DTQGVN Levonorgestrel (t trong t cung) 155

Interferon alfa - n3 tim phi c bo qun v gamma. Interferon beta c to ra bi

2 8oC v khng ng lnh. Dung nhiu loi t bo khc nhau, nh nguyn
dch tim n nh nhit phng bo si v i thc bo. Interferon beta -
trong 24 gi. 1a v interferon - 1b c sn xut bng
Interferon alfa - 2a tim, bt v khun v cng ngh ti t hp DNA. Trnh t acid
dung dch thuc pha phi nhit amin ca interferon beta - 1a ging nh ca
2 8oC v khng ng lnh. Dung interferon beta t nhin ca ngi.
dch pha long ng km theo thuc cng Interferon beta - 1b khng c mch nhnh
khng c ng lnh. Dung dch carbohydrat thy trong interferon t nhin.
thuc pha, n nh c 30 ngy Interferon beta c s dng cho ngi bnh
nhit 2 8 oC v c 24 gi nhit x cng ri rc thuyn gim, c ti pht
phng. (c im l c t nht hai cn ri lon
Bt interferon alfa - 2b tim, dung thn kinh trong vng hai nm trc km
dch tim v dung dch thuc pha phi theo phc hi hon ton hoc khng hon
nhit 2 8oC. Bt dng tim ton) m vn c th i li khng cn gip
v cc loi dung dch cha pha thuc n . Thuc c ch nh gim tn s
nh 45oC ti 7 ngy. Dung dch thuc v mc nng ca cc ln ti pht lm
pha n nh trong mt thng 2 sng. Interferon beta th hin tc dng
8oC. sinh hc bng cch gn vo nhng th
th c hiu trn b mt ca cc t bo
Qu liu v x tr
ngi. S gn kt ny khi ng cho mt
Cha c cc bo co v qu liu nhng nu lot s kin phc tp trong t bo dn
tim nhc li interferon liu cao c th n th hin nhiu sn phm gen v
gy ng lm su, mt nhc v hn m. cht ch th do interferon gy nn.
Nhng ngi bnh ny cn a vo vin Nhng cht ny c coi l nhng cht
theo di v iu tr h tr thch hp. trung gian ca cc tc dng sinh hc ca
Nhng ngi bnh b phn ng nghim interferon beta.
trng vi interferon alfa thng bnh phc C ch tc dng ca interferon beta trong
trong vng vi ngy sau khi ngng dng bnh x cng ri rc cha c bit r.
thuc v c chm sc h tr. Hn m gp Dc ng hc
0,4% ngi bnh ung th trong cc th Dc ng hc v kh dng sau khi tim
nghim lm sng. bp v di da khc nhau gia cc loi
Thng tin qui ch thuc. Sau khi tim bp interferon beta -
Thuc c bng A. 1a, nng cc i (c xc nh bng
hot tnh chng virus in - vitro ti u) t
c trong khong 5 - 15 gi sau dng
thuc. Ri hot tnh gim dn, vi na i
Interferon Beta
khong 10 gi.
Tn chung quc t: Interferon beta. Sinh kh dng khi tim bp cao gp 3 ln
sinh kh dng khi tim di da. Interferon
M ATC: Interferon beta natural: L03A beta - 1a khng c tim di da. iu ny
B02, ngc vi cc loi v dng khc ca interferon.
Interferon beta - 1a: L03A B07, Bi vy cn phi c rt cn thn t hng
Interferon beta - 1b: L03A B08. dn thuc ng km trong hp thuc.
Loi thuc: Cht iu ha min dch. Sau khi tim di da mt ln hoc nhiu ln
Dng thuc v hm lng liu 0,5 mg/ngy interferon beta - 1b cho
Interferon beta - 1a bt pha tim: L 33 ngi tnh nguyn kho mnh, nng
microgam (6,6 triu n v quc t) km interferon beta - 1b trong huyt thanh th-
theo dung dch pha tim bp. ng di 100 vqt/ml. Nng nh
Interferon beta - 1b, bt pha tim: L interferon beta - 1b trong huyt
300 micro- thanPhonh t c trong khong 1 n 8
gam (9,6 triu n v quc t) km theo gi, vi nng nh trung bnh ca
dung dch pha tim di da. interferon l 40 vqt/ml.
Dc l v c ch tc dng Ch nh
Interferon l mt h protein c trong t Interferon beta - 1a: iu tr dng ti pht
nhin, trng lng phn t khong t ca bnh x cng ri rc, lm chm
15.000 n 21.000 dalton. xc nh tn ph thm v lm gim s ln nng ln
c ba nhm interferon chnh, alpha, beta ca bnh.
156 Levonorgestrel (t trong t cung)
Interferon beta - 1b: c ch nh lm
gim s ln bnh nng ln ngi bnh
ngoi tr x cng ri rc thuyn gim c ti
pht.
Chng ch nh
Qu mn vi cc loi interferon t nhin v
ti t hp; qu mn vi albumin huyt
thanh ngi hoc cc thnh phn khc ca
ch phm.
C thai.
Ngi bnh trm cm nng v/hoc c
nh t vn; ngi bnh c tin s ng
kinh m khng th iu tr v kim sot
c mt cch cht ch.
Thn trng
Cha c thng bo no v iu tr
interferon cho ngi bnh di 16 tui, v
vy khng c dng interferon beta cho tr
em. Cng cn thy rng kinh nghim
iu tr bng interferon beta di ngy
vn cn cha nhiu, v vy iu c
bit quan trng l phi theo di cht ch
ngi bnh phng nhng phn ng
khng mong mun.
iu quan trng l phi thng bo cho ngi
bnh v cc tc dng ph trong khi iu
tr, k c cc triu chng gi cm. Cc
triu chng ny thng r nht khi bt u
iu tr v gim dn trong qu trnh
iu tr.
Ngi c tin s bnh thn kinh, c bit
l c co git v bnh ng kinh, th cn
phi theo di rt cht ch v c th cn
phi c bin php iu tr iu
chnh cho c bnh ng kinh trong thi
gian thc hin iu tr bng interferon.
c ti liu ni rng interferon c th
thc y trm cm v thm ch c
nh t t ngi bnh c xu hng pht
trin trm cm. Nguy c ny cng thng
tng ln trong s cc ngi b bnh x
cng ri rc. Bc s iu tr phi khm
xt cn thn triu chng trm cm, nu
c th phi iu tr mt cch thch hp,
k c vic ngng s dng interferon.
Ngi bnh suy gim nng chc nng thn
v/hoc gan v ngi bnh c tin s suy
ty cn c ch c bit v liu lng
v cc nguy c tc dng ph trong qu
trnh iu tr.
Ngi bnh c bnh tim mch nh cn au
tht ngc, suy tim mn hoc lon nhp
tim phi c theo di cht ch chc nng
tim, v c th c nguy c lm cc bnh
nng ln trong thi gian s dng
interferon beta. Bn thn hi chng gi
cm c th lm tng v lm trm trng
DTQGVN
cc triu chng ngi bnh c tin s
bnh tim.
Ngi bnh to khng th chng li
interferon, bi vy (khng th trung ha),
mt s ngi bnh c iu tr hot lc
ca interferon beta c th b gim. Cc
khng th trung ha lm gim hot lc
sinh hc ca interferon beta. C nguy c
khng th trung ha t mc cao khng
i (hnh cao nguyn) sau 12 thng
iu tr. Cc ti liu theo di ngi bnh
iu tr c 2 nm cho thy khong 8%
cc ngi bnh c xut hin khng th
trung ha.
Thi k mang thai
Chng ch nh interferon beta cho ngi
mang thai v nguy c tim tng cho thai
nhi. Cha c nghin cu v iu tr
interferon beta cho ngi mang thai. S
dng liu cao cho kh Rhesus gy ra sy
thai. Trong khi cha c s liu nghin cu
trn ngi th iu ny c ngha l cng
c nguy c tng t cho ngi. Ph n
tui sinh nn kim tra xc nh
khng c thai trc khi bt u s dng
interferon beta v phi ung thuc nga
thai trong thi gian iu tr.
Nu ngi bnh mang thai ngay trong thi
k ang iu tr, nn ngng interferon v
khng c bt u li cho n khi .
Thi k cho con b
Cn thiu thng tin v nng interferon
trong sa.
Do c tim nng gy cc phn ng ph
nng tr em, nn khuyn co hoc phi
ngng cho con b, hoc phi ngng iu
tr bng interferon beta cho n khi thi
cho con b.
Tc dng khng mong mun (ADR)
Trm cm v t vn c thng bo nh
l nhng tc dng khng mong mun,
l l do phi ht sc thn trng i vi
ngi c tin s b trm cm.
Cc phn ng ph ph bin nht khi iu
tr bng interferon l hi chng gi cm
bao gm au c, st, n lnh, mt mi,
au u v bun nn. Cc triu chng
ny hu nh rt hay gp giai on u
iu tr v gim dn trong thi gian
iu tr.
Thng gp, ADR > 1/100
Chung: au u, hi chng gi cm, st,
n lnh, suy nhc, au c, chng mt.
Thn kinh trung ng: Kh ng, trm cm.
Tiu ha: a chy.
t gp, 1/100 > ADR > 1/1000
Chung: Chn n, phn ng qu mn.
DTQGVN
Tun hon: Gin mch, nh trng ngc,
bnh c tim v suy tim mn.
Thn kinh trung ng: Kch ng, co git.
Ni tit: Bng huyt v/hoc a kinh.
Tiu ha: Bun nn, nn.
Da: Pht ban, phn ng ti ch tim, rng
tc.
C - xng: au khp.
Him gp, ADR < 1/1000
Chung: Phn ng d ng nghim trng, k
c phn v.
Ngi bnh c th c cm gic nh ngt
ngay sau mi tim interferon beta u
tin. Phn ng ny thng c tnh n l
mt ln, him xy ra li nhng mi tim
sau. Him khi c cc cn co git v co
cng (chut rt). Lon nhp cng l mt
chng him gp v thng xy ra ngi
bnh c t bm sinh. Bi vy vn
quan trng l khai thc cho ng tin s
bnh tt ca mi ngi bnh trc khi bt
u iu tr.
C th xy ra sm, trong qu trnh iu
tr, nhng cn co cng thong qua
v/hoc yu c nghim trng, thm ch
c th lm hn ch vn ng. Nhng t
co cng ny ngn, lin quan nht thi vi
tim thuc v c th ti pht khi tim
thuc li. Cng c mt vi kt qu xt
nghim bt thng, nhng thng khng phi
l l do cn n can thip/iu tr
tch cc no. S lng t bo lymph, tiu
cu, bch cu trung tnh v hng cu b
gim; cng nh c s tng nng
creatinin huyt thanh, kali huyt thanh,
urat huyt thanh v nng
transaminase. Cng c th tng calci niu
thong qua.
Hng dn cch x tr ADR
Hi chng gi cm hu ht xy ra vo thi
im bt u iu tr, v ch yu p Phi ngng iu tr nu bnh tin trin
ng vi paracetamol. St thng ht trong
vng 12 gi. C th lm gim st bng
cch iu tr trc vi thuc h st.
T l phn ng ti ch tim, phc hp triu
chng gi cm thng gim theo thi gian.
Nu phn ng qu mn nng xy ra, phi
ngng thuc interferon v thc hin cc
iu tr thch hp.
Nhng ngi bnh b trm cm v c
nh t t phi c theo di rt cht ch,
nn cn nhc ngng s dng liu
php.
Nu s lng tuyt i bch cu trung tnh
thp hn 750/mm 3 th nn ngng iu
tr bng interferon beta. Khi tr s ca
bch cu tr li > 750/mm 3 th c th dng
li, nhng vi liu gim 50%.
Levonorgestrel (t trong t cung) 157
lm gim bt cc tc dng khng mong
mun t va n nng khc, c th phi
thay i phc liu lng ca interferon
beta hoc thm ch phi chm dt s
dng thuc ny.
Liu lng v cch s dng
Liu khuyn co ph thuc vo loi
interferon beta - 1a hay 1b. Liu v ng
tim bp hay di da rt khc nhau. Cn
phi c cc thng tin hng dn s dng
c trong hp thuc.
i vi interferon beta - 1a liu khuyn co
iu tr bnh x cng ri rc thi
k bnh kch pht l dng liu 30
microgam (1 ml dung dch), tim bp mi
tun mt ln.
i vi interferon beta - 1b, tim di da, vi
liu 0,25 mg (1 ml dung dch), cch 1
ngy tim 1 ln.
iu tr ch nn c ch nh bi cc
nh thn kinh hc c kinh nghim lu
nm v bnh ny. i vi interferon beta -
1a, s an ton v hiu qu ca cc liu
khc vi liu 30 microgam tim bp mi
tun mt ln cha c nghin cu. Bi vy,
c th l liu ti u vn cn cha c xc
nh.
Nn thay i v tr tim thuc hng tun.
Thi gian iu tr cn ko di bao lu
vn cha r.
Cc thng tin lm sng ch mi c thi
gian theo di trong vng 2 nm. Bi vy,
cn phi nh gi iu tr sau 2 nm v
quyt nh tip tc hay ngng iu tr
phi da trn nh gi lm sng rt cn
thn.
Vn cn cha c kt lun v dng no ca
interferon beta l hiu qu nht trong
iu tr x cng ri rc, cng nh cha c
ti liu v liu lng no l ti u.
thnh x cng ri rc mn tnh tin trin.
Trc v 24 gi sau khi tim, ngi bnh nn
dng thuc h st gim au gim hi
chng gi cm. iu quan trng l hng
thng phi theo di ngi bnh v ton b
tnh trng huyt hc, cng thc, s lng
bch cu, tiu cu v xt nghim chc
nng gan. Thm na, cng phi theo di
ngi bnh v mt sinh ha gim st
bnh.
Tng tc thuc
Vi interferon beta, cha c nhng nh gi
mt cch h thng v cc tng tc thuc.
Nhng nhn xt s b v tng tc gia
interferon beta vi corticosteroid hoc
ACTH vn cn cha c nh gi mt cch
h thng. Cc nhn xt lm sng ch ra
158 Levonorgestrel (t trong t cung) DTQGVN

rng c th iu tr ngi bnh b x linolenic, stearic, vi xp x 60% acid bo

cng ri rc bng interferon beta phi hp l nhng acid bo cn thit. Kch thc v
vi corticosteroid hoc ACTH trong thi k tnh cht sinh hc ca cc tiu phn nh
bnh tng nng. Phi thy rng interferon dch rt gn vi tnh cht sinh l ca cc
c th lm gim nng v hot tnh ca vi th nh trp.
enzym gan chuyn ha thuc cytochrom Sau khi tim truyn tnh mch intralipid,
P450. Bi vy cn c bit thn trng khi nh lipopro-
dng interferon phi hp vi cc thuc c tein lipase, cc triglycerid c thy phn
ca s iu tr hp v s thi tr cc thnh acid bo t do v glycerol, sau
thuc ph thuc vo hot tnh ca cc acid bo t do ti cc m, y
enzym gan cytochrom P 450. iu thn trng chng b oxy ha cung cp nng lng
ny lin quan n nhiu thuc chng cho hot ng ca c th hoc c ti
ng kinh v chng trm cm.
tng hp thnh triglycerid d tr hay
n nh v bo qun tham gia to thnh cc cu trc c quan.
Phi bo qun interferon beta - 1a (dng Glycerin c chuyn ha thnh carbon
bt pha tim) nhit 2 - 8 oC, trong dioxyd v glycogen hoc c s dng
t lnh. Nu khng c t lnh, c th bo tng hp cht bo ca c th.
qun 25oC trong vng 30 ngy. Khng - Ch phm lipid c nng m c
c nhit cao. Khng ng tim truyn tnh mch rt ph hp cho
lnh. Sau khi pha tim, cn dng ngay nhng ngi cn hn ch a dch vo c
cng sm cng tt, trong vng 6 gi, bo th. Intralipid cn c dng cho ngi c
qun 2 - 8 oC, khng ng lnh. nhu cu v nng lng tng hoc c yu cu
Interferon beta - 1b (dng bt pha v nng lng c bn. Nng lng c cha
tim) phi bo qun trong t lnh nhit trong ch phm intralipid 30% l 12,6 MJ
t 2 - 8 oC. Sau khi pha tim, nu (3000 kilocalo)/lt; nng osmol/lt ca
khng dng ngay, sn phm phi t intralipid 30% khong 310 mOsm/lt, pH
lnh v dng trong vng 3 gi. Trnh ca intralipid l khong 8.
ng lnh v trnh lc dung dch. Nu Intralipid c dng tim truyn tnh
khng c t lnh, phi cc l interferon mch chm l mt phn ca ch dinh
beta - 1b cng mt cng tt, di 30oC, trnh dng theo ng tim truyn, thng kt hp
nng, nh sng, v dng trong vng 7 ngy. vi cc amino acid hoc dung dch carbon
hydrat.
Qu liu v x tr Khi s dng nh ngun cung cp nng lng,
Cha c ti liu no ni v qu liu. Ch c liu lng ca intralipid c xc nh bi
li khuyn l khi qu liu cn iu tr h nhu cu v nng lng v trng thi lm
tr, da vo triu chng. sng ca ngi bnh. Lng intralipid dng
Thng tin qui ch khng nn vt qu 60% lng calo cn thit
Thuc c bng A. ca ngi bnh.
Ch nh
Intralipid c ch nh trong nhng trng
Intralipid hp cn b sung dinh dng ngoi ng
tiu ha cung cp nng lng v acid
bo cn thit nh khi khng n c do chn
Tn chung quc t:
thng, nhim khun, bng nng, hoc
M ATC: Cha c. sau khi m ngi c ri lon dinh dng.
Loi thuc: Cung cp dinh dng cho c Chng ch nh
th. Sc.
Dng thuc v hm lng Chuyn ha lipid b suy yu nng (suy
Nh dch truyn tnh mch, c cha thn, i tho ng khng c kim sot,
10, 20 hoc 30% du u tng. vim ty, suy gan, thiu nng tuyn gip
c tng triglycerid mu, v nhim khun).
D ng vi protein u tng.
Dc l v c ch tc dng
D ng nng vi trng v phospholipid
Lipid dng truyn tnh mch
ca lng trng c s dng lm cht
(intralipid) l nh dch ca du u tng,
nh ha trong intralipid.
c nh ha bng cc phospho lipid ly t
Tng lipid mu bnh l.
lng trng. Intralipid gm hn hp cc
triglycerid trung tnh ca cc acid bo ch Thn trng
yu nh acid linoleic, oleic, palmitic, Bnh phi.
DTQGVN
Suy thn v mt s ri lon ng mu.
Nu cn iu tr bng intralipid cho nhng
ngi bnh , cn theo di kh nng thi
tr cht bo ca h.
Thi k mang thai
Khng c nguy c c bit cho bo thai
Thi k cho con b
Khng c nguy c c bit cho tr b
sa m
Tc dng khng mong mun (ADR)
t gp, 1/1000 < ADR < 1/100
Ton thn: St, run, bun nn.
Da: mt.
Him gp, ADR < 1/1000
Ton thn: Phn v, au bng.
Mu: Tan mu, tng hng cu li.
Tun hon: Tng/h huyt p.
Gan: Tng enzym gan.
H hp: Nhp th nhanh.
Khc: Cng au dng vt.
Hng dn cch x tr ADR
Cn p dng k thut v khun nghim
ngt khi thay ti ng v khi truyn tnh
mch intralipid.
Liu lng v cch dng
Kh nng chuyn ha v thi tr lipid ca
ngi bnh s xc nh liu lng intralipid
cn dng. Ch phm intralipid 30% c th
c truyn tnh mch ring hoc hn hp
vi dung dch khc trong ti plastic (khng
c phthalat).
Lng intralipid tim truyn tnh mch
khng nn vt qu 3 g/kg cn nng/24 gi.
Tc truyn 333ml intralipid 30%
khng nn di 5 gi.
Xt nghim kh nng o thi lipid: Trc
khi tim truyn, ly mu mu v ly tm,
nu thy huyt tng ging nh sa hoc
trng c, th khng c truyn
intralipid. Phng php ny khng xc
nh c tnh trng tng triglycerid mu.
Vi nhng ngi bnh nghi ng khng dung
np lipid, cn dng nhng phng php xt
nghim c hiu phn tch
triglycerid huyt thanh.
n nh v bo qun
Bo qun intralipid trong nhng bao gi
ng y, nhit di 25oC v trnh
nh sng.
Sau khi m intralipid tim truyn,
cn s dng ngay cho ngi bnh hoc s
dng trong vng 24 gi.
Tng k
Khi thm nhng cht khc vo intralipid
tim truyn phi p dng nghim ngt
k thut v khun.
Levonorgestrel (t trong t cung) 159
Theo quy nh chung, cn trnh thm
nhng cht khc vo intralipid v nh vy
c th ph hy nh dch v tng nguy c
tc mch do lipid.
Nh dch cht bo c th ha tan cht
ha do phthalat c trong plastic dng lm
ti ng v b tim truyn, v vy nht
thit phi s dng thit b v bao gi
khng cha phthalat.
Thng tin qui ch
Intralipid dng tim truyn phi c k
n v bn theo n.
Iobitridol
Tn chung quc t: Iobitridol.
M ATC: V08A C04.
Loi thuc: Thuc cn quang cha 3
nguyn t iod, tan trong nc, c nng
osmol/kg thp.
Dng thuc v hm lng
L 20, 50, 60, 100, 150 v 200 ml tim
c nhiu hm lng:
350 mg iod/ml, tng ng 767,8 mg
iobitridol/ml,
300 mg iod/ml, tng ng 658,1 mg
iobitridol/ml,
250 mg iod/ml, tng ng 548,4 mg
iobitridol/ml,
Dc l v c ch tc dng
Iobitridol l cht cn quang cha iod hu
c, mi phn t c 3 nguyn t iod, vi t
l iod chim 45,6%. Iobitridol l loi
monomer khng dng ion, tan trong nc
v c nng osmol/kg thp. Thuc gy
tng hp thu tia X khi chiu qua c th, do
hin r cu trc ca c quan tp trung
nhiu iobitridol. Mc cn quang t l
thun vi nng iod.
Thm d tnh dung np chung i vi h
thng huyt ng, tim mch, h hp, tit
niu, thn kinh chng t iobitriol tng
t nh vi cc ch phm cn X quang c ba
iod, tan trong nc khng dng ion, c
nng osmol/kg thp.
Ch nh
Loi c nng 350 v 300 mg iod/ml:
Chp ng tit niu qua ng tnh
mch.
Chp ct lp vi tnh s no v ton thn.
Chp ng mch (c mch vnh tim).
Chp mch k thut s bng ng tnh
mch
160 Levonorgestrel (t trong t cung)
Chp X quang tim, mch ln
Loi c nng 250 mg iod/ml:
Chp ct lp vi tnh ton thn.
Chp tnh mch.
Chp mch k thut s bng ng ng
mch.
Chng ch nh
Ngi c tin s d ng vi cc thnh phn
ca thuc.
Khng dng chp ty do cha c nghin
cu.
Ngoi ra, thuc khng c chng ch nh
tuyt i.
Thn trng
Ging nh cc thuc cn quang c iod khc,
iobitridol c th gy ra cc phn ng mn
cm v c th gy tc mch do nh hng
ln h ng mu.
C th cho dng d phng mn cm bng
khng histamin hoc corticosteroid nhng
cc bin php ny u khng c gi tr
chc chn.
Thi k mang thai
Cha xc minh c tnh v hi ca thuc
nhng theo khuyn co chung, trnh lm
cc th thut X quang khi mang thai.
Thi k cho con b
Cha c nghin cu trn ngi, nhng t l
iobitridol c trong sa ng vt m vo
khong 3%. Do vy, khng nn cho con b
trong t nht 24 gi sau khi dng thuc.
Tc dng khng mong mun (ADR)
Thuc ny c th gy kch ng ti ch,
nht l khi cho dng liu cao, tim nhanh.
Khi tim ra ngoi mch mu, iobitridol gy
hoi t cc t chc xung quanh.
Thuc ny hay gy ra bun nn, c v kim
loi trong ming, nhc u, mt mi. t
khi b nng hn nh nn, kh th, ri lon
v tim mch, gy c vi thn. Khi dng
liu cao (25 - 50 mg/kg), iobitridol c th
gy suy h hp hay nhng biu hin bt
thng v m hc trn c quan ch (gan,
thn).
Hng dn cch x tr ADR
X l theo triu chng v cn c sn ph-
ng tin hi sc thch hp khi lm cc th
thut X quang.
Liu lng v cch dng
Liu lng tu thuc theo th thut v khu
vc cn to i quang, th trng v chc
nng thn ca ngi bnh c bit tr
DTQGVN
em. Tin hnh theo t hng dn vi tng
sn phm ca nh sn xut.
Tng k
Iobitridol tng k vi vi nhiu loi thuc.
V vy, khng trn thuc khc vo chung
bm tim vi iobitridol k c thuc khng
histamin hoc corticoid.
n nh v bo qun
Bo qun ni mt, nhit di 30 oC, trnh
nh sng.
Thng tin quy ch
Iobitridol c trong Danh mc thuc cha
bnh ch yu s dng ti cc c s khm
cha bnh, nm 2005.
iodamid meglumin
Tn chung quc t: Meglumine
iodamide.
M ATC: V08A A03.
Loi thuc: Cht cn quang monome dng
ion.
Dng thuc v hm lng
Thuc tim: Dung dch tim v khun cha
65% iodamid meglumin (tng ng vi
300 mg iod/ml). T dc: Dinatri edetat.
Thay khng kh trong l bng nit.
Dc l v c ch tc dng
Iodamid meglumin l cht cn quang
monome dng ion cha iod c tnh cht v
cng dng tng t nh diatrizoat.
S dng iodamid meglumin khng cn c
vo tc dng dc l ca thuc m da vo
s phn b v bi tit ca thuc trong c
th. Cc hp cht iod hu c tng kh
nng hp thu X quang khi i qua c th
v c dng ha cu trc c th ti
nhng ni thuc tip gip. Mc cn
quang t l thun vi ton lng (nng
v th tch) cht cn quang cha iod trn
ng i ca tia X.
Ni chung cc cht cn quang monome
dng ion c p sut thm thu rt cao khi
dng nng thch hp quan st
trong chp X quang v dung dch c nng
u trng ny gy tc dng khng mong
mun vi t l tng i cao. Ngoi ra,
nhng hp cht monome ny t kh nng
dung np hn cc cht cn quang dime
dng ion (th d acid ioxaglic) c p sut
thm thu thp hn, v cc cht cn
quang dng khng ion (th d iohexol,
iopamidol) cng vn l nhng cht c p
sut thm thu thp hn.
DTQGVN
Tim tnh mch, iodamid meglumin c th
gy li tiu thm thu.
Dc ng hc
Sau khi tim tnh mch nhanh, iodamid
meglumin thng to cn quang
nhn thy ng tit niu trong vng 1 -
10 pht ty theo chc nng thn ngi
bnh. ngi suy thn do thuc bi tit
chm nn sau khi tim tnh mch 30 pht
hoc lu hn vn c th khng nhn
thy ng tit niu. ngi suy thn
nng c th khng nhn thy g.
Sau khi tim tnh mch, iodamid meglumin
phn b nhanh khp dch ngoi t bo.
Cn cha bit iodamid meglumin c i qua
nhau thai khng. Thuc bi tit vo sa
m. T l lin kt vi protein huyt tng
ca thuc di 5%.
Sau khi tim tnh mch nhanh ngi c
chc nng thn bnh thng, nng
nh iodamid meglumin t c ngay,
sau gim xung theo kiu hai pha, pha
khi u c na i khong 3 pht v
pha cui c na i khong 1 gi 20 pht.
ngi suy thn, na i ca thuc pha
cui l 4 - 16 gi.
Iodamid meglumin thi tr gn nh hon
ton trong nc tiu dng khng i, ch
yu qua lc cu thn.
C t nht mt phn ba liu tim tnh
mch thi tr vo nc tiu qua ng thn.
ngi bnh c chc nng thn bnh thng,
khong 95% liu iodamid meglumin tnh
mch thi tr trong nc tiu v 0,5% thi
tr trong phn trong 72 gi; di 1,5% thi
tr trong nc tiu di dng cht chuyn ha
cha c xc nh. Iodamid meglumin o
thi qua thm tch mng bng hoc thm
tch mu.
Ch nh
Iodamid meglumin c dng lm thuc cn
quang tim tnh mch chp thn xc
nh cc bt thng ng tit niu (th
d, xc nh v tr tc nghn ng tit
niu).
Ch : cht cn quang monome dng ion
c t l tc dng c hi tng i cao, mt
phn do p sut thm thu ln. Dng cc
hp cht c p sut thm thu thp hn
nh cht cn quang dime dng ion v cht
cn quang dng khng ion c th c
dung np tt hn.
Chng ch nh
Tin s qu mn vi cht cn quang cha
iod. V niu.
Thn trng
Levonorgestrel (t trong t cung) 161
C th kh hoc khng nhn thy c -
ng tit niu trong chp X quang thn -
tnh mch ngi suy thn nng. Mc
du trc y dng cch hn ch c nc
vo c th trc khi X quang thn - bng -
ng tim tnh mch khong t 12 n 15
gi tng nng iodamid meglumin
to cn quang trong ng niu, nhng
phn ln cc bc s lm sng hin nay
u cho l tt c ngi bnh u cn
phi c tip nc y . Tip nc y
c tm quan trng c bit tr nh,
ngi cao tui hoc ngi bnh ur huyt
cao (c bit l ngi bnh a niu,
thiu niu, i tho ng, hoc bnh
hng cu hnh lim). S mt nc khng
mong mun nhng ngi bnh ny c
th tng ln do tc dng li tiu thm thu
ca thuc.
Khng c hn ch nc trc khi chp X
quang ngi bnh a u ty v c th to
iu kin gy kt ta protein u ty
khng hi phc ng thn. V niu do
mt nc v/hoc do cht cn quang
dn n tng ur - huyt tin trin, suy
thn, v t vong ngi bnh a u ty
dng cht cn quang tim tnh mch. Nu
dng iodamid meglumin cho ngi bnh
a u ty, cn phi b dch v kim ha
nc tiu gim thiu hoc ngn chn
kt ta protein u ty ng thn.
Truyn tnh mch iodamid meglumin lm
tng ti thm thu, cn lu tc dng ny
ngi b suy tim sung huyt hoc b suy
gim chc nng thn.
Ngi suy tim mi pht c nguy c b ph
phi khi dng liu ln cht cn quang dng
ion trong chp X quang thn bng ng
tnh mch liu cao. Cn trnh c th b
mt nc trc khi chp. Vic c th mt nc
c th do hn ch a nc vo c th, do
nn, do a chy, do dng thuc li niu
hoc do king mui trong mt thi gian
di.
Chp X quang tnh mch ng tit niu
liu cao ngi ur huyt cao v ngi i
tho ng b mt nc c th c nguy c
gy suy thn. Hn na, suy thn c th
xy ra ngi i tho ng vi liu cn
quang kh thp ng vi 17 g iod, mc du
c b nc y .
Tim vo mch cht cn quang cho ngi c-
ng gip hoc c nhn tuyn gip s lm
bnh nng thm, thm ch n mc gy
cn cng gip cp.
Ngi bnh c tin s hen ph qun hoc
d ng hoc gia nh c tin s d ng
c th tng nguy c phn ng vi cht cn
quang. Trong khi tim c th xy ra co
tht ph qun, v ch mt lng nh t 0,5
162 Levonorgestrel (t trong t cung)
- 1 ml cht cn quang cng c th to cn
xanh tm nng. Co tht ph qun c th
xy ra vi bt k cht cn quang no nhng
dng nh c t l cao hn khi trong cht
cn quang c meglumin.
Chp X quang tnh mch ng tit niu
ngi bnh bit hoc nghi c u ty th-
ng thn c th lm huyt p t ngt
tng cao. Nu phi dng iodamid meglumin
ngi bnh ny th phi dng liu thp
nht, theo di huyt p tht cn thn
trong qu trnh chp, v chun b mi
thit b thuc men iu tr cp cu
tng huyt p.
Thi k mang thai
Cha c nhng nghin cu y , c
kim tra cht ch trn ngi mang thai. Tuy
nhin, cc cht cn quang hu c cha iod
khc, dng gn k sinh , gy gim
nng tuyn gip cho mt vi tr s sinh.
Ch dng cht cn quang ny khi li ch
mang li hn hn nguy c c th gy ra.
Ngoi ra, phn ln cc bc s lm sng
u c kin cho rng chp X quang
chn lc bng l chng ch nh trong
thi k mang thai v nguy c c th xy
ra cho thai nhi, do tip cn vi tia x.
Thi k cho con b
Iodamid meglumin phn b vo sa m.
V thuc c kh nng gy tc dng khng
mong mun vi tr ang b m, nn ngi
m khng nn cho con b trong t nht 24
gi sau khi dng iodamid meglumin.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Tiu ha: Bun nn, nn.
Da: My ay, nga.
Tun hon: Gin mch ngoi vi, bng
ton thn, h huyt p hoc tng huyt
p, nhp tim nhanh hoc nhp tim chm,
nh trng ngc, tc ngc.
Thn kinh cm gic: Cm gic nng.
Khc: Ht hi.
t gp, 1/1000 < ADR < 1/100
Tiu ha: V kim loi hoc ng, khn
ging, nn khan, hoc nght th, kh
nut, cm gic rt hng hoc nng quanh
hu mn.
Thn: Thiu niu hoc v niu, protein
niu nht thi, tng creatinin huyt thanh
v ur huyt nht thi, c tinh th niu
urat hoc oxalat nh, c cm ng vng h
lng.
H hp: Kh th, th nng, ho, cn hen,
th kh kh, co tht thanh qun, co tht
ph qun, th nhanh su, ph phi hoc
thanh qun, xanh tm tin trin n bt
tnh.
DTQGVN
H thn kinh: Bn chn, l ln, lo lng,
kh , nhc u, hi chong vng, chng
mt, run tay, rt run, kch ng, phn
ng hysteria, t cng u v c, ngt,
lit nh mt bn hoc cn co git.
Ti ch: Vim tnh mch huyt khi, vim
m t bo, au nhc, ban , hoc hoi
t m ti ch tim, cm gic nng hoc rt
nng, co tht tnh mch hoc au tnh
mch, xp cc b tnh mch c tim, khi
t mu, bm mu. i vi k thut dng qua
da: huyt khi hoc cc bin chng do
chn thng c hc ca k thut ny.
Mu: Gim bch cu trung tnh, tng nh
bch cu a eosin hoc tng bch cu a
base, tng bch cu tng i, hoc gim
lymph bo, ngng kt hng cu, hng cu
rng ca, cn tr to cc mu ng.
Khc: Sung huyt mi, vim mi, chy nc
mt, ban da, ph mch, ph mi mt, m
xut huyt mt hoc kt mc, ra m
hi v yu sc, n lnh, st, xanh xao, co
cng c.
Him gp, ADR < 1/1000
Tun hon: Sc, lon nhp tim (v d: rung
tht).
Tiu ha: Sng tuyn nc bt.
Hng dn cch x tr ADR
Cn theo di phn ng nng c th xy
ra ngi bnh trong khi v t nht 30 - 60
pht sau khi cho dng iodamid meglumin.
C th c nhng phn ng nng nh try
tim mch, bt tnh, co tht ph qun, ph
thanh mn, ph phi, rung tht, ngng
tim, hi chng nhi mu c tim, v lon
nhp tim.
Phi chun b sn sng y tt c
nhng thuc men v phng tin h tr
iu tr cc phn ng nng.
Vic iu tr ty thuc vo cc biu hin
lm sng. Triu chng ch quan nh, nh
cm gic nng v bun nn s mt nhanh
khi gim tc tim hoc ngng mt lc.
Trng hp phn ng nng, cn tim tnh
mch steroid da theo kinh nghim v cho
th oxygen khi cn. Sc h huyt p khng
do tim thng p ng tt nht vi liu
php b dch, nhng i khi c th cn
n thuc co mch tng huyt p.
Adrenalin tim di da ch nh ch yu
i vi phn ng co tht ph qun v cc
phn ng kiu d ng khc, nhng phi s
dng thn trng, trnh lon nhp tim. Tim
tnh mch aminophylin c th c tc dng
trong co tht ph qun. Tim tnh mch
adrenalin long (1/10000) i khi c ch
nh iu tr tru tim mch trong
phn v, nhng phi ht sc thn trng.
Tim tnh mch atropin (0,6 mg) c th
DTQGVN
cn cho phn ng i giao cm. Thuc
khng histamin tim tnh mch c tc dng
vi ph mch thn kinh, nhng li c th lm
nng thm phn ng h huyt p. i vi
cn co git nhim c ha cht phi tim
tnh mch diazepam v th oxy.
D phng cc phn ng c th:
Ngi bnh c tin s d ng cn cho dng
trc thuc khng histamin
corticosteroid. Thng ch cho dng trc
steroid, c bit ngi b hen. Trng hp
hen d ng, nn iu tr d phng bng
steroid cng vi natri cromoglycat. iu tr
trc bng prednisolon v diphenhydramin
lm gim t l phn ng ton thn tc
th. c hiu qu tt nn dng steroid
cch mt thi gian c hiu lc trc
khi dng cht cn quang. iu tr
methylprednison 24 gi v 30 pht trc khi
tim thuc cn quang c th gim ph
phi ng k. i vi ngi bnh c nguy
c cao, khi iu kin thi gian cho php,
phc iu tr 3 ngy mi ngy 32 mg
methylprednisolon vi liu cui cng cch 2
gi trc khi tim cht cn quang c th
gim c t l phn ng. Khi khng th
iu tr trc trong mt thi gian di, tim
steroid liu n cch 6 gi trc khi tim
cht cn quang cng c th c tc dng.
Trong trng hp nghi b bnh u ty thng
thn, nn cho ngi bnh iu tr trc vi
thuc chn alpha, v c nguy c gy cn
tng huyt p.
Ngi bnh thuc nhm c nguy c nn -
c tr liu d phng trc gim thiu
nguy c huyt khi v tc mch.
Liu lng v cch dng
Iodamid meglumin tim tnh mch. Ngi
bnh cn c tip nc y . Cn nhn
n trc khi dng cht cn quang trnh
ht phi thc n khi b nn. Nhit
thuc tim iodamid meglumin khi a vo
c th cn ngang bng thn nhit. Mt
s bc s lm sng ngm l thuc vo
nc m a nhit ca thuc ln
nhit ca c th. Nn chp X quang
thn thng quy trc khi dng thuc so
snh.
Chp X quang tnh mch ng tit niu:
Tr khi c chng ch nh, mt s bc s
lm sng khuyn dng thuc nhun trng
bui ti trc khi chp X quang tnh mch
ng niu. Khng nn tht tho v c th
lm tng kh d trong rut. Phn ln cc bc
s lm sng cho rng tt c ngi bnh
u cn cung cp nc. Trng hp suy
gim chc nng thn, khng nn chp X
quang tnh mch ng tit niu nhc li
Levonorgestrel (t trong t cung) 163
trong t nht 48 gi v c th gy thiu
niu hoc v niu.
chp X quang tnh mch ng niu,
tim tnh mch nhanh dung dch 65%
iodamid meglumin.
Liu ngi ln: Nh sn xut gii thiu dng
dung dch iodamid meglumin 65% tim
tnh mch nhanh vi liu thng thng 0,8
v ml/kg, ti liu ton b ti a l 50 ml, tim
trong 1 - 2 pht. Phn ln cc bc s lm
sng u khuyn liu thng thng cho
ngi ln c th trng trn 45 kg dng dung
dch 65%, tim tnh mch nhanh l 35 -
85 ml.
Liu tr em: Nh sn xut gii thiu dng
dung dch iodamid meglumin 65% tim
tnh mch nhanh vi liu thng thng 20
ml cho tr em 11 - 12 tui, 18 ml cho tr
em 8 - 10 tui, 15 ml cho tr em 6 - 7
tui, 12 ml cho tr em 3 - 5 tui, 10 ml
cho tr em 1 - 2 tui, 8 ml cho tr em t 6 -
12 thng tui, v 5 ml cho tr em di 6
thng tui. Phn ln cc bc s lm sng
u khuyn liu thng thng dung dch
iodamid meglumin 65% tim tnh mch
nhanh tr em c th trng 4,5 - 45 kg l
25 - 30 ml v tr em c th trng di 4,5 kg
l 10 ml. Hoc mt s bc s lm sng
khc li khuyn dng liu khong 2 ml/kg
cho tr em c th trng t 4,5 kg n
12,5 kg.
1 - 10 pht sau khi tim tnh mch nhanh
iodamid meglumin, l c th nhn r -
ng niu nht ngi bnh c chc nng
thn bnh thng; nhng ngi suy thn
th sau 30 pht hoc lu hn c th vn
khng nhn thy. Nu cn, c th chp X
quang bng quang 20 pht sau khi tim
tnh mch nhanh ngi bnh c chc
nng thn bnh thng.
ngi bnh tng huyt p, c th chp
phim X quang thn v/hoc chp phim X
quang lin tip v nhanh ng niu ngay
sau khi tim thuc tnh mch nhanh
pht hin bnh v mch thn.
Tng tc thuc
Thuc c tc dng tng bi tit acid uric c
th thc y bnh thn pht trin.
Thuc chng vim khng steroid cng c
th lm tng nguy c ni trn.
Nu ang dng metformin, c nhiu nguy
c gy nhim acid lactic hn.
iu tr trc bng interleukin - 2 r rng c
th gy phn ng qu mn khng in
hnh ca cht cn quang di dng nhiu
kiu gy c khc nhau v khng th
phng nga nhng phn ng ny bng tr
liu trc vi steroid.
164 Levonorgestrel (t trong t cung)
Hydralazin dng nh lm tng nguy c vim
mch di da cp tnh.
n nh v bo qun
Cn bo qun trnh nh sng v nhit
cao. C th hnh thnh cc tinh th trong
cc ch phm iodamid meglumin; c th
lm tan tinh th bng cch ngm l thuc
vo nc nng, thnh thong lc.
Tng k
Thuc tim iodamid meglumin tng k v
l hc vi thuc tim diphenhydramin
hydroclorid.
V c th to thnh ta, nn cc cht cn
quang tia X v thuc khng histamin
khng c trn chung trong bm tim.
Qu liu v x tr
c nhng trng hp ng c t ngt
gy t vong tr nh. Bin chng dn
n t vong l ph phi cp hoc co git.
Co git c th do trng thi tng thm thu
hoc do c tnh ha hc ca cht cn
quang.
Khng c thuc gii c c hiu cho
iodamid meglumin, nn phi iu tr
triu chng. Trng hp qu liu do s xut
hoc b suy thn nng, c th loi cht
cn quang bng thm tch, v cn iu
chnh cn bng nc v cc cht in
gii.
Thng tin qui ch
Iodamid meglumin phi k n v bn
theo n.
Iohexol
Tn chung quc t: Iohexol.
M ATC: V08A B02.
Loi thuc: Cht cn quang loi khng ion
ha.
Dng thuc v hm lng
Thuc tim iohexol 140 mg iod/ml; l 50
ml, 200 ml.
Thuc tim iohexol 180 mg iod/ml; l 10 ml, 15
ml, 50 ml.
Thuc tim iohexol 210 mg iod/ml; l 15
ml, 50 ml, 100 ml.
Thuc tim iohexol 240 mg iod/ml; l 10
ml, 20 ml, 50 ml, 200 ml.
Thuc tim iohexol 300 mg iod/ml; l 10
ml, 20 ml, 40 ml, 50 ml, 75 ml, 100 ml,
200 ml.
Thuc tim iohexol 350 mg iod/ml; l 20
ml, 40 ml, 50 ml, 100 ml, 200 ml.
DTQGVN
Tt c cc ch phm trn u cha 1,21
mg tromethamin v 0,1 mg calci dinatri
edetat.
Dc l v c ch tc dng
Iohexol l mt thuc cn quang khng ion
ha. Thuc c kh nng tng hp thu X -
quang khi thuc i qua c th, v vy
lm hin r cu trc c th. Mc cn
quang ca thuc t l thun vi ton lng
(nng v th tch) cht cn quang c
iod trn ng tia X.
Truyn nh git iohexol vo bng quang,
thn, niu qun, t cung v vi t cung
cho php nhn thy nhng vng ny.
Sau khi tim trong mng no ty vo
khoang di mng nhn, iohexol khuch tn
vo dch no ty v cho php nhn thy
khoang di mng nhn u v ng
sng.
Sau khi tim vo mch, iohexol cn quang
lm mch ny hin r trn dng chy v
cho php nhn thy cu trc bn trong
cho n khi mu b pha long ng k.
Dc ng hc
Khi truyn nh git vo bng quang, c
mt lng nh iohexol c hp thu qua bng
quang. Khi truyn nh git vo t cung,
phn ln iohexol trong khoang t cung
thot xung m o ngay sau khi kt
thc th thut. Tuy nhin, bt c cht cn
quang no cn li trong t cung hoc
khoang mng bng u c hp thu ton
thn trong vng 60 pht. Nu cc ng, vi
trng b tc nghn v gin n th c th
ti 24 gi iohexol cha c hp thu.
Khi tim trong mng no ty, iohexol
khuch tn ln pha trn nh dch no ty,
thm vo cc bao r dy thn kinh, nhnh
r dy thn kinh v cc vng hp ca
khoang di mng nhn. Iohexol cng vo
dch ngoi t bo m no v mt mng
mm m no v tiu no k st cc vng d i
mng nhn. ngi c tun hon dch no
ty bnh thng, iohexol t dch no ty
thi tr vo mu trong vng vi gi.
Sau khi tim tnh mch iohexol phn b
nhanh khp dch ngoi t bo, khng
ng li ng k trong cc m, khng qua
hng ro mu - no, nhng c tch t trong
m k cc khi u c tnh no do khi u
ph v hng ro mu - no.
Di 2% thuc lin kt vi protein huyt tng.
Na i ca thuc ngi bnh c chc
nng thn bnh thng khong 2 gi. Nng
nh trong huyt thanh t ngay sau
khi tim vo mch, nhng st xung nhanh v
iohexol phn b khp cc ngn ngoi mch
mu.
DTQGVN
Thi gian t tc dng cn quang tt nht
thay i ty theo th thut v vng tin
hnh chp X quang; i vi chp X quang
ty sng thng thng: t ngay v trong
vng 30 pht; i vi chp X quang ty
sng ct lp in ton: 1 gi (vng ngc),
2 gi (vng c), 3 n 4 gi (b y);
i vi chp X quang ng mch: t
ngay; i vi chp thn ng tnh mch:
5 n 15 pht.
Iohexol chuyn ha khng ng k. Thn
bi tit n 95% thanh thi ton c
th. ngi bnh c chc nng thn suy
gim, iohexol thi tr ko di ty theo mc
suy gim; v th m lm ko di thi
gian c nng iohexol trong huyt t-
ng, bi tit qua ti mt v vo rut non
c th tng.
Ch nh
Iohexol c dng rng ri trong X quang
chn on, bao gm: Chp bng quang -
niu o ngc dng; chp t cung - vi
trng; chp ty sng vng tht lng, ngc,
c v ton ct (phng php chp thng
thng hoc chp ct lp in ton); chp
ng mch ch (cung ng mch ch,
ng mch ch ln, ng mch ch bng
v cc nhnh); chp ng mch no hoc
ngoi vi; chp tnh mch ngoi vi; chp
ng mch v tnh mch loi tr nn (x-
ng, m mm), (hoc k thut chp
ng mch v tnh mch in ton - loi
tr) u, c, bng, thn v ngoi vi;
chp niu tnh mch; chp thot v
ngi ln; lm ni bt hnh nh chp ct
lp in ton (chp no, chp c th);
chp ty ngc dng ni soi v chp ng
mt ty ngc dng ni soi; chp khp; ung
iohexol pha long kt hp vi tim tnh
mch iohexol tng tng phn trong
chp ct lp in ton bng; ung
iohexol khng pha long chp X quang
ng tiu ha.
Chng ch nh
i vi tt c cc th thut, chng ch nh
iohexol ngi c tin s d ng hoc hen,
ngi suy thn nng.
S dng trong mng no ty: Chng ch
nh iohexol ngi nghin ru mn, ngi
b chy mu di mng nhn, ngi c tin
s ng kinh, ngi b nhim khun ton
thn hoc cc b nng, hoc b x
cng lan ta.
S dng trong mch: Chng ch nh
ngi cng gip v ngi b bnh hng
cu lim.
S dng chp tim mch: Chng ch nh
ngi suy tim khi pht, ngi b tng huyt
p ng mch phi nng.
Levonorgestrel (t trong t cung) 165
Chp X quang ng mch no: Chng ch
nh ngi b x cng ng mch lu
ngy (nng), ngi b tim mt b, ngi mi
b nghn mch no, ngi tng huyt p
nng, lo suy hoc b huyt khi.
Thn trng
Ngi mn cm vi iod v cc cht cn
quang c iod khc cng c th mn cm
vi iohexol, v c th tng nguy c phn
ng dng phn v.
Dng iohexol chp t cung - vi trng,
c th tng nguy c bin chng ngi b
nhim khun ng sinh dc, lm nng
thm bnh vim vng chu cp tnh. Nn
thn trng c ngay sau khi phu thut t
cung hoc c t cung trnh nguy c
gy bin chng.
Khi tim vo mch, iohexol c th lm
huyt p tng nhanh ngi c u t bo a
chrom; phi duy tr liu iohexol mc ti
thiu v phi theo di huyt p trong qu
trnh tin hnh; cng nn iu tr trc
bng thuc chn alpha - adrenergic, th d
phentolamin.
Dng iohexol chp X quang ng mch no,
c th tng nguy c huyt khi v nghn
mch ngi b homocystin niu.
Dng chp X quang ng mch ngoi vi,
iohexol c th gy co tht mnh tnh
hoc ng mch trong bnh Buerger, c
th tng nguy c bin chng ngi thiu
mu cc b nng do nhim khun i ln.
Dng chp thn qua ng tnh mch,
iohexol c th tng nguy c suy thn cp
ngi i tho ng.
Dng chp X quang khp, iohexol c th
tng nguy c bin chng ngi b nhim
khun ti hoc gn khp kho st.
Thi k mang thai
Cha c nhng nghin cu y , c kim
tra cht ch, v vic dng iohexol cho ngi
mang thai. Tuy nhin, cc cht cn quang
hu c cha iod khc dng gn ngy sinh
gy gim nng gip mt vi tr s sinh.
Hn na, cng khuyn khng dng X
quang chn lc bng trong thi k mang
thai v nguy c ca tia X gy ra cho thai
nhi.
Khng nn truyn nh git vo t cung
trong thi k mang thai hoc t nht 6
thng sau khi sinh v th thut c th lm
tng nguy c bin chng nh gy nhim
khun trong t cung.
Thi k cho con b
Mc du cha bit iohexol bi tit trong
sa m ti mc no, nhng khuyn
khng nn cho con b trong t nht 24 gi
sau khi dng iohexol.
166 Levonorgestrel (t trong t cung)
Tc dng khng mong mun (ADR)
Tc dng khng mong mun c th thay
i trc tip theo nng , k thut s
dng v bnh l c bn. Tng p lc thm
thu, th tch, nng , nht v tc
dng thuc c th lm tng t l v
tnh nghim trng ca cc tc dng khng
mong mun.
Phn ln cc tc dng khng mong mun
thng t gii hn v khng lu di.
Thng gp, ADR>1/100
Ton thn: Nhc u nh hoc va, au
lng, chng mt, au (c th do p lc v
th tch khi tim vo ng gan, ng ty).
Tiu ha: Bun nn v nn nh hoc va
(tim di nhn hoc mch mu); a chy
nh v tm thi (khi ung); au bng
hoc d dy, kh chu (tim vo ti mt
hoc t cung).
Thn kinh: Kch ng mng no (cng c)
(ch khi dng ng no ty).
Tun hon: Nhp tim chm (chp X quang
tim mch).
C xng: au khp hoc lm bnh au
khp nng ln, sng khp (tim vo bao hot
dch).
t gp, 1/100>ADR>1/1000
Ton thn: Nhc u nng, mt mi tht
thng hoc yu c, v m hi (tim vo d-
i nhn), st (tim mch mu, ti mt).
Tiu ha: Chn n (tim vo di nhn), v
kim loi (tim mch mu), cng gin thn -
b thn (tim ti mt, t cung).
Thn kinh: Cm gic nng tht thng v
nh, tai (tim vo di nhn); ng g (tim
vo di nhn, mch mu, ti mt, t cung).
Mt: Tng nhy cm vi nh sng (tim vo
di nhn), nhn m hoc c cc thay i
th gic khc (tim mch mu).
Tit niu - sinh dc: Tiu tin kh (tim vo
di nhn).
Da: My ay (tim mch mu).
Ti ch: au hoc nng rt ti ch tim (tim
mch mu).
Him gp, ADR < 1/1000
Phn ng mn cm: Phn ng dng phn
v; phn ng d ng gi c biu hin nh n
lnh lin tip, st lin tip, v m hi, ban da
hoc my ay, nght mi, ht hi, sng
mt hoc da, ph thanh qun, th kh kh,
nng ngc hoc ri lon th (tt c cc -
ng dng thuc).
Lu : Phn ng d ng gi c tch cht tm
thi v c th l nhng biu hin khi
u ca phn ng dng phn v nng
hn.
Tun hon: H huyt p nng (tim vo di
nhn hoc tim mch mu), nhim c
DTQGVN
tim, gy nhp tht nhanh hoc rung tht,
vim tnh mch huyt khi, nhp tim
chm (tim mch mu).
Thn kinh: Vim mng no v khun (tim
vo di nhn), co git (tim mch mu).
H hp: Co tht ph qun hoc ph phi
(tim vo di nhn hoc tim mch mu).
Hng dn cch x tr ADR
Phn ng ging d ng nh: Tim tnh
mch thuc khng histamin nh
diphenhydramin hydroclorid (tr ngi bnh
ng kinh).
Phn ng nng hoc e da tnh mng:
Theo di cn thn cc du hiu sng v
tin hnh iu tr cp cu k c h hp
nhn to vi oxy, nu cn, i vi suy h
hp, v p tim trong trng hp ngng tim.
Phn ng dng phn v hoc phn ng
ging d ng cp: Truyn tnh mch chm
0,1 mg adrenalin (1:10.000).
Co tht ph qun va v nh: Tim di da
0,1 mg n 0,2 mg adrenalin (1:1000), tr
trng hp h huyt p khi ang dng thuc
chn beta. Trng hp ht sc khn cp,
truyn tnh mch chm 0,1 mg adrenalin
(1:10 000), sau truyn lin tc vi tc
khi u 0,001 mg/pht, tng tc
n 0,004 mg/ pht, nu cn. (Lu : Ngi
bnh ang dng cc cht chn beta -
adrenergic khng nn cho dng adrenalin
v gy nguy c kch thch alpha -
adrenergic qu mc, c th dn n tng
huyt p, nhp tim chm phn x v block
tim. nhng ngi bnh ny, thay adrenalin
bng dng isoproterenol khc phc co
tht ph qun v noradrenalin gii
quyt h huyt p).
Ngng tim: Tim tnh mch 0,1 n 1 mg
adrenalin.
phc hi li huyt p, truyn tnh mch
cc dch v/hoc thuc tng huyt p.
Nu do h huyt p m cn thuc tng
huyt p, th truyn chm noradrenalin
0,008 n 0,012 mg/pht hoc
phenylephedrin 0,1 n 0,18 mg/pht,
c pha long thch hp. Nu h huyt p
do cng i giao cm (phn ng i giao
cm vn - mch), th tim tnh mch 1 mg
atropin, sau mt n hai gi tim nhc li
nu cn.
kim sot cn co git, tim tnh mch
chm 5 n 10 mg diazepam, hoc tim
bp hoc tnh mch phenobarbital natri
vi tc d khng c qu 30 n 60
mg/pht.
iu tr trc bng corticosteroid v/hoc
thuc khng histamin c th gim thiu t
l v tnh nghim trng ca phn ng
nhng ngi c tin s phn ng nng vi
cht cn quang hoc c nhng nguy c
DTQGVN
cao (nh hen hoc c tin s d ng, mt
nc, tin s ng kinh, u t bo a chrom).
Mt vi cng trnh nghin cu cho thy
rng dng thm ephedrin c tc dng tt
phng nga cc phn ng dng phn
v (tr nhng ngi c tin s tng
huyt p hoc c bnh tim mch).
Liu lng v cch dng
Liu lng v hm lng dng thay i ty
theo k thut v ng dng cht cn
quang.
Chp X quang ty sng:
Phi tim trong mng no ty chm trong
thi gian 1 n 2 pht trnh ha ln
qu nhiu vi dch no ty, dn n lm
long iohexol v lm thuc phn tn sm
v pha u.
Khng nn tim lp li ngay, v c nguy
c gy qu liu. Sau 48 gi hoc tt hn
l 5 n 7 ngy mi nn tim li.
Liu ngi ln thng thng:
10 - 15 ml dung dch cha 18% iod, hoc
6 - 12 ml dung dch cha 24% iod, hoc 6
- 10 ml dung dch cha 30% iod.
Liu tr em thng thng:
Tr nh di 3 thng tui: 2 - 4 ml dung dch
cha 18% iod, hoc 2 - 3 ml dung dch
cha 21% iod.
Tr nh t 3 thng n 3 tui: 4 - 8 ml
dung dch cha 18% iod, hoc 3 - 6 ml
dung dch cha 21% iod.
Tr em t 3 n 7 tui: 5 - 10 ml dung
dch cha 18% iod, hoc 5 - 8 ml dung
dch cha 21% iod.
Tr em t 7 n 13 tui: 5 - 12 ml dung
dch cha 18% iod, hoc 5 - 10 ml dung
dch cha 21% iod.
Tr em t 13 n 18 tui: 6 - 15 ml dung
dch cha 18% iod hoc 6 - 14 ml dung
dch cha 21% iod.
Chp X quang tim mch (tim mch mu):
Liu ngi ln thng thng: 30 - 295 ml
dung dch cha 35% iod.
Liu tr em thng thng: 1,75 ml/kg th
trng n tng liu ti a l 291 ml
dung dch cha 30% iod, hoc 1,25 ml/kg
th trng n tng liu ti a l 250 ml
dung dch cha 35% iod.
Chp X quang tnh mch:
Liu ngi ln thng thng: 40 - 150 ml
dung dch cha 24% hoc 30% iod.
Chp tnh mch ng tit niu:
Liu ngi ln thng thng: 0,7 - 1,3 ml/kg
th trng, dung dch cha 30% hoc 35%
iod.
Liu tr em thng thng: 1 - 1,5 ml/kg th
trng, dung dch cha 30% iod, khng c
tim qu tng liu 3 ml/kg th trng.
Chp ct lp in ton bng (ung phi
hp vi tim tnh mch):
Levonorgestrel (t trong t cung) 167
Liu ung ngi ln dng cch 20 n 40
pht, tr em cch 30 n 60 pht trc liu
tim tnh mch.
Liu ngi ln thng thng: Ung 500 n
1000 ml dung dch cha 0,6 n 0,9%
iod, phi hp vi tim tnh mch 100 n
150 ml dung dch cha 30% iod.
Liu tr em thng thng: 180 n 750 ml
dung dch cha 0,9 n 2,1% iod cho
ung lm mt ln hoc trong 30 n 45
pht, dng phi hp vi tim tnh mch 1
n 2 ml/kg th trng dung dch cha
24% hoc 30% iod. Tng liu ung khng
c vt qu liu tng ng vi 5 g iod i
vi tr em di 3 tui, 10 g iod i vi tr em
t 3 n 18 tui. Tng liu tim tnh
mch khng c vt qu 3 mg/kg th trng.
Chp X quang ng tiu ha:
Liu ngi ln thng thng: Ung 50 n
100 ml dung dch cha 35% iod.
Chp X quang bng quang - niu o ngc
dng:
Liu ngi ln thng dng: Truyn nh git
vo bng quang 50 ml n 300 ml dung
dch cha 10% iod hoc 50 ml n 600
ml dung dch 5% iod, ty theo tui v
dung tch ca bng quang.
Chp t cung - vi trng: Liu ngi ln
thng thng: Nh git vo t cung 15 -
20ml dung dch 24% hoc 30% iod.
Tng tc thuc
Tim mch mu iohexol ng thi vi cc
cht chn beta - adrenergic c th tng
nguy c gy phn ng dng phn v va
v nng; tc dng h huyt p cng c
th nng ln.
Cc thuc ung chp X quang ti mt
c th lm tng nguy c gy c vi thn
khi cn tim mch mu iohexol ngay sau
, c bit ngi bnh suy chc nng
gan.
C th tng nguy c h huyt p nng nu
dng iohexol ng thi vi cc thuc c tc
dng h huyt p.
Tim iohexol trong mng no ty hoc
trong mch ng thi vi dng cc thuc
gy c thn khc c th tng kh nng
nhim c thn.
n nh v bo qun
Bo qun nhit phng, t 15 n
300C trong l trnh nh sng. Trnh lm
ng lnh.
Iohexol l dung dch trong, khng mu
hoc c mu vng nht. Khng c dng
nu dung dch b vn c hoc bin
mu. Phn cn li khng dng n phi b.
Thng tin qui ch
Iohexol c trong danh mc thuc thit yu
Vit Nam ban hnh ln th 4 nm 1999.
Thuc c bng B.
168 Levonorgestrel (t trong t cung) DTQGVN

IPRATROPIUM BROMID tn; trong co tht ph qun cp th khng

my tc dng nu ch dng mt mnh.
Tn chung quc t: Ipratropium bromide. Ch nn dng thuc ny cho nhng ngi
bnh no dng cc thuc kch thch beta 2
M ATC: R01A X03, RO3B B01.
vi liu thng thng m b tc dng ph
Loi thuc: Thuc gin ph qun khng nng. Trong nhng trng hp ny,
acetylcholin. ipratropium c th thay th hon ton
Dng thuc v hm lng thuc kch thch beta2 hoc dng phi hp
vi thuc kch thch beta 2 liu thp (v d
Dch cho kh dung: 4 mg/10 ml, trong dng
Combivent). Trong cn hen cp th phi
c bm thuc theo liu (200 liu).
phi hp vi thuc khc (corticoid, thuc
Dung dch phun sng: 0,25 mg/2 ml (cho kch thch beta2...).
tr em); 0,5 mg/ml (cho ngi ln). Dng phi Ipratropium v cc thuc khc dng iu
hp vi thuc kch thch beta2 iu tr tr hen v bnh nghn phi mn tnh
hen nng, cn hen c tnh ti cc trung (glucocorticoid, salbutamol) khng c tc
tm chuyn khoa. dng cha khi bnh hon ton hoc loi
Dung dch nh mi: 4 mg/10 ml. tr c cn hen ti pht. Xem thm chi tit
Dch phun mi (xt mi) 0,03% (chai v iu tr hen cc phn khc
30 ml) v 0,06% (chai 15 ml). (salbutamol, glucocorticosteroid, theophylin,
Dc l v c ch tc dng adrenalin, chromoglicat).
Ipratropium l thuc khng acetylcholin nn Dng trong thm d chc nng h hp.
c tc dng c ch i giao cm. Khi c Dng trong tc nghn ng dn kh c hi
phun, ht, thuc c tc dng chn lc gy phc, nht l trong vim ph qun mn
gin c trn ph qun m khng nh hng tnh.
n s bi tit dch nhy ph qun, n Chy nc mi nhiu khng do nhim khun
cc chc nng khc ca c th, c bit ngi trn 12 tui (dung dch nh
l chc nng ca tim - mch, mt v ng mi).
tiu ha. Chng ch nh
Dc ng hc: Khng dng ipratropium bromid cho ngi
Tc dng gin ph qun xut hin khong 3 bnh c tin s qu mn vi lecithin u
pht sau khi phun, ht thuc v ko di t nnh (l t dc trong thnh phn ca thuc)
4 n 6 gi. Mc gin ph qun khng hoc vi cc thc phm nh u nnh, lc.
ph thuc vo nng ipratro- Khng dng ipratropium bromid cho ngi
pium trong huyt tng. Tc dng ln bi bnh qu mn vi atropin v dn xut
tit dch mi xut hin 5 pht sau khi dng atropin.
thuc t mc ti a trong vng 1 n 4
gi v ko di ti 8 gi. Thn trng
Thuc hp thu km ng tiu ha; khng Khng bt u dng ipratropium bromid
i qua hng ro mu - no. Nu ung hoc giai on cp ca co tht ph qun ang
dng thuc ngoi ng tiu ha th ch c i hi phi c gii quyt co tht nhanh.
15 - 30% liu dng c hp thu. Lng thuc Thn trng khi dng ipratropium bromid cho
c hp thu cc ph qun l rt nh. nhng ngi bnh glcm gc hp, ph i
Na i thi tr l khong 3,5 gi. Thuc tuyn tin lit, cht hp c bng quang.
ch yu o thi qua nc tiu. B glcm, nu phi dng thuc th phi
Hin nay, ipratropium c phi hp vi che mt trnh thuc c th bn vo
salbutamol theo t l 3,0 mg salbutamol mt. Nn dng dng bm kh dung.
sulfat (= 2,5 mg salbutamol base) v 0,5 mg Ngi bnh tit nhiu m di cn c
ipratropium bromid (bit dc: Combivent). S iu tr thch hp trc v trong khi dng
phi hp hai loi thuc ny c tc dng lm thuc.
gin ph qun mnh hn ipratropium cho Khi ngi bnh cm thy liu dng thng th-
php gim liu salbu- tamol, do hn ch ng tr nn km tc dng cn phi tng
c tc dng ph ca thuc kch thch liu thuc gin ph qun hng ngy, th
beta2. l du hiu bnh nng hn. Lc ny
Ch nh ngi bnh nn n thy thuc khm,
Hin nay, ipratropium khng cn c coi l khng nn t tng liu ln mi.
thuc hng u iu tr hen. N ch
Thi k mang thai
c s dng khi cc thuc kch thch beta 2
Mc d trn thc nghim khng thy thuc
tc dng khng mnh hoc c tc dng
ph nng. Trong iu tr duy tr i vi c tc dng gy qui thai nhng vn khng
bnh hen, ipratropium ch c vai tr khim
DTQGVN
nn dng thuc cho ngi bnh trong nhng
thng u mang thai.
Thi k cho con b
Trnh dng thuc cho ngi cho con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Kh ming, mi, hng b kch ng.
Ri lon iu tit mt.
t gp, 1/1000 < ADR < 1/100
B tiu tin.
Him gp, ADR < 1/1000
Ton thn: p ng phn v.
Tun hon: Nhp tim nhanh, nh trng
ngc.
Ngoi da: Ph Quinck, ni my ay.
Tiu ha: Ri lon nhu ng.
H hp: Co tht ph qun, co tht thanh
qun.
Glcm: Nguy c xut hin glcm cp
ngi bnh c tin s glcm gc hp.
Liu lng v cch dng
Hen l mt bnh tin trin theo thi gian
vi cc mc nng nh rt khc nhau;
v vy liu dng phi ty tng ngi. Vic
iu chnh liu hng ngy v s ln dng
thuc (glucocorticoid v cc thuc gin ph
qun) phi da vo kt qu thm d chc
nng h hp, vo lu lng nh th ra. Nu
khng c my o lu lng nh th c th
hng dn ngi bnh thi vo mt qu bng
nh gi.
Dng kh dung: Ngi ln v tr trn 6 tui:
20 - 40 microgam (1 - 2 xt), 3 - 4 ln mi
ngy; tr di 5 tui: 20 micrgam (1 xt) 3
ln mi ngy.
Dng phun sng: 100 - 500 microgam, c
th ti 4 ln mi ngy. Tr 3 - 14 tui: 100 -
500 microgam, c th n 3 ln mi ngy.
Ch : Tc dng ca thuc cn ph thuc
vo vic s dng dng c phun thuc, phi
hp gia tay v th l iu kh lm, nht
l i vi tr em. C th lm tng tc dng
ca liu thuc bng cch dng mt bnh
cha bng cht do c bit, t hp ph
cc ht thuc, ni vi dng c phun thuc.
V d dng cc giy ph nha: c mt l
nh y cc t va u phun ca
dng c p cc vo mi ming; bm mt
liu vo trong cc th liu s ta ra
trong cc, ngi bnh ht su vi hi. V
ngi bnh khng phi phi hp vic xt
thuc v vic ht vo nn dng thuc c
d dng hn v tc dng ca liu thuc
c th tng ln.
iu tr chy nhiu nc mi khng do
nhim khun: 40 microgam vo mi l mi,
2 - 4 ln mi ngy. Khng cn phi tng s
ln ht hay s ln dng thuc trong ngy
v thuc c tc dng ko di.
Levonorgestrel (t trong t cung) 169
n nh v bo qun
Trnh thuc ch nng (trn 50C). Trnh
nh sng mt tri.
Qu liu v x tr
Lm dng thuc c th lm tng nguy c
tc dng ph. Trng hp ny ch cn iu
tr triu chng v gim liu.
Thng tin qui ch
Thuc c bng B.
Irbesartan
Tn chung quc t: Irbesartan.
M ATC: C09C A04.
Loi thuc: Thuc iu tr tng huyt p
thuc nhm cht i khng th th
angiotensin II.
Dng thuc v hm lng
Vin nn 75 mg, 150 mg, 300 mg.
Vin nn phi hp vi hydroclorothiazid:
150 mg/12,5 mg; 300 mg/12,5 mg.
Dc l v c ch tc dng
Irbesartan l mt dn cht tetrazol, mt
cht phong b cc th th typ I ca
angiotensin II typ AT 1. Irbesartan c ch
tc dng sinh l ca angiotensin II, k c
tc dng tit aldosteron v co mch, do c
ch chn lc th th AT1 ca angiotensin II
nhiu m, bao gm c tuyn thng thn
v c trn thnh mch.
Liu thng thng irbesartan c tc dng
lm h huyt p tng t nh liu thng th-
ng ca losartan, enalapril hoc atenolol,
nhng khc vi losartan, irbesartan khng
phi l mt tin cht v tc dng dc l
khng ph thuc vo s thy phn gan.
Irbesartan cng khng ging cc thuc c
ch enzym chuyn, irbesartan khng c
ch enzym chuyn angiotensin I thnh
angiotensin II v nh vy khng c ch s
ging ha bradykinin v cc kinin khc, nn
khng gy ho khan dai dng, mt tc
dng khng mong mun ph bin khi
dng cc thuc c ch enzym chuyn.
Khi dng irbesartan vi liu c khuyn
co, kali huyt khng thay i nhiu tr
khi c suy thn v/hoc suy tim.
Thuc lm h huyt p nhng tn s tim
thay i rt t. Tc dng h huyt p ph
thuc vo liu v c khuynh hng khng h
thm khi ung mt liu cao hn 300 mg/1
ln mi ngy. Huyt p h ti a trong
khong 3 - 6 gi sau khi ung. Tc dng
chng tng huyt p duy tr t nht 24 gi.
Hiu qu chng tng huyt p biu hin
trong vng 1 - 2 tun, hiu qu ti a t
c trong vng 4 - 6 tun k t khi bt
170 Levonorgestrel (t trong t cung)
u iu tr v duy tr khi iu tr lu
di. Nu ngng iu tr, huyt p li dn
dn tr li tr s ban u, nhng khng c
hin tng bnh nng t ngt khi ngng
thuc.
Tc dng chng tng huyt p ca
irbesartan v thuc li tiu thiazid c tnh
cht cng hp.
Dc ng hc
Thuc hp thu nhanh qua ng tiu ha vi
sinh kh dng t 60 - 80%. Thc n khng
lm thay i nhiu tnh sinh kh dng
ca thuc.
Thuc chuyn ha mt phn gan
to thnh cc sn phm khng c hot
tnh. Nng nh trong huyt tng
t c khong 1 - 2 h sau mt liu
ung. Nng thuc trong mu t n
trng thi cn bng n nh sau 3 ngy
ung thuc. Irbesartan lin kt 96% vi
protein huyt tng. Th tch phn b
ca thuc vo khong 53 - 93 lt. Thuc
thi tr qua mt v nc tiu. Sau khi ung
hoc tim tnh mch, khong 20% lng
thuc thi tr qua nc tiu dng chuyn
ha v di 2% dng khng chuyn ha.
Na i bn thi l 11 - 15 h.
Ch nh
Tng huyt p ng mch v cn, c
bit cho nhng trng hp dng thuc c
ch enzym chuyn b ho v gim
nguy c b t qu ngi b ph i
tht tri.
Bnh thn do i tho ng typ 2 c tng
huyt p.
Chng ch nh
Qu mn vi mt trong cc thnh phn ca
thuc.
Ph n c thai.
Ph n ang cho con b.
Thn trng
Gim th tch mu: nhng ngi bnh b
gim th tch mu nh mt mui v nc do
dng nhm li tiu mnh, tiu chy hoc
nn ko di. Cn thit phi iu tr gim
th tch mu trc khi cho dng irbesartan.
Hp ng mch thn: Vi nhng ngi
bnh b hp ng mch thn khi dng
irbesartan c nguy c tt huyt p nng
v suy gim chc nng thn.
Ghp thn hoc suy thn: Cn phi thn
trng vi nhng ngi bnh ny. Kim tra
thng xuyn nng kali v creatinin
huyt l cn thit.
Kali huyt cao: C th gp phi hin tng
tng kali huyt khi dng irbesartan c
DTQGVN
bit l nhng ngi bnh c chc nng
tim, thn km. Vi nhng ngi bnh ny
nn thng xuyn kim tra kali huyt. Trnh
dng ng thi irbesartan vi thuc li tiu
gi kali.
Cng aldosteron tin pht: Nhng ngi
bnh cng aldosteron tin pht thng
khng p ng vi cc thuc chng cao
huyt p tc dng thng qua c ch h
renin-angiotensin nn irbesartan cng
khng c tc dng trn nhng ngi bnh
ny.
Cng nh vi cc thuc gin mch khc,
irbesartan phi dng thn trng trong cc
bnh nh: Hp van ng mch ch v hp
van hai l, bnh c tim ph i tc
nghn.
Ni chung irbesartan phi dng thn trng
cho ngi bnh c trng lc thnh mch v
chc nng thn ph thuc ch yu vo
hot ng ca h renin-angiotensin-
aldosteron (th d ngi bnh b suy tim
sung huyt nng hoc b mt bnh thn
nng nh hp ng mch thn hai bn):
Nguy c h huyt p mnh, t ngt d
gy nhi mu c tim hoc tai bin mch
mu no
Thi k mang thai
Chng ch nh dng thuc cho ph n
ang mang thai.
Trong 3 thng u thai k chng ch
nh do thn trng. Trong 3 thng gia
hoc 3 thng cui ca thai k: C th gy
nh hng trc tip ln h thng renin-
angiotensin, gy suy thn bo thai
hoc tr s sinh, bin dng s mt, thm
ch lm cht thai. Khi pht hin c thai,
ngng thuc cng sm cng tt, nu
dng thuc trong mt thi gian di, cn
kim tra chp s v chc nng thn bng
siu m cho thai nhi.
Thi k cho con b
Chng ch nh dng thuc cho ph n
ang cho con b.
Tc dng khng mong mun (ADR)
ADR thng nh v thong qua
Thng gp, ADR > 1/100
Chng mt, nhc u v h huyt p th
ng lin quan n liu dng.
Tt huyt p c th xy ra, c bit
ngi bnh b gim th tch mu (v d
nhng ngi bnh ang dng thuc li tiu
liu cao). Suy thn v gim huyt p
nng khi c hp ng mch thn 2 bn.
t gp, 1/1000 < ADR < 1/100
DTQGVN
Ban da, my ay, nga, ph mch, tng
enzym gan. Tng kali huyt, au c, au
khp.
Him gp, ADR < 1/1000
Ho, ri lon h hp, au lng, ri lon tiu
ha, mt mi, gim bch cu trung tnh.
Hng dn cch x tr ADR
Cc tc dng khng mong mun him xy
ra, thng nh, khng cn x tr g c
bit. Nu bt u dng thuc nn ch
iu tr gim th tch mu nu c.
Liu lng v cch dng
Liu lng ca irbesartan phi c iu
chnh cho tng ngi bnh cn c vo p
ng lm sng.
Liu khi u v duy tr thng thng
hng ngy l 150 mg, ung mt ln duy
nht trong ngy, c th ung trong, trc
hoc sau ba n.
Liu 150 mg mt ln duy nht trong ngy
cho php kim sot huyt p trong 24 gi
tt hn liu 75 mg. Nhng liu 75
mg/ln/ngy c ch nh cho cc ngi
bnh phi lc mu hoc ngi trn 75 tui.
Nu liu 150 mg/ln/ngy khng
kim sot huyt p th c th tng liu
ln 300 mg/ngy hoc dng thm mt
thuc chng tng huyt p khc. V d
nu kt hp irbesartan vi mt thuc li
tiu nh hydroclorothiazid s thu c mt
tc dng h huyt p cng hp.
Suy thn: Khng cn iu chnh liu
nhng ngi bnh suy thn. Vi nhng ngi
bnh phi lc mu liu khi u l 75
mg/ngy.
Gim th tch mu: Khi b gim th tch
mu hoc mt nc v mui th cn khc
phc nhng hin tng ny trc khi dng
irbesartan.
Suy gan: Khng cn iu chnh liu vi
cc ngi bnh c suy gan nh hoc va.
Cha c kinh nghim lm sng vi suy gan
nng.
Tr em: Cha xc nh c v tnh an ton
v hiu qu ca irbesartan trn tr em.
Ni chung, liu dng cn c iu chnh
sau 1 - 2 thng nu huyt p cha c
kim sot. C th cn iu tr nhiu
thng mi kim sot tt c huyt p.
Qu liu v x tr
Liu ti 900 mg/ngy dng cho ngi ln
trong 8 tun khng gy bt c mt du
hiu c tnh cp no. Trong trng hp
qu liu, triu chng lm sng nhiu kh
nng xy ra l h huyt p v nhp tim
nhanh. Nhp chm cng c th xy ra.
Cha c liu php c hiu trong iu tr
qu liu irbesartan. Ngi bnh cn c
Levonorgestrel (t trong t cung) 171
theo di nghim ngt, iu tr triu
chng v tr lc. Mt s bin php c th
p dng nh gy nn v/hoc ra d dy,
dng than hot tnh. Khng th loi b
irbesartan bng cch lc mu.
Tng tc thuc
Vi cc thuc chng tng huyt p khc:
Cc thuc chng tng huyt p khc c th
lm tng tc dng h huyt p ca
irbesartan. Mc d vy irbesartan vn c
th kt hp c vi cc thuc chng tng
huyt p khc nh cc thuc chn beta,
chn calci hoc cc thuc li tiu nhm
thiazid. Mt iu tr trc bng thuc li
tiu liu cao c th to ra hin tng
gim th tch mu v nguy c tt huyt
p khi dng irbesartan.
B sung kali hoc cc thuc li tiu gi
kali: Dng ng thi irbesartan vi cc
thuc li tiu gi kali hoc b sung kali
c th lm tng nng kali huyt.
Lithi: Tng nng lithi huyt thanh v
c tnh c th hi phc c c bo
co khi phi hp vi cc thuc c ch
enzym chuyn. Bi v tng tc cha c
xc nh vi irbesartan v cha c th loi
tr c nn vn phi theo di cht ch
nng lithi huyt thanh.
Nhng thng tin tng tc khc: Dc ng
hc ca digoxin khng b thay i khi
dng ng thi mt liu irbesartan 150
mg ngi kho mnh.
Dc ng hc ca irbesartan khng b
thay i khi kt hp vi hydroclothiazid.
Irbesartan c chuyn ha ch yu bi
CYP 2C9 v c th bi c lin hp vi acid
glucuronic. Tc dng ca cc thuc gy
cm ng CYP 2C9 nh rifampicin i vi dc
ng hc ca irbesartan cha c nh
gi. Cc d kin thc nghim khng cho
php tin on c cc tng tc gia cc
thuc c chuyn ha lin quan n cc
isoenzym ca cytochrome P 450 nh CYP 1A1,
CYP 1A2, CYP 2A6, CYP 2B6, CYP 2D6, CYP
2E1 hoc CYP 3A4. t c kh nng c ch
lin hp vi acid glucuronic a n nhng
tng tc lm sng c ngha. In vitro,
cc tng tc gia irbesartan vi warfarin,
tolbutamid hoc nifedipin c quan st
thy. Mc d vy cha c tng tc v mt
dc ng hc v dc l c ghi nhn khi
dng kt hp irbesartan vi warfarin cho ng-
i kho mnh. Dc ng hc ca irbesartan
khng b bin i khi kt hp vi
nifedipin.
172 Levonorgestrel (t trong t cung) DTQGVN

n nh v bo qun Cng ging nh halothan, isofluran lm gim

Bo qun trong l nt kn, nhit di
30 oC.
Thng tin quy ch
Irbesartan c trong Danh mc thuc cha
bnh ch yu s dng ti cc c s khm
cha bnh, nm 2005.
Isofluran
Tn chung quc t: Isoflurane.
M ATC: N01A B06.
Loi thuc: Thuc gy m (d bay hi).
Dng thuc v hm lng
Isofluran ng trong cc chai mu 100 ml
v 250 ml.
Isofluran l mt dch lng bn vng,
khng mu, trong sut, khng cha cht
ph gia hoc ha cht gi n nh.
Thuc khng b phn hy khi gp vi
soda v khng n mn nhm, thic, ng
thau, ng hoc st. Thuc c mi te
hng cay nh.
Dc l v c ch tc dng
Isofluran mt cht ng phn ca
enfluran, l mt thuc gy m ng h
hp, khng chy. Thuc c dng khi
m v duy tr trng thi m. Dng isofluran
th khi m v hi tnh nhanh. Tuy th
mi hng cay nh ca thuc hn ch tc
khi m, nng thuc ht vo tng
qu nhanh c th dn n ngng th, ho
hoc co tht thanh qun. Isofluran gy
m khng kch thch nc bt v kh ph
qun tng tit qu nhiu. Cc phn x hu
- thanh qun gim nhanh chng, to iu
kin d dng cho t ng kh qun nu
cn. Mc gy m ca isofluran c th
thay i nhanh v chnh xc, p ng
nhu cu thay i. Du hiu lm sng
gip phn on su ca tnh trng
m l huyt p v h hp u gim t t. ca isofluran thp nn thuc khng c
Huyt p ng mch ton thn gim dn
theo mc gy m su bng isofluran,
ging nh khi dng enfluran v halothan.
Tuy vy, khc vi cc thuc k trn, khi
dng isofluran gy m lu lng tim vn c
duy tr hon ho. H huyt p, do sc cn
thnh mch gim cng vi gin mch, xut
hin c bit da v c. Nng thuc
cng tng th isofluran cng c ch h
hp. Nu tin m dng cc cht ging
thuc phin (opioid) th h hp b c ch
nghim trng; trnh tnh trng
carbondioxid huyt tng qu cao, cn tin
hnh thng kh tr lc hoc c kim sot.
trng lc c ph qun b co tht, do
c chp nhn s dng cho ngi bnh hen
suyn.
Dng isofluran gy m, lu lng mu no
tng nh, trong khi chuyn ha ca no
ch gim nh so vi halothan. V nhng l
do trn, ngi ta a dng isof-
luran trong phu thut thn kinh; ngoi ra,
isofluran cn bo v mt phn no cho no
khi b tn thng do gim oxygen huyt
hoc do thiu mu cc b. Khng ging
cht ng phn enfluran, isofluran khng
gy co git. Isofluran lm gim p ng
ca c vn i vi kch thch thn kinh
ko di v tng cng tc dng phong b
thn kinh - c ca c 2 loi thuc gin c
kh v khng kh cc. V phng din ny,
isofluran tc dng mnh hn halothan.
Ging enfluran, isofluran lm tim nhy cm
vi tc dng gy lon nhp tim ca
adrenalin song km hn so vi halothan, do
adrenalin c th dng cm mu ti
ch vi liu ln hn so vi khi dng halothan.
Hiu lc gy m ca isofluran ging nh
hiu lc ca enfluran. mc gy m
thng thng isofluran c th gy gin c
thch hp cho mt s phu thut vng bng,
nhng nu cn gin c su hn, phi dng
thm cc liu nh thuc gin c tim tnh
mch.
Dc ng hc
Isofluran c hp thu qua ng th. So vi
cc thuc gy m c halogen khc th
isofluran ch b chuyn ha mt phn rt
nh. Trung bnh 95% isofluran c pht
hin trong kh th ra, trong lc c
khng y 0,2% lng isofluran a vo c
th b chuyn ha. Cht chuyn ha ch
yu l acid trifluoro - acetic. ngi bnh
gy m bng isofluran, nng nh
trung bnh ca fluorid v c trong huyt
thanh thng di 5 micromol/lt, sau khi gy
m khong 4 gi, ri tr v mc bnh th-
ng trong vng 24 gi. Do t l chuyn ha
hoc t gy c cho thn v gan.
Ch nh
Isofluran c dng khi m v duy tr
m.
Chng ch nh
Ngi bnh mn cm vi isofluran v cc
thuc gy m c halogen khc, hoc ngi
bnh c tin s st cao c tnh sau khi
dng thuc.
Thn trng
Isofluran l mt thuc c ch h hp mnh,
tc dng ny tng ln do dng cc thuc tin
m (loi opioid) hoc do s dng ng thi
DTQGVN Levonorgestrel (t trong t cung) 173

cc thuc c ch h hp khc. Phi theo di khi khng c stress phu thut. Cn xut
cht ch tnh trng h hp v thc hin hin tng nht thi glucose huyt v
thng kh h tr hoc c iu khin khi creatinin huyt thanh, gim phosphatase -
cn. kim v cholesterol huyt thanh. ngi
Ngi b bnh nhc c rt nhy cm vi cc bnh mn cm, isofluran c th gy st
thuc gy c ch h hp, do isofluran cao c tnh.
phi c dng thn trng i vi nhng ng- Thng gp, ADR > 1/100
i bnh ny. Mu: Tng bch cu.
Cng nh tt c cc thuc gy m c Tun hon: H huyt p, lon nhp tim.
halogen, gy m bng isofluran lp li H hp: c ch h hp.
Chuyn ha: Tng glucose huyt v
trong mt khong thi gian ngn cn c
creatinin huyt thanh, gim phosphatase -
ch nh thn trng.
kim v cholesterol huyt thanh.
i vi ngi b tng p lc ni s, phi dng
t gp, 1/1000 < ADR < 1/100
isofluran mt cch thn trng v isofluran
D dy - rut: Bun nn, nn.
lm tng lu lng mu no v km theo tng
Him gp, ADR < 1/1000
p lc dch no ty.
D dy - rut: Tc rut sau phu thut.
Trong giai on khi m tr em, nc bt v
Chuyn ha: St cao c tnh.
kh ph qun c th tng tit, v c th
gy co tht thanh qun. Hng dn cch x tr ADR
Isofluran tng r rt tc dng ca cc thuc Trong qu trnh gy m bng isofluran,
gy gin c khng kh cc. phn ng khng mong mun thng gp l
c ch h hp v h huyt p, do cn
Thi k mang thai phi theo di cht ch h hp v huyt p.
Nhng th nghim v kh nng sinh sn Cn thit phi thc hin nhng bin php
thc hin trn ng vt chng t isofluran h tr chng h huyt p v c ch h
khng nh hng n kh nng sinh sn, hp do gy m qu su. Khi cn gim
thai nghn, sinh v kh nng sng ca nng isofluran ht vo. i vi ngi bnh
con ci. Tuy nhin s lin quan ca nhng phu thut thn kinh, thng kh phi phi
nghin cu ny ngi cha c r. Tnh an c iu khin. Trong qu trnh gy m
ton ca thuc trong thi gian mang thai su, lu lng mu no c xu hng tng, v
cha c xc nh, do phi trnh dng phng tng p lc ni s, cn tng
isofluran trong thi k mang thai. thng kh phi cho ngi bnh trc v trong
Thi k cho con b qu trnh gy m.
Cho con b ch c thc hin sau khi kt trnh phn ng khng mong mun c
thc gy m 12 gi. th xy ra trong qu trnh khi m bng
isofluran c th dng loi thuc barbiturat
Tc dng khng mong mun (ADR) tc dng ngn, tip theo l ht hn hp
Ging nh cc thuc gy m c halogen isofluran.
khc, thy cc tc dng khng mong
mun khi s dng isofluran nh: c ch h Liu lng v cch dng
hp, h huyt p, lon nhp tim v st cao Phi s dng bnh bc hi chuyn dng cho
c tnh. Cc thuc gy m c halogen c isofluran c th kim sot c chnh
xc nng thuc m cung cp.
nguy c gy lon nhp tim. Nhng khc vi
Nng ph nang ti thiu ca isofluran
halothan v enfluran; isofluran c ch tim
thay i ty theo tui. Xem bng sau:
t hn v cng lm c tim nhy cm vi
cc thuc ging giao cm (cng giao cm)
Tui (nm) O2 (100%) O2+ N2O
t hn halothan v enfluran. Tuy lon nhp
(60%)
nh v lon nhp tht xut hin tng ng
1 - 6 thng 1,60% -
vi t l 3,9% v 2,5% trn s ngi bnh
7 - 11 1,87% -
dng isofluran nhng s gy lon nhp tim
thng 1,80% -
ca isofluran c chng minh nh hn
1 - 2 nm 1,60% -
halothan. H huyt p v c ch h hp
3 - 5 nm 1,62% -
xut hin tng ng khong 8% v 12%
6 - 10 nm 1,40% 0,58%
trn ngi bnh. Rt run, bun nn v nn 10 - 15 1,16% 0,53%
c th xy ra trong qu trnh hi tnh. nm
Dng isofluran khi m th khng m
Tui (nm) O2 (100%) O2 + N2O
du bng halothan, c th ho, co tht (70%)
thanh qun. thy tng bch cu, ngay c
26 4 1,28% 0,56%
174 Levonorgestrel (t trong t cung)
44 7 1,15% 0,50%
64 5 1,05% 0,37%
Khi m: Nu dng isofluran cho khi m
th nng bt u l 0,5%. Nng t Thuc c bng B.
1,5 - 3,0% thng dn n m cho phu
thut trong vng 7 - 10 pht.
Mt thuc barbiturat tc dng ngn hoc
mt thuc khi m tnh mch nh
midazolam, etomidat c khuyn co dng
trc khi cho ht hn hp isofluran.
Isofluran c th s dng vi oxygen hoc
vi hn hp oxygen - protoxid nit
Dng cho duy tr m: M giai on phu
thut c duy tr vi nng 1 - 2,5%
isofluran km protoxid nit v oxygen.
Nu ch dng vi oxygen duy nht nng
isofluran phi tng cao t 1,5 - 3,5%.
Tng tc thuc
Isofluran khng c kt hp vi cc thuc
ging giao cm (cng giao cm) v s kt
hp ny c th dn ti lon nhp tht nghim
trng, c bit trong trng hp carbon
dioxyd huyt tng cao.
Isofluran tng r rt tc dng ca tt c cc
thuc gin c thng dng, tc dng ny th
hin mnh nht i vi cc thuc gin c
khng kh cc. Do nhng thuc ny
ch dng vi liu bng 1/3 n 1/2 liu th-
ng dng. Neostigmin c tc dng i vi
cc thuc gin c khng kh cc nhng
khng nh hng n tc dng gin c ca
chnh isofluran.
Isofluran c th tng tc dng gy c hi
gan ca isoniazid bng cch tng to cc
cht chuyn ha c hi ca isoniazid.
Phi ngng iu tr bng isoniazid mt
tun trc khi phu thut v khng c tip
tc dng isoniazid cho ti 15 ngy sau.
Cc thuc gim au morphin tng tc dng
c ch h hp ca isofluran.
Isofluran c th gy h huyt p nghim
trng ngi bnh iu tr bng cc thuc
chn calci, c bit i vi cc dn cht
dihydropyridin (nh nifedipin, nicardipin,
nimodipin, nitrendipin).
n nh v bo qun
Bo qun nhit di 300C, trnh nng.
Chai thuc phi ng.
Qu liu v x tr
Thuc dng qu liu gy h huyt p r rt
v c ch h hp. Trong trng hp qu liu,
cn ngng ngay thuc gy m, kim tra
ng th c thng thong khng v ty
theo tnh hnh c th m tip tc s
DTQGVN
dng oxygen vi h hp h tr hoc c
iu khin. Cn h tr v duy tr tha
ng tnh trng huyt ng.
Thng tin qui ch
Isoniazid
Tn chung quc t: Isoniazid.
M ATC: J04A C01.
Loi thuc: Thuc chng lao.
Dng thuc v hm lng
Vin nn 300, 150, 100 v 50 mg. Sir 50
mg/5 ml. ng tim 1 g/10 ml.
Dc l v c ch tc dng
Isoniazid l mt trong nhng thuc ha
hc u tin c chn trong iu tr lao.
Thuc c hiu cao, c tc dng chng li
Mycobacterium tuberculosis v cc
Mycobacterium khng in hnh khc nh
M. bovis, M. kansasii. Isoniazid dit khun
ph thuc vo nng thuc v tr tn
thng v mc nhy cm ca vi khun.
C ch tc dng chnh xc ca isoniazid
vn cha bit, nhng c th do thuc c
ch tng hp acid mycolic v ph v thnh
t bo vi khun lao. Nng ti thiu c
ch in vitro i vi trc khun lao t 0,02 -
0,2 microgam/ ml.
Khng thuc mc phi v t nhin ca M.
tuberculosis i vi isoniazid c in vivo v
in vitro c chng minh din ra theo
kiu bc thang. C ch khng thuc c
th do vi khun t bin di truyn khng
thuc. Cc chng khng thuc pht trin
nhanh, nu isoniazid dng n c
iu tr lao, nhng t hn nu dng thuc
vi mc ch d phng. phng khng
thuc, phi dng phi hp isoniazid vi 3 - 4
thuc iu tr lao khc v khng bao gi
c dng n c. Vit nam, theo
nghin cu ca Vin lao v bnh phi th
hin nay t l khng isoniazid l 20%. y
l mt t l khng cao bo ng, v vy
cn phi tun th cht ch theo hng dn
iu tr chun i vi bnh lao.
Dc ng hc
isoniazid hp thu nhanh v hon ton theo
ng tiu ha v tim bp. Sau khi ung
liu 5 mg/ kg th trng c 1 - 2 gi th
t nng ti a trong huyt thanh l
3 - 5 microgam/ml. Thc n lm chm hp
thu v gim sinh kh dng isoniazid.
Isoniazid phn b vo tt c cc c quan,
cc m v dch c th. Nng thuc
DTQGVN
trong dch no ty bnh thng ch bng
20% nng thuc trong huyt tng,
nhng trong vim mng no nng ny
tng ln 65 - 90%. Nng thuc t c
trong mng phi bng 45% nng
thuc trong huyt thanh. Thuc thm c
vo hang lao, d dng qua nhau thai v
vo thai nhi.
Isoniazid chuyn ha gan bng phn ng
acetyl ha, ch yu to thnh
acetylisoniazid v acid isonicotinic. Na
i thi tr ca isoniazid ngi bnh c
chc nng gan thn bnh thng l t 1 - 4
gi ph thuc vo loi chuyn ha thuc
nhanh hoc chm v ko di hn ngi
bnh suy gim chc nng gan hoc suy
thn nng. Trung bnh 50% dn s chu
Phi v chu u thuc loi chuyn ha
isoniazid chm, ngc li, ngi chu ch
yu thuc loi chuyn ha nhanh.
Hiu qu iu tr ca isoniazid khng
khc nhau gia nhm chuyn ha nhanh
v chm, nu isoniazid c dng hng
ngy hoc 2 - 3 ln trong tun. Tuy nhin
hiu qu iu tr s gim nhm ngi
bnh chuyn ha isoniazid nhanh nu
ch dng isoniazid 1 ln trong tun.
Khi chc nng thn gim, thi tr isoniazid
ch hi chm li, nhng iu ny li nh h-
ng nhiu n nhm ngi bnh chuyn
ha chm. V vy nu ngi bnh suy thn
nng, c bit c thanh thi creatinin
di 25 ml/pht m ngi bnh ny li thuc
loi chuyn ha chm th nht thit phi
gim liu.
Xp x 75 - 95% thuc thi tr qua thn
trong vng 24 gi di dng cht chuyn
ha khng hot tnh. Mt lng nh thi qua
phn. Thuc c th c loi khi mu
bng thm phn thn nhn to hay thm
phn mng bng.
Ch nh
D phng lao:
Isoniazid c ch nh d phng lao cho
cc nhm ngi bnh sau:
Nhng ngi trong gia nh v ngi thng
xuyn tip xc vi ngi mi c chn on Tiu ha: Bun nn, nn, a chy, au vng
bnh lao (AFB (+)) m c test Mantoux d-
ng tnh v cha tim phng BCG.
Nhng ngi c test Mantoux dng tnh
ang c iu tr c bit nh iu tr Thn kinh: Vim dy thn kinh ngoi vi
corticosteroid di ngy, thuc c ch min
dch, thuc c hi vi t bo hoc iu t gp, 1/1000 < ADR < 1/100
tr bng chiu tia x.
Ngi nhim HIV c test Mantoux dng
tnh hoc bit c tip xc vi ngi
bnh c khun lao trong m, ngay c khi
test Mantoux m tnh.
Levonorgestrel (t trong t cung) 175
iu tr lao:
Isoniazid c ch nh phi hp vi cc
thuc chng lao khc, nh rifampicin,
pyrazinamid, streptomycin hoc
ethambutol theo cc phc iu tr
chun. Nu vi khun khng isoniazid hoc
ngi bnh gp tc dng khng mong
mun nng, th phi ngng dng isoniazid
thay bng thuc khc.
Chng ch nh
Ngi mn cm vi isoniazid, suy gan nng,
vim gan nng, vim a dy thn kinh
v ngi ng kinh.
Thn trng
Vi ngi suy gim chc nng thn nng, c
thanh thi creatinin di 25 ml/pht, phi
gim liu isoniazid, c bit l ngi
chuyn ha isoniazid chm.
Trong thi gian iu tr isoniazid m ung
ru hoc phi hp vi rifampicin th c
nguy c lm tng c tnh vi gan.
Thi k mang thai
Cho ti nay cha c bng chng nguy c
no i vi m v thai khi dng isoniazid
cho ngi mang thai. Nn b sung vitamin
B6 trong khi dng isoniazid.
Thi k cho con b
Cha c ti liu cng nh du hiu no v
cc tc dng khng mong mun xy ra vi
tr ang b m khi cc b m ny iu
tr isoniazid.
Tc dng khng mong mun (ADR)
Thc t lm sng cho thy tc dng
khng mong mun chim khong 5%
tng s ngi bnh iu tr isoniazid. Tc
dng khng mong mun thng gp nht
l ri lon chc nng gan v nguy c ny
tng ln theo tui ngi bnh. Ngoi ra, cc
tc dng khng mong mun khc nh phn
ng mn cm v gy vim thn kinh ngoi
vi cng thng xy ra.
Thng gp, ADR >1 /100
Ton thn: Mt mi, chn n.
thng v.
Gan: Vim gan (vng da, vng mt, tng
transaminase).
biu hin t b tay hoc chn.
Mu: Gim tiu cu, mt bch cu ht,
thiu mu.
Mch: Vim mch.
Xng khp: au lng, au khp.
Da: Ni nga rt thng gp.
176 Levonorgestrel (t trong t cung)
Thn kinh: Co git, thay i tnh tnh
hoc tm thn.
Cc tc dng khc: Mn cm nh ban da,
methemo-
globin huyt, b i, tng cn, au ti
ni tim.
Hng dn cch x tr ADR
Ni chung, cc tc dng khng mong mun
ca isoniazid thng mt i khi ngng
thuc. Tuy nhin cng c nhng tc dng
khng mong mun ko di, v d nh trng
hp vim gan. Nhng yu t nguy c lm
tng tc dng khng mong mun ca thuc
gm ngi cao tui, ngi b bnh i tho
ng, suy thn mn, suy gan, nghin ru,
suy dinh dng v ngi ang dng thuc
chng ng kinh nh hydantoin.
gim bt tc dng khng mong mun ca
isoniazid i vi h thn kinh, phi thng
xuyn dng thm vitamin B6 hng ngy vi
liu t 10 mg/ngy.
Liu lng v cch dng
Tt nht l trc n 1 gi hoc sau n 2 gi.
C th ung thuc cng vi ba n, nu b
kch ng ng tiu ha.
Phng bnh:
Tr em: Ung 5 mg/kg/24 gi, ti a 300
mg/24 gi, ngy mt ln trong 6 - 12
thng.
Tim bp, 10 mg/kg th trng, cho ti 300
mg mi ngy mt ln.
Ngi ln: Ung 5 mg/kg/24 gi (liu thng
dng l 300 mg/24 gi). Dng hng ngy
trong 6 - 12 thng.
Tim bp, 300 mg mi ngy mt ln.
iu tr:
isoniazid bao gi cng phi dng phi hp
vi cc thuc chng lao khc, nh
streptomycin, rifampicin, pyrazinamid v
ethambutol theo cc phc iu tr
quc gia.
Liu iu tr thng thng ngi ln v
thiu nin:
Phi hp vi cc thuc chng lao khc (da
vo chng trnh quc gia chng lao).
Ung 300 mg isoniazid mi ngy mt ln,
trong sut thi gian iu tr, hoc 10
mg/kg th trng, dng hng ngy hoc
mi tun ung 2 hoc 3 ln theo quy
nh ca phc iu tr.
Tim bp, 5 mg/kg th trng, mi ngy
mt ln, trong sut thi gian iu tr;
hoc mi tun tim 2 hoc 3 ln theo quy
nh ca phc iu tr.
Liu iu tr thng thng tr em:
Phi hp vi cc thuc chng lao khc (da
vo chng trnh quc gia chng lao).
Ung 10 mg/kg: 3 ln/tun hoc 15
mg/kg: 2 ln/tun.
DTQGVN
Tim bp, 5 mg/kg th trng, cho ti 200
mg mi ngy mt ln.
Tng tc thuc
Isoniazid c ch chuyn ha mt s thuc.
Khi dng kt hp isoniazid vi cc thuc ny
c th lm tng nng trong huyt
thanh v lm tng c tnh ca thuc
phi hp, nht l cc thuc cha ng
kinh. Cc thuc sau y khi phi hp vi
isoniazid phi iu chnh liu: alfentanil,
cc cht chng ng mu dn cht
coumarin hoc dn cht indandion, cc
benzodiazepin, carbamazepin, theophylin,
phenytoin, enfluran, disulfiram v
cycloserin.
Cc tng tc khc:
Dng ng thi rifampicin, acetaminophen
hoc ru vi isoniazid c th lm tng c
tnh vi gan, c bit ngi c tin s
suy gan.
Dng ng thi isoniazid vi niridazol c
th lm tng tc dng khng mong mun
i vi h thn kinh, nh co git v ri lon
tm thn.
Isoniazid lm gim nng ketoconazol
trong huyt thanh, v vy lm gim tc
dng iu tr nm ca thuc ny.
Cc corticoid lm tng thi tr isoniazid,
v vy lm gim nng v tc dng ca
isoniazid, c bit nhng ngi bnh
chuyn ha isoniazid nhanh.
Cc thuc khng acid, c bit mui
nhm lm gim hp thu isoniazid. V vy
2 thuc ny cn phi ung cch nhau t
nht 1 gi.
n nh v bo qun
Isoniazid phi bo qun nhit di
40oC, tt nht t 15 - 30 oC trong l nt
cht, trnh nh sng.
i vi dng thuc tim isoniazid, phi bo
qun ch mt, trnh ng bng
Qu liu v x tr
Du hiu v triu chng:
Bun nn, nn, chng mt, ni ngng,
mt nh hng, tng phn x, nhn m,
o th gic... Cc triu chng qu liu th-
ng xy ra trong vng 30 pht n 3 gi
sau khi dng thuc.
Nu ng c nng, c ch h hp, v c
ch thn kinh trung ng, c th nhanh
chng chuyn t sng s sang trng thi
hn m, co git ko di, toan chuyn ha,
aceton niu v tng glucose huyt. Nu
ngi bnh khng c iu tr hoc iu
tr khng trit , c th t vong.
Isoniazid gy co git l do lin quan n
gim nng acid gamma aminobutyric
(GABA) trong h thng thn kinh trung -
ng, do isoniazid c ch hot ng ca
pyridoxal - 5 - phosphat trong no.
X tr:
DTQGVN Levonorgestrel (t trong t cung) 177

Trong x tr qu liu isoniazid, vic u

tin l phi m bo ngay duy tr h hp
y .
Co git c th x tr bng cch tim tnh
mch diazepam hoc cc barbiturat c
thi gian tc dng ngn, kt hp vi
pyridoxin hydroclorid. Liu dng ca
pyridoxin hydroclorid ngang vi liu
isoniazid dng. Thng u tin tim
tnh mch 1 - 4 g pyrido-
xin hydroclorid, sau c 30 pht tim
bp 1 g cho ti khi ton b liu c dng.
Nu cc cn co git c kim sot v
qu liu isoniazid mi xy ra trong vng 2 -
3 gi th cn ra d dy. Theo di
kh/mu, cht in gii, glucose v ur
trong huyt thanh. Tim truyn natri
bicarbonat chng toan chuyn ha v
nhc li nu cn.
mt s ngi bnh vn cn trng thi
hn m sau khi iu tr co git bng
diazepam v pyridoxin, th sau khong 36
- 42 gi hn m s tim thm 1 liu t
3 -5 g pyridoxin hydroclorid na, khong
30 pht sau, ngi bnh s tnh hon ton.
Tuy nhin, nu dng pyridoxin qu liu th
cng c th gy cc tc dng khng mong
mun v thn kinh. V vy, phi xem xt
khi dng pyridoxin iu tr co git
hoc hn m do isoniazid.
Cc thuc li tiu thm thu cng phi
dng cng sm cng tt gip thi
nhanh thuc qua thn ra khi c th v
phi tip tc trong nhiu gi sau khi cc
triu chng lm sng c ci thin
m bo thi ht isoniazid v ngn
chn hin tng ti ng c. Theo di cn
bng dch vo v dch ra.
Thm phn thn nhn to v thm phn
mng bng cn c dng km vi dng
thuc li tiu. Ngoi ra phi c liu php
chng gim oxy khng kh th vo, h
huyt p v vim phi do sc.
Thng tin qui ch
Isoniazid c trong danh mc thuc thit
yu Vit Nam ban hnh ln th 4 nm
1999.
Thuc dng tim phi c k n v bn
theo n.
178 Levonorgestrel (t trong t cung)
Isoprenalin
(Isoproterenol)
Tn chung quc t: Isoprenaline.
M ATC: R03C B01, R03A B02, C01C A02.
Loi thuc: Thuc ch vn adrenergic
khng chn lc, gin ph qun, cng giao
cm.
Dng thuc v hm lng
Isoprenalin hydroclorid:
ng tim 2 mg/2 ml; 0,2 mg/1 ml; 1 mg/5
ml; 2 mg/10 ml.
Vin nn t di li 10 mg; 15 mg. Vin
nn ung 30 mg.
Bnh xt kh dung 30 mg/15 ml; 45
mg/22,5 ml; 37,5 mg/15 ml.
Bnh phun m 1,24 mg/4 ml; 2,48 mg/4
ml; 1,25 mg/0,5 ml; 75 mg/30 ml; 2,5
mg/0,5 ml; 50 mg/10 ml; 300 mg/60 ml;
100 mg/10 ml.
Isoprenalin sulfat:
Bnh xt kh dung 30 mg/15 ml; 45
mg/22,5 ml; 32,5 mg/15 ml.
Dc l v c ch tc dng
Isoprenalin tc dng trc tip ln th th
beta - adrenergic. Isoprenalin lm gin
ph qun, c trn d dy rut v t cung
bng cch kch thch th th beta - 2 -
adrenergic. Thuc cng lm gin mch tt
c cc mch mu. Ngoi ra, khi dng ng
tim hoc ht, isoprenalin c ch gii
phng histamin do khng nguyn gy ra,
c ch cht phn ng chm ca phn v
SRS - A, gim nh co tht ph qun, lm
tng dung tch sng ca phi, lm gim
th tch cn trong phi v lm cc dch
tit phi d dng thot ra ngoi.
Isoprenalin tc ng ln cc th th beta -
1 - adrenergic tim, lm tng tn s
thng qua nt xoang nh, tng co bp c
tim.
liu iu tr, thuc t hoc khng tc Chng ch nh
dng ln th th alpha - adrenergic. Tc
dng ch yu l gin c trn; lm gin
ph qun thng dng dng ht, cn tc
dng lm tng tn s tim ch xut hin
khi dng thng xuyn. Trng hp nhp tim
nhanh v run do isoprenalin gy kh chu
cho ngi bnh, nn gim liu v dng thm
ipratropium s duy tr c gin ph qun
km theo gim tc dng ph.
Dc ng hc
Isoprenalin ung vo chuyn ha nhanh
ng tiu ha.
DTQGVN
Gin ph qun xy ra nhanh ngay sau khi
ht thuc vo v ko di khong 1 gi.
Tc dng ca thuc tn ti vi pht sau khi
tim tnh mch v 2 gi sau khi tim di da
hoc t di li, v 2 - 4 gi sau khi t
trc trng mt vin ngm di li.
Thuc chuyn ha ch yu gan v cc
m khc, nh enzym catecholamin - O -
methyltransferase.
ngi ln b hen, 75% isoprenalin bi tit
qua nc tiu sau 15 gi, khi tim tnh mch
c liu v sau
22 gi, khi truyn tnh mch 30 pht.
Cn tr em b nng, sau khi tim tnh
mch, 40 - 50% liu dng bi xut qua nc
tiu nguyn dng v phn cn li di dng 3
- O - methylisoproterenol.
ngi ln, trong vng 48 gi sau khi ung
hoc ht, 50 - 80% liu bi tit qua nc
tiu di dng lin hp isoprenalin sulfat,
khong 5 - 15% nguyn dng v di 15%
dng 3 - O - methylisoproterenol lin hp
hoc t do.
Khi ht, isoprenalin tc dng gin ph qun
nhanh v cng thi tr nhanh khi mu, v
do vy khng gy tch t thuc.
Ch nh
Dng ht c ch nh gim co tht
ph qun trong hen ph qun cp v
gim co tht ph qun cn hi phc trong
t cp hoc vim ph qun mn nng
ln.
Dng vin nn dng cho bnh phn ly nh
tht mn tnh nh l thuc iu tr hng
th 2, tm thi khi khng c my to nhp.
Dng ng tim dng trong trng thi sc do
tim hoc ni c t, trong cc cn
Stockes - Adams cp tnh v cc trng hp
cp cu tim khc, trong nhp tim chm
nng do cc thuc i khng adrenergic
v disopy-
ramid, v trong nh gi khuyt tt tim
bm sinh.
D ng vi sulfit hoc isoprenalin hoc cc
amin tc dng ging thn kinh giao cm
khc.
Bnh tim nng.
Tin s b lon nhp tht.
Cng gip khng kim sot; hi chng c-
ng gip.
Bnh mch vnh cp; tng huyt p nng.
Ngi bnh d b rung tht hoc nhp
nhanh tht.
Thn trng
Ngi cao tui, i tho ng, bnh thn,
bnh tim mch, cng gip.
DTQGVN
S dng thuc qu nhiu v ko di s
gim tc dng.
Isoprenalin ch c dng trong phn v
ngi bnh c iu tr vi thuc chn
beta. Ngoi trng hp ra, bao gi cng
phi dng adrenalin iu tr phn v.
Thi k mang thai
Thuc c dng nhiu nm cho ph n
mang thai m khng gy hu qu xu r
rt. V vy, nu cn thit, c th dng
thuc cho ph n mang thai khi khng c
thuc thay th an ton hn.
Thi k cho con b
Cha c thng tin v s bi tit ra sa. Khi
dng cho ph n cho con b cn thn
trng.
Tc dng khng mong mun (ADR)
Tc dng khng mong mun nng rt t
xy ra c bit khi dng thuc dng ht.
Phn ln cc tc dng khng mong mun
gim nhanh khi ngng thuc hoc c th
gim i trong khi vn ang dng thuc.
Thng gp, ADR > 1/100
Thn kinh: Bn chn, lo lng, au u,
chng mt, yu c.
Tiu ha: Bun nn, nn.
Tim mch: Nhp nhanh, nh trng ngc,
au vng trc tim, au kiu au tht
ngc.
Cc b phn khc: Da bng , run, ra m
hi.
Liu lng v cch dng
Gim co tht ph qun trong hen cp:
Tr em:
Kh dung qua ming: 1 - 2 liu xt, cho ti
6 ln/ngy.
Phun sng: 0,01 ml/kg dung dch 1%, liu
ti thiu 0,1 ml; liu ti a 0,5 ml pha
vo 2 - 3ml dung dch natri clorid ng
trng; liu tng ng khi dng dung dch
0,25% v 0,5% c th khng pha long.
Bnh xt isoprenalin sulfat 0,4% ch c
dng cho tr em p ng vi thuc gin ph
qun di s gim st ca ngi ln.
Ngi ln:
Kh dung qua ming: 1 - 2 liu xt, 4 - 6
ln/ngy.
Phun sng: 0,25 - 0,5 ml dung dch 1%
pha vo 2 - 3ml dung dch natri clorid
ng trng; liu tng ng khi dng
dung dch 0,25% v 0,5%, c th khng
pha long.
Khi dng bnh kh dung c nh liu,
phi ch
1 pht xc nh tc dng ca thuc
trc khi xem xt cho ht ln th 2.
Levonorgestrel (t trong t cung) 179
Nu 3 n 5 ln xt trong vng 6 - 12 gi
m khng hoc rt t th khng
nn tip tc iu tr kh dung n c.
iu tr hen mn tnh ngi ln v tr em
(xem Salbutamol v Budesonid).
iu tr phn ly nh tht mn tnh, dng
thuc hng th hai isoprenalin, phng
php tm thi trong iu kin khng c
to nhp:
Ngi ln v cao tui:
Liu lng phi ph hp cho tng ngi bnh.
Bt u iu tr, tt nht nn thc hin
bnh vin vi cc phng tin sn sng
gim st in tm v hi sc tim
mch.
Liu khi u l 1 vin nn (30 mg) cch
6 gi mt ln v c th tng nhanh nu
cn. Liu hng ngy trong khong t 90
mg mt s ngi bnh n 840 mg
mt s ngi bnh khc vi khong cch cho
thuc khc nhau t 8 gi ti 2 gi. Liu ti -
u l liu kim sot tt tn s tim v c tc
dng ph ti thiu.
Phi nut c vin, khng dng loi vin ny
t di li.
Tr em: Chng ch nh.
Thuc tim thng c truyn tnh mch vi
dextrose 5% hoc nc ct pha tim v c
dng trong cc trng hp sau:
Ngi ln v cao tui:
Tnh trng sc: Truyn 0,5 - 10
microgam/pht.
Cn Stokes - Adams cp tnh: Truyn 4 - 8
micro-
gam/pht.
Nhp tim chm nng: Truyn 1 - 4
microgam/pht.
nh gi khuyt tt tim bm sinh: Truyn
1,5 - 4 microgam trong 1 pht.
Tr em: iu chnh liu trn theo trng l-
ng c th.
Tng tc thuc
Dng ng thi vi adrenalin, aminophylin
v phn ln cc thuc gin ph qun ging
thn kinh giao cm khc c th lm tng
tc dng v tng c vi tim.
Dng isoprenalin cho ngi bnh ang dng
cyclopro-
pan hoc thuc m h halogen c th
gy lon nhp. Dng thuc phi thn trng
hoc khng dng khi ngi bnh ang dng
cc thuc m ny.
Tc dng isoprenalin ln tim, tc dng gin
ph qun v gin mch s b i khng bi
thuc chn beta - adrenergic nh
propranolol. C th dng propranolol
iu tr nhp tim nhanh do isoprenalin
nhng khng nn dng cho ngi b hen v
c th lm tng co tht ph qun.
180 Levonorgestrel (t trong t cung)
Khi dng ng thi vi cc glycozid
tim,thuc chng trm cm, dn cht
xanthin, cc thuc m, thyroxin, c th
lm c tim thm nhy cm.
n nh v bo qun
Bo qun di 30oC, trnh nh sng v nng.
Tng k
Vi dung dch kim, khi trn vi aminophylin,
furosemid.
Qu liu v x tr
Triu chng: Run, bun nn, nn, h huyt
p, tng tn s tim, kch thch h thn
kinh trung ng.
iu tr: Ngng ngay thuc, h tr cc chc
nng sng cho n khi ngi bnh n
nh. Thuc chn beta - adrenergic c
th lm gim tc dng c v phi theo
di st tn s tim. Thm phn mu khng
c tc dng trong trng hp ny.
Thng tin qui ch
Isoprenalin c trong danh mc thuc thit
yu Vit Nam ban hnh ln th 4 nm
1999.
Thuc c bng B.
Isosorbid
Tn chung quc t: Isosorbide.
M ATC:
Loi thuc: Thuc li tiu thm thu.
Dng thuc v hm lng
Dung dch 45% (100 g/220 ml) c 4,6 mEq
natri v 0,9 mEq kali trong 220 ml dung
dch.
Dc l v c ch tc dng
Isosorbid l thuc li tiu thm thu, khng
cha cc cht in gii. Isosorbid tc ng
trn c ng ln gn v quai Henle.
Isosorbid khng c tc ng trn th th
c hiu, m tc ng vo thnh phn
dch ng thn bng cch phn tn vo
dch ngoi t bo. Isosorbid c ch s ti
hp thu Na+ v Cl ng ln gn v nhnh
ln ca quai Henle. o thi Na+, K+, Ca2+,
PO43 c tng ln. Lu lng mu trong thn
tng, mc lc cu thn ca cc nephron
nng tng ln. Ngc li mc lc cu thn ca
cc nephron su li gim. V vy thuc
lm tng nng thm thu huyt thanh,
t lm tng th tch trong mch v lm
gim p lc ni s v p lc trong nhn cu.
Isosorbid lm tng kh nng o thi hu
ht cc cht in gii bao gm Na +, K+,
Ca2+, Mg2+, Cl, HCO3, PO4 3.
Dc ng hc
DTQGVN
Isosorbid hp thu nhanh sau khi ung v
phn b n tt c cc dch trong c th.
Tc dng thuc xut hin trong vng 30
pht v ko di t 5 n 6 gi. Thuc
thm tt vo nhn cu v thi gian t tc
dng ti a l 1 gi n 1,5 gi. Thi gian
bn hy t 5 n 9,5 gi.
Thuc gn nh khng chuyn ha v thi tr
ch yu di dng khng i qua nc tiu.
Ch nh
Isosorbid l thuc li tiu thm thu dng
lm gim p lc trong nhn cu trc v sau
phu thut mt.
iu tr ct cn glcm cp tnh.
Chng ch nh
Ngi bnh v niu do bnh thn nng.
Ngi bnh khng p ng vi liu thuc
dng th.
Ngi bnh hay b bun nn, nn.
Thn trng
Thn trng khi dng thuc cho ngi bnh b
suy tim sung huyt km suy thn.
Thi k mang thai
Khng c thng tin y no v tc
dng gy qui thai ca thuc hay tc dng
ph khng mong mun ca thuc n bo
thai.
Tc dng khng mong mun (ADR)
Thuc t gy bun nn v nn hn cc
thuc li niu thm thu khc.
Cc tc dng khng mong mun khc gm:
Nhc u, l ln, mt phng hng.
Him gp: Tng natri huyt, tng thm
thu, pht ban, ngt, chng mt v hi
chng mt.
Liu lng v cch dng
Ch dng ng ung, liu u tin dng t
1 - 3 g/kg th trng, ung 2 - 4 ln/ngy ty
theo hng dn ca thy thuc.
n nh v bo qun
Bo qun trong l kn, trnh nh sng.
isosorbid dinitrat
Tn chung quc t: Isosorbide dinitrate.
M ATC: C01D A08, D03A X08.
Loi thuc: Thuc gin mch.
Dng thuc v hm lng
Vin nn (nhai, ngm, ung, tc dng ko
di): 5 mg, 10 mg, 20 mg, 40 mg, 60 mg.
Vin nang (tc dng ko di): 20 mg, 40
mg.
DTQGVN
Dung dch kh dung: 1,25 mg. Dung dch
kh dung c cha ethanol, glycerol.
Dc l v c ch tc dng
C ch tc dng chung ca nhm nitrat:
Vo trong c th, cc nitrat c chuyn
ha thnh gc oxyd nitric (NO) nh
glutathion - S - reductase v cystein; NO
kt hp vi nhm thiol thnh nitrosothiol (R -
SNO), cht ny hot ha guanylat cyclase
chuyn guanosin triphosphat (GTP)
thnh guanosin 3'5' monophosphat vng
(GMPc). GMPc lm cho myosin trong cc si
c thnh mch khng c hot ha, khng
c kh nng kt hp vi actin nn lm gin
mch.
Dc l: Cc nitrat tc ng ch yu trn h
tnh mch, vi liu cao lm gin c h
ng mch v c mch vnh. Gin h tnh
mch lm cho ng mu ngoi vi v
trong cc ph tng, gim lng mu v tim
(gim tin gnh), hu qu l gim p lc
trong cc bung tim. Gin cc ng mch
dn n gim sc cn ngoi vi (gim hu
gnh), kt qu lm gim huyt p nht l
huyt p tm thu, tuy khng nhiu nhng
c th gy phn x giao cm lm mch hi
nhanh v tng sc co bp c tim. Cc nitrat
cn c tc dng c ch kt tp tiu cu.
Trong suy vnh, gim tin gnh, gim hu
gnh s lm gim cng v mc tiu th oxy
ca c tim, cung v cu v oxy ca c tim
c cn bng s nhanh chng ct cn
au tht ngc. Thuc cng lm gin ng
mch vnh, lm mt co tht mch, dng
lu di cn c tc dng phn b li mu c
li cho cc vng di ni tm mc v lm pht
trin tun hon bng h.
Trong suy tim, nitrat do lm gim lng mu
v tim nn ci thin c tin gnh, lm
gim p lc tht phi v p lc tun hon
phi, nh vy gim cc du hiu mu, vi
liu thch hp, thuc li lm gim hu gnh,
to iu kin cho tim tng mu tt hn,
tng th tch tm thu v cung lng tim.
Dng cc nitrat lu di, d xy ra hin tng
"thot thuc" lm mt dn tc dng ca
thuc. Ngi ta gii thch c th do thiu d
tr - SH, do thiu enzym glutathion - S -
reductase cn thit chuyn ha cc
nitrat, do tng th tch ni mch, do hot
ha cc c ch lm co mch p ng vi
hiu ng gin mch ca thuc... V vy
trong ngy nn thu xp c mt thi gian
khong t nht 8 gi khng dng thuc.
Dc ng hc
Isosorbid dinitrat (ISDN) c dng di dng
ung, thuc hp thu nhanh hn khi ngm
di li hoc nhai. Thuc c chuyn ha
nhiu khi qua gan ln u. Hai cht
Levonorgestrel (t trong t cung) 181
chuyn ha chnh u c hot tnh l
isosorbid - 2 mononitrat (2 - ISMN) c thi
gian tc dng ngn v isosorbid - 5
mononitrat (5 - ISMN) c thi gian tc dng
di hn.
Thuc kt hp vi protein huyt tng ti 28
12%, thi tr ch yu qua nc tiu.
Na i thi tr huyt tng ca ISDN l 50
20 pht, ca 2 - ISMN khong 2 gi, ca 5 -
ISMN khong 5 gi.
Thi gian tc dng ca thuc ph thuc vo
cch dng thuc:
Ngm di li: Bt u c tc dng sau 2
pht, tc dng ti a sau 15 - 45 pht, ko
di 1 - 3 gi.
Nhai: Bt u c tc dng sau 5 - 20 pht,
ko di 1 - 3 gi.
Ung: Bt u c tc dng sau 15 - 45
pht, tc dng ti a sau 45 - 120 pht,
ko di 2 - 6 gi. Dng vin gii phng
chm c th ko di ti 24 gi.
Ch nh
Phng v iu tr cn au tht ngc.
iu tr suy tim sung huyt (phi hp vi
cc thuc khc).
Chng ch nh
Huyt p thp, try tim mch.
Thiu mu nng.
Tng p lc ni s, glcm.
Nhi mu c tim tht phi.
Hp van ng mch ch, bnh c tim tc
nghn.
Vim mng ngoi tim co tht.
D ng vi cc nitrat hu c.
Thn trng
Khi dng thuc, phi tng liu t t
trnh nguy c h huyt p th ng v
au u mt s ngi bnh; nn ngi
hoc nm sau khi dng thuc.
Khi dng liu cao, khng nn gim thuc
t ngt.
V cha c thng tin v nh hng ca
thuc i vi ph n c thai v thuc c
qua c sa m khng, khng nn dng
thuc cho ph n ang cho con b.
Thi k mang thai
Cha c bo co no v nh hng ca thuc
vi ph n mang thai.
Thi k cho con b
Cha bit thuc c thi tr qua sa hay
khng. Khng nn dng isosorbid dinitrat
cho ngi ang cho con b.
Tc dng khng mong mun (ADR)
Nhng ngy u iu tr thng c nhc
u (25% ngi dng), do tc dng gin mch
ca thuc. Triu chng ny ht sau mt
tun.
Thng gp, ADR < 1/100
182 Levonorgestrel (t trong t cung)
Tim mch: Gin mch ngoi vi lm da bng
nht l ngc v mt, gin cc mch
trong mt d gy tng tit dch v lm
tng nhn p, gin cc mch trong no c th
gy tng p lc ni s v lm au u.
H huyt p th ng, chong vng, chng
mt hay xy ra khi dng thuc cho nhng
ngi bnh c huyt p thp, ngi gi.
t gp, 1/1000 < ADR < 1/100
Ngoi da: C th c ni ban, vim da trc
vy, ri lon tiu ha.
Him gp, ADR <1/1000
Mu:Vi liu cao hn liu iu tr, c th
c methemoglobin mu do thuc oxy ha
Fe++ ca huyt cu t thnh Fe+++ lm cho
huyt sc t khng vn chuyn c
oxygen.
Tiu ha: Bun nn.
Liu lng v cch dng
iu tr cn au tht ngc: Ngm di li
hoc nhai: 2,5 - 10 mg/ln; 2 - 3 gi mt
ln cho n ht cn au; c th dng
dng phun (spray) 1,25 mg/ln, phun 1 - 3
ln vo di li khng ht, mi ln cch nhau
30 giy.
Phng cn au tht ngc: Ung: 10 - 20
mg/ln, 3 - 4 ln mi ngy, c th dng
dng gii phng chm 20 - 40 - 60 mg
gim s ln ung.
iu tr suy tim sung huyt:
Ngm di li hoc nhai 5 - 10 mg, hoc
ung 10 - 20 mg/ln hoc hn, 3 - 4 ln
mi ngy ri gim xung liu duy tr, lc
ny c th dng vin gii phng chm.
Ngi cao tui: Khng c ch dn c
bit, tuy nhin cn thn trng, nht l vi
ngi mn cm vi thuc gy h huyt p.
Tr em: an ton v hiu qu ca thuc
i vi tr em cha c xc nh.
Tng tc thuc
Cc ch phm c cha nitrat khi dng vi ru
s lm tng tc dng gin mch v gy h
huyt p t th ng nghim trng.
Khi dng thuc cng vi disopyramid
phosphat tc dng chng tit nc bt ca
disopyramid cn tr s ha tan ca vin
ngm isosorbid dinitrat.
n nh v bo qun
Thuc bo qun ni kh ro trong dng c
kn, nhit 15 - 30OC.
Qu liu v x tr
Triu chng: Thng gp nht khi dng qu
liu l h huyt p, au u nh ba b,
nhp tim nhanh, bng mt. Khi liu
qu cao c th xy ra methemoglobin
huyt.
Cch x tr: iu tr h huyt p cn
ngi bnh t th nm nng cao 2 chn,
c th tim truyn dch, iu tr chng
DTQGVN
xanh tm do methemoglobin huyt bng
cch tim tnh mch chm xanh methylen
vi liu 1 - 2 mg/kg th trng. Ra d dy
ngay lp tc nu dng thuc qua ng
ung.
Thng tin qui ch
Isosorbid dinitrat c trong danh mc thuc
thit yu Vit Nam ban hnh ln th t nm
1999.
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 20 mg; thuc vin ngm di l-
i c hm lng ti a l 5 mg. Kh dung
phn liu c hm lng ti a l 1,25
mg/ln phun.
ISRADIPIN
Tn chung quc t: Isradipine.
M ATC: C08C A03.
Loi thuc: Chn knh calci/chng tng
huyt p.
Dng thuc v hm lng
Vin nang: 2,5 mg v 5 mg.
Vin nn 2,5mg.
Vin gii phng chm: 5 mg, 10 mg.
Dc l v c ch tc dng
Isradipin l thuc h huyt p loi chn
knh calci, thuc nhm dihydropyridin.
Thuc chn knh calci trn cc knh typ L
ph thuc in th c trn ng mch
hiu qu hn so vi cc knh calci t bo
c tim. Nh vy thuc lm gin tt c cc
ng mch, c bit cc ng mch
no v c xng m khng lm suy gim
chc nng tim. Do gin mch ngoi vi nn
huyt p ng mch gim.
Isradipin c ch chn lc nt xoang, nhng
khng c tc dng n dn truyn nh
tht, hoc n co c tim. Do vy
isradipin hu nh khng gy nhp tim
nhanh do phn x v khng ko di
khong P - Q.
H huyt p t c trong vng 24 gi sau
khi ung thuc, vi liu 2 ln 1 ngy, v
tc dng hon ton s t c trong vng
mt tun, hoc i khi sau 2 - 3 tun
dng liu duy tr.
C th dng isradipin phi hp vi cc thuc
chn beta, thuc li tiu hoc thuc c
ch enzym chuyn i angiotensin.
Dc ng hc
Sau khi 90 - 95% thuc c hp thu qua
ng tiu ha, thuc chuyn ha mnh bc
u gan, dn n sinh kh dng
DTQGVN
khong 15 - 24%. Khi ung 1 liu 2,5 - 20
mg, trong vng 20 pht, thy thuc trong
huyt tng v nng nh t c
sau khong 2 gi.
Ung isradipin vi thc n, hp thu b
chm li v thi gian t nng nh s
tng thm khong 1 gi, nhng khng nh
hng n sinh kh dng. 95% thuc lin
kt vi protein huyt tng. C nng
nh trong huyt tng v din tch di
ng cong u biu th mi lin quan
tuyn tnh vi liu dng trong khong t 0
n 20mg.
Thuc thi tr qua 2 pha, c na i u
1,5 - 2 gi, v na i cui l 8 gi.
Sau khi ung vin isradipin gii phng
chm, tc hp thu b chm li v nng
thuc trong huyt tng t dao ng
trong sut thi gian 24 gi gia 2 ln
ung.
Thuc chuyn ha hon ton nn khng
tm thy thuc nguyn dng trong nc
tiu. Khong 60 - 65% liu thuc ung bi
tit trong nc tiu v 25 - 30% thi tr qua
ng phn.
Cc s liu cho thy khng c tng quan
r gia dc ng hc v chc nng thn;
ngi bnh suy thn, thy c tng v gim
sinh kh dng ca thuc. Sinh kh dng
cao hn ngi cao tui v ngi suy gan
(cho ti 27%).
Ch nh
Huyt p cao. C th dng mt mnh
hoc phi hp vi thiazid li tiu.
Chng ch nh
Suy tim cha iu tr.
Qu mn vi bt c thnh phn no ca
thuc.
Thn trng
Hp ng mch ch, suy tim sau nhi mu
c tim cp, suy gan.
iu chnh liu ty theo ngi bnh suy
gan, suy tim, suy thn v ngi cao tui.
Thn trng ngi bnh c hi chng suy
nt xoang, xc nh hoc rt nghi ng
m khng t c my to nhp v ngi
c huyt p tm thu thp.
Thi k mang thai
Khi dng ng vt, khng chng t c
tim nng gy qui thai hay c cho
phi. Tuy nhin cha c nghin cu tha
ng v c kim tra cht ch ngi
mang thai. V vy khi dng cho ngi mang
thai cn cn nhc gia li ch cha bnh
v nguy c cho thai.
Thi k cho con b
Levonorgestrel (t trong t cung) 183
Cha bit thuc c bi tit qua sa hay
khng; tuy vy, ph n ang dng isradipin
nn ngng cho con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Ton thn: Ph c chn, au u, chng
mt, mt mi, nng bng mt.
Tun hon: nh trng ngc, nhp nhanh.
t gp, 1/1000 < ADR < 1/100
Tun hon: au tht ngc nng thm.
Tiu ha: Bun nn, to bn.
Gan: Tng transaminase.
Tm thn: Ri lon gic ng.
Him gp, ADR < 1/1000
Tun hon: Ngoi tm thu, gim huyt p.
Da: Ngoi ban, nga.
Gan: Tng bilirubin.
Chuyn ha: Tng glucose huyt.
C xng: au khp, au c.
Ni tit: To v n ng (c th hi
phc).
Cc tc dng khng mong mun c khuynh
hng gim hoc ht khi tip tc iu tr.
Liu lng v cch dng
Liu khuyn co trong tng huyt p nh
v trung bnh l 2,5 mg, ngy ung 2 ln
hoc 5 mg, ngy ung 1 ln.
ngi cao tui v ngi suy gan hoc
thn, liu khi u thch hp hn l mi
ln 1,25 mg, ung mi ngy 2 ln hoc
2,5 mg ung mi ngy mt ln.
Nu ung 2,5 mg, 2 ln mi ngy m sau
4 tun vn cha c hiu qu th phi hp
thm thuc h huyt p khc hoc tng
liu 5 mg, 2 ln mi ngy.
Thuc thng bt u p ng trong vng
2 - 3 gi sau khi ung. p ng ti a c
th phi sau 2 - 4 tun. Nu sau 4 tun
khng p ng c nh mong mun, th
c cch 2 - 4 tun c th tng thm 5 mg
mi ngy cho ti ti a 20 mg/ngy. Tuy
nhin, a s ngi bnh khng p ng
thm vi liu cao hn 10 mg/ngy v tn
sut tc dng khng mong mun tng ln
khi liu cao hn 10 mg/ngy.
Tng tc thuc
Dng ng thi vi cimetidin (mt cht c
ch h thng cytochrom P 450) lm tng
50% sinh kh dng ca thuc.
Rifampicin c th lm tng chuyn ha v
tng thanh thi isradipin.
Thn trng khi dng ng thi vi thuc
chng ng mu v thuc chng co git.
Gim liu isradipin v theo di cht ch
khi dng ng thi vi cc thuc chng
tng huyt p v gin mch khc (c
bit cc dn xut nit).
184 Levonorgestrel (t trong t cung)
n nh v bo qun
Bo qun di 30C, trong l kn, trnh
nh sng v m.
Qu liu v x tr
Kinh nghim qu liu v isradipin cn rt
t.
Qu liu c th gy gin mch ngoi vi qu
mc vi hu qu gim huyt p mnh v c
th ko di v gy nhp tim nhanh.
X l: Gy nn, ra d dy, ung than
hot, sau 30 pht dng thuc ty mui
nh. Isradipin lin kt mnh vi protein nn
khng loi c bng thm tch mu. Qu
liu isradipin biu th lm sng bng h
huyt p mnh, nn phi iu tr h tr
tim mch, bao gm, kim tra chc nng
tim v h hp, nng cao cc chi di, ch
n th tch dch tun hon, v lu lng
nc tiu. C th dng mt thuc co mch
gip phc hi huyt p tr li bnh th-
ng, min l khng c chng ch nh.
H huyt p ko di hoc ri lon dn
truyn nh tht c th c x l bng
tim tnh mch mui calci, hoc glucagon.
Phi ngng cimetidin trong trng hp ny
(nu ang s dng ng thi vi
isradipin) v c nguy c lm tng thm
nng isradipin trong huyt tng.
Thng tin qui ch
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 5 mg.
itraconazol
Tn chung quc t: Itraconazole
M ATC: J02A C02.
Loi thuc: Chng nm.
Dng thuc v hm lng
Vin nang 100 mg; dung dch ung: 10
mg/ml (150 ml).
Dc l v c ch tc dng
Itraconazol l mt cht triazol tng hp
chng nm c tc dng tt hn ketoconazol
i vi mt s nm, c bit i vi
Aspergillus spp. N cng c tc dng chng li
Coccidioides, Cryptococcus, Candida,
Histoplasma, Blastomyces v Sporotrichosis
spp. Itraconazol c ch cc enzym ph thuc
cytochrom P450 ca nm, do lm c ch
sinh tng hp ergosterol, gy ri lon chc
nng mng v enzym lin kt mng, nh h-
ng n s sng v pht trin ca t bo iu tr duy tr: nhng ngi bnh AIDS
nm.
DTQGVN
Mt s nghin cu invitro thng bo mt
s nm phn lp c trong lm sng, k
c cc loi Candida, khi km nhy cm
vi mt thuc chng nm azol th cng
km nhy cm vi cc dn cht azol khc.
Dc ng hc
Itraconazol c hp thu tt khi ung ngay
sau ba n hoc ung cng thc n, do
thc n lm tng hp thu.
Kh dng sinh hc tng i ng ung
ca vin nang so vi dung dch ung l trn
70%. ha tan ca itraconazol tng ln
trong mi trng acid. Nng nh huyt
thanh t c 20 microgam/lt, 4 - 5 gi
sau khi ung mt liu 100 mg lc i, tng
ln 180 microgam/lt khi ung cng thc n.
Trn 99% thuc gn vi protein, ch yu vi
albumin, ch khong 0,2% thuc dng t
do. Thuc ho tan tt trong lipid, nng
trong cc m cao hn nhiu trong huyt
thanh. Itraconazol chuyn ha trong gan
thnh nhiu cht ri bi tit qua mt hoc
nc tiu. Mt trong nhng cht chuyn ha
l hydroxyitraconazol c tc dng chng
nm, v c nng huyt thanh gp i
nng ca itraconazol trng thi n
nh. 3 - 18% liu ung c bi tit qua
phn di dng khng bin i. Khong
40% liu c bi xut ra nc tiu di dng
hp cht chuyn ha khng cn hot tnh.
Mt lng nh thi tr qua lp sng v tc.
Itraconazol khng c loi tr bng thm
tch. Na i thi tr sau khi ung 1 liu
100 mg l 20 gi, c th di hn khi dng
liu cao hng ngy.
Ch nh
Nm Candida ming - hng.
Nm Candida m h - m o.
Lang ben.
Bnh nm da nhy cm vi itraconazol (nh
bnh do Trichophyton spp., Microsporum
spp., Epidermophy-
ton floccosum) th d bnh nm da chn,
da bn, da thn, da k tay.
Bnh nm mng chn, tay (tinea
unguium).
Bnh nm Blastomyces phi v ngoi
phi.
Bnh nm Histoplasma bao gm bnh mn
tnh khoang phi v bnh nm
Histoplasma ri rc, khng mng no.
Bnh nm Aspergillus phi v ngoi phi
ngi bnh khng dung np hoc khng
vi amphotericin B.
phng nhim nm tim n ti pht.
DTQGVN
phng nhim nm trong thi gian gim
bch cu trung tnh ko di, m cch iu
tr thng thng t ra khng hiu qu.
Chng ch nh
Mn cm vi itraconazol v cc azol khc.
Ngi bnh ang iu tr vi terfenadin,
astemisol, triazolam dng ung, midazolam
dng ung v cisaprid. (xem Tng tc
thuc)
iu tr bnh nm mng cho ph n mang
thai hoc d nh c thai.
Thn trng
Trong nhim nm Candida ton thn nghi
do Candida khng fluconazol th cng c
th khng nhy cm vi itraconazol. Do vy,
cn kim tra nhy cm vi itraconazol
trc khi iu tr.
Tuy khi iu tr ngn ngy, thuc khng
lm ri lon chc nng gan, nhng cng
khng nn dng thuc cho ngi bnh c
tin s bnh gan hoc gan b nhim
c do cc thuc khc. Khi iu tr di
ngy (trn 30 ngy) phi gim st nh k
chc nng gan.
Thi k mang thai
Itraconazol gy pht trin bt thng bo
thai chut cng. Cha c nghin cu trn ph
n mang thai, nn ch dng cho ph n
mang thai khi tht cn thit.
Thi k cho con b
Khng nn cho con b khi dng itraconazol.
Tc dng khng mong mun (ADR)
Khi iu tr ngn ngy, tc dng khng
mong mun thng xy ra khong 7% ngi
bnh, phn ln l bun nn, au bng,
nhc u v kh tiu.
Khi iu tr di ngy ngi bnh c
bnh tim n v phi dng nhiu loi thuc
cng lc th tc dng khng mong mun
xy ra nhiu hn (16,2%).
Hu ht cc phn ng ph xy ra ng
tiu ha v vi tn xut t nht 5 - 6% trn s
ngi bnh iu tr.
Thng gp, ADR > 1/100
Ton thn: Chng mt, au u
Tiu ha: Bun nn, au bng, to bn, ri
lon tiu ha.
t gp, 1/1000 < ADR < 1/100
Ton thn: Cc phn ng d ng nh nga,
ngoi ban, ni my ay v ph mch; hi
chng Stevens - Johnson.
Ni tit: Ri lon kinh nguyt.
Gan: Tng c hi phc cc men gan, vim
gan, c bit sau khi iu tr thi gian
di.
Levonorgestrel (t trong t cung) 185
Ngoi ra cn thy c nguy c vim gan,
gim kali huyt, ph v rng lng, tc, c
bit sau iu tr thi gian di trn 1 thng
vi itraconazol. Cng c th gp bnh thn
kinh ngoi vi, nhng him.
Hng dn cch x tr ADR
nh k theo di enzym gan, ngng thuc
nu thy bt thng v du hiu vim gan.
Liu lng v cch dng
Cch dng: Vin nang v dung dch ung
khng th dng thay ln nhau c. Vin
nang phi ung ngay sau ba n v phi
nut. Dung dch ung, c chng minh ch
c hiu qu i vi bnh nm Candida
ming v thc qun v phi ung vo lc
i; khi ung, phi sc mnh dung dch
trong ming vi giy ri mi nut.
Liu lng:
Ngi ln:
Vin nang: iu tr ngn ngy:
Nm Candida m h - m o: 200 mg,
ngy ung 2 ln, ch ung 1 ngy hoc
200 mg, ngy ung 1 ln, ung trong 3
ngy.
Lang ben: 200 mg, ngy ung 1 ln, ung
trong 7 ngy.
Bnh nm da: 100 mg, ngy ung 1 ln,
ung trong 15 ngy. Nu vng sng ha
cao, phi iu tr thm 15 ngy vi liu
100 mg mi ngy.
Nm Candida ming - hu: 100 mg, ngy
ung 1 ln, ung trong 15 ngy. Ngi bnh
b bnh AIDS hoc gim bch cu trung
tnh: 200mg, ngy ung 1 ln, ung trong
15 ngy (v thuc c hp thu km
nhm ny).
iu tr di ngy (nhim nm ton thn)
ph thuc vo p ng lm sng v nm.
Bnh nm mng: 200 mg, ngy ung 1 ln,
trong 3 thng.
Bnh nm Aspergillus: 200 mg, ngy ung
1 ln, ung trong 2 n 5 thng. C th
tng liu: 200mg/ln, ngy ung 2 ln, nu
bnh lan ta.
Bnh nm Candida: 100 - 200 mg, ngy
ung 1 ln, ung trong 3 tun n 7
thng. C th tng liu: 200 mg, ngy 2
ln, nu bnh lan ta.
Bnh nm Cryptococcus (khng vim mng
no): 200 mg/ln, ngy ung 1 ln, ung
trong 2 thng n 1 nm.
Vim mng no do nm Cryptococcus: 200
mg/ln, ngy ung 2 ln. iu tr duy tr:
200 mg, ngy ung 1 ln.
Bnh nm Histoplasma v Blastomyces:
200 mg/ln, ngy ung 1 ln hoc 2 ln,
ung trong 8 thng.
186 Levonorgestrel (t trong t cung) DTQGVN

iu tr duy tr trong bnh AIDS: 200 khng acid, hoc cc cht khng H2 (nh
mg/ln, ngy ung 1 ln. cimetidin, ranitidin) hoc omeprazol,
D phng trong bnh gim bch cu trung sucralfat, kh dng sinh hc ca itraconazol
tnh: 200 mg/ln, ngy ung 1 ln. s b gim ng k, lm mt tc dng iu
Dung dch ung: tr chng nm. V vy khng nn dng
Bnh nm Candida ming - hng: 200 mg ng thi hoc phi thay itraconazol bng
(20 ml), ngy 1 ln, trong 1 - 2 tun. fluconazol hay amphotericin B.
Bnh nm Candida thc qun: 100 mg (10 Cc thuc cm ng enzym th d
ml), ngy 1 ln, iu tr ti thiu 3 tun. rifampicin, isoniazid, phenobarbital,
Sau khi cc triu chng , phi tip tc phenytoin lm gim nng ca
itraconazol trong huyt tng. Do nn
iu tr trong 2 tun.
thay thuc chng nm khc nu xt thy
Tr em: Hiu qu v an ton thuc cha c
iu tr bng isoniazid hoc rifampicin l
xc nh. cn thit.
Ngi cao tui: Nh liu ngi ln.
n nh v bo qun
Tng tc thuc Bo qun ni kh, nhit phng (15 -
Itraconazol l cht c ch h thng enzym 30oC), trnh nh sng.
cytochrom P450 3A do vy trnh dng ng Dung dch ung: Bo qun nhit di
thi itraconazol vi cc thuc c chuyn 25oC. Khng lm ng lnh.
ha bi h thng enzym ny v nng
cc thuc ny trong huyt tng c th tng Qu liu v x tr
dn n tng v ko di tc dng iu tr Cha c nhiu thng tin v trng hp qu
v c tc dng khng mong mun. liu. Mt s ngi bnh dng liu trn 1000
Terfenadin, astemisol, cisaprid c th tng mg c cc triu chng tng t phn ng
nng trong huyt tng nu ung cng ph liu khuyn dng.
vi itraconazol, d dn n lon nhp tim iu tr: Ngi bnh cn c iu tr triu
c th cht ngi. Chng ch nh phi chng v h tr, ra d dy nu cn thit.
hp ny. Khng c thuc gii c c hiu. Khng
Diazepam, midazolam, triazolam ung c loi c itraconazol bng thm tch mu
chng ch nh dng cng itraconazol. Nu (thn nhn to).
midazolam c tim tnh mch trong tin Thng tin qui ch
m phu thut th phi theo di tht Thuc c bng B.
cn thn v tc dng an thn c th ko
di.
Itraconazol dng cng vi warfarin lm tng
tc dng chng ng ca cht ny. Cn IVERMECTIN
theo di thi gian prothrombin ngi bnh
gim liu warfarin nu cn. Tn chung quc t: Ivermectin.
Vi cc thuc chn calci, c th gp ph, M ATC: P02C F01.
tai. Cn phi gim liu nu cn. Loi thuc: Thuc chng giun sn.
Vi cc thuc h cholesterol nhm c ch Dng thuc v hm lng
HMG - CoA reductase nh lovastatin, Vin nn 6 mg.
atorvastatin, simvastatin, pravastatin...,
Dc l v c ch tc dng
itraconazol c th lm tng nng cc Ivermectin l dn cht bn tng hp ca
thuc ny trong mu. gim nguy c mt trong s avermectin, nhm cht c cu
vim c hoc bnh c, c th tm ngng trc lacton vng ln, phn lp t s ln men
cc thuc ny nu cn phi iu tr nm Streptomyces avermitilis. Ivermectin c
ton thn. ph hot tnh rng trn cc giun trn v
Digoxin, dng cng vi itraconazol, nng tit tc ca gia sc, do c dng nhiu
trong huyt tng s tng. Phi theo di trong th y. Thuc ln u tin c dng
iu chnh liu. cho ngi vo nm 1981. Ivermectin c hiu
H ng huyt nng xy ra khi dng qu trn nhiu loi giun trn nh giun ln,
cc thuc ung chng i tho ng km giun tc, giun kim, giun a, giun mc v
vi cc thuc chng nm azol. V vy cn giun ch Wuchereria bancrofti. Tuy nhin,
theo di cht ch nng ng trong mu thuc khng c tc dng trn sn l gan v
iu chnh liu cc thuc ung chng sn dy.
i tho ng. Hin nay, ivermectin l thuc c chn
Itraconazol cn mi trng acid dch v iu tr bnh giun ch Onchocerca
c hp thu tt. V vy nu ung cng cc volvulus v l thuc dit u trng giun ch
DTQGVN
rt mnh, nhng t tc dng trn k sinh
trng trng thnh. Sau khi ung c 2 - 3
ngy, u trng giun ch da mt i nhanh;
cn u trng gic mc v tin phng mt
th chm hn.
Tc dng ca thuc c th ko di n 12
thng. Mt thng sau khi dng, u trng ti t
cung giun ch trng thnh khng thot ra
c, ri b thoi ha v tiu i. Tc dng
ko di trn u trng rt c ch trong vic
ngn chn con ng ly lan ca bnh.
bit kh r c ch tc dng ca
ivermectin i vi giun ch Onchocerca.
Thuc gy ra tc dng c trc tip, lm
bt ng v thi tr u trng qua ng
bch huyt. Ivermectin kch thch tit cht
dn truyn thn kinh l acid gama - amino
butyric (GABA). cc giun nhy cm, thuc
tc ng bng cch tng cng s gii
phng GABA sau sinp ca khp thn kinh
c lm cho giun b lit.
Ivermectin khng d dng gia nhp c
vo h thng thn kinh trung ng ca cc
loi ng vt c v, v vy, khng nh h-
ng n s dn truyn thn kinh ph
thuc GABA ca cc loi ny.
Cn cha bit r kh dng sinh hc tuyt
i ca thuc sau khi ung. Ni chung,
khng thy c s khc nhau v nng
nh trong huyt tng gia dng vin nn
v dng vin nang (46 so vi 50
microgam/lt). Tuy nhin, khi
ivermectin trong mt dung dch nc c ru,
nng nh tng gp i v sinh kh
dng tng i ca vin nn ch bng 60%
sinh kh dng ca dng dung dch. Thi
gian t ti nng nh trong huyt t-
ng khong 4 gi v khng khc nhau gia
cc dng bo ch. Ivermectin c th tch
phn b biu kin khong 48 lt, v
thanh thi rt thp (khong 1,2 lt/gi).
Na i thi tr sau khi ung dng dung
dch khong 28 gi. Khong 93% thuc lin
kt vi protein huyt tng. Chuyn ha ca
thuc cha c nghin cu k, tuy nhin
thy thuc b thy phn v b kh methyl
gan. Ivermectin bi tit qua mt v thi
tr gn nh ch qua phn. Di 1% liu dng
c thi qua nc tiu.
Ch nh
Ivermectin c la chn iu tr bnh
giun ch Onchocerca, mc d thuc c
hiu qu tt trong iu tr cc bnh giun
k c giun ln rut do Strongyloides
stercoralis. Vai tr ca ivermectin trong
bnh giun ch h bch huyt cn cha -
c nghin cu k.
Chng ch nh
Chng ch nh ngi mn cm vi
ivermectin v mt thnh phn no
Levonorgestrel (t trong t cung) 187
ca thuc: Chng ch nh nhng
bnh c km theo ri lon hng ro mu
no, nh bnh trypanosoma chu Phi v
bnh vim mng no.
Thn trng
Cn cha c nhiu kinh nghim dng thuc
cho tr em di 5 tui, v vy khng dng
cho la tui ny.
Do thuc lm tng GABA, nn c quan nim
cho rng thuc c tc dng trn h thn
kinh trung ng ngi m hng ro mu no
b tn thng (nh trong bnh vim mng
no, bnh do Trypanosoma).
Khi iu tr bng ivermectin cho ngi b
bnh vim da do giun ch Onchocerca th
tng phn ng, c th xy ra cc phn ng
c hi nng hn, c bit l ph v lm
cho tnh trng bnh nng ln.
Thi k mang thai
Ti liu trn ngi cn hn ch. Trong mt
nghin cu din rng 14 000 ngi bnh
dng thuc mi nm mt ln, trong 3 nm
c 203 tr c sinh ra t nhng ngi m
dng thuc khi mang thai. Kt qu cho thy,
nhng khuyt tt cc tr sinh ra t cc b
m dng thuc khng khc c ngha vi
cc tr ca cc b m khng dng thuc. V
bnh u trng giun ch Onchocerca d
gy ra m la, li cha thy c bo co v
kh nng gy qui thai, mc d thuc
c dng trn mt phm vi rt rng, nn c
dng
th dng ivermectin sau khi c thai c 3
thng.
Thi k cho con b
Ivermectin tit vo sa m vi nng
thp (di 2% lng thuc dng). An ton vi
tr s sinh cha c xc nh, do ch
dng thuc ny cho ngi m khi thy c li
cho m hn.
Tc dng khng mong mun (ADR)
Ivermectin l thuc an ton, rt thch hp
cho cc Chng trnh iu tr trn phm vi
rng. Hu ht cc tc dng khng mong
mun ca thuc l do cc phn ng min
dch i vi cc u trng b cht. V vy,
mc nng nh ca tc dng ny c lin
quan n mt u trng da. Cc tc
dng khng mong mun c thng bo
gm st, nga, chng mt hoa mt, ph,
ban da, nhy cm au hch bch huyt,
ra m hi, rng mnh, au c, sng khp, s-
ng mt (phn ng Mazzotti). H huyt p
th ng nng c thng co c km ra
m hi, nhp tim nhanh v l ln.
Tc dng khng mong mun thng xy ra
trong 3 ngy u sau khi iu tr v ph
thuc vo liu dng. T l cc tc dng
khng mong mun c thng bo rt
khc nhau. Trong mt bo co gm 50 929
ngi bnh dng ivermectin, tc dng ph
188 Levonorgestrel (t trong t cung)
khong 9%. nhng vng c dch lu hnh
nhiu, t l cc tc dng khng mong
mun c th cao hn nhiu.
Di y l ADR: Trong iu tr bnh giun
ch Onchocerca liu 0,1 - 0,2 mg/kg:
Thng gp, ADR > 1/100
Xng khp: au khp/vim mng hot dch
(9,3%).
Hch bch huyt: Sng to v au hch bch
huyt nch (10,0% v 4,4%), c (5,3%
v 1,3%), bn (12,6% v 13,9%).
Da: Nga (27,5%); cc phn ng da nh ph,
c nt sn, mn m, ban da, my ay
(22,7%).
Ton thn: St (22,6%).
Ph: Mt (1,2%); ngoi vi (3,2%).
Tim mch: H huyt p th ng (1,1%),
nhp tim nhanh (3,5%).
t gp, 1/1000 < ADR < 1/100
Thn kinh trung ng: Nhc u (0,2%).
Thn kinh ngoi vi: au c (0,4%).
Hng dn cch x tr ADR
Ivermectin c th gy cc phn ng da v
phn ng ton thn vi mc khc nhau
(phn ng Mazzotti) v cc phn ng trn
mt cc ngi bnh b giun ch
Onchocerca. Cc phn ng ny c th l
hu qu ca p ng d ng v vim do
cc u trng b cht. C th iu tr cc
phn ng ny bng cch dng thuc gim
au, thuc khng histamin hoc tim
corticosteroid ngay khi mi xut hin cc
triu chng. Liu dng ty theo mc ca
cc phn ng.
Khi b h huyt p th ng, cn b dch
bng ng ung, nm ngh, truyn tnh
mch nc mui sinh l hoc tim
corticosteroid.
Cn nh rng ivermectin khng dit c k
sinh trng Onchocerca trng thnh, do
thng xuyn theo di v ti iu tr l cn
thit. Phi dn d ngi bnh.
Liu lng v cch dng
Ivermectin ung vi nc vo bui sng sm
khi cha n hoc c th vo lc khc, nhng
trnh n trong vng 2 gi trc v sau khi
dng thuc.
Cha xc nh c an ton cho tr em d-
i 5 tui.
Ngi ln v tr em trn 5 tui: Dng mt liu
duy nht 0,15 mg/kg. Liu cao hn s lm
tng phn ng c hi, m khng tng hiu
qu iu tr. Cn phi ti iu tr vi liu Thuc tim: Kali clorid m c pha tim
nh trn hng nm chc chn khng
ch c u trng giun ch Onchocerca.
Nu ngi bnh b nhim nng u trng
vo mt, th c th phi ti iu tr th-
ng xuyn hn, chng hn nh c sau 6
thng phi dng thuc li mt ln.
DTQGVN
Hng dn liu dng ivermectin iu tr
nhim Onchocerca:
Th trng Liu ung duy nht (vin 6
(kg) mg)
15 - 25 0,5 vin
26 - 44 1 vin
45 - 64 1,5 vin
65 - 84 2 vin
85 0,15 mg/kg
Tng tc thuc
Cha thy c thng bo v tng tc thuc c
hi, nhng v mt l thuyt, thuc c th
lm tng tc dng ca cc thuc kch thch
th th GABA (nh cc benzodiazepin v
natri valproat).
n nh v bo qun
Bo qun nhit di 30 oC.
Qu liu v x tr
Cc biu hin chnh do nhim c
ivermectin l ban da, ph, nhc u, hoa
mt, chng mt, suy nhc, bun nn, nn,
a chy. Cc tc dng khng mong mun
khc gm cc cn ng kinh, mt iu
ha, kh th, au bng, d cm v my
ay.
Khi b nhim c, cn truyn dch v cc
cht in gii, tr h hp (oxygen v h
hp nhn to nu cn), dng thuc tng
huyt p nu b h huyt p. Gy nn
hoc ra d dy cng sm cng tt. Sau
, dng thuc ty v cc bin php chng
c khc nu cn ngn cn s hp thu
thm thuc vo c th.
KALi clorid
Tn chung quc t: Potassium chloride.
M ATC: A12B A01, B05X A01.
Loi thuc: Cht in gii.
Dng thuc v hm lng
Thuc ung: Vin nang, tc dng ko di 8
mmol v 10 mmol kali clorid; dung dch 10,
15, 20, 30, 40 v 45 mmol/15 ml; thuc bt
pha dung dch 15, 20 v 25 mmol/gi
(mi hoa qu); thuc bt ch dch treo
20 mmol; vin nn, tc dng ko di
6;7;8;10 mmol.
1,5 mmol/ml v 2,0 mmol/ml (50 ml).
Ch : 1 mmol tng ng 75 mg kali
clorid.
Dc l v c ch tc dng
Kali l mt cation ch yu (xp x 150
n 160 mmol/lt) trong t bo. dch
ngoi bo, hm lng kali thp (3,5 n 5
DTQGVN
mmol/lt). Mt enzym lin kt vi mng l
Na+ - K+ - ATP - ase c tc dng vn chuyn
tch cc, bm Na+ ra ngoi v K+ vo trong
t bo duy tr s chnh lch nng
ny. Chnh lch nng K+ trong v ngoi
t bo cn thit cho dn truyn xung
ng thn kinh cc m c bit nh tim,
no, v c xng, cng nh duy tr chc
nng thn bnh thng v cn bng kim
toan.
Kali clorid hp thu nhanh qua ng tiu
ha, v hp thu tt hn cc mui kali khc
khng phi kali clorid, thuc c thi tr
ch yu qua thn (khong 90%), v phn
(khong 10%). Khng ging natri, kh nng
gi kali ca thn km, ngay c khi c th
thiu nng.
Ch nh
Kali clorid thng c la chn iu tr
gim kali mu, v ion clorid cng cn
iu chnh gim clo mu thng xy ra
cng vi gim kali mu. Kali clorid c ch
nh iu tr gim kali mu nng ngi
bnh dng thuc li tiu thi kali iu
tr cao huyt p v cn cha bin chng.
Kali clorid cn c dng phng gim kali
mu nhng ngi c bit c nguy c
gim kali mu (v d: ngi bnh dng
digitalis b lon nhp tim nng, v gim
kali mu lm tng c tnh ca glycosid
tim).
Kali clorid cng c th ch nh cho ngi
b x gan c chc nng thn bnh thng,
mt s trng thi a chy, k c do s dng
thuc nhun trng di ngy, nn ko di,
hi chng Bartter, bnh thn gy mt kali,
v nhng ngi bnh (k c tr em) iu
tr corticosteroid ko di.
Chng ch nh
Kali clorid chng ch nh khi tng kali
mu, v tng thm kali c th gy ngng
tim.
Kali clorid dng vin chng ch nh khi
thc qun b chn p, d dy chm tiu,
tc rut, hp mn v, v cn tr kali clorid
qua d dy - rut c th gy kch ng d
dy rut nng hn, do nng kali cao ti
ch.
Thn trng
S dng thn trng ngi b suy thn
hoc suy thng thn, bnh tim, mt nc
cp, say nng, ph hy m rng nh bng
nng, hoc ngi dng thuc li tiu t thi
kali.
ngi lot d dy t trng, phi chng ch
nh dng dng vin. Phi thn trng khi
ghi n thuc c kali ung dng rn,
Levonorgestrel (t trong t cung) 189
c bit khi dng liu cao cho ngi mang
thai hoc ngi bnh ng thi dng thuc
khng acetylcholin, v c kh nng lm
gim nhu ng d dy - rut.
ngi b suy gim chc nng thn, cn
cn thn khi k n kali clorid, v c th
c nguy c tng kali mu. Theo di cc cht
in gii trong huyt thanh c bit cn
thit nhng ngi b bnh tim hoc thn.
mt s ngi bnh thiu magnesi do dng
thuc li tiu s ngn cn hp thu kali rut,
v vy cn phi iu chnh gim magnesi
huyt iu tr gim kali mu.
Nu dng kali clorid khi c tiu chy, mt
dch kt hp vi s dng kali clorid c th
gy c tnh trn thn, v c th c nguy
c tng kali mu.
Kali clorid c th lm trm trng thm
bnh lit chu k c tnh cht gia nh
hoc cc bnh lon trng lc c bm sinh,
v vy cn phi thn trng.
Thi k mang thai
S dng thn trng ngi mang thai, v
kali clorid c trong cu to t nhin ca m
v dch. Nng kali cao hay thp u
c hi cho chc nng tim ca m v thai,
nn phi theo di st kali huyt thanh.
Thi k cho con b
Vic dng kali c xem l an ton trong
thi k cho con b. Sa ngi bnh thng
c t kali. Nu nng kali huyt thanh
ca m c duy tr mc sinh l, th
khng c hi g cho a tr b m, khi
m dng kali clorid.
Tc dng khng mong mun (ADR)
Khi dng lu di kali clorid, c th xy ra
tng kali mu, nhp tim khng u l du
hiu lm sng sm nht ca tng kali mu
v c pht hin d dng bng in tm
.
Thng gp, ADR > 1/100
Tiu ha: Tiu chy, bun nn, au d dy,
kh chu, hoc trng bng nh, nn.
t gp, 1/1000 < ADR < 1/100
Tun hon: Tng kali mu, nhp tim khng
u hoc chm.
Xng: Mt cm gic hoc nh kim chm
bn tay, bn chn hoc mi, chi di yu
hoc c cm gic nng.
H hp: Th nng hoc kh th.
Him gp, ADR < 1/1000
Tiu ha: au bng hoc au d dy, chut
rt, phn c mu (mu hoc mu
en).
H hp: au ngc hoc hng, c bit khi
nut.
Hng dn cch x tr ADR
190 Levonorgestrel (t trong t cung)
Lon nhp tim l du hiu lm sng sm
nht, pht hin c bng in tm . li niu.
Ngng dng kali clorid ngay.
a chy, bun nn, au bng thng xy ra
khi dng thuc ung, phi ung cng thc n
hoc phi pha long.
Liu lng v cch dng
Ung mui kali phi ung vo ba n
hoc sau ba n vi nhiu nc. Thuc nc
phi pha long trc khi dng.
Tim tnh mch: Phi pha long nng
kali clorid vi mt th tch ln (1000 ml) ca
dch thch hp truyn tnh mch, nng
kali tt nht l 40 mmol trong mt lt,
v khng vt qu 80 mmol trong mt lt.
trnh tng kali mu trong khi truyn tnh
mch, tc truyn khng c nhanh, tc
10 mmol trong mt gi thng l an
ton, khi lng nc tiu thi ra tha ng
(trong iu tr cp cu, tc truyn l
20 mmol/gi). Thng thng, tc truyn
khng bao gi c php vt qu 1 mmol
trong mt pht cho ngi ln v 0,02 mmol
cho mt kg th trng trong mt pht i
vi tr em. Nu tc truyn vt qu 0,5
mmol/kg/gi, thy thuc phi ngi bn cnh
v theo di in tm lin tc. Trong
sut thi gian dng tc cao, ngi bnh
cn c theo di thng xuyn v lm sng
v in tm . Nu c ri lon chc chng vim khng steroid (NSAID), cc tc
nng thn, c bit l suy thn cp nh c
du hiu thiu niu v/ hoc tng
creatinin huyt thanh, xy ra trong khi
truyn kali clorid, cn ngng truyn ngay.
C th truyn li nu cn, nn dng rt
thn trng v theo di cht ch.
iu tr gim kali mu
Ngi ln: Ung phng trong liu php li
niu: 40 mmol/ngy kali clorid c th
phng c gim kali huyt phn ln s
ngi bnh dng thuc li niu di ngy. i
vi ngi tng huyt p khng bin chng,
khng ph, iu tr ngoi tr, thng khng
cn b sung kali; tuy nhin, nu kali huyt
thanh di 3 mmol/lt, nn dng 50 - 60 mmol
kali/ngy. i vi ngi bnh ph (th d suy
tim, x gan c trng) cho 40 - 80
mmol/ngy (thiu nh) hoc 100 - 120
mmol/ngy (thiu nng) km theo di cn
thn kali huyt thanh.
Tim truyn nh git tnh mch ngoi bin
(kali huyt thanh nh hn 2,5 mmol/lt) tc
truyn 10 - 20 mmol/gi; dnh tc
nhanh hn 20 mmol/gi cho nhng trng hp
cp cu; c th lp li cch 2 - 3 gi nu
cn, nhng nng kali trong dch truyn
khng c vt qu nng ti a 40
mmol/lt.
DTQGVN
Tr em: Ung 1 - 2 mmol/kg trong liu php
Ngi cao tui: Liu thp hn ngi bnh
thng v chc nng thn gim mt s ng-
i do tui cao.
Cc trng hp khc: Liu duy tr da vo
kali huyt thanh. Tn thng thn, gim
nhu cu. i vi ngi c tn thng thn
hoc b blc tim bt c th no, phi gim
tc truyn xung mt na v khng -
c vt qu 5 - 10 mmol/gi.
Liu lng ph thuc vo ion - huyt
thanh v cn bng kim toan. Thiu kali
c tnh theo cng thc: mmol kali = kg
th trng x 0,2 x 2 x (4,5 - kali huyt
thanh hin ti tnh theo mmol); (th tch
ngoi t bo c tnh t th trng kg x
0,2)
Tng tc thuc
Kali clorid c th tng tc vi amphotericin
B, corti-
costeroid, glucocorticoid, corticotropin,
ACTH, gentamicin, penicilin (k c
azlocilin, carbenicilin, mezlocilin,
piperacilin, ticarcilin), polymyxin B. Nhu
cu kali c th tng nhng ngi dng cc
thuc trn, do tng bi tit kali qua thn,
cn theo di cht ch kali huyt thanh.
Cc thuc c ch enzym chuyn, thuc
nhn chn beta giao cm, mu t ngn
hng mu (c th cha kali ti 30 mmol
trong mt lt huyt tng hoc ti 65
mmol trong mt lt mu khi bo qun qu
10 ngy), cyclos-
porin, thuc li tiu t thi kali, heparin,
sa c t mui, cht thay th mui, s
dng ng thi vi kali clorid c th tng
nng kali huyt thanh, lm tng kali
mu nng gy ngng tim, c bit
trong suy thn, v khi s dng cc cht
chng vim khng steroid cng vi kali
clorid c th tng nguy c tc dng ph
i vi d dy - rut.
Kali clorid cn s dng thn trng ngi
dng mui calci ng tim, v c nguy c
gy lon nhp tim.
Khi dng kali clorid kt hp vi thuc li tiu
thiazid (lm mt nhiu kali), c nguy c
tng kali mu nu ngng thuc li tiu.
Kali clorid dng ng thi vi insulin hoc
natri bicarbonat gy gim kali huyt thanh
do thc y ion kali vo trong t bo.
Kali clorid khng c dng ng thi ng-
i b blc tim hon ton hoc nng ang
dng digitalis (v d nh: digoxin), tuy nhin
nu phi b sung kali phng
hoc iu tr h kali mu nhng ngi
DTQGVN
dng digitalis th phi theo di cht ch
nng kali huyt thanh.
n nh v bo qun
Bo qun di 300C, trnh lm ng lnh,
bo qun trong thng kn hoc gi l kim
loi.
Tng k
Kali clorid khng c pha vo manitol, mu
hoc cc sn phm mu, hoc dung dch
cha aminoacid hoc c cha lipid, v c
th lm kt ta nhng cht ny hoc
gy tan hng cu truyn vo.
Qu liu v x tr
Triu chng: Gp nhng thay i trn
in tm in hnh (sng T tng iod phng x, kali iodid bo v c tuyn
bin v nhn, sng P bin mt, phc hp gip bng cch ngn cn thu np ng v
QRS gin rng).
iu tr: Dng dextrose 10% pha thm 10
n 20 n v insulin trong mt lt v
truyn vi tc 300 n 500 ml dch
trong mt gi.
iu chnh nhim toan bng natri
bicarbonat 50 mmol tim tnh mch trong 5
pht. C th nhc li liu ny trong vng
10 n 15 pht.
Dng calci gluconat (0,5 n 1 gam, tim
tnh mch trong 2 pht) chng li tc
dng c trn tim.
S dng nha trao i ion rt kali tha
ra khi c th bng s hp ph v/ hoc
trao i kali.
Ung natri polystyren sulfonat 20 n 50
gam nha trao i ion pha trong 100
n 200 ml dung dch sorbitol 20%. Liu
c th cho 4 gi mt ln, 4 n 5 ln
trong mt ngy ti khi nng kali tr v
mc bnh thng.
C th cn thit s dng lc mu thn
nhn to hoc thm phn mng bng
lm gim nng kali huyt thanh ngi
suy gim chc nng thn.
Thng tin qui ch
Kali clorid c trong danh mc thuc thit
yu Vit Nam ban hnh ln th t nm
1999.
Thuc dng tim phi k n v bn theo
n.
Kali iodid
Tn chung quc t: Potassium iodide.
M ATC: V03A B21, S01X A04, R05C A02.
Loi thuc: Thuc tr cng gip.
Dng thuc v hm lng
Levonorgestrel (t trong t cung) 191
Dung dch ung 1 g/ml; siro 325 mg/5 ml;
vin nn 130 mg; vin bao tan rut 300
mg.
Dc l v c ch tc dng
ngi bnh cng gip, kali iodid lm gim
nhanh cc triu chng bng cch c ch
gii phng hormon gip vo tun hon.
Tc dng ca kali iodid trn tuyn gip bao
gm gim phn b mch mu, lm chc
m tuyn, co nh kch thc t bo, ti
tch ly cht keo trong cc nang v tng
iod lin kt. Nhng tc dng ny c th
to thun li cho vic ct b tuyn gip,
nu dng thuc trc khi phu thut.
Nu ung trc v sau khi dng cc ng v
phng x. Nu dng kali iodid ng thi vi
tip xc phng x, tc dng bo v xp x
97%. Nu dng kali iodid 12 v 24 gi trc
khi tip xc phng x th tc dng bo v
tng ng l 90% v 70%. Tuy nhin, nu
dng kali iodid 1 v 3 gi sau khi tip xc
phng x th tc dng bo v tng ng l
85% v 50%. Nu ung sau 6 gi th tc
dng bo v khng ng k.
Cc iodid c hp thu d dng qua ng
tiu ha. Nng cc iodid trong mu
c bit thp (0,2 n 0,4
microgam/decilit). Kali iodid c hp thu
tt khi ung v c bi tit qua thn. Tc
dng ca kali iodid trn chc nng tuyn
gip thng xut hin trong vng 24 gi v
t ti a sau 10 - 15 ngy iu tr lin
tc; tuy nhin thuc khng kim sot c
hon ton cc biu hin ca chng cng
gip v tc dng ca thuc gim i sau
mt thi gian.
Kali iodid qua c nhau thai v bi tit vo
sa.
Ch nh
Kali iodid c ch nh trong:
iu tr cng gip trc khi phu thut ct
b tuyn gip hoc iu tr cn
nhim c gip (cng vi thuc khng
gip).
c dng lm cht bo v tuyn gip chng
nhim x, trc v sau khi ung hoc ht cc
cht ng v phng x iod, hoc trong tr-
ng hp cp cu phng x.
iu tr thiu ht iod.
iu tr bnh nm da do Sporotrichium.
iu tr ban nt.
Kali iodid c dng cng vi mt thuc
khng gip trng lm thoi trin tuyn
gip trc khi ct b tuyn ny.
192 Levonorgestrel (t trong t cung)
Kali iodid cng c dng lm thuc long
m, nhng khng thy r tc dng.
Chng ch nh
C tin s mn cm vi kali iodid; ngi
ang b vim ph qun cp.
Thn trng
V c vi c nhn mn cm r rt vi
iodid, nn phi thn trng khi dng kali
iodid ln u.
Cn thn trng ngi tng kali mu, tng
trng lc c bm sinh (kali lm chng
bnh trm trng thm), suy gim chc
nng thn, bnh lao (do thuc kch thch
v tng tit dch), khi dng ko di ngi
cng gip (gy tng sn, u tuyn gip,
thiu nng gip, bu c n thun).
Cn thn trng khi dng iod hoc mui iod
cho tr em: Ngi bnh trn 45 tui c
hoc khng c bu c c nhn c bit
d b tng nng gip (Basedow - ha do
iod) khi b sung iod. Do phi gim
liu v khng c dng iod du.
Phi ht sc thn trng khi dng vin bao
tan rut, v dng thuc ny c th gy
thng tn rut non lm cho rut tc
nghn, xut huyt, thng v t vong.
Thn trng khi dng kt hp vi cc thuc
khc, c bit thuc c tng tc vi kali
iodid nh thuc khng gip, captopril,
enalapril, lisinopril, thuc li tiu gi kali,
lithium, natri iodid...
Thi k mang thai
Kali iodid qua c nhau thai, v vy vic
s dng thuc trong khi mang thai c th
gy gim nng gip v/hoc bu gip
bm sinh. Khng nn dng thuc trong thi
k mang thai.
Thi k cho con b
Kali iodid vo sa v c th gy ban da,
c ch tuyn gip tr s sinh. V vy
khng c cho con b.
Tc dng khng mong mun (ADR)
S dng kali iodid thi gian ngn vi liu
thp, thng t gy tc dng khng mong
mun, nhng khi iu tr di ngy, c
tnh ca kali iodid c th xy ra.
Thng gp, ADR > 1/100
Tiu ha: a chy, bun nn, nn, au d
dy.
t gp, 1/1000 < ADR < 1/100
Mu: Tng bch cu a eosin.
Da: My ay.
H bch huyt: Sng hch bch huyt.
C quan khc: Sng cnh tay, mt, chn,
mi, li, v/hoc sng hng; au khp.
DTQGVN
Him gp (khi dng ko di), ADR <
1/1000
Ton thn: au u nng.
Tiu ha: Tng tit nc bt, nng bng
ming, v kim loi, au rng li.
Da: L lot da.
Tun hon: Nhp tim khng u.
C quan khc: L ln, t, au nhi dy
thn kinh, au hoc yu tay, chn, mt
mi bt thng, cm gic nng hai cng
chn.
Hng dn cch x tr ADR
Khi tc dng khng mong mun xy ra,
cn ngng iu tr.
Liu lng v cch dng
iu tr cng gip trc khi phu thut ct
b tuyn gip: (phi hp vi 1 thuc khng
gip cho trc ngn chn iod st nhp
vo d tr mi hormon): Iod c th cho di
dng dung dch kali iodid mi ml cha 130
mg iod t do v phi hp; 1 liu 0,1 - 0,3
ml cho vo sa hoc nc ngy ung 3 ln
trong 7 - 14 ngy. Mt cch khc, liu gi
trn c cho ti
250 mg ngy 3 ln vi thc n.
iu tr cn nhim c gip, Kali iodid
c dng phi hp vi 1 thuc khng gip
cho 1 gi trc khi dng thuc iod. Liu: 50 -
100 mg ngy 2 ln.
Bo v tuyn gip chng nhim x:
Ngi ln: Ung 100 - 150 mg, 24 gi trc khi
dng hoc tip xc vi iod phng x, sau
, ung mi ngy 1 ln, trong 3 n 10
ngy.
Tr em di 1 tui: Ung 65 mg, 1 ln/ngy,
trong
10 ngy sau khi dng hoc tip xc vi iod
phng x.
Tr em t 1 tui tr ln: Ung 130mg, 1
ln/ngy, trong 10 ngy sau khi dng hoc
tip xc vi iod phng x.
Chng nm:
Ngi ln: Ung 600 mg, 3 ln/ngy, liu c
th tng tng 60 mg cho mi liu, cho ti
liu ti a c th dung np c.
Tr em: Cha xc nh c liu.
B sung iod:
Ngi ln: Ung t 5 n 10 mg/ngy.
Tr em: Ung 1 mg/ngy.
Ung thuc sau ba n hoc ung cng vi
thc n hay sa gim kch ng d dy.
Tng tc thuc
Dng ng thi kali iodid vi thuc khng
gip c th gy thiu nng tuyn gip v
tng tc dng gy bu gip ca thuc
khng gip hoc kali iodid. Cn nh k
DTQGVN
xc nh tnh trng tuyn gip pht
hin nhng thay i trong p ng
tuyn gip - tuyn yn.
S dng kali iodid cng vi captopril,
enalapril, lisino-
pril c th lm tng kali huyt, do cn
phi theo di thng xuyn nng kali
huyt.
Dng cc thuc li tiu gi kali cng vi kali
iodid c th lm tng kali huyt v lon nhp
tim, hoc ngng tim.
S dng kali iodid cng vi lithi c th gy
gim nng tuyn gip v gy bu gip.
n nh v bo qun
Bo qun thuc di 400C, tt nht l trong
khong
15 n 300C, trong l hoc hp kn,
trnh nh sng.
Hin tng kt tinh c th xy ra trong
dung dch kali iodid ung, iu kin
bo qun bnh thng, c bit khi
trong t lnh; tuy nhin, lm m v lc,
tinh th s tan tr li. Kali iodid b oxy ha
c th gii phng iod t do lm cho dung
dch chuyn mu vng nu. Nu dung
dch b chuyn mu phi vt b.
Qu liu v x tr
Triu chng: C v kim loi, nng bng
ming, au rng, lot li, vim tuyn nc
bt, thng tn da do iod. Tit nhiu nc
bt, s mi, au u vng trn, v ho c
m, tt c ging nh khi b vim xoang
hoc cm lnh. Khi nng, tit nhiu dch
ph qun c th gy ph phi. Cc biu
hin qu mn khc gm ban xut huyt,
huyt khi gim tiu cu, v vim quanh
ng mch c nt, nguy him cht ngi.
iu tr: Cc triu chng ng c iod mt
nhanh sau khi ngng dng iod. V vy, khi
nhim c, cn ngng iu tr. Iodid
cnh tranh vi clorid trong ti hp thu ng
ln gn, nn s bi niu mui lm tng
o thi iod qua thn v thch hp vi
nhng ca nhim c iod nng. Khi b
vim tuyn nc bt v b thng tn da do
iod, c th iu tr bng corticosteroid.
Kanamycin
Tn chung quc t: Kanamycin.
M ACT: A07A A08, J01G B04, S01A A24.
Loi thuc: Khng sinh nhm
aminoglycosid.
Levonorgestrel (t trong t cung) 193
Dng thuc v hm lng
L kanamycin sulfat bt kt tinh mu
trng tng ng 500 mg hoc 1 g
kanamycin base.
Nang kanamycin sulfat tng ng 500 mg
kanamy-
cin base.
Dc l v c ch tc dng
Kanamycin l mt khng sinh nhm
aminoglycosid, thu c t mi trng nui
cy Streptomyces kanamyceticus. V mt
dc l hc v dc ng hc, kanamycin t-
ng t nh cc aminoglycosid khc. Ni
chung cc aminoglycosid c ph khng
khun vi vi khun hiu kh Gram m v
mt s Gram dng nh Acinetobacter,
Citrobacter, Enterobacter, Escherichia coli,
Klebsiella, Proteus c sinh v khng sinh
indol, Providencia, Pseudomonas,
Salmonella, Serratia v Shigella. Tuy nhin
ph khng khun ca tng loi c khc
nhau. Vic s dng aminoglycosid trn lan
lm cho cc chng vi sinh vt ni trn khng
khng sinh pht trin rt nhanh. Ni chung,
tnh hnh khng i vi kanamycin ln hn
so vi gentamicin hoc streptomycin.
Theo thng bo ca ASTS nm 1997, mc
khng kanamycin ca Citrobacter vo
khong 50%, Herella khong 60%, Proteus
khong 55,8%, P. aeruginosa khong 81,4%,
Enterobacter khong 50%, E. coli khong
44,7%.
Trong s cc vi khun Gram dng,
aminoglycosid thng c tc dng i vi t
cu vng v t cu S. epidermitis, nhng
theo bo co 1997 ca ASTS khong 38%
khng thuc.
Tuy nhin, aminoglycosid khng c tc dng
i vi lin cu khun, v a s chng vi
khun ng rut Enterococcus khng
thuc. i vi cc chng Myco-
bacterium, kanamycin c hot tnh in - vitro
vi cc chng M. kansaii, M. marinum v M.
intracellulosa. Tuy nhin, tc dng lm
sng ca kanamycin vi cc chng ny so vi
cc aminoglycosid khc cha c chng minh
y .
Thng c s khng thuc cho gia
kanamycin, neomycin v paromycin, nhng
khng thy khng cho gia kanamycin v
streptomycin vi cc chng Mycobacterium
nh vi cc chng vi khun khc.
i vi M. tuberculosis, nu kanamycin dng
n c th chng ny s khng rt
nhanh, do vy khng c dng n tr liu
i vi chng ny.
Dc ng hc
Ging nh gentamicin, kanamycin hp th
km qua ng tiu ha, nhng hp th
194 Levonorgestrel (t trong t cung)
nhanh qua ng tim bp. Sau khi tim
bp 1 gi, liu 500 mg v 1 g, nng ti
a t c trong huyt thanh tng ng 20
v 30 microgam/ml. Na i ca kanamycin
l 3 gi. Kanamycin thi tr nhanh qua lc
cu thn v phn ln liu tim thi qua nc
tiu trong vng 24 gi. Kanamycin xut
hin trong mu dy rn v trong sa.
Ch nh
Kanamycin c dng trong thi gian ngn
iu tr nhim khun nng do cc
chng vi khun nhy cm (nh E. coli,
Proteus, Enterobacter aerogenes, Klebsiel-
la pneumoniae, Serratia marcescens v
Mima- Herella) khng li cc
aminoglycosid khc t gy c c quan
thnh gic hn.
iu tr lu v nhim khun lu mt tr Tuy nhin c 3 vn cn phi lu i vi
s sinh.
Cng nh gentamycin, trong nhng trng
hp nhim khun nng, khi cn thit,
kanamycin c th dng vi penicilin hoc
cephalosporin, nhng trnh dng khi c c
tnh trn tai v trn thn.
Kanamycin cng c dng nh thuc hng
th hai trong iu tr lao, nhng nay thng
dng cc thuc khc an ton hn.
Chng ch nh
Ngi bnh c tin s qu mn hoc c phn thn.
ng c vi kanamycin hoc cc
aminoglycosid khc
Thn trng
Trong trng hp chc nng thn suy gim,
thn khng th thi tr c hiu qu
kanamycin v nng kanamycin trong
huyt thanh tng ln nhanh, cn phi gim
liu trnh c. ngi bnh suy thn,
thi gian kanamycin lu li trong huyt
thanh ko di. Khi cn phi s dng
kanamycin cho ngi bnh v niu, phi
dng thuc cch 3 n 4 ngy mt ln v
liu cng phi gim cn 1/2 liu bnh th-
ng. Tuy nhin liu php an ton nht l
phi kim sot nng thuc trong
huyt thanh khng qu 30 microgam/ml.
Phi lun lun thn trng khi dng
kanamycin v ch nn dng trong trng hp
nhim khun nng hoc khng thuc do
cc loi vi khun khng cc khng sinh
khc nhng cn nhy cm vi kanamycin v
nng thuc trong mu khng c qu
30 microgram/ml.
Thn trng khi dng kanamycin cho ngi
bnh nhc c v kanamycin c mt t hot
tnh ging cura. V vy, c mt s tr-
ng hp ngng th hoc suy h hp do tim
kanamycin trong mng bng. Thm vo ,
DTQGVN
bnh l thn kinh v cm gic, vn ng
xy ra khi dng kanamycin ti ch trong
phu thut ct sng. Kanamycin lm gim
nh trng lc c nhng ngi bnh nhc
c, v vy khng c tim vo mng bng
trong phu thut nhng ngi bnh
dng thuc phong b thn kinh c.
Thi k mang thai
Khng dng kanamycin cho ngi mang thai.
Thi k cho con b
Kanamycin bi tit vo sa, t l
kanamycin trong sa v mu l 0,05 - 0,40.
Sau khi tim bp 1 g, nng nh ca
kanamycin trong sa l 18,4 mg/lt. Khng
thy c nh hng ti tr b m, v
kanamycin hp th km qua ng ung.
tr b m: Thay i h vi sinh ng rut,
nh hng trc tip n a tr (d ng
hoc qu mn) v lm sai lch kt qu
nui cy vi khun khi c st cn thit phi
lm xt nghim ny.
Tc dng khng mong mun (ADR)
Ging cc aminoglycosid khc, phn ng
khng mong mun quan trng nht ca
kanamycin l c vi tai, phong b thn
kinh c, phn ng qu mn v nhim c
Thng gp, ADR > 1/100
Phn ng ph thng gp nht ca
kanamycin l c vi tai. Sau khi dng ko
di (1 g/ngy t 30 - 180 ngy) tn sut
ca phn ng ny khong trn 40%.
Phn ng nhim c thn: Phn ng ny
t gp khi dng liu thp di 15
mg/kg/ngy v thi gian iu tr ngn,
nhng nu tng liu 30 g hoc hn, th
t l nhim c vi thn c th l 50%
hoc hn.
c vi tai tng ln khi kt hp kanamycin
hoc aminoglycosid khc vi vancomycin.
t gp, 1/1000 < ADR < 1/100
c tnh vi tin nh xy ra di 10% tr-
ng hp iu tr vi liu bnh thng v
thng hi phc sau khi ngng thuc.
Phn ng mn cm khi tim (ban da,
st do thuc) t hn streptomycin. D
ng cho vi cc aminoglycosid khc l th-
ng xuyn.
Him gp, ADR < 1/1000
Phong b thn kinh c, d cm. Chong
phn v him xy ra.
Hng dn cch x tr ADR
Nu xut hin tai hoc cc du hiu
nhim c thnh gic khc, phi gim liu
hoc ngng kanamycin.
DTQGVN
i khi thy c tr niu trong v ht trong
mu nc tiu ly trong 16 gi u sau khi
dng kanamycin liu cao, nhng khng gy
tn thng thn vnh vin v cc tr niu
s ht khi ngng thuc.
Trong a s bnh vin, kanamycin c
thay th bng cc aminoglycosid khc t
c hn.
Liu lng v cch dng
Kanamycin sulfat c th tim bp hoc
tnh mch hoc ung (t dng):
Tim bp
Dung dch tim kanamycin c nng 250
mg/ml, ngha l 1 g pha vi 4 ml nc ct
tim.
Ngi ln:
Nhim khun cp: 1 g/ngy chia lm 2 - 4
ln. Liu trnh iu tr gii hn trong 6
ngy v tng liu khng qu 10 g.
Nhim khun mn: 3 g/tun (1 g/ngy dng
cch nht) hoc 1 g/2 ln/ngy, 2 ln/tun,
tc 4 g/tun. Tng liu khng qu 50 g.
Tr em:
Nhim khun cp: 15 mg/kg/ngy chia 2 - 4
ln, khng qu 6 ngy.
Nhim khun mn: Khng c liu c
bit.
Ngi cao tui:
Gim liu, thn trng nh vi ngi bnh suy
thn.
Tim tnh mch
Ch dng cho ngi bnh nhim khun
nng hoc e da try tim mch.
Dung dch kanamycin tim tnh mch c
nng
2,5 mg/ml hoc 5 mg/ml. Ha l thuc 1 g
vi 200 - 400 ml dung dch tim natri clorid
0,9% hoc glucose 5%. Nu l thuc 500
mg th dng th tch bng mt na -
c nng 2,5 - 5 mg/ml.
Liu ngi ln v tr em l 15 mg/kg/ngy
chia lm
2 - 3 ln, truyn chm vi tc 3 - 4
ml/pht trong thi gian 30 - 60 pht.
Gim liu vi ngi bnh suy thn hoc ngi
gi yu.
Ung (t dng)
Thuc b tr trong iu tr hn m gan l
do kanamycin c ch vi khun sinh ra NH 3
rut. Ngy 8 - 12 g chia nhiu ln.
Thuc b tr vi ty hoc gy nn
lm sch rut trong mt thi gian ngn.
Mi gi ung 1 g, lin trong 4 gi. Sau
c 6 gi ung 1 g trong 36 - 72 gi ty
tnh trng ngi bnh.
Tng tc thuc
Levonorgestrel (t trong t cung) 195
Bn thn kanamycin d gy c cho tai
v cho thn. c tnh vi tai v thn tng
ln nu phi hp vi:
Khng sinh khc thuc nhm aminosid.
Thm ch nu ngi bnh dng
streptomycin hoc viomycin, nay dng
kanamycin c tnh cng tng. Cc thuc
khc cng d gy c cho tai v thn nh
vancomycin, capreomycin. Vi cc thuc li
niu mnh nh acid ethacrylic, furosemid.
Cc thuc cng d gy c tnh cho thn
nh ciclosporin, amphotericin B, cisplatin
nu phi hp vi kanamycin s lm tng c
tnh cho thn.
c tnh gy kh th v c ch h hp ca
kanamycin (c bit l khi tim trong
mng bng) tng ln khi phi hp vi thuc
gin c, thuc m.
Calci gluconat lm gim tc dng ging
cura ca kanamycin, cn neostigmin li c
tc dng i khng cura mnh hn
(neostigmin l cht gii c cc cht gin
c kiu cura). Calci c ch kh nng
chng vi khun ca kanamycin trn mt s
loi vi khun. V vy khng dng
kanamycin tim phc mc cng vi dung
dch calci.
Nu ang dng thuc chng ng ng
ung th phi thay i liu khi phi hp
vi kanamycin, v kanamy-
cin lm gim vic sn sinh ra vitamin K ni
sinh.
n nh v bo qun
Bo qun trong l kn trnh nh sng,
nhit t 15 - 30 0C.
Dung dch thuc trc khi tim phi kim
tra bng mt. Khng c dng nu thy
vn c hoc bin mu.
Tng k
Dung dch kanamycin truyn tnh mch t-
ng k vi cc thuc sau: Amphotericin,
barbiturat, cephalotin natri, clopromazin,
cc cht in gii (Ca2+, Mg2+, citrat hoc
phosphat), heparin, hydrocortison, natri
methicilin, methohexiton, nitrofurantoin,
phenytoin, proclorperazin, sulfafurazol.
Khng c pha trn kanamycin vi cc
khng sinh khc tim, m mi khng
sinh phi tim truyn ring (nh vi penicilin
hoc cephalosporin).
Qu liu v x tr
Trong trng hp qu liu gy c, c th
loi b kanamycin ra khi mu bng thm
tch mu hoc thm tch mng bng. tr
s sinh c th truyn thay mu.
Thng tin qui ch
196 Levonorgestrel (t trong t cung)
Kanamycin dng ung, dng tim phi k
n v bn theo n.
ketamin
Tn chung quc t: Ketamine.
M ATC: N01A X03.
Loi thuc: Thuc m khng thuc loi
barbiturat.
Dng thuc v hm lng
Ketamin tim tnh mch hay tim bp di
dng ketamin hydroclorid. Liu lng c
tnh theo ketamin base.
L 20 ml (10 mg/ml), dung dch c pha
ng trng vi natri clorid.
L 10 ml (50 mg/ml), 5 ml (100 mg/ml).
Hai loi sau c cha thm phemerid
(benzathonium clorid) 1: 10000 lm cht
bo qun.
Dc l v c ch tc dng
Ketamin c tc dng gy m phn lp do
ct t chn lc nhng con ng hi t
no, thuc gy du thn kinh v lm mt
tr nh trong ngi bnh vn c v tnh
nhng cch bit vi mi trng, bt ng v
khng cm thy au. Vi liu thp khng
gy m, ketamin c tc dng gim au
c th do tng tc vi cc amin sinh hc v
opiat. Bnh thng ketamin khng nh hng
trn cc phn x hng v thanh qun; tr-
ng lc c vn bnh thng hoc hi tng.
Tc dng kch thch h hp v tim mch
ca ketamin c th s dng cho nhng
ngi c nguy c cao trong sc do gim
th tch mu. Thuc c tc dng gin ph
qun v do cng c th dng cho
nhng ngi b hen ph qun v iu tr
hen bng th my. Tc dng ging giao
cm b c ch nu dng trc cc thuc
khng acetylcholin. C th s dng tc
dng gim au ca ketamin h tr cho
gy t tng vng hay trong cc trng hp
chn thng rng. Trn lm sng ketamin
thng phi hp vi a s thuc m thng
thng v cc thuc gin c nu h hp cu
ngi bnh vn c duy tr.
Tim tnh mch liu 2,0 mg/kg c tc dng
gy m phu thut trong vng 1 pht
sau khi tim v ko di tc dng 5 - 15
pht. Tim bp liu 10 mg/kg c tc dng
gy m phu thut trong 3 - 5 pht
sau khi tim v ko di tc dng 12 - 25
pht. ko di thi gian gy m hay
gim au c th tip tc truyn nh git
ketamin.
DTQGVN
Dc ng hc
Ketamin hp thu nhanh sau khi tim v
phn b nhanh vo cc m c ti mu tt
k c no. Nghin cu trn sc vt cho thy
ketamin tp trung nhiu m m, gan v
phi. Na i phn b khong 7 - 11 pht
v th tch phn b khong 3,3 lt/kg.
Ketamin chuyn ha gan to thnh cht
chuyn ha c hot tnh. Cc ng chuyn
ha khc l phn ng hydroxyl ha vng
cyclohexan v lin hp vi acid glucuronic.
Tuy nhin tc dng gy m c th chm
dt khi c s phn b li nng thuc t
no n cc t chc ngoi vi: 90% liu c
bi xut ra nc tiu trong c khong 4%
di dng ketamin nguyn vn, 5% c thi
tr theo ng phn. Na i thi tr l
khong
2 - 3 gi v tc thanh thi l 1,3
lt/pht.
Ch nh
Gy m chn on hay phu thut
ngn m khng yu cu phi gy gin c;
gy m sau duy tr m bng cc thuc
khc, v gy m b sung. Ketamin c gi
tr c bit trong gy m nhiu ln tr
em.
Cc lnh vc p dng c bit hay cc
loi hnh th thut:
Khi a chung s dng tim bp.
Ct b m hoi t, bng b gy au, ghp
da ngi b bng, v c cc phu thut
nng khc.
Cc k thut chn on thn kinh nh bm
hi chp no, chp no tht, lm ty v
chc ng sng.
Cc k thut chn on v m mt, tai,
mi, mm, k c nh rng.
Gy m ngi c nguy c thp suy sp
chc nng sng, hay phi trnh gy suy
sp chc nng sng, nu c th.
Cc k thut chnh hnh nh nn xng
kn, ng inh xng i, ct ct v sinh
thit.
Soi i trng sigma tiu phu thut hu
mn v trc trng, ct bao quy u v
xoang chn lng.
Cc thao tc t catheter vo tim.
M t cung ly thai, thuc gy cm ng m
khi khng b tng huyt p.
Gy m ngi hen, hoc lm gim thiu
nhng nguy c b cn co tht ph qun
hay cn phi gy m ngay khi ang b co
tht ph qun.
Chng ch nh
Khng dng thuc nhng ngi b cao
huyt p v s gy hu qu nghim trng,
k c nhng ngi c tin s tai bin mch
DTQGVN
mu no. Khng ch nh cho ngi bnh
b sn git hay tin sn git.
Thn trng
Ch c dng thuc ti bnh vin di s h-
ng dn ca cc thy thuc gy m c kinh
nghim, tr trng hp cp cu.
Ging nh i vi mi thuc m, phi c sn
cc trang b hi sc cp cu.
Cc barbiturat v ketamin tng k nhau v
mt ha hc do to thnh ta, v vy
khng tim cng mt bm tim.
Dng barbiturat v/hoc thuc ng cng vi
ketamin c th ko di thi gian hi phc.
Trong thi gian hi phc c th c hin tng
m sng cp. T l phn ng ny c th
gim bt nu gim thiu kch thch ngi
bnh bng li v bng xc gic, nhng vn
phi theo di cc du hiu sinh tn. Khng
nn dng ketamin cho nhng ngi d b o
gic hoc ri lon tm thn.
Ketamin c th gy tng nhn p v khng
dng khi c tn thng mt hay tng nhn
p.
V cc phn x hng v thanh qun thng
vn hot ng, nn trnh kch thch hng
bng c hc, tr khi dng thuc gin c.
Mc d c bo co v kh nng ht phi
cht cn quang khi dng ketamin trong gy
m thc nghim, song trn thc t lm
sng t khi c vn ny.
Nn theo di lin tc chc nng tim trong
qu trnh gy m nhng ngi bnh c
cao huyt p hay suy tim mt b.
V c trng hp tng p lc dch no
ty trong khi gy m bng ketamin, nn
cn phi lu c bit i vi nhng ngi
bnh c p lc dch no ty tng trc khi
gy m.
Nn tim liu tnh mch trong thi gian 60
giy, nu nhanh hn c th gy hin tng
suy h hp tm thi hoc ngng th.
Trong cc phu thut c gy au ni tng,
nn dng ketamin phi hp vi mt thuc
gim au ni tng.
Dng thn trng i vi ngi nghin ru v
nhim c ru cp.
Khi dng ketamin ngi cho bnh ngoi tr,
khng nn cho v khi cha hi phc hon
ton khi cn m.
Thi k mang thai
Nghin cu nh hng ca ketamin trn thai
nhi khi dng thuc trong lc cho thy
liu ln hn 2 mg/kg c th gy suy yu
v lm tng trng lc c tr s sinh. Vi
liu thp hn (0,25 - 0,5 mg/kg) tuy an
ton trong gim au, song vn phi thn
trng.
Levonorgestrel (t trong t cung) 197
Thi k cho con b
Cha c ti liu no ni v nhng tai bin
xy ra ngi. Tuy nhin v na i thi
tr ca ketamin l 2,17 gi nhng ngi
bnh khng dng thuc trc , cho nn
sau khong 11 gi, khng cn thy thuc
trong huyt tng ca ngi m na. V
vy cho b sau thi gian ny s khng c
mt lng ketamin ng k gy tc dng d-
c l tr.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Tim mch: Huyt p c th tng. Mc
tng huyt p thay i t 20 - 25% so vi
trc khi gy m. Nhp tim nhanh cng th-
ng thy sau khi dng ketamin.
Thn kinh: Tng trng lc c, c cc biu
hin c ng co cng v git rung i khi
ging nh cn ng kinh. Nhng biu hin
ny khng phi do mc gy m cn
nh v khng cn tng thm thuc m.
Tm thn: Cc phn ng cp gm m
sng, c trng bi nhng gic m sng
ng (vui v hay khng vui v) hoc o t-
ng c hay khng km theo hot ng tm
thn vn ng, c biu hin bng l ln
v hnh vi kch ng, o th gic. Thng
gp nhiu hn nhng ngi bnh trong
khong 15 - 45 tui. Mc d nhng gic
m v o gic thng b mt i khi tnh
dy nhng mt s ngi c th hi tng li vi
tun sau phu thut.
Biu hin khc: Run, pht m ngng.
t gp, 1/1000 < ADR < 1/100
Tim mch: Nhp tim chm, h huyt p.
H hp: Suy h hp, c th dn ti ngng
th nu tim tnh mch qu nhanh hoc
tim liu cao.
Tm l: Ging nh trn i vi nhng ngi
bnh di 15 tui v trn 65 tui.
Tiu ha: Nn nhng thng khng nng.
Him gp, ADR < 1/1000
Tim mch: Lon nhp tim.
H hp: Co tht thanh qun hay cc dng
tc ng h hp khc.
Tiu ha: n khng thy ngon,bun nn
hoc nn.
Nhn khoa: Nhn i, rung git nhn cu
(nhy mt), tng nh nhn p.
Biu hin khc: au ch tim, ban tm
thi v/hoc ban dng si.
Hng dn cch x tr ADR
C mt s bin php c th lm gim cc
phn ng cp:
Cho ung trc lorazepam 4 mg hoc
diazepam 10 mg.
198 Levonorgestrel (t trong t cung)
Tim tnh mch diazepam 0,15 - 0,3 mg/kg
vo cui thi gian gy m hay midazolam
125 microgam/kg 3 pht trc lc khi m.
Dng liu khi u khng qu 2 mg/kg v
duy tr m vi liu 0,5 - 1 mg/kg.
Truyn tnh mch nh git liu thp.
Dng glycopyrolat thay cho atropin hoc
scopolamin trong tin m.
Duy tr gy m bng cc thuc khc.
iu tr cc phn ng khng mong mun:
i vi suy h hp hay ngng th: Nn h tr
h hp bng my trc khi dng cc thuc hi
sc.
i vi phn ng cp nguy kch: Dng
barbiturat c tc dng ngn hay cc ngn.
Liu lng v cch dng
Cho ngi ln, ngi cao tui v tr em:
Gy m ton thn:
Liu khi u:
Tim tnh mch liu duy nht 1 - 2 mg/kg
trong 60 giy hoc truyn tnh mch nh
git dung dch ketamin 0,1% trong
dextrose 5% hay natri clorid 0,9% vi tc
truyn nh git trong khong 20
ml/pht bng k thut nh git (microdrop).
Khng nn dng qu 4,5 mg/kg.
Tim bp: 5 - 10 mg/kg, khng nn dng qu
13 mg/kg.
Liu duy tr:
Tim tnh mch mt ln, tim nhc li na
liu khi u nu cn; hoc truyn nh
git vi tc 10 - 50 microgam/kg vi tc
1 - 2 mg/pht. Liu duy tr ph thuc
vo yu cu gy m ca ngi bnh v dng
thm thuc m khc. Nhng vn ng co
cng v git rung c th xy ra trong khi
gy m khng c ngha l cn phi dng
thm ketamin.
Tim bp lp li mt na liu khi u khi
cn thit.
Gy m thm vo gy t ti ch: Tim tnh
mch 5 - 30 mg (ti a 30 mg) trc khi dng
thuc t ti ch. C th tim nhc li khi cn
thit.
Tc dng du thn kinh v gim au:
Tim tnh mch khi u l 200 - 750
microgam (0,2 - 0,75 mg)/kg trong 2 - 3
pht, sau tip tc truyn tnh mch 5 -
20 microgam (0,005 - 0,02 mg)/kg/pht.
Tim bp khi u l 2 - 4 mg/kg, sau
tip tc truyn tnh mch 5 - 20
microgam/kg/pht.
Tng tc thuc
Khi dng phi hp vi tubocurarin v
atracurium, ketamin lm tng tc dng c
ch thn kinh c ca cc thuc ny.
Dng ketamin cng vi theophylin lm tng
nguy c gy cn ng kinh v nhp tim
nhanh.
DTQGVN
Nn dng thn trng ketamin i vi ngi
bnh ang dng hormon gip trng v c
nguy c tng huyt p v nhp tim nhanh.
Cc thuc m ng h hp loi
halogenhydrocarbon nh enfluran,
halothan, isofluran v methoxyfluran c
th ko di na i thi tr ca ketamin.
V vy khi dng phi hp vi cc thuc ny
c th lm chm s hi phc ca ngi
bnh sau gy m.
Cc thuc chng cao huyt p hay c ch
thn kinh trung ng k c nhng thuc
dng tin m hay khi m, b sung
hoc duy tr m c th lm tng nguy c
h huyt p v/hoc c ch h hp khi
dng kt hp vi ketamin.
n nh v bo qun
Thuc c bo qun di 40OC, tt nht l
15 - 30OC tr khi c yu cu c bit ca
ni sn xut. Trnh nh sng v nng,
trnh ng bng.
Dung dch 1 mg/ml ketamin trong dextrose
5% hay natri clorid 0,9% bn vng trong
24 gi.
Tng k
Khng tim ketamin v barbiturat trong
cng mt bm tim v 2 cht ny tng k
nhau, s to thnh ta. Cc nh sn xut M
ngh khi cn phi hp ketamin vi
diazepam, nn dng ring bit tng loi v
khng trn ln trong cng mt dng c.
Qu liu v x tr
Dng qu liu c th gy c ch h hp,
v vy nn dng bin php thng kh
h tr. Tr h hp bng my duy tr
bo ha oxygen thch hp trong mu v
o thi carbondioxyd thng c s dng
hn l dng thuc hi sc.
Ketamin c an ton ln, mt s trng
hp dng qu liu ketamin khng ch nh
(gp 10 ln liu thng dng) c theo
di trong mt thi gian di song vn c
hi phc hon ton.
Thng tin qui ch
Ketamin c trong danh mc thuc thit yu
Vit Nam ban hnh ln th t nm 1999.
Thuc c bng A.
ketoconazol
Tn chung quc t: Ketoconazole.
M ATC: D01A C08, G01A F11, J02A B02.
Loi thuc: Chng nm c hot ph rng.
Dng thuc v hm lng
Vin nn 200 mg; hn dch 100 mg/5 ml;
kem bi ngoi 2%; x phng gi u 2%.
DTQGVN
Dc l v c ch tc dng
Ketoconazol thng c tc dng km hm
nm nhng thuc cng c th dit nm
nng cao v dng ko di hoc trn nm
rt nhy cm.
Cng nh cc dn cht azol chng nm khc,
ketoco-
nazol c ch hot tnh ca cytochrom P450
l h enzym cn thit cho qu trnh kh
methyl cc 14 alpha - methyl - sterol (th
d lanosterol) thnh ergosterol l sterol
chnh ca mng t bo nm, lng
ergosterol b gim s lm thay i tnh
thm v chc nng ca mng t bo. Tc
dng dit nm ca ketoconazol nng
cao c th l do tc dng ha l trc tip
ca thuc trn mng t bo nm. Vi
Candida albicans, cc thuc chng nm loi
azol c ch s bin i t dng bo t
chi thnh th si c kh nng xm nhp
gy bnh.
Ketoconazol l thuc chng nm c ph
rng, tc dng trn nhiu loi nm gy
bnh nh Candida spp, Blas-
tomyces dermatitidis, Coccidioides immitis,
Epidermo-
phyton floccosum, Histoplasma
capsulatum, Paraco-
ccidioides brasiliensis, Malassezia furfur,
Microspo-
rum canis, Trichophyton mentagrophytes
v T. rub-
rum, mt vi chng Aspergillus spp,
Cryptococcus neoformans v Sporothrix
schenckii. Thuc cn tc dng trn mt vi
vi khun Gram dng.
Dc ng hc
Ketoconazol hp thu nhanh ng tiu
ha, tt nht l pH acid. ngi ln khe
mnh lc i sinh kh dng ca thuc
ung dng vin nn thng thng hay hn
dch l tng t, nhng dng dung dch
th hi cao hn.
Sau khi ung, thuc ha tan trong dch d
dy v chuyn thnh dng mui hydroclorid
ri c hp thu d dy. Sinh kh dng ca
thuc ung ph thuc vo pH d dy, pH
tng s lm gim hp thu thuc, do nu
dng ng thi vi cc thuc lm tng pH d
dy s lm gim hp thu ketoconazol. nh
hng ca thc n i vi tc v mc nhiu hn ngi cao tui, ph n, ngi
hp thu thuc d dy cn cha c xc
nh r, tuy nhin nh sn xut cho rng
dng ketoconazol vi thc n s lm tng mc
hp thu thuc v lm cho nng
thuc trong huyt tng m c hn,
l do thc n lm tng tc v mc tr em nn ht sc thn trng.
ha tan ca thuc.
Nng thuc ti a trong huyt tng
t c sau khi ung 1 - 2 gi. C s khc
Levonorgestrel (t trong t cung) 199
nhau nhiu v tc v mc hp thu
gia nhng ngi bnh.
Ketoconazol phn b vo cc dch khp b
vim, nc bt, mt, nc tiu, sa, ry tai c
cht nhn, phn, gn, da, cc m mm,
tinh hon (mt lng nh), thuc qua c
nhau thai nhng khng qua c hng ro
mu - no nn ch t mt lng khng ng
k trong dch no ty.
T l lin kt vi protein huyt tng l 84 -
99%, ch yu l vi albumin.
Nng thuc trong huyt tng din bin
theo kiu 2 pha, c na i xp x 2 gi
pha u v xp x 8 gi pha cui.
Ketoconazol chuyn ha mt phn gan
to ra cc dn cht khng c hot tnh qua
qu trnh oxy ha v thoi ging vng
imidazol v piperazin, qu trnh O - dealkyl
oxy ha v hydroxyl ha nhn thm. Con
ng chnh thi tr thuc v cc cht
chuyn ha ca n l qua mt ri vo
phn.
Ch nh
Thuc ung (tc dng ton thn):
Bnh nm ton thn
Bnh nm ti ch (sau khi iu tr ti ch
khng kt qu):
Bnh nm Candida da, nim mc nng,
mn tnh. Bnh nm nng ng tiu ha
mn tnh.
Bnh nm Candida m o mn tnh.
Nhim khun da v mng tay (tr mng
chn).
D phng bnh nm ngi suy gim min
dch.
Thuc bi ti ch:
Cc bnh nm da v nim mc (Candida,
Tricho-
phyton rubrum, T. mentagrophytes,
Epidermophyton floccosum, Malassezia
furfur...).
Chng ch nh
Mn cm vi thuc.
Thn trng
Ketoconazol c th gy c cho gan v
th khng nn dng cho nhng ngi b
bnh gan. Bin chng gan thng gp
nghin ru hoc b suy chc nng gan do
nhng nguyn nhn khc.
V ketoconazol cng c kh nng c ch
qu trnh tng hp cc steroid v chuyn
ha vitamin D, do khi iu tr ko di
Dng ketoconazol ko di nhm d phng
cc bnh nm cho nhng ngi suy gim
200 Levonorgestrel (t trong t cung)
min dch c th gy ra nhng thay i
hormon nghim trng.
Thi k mang thai
Ketoconazol gy qui thai chut (dnh
ngn v thiu ngn) liu 80 mg/kg/ngy
(gp 10 ln liu ung ti a khuyn dng
cho ngi).
Ketoconazol qua c nhau thai, nhng cn
cha c nhng nghin cu y ngi.
Thuc ch dng cho ngi mang thai khi li
ch iu tr xc ng hn cc nguy c c nghim chc nng gan tng ng k, hay
th gy ra cho thai nhi.
Thi k cho con b
Thuc c th tit vo sa, do ngi m
ang iu tr vi ketoconazol khng nn
cho con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Tiu ha: Bun nn, nn (khong 3 - 10%
ngi bnh), au bng, to bn, y hi,
chy mu ng tiu ha, a chy. Cc tc
dng ny c lin quan n liu dng v c
th gim thiu nu dng thuc cng vi thc
n.
Da: Nga (khong 2% ngi bnh), ngoi
ban.
t gp, 1/1000 < ADR < 1/100
Gan: Tng tm thi nng transaminase
trong huyt thanh.
Thn kinh: au u, chng mt, kch
ng, ng g hoc st.
Da: Pht ban, vim da, ban xut huyt v
my ay.
Him gp, ADR < 1/1000
Ton thn: Phn ng phn v, phn ng
qu mn.
Thn kinh: Ri lon thn kinh - tm thn
(khuynh hng t t, trm cm nng...).
Ni tit: V to (do tc dng tng prolactin
bi tuyn yn) v gim kh nng tnh dc
ngi bnh nam (do c ch qu trnh
tng hp testosteron).
Gan: Vim gan.
C xng: Chng yu c v au c.
Cc tc dng khc: Gim tiu cu, gim
bch cu, tng triglycerid huyt; thiu nng
tuyn thng thn; rng lng, tc, d cm;
cc biu hin tng p lc ni s; kch ng,
cm gic rt bng ni bi thuc.
Vim gan thng biu hin r trong vng vi
thng iu tr u tin nhng i khi cng
xut hin trong tun iu tr u tin.
Hu ht cc trng hp c vi gan c
ghi nhn l cc ngi bnh dng thuc tr
nm mng v nhiu ngi khc dng thuc
tr cc bnh nm da mn tnh dai dng.
Mc d tc dng c do ketoconazol gy
ra vi gan thng c th hi phc sau khi
DTQGVN
ngng thuc vi thng nhng cng xy ra
mt s him trng hp xu (nh hoi t gan
cp, bin i m gan hoc t vong).
Hng dn cch x tr ADR
Nu phi iu tr ko di th trc khi dng
thuc, cn xt nghim chc nng gan v
sut thi gian iu tr c 1 hoc 2 thng
li kim tra t nht mt ln, c bit l
nhng ngi bnh ang dng cc thuc khc
c c tnh mnh vi gan. Khi kt qu xt
thay i khng bnh thng ko di, hoc
xu i, hoc km theo nhng biu hin ri
lon chc nng gan khc, cn ngng thuc.
Liu lng v cch dng
C th ung ketoconazol trong hoc sau
khi n nhm lm gim bun nn v nn.
m bo s hp thu thuc ngi bnh
thiu hoc b gim acid hydrocloric dch
v, ngi ta khuyn nn ha tan mi vin
thuc trong 4 ml dung dch acid hydrocloric
0,2 N, ngi bnh c th pha long tip vi
mt lng nc nh v ung qua mt ng bng
thy tinh hoc plastic trnh tip xc vi
rng v sau ung tip thm ngay mt
cc nc na.
Thuc cng c dng bi ti ch, ni b
nm v vng xung quanh.
Liu ung:
Tr em trn 2 tui: 3,3 - 6,6 mg/kg/ngy,
ung 1 ln/ngy.
Ngi ln: Liu thng thng 200 mg/ngy,
nu nng 400 mg/ngy, ung lm mt ln.
Liu dng c tr cho cc bnh nm da nh
sau:
Bnh nm b mt khi khng vi iu tr
ti ch
Nm Candida (thc qun, m o hoc
da, nim mc mn tnh): 200 mg/ln/ngy
trong 1 - 2 tun.
Nm da u: 400 mg/ln/ngy trong 6
tun (ti thiu)
Nm da thn hoc da i: 200
mg/ln/ngy trong
4 tun hoc 400 mg/ln, mt tun ung 1
ln, trong
4 - 8 tun.
Nm da chn: 200 mg/ln/ngy trong 6 - 8
tun
Nm loang: 400 mg/ln/ngy trong 1 hoc
nhiu thng.
Bnh nm ton thn
Do Blastomyces: 400 mg/ln/ngy trong 6 -
12 thng (vi vim mng no, nm ng
sinh dc - tit niu, hoc cc bnh nm
nguy him, nn dng ampho-
tericin).
Do Candida: Dng amphotericin thch hp
hn.
Do Chromomyces: 200 mg/ln/ngy.
DTQGVN
Do Histoplasma: 400 mg/ln/ngy trong 6
thng cho cc bnh nh khu tr hoc ri rc.
Do Paracoccidioidomyces: 200 - 400
mg/ln/ngy trong 6 thng, mt s trng hp
c th ko di ti 18 thng.
Bi ti ch
Nm Candida da, lang ben, nm da thn
hoc nm da i: Bi 1 ln/ngy trong 2
tun.
Vim da b nhn: Bi 2 ln/ngy trong 4
tun hoc cho n khi khi bnh.
Nm da chn: Bi 1 ln/ngy trong 2 tun.
Tng tc thuc
Vi cc thuc nh hng n acid d
dy:
V acid d dy cn thit ha tan
v hp thu ketoconazol, nu dng cng vi
cc thuc lm gim acid hoc lm tng
pH d dy (nh cc cht khng acid,
cimetidin, ranitidin, cc cht khng
muscarin) c th lm gim s hp thu ca
thuc chng nm.
Hp thu ketoconazol cng b gim khong
20% khi dng cng vi sucralfat (nhng khng
phi do lm tng pH d dy).
Nu cn thit phi s dng cc thuc c
nh hng n acid ca d dy hoc
sucralfat cho ngi bnh ang iu tr
ketoconazol th cc thuc ny phi cho
dng sau khi ung ketoconazol t nht l 2
gi.
Vi thuc gy c cho gan
V ketoconazol c c tnh cao vi gan nn
khi ngi bnh dng thuc chng nm ng
thi vi cc thuc khc cng c kh nng
gy c cho gan, th phi theo di cn
thn, nht l i vi nhng ngi cn iu
tr ko di hoc c tin s b bnh
gan.
Vi terfenadin v astemisol
Ko di khong QT v nhng tc dng trn
tim mch tuy him nhng nguy him nh lon
nhp tim, ngng tim, nh trng ngc,
ngt v t vong xy ra trong s nhng
ngi bnh dng ketoconazol ng thi vi
terfenadin cc liu khuyn dng. Nhng
tc dng tng t trn tim mch cng xy ra
khi dng ketoco-
nazol v erythromycin ng thi vi nhng
liu khuyn dng ca astemisol.
Vi cisaprid
Ketoconazol c ch chuyn ha cisaprid.
Dng ng thi ketoconazol v cisaprid, s
lm tng ng k nng cisaprid trong
huyt tng v mt s him trng hp c
khong QT b ko di, nhp nhanh tht,
rung tht v xon nh. Do cm dng
ng thi ketoco-
nazol v cisaprid.
Levonorgestrel (t trong t cung) 201
Vi midazolam v triazolam
Nu dng ng thi, ketoconazol s nh h-
ng ti dc ng hc ca midazolam hoc
triazolam gy tng nng nh trong
huyt tng v ko di na i huyt tng
ca cc benzodiazepin ny. V nng
trong huyt tng tng, nn tc dng an
thn v gy ng ca 2 thuc trn c th s
mnh hn v ko di hn.
Cm dng ng thi ketoconazol v
triazolam. Cn c bit thn trng nu
tim midazolam cho ngi bnh ang iu
tr ketoconazol.
Vi ciclosporin
S dng ng thi ketoconazol v
ciclosporin lm tng nng ciclosporin
huyt tng v nng creatinin huyt
thanh. Mt s thy thuc khuyn nn cn
nhc gim liu ciclosporin hoc thay th
ciclosporin bng mt thuc gim min
dch khc. Nhng ngi bnh dng 2 thuc
ny n nh th c th cn tng liu
ciclosporin khi ngng ketoconazol.
Vi rifampicin v isoniazid:
Dng ng thi ketoconazol vi rifampicin
hoc isonia-
zid s lm gim nng ketoconazol trong
huyt thanh, do khng nn dng ng
thi.
Vi cc cht chng ng mu coumarin
Ketoconazol c th lm tng tc dng
chng ng ca cc thuc nhm coumarin.
Khi dng ng thi, cn theo di cn thn
tc dng chng ng v iu chnh liu
thuc chng ng.
Vi phenytoin
Dng ng thi ketoconazol v phenytoin
c th lm thay i chuyn ha ca mt
hoc c 2 thuc ny. Cn gim st nng
trong huyt thanh ca c 2 thuc nu
dng ng thi.
Vi ru
Phn ng disulfiram bao gm bng, ni
ban, ph ngoi vi, bun nn v au u,
xy ra vi mt s him ngi bnh ung ru
trong thi gian iu tr ketoconazol nhng
thng s mt i sau t gi. Do mt s
thy thuc khuyn khng nn ung ru
trong khi iu tr v trong 48 gi sau khi
ngng dng ketoconazol.
Vi cc cht corticosteroid
Vic dng ng thi ketoconazol v
prednisolon hoc methylprednisolon c th
lm tng nng ca corti-
costeroid trong huyt tng do lm gim
thanh thi
2 thuc ny. Ketoconazol c th lm tng
tc dng c ch tuyn thng thn ca cc
corticosteroid. iu chnh liu
202 Levonorgestrel (t trong t cung)
corticosteroid c th l cn thit nu dng
ng thi ketoconazol.
Vi loratadin
Mt s t ngi bnh ung ketoconazol vi
liu 200 mg x 2 ln/ngy, nu dng ng
thi liu duy nht
20 mg loratadin s lm tng din tch di -
ng cong (AUC) ca loratadin trung bnh
ln 302%, tng nng nh ca
loratadin trong huyt tng trung bnh ln
251%, tng AUC
decarboethoxyloratadin (cht chuyn ha
c hot tnh ca loratadin) trung bnh ln
155% v tng nng nh ca cht ny bnh tim t trc, iu ny c th gy suy
trong huyt tng trung bnh 141% so vi
nhng ngi dng loratadin v gi dc
(placebo).
n nh v bo qun
Bo qun cc ch phm ketoconazol nhit
thch hp t 15 n 30C trong cc chai
l v hp kn, nt cht.
Trnh ng lnh dng hn dch ung v nguy c lot d dy v chy mu ng
kem bi ngoi. Dng x phng gi u cn
trnh nh sng.
Qu liu v x tr
Trng hp qu liu, nn ra d dy vi natri
bicarbonat.
Thng tin qui ch
Ketoconazol c trong danh mc thuc thit
yu Vit Nam ban hnh ln th t nm
1999.
Thuc dng ung phi k n v bn theo
n.
Ketoprofen
Tn chung quc t: Ketoprofen.
M ATC: M01A E03, M02A A10.
Loi thuc: Thuc chng vim khng steroid
(NSAID).
Dng thuc v hm lng
Nang 25 mg, 50 mg, 75 mg; nang gii
phng ko di 100 mg, 150 mg v 200
mg; vin nn 12,5 mg, 25 mg, 100 mg,
150 mg; vin nn gii phng ko di 200
mg; bt pha tim bp tht: 100 mg; thuc
n np trc trng: 100 mg; gel 2,5% (khi
lng/khi lng)
Dc l v c ch tc dng
Ketoprofen, dn cht ca acid phenyl
propionic, l thuc chng vim khng
steroid (NSAID). Ging nh cc thuc chng
vim khng steroid khc, thuc c tc dng
chng vim, gim au v h st.
C ch chung cho cc tc dng nu
trn l do c ch tng hp prostaglandin
DTQGVN
v leukotrien. Ketoprofen c tc dng
khng bradykinin v c tc dng n nh
mng lysosom.
Ging nh tt c cc thuc chng vim
khng steroid khc, ketoprofen lm tng
thi gian chy mu do c ch tng hp
prostaglandin tiu cu, dn n c ch
kt t tiu cu (tc dng trn tiu cu lin
quan n liu dng v c th phc hi; vi
liu thng thng tc dng ny l va hoc
ca nh).
c ch tng hp prostaglandin thn lm
gim lu lng mu n thn. ngi c
thn cp v suy tim, c bit ngi c
bnh suy tim mn. Gim sn xut prostag-
landin thn dn n gi nc trong c
th v gy suy tim cp.
c ch tng hp prostaglandin d dy
lm gim to cht nhy d dy, dn n
tiu ha, c bit ngi cao tui.
Trong iu tr vim khp dng thp hoc
h (thoi ha) xng khp, cc thuc chng
vim khng steroid thng c dng ch
yu gim au hn l chng vim; cc
thuc ny ch c ch tng hp v c ch
gii phng cc cht trung gian gy au
v vim (prostaglandin, bradykinin,
histamin), do ketoprofen ch lm nh
bt cc triu chng ca bnh nh au,
cng , v lm tng gii hn vn ng v
cc hot ng chc nng; thuc khng lm
ngng bnh lu di hoc o ngc qu
trnh bnh c bn. t c iu ,
ngi bnh phi c iu tr vi cc thuc
c ch min dch nh dng liu cao
glucocorticoid.
Tc dng gim au ca ketoprofen l do
c ch tng hp prostaglandin.
Prostaglandin lm cc th th au tng
nhy cm vi cc kch thch c hc v vi
cc cht trung gian ha hc khc (nh
bradykinin, hista-
min). Bi vy, trong lm sng, ketoprofen
l thuc gim au rt c hiu lc trong
cc trng hp au sau phu thut. V c
nguy c gy chy mu, khng dng
ketoprofen iu tr au lin quan
n chy mu kn o (au sau khi b
tai nn) hoc au lin quan n chn th-
ng h thn kinh trung ng.
Dc ng hc
Ketoprofen hp thu nhanh qua ng tiu
ha. Sau khi ung 1 liu thuc dng vin
nang thng thng v vin nang gii phng
ko di, nng nh trong huyt
thanh tng ng xut hin khong 0,5 - 2
DTQGVN
gi v 6 - 7 gi. Thc n khng lm thay
i kh dng sinh hc ton b ca
ketoprofen, nhng lm chm tc hp
thu ketoprofen. Na i thi tr trong
huyt tng ca thuc sau khi ung vin
nang thng thng v vin nang gii phng
ko di tng ng l 2 - 4 gi v 5,5 - 8
gi. Nng n nh ca thuc trong
huyt tng t c trong vng 24 - 48 gi
sau khi dng thuc lin tc.
Ketoprofen lin kt mnh vi protein huyt
tng (khong 99%). Th tch phn b
ca thuc xp x Ketoprofen tit vo sa ngi vi nng
0,1 lit/kg. Chuyn ha ch yu ca thuc
l lin hp vi acid glucuronic, sau cht
lin hp ny c bi tit ch yu qua nc
tiu.
Ch nh
Vim khp dng thp (h khp, thoi ha
khp).
Vim ct sng dnh khp, bnh c xng
cp v chn thng trong th thao.
Thng kinh hoc au sau phu thut.
Bnh gt cp.
Chng ch nh
Qu mn vi ketoprofen.
Lot d dy, lot hnh t trng.
Co tht ph qun, hen, vim mi nng,
v ph mch hoc ni my ay do aspirin
hoc mt thuc chng vim khng steroid
khc gy ra.
X gan.
Suy tim nng.
C nhiu nguy c chy mu.
Suy thn nng vi mc lc cu thn di 30
ml/pht.
Thn trng
Tr em di 15 tui: An ton v hiu qu
ca thuc cha c xc nh. Khng nn
dng ketoprofen cho la tui ny.
Ketoprofen c th gy gi nc trong c
th v lm tng nng creatinin trong
huyt tng v phi dng thn trng ngi
suy tim nh/va, hoc suy thn nh/va,
hoc ngi cao tui. Liu ti a hng
ngy phi gim v chc nng thn phi -
c gim st nhng ngi bnh . Phi
dng ketoprofen thn trng ngi c tin
s lot d dy t trng. Phi theo di cht
ch nhng ngi bnh ny pht hin
cc du hiu v triu chng thng vt
lot hoc chy mu ng tiu ha. Thuc
ung cng vi thc n, sa hoc cc thuc
chng acid.
Thi k mang thai
Khng dng ketoprofen cho ngi mang thai,
c bit trong 3 thng cui thai k hoc
khi gn chuyn d: Ging nh cc thuc c
Levonorgestrel (t trong t cung) 203
ch tng hp prostaglandin, ketoprofen
gy nguy c tng p lc phi tn lu tr
s sinh, do ng ng ng mch trc khi
sinh. Ketoprofen gy nguy c chy mu
thai nhi v ngi m. Ketoprofen c ch
chc nng thn ca thai nhi gy v niu
cho tr s sinh. Ketoprofen cn c ch
chuyn d , ko di thi gian mang thai
v c th gy c cho ng tiu ha v
t nc i, nu dng thuc trong thai k.
Thi k cho con b
thp. Khng khuyn co dng thuc ny
cho ngi m trong thi k cho con b.
Tc dng khng mong mun (ADR)
Tc dng khng mong mun ca
ketoprofen thng nh v ch yu l -
ng tiu ha. Tuy nhin, tc dng khng
mong mun c th nng ti mc phi
ngng thuc 5 - 15% ngi bnh v tn
sut tc dng khng mong mun ni chung
gim khi tip tc iu tr.
Thng gp, ADR >1/100
Tiu ha: Kh tiu, au thng v, bng rt
hng, nn.
t gp, 1/1000 < ADR < 1/100
Ton thn: Mt mi, nhc u, chng
mt.
Tiu ha: Lot ng tiu ha, a chy, to
bn.
Da: Nga, ni ban.
Mu: Thi gian mu chy ko di, huyt
niu.
Him gp, ADR < 1/1000
Ton thn: Sc phn v.
Da: Vim da bong vy, ni my ay, ph
Quinck, mn cm vi nh sng, hoi t biu
b do c tnh.
Gan: Vim gan.
ng h hp: Hen, vim mi.
Niu sinh dc: Vim thn, hi chng thn
h.
Hng dn cch x tr ADR
Thy thuc cn theo di ngi bnh iu
tr lu ngy v du hiu v triu chng
ca lot v chy mu ng tiu ha,
thng bo cho h theo di st nhng du
hiu . Nu nhng du hiu xy ra,
nn ngng thuc.
Khi iu tr bng ketoprofen cho ngi suy
tim va/nh, suy thn hoc ngi b bnh
gan nh, iu rt quan trng l phi theo
di cn bng nc/in gii, v c nguy
c gi nc.
Ngi bnh ang dng ketoprofen m c ri
lon th lc cn c kim tra, nh gi v
mt.
204 Levonorgestrel (t trong t cung) DTQGVN

Liu lng v cch dng Khi iu tr ng thi ketoprofen vi v

iu tr thuc theo ng ung:
Nn ung ketoprofen cng vi thc n hoc
vi mt cc nc y; trnh dng ung kiu coumarin cc sulfonamid, v cc
c cn gim tc dng c hi i vi - hydantoin (th d phenytoin), thy thuc
ng tiu ha ca thuc.
Bnh vim:
Vin nn hoc nang thng thng:
Ngi ln: iu tr triu chng vim
khp dng thp cp hoc mn hoc vim
xng khp hoc nhng bnh c xng: 50
mg, dng 3 ln/ngy. C th tng liu ti
100 mg, dng 2 - 3 ln/ngy.
Vin nn hoc nang gii phng ko di:
Chng vim khp dng thp:
Ung: 150 mg hoc 200 mg 1 ln mi
ngy vo bui sng hoc chiu. Ngi cao
tui hoc suy yu ung liu thp hn.
Dng thuc ny khng dng iu tr
ban u. Liu duy tr hng ngy phi -
c xc nh bng cch dng vin gii phng
nhanh hoc ko di. Sau , nu mun,
c th dng liu gii phng ko di, min
l liu cn thit c th t c vi hm l- vi thuc li niu.
ng c dng.
Thng kinh:
iu chnh liu lng ketoprofen ty theo
tng ngi: 25 - 50 mg/ln, ti 3 ln/ngy
khi cn. iu tr keto -
profen ngay t khi bt u xut hin
triu chng ca bnh.
au cp:
Ngi ln: 25 - 50 mg ti 4 ln/ngy.
Ch :
iu tr thuc theo ng trc trng:
Ngi ln: t vin n 100 mg vo trc
trng ban m. Khi iu tr kt hp gia
ng ung v ng trc trng, tng liu
ti a hng ngy l 200 mg.
iu tr thuc theo ng tim bp:
Ngi ln: iu tr t cp nng cc steroid khc c th lm thay i thi tr
bnh c xng hoc khp hoc au sau
phu thut chnh hnh: 50 - 100 mg, c 4
gi mt ln, tng liu ti a trong 24 gi
l 200 mg.Phi cn nhc nguy c/ li ch
khi k n liu ti a 300 mg v c
nhiu tai bin hn so vi liu 200 mg/ 24
gi.
i vi ngi suy thn hoc suy gan:
Nn gim liu t 33% n 50% liu thng
thng.Liu ti a ca ketoprofen cho ngi
suy thn nh l 150 mg/ngy v suy thn
va l 100 mg/ngy. Ngi bnh suy gan c
nng albumin trong huyt thanh di
3,5 g/dL nn dng liu ban u ketoprofen
l 100 mg/ngy.
Tng tc thuc
nhng thuc gn kt mnh vi protein
huyt tng nh cc thuc chng ng
phi theo di ngi bnh cht ch v iu
chnh liu khi cn. V ketoprofen gn
kt mnh vi protein, nn c th thay ch
lin kt protein ca nhng thuc khc.
Aspirin: Khng nn iu tr ketoprofen
ng thi vi aspirin v cc thuc chng
vim khng steroid khc hoc corticoid v
lm tng tc dng c hi.
Thuc li niu: Ketoprofen dng ng thi
vi hydroclorothiazid gy gim thi tr clo
v kali ra nc tiu so vi ch dng
hydroclorothiazid n c. Ngi dng
thuc li niu ng thi vi ketoprofen c
nguy c ln dn n suy thn th pht do
gim dng mu n thn gy ra bi c
ch tng hp prostaglandin. Do , phi
theo di ngi bnh cht ch, iu chnh
liu khi cn v theo di cn bng n-
c/in gii khi dng ng thi ketoprofen
Warfarin: Khi iu tr ng thi
ketoprofen vi warfarin, cn phi theo di
ngi bnh cht ch v c 2 thuc, v c
th tng nguy c chy mu do prostag-
landin c vai tr quan trng trong cm
mu v keto-
profen c ch tng hp prostaglandin.
Probenecid: Khng nn dng ng thi
ketoprofen v probenecid, v probenecid
c th lm tng nng trong huyt tng
ca ketoprofen do lm gim thanh thi
ketoprofen trong huyt tng khong mt
phn ba.
Methotrexat: Khng nn dng ng thi
ketoprofen v methotrexat, v ketoprofen
cng nh cc thuc chng vim khng
methotrexat dn n tng nng trong
huyt thanh ca methotrexat v tng c
tnh.
Lithi: Khi s dng ng thi ketoprofen v
lithi, phi theo di nng lithi trong
huyt tng v c s tng c tnh ca
lithi do tng nng cht ny trong huyt
tng.
n nh v bo qun
Bo qun ketoprofen ni kh mt, di
250C, trong nhng bao gi kn v trnh
nh sng.
Qu liu v x tr
Nh cc dn cht ca acid propionic khc,
ketoprofen t c hn aspirin. Phn ln
triu chng qu liu ketoprofen c th l
ng g, au bng v nn, nhng cng c
DTQGVN
th h huyt p, co tht ph qun v
chy mu ng tiu ha.
Khng c thuc c hiu gii c. iu
tr qu liu thng l iu tr triu chng
v h tr. C th gy nn, ra d dy, c
th dng than hot lm gim s hp
thu v ti hp thu ca ketoprofen. Khng
th p dng bin php gy li niu mnh,
kim ha nc tiu, thm tch mu hoc
truyn mu, v ketoprofen gn kt mnh
vi protein huyt tng.
Thng tin qui ch
Thuc dng tim phi k n v bn theo n.
ketorolac
Tn chung quc t: Ketorolac.
M ATC: M01A B15, S01B C05.
Loi thuc: Gim au, thuc chng vim
khng steroid.
Dng thuc v hm lng
Vin nn: 10 mg (dng ketorolac
trometamol).
ng tim (dng ketorolac trometamol) 10
mg/ml, 15 mg/ml, 30 mg/ml.
Dung dch tra mt: 0,5% ketorolac
trometamol.
Dc l v c ch tc dng
Ketorolac l thuc chng vim khng
steroid c cu trc ha hc ging
indomethacin v tolmetin. Ketoro-
lac c ch sinh tng hp prostaglandin.
Thuc c tc dng gim au, chng vim,
h nhit nhng tc dng gim au ln hn
tc dng chng vim. Khc vi cc thuc
opioid, ketorolac khng gy nghin hoc
c ch h hp. Ngoi ra, ketorolac cn c
tc dng chng vim khi dng ti ch
mt. Tuy nhin, v ketorolac c ch tng
hp prostaglandin, nn cng tng nguy c
chy mu do c ch kt tp tiu cu v
tng nguy c lot d dy. Tng t, c ch
tng hp prostaglandin thn c th gy
gim dng chy qua thn ngi b suy
gim chc nng thn. Ketorolac l cht
khng steroid c tc dng gim au mnh
v chng vim va phi, c dng thay th
cho cc thuc nhm opioid v cc thuc
gim au khng steroid, trong iu tr
gim au va n nng sau phu thut,
v c th dng trong iu tr au c x-
ng cp hoc au khc v vim mt.
Thuc di dng mui trometamol (mui
tromethamin), dng ng ung, tim bp
hoc tim tnh mch v tra mt.
Dc ng hc
Levonorgestrel (t trong t cung) 205
Sau khi tim bp hoc ung, ketorolac
hp thu nhanh v hon ton. Tc hp
thu gim khi ung thuc cng ba n c
nhiu cht bo, nhng lng hp thu khng
gim. S hp thu khng b nh hng khi
dng ng thi vi cc thuc khng acid.
Th tch phn b khong 0,15 - 0,33
lt/kg. Lin kt protein rt cao
(> 99%). Di 50% liu c chuyn ha.
Na i thi tr ngi ln c chc nng
thn bnh thng khong 5,3 gi v ko
di hn ngi gim chc nng thn
(khong 10,3 - 10,8 gi hoc hn). Mt l-
ng nh thuc phn b vo sa m.
Ch nh
iu tr ngn ngy au va ti nng sau
phu thut, dng thay th cc ch phm
opioid.
Dng ti ch iu tr triu chng vim
kt mc d ng theo ma.
Chng ch nh
Tin s vim lot d dy hoc chy mu -
ng tiu ha.
Xut huyt no hoc c nghi ng. C a
chy mu, c ri lon ng mu. Ngi
bnh phi phu thut, c nguy c cao
chy mu hoc cm mu khng hon
ton. Ngi bnh ang dng thuc chng
ng.
Qu mn vi ketorolac hoc cc thuc
chng vim khng steroid khc; ngi bnh
b d ng vi cc cht c ch tng hp
prostaglandin hoc aspirin.
Hi chng polyp mi, ph mch hoc co
tht ph qun.
Gim th tch mu lu thng do mt nc
hoc bt k nguyn nhn no.
Gim chc nng thn va v nng.
Ngi mang thai, lc au v s thai hoc
cho con b.
Tr em di 16 tui: An ton v hiu qu
ca thuc cha c xc nh. Khng nn
dng ketorolac cho la tui ny.
Thn trng
Khng kt hp ketorolac vi cc thuc
chng vim khng steroid khc, vi aspirin
v corticosteroid.
Thn trng nu thy chng mt hoc
bun ng; khng li xe, vn hnh my mc
hoc lm cc cng vic cn tnh to.
Khi iu tr ngi bnh b gim chc nng
thn, suy tim va hoc bnh gan, c
bit trong trng hp dng ng thi vi
thuc li tiu, cn xem xt nguy c gi n-
c v nguy c lm chc nng thn xu
hn. Gim liu i vi ngi c trng lng
di 50 kg.
206 Levonorgestrel (t trong t cung)
Thn trng khi dng thuc cho ngi cao
tui v ngi bnh ny ketorolac thi tr
chm hn v h nhy cm hn vi cc tc
dng c vi thn v c hi ng tiu Liu lng, cch dng
ha.
Thi k mang thai
Khng dng thuc ny cho ngi mang thai.
Thi k cho con b
Khng dng thuc ny cho ngi ang cho
con b.
Tc dng khng mong mun (ADR)
Hu ht cc phn ng bt li ca thuc c
triu chng h thn kinh trung ng nh
au u, chng mt v bun ng. Ngoi
ra, mt s phn ng ng tiu ha th-
ng gp nh kh tiu, bun nn, au v
kch ng. Cn lu rng ngi bnh iu
tr bng thuc chng vim khng steroid
nh ketorolac c th b suy thn cp hoc
tng kali huyt hoc c hai. c bit thn
trng trong trng hp ngi bnh b suy
thn trc .
Thng gp, ADR > 1/100
Ton thn: Ph, au u, chng mt.
Thn kinh trung ng: Mt mi, ra m hi.
Tiu ha: Bun nn, kh tiu, au bng,
a chy.
t gp, 1/1000 < ADR < 1/100
Ton thn: Suy nhc, xanh xao.
Mu: Ban xut huyt.
TKTW: Trm cm, phn kch, kh tp trung
t tng mt ng, tnh trng kch ng, d
cm.
Tiu ha: Phn en, nn, vim ming,
lot d dy, to bn dai dng, y hi,
chy mu trc trng.
Da: Nga, my ay, ni ban
H hp: Hen, kh th.
C xng: au c.
Tit niu: i tiu nhiu, thiu niu, b
tiu.
Mt: Ri lon th gic.
Phn ng khc: Kh ming, kht, thay i
v gic.
Him gp, ADR < 1/1000
Ton thn: Phn ng phn v, bao gm co
tht ph qun, ph thanh qun, h huyt
p, ni ban da, ph phi.
Mu: Chy mu sau phu thut.
TKTW: o gic, m sng.
Da: Hi chng Lyell, hi chng Stevens -
Johnson, vim da trc vy, ban da dt sn.
C xng: Co git, tng vn ng.
Tit niu: Suy thn cp, tiu tin ra mu,
ur niu cao.
Tai: Nghe km.
DTQGVN
Hng dn cch x tr ADR
Ngng thuc nu thy c phn ng ph
xy ra.
Cch dng:
Liu php ketorolac phi bt u bng
tim, sau liu thm c th tim hoc
ung. Tuy nhin, thi gian iu tr bng
bt c ng no hoc phi hp cc ng
(ung, tim) cng khng c qu 5 ngy.
Ngi bnh phi c chuyn sang iu tr
bng 1 thuc gim au khc cng nhanh
khi c th.
Ung thuc trong ba n hoc n nh
gim kch ng d dy, mc d c th ung
2 liu u vo lc i tc dng
nhanh hoc dng vi thuc khng acid.
Ung thuc vi mt cc nc y, v gi
t th ng thng trong 15 - 30 pht
gim nguy c kch ng thc qun.
Liu tim tnh mch phi tim chm t
nht 15 giy. Liu tim bp phi tim
chm, su vo trong c.
Liu lng:
Tim:
Liu thng thng ngi ln:
Gim au:
Ngi bnh t 16 - 64 tui, cn nng t
nht 50 kg v c chc nng thn bnh th-
ng:
Tim bp: 1 liu duy nht 60 mg, nu cn,
c th cho ung thm ketorolac hoc 1
thuc gim au khc, hoc:
Tim bp: 30 mg cch 6 gi/1 ln, cho ti
ti a 20 liu cho trong 5 ngy, hoc:
Tim mch: 30 mg tim 1 liu duy nht
hoc lm nhiu ln cch 6 gi/1 ln, cho
ti ti a 20 liu trong 5 ngy.
Ngi bnh < 50 kg v/hoc c chc nng
thn b suy gim:
Tim bp: 1 liu duy nht 30 mg, nu cn
c th cho tip ung ketorolac hoc 1
thuc gim au khc; hoc:
Tim bp: 15 mg cch 6 gi/1 ln, cho ti
ti a 20 liu trong 5 ngy, hoc:
Tim mch: 15 mg 1 liu duy nht hoc
lm nhiu liu cch 6 gi/ 1 ln, cho ti ti
a 20 liu trong 5 ngy.
Ghi ch: Liu v s ln cho c khuyn
co trn khng c tng nu au khng
hoc au tr li trong khi dng thuc.
Liu ti a thng thng k n cho ngi
ln:
Ngi bnh 16 - 64 tui 50 kg, chc nng
thn bnh thng:
Tim bp hoc tnh mch: 120 mg/ngy
Ngi bnh < 50 kg v/ hoc c chc nng
thn suy gim:
Tim bp hoc tnh mch: 60 mg/ngy.
DTQGVN
Liu thng thng ngi cao tui: Ging
nh i vi ngi < 50 kg hoc c chc nng
thn suy gim.
Ung:
Liu thng thng ngi ln:
Gim au: Ung; tip theo sau liu php
tim ban u.
Ngi bnh 16 - 64 tui 50 kg, chc nng
thn bnh thng: 20 mg ban u, tip
theo l 10 mg cho ti 4 ln mi ngy, cch
nhau 4 - 6 gi/ 1 ln, nu cn.
Ngi bnh < 50 kg v/ hoc chc nng thn
suy gim:
10 mg cho ti 4 ln/ ngy, cch 4 - 6 gi/ 1
ln nu cn. Liu ti a thng thng k
n cho ngi ln:
Ung: 40 mg/ngy
Liu thng thng ngi cao tui:
Gim au: ung (sau khi tim): 10 mg,
cho ti 4 ln/ ngy cch 4 - 6 gi/ 1 ln
Liu ti a k n cho ngi cao tui:
Ung: 40 mg/ ngy.
Tng tc thuc
Hu ht cc tng tc di y cha c
thng bo i vi ketorolac, nhng c
thng bo i vi cc thuc chng vim
khng steroid khc, do vy cng cn cn
nhc v thn trng khi dng ketorolac,
c bit khi dng thuc di ngy.
Cc thuc chng vim khng steroid c th
lm tng nguy c suy thn th pht ngi
bnh ang dng thuc li tiu, do gim
dng mu qua thn.
Cc thuc chng vim khng steroid lm
gim thanh thi lithi, dn n tng
nng lithi trong huyt tng hoc
huyt thanh.
Dng ng thi ketorolac v probenecid
lm gim thanh thi v lm tng nng
trong huyt tng, tng din tch di
ng cong (AUC) ton phn v tng na
i ca ketorolac.
n nh v bo qun
Bo qun thuc tim v thuc vin
ketorolac nhit 15 - 30 0C, trnh nh
sng; phi gi thuc vin trong l tht kn
v trnh qu m.
Tng k
Khng c trn thuc tim ketorolac trong
cng bm tim vi morphin sulfat, pethidin
hydroclorid, prome-
thazin hydroclorid hoc hydroxyzin
hydroclorid v c th b ta ketorolac.
C th pha thuc vi cc dung dch mui
0,9%, dextrose 5%, Ringer, Ringer lactat.
Qu liu v x tr
Levonorgestrel (t trong t cung) 207
Dng qu liu c th gy au bng v
lot ng tiu ha, thng khi sau khi
ngng thuc. Cn theo di ngi bnh cn
thn v iu tr theo cc triu chng.
Nu suy thn, c th cn thm tch mu.
Tuy nhin, thm tch khng chc loi
c ketorolac ra khi c th sau khi dng
qu liu; c thng bo ngi bnh
ang thm tch, c gim thanh thi
v ko di na i ca ketorolac.
Thng tin qui ch
Thuc dng tim phi c k n v bn
theo n.
km OXYD
Tn chung quc t: Zinc oxide.
M ATC: C05A X04.
Loi thuc: Thuc bo v da.
Dng thuc v hm lng
Thuc m km oxyd 46%.
Km oxyd thng c dng phi hp vi cc
hot cht khc trong cc ch phm gm
nhiu v thuc, di cc dng: kem dng
ngoi, h bi, thuc m, n trc trng,
bt phn tr em, bng dnh...
Dc l v c ch tc dng
Km oxyd c tnh cht lm sn da v st
khun nh v c dng bi ti ch bo
v, lm du tn thng chm (eczema) v
cc ch trt da nh. Km oxyd thng c
dng vi hc n than hoc ichthammol
iu tr chm. Km oxyd phn x tia
cc tm nn cn c dng trong cc thuc
bi chng nng.
Trong phn ln cc ch phm cha km
oxyd cn c nhng cht khc nh titan
oxyd, bismuth oxyd, glyce-
rol, bm (nha thm) Peru, ichthammol...;
c bit cc cht m c tnh cht bt kn
nn c th d gy bi nhim. Mt vi
cht cn c th gy d ng.
Km oxyd cng cn l cht c s lm
mt s loi xi mng nha khoa. Khi trn vi
acid phosphoric, km oxyd to thnh mt
vt liu cng m thnh phn ch yu l
km phosphat; vt liu ny trn vi du
inh hng hoc eugenol dng hn
rng tm thi.
Ch nh
Di nhng dng thuc m v h bi dc
dng, km oxyd c dng rng ri trong
iu tr da kh, cc bnh da v nhim
khun da nh:
Vng da b kch ng do l d tiu ha, hu
mn nhn to, m thng bng quang.
208 Levonorgestrel (t trong t cung)
iu tr h tr chm (eczema).
Vt bng nng, khng rng.
Chy nng, hng ban do b chiu nng,
bo v da do nng.
Trng c, cn trng chm t, ban do t
lt, vy da u, tng tit nhn, chc, nm
da, vy nn, lot gin tnh mch, nga.
Chng ch nh
Qu mn vi mt hoc nhiu thnh phn
ca ch phm, c bit vi pyrazol.
Tn thng da b nhim khun.
Thn trng
Trc khi bi thuc v trong qu trnh iu
tr phi m bo v khun vng c bi bch hu bng gii c t bch hu n
thuc v c th bi nhim cc vng b
thuc che ph.
Mt s ch phm khng thch hp vi cc
tn thng c tit dch.
Tc dng khng mong mun (ADR)
Him gp, ADR < 1/1000
Cc t dc, bm (nha thm) Peru, lanolin
c th gy chm tip xc.
D ng vi mt trong cc thnh phn ca
ch phm.
Hng dn cch x tr ADR
Ngng dng ch phm.
Liu lng v cch dng
Tn thng trn da: Sau khi kh khun, bi
u mt lp thuc mng ln vng da b tn Khng c t bch hu c dng trong
thng, 1 - 2 ln mt ngy. C th dng mt
ming gc v khun che ln.
Chm, nht l chm b lichen ha: Bi mt
lp dy ch phm (h nc - pte leau)
c cha ichthammol, km oxyd, glycerol ln
vng tn thng, 2 - 3 ln mt ngy.
au nga hu mn, nht l trong nhng
t tr: Bi thuc m hoc t n trc khuch tn v tit c t, ngn chn v
trng c km oxyd, bismuth oxyd, resorcin,
sulphon, caraghenat vo hu mn, ngy 2
- 3 ln, sau mi ln i ngoi. Khng nn
dng di ngy. Nu sau 7 - 10 ngy dng
khng thy th phi thm khm hu
mn trc trng tm nguyn nhn
gy chy mu v cui cng pht hin
bnh c tnh.
Tn thng do suy tnh mch mn tnh,
bng sau phu thut gin tnh mch: Bi
ph vt thng bng ch phm c 20%
km oxyd trong vaselin.
n nh v bo qun
Bo qun trong l kn, trnh m. Bo qun
thuc m nhit < 25 0C.
Thng tin qui ch
Km oxyd c trong danh mc thuc thit
yu Vit Nam ban hnh ln th 4 nm
1999.
DTQGVN
Khng c t bch hu
Tn chung quc t: Diphtheria antitoxin.
M ATC: J06A A01.
Loi thuc: Khng c t.
Dng thuc v hm lng
Khng c t bch hu l mt dung dch
protein tinh ch, m c (ch yu l
globulin min dch) v khun, khng c
cht gy st, c cha cc khng th chng
c t. Dung dch c iu ch t huyt
tng hay t huyt thanh nga khe mnh
c gy tng min dch chng c t
thun hoc phi hp vi c t bch hu.
Dng thng phm thng cha t nht 500
vqt/ml.
Cc thnh phn khc: Khng c t bch
hu cha cresol hoc m - cresol l cht
bo qun.
Dc l v c ch tc dng
Cc khng th khng c t bch hu c
trong ch phm c kh nng kt hp v
trung ha cc c t do vi khun
Corynebacterium diphtheriae sinh c sn
xut ra.
Ch nh
iu tr bnh bch hu v rt him trng
hp c dng phng bnh cho ngi
tip xc vi bnh nhng cha c triu chng
v cha c min dch.
Thuc khng khun (erythromycin,
penicilin G) c th loi tr c vi khun
khi cc vim nhim, ngn chn s
chm dt tnh trng mang vi khun. Tuy
nhin, cc thuc khng khun khng c gi
tr trung ha c t bch hu v khng
th thay th c khng c t trong iu
tr bnh. Sau khi iu tr bng thuc
khng khun (khong 14 ngy) c th
khng nh vi khun b loi tr ht,
khi 3 ln nui cy vi khun lin tip cho
kt qu m tnh. Mc du hiu qu
iu tr bnh bch hu th ngoi da
bng khng c t bch hu cn cha c
xc nh, v hu ht cc trng hp nh vy
l do C. diphtheriae khng sinh c t
gy ra, nhng mt s nh lm sng vn
khuyn co nn dng khng c t bch
hu, v xy ra di chng nhim c
mt s ngi bnh th ny.
Khng khuyn co dng khng c t bch
hu phng bnh cho ngi trong cng
nh hoc tip xc trc tip vi ngi mc
bnh bch hu ng h hp hoc ngoi
DTQGVN
da khi cha c biu hin bnh v cha c
min dch, v c nguy c xy ra cc tc
dng khng mong mun (v d nh qu
mn, bnh huyt thanh) lin quan n
huyt thanh nga, ngay c khi khng th
theo di cht ch c vic tip xc. V
hiu qu ca vic phng bnh bng thuc
khng khun ch l do suy on m
khng c chng minh trong cc kiu tip
xc nh vy, nn mt vi chuyn gia
khuyn ngh nn dng khng c t bch
hu khi khng c iu kin theo di cht
ch trong khong 7 ngy. Khi khng c t
bch hu dng nh vy th nn km vi mt
loi thuc khng khun phng v sm
bt u vic gy min dch ch ng.
Phng php phng bnh cho ngi tip xc
ngi bnh th h hp v th ngoi da l
nh nhau; tuy nhin, nu th ngoi da l do
chng vi khun C. diphtheriae khng c
tnh gy nn th khng cn thit phi
iu tr d phng.
Chng ch nh
D ng vi huyt thanh nga.
Thn trng
Trc khi tim khng c t bch hu, cn
pht hin tin s mn cm vi huyt thanh
nga, tin s hen suyn hoc cc phn
ng d ng khc; tuy nhin, test nhy cm
cn c tin hnh cho tt c cc i tng
k c khng c tin s d ng trc khi tim
ch phm c cha huyt thanh nga.
Ht sc thn trng khi dng khng c t
bch hu cho nhng ngi c tin s d
ng v/hoc trc y c biu hin mn
cm vi huyt thanh nga. Cn chun b
sn adrenalin v cc bin php h tr khc
x tr ngay phn ng phn v nu
xy ra.
Thi k mang thai
Hin khng c d liu v vn ny.
Thi k cho con b
Hin khng c d liu v vn ny.
Tc dng khng mong mun (ADR)
Cc phn ng phn v vi huyt thanh
nga c trng bi nhng hin tng ni
my ay, kh th, try mch, xy ra tc
th vi t l 7% ngi ln sau khi c tim
khng c t bch hu. Bnh huyt thanh
xy ra vo ngy th 12 tr i sau khi tim
khng c t bch hu v biu hin l
ni my ay, st, nga, kh chu, sng
hch bch huyt v au khp, gp vi t l
5 - 10% ngi ln sau khi c tim
phng bng khng c t bch hu, nhng
thng xy ra nhiu hn khi dng vi liu
iu tr. Bnh huyt thanh thng sm xy
Levonorgestrel (t trong t cung) 209
ra (thi gian bnh di 7 - 12 ngy)
nhng ngi trc y mn cm do c
iu tr bng huyt thanh nga. Cc
thuc salicylat, khng histamin hay cc
corticosteroid c th c hiu qu trong
iu tr bnh huyt thanh. T l cc
phn ng phn v v bnh huyt thanh
c lin quan mt thit vi lng huyt thanh
nga dng, vi nhy cm ca ngi
bnh v vi tin s tim huyt thanh
nga.
Liu lng v cch dng
Cch dng
Khng c t bch hu c dng theo -
ng tim bp hoc truyn nh git chm
theo ng tnh mch. Phi th test nhy
cm cho mi i tng trc khi dng khng
c t bch hu.
Khng c t bch hu cn c ln ti
nhit 32 - 34 oC trc khi s dng; cn
theo di cn thn khng vt qu 34oC.
Cc mu bnh phm nui cy vi sinh
vt cn c ly trc v sau khi iu tr hay
d phng bnh bch hu.
Khi truyn theo ng tnh mch, liu
thch hp ca khng c t bch hu cn
c pha long vi mt th tch thch hp
dung dch natri clorid 0,9% hoc dung
dch dextrose 5% c c nng pha
long khng c t mc 1:20. Sau c
th truyn trc tip vo tnh mch vi tc
khng qu 1 ml/pht.
Test nhy cm v phng php gii mn
cm
Trc khi dng khng c t bch hu cn
tin hnh lm cc test ly da hay trong da
v test gic mc pht hin nhy
cm vi huyt thanh. Trong trng hp c
th th tin hnh ng thi c hai test
gic mc v trong da hoc ly da. Php
th trong da c tin hnh bng cch pha
long khng c t vi dung dch natri
clorid 0,9% c c dung dch nng
1:100, ri tim trong da 0,1 ml; c kt
qu sau 20 pht. Khi ngi bnh c tin s
d ng, cn tin hnh test trong da s b
bng cch tim 0,05 ml dung dch pha
long 1:1000. Mi tim i chng, dng
dung dch natri clorid 0,9%, to thun li
cho vic nhn nh kt qu. Test trong
da dng tnh khi thy ni my ay c
hay khng c chn gi v mt vng hng
ban bao quanh. Mt cch khc l lm test
ly da th nhy cm, bng cch
nh trn vng da nh th 1 git khng
c t pha long 1:100 v sau ly trn
git thuc mt vt vo da c di
chng 0,64 cm, ri c kt qu sau 20
pht. Cn tin hnh lm mt test i
210 Levonorgestrel (t trong t cung)
chng bng cch dng dung dch nc mui
sinh l 0,9%. Test ly da c coi l dng
tnh khi xut hin mt qung my ay,
c hoc khng c cc chn gi v c mt
vng ban bao quanh. Test gic mc c
tin hnh bng cch nh mt git khng
c t bch hu pha long 1:10 vo ti
cng ca mt bn mt v c kt qu sau
15 pht. Test i chng cng c lm t-
ng t bng nh mt git dung dch nc
mui sinh l 0,9% vo mt bn kia. Test
gic mc c coi l dng tnh nu ti mt
bn th xut hin phn ng nga, au rt,
v chy nc mt; cc du hiu v
triu chng ny s ht khi nh vo mt b
phn ng 1 git dung dch adrenalin dng
cho mt. Test trong da, test ly da v test
gic mc m tnh thng c coi l c gi
tr tin cy, nhng khng phi l mt quy
tc tuyt i loi tr s mn cm ton
thn. Mt khi test da v gic mc dng
tnh hoc nghi ng th nn cn nhc
vic dng khng c t bch hu hn
ch ri ro; nu bt buc phi dng, th
nn tin hnh gii mn cm.
Phng php gii mn cm c tin hnh
nh sau: Tim di da cc liu khng c t
bch hu k tip nhau c 15 pht mt ln
theo tun t: 0,05 ml dung dch pha long
1:20, 0,1 ml dung dch 1:10, 0,3 ml dung
dch 1:10, 0,1 ml khng c t khng pha
long v 0,2 ml khng c t khng pha
long; cui cng sau 15 pht tim bp 0,5
ml khng c t khng pha long. Nu
phn ng qu mn xy ra bt c thi
im no trong quy trnh trn, th phi
tin hnh t ga r ngay phn trn ca
ni tim ri tim adrenalin vo vng trn
ca ga r. Sau 1 gi, c th lm tip tc
phng php gii mn cm cho n liu
cui cng. Nu khng c phn ng g sau
khi tim bp 0,5 ml khng c t khng
pha long, th liu thng dng cn li s -
c tim bp hoc tnh mch.
iu tr bnh bch hu
Liu khng c t dng iu tr bnh sng; ng lnh khng nh hng ti hiu
bch hu ph thuc vo v tr, kch thc
cc mng gi, mc nhim c v thi
k ca bnh. Nn tim mt ln c tng
liu khng c t. Trc khi tim cn pht
hin tin s mn cm vi huyt thanh
nga, tin s hen suyn hoc cc phn
ng d ng khc; tuy nhin, test nhy cm
cn c tin hnh cho tt c cc i tng
k c khng c tin s d ng trc khi tim
ch phm c cha huyt thanh nga. Bt
c vic tr hon no trong vic dng thuc
u c th dn n phi tng liu v
gim hiu qu ca thuc. Liu thng dng
DTQGVN
cho ngi ln v tr em l 20.000 n
40.000 n v i vi cc trng hp bch
hu hng - thanh qun pht bnh c
48 gi; 40.000 - 60.000 n v nu bnh
c tn thng vng mi hng, hoc
80.000 - 120.000 n v cho th bnh
lan ta mnh hoc ko di qu 3 ngy
hoc cho nhng bnh nhn c sng hch
c. Cn theo di ngi bnh v iu tr
h tr ngay t u v tip tc cho n
khi ht tt c cc triu chng ti ch v
ton thn, hoc cho n khi xc nh
c mt loi vi sinh vt gy bnh khc.
ng thi, dng phi hp thm thuc khng
khun nh erythromycin, penicilin G.
Phng bnh bch hu
Khng c t bch hu him khi c dng
phng bnh. Khi vic phng bnh
thy l cn thit i vi nhng ngi tip
xc vi ngi bnh th ng h hp hoc
th ngoi da m trc y cha c tim
phng bng gii c t th cn phi dng
khng sinh thch hp trong 7 - 10 ngy
(ung erythromycin hoc tim bp mt
liu duy nht benzathin penicilin G), ng
thi gy min dch ch ng bng mt
liu gii c t bch hu v tim mt liu
duy nht khng c t bch hu. Liu
khng c t phng bnh ph thuc
vo thi gian, mc tip xc v iu
kin sc khe ca ngi c tim. Thng th-
ng l tim bp mt liu duy nht cho ng-
i ln v tr em, t 5.000 n 10.000 n
v khng c t.
Tng tc thuc
C th dng khng c t bch hu phi
hp vi gii c t bch hu. Tuy nhin,
khng c trn chung khng c t v
gii c t vo mt bm tim v cng
khng c tim vo cng mt v tr, v
chng c th trung ha tc dng ca nhau.
n nh v bo qun
Khng c t bch hu cn c bo qun
nhit lnh t 2 n 8 oC v trnh nh
lc ca thuc.
Thng tin qui ch
Thuc phi c k n v bn theo n.
Labetalol hydroclorid
Tn chung quc t: Labetalol.
M ATC: C07A G01.
DTQGVN
Loi thuc: Thuc chng tng huyt p;
thuc chn beta - khng chn lc.
Dng thuc v hm lng
Vin bao phim: 100 mg, 200 mg, 300 mg
hoc 400 mg labetalol hydroclorid.
Thuc tim, ng tnh mch: 5 mg/ml
labetalol hydroclorid, trong l 20 ml, 40 ml
hoc 50 ml v trong ng tim cha sn
thuc n liu, 4 ml hoc 8 ml.
Dc l v c ch tc dng
Labetalol l i din cho loi thuc c tc
dng i khng cnh tranh c cc th
th adrenergic alpha - 1 v beta. Thuc
dng lm sng l mt hn hp racemic
ca 4 cht ng phn lp th. Tc dng
dc l ca thuc phc tp, v mi cht
ng phn c hot tnh tng i khc
nhau. Tc dng ca hn hp gm chn
chn lc th th alpha - 1 (so snh vi th
th alpha - 2), chn th th beta - 1 v
beta - 2, hot tnh ch vn mt phn th
th beta - 2, v c ch s thu np
noradrenalin bi t bo thn kinh (tc
dng ging cocain). Hiu lc ca hn hp
v chn beta - adre-
nergic gp 5 n 10 ln so vi chn alpha
- adrenergic. Labetalol cn c tc dng
trc tip gy gin mch v do vy lm
gim sc cn ngoi bin.
Tc dng ca labetalol trn c cc th th
adrenergic alpha - 1 v beta gp phn lm
h huyt p ngi tng huyt p. Chn
th th alpha - 1 dn n gin c trn
ng mch v gin mch, c bit t th
ng. Chn beta - 1 cng gp phn vo
tc dng h huyt p, mt phn do chn
kch thch phn x giao cm tim. Thm
vo , hot tnh ging thn kinh giao
cm ni ti ca labetalol th th beta - 2
c th gp phn lm gin mch.
Labetalol c dng c hiu qu di dng
ung iu tr tng huyt p mn tnh
v di dng tim tnh mch iu tr
cp cu tng huyt p c hiu qu.
Labetalol lm h huyt p nhanh hn so
vi cc loi chn beta khc. Tc dng h
huyt p y thy trong vng 1 - 3
gi sau khi ung 1 liu.
Dc ng hc
Labetalol c hp thu hon ton qua ng
tiu ha, nhng v c s thanh thi khi qua
gan bc u ln, nn kh dng sinh hc khi
ung trung bnh ch bng 18 5%, v
thay i nhiu. Kh dng sinh hc c th
tng khi ung thuc vi thc n. Gn vi
protein huyt tng mc va: 50%.
Sau khi ung, nng nh huyt tng
t c trong vng 40 pht n 2 gi; tc
Levonorgestrel (t trong t cung) 211
dng h huyt p xut hin trong vng 20
pht n 2 gi, t ti a trong vng 1 -
4 gi, v ko di ty theo liu trong
khong 8 - 12 gi hoc 12 - 24 gi t ng
ng vi liu 200 hoc 300 mg. Sau khi
tim tnh mch, tc dng h huyt p xut
hin trong vng 2 - 5 pht, t ti a
trong vng 5 - 15 pht, v ko di 2 - 4
gi.
Sau khi tim tnh mch, th tch phn b
trung bnh l 9,4 3,4 lt/kg. Na i
thi tr l 4,9 2 gi. Na i thi tr ca
thuc c v khng thay i ngi suy
thn hoc gan, nhng c th tng ngi
suy thn nng. thanh thi ton phn:
25 10 ml/pht cho 1kg.
Labetalol chuyn ha nhanh v nhiu
gan do bin i oxy ha v lin hp
glucuronid; tc chuyn ha b nh h-
ng bi nhng thay i v lu lng mu
gan. Khong 55 - 60% liu thuc bi tit
qua nc tiu, ch yu di dng cht lin hp
glucuronid, trong vng 24 gi, v khong
30% bi tit qua phn trong vng 4 ngy.
Di 5% liu thuc bi tit qua nc tiu
dng khng thay i.
Ch nh
Vin nn labetalol hydroclorid dng iu
tr tng huyt p. C th dng mt mnh
hoc kt hp vi thuc chng tng huyt
p khc, c bit vi thuc li tiu thiazid
v li tiu quai.
Thuc tim labetalol hydroclorid c ch
nh iu tr tng huyt p nng.
Chng ch nh
Hen ph qun, suy tim r, blc tim II
v III, sc do tim, nhp tim chm nhiu,
nhng bnh khc kt hp vi h huyt p
nng, ko di v ngi c tin s qu mn
vi bt c thnh phn no ca thuc.
Thn trng
Ngi c suy gim chc nng tim, v c th
thc y suy tim sung huyt; ngi c suy
gim chc nng gan, v chuyn ha ca
thuc c th gim. Khi d kin ngng
thuc sau thi gian di iu tr vi
labetalol, c bit ngi c bnh thiu
mu cc b c tim, phi gim dn liu
trong thi gian 1 - 2 tun; theo di cn
thn v khuyn ngi bnh tm thi hn
ch hot ng th lc.
Nu dng labetalol ung cho ngi b co
tht ph qun khng do d ng (v d,
vim ph qun mn tnh, kh ph thng),
phi s dng liu thp nht c ch t
nht hot tnh ch vn beta - adrenergic.
Dng thn trng cho ngi b i tho -
ng ang dng thuc h ng huyt,
212 Levonorgestrel (t trong t cung)
c bit ngi c bnh khng n nh, Da: Ban.
v labetalol c th che lp du hiu v
triu chng h ng huyt cp tnh; cn
iu chnh liu thuc h ng huyt.
Nu tip tc dng labetalol ngi phi
m ln, phi bo cho bc s gy m bit,
v c th xy ra h huyt p nghim
trng, ko di v kh khn trong vic
phc hi hoc duy tr nhp p ca tim.
Ch dng labetalol ng tnh mch cho
ngi bnh nm trong bnh vin; ngi
tng huyt p nng, phi dng liu thch
hp t mc gim huyt p mong
mun trong thi gian di bao nhiu ty theo
trng thi lm sng ca ngi bnh. Ngi
bnh phi nm lu c th ti 3 gi sau khi
tim, truyn thuc ng tnh mch, v
triu chng h huyt p th ng c th
xy ra.
Thi k mang thai
Hin cha c nghin cu y v c
kim chng v vic dng labetalol ph
n mang thai. V cc thuc chn beta c
tc dng khng mong mun trn thai v
cc thuc h huyt p c th lm gim lu
lng mu trong nhau thai vi hu qu
nghim trng, nn ch dng labetalol trong
thi k mang thai nu li ch c th t
c tri hn nguy c c th xy ra vi
thai.
Thi k cho con b
Mt lng nh labetalol phn b trong sa
m, nhng khng chc c nguy c tc
dng khng mong mun trn tr nh b
sa m. Phi dng thn trng labetalol
ph n ang cho con b.
Tc dng khng mong mun (ADR)
Phn ln tc dng khng mong mun ca
labetalol u nh, nht thi, v xy ra
sm trong tin trnh iu tr. C th
chia ADR thnh 3 nhm (theo th t tn s
gim dn): tc dng khng c hiu, tc
dng lin quan vi hot tnh chn alpha -
adrenergic, v tc dng lin quan vi hot
tnh chn beta - adrenergic ca thuc.
Thng gp, ADR > 1/100
Tim mch: H huyt p th ng, ph.
Thn kinh trung ng: Hoa mt, mt mi,
chng mt, nhc u.
Ni tit v chuyn ha: Gim kh nng
tnh dc.
Tiu ha: Bun nn, kh chu d dy, v
gic khc thng.
Thn kinh - c v xng: D cm.
H hp: Kh th, ngt mi.
t gp, 1/1000 < ADR < 1/100
Thn kinh trung ng: Ng l m.
DTQGVN
Tiu ha: a chy, nn.
Mt: Th gic khng bnh thng.
Hng dn cch x tr ADR
Khi c du hiu hoc triu chng u
tin sp xy ra suy tim, trong khi iu tr
bng labetalol, hy dng liu php thch
hp (v d, glycosid tr tim, thuc li tiu)
v theo di cht ch ngi bnh; nu suy
tim vn tip tc, phi ngng labetalol, nu
c th th gim liu dn dn trc khi
ngng. Nu au tht ngc tng ln hoc
c suy ng mch vnh cp tnh sau khi
tm ngng hoc ngng iu tr bng
labetalol, phi nhanh chng dng thuc li,
t nht l tm thi, v p dng bin php
thch hp iu tr au tht ngc
khng n nh. iu tr h huyt p nht
thi do dng labetalol ng tnh mch
bng cch t ngi bnh t th u
thp chn cao, truyn dch tnh mch
v/hoc tm thi ngng thuc.
C th phng nga ADR v thn kinh ca
labetalol bng cch gim liu hoc thay
i biu thi gian dng thuc.
Phi ngng thuc ngay nu c vng da
hoc kt qu xt nghim biu hin th-
ng tn gan. Vng da v ri lon chc
nng gan thng phc hi sau khi ngng
thuc. Lm xt nghim chc nng gan khi
c du hiu hoc triu chng u tin v
ri lon chc nng gan (v d, nga, nc
tiu sm mu, chn n ko di, vng da,
hi chng ging cm).
Liu lng v cch dng
Cch dng
Labetalol hydroclorid thng dng ung, nh-
ng c th tim tnh mch chm hoc
truyn tnh mch chm lin tc.
Liu lng
Liu ung ngi ln: Chng tng huyt p
nng:
Ban u: Ung, 100 mg, 2 ln/ngy, hiu
chnh liu vi lng tng thm 100 mg, 2
ln/ngy, c 2 hoc 3 ngy hiu chnh
mt ln cho ti khi t hiu qu mong
mun.
Duy tr: Ung, 200 mg n 400 mg, 2
ln/ngy.
Ghi ch: C th chia thnh 3 ln ung
trong ngy khi c tc dng ph nh bun
nn hoc chng mt. Trong tng huyt p
nng, c th cn dng liu 1,2 n 2,4g
mt ngy, chia 2 hoc 3 ln ung.
Liu tim ngi ln: Chng tng huyt p
nng:
DTQGVN
Tim tnh mch, 20 mg (0,25 mg/kg cho
mt ngi cn nng 80 kg) tim chm
trong 2 pht; c th tim b sung 40 mg
v 80 mg c 10 pht mt ln cho ti khi
t mc huyt p mong mun hoc tng
liu 300 mg, hoc c th:
Truyn tnh mch, vi tc 0,5 mg n
2 mg/pht, hiu chnh liu ty theo p
ng; tng liu cn thit c th t 50 n
300 mg.
Ghi ch: Ngi cao tui c th tng hoc
gim nhy cm vi liu thng dng cho
ngi ln.
Tng tc thuc
Dng ng thi labetalol vi thuc li tiu
hoc thuc gim huyt p khc c th
lm tng tc dng h huyt p; cn hiu
chnh liu cn thn. Phi rt thn trng
khi s dng ng thi labetalol v thuc
chn knh - calci v tc dng iu tr v
ADR ca 2 thuc cng hp.
Dng ng thi labetalol tnh mch v
thuc gy m halothan gy tc dng hip
ng h huyt p; phi hiu chnh nng
halothan.
Ung ng thi cimetidin lm tng sinh
kh dng v ung ng thi glutethimid
lm gim sinh kh dng ca labetalol
ung; phi hiu chnh cn thn liu lng
labetalol.
Labetalol c th i khng vi tc dng
gin ph qun do thuc ch vn beta -
adrenergic ngi bnh b co tht ph
qun; c th cn dng liu ln hn thuc
gin ph qun ch vn beta - adrenergic
ngi bnh dng labetalol.
Dng ng thi labetalol vi nitroglycerin
c th gy tc dng cng hp h huyt p.
Dng ng thi vi thuc chng trm cm
ba vng c th gy tng t l run.
n nh v bo qun
Bo qun vin nn labetalol hydroclorid
nhit t acid lactic, do to ra mt mi trng
2 - 300C, trong l kn, trnh nh sng. Bo
qun thuc tim labetalol hydroclorid
nhit t 2 - 30 0C, trnh nh sng v
khng ng lnh.
Qu liu v x tr
Biu hin: Triu chng ch yu ca qu
liu labetalol c lin quan vi h tim mch
nh h huyt p, nhp tim chm, suy tim,
co tht ph qun, bun nn, nn, nhc
u.
iu tr: iu tr bao gm cha triu
chng v h tr. Ung qu liu cp tnh,
cn lm sch d dy ngay bng gy nn
hoc ra d dy. Dng than hot sau khi
gy nn hoc ra d dy c tc dng
Levonorgestrel (t trong t cung) 213
ngn nga hp thu labetalol. Phi ngi
bnh nm, nu cn chn nng cao
tng cung cp mu cho no. Nu nhp tim
chm, c th dng atropin hoc adrenalin.
C th dng thuc nng huyt p (v d,
noradrenalin, dopamin) nu h huyt p
nghim trng. Vi suy tim, c th dng
thuc tr tim v thuc li tiu; dopamin
hoc dobutamin cng c th c tc dng
tt. Glucagon cng c th c hiu qu
iu tr suy c tim v h huyt p.
C th dng thuc ch vn beta - 2
adrenergic iu tr co tht ph
qun. Vi cn co git, c th dng dia-
zepam. Thm tch thn nhn to hoc
thm tch phc mc khng loi tr c
labetalol mc ng k.
Thng tin qui ch
Thuc c bng B.
LACTOBACILLUS ACIDOPHILUS
Tn chung quc t: Lactobacillus
acidophilus
M ATC: A07F A01
Loi thuc: Vi khun sinh acid lactic
Dng thuc v hm lng
Gi thuc dng bt hoc cm c 100 triu
hoc 1 t vi khun ng kh.
Vin nn c 300 - 600 triu vi khun ng
kh, vin thng hoc vin tan trong rut.
Nang c 1 - 5 t vi khun ng kh, nang
thng hoc nang tan trong rut.
ng 7 ml hn dch c 350 - 500 triu vi
khun.
Gi thuc dng bt cha 5 - 10 t xc vi
khun b dit bng nhit .
Dc l v c ch tc dng
L. acidophilus l mt trc khun vn thng
c tr ng tiu ho, c kh nng sinh ra
khng thun li cho s pht trin ca cc vi
khun v nm gy bnh k c cc vi
khun gy thi ra. L. acidophilus c
dng trong nhiu nm iu tr a
chy cha c bin chng, c bit do vi
khun ch rut b bin i do dng
khng sinh. Ch phm L. acidophilus c
iu ch t mi trng nui cy m
c, lm kh v c kh nng sng v
pht trin khi ung hoc c iu ch t
xc vi khun git cht bng nhit. Tuy
nh sn xut a ra kin l xc vi
khun git cht c kh nng km khun,
kch thch khng c hiu nim mc rut
tng tng hp IgA, kch thch tng tr-
214 Levonorgestrel (t trong t cung)
ng vi khun ch sinh acid lactic, ngn
chn cc vi khun gy bnh xm nhp,
nhng cho n nay cha c mt nghin cu
no nghim tc tnh cht khoa hc
chng minh tnh hiu qu ca L.
acidophilus trong iu tr a chy. Sa
chua (Yoghurt) l 1 ngun ph bin cung
cp vi sinh to acid lactic. Nhiu nc coi
cc ch phm ny l mt thc phm,
hoc thc phm b sung v khng cn
ni n ch li trong iu tr a chy.
Cc ch phm c L. acidophilus khng c
trong phc iu tr a chy cp tr
em ca T chc Y t th gii v ca B Y
t.
Ch nh
iu tr ph trong a chy cng vi bin
php tip nc v in gii.
Thay th vi khun ch b mt do dng
khng sinh.
Chng ch nh
Khng dng cho ngi st cao tr khi c ch
nh ca bc s chuyn khoa.
Nu ch phm ca L. acidophilus c
lactose, khng c dng cho ngi c
galactose huyt bm sinh, hoc thiu
lactase.
Khng dng cho ngi mn cm vi sa v
cc ch phm ca sa.
Thn trng
Nu sau 2 ngy iu tr m vn b a
chy, cn khm li.
Cn gim st theo di khi dng ch phm
cha L. acidophilus cho tr s sinh v tr
em di 3 tui.
Thi k mang thai
Cho n nay, cha thy thuc gy d ng
hoc c cho thai. Tuy nhin s liu cn
t. Tt nht l khng dng khi mang thai.
Thi k cho con b
Khng c chng ch nh vi ph n cho
con b.
Tc dng khng mong mun (ADR)
Khi bt u dng thuc c hin tng sinh
hi trong rut, nhng hin tng ny gim
dn trong qu trnh iu tr. Nhim acid
chuyn ha xy ra khi dng vin nn;
i khi to bn.
Hng dn cch x tr ADR
Cha c ADR c bit cn phi x tr.
Liu lng v cch dng
Cch dng: Thuc thng c ung vi sa,
nc qu hoc nc un si ngui. Cc
nang, vin nn v cc ht c th nhai
hoc nut nguyn vin hoc nang. Vin
DTQGVN
nn phi nghin trc khi cho tr em ung,
vin tan trong rut phi nut nguyn nang.
Liu lng:
Ch phm c L. acidophilus v natri
carboxy-methylcellulose: 2 nang/ln, ngy
ung 2 - 4 ln.
Ch phm c L. acidophilus v L. bulgaricus:
2 nang/ln, 4 vin nn/ln hoc 1 gi ht/ln,
ngy ung 3 - 4 ln.
Ch phm gii phng chm rut cha L.
acidophilus v L. casei: 1 nang mi ngy
trong 2 tun u iu tr; sau c th
tng liu ti ti a 3 nang/ngy nu cn.
Vi cc ch phm khc (iu ch t xc vi
khun b git cht do nhit) cn tham
kho hng dn ca nh sn xut.
Cn ch : Thuc ny ch l mt thuc
th yu trong iu tr a chy cha c
bin chng mt nc v in gii. Trc khi
dng bt c dng thuc no, cn phi nh
gi ng tnh trng mt nc v in gii
ca ngi bnh.
n nh v bo qun
Nn bo qun 2 - 8 oC, c th
nhit phng vi cc ch phm ng
kh, trnh nh sng.
Tng k
Khng ch phm cha L. acidophilus
nhit trn 60 oC.
Qu liu v x tr
Cha thy c du hiu qu liu.
Thng tin quy ch
Lactobacillus acidophilus c trong Danh
mc thuc cha bnh ch yu s dng ti
cc c s khm cha bnh, nm 2005.
Lactulose
Tn chung quc t: Lactulose.
Loi thuc: Thuc kh c amoniac, thuc
nhun trng.
M ATC: A06A D11.
Dng thuc v hm lng
Dung dch ung, siro 10 g/15 ml (15 ml,
200 ml); ti ng bt kt tinh khong 30
liu; ch phm c phi hp vi mt s ng
khc, nh lactose, galactose, tagatose v cc
ng ceton khc (20 - 40%).
Dc l v c ch tc dng
Lactulose l mt disacharid tng hp, cha
galactose v fructose, c chuyn ha bi
cc vi khun ng rut thnh acid lactic v
mt lng nh acid acetic v acid formic.
Nhng acid ny lm gim pH ca phn v
chuyn amoniac (NH3) l dng khuch tn
sang dng ion amoni (NH4+) khng khuch
DTQGVN
tn c t rut vo mu. Hn na, do mi
trng rut c tnh acid hn mu, nn
amoniac c th khuch tn t mu vo
rut, ri li chuyn thnh ion amoni khng
hp thu c. Kt qu l hm lng amoniac
trong mu gim. Tng t, s hp thu cc
amin (cng tham gia gy bnh no do gan)
c th cng gim.
Nguyn nhn chnh gy ng c thn
kinh trung ng ngi b hn m do gan l
tng amoniac trong mu. Do vy, lactulose
c dng trong iu tr bnh no do gan,
nhng cn dng liu cao. Khong 75 - 85%
ngi bnh c p ng lm sng tt vi
iu tr lactulose. V lactulose khng gy
c, nn c dng thay th cho cc khng
sinh nh neomycin, c bit khi cn iu
tr lu hoc c chng ch nh vi
neomycin. Lactulose khng c tc dng
iu tr bnh no khng do nitrogen nh
cc bnh no do thuc hoc ri lon
chuyn ha, in gii. Lactulose khng c
tc dng trong iu tr hn m c lin
quan n vim gan nhim khun hoc cc
ri lon cp khc gan. Khi tng amoniac
huyt do ri lon chuyn ha bm sinh,
dng lactulose cng khng c tc dng.
Lactulose c tc dng thm thu ti ch
i trng, nn lm tng lng nc trong
phn, lm mm phn v kch thch nhu
ng rut. Tc dng ny c th phi 72 gi
sau khi dng thuc. Tuy nhin, tc dng
nhun trng ca n khng tt hn nhng
thuc nhun trng r tin khc, nh magnesi
sulfat hoc sorbitol (nhng thuc ny t
gy nn hn lactulose).
Dc ng hc
Lactulose hu nh khng c hp thu -
ng tiu ha. Thuc n rut gi, ch yu
dng cha chuyn ha. Thuc c chuyn
ha bi cc vi khun, to thnh cc acid
hu c, ch yu l acid lactic. Bi tit qua
nc tiu di dng cha chuyn ha khong
3% hoc t hn. Thuc thi tr ch yu
qua phn.
Ch nh
Phng bnh no do gan (tng amoni huyt).
To bn mn tnh.
Chng ch nh
Ngi bnh c galactose huyt hoc ch
yu cu hn ch lactose.
Qu mn vi bt c thnh phn no trong
ch phm.
Thn trng
Vi ngi i tho ng, v mt lng nh
lactose v galactose t do c trong mt s
dng bo ch ca thuc.
Levonorgestrel (t trong t cung) 215
Thi k mang thai
Cha c du hiu thuc nh hng ti sinh
sn hoc gy hi cho bo thai.
Thi k cho con b
Cha c thng tin.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Tiu ha: y hi, a chy (qu liu).
t gp, 1/1000 < ADR < 1/100
au bng, bun nn, nn, tng natri huyt.
Hng dn cch x tr ADR
Nu b a chy, cn gim liu ngay; nu
vn cn a chy, ngng dng thuc.
Liu lng v cch dng
Phng bnh no do gan:
Ngi ln: Bt u: 20 - 30 g (30 - 45 ml
dung dch lactulose), 3 ln/ngy. Sau ,
c 1 - 2 ngy li iu chnh liu c
th i tin 2 - 3 ln trong ngy.
Tr em: Tr nh: 2 - 6 g (3 - 9 ml)/ngy, chia
lm nhiu ln.
Tr ln v thiu nin: 30 - 60 g (45 - 90
ml)/ngy, chia lm vi ln, sau c 1 - 2
ngy li iu chnh liu c th i
tin 2 - 3 ln/ngy. Nu liu bt u gy
a chy, cn gim liu ngay, nu vn cn
a chy, th ngng dng thuc.
Tin hn m hoc hn m do gan: Dng -
ng trc trng: 200 g (300 ml) c pha
long vi 700 ml nc hoc natri clorid 0,9%,
gi trong 30 - 60 pht, dng 4 - 6 gi mt
ln.
To bn: Khi u c th dng 2 ln/ngy.
Trong t iu tr nn iu chnh liu
theo tng ngi, nhng nn theo hng dn
sau:
Ngi ln: 10 g, 2 ln/ngy, tng n 40
g/ngy, nu cn thit. Liu duy tr: 7 - 10
g/ngy.
Tr 5 - 10 tui: 6 g, 2 ln/ngy; tr di 5
tui: 3 g, 2 ln/ngy; tr di 1 tui: 2 g, 2
ln/ngy.
Tng tc thuc
Khng dng ng thi vi cc thuc nhun
trng khc, v gy i tin nhiu, lm
kh xc nh chnh xc liu lactulose cho
iu tr bnh no do gan.
Cc thuc khng acid khng hp thu c th
nh hng ti s to acid ng rut ca
lactulose.
Mt s thuc khng khun c th nh hng
n h vi khun ng rut gip chuyn
ha lactulose; tuy nhin, neomycin c th
dng ng thi trong iu tr bnh no do
gan.
n nh v bo qun
Bo qun nhit phng.
216 Levonorgestrel (t trong t cung) DTQGVN

Qu liu v x tr ngi bnh c s lng t bo CD4 di 500

Triu chng: a chy, au bng, nhim trong 1 mm3. Liu php ny cng c th
kim do gim clor huyt, mt nc, h huyt dng cho nhng ngi bnh c mt HIV
p, gim kali huyt. trn 30.000/ml huyt tng, khng ph
iu tr: Khng c thuc gii c c thuc vo s lng t bo CD4, v mt
hiu, ch yu l iu tr triu chng. HIV l mt yu t tin lng s tin trin
ca bnh. Mt virus cao hn dn n
gim t bo CD4 nhanh hn. Mc tiu
iu tr l t mt HIV mc khng
Lamivudin th pht hin c. Liu php chun hin
nay gm 2 thuc tng t nucleosid khng
Tn chung quc t: Lamivudine.
retrovirus, cng vi mt thuc c ch
M ATC: J05A F05. protease. S tun th iu tr c tnh
Loi thuc: Thuc khng retrovirus. quyt nh cho hiu lc duy tr ca
thuc.
Dng thuc v hm lng
Ngi bnh iu tr khng c kt qu
Lamivudin, ung: Dung dch 10 mg/ml. (tng gp 3 ln mt virus, hoc gim
Vin bao phim 150 mg. s lng t bo CD4, hoc tin trin thnh
Lamivudin kt hp, ung: Vin bao phim bnh AIDS) phi chuyn sang dng mt
cha 150 mg lamivudin v 300 mg kt hp thuc khng retrovirus khc. Phi
zidovudin. la chn kt hp thuc mi sao cho nguy
Dc l v c ch tc dng c khng cho vi nhng thuc dng l
Lamivudin l 1 thuc tng hp khng ti thiu. Khi liu php c khng c tc
retrovirus, thuc nhm dideoxynucleosid dng cn cho thm thuc mi, nguyn tc
c ch enzym phin m ngc ca virus. l cho thm khng ch mt thuc, m kt
c tc dng lamivudin phi c enzym t hp 2 thuc mi.
bo phosphoryl ha v bin i thnh Xem xt nguy c ca tng tc thuc khi
mt cht chuyn ha c hot tnh, cht iu tr vi cc thuc khng retrovirus.
chuyn ha 5 - triphosphat. Cht chuyn Dc ng hc
ha ny c cu trc tng t deoxycytidin Sau khi ung, lamivudin hp thu nhanh vi
triphosphat l c cht t nhin cho enzym sinh kh dng khong 80%. Sau khi tim
phin m ngc. Thuc c hot tnh cnh tnh mch, th tch phn b l 1,3 0,4
tranh vi deoxycytidin triphosphat t nhin lt/kg. T l gn vi protein huyt tng
hp nht vo DNA ca virus bi enzym thp (< 36%). 5 - 6% thuc c chuyn
phin m ngc, gy kt thc sm tng hp ha thnh cht trans - sulfoxyd. Na i
DNA ca virus. Lamivudin c c tnh rt thi tr trong huyt tng trung bnh l
thp i vi t bo. 2,5 gi v khong 70% ca liu c thi
Lamivudin c hot tnh km virus HIV typ tr khng thay i trong nc tiu. Na
1 v 2 (HIV - 1, HIV - 2), v cng c tc i ca lamivudin triphosphat trong t
dng c ch virus vim gan B ngi bnh bo ko di, trung bnh trn 10 gi trong
mn tnh. Tuy c dung np tt, nhng t bo lympho mu ngoi bin. thanh
khng c dng lamivudin n c, v thi ton b l 0,37 0,05 lt/gi/kg.
d sinh khng thuc. S khng ny do t Ch nh
bin v enzym phin m ngc, lm gim Nhim virus HIV phi dng kt hp vi t
tnh nhy cm hn 100 ln v lm mt tc nht mt thuc dideoxynucleosid c ch
dng khng virus trn ngi bnh. Liu enzym phin m ngc khc, thng kt hp
php phi hp lamivudin v zidovudin ng- vi zidovudin hoc stavudin.
i bnh cha c iu tr trc y, lm
gim khong 10 ln mt virus trong Chng ch nh
huyt tng, tc dng ko di hn 1 nm, Qu mn vi bt c thnh phn no ca
thuc.
mc d c s t bin ca enzym phin
Bnh thn nng.
m ngc.
Cch dng thuc khng retrovirus: Trong Thn trng
liu php khng retrovirus, thuc chn lc tr em c tin s vim ty hoc c yu
l nhng thuc tng t nucleosid. Hin t nguy c pht trin vim ty, khi dng
nay cha bit r lc no l thi im tt kt hp lamivudin v zidovudin phi theo
nht bt u iu tr vi thuc di cht ch. Khi c nhng du hiu lm
khng retrovirus. Liu php khng sng, hoc kt qu xt nghim khc th-
retrovirus cng lm tng thi gian sng st ng nghi l vim ty, cn phi ngng
thuc ngay. Ch dn cho ngi thn hoc
DTQGVN
ngi trng nom tr em nhim HIV v
nhng du hiu v triu chng ca vim
ty. ngi b suy chc nng thn, tr di 12
tui v thiu nin cn nng di 50 kg,
khng dng ch phm kt hp c nh
cha lamivudin v zidovudin, v khng
th hiu chnh ring tng thuc.
Bo cho ngi bnh bit l lamivudin khng
cha khi nhim HIV, h vn tip tc
mang bnh do nhim HIV, k c nhim
khun c hi. Ngi bnh vn phi c
theo di v chm sc lin tc. Ch dn cho
ngi bnh bit l lamivudin khng lm
gim nguy c ly truyn HIV, v h phi
dng bao cao su bo v bn tnh.
Thi k mang thai
C th dng lamivudin cho ngi mang
thai, c bit khi c c may bo v khi
ly nhim sang thai nhi. Trng hp dng
lamivudin kt hp ung (vin lamivudin v
zidovudin), trnh dng cho ngi mang thai.
Thi k cho con b
Mc d khng bit lamivudin c bi tit
trong sa ngi hay khng, c kh nng
xy ra nhng tc dng khng mong mun
do lamivudin tr nh b sa. Cng c
nguy c cao ly nhim HIV do b sa. Ch
dn cho ngi m b nhim HIV khng nn
cho con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Thn kinh trung ng: Nhc u, mt ng,
kh chu, mt mi, au, chng mt,
trm cm, st, rt run.
Tiu ha: Bun nn, nn, a chy, chn n,
au bng, kh tiu, tng amylase.
Thn kinh - c v xng: Bnh dy thn
kinh ngoi bin, d cm, au c, au
khp.
H hp: Du hiu v triu chng mi,
ho.
Da: Ban.
Huyt hc: Gim bch cu trung tnh,
thiu mu.
Gan: Tng AST, ALT.
t gp, 1/1000 < ADR < 1/100
Tiu ha: Vim ty.
Huyt hc: Gim tiu cu.
Gan: Tng bilirubin huyt.
Hng dn cch x tr ADR
Phi ngng lamivudin ngay nu c nhng
du hiu lm sng, triu chng, hoc
kt qu xt nghim cho thy c th xy
ra vim ty.
Liu lng v cch dng
Bao gi cng phi dng lamivudin kt hp
vi t nht mt thuc khng retrovirus, th-
ng kt hp vi zido-
vudin hoc stavudin.
Levonorgestrel (t trong t cung) 217
Cch dng: Lamivudin v ch phm kt
hp c nh cha lamivudin v zidovudin
c dng ung, khng cn lu n cc
ba n, Vi ngi bnh iu tr bng thuc
khng retrovirus, phi nh gi lin tc
c tnh v tin trin ca bnh, v thc
hin nhng thay i trong cch dng
thuc khi c ch nh.Thi gian c hiu
qu ca mt kt hp thuc khng
retrovirus c th b hn ch, v cn phi
xc nh, nh k u n, mc RNA
ca HIV - 1 v s lng t bo TCD4 +,
xc nh nguy c tin trin ca bnh v
quyt nh thay i ch dng
thuc khng retrovirus nu cn. Duy tr
liu lng ti u c tnh quyt nh
trnh hot tnh khng retrovirus di mc ti
u.
Liu lng: Liu lng thuc khng retrovirus
da trn th trng v tui ca ngi bnh.
Ngi ln v thiu nin 16 tui tr ln: 150
mg lami-
vudin v 300 mg zidovudin cch 12 gi
mt ln cho ngi cn nng 50 kg tr ln,
2 mg lamivudin/kg th trng v 4 mg
zidovudin/kg th trng, cch 12 gi mt
ln cho ngi cn nng di 50 kg.
Thiu nin 12 n 16 tui: 150 mg
lamivudin v 300 mg zidovudin cch 12 gi
mt ln cho ngi cn nng 50 kg tr ln;
khng c t liu y ch dn liu
dng cho thiu nin di 50 kg th trng.
Tr em t 3 thng n 12 tui: 4 mg
lamivudin/kg, cch 12 gi mt ln, ti a
ti liu 300 mg lamivudin mi ngy.
Liu lng cho ngi suy gim chc nng
thn: Phi gim liu ngi bnh 16 tui
tr ln c thanh thi creatinin gim.
nh hng ca suy thn trn thi tr
lamivudin tr em v thiu nin di 16
tui cha c bit r, nn hin nay khng
c ch dn v liu cho ngi bnh nhm
tui ny c thanh thi creatinin gim.
Bng iu chnh liu dng theo thanh
thi creatinin
thanh thi Liu dng lamivudin
creatinin (cho ngi 16 tui tr
(ml/pht) ln)
50 150 mg, ngy 2 ln
30 - 49 150 mg, ngy 1 ln
15 - 29 Ngy u tin 150 mg,
ri nhng ngy sau
100 mg, ngy 1 ln.
5 - 14 Ngy u tin 150 mg,
ri nhng ngy sau 50
mg, ngy 1 ln.
<5 Ngy u tin 50 mg,
ri nhng ngy sau 25
mg, ngy 1 ln.
218 Levonorgestrel (t trong t cung)
Tng tc thuc
Nng zidovudin trong huyt tng tng
ln ng k (khong 39%) khi dng kt
hp vi lamivudin.
Trimethoprim/sulfamethoxazol lm tng
sinh kh dng ca lamivudin (44%) th
hin qua tr s o din tch di ng
cong nng - thi gian (AUC), v lm
gim thanh thi qua thn (30%).
Mc d AUC khng b nh hng nhiu, s
hp thu lamivudin b chm li v nng
nh huyt tng thp hn 40% khi cho
ngi bnh ung thuc lc no so vi khi
ung thuc lc i.
n nh v bo qun
Bo qun vin nn lamivudin 2 - 30 oC
trong l y kn, v dung dch lamivudin
ung 2 - 25 oC trong l y kn. Vin
lamivudin kt hp ung (lamivudin,
zidovudin), trnh m v trnh nh sng.
Qu liu v x tr
C rt t thng tin v qu liu, mc d khi
qu liu, khng thy c du hiu lm sng
hoc triu chng, mt khc xt nghim
mu vn bnh thng. Khng c thuc gii
c. Khng bit r lamivudin c b loi tr
bng thm tch mng bng hoc thm tch
mu hay khng.
Thng tin qui ch
Thuc c bng A.
Thnh phm gim c: Thuc vin c hm
lng ti a l 100 mg, dung dch ung c
nng ti a l 0,1%.
Lansoprazol
Tn chung quc t: Lansoprazole.
M ATC: A02B C03.
Loi thuc: Thuc c ch tit acid dch
v, thuc c ch bm proton.
Dng thuc v hm lng: Vin nang gii
phng chm (cha ht bao, tan trong rut):
15 mg, 30 mg.
Dc l v c ch tc dng
Lansoprazol l dn cht benzimidazol c tc
dng chng tit acid d dy. Lansoprazol c
lin quan cu trc v dc l vi omeprazol.
Lansoprazol lin kt khng thun nghch vi
H+/K+ ATPase l mt h thng enzym c
trn b mt t bo thnh d dy, do
lansoprazol c ch s chuyn vn cui cng
cc ion hydrogen vo trong d dy. V h
thng enzym H+/K+ ATPase c coi l chic
bm acid (proton) ca nim mc d dy, nn
lansoprazol v omeprazol c gi l nhng
DTQGVN
cht c ch bm proton. Lansoprazol c
ch d dy tit acid c bn v khi b kch
thch do bt k tc nhn kch thch no.
Cng nh vy, lansoprazol c dng iu
tr ngn ngy chng lot d dy - t trng
v iu tr di ngy cc chng tng tit
dch tiu ha bnh l (nh hi chng
Zollinger - Ellison, u a tuyn ni tit, tng
dng bo h thng).
Mc c ch tit acid d dy ph thuc
vo liu dng v thi gian iu tr, nhng
lansoprazol c ch tit acid tt hn cc
cht i khng th th H2.
Lansoprazol c th ngn chn Helicobacter
pylori ngi lot d dy - t trng b
nhim xon khun ny. Nu phi hp vi
mt hoc nhiu thuc chng nhim khun
(nh amoxicilin, clarithromycin), lansoprazol
c th c hiu qu trong vic tit tr vim
nhim d dy do H. pylori.
Dc ng hc
Lansoprazol hp thu nhanh, nng ti
a trung bnh t c trong khong 1,7
gi sau khi ung, vi kh dng sinh hc
tuyt i trn 80%. ngi kho, na i
trong huyt tng l 1,5 ( 1,0) gi. C nng
thuc ti a v din tch di ng
cong (AUC) u gim khong 50% nu
dng thuc khong 30 pht sau khi n.
Lansoprazol lin kt vi protein huyt tng
khong 97%. Lansoprazol chuyn ha
nhiu gan nh h enzym cytochrom P450
thnh hai cht chuyn ha chnh:
sulfon lansoprazol v hydroxy lansoprazol.
Cc cht chuyn ha c rt t hoc khng
cn tc dng chng tit acid. Khong 20%
thuc dng c bi tit vo mt v nc tiu.
Thi tr lansoprazol b ko di ngi b
bnh gan nng, nhng khng thay i
ngi suy thn nng. Do vy, cn gim liu
i vi ngi b bnh gan nng.
Ch nh
iu tr cp v iu tr duy tr vim thc
qun c trt lot ngi bnh tro ngc d
dy - thc qun (dng ti 8 tun).
iu tr lot d dy - t trng cp.
iu tr cc chng tng tit toan bnh l,
nh hi chng Zollinger - Ellison, u a tuyn
ni tit, tng dng bo h thng.
Chng ch nh
Qu mn vi lansoprazol hoc cc thnh
phn khc ca thuc.
C thai trong 3 thng u.
Thn trng
Cn gim liu i vi ngi b bnh gan.
Ngi mang thai v cho con b.
Thi k mang thai
DTQGVN
Cha c thng bo dng lansoprazol cho ngi
mang thai. Khng bit r thuc c i qua
nhau thai vo bo thai khng. Tuy nhin,
dng lu v vi liu cao gy ung th trn
c chut nht v chut cng c v ci,
do vy nn trnh dng cho ngi mang thai,
t nht l trong 3 thng u, nhng tt nht
l khng nn dng trong bt k giai on
no khi thai nghn.
Thi k cho con b
C lansoprazol v cc cht chuyn ha
u bi tit qua sa chut cng v c
th s bi tit qua sa ngi m. V tc
dng gy ung th ca thuc trn sc vt
c chng minh, nn trnh dng ngi cho
con b.
Tc dng khng mong mun (ADR)
Cc phn ng ph thng gp nht vi
lansoprazol l ng tiu ha nh a chy,
au bng, ngoi ra mt s ngi bnh c
au u, chng mt.
Thng gp, ADR > 1/100
Ton thn: au u, chng mt
Tiu ha: a chy, au bng, bun nn,
nn, to bn, kh tiu.
Da: Pht ban.
t gp, 1/1000 < ADR < 1/100
Ton thn: Mt mi
Cn lm sng: Tng mc gastrin huyt
thanh, enzym gan, hematocrit, hemoglobin,
acid uric v protein niu.
Liu lng v cch dng
Vim thc qun c trt lot:
iu tr triu chng thi gian ngn cho tt
c cc trng hp vim thc qun:
Liu ngi ln thng dng 30 mg, 1ln/ngy,
trong 4 - 8 tun. C th dng thm 8 tun
na, nu cha khi.
iu tr duy tr sau cha khi vim thc
qun trt lot gim ti pht: Ngi ln 15
mg/ngy. Cha xc nh c mc an
ton v hiu qu khi iu tr duy tr lu
qu 1 nm.
Lot d dy: 15 ti 30 mg, 1 ln/ngy, dng
trong 4 - 8 tun. Nn ung vo bui sng
trc ba n sng.
Lot t trng: 15 mg, 1 ln/ngy, dng
trong 4 tun hoc n khi khi bnh.
Dng phi hp vi amoxicilin
clarithromycin trong iu tr nhim H.
pylori ngi bnh lot t trng th hot
ng nh sau:
Phi hp 3 thuc: 30 mg lansoprazol + 1 g
amoxicilin v 500 mg clarithromycin, dng 2
ln hng ngy, trong 10 n 14 ngy. Tt
c 3 loi thuc u ung trc ba n.
Levonorgestrel (t trong t cung) 219
Phi hp 2 thuc: 30 mg lansoprazol + 1 g
amoxicilin, dng 3 ln hng ngy, trong 14
ngy. C 2 loi thuc u ung trc ba n.
iu tr duy tr sau khi lot t trng
khi: 15 mg/1 ln/ngy. Cha xc nh c
mc an ton v hiu qu khi iu tr
duy tr lu qu 1 nm.
Tng tit toan khc (hi chng Z.E.)
Liu thng dng cho ngi ln bt u l 60
mg, 1 ln/ngy. Nn ung vo bui sng tr-
c ba n. Sau , iu chnh liu theo
s dung np v mc cn thit
c ch tit acid dch v v tip tc iu
tr cho n khi t kt qu lm sng.
Liu ung trong nhng ngy sau cn
khong t 15 - 180 mg hng ngy duy
tr tit acid dch v c bn di 10 mEq/gi
(5 mEq/gi ngi bnh trc c phu
thut d dy). Liu trn 120 mg/ngy nn
chia lm 2 ln ung.
Cn iu chnh liu cho ngi c bnh gan
nng. Phi gim liu, thng khng c vt
qu 30 mg/ngy.
Lansoprazol khng bn trong mi trng
acid (dch d dy), v vy phi ung
lansoprazol trc khi n v khng cn v hoc
nhai vin nang.
Tng tc thuc
Lansoprazol c chuyn ha nh h
enzym cytoch-
rom P450, nn tng tc vi cc thuc khc
c chuyn ha bi cng h enzym ny.
Do vy, khng nn dng lansoprazol cng vi
cc thuc khc cng c chuyn ha bi
cytochrom P450.
Khng thy c nh hng lm sng quan
trng ti nng ca diazepam, phenytoin,
theophylin, pred-
nisolon hoc warfarin khi dng cng vi
lansoprazol.
Lansoprazol lm gim tc dng ca
ketoconazol, itraconazol v ca cc thuc
khc c s hp thu cn mi trng acid.
Sucralfat lm chm v gim hp thu
lansoprazol (khong 30%).
n nh v bo qun
Bo qun nhit phng.
Qu liu v x tr
v Triu chng: H thn nhit, an thn, co
git, gim tn s h hp.
iu tr h tr: Phng php thm tch
khng loi c thuc.
Thng tin qui ch
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 30 mg.
220 Levonorgestrel (t trong t cung)
Levodopa
Tn chung quc t: Levodopa.
M ATC: N04B A01.
Loi thuc: Thuc chng bnh Parkinson,
thuc gy tit dopamin.
Dng thuc v hm lng
Vin nn 100 mg, 250 mg, 500 mg
levodopa.
Nang: 100 mg, 250 mg, 500 mg levodopa.
Dc l v c ch tc dng
Levodopa (L - dopa, L - 3,4 -
dihydroxyphenylalanin) l tin
chuyn ha ca dopamin. C bng chng
cho thy cc triu chng ca bnh
Parkinson c lin quan n s suy gim
dopamin trong th vn. Dng dopamin
khng c tc dng trong iu tr bnh
Parkinson v dopamin khng qua c
hng ro mu - no. Tuy nhin, tin cht
ca n l levodopa qua c hng ro mu
- no v chuyn thnh dopamin trong no.
c coi l c ch levodopa gim
nh c cc triu chng ca bnh
Parkinson.
Nu ung ring levodopa, thuc b kh
carboxyl nhiu bi cc enzym nim mc
rut v cc v tr ngoi bin khc, do
thuc cha b bin i ti c tun hon
no tng i t v c l ch c di 1%
thuc vo c h thn kinh trung ng.
Ngoi ra, dopamin c gii phng vo
tun hon do s kh carboxyl ca
levodopa ngoi bin, gy tc dng ph,
c bit l bun nn. c ch enzym
decarboxylase ngoi bin lm tng r rt
lng levodopa ung vo cha chuyn ha
qua hng ro mu - no v gim c
tc dng khng mong mun ng tiu
ha. Trong thc tin, hu nh levodopa bao
gi cng c ung phi hp vi mt cht c
ch decarboxylase tc dng ngoi bin, th
d carbidopa hoc benserazid. Dng thuc
carbidopa/levodopa hay c k n nht
l dng 25/100, cha 25 mg carbidopa v
100 mg levodopa (xem chuyn lun
carbidopa - levodopa).
Ung levodopa cng vi cht c ch
decarboxylase gim c 70 - 80% liu ca
levodopa.
Dc ng hc
Tuy c mt lng ng k levodopa b
chuyn ha trong d dy v rut, nhng
thuc c hp thu nhanh chng qua ng
tiu ha. Khi ung cng vi thc n, thuc
c hp thu ng tiu ha chm hn.
Levodopa phn b rng ri trong phn ln
DTQGVN
cc m. Na i ca levodopa trong huyt
tng khong 1 gi. Khi ung phi hp
carbidopa v levodopa, na i ca
levodopa trong huyt tng tng ln
khong 1,5 - 2 gi. a phn lng levodopa
c hp thu b kh carboxyl thnh
dopamin. Carbidopa ch c ch s kh
carboxyl ca levodopa ngoi bin, v
ging dopamin, carbidopa khng qua c
hng ro mu - no. Khong 80 - 85% liu
levodopa ghi du phng x bi xut qua n-
c tiu trong vng 24 gi.
Ch nh
cht Tt c cc th hi chng Parkinson (ngoi
tr cc trng hp hi chng ngoi thp do
thuc gy ra).
Bnh Parkinson t pht,
Hi chng Parkinson sau vim no,
Hi chng Parkinson do x cng ng
mch no,
Hi chng Parkinson sau tn thng h
thn kinh trung ng do nhim c
cacbon mono oxid hoc bi mangan.
Chng ch nh
Bnh glcm gc ng.
V levodopa c th kch hot u hc t c
tnh, thuc khng c dng cho ngi c tin
s ung th hc t c tnh, hoc c tn th-
ng da, nghi ng cha chn on.
Khng c dng levodopa cng vi cc cht
c ch monoamin oxidase (MAO). Phi
ngng cc cht c ch ny 2 tun trc khi
bt u iu tr bng levodopa.
Bnh ni tit, bnh gan, thn hoc tim
mt b nng.
Cc chng lon tm thn hoc bnh
nhiu tm nng.
Mn cm vi thuc.
Trnh dng cho nhng ngi di 25 tui v
ngi mang thai.
Thn trng
Levodopa phi c dng thn trng cho ngi
b i tho ng, cng gip, glcm gc
rng, h huyt p.
Phi ngng thuc 24 gi trc khi gy m.
Trong trng hp phu thut, khng c
dng cyclopropan hoc halothan.
Thn trng i vi ngi bnh c tin s
nhi mu c tim, suy ng mch vnh
hoc lon nhp tim. Cn phi kim tra T
thng xuyn.
c bit thn trng khi dng cho ngi
bnh sa st tr tu do tn thng no,
nguy c l ln hoc tm thn.
Khi dng vi thuc khng acetylcholin th
liu mi thuc phi gim.
DTQGVN
Nn nh k kim tra nh gi chc nng
thn, gan, tim mch, to huyt trong khi
iu tr ko di mi ngi bnh.
Thi k mang thai
Levodopa gy d tt cc ph tng v x-
ng thai nhi, v vy, khng dng cho ngi
mang thai.
Thi k cho con b
Khng nn cho con b trong thi gian
iu tr bng levodopa hoc khng dng
levodopa cho ph n ang cho con b,
v thuc phn b trong sa v c ch
tit sa.
Tc dng khng mong mun (ADR)
Trong qu trnh iu tr, cc tc dng
khng mong mun thng gp nht l h
tiu ha nh chn n, bun nn, nn, thng
do tc dng ngoi bin ca dopamin.
Thng gp, ADR > 1/100
Thn kinh trung ng: au u, chong
vng, trm cm, kch ng.
Tiu ha: Chn n, bun nn v nn, xut
hin trong hu ht ngi bnh liu u
iu tr.
Ni tit: Nc tiu v cc dch c th
chuyn mu nht, men gan c s thay
i.
t gp, 1/1000 < ADR < 1/100
Thn kinh trung ng: au u nng, ra
m hi.
Tiu ha: Chn n, nn.
Tim mch: Lon nhp tim, h huyt p.
Tm thn: Mt ng, l ln, trm cm, phn
ng lon thn.
Khc: Chng tng ng (triu chng tt -
bt).
Him gp, ADR < 1/1000
Thn kinh trung ng: Lon thn.
Mu: Thiu mu tan huyt, gim bch cu,
gim tiu cu.
Gan: Transaminase tng.
Hng dn cch x tr ADR
Dng levodopa iu tr, phi bt
u vi liu thp v tng dn vi lng nh,
cch 6 - 7 ngy mt ln.
C th gim bun nn v nn bng cch
ung thuc cng hoc ngay sau ba n.
C th dng domperidon hn ch nn.
Dng levodopa phi hp vi cht c ch
men decarboxylase (v d: carbidopa
hoc benserazid) c th hn ch c tc
dng khng mong mun ca levodopa (v
d: au u, nn). Tng ng l 1 du
hiu qu liu. gim ADR, cn phi
iu chnh liu t t.
Liu lng v cch dng
Levonorgestrel (t trong t cung) 221
Liu ti u hng ngy ca levodopa (ngha
l liu ci thin ti a c bnh v dung
np c tc dng khng mong mun), cn
phi c xc nh v d liu cn thn vi
tng ngi bnh. Mt khi xc nh c
liu, liu duy tr c th cn phi gim khi
ngi bnh cng cao tui. Liu khi u
gi l 125 mg ngy ung 2 ln, tng dn
cch 3 - 7 ngy/1 ln, ty theo p ng, c
th ti 8 g mt ngy chia lm nhiu ln.
Liu khi u thng thng l 0,5 g n 1
g mi ngy, chia lm 2 hoc nhiu ln,
ung km vi thc n. Sau , tng liu
hng ngy c tng thm dn t 100 - 750
mg, c 3 - 7 ngy mt ln ty theo dung
np. Liu duy tr thng t 2,5 n 6 g
mi ngy v khng vt qu 8 g mi ngy.
Gii hn k n thng thng cho ngi ln: 8
g/ngy.
Tng tc thuc
Cc thuc tm thn: Khng c ung cc
cht c ch monoamin oxidase cng vi
levodopa v c th dn n cn tng
huyt p.
C th dng cc thuc chng trm cm ba
vng cho ngi bnh ang ung levodopa,
tuy nhin cc thuc chng trm cm ba
vng c th gy nng thm chng h
huyt p th ng v c th nh hng
n hp thu ca levodopa do lm chm
s tho rng d dy v chm a
levodopa n cc v tr hp thu rut.
Ngoi ra, cc phn ng khng mong mun
khc nh tng huyt p v lon vn ng
c th xy ra (tuy him) khi dng phi hp
cc thuc ny. Phenothiazin, butyrophenon
v c th c thioxanthen v cc thuc
chng lon tm thn khc i khng vi
tc dng iu tr ca levodopa. Phi dng
thn trng nhng thuc ny trong khi
iu tr bng levodopa.
Pyridoxin: Dng 10 - 25 mg pyridoxin
hydroclorid (vitamin B 6) c th o ngc
tc dng chng Par-
kinson ca levodopa, khi dng levodopa
n c (khng km carbidopa). Ngi
bnh khng nn ung cc ch phm
vitamin trong khi iu tr bng levodopa,
nu khng c li khuyn ca thy thuc.
Cc thuc khng acetylcholin c th tc
dng hip ng vi levodopa gim run
trong hi chng Par-
kinson v tng tc ny hay c s dng c
li cho iu tr, tuy nhin cc thuc khng
acetylcholin c th lm trm trng thm
cc c ng bt thng khng ch ng.
Cc thuc h huyt p: Phi dng thn
trng levodopa ngi bnh ang dng cc
222 Levonorgestrel (t trong t cung)
thuc h huyt p nh methyldopa hoc
guanethidin. Nu ung cng c th phi
gim liu cc thuc trn. Ngoi ra,
methyldopa (cng nh carbidopa) l mt
cht c ch decarboxylase v c th gy
tc dng c i vi h thn kinh trung -
ng nh lon tm thn, nu ung cng vi
levodopa.
C thng bo dng reserpin cng vi
levodopa lm gim p ng ca ngi
bnh i vi levodopa.
Cc thuc khc: Dng levodopa cng vi
cyclopropan hoc cc thuc gy m
hydrocarbon halogen ha c th dn n
lon nhp tim.
Cch bo qun
Levodopa b oxy ha v sm mu nhanh
khi tip xc vi m. Mu thay i chng
t thuc mt tc dng.
Levodopa phi c bo qun trong
ng kn, trnh nh sng, hi m v gi
nhit < 40 0C, tt nht l nhit
15 - 300C. Trnh cc vin nn gii
phng chm nhit > 30 0C.
xa tm vi ca tr em.
Qu liu v x tr
Chng ri lon vn ng kiu ma git
xy ra thi gian nh tc dng, sau mt
liu p ng ca thuc trc , nhng lon
trng lc khu tr (thng vo mt chn) c
th xy ra khi c mt tc ng nh c lin
quan ti, v d, lc tnh dy sau mt m
ng nhiu gi, sau liu levodopa gn
nht.
V khng c thuc gii c c hiu
cho qu liu levodopa cp, cn iu tr
triu chng v h tr, s dng cc liu
php sau y: Ra d dy ngay, dng
thuc chng lon nhp nu cn. Ung
pyridoxin vi cc liu t 10 - 25mg c th
o ngc tc dng iu tr ca levodopa;
tuy nhin trong iu tr qu liu cp cha
xc nh c li ch ca pyridoxin. Gi tr
ca thm phn trong iu tr qu liu
cha c bit r.
Thng tin qui ch
Thuc c bng B.
levofloxacin
Tn chung quc t: Levofloxacin
M ATC: J01M A12
Loi thuc: Khng sinh nhm quinolon
DTQGVN
Dng thuc v hm lng
Vin nn bao phim 250 mg, 500 mg, 750
mg.
Thuc tim 250 mg/50 ml, 500 mg/100 ml,
500 mg/20 ml.
Dc l v c ch tc dng
Levofloxacin l mt khng sinh tng hp
c ph rng thuc nhm fluoroquinolon.
Cng nh cc fluoroquinolon khc,
levofloxacin c tc dng dit khun do c
ch enzym topoisomerase II (ADN-gyrase)
v/hoc topoisomerase IV l nhng
enzym thit yu ca vi khun tham gia
xc tc trong qu trnh sao chp, phin
m v tu sa ADN ca vi khun.
Levofloxacin l ng phn L-isome ca
ofloxacin, n c tc dng dit khun mnh
gp 8 - 128 ln so vi ng phn D-isome
v tc dng mnh gp khong 2 ln so vi
ofloxacin racemic. Levofloxacin, cng nh
cc fluoroquinolon khc l khng sinh ph
rng, c tc dng trn nhiu chng vi
khun Gram m v Gram dng.
Levofloxacin (cng nh sparfloxacin) c tc
dng trn vi khun Gram dng v vi khun
k kh tt hn so vi cc fluoroquinolon
khc (nh ciprofloxacin, enoxacin,
lomefloxacin, norfloxacin, ofloxacin), tuy
nhin levofloxacin v sparfloxacin li c tc
dng in vitro trn Pseudomonas
aeruginosa yu hn so vi ciprofloxacin.
Ph tc dng:
Vi khun nhy cm in vitro v nhim
khun trong lm sng:
Vi khun a kh Gram m: Enterobacter
cloacae, E. coli, H. influenza, H.
parainfluenza, Klebsiella pneumonie,
Legionalla pneumophila, Moraxella catarralis,
Proteus mirabilis, Pseudomonas aeruginosa.
Vi khun khc: Chlamydia pneumoniae,
Mycopasma pneumoniae.
Vi khun a kh Gram dng: Bacillus
anthracis, Staphylococcus aureus nhy
cm methicilin (meti-S), Staphylococcus
coagulase m tnh nhy cm methicilin,
Streptococcus pneumoniae.
Vi khun k kh: Fusobacterium,
peptostreptococcus, propionibacterium.
Cc loi vi khun nhy cm trung gian in
vitro
Vi khun a kh Gram dng: Enterococcus
faecalis.
Vi khun k kh: Bacteroid fragilis,
prevotella.
Cc loi vi khun khng levofloxacin:
Vi khun a kh Gram dng: Enterococcus
faecium, Staphylococcus aureus meti-R,
Staphylococcus coagulase m tnh meti-
R.
Khng cho: In vitro, c khng cho gia
levofloxacin v cc fluoroquinolon khc. Do
DTQGVN
c ch tc dng, thng khng c khng
cho gia levofloxacin v cc h khng
sinh khc.
Dc ng hc
Sau khi ung, levofloxacin c hp thu
nhanh v gn nh hon ton; nng
nh trong huyt tng thng t c sau
1 - 2 gi; sinh kh dng tuyt i xp x
99%. Cc thng s dc ng hc ca
levofloxacin sau khi dng ng tnh mch
v ng ung vi liu tng ng l gn
nh nhau, do c th s dng hai ng
ny thay th cho nhau. Levofloxacin c
phn b rng ri trong c th, tuy nhin
thuc kh thm vo dch no ty. T l
gn protein huyt tng l 30 - 40%.
Levofloxacin rt t b chuyn ha trong
c th v thi tr gn nh hon ton qua
nc tiu dng cn nguyn hot tnh, ch
di 5% liu iu tr c tm thy trong n-
c tiu di dng cht chuyn ha
desmethyl v N-oxid, cc cht chuyn ha
ny c rt t hot tnh sinh hc. Thi gian
bn thi ca levofloxacin t 6 - 8 gi, ko
di ngi bnh suy thn.
Ch nh
Nhim khun do cc vi khun nhy cm vi
levofloxacin, nh:
Vim xoang cp.
t cp vim ph qun mn.
Vim phi cng ng.
Vim tuyn tin lit.
Nhim khun ng tit niu c bin chng
hoc khng.
Nhim khun da v t chc di da c bin
chng hoc khng.
D phng sau khi phi nhim v iu tr
trit bnh than.
Chng ch nh
Ngi c tin s qu mn vi levofloxacin,
vi cc quinolon khc, hoc vi bt k
thnh phn no ca thuc. ng kinh,
thiu ht G6PD, tin s bnh gn c do
mt fluoroquinolon. Tr em nh hn 18
tui.
Thn trng
Vim gn c bit l gn gt chn
(Achille), c th dn ti t gn. Bin
chng ny c th xut hin 48 gi u
tin, sau khi bt u dng thuc v c th
b c hai bn. Vim gn xy ra ra ch yu
cc i tng c nguy c: ngi trn 65
tui, ang dng corticoid (k c ng
phun ht). Hai yu t ny lm tng nguy
c vim gn. phng, cn iu chnh
liu lng thuc hng ngy ngi bnh ln
tui theo mc lc cu thn.
nh hng trn h c xng: Levofloxacin,
cng nh phn ln cc quinolon khc, c th
Levonorgestrel (t trong t cung) 223
gy thoi ha sn khp chu trng lc
trn nhiu loi ng vt non, do
khng nn s dng levofloxacin cho tr em
di 18 tui.
Nhc c: Cn thn trng ngi bnh b
bnh nhc c v cc biu hin c th
nng ln.
Tc dng trn thn kinh trung ng: c
cc thng bo v phn ng bt li nh ri
lon tm thn, tng p lc ni s, kch
thch thn kinh trung ng dn n co
git, run ry, bn chn, au u, mt
ng, trm cm, l ln, o gic, c mng, c
nh hoc hnh ng t st (him
gp) khi s dng cc khng sinh nhm
quinolon, thm ch ngay khi s dng
liu u tin. Nu xy ra nhng phn ng
bt li ny trong khi s dng levofloxacin,
cn dng thuc v c cc bin php x tr
triu chng thch hp. Cn thn trng khi
s dng cho ngi bnh c cc bnh l trn
thn kinh trung ng nh ng kinh, x
cng mch nov c th tng nguy c co
git.
Phn ng mn cm: Phn ng mn cm vi
nhiu biu hin lm sng khc nhau,
thm ch sc phn v khi s dng cc
quinolon, bao gm c levofloxacin c
thng bo. Cn ngng thuc ngay khi c
cc du hiu u tin ca phn ng mn
cm v p dng cc bin php x tr thch
hp.
Vim i trng mng gi do Clostridium
difficile: Phn ng bt li ny c thng
bo vi nhiu loi khng sinh trong c
levofloxacin, c th xy ra tt c cc
mc t nh n e da tnh mng.
Cn lu chn on chnh xc cc trng
hp a chy xy ra trong thi gian ngi
bnh ang s dng khng sinh c
bin php x tr thch hp.
Mn cm vi nh sng mc t trung
bnh n nng c thng bo vi
nhiu khng sinh nhm fluoroquinolon,
trong c levofloxacin (mc d n
nay, t l gp phn ng bt li ny khi s
dng levofloxacin rt thp < 0,1%). Ngi
bnh cn trnh tip xc trc tip vi nh
sng trong thi gian iu tr v 48 gi
sau khi iu tr.
Tc dng trn chuyn ha: Cng nh cc
quinolon khc, levofloxacin c th gy ra
ri lon chuyn ha ng, bao gm tng
v h ng huyt thng xy ra cc ngi
bnh i tho ng ang s dng
levofloxacin ng thi vi mt thuc ung
h ng huyt hoc vi insulin; do cn
gim st ng huyt trn ngi bnh ny.
Nu xy ra h ng huyt, cn ngng
224 Levonorgestrel (t trong t cung) DTQGVN

levofloxacin v tin hnh cc bin php x khi xut hin a chy trong khi ang dng
tr thch hp. levofloxacin.
Ko di khong QT trn in tm : S Khi xut hin du hiu vim gn cn
dng cc quinolon c th gy ko di ngng ngay thuc, hai gn gt ngh
khong QT trn in tm mt s ng-
vi cc dng c c nh thch hp hoc
i bnh v mt s him ca lon nhp, do
cn trnh s dng trn cc ngi bnh np gt chn v hi chn chuyn khoa.
sn c khong QT ko di, ngi bnh h Liu lng v cch dng
kali mu, ngi bnh ang s dng cc Liu lng
thuc chng lon nhp nhm IA (quinidin,
procainamid) hoc nhm III (amiodaron, Liu dng ca levofloxacin p dng cho c
sotalol); thn trng khi s dng ng ung v ng tnh mch:
levofloxacin cho cc ngi bnh ang trong Nhim khun ng h hp
cc tnh trng tin lon nhp nh nhp chm t cp ca vim ph qun mn tnh: 500
v thiu mu c tim cp. mg, 1 ln/ngy trong 7 ngy.
Vim phi mc phi ti cng ng: 500
Thi k mang thai mg, 1 - 2 ln/ngy trong 7 - 14 ngy
Khng dng levofloxacin cho ph n c Vim xoang hm trn cp tnh: 500 mg, 1
thai. ln/ngy trong 10 - 14 ngy
Thi k cho con b Nhim trng da v t chc di da
Cha o c nng levofloxacin trong C bin chng: 750 mg, 1 ln/ngy trong
sa m, nhng cn c vo kh nng phn 7-14 ngy
b vo sa ca ofloxacin, c th d on Khng c bin chng: 500 mg, 1 ln/ngy
rng levofloxacin cng c phn b vo trong 7-10ngy
sa m. V thuc c nhu nguy c tn Nhim khun ng tit niu
thng sn khp trn tr nh, khng cho con C bin chng: 250 mg, 1 ln/ngy trong
b khi dng levofloxacin. 10 ngy.
Khng c bin chng: 250 mg, 1 ln/ngy
Tc dng khng mong mun (ADR) trong 3 ngy.
Thng gp, ADR > 1/100 Vim thn - b thn cp: 250 mg, 1
Tiu ho: Bun nn, a chy.
ln/ngy trong 10 ngy.
Gan: Tng enzym gan.
Thn kinh: Mt ng, au u. Bnh than:
Da: Kch ng ni tim iu tr d phng sau khi phi nhim vi
t gp, 1/1000 < ADR < 1/100 trc khun than: ngy ung 1 ln, 500
Thn kinh: Hoa mt, cng thng, kch mg, dng trong 8 tun.
ng, lo lng iu tr bnh than: Truyn tnh mch, sau
Tiu ho: au bng, y hi, kh tiu, nn, ung thuc khi tnh trng ngi bnh
to bn. cho php, liu 500 mg, 1 ln/ngy, trong
Gan: Tng bilirubin huyt. 8 tun.
Tit niu, sinh dc: Vim m o, nhim Vim tuyn tin lit: 500 mg/24 gi,
nm candida sinh dc.
Da: Nga, pht ban truyn tnh mch. Sau vi ngy c th
Him gp, ADR < 1/1000 chuyn sang ung.
Tim mch: Tng hoc h huyt p, lon Liu dng cho ngi bnh suy thn:
nhp thanh thi
Tiu ho: Vim i trng mng gi, kh creatinin
Liu
Liu duy tr
ming, vim d dy, ph li ban u
(ml/pht)
C xng - khp: au khp, yu c, au Nhim khun ng tit niu c bin chng, vim
c, vim ty xng, vim gn Achille. thn - b thn cp
Thn kinh: Co git, gic m bt thng, 20 250 mg 250 mg mi 24
trm cm, ri lon tm thn gi
D ng: Ph Quinck, chong phn v, hi 10 - 19 250 mg 250 mg mi 48
chng Stevens-Johnson v Lyelle. gi
Cc ch nh khc
Hng dn cch x tr ADR 50 80 Khng cn hiu chnh
Cn ngng levofloxacin trong cc trng liu
hp: Bt u c cc biu hin ban da 20 49 500 mg 250 mg mi 24
hoc bt k du hiu no ca phn ng gi
10 - 19 500 mg 125 mg mi 24
mn cm hay ca phn ng bt li trn gi
thn kinh trung ng. Cn gim st ngi Thm tch mu 500 mg 125 mg mi 24
bnh pht hin vim i trng mng gi
gi v c cc bin php x tr thch hp Thm phn phc mc 500 mg 125 mg mi 24
DTQGVN
lin tc gi
Liu dng cho ngi bnh suy gan: V phn
ln levofloxacin c o thi ra nc tiu di
dng khng i, khng cn thit phi
hiu chnh liu trong trng hp suy gan.
Cch dng
Dng ng ung:
Thi im ung levofloxacin khng ph
thuc vo ba n (c th ung trong hoc
xa ba n).
Khng c dng cc antacid c cha nhm
v magnesi, ch phm c cha kim loi
nng nh st v km, sucralfat, didanosin
(cc dng bo ch c cha antacid) trong
vng 2 gi trc v sau khi ung
levofloxacin.
Dng ngoi ng tiu ho:
Levofloxacin ch c dng bng cch
truyn tnh mch chm, truyn nhanh s
dn n nguy c h huyt p. Thi gian
truyn ph thuc vo liu lng thuc (liu
250 mg hoc 500 mg thng truyn trong
60 pht, liu 750 mg truyn trong 90
pht). Khng c dng tim bp, tim
vo ng sng, tim phc mc hoc tim di
da.
Cc dung dch c cha levofloxacin vi
nng 5 mg/ml trong dextrose 5%, c
th dng ngay khng cn pha long. Dung
dch levofloxacin vi hm lng 500 mg/20
ml trong l thuc tim bt buc phi pha
long trong cc dung dch tng hp thnh
dung dch c nng 5 mg/ml trc khi s
dng. Cc dung dch tng hp dng
pha long c nh sn xut quy nh
trong thng tin trn nhn thuc. Mt s
dung dch tng hp thng dng l: dung
dch dextrose 5%, dung dch natri clorid
0,9%, dung dch dextrose 5% v natri
clorid 0,9%, dung dch Ringer Lactat v
dextrose 5%, dung dch natri bicarbonat
5%, dung dch Plasma Lyte 56/5%
dextrose, dung dch natri lactat 1/6M,
dung dch dextrose 5% v natri clorid
0,45%, nc ct pha tim.
Tng tc thuc
Antacid, sucralfat, ion kim loi, multivitamin:
Khi s dng ng thi c th lm gim hp
thu levofloxacin, cn ung cc thuc ny
cch xa levofloxacin t nht 2 gi.
Theophylin: Mt s nghin cu trn ngi
tnh nguyn kho mnh cho thy khng c
tng tc. Tuy nhin do nng trong
huyt tng v AUC theophylin thng b
tng khi s dng ng thi vi cc quinolon
khc, vn cn gim st cht ch nng
theophylin v hiu chnh liu nu cn khi
s dng ng thi vi levofloxacin.
Levonorgestrel (t trong t cung) 225
Warfarin: Do c thng bo warfarin tng
tc dng khi dng cng vi levofloxacin, cn
gim st cc ch s v ng mu khi s
dng ng thi hai thuc ny.
Cyclosporin, digoxin: Tng tc khng c
ngha lm sng, do khng cn hiu
chnh liu cc thuc ny khi dng ng
thi vi levofloxacin.
Cc thuc chng vim khng steroid: C
kh nng lm tng nguy c kch thch
thn kinh trung ng v co git khi dng
ng thi vi levofloxacin.
Cc thuc h ng huyt: Dng ng thi
vi levofloxacin c th lm tng nguy c
ri lon ng huyt, cn gim st cht
ch.
n nh v bo qun
Bo qun nhit 15 - 30 oC, trong l
kn, trnh nh sng.
Dung dch thuc sau khi pha long trong
dch tng hp, n nh trong vng 72
gi nhit di 25 oC v trong vng 14
ngy nhit 5 oC. Dung dch pha
long ny c th n nh ti 6 thng nu
bo qun nhit - 20 oC; sau khi a
ra khi t lnh, tan ng nhit
phng, khng tan ng bng l vi sng
hoc ngm trong nc nng. Khng
ng lnh li sau khi tan ng. Cc l
thuc khng cha cht bo qun nn ch
dng mt ln, phn cn tha phi loi b.
Tng k
V c rt t cc thng tin v tng k ca
levofloxacin, khng thm bt k mt thuc
no khc vo dung dch truyn
levofloxacin hoc vo cng mt ng
truyn.
Qu liu v x tr
V khng c thuc gii c c hiu, x
tr qu liu bng cch loi thuc ngay khi
d dy, b dch y cho ngi bnh.
Thm tch mu v thm phn phc mc
lin tc khng c hiu qu loi levofloxacin
ra khi c th. Theo di in tm v
khong cch QT ko di.
Thng tin quy ch
Levofloxacin c trong Danh mc thuc
cha bnh ch yu s dng ti cc c s
khm cha bnh, nm 2005.
Levomepromazin
(METHOTRIMEPRAZIN)
Tn chung quc t: Levomepromazine.
M ATC: N05A A02.
226 Levonorgestrel (t trong t cung) DTQGVN

Loi thuc: Thuc chng lon thn, gim i bi tit vo phn v nc tiu (1%).
au khng gy nghin, an thn. Na i huyt thanh khong 20 gi. Cc
Dng dng v hm lng cht chuyn ha cng c tc dng, nhng
km hn so vi thuc nguyn dng. Bi
Vin c vch chia: Methotrimeprazin
tit tng i chm, v cc cht chuyn
maleat 25 mg.
ha vn c trong nc tiu ti 1 tun sau
Dung dch ung (dng methotrimeprazin
khi dng mt liu duy nht.
hydroclorid) 40 mg (base)/ml.
Siro (dng methotrimeprazin hydroclorid) Ch nh
25 mg (base)/ml. Bnh tm thn phn lit, lon thn chu k,
ng tim (dng methotrimeprazin hydroclorid) lon thn giai on hng cm, lon thn thc
25 mg/ml. th. Ri lon nhn cch c thi gy g
Methotrimeprazin hydroclorid 1,11 g tng v hnh vi hng ngoi qu mc.
ng 1 g methotrimeprazin. iu tr au qu mc, phi hp vi cc thuc
Methotrimeprazin maleat 1,35 g tng - gim au.
ng 1 g methotrimeprazin. gim au v an thn khi cn trnh
gy c ch h hp trong khi chuyn d
Dc l v c ch tc dng .
Methotrimeprazin, trc y gi l Tin m trc khi m.
levopromazin, l dn cht ca
phenothiazin c tc dng dc l tng t Chng ch nh
clorpromazin v promethazin. Tuy nhin, Qu mn vi phenothiazin.
mt s tc dng trung ng ca Bnh thn, tim hoc gan nng hoc c
clorpromazin c khuch i tin s co git.
methotrimeprazin. Tc dng an thn, kh Qu liu barbiturat, opiat hoc ru.
nng tng cng tc dng gy ng v gim Hn m.
au mnh hn. Methotrimeprazin gim Gim bch cu v c tin s gim bch
au ging morphin v meperidin (15 mg cu ht.
methotrimeprazin hydroclorid c tc dng Bnh nhc c.
gim au v lm sng tng ng 10
Thn trng
mg morphin sulfat hoc 75 mg meperidin
V methotrimeprazin c th gy h huyt
hydroclorid). Cho n nay, cha c bo co
p th ng ng k, ngi bnh dng
dng thuc ny dn n du hiu nghin
thuc phi nm ti ging hoc phi c
thuc, l thuc thuc hoc hi chng cai
thuc, ngay c khi dng liu cao hoc ko gim st cht ch t nht trong 6 - 12 gi
di. Tc dng gim au ti a thng t sau mi ln ung nhng liu u tin.
c trong vng 20 - 40 pht sau khi tim Cn thn trng khi dng thuc cho ngi
bp v duy tr khong 4 gi. Thuc t ra cao tui hoc ngi suy nhc c bnh tim
khng tc ng n phn x ho. c ch v nguy c h huyt p nng. nhng
h hp t xy ra vi methotrimeprazin. Tc ngi ny cn phi gim liu u tin v
dng c ch iu ho thn nhit v kh c th tng dn nu cn trong khi
nng chn cc phn x c lin quan ca phi kim tra thng xuyn mch v huyt
methotrimeprazin mnh gp 2 n 4 ln p.
so vi clorpromazin. Tc dng chng nn v i vi ngi dng thuc thi gian di, phi
khng cholinergic tng ng. nh k xt nghim mu v test gan, v
Methotrimeprazin l cht i khng th c th c cc tc dng ph v huyt hc
th histamin rt mnh, gp khong 2 ln v gan nng.
cho mi liu tnh theo mg, v Natri metabisulfit cha trong
methotrimeprazin cng c tc dng chng methotrimeprazin hydro-
ph rt mnh, c lng gp khong 5 ln so clorid tim c th gy phn ng kiu d
vi clorpromazin chng ph do serotonin. ng, bao gm phn v v cn hen nguy
Dc ng hc kch hoc nh, mt s ngi nhy cm
Sau khi ung, nng nh (hay xy ra ngi hen hn ngi khng
methotrimeprazin trong huyt tng t hen). Cn chun b phng tin cp cu
c t 1 n 4 gi v sau khi tim mng sn sng. Nu xy ra h huyt p nghim
t 30 n 90 pht. Khong 50% thuc trng v lm sng, phi dng
ung vo tun hon ton thn. phenylephrin hoc methoxamin. Khng -
Methotrimeprazin chuyn ha gan thnh c dng adrenalin v c th lm huyt p
sulfoxid v cht lin hp glucuronic v bi h thm.
tit nhiu vo nc tiu di dng cc cht Thn trng khi ch nh cho cc ri lon
. Mt lng nh thuc dng khng bin tm thn hng cm.
DTQGVN
Thi k mang thai
Ging nh cc phenothiazin khc, khng c
dng methotrimeprazin cho ngi bnh ba
thng cui thai k, v tng nguy c phn
ng khng mong mun v thn kinh v
vng da cho tr s sinh. V nhng nguy
c , nn trnh dng cc thuc an thn
kinh trong ba thng cui thai k. Tuy nhin,
c th cho methotri-
meprazin trong lc chuyn d , v rt t
khi xy ra gim cn co t cung.
Thi k cho con b
Vi liu dng gim au trong khi
chuyn d, sa m c th cha mt lng
thuc khng ng k. Nhng xt v nng
v liu lng tr nh, rt nhiu kh
nng l khng c bt k nguy c no cho
tr.
Tc dng khng mong mun (ADR)
Tc dng khng mong mun ca
methotrimeprazin ging nh ADR ca cc
phenothiazin khc, nhng h huyt p th
ng nng hn v xy ra thng xuyn
hn so vi cc phenothiazin khc.
Thng gp, ADR > 1/100
Tim mch: H huyt p th ng, tim p
nhanh, nh trng ngc.
Thn kinh: Hi chng ngoi thp: Lon trng
lc c cp, ng ngi khng yn, hi chng
Parkinson, run quanh ming, lon vn ng
mun (sau iu tr di ngy).
Tc dng h thn kinh t qun: Kh
ming, nhn m, b tiu tin, to bn,
bun ng.
Da: Mn cm nh sng, pht ban ngoi da,
phn ng qu mn (my ay, dt sn,
chm xut huyt hoc ph).
H hp: Sung huyt mi (ngt mi).
t gp, 1/1000 < ADR < 1/100
Mt: Ri lon iu tit.
Ni tit v chuyn ha: V to nam, thay
i v tnh dc, tng cn
Tit niu - sinh dc: Kh tiu tin.
Tiu ha: Bun nn, nn, au vng d dy.
Thn kinh c: Run.
Him gp, ADR < 1/1000
Thn kinh: Hi chng c tnh do thuc an
thn kinh, ri lon iu ho thn nhit,
h thp ngng co git.
Da: Da bin mu (nhim sc xm - xanh
do dng thuc di ngy).
Ni tit v chuyn ha: Tit nhiu sa.
Tit niu - sinh dc: Lit dng.
Huyt hc: Mt bch cu ht, gim bch
cu.
Gan: Vng da mt, nhim c gan.
Mt: Bnh vng mc sc t.
Levonorgestrel (t trong t cung) 227
Hng dn cch x tr ADR
trnh h huyt p th ng, ngi bnh
dng thuc phi nm ti ging hoc phi
c theo ri t nht 6 - 12 gi, sau mi ln
ung nhng liu u tin.
Liu u tin ngi cao tui hoc ngi
c bnh tim phi gim v c th tng dn
nu cn trong khi phi kim tra thng
xuyn mch v huyt p.
Bn hi chng thn kinh (lon trng lc c
cp, ng ngi khng yn, hi chng
Parkinson v hi chng c tnh do thuc
an thn kinh him gp) thng hay xut
hin t lu sau khi dng thuc, v hai hi
chng xut hin mun (thnh thong run
quanh ming v lon vn ng mun) xy
ra sau khi dng thuc di ngy.
Phn ng lon trng lc c cp p ng
rt tt khi tim cc thuc chng Parkinson
khng cholinergic. Ung cc thuc khng
cholinergic cng c th phng c lon tr-
ng lc c
ng ngi khng yn p ng km vi cc
thuc chng Parkinson. Phi gim liu l-
ng. Dng benzo-
diazepin hoc liu trung bnh propranolol
c th c ch li.
Hi chng Parkinson thng c x tr bng
cc thuc chng Parkinson (th d
benztropin) c tnh cht khng cholinergic
hoc amantadin.
Hi chng c tnh do thuc an thn kinh
him gp nhng nng v c t l t vong
cao (trn 10%). iu tr hi chng ny
phi nhanh v mnh, lm h nhit do st
cao bng dng khn lnh v.v., gii quyt
tnh trng mt nc v h tr ton thn.
Cc bin php c hiu gm c thuc
ch vn dopamin, amantadin v
bromocriptin, v thuc chng co c
dantrolen.
Lon vn ng mun xut hin hng
thng hoc hng nm sau khi bt u
dng thuc chng lon thn, v khong
50% trng hp l s khng hi phc. Cc
yu t nguy c i vi lon vn ng
mun gm c tui cao, bnh no thc th,
triu chng "ph nh", tin s hi chng
Parkinson v nghin ru, liu cao v/hoc
dng lu di. iu tr gm gim liu khi
c th. C nhiu liu php c hiu
c th gm c cc thuc lm gim
dopamin nh tetrabenazin, benzodiazepin
c dng lm thuc gin c ton thn, v
lithi.
Run quanh ming p ng tt vi cc
thuc khng cholinergic v vi ngng
thuc.
228 Levonorgestrel (t trong t cung)
Vng da xy ra t ngy sau khi iu tr
trong tun th 2 n tun th 4. Vng da
thng nh v c th ht khi cho dng
thuc tip tc. Nu mt ngi bnh b
vng da do thuc an thn kinh m cn
phi dng thuc lin tc, c l an ton nht
l dng liu thp ca mt thuc mnh khc.
Ri lon v mu: i khi c tng hoc gim
nh bch cu v tng bch cu a eosin.
Gim bch cu ht l mt bin chng
nng nhng him xy ra (khng qu 1 trn
10 000 ngi bnh). Bin chng ny thng
xy ra vo 8 n 12 tun u iu tr,
cn phi theo di mu hng tun trong 18
tun u, v sau t nht mi thng 1
ln. Bng cch ny, c th ngn nga c
hu ht cc trng hp dn n mt bch
cu ht c kh nng gy t vong.
Cch phng nga tt nht l dng liu thp
nht c hiu qu ca thuc chng lon
thn iu tr di ngy v ngng iu tr
ngay khi thy cn thit hoc khi khng
t c p ng mong mun.
Liu lng v cch dng
Ung:
Liu dng thng thng ngi ln v thiu
nin:
Lon tm thn v au nng:
Ung ban u: 50 - 75 mg (base)/ngy
chia lm 2 hoc 3 ln, ung vo ba n,
liu tng dn nu cn v chu c thuc.
Nu liu ban u cn n 100 - 200
mg/ngy, ngi bnh phi nm ti ging
trong vi ngy u trnh gim huyt
p th ng.
C th cn n liu 1 g hoc hn mi
ngy iu tr lon tm thn nng.
An thn hoc au va:
Liu ung ban u: 6 - 25 mg (base)/ngy
chia lm 3 ln, ung vo ba n, liu tng
dn nu cn v dung np.
C th gim bun ng ban ngy, nu cn,
bng cch chia liu hng ngy khng u
nhau, phn liu cao ung vo ban m.
Liu thng thng tr em:
Lon tm thn hoc au hoc an thn:
Liu ban u: 250 microgam (0,25 mg)
(base)/kg/ngy chia lm 2 hoc 3 ln
ung cng ba n; liu tng dn nu cn
v dung np c.
Liu khng c vt qu 40 mg/ngy tr di
12 tui.
Liu thng thng ngi cao tui: 1/2 liu
thng thng ngi ln. Ngi bnh tm
thn thc th hoc b trng thi l ln
cp phi dng liu ban u bng 1/3
hoc 1/2 liu thng thng ngi ln. Liu
tng dn nhng khng sm qu cch 2 - 3
ngy, nn cch 7 - 10 ngy nu c th.
Tim:
DTQGVN
Liu thng thng ngi ln v thiu nin:
Bnh tm thn nng hoc au cp
tnh, kh cha:
Tim bp ban u: 10 - 20 mg cch nhau
4 - 6 gi, liu c th tng khi cn i vi
au v an thn.
au trong sn khoa:
Tim bp ban u:15 - 20 mg; iu
chnh liu v tim lp li khi cn.
au sau phu thut:
Tim bp: 2,5 - 7,5 mg ngay sau phu
thut, iu chnh liu v tim lp li
cch nhau 3 - 4 gi khi cn.
Sau khi cho liu u tin, ngi bnh phi
nm ti ging t nht 6 gi trnh gim
huyt p th ng, chng mt hoc
ngt.
Tc dng cn li cu thuc m c th cng
thm vo tc dng ca thuc ny.
An thn trong tin m: Tim bp: 2 - 20
mg/45 pht - 3 gi trc khi phu thut.
B tr gy m trong khi phu thut hoc
chuyn d :
Tim truyn tnh mch: 10 - 25 mg pha
trong 500 ml dung dch dextrose 5%,
truyn vi tc 20 - 40 git / pht.
Liu thng thng tr em:
Bnh tm thn hoc au nng: Tim
bp: 62,5 - 125 microgam (0,062 - 0,125
mg)/kg/ngy tim 1 ln hoc chia nhiu
ln.
B tr gy m trong phu thut: Tuyn
tnh mch 62,5 microgam (0,062 mg)/kg
pha trong 250 ml dung dch dextrose 5%,
truyn vi tc 20 - 40 git/pht.
Liu thng thng ngi cao tui:
au: Tim bp ban u 5 - 10 mg cch 4 -
6gi/ln, liu tng dn khi cn v dung
np c.
Tng tc thuc
Thuc c ch thn kinh trung ng:
Methotrimeprazin c tc dng cng hoc
c th tng cng tc dng ca cc thuc
c ch thn kinh trung ng khc nh opi
hoc cc thuc gim au khc, barbiturat
hoc cc thuc an thn khc, thuc khng
histamin, thuc trn tnh hoc ru. Khi
dng methotrimeprazin ng thi vi cc
thuc c ch thn kinh khc, phi thn
trng trnh qu liu.
Thuc khng acetylcholin: Thuc c th
tng cng tc dng ca cc thuc khng
acetylcholin v cc thuc gin c xng nh
succinylcholin. Phi thn trng khi dng
thuc ng thi vi atropin hoc
scopolamin v c th xy ra tim p
nhanh v st huyt p, v cc phn ng
h thn kinh trung ng nh kch thch, m
sng v cc triu chng ngoi thp c th
b nng ln. Khi dng methotrimeprazin
DTQGVN
ng thi vi atropin hoc scopolamin,
phi gim liu atropin hoc scopolamin.
Thuc h huyt p: V c th xy ra tng
tc dng h huyt p, nn chng ch nh
dng methotrimeprazin cho ngi bnh
ang dng thuc h huyt p k c thuc
c ch monoamin oxydase.
Epinephrin (adrenalin): Methotrimeprazin
o ngc tc dng co mch ca adrenalin.
n nh v bo qun
Thuc tim, dung dch ung v siro phi
bo qun trong ng kn, nhit
15 - 30oC. Trnh nh sng v trnh
ng lnh.
Thuc tim, bo qun 15 - 30 0C, trnh
nh sng.
Tng k
C th tim cng bm tim
methotrimeprazin hydro-
clorid vi atropin sulfat hoc scopolamin
hydrobromid nhng khng c trn vi cc
thuc khc.
Qu liu v x tr
Tr em rt nhy cm vi cc thuc an thn
kinh. c thng bo l 350 mg
clorpromazin cho mt tr 4 tui gy t
vong. Cng c bo co nhim c rt
nng ngi ln vi liu 625 mg.
Triu chng qu liu: c ch thn kinh
trung ng l triu chng tri nht. Mt
iu ha, chng mt, ng g, bt tnh,
co git, c ch h hp. Triu chng ngoi
thp c th xy ra mun. Nhp nhanh
xoang, thi gian Q - T ko di, blc nh
tht, QRS gin rng, nhng t khi gp lon
nhp tht nng. Gim huyt p. Hi
chng c tnh do thuc an thn kinh.
iu tr: Ra d dy cng vi than hot. H
tr h hp v iu chnh cn bng kim
toan. Chng co git: Diazepam 10 - 20 mg
cho ngi ln, 0,1 - 0,2 mg/kg cho tr em.
Triu chng ngoi thp, cho biperiden 2 - 4
mg (tr em 0,04 mg/kg tim bp cch nhau
30 pht. Theo di in tm . Chng
lon nhp, dng thiori-
dazin. H huyt p, cho truyn dch tnh
mch v dopamin, noradrenalin,
dobutamin
Thng tin qui ch
Levomepromazin c trong danh mc thuc
thit yu Vit Nam ban hnh ln th 4
nm 1999.
Thuc c bng B.
Levonorgestrel (t trong t cung) 229
Levonorgestrel
(Cy di da)
Tn chung quc t: Levonorgestrel.
M ATC: G03A C03.
Loi thuc: Gestagen.
Dng thuc v hm lng
Cy di da, mt b Norplant gm c 6 nang
mm ng kn, mi nang cha 36mg
levonorgestrel.
Dc l v c ch tc dng
Levonorgestrel cy di da l mt b trnh
thai c tc dng di ngy (5 nm). B gm
c 6 nang mm ng kn lm bng
polydimethylsiloxan gii phng
levonorgestrel trong 5 nm. Nang cy c
cy nng di da vng cnh tay. Th thut
cy hoc b nang phi c thc hin
trong iu kin gy t do bc s c
o to tt v k thut. Sau khi cy s c
70 microgam levonorgestrel c gii
phng ra trong 24 gi. Sau tc gii
phng thuc gim chm, sau 1 nm t
mc 30 microgam trong 24 gi. Nng
levonorgestrel trong huyt tng t mc
cao nht trong nhng thng u (6 n
12 thng), t xp x 1,1 nanomol/lt.
Sau trong nhng nm tip theo nng
thuc trong huyt tng n nh
khong 0,9 nanomol/lt.
Khi levonorgestrel hp thu c 30
microgam/24 gi, thuc c tc dng lm
gim tnh thm ca dch tit c t
cung, gy kh khn cho s xm nhp ca
tinh trng. Ngoi ra cn c tc dng c ch
s trng thnh ca non nang v c ch
phng non. S tng sinh ca ni mc t
cung gim, ni mc tr nn mng v t
mch mu gy kh khn cho trng lm t.
Th nghim lm sng xc nh nang
cy di da levonorgestrel cung cp
progestagen liu thp c tc dng
trnh thai an ton tt nh sau th thut
trit sn. Nhng nghin cu trn lm sng
cho thy trong 5 nm, t l c thai
nhng ph n dng thuc l 0,5 c thai
trn 100 ngi.
Sau khi b nang cy di da, levonorgestrel
khng cn thy trong huyt tng sau 24 -
36 gi, v chu k kinh nguyt bnh thng
tr li ngay ging nh sau khi ngng s
dng vin trnh thai. Progestogen liu thp
khng hoc rt t tc ng n HDL/LDL
- cholesterol, SHBG (globulin gn hormon
steroid) hoc dung np glucose.
Ch nh
230 Levonorgestrel (t trong t cung)
Trnh thai.
Chng ch nh
Vim tnh mch huyt khi th hot ng
hoc bnh huyt khi tc mch.
Chy mu t cung bt thng khng r
nguyn nhn.
C thai hoc nghi ng c thai.
Bnh gan cp tnh, u gan lnh tnh hoc
c tnh.
Nghi hoc xc nh c carcinom tuyn
v.
C tin s tng p lc ni s v cn.
Thn trng
Levonorgestrel cy di da phi c dng
thn trng i vi ngi c bnh gan, ng
kinh, bnh van tim, ngi c tng nguy c
cha ngoi t cung v bnh i tho -
ng.
ngi c tin s bnh huyt khi tc
mch th ch nn dng levonorgestrel cy
di da khi cc phng php khc khng
thch hp v sau khi cn nhc cn
thn v cc mt nguy c v li ch.
Thuc trnh thai loi hormon c th gy
gi nc mc nht nh, nn thuc
phi c dng thn trng nhng ngi
mc nhng bnh c th b nng thm
do gi nc, nh hen suyn v ph thng.
Thi k mang thai
Rt him c bo co v d tt bm sinh
con cc b m v dng levonorgestrel
cy di da trong giai on u ca thai k.
Nhng nghin cu dch t hc din rng
cho thy nhng ph n dng thuc
trnh thai ung trc khi c thai, nguy c
xut hin khuyt tt khi sinh con h
khng tng.
Thi k cho con b
Levonorgestrel c phn b trong sa
m, nhng vi hm lng thp nn khng c
nguy c no ng quan tm.
Tc dng khng mong mun (ADR)
Nhng phn ng khng mong mun xy ra
khi dng levonorgestrel cy di da trong
nm u l ri lon kinh nguyt, thng l
kinh nguyt ko di, khng u hoc a
kinh, v kinh v au hoc nga xung
quanh vng cy, au u, tnh trng
kch ng, bun nn, nn, hoa mt,
chng mt, ngon ming hoc chn n
tht thng, tng cn, au v, rm lng,
rng tc. Cn c th c cc phn ng khc
nh xung sa, vim c t cung, thay i
tnh kh, trm cm, au c xng, kh
chu vng bng, vim m o.
Thng gp, ADR > 1/100
DTQGVN
Ton thn: Tnh trng nng ny.
Ni tit: Kinh nguyt khng u, v kinh,
cng v.
Da: Trng c.
t gp, 1/1000 < ADR < 1/100
Ton thn: au u, trm cm.
Tiu ha: Bun nn.
Him gp, ADR < 1/1000
Ton thn: Tng cn.
mt t l nh nhng ph n dng thuc
trnh thai ung, xut hin tng huyt p.
Ngng thuc, huyt p li tr v bnh th-
ng.
Hng dn cch x tr ADR
Ging nh bt k phng php no dng
hormon trnh thai, levonorgestrel cy
di da ch c dng di s gim st v y t.
Thm khm cc c quan vng khung chu
v tuyn v cng vic o huyt p cn -
c theo di vi cc khong cch thi gian
thch hp. Do mt s ngi dng
levonorgestrel cy di da c nhng thi k
v kinh nn khi khng c kinh nguyt
khng c dng chn on thai
nghn. Bt k lc no nghi c thai u
phi tin hnh xt nghim thai nghn.
Sau mt thi gian c kinh bnh thng
u n m b mt kinh trong vng 6
tun l hoc hn chng t c thai. Khi
c thai phi ly b cc nang cy di da
ra. Cha ngoi t cung xy ra nhng
ngi s dng cy di da. Nguy c cha
ngoi t cung tng ln vo nhng nm th
4, th 5 sau khi cy di da v nhng ph
n nng cn. Bt c ngi bnh no c
au vng bng di hoc c mang phi
xem xt loi tr cha ngoi t cung.
Do levonorgestrel vi liu thp khng
c ch hon ton s pht trin ca
bung trng nn c th gy nguy c pht
trin cc nang bung trng. Thng thng
nhng nang ny d t tiu i.
Liu lng v cch dng
Levonorgestrel cy di da c ch nh
cho nhng ph n t 18 n 40 tui.
Thi gian dng trong 5 nm. L tng nht l
cy vo ngy th nht ca vng kinh, cng
c th cy vo ngy th 2 n ngy th 5
v phi dng thm mt bin php trnh
thai khc khng c hormon trong vng 7
ngy sau khi cy. Tng liu cy l 216
mg. Cy di da vng gia cnh tay trn
np gp khuu tay t 8 n 10 cm pha
trn. Phn b cy theo hnh qut v hng
v pha nch, cch nhau 15%, tt c l
750.
Levonorgestrel cy di da phi c ly ra
sau 5 nm. C th ly ra vo bt c thi
im no ca chu k kinh nguyt. Tc
DTQGVN
dng trnh thai trn thc t s mt ngay,
v cn c mt bin php mi bt u nu
mun tip tc trnh thai.
Tng tc thuc
Nhng thuc cm ng enzym gan nh
barbiturat, primidon, phenobarbiton,
phenytoin, phenylbutazon, rifampicin,
carbamazepin v griseofulvin c th lm
gim hiu lc ca thuc. i vi nhng ph
n ang dng thuc cm ng enzym gan
iu tr di ngy, phi dng mt phng
php trnh thai khc.
n nh v bo qun
Bo qun nhit phng t 20 - 25 0C.
Qu liu v x tr
Qu liu c th xy ra nu nh trong c
th hin c levonorgestrel vi s lng
nhiu hn 6 nang. Tt c cc nang cy
u phi ly ra ht trc khi tin hnh cy
cc nang mi. Qu liu c th gy dch
cng cc tc dng km theo v chy mu t
cung bt thng.
Thng tin qui ch
Levonorgestrel c trong danh mc thuc
thit yu Vit Nam ban hnh ln th 4
nm 1999.
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 0,03 mg.
Levonorgestrel
(t trong t cung)
Tn chung quc t: Levonorgestrel.
M ATC: G03A C03.
Loi thuc: Gestagen.
Dng thuc v hm lng
t trong t cung: Gii phng 20
microgam levonorgestrel/24 gi.
Dc l v c ch tc dng
Levonorgestrel l cht progestogen tng
hp. Thuc tc dng v c dng ging
progesteron. Thuc khng c hot tnh
estrogen ng k v c hot tnh cao
ging progesteron.
Thuc c s dng trong nhng dng
thuc trnh thai c hormon, mt trong
nhng dng c dng l t trong t
cung, dng ny gii phng hormon trc
tip vo t cung. Dng thuc ny cho
php s dng mt liu thuc thp hn so
vi cc dng thuc trnh thai khc cng
cha levonorgestrel. Dng c cy trong t
cung c lm bng polyethylen, gm c
mt ng hnh tr ng levonorgestrel.
Levonorgestrel (t trong t cung) 231
ng hnh tr ny c ph mt mng
polydimethyl - siloxan kim sot s
gii phng levonorgestrel. Cn ci khung
c hnh ch T c tm bari sulphat
c th hin hnh d dng di tia X.
Tc dng dc l trnh thai ca
levonorgestrel l do c ch tng sinh ni
mc t cung v lm thay i tit dch
c t cung lm cho tinh trng kh xm
nhp. mt s ph n hin tng rng
trng cng b nh hng.
Dng c t trong t cung hng ngy gii
phng 20 microgam levonorgestrel trong
vng 5 nm. Trong mt vi tun u sau
khi t dng c, nng thuc trong
huyt thanh n nh mc 0,3 - 0,6
nmol/lt. Nng tng c nhn cng
rt n nh.
Nhng th nghim lm sng cho thy
trong nm u dng thuc, tc dng nga
thai cao vi t l 0 - 0,2 trng hp c thai
trong 100 ph n dng thuc. Tn s xut
hin cha ngoi t cung trong 5 nm 100
ph n l 0,02. Do c tc dng kiu
gestagen i vi ni mc t cung nn chy
mu kinh c chiu hng gim.
Sau khi ly dng c cy ra th trong vng
24 - 36 gi, levonorgestrel khng cn thy
trong huyt tng v kh nng c thai li
sm xut hin.
Ch nh
Dng trnh thai v dng iu tr chng
rong kinh v cn.
Chng ch nh
Levonorgestrel (t trong t cung) chng
ch nh vi ngi c nhim khun ng
sinh dc, c u c tnh t cung hoc nghi
c ri lon chy mu t cung cha r nguyn
nhn, t cung c khuyt tt, bnh gan
cp tnh, u gan, vim tnh mch huyt
khi hoc bnh huyt khi tc mch th
hot ng.
Thn trng
Levonorgestrel phi dng thn trng ngi
c bnh gan, ng kinh, bnh van tim v
ngi c tng nguy c cha ngoi t cung
v bnh i tho ng.
Thi k mang thai
Progestagen dng liu cao c th gy
nam tnh ha thai nhi n. Tuy vy, cc s
liu trn sc vt th nghim khng chng
t tnh xc ng trn ngi dng phng
php ny do thuc c gii phng vi liu
thp vo t cung.
Thi k cho con b
232 Levonorgestrel (t trong t cung)
Levonorgestrel vo sa m, nhng nguy c
i vi tr b m c coi nh rt t kh nng
xy ra do liu thp.
Tc dng khng mong mun (ADR)
Ri lon kinh nguyt xut hin gn 30%
ph n dng dng c t levonorgestrel
trong t cung.
Thng gp, ADR > 1/100
Ton thn: Thay i thn trng, au lng
v au xut pht t t cung.
Ni tit: Ph, v cng.
Thn kinh trung ng: Nhc u, trm
cm.
Tiu ha: Bun nn.
Tit niu - sinh dc: Chy mu m o
(chy mu ko di, hoc thng xuyn
chy mu thm git), nang bung trng
c hi phc.
Da: Trng c.
Him gp, ADR < 1/1000
Thn kinh trung ng: Gim tnh dc.
Ni tit: Rm lng, ra m hi, rng tc, tc
nhy.
Hng dn cch x tr ADR
Ri lon kinh nguyt thng xut hin di
dng hay chy mu t mt, nhng cc dng
khc cng c th xut hin. Sau vi thng
dng thuc (3 - 6 thng) ri lon kinh
nguyt thng gim. 10 - 20 % bnh nhn
dng thuc b v kinh.
Thuc vi liu thp khng c ch
hon ton s pht trin ca bung trng
nn c nguy c pht trin nang bung
trng. Nhng nang ny thng bin i mt
cch t nhin.
Trc khi t dng c vo t cung cn tin
hnh kim tra ph khoa v hi tin s ng-
i bnh loi tr nhim khun ng
sinh dc, u c tnh v c thai. Ri lon kinh
nguyt nh t kinh, v kinh cn phi c
kho st. Thnh thong c trng hp dng
c b tut khi t cung m ngi ph n
khng bit.
Triu chng ca s tut hon ton hoc
mt phn dng c t l tng kinh
nguyt, iu ny lm gim tc dng trnh
thai ca thuc.
Cn trnh tai bin thng t cung bng
cch chn nhng nhn vin y t c
o to tt v nghip v tin hnh
t dng c. Nguy c khi i qua c t
cung cng cn phi tnh n. Trng hp
t cung b thng, phi ly dng c ra
ngay, x l l thng v bin chng km
theo.
Levonorgestrel liu thp c th nh hng
n s dung np glucose, cho nn
nhng ngi i tho ng phi theo di
DTQGVN
mt cch cht ch nng glucose
huyt.
Sau khong thi gian 3 - 6 thng u m
chy mu m o vn hay xy ra, phi
dng mt bin php trnh thai khc. Ngi
bnh cn c kim tra y v ph
khoa.
Trong vng 60 ngy hoc hn, m khng
c kinh xut hin th iu quan trng l
phi kim tra kh nng c thai v kim tra
v tr dng c t trong t cung.
Sau nhiu ln xt nghim xc nh
khng c thai m vn khng thy kinh
th iu tr t kt qu c ch ni
mc t cung.
Liu lng v cch dng
t dng c sau khi kinh nguyt xut hin
7 ngy. Khi mun thay i t mt phng
php trnh thai an ton khc sang s dng
t levonorgestrel trong t cung th vic
t c th thc hin bt c thi
im no ca chu k kinh nguyt. Sau 5
nm, dng c t trong t cung phi c
thay ci mi.
Tng tc thuc
Nhng thuc cm ng enzym gan nh
barbiturat, primidon, phenobarbiton,
phenytoin, phenylbutazon, rifampicin,
carbamazepin v griseofulvin c th lm
tn hi n hiu lc trnh thai ca
levonorgestrel. i vi nhng ph n ang
dng thuc cm ng enzym gan iu tr
di ngy phi dng mt phng php nga
thai khc.
n nh v bo qun
Bo qun nhit trong phng 20 -
250C.
Thng tin qui ch
Levonorgestrel c trong danh mc thuc
thit yu Vit Nam ban hnh ln th 4
nm 1999.
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 0,03 mg.
Levonorgestrel
(vin ung)
Tn chung quc t: Levonorgestrel.
M ATC: G03A C03.
Loi thuc: Gestagen.
Dng thuc v hm lng
DTQGVN
Vin ung (Microval, Norgeston), mi vin
cha 30 microgam levonorgestrel.
Dc l v c ch tc dng
Levonorgestrel l mt cht progestogen
tng hp dn xut t nortestosteron.
Thuc c tc dng v cch dng cng ging
nh m t vi cc progestogen ni
chung, nhng l thuc c ch phng non
mnh hn norethisteron. Vi ni mc t
cung, thuc lm bin i giai on tng
sinh do estrogen sang giai on ch tit.
Thuc lm tng thn nhit, to nn
nhng thay i m hc lp biu m
m o, lm th gin c trn t cung, kch
thch pht trin m nang tuyn v v c
ch tuyn yn. Cng nh cc progestogen
khc, levonorgestrel c nhiu tc dng
chuyn ha; thuc c th lm gim lng
lipoprotein t trng cao (HDL) trong mu.
Levonorgestrel thng dng trnh thai.
Tc dng trnh thai ca levonorgestrel c
th gii thch nh sau: Thuc lm thay
i dch nhy c t cung, to nn mt
hng ro ngn cn s di chuyn ca tinh
trng vo t cung. Qu trnh lm t ca
trng b ngn cn do nhng bin i v
cu trc ca ni mc t cung. C bng
chng gi rng chc nng ca hong th
b gim cng ng gp mt phn vo tc
dng trnh thai. Dng trnh thai,
levonorgestrel c s dng di dng vin
trnh thai ung ch c progestogen (nh
vin Microval, Norgeston) hoc phi hp vi
estrogen trong vin trnh thai ung kt
hp. Levonorgestrel cng c dng di dng
thuc trnh thai tc dng di ngy bng
cch t di da (nh Norplant) hoc t
vo trong t cung (Levonova).
Dc ng hc
Sau khi ung levonorgestrel hp thu nhanh
chng v hon ton ng tiu ha v
khng b chuyn ha bc u gan. Sinh
kh dng ca levonorgestrel hu nh bng
100%. Trong huyt thanh, levonorgestrel
lin kt vi globulin gn hormon sinh dc
(SHBG) v vi albumin. Con ng chuyn
ha quan trng nht ca levonorgestrel l
kh oxy, tip sau l lin hp. Tc thanh
thi thuc c th khc nhau nhiu ln
gia cc c th; na i thi tr ca
thuc trng thi n nh xp x 36
13 gi. Levonorgestrel v cc cht chuyn
ha bi tit qua nc tiu v phn.
Nng levonorgestrel trong huyt thanh
c th c ch phng non l 0,2
microgam/lt. Khi ung, nng nh
trong huyt thanh xut hin sau 1,1
Levonorgestrel (t trong t cung) 233
0,4 gi. Ung 30 microgam levonorgestrel
c nng nh l 0,9 0,7
microgam /lt. Cc cht gy cm ng
enzym microsom gan nh rifampicin,
phenytoin c th lm tng tc chuyn
ha ca hp cht ung trnh thai c c
estrogen v progestogen, do nng
iu tr trong mu ca nhng hp cht
ny b gim.
Tun hon gan - rut ca cc thuc trnh
thai dng ung c th b nh hng bi h
vi khun ng rut. Trong huyt tng,
levonorgestrel c th lin hp vi sulfat v
acid glucuronic. Nhng dng lin hp ny
c bi tit vo mt ri n rut, y
chng c th b vi khun rut thy phn
v gii phng thuc nguyn dng, dng ny
li c ti hp thu vo tun hon ca. Cc
thuc khng sinh c ch tc dng ny ca
vi khun, kt qu l gim nng
hormon trong huyt tng.
Ch nh
Levonorgestrel s dng trnh thai.
Microval v Norgeston l nhng thuc
trnh thai loi ung. Levonorgestrel c
dng lm thnh phn progestogen trong
liu php thay th hormon trong thi k
mn kinh.
Chng ch nh
Mang thai hoc nghi mang thai.
Chy mu m o bt thng khng chn
on c nguyn nhn.
Vim tc tnh mch hoc bnh huyt
khi tc mch th hot ng.
Bnh gan cp tnh, u gan lnh hoc c
tnh.
Carcinom v hoc c tin s bnh .
Vng da hoc nga dai dng trong ln c
thai trc.
Thn trng
Levonorgestrel phi c dng thn trng
i vi ngi ng kinh, bnh van tim,
bnh tun hon no, v vi ngi c tng
nguy c c thai ngoi t cung v bnh
i tho ng. Levonorgestrel c th gy
dch, cho nn khi k n levonorgestrel
phi theo di cn thn ngi hen suyn,
ph thng.
Thi k mang thai
Progestogen dng vi liu cao c th gy
nam tnh ha thai nhi n. Tuy c s liu
trn sc vt th nghim, nhng trn ngi
dng thuc vi liu thp th khng pht
hin c vn g. Nhng nghin cu
din rng cho thy nguy c v khuyt tt
bm sinh khng tng nhng tr em c
234 Levonorgestrel (t trong t cung)
m dng thuc ung trnh thai trc khi
mang thai.
Thi k cho con b
Thuc trnh thai ch c progestogen dng
trong thi k cho con b khng gy nguy
hi g cho tr em. Nu bt u dng 6
tun sau khi th thuc khng lm gim
tit sa nn l thuc trnh thai c a
thch trong thi k cho con b.
Tc dng khng mong mun (ADR)
Kinh nguyt khng u thng gp ngi
dng thuc trnh thai progestogen duy
nht v thng l l do ngi dng thay
i phng php.
Thng gp, ADR > 1/100
Thn kinh: Nhc u, trm cm, hoa mt
chng mt.
Ni tit: Ph, au v.
Tiu ha: Bun nn.
Tit niu - sinh dc: Ra mu (chy mu th-
ng xuyn hay ko di, v ra mu t), v
kinh.
t gp, 1/1000 < ADR < 1/100
Ton thn: Thay i cn nng.
Thn kinh: Gim dc tnh.
Ni tit: Rm lng, ra m hi, hi.
Hng dn cch x tr ADR
Tc dng khng mong mun thng gp
nht trong liu php levonorgestrel l ri
lon kinh nguyt (khong 5%). Tip tc
dng thuc th ri lon kinh nguyt gim.
Chy mu m o tht thng khi s dng
levonorgestrel c th che lp nhng triu
chng ca ung th c t cung hoc ung th
ni mc t cung, do cn phi nh k
(6 - 12 thng) khm ph khoa loi tr
ung th. Cha ngoi t cung xy ra nhiu
hn nhng ph n dng thuc trnh thai
ung ch c progestogen. Nguy c ny c
th tng ln khi s dng levonorgestrel di
ngy v thng nhng ngi tng cn.
nhng ph n ang dng levonorgestrel
m c thai hoc ku au vng bng di
th thy thuc cn cnh gic v kh nng
c thai ngoi t cung. Bt k ngi bnh
no ku au vng bng di u phi thm
khm loi tr c thai ngoi t cung. Ng-
i ta thy khi dng levonorgestrel hoc
thuc trnh thai ung nguy c b bnh
huyt khi tc mch tng. ngi dng
thuc, nguy c tng khong 4 ln so
vi ngi khng dng thuc. Khi ngi dng
thuc b vim tc tnh mch hoc bnh
huyt khi tc mch, phi ngng thuc.
nhng ph n phi trng thi bt ng
ko di do phu thut hoc do cc bnh
khc cng phi ngng thuc. Nu mt th
DTQGVN
gic mt phn hoc hon ton, dn dn
hoc t ngt, hoc xut hin li mt,
nhn i, ph gai th, nhc u d di
phi ngng thuc ngay tc khc.
Liu lng v cch dng
Trnh thai bng hormon:
Vin progestogen duy nht trnh thai: Liu
hng ngy tng ng vi 30 hoc 37,5
microgam levonor-
gestrel.
Vin ung trnh thai phi hp bo ch theo
1 pha (phi hp vi 1 thuc): Liu hng
ngy tng ng vi 150 - 250 microgam
levonorgestrel.
Vin ung trnh thai phi hp ung tip
ni: Liu hng ngy tng ng vi 50 cho
n 125 microgam levonorgestrel.
Vin progestogen duy nht trnh thai c
ung vo ngy th nht ca chu k kinh
nguyt v dng mi ngy 1 vin khng t
qung sut thi gian mun trnh thai.
Thuc phi dng vo mt thi im c
nh trong ngy, tt nht l sau bui
cm ti hoc khi i ng, gi khong
cch gia nhng ln dng thuc lun lun
vo khong 24 gi. Nu khong cch
ko di hn 27 gi th tc dng trnh thai
c th b gim. Trong chu k u dng
thuc, cn p dng thm mt bin php
trnh thai khc (khng dng phng php
thn nhit) trong vng 14 ngy u dng
thuc. Nu vin thuc khng c ung vo
gi quy nh hng ngy, th vin thuc
qun phi c ung cng sm cng tt
v vin thuc tip theo ung vo gi quy
nh nh thng l. Nhng phi dng thm
bin php trnh thai khc trong thng ,
khng dng hormon (khng dng phng php
thn nhit) cho n khi thuc c dng
u n trong 14 ngy.
Sau khi ung 1 vin thuc nu b nn sm
cn ung mt vin thuc na trong vng 3
gi th mi duy tr c kh nng trnh
thai. Trong trng hp ny s dng vin
thuc cui cng mi v. Nu nn hoc
a chy ko di, nh hng n s hp
thu thuc th cn p dng thm mt bin
php trnh thai khc trong vng 14 ngy
k t khi ht nn ma v a chy.
Chy mu kinh, chy mu thm git bt
thng c th xy ra mt s ph n khi
bt u dng thuc, nhng sau mt vi
chu k u kinh nguyt li tr li u
n.
Trnh thai khn cp:
C th cho ung levonorgestrel vi liu
750 microgam trong vng 72 gi sau giao
DTQGVN
hp (nn cng sm cng tt), lp li sau 12
gi.
Liu php thay th hormon trong mn
kinh:
Phc in hnh tng ng 75 n
250 microgam levonorgestrel ung trong
10 n 12 ngy ca chu k 28 ngy.
Tng tc thuc
Cc cht cm ng enzym gan nh
barbiturat, pheny-
toin, primidon, phenobarbiton, rifampicin,
carba-
mazepin v griseofulvin c th lm gim
tc dng trnh thai ca levonorgestrel. i
vi ph n ang dng nhng thuc cm
ng enzym gan iu tr di ngy th
phi dng mt bin php trnh thai khc.
S dng ng thi cc thuc khng sinh
c th lm gim tc dng ca thuc, do
can thip vo h vi khun ng rut.
n nh v bo qun
Bo qun nhit phng 20 - 25 0C
hoc thp hn.
Qu liu v x tr
Cha c thng bo no cho thy dng qu
liu thuc trnh thai ung gy tc dng
xu nghim trng. Do ni chung khng
cn thit phi iu tr khi dng qu liu.
Tuy vy, nu qu liu c pht hin sm
trong vng 1 gi v vi liu ln ti mc m
thy nn x tr th c th ra d dy,
hoc dng mt liu ipecacuanha thch
hp. Khng c thuc gii c c hiu v
iu tr l theo triu chng.
Thng tin qui ch
Levonorgestrel dng ung c trong danh
mc thuc thit yu Vit Nam ban hnh
ln th 4 nm 1999.
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 0,03 mg.
LEVOTHYROXIN
Tn chung quc t: Levothyroxine.
M ATC: H03A A01.
Loi thuc: Hormon tuyn gip.
Dng thuc v hm lng
Vin nn: 25, 50, 75, 88, 100, 112, 150,
175, 200, 300 microgam.
L 200 microgam, 500 microgam bt kh
pha tim.
Dung mi pha tim: dung dch natri
clorid 0,9%.
Dc l v c ch tc dng
Levonorgestrel (t trong t cung) 235
Levothyroxin l cht ng phn t tuyn
ca thyroxin, hormon ch yu ca tuyn
gip. Trn th trng l ch phm tng hp.
Tuyn gip tit 2 hormon chnh l thyroxin
(T4) v triiodothyronin (T3). Lng T3 v T4 gii
phng t tuyn gip bnh thng vo tun
hon v c iu ha bi thyrotropin
(TSH) tit t thy trc tuyn yn. S bi tit
TSH li c iu ha bng mc T 4 v T3 lu
hnh v yu t gii phng thyrotropin
(TRH) tit t vng di i. Nhn bit c h
thng iu ha ngc phc tp ny l mt
iu quan trng trong chn on v iu
tr lon nng gip.
Tc dng dc l chnh ca hormon gip
ngoi sinh l tng tc chuyn ha ca
cc m c th, gip iu ho pht trin v
bit ha t bo. Nu thiu hormon ny
tr em, s chm ln v chm trng thnh h
xng v nhiu b phn khc ca c th,
c bit chm ct ha cc u xng,
chm tng trng v pht trin b no. Cc
tc dng dc l ny biu hin mc t bo
qua trung gian, ch yu qua
triiodothyronin; phn ln triiodothyronin bt
ngun t thyroxin qua kh iod cc m
ngoi vi.
Hormon tuyn gip lm tng tiu th oxy
a s cc m v tng tc chuyn ha
c bn v chuyn ha ng, lipid v
protein. Nh vy, hormon tc ng mnh
n mi c quan v c bit quan trng
i vi pht trin h thn kinh trung ng.
Hormon tuyn gip cng t ra c tc dng
trc tip n m, nh lm tng co bp c
tim.
Levothyroxin hp th hi trng, hng trng
v mt t t trng. Hp thu dao ng t
48% n 79% ty thuc vo mt s yu t.
i lm tng hp thu. Hi chng km hp
thu, cng nh cc yu t dinh dng (sa u
nnh, dng ng thi nha trao i anion
nh cholesty-
ramin) lm mt nhiu qua phn.
Trn 99% hormon lu hnh lin kt vi protein
huyt tng, gm c globulin lin kt
thyroxin (TBG), tin albumin v albumin
lin kt thyroxin (TBPA v TBA) c i lc
khc nhau ty theo tng hormon. L -
thyroxin (T4) c i lc lin kt mnh hn L -
triiodothyronin (T3) c trong mu tun
hon v trn t bo, iu ny gii thch
tc dng ko di ca hormon. Na i
huyt tng ca T4 l 6 - 7 ngy, cn T 3 l 1
ngy. Cc na i ca T4 v T3 gim ngi
cng gip v tng ngi suy gip. T3 v T4
lin hp vi acid glucuronic v sulfuric trong
gan v bi tit vo mt.
Ch nh
iu tr thay th hoc b sung cho cc
hi chng suy gip do bt c nguyn nhn
236 Levonorgestrel (t trong t cung)
no tt c cc la tui (k c ph n t gp, 1/1000 < ADR < 1/100
c thai), tr trng hp suy gip nht thi
trong thi k hi phc vim gip bn cp.
c ch tit thyrotropin (TSH): Tc dng ny
c th c ch trong bu c n thun v
trong bnh vim gip mn
(Hashimoto), lm gim kch thc bu.
Phi hp vi cc thuc khng gip trong
nhim c gip. S phi hp ny ngn
chn bu gip v suy gip.
Chng ch nh
Nhim c do tuyn gip cha c iu tr
v nhi mu c tim cp.
Suy thng thn cha c iu chnh v lm
tng nhu cu hormon thng thn cc m
v c th gy suy thng thn cp.
Thn trng
Rt thn trng khi dng cho ngi bnh tim
mch v tng huyt p. Xut hin au vng
ngc v tng nng cc bnh tim mch khc
cn phi gim liu.
Nhng ngi i tho ng hoc i tho
nht hoc suy thng thn, khi iu tr
levothyroxin s lm tng thm cc triu
chng bnh. iu chnh cc bin php
iu tr cho hp l trong cc bnh ni tit
song hnh ny l rt cn thit. iu tr hn
m ph nim phi dng km glucocorticoid.
tr em dng qu liu gy lin sm khp s.
Nu dng phi hp thuc chng ng mu
ung cn kim tra thng xuyn thi gian
prothrombin xc nh c cn iu
chnh liu lng hay khng.
Thi k mang thai
Cc hormon tuyn gip khng d qua hng
ro nhau thai. Cha thy tc dng no n
bo thai khi ngi m mang thai dng
hormon gip. Vic iu tr vn c tip
tc cho ngi ph n thiu nng tuyn gip
v trong thi k mang thai, nhu cu
levothyroxin c th tng. Cn iu chnh
liu bng cch kim tra nh k nng
TSH trong huyt thanh.
Thi k cho con b
Mt lng nh hormon tuyn gip c bi tit
qua sa. Thuc khng gy tc dng c hi
n tr nh v khng gy khi u. Tuy nhin
cn thn trng khi dng thuc cho ph n
cho con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Triu chng cng gip: St cn, nh
trng ngc, hi hp, d kch thch, a
chy, co cng bng, v m hi, nhp tim
nhanh, lon nhp tim, au tht ngc, run,
au u, mt ng, khng chu c nng,
st.
DTQGVN
Rng tc.
Him gp, ADR < 1/1000
D ng.
Tng chuyn ha, suy tim.
tnh Long xng.
Gy lin sm ng khp s tr em.
U gi no tr em.
Liu lng v cch dng
Levothyroxin thng dng ung, cng c th
tim tnh mch hoc tim bp. Liu dng
phi c iu chnh cn thn theo nhu
cu v p ng ca mi ngi.
Suy tuyn gip nh ngi ln:
Liu khi u: 50 microgam/ngy, ung 1
ln. Tng thm liu hng ngy t 25 - 50
microgam trong khong thi gian t 2 - 4
tun cho n khi c p ng mong mun.
ngi bnh tim, liu khi u 25
microgam/ngy hoc 50 microgam cch 2
ngy/1 ln. Sau iu chnh liu c 4
tun li thm 25 microgam cho ti khi t
kt qu iu tr. ngi khng c bnh
tim, c th nhanh chng t c liu duy
tr (100 - 200 micro-
gam) sau khi iu chnh theo nh gi
lm sng.
Suy tuyn gip nng ngi ln:
Liu khi u: 12,5 - 25
microgam/ln/ngy. Tng thm 25
microgam vo liu hng ngy trong khong
thi gian t 2 - 4 tun cho n khi c p
ng mong mun. Liu duy tr: Ung t 75 -
125 microgam/ngy ung 1 ln.
Suy tuyn gip ngi cao tui:
Liu ban u: 12,5 - 25
microgam/ln/ngy. Liu tng dn: trong
khong t 3 - 4 tun cho n khi c p
ng mong mun.
Liu ngi ln, iu tr duy tr: 100 - 200
micro-
gam/ngy, c th cao hn ty theo ngi
bnh.
iu tr liu thay th cho tr em di 1 tui:
25 - 50 microgam/ln/ngy.
iu tr liu thay th cho tr em trn 1
tui: 3 - 5 microgam/kg/ngy. Liu tng
dn cho n liu ca ngi ln khong 150
microgam/ngy, t vo u hoc gia
tui thiu nin. Mt s tr em c th cn
liu duy tr cao hn.
Cng c th dng liu nh sau:
0 - 6 thng: 25 - 50 microgam hoc 8 - 10
micro-
gam/kg/ngy.
6 - 12 thng: 50 - 75 microgam hoc 6 - 8
microgam/kg /ngy.
DTQGVN
1 - 5 tui: 75 - 100 microgam hoc 5 - 6
micro-
gam/kg/ngy.
6 - 12 tui: 100 - 150 microgam hoc 4 - 5
microgam /kg/ngy.
Trn 12 tui: trn 150 microgam hoc 2 - 3
microgam /kg/ngy.
iu tr suy gip bm sinh (chng n
n) tr s sinh kho, thng:
37,5 microgam/ln/ngy (t 25 - 50
microgam).
Tr non, cn nng di 2 kg, tr s sinh
c nguy c suy tim:
Bt u 25 microgam/ngy, tng dn ti
50 micro-
gam/ngy trong 4 - 6 tun.
Vi ngi bnh khng ung c, c th tim
tnh mch hoc tim bp:
Liu ngi ln bng 1/2 liu ung nu trn.
Liu tr em bng 1/2 n 3/4 liu ung nu
trn. Tuy nhin cn theo di iu chnh liu
cho ph hp.
iu tr hn m ph nim:
Thng tim tnh mch nng 100
microgam/ml; hoc c th cho ung bng
ng thng d dy nhng tim tnh mch c
chung hn.
Liu khi u tim tnh mch cho ngi ln:
400 microgam (t 200 - 500 microgam),
sau 6 - 8 gi c biu hin p ng, nhng
tc dng iu tr cao nht cha t c cho
ti 24 gi. Ngy th 2 c th cho thm 100 -
300 microgam hoc hn nu cha t c
hiu lc mong mun. Liu tim duy tr: 50
- 200 microgam/ngy cho n khi bnh
n nh hoc ngi bnh ung c. Nng
thyroxin tr li bnh thng trong huyt
thanh, thng t c trong vng 24 gi. 3
ngy tip theo nng triiodothyronin
huyt thanh tng gp ba ln. Ngi bnh c
bnh tim, c th tim tnh mch vi liu nh
hn.
Tng tc thuc
Corticosteroid: S thanh thi qua chuyn
ha cc corticosteroid gim ngi bnh
suy gip v tng ngi cng gip, do
c th thay i cng vi s thay i ca
tuyn gip. iu chnh liu phi da vo
kt qu nh gi chc nng tuyn gip v
tnh trng lm sng.
Amiodaron: Amiodaron dng mt mnh c
th gy cng gip hoc suy gip.
Thuc chng ng, coumarin hoc dn
xut indano -
dion: Tc dng ca thuc chng ng ung
c th b nh hng, ty thuc trng thi
tuyn gip ca ngi bnh; khi tng liu
hormon tuyn gip c th cn phi gim
liu thuc chng ng; iu chnh liu
thuc chng ng da vo thi gian
prothrombin.
Levonorgestrel (t trong t cung) 237
Thuc chng i tho ng v/hoc
insulin: Hormon tuyn gip c th lm tng
nhu cu insulin hoc thuc chng i tho
ng; nn theo di cn thn vic kim
sot i tho ng, khi bt u hoc khi
thay i hoc ngng iu tr tuyn gip.
Tc nhn chn beta - adrenegic: Tc dng
ca 1 vi loi thuc ny b gim khi ngi
bnh b bnh suy gip tr li bnh thng.
Cc cytokin (interferon, interleukin): C th
gy c chng suy gip v cng gip.
Cc glycosid tr tim: Tc dng ca cc thuc
ny c th b gim. Nng digitalis
trong huyt thanh c th b gim ngi c-
ng gip hoc ngi bnh b suy gip tr
li bnh thng.
Ketamin: Gy tng huyt p v nhp tim
nhanh nu dng ng thi vi levothyroxin.
Maprotilin: Nguy c lon nhp c th tng.
Natri iodid (123I v 131I): S hp thu ion nh
du phng x c th b gim.
Somatrem/Somatropin: Dng ng thi vi
hormon tuyn gip qu nhiu c th lm
ct ha nhanh u xng. Suy gip khng
c iu tr c th nh hng n p
ng tng trng vi 2 thuc ny.
Theophylin: S thanh thi ca theophylin
gim ngi suy gip v tr li bnh thng
khi tuyn gip tr li bnh thng.
Thuc chng trm cm 3 vng: Dng ng
thi s lm tng tc dng v tng c tnh
ca c 2 thuc, c th do tng nhy cm vi
catecholamin. Tc dng ca thuc trm
cm ba vng c th n sm hn.
Thuc ging thn kinh giao cm: Dng
ng thi c th tng nguy c suy mch
vnh ngi bnh b mch vnh.
n nh v bo qun
Levothyroxin khng bn khi tip xc vi nh
sng, khng kh nng, m. Ty k thut bo
ch v nh sn xut, thm ch c vin
khng bn nhit thng, phi bo
qun 8 - 15C. Bt pha tim phi dng
ngay khi pha xong v khng c trn vo
bt k dch tim tnh mch no khc. Phn
khng dng phi hy b khng lu gi
dng v sau.
Qu liu v x tr
Triu chng:
Gy trng thi tng chuyn ha tng t nh
nhim c gip ni sinh. Du hiu v triu
chng nh sau: Gim cn, tng thm n,
nh trng ngc, bn chn, a chy, co
cng bng, v m hi, nhp tng nhanh,
tng huyt p, lon nhp, git rung, mt
ng, s nng, st, ri lon kinh nguyt. Triu
chng khng phi lc no cng l r, c th
nhiu ngy sau khi ung thuc mi xut
hin.
238 Levonorgestrel (t trong t cung) DTQGVN

X tr: 5% thnh 250, 500, 1000 ml dch tim

Levothyroxin cn c gim liu hoc truyn tnh mch lidocain hydroclorid
ngng tm thi nu du hiu v triu 0,2%, 0,4%, 0,8%, 1%.
chng qu liu xut hin. Qu liu cp, Thuc dng ngoi: Gel: 2% (30 ml); 2,5%
phi iu tr triu chng v h tr ngay. (15 ml). Thuc m: 2,5%, 5% (35 g). Dung
Mc ch iu tr l lm gim hp thu dch: 2% (15 ml, 240 ml); 4% (50 ml).
ng tiu ha v chng tc dng trn thn Kem: 2% (56 g).
kinh trung ng v ngoi vi ch yu l Dc l v c ch tc dng
nhng tc dng tng hot ng giao cm. Lidocain l thuc t ti ch, nhm amid, c
C th ra d dy ngay hoc gy nn nu thi gian tc dng trung bnh. Thuc t ti
khng c chng ch nh khc (hn m, co ch phong b c s pht sinh v dn
git, mt phn x nn). Cholestyramin truyn xung ng thn kinh bng cch
hoc than hot cng c dng gim gim tnh thm ca mng t bo thn
hp thu levothyroxin. Cho th oxy v duy kinh vi ion natri, do n nh mng v
tr thng kh nu cn. Dng cc cht chn c ch s kh cc, dn n lm gim lan
beta - adre- truyn hiu in th hot ng v tip
nergic v d propranolol chng nhiu l blc dn truyn xung ng thn
tc dng tng hot ng giao cm. Tim kinh. Lidocain hin c dng rng ri nht,
tnh mch propranolol 1 - 3 mg/10 pht gy t nhanh hn, mnh hn, rng hn
hoc ung 80 - 160 mg/ngy c bit l v thi gian di hn so vi procain cng
khi khng c chng ch nh. C th dng nng . Lidocain c chn dng cho ngi
cc glycosid tr tim nu suy tim sung huyt mn cm vi thuc t loi este. Lidocain c
xut hin. Cn tin hnh cc bin php phm vi ng dng rng ri lm thuc gy
kim sot st, h ng huyt, mt nc khi t, c hiu lc trong mi trng hp cn mt
cn. Nn dng glucocorticoid c ch thuc gy t c thi gian tc dng trung
chuyn ha t T4 thnh T3. Do T4 lin kt bnh.
Lidocain l thuc chng lon nhp, chn
protein nhiu nn rt t thuc c loi ra
knh Na+, nhm 1B, c dng tim tnh
bng thm phn.
mch iu tr lon nhp tm tht.
Thng tin qui ch Lidocain lm gim nguy c rung tm tht
Levothyroxin c trong danh mc thuc thit ngi nghi c nhi mu c tim. Tuy vy,
yu Vit Nam ban hnh ln th t nm t l sng st khng tng ln m cn c
1999. th b gim, nu trong vic s dng
Thuc dng tim phi k n v bn theo lidocain khng c nhng phng thc chn
n. on cn thn trnh iu tr cho
nhng ngi m lidocain c th lm tng
nguy c blc tim, hoc suy tim sung
huyt. Do khng c dng lidocain
Lidocain iu tr mt cch thng thng cho mi
ngi bnh, tr khi c chn on y .
Tn chung quc t: Lidocaine. Lidocain chn c nhng knh Na + m v
M ATC: C01B B01, C05A D01, D04A B01, knh Na+ khng hot ha ca tim. S phc
N01B B02, R02A D02, S01H A07, S02D hi sau nhanh, nn lidocain c tc dng
A01. trn m tim kh cc (thiu mu cc b)
mnh hn l trn tim khng thiu mu cc
Loi thuc: Thuc t, thuc chng lon nhp b.
nhm 1B. Dc ng hc
Dng thuc v hm lng Lidocain hp thu tt khi ung (35 11%),
Hm lng v liu lng c tnh theo nhng b chuyn ha bc u gan nhiu,
lidocain hydroclorid. Thuc tim: 0.5% (50 do lidocain km hiu qu khi ung
ml); 1% (2 ml, 5 ml, 10 ml, 20 ml, 30 ml, iu tr lon nhp tim. C th duy tr
50 ml); 1,5% (20 ml); 2% (2 ml, 5 ml, 10 nng iu tr ca lidocain trong
ml, 20 ml, 30 ml, 50 ml); 4% (5 ml); 10% huyt tng bng tim bp cch qung, nh-
ng ng tim tnh mch c a dng hn.
(3 ml, 5 ml, 10 ml); 20% (10 ml, 20 ml).
Cc cht chuyn ha glycin xylidid (GX) v
Dung dch tim truyn tnh mch trong
mono - ethyl GX c tc dng chn knh
glucose 5%: 0,2% (500 ml); 0,4% (250 ml, Na+ yu hn lidocain. Nng lidocain
500 ml, 1000 ml); 0,8% (250 ml, 500 ml): trong huyt tng gim theo hm 2 s m
Dung dch 4% (25 ml, 50 ml), dung dch sau mt liu tim tnh mch. Sau khi tim
5% (20 ml) pha vi dung dch glucose tnh mch, na i ban u (8 - 10 pht)
DTQGVN
biu th s phn b t ngn trung tm
sang cc m ngoi bin; na i thi tr
cui (100 - 120 pht) biu th s chuyn
ha thuc gan. Hiu lc ca lidocain ph
thuc vo s duy tr nng iu tr
trong huyt tng ngn trung tm.
Thi tr trong nc tiu: 2 1%. Gn vi
protein huyt tng: 70 5%. thanh
thi: 9,2 2,4 ml/pht/kg. Th tch phn
b: 1,1 0,4 lt/kg. Nng c tc dng:
1,5 - 6 microgam/ml. Nng c, i
khi: 6 - 10 microgam/ml, thng gp > 10
microgam/ml. ngi suy tim, th tch
phn b trung tm v thanh thi
gim. thanh thi cng gim trong bnh
gan. Bnh nhi mu c tim cp tnh lm
tng gn lidocain vi protein, v lm gim
t l thuc t do.
Ch nh
Gy t ti ch nim mc trc khi khm
nghim, ni soi, t thit b k thut,
hoc tin hnh cc th thut khc v
lm gim triu chng au trong nhiu
bnh. Gy t tng lp v cc k thut gy
t phong b thn kinh bao gm gy t
thn kinh ngoi vi, gy t hch giao cm,
gy t ngoi mng cng, gy t khoang
cng, v gy t ty sng.
Tim iu tr cp tnh cc lon nhp
tht sau nhi mu c tim hoc trong khi
tin hnh cc thao tc k thut v tim nh
phu thut tim hoc thng tim. Lidocain
l thuc chn lc iu tr ngoi tm
thu tht trong nhi mu c tim, iu tr
nhp nhanh tht v rung tm tht.
Chng ch nh
Qu mn vi thuc t nhm amid; ngi
bnh c hi chng Adams - Stokes hoc
c ri lon xoang - nh nng, blc nh -
tht tt c cc mc , suy c tim
nng, hoc blc trong tht (khi khng c
thit b to nhp); ri lon chuyn ha
porphyrin.
Thn trng
Khng dng ch phm lidocain cha cht
bo qun gy t ty sng, gy t
ngoi mng cng, hoc khoang cng.
Dng ht sc thn trng cho ngi c bnh
gan, suy tim, thiu oxygen mu nng, suy
h hp nng, gim th tch mu hoc
sc, blc tim khng hon ton hoc nhp
tim chm, v rung nh.
Dng thn trng ngi m nng hoc suy
nhc, v d b ng c ton thn vi
lidocain.
Khng c tim thuc t vo nhng m b
vim hoc nhim khun v khng cho vo
niu o b chn thng v trong iu
kin nh vy, thuc s c hp thu nhanh
Levonorgestrel (t trong t cung) 239
v gy phn ng ton thn thay v phn
ng ti ch.
Thi k mang thai
Lidocain c dng nhiu trong phu
thut cho ngi mang thai m khng thy
thng bo v nhng tc dng c hi i vi
ngi m v thai nhi.
Thi k cho con b
Lidocain c phn b trong sa m vi l-
ng rt nh, nn khng c nguy c gy tc
dng c hi cho tr nh b m.
Tc dng khng mong mun (ADR)
Cng vi tc dng phong b dn truyn
si trc thn kinh ti h thn kinh ngoi vi,
thuc t nh hng n chc nng ca tt
c nhng c quan m s dn truyn xung
ng ti. Do thuc c tc dng quan
trng trn h thn kinh trung ng, cc
hch t ng, khp thn kinh - c, v tt
c cc dng c. Mc nguy him ca
ADR t l vi nng ca thuc t trong
tun hon.
Thng gp, ADR > 1/100
Tim mch: H huyt p.
Thn kinh trung ng: Nhc u khi thay
i
t th.
Khc: Rt run.
t gp, 1/1000 < ADR < 1/100
Tim mch: Blc tim, lon nhp, try tim
mch, ngng tim.
H hp: Kh th, suy gim hoc ngng h
hp.
Thn kinh trung ng: Ng lm, hn m,
kch ng, ni lu nhu, cn co git, lo
u, sng khoi, o gic.
Da: Nga, ban, ph da, t quanh mi v
u
li.
Tiu ha: Bun nn, nn.
Thn kinh - c v xng: D cm.
Mt: Nhn m, song th.
Hng dn cch x tr ADR
i vi phn ng ton thn do hp thu qu
mc: Duy tr thng kh, cho 100%
oxygen, v thc hin h hp h tr hoc
ch huy, khi cn. mt s ngi bnh, c
th cn phi t ng ni kh qun.
i vi suy tun hon: Dng mt thuc co
mch v truyn dch tnh mch.
i vi chng methemoglobin huyt: Cho
xanh me-
thylen (1 - 2 mg/kg th trng tim tnh
mch).
i vi co git: Cho mt thuc chng co
git benzo-
diazepin; cn nh l benzodiazepin tim
240 Levonorgestrel (t trong t cung) DTQGVN

tnh mch c th gy c ch h hp v huyt tng cao hn bnh thng duy

tun hon, c bit khi tim nhanh. tr hiu lc chng lon nhp.
Liu lng v cch dng Tng tc thuc
Thit b hi sc, oxy v nhng thuc Adrenalin phi hp vi lidocain lm gim tc
cp cu phi sn sng c ngay, nu hp thu v c tnh, do ko di
cn. Khi dng thuc t khm nghim thi gian tc dng ca lidocain. Nhng
hoc thc hin k thut vi dng c, liu thuc t dn cht amid c tc dng chng
khuyn co l dng cho mt ngi trung lon nhp khc, nh mexiletin, tocainid,
bnh; cn hiu chnh liu theo tng c hoc lidocain dng ton thn hoc tim
nhn, da trn tui, kch thc v tnh gy t cc b: s gy nguy c c hi
trng c th, v d on tc hp thu (do tc dng cng hp trn tim); v nguy
ton thn t ch tim. c qu liu (khi dng lidocain ton thn
Gy t ti ch nim mc mi, ming, hng, hoc thuc tim gy t cc b), nu
kh ph qun, thc qun v ng niu - ng thi bi, p lidocain trn nim mc
sinh dc: Bi trc tip dung dch lidocain vi lng ln, dng nhiu ln, dng vng
hydroclorid (2% - 10%). Liu ti a an ming v hng, hoc nut.
ton gy t ti ch cho ngi ln cn Thuc chn beta: Dng ng thi vi
nng 70 kg l 500 mg lidocain. lidocain c th lm chm chuyn ha
Gy t tng lp: Tim trc tip vo m lidocain do gim lu lng mu gan, dn
thuc tim lidocain hydroclorid (0,5% - n tng nguy c ng c lidocain.
1%); khi khng pha thm adrenalin: Liu Cimetidin c th c ch chuyn ha
lidocain ti 4,5 mg/kg; khi c pha thm lidocain gan, dn n tng nguy c ng
adrenalin: c th tng liu ny thm mt c lidocain.
phn ba (7 mg/kg). Sucinylcholin: Dng ng thi vi lidocain
Gy t phong b vng: Tim di da dung c th lm tng tc dng ca
sucinylcholin.
dch lidocain hydroclorid vi cng nng
v liu lng nh gy t tng lp. n nh v bo qun
Gy t phong b thn kinh: Tim dung Bo qun thuc tim lidocain hydroclorid
dch lidocain vo hoc gn dy thn nhit 15 - 300C; khng c ng
kinh hoc m ri thn kinh ngoi vi c bng. Dung dch lidocain hydroclorid c
tc dng gy t rng hn so vi nhng k sc bn ln i vi thy phn acid hoc
thut nu trn. phong b trong 2 - 4 kim v do c th hp tit khun; tuy
gi, c th dng lidocain (1% - 1,5%) vi vy, khng c hp nhng l ng thuc
dng cho nha khoa c np y khng
liu khuyn co trn (xem Gy t tng
chu c nhit hp. Dung dch cha
lp). adrenalin khng n nh khi hp. V
iu tr cp tnh lon nhp tht: trnh dung dch lidocain gy t ty sng
s mt tc dng c lin quan vi phn b, cha dextrose, nn c th chuyn thnh
dng ch liu np 3 - 4 mg/kg trong 20 ng caramen nu un nng ko di,
- 30 pht, v d, dng liu ban u 100 hoc khi c bo qun trong thi gian di.
mg, tip theo cho liu 50 mg, c 8 pht Khng dng dung dch b kt ta.
mt ln cho 3 ln; sau , c th duy tr
Qu liu v x tr
nng n nh trong huyt tng bng Lidocain c ch s iu tr hp, c th
tim truyn 1 - 4 mg/pht, thay th xy ra ng c nng vi liu hi cao hn
thuc b loi tr do chuyn ha gan. liu iu tr, c bit khi dng vi
Thi gian t nng lidocain trng thi nhng thuc chng lon nhp khc. Nhng
n nh l 8 - 10 gi. triu chng qu liu gm: an thn, l ln,
Ghi ch: Trong suy tim v bnh gan, phi hn m, cn co git, ngng h hp v c
gim tng liu np ban u v tc hi tim (ngng xoang, blc nh - tht, suy
tim truyn duy tr, cng nh khi tim tim, v gim huyt p); cc khong QRS
v Q - T thng bnh thng mc d c th
truyn ko di. Cn thng xuyn o nng
ko di khi b qu liu trm trng. Nhng
lidocain huyt tng v iu chnh tc dng khc gm chng mt, d cm,
liu bo m nng huyt tng run, mt iu ha, v ri lon tiu ha.
vn trong phm vi iu tr (1,5 - 5 iu tr ch l h tr bng nhng bin
microgam/ml) gim thiu c tnh php thng thng (truyn dch, t t
ca thuc. Mt s ngi bnh c nhi mu th thch hp, thuc tng huyt p, thuc
c tim cp c th cn nng lidocain chng lon nhp, thuc chng co git);
natri bicarbonat c th phc hi QRS b
ko di, lon nhp chm v gim huyt
DTQGVN
p. Thm phn mu lm tng thi tr
lidocain.
Thng tin qui ch
Lidocain c trong danh mc thuc thit
yu Vit Nam ban hnh ln th 4 nm
1999.
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 250 mg; thuc tim c hm l-
ng ti a l 200 mg i vi dng thuc
phn liu v nng ti a l 2% i
vi dng thuc cha phn liu. Kh dung
phn liu c hm lng ti a l 10%/ln
phun; dung dch nht lng c nng ti
a l 2%; gel bi nim mc c nng ti
a l 2%.
Lincomycin Hydroclorid
Tn chung quc t: Lincomycin
hydrochloride.
M ATC: J01F F02.
Loi thuc: Khng sinh lincosamid/khng
sinh chng t cu.
Dng thuc v hm lng
Lincomycin ung v tim l lincomycin
hydroclorid, nhng liu lng c tnh theo
lincomycin khan.
L 250 mg v 500 mg dng bt tim,
km ng dung mi pha tim.
ng tim 300 mg/2 ml v 600 mg/2 ml.
Vin nn hoc vin nang 250 mg v 500
mg.
Dc l v c ch tc dng
Lincomycin l khng sinh thuc lincosamid
thu c do nui cy Streptomyces
lincolnensis, cc loi lincol-
nensis khc hay bng mt phng php khc.
Lincomycin c tc dng chng vi khun nh
clindamycin, nhng t hiu lc hn. Thuc
ch yu km khun a kh Gram dng v
c ph khng khun rng i vi vi khun
k kh.
C ch tc dng: Lincomycin, cng nh cc
lincosa-
mid khc gn vo tiu phn 50S ca
ribosom vi khun ging cc macrolid nh
erythromycin v cn tr giai on u ca
tng hp protein. Tc dng ch yu ca
lincomycin l km khun, tuy vy nng
cao c th dit khun t t i vi cc hp thu. Tim bp 600 mg t nng
chng nhy cm.
Ph tc dng: Thuc c tc dng i vi
nhiu vi khun a kh Gram dng, bao gm
cc Staphylococcus, Strep-
Levonorgestrel (t trong t cung) 241
tococcus, Pneumococcus, Bacillus anthracis,
Corynebac-
terium diphtheriae. Tuy nhin, khng c tc
dng vi Enterococcus.
Phn ln cc vi khun a kh Gram m, nh
Entero-
bacteriaceae khng lincomycin; khc vi
erythromy-
cin, Neisseria gonorrhoeae, N. meningitidis
v Hae-
mophilus influenza thng khng thuc.
Lincomycin c ph tc dng rng i vi
cc vi khun k kh. Cc vi khun k kh
Gram dng nhy cm bao gm Eubacterium,
Propionibacterium, Peptococcus,
Peptostreptococcus v nhiu chng
Clostridium perfrin-
gens v Cl. tetani.
Vi liu cao, lincomycin c tc dng i vi
cc vi khun k kh Gram m, trong c
Bacteroides spp.
Thuc cng c mt vi tc dng i vi
ng vt n bo, nn c dng th
trong iu tr bnh vim phi do
Pneumocystis carinii v bnh nhim Toxop-
lasma.
Nng ti thiu c ch ca lincomycin
i vi cc chng vi khun nhy cm nht
nm trong khong t 0,05 - 2 microgam/ml.
Khng thuc: S khng thuc pht trin
chm v tun t. C s khng cho vi
clindamycin.
Phn ln vi khun a kh Gram m, nh
Enterobac-
teriaceae c bn cht khng lincomycin, nh-
ng mt s chng khc, lc thng nhy cm
cng c th tr thnh khng thuc. C ch
khng thuc, ging nh i vi erythromycin,
gm c s methyl ha v tr gn trn
ribosom, s t bin nhim sc th ca
protein ca ribosom v trong mt s t
phn lp t cu, s mt hot tnh enzym
do adenyltransferase qua trung gian
plasmid. S methyl ha ribosom dn n
hin tng khng cho gia lincomycin v
clindamycin.
Dc ng hc
Ung 1 liu 500 mg lincomycin, khong 20
n 30% liu c hp thu qua ng tiu
ha v t c nng nh huyt tng
t 2 - 7 microgam/ml trong vng 2 - 4 gi.
Thc n lm gim mnh tc v mc
nh trong huyt tng t 8 - 18
microgam/ml trong vng 30 pht.
Na i ca lincomycin khong 5 gi.
Lincomycin c phn b vo cc m, bao
gm c m xng v th dch, nhng t vo
242 Levonorgestrel (t trong t cung) DTQGVN

dch no ty, tuy c th c phn b kh Tc dng khng mong mun (ADR)

hn khi mng no b vim. Tc dng khng mong mun thng gp
Thuc khuch tn qua nhau thai v ngi ta nht l ng tiu ha, ch yu l a
tm c 0,5 - 2,4 microgam/ml lincomycin chy.
trong sa m. Lin- Thng gp, ADR > 1/100
comycin khng loi c nhiu khi mu qua Tiu ha: Bun nn, nn, a chy, i khi do
thm tch. pht trin qu nhiu Clostridium difficile gy
Lincomycin b kh hot mt phn gan v nn.
c bi xut qua nc tiu v phn, di dng t gp, 1/1000 < ADR < 1/100
khng bin i v dng chuyn ha. Da: My ay, pht ban.
Ch nh Cc tc dng khc: Phn ng ti ch sau tim
Nhim khun nng do cc vi khun nhy bp, vim tnh mch huyt khi sau tim
cm, c bit Staphylococcus, tnh mch.
Streptococcus, Pneumococcus ngi bnh Him gp, ADR < 1/1000
c d ng vi penicilin nh p xe gan; nhim Ton thn: Phn ng phn v.
khun xng do Staphylococcus; nhim Mu: Gim bch cu trung tnh (c th
khun ph khoa nh nhim khun m phc hi c).
o, vim mng trong t cung, vim vng Tiu ha: Vim i trng mng gi, vim
chu; vim mng bng th pht; p xe thc qun khi iu tr bng ng ung.
phi; nhim khun huyt; mn nht bin Gan: Tng enzym gan (phc hi c), nh
chng v lot do nhim khun k kh. tng transaminase.
Nhim khun do cc khun khng penicilin. Hng dn x tr ADR
Nhim khun cc v tr thuc khc kh ti a chy nng c th lin quan n vim
nh vim ct ty cp tnh v mn tnh, cc i trng mng gi do c t gii phng t
nhim khun do Bacteroides spp. s pht trin qu mc Clostridium difficile
gy ra. iu ny c th xy ra sau khi
Chng ch nh iu tr bng lincomycin. Ngi cao tui v
Qu mn vi lincomycin hoc vi cc thuc th trng xu c nguy c cao. C th iu
cng h vi lincomycin. tr pht trin qu mc Clostridium difficile
Thn trng bng metronidazol hoc vancomycin.
Phi thn trng khi dng cho ngi c bnh Liu lng v cch dng
ng tiu ha, c bit ngi c tin s Cch dng: Thuc c th ung, tim bp,
vim i trng. Ngi bnh cao tui v n hoc tim truyn tnh mch.
c th d b tiu chy nng hoc vim Ung: Ung xa ba n, t nht 1 gi trc khi
i trng c mng gi. Cn thn trng i n
vi ngi b d ng, ngi b suy gan hoc Tim: C th tim bp su hoc tim
suy thn nng. i vi nhng ngi ny, truyn tnh mch. truyn tnh mch,
phi iu chnh liu lng cho ph hp. i pha vi dung dch glucose 5% hoc dung
vi ngi bnh iu tr lu di bng dch natri clorid 0,9% trn c s 1 g linco-
lincomycin v vi tr nh cn phi theo di mycin pha vo t nht 100 ml dung dch
nh k chc nng gan v huyt hc. thch hp v truyn nh git t nht trong
Lincomycin c tc dng chn thn kinh - 1 gi (100 ml/1gi).
c, nn cn thn trng khi dng vi cc Khng c tim trc tip vo tnh mch.
thuc khc c tc dng tng t (cc thuc Vi ngi suy thn nng, liu dng thch hp
chng a chy nh loperamid, thuc phin bng
lm nng thm vim i trng do lm 25 - 30% liu bnh thng.
chm bi tit c t). Hin nay clindamycin c a dng hn
Thi k mang thai lincomycin, v hp thu v tc dng tt
Cha c thng bo lincomycin gy ra hn.
khuyt tt bm sinh. Thuc i qua nhau Liu dng:
thai v t khong 25% nng huyt Ung: Ngi ln: 500 mg, 3 ln/24 gi (500
thanh m dy rn. Cc tr sinh ra u mg ung cch nhau 8 gi); nu rt nng:
cha thy b nh hng g. mi ln 1 g 3 ln/ 24 gi.
Thi k cho con b Tr em trn 1 thng tui: 30 mg/kg th
Lincomycin c tit qua sa m ti mc c trng/24 gi chia lm 3 - 4 ln; nu rt
kh nng gy nh hng xu n tr b nng: 60 mg/kg th trng/24 gi, chia 3 - 4
m. Do cn trnh cho con b khi ang ln.
iu tr bng lincomycin.
DTQGVN
Tim bp: Ngi ln: 600 mg (2 ml) 1 ln
trong 24 gi; nu rt nng: 600 mg (2 ml)
cch nhau 12 gi.
Tr em trn 1 thng tui: 10 mg/kg th
trng, 1 ln trong 24 gi; nu rt nng: 10
mg/kg th trng, cch nhau 12 gi.
Tim truyn tnh mch:
Ngi ln: 600 mg - 1 g, cch nhau 8 - 12
gi/1 ln; nu rt nng: liu ti a c th
8 g/24 gi.
Tr em trn 1 thng tui: 10 - 20 mg/kg/24
gi, ty theo mc nng ca bnh v
phn chia liu ging nh ngi ln.
Thn trng
Phi gim liu i vi ngi suy thn.
Tng tc thuc
Aminoglycosid: Lincomycin khng nh hng
n dc ng hc ca gentamicin, nhng
an ton cha c nh gi khi phi hp
hai thuc .
Kaolin: Cc thuc chng a chy c cha
kaolin lm rut gim hp thu lincomycin.
trnh iu ny, cho ung lincomycin 2
gi sau khi dng kaolin.
Theophylin: Lincomycin khng tng tc vi
theophylin.
Thuc trnh thai ung: Tc dng ca thuc
trnh thai loi ung c th b c ch hoc
gim do ri lon vi khun ch bnh thng
rut lm chn chu k rut - gan.
Thuc chn thn kinh - c: Phi thn trng
khi phi hp vi lincomycin, v lincomycin c
tnh cht tng t.
Thc n v natri cyclamat (cht lm ngt):
Lm gim mnh s hp thu lincomycin (ti
mc 2/3).
n nh v bo qun
Cc vin nn v vin nang c bo qun
trong l kn, nhit c kim sot 15 o -
30oC v trnh nh sng.
Lincomycin loi tim c ng thnh liu
n hoc a liu trong cc l, tt nht l
bng thy tinh loi 1.
Tng k
Dung dch lincomycin c pH acid v c th
tng k vi dung dch kim hoc vi cc
thuc khng bn vng pH thp. Tng k
vi ampicilin, benzyl peni-
cilin, carbenicilin, colistin sulphamethat
natri,
mycin, methicilin, novobiocin v phenytoin
natri trong mt s iu kin.
Thng tin qui ch
Lincomycin c trong danh mc thuc thit
yu Vit Nam ban hnh ln th 4 nm
1999.
Levonorgestrel (t trong t cung) 243
Thuc phi k n v bn theo n.
Liothyronin
Tn chung quc t: Liothyronine.
M ATC: H03A A02.
Loi thuc: Hormon tuyn gip.
Dng thuc v hm lng
Vin nn natri liothyronin ung: 5
microgam; 25 microgam; 50 microgam
(liothyronin base).
Thuc tim natri liothyronin (ch tim
tnh mch): 10 microgam (liothyronin
base) trong 1 ml.
Dc l v c ch tc dng
Cc thuc nt tit t tuyn gip l nhng
ch phm thin nhin hoc tng hp cha
natri tetraiodothyronin (T 4, levothyroxin)
hoc natri triiodothyronin (T 3, liothyronin)
hoc c hai. Nhng ni tit t ny lm
tng tiu th oxy phn ln cc m ca c
th, lm tng tc chuyn ha c bn
v chuyn ha carbohydrat, lipid v
protein v th c nh hng n mi c
quan v c bit quan trng n s
pht trin h thn kinh trung ng ca tr
nh.
Liothyronin l T3 (triiodothyronin) c hot
tnh, gn trc tip vi th th thyroxin
trong t bo v tc ng n nhn t
bo. Liothyronin c cng tc dng dc l nh
thyroxin natri v cc ch phm t tuyn
gip, nhng cng c nhiu khc bit quan
trng (xem Dc ng hc). Liothyronin i
khi c dng khi cn phi c tc dng
nhanh chng hn nh trong hn m do
gim nng gip hoc chun b ngi bnh
dng liu php 131I iu tr ung
th tuyn gip. Liu php thay th dng
liothyronin lu di t c dng v phi
dng thuc nhiu ln, gi cao v tng tm
thi nng triiodothyronin trong huyt
thanh trn mc bnh thng.
Dc ng hc
Sau khi ung, liothyronin natri hp thu gn
hon ton qua ng tiu ha (khong
95%). Liothyronin c thi gian tim tng
rt ngn, tc dng xut hin trong vng
vi gi. Liothyronin c chuyn vn trong
kana- mu, ch gn vi globulin gn thyroxin v
albumin. Ch c 0,5% di dng t do,
khng gn vi protein. Th tch phn b
ln hn nhiu so vi thyroxin. Liothyronin
khng c tc dng tch ly, v khi ngng
iu tr, ngi bnh tr v trng thi
chuyn ha trc iu tr trong vng 2 - 3
ngy. Triiodothyronin c to thnh mt
244 Levonorgestrel (t trong t cung)
phn tuyn gip v mt phn gan. Vai
tr ca gan l chuyn
tetraiodothyronin thnh triiodothyronin vi
mc cn thit. Sau , gan cng
chuyn i triiodothyronin thnh nhiu
cht chuyn ha khng c hot tnh, c
thi tr qua thn v phn. Bnh thn v
gan t nh hng n s chuyn ha ny.
Tc dng ca liothyronin xut hin nhanh
hn v thi gian tc dng ngn hn so vi
levothyroxin. Na i huyt tng ca
liothyronin l khong 1 - 2 ngy v ca
levothyroxin l 6 - 7 ngy. Na i huyt
tng ca liothyronin v levothyroxin gim
ngi tng nng tuyn gip v tng ngi
gim nng tuyn gip.
Sau khi tim tnh mch mt liu
liothyronin natri, p ng chuyn ha c
th pht hin c trong vng 2 - 4 gi v
tc dng iu tr ti a trong vng 2
ngy. Sau khi ngng t iu tr di
ngy, tc dng tn ti lu hn s c mt
ca lng ni tit t c th pht hin c
(ti 72 gi vi liothyronin, v 1 - 3 tun vi
levothyroxin).
Liothyronin c th c a dng hn
levothyroxin khi mun c tc dng iu
tr nhanh hoc tc dng ht (phc hi)
nhanh, hoc khi qu trnh hp thu -
ng tiu ha hoc s bin i ngoi bin
t thyroxin sang triiodothyronin b suy
gim. Trong iu tr di ngy, s dng
liothyronin khng thun tin bng
levothyroxin, v levothyroxin c tc dng
ko di hn, to iu kin chuyn ha
n nh hn v cung cp lin tc cho
gan c cht T4 sn xut T3.
Gim nng tuyn gip c iu tr sut
i bng liu php thay th vi thyroxin.
Tuy nhin, do liothyronin c tc dng nhanh
nn c th dng khi u trong nhng
trng thi gim nng tuyn gip nng, th
d hn m ca ph nim.
Ch nh
Liothyronin c ch nh khi cn c tc
dng nhanh nh trong:
Hn m do gim nng tuyn gip.
Chun b ngi bnh dng liu php 131I
iu tr ung th tuyn gip.
c dng lm test c ch triiodothyronin
chn on ngi nghi tng hot ng
do tuyn gip v quyt nh iu
tr tng nng gip. Gim nng tuyn gip
tt nht l c iu tr thay th bng
levothyro-
xin m khng dng liothyronin.
Chng ch nh
DTQGVN
Suy v tuyn thng thn cha iu tr, suy
i tuyn yn cha iu tr, nhim c do
tuyn gip cha iu tr.
Thn trng
ngi gim nng tuyn gip c suy v
tuyn thng thn hoc suy tuyn yn,
phi dng corticosteroid trc liu php thay
th bng ni tit t tuyn gip, v s
chuyn ha nhanh chng tr li bnh th-
ng t mt trng thi gim nng tuyn gip
nng, c th dn n suy v tuyn thng
thn cp tnh v sc. Vi cng l do
cng cn dng b sung corticosteroid cho
ngi gim nng tuyn gip ko di hoc
nng, gm c ph nim.
ngi nhi mu c tim v bnh c tim,
dng ni tit t tuyn gip cn phi kt
hp vi vic theo di tim cn thn, v T 3
cng vi angiotensin II l nhng yu t tng
trng rt mnh i vi c tim. Sau nhi
mu c tim, c nguy c ln pht trin suy
tim. Do , thng dng, v d, captopril
trong 1 - 2 thng sau nhi mu c tim. Tc
dng cng hp ca liu cao T 3 v
angiotensin II sau nhi mu c tim lm
tng nguy c pht trin suy tim. Do
vic s dng thuc c ch men chuyn
angiotensin l rt quan trng. Tng nng
tuyn gip t n c th gy ph i c
tim.
Thi k mang thai
Ni tit t tuyn gip c th qua nhau
thai, nhng ch mc hn ch. C th dng
liothyronin cho ngi mang thai.
Thi k cho con b
Mt lng nh ni tit t tuyn gip c bi
tit trong sa ngi. Ngi m cho con b
c th tip tc iu tr vi liothyronin.
Tc dng khng mong mun (ADR)
Khi qu liu hoc tng liu qu nhanh, c
nguy c xy ra nhng triu chng nh khi
tng nng tuyn gip, gm nh trng
ngc, nhp tim nhanh, lon nhp tim, au
tht ngc. Nhng triu chng ny lin
quan trc tip vi s tng nng T 3. Khi
, ngng thuc trong 2 - 3 ngy, ri li
tip tc vi liu hng ngy thp hn.
t gp, 1/1000 < ADR < 1/100
Tim mch: nh trng ngc, nhp tim
nhanh, lon nhp tim, au ngc.
H thn kinh trung ng: Tnh trng kch
ng, mt ng, st, nhc u, mt iu
ha.
Da: Rng tc lng.
Ni tit v chuyn ha: Thay i trong
chu k kinh nguyt.
Tiu ha: St cn, tng ngon ming, a
chy, co cng c bng.
DTQGVN
Thn kinh - c v xng: au c, run bn
tay, run.
H hp: Hi th ngn.
Khc: Tot m hi.
Hng dn cch x tr ADR
C th gim t l ADR bng cch tng
chm liu ban u ti liu ti thiu c
hiu lc. Tr em c th b rng tc
nhng thng u iu tr, nhng khng
cn ngng thuc, tc thng mc li, ngay
c khi tip tc dng thuc. C th gim bt
ADR nh tng hot ng tr em bng dng
liu bt u tng ng mt phn t liu
thay th y , ri mi tun tng thm
mt phn t cho ti khi t liu thay th
y . Nu xy ra triu chng tng nng
tuyn gip, ngng thuc trong
2 - 3 ngy trc khi dng li vi liu thp
hn. Nu xy ra ADR tim mch, phi gim
liu liothyronin.
Liu lng v cch dng
20 - 25 microgam natri liothyronin tng -
ng xp x 100 microgam natri thyroxin
(levothyroxin).
Phi hiu chnh liu theo tng ngi bnh
da trn p ng lm sng, test sinh ha
v phi gim st u n.
Ngi ln gim nng tuyn gip:
Liu ung ban u thng thng: 10 - 20
microgam mi ngy, i vi ngi cn
nng 70 kg. Liu ny thng phi tng ti
80 - 100 microgam/24 gi t c kt
qu mong mun. Liu c chia lm 2 - 3
ln/ngy.
Liu duy tr thng thng: 25 - 50
microgam/ngy.
Ngi cao tui gim nng tuyn gip:
i vi ngi cao tui, ngi b bnh tim
mch hoc vi ngi b gim nng tuyn
gip nng lu ngy, iu tr phi t t
hn, dng liu ban u thp hn (2,5 - 5
microgam/ 24 gi), liu tng nh hn v
khong cch gia cc ln tng thuc cng
di hn khi cn.
Tr nh v tr em:
Levothyroxin l thuc thng c chn
dng. Nhng liothyronin cng c dng
trong gim nng tuyn gip bm sinh vi
liu: 5 microgam, ngy 1 ln. Cch 3 - 4
ngy tng mt ln, mi ln tng 5
microgam/ngy, cho ti khi t kt qu
mong mun.
Hn m ph nim:
Ngi ln tim tnh mch chm liu ban
u 5 - 20 microgam, lp li nu cn, th-
ng cch nhau 12 gi. Nu ngi bnh
bit hoc nghi ng mc bnh tim:
5 - 20 microgam. Liu b sung phi cho t
nht 4 gi sau liu u tin nhng khng
qu 12 gi gia cc liu trnh giao
Levonorgestrel (t trong t cung) 245
ng nng thuc. Cng cn cho c
corticosteroid.
Dng liu php ung ngay khi tnh trng
ngi bnh n nh v c th ung -
c thuc. Bt u bng ung liu thp,
sau khi ngng tim tnh mch.
Bu gip n thun ngi ln:
Liu thng thng ban u: 5
microgam/ngy. Cch 1 - 2 tun, tng thm
5 - 10 microgam/ngy, cho ti khi t liu
25 microgam/ngy. Sau tng thm 12,5
hoc 25 microgam/ngy, cch 1 - 2 tun,
cho ti khi t kt qu mong mun.
Liu duy tr: Ung: 50 - 100
microgam/ngy.
Th nghim c ch bng triiodothyronin:
Cho ung 75 - 100 microgam liothyronin
mi ngy, trong 5 - 7 ngy. Xc nh lng
iod phng x I 131 hp thu trc v sau t
ung liothyronin ni trn. Vi ngi bnh
tng nng tuyn gip, lng iod phng x
hp thu s khng thay i ng k, tri
li vi ngi c chc nng tuyn gip bnh
thng, lng iod phng x hp thu s b
gim.
Tng tc thuc
Dng ng thi cholestyramin hoc
colestipol c th lm gim tc dng ca
liothyronin do lin kt v v vy lm chm
hoc ngn cn s hp thu. Phi dng hai
thuc ny cch nhau 4 - 5 gi v theo di
u n nhng xt nghim v chc
nng tuyn gip.
Khi dng ng thi, liothyronin c th lm
tng nhu cu thuc tr i tho ng; cn
cn thn theo di kim sot i tho -
ng, c bit khi bt u, thay i
hoc ngng iu tr vi ni tit t tuyn
gip.
Vic s dng ng thi vi estrogen c
th lm tng nhu cu v liothyronin do
tng nng globulin gn thyroxin trong
huyt thanh.
Liothyronin c th lm tng tc dng ca
thuc ung chng ng; cn hiu chnh
liu lng thuc ung chng ng da vo
thi gian prothrombin.
Ni tit t tuyn gip c th lm tng tc
chuyn ha ca digitalis, do cn
tng liu digitalis.
n nh v bo qun
Bo qun vin nn liothyronin natri trong
l kn, nhit di 400C, tt nht l
15 - 300C. Bo qun thuc tim liothyronin
natri 2 - 80C.
Qu liu v x tr
Khi dng qu liu di ngy, nu xy ra cc
triu chng tng nng tuyn gip, phi
246 Levonorgestrel (t trong t cung)
ngng liothyronin trong 1 - 2 ngy, sau
dng li vi liu thp hn.
Khi qu liu cp tnh vi liu ln, nu c
th c, lm gim hp thu qua ng tiu
ha bng cch gy nn v sau iu
tr triu chng v h tr, gm: lm sch d
dy; cho th oxy; dng glycosid tr tim nu
xy ra suy tim sung huyt; iu tr cc
chng st, gim ng huyt hoc mt
dch; dng thuc khng adrenergic nh
propranolol iu tr chng tng hot
tnh thn kinh giao cm, v d nhp tim
nhanh.
Thng tin qui ch
Thuc dng tim phi c k n v bn ca tim v tng th tch tm thu. Lm
theo n.
Lisinopril
Tn chung quc t: Lisinopril.
M ATC: C09A A03.
Loi thuc: Thuc c ch enzym chuyn
angiotensin.
Dng thuc v hm lng
Vin nn 2,5 mg, 5 mg, 10 mg, 20 mg v 40
mg lisinopril.
Dng lisinopril phi hp: Vin nn 20 mg
lisinopril kt hp vi 12,5 mg hoc 25 mg
hydroclorothiazid.
Dc l v c ch tc dng
Lisinopril l thuc c ch enzym chuyn
angiotensin v l mt dn cht lysin c
cu trc tng t enalapril vi tc dng ko
di. Enzym chuyn angiotensin l enzym
ni sinh c vai tr chuyn angiotensin I
thnh angiotensin II. Angiotensin I tng
trong mt s bnh nh suy tim v bnh
thn, do p ng vi tng renin.
Angiotensin II c tc dng kch thch tng
trng c tim, gy tim to (ph i c tim),
v tc dng co mch, gy tng huyt p.
Thuc c ch enzym chuyn lm gim
nng angiotensin II v aldosteron do
lm gim natri v nc, lm gin mch
ngoi vi, gim sc cn ngoi vi c i
tun hon v tun hon phi. Ngoi ra,
thuc cn nh hng ti h kallikrein - kinin,
lm gim s phn hy ca bradykinin,
dn n tng nng bradykinin, y
chnh l nguyn nhn gy mt s tc
dng khng mong mun nh ph mch v ho
ko di ca cc thuc c ch enzym
chuyn.
Trong cao huyt p: Thuc c ch enzym
chuyn thng lm gim huyt p tr khi
tng huyt p do cng aldosteron tin
pht. Khi mi iu tr, s thay i huyt
DTQGVN
p lin quan cht ch vi hot tnh renin
huyt tng v nng angiotensin II
trong huyt tng trc khi iu tr. Tuy
nhin sau vi tun iu tr, phn ln ngi
bnh thy gim huyt p kh mnh v tc
dng gim huyt p lc t hoc khng
lin quan n hot tnh renin huyt tng
trc khi iu tr. Cc thuc c ch enzym
chuyn l thuc h huyt p c ng dng
rng ri trong lm sng.
Trong suy tim: Cc thuc c ch enzym
chuyn lm gim hu gnh v gim cng
thnh mch th tm thu, lm tng cung
lng v ch s tim, lm tng sc co bp
gim tin gnh v gim cng thnh mch
tm trng. Ci thin c huyt ng tt
hn do tng kh nng gng sc v c
ch h thn kinh giao cm mnh hn. Lu
lng mu no v mch vnh vn duy tr
tt ngay c khi huyt p b h. Cc thuc
c ch enzym chuyn c ch nh dng
cho ngi bnh gim chc nng tm thu,
nhm ngn chn hoc lm chm s tin
trin ca suy tim, gim t l t t v
nhi mu c tim, gim t l nm vin v
ci thin cht lng cuc sng. Tr trng hp
chng ch nh, cc thuc c ch enzym
chuyn u c dng cho mi ngi bnh
suy chc nng tht tri, c hay khng c
nhng triu chng suy tim r.
Trong nhi mu c tim: Lisinopril cng nh
cc thuc c ch enzym chuyn khc l
thuc chun trong iu tr ngi bnh
nhi mu c tim, c dng trong vng 24
gi sau khi bt u cn nhi mu. Ngoi
ra, thuc cng c tc dng d phng nhi
mu c tim.
Trong bnh thn do i ng: Bnh i
tho ng km theo tng huyt p chc
chn s dn ti bnh thn do i tho -
ng. y l nguyn nhn chnh gy suy
thn giai on cui. Lisinopril v cc thuc
c ch enzym chuyn chng t lm
chm suy thn trong bnh thn do i
tho ng. Thuc c ch enzym chuyn
c th lm chm bnh thn mn tin
trin, nh trong i tho ng. Do , tr
khi c chng ch nh, ngi b bnh
thn do i tho ng (d huyt p bnh
thng hay tng) nn c iu tr bng
thuc c ch enzym chuyn.
Dc ng hc
Lisinopril c hp thu chm v khng hon
ton qua ng tiu ha. S hp thu ca
lisinopril rt khc nhau gia cc c th, c
th t 6 - 60% liu dng c hp thu, nhng
trung bnh khong 25%. Thc n khng
nh hng ti s hp thu thuc qua ng
DTQGVN
tiu ha. Bn thn lisinopril l mt diacid
c sn hot tnh khi vo trong c th
khng cn phi qua qu trnh chuyn ha
mi c hot tnh nh mt s thuc c ch
enzym chuyn khc. t nng ti a
trong huyt tng sau khong 7 gi v duy
tr tc dng khong 24 gi. Lisinopril
khng lin kt vi protein huyt tng.
Thuc thi tr qua nc tiu dng khng
bin i. Na i thi tr sau khi ung
nhiu liu ngi bnh c chc nng thn
bnh thng l 12 gi. C th loi b
lisinopril bng thm tch mu.
Ch nh
iu tr tng huyt p: Dng n c
hoc phi hp vi cc thuc iu tr tng
huyt p khc nh thuc li tiu thiazid,
thuc chn alpha hoc chn knh calci...
iu tr suy tim: Dng kt hp lisinopril vi
cc glycosid tim v cc thuc li tiu
iu tr suy tim sung huyt cho ngi
bnh dng glycosid tim hoc thuc li
tiu n thun m khng .
Nhi mu c tim cp c huyt ng n
nh: Dng phi hp lisinopril vi cc thuc
lm tan huyt khi, aspirin, v/hoc cc
thuc chn beta ci thin thi gian
sng ngi bnh nhi mu c tim cp c
huyt ng n nh. Nn dng lisinopril
ngay trong vng 24 gi sau cn nhi mu
c tim xy ra.
iu tr bnh thn do i tho ng.
Chng ch nh
Khng dng lisinopril cho ngi bnh b hp
l van ng mch ch, hoc bnh c tim
tc nghn, hp ng mch thn hai bn
hoc mt thn n c v ngi bnh
qu mn vi thuc.
Thn trng
Ngi c bnh thn t trc hoc dng liu
cao cn phi theo di protein niu. Xt
nghim u n s lng bch cu l cn
thit i vi ngi b bnh colagen mch
hoc ngi dng thuc c ch min dch.
Ngi b suy tim hoc ngi c nhiu kh
nng mt mui v nc (th d dng thuc
cng vi thuc li tiu hoc cng vi thm
tch) c th b h huyt p triu chng
trong giai on u iu tr bng thuc c
ch enzym chuyn. C th gim thiu triu
chng ny bng cch cho liu khi u
thp, v nn cho lc i ng.
V nng kali huyt c th tng trong
khi iu tr bng thuc c ch enzym
chuyn, nn cn phi thn trng khi dng
cc thuc li tiu gi kali, hoc khi b
sung thm kali.
Thi k mang thai
Levonorgestrel (t trong t cung) 247
Cc thuc c ch enzym chuyn c nguy
c cao gy bnh v t vong cho thai nhi
v tr s sinh nu trong thi k mang thai,
nht l trong 3 thng gia v
3 thng cui ca thai k, b m dng thuc
ny. V vy khng dng lisinopril cho ngi
mang thai, nu ang dng thuc m pht
hin c thai th cng phi ngng thuc
ngay.
Thi k cho con b
Cha xc nh c thuc c bi tit vo
sa m hay khng, khng nn dng thuc
cho ngi ang nui con b.
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Ton thn: au u.
H hp: Ho khan v ko di.
t gp, 1/1000 < ADR < 1/100
Tiu ha: Bun nn, mt v gic, a chy.
Tun hon: H huyt p.
Da: Ban da, rt sn, my ay c th nga
hoc khng.
Khc: Mt mi, protein niu, st hoc
au khp.
Him gp, ADR < 1/1000
Mch: Ph mch.
Cht in gii: Tng kali huyt.
Thn kinh: L ln, kch ng, cm gic t
b hoc nh kim chm mi, tay v
chn.
H hp: Th ngn, kh th, au ngc.
Mu: Gim bch cu trung tnh, mt bch
cu ht.
Gan: c vi gan, vng da, mt, hoi t
gan v tn thng t bo gan.
Ty: Vim ty.
Hng dn cch x tr ADR
Ho: (chim t l 5 - 20% ngi bnh) th-
ng gp trong tun u iu tr, ko
di sut thi gian iu tr, i khi phi
ngng iu tr. Tc dng khng mong
mun ny c th do thuc gin tip gy
tch ly bradykinin, cht P v/hoc
prostaglandin phi; s mt trong vng
vi ngy sau khi ngng lisinopril.
Ph mch: (chim t l 0,1 - 0,2% ngi
bnh) biu hin l ngi bnh nhanh
chng b sng phng mi, ming, hng,
mi, thanh qun, thanh mn v ph li; tc
dng khng mong mun ny thng khng
lin quan ti liu dng v gn nh lun lun
xy ra trong tun u iu tr, thng l
trong vi gi u sau khi bt u dng
thuc. Ph mch c th dn ti tc nghn
ng h hp, suy h hp, thm ch gy
t vong. Mc d c ch tc dng cha bit
r nhng c th do tch lu bradykinin,
cht P v/hoc prostaglandin, do cm ng
248 Levonorgestrel (t trong t cung)
t khng th c hiu ca m hoc do
c ch yu t bt hot b th 1 -
esterase. Khi thy cc triu chng ph
mch xy ra phi ngng lisinopril ngay lp
tc, tc dng khng mong mun ny s
mt dn sau vi gi. Trng hp cp cu
phi dng adrenalin, thuc khng histamin,
v/hoc corticoid iu tr.
au ngc thng km vi h huyt p nng.
H huyt p: Thng xy ra khi dng liu
u tin ngi bnh c tng hot tnh
renin huyt tng. Cn phi thn trng v
tc dng ny ngi bnh n t mui, ngi
bnh ang iu tr phi hp nhiu thuc
h huyt p v ngi bnh b suy tim sung
huyt. nhng ngi bnh ny nn khi
u iu tr vi liu rt thp hoc tng
n mui v ngng thuc li tiu 2 - 3 ngy
trc khi bt u iu tr.
Tng kali huyt: Lisinopril gy tng kali
huyt ngi bnh suy thn, ngi bnh
dng thuc li tiu gi kali, dng cc cht
b sung kali, dng thuc chn beta hoc
dng cc thuc chng vim khng steroid.
Protein niu thng xy ra vi ngi bnh
suy thn.
Ban da (rt sn, my ay) thng mt i
khi gim liu hoc ngng thuc hoc tr-
ng hp nng th nn dng mt thuc
khng histamin.
Gim bch cu trung tnh, mt bch cu
ht thng gp ngi bnh suy thn hoc
bnh colagen mch. Gim bch cu trung
tnh dng nh lin quan n liu dng v
c th bt u xut hin trong vng 3
thng k t khi bt u iu tr.
Liu lng v cch dng
Lisinopril l thuc c ch men chuyn c
tc dng ko di, v vy thuc c dng
ng ung v ngy dng 1 ln.
Ngi ln:
iu tr tng huyt p:
Liu khi u: 5 - 10 mg/ngy, iu
chnh liu theo p ng lm sng ca
ngi bnh.
Liu duy tr: 20 - 40 mg/ngy.
Lm thuc gin mch, iu tr suy tim
sung huyt:
Liu khi u: 2,5 - 5 mg/ngy, iu
chnh liu theo p ng lm sng ca
ngi bnh.
Liu duy tr: 10 - 20 mg/ngy.
Nhi mu c tim: Dng cng vi thuc tan
huyt khi, aspirin liu thp v thuc
chn beta.
Liu khi u: Dng 5 mg trong vng 24
gi sau khi cc triu chng ca nhi mu
c tim xy ra, tip theo sau 24 v 48 gi
dng liu tng ng 5 v 10 mg.
DTQGVN
Liu duy tr 10 mg/ngy, iu tr lin tc
trong 6 tun; nu c suy c tim th t
iu tr ko di trn 6 tun.
Tr em: Cha xc nh c hiu qu v
an ton ca thuc.
iu tr tng huyt p km suy thn:
Nu thanh thi creatinin t 10 - 30
ml/pht, dng liu khi u 2,5 - 5
mg/ln/ngy. Nu thanh thi creatinin
< 10 ml/pht, dng liu khi u 2,5
mg/ln/ngy. Sau iu chnh liu da
vo s dung np thuc v p ng huyt
p ca tng ngi bnh, nhng ti a khng
qu 40 mg/ln/ngy.
iu tr suy tim, c gim natri huyt:
Nng natri huyt thanh < 130
mEq/lt), hoc thanh thi creatinin <
30 ml/pht hoc creatinin huyt thanh >
3 mg/decilit, liu ban u phi gim
xung
2,5 mg. Sau liu u tin, phi theo di
ngi bnh trong 6 - 8 gi cho ti khi huyt
p n nh.
iu tr nhi mu c tim v suy thn:
(nng crea-
tinin huyt thanh > 2 mg/decilit), nn dng
lisinopril khi u thn trng (vic iu
chnh liu ngi bnh nhi mu c tim
v suy thn nng cha c lng gi). Nu
suy thn (nng creatinin huyt thanh
> 3 mg/decilit) hoc nu nng
creatinin huyt thanh tng 100% so vi
bnh thng trong khi iu tr th phi
ngng lisinopril.
Nu ch iu tr cn phi phi hp vi
thuc li tiu ngi bnh suy thn nng
th nn dng thuc li tiu quai nh
furosemid s tt hn li tiu thiazid.
Tng tc thuc
Cc thuc cng giao cm v chng vim
khng ste-
roid, c bit l indomethacin c th lm
gim tc dng h huyt p ca lisinopril.
Ciclosporin, thuc li tiu gi kali v cc
thuc b sung kali c th gy nng thm
tng kali huyt do lisinopril.
Lisinopril c th lm tng nng v c
tnh ca lithi v digoxin khi dng ng
thi.
Estrogen gy dch c th lm tng
huyt p.
n nh v bo qun
Bo qun thuc nhit di 400C, tt
nht l t 15 - 30 0C, trong bao gi kn.
Qu liu v x tr
Biu hin qu liu c th l gim huyt
p. Cch iu tr l truyn tnh mch
dung dch mui ng trng. C th loi
b lisinopril bng thm tch mu.
DTQGVN
Thng tin qui ch
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 10 mg.
LITHI CARBONAT
Tn chung quc t: Lithium carbonate.
M ATC: Cha c.
Loi thuc: Thuc chng lon tm thn.
Dng thuc v hm lng
Vin nn hoc vin nang cng 200 mg, 250
mg, 300 mg, 400 mg; 37 mg lithi carbonat
tng ng vi 7 mg lithi hoc 1 mmol lithi.
Vin gii phng chm 300 mg, 450 mg, 600
mg. Vin bo ch dng bao phim tan chm
to nng nh ca lithi trong huyt
thanh thp hn dng lithi bnh thng.
Cc mui khc ca lithi gm gluconat
(Neurolithium), acetat (Quilonorm), citrat
(Litarex), sulfat (Lithionit).
Dc l v c ch tc dng
Lithi c tc dng phng nga c hai pha h-
ng cm v trm cm ca bnh hng cm -
trm cm n cc hoc lng cc. Mun
vy, phi dng lithi rt u n.
Ngoi tc dng phng bnh, lithi cn c tc
dng iu tr trong cc trng hp hng cm.
Tc dng y t c trong vng 1
tun.
C ch tc dng chnh xc ca lithi trong
vic n nh ri lon tnh kh cn cha
chc chn, v sinh hc ca cc ri lon
ny cha r rng v v tc dng ca lithi,
mt cation n gin, li kh phc tp. Lithi
khng thay th c natri trong bm natri
v khng th duy tr c hiu th mng.
nng iu tr, lithi c ch s gii
phng ph thuc calci ca noradrenalin v
dopamin, nhng li lm tng gii phng
serotonin.
Lithi cng c ch s thy phn inositol
phosphat no, do lm gim hm lng
nhm cht thng tin th hai ny trong t
bo. Cc phosphatidylinositid ny gim i
c th lm gim nhy cm ca cc neuron
vi cc cht dn truyn thn kinh ni sinh.
Dc ng hc
Lithi hp thu nhanh v gn nh hon ton
sau khi ung. Sau khi hp thu, lithi phn
b khp cc dch ca c th. Thuc qua
hng ro mu no rt chm. Trng thi n
nh thng t c sau 5 - 6 ngy iu
tr. Nng trong no v dch no ty ch
bng mt na so vi trong huyt tng. L
mt ion kim loi, lithi khng b chuyn ha
v khng gn vi protein huyt tng.
Levonorgestrel (t trong t cung) 249
Thi tr lithi ch yu qua thn vi na i
trong huyt tng l 22 gi. thanh thi
gim khi tui tng ln, nhng thng thng
vo khong 10 - 30 ml/pht. Tuy nhin cn
bit rng, thanh thi thay i nhiu
gia cc c th.
thn, lithi ti hp thu cnh tranh vi Na +.
Mc ti hp thu khong 80% cu
thn, s cn li ti hp thu ng thn.
Khi n t mui, ti hp thu lithi tng ln
ng k to nn nng c trong mu.
C nhiu ch phm ca lithi. Mt s ch
phm gii phng chm ti trn 4 - 5 gi, lm
cho nng thuc trong mu khng tng
vt ln so vi cc vin thuc thng thng.
Ch nh
iu tr v phng bnh hng cm, hng cm
nh, bnh hng cm - trm cm v trm cm
ti pht.
Chng ch nh
Ngi b bnh thn, bnh tim mch, bnh
Addison.
Thn trng
Cn ht sc thn trng trong trng hp c
bin i trn in tm , cao huyt p,
bnh nhc c, ng kinh, v iu tr cho
ngi cao tui. Nu c bin i nghim
trng trn in no cng cn phi ht
sc ch .
Ngi bnh ang n ch hn ch mui,
d c nng lithi trong mu cao do tng
s ti hp thu qua thn v cn c thng
bo l nu thay i ch n ung nh n
t mui chng hn c th gy nguy c
nhim c, hoc dng nhiu ch, c ph s
lm tng thi tr lithi.
Ngi bnh ang ln cn ng kinh cng
d pht trin cc phn ng c hi.
Ngi bnh cn c hng dn v thng bo
k v cc triu chng nhim c, v khi
ng c xy ra phi bo ngay cho thy
thuc iu chnh li liu lng.
Khi b mt bnh thc th nng, nht l khi
mt cn bng nc in gii, c th xt n
ngng thuc ngn ngy.
Khng nn ngng thuc vi l do l iu tr
khng c hiu qu tr khi dng lithi c
t nht 1 nm.
Thi k mang thai
Bng chng dch t hc cho thy khi dng
thuc cho ph n mang thai, lithi c th
gy nhim c tuyn gip cho thai v c
tim nng gy c trn tim thai. V vy
ch c dng khi buc phi dng cu
m.
Thi k cho con b
Nng thuc t c trong sa kh cao,
v vy d gy nguy c cho tr b nh tng
250 Levonorgestrel (t trong t cung)
trng lc c, gim thn nhit, xanh tm
v bin i in tm . V vy khng
cho con b khi m ang iu tr lithi.
Tc dng khng mong mun (ADR)
Ranh gii gia liu iu tr v liu c
ca cc mui lithi rt hp. Cc tc dng
khng mong mun thng lin quan trc tip
n nng lithi trong huyt thanh v
nhy cm ca bn thn ngi bnh v
him xy ra mc di 1,0 mmol/lt.
Cc phn ng nh v va thng xy ra
nng trn 1,5 mmol/lt, cn cc phn
ng va v nng nng t 14 mg/lt
tr ln.
Cc phn ng c hi xy ra c lin quan ti
nng lithi trong huyt thanh, k c
nng iu tr.
Thng gp, ADR > 1/100
Ton thn: Mt mi, ng lm, mt nc,
gim th trng, kht, hoc tng th trng
qu mc, ph n c chn hoc c tay,
phng mi.
Thn kinh trung ng: Hoa mt, chng
mt, bun ng, chm tm thn - vn
ng, khng ng yn, l ln, sng s,
tai, o gic, tr nh km, hot ng tr lc
chm, hay git mnh, hi chng no thc
th xu i.
Tun hon: Bin i trn in tm
nh sng T dt, ng in hoc o ngc.
Ni tit: Tuyn gip bt thng: bu c n
thun, gim nng tuyn gip (k c ph
nim) km theo T3 v T4 thp. S thu nhn
iod c th tng.
Tiu ha: Chn n, bun nn, nn, a chy,
vim d dy, sng tuyn nc bt, au bng,
tit nhiu nc bt, y hi, kh tiu, kh
ming.
Da: Trng c, kh tc v rng tc, hi, da t
b, vim nang lng mn, kh da.
Thn kinh: Run tay.
Mt: Nhn m, c im ti tm thi th
trng.
Tit niu sinh dc: Glucose niu, gim
thanh thi creatinin, albumin niu, v cc
triu chng ca i tho nht do thn gm
c i nhiu, kht v chng kht nhiu,
bt lc (ri lon tnh dc).
t gp, 1/1000 < ADR < 1/100
Ton thn: Nhc u, st, c v kim loi,
lon v gic, c v mn, tc ngc.
Thn kinh trung ng: Run ry, mt iu
ha, ma vn, ma git, tng phn x gn
xng, cc triu chng ngoi thp bao gm
lon trng lc c cp, cng (cng tng
cn) bnh rng, cn ti xm, cn kiu
ng kinh, ni lp bp, rung git nhn
cu, tiu tin khng t ch, hn m.
DTQGVN
Bin i in no : Tn s chm, gin
rng, tng ri lon nhp c s ca in
no.
Mu: Tng bch cu, tng glucose huyt
thong qua, tng calci huyt, h huyt p,
tru tun hon ngoi vi.
Da: Bnh vy nn hoc bnh c nng ln,
nga ton thn km hoc khng pht ban,
lot da, ph mch (ph Quincke).
C - xng: Tng kch thch c (rung c
cc b, co git c, hot ng git rung cc
chi), tng trng lc, my c, khp sng v
au, au nhiu khp, su rng.
Thn kinh: U gi no (tng p lc ni s v
ph gai th). Nu khng sm pht hin, cc
im m c th ln ln, th trng co hp v
c th m do teo th thn kinh, li mt.
Nu xut hin, cn ngng thuc ngay.
Ni tit: Tng nng cn gip, tng nng gip
(him hn so vi thiu nng tuyn gip).
Phn ng khc: Cc ngn tay, ngn chn b
au v bin mu, cc chi lnh trong vng 1
ngy khi bt u iu tr.
Hng dn cch x tr ADR
c tnh do lithi c lin quan cht ch vi
nng lithi trong huyt thanh v c th
xy ra liu gn vi liu iu tr. Do ,
ch iu tr bng lithi khi c phng
tin theo di nng lithi trong huyt
thanh.
Phi hng dn cho ngi bnh v cc triu
chng c s xy ra khi iu tr lithi di
ngy. iu tr di ngy vi lithi c th gy
ra nhng thay i vnh vin thn v
lm suy thn. Nng lithi cao trong
huyt thanh, k c cc t nhim c cp
tnh do lithi c th lm tng tc hi trn
thn. Cn lun lun dng liu thp nht c
hiu qu trn lm sng. Ngi bnh ch
nn dng lithi qu 3 - 5 nm nu thy thuc
thy vn cn c li.
Ngi bnh phi bo cho thy thuc bit
nu c i nhiu hoc kht nhiu. Khi c
nhng t b nn, bun nn hoc cc tr-
ng hp khc c nh hng n mt mui,
mt nc (k c ch n king mui hoc
n qu nhiu mui) u phi bo cho thy
thuc. Ngi bnh nn duy tr ch n
mui v ung nc bnh thng. Nn theo di
chc nng thn thng xuyn ngi bnh
i nhiu v kht nhiu. Nhng ngi cao
tui rt d nhim c do lithi.
Ngi bnh ngoi tr v gia nh ngi bnh
cn bit phi ngng dng lithi v bo co
cho thy thuc bit nu c cc biu hin
lm sng v nhim c lithi nh a chy,
nn, run ry, mt iu ha d nh, bun
DTQGVN
ng, yu c. C th khng ch run ry
bng dng liu nh propranolol.
Kh nng dung np lithi ln hn trong lc c
cn hng cm cp v gim khi cc triu
chng hng cm gim i.
Dung np lithi cng gim khi ra m hi
hoc a chy ko di; khi phi tip
dch v tip mui vi s theo di cn thn
ca thy thuc; ng thi phi gim liu
hoc tm ngng dng lithi cho n khi cc
biu hin gii quyt c.
Ngoi ra m hi v a chy, nu c nhim
khun km nhit tng cng phi gim
liu hoc ngng thuc.
Lithi c th gy tn hi n kh nng lao
ng tr c v chn tay. Ngi bnh nn
thn trng vi cc hot ng i hi phi c
s tnh to (nh li xe v vn hnh my).
Liu lng v cch dng
Cch dng: Thuc ung. C th ung 1
ln vo bui sng hay lc i ng, hoc c
th chia liu ung vo sng v ti hoc 3
ln. Vin gii phng chm, hoc c nng
n nh khng c nhai hoc nghin.
Khi thay i dng bo ch, phi coi nh
bt u iu tr ln u tin, v kh
dung sinh hc ca thuc c th thay i.
iu tr u tin phi c thc hin ti
bnh vin l ni c th gim st u
n nng lithi trong huyt thanh. Mc
tiu l iu chnh liu c nng
lithi huyt thanh t 0,6 n 1,2 mmol/lt
12 gi sau liu cho cui cng. Liu u tin
chnh xc phi da vo tui v trng lng
ngi bnh; ngi bnh tr thng cn liu
cao hn, ngi cao tui thng cn liu thp
hn liu trung bnh.
Cn hng cm cp tnh:
p ng ti u ca ngi bnh thng t c
liu 1500 - 1800 mg/ngy, chia 3 ln.
Cho trong 5 ngy hoc 7 ngy u. Ly
mu nh lng nng lithi huyt 12 gi
sau liu cho cui cng (vo ngy th 5
hoc th 7 iu tr) v iu chnh liu
sao cho nng lithi trong huyt thanh
t c t 0,6 - 1,2 mmol/lt. Tuy nhin liu
s dng cn c iu chnh trn tng c
nhn ty theo nng trong huyt thanh
v p ng lm sng. Cn theo di u
trng thi lm sng ca ngi bnh v nng
lithi trong huyt thanh. Nng trong
huyt thanh cn xc nh mi tun 2 ln
trong giai on cp tnh cho n khi nng
trong huyt thanh v p ng lm
sng n nh. Lc ny, cn chuyn
sang giai on iu tr lu di.
iu tr lu di:
Nng lithi mong mun trong huyt
thanh l 0,5 - 1 mmol/lt, thng t c vi
Levonorgestrel (t trong t cung) 251
liu 900 - 1200 mg/ngy, chia 3 ln. Liu
dng c th thay i theo tng ngi.
nh lng nng lithi trong huyt thanh.
Nng lithi trong huyt thanh cn nh
lng hng tun lc bt u iu tr di
ngy, sau 2 tun mt ln v tip theo
l mi thng mt ln. Nhng trng hp
khng thy c tai bin trong iu tr duy
tr, c th nh lng 2 thng mt ln.
Phi nh lng thm nu xy ra cc biu
hin c do lithi (xem di), nu thay i
liu, nu pht sinh ra mt bnh ng ch
no trong khi iu tr, nu ti pht
cc biu hin hng cm hoc trm cm,
hoc nu thay i nhiu v lng dung
dch v mui n.
Do kh dng sinh hc ca thuc c th
thay i ty theo dng bo ch; v vy,
nu thay i ch phm thuc dng cng
phi nh lng nng lithi hng tun cho
n khi t n trng thi n nh tr
li.
c kt qu xt nghim n nh, vic
nh lng lithi huyt thanh phi tin hnh
12 gi sau ln ung thuc gn nht.
Nhng ngi bnh nhy cm bt thung vi
lithi, c th xut hin cc biu hin c
nng lithi trong huyt thanh t 1 - 1,5
mmol/lt.
Ngi cao tui thng p ng vi liu thp
hn v c th xy ra cc biu hin c
nng m cc ngi bnh bnh thng
khc chu c. Liu dng thng l 500 -
1000 mg/ngy. Cc triu chng c c th
xy ra vi nng lithi trong huyt thanh
trn 1 mmol/lt.
Tr em di 12 tui: Khng khuyn co dng.
Tng tc thuc
Dng lithi ng thi vi ch phm c iod,
c bit kali iodid c th gy suy gip.
Mt hi chng no (gm c yu mt, ng
lm, st, run ry, l ln, c triu chng
ngoi thp, tng bch cu) xy ra mt vi
ngi bnh iu tr phi hp lithi vi thuc
lit thn kinh, nht l haloperidol. Trong
mt s trng hp c th dn n tn th-
ng no khng phc hi c. Do cn
theo di cht ch cc ngi bnh iu tr
phi hp nh vy hoc ngi bnh c hi
chng no thc th hoc c tn thng h
thn kinh trung ng pht hin sm c
tnh thn kinh v nu xy ra cc biu hin
nh trn, cn ngng thuc ngay.
Cc triu chng i tho nht do thn hay
xy ra ngi bnh dng phi hp vi cc
thuc chng trm cm c cu trc 3 hoc 4
vng. Dng phi hp carbamazepin v lithi c
th tng nguy c c trn thn kinh.
252 Levonorgestrel (t trong t cung)
Dng phi hp thuc chn knh calci vi lithi
c th lm tng nguy c c thn kinh di
dng mt iu ho, run ry, bun nn,
nn, a chy, tai.
Ni chung cn trnh dng phi hp cc thuc
li tiu hoc thuc c ch men chuyn vi
lithi. Nu cn phi hp, phi rt thn trng,
v cc thuc ny lm tng thi tr natri nn
lm gim thanh thi ca lithi, dn n
tng nng lithi trong huyt thanh v
gy nhim c. Khi phi hp, cn gim
liu lithi v thng xuyn nh lng nng
lithi trong huyt thanh.
Nhiu thuc khi phi hp vi lithi s lm gim
thanh thi ca lithi, nn lm tng nng
lithi trong huyt thanh, dn n c
do lithi. l cc thuc chng vim khng
steroid (c bit indomethacin v
piroxicam), metronidazol, tetracyclin. Nu
cn phi hp phi theo di ngi bnh cht
ch. Tuyt i trnh dng phi hp lithi vi
quinidin v codein.
Cc thuc sau y lm tng thi tr lithi
qua nc tiu, nn lm gim nng lithi
trong huyt thanh: Aceta-
zolamid, ur, cc dn cht ca xanthin v
cc cht kim ha nh natri bicarbonat.
Lithi c th ko di tc dng ca cc thuc
phong b thn kinh - c. Do khi dng
phi hp phi ht sc thn trng.
Dng phi hp fluoxetin vi lithi c th lm
tng m cng c th lm gim nng
lithi trong huyt thanh. Nhng ngi bnh
phi dng phi hp, cn theo di rt cht
ch.
n nh v bo qun
ni mt, kh, di 300C.
Thi hn bo hnh cho thuc vin nn l 5
nm.
Qu liu v x tr
Nng lithi gy c ( 1,5 mmol/lt) rt
gn vi nng iu tr (0,6 - 1,2
mmol/lt). Do , iu quan trng l ngi
bnh v ngi nh ngi bnh cn theo di
pht hin sm cc triu chng ng c Loi thuc: Thuc tra mt n nh dng
ngng thuc v bo cho thy thuc bit
c cch x tr.
Cc triu chng sp xy ra nhim c.
Cc triu chng ng tiu ha xut hin v
nng dn ln, yu c, thiu phi hp n ,
tnh trng bun ng, hoc ng lm l
nhng biu hin sm ca nhim c, c
th xy ra nng lithi di 2 mmol/lt.
Nu c tnh tng ln s xut hin mt
iu ho, chng mt lo o, tai, nhn
m, run ry, co rt c, i nhiu v nc
tiu long. Khi nng lithi trong mu trn
DTQGVN
2 - 3 mmol/lt s xy ra mt phng hng,
cc cn ng kinh, hn m v cht.
X tr
Khng c thuc gii c c hiu khi ng
c lithi. Nu xy ra ng c, phi ngng
thuc ngay v nh lng nng lithi
trong huyt thanh c 6 gi mt ln.
Nu mi ung thuc, cn ra d dy v tin
hnh cc bin php h tr chung.
Cn c bit ch duy tr cn bng nc
v in gii cng nh chc nng thn.
Khng c dng cc thuc li niu thi natri
trong bt c tnh hung no. C th dng
thuc li niu kim tng thi tr lithi.
Ur, manitol v aminophylin u lm tng
ng k s thi tr lithi.
Nu nng lithi trong huyt thanh trn
mc 4 mmol/lt, hoc nu ngi bnh c h
tn thc th, hoc nu nng lithi
trong huyt thanh khng gim ti mc na
i thi tr phi nh hn 30 gi, cn phi
thm tch phc mc hoc thm tch mu
ngay. Phi tip tc thm tch n khi
huyt thanh v dch thm tch khng cn
lithi. Cn theo di nng lithi trong
huyt thanh thm t nht 7 ngy, v c
th lithi trong cc m khuch tn dn tr li
mu.
Thng tin qui ch
Lithi carbonat l mt thuc thit yu trong
danh mc thuc thit yu ca T chc y
t th gii. Thuc khng c trong danh
mc thuc thit yu Vit Nam ban hnh
ln th t nm 1999. Ch c bc s chuyn
khoa mi c ch nh cho dng lithi
carbonat.
lodoxamid tromethamin
Tn chung quc t: Lodoxamide
tromethamine
M ATC: S01G X05
bo, chng d ng
Dng thuc v hm lng
L thuc tra mt c u nh git 5, 10,
15 ml dung dch lodoxamid 0,1% di dng
lodoxamid tromethamin 178 mg trong 100
ml (1,78 mg lodoxamid tromethamin tng
ng 1 mg lodoxamid). Dung dch c
cht bo qun l benzalkonium clorid
0,007% (7 mg trong 100 ml).
ng nha n liu 0,4 ml dng 1 ln,
c nng v thnh phn dung dch nh
trn.
DTQGVN
Dc l v c ch tc dng
Lodoxamid tromethamin l mt thuc c
tc dng n nh dng bo. Thuc ngn
cn s hot ha v s gii phng cc cht
trung gian gy vim (nh histamin,
leucotrien) t cc t bo c lin quan n
phn ng mn cm nh dng bo, v c ch
ha hng ng bch cu a eosin.
Lodoxamid tromethamin c nhiu tc dng
dc l ging natri cromolyn (natri
cromoglicat) v natri nedocromil, nhng c
cng tc dng mnh hn nhiu ln,
nu tnh theo khi lng thuc. Lodoxamid
tromethamin khng c tc dng lm co
mch, khng histamin v chng vim trc
tip. C ch tc dng c th l lodoxamid
tromethamin ngn cn s chuyn vn calci
vo dng bo khi c khng nguyn kch
thch.
Dung dch thuc tra mt lodoxamid 0,1%
c dng iu tr triu chng mt s
bnh d ng mt nh vim kt mc, gic
mc, v kt - gic mc ma xun. Ging
nh cc thuc n nh dng bo khc,
iu tr bng lodoxamid tromethamin v
bn cht c tc dng phng bnh. Mt khi
cc cht trung gian c gii phng v
bnh pht trin, th lodoxamid
tromethamin khng c hiu qu. Tuy nhin,
thuc vn c dng ngn nga cc phn
ng d ng do ngi bnh vn tip tc b
phi nhim vi khng nguyn.
Dc ng hc:
Nh mt git lodoxamid 0,1% vo mi
mt, 4 ln mi ngy, trong 10 ngy lin
tip, cho 12 ngi tnh nguyn kho mnh,
khng pht hin thy c lodoxamid trong
huyt tng. Phng php dng c kh
nng pht hin c nng lodoxamid
trong huyt tng t 2,5 nanogam/ml tr
ln.
S thi tr lodoxamid ch yu qua thn.
Dng 14C-lodoxamid ung, thy na i
thi tr qua nc tiu l 8,5 gi.
Ch nh
Vim mt d ng, vim kt mc ma xun,
vim gic mc ma xun, vim kt - gic
mc ma xun.
Chng ch nh
Mn cm vi lodoxamid tromethamin hoc
vi bt c thnh phn no c trong ch
phm.
Thn trng
an ton v tnh hiu qu cha c xc
nh i vi tr em di 2 tui. i vi tr ln
hn, cho ti nay cha c vn c bit
no lin quan n tui c thng bo.
Levonorgestrel (t trong t cung) 253
Tuy vy, cn phi thn trng khi dng cho
tr em.
Vi ngi cao tui (trn 65 tui), cha thy
c s khc nhau v hiu qa v tai bin
khi dng lodoxamid tromethamin so vi ngi
tr.
Thi k mang thai
Trn thc nghim, lodoxamid tromethamin
khng gy qui thai v khng gy tn th-
ng n chc nng sinh sn ca chut cng
trng v th khi cho ung lu di, liu 100
mg/kg mi ngy. Tuy nhin, cha c nghin cu
y ngi mang thai. Ch dng khi tht
cn thit.
Thi k cho con b
Cn cha nghin cu xem lodoxamid
tromethamin c bi tit vo c sa m
hay khng. Tuy nhin, khi tra mt mi ln
1 git cho mi mt, ngy 4 ln, lin trong
10 ngy, khng pht hin c lodoxamid
trong huyt tng, nn chc cng s khng
pht hin c trong sa (xem thm phn
Dc ng hc).
Tc dng khng mong mun (ADR)
Thng gp, ADR > 1/100
Mt: Cm gic bng rt mt, au nhi
nh b cn trng t nhng thong qua.
t gp, 1/1000 < ADR <1/100
Mt: Nhn m, cm gic nh c d vt
trong mt, mt, nga mt, chy nc
mt.
Him gp, ADR < 1/1000
Mt: Mt nhy cm vi nh sng, hoa
mt, vim m mt, vim lot gic mc, s-
ng mt, c d mt.
Thn kinh: Nhc u, chng mt, bun
ng.
Da: Ban da.
Tiu ho: Bun nn, kh chu d dy.
Hng dn cch x tr ADR
Dng tra mt theo ng liu lng v cch
dng, cc tai bin thng gim dn trong
qu trnh iu tr, m khng cn phi c
x tr g c bit.
Liu lng v cch dng
Vim kt mc d ng, vim mt d ng,
ngi ln v tr trn 4 tui, mi ln nh 1 - 2
git vo mi mt, ngy 4 ln, dng nhiu
ngy duy tr kt qu. Cha nghin cu
dng cho tr em t 4 tui tr xung.
iu tr vim kt mc ma xun, vim
gic mc ma xun, vim kt - gic mc
ma xun, liu lodoxamid cho ngi ln v
tr em trn 2 tui l 1 - 2 git dung dch
0,1% vo mi mt, ngy 4 ln. Trong
ngy, nu pht hin ln no qun khng
254 Levonorgestrel (t trong t cung)
tra mt, phi tra thuc ngay. Trong vng 1
tun l, cc triu chng nh nga,
mt, chy nc mt thng c ci thin,
nhng vn phi dng thuc tip n 3
thng.
Khi tra mt, khng u nh git ca
l thuc chm vo mt. Trong thi gian
dng thuc, khng nn eo knh p trng.
Dung dch tra mt hin c trn th trng:
Khng c ung, khng c tim, k c
tim di kt mc, hoc tim trc tip vo
tin phng ca mt.
Tng tc thuc
Trong mt s trng hp bnh nng, c th
phi hp vi thuc tra mt corticosteroid
triu chng bnh ci thin c nhanh
hn.
n nh v bo qun
Thuc tra mt lodoxamid tromethamin
phi ng trong bao gi kn, bo qun
nhit 15 - 27 oC, trnh nh sng; hoc
theo hng dn ca nh sn xut.
Thuc tra mt lodoxamid tromethamin th-
ng c benzalkoni clorid lm cht bo
qun, vi nng thng l 0,007%, khng
c qu 0,03%. Vi nng , khng
gy tc hi cho mt.
L thuc tra mt dng xong, phi y
kn, vo ni sch s, thong, mt,
trnh nh sng. C th dng c 15 ngy
k t khi m l thuc. Loi n liu, ch
dng mt ln, ri vt b.
Qu liu v x tr
Dng ti ch qu liu, ra sch mt bng vi
nc sch.
Dng thuc ton thn, cc tc dng ph
bao gm: Cm gic nng bng, au u,
chng mt, mt mi, v m hi, nn,
phn lng, i rt hoc mt tiu khng
cm c. Nu n sm, c th gy nn,
ra d dy trong trng hp ung nhm.
Thng tin qui ch
Lodoxamid tromethamin c trong Danh
mc thuc cha bnh ch yu s dng ti
cc c s khm cha bnh, nm 2005.
Lomustin
Tn chung quc t: Lomustine.
M ATC: L01A D02.
Loi thuc: Chng ung th, tc nhn alkyl
ha.
Dng thuc v hm lng
Dng ung: Nang 10 mg, 40 mg v 100
mg.
V 2 nang lomustin 10 mg
V 2 nang lomustin 40 mg
DTQGVN
V 2 nang lomustin 100 mg.
Dc l v c ch tc dng
Lomustin (CCNU) l thuc ha tr liu
alkyl ha dng cha ung th. V ha
hc, lomustin l dn cht nitrosoure, rt
tan trong lipid, d hp thu qua ng ung
v chuyn ha thnh cc cht c hot
tnh. Chnh nhng cht chuyn ha ny
c tc dng alkyl ha. Cc cht chuyn
ha c hot tnh gn v c ch nhiu
ch ch cht bn trong t bo, bao gm
cc chng enzym quyt nh cn thit
cho s phn chia t bo, DNA -
polymerase, tng hp RNA v protein. Khi
cc t bo ung th pht trin khng vi
mt thuc alkyl ha, thng ch khng mt
phn vi cc thuc alkyl ha khc. Cc dn
cht nitrosoure khng c hiu theo chu
k t bo, v c th tc ng trn cc t
bo bt k giai on no ca chu k,
ngay c vi t bo pha ngh G 0.
Dc ng hc
Lomustin hp thu nhanh qua ng tiu ha.
Thuc cng c hp thu sau khi bi. nh
nng huyt tng ca cht chuyn ha
tng trong vng 1 - 6 gi sau khi ung mt
liu lomustin.
Lomustin v cc cht chuyn ha ca n
qua c hng ro mu - no v chuyn vo
t bo nhanh chng nh tnh ha tan
trong lipid cao ca n.
Mc d lomustin cha bin i khng pht
hin c trong dch no ty, nhng cc cht
chuyn ha c hot tnh ca thuc th
xut hin vi nng ng k trong vng
30 pht sau khi ung. Nng trong dch
no ty ca cc cht chuyn ha bng 15 -
50% so vi nng trong huyt tng.
Cht chuyn ha ca lomustin xut hin
trong sa nhng vi nng thp hn
trong huyt tng ca ngi m. Thc t,
ton b liu lomustin c chuyn ha
trong vng 1 gi sau khi ung. Na i
ca cc cht chuyn ha theo 2 pha: Na
i ban u l 6 gi, na i ca pha th
hai trong huyt tng l 1 - 2 ngy v 15 -
20% cc cht chuyn ha cn li trong c
th 5 ngy sau khi ung lomustin. S ko
di ca nng huyt tng phn nh s
phi hp ca lin kt protein vi s tun
hon gan - rut ca cc cht chuyn ha.
Lomustin thi ch yu qua nc tiu di
dng cht chuyn ha.
Thi tr: Thn (hon ton di dng cht
chuyn ha), phn (di 5%), h hp
(10%).
Ch nh
Lomustin c dng phi hp iu tr u no
tin pht, v di cn u phi (c bit l
ung th t bo nh ca phi khng phc
hi), u ng tiu ha, ung th v, ung th
thn. Lomustin c th c dng thay th
DTQGVN
trong iu tr bnh Hodgkin lan ta ng-
i bnh khng vi phc iu tr
khc. Thuc cng c th dng iu tr u
lympho khng Hodgkin.
Chng ch nh
Khng dng cho ngi c tin s mn cm
vi lomustin.
Thn trng
Lomustin l thuc c, v th phi c
dng di s theo di thng xuyn ca bc s
c kinh nghim trong ha tr liu ung th.
Phi dng cn thn cho ngi bnh b gim
tiu cu, bch cu hoc hng cu.
Thi k mang thai
Khng dng cho ngi mang thai.
Thi k cho con b
Lomustin l thuc alkyl ha rt c c th
nh hng ti thai nhi, mt s sn phm
chuyn ha ca lomustin xut hin trong
sa, v vy khng cho con b trong thi
gian iu tr lomustin.
Tc dng khng mong mun (ADR)
Lomustin gy c ch xng di dng gim
tiu cu v gim bch cu. Tc dng ny
lun lun xy ra liu iu tr. Mc
nng ca c ch ty xng lin quan n
liu dng. Tc dng khng mong mun ca
h tiu ha xut hin vi cc tn xut khc
nhau t 3% n 70% ph thuc vo liu.
Trong qu trnh iu tr ko di (vi liu
trn 1200 mg/m 2 din tch c th) c
nguy c cao nhim c thn.
Thng gp, ADR > 1/100
Mu: Thiu mu, gim bch cu, gim tiu
cu.
Tiu ha: Bun nn, nn, vim ming.
Tc: Rng tc.
Gan: Nhim c gan nht thi vi tng
transaminase.
Niu sinh dc: Nhim c thn.
t gp, 1/1000 < ADR < 1/100
Thn kinh: Mt phng hng, ng lm, mt
iu vn v lon vn ngn.
Da: Vim da, nga, au da.
Him gp, ADR < 1/1000
Da: Bm tm.
Mu: D b chy mu.
Tiu ha: Vim hng.
Hng dn cch x tr ADR
C th dng cc thuc chng nn nh
metoclopramid hn ch cc tc dng
khng mong mun ng tiu ha.
Liu lng v cch dng
Liu bnh thng ca ngi ln v thiu
nin.
Khi u dng mt mnh lomustin: Ung
100 n 130 mg/m 2 c th v lp li th-
ng l 6 tun 1 ln. Vic lp li lomustin
Levonorgestrel (t trong t cung) 255
ch c cho khi cc t bo mu tr v
mc chp nhn c (tiu cu >
100.000/mm 3, bch cu > 4000/mm 3).
Khi dng phi hp vi cc thuc khc th
phi gim liu lomustin.
ngi bnh c chc nng ty xng suy
yu, th phi gim liu xung cn 100
mg/m2 din tch c th 6 tun 1 ln.
Khi lomustin dng phi hp vi cc thuc c
ch ty khc th phi iu chnh liu.
Lomustin c th dng phi hp vi cc cht
khc theo nhiu phc khc nhau. V
d:
Lomustin, doxorubicin v vinblastin.
Cyclophosphamid, methotrexat v
lomustin.
Methotrexat, doxorubicin,
cyclophosphamid v lomustin.
Procarbazin, vincristin, v lomustin.
Tng tc thuc
S phi hp ca theophylin v lomustin th-
ng lm tng nhanh s gim bch cu v
gim tiu cu vn thng xy ra vi tc
nhn alkyl ha ny.
Theophylin gy c ch phosphodiesterase
trong chc nng ca tiu cu.
n dnh v bo qun
Nang lomustin phi c bo qun kn
trong bao gi nhit di 400C, tt
nht t 15 - 300C.
Nang lomustin bo qun kn trong bao
gi nhit phng c n nh t
nht 2 nm.
Tng k
Khng tm thy ti liu.
Qu liu v x tr
Lomustin l mt tc nhn ha tr liu
gy nhim c thn mn tnh vi nhiu
mc khc nhau.
Qu liu c th dn n gim ton th
huyt cu.
iu tr qu liu l iu tr triu chng
v h tr. Cha c thuc gii c no c
chng minh l c tc dng i vi qu liu
lomustin.
Thng tin qui ch
Thuc c bng A.
Loperamid
Tn chung quc t: Loperamide
hydrochloride.
M ATC: A07D A03.
Loi thuc: Thuc tr a chy.
Dng thuc v hm lng
256 Levonorgestrel (t trong t cung)
Vin nang, vin nn, di dng hydroclorid: 2
mg.
Dung dch ung dng hydroclorid: 1 mg/5
ml (60 ml, 90 ml, 120 ml).
Dc l v c ch tc dng
Loperamid l mt thuc tr a chy c
dng cha triu chng cc trng hp
a chy cp khng r nguyn nhn v
mt s tnh trng a chy mn tnh. y
l mt dng opiat tng hp m liu bnh
thng c rt t tc dng trn h thn kinh
trung ng. Loperamid lm gim nhu ng
rut, gim tit dch ng tiu ha, v tng
trng lc c tht hu mn. Thuc cn c
tc dng ko di thi gian vn chuyn qua
rut, tng vn chuyn dch v cht in
gii qua nim mc rut, do lm gim s
mt nc v in gii, gim lng phn. Tc
dng c l lin quan n gim gii phng
acetylcholin v prostaglandin.
Dc ng hc
Xp x 40% liu ung loperamid c hp
thu qua ng tiu ha. Thuc c chuyn
ha gan thnh dng khng hot ng
(trn 50%) v bi tit qua phn v nc tiu
c di dng khng i v chuyn ha (30 -
40%). Nng thuc tit qua sa rt
thp. Lin kt vi protein khong 97%. Na
i ca thuc khong 7 - 14 gi.
Ch nh
iu tr hng u trong a chy cp l d
phng hoc iu tr tnh trng mt nc v
in gii, iu ny c bit quan trng
i vi tr nh v ngi cao tui suy nhc.
Loperamid ch c ch nh ng hng
th 2 iu tr triu chng a chy cp
khng c bin chng ngi ln hoc lm
gim th tch cht thi sau th thut m
thng hi trng hoc i trng.
Loperamid khng c 1 vai tr no trong
iu tr thng quy a chy cp tr em
v khng c coi l 1 thuc thay th
liu php b nc v in gii bng ng
ung.
Chng ch nh
Mn cm vi loperamid.
Khi cn trnh c ch nhu ng rut.
Khi c tn thng gan.
Khi c vim i trng nng, vim i trng
mng gi (c th gy i trng to nhim
c).
Hi chng l.
Bng trng.
Thn trng
Thn trng vi nhng ngi bnh gim chc
nng gan hoc vim lot i trng.
DTQGVN
Ngng thuc nu khng thy c kt qu
trong vng 48 gi.
Theo di nhu ng rut v lng phn,
nhit c th. Theo di trng bng.
Thi k mang thai
Cha c cc nghin cu trn ph n c
thai. Khng nn dng cho ph n c thai.
Thi k cho con b
V loperamid tit ra sa rt t, c th dng
thuc cho b m ang cho con b nhng
ch vi liu thp.
Tc dng khng mong mun (ADR)
Hu ht cc tc dng ph thng gp l
phn ng ng tiu ha.
Thng gp, ADR > 1/100
Tiu ha: To bn, au bng, bun nn,
nn.
t gp, 1/1000 < ADR < 1/100
Ton thn: Mt mi, chng mt, nhc
u.
Tiu ha: Trng bng, kh ming, nn.
Him gp, ADR < 1/1000
Tiu ha: Tc rut do lit.
Da: D ng.
Ch : Cc tc dng ph trn h thn kinh
trung ng nh ng gt, trm cm, hn m,
thng hay gp vi tr em di 6 thng tui.
V vy loperamid khng c dng trong
iu tr a chy cho tr nh.
Liu lng v cch dng
Ngi ln:
a chy cp: Ban u 4 mg, sau mi
ln i lng, ung 2 mg, ti a 5 ngy.
Liu thng thng: 6 - 8 mg/ngy. Liu ti
a: 16 mg/ngy.
a chy mn: Ung 4 mg, sau mi ln
i lng, ung 2 mg cho ti khi cm a. Liu
duy tr: Ung 4 - 8 mg/ngy chia thnh
liu nh (2 ln).
Ti a: 16 mg/ngy.
Tr em: Loperamid khng c khuyn co
dng cho tr em 1 cch thng quy trong a
chy cp.
Tr em di 6 tui: Khng c khuyn co
dng.
Tr t 6 - 12 tui:
Ung 0,08 - 0,24 mg/kg/ngy chia thnh 2
hoc 3 liu. Hoc:
Tr t 6 - 8 tui: Ung 2 mg, 2 ln mi ngy.
Tr t 8 - 12 tui: Ung 2 mg, 3 ln mi
ngy.
Liu duy tr: Ung 1 mg/10 kg th trng,
ch ung sau 1 ln i ngoi.
a chy mn: Liu lng cha c xc nh.
Tng tc thuc
DTQGVN
Tng c tnh: Nhng thuc c ch h
thn kinh trung ng, cc phenothiazin, cc
thuc chng trm cm loi 3 vng c th
gy tng tc dng khng mong mun ca
loperamid.
n nh v bo qun
Bo qun nhit phng 15 - 30oC.
Qu liu v x tr
Triu chng: Suy h hp v h thn kinh
trung ng, co cng bng, to bn, kch ng
ng tiu ha, bun nn v nn. Tnh
trng qu liu thng xy ra khi liu dng
hng ngy khong 60 mg loperamid.
iu tr: Ra d dy sau cho ung
khong 100 g than hot qua ng xng d
dy. Theo di cc du hiu suy gim thn
kinh trung ng, nu c th cho tim tnh
mch 2 mg naloxon (0,01 mg/kg cho tr
em), c th dng nhc li nu cn, tng
liu c th ti 10 mg.
Loratadin
Tn chung quc t: Loratadine.
M ATC: R06A X13.
Loi thuc: Thuc khng histamin.
Dng thuc v hm lng
Vin nn loratadin 10 mg, vin nn loratadin
tan r nhanh (Claritin reditabs) 10 mg, siro
loratadin 1 mg/ml.
Dc l v c ch tc dng
Loratadin l thuc khng histamin 3 vng
c tc dng ko di i khng chn lc
trn th th H1 ngoi bin v khng c tc
dng lm du trn thn kinh trung ng.
Loratadin thuc nhm thuc i khng th
th H1 th h th hai (khng an thn).
Loratadin c tc dng lm nh bt triu
chng ca vim mi v vim kt mc d
ng do gii phng histamin. Loratadin cn
c tc dng chng nga v ni my ay
lin quan n histamin. Tuy nhin,
loratadin khng c tc dng bo v hoc
tr gip lm sng i vi trng hp gii
phng histamin nng nh chong phn v.
Trong trng hp , iu tr ch yu l
dng adrenalin v corticosteroid.
Thuc khng histamin khng c vai tr
trong iu tr hen.
Nhng thuc i khng H 1 th h th hai
(khng an thn) nh: Terfenadin, astemizol,
loratadin, khng phn b vo no, khi dng
thuc vi liu thng thng. Do ,
loratadin khng c tc dng an thn, ngc
Levonorgestrel (t trong t cung) 257
vi tc dng ph an thn ca cc thuc
khng histamin th h th nht.
iu tr vim mi d ng v my ay,
loratadin c tc dng nhanh hn astemizol
v c tc dng nh azatadin, cetirizin,
chlopheniramin, clemastin, terfena-
din v mequitazin. Loratadin c tn sut tc
dng ph, c bit i vi h thn kinh
trung ng, thp hn nhng thuc khng
histamin thuc th h th hai khc.
V vy, loratadin dng ngy mt ln, tc
dng nhanh, c bit khng c tc dng an
thn, l thuc la chn u tin iu
tr vim mi d ng hoc my ay d ng.
Nhng thuc khng histamin khng c tc
dng cha nguyn nhn m ch tr gip
lm nh bt triu chng. Bnh vim mi
d ng c th l bnh mn tnh v ti
din; iu tr thnh cng thng phi
dng cc thuc khng histamin lu di v
ngt qung, v s dng thm nhng thuc
khc nh glucocorticoid dng theo ng ht,
v dng ko di.
C th kt hp loratadin vi pseudoephedrin
hydroclo-
rid lm nh bt triu chng ngt mi
trong iu tr vim mi d ng c km
ngt mi.
Dc ng hc
Loratadin hp thu nhanh sau khi ung.
Nng nh trong huyt tng trung
bnh ca loratadin v cht chuyn ha c
hot tnh ca n (descarboethoxy-
loratadin) tng ng l 1,5 v 3,7 gi.
97% loratadin lin kt vi protein huyt t-
ng. Na i ca loratadin l 17 gi v
ca descarboetho-
xyloratadin l 19 gi. Na i ca thuc
bin i nhiu gia cc c th, khng b
nh hng bi ur mu, tng ln ngi cao
tui v ngi x gan.
thanh thi ca thuc l 57 - 142
ml/pht/kg v khng b nh hng bi ur
mu nhng gim ngi bnh x gan. Th
tch phn b ca thuc l 80 - 120 lt/kg.
Loratadin chuyn ha nhiu khi qua gan
ln u bi h enzym microsom
cytochrom P450; loratadin ch yu
chuyn ha thnh
descarboethoxyloratadin, l cht chuyn
ha c tc dng dc l.
Khong 80% tng liu ca loratadin bi
tit ra nc tiu v phn ngang nhau, di
dng cht chuyn ha, trong vng 10
ngy.
Sau khi ung loratadin, tc dng khng
histamin ca thuc xut hin trong vng 1
- 4 gi, t ti a sau 8 - 12 gi, v ko
di hn 24 gi. Nng ca loratadin v
descarboethoxyloratadin t trng thi n
nh phn ln ngi bnh vo khong
ngy th nm dng thuc.
258 Levonorgestrel (t trong t cung)
Ch nh
Vim mi d ng.
Vim kt mc d ng.
Nga v my ay lin quan n histamin.
Chng ch nh
Qu mn vi bt k thnh phn no ca
thuc.
Thn trng
Suy gan.
Khi dng loratadin, c nguy c kh ming,
c bit ngi cao tui, v tng nguy
c su rng. Do , cn phi v sinh
rng ming sch s khi dng loratadin.
Thi k mang thai
Cha c nhng nghin cu y v
kim tra tt v s dng loratadin trong
thai k. Do ch dng loratadin trong
thai k khi cn thit, vi liu thp v trong
thi gian ngn.
Thi k cho con b
Loratadin v cht chuyn ha
descarboethoxyloratadin tit vo sa m.
Nu cn s dng loratadin ngi cho con
b, ch dng loratadin vi liu thp v
trong thi gian ngn.
Tc dng khng mong mun (ADR)
Lon nhp tht nng xy ra khi iu
tr vi mt s thuc khng th th
histamin H1 th h 2. iu khng xut
hin khi iu tr bng loratadin.
Khi s dng loratadin vi liu ln hn 10
mg hng ngy, nhng tc dng ph sau
y c th xy ra:
Thng gp, ADR > 1/100
Thn kinh: au u.
Tiu ha: Kh ming.
t gp, 1/1000 < ADR < 1/100
Thn kinh: Chng mt.
H hp: Kh mi v ht hi.
Khc: Vim kt mc.
Him gp, ADR < 1/1000
Thn kinh: Trm cm.
Tim mch: Tim p nhanh, lon nhp
nhanh trn tht, nh trng ngc.
Tiu ha: Bun nn.
Chuyn ha: Chc nng gan bt bnh th-
ng, kinh nguyt khng u.
Khc: Ngoi ban, ni my ay, v chong
phn v.
Hng dn cch x tr ADR
S dng loratadin vi liu thp nht m c
hiu qu.
Liu lng v cch dng
Ngi ln, ngi cao tui v tr em t 12
tui tr ln:
DTQGVN
Dng mt vin nn 10 mg loratadin hoc
10 ml (1 mg/ml) siro loratadin, dng mt
ln/ngy hoc dng mt vin nn Claritin -
D (loratadin 10 mg vi pseudoephedrin
sulfat 240 mg).
Tr em: 2 - 12 tui:
Trng lng c th > 30 kg: 10 ml (1
mg/ml) siro loratadin, mt ln hng ngy
Trng lng c th < 30 kg: 5 ml (1 mg/ml)
siro loratadin, mt ln hng ngy.
An ton v hiu qu khi dng loratadin cho
tr em di 2 tui cha c xc nh.
Ngi b suy gan hoc suy thn nng (
thanh thi creatinin < 30 ml/pht), dng
liu ban u l 1 vin nn 10 mg
loratadin hoc 10 ml (1 mg/ml) siro
loratadin, c 2 ngy mt ln.
Tng tc thuc
iu tr ng thi loratadin v cimetidin
dn n tng nng loratadin trong
huyt tng 60%, do cimetidin c ch
chuyn ha ca loratadin. iu ny khng
c biu hin lm sng.
iu tr ng thi loratadin v
ketoconazol dn ti tng nng loratadin
trong huyt tng gp 3 ln, do c ch
CYP3A4. iu khng c biu hin lm
sng v loratadin c ch s iu tr
rng.
iu tr ng thi loratadin v
erythromycin dn n tng nng
loratadin trong huyt tng. AUC (din
tch di ng cong ca nng theo thi
gian) ca loratadin, tng trung bnh 40% v
AUC ca descarboe-
thoxyloratadin tng trung bnh 46% so vi
iu tr loratadin n c. Trn in
tm khng c thay i v khong
QTc. V mt lm sng, khng c biu
hin s thay i tnh an ton ca
loratadin, v khng c thng bo v tc
dng an thn hoc hin tng ngt khi
iu tr ng thi 2 thuc ny.
n nh v bo qun
Bo qun loratadin nhit t 2 - 25 0C,
ni kh trnh nh sng mnh
Vi vin nn loratadin tan r nhanh, s dng
thuc trong vng 6 thng sau khi m ti
nhm ng v thuc v s dng thuc
ngay nu bc vin nn ra khi v.
Qu liu v x tr
ngi ln, khi ung qu liu vin nn
loratadin
(40 - 180 mg), c nhng biu hin: Bun
ng, nhp tim nhanh, nhc u. tr em,
c biu hin ngoi thp v nh trng
ngc, khi ung siro qu liu (vt
10 mg). iu tr qu liu loratadin thng
l iu tr triu chng v h tr, bt u
DTQGVN
ngay v duy tr chng no cn cn thit.
Trng hp qu liu loratadin cp, gy nn
bng siro ipeca tho sch d dy ngay.
Dng than hot sau khi gy nn c th
gip ch ngn nga hp thu loratadin.
Nu gy nn khng kt qu hoc chng
ch nh (th d ngi bnh b ngt, co
git, hoc thiu phn x nn), c th tin
hnh ra d dy vi dung dch natri clorid
0,9% v t ng ni kh qun phng
nga ht phi dch d dy.
Loratadin khng b loi bng thm tch
mu.
Thng tin qui ch
Thuc c bng B.
Thnh phm gim c: Thuc vin c hm
lng ti a l 10 mg.
Lorazepam
Tn chung quc t: Lorazepam.
M ATC: N05B A06.
Loi thuc: Chng lo u, an thn gy
ng.
Dng thuc v hm lng
Dung dch m c ung: 2 mg/ml
(c polyethyl-
englycol 400 v propylenglycol)
Vin nn: 0,5 mg, 1 mg, 2 mg v 2,5 mg.
Vin nn t di li: 0,5 mg, 1 mg, 2 mg.
ng tim: 2 mg/ml (c alcol benzylic 2%;
polyethy-
lenglycol 400 v propylenglycol).
ng tim 4 mg/ml (c alcol benzylic 2%;
polyethy-
lenglycol 400 v propylenglycol).
Dc l v c ch tc dng
Lorazepam l mt benzodiazepin, dng
iu tr cc tnh trng lo u, mt ng,
co git hoc trong cc phc kim sot
triu chng bun nn hay nn do thuc
chng ung th v cng cn c dng nh mt
thuc tin m c tc dng an thn trong
phu thut.
Lorazepam tan trong lipid v thm c vo
thn kinh trung ng do tnh cht ny.
Lorazepam lm tng s dn truyn ca
acid gamma aminobutyric (GABA), l cht
c ch dn truyn thn kinh no, do
gn vi cc th th benzodiazepin c
hiu.
Trong c th GABA cng c ch s dn
truyn ca nhiu cht quan trng khc nh
Levonorgestrel (t trong t cung) 259
noradrenalin, seroto-
nin, dopamin v acetylcholin.
Trong lm sng lorazepam l thuc c tc
dng ngn.
Lorazepam v alprazolam l cc
benzodiazepin c nguy c cao gy ph
thuc thuc, mt khc thi gian iu tr
ko di cng lm tng t l ny. Cc triu
chng cai thuc xy ra sm v c th
nng hn khi dng cc benzodiazepin c
tc dng ngn nh lora-
zepam. Ni chung, cc benzodiazepin ch
c dng iu tr thi gian ngn.
Bng phng php so snh m i trong
lm sng gia clonazepam v lorazepam
trn cc ngi bnh c cn hng cm cp
th lorazepam t ra c tc dng ci thin
c cc triu chng nhng ngi bnh
khng p ng vi clonazepam iu tr
trong hai tun. Nh vy chng t c th
dng lorazepam iu tr cn hng cm
cp.
ngi ln, lorazepam c dng trc khi phu
thut an thn, chng lo u. Ch nh
lorazepam ng tim c bit c li cho
nhng ngi bnh hay s hi, gip h gii ta
mi lo lng trc khi phu thut.
Lorazepam cng c dng ring l nhng th-
ng l dng kt hp vi cc thuc khc (nh
cht i khng th th 5 - HT3 v cc
corticoid) kim sot triu chng bun
nn hoc nn c lin quan n ha tr
liu ung th, k c vi cisplatin.
Cc benzodiazepin c tc dng mnh v
hiu qu khi bt u iu tr trng thi
ng kinh. Diazepam v lorazepam l
nhng benzodiazepin c s dng rng ri
nht cho mc ch ny nhng lorazepam
c thi gian tc dng ko di hn.
Dc ng hc
Khi ung, lorazepam hp thu d dng -
ng tiu ha v sinh kh dng khong
90%. Nng nh huyt tng t c
khong 2 gi sau liu ung v 60 n 90
pht sau liu tim bp.
T l tit qua nc tiu di 1% ca liu dng,
do suy thn t nh hng n s thi
tr thuc. Phn thuc lin kt vi huyt t-
ng ln ti 91 2% nng thuc trong
huyt tng, nhng gim ngi bnh suy
gan, tng ur mu.
H s thanh thi trung bnh ca
lorazepam l 1,1 0,4 ml/pht/kg v tng
ln ngi bnh b bng. Th tch phn
b l 1,3 0,2 lt/kg v tng ngi bnh
x gan, bng, ur huyt cao. Na i thi
tr huyt tng trung bnh ngi bnh
bnh thng l 14 5 gi v cng tng
ngi b x gan, ur huyt cao, tr s sinh
v gim ngi b bng.
260 Levonorgestrel (t trong t cung)
C th dng lorazepam an ton cho nhng
ngi suy chc nng gan nng v s to
thnh glucuronid khng ch li ni bo
gan.
Dc ng hc gia ngi khe mnh bnh
thng khc nhau sau mi liu n, sau
nhiu liu lp li v c hoc khng c
mt neomycin v cholestyramin. Hai
thuc ny c kh nng chn vng tun
hon gan - rut ca thuc. V vy
neomycin v cholestyramin c th lm
tng thanh thi lorazepam ti khong 45%
do lm gin on vng tun hon gan -
rut.
Lorazepam qua c hng ro mu - no v
nhau thai, thuc cng c phn b vo
sa m.
Ch nh
iu tr cc trng thi lo u, iu tr
ngn ngy tnh trng mt ng v trong
cn ng kinh lin tc. Thuc cng c
dng nh mt thuc tin m v cng c s
dng trong cc phc chng nn
kim sot triu chng bun nn v nn
lin quan vi ha tr liu ung th.
Chng ch nh
c qu mn vi benzodiazepin v vi cc
dung mi pha ch dng thuc tim (nh
polyethylenglycol, propylenglycol v alcol
benzyl), glcm gc hp cp tnh.
Thn trng
Nhng ngi ang dng lorazepam khng
c vn hnh cc my mc hoc tham gia
vo cc cng vic nguy him, khng c
li xe c ng c trong vng 24 n 48
gi v h khng th tp trung c tt. S
dung np ca h i vi ru v cc thuc c
ch thn kinh trung ng khc s b gim.
Nhng ngi b bnh thn hoc bnh gan
mc nh hoc trung bnh ch nn
dng lorazepam liu thp nht.
Nguy c ca s ph thuc thuc v cai
thuc:
Ph thuc thuc thng xy ra sau khi dng
u n cc thuc benzodiazepin, ngay
c liu iu tr trong thi gian ngn,
c bit l nhng ngi c tin s
nghin thuc, nghin ru hoc ri lon
nhn cch.
Cc triu chng cai thuc (co git, run ry,
chut rt c v bng, nn, tot m hi)
xy ra khi ngng thuc t ngt. Cc
triu chng nghim trng hn thng ch
gp nhng ngi bnh s dng thuc
liu cao v ko di. Do khi dng cc
benzodiazepin mt cch u n (thm
ch ch trong t tun) th khng c
ngng thuc t ngt m phi gim liu
t t trong khong vi tun hoc vi
thng ri mi ct hn.
DTQGVN
Lorazepam v alprazolam l nhng
benzodiazepin c nguy c cao gy ra
tnh trng ph thuc thuc.
Thi k mang thai
Lorazepam i qua hng ro nhau thai v
nng thuc cung rn tng t nh
nng trong huyt thanh ngi m.
Chng ch nh s dng u n
lorazepam cho ngi mang thai v thuc s
tp trung trong cc m ca thai nhi,
chc nng chuyn ha ca gan km nht.
Thuc c th gy trm cm, suy gim tr-
ng lc tr s sinh v nu dng cui
thai k a tr sinh ra s kh b. Tr nh c
th b chng cai thuc (d b kch thch,
khc, co git c) sau khi sinh 2 - 3 tun
nu ngi m dng thuc u n vi liu
gy ng khi ang mang thai.
Thi k cho con b
Lorazepam bi tit vo sa m vi nng
thp. V l mt dn cht
benzodiazepin tc dng ngn nn c th
dng lorazepam an ton trong thi k cho
con b.
Tc dng khng mong mun (ADR)
Cc tc dng khng mong mun ca thuc
thng xut hin lc mi bt u iu tr
v ni chung s ht khi tip tc dng thuc
hoc gim liu.
mt vi ngi bnh, c hin tng gim
bch cu hoc tng LDH. Do nn thng
k kim tra mu v chc nng gan cho
nhng ngi s dng thuc thi gian di.
Thng gp, ADR > 1/100
Thn kinh trung ng: An thn, long
chong (t l mc tng theo tui), ng
nhiu, ng g, chng mt, mt mi, l
ln, m sng, o gic.
Ti ch (khi tim bp): au ni tim, cm
gic nng bng.
t gp, 1/1000 < ADR < 1/100
Thn kinh trung ng: Trm cm, au
u, ri lon gic ng, kch ng.
Tim mch (sau khi tim): Tng hoc h
huyt p.
Him gp, ADR < 1/1000
Thn kinh trung ng: Bun nn, nn (
nhng ngi bnh dng lorazepam dng
tim kt hp vi cc thuc khc trong gy
m v phu thut) mt tr nh nht thi
hoc ri lon tr nh.
Mt: Ri lon chc nng mt, nhn mt
ha hai.
Da: Pht ban, vim da.
Liu lng v cch dng
Lorazepam c dng theo ng ung
hoc tim. Ch tim bp khi ngi bnh
DTQGVN
khng th ung hoc tim tnh mch c
v phi tim bp su.
Nu s dng dung dch ung m c
phi pha long vi 30 ml nc, hoc nhiu
hn, trc khi ung.
Ngay trc khi tim tnh mch, dung dch
tim phi c pha long vi 1 th tch tng
ng ca nc ct pha tim (hoc dung
dch tim natri clorid 0,9% hay dung dch
tim glucose 5%) v khng c dng nu
dung dch i mu hoc b ta. Sau khi
pha long, thuc c th tim t t trc tip
vo tnh mch hoc truyn tnh mch
(khi pha vi dung dch natri clorid 0,9%
hoc glucose 5%). Khi tim trc tip vo
tnh mch cn ht th kim tra m
bo chc chn thuc khng b tim vo
ng mch v khng b thot quanh
mch.
Phi rt thn trng khi dng lorazepam
dng tim cho ngi cao tui, ngi bnh
nng hoc c tn thng phi v c
th gy ngng tim do thiu oxy. Cn
chun b sn cc thit b hi sc h l 34%. Nu cn thit phi tng liu
tr h hp.
iu tr cc trng thi lo u:
Ung: 1 - 6 mg/ngy; chia 2 - 3 ln; liu
cao nht c ung vo bui ti. Khi cn
c th dng ti 10 mg/ngy.
Tim: Dng cho cc trng thi lo u cp,
0,025 - 0,03 mg/kg/ln; cch 6 gi tim
mt ln.
iu tr mt ng do lo lng: Ung 1 - 4 mg
khi i ng.
Trong tin m:
Ung: 2 - 3 mg vo bui ti trc khi phu
thut, nu cn sng hm sau c th ung
thm mt liu nh hn. Hoc ung 2 - 4
mg trc phu thut 1 - 2 gi.
Tr em t 5 - 13 tui ung 0,5 - 2,5 mg
(0,05 mg/kg) t nht mt gi trc phu
thut.
Tim: Tim tnh mch 0,05 mg/kg trc phu
thut 30 - 45 pht hoc tim bp 60 - 90
pht trc phu thut.
iu tr trng thi ng kinh lin tc: Tim
tnh mch liu duy nht 4 mg; vi tr em
dng mt na liu trn.
Phng bun nn v nn lin quan n
ha tr liu ung th:
Ung 1 - 2 mg cng vi dexamethason trc
khi bt u ha tr liu. Hoc tim tnh
mch chm 1,5 mg/m 2 (thng c th ti
liu ti a l 3 mg) 45 pht trc ha tr
liu.
Vi ngi cao tui hoc suy nhc ch dng
mt na liu ngi ln hoc t hn.
Tng tc thuc
Levonorgestrel (t trong t cung) 261
Dng ng thi hoc trong giai on hi
phc do lorazepam vi cc thuc nh hng
n thn kinh trung ng (nh cc
phenothiazin, cc opiat, cc barbiturat,
ethyl alcol, scopolamin, cc cht c ch
MAO v cc thuc chng trm cm khc)
c th lm tng tc dng ca lorazepam.
Vic kt hp ny c th gy nn s an
thn qu mc lm tc nghn h hp mt
phn. Phi chun b sn sng cc thit
b cn thit duy tr thng kh v h
hp h tr.
Scopolamin khng c tc dng cng hp c
li khi dng ng thi vi lorazepam nhng
c th lm tng tc dng an thn, gy o
gic v ri lon tc phong.
Lorazepam c th lm gim liu ca dn
cht fentanyl cn khi m v lm gim
thi gian mt thc vi liu khi m.
Dng ng thi neomycin v cholestyramin
vi loraze-
pam c th lm gim na i thi tr ca
lorazepam dng ung khong 26% v tng
s thanh thi ca lorazepam dng t do
lorazepam.
Thc n c th gim v cn tr tc dng
gy ng ca lorazepam v do gic
ng s bt u chm v tc dng ca
thuc cng b gim i.
Bo qun
Dung dch ung v dung dch tim
lorazepam c bo qun nhit 2 -
80C, trnh nh sng; khng c ng
lnh dng tim. Khng c dng nu dung
dch bin mu hoc b ta. Dung dch
ung cn ng trong chai, l nt kn.
Dng vin phi gi trong cc bao b kn
nhit 15 - 300C.
Tng k
Lorazepam tim tng k vt l vi dung
dch tim buprenorphin.
Qu liu v x tr
Qu liu cc benzodiazepin thng biu
hin bng c ch thn kinh trung ng
nhng mc khc nhau t ng g n
hn m. Trng hp nh, cc biu hin l
ng g, l ln v ng lm. Trng hp nng
hn, c th long chong, gim trng lc,
h huyt p, trng thi bun ng, hn m
1 n 3 v rt him khi t vong.
iu tr qu liu ch yu l iu tr h tr
cho n khi thuc b loi tr khi c th.
Phi theo di cn thn nhng du hiu
sng v s cn bng dch. Phi duy tr
thng kh v h hp h tr khi cn thit.
Vi nhng ngi bnh c chc nng thn
bnh thng th gy bi niu mnh bng
cch truyn dch v cc cht in gii c
262 Levonorgestrel (t trong t cung)
th lm tng s thi tr thuc ra khi c
th. Cc thuc li tiu thm thu (nh
mannitol) c th c tc dng b tr. Nu
tnh trng nguy kch hn th c th ch
nh thm tch thn v truyn thay mu.
Trng hp qu liu ng ung, cng vi cc
bin php chm sc h tr chung, cn tin
hnh gy nn v/hoc ra d dy. Nu b
h huyt p (mc d t khi xy ra) thng
c th kim sot c bng tim
noradrenalin bitartrat.
C th dng flumazelin (thuc khng
benzodiazepin) cho ngi bnh ang nm
vin nh mt cht ph tr cho iu tr qu
liu benzodiazepin nhng khi ch nh
cn cnh gic v nguy c gy cn ng
kinh lin quan n vic s dng
flumazelin, c bit nhng ngi dng
benzodiazepin ko di.
Thng tin qui ch
Thuc hng tm thn.
Losartan
Tn chung quc t: Losartan.
M ATC: C09C A01.
Loi thuc: Cht i khng th th
angiotensin II.
Dng thuc v hm lng: Vin nn bao
phim, dng mui kali: 25 mg, 50 mg.
Dc l v c ch tc dng
Losartan l cht u tin ca nhm thuc
chng tng huyt p mi, l mt cht
i khng th th (typ AT 1) angiotensin II.
Angiotensin II, to thnh t angiotensin I
trong phn ng do enzym chuyn
angiotensin (ACE) xc tc, l mt cht co
mch mnh; l hormon kch hot mch
ch yu ca h thng renin - angiotensin,
v l mt thnh phn quan trng trong
sinh l bnh hc ca tng huyt p.
Angiotensin II cng kch thch v tuyn
thng thn tit aldosteron.
Losartan v cht chuyn ha chnh c
hot tnh chn tc dng co mch v tit
aldosteron ca angiotensin II bng cch
ngn cn c chn lc angiotensin II, khng
cho gn vo th th AT 1 c trong nhiu
m (th d c trn mch mu, tuyn thng
thn). Trong nhiu m, cng thy c th
th AT2 nhng khng r th th ny c lin
quan g n iu ha tim mch hay
khng. C losartan v cht chuyn ha
chnh c hot tnh u khng biu l tc
dng ch vn cc b th th AT 1 v u Qu mn vi losartan hoc bt k thnh
c i lc vi th th AT 1 ln hn nhiu
DTQGVN
(khong 1000 ln) so vi th th AT 2.
Losartan l mt cht c ch cnh tranh,
thun nghch ca th th AT 1. Cht
chuyn ha c hot tnh ca thuc mnh
hn t 10 n 40 ln so vi losartan, tnh
theo trng lng v l mt cht c ch
khng cnh tranh, thun nghch ca th
th AT1. Cc cht i khng angiotensin II
cng c cc tc dng huyt ng hc nh
cc cht c ch ACE, nhng khng c tc
dng khng mong mun ph bin ca cc
cht c ch ACE l ho khan.
Dc ng hc
Sau khi ung, losartan hp thu tt v
chuyn ha bc u nhiu qua gan nh
cc enzym cytochrom P450. Kh dng sinh
hc ca losartan xp x 33%. Khong 14%
liu losartan ung chuyn thnh cht
chuyn ha c hot tnh, cht ny m
nhim phn ln tnh i khng th th
angiotensin II. Na i thi tr ca
losartan khong 2 gi, v ca cht chuyn
ha khong 6 - 9 gi. Nng nh
trung bnh ca losartan t trong vng 1
gi, v ca cht chuyn ha c hot tnh
trong vng 3 - 4 gi.
C losartan v cht chuyn ha c hot
tnh u lin kt nhiu vi protein huyt
tng, ch yu l albumin v chng khng
qua hng ro mu - no. Th tch phn b
ca losartan khong 34 lt v ca cht
chuyn ha c hot tnh khong 12 lt.
thanh thi ton phn trong huyt tng
ca losartan l khong 600 ml/pht v ca
cht chuyn ha c hot tnh l 50
ml/pht; thanh thi ca chng thn t-
ng ng vi khong 75 ml/pht v 25
ml/pht. Sau khi ung losartan ghi du 14C,
thu li khong 35% phng x trong nc
tiu v khong 60% trong phn.
ngi bnh x gan t nh n va, din
tch di ng cong (AUC) ca losartan v
ca cht chuyn ha c hot tnh cao
hn, tng ng, gp 5 ln v 2 ln so vi
ngi bnh c gan bnh thng.
Ch nh
iu tr tng huyt p: C th dng n
c hoc phi hp vi cc thuc chng
tng huyt p khc (th d thuc li tiu
thiazid). Nn dng losartan cho ngi bnh
khng dung np c cc cht c ch ACE.
Losartan ang c th nghim trong
iu tr suy tim. y l li im ln ca
cc loi i khng th th angiotensin, nn
cng c th dng iu tr suy tim ging
nh cc ch nh ca thuc c ch ACE.
Chng ch nh
phn no ca ch phm.
DTQGVN
Thn trng
Cn phi gim st c bit v/hoc gim
liu ngi bnh mt nc, iu tr bng
thuc li tiu v ngi bnh c nhng yu
t khc d dn n h huyt p. Ngi
bnh hp ng mch thn hai bn hoc
mt bn, ngi ch cn mt thn cng c
nguy c cao mc tc dng khng mong
mun (tng creatinin v ur huyt) v cn
c gim st cht ch trong iu tr.
Ngi bnh suy gan phi dng liu thp
hn.
Thi k mang thai
Dng cc thuc tc dng trc tip ln h
thng renin - angiotensin trong ba thng
gia v ba thng cui ca thai k c th
gy t nc i, h huyt p, v niu, thiu
niu, bin dng s mt v t vong tr s
sinh. Mc d, vic ch dng thuc ba
thng u ca thai k cha thy c lin
quan n nguy c cho thai nhi, nhng d
sao khi pht hin c thai, phi ngng
losartan cng sm cng tt.
Thi k cho con b
Khng bit losartan c tit vo sa m
hay khng, nhng c nhng lng ng k
losartan v cht chuyn ha c hot tnh
ca thuc trong sa ca chut cng. Do
tim nng c hi cho tr nh ang b m,
phi quyt nh ngng cho con b hoc
ngng thuc, c tnh n tm quan trng
ca thuc i vi ngi m.
Tc dng khng mong mun (ADR)
Phn ln cc tc dng khng mong mun
u nh v mt dn vi thi gian.
Thng gp, ADR > 1/100
Tim mch: H huyt p.
Thn kinh trung ng: Mt ng, chong
vng.
Ni tit - chuyn ha: Tng kali huyt.
Tiu ha: a chy, kh tiu.
Huyt hc: H nh hemoglobin v
hematocrit.
Thn kinh c - xng: au lng, au chn,
au c.
Thn: H acid uric huyt (khi dng liu
cao).
H hp: Ho (t hn khi dng cc cht c
ch ACE), sung huyt mi, vim xoang.
t gp, 1/1000 < ADR < 1/100
Tim mch: H huyt p th ng, au
ngc, blc A - V II, trng ngc, nhp
chm xoang, nhp tim nhanh, ph mt,
mt.
Thn kinh trung ng: Lo u, mt iu
ho, l ln, trm cm, au na u, au
u, ri lon gic ng, st, chng mt.
Levonorgestrel (t trong t cung) 263
Da: Rng tc, vim da, da kh, ban ,
nhy cm nh sng, nga, my ay, vt
bm, ngoi ban.
Ni tit - chuyn ha: Bnh gt.
Tiu ha: Chn n, to bn, y hi, nn,
mt v gic, vim d dy.
Sinh dc - tit niu: Bt lc, gim tnh
dc, i nhiu, i m.
Gan: Tng nh cc th nghim v chc
nng gan v tng nh bilirubin.
Thn kinh c xng: D cm, run, au x-
ng, yu c, ph khp, au x c.
Mt: Nhn m, vim kt mc, gim th
lc, nng rt v nhc mt.
Tai: tai.
Thn: Nhim khun ng niu, tng nh
creatinin hoc ur.
H hp: Kh th, vim ph qun, chy mu
cam, vim mi, sung huyt ng th, kh
chu hng.
Cc tc dng khc: Tot m hi.
Liu lng v cch dng
Liu dng ty thuc tng ngi bnh v phi
iu chnh theo p ng huyt p. Liu
khi u ca losartan thng dng cho ngi
ln l 50 mg mi ngy; c th dng liu
khi u thp hn (th d 25 mg mi
ngy) cho ngi bnh c kh nng mt
dch trong lng mch, k c ngi ang
dng thuc li tiu, hoc suy gan.
Liu duy tr thng thng l 25 - 100 mg,
ung mt ln hoc chia lm 2 ln mi
ngy. Khng cn phi thay i liu cho
ngi bnh cao tui hoc ngi suy thn,
k c ngi ang thm phn mu.
Ni chung, nu khng kim sot c
huyt p vi liu dng, th cch 1 - 2
thng mt ln phi iu chnh liu lng
thuc chng tng huyt p.