SinhHoc - Edu.vn - Giao Trinh Duoc Ly

MUC LUC T ONG
CHNG I. M AU.......................................................................................................... 3
1.1. Gii thieu mon hoc ....................................................................................................... 3
1.2. Dc ong hoc............................................................................................................... 4
1.2.1. S hap thu............................................................................................................... 5
1.2.2. Phan bo ................................................................................................................. 11
1.2.3. Chuyen hoa (bien oi sinh hoc) ........................................................................... 13
1.2.4. Bai thai ................................................................................................................. 13
1.3. Dc lc hoc ................................................................................................................ 16
1.3.1. Receptor (ni tiep nhan, iem ch) .................................................................... 16
1.3.2. Cac cach tac dung cua thuoc................................................................................ 18
1.3.3. Tng tac gia hai dc pham (thuoc) ................................................................ 18
1.4. Nhng yeu to anh hng en tac du ng cua dc pham........................................ 20
1.4.1. Cac yeu to ben trong c the ................................................................................. 20
1.4.2. Yeu to ngoai c the (lien quan en thuoc) .......................................................... 21
1.5. Thong tin ve mot loai thuoc ...................................................................................... 22
1.5.1. Ten thuoc.............................................................................................................. 22
1.5.2. Ch nh va chong ch nh (indications va contraindications) ............................ 22
1.5.3. Lieu lng va ng cung cap (Dosage va Administration) ............................... 23
1.5.4. Dang trnh bay (Presention) ................................................................................. 23
1.5.5. Bao quan (storage) ............................................................................................... 23
1.5.6. Han dung (expiration date) .................................................................................. 23
1.5.7. Thi gian ngng thuoc (Withholding periods) ..................................................... 23
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CHNG I
DC LY AI CNG
Gii thieu mon hoc
Dc ong hoc
Dc lc hoc
Nhng yeu to anh hng en tac du ng cua dc pham
Thong tin ve mot loai thuoc
1 Chng I. M AU
1.1. Gii thieu mon hoc
Dc ly hoc (Pharmacology) la mon hoc nghien cu ve nguyen ly va nhng
qui luat tac ong lan nhau gia thuoc vi c the sinh vat, e cap en nhng kien thc
lch s, nguo n goc, ca u truc cua thuoc. S tac ong va c che ve so phan cua thuoc trong
c the, cong dung cung nh tai bien khi s dung thuoc, trong o chia la m 2 phan:
- Dc ong hoc (pharmacokinetics): nghien cu ve tac ong cua c the oi vi
thuoc hay so phan cua thuoc trong c the qua cac qua trnh ha p thu, phan bo, chuyen hoa
va ao thai.
- Dc lc hoc (pharmacodynamics): nghie n cu ve tac ong cua thuoc oi vi c
the ve mat tnh chat cng o va th i gian.
Thuoc: la nhng chat (t nhien, tong hp hay ban tong hp) khi c a vao c
the sinh vat se co tac ong lam thay oi chc nang cua c the. S thay oi nay co the la
hu ch trong trng hp ieu tr hoac co the gay tac hai trong trng hp ngo oc. Do
o ranh gii gia thc an, thuoc va chat oc thng khong ro ret, no phu thuoc nhieu
yeu to, trong o yeu to lieu lng la quan trong.
Hnh 1.1 S o bieu dien cac qua trnh dc lc hoc
va dc ong hoc lien quan ti tac dung thuoc
1.2. Dc ong hoc
Dc ong hoc la mon hoc dien ta bang toan hoc ve toc o va mc o hap thu,
phan phoi va ao thai cua thuoc trong c the. Mon hoc nay chu yeu lam ro moi lien he
gia so lng thuoc va lan s dung thuoc, cng o va thi gian tac ong. Hien nay co
chieu hng tang ap dung hieu biet ve dc ong hoc e s dung thuoc tren lam sang,
ac biet la s ca the hoa lieu dung. Sau ay la 3 thong so dc ong quan trong:
1. He so thanh thai (clearance): Bie u th kha nang a o thai thuoc cu a c the.
2. The tch phan phoi (volume distribution): La c so khoang bieu kien trong c
the co the cha thuo c.
SINH KHA DUNG
PHAN PHOI HE SO THANH THAI
Lieu dung
Nong o thuoc trong
tuan hoan
Thuoc chuyen hoa va
ao thai
Thuoc chuyen hoa va
ao thai
Nong o thuoc trong
tuan hoan
Tac ong dc ly
ap ng lam sang
Hiep lc
S dung
oc tnh
D
O
N
G

H
O
C
D
C

L
C

H
O
C
3. Sinh kha dung (bioavailability): La ty le thuoc hap thu vao he tuan hoan so vi
lieu dung.
Cac ng dung thuoc va ao thai thuoc chnh

la qua trnh dc pham tham nhap vao noi moi trng. Du dung
ng cho thuoc nao dc pham muon en cac receptor e phat sinh tac ong dc lc
thng phai i qua mot hay nhieu mang te bao, do o s hap thu thuoc phu thuoc ban
chat cua mang te bao.

T ngoai vao trong co 3 lp chnh
- ac biet co lp keratin (lp sng) ngoai cung.
- Thng b: la mo lien ket chong gom co si collagen, s i an hoi, mach mau,
si than kinh va ca c phan phu nh tuye n mo hoi, nang long.

Tiem tnh mach
Tiem bap

Phan
Nc tieu
Tnh mach
ca
Chat
chuyen hoa
ng mat

Sa
mo hoi

Tiem
trong vo
Kh th ra Dang ht
- Ha b: la to chc a c biet tr thanh mo m.
Lp sng gom te bao chat co bao tng a hoan toan b keratin hoa. Cau tru c cua
lp nay day a c do s gan ke t chat che gia cac te bao. Lp sng c coi nh ha ng rao
che ch rat tot cua da bi kho b thuy giai bi cac tac nhan nh acid, base loang hay
enzym.

- Lp sng la hang ra o can tr thuoc tha m qua da.
- Hap thu thuoc qua da phu thuoc he so phan chia D/N cua thuoc
Chat tan trong lipid qua lp bieu b hoac tuyen ba nang long, tuyen mo hoi. Chat
khong tan trong lipid dang nhu tng qua tuyen ba va tuyen mo hoi.

- Tnh hoa tan cua dc pham: thuoc dang dung dch nc de hap thu hn dung
dch dau, dung dch dang treo hoac dang ran. V dang dung dch nc thuoc c hoa
tan nhanh chong vao pha nc ni hap thu.
- Nong o dc pham tai ni hap thu: nong o nay cang ln th s hap thu cang
nhanh oi vi cac thuoc qua mang bang cach khuech tan qua lp lipid.
- pH ni hap thu: trong c the co 2 ni ma s thay oi pH rat ln, pH dch v 1,5 -
7, pH nc tieu 4,5 - 7,5. oi vi acid rat yeu nh phenytoin va nhieu barbiturat pKa >
7,5 chu yeu dang khong ion hoa tat ca moi pH. o la nhng acid ma s hap thu
khong tuy thuo c pH. Acid co pKa = 2,5-7,5, s thay oi pH lam thay o i ty le ion hoa va
khong ion hoa, cac acid nay hap thu de trong moi trng acid. Cac acid co pKa< 2,5 th
phan khong ion hoa rat thap nen s hap thu rat cham ngay ca trong moi trng acid.
1.2.1.1. Cac phng cach van chuyen
(1) Van chuyen thu ong (khuech tan)
- Thuoc t ni co nong o cao khuech tan en ni co nong o thap, o la s van
chuyen theo chieu gradien nong o, khuech tan thuan dong. Toc o khuech tan ty le
thuan vi gradien nong o 2 ben mang va he so phan ly lipid/nc cua thuoc. He so
lipid khong ion hoa/he so phan phoi nc cang ln th toc o khue ch tan cang nhanh cho
en khi at trang thai tnh, nong o thuoc t do 2 ben mang te bao can bang. oi vi
nhng chat ion hoa, tuy mc o ion hoa cua cac phan t thuoc va gradien nong o cac
ion, hieu so pH gia 2 ben mang te bao se quyet nh s phan phoi khong eu cua thuo c
o.
- Nhng thuoc toan manh, kiem yeu hoac nhng chat phan cc manh nh muoi
amonium bac IV rat kho vt qua mang te bao. Nhng chat tan c trong nc co
lng phan t nho (<200MW) se theo nc vao noi bao, qua khe, lo cua mang te bao
nh c che khuech ta n thu ong.
Thuy ong hoc va nhng yeu to tham thau giup cho nc qua mang (ngoai tr
mach mau khu vc than kinh trung ng) o la c che xuyen mang cua thuoc mao
mach hau het cac mo trong c the. Luc nay toc o xuyen mang khong phai do o hoa
tan cua thuoc trong lipid hay o pH ma do lu lng mau o quyet nh.
- Ch phu thuoc tnh chat hoa ly cua mang va thuoc
- Thuan chieu gradien nong o
- Khong ton nang lng
Co 3 cach van chuyen
- Qua lp lipid cua mang: thng cac chat tan trong lipid, khong ion hoa (khong
phan cc) de qua hn.
- Qua lo cua mang: tuy thuoc ng knh cua lo va trong lng phan t cua thuoc.
ng knh nay cung thay oi tuy tng mo.
V du: d mao mach = 40 A
0
d ni khac = 4 A
0
- Qua khe cac te ba o: khoang cach gia cac khe cung thay oi tuy mo
V du: mach mau > ruot > mo than kinh
(2) Van chuyen chu ong (tch cc)
Mang te bao cung cap chat chuyen ch cho s van chuyen, nen con c goi la
van chuyen chuyen ch.
Van chuyen tch cc co cac ac iem sau: tnh chon loc cao, canh tranh vi chat
giong nhau, can cung cap nang lng, can co chat chuyen ch (chat mang), van chuyen
ngc chieu gradien nong o, co hien tng bao hoa.
Van chuyen tch cc rat t lien quan en o hap thu, ma la c che tac dung quan
trong cua thuoc co tac ong len acid amin, ng, vitamin (cac chat noi sinh) hoac cac
chat dan truyen than kinh van chuyen qua mang te bao than kinh, mang li mach mau,
cau than va mang te bao gan.
Co mot so thuoc co o ion hoa cao nhng lai de dang xuyen qua mang te bao. V
du xuyen qua mang hong cau cua glucose, xuyen qua mang than kinh cholinergic cua
acetylcholin; nhng chat nay ket hp vi chat chuyen ch e tang o hoa tan trong m
nh o xuyen qua c lp lipid cua mang roi khuech tan vao ben trong te bao.

Thuoc c hap thu qua niem mac da day, ruot non
- u iem: ng cap thuoc nay tien li, de thc hien va an toan nhat.
- Nhc iem: s hap thu phu thuoc nhieu yeu to nh tnh trang cua da day ruot,
thanh phan thc an. ng cap nay thuoc co the b mat tac dung do o pH thap cua
dch v va cac enzym tieu hoa co the pha huy thuoc. oi vi gia suc, viec cung cap
thuoc bang ng uong can phai chu y ve lieu lng, v co the se khong cung cap u,
ac biet la trng hp tron vao thc an, nc uong. Them vao o, ng ca p nay khong
nen s dung oi vi cac thuoc co mui v kho chu, gay kch ng, cac thuoc co tnh ion
hoa.

Thuoc khuech tan thu ong do chenh lech nong o, do mao mach ln nen nhieu
phan t thuoc qua c.
- u iem: thuoc c hap thu nhanh va nhanh co tac ong. Cap thuoc bang
ng tiem chch se giai quyet c nhng han che cua ng uong, lieu dung nho hn
lieu cho uong.
- Nhc iem: ng tiem chch oi hoi ieu kien vo trung, ngi cap thuoc phai
co ky thuat. Thuoc du ng cho ng tiem chch thng at tien, kem an toan va gay au.

Thuoc ha p thu qua mo di da trc tien phai khue ch tan trong gian bao chat, sau
o tham qua noi mo mao mach. Do o, s hap thu thuoc tuy thuoc vao:
- o nht cua gian bao chat: thanh phan quan trong tao o nht cua gian bao chat
la acid hyagluronic.
- Tnh tham cua mao mach: muon thay oi toc o hap thu qua mo d i da can chu
ong thay oi o nht cua gian bao chat hoac thay oi tnh tham mao mach. V du: khi
muon giam toc o hap thu ong thi tang thi gian tac ong oi vi thuoc co tac ong
ngan nh penicilline, heparin, insulin va giam oc tnh nh procain dung chat gay co
mach (procain-epinephrine), dung ta dc dang keo t khuech tan e tang o nht
(pectin, gelatin). Khi muon tang toc o hap thu khi chch dung dch ang trng dung
men hyagluronidase e giam o nh t, dung cha t dan mach.
Thuoc se co tac du ng sau 30-60 phut, lieu dung thng ch bang 1/3 lieu uong.
Nen tranh dung ng nay cho cac thuo c co tnh kch ng, gay xot.

Thuoc co tac dung nhanh hn khoang 10 - 30 phut, lieu dung bang 1/2 lieu uong.
Dung e tiem cac dung dch nc, dung dch dau hay nhu dch dau nh loai glycoside tr
tim, kch to sinh duc, cac corticosteroid.
Co the tiem cac thuoc ma ng tiem di da gay au xo t.

ay thuoc khong phai c hap thu na ma la tham nhap nhanh chong va toan
ven vao he tuan hoan chung, co tac dung sau 30 giay en 5 phut, lieu cap bang 1/2-1/4
lieu uong. ng tiem nay thng ap dung cho cac trng hp cap cu hoac can thuoc
co tac dung tc th i.
Can het sc than trong khi dung ng cap nay, neu chch mot lng ln (250-
1000ml) can lu y s ang trng vi huyet tng, toc o cap thuoc cham e tranh s
thay oi can bang cac chat keo trong huyet tng, luon theo doi ca c phan ng cua c the
khi tiem thuoc va dung moi thng dung la nc, tuyet oi khong s dung cac dung moi
la cac chat dau, chat khong tan v co the gay nghen mach, tranh dung cac chat gay tieu
huyet, gay ket tua ca c thanh phan cua mau hay co hai cho c tim.

Vi be mat hap thu ln cung mang li mao mach phat trien cua phuc mo, thuoc
c hap thu nhanh chong gan bang ng tiem tnh mach.
S dung ng cap na y can chu y tranh gay viem nhiem, thung ruot, bang quang.
ng cap nay thng dung khi can cap mot lng ln thuoc trong thi gian ngan
ma ng tiem tnh mach kho thc hien.
Tiem trong da (intradermic, I.D)
Thng gap trong cac th nghiem lao to (tuberculin test) hoac th d ng vi
khang sinh.
(3) Cac ng cap thuoc khac
ng tham qua ma ng nhay kh qua n, cuong phoi, b mo phe nang
Thng ap dung cho cac thuoc bay hi hoac de bay hi, kh dung. Thuoc se c
hap thu qua dien tch rong ln cua bo may ho hap va mang mao quan va he tuan hoan
chung.
ng trc trang (rectum mucosa)
ac iem hap thu: hap thu chat tan trong lipid va t ion hoa. Thuoc se tranh c
tac ong chuyen hoa tai gan va cua dch tieu hoa v vay lieu dung nho hn lieu cho
uong. Co the dung cho cac thuoc co mui v kho chu. Tuy nhien, ng cap nay ch ap
dung cho cac thuoc khong b huy bi men penicillinase.
ng boi ngoai da, at vao am ao, t cung...
ng boi ngoa i da: cho tac dung tai cho o i hoi phai hoa tan c trong chat beo
nh m, vaseline, lanoline. e thuoc c hap thu nhanh chong nen cha sat mat da e
ong tuyen mo hoi m rong va cac mao mach trng n, tron them cac chat gay trng
mach nh nicotinamid hoac cac chat gay kch ng nh salicylate metyl.
1.2.2. Phan bo
The dch gom dch ngoai bao va dch noi bao, trong o pH dch ngoai bao (pH
=7,4) ln hn noi bao (pH=7). Nhng thuoc co tnh acid yeu b ion hoa dch ngoai bao
nen nong o o cao hn v khong phan phoi vao ben trong te bao c. Nhng thuoc
kiem yeu th kha c, o pH hi kiem dch ngoai bao, khong ion hoa, thuoc vao c ben
trong mang te bao nen nong o thuoc ngoai bao cao hn. Noi chung, a so cac thuoc
eu phan bo nhieu hn dch ngoai bao, ngay ca nhng thuoc co o khuech tan ln nh
cac thuoc tan trong nc, cac ion Na
+
, Cl
-
cung vay. Bi v muon vao ben trong dch noi
bao phai nh en c che van chuyen tch cc. Nhng thuoc tan trong dau va nhng thuoc
co kha nang gan ket vi cac thanh phan cau tao ben trong te bao th c phan phoi va o
tan ben trong.
Trong qua trnh van ong cua phan t thuoc, s can bang nong o thuoc cac
dch, cac mo noi chung la bien ong, s phan bo thuoc trong c the la khong ong eu.

Thuoc vao he tuan hoan chung se c phan bo chu yeu en ni tac ong, t o
sinh ra tac ong dc ly. Trc khi at ti trang thai can bang ong, thuoc c phan
phoi u tien en nhng ni co lng mau nhieu nhat nh tim, gan, than, nao. Trang thai
nay do lng mau c bm en va lng mau tai cho quyet nh.
Sau o thuoc c nhanh chong phan phoi lai e en c, da b, m va cac tang.
Toc o phan phoi lai tuy thuoc vao lng mau en, o hoa tan trong dau va o gan ket
vi protein. Nhng thuoc co o gan ket cao va ben vng rat kho phan phoi en ni tac
ong, chuyen hoa kho va thai tr cham, sau khi c phan phoi thuoc bc vao giai
oan chuyen hoa, bai thai.
Nhng thuoc co to c o phan bo nhanh, thuoc dung lieu cao 1 lan hay nh ng thuoc
c bo sung nong o lien tuc thuoc se c phan bo lai nhieu lan. Trc tien, thuoc
c a vao d tr cac mo t o phan bo en cac ni khac xuoi theo dong chay cua
mau, en mo ch va phat huy tac dung. Du c phan bo au, thuoc cung co the nam
dang t do hoac ket hp vi cac thanh phan khac cua mo.
Viec phan bo thuoc mau phu thuoc vao so v tr gan va ai lc cua thuoc vi
protein. mo, s phan bo phu thuoc ly hoa tnh cua thuoc, mc o tuan hoan tai mo va
ai lc cua thuoc vi mo.

Chuyen hoa thuoc hay bien oi sinh hoc cua thuoc la khau quan trong khong the
thieu c trong toan bo qua trnh thuoc tac ong en c the va x ly cua c the oi vi
thuoc ma cuoi cung se cho 4 ket qua: chuyen hoa thuoc thanh chat vo hoat, chuyen
thuoc ban au von khong co tac dung dc ly thanh chat co hoat tnh, chuyen thuoc co
hoat tnh nay thanh chat co hoat tnh khac, tao ra vat chat co oc tnh.
Chu yeu do he microsomes cua gan am nhan, ngoai ra, con co tai phoi, than,
lach... thong qua cac phan ng oxy hoa, kh, thuy phan, tong hp ac biet la phan ng
lien hp v i acid glucuronic e tao thanh nhng phan t ester co cc cao, tan trong nc,
kho tham qua mang te bao, khong con hoat tnh dc l c va de ao thai ra ngoai.

- Yeu to di truyen: s khiem khuyet men do di truyen anh hng tram trong en
qua trnh chuyen hoa thuoc chang han nh thieu men pseudocholinesterase lam tr hoan
thuy phan succinyl choline keo dai tac du ng liet c cua thuoc.
- Yeu to khong di truyen: Tng tac gia thuoc va thuoc, cung mot luc dung 2
hoac nhieu loai thuoc th chuyen hoa cua moi thuoc noi chung b cham lai, thuoc b huy
cham.

ay la ng ao thai chu yeu cua cac chat co cc, tan trong nc, phan t lng
nho (PM < 500) hoac cac thuoc b chuyen hoa cham. S ao thai thuoc qua than gom co
3 tien trnh loc cau than, tai hap thu va ba i tiet ong than.
(1) Loc cau than
Dang thuoc t do cung nh chuyen hoa chat cua no trong huyet tng qua c
con dang ket hp th khong qua c mang loc cua cau than. Ty suat loc va ty le gan
ket thuoc co anh hng en toc o qua loc, thuoc se c bai thai rat cham khi ty suat
loc giam va o gan ket cua thuoc cao. C che nay phu thuoc lng thuoc gan vao
protein huyet thanh va toc o loc cua cau than.
Hau het thuoc c loc qua cau than tr dang gan vao protein huyet tng. S loc
qua cau than chu anh hng cua cac yeu to sau:
- Kch thch phan t thuoc: ng knh cua lo mao mach cau than khoang 50A
0
, s
loc qua cau than b han che vi cac thuoc co ng knh d > 20A
0
, con khi thuoc co
ng knh d = 42A
0
th khong the loc qua cau than.
- ien tch phan t thuoc: thuoc mang ien tch qua ca u than cham hn chat khong
mang ien tch v co tng tac tnh ien gia phan t c loc va ien tch am tren thanh
mao mach. V du: Sulfat dextra loc cham hn dextra trung tnh ngay ca khi kch thc
phan t cua chung tng ng.
- Hnh dang phan t thuoc: S khac biet ve hnh dang ba chieu cua ai phan t
thuoc han che s loc qua cau than. V du cac phan t hnh cau (nh protein) loc qua cau
than kho hn cac pha n t duoi thang nh dextran.
(2) S khuech tan thu ong
Qua trnh thuoc i t long ong than vao mau theo cach thu ong, xay ra oi vi
cac thuoc tan trong lipid va khong ion hoa. S khuech tan thu ong pH nc tieu (4,5
8,0), chu ong thay oi pH nc tieu gay ao thai thuoc theo y muon do lam tang dang
thuoc ion hoa.
V du: Neu ngo oc chat kiem yeu (quinidin, amphetamin..) nen acid hoa nc
tieu (bang NH
4
CL). Neu ngo oc thuoc la acid yeu (phenylbutazon, streptomycin,
tetracyclin, lumminan) nen kiem hoa n c tieu (bang NaHCO
3
).
(3) S bai tiet chu o ng qua ong than
Qua trnh nay chu yeu theo c che van chuyen tch cc, can co chat chuyen ch,
ngc chieu vi gradien nong o va co hien tng bao hoa. Hai thuoc co cung c che
bai thai giong nhau se co canh tranh c che v du nh penicilline va probenecid, ket qua
canh tranh c che la probenecid c bai thai ra ngoai trc. Co hai he thong van
chuyen chnh ong than.
- He thong van chuyen anion hu c: van chuyen penicillin, salicylat, acid
ethacrynic, probenecid, phenylbutazon, dan xuat glucuro, sulfo hp.
- He thong van chuyen cation: van chuyen mecamylamin, tolazolin,
hexamethonium, morphin, procain, neostigmin, quinin, amilord, triamteren va cac hp
chat noi sinh nh catecholamin, histamin, cholin va thiamin.
Moi thuoc co to c o bai tiet toi a (transport maximum = Tm) rieng, co thuoc pha i
qua chuyen hoa mi c bai tiet (chat lien hp). S bai tiet chu ong quan trong trong
ao thai thuoc v cac anion va cation thng gan vao protein huyet tng nen kho loc
qua cau than. S bai tiet chu ong thai thuoc hieu qua va nhanh. Mot thuoc c ao
thai qua than co t
1/2
< 2 gi co ngha la co 1 phan c bai tiet qua than. Co thuoc c
bai tiet qua ong than nhng t
1/2
dai hn v co tai hap thu thu ong ong uon xa.
He thong bai tiet nay van chuyen chu ong can chat mang nen co hien tng bao
hoa (khi nong o thuoc cao) va hien tng canh tranh. Hien tng canh tranh e bai tiet
gia cac thuoc co y ngha lam sang. S canh tranh sau ay la co li ve mat s dung
thuoc: probenecid canh tranh e bai tiet qua ong than vi penicillin, ket qua la
probenecid c bai tiet lam giam bai tiet penicillin nen keo dai thi gian tac dung cua
penicillin.
o la ieu mong muon trong tr lieu v thi gian tac ong cua penicillin ngan. Co
khi s canh tranh e bai tiet gia cac thuoc gay tac hai nh probenecid, khang viem
khong steroid (nh salicylat) canh tranh bai tiet vi methotrexat, lam giam bai tiet va
lam tang nong o huyet tng cua methotrexat gay oc tnh. Tng t khang histamin
H
2
lam giam bai tiet procainamid nen lam tang nong o huyet tng cua chat chuyen
hoa co hoat tnh cua procainamid la N-acetylprocainamid, gay oc. Quinin, verapamil.
diltiazen, flecainid, aminodaron lam giam bai tiet digoxin nen lam tang nong o huyet
cua digoxin gap 2 la n.
S tai hap thu t long ong than vao mau theo s khuech tan thu ong. Gradien
nong o mat trong va mat ngoai te bao ong than lam cho cac phan t chuyen dch t
ni co nong o cao e n ni co nong o thap di hnh thc khue ch tan.
Nhng chat acid yeu khong phan c c va nhng chat kiem yeu ca ong ln gan
va ong ln xa. Nhng chat tan trong m c ong than tai hap thu nhieu hn chat tan
trong nc. Nhng chat ion hoa, phan cc trai lai b ong than bai thai ra ngoa i. Do o pH
nc tieu anh hng en tai hap thu.
Cac thuoc kiem yeu hoac acid yeu chu anh hng rat ln khi o pH bien thien
t 5-8. V du: acid salicilic, mot thuoc toan yeu, gap phai s bien thien pH nc tieu t
6,4 kiem hoa len 8 th s bai thai cua no se tang 4-6 lan, cac thuoc khong phan cc se t
1% giam xuong 0,04%. ieu nay c ng dung trong viec giai oc tren nguyen tac la
tang cac dang ion hoa cua thuoc, la m thuoc de tan trong nc t o de thai ra ngoai.

1. Cac chat tan trong nc c bai thai chu yeu qua ng tieu.
2. Cac chat khong tan trong nc c bai thai chu yeu qua phan.
3. Cac chat kh, de bay hi c bai thai chu yeu qua ng ho hap.
4. Cac kim loai nang (As, Hg...) c bai thai chu yeu qua da, mo hoi.

La bat c thanh phan nao cua te bao, ket hp vi thuo c va khi au mot chuoi cac
hien tng sinh hoa e dan en ca c tac ong dc lc.
Ve ban chat hoa hoc, receptor la cac ai phan t sinh hoc nh acid nucleic, lipid
mang te bao nhng ha u het chung co ban chat protein, go m cac loai protein nh sau:
- Protein ieu hoa: lam trung gian cho cac chat noi sinh nh chat truyen than kinh,
autacoids, hormon.
- Enzyme nh dehydofolat redutase la receptor cua methotrexat.
- Protein van chuyen: Na
+
, K
+
ATPase la receptor cua glycosid tr tim.
Hoat tnh sinh hoc cua thuoc phu thuoc va o ai lc cua thuoc va receptor cung hoa t
tnh ban the.
Ai lc c bieu th bang hang so phan ly K
D
. K
D
cang nho nong o hon hp (thuoc
receptor cang ln tc thuoc gan nhieu vao receptor)
Hoat tnh ban the = kha nang phat sinh tac ong cua hon hp (thuoc receptor).
D: thuoc
R: receptor

Lien ket gia receptor vi thuoc la cac lien ket ion, hydro, k nc, vanderwal va
lien ket cong hoa tr. Trong o lien ket cong hoa tr ben vng nhat nen thi gian tac
ong se dai neu co lien ket nay.

- Tnh chon loc cao oi vi chat chu van (agonites). Nhat la nhng chat chu van
kch thch noi sinh nh chat dan truyen than kinh, kch to hoac nhng chat co hoat tnh
noi sinh. Can c vao chat chu van noi sinh ma at ten cho receptor nh cholinoreceptor,
adenoreceptor, dopaminergic.
- Tnh chon loc cao o i vi chat oi van (antagonistes). Chat oi khang canh tranh
la cho da quan trong e phan nh cac thu the N
1,
N
2,
H
1,
H
2
..
- Tnh nha y cam cao oi vi hieu ng sinh hoc. Ch can mot nong o nho chat chu
van cung u tao ne n hieu ng sinh ly, sinh hoa ro ret.
- Receptor khong phai la c chat cua men hoac chat canh tranh vi men. Receptor
co the la lipoprotein hoac glycoprotein, co the tao thanh men hoac n v th yeu cua
men nhng khong phai la c chat cua men nen khong b receptor pha huy.
K
1
DR D + R
K
2
[ D][ R]
[ DR]
K
D
=

- Tac dung tai cho : la tac dung xuat hien ngay ni ta cung cap thuoc.
V du: sat trung da, diet vi khuan ta i cho
- Tac dung phan xa: tac dung dc ly co c thong qua s dan truyen kch thch
t ni cung cap thuo c en c quan kha c qua he than kinh trung ng.
V du: ngi ammoniac; kch thch tuan hoan, ho hap
- Tac dung chon lo c: la tac dung rieng, ac hieu oi vi 1 hoac 1 so c quan.
V du: digitalin (Coramin) co tac dung u tien tren tim
- Tac dung trc tiep va gian tiep: tac dung gian tiep la hau qua cua tac dung trc
tiep. V du: tac dung trc tiep cua cafein la tang cng tuan hoan, tac dung gian tiep la
gay li tieu
- Tac dung chnh va tac dung phu : tac dung chnh la muc ch can at cua ieu tr,
tac dung phu la tac dung khong mong muon, co khi con gay oc cho c the. Do o, cac
nha ieu che dc pham luc nao cung co gang han che hoac loai bo hoan toan tac dung
phu cua thuoc.
V du: tac dung chnh cua Chloramphenicol la tieu diet vi khuan gay benh, tac
dung phu la gay suy tuy, thieu mau vo tao.

(1) nh ngha
Dc pham A goi la hiep lc vi dc pham B khi A lam tang hoat tnh cua B ve
3 phng dien: thu ngan tiem thi, tang cng o ta c ong, tang thi gian tac ong.
(2) Phan loai
- Hiep lc bo sung: la s hiep lc khi hoat tnh phoi hp cua hai dc pham bang
tong hoat tnh cua moi dc pham khi dung rieng re.
Cong thc: C = a + b Trong o: a la hoat tnh ban the cua A
b la hoat tnh ban the cua B
C la hoat tnh ban the cua A+B
V du: Scopalamin va morphin. Penicilline va streptomycine
- Hiep lc boi tang: khi hoat tnh cua hai dc pham ln hn tong hoat tnh cua
moi dc pham khi dung rieng re.
Cong thc: C > a + b
V du: Bactrim = Sulfamethazol + Trimethoprim
(3) C che
C che trc tiep: hiep lc do tac ong tren ni hap thu.
- Hiep lc tren cung ni tiep thu: Quinidin va cloroquin cung gan tren DNA cua
nhan ky sinh trung sot ret.
- Hiep lc tren ni tiep thu khac nhau: Atropin va epinephrine cung lam m rong
con ngi nhng tac ong tren hai ni tiep thu khac nhau. Atropin c che tac ong thu
hep con ngi cua acetylcholin tren c vong.
C che gian tiep: hiep lc tren cac giai oan hap thu, phan bo, chuyen hoa va
ao thai thuoc.
V du: phoi hp penicilline vi propenecid lam keo dai thi gian tac ong cua
penicilline v ca hai canh tranh e ba i tiet ong than.
Y ngha trong ieu tr
Phoi hp thuoc lam tang hoat tnh ma khong lam tang oc tnh
Tranh hien tng e khang thuoc
Tuy nhien, s hiep lc co the gay oc hai trong cac phoi hp sau:
- Thuoc an than v i ru ethylic
- Glycosid loai igital vi muoi Ca
2+
- Cac chat c che hoa t nang cua MAO vi norepinepherin hay epinephrine.

(1) nh ngha: hai dc pham oi khang nhau khi hoat tnh cua mot trong hai
dc pham lam giam hay tieu huy hoa t tnh dc pha m kia.
(2) Phan loai
oi khang do trung hoa phan ng hoa hoc: tac ong cua cyanur b tieu huy
bi hyposulfit Na, ng dung e giai oc cyanur.
oi khang canh tranh va khong canh tranh
oi khang canh tranh: la loai oi khang hoan toan trc tiep v tranh gianh cung
ni tiep thu. V du: Acetylcholine va atropin, histamin va thuoc khang histamin.
- oi khang canh tranh thuan nghch: khi chat oi khang khong gan chat vao ni
tiep thu. Do o, khi tang nong o chat chu van gay lai hoat nang cua chat nay. V du:
Acetylcholine va atropin.
- oi khang canh tranh khong thuan nghch: khi chat oi khang gan chat vao ni
tiep thu. V du: cha t khang epinephrine nh dipenamid, phenoxybenzamin.
oi khang khong canh tranh: chat oi khang tac ong vao ni tiep thu khac vi
ni tiep thu c hoat hoa bi chat chu van. V du papaverin la chat oi khang khong
canh tranh cua BaCl
2
hoac acetylcholin ta i c trn cua ruo t, t cung nen du co tang nong
o BaCl
2
hoac acetylcholin cung khong gay lai hoat nang cua chat nay.
Y ngha trong ie u tr
Tranh phoi hp hai dc pham oi khang dan en la m giam hieu lc thuoc
Giai oc trong trng hp ngo o c
1.4. Nhng yeu to anh hng en tac du ng cua dc pham
1.4.1. Cac yeu to ben trong c the
(1) Tuoi tac
gia suc non, he thong chuyen hoa cha hoan chnh nh thieu enzyme UDP
glucuronyl transferase nen de ngo oc khi dung cac thuoc c chuyen hoa theo cach
glucuro hp nh Chloramphenicol gay hoi chng xam thu non va de b nhiem oc
billirubin, trong khi gia suc gia chc nang cua cac c quan tren a b giam nen khi
dung thuoc cho cac oi tng tren can phai than trong.
S gan thuoc vao protein huyet tng kem.
Hang rao mau nao cha hoan chnh v vay can than trong khi dung thuoc tac o ng
len he than kinh trung ng.
He thong bai thai thuoc qua than cung cha hoan chnh nen thuoc c bai thai
cham hn thu tr ng thanh.
(2) Trong lng: can c vao trong lng hoac dien tch be mat c the e tnh
lieu lng thuoc can cap.
(3) Phai tnh: mc o nhay cam vi thuoc cua thu c va thu cai co the khac
nhau. V du: con cai nhay cam v i thuoc ngu, strychnin hn con c.
(4) Trang thai c the: mot so ca the nhay cam vi thuoc do bam sinh hay do thau
nhan., th ngay nhng lieu nho cung co the gay ra phan ng d doi, co khi nguy hiem
en tnh mang.
(5) Cach dung thuoc: lien quan en hien tng quen thuoc, le thuoc thuoc, e
khang thuoc.
(6) ieu kien dinh dng: trong thc an, protein ac biet lien quan en hien
tng gan ket thuoc cung nh cac enzym chuyen hoa thuoc.
(7) Tnh trang benh ly: ac biet la cac benh ve gan than lam thuoc chuyen hoa
va bai thai cham nen de gay ngo oc. Benh viem gan hoac x gan lam giam ham lng
cytochrome P
450
gan nen chuyen hoa nhieu thuoc b giam nh pyramydon,
mepropamate. Cac thuoc bai thai chu yeu qua than nh glycosid, quinidin khi s dung
can chu y oi vi thu mac cac benh ve than e tranh tch luy va gay ngo o c.

(1) Chat lng cu a dc pham: hang san xuat, ieu kien bao quan...
(2) Cau truc hoa hoc: 1 thay oi (du rat nho) ve cau tao hoa hoc cua dc pham
cung anh hng en tac dung cua d c pham o.
V du: PABA yeu to sinh trng cua vi khuan
Sulfonamid: thuo c chong vi khuan
(3) Tnh chat vat ly : co lien quan e n
o hoa tan trong n c va trong lipid e thuoc c hap thu vao trong c the
o boc hi: oi v i cac loai thuoc me bay hi
Dang bao che: bot, nc, dung dch treo...
(4) S hieu biet trong s dung
- Lieu dung va nong o: lieu toi thieu co tac dung (lieu ngng): lng thuoc cho
vao c the e bat au co tac dung.
Lieu ieu tr (thng cao hn lieu ngng): c s dung lam sang nham muc
ch khoi phuc chc nang bnh thng cua c the va gay ro i loan benh ly.
Lieu gay oc (cao hn lieu ieu tr): lieu bat au co nhng benh ly oc hai.
Lieu gay chet (LD50) gay chet 50% ong vat th nhgiem.
- Nhp cung cap thuoc: phu thuoc vao thi gian ban huy (T1/2) cua thuoc. T1/2 la
thi gian can thie t e nong o thuoc trong huye t tng giam i mot na.
Nhp cung cap thuo c (khoang cach gia cac lan s dung)
3-4 lan / ngay neu T1/2 t vai phut - 4 gi
2 lan / ngay neu T1/2 t 4 gi - 10 gi
1 lan / ngay neu T1/2 t tren 12 gi

Mot biet dc thng co 3 ten chu ye u sau:
Ten khoa hoc (chemical name): c goi theo cau tao hoa hoc cua biet dc o,
ten nay co khi khong c ghi tren nhan thuoc.
Ten hoat chat (generic), V du: ten hoa t chat (oxytetracyclin)
Ten thng mai: Terramycin (PFIZER)

Ch nh: s dung thuoc trong trng hp nao? benh g ?.
Chong ch nh: khong c phep s dung thuoc trong nhng trng hp cu the
nham e phong oc tnh va cac tai bien khi dung thuo c.
Ngoai ra co the co phan than trong khi dung thuoc (precaution).

Lieu lng se thay oi tuy theo ng cap thuoc, loai gia suc va muc ch s
dung.

Lien quan en ng cap thuoc:
- Bot tron vao thc an (Feed additive), nc uong (drinking water)
- Vien uong (tablet)
- Siro uong (syrup)
- Kem an (cream)
- Bot pha tiem (powder for injection)
- Dung dch tiem (solution for injection)
- Dung dch xt (spray)...

Qui nh phng cach bao quan nham tranh lam h hong cac hoat chat trong biet
dc
-
Cho biet thi han toi a co the dung thuoc.

Trong thu y, ngi s dung thuoc con can chu y en thi gian ngng thuoc trc
khi giet mo (oi vi heo tht, bo tht, ga tht...), trc khi s dung cac suc san (sa, mat
ong, trng ga...) e am bao van e an toan thc pham.
1
2 Chng 2. THUC TC DNG TR THN KINH
C C CH H THN KINH TRUNG NG
c m
Trc nm 1845, iu tr bng phng php gii phu cha c ph bin do bi th/u
phng php tha ng to ra trng thi m o nm 1845 146 h/u qa gy m ca nitrous
oxide v c tnh gy m ca c chloroform v diethyl ether c cng nhn. Nhng thng tin
ny nhanh ch ng tr th nh thac gy m cho ngnh dc thi by gi ng thi chng cng l
c c cht u ti n ca nhm thuc m bay hi.
Nm 1929, cyclopropan c gii thiu nh mt thuc m bay hi th 4. Trong 4 thac
n y ch c nitrous oxid cj n c s dng trn lm sng cho n ng y nay ther r cyc/opropan th
d gy chy n cj n ch/oroorm g y c cho gan.
C c ngh/ n cu tip theo v thuc m bay hi m chng c c tnh khng gy ch y n
cng nh khng c c tnh cao khng ngng pht trin, vo nm 1956 tm thy Halothan
(LT) n y hn, hai cht ether halogen ho c gii thiu l en/arane
(TC) r /so/arane () c d c tnh ca cc loi thuc m bay hi c
/ m g/m i rt nhiu tuy nhi n thac m dng qua ng ti m ch/ch rn c s dng rng r /
hn.
nh ngha
Thac m / cht khi cp vo c th s tc ng l n h thn kinh trung ng sinh ra trng thi
ng, u ti n / s mt thc v cm gic, k n l s gi n ngh ho n to n ca c vn, nhng
khang / m o trn cc hot ng ca h tun ho n r ha hp.
C ch tc ng ca thuc m
C nhi 'W W' '
t sinh l thn kinh
Thac m c ch cu trc li.
Thac m gn v o //p/d ca m ng t b o g y cn tr trao i Na+ qua m ng do ngn
cn s kh cc ca m ng t b o n n c ch s dn truyn ca lung thn kinh.
t dc l thn kinh
C c nron nhy cm phn bit vi thuc m
T b o sng lng ty sng rt nhy cm vi thuc m S gim hot tnh ca nron v ng
n y / m g/m dn truyn cm gic theo ng ty i th k c cm gic au (giai on 1).
Giai on c ch l do s kch thch cc nron c ch c ng ri s l m d d ng cc nron
k/ch th/ch
2
Thac m lm suy nhc cu trc li truyn ln a n c ch phn x ty g y g/ n c
(giai on 3).
Cc nron ca trung tm h hp v rn mch h nh ty tng i t nhy cm ri thuc
m (giai on 4).
Dc ng hc
Thac m / cht kh hoc cht lng d bay hi trc ti n r o phi, sang mu ri n n o
gy tc ng.
S thm nhp v o phi ph thuc nng thuc m trong kh/ h/t r o r s thang kh/ phi.
S thm nhp t phi v o m a ph thuc nng thuc m trong m a t/nh thm ca th nh
ph nang v c bit tnh hj a tan ca thuc m trong m akh/ ch s n y c ng cao thac m c ng
tan nh/u trong mu nn t lc cng trong ng mch chm, t cn bng trong n o chm r ry
g y cm ng chm. Thuc m n o /t tan trong m a g y cm ng nhanh.
Thac m / cht kh hoc cht lng d bay hi c o thi qua phi, mt phn c th
t/ch t trong cc m m, sau cng o thi qua thn hoc qua phi. Thac m ng tnh mch
o thi qua ng tiu dng mt hot tnh. Halothan / thac m bay hi duy nht cj n s dng,
khong 30% halothan c b chayn ha th nh gc t do (chlorotrifluoroethyl) gy c cho gan.
ethoy/aran / ether ha/othan h a h/n nay t c d ng r n 5 thac b chuyn ha th nh
/aor v oxalate gy c gan. Enfluran cng to fluor nhng vi s lng rt t, cj n 2 /t b
chayn ha. Tim lc ca thuc m dng ng h hp c biu th bng nng ph nang ti
th/u (MAC m/n/mam /rero/ar Concentrat/on) / nng thac mt atmosphere cn c ti
ph nang 50% bnh nhn khng p ng vi mt kch thch au c ti a chan ha.
i thuc m c mt MAC xc nh nhng MAC, nhng MAC c th thay i ri cc
bnh nhn t y theo tai, tnh trng t/m mch, cc thuc c s dng phi hp. h/ s dng c ng
/ c nh/u thuc m th g/ tr MAC ca chng cng lc vi nhau. / d Methoxyfluran c MAC
16 ngha l c 16 ph n t kh ht v o / methoy/aran
Thac m dng ng tnh mch o thi qua ng tiu sau khi b chuyn ha th nh
dng mt hot tnh. N2O c MAC > 100 l thac m yu nht.
Dc lc hc
Tc ng tr n t/m mch: halothan, enfluran v isoenfluran u l m g/m huyt p t l vi
nng trong ph nang ca chng.
Tc ng tr n ha hp: tt c thuc m dng ng h hp u lm suy nhc h hp; nhiu
nht l /so/aran r en/aran /t nht l d/ethy/ ether
Tc ng tr n n o: thac m / m g/m chuyn ha n o nhng lm tng lu lng n o do
g/m sc cng mch n o
3
Tc ng tr n thn: thuc m / m g/m tc ca cu thn v lu lng thn do g/m sc
cn mch thn.
Tc ng tr n gan: thac m dng ng h hp l m g/m lu lng gan t 15 45 so ri
trc khi gy m
a ca vic d c m
ng trong phu thut
ng chng shock, co git
ng trong g y ng, gim au
Cc giai on ca thuc m
Giai on 1: Gim au
Th cj n tnh nhng bun ng, p ng vi kch thch au gim. Mc gim au thay i
/n gia cc thuc, r nht vi eter v n/troas oxid nhng km vi ha/othan
Giai on 2: Kch thch
T khi th mt thc n khi bt u h hp c nhp iu. Th mt thc, khng cj n p
ng vi kch thch ngoi tr kch thch au. Lc n y thac m c ch v n o / m mt s khng ch
ca v n o i ri cc trung tm vn ng di v kh/n th trng thi kch ng, giy gia, pht
t/ng k a trong hng, bn chn c ng kiu nga phi, h hp su v chm, m mt m rng, ng
t gin, ch th i ma, cc cht nn c th lt qua kh qun gy vi m phi r c th dn n t
rong
Giai on 3: Phu thut
Thac m c ch vng di v v ta sng gy mt thc, mt phn x, gi n c r n /a/
on n y c th nhn bit khi s h hp u, tip theo l phn x ng m mt khi kch thch gic
mc, ngng c ng mt, h hp tr n n chm v u n, nhp tim v hayt p bnh thng.

t c d ng trong th y S d ng qa //u thuc m s dn ti m s a
a hp u nhng chm
C hon ton gi n th mm nhn
Phn v nc tiu b / thi ra ngo /
t phn x m mt
h/t c th gim, th run v co mch
Giai on 4: T t h y
Thac m c ch trung khu h hp v rn mch h nh ta gy lit h hp ho n to n dn
n ngng h hp v ngng tim, th c th cht sau 3 4 ph t ry khng nn vt qu giai
4
on 3.
h/ ngng s dng thuc m hot ng ca trung khu thn kinh hi phc theo th t ngc
/i (hot ng ca trung khu n o mt sau th hi phc trc).
ng tai bin lc gy m v cch ph
Chy nc bt, nn ma
Cho th nhn i ti th/u 12 gi trc phu thut
Tim Atropin l m g/m tit nc bt
Shock
c im: tt huyt p, th gi y g/a do ty sng b c ch.
Can th/p: tng huyt p bng cch truyn mu, truyn dch, d ng c c /oi thac kch
th/ch thn kinh nh: Nikethamide, mphetam/n Cae/n Camphorate
thn nhit
Cn gi m th lc gy m (dng n hng ngoi si m).
n ca thuc m
hi pht nhanh v m du, hi phc nhanh.
hong cch an to n rng.
/ n c hon ton, mt thc, gim au c ch phn x ni tng.
t nh hng chc nng sng (tim mch, h hp) bo v phn x.
hang b chuyn ho th nh cht c v o thi nhanh.
/n nay khng c thuc m no t tt c cc ti a chan tr n ch/nh r ry phi phi hp
/i dng cc u im v /oi b nhc im ca tng thuc.
la chn thuc m
Tr a bj : etam/ne
Ch m o: o/et// etam/ne arb/ta/ sod/am
eo: Pentobarb/ta/ Th/openta/ sod/am
ga: Ketamine
c m dng ng tnh mch
1. Tnh ch W
hi pht m nhanh r 2 / do:
t tan trong lipid n n qaa h ng r o m a n o rt nhanh.
Ph n phi nhanh n cc m c lu lng mu cao (n o t/m gan thn)
T c dng ngn hn (20 3ph t) d chayn ha rt chm do ti phn phi n c c ma c
lu lng mu thp (m m, c vn nn nng trong n o g/m nhanh, t c dng gy m chm dt
5
nhanh)
S gim lu lng tim (suy tim sung huyt) th t l mu n n o tng (v c th lun u
tin ti mu cho n o) r ry phi gim liu thuc trnh suy thn k/nh trang ng nng, tri li
nu tng lu lng tim (lo lng thi qu, nhim c tuyn g/ p) th tng liu thuc m i bnh
nh n cao tai n n d ng //u thuc m thp r c /u lng tim thp, khi tht c th gim v g/m
thanh thi thuc.
hn chang thi g/an b n hy ca thuc m dng ng tnh mch u d / r ry nu ti m
tnh mch lp li nhiu ln c th gy tch t thuc trong c vn v m m n n bnh nhn tnh
chm. V ry n n day tr m bng cc thuc c thi gian bn hy ngn (14 g/) nh ketamin,
methohe/ta/ m/dao/am droper/do/ etom/date propoo/
2. Ch | QK
Cm ng m : hu ht thuc m ng tnh mch c d ng cm ng m trc kh/ d ng
thac m ng h hp. Thiopental l thac cm ng m thang dng nht, etopidate v propoo/ /
cht thay th. Tt c u duy tr t c dng 20 3 ph t nu ti m tnh mch.
y m day tr trong c c phu thut ngn, khng cn th m thac m ng h hp:
propoo/ ketam/n m/dao/am
Phi hp duy tr m kh/ cn tc dng gim au v g y ng: thuc m /oi narcot/c (t/ m
tnh mch).
sung cho thuc m ng h hp.
i thuc m
c m khng bay hi

u trc ha hc
L cht chuyn ha ca acid Barbituric. Acid barbituric l ac/d mnh, rt d phn /y n n
khang thm v o thn kinh trung ng v ry khng c tc dng gy ng. arb/tarat / ac/d ya /t
phn ly, phn khng phn ly tan c trong lipid v thm qua c h ng r o m a n o nhaa tha/
ao gm nhiu loi thuc c tc dng gy m d / hoc ngn.
arb/tarate c ch gii phng acetylcholin, norepinephrin v g/atamate cng c h/u
qa tr n r pentobarb/ta/ to th nh m/met/c c g/m au c to ra t y
6
thac v o //u, ng cp, dc ng hc ca thuc v /o / iu tr. Ngo / ra h/u qu ca thuc
c th thay i bi tui v iu kin vt l ca bnh nhn hoc bi s hin din ca thuc khc.
hng thuc nhm barbiturat suy yu cm gic v ng r n o / m g/m hot ng ca dy
thn kinh vn ng v to ra s gim au nhng liu thp. Mt v / barbiturat nh phenobarbital
c s dng nh thuc chng co git bi v ch ng c khuynh hng gim hot ng ca dy thn
k/nh rn ng nhng gim au khng ng k. ngi, n c xem nh l nhng barbiturat l m
g/m s chuyn ng linh hot ca mt (REMrap/d eye morement) g y ra trng thi ng.
u ht cc lo / barb/tarat c th / ngay n nh n g y say g/m chc nng h hp nhng
mt s lo / th c th kch thch nh. Nhng liu an thn hoc gy ng, s gim nhp h hp tng
t nh trong sinh l g/c ng bnh thng. Khi tng liu, s suy yu trung tm h hp h nh ty
tng ln kt qu l g/m nhp th, hn m s a r L S ngng h hp khong 4 gi thp
hn nhng liu m n / ngay n nh n g y ngng tim.
Thac c s dng ch trn mo, chng c bit nhy cm vi nh hng l m say g/m
chc nng h hp ca barbiturat. Tr n ch barb/tarate g y chng tim p nhanh, c tim co li v
i khng vi tng s ngoi bi n (tota/ peripheral). Barbiturat l nguyn nhn lm rn v nha
ng ca h thng c trn rat. Tuy nhi n nhng nh hng n y th khang at hin nhiu du
h/u lm s ng arb/tarate / m g/m nhy cm ca a cui c ng (endp/ate) d y thn kinh rn
ng vi acetylcholin, do lm th gi n nh c xng. Do bi h thng bp c khng th gi n
ho n to n s gi n ngh nhng c xng khc c l cn thit cho th tc g/i phu.
Cha c nh hng chnh xc tr n thn ca barbiturate, nhng mt v / s h hi r thn c
th xy ra tip theo chng thiu mu khi s dng qu liu. Chc nng gan th cng cha c nh
hng chnh xc khi c s dng cp tnh nhng khi d ng barb/tarat k o d / g y nhy cm vi
enyme h thng microsomal ca gan th c chng minh (c bit l phenobarb/ta/)
c d barb/tarat / m g/m ti a th oxy tt c cc m, khng lm thay i mc chayn
h a th c o lng khi d ng //u an thn. Mc chuyn ha c bn c th gim dn n kt
qa l g/m nhit c th khi barbiturat c d ng nhng liu gy m
Phenobarb/ta/ sod/am d /
arb/ta/ sod/am d /
mobarb/ta/ sod/am trang bnh
Pentobarb/ta/ sod/am ngn
Secobarb/ta/ sod/am ngn
Th/openta/ sod/am rt ngn
Th/ama/y/ sod/am rt ngn
Th/a/barb/tone sod/am rt ngn
7
n ha
arb/tarate b chuyn ha bi enzyme microsom gan nhm th C5, cc cht chayn ha
// n hp vi acid glucuronic ri b o thi qua nc tiu. Kim h a nc tiu lm tng s o thi
n y arb/tarate g y cm ng enzyme microsome gan nn lm tng tc chuyn ha ca chnh n
r c c cht ni sinh v ngoi sinh cng chuyn ha qua microsom gan.
nh
n thn, gy ng: phi hp vi cc thuc khc tr cc ri lon chc nng v t/ a h a
sng vim niu o, bnh ng h hp.
L m g/ n c, chng co git: thng d ng phenobarb/ta/ c thi gian tc ng d /
Gy m: dng barbiturat c tc ng cc ngn nh thiopental.
Tng tc thuc
Ru ethylic v c c cht c ch thn kinh trung ng khc lm tng c tnh ca
barbiturate. Barbiturate thng phi hp vi griseofulvin, hormon steroid, d/pheny/hydanto/n c c
dn xut coumarin, vitaminD
c tnh ca barbiturates
T/ m qa nhanh hoc qu liu
Try ha hp, phi cp cu bng th oxy
huyt n o m ng n o
Say gan tr n c c th b bnh gan khi dng nhm barbiturates tc ng ngn
Khng dng cho th s sinh do khong an to n hp v thi gian tc ng ko d /
1. Pentobarbital sodium
- C 'WU 'Ri '
- Tnh ch W'yD' ''N 'P i, c m u tr ''G 'E W'WL'W 'R 'G ' W' hj a
tan trong nc v a/coho/ pa 75 /coho/ hoc propylene glycol c kt hp v o dang dch
tim tng tnh n nh, khng n n pha r o dang dch c tnh acid.
hng dung dch hoc nhng thuc c bit l c tnh tng hp vi pentobarb/ta/
sod/am: dang dch dextrose (IV), dung dch ti m /ngers /ngers /actate Sa//ne phc hp
detrose sa//n phc hp dextrose Ringers, phc hp dextrose /ngers /actate am/kac/n sa/ate
am/nophy///n atrop/n sa/phat ca/c/am ch/or/d cephap/r/n sod/am ch/oramphen/co/ sod/am
sacc/nate hya/aron/dase hydromorphone C/ //doca/n C/ neot/gm/n methy/sa/phate
scopa/am/n r sod/am b/carbonate sod/am /od/ne th/openta/ sod/am r rerapam/n C/
hng dung dch hoc nhng thuc c bit l khng tng hp ri pentobarb/ta/ sod/am:
benqa/nam/d C/ batorphano/ tartrate ch/oroma/n C/ c/met/d/n C/ ch/orphen/ram/n
ma/eate code/n photphate d/phenhyram/n C/ droper/do/ phentany/ c/trate proper/do/ phentany/
c/trate g/ycopyrro/ate hydrocort/so/ sod/am sacc/nate hydroy/ne C/ /nsa//n meper/d/n C/
na/baph/ne C/ norep/nephr/ne b/tartrate oytetracyc//n C/ pen/c////ne potass/am
- Ch th nghi n lo i g r co g/t
cho m o r ch hang dng iu tr co git do bi ng c //doca/ne
Pentobarbital c s dng nh thuc gim au v g y t cho nga, bj heo d cu.
Thng dng sau khi t/ m thac tin m gim liu pentobarbital v tr nh t c dng ph.
Pentobarb/ta/ / th nh phn hot ng chnh trong nhng dung dch m g/ p cho bnh nhn mc
bnh nan y cht khng au n.
- ang
hoc cp qua ng trc tr ng Thac bt u c tc dng t 10 15 ph t saa kh/ ang, khong 1
ph t saa kh/ t/ m
/ng nh nhng thuc khc trong nhm barbiturat, pentobarbital phn phi nhanh ch ng
n hu ht cc m ca c th nhng tp trung cao nht gan v n o 3545 thac li n kt vi
prote/n hayt tng, thuc qua c nhau tha/ r sa.
Pentobarbital c chuyn ha gan, b / thi qua nc tiu. Th nhai li, c b/t d r
cu, chuyn ha pentobarbital rt nhanh.
- Ch bnh tim
hoc bnh h thng h hp hang d ng //u cao cho bnh nhn b vi m thn cp hoc suy gim
chc nng h hp, bnh gan.
h/ t/ m tnh mch phi ti m tht chm. Thuc c th l m g/m chc nng h hp khi gy
m. Mo c khuynh hng c bit nhy cm vi hiu qu l m g/m au h thng ha hp ca
barb/tarat r ry cn ch khi s dng cho lo / n y o c nhy cm vi nh hng ca
barbiturate hn mo ci.
- B n ch trong th phc
kh/ d ng //u gy m arb/tarate c th gy kch ng khi tim di da mch mu ngoi bi n
khng dng ng tim ng mch.
- narcot/c
phenoth/a/ne ant/h/stam/n ra/pro/c ac/d r ch/oramphen/co/ h tha m g/ /

pentobab/ta/ g qa/n/d/n theophy///n metron/dao/e
Pentobarb/ta/ ph arosem/de c th nh tr
c th m a c
- Li ng:
n th o: 24mgkg t/ m t
y m cho ch : 13mg kg t/ m t
Ch m m d 12 gcon t/ m t
L m m d n heo: 2 mg kg th
T/ n heo: 2 4 mg kg th m t g y t r ng
g/
2. Thiopental sodium
- C
- Tnh ch m u tr th
d a tr ng j a tan trong n c Th/openta/ c pa76 r /
m
L loi barbiturate tc ng rt ngn, l thuc m c tc ng mnh, nhanh v ng
h
h
ch/oramphen/co/ sod/am sacc/nate hyag/aron/dase hydrocort/so/ sod/am sacc/nate neot/gm/n
methy/sa/phate o/to/n pentobarb/ta/ sod/am phenobarb/ta/ sod/am potasa/am ch/or/de
scopa/am/n r sod/am /od/ne r tabocarar/ne ch/or/de
h /actate
am/kac/n sa/phate atrop/n sa/phate ben/qa/nam/de cephap/r/n sod/am ch/oproma/n
code/nphotphat d/menhyr/nate epher/n sa/phate g/ycopyrro/ate hydromorphone /nsa//n
/erorphano/ b/tartrate meper/d/n metaram/no/ morph/ne sa/phate norep/nephr/ne b/tartrate
pen/c////ne potas/am

- Ch th v sod/am
ch kh c r / ch day nh

- m t tr tr
th / ng m Tha o n o saa
o b r
ma m o
Tha c b / th
kho 4 tha j n ho
Th/openta/ c th
- Ch t/ m t
m
- B o c th nh tr m thu c c th
m t n m hypog/ycem/a
- Li ng: li m cho ti 35 mg / kg, ti m t
// 15 mg kg t/ m t
-
3. Thiabarbitone sodium
L/ ch m o: 72 mg kg t/ m t
L/ a g y m cho ng 33 mg kg t/ m t c th
m th
(2) KETAMIN
Cu trc ho hc
Tnh cht
etam/n c m a tr 25261oC
j a tan trong n ) r a/coho/ (1g14m/) hang tr r
d/aepam trong c ng m m ho m t ( bag) r c th
11
Dc lc hc
etam/n / /oi thuc m hot ng nhanh. Ketamin c ch GABA v cng cn tr
seroton/n norep/nephr/ne r dopam/n n o n to ra trng thi m giai on 1 r 2 khang c
giai on 3. Tr n m o saa kh/ d ng etam/n c th gy gim th n nh/t trung bnh 16oC Saa kh/
t/ m tnh mch khong 306 g/ y t/ m bp t 3 ph t ketam/n bt u hot ng. S hi sc s
k o d / nu ketamin c s dng phi hp vi barbiturat, benzodiazepines, hoc narcotics.
etam/n / /oi thuc gy m r g y mt cm gic c tc ng mnh. liu c tc ng gy
m r g y mt cm gic (1mg/kg) s l m cho bnh nhn at hin h nh r/ t ch b/t vi mi
trng xung quanh, bnh nhn xut hin trng thi khng ng, mt m, nhng c ng t do v
thc. Thuc cng c th gy o gic nh hng n tm thn nhng trng hp d ng qa //u.
C ch tc ng: c ch cht dn truyn
T c dng: gy m ngn, gim au do can thip v o h/u ng m ng t b o kh/ chu cht dn
trayn thn kinh ac/d g/atam/c etam/n / cht gy m qua ng tnh mch duy nht c kch
th/ch t/m mch: nhp tim, huyt p ng mch v cung lng tim u tng r rt. Ketamin lm tng
/ang mu, tng ti a th oxy n o
T c dng ph: Tng tit nc bt do cn d ng trop/n / m cht tin m (1 mg1
kg th trng).
i lon tm thn (phj ng nga bng Diazepam)
Tng nh nhp tim v tng huyt p
etam/n / cht gy m qua ng tnh mch duy nht c kch thch tim mch: nhp tim,
hayt p ng mch v cung lng tim u tng r rt. Ketamin l m tng lung mu, tng ti a th
oy n o
etam/n khang nh hng n chc nng h hp liu thng thng nhng d ng //u cao
s l m g/m chc nng h hp.
Dc ng hc
etam/n ph n phi n hu ht trong c th nhng tp trung cao nht n o gan phi v
ma m. Thuc li n kt vi protein huyt tng khong 50% nga, 53 ch, 3753 m o
Ketamin c chuyn ha gan v b / thi dng cj n hot tnh trong nc tiu.
ng ch nh
etam/n chng ch nh vi nhng bnh nhn nhy cm vi n, c th tng p lc ca h
thn kinh trung ng. Trn nhng con vt c du hiu mt mu j / hi cn gim liu ketamin.
hng bnh nhn cng gip c th tng huyt huyt p v nhp tim nu d ng ketam/n hng du
h/u trong th y th cha c bit.
12
t m o rn m sau khi d ng ketam/n r ry n n kt hp vi cht bi trn gic mc bo
r mt trnh cc chn thng, ngn nga s kh gic mc. Bi v ketam/n c th lm tng p sut
m a cn thn v ngay c gy xut huyt sau khi gii phu l rt cao. Khng cn thit phi ch
n loi thc n cho n v nc ung cang cp cho th trc khi gii phu nhng c nhng
ngh l nn ngng thc n khong 6 gi trc khi gii phu.
hong 20% s m o d ng ketam/n gp tnh trng co git sau khi d ng //u iu tr. C th
gy au v tr tim. gim bt nhng nh hng do bi qu nhy cm vi thuc hoc nhng du
h/u khc ca h thn kinh t tr, atropine hoc glycopyrrolate thng c ti m kt hp.
u
Ketamin c xem nh l c ch s cao trong tr liu (khong 5 gi hoc hn khi so s nh
ri pentobarbital). Khi d ng thac vi liu qu mc hoc ti m nhanh s xy ra du hiu suy gim
ha hp c th iu tr bng cch s dng cc thuc tr sc. Yoh/mb/ne ri 4aminopyridine c
xut s dng nh mt cht i vn ch yu.
Tng tc thuc
arcot/cbarb/tarates hoc diazepam nu c phi hp c th ko d / thi gian g y m ca
ketam/n h/ s dng vi halothane, tc dng gy m ca Ketamin c th ko d / r nh hng
k/ch th/ch t/m ca ketamin c th b c ch. Tng t, chloramphenicol (ngoi ti a h a) c th ko
d / h/u qu gy m ca ketam/n Thyro/d hormones khi dng ng thi vi ketamin c th gy
tng huyt p v tim p nhanh ngi v proprano/o/ c th c li trong iu tr nhng nh hng
n y Sacc/ny/ cho//ne r tabocarar/ne g y nh hng hoc ko d / s suy gim ha hp.
u d

+ Diazepam 0.5 mg/kg IV diazepam, sau dng ketamin 10mg/kg IV (ooth
1)
/dao/am 66 22mgkg hoc IV, sau d ng ketam/n 6611mgkg
(ansager 1)
+ Xylazine 2.2mg/kg IM, sau 10 pht tim ketamin 11mg/kg IM. Ch c trng
lng >22.7 kg th g/m liu ca c hai thuc khong 25% (Booth, 1988).
trop/n 44 mgkg saa 15 ph t t/p tc cho xylazin 1.1mg/kg, IM, 5 ph t
sau dng ketamin 22mg/kg, IM (Booth, 1988).
t hp Atropin hoc glycopyrrolate trc khi ti
ketamin gim bt s nhy cm ca dc phm, 24mgkg hoc 1133mgkg (ar/d
15)
j : T/ m trop/n hoc xylazin, sau ti m ketam/n 2mgkg (Tharmon r enson
13
16)

+ Tim Atropin, sau tim ketamin 11mg/ kg IM. ko d / thi gian gim au v tng
thi gian gy m n n t/ m th m ketam/n 24mgkg
etam/n 22mgkg kt hp vi acepromazin 1.1mg/kg , IM (Swindle, 1985).
t/ m tnh mch 2 5 mg kg th trng liu u
L/u duy tr bng //u u, cch nhaa 1 ph t Thac d ng cho c c /o / g/a s c

Thac m d ng cho t/u gia sc (Ch m o)
T/n m bng Atropin liu 1 mg / 10 kg th trng
Saa 1 ph t ch/ch o/et//
u d
Ch : 725 mgkg th trng (ti m bp), 51 mgkg th trng (ti m tnh mch)
o: 115 mgkg th trng (ti m bp); 7,5 mg/kg th trng (ti m tnh mch)

u trc ho hc
t ha hc
entany/ c/trate c m a trng, dng bt tinh th, tan yu trong nc v a/coho/ khang m /
r, pKa = 8.3 v nh/t tan chy 147152oC
entany/ c/trate / mt butyrephenone an thn, c m a trng n v ng s ng khang c hnh
dng nht nh hoc c dng ht kt tinh ln. Hj a tan nc (1g/10 L) v a/coho/ (1g6m/) khang
m / r, pKa =7.6 nh/t tan chy 14414oC hng sn phm thng mi Innovar v
nnorar et p khong 335
o qun/ tnh bn vng/ tnh cnh tranh
ng thuc ti m hay / thy tinh th c bo qun nhit phj ng r tr nh nh s ng
nnorar c th tng hp vi c c cht sau: W, lactated Ringers, D5 trong /actate /ngers
potass/am ch/or/de r sod/am b/carbonate
14
Dc lc hc
h m batyrephenones (r/ d nh Droperidol) c xem nh l mt lp thuc an thn v
g/m au (hiu qu gim au thp hn phenothiazines) hot ng nh mt cht chng nn, gim
hot ng ca dy thn kinh vn ng v c ch catecho/am/n ca h thn kinh trung ng
(dopam/n norep/nephr/ne) Tr n ch ,QQRYDU |Oj P|W Q|P F| ||WRQH||F D|WK Q|NLQK|P t |Y
l m gi P|K W|i S| Q mch. Tr n mo, gy tng nhp tim Innovar gy tng nhp tim.
dng/ch nh
entany/ trong th y ch c cho php d ng tr n ch th c s dng mt mnh
g y m an thn cho tiu phu, nha khoa, phu thut chnh hnh c c thao t c phu thut trong thi
g/an ngn. N gp phn ngn chn tnh kch ng tr n ch. Fentanyl/ Droperidol c s dng nh
thac an thn/ gy m tr n m o
Dc ng hc
ot ng ca thuc s xy ra sau khi ti m tnh mch trong vj ng r / ph t r d / hn khng
ng k so vi ti m bp. Tr n m o saa kh/ t/ m S h/u qu tc ng y ra sau 20 3 ph t
To n b thuc c chuyn ha gan v b / thi qua nc tiu. Hiu lc ca thuc ko d / 34
ph t saa kh/ t/ m tnh mch, hu ht th s c an thn khong v / g/ sau khi ti m saa kh/ ngng
g y m Cn khong 15 g/ ch hi phc ho n to n saa kh/ g y m thac bng ng tnh
mch.
ng ch nh/ch
Khng c b sung thuc v o thc n cp cho th. S dng ch vi cc thac cc
thac l m m du h thn kinh trung ng, cn g/m liu d ng c c thac m kh c kh/ d ng kt hp
nnorar L/u d ng ca pentobarbital cn c gim khong 4 gi sau khi d ng nnorar t/ m
mch ngoi vi c th gy kch ng cc ma ang qaanh cn trnh s thot mch. Ch sn c c
th khng hiu qu g y m ca Innovar liu thng thng nhng chng cng gy r ng mnh
t/t nh/u nc bt, ti a chy.
t li/cnh bo
t li ca Innovar tr n ch bao gm i tiu, y hi, suy gim h hp, gy au, g/t nh n
cu. Tim p chm v t/t nhiu nc bt c th thy nu th khng c iu tr vi atropin hoc
c c thac i giao cm khc. Hi chng c gi l oody chestc th xy ra sau khi ti m tnh
mch nhanh. H thng bp tht v ng ngc tr n n rn chc v / m cn tr s th bnh thng
nhng c th iu tr vi na/oon c c thac d n c. Kch thch thn kinh trung ng, tht iu vn
ng, hot ng bt thng c th thy heo sau khi ti m bp.
u
15
a //u l m nh hng nhiu nht n h thng h hp v hoc c ch h thn k/nh trang
ng. Th mi sinh nhy cm vi nh hng ca thuc hn th trng thnh. Cc tnh c khc
bao gm suy yu tim mch, r ng mnh co cng c v co g/t. Naloxon l thac c chn iu
tr suy gim h hp.
u qu liu nghi m trng, cn d ng na/oon th m //u /p li, n n k/m tra cht ch
g/m bt cc nh hng ca naloxon trc khi fentanyl t ti cc mc di c t (subto/c)
n s dng cc thit b tr h hp trong trng hp suy g/m chc nng h hp. 4
aminopyrimidin c chng minh l hot ng nh cht i khng vi droperidol tr n ch liu
5mgkg t/ m tnh mch. Pentobarbital (6.6mg/kg) dng trong iu tr cc nh hng tr n h thn
kinh trung ng (co g/t), dui thng hoc co cng c c.
Tng tc thuc
C c thac l m m du thn kinh kh c (thac khng histamin, phenothiazines, barb/tarates
thac an thn, alcohol,) c th lm suy nhc h thn kinh trung ng v h h hp khi c s
dng vi fentanyl (opiate). Thuc m /oi opiate th chng ch nh i vi bnh nhn ang d ng
c c cht c ch monoamin oxidase (MOA) (t khi c d t 14 ng
t ny. i vi droper/do/ (batyrephenones) c c cht l m m du thn kinh trung
ng nh (barbiturates, narcotic,) c th gy suy nhc h thn kinh trung ng nu c s
dng vi (butyrephenones).
u d

Cn ngn nga tnh trng tim p chm v t/t nhiu nc bt, atropin (0.045 mgkg S)
hoc glycopyrrolate nn c ti m khong 15pht trc khi ti m tnh mch hoc tim ng thi vi
t/ m bp.
a) /m au, an thn: 1ml/6.81kg (1115 m/kg) t/ m bp hoc 1ml/11.3527kg
(37 m/kg) t/ m tnh mch.
b) y m :1m/12kg t/ m bp hoc 1ml/11.35273kg t/ m tnh mch. Cn t/ m th m c c
/oi thuc m nh barbiturates, halothane khong 10 pht sau khi ti m t/ m bp v 1 ph t saa kh/
t/ m tnh mch.
c) an thn: 0.35m/55kg t/ m tnh mch.
T/n m : 1m/2kg t/ m bp.
Gy m l m d n d d y: 1m/13kg pha /o ng trong dang dch c cha mai, ti m
chm tnh mch (Morgan, 19)

1m/kg th trng, SQ, hiu qu cao nht xy ra gia 306ph t saa kh/ t/ m (randy r
16
eath 17)

u trc ho hc
t ha hc
L mt imidazobenzodiazepin, midazolam c m a trng n v ng s ng dng bt t/nh th
ri pKa =6.15. Tnh hj a tan trong cht lng ca midazolam HCl tu thac v o p nhit
25oC r p34 13 mg m/dao/am C/ hj a tan trong 1ml nc.
o qun/ tnh n nh/ tnh tng hp
o qun nhit phj ng (153oC) tr nh nh s ng
Midazolam c tnh tng hp vi cht sau: D5W, lactated Ringers, atropin sa/phate
entany/ c/trate g/ycopyrro/ate hydoy/ne C/ prometha/ne C/ saatany/ c/trate ketam/n C/
meper/d/ne C/ morph/ne sa/phate na/baph/ne C/ scopo/am/n r
Dc lc hc
/dao/am th hin hot tnh dc lc tng t benzodiazepin.
dng/ch nh
h/ kt hp vi cc thuc m c h/u lc mnh (ketamin hoc fentanyl) to hiu qa an thn
cao ngi, midazolam l m g/m nh hng ca dreamlike, tng p sat mch mu v nhp tim
do ketam/n g y ra
h/ so s nh ri cc thuc d ng g y m cm ng nhm thiobarbiturate (thiamylal,
th/obenta/) m/dao/am c h/u qu l m g/m au tr n t/m phi thp hn, l mt cht c th hj a tan
trong nc, c th trn ln vi mt v / cht khc, v khang c khuynh hng tch ly trong c th
saa kh/ d ng //u lp li.
/dao/am rt c hiu qu khi d ng mt mnh nh cht gy cm ng m /c ng dng
thac tr n / m s ng trong th y cng nh vic phi hp vi cc loi thuc kh c n n c s ch dn.
Dc ng hc
Saa kh/ t/ m bp, midazolam hp thu rt nhanh v gn nh hon ton (khong 1) c
17
d c c ch phm midazolam bn tr n th trng khng d ng qaa ng ung nhng midazolam
c hp thu rt tt sau khi ung. T l thuc li n kt ri protein rt cao (947) r qaa h ng r o
m a n o mt cch nhanh chng.
Thac c chuyn ha gan. Cht chuyn ha cj n hot tnh c hnh th nh (
hydroxymidazolam) nhng bi v thi gian bn hy ca n rt ngn v hot ng dc lc hc
chm hn nn hiu qu lm sng khng ng k. ngi, thi g/an b n hy v thi gian hot ng
ca thuc trong huyt thanh c xem nh ngn hn diazepam. Thi gian bn hy ca diazepam
ngi khong 2 gi trong kh/ m/dao/am khong 30 gi.
ng ch nh/ch
nh nhn nhy cm vi benzodiazepines, tng nh n p cp tnh v ry cn trnh tim ng
mch v nh bnh nhn b bnh gan thn, sung huyt tim c th l m b / thi thuc chm. Cn ch
tr n bnh nhn b hn m shock say g/m h hp i ri thuc, phn phi ca midazolam v o sa
th cha c bit nhng benzodiazepin kh c r c c cht chuyn ha ca chng th ph n phi v o
sa v c th g y nh hng tr n h thn kinh trung ng.
t li/c
Thac gy nh hng n nhp h hp, nhp tim, huyt p. Suy gim h hp thng thy
tr n bnh nhn nhn thuc nhm narcotic hoc COPD. Bt li thng thy khong 1% nhng >5%
tr n bnh nhn nhn midazolam: gy au ch ti m d ng cc b, au u, ban nn, i ma v
nc.
Tng tc thuc
S dng barbiturates hoc cc thuc l m m du thn kinh trung ng khc c th gy tng
say g/m h hp n mc nguy him. Narcotic (bao gm Innovar) c th gy tng nh hng gy
ng ca midazolam v g y g y g/m th n nh/t khi d ng chang ri meperidine. Midazolam c th
g y g/m liu quy nh ca cc thuc m bay hi hay thiopental.
u d
Ch m o: 66 22mgkg hoc IV. Nga: 0.01144 mgkg (andsager 1)

u trc ho hc
C
12

1

Tnh cht
L m n a d//sopropy/pheno/) ang d m d
ch nh 225mgm/ g/ycero/ 12mgm/ /ec/th/n tr Propoo/ cj n

Bo qun/ tnh n nh/ tnh tng hp
ang d m propoo/ c
ch m t
m
Dc lc hc
Propoo/ / ch kh ho
c ch ch c m ch
g y m (sabenesthet/c) propoo/ g y an th ch nh r/ m
qaanh n t/m m propoo/ bao g
h
Tha m tha ng //
nh/ khang c ho
t/nh ch m g/
S dng/ ch nh
o trong kh/ qa
ho
Dc ng hc
Saa kh/ t/ m t o h ng r o m a n o r m
saa 1 ph t Th 5 ph t 5 tha n k prote/n hay
tha/ hj a tan cao trong //p/d r r o trong s
Th s r nhanh t o
nh c c ch cj n ho / th
ch n m o ra khang t ch Th
ph h g/
Chng ch nh/ch /an to n cho sinh sn
Propoo/ ch nh ph o c
tha n s an th
S n b n d c n t/m m / m say
g/ propoo/ c n k r
nh y th h/
y c c tha kh c s
th n b o
b nh Propoo/ c th t/nh an to n kh/ s
d mang tha/ th ch
r ngh/ g/ s/nh
Bt li/cnh bo
tha m tr (cyanos/s) n
n c (25 //
m s / // g y g/
ph ng h/stam/n nh n r g y ph m say
y r m g/

g/ n c n / th c ch t/ m t
d/aepam Tay nh/ n r ng th c th n
b / n
e/n body h a
ch th nh e/n bodydo b
h n y n n thay th a ph/a tr n r m
m c
Tng tc thuc
(aceproma/n op/ates) c th m n
m r
b/ kh/ c c tha ng m say
y g/an bnh ph n b m m d
th c r
C c tha m 45 cimetidine) hoc
fentanyl, halothane c th ko d i thi gian bnh phc nu d ng kt h
Liu d ng
Ch v m o
a) 4mgkg (abbe// 14)
b) an th kgph t
c) t/ 25kg th

Sanderson r cng s, 1993).
d) 6 mgkg tr n th khe khong 25% liu c tnh c cp sau mi 30 g/ y cho
n cho n khi c th lun ng v o kh/ qan. Sau khi cm ng, khong thi gian gy
m ch khong 2.54 ph t y m day tr n n s dng thuc m bay hi hoc tip tc
cp propofol 0.4mg/kg/pht.
(7) ETOMIDATE
Cu trc ho hc
C
12
12
2
tom/date (m/date) / mt thuc cm ng m c mt s tnh cht ha hc khc ri nhm
barb/tarate r benod/aep/n h/ t/ m tnh mch, tnh trng mt thc s xy ra sau 1 pht v
trc 5 pht, bnh nhn ho n to n tnh to sau 714 ph t Thac c chuyn ha nhanh gan v
hayt tng. Mc d thi gian bn hy ca thuc khong 4 gi tuy nhi n h/u qu ca thuc tr n
/ m s ng rt thp sau 115 g/.
tom/date th/u tc dng l m g/m au v cc c tnh l m g/ n c, gy my c
(myoc/onas) kh/ t/ m ry, s dng ng thi cc thuc c ch thn kinh c nh sacc/ny/ cho//n
c bit l trong trng hp lun ng v o b n trong kh/ qan s i theo sau . Khng ging nh
barb/tarate etom/date ch gy suy gim nh cu trc ca vng di i v say g/m h hp v t/m
mch cng khng ng k.
o bi tnh t nh hng n tim mch v thi gian tc ng ngn, etomidate c s dng
cm ng m tr n bnh nhn c nguy c ri ro cao hoc khang man ko di tc ng ca
benzodiazepin. Gy my c, gy aa v tr t/ m / t c dng ph thng thy ca etomidate.
Thac c kh nng c ch p ng ca v thng thn, y l g/i hn ch yu ca chng
r li ch lm s ng ca chng. Bnh nhn s tnh li nhanh chng v ri khi trng thi m u h
phi tri au n trong khi gii phu hoc thao tc, trong trng hp n y bnh nhn cn c gim
au, tim tnh mch narcotics thng c hiu qu. C 3 loi narcotics thng c dng l m
g/m au.
entany/ (SL) / cht u ti n n xut th 2 ca n l a/entany/ (LT)
r sa/entany/ (ST) Tt c 3 loi narcotics tng hp ny u c t/nh cht dc l ging nh
morph/ne hng thuc ny thng c s dng l m mt cm gic au do thi gian tc ng
tng i ngn v g/ p n nh thn kinh t tr bng cch c ch thn kinh giao cm kch thch cm
gic au v ry c tc dng gim rt mnh cho gii phu.

Tt c 3 loi thuc trn u c hiu lc gim au mnh hn morphine. Nhng //u tng
ng th ch ng g y say g/m h hp mc ging nhau. //u g y m c c thac n y g y tnh
trng sressree mt cch tng i do bi mc thay i tim mch rt thp v g/m hot ng
ca h thn kinh giao cm. Khi cp thuc trc gii phu, bt c thuc n o d gy stress v mt
s/nh / b lm dng trong trng hp soi thanh qun, lun ng v o kh/ qan v rch da. Cc thuc
n y cj n c s dng cho bnh nhn b yu sc khng c kh nng dung np tt ri hu ht cc
/oi thuc m bay hi.

/entany/ (LT) ch bng h/u lc ca fentanyl, thi gian tc ng ch bng 1/3
hoc (515 ph t) r ry alfentanyl c xem l narcotic tc ng ngn. Alfentanyl thng c
cp qua ng tnh mch li n tc duy tr trng thi m c d a/entany/ c thi gian tc ng
ngn nhng hiu qu tr n / m s ng s k o d / do s chm phn phi li thuc t n o n m c v
ma m.
L/u lp li c th p dng ko di hn hiu qu ca thuc nhng ni d tr thuc
trong c th tr n n b o hj a ri thuc v nng thuc trong mu s tng / n h/ g y m bng
a/entany/ cn ch n cc du hiu suy gim h hp ca th r cn chun b phng php iu
tr thch hp.
c m bay hi
so/arane en/arane r ha/othane / ba cht gy m bay hi c ng dng trong g y m
thc tin. Chng l c c cht lng d bay hi. Nitrous oxid, l mt cht kh ri cc tnh cht gy m
n thng c kt hp vi mt cht lng d bay hi khc gim bt hiu lc gy m saa kh/ g/i
phu.
n v liu d ng cho thac m bay hi nitrous oxide khng c tnh bng m///grams hay
m//////ters //u ca chng c tnh bng phn trm thuc m bay hi trong c mt hn hp kh m
bnh nhn ht v o So s nh g/a cc thuc th c l m bi so snh phn trm bc hi ca mi hp
cht cn to ra trng thi m

t ha hc
L thac m dng xng hi, halothan khng mu, kh chy, c mi c trng kt hp gia
chloroform v ng (sweet), v nng. Halothan tan yu trong nc r to th nh hn hp vi
a/coho/ Trng lc ri ng ca halothan l 172 r p sat bc hi l 243 mm g C ca halothan
trong oy / 7
o qun/ tnh n nh/ tnh cnh tranh
Halothan c bo qun nhit di 40oC trong vt cha kn. Tnh n nh ca halothan

ch yu c kt hp vi thymol v ammon/a Thymo/ khang / m bc hi v ry n c th l m cho
cht bay hi bin thnh mu vng. Khng c s dng cc cht b/n m a hng cht bin
m a c th c l m sch bi d/ethy/ ether
u c hi m, halothan bc hi c th phn ng vi vt bng nhm, ng thau, ch Cao sa
r c c cht do khc trong hn hp vi halothan c th l m g/m nhanh t c dng ca chng.
Dc lc hc
C ch tc ng ca hu ht thuc m bay hi th khang c bit r ch ng c th quy
nh/u chc nng ca t b o thn kinh n o bi hot ng ca lp lipid m ng t v / nh hng
dc lc hc ca halothan bao gm: suy nhc thn kinh trung ng, suy gim trung tm iu hj a
nh/t c th, tng lu lng mu n n o g/m h hp, gim thn nhit, co mch v / m say yu
c tim.
C (m/n/ma/ a/reo/ar concentrat/on ) trong kh/ 2 ca halothan rt khc nhaa: ch
76 m o 2 nga= 0.88; ngi = 0.76. Mt v / yu t l m b/n i C (nh/t , cc thuc
/ m say g/m chc nng ca h thn kinh trung ng, tai, ang c bnh cp tnh)
dng/ch nh
a/othan c d ng / m thac m trong th y do bi tnh an to n h/u lc cao, c th kim
sot trong khi dng, khng chy, gi tng i thp.
Dc lc hc
Halothan c hp thu nhanh chng qua phi. Khong 12% thuc hp thu c chayn ha
bi gan to th nh tr//aoroacet/c ac/d (s lng thp), chlorine v gc brom/de tt c chng c
b / thi qua nc tiu. Phn ln thuc hp thu s c b / thi li qua phi v cai c ng / thi qua
hi th. Halothan cj n c phn phi v o sa.
ng ch nh/ ch / an to n
a/othan chng ch nh cho bnh nhn c tin s d gia tng thn nhit hoc ng c gan
kh/ d ng ha/othan say g/m chc nng gan, tng nhp tim, chn thng u. Trn ng vt,
ha/othan c th gy qui thai v ry ch d ng kh/ cn thit.
t li/cnh bo
C th l m g/m thn nhit v iu ny c lin quan n liu. Hi chng gim th n nh/t
stress (hyperthem/a stress) thng thy tr n heo nga, ch, v m o a/othan c th gy suy tim,
g/m nhp tim. Tc dng l m g/m thn nhit ca a/othan c th iu tr bng dobutamin.
Lidocaine c dng iu tr hoc ngn nga s gim nhp tim do halothan. ngi, v ng da
(aand/ce) r hoi t gan sau khi gy m c bit rt r
nh hng n y trong th y th cha c bit tuy nhi n ha/othan s chng ch nh trong

tng lai nu triu chng st do halothan cha c gii thch, v ng da r nhng du hiu khc do
ng c gan xy ra.
Tng tc thuc
Acetaminophen khng c dng nh thuc l m g/m au trn th sau khi c gy m
bng halothan i v ha/othane / m cho c tim nhy cm vi nh hng ca cht kch thch thn
k/nh g/ao cm, c bit cc catecholamin, bao gm dopam/n ep/nephr/ne norep/nephr/ne epher/ne
metaram/no/ u cn d ng c c thac n y n n s dng ch v cn gim l/u nu cc triu chng
bt li xy ra.
C c thac c ch thn kinh c loi khng kh cc (non depo/ar//ng) am/nog/ycos/des
//ncomyc/ne cn ch khi kt hp vi thuc m ha/othan r c th / m phong b thn kinh c.
t cch gin tip, d tabocarar/ne c du hiu gy gim huyt p khi d ng kt hp vi
ha/othan t hp ng thi succinylcholine vi cc loi thuc m bay hi (ha/othan cyc/opropan
nitrous oxid, diethyl ether) lm gia tng nh hng tr n t/m (tim p chm, lon nhp tim, kh th)
r tr n bnh nhn nhy cm gy gia tng nh/t n mc nguy him.
u d
Ch m o: a) 3 (//u u); 0.515 (//u duy tr) (Pap/ch 12)
b) 535 (abbe//) 14)
ga: 23 (re/ser 12)

u trc ho hc
L mt trong hai thac m ether halogen ha (enflurane v isoflurane) c s dng tr n
/ m s ng n/arane c h/u lc bng khong mt ca halothane, MAC ca n l 16 c d
en/arane g/ng vi halothan nhiu kha cnh tuy nhi n rn c im khc nhau vi cc so snh
sau y:
T/nh hj a tan ca enflurane trong mu v ma m th mc trung gian gia ha/othan r
/so/arane ry, tnh gy m nhanh hn halothan v chm hn isoflurane. hong 95 //u
b / thi khng qua ng phi.
24
n/arane cng ging nh ha/othane / m g/m huyt p. Tuy nhi n en/arane ch yu gy
d n n mch ngoi vi nhng lm suy gim co tht tim. T kt qa l m g/m huyt p, enflurane gy
g/m lu lng mu n thn do gim lng nc tiu.
Tuy nhin, qua ng ung enflurane / m g/m lu lng mu n tim gy ra cc du h/u nghi m
trng khng mong mun tr n bnh nhn mc bnh tim, khng l m thay i nhp tim. Enflurane t
nh hng n tim hn halothan.
n/arane g y say g/m chc nng h hp ph thuc liu cng nh lm say g/m p ng
ca trung tm h hp do l m g/m lng oxigen v tng lng carbon d/o/de trong m a cn
p ng lc mu bng oxy nh mt phn x bo v.
n/arane / m d n c t cung tng t halothan v ry cn lu kh/ s dng tr n th mang
tha/
n/arane g y d n h c xng tt hn halothane nhng hiu qu n y khang c ngha
trong r/c gii phu cc xoang chnh bn trong c th v ry vic th m c c cht c ch thn kinh c
th rt quan trng trong nhiu trng hp.
nh hng duy nht ca thuc m en/aran / to ra m hnh in n o tng t nhng
bnh nhn mc chng ng kinh. Enflurane c phi l thac gy co git hay khang th rn cj n ang
tranh /an, nhng nhiu kinh nghim tr n / m s ng r loi thuc m n y cho thy c th s dng an
to n cho hu ht cc bnh nhn, khang g y co g/t ngoi tr d ng //u rt cao. Ging nh
ha/othane en/arane lm tng s trao i cht v mc ti a th oxi n o d n mch mu n o tng
lng mu n n o r CP
t v / b o c o t ngh/m cho thy c s h hi gan trn do enflurane nhng hoi t gan
do en/arane th cha c bit, ngay c khi thuc c cp cho bnh nh n b gim oxi huyt
ngh/ m trng.

u trc ho hc
t ha hc
L mt loi thuc m bay hi, isoflurane th khang m a khang d chy, cht lng n nh,
25
c mi hng nh m / ether 20oC, trng lc ri ng ca enflurane l 146 r p sat bay hi l
23 mmg
o qun/tnh n nh/ tnh nh tranh
Isoflurane c bo qun nhit phj ng n khang b tc ng bi nh sng nhng gi
trong rt cha kn, chng nh sng. Isoflurane khng lm h hi vt dng bng nhm, ng thau,
th/c, st
Dc lc hc
Tng t halothane, MAC ca enflurane trong kh/ 2 th kh c nhaa theo /o /: ch 15
nga=1.31, ngi= 1.2.
dng/ch nh
so/arane / mt thuc m bay hi m n c mt s nhng thun li nht nh hn so vi
ha/othane hay metho//arane do bi n l m g/m bt hiu qu ca thac gim au trn c tim v
kh nng nhy cm vi catecholamin s dng n mt c ch an to n tr n bnh nhn b bnh gan,
thn. Gi th nh ca isoflurane cao hn methoxyflurane v halothane l im bt li.
Dc ng hc
Isoflurane c hp thu nhanh chng t ph nang. N c phn phi nhanh v o n o r i
qaa nhaa tha/ Phn ln thuc c b / thi qua phi, ch khong 17 thac c chuyn ha
gan r ch mt lng nh fluoride c to th nh
t li/cnh bo
Chng gim huyt p c th xy ra v lin quan n lia Say g/m chc nng h hp cng
ph thuc liu, nh hng n h ti a h a (ban nn, i ma, tc rat) c bit rt r Say t/m
tim p chm cng c th xy ra.
Tng tc thuc
Tc ng trn c tim ca isofluran ging nh hiu qu ca cc thuc kch th/ch thn kinh
g/ao cm (dopamine, epinephrine, epherine, metaraminol,) ch v cn kim tra cn thn.
Thac phong b thn kinh c khng kh cc, aminoglycosides, lincomycines cn c ch
kh/ kt hp vi cc thuc m ha/ogen h a r c th gy ngn chn thn kinh c. Kt hp ng
thi succinylcholine vi cc loi thuc m bay hi (halothan, cyc/opropan n/troas o/d d/ethy/
ether) lm gia tng nh hng tr n t/m (t/m p chm, lon nhp tim, kh th) v tr n bnh nhn
nhy cm gy gia tng nhit n mc nguy him.
u: tng t halothane.
(4) NITROUS OXIDE

Tnh cht ha hc
/troas o/de khang m a khang m / r / trong
d ng m th nh th n khang th t
mong ma nh t/nh / m g/ /troas o/de
h kh c c h/
S dng
/troas o/de khang hj a tan m n o r r n o
o hj a m b
/ th trang (concentrat/on) c
o kho 7 n r 35 2 c th ang / m m

Tay nh/ n s n c n (amnes/a) s
kh/ k narcot/cs ho kh c r ng c c
/o ch 7 /troas o/de 353 kh/ o/ 52 ha/othane
en/arane ho t y tha o C c tnh tr
r nh n) C c ch nh nha c n ngh
/ c
/troas o/de c n t/m m m g/ th
cang sa y c
kh/ n th g/ao c
o k m c
d ng benod/aep/ne ho
h ho c th
d ng cho b n/troas o/de c
s th n trong s
g y c c d tr n h th
c tnh
/troas o/de c th

j n t c h b/
2.1.1. Thuc an thn Thuc ng v chng co git
ng //
(1) BARBITURATES
Cu trc ho hc
C t c d k/nh r g y ng ng // ng /
Phenobarb/tone: ch / y 3 / y 3 /
(2) BROMIDES
Tnh cht ha hc
rom/de c m a tr / d nh / t/nh th
j a tan trong n brom/de12m/) Potass/am brom/de
ch brom/de
Tr brom/de s ma
/o m k ng d
Dc lc hc
k m g/ n
ho chay o m ng t o / m
ng t h ch
Ch nh
d ng m
mnh pheno/barb/ta/ (hay pr/m/don) th khang cho k h
ch ng phenobarb/ta/ th c th ng m mnh brom/de
kho c saa kh/ d ng brom/de
Dc ng hc
n ngo
b o brom/de khang // n k prote/n hay o r s
Chng ch nh
Th g/ r th b n cho th s/nh s th ch
28
c chng minh. S dng thuc cho th m hoc th non u nh hng n sc tng trng ca
th
nh bo/bt li
/m au trong thi gian ngn thng thy tr n ch kh/ d ng brom/de kt hp
phenobarb/ta/ g c s xy ra nu gim au ko d / ri cc triu chng ng ngn, tht iu vn
ng, r ng mnh r nhng biu hin khc ca thn kinh trung ng. / m / ch c th xy ra tr n
ch nu trong iu tr kt hp bromide vi pr/m/don hay phenobarb/ta/ c th gy ra i ma, ti a
chy, to bn, pht ban ( ngi).
u dng ng ung potassium bromide liu cao v nhanh s xy ra ri lon cp tnh h
t/ a h a
u/ ng c cp tnh
g c thng thy hn nhng liu m n t/nh nhng ng c cp tnh cng t/m n vi
c c du hiu nh au c, ng t khng u v phn x km. Kt hp dng ng ung hoc
ng ngoi ti a h a sod/am ch/or/de ngoi ti a h a g/acose r thac li tiu (nh furosemic) th
s l m g/m bt tc hi do ng c cp t/nh hoc m n t/nh o thac b / thi chm, d b ng c
kh/ d ng / a d / ban ng, ri lon phi hp ng tc.
Tng tc thuc
g c bromide c th xy ra nu ion chloride trong ng ti a h a b gim thp v ry s
ngay h/m cho bnh nhn d ng khu phn c hm lng mui thp. Ngc li, b sung sodium
ch/or/de r o khu phn c th l m g/m mc bromide trong hayt thanh gip hn ch co git. Do
bi bromide c tc dng an thn do d c th kt hp vi cc thuc an thn khc (CNS sedating
drags) Thac li tiu (d/aret/cs) c th nh hng b / thi bromide do s nh hng n liu
nha cu (dosage reqa/rement)
u d
ng cho ch ri mc ch trn an thn kinh chng co git ch, liu d ng: 3 1 g /n
(ang).

u trc ho hc
29
C
2
24
C/ S
t ha hc
Ch/orproma/ne / dn xut ca propylamino phenothyazine, chlorpromazine l prototyp/c
phenoth/a/ne c m a trng n trng kem, khng m / c r ng, dng bt tinh th. Hj a tan trong
nc (1g/1ml) v a/coho/ (1g15m/) j a tan trong nc v trng to th nh dang dch ti m c
p 35
hng ch phm c bit l c tnh tng hp khi phi hp ti m ri Ch/orproma/ne
C/: tt c cc cht lng c th ti m tnh mch, acid ascorbic, atropin sa/phate batorphano/ tatrate
d/phenhydram/ne droper/do/ entany/ c/trate g/ycopyrro/ate hepar/n sod/am hydromorphone
C/ hydroy/ne C/ //doca/ne C/ meper/d/ne metoc/operam/de metaram/no/ b/tatrate
morph/ne sa/phate pentao/ne /actate proma/ne C/ prometha/ne scopa/am/ne C/ r
tetracyc//ne C/
hng ch phm c bit l khng tng hp vi chlorpromazine HCl: am/nophy//ne
amphoter/c/n ch/oramphen/co/ sod/am sacc/nate ch/oroth/a/de sod/am d/menhydr/nate
meth/c////ne sod/am methohe/ta/ sod/am nac////n sod/am pen/c////ne potass/am pentobarb/ta/
sod/am phenobarb/ta/ sod/am r th/openta/ sodium. Tnh tng hp ph thuc v o c c yu t nh
p nh/t v cht pha lo ng c s dng.
nh
Tr n / m s ng ch/orproma/ne d ng / m thac an thn, chng nn ma th nh, ngn tit
apomorphine gy i trn ch nhng khng c tc dng tr n m o Ngn i ma do morphin tr n ch
nhng khng ngn c i ma do sulphate ng hoc d/g/ta//s g/ycos/de
Dc ng hc
Chlorpromazine c hp thu nhanh sau khi ung, chuyn ha gan. Thuc cng c hp
tha nhanh qaa t/ m bp nhng tc dng chm hn so vi ti m tnh mch. Ch/orproma/ne ph n
phi khp c th v tp trung n o cao hn trong huyt tng 5 ch/orproma/ne trong hayt
tng lin kt vi protein huyt tng (phn ln vi albumin). Thuc c chuyn ha gan v
thn nhng bi thi thac cha c bit r c bit tr n ch r m o
30
ng ch nh/ ch
Nn dng ng ti m tnh mch v thac c th gy sng v xt c nu ti m bp tc
nhanh
t li/ cnh bo
Ch/oroma/ne c th gy hi chng extrapyrimidal m o kh/ d ng //u cao. hng du
h/u bao gm r ng mnh (tremor) ran ry, khng linh ng v khng c th gi n ng mc. Gy
cht (/ethagry) t/ a chy, mt kh nng co tht c vj ng hu mn. Gy mt iu hj a nga do vy
nga d b kch thch v tr n n hang d chnh v ry ng y nay ch/oroma/ne rt t c s dng
tr n nga.
Tng tc thuc
g c Physotigmin c th b nh hng bi chloromazine. Ng c bi thuc d/t c
paraqaat b tng l n bi chloromazine. Barbiturates, narcotics c th tng hiu qu khi phi hp
phenoth/a/nes a/n/d/ne phi hp vi phenothiazine l m g/m au tr n t/m C c thac chng ti a
chy (Kaolin/ pect/n b/smash sabsa//c//ate) r c c cht khng acid (antacids) gim hp thu c
dng qua ng ang. Propranolon kt hp vi phenothiazine c th tng nng ca c hai cht
ny trong mu. Phenothiazine ngn chn th th ? adreneg/c nu d ng ep/nephr/ne sau . Chuyn
h a phenyto/n b gim nu dng ng thi vi phenoth/a/ne ot ng ca Procain c th b nh
hng bi phenothiazine. Dipyron kt hp vi phenothiazine l m g/m thn nhit nghi m trng.
u d

Chng nn: 0.5mg/kgP, ti m bp (De oro 16)
/m au: 3mg/kg P, ng ung.
T/n m: di 1.1mg/kg, IM 115 g/ trc khi gii phu (Booth, 1988).
Chng nn: 0.05mg/kg, IV hoc 0.5mg/kg, SQ.
/ n c do co git tetanus: 2mg/kg, IM (Morgan, 1988)
j : 221 mgkg 1 44 mg kg (oard 16)
L/u ung: 1 2 mg kg th trng, 2 4 /n / ng y
T/ m bp: 0,5 1 mg kg th trng, 2 4 /n / ng y
T/ m tnh mch: 0,5 mg / kg th trng, 2 4 /n / ng y
nh Colic nga: 1,5 mg / kg th trng, ti m bp

31
u tr c
C
16
13
C/
2

t ha hc
L benod/aep/n d/aepam c m a trng n m a r ng dng bt tinh th, khang m /
nh/t tan chy 131135oC, pKa =3.4. Diazepam khng ng lc u nhng rt ng sau khi nm
/ a j a tan trong nc (1g/333ml), cn (1g/25ml), tan km trong propy/eng/yco/ t hp vi
beno/c ac/d hoc sodium benzoate to th nh dang dch ti m c p 626
Dc lc hc
/aepam cng nh nhng benzodiazepin khc lm suy nhc vng i v r ng di i
ca n o r ry n c tc dng an thn , gi n c v chng co git. C ch hot ng cha c bit
r nhng nguyn l c bn bao gm: i khng vi serotonin, tng gii phng hoc to iu kin
cho gamma am/nobatyr/c ac/d hot ng, gim gii phng acetyl n o
hng receptor c bit ca benzodiazepin c nh v n o thn, gan, phi v t/m ca
ng vt hu nh, nhng lo / kh c th cha c bit.
nh
n thn, gi n c, tng tn h thm n, chng co git.
Dc ng hc
/aepam hp thu nhanh qua ng ung, mc cao nht trong huyt tng khong 3 ph t
n 2 gi sau khi ung. Thuc hj a tan mnh trong lipid v ph n phi khp c th, c th v o sa;
n qua c h ng r o m a n o r // n kt rt mnh ri protein huyt tng.
Diazepam c chuyn ha gan to th nh chayn ha cht bao gm: desmethy/d/aepam
(nord/aepam) temaepam r oaepam nhng cht n y // n kt ri glucuronic v b / thi qua
nc tiu.
ng ch nh/ ch
T/ m chm khi ti m tnh mch tr n th nh, c th gy nghn mch, shock, khang d ng cho
th mang tha/ r naa/ con S dng ch i vi bnh nhn b bnh gan thn, suy nhc hoc gi
yu. Thuc c th gim kh nng ca th l m r/c. Th con c sinh ra t th m nhn
32
benzodiazepines tc ng ngn vi liu qu cao trc khi sinh s b chng kh th, suy yu p ng
chayn h a ri stress /nh.
t li/ cnh bo
Thay i hot ng m o (d ng, suy nhc, hnh vi khc thng) sau khi d ng d/aepam
ngo / ra nhng thng tin gn y cho bit diazepam cj n nh hng n gan khi dng qua ng
ang.
Tng tc thuc
Chayn ha ca d/aepam c th gim v an thn qu mc c th xy ra nu d ng chang ri
c c thac sau: cimetidin, erythromycine, isoniazid, ketoconazole, proprano/o/ r ra/pro/c ac/d
ntac/ds nh hng n hp thu thuc v ry cn cp thuc cch nhau 2 gi trnh kh nng
tng tc ny.
Tc ng dc lc ca digoxin c th gia tng, kim tra cc mc digoxin trong hayt thanh
hoc cc triu chng ng c. Rifampin nh hng n cc enzyme ca h thng microsomal gan
r / m g/m hot tnh dc lc ca benod/aep/nes
u lng
n thn: 0.26mgkg 25mgkg P (organ 1)

ng kinh: 0,51mgkg
Co g/t: 14mgkg

Kch thch tnh thm n: 0.0515mgkg
ng kinh:0.51mgkg
Thac ti m: 2 m/ 1 mg
L/u d ng t/ m bp: 0,2 mg / kg th trng

u trc ho hc
C
1

22

2
S
33
t ha hc
L dn xut ca phenothiazin c m a r ng khang m / r ng, dng bt. Hj a tan trong
nc (1g/27ml), alcohol ( 1g/13ml), chloroform (1g/3ml).
Dc lc hc
ceproma/n / mt phenothiazine c tc dng an thn, ngn chn receptor ca dopam/n
ph/a saa synapse h thn kinh trung ng v ry ngn gii phng dopamin do nh hng n
nh/t c th, mc chuyn ha c bn, ng kinh, p sat mch mu, cn bng hormon v s tnh
t o
nh
ng cho ch m o trong trng hp d ng da, chng i v g y m Tr n nga, d ng g y t
cc b. c s dng nh l thuc an thn tr n heo bj th, cu v d ceproma/ne cj n c
dng gim nh hng tng thn nhit do ha/othane tr n nhng heo nhy cm. Ngo / ra
phenoth/a/ne cj n kh ng t c ng kiu cho//n (ant/cho//nerg/c) kh ng h/stam/n chng co tht,
ngn chn th th ? adrenerg/c Trong th y aceproma/n d ng ch yu vi mc ch gy m
Tc ng dc lc ca acepromazin bao gm: chng nn, chng co tht v t c ng gim
th n nh/t. Mt v / ngh/ n cu cho bit, acepromazin c tc ng chng co g/t nhng v mt th y
cho thy khng n n d ng phenoth/a/ne cho th b ng kinh hoc nhng tn thng c th dn n
co g/t.
ceproma/ne c th l m g/m nhp h hp nhng rt t hoc khng li n qaan n cht kh
trong mu (blood gas), b o hj a p hoc oxyhaemoglobin. Liu ph thuc v o s gim
hematocrit thng thy khong 30 pht sau khi d ng tr n nga v ch Ch s hematocrit nga
g/m 50% so vi trc khi d ng go / ra / m say yu p sut mu trong ng mch tr n ch g y
tng p sut tnh mch trung tm.
Dc ng hc
Dc ng hc ca c nghi n cu tr n nga (Ballard v cng s, 1982). Thac c
ph n phi vi th tch ln v hn 99% lin kt vi prote/n hayt tng. Tc ng chm, khong
15ph t saa kh/ t/ m tnh mch. Hiu qu cao nht t 306 ph t saa t/ m
ceproma/ne chayn ha gan v b / thi qua nc tiu dng cht chuyn h a // n kt
hoc khng li n kt. Cht chuyn ha c tm thy trong nc t/u nga khong 96 gi sau khi
d ng thac.
ng ch nh
Ch trong s dng hoc d ng //u thp i vi th b suy gim chc nng gan, bnh tim v
suy nhc c th. Do nh hng l m g/m huyt p, acepromazine chng ch nh i vi nhng
34
bnh nh n b gim oxi huyt v shock T/ m chm tnh mch. Acepromazine khng c hiu qu l m
g/m au. Ch nhy cm ri thuc hn cc loi khc nh gim huyt p, suy gim chc nng tim
mch.
u lng

T/n m :3 5mgkg
n thn: 0.0252mgkg
y m : 12 mgkg

n thn: 0.051 mgkg
:
n thn: 1mg/kg, IM.

n thn: 0.012 mgkg
ng ung: d ng cho ch m o
L/u d ng: 1 3 mg kg th trng
ng chch: Komisirastress
L/u d ng: 5 1 mg kg th trng

u trc ho hc
t ha hc
L cht i vn benzodiazepin, flumazenil l dn xut 1,4/m/daobenod/aep/n
enod/azepin tng hp vi cc cht sau: lactated Ringers, D5W hoc nc mai bnh
thng.
Dc lc hc
/amaen// / cht c ch cnh tranh ca benzodiazepines ti receptor benod/aep/ne h
thn kinh trung ng. N gy trung hj a t c dng an thn ca benod/aep/n
dng/ch nh
Flumazenil c s dng ph hy tc dng ca sau khi benzodiazepin c d ng //u
iu tr hoc d ng qa //u. Flumazenil rt hu hiu trong iu tr bnh n o c bit l bnh m n
t/nh kh cha.
Dc ng hc
Flumazenil thng dng ng ti m tnh mch. N c phn phi nhanh v cng c
chayn ha nhanh gan. ngi, thi gian bn hy ca thuc trung bnh khong 1 gi.
ng ch nh/ch /an to n
/amaen// chng ch nh cho bnh nhn nhy cm vi n hoc nhng benod/aep/n kh c
/amaen// cng khng c d ng cho bnh qu liu nghi m trng thac chng trm cm 3 vj ng
liu cao, Flumazenil g y qa / tha/ mt v / th th/ ngh/m. Trong thi gian mang thai ch
c d ng thac khi cn thit.
t linh bo
ngi, Flumazenil ng kinh mt v / bnh nhn. Ngo / ra /amaen// cj n g y phn
ng ti ch ti m / ma, gi n mch da, mt thng bng, tht iu vn ng, o gic.
Tng tc thuc
Flumazenil khng lm thay i dc ng hc ca benzodiazep/n /u qu ca nhng
benzodiazepin tc ng ko d / s c tng l n saa kh/ t c dng ca /amaen// g/m xung.
u lng

Cht i vn ca benzodiazepines: 25mgkg (ednarsk/ 12) 1mgkg (/k/
12)
c gim au
Thac gim au l thac l m g/m hoc mt cm gic au v khng tc ng l n ngay n
nhn gy au. Khc vi thuc m thac gim au khng l m mt cc cm gic khc.
C ha/ /oi thuc gim au:
Thac gim au gy ng hay gy nghin: morphine v c c thac g/m au loi op/o/d C c
thac n y / m g/m cc cn au ni tng.
Thac gim au h st hay gim au khng gy nghin: aspirin v dn xut sa//cy/at c c
thac n y c t c dng l m g/m au ngun gc ngoi bi n / m h st v kh ng r/ m
cm gic au
C ha/ /oi cm gic au:
Cm gic au ngun gc ngoi bin: thng l s au c xc nh v tr do s dn truyn

cm gic t nhng u tn c ng cm gic da i n v n o nh au rng, au c
Cm gic au phn tn su: l s au khng xc nh v tr, cc cm gic bt ngan t cc
c quan ni tng su nh d d y t/m phi.
Q|F P|Li F|D|Fy|||Q URQ|
Nron 1: nron lng cc (nron T) tn c ng da, ni tng i n sng sau ty sng.
Nron 2: i t ty sng ln i th.
Nron 3: t i th l n r n o
i th l ni chn lc nhng cm gic a ln v n o r c nh nhng phn ng thc
rt c tnh bo v nh m rng con ngi, tng nhp tim v ha hp, co mch hoc gi n mch, b /
t/t dch Tt c to th nh du hiu ca s au.
n o ph n t/ch cm gic au v xc nh phn ng i ph. T b o T ca sng ty sng
g/ vai trj qaan trng trong dn truyn cm gic au. Cm gic au ch khi pht khi tn s nhng
ang /c ri khi t bo ny trn ngng. Khi c kch th/ch mnh t b o t/t cc cht nh
prostag/and/n / m nhy cm receptor gy au to xung lc theo ng cm gic au v trung ng.
C c thac l m g/m au c ch tng hp prostaglandin nn ngn cn pht sinh cc xung lc gy
au.
c s dng thuc gm au
a) Nn iu tr sm trc khi cn au xy ra , ngn au cp tr thnh au m n t/nh kh
cha.
b) Thac l cch c bn nhng iu tr bng tm l, vt l (xoa bp, nhit lnh) cng l m
tng tc dng ca thuc gim au.
c) La chn thuc thch hp nht: Theo WHO (1986) iu tr au m n t/nh theo k/u bc
thang (nu cn au ko di hoc gia tng).
Giai on 1: khng opioid (nh NSAIDs)
Giai on 2: khng opioid + thuc phi hp
Giai on 3: opioid yu + khng opioid + thuc phi hp
Giai on 4: opio/d mnh + khng opioid v thac phi hp
d) Ti u ha ng s dng:
ng ung thng dng nht nhng khng hiu lc vi loi au nng (ung th t/n trin
) r phi dng thng xuy n (morph/ne 23 g/ ung 1 ln) v ry phi thay bng morphine v
ph ng th/ch chm hoc d ng cht c t1/2 di nh methadon. ng ti m trayn tnh mch c nhiu
u im hn ng ung v ( hp thu thay i v khi pht chm). Bt li ca ti m trayn
tnh mch l phi m k/m r o tnh mch, ti m trayn di da trnh c nhc im . ng
cho thac qua da c s dng th nh cang ri fentanyl /oi opioid tan trong lipid.
iu tin li ca ng thm thuc qua da l n gin, khng gy tn thng m nhng
khang chan c nng trong mu trong thi gian ngn t c tc gim au ti u
cho tt c bnh nhn. ng ti m ngo / m ng cng r t/ m trong r nhm a mt lng thuc
nh n gn v tr tc ng n n h/u /c gim au rt tt vi rt t hiu lc to n th n C c thac t
tan trong //p/d (morph/ne) khi pht tc ng chm nhng thi gian gim au ko di, ngc li cc
thac tan nhiu trong lipid (nh methadone, meperidine, fentanyl, sulfentanyl) khi pht tc ng
nhanh nhng thi gian gim au ngn (do thuc khuch tn nhanh v ri n o nhanh
e) C th ha //u d ng: mt im chung ca opioid gim au l kh c b/t ln v //u gim
au ti u gia cc bnh nhn. Khc phc iu bng cch ti m trayn tnh mch c chun .
) gay n tc s dng thuc gim au tr au do ung th
Chn thuc gim au th/ch hp
Xc nh liu d ng da tr n nha cu bnh nhn
Ch liu chia u trong ng y tr nh d ng kh/ cn.
ng chn trc cn au, trnh cn au xy ra mi d ng thac
/m n mc thp nht tc dng an thn v c c t c dng ph khc
n s dng ng ung bt c khi n o c th
iu tr sm bun nn v t o b n
S dng thuc phi hp bt c khi n o cn
ang np v / thuc thuc khng phi l rn ng quan tm
(1) ANALGIN
na/g/n / mt loi thuc c ch thn kinh trung ng. Analgin 2
Tnh cht
na/g/n c bn cht ha hc l natr/ methy/am/nopheny/ d/methy/pyra/onmethansa/onat
na/g/n 2 cha cc th nh phn vi hm lng sau:
na/g/n 2g
38
ang ma/ r cht bo qun V 1m/
Ch phm l mt dung dch trong sut, khng m a c p trong phm vi 5,0 7 ng
trong ng 2mL. Bo qun trnh nh sng.
ng
Analgin tng t nh Pyramidon, c tc dng ni bt l m g/m au, ct nhanh cn au v
/p li chc nng sinh l bnh thng ca hot ng thn kinh. Ngo / ra thac cj n c t c dng
chng thp khp v c t c dng gii nhit, h st trong chng mc nht nh.
nh
Trong th y hc, Analgin c d ng trong:
iu tr cc chng au d d y rat cp tnh gy au d di nh hi chng au bng nga,
chng bng y hi cp tnh lo / nha/ /i, nh c kh nng khi phc hot ng ti a h a r bnh
thng ha nhu ng rut.
iu tr bnh gi n d d y cp tnh km theo au bng (n n phi hp vi cc loi thac
chng l n men)
iu tr vi m phong thp c, thp khp, au dy thn kinh
u lng
T/ m thac v o bp tht, di da hay tnh mch vi liu:
Tr a bj nga: 1 2m/
Ln, d cu: 5 15m/
Ch : 2 5m/

t ha hc
Codein t tan trong nc nhng d tan trong cn. Codein c m a trng, mn, dng bt tinh
th.
Dc lc hc
Codein c dng l m g/m ho, gim cn au nh rt tt.
nh
Dng ng ung i vi th nh l m g/m au trong trng hp salicilate khang c
h/u qu hoc nhng thuc gim au dng ng ngoi ti a h a khc khng m bo. N cng
c s dng nh mt cht chng ho hoc chng t/ a chy.
Dc ng hc
Saa kh/ ang, nhng mui codein hp thu rt nhanh, d ng thac qua ng ung c h/u
qa hp thu bng 2/3 ng ngoi tiu ha, tc ng sau 30 pht, hiu qu g/m au c th ko d /
39
46 g/; thuc c chuyn ha gan v b / thi qua nc tiu, thuc c th qua nhau thai, qua
sa.
ng ch nh
Tt c cc thuc gim au n n s dng ch i vi cc th b nhc nng tuyn g/ p bnh
thn, khng d ng cho th nhy cm vi thac gim au gy ng (narcot/c) th g/ yu, bnh tt;
t/ a chy do ng c thc n cho n khi thc n b / thi ht ra ngo / hoc d ng /p li trong cc
trng hp vi m rat.
Khng dng codein trong cc trng hp chn thng vng u, tng p sut m a n o
hoc cc cn bnh cp tnh xoang bng (au bng nga). Lu tr n bnh nhn mc bnh ng
ha hp hoc suy gim chc nng h hp cp tnh.
hang d ng kt hp vi sn phm c cha acetaminophene cho m o
T c dng gim au yu hn Morphin, nhng mnh hn cc thuc gim au h st kh c
t li/cnh bo
Code/n c kh nng dung np tt tuy nhi n bt li cng c th xy ra c bit liu cao hoc
//u lp li. Thng thy tc dng gy ng. Ngo / ra cj n nh hng n d d yrat bao gm bing
n, i ma, to bn, tc rut, co tht ng ty v ng mt. Tr n m o thac c th gy kch thch h
thn kinh trung ng nh d b kch ng, r ng mnh co g/t.
u/ ng c cp tnh
a //u dn n suy gim h hp v thn kinh trung ng hu ht cc lo / nh hng
kh c bao gm suy tim mch, gim thn nhit, nhc trng c xng. Naloxon c dng iu
tr suy gim h hp. Khi qu liu nghi m trng, n n d ng //u lp li naloxon v cn tun th cht
ch tc hi ca naloxon c th g/m bt trc khi c c mc di c t (subtoxic) ca codein c
th t c.
Tng tc thuc
C c /oi thuc m thac khng histamin, phenothiazin, barbiturate, thuc an thn,
alcohollm tng suy gim h hp v thn kinh trung ng khi phi hp vi meper/d/ne C c
thac kh ng cho//nerg/c kt hp vi codein lm tng tnh trng to bn. ngi, meperidin (phc
hp li n kt vi codein) c chng ch nh t nht 15 ng y saa kh/ nhn MOA (monoamine
oxidase inhibitots) (t c d ng trong th y)
T c d Q|SK ||k |Wi R|EyQ|| F|FK |K|K S|
ng / a c th gy nghin
Khng dng cho trng hp ho c nhiu m v g y t/ch m ph qun.
/ng n, i, to bn, tc rut, co tht ng dn mt v ty.
40
u d

Chng ho: 0.13mgkg P
/m au: 0.51mgkg P
Chng ti a chy: 0.255mg kg P (cho ang) 0.3 6 mg kg th trng, ng y 3
/n.

u trc ho hc
C
17
3
41
t
orph/n / /ca//ot ch/nh ch/t xut t nha cy thuc phin (Papaver somn/eram L) ri
t l 9 1 Thac c Bng A.
orph/n c dng kt tinh hnh k/m m a trng, khng m / r rt ng, kh tan trong nc.
C c mai clohydrat v sa/at d hj a tan hn trong nc, tan trong ru v
hng thuc tng hp vi morphine sulphate:Atropin sulphate, benzquinamid C/
barorphano/ tartrate ch/oproma/n C/ d/phenhyhydram/n C/ dobatam/n C/ droper/do/
entany/ c/trate g/ycopyrro/ate hydroy/ne C/ metoc/obram/de pentaoc/ne /actate proma/ne
C/ scopo/am/n r r sacc/ny/cho//ne ch/or/de
hng thuc khng tng hp vi morphine sulphate: aminophyl//n ch/oroth/a/d sod/am
hepar/n sod/am meper/d/n pentobarb/ta/ sod/am phenobarb/ta/ sod/am phenyto/n sod/am sod/am
b/carbonate r th/obenta/ sod/am
ai dc dng l c/ohydrat ngm 3H2O.
Trong c th, Morphin li n kt vi protein huyt tng. Chng b v hot gan th nh c c
dn cht glycurono hay sunfo kt hp, c b / t/t qua ng nc t/u v ng mt (chu trnh
rat gan)
ng
orph/n / thac an thn mnh, c tc ng l n tt c cc chng au. N c nh tr n c c
th th Morphin. S c nh n y g y n n s hot ha cc nron c ch ca ty sng v tr n ty m
ch ng phong b thng tin au n ty v thn kinh trung ng.
T c dng gim au ca Morphin ph thuc v o //u lng, ng cho thuc v t/nh nhy
cm ca c th. Morphin l cht gy nghin v g y trng thi sng khoi, i lc km theo hoang
tng, o gic.
42
/a s c phn ng i vi thuc rt khc nhau v phn ln chng (nga, la, tru, bj d
/n, m o) b/u hin bn chn. Morphin l cht kch thch nga khi ti m di da, nhng l cht
/ m m du khi ti m tnh mch, nn c dng iu tr chng au bng nga.
Thac gy gi n mch, l m chm nhp tim nh.
Thac gy tc dng thay i tr n trang t m g y nan
Thac c ch nhu ng rut, l m say yu b / t/t dch tiu ha, tng trng lc cc c tht
(c ch/u hng gy to bn, gi nc tiu).
nh
Cc cn au d di, cp tnh b n ngo / (da n/ m mc) hay su (xng khp, ni tng)
ca cc lo / g/a s c
L m du au to n th n t/ m tnh mch trong cc chng au bng nga (ri liu 25
5g mt hay hai ln ti m) Cng c d ng ri liu thp trong chng au d d y do h v
m rng.
Dc lc hc
o nga, cu, d bj r heo rt c hiu qu khi d ng orph/ne trong kh/ ch ngi v
loi linh trng khc khng nhy vi Morph/ne C ch v mo u i khi d ng orph/ne nga,
th nha/ /i v heo th khang /ng nh meperidin, morph/ne c th gy phng thch histamin t t
b o mast
orph/ne c h/u qu chng ho tr n ch tay nh/ n thac c th l m g/m thn nh/t tr n ch
r th. Ngc li thn nhit c th gia tng bj d nga v m o Gy co ng t ngi, th v
ch. Trn ngi, morphine c s dng nh cht / m g/m au trong iu tr chng nhi mu c
t/m r sang hayt tim, l s /a chn ti u trong iu tr hi chng t/m phi ch.
orph/ne c th gy gim nhu ng v g/m s tit dch d d y rat. Tr n ch morph/ne
g y g/m nhu ng rut v dn n to bn. S tit dch d d y r dch mt c th gim sau khi
tim nhng sau HCl ca dch d d y c th tng li
orph/n c th gy tiu nhiu, nhng liu cao (>2.4mg/ kgP, IV) s tit nc tiu c th
g/m do gii phng hormone ADH (antidiuretic hormon), l ngay n nh n g y tng sc trng bng
qaang r ry c th gy kh khn khi i tiu.
Dc ng hc
orph/ne c hp thu khi ti m tnh mch, ti m bp, qua trc tr ng Tp trung nh/u nht
thn, gan, phi, thp nht n o qaa nhaa tha/ nhng mc thp hn tm thy nhu m v
morph/ne dng t do tm thy c xng. Morphine gy n th mi sinh nu cp thac cho
th trong thi gian mang thai, qaa sa m d liu nh.
43
Thac c chuyn ha gan v b / thi qua thn. Do m o chayn ha khng ho n to n
qua ng n y r ry thi gian bn hy thuc c th ko d / nga, thi gian bn hy ca thuc
trong hayt thanh c bit l khong 88 pht sau kh/ d ng //u 0.1mg/ kg P, IV. Nhng liu c th
ph t h/n trong huyt thanh khong 48 gi v 6 ngy trong nc tiu. Thi gian bn hy thuc tr n
m o khong 3 g/.
Morphine c s dng trong iu tr cc cn aa cp tnh ch, bj nga, heo, d cu;
d ng / m thac tin m ch v heo chng ho, chng ti a chy v mt s bt thng tr n t/m ch
ng ch nh
Lu c c trng hp bnh sau: bnh thn, nhng bnh cp tnh xoang bng (co//c) bnh
ng niu, th g/ yu
u lng
Morphin clohydrat dng ti m tnh mch hay tim di da. i lc dng di dng xir,
ru thuc, bt thuc
1 ang dch ti m 1 (1mL cha 1cg Morphin clohydrat).
/ra orph/n 2g cha 1cg orph/n c/ohydrat (ng C)
t Morphin 1g cha 1cg
Ru thuc Morphin 1g cha 1cg orph/n c/ohydrat (ng C)
Cao orph/n 5cg 1cg
Laadanam Sydenham 1g 1cg
/ra thac phin 2g 1cg
/ra d/acode 1g 1cg
t Dover hong 1g 1cg
2 T/ m dang dch 1% Morphin clohydrat cho gia s c ri liu sau:
ng vt L/u iu tr L/u c
ga 25 75cg 3 5g
Tr a bj 5 1g 4 5g
Ch /n 5mg 5cg 1g
Ch nh 1g
o
3 Cho g/a s c a
ng vt Bt thuc phin Chit xut thuc phin Ru thuc phin
Nga 6 1g 5 1g
Tr u b 1 15g 5 1g
Ch ln 1 5g
L/
so r
tha 1 5
Ch nh 5 1g
M o 5 1g
/ra tha /ra d/acode /ra orph/n
Ch
a c ph
4 16 tha ng y
45 /
L/
Ph/ y
M o 13 tha c ph ng y 412 tha c ph ng y
C ng //

Tha
(4) MEPERIDINE HCl
Cu trc ho hc
Tnh cht ha hc
L tha a tr ho
b / r j a tan trong n a/coho/ pa7715 r
nh/ 1 oC eper/d/ne cj n b/ n kh c nhaa: Peth/d/ne C/
o/ant/n o/anto/ ado/ate hay son/peca/ne
dang d
t/ m /ngers /ngers /actate detrose 25 5 1 ph detrose atrop/n
benqa/nam/de batorphano/ ch/oproma/ne d/menhyh/r/nate d/phenhyh/dram/ne C/
dobatam/ne droper/do/ entany/ c/trate g/ycopyrro/ate metoch/opram/de pentaoc/ne /actate
proma/ne C/ sacc/ny/ cho//ne r repramy/ C/
C c ch predn/so/one
sacc/nate amobarb/ta/ sod/am hepar/ne sod/am hydrocort/so/ sod/am sacc/nate meth/c////ne

n/troaranto/n sod/am oytetracyc//n C/ pentobarb/ta/ sod/am morph/ne sa/phate phenyto/n
sod/am sod/am /od/ne tetracyc//n C/ th/openta/sod/am r th/amy/a/ sod/am
Dc lc hc
/ tha m b
sang T/ c ph ng
/t g y say g/ narcot/c kh c r r r h
cho g y m trong s ph ng th/ch h/stam/n g/
ng ho eper/d/ne k
c h/ nh s ph
kh/ g/
eper/d/ne /t g y g/ g g/
h th n r
c nh n p L/
ch morph/ne m c c d ng r o: g/
r ng mnh ph qa m n ngo /
Dc ng hc
Saa kh/ t/ m b
g/ m b a d / 16 g/ /
ch r m o th nh 12 g/ nh n / m s ng Tha
kho / th j n ho
t/
Ch nh/ s dng
Tha d
th n ng
ch ph / kh c tha
Chng ch nh
eper/d/ne ch n b a ch
t / th a h a eper/d/ne n n s tr n b b
tnh tr b c th
c trong ch s ng
ha h ph th ba
chng ch nh i vi bnh nhn b t bi lo / b cp Centruroides sculpturatus Ewing v

L|Y F| F|WU |QrQ|Fy| F|O F||||||
Bt li/cnh bo
eper/d/ne c th gy d ng khi tim di da v t/ m rt chm v o tnh mch hoc c th
/ m g/m huyt p. liu thng thng, mi quan tm u ti n / nh hng ca opioids n chc
nng h hp. liu ti m tnh mch, thuc s gy co ph qun ch. Hiu qu l m m du h thn
kinh trung ng ca thuc s l m cn tr kh nng l m r/c ca th. Anh hng tr n d d y rat
bao gm: bun nn, / ma v g/m nhu ng rut.
Tr n ch meper/d/ne c th gy gi n ng t (khng ging morphine). Nu cp thac qua
ng ung, thuc c th gy d ng ni m mc ming v g y t/t nhiu nc bt, c bit l m o
u d ng meper/d/ne g y m cho nga th c th lm tim p nhanh, nhiu m hi v th
nhanh
Qu liu
C th gy suy gim h hp hoc suy gim chc nng ca h thn kinh trung ng hu ht
c c /o / hng nh hng khc bao gm suy yu tim mch, hh t n nh/t, nhc trng c xng.
t v / /o / (nht l m o) c b/u hin kch thch h thn kinh trung ng (phn x qu mc,
r ng mnh) r c c b/u hin ng k/nh liu ln hn 20mg/kg.
a/oon / thac c chn iu tr suy gim h hp. Qu liu nghi m trng, na/oon
cn d ng th m //u lp li. Pentobarbital thng c dng iu tr c c k/ch th/ch h thn kinh
trung ng v ng kinh m o t hp barbiturates vi narcot/c c th tng say g/m h hp.
Tng tc thuc
C c /oi thuc m thac khng histamin, phenothiazines, barbiturates, thuc an thn,
a/coho/ c th lm gia tng suy gim h hp khi c phi hp vi meperidine.
eper/d/ne chng ch nh cho bnh nhn nhn cc cht c ch monoamin o/dase (
/nh/b/tors) (h/m khi c d ng trong th y) /t nht 15 ng y saa d ng c c cht n y t v / bnh
nhn b/u l cc du hiu qu liu opiate khi meperidine c d ng liu iu tr ng thi vi
c c cht MOA.
Liu d ng
Thac cn c ti m chm tnh mch.
Ch
/m au trong vi m thn cp tnh: 51mgkg (organ 1)
/m au khi bng: 3 5 mgkg (organ 1)
n thn: 51mgkg (
T/n m : 2565 mgkg (ooth 1)

/m au: 21mgkg hoc SC (Jenkins, 1987)
n thn: 14mgkg (organ 1)
T/n m : 2244 mgkg (ooth 1)
m au 3.3 c SC
a: gim au 2.2 c 0.2 a c th nhy cm vi nh
hng kch thch h thn kinh trung ng ca thuc v ry hn ch nh hng n y c th d ng
aceproma/ne (24mgkg ) hoc xylazine (0.30.5 mg/kg, IV) IM gim bt s thay
i trong ca h nh r/ ca th do thuc g y ra
c c tc dng nh cht kim ch. Meperidine c s dng liu 1 kt
hp vi promazine (2mg/kg, IM) hoc atropin (0.07 mgkg ) c t c dng nh cht tin m
4560 pht trc khi d ng arb/tarates hoc thuc m bay hi. Tt c cc thuc n y n n t/ m cc
r tr khc nhau.

C
1
27
t ha hc
Pentazocine c tng hp t 2 mui khc nhau. Mui hydrochloride, dng thuc ang, c
m a trng, dng bt tinh th. Tan trong t do trong nc v cn. Dung dch tim c chun b t
pentaoc/ne khang ngay n cht vi cht ph gia l ac/d /act/c Pentaoc/ne / mt base yu vi pKa

t s cht c tnh tng hp vi pentazocine lactate:atropin sulphate, benqa/nam/de C/
batorphano/ tatrate ch/oproma/ne C/ d/menhyhydrate C/ droper/do/ entany/ c/trate
hydromorphone hydroy/ne C/ meper/d/ne C/ metoch/opram/de morph/ne sa/phate
perphena/ne droy/ne C/
t s cht c tnh khng tng hp vi pentazocine lactate: am/nophy///ne amobarb/ta/
sod/am /an//ne meg/am/ne g/ycopyrro/ate pentobarb/ta/ sod/am phenobarb/ta/ sod/am
48
secobarb/ta/ sod/am r sod/am b/carbonate
Dc lc hc
Pentaoc/ne b/u l nhiu c im ging vi nhm cht ch vn opiate tht s. c h/u
/c l m g/m au bng mt na morphine v gp 5ln meperidine. N l cht i vn (antagonist)
rt yu ti receptor opiate mu khi so snh vi naloxon. Ngoi c tnh l m g/m au, pentazocine c
th gy suy gim h hp, gim nhu ng rut, an thn, chng ho. c tnh gip an thn ca thuc c
th thp so ri cc opiates khc v do thuc thng khng c dng tin m trc khi g/i
phu.
Trn ch, pentazocine c bit s gy gim p sut huyt tam thi.
Dc ng hc
Pentaoc/ne hp thu tt saa kh/ ang, ti m tnh mch v tim di da. Do bi h/u qu
chayn ha ban u (firstpass) cao ch khong 1/5 liu ung s lu thng vo c th khi chc nng
gan bnh thng. Sau khi hp thu, thuc c phn phi rng khp cc m. nga, khong 80%
thac // n kt vi protein huyt tng. Pentazocine qua nhau thai v lng thuc trong huyt thanh
ca b o tha/ ch/m khong 6065% lng phn phi trong c th th m. Lng thuc i v o trong
sa th cha c bit.
Thac c chuyn ha gan v bi thi qaa thn. nga, khong 30% thuc c b / thi
bi glucuronide. Pentazocine v cht chuyn ha ca chng c ph t h/n trong nc tiu nga
khong di 5 ng y saa kh/ t/ m thac. Khong 15 thac c b / thi khng b bin i trong
nc tiu. Thi gian b n hy ca thuc trong huyt tng khc nhau cc lo /:ga Pony
7ph t ch 22ph t m o4ph t eo 4 ph t Th tch phn phi cao khong 0.59L/kg
nga, 27 Lkg m o nga, thuc bt u hot ng t 23 ph t saa kh/ t/ m tnh mch, hot
ng mnh nht sau 51 ph t
dng/ch nh
Dng trong au bng nga (colic) hay gim au sau khi gii phu ch g y xng, vt
thng, ri lon lin quan n xng sng tr n ch cj n c d ng g/m au cho mo v heo.
ng ch nh/ch
Tt c opioates nn c s dng ch i vi bnh nhn nhc nng tuyn g/ p bnh
thn. Ging nh cc opiate khc, pentazocine s dng ch i vi bnh nhn b chn thng u,
say g/m chc nng thn kinh trung ng. Khng n n s dng pentazocide nh thuc ch lc trong
iu tr cn bnh m ch n n xen nh l thuc c kt hp iu tr l m g/m au.
t li/cnh bo
Tr n ch bt li thng thy sau khi d ng thac qua ng ngo / t/ a h a / s t/t nc
49
bt. Nhng bt li khc thng thy liu thng thng nh rng mnh / ma v sng phng
ch ti m liu rt cao (6mg/kg) ch c th pht trin chng tht iu vn ng, r ng mnh co
g/t, sng ch ti m
ga c th b tht iu vn ng v c c tr/u chng kch thch thn kinh trung ng, nhp
mch v nhp h hp c th tng cao.
a //u: khng nn cho th n trc khi cp khi thuc qua ng ung. Cc triu chng qu liu
c th iu tr vi (O2 , cht lm tng p lc mu, dch truyn tnh mch), suy gim h hp c th
iu tr vi naloxon
Tng tc thuc
Thac m thac khng histamin, phenothiazines, barbiturates, thuc an thn, a/coho/ c
th tng suy gim h hp v h thn kinh trung ng v ry cn gim //u.
u d
Ch : g/m au: liu u 1.65 mg/kg, sau 33.3mg/kg, IM. Hiu lc ko d / khong 3 gi.
u d ng //u lp li, n n t/ m v tr khc.
o: g/m au: 2.233 mgkg S hoc IV (Booth, 1988)
ga: gim au: 0.3366 mgkg S hoc IV (Jenkins, 1987)
eo: g/m au: 2.0 mg/kg, IM (Jenkins, 1987).
50

t ha hc
L cht i vn opioate, cu trc ca naloxone HCl c lin quan n oomorphone dng bt
m trng, pKa=7.94. Naloxone hj a tan trong nc v /t tan trong cn. Naloxone cj n c bit n
ri t n kh c / a//y/noroymorphone
Dc lc hc
Naloxone l c xem nh cht i vn opiate thun ty. C bn th na/oone khang c
h/u qu gim au. C ch tc ng ca n th cha c bit, nhng c th tin rng hot ng ca
thac nh mt cht cnh tranh i vn bi s li n kt vi cc v tr tr n receptor op/ate ma kappa
r s/gma a/oone cng c tc ng dc lc liu cao bao gm tng lng dopamine trong m a
v i vn
Dc ng hc
a/oone ch c hp thu mt phn qua ng ung v thac nhanh chng b ph hy khi
vo ng ti a h a do ry cn d ng //u cao hn rt nhiu khi cp thuc qua ng n y h/ thac
c cp qua ng tnh mch, na/oone bt u hot ng rt nhanh t 1 2 ph t t/ m bp khong
5 ph t saa kh/ cp thuc. Thi gian tc ng ko d / 4590 pht nhng c c th ln n 3 gi.
a/oone ph n phi nhanh n khp c th, mc cao nht tm thy n o thn, lch, c
xng, phi v t/m Thac cng d dng qua nhau thai. Naloxone c chayn ha gan, b / thi
qua nc tiu. ngi, thi gian bn hy ca thuc l khong 601 ph t
Ch : na/oon g y hi chng nghin cp tnh khi d ng //u cao. Naloxone khang g y qa /
tha/ ng vt nhng c th tch t chng nghin cho b o tha/ ngi ph thuc opiate.
Tng tc thuc
a/oone cng c hiu qu i khng vi cc cht ch vn/ i vn khc nh: batorphano/
pentaoc/ne na/baph/ne
51
u d
c IM.
a: 0.01

C
21
27
c nhm phenylheptylamin, l c c hiu lc g/m

au tng ng Morphine, c thi gian tc ng d / nht trong s cc thac gim au loi
narcot/c Thi gian bn hy ca thuc trong huyt tng liu u khong 24 gi v c th ko d /
hn sau khi dng liu lp li. Thuc c d ng g/m au trong cc trng hp au d di c bit
l au m n t/nh L/u php g/m au thng bt u vi cc narcotics tc ng ngn m sau n
s b ngn /i bi hiu qu ca methadone. Methadone khng c hiu qu gim au trong g/i phu
u gi bi v n c kh nng gy suy gim h hp b o tha/ k o d / Methadone, thng c d ng
qua ng ung, l //u php quan trng nht gii c hoc duy tr nh/t trong iu tr chng
ngh/n do narcotic. Hi chng cai thac nh hn nhng ko di hn morph/ne do gn nhiu v o
prote/n hayt tng.

L thac gim au trung ng ng thi l cht ch vn opioid yu. Tramadol c ch au
ty sng thng qua hot ha monoamin. c dng gim au t trung bnh n nng. Liu d ng
51 mg P mi 46 g/, liu ti a 4mgng y Li ch ca tramadol l /t g y /m dng v /t
g y say ha hp. Tc dng ph tng t cc cht opioid khc nh an thn, chng mt, kh m/ng,
52
ban nn, t o b n C th gy co git nhng him gp, thng xy ra khi qu liu (5mgng y)
dng ng thi SSRI v c c cht ch vn opioid khc; ang d ng c c thac l m g/m ngng co
g/t nh IMAO, bnh nhn ng kinh, chn thng u; ri lon chayn ha, nhim khun h thn
kinh trung ng.
C KCH THCH H THN KINH TRUNG NG

c cu to
Thac tng hp, l d/ethy/am/d ca acid nicotinic, cng thc gn ging vi r/tam/n PP
L thac k/ch th/ch h nh ty nht l r ng trang t m ha hp. Kch thch trung t m rn
mch yu hn, c d ng trong say ha hp v rn mch c tnh cht trung ng.
ng
Tr n h thn kinh: /ch th/ch trang kha ha hp.
/ch th/ch trang kha rn mch
T c t c dng tng huyt p, ci thin huyt p khi tt huyt p. Thuc c d ng trong
nhng ca suy h hp. Do thn kinh trung ng b c ch qu .
u d
ga, tru, bj : 256 g con
Ch : 2575 g con
o: 255 g con
ng cp thuc: ang hoc tim di da.

C
13
Dc lc hc
53
mphetam/n / thac kch thch thn kinh trung ng c a vo c th kch th/ch
thn kinh trung ng hot ng mnh. Amphetamin hot ng ch yu bi s gii phng
norep/nephr/ne h/u qu ca chng ngoi vi thn kinh t tr rt g/ng vi norepnephrine ca
chnh n. Chng lm tng p sut mu; gim hoc tng nhp tim ph thuc v o mc phn nh ca
ngh/m p l bao nh/ a bi thay i ca p sut mu; thng mi; gi n ng t mt; nh hng n
s chuyn ha g/acose r m.
aan trng hn, chng vo thn kinh trung ng rt tt, hiu qu kch thch mnh hn
nhng thuc kch thch thn kinh giao cm khc v l l do ch yu dn n lm dng thuc.
Thac tc ng nhanh thng ch mt hoc hai liu.
Thac dung np ch yu ngoi vi v thn kinh trung ng. S dung np thuc mt cch
nhanh chng thuc hot ng th c gi l tachyphy/a/s gay n nh n ch yu ca s dung
nhn thuc c qaan h vi c ch hot ng ca ch ng: ch ng g/i phng norepiephrine t n o r
nu khong cch ca mt liu vi //u k ngn, thi gian khng cho thn kinh cha nhng
dn truyn c b sung v r ry cng p ng b gim bt.
nh lm
Amphetamin khng c tn thnh s dng nh l cht kch thch ngoi vi thn kinh
ngoi vi thn kinh giao cm. iu tr chng ng gt, lon thn kinh chc nng, gim au, chng bo
ph b/ng n.
ng ch nh, tng tc thuc, c tnh
/u qu cnh tranh ngoi vi thn kinh t tr c quan h vi chng ch nh thac, tng
t c thac, du hiu v hi chng ng c.
hng vn tim mch, c bit chng cao huyt p l qaan trng nht v ngay h/m nht li n
quan n h thn kinh ngoi vi. Th m vo , kch thch qu mc thn kinh trung ng cng cn
phi lu nhng tai bin xy ra ch yu do s qu liu.
ng
Tng huyt p
/ch th/ch trang kha ha hp l m th nhanh, su
p dng lm s ng: try h hp, tt huyt p.
u dng: (tim di da)
ga, bj :13 mg con
T/u gia sc: 1.144 mg kg th trng
Lu : d ng / a g y ngh/n, tng huyt p, lon nhp tim.
54

t
L cht kch thch h thn kinh trung ng, tc dng mnh tr n trang kha rn ng l m g/a
tng trng lc c, v cc vng nhn cm ti v n o trang kha ha hp, trung khu vn mch v thn
k/nh ragas
ng lm s
Kch thch tng cng v tn s tim, c th phi hp vi digitalis, hoc strychn/n
Kch thch c trong trng hp c yu
L m hi tnh hot ng n o
Li tiu trong bnh ph thn, gan do suy tim
u d ng hoc chch di da 1 n/ng
Tr a bj : 14 gcon /n.
eo: 315 g con /n.
Ch 525 mg con /n.
ga 5 g con /n.
ng ch nh
Trong trng hp cao huyt p
nh vi m thn cp trong cao huyt p
Cn thn khi d ng tr n nga c mang
2.2.4. Strychnine
Cu trc ho hc
C
21
22
2
Strychnos decassata
Tnh cht
L a/ka/o/d ca ht m t/n (Strychnonox nux vomica), strychnin kch thch tt c c c phn
ca h thn kinh trung ng.
T c dng
c ch men acetylcholinesterase, ngn phn gii acetylcholine y n n s tch t
acety/cho//ne tr n b mt neuron lm tng trng lc c trn, c vn.
| Q |F D|VWUFKQLQH||LD|W Q |E W|G FK|WLr|KyD||W Q |WU F|G |G k/ch th/ch
nhu ng rut.
- Strychnin, l c t gy cht do c hp thu d d ng sau khi ung. N c n c
d ng / m cht c i vi chim v ng vt gm nhm. Strychnin c xem nh l mt cht kch
thch c tc ng mnh nhng hiu qu ch yu ngn chn li n h gia n o r ty sng. c ch h
hp, gy au, co cng to n th n
p dng lm s ng
|OL |L |WU ||W Q |F Q |SK Q| |W |G D|Fi F|FK Q |W W|
liu cao hn, Strychnin cng kch thch trung tm h hp v t/m mch h nh ty gy tng
hayt p, gim nhp tim, kch thch v n o g y thc tnh. Strychnin lm tng mc kch thch cc
nron do n ngn chn tc ng c ch thng qaa g/yc/n / mt cht dn truyn c ch quan trng
ca cc nron vn ng v nron trung gian ty sng. Strychnin tc ng nh mt cht i khng
cnh tranh chn lc ngn chn tc ng c ch ca glycin ti tt c receptor ca glycin.
liu c, strychnin l mt cht gy co mch dng un vn: u ng r sau, lng an cong,
t chi co cng, h m kh/t /i. Kiu co git n y / b/u hin kch thch ty sng do c ch t b o trang
gian lm suy nhc.
Tr thn kinh, nh ci thin cc phn x v gia tng nhng phn ng thn kinh.
Tr sc, kch thch ti a h a ngon m/ng trong cc trng hp bnh ang trong giai on
phc hi.
u d
ng / con / ln Tim di da/ng
j
eo d cu
Ch
o
ga
15 mg
5 mg
1 mg
5 mg
1 mg
15 mg
5 mg
1 mg
5 mg
1 mg
| F|VWUFKQLQH
Co g/t do phn x , c thi k y n ngh, s ng chm , ting ng, s gy co g/t tr li.
Th cht do ngt th v co c ph qun.
| L |WU |Q | F
T/ m tnh mch Barbiturate i vi th nh
Cho ang hoc ti m tnh mch Chloralhydrate

u trc ho hc
C
1
16
Ly t tinh du g c y /ong n o (C/nnamomam camphora)

Tc ng dc lc
Tr n thn kinh trung ng: kch thch ch yu v o h nh n o c bit l trang kha ha hp v
rn mch nht l kh/ trang t m n y b suy nhc. liu mnh tc ng r o r n o g y co g/t.
Trn tim: tc ng phc tp v khng u. tim b suy nhc bi cc liu c ca chloral,
ch/oroorm th /ong n o / m nhp tim v bin tr v bnh thng v / m chm s rung tim. L m
g/ n mch v g/m au.
ng
/ch th/ch h

S h
ng / m tha b

ng dng lm s ng
m g/ ha h
r ng
j ng h ng
/ | S |WK W||Y W|Fy|P
Liu dng: (chch di da)
Gia s c Du long n o 20% Dung dch long n o 10%
g j
eo d c
Ch
4 m/
6 m/
2 m/
1 m/
2 m/
6 m/
2.2.6. Dextroamphetamine
Dc ng hc
a h a ph n ph th d
o / h/ 6 ph t Tha /
th ac/d c
detroamphetam/n khang b r d ng kha j ng m a Tha / t/
th k o d / th nh th 6 g/ b /
t/ bnh th qaan tr m ng
n r n c // n
qaan g/ n t/ ph ng norep/nephr/ne
k/ch th/ch r ng r o ca o r
c n k n k r o C c
m r
/ch th/ch t m t
/ c c tha n qaan
r ngo ang n
n
58
g y cht ca amphetamin. Mt v / c th ch tri qua thay i nh thn kinh trung ng v ngoi
r/ saa kh/ d ng //u gp 1 /n iu tr. liu tng t nh th, amphetamine d d ng g/t cht
nhng c th khng pht tr/n dung np amphetamine. Dung np s khng pht trin kh/ //u d ng
ca amphetamine c kh nng gy ri lon tm thn. Mt nguy n nh n ca s dung np l g/i
ph ng r saa c ng / s suy yu (depletion) ca norep/nephr/ne ti im cui c ng ca thn kinh
Ch sau mt hoc t hn hai liu, norepinephrine sn s ng g/i phng nhng liu t/p theo
r r ry cng tc ng b suy yu. Nguy n nh n kh c ca s dang np l s b / thi gia tng:
b/ng n, l m b/n i to n b chuyn ha ca c th, u ti n / t/ch ketos/s hng th ketone
c b / t/t qua nc tiu, chng lm acid ha nc tiu v r ry thc y b / thi amphetamine
r g/m lng amphetam/ne trong m a
Tc ng thn kinh ngoi bin: tc ng kch thn kinh giao cm ngoi bi n g y g//
ph ng norep/nephr/ne t thn kinh giao cm ngoi bi n L/u iu tr thng c dng tc
ng n thn kinh trung ng thng gy gi n ng t, tng nh nhp tim v hayt p.
nh lm sng v ng cp
Amphetamin c s dng ch yu nh cht k/ch th/ch thn kinh v iu tr chng bo
ph iu tr s thiu ht ri lon hot ng thi qu v chng ng r. Dextroamphetamine c s
dng kh ph bin. Amphetamin c gii hn s dng nh cht chng trm cm bnh nhn b
bnh parkinson v nh mt thuc kt hp trong iu tr cho nhng ngi b ng kinh. Chng cng
c g/ tr trong iu tr phc hi tm tnh nhng bnh nhn ri lon bnh tm thn nhng
khang mang /i hiu qu tha ng nh mong i v n b nh hng do bi s lm dng thuc.

u trc ho hc
C
14
2
Dc ng hc
Methylphenidate (RITALIN) c hp thu tt qua ng ti a h a r ph n phi khp c th.
ot ng ca thuc xut hin khong 1gi sau khi cp thuc qua ng n y r k o d / khong 6
g/. Thuc hon ton c chuyn ha gan th nh dng khng cj n hot tnh v c chuyn ha
59
r b / thi qua nc tiu.
ethy/phen/date g y k/ch th/ch n o mc trung bnh r k/ch th/ch thn kinh giao cm,
nhng hiu qu tr n r n o rt mnh (tr nh) hn amphetamines. Vi detroamphetam/n dang
nhn thuc thn kinh trung ng v pht trin hiu qu liu khi c s dng li n tc.
Methylphenidate thng c chn iu tr ADHD th nh v chng ng r (narcolepsy) th
/n.
hng sn phm cho hiu qu tc thi hoc dng vi n ph ng th/ch dn (TLS)
thng d ng trong c c ch nh. Hu ht th nh b ADHD u p ng ri methylphenidate. Ci
th/n cc triu chng c th thy khong vi ngy n r / tan sau khi bt u iu tr. Nu khng
c du hiu ci thin sau 1 thng, vic t/p tc iu tr bng methylphenidate cng s khng mang
/i kt qu khi khang n n t/p tc m phi thay th bng mt loi thuc khc.
i dextroamphetamin, nu bnh nhn p ng vi thuc th n n qayt nh tip tc iu tr
/t nht 6 thng. Nu bnh nh n d ng thac dng vi n TLS cho ang ho n to n khang nha/
thac.
ng ph, bt li, chng ch nh
ethy/phen/date cng ging nh amphetamines. Trng thi bn chn v chng mt ng l
t c dng ph thng thy, c bit l tr em cng d nhy cm vi chng bing n, gim cn, tr
ho n tm thi s tng trng trong sut thi gian iu tr. Methylphenidate gy thiu mu mt v /
bnh nhn.

t ha hc
oaprame c m a trng n trng ng khang m / dng bt tinh th n nh ngo / nh
sng v khng kh, tan trong nc v tan yu trong alcohol v tan hu ht trong cn. Benzyl alcohol
hoc chlorobutanol c kt hp nh mt cht bo qan dung dch ti m
Dc lc hc
oaprame / thac kch thch thn kinh trung ng c d ng ph bin. Tc ng kch
th/ch ha hp l kt qu kch thch trung tm h hp h nh ty. Tng nh nhp v th tch h hp
nhng tng oxi ha ng mch khng xy ra sau . Do bi doxaprame tc ng tr n h h hp kt
qa lm tng tiu th O2 v sn s/nh C
2

Dc ng hc
Thac bt u tc ng sau khi ti m tnh mch khong 2 pht. Thuc c phn phi tt
r o c c ma Tr n ch doaprame chayn ha nhanh v c b / thi qua nc tiu khong 244
g/ sau khi ti m t lng nh thuc c b / thi sau khi dng qua ng ung khong 120 gi.
60
dng/ch nh: ch phm Dopram nh:
Ch m o nga: kch thch h hp trong v sau khi gy m, nhanh chng nh thc v phn
ng li sau khi gy m
Ch m o mang tha/: k/ch th/ch ha hp trong k thut m ly thai.
oaprame cng c dng trong iu tr suy gim h hp cho th thng phm v th nh do
d ng qa //u barbiturate.
ng ch nh
Doxaprame khng c s dng nh mt cht thay th tr h hp trong cc trng suy
ha hp ngi m trng. Chng ch nh trong cc trng hp ng kinh, chn thng u, tng huyt
p ngh/ m trng, bnh tim mch, ri lon th cp do ri lon thn kinh c, tc mch phi, kh
th, bnh suyn cp tnh, ph n o Tr nh t/ m c ng mt v tr trong thi gian d / Ch m o mang
tha/ n n t/ m thac di da.
t li/ cnh bo
Lon nhp tim, tng huyt p, ng kinh dn n nhim kim h hp (alkalosis). hng bt
/i n y s xy ra khi d ng //u lp li hoc liu cao.
u
C c du hiu bao gm: tng huyt p, c xng hot ng thi qu, tim p nhanh, ng
kinh. Thng d ng c c /oi barbiturate tc ng ngn ti m tnh mch g/m hot ng thi qu do
k/ch th/ch qa mc thn kinh trung ng.
Tng tc thuc
p /c ca mu s tng l n kh/ doaprame kt hp ri cc thuc kch thn kinh g/ao cm.
oaprame c th l m g/m hiu lc ca cc thuc gi n c. Doxaprame lm tng gii phng
epinephrine; do cn cp thuc tr khong 10 pht sau khi ngng cp thuc m (ha/othane
enflurane) lm cho c tim nhy cm ri catecholamines.
u d
p th mi sinh: nh 1 t di li hoc
1m/ t/ m tnh mch rn (lu s dng sn phm c cha benzyl alcohol bo qun).

a: 0.5 a con; l a con tnh
/i: 0.02 5 mgkgph t

t ha hc
L am/n k/ch th/ch thn kinh giao cm, phenylpropranolamin HCl c m a trng, dng bt
61
t/nh th, c mi thm nh, nhit tan chy 19114oC pa 4 j a tan trong nc (1g/1.1ml)
r cn (1g/7ml). Phenylpropranolamin HCl cj n c bit n vi t n h a hc dlorepher/ne C/
Dc lc hc
C ch tc ng ca HCl th cha xc nh, song ngi ta tin rng pheny/proprano/am/n
g/ n t/p tc ng n c hai receptor ? v adrenerg/c bi n g y g/i phng norepinephrine. Nu
d ng thac ko d / hoc d ng qa //u thng ay n norep/nephr/ne s b gii phng ht ra khi
ni nhng d tr n v g y tachyphylaxis sau . Tachyphylaxis khang at hin ch m o
Tc ng dc l ca phenylpropranolamin HCl bao gm tng co mch, nhp tim, lu lng mu
mch v nh hayt p, kch thch nh thn kinh trung ng, gim xung hayt mi v tnh thm n.
Phenylpropranolamin HCl lm tng sc th / (tone) ca c vj ng b ng qaang r g y ng kn c t
cung; y l nhng ch nh quan trng ca phenylpropranolamin HCl trong th y.
dng/ ch nh
Pheny/proprano/am/n d ng ch yu trong iu tr gim trng lc c vj ng b ng qaang
ch m o go / ra thac cj n c dng trong iu tr xung huyt mi (nasa/ congest/on) th
nh.
Dc ng hc
Cha c thng tin v dc ng hc ca thuc trong th y. ngi, pheny/proprano/am/n
HCl c hp thu nhanh chng sau khi ung v bt u tc ng (chng xung hayt mi) t 153
ph t saa kh/ d ng thac v h/u qu tc ng k o d / khong 3 gi (thuc dng bao nhng hoc
dng vi n)
Pheny/proprano/am/n C/ ph n phi n cc m v dch khc nhau, bao gm h thn kinh
trung ng. Tc hi cha c bit nu thuc qaa nhaa tha/ r r o sa. Phn ln thuc c
chayn ha th nh c c cht hot tnh, nhng khong 80 thac b / thi khng bin i trong
nc tiu khong 24 gi sau khi d ng thac. Thi gian bn hy ca thuc trong huyt thanh khong
34 g/.
ng ch nh/ch
Ch kh/ s dng phenylpropranolamin HCl cho ngi b tng nh n p n rng
(hypertrophy) tayn tin lit, cng nng tuyn gip, tiu ng, ri lon tim mch, v tng huyt
p
t li/cnh bo
T c dng ph bao gm: trng thi hiu ng, d b kch thch v tng huyt p, b/ng n.
u
a //u gy nh hng nghi m trng n tim mch (huyt p, nhp tim, suy tim mch), nh
62
hng n thn kinh trung ng (hn m). Nu xy ra qu liu, n n ra sch d d y r kt hp
d ng than hot tnh hoc cht ty nh.
Tng tc thuc
Pheny/proprano/am/n C/ khang n n kt hp vi cc thuc kch thch thn kinh g/ao cm
(epher/ne) r / m tng c tnh. Khng n n d ng Pheny/proprano/am/n C/ khong 2 tun sau khi
bnh nhn d ng c c cht c ch u dng ng thi
i c cc NSAIDs khc, bao gm aspirin),
t chng trm cm ba vj ng c c cht c ch hch (ganglionic).
Tng nguy c lon nhp tim nu cp phenylpropranolamin HCl cho bnh nhn d ng
cyc/opropane hoc cc thuc m ha/othane h a hydrocarbon Proprano/o/ thng c d ng kh/ c c
tng tc trn xy ra.
u lng
Ch, mo: iu tr gim trng lc c vj ng b ng qaang: 125 5mg P (Labato 1)
hoc 1.1mg/kg, PO.

u trc ho hc
Pemoline (CYLERT) c s dng c nht cho iu tr ADHD. c hp thu tt saa kh/
ang v thi gian tc ng ko d / khong 12 gi. Khong ph n na liu thac c hp thu s b /
thi cj n hot tnh trong nc tiu.
Pemoline c a vo s dng bi tc ng c li ca n l lm gia tng d tr hoc tng
hp dopamine, mt cht kch thch dn truyn thn kinh, mt phn ca thn kinh trung ng T c
ng tr n c c tr/u chng ADHD c th s khng t/n trin khong 34 tan v ry bnh nhn n n
thn trng. Pemoline c th gy g/m kch thch n o hn nhng thuc khc dng iu ADHD v
h/u qu kch th/ch thn kinh giao cm ngoi bi n / thp nht. Pemoline c th gy tn thng
gan ri lon vn ng. Hu qu ca s lm dng pemoline th nh hn so vi hu ht cc
amphetam/ne kh c hoc methylphenidate.
63
C TC NG TR N KINH NGOI BI C T
Nm 1860, Niemann ph n /p c cocain v o//er d ng coca/n g y t nh n khoa nm

14
Nm 1905, Einhorn tng hp c procain.
Nm 1943, Lofgren tng hp c lidocain.
nh ngha
Thac t / nhng dc phm c th tm thi l m g/m hoc mt cm gic ni t/p c
c bit l cm gic au do hy b tnh cm ng v t/nh dn truyn ca thn kinh hay cc dy tn
c ng ca thn kinh.
Cc phng php gy t
T b mt: l m mt cm gic do ch m tn c ng ca dy thn kinh cm gic b t //t.
Phng php ny c p dng rng r / kh/ g y t m ng nh y mt, mi, m/ng, da b try st.
hang t c dng tr n da ngay n rn v b/u b sng ha, thuc t khang th thm v o
T thm: ti m nh/u ln,cc th tch nh v o m Thac khuych tn chung quanh ni
ch/ch / m t ch m tn c ng ca dy thn kinh.
y t m ng cng hoc ngo / m ng cng ty sng (Epidural tradaran anesthes/a)
Bm thuc v o trong khong trng m ng cng ca pha sau ty sng (gia cc xng ct).
Thac tc dng l n d y thn kinh ty sng pha sau, trc khi dy n y ra khi ct ty sng v ph n
ch/a khp c th.
C ch tc ng
S truyn xung ng thn kinh l do s gia tng t ngt kh nng thm thu ca m ng t
b o thn kinh vi nhng ion K trong t b o ri ion Na ngo / t b o S khuych t n n y g y n n s
thay i in th gia b n trong r b n ngo / m ng t bo, lm in th m lan rng nhanh chng
dc theo dy thn kinh khi xung ng lan truyn
Thac t kh/ r o ma c t/nh k/m nh, s b thy gii chm, phng thch base a/ka/o/d t c
dng gim kh nng thm thu ca m ng t b o thn kinh, s thay i in th m ng b ngn chn.
Dc ng hc
p thu
Thac t hp thu vo c th t y thac v o nh/u yu t: liu lng, v ng t/ m chch, gn
kt, s c mt ca thuc co mch trong thac t th nh phn l ha, v tc ng dc l ca thuc
t
v ng c nh/u mch mu thuc t c hp thu nhanh hn.
h/ d ng thac t phong b cc khu vc thn kinh, nng thuc t hp thu trong m a cao
64
nht khi gy t lin sn v thp nht kh/ g y t thn kinh ta.
h/ thac t c s dng phi hp vi thuc co mch nh adrenalin th hp tha g/m ,
h/u ng gy t ti ch ko d /
hng loi thuc t tan trong //p/d thi gian duy tr g y t k o d / do ph n t thac c
gn kt cao vi m tip xc nh bupivacain, etidocain.
Coca/n / /oi thuc t c t/nh cht ging giao cm, co mch, cho n n khang phi pha th m
thac co mch.

Saa kh/ t/ m nht l c c /oi thuc t thac nhm amid, c phn phi nhanh hu ht
c c ma k c n o gan thn v t/m thac cj n n tn ni d tr k c ma m. S phn phi thuc
co mch.
n ha
Thac t c chuyn ha gan tr th nh chayn ha cht tan trong nc v thi tr qua
thn.
Thac t dng BH+ (khng ion ha) ph n phi nhanh trong m, rt t hoc khng thi tr
qua ng nc tiu. Khi nc tiu toan ha, th base bc III b ion ha tr th nh dng ion ha,
khang t / hp thu m thi tr nhanh qua thn.
Thac t thac nhm ester thy phn rt nhanh bi men butyry/ cho//nesterase trong m a
Thac t thac nhm amid b thy phn bi men microsomal enzym gan.
Pr//oca/n (nhanh nht) > etidocain > lidocain > mepivacain > bupivacain (chm nht).
c tnh
Tr n thn kinh trung ng: gy bun ng, ri lon th g/ c r th/nh g/ c //u cao c th
g y rang nh n cu, co git ri cht do suy thn kinh trung ng.
Tr n thn kinh ngoi bi n: / m mt cm gic v rn ng sau khi gy t ty sng liu cao.
Tr n t/m mch: thuc t tc ng trc tip ln c tim v c trn ca m ng t c ng gin
t/p l n h thn kinh t ch, gim co bp tim v d n t/u ng mch dn n tt huyt p, try tim
mch.
i thuc t

u trc ho hc
65
C
17
21
4
t
Cocain l alkaloid chnh c chit xut t l cy Erythroxylon coca v c c /o /
Erythroxylon kh c.
Tc ng dc lc
Tc ng gy t : d ng trong g y t b mt v dn truyn.
Tr n thn kinh trung ng: gy hng phn cc trung khu v tinh thn, cm gic r rn
ng. Liu thp to cm gic sng khoi, mt s mt mi, gia tng tr tng tng, o gic. L/u
cao g y ran ry, co git.
Tr n ha hp v t/m mch: kch thch trung tm h hp v rn mch ca h nh ty, sau
/ m t //t trung khu n y ry, ng c cocain s cht v say ha hp r try tim mch.
Tr n h thn kinh thc vt: Cocain c xem l cht cng giao cm gin tip do c ch
g/i phng norep/nerphr/ne tn c ng g/ao cm hu hch v c ch s tha hi nor ep/nephr/ne
si trc. Do , cocain lm tng huyt p, gi n ng t, tng nhp tim.
h mt nga, ch chun b khm mt hoc gii phu. D ng dang dch 3 5 nh
thng v o mt, 2 5 g/t.
y t m ng nh y mi, thanh qun, khoang ming th ln hoc th nh bng c ch nh
mi, bm vo ming.
hang d ng g y t thm hoc m ng cng ty sng.
c tnh
liu cao gy ti xanh, run ry co g/t, ngt xu do c ch mnh trung khu h hp v rn
mch, d ng / a g y ngh/n.

u trc ho hc
66
c
c s dng nh l tc nhn chng chng lon nhp tim. Procain HCl khng m / m a
trng n v ng n a h t m, dng bt tinh th, pKa = 9.23, nhit tan chy 16516oC tan trong
nc v a/coho/
t s cht c xem l tng hp vi procain hydrochloride to th nh dang dch pha
tim:sodium chloride 0,9%, nc (d ng pha t/ m) dopatam/n C/ //doca/n C/ r rerapam/n
HCl. Tnh tng hp t y thac pH, s tp trung, nhit v cht pha lo ng c s dng.
Dc lc hc
L t c nh n chng chng /on nhp tim lp 1A, procain HCl c tc ng tr n t/m tng t
qa/n/d/n k o d / kh nng chu ng ca c tm nh v t m tht, gim kch thch c tim. N chng
tc ng kiu cholin, tc ng tr n nhp tim th cha c b/t r nhng thng tng nh hoc
khng thay i.
Dc ng hc
Thc n, i, s gim pH d dy u l m tr ho n s hp thu thuc. Phn phi thac cao
nht n o gan / ch thn, phi, tim v c. Khong 15% thuc li n kt vi prote/n hayt tng (ch),
thac qua c nhau thai v b / thi v o sa.
ngi, procain chuyn ha th nh acety/proca/nam/de (P) mt cht chuyn h a cj n hot
t/nh Tay nh/ n ch, vic procain chuyn ha NAPA cha c b/t. ch, khong 90% liu
t/ m tnh mch procainamide v c c cht chuyn ha c b / thi qua nc tiu khong 24 gi sau
kh/ d ng thac.
ng ch nh: ch i vi bnh nhn b bnh tim, gan, thn.
t li/ cnh bo
Tr n ch thac gy nh hng n d d y rat bao gm bing n i ma, ti a chy. nh
hng tr n t/m mch bao gm suy tim g/m huyt p, tc nt AV, st, /eakopen/a /m huyt p
y ra khi ti m nhanh tnh mch. Trn ngi c th xy ra hi chng SLE nhng nh hng n y
tr n ch th cha c bit. N n g/m liu tr n bnh nhn b suy thn, sung huyt tim hoc cc bnh
ngh/ m trng khc. L/u 44 mg/ kg th trng gy cht m o nu tim nhanh (trng hp ti m chm
//u gy cht ln n 440 mg / kg) do l m h huyt p.
u
Tr/u chng ca s qu liu bao gm gim huyt p, gy cht, ri lon, bun nan T/ m tnh
mch vi dopam/n pheny/ephr/ne norep/nephr/ne c h/u qu iu tr chng gim huyt p.
Trayn tnh mch 1/6 mol sodium lactate c s dng l m g/m nhim c tr n t/m do
proca/nam/de ng thac li tiu hay bt c cc cht lng khc kch thch s tiu c th nh
67
hng n b / thi thuc qua thn.
Tng tc thuc
C th trung hj a t c dng ca pyridostigmin, neostigmin hoc cc thuc khng
cho//nesterases kh c s dng ch i vi b ng c do digitalis khi iu tr vi ka// //doca/n
hoc phenytoin khng c h/u qu. Cimetidine l m g/m b / thi thac qua thn, kt qu lm tng
lng procainamide trong huyt thanh. Procainamide c th ko d / t c dng ngn cn hot ng
thn kinh c trong s gi n c ca succinyl choline v am/nog/ycos/des
c s dng rng r / do c tnh thp, hiu qu tc th
Tay nh/ n thi gian gy t ngn do cn kt hp vi cc thuc co mch, hoc thac tr
ho n hp thu ko d / thi gian gy t nh Adrenaline.
ng lm s
y t thm gii phu ngoi bi n th/n th c
ng 2% d ng tr n th nh
ng 4% d ng tr n th /n
t d ng g y t b mt do hiu qu km hn cocaine, butacaine
ng g y t m ng cng ty sng, dung dch 2%.

c cu to
t ha hc
L thac gy t r chng chng lon nhp tim c hiu lc cao, lidocain HCl c m a trng,
c r ng nht, dng bt tinh th vi nhit tan chy 747oC pa 76 rt d hj a tan trong
nc v a/coho/ L/doca/n cj n c bit n vi t n kh c / //gnoca/n C/
L/doca/ne c th tng hp vi hu ht cc cht lng c s dng truyn tnh mch bao
gm: aminophyllin, bretylium tosylate, calcium ch/or/deg/aceptateg/aconate carben/c////n
d/sod/am ch/oramphen/co/ sod/am sacc/nate ch/oroth/a/d sod/am c/met/d/n C/ deamethasone
sod/am photphat d/go/n d/phenhydram/n C/ dobatam/n C/ epher/ne sa/phate erythromyc/ne
/actob/onate g/ycopyrro/ate hepar/n sod/am
L/doca/ne khang th tng hp vi dopamin, epinephrine, isoproterenol hay norep/nephr/ne
68
amp/c////ne sod/am cephao//n sod/am methohe/ta/ sod/am phenyto/n sod/am
Dc lc hc
Lidocain c xem l thac chng chng lon nhp tim thuc nhm IB (membrane
stab////ng n nh m ng) ot ng ca lidocain bi s kt hp cht ch ri k nh sod/am kh/
khang hot ng c ch khi phc sau khi ti kh cc. //u iu tr, lidocain l m say g/m giai
on 4 ca s kh cc, gim tnh t ng, v n / c ch kh c / n / m g/m hoc khng thay i
h/u ng v t/nh k/ch th/ch ca m ng t b o hng hiu qu ny c c cc mc lidocaine
trong hayt thanh m cc mc khng l m c ch tnh t ng ca nt SA v tc ng nh n
t/nh dn truyn ca nt AV hoc dn trayn His Park/ne
Dc ng hc
L/doca/n khang c h/u qu qua ng ung. Nu dng ng ung vi liu rt cao s xy
ra nhng triu chng ng c. Nu ti m tnh mch liu iu tr, thuc s c tc ng sau 2 pht v
k o d / 12 ph t Saa kh/ t/ m thac nhanh chng ph n phi t huyt tng n cc c quan
nh thn, gan, phi, tim v ph n phi rng khp n cc m ca c th. N c i lc cao vi m m
r nhng m cha m, thuc li n kt vi protein huyt tng, u ti n / ac/d g/ycoprote/n
Tr n ch mc li n kt ca Lidocain vi protein n y rt khc nhau, c th cao hn ch
b cc chng vi m //doca/n c th c phn phi v o sa. Lidocain c chuyn ha gan to
th nh cht chuyn ha hot ng (MEGX v ) hong 10% liu m ng cp khng phi l
ng ti a h a th b / thi dng cj n hot tnh trong nc tiu.
ng ch nh
Mo c khuynh hng nhy cm vi nh hng ca thuc tr n thn kinh v ry cn lu
kh/ s dng. Lidocain chng ch nh cho th nhy cm thuc t nh m am/d th mc bnh gan,
sang hayt tim, shock, suy gim h hp.
qu liu
Tr n ch nu mc lidocaine trong huyt thanh >8?g/ml s xut hin cc triu chng ng
c bao gm: tht iu vn ng, chng git cu mt, gim huyt p, //u cao l m say g/m chc
nng h tun ho n Co g/t hoc b kch thch c th iu tr bng diazepam hoc barbiturate tc
ng ngn.
Tng tc thuc
S dng ng thi lidocaine vi cimetidine hoc propranolol tng hiu qu hoc tng nng
ca lidocaine trong huyt thanh.
C c thac chng chng lon nhp tim khc nh procainamide, quinidine, propranolol, phenyto/n
kh/ phi hp vi lidocaine c th h tr hoc tng phn tc dng trn tim v c tnh c th gia
tng. Phenytoin khi dng ng ti m tnh mch vi lidocain lm tng suy tim L/u cao lidocaine
c th ko d / sacc/ny/cho//n g y kh th.
T/ m qa nh/u m khang kt hp vi Adrenaline thuc hp thu qu nhanh l m say yu h
thn kinh trung ng gy bun ng, c th gy co rt c, h huyt p, i ma.
u d
Ch : L/u u, t/ m tnh mch 24 mg/kg sau tim liu duy tr 25 gkg (oses
1988) sau tim liu duy tr 5 gkg
23 mgkg t/ m chm tnh mch, d ng //u lp li sau 1015 ph t //u lp li ti a 8mg/kg
khong 10 pht.
t nhy cm vi tc ng h n kinh trung ng ca lidocaine, cn thn trng
v iu tr co git vi diazepam.
L/u u 115mgkg t/ m tnh mch sau ti m //u duy tr 14gkg t/ m tnh mch
(oses 1)
5 mgkg t/ m chm tnh mch (Miller, 1985).
a: 1 nh mch (Hilwig, 1987).
i c ng nng thuc c tc dng nhanh v mnh hn 2 ln so vi Procaine.
y t ti ch: dung dch 0,5% th nh; 1% th ln.
y t m ng cng ty sng: 1 2 th nh
2 3 th ln
( n d ng chang ri dung dch Adrenaline 1/100.000 ko d / thi gian gy t )

u trc ho hc
T c dng gy t mnh hn procaine gp 16 ln khi ti m tnh mch nhng cng c hn gp
1 /n, tc ng ko di hn procain.
C ch d ng:
y t mt: 0,5% th nh, 1% th ln
y t b mt m ng nh y: 2
y t thm: 1% cho th nh, 2% th ln

Ch dng gy t b mt do c tnh cao
C ch d ng: g y t b mt ni m mc mt, mi, ming, cung hng: dung dch 2% cho th
nh, 4 5 cho th /n.

(C)
ap/raca/ne c h/u lc gp 4 ln lidocaine v thi gian tc ng ko d / khong 12 g/ khi
dang dch ti m ca Bupivacaine c cha epinephrine. N c s dng rt nhiu trong sn khoa, rt
t gy tc ng bt li tr n th s sinh. Tuy nhin, thac chng ch nh trong k thut paracervical
b/ock techn/qaes trong sn khoa ang dch Bupivacaine mnh nht nng 0.75%, dng c
tt c cc thuc trong sn khoa. Thuc c th gy cht do l m ngng tim. Tng t, thuc cng g y
ngay h/m nu ti m tnh mch gy t r ng

Etidocaine thng c dng c ch thn kinh, gy t tht lng hoc gy t ui. Hiu
/c ca Etidocaine c phn thp hn lidocaine nhng thi gian tc ng ko di hn khong 50%.
(Carboca/ne)
ep/raca/ne th nh phm c th nh phn khang cha cht gy co mch. Thuc d ng g y t
71
thm hoc phong b thn kinh. Hiu lc ca Mepivacaine gp 2 ln lidocaine nhng thi gian tc
ng ngang nhau. Cng thc ca Mepivacaine d ng trong nha khoa c cha levonordefrin, cht gy
co mch kch thch thn kinh giao cm. N n ch kh/ s dng v ep/raca/ne c th qua rt nhau
tha/ ri lng ln do c th gy chng tim p chm cho thai nhi. Cn gim liu dng i vi
bnh nh n say thn.
Prolicaine thng s dng rng r / trong nha khoa

(mer/ca/ne)
enoca/ne / thac gy t cc b c tm thy ch yu OTC (overthecounter) c
dng l m g/m au da v kh chu m ng nh y (r m nng, cn trng t, pht ban, au thanh
qan, au rng ) enoca/ne / thac gy t tng i yu so vi procain. Thuc c kh nng gy
tc ng bt li bi v thac d g y /m dng khi d ng tr n r ng da rng hoc b try xc gy d
ng nh nh vim da Sn phm Benzocaine dng nh du thng d ng g y t m ng nh y oang
mi, hoc d dng bi trn vo cc dng c (ng thng tiu, dng c soi thanh qan).

Ch/oroproca/ne / thac gy t thm v phong b thn kinh. N c chuyn ha nhanh hn
proca/ne r thi gian tc ng cng ngn hn. V // do tr n Chloroprocaine thng c s dng
trong sn khoa. Chloroprocaine b mt hiu lc khi kt hp vi cht gy co mch. Sn phm
Ch/oroproca/ne c cha cht bo qun s khng c d ng trong g y t ui hoc gy t ngo /
m ng cng.
C TC DNG L THN KINH T CH
ng quan v h thn kinh t ch
thn kinh t ch l /oi h thn kinh hot ng c lp tng i vi v n o n ch/ phi
hu ht hot ng ca s sng: tun ho n ha hp, ti a h a chayn h a n/u dc v mt s hot
ng ni ngoi tit ca c th.
Ph n /oi: h thn kinh t tr c chia l m 2 nh m:
h m ph g/ao cm
72
h m g/ao cm
Thn kinh ph giao cm: xut pht t trung n o h nh ty, xng cng ct sng. y thn
k/nh agas / d y ph g/ao cm chnh ca c th.
Thn kinh giao cm: xut pht t min ngc, thc lng ca ct sng
h m ph g/ao cm v g/ao cm sau khi xut pht u phn chia v i n tn cc c qaan nhm
iu khin s hot ng ca tt c cc c quan trong c th. Hai nhm ny thng c tc dng i
nghch nhau nhm gi cho cc c quan hot ng trng thi cn bng.
Th/ d:k/ch th/ch h giao cm: tim p nhanh
k/ch th/ch h ph giao cm: tim p chm
t trung gian ho hc
giao cm: Adrenaline v oradrena//ne h cm ng vi n c gi l drenerg/c
ph giao cm: Acetylcholine, h cm ng gi l cho//nerg/c
c kch thch dy thn kinh giao cm

u trc ho hc
C
13
3
t ha hc
drena//n (ep/nephr/ne) / catecho/am/n ni sinh, ni tit ra nhiu nht l ty thng thn,
ngn hu hch giao cm, m thn kinh trung ng. Adrenalin dng lm thac c c t 2 ngun:
ch/t t ty thng thn gia sc v tng hp, c m a trng, dng bt tinh th. Kh tan trong nc.
o qun
epinephrine HCl nn c bo qun trong vt cha kn, trnh nh sng do bi n s b oxi
h a kh/ gp nh sng v khang kh/ hang d ng kh/ thac chuyn sang m a hng, nu hoc kt ta.
p/nephr/ne s b ph hy nhanh chng bi cc cht k/m v c c cht c tnh oxi ha.
Epinephrine HCl tng hp vi cc cht sau: dextran 6% trong dextrose 5%, detran 6
trong nc mui bnh thng, phc hp dextrose /ngers phc hp detrose /actate /ngers
phc hp mui dextrose, dextrose 2.5%, dextrose 5%, detrose 1 sod/am /actate 16
am/kac/ne sa/phate c/met/d/ne C/ dobatam/n C/ metaram/no/ b/tartrater rerapam// C/
C onoso/ PSL onoso/ PSL onoso/

Tdetrose 5 sod/am ch/or/de 5 sod/am b/carbonate 5 am/nophy///n cephap/r/n sod/am
hya/aron/dase mephenterm/n sa/phate sod/am b/carbonate aar/n sod/am
Dc lc hc
p/nephr/ne / ch m
g/ n c m m t
t m tha
Ch nh
/ m kha/ ph j n d ng k h
/ t c d
Dc ng hc
Tha yra nh
ng r o m a n o nh ph n ph o s
nh monoam/n o/dase r catecho
methy/transerase th nh ch khang cj n ho
Chng ch nh
hang d ng g y t c th tr c da
Dc lc hc
Trong g y t : k o d / th do t c d r tha
theo t r th
C o m ng nh y m nh
11 cho th /
Ch
Ch
Ch o t/m: t 1m/ th
Liu d ng
m b
g j : 2 m/
C 3 m/
Ch m o: 1 5 m/
T/ m t ch 11)
L/ //
(2) Phenylephrine HCl

Cu trc ho hc
C
9
H
13
NO
2
Tnh cht ha hc
L am/n k/ch th/ch receptor adrenerg/c c C/ c r
/ m a tr 145146oC tan t
a/coho/
Bo qun/ tnh n nh/ tnh tng hp
chay a n a ho
t
m t c c ch
ch/oramphen/co/ sod/am sacc/nate dobatam/n C/ //doca/ne C/ potass/am ch/or/de r sod/am
b/carbonate
k/m /o
Dc lc hc
n th adrenerg/c ph/a
n adrenerg/c Ch ng // adrenerg/c m

m t m
ngo r t m tha /t / m g/ cang sa
g
m Pheny/ephr/ne / n th co m
cang
S dng/ch nh
shock tha c
mong ma
b (ha/othane) ho ng c c /o y nh
ng c c tha
t/nh g y g/ tha
(gang//on/c)
Phenylephrine HCl dng iu tr gim huyt p do barbiturate hoc thuc l m m du thn
kinh trung ng cj n ang tranh lun. Phenylephrine HCl cj n c t c ng k o d / h/u qu gy t
ct sng. Phenylephrine HCl cj n c d ng trong nh n khoa
Dc ng hc
Thac c chuyn ha rt nhanh qua ng ti a h a saa kh/ ang v tc ng tr n t/m
mch s khi khng t c khi dng ng ung. Khi ti m tnh mch, h/u qu lm tng huyt p
at hin ngay lp tc v k o d / 2 ph t /u qu lm tng huyt p bt u xut hin sau khi
t/ m bp khong 10 pht v k o d / 1 g/. Thuc c chuyn ha gan v h/u qu ca n cng
b gii hn bi s hp tha r o ma
Chng ch nh/ch y
Chng ch nh cho bnh nhn tng huyt p nghi m trng, tim p nhanh. Ch kh/ d ng
thac tr n th g/ yu, cng g/ p
Bt li/cnh bo
Lon nhp tim, n n k/m tra huyt p thng xuyn trnh cao huyt p. Hoi t v tr c da
ang qaanh r ng t/ m d ng dang dch phentolamin 51 mg1115ml nc mui bnh thng
t/ m r o ang qaanh r ng da b hoi t.
Qu liu
a //u phenylephrine c th gy tng huyt p, co git, i ma, nhp ngoi tm tha at
hayt n o iu tr tng huyt p bng cch ti m phento/am/n (cht c ch th th ?), iu tr lon
nhp tim bng propranolol (thuc c ch th th ?).
Tng tc thuc
Pheny/ephr/ne c th gy lon nhp tim nu dng ng thi vi thuc gy m bay hi
ha/othane hoc thuc tr tim (digitalized). Khi d ng chang ri cc thuc gic , nh hng l m
tng huyt p c th gia tng. Atropin ngn chn phn ng tim p chm do pheny/ephr/ne g y ra
C c cht c ch MAO (monoamin oxidase /nh/b/tors) khang n n s dng kt hp vi
pheny/ephr/ne r / m tng huyt p rt mnh.
L/u lng: ch m o 15mgkg hoc 1mg, IM; nga 5mg, IV.
(3) Isoproterenol HCl
Cu trc ho hc
t ha hc
soprotereno/ C/ cj n c gi l /soprena//n C/ / cht tng hp ?adrenerg/c m a
trng, dng bt tinh th, tan t do trong nc, t tan trong alcohol.
o qun/tnh n nh/tnh tng hp
soprotereno/ C/ cn c bo qun nhit phj ng tr nh nh s ng khang kh/ , hi
n ng ang dch Isoproterenol HCl s chuyn sang m a hng hoc m a n a nu trong dung dch c
/n cht kim, kim loi hoc dung dch khng c y k/n hang n n s dng i m a hoc
kt ta. Nu Isoproterenol HCl c trn ln trong c c dang dch hoc cc thuc to th nh hn hp
c p 6 th c c hn hp n n s dng ngay.
Isoproterenol HCl tng hp vi cc dung dch ti m tnh mch (ngoi tr sodium
b/carbonate 5) r c c thac sau: calcium chloride/gluceptate, cephalothin sod/am c/met/d/ne
C/ dobatam/ne C/ hepar/ne sod/am mag/es/am sa/phate ma/t/r/tam/ne /nas/on net//myc/ne
sa/phate oytetracyc//ne C/ potass/am ch/or/de sacc/ny/cho//ne ch/or/de tetracyc//ne C/
rerapam// C/
Isoproterenol HCl khng tng hp vi sod/am b/carbonate r am/nophy///ne
Dc lc hc
soprotereno/ / cht ch vn tng hp ?1 v 2adrenergic, tc ng khng ng k n ?
adrenerg/c liu iu tr. Hot ng gii phng adrenalin (adrenergic) ca Isoproterenol l kt qu
ca vic kch th/ch sn xut AMPrj ng T c ng ch yu ca Isoproterenol l / m g/ n c trn kh
qan, gi n mch ngoi bi n h c xng. Ngoi ra, Isoproterenol cj n / m ngn chn gii phng
h/sam/n do c c kh ng ngay n trang g/an (ant/genmed/ated) r / m chm gii phng c c cht g y
qa mn (SRS)
/u qu huyt ng hc bao gm: gim khng tng s ngoi bi n (tota/ per/phera/)
tng cng sut tim, tng lng mu t tnh mch tr v tim.
Dc ng hc
soprotereno/ rt d b mt hot tnh khi vo ng ti a h a t thuc di li khang chc
chn thuc c hp thu, hiu qu thng thy sau 30 pht. Ti m tnh mch cho hiu qu tc thi
nhng ch c ko d / khong v / ph t nu khng tip tc cp thuc. Thuc c chuyn ha gan
r c c ma kh c do bi enzyme catecho/ methy/transerase to th nh cht chuyn ha hot tnh
77
thp.
dng/ch nh
Isoproterenol c s dng ch yu trong iu tr co tht ph qun cp tnh, lon nhp tim
(phong b ho n to n n t ) kt hp chng shock.
ng ch nh/ ch y
soprotereno/ chng ch nh i vi bnh nhn mc chng tim p nhanh hoc n t b
phong b do bi trng c glycoside tr n t/m /on nhp tm tht, thiu m a mch vnh, cng
g/ p bnh thn, tng huyt p, tiu ng.
t li/ cnh bo
soprotereno/ c th lm tim p nhanh, kh chu, r ng mnh d b kch thch, au u, c
th suy yu, i ma. Do bi Isoproterenol c thi gian tc ng ngn v ry tc ng bt li thng
khang ngay h/m v khng j / hi phi ngng iu tr nhng cn gim liu hoc cn c pha
/o ng soprotereno/ g y /on nhp tim nhiu hn so vi dopamine v dobatam/ne r ry him khi
c s dng trong iu tr c c bnh v tim.
u
Tr/u chng u ti n ca s qu liu l tng huyt p, sau huyt p gim ang, tip theo
nhp tim tng v cc du hiu lon nhp tim khc. Nu tim p nhanh ko di, iu tr bng cht
phong b ?adrenerg/c (nu bnh nhn khng mc chng lit ph qun).
Tng tc thuc
hang kt hp Isoproterenol vi cc amin kch thch thn kinh giao cm (ep/nephr/ne) r
lm tng hiu qu tc ng v gy c. Propranolol (hoc cc cht phong b ?adrenerg/c kh c) c
th i vn hiu qu Isoproterenol tr n t/m g/ n ph qan v g/ n mch do chng ngn chn tc
ng ca Isoproterenol tr n adrenerg/c C c cht phong b ?adrenerg/c c th c kt hp
iu tr chng tim p nhanh.
u Isoproterenol s dng kt hp vi cc thuc gy nhy cm c tim (halothane,
d/go/n) n n theo d / c c du hiu lon nhp. Tng huyt p nu Isoproterenol c d ng kt hp
ri cc thac gic (oxitoxic agent). Isoproterenol kt hp vi thuc li tiu (furosemic) s nh
hng n s nhp nh ng ca nhp tim v ry tng nguy c lon nhp. S dng ng thi
soprotereno/ r tng gy c tr
u l
a) ngn nga tim p chm, phong b ho n to n n t : 4mg trong 25m/ 5 nh git

tnh mch cho n khi c hiu qu. 0.04gkgph t trayn tnh mch. 0.12 mg t/ m bp
78
hoc 0.4mg trong 250ml D5W, ti m chm tnh mch.
b) co kh/ qan: 0.12 mg t/ m tnh mch hoc di da.

a) ngn nga tim p chm, phong b ho n to n n t : //u dng tng t tr n ch
b) sayn: 0.2 mg trong 100ml D5W, ti m tnh mch hoc 0.0046mg t/ m bp.
a: iu tr gi qun trong thi gian ngn: ch mui r
trayn tnh mch 0.4?g/kg. Cn c dng c theo d / nhp tim li n tc v ngng dng thuc nu nhp
tim tng gp i bnh thng.
c lit giao cm
L thac c tc dng phong b hiu qu ca dy thn kinh giao cm, hay ni c ch kh c /
phong b tc ng kiu adrenaline.
T c dng: d n mch h huyt p.
C c /oi thuc lit giao cm t c ng dng trong th y.

Dc ng hc
Thac c hp thu qua ng d d y rat, b / thi rt nhanh qua thn h/ d ng ng
ang, thuc khng t c nng ti a trong mu do vy kt qu iu tr khng cao. Do
thac ch c dng ng ngoi ti a h a
Dc lc hc
Phento/am/n phong b receptor ?1 v 2 eceptor 1 tm thy pha sau synapse tr n c c
c quan p ng kch thch, p ng gin tip bao gm co mch v g/ n ng t. Khi chng b
phong b, s xy ra tc dng ngc li. Receptor ?2 tm thy ch yu pha trc synapse ti im
cai c ng ca dy thn kinh adrenergic. S kch thch receptor ?2 / m c ch gii phng
norep/nephr/ne t thn kinh c hot ha. Do bi tnh phong b cc receptor n n phento/am/ne
tng gii ph ng norep/nephr/ne
Tc ng tr n t/m mch: do phentolamin phong b tc ng ca cc receptor, k/ch th/ch g/i
ph ng norep/nephr/ne r ep/nephr/ne g y d n c c t/u ng mch, huyt p cng nh khng
tng s ngoi bi n g/m thp. Mc suy g/m huyt p nhiu hay t t y thac vo cng
(tone) ca dy thn kinh giao cm khi cp thuc. Bnh thng, t th nm nghi ng (ngi), cng
giao cm thp, huyt p gim rt t. Khi cng giao cm cao, v d t th ng, kt hp
d ng cht co mch liu cao (kch thch receptor ?), huyt p s gim rt nh/u.
h nng l m g/m huyt p ca phentolamine rt c hiu qu khi bnh nhn t th ng.
T th ng l m cho bnh nhn khi ng cc phn ng mt cch nhanh ch ng t gip hot ha
h thn kinh giao cm, gy co mch ngn mu t khi chung (pooling) ca c th xung chn.
79
h/ c mt phentolamine, d y thn kinh giao cm c hot ha nhng cc mch mu khng th co
/i bi v c c receptor ca thn kinh giao cm b phong b. Mu t khi chang ang chn,
hayt p gim mt cch nhanh chng v / m g/m lu lng mu n o h/ iu n y y ra, bnh
nh n s b chong r m sng (lightheaded) r ngt xu. iu n y cng ging nh tc ng l m
g/m huyt p khi c th gi t th ng m khang d/ chayn trong thi gian d /
Tc ng gin tip tr n t/m: phento/am/n khang nh hng mt cch trc tip n nhng
mt chnh ca chc nng tim; l ra/ trj ca receptor ?1. Tuy nhi n do bi phentolamine l m cho
hayt p thp hn bnh thng l m hot ha phn ng ca c quan nhn cm p (baroreceptor) v
d y thn kinh giao cm hot ng; gin tip lm tng nhp tim v co c tim. Phento/am/ne phong b
hot ng ca receptor ? pha trc (?2) ngn cn sinh l c ch phn hi (feedback inhibition)
g/i phng norepinephrine. Khi s lng norepinephrine tng ln lm tng kch thch c tim.
Tc ng khc: nhng tc ng trc tip khc ca phentolamine c to ra do bi s
phong b receptor ?,bao gm hp ng t, tng chy nc mt, tng tit acid dch v v tng nhu
ng rut. Tt c nhng tc ng tr n cho thy phentolamine cnh tranh hot ng i giao cm
trn c quan ch. Phong b receptor ? cng l m g/m s xut tinh.
nh lm sng/ng cp
Phentolamine c d ng ch yu tc ng n mch mu; hn ch tng phn u l /
thng thn (pheochromocytoma), iu tr thot mch do bi cht gy co mch (norepinephrine).
T/ m hoc trayn tnh mch l ng cp thng dng nht, t/ m bp gy au. Phentolamine ch
tim di da ngn nga s thot mch do c c cht gy co mch.
ng ph/bt li/ chng ch nh
T c dng ph tr n t/m mch: phentolamine cng nh cc cht phong b receptor ? u gy
t c dng ph nghi m trng n tim mch. Gy gim huyt p t th ng ngay c liu thng
thng. Liu cao gy gim huyt p v tng nhp tim. Thac phong b receptor ? c kh nng gim
hayt p nhiu hn cc nhm thuc kh c /m huyt p c th gy thiu mu cc b c tim c th
dn n nhi mu c tim, c bit i vi bnh nhn mc bnh ng mch v nh Phento/am/ne
chng ch nh i vi bnh nhn tri qua mt ln t qu. C th xy ra tn thng n o do bi
tng huyt p tng qa mc, tuy nhi n hayt p gim cng g y ngay h/m, gim lu lng mu
n o ra tng nhi mu n o
Tng tc thuc
Phento/am/ne kt hp vi cc thuc chng cao huyt p khc hoc alcohol s hayt p gim
thp hn hoc lm tng nhp tim khi kt hp vi cht ch vn kch th/ch thn kinh giao cm tc
ng receptor ? (epinephrine v c c cht gy d n ph qan).
80
u/ c tnh
a //u cc thuc phong b receptor ? c th gy gim huyt p nghi m trng r phn x
k/ch th/ch t/m dn n shock, lon nhp tim, nhi mu c tim. iu tr bng cch d ng pheny/ephr/n
hoc methoxamine, norepinephrine.

u trc ho hc
C
1
22
C/
t ha hc
L cht phong b receptor ?, phenoxybenzamine c m a trng, khng m / dng bt tinh
th, nhit tan chy l 136141oC pa 44 hj a tan trong nc (4mgm/) r a/coho/
(167mgm/)
Dc lc hc
Phenoybenam/ne phong b receptor ? khng cnh tranh tun ho n (c/rca/at/ng)
epinephrine v norepinephrine. Tc ng ca phenoxybenzamine c m t nh l cht ha hc
ct dy thn kinh giao cm (chemical sympathectomy). Khng tc ng n receptor ? hoc thn
kinh i giao cm. Phenoybenam/ne lm tng lu lng mu n da, lu lng mu n o h
xng cha c bit. Phenoxybenzamine cng l m c ch d n ng t, co mi mt v co m ng
nh y (/o / cm).
nh/s dng
Phenoxybenzamine c s dng tr n ch yu tr n th nh (ch, mo) iu tr chng
tng trng lc c vj ng b ng qaang iu chnh trng thi hot ng ca c vj ng
Phenoxybenzamine c kt hp iu tr cao huyt p trc khi gii phu u l / thng thn
(pheochromocytoma) hoc kt hp iu tr nhim c ni s/nh nga, Phenoxybenzamine c
dng iu tr vi m m ng giai on u r l ch tit ti a chy.
Dc ng hc
Thang t/n r dc ng hc ca thuc ny trong th y cha c r ngi,
Phenoxybenzamine c hp thu rt khc nhau t ng ti a h a ri gi tr sinh hc t 20
3hi u tc ng ca Phenoxybenzamine rt chm (v / g/) v tng dn vi ngy sau .
/u qu ko d / 34 ng y mc d khang t/p tc cp thuc.
81
Phenoybenam/ne rt hj a tan trong //p/d r c th tch ly trong m m ca c th.
Phenoybenam/ne c qaa nhaa r sa m hay khng th cha c bit. Thi g/an b n hy ca
thac khong 24 gi. Thuc c chuyn ha v b / thi qua nc tiu v qaa mt.
ng ch nh
Phenoybenam/ne chng ch nh tr n nga c du hiu au bng (colic) v bnh nh n c
du hiu gim huyt p. Theo Labato (1988), khng d ng Phenoybenam/ne cho ch b tng nh n
p hoc tiu ng. Phenoxybenzamine c s dng ch i vi bnh nhn b suy tim hoc cc
bnh tim khc do bi Phenoybenam/ne c th lm tim p nhanh c th gy h hi thn hoc x
cng ng mch v nhn o
t li/cnh bo
Phenoybenam/ne phong b receptor ? gy ra cc tc ng bt li, bao gm: g/m huyt
p, tng huyt p, hp ng t, tng p lc b n trong mt (intraocular), tim p nhanh, c ch s
at tinh, xung huyt xoang mi, suy nhc, cho ng r ng r nh hng d d y rat (bun nn, i
ma) v c th gy to b n nga.
u
u hiu qu liu bao gm: chong vng, ngt, tim p nhanh, i ma, gy cht hoc shock.
a d dy l cch iu tr tt nht. Cn d ng thac iu tr gim hayt p. Epinephrine c
chng ch nh v hu ht cc thuc gy co mch khc cng khng c hiu qu thay i ho n
ton tc ng phong b receptor ?. Nu c c tr/u chng tr n y ra mc nghi m trng c th
d ng norep/nephr/ne (/erartereno/) t/ m tnh mch.
Tng tc thuc
Phenoxybenzamine i vn hiu qu ca cc thuc kch thch thn kinh giao cm (receptor
) (pheny/ephr/ne) u kp hp vi thuc c tc ng tr n c 2 receptor (ep/nephr/ne) s l m
g/m huyt p nghi m trng, d n mch, tim p nhanh
u d
iu tr mt phn x:
a) 515mg P 1/n/ng y
b) //u u 10mg, PO 1ln/ng y nu ch khng p ng vi thuc sau 4 ng y th c th tng
//u 10mg,PO mi liu cch nhau 12 gi. Nu sau 4 ng y na m rn khng p ng vi
thac th tng liu l n 1mg P mi liu cch nhau 8 g/.
iu tr tng p trc khi gii phu u l / thng thn:
a) 215mgkg P khong 14 ngy trc khi gii phu. D ng //u thp v tng dn cho n khi
82
hayt p g/m nh mong mun. Propranolol c th c kt hp iu chnh lon nhp tim v
tng huyt p (0.155mgkg P) Cht phong b receptor c th c kt hp vi
phenoxybenzamine trong trng huyt p tng ngh/ m trng.
Mo: iu tr mt phn x: 0.5mgkg P 1/n/ng y
a:
a) 0.66mg/kh trong 500 ml nc mui, IV.
b) 12mgkg P
c) 26mg mi liu cch nhau 12 gi iu tr ti a chy nhiu nc.

u trc ho hc
C
16
21
2
t ha hc
L thac c ch khng c trng receptor ?adrenerg/c Proprano/o/ C/ c r ng, khng
m / m a trng, dng bt, pKa = 9.45, nhit tan chy khong 161oC, hj a tan trong nc v
a/coho/ (1g2m/) pH 45 dang dch propranolol s ph t hanh quang.
o qun/ tnh n nh/tnh tng hp
n bo qun nhit phj ng (153oC) r tr nh nh s ng ang dch proprano/o/ s b
ph n hy nhanh chng pH kim. Dung dch ti m proprano/o/ c th tng hp vi D5W, 0.9%
sod/am ch/or/de /actated /ngers dobatam/n C/ rerapam// C/ r benqa/nam/de C/
Dc lc hc
Proprano/o/ phong b c receptor ?1 v 2 adrenergic trn c tim, ph qun, c trn mch
m a Proprano/o/ khang c bn cht hot ng kch thch thn kinh giao cm. Ngo / ra Proprano/o/
g/ c tnh n nh m ng (g/ng nh quinidine) nh hng ch yu n hot ng t/m r dn n
say t/m T c dng th yu ca Proprano/o/ tr n t/m mch bao gm: gim nhp tim, gim tnh truyn
ca nt AV, gim cang sat hot ng tim, gim nhu cu O2 ca c tim, gim lu lng mu n
thn v gan g/m huyt p, c ch hiu qu kch thch tim p nhanh ca /soprotereno/
nh hng in sinh l hc (electrophysiologic) tr n t/m bao gm: gim tnh t ng,
khang nh hng n tc dn truyn.
83
go / ra cj n c h/u qu lm tng sc khng ng h hp (c bit l bnh nh n b tht
ph qun), ngn nga chng au na u, tng hot ng t cung, g/m kt tp tiu cu, tng tun
ho n bch cu a acid.
Dc ng hc
Proprano/o/ rt hj a tan trong //p/d r qaa h ng r o m a n o mt cch nhanh ch ng Th tch
ph n phi 3.311Lkg ch. Propranolol qua c nhau thai v r o sa nhng vi lng nh.
ngi, khong 90% Propranolol li n kt vi protein hayt tng.
Proprano/o/ chayn ha phn ln gan. Cht chuyn ha hot ng, 4hyroyproprano/o/
c ng ha sau khi dng qua ng ung hong 1% liu c b / thi khng b bin i
trong nc tiu. Thi gian bn hy ca thuc tr n ch 772 g/.
dng/ch nh
Trong th y, Propranolol c dng cha tr chng lon nhp tim, Propranolol ci thin
bnh l trn c tim (hypertrophic), iu tr chng cao huyt p, iu tr cc du hiu kt hp gia u
/ / thng thn v bnh nng tuyn gip (thyroto/cos/s)
Propranolol c hp thu tt qua ng ung, chuyn ha bc u gan l m g/m gi tr
s/nh hc ca thuc khong 227 ch.
ng ch nh/ch
Proprano/o/ chng ch nh i vi bnh nhn nhy cm vi nhm thuc n y phong b tim
nh/u hn 1 , bnh tim, tim p chm, co kh qun.
Proprano/o/ cng chng ch nh i vi bnh nhn gim glucose huyt. Proprano/o/ c th
gy tng hoc gim glucose huyt, do n n ch kh/ s dng cho bnh nhn b bnh tiu ng.
Proprano/o/ c th che giu cc du hiu ca bnh nng tuyn gip nhng trn / m s ng
propranolol c s dng iu tr cc du hiu ca bnh n y
Proprano/o/ s dng ch vi thuc tr tim hoc nhng bnh nhn b nhim c thac tr
tim gy tim p chm n mc nguy him.
t li/cnh bo
t li thng xy ra bnh nhn gi yu, bnh mt b (decompensat/ng) t/m cp tnh. Bt
/i lm s ng bao gm: tim p chm, g y cht, suy nhc, gim tnh dn truyn ca nt AV, gim
hayt p, gim ng huyt, co ph qun. Bt tnh v t/ a chy thng thy tr n ch Thac c th
g y ngh/n nu d ng / a d /
u
a //u thng gy gim huyt p hoc tim p chm. Nhng da h/u khc bao gm: co
g/t, co tht ph qun, gim ng huyt, suy h hp, ph phi, lon nhp khc ( c bit phong b
84
n t ) hoc suy tim. Ra d d y kt hp d ng than hot tnh gii c qu liu. B sung cht
in gi / g/acose m y theo d / nhp t/m nhp h hp, huyt p (nu c th). D ng c c dch truyn
hoc cc thuc l m tng huyt p iu tr gim huyt p. Dng atropin iu tr tim p chm.
u atropin khng c hiu qu, thay th bng isoproterenol. Nn dng my iu hj a nhp
kt hp iu tr. D ng thac tr tim glycosides, thuc li tiu v cang cp O2, nu cn thit c th
t/ m tnh mch aminophylline. Glucagon (51mg ) c th lm tng nhp tim v hayt p; hn
ch nh hng gy suy tim ca propranolol. iu tr co git c th d ng d/aepam
Tng tc thuc
Proprano/o/ c th phong b hot ng ca cc thuc kch thch thn kinh giao cm
(ep/nephr/ne pheny/proprano/am/ne) kt hp vi thuc t (anesthet/c agents) gy suy tim (c tim).
Phenoth/a/nes phi hp vi Propranolo/ / m g/m huyt p ngh/ m trng. Thyroides hormone c
th l m g/m hiu qu ca cc thuc phong b receptor ?. Cn gim liu Propranolol khi iu tr
khi u vi meth/mao/e hoc propylthiouracil. Cimethidin l m g/m chuyn ha proranolol do
ry / m tng lng proranolol trong mu. Furosemide v hydralazine lm tng hiu qu ca
prorano/o/ T c dng ca tubocurarine v sacc/ny/cho//ne c th nh hng n h/u qu iu tr
ca proranolol. Gy cm ng cc enzyme gan bng phenobarb/ta/ r/amb/n hay phenyto/n c th
tng chuyn ha proranolol. Proranolol c th ko d / t c dng l m g/m ng huyt ca insulin.
/u qu ca theophy///ne (g/ n ph qun) c th ngn chn bi Proranolol. N n ch kh/ phi hp
c c thac phong b receptor ? vi thuc phong b k nh Ca (ca/c/am channe/ b/ockers)
u d
Ch
a) 26 mgkg t/ m chm. 0.21mgkg P
b) Lon nhp tim: ch nh 2.52mg P mi liu cch nhau 812 g/. Ch trung bnh /n:
14mg P Ch /n hn:40mg P mi liu cch nhau 812 g/.
c) /m huyt p: 2.51mg P

a) 4mgkg
b) /m huyt p: 2.51mg P
c) Cng nng tuyn gip: 2.5mg, PO.
d) Lon nhp tim: 2.5 mg, PO, mi liu cch nhau 1224 g/.
a
a) 13 mgkg 2 /n/ng y
b) ng ung: ng y th 1&2:175mg; ng y 34: 275mg ng y 56: 35mg T/ m tnh mch
ng y th 1&2: 25mg; ng y 34: 5mg ng y 56: 75mg
85
86

u trc ho hc
t ha hc
L thac phong b ?adrenerg/c teno/o/ c m a trng, dng bt tinh th. 37oC 265mg
teno/o/ hj a tan trong 1 m/ nc. .
Dc lc hc
teno/o/ / thac c trng phong b tng i receptor ?1. liu cao, Atenolol s mt
t/nh phong b ?1 m s xy ra phong b ?2. Atenolol khng c bn cht kch thch thn kinh giao
cm nh pindolol v cng khng c hot tnh n nh m ng g/ng nh pindolol hay propranolol.
Tc ng th cp ca atenolol tr n t/m mch bao gm: gim nhp tim, dn truyn AV gim, gim
nha cu oxy cho c tim, gim hayt p, hn ch tng nhp tim do isoproterenol.
dng/ch nh
o bi tng i an ton s dng cho th b lit ph qun, altenolol thng c chn
hn propranolol. C hiu qu i vi lon nhp tr n t m tht, tm tht co bp sm, tng huyt p v
iu tr trin dng (hypertrophic) trn c tim m o
Dc ng hc
ngi, ch khong 506 //u ung c hp thu. Tuy nhi n thac hp thu rt nhanh
im c trng l thuc li n kt rt thp vi protein huyt tng v phn phi tt n hu ht cc
ma /teno/o/ /t hj a tan trong //p/d r khang g/ng vi proprano/o/ ch mt lng nh atenolol
c phn phi v o h thn kinh trung ng, /teno/o/ qaa nhaa tha/ r nng thuc trong sa
cao hn cc ni khc tm thy trong hayt tng. Bin i sinh hc ca /teno/o/ gan rt thp;
khong 405 /teno/o/ b / thi cj n hot tnh trong nc tiu v phn cj n /i ch yu c b /
thi qua phn (dng cj n hot tnh, thuc khng c hp thu). Thi gian b / thi ca thuc ch l
32 g/.
ng ch nh/ ch / n
Th b suy tim, th nhy cm vi thuc trong nhm n y phong b tim ln hn 1 , tim p
chm. cc thuc phong b khng c trng receptor ? cj n chng ch nh cho bnh nhn b tc dng
ph (lon nhp tim) khi d ng c c thac ny iu tr suy tim. Chng ch nh tng i i vi
bnh nhn b lit ph qun phi, bnh thn, gim chc nng ca cc nt dn truyn.
liu cao, Altenolol c th che giu cc du hiu li n kt vi gim ng huyt. cng
c th gy gim ng huyt hoc tng ng huyt v do cn ch kh/ s dng cho bnh nhn
b tiu ng. Altenolol c th gy nhim c tuyn gip nhng trn lm sng Altenolol thng
c dng iu tr tnh trng n y
t li/cnh bo
t li thng xy ra th gi yu hoc bnh gy mt b (decompensat/ng) nhp t/m cp
t/nh t li th hin tr n / m s ng bao gm: gim nhp tim, gy cht, suy nhc, suy yu dn
trayn AV, gim huyt p, gim ng huyt, co ph qun (t hn cc thuc phong b ?1 khc). Bt
tnh v t/ a chy thng thy ch. Thuc c th gy nghin khi d ng / a d /
u
u hiu qu liu: gim huyt p, tim p chm, lit ph qun, suy tim v g/m ng
hayt. Nu ung qu liu, ra d d y kt hp vi than hot tnh gii c. /m tra huyt p,
ng hayt. iu tr cc nh hng tr n t/m mch. S dng dch truyn v c c cht lm tng huyt
p iu tr gim huyt p. D ng atropin iu tr tim p chm. Nu atropin khng c hiu qu,
c th d ng isoproterenol nhng thn trng. Suy tim c th d ng thac tr tim glycosides.
/acagon c th lm tng nhp tim v hayt p.
Tng tc thuc
/teno/o/ c th phong b tc dng ca cc thuc kch thch thn kinh giao cm
(metaproterenol, terbutaline, epinephrine, phenylpropanolamine) v ngc li cc thac n y cng
/ m g/m hiu lc ca altenolol.
Phenoth/a/nes kt hp vi Altenolol c th l m g/m huyt p nghi m trng.
arosem/c r hydra/a/ne hoc cc thuc gy gim huyt p c th tng nh hng l m g/m huyt
p ca Altenolol. Altenolol c th ko d / h/u qu iu tr g/m ng huyt ca insulin.
S dng ng thi cc thuc phong b receptor ? vi cc thuc phong b k nh Ca n n ch
i vi bnh nhn c tin s bnh trn c tim hoc suy tim.
u d

Lon nhp tim, gim huyt p, nhi mu c tim:
a) 1255mg 1 hoc 2 ln/ng y
b) 251 mgkg P i liu cch nhau 1224 g/.
c) 62525 mg mi liu cch nhau 12 gi.
e) iu tr tng huyt p: 2mg/kg, 1ln/ng y
M o:
a) y
b) Lo 625125mg P 1 / y
2.4.4. Thuc kch thch ph giao cm
(1) Pilocarpin Nitrate
Cu trc ha hc
C
11
16
2
Tc ng dc lc
Tr n m ng t n p saa
nh n p k o d / S / r / g/ y cj n t c n s
ch
r
h a ng qaang t / m
Tr n tay d y

Tr n t/m m n t/m m h/ch th / m
g/ ch p//ocarb/n g y
r y b atrop/n
Tr n th h
t/ m acety/cho//n ho
T c dng
/ch th/ch b / t/
y ra
ng tr

Liu dng: tim di da
g 2 mg
j : 2 4 mg
/ch th/ch nha/ / 6 mg
eo: 2 5 mg
Ch : 5 2 mg
o: 1 3 mg
c tnh
y kh th
y ng
T/ a ch
/
(2) Acetylcholine (ACh)
Cu trc ho hc
Dc ng hc
Ph n t cho//ne / th nh ph n ph n t nhaa b
m y d ng b nh th
Ch b y r h y
c c tha g/ao c a h a
Ch b ngay / y c r
trong m a ch khang chay r cj n
cho//nesterase
C ng // h th/ch th
k/nh g/ao c
nonspec//c cho//nesterase hay pseadocho//nesterase hn chang ch ng b
cho ph p ch ng t h
Dc lc hc
t c h a
h n /o y tha r o r
/ch th/ch ho

kch thch tit nhiu hn hoc co c ph qun. Nhng p ng trn cc c quan c xem l s
c ch bao gm: chm nhp tim, gi n c trn tiu ng mch.
Trong nh/u trng hp, c p ng kch thch v c ch c th xy ra nhng phn khc
nhaa ca c ng mt c quan. V d, p ng ca mt loi thuc kch th/ch thn kinh giao cm, co
mt vi c b ng qaang r rat nhng cc c khc th g/ n ra Tt c nhng p ng tr n s b
phong b bi atropin.
T c ng tr n mt: ACh gy co c vj ng m ng mt, ng t tr n n nh hn. iu n y gi
/ tnh trng thu hp ng t. Hiu qu ca nhng liu cao thuc kch thch thn kinh ph giao cm
vt qua nh hng ca kch thch thn kinh giao cm s g y g/ n ng t r c th nhn r hn.
ACh gy co c th mi mt v iu chnh hnh dng ca thy tinh th. Co c th mi lm cho ng
t ln hn (fatter) do ry mt ch nhn thy nhng im gn.
Tc ng tr n t/m mch: ACh tc ng trc tip gy gi n c trn tiu ng mch, g y g/ n
mch. iu n y ch xy ra v tr m c s khc bit gia tc ng do k/ch th/ch ph g/ao cm t
nh/ n r k/ch th/ch ph g/ao cm c to ra do thuc. C c t/u ng mch khng b kch thch bi
h thn kinh ph giao cm v r ry n s m rng p ng khi kch thch thn kinh.
ayt p s khng gim nhiu liu thng thng bi v phn ng ca c quan nhn cm
p c gim xung, dn n tng hot ng ca h thn kinh trung ng, bao gm co mch
chng gim huyt p. N n d ng //u rt cao huyt p g/m xung mt cch ng k.
Acetylcholine c gii phng t thn kinh ph giao cm tc ng tr n t/m thn k/nh ph
r, tc ng trc tip l m g/m nhp tim. Tuy nhi n kh/ d ng //u thp Ch hoc cc thuc kch
th/ch ph g/ao cm khc th c th lm tng nh nhp tim. S tng nhp tim ch c th c trung
hj a mt cch gin tip bi phn ng ca c quan nhn cm p v hot ha thn kinh giao cm.
L/u cao ACh vt qua phn ng ca c quan nhn cm p v ry nhp tim lun /aan thp.
Ch trc tip l m chm dn truyn xung in qua nt AV, ch yu l // n kt in phi hp co bp
t m tht v t m nh. Liu cao, phong b mt phn hoc ho n to n n t r c th l m ngng tim.
dng/ch nh
ACh thng c dng iu tr tng nh n p r nhng ri lon c li n qaan n mt,
bnh ng tit niu.
ng ph/bt li/chng ch nh
T c dng ph thng thy mt v t/m mch. Tc dng ph mt bao gm: tit nc mt
qa mc, cn th do tc ng ca thuc trn c th mi, gim tm nhn ni c nh s ng yu l kt
qa ca tnh trng thu hp ng t. C th xy ra au u. ACh chng ch nh cho bnh nhn vi m
mng mt cp tnh, hoc nhng phn ng qu nhy cm khc mt.
Thac kch thch thn kinh ph giao cm c th gy gim huyt p. Chong r ng v au u
nh do lng mu n o thp. Gi n ng mch n o c th gy au u. Gim huyt p kt hp tng

nhp tim c th l m g/m lu lng mu c tim, tng nhu cu oxy c tim.
Qu liu/ c tnh
u hiu qu liu bao gm: kh chu xoang bng, t/t nhiu nc bt, da, m hi,
ban nn v / ma. Nhng thay i mt bao gm: thu hp ng t, chy nc mt. Thay i
h thn kinh trung ng: tnh trng khng y n hn lon, /o /ng, co git.
iu tr: d ng atrop/n 60.8 mg, tim di da. Atropin tc ng tr n receptor mascar/n/c
phong b hiu qu ca ACh hoc cc thuc kch thch ph giao cm khc. N n chan b sn
atropin khi dng ACh, c bit l dng ng ngoi t/ a h a u tim p chm, gim huyt p, lit
ph qun nghi m trng c th iu tr bng epinephrine. C th d ng m y tr tim hoc tr h hp.
C th d ng dch truyn hoc cht in gii qua ng ngoi ti a h a
(3) Bethanechol
ethanecho/ (CL) ch c hiu qu kch thch ph giao cm khi c cp qua
ng ang, c th d ng dang dch v trng tim di da, bethanochol tc ng rt tt n b ng
quang v ng tiu ha, tc ng nh tr n t/m mch. Hu nh thuc khng c kh nng kch thch
receptors n/cot/n/creceptors ACh c tm thy hch thn kinh t tr v t bo c xng. Mt
lng nh bethanochol c thi v o sa m.
Ch nh
Bethanechol c ch nh trong iu tr b tiu cp tnh (b tiu khng do tc nghn c hc
lm nc tiu khng thot ra c). Trng thi n y c th xy ra khi b ng qaang tr n n k m hot
ng sau khi gii phu hoc s sinh hoc nhng ri lon g y k/ch th/ch thn kinh khng tha ng
b ng qaang
Khi p ng tha ng lm tng lng nc tiu, hot ng ca b ng qaang tr /i trng
th / bnh thng th khang n n t/p tc d ng bethanecho/ (nht l d ng ng ti m) nh nhn
ang trong thi gian hi phc sau gii phu ng tit niu hoc ng ti a h a khang n n d ng
bethanecho/ hoc cc thuc kch thch thn k/nh ph g/ao cm thng thng khc. Nu khng cc
cu trc b kch th/ch s gy tn thng vt l.
Bethanechol c s dng hn ch lit rut sau khi gii phu tc rut. N n tim di da
khong 12 g/ sau khi n trnh gy bun nn, i ma, chng chut r t (cramp/ng) hag t/ m
bp, ti m tnh mch. Cn theo d / bnh nh n khong 10 pht sau khi tim kim tra p ng.
Atropin c dng chng li cc t c dng ph. Khng dng bethanechol kch thch i tiu
nu nghi ng b tiu do tc nghn ng dn tiu.
Cn kim tra lng nc ung v o r thi ra. Kim tra m rat v bt mch rut nh k.
/m tra xem c mu trong phn v nc tiu hay khng. Nu lng nc t/u thot ra tng l n
khong 153 ph t saa kh/ d ng bethanecho/ liu thng thng th khang n n t/p tc d ng thac
m cn thng b ng qaang u liu u tin khng lm tng c lng nc tiu khng n n t/p
tc d ng thac cho n khi vt tc nghn c loi b. Nu khng lu iu n y c th dn n v
b ng qaang ng niu. Kim tra huyt p, nhp tim, o in tm .

Carbacho/ / thac kch thch ph giao cm t c s dng hn cc thuc khc. c h/u
qa kch thch receptor nicotinic. Ging nh bethanachol, carbachol cng tc ng rt tt n h tit
n/u v tiu ha, nhng trn lm sng thng d ng trong g/i phu mng mt (iris) v c th mi.
ang dch carbachol (ISOPTO CARBACHOL) chuy n tr bnh mt thng dng gim
p /c b n trong mt i vi bnh nhn b tng nh n p Trong trng hp iu tr bng pilocarpine
hay cc phng php iu khc khng c hiu qu th mi d ng Carbacho/ trong thi gian di
iu tr tng nh n p ng t b tha hp sau khi d ng thac 2pht v k o d / 4 g/.
Carbachol c tim vo pha trc khoang mt trong thi gian gii phu mt. Carbacho/
c th gy git c m mt (khu mtb/epharospasm) Co g/t c nhng ni khc cng c th xy
ra nu thuc c hp thu mt cch h thng. Thuc c th gy kch thch hch thn kinh t ng
g y ra nhng thay i khc nhau tr n t/m mch. C th gy au u, au mt v ang hayt kt
mc, trong trng hp n y n n d ng thac gim au. D ng //u v ng ti m th/ch hp gip hn
ch cc nh hng tr n

Methacholine (PROVOCHOLINE) c s dng trong chn on p ng qu mc ca ph
qan nhng bnh nhn nghi b suyn, nhng bnh nhn khang c b/u hin lm s ng th r/c
d ng ethacho//ne cho kt qu chn on r hn. ng dng ny c p dng tr n thc t nu ph
qan co li (hen) do cc tc nhn g y nh/m c muscarin (muscarinic agent). Thuc c th c
d ng dng xng.
ch ranh g/i (baseline) chc nng phi c o lng khi p ng vi dung dch bay hi
c cha mui v cn kim tra lp li nu d ng //u cao li n tc. Nu t c dng ph xy ra bnh nhn
cn c ti m atrop/n c c thac khn cp khc, O2 r nhng phng php tr h hp.
c lit ph giao cm
Thac lit ph giao cm c tc dng ngn Acetylcholin pht sinh hiu qu tr n nhng c
quan c dy hu hch phn b n.

t ha hc
hang m a hoc m a trng, khng m / dng bt tinh th hj a tan trong nc (1g 5m/)
cn (1g/5ml), glycerin (1g/2.5ml); dung dch c tnh acid nh hoc trang t/nh bo qun nhit
phj ng (153oC)
trop/n sa/phate dng ti m c th tng hp vi cc cht sau: benzquinamid HCl,
batorphano/ tatrate ch/oroma/ne C/ c/met/d/ne C/ d/menhydr/nate d/phenhydram/n C/
dobatam/n C/ droper/do/ entany/ c/trate g/ycopyrro/ate hydromorphone C/ hydroy/ne
C/ meper/d/ne C/ morph/ne sa/phate na/baph/ne C/ pentaoc/ne /actate pentobarb/ta/
sod/am perphena/n proch/opera/ne ed/sy/ate proma/ne C/ prometha/n C/ r scopa/am/n
C/
Atropin sulphate khng tng hp vi cc cht sau: norepinephrine bitatrate, metaram/no/
b/tartrate methohe/ta/ sod/am r sod/am b/carbonate
Dc lc hc
trop/n c ch acetylcholin cng nh nhng cht kch thch giao cm khc. Nhng //u cao
c th ngn chn receptor nicotinic ti hch thn kinh t tr v thn kinh c gp nhau, gim nhu
ng d d y rat v ng tit niu. Liu thp s hn ch c tnh trng t/t nc bt, tit dch
cang phi v m hi (tr nga). Liu trang bnh trop/n / m c ch iu tit, d n ng t,
tng nhp tim. Liu rt cao ngn chn tit dch d d y
dng/ ch nh
Ch nh ch yu ca atropin trong th y bao gm:
ng / m thac tin m ngn nga hoc gim tit dch ng h hp.
Ngn chn khng ho n to n n t
/i c qu liu cc thuc kch thch giao cm ( physostigmine,)
/i c photphat hu c
Ngn tit nc bt
iu tr bnh co ph qun (bronchoconstr/ct/re)
Dc ng hc
trop/n ph n phi khp c th sau khi qua ng ung, ti m bp, xng, t trong kh/ qan,
saa kh/ t/ m tnh mch hiu qu cao nht tr n t/m saa 34 ph t trop/n ph n phi khp c th, v o
n o qaa nhaa tha/ r mt lng nh c th v o sa. Chayn ha gan v b / thi qua nc tiu,
khong 30% thuc cj n hot tnh trong nc tiu.
Dc lc hc
Thay i theo liu d ng //u nh (0,51mg) nh hng n tit dch ng h hp v nc bt.
L/u ln hn 2mg tc ng l n m/ mt, tim. Liu ln hn na tc ng l n b ng qaang r t/ a h a
sau cng tc ng n b / t/t dch v.
Tr n h thn kinh: kch thch nh h hp do tc ng nh l n h thn kinh trung ng
94
Tr n t/m mch: Liu iu tr thng thng khng nh hng n tim mch. Tuy nh/ n trong
trng hp tim b c ch do dy thn kinh Vagus b tc ng bi mmon/ac hoc Chloroform,
/cot/ne trop/n c t c dng lm tng nhp tim do tc ng l m c ch dy thn kinh Vagus.
Tr n kh/ qan
ph giao cm c tc ng lm tng tit cht nh y co rt c ph qun. Atropin phong b
xung ng thn kinh ph giao cm, do l m d n ph qun, gim s b / t/t cht nhy, do
thng c s dng trong trng hp shock do d ng thac (gy co tht c ph qun)
Tr n d d y rat
trop/n phong b hiu ng l m co tht c trn ca Acetylcholin, l m g/m nhu ng rut,
chng co tht rut, do i khi c s dng trong trng hp au bng do co tht rut, ti a chy
qa nng gy mt nc
ng ch nh
trop/n chng ch nh i vi bnh nhn b tng nh n p nhy cm vi thuc kh ng
cholinergic, tim p nhanh, thiu mu cc b c tim, xut huyt cp tnh, bnh gy cn tr ti a h a
/o t d d y S dng ch tr n nga v c th l m g/m nhu ng rut v gy au bng trn ng
rt nhy cm.
ng
Ngn cn tng tc ca acetylcholin v ni tip thu tr n t b o h/u ng.
c tnh
Tr/u chng ng c:
ha m/ng, kht nc
h nat
T o b n
Tim p nhanh, th nhanh s a
i lon vn ng
Run c
Co g/t
Say yu h hp cht
/i c Atropin:
u ng c qua ng ung: d ng thac gy i ma, kt hp ra d d y
u ng c qua ng tim di da: d ng c c /oi thuc tc ng kiu choline
g/i c nh morphin chlohydrate tim di da gii c trop/n
ng lm s
95
Cha ph phi gia sc
/m co tht kh/ ph qun trong shock hoc do d ng
Chng co tht c trn
c ch b / t/t nc bt v cht nhy kh qun do thng c d ng nh cht
t/n gy m
ng cha tr cc trng hp ng c:
P//ocarp/n
reco//ne
/ptere
orph/ne
Ch/oroorm
C c /oi thuc tr su, phospho hu c
u d
T/n gy m : 5 1mg kg th trng, chch di da
c ch b / t/t, chng co tht c trn v cc mc ch khc (chch di da)
ga: 10 mg
Tr a bj : 3 1 mg
eo: 1 3 mg
Ch : 1 mg
1
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W|QK S|Q |QyL|NKi Q|VLQK|k |Q P |WU W||
F|k |FK W| L|Y L|E QK|QKkQ||F Q|QK |V |K S|WK |F D|Fi F|G F|SK P |NKR Q|
|O P |WU |WtQK|QKL Q|KR F| F|L P |E W|
3HQLFLOOLQV| F|SKi W|KL Q|Fy|WU Q|TD|QKD|WKDL|Yj | |DQ|WR F|V |G Q
W|WK L|LDQ|P DQ|WKDL|W W| L|NKQ| F|V |G Q|Y Q|NKQ F|
L|Y L|Q L|Fy|WL |V |E |VLQK|FRQ|Ti L|WKDL|O Q| |N W|K S|Y L|WK F| F|
|G Q|FK |NKL|NK |Q Q|Fy|O L|WURQ|W Q|WU Q|Y L|FK |V P ||K F|FK Q|Fi F|
ORj L|QK ||U Q||FKLP ||UD||KHR|Yj |VyF| |F P |Li Q S| L|Y L|SHQLFLOOLQV||
25 h '' ' ' '''
7i F| Q|E W|O L|F D|SHQLFLOOLQV|WK Q|NKQ|QKL Q|Yj |WK Q| |UD|Y L Q|
|WK S|
Q| Q|P Q|F P | L|Y L|WK F|NKQ|OLrQ|TDQ| Q|OL ||Fy|WK | |UD|Y L|Wi F
|U |FK Q|SKi W|EDQ||V W||HRVLQRSSKLOLD||QHWURSHQLD|
|Q L|| F|WtQK|WU
QK|QKkQ|QK |F P |Y L Q|V |QK |F P |Y L|SHQLFLOOLQV||7 |O |P F|SK L|
Q| Q| L|Y L QK|QKkQ|WK||WK D| F|EL W|
F|Yj R| Q|P L Q||SHQLFLOOLQV|Fy |O Q
Q| Q||QQ|P D||WL |||% L|Y Q|Fy|WK |O Q| L |YL|VLQK|Y W|
Q|U W||NKi Q|VLQK|N W|K S|Y L|V |WL |Fy|WK | |UD||Qy|W W F|O D|FK Q|V |
Q| F|O |WU |WURQ|N W D| Q|Y W
L|OL |FDR|V |G Q|WURQ|P W|WK L|LDQ|NpR|G |N W|K S|Y L|R |KRi |WK Q|NLQK
W|V |L |KR |WU F|G |SHQLFLOOLQV|HP |QK |FK Q | F|
DQ||L |Qj | Q|P LQK|Y |Fi F|HQ P | | QK|K Q |NKi F |FKy|EDR| P ||
Q|OR Q|QK S|WLP ||FK Q|NKy|WL Q|HGHP D|
W|Y
Q| |FK |P i |FDP | |Q L||1 K Q L|
F|Q P |NKL|V |G Q|FKQ|FKR|W W|F |Fi F|ORj L| Q|Y W|WURQ|LDLR Q|KL Q|QD|Y
|SKkQ|QKi QK|Q QK|K Q|FK D| F|U
|Ti |OL ||Q | F|F S|WtQK
20
|G Q|Ti |OL |NKQ|L Q|QK |Q rQ|QKk W|TDQ|WU Q
NKi F|K Q|V |D| Q|F D|,||QK Q| QK|K Q|NKi F|O | |SK Q|QK Q|Wi F Q|E W|
L|| |Q L|OL |U W|FDR|F D|SDUHQWHUDO|SHQLFLOOLQV|| F|EL W|Oj | L L|E QK|QKkQ|E |E QK|Y |
Q||Fy|V | QK|K Q|1 6|k |UD|
27 S tng t c thac
|WURQ|SK P | F|L L|WKtFK|U Q|SHQLFLOOLQV|Fy|WK |Fy
Q| F|FKQ|KR F|F Q|K S|FK Q|O L|YL|NK Q|NKL|G L|DP LQROFRVLGHV F|
|G Q|NKi Q|VLQK|GL W|NK Q||H||||FKORUDP SKHQLFRO||HUWKURP FL

L|SHQLFLOOLQV|QyL|FKQ|Oj |FK D| F|NK Q|Fi R|| F|EL W|WURQ|QKL P S|WtQK|Q L|
W|VLQK|VL|Q |Q |P W|Fi FK|QKDQK|FKyQ|Y |SHQLFLOOLQV|Fy|NK QK|
K Q|KR W| Q|W W|K Q|WURQ|V |SKi W|WUL Q|F D|YL|NK Q| |W S|WUQ|WK S||FK F|FK Q|
F|QDIFLOOLQ| |NKi Q|NK Q|W W|NKL|G L|
ULIDP SLQ||QK Q|G |QKLrQ|y|Oj |V | L Q|GL Q|Y L|P F| |W S|WUQ|
W|K S|Y L|Fi F|FK W|VD|

1 DGRORO||3LQGRORO||2 SUHQRORO||6RWDORO||7LP RORO||W Q|Q |F |E |FKRi Q|SK Q|Y

F|K |QKL W||FK W|DFLG|KyD|Q F|WL ||W Q|KL F|
W|KR W|WtQK|Q |W R|K S|FK W|Y L|SHQLFLOOLQH

P |KL |O F|SHQLFLOOLQH

W|K S
Q|||WK F|NKi Q|DFLG| P |
S|WK|SHQLFLOOLQH|
W|K S|Ok|G L|SHQLFLOOLQH|W Q|Q |F |E L|QKL P |
R|Y |SHQLFLOOLQH|NKi Q|EHWDODFWDP DVH|
|P W|NK |Q Q|NKi Q|NK Q|Q |N W|K S|Y L
21
2 Probenec/d
ma
y i iK
` a
yi ia

2 Tha '' '' ''j ng th/ ngh/
aaai oyoa
` aaiiFKh a

h a i
Ee
i y a i yK
oy i
ia
s i i
eia
21 ' '' '
eaaai
y
3 PCLL
` ad
`
NS
e
NU
k
O
l
Q
p
qy
k
22
31 T/nh ch ' '
maaad W|SHQLFLOOLQV|W |QKLrQ|Yj |WK| F|W |3HQLFLOOLQP |FKUVRHQP
i |G a L|P L|NKi F||3HQLFLOOLQV||NDOL||F Q| F|EL W|QK oeaaaaI
i |Q F|KR F|WLQK|WK |SHQLFLOOLQ||Fy|P i Q|WLQK|WK ||1 y|WDQ QK|WURQ|Q F|Yii
i Q||+L |O F|F D|SHQLFLOOLQV||NDOL|WK Q| |UDi |P W| Q|Y ||0 W|P |F D|
SHQLFLOOLQV||NDOL|W Q| Q|Y L|||||J||||| Q|Y r pmENPRRJ||||| Q|Y |8 63|FKR|P W|
a |Fy|KL |O F|||6D|NKL|W |FK F|O Leaaad aa |iay L|S+||JUIR D|
NIT be D|||SK Q|WUL | Q|Y aK
maaad k iaE Q| F|EL W|QK |Oj |EHQ OSHQLFLOOLQ|VRGLP ||W |Q F|KR Fia
i |SHQLFLOOLQ||Fy|P i Q|KR F|WU Q|K L|Yj Q||. KR Q|||P |KRii|P O|Q F||
e a |O F|F D|SHQLFLad k ia |UD|QKDQK|W |P W| Q|Y ||0 W|P D|3HQLFLOOLQV||1 DWUL|
W Q| Q|Y L|||||J||||| Q|Y |8 63||||||J||||| Q|Y r pm W|OL |Fy|KL |O F||
p ai |FK F|O L|SHQLFLOOLQV||1 DWUL|FKR|OL iay L|S+||JTIR D||P ( T|F D|||SK Q|
ia | Q|Y |1 DWUL|
maaad eaE Q| F|EL W|QK |Oj |33 ||THRV|3URFDLQH|3HQLFLOOLQV
d I oeaaamaImamaaad Ima oeaaaF W|
L|P RQRK GUDWH|F D|3HQLFLOOLQV|||7UrQ| Q|Y W|WKt|QKL P i |SKkQi
eaaad W| Q|QK |P W|NKR|G |WU |KR F|Oj |Q L W|L |P |F D|SHQLFLOOLQV|||Qy|
i Q|Yiaa W||+Ri Q||JQIR i|P O|Q F|Yi Q||||P |
iN Q||+L |O F|F D|SHQLFLOOLQV|eaa |UD|QKDQK|W |P W| Q|Y ||0 W|P |F D|
3HQLFLOOLQV||SURFDLQHL|W Q| Q L||||J||||| Q|Y |8 63||||||J||||| Q|Y |8 63|FKR|
W|OL |Fy|KL |O F||6Dai |FK F|O L|SHQLFLOOLQV||1 DWUL|FKR|OL |WLy L|S+||JTIRK
32 ' '' ' '' ' '
maaad a k iL|QrQ| F|E R|Y |K L| P | |Q Q|Q D|V |WK |SKkQ D|
W||3HQLFLOOLQV||NDOL|G Q|YLy |KRiy R|T Q|WURQ|SKa W| | |
a Q|Ki P ||QKLy P |E |Eyaoe K6D|NKL|i F| QK|O L|WK
|WDQ|Qy R|T Q| |QKa W| |W ||JUM` Ei |O QK||Y |VD||||QoK
3HQLFLOOLQV||NDOL|Yj |1 DWUL|iay i |E R|T Q|WURQ|SKa W| |||JPMM` K
6D|NKL|KRj | |WLy i | Q| QK|WURQ|||Qo | F|L |WURQ|W |O QK|||JUM` F
OQa |Q | |QKL W| |SKKmaaad eay R|T Q| a W| ||J||||Q Q|
D|V |yQ|E Q|
23
q y i a
eaaad
eia W iay a aI a aL iI eeaa a I
eaa aiIa iaae ` i Ia oaeeiIaia ii
a I iaieaI a ioaiI a ioai e ` i I ea iI
oi oa eiiLiaiIoaeaaa aiIaa
e ` i I iaaaa KK
i i
eaaad eia aiay W aa iI aeoaIeiaa I
e ae ` i Ie ae ` i Ieaa Iooae ` i Ia oa
e ` i I ie ae ` i Ioiioae ` i Ieiaia Ieea
oiIe ae ` i Ie iae ` i Ia aiIiioae ` i I
ai a e
ii aiay Wa i
NMBIiRBEi OQa a
aMIVB eaa aiI
a iaae ` i Ia oaeeiIaia iia Iaeo ae ` i I
oi oaiaiIi aa iIoiaa aiI oa
iI iaaaa Iaiiaa Ieo aa iIea
a eeiIeae ` I e ae ` ai a J e ` K
eaaa
d a aiay W eiaa I oa iIeiaa Ie a
e ` Ieaa Iooae ` Ia oae ` I ioeaa
aiIoiioae ` i K
p e i
EiiaFIa o
i aa a ia o qaX

33 S ' '' '
maaai y
EJ oiaieiaI a
24
d JI ai JKk a I
yI
a a

34 gh/ n c ' '
maaad eia Eh aF y i
JioK` i
JPMBKk i e a
maaad eia y
a a
y i y y
yREL y i JQa EIs F SJTa
maeaaad i eaaad aiay
eia Eh aF

iaeaaad y e
i
aiaeaaad
ya Iaa eaaa i
p a
i ia
o ay K y
aKmia o
aK
maaad e aia i
i
aK
i a
'
F a

25

maa JOQK
maaad iaWRMKMMMIr LI eRoEr eNVUUFK
F
oi
UMKMMMIr L oKk a ia oi y NMMKMMM
oKEc NVURFK
F
a
maaad eaW JOQK
maaad iaWQMKMMMIr LI eRoEh aNVUVF
F maaad eia JU
E aNVUVFK
F i a Wmaaad eia La WORKMMMIr LeSK
qay i oy aI
a o pNVUVFK
' o
J
a
J
J JOQK
Jmaaad iaWRMKMMMIr LI eRoEr eNVUUFK
Jmaaad eia La WOMKMMM
J oi
UMKMMMIr L oKk a ia oi y NMMKMMM
oKEc NVURFK
Jmaaa ml
a
JOQK
maaad iaWQMKMMMIr LI eRoEh aNVUVF
26
maaad eia RR JU
E aNVUVFK
''
F maaad eaWQQKMMM oK
maaad iaWQQKMMMSSKMMMIr LI oEr eNVUUFK
F aeaaad SSKMMMIr LI
pn oKh o o o Ee ae
NVUSFK
F maeaaad WQQKMMMIr LI oK
p I

F maeaaad WNMKMMMOMKMMMIr LI eNOJOQK
iaeaaad WNMKMMMOMKMMMIr LI Ipn eQUKEgaNVUSFK
'
F maaad eia WRKMMM
maaad a WRKMMMRMK
maaad eaWRKMMM
F maaad a WORKMMM
maaad eaWOMKMMM
maaad iaWRMKMMMIr LI eOoEr eNVUUFK
F s
NMKMMMIr LI NRKMMMIr LI eNOK a
i i o
eaeaaad KEi iKNVUPFK
F k
QQKMMMIr LIs eaEeaaaia t ai
NVUTFK
F h aa Wmaaad eia QMKMMM
Ir Is ea
27
F s yeaaad
Ea Leia FOMKMMM eaaa
d WOMKMMMr LI KE NVUTFK
F maeaaad WORKMMMr LI eNOJOQK
maaad a WNRKMMMOMKMMMr LIs mii
NVUTFK
F maaad eia WNOKRMM
maaad a WNOKRMMNM
maaad eaWOMKMMM
'
F maeaaad WQMKMMMIr LI oK
m oK
Ee NVUSFK
F maeaaad WSKSMMIr LI o oK
m OOKMMMIr LI

''
ioWm LI
o oKp
i oy
35 L/ ' '' '' ' ' '
qo
qay eaaad maPMMKMMMr L ia` oiaaNMM ORM I
yI
i ii oK
q aa yEa oXyQoI
oXSoK
28
4 PCLL PTSS
`
`
NS
e
NU
k
O
l
R
p
qy Jeoi aeaaaa
k
41 T/nh ch ' '
yIeaaas

aI i
ia iiiKe a eaaas eia
a i
NPUM
eaaas Kq oay

42 ' '' ' '' ' '
maaas eia y y
ENRJPMM` FKp aia iy OJUM` Ei
oK
''''' ''' ' '' '
maaas i
eaaai yI ee
I a

I eaaad oy
''''' ' '
29

a e e
i Jioi a
i JTPBK a
y y i
o o
a i i a e
i
p i
a RMB
eaaad FK
`
q
i PISRa
KEp iKNVUPFK
i a
'
J RIRNN Lml eSJUE aNVUVF
J NM Lml eUEh aNVUVF
' o
J RIRNN Lml eSJUE aNVUVF
J NM Lml eUEh aNVUVF
'
J SSKMMMr LEQNIOR LFml
ei E
NVUTFK
J NNMKMMMr Lml ESUITR LFml eSEi a
o
J NNMKMMMr Lml eSJNOE NVUTFK
45 Thang t/n kh ch h ng
30
q oy
ia y i
oK
46 L/ ' '' ' ' ''a cha ' ' '' '' ' '
461 Th y s ' ' ' '
p aaad a aio
'''''' ' s ' ' ' '
maaas eia yNOR IORM IRMM K
maaas eia OMM I
ORM LR iNMM INRM INRM OMM K
5 PCLL: mo/c////n r mp/c////n
` eaaa
aaa
`
NS
e
NV
k
P
l
R
p
eaaa
`
NS
e
NV
k
P
l
Q
p
51 h ' ' chang

eaaaa piei
e aI apieo
` iaaK eaaa a
baaaIp mi iaK
31
aaae |Wi F| Q|L Q|QK |P SLFLOOLQ|QK Q|Wi F| Q|NpP |K Q|FK Q
L|P W|Ya a P |UDP |kP |EDR| P |QK |( |FROL||Fi F|ORj L|6DP RQHOOD||+ |K W a
Q|N |NI L|WU |QK Q|G Q| W|EHWDJi D|%DFWHURLGHV|i |F P |
L|DP R LFLOOLQ||P LQRSHQLFLOOLQ|G |E |SKi |K |E L|EHWDJODFWDP DVH|GR|y|Qy|NKQ|Fy|KL |
F|FK Q|O L|QK Q|YL|NK Q|V Q|VLQK|UD|Fi F|P HQ ||+ |K W|Fi F|Gh aImi I
m i |NKi Q|
k Q| F|
aaa Q| W|Ei Q|W Q|K S|F D|DP SLFLOOLQ|
eaaa W|Ei Q|W Q|K S|F D|SHQLFLOOLQ|
qy F|
aaaJQJqaJNJaoxPKOKMzeiJOJoaaISJxx aEQJ
ooeoFioz azJPIPJa ioJTJJIiaoixOpJxO eIR eIS
iEpGFzz
eaaaJQJqaJNJaoxPKOKMzeiJOJoaaISxx aeoJ
ioz azJPIPJa ioJTJJIxOpJxOeIReISiEpGFzz
eaaa a QJqaJNJaoxPKOKMzeiJ OJoa aI
Sxx aeoJioz azJPIPJa ioJTJJI a iI xOpJxO eIR
eISiEpGFzz
` i F|SKkQ|W | J aaaJ` NSe NVk Pl RpKPe Ol
J eaaaJ`
NS
e
NV
k
P
l
Q
p
J eaaaa J`
NS
e
NU
k
P
k l
Q
p
q Q|O Q|SKkQ|W | J aaaJQNVKQS
J eaaaJPQVKQN
J eaaaa JPTNKPV
''''' ''' ' '
'''''' ' '' ''' a qa
aeaaa F|FK |V |W Q|K S|Yi FK|W |E a Q||1 K Q|NKi Q|VLQK|Q
i S|TD|Yi FK|W |E i Q|FQ|QK Q|SURWHLQ| F|EL W|Eyi i a
Q||7i F| Q|WUyi |Ej R|W Q|WU Q||V |OLy W|F D|DP SLFLOOLQ|KD aaai
i |Eoi |Q L|FKR|YL F|V Q| W|SHSWLGROFDQ|F D|Yi FKi |Ej R|Yj |VD|y|WLr|K |
i |EK
32
S|TD|Yi FK|W |E Q|UDP |kP |QKDQK|K Q
|QKLrQ|QK |Oj |3HQLFLOOLQ||Yj |GR|y|KL |T |WL W|QK Q|YL|NK Q |K Q|
P R LFLOOLQ|L|Yj R|Yi FK|W |E Q|UDP |kP |G |Gj Q|K Q|DP SLFLOOLQ||L |
F|HP |QK |P W|Y Q| |F |E Q|Y |KR W| Q|F D|DP R LFLOOLQ|O Q|K Q|FK Q|O L|YL Q|

522 S ' '
Q|Y Q|WURQ|G FK|G |G Q|Q Q| F|NKi F
D|DP SLFLOOLQ|Y |K S|WK|NKi F|QKD|VD|NKL|F S|E Q Q| Q|7 |O |
DP R LFLOOLQ| F|K S|WK|FDR|K Q|DP SLFLOOLQ|NKL|F S|E Q| Q| Q |P
Q|QKDL|O L|||SUHUP LQDQW|FDOYH|||
D||DP SLFLOOLQ|VRGLP |F Q|K S|WK|W W|VD|NKL|WL S||WLrP |G L|GD||W
Q| Q|K S|WK|NpP |K Q|WUrQ|Q D|WU Q|WK |K S|WK|E Q Q| Q|F D|
DP R LFLOOLQ| F|Ei R|Fi R|NKR Q||||| S|E Q| Q|
S|WK Q| S|K QQK Q|O L|NpR|G L|LDQ|WURQ|
P i |K Q|DP SLFLOOLQ|VRGLP |
W|E Q|FK Q|FKR|U Q|DP R LFLOOLQ|Y |F QK
|KL |T |G F| Q|K F|L D|F |KDL|OR L|WK F||GR|y|V | W|K S|L D|KDL L|WK F|
|KL |K Q|V |K S|WK|P W|P
Q|W L||% Q|QKDL|O L|||DP R LFLOOLQ|N W|K S|Y L|FODYODQDWH|OL |||
Q|O Q|WK S|WK|||
Q|W L||DP R LFLOOLQ|N W|K S|Y L|FODYODQ S|WK|NpP |K Q|WK|| Q|
L|Y L|F W|OL ||1 Q| |DP R LFLOOLQ|WURQ|K W|WKDQK| |OL |L |WU NKQ| W| F|
P |QK | |WK|||W Q|W L|
523 Ph n b
|NKi |QKDQK|Y Q| Q|K |K W|Fi F|G FK|P |WU |G FK W||
Q|WL Q| W|| Q|G FK|Q |WK S|WU |NKL|P |YL P |TD|G FK S|WK
|
524 / th

33
a ySTeiIk I Toi QQeiK
QSeiK
G eaaa
TPeiIOMeiIk JPReiIq
'''' ' ' ' '' '
y SKOJ
VKT L iNSeiKk iaa y i
i y i
i
ai eaaa aia JORB
a
54 h ' ' phj ng ng
541 h ' '''' ' ' 'n qaan
k
eaaa K
542 h ' / nh '
q W
y y
yi i i o y
aiK
`
y i o aeaaai a

k aa
i iy

543 Tr n th mang tha/ Th s/nh s
a
ii yI
ay ia i
iaK
34
544 Trong s
i e
i aI
52 CLL
521 o h
i iaoiKqy
i aI i s i
aaa y ooiy eoK
aaa Joo eaaaI o i JOPPPK
522 ' ''' ' '''' '
aaa yI ayI y
e NRPM` iaKh a
i i i
ia oKp aeIi y
iioi eiPi NOi a
e
''''''' '''' ' ''' '
a
aaae eaaaK
aa
i o
''''''' ' '
aaaiaoiii oK
p a a o
q
a i
o I i o P

p a MKOi L
iyKq a a
e
35
aaa i` pca y NM
SMB i i
i i
i a a
OMB aaa
aK
aaai
e ia
aeaaaE
i QR
VMei VMei Ke NKV LL aK
525 L/ '
Ch

a) NNJOO Lml eUJNOa
b) qaoi y E aJIaiEFWRKRNN LI opn eU
a OO Lml eUNOE aNVUVF
c)
d) y ia
e) OO Lml eNOa
f) NMRR LeSNOa NN LIs II Iopn eSNOa
NVUQF
g) NNOO Lml eUNOa NVURFK
o

a) NNJOO Lml eUJNOa
b) qaoi y E aJIaiEFWRKRNN LI opn eU
a OO Lml eUNOE aNVUVF
c) NNOO Lml eUNOa NVURFK
36
d) y
OQa
e) OO Lml eNOa
Tr a bj

a) aW aaaiaoiWT Lml eUNOa
b) SNM Lpn oI eOQa
oFEgaNVUSF
c)
NVUSFK
d) opn eNOa
NVUTFK
e) NPKONRKQ LI opn oEr eNVUUFK
k

a) PM Lml eSa NVUTFK
b) aaaiaoiWOM LeNOa FK
Ch/m

a) aWNRMNTR Lml INJO oE J
E o FRM L FE` NVUSFK
b) NMM LeUa e NVVPFK
j s t

aWOO Lml eNOOQa

526 Thang t/n kh ch h ng
q i
i o oK
aaai i k
37
e iia o i
a
53 CLL CLLT PTSS
CLL CLLC C
` imia
531 o h
i Ji I ieia i
ia OKTEiaF i
eK
a
eia iK
532 ' '' ' ''' '
q y e

y
p a i i
NMoa y oK
5.3.1 '
` aa a o
iaaa
y
ay Ji I eaaapieo
aK
38
eaaaE
iI ii
a
a i o
ay i m
aK
h a

aaaE Ji Fi
h ai J y iy
i OWNiii

oK
5.3.2 S ' ''' K ' K
aaaLmia i y
o a
a o
'''''' ' ' '' ' '
y
aaaK
` ieia i o
yJa MKPVa a
I i

` ieia i MKPOi Liy e
e ia Kk i
i ay FK
k
eiai o
iKk oy o
e aiaK` i i
39
` aa yE
NJ aJQJoo iJOJKh a o
Ji o ai y
ia OTBai eI NSPPBe

LR aaa
i a
q
F
Ch

F NPKTR Lml aXi F
F NMOM LE aaaFml aE NVUUF
F NNOO Lml eUNOa aNVUVF
o

F SOKR Lml aXi F
F NMOM LE aaaFml aE NVUUF
F NNOO Lml eUNOa aNVUVF
53 PCLL PCLL S
531 C ' ' '
532 Cang th '' ''C1613a4S
qy JSJxEo FJOJ aJOJeoi azJPIPJa ioJTJJQJ
iaJNJaoxPKOKMzeiJOJoaaIa iXa EJFeJ aoJ
eaaaIa iX
40
54 PCLL TYT
`
NS
e
OR
k
P
l
T
p
541 o t/nh
i I eaaa iaoia i
ia aI i i
iaoiENP L
o oiaoi ee R
TKR a
eaaaa a aI i
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ee UNM
a i a
eaaao K eaaa aoeaaaKI v JSNMUIo
o i NPQNK
y
y ENRJPMM` FKp a
iI o JUM` F
o K
eaaaiaoi y EmoFi e
JUM` F K
i y
Na i
41

i ie ii
qa
ay a
ei y o
iyQUa OM L oi QM` Ka
i yOQa
i iio aI
iyQa
iy
y iiaFeaa I eaa aiI eae `
e ae ` K

aa iI e a e ` I e a e ` I oi oa iaiI
i oae ` Ioae ` Ioiaa aiI oa iI
a oae ` Ioiioae ` Ieo oa iIeeaaoiI
a ai iioae ` Kp e y
ee I K y

''''''' '
eaaa a
yo eaaa
eaaaI e ea Kd a
eaaai y oi iJ

a
Jeaia mi Eei
aaai aiiKk
ii oiaIaI oe I a K
543 S ' '' '
42
qy I eaaa a
io
iay yi aK
iaoii
a oKp a o i
aE a
i e
h a iay
y
a iK
p a I
MKNSTi Liy Kq ya ia
e ` cpa ay
SMB i
i i
iai i
h aK
i
eaaa aiae ia
eaaaaE
aia ia a QRUMei
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i a
Ch

a) NMJRM Lml IIs II Ipn eSJUa
b) qaoiiay EmoFWRKRNN LI opn eUa
NN LIs opn eUa
a JPP Lml eUa aNVUVF
c) y i OO LI IIs Iopn iaJea
E NVUUF
43
d) L|Y L|8 7,|P Q|F P ||||P |N|Qoml aiaEo i NVUVF
e) NMOM LeSIs II Ipn Eh aNVUVF
f) NMJRR LeSNOa |32 ||||NN LIs II Iopn eSNOa |||UHHQNVUQF
g) qaoiiay EmoFWNMRM LI opn eSUa |
L|Y L|YLrP |F |NK S| Q|EHWDJ oiaWOM Lml eSa |||) RUG|Y
NVURF
o
L|Y L|E QK|P Q|F P |
a) NMJOM Lml IIs II Ipn eSJUa |||3DQLFK||||||
b) qaoiiay EmoFWRKRNN LI opn eUa
L|6RGLP ||||||NN LIs opn eUa |
a Q| Q|||||JPP Lml eUa ||URQVRQ|Y aNVUVF
c) a Q| Q|||||JOM Lml eUa |||) RUG|Y NVURF
d) L|Y L|E QK|QKL P |WUQ| Q|K|K S|||||OM Lml oiay L|WK |T||NO
a ||5 RGHEVK||||||
e) NMOM LeSXRNM LIs II Ipn Eh aNVUVF
f) Q|WLy i Q|Ti W||||P |N|32 |WLG||KD||||OO LI IIs Iopn iaJea
E NVUUF
g) NMJSM LeSNOa |32 ||||NN LIs II Iopn eSNOa |||UHHQNVUQFK
Tr a bj
a) QNM LI eOQa ||P L|NKQ|FK | QK|||||NM Lml eNOOQa
EgaNVUSF
b) L|Y L|E QK|QKL P |WU Q|K|K S||P SLFLOOLQ|WULK GUDWH||3ROIOH||OO L
pn eNOa |||WK L|LDQ|Q Q|WK F| |QK ||||QoFEe aeNVUSF
c) L|Y L|E QK|QKL P |WUQ| Q|K|K S||P SLFLOOLQ|VRGLP ||||P |N|64 |T|||L
eaaaiaoiWNN LI eOQa |||%HHFK|||||E|
d) eaaaiaoiWNRJOO Lpn oI eOQa WLG|||8 SVRQ|||||||
eo:
44
a) eaaaa WSU Lpn oI eUa
g '

a) eaaaa WNMJRM LIs oI iaK
eaaaiaoiWRJOM LI aEo aNVUTF
b) eaaaa WNNJNR LIs oI iaeaE NVUTFK
c) k JUa
iX Toi
E` ea piNVUTFK
d) eaaaiaoiWNN LI eSa
eaaaa WOO LI eNOa
e) eaaaa WOO LI eSJNOa NMM LIs eSa
eaaaiaoiWNNJOO LI eNOa
55 TP
551 a h
i o eaa aIiaeai
NSPIOKiaea iaeaok EOJ eieeaoFoa
E md FK
'''''' ' '
i i J
oiaa aFi qaeaoiaa aKm o ii
ai
'''''' ' '
qaea i
ai ai i
45
J` i
Ji
qaea
J

Ji a W
JQM LIml aiOa
oK
56 TCCL S
561 a h
i JoeaaaIiaoaaa i
ii y
RKOJSKR bea Iee SJUK
'''''' ' '
y
piei o aIqaaaa
m aKh a
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a
'''''' ' '
y Kk
JSMeiKd a i
PMB aiay
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46
i o i
o ay Kq MKPQi LI JMKORi LK
q y ea
ai
L/ ' ng:
Ch m o
k a JNNM
LIIs II Ipn I
g
k a WQQ LIIs
s ay iiOR y iI
r pm y a aKp ai iIia
y J i
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57 CLCLL S CLCLL T
`
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e
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k
P
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R
Jk Je
O
l
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571 a h
i aoJeaaaIaaa eaaa i
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aoeaaaa o ioeoaoeaaaa K
572 '
47
` aaa y y a
a NRJPM` K
o K
'''''' ' ' ' '
` aaIaaa aae
eaaa
eaaae yKe a

a eaaa ieoK
k pieo i pieo iaaaK
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pieo
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'''''' ' '
` aa
yi
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q
Kh y

ai
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Ch m o
Jk a JQM LIml JUa
NMJNR LIml IIs I
J y pieo WNM LIml K
Js ay i
j
J
48
J J` FW a i
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5 TCL PTSS
51 a h
i aeaaaI i I i
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'''''' ' '
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53 S ' ' '
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ay a
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L/ ' ng:
J` I Wk a JOO LIml Ki a
5 CLCLL
`
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e
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k
P
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l
R
pk e
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49
51 a h
i aoeaaaIaaaa eaaa i
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a aaaa aaaa I aeo io
ao a K
'''''' ' '

i
JTSBKq o q
Ii
KVRJVVBi y
ai
L/ ' ng
Ch m o
k a
F NNJOR LIml I
F NMJRM LI Ua
F k a pieo WNMJOM LIml K
51 CLL S
`
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e
NU
k
P
l
R
pk e
O
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511 a h
50
i aoJeaaaI aeaaa i eaaaK
a i i iai
a a eh OKUKN aa
JVRMaaKN aa y i
OKUJPKN bea K
512 ' '' ' '' '
l aa yI y y
a ENRJ e
oI ia oK
p ae y i y ia
aMKVB NST L ii o e
To
l aai
iRB NMBia aMKVBIiio aIa aMKVB
aa eiIeeaaa I eaa aiIe ae ` I
eia aIa ai e aK
iioae ` I
''''''' ' '
i
e
JPRBKp aiay
y K
q e
iee MKQi L MKPi L
y I UVJVQBi y

e ai ai
e
L/ ' ng
Ch m o: h/ ' ng nh ' '
51
F OMJQM LIml K
F RKRJNN LIIs K
F k a pieo WNMJOM LIml IIs
F s ay JSM LIa i
QJSi
F s ay
F s ay
g '' ' ng nh '
F OMJPM LIml I
F ORJRM LII IIs K
511 CCLL S
`
NT
e
NS
k
O
l
S
pk
O
5111 a h
` aaa J
i Ii qi
K y i e TTM
aaa QKTJSKR bea Kp a oyI JUK
` aaaaa ` aaaa o o i OMSQK
` aaaaa
aoiaaaI i Iii
K` aaaaoa aaaa o
aoaaaa K
5112 ' ''' ' '' '
52
Ioa y Ia
PM` I aeaaaaa Eiay Is F
y I Fi o a P
o
` aaai y i i W
a iaae ` Ia oaeeiIe ae ` Ioiaa aiI
aae ` I iaIeo oa eiIeia aIeae ` I
a ai e ae ` K
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oa eiI eaa aiIoiaIi oa eiI
oa eiIa oae ` Ioiioae ` Iiioae ` ai a
K eK
''''''' ' '
J iaJe eaaaI
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E eaaaF a
bKaIh aI e ea Kk aIi a
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5114 S ' '' '
m
a aoaKe a
a i aoai
aoai

a i y
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53
''''''' ' '
y I ay

JQMBa Kaoa
K

e

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y y K
q MKNUJMKOi LI JMKQi LKOVJSMBi ay
i I
y y
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Ch m o
Fk a JRM LIml I SJUa NR
LIml IIs XNR LIIs I Ua JNNM LIIs I Ua

g ''' ' ng nh ' ''''' kg c ch nhaa 6 g/ '
54
512 TCLL
`
NT
e
NV
k
O
l
S
k p
121 ' '
iaaaa EpieaaF a
o ii JSM
ei aiay JSa y
JPa y i
iaaa eaaa eaaa i o
ay y K
h JRMBei y ia o
ay JVMBXaaI
aa aaaVMBK
iaaaai ie i i
K` i e
K
122 Ch ' ' '' ' '

a i o iaaa
a pieo i

` a eaaaa a

a
e
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55
i a
apieo i a o y
iK
123 Ch ' ' ' ' ' '
iaaaioe y
aaaKa a aI
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iaaaa FKs ay i o

iaaa eaaa eaaa i
oiaK a yi o
i y
a yia i a
aaK
13 CPCLL YCL
eaaaoa q

eaaa

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i
56
14 P CLSTT S
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NT
k
P
l
Q
pKe
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I ae
141 a h
I ae oi a e I i Q| Q|WU Q
Ii P ||G Q|SK F|K S|WLQK|WK || |QKL W| |SKINN I ae
WDQ|WURQ|||P O|Q F|
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i P ||SK F|K S|NKQ|N W|WLQK||Kii F|||UDP ||P O||
q |O |SKD|WU Q|K Q|K S|G Q|WLy NWNIee FK|WLy SKRJTKRK` W| P |Oa
aiK
142 ' '' ' '' '
a Q|E W|WLy iy R|T Q| |QKL W| |SKEYPM` FKq F|WLy Q|
W|VD|NKL|SKD|Y L|Q F|P L|Ei Q|Y|W R|T Q||||L | |QKL W| e
QUa |Q |E R|T Q|O QK|
'''''' ' '
m F|K S|NKi Q|VLQK|FDUEDSHQHP |Y W| F|FK |+3|,||FLODVWDWLQ||Fy|SK |NKi Q
Q|U Q||,P LSHQHP |Fy|Wi F| Q|GL W|NK Q|QK Q|F Q|Fy|WK |Fy|Wi F| Q|N Q| L|
a W|V |YL|NK Q||,P LSHQHP |Fy|F |WUF|W Q|W |SHQLFLOOLQH|Y W|K S|Y L|K |K W|Fi F|
eia eaaa Q|YEeaaaaaeiaFGR|y| F|FK |W Q|K S|WKi |
a Q|
,P LSHQHP |Wi F| Q| Q|K |K W|F |NK Q|UDP |G Q|KL |NKt|Ei |Fy|Wi F Q|
Q| L|Y L|HQWHURFRFFL|||YL|NK Q|UDP |G Q|KL |NKt|Ke |EDFLOOL|||Wi F| Q|
Q| L|Y L|/ LVWHULD|||YL|NK Q|UDP |kP |KL |NKt Ee ea IbiiaI
57
|G Q |N W|V |G
F|FK |+3|,|WURQ|Ti |WU Q|KyD|LP LSHQHP |WU |E Q D|

Q|WK Q|| L |Q Q| Q|||N W|T ||Oj P |W Q|O Q|Q F|WL |Y R|Y | Q O Q| Q|
L|W |NKL|FK |G W|P
144 S ' 'ch '
,P LSHQHP | F|V |G Q|WU | |L |WU |QKL P |WU P |WU Q
|T |KR F|Fy|Wi F|G Q|E W|O L|
''''' ' '
|KDL|WK F| | F|K S|WK|i Q|N |TD| Q|WL |VLQK|K F|F D
S|O Q||||| L|Y L|LP LSHQHP |Yj ||||| L|Y L|FLODVWDWLQ|
L|NK S|F |WK ||WK F|Fy|WK |TD|QKD|WKDL|Y D| L|WU |Q
W|K S|Y L|FLODVWDWLQ||LP LSHQHP |Fy|WK |E L|TD|WK Q|Y Q||. KR Q|||||
P LSHQHP | F|WK L|TD|Q F|WL ||||||F L|FK D|U |E L||7K L|LDQ|Ei Q|K |
|| |
146 Ch ' '
QK|QKkQ|QK |F P |Y L|Fi F|WK Q|F D|WK F|KR F|Fi F|NKi Q|VLQK|NKi F F|
| |UD|SK Q| Q|FKpR| QK|QKkQ|V |
Q||U L|OR Q|WK Q|NLQK|WUQ| Q|| Q|NLQK||FK Q|WK Q| ||Y F|V |Oj P |W Q|P F|
|U L|OR Q|
146 ' ' '
W|O L|Fy|WK | |UD| | Q|WL D||EL Q| Q||WL |||k | F|K Q|
LQK|WUQ| Q||FR|L W|||Ti |QK |F P ||Q D||V W||Ti |P Q|||SK Q| Q|GR Q|P FK|
Q|K W|NK L||WU Q|W QK|P FK|QKDQK|Fy|WK |k | F|K |WL
''''' ''
|T |F QK|WUDQK|E L| |NpR|G L|LDQ|Ei Q|K D|
LP LSHQHP ||,P LSHQHP |Fy|Wi F| Q|KL S|O F|Y L|Fi F|NKi Q|VLQK|QKyP DP LQROFRVLGHV|| F|
W|Fy|KL |T |Y L|( QWHURFRFFV||6WDSK ORFRFFV|DUHV|Y |
W|K S|Q Q|Fy|WK | L|NKi Q|WURQ|YL F Q|O L|YL|NK Q|QKyP ||3VHGRP RQD
''''' ' ' '

58
| |UD|Q |N W|K S|LP LSHQHP |Y L|Fi F|NKi Q|VLQK|NKi F|WK F|QKyP | |
Q|O L|P W|Y Q|WK F|QKyP |( QWHUREDFWHULDFHDH|||EDR| P |QKL
W|V |G
S|O F|Y L|WULP HWKRSULP |VOID| |FK Q|O L|1 RFDUGLD|DVWHURLGHV|

KORUDP SKHQLFRO| L|NKi Q|Y L|KL |T |NKi Q|NK Q|F D|LP LSHQHP |
|G D||QKL P |WU |F P ||||P |N||, ||P L|OL |Fi FK|QKD|| |
59
k e ` bme i l pml o Ik
C ' ' '
1 T T C
a
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60
k aeeai a e

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61

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62
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15 Ch ' ' ''''' n cho th s/nh s
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16 ' ' '
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17 h '' ' ' ' '
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63

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64
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65
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66
QP |Y||E P |WK F|FK P ||; RD|QK |E |Y|NKR Q||||SKW|Y W|V D|NKR Q||||L ||
|G |O S|O L|VD|NKL|G | | F||||L |
D|||HIDUL|||||W Q|W |QK |WUrQ|QK Q|QrQ|WK F|KL Q| |WK L|L P |E D
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3 CPL
31 a h
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F | |FKy||6 |G Q|OkP |V
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34 S ' ' '
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|||Q Q| |WK F|FDR|QK W|WURQ|K W|WKDQK|NKR Q|||||||P O||FK Q||||||WK F|
W|Y L|SURWHLQ|K W|W Q||FKy|||7K F| F|E L|TD|Q F ||WK L|LDQ|Ei Q|K |
Q|||L | |FKy||||L | |P Q|||||WK F|E L|NKQ|E |EL Q| L|WURQ|Q F|
||+ S|WK|WK F| |Q D|WU Q|WK W|WK S Yj |NKQ|i Q|WLQ|F ||Li |WU |VLQK|K F|F D|
F|NKL|G Q| Q| Q||Q D|FRQ|WKD| L|NKR Q
L|LDQ|Ei Q|WK L|WUQ|E Q||||||L |VD|NKL|G | Q|
L/ ' ng
Ch m o
P |WU |F P ||||P |N||32 || L |WU |QKL P |WU P |tW|QK W
P |WU F| W|QL |tW|QK W|||Qj || |WU |tW|QK W||||Q
W|V W|Y |FK Q|E QK||1 Q|V |G Q|WK F|Q NKQ|i S| Q|Y L|WK F|
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67
4 CL S
41 a hc
F|Fy|P ||WU Q|KR F|WU Q|Q Q|E W|WLQK ||
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4.2. Dc lc hc/ ph tc ng
L|0 ,|F D|FHSKDROLQ|NKi F|Y L|FHSKDORWKLQ|FHSKDSLULQ|Y |Fi F|QK
F|OkP |Vj Q| |QK |Q P |WUD|Fi F|OR L|YL|NK Q|QK |F P |Y L|NKi Q|VLQK|Q
5 CP S
51 a hc
|K |,,,||FHIRSHUDRQH|VRGLP |Fy|FK D|Gk |QDQ|SLSHUDLQH|
Q||G Q|E W|WLQK|WK ||WDQ|W |GR|WURQ|Q F||tW W| |SK
L|D|WURQ|Fi F|GQ|G FK QK|P FK|NKR Q|||||
FK|WL L|UDP |FK D
5.2. Dc ng hc
S|WK|TD| Q| Q||Q Q|G Q| Q|QR L|WL
KyD||1 y| F|SKkQ|SK L|NK S|F |WK ||Q Q| |WK F|WURQ|Q S|Q |P |
68
ay K` ee ia eeaI
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QK|P FK|||KD|||O Q|WURQ|Q S| |WU
|L |P F||||P |SRQG|WK F| Q|||OEE||||||
Q|G Q|O Q||G Q|WK |Y Q||| L||||L |KR F|FKLD|UD|P L
||| L|K FODWH|||UDP |SHU|N|WK F| Q|
Q|SK P |WL S|P L|W Q||%DFN|Y
Lo / bj s t:
|QKL P |WU
KR| Q|Y W|K |U L|Q Q|| Q| P |
WUQ| Q|K|K S|WU |QKL P |0 FRSODVP D|
|OR L|Q
162
3 ytetrcyc//ne
31 a t/nh
qioa
i iiiK
l oiioae ` i I i oii
io
22 ' ''' ' '
q l oiioae ` i
oiioai a
a NR
l oiioae ` i ii y i o
i i y

ia aia ii
a IiaieaIa oaiI a aI aei e ` i I ioei e ` i I
eaeaaiiiIeo oa iIeia aIiioae ` i
ai a J e
i
i a
aL iI aaa aa I eia a I eeaa a I
ea a aiI oi oa eiiI ea a I
oiaa aiIaiI iaaaa I iaia I
aaa Ieaaad eia La Ieiaia Ieai
o I
aK
23 '
a i eia a
ia o
qioa
ia iy i
163
Iiioa
i a
ya
oa aiiaKq yI a iy
a a

eI a iaIiaa eaIiiaI i aia oiIk aK
k i ia ai a a
ea eImi iaIa v aa
eiaKk a a
m ai iioaIia
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o
l oiioa iioa a

24 S ' ' '
` IiI
i a K
''''' ' '
` iioai
JUMBKp i
e a oa
l oiioa i
iiay Kp JOMMo F y
i
e e ia
iai l oiioae ` pc

164
iioae
aoaeii i a
ia i yi
NIQi Lh iy MIUi Lh iyaKq J
QMBl oiioaEiRNMFK
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a aia
i y
eK` Sa y IQIPVITa
iyaINMIRa y a y PISa y
26 Ch ' '
l oiioai
iioa K iioai ia
iaa
a iaKl oiioa
yi ooa
aoaK
qy
i aKi a i o

iioa
27 T c d 'ph
l oiioa iioa i
Ki a o ai

qioa
r k i
oii
qyaa oya ii
165
qay i meooJ
i oy oai o
o oyi y
i i
qy oy iay

ia o
k y
aiioaKqioa y e

qioai a

2 a // ' '
qioaii e a y i
i a a o iay
oiioaii aye i
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i o
qay i o
a aI e a
y ii y ii
Jiiaia aiai
a oiK
2 ''
h a
a
aI a Ia
a iiaii oK` o
e NJOa
iaK
166
r
iioa i Pa a
iioaKr i
K
i a
i
K
qioai y
IaaK oi aa

qioai a
ia ia
iio iioae ` i oiioai
o

ieoaK
21 '' '' '
qioa oya i

qioai oya ia
ea i
i i
qioa oy y
a
211 L/ d ng
Ch :

F OM Lml iaE NVUUF
F NM Lml iay i TR Liay i
eNOa NVURF
167
F OM Lml iay
F RRUOIR Lml eUa aNVUVF
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NVUVF
F c iaWOO Lml iaPi
o:

FOM Lml iaE NVUUF
F NM Lml iay i TR Liay i
eNOa NVURF
F OM Lml Iiay i y
F RRUOIR Lml eUa aNVUVF
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NVUVF
F c iaWNSOM Lml iaPi
/a s c:

F RNM Liay TOa y
OIRR Liay i
NMOM Lml eNOa
Fq RM L iay pn
eOQ y i OQa
a NMM L y
a OMM L y PQoK
qay y e NM
y eKqay i
a y i i y i

F i y y i oIh
iiay a i Eh NVUSF
168
F y e RM L
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a
F SNN Liay OM ml eSa NVUSF
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eQUa
F OOPP Liay oKk i o JOMMWPVIS L
iay a
g '

F RNM Liay i
F k a y y e
KE NVUTF
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eo:
W
F y y i oKh
iiay a
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TIR Liay oKE iNVUPF
C ' d :

F y oIh i
iay a
F SNN Liay y i OM Lml eSa
NVUSFK
Ch/m:
169
nh vt (chlamydiosis):
Q|SK P ||/ 5 | S|P L|||
Q|FK P |QKL|Q |Fy|E QK|NLQK|Q L|K S|Y L|WHWUDF FOLQH
Q|WL S|Fy|WK |O Q| |P |
Q|SK P ||/ 5 S|P L|Q F

Lo / bj s t:
L |WU |QKL P |WU
L|Q
170
PLYPPT
1T/nh ch '
W|QK ||EDFLWUDFLQ||WURWKULFLQ||P HWKRFLGLQ
' '
Q| F|W |Q P |P Q|WL W|UD
F|KyD|K F| Q|QKD|Y |FROLVWL F| L|O

F|KyD|K F|SK F|W S|Fy|QKL |DFLG|DP LQ||/
W|DFLG|DP LQ| F|EL W|O W|DFLG
|Fy||
S|WK |TD| Q|WL S|Q Q| |K |KL | W|WURQ||||SKW
||7K F|NK FK|Wi Q| |Y S|Y |E
L|G FK|Q ||7 |O |WK F|OL W|Y L|SURWHLQ|K W|W Q F|E L|FK |
|TD|WK Q|
Q|GL W|NK Q|
W|SK | P |NK Q|UDP |kP ||( |FROL||. OHSVLHOOD||6DOP RQHOOD||3 RFLDQLF||. KQ|Fy
|T |Y L|3URWHV|
| F|O F|K F||7i F|G Q|Y |E Q|GR|WtQK|KR W|GL Q|FDWLRQ||O
WKD| L|VLQK Q|FKR|YL|NK Q|FK W|
y| F|WtQK|WK Q||WL |F |Y Q|WK Q||Y Q|NLQK|F ||ROLVWLQ|tW| F|QK W|Q F|V |
Q|
1 Po/ym/c/n
/ j |NKi Q|VLQK| F|WUtFK|W |P L|WU Q|QL|F |%DFLOOV|SROP D
11 T/nh ch
K Q|G Q|G L|G Q|P L|V L|WDQ|WURQ Q F|Y
FK|E Q|Y Q||7K F|Fy|WU Q|O Q|SKkQ|W |FDR||||||||| |O Q||WK F|
NKQ|L|TD|Fi F|Uj R|F Q|F D|Fi F|P ||NKQ|Y F|P F|Y Q||F Q|NKQ |WK P |Y
|E F|E |FK Q|KyD|||||WURQ|F |WK ||% W|FK | |TD|WL |F |WK Q||FK |
W|SK Q|Fy|KR W|WtQK|QK Q|F Q| W|NK Q| | Q|WL |
171
12 o '' '
q Q|GL W|NK Q|QKDQK||OR L|Vi W|WUKs L|WtQK|KR W|GL QiaI i Q|
ii P |WK I FK|Wi Q|QK Q|FK W|Kiii |E a Q||Qy|Fy|Wi F|G Q|KR W|
a Q|WUy a eeaeaiyi |E a Q K
Je W|SK |EDR| P ||WU F|NK Q|UDP |kP ||FROLEDFLOOL||VKLHOOD||S RFLDQLF||
e I eaI L|WU |SURWH Kq F|NK Q|S RFLDQLF|U W|QK |F P |Y Li F|
Jk Q| | F|FK |W L|WKL |OMKNJR L K
Je W|WtQK|NKi Q|VLQK|P QK|QK W| |S+ ||||6 | |NKi Q|WK F|F D|YL|NK Q| |UD|
o P ||y| |NKi Q|FKpR|Y L|FROLVWLQ|
13 T c d ' ' ' '
J| F|WtQK|i Q|FDR||Q F|WL |Fy| Q|P FK||F OLQGUH||P i ||8 Uyi K
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L|P HWKDQHVOSKRQDWH|tW| F|K Q|VOSKDWH|
J` Q|WK Q|NLQK|F
J| D| |L P |WLy
2 Co//st/n (co//myc/n)
m ia Q|W |Q P |||||| |1 K W|% Q|E Q|Fi FK|F |HUREDFLOOV|FROLWLQV|| k |O W
eoeeiai F|SK F|W S||FK |NKi F|SROP LFLQ| |FK |NKQ|Fy|SKHQ ODODQLQ|
21 T/nh ch
L|WK Q|G ei i eiK W|WU Q||WDQ|WURQ F||
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ii W|Qj | |WU |E QK| Q|U W||. KL|WLy S||WK F W|Q Q| |K |KL |VD|
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22 o '' '
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KHP RSKLOV||i F|SURWHV|WK Q| |NKi Q|
Jq Q|GL W|NK Q
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172
23 Ch ' nh
Jq aa
Jq
aK
J
Jq
173
k e d i v ` l mbmqIa
1 T/nh ch '
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J` i
J
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1 ancomyc/n

ai i
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11 T/nh ch
s oa o iO
i y I i
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ai IVMBiOQa
12 o ''h ng s/nh
174
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e i
a ii K
Je

a K
Jk JR L
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J o a a oaK
13 Ch ' nh

iia Ie
q y i i y a iaa aaa
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14 '' t c d '
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aiaIi oaI oaI oaIe oaIeo oaIiei oaI
i oa i
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oiaI iaaaIeaaaIeoiaIeaI aWe
o
Hk y
2 /stocet/n
qi
WTMB PMB K
175
21 T/nh ch
q o
i
a y y y i
aiNOa h
y o a
ESMJTMBFiOQa
22 o '' '
Jq
Je y
o

Jq J aK
k MKR L Kee RJTi i aKp

a K
23 T c d '
J y i
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24 Ch '
i
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3 Te/cop/an/n
i aoeeia
e
iaaaIi Ji aK
` e e
o y iia I ay e
176
` i

q
K
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Iiay
177
` ` h e k d pIk e h e `
1 orob/oc/n
qi piei oa K
11 T/nh ch
qai I a
eiKa
y
o
i
a eI
i a
12 o '' '
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J
a a i a
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ei K
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RJNM L K
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a K
Jp a a aai I a
a a Kh i e aa a
iioai a i K
13 ' c t/nh r t c d ng ph
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178
14 Ch '
Jq
J i
oyiy
15 Ch ' '

2 osomyc/n

oai
21 T/nh ch
Jh i i Io i
Jk a
a
a Ii eiei
oi eeaK
ii a
i o y SeeiK
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Jp y
K
Ji
eaaaIeeaI aaEi oaI oaIiei oaFIa oaI

Jq IiaIe
ea I
e
23 Ch ' ' ' y
G` Wi i
179
24 ' p tha
J c oa a
i oaI oaIeaaaI oaK
J
JmeiW
3 ac/d/ne
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Jqi
J
c aik iai
k ia
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i Ii i
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32 o '' '
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Jo i
a Kh i
MKMPJMKNO L I QJNS L I
aay e QJNS L Kee i i i ii aSKq
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33 T c d '
180
Ju i iay Kk oe aa

Ja
Js ay e
34 Ch '
Jq
ay e y i
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4 /troaranto/n
41 T/nh ch
Jk aiia ai aiKe

J
o
y Ka oiaF i i
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42 o '' '
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181
Jq
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k OR L Kk y
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44 Ch '
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45 Ch ' ' 'i
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aeaI e aIaaaaIaIaIaaaIeaI
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182
h e k d pIk e qo
1 /eomyc/n Sa/phate
11 a h
i ai a
ia aI I E e FI
y QKRJSK
ai oa O
12' ' '
i
i i

a k K
13 S ' ngch '
r
K
14' ' '
oa y y
Kq o e ai

15 Ch ' '
oai i
e aiaK
16 '
k Kk
a
i y oI ay e e
i
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17 ''
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e a e
183
1 L/ ' ng
Th nh '
8 Q|WK |W |Ea |P |K ||E QK|E FK|F ||Q|WK |EL |P ||||8 |P ||||, |KR F
F|64 ||O Q|QoIa |WUPJ||Qj ||VD|y||||8 |P ||||OL |WUToKi a |W LD|||||
r L OK
2 act/nomyc/n
21 a h
i a Q|Q|WK ||DQWLQHRSODVWLF|||Fy|P j | |Vi Q||G Q|E W|WLQKi ||tW|
i P ||WDQ|WURQ|Q F| |||R||WDQ|QK | |||R||K |SK P |WK Q|P L|Oe F S|
GDFWLQRP FLQ|Yj |P DQQLWRO| F|O QK|NK|
22' ' '
a ia oaa |T | L|Y L|YL|NK Q|UDP |G Q|W |QKLrQ|F QQ Q|Q D| F|
i |F D|WK F|NKL|V |G Q|FKR|P F|tFK|QoKa ia oa F|FK i Q|K S|1 Jei
o k Ka ia oai R|WKe F|K S|Y L|1 |YQ Q|F Q|KR W| Q|F D|1 |NKQ|
||DFWLQRP oa Q|FK W|WKk|QK Q|P L Q FK|
23 S ' ' '
DFWLQRP FLQ|G Q|WURQ|L |WU |WkQ|E FK|F |G Q|O L|VDUFRP D| Q|Yj |P |
P |
24' ' '
DFWLQRP FLQ|tW| F|K S|WK|GR|Y |SK L|G Q| Q|WLy i QK|P FK|q F| F|
ee L|QK Q| |FDR|W i | |P j Q| Q|Yj |QKkQ|W Ka ia oae
iaKq F|Eai L| |G Q|F W|WtQK|WURQ|P WYj |Q F|WL |
25 Ch ' '
QK| |F P |Y L|Fi F|WKe Q|F D|WK F||E QK|QKkQ|Fy|WL Q |E QK| |
P j Q| Q||Voa P |FK F|Q Q|KR F|QKL P |WUK
a ia oaoa P | F|WKDL|Yoe aia |FK W||WK |Y W|KDP VWHU |
a |FDR|K Q|OL |Giy |NKQ|Qyi F|WURQ|WK La
iaK
26 ' '' '
184
a ia oa o
y i o y Ka ia oai
a iK
q oa i oi

27' ''
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oiaI eiaa oi a
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` ai ah K
3 oorab/c/n C/
31 a h
i a
Iii
Ka y iIee
y PKUJSKRKa aae ` e oo oae ` I
e oo oae ` I a o y a oaK
32 '
q y i JU` Ii
Ka y K
a aae ` i y i i PKPB
ia aPBIa Rt Ik o Eee TKQFIiio a a a
MKVBK
i
eiaa I ia eeiIae I aI aI
eaa oiaa aiK
33' ' '
a aae ` o
Ka aai
eia a Kq
185
i yi ia
i y i
Kq i i
i y K
34 S d ' '
q
K
35' ' '
a aa y y
i y y y i
y eiia o
ia ee
q e
i ii i aa
ai eK
p Roi ai
ai MKSa OI
i ai POa
F K
36 Ch ' '
q
aao
ia
37 ' ' '
y o Ea
iay ay a
a
y i
aeo aEa J
OTIiay i
ia yKqaiay I i
186
e Kk i i iay a aiUKQBINRJPM
a aMKVB Q iKp
iaLa pl Ki a PJRoK
3' ''
a aai
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3 L/ ' ng
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F PM L OIIs y iEai aioF o
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1
Chng 4
C KH TR C ST TR
t s khi nim
ng nguy c st tr tr ng thng thng
t st tr
c st tr m, chung tr i, dng c chn nui
dng thuc st tr ng tr ong chn nui
2
Chng 4. THUC KH TR C ST TR
T S KHI NIM
Thu ng (disinfactants) l nh u di ho
c c vi sinh v ng ph h nguy n
sinh ch khu lun c
sinh.
Thu ng (antiseptics) l nh sinh
s m o
v
Ranh gi ng v ch ng c r c
th ch ng ho ng t y theo n p d
2 NG NGUY C ST TR TRNG THNG THNG
ng c sinh t c
d
V d
ng c d
khi p d b l
h o vi tr ng, c

V d ng
R
V d ng b
thu
hi
qu
V d
C ng kh ng ph h
V d u di
T S

3
Thu i
n m nh
n y s m
gi tnh li n t c ch n y, c c ph n t
d m cho c c vi khu
khi r
C t c d n vi khu n vi khu
Gr-
Ho m potassium iodine (KI) v gi

S ng ph
2 n (alcohol )
C isopropanol
C m bi l m gi nh
ethanol 70% v isopropanol 50%. Th
C t c d n c c t - tr n
n b o t

(albumin)
S ng tay, da

Iod khu o t o v can thi o c c ph n sinh
ch c th glycerin.
4
C t c d n vi khu c K v c c vi
khu o
C c ch
Dung d a tan trong c

PVP iodine 10% (polyvinylpyrrolidone iodine- iod h - Iodophore: g
I2, ch a tan, ch mang (ph ng thch d
S m, r
quan sinh d
c (mer cur ochr ome)
C
Ch c ch
h ng l 2-5 %. Ng y nay, c c ch
t kch d n,
nhi ng g h a ch
D ng s t tr ng c
4.3.5. Nc oxy gi 22
Thu ph ng thch oxy
m ng nh y hay c catalase. K i ch
C c t c d ng nh n c c vi khu -
b o t i hi.
c tm (per manganate potassium KMnO4)
5
Ph ng thch [O] khi ti g ch n ngo i. Khi
dung d u n u th khng c n ho
C t c d ng tay, v (dung
d
ch 1%
S t tr ng b n ngo i: vi m mi m m ng, r

C ST TR M, CHUNG TRI, DNG C
CHN NUI
T c nh n v
t
t kh t m
C ch st khun
u
Th o ch v o

dng S h
iu kin 180oC trong 2-3 gi 121
o
C/1atm trong 15-20
2 c tm (ultr a violet UV)
= 2500-2800 A
o
Ch - v vi khu o t
'Ki
S ng ph ng th nghi ng gi
T c nh n h a h

HCl, H2SO4 0,1-1N: s n
Acid boric: kh ng y

Th m nh o c c ph n t m tan ch ng ho ch ng
6
C kh u di i khu heo,
FMD). u di o t
Dung d ng 4-8 0/00 d ng s t tr ng d
nh ph n, dung d
vi s

H t CO2 trong khng kh t sinh nhi ngo i
khng kh th CaO t c d n t c d
Khng c t c d n b o t Clostridium
S n s n, n ng n n ch c th v
m ng th
2 t tr ng xp
Ch pha
c nh t n b m tr
Ca(OH)
2
+ CO
2
CaCO
3
D ng s t tr ng chu
c 4 th h I: Benzalkoniumchlor ide (Zephir an, Antiger m)
Thu onium b ph n
anion).
Th nh vi khu y r 9% vi khu
ti u di n nh t
T c d n vi khu - b o
t BK
S t tr ng da, v -1/1000
Th
Kh ng chu
a 12% Cl hot tnh )
C
7
C
7
H
7
ClNNaO
2
S * 3 H
2
O
nh acid hypocloro (HOCl) r
thch Cl c t c d o, tho i bi v b
acid nh n
T c d n vi khu
n nh , d ng

C
n, l ch y nay, do

n sinh ch nh t protein
Dung d u di o nhi
- o,
r h khng s
s t sinh v s i hi

8
T c d di n virus.
bi
Dung d -0,5% d ng s t tr ng tay, dung d ng chu
Crezol c th ng l , m y m y th
a 34
L ch ng m
alkylh a nh m -NH2 , -SH c v ng nitrogen trong c c base purin
C t c d n h o t
S ng d tr ng
ph
Dung d b
- 15-30ml dung d ng kh ng m y c
vi tr ng, chu
- 1,5L Formol 36% +1600g KMnO4 kh ng l m vi
m m m ch nguy

2 c kh tr i hp
u l ng v gi
ch ng, c c nh s ng ph
V d VIRKON (BAYER): peroxygen, ch
(surfactants), acid h
PROPHYL (COOPHAVET): 4 chloro 3-methyl phenol, 3-benzyl
4 chlorophenol
TH4 (SOGEVAL): glutaraldehyd, ph
terpineol, d
DNG THUC ST TRNG TRONG CHN NUI
B nh nui d do
b suy ngh Kh ng sinh v
Vaccin, s t tr ng chu bi ph p tch c h
nh ng ng
9
v v ng
Th
th ch ng ch nh
vaccin ho m ph tr ng. C c t
th
qui trnh s t tr ng chu n ng c
lo h h m
T i li hi
bi tr ng, quy trnh
s t tr ng hi c c ki h lo
nh ngha thuc st tr
Thu ng l lo y thu o c v ch
t o Vi khu i vi khu kh c nhau.
2 C ch dit khun ca thuc st tr
Tc ng l mt t b
L m gi tnh th ng t o vi sinh v
khu o trong t o g y hi m v o vi khu
Th d
m thu v b n:
y ra tr n c c thu a tan m
thu o nguy n sinh ch n sinh ch
Iodine, phenol, cresol, th
u ca c st tr ng:
M ng l t i t c d t khu n ph
ki v ki
quy
- T c d u
- K o d i t c d ng 1-
nhi
10
- Ph u di ng gram
o t r ng, c c virus c v c c virus khng
c v
- C ho i h t
r nh tr ng.
- An to n tuy t
ng chu ng tu s
s t tr ng m l n chu v
sang th kh n. Kinh
nghi ng an to n phun x
l y lan b n, h t
t
- n d c c v th p.
R n d h
tr tr
- m m n to n khng

- D ng b l m
nhi
-
11
ng 4.1. c im ca mt s cc loi thuc st tr
c st tr n ch
1. Acid h Ph

n cho
gia s c.
Ho
ch trong

Ho n.

t n v o c c k
T c d n c c Nha b o.
n d
2. Formaldehyde Ph

ph n
D ng l u khng t n
s
Kch
d
G y kch g y
o nh m
khng an to n.
ng
k
3. Phenol T c d

n.
n d
n Virus khng c
v
n da, g y kch
ni m m
gia s c trong chu
Tnh th
v o c c k
ng th
4. Ammonium b Ti u di
b o t ng, n m
Kh
m
R
h n, khng
g y kch

nhanh.
Ho n virus khng v
b
Ho
ch n.
5. Glutaraldehyde Ph
virus
khng v
n d

s c.

Kh
th o c c k n n
chu
G y kch
6. Chlorine M i kh ch

tnh cao, g y kch m m
n c c d nui.
Ho n virus khng v
b
12
Ho
ch n.
7. Iodine Di m c
c c lo i virus g y b
R
gia s c.
n d
Th n 24
gi
m b
c u.
Phng php st tr ng
n s t tr ng chu
tr i l ng l c xu
s c ( s t tr ng cu -10 ng y s t tr ng m
l
i k:
n b t tr ng n y c
l m th
d
- D y ch nhi
m m gi hi
tr ng.
- T
tr
n t m
t pha x ph ng phun
x m s dnh cao.
' ' ' - ' ' 'K ' ''K ' ' ' ' '
chu v
nh vi
khi phun thu
tr ng.
ng
13
6D|Fi F|E F|WU n, v Q|F n nhi |P P |E QK|KL Q|GL Q|WURQ|FK Q||YL F|V t tr ng |
bu F|Q y r W|F Q|WKL W| |GL W|W W|F |Fi F|P P |E QK||GR|y|F Q|O D|FK Q|OR Lthu F|Fy|SK |Vi W|
tr ng r Q|EDR| P |Fi F|OR i virus, vi tr ng, c c lo i n P |P F|
C Q|O |: Ph L|SKQ| W| | W|E |P W||WK Q|||OtW|WK F|Vi W|WUQ| pha lo ng ch |
s |d Q|FKR||-4 m2 b |P W|| Q|WK L|SK L|F Q|FK| | Q|Fi F|Q L|P j |WK F kh ng P | Q||
F|EL W|O c c b |P W| S||O |FK ||3KD|OR ng thu F|SK L|Q n Q| |
'''' '' '/ ' ' ' chuy '' L' ' L
- T t c |Fi F|WUDQ|WKL W|E | di chuy Q|WURQ|E F|||FK D|U W|QKL |P P |E QK|GRy|
c Q|SK L|FK r D|E Q| ph ng v L|E n ch L||KR F|SKQ| W|E Q|Q F| ph ng d L|i S|
su W|FDR||6D|y|FK Q| Q|Y |WUt|V FK|V | |SKQ|WK F|Vi W|WU ng ho F|QKQ|Y o b Q|Fy|
ch D|WK F|Vi W|WU ng.
-| L|Y L|K |WK Q|FQ|F S|Q F||3KD|WK F|Y cho tr F|WL S|Y o h |WK Q||6Dkhi
m |Y i cho n F|FK ||NKyD|Fi F|YDQ|O L|| |rQ||||SKW| Q|||L ||VD|y| to n b |WK F|
s t tr ng ra kh L|K |WK Q|F S|Q F||Q |F Q|Fy|WK | |O L|E Q|Q F WK Q|WU F|NKL|FKR|
Q F| Qg v o h |WK Q|
-| L|Y L|F Q|U nh: X |WR n b |Q F||G Q|V FK|F Q|E Q||SKkQ||Ui F|| |O L|E Q Q F|
r L|SKQ|WK W|Vi W|WU ng.
''
+ B |WU Q|FK Q|WU L| s t tr ng trong v ng 2-||Qj || |WK F|GL W|K W|W W|F c c
m P |E QK||/ S| W|O L|Fi F|G Q|F |FK Q|QL| s t tr ng nh |P i Q| Q||P i Q u Q WU F|
khi cho gia s c v o chu Q|
+ C ng v L|YL F|W | |- s t tr ng, nh P |WUi QK|V |Wi L|QKL P |F D|P P |E QK|Y o
chu Q|WU L||F Q|SK L|WKL W|O S|K ng r o v |VLQK|EDR| P |Fi F|Y Q| |VD|k |
- Ki P |VRi W|FK W|Q L|Yj |FKy|P qR||Q L|Y o khu v F|FK Q|WU L|SK L|W P |U Ds FK|
v thay qu Q|i R|
- Ch | D|Fi F|Y W|G Q|V FK|Y o chu Q|WU L|
- Ph L|Fy|K |Vi W|WU ng ch n t L|F D|UD|Y o, thu F|Vi W|WU ng ch D|WURQ|K |SK L| Q QK||
c ph |GL W|NK Q|U Q |Y c ho W|WtQK|W W|WURQ|P L|WU Q|Fy|FK W|K |F |
- Ph L|NL P |VRi W|WR n di Q|OR i g P |QK P |Y cn tr ng |NK|Y F|FK Q|WU L|Y khu
v F|Q|TDQK|
14
- Ph L|Fy|K |Vi W|WU ng xe c |W L|F Q|WU L||K |SK L|FK D| |WK F|Vi W|WU ng v khng
b |QKL P |E Q||7KD|WK F|NKL|WK |K |Vi W|WUQ| d |E Q||WK F|E |OR ng L|VDF Q|P D|
l Q||KR F| QK|N |WKD |WK F|VD||-3 ng y s |G Q||1 |G Q|SK Q|SKi S phun x W|Y o xe
c Q|O | | Q|Ei QK|H|Y c c ch |G |E Q|WU n th n xe.
St tr ng nh k:
-| F|WK F|KL Q||10 ng y 1 l Q|WURQ|WK L|LDQ|QL|G Q|WK|| Q|O | vi F s t
WUQ| QK|N | |UD|OF|Fy|LD|VF|DQ|V Q|WURQ|FK Q||GR|y|SK L|O D|FK Qlo L|WK F|
an to n tuy W| L||NKQ| F|K L|FKR|LD|VF|| Q|WK L|OF|Q y do khng th |W | ||FK W|
h |F |W Q| Q|WURQ|FK Q|U W|O Q|GR|y|SK L|O | | Q|KR Wtnh c D|WK F|WURQ|L |
ki Q|Fy|FK W|K |F |
T m l L| | QK|N |Vi W|WU ng hai ti u chu Q|VD|k |F Q| F|O |:
- Thu F|Vi W|WU ng ph L|W W| L|DQ|WR n cho gia s c.
- Thu F|SK L|Fy|KR W|WtQK|GL W|NK Q|FDR|WURQ |L |NL Q|Fy|FK Wh |F |
c st tr
n: tr ong 100 mL cha
PVP Iodine......................................................10 g
Excipients qs ...............................................100 ml
4.5.7.2. c im
Ph |Vi W|NK Q|U Q||EDR| P |W W|F |Fi F|OR L|YL|NK Q|UDP |kP ||UDP |G Q||Ej Rt |YL|
tr ng, n P |P F||E o t |Q P m F||Fi F|OR L|0 FRSODVP D||Fi F|Q rQ|VLQK| Q v W||Fi F|OR L|
virus g y b QK|Y c |WU n m W|V |OR L|WU Q|N |VLQK|WU ng.
7i F| Q|GL W|NK Q|U W|QKDQK|FK |VD||-10 gi y.
R W| Q| QK|WURQ|P L|P L|WU Q|N |F |WURQ|SKkQ|| W||F Q|U nh, x c ch W||Ry|
thu F|WL S|W F|GL W|NK Q|WURQ|Y ng 24 gi |Q |Fy|V |Wi L|QKL P |F D|P P |E QK|
Thu F|U W|DQ|WR n, khng g y ng | F|FKR|LD|VF|Yj |Q L|V |G Q|N |F |WU Q h S|
phun x W|WU F|WL S|OrQ|LD|VF|DQ|P F|E QK||NKQ|k ||QKL P |P LWU Q|
Hi k|T |NK |WU ng Q| QK|WURQ|P L|Q Q|Q F|V |G Q
L lo L|WK F|O |W Q |WURQ|YL F|Vi W|WU ng chu Q|WU L| QK|N |Y cu L|N |
st khun
15
ng 4.2. Ph st khun tr
nh
Staphylococcus aureus Vi m v , vi m t
Proteus mirabilis Vi m ru m ni
Proteus vulgaris Vi m ru u ch m ni
Streptococcus faecalis V
Streptococcus pyogenes Nhi ng v
Streptococcus agalactiae Vi m v .
Salmonella pullorum B con.
Salmonella gallinarum l
Salmonella tiphimurium.
Shigella Vi m ru
Klebsiella pneumoniae I Vi m ph
Diplococcus pneumoniae Vi m ph
Mycobacterium tuberculloris B
Clostridium spp Vi m ru n, u
Bordetella bronchiseptica Vi m teo m
Pasteurella multocida T ng
Vibrio cholerae Vi m ru -ti u ch
Vibrio parahaemolyticus Nhi ng
Vibrio arvegi Ph t s ng
Vibrio plendidus Ph t s ng m
ng 4.3. Ph st khun i vi vir us
nh
Virus Adeno Vi m ph m ru m gan.
Gi
Gumboro virus Gumboro
Hepatitis virus Vi m gan th m
T.G.E corona virus Vi m d y ru
I.B virus Vi m ph qu
Auzeszkysvirus Auzeszky
I.B.R virus Vi m ph ngh
Newcastle virus D
African Swine Fever virus D
Hog cholera virus D
Rota virus Vi m ru
Rabies virus B
Pox virus B
F.M.D virus B
Parainfluenza virus B
Reo virus B ng m ru
st khun i vi nm v vi tr
16
- B o t
- B o t
- Aspergillus flavus
- Aspergillus niger
- Candida albicans
- Microsporum
- Trycophyton spp
- Trichomonas
17
4.5.7.4. Hng dn s dng
c ch l pha lo
- 1: 100
- S t tr ng chu 1: 200
- S t tr ng tr n th b 1: 400
- c 1: 500
- S t tr ng xe ch v
( h ng ng y)
1: 500
- Kh 1: 500
- H ng 1: 500
- S t tr ng b 1: 70
- S t tr ng v 1: 4( 4 ph )
- Th 1: 750
- Kh ng ngu 1: 1000
- S t tr ng d 1: 250
- S t tr ng b 1: 200
- X -15 ng y 1 l 4-5 ppm
- y x 8-10 ppm
khi s
- N n phun x pha/ 3m2 b
- Khng n n pha tr ng kh c.
- Khng d ng chung v nh x
- n ch o m n r l
- ng.
- Gi
c st tr
Ch
thu ng v -x
n: Tr ong 1 lt
PVP Iodine ................................................. 100 g
..................................... 1000 mL
4.5.8.2. c tnh
PVP Iodine l thu ng v h
c c lo g g y nhi ng da, v bi
t c d u di o t ng g y b c c lo o kh c.
18
ng
- S t tr ng v
- S t tr ng v ng m
- S t tr ng r
- Gi p v
dng
- R .
- Gi nh x v 20 cm.
- o v ng c ng.
- M y n n s t tr ng v
Lu

Khng phun thu o ni m m
Khng k ng c ngu s d
xu

c st tr
ng ph
n: Tr ong 1 Lt
Glutaraldehyde...................................................... 150 g
Alkylbenzyldimethyl ammonium chloride ...........100 g
2 ng: Ph dit khun r ng i vi vir us, vi tr vi tr
mycoplasma, n
ch t heo, hi chng r i lon h hp n, ti y do
virus, T.G.E, Aujeszky, b m n o Nh ng, ph
vi m ph m ru E.Coli, Salmonella,
Clostridium, b ng.
t: Newcastle, dch t vt, Gumbor o, u g i chng gim
m gan do virus, CRD, C.CRD, vi m kh
c ng, b v c c b
19
ch t tr u b y do vir us, vi i, vi
t ng, b do n
c c b

- Hi di
- C t c d n ch
- K o d i t c d y sau khi s t tr ng.
- R cho gia s c.
- Thu
- Khng g y kch n d g c pha lo ng)
c ch s dng ng pha lo
- 1/ 400 ( 2,5 mL/ Lt )
- S t tr ng chu
chu
1/ 300 ( 3,3 mL/ Lt )
- T 1/ 100 ( 10 mL/ Lt )
- S t tr ng xe ch gi v
s
1/ 500 ( 2 mL/ Lt )
- Kh ng tr 1/ 1.000 ( 1mL/ Lt )
- Kh 1/ 2.000 ( 0,5 mL/ Lt )
Lu y: Ra sch chung tr i, dng c, hoc b mt cn ty u tr c khi phun thuc,
t thu 3 m2 b dnh v o m
v o tay.
c st tr
ng th
n
20
Glutaraldehyde .............................................................................. 2%
Alkyldimethylbenzylammonium chloride................................. 8,68%
Octyldecyldimethylammonium chloride................................... 6,51%
Dioctyldimethylammonium chloride......................................... 2,60%
Didecyldimethylammonium chloride........................................ 3,91%
Inert ingredients ......................................................................... 76,3%
2 ng
S t tr ng hi t
vi tr ng, Mycoplasma, n
- ch t heo, ph thng hn, t huyt tr y do vir us
ho m ph h do xo do n
v c c b ng kh c.
- m: Gumbor o, Newcastle, CRD, Mar eks, u g ch t vt, vi
ng, vi m thanh kh qu n
c c b
- u: FMD, dch t, ti y do vir us, thng hn, lepto, sy
vi m ph m v v c c b
4.5.10.3. u im ca biosept
- R n khi phun thu o chu
- K o d i t c d y.
- Hi
- n d
- Thu
c ch s dng ng pha lo
ng, x c ch
S t tr ng chu
S t tr ng chu c d
S t tr ng chu tr ng.
S t tr ng xe ch m
1/100
1/300
1/150-200
1/250
1/400
21
s
Kh ng tr
1/1.000
Lu
R ho
X pha / 2,5-3 m2 b
o m
1
Chng 5
C TR K SINH TR M
thuc tr k sinh tr m
t cc nhm thuc tr k sinh tr m
thuc tr k sinh tr m
2
Chng 5. THUC TR K SINH TR M
c tr k sinh tr m
c tr giun sn
Thu nh
n. V v
ch
H ph n
lo nh cestodes (s n d y), trematodes (s n l ) ho tr n).
gian
l c t m u n ng hay m u l ng Taenia solium s
c nh s u h a
gian m u l nh s
m o, m th n b o. ngh
n ngo i n trong.
c
li n quan t i nh nh s
d cng nghi
l m ch th
3. Nematodes hay giun tr n c th nh tr n, d i, s y v ru
th nui, th hoang d hay chim. M giun ph tm th
m ph cu ,
nh
s y bao g i bi ng r
n, s n l hay s n d y, th
nhi ng v thi m tr S
nhi nh tr nhi ng c s
cao; ho s
b m v o l c y c u tr ng g y nhi
Trong nhi
nghi m tr nhi lng.
2 nh hng ca k sinh vt tr
K sinh c th ng nhi
1. K sinh c th
2. K sinh c th
3. K sinh c th redworm
4. K sinh c th
a. Ru giun tr n.
b. M Filaroids.
c. Tim giun tim
d. Gan - s n l gan.
5. K sinh c th
6P'' ' S'L P'/ '/ ''
6. K sinh c th b ph
t tr ng di h nh trong m Toocara can/s
i quan h k sinh vt
To n b k ch nay
v y, gi r
nhau.
Vi g y h ng lo
c c y
lng k sinh vt: s nhim lm s i vi khun hoc vir us ph thuc
v o s o v ng g y nhi
nhi
2 tc hi ca k sinh vt: mc tc hi khc nhau ca k sinh vt v c
kh c nhau c c lo i th . M ng t g y t c h kh c: Th d
d nh nguy hi scar/ds hn chang k
s/nh r ' ' ' ' y r ph 'St'n ra ''
khng ca k ch: th tr ng thnh khng mnh hn th non. S
kh ng k sinh v n c
Th n kh ng th th
c th tr ng.
Th c th nh tr dinh
Ph
ru l y nhi
ch v kh duy nh
ph h nh tr qu i ch
kh c g p ph ki b ng c
Sau c ng, s m u h a khng c bi ch
khi nhi ng ho
bi y v 9000 tr n 1g
ph n). Tuy nhi n, c ti u di
khng c d nh m n.
Nh r ng ph
tr
ng giun sn thng gp th nui
Giun sn c phn l i da v i phu hc:
1. S n d y d
2. S n l d
3. Giun tr n (nematoda) hnh tr n. Nh m n y c th nh hai ph n nh m:
Strongyloid v Ascaroid
i giun sn nga
m th
ph t hi v.v
Giun tr n l giun s n quan tr
nop/ocepha/a pero//ata (tr n ng '

c th |FK W|NKL|QKL P |Q Q|| P |||L Q|VD|
1. Strongylus
2. Triodontophorus
3. Trichonema
4. Trichostrongylus

Ba gi Q| |N |VLQK| |U W|L . Gi Q|WK ||| F|SKi W|KL Q| |U W|QRQ||O mot
trong s |tWgiun s n c th |GL|FK Q|W |Q D|VDQ|E , c |Yj |Q F|O L||L Q|WK 5 bao
g P |LFWRFDOOV|DUQILHOGL||Fy|WK | F|Wm th | |Q D||O D|Y di Qbi Q|SK F|W S|WURQ|
WU Q|K S|E QK|FP | |Q D|
2
Ascaridae |Q D|tW|TDQ|WU Q|K Q|6WURngylidae. Bao g P |||L Q|
1. Parascar/s
2. yar/s (seatorm h/porm ho 'SLP'
3. Strongy/o/des
6
Oxyuris equi
t s lo th nhai li
ng k sinh tr m tr u, b u r t tng ng v cch iu
b g.

Moniezia s ra
c c d x.

v
g y b m tr an c v c nh

d d m cc lo
th m tr lo i Nematodirus,
Bunostomum (hookworm) v Coo tr i c
gi c th b
Oesophagostomum (giun k ,
Giun ph id: Dictyocaulus filaria v D. vivipara,
' 'Lr' 'k ' '' ''k ' 'khan
, m i k sinh nhi
t s loi k sinh tr heo

D nh c heo,
heo l k ch m th
ru k ch ng c y.
2
ng nh nga, sn l c th y heo, nhng thng khng gy
b

6 L'Y 'LL' ''L' '''6 L' P'''L ' y
1. ' ' '' ' 'P 'P L'
7
2. 't' ' ' '
3. ' 'S L''
t s loi k sinh tr ch m

o th t h

b
kho ngu
2 ng i vi ch m Anh.

Giun tr n th
LL' ' '' '' '7 'Y
PL' ' '' ''
(hookworm). M h nh vi n c m th
i thu Dirofilaria immitis, nh
s m
t s loi k sinh tr gia cm

gia cm, Davaineidae, sng tr ong r ut non gm 4 ging: Davainea v
' ''Y L'PL'Y
2
Sn l c pht hin vt nhng khng quan tr ng cc gia cm khc.

Str ongylidae c t y gia cm gm: Syngamus (gapewor m) v
' ' ''
Ascarididae Heterakis (giun m
th
Gi m th m
th ru m tr b

8
5.1.10. c tnh ca thuc tr giun sn
Thu c c c tnh ch
t
v d ng li tr ng v
ch hi s n c t
ki y ru s n l gan,
khi s
2. Ph
n giun s n c th nh
4. Thu cho

5. Gi th nh ch nh ki
6.
dng thuc u tr giun sn
Gi tr nh ki
b ng c ngh
tr bon tetrachloride c th
n tr ng c
tr u b hi nay l u ph ng
thu k
2 u hot ng ca thuc iu tr giun sn
nhng nghi u nhng nm 1970 ngi ta nh nng lng c
t n men k hi
m c . H quan tr
m c
ch
th nh c y. S
c
ch
9
c m t li giun s n khng c n kh
o th nh ru
C ch tc ng ca t huc tr gi
khng vi thuc iu tr giun sn
khng vi thuc iu tr giun sn c bo co t nhiu nm qua, ban
Australia (Le
cng b n s 1972 khi kh m ph
kho n c Pastoral Reseach Station in
Armidale) s nh th Thiabendazole 50 mg/kg tr
m th nh. Le Jambre v ctv c
kh ng v tr n m nh th nh r
d
th n nhi v nh
nay thu ng r i, tuy nhi n s khng tr th nh
v r
thu hng qua s n.
10
T n c ng v khuy

1. S u di v
ch .

11
2 t cc nhm thuc tr k sinh tr m
2 c ni v i k sinh
(1) Nh m Avermectines
Abamectin
Doramectin
Ivermectin
Eprinomectin
(2) Nh m Milbemycines
Moxidectin
Milbenmycin oxim
22 c tr giun sn
22 c tr giun tr
(2) Nh m Milbenmycine
(3) Nh m Benzimidazole
Albendazole
Fenbendazole
Flubendazole
Mebendazole
Oxfendazole
Oxibendazole
Thiabendazole
(4) Nh m Pro-benzimidazoles
Thiophanate
Febantel
Netobimin
(5) Nh m Imidazothiazoles
Tetramisole
Levamisole
(6) Nh m Tetrahydropyrimidines
Pyrantel pamoate
Pyrantel tartrate
Morantel
(7) Nh m Organophosphates
Dichlorvos
Haloxon
Trichlorfon
Fenthion
Cythioate
Metrifonate
Coumaphos
Malathion
(8) Nh m Salicylanilide
Closantel
Niclosamide
Oxyclozanide
Rafoxanide
(9) Nh m Piperazine
Piperazin
Diethylcarbamazine citrate
(10)Nh m kh c:Nitroscanate, Praziquantel
222 c tr sn dy
(1) Nh m Halogenophenol
Bithinoloxyle
(2) Nh m Salicylanilide (Niclosamide)
(3) Nh m Benzimidazole
(4) Nh m kh c : Nitroscanate, Praziquantel
Bunamidine hydrochloride, Epsiprantel
22 c tr sn l gan cha tr ng

(1) Nh m Halogenophenol (Bithinoloxyle)
(2) Nh m Salicylanilide (Oxyclozanide)
(3) Nh m Disulfonamides
Clorsulon
22 c tr sn l gan tr ng
u tr
(1) Nh m Benzimidazole (Albendazole)
6) Nh m polyether ionphore
Monensin
Narasin
Salinomycin
12
(2) Nh m Halogenophenol (Nitroxinil)
(3) Nh m Salicylanilide (Closantel)
22 c tr sn l gan nh
Albendazole
Thiophanate
Notobimin
2 c tr cu tr
(1) Nh m Sulfonamides
Sulfaquinoxalin
Sulfaguanidine
Sulfadimethoxine
Sulfadimidine
(2) Nh m Diaminopyrimidine
Diaveridine
Pyrimethamine
(3) Nh m Nitrofuran
Furazolidon
(4) D
Ethopabate
Dinitolmide
Robenidine
(5) C c h ng
Clazuril
Toltrazuril
Diclazuril
Phoxim
Phosmet
Narasin
Salinomycin
Amprolium
Halofuginone
2 c tr ngoi k sinh
(1) Nh m Organochlor
Lindane
(2) Nh m Organophosphates (Coumaphos)
(3) Nh m Carbamate
Carbaryl
Methomyl
Bendiocarb
(4) Nh m Carbamate
Carbaryl
Methomyl
Bendiocarb
(5) Nh m Pyrethines
Pyrethrin
Deltamethrin
Cyfluthrin
Phenotrine
(7) Nh m Phenylpyrazoles
Fipronil
(8) Nh m kh c
Amitraz
Closantel
Piperonyl
Rotenone
(9) Nh m Organo arsenic
Roxarsone
(10) Nh m Polyether ionophore
2 c tr k sinh tr ng ng mu
(1) Nh m Diamidine
Pentamidine
Phenamidine, Lomidin
(2) Nh m Carbanilides
Imidocarbe
(3) Nh m kh c: Berenil, Trypamidium
2 c tr nguyn sinh ng vt
(1) Nh m Nitroimidazole
Dimetridazole
Carnidazole
Ronidazole
Metronidazol
(2) Nh m Organo arsenic (Roxarsone)
(3) D
(3) Ch di
Benzalkonium
(4) Acid h
A. Boric
A. Salicylic
(5) Nh m kh c
Fluconazol
Amphotericin B
Nystatin
13
Antimoniate
2 c tr nm
(1) Nh m kh ng sinh
Griseofulvine
Natamycin
Nystatin
(2) D
Ketoconazole
Enilconazole
Myconazole
Flucytosin
Itraconazole
Miconazole
Clotrimazole
2 c ni v i k sinh
2

C 4 th nh ph B2.

C
48
H
74
O
14
(22,23-dihydroxyavermectin B
1a
)

L 1 avermectin tr u v ng nh h a
a tan thylence glycol,
d
Lu tr /tnh bn /kh nng tng hp thuc
Ivermectin nh ng (1530oC)
u ti m dda( ng t v
ng v tr nh nh s ng.
Dc l
n b -
ron synap b n trong giun tr n ho

Ivermectin g y ra ch sau c ng l ch
Ivermectin khng hi s n d y.
dng ch nh
ki lo i k sinh tr ng c
h
Ivermectin ch nh (strongylus
ra/gar/s S edentatas S eqa/nas Tr/odontophoras spp) r nh ' ' ng c
nh v ng 4 th ng tu t c (con nh), nh
y...
n (con tr nh v ng
kho nh v ng 4 th ng tu c
r 1 ph gh xin tham chi
thng tin s
n, ch m s ch
nh

s ng v n 10mg/20kg th
Dc ng hc
nhai
l y k p, s 1/3 c
sinh h
Ivermectin ph n ph o t o trong CSF, do
(Collie) cho ph p thu v o b n trong
nhi lo i kh c.
Ivermectin c th i
i th b i th
Tc ng i khng/thn tr ng khi s dng/tnh an to sinh sn
Nh s th ng
tu n c Tuy nhi n
ng khng bi hi u ch

Ivermectin khng s s ng
cho th n s (Collie) tr khng c
ng b s
xu thu
Do n thu
v con c i gi
Thu l m b
nghi n
c
b o thai. S
Tc ng khng mong mun/cnh bo
ng b
ph c th ng s ph
l s , sau 1 2 ng y s ivermectin. N

iun ch
do ph n k
Khi s ng Hypoderma bovis, ivermectin c th m
tr ng khi ch ng ng khi b gi
y ra ch l ng b quanh th
l m phnh l n, nh n y c th
tr a v a v
v ng b s c c th phnh l n
v m. S 10ml t m.
ho v
thu i kh c.
dng qu lu/c tnh cp tnh
|Q D|OL ||||P |N||32 ||||O Q|OL | |QK ||NKQ|k | F||QK Q|OL ||P |N
g y suy gi P |WU F|TDQ||E Q|FK Q|Y th W|L |Y Q| Q|
|LD|VF||OL | S||||O Q|OL |L |WU || Q|WL m, s |k | F|| ||P |N||LD|VF
bi |KL Q|WUL ch Q|WK W|L |Y Q| Q|||E Q|FKi Q||L|NKL|FK W|
|F ||WUL |FK Q|WK W|L |Y Q| Q|Y bu Q|FKi Q|NKL|V |G Q|OL ||P |N
|O Q||WUL |FK Q|F D|V |QKL P | F||W li W||WK W|L |Y Q| Q|||W |WK |Q P ||b n v
gi n Q|W || |OL |||P |N||1 K Q|FRQ|O Q|Fy|WK |G |E | QK|K Q|K Q|GRivermectin
F|V |G Q|OL |FDR||L |Qj | F|WKt|Q KL P |
|FKy||Q | F|KL P |NKL| W|KL Q| |OL ||P |N||||||||N||KR F|tW|K Q||/ L
2,5mg/kg g y gi n Q|W ||||P |N|V |UQ| W|KL Q||/ L |||P |N|V |UQ|P QKK Q|v
ch Q|WK W|L |Y Q| Q||FKy|V |FK W|NKL|OL ||||P |N|QK Q|/ |||Oj 80mg/kg, nh Q|
FKy|V Q|FK S|QK Q| |OL ||||P |N||32 |||||W Q|P khng th |EL |KL Q|F D|WtQK| F|
QK Q|Y L||| 2mg/kg c Q|WK L|N nh |Y |Oj P |W Q gi n Q|W |Y gi P |FkQ||||||FK v L|
li ||P |N|Q y, 14 tu Q|SKi W|WUL Q|WUL ch Q|F D|V |E Q|FKi Q||UQ||EL Q| Q||WK W|L |
v Q| Q|Y m W|Q F|
Gi Q|FKy|ROOLH| QK|K Q|O do s |QK |F P | F|WtQK|F D|LYHUP HFWLQ|K Q|FKy kh c
v do thu F| F|Q P |Y o h ng r o m u n o |1 6| |L ng ch n y.
Ivermectin n i chung c th |V |G Q|DQ|WR n cho ch Collie khi s |G Q|SK ng giun
tim v L|OL |WKtFK|K S|
V L|OL |FDR|FKy|QK |F P |SKi W|WUL Q|EL |KL Q|WtQK| F|F D|SK Q| Q|SK || QK
K Q|1 6||KRD|P W||P W|V F||U L|OR Q||UQ|U ||FK |Q F|E t, l o o, ng W|| Q|Y t |
vong) c Q|SK L|QK Q|V |FK P |VyF|Yj |L |WU |WUL |FK Q||F Q|O m s FK|U W|FKy|KR F|P o.
Nh Q|WUL |FK Q| F| |P qR| F| W|KL Q|NKR Q|||K|WL u h a th F| Q|
Tri |FK Q| P ||O F||N u la, gi n Q|W ||EL Q| Q||FKkQ|WD|Uun, c s |i S| Q|NKQ |
||FK Q|P , n Q|WDL||F |P W|NKQ|KR W| Q|K |WK Q|WK Q|NLQK|WK Q suy gi P |Y i
tu Q||QK Q|WUL |FK Q|Q y xu W|KL Q|Yj L|Qj |Yj |D|V |Fi F| Q v W|NKL|SK F|O L||| 4
tu Q||. K Q|Fi R|Y |V |FK P |VyF|

Khi s |G Q|OL |WU |LQ|FK |LYHUP HFWLQ|Fy|WK |FKR|KL |T |VDL||SK | QK|N W|T D |
Q|Y W|Y L|V |QKL P |LQ|WLP

17

a. 0,06mg/kg PO 1 l
b. 0,03 0,06mg/kg, PO 1 l
c. Li
1989)
d. Li nhau.
Ch 12kg (68(g); 13-25kg (36(g) v 26-45kg (272(g). Ch cho ch d ng li
nh ph b
ho ra, n Nh
45kg c n s d
ph h o s l n. Vi ng giun tim h
c ki (T.canis, T.leonina) v giun m c (A.Caninum,
U.Stenocephala, A.Braziliense) c hi qu c c ch ph ng ng
k sinh
giun ch: 3 n sau khi s dng 0,05mg/kg (pha lo
ch (ivomec() 1: 10 dung d i tri
(gi n u ch y. N kh ng
nghi m tr ti m. N
hi sau 3 4 tu hi
tnh th ph ng b 1tu l
50 200(g (0,05 0,2mg/kg). Ch tu
o bu i hi ng y, n
khng c , c th o chi ch Collies ho
Collie Mix. (Rawlings and Cavert 1989).
i k sinh
Tr
l y th

(Bauer
1988).
18
Tr n, giun m c 200g/kg, PO 1 l
1988).
a: iu tr k sinh:
a. 200g/kg (0,2mg/kg), PO.
b. 0,2mg/kg PO; c ch 4 ng y tr
, 1 l

Tr
a. - MSD).
c
Tr
a. 0,2mg/kg, PO ho
u:
a. 200g/kg, SQ (Bennert 1986)
b. 200(g/kg, SQ 1 li y cho d ). (Upsen 1988)
a. Tr
lng ch n): 2mg/ml, PO.
i chim: 220(g/kg, IM
V
Amazon: 0,1mg, IM
V
Chim y
a. tr ng v nh n
't'' 'P 'Y L
propylece glycol.
V i kh c: 200(g/kg IM ho 14ng y.
C t: 0,01ml IM ho
b. 200(g/kg (0,2mg/kg) SQ: pha v
hu ht cc loi giun tr i k sinh
a. T , r
19
a (Gauvin 1993)
1. Hi ng
2. s
d
2
t ho hc
Doramectin l 22, 23,- dyhydro-
hi ru
ngo ng.
, c t c d ng l ng d y v ru kg
tr Dictyocaulus 25(g cho 1 kg
tr
ng d y v ru tr

u l n c t c
d Trichuris. 100 (g/kg tr trong 11
ng y.
ng v ng
ki n d y-ru m ngo
Doramectin c hi ng sau:

20
Giun tr n d y-ru ng) Ostergia spp. bao
g

Giun ph ng)
i k sinh
Hypoderma bovis v H. lineatum.

Lu
- Tr u b ng c khi gi
- Doramectin khng s s c i 28 ng y sau khi
sinh.
22

Milbenmycin oxim ch 20% d -
didehydromilbenmycin. C c gi
kh ng sinh Macrolid.
Dc l hc
Milbemycin ph v
butyric acid (GABA)
nh
Milbemycin d n n n d ng m l
LPPLL''Y 'L ' 'L'Py'' P'LP''''7 ' 'y'L qu
21
c c lo ng kh c bao g n (Toxocara canis),
'y''PLP L' ' 'L ' ' ' 'L P ng giun tim
Dirofilaria immitis.
Dc ng hc
Milbemycin c hi y sau khi nhi ng Dirofilaria
ng ch nh
M i ch c s ng tu n c

t li
c c d n ch , nh gi ch
Collie. Khi thay th n n d ng milbemycin li n t
30 ng y.
Ch con 8 tu /kg (g ng li n t y,
n khng xu xu
ch run.
u
h v

u d
a giun tim: 0.5 t ln/ thng (iu tr giun mc, giun
tr n, giun roi)
-1 mg/kg, PO, 1 l y, d ng t nh y; 1 mg/kg,
PO, 1l y, kho nh c
a giun tim: 0.5 n/thng.
22 c tr giun tr
Ngo i nh m Avermectin v nh m Milbenmycin c n c m
2
1961, m
tr c m ng th ng.
C tr u b c nhi nh,
22
n ru nh gi tr
n y.

C
16
H
13
N
3
O
3
Mebendazole l thu

t
Mebendazole c t n h a h N (benzoyl 5 benzimidazole 2) carbamate methyl.
Thu u x m v ng nh n
h m m
Ch Mebenvet (do Hungari s
Mebendazole, c d n c u tr
ng v nh
Mebendazole c ho nh, ng c
giun tr n v m i k sinh v
h n k sinh u h a v m i s n d y
' ' L' L' ' 'L ' 'Y L'L' ' ' ' 'r'
, , , , , ,
' ' ' S' L'Y L'L' '6 L'Y 'L'y
.
Thu n hi l
nh .
u lng
D , c 20 mg Mebendazole/kg th 200 mg Mebenvet/kg th
tr u n c n n n.
* Ch : Khng gi cho u y.
23
2
C
12
H
15
N
3
O
2
S
Albendazole l d
t
Thu u tr nh ph 5n
propionylthio 2 benzimidazol carbonat methyl. Thu o ch nh
kh i gia s c.
Ch
ng v nh
Albendazole c t c d i giun tr n u h a c nhai
l c nh v ng, l m gi
i xu i.
Thu phong b n, l m giun
b u di
Ch ' ' L'Y L' c ''k'j : Ch ' 'th c '' L'Y L' r c c
lo i nhai l
Thu y ru stertag/a
Tr/chostrongy/as Cooper/a ematod/as Charbert/a, esophagostomam /ctacaa/as
asc/o/a hepat/ca (d ' ' nh) r on/e/a Tha 'y'L ' ' S
Bunostomum phlebotonum.
o,
n ch , Albendazole

nghi n c y khng th c
Albendazole.
Dc ng hc
24
Thu idazole kh c. Kho 47%
li i th y.
ng ch nh
Khng d ng cho b ng 45 ng y sau
khi ph chu v
c
ng bt li
b ng bt li liu ngh. Ch c th bing
ng li y. M o c th nh bi
u
u 300mg/kg (gp 30 ln liu ngh) v 2 gy cht b
u. Li . C
m o y, 14-21 ng y s c
u

Tr
- 50mg/kg, m y, l
Tr
- 9.5 mg/kg trong 55 ng y ho
trong 2 tu
Tr
a) 50 mg/kg, m -14 ng y
Tr
a) 50 mg/kg, PO, 21 ng y.
b) 30 mg/kg, PO, 12 ng y.
Tr
a) 10 mg/kg, PO
b) 7.5 mg/kg, PO, tr nh.
Tr -10 mg/kg, PO
25
u
b) Tr k sinh nh nh.
c) Tr nh

C
15
H
13
N
3
O
2
S
t
Thu u tr thu
d zimidazole.
ng v nh

/eon/na) g/an m c (ncy/ostoma can/nam nc/nar/a stenocepha/a) g/an t c (Trichuris
vulpis) v s n gi y (Taenia pisiforms). Fenbendazole kh ch

Capillaria aerophilia:, Filaroides hirthi v Paragoniums kellicoti tr n ch .
: th nh;
Haemonchus contortus, Ostertagia ostertagi, Trichostrongylus co/abr/gorm/s
esophagostomam rad/atam r /ctyocaa/as r/raparas c 'y'L qu
ch ng k n n non. M
ch
ch nh hnh th nh c stertag/a ostertag/
n ng
(strongyles) (Sedentatas Seqa/nas Sra/gar/s Cyathostomam spp Cy//cocy/as spp
Cy//costephanas spp Tr/odontaphoras spp) r g/an k/m (yar/s eqa/)

giun ph apiri), Hyostrongylus rubidus, giun t c (Trichuris suis) v
Stephnuris dentatus.
26
M tr
m o, d , c l
Dc ng hc
Fenbendazole ch b v
ng 0,11 g/ml v 0,07 g/ml.
nh ch oxfendazole (sulfoxide) v sulfone.
v heo kho c i th
nh
ng ch nh/ ph a
ang tr ong giai on cho sa hoc cho nga
nui th
ng ph/ cnh bo
d th
c n c th ng ch li
m n m o khi d ng fenbendazole.
u/c tnh
Fenbendazole dung n
Thu
nghi
Tng tc thuc
Oxfendazole ho
(Dibromsalan, Tribromsalan). N n s thai v g y
ch
u d
Tr s n d y (Taenia spp).
a) 50 mg/kg, PO, li n t y.
b)
Tr
a) 50 mg/kg, PO, m y 1 l n t y.
Tr
27
a) 50 mg/kg, PO, m y 1 l n t y, l trong
3 tu
b) 50mg/kg, PO, trong 3-10 ng y
Tr
a) 25-50mg/kg, 2 l y, 10-14 ng y.
Tr
a) 50mg/kg, PO, 1l y, li n t y. N ph
nh
Tr
a) 50mg/kg,PO, 3 ng y.
Tr
a) 50-100 mg/kg, PO, chia l m 2 l -14 ng y.
Tr
a) 50mg/kg, PO, 1l y, 3 ng y, l -3 tu
th ng.

Tr s n d y (Taenia spp).
a) 50 mg/kg PO, trong 5 ng y.
Tr trongylus abstrusus, Capilliria aerophilia).
a) 50 mg/kg PO, trong 10 ng y.

T

u d
5mg/kg PO.
Tr Ostertagia ostertagi: li
a: Tr k sinh nhy cm: 5mg/kg PO, 10 mg/kg tr giun a.
k sinh nhy cm vi liu 5mg/kg PO, 3 n v c n tr ong 3
ng y, d ng 10 mg/kg tr
u v k sinh nhy cm vi liu 5mg/kg PO, tr n v c n tr ong 3

ng y.

t
L benzimidazole t |LQ|Vi Q||R IHQGDROH|Fy|P u tr Q| Q| Q|WU Q|Y c m i
F|WU Q||1 y|K a tan trong n F||2 IHQGDROH|O chuy Q|KyD|VOIR LGH|F Dfenbendazole.
o qun
N n b R|T Q|Fi F|V Q|SK P |R IHQGDROe W|QKL W| |SK ng v tr nh nh s ng.
dng
2 IHQGDROH| F|FK | QK| |W |WU |Fi F|OR L|LQ|N |VLQK|FKR|Q D||3DUDVUDULV
eqaoram Strongy/es edentatas Seqa/nas Sra/gar/s), yar/s eqa/. Oxfendazole c Q|
F|G ng cho tr u b , d , c |Y heo.
Dc ng hc
Khng gi Q|Fi F|SK F|K S|EHQLP LGDROH|NKi F||R IHQGDROH| F|K S|WK|G d ng
TD| |WL u h a. Th L|LDQ|Ei Q|K |NKR Q|||||L |WU n tr n c |Y 5.25 gi tr n d .
2 IHQGDROH| F|K S|WK|V | F|FK Q|KyD|W R|WK nh ph F|K S|F n ho W|WtQK||
fenbendazole (sulfonide) v sulfone.
ng ch nh
khng ch | QK|NKL|G ng cho ng D|W |QKL n c Q|FK| |NKL|G ng thu F|FKR|Q Db QK|
v ng D| |V F||2 IHQGDROH|DQ|WR n cho ng D|Fi L|P DQ|WKDL|
t li
Thu F|Fy|WK |k |SK Q| Q|QK |F P |WK |F S| |L L|SKyQ kh ng nguy n do k sinh
ch W|k |UD||QK W|O d ng li |FDR|
Tng tc thuc
Oxfendazole ho F|IHQEHQGDROH|NKQ|Q n k W|K S|Y L|EURP VDODQ|IONLFLGHV

(Dibromsalan, Tribromsalan), n |N W|K S|WK F|V |O m s |WKDL|E v g y ch W|F |

Tr |N |VLQK|Qh |F P |
Ng D|||||P |N||32 |
B : 4.5 - 5 mg/kg, PO
Heo: 3 - 4.5 mg/kg, PO.
C ||||P |N||32 |
D : 7.5 mg/kg, PO

C
12
H
15
N
3
O
3

L m W|EHQLP LGDROH|W |WU |LQ|Vi Q||R LEHQGDROH|Fy|G Q|E W|P u tr Q||WDQ
WURQ|Q F|

2 LEHQGDROH| F|V |G Q| |W |WU |Fi F|OR L|N |VLQK|VD|k | |Q D||3DUDVFDULV
eqaoram Strongy/es edentatas Seqa/nas Sra/gar/s g/am k/m r yar/s eqa/.
Oxfendazole c n F|V |G Q|FKR|E , c |Y heo.

Ng D| |V F|KR F|WU L|TD|E QK|D|E Q||FROLF|||nhi P | F|P i |KR F|Fi F|E QK
nhi P |WU ng. Oxibendazole s |G Q|DQ|WR n cho ng D|Fi L|P DQ|WKDL|

G y ph Q| Q|QK |F P |WK |F S| |L L|SKyQ|NKi Q|Q n do k sinh ch W|k ra,
nh W|O d ng li |FDR|
Oxibendazole k W|K S|Y L|GLHWK OFDUEDP DLQH|Fy|WK (Filaribits Plus ) c th g y
vi m gan (periportal hepatitis) |FKy|

u
Li n ng l
cho ng
u d
Tr
Ng
B , c -20mg/kg, PO.
Heo: 15 mg/kg, PO.

Thiabendazole l h
oroform v ether. T n h a h 2-(4-Thiazolyl)-benzimidazole.
dng/ch nh
ng tr n ch : Toxocara canis,
T/eon/na Strongy/o/des stercoran/ r //aro/des cj n ' ' 'P '/ c h
th m b n
Penicillinum n n
c
ng tr n tr u b : Haemonchus spp
stertag/a spp Tr/chostrongy/as spp ematod/ras spp Cooper/a spp r
esophagostomam rad/atam
ng tr n c d : Haemonchus
spp stertag/a spp Tr/chostrongy/as spp Cooper/a spp r esophagostomam rad/atam,
Chabert/a spp., anostomam spp.
ng tr n ng
Crasterstomam spp., esophagodontas spp Poster/ostomam spp Cyathostomam spp
Cy//cocy/as spp Cy//costephanas spp yar/s spp r Parasacar/s spp
ng tr n heo: ng n
(Ascaris suum) v heo con b
M nh, thiabendazole c ki
v l
hi c d sinh

Dc lc hc
ph n b
n ao nh -7 gi ng. Thu s
chuy glucuro h a hnh th nh g
Kho ng thu i th 5% b i th
qua ph n. To n b i th th ng 5 ng y.
ng ch nh/ ph a
nguy n nh n g n hi qu i
n, o n
n nh n g y nhi
T c d i
n ch , g y i m u ch hn m ,
l ho i. Ch nh
thiabendazole. Thiabendazole c th bi (toxic epidermal
necrolysis)
u/c tnh.
ng liu t nht 20 ln liu iu tr nga.
Li -1000 mg/kg g y bi l 700mg/kg
v 1200 mg/kg
Tng tc thuc
Thiabendazole c th inophylline) t c c
v
u d
Tr ng:
a) 50 mg/kg, PO, 1 l y, 3 ng y; l
b) Tr -60 mg/kg, PO.
c) Tr -70mg/kg, m li nh 20-45
ng y; 70 mg/kg, 2 l y, li nh 2 ng y, sau PO, 2
l y, li nh 20 ng y.
Tr
a) Tr Penicillium: 30-70 mg/kg, 2l y, PO
ho -45 ng y.
b) Tr y ho k v
ketoconazole: 20 mg/kg, PO, 1l y ho
Li : 10-20 mg/kg, PO, 1 l y
c) Tr - y, trong
10 ng y. U y, 2 l y, li n t
d) y, PO, 6-8 tu h
v l m gi -50% ch

k sin y cm: 60 mg/kg,PO i vi Cooper ia v m nng
c c lo n nh n d -3 tu 50 100
mg/kg, PO.
a: Tr k sinh nhy cm: 44 mg/kg PO. 88 mg/kg cho giun a.
k sinh nhy cm: i vi m Str onggyloides r ansomi: 62
83 mg/kg PO. N 7 ng y. Ph ng ng
0,1%/ t -0,02% /t
14 tu
- 75 mg/kg PO ho 50mg/kg PO.
u
k sinh nhy cm: u n
50 100 mg/kg PO (c
c khng bu: Tr k sinh nhy cm: 50 1

d i ng y khi con v h tr ng.
k sinh nhy cm:

500mg/kg PO 1 l y, l 14 ng y..
22

22
t ha hc
L phenylguanidine t u, khng h a tan
alcohol. C n quan v
s nh fenbendazole v oxibendazole r n
probenzimidazole.
Dc lc hc
Febantel (uptake)
n ho nh,
fenbendazole v oxibendazole.
dng/ch nh
Febantel d d edentatas
Seqa/nas Sra/gar/s Parascar/s eqaoram (c ' ' ' nh r ' ng) /ar/s eqa/
(d ' ' nh r ' 'LL' '''' ' '') ' h
d y.
Febantel k
th nh v ch non: giun m c (An giun roi
(Trichuris vulpis), v s n d y (Dipylidium caninum v Taenia taen/aeorm/s).
34
M febantel h n tr u b v c tr n
85% khi d ng t masal nematodes, nematodes ru non, nematodes
ru (Oesophagostomum spp), giun ph trematodes (F.hepatica- -15 tu
khng d ng cho c
Dc ng hc
Tr n ng u h a v chuy nhanh
ch ng t nh fenbendazole-sulphone, fenbendazole v oxibendazole. Febantel c n
h v heo. C chuy .
N 6-12gi 12-24 gi sau khi
d ng thu (Combotel) ch c b
colic, ti u ch kh
cho th nh o) mang thai.
ng ph
nh tr m n d ng) c th
x u ch
ti u
ch m tr y tr ho
h c khi c praziquantel)
d ng li m o. Ch c th
nn kh, bi u ch m
3% s nghi n l m s ng. M o (<10%) c d
b n ch nh, khng nghi m tr
u
Li hematocrit k o
d i 3 tu ng thu ng li ch u ch
LD50 c n ch > 10mg/kg. Khi d ng li n ch , m o
nh ho n ch , m o con li n t ng y g y ti
u ch ng li -10mg/kg, PO trong 90
ng y s n v tuy
u d
Ch , m o: s
35
a) L tel)/1mg/kg (praziquantel), PO, li nh 3
ng y.
u tr
i: Ty tr nematodes d d t: 5
a: 6mg/kg, PO hoc d ng ng; iu tr lp li tr ong 6 u ti nhim.
2
2

Thiophanate thu ng th nh
Benzimidazole carbamates.
t
Thiophanate l diethyl 4, 4 0 phenylene bis (3-3 thioallophanate) ho - bis (3-
ethoxycarbonyl-2-thiouredo)-benzene.
Thiophanate b u v ng-n u nh
methanol, ethyl acetate v acetone; tan m
Dc l
Thiophanate h bi
trong gan v th sau 8 gi
thu thu i ti
ng v nh
Thiophanate l thu
nh v ng ch y-ru , c v nh k sinh
g y vi m ph d . Thiophanate c n c t c d nh k
sinh y v ng, giun k heo th
cu, Thiophanate c tc dng chng li cc giun sn sau:
Haemonchus contortus hi 9%
Trichostrongylus axei hi
36
Ostertagia spp hi
Trichostrongylus spp hi
Cooperia spp hi
Nematodirus spp hi
Bunostomum spp hi
Oesophagostomum columbianum hi
Oesophagostomum venulosum hi
Chabertia ovina hi
tr u b ng chng li cc giun sn sau:
Haemonchus placei hi
Trichostrongylus axei hi
Ostertagia spp hi
Cooperia spp hi
heo, Thiopha ng chng li cc giun sn sau:

Thiophanate c n c t c d 14
ng y.
u lng
Thiophanate c n gi
d ng cho tr u b , c d ; 22,5% w/w d y-ru
heo. C th n to v 22,5% w/w d tr u b , c
d .
Li nh b y trong b XLIII cho c
d . Tr u b 15 ml cho 45 kg (100lb) tr nhi m
tr
37
ng 5.2 Liu ca 20% thiophonate th vn i vi tr u b
ng lng sng (kg) u thng thng(ml)
u ti a tr ong tr ng
p nhim nng
90
135
180
225
270
30
45
60
75
90
60
90
120
150
180
ng 5.3 Liu ca 20% thiophonate th vn i vi cu v
ng lng sng (kg) u thng thng(ml)
u iu tr nh
cu non v
i (ml)
<10
11 20
21 40
>40
2,5
5
10
15
5
10
15
22,5
ng 5.4 Liu lng Thiophanate 22,5% pr emix d
i heo
i k

c
n nht
l
c

c
n (w/w)
c thp t
c n sau

Heo n i v heo n
Heo cai s heo
nui th
Heo n i v heo n
Heo nui th
14 ng y
14 ng y
1 l
1 l
2 kg/t
1 kg/t
20kg/t
10kg/t
0,045%
0,0225%
0,45%
0,225%
2kg/150kg P/ng y
(4 lb/150kg P/ng y)
1,5kg/50kg P/ng y
(3 lb/100kg P/ng y)
2kg/150kg P/ng y
(4 lb/150kg P/ng y)
1,5kg/50kg P/ng y
(3 lb/100kg P/ng y)
ng5.5. Liu Thiophanate 22,5% dng pr emix tr u b u
i k d
c ngn
t
l pr emix
c

c n
c thp nht tr ong

c n sau c
5 ng y - 1,25 kg/100 kg c 0,28% - 0,75% c
38
1 l
kh
- 4 kg/100 kg c
kh
0,9%
c ng/100kg P/ng y.
- 0,75 kg/100 kg/ 1 l
2
Thu g c y l Levamisole, c
1966. Tetramisole l h
v -isomer, levamisole. T
kh m ph n y, Tetramisole tr n c s levamisole li c l
t

Levamisole l (1-2:3:5:6-tetrahydro-6-phenyl- imidazo (2,1-6) thiazole
ramisole. N l h tr
tan nhi n c th m ho
Dc l
Levamisole h
trong 1 gi m thu c n t y. Thu i ti ph n v
40% b i ti
u tc ng
H n b h
trung t m v t li ng, ph h a
carbohydrate. Trung t m t sacc/nate
o/dat/on
ng v ng
Levamisole c ph nh v
tr ng c peria, Nematodirus, anostomam
esophagostomam etastrongy/as scsr/s yostrongy/as r Tr/char/s c t c d '
ch ' L'L'S L' L''1 y'y'/ ' ' ' L' g y nhi t
nhi n. Levamisole c t c d g v
v T. colubriformis.
u lng
So v
thu n, u m.
u ung:
Tr u b : 7,5 mg/kg tr
C
Heo: 7,5 mg/kg tr
Gia c 36 mg/kg tr
Li
Tnh an ton v tnh c
Levamisole an to n li
gi tr ng th s b m
khng gi y.
2 ng Benzimidazoles khc
Nh n c l
t tr c m y
l ch ng chuy b i ti
t thay th
qu n s i ti

Nh i ti
thiabendazole v c ph b i ti i h
li
t
ng bt tinh th tr ng.
ng bt khng kt tinh, m ng nht n v t.
T trong

chuyn ho
Do tan ch s y v
ru n, thu x
4 gi oxfendazole c th cao nh
15 24 gi v
trong huy cung c
b t
Nh a tan v b i ti
p thu km v n nh bi tit nguy n tr ong ph 5
10% b i ti nh m l
ph i ti n nguy n v Cambendazole.
S i ti v g
thu m th y
trong gan sau khi d ng li
ng
14 ng y, v ng thu
Albendazole khng s s
gi l 14 ng y). V oxfendazole, ngng dng thuc 14 ngy tr t
cho tt c cc loi th, khng d ng s
u tc ng
Nh m ch
glycogen. Ki y quan tr o ru ng khng th
h S|WK|Fh W|GLQK|G Q|F L|F ng ch W|GR|WKL |OFRHQ||1 K Q Benzimidazoles m L||Y

chuy Q|KyD|FK P ||NpR|G i QK|K Q|WUrQ|LQ|Vi Q|Yj |W Q|V thi |K W|OFRHQ|
Tnh an ton v tnh c
%HQLP LGDROHV| F|FK | Q|W W| |Y W|QL||) HQEHQGDROH|Fy|WK |G ng li g S|
1000 l Q|OL |L |WU |NKQ|Fy|E W|N |SK Q| Q|OkP |V ng n o. Ch |Fy
n ng c gn liu iu tr (khng mun n v t mi tr u b d ng g S|||O Q|
li |NK Q|Fi R||
M W|V |%HQLP LGDROHV|k |Ti L|WKDL|NKL|G ng thu F|LDL|R Q| |WK L|LDQmang
WKDL|| L |Qj | F|FQ|QK Q| |QK|G Q|DOEHQGDROH|L |WU |Vi Q|Oi |DQ||VD|NKLc thai 1
th ng |F |Fi L||% c i c Q|NKQ|G ng thu F|WURQ|||WKi Q| |WK Lgian mang thai. C |
parbendazole v cambendazole c th |k |Ti L|WKDL| |F |WUong tu Q|WK |||||||KR F|||F D|
thai k |
u lng
u kim sot hn 95% k cu v sau:
Albendazole: 5 mg/kg tr Q|O Q
Cambendazole: 25 mg/kg tr Q|O Q
Fenbendazole: 5 mg/kg tr Q|O Q
Menbendazole: 15 mg/kg tr Q|O Q
Oxfendazole: 5 mg/kg tr Q|O Q
Oxibendazole: 10 - 20 mg/kg tr Q|O Q
Parbendazole: 20 30 mg/kg tr Q|O Q
T W|F |%HQLP LGDROHV|F S| Q| Q||KQ|Fy|Li |WU | F|EL W|Wi F| Q|FK Q l L|
LDL|R Q| |WUQ|| F|EL W|TDQ|WU Q|WU Q|K S|QKL P | |WU ng Ostertagia type 2 |WUk|
b .
u v
T W|F |%HQLP LGDROHV|W |WU | F|QK Q|N |VLQK|WUQ|FKtQK|QK |%QRVWRP P |
Chabert/a Cooper/a aemonchas ematod/ras ephagostomam sterag/a
Strongy/o/des r Tr/chostrongy/as spp
c bit hn chng li sn l gan
v L|OL ||||- 15 mg/kg tr Q|O Q|
a

th S|FK Q|O L|7ULFKRVWURQ OV|DHL||/ L |WKtFK|K S|F DBenzimidazoles l 10 - 15
mg/kg tr Q|O Q|

L |WU |OL |O S|O L|||||P |N|WU Q|O Q|OL n t F|||Q y.
2


43
t ha hc
Pyrantel l d u v ng
ho alcohol. Pyrantel tartrate h a tan trong n nhi
mu base.
Pyrantel palmoate c n pyrantel embonate.
Dc lc hc
nh
nh m t li nicotine v ho

dng/ch nh
,
giun m c (Ancyostoma caninum, Uncinaria stenocephala), v giun d y (Physaloptera).
ng r Seqa/nas Parascar/s
eqaoram r Probstyt/mayr/a r/rapara Tha 'y'L qu Oxyuris equi,
S. edentatus v strongyles nh hi ng (A.
perfoliata) khi d ng li khuy n d ng.
M c c ch ng cho b , c pyrantel
tartrate c th c c lo Tr/chostrong//as
spp ematod/ras spp Chabert/a spp Cooper/a spp r esophagostomam spp.
2
t ho hc

saam) esophagostomam spp Tha ' 'y'/ ' ' ' L'L' ' y heo
(Hyostrongylus rubidus). Ngo i ra, c th ng cho chim ki g.
Dc ng hc
44
Pyrantel palmoate h thu
nhi
l -3 gi au khi d ng thu
nhai l
Thu b i th
ng ch nh
Ch khi d ng thu n cho th trong th v
nui con.
ng ph: pyr antel pamoate thng gy i.
u
Pyrantel c kho n trung bnh. Li
l LD 50 c
pyrantel tartrate 170mg/kg v > 690 mg/kg (pyrantel palmoate) ng l u
d i li y s li y trong 3 th ng
th khng xu ng
hi nhi c c t c
Tng tc thuc
levamisole) n n pyrantel
khng n n k levamisole.
C i th n p pyrantel v
diethylcarbamazine.
Piperazine v pyrantel c ch v n k ch ng
v
u d

a) 5 mg/kg, l
b) 15 mg/kg, PO, 30 ph t sau b tu

tr
Physaloptera.
b) 1mgkg P / S' L'''' '
a:

b) 19 mg/kg, PO
c) Pyrantel tartrate: 22 mg/kg, PO. T
i: pyr antel tar tr ate 25 mg/kg, PO
r ut: 4.5 mg/kg,PO. Lp li tr ong 14 ng

Morantel Citrate
Morantel v pyrantel l d ester methyl
t thu c
m

Morantel tartrate l -methyl-2-thienyl) vinyl] 2-
methyl-1, 4, 5, 6-tetrahydropyrimidine tartrate. N d u v ng nh nhanh

Dc l
Thu y v ph n ru
m u t 6gi kho i ti

u tc ng
cho//nesterase
r t // 'L'
ng ng
Morantel l thu n
nh y-ru tr u b , g srerag/a
Tr/chostronggy/as Cooper/a ematodr/as Chabert/a r esophagostomam.
46
u lng
Morantel c th ng k
giun ph y li ng 2% Morantel tatrate v 5,9%
diethylcarbamazine:
C 7 ml cho 7 17 kg tr
14 ml cho 18 37 kg tr
21 ml cho 38 50 kg tr
28 ml cho tr n 50 kg tr
Tr u b : 28 ml cho 50 kg tr
Thu
Tnh an ton v tnh c
Morantel l thu n, c th ng li Tuy
nhi n, Morantel ra kh
47
2
H
1950, h n c v
k o d i t c d nothiazine. Trong c c th t c d
l n th tr u
b .
u tc ng
n giun tr n l ng
ho ng c ph
cho k sinh tr ng. Men cholinesterase c ng r v
organophosphorus, v v
so t b kh
M
Haloxon, Trichlorphon.

t ha hc
Dichlorvos l thu n h a h
l 2.2 dichlorovinyl dimethyl phosphat hay DDVP.
Dc lc hc
C c c organophosphat kh c, Dichlovos c
d
nh

v giun m c (Ancylostoma caninum, A. tubaeforme, Uncinaria stenocephala) Ngo i ra,
thu n d ng cho heo
'' 'y hi ph ng
48
ng Thu c c n d ng d
t o v ng c o di ve.
ng ch nh
Khng d ng cho ng u ch ng
y. Khng d ng thu m o n d hi
t o b n nghi m tr n m u ho d
tr ng. Ch nhi n d ng dichlorvos. Dichlorvos khng n n k
lo thu khng n n
d ng dichlorvos n d ng thu
ng ph
M o, th non, th y nh
u
Qu li ng mnh, tim v
ti u ch theophylline,
aminophylline, reserpin, ho phenothiazine ) khi ng

Tng tc thuc
Acepromazine ho kh c khng n n k
oganophosphate. Do c tnh kh ng cholinesterase, tr nh k
DMSO. T c d n n Trong
v ng 48 gi ng organophosphate th khng n n d ng succinylcholine ho
thu n c morphine, neotigmine v
pyridotigmine v ch ng c th
u d

a) 26.4-33 mg/kg, PO
nh: 27-33 mg/kg; ch con: 11mg/kg

2
49
22
22
C
14
H
14
Cl
l3
O
6
P
Haloxon v Coumaphos c quan h n c s
ph 1962 s
d , c lo i g

c Haloxon l 2
phosphat 1NN. N d u tr m
acetone v chloroform.
u tc ng
inesterase c ng v v s
lo ng t b
ng v ng

' ' L'2 L '
' L'1 PL' ' 'L ' ' '
T c d v c
tr n 90% ch
Oesophagostomum spp.
u lng
Tr u b : 44 mg/kg tr
C 50 mg/kg tr
Tnh an ton v tnh c
- Khng s
- Khng s tr u b c i mu
- C
- Khng s

2
2

2
c
Fenthion l organophosphat di u v ng, khng m u, d nh
d
Dc lc hc
c ch
truy
nh
- (kh s
ph h ng.
r
ng ch nh
tr
b ng cho b d b sau khi
y ho c d c
ho ng.
ng ph
Tr n ch , t c d ng Pro-Spot c bi u
ch n t , fenthion c th m c
n sau (posterior). N khng d ng atropin (ngo
tr m tr y m gi ng b
(relieve bloat); c th ng trocar ho ng thu m.
u
, n qu li
Tr nh k theophylline/aminophylline, reserpin
v c c thu phenothiazine). C th
b ng atropin v pralidoxime.
Tng tc thuc
1 th ng sau khi d ng organophosphate th khng n n d ng acepromazine ho
phenothiazine kh c. Do fenthion c tnh kh ng chilonesterase, n n tr nh k h
organophosphate v levamysole. T c
d organophosphate.
Khng n n d ng succinyl choline ho n c kh c sau khi d ng
organophosphate t nh orgenophosphate v
physotigmine v pyridotigmine v ch ng c th
u d
Ch : 4-

L thu
257.4. Trichlofon c n metrifonate.
52
Dc lc hc
Thu g y
c
nh
nh (immature)
nh Parascaris equorum, Oxyuris equin, Gastrophilus nasalis, /ntert/na//s
Ph ' S'SLL'Y p/pera/ne cj n tr ' ' ' v S.vulgaris. Ph
trichlorfon v ng tr n b v ch
n v gi tr
Dc ng hc
Thu
kho -3 tu ng.
ng ch nh
Khng d ng cho ng o th ng cu
mang thai) ho u ch m tr nhi ng,
ng
ng ph
Tr n ng u ch ng trichlorfon. C c t c d
ph y s m tr n b , thu ti
g y li
u
Qu li
(cholinergic toxicity). / ho
ti u ch th ng

Tng tc thuc
C c thu c c
thu n c c th
e. C trichlorfon v
phosphat h

53
u d
a:
k sinh nhy cm:
a) 35- -8 tu
thu m ho thu
c th
b) 40 mg/kg, PO tr n (nematode) v m v
m
iu tr ti ch mng v n
15ml c d ng
thu (internal
medicine), phosphat h

Tinh th cao
n n tr nh ti m m
m t li
i ra c n
n.
S -1300lt
2

22
2
t ho hc
Ch W|E W|WU Q|NKQ|WDQ|WURQ|Q F||E i th L|TD|P W
C ch
LD|W Q|WtQK|WK P |F D|W|WK || F|FK |Ti |WUnh sinh n Q|O Q|E Q|Fi FK|Wi FKL|
ph Q| Q|SKRVSKRUO|R KyD|
y|Wi F| Q|WU n s n l gan d Q|WU Q|WKj QK|Yj |FK D|WU Q|WK nh, di W| F giun
tr n h t m u (Heamonchus contortus), giun m c ch
c tnh th S||W Q|G |WURQ|VF|V Q|tW||NKQ| QK|K Q|Fi F|FK ti u sinh s Q|F Dth
u lng:
10-15mg/kgP (P.O)
2
C
13
H
8
Cl
2
N
2
O
4

Niclosamide l 2, 5-dichloro-4-nitrosalicylanide.
Niclosamide d Q|E W||P j |NHP ||W|WDQ|WURQ|Q F||WDQ| |||R|WURQ|||||SK QU ||
D ng cho ch m o d Q|YL n, m L|YL n ch D|||||P |1 LFORVDP LGH|
Dc l
1 LFORVDP LGH|tW| F|K S|WK| Q|WL u h a; bi Q| L|WK nh d Q|NKQ|KR W| Q
aminoclosamide.
u tc ng
Ho W|WtQK|F D|1 LFORVDP LGH|Q Q|FK Q|V |K S|WK|OFRVVH|F D|Vi Q|Gk ||LQ|Vi Qch W|
do b |Q Q|FK Q|FK|WUnh Krebs v tch t |DFLG|ODFWLF|
ng v ng
Niclosamide c hi |T | L|Y L|Vi Q|Gk |FKy||P o, tr u, b , d , c |
Tr u, b , d , c || Q
Ch , m o: vi n.

Tr u, b : 50 mg/kg tr Q|O Q
D , c ||||||P |N|WU Q|O Q
Ch , m o: u Q|||YL n (500mg) cho 3 kg tr Q|O Q|

D Q|WLQK|WK |WU Q||NKQ|WDQ|WURQ|Q F||3KkQ|E |QKL | |DQ|th Q||U W||% i th L|
nhanh qua m W|

K D|U r ng nh Q|R FORDQLGH|Wi FK|L|SK Q| Q|SKRVSKRUO|R KyD| |W|WK |

R W|Fy|KL |T | |WL u di W|Vi Q|Oi |DQ|QK Q|NpP |KL |T |WU n s n l d |F |Y ch |Fy|
hi |T |WU n s n l WU Q|WK nh.

Th S||OL |k | F||||O Q|OL |L |WU ||. KQ| QK|K Q|NKL|G ng cho th c thai.
T Q|WU |tW|Q n th L|LDQ|Q Q|WK F|WU F|L W|P |Q Q|Y khng c Q|Q Q|WU Fkhi d ng
s D|

C
9
H
11
Cl
2
l
2
NO
3
56

Rafoxanide l h -chloro-4 (p-chorophenoxy)-3, 5-diiodo
salicyl anilide.
Thu n ch , m u tr .
Dc l
v c
sau khi c 48 gi huy
tr u b v c
o. Th 10 ng y.
ng v ng
Rafoxanide c t c d

u lng
Li g tr tr u,
b , c 10 mg/kg tr
s n l gan v giun tr n d y-ru , c
Tnh an ton v tnh c
Thu v 45 mg/kg tr
o. Li n 45 mg/kg tr

2

Hexahydrate khng b tan ch thu adipate
(t hydrochlorid. T d
ngo i.
u tc ng
T hi
acetylcholine v l m t li ru
d ng v thu
ng v ng
57
T c d n giun tr n v giun k h nui; n c hi C
t c d n whipwormho
u di th nh
nh
60% c c lo i Triodontophorus v Strongylus vulgaris. Khng c t c d i
Strongylus kh c, Habronema hay s n d y.
v c n giun tr n v giun k Ascaris

'/ ' ' L'Y L' ' '
o, hi i Toxocara v Toxascaris, tr n 75%
v khng t c d n whipworm hay s n d y.

m
u lng
a: 0,2 g/kg tr ng lng. Ti a 80 g (nga con 30 g, 1 tui 60 g).
ng lng/ ln, 3 ln c tr ong thc n, khng qu
30g/l
ng lng (ch con<2 kg, m u thp hn
0,25g).
m: khong 0,3 g cho 1 con tr ng th ng 32mg/kg tr ng lng)
1 l n t 2 ng y.
T
Tnh an ton v tnh c
g y
nn
2
58
C
10
H
21
N
3
O
c
L d iperazine, diethylcarbamazine citrate (DEC) c m u tr nh
d i ho i nh r a tan

Dc lc hc
n h inh gi
nghi
nh
ng giun tim Dirophilaria immitis v /ho tr n
ch . Ngo i ra, thu n o, ch (ferret) v c c
lo i th hoang d kh c. m ph qu
viviparous b .
Dc ng hc

chuy
chi -
ng ch nh
Diethylcarbamazine ch
th nh c thu ph
- c
nh s
nh), c th ng t i nhi b N
d ng b ng b
t n b microfilaria.
ng ph
D ng DEC ng giun tim th ti u
ch i. D ng li m i k sinh nh c th
t c d u h a. K i ph t
g y r u h a. N kho ng
DEC s bao g u
59
ch
ph kho -2 gi ng thu c th
c ch d ng d truy
Tng tc thuc
Khng k
levamisole) v
u d
Ph ng giun tim: 6.6 mg/kg,PO, d ng h o m a c mu 2 th ng

Tr -110 mg/kg, PO; c th y.
Tr trnh
3 ng y.
giun a: 55
n sng: Ph n/ng
Dictyocaulus vivipar ous (giai on cha tr ng th 22 c
ng y; 44mg/kg, IM, 1 l
2

t
ng ph n, giun m c
v c n ch . 100% giun b ch nh
th n cho ch mang thai.
C ch
L m t ng t
th o l m ph n r v m giun ch
tc ng: giun a ch m
c tnh: c kh nng to nitr osamin
u lng: 50mg/kgP (P.O)
60
2
C
19
H
24
N
2
O
2

Praziquantel c cng th 2-cyclohexyl carbonyl-1,3,4,6,7,11b-
hexahydro-2-pyrazino (2,1-a) isoquinolon-4- ng d n ho m.
Praziquantel l d u tr b
tnh th alcohol.
Dc l

60 ph t. Thu m t thu ph n ph
kh o ru th b i ti l
n m h ch
k ch thch kh
n
sinh s trematode, praziquantel c c th
Praziquantel c
tnh th glucose b
giun s n
Dc ng hc
Praziquantel h ho n to n sau khi u h a
-120 ph t sau
khi u th qua h ng r o m u n o v o h
n kia (across) th nh ru i th th
gian b n h nh tr n ch l 3 gi
ng v ng
61
Thu ng. Bao
g
ydat/gena taen/aorm/s a/t/ceps ma/t/ceps r /py//d/am can/nam

Thu n t c d i s n d y g y nhi
Tnh an ton v tnh c
n r LD
50 v
200mg/kg thu u h a li -100mg/kg o th
v m 200mg/kg g y ch o.
ng ch nh
Khng d ng praziquantel cho ch con nh m o con nh
tu n , n s febantel c ng m
nh s c th ng cho ch v m o con
l an to n cho th mang thai.
ng ph
ch ti u ch
y ch o, ch kho
th nh h b ti u ch
m th nghi m t
m, i m u v o (kho
ti u ch m.
u d

Tr
a) ch/nococcac grana/osas: 10mg/kg
b) /phy//obothr/am sp: 7.5mg/kg, PO
c) Sp/rometra mansono/des ho 'LS LP'LL''75 mgkg PO,
1 l y, li nh 2 ng y.
Tr ng li n t y.
u: Tr tt c cc lo a Moniezia, Stilesia hoc Avitellia: 1
62
m:
a) S n d y ph :10 mg/kg
b) S n d y v s n l : 5-10mg/kg, PO ho
Lo i b s t:
a) S n d y v m i lo i s n l i: 7.5 mg/kg, PO 1l
l
b) Tr -7 mg/kg.
22 c tr
- Nh m Halogenophenol (Bithinoloxyle)
- Nh m Salicylanilide (Niclosamide)
- Nh m Benzimidazole
22

Bunamidine hydrochloride l thu i, m u tr d
tinh th alcohol (1g/2ml
alcohol).
Dc lc hc
L thu m v
c g y ch u
t
dng/ch nh
Bunamidine d
p/s/orm/s r ch/nococcas grana/osas 'y'' LS LLP'Lam r Taen/a taen/ae
p/s/orm/s 'P o '' ''PLL' ' ' ' praziquantel v esiprantel b
v c c lo y c hi t
Dc ng hc
Bunanidine ch u h a, chuy
ng ch nh
Khng d ng cho ch , m o b
khng th y sau khi d ng bunamidine. Bunamidine c th
d sinh tinh
ng ph
Tr n ch , t c d i, ti u ch
kh th ch n m o, thu
ph ph ch nh lnh.
u
th
g y ch m ch Qu li
li g (g
3 l o.
Tng tc thuc: Bunamidine khng n t hp vi Butamisiole.
u d

Tr
- 25-50mg/kg, PO, ph -4 gi
th
- 22-51mg/kg,PO; cho th nh
2
c
L m -benzazepin d u d m u
tr -pyrazine.
Dc lc c

a c o v i
ra, thu u h a th
l bong tr c v ph v
sinh.
nh
Teania
p/s/orm/s tr n ch r /py//d/am can/nam r Tean/a tean/aeorm/s tr n m o
Dc ng hc
ph i th kho
0.1% b i th
ng ch nh
n
c ai. An to n khi d ng cho th mang thai v th nui th bi
ng ph
ti u ch
u d
ng m
ng m
2 c tr sn l gan cha t r ng th
- Nh m Halogenophenol
- Nh m Salicylanilide (Oxyclozanide)
2

C
8
H
8
Cl
3
N
3
O
4
S
2
t ho hc
L m n h a h 4- amino -6-trichloroethenyl
-1,3-benzenedisulfonamide.
Dc lc hc
-phosphoglycerate kinase
v phosphoglyceromutase c nh c
trnh -Myerhof). S n d y b chuy

ch
nh
nh v
nh . Thu nh nh
tu magna (c ''' ' ''
h/ 'T ' n to n saa kh/ m 'L ' ''y't'L ng.
Clorsulon khng c hi (Paraph/stomam).
Dc ng hc
Tr n b , sau khi u
huy m th g v
25% trong h ng thu -12 gi n

ng ch nh
Khng d ng cho b s to n
cho th mang thai v th gi
u
Clorsulon r n khi cho b v c g y

u d
B , d , c
- Nh m Disulfonamides (Clorsulon)
2 c tr sn l gan tr ng th u tr
- Nh m Benzimidazole (Albendazole)
- Nh m Halogenophenol (Nitroxinil)
- Nh m Salicylanilide (Closantel)
2 c tr sn l nh
- Nh m Benzimidazole (Albendazole)
- Nh m Pro-benzimidazoles (Thiophanate)
2 c tr cu tr
2
Sulfamid v Diaminopyrimidin hi S|O F|Y L|QKD|WURQ|L |WU |F |WU ng. M Lch W|
Wi F| Q|OrQ|KDL|E F|N |WL S|QKD|F D|Ti |WUnh bi Q|G ng. C hi |T |K Q|WURQ giai
R Q|VLQK|V Q|Y|WtQK|F D|F |WU ng.
Ch | QK|WURQ|YL F|SK ng v tr |W W|F |Fi F|OR L|F |WU ng, b QK|GR|7R RSODVP Dg y ra
Ch Q|FK | QK||j | |WU Q|WK Q|SK P
Ph L|K S|
* Sulfaquinoxalin + Diaveridin + vitamin K
* Sulfadimidin + Sulfadimethoxine + Diaveridin + vitamin K
* Sulfaquinoxalin + Pyrimethamin
C ch d ng: cho gia c P | WK Q|WU n trong th F| Q|KR F|SKD|WURQ|Q F| Q
L |WU |||-5 ng y
Ph ng: u Q|||Q y-ngh |||Q y- u Q|||Q y

C
12
H
14
N
4
O
4
S
c
/ j |VOIRQDP LGH|Wi F| Q|G i, sulfadimethoxin khng c m i, d Q|E W|WU Q|NHP |t
WDQ|WURQ|Q F|Y alcohol.
nh
Sulfadimethoxin d Q|WL m v d Q|YLrQ| F|FK | QK|WURQ|L |WU |E QK| Q h
h S||QL |G F||QKL P |WU ng ru W|P m m P |GR|YL|NK Q|QK |F P |Sulfadimethoxin c n s |
d Q| |WU |F |WU ng |FKy|
|Q D||VOIDGLP HWKR LQ| F|FK | QK|WURQ|L |WU |QKL P |WU ng h h S|GRStreptococcas
eqa/
|E , thu F| F|G Q|WURQ|L |WU |SK F|K S|V W|Y Q|FK Q||VKLSSLQ|IHYHU
complex), b QK|E K|F ||YL m ph L|Y th L|U D| Q|FKkQ|GR|YL|VLQK|Y W|QK |F P g y ra.
|LD|F P ||VOIDGLP HWKR LQ| F|SKD|WURQ|Q F| Q| |L |tr |F |WU ng, d FKt |

g v s |P L|WU Q|QKL P |

|FKy||P o, heo v c ||VIDGLP HWKR LQ| F|K S|WK|QKDQK|Y ph n ph L|W W|Th |
tch ph n ph L|W Q| L|WKD| L|W |||||/ |N | |F | Q|||||/ |N| |E v ng D|T |O |WK F|
li n k W|Y L|SURWHLn huy W|W Q|U W|FDR|
|K |K W|Fi F|ORj L||VOIDGLP HWKR LQ| F|DFHWO|KyD| |DQ|W R|WK nh
acetylsulfadimethoxin v khng b |EL Q| L| |DQ||6OIDGLP HWKR LQ|Fy|WK L|LDQ|Ei Q|K d i
GR|y|Qy| F|Wi L|K S|WK|i Q|N | | Q|WK Q||7K L|LDQ|Ei Q|K |F D|WK c m W|V |OR i
QK |VD||KHR||||L ||F ||||L ||Y ng D||||||L |

Nhi P |WU ng nh |F P |||||P |N||32 |KR F|,0 ||||O Q|Q y.
Tr |F |WU ng:
a) 55 mg/kg, PO, li | |F D|Qj | |WLrQ|L |WU ||VD|y||||||P |N||32 |||
l Q|Qj |FKR| Qkhi khng c n tri |FK Q|E QK| F|K Q|||Qj |
b) 50 mg/kg, 1 l Q|Qj |Yj R|Qj | |WLrQ||VD|y||||P |N|||O Q|Q y, 14-20 ng y.
7URQ|NKL|L |WU |F Q|N W|K S|FK P |VyF||EDR| P |FQ|F S| |Q F||GLQKG Q|W W

d) 110 mg/kg, PO ho F|, ||O Q|Q y.
e) 55 mg/kg, IV li | ||VD|y||||||P |N||, ||O Q|Q y.
f) 110 mg/kg, PO, m L|OL |Fi FK|QKD||||L |
22

L d Q| W|QLWURIUDQ|NKi Q|NK Q|NKi Q|SURWRRDO||IUDROLGRQH|Fy|Y | Q|m u
v ng, d Q|E W|WLnh th ||WDQ|WURQ|Q F|
68
Dc lc hc
n h n sinh
cholera,
Trichomonas, Coccidia v nhi ng E.coli, Enterobacter, Campylobacter, Salmonella, v
Shigella. Khng ph ng
ch ch
nh
Furazolidone l thu i c c vi
khu n.
Dc ng hc
C c chuy i th u, c c ch thu
nhanh ch ng chuy b i th
ng ph
Furazolidone g y bi a, chu ti u ch c
thu th
trong d y.
Tng tc thuc
Do b v n k c c
thu c sau: buspirone, amin k ch thch th epherine,
), thu ng, c c ch monoamin oxidase kh c, c ho
c c th nh
furazolidone c th disulfiram.
u d

Tr m k ng: 2.2 mg/kg, PO, m nh
7ng y; Tr ng: 8-20mg/kg, PO, li nh 7ng y.

a) Tr y (c ch nhau 12 gi nh 7-10 ng y; n
k o d i th qu
b) Tr m k ng: 2.2 mg/kg, PO, m trnh 7
ng y; Tr ng: 8-20mg/kg, PO, li nh 7ng y.
69
a: 4 mg/kg, PO.
2 p cht d v

C
14
H
19
N
4
t ho hc
Ch o th n schizolnt v l ch
kh ng c
ng c ng cho gia c ng, khng c

Tr -110 ppm

2

Monensin l m
cinn Bungari s
t
Monensin natri t h a tan trong n a tan trong dung mi h
Thu i ti gi .
Ch nh ph
Monensin natri 10 g
Ch
Thu nh bao 20 kg. H ng thu y s
ng v nh
Monensin c t c d ng c gia c o gia c
chu k ng.
V
ng li gan.

Ch : Thu ng
u lng
Tr o th , b ngh v th
-100ppm (90-100g/ t

n 2-3 l b
li
o th -5 ng y.
2

C
24
H
35
NO
5
c
L thu ng, decoquinate c m u kem, d m i
nh a tan trong n
Dc lc hc
Decoquinate l 4 hydroxy quinolone ng. Decoquinate t c
ng nh o t o ru
c n l c ng
v o h
k sinh.
dng/ch nh
ng cho b v d bao g
n/nako/h/yak/mor/ae go / ra tha 'j n ' ' ' ' tr ng cho g gi
(broiler) : E.tenella, E.necatrix, E.acervulina, E.mivati, E.maxima, barnett/
- Ch ng, decoquinate khng c hi
tr ng v ch ng d nh. Khng d ng decoquinate cho th
s ho
u d
c
Ph ng c ng
a) S y tr nh t nh
ng y.

Ph ng c ng: 0.5 mg/kg/ng y tr
2 c tr ngoi k sinh
- Nh m Organophosphore (Coumaphos)
- Nh m Carbamate
- Nh m Pyrethirnes (Pyrethrin)
- Nh m Avermectin
- Nh m Phenylpyrazoles (Fipronil)
- Nh m Organo arsenic (Roxarsone)
- Nh m polyether ionphore
2

Thu
ng v o lng da c
gia s c, gia c
m gi
S , ve, b phun
x sinh. N n th o s ng s l l 14
ng y.
2

t ha hc
72
Amitraz c tnh ch u v ng nh 87o, t
h a tan trong n a tan
' ' ' L' 'L ' ''
Lu tr /tnh bn/kh nng tng hp thuc:
Kh .
Khng tr
Dc l
V n th

nghi m tr ph ng thch ( 2
q y.
dng/ch nh
ph n
c c c lo n nh n)
ng i khng/thn tr ng khi s dng/tnh an to sinh sn
Khng s s khuy khng s
d n nh y.
Nh gi
(l m d thi
nui. B nh th
Tnh an to n cho s ch

ng ph/cnh bo
c
th h m ng tr
n trong v nh v ng r
d
Amitraz c th ' ' ' o v th '' 'K ' n tr nh khng s ' '
dng qu liu/c tnh
73
o. Nh y, PO li n
t y. Bi huy
nhi
hi m tr
ph p n m gi y, c th ng
m t
Kh 0,2mg/kg, IV (b th cho
kh n c N
u khng khi ph y ru
Tng tc thuc
Khng ph c c thu
SPL'''''L ' ' 'P
u d

Ch lng d i v v n c s bng d
250ppm,( pha chai
10,6ml c kh). L
ng y cho 3 6 l
n th nh
hnh ti sau
30 ng y m ng dung d
thay v d ng 250ppm m t c d c h
n. N
s

Tr -Mitaban() trong 9 lt
y cho 2-3 l
2 c tr k sinh tr ng ng mu
2

74
Thu
Ch d ng (Babesia, Theileria) , d c n mao
tr ng (Trypanosoma, Leishmania) ng
S n ti m SC) l y.
v -3-4mg/kgP
: 3mg/kgP/IM (dung d
2
D
Ch d ng, bi n tr ng , ng o
Li Gia s c l -3mg/kgP (SC, IM)
Ch m o: 5 mg/kgP

Berenil l thu dung n h tr ng

t
ng vi m, h t nhanh tr ong nc. Dung dch thuc n nh
nhi ng trong 5 ng y. Khi gi th y.
B th u, tr nh nh s ng.
ng v nh
Berenil c t c d n mao tr ng, l d ng v khng g y
ra c c ch ng c s
V nh th m m ng c
b d ng v ti n mao tr ng do c c lo i: Piroplasma sp., Trypanosoma vivax v T.
congolense g y ra.
Ch d ng v ti n mao
tr ng . Thu non v d gi y u.
u lng
Ti m s u v o b v -16 mg/1 kg th
(Thu

Lomidin l thu
75
t
Lomidin l ch ch
theo cng th
Ch
ng v nh
Lomidin c t c d i l d ng v ti n mao tr ng i gia
d c
Ch : Thu d ng v ti n mao
tr ng .
u lng
Ti m b .
Li kg th

Trypamidium l thu ng ng ch tr ng

t
Trypamidium c d Isometamidium chlorua
hydrochlorua. Khi s thu nh dung d -2%.
Thu h

ng v nh
Trypamidium c ho n c c lo i ti n mao tr ng g y b , d c
ng , ch kh c t c d i t 2-4
th ng.
Thu m s u v o b m v o t
m
Ch ng ph ng v tr n mao tr ng d .
u lng
D ng cho d v nh dung d 1-
2%. Ti m s u v o b nh dung d -1% ti m v o t m
76
ng b ng li th

Ch thu ng b
Ti m thu o t a tr
ti m.
C c dung d pha ph ng ngay trong ng y n qu t
l
2 c tr nm
2

t ho hc: C ngun gc t nm Penicillinum gr isofulvin. Bt khng
u ch
m ng.
C ch tc ng: gn v u tr c h ng l thoi phn b c ch s phn
b o c hnh th nh nh o n i ra c n l m x o tr
t nh t o s m s
tc ng: tr u m ngo
'T 'L ' ' P'k ' ' L' '

nh: nm da, mng, lng do cc nm nhy cm gy r a cho gia sc.
u lng:
Ch m o 20 50mg/kg P.
22 n xut ca Imidazole

77
Thu n
th

lanosterol, t ng t m x o tr c c ho
o ho m ch b o.
Ph i da v n /stop/asma
hang c h/ 'T ' L'Y L'SL
Li Ch : 10-20mg/kgP (P.O ho -8 tu
Ng -6 mg/kgP
Ch : ng ng chung v
2

L triazole t u tr nh

o qun
Fluconazol d n n n b u m n n b
qu -30oC.
Dc lc hc
Fluconazol l ph imidazol
ng t o n c
ng t o, tho t d o v l m suy y h
(precursor) t pyrimidine. Fluconazol c hi ch
b n th
kh ng n ng Candida, Cryptococcas /stop/asma r /astomyces
khang c h/ 'T ' L'Y L'SL'
dng

vi m m ng n o, b tomyces) v histoplsmosis. N c
78

c c lo n thu v
ng th tr n s
t c nhi t c d
Dc ng hc
Fluconazol h g ng
u n k ph n ph thu
nh o n o, m d o. Thu i th th
gian b n h nh
ng ch nh
Fluconazole khng n n s
kh ng n b
t li
Thu ti u
h a ( i m u ch . Hi
enzyme ng gi (thrombocytopenia).
u
Chu n s ng li i ng y sau khi d ng
li -2 mg/kg. Chu ng li h ch
m xanh tm (cyanosis). N ng li

Tng tc thuc
Fluconazole k
'T '' ' L'Y L'S'Y ' L'/ 'L' ' S' n
Aspergillus. Fluconazole c th ng wafarin ho
h a fluconazole.

huy l m gi

b ho astemizole.
u d
79
m nm nhy cm: 2.5 n/ng u tr 2 n.
Mo: iu tr Cr yptococcus, nhim nm ng tit niu hoc thn kinh tr ung
-10mg/kg, PO. M
Chim: Fluconazole vi cc thuc khc tr ong iu tr nm
Aspergillosis: 5-10 mg/kg, PO, 1 l y, li nh 6 tu ho ng
sau Amphotericine B.
2
c
Amphotericin l polyene kh ng n
6SP '''PSLL'y'P 'Y ' 'P'' ' ' 'P tan
amphoteric c tnh acid ho
o qun
Amphotericin B n n b -8 oC, trong v tr nh nh
s ng.

chloride 0.2%, heparin sodium, heparin sodium v phosphate,
hydrocortisone sodium phosphate /succinate v sodium bicarbonate.
Amphotericine B c nh th Ringer,
D5-lactate Ringers, amino acid 4.25%-dextrose 25%, amikacin, calcium
chloride,/gluconate, carbenicilline disodium, chlorpromazine HCl, cimetidine HCl,
diphenhydramine HCl, dopamine HCl, edetate calcium disodium (Ca EDTA), gentamtcin
sulphate, kanamycine sulphate, lidocaine HCl, metaraminol bitartrate, methyldopate HCl,
nitrofurantoin sodium, oxytetracycile HCl,
Dc lc hc
Amphotericin B l thu u di i n y theo
t ergosterol) tr n
m ng t o v l m bi ng t o k o theo K+ b n trong t o v c c
ph n t o tho t ra kh o. Do vi khu ricketsia khng ch
c c sterol v v qu y. M ng t o
y k

c nhau v sterol m Amphotericin B k
cholesterol khng b ergosterol.
Trong nhau,
bao g
Cryptococcas ''Y '6SL'' 'y'/ S' ' ' ' v
Amphotericin B khng c hi m o. Ngo i ra, trong
nghi n c hi i lo i nguy n
Leishmania spp, v Naegleria spp.
dng
Trong th y, amphotericin B ch n ch .
Dc ng hc
Amphotericin B t h u h a, thu c c
ng ph ng ngo i tim, ho d ng
b o m ng ph thu o chi
kho
Kho -95% amphotericin trong m u li n k
h a amphotericin th ch nh biphasic). Th b n th
l -48 gi chi y.
n tm th
Kho -5 % thu i th n ho
ng ph
Amphotericin B r
c -1 g/kg) k
amphotericin B truy th
hi ng k amphotericin B v
gi
l m s ng h (1986), s ml/kg mu nh
o hai kh sau khi d ng amphotericin v ng cho r y

M o d c c d ng kh c v
v i m m
t
Tng tc thuc
n th aminiglycosides
(gentamycin, amikacin, kanamycin, ), polymycin B, colistin, ciplastin, methoxyflurane
hay vancomycin.
Amphotericin c th v
c c glycosides tr n c potassium (thiazide
ho m K c
Amphotericin v flucytosin c tnh hi ng n r
L'SS' ' 'y' 'P' ' 't' ' L' hi
kh ng n Aspergillus), v tetracycline kh ng n
kh ng v
u d
m nm nhy cm
ng dung d
h m kho
c pha.
L n v -12mg/kg.
Blastomycosis
a) Amphotericin B 0.5 mg/kg, 3 l u 6mg/kg, k
ketoconazole 10-20mg/kg (30mg/kg n
m 6 th ng.
b) Amphotericin B 0.15-0.5 mg/kg, IV, 3 l y, PO
(40mg/kg, PO b th ng trong 3 -4 th ng
ho n gi ng li ). Khi li
amphotericin B l 4-6 mg/kg, th b ng li 0.15-0.25 mg/kg, IV, 1 l
82
ho ng ketoconazole 10 mg/kg, PO, 1 l y. N b d ng
ketoconazole li -40 mg/kg, PO.
Cr yptococcosis
Amphotericin B 0.15-0.4 mg/kg, IV, 3l -175 mg/kg, PO.
Khi li 4-6 mg/kg th b ng li duy tr
0.15-0.25mg/kg, IV, 1l ketoconazole
2.5-5 mg/kg, PO, 1l y.
Histoplasma
Amphotericin B 0.15-0.5mg/kg, 3l -20 mg/ng y, PO,
1l y, d ng trong 2- n gi l 2-
4mg/kg, b ng li 0.15-0.25mg/kg, IV, 1l ng ketoconazole
10mg/kg, PO.
a:
Nhi
c) 0.3mg/kg trong D5W, IV
d) Tr pulmmonary mycoses: ng y 1:0.3 mg/kg, IV; ng y
2: 0.45mg/kg, IV; ng y 3: 0.6 mg/kg, IV.

t ha hc
Nystatin l m
ng n u nh i gi ng c
tan r
Dc lc hc

m ng t o n ng t o k o theo K b n trong t b o v
c c th nh ph n t o th at ra ngo i t o. Nystatin c t c
nhi tr
m -h d y ru
nh
83
Ny ng ch o v
chim. Nystatin c n th nh ph ch
s
Dc ng hc
b i th n b
n ho u h a v g y c c m b n

ng ph
Nystatin c th u h a (bi u ch ng li cao.

Tng tc thuc
C c s ng cho g v g t y (Myco 20 - Solvay) khng n n
k trong th nh ph m
c th c
u d
nm Candida (ung)
c)
d) 50,000-
e) y
nhim nm Candida (ung) 100,000 n v, PO, mi liu cch nha
m: Nm da v m gy ti y (Candida albican).
a) Tr -20), li nh 7-10 ng y.
N
a) Chim nui nh nh 7-10 ng y. N b
c th ng Myco -20 )
b) Tr ng kh ng sinh ho
100,000UI/ml/300g th -3l y, li nh 7-14 ng y.

Nhi a:100,000UI/kg, PO, 1l y, li nh 10
ng y.

c
Flucytosin l thu F|NKi Q|Q P |S ULP LGLQH| F|IORU|KyD|||IOF WRVLQH|Fy|P u tr Q|
Q|WU Q|Q , d Q|E W|WLQK|WK ||NKQ|P i ho F|Fy|P i nh ||S. D|W ||||-10.71. Tan nh |
WURQ|Q F|Y alcohol. Flucytosine c n F| L|O 5-fluorocytosine.
Dc lc hc
Flucytosin th m nh S|Y o t |E o n P || |k |Qy|NK |DP LQ| |W R|WK nh fluorouracil.
) OF WRVLQ|Wi F| Q|QK |P W|FK W|NKi Q|FK Q|KyD|E L|V |F QK|WUDQK|Y LUDFLO||GR|y|F Q|
tr |FK Q|KyD|S ULP LGLQH|Y cu L|F ng l F|FK |W Q|K S RNA v protein. Flucytosine
c Q|Fy|WK | F|EL Q| L|WK nh acid fluorodeoxyuredylic F|FK |W Q|K S|WKP LGLODWH|Y
cu L|F ng l t Q|K S|1 || |W Ej R|Q L||F WRVLQH|GHP LGDVH|NKQ|Fy|KR F|Fy|Wi F| Q|
r W|QK || |FK W||WK F| Fchuy Q|KyD|W R|WK nh fluorouarcil, nguy n nh n g y qu i thai |
lo i n y.
nh
Flucytosine r W|Fy|KL |T |NKi Q|Q P |USWRFRFFV|Y Candida. N |G Q| Q
Flucytosine, tnh tr Q|NKi Q|WK F|V | |UD|QKDQK|FKyQ|| F|EL W|O n P Cryptococcas
'Y L' ' S'' S' L'r ma b t ' ''PL'' i S| Q|Y L|
thu F|
Dc ng hc
Flucytosine h S|WK|W W|VD|NKL| Q|Y ph n ph L|U Q|NK S|F |WK ||7K F| Q|O m
gi P |W |O |WK F|K S|WK|||-4% thu F| F|K S|WK|OL n k W|Y L|SURWHLQ|K W|W Q|Thu F|
b i th L|F n ho W|WtQK|WURQ|Q F|WL |
ng ch nh
Suy th Q||V |W | Q||E QK|Y |P i ||E QK|DQ||7K F|Fy|WK |k |Ti L|WKDL|FKR
chu W|
ng ph
Bao g P |V |W | Q||U L|OR Q|WL u h a, ph t ban, lo t mi Q|W Q|Q Q| enzym
|DQ||WKD| L|W S|WtQK|Y co gi W| |P o.
Tng tc thuc
Trong Q|QKL P ||DP SKRWHULFLQ|%|KL S|O F|Y L|IOFWRVLQH|NKi Q|Q P Cryptococcas
r Cand/da
u d

Tr |USWRFRFFV|
a) Flucytosine 25-50mg/kg, PO, t L|WKL |||W Q||DP SKRWHULFLQ|%|||||P |N||, ||||
l Q|W Q||W L|WKi ||-5 tu Q|FKR| Q|NKL| W|OL |WtFK|O |O 4mg/kg.
b) Flucytosine 150-175 mg/kg,PO k W|K S|Y L|DP SKRWHULFLQ|%|||||-0.4 mg/kg, IV, 3
l Q|W Q||. KL|OL |W Q|V |F D|DP SKRWHULFLQ|%|O 4-6 mg/kg, b W| |G ng li |G |WU
0.15-0.25 mg/kg, IV, 1 l Q|WKi Q|N W|K S|Y L|) OF WRVLQH| |OL |QK tr n ho F|Y L|
ketoconazole |OL |||P |N||32 |||O Q||Q y.
Tr |Q P |DQGLGD|QL | R|
c) Ki P |KyD|Q F|WL |E Q|Fi FK|FKR|WK| Q|VRGLP |ELFDUERQDWH|FKR| Q|NKL|S+
Q F|WL ||||||6D|y|G ng flucytosine |OL |||P |N||32 ||P L|Oi |Fi FKnhau 8
gi |

Tr |USWRFRFFV|
d) Flucytosine 200mg/kg/ng y, PO, chia 2 l Q||P L|O Q|Fi FK|QKD|||L ||. W|K S|Y L
amphotericin B (0.25mg/kg trong 30ml D5W, IV), li |WUnh 3-4 tu Q|
e) Flucytosine 25-50mg/kg, PO, 4-6 tu Q||N W|K S|DP SKRWHULFLQ|%||||5mg/kg, IV,
3l Q|W Q|||-4 tu Q|
f) Flucytosine 125-250mg/ng y, PO k W|K S|DP SKRWHULFLQ|%|||||-0.4 mg/kg, IV,
3l Q|W Q||. KL|OL |W Q|V |F D|DP SKRWHULFLQ|%| W||-6mg/kg, b W| |G ng li duy
tr amphtericin B |P F|||||-0.25 mg/kg, IV, 1l Q|WKi Q|Y L|IOF Wosine li |WU n
ho F|NHWRFRQDROH| |OL |||P |N||32 ||||O Q|Q y.

Itraconazole l thu F|NKi Q|Q P |WULDROH|W Q|K S||Fy|F |WUF|W Q|W fluconazole
tr Q|O Q|SKkQ|W |||||Y pKa = 3.7.

Fluconazole l ph F|K S|triazole c tnh ki P |Q P ||IQLVWDWLF|||i F|G Q| W
WULDROH|Wi F| Q|E L|V |WKD| L|P ng t |E o c D|Q P |QK |F P |GR|y|Oj P |W Q tnh th P |
c D|P ng t |E o l m cho c c th nh ph Q|E n trong t |E o th at ra ngo i v suy y |K S|WK|
ti Q|FK W|SULQ|Y pyrimidine. Itraconazole c hi |T |Y L|Fi Fn P |k |E QK|NKi F|QKD|EDR|
86
g n i da. Trong itraconazole c hi ng
c Cryptococcas /stop/asma /astomyces r Tr/panosoma
cra/
nh

Cryptocca/ men/ng/t/s /astomycos/s r /stop/asmos/s cj n c h/ 'T ' ' L
n k
h hormon (khng gi ph n th nh
ketoconazole. tr
Coccidioides immitis g y vi m t
nh
H y thu o pH d y v s d y.
C y r th
thu ph n ph i kh
c c m, nh m c n d
trung c m m th o, th

nh nhi nhau,
n ho
ng ph
Itraconazole g y t c d u h a, bao g u ch bi
v vi m m o, t c d s
suy gan.
u
N Itraconazole.
Tng tc thuc

kh ng acid, c c thu cimetidine, ranitidine, ) ho didanosine s
l m gi ng c c lo n, n n d ng sau Itraconazole
2 gi v
chuy
87
k
phenytoine ho
t n c c thu
glipizide, ) l m gi huy
u d

Tr
a) 5mg/kg, PO, 1-2l y

Tr y.
N -2 l y; k cin B.
a:
Tr y.

Miconazole c c
tr
do Candida, d m ho m t m
m amphotericin khng c hi dung n
Miconazole d m i ch
Ti m t c th ho
tim n do c c ch b
ch m t n th ng
c b

c khng nm ph r ng, t hp thu qua ng ti
thu n hnh thoi (MYCELEX) ng
-h dung d
kem (LOTRIMIN) d ng tr versicolor. D
tr
2 c tr nguyn sinh ng vt

88

c
Metronidazole l ch
khu u tr
v ng nh alcohol. Base Metronidazole
d n ho h ti m t Metronidazole HCl t
ti m, r
o qun
Metronidazole d n v HCl d n b v
tr nh nh s ng.
inophylline,
carbenicilline disodium, cefazolin sodium, cefotaxim sodium, cefoxintin sodium, cefuroxim
sodium, cephalothin sodium, chloramphenicol sodium succinate, clindamycin phosphate,
disopyramide phosphate, gentamycin sulphate, heparin sodium, hydrocortisone sodium
succinate, hydromorphone HCl, magnesium sulphte, meperidine HCl, morphine sulphate,
moxalactam disodium, multielectrolyte concentrate, multivitamin, neltimycin sulphate,
penicilline G sodium v tobramycin sulphate.
C c thu
naftate v dopamin HCl.
Dc lc hc
Metronidazole c t c d acid nucleic
c
Metronidazole c hi bao g
( ), Fusobacterium, Veillonella, Clostridium sp,

Metronidazole c l n

Trophozoite c encyst (bao nang).
nh
89
i trong m o. N c n

LLP'L''Y 'L ' 'L P'' ' 'Y P' ' 't'
Dc ng hc
Metronidazole h r
cao ( -100%)., nh 80%. N th
d y s
Metronidazole r d a tan trong lipid v v r
r v d
bao g thu n k
huy ng r
Metronidazole chuy n ho
khng c n ho i th thu
c ch nh th -5 gi -4.3 g
ng ch nh
Metronidazole ch
Nitroimidazole. Metronidazole ch khi s
Metronidazole g y qu i thai i th th nghi v n d ng thu
trong th
ng ph
T c d n ch bao g ni
bi ti u ch
Ng ng li
u
Metronidazole c d n
t
Tng tc thuc
Metronidazole c th i PT c
courmarin kh c.
Phenobarbital ho l m
gi
90
Cimetidine c th m gi c
metronidazole.
Alcohol c th
v
u d

g) li
trnh 5 ng y.
h) 50mg/kg/ng y, PO
Nhi ng k
a) Vi khu m m ng n o: 25-50mg/kg, PO, m gi
b) Vi m t i m -30 mg/kg, PO; c th Li
trnh 4-6 tu
c) Vi m ru - 60 mg/kg, PO
d) Tr y, 1l y. Li nh 5 ng y.

-20 mg/kg, PO, 1l y, li nh 5 ng y.
Nhi ng k
a: Nhim tr kh: 152 i liu cch nhau 6 gi.
m tr kh: 50 mg/kg/ln/ ng u tr
6 Chng 6. THUC KHNG VIM V KHNG HISTAMIN
6.1. THUC KHNG VIM
6.1.1. Khi nim
s ay ' ' ' ' '' ''' ' 'Ie '
a ' '' ' '' ' ' '''''' ' ' ''' ' ' ''
'' '''
6.1.2. Cc giai on ca qu trnh vim
6.1.2.1. Giai on cp
i ' ' '' ' ''' ''' ' ' ' ' ''
ay
Cht trung gian Ngun gc
Dn
mch
Tng tnh
thm mch
Ho hng
ng
Gy
au
e ai a q ' i HH J J
pia qa ' HLJ J J
oaa e o ' HHH J HHH
miab
O
HHH HHH H
i ia J HHH J
6.1.2.2. Giai on p ng min dch
' ' 'I ' ''''' '' 'y iay a '
o ay ' ' ' '' ' ' ' ''' ' ' ' ' '
I ' ' 'ioi ' ' ' ' '
6.1.2.3. Giai on vim mn
ia ''''''' '' ' '' '' i '
' ' ei ' '' ''2 '''' ''' o
i ' ' '' ' ' ' ' '
k a ay e ' '' '' ' ' ' ' ' ' ''y F '
oi ' ''' ai ' ' '' ' ''' '' ' '
6.1.3. Cc cht khng vim
` '''' ' ' ' 'o ' ' ' '
' ' ay ' ' ' ' ' ' ' ' ''' ay
6.1.4. C ch tc ng ca thuc khng vim
6.1.5. Phn loi
Thuc khng vim glucocorticoid
6.1.5.1. Glucocorticoid t nhin
d ''' ''oiaEiaF ia iaai ay
' '' ' ' ' '' ' ' ' ''''y ' ay
i ' ' '''' ' ''y iaai ' '' '
` ''' ' '''''ia
Endoperoxid
Tac nhan gay viem
Phospholipid mang te

orticost eroid
Acid Arachidonic
Hydroperoxid

Leukotrien

Prostacyclin
Prostaglandins
Thromboxan
NASIDs
NASIDs mi
VIEM
iu ho bi tit
Hnh 6.1: C ch iu ho bi tit cortisol v cc glucocorticoid khc
h aia o ' '''' ' '' ' ' ''' '' '
Ei o 'yFK ` qe oe iia ' ' ' 'aia ''''' ' '
' ' ' ' 'i o ''' ' ' ' ` qe K
' ' ' ' '' 'NR''''''''' '' ' '
OJP '' '' '''' '' 'i '' '' ' 'ii '
''' '' ' '' ' '' ' 'y '''
' ' 'a ' ' ` qe oi ' ' '' 'aia ' '''''
' ' ''' '' ' ' '' Ua ''''' ' '''' 'y i '
'' ' ' ' ' 'y I ' ' ' ' ' ' ' '
i ' ' ' ' 'o 'i ''aa 'o '''' ' ' '
' ' o ' ' '' iaaa 'y ' '
'i ' 'oK
6.1.5.2. Glucocorticoid tng hp
C ch tc ng
o ei '' ' '' ' ' ' ' ''
''' ' ' ' '' '' '''' ' ' '
'' ' '' ' ''y '' ' 'ie ei '
' ' '''' 'aeia o ' ''''' ' '
' ' ' ''' ''i IeiaK
Tc dng ph
q ' ''''' ' 'k Ia ' ''
q '' ' '' ''' '
q ' ' ' '''' '' '' '' '''
i i ' '''' ' '' ' ' ' '' '' a '
o
d a ' ' ' o e ' ' ' '' ''' ' a '
'
Ch nh
a ' '' ' '' ' ' '
h ay ' 'yE ' ''' '' 'I a ' '''''
` ' '''' ' '' ' ''' ' '' '' ''' ' '
'''
Chng ch nh
qa ' '''' ' a '' 'yF
i '' ' '''' ' ' ''' ' '
i ia '''' ' ' '
' '' ''y '''' IEi '' ' ' ' '
'''''' '' ''' '''''
Mt s thuc khng vim glucocorticoid
Tn hot cht
Khng
vim
Gi mui
Thi gian
Tc ng
Liu dng
e oia
E` iaF
` ia
ma
ma
N
MKU
Q
R
N
MKU
MKP
MKP
k '''
EqNLO SJNOF
q
EqNLO NOJOQF
ONM LmEml F
MKSJOIR LmEml F
i i
a i
OR
PM
M
M a a
EqNLO OQJPSF
MIOJO LmEml F
6.1.6. Thuc khng vim khng steroid (non-steroidal anti-inflammatory drugs - NSAID)
6.1.6.1. Cc NSAID c
(1) Aspirin
eaaaiaaaiK
Tnh cht
eaa '' 'a ''' IiiPMMe ' '' '
' ' ' '''yiK
q '' '' ' ' ' 'eaaea 'aiaoa ai
yiaKq o '' ' ' '' '' ''''' ' ' 'yio
' '
' ''' ' ' ' ' '' ' ' ' '''` aiiI
mei iKq ' ' ' ' '''' iaaI ''
Ch nh
' 'i 'y I ' ' '' ''y '
ay oi '''''' ''' ' ' ''''''' ' ' '
''''' ' '' ' ''' '' ''' ''' '''
a ' ''' ''' ''' ''
Liu lng
` a 'yIo ay ' ''' ''' ' a ' '
oW
d a WNR PMK
d a WOR
d a WMIORO
s ' ' '' ' ''''''''oI ''' '' ' ' ''
bFK
C h :
- '''''' ' ''o ' '
- q '' '' '' ' ' X
- q '' ' '''' ' 'a Iyi ' ' 'a
oX
- q ''ai '' ' '
- ` i ''' 'oIi 'oI '
- e a ' 'y e a '
(2) Paracetamol
Tnh cht
mi iy i aeI ' '' i ''y 'k Jio
e aeI ' ' '' ' ' ' ' iaaIy
' '' ' ''''' ' ' ' ' ' '' ' '' '
a ' 'oe ' ' ' '' '' i ' ' 'i ' '
' '''' '''' '''
Tc dng
mi i '' ' 'yIi ' ' '' '''' '
eaa ' ' ' ' ''' ' ' ' '' ''' ' '
ay K
s ' ' ' '''' a '' 'i '
oIo ' ' '' ''' '' '' ' ' '
aKp '' ''' ' '' oo ''' 'ia ''yi '
' ' '' '
s ' ''aIi '' 'o ' '' ' ' '
i a ' ' ' ' '' 'i '''I ' '
aI ' '
s ' ' ''' i ' ' ''' ' '' ' ' ' '
NMNRK
ioiei a i ''aiaaa ei I
' ' ' 'i ' '' ''' 'i ' ''
mi o '' '''''' ' 'aia '' ' ''
q '' '' '' '' 'Oa '''' 'q '' '' '
i '' ' ''' ' '''''Pa '
Ch nh
' 'i '' '' ' ' '' '' ' i '
' ' ' ' '''o '''' ''' '
q i '' ''' ' ''' '' ' ' ' ' a
e PQoK
` ' '
' 'a
Liu lng
` aaa ' 'o P '
q I WNRQM
i ''y WRNR
k WNMPM
` WNP
h ya ' '' ' ' ' ' ' ' '
C h :
p ' ' ' ' ' i ' ' ' ' ' ' 'Xi
' ' ' '' ''' '' ' ' '
` ' ' ' ' ' ''' ' ''
q '' '' ' 'a Ea ' ' ' ' ''''
6.1.6.2. Cc NSAID mi
` i ''y I ''' ''' ' ' ' ' '' ' '' '
' ' ' ' ' '' ' ''''y ' ' ''' i '
ay ' '''
Ch nh
s ay ' ''' ' '''
h ay ' ''aEi ay F
Chng ch nh
p oIi
i i 'oI ia
` '
a ' ' '
Mt s thuc NSAID mi
Tn thuc T1/2 c im
mo i
maa
I e
a a
SR
RT
O
NIN
h ay 'a ' '' '' ' '
' ''aK
' ' ' ' 'oIoN
a ' ' '
e a ' ''y ' ' ' '
(3) Betamethasone
Ha hc
i i iaai ' ''' ' ' ''
' ''''a eeiKa ''' ' 'a '
''' ''' 'y K '' ' '' '
i ' ' ' ' ' ' '''' iay K i i '
' aK i i aI i '' ' '' '''''
'' '' i ' i ''' ' '''aIii
''' '''' eei aI i '' ' '' ''' '
'' 'i iK
Chng ch nh
Betasone ch Q |FK | QK| L|Y L|WK|E |QKL P|WU ng (do vi khu Q||F S|WtQK|KR F
iK i i a ' ' '' i ''' '' ' '' '
''
Liu dng
q 'y '''
Betasone : 0.25-0.5 ml/20 pound tr Q |O Q |F |WK ||,0 ||/ L |G ng c th |WKD| L
ioiii ' ' 'i 'a ' ' ' ' ' ''''''''''
(3) Dexamethasone
Dexamethasone Sodium Phosphate
Dexamethasone 21- Isonicotinate
Ha hc
a i iaai ' ''''aI i ' '
'' '' ' '' ' ''''''''' ''a ia
eei a ''a '' i ' ' ' ' '' ''
a iONJaaiai a '' i ' ' '' ' '' '
''' ' ' ' ' '''''
aeoaI oa eiIa iaae ` IoeoiIaae ` Iaa
a Iia oa eiIeeaaoi e aK
a ia eei '' ' ' '''''
aae ` I i aaiii oaK
Chng ch nh
a ia ' ' ''' ' ' ''y '
' 'a ii ' ' ' ' ' ' Ea aaoFK
Liu dng
Ch:
qay MIMNMIMNR Liay Is Ei ''NWNM ''' ' '
' ' ' ' ' '' ''
Mo
J' ' ' '' ' ''' '''' '
J' ' '' ' ' ' ' ' '' ia aiX
a ''''' '
J' ' ' 'y Wa '''''2 '''' 'oIayi '''' '''''' ml I
O ' '
J' ' ' ' ''''' ' ' ''I ' ' '' '
iFWa '''S L Oml IN 'oIiOoK
Tru b
J' ' '' 'o ' ' '''''' ' '
J' ' '' ' '' '' ' ' '' ''aWNJO LIs K
(4) Piroxicam
Ha hc
i ' ' ''JiaF ay I i ''' ' ''''
'' '' ''' ' ' ' ''y Jia K
Dc lc hc
''' ''y Ia '' ' '' ' ''y i '
' ' ' ' ' ''' ' ' ' '' ' i '' ' '
i ' ''' '' ' ' ' ' ' ''' ' ' '
o 'y ' ' ' ' ' '
Ch nh
qyIeaa i ' '' '''' ' ' '
''aIeaa ' ' '' ' '' ' 'a ' e K
Dc ng hc
' ' '' '' ' '' ' ' a ' ' ' '' ''
'''' ' ' ' '' '' ' ' 'y i eia o ' '
''' ' ' ' ' ' ' '''''' ' ' ''''' ' '' '
'''
Chng ch nh
q ' ' ' ' ' ' ' '' ' ' ''''
oI ' ' ' '' ' ' ' ''''''''
Tc dng ph
maa oi 'o ' '' ' ' ' ''''ooi oI
' ' ' ay e '' ' ' ' ' ''' ''''eK
Tng tc thuc
a ' ' ' 'y '' ' ' '''''' ' i '
' '' 'y '' ' ' ' ' '''' ''
eo iKmaa ' ' ' ' ' 'oi '''' ' ' ' '
i '' ''eaI a F ' ' '' EaFEeaaI aaI
'''' ''' ' ' ' i 'oKk p Ia i '
a 'ai '' '' '
Liu dng
Ch
h ay W
F MKP LIml I ' ' ' QUa
h ' ' ' '' ' 'a ' 'e W
F MKP LIN 'o
(5) Flunixin Meglumine
Ha hc
c aa ai ''y JiaI ' ' '' ' a
iaKc aaiy 'PJeoaaJoaaK
Dc lc hc
c aa ' ' 'a ''''y I ' ''' '
' ' ' ' '' ' ' ' ' ' ''''y i '
a ' '''''
Dc ng hc
c aa ''' ' ''' '' ''UMB '
' ' ''' '''''''' ' ' ''''' '' '' '
'''' '' '' ' ' ' ' ' ' ''''' '' ''''' ''
UKNa '''' ' i '' ' ' ' ia '''' '''i '''
Ch nh
'' ' ' '' '' Kq ' ' ' ''
' a 'y a ''' ' ' ' ' ' '' ' '' '
'''''' ' ''' ''y ' II ay '
iI '' ''y 'a '''W ' '''y ''
a '' ' ' '' '''iay o 'yXe W ay Iiay ''
K
Chng ch nh
i i 'oI ' '''' ' ' ' ' ''' '' 'a
'''''''i ''K
Tc dng ph
' ' ''y Ia '' ' '''''' ' 'i
ii ''' ''' ' ' ' '' ' ''' ' ''i
'''yi ''' ' ' 'o '' eia o '' ''' ' '
iay i ' ' ' ' '' ' '' ' ''y ''''a '
' aK
Tng tc thuc
` a ' '' '''''' '' ' ' ''
i ''y IaoiI aIi ' ' ' '' aI
iiiIeaaKs ' '' ''' a ' ' ' ' ''
Liu dng
Ch:
F MKRJOKO LII ' '' 'N '
F N LII ' ''' 'oIe PoK
F a iWMKOR LIIs IN 'oIe RoKa '
ae ' '''''' '
F ' ''''''''' '''' 'oK
F d a 'o ''''''' ''' '
F q ' ' 'oI ''''''''' '''JO 'oK
B:
F ''''''''''''''' ' Ua '' '
F q ' '' ''''''JRMM IIs ' '' ' ' ' ' ' 'OJP
oK
Nga:
F qay NKN LIIs ' ''' ' '''' '' ' '' ' ''' '
a ' 'iay Is K
(6) Hydrocortisone
Ha hc
e oia ' ' ' '''''' ' '
i o ' ' ''''aI i '' ' '' '' ''
'Ke oia '' ' '
e oia '''iaiiIoiaa eeiI
oiaa aiK
''' ' ' ' ' '''''
eiaa I oa eiIeeaaa I i aaiiiIa
ai e ae ` K
''' ' ' ' '' 'i ''
io aIo aiiI aaI aeoaI eiaa Ia a
iIeeaaa I eaa aiIa oaeeiI
oi oaiaiIaae ` Iia oaa Ieaaad eia I
eaeaaa Ieo aa eiIeia aIeeaaoiI
a aiIiaeia I oae ` I e ae ` Ie 'J` K
e oiaa ai '' ' '' 'i ''
eaaa a I oa eiI ai ii a I aeoaiI
aeoo ae ` I aae ` Iea eiIeaa Ioae ` I
i a aiiiI iaaa a I aa a I oiioa e ` I
eiaia Ieaia Ie iae ` Iaia
iioaK
Liu dng
Ch, mo: Khng vim
R LIml I '''' '''''' ' ' '''' 'o
Shock:
Fe oiaa aiWNRM LIIs
Fe oiaa aiWRM LIIs
B
h ' ' ' ' ' ' ' ' '' '''''JSMM iNMMM K
Nga
h ay We oiaa aiWNJQ LIIs
(7) Ketoprofen
Ha hc
i ' ' '''' ''y JiaI i '' '
''''' ''' '''' ''''' '''''' '
' '''''''
Dc lc hc
''' ' ' ' ' ''y J'''''
a ''' ' '''y Kh ie ' ' '''ai '
iia ' ''' '''' ' ' ' eia ' ' ''
h ie ' '' ' ' '
Ch nh
qy ''' '' ' 'y a ''' ' '
'
Dc ng hc
h ie '''' ' ''''' '' ' '
' a ' ''' '' ' ' '' '' ' E ' '
''''''' ' ' ' '' 'Oa '''i ' ' ' '' '
NOa '' ' '' '' ' ' ' ''''' 'h iei ' ''''
Chng ch nh
i i 'oI ' '''' '''y ' '' '' '
'' '''' ' ' ' '' '' '' ' '
' ' ' '''''iei a ' ' ' ' ''''
i '''' ' 'iaKi a ' i ' ''' ' ''' ' '
' ' ' '' ''' ''a ia ' ' ' '
eiai ' ' ' ''' '
Tc dng ph
'' '' ' ' ''' '' '''' o
' 'o '' 'o '' ' ' ''y E ''''y ' '
Qu liu
' '' 'a ''' LIIs IN 'oINRo ' ' ' '
s ay '' 'a '''''oIRoE '''' ' ' ' ''a
a '''''oIRoE '''' ' ' ' ''' '' ' '' ''
'' '' '' i '' 'y 'oI ay i ''y Ki a RM ''
OMMM LIml K
Tng tc thuc
h ie ''y '' ' ' ''eo iI
iei ''' 'o ' ' ' ' ' ''' o' ''''
ie ' ' ' '' ''' '' ' ' ' ''
'y EeaaI aaIeo iI iaiaI FKh ' '
ie '''' a ' 'i ' 'e ' ''''
a 'y ' '' ' '' ' '' ' a 'ai '
iii o ' '
Liu dng
k ''''''''' ''' 'oIRoK
(8) Methylprednisolon
Ha hc
ioeaS J ioeaK ioea iaai
eI aI iiai K
ng tim tng hp vi cc dung dch v c sau:

t c tnh cnh tranh vi methylprednisolon sodium succinate: calc

Ch ' '
d t, ri lon tm thn cp tnh, v i chng Cushinoid. Tiu
ng, lo g xng, lon thn kinh, suy thn.
Li 'ng
Ch:

u u: 1 n, 5 u hiu lm s
m, d u n nh (1 p v ng 7 sng, n/ng n.
Sau gim liu
i liu cch nhau 8 gi. Methylprednisolone
i 14 ng
(9) Fludrocortisone Acetate
Ha h
ng hp, c tc ng ca mt cht khong cortico
ng bt m ng hoc v t hoc ng
, khng m t tan chy khong 225oC, khng tan trong nc, tan trong
c gi l
c tn thng mi: Florinef

Acetate.
' '
t corticosteroid c hiu lc cao; c c hai tc dng ca
mineralocorticoid v glucocorticoid. N c s dng i hiu lc ca
tr tc ng ca mineralocoricoid l ngoi bi ng thn, ni tng hp
ng nh hng b i K+v c c th o sa.
Ch nh
Fludrocortisone c d iu tr thiu nng tuyn thng thn nh
c c c dng tr tng kali huyt (hyperkalemia).
Dc ng hc
Fludrocortisone c hp thu tt qua ng ti i mc cao nht khong 1.7 ,
i gian bn hy khong 3,5 , nhng tc ng sinh hc ko d ng 18.
Qu liu
u c th dn n gim huyt p, ph ng v Kali huyt; cn cung cp
t in gii. Nn ngng dng thuc cho n khi cc du hiu tr m dn v sau bt u
u thp hn.
Tng tc thuc
u kt hp fludrocortisone vi amphotericin B hoc li tiu l
c li tiu c th gy mt l
t tc dng ca fludrocortisone. Fludrocortisone lm tn u bnh nhn tiu
ng v m nng salisylate trong mu.
Liu dng
Ch
thng thn:
u u: 0.1 ng ng m tra nng sodium hoc potassium trong
t thanh mi 1 n sau khi d c.
kali t: 0.1 kali huyt c th do iu tr suy v thng thn.
Mo
thng thn: 0.1mg/ng b sung prednisolone hoc prednisone
u 1.25mg/ng c ti liu 10 mg, IM, n/thng.
(11) Glucocorticoid
Dc lc hc
u qu i vi hu ht cc loi t bo v c quan ng vt hu .
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''' ''''' ' '' ' '
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i 'Ii ''y a ' 'y a ' ' Ea aaai aaFK a '
' ' '' '' ' ' '' ' '' ' '
' ' ' ' ''' iaaii i
i ' ' '' 'iaeai ' ' 'y ' ' ' ' ' ' i '''
'' '' ' ''' ' ' ' ' '' ' ' i '' '''
'' ' ' ' ' '' 'yKqaoaI ' '' '
' '' '''' ' ' ' ' ' ' ' ' ' '' ' '
FK
e ' ' '' '' '' ' ''' '' ' '' ' '
ia ' ''''' ' ' ' ''' 'ai '' '
'' ' '''' ' '' ' '
'' ' ' '''ai '' '' 'yi ' '
eE FI '' ' ' '''
'' ''''ia ' ''' ' ' ' '' '
ia 'i ' '''a ' '''' ' ' ' ' ' iai '
' ' ''' '' ''' 'ia '' ' ' 'a
' ' ' '' ' ' ' ' '''d iaaay ' '
eia o ' ' ' ''a '' ' ''a ' ' ' '' '
'' ''
q '' ' ' ' '' '' ' ' ''
'' '' ''' '' ' ' '' ' 'K
a W ' '' '''''' ' ' ''
Ch nh
' ' ' '' ' '''' ''y '' ' '
'' '' ' ''' ''''' ' ''' ' '' ' '' '' '
' ''' ''' 'y Ei 'FKKKd iaa i ' ' ' '
' ' ' ' ' ' a ' '''' ' '
Chng ch nh
' ' '' ' ' ' '' ' ' ''' ' '
iay ''' ' ' ' ' ' '' ' ' ' '' ' '
iaaK
Tc dng ph
q ' ' ''' ' ' '' ' '''' ' 'aa '
K h ' ' a ' ' ' ' ' ' ' ' ' '
Eoeiaa FKq 'oa '' 'i ' '''' ' i '
' '' '
k ai 'a ' ' ' ' ' K 'yI ''
EeoaeaFI ' ' '' ''''''' ''''
6.2. HISTAMIN
6.2.1. Cu trc ho hc ca histamin
e ai aOEQa aoFio a
6.2.2. Ngun gc tng hp v phn phi
q ' ''' ' ' ' ' ' '''''
i ''' ' ' '' ' ' ' '
me '' '' '' ''' ' i ' iE '''y '
e ' ''y ' '''' ' ' ' ' '''' ''' ' '''
'' ' ' ' ' ' ' ''''' '''
6.2.3. Phng thch
h a oyia '' 'i '''y ' ' ' '' ' ' '
iy ' ' ' i ea ' ' 'oeiai a aIe '
''a '' ' '' '
' ' ' ' '''''' ' ' ' 'i
iyi ' i ' ' ' ' ' ' i '' ' ' ' EeaFI
'' ' '' ''' ' ' ' ' ' ' '
6.2.4. C ch tc ng
' ''' ' ' ' ' '''''' '' Ie ' ''
i o ' ' '' ' ''''''' ''' 'oIi ''' '' '''' ' ''
' '''' ' ' '
d aia ' ' ''' ' ''
'' ' '' o ' ''' '
` i ' '
` i ' ' '' '
h ii a '
q ' ' ' ' 'y ' ' '' ' ' ''' '' ''''' ''
i '' ' '''' '''
6.2.5. Tc dng dc lc
Tr n tim m m gi n c c ti ng ti ''
' ' '' 'ya ' ' ' 'yIa ' ''iKq ' '
''''''''' ''' ' '''' ' ' '
'' ' '' '' '''o ' ' ' ' ' ' ''''
eF ''' '' 'ei ' '' ' ai ao ' ' ''' ''
i ' '' ' ' ' ' 'i '
nh h ng c u
' ' ''' ''y '' '' ' ' '' ' 'a
' ''' ' ' '' ' '' ' ''i '' e ''I
' '' ' '' ' ' '
T ng th inh: Histamin kch thch r
''' '' ' ''''''''' ' ' '''
' '
Tr n m b i ti y b i ti b i
ia 'ea ' ' ' ' ' '' '' ' '' '' 'o ' ' 'y
i o ''' ' '''aia ' ' ' ' '
6.3. THUC KHNG HISTAMIN
` i ''' ' ' ' ' ''iaai
' ' ' ' ''y Ie ' ' '
Nhm Tn thuc Receptor c im - Liu dng
o a
bi a
miaa
maeaa
` ea a
a aeo a
E bk a o v i F
m ia
Eme bk bo d k F
i a
Ee Ipq i l k d F
e
N
e
N
e
N
e
N
i '
i '
i ' 'JMIOJN LmEI I
Is Iml F
h i 'JOIRJNM Lm
Eml Fa
(1) Cyproheptadine HCl
Ha hc
` oeeiai ''''' ' ' '''' i
' '' ' '' Kh '''''iiN 'OUKS L
K
Dc lc hc
` ' ' ' ' ''''''''' ' '
'' '' ' ' ''yeie N ' ' ' '' i ''
ai '' ' '''' ' '' ' ' '''
` oeeia ''' '' ''e 'y` K
Ch nh
' ' ' ' ''' ' '' '''
' 'Kk aIi ' ' ' '' ' ' ' ` ai '
` oeeiai iaK
Dc ng hc
' ' '' ''' '' ' ''i ''a
i '' ' '
Chng ch nh
q ' ' ' ' ' '' ' 'e I oia Ki a ' '''' a '
' ''' ' ' ' ' '' '' '
Tc dng ph
` oeeia ' ' ' ''' ''' '' '' ''
E oI FK
Qu liu
' ' ''' ''' '''' '' '''oIia '
Iia ''' ' '' ''i ' ' '''' ' ' ' '
' ' '' ''' ' ''a '
Tng tc thuc
k ' ' '' ' ' ''' ' '' ''
i '' '' ' '' ' ' '' ' ''' ' ' ' a
''''' ' ' ' '' ' ' ' ai aK
` oeeia ' ' ''''' ' ' ' ''
eiai o ''
Liu dng
Ch:
h ai aW
F NKN LIml I ' ' '''JNOa '
F MKPJO LIml K
Mo:
'''' '
F OJQ LIml INJO 'oK
F O LI '''' '' 'ToI ' ' ' ' ' ' '
(2) Chlorpheniramine Maleate
Ha hc
i eeo aEo aF ai aI` ea a i aI
i '' ' '' ''a ' '' ''''JNPR` Ieh VKOKe ii '''''''
ENLNM FK
' ' ' ' ' ' '' 'y i ' 'i W
aa iIaiai aROBLaiaia UBKIi i a
SMB Ii ia UMBK
` ea a '' ' ' ''''''''
eaeaaiiIeiaia aae a aROBK
Dc lc hc
` ''''''''' ' ''' ' ' i
iyeie NK` ' ' ' ' ' '' '' '
'' ' ''yi 'Kk ai ai aI 'o ' '
a 'i ''' ' ' '' Ks ai '''
i ' ''''' iaEoeeiaIiaFK
Ch nh
` i '''' ' ' ' '' ' ' ''
Dc ng hc
qyi ''ea aee ' '''y Is Ii ''' ' ' '
ia Ii ''I '' KTMBi 'y ' '' ' '` ea a
' '' ''
Chng ch nh
'''''''''' ' '' ' '
i o ' ' '' ' ''' ' ''' '' ' ' Eoeioaa FI
'' '
Tc dng ph
'' ' ''' ''''' ' '' ' ' ' 'y
Eiay ''' ''a ' ''' ' ' '' ''' ''' ''''''''''''''''''''''''''''
Qu liu
n a '''' ''' '' '' '' '' '' ' '
' '' '''' '' '' ' ' ' 'oIo i ' '
i ' ''' '' ' ' ' '' ''aa ' ' 'oK
'' '' ' ' '' '' '''i ai i '
ae K
Liu dng
Ch:
F QJU Iml I ' ' ''''' '
F OJQ Iml K
Mo:
h ' ' ' 'y 'WO Iml I ' ' ''''' '
(3) Dimenhydrinate
Ha hc
n xut ethanolamin khng histamin, Dimenhydrinate cha ng
t v ng, ng bt tinh
, m ng, nhit tan chy 102 trong nc v do
c alcohol.
Dimenhydrinate tng hp vi hu ht cc dung dch truyn tnh mch v c:

nh tranh vi cc cht sau: aminophylline, ammonoum c

Dc lc hc
ng i, i giao cm, u thn kinh v
c b. C ch tc ng ca thuc chng i l c ch kch thch tin
ng khng giao cm ca thuc c th l kch thch a tin
li. Tc dng l u thn kinh trung ng (CNS c dung np sau
vi ngy iu tr v u qu chng i cng gim t nu iu tr ko d
Ch nh
Dimenhydrinate c ch nh chng i cho ch v
Dc ng hc
c c hp thu tt sau khi ung v ng chng i sau khi ung 30 pht.
ng i ngay lp tc sau khi ti nh mch. Thi gian tc ng t 3 .
c chuyn ha gan.
Liu dng
Ngn nga v i:
Ch:
i liu cch nhau 8 gi.
n/ng
Mo:
' ' '''' '
'
(4) Doxylamin Succinate
Ha hc
' ''''' ' ' ' '
' ' ' '' ' '' ''''
Dc lc hc
' ' ''' ''''' ' '
'''' ' '' '
Ch nh
' '''' ' ' ' ' ''' '
Chng ch nh
' '' ' ''''
'
Qu liu
''' '' '''' '' ' ' ' '
Tng tc thuc
' ' ' ' ' ''' '' '' ' '
' '
' '' '' ' ''
Liu dng
Ch, mo: 1.1-2.2 mg/kg, IM hoc SQ, mi liu cch nhau 8-12 gi.
Nga: 0.55 mg/kg, IV (tim chm), IM hoc SQ. Liu duy tr: 2.2-4.4mg/kg/ngy, PO,
chia '
B: 200-300mg, mi liu cch nhau 8-12 gi, PO, IM hoc SQ.
Cu, heo: 100 mg, mi liu cch nhau 8-12 gi, PO, IM hoc SQ.
(5) Hydroxyzine HCL
e m
e
n xut pipera ng, dng bt,
khng mi, tan trong nc v ng t,

Hydroxyzine tng hp vi cc thuc sau: atropin sulphate, benzquinamide HCl,

Dc lc hc: (tt cc cht khc), hydroxyzin do bi s cnh tranh vi histamin ti cc
c khng histamin khng c ch gii phng histamin nhng i
i hiu qu ca histamin. Ngo ng khng
tnh i giao cm , an thn, gy t ng i.
Dc ng hc: Hydroxyzine hp thu tt v ng. Hiu qu ti a 6
trn ch v di 12 gi mo. Hydroxyzine c chuyn ho nhanh
ng ch nh: ch dng hydroxyzine cho bnh nhn bi trin tuyn gip, co
t c b ng. Hydroxyzine gy qui thai cho
m.
ng ph: hydorxyzine gy an thn. ch, tc dng n hn. Thuc khng
gy c n ng nhy cm. Ch thng pht trin chng
t trong khi ung thuc ny. Cha xc nh c liu an to
u/c tnh cp tnh: qu liu gy tng tnh an thn v m huyt p.
Tng tc thuc: Nu kt hp hydroxyzine vi c lm suy nhc thn kinh
ng s gia tng kh nng lm suy nhc thn kinh trung ng. Tng t, u kt hp
i cc tc nhn gy i giao cm th l gia tng hiu qu n
c ch hoc ngn cn hiu qu gy co ma epinephrine. S dng
c metaraminol.

pruritus: 2.2 mg/kg, PO, 3 ln/ng
b) atopy: 2.2 mg/kg, PO
c) cht: 2 mg/kg, PO
d) n/ng
a:
c PO, 2 ln/ng
dng mi palmoate: 0.67 mg/kg, PO, 2 ln/ng
K ''
' ' ' '
' i ' 'K 'K ' i
'' ' i ' '' i ' 'Ki '
' '' K'
T K ''''' ' ' ' '
TKNK ' ' ' ' '
' i
Thi |P i |O s |WKL |K W|WK |WtFK|P i ||L P |V |O Q|K Q|F ||L P |Kj P |O Q
hemoglobin xu Q|G L|P F|K Q|V |VLQK|O |

' i ''K ' ''' ' i '' S'tK'K 'K' S'K'p '
do nhu c |GLQK|G Q|LD|W Q|WURQ|Fi F|LDL|R Q|SKi W|WUL Q||KHR|FRQ|V |VLQK|gia s c mang
thai). L c n y h Q|F |V |QK |K Q|Enh thu Q|Yj |Kj P |O Q hemoglobin s |L P |
' i '' ' i ' ' S'K '
tr ng (giun m c...)
' i '' ''i 'E ' 'E 'SKi 'K '' r'K'
v W||WL n mao tr ng, l d Q|WU ng...), vi khu Q||YLUV||FK W| F|KyD|K F|||
' i '' ''' ' ' ' ' 'i ' '' 'K'K ' ''E K
truy Q|QKL P |GR|YLUV||DUUp|||FK W|KyD|K F||FKORUDP SKHnicol). L c n y kch WK F|Y s |O Q |
h Q|F |Y Q|Enh th Q|QK Q|V |O Q|WK gi P |
' 'r'' 'i ' ' i
T Q|K S|KHP RORELQ|Oj |LDL|R Q| |F D|Ti |WUnh s Q| W|K Q|F ||6 |W Q|K S nh n
hem x |UD|FK | | |W|Wh ||6FFLQ O|FR | s Q|SK P |W |FK|WUnh Krebs s |N Wh S|Y L|
Glycin qua m W|V |E F| |W R|Q n pyrole. 4 pyrole hnh th nh 1 ph n t protoporphyrin. Sau
y||) H| F| Q|N W|Yj R| |W R|WK nh nh n hem. Cu L|F ng, 4 nh n heme g Q|N W|Y L|SKkQ|W |
ORELQ| |W R|WK nh hemoglobin.

M W|WURQ|QK Q| |W |F |E Q|WKDP |LD|Ti |WUnh t R|P i |O Fe. Fe3+ trong th F| Q
F|+O|G |G y kh |WKj QK|) H|||Yj | F|K S|WK|QKL |QK W| |Wi |WU ng. Fe s | Q v L|
apoferitin th nh ferritin. Khi c Q|WKL W|IHUULLQ|V |QK |) H|UD|Fho Transferin v Qchuy Q|| Q|
nh Q|Q L|F Q|WKL W
Thi
Heo con nui theo l L|FQ|QKL S|Fy|Q Q|V W|FDR|Yj |SK Q|WK F|QL|QK W||NKQ|
nh Q| F|Q Q|FQ|F S|V W|Q o ngo i th F| Q||Q n nhu c |) H|FDR||1 |FK |E s D|P |WK
heo con s |E |WKt |) H||7URQ|||W Q| ||KHR|FRQ|W Q|NKR Q||||||nhu c |) H|NKR Q|
|||P ||) H| F|FQ|F S|W |V D| |NKR Q|||P ||W Q| Q 1mg/ ng y), Fe d |WU |
kho Q|||P ||R|y|F Q|SK L|FQ|F S|E |VQ|) HFKR|KHR|FRQ|WURQ||||Qj | ||7K Q|
c S|Y o ng y th |||Y th ||||||||P ||FRQ|||, 0 |
Protein l ngu Q|FQ|F S|Q n li | |W R|ORELQ||R|y||FKQ|WD|NKQ|WK |Wi FKr L|

vi F|L |WU |WKL |P i |Y L|P W|NK |SK Q| | |SURWHLQ|| P | Q|Y W|

Vitamin B12 l coenzym methylcobalamin, B12 c ng v L|DFLG|) ROLF|V |WKDP |LD|Y o qu
trnh v Q|FK Q|QKyP |P HWK O|Knh th nh nh n purin v pyrimidin; chuy Q|KyDpropionate
th nh succinyl coA cho qu trnh t Q|K S|SRUSK ULQ|

Acid folic gi |YDL|WU quan tr Q trong s |W Q|K S|SULQ|Y pyrimidin, qu trnh chuy Q|
h a serin v glycin (ch W|FKR|QKyP |P HWK O|||R|IROLF|U W|TDQ|WU Q|WURQ|V |W Q h S|DFLG|
nucleic n n c c m c t F| |SKkQ|FKLD|QKDQK||FDR||QK |W |E o ni m m F ru W||W |E o t |
Q|U W|F Q|IROLF|

LWDP LQ|%||WKDP |LD|WURQ|LDL|R Q| |F D|Ti |WUnh t Q|K S|SRUSK ULQ|NKLsuccinyl
coA v Glycin t R|WK nh acid aminolevulinic

Cobalt l m W|WK nh ph Q|F D|YLWDP LQ|%|||| DQRFREDODP LQ||Fy|YDL|WU l m W| Q y |
t ||RIDFWRU||WUong s |W Q|K S|SULQ|||S ULP LGLQ|Y s |Knh th nh h Q|F |

Q|O m W| Q| |W |FKR|QKL |HQ P |R KyDNLP |OR L|QK |IHUUR LGDVH|R KyDFe2+
d |WU |WURQ|) HUULWLQ|WKj QK|) H|||| F|Y Q|FK Q|E L|7UDQVIHUULQ|Y k W|K S v L|QKkQ|KHP ||
ho F|WKDP |ia v o h |WK Q| WRFURP ||R LGDVH|Y Q|FK Q|L Q|W trong chu L|K|K S|P |
b o t Q|K S|73
C c y |W |NKi F||YLWDP LQ|QKyP |%||YLWDP LQ|||YLWDP LQ|( ||0 Q|||

Iron dextran : 200mg/ml
Ph ng ng D|WKL |V W|FKo heo con, m W|OL |G |QK W||,0 ||Y o ng y tu L|WK |||

Ferrous .................... 100mg/ml
B12 ......................... 75g/ml
S |G Q|FKR|KHR|FRQ||||P O||,0 |

Fe ............................ 18mg
Cu carbonate .......... 6mg
Co sulfate................ 3,75mg
Vi n nang d ng cho ch t |||-15kg (1 vi n), 5kg (1/2 vi n)

Fe ............................ 27,5,g
B12.......................... 20mg
Folic ....................... 3,3 g
Cobalt ..................... 33,3mg
Dextrose
B W|G ng cho ng D|||-30g/ ng y t y theo tnh tr Q|WKL |P i

Fe.........................230mg
B1........................15mg
B2........................25mg
B5........................300mg
B6........................15mg
B12......................500g
Folic......................7,5mg
Cu .........................18mg
Co .........................1mg
Glycin ..................100mg
Lysin.....................200mg
Methionin .............100mg
D ng cho ng D|||||-500kg) 1 g i / 10 ng y
'
Vitamin C.............100mg
B12.......................15 g
Fe fumarate ..........300mg=100mgFe
Folic .....................1,5mg
D ng FKR|Q L|O Q|||YL n/ ng y (tr nh kch Q|E Q|Fi ch u Q|WU F|E D| Q|
TKOK ' ' ' ' ' ' '
' i
L hi Q|W Q|P i |W |WK |O Q|FK Q|WK nh th | F|VD|NKL|UD|NK L|P DR|P FK||-4 ph t.
Hi Q|W Q|Q|P i |O do s |FK Q|QK Q|SKkQ|W |ILEULQRHQ|K a tan trong huy W|W Q|
th nh nh Q|V L|ILEULQ|NKQ|K a tan nh |F|Wi F|F D|WKURP ELQ|
Bnh th Q|WURQ|P i |NKQ|Fy|WKURP ELQ|FK |Fy|WL Q|FK W|F D|WKURP ELQ|O
prothrombin. Nh |F|Wi F|F D|SURWKURP ELQNLQDVH||SURWKURP ELQ|P L|EL Q|WK nh thrombin.
3URWKURP ELQNLQDVH| F|WK nh l S|WKHR||| Q|
' 'K
Khi m b |W Q|WK Q|L L|SKyQ| |W |,,,|F D|P ||WKURP ERSODVWLQ|F D|P ||Y
phospholipid c D|P ||+DL| |W |WU n c ng v L|D|||O m ho W|KRi | |W |,,||< |W |,, ho W|
ho c ng v L|D|||KR W|KRi | |W |; ||< |W |; |KR W|KRi |F ng v LCa2+ v phospholipid c D|
m ho W|KRi | |W ||WK nh l S|SK F|K S|SURWKURP ELQHVD|QR L|VLQK|
' 'K
Khi m u ti S|F|Y L|E |P W|O |QK |WK |WLQK|KR F|Fi F|V L|FROODHQ|E |SK L|Ej |OFth nh
m FK|W Q|WK Q|Oj P |KR W|KRi | |W |; ,,||< |W |; ,,|KR W|KR Ca2+, phospholipid ti |F |O m
ho W|KRi | |W |; ,|Y c |WK | |W |,; ||; ||U L| |W || F ho W|KRi ||< |W |; |KR W|KRi ||
y |W ||KR W|KRi ||D|||Y phospholipid ti |F |W Rth nh ph F|K S|P HQ|SURWKURP ELQDVH|Q L|
sinh.
S |WDQ|F F|P i ||VD|NKL|Q||| 6 ng y c F|P i |V |WDQ|G Q|G L|Wi F|G Q|F D
plasmin, nh |y|WUi QK|K W|NK L|WURQ|O ng m FK|
Trong ph Q|Q y g P |||QKyP |WK F|QK P | F|FK |WK nh l S|F F|P i |Q|KD|SKkQhu |
c F|P i |Q|WKHR|F |FK |NKi F|QKD|
Nh m F|FK |WK nh l S|F F|P i |Q|GR|Wi F| Q|tr n y |W |Q|P i ||WK F
ch Q|Q||DQWLFRDODQW|GU||
1 KyP |Wi F|Wi F| Q|WU n plasmin l m tan c F|P i |Q||WK F|O m tan huy W|NK L
(antithrombotic drug).
Nh m F|FK |WK nh l S|F F|P i |Q|GR|Wi F| Q|WU n ti |F ||WK F|NKi Q|WL c |
(antiplatelet drug).
' '' i
C c y 'W 'WUR 'Ti 'WUnh ''Pi
I : Fibrinogen VII : AHG
II : Prothrombin IX : Thromboplastin huy W|W Q
III : Thromboplastin m X : Struart- Prothrombinkinase

aa aa

u IIG
mi a
q e
s ai a
q a
c aai c aa
i
c aa
`
OH
IV : Ca
2+
XI : PTA
V : Proacelerin XII : Hegeman
VI : Proconvertin XIII : Q| QK|ILEULQ
'' i
'' i ' 'K '' ' i '
- C c y |W |W S|WUQ||FRQFHQWUDWHG|IDFWRU|| P |Fy||WKURP ERSODVWLQ||WKURP ELQ|
fibrinogen, gelatin c t c d Q|F P |P i |WURQ|SK |WK W| L|Y L|P FK|P i |QK |
- Ch W|O m se: FeSO4, acid tanic, nitrate b F|Fy|Wi F| Q|F P |P i |W L|FK |GR|O m tr P |
hi Q|SURWHLQ|P i |
- Epinephrin (Norepinephrin)1/10.000-||||||||||Fy|Wi F| Q|F P |P i |W L|FK |WU n m ng
nh y (m t, n L||P L Q||GR|Wi F| Q|FR|P FK|QR L|YL|
'' i 'K 'K
' ' '''K 'K ' '' ''y' 'SK E'K S''Kr ' 'y
b QK|F |WU ng v tnh tr Q|V |G Q|NKi Q|VLQK|Ok|G i l m gi P |V |O Q|YL|VLQKv W|W Q|K S|
vitamin d |d Q| Q| W|K W
Ph ng ng D||E |VQ |YLWDP LQ|. |WURQ|NK |SK Q|||||P |N|WK F| Q
Vitamin K1 : 2,5/kg/12h (PO) ho F|||||P |N3|||K||,0 ||6|
Vitamin K3 h S|WK|FK P |K Q|QrQ|i S|G Q|WURQ|Fi F|WU Q|K S|WKL |P n tnh

C t c d Q|Q|P i |GR|KR W|KyD|P HQ|WKURP ERNLQDVH|Y g y co m FK
Ti |LD|VF||||||-0,03g/kgP pha dung d FK||||||,0 |
'Ki '
'Ki ''

1 P ||||||0 F/ HDQ| ph t hi Q|Y t ch heparin ra t |DQ||Q|O m m W|VLQK|YL n t W
nghi S|WU Q|: LOOLDP |+|
KDUOHV|+||%HVW||Q L|NKi P |SKi |UD|LQVOLQ||F Q|O th |WK F| |WLrQ| gi L|WKL
heparin v o trong y h F|OkP |Vj Q|Yj | F| Q|G Q|W L|WU Q| L|K F|7RURQWR|
'Ki 'K
7URQ|F |WK ||KHSDULQ|Fy|WUong c c m ch D|W |E o mast (gan, ph L||WK Q||WLP ||Heparin
c tr n th |WU Q|O mucopolysaccharide sulfat ho g P |Fi F| Q|Y |O S|O L|F D|-glucosamin,
acicd D-glucurocnic v acid L-iduronic. Heparin c tnh acid cao v P DQ|L Q|WtFK|kP |Q n khi
ng | F|G ng ch W|NL P |P DQ|L Q|WtFK|G Q||QK |SURWDP LQ| |WUQ|KR . C c ch |SK P |WL u
chu Q|KHSDULQ|Ei Q|WU n th |WU Q| F|FKL W|W ph L|SKkQ|W |O Q|||||| 30.000 KDA. Tr Q|
O Q|SKkQ|W |F ng l Q|WK |E |WK Ltr |NK L|P i |F ng nhanh.

Khng h S|WK|TD| Q|WL u ho n n ph L|G Q| Q|WL m chch. Heparin b |WKRi L
ho ch | |E L|K |Y ng n L|P ||+HSDULQ|NKQ|TDQ|QKD|WKDL|Q n c th |G ng th Lk |P DQ|
thai. Th L|LDQ|Ei Q|WK L|||| 90 ph t, th L|LDQ|Q y k o d i khi c suy th Qn Q|Heparin l m
k o d i aPTT (activated partial thromboplastin time) t F|WK n n c Q|WKHR|G i aPTT trong th L|
gian s |G Q|| o th L|FK P |TDQ|WK Q|WKHR| Q|K F|E F 1 t F|O t F| | o th L|SK |WK F|
li |Q n t1/2 c Q|SK |WK F|OL |

Heparin|W Q|F Q|Wi F|G Q|F D|DQWLWKURP ELQ|,,,|O m W| |W |FK Q|Q|P i |
Antithrombin g Q|Y L|WKURP ELQ|WK nh m W|SK F|K S|E Q||SK Q| Q|y|QKDQK| S|||||l Q|Q |
c heparin. |OL |FDR|KHSDULQ| F|FK |N W|W |WL |F |

Ph ng v ch D|WU |Fi F|E QK|QK n t F|P FK|QK |YLrP |W QK|P FK|K W|NK L||W F m FK|
QK |YLrP |W QK|P FK|K W|NK L||W F|P FK|SK L||YLrP | Q|P FK|Y nh. Do t c d Q nhanh n n
KHSDULQ| F|V |G Q|NKL|F Q|Wi F|G Q|W F|WK (l c kh L| |WU |OL |KHSDULQ| F|G ng trong 1
N-acetyl
glucosamin
6-0-sulfat
Acid
glucuronic
N-sulfated
glucosamin
3,6-0-disulfat
Acid
iduronic
2-0-sulfat
N-sulfated
glucosamin
6-0-sulfat
2 tu Q|QD|VD|QK L|P i |F |WLP ||R|NKQ|TDQ|QKD|WKDL|QrQheparin l thu F|O D|FK Q|NKL|
mang thai. Heparin ph n t |O Q|WK S| F|G ng Q Q|K W|NK L|VD|L L|SK |

C c ch Q|FK | QK|VD|k |FKQ|FKR|Fi F|WK F|FK Q|Q|P i |
Ch |P i ||ORpW| |GD|||Fy|NK QK|K Q|FK |P i ||E QK| D|FK |P i ||L P |WL c ||
W Q|K W|i S|NKQ |NL P |VRi W| F||FK |P i |Q o.
- p d Q|OkP |V ng:
||1 Q|V |Q|P i |F F|NKL|WU Q|W QK|P FK
+ L |P i |NKQ|Q
||1 Q|W R|K W|NK L|NKL|QK Q|P FK|Y nh (b QK|WLP |
- Li d ng
Ch : 75-||||,8 |N3||||P ||||,8 |||, ||NKQ|G Q| Q|WL m b S|Y s |k |NK Lt |
P i ||NKQ|G Q| Q| Q|Y khng h S|WK|TD| Q|WL u h a)

L nh Q|FK W|W Q|K S|G Q| W|F D||-hydroxy coumarin
|FK |Wi F| Q||YLWDP LQ|. |SK i h S|Y L|SURHQ P |WURQ|DQ| |W R|WK nh enzym c
ho W|WtQK|WKDP |LD|W Q|K S|SURWKURP ELQ||Fi F|WK F|NKi Q|Q|OR L|FRP DULQ L|NKi Q|F QK|
tranh v L|YLWDP LQ|. |

: DIDULQ| F|K S|WK|KRj Q|WRj Q|Yj |QKDQK|FKyQ|TD| Q|WL u h a v v |Qy|WK Q
F|F S|TD| Q| Q||Fy|WK |G Q| Q|WLrP ||, ||,0 ||QK Q|Q |G Q| Q ti m thu F|
tW|FKR|Wi F| Q|W L| ||: DIDULQ|OLrQ|N W|U Q|U i v L|SURWHLQ|K W|W Q Yj | F|FK Q|KyD|
b L|KHSDWLF|HQ P HV||i F|HQ P HV|Q y c th | F|FK |KR F|NtFKthch b L|QKL |W Q|Wi F|
thu F||0 W|V |FK W|FK Q|KyD|F D|ZDIDULQ|WK F|E i th L|TD| Q|WL ||0 W|V |NKi F| F|
b i th L|TD|P W|Y c th | F|Wi L|K S WK|WU F|NKL| F|E i th L|TD|SKkQ||7K L|LDQ|Ei Q|
h y c D|ZDIDULQ|WKQ|WK Q kho Q||||L |
' 'K
V |WUt|Wi F| Q|F D|ZDIDULQ|NKQ|SK L| |P i ||: DIDULQ|Wi F| Q| |DQ||Qy| F|FK t Q|
h S|Fi F| |W |NKi Q|Q|SK |WK F|YLWDP LQ|. || |W |; ||,; ||,,|Y prothrombin).
' K' ' ' ' ' S
: DIDULQ| F|V |G Q | |SK ng b QK|WURQ|P W|th L|LDQ|Gj L|Yj |L |WU |FK Q|K W
kh L| |W QK|P FK|KR F|W F|P FK| |SK L|| F|N W|K S|WURQ|L |WU |QK L|P i |F |WLP v ch |Q |
s | Q|N W|ILEULO| |WkP |QK |NKL|WK nh t m nh |Fy|V |KL Q|GL Q|F D|Y W|W F m FK||/ L | |||-15
mg/kg. Li |G |WU kh c nhau cho m L|Fi |WK ||WKQ|WK Q|W ||-10mg/ng y. C th |N W|K S|
wafarin v L|SURWKURP ELQ|WURQ|WU Q|K S|F Q|NKi Q|Q nhanh cho b QK|QKkQ|F Q|NpR|G i
th L|LDQ|NKi Q|Q||+HSDULQ|FKR|KL |T |W F th L||G ng li n t F||-||Qj |FKR| Q|NKL|
wafarin b W| |Fy|t c d Q|
'SK 'K 'K ' K
Thi |K W|YLWDP LQ|. |WURQ|NK |SK Q|V |Oj P |W Q|Wi F| Q|F D|ZDIDULQ||GR|y|V |P W
nhi |YLWDP LQ|. |WURQ|SKkQ|k |FK |P |KL| ||VWHDWRUUKHD|||. K |SK Q|Fy|QKL vitamin K
s |k |Fi F|G |KL | L|NKi Q|Y L|Wi F| Q c D|ZDIDULQ|
'i 'K
C c thu
- Thu F|NKi Q|OR Q|QK S|WLP ||DP LRGDURQ|Yj |TLQLGLQH|| F|EL W|Y L|Fi F|WK F|NKi Q
Q|G Q| Q|
- M W|Y i kh ng sinh v m W|V |WK F|FK Q|YL|WU ng kh c bao g P |FHSKDORVSRULQ|
chloramphenicol, erythromycin, metronidazole, acid nalidixic, v nh m sulfonamide.
- Kch thch t |VWHURLG|EDR| P |GDQDRO|Y m W|Y i testosteron.
- NSAIDs
- C c ch W|SKRQ|E |UHFHSWRU|KLVWDP LQ|+||QK |FLP HWLGLQH||P W|OR L|WK F| F|G ng
r Q|U i trong L |WU |lo t ho F|U L|OR Q|K |WL u h a.
- Hormone thyroid
C c thu
- Aminoglutethimide, thu F| F|G Q| | F|FK |W Q|K S|VWHURLG|WK Q|WK Q
- Barbiturate, phenytoin, ethchlorvynol, v glutethimide.

Streptokinase l enz P H| F|W Q|K S|E L|VWUHSWRFRFFV|GQ|K W|||EDR| P |Fi F ch |
ph P |6WUHSWDVH||NDELNLQDVH|
' 'K
Streptokinase l m W|SURWHLQ|Y v |NKQ|WK |F S|WK F|TD| Q| Q|Y thu F|V b |
ph h |E L|DFLG|G |G y
' 'K
Streptokinase ph Q| Qg v L|Q n sinh ch W||WK Q|WK | |F F|P i |Q|KR F|E o
W Q|Yj |EL Q| L|Qy|Y L|SODVP LQ|Y c c enzyme ph n gi L|Fi F|SURWHLQ|NKi F|Plasmin l m tan
fibrin |Fi F|F F|P i |Q||ILEULQRHQ|Y m W|Y i protein kh c |F F|P i Q|Yj |SURWHLQ|W |GR|
trong huy W|W Q|
' K' ' ' ' ' S'
B QK| |SK L|KR F|QK Q|P FK|KD|W F|P FK||6WUHSWRNLQDVH|Fy|WK | F|WU Q|W QK
m FK| |SKi |K |Y W|k |W F|P FK|KR F|QK Q|P FK| | Q|P FK|KR F|W QK|P FKph L||/ L |
|||||8 ,| F|WU Q| |P FK|QR L|YL|NKR Q|||ph t, li |G |WU 100UI/ gi ||1 |
VWUHSWRNLQDVH| F|G Q| |SKi |K |Y W|W F|P FK| |SK L|WK li |G |WU F|F S|NKR Q||||
gi |VD|NKL|G ng li | |
Nh L|P i |F |WLP |F S|WtQK||WU Q|P FK|Yj QK|VWUHSWRNLQDVH| |L |WU |WKL |P i |F F b |
F |WLP |F S|WtQK|v c c d |KL |QK L|P i |F |WLP |F S|WtQK|N W|K S|Y L|W F|QK Q Q|P FK|
v nh gi p khi ph F|O |O Q|P i | |P FK|Yj QK| |L L|K Q|Y ng m ch W|Y m W|FK F|Q Q||
thu F|F Q|Fy|Wi F|G Q| L|Y L|FK Q|OR Q|QK S|WLP |Y suy tim; khi ph F|O |O Q|P i | |F |
tim. Li |WKQ|WK Q|NKR Q|||||||||,8 ||OL |G |WU 2000 IU.
'SK
Streptokinase k o d i qu trnh kh ng Q|Enh th Q||WK L|LDQ|F D|WKURP ELQ||WKH
WKURP ELQ|WLP H|||377|Yj |37| F|W Q|OrQ|Oj P |W Q|Q |F |FK |P i |WK c S|| F|EL W|O |Y |
tr ti m. Ch Q|FK | QK||FK |P i |Q L|VLQK||FK |P i |WURQ|V |gi L|SK |ErQ|WURQ| Q|
s Q||Q|WK |Q o ho F|Fi F|NK W|L P | |P FK|EDR| P phnh m FK||6WUHSWRNLQDVH|Fy|WK |k |
ph Q| Q|G | Q||NK F|SK F|E Q|Fi FK|F S|WK m thu F|NKi Q|KLVWDP LQ|KR F|FRUWLFRsteroid.
Streptokinase c th |k |V W|QK |

Khng k W|K S|6WUHSWRNLQDVH|Y L|KHSDULQ|KR F|Fi F|WK F|NKi Q|Q|NKi F|QK Q
KHSDULQ| F|FK | QK|NKL|G Q|VWUHSWRNLQDVH|L |WU |QK Q|P FK|Y nh.
(5) Bivalirudine
Bivalirudine, ch W|W Q|K S||O m W|SHSWLG|Fy||||DP LQRDFLG||O ch W| F|FK |WKURP ELQc
tnh thu Q|QK FK|Y tnh ch Q|O F|FDR||y|Wi F| Q| L|NKi Q||F |Y |WUt|F t c va t?y tr? li n
k W|DQLRQ|F D|Y ng tu Q|KR n v thrombin li n k W|ILEULQ||%LYDOLUGLQl ch W|Q Q| | L|Y L|
thrombin va b |WK |SKkQ|W L|SK Q|F n l L||U|-Pro4 b Lenzyme n y. Trong Q|QKL P ||
bivalirudin k W|K S|Y L|WKURP ELQ|F |G Q|W |GR|Y d Q|OL n k W|Y L|SURWHLQ|K W|W Q|Yj |GR|
y|NKQ|WK |QK Q|EL W| F|Fi F|FK W| F|FK n L|VLQK|WURQ|V |W Q|Wi F|Qj |
T c d ng ph
Ch |P i |O t c d Q|SK |FK | |F D|ELYDOLUGLQ|| QK|K Q|FK | |F D| Whuy W| |
b QK|QKkQ|QK Q|WK F|TD| Q|W QK|P FK|NKR Q||||Y th S|K Q|Q |N W|K S v L|KHSDULQ|
li |FDR||i F||Wi F|G Q|SK |NKi F|EDR| P ||D|O Q||D| |Fi F|Y ng kh c, i, D| ||Y h |
huy W|i S||%LYDOLUGLQ|NKQ|k |L P |WL |F |F Q|QK |NKQ sinh kh ng th |NKi Q|
bivalirudin.
(6) Argatroban
L d Q| W|F D|DP LQR|DFLG|W |QKL n L- arginin v l ch W|Fy|Y |WUt|Wi F| Q|FKtQKx c,
c QK|WUDQK|| F|FK |WK Q|QK FK|WKURP ELQ||. i=0.04mM). Argatropan c tnh ch Q|O F FDR| L|
v L|WKURP ELQ|Fy|Wi F| Q| F|FK |W L|WKL |OL n quan t L|VHULQH|SURWHDVH|QK trypsin, y |W |; D|
v kallikrein.
Trong Q|QKL P ||KL |T |F D|UDWURSDQ|EDR| P || F|FK |V |W R|WK nh fibrin, Fch |
ho W|WtQK|F Dy |W |NKi Q|Q|||,,,||; ,,,||SURWHLQ||Y F|FK |N W|W S ti |F ||UDWURSDQ|
F|G Q|QK |P W|FK W|NKi Q|Q|WURQ|WU Q|K S|SK ng v tr ch Q|K W|NK L|Q |Q |
L |WU |E Q|KHSDULQ|k |L P |WL |F ||KHSDULQ-induced thrombocytopenia (HIT)) k o d i
kho Q|||Q y sau khi d ng heparin.
7 |QKLrQ||VD|y|V |O Q|WL |F |V |WU |O L|Enh th Q|P F|G ti S|W F|L |WU v L|
heparin. H L|FK Q|Qj | F|P |W |OD||+,7|WSH|,|| |WSH|,,||i S| Q|P L Q|G FK|WUQ gian r
Uj Q|K Q||Yt|G |QK |L P | F|K |qu |GR|L P |V |O Q|WL |F ||%L Qch Q|WK Q| |UD| |
HIT type II: ngh Q| Q|P FK|N W|K S|Y L|W |O |FK W|NKR Q|||||Y Q |F |WK |WK W|F W|F W|
(amputation) kho Q|||||
B QK|QKkQ|F Q|Fy|WK | S|FK Q|K W|NK L|QK |W F|P FK| |SK L||WUrQ| |P W|W QK
m FK|F D|K |W Q|KR n. M F|NKi F||F Q|Fy|EL |KL Q|Y |P W|OkP |V ng bao g P ho L|W |GD|| |
kh ng heparin,v xu W|K W|| L |WU |E F| |F D|+,7|O ng Q|F S heparin, tuy nhi n b QK|
nh n c Q|F Q|NKi Q|Q| |Q Q|Q D|Yj |L |WU |FK Q huy W|NK L||i F|Fh W| F|FK |
thrombin tr F|WL S|EL |O |P W|V |WK Q|O L|Y |P W|O thuy W|N |F |KHSDULQ|QK |P W|FK W|NKi Q|
Q|EDR| P |
1) F|FK |V |Q|P i |TD|F |FK |Wi F| Q| Q||VLQOH|
2) tr F|WL S| QK|K Q | Q|FK F|Q Q|F D|WKURP ELQ|P j |NKQ| i h L|Fi F| Q| |W |QK |
antithrombin III, ...)
3) F|FK |WKURP ELQ| Q|N W|Y L|F F|P i |Q
4) lo L|WU |+,7|QK |P W|Wi F|G Q|SK |F D|YL F|L |WU
5) F|FK |WKURP ELQ||NKQ|L Q|KHSDULQ||NKQ|E |E W|KR W|E L|WL |F |KR F|SURWHLQhuy W|
W Q
6) argatroban, ch W| F|FK |W Q|K S|WKURP ELQ||Fy|hi |O F| Q| QK|K Q|Yj |W Q| |DQto n
NKL| F|VR|Vi QK|Y L|KHSDULQ| F|FKL W|W |P | Q|Y W|
7) c c ch W| F|FK |WKURP ELQ|WU F|WL S|tW|k |Wi L|Q|P i |WU |O L|VD|NKL|Q Q|WK F||

C S| Q|WK L|ELYDOLUGLne ho F|DUDWURSDQ|FKR|E QK|QKkQ|G ng heparin, wafarin l m
W Q|Q |F |k |FK |P i ||WtQK|DQ|WR n v hi |T |F D|Fi F|WK F|NKi Q Q|P L|FK D| F|
bi W|Q |N W|K S|FKQ|Y L|Fi F|FK W| F|FK |WL |F |NKi F|QK DVSLULQ||K D|Fy|E Q|FK Q|Y |
W Q|Wi F|G F| Q|K F|Y L|Fi F|FK W| L|NKi Q| 3|ticlopidine, v ch W| L|NKi Q|
3,,E|,,,D||DEFLLP DE|Yj |W Q|Wi F|Y L|KHSDULQ|Fy tr Q|O Q|SKkQ|W |WK S||||
Argatropan l ch W|Q Q|<3||||||GR|y|Fi F|WK F| QK|K Q| Q|K |WK Q|FK Qh a
c D|WK F|Qj |OLrQ|TDQ| Q|ELRGLVSRVLWLRQ|F D|Fi F|WK F|NKi Q|Q|P L|Q y.

Hi |T |NKi Q|Q|F D|WK F|NKL|WL m t QK|P FK|SK |WK F|Y o n Q| |F D|WK F
trong huy W|W Q||1 |NKQ|WL S|W F|VD|NKL|WU Q|W QK|P FK| F||||SKW||||||-0.06),
thng s |Q|P i |V tr |O L|Y FK|UDQK|L L|WURQ|NKR Q|||L ||||-165 ph t) v khng ph t
hi Q| F|Q Q| |WK F|WURQ|K W|W Q|||||||
B i th L|ELYDOLUGLQ|FK | |E L|V |WKDQK|WK L|Fi F|FK W|FK Q|KyD||NKR Q|||||OL b i
th L|F n ho W|WtQK|WURQ|Q F|WL |
Chuy Q|KyD|Eivalirudin c th | |UD| |DQ|KR F|WKHR| Q|SKkQ|L L|SURWHLQ|W L|Fi F|Y |WUt
kh c (m FK|P i |||||||7K L|LDQ|Ei Q|K |F D|WK F|WURQ|K W|W Q|NKL|WLrP |W QKm FK|O t
K Q|||L ||3K Q|WK F| F|E i th L|VD|NKL|F S|NKR Q|||L |FK Q|W |WKDQK|WK Lc c ch W|
chuy Q|KyD|Oj |FRQ| Q|E i th L|FKL P | |WK |
Argatropan kh L|SKi W|KR W|WtQK|NKi Q|Q|W Q| L|QKDQK||V Q|V ng t Q|FQ|Y o c c
v |WUt|P F|WL u tr n thrombin. tr Q|WKi L| Q| QK|F D|DUDWURSDQ|WURQ|K W|W Q W| F|
kho Q|||L |VD|NKL|WU n t QK|P FK|OL n t F| |OL | |WL n. |WK||W |O thu F|OL n k W|Y L|
protein huy W|W Q||||-|||||UDWURSDQ| F|FK Q|KyD| |DQqua s |W R|WKj QK|QKkQ|WK P |
c D|K S|FK W|G |Y ng quinolon. |WKDQK|WK L|O 4.4mL/min/kg, |WK| F||6D||||L ||NKR Q|
23-12% thu F|E i th L|F n ho W|WtQK|WURQ SKkQ|Yj |Q F|WL |||

Citrate sodium k W|K S|Y L|D|||WURQ|P i ||Q Q|F Q|SURWKURP ELQ|EL Q|WK nh thrombin.
Q|LWUDWH|VRGLP |QK |FK W|NKi Q|Q|Fy|WK |O m|QK Q|Yj |K |K Q|W |E o m u.
S |G Q|||- B R|T Q|P i |||GQ|G FK||||-3,8%
- C c x t nghi P |QKL n c |Y |P i

EDTA t l m bi Q| L|Knh th i v kh |Q Q|E W|P u c D|Fi F|W |E o m u
S |G Q||||P ||P O|P i

Ch |G ng trong c c x t nghi P |P i
Oxalate potassium : 2mg/ml m u
TKPK

M W|Q F|O hi Q|W Q|L|N m v L|P W|FkQ|E Q|DFLG|EDVH|| |FK Q|O L|QK Q|i Rtr Q|
v |S+|P i ||WUQ| F|WRDQ||WUQ| F|NL P |||F |WK |Fy|Fi F|F |FK |L |K a nh |Y o:
- 4 h |WK Q| P |||ELFDUERQDWH||SKRVSKDWH||+E||SURWHLQ|
- Ph Q| Q|OL n h S|Y L|DFLG|OFURQLF| |DQ
- H |WK Q|WKQ|NKt|SK L
- Qu trnh lo L|WK L|+||Y t i h S|WK|+2 |- |WK Q

7UQ| F||WRDQ|GR|WKrP |Yj R|F |WK |||DFLG||WURQ|WU Q|K S|E QK|NHWRVH||E QK|WL
Q||KD|F |Oj P |YL F|Ti |P F||KR F|P W|L|||EDVH|OL n h S||WU Q|K S|WL u ch |G |G L|||
v L| F|WU Q|Oj |V |WKL |K W|+2 |- v potassium
C c dung d FK| Q|WU Q|Fy|WK |FQ|F S|WURQ|WU Q|K S|Q y l : NaCl, KCl,
NaHCO
3
.
Li |O Q|F S|F Q|F Q|F |Y o tnh tr Q|P W|Q F||W |QKL n li |F |E Q|Fy|WK |F S l :
40ml/kgP (PO, IV)

7UQ| F|NL P |GR|WKrP |Yj R|F |WK |||EDVH|||WU Q|K S|Q | F|1 +|||KR F|P W|+|
|WU Q|K S|QQ|P D| |WK| Q|Y ||Y L| F|WU Q|Oj |V |WKL |K W|O-.
C c dung d FK| Q|WU Q|Fy|WK |FQ|F S|O : NaCl, KCl, CaCl2, Ringers.

Nh |||P W|Q F||||| S|WURQ|WU Q|K S|WL u ch ||yL|P D||%L |Ki Q|O da m W| n
tnh nh ||QL m m F|Y Q|F n W||Fy|EL |KL Q|NKi W|
Trung bnh : m W|Q F|NKR Q|||||OF|Qj | | n h L|F D|GD|NpP ||QL m m F|NK|lng
|i F||K Q|Y Q|F n W|
N Q|||P W|Q F|NKR Q|||||GD|P W|j Q|WtQK|Yj | |P P |P L||QL m m F|Y h Q kh,
c |P W|P P |Y h m s u.
1
Chng 8
THUC TC NG TR N H H HP V TI U H A
( H thng h hp
( Thuc tc ng tr n h h hp
( Thuc tc ng l n h ti u h a
2
Chng 8
THUC TC NG TR N H H HP V TI U H A
H thng h hp
Q|K|K S|Oj |Q L|2 || F|FQ|F S|Yj R|F |th |Yj |2 || F|WK L|UD|QR / qaa
Fi F|F |TDQ|QK |P L||RDQ|P L|| W|K ||WKDQK|T Q||NKt|T Q||SK |T Q||6 WUDR| L|NKt|
|UD| |SK |QDQ|
|WK Q|SKj ng r |WUrQ| Q|K|K S| P |QKL | |W | P |E R|FKR|V |WKQ sa W|
c D|Ti |WUnh d Q|NKt||Y trao L|NKt|
|WK Q|OQ|UQ|Y ch W|QK y d FK||QK y do t |E o hnh /y t/ W|UD||WKDQK|G FK
(seroas /a/d) ch | |GR|FKLF|W Q|G L|QLm ( sabmacosa/ g/and) t/ W|UD||LS|E / th L|Fi F|
r W|O |UD|QR /
Ph Q| |K W|K L|Yj |KR|Fy|Wi F| Q|F |K F|LS|W Q|QRDL|Y W|UD|QR /
||i F| L|WK F|E o ph |QDQ|Fy|YDL|WUj th F|E o r W|O
|WK Q|OP SKR|G F| Q|K|K S||K FK|||Fy|QKL P |Y | |O |Fi F|FK W|Kj a tan
go / ra cj n c ntereron /ysosym c c kh ng th |WL W|W L|FK ||, ||, ||P L Qd FK|
qaa trang g/an t |E o c Q|O m W|SK Q|F D|K |WK Q|SKj ng r |
/ m nh/ P | Q|K|KkS|Y ph L|GR|U W|QKL |Q n nh n kh c nhaa (h a ch W
k/ch Q||YL|NK Q||YLUV||0 FRSODVP D||Nt|VLQK|WU ng n P |||||k |QK Q|i R|WU QWK Q|
g S|QK W|O c c d |KL ||WK |QKDQK||kh th ||WL W|G FK|W |P L||KR|||
Thuc tc ng tr n h h hp
8.2.1. Nguy n tc chung
|WU |K |WK Q|SKj ng r |F D|F |WK |||L | P ||FQ|F S|GLQK|G Q| | |g/ P |
c c y |W |k |VWUHVV|
|7 Q|YL F|OR L|WK L|Fi F|FK W|G FK|Ti |QKL |WURQ| Q|K|K S|||WK F|L |Kj a t/ W|
d FK||WK F|O m /o ng ch W|QKj ||ORQ|j P |
/ P |Wnh tr Q|KR|NKDQ|Ti |P F|Y k o d / g y m W|V F|||WK F|L P |KR
|LD|W Q|V |WKQ|WKRi Q|NKt|WUrQ| Q|K|K S|||WK F|L Q|SK |T Q||WK F ch Q|
sang hay W|
/ P |WKL |QK Q| QK|K Qg do r/ m nh/ P |k |UD||WK F|NKi Q|VLQK||WK F|WU k/
s/nh tr ng n P ||WK F|NKi Q|YLm
3
8.2.2. Thuc gin ph qun
8.2.2.1. Theophyllin v c c cht thuc nhm Xanthin ( cafein, theobr omin)
C t c d Q|O m g/ n c |WU Q|NKt|SK |T Q|GR| F|FK |SKRVSKRGLHVWHUDVH||O m g/a W ng
cP trong t |E o Theophy///n F|FK |GHQRVLQ|W L|UHFHSWRU|F D|Qy|denos/n g y co th W|
kh/ qa Q||W Q|SKyQ|WKtFK|KLVWDP LQ|W |SK L
Ch | QK| || WURQ| Fi F| WU Q| K S| NKy| WK | GR| FR| WK W
Ch m o: 51mgkgP ng y (P)
g D||WUk|Ej : 5mgkgP
8.2.2.2. C c thuc khc : c th s dng
phedr/n : 13mgkgPh P cho ch m o
trop/n : 24mgkg ( SC)
h ng r/ m ( em b / tha F|NKi Q|YLm)
8.2.3. Thuc iu h a dich tit kh ph qun
|L |Kj a d FK|WL W|WUrQ| Q|K|K S||WD|Fy|WK |G ng c c c ch saa: g/ P |O Q
QKj ||W Q|SKD|Q F|O m /o ng j P ||W Q|KRDW| Q|F D|K |WK Q|OQ|UQ|
8.2.3.1. Bromhexine
L m g/ P |SKkQ|WL W|G FK||QK y b Q|Fi FK|L |Kj a ho W| Q|F D|Fi F|W |E o hnh
O|| Q|WK L|LS|Fi F|OQ|UQ| |QLm m F| Q|K|K S|KR W| Q| |G FKnh y ra
ngo / gj a/ ra bromhe/ne cj n c kh |Q Q|LD|W Q| |W S|WUQ|F Dkh ng s/nh tr n
Q|K|K S
Ch | QK|||Fi F|WU Q|K S|W Q|WL W|G FK|Fy| m (macoas) trong c c b QK|YLm
thanh kh/ qa Q||YLm ph |T Q|SK L||YLm ph L
L/ |O Q|| g D||||||25mgkgP ng y 7 ng y
ngh : 51mgkg ng y
Ch m o: 1mgkg 2/ Q||Q y
8.2.3.2. N. Acetylcystein
H a hc
acety/cyste/n c m a tr Q||G Q|E W|WLQK|WK ||Fy|P / acet/c nh ||7DQ|W |GRtrong
Q F|Y acoho/
Dc lc hc
4
acety/cyste/n r o ph L|V |LS|L P | |QK y c D|F |FK W|WL W|Fy|P |Y khang c
m |Y g/ p /o L|WK L|Fi F|FK W|WL W|Q y b Q| Q|KR||1 KyP |VOK GUO|W |GR|V / m g/ P |Fi F|
// n k W|GLVOILGH|F D|P FRSURWHLQ||7K F|NKQ| QK|K Q| Q|P s Q|KR F|KR F|ILEULQ||
acety/cyste/n c Q|Fy|WK |O m g/ P |NKa r F|W QWK Q|DQ|KR F||P HWKHP RORELQHP LD|
do acetam/nophen g y ra
S dng/ ch nh
cety/cyste/n c t c d Q|O m tan ch W|QK y |SK L|Y m W|Yj |L |WU |Q | F|GR
acetam/nophen tr n th nh |
Dc ng hc
h/ nh |Y o m W|KR F|F S|Y o ph L||SK Q|O Q|Wha F|E | QK|K Q|E L|SK Q| Q
sa/hydry/ d/sa//de r ph Q|Fj n / L| F|K S|WK||i F|WK F| F|K S|WK|E |EL Q L|W R|
th nh cyste/n |DQ|Yj |VD|y| F|FK Q|KyD|
Qu liu/ c tnh
L 5 c D|DFHWOF VWHLQ|WUn ch / 1gkg (P) r 7mgkg () acety/cyste/n
an to n trong h |K W|Fi F||WU Q|K S|Ti |OL |
Tng tc thuc
ng than ho W|WtQK| |K S|SK |DFHWDP LQRSKHQ|DQ|Fj n tranh /a Q|E L|WKDQ|KR W
t/nh c Q|Fy|WK |K S|SK |DFHWOF VWHLQ|||||
C ch
Ph n h |Fi F|P FRSURWHLQ|TD|Fi F|Q L|GLVOILGH|E ng c c g F|VOK GUO|W |GR| j P |
s |WDQ|UD|WK nh c c ph n t |QK ||V |NKQ|W R|QK y r /t c t/nh ch W|k |YLm d |WK L|UD|
ngo / Tay nh/ n tha F|Q y c th |O m b W|KR W|SHQLFLOOLQ||G |k |KR| /
8.2.4. Thuc gim ho
8.2.4.1. Codein v c c chuyn ha cht t opioid (opium, hydromorphin)
F|FK |SK Q| |KR|GR|Wi F| Q|On trang hka ho |K nh t ||WK F|QKyP |WK F|KR
QDUFRWLF|||Fy|NK QK|K Q|k |QKL Q|
Ch | QK||Fi F|WU Q|K S|KR|NKDQ||NKQ|WL W|G FK||Y k o d /
L/ |O Q|||Ch m o: 12mgkgP Ps
eo : 156mg
g D|||||2 g
5
8.2.4.2. Dextromethorphan
L ng phn quay phi, dn xut methyl ether ca levor phanon. Thuc n y
khang c t c d Q|L P |D||NKQ|k |QKL Q|Yj |tW|k |Wi R|EyQ|K Q|FRGHLQ||tWkhang g y
ba Q|Q ||+L |T |FK Q|KR|W Q| Q|FRGHLQ||HWURP HWKRUSKDQ| F ch | QK|NKL|
code/n khang c h/ |T |FK Q|KR|
T c d Q|SK ||U L|OR Q|WLa h a ph ng th/ch h/stam/n
Ch Q|FK | QK||KR|P n t/nh (tr n kh/ ph L||KHQ|V Q||KR|Fy|Ti |QKL |FK W|WL W|c
Q |F |V |K|K S|
8.2.5. Thuc tr sung huyt mi
8.2.5.1. Phenylpropanolamin
H a hc
L am/n k/ch th/ch th Q|NLQK|LDR|F P ||3KHQ OSURSDQRODP LQ|+O|Fy|P a tr Q|d Q|
b W|WLQK|WK ||Fy|P L|WK P |QK ||QKL W| |WDQ|FK ||||14o C pa 4
Pheny/propano/am/n C/ cj n F| L|O d/ norephedr/ne C/
Dc l hc
Pheny/propano/am/n C/ k/ch th/ch g/ n t/ S|UHFHSWRU||Y b L|V |L L|SKyQ
norep/nephr/ne S |G Q|NpR|G / ho F|Ti |OL |WK Q| n s |WKi R|K Wnorep/nephr/ne |
c c r |WUt|G |WU ||||||
T c d Q|G F|O |F D|SKHQ OSURSDQRODP LQ|EDR| P ||W Q|FR|P FK||QK S|WLP |hay W|
p k/ch th/ch nh |WK Q|NLQK|WUQ| Q||L P |Q|K W|P L|Yj |W Q |WtQK|WKqP Q|
S dng/ch nh
3KHQ OSURSDQRODP LQ| F|V |G Q|FK | |FKR|L |WU |QK F|F |Yj ng b ng qaang
g y co th W|NKQ|OLn t F| |FKy|Y m o go / ra tha F|Fj n F|G Q| tr sang hay W|
m L| |WK|QK |
Dc ng hc
3KHQ OSURSDQRODP LQ| F|K S|WK|QKDQK|FKyQ|VD|NKL| Q|Y th L|L P |E W|
Wi F| Q|NKR Q||||||SKW|VD|Yj |NpR|Gi L|Wi F| Q|NKR Q|||L ||7K F|SKkQph L| Q|Fi F|
ma kh c nhaa r d FK|FK W||EDR| P |K |WK Q|NLQK|WUQ| Q||3K Q/ Q|WK F| F|FK Q|
h a th nh ch W|Fj n ho W|WtQK|
Chng ch nh
7 Q|QKn p b L|WUL Q|W Q|WL Q|OL W||W Q|Li S||WL | Q||U L|OR Q|WLP |P FKho F|
W Q|K W|i S||3KHQ OSURUDQRODP LQ|Fy|WK |k |L P |U Q|WU Q|
T c dng ph
ao g P |NtFK| Q||G | Q||W Q|K W|i S||EL Q| Q|
Tng tc thuc
hang k W|K S|SKHQ OSURSDQRODP LQ|Y L|Fi F|WK F|NtFK|WKtFK|WK Q|NLQK|WUQ| Q
(epher/ne ) 2 ta Q|VD|NKL|G ng c c ch W| F|FK |P RQRDP LQ|R LGDVH|WK khang n n d ng
pheny/propano/am/n W|K S| Q|WK L|SKHQ OSURSDQRODP LQ|Y L/ndometh/c/n (ho F|Fi F|
Ss kh c bao g P |DVSLULQ|||UHVHUSLQ||Fi F|FK W|SKRQ|E h FK|V |W Q|Q |F |W Q|
hay W|i S||. W|K S| Q|WK L|SKHQ OSURSDQRODP LQ|Y Lcyc/opropane ho F|Fi F|WK F|P
hydrocacbon ha/ogen h a
8.2.5.2. C c thuc khc
aca/yptas terp/n mentho/ c Q|WK Q|Fy|P W|WURQ|WK F|KR|QK Q|Wi F|G Q ch |
y |F D|FKQ|Oj |Vi W|WUQ| Q|K|K S|
Thuc tc ng l n h ti u h a
8.3.1. Nguy n tc chung
/ Q|SKi S|K |WU |||L |TDQ|WU Q|QK W|O g/ |FkQ|E Q|Q F|Y ch W|L Qg/ LFKR|F |
th |O S|O L|QK| Q|Enh th Q| | Q|WLa h a g/ P |Q |F |WLr|FK do s |On men
c D|YL|VLQK|Y W| |U W|L
/ Q|SKi S|L |WU |Fy|WtQK|K |WK Q||V |G Q|Fi F| |W |NL P |VRi W|Yj |L |FK QKc c
d |KL |OkP |V ng: ch Q|QQ||L |Kj a nh| Q|U W||L |Kj a / Q|DFLGW Q|WL W|Ti |
m F||K S|SK |FK W| F||E R|Y |QLm m F||NtFK|WKtFK|V |QRQ|P L Q|||
/ Q|SKi S|L |WU | F|KL ||QK P |Y o c c ngay n nh n g y ra r L|OR Q|||WK Fkh ng
s/nh tha F|WU |Nt|VLQK|WU ng tha F|FK Q|WL W|G FK||WK F|QK Q|WU Q|
8.3.2. Thuc tr ti u chy
T/ a ch |O tnh tr Q|W Q|V |O Q| L|WL Q|Y L|W Q|NK L|O Q|Y th |WtFK|SKkQ|W Q|
m W|Q F|Y ch W|L Q|L L|WKHR|SKkQ|GR|W Q|WK Q|NK |Q Q|K S|WK|Q Fc D|U W||7U |WLa
ch |O / m g/ P |Fi F|F Q|WLr|FK |KDy g/ P |WUL |FK Q|
T/ a ch |Enh th Q|O m W|SK Q| Q|Fy|O L|FKR|F |WK | |W Q|QKDQK|FK W| F ra
QRj L||QK Q|Q |WLa ch |Ti |P F||F |WK |P W|Q F|Ti |QKL |V |Q |KL P Q|WtQK|
m Q|||P W|Q F|QRDL|E o r m W|Q F|Q L|Ej R|||R|y|SK L|G ng tha Fc P |WLa ch |KD |
tha F|O m g/ P |FR|WK W|F |WU Q| Q|WLa h a
C c loi ti u chy
T/ a ch |GR|WK P |WK ||. KL|WURQ|U W|Fy|QK Q|FK W|NKQ| F|K S|WK|O L|Fy kh |
Q Q|NpR|Q F|Y o /j ng ra W|QK |VRUELWRO||OFHULQ||WK F|QK Q|WU ng c /acta/ose g
T/ a ch |GR|E / t/ W||NKL|WK nh ra W|E |W Q|WK Q|Oj P |W Q|Ej L|WL W||Fi F|FK W|L Qg/ L|
r o /j ng ra W||7K nh ra W|E |W Q|WK Q|Fy|WK |GR|YL|NK Q||( |FROL||6DOP RQHOOD|
YLUV''5RWDYLUV'''r'VL' 'Y W''( ''LVWROWLD''' )
T/ a ch |GR|U L|OR Q|QK| Q||GR|WK F|F Q| L|LDR|F P ||NKi Q|VLQK
(amp/c////ne erythromyc/n) antac/d ch D|0 ||||WKHRSK OOLQH||LQGRP HWKDFLQ||FK |SK P
ch D|) H||||OHYRGRSD||SURSUDQRORO|
D|Y o tr/ |FK Q||FKLD|O m 2 /o L|
T/ a ch |F S|WtQK||NpR|G /|G L|||W Q|||GR|YLUV||YL|NK Q|Y th F| Q|
T/ a ch |P n t/nh (k o d / h Q|||W Q|||GR|WK F|SK P |k |WLa ch ||E QK|YLm
ra W||E QK|O ||F Q|Li S|
8.3.2.1. Atropin
Tha F|QKyP |OL W|SKy|LDR|F P ||DQWLFKROLQHULF|DHQWV||GR| L|NKi Q|F QK|WUDQKr L|
ch W|G Q|WU n th Q|NLQK|SKy|LDR|F P ||DFHWOFKROLQ|||1 Rj L|Wi F| Q|FK Q co th W|F |
WU Q||DWURSLQ|Fj n c c c t c d Q|F D|P W|WK F|F Q|LDR|F P :
7i F| Q|WUn m W||O m g/ n Q|W |i S|G Q| |VRL|i |P W|
Tr n t/m m FK||W Q|QK S|WLP ||Gn m FK|P i |GD||G ng ch Q|tr |WLP |
Tr n h |K|K S||Ln kh/ ph |T Q||L P |WL W|G FK||G ng tr |KHQ|V Q||WK F t/ Q|
m
Tr n h |WLa h a : g/ P |FR|WK W|F |WU Q||L P |WL W|G FK||G m c P |WLa ch |
/ L| F|NKL|Q | F|Fi F|WK F|F Q|SKy|LDR|F P ||SLORFDUSLQ||
L/ |O Q|||||||4mgkgP SC
8.3.2.2. Loperamid (Imodium)
Tha F|QKyP |WK F|L P |D|SLSHULGLQ|RSLRLG|| F|W Q|K S| |Fy|Wi F| Q chay n
b/ W|WUrQ|F |TDQ|WLr|KyD||+ S|WK|FK P | | Q|WLa h a chay Q|KyDho n to n |DQ|Y
b / th L|TD|P W|WKHR|SKkQ|
Ch | QK||WLa ch khang do ngay n nh n Sa/mone//a Sh/ge//a g y ra

Ch Q|FK | QK||| |P o
L/ |O Q|||||||P |N3||32 |
8.3.3. Thuc bo v ni m mc
L c c ch W|K S|SK | F|W ||YL|NK Q||G FK||NKt||WK F|Qj |NKQ| F|K S|WKr o h |
ta Q|KR n n n /t c t c d Q|SK ||7 |QKLn c c ch W|Q y khang tr | F|WLa ch |F S||
n Q|
8.3.3.1. Aluminum magnesium trisilicate (Attapulgit)
Phosphate a/am/nam th |NHR||3KRVSKDOHO|
/am/nam s///cate hydate h a t |QKLn (ao//n)
C c tha F|Q y t R|WK nh nh Q|O S|HO||V D|Oi Q|WUn b |P W|QLm m c b R|Y n/ m
m F|WUi QK|NK L|Fi F|FK W| F| Q|WK L|L P |QK| Q|U W|Yj |W Q| | F|F Dph n do kh |
Q Q|K S|WK|P W|O Q|Q F|O Q||| S|||O Q|WU Q|O Q|F D|Qy||
L/ |O Q||| o : 51mg
Ch : 12mg
Tr a bj : 3g
Ch Q|FK | QK||G ng chang r L|NKi Q|VLQK|QKyP |WHWUDF FOLQ|Y qa/no/on
8.3.3.2. Than hot tnh
Than ho W|WtQK|NKQ| F|K S|WK|W | Q |WLr|KyD|QK Q|Fy|NK |Q Q|K S|WKc c
ch W|O Q|QKDQK|FKyQ|||W |y|K S|SK |Fi F|FK W|| F|Yj |Oj P |W Q| | F|F Dph n
Ch | QK| t/ a ch |GR| |K L|| Q|NKQ|WLr||WUQ| F| Q|WLa h a
L/ |O Q||||12 mgkg
(1) Kaolin/pectin
H a hc
ao//n / m W|DOP LQP |VLOLFDWH|K GUDWH|KyD|G Q|E W|P Q||P a tr Q|Vi Q|khang
m / khang r |||||
Pect/n / m W|FDUERK GUDWH|WU ng h S|FK | |O methoy/ated ac/d po/yga/actaron/c
Pect/n c m a tr Q|KR F|WU Q|Y ng khang m / d Q|QK ||1 y| F tr/ch t |WLQK|FK W|
g/ Q|QK |WLQK|FK W|F D|Y |FDP |T W|KR F|W |E W|Wi R|
Dc l hc
ao//npect/n c t/nh h S|SK | F|W |Y b R|Y |QLm m F|U W||R|y|r/ kha Qr

F|W | F|K S|WK|WURQ|U W|Yj |Wi F| Q|FKH|SK |F D|WK |Y Q|Fy|WK |E R|Y m ng nh y
c D| Q |WLa h a b |YLm Th nh ph Q|F D|SHFWLQ||G Q|DFLGga/actaron/c s |O m g/ P |S+|
| Q|WLa h a
Ch nh
7URQ|WK|||NDROLQ|SHFWLQ| F|G Q| tr |WLa ch ||K S|SK | F|W |WURQ|WU Q
h S|Q | F|WK F| Q|
Dc ng hc
. DROLQ|Yj |SHFWLQ| |NKQ| F|K S|WK|VD|NKL| Q||7Un pect/n b |SKkQh |
WURQ| Q|U W|
Chng ch nh
C Q|WK Q|WU Q|NKL|G Q|SHFWLQ|WURQ|WU Q|K S|WLa ch |n Q||NKQ|G ng pect/n
QK |FK W|WKD |WK |Fi F|G FK|WU Q|KR F|Fi F|FK W|L Q|L L|
T c dng ph
L/ |FDR|KR F|G Q|WK Q| n c th |k |yL|P D|| |FK W||NDROLQ|SHFWLQ|O m W Q|
m W|VRGLP |TD|SKkQ|WLa ch |
Tng tc thuc
ao//npect/n c th | F|FK |K S|WK|OLQFRP FLQ||1 |F |||OR L|F Q| F|V |G Q c ng
/ c c S|NDROLQ|SHFWLQ|tW|QK W|||L |WU F|KR F|||L |VD|NKL|F S|OLQFRP FLQ|ao//npect/n
c th |O m g/ P |K S|WK|GLR LQ|
Liu d ng:
Ch m o: tr |WLa ch |Y L|OL ||2 m/kg P m L|OL |Fi Fh nhaa 46 g/ |
g | F|WLa h a th |F S|||5 mgkg P m L|OL |Fi FK|QKD||6 g/ |
j tr Q|WK nh: 41 /oP : 23 /oP / S|O L|P L||4 g/ |KR F|QK |FK
QK|FKR| Q|NKL|F L|WKL Q|Fi F|L |NL Q||1 |NKQ|WK |WL Q|WUL Q|WURQ|Yj ng 4 g/ |VDa
kh/ d ng tha F|
8.3.4. Thuc nhun tr ng, thuc x (Laxative Cathartics)
Ch | QK|||WU Q|K S|Wi R|EyQ||OR L|E |Y W|O ||FK W| F|NK L| Q|WLa h a /o Lb |
SKkQ|WU F|NKL|SK |WK W|
Ch Q|FK | QK|||Lm ra W||FR|WK W|GR|QK Q|U W||WK|P DQ|WKDL|
8.3.4.1. Paraffin
Tha F|QKyP |WK F|QK Q|WU Q|O m m P ||WU Q||y|Q Q| F|W |G |NKRi Q| ng
/ a c th |O m g/ P |K S|WK|YLWDP LQ| ( . ||1 n a Q|OF|yL|
L/ |O QV|| o: 26m/
Ch : 53 m/
eo: 253m/
Tr a bj : 255m/
8.3.4.2. MgSO
4
, Mg(OH)
2
, Mg
3
(PO
4
)
2
Tha F|QKyP |WK F|QK Q|WU Q|WK P |WK ||i F|WK F|Q y t R|P W|UDGLHQW|
Q F|Y o ra W|Lj ||W Q|QK| Q|U W| Q|WK L|NtFK|WKtFK|KR W|WtQK|F D
SDUHRPL'Oj P'W 'WL W'G 'Y W
Ch cang c S| | |Q F||WK Q|WU Q| |th c b QK|WK Q|
L/ |O Q|| o: 25g
Ch : 525g
eo: 25125g
Tr a bj : 255g
8.3.5. Thuc gy nn
7K Q|V |G Q|FKR|FKy||tW|V |G Q|FKR|KHR|Y khang d ng cho c c /o / kh c r tr a
bj ng D||OR / g P |QK P |NKQ|Fy|SK Q| |QQ
Ch | QK|||k |QQ| |/o L|E |FK W| F
Ch Q|FK | QK|||QK Q|WKDQK|T Q||KHUQL||QK Q|U W||E W|W QK
|FK |||NtFK|WKtFK|L P |WL S|QK Q| |QR L|YL|KR F|Fi F|WUQ|NK|WUQ| Q
8.3.5.1. C c cht kch thch v ng ngoi vi
% P |Q F| P ||Q F|R |Lj ||Q F|P L|Y o d |G y ra W
nS4 : L/ |O Q|FKR|FKy|||||3m/ P
S/ro /pecac : L/ |O Q|FKR|P o : 26m/ P
8.3.5.2. C c cht kch thch tr ung khu tr ung ng
pomorph/n : // |FKR|FKy|||||P |N|6|
y/a/n : // |FKR|P o 51mgkgP
8.3.6. Thuc chng nn

8.3.6.1. Kh i nim
a Q|QQ|Y / m D|GR|Fi F|U L|OR Q | Q|WLa ho do d/ chay Q||GR|U L|OR Qt/ Q|
nh ho F|O tr/ |FK Q|WK Q| S|OF|P L|P DQ|WKDL||Wi F|G Q|SK |F Dnh/ |WK F|QK |
tha F|WU |Q|WK ||WK F|P |QQ|Ok|Q y s |k |P W|Q F|Y ch WL Q|L L||Y r |F Q|
E |Q F|Y ch W|L Q|L L
i S| Q|QQ|O 1 ph Q| |Fy|WUQ|WkP | |K nh ta |
Q|WU Q|Y o t |Y ng CT (chemoreceptor tr/gger one) c c ph Q|NKi F|F Dn o
r t |QR L|ELrQ|| |TDQ|WK F|KL Q| Q|Wi F|QQ|Oj |F |KRj Q|Yj |Fi F|F |E Q|
7UQ|WkP |QQ| F|NtFK|WKtFK|E L|Fi F| Q|FKay Q|Yj R|VD|k |
T |Y ng CT n P | |V n n o th S|||WK F|SRVWUHP D|O r ng m h ng r o m a n o
ph t tr/ Q|NpP |Qn ch |Wi F| Q|F D|QKL |KRi |FK W|k |QQ|W |W Q|KR n chay Q|VDQ|QK |
apomorph/n /erodopa g/ycos/d t/m tha F|WU |Q|WK ||QLFRWLQ| F|W |r/ras
T |Fi F|SK Q|NKi F|F D|Q o nh |Y |Qo (s |V |K/ k/ F |||Fi F|NtFK|WKtFK|NK
g/ c th |Li F||V |F|Li F||D| Q|||W |E |P i |WL Q|nh c D|WDL||NKL|L|W a e / m d/
chay Q|Fi F|F | ||F |Qn k/ch th/ch b |P i |WL Q|nh)
T |QR L|ELn: c c ang / F|SKi W| W|W |G |G y (b |NtFK|WKtFK|E L|62 |||WLD| |r/
kha Q||YLUV||Yj |Fi F|Q L|NKi F| |QR L|ELn qaa trang g/an c c d y ph |Y |Y g/ao c P |U L|
WKHR| Q|QKkQ| Q| F|KR F|TD|7=||NtFK|WKtFK|WUQ|WkP |QQ
T |WUQ|WkP |QQ|Fy|QK Q|Q|O F| Q|Fi F|F |E Q| |NK L|SKi W| Q|Wi F|QQ|
Ph Q| Q|QQ|WK Q|N m theo s |FK |Q F|E W||P |KL||FRQ|Q L|P |U Q||DQKao
T L|Y ng CT c c c receptor: 5T3 2 1 T L| Q|QKkQ| Q| F|Fy|Fi F
receptor: 5T3 2 1 1 T L|U W|Fy|UHFHSWRU

Hnh 8.1: C ch gy nn
Trang kha nan |K nh t |QK Q|Fi F|Q|O F|W |Y ng CT (cheomoreceptor tr/gger
one) |Qo th W|, ||7 |WUQ|NK|QQ| W|KL Q|Q|O F| QF |KRj QK||F |E Q|k | Q|
t c nan
T L|Y ng CT c c c receptor c D|GRSDP LQ||KLVWDm/n acety/cho//n
8.3.6.2. C c loi thuc chng nn
Metoclopramide (Primperan), Domperidone : thuc nhm Benzamin c ch
receptor dopam/n hang qaa h ng r o m a n o n n t Q| L|DQ|WR n
L/ |O Q|||FKR|FKy 15mgkgP ( P SC)
2mgkgP ()
Chlorpromazin, Acepromazin : thuc nhm Phenothiazin, cht khng
h/stam/n kh ng dopam/nerg/c kh ng cho//nerg/c
L/ |O Q|||FKR|FKy||||1mgkgP (SC P)

C TC NG L SINH DC V T NIU
i tit t s inh dc
c l i tiu
C TC NG L SINH DC V T
U
9.1. i tit t s inh dc
C c h ' ''' 'L' ' 'L 'L ' L' ' 'L'Y n L
ti theo c ch 'S ' L'kP 't''LY''' 'L 'L ' ''7 ' '
t th 'L/ '' 5 ''SL'L'P '' sinh d ' nh ph ' '
chuy ' ' o th y tr 't't' 'Sk't ') 6 ''L'LP L
hormone ) nang no n hu6ng ph ' 'Y LH (luteinizing hormone ) ho ng th '
h ng ph ' '' L'/ ' ' ') 6 ''' n tr n bu ' 'S/ 'L 'Y
chn (de graff). L ''L '' y c ng nhi ' ' m 't't'
(positive '' L'Y L' ' ' 'L c r L' ' o th y ph n ti '''L' m
l ' ') 6 ' ''''' ' ' 'Y ho ng th ' ' nh l S''
Progesteron ti ra t ' ng th ' ' ' ' ' ' ''LY''''1 '
gia s c c thai, ho ng th ' ' L' 'L' 'Y ph n ti '3 ogesteron. N 'L'
khng c thai ho ng th ' '/ L'y '' ' L'L' ' ' L'L' ' ' i
prostaglandin F2( (PG F2( ) ti '' ' L'P ' '' 'S/ 'Y ' ng th ''
Progesteron s 'L P ' ' m 't't' ' ' o th y ph n ti t Oxytoxin
g y hi ' 'L' ' ' ' ' ' L'
c tc ng l cung v ng tr ng
t thanh ng a ch a
L m ' L'L' ' ng ph ' '' 5 ''L '' S' L'P ' '' '
c c c mang. C ho 't'L' 'L ') 6 'Y m 't' '''y '/ ' ' m
nang no n ph t tri
Ch ' ''/ ' ' S' P 'S/ 'L 'L' ''L' ' ' L'
ti
G y si u b i no n ' trong cng t c chuy ' 'S L
Li ' '
Heo: 1000 UI (SC, IM)
B : 1500-3000 UI v o kho ' y th '''13 c '' ''1 '
thu phi th sau 48h ti m PG F2(
Ch : 110 UI/kgP
c h n t
'L ' ''L' L''y '/ ' 'L ''Y/ 'P 't't' ' '
FSH n n c t c d 'k ' ' .
Ch ' '' - Nang th ' ' '' '' ' ' , ng ''y ''
tr khng r '
-' ' ' P ' '' n nang nh
-'t't'/ ''P q'' ' P 'Y nhi
Li ' '
B : 1500-3000 UI (IM, SC)
Ch : sau khi s ' '3 6 '''''''' '' '
t ch phm phi h p
- PG 600: 400UI PMS +200UI HCG
- Synovet: 400UI PMS +200UI HCG
S ' 'L ' ' P ' ' '''/ L''''-10 ng y sau cai s '' 'k '
l n gi '' '''' y

Ch ' '' -' ' ' ''L' ' ' L'L
- Vi m da do n L'L ' 'y
- G y s 'L' 'L' ' m t ' ' L' '
-Th o s ' 'YL m ' '' (thai ch ' u, vi m t ''
c m ''''
Li ' '
- Tr u b : 3-5mg
- Heo 2-4mg
- Ch 0,01-0,1mg

Ch ' '' - An thai, ph ng ng ' 'L
- Ch ' '' '''' '
- G y l n gi ' ' ' 'k'
Li ' '
- Tr u b : 100mg h ng ng y tr ' y th '''' ''
- Ch : 2-3mg/kg/ng y ph ng ng ' 'L

Pros taglandin F2( v c c h a d t ng t
Dinopros t, PG F2(
Ch ' '
- Tr ' S' ' n gi ''Y 'L'' ' ng th
- G y s 'L'''P ''' ' S'L' ' u, ch '
phi, b 'P '' '
Li ' '
- B : Dinoprost ...... 25mg
Cloprostenol..0,5mg
Fenprostalen.1mg
- Heo: Etiproston......1,7mg (IM)
thc
Do h ' ' 'L/ 'L ''Y ' ' ' ' ' ' o th y)
Ch ' '
- Ph ng tr ' 'L ' '' ' '''y S'
-' ' ' trong c c b '' ''''YL m n L'P ''YL m b '
m 's t nhau)
- C P 'P / ''L' '' 'P / ''S ' ' '
Ch ' ' '''L' ' '' a m
Li ' '
-' L'L'''''-40 UI (IV,IM,SC)
- Heo: 5-20 UI
- Ch m o 1-2 UI
9.2. c l i u

- Thu 'y P ' ' L'L '' ' L'TL'''''/ ' 'P ' n
c c lo L'/
- C ch '' ' '/ L' S'''''Y '1 '' ' L' ' L' L' '''
Ca++, Mg++
- Ch ' ''3 th ''LP '' ''S ph L'' 'LP '''''' 'Ca huy
- Ch ' ' ''t'L ''P 'L'' ng chung c c thu 'k ' 't'L/
- Li ' ''y '''-4mg/kg (IV, PO)

- Thu 'y P ' L'L 'L 'L P ''
- C ch '' ' '/ L' S''1 '' ' ' ''' L ' ''L 'P '
th gi P ' n gi P ' i ti '''Y o n 'L
- Li ' '''y ''''-2mg/kgP (PO)
Pilocarpin l ancaloit l ' '/ 'k '3 LS'LL' ' '5 ''
Hi '3 LSL' ' ' ' ' S''7 ' ' ''
t
Pilocarpin d ' ' 'L' 'P u tr '' '/ '''' '' ''
khng tan trong te. C c mu L' ' ' ' clohydrat, sunfat v nitrat d L'
d dung d ' '''' ''''''7 ' ' 'L' a ra khng kh. B 'T '
trong l ''t''1 L' d 'P L' ' ng nhi ' n, khng b ' ' i
khng kh, h a tan trong 8 ph ' '
ng
Pilocarpin kch thch d y th 'L'Sy 'L' P ' ng t ' Eserin l m
k o L'/ ' ' ' L'''y 'y '/ ' '
1. 7 ' ' i ti '' ' ' b i ti ' '''P ' L''Y c c tuy ' '
b ( ' ''k ' i ti ''-10 lt nu ' '''''S''
2. G y co b p m ' S' tr n c ' 'Y 'P ' '' ' ' '
3. L m '' ' 't't' ' ' ' v d ' 'L'L m t '
m (li '''P '100kg th ' ''
4. T L' ''L' 'P '' 'k '' ' ' m gi P '/ S' ' 'P '
5. Thu ' ' ' 't'Y ' ' 't'T 'Y t ''' L'L '
cao, thu ' m gi P ' S'LP 'Y huy '/ S'
nh
Thu ' ' ng trong m ' ' '' '' 'ti u h a ' ' y
(nh ' do co th ' 'Y '''' '/ ' '' 'Y li ' ' ' ' i nhai l L'''
t th 'T ''Y ' ' 'k'' nh ' ' i ti ' ''' 'Lr ' '
th 'Lnh 'P ''7 ' 'k 't' ' ng c th L' ' '
u l ng
Ti m d L''' '3 LSL'L''''''P ' '''P ' ' ''Y L'
li sau:
Tr u, b , ng : 100 - 400mg.
D , c '' : 20mg.
Ch : 0,5 - 5mg.
Ch :
- Khng d ng thu ''/ ''Y ' 'LP '''y ' '' ' '' '
ph n;
- Gi L' c do d ng thu 'T/ 'L ' '/ 'L m Atropin v c c thu ' '
tim, tr ' '
- C th ' ng dung d 'L m ph L' S'3 LSL-Eserin (g P '3 LSL'
nitrat 5-10cg, eserin sunfat 5cg v nu ' '''P ''L m v L'L ' tr n.
Strychnin l m 'loit chi ' ' ' 'k 'P ti ''k 'P ti 'P '
nhi ' n ''Y ' '' 'P ti ' ' ''''''6 L'Y 1,5% Brucin
(bruxin)
t
Strychnin c d 'L' 'nh kim, khng m u, khng m i, v ' ' ' ''
tan trong n 'Y khng tan trong te. Thu ' ' ' ng d L' ''P L'
sunfat hay arseniat. Mu L'L/ ' '' n trong n '' L' ' ng l sunfat
trung tnh ng P '''2 '''''''''L''' L'P L' P '''2 '''''
strychnin v 15% asen) c ' ' ng. Mu L' 'c 'Y ''6 L'y L'
chung r ' '
ng
6 L'/ ' ' ' ' n t ' 'P ' 't't' L'Y L'/ ''
t m ph ' ' ' nh n o t ' '
V L''L ' ''L' m ' ' ''P ' 't' ' P ' n th n v
tnh nh ' P ri ng bi ' '/ ' 'S ''P ' ' ' ng l ' ' v
tim, g y co m '' ' '/ S'
V L'L ' L'''P ' ' 'Y 'T/ '''6 L'k ' ' P 'L/ '
r '
V L'L '''6 L'k ' '' b 'P ' ng l '''Y ' ''L 'Lb '
m t't' 'y 'Y ' ' ' 'Y c l ' ' ' '' ' '
nh
Strychnin c th ' ng l m thu ' ' n th n trong c c tr ' S' '
nh ' th '' '/ L'P 'P L''L ' ''' 'L' ' ''t't' '
kinh trong nh ng ch ' ' , li ' , b L'L '' 't' 'S L''S ph L''
c ng ''k'' v L'L ' ' S'Y n n s ' 'L'' m ch ' L'/ '
'L L 'L' ' ' '/ ' L' ' ''LL''' m thu 'L ' 'Y L'
li cao.
u l ng
Do c h 't'P ' n t d ng cho gia s c u '' 'L m d L''' '
d ng dung d ''''Y L'L'' 'Y dung d ''''Y L'L'' ''' ' ng
li th S' L' ' 'r '' 'L ' L''' L'L P ' ' 'Y b ' ' ng
l Lv L' S' 'nh v '
6 'k ''L ' ng h ' y cho u '
t m n ch Strychnin
Ng '' 2 -10g 50 -100mg
Tr u, b 5 - 20g 50 -150mg
L '' , c 1 - 3g 2 - 5mg
Ch 0,05 - 0,25g 0,2 -1mg
M o 0,05 - 0,05g -
Li 'L m d L''' '6 L trong m ' y:
Ng '' : 0,03 - 0,1g
L '' , c : 0,002 - 0,005g
Tr u, b : 0,05 - 0,15
Ch : 0,001g
'L ' ''y ' ' ng b tr ' 'P ti ' 'P L'6 L'' '
qu 1% Strychnin c b '
Ch : Khi b gi li ),
Clorofooc, Morphin. T ' ' d ng Parandehyt: 10-20g cho u ' ''P ' a
tan Y ''''P ' ' ' ng (5-6%).
Acepromazin, d ' ' '3 L L'' n h a h ' Ethylon 3

(dimethylamino 3 Propyl) 10 Phenothiazin, c n c t n th ng ph P '/ '
Plegicil, Vettranquil v Calmivat. Thu ' ''
t
Thu 'nh b y d L' 'YL n n n 12,5 25mg v 'L m 10mL ch '
10mg trong 1mL hay 'L m 5mL ch ''P '''P 'Y d ' ''''
ng
Thu 'y '/ ' g an th 'L ' Chlopromazin: l m suy y ' ' '
kinh trung ng, d ' L' '/ L' n t 'Y th gi n c , l ch 'P ' 'L P '
l ' Lv L'/ ' L' ' ''LL'' 'SL ''Y c c ch 'k ''' '
c b '' m gi P 'L '' ' '/ p, ch 'LP L'' 'k ' '' ' '
Adrenalin, ch ' ' ''L '
nh
Thu ' ' ng cho c c gia s c d ' 't't''' ' 'L P ''kP '
s ng, ho 'S ' '''y ' ' m gi P ''''' 30% li ' 'k 'P ), Thu ' n
d ng ' P 'y c ' ''P L '' ''P ''L'''y 'P y '' 'Y tr u b ,
d ng trong v ' 'L'' ' m gi P 'L' '
u l ng
Cho gia s c nh ' ' 'L m t 'P '' L''' S' ''L'' 'L m
t m ' ' S' ''7 'k '/ ' ''Y ng 15-20 ph t ( cho u ''L m
b S th '' L'''Y 5 ph t (ti m t 'P '' n ch v 10 ph t ti m (t 'P ''
tr n ng 'Y k o d i t ''-12 gi '
ng
i da
p tht

nh mch
Ch 1 3mg / kg - -
D , c - - 0,5mg / kg P
M o
10 30mg (t y
c '
- -
L - 0,5 1mg / kg P -
Tr u, b ,
ng
10 20mg / kg P, IM 5mg / 100 kg
Ch :
Do t c d ' m gi P ' '/ S'' n tr nh d ng trong m ' ' ' S'
Trong tr ' S'T/ 'L '' ' L'/ ' ' ' m 'P L' m t '
d 'ki ' P Shetamin. Trong can thi S'SS ' ' '' ' n d ng m 'P nh
Acepromazin m khng c 'k ' ho 'Y L'P ' '/ 'LP L'
Phenergan.
Atropin l ancaloit chi ' ' '/ 'k '''S'''k ' '
d '' 'P LP ''v c y thi n ti n t '' P 'L''Y'Y '7 '
B '''' ' Belladon).
t
Atropin c d ' ' 'L' ' 'P u tr ''Y ' ''L ''
n '' trong Clorofooc, d ' '/ '' L' 'Y o n ' ' ' ''7 '
th d ng 'd 'P L''
't' s '' S' L'Y L'SL' ' ' L' y theo lo i. Th ' '
c P 'L P ' '' L''y 'Y 'P q'''y ' ' L' ' 'P nh ' i t nh '
c P ' c '' v nh ' th '
Atropin t ng k 'Y L'3 LSL''( L''L'
Thu 'L m 1/2000, kh ' ng b '/ ' S'7 ' ''''''L n ti S''
3-4 ng y.
ng
Atropin l m ng ' m h ' ''P L'' ' l m li ' 'L'Sy 'L'
c P 'do n lo L' 'P L'S ' ' '/ ' 'T' ' ng c 'k'' 'L'
nh c P 'Y i Acetylcholin, n c ng lo L' '/ ' ' '3 LSL''( L'Y
Arecolin. 'y 'y 'y '/ ' ' n b 'P / ' ' S' 'L ' 'YL ' L' '/ ''
th c tr n v l m gi P ' ' ' i ti ' ' '/ 'S 'T ''/ ' ' m kh)
l m gi P '''L P '' S'c tr ''' ' ' y- ru ''L P 'L ' ' '' '
v 'm ' L''L ' ' ''L 't'S 'T '' ' S'LP 'Y co m 'P / ''' '
m m u tim v ph L'' m gi P ''

S '' S' SL' '/ ' i khng gi '''7 ' ' ' P 'L P '
d ' sau: Ng L'''y '''P o r L' '/ ' L' ' '''y 'pP ' ' P '
nh ' c ''r 'Y ' 'L ' th '
nh
Ch 'S ph L'L''' 'L ' ph ph L' S't' ' '''L P ' n co
th kh qu 'Y vi m ph 'T ' 'L'' 'L ' ' ' ' ' i ph ph L''
ch d ' ' ' 'k ' 'T 'k' ' 'P / ' ' S''L 'T 'L ' ' ' ''
ch ' ' ' ' 'Y v gia s c kh c; l m gi P '''S ' 'P '
(th tinh th ''' m gi P 'L ' ''/ ' ' ' n c ' 'YLr P ' ' ''
vi m k 'P 3 ng ng '' ' S'Y L'P SL''L'k 'P b ' te hay
clorofooc; gi L' 'L'L P ' '3 LSL'' L'' LS '' SL'Y
Clorofooc, c c thu ' s u thu ' S' ' ' ; bi c c v ' ng l m gi P '
d L' ' 'P '
u l n
Ti m d L'''' ''''''''Y L'L '''t' 'SL''
Ng : 1 8cg
Tr u , b : 3 10cg
L : 1 3cg
Ch : 1mg
Nh 'Y o m '' ''t'SL'''''' ng thu 'P 'Y L' '
16cg Atropin trong 20g vazolin.
L' ' WURS 'i 'WL L'
tri ' ' '' S'SL' 'L n l : gi n ' '' '/
ni m m ''t't' o v t ' S'LP ''
Chlorpromazin l m ' L' '' ''P ' ' ' 'SL L, l

Clohydrat c '-3 (dim tyl-amino-3 propy)-10phenothiazin, c n c t n th '
ph P l Largactil.
t
Thu 'y ' 'L' ' '' '' P '' ' a tan trong n '''
r 'Clorofooc. Dung d 'y 't' L' ''S'L '''''Y 6,5). Thu c b ' '
th nh m u h 'L''/ '/ '
B 'T ' '' 'P u, tr nh nh s ng.
Thu ' ' ' '' '' 'Lr P 'y ''P ' '''P ' ng
truy ' m '' 'Lr P 'y ''P ' '''P ' 'L m b S' ''' '''''''
gi '= 1mg Largactil). Thu 'YL n ch '''P 'Y 100mg, thu ' ' '''P 'Y
100mg.
ng
Chlorpromazin g y li ' 'L'' m gi P ' '/ ' ' 'L'' '
ch b i ti 'L'' 'T ' th ' i ti 'L 'L''y 't' 'L L'
tr co gi ''' ' . L m gi P 't'P 'P '
Thu 'P ' '/ ' '/ ' L' 'k 'P , thu 'k ' ''' 'L P '
'n n c th 'L P 'L '/ ' L' 'y ' '/ 'L P ' '
Thu ' n l m h 'L ' m gi P '' L' ' S' ' ' ' o th 'L''
Ngo i ra thu ' n c t c d ' ' '' '/ '' ''L '
nh: Suy nh t thn kinh trung
u l ng: Ti nh mch ha y bp tht.
n:
- Ti m t 'P ''' ' ng) 30 75mg / 100kg th ' '' 'Y '
qu 125mg '' ' 'P / ''
- Ti m b S' ''''' 100mg / 100kg th ' '
- Ti m nh ' L''' 4 l '' y (b ' 'Y/ '

- Ti m t 'P ''''''''P ' L'Y L'/ ''Y '''nh t ''''''P ' L'
v Lc c con v ' '
- Ti m b S' '''P '''' ' ' 'L ' 'Lg y m .
- Th 'Y o tr ' ng: 25 ''''P ' L'Y L'y 'Y 12 '''P ' L'Y L'P o.
- Cho u '''' 3mg / kg th ' ''P ' y, chia li ' m 2 3 l '
u '
12

- ' '' ' ' d ng h ' S'SP L-Promethazin (Phenergan)
v Ll 'ng nhau. Ti m t 'P ' ' S' n v L'L '''' 50mg / 100kg th
tr '
- Thu 'y '/ ' ' 'L P ' 'L'Sy 'L' P ' ' t c d '
ch ti 'L' ' 'L' '
Diazepam, t n th ng ph P 'T'L ' Valium, Seduxen l thu 'an th '

thu nh m c c Benzodiazepin c tr n 2000 h S' ' ' ' S'L ' '
Tnh ch
Diazepam l ch '' ' S'y ' '' ' a tan trong n '' a tan
trong 'P L' 'L '
ng
Diazepam, c ' c c Benzodiazepin, c t c d '' sau:
1. Tr n h ' 'L'' ng, thu 'y '/ ' '' 'L L''' gi ' ,
ch ''L ''P ' 'L P ' ' '/ ' ' '' 'L P ''Y thu 'k '
m kh, khng g y tr ' L' n h ' 'L' 'Y ' '/ ' ' '
Phenothiazin.
2. Tr n h ' ' S'' 'y ' 'k ' ' ' ' S'
3. Tr n h 'LP 'P '' 't'y '/ ' '
nh
D ng trong c c tr '/ L'' '' 't' ' ' i, b ' ''''
chu 'P / ' P ' kh c nhau (n L'L'''' ' 'Y/ '' ' 'Y c c
ch 'k co gi ''/ ' ' S' ' ''' ''S ' '
ng ch nh: D ng, thiu nng h hp nghi ng
u l ng
Ti m b S' ' ' 'P '' L''

u
ng cho thuc
t u tc
ng (pht)
i gian tc
ng (gi )
L 1 2 B S' (t 'P ' 2 10 4 6
Ch 1 2 B S' '' 'P ' 10 15 6 8
Th 1 B S' '' 'P ' 5 10 1 2
13
Chu ' 2,5 D L''' S' ' 2 - 5 1 2

t
Tinh th ' 'P ''P L' 'Y ' ''Y ' ''y 't' ''' ' a tan
trong n '' '/ 'L' S'' o, menthol, c c h S' 'S'' ' '
thu ' axt h a theo th L'L' n ch 'S' 'L' ' ''7 ' ' ''
Thu ' ng k 'Y L' ''/ 'P L' 'k'/ '/ '
T c d
Thu 'k 'P m '' 'L ' Lv L' ''k'' v l ''7 'y '/ '
d g y m , g y ng '' ''L '' '' ''k 'L n m 'P / ' L'
bi n (c ngu ' ' 'L'' ng) l m gi P ' '/ S' 'P '' ' '
l Lcho vi ' 'P / ' L'/ 'Y ' ng. Thu ' m suy gi m trung t m h h S''
l m ch P ' S' ' 'L 'L ' '
nh
L m gi P ''P khng c 'k ' ; g y m trong ph ' '' m gi P ' n
ng ''L P '' ' ' '' ' ' P '-da, ch ' ' '6 L
u l ng
1. G y m : Ti m t 'P 'k ' ''10 15 ph t v k o d i 1 ti ' L'
tr u, b , ng '
Tr u : 10g / 100kg th ' ''' ''' 10%)
Ng : 10g / 100kg th ' ''' '''''
L : 170 173mg / kg th ' ''' ''''''L m ch P 'Y o t '
m tai).
Thu 'k 't' ' nh t h m 'Y t ' 'L n k '' n ph L'L m v o
th 'chnh x c
2. Gi P ''' '' ''' ' ' 'Y o h 'P ''L m t 'P '
hay ti m ph c m 'Y L'L ''
Li '' ''' 'S' ng t nh ' 1/50
Tr u, b , ng : 20 60g
L : 5 10g
D , c : 5g
Ch : 0,5 6g
3. ' ' ''y ''7 'Y o h 'P ' '''t'' '' '
30 60% h a tan v o n ' P '
Cho n u 'P L'L '''a c ph xir Chloral hydrat 1/20
4. Ch ' '' S' 'Y o ch ' '' '' ''''''y
cho th m 9% glyx rin).
5. Ch ' P ''''' / S' L' ' ' S'' -phenol-r 'L '
v Lt ' ''''''' ' ' S'' -phenol-r 'L 'Y L' ' '''''''''''
6. Ch ' ' '6 L''''Y ' 'Y L'L 'k 'P .
Ch :
- Khng d ng thu 'Y L'L''y ' 'L ''P ' '
- Khng d ng v L'L''P ' 'LP 'S L''' ' ' gia s c c i
c ch ' ' L' ' L'
- Khng d ng cho lo i m o
- Khng d ng trong m ' '' 'L'
- L'Y L' ' n che m 'Y tr nh m L'L ' ''/ 'LL' ' P '
v h L' '
- Thu 'y '/ ' ' m tan m u, n n vi '' m v o dung d 'L m
Natri citrat l c l L'

C n g L''P 'k 'P r ''P ' ' ng, tricloromethan, tr nh
l P v L'P ' ng ph P '
t
Ch ' ng khng m u, n ' n n '' ' '''''''P i d ' ' 'L ''Y '
cay ' ''y 'P / 'Y ng ''t' a tan trong n ''''''' a tan trong
r '' te, khng tan trong glyxerin, bay h i , h i b ' n c th '/ ''1 y ' dung
mi c 'L ' '' 'b o, it, nh 'p''' 'P ' ''''L ''7 ' '
B ''
Clorofooc c ch a 5% c ' ' L't'' ' ' ' ' '

g y m . Thu 'k 'P n y ph L' 'T ''nh th 'L'P '' ' ''''
th t'' ' i m t v t L'
ng
Clorofooc c t c d 'k 'P to n th n, g y t li ' ' n trong v b n
ngo i. T 'L'/ '' ' ''/ '' ' ''1 y ' n l m gi P '''L P '
ng ' n ngo i. Thu ' m suy gi P '/ ''kP 'Y 'P ' 'L ' S'' '
p v m L' ' ' 'LP .
Thu 'k ' ' ' ng khi ti m v L'L ''Y o m 'P / ''Y o tim, v o
ph c m ''Y o l ' '
nh v u l ng
1. G y m : Cho con v '' ' ' th ' P '' L'' P '' ''
(tr nh ' ' 'Y o xoang m L''
2. T 'L''/ '' ng dung d ch b o h a 10% trong n ''' '
Tr u, b , ng : 25 50g
L '' , c : 5 10g
Ch : 0,5 5g
M o : 0,2 1g
3. Ch ' 'y ''y ' '''a c ph n ' 'y ''' a 75
100g n '' o h a trong 5og xir) cho u ''' 6 l ' ng y.
ng tim t nhi
quan tr nh ' ' ng ' 'Y 'y ' 't' L'Y L''' n trong nh '
P g 'k ' ' n ' ' ' '
Droperidol l thu 'k 'P thu 'y P '/ 'Snon. Thu ' 'L P
B '
t
SL'y L''y ' 't' S'Y 'y ' '' n cao. Thu ' L'/ '
v LAdrenalin, Nor-adrenalin v apomorphin, b i ti ''Y L' 'P 'L'/ '/ '
d c 'y ''''L ' ' i ch tnh t 'L'' ng thu ''Ti m b S' ' '
m ''LL' ' P ' 'Y o kho ''''S'Y th L'L'/ ' 'k ''P k o
d i t '''S' 'P 'L '
ng
Droperidol c t c d '' ' ''P ' L'/ 'Y L' SP SL'L L''
ti k 'P r ''P ' ' 'L ' ' ' c ng ''Y c c thu 'L P '' ng
'c t c d ' 'Y ' 'L' 'Y ' L'Y L' ' 'L P ' ' S'k '' L'
c c thu 'L P ''Y gi P 'P ' L'Lr '' L'/ 'Y L'L'Y Nor-
adrenalin.
Thu ' 'y '/ ' ' m gi n ' ''L 'L v ch 'L 'L''
v ti ' SL''k ' 'k'L 'Y L'L ''
nh
Droperidol trong th y h ' ' ' '
- Trong ki P ''kP ' n, ph ' ' ' 'y ' ' m d ''
- Trong g y m ng '' '''-40 ph t) k ' S'Y L' '' '/ ' L'Y L'
l khi ph ' '
- 7'k 'P r ' L'Y L'y '' ' S'Y L' '' '/ '
u l ng
ch:
Trong ki P ''kP ' ng: 1mg / kg th ' ''L m b S' ' ' 'P '
Trong ph ' ''''P ''P ''y ''''' ' S'Y L'
5mg Phenoperidin
0,5mg Atropin
N ' 'L ''L m m 'L ' S' ' ' ' m m 'P L'' v m ''
th '
l n:
- Trong ph ' ' '''''' 0.4mg / kg th ' ''7L m b S' '' ' S'
v LPhenoperidin, Atropin (c th ' ' S'Y L'1 L' L'L''1 L
hydroxybutyrat, Nit protoxyt).
Ch : Khng n n l m s u th m s b
m Halothan, Methyxyfluoran, te, v.v

te g y m c n g L' te thylic, te xy. (Khng n n nh P 'Y L' te thng
th '' ' ' 'k 'P )
t
Ch 'hng m u, r 'L' ''P i d ' '' ' ''Y '/ ' '' a tan
trong 10 ph ' ''' o, iodoform, c c ch 'p' 'k''' te g y
m l ch ' '''' P ; te tinh c ' ng ph P '''' P , ch '''' 'Y
m 'tn '
te g y m khng b 'Y ' L'Y L'L ' '' 'y '' 't'Y '
ngo i / '/ 'Y 'L'y ' ' ' ' '/ ' 'Y peroxyt g y kch
' Lv L' ' ' S'' 'T ''' ' 'L' ' i m t, tr nh nh s ng.
Khng n n d ng te d ' ' 'k 'P n u l ' 'y ' b ' ' ' n
24 gi '
ng
te d ' 'y ' '/ ' '/ '' n c c h ' quan
1. Tr n h ' 'L
G y m to n th n nh ' ' i, t c d 'k 'P r 'P '' 'k'P kh '
gi P oxy h a.
2. Tr n h 'LP 'P
- Tr n tim v L'L ' S'Y trung bnh: Kch thch tim; v L'L '' m suy
gi P to n b ' ' 'LP ''
Tr n c c m 'P / ''Y L'L ' S'Y trung bnh: N i chung khng l m thay
Lhuy '/ S''/ S' ' 'P 'Y ' 'L 'Y ''Y L'L '''k 'L n m '
to n th n v L' 'L P ' 'r L' ' S'/ S' ' 'P '
3. Tr n h ' ' S
G y kch ' n ni m m ' ' ' S''' '' ' 'L n v o th L' '
g y m hay th L' ' ' ''
4. Tr n h 'L u h a
- L m suy gi P ' ng l ' v s ''y S' ' 'L u h a;
- 7/ ' ' 'L S' '/ 'trung t m th 'L''k ' ' 'Y bu '
m 'Y ' 'k 'P nh ' '' L' ' ' ''
5. Tr n t '
- Ch ' m suy y ' ng l ' v s ''y S' ''P 'L'Y L'L '
cao;
- V 'T' ng r o b o thai v g y s ' 'L P ''kP ' 'L' ''
v s sinh.
6. 7r '' L'
V L'L ''y ' ' ' L' 'S/ 'L ' '' ''' L' '
nh
a) G y m to n th n, b '/ ''t'T' 'P L' L'T' 'LL' '
- LL' ''''LL' 'k 'P
- LL' ''''LL' 't't
- GiaL' ''''S '
- LL' '''' ' L'
b) Bi qu t te th ng ph P ' 'k ' c ' ' i da, s t tr ng v ' ng
b n ngo i.
u l ng
a) G y m b '/ '' L
Ng ''k' : 100 400g
L '''' : 100g
Ch : 10 50g
b) S t tr ng g y t : D ng h ' S' ' ' te trong th ng ph P 'Y c '
90o.
Ch :
- Thu 'k ' ' '' 'P '' 'L 'L i v nguy c b ' 'L'k '
m v l c t ' '
- Thu 'y ' ' g y ch y n
- Thu ' m cho gia s c c m i kh ch
- P ' 'L P ' ''/ ' ' '/ ' '''''
Ketamin l m ' L' ' 'k ' v g y m r ' ''7 ' n c c c t n

th ng ph P ' Imalgene, Clorketam. Mu L' ' ' clohydrat
Tnh ch
Thu ' ' th ' S' '''' S' ' L' ''y ' ' ng ti m
d L''b S' ' ' 'P ''7 ''' S' ' L' '' n c th ' ng cho
m L' '' '
ng
Thu 'S' '/ '' 'L'Y ' o v kch ho ' '/ ' ''
k ' 'Tr '/ L'k ' k o d i v c ch ' ' '' ' n b 'P '' ' L'
g y ng 'Y duy tr c c ph ' ' ' 'Y kh qu ''' ' '' ' L't'
thch tim v h h S'
Sau khi b ' '' ' ' khi t 'Y ' '''Y ' L'' '
- 7 ' 'S ' 'Y L' ' '/ 't't' n ngo i (ti ' ''/ '
s ng ). 'y ' L'L' ' ' ' 'L ''
- Tuy nhi n thu 'Y ' ' ' 'L ' ' '' ' 'P '' ' '
co th thanh mn. Nh ng thu ' 'k 'P 'L ' L' o tr n s ''y S' ' '
cung Y '/ ' ' '/ L' L'Y L' o thai.
nh
Thu ' ' ' ' ' ''Y ''k '' ''k ' c ' ''k 'P
to n th n.
'L 't' S''L''L ' L''/ ''Y ' ' ' ng.
Ch ' '
Thu ' ' ' ng:
- '/ ''Y ' ' 'L'' '' ' ' L'/ ' ' y co gi '
- '/ ''Y ''L ' '' ' ' ' c ph S'
- Thi ' ' ' '' ' i m o).
u l ng
- Thu 'y ' L'L'k 'P ng ''' 10 ph t khi ti m d L''''' 10 ph t
khi ti m b S' '''''Lk 'L'L m t 'P '

''' L' '
Ti m b S' ''''P '''' '
Ti m t 'P ''''''' '
Th L'L'k 'P l kho ''''S''y ' 'p' i b '/ 'L m li 'L'
nh hay ti m truy ' 'P '
1. Lo i ng
Ti m b S' ''''P '''' '
Ti m t 'P '''P '''' '
2. Lo i d , c
Ti m b S' ''''P '''' '
Ti m t 'P '''P '''' '
3. Tr u b v lo i l
Ti m b S' ''''P '''' '
Ti m t 'P '''P '''' ' '
N 'L' 'L ''y ' 'k'L ' b ' u ' n l n 20 25% (li ' '
t DL50' L'Y L'L 'L m t 'P ' l v o kho '''' 60mg / kg).
Novocain c n g L' Procain v nhi ' n kh c nh Syncain, Scurocain,

Velecain, Allocain, Ethocain v.v l d ' ' 'L'L ' ' 'k ''

Novocain c d 'L'h ' '' L' ''P '' '' ' 'Y ng
khi ra nh s ng, b 'Sk' ' 'L ' ''' ' 'Sk'' 'P / ''/ ' '
ch '' bi ' ''
1 YL'pP ' ' n Cocain t ''' 6 l ''7' 'L 'L ' '' L''
d ng mu L' '' L'Lmu L''' ''' n khoa t ' ' d ng
mu L'S 'SSL'
ng
Novocain c t c d 'k ' v gi P ''
Khi ti m v o m u, thu ' ' ' 'L' 'Y '' ''y S' '
tr n, co th ' 't'T ''1 YL' n l m gi n m 'P / u.
21
Novocain t ng t ' cocain, th P 'T' S' n c 'L m m ' ' ' ng
v l m m ' P ' '/ ' 'k ' 'L' P 'L/ ' ''/ ' 'k ' .
L'P ' '/ ' 'k ' c '1 YL'Y l m gi P '/ ' 'L n
m ' '1 YL'
V L'' lo ng v li ' S''1 YL't't' 'L' ng ph '
nh 'P ' ' 'S 'L' ' ' th ' n c t c d ' ' '
Ch nh
7''''1 YL' ' ' '
L m thu 'k ' t ' ''k ' t ' '''k ' d ng l ng hng;
g y t ngo i m ng c ''k ' trong nh n khoa (ph ' '''S' ' 'L'
bao quanh v ' ng, ch ' ng, ch ''k'' ng kh S''L' S''/ '
b ' S'ch '' ''L ''' 't'T ''' '' ' 'YL m
t cung tr u, b , ch ' ' 'L' ''S th '
Liu l ng
1. G y t t L' ''L m d L''' ''' 3% v L'L
Tr u, b , ng : 0,5 1,5g
L '' , c : 0,15 0,3g
2. Ch '' '''L '' 't'T '''S 'T ''7L m t 'P '
dung d 1 5%, v L'L ' n.
3. Ch '' ng: Ti m d L''' ''' 3% v L'L 'y L' n.
4. G y t ngo i m ng c ''7L m dung d ''''' 'L''L''S '
thu 'th L'L' '' L'''''L '' '' '''' ' S'Y L' L'L'
ph thu 'p' i (2 gi ' L'
5. G y t trong ph ' ' n khoa: nh '' ''''' ' ' d ng v L'
mu LPhenylpropionat novocain.
6. Ch ''k'' ng kh p v.v ; dung d '''Y o bao kh S'
7. Ch 'YL m t '''7Lr P 'Y ' 'P ' ' '' 'Y L'L '
150mL. Ti m nh ' L'''''L '
8. Phong b 'Y ' ng, ch ' ng (bao quanh): dung d ''''''
9. Ch ' 'L' ''S th '' ''L''''' 0,5%.

22
- Novocain (Procain) khng thch h S'' i v ''p''Y c c lo i chim nh ''
k c '3 LLL' Procain.
Pentobarbital l lo i thu ' ' n c t n th ng ph P ' Nembutal,

Pentabarbital sodic.
t
Thu ' ' '' a tan d '' '
Thu ' 'nh b i d L' '' ' '''P '''''P
ng
Thu 'y '/ ' '' ' ' ' i h n (30 40 ph t t y theo li '''L S'
y l g y ng 'p' i 1 2 gi ' ' n t y theo c th ' ' i, c th ' ' L''''
gi 'y 'L' ''''L ' 'P ' ''P o.
nh
G y m to n th n; trong c c r L' ' 'L''' ' ''6 L'
Metaldehyd; trong c c c n co gi '' 'L/ ''L'L '' '
u l ng
Li ' s '
1. Trong g y m , ti m t 'P ' P '' ''''
Gia s c l ''''P '''' '
L' ' ' ''''P '''' ' '''S' ng dung d 'Y L''' L' '
n c ''
N i chung, th L'L'k m l 30 40 ph t v t ' '''' 2 gi ''y ' '
tim v o ph c m ''P o, l ''5 L ng ' ' 'L'L 'y ' 'L m v o tinh
ho n.
T c d 'k 'P sau 10 15 ph t.
2. Trong g y ch ' ''' ng dunh d '''''L m v o t 'P '

-C '' i c c con v '' ' 'L ' ' ' ph L' S' '
-Khi con v ' ' ' ' ti m Strychnin li ''
Thiotetrabarbital l m ' L' ' 'y ' n th ng ph P ' Thionarcex.

23
Ch 'S P '7L' mu L'L' ' L''''' ''''methyl propyl)
Thiobarbituric.
t
Thu 'y ' ' ' 'L' '' a tan trong n 'Y cho m '' '
xanh l c y nh ''y 'S'' n 10.
Thu ' ' ng d L' '' ' ' ''''''Y khng d ng khi
pha ch '''L ' '''L 'L'' xu 'L ' '' ' ' ' ' ' L'
t c d ' '2 '' 't'
ng
Thu 'k ' 'L P ' 'L'' ng, c c ch 'S ' ' S'' 'L ''
l m gi P ' '/ S''7 'k 'P t 'Y nhanh.
nh
Thu ' m g y m trong ph ' 'p' i, b ' 'L m t 'P '''y '
c th 'L m l L' ' 'L '
Tr u, b : 5 7mg / kg th '
B , ngh : 3mg / kg th '
Ng : 10mg / kg th '
C '' : 10 15mg / kg th '
Ch , m o : 25 / kg th ' ''' ''''' ''''''' ' '''
g y'P r ' ''''S'' ng dung d ''''''Y L'L '''P '''' ' '

Xylazin l m ' L' ' ' ng trong g y m gia s c, c c t n th ng
ph P '5 P S''7'L ' ' L'' ng Xylazin chlohydrat.
t
Thu 'y ' n h a h ' 2 (2,6 xylidino) 5,6 dihydro-4H-1,3 thiazin-xylazin.
Thu 'nh b y d L' '' 'L m 2%.
ng
Xylazin c t c d ' m gi P '''k ' v th gi n c , g y tr '/ L'' '
t hay nhi ' y theo lo i gia s c.
T c d '' ''k 'P v th gi n c l do s 'S' ' 'S ' '
d truy '' 'L'T'L-n p '' ng th 'L''7 ' n c t c
24
d P ' 'L P ' ''/ ' ' ' ' '/ ' L' ' 'L P ' 'L''
thu 'th ' 'k 'P r '' 'L ' Ketamin)
' i nhai l L''u 'k ' 'L ' ' 'Y ch ' '
Vi 'S L' S' ' ' ' ''L'S L' S'P L-Xylazin c th 'k
m cho ng ' ''''S'
Tuy nhi n Xylazin c th 'k 'L P ' S' ' 'LP 'Y gi P ' '/ S'' '/ '
lo i nhai l L''' ' ''y S' ' y tr ' '/ ' i nhai l L'Y L' ' g y ra
ch h i. Thu ' 'y ' ' nguy n nh n c ' 'kP ' ' '' 'LP ''
t ph '' ' L' ' '' '''7 ' 'k ' ' ' L' ' '' ' m o),
kch thch co b p t '' ''Y 'y ' '
T c d ' ' ' L'/ ' '' i, li ' 'Y ' ' ' '
nh
G y an th ''k 'P r ' ''L S'S ' '''L S' ''' ' '
khi c ' 'L P ''kP ' ng, ph ng ng '''Y ' 't't''t' '' ng
trong g y m t '' ' 'L'' '''
Ch ' '
Khng d ng thu ''
-Xo ' ' y;
-C c b 'LP 'Y tr '/ L'/ '' '
-Th L' 'P 'L' L'
u l ng
T c d ' ' ' ' L''L '' ' ' 'Y lo i.
1. 'k'' :
- G y gi P '' ' th gi n an th '
Ti m b S' ''''''P '''' ' '' '''''P '''''''' ' '' '
2%)
Ti m t 'P ''''''P '''' ' '' ''''P '''''''' ' ''
d 2%)
- G y gi P ''Y ' th gi ' , g y t th '/ '''i S'S '
thu nh '
Ti m b S' '''''P '''' ' '' ''''P '''''''' ' ''' '
2%)
Ti m t 'P '''''''' 0,15mg / kg th ' '' '''''' 0,25mL / 100kg
th tr ''' ''''
- G y an th 'k''/ ' ' n t, d ng trong can thi S'S ' ' '
Ti m b S' '''''P '''' ' '' ''P ''''''' ' '' ''''
Ti m t 'P '''''' 0,5mg / kg th ' '' ''''' 0,5mL / 100kg th '
dung d ''''
2. ' '' y t ''Y ''' 'Y g y m , t gi n c , thch h S'rong t
th '
Ti m t 'P '''- 5mL / 100kg th ' ''' ''''
3. 'y ''7L m b S' ' 'L m t 'P 'Y L'L '' ''Y ' 'y L''
1 3mg / kg th ' '' ''''P '''''' ' '' ''''
4. 'P o: Ti m b S' ' ' L'''' mg / kg (t ''''' 0,2mL / kg th '
dung d ''''
Ch :
- Th ' 'L'S L' S'Y L'/ ' L'k ' ''k 'P (nh barbituric,
ketamin, chloral hydrat);
- Khng n n ph L' S'Y L''
- C ' 'L' ' ' ' ' i d ;
- Thu ' 'k ' '' L' ' '' n cho nh 'y L'L'L m thu '
- Khi qu li '''L S' '/ ' L' ' Doxapram chlohydrat
(Dopram), Tetrazolus (Priscol);
- Thu 'L L' ''LP L''LSP '
Antipyrin c n g L' Analgesin (A-nan-gi -din) hay Phenazon (Ph -na-don).

Antipyrin c n m ' ' '/ ' Antipyrin salixilat, c n g L' Salpyrin.
t
Tinh th ' 'P u, r ''' '' ''Y L' ' ' '
thu '''trong c ''Y ' L' '
T ng k 'Y L'3 nol (h a h S' nh th ' ''5 L''1 S'' thol,

Chloral, Natri salixilat, Salol (th nh h ' S' ' ''' '3 ''/ ' L''
ch ch t, Calomel (c th 'k 'L P ' ''
Thu ' i ti ' ''T' 'L 'Y l m n 'L ' ' P 'P ' '
ng
Antipyrin c t c d ' ' ''' ng nhi '' S'S 'L ' a th n
nhi 'l m h ' n s ''7 ' n l m gi P ''Y l m c ' ''k ''P ' '
b 'l m c P 'P / 'P 'P '
nh
C c tr ' S' ''' P ' '' 'P / 'P 'P ' i da; ch 'P / '
m L'c ' '' L'Y L'y ''
u l ng
Cho gia s c u ''' ' S' ''
Tr u, b : 15 20g
D , c : 5 10g
Ng : 15 20g
Ch : 1 2g
C P 'P / ' n ngo i: b ' '' ' P ' '''' 40%
Ch : Tr nh tr
th
1
9.1.1. Strychnin
Strychn/n /a mot anca/o/t ch/et aat ta hat cay ma t/en Cay ma t/en moc nh/ea a
naac ta ra n do at ma t/en chaa gan 15 Strychn/n ra 15 rac/n (bra/n)
Tnh chat
Strychn/n co dang t/nh the hnh k/m khong maa khong ma/ rj cac ky dang tan
trong naac ra khong tan trong ete Thaoc thaang daac dang daa/ dang mao/ sanat hay
arsen/at ao/ n/trat de tan han trong naac ao/ daac dang /a sanat trang t/nh ngam
5
2
(74 strychn/n) rsen/at monobas/c ngam 2
2
(65 strychn/n ra 15 asen)
cang daac dang ao/ cacody/at cang ray Strychn/n no/ chang rat doc
Tac dung
Strychn/n tac dong cha yea /en tay song /am tang k/ch th/ch do/ ra/ cac trang tam
phan a caa hanh nao tay song
a/ //ea nhe strychn/n /a mot thao c bo /am tang t/nh nhay cam toan than ra t/nh
nhay cam r/eng b/et caa cac bo phan /am tang caang traang /ac caa ca ra t/m gay co
mach tang hayet a p
a/ //ea ha/ cao (ma khong daac raat qaa) Strychn/n gay tang cam g/ac ro ret
a/ //ea cao Strychn/n gay doc ca bj mat traang /ac con rat bj co g/at kh/ bj mot
k/ch th/ch nao do ra bj ngat tha r ca /ong ngac khong hoat dong daac
Ch nh
Strychn/n co the dang /am thaoc bo toan than trong cac traang hap say nhaac ca
the (trang tha/ met mo / b/eng an) than k/nh say nhaa c k/ch th/ch than k/nh trong nhang
chang nhaac ca //et ca ba/ //et Chong kh/ thang pho/ (pha pho/) caa ngaa traa bo ra/
//ea rat thap ra nen sa dang arsen/at Lam chat do/ khang de g/a/ doc kh/ bj ngo doc cac
/oa/ thaoc nga (barb/tar/c) Lam thaoc d/et chaot ra/ //ea cao
Lieu lng
o co hoat t/nh manh nen /t dang cho g/a sac aong De t/em daa/ da thaang dang
dang djch 1 ra/ g/a sac /an ra dang djch 1 ra/ g/a sac nho an daa dang //ea thap
2
ro/ tang dan /en cho den //ea to/ da ro/ g/am dan aong ra bat daa dang /a/ ra/ nhjp do
nha ray
Saa day /a //ea dang hang ngay cho aong:
Bot ma tien Dung dch Strychnin
gaa /aa 2 1g 5 1mg
Traa bo 5 2g 5 15mg
Lan de caa 1 3g 2 5mg
Cho 5 25g 2 1mg
eo 5 5g
L/ea t/em daa/ da dang djch Strychn/n trong mot ngay:
gaa /aa : 3 1g
Lan de caa : 2 5g
Traa bo : 5 15
Cho : 1g
De d/et chaot co the dang ba tron bot ma t/en hay mao/ Strychn/n (khong qaa
1 Strychn/n ca ban)
C hu y:h/ bj ngo doc th g/a/ doc bang C/oran ( //ea gay me) C/oroooc
orph/n Tot nhat /a dang Parandehyt: 12g cho aong hay mL hoa tan rao 1mL
daang dang traang (56)
9.1.2. Acepromazin
ceproma/n dan aat caa Phenoth/a/n ten hoa hoc /a thy/on 3
(d/methy/am/no 3
Propy/) 1 Phenoth/a/n con co ten thaang pham khac /a P/eg/c//

ettranqa// ra Ca/m/rat Thaoc bang
Tnh chat
Thaoc trnh bay daa/ dang r/en nen 125 25mg ra ong t/em 1mL chaa 1mg
trong 1mL hay ong t/em 5mL chaa 5mg trong 1mL ra dang caong 1
Tac dung
Thaoc co tac dang an than g/ong nha Ch/oproma/n: /am say yea he than k/nh
trang aang dan ta/ trang tha/ yen tnh ra tha g/an ca /a chat /am tang t/em /ac do/ ra/
3
cac /oa / thao c nga (bacb/tar/c thaoc ph/en) ra ca c chat gay ra an than cac bo /am g/a m
nh/et ha hayet ap chong h/stam/n chong gay non ac che drena//n chong soc chong
co g/at
Ch nh
Thaoc daac dang cho cac g/a sac de bj k/ch th/ch hang da de k/em tra /am sang
hoac phaa thaat (co the /am g/am 2 3 //ea thaoc gay me) Thaoc con dang de
cham soc cac bo (m/eng rang mat ta/) dong mong cho ngaa ra traa bo dang trong
ran chayen g/a sac de /am g/am ta/ nan
Lieu lng
Cho g/a sac nho aong hay t/em tnh mach daa/ da bap thjt g/a sac /an t/em tnh
mach hay bap thjt Thaoc gay tac dang trong rong 152 phat ( cho aong t/em bap thjt
daa/ da) ra 5 phat (t/em tnh mach) tren cho ra 1 phat t/em (tnh mach) tren ngaa ra
keo da/ ta 612 g/a
Cho uong
Tiem di da
Bap tht
Tiem
Tnh mach
Cho 1 3mg kg
e caa 5mg kg P
eo 1 3mg (tay ca)
Lan 5 1mg kg P
Traa bo ngaa 1 2mg kg P 5mg 1 kg
C hu y:
o tac dang /am g/a m hayet ap nen tranh dang trong mot so traang hap
Trong traang hap qaa //ea thaoc do/ khang chon /aa /a mot am/n /am tnh day
k/ea mphetam/n Trong can th/ep pphaa thaat nho ch nen dang mot mnh
ceproma/n ma kho ng can gay te hoac ra/ mot chat khang h/stam/n nha Phenergan
9.1.3. Atropin
trop/n /a anca/o/t ch/et aat ta /a cay e//adon (tropabe//adon) cay ca doc
daac (atara stramon/am) ra cay th/en t/en ta (yoscyamas n/ger) rr Thaoc doc
ang ( cang nha e//adon)
4
Tnh chat
trop/n co dang bot hay t/nh the nho maa trang rj dang tan nh/ea trong naac tan
trong C/oroooc de bj chay h/ sa rao naac thay nhan tay Thaoc thaang dang a dang
mao/ sanat
Doc t/nh /a sa dang nap do/ ra/ atrop/n rat thay do/ tay theo /oa/ Tha ta nhay
cam g/am dan: ngaa/ cho ra meo saa do den /oa/ an co ma nhang /oa/ /t nhay cam /a
caa de ra nhat /a tho
trop/n taang k ra / P//ocarp/n ser/n reco//n
Thaoc t/em 12 kha trang bang cach hap Tynda// a7
C //en t/ep trong 34

ngay
Tac dung
trop/n /am ngang ham he (mascar/n) tac /a /am //et than k/nh pho g/ao cam
do no /oa/ tra mo/ phan ang caa cac tha qaan tan cang caa da y than k/nh nhay cam ra/
cety/cho//n no cang /oa/ tra tac dong caa P//ocarp/n ser/n ra reco//n o do no co
tac dang tre n bo may ho hap the h/en a r/ec /oa/ tra cac co that ca tran ra /am g/am dan
sa ba/ t/et djch a cac phe qaan (tac dang /am kho) /am g/am ho g/am co bap ca tran
nha dong da day raot g/am t/et djch raot djch rj mo ho/ g/an dong ta g/an kh/ phe
qaan tang nhjp t/m ra co mach maa ( tra mach maa t/m ra pho/) /am g/am daa
Sa dang nap trop/n a cac /oa/ khong g/ong nhaa Tha ta nhay cam g/a m dan nha
saa: gaa/ cho meo ro/ den cac /oa/ an co trong do kem nhay cam nhat /a caa de ra
dat b/et /a tho
Ch nh
Chaa pha pho/ g/a sac dac b/et /a pha pho/ cap t/nh caa ngaa g/am can co that
kh/ qaan ra r/em phe qaan a g/a sac dac b/et a ngaa thaang dan ta/ pha pho/ chaa dj
ang caa ngaa gay haa qaa saa a bo may ho hap (h/ea qaa d/ea trj rat tot) chang tha doc
caa ngaa ra ra g/a sac khac /am g/am daa trong phaa thaat mat (thay t/nh the) /am
g/am t/et djch trong cac benh caa han caa nha r/em dong ta r/em ket macPhong ngat
5
(ket hap ra/ morph/n) kh/ gay me bang ete hay c/oroooc g/a/ doc kh/ nh/em doc
P//ocarp/n reco//n /ptere orph/n ra C/oroooc cac thaoc tra saa thaoc hap chat
haa ca bo/ cac ret thaang /am g/am daa daa/ dang thaoc ma
Lieu lng
T/em daa/ da dang djch 12 ra/ //ea saa (t/nh bang trop/n):
gaa : 1 cg
Traa bo : 3 1cg
Lan : 1 3cg
Cho : 1mg
ho rao mat dang djch trang t/nh trop/n sanat 1 ang thaoc ma ra/ ty /e
16cg trop/n trong 2g rao//n
C hu y:/a/ doc trop/n bang cach t/em orph/n ch/ohydrat rao daa/ da ( hang
tr/ea chang khong dang nap trop/n daa t/en /a: g/an dong ta kho cac n/em mac k/ch
th/ch nao ra tang nhjp t/m)
9.1.4. Chlorpromazin
Ch/orproma/n /a mot /oa/ thaoc an than mot dan aat caa phenoth/a/n /a
C/ohydrat caa c/o3 (d/mety/am/no3 propy)1phenoth/a/n con co ten thaang pham
/a Largact//
Tnh chat
Thaoc co dang t/nh the trang khong hat am rat hoa tan trong naac trong raaa
C/oroooc ang djch co t/nh a/t nhe (p g/aa 4 ra 65) Thaoc bj chayen thanh maa
hong kh/ ra anh sang
ao qaan thaoc trong /o maa tranh a nh sang
Thaoc thaang a dang dang djch: ong t/em dong 2mL chaa 5mg dang trayen tnh
mach ong t/em dong 5mL chaa 25mg de t/em bap thjt dang djch 4 (1 g/ot 1mg
Largact//) Thaoc r/en chaa 25mg ra1mg thaoc dan chaa 25mg ra 1mg
6
Tac dung
Ch/orproma/n ga y //et than k/nh /a m g/am nhe tac dang caa acety/cho//n ac che
ba/ t/et drena//n do haa qaa ca the ba/ t/et nh/ea drena//n Co t/nh chat g/a/ tra co
g/at co that nhe La m g/am t/nh mao mach
Thaoc /am tang tac dang cac /oa/ thaoc gay me thaoc gay nga thaoc g/am daa
nen co the g/am //ea cac /oa/ thaoc do de tranh nh/e m doc
Thaoc con /am ha nh/et /am g/am trao do/ ho hap caa he te bao than k/nh goa/
ra thaoc con co tac da ng chong non chong choang chong co g/a t
Ch nh: Say nhaat than k/nh trang aang
Lieu lng: T/em tnh mach hay bap thjt
Gia suc ln:
T/em tnh mach: (thaang dang) 3 75mg 1kg the trong (khong raat qaa
125mg a ngaa thaan maa)
T/em bap thjt: 5 1mg 1kg the tro ng
T/em nhac /a/ 3 4 /an trong ngay (benh aong ran)
Cho va meo:
T/em tnh mach: 25 5mg do/ ra/ cac con rat trang bnh ta 12 2mg do/ ra/
cac con rat nho
T/em bap thjt: 2mg kg the trong naa g/a traac kh/ gay me
That rao trac tra ng: 25 2mg do/ ra/ cho ra12 25mg do/ ra/ meo
Cho aong: 2 3mg kg the trong trong mot ngay ch/a //ea /am 2 3 /an cho
aong
C hu y:
ngaa tot nhat /a dang hon hap Ch/orproma/nPrometha/n (Phenergan) ra/
/aang ngang nhaa T/em tnh ma ch hon hap tren ra / //ea 25 5mg 1kg the trong
Thaoc co tac dang say g/am than k/nh pho g/ao cam cang nha tac dang chong
t/et Cho//n khong the co/ thaang
7
9.1.5. Diazepam
/aepam ten thaang pham qaen b/et /a a//am Sedaen /a thaoc an than thaoc
nhom cac enod/aep/n co tren 2 hap chat daac tong hap h/en nay
T/nh chat
/aepam /a chat tong hap hoa hoc khong hoa tan trong naac hoa tan trong
dang mo/ dac b/et
Tac dung
/aepam cang nha cac enod/aep/n co tac dang chang nha saa:
1 Tren he than k/nh trang aang thaoc co tac dang an than g/a/ /o tha g/an ca
chong co g/at /am tang t/em /ac caa cac thaoc nga thaoc g/am daa ra thaoc gay me
kh/ khong gay tra nga/ tren he than k/nh thac rat caa cac dan chat caa Phenoth/a/n
2 Tren he ho hap thao c co the gay say yea ho hap
3 Tren he t/m mach thaoc /t co tac dong
Ch nh
ang trong cac trang tha/ /o /ang (bj k/ch ang sa ha / bon chon) trong chaan me
cac tham do khac nhaa (no/ so/) trong benh aon ran ngo doc r cac chat gay co g/at
cac traang hap ang ca daa dan do phan a
Chong ch nh: j ang th/ea nang ho hap ngh/em trong
Lieu lng
T/em bap thjt hay tnh mach daa/ da:
Loai
Lieu
(mg/kg)
ng cho thuoc
Bat au tac
ong (phut)
Thi gian tac
ong (gi)
Lan 1 2 ap thjt (tnh mach) 2 1 4 6
Cho 1 2 ap thjt (tnh mach) 1 15 6
Tho 1 ap thjt (tnh mach) 5 1 1 2
Chaot /ang 25 aa/ da (bap thjt) 2 5 1 2
9.1.6. Chloral Hydrat

Tnh chat
T/nh the khong maa ma/ hang ra oc rj dang co t/nh an da rat hoa tan trong
naac bj chay kh/ gap /ong nao mentho/ cac hap chat pheno/ ang djch thaoc bj a/t
hoa theo tha/ g/an nen ch pha che kh/ sa dang Thaoc thaoc ang C
Thaoc taang k ra/ raaa Cac mao/ thay ngan anh sang
Tac dang
Thaoc gay me manh dat b/et do/ ra/ ngaa traa bo ra /an Thaoc co tac dang
gay me gay nga chong co g/at chong co cang gay g/an mach maa ngoa/ b/en (co
ngaon goc than k/nh trang aang) /am g/am hayet ap dong mach tao thaan /a/ cho r/ec
chay maa ta/ cac ret thaang Thaoc /am say g/am trang tam ho hap /am cham nhjp tha
a //ea d/ea trj
Ch nh
Lam g/am daa ma khong can gay te gay me trong phaa thaat /am g/am can
ngaa g/am daa bang a ngaa chaa benh nam /ongda chaa ngo doc Strychn/n
Lieu lng
1 ay me: T/em tnh mach gay nga saa 1 15 phat ra keo da/ 1 t/eng raa/ a
traa bo ngaa
Traa : 1g 1kg the tro ng (dang djch 5 1)
gaa : 1g 1kg the tro ng (dang djch 2)
Lan : 17 173mg kg the trong (dang djch 3 t/em cham rao tnh mach
ta/)
Thaoc gay k/ch ang thanh tnh mach ra to chac //en ket nen pha/ t/em rao than
ch/nh ac
2 /am daa chaa daa bang: Cho aong hay that rao haa mon t/em tnh ma ch hay
t/em phac mac ra/ //ea saa:
L/ea cho aong: ang djch pha /oang /t nhat /a15

Traa bo ngaa : 2 6g
Lan : 5 1g
e caa : 5g
Cho : 5 6g
3 Daa bang ngaa cho: That rao haa mon ngaa 1 //t dang djch Ch/ora/ hydrat 3
6 hoa tan rao naac am
Cho no aong mo/ g/a 1 tha ca phe /ro Ch/ora/ hydrat 12
4 Chong ngaa: Dap ngay rao cho ngaa dang dach Ch/ora/ hydrat 1 (co cho
them g/yer/n)
5 Chong nam /ong da: Dap ta/ cho hon hap Ch/ora/ hydratpheno/raaa /ot ra/
ty /e 1:1:1 hoac hon hap Ch/ora/ hydratpheno/raaa /ot ra / ty /e 1:15: 25
6 Chaa ngo doc Strychn/n: Cho con rat aong ra/ //ea gay me
Chu y:
hong dang thaoc ra/ g/a sac co da k/en cho mo thjt
hong dang ra/ g/a sac mac benh t/m pho/ gan than cang nha g/a sac ca/ co
chaa a tha/ ky cao/
hong dang cho /oa/ meo
hong dang trong mo ta cang /ay tha/
Do/ ra/ ngaa nen che mat ra tranh mo/ t/eng dong trong ca c g/a/ doan cam ang
ra ho/ tnh
Thaoc co tac dang /am tan maa nen r/ec cho them rao dang djch t/em atr/
c/trat /a co /a/
9.1.7. Cloroform
Con go/ /a Ch/oroorm gay me c/oroorm daac dang tr/c/oromethan tranh /am
ra/ c/oroorm thaang pham
1

Chat /ong khong maa nang han naac (ty trong 147) ma/ dja ngot dac b/et rj cay
ban daa saa do mat ra ngot /t hoa tan trong naac (dang 1) hoa tan trong raaa ete
khong tan trong g/yer/n bay ha/ ha/ boc /en co the chay o /a dang mo/ caa nh/ea
chat (chat beo /o t nhaa ket) ot gam chaa 6 g/ot Thaoc doc ang
C/oroooc co chaa 5 con tayet do/ t/nh theo trong /aang da daac dang de gay
me Thaoc gay me nay pha/ bao qaan trong bnh thay t/nh maa dang day nat that k/n
dat na/ mat ra to/

C/oroooc co tac dang gay me toan than gay te //et cho ben trong ra ben ngoa/
Tay g/an san chong non sat trang daang raot o con /am g/am daa g/am ngaa a ben
ngoa/ Thaoc /am say g/am cac trang tam ran mach a //ea thap hayet ap ra mo/ chac
nang caa t/m
Thaoc gay chet nhe nhang kh/ t/em ra/ //ea cao rao mach maa rao t/m rao
phac mac rao /ong ngac

1 ay me: Cho con rat (dat a ta the nam) nga/ c/oroooc tam trong bong (tranh
de bong /ot rao oang ma/)
2 Tay g/an: san: ang dang djch bao hoa 1 trong naac cho aong
Traa bo ngaa : 25 5g
Lan de caa : 5 1g
Cho : 5 5g
eo : 2 1g
3 Chong non cho: Cho aong 1 tha ca phe naac daang co c/oroooc (hoa 75
1g naac c/oroooc bao hoa trong 5og /ro) cho aong 5 6 /an trong nga y
11
C hu y:o doc t/nh thaoc co the gay nhang ton thaang t/m /t nh/ea qaan trong
nhang ton thaang a than ra co do c t/nh do/ ra/ gan nen trong nhang nam gan da y khong
con daac sa dang naa
9.1.8. Droperidol
roper/do/ /a thaoc gay me thaoc nhom cac atyrophenon Thaoc ngay h/em
ang
Tnh chat
roper/do/ no/ chang co doc t/nh thap ra co do an toan cao Thaoc do/ khang ra/
drena//n oradrena//n ra apomorph/n ba/ t/et nhanh ra/ sa mat d/ cac tac dang caa
no saa 5 g/a a /oa/ cho t/nh ta kh/ cho dang thaoc T/em bap thjt hay tnh mach g/a/
doan cam ang rao khoang 1 phat ra tha/ g/an tac dong gay me keo da / ta 45 phat den
mot g/a
Tac dung
roper/do/ co tac dang an than rat manh do/ khang ra/ pomorph/n g/a/ /o t/en
gay me /am tang caang h/ea /ac caa thaoc nga ra cac thaoc g/a m daa hang daa co tac
dang bao re than k/nh thac rat do/ ra/ sa say g/am ho hap gay ra ba/ cac thaoc g/am
daa ra g/am mach ngoa/ b/en do do / khang ra/ drena//n ra oradrena//n
Thaoc khong co tac dang /am g/an dong ta t/et Cho//n ra chong t/et Cho//n ra
t/et orph/n gay ha than nh/et ra/ //ea cao
Ch nh
roper/do/ trong tha y hoc daac sa dang:
Trong k/em tra /am san phaa thaat nho a cho de /am dja daa
Trong gay me ngan (ta 34 phat) ket hap ra/ thaoc an than khac do/ ra/ /an
kh/ phaa thaat
Trong gay me do/ ra / cho ket hap ra / thaaoc an than khac
Lieu lng
a. cho:
12
Trong k/em tra /am sang: 1mg kg the trong t/em bap thjt hoac tnh ma ch
Trong phaa thaat: 25mg cho mot con cho 2 kg ket hap ra /:
5mg Phenoper/d/n
5mg trop/n
ea can th/et t/em mot //ea thap thao c nga de /am ma t mo/ co ca ra mat y thac
b. ln:
Trong phaa thaat ngan: 1 4mg kg the trong T/em bap thjt ket hap ra/
Phenoper/d/n trop/n (co the ket hap ra/ atr/ hydroyd/on sacc/nat atr/
hydroybatyrat /ta protoyt)
C hu y:hong nen /am saa them sa gay me bang mot thaoc an than manh nha
a/othan ethyy/aoran ete rr
9.1.9. Ete
te gay me con go/ /a ete ethy//c ete oy (hong nen nham ra/ ete thong
thaang khong dang de gay me)
Tnh chat
Chat khong ma a rat //nh dong ma / dja ngot rat oc rj rat bo ng hoa tan trong 1
phan naac /ong nao /odoorm cac chat beo thay ngan c/oraa te gay me /a chat /ong
66
o
ome ete t/nh cat thaang pham 65
o
ome chaa 3 raaa ra mot /t naa c
te gay me kho ng be n rang do/ ra/ nh/et do oy hoa trong khong kh/ ra a ngoa/
anh sang ra kh/ do chaa nhang /aang nho cac a/dehyt ra peroyt gay k/ch ang do/ ra/
daang ho hap ao qaan trong /o thay t/nh a na/ mat tranh anh sang
hong nen dang ete daac dang de ga y me nea /o chaa no da bj ha ta tren 24 g/a
Tac dung
te daac dang co nha ng tac dang khac nhaa tren cac he ca qaan
1 Tren he than k/nh
ay me toan than nha bay ha/ tac dang gay me rat manh rat saa ma kho ng g/am
oy hoa
13
2 Tren he t/m mach
Tren t/m ra/ //ea thap ra trang bnh: /ch th/ch t/m ra/ //ea cao /am say g/am
toan bo chac nang t/m
Tren cac mach maa ra/ //ea thap ra trang bnh: o/ chang khong /am thay do/
hayet ap ap /ac dong mach ran daac g/a rang ra/ //ea cao: gay g/an mach toan than
ra/ sa g/am dan ro/ say sap ap /ac dong mach
3 Tren he ho hap
ay k/ch ang tren n/em mac daang ho hap ( sa co that tat nh/en rao tha/ ky daa
gay me hay tha/ ky tnh day)
4 Tren he t/ea hoa
Lam say g/am traang /ac ca ra sa co bop caa ong t/ea hoa
Tac dong trac t/ep den cac trang tam than k/nh gay baon non ra baon maa
(rao daa gay me nhat /a a tha/ ky tnh day)
5 Tren ta cang
Ch /am say yea traang /ac ca ra sa co bop ta cang mang tha/ ra/ //ea cao
aat qaa hang rao bao tha/ ra gay sa say g/am trang tam than k/nh a con rat
sa s/nh
6 Tren trao do/ chat
a/ //ea cao co the dan ta/ sa phat tr/en sa toan hayet do trao do/ chat
Ch nh
a) ay me toan tha n bang cach cho h/t qaa daang ma/ tra/ qaa bon g/a/ doa n:
/a/ doan 1: g/a/ doan gay me
/a/ doan 2: g/a/ doan k/ch th/ch
/a/ doan 3: phaa thaat
/a/ doan 4: doc ha/
b) o/ qaet ete thaang pham de gay te cac bo ngoa/ da sat trang ret thaang ben
ngoa/
14

a) ay me bang cach cho nga/
gaa traa bo : 1 4g
Lan (1ookg) : 1g
Cho : 1 5g
b) Sat trang gay te : ang hon hap do ng /aang ete trong thaang pham ra con
o
Chu y:
Thaoc gay bon chon non maa chay nh/ea g/a/ ra ngay ca bj ngat kh/ gay me
ra /ac tnh day
Thaoc co ngay ca gay chay no
Thaoc /am cho g/a sa c co ma/ kho chja
Lam tang t/em /ac cho tac dang caa cac chat cara (carase)

etam/n /a mot /oa/ thaoc de gay te ra gay me rat tot Thaoc con co cac ten
thaang pham /a ma/gene C/orketam ao/ daa c dang /a c/ohydrat
T/nh chat
Thaoc daac ca the hap tha nhanh dang nap tot ta/ cho co the dang t/em daa/ da
bap thjt hay tnh mach Thaoc dang nap tot ta/ cho nen co the dang cho mo/ con daang
cho thaoc

Thaoc phong be cac ang than k/nh ro nao ra k/ch hoat nhen cac caa trac ke can
Trang tha/ gay te keo da/ ra co chat /aang tot da a tren be mat dong tha/ gay nga ra
day tr cac phan a caa haa ra kh/ qaan trong /ac ca dong tha/ k/ch th/ch t/m ra ho hap
Saa kh/ bat daa cho thaoc cang nha kh/ tnh ray a con rat ngaa/ ta thay:
Tang do phan ang ra/ tat ca cac k/ch th/ch ben ngoa/ (t/eng dong anh sang)
cho do/ kh/ thay nhang dot ngot g/at rang
15
Tay nh/en thaoc ran den sa tang t/et naac bot chay naac mat kha nang co that
thanh mon hang thaoc khong gay mot b/en do/ nao tren sa co bop caa ta cang ra tac
dong say thoa/ do/ ra/ bao tha/
Ch nh
Thaoc daac dang de co djnh con rat gay an than gay te cac bo gay me toan
than
Dac b/et th/ch hap cho g/a sac nh/ea tao / cac con rat bj chan thaang
Chong ch djnh
Thaoc khong daa c dang:
cac con rat bj dong k/nh bj ngo doc ba/ cac chat gay co g/at
cac con rat dang d/ea trj bang thaoc haa ca co photpho
Th/ea nang than nang (a /oa/ meo)
Lieu lng
Thaoc co tha/ g/an gay me ngan 5 1 phat kh/ t/em daa/ da 5 1 phat kh/
t/em bap thjt 3 g/a y kh/ t/em tnh mach
1 Loa/ an thjt
T/em bap thjt: 15mg kg the trong
T/em tnh mach: 5g kg the trong
Tha/ g/an gay me /a khoang 2 phat co the keo da/ bang cach t/em //ea ch/a nho
hay t/em trayen tnh mach
1 Loa/ ngaa
T/em tnh mach: 2mg kg the trong
2 Loa/ de caa
3 Traa bo ra /oa/ /an
16
ea kh/ can th/et co the nang //ea ca ban nea a tren /en 2 25 (//ea ch ta
L
5
do/ ra/ //ea t/e m tnh mach /a /a rao khoang 5 6mg kg)
9.1.11. Novocain
oroca/n con go/ /a Proca/n ra nh/ea ten khac nha Synca/n Scaroca/n e/eca/n
//oca/n thoca/n rr /a dan aat caa Coca/n ch/et aa t ta cay Coca
Tnh chat
oroca/n co dang t/nh the trang ha/ dang tan manh trong naac de bj rang kh/ ra
anh sang bj phan hay a nh/et do cao bj thay phan nhanh a maa cac to chac dac b/et a
gan
oroca/n kem doc han Coca/n ta 4 6 /an Trong thac t/en d/ea trj ngaa/ ta dang
mao/ c/ohydrat do/ kh/ mao/ borat benoat trong nhan khoa tot nhat /a dang mao/
pheny/ prop/onat
Tac dung
oroca/n co tac da ng gay te ra g/am daa
h/ t/em rao maa thaoc ac che than k/nh thac rat chong co bop caa ca tran co
that caa kh/ qaan oroca/n con /am g/an mach maa
oroca/n taang ta na coca/n tham qaa /ap tren caa n/em mac rat de dang ra /a m
mat cam ang cac ngo n day than k/nh cam g/ac tao ra tac dong gay te
drena//n /am tang tac dang gay te caa oroca/n ra /am g/am tac dang g/an
mach caa oroca/n
a/ dang djch /oang ra //ea thap oroca/n k/ch th/ch than k/nh hang phan nhe
/am tang chac phan d/nh daang caa ca the nen co tac da ng chaa benh
Ch nh
Trong tha y oroca/n daac ch djnh:
17
Lam thaoc gay te tot nhat trong gay te tay song ga y te dang /ang hong gay te
ngoa/ mang cang gay te trong nhan khoa (phaa thaat) phong be than k/nh bao qaanh
ret thaang chan thaang chaa bong gan sang khap sa/ khap cac benh khap chaa daa
bang co g/ay co that kh/ qaan hen sayen chaa benh r/em ta cang traa bo chaa benh
say d/nh daang pha thang
Lieu lng
1 ay te ta/ cho t/em daa/ da dang djch 2 3 ra/ //ea
Traa bo ngaa : 5 15g
Lan de caa : 15 3g
2 Chaa daa bang co g/at co that kh/ qaan hen phe qaan: T/em tnh mach dang djch
1 5 ra/ //ea tren
3 Chaa daa /ang: T/em daa/ da dang djch 2 3 ra/ //ea no/ tren
4 ay te ngoa/ mang cang: T/em dang djch 1 trong naac s/nh /y kh/ phaa thaat
tha/ g/an ngan (to/ da: 1 g/a) hay dang djch 2 ket hap ra/ drena//n kh/ phaa thaat keo
da/ (2 g/a raa/)
5 ay te trong phaa thaat nhan khoa: nho dang djch 1 tot nhat /a dang ra/ mao/
Pheny/prop/onat noroca/n
6 Chaa bong gan sang khop rr dang djch 2rao bao khap
7 Chaa r/em ta cang: T/em rao dong mach cha bang dang djch ra/ //ea 15mL
T/em nhac /a/ saa 6 g/a
Phong be ret thaang chan thaang (bao qaanh): dang djch 25
Chaa say d/nh daang pha thang: bang dang d/ch 25 5
C hu y
oroca/n (Proca/n) khong th/ch hap cho /oa/ ret (ket) ra cac /oa/ ch/m nho ke
ca Pen/c////n Proca/n
1
9.1.12. Pentobarbital
Pentobarb/ta/ /a /oa/ thaoc nga con co ten thaang pham /a embata/
Pentabarb/ta/ sod/c
Tnh chat
Thaoc bot trang hoa tan de trong naac
Thaoc thaang trnh ba/ daa/ dang dang djch chaa 65mg trong 1mL
Tac dung
Thaoc co tac dang an than ngan hay da/ han (3 4 phat tay theo //ea) t/ep do
/a gay nga keo da/ 1 2 g/a hay han tay theo ca the hay /oa/ co the dat ta/ 24 g/a co
kh/ den 72 g/a a mot so con meo
Ch nh
ay me toan than trong cac ro/ /oan than k/nh trong ngo doc do Strychn/n
eta/dehyd trong ca c can co g/at aong g/an k/nh g/at daa bang
Lieu lng
L/ea ca sa:
1 Trong gay me t/em tnh mach cham dang djch 6:
/a sac /an: 15mg kg the trong
Loa/ an thjt nho: 3mg kg the trong ( pha /oang dang djch ra/ 3 kho/ /aang naac
cat)
o/ chang tha/ g/an gay me /a 3 4 phat ra tnh day saa 1 2 g/a Co the t/m
rao phac mac cho meo /an /eng a /an dac kh/ th/en co the t/em rao t/nh hoa n
Tac dang gay me saa 1 15 phat
2 Trong gay chet khong daa dang danh djch 2 t/em rao tnh mach
C hu y
Can theo do/ cac con rat nea aat h/en ngat tha th pha/ cap caa
h/ con rat bj ngo doc th t/em Strychn/n //ea cao
1
9.1.13. Thiotetrabarbital
Th/otetrabarb/ta/ /a mot /oa/ thaoc nga co ten thaang pham /a Th/onarce
Che pham Th/a/batone /a mao/ natr/ caa a/t 55 a/ky/ (2 methy/ propy/)
Th/obarb/tar/c
Tnh chat
Thaoc co dang bot ket t/nh trang hoa tan trong naac ra cho mot dang djch anh
/a cay nhat co p cao tren 1
Thaoc thaang dang daa/ dang dang djch nong do 25 ra khong dang kh/ pha
che 1 g/a hay 2 g/a kh/ chang da aat h/en dac do sa ket taa caa thaoc daa/ tac dang
caa C
2
khong kh/
Tac dung
Thaoc gay say g/am than k/nh trang aang cac chac phan ho hap ha nh/et /am
g/am hayet ap Thao c gay me tot ra nhanh
Ch nh
Thaoc /am gay me trong phaa thaat keo da/ bat daa t/em tnh mach saa do co
the t/em /a/ nea can th/et
Traa bo : 5 7mg kg the trong
e nghe : 3mg kg the trong
gaa : 1mg kg the trong
Caa de : 1 15mg kg the trong
Cho meo : 25 kg the trong (dang djch14 hay 12) a ngaa de
gay me den 1 phat dang dang djch 25 ra/ //ea 17mg kg the trong
9.1.14. Xylazin
y/a/n /a mot /oa/ thaoc nga dang trong gay me g/a sac co co ten thaang pham
/a ompan Trong d/ea trj ngaa/ ta dang y/a/n ch/ohydrat
2
Tnh chat
Thaoc co ten hoa hoc /a 2 (26 y//d/no) 56 d/hydro413 th/a/ny/a/n
Thaoc trnh bay daa / dang dang djch t/em 2
Tac dung
y/a/n co tac dang /am g/am daa gay te ra tha g/an ca gay trang tha/ nga /t
hay nh/ea tay theo /oa/ g/a sac
Tac dang an than gay me ra tha g/an ca /a do sa phong be tang phan sa dan
trayen ang than k/nh qaa /nap a trang aang than k/nh Thaoc con co tac dang /am
tang t/em /ac tac do ng caa tat ca cac /oa/ thaoc say g/am than k/nh thaoc an than thaoc
gay me (dac b/et /a etam/n)
/oa/ nha/ /a/ thao c gay tang t/et naac bot ra chaang bang
/ec pho/ hap thaoc can than trong h/ pho/ hap etam/ny/a/n co the gay
me cho ngaa khoang 2 phat
Tay nh/en y/a/n co the gay g/am thap tan so t/m ra g/am hayet ap (a cac /oa/
nha/ /a/) ac che co bop da day traac caa cac /oa/ nha/ /a/ ra/ ngay ca gay ra chaang ha/
Thaoc cang co the /a ngayen nhan caa b/oc tam nh that (chen t/m) tang phan (a /oa/ an
thjt ngaa) Thaoc cang gay non a /oa/ an thjt (nhat /a meo) k/ch th/ch co bop ta cang a
con rat co chaa
Tac dang thaoc thay do/ dang ke theo /oa/ //ea /aang ra daang trayen thaoc
Ch nh
ay an than gay me de can th/ep phaa thaat can th/ep san khoa khong che kh/
can de k/em tra /am sang phong ngaa con rat bj k/ch t/ch k/ch dong dang trong gay
me ta a de bat g/a sac hay tha hoang
Chong ch djnh
hong dang thaoc trong:
oan da day
Cac benh t/m ra trang tha/ choang say gan
21
Tha/ ky mang tha/ cao/
Lieu lng
Tac dang caa thaoc thay do/ theo //ea daang traye n thaoc ra /oa/
1 traa bo:
ay g/am daa nhe tha g/an an than:
T/em bap thjt: 5mg kg the trong (tac 25mL 1 kg the trong dang djch 2)
T/em tnh mach: 2mL kg the trong (tac 1mL 1 kg the trong dang djch
2)
ay g/am daa raa tha g/an ca gay te thoa dang trong can th/ep phaa thaat
nho:
T/em bap thjt: 1mg kg the trong (tac 5mL 1 kg the trong dang djch 2)
T/em tnh mach: 34 15mg kg the trong (tac 17 25mL 1kg the
trong dang djch 2)
ay an than saa tac dang ro net da ng trong can th/ep phaa thaat /an:
T/em bap thjt: 2mg kg the trong (tac 1mL 1kg the trong dang djch 2)
T/em tnh mach: 3 5mg kg the trong (tac 3 5mL 1kg the trong
dang djch 2)
2 ngaa: tay tang con rat n than ra gay me ta g/an ca th/ch hap trong ta the
dang:
T/em tnh mach: 3 5mL 1kg the trong dang djch 2
3 cho: T/em bap thjt hay t/em tnh mach ra/ //ea (de con ra t nhjn do/):
1 3mg kg the trong (tac 5mL 1kg the trong dang djch 2)
4 meo: T/em bap thjt hay daa/ da 2 mg kg (tac 1 2mL kg the trong
dang djch 2)
C hu y:
Than trong kh/ pho/ hap ra/ cac /oa/ gay nga gay me (nha barb/tar/c ketam/n
ch/ora/ hydrat)
22
hong nen pho/ hap ra/ a/otan
Can than kh/ sa dang thaoc a /oa/ de
Thaoc de gay non cho /oa/ an thjt can cho nhjn do/ kh/ t/e m thaoc
h/ qaa //ea can th/ep bang cac /oa/ thaoc nha oapram ch/ohydrat
(opram) Tetrao/as (Pr/sco/)
Thaoc g/a/ doc: Yoh/mb/n //pameo/
9.1.15. Antipyrin
nt/pyr/n con go/ /a na/ges/n (nang/ed/n) hay Phenaon (Phenadon)
nt/pyr/n con mot dan aat khac /a nt/pyr/n sa////at con go/ /a Sa/pyr/n
Tnh chat
T/nh the khong maa rat tan trong naac (gan ngang ra/ trong /aang caa thaoc) tan
trong con rj ha/ dang
Taang k ra/ Pheno/ (hoa hap thanh the ran) esorc/n aphto/ entho/
Ch/ora/ atr/ sa////at Sa/o/ (thanh hon hap chay naac) sat Perc/oraa cac a/t chat
chat Ca/ome/ (co the gay nh/em doc)
Thaoc ba/ t/et rat nhanh qaa naac t/ea ra /am naac t/ea bj nhaom maa do
Tac dung
nt/pyr/n co tac dang ac che trang kha tang nh/et gap phan d/ea hoa than nh/et
/am ha can sot Thaaoc con /am g/am daa ra /am can saa gay co mach cac bo /a m cam
maa mao mach
Ch nh
Cac traang hap sot cao cam /anh chay maa mao mach ngoa/ da chay maa ma/
cat saa (do/ ra/ cho )
Lieu lng
Cho g/a sac aong (trong traang hap so t):
Traa bo : 15 2g
e caa : 5 1g
23
gaa : 15 2g
Cho : 1 2g
Cam maa ben ngoa /: bot hay dang djch dam dac 1 4
C hu y:Traac kh/ cho con rat aong thaoc can k/em tra tnh trang caa than

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MUC LUC T ONG

phenoth/a/ne ant/h/stam/n ra/pro/c ac/d r ch/oramphen/co/ h tha m g/ /

gic au v ry c tc dng gim rt mnh cho gii phu.

Halothan c bo qun nhit di 40oC trong vt cha kn. Tnh n nh ca halothan

nh hng n y trong th y th cha c bit tuy nhi n ha/othan s chng ch nh trong

(4) NITROUS OXIDE

n thn: 0.26mgkg 25mgkg P (organ 1)

Cm gic au ngun gc ngoi bin: thng l s au c xc nh v tr do s dn truyn

sacc/nate amobarb/ta/ sod/am hepar/ne sod/am hydrocort/so/ sod/am sacc/nate meth/c////ne

chng ch nh i vi bnh nhn b t bi lo / b cp Centruroides sculpturatus Ewing v

T/n m : 2565 mgkg (ooth 1)

c nhm phenylheptylamin, l c c hiu lc g/m

Ly t tinh du g c y /ong n o (C/nnamomam camphora)

Nm 1860, Niemann ph n /p c cocain v o//er d ng coca/n g y t nh n khoa nm

C onoso/ PSL onoso/ PSL onoso/

(2) Phenylephrine HCl

a) ngn nga tim p chm, phong b ho n to n n t : 4mg trong 25m/ 5 nh git

nh do lng mu n o thp. Gi n ng mch n o c th gy au u. Gim huyt p kt hp tng

|G Q|NKi Q|VLQK|GL W|NK Q||H||||FKORUDP SKHQLFRO||HUWKURP FL

W|K S|Y L|Fi F|FK W|VD|

W|KR W|WtQK|Q |W R|K S|FK W|Y L|SHQLFLOOLQH

F|FK |+3|,|WURQ|Ti |WU Q|KyD|LP LSHQHP |WU |E Q D|

''''' ' ' '

S|O F|Y L|WULP HWKRSULP |VOID| |FK Q|O L|1 RFDUGLD|DVWHURLGHV|

1 y| F| |QK |G |U W|FDR|F S|E Q| Q| Q| F|WL Q|K Q

311 L/ ' ' c ch d ng

nop/ocepha/a pero//ata (tr n ng '

u v k sinh nhy cm vi liu 5mg/kg PO, tr n v c n tr ong 3

Oxfendazole ho F|IHQEHQGDROH|NKQ|Q n k W|K S|Y L|EURP VDODQ|IONLFLGHV

c khng bu: Tr k sinh nhy cm: 50 1

k sinh nhy cm:

c thp nht tr ong

h S|WK|Fh W|GLQK|G Q|F L|F ng ch W|GR|WKL |OFRHQ||1 K Q Benzimidazoles m L||Y

Tai lieu chia se tai: wWw.SinhHoc.edu.vn

trnh -Myerhof). S n d y b chuy

|LD|F P ||VOIDGLP HWKR LQ| F|SKD|WURQ|Q F| Q| |L |tr |F |WU ng, d FKt |

Protein l ngu Q|FQ|F S|Q n li | |W R|ORELQ||R|y||FKQ|WD|NKQ|WK |Wi FKr L|

Ch | QK||WLa ch khang do ngay n nh n Sa/mone//a Sh/ge//a g y ra

ao//npect/n c t/nh h S|SK | F|W |Y b R|Y |QLm m F|U W||R|y|r/ kha Qr

8.3.6. Thuc chng nn

- Ch : 2-3mg/kg/ng y ph ng ng ' 'L

Acepromazin, d ' ' '3 L L'' n h a h ' Ethylon 3

Chlorpromazin l m ' L' '' ''P ' ' ' 'SL L, l

Diazepam, t n th ng ph P 'T'L ' Valium, Seduxen l thu 'an th '

Clorofooc c ch a 5% c ' ' L't'' ' ' ' ' '

Ketamin l m ' L' ' 'k ' v g y m r ' ''7 ' n c c c t n

Novocain c n g L' Procain v nhi ' n kh c nh Syncain, Scurocain,

Pentobarbital l lo i thu ' ' n c t n th ng ph P ' Nembutal,

Thiotetrabarbital l m ' L' ' 'y ' n th ng ph P ' Thionarcex.

Antipyrin c n g L' Analgesin (A-nan-gi -din) hay Phenazon (Ph -na-don).

T ng k 'Y L'3 nol (h a h S' nh th ' ''5 L''1 S'' thol,

Propy/) 1 Phenoth/a/n con co ten thaang pham khac /a P/eg/c//

C //en t/ep trong 34

9.1.6. Chloral Hydrat

L/ea cho aong: ang djch pha /oang /t nhat /a15

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