhim khun nng mc trong bnh vin (nhim khun huyt, ngi b suy gim min dch). D phng bnh no m cu v nhim khun ngi suy gim min dch.

Chng ch nh
Ngi c tin s qu mn vi ciprofloxacin v cc thuc lin quan nh acid nalidixic v cc quinolon khc. Khng c dng ciprofloxacin cho ngi mang thai v thi k cho con b, tr khi buc phi dng.

Thn trng
Cn thn trng khi dng ciprofloxacin i vi ngi c tin s ng kinh hay ri lon h thn kinh trung ng, ngi b suy chc nng gan hay chc nng thn, ngi thiu glucose 6 phosphate dehydrogenase, ngi b bnh nhc c.

Liu lng v cch dng

Liu ung (ciprofloxacin hydroclorid): Mun thuc hp thu nhanh, nn ung thuc 2 gi sau ba n. Ngi bnh cn c dn ung nhiu nc v khng ung thuc chng toan d dy trong vng 2 gi sau khi ung thuc.

Thi gian iu tr ciprofloxacin ty thuc vo loi nhim khun v mc nng nh ca bnh v cn c xc nh ty theo p ng lm sng v vi sinh vt ca ngi bnh. Vi a s nhim khun, vic iu tr cn tip tc t nht 48 gi sau khi ngi bnh khng cn triu chng. Thi gian iu tr thng l 1 - 2 tun, nhng vi cc nhim khun nng hoc c bin chng, c th phi iu tr di ngy hn.

Liu truyn tnh mch (ciprofloxacin lactat)

Tng tc thuc
Khng c tng tc vi cc thuc trong n

Tng k
Dung dch tim truyn ciprofloxacin c pH t 3,9 n 4,5 v tng k vi cc thuc tim khng n nh v mt l ha khong pH ny. thy c tng k gia ciprofloxacin v heparin natri, gia ciprofloxacin hoc pefloxacin vi penicilin, fluocloxacilin, amoxycilin, dng kt hp amoxycilin v clavulanat kali, aminophylin, v clindamycin. V vy, khng c trn thuc tim ciprofloxacin vi cc thuc tim khc c pH cao.

Theo martindal

Tc dng trn gan

Fluoroquinolones, trong c ciprofloxacin, c th gy ra tng men gan . Trong hu ht cc bnh nhn hiu ng ny l thong qua v hi phc m khng cn dng thuc. Khng c tng tc cn lu vi cc thuc trong ca lm sng