De Cuong Duoc Ly

DC L I CNG
Cu 1 : Vn chuyn thuc qua mng sinh vt , nghia
Bi lm
1. Khuych tn thu dng ( Tiu cuc )
a ) inh nghia
- L su vn chuyn cc cht do khuych tn qua mng sinh vt, t l vi Gradien nng d, t noi
c nng d cao dn noi c nng d thp, khng tiu tn nng luong, khng cn vt mang v
khng theo mun
b) iu kin
- Thuc no va tan trong nuc, va tan trong lipid s khuych tan nhanh
- Nng d thuc mt bn mng cao th vn chuyn cng d dng v s bo ho khi nng d
thuc hai bn mng bng nhau
- Thuc vn chuyn theo hnh thc bi dng phi dang khng bi ion ho
c) nghia
- i vi thuc c tnh cht l acid : pH ca mng cng thp th su hp thu thuc cng cao v
nguoc lai d pH cng cao th su hp thu thuc ca mng cng thp, thuc hp thu t noi c pH
thp dn noi c pH cao
- i vi thuc c tnh cht l base : pH ca mng cng cao th su hp thu thuc cng cao v
nguoc lai d pH ca mng cng thp th su hp thu thuc qua mng cng thp, thuc hp thu t
noi c pH cao dn noi c pH thp
2. Vn chuyn tch cuc
- L su vn chuyn thuc t noi c nng d thp dn noi c nng d cao ( nguoc bc thang nng
d ) dang vn chuyn ny di hi nng luong do ATP thu phn
- iu kin : Cht vn chuyn mng cn c dc dim
+ C i luc cao vi thuc, tao phc vi thuc
+ ua thuc qua mng
+ Phn ly v tr lai vi tr ban du
- c dim ca h vn chuyn
+ Tnh bo ho : S luong carrier c han
+ Tnh dc hiu : Carrier ch tao phc vi vi cht c cu trc dc hiu vi n
+ Tnh canh tranh : u tin vn chuyn thuc quen v thuc c cu trc gn ging carrier
+ Tnh c ch :
- C hai dang vn chuyn tch cuc
+ Vn chuyn thun loi : Km theo cht vn chuyn lai c su chnh lch bc thang nng d,
khng di hi nng luong
+ Vn chuyn tch cuc thuc thu : L vn chuyn di nguoc bc thang nng d, t noi c nng d
thp dn noi c nng d cao, di hi nng luong
3. Loc qua ng dn
- Mng sinh vt c nhng ng dn cho qua nhng thuc khng tan trong lipid v tan trong nuc,
thuc c trong luong phn t thp s chui qua ng bng p luc loc
Cu 2 : Hp thu thuc qua dung ung v tim, nghia
Bi lm
Phu thuc
- ho tan ca thuc
- pH tai ch hp thu
- Nng d thuc, phn b mach mu tai vng hp thu
- Din tch vng hp thu
1. Hp thu qua dung tiu ho
- u : D dng v l dung tu nhin
- Nhuoc : Bi cc enzym tiu ho ph hu hay tao phc vi thc n lm chm hp thu, hay kch
thch ph hu nim mac dung tiu ho
- Nim mac lui : Thuc ngm thng vo h thng tinh mach, khng bi ph hu da dy v khng
bi chuyn ho gan, c tc dung tai ch hay ton thn,
- Thuc ung
+ da dy : t hp thu v ch hp thu thuc c bn cht acid yu do nim mac t mach mu, thi
gian thuc da dy lu nn hp thu chm hoc bi ph hu bi enzym da dy
+ rut non : Ch yu cc thuc duoc hp thu tai dy do din tch ln v mach mu phong ph,
Thuc hp thu duoc d vo h thng tinh mach gan vo gan v bi phn hu nhanh bi h thng
enzym dy v theo dich mt d vo t trng tao thnh vng tun hon "gan-rut". Kt qu l
nng d thuc trong mu tng chm nn chm c tc dung duoc l, chm thi tr v thi gian bn
hu di
+ rut gi : Thuc khng ung duoc v c mi kh chiu, c tc dung nhanh, tai ch hay ton
thn phn ln thuc thm vo h thng t/m truc trng trn d vo tinh mach ca vo gan phn
nh ngm vo h thng t/m truc trng gia v dui d d vo tun hon chung
2. Hp thu qua dung tim
- Tim dui da : Tim cc thuc d ho tan v gy dau, thuc hp thu vo t chc lng lo dui da
vo mu v h thng bach huyt
- Tim bp : Hp thu nhanh v t dau do co co lm lng mao mach dn rng din tch trao di vo
luu luong mu tng, c t soi cm gic hon dui da, tim dung dich nuc v du khng tim
thuc gy dng vn protein
- Tim tinh mach : Thuc hp thu nhanh, hon ton v cung d manh, c th dua 1 luong thuc
ln vo t/m, liu dng chnh xc, thung dua thuc gy hoai t dui da, bp v huyt tuong,
khng dua cc thuc c bn cht du, cht lm tan mu, cht gy phn ng ...
3. Cc dung khc
- Thuc dng ngoi da : C tc dung nng, tai ch dng d st khun, chng nm nhu thuc bi,
nh, cao dn...
- Qua phi : Cc cht kh v cc thuc bay hoi
- Tim tu sng : Tim vo khoang dui nhn hoc ngoi mng cng ...
Cu 3 : Phn phi thuc trong co th v nghia
Bi lm
C nhiu yu t nh hung dn phn phi thuc trong co th
- V pha co th : Phu thuc vo tnh cht mng t bo, noi mach mu nhiu hay t v d pH ca
mi trung
- V pha thuc : Phu thuc vo phn t luong, d tan trong nuc v trong lipid, tnh acid hay
base, d ion ho, i luc ca thuc vi receptor
1. Gn thuc vo protein huyt tuong
- Sau khi thuc hp thu : Thuc qua mu chuyn ti noi c tc dung, thuc vo mu tn tai hai
dang
+ Dang kt hop vi protein huyt tuong
+ Dang tu do
- nghia :
+ Khi dang kt hop thuc chua ngm qua mng v chua c hoat tnh, ch dang tu do thuc mi
c tc dung v dc tnh
+ Protein l kho du tr thuc, phc hop thuc-protein ko di su c mt thuc trong mu l
ngun cung cp thung xuyn dang tu do, tc dung ko di ca thuc
+ Do duoc gn vo protein huyt tuong nn tnh ho tan ca thuc tng ln
+ Nu hai thuc c i luc vi nhng noi ging nhau protein huyt tuong chng s di khng canh
tranh nn phn tu do ca thuc tng do d tc dung duoc l v dc tnh tng, luu trong phi hop
thuc khi diu tri
2. Receptor ( Rp )
- Thuc khng th phn ng moi noi trong co th thuc cn kt hop vi Rp d pht huy hoat tnh
hoc d km hm hoat tnh ca cht khc
- C 2 loai cht tao phc vi Rp
+ Cht ch vn : Tao phc vi Rp l khu du tin gy lung kch thch qua d pht huy tc dung
+ Cht di khng :
Tc dng ln cng mt noi ca Rp vi cht ch vn ( di khng canh tranh )
Tc dng ln mt noi Rp, khc vi cht ch vn, bin Rp thnh cht di dang, hu qu l cht ch
vn khng kt hop duoc ( di khng khng canh tranh )
3. Hng ro thn kinh
- Thuc phi vuot qua 3 hng ro
+ Hng ro mu-no : Tao bi mach mu v t bo tk dm, thuc tan nhiu trong lipid d thm,
thuc tan trong nuc kh thm
+ Hng ro mu-mng mach : tuong tu nhu trn
+ Hng ro DNT-no : Thuc hp thu bng khuych tn thu dng
4. Phn phi theo nhau thai
- Luu luong mu tun hon rau thai v mu me rt cao, phn phi thuc thung c tnh chon loc
cho qua cc cht c trong luong phn t thp, cht acid, gy nh hung ti thai nhi do d thn
trong khi dng thuc cho phu n mang thai
Cu 4 : Chuyn ho thuc trong co th, nghia thuc tin
Bi lm
Chuyn ho thuc trong co th chia lm 2 pha
1. Pha I
- L nhng phn ng oxy ho kh hay thu phn
- Phn ng oxy ho kh
+ L phn ng ph bin nht xc tc bi nhiu enzym c trong ty th gan, din hnh l Cyt-P450 ,
phn ng di hi nhiu nng luong
Cyt-P450
-H + NADPH + H+ + 2 --------------- -H + NADP+ + H2
+ Cc thuc lm tng cm ng enzym Cyt-P450 s tng phn ng oxy ho thuc, lm gim tc
dung , nguoc lai thuc lm c ch enzym Cyt-P450 lm gim phn ng oxy ho gy tng tc dung
v dc tnh ca thuc
- Phn ng thu phn
+ Cc ester ( procain, aspirin , succinylcholin...)
R1CR2 ----- R1CH + R2H
+ Cc amid ( procainamid, lidocain, indomethacin)
RCNHR1 ----- R-CH + R1NH2
- Phn ng kh
+ Kh hoat tnh ca cc ester, amid xc tc l cc esterase, amidase
RN2 ---- RN ---- RNHH ---- RNH2
- nghia
+ a s cc thuc bi kh hoat tnh gan, do d han ch dng thuc cho bnh nhn bi bnh gan
+ Chc nng gan c lin quan dn qu trnh chuyn ho thuc do d phi h tro chc nng gan
trong qu trnh diu tri
+ a s cc phn ng kh dc du cn oxy do d cn duy tr tun hon, h hp v chuyn ho
trong trung hop nhim dc thuc
2. Pha II
- L cc phn ng kin hop, sau khi ging ho th cht mi duoc tao thnh s kt hop vi acid
acetic, suluric, mercapturic... tao thnh cht lin hop t tan trong lipid d do thi qua thn v
mt
- Phn ng lin hop pha II gm
+ Lin hop vi acid acetic : Thuc c gc amin bc I, sulmid...tao tinh th sc canh c th gy tn
thuong b my tit niu
+ Lin hop vi acid Glucuronic : xc tc l DPglucuronyltranerase c gan, dang kt hop ny
tan trong nuc nn thi tr nhanh qua thn v mt do d c tnh gii dc cho co th
Cu 5 : Thi tr thuc qua gan v thn , nghia
Bi Lm
1. Thi tr qua thn
- Phn ln cc thuc tan trong nuc duoc thi tr qua thn
- Qu trnh thi tr
+ Loc thu dng qua cu thn : L qu trnh vn chuyn thu dng thuc dang tu do khng gn
vi protein huyt tuong
+ Bi tit tch cuc qua ng thn : L qu trnh vn chuyn tch cuc xy ra ch yu ng luon gn
+ Khuych tn thu dng qua ng thn : Hp thu mt phn thuc thi tr nuc tiu du d l cc
thuc tan trong lipid, khng bi ion ho pH nuc tiu, cc base yu khng duoc hp thu, xy ra
ch yu ng luon gn v xa v phu thuc vo pH nuc tiu
- nghia :
+ Lm gim thi tr d tit kim thuc : Tng tc dung ca thuc v tng hiu qu diu tri
+ Tng thi tr d diu tri ng dc : Thuc c tnh acid mun tng thi tr phi tng pH mu ,
thuc c tnh base mun tng thi tr phi gim pH mu
+ Theo di chc nng thn
2. Thi tr qua gan
- Sau khi chuyn ho gan dang lin hop vi acid glucuronic thuc duoc thi tr qua mt xung
rut sau d duoc ti hp thu v gan qua dung tinh mach ca ( chu trnh gan-rut )
- nghia
+ Nhng thuc ny tch lu trong co th lm ko di tc T1/2- ca thuc huyt tuong do d ko
di thi gian dung ca thuc
Cu : Cc tc dung ca thuc ( chnh - phu, tai ch - ton thn ), nghia
Bi lm
1. Tc dung tai ch - ton thn
- Tc dung tai ch
+ L tc dung ngay tai noi thuc tip xc, khi thuc chua duoc hp thu vo mu, thuc bi ngoi
da
+ V du thuc boc nim mac dung tiu ho
- Tc dung ton thn
+ L thuc c tc dung ton thn sau khi thuc duoc hp thu vo mu qua dung h hp, tiu ho
hay tim
+ V du : thuc m, tro tim hay loi niu
- nghia
+ Hai tc dung trn ch mang tnh cht tuong di v nu dng qu liu th s dn ti mt tc dung
khc d l tc dung ton thn
2. Tc dung chnh - phu
- Tc dung chnh : L tc dung diu tri
- Tc dung phu : Ngoi tc dung chnh th thuc cn c cc tc dung phu khng c nghia trong
diu tri goi l tc dung khng mong mun, n gy cm gic kh chiu cho ngui bnh dc hai cho
co th nhu gim huyt p, xut huyt tiu ho, gim bach cu hay suy gim h thng min
dich ...
- nghia
+ Nm duoc cc tc dung khng mong mun ca thuc d c cc chon lua thuc trong diu tri hay
d phi hop cc loai thuc nhm dat hiu qu cao nht trong diu tri v gim duoc cc tc dung
khng mong mun
Cu : Cc tc dung phi hop ( hip dng cng - tng mc ) , nghia
Bi lm
1. Tc dung hip dng cng
- Thuc A c tc dung a , Thuc B c tc dung b, khi phi hop thuc A v B th c tc dung l c
- Nu c a + b th thuc A v B c tc dung hip dng cng
- nghia : Phi hop cc thuc trong diu tri , muc dch v tng hiu qu dng thuc trong diu tri
v nht l d gim t l khng thuc v gim tc dung khng mong mun
2. Tc dung hip dng vuot mc
- Nu phi hop thuc A v B c tc dung c a + b th hai thuc trn c tc dung vuot mc ch
khng ch l cc tc dung hip dng thng thung
- nghia : y l nguyn tc tao nn cng thc khng khun hoc chng st rt c hiu qu cao,
c nghia trong cng tc diu tri nhu
+ bactrim (biseptol, cotrioxazol) sulamethoxazol + trimethoprim
+ ansida suladoxin + pyrimethamin
Cu : Cc co ch tc dung ch yu ca thuc
Bi lm
1. Receptor ( Rp )
- L mt thnh phn dai phn t tn tai mt luong gii han trong cc t bo dch, c th nhn bit
mt cc dc hiu ch mt phn t "thng tin" tu nhin ( hormon, cht dn truyn thn kinh ) hoc
mt tc nhn ngoai lai ( cht ho hoc, thuc ) d gy ra mt tc dung sinh hoc dc hiu
- Rp c hai chc phn
+ Nhn bit cc phn t thng tin bng su gn dc hiu cc phn t ny vo Rp bng cc lin kt
ho hoc, lk ion, lk hydro, lk Vanderaals , lk cng ho tri
+ Chuyn tc dung tuong h gia phn t gn v Rp thnh mt tn hiu d gy ra mt dp ng t
bo
- Thuc gn vo Rp phu thuc vo i luc ca thuc v Rp, tc dung ca thuc l do hiu luc ca
thuc trn Rp d
2. Co ch tc dung thng qua Rp
- Thuc tc dung truc tip trn cc Rp ca cht ni sinh, thung mang tnh dc hiu
- Nu thuc gn vo Rp c tc dung ging cht ni sinh th goi l cht ch vn
- Nu thuc gn vo Rp c tc dung khng ging cht ni sinh hay ngn cn cht ni sinh gn vo
cc Rp gy c ch cht dng vn goi l cht di khng
- Bn cht ca Rp thuc
+ Cc enzym chuyn ho hoc diu ho cc qu trnh sinh ho c th bi thuc c ch hay hoat
ho
+ Cc ion : Thuc gn vo cc knh ion lm thay di su vn chuyn ion qua cc mng t bo ngn
cn su kh cuc mng t bo
3. Co ch tc dung khng thng qua Rp
- Thuc c tc dung khng cn kt hop vi cc Rp
- Thuc c tc dung thng qua tnh cht l ho, khng dc hiu
+ Cc mui cha cc ion kh hp thu qua mng sinh hoc c tc dung ko nuc t ngoi gian bo
vo lng mach
+ Thuc c tc dung lm tng p luc thm thu trong huyt tuong, khi loc qua cu thn khng bi
THT ng thn do d lm tng p luc thm thu ng thn c tc dung loi niu
+ Than hoat tnh hp thu cc hoi, dc t nn dng cha dy bung v gii dc
+ Cc base yu l trung ho dich vi acid da dy
- Thuc c cu trc tuong tu nhng cht sinh ho bnh thung thm nhp vo cu trc t bo lm
thay di chc phn cc t bo tc dung km hm su pht trin cc t bo ung thu , chng virus..
Cu : Cc yu t nh hung dn tc dung ca thuc ( cu trc, tc dung, dc dim ca ngui
bnh v tui v gii )
Bi lm
1. V thuc
a) Thay di cu trc lm thay di duoc luc hoc ca thuc
+ Thuc + Rp Thuc-Rp Rp c tc dung duoc l
+ Rp mang tnh dc hiu nn thuc phi cng phi c cu trc dc hiu vi Rp su thay di nh
v cu trc thuc gy thay di ln v tc dung
- Tng hop thuc mi nhm
+ Lm tng tc dung diu tri v gim tc dung khng mong mun
+ Lm thay di tc dung duoc l
+ Lm thuc tr thnh cht di khng tc dung
+ Cc dng phn quang hoc hay dng phn hnh hoc thuc cng lm thay di cung d tc dung
hay lm thay di hon ton tc dung ca thuc
+ Sn xut thuc dc hiu gn vo cc dui typ ca cc Rp
b) Thay di cu trc lm thay di duoc dng hoc ca thuc
- Cu trc thuc thay di lm tnh cht l ho ca thuc thay di nh hung dn d tan ca thuc
trong nuc hay lipid, dn su gn thuc vo protein, d ion ho ca thuc v d bn vng ca
thuc
c) Dang thuc
- Trang thi ca duoc cht
+ tn : nh, min, din tip xc tng nn hp thu nhanh
+ Dang v dinh hnh v tinh th : d tan v d hp thu
- T duoc
+ nh hung dn d ho tan v khuych tn ca thuc
- Ki thut bo ch v dang thuc
+ nh hung dn Hoat tnh ca thuc duoc bn vng
Duoc cht duoc gii phng vi tc d n dinh
Duoc cht duoc gii phng tai noi cn tc dung
Thuc c sinh kh dung cao
3. V ngui dng thuc
a) c dim v tui ( tr em )
+ Su gn thuc vo protein huyt tuong cn t , thuc dy bilirubin khi phc hop protein-bilirubin
gy ng dc bilirubin
+ H enzym chuyn ho thuc chua dy d
+ H thi tr thuc chua pht trin
+ H TK, h thng hng ro mu no chua pht trin nn nhay cm v thuc d ngm qua
+ T bo cha nhiu nuc nn khng chiu duoc thuc gy mt nuc
+ M v co quan dang pht trin nn thn trong khi dng thuc
b) c dim v gii ( n )
- Thi k c kinh nguyt : Ch dng thuc khi vo thi k
- Thi k mang thai :
+ 3 thng du d gy di tt bm sinh
+ 3 thng gia nh hung xu dn su pht trin ca bo thai chc phn pht trin cc co quan
+ 3 thng cui : c th gy sy thai hay d non
- Thi k cho con b
+ Nhiu thuc thi tr qua sa gy dc cho con
THC C CH THN KINH TRNG NG
Cu 10 : Thuc t Novocain
Bi lm
- Thuc dc bng B , tng hop
- L thuc t mang dung ni ester, tan trong nuc
- Khng thm qua nim mac, khng lm co mach, nhung c tc dung phong ta hach nn lm gin
mach v ha huyt p , khi gy t nn phi hop vi adrenalin lm co mach tng thi gian gy t
- Dng lm thuc gy t dn truyn, dung dich 1 - 2 v khng qu 3mg/kg cn nng
- c tnh : di ng, co git c ch thn kinh trung uong
Cu 11 : Thuc ng Barbiturat ( tc dung, ch dinh )
Bl lm
1. Tc dung duoc l
- Trn thn kinh
+ c ch TKT ,
+ An thn : chng co git, dng kinh do lm gim tnh kch thch ca v no
+ Vi liu gy m, barbiturat c ch tu sng, lm gim phn xa da synap v c th lm gim p
luc DNT khi dng liu cao
- Trn h h hp
+ c ch truc tip trung khu h hp hnh no nn lm gim bin d v tn s nhip th, gim s
dung 2 no, gy ho ht hoi, co tht thanh qun , liu cao gy hu hoai trung khu h hp lm
gim dp ng vi C2,
- Trn h thng tun hon
+ Vi liu gy ng t nh hung dn h thng tun hon
+ liu gy m thuc lm gim luu luong tim v ha HA
+ liu dc gy c ch tim
2. Ch dinh
- An thn
- Chng co git
- Gy ng, tin m
- Gin co, gim dau do co tht
- Chng dng kinh ( trnh dng vi cc thuc c ch h TKT )
Cu 12 : Morphin (duoc dng hoc, tc dung, co ch, ch dinh )
Bi lm
1. Duoc dng hoc
- Hp thu
+ D hp thu qua dung tiu ho, ch yu t trng , hp thu nhanh qua dung tim dui da hay
bp
- Phn phi
+ huyt tuong 1/3 duoc gn vi protein,thuc phn phi hu ht cc m ( gan, lch, thn,
phi.. ) vi tr tc dung ch yu h TKT, qua hng ro mu no v nhau thai tham gia vo chu
trnh gan-rut
- Chuyn ho
+ gan lin hop vi acid glucuronic v kh N-metyl, T1/2 khong 2-3 h
- Thi tr
+ Bi tit ch yu qua thn dang 3-glucuronid-morphin
+ Thi gian bn thi t 2,5-3h
+ Mt phn nh bi tit qua mt , m hi, nuc bot, sa me, da dy ..
2. Tc dung duoc l v co ch tc dung
a) Tc dung gim dau
- Gim dau c tnh chon loc, tng ngung nhn cm vi dau, khng gy ri loan tri gic, loai tr
duoc moi cm gic gy dau
- c ch xung dng dau mang tnh tch hop trn cu trc TKT
- Ch yu vi cc con dau su, khng c hay t tc dung vi con dau nh hay nng
b) Co ch
- Do kt hop vi cc loai Rp
+ Rp ( muy) : gim dau, gim h hp, co dng t, lin quan dn cm xc
+ Rp ( kappa) : gim dau, xc cm, an thn
+ Rp ( delta ) : gn chon loc vi enkephalin tham gia vo tc dung gim dau
+ Rp ( sigma ) : t lin quan ti diu tri, gin tip tc dung dn nhn thc, tm thn v vn
dng
- Khi Morphin gn v Rp th
+ c ch dn truyn cm gic dau
+ Lm tng ngung dau, thay di tnh cht dau v trang thi tm l bnh nhn
+ Gim gii phng cht dn truyn trung gian
+ c ch cc Rp vng sau synp
+ Lm mt tc dung gy dau ca cht P
+ Lm m knh K+, thay di su gn v thu hi Ca2+ vo ngon dy tk lm thay di su dn truyn
ca dy tk
b) Tc dung gy ng
- Liu cao gy gim hoat dng tinh thn v gy ng
- Liu thp gy bn chn mt ng
- Trn h TKT c tc dung c ch
c) Tc dung gy sng khoi
- Liu diu tri gy cm gic sng khoi d chiu
+ Tng cung cm gic duong tnh : tng hoat dng cc co quan tnh gic, xc gic
+ Cm gic m tnh : lo u cng thng so hi
d) Tc dung c ch h hp
- liu diu tri : tc dung truc tip ln trung khu h hp gy c ch h hp
- liu cao : c ch manh trung khu h hp v tn s v bin d, nhay cm vi thai nhi, tr em,
- Co ch : Gim d nhay ca trung khu h hp vi nng d C2 trong mu ( kch thch Rp )
e) Tc dung c ch ho
- Tc dung c ch trung khu gy ho
g) Tc dung khc
- Tc dung trn vng dui di : mt thng bng, diu ha nhit
- Tc dung trn ni tit : c ch gii phng Hormon hung sinh duc, v thuong thn
- Tc dung trn co tron : Gim nhu dng rut, co co vng gy b di, co co kh ph qun
- Gy nn liu diu tri , liu cao th c ch trung khu nn
- Co dng t : kch thch dy III
- Tng phn xa tu
- Tc dung trn tim mach : chm mach do kt dy v gii phng Histamin, liu cao gy ha HA
- Tc dung trn bi tit : gim tit dich mt , tu, da dy, m hi ...
- Tc dung trn chuyn ho : gim oxy ho gy tch lu acid, ph
- Tc dung trn da : gy dn mach da, gy nga
3. Ch dinh
- Gim dau di vi nhng con dau ln, d di, hay cc thuc gim dau khc khng c tc dung
- au sau phu thut, ung thu giai doan cui ( khng dng qu ngy )
- Tin m
- Ph phi cp th nhe v va
- Gim ho
- Chng di lng
4. Chng ch dinh
- au bung ngoai khoa cp chua chn don xc dinh r nguyn nhn
- Chn thuong so no, nguy co gim HA, tng p luc ni so, co git
- Suy h hp, hen ph qun
- Tr em 5 tui, phu n c thai hay dang cho con b
- Ng dc ruou, thuc ng Barbiturat, C v cc thuc c ch h hp khc
- Chng ch dinh tuong di vi bnh gan v thn man tnh
Cu 13 : Cc dn cht tng hop thay th Morphin
Bi Lm
1. Pethidin ( Meperidin, Dolosal, Dolacgan )
- Tc dung : gim dau, an thn, c ch h hp, co co tron, t gy nn, ha HA, tng luu luong tim
lm tim dp nhanh
- Tc dung phu : t dc hon morphin, bun nn, nn, c th c tc dung trn h TKT
- Duoc dng hoc : D hp thu qua cc dung dng, sau khi ung 50 thuc thi qua chuyn ho
tai gan, T1/2 3h , gn vi protein khong 0
- Ch dinh : gim dau, tin m, liu luong ung/0,05g/ln dng 2-3 ln/ngy , tim bp 1ml(1)
0,05g/ln tim 3ln/ngy
- Chng ch dinh : nhu Morphin
2. Loperamid ( Altocel, Imodium, Lopemid )
- Tc dung : t tc dung trn h thn kinh trung uong, lm gim nhu dng rut, gim tit dich
dung tiu ho tng truong , tng truong luc co tht hu mn, tng vn chuyn dich v cht din
gii qua nim mac rut lm gim su mt nuc v din gii
- Tc dung phu : To bn, dau bung, bun nn, mt mi, chng mt, nhc du ...
- Duoc dng hoc : Hp thu 40 qua dung tiu ho, thuc gn vi protein huyt tuong, T1/2
-14h, thi tr qua phn, nuc tiu dui dang d chuyn ho ( 30-40) v cn hoat tnh
- Ch dinh : iu tri a chy cp v man
- Chng ch dinh :
+ a chy c kt hop vim rut kt c mng gi , trung bung
+ Hi chng phn ly
+ Tn thuong gan, tr em dui tui
3. Methadon ( Dolophin, Amidon, Phenadon )
- Tc dung : Tuong tu morphin nhung nhanh hon v ko di hon,gim dau manh hon pethidin t
gy to bn nhung gy bun nn v nn
- Tc dung phu : Gy tng tit m hi, tng BC lympho, tng protein mu
- Duoc dng hoc : Hp thu tt qua dung tiu ho, 0 gn vi protein, chuyn ho qua gan v
thi tr theo nuc tiu v mt , T1/2 15-40h
- Ch dinh : Dng d gim dau v cai nghin morphin, herpin
4. entanyl ( Sublimaze, etanest, Leptanal )
- Tc dung : gim dau manh gp 100 ln morphin, tc dung nhanh sau 3-5' tim IV ko di 1-2 h
- Duoc dng hoc : Tim IM hay IV, 0 thuc gn vi protein huyt tuong , phn b mt phn
trong DNT, rau thai v sa . Thuc chuyn ho tai gan v mt hoat tnh, thi tr qua nuc tiu
- Tc dung phu :
+ Ton thn : chng mt, n ln, o gic ...
+ Tiu ho : bun nn, nn, to bn, co tht ti mt...
+ Tun hon : chm nhip tim, ha HA thong qua, dnh trng nguc hi hp
+ H hp : th nhanh, suy h hp, ngat th
+ Co xuong : Co cng co lng nguc, git rung
+ Mt : co dng t
- Ch dinh
+ Gim dau trong v sau phu thut
+ Phi hop vi droperidol d gim dau v an thn
+ Phi hop trong gy m
- Chng ch dinh
+ Cc trung hop dau nhe
+ Nhuoc co
+ Thn trong trong cc bnh phi man, CTSN v tng p luc ni so , bnh tim ...
5. Propoxyphen
- Tc dung : gim dau km
- Duoc dng hoc : sau ung 1-2h dat Cmax trong mu, chuyn ho ch yu tai gan , T1/2 -12h ,
- Tc dung phu : Gy c ch h hp, co git, hoang tung v o gic, dc vi tim
- Ch dinh : gim dau nhe v trung bnh, phi hop vi aspirin hay acetaminophen
. Cc opioid c tc dung hn hop ( Pentazocin )
- Tc dung : An thn, gim dau v c ch h hp, liu cao lm tng HA v nhip tim
- Duoc dng hoc : D hp thu qua dung tiu ho, sau 1-3h dat Cmax trong mu, T1/2 4-5h ,
thuc chuyn ho ln 1 tai gan nn ch c 20 vo vng tun hon, thuc qua duoc hng ro rau
thai
- Tc dung phu : an thn, v m hi, chng mt, bun nn v nn, c ch h hp liu cao
- Ch dinh : Trong con dau nng, man tnh, hoc cc thuc gim dau khc khng c tc dung
Cu 14 : Benzodiazepin ( tc dung, ch dinh )
Bi lm
1. Tc dung
- Trn h TKT : c ch dc bit trn h thng lui hoat ho di thi, h vin v tu sng, do d
+ C tc dung an thn gii lo, lm gim xc cm qu mc, gim lo u bn chn , trang thi hung
hn cng thng thn kinh
+ Gy ng, tao cho gic ng dn nhanh khng c tc dung gy t
+ Chng co git, gim truong luc co
- Tc dung ngoai bin
+ Gin mach vnh khi tim IV
+ Liu cao phong to thn kinh co
- Co ch
+ BZD gn vi cc Rp dc hiu vi n trn h thng TKT, bnh thung khi khng c BDZ cc Rp
ca BZD bi mt protein ni sinh chim gi GABA khng gn duoc vo Rp ca h GABA-ergic
knh Cl- ca neuron bi dng lai. Khi c mt BZD dy protein ni sinh v chim Rp GABA gn
vo Rp ca n m knh Cl- Cl- di t ngoi vo trong t bo gy uu cuc ho
2. Tc dung khng mong mun
- Gim tr nh
- Bn chn lo lng, o gic, tim dp nhanh
3. Ch dinh
- An thn
- Gy ng
- Chng co gt, tin m
- Gin co, gim dau do co tht
- Chng dng kinh
Cu 15 : Thuc an thn ch yu dn xut ca phenothiazin ( tc dung, ch dinh )
Bi lm
Clopromazin ( Largactil , Plegomazin , Aminazin )
1. Tc dung duoc l
- Trn h TKT
+ Gy trang thi th o v tm thn vn dng, khng c tc dung gy ng,
+ Gim cm gic thao cung vt v
+ Gy hi chng ngoi b thp ~ Parkison, dng tc cng do, tng truong luc co
+ Gim thn nhit do c ch trung khu diu nhit
+ Chng nn do c ch trung khu nn sn no tht IV
+ c ch trung tm truong luc giao cm diu ho vn mach
+ Vn dng : liu cao gy gi nguyn tu th
- Trn h thng TKTV
+ Tc dung hu Z' : dn dng t, to bn, gim tit dich, nuc bot, m hi..
+ Tc dung phong to Rp d1 adrenergic ngoai bin
- Trn h ni tit
+ Lm tng tit prolactin gy chy sa v chng v to dn ng
+ Lm gim tit SH v LH gy c ch phng non v mt kinh
- Tc dung khng H1 : yu
2. Ch dinh
- Loan thn kinh, tm thn phn lit, thao cung, hoang tung v o gic
- Sn git
- Tin m, gy m ha thn nhit, ha HA
- Chng nn, chng dau, an thn, chng rung tim ,chng nga
Cu 1 : Thuc an thn dn xut ca Butirophenol ( tc dung, ch dinh )
Bi lm
Haloperidol
1. Tc dung duoc l
- c ch cc phn xa tu nhin v phn xa c diu kin
- c ch trang thi kch thch tm thn vn dng , c ch manh thao cung
- c ch manh hoang tung
- Lm mt o gic nhanh
- Tc dung an thn chng lo u vi liu thp
- Khng c hay t tc dung hu Z v gy ng do khng gn vo Rp d1 v H1
2. Ch dinh
- Cc trang thi thao cung hoang tung
- Cc trang thi hong loan tm thn cp v man tnh, tm thn phn lp
- Chng nn, nn do thuc chng K hay sau chiu xa
Cu 1 : Co ch tc dung ca thuc ha st - gim dau - chng vim
Bi lm
1. Tc dung gim dau
- Tc dung vi cc chng dau nhe khu tr, dau do vim
- Khng c tc dung vi dau ni tang, khng gy ng, khng gy nghin
- Do lm gim ZPG2d nn cc CVPS gim tnh cm thu ca cc dy cm gic vi cc cht gy
dau
2. Tc dung ha st
- liu 0 CVPS ch lm ha thn nhit trn nhng ngui st do moi nguyn nhn
- Khi VK, dc t ... xm nhp co th kch thch BC sn xut cht gy st ni tai nhu cytokin
( IL1 , IL ), intereron, TNd hoat ho prostaglandin synthetase tng Z PG gy st theo
co ch tng sn nhit v gim thi nhit. Thuc CVPS c ch prostaglandin synthetase Z PG
st do qu trnh thi nhit
- Do khng c tc dung dn nguyn nhn gy st khi thuc bi thi tr st tr lai
3. Tc dung chng vim
- Cc CVPS c tc dung trn hu ht cc loai vim do
- c ch sinh ZPG do c ch cyclooxygenase lm PGE2 v 1d l nhng cht trung gian ho hoc
ca phn ng vim
- Lm bn vng mng lysosom gii phng cc enzym phn gii do d c ch qu trnh vim
- i khng vi cht trung gian ho hoc ca phn ng vim do tranh chp vi co cht ca enzym ,
c ch di chuyn BC, c ch kt hop KN-KT
Cu 1 : Aspirin
Bi lm
1. Tc dung duoc l
- Ha st v gim dau, khng gy ha thn nhit
- Chng vim : ch c tc dung khi dng liu cao
- Tc dung thi tr acid uric : liu thp 1-2g/ngy acid uric qua nuc tiu do bi xut L ,
liu cao 2-3g/ngy di nhiu urat do c ch THT uric LN
- Tc dung trn tiu cu v dng mu :
+ Liu thp 40-325mg/ngy c ch cyclooxygenase ca tiu cu Z thromboxan A2
dng vn tiu cu
+ Liu cao c ch cyclooxygenase ca thnh mach Z PG I2 l cht chng kt dnh v lng
dng tiu cu dng vn tiu cu
- Tc dung trn ng tiu ho : Gy lot da dy do Z PGE l cht kch thch tit cht nhy bo v
nim mac da dy
2. Duoc dng hoc
- Bi ion ho da dy khuych tn qua mng hp thu vo mu 50-0 gn vi protein
huyt tuong, s cn lai phn hu thnh salicylic bi chuyn ho gan, T1/2 ~h thi tr qua
nuc tiu 50/24h
3. c tnh
- Dng lu gy bun nn, tai, nhc du, dic ..
- c ng : ph, my day, mn, hen
- ut huyt da dy
- Ng dc vi liu trn 10g, kch thch h hp lm th nhanh su
4. Liu luong v ch phm
- Acexal, Aspro,Polopirin : vin nn 0,5g ung 1-g/ngy chia lm nhiu ln
- Aspegic : dang mui, 1 lo ~ 0,5g aspirin tim IV hay IM liu 1-4lo/ngy
- Aspirin pH : vin nn cha 0,5g aspirin, dng dung ung, dat Cmax sau h, T1/2 h
Cu 1 : Voltaren ( Dicloenac natri )
Bi lm
- L dn xut ca acid phenylacetic
- Tc dung
+ Chng vim trong vim khp man tnh tuong tu nhu aspirin
+ So vi aspirin tc dung phu trn h tiu ho t hon nhiu
+ i khi gp vim gan vng da
- Duoc dng hoc
+ T1/2 1-2h, nhung thuc tch lu dich bao khp nn tc dung vn gi duoc lu
- Ch phm v liu luong : vin 50-100mg , ung 100-150mg/ngy
Cu 20 : Cc thuc ha st - gim dau - chng vim mi nhm xicam
Bi lm
- L nhm thuc gim vim mi c nhiu uu dim
- Tc dung :
+ Chng vim manh, liu diu tri ch bng 1/ so vi cc thuc th h truc, tc dung dau xut
hin nhanh, na h sau khi ung
- Duoc dng hoc :
+ T1/2 di khong 2-3ngy, dng liu duy nht trong 24h, thuc gn vo protein ti nn d
c nguy co tch lu thuc
+ Thuc t tan trong m nn d thm vo t chc bao khp bi vim, t thm vo m thn kinh nn
gim duoc nhiu tai bin
- Tc dung khng mong mun :
+ Thung nhe v t l thp so vi cc CVPS khc ngay c khi dng thuc ko di
- Ch dinh
+ Dng trong cc trung hop vim man ko di
- Ch phm v liu luong
+ Piroxicam ( eldene ) 10-40mg/ngy : nhiu tai bin nn khng dng
+ Tenoxicam ( Tilcotil ) 20mg/ngy
+ Meloxicam ( Mobic ) ,5-15mg/ngy
Cu 21 : Thuc diu tri bnh Parkinson ( tc dung , ch dinh )
Bi lm
1. Thuc cung h dopaminergic
Levodopa ( l-dopa, Dihydrooxyphenyl alanin, DPA )
- Tc dung duoc l :
+ Chng Parkinson
+ Tc dung ni tit : Gin tip kch thch tuyn yn gim bi tit prolactin
+ Tc dung trn h tim mach : lm tng nhe nhip tim, c th gy loan nhip do kch thch vo Rp
1 ca h Adrenergic
- Tc dung khng mong mun
+ Levodopa khng qua duoc hng ro mu no nn luong dopa v noadrenalin ngoai vi tng cao
gy nn tc dung khng mong mun
+ Ri loan tiu ho : nn, chn n , gim cn
+ ng tc bt thung : ming - lui - mt - cc chi, c , gy
+ Ri loan tm thn : trm cm, l ln, hoang tung
+ Ri loan tim mach : Tut HA, loan nhip, suy tim ...
- Ch dinh
+ Levodopa ( Dopar, Larodopa ) vin 100-250 hay 500mg
Ch dinh nghim ngt, theo di tai BV, ung liu dn, chia lm nhiu ln trong ngy, ung sau
ba n , liu trung bnh 3-3,5g
Ch : Khi dang dng l-dopa, khng nn dng cc thuc c ch IMA do c th gy con HA ,
liu cao B c th lm tc dung ca l-dopa
+ Phi hop Levodopa vi cc thuc phong to dopa decarboxylase
Modopar : vin nang cha 0,g levodopa + 0,015g bensarazid
Sinemet : vin nn 100 v 250 mg cha levodopa + dmethyldopahydrazin hoc carbidopa t l
10/1
Amantadin ( mantadix, Symadin ) vin nang 100 mg / ln x 2 ln /ngy
Bromocriptin: vin nn 2,5mg, vin nang 5mg, liu du 2,5mg x 2ln/ngy, tng dn liu ti da
100mg.ngy
Pergolid ( Permax ) vin 0,05mg, 0,25 mg v 1 mg.
Selegilin ( Eldepryl ) vin 5 mg
2. Thuc hu ph giao cm trung uong
- Tc dung hu Z' dng phi hop vi levodopa
- Nhuoc dim : khng cholinergic ngoai bin lm gin dng t, ming kh, to bn, khng dng
cho ngui nhn p, ph dai tin lit
- Loai thin nhin : Hyoscyamin 0,1-0,5mg, Atropin sulat 0,3-0,mg, Scopolamin 0,25-1mg
- Loai tng hop
+ Trihexylphenidyl (Artan, Parkinan ) vin 2 v 5mg, ung -12mg/ngy chia nhiu ln
+ Dietazin ( Diparcol ) ung 0,05g/ngy , dn ti 0,2 - 1g
+ Procyclindin (Kemadin): 5-20mg/ngy,
+ rphenadrin(Disipal): 150-400mg/ngy
Cu 22 : Thuc chng dng kinh Hydantoin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Phenytoin c tc dung chng moi th dng kinh nht l dng kinh ln nhung khng gy c ch
ton b h thn kinh trung uong
- Khng c hiu luc vi cc con dng kinh nh
- Tc dung trn con co git dng kinh ~ phenolbarbital nhung khng gy an thn v ng
- Tc dung lm n dinh mng t bo thn kinh v co tim nn c tc dung chng loan nhip
2. Tc dung khng mong mun
- Da v nim mac : Vim loi qu sn, mn da, lupus ban d
- Mu : thiu mu HC do thiu acid olic, gim BC
- Tiu ho : con dau bung cp
- Thn kinh : lin quan dn liu 0 , rung git nhn cu, mt phi hop vn dng, ri loan tm thn
- uong : ci xuong hay mm xuong do ri loan chuyn ho VD
3. Ch dinh
- Chng dng kinh cc con ln
- Khng dng trong cc con dng kinh nh khng c con co git
- Phetonyl ( Dihydan, Dilantin ) vin nn 30-100mg, liu du 3-5mg/kg, ng tim 50mg/ml tim
IV 50mg/pht
Cu 23 : Thuc chng trm cm
Bi lm
1. Thuc chng trm cm loai 3 vng
- Trn TKT :
+ Khng gy gi nguyn tu th, khng gy ha thn nhit, dau nhe
+ Ko di tc dung ca barbiturat
+ Khng cholinergic trung uong v ngoai bin
+ Chng co git
+ i khng nhiu tc dung ca reserpin do ngn cn duoc tc dung lm can du tr catecholamin
ca reserpin
- Trn TKTV
+ Tng tc dung ca adrenalin v noradrenalin do c ch thu hi catecholamin
+ i khng tc dung vi cc thuc cung giao cm gin tip do lm tnh thm ca mng soi
truc vi catecholamin
+ Liu cao, c ch trung khu Z gy ha HA, luu luong tim, khng phng tinh
+ Hu Z' lm gin dng t, nhu dng rut
+ Tc dung khng Histamin
- Trn tim mach
+ Liu thp lm HA , liu cao c ch co tim, cung luong tim v HA
+ Chng loan nhip, liu cao gy bloc nhi tht
2. Thuc c ch MonoAminxydase ( IMA )
- Tc dung ha HA, khng dng d 0 HA
+ Dui tc dung ca IMA cc NA du tn cng cc dy Z cao, tc dung theo co ch diu ho
nguoc, c ch hoat tnh ca tyrosin hydroxylase lm ZNA
+ gan cc MA bi c ch tyramin khng bi kh amin s tp trung du mt cc dy Z bi
dopamin oxydase '''' octapamin tranh chp vi NA
+ Khi xung tc xut hin khng gii phng NA m gii phng octopamin khng c tc dung
p
- Tc dung chng dau tht nguc : khng lm gin mach vnh, lm nhu cu s dng 2 ca co
tim
- Ko di tc dung ca barbiturat do IMA c ch microsom gan do d lm chm su ph hu
barbiturat
Cu24 : Thuc diu ho hoat dng tm thn Lithi ?
Bi lm
1. Tc dung
- Tc dung an thn
+ Khng c tc dung trn ngui bnh thung, tc dung ca phenolbarbital, khng tuong tc vi
reserpin
+ i khng vi tc dung kch thn ca imipramin, amphetamin
- Tc dung khc
+ Liu 1-1,5mEq/kg tim IV gy HA, trn co tim lm nhip co bp v chng loan nhip
2. Duoc dng hoc
- ng d hp thu, dat Cmax sau 30-120', khng gn vi protein huyt tuong
- Vo thn, tim d hon vo gan, co, kh qua hng ro mu-no, CDNT ~ 40-50 huyt tuong
- Thi qua thn 5, 40-0 thi trong ngy du, sau d chm dn sau 10-14 ngy
3. Co ch
- Trao di ion qua mng ch yu ca Na+ , K+ v Ca2+
+ K+ gi kh nng cho t bo sn sng kh cuc
+ Na+ thuc hin kh cuc v gii phng nng luong du tr t bo
+ Ca2+ gii phng cht trung gian ho hoc
- Thng qua 4 knh
+ Knh Na+ K+ - ATPase : dy 3Na+ ra v nhp vo 2K+
+ Knh r Na+ : ung tc kch thch lm Na+ vo nhanh
+ Bom trao di Na+ - Na+
+ Bom trao di Na+ - Ca2+ : dy Na+ ra thu Ca2+ vo gii phng cht trung gian ho hoc
- Lithi
+ Thay th cho Na+ knh r Na+ v bom Na+ - Na+ d nhp vo t bo
+ Li+ vo t bo s thay th cho Na+
+ Na+ trong t bo su trao di Na+ - Ca2+
+ Ca2+ tu do trong t bo gii phng cht trung gian ho hoc
4. Ch dinh
- Du phng con tin trin ca bnh hung trm cm
- Kt hop thuc an thn ch yu d 0 con hung cm
- Kt hop thuc chng trm cm d 0 trm cm
5. Chng ch dinh
- Moi suy thn cp v man do cn tr thi tr
- Moi suy tim v ri loan nuc din gii
- Cao huyt p, dng thuc loi niu
- Phu n c thai 3 thng du
- Ngui tr tu km pht trin hay suy yu tuyn gip
. Tc dung phu v dc tnh
- Nhe : kht, nn, chng mt, run tay, di nhiu, ung nhiu, ln cn, ph ...
- Va : Nn, tiu chy, run tay manh, kh nut, chng mt ...
- Nng : Ri loan tri gic, mm co, phn xa v rung git nhn cu, hn m ...
. Liu luong v ch phm
- Lithi carbonat ( Li2C3 ) vin teralit 250mg , mEq
- Lithi gluconat ( Neurothilium ) dung dich ung, ng 5ml 1g lithi gluconat 5 mEq
- Liu du 10 - 15mEq/l/ngy , dn . Duy tr tu CLi mu, ngy 2-3 ln
THC KCH THCH H THN KINH THUC VT
Cu 25 : Thuc kch thch h M-cholin
Bi lm
1. Acetylcholin
- Chuyn ho
+ Acetylcholin duoc Z t cholin v AcetyCoA dui su xc tc ca Cholin-Acetyl-tranerase
+ Sau khi tc dung ln Rp ca h cholinergic mng sau synap th bi bt hoat dui tc dung ca
Cholinesterase
+ Ach l cht trung gian ho hoc ca h Cholinergic c tc dung rt phc tap
- Liu thp 10 g/kg tim IV tc dung ch yu ln hu hach Z'
+ Chm nhip tim, gin mach v ha HA
+ nhu dng rut
+ Gy co tht co tron kh qun
+ Co tht kh qun v tit nuc bot v tuyn m hi
- Liu cao hoc khi h M-cholin bi c ch : tc dung ln cc hach thuc vt, tu thuong thn ( H
N )
+ Lm nhip tim, co mach HA
+ Kch thch h hp thng qua phn xa xoang cnh
+ Hung phn Rp cholin vng dui v v thn no gy tng dng kiu parkinson
- p dung 0 :
+ Ach bi hu nhanh trong co th, tc dung ngn v dt ngt nn t s dung
2. Cc ester cholin khc
- Tc dung
+ Thuc c tc dung ging Ach nhung tc dung di hon v khng bi cholinesterase ph hu
- Ch dinh
+ Bnh nhn p
+ Lm chm nhip tim trong cc trung hop tim nhanh kich pht
+ Vim dng mach
+ To bn, b di sau m
- Thuc
+ Bentanechol (recholin ) : ung 5-30 mg , vin 5-10-25-50 mg , tim dui da 2,5-5 mg x 3-4
ln/ngy
+ Carbachol : ung 0,5-2 mg/ngy , tim dui da 0,5-1 mg/ngy
+ Muscarin
+ Pilocarin ( pilocarpinum ) : nh mt
Cu 2 : Thuc c ch h M-cholin
Bi lm
Atropin ( thuc dc bng A )
1. Tc dung
- L cht di khng tranh chp vi ACh Rp ca h M-cholin, ch liu cao mi thy c tc dung
di khng trn h N-cholin
- Trn mt
+ Lm gin dng t , kh nng diu tit
+ Lm tng nhn p, gin co mi
- Trn tuyn bi tit : tit nuc bot, m hi v dich da dy
- Trn co tron : Hu co tht co tron cc tang rng, nhu dng rut, gin co tron ph qun khi
dang co tht
- Trn trung tm h hp : Kch thch nhe nn c th dng 0 hen
- Tim :
+ Liu thp kch thch dy , chm nhip tim,
+ Liu cao : c ch Rp Muscarinic ca tim gy nhip nhanh
- Mach : Lm dn mach da khng nh hung dn HA
- TKT : c ch hoat tnh cc trung khu dui v, ri loan tin dnh
- Liu cao : gy mach nhanh, gin dng t, lit diu tit mt, xung huyt da v nhit d co th,
kch thch trn no gy thao cung o gic
2. Ch dinh
- Dng lm thuc tin m
- dau do co tht co tron cc tang rng
- Nh mt, soi dy mt hay 0 vim mng mt , gic mac
- 0 nhim dc nm, thuc phong to cholinesterase
- Block nhi tht, tim dp chm do cung Z'
- Bnh v hi chng Parkinson
- Trong cc con hen
3. Chng ch dinh
- Bnh nhn p
- B di do ph tuyn tin lit
4. Ch phm
- Atropin sulat
- Cn thuc Belladon : cha 0,03 alcaloid
- Cao kh Belladol : cha 1,5 alcaloid, ung 10-20mg/ngy x 2 ln/ngy
- Scopolamin
- Homatropin
Cu 2 : Thuc kch thch h N-cholin
Bi lm
1. Tc dung
- Tc dung trn tim mach
+ Pha I : ha HA tam thi
+ Pha II : HA manh
+ Pha III : Ha HA ko di
- Trn h hp : kch thch lm tng bin d v tn s
- Mt : Gin dng t
- H tiu ho : tit dich, nhu dng rut
2. Co ch
- Ban du Nicotin kch thch hach Z', trung tm c ch tim hnh no tim dp chm v ha HA
- Tip theo Nicotin kch thch hach Z, trung tm vn mach tim dp nhanh, HA, nhu dng rut
, Kch thch thuong thn lm tit adrenalin Rp xoang cnh kch thch trung khu h hp
- Sau cng : kit qu do bi kch thch qu mc v ha HA ko di
3. Ch phm
- Nicotin : dc tnh cao, khng dng 0, dng d nghin cu
- Lobelin : l Alcaloid ca Lobelia inlata dng d kch thch h hp
- ititon : l alcaloid ca Themopsis, tc dung ~ Lobelin
Cu 2 : Thuc c ch N-cholin
Bi lm
I. Thuc c ch N-cholin ca hach
1. c dim
- Thuc ngn cn lung xung dng t soi tin hach dn soi hu hach
- Canh tranh vi cc ACh tai Rp mng sau synap tai hach
2. Tc dung
- ng mach nh ( Z ) : gin mach, ha HA
- Tinh mach ( Z ) : gin mach, tr tun hon, cung luong tim
- Tim ( Z' ) : tim dp nhanh
- ng t ( Z' ) : gin
- Rut ( Z' ) : nhu dng v truong luc, gy to bn
- Bng quang ( Z' ) : b tiu tin
- Tuyn nuc bot ( Z' ) : tit, kh ming
3. Tc dung phu
- Ha HA tu th dng, ri loan mach no, mach vnh v tit niu do phong to hach Z
- tit dich, nhu dng rut, kh ming to bn, gin dng t do phong to hach Z'
4. Ch dinh
- Bnh huyt p
- Ha HA diu khin trong phu thut
- Ph phi cp
5. Ch phm
- Tetra-ethyl-amoni ( TEA ) : tim IM 0,25-0,5 g/ln x 1-2 ln/ngy
- Hexametoni : tc dung manh hon TEA 10-20 ln
- Pentametazon ( pendiomid ) : tc dung ko di ~ 0'
- Methioplegium ( aronad )
II. Thuc c ch N-cholin co vn
1. Tc dung
- Ngn lung xung dng thn kinh ti co bn vn dng gin co
- Th tu lit co : Co mi mt, co mt, c, co chi trn, co chi dui, co bung, co lin sun, co honh
- c ch trung khu h hp
- Gin mach, ha HA
2. Ch dinh
- Thuc gin co trong phu thut v cc th thut ngoai khoa
- Sn khoa : m ly thai
- Thuc chng co git
3. Ch phm
- Tranh chp vi ACh bn vn dng : d-Tubocurarin , Galamin
- Tc dng nhu ACh : Succinylcholin ( myorelaxin ) , Dercametaoni bromid
Cu 2 : Thuc cung TCT d v ( adrenalin v noradrenalin )
Bi lm
I. Adrenalin
1. Tc dung ( trn c Rp d v )
- Trn tim mach :
+ Lm tim dp nhanh v manh ( Rp )
+ Lm p luc dt ngt quai ch v xoang cnh, gy phn xa p qua dy herinh v cyon lm
cung dy tim dp chm
+ Co mach mt s vng: mach da v tang ( Rp d )
+ Gin mach co vn v mach phi ( Rp )
Kt qu l lm HAmax nhung HAmin nn HAtb khng tng
- Trn ph qun
+ t c tc dung trn ngui bnh thung nhung lm gin manh trn ngui bi co tht ph qun do
hen
+ Ct con hen nng nhung mt tc dung ln sau
- Trn chuyn ho : hu glycogen gan tao glucose Glc mu , chuyn ho co bn
2. Ch dinh
- Ngng tim dt ngt
- p truc tip vo vt thuong bn ngoi d cm mu
- Trn vi thuc t lm thi gian v hiu luc gy t
2. Ch phm
- Adrenalin chlohydrat : ng 1ml 1mg
II. Noradrenalin
1.Tc dung
- Kch thch trn c Rp d v nhung ch yu trn Rp d1 v t tc dung trn Rp
- Kch thch Rp d nn co mach HA ( max v min ) HAtb
- t tc dung trn Rp nn t nh hung ti nhip tim khng gy phn xa cung ph vi
- Tc dung lu hon Adrenalin nn khng c giai doan HA
- Tc dung trn ph qun yu do c Rp 2
- Tc dung trn dinh dung v chuyn ho km adrenlain
2. Ch dinh
- Cp cu nng HA trong trung hop tru tim mach, sock bng, sock chn thuong
- Liu : ng 1ml 1mg , truyn nh giot IV 1-4 mg/250-500ml dd glucose dng truong , khng
tim SC hay IM do lm co mach ko di, gy hoai t noi tim
3. Ch phm
- Dopamin : ng 200mg/5ml , truyn IV 2-5g/kg/pht
Cu 30 : Thuc c-ng chn lc Rp
Bi lm
1. Metaraminl ! "ramin #
$ c m%ch & t'ng c ()p tim- T*c +,ng : c-ng
- Ch- ./nh : 0ng 1" trng tr-ng h2p gi3m 1" .4t ng4t$ trng 5c6 & ch7n th-8ng
- Thuc :
9 Ti:m ;< 0$= - =mg trng tr-ng h2p c7p c>u
9 Tru?@n ;< +ung +/ch 10mgA1ml
9 C) thB ti:m ;M ha? CC $ ng 1ml D 0$01 g metaraminl (itartrat
E. Fhen?lephrin ! 0e5?nephrin #
Glc hu?Ht 1" 6I +i$ 6hJng m%nh (Kng 0"$ 6hJng 3nh h-Lng .Hn nh/p tim$ 6hJng 6Mch thMch TNTO & 6hJng lm
1$ t*c +,ng c m%ch - T*c +,ng : Ou ti:n tr:n
- Ch- ./nh : 0h- 0ra+renalin
- Thuc :
9 Ti:m ;M =-10 mg
9 Tru?@n ;< 10-1=mgA1000ml +ung +/ch Glc .Png tr-8ng
3. Clni+in ! Catapre55an #
- T*c +,ng
1" ngQn$E tr-Rc 5?nap S TO g? 9 C-Tng Rp
1" l-u l-Ung m*u S nV$ t%ng$ thWn$ m%ch &nh$ +Xn .Hn $ tr-8ng lYc nh/p tim$ g? 9 TuZn hn : [m
gi3m gi3i ph)ng 0" S neurn
9 Ti:u h* : Gi3m (i tiHt n-Rc (t$ m\ hJi$ +/ch &/
9 TNTO : T*c +,ng an thZn$ gi3m .au g? m]t m^i
- Ch- ./nh
9 T'ng 1" thB &_a & n`ng
9 Trng cai nghi]n ma tua
- Chng ch- ./nh
9 C*c tr%ng th*i trZm c3m
- [i@u l-Ung
9 <i:n 0$1=mg$ ung li@u t'ng +Zn tbi c &i:nAng?
Cu 31: Thuc c-ng chn lc Rp
Bi lm
1. C*c t*c +,ng chMnh
E- T*c +,ng giVn phH du3n : c*c nh*nh phH du3n$ .`c (i]t c*c nh*nh phH du3n nh^ c) nhi@u Rp
1" nhanh & m%nhE $ giVn m%ch ce &n$ m%ch nV$ m%ch &nh. ru4t + .) lm - T*c +,ng +Vn m%ch : T*c +,ng l:n
1 $ t'ng tZn 5$ 5>c c ()p$ tc .4 +Xn tru?@n & 6h3 n'ng t-bi m*u ch tim- T*c +,ng tr:n tim : Cng
+a 53? thaiE$ giVn tf cung$ gi3m c thQt$ +gng - T*c +,ng tr:n ce tf cung : C-Tng
E. Ch- ./nh
- ChWm nh/p th-ng hu?:n
- 1en phH du3n
- Ri l%n tuZn hn 6im the h% 1"
- Truj m%ch$ 5u? tim & ch*ng
3. ChH phkm
- ;5prterenl !i5uprel$ aleu+rin$ ..#
- Metaprterenal ! rciprenalin$ metaprel #
- "l(uteral !5al(utaml$ &entlin #
- lth?lephrin !emmrtil#
- l5h5uprin ! +u&a+ilan #
n"+renergicCu 3E : Thuc huo
Bi lm
- T*c +,ng:
9 GiVn m%ch h% hu?Ht *p
- T*c +,ng ph,:
9 pq g? h% hu?Ht *p t- thH .>ng
9 0h/p tim nhanh
9 C .\ng tf
9 0Jn$ -a l^ng
- Ch- ./nh:
9 Cen t'ng hu?Ht *p$ chkn .*n u tuo th-Ung thWn$ .i@u tr/ (]nh Ra?nau+
- C*c thuc & li@u l-Ung
9 0h)m halal6?lamin ! phenh?(enramin$ +i(enamin # : &i:n nang 10mg$ ung E-10 &i:nAng?
9 pXn hu7t imi+arlin ! tlarlin$ phentlamin # : Tlarlin ! Fri5cl$ pi&a5cn # ung ha? ti:m ;M E=-=0mgAng?$
Fhentalamin ! Regitin # ung E0-s0mgAng?
9 Frar5in : ung 1-E0 mgAng?
9 "l6ali+ nhn in+l ! ergtamin$ ergmetrin$ ?him(in # : ergtamin ung s-cmgAng? ha? ti:m CC 0$1-0m= mgAng? $
?him(in =-10 mgAng?
n"+renergicCu 33 : Thuc huo
Bi lm
1. T*c +,ng chMnh :
- 1uo gia c3m
- Tr:n tim : 9 Gi3m nh/p tim
9 Gi3m lYc c ()p cta ce tim
9 Gi3m l-u l-Ung tim
9 Gi3m 5f +,ng hi cta ce tim
- Tr:n 6hM du3n : G? c thQt
- Tr:n chu?Bn h* : >c chH huo gl?cgen & lipi+
- Tr:n ThWn : gi3m tiHt renin$ h% 1" tr:n ng-i c) 1" ca
- T*c +,ng un ./nh mng : ging duini+in gi3m tMnh th7m cta mng tH ( ce tim &bi in natri.
E. Ch- ./nh :
- Cen .au thQt ngYc
- [%n nh/p tim : l%n nh/p + c-ng gia c3m$ nh/p nhanh &J c'n
- T'ng hu?Ht *p.
- C-Tng tu?Hn gi*p.
- Ch>ng .au nfa .Zu ! h4i ch>ng migraine #.
3. Chng ch- ./nh :
- Cu? tim
- Blc6 nhv th7t.
- 0h/p hang chWm.
- 1en phH du3n.
- w*i th* .-Tng.
s. T-8ng t*c thuc :
- C*c thuc g? c3m >ng c*c enr?m$ chu?Bn h* S gan nh- phen?ltin$ rimampin$ phen(ar(ital... 5x lm t'ng chu?Bn h*$
gi3m t*c +,ng cta thuc huo (eta a+renergic
- C*c thuc chng &i:m phi 5teri+ lm gi3m t*c +,ng h% hu?Ht *p cta c*c thuc huo gia c3m (eta .
- 1i]p .\ng &bi c*c thuc ch`n 6:nh calci$ c*c thuc h% hu?Ht *p.
=. ChH phkm :
9 Frpranll ! in+eral$ a&lcar+?l #.
<i:n s0mg & 1c0mg. yng 1E0 mg - 1c0 mg A ng?.
9 zprenll !Tra5icr#
9 "ce(utll ! Cectran #.
9 [a(etall ! Tran+ate #
9 "tenln !Tenrmin#
T1yC C10G 01;qM N1yk0 < 01;qM w{0 Bz
Cu 3s : C*c l%i Culmami+ ! t*c +,ng & ch- ./nh #
Bi lm
[ ch7t tung h2p +Xn hu7t cta Culmanilami+
1. T*c +,ng & ce chH
- [ ch7t 6|m 6hukn
aci+ mlic cta &i 6hukn- >c chH tranh ch7p &bi F"B" trng du* tr|nh
- >c chH h?+rmlat 5?ntheta5e
- Fhu 6h*ng 6hukn r4ng hZu hHt c*c cZu 6hukn & trYc 6hukn Gr!-# $ Gr!9#
E. Fhn l%i
- 17p thu nhanh & th3i tr_ nhanh : Culma+iarin$ Culmamurarn ! Gantri5in # $ Culmamethharl ! Gantanl # $ .%t Cmah 5au E-
sh$ T1AE c-}h$ th3i tr_ ~=AEsh
- [%i h7p thu r7t Mt : Culmaguani+in ! Gani+an # $ 5alar5ulmapiri+in ! Calarp?rin #
- [%i th3i tr_ chWm : Culma+hin ! ana5il #$ T1AE -~ ng?
- [%i +gng t%i ch : Culmacetami+ $ mameni+$ Mt ha? 6h) tan trng n-bc
3. ChH phkm & c*ch +gng
- <i:m .-ng tiHt ni]u
9 Culma+iarin : &i:n nIn 0$=g
9 Culmamethharl ! Gantanl # : &i:n nIn 0$=g
9 Culmamurarn ! Gantri5in # : &i:n nIn 0$=g
9 0g? .Zu ung Eg h s lZn$ ng? 5au 1g h s lZn h =-10 ng?
- 0hiqm 6hukn ti:u h*
9 Culmaguani+in ! Gani+an # : &i:n nIn 0$=g$ ung 3-sgAng?
9 Culma5alarin ! "ralin # : &i:n nIn 0$=g$ ung 3-sgAng?
- pgng (Ji t%i ch
9 B%c Culma+iarin ! Cil&a+en # 10mgAg 6em (Ji
Cu 3= : Fhn l%i 6h*ng 5inh $ ngu?:n tQc chung 6hi 5f +,ng 6h*nh 5inh
Bi [m
;. Fhn l%i 6h*ng 5inh ! c'n c> & c7u trc h* hc #
-lactam1. 0h)m
- Fhn nh)m c*c Fenicilin$
- Fhn nh)m c*c Cephal5prin !thH h] 1$ E$ 3$ s#
E. "mingl?c5i+ : ! Ctreptm?cin$ Gentam?cin$ Nanam?cin$ Cpectinm?cin$ ... #
3. [inc5ami+ : ! [incm?cin$ Clin+am?cin#.
s. Macrli+ : ! lr?thrm?cin $ zlean+m?cin$ Cpiram?cin$ Clarithrm?cin$ ... #.
=. Fhenicl : ! Clramphenicl $ Thiamphenicl#
c. Tetrac?lin: ! Tetrac?clin$ h?tetrac?clin$ ph?c?clin$ Minc?clin#
. Rimam?cin : Rimam?cin $ Rimampin.
}. Nh*ng 5inh .a Fepti+: Fl?m?cin$ Bacitracin.
~. 0h)m tung h2p
- uinln
9 0h)m uinln 6inh .iBn
9 0h)m uinln mbi : r5hacin$ Femlhacin$ mlhacin$ Ciprmlhacin$
- pXn hu7t cta =- 0itr- imi+ar l: ! lag?l $ Metrni+arl #$ Culmanilami+
10 . 0h)m 6h*ng 5inh chng n7m : 0?5tatin$ "mphtericin B$ Gri5emul&in
;;. 0gu?:n tQc +gng thuc 6h*ng 5inh
1. Ch- 5f +,ng 6h*ng 5inh 6hi c) nhiqm 6hukn
E. Chn .ng 6h*ng 5inh
3. Chn +%ng thuc thMch h2p
s. Fh3i 5f +,ng .t li@u.
=. Fh3i 5f +,ng .t thTi gian du? ./nh
c. Cf +,ng 6h*ng 5inh +Y phng h2p la
. Ch- phi h2p 6h*ng 5inh 6hi thWt cZn thiHt
Cu 3 : Cc Penicillin tu nhin v dn xut bn tng hop
Bi lm
I. Penicillin tu nhin
1. Tc dung
+ Cu khun Gr(+) tu cu, lin cu, ph cu v
+ Cu khun Gr(-) : lu cu, mng no cu
+ Truc khun Gr(+) : n vn, than, bach cu, ho g
+ on khun giang mai
Tc dung manh trn cc VK dang giai doan phn chia, t c tc dung trn VK khng giai
doan phn chia, kt hop vi nhm tetracylin v cloramphenicol th tc dung
- Khng tc dung trn truc khun Gr(-) : l, thuong hn v E.coli
- Tu cu tit lactamase
- Truc khun lao v cc loai nm
2. Co ch tc dung
- c ch tao vch VK do thuc tao phc vi tranpeptidase l enzym ni cc peptidoglycan VK
khng tao duoc vch, do d cc thuc km lm tc dung ca KS
3. Ch phm
- Benzylpenicilin ( Penicilin G ) :
- Procain-Penicilin : tc dung ko di
- Benzathin-penicilin : Tc dung ko di 4 tun
- Phenoxypenicilin ( Penicilin V )
II. Cc Penicilin bn tng hop
1. Muc dch
- sc chng d ca thuc vi su ph hu ca penicilinase
- Gi thuc n dinh pH da dy
- M rng ph tc dung khng khun
2. Ch phm
- Cc penicilin khng lactamase ( Penicilin M )
+ Ampicilin, Amoxicilin, Hetacilin : hp thu tt, t gy thch ng dung tiu ho
- Penicilin ph rng
+ Carboxypenicilin (carbennicilin, ticarcilin)
+ reidopenicilin (mezlocilin, azlocilin, piperaclin)
- Penicilin ph tc dung hep
+ Pivmecilinam : tc dung ln E.coli, Salmolella, shigella
Cu 3 : Cc khng sinh c ch lactamase
Bi lm
Tc dung
- L acid clavulanic v sulbactam c tc dung khng sinh yu nhung gn khng hi phuc vi
lactamase v c i luc cao vi lactam
- Phi hop vi khng sinh nhm lactam s lm bn vng v cung hoat tnh ca khng sinh
ny
Ch phm
- Acid clavulanic + Amoxicilin Augmentin : vin nn 250,500mg, lo 500mg
- Acid clavulanic + Ticarcilin Claventin
- Sulbactam + Ampicilin nasyn : vin nn 220mg , ng tim 500-1000mg
- Tazobactam + Piperacilin Zosyn
Cu 3 : Cc Cephalosporin ( tc dung v ch dinh )
Bi lm
- L khng sinh ph rng
1. Th h I : Caalotin, Ceazolin, Cealexin, Ceaclor, Ceadroxil ...
- c dim tc dung
+ Ph tc dung gn ging Ampicilin v Meticilin
+ Khng sinh dit khun Gr(+) manh, truc khun Gr(-), truc khun dung rut ( E.coli, thuong
hn, l ) , cc tu cu tit Penicilinase
- Khng tc dung vi
+ Tu cu vng
+ Virus v vi khun Gr(-) k kh
- Ch dinh
+ Nhim khun m bnh cn chua r
+ Phi hop vi Aminoglycosid
+ Nhim khun do tu cu v vim thn
2. Th h II : Ceamandol, Ceoxitin, Ceuroxim, Zinace ...
- c dim tc dung
+ Ph tc dung manh, hon th h I
+ Tc dung manh vi c lactamase
+ Tc dung dit c vi khun gy bnh dung rut
+ Tc dung dit c vi khun k kh nhung yu
- Ch dinh
+ Nhim khun Gr(-)
+ Nhim khun phi, vng bung
+ Nhim khun tit niu, phu khoa, da
+ Bnh lu d khng Penicilin
3, Th h III : Ceotaxim, Cetriaxon, cetazidim, Suprax
- c dim tc dung
+ Ph rng, qua duoc hng ro mu no
+ Dit VK Gr(+) yu hon th h I
+ Dit VK Gr(-) manh hon th h I v II
+ Dit truc khun rut d khng th h I do tit lactamase
- Ch dinh
+ Cc nhim khun nghim trong
+ Khi VK khng Cephalosporin th h I v II
+ Vim mng no do VK Gr(-)
4. Th h IV : Ceepim bit duoc Maxipim
- Tc dung
+ Manh hon th h III
+ Dit c VK Gr(+) v Gr(-)
- Ch dinh
+ Dng trong vim phi, vim mng no v nhim khun huyt
Cu 40 : Streptomycin ( tc dung, ch dinh v dc tnh )
Bi lm
1. Tc dung
- Gn vo tiu phn 30S ca ribosom VK doc sai m mARN Z bi gin doan
- Ph tc dung
+ VK Gr(+) : tu cu, ph cu, lin cu
+ VK Gr(-) : Salmonella, Shigella, Haemophilus...
+ on khun giang mai
+ L KS chng lao hng du
2. Ch dinh
- iu tri lao : phi hop vi khng sinh khc
- Mt s nhim khun tit niu, dich hach, Brucella : phi hop vi tetracyclin
- Nhim khun huyt do lin cu : phi hop vi penicilin G
3. c tnh
- Gy tn thuong dy VIII ri loan tin dnh v c tai gy chng mt, mt diu ha mt thnh
luc, c th gy tn thuong khng hi phuc
- c cho thn v phn ng qu mn
- Tc dung mm co, c th gy ngng h hp do lit co h hp
- Khng dng cho phu n c thai v ngui nhuoc co
Cu 41 : Cc khng sinh nhm aminoglycosid ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Khng sinh dit khun ph tc dung rng : Gr(+) v Gr(-)
- Ch yu trn vi khun Gr(-) : cu khun, truc khun
- Phi hop vi Penicilin G dit lin cu, do cn tr tao vch VK tao diu kin cho AG thm vo trong
VK dn dch ribosom
- C th tc dung trn don bo, sn dy
2. Tc dung phu
- Gy tn thuong dy VIII ri loan tin dnh v c tai gy chng mt, mt diu ha mt thnh
luc, c th gy tn thuong khng hi phuc
- c cho thn v phn ng qu mn
- Tc dung mm co, c th gy ngng h hp do lit co h hp
- Khng dng cho phu n c thai v ngui nhuoc co
3. Co ch
- AG dit khun, c ch Z VK mc ribosom
- Streptomycin gn vo tiu phn 30S ca ribosom
- Cc aminoglycosid khc gn c vo tiu phn 30S v 50S ca ribosom
4. Ch dinh
- iu tri lao : Streptomycin, Kanamycin
- Mt s nhim khun tit niu, dich hach, Brucella : Gentamycin, Tobramycin
- Nhim khun huyt do lin cu : Gentamycin
- iu tri nhim khun bnh vin : Amikacin
Cu 42 : Cc Lincosamid ( tc dung, ch dinh )
Bi lm
1. Tc dung
- Khng sinh dit khun dng c dung ung v tim
- Co ch : c ch Z protein ca Vk, gn vo tiu phn 50S ca ribosom lm cn tr tao da peptid
2. Tc dung phu
- Vim rut kt mac gi ( dng di ngy ) : di lng, co cng co thnh bung v st
- Gy ri loan tiu ho
- Vim tinh mach, ha HA, vim lui v ri loan vi gic
3. Ch dinh
- Lincomycin : 0 nhim khun Gr(+) : tu cu, lin cu, ph cu
- Clindamycin :
+ Nhim vi khun ki kh m dao, rut
+ Nhim khun khung chu ( Nhim khun sinh duc n )
+ Nhim khun phi
+ Nhim khun huyt
+ Nhim tu cu, lin cu, ph cu
Cu 43 : Erythromycin
Bi lm
1. Tc dung
- Thuc c tc dung km khun, nhung cng c tc dung dit khun trn nhng chng VK nhay
cm vi nng d cao : tu cu, lin cu
- Co ch : Thuc gn vo tiu phn 50S ca ribosom c ch Z protein
+ Co ch tc dung ~ Lincosamid, Macrolid v Cloraphenicol c ch di khng khng dng
phi hop
2. Ch dinh
- Nhim khun h hp, rng - hm - ming, tit niu - sinh duc
- Bnh do Rickettsia, Toxoplasma, vim c t cung, niu dao ...
- Vim m t bo, mach bach huyt, tai-mi-hong, mi mt ...
- Nhim khun ton thn do lu cu
- Di ng do lactam
- iu tri du phng : vim mng trong tim do lin cu, vim khp, vim mng no
3. Ch phm
- Erythromycin estolat, propionat : dung ung
- Erythromycin ethylsuccinat : Tim bp ( IM )
- Erythromycin glucoheptonat : Tim tinh mach ( IV )
Cu 44 : leandomycin v Spiramicin ( tc dung v ch dinh )
Bi lm
1. Tc dung : dit khun
- Cu khun Gr(-), v VK Gr(+),
- Vi khun ki kh, xon khun giang mai v Leptospira
- Cc chng ni bo Mycoplasma, Chlamydia, Rickettsia, Toxoplasma
- Dit Helycobacter pyroly : diu tri vim lot DDHTT
- iu tri VCTC v du phng thp khp cp
- Chng vim nht l trong VPQ v hen d quen glucocorticoid
2. Ch dinh
- leandomycin
+ Nhim khun dung h hp, rng-hm-mt, sinh duc tit niu
+ Cc chng ni bo gy vim c t cung, truc trng, niu dao ...
+ Vim m t bo, mach bach huyt, tai-mi-hong, mi mt ...
+ Nhim khun ton thn do lu cu
+ Vim lot DD-HTT
+ Du phng thp khp cp, vim mng trong tim do lin cu
- Spiramicin
+ Nhim lu cu, ph cu nhng ngui di ng vi lactamin
+ Cha toxoplasma phu n mang thai
+ iu tri du phng cho ngui tip xc vi vim mng no tu
+ Vim xuong khp do tu cu
+ iu tri amip nhung khng c tc dung vi l amip gan
Cu 45 : Chloramphenicol ( Chlorocid ) , tc dung v ch dinh
Bi lm
1. Tc dung
- Ph tc dung rng c VK Gr(-) v Gr(+)
- Rickettsia
- c bit trn VK gy thuong hn
- Co ch : c ch Z protein ca VK do c ch tiu phn 50S ca ribosom
2. c tnh
- Liu cao di ngy gy suy tu
- Gy thiu mu
- Vim dy thn kinh thi gic, ngoai bin, m sng
- Gy phn xa qu mn, m day, phn v
- Hi chng xm : nn, th nhanh, tm xm, ng lim, tru tim mach v t vong
- Ri loan tiu ho
3. Ch dinh
- iu tri thuong hn : phi hop Ampicilin, Amoxicilin, Biseptol
- Nhim khun dung rut
- Nhim rickettsia
- Nhim khun mt v tai
- Vim mng no : phi hop vi cephalosporin th h III
- Nhim khun h TKT : phi hop Penicilin G v Mentronidazon
- Nhim khun Brucella, Tularemia, hoai thu sinh hoi...
Cu 4 : Tetracyclin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Thuc km khun c ph khng khun rng nht hin nay
- Tc dung trn
+ Cu khun Gr(+) v Gr(-) : km penicilin
+ Truc khun Gr(+) i kh v ki kh
+ Truc khun Gr(-), truc khun m xanh t nhay cm
+ on khun , Rickettsia, amip, Trichomonas
- Co ch : Gn vo tiu phn 30S ca ribosom lm ngn cn ARNt chuyn acid amin vo chui
polipeptid
2. Ch dinh
- Nhim Rickettsia
- Nhim Mycoplasma pneumoniae
- Nhim Chlamidia : vim phi, ph qun, vim xoang , mt ht ...
- Bnh ly truyn qua dung tnh duc
- Nhim truc khun : Brucella, t, E.coli
- Trng c
Cu 4 : Riampicin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Dit vi khun lao v phong
- Cu khun Gr(+) : Tu cu vng, tu cu da, lin cu v lu cu
- Vi khun Gr(-), E.coli, truc khun m xanh, Haemophilus inluenzae, Nesseria meningitidis
- Dit c VK trong v ngoi t bo
- Trong mi trung acid tc dung manh gp 5 ln
2. Tc dung khng mong mun
- Pht ban
- Ri loan tiu ho : bun nn v nn
- St
- Ri loan tao mu
- Vng da, vim gan gp ngui c tin s bnh gan, nghin ruou
2. Ch dinh
- iu tri lao v phong
- Ch phm Riampicin ( Riampicin, Rimactan, Riadin ) vin nang hoc vin nn 150-200mg
- Phi hop vi cc thuc chng lao khc khng dng don dc
- Liu 10-20mg/kg x 1ln/ngy, ti da 00mg/24h
- Khng dng thuc ngui suy chc nng gan
Cu 4 : Metronidazol ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Dit amip ngoi rut v amip thnh rut (apxe gan, no, phi, lch )
- iu tri Trichomolas dung niu-sinh duc , bnh do Giardia lamblia v cc VK k kh bt buc
- Co ch : Trong cc VK k kh v dng vt nguyn sinh, 5-Nitro bi kh cht trung gian dc vi
t bo kt hop vi cu trc xon ca AND v cc soi AND cht t bo
2. Tc dung phu
- Tiu chy, bun nn, sn da
- au du, chng mt, bun ng
- Ri loan thn kinh, gy con dng kinh, vim da dy thn kinh ...
- Vim tu , nuc tiu xm mu do cht chuyn ho ca thuc
3. Ch phm v ch dinh
- Metronidazol ; vin nn 250, 500 mg , dich treo Metronidazol benzoat
- L amip cp rut : 50mg, ngy ung 3 ln x 5-10 ngy
- Apxe gan do amip v amip trong cc m : 500-50mg/ln/24h ngy 3 ln x 5-10 ngy , tr em
30-40 mg/kg/24h chia 3 ln x 5-10 ngy
- Nhim Trichomolas vaginalis
- Bnh do Giardia lamblia : 20 mg/ln ngy 3 ln trong 5- ngy , tr em 15mg/kg/24h chia 3
ln dng 5-10 ngy
- Nhim khun k kh, vim mng trong tim, nhim khun toan thn, apxe no, vim mng no c
m, vim lot loi cp v vim chn rng
Cu 52 : Cc thuc diu tri phong
Bi lm
1. DAPSN (DDS)
- Tc dung km khun, khng dit khun
- Co ch : Do c co ch ~ PABA c ch tranh chp vi PABA trong qu trnh Z acid olic , c ch
dihydroolat synthetase
- Ch dinh : Phi hop vi cloazimin hay riampin
2. RIAMPIN
- L khng sinh dit khun phong v lao manh
- Thuc khuych tn vo m thn kinh km nn khng lm triu chng thn kinh do truc khun
phong gy nn
- Ch dinh : Phi hop vi cc thuc 0 phong khc
3. CLAZIMIN
- Tc dung km khun phong
- Co ch : Gn vo AND lm c ch su nhn di ca AND
- Hp thu nhanh v tch lu lu trong m, thi tr qua thn ch yu
- Ch dinh : Phi hop vi DAPSN v RIAMPIN trong diu tri phong
4. Ngoi ra cn c cc thuc khc
- Suloxon : Co ch, tc dung ~ DAPSN
- Thalidomid : Tc dung an thn
- Ethionamid : Tc dung km khun v dit khun, dng thay th cho cloazimin
Cu 53: Phn loai thuc st rt
Bi lm
1. Thuc dit th v tnh trong HC
- Cloroquin (Aralen, Avloclor, Malarivon, Nivaquin )
+ Hiu luc cao vi th v tnh trong HC ca c 4 loi KSTSR, tc dung va phi vi giao bo
P.vivax , P.malariae , P.ovale , khng nh ti giao bo ca P.alciparum
+ Co ch : c ch polymerase lm tch lu heme gy dc lm ly gii KSTSR , c ch AND v
ARNpolymerase ngn cn Z nucleoprotein
- Quinin
+ Tc dung nhanh hiu luc cao vi th v tnh ca c 4 loai, dit duoc giao bo ca P.vivax,
P.malariae , t hiu luc vi P.alciparum
- ansidar
+ Dit th v tnh trong HC ca P.alciparum , yu vi P.vivax, khng nh hung dn giao bo v
giai doan gan ca P.alciparum v P.vivax
+ Co ch : c ch enzym Z acid olic VK khng Z duoc AND v ARN
- Meloquin ( Eloquin, Larianm Mephaquin )
+ Tc dung manh vi th v tnh trong HC ca P.alciparum v P.vivax, nhung khng dit duoc
giao bo ca P.alciparum v th gan ca P.vivax
- Artemisinin v cc dn xut
+ Dit th v tnh ca loai, khng c tc dung trn giai doan gan
- Haloantrin ( Halan )
+ Dit th v tnh ca P.alciparum, khng c tc dung trn giai doan gan, th thoa t
rng v giao bo
2. Thuc dit giao bo ( Primaquin )
- Tc dung tt vi th ngoai HC ban du gan ca P.alciparum v cc th ngoai HC mun ca
P.vivax v P.ovalae
Cu 54 : Cloroquin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Hiu luc cao vi th v tnh trong HC ca c 4 loi KSTSR, tc dung va phi vi giao bo P.vivax
, P.malariae , P.ovale , khng nh ti giao bo ca P.alciparum
- Co ch : c ch polymerase lm tch lu heme gy dc lm ly gii KSTSR , c ch AND v
ARNpolymerase ngn cn Z nucleoprotein
2. Tc dung phu
- Liu 0 : dau du, chng mt, bun nn, dau bung, a chy, ri loan thi gic...
- Liu cao ko di : gy tan mu, thnh luc, nhm ln, bnh gic mac, rung tc, ha HA ..
3. Ch dinh
- Dng diu tri v phng st rt
- Dng trong th SR nhe v va khng dng trong SR nng v c bin chng
- Du phng cho ngui di vo vng SR luu hnh
- Dit amip gan, vim da khp dang thp, lupus ban d
Cu 55 : Quinin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Tc dung nhanh hiu luc cao vi th v tnh ca c 4 loai, dit duoc giao bo ca P.vivax,
P.malariae , t hiu luc vi P.alciparum
- Co ch :
+ c ch polymerase lm tch lu heme gy dc lm ly gii KSTSR , c ch AND v
ARNpolymerase ngn cn Z nucleoprotein
- Kch ng tai ch : kch ng DD gy bun nn, nn
- Tim SC : gy apxe v khun
- Tim IV : gy gin mach, c ch co tim, ha HA,
- Co tron : co bp t cung
2. iu tri
- iu tri SR nng do P.alciparum, v SR c tnh
- Kt hop vi Tetracyclin, asidar...
- Hiu luc km nn khng dng 0 dot cp do P.vivax, P.malariae v P.ovale, khng dng khi
P.alciparum cn nhay cm vi cloroqin
- Ch dinh cho phu n c thai
- t dng d phng bnh
Cu 5 : Primaquin , Quinocid ( tc dung , ch dinh )
Bi lm
1. Tc dung
- Tc dung tt vi th ngoai HC ban du gan ca P.alciparum v cc th ngoai HC mun ca
P.vivax v P.ovalae do d trnh duoc ti pht.
- Thuc dit duoc giao bo ca c 4 th nn c tc dung chng ly lan
2. Tc dung phu
- Liu 0 : dau bung, kh chiu vng thuong vi
- Liu cao : bun nn v nn
- c ch tu xuong gy thiu mu v tan mu
3. Ch dinh
- iu tri st rt do P.vivax v P.ovale
- Phi hop vi cc thuc dit th v tnh trong HC
- iu tri trong cng dng d ct dung lan truyn ca KSTSR, dc bit P.alciparum khng
cloroquin
Cu 5 : Pyrimethamin ( tc dung v ch dinh )
Bi lm
- L thuc phi hop gia Suladoxin 500mg + Pyrimethamin 25 mg
1. Tc dung
- Pyrimethamin l dn xut ca diaminopyrimidin tc dung chm vi cc th v tnh trong HC ca
4 loi KSTSR
- Thuc c ch cc th hu tnh pht trin trong co th mui nn c tc dung ngn chn su lan
truyn SR trong cng dng
2. Ch dinh
- iu tri SR do P.alciparum khng cloroquin
- Phi hop vi Quinin
- Du phng cho ngui di vo vng c dich luu hnh trong thi gian di
3. Chng ch dinh
- Di ng vi thuc, ngui bi bnh mu, gan, thn nng v phu n c thai
- Thn trong khi dng thuc vi phu n cho con b, ngui thiu GPD, hen ph qun
4. Liu luong
- iu tri SR : ung 25mg Suladoxin + 1,25 mg pyrimethamin/kg
- Du phng SR : ung 1 vin/tun hoc 3 vin/thng
Cu 5 : ansidar ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Dit th v tnh trong HC ca P.alciparum , yu vi P.vivax, khng nh hung dn giao bo v
giai doan gan ca P.alciparum v P.vivax
+ Co ch : c ch enzym Z acid olic VK khng Z duoc AND v ARN
2. Ch dinh
- iu tri SR do P.alciparum khng cloroquin
- Phi hop vi Quinin
- Du phng cho ngui di vo vng c dich luu hnh trong thi gian di
3. Chng ch dinh
- Di ng vi thuc, ngui bi bnh mu, gan, thn nng v phu n c thai
- Thn trong khi dng thuc vi phu n cho con b, ngui thiu GPD, hen ph qun
4. Liu luong
- iu tri SR : ung 25mg Suladoxin + 1,25 mg pyrimethamin/kg
- Du phng SR : ung 1 vin/tun hoc 3 vin/thng
Cu 5 : Meloquin ( tc dung v ch dinh )
Bi lm
- L thuc Z dn xut ca 4-quinolin-methanol
1. Tc dung
- Tc dung manh dn th v tnh trong HC ca P.alciparum v P.vivax nhung khng dit duoc giao
bo ca P.alciparum v th gan ca P.vivax
- C hiu qu cao trn cc KST da khng cc thuc SR khc nhu cloroquin, pyrimethamin
2. Tc dung phu
- Liu phng bnh : bun nn, nn, tiu chy, dau du, chng mt
- Liu cao: cc triu chng trn km theo tai, ri loan tri gic, loan tm thn,
3. Ch dinh
- iu tri v du phng SR do P.alciparum khng thuc
- Chng ch dinh
+ Tin s bnh tm thn, dng kinh, loan nhip
+ Tr em 3 thng , ngui suy gan, suy thn
- Thn trong
+ Ngui li xe, vn hnh my mc
+ Phu n c thai, tr em 2 tui
Cu 0 : Artemisinin ( tc dung v ch dinh )
Bi lm
1. Tc dung
- Dit th v tnh trong HC c 4 loi KSTSR, k c P.alciparum khng cloroquin
- Khng c tc dung trn giai doan gan, trn thoa trng v giao bo ca Plasmodium
2. Tc dung phu
- Ri loan tiu ho
- Nhc du chng mt v hoa mt
- Chm nhip tim
3. Ch dinh
- iu tri SR nhe c 4 loi Plasmodium
- iu tri SR nng do P.alciparum da khng thuc hoc SR c tnh
- Liu luong
+ Artemisinin : ngy du 20mg/kg , ngy 2-5 : 10mg/kg
+ Artesunat : ngy du 4mg/kg , ngy 2-5 : 2mg/kg
Cu 2 : Emetin v Dehydroemetin
Bi lm
1. Tc dung
- Dit amip trong cc m, t c tc dung trn amip rut
- Co ch : Cn tr su chuyn dich phn t ARNm doc theo ribosom nn c ch khng phuc hi su
Z protein ca amip
2. Tc dung khng mong mun
- Phn ng tai ch : dau, apxe v trng
- TK co : mt mi, dau co
- Tim : ha HA, nhip tim nhanh v loan nhip
- Tiu ho : Bun nn, nn, dau bung v a chy
3. Ch dinh
- L amip nng
- Apxe gan do amip
Cu 3 : Tc dung diu tri amip v trng roi ca Metronidazol
Bi lm
1. Tc dung
- Dit amip ngoi rut (apxe gan, no, phi... ) v amip thnh rut
- Dit amip th hoat dng nhung t nh hung dn th kn
- Tc dung diu tri Trichpmolas dung niu-sinh duc, bnh do Giardia lamblia v cc VK ki kh bt
buc
- Co ch : Trong cc VK k kh v dng vt nguyn sinh, 5-Nitro bi kh cht trung gian dc vi
t bo kt hop vi cu trc xon ca AND v cc soi AND cht t bo
2. Tc dung phu
- Tiu chy, bun nn, sn da
- au du, chng mt, bun ng
- Ri loan thn kinh, gy con dng kinh, vim da dy thn kinh ...
- Vim tu , nuc tiu xm mu do cht chuyn ho ca thuc
3. Ch phm v ch dinh
- Metronidazol ; vin nn 250, 500 mg , dich treo Metronidazol benzoat
- L amip cp rut : 50mg, ngy ung 3 ln x 5-10 ngy
- Apxe gan do amip v amip trong cc m : 500-50mg/ln/24h ngy 3 ln x 5-10 ngy , tr em
30-40 mg/kg/24h chia 3 ln x 5-10 ngy
- Nhim Trichomolas vaginalis
- Bnh do Giardia lamblia : 20 mg/ln ngy 3 ln trong 5- ngy , tr em 15mg/kg/24h chia 3
ln dng 5-10 ngy
- Nhim khun k kh, vim mng trong tim, nhim khun toan thn, apxe no, vim mng no c
m, vim lot loi cp v vim chn rng
Cu 4 : Thuc ty giun theo co ch lm lit giun
Bi lm
1. Co ch
- Gy uu cuc ho lm co giun dp ng vi acetylcholin c tc dung lm giun lit mm, mt
kh nng bm vo thnh rut nn bi nhu dng rut tng ra ngoi
- Phong b dn truyn thn kinh ca co giun lm co giun co cng mt kh nng bm v bi tng ra
ngoi
2. Ch phm
- Pyrantel pamoat ( Cobantril, Combantrin, Helmex, Helmintox )
- Pipemazin ( Antepar, Vermitox, Pripsen )
- Levam isol (Ergamisol, Solaskil, Ketrax )
- Diethylcarbamazin ( Banocid, Hetrazan, Loxuran, Notezin )
- Ivermectin
Cu 5 : Thuc ty giun theo co ch c ch ngun dinh dung
Bi lm
1. Tc dung
- Hiu qu cao trn cc giai doan trung thnh v u trng ca giun da, kim, tc, mc, m
- Dit duoc trng giun da v mc, nang sn
- Co ch : Thuc lin kt tiu qun KST, c ch su trng hop tiu qun thnh vi tiu qun hp
thu Glc can du tr glycogen, ATP giun bt dng v cht
c ch h umarat reductase dc hiu ty th t bo giun
2. Ch phm
- Mebendazol ( urgaca, Vermox, Mebutar, Nemasole )
- Albendazol ( Albenza, Eskazole, Zeben, Zentel )
- Thiabendazol ( Mintezol )
Cu : Cc thuc diu tri sn
Bi lm
1. Co ch
- Lm tnh thm mng t bo sn vi Ca2+ lm sn co cng v lit, mt tnh bm dnh v bi
tng ra ngoi bi nhu dng rut
- c ch su oxy ho nh hung dn chuyn ho nng luong ca giun sn, c ch thu nhp Glc,
khng bm duoc vo thnh rut v bi dy ra ngoi
2. Ch phm
- Niclosamid ( Cestocida, Yomesan, Tredemine, Niclocide )
- Praziquantel ( Biltricid, Cisticid, Droncit, Cesol )
- Metriornat ( Bilarcil )
- xamniquin ( Mansil, Vansil )