THUC KCH THCH THN

KINH TRUNG NG
(TKTTKTW)
i tng: Y3 Chnh quy.
Thi gian: 4 tit.
Nm hc: 2009/2010.

MC TIU

1. nh ngha v phn loi.

2. Dc ng hc v dc lc hc:

2.1. Thuc kch thch u tin trn no

2.2. Thuc kch thch u tin trn
hnh no.
2.3. Thuc kch thch u tin trn ty
sng.

NH NGHA TKTTKTW

Thuc tc ng ln h TKTW lm tng

hot ng th cht v tinh thn.

1. Tm thn.

2. Tun hon, h hp.

3. Vn ng.

PHN LOI TKTTKTW

NO

HNH
NO

TY
SNG

PHN LOI TKTTKTW

TM THN

NO

TUN HON
H HP

HNH NO

VN NG

TY SNG

PHN LOI TKTTKTW

1.

u tin trn no:

Tm thn: Amphetamine, chng
trm cm 3 vng,
IMAO.
2. u tin trn hnh no:
H hp v tun hon: Cc dn
xut Methylxanthine
3. Ty sng:
Phn x ty: Strychnine

HIU QU CA TKTTKTW

c
+ Tin

Mt tin
Khng
Mt tin

C CH TC DNG

C CH TC DNG
HA CHT TG
C CH

C CH

HA CHT TG
KCH THCH

TNG
CNG

THUC
KTTKTW

C CH TC DNG

CC DN XUT
METHYLXANTHINE
1.

Caffein:
Cph (100-150mg/ly).
Tr (30-40mg/ly).
Cacao (15-18mg/ly).
2. Theophyline: Tr v cacao.
3. Theobromine: Cacao.

CAFFEINE
Thuc

Tm

Mua

s dng ph bin nht.

thy trong c ph, tr, cacao.

v bn d dng c php
lut cho php.

HIU QU DC L
Liu

thp: 50-250mg: Tnh to

tinh thn, gim u oi, gim mt.
Liu cao hn: 250-600mg: D
kch thch, cm gic rng mnh,
mt ng, au u.
Liu cao: Trn 1000mg: Kch
thch mnh, m sn, c th co
git.

TC DNG LN TIM MCH

Liu

thp gy tng tn s v sc
co bp c tim qua kch thch c
tim trc tip.
Liu cao hn: Nhp nhanh v lon
nhp.
Liu cao + TM nhanh: c th gy
gin mch ngoi bin, ngng tim.

TC DNG DC L LN CC
C QUAN KHC
Thn:
C
H

Li tiu.

trn: Gin c trn.

hp: Kch thch ln

trung tm h hp.

TC DNG
KHNG MONG MUN
Kch

thch tng tit dch v.

Ph

thuc thuc v c
tnh tm thn.

ng (Aminophylline)

S DNG IU TR

OTC: Theophylline (d phng hen

mn), gim cc triu chng trong
cn hen cp.
Phi hp mt s thuc c tc dng
gy bun ng: Antihistamine
(Chlorpheniramine).
Caffeine citrate: Suy h hp tr s
sinh.

THN TRNG
1.
2.
3.
4.
5.
6.
7.

Suy vnh.
Tng huyt p.
Cng gip.
Ph no.
ng kinh
Nhp nhanh.
Ngoi tm thu.

METHYLXANTHINE
C CH TC DNG

METHYLXANTHINE
C CH TC DNG

CC THUC TC DNG
TM THN (V NO)
1. Thuc kch thch tm thn.
2.1. Amphetamine
2.2.Pipradrol.
2. Thuc chng trm cm.
2.1.Thuc chng trm cm 3
vng.
2.2.Thuc c ch men MAO.

AMPHETAMINE
Tng cng hot ng ca: Dopamine,
Serotonine, Nor-epi.
Kch thch tm thn mnh, gy tnh to.
iu tr chng ng r, ng c thuc ng,
thuc m.
Gim cm gic mt mi, kch thch h hp,
tng chuyn ha c s, tng s t tin.
Hn ch s dng: Nghin, tm thn.

THUC CHNG TRM CM 3

VNG: IMIPRAMINE
c ch s thu hi serotonin:

IMIPRAMINE
C tnh cht DL nh cc thuc chng trm
cm 3 vng khc: Amitriptyline, doxepine.
Khng cholinergic (Khng hot ng ca
Acetylcholine) lm sng:
1. Kh ming
2. Ra m hi.
3. Tng nhp tim.
4. To bn.
5. Tng huyt p.

IMIPRAMINE
Hp

thu tt qua ng tiu ha.

Chuyn

ha gan to ra cht c
tc dng dc l mnh.

Gn

mnh vo protein huyt

tng.

Thi

tr ch yu qua thn:

IMIPRAMINE

Ch nh:

1. Trm cm (kt qu r sau 10-20

ngy)

2. Cc triu chng au do ung th,

vim dy thn kinh

3. i dm tr em trn 5 tui:

IMIPRAMINE
Chng

ch nh:
1. IMAO (Monoamine oxidase
inhibitors): 14 ngy.
2. Suy gan thn nng:
3. Giai on cp ca NMCT.
4. ng kinh.
5. Tin s nhy cm vi cc thuc
chng trm cm 3 vng.
6. Glaucoma.

IMIPRAMINE
Ph

n c thai:
+ Cha m bo an ton.
+ Khng nn: 3 thng u v 7
tun sau.
+ Thi gian cn li: So snh li ch
Cho con b.
+ Qua c sa m.
+ Ngng thuc hoc ngng b.

TC DNG
KHNG MONG MUN

1. Lon thn: c mng, hoang tng, l

ln.

2. Ri lon thn kinh: Mt thng bng,

lon cm gic...

3. Ri lon chuyn ha: Tng cn.

4. Ri lon ni tit v tnh dc.

TNG TC THUC
Chng

ch nh hon ton: MAO.I.

Khng

khuyn:

1.

Alcool.

2.

Clonidine.

CC THUC KHC
1.

Clomipramine (Anafranil).

2.

Amitriptyline (Laroxyl).

3.

Maprotiline (Ludiomil).

TK

Vidal, Dc th quc gia.

THUC C CH
MONO AMIN OXYDASE
MAO:

amin.

kh amin-oxy ha cc mono

khp c th, c bit thn kinh

TW.

Khi

c ch MAO: Catecholamin v
Serotonin tng cao.

CC THUC C CH MAO
C nht.
Noradrenaline, Serotonine, dopamine.

IMAO
IMAO-A:

c hiu hn vi
Noradrebaline v Serotonine.

IMAO-B:

c hiu hn vi
Dopamine.

ch c hi phc v c ch
khng hi phc.

IMAO
Chng

ch nh:
1. Hoang tng.
2. Tin s bnh mch mu no.
Trong

qu trnh iu tr:
1. Khng Alcool.
2. Trnh cc thc n cha
Tyramine, (IMAO-A).

TC DNG PH V C TNH
1.

Run, mt ng, v m hi, l ln,

o gic.

2.

Tt huyt p khi ng.

3.

Vim gan nhim c.

TC DNG PH V C TNH
(tt)
4.

Nhc u v nn khi s dng ru

(do tng t ngt cc amin ngoi
sinh).

5.

Cn tng HA kch pht (do tng

t ngt NA): Khi s dng cc thc
n c cha nhiu Amin: Phomat...

THUC KCH THCH U TIN

TRN TY SNG (STRYCHNINE)
Alcaloid cy m tin.
Vi liu iu tr (liu rt thp): Tng cng
phn x ty, tng c lc, iu tr i dm.
Liu cao: (+) hnh no v v no.
Liu c:

CU HI KIM TRA
N V HC TRNH
Trnh by tc dng dc l ca
Caffein?
Thi gian: 15 pht.