BI TP CC M HNH DC NG HC C BN

Bai 1
Mt thuc c S= 0,85 , F= 0,9 c hp thu nhanh.Nng iu tr t 2-10 ug/ml.
Theo m hnh dc ng 1 ngn v c h s thanh thi l 3,2l/h. Th tch phn b l
48l. Cho bit liu gy tc dng ca thuc ny( liu khi pht ). Bit ta c vin nn
250mg iu ch.
Bai giai:
Ta co :

Th tic h phn b Vd = 48l

thanh thai h th ng: Cl = 3,2 l/h

H ng s t c thai tr Ke = Cl/Vd = 3,2/48 = 0.067 (h)
T = (lnCmax lnCmin)/Ke = ln(10/2)/0.067 = 24 (h)
Ta co: n ng n inh
(Cssmax = (D.S.F)/ Vd. (1 e-ke.t)
D = Cssmax. Vd. (1 e-ke.t)/S.F
= 10.48.(1- e-0.067.24)/0.85.0.9
= 500mg
V y li u dung i vi thu c nay la: 500/250 = 2 (vin nen mi ngay).
Nhom : 1

Ly Hi u Bya
Nng Thi Bin
h
Nguyn An a t

Bi 2
Mt bnh nhn trng thnh (70kg) c nng theophylline di ngng iu tr
(5g/mL) c nhn vo khoa Hi sc cp cu. Da vo cc tham s dc ng
hc bnh qun ( Vd= 0.5L/kg, t1/2=8h), tnh liu ti bolus tnh mch v liu duy tr
(truyn tnh mch) nng nng thuc ln 15g/mL.

Th tch phn b ca c th:

Vd = 0.5(L/kg) x 70(kg) = 35(L)

Liu ti nng nng ln 15g/mL khi c th c sn nng 5g:

LD = Css.Vd = (15-5(g/mL))x35(L) = 350mg
thanh thi ca thuc: Cl = ke x Vd = ln2/t1/2 x Vd =

2
8()

x 35(L) = 3 (L/h)

Liu duy tr : MD = Css x Cl = 15 (g/mL) x 3 (L/h) =45 (mg/h) = 1080 (mg/ngy)

Nhm 2:

Lu M Duyn
L N Khi H
Phm Th H

Bi 3
Mt thuc dng vin nn c S= 0,62 vi sinh kh dng F= 0,7 tun theo m hnh
Dc ng hc mt ngn c h s thanh thi ton phn Cl = 2,5 l/h v th tch phn
b Vd= 50l. Hng s tc hp thu ng ung Ka= 0,4/h. Tnh Tmax, Cmax, AUC
trong trng hp vin nn 250mg c ung?
Tm tt:
S=0,62

F=0,7

Cl= 2,5l/h

Vd= 50l

Ka=0.4/h

D=250mg

Tm Tmax, Cmax, AUC?

Bi gii:
# Lu : Ch thch cc i lng:
Ka: Hng s hp thu
Ke: Hng s thi tr
Cpo: Nng thuc ban u trong mu ti thi im to
Cp: Nng thuc trong mu thi im t
Vd: Th tch phn b
Cl: H s thanh thi
AUC: Din tch di ng cong

Ta c: Ke l Hng s tc thi tr v c tnh theo cng thc:

Ke =

2,5 /
50

= 0,05/h

 Thi gian nng thuc t cc i Tmax:

Tmax =

ln(

0,4
)
0,05

ln(

= 5,94 (h)

0,40,05

Do tn ti cng thc: Cp= Cpo . e-ke.t nn ta c cng thc tnh Nng cc i

Cmax l:
Cmax = Cpo . e-ke.Tmax =

. e-ke.Tmax ( ng tnh mch)

-Trng hp bi ny l ng ung nn:

Cmax =

..

. e-ke.Tmax =

250 . 0,7. 0,62

50

. e-0,05. 5,49 = 1,6 mg/l

Din tch di ng cong:

Cl=

=> AUC=

( ng tnh mch)

-Vi ng ung c sinh kh dng F, h s mui S:

AUC=
Nhm 3:

. .

o Th Hng
Lm Th Hu
Nguyn Th Hin

250. 0,7. 0,62

2,5/

=43,4 (mg.l/h)

Bi 4
Mt bnh nhn nng 80kg c tim bolus tnh mch liu 500mg aminophylline
dihydrate (t l mui theophylline l S=0,8) mi 8h. Gi s rng bnh nhn c cc
thng s dc ng hc trung bnh ca theophylline (Vd= 0,5 L/kg v t1/2 =8h).Hy
d on nng nh v y trng thi n nh.
Tm tt:
Bnh nhn, m=80kg
Tim iv bolus, liu D=500mg, Khong cch a liu =8h.
Vd=0,5L/kg; t1/2= 8h.
Tnh Css_max=?; Css_min=?
Gii:-Th tch phn b trn 80kg th trng bnh nhn:
Vd = 0,5x80 = 40 (L)
-Nng nh trong huyt tng sau khi tim liu bolus 500mg
aminophylline dihydrate vi t l mui theophylline S l:

SxD
C0 =
Vd = 10 mg/L
-Nng nh trng thi n nh :

Css _ max

C0
ln 2
kel * , vi hng s tc thi tr Kel=
1 e
t1/2

Thay cc gi tr c th vo cng thc trn, ta c :

Css_max=

10
1 e

ln 2
x8
8

20 mg/L

-Nng y trng thi n nh:

Css_min= Css _ max .e
Nhm 4:

L Vn Ha Hip
Ng Ch Hiu
Nguyn Th Thanh Ha

kel *

20.e

ln 2
x8
8

10 mg/L

Bi 6
Bng 1 cho thy nng huyt thanh ca mt thuc bit bnh nhn X. Hy ghi
r n v ca thng s Pk.
a) Xc nh qu trnh thi tr l phng trnh bc 1 hay bc 0? V th da trn
d liu c.
b) Tnh Ke, hng s tc thi tr bc 1.
c) Tnh AUC t thi im ban u (t0) n thi im cui cng (tcui) v AUC t
t0 n t
d) Tnh nng thuc X trong huyt thanh ti thi im t=5 (gi).
Thi Gian t
(gi)
0
1
1,5
2
4
6
8
10
12

Nng C (ng/ml)
20
16,37
14,82
13,41
8,99
6,02
4,04
2,71
1,81

Gii:
a) Ta c
Thi Gian t
(gi)
0
1
1,5
2
4
6
8
10

Nng C
(ng/ml)
20
16,37
14,82
13,41
8,99
6,02
4,04
2,71

lnC
2,995
2,795
2,695
2,596
2,196
1,795
1,396
0,996

12

1,81

0,5933

Qu trnh thi tr l qu trnh dc ng hc bc 1 ( th ca lnC theo thi gian

l mt ng thng).

LnC theo T (gi)

3.5
3
2.5
2
1.5
1
0.5
0

lnC

10

15

Nng Thuc C (mg/l) theo Thi

Gian T (gi)
25
20
15
Nng C (mg/ml)

10
5
0
0

10

15

b) Ta c cng thc:
lnC1 - lnC2
2,795 - 2,695
=
t2 - t1
1 - 1.5
Suy ra phng trnh: lnC = 2,995 - 0,2*t
ke =

= -0,2

c) Theo quy tc tnh din tch hnh thang, ta c bng tnh AUC sau:

Thi Gian T
(gi)
0
1
1,5
2
4
6
8
10
12

Nng C
(ng/ml)
20
16,37
14,82
13,41
8,99
6,02
4,04
2,71
1,81

AUC mt
phn
18,19
7,8
7,06
22,39
15,01
10,06
6,74
4,52

AUC (t0 -> cui) = AUC = 91,77 ng*h/ml

AUC (tcui -> ) = Ct=12 /ke = 9,05 ng*h/ml
AUC (t0 -> ) = 91,77 + 9,05 = 100,82 ng*h/ml
d) t = 5h : lnC = 2,995 - 0,2*t
Vy Ct =5 = 7,352 ng/ml
Nhm 6 :

Nguyn Thu Hng

L Hong Cng Huy
Triu Bch Kim

Bi 7
Mt bnh nhn suy gan v mt bnh nhn suy thn cn c iu tr vi mt thuc
chng lon nhp tim mi. Theo nghin cu tm c theo di thng tin t Stopabeat
trn nhm bnh nhn ging nhau qua x l c: ngi bnh thng: h s thanh
thi= 45l/h, th tch phn b= 175l; ngi suy gan: h s thanh thi= 15l/h, th tich
phn b= 300l; ngi suy tim: h s thanh thi= 30l/h, th tch phn b= 100l. Tnh
liu tn cng bng ng tnh mch( LD) v liu duy tr bng ng tnh mch(
MD) t c nng l 10mg/l t hai bnh nhn da trn s liu cho trn v
c lng thi gian nng thuc trng thi n nh.
Li gii:
bnh nhn suy gan: Cl= 15 l/h, Vd= 300l
Liu tn cng: LD= Css* Vd= 10(mg/l)*300(l)= 3000( mg)
Liu duy tr:

MD= Css*Cl= 10(mg/l)*15(l/h)= 150( mg/h)

Thi gian bn thi: t1/2=

0,693

0,693300()

15( )

= 13,9( h)

Thi gian nng thuc trng thi n nh: 3-5t1/2= 42- 70(h)
bnh nhn suy tim: Cl=30l/h, Vd= 100l
Liu tn cng: LD= Css* Vd= 10(mg/l)*100(l)= 1000( mg)
Liu duy tr: LD= Css* Cl= 10(mg/l)*30(l/h)= 300( mg/h)
Thi gian bn thi: t1/2=

0,693

0,693100()

30( )

= 2,3(h)

Thi gian nng thuc trng thi n nh: 3-5 t1/2= 7- 12(h )
Nhm 7:

Nguyn Th L
V Mnh Linh
H Th Loan

Bi 9
EV l mt bnh nhn nam 42 tui, nng 84kg b mt cn hen cp tnh. S dng
phng trnh m hnh mt ngn, tnh ton mt liu tn cng tim bolus theophyllin
IV (c tin hnh hn 20 pht) v tc truyn lin tc t c mt nng
n nh Css=12mg/L. Cho rng V=40L, t1/2=5h.
Bi gii:
a) Liu tn cng: LD=Cp.Vd =Css.Vd =12(mg/L).40(L)=480(mg)
Khong 500mg truyn tnh mch trong 20 pht
b) Tc truyn thuc = Css.Cl
Cl=ke.Vd =

0,693
1/2

. Vd =

0,693
5()

. 40(L) = 5,56(L/h)

Tc truyn thuc=Css.Cl =12(mg/L).5,56(L/h) = 67(mg/h) ( khong 70mg/g)

Nhm 9:

Nguyn Hng Nga

Nguyn Th Thanh Nga
Lng Th Ngn

Bi 10
JB, nam, 78 tui, nng 100kg, b suy tim v ang c iu tr bng Digoxin. Liu
dng Digoxin ca ngi ny l 125 g/ngy, nng Digoxin t c trng thi
n nh bng 0.6 g/l.
a) Khi F= 0.7, tnh thanh thi ca thuc l bao nhiu khi nng trung bnh
ca thuc t trng thi cn bng ?
b) Tnh liu tn cng mi ca Digoxin dng cho bnh nhn khi nng d ti trng
thi cn bng Css= 1.2 g/l ?
Bi gii :
a) Ta c:
Nng trung bnh ti trng thi cn bng : Css = F(D/)/Cl
=> H s thanh thi : Cl = F(D/)/Css
=[0,7(125g/1d]/0.6 (g/l) = 146 l/d

b) Ta c :
Nng n nh mi Cssnew=> Liu tn cng mi Dnew
Nng n nh c Cssold => Liu tn cng c Dold

=> Liu tn cng mi cho bnh nhn khi Css = 1,2g/l l:

Dnew= Dold(Cssnew/Cssold )
= 1.25g [(1,2g/l) /0,6(g/l)
= 250g
Liu dng l 250g
Nhm 10:

Nguyn Ngc Kim Ngn

H Th Bch Ngc
inh T Nhi

Bi 11
QJ l mt bnh nhn nam 67 tui, cn nng 80kg. ang c iu tr bnh phi tc
nghn mn tnh (COPD). S dng theophylline phng thch ko di (ng ming)
trong phc iu tr. Gi s F = 1.0, V = 40 L, v t1/2 = 5h. Hy tnh liu
theophylline ng ming cn dng mi 12 gi t Css = 8 mg/L (nng
trng thi cn bng)
Bi lm

1/ Da
bng trn, ta c:

vo

Vi Css = 8 mg/L, = 12h, F = 1, nn ta cn tm Cl.

V e =

nn u tin cn tm ke :
1/2 =

ln 2
ln 2
0.693
=> e =
=
= 0.139 -1
e
1/2
5

2/
e =

=> s = e .d = 0.139 -1 .40 = 5.56 /

d

3/
=

. .

Suy ra:
=

8 5.56 12
= 534 500
1.0

Vy liu nn dng l 500mg theophylline.

Nhm 11:

Hn Bo Nhi
Phm Th Hng Nhung
Trn Tun Phong

Bi 12
Mt bnh nhn mc bnh suy tim c iu tr bng digoxin v sau phi thm
furosemid do suy tim sung huyt. thanh thi l 1l/pht. Trc khi dng
furosemid, Vd l 130l, sau khi dng furosemid, Vd gim cn 87l. Hy cho bit thi
gian bn thi t1/2 v thi gian thuc t Css thay i nh th no trong thi gian
trc v sau khi bnh nhn dng furosemid?
Bi gii
Ta c : thanh thi : Cl = Vd.0,693/t1/2
Suy ra : t1/2 = Vd.0,693/Cl
Ta tnh c : t1/2 trc = 90,09 pht
t1/2 sau = 60,291 pht

T trc v sau khi dung thuc th th tch phn b gim

Vd = Vd tr - Vd sau = 43l

M thanh thi l 1l/pht

Suy ra thi gian thuc t Css l
Nhm 12:

Nguyn Hu Thnh Ph
Nguyn Quang Ph
Trn Th Nht Phng

t=

Vd / Cl = 43 pht .

Bi 13
Mt bnh nhn n 55 tui c truyn 80mg gentamicin, cch 8 gi mt ln. Sau 30
pht ngng a thuc, ly mu mu xc nh nng thuc l 5,2mcg/ml. 7h sau
ngng truyn, o c nng thuc l 1,7mcg/ml. Tnh cc gi tr sau:
a. t1/2
b. Nng thuc gi th 8 sau khi ngng a thuc
c. Tnh thi gian cn thit nng thuc gim t 5,5mcg/ml ti 0,5mcg/ml
Ta c
LnC1=Ln Co- ket1
LnC2=Ln Co-ket2
LnC1-LnC2=-ke (t1+t2)
Ke= (LnC2-LnC1)/ (t1+t2)
Suy ra T 0.5 = ln2/ Ke = 4.65 (h)
Cu b: C8= C2 * e ^ (-ke(t2+t8))
p s: 0.1817 ( mcg/ml)
Cu c:
Ta c delta T= (ln ( 5.5)- ln (0.5) )/ ke
p s: 16.08 (gi)
Nhm 13:

Lng Mnh Quang

Phm Vn Qy
L Th Qunh

Bi 14
Mt bnh nhn nhi nam b ng kinh t pht v iu tr bng phenytoin, 200mg hng
ngy, dng liu n bui ti. Sau mt tun, nng phenytoin trong huyt thanh
ca bnh nhn l 25mol/l. Khong liu iu tr trong huyt thanh l 40-80mol/l.
Liu c tng ln 300mg/ngy. Mt tun sau, bnh nhn phn nn b long chong,
chng git cu mt, nng phenytoin trong huyt tng l 125mol/l. Liu c
gim xung 250mg/ngy. Triu chng tin trin t t v nng phenytoin trong
huyt tng gim xung 60mol/l (trong khong iu tr). Gii thch mi lin h
gia liu dng, nng thuc trong huyt tng v triu chng lm sng trn bnh
nhn ny?
Bi lm
i vi phenytoin, iu quan trng cn lu l phenytoin tun theo dc ng hc
khng tuyn tnh. Khong iu tr ca nng phenytoin trong huyt tng hay
huyt thanh l 40-80umol/L. Phenytoin gn ch yu vi albumin trong huyt tng.
T l gn gim tr nh.Thi gian o thi 50% liu thuc tng khi tng liu(
thi gian bn thi khng phi khng i vi mt thuc m ph thuc vo liu dng
ban u ca thuc).V tng liu thuc khng tng t l vi lng thuc trong c th
mt khi qu trnh o thi c bo ha .(v vy trn lm sng phenytoin dng nng
huyt tng iu chnh thuc.)
Khi liu dng 200mg hng ngy,sau mt tun nng phenytoin trong huyt tng
ca bnh nhn l 25 umol/l ,nng thp v khng nm trong khong iu tr nn
khng c tc dng iu tr
Khi liu dng tng ln 300mg hng ngy ,sau mt tun nng phenytoin trong
huyt tng ca bnh nhn qu ln hn khong iu tr,nng qu ln gy ng
c thuc do dng qu liu dn n long chong v chng git cu mt.(Khng c
thuc c hiu cho vic s dng qu liu phenytoin m phi gim liu t t,khng
c ngng thuc t ngt)
Khi gim liu xung 250mg th nng trong huyt tng nm trong khong
iu tr nn c tc dng v cc triu chng do ng c thuc gim mt t t.