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THUC V H TIU HA

I TNG GING DY: DSH

Cn Th, 2016

NI DUNG
THUC CHA LET D DY T TRNG.
THUC CHNG HI LU D DY THC QUN.

THUC CHNG NN.


THUC GY NN.

THUC CHA TIU CHY.


THUC NHUN TRNG TY X
2

MC TIU
Nhn dng c cng thc cc thuc tr lot d dy t
trng.

Trnh by c lin quan gia cu trc v tc dng ca


thuc i khng ti th th H2 ca histamin.
Trnh by c tc dng, tc dng ph ch nh ca cc

thuc trung ha acid d ca dch v, thuc c ch bm


proton, cht tng cng yu t bo v.
4

DA DAY

C trn

DA DAY

Than kinh ket noi

Mo than
kinh
mau

Bieu b

HNH THANH VET LOET


Niem mac bnh thng

viem
Cac te bao niem mac
b ton thng
loet

Day than kinh X

YEU

TO
KCH
THCH

TIET
ACID
DCH
V

Te bao vien

Giam
tnh acid

Giam
tiet acid

Tuyen tiet acid

Thc an

Gia tang
tiet chat nhay
Tuyen tiet
chat nhay
e bao ve
CAC TUYEN TIET DA DAY, THUOC CHA LOET DA
DAY

PHN LOI
1. THUC TRUNG HA ACID D CA DCH V

2. THUC TC NG LN S TIT DCH V


2.1 Thuc i khng ti th th H2 ca
histamin
2.2 c ch bm proton
3. TNG CNG YU T BO V
3.1 Gia tng ti mu d dy
3.2 Bo v nim mc
4. THUC TR NHIM KHUN HLICOBACTER
PYLORI

THUOC CHA LOET DA DAY TA TRANG

THUOC

(+) Kch thch tiet acid

oi khang
H2
c che bm

Bm proton

TE BAO
VIEN

LONG
DA DAY

1. THUC TRUNG HA ACID D CA DCH V


Gm cc mui Na, Ca, Mg, Al.
c chia thnh 2 nhm theo thnh phn c
hot tnh:
- Phn anionic ca phn t: Ca carbonat,
Na bicarbonat
-

Phn cationic ca phn t: mui Mg, Al

HOAT
CHAT

NaHCO3

CaCO3

DA
DAY

RUOT

+ HCl

TA TRANG

NaCl
hap thu

Tai hap thu


nguy
c
nhiem kiem

CaCl2

Al(OH)3

AlCl3

Mg(OH)2

MgCl2

90%
CaCO3
khong tan
10% CaCl2 tai
hap thu
nguy
c
nhiem kiem

HONG TRANG

TNG
TAC
RUOT GIA

Xa phong Al,
AlPO4
Xa phong Mg

THUOC

INH,
tetra
MgCO3
tan

TRUNG HOA ACID

Tuy

Hap thu

KHANG ACID
Khong hap thu

tuy

Hap thu

2. THUC TC NG LN S TIT DCH V


2.1. Thuc i khng ti th th H2 ca
histamin
Histamin c tc ng trn t bo vin
ca mng nhy tit
S tit histamin c khi ng bi
dy thn kinh vague (th th M1) v
gastrin.
Histamin c 2 th th : H1, H2

Dng rng c nh ln th th H1 cn dng


gn s c nh ln th th H2.
H
N

N
CH2CH2NH3+

H
N

HN

CH2CH2NH3+

5,1 nm

4,37 nm

HN

NH3+

Dng rng
H1

H3N+
3,14 nm

dng gn
H2

Cc nghin cu c thuc i khng ti th th


H2.
H
N

H
N

the nhom guanidin

NH
N

CH2CH2NH2

H
N
N

CH2CH2

guanyl-histamin

Hat tnh tng

NH2

guanyl-histamin

keo dai mach C

NH

CH2CH2 NH

NH
NH2

N
N

CH2CH2 CH2

NH C

homo-guanyl-histamin

NH
NH2

H
N

N
NH the guanidin bang thioure
N
NH2
homo-guanyl-histamin

CH2CH2 CH2 NH C

H
N
N

H
N

S
metyl hoa v tr 5

CH2CH2 CH2 NH C
burinamide (1972)

NH CH3

CH2CH2CH2

NH C

NH CH3

burinamide (1972)

CH3
S
CH2

CH2CH2

NH

metiamide

C
NH CH3

Hat tnh rt cao, khng th dng bng ng ung


S
R

CH2CH2 NH

metiamide

C
NH CH3

1. a S vao mach carbon

2. the bang cyanoguanidin N

H
N

CH3
N
CH2 S CH2CH2 NH
cimetidin (1977)

1- Ung c
2- t c

NH CH3

Cimetidin (TAGAMET)
liu iu tr, c ch cytocrom P450
nn nh hng n nhiu thuc khc
khi tr liu phi hp vi diazepam,
warfarin, phnytoin, thophyllin.

H
N

CH3

Nimidazol CH2 S CH2CH2

N C
NH C

NH CH3

Ranitidin (AZANTAC)

c i lc vi cytocrom P450 km
cimtidin 4 ln nn nguy c
tng tc thuc rt thp; khng
lm thay i nng ca
indometacin trong mu khi tr liu
ng thi.
Famotidin (PEPDINE)

thc t khng giao thoa vi


cytocrom P450

3HC

CH2

3HC

CH2SCH2CH2NHC

NHCH3
CHNO2

furan

NH2
C

NH2

NSO2NH2

S
CH2SCH2CH2

thiazolin

NH

NH2

Nizatidin (NIZACID)

(CH3)2N

CH2
S

CH2SCH2CH2

thiazolin

NH

CHNO2
NHCH3

21

THUC C CH BM PROTON
Long da day

Te bao
mang nhay

Ni chuyen

Te bao vien

2.2 c ch bm proton: dn xut ca benzimidazol

Omeprazol (MOPRAL)

Nhn benzymidazol b th v tr
s 5 bi nhm metoxy
Nhn pyridin b th bi metoxy
v tr 4, dimetyl v tr 3 v 5

CH3

CH3

OMe

N
CH2

CH 3

Lanzoprazol (LANZOR)

Nhn
pyridin
b
th
bi
trifluoetoxy v tr 4, metyl v tr
3

N
N
H

Pantoprazol, EUPANTOL

Nhn benzymidazol b th v tr
s 5 bi nhm difuorometoxy
Nhn pyridin b th bi metoxy
v tr 3 v 4

OCH2CF3

CH3

CH2
N

HF2CO

H3CO

N
N
H

S CH2
O

OCH3

C ch tc ng
c ch chn lc trn H+/K+ ATPase, men ny t
bo vin gip cho s vn chuyn ion H+ c tit
ra t bn trong t bo i ra d dy kt hp vi
ion Cl- to nn HCl.
S c ch do tc ng vo nhm -SH ca enzym.
H3C

CH3

H3C

S
N

H3C

CH3

H+

N
NH

CH3

H3C

- H2O

N
N

OCH3

OCH3

OCH3

OCH3

H3C
acid sulfenic

S
N

H3C

CH3

enzym-SH

S
OH
NH

H3C

sulfenamid

N
N

H3C

S
NH

enzym

ESOMEPRAZOL

OMEPRAZOL

RABEPRAZOL
25

26

ESOMEPRAZOL- MAGIESI
27

3. TNG CNG YU T BO V
3.1. Gia tng ti mu d dy :
misoprostol (CYTOTEC)
Prostaglandin bn tng hp nn bn
hn loi t nhin c trong c th.
Kch thch s to ra cht nhy, c ch tit
acid.
c dng d phng lot d dy do
dng thuc NSAIDs.

Thng gy co tht c trn nn hn ch


s dng cho ph n c thai, gy tiu chy.

29

3.2. Bo v nim mc
- Sucralfat (KAL)
Cht c kh nng gy ra s phng thch
prostaglandin
Phn t cha nhiu nhm nhm
hydroxyd
Khng khng acid do trung ha m c
kh nng to hp cht keo pH <4.
C kh nng bo v mng nhy trnh
c tc dng tn cng ca acid, pepsin,
acid mt.
Nn dng thuc lc d dy rng (trc
ba n 1 gi hoc vo ban m).

31

- Carbenoxolon (CAVED)
L dn xut ca acid glycyrrhizic c
trong r cy cam tho.
Lm thay i lng cht nhy,

Lm tng dy lp mng nhy


C tc ng tng t aldosterol lm tng
ti hp thu NaCl v nc thn nn gy
ph

O
C

(CH2)6

H
HO

OCH3

C C CH2

misoprostol

CH3

HO
C

(CH2)3

CH3

CH2OR

CH2OR

O
RO

OR
O

RO
OR

CH2OR
OR

R = SO3 [ Al2 (OH)x (H2O)y]

sucralfat

4. THUC TR NHIM KHUN Hlicobacter pylori


Cc khng sinh

Helicobacter pylori

Ta trang

Mon v

hang

viem

loet
Vet loet

Ta trang

Xuat huyet

Helicobacter pylori TAN CONG NIEM MAC DA DAY

TIEU DIET

Viem da day
Loet da day

Helicobacter pylori

ngay
ngay
ngay

MT S THUC

THNG DNG

42

NHM HYDROXYD

Al(OH)3

P.t.l: 102,0

iu ch
T phn nhm vi natri carbonat
Al2(SO4)3 + 3Na2CO3 =

Al2(CO3)3 + 3Na2SO4

Nhm carbonat thy phn trong dung dch nc phng


thch kh CO2
Al2(CO3)3 + 3H2O = 2Al(OH)3 + 3CO2

43

NHM HYDROXYD

Al(OH)3

P.t.l: 102,0

Kim nghim
nh tnh
Phn ng ca ion nhm.
Th tinh khit
- Tp cht kim, kh nng trung ha acid,
- Clorid, sulfat,
- Kim loi nng, arsenic
- nhim vi khun.
nh lng
Phng php chun Na EDTA.
44

NHM HYDROXYD

Al(OH)3

P.t.l: 102,0

Tc dng
- Khng acid do tip xc.
- Tc ng ngn t 30-60 pht.
- Gn ln glycoprotein ca mng nhy chm s
tho sch d dy.
- Khng khng tit acid khi ngng thuc c th
gy ra hiu ng di ngc.

45

NHM HYDROXYD

Al(OH)3

P.t.l: 102,0

Ch nh
Ty theo cc cn au c th dng 4 n 8 ln mi ngy
(cch nhau mi 2-3 gi).
Tc dng ph
- Gim hp thu cc thuc dng ng thi do b hp
ph (furosemid, indometacin, tetracyclin, digoxin,
isoniazid).
- To bn.
- Dng lu di c nguy c b mt PO43- ca c th.
46

CIMETIDIN

C10H16N6S

P.t.l: 252,3

N
HN

S
N

N
H

C
N
H

N
CH3

H3C

47

CIMETIDIN

C10H16N6S

P.t.l: 252,3

Kim nghim

nh tnh
Ph hp thu IR, im chy, phn ng mu.
Th tinh khit

Tp cht lin quan, kim loi nng, gim khi lng do


sy, tro sulfat
nh lng
Phng php mi trng khan, dng dung dch chun
HClO4, xc nh im kt thc bng in th k.

48

CIMETIDIN

C10H16N6S

P.t.l: 252,3

Tc dng

- i khng tng tranh c chn lc ti cc th


th H2 ca histamin mng t bo vin c
ch dy chuyn chuyn ha v s tit acid
- S c ch ch yu trn nng acid. Mc
c ch ty thuc vo liu s dng.
Ch nh
- Lot d dy- t trng tin trin, d phng ti pht.
Vim thc qun do hi lu d dy- thc qun.

Chng ch nh
- Nhy cm vi thuc.
49

CIMETIDIN

C10H16N6S

P.t.l: 252,3

Tng tc thuc
y l cht khng androgen v c ch cytocrom P450
nn tng tc vi nhiu thuc khc khi dng chung:
- Vi Ketoconazol: lm gim nng ketoconazol
trong mu
- Vi Warfarin: ko di T1/2 ca Warfarin trong huyt
tng
- Vi cc Benzodiazepin : chm chuyn ha thuc
gan; ko di T1/2
- Theophyllin, phenytoin, carbamazepin: tng T1/2
trong huyt tng ko di tc ng.
-Thuc chn beta (propranolol, labetalol,metoprolol):
tng tim lc.
50

OMEPRAZOL

C17H19N3O3S

P.t.l: 354,4

Ten khoa hoc: (5-methoxy-2-[(RS)-[(4-methoxy-3,5dimethylpyridin-2-yl)methyl]sulfinyl] -1Hbenzimidazol

H3CO

H3C

N
N
H

O
S CH2

OCH3
CH3

51

OMEPRAZOL

C17H19N3O3S

P.t.l: 354,4

Kim nghim
nh tnh

Ph hp thu IR, ph hp thu UV, sc k lp mng


Th tinh khit
Dng dung dch, hp thu, tp cht ca omprazol,
cht tng t, cn dung mi, gim khi lng do sy,
tro sulfat (< 0,1%, 1g).
nh lng
Phng php acid-base:

- Dung mi cn-nc.
- Chun bng NaOH 0,5M.
- Xc nh im kt thc bng in th k.
52

OMEPRAZOL

C17H19N3O3S

P.t.l: 354,4

Tc dng

- c ch chn lc trn H+/K+ ATPase do tc ng


vo nhm -SH c ch s tit acid dch v
- Thi gian tc ng rt di (> 24 h) cho php
dng thuc 1 ln mi ngy nn hu hiu hn loi
i khng vi th th H2 ca histamin.
Ch nh

- Lot d dy, lot t trng tin trin. Vim thc


qun do hi lu d dy- thc qun.
53

OMEPRAZOL

C17H19N3O3S P.t.l: 354,4

Tc dng ph
- Him gp, bun nn (4%), y hi (4%), chng
mt nhc u (3,5%), tiu chy.

Chng ch nh
- Ph n cho con b (do cha c kt qu nghin
cu).

54

55

MC TIU
Nhn dng c cng thc cc thuc tr hi
lu d dy thc qun.
Trnh by c tc dng, tc dng ph ch
nh ca cc thuc tr hi lu d dy thc
qun.
56

NHU ONG
Thc an

Thc quan
C vong co that

C vong dan ra
Mon v
Da day
57

Thc quan co nhiem vu a thc an xuong da day

C vong di thc quan co nhiem vu ngan nga


s trao ngc t da day vao thc quan,
Chat cha trong da day thng rat acid va cha
nhieu men tieu hoa protein.

Hoi lu
+ la mot hien tng sinh ly bnh thng sau khi
an,
+ ch tr thanh benh ly khi co s lap lai, keo dai
gay ra loet thc quan.
+ khong phai la benh do s tiet acid ma do roi loan
ve van ong cua thc quan va tam v.
58

59

Fig. FDA Warns of Increased Bone Fracture Risk With Popular Reflux Drugs

PHAN LOAI THUOC

1. Kch thch chc nang van ong thc quan da


day

2. Kch thch nhu ong thc quan, tang trng lc


c vong di thc quan, tang van ong thc
quan da day ta trang va thuc ay s thao
sach da day.

60

C
che
tac
ong

CISAPRIDE
(PREPULSID)

DOMPERIDON (MOTILIUM-M)

Gia tang s phong thch


acetylcholin (gia tang lan
song ngoai bien va s co
that cua c vong tren thc
quan).

Domperidon qua hang rao


mau-nao yeu nen tac ong
chu yeu tren cac thu the
ngoai bien dopaminergic
cua ong tieu hoa, tac ong
oi khang vi dopamin.
Thay oi chc nang van
ong da day-ruot trong s
tr (), hoi lu thc quan-da
day, viem thc quan do hoi
lu, cham tieu, trng bung.

Kch thch chc nang van


ong da day-ta trang bang
cach lam de dang s thao
sach da day.

Ch
nh

Hoi lu thc quan-da day,


viem thc quan do hoi lu
thc quan-da day.
O

H3 CO

C NH

N(CH2 )3 O

OCH3
Cl
NH2

nong, hoi lu thc quan


da day, viem thc quan do
hoi lu, cham tieu, snh hi,
chong non.
F

N
N
H

O
O

N
H

Cl

61

CISAPRIDE (PREPULSID)

DOMPERIDON (MOTILIUM-M)

Tac
dung
phu

Roi loan tieu hoa (5%), khi


b tieu chay th nen giam
lieu dung.
Nhc au, chong mat, buon
ngu.

Roi loan ngoai thap nhng


hiem (1 phan trieu).

Tng
tac
thuoc

Co the b xoan nh khi phoi


hp vi cac thuoc lam cham
s chuyen hoa cua
cisapride: fluconazole,
ketoconazole, itraconazole,
miconazole, macrolid ngoai
tr spiramycine.
Phoi hp than trong vi
thuoc khang cholinergic,
benzodiazepin, ru do oi
khang tac ong tren s van
ong da day.

Khang cholinergic do oi
khang tac ong tren s van
ong da day.

62

63

MC TIU
Nhn dng c cng thc cc thuc
chng nn - gy nn.
Trnh by c tc dng, tc dng ph,
ch nh ca cc thuc chng nn - gy

nn
64

65

CAC CHAT TRUNG


GIAN HOA HOC co
lien quan en phan xa
non

THUOC CHONG NON c che ng truyen


vao thong qua viec c che cac chat trung
gian hoa hoc nay

Dopamin (D2)

oi khang vi thu the cua dopamin

lam tang tnh van


ong cua da day

- Domperidon (MOTILIUM),
- Metoclopramid (PRIMPERAN)
- Alizapride (PLITICAN)

Serotonin hay 5hydroxy tryptamin (5HT3)

oi khang vi thu the 5-HT3 cua serotonin

la 1 tn hieu tien non


quan trong tren
ng truyen vao
thong qua cam thu
quan hoa hoc

- Ondansetron(ZOPHREN)
- Granisetron (KYTRIL)
- Tropisetron (NAVOBAN)

66

CAC CHAT TRUNG


GIAN HOA HOC co lien
quan en phan xa non

THUOC CHONG NON c che ng truyen


vao thong qua viec c che cac chat trung
gian hoa hoc nay

Acetylcholin

Gia tang phong thch acetylcholin

anh hng en ng
truyen vao trung tam
non (thu the
muscarinic)

- Dan chat khang cholinergic:


scopolamin SCOPODERM TTS
- Lam tang ap suat cua c vong
di thc quan tao de dang cho
s ay cac chat xuong da day:
cisapride, PREPULSIDE

Histamin

Khang histamin H1

co thu the H1 nam


tren ng truyen vao

- dimenhydrinat NAUSICALM,
- diphenhydramin NAUTAMINE

67

Granisetron (KYTRIL)

Ondansetron (ZOPHREN)
O

CH3
N

CH3

NH

CH3

CH3

Tropisetron (NAVOBAN)
N

CH3

O
N
H

68

69

Thuoc gay non do kch thch thu the cua


dopamin

Apomorphin
- La dan xuat tong hp t morphin.
- Kch thch rat manh len thu the cua dopamin nhat la trung tam non.
- Thng gap nguy c b suy ho hap.
- Khong dung cho tre em di 30 thang

- Giai oc bang naloxon.

70

Thuoc gay non do kch thch thu the cua


dopamin
CAO LONG IPECA CUANHA
Hoat chat emetin co tac ong kem apomorphin nen co
the dung cho tre em di 30 thang.
Lu y
- Ch dung e s cu khi ngo oc qua ng tieu
hoa.
- Khong dung khi benh nhan b hon me do phan xa
bao ve ng ho hap kem.
- Khong dung khi benh nhan b nhiem chat oc an
da
71

Thuoc gay non do tac ong kch thch


ngoai bien
CuSO4 0,3g% , ZnSO4 0,3 1% : gay kch thch luong
than kinh truyen en trung tam gay non.

72

73

MC TIU
Nhn dng c cng thc phn t cc
thuc tr tiu chy.
Trnh by c tc dng, tc dng ph,
ch nh ca cc

74

NGUYEN NHAN
- Nhiem trung: benh sot thng han; viem ruot cap

tnh hay th cap do salmonella, staphylococ, vi


khuan ruot (thng xay ra tre em).
ieu tr nguyen nhan bang khang sinh sau khi lam

khang sinh o
- Nhiem virus. Ch co the ieu tr trieu chng.
- Ky sinh trung: amib ruot, cac ky sinh khac

- Dung thuoc: thuoc co thuy ngan, colchicin,


khang sinh pho rong, khang nam.

Can ngng ngay thuoc va co bien phap bu nc.


75

- Nhiem oc, ngo oc thc an thng xay ra cho


nhieu ngi cung mot luc khi dung cac thc an
nh tht, ca, sa, nam, o hop khong c che
bien, bao quan tot.
ieu tr nguyen nhan bang sulfamid khang khuan
ng ruot, Neomycin
- B ung th ng tieu hoa: da day, tuy, ruot
thng xay ra nhng ngi tren 50 tuoi va
khong co nguyen nhan ro rang.
Co the chan oan bang cach sieu am, X quang.

- Roi loan chc nang tieu hoa: la nguyen nhan


cuoi cung sau khi a loai tr cac nguyen nhan
khac.
76

MUC CH IEU TR
- Ngan chan s mat nc va chat ien giai.

- Cam i cau mac du khong nguy hiem nhng bat


tien.

CAC THUOC TR TIEU CHAY


La nhng thuoc co tac ong thuan tuy tren trieu
chng, cho nen khi dung thuoc van phai chan
oan va ieu tr nguyen nhan.

77

CAC THUOC CHA TIEU CHAY


1. Dung dch bu nc (ORESOL)
Bu nc la cach ieu tr chu yeu chng tieu chay

2.

San pham t vi khuan


2.1. Saccharomyces boulardii (ULTRALEVURE)
2.2. Lactobacillus acidophilus (
ANTIBIOPHILUS)

3. Chat hap phu: pectin (GELOPECTOSE),


lactoprotein metyl (SACOLENE), kaolin
78

4. Lam giam nhu ong ruot


Morphin

lam giam nhu ong ruot va


giam tiet dch ruot.

Lopera
mid

Cau truc piperidin,


Tac ong manh hn morphin
va i vao nao rat t

N
Cl

(DIASED)

CH2CH2

HO

IMODIUM
Dipheno
xylat

CH3
O

H3C

Cau truc piperidin, b deeste


hoa thanh difenoxin la chuyen
hoa chat co hoat tnh manh
hn morphin

C6H5
NCH2CH2
COOC 2H5

C
C6H5

79

CN

ORESOL
Thanh phan 1 goi
Glucose

20 g

NaCl

3,5 g

Na citrat

2,5 g

KCl

1,5 g

80

ORESOL

Cach s dung
- Pha vi nc uong e c 1 lt, uong cang
nhieu cang tot, khong co lieu toi a.
- S hap thu glucose keo theo s hap thu de
dang cua cac ion va nc phuc hoi s mat
nc va chat ien giai.
- Co the dung thc uong giau Na+ va K+
81

DIPHENOXYLAT HYDROCLORID
Kiem nghiem
nh tnh
Pho hap thu IR, phan ng cua Cl-.
Th tinh khiet
Dang dung dch, chat tng t, giam khoi
lng do say, tro sulfat.
nh lng
Phng phap chuan o acid-base, dung ien
the ke xac nh iem tng ng.

82

DIPHENOXYLAT HYDROCLORID

Tac dung phu


- Qua lieu: suy ho hap nang vi trieu chng
cua atropin roi hon me. ieu tr bang naloxon
va kem theo thong kh.

83

DIPHENOXYLAT HYDROCLORID
Can than khi dung
- Khong dung cho tre di 30 thang, phu n
co thai hoac cho con bu.
- Khong dung khi b l cap tnh phan co mau
va sot cao, tieu chay do dung khang sinh.
- Do co atropin nen co the gay glaucom cap.
Tng tac thuoc
- Tranh phoi hp: ru v nguy c gay ngu.
84

LOPERAMID HYDRO CLORID


Kiem nghiem
nh tnh
- Pho hap thu IR, phan ng cua Cl-, sac ky lp
mong.
Th tinh khiet
- Dang dung dch, chat tng t, giam khoi
lng do say, tro sulfat
nh lng
- Phng phap chuan o acid-base, xac nh
iem tng ng bang ien the ke.

85

LOPERAMID HYDRO CLORID


Ch nh
- c e ngh e d phong tieu chay do s
dung khang sinh, ket hp vi chat bu nc.

Tac dung phu


- Tao bon, nga.
- Qua lieu co the gay tac liet ruot va suy he
than kinh trung ng - co the cha bang
naloxon.
86

LOPERAMID HYDRO CLORID


Than trong khi dung
- Khong dung cho tre em di 2 tuoi, b l cap
tnh phan co mau va sot cao, tieu chay do
khang sinh.
- Can than oi vi ngi b suy gan.
- Phu n vao 3 thang au cua thai ky ch dung
khi can thiet.

87

88

MC TIU
Nhn dng c cng thc cc thuc
nhun trng.
Trnh by c tc dng, tc dng phu,
Ch nh ca cc thuc nhun trng

89

THUOC NHUAN TRNG, THUOC XO


Thuoc nhuan trng, thuoc xo c dung e tr tao
bon do lam gia tang va de dang s bai xuat phan
bang cach:
- gia tang tac ong tai cho nhu ong ruot va/ hoac
- lam mem chat cha trong ruot.
Tac ong cua thuoc nhuan trng em du hn
thuoc xo v cho phan co dang nh bnh thng con
thuoc xo th lam tieu chay.
Cac thuoc nay c phan biet vi nhau do cng o
tac dung va lieu dung.
90

TRNG HP S DUNG THUOC


NHUAN TRNG

- Trng hp roi loan s van chuyen ruot gia


do dung thuoc (opiace), bat ong lau ngay,
tuoi gia.
- Can gia tang s tong xuat chat oc, chuan b
cho noi soi, quang chan oan hoac phau thuat.

91

PHAN LOAI

1. Thuoc dang x
2. Thuoc nhuan trng do tnh tham thau

3. Thuoc nhuan trng kch thch


4. Thuoc dung qua ng trc trang

92

PHAN LOAI
1. Thuoc dang x
La cac polysacarid nh pectin, gom, glycoprotein
co trong rau qua, ngu coc nguyen ven.
La nhng si khong tan trong nc
Gom nhng chuoi carbon khong b tan cong bi
cac men tieu hoa, khong c hap thu lien ket vi
nc va cac ion trong ruot nen phong len.
1.1. Si thc an: cam lua m (ACTISSON)
1.2. Chat nhay: tao
1.3. Gelose: agar-agar (GELOGASTRINE)
1.4. Gom: nha trom (NORMACOL)
1.5. Hat lanh (TRANSILAX, OSMOLAX)

93

2. Thuoc nhuan trng do tnh tham thau

Thuoc dang muoi

Na, Mg co tac ong do kha nang gi nc lai trong ruot.


Thng c dung e chuan b cho phau thuat ong tieu hoa, noi soi
ruot, ngo oc, loai tr ky sinh trung ruot kem theo thuoc diet giun san.

Natri

Na citrat: MICROLAX,
Na phosphat, Na tartrat, Na
sulfat.

Khong nen dung cho ngi


b suy than, tim.

Magnes
i

Mg hydroxyd:
CHLORUMAGENE,
Mg citrat: LIMONADE
GODFRIN.
Nhuan trng: lieu 5-10g,
Tay xo: lieu 20-50g

kch thch tiet


cholecystokinin la hormon
lam tang nhu ong ruot

94

Thuoc dang ng
cac loai ng do co cau truc phc tap nen khong c c the
hap thu
Lactulose,
-D galacto
pyranosyl(1,4) -D-

fructofuranos
e:
(DUPHALAC)

Lactitol, -Dgalactopyrano
syl-(1,4)sorbitol,
(IMPORTAL)

Nhuan trng: 15-45ml/ ngay


Con c dung trong benh nao
gan man (encephalopathie
hepatique chronique) do lam
giam s hap thu amoniac vao
CH OH
mau bang cach:
OH
- lam gia tang tieu thu
OH
amoniac bi vi khuan ruot
- chuyen NH3 thanh dang
ion NH4+ khong hap thu
va thai qua phan.

CH2OH

O
O

CH 2 OH

CH2OH

OH

OH O

OH

nh lactulose, de tan va v t
ngot hn nen c a dung. CH OH
Ngi ln: 10-30 g/ ngay
Tre em: 0,25 g/ kg/ ngay
Tre s sinh: 2,5 g/ ngay

OH

OH

OH

OH
OH

CH2OH

95

Mannitol
(SORBITOL)

Polyetylen
glycol ang
trng
phoi hp vi
Na sulfat, Na
carbonat, Na
clorid

t hap thu, co the dung


bang cach uong hoac qua
ng trc trang.
c dung chung vi natri
sulfonat polystyren trong
trng hp tang kali huyet,
than hoat trong trng hp
ngo oc thuoc e tranh tao
bon do cac chat nay gay
ra.
5-15g/ngay.
dung cho benh nhan trc
khi chup hnh ruot, do the
tch dung qua ln mot chat
long khong c hap thu
nen tong ra ngoai 1 lng
ln cac chat cha trong
ong tieu hoa nhng khong
gay mat nc do dung dch
ang trng. Khong dung
cho benh nhan b nghen
ruot. 10-20 g/ ngay.

CH2OH
HC
HO

OH

CH
HC OH
HC OH
CH2OH

96

3. Thuoc nhuan trng kch thch


Dau parafin
hay
dau vaselin

Khong c hap thu, ch


co tac dung lam mem va
giup cho phan c di
chuyen de dang.
Ngan can s hap thu cac
vitamin tan trong dau khi
dung lau dai.
Co nguy c ht vao kh
quan do vo y nen can
than trong ngi benh
liet ging, tre em, ngi
b nuot kho. Lieu 1-2
muong cafe/ngay.

Phenolphta
lein
(PURGANOL
)

Lieu 0,05-0,1g/ngay, co
tac dung sau 6-8 gi
Tac dung phu: nhc K
huyet, roi loan nhp tim,
me ay, co khi lam tang
aldosterol th cap va
nhuyen xng nen hien
gi khong con c dung
na.

HO

OH
C
H
C

OH

diphenylmetan
97

Bisacodyl
(NEOBOLBO
LAXINE,
DULCOLAX)

Na
picosulfat

Khi tiep xuc trc tiep


vi ruot th
gay tang tiet dch
Lieu uong la 5-10
mg/ngay, co tac dung
sau 8-10 gi
Lieu dung cho dang
thuoc an la 10 mg, co
tac dung sau 10-40
phut.

diphenylmetan

Lieu dung 5- 10 mg/


ngay

(FRUCTINES
VICHY)

OCOCH3

H3COCO

Na O3 SO

SO3 Na

C
N

diphenylmetan
Nha

nha turbith (cha voi),


jalap (khoai xo).

98

Antraquinon:
* Glucoside
thien nhien:
Bourdain, la
muong trau
(sene), lo hoi
(aloes).

* Dang thien nhien


Phan t glycosid
antraquinon co 2 nhom
hydroxyl ma 1 nhom
lien ket vi ng
(gluco, ramno).
Can c vi khuan ruot
thuy phan mi co tac
dung, tac ong yeu hn
dang tong hp nhng
khong b ton thng ruot.

* Tong hp:
Dantrone,
Nerprun

* Dang tong hp co tac


dung ngay va manhhn
nhng gay tonthng
ruot

Dau thau
dau (ricin)

Trong ruot non c cac


enzym thuy phan thanh
glycerol va acid ricinoleic
co hoat tnh. Mang nhay ta
trang phong thch vao mau
hormon ruot la chole
cystokinin/pancreatozymin
kch thch nhu ong ruot.
c dung e ngan can
hap thu chat oc trong
trng hp ngo oc (ngoai
tr chat oc than dau v
trong trng hp nay cac
muoi mat se de dang hn).

la triglycerit
cua acid
ricinoleic.
Lieu 1530ml/ngay, co
tac dung sau 3
gi.

O
vi khuan ruot
OH

OH

OH

OH

OH

OH

ng

acid ricinoleic

O CH2

acid ricinoleic O CH
acid ricinoleic O CH
2

da u ricin

Vi khuan ruot

C6H13

CH CH2 CH
OH

CH (CH2)7 COOH

acid ricinoleic

99

4. Thuoc dung qua ng trc trang


Dang thuoc an

nhuan trng do tao hi.

* Natri bicarbonat + kali bitartrat


(EDUCTYL)
* Glycerin, mannitol + PEG
(RECTOLAX)

Dang thut ra
* Sorbitol (MICROLAX)

lam nhn hoac lam long phan


gay phan xa bai xuat phan sau
khi dung 5 - 20 phut.

* Gelatin + glycerin (BEBEGEL)

100

LAM DUNG THUOC NHUAN TRNG


oi vi ngi co tong trang tot th thuoc nhuan
trng la lu y th hai sau viec ch nh 1 che o an
nhieu chat x, uong nhieu, hoat ong the lc hp ly.

Khi phai dung thuoc th:


+ nen dung lieu hu hieu nhng thap nhat,
+ cang t dung cang tot

+ ngng thuoc ngay khi can thiet.


Neu b tao bon do s dung dc pham th nen
thay oi thuoc ieu tr.
101

102

MAGNESI SULFAT
Kiem nghiem

nh tnh
Phan ng cua ion Mg++, SO4 -
Th tinh khiet

Dang dung dch, gii han acid-kiem, clorid, arsenic,


kim loai nang, sat, giam khoi lng do say kho.
nh lng

Phng phap complexon.

103

MAGNESI SULFAT
Tac dung

- Ion SO4 -- khong c hap thu nen gi lai cac


cation e co s can bang ien tch.
- Ion Mg++ con co the kch thch mang nhay ta
trang tiet ra cholecystokinin hay pancreatozymin
lam tang nhu ong ruot.
- Thuoc nay con c goi la thuoc xo muoi, gay
ra s bai xuat phan long sau khi uong 1-3 gi
nen co the dung e thao sach ruot khi b ngo
oc.

104

MAGNESI SULFAT

Ch nh

- Tao bon, thi gian dung thuoc khong qua 8-10


ngay.
Chong ch nh
- Khong nen dung MgSO4 cho ngi suy than do
co nguy c ngo oc Mg.

105

LACTULOSE

C12H22O11

P.t.l: 342,3

Kiem nghiem
nh tnh

- Sac ky lp mong, phan ng tao tua vi Cu tartrat,


phan ng mau vi amoniac, nang suat quay cc.
Th tinh khiet
- o trong va mau cua dung dch, pH, nang suat
quay cc,
- Chat tng t la galactose, lactose, epilactose,
tagatose va fructose, methanol, bor, ch.
- Ham lng nc, tro sulfat.
- Nhiem vi khuan
nh lng
- Sac ky long.

106

LACTULOSE

C12H22O11

P.t.l: 342,3

Tac dung

- La thuoc nhuan trng dang tham thau.


- Tac ong keo dai 24-48 gi, de dung nap ngay
ca phu n co thai va tre con.

- Khong tai hap thu ong tieu hoa ma chuyen


dang ruot gia thanh acid lactic, acetic, thai
qua phan.
- B thuy phan bi he vi khuan ruot tao thanh
acid lactic va acid acetic, kch thch nhu ong
ruot.
107

LACTULOSE

C12H22O11

P.t.l: 342,3

Ch nh
- Tr tao bon ngay ca cho phu n co thai va tre
con. Co tac ong sau 30 phut en 3 gi.
Chong ch nh
- Che o an kieng lactose, viem ruot.

108

BISACODYL

C22H19NO4

Ptl: 361,4

Kiem nghiem

nh tnh
- Pho hap thu IR, iem chay, pho hap thu UV,
sac ky lp mong.

Th tinh khiet
- Gii han acid-kiem, chat tng t, giam khoi
lng do say.
nh lng
- Phng phap moi trng khan.
109

BISACODYL C22H19NO4 Ptl: 361,4


Tac dung

- Gia tang nhu ong ruot va s bai tiet nc,


cac chat ien giai.
Ch nh

- Tao bon, dung khong qua 8-10 ngay.


Chong ch nh
- Phu n co thai, cho con bu, tre em di 15 tuoi,
au bung khong ro nguyen nhan.
Tng tac thuoc
- Khong phoi hp vi cac thuoc gay xoan nh.
110

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