Cng Dc L inh Ngc H Dy3

DC L I CNG Cu 1 : Vn chuyn thuc qua mng sinh vt , ngha Bi lm 1. Khuych tn th ng ( Tiu cc ) a ) nh ngha - L s vn chuyn cc cht do khuych tn qua mng sinh vt, t l vi Gradien nng , t ni c nng cao n ni c nng thp, khng tiu tn nng lng, khng cn vt mang v khng theo mun b) iu kin - Thuc no va tan trong nc, va tan trong lipid s khuych tan nhanh - Nng thuc mt bn mng cao th vn chuyn cng d dng v s bo ho khi nng thuc hai bn mng bng nhau - Thuc vn chuyn theo hnh thc b ng phi dng khng b ion ho c) ngha - i vi thuc c tnh cht l acid : pH ca mng cng thp th s hp thu thuc cng cao v ngc li pH cng cao th s hp thu thuc ca mng cng thp, thuc hp thu t ni c pH thp n ni c pH cao - i vi thuc c tnh cht l base : pH ca mng cng cao th s hp thu thuc cng cao v ngc li pH ca mng cng thp th s hp thu thuc qua mng cng thp, thuc hp thu t ni c pH cao n ni c pH thp 2. Vn chuyn tch cc - L s vn chuyn thuc t ni c nng thp n ni c nng cao ( ngc bc thang nng ) dng vn chuyn ny i hi nng lng do ATP thu phn - iu kin : Cht vn chuyn mng cn c c im + C i lc cao vi thuc, to phc vi thuc + a thuc qua mng + Phn ly v tr li v tr ban u - c im ca h vn chuyn + Tnh bo ho : S lng carrier c hn + Tnh c hiu : Carrier ch to phc vi vi cht c cu trc c hiu vi n + Tnh cnh tranh : u tin vn chuyn thuc quen v thuc c cu trc gn ging carrier + Tnh c ch : - C hai dng vn chuyn tch cc + Vn chuyn thun li : Km theo cht vn chuyn li c s chnh lch bc thang nng , khng i hi nng lng + Vn chuyn tch cc thc th : L vn chuyn i ngc bc thang nng , t ni c nng thp n ni c nng cao, i hi nng lng 3. Lc qua ng dn - Mng sinh vt c nhng ng dn cho qua nhng thuc khng tan trong lipid v tan trong nc, thuc c trng lng phn t thp s chui qua ng bng p lc lc

 Cng Dc L inh Ngc H Dy3

Cu 2 : Hp thu thuc qua ng ung v tim, ngha Bi lm Ph thuc - ho tan ca thuc - pH ti ch hp thu - Nng thuc, phn b mch mu ti vng hp thu - Din tch vng hp thu 1. Hp thu qua ng tiu ho - u : D dng v l ng t nhin - Nhc : B cc enzym tiu ho ph hu hay to phc vi thc n lm chm hp thu, hay kch thch ph hu nim mc ng tiu ho - Nim mc li : Thuc ngm thng vo h thng tnh mch, khng b ph hu d dy v khng b chuyn ho gan, c tc dng ti ch hay ton thn, - Thuc ung + d dy : t hp thu v ch hp thu thuc c bn cht acid yu do nim mc t mch mu, thi gian thuc d dy lu nn hp thu chm hoc b ph hu bi enzym d dy + rut non : Ch yu cc thuc c hp thu ti y do din tch ln v mch mu phong ph, Thuc hp thu c vo h thng tnh mch gan vo gan v b phn hu nhanh bi h thng enzym y v theo dch mt vo t trng to thnh vng tun hon "gan-rut". Kt qu l nng thuc trong mu tng chm nn chm c tc dng dc l, chm thi tr v thi gian bn hu di + rut gi : Thuc khng ung c v c mi kh chu, c tc dng nhanh, ti ch hay ton thn phn ln thuc thm vo h thng t/m trc trng trn vo tnh mch ca vo gan phn nh ngm vo h thng t/m trc trng gia v di vo tun hon chung 2. Hp thu qua ng tim - Tim di da : Tim cc thuc d ho tan v gy au, thuc hp thu vo t chc lng lo di da vo mu v h thng bch huyt - Tim bp : Hp thu nhanh v t au do c co lm lng mao mch dn rng din tch trao i vo lu lng mu tng, c t si cm gic hn di da, tim dung dch nc v du khng tim thuc gy ng vn protein - Tim tnh mch : Thuc hp thu nhanh, hon ton v cng mnh, c th a 1 lng thuc ln vo t/m, liu dng chnh xc, thng a thuc gy hoi t di da, bp v huyt tng, khng a cc thuc c bn cht du, cht lm tan mu, cht gy phn ng ... 3. Cc ng khc - Thuc dng ngoi da : C tc dng nng, ti ch dng st khun, chng nm nh thuc bi, nh, cao dn... - Qua phi : Cc cht kh v cc thuc bay hi - Tim tu sng : Tim vo khoang di nhn hoc ngoi mng cng ...

 Cng Dc L inh Ngc H Dy3

Cu 3 : Phn phi thuc trong c th v ngha Bi lm C nhiu yu t nh hng n phn phi thuc trong c th - V pha c th : Ph thuc vo tnh cht mng t bo, ni mch mu nhiu hay t v pH ca mi trng - V pha thuc : Ph thuc vo phn t lng, tan trong nc v trong lipid, tnh acid hay base, ion ho, i lc ca thuc vi receptor 1. Gn thuc vo protein huyt tng - Sau khi thuc hp thu : Thuc qua mu chuyn ti ni c tc dng, thuc vo mu tn ti hai dng + Dng kt hp vi protein huyt tng + Dng t do - ngha : + Khi dng kt hp thuc cha ngm qua mng v cha c hot tnh, ch dng t do thuc mi c tc dng v c tnh + Protein l kho d tr thuc, phc hp thuc-protein ko di s c mt thuc trong mu l ngun cung cp thng xuyn dng t do, tc dng ko di ca thuc + Do c gn vo protein huyt tng nn tnh ho tan ca thuc tng ln + Nu hai thuc c i lc vi nhng ni ging nhau protein huyt tng chng s i khng cnh tranh nn phn t do ca thuc tng do tc dng dc l v c tnh tng, lu trong phi hp thuc khi iu tr 2. Receptor ( Rp ) - Thuc khng th phn ng mi ni trong c th thuc cn kt hp vi Rp pht huy hot tnh hoc km hm hot tnh ca cht khc - C 2 loi cht to phc vi Rp + Cht ch vn : To phc vi Rp l khu u tin gy lung kch thch qua pht huy tc dng + Cht i khng : Tc ng ln cng mt ni ca Rp vi cht ch vn ( i khng cnh tranh ) Tc ng ln mt ni Rp, khc vi cht ch vn, bin Rp thnh cht d dng, hu qu l cht ch vn khng kt hp c ( i khng khng cnh tranh ) 3. Hng ro thn kinh - Thuc phi vt qua 3 hng ro + Hng ro mu-no : To bi mch mu v t bo tk m, thuc tan nhiu trong lipid d thm, thuc tan trong nc kh thm + Hng ro mu-mng mch : tng t nh trn + Hng ro DNT-no : Thuc hp thu bng khuych tn th ng 4. Phn phi theo nhau thai - Lu lng mu tun hon rau thai v mu m rt cao, phn phi thuc thng c tnh chn lc cho qua cc cht c trng lng phn t thp, cht acid, gy nh hng ti thai nhi do thn trng khi dng thuc cho ph n mang thai

 Cng Dc L inh Ngc H Dy3

Cu 4 : Chuyn ho thuc trong c th, ngha thc tin Bi lm Chuyn ho thuc trong c th chia lm 2 pha 1. Pha I - L nhng phn ng oxy ho kh hay thu phn - Phn ng oxy ho kh + L phn ng ph bin nht xc tc bi nhiu enzym c trong ty th gan, in hnh l Cyt-P450 , phn ng i hi nhiu nng lng Cyt-P450 + X-H + NADPH + H + O2 --------------- X-OH + NADP+ + H2O + Cc thuc lm tng cm ng enzym Cyt-P450 s tng phn ng oxy ho thuc, lm gim tc dng , ngc li thuc lm c ch enzym Cyt-P450 lm gim phn ng oxy ho gy tng tc dng v c tnh ca thuc - Phn ng thu phn + Cc ester ( procain, aspirin , succinylcholin...) R1COOR2 ----- R1COOH + R2OH + Cc amid ( procainamid, lidocain, indomethacin) RCONHR1 ----- R-COOH + R1NH2 - Phn ng kh + Kh hot tnh ca cc ester, amid xc tc l cc esterase, amidase RNO2 ---- RNO ---- RNHOH ---- RNH2 - ngha + a s cc thuc b kh hot tnh gan, do hn ch dng thuc cho bnh nhn b bnh gan + Chc nng gan c lin quan n qu trnh chuyn ho thuc do phi h tr chc nng gan trong qu trnh iu tr + a s cc phn ng kh c u cn oxy do cn duy tr tun hon, h hp v chuyn ho trong trng hp nhim c thuc 2. Pha II - L cc phn ng kin hp, sau khi ging ho th cht mi c to thnh s kt hp vi acid acetic, sulfuric, mercapturic... to thnh cht lin hp t tan trong lipid d o thi qua thn v mt - Phn ng lin hp pha II gm + Lin hp vi acid acetic : Thuc c gc amin bc I, sulfmid...to tinh th sc cnh c th gy tn thng b my tit niu + Lin hp vi acid Glucuronic : xc tc l UDP_glucuronyltranferase c gan, dng kt hp ny tan trong nc nn thi tr nhanh qua thn v mt do c tnh gii c cho c th

 Cng Dc L inh Ngc H Dy3

Cu 5 : Thi tr thuc qua gan v thn , ngha Bi Lm 1. Thi tr qua thn - Phn ln cc thuc tan trong nc c thi tr qua thn - Qu trnh thi tr + Lc th ng qua cu thn : L qu trnh vn chuyn th ng thuc dng t do khng gn vi protein huyt tng + Bi tit tch cc qua ng thn : L qu trnh vn chuyn tch cc xy ra ch yu ng ln gn + Khuych tn th ng qua ng thn : Hp thu mt phn thuc thi tr nc tiu u l cc thuc tan trong lipid, khng b ion ho pH nc tiu, cc base yu khng c hp thu, xy ra ch yu ng ln gn v xa v ph thuc vo pH nc tiu - ngha : + Lm gim thi tr tit kim thuc : Tng tc dng ca thuc v tng hiu qu iu tr + Tng thi tr iu tr ng c : Thuc c tnh acid mun tng thi tr phi tng pH mu , thuc c tnh base mun tng thi tr phi gim pH mu + Theo di chc nng thn 2. Thi tr qua gan - Sau khi chuyn ho gan dng lin hp vi acid glucuronic thuc c thi tr qua mt xung rut sau c ti hp thu v gan qua ng tnh mch ca ( chu trnh gan-rut ) - ngha + Nhng thuc ny tch lu trong c th lm ko di tc T1/2 ca thuc huyt tng do ko di thi gian dng ca thuc

 Cng Dc L inh Ngc H Dy3

Cu 6 : Cc tc dng ca thuc ( chnh - ph, ti ch - ton thn ), ngha Bi lm 1. Tc dng ti ch - ton thn - Tc dng ti ch + L tc dng ngay ti ni thuc tip xc, khi thuc cha c hp thu vo mu, thuc bi ngoi da + V d thuc bc nim mc ng tiu ho - Tc dng ton thn + L thuc c tc dng ton thn sau khi thuc c hp thu vo mu qua ng h hp, tiu ho hay tim + V d : thuc m, tr tim hay li niu - ngha + Hai tc dng trn ch mang tnh cht tng i v nu dng qu liu th s dn ti mt tc dng khc l tc dng ton thn 2. Tc dng chnh - ph - Tc dng chnh : L tc dng iu tr - Tc dng ph : Ngoi tc dng chnh th thuc cn c cc tc dng ph khng c ngha trong iu tr gi l tc dng khng mong mun, n gy cm gic kh chu cho ngi bnh c hi cho c th nh gim huyt p, xut huyt tiu ho, gim bch cu hay suy gim h thng min dch ... - ngha + Nm c cc tc dng khng mong mun ca thuc c cc chn la thuc trong iu tr hay phi hp cc loi thuc nhm t hiu qu cao nht trong iu tr v gim c cc tc dng khng mong mun Cu 7 : Cc tc dng phi hp ( hip ng cng - tng mc ) , ngha Bi lm 1. Tc dng hip ng cng - Thuc A c tc dng a , Thuc B c tc dng b, khi phi hp thuc A v B th c tc dng l c - Nu c = a + b th thuc A v B c tc dng hip ng cng - ngha : Phi hp cc thuc trong iu tr , mc ch v tng hiu qu dng thuc trong iu tr v nht l gim t l khng thuc v gim tc dng khng mong mun 2. Tc dng hip ng vt mc - Nu phi hp thuc A v B c tc dng c > a + b th hai thuc trn c tc dng vt mc ch khng ch l cc tc dng hip ng thng thng - ngha : y l nguyn tc to nn cng thc khng khun hoc chng st rt c hiu qu cao, c ngha trong cng tc iu tr nh + bactrim (biseptol, cotrioxazol) = sulfamethoxazol + trimethoprim + fansida = sulfadoxin + pyrimethamin

 Cng Dc L inh Ngc H Dy3

Cu 8 : Cc c ch tc dng ch yu ca thuc Bi lm 1. Receptor ( Rp ) - L mt thnh phn i phn t tn ti mt lng gii hn trong cc t bo ch, c th nhn bit mt cc c hiu ch mt phn t thng tin t nhin ( hormon, cht dn truyn thn kinh ) hoc mt tc nhn ngoi lai ( cht ho hc, thuc ) gy ra mt tc dng sinh hc c hiu - Rp c hai chc phn + Nhn bit cc phn t thng tin bng s gn c hiu cc phn t ny vo Rp bng cc lin kt ho hc, lk ion, lk hydro, lk Vanderwaals , lk cng ho tr + Chuyn tc dng tng h gia phn t gn v Rp thnh mt tn hiu gy ra mt p ng t bo - Thuc gn vo Rp ph thuc vo i lc ca thuc v Rp, tc dng ca thuc l do hiu lc ca thuc trn Rp 2. C ch tc dng thng qua Rp - Thuc tc dng trc tip trn cc Rp ca cht ni sinh, thng mang tnh c hiu - Nu thuc gn vo Rp c tc dng ging cht ni sinh th gi l cht ch vn - Nu thuc gn vo Rp c tc dng khng ging cht ni sinh hay ngn cn cht ni sinh gn vo cc Rp gy c ch cht ng vn gi l cht i khng - Bn cht ca Rp thuc + Cc enzym chuyn ho hoc iu ho cc qu trnh sinh ho c th b thuc c ch hay hot ho + Cc ion : Thuc gn vo cc knh ion lm thay i s vn chuyn ion qua cc mng t bo ngn cn s kh cc mng t bo 3. C ch tc dng khng thng qua Rp - Thuc c tc dng khng cn kt hp vi cc Rp - Thuc c tc dng thng qua tnh cht l ho, khng c hiu + Cc mui cha cc ion kh hp thu qua mng sinh hc c tc dng ko nc t ngoi gian bo vo lng mch + Thuc c tc dng lm tng p lc thm thu trong huyt tng, khi lc qua cu thn khng b THT ng thn do lm tng p lc thm thu ng thn c tc dng li niu + Than hot tnh hp th cc hi, c t nn dng cha y bng v gii c + Cc base yu l trung ho dch v acid d dy - Thuc c cu trc tng t nhng cht sinh ho bnh thng thm nhp vo cu trc t bo lm thay i chc phn cc t bo tc dng km hm s pht trin cc t bo ung th , chng virus..

 Cng Dc L inh Ngc H Dy3

Cu 9 : Cc yu t nh hng n tc dng ca thuc ( cu trc, tc dng, c im ca ngi bnh v tui v gii ) Bi lm 1. V thuc a) Thay i cu trc lm thay i dc lc hc ca thuc + Thuc + Rp Thuc-Rp Rp* c tc dng dc l + Rp mang tnh c hiu nn thuc phi cng phi c cu trc c hiu vi Rp s thay i nh v cu trc thuc gy thay i ln v tc dng - Tng hp thuc mi nhm + Lm tng tc dng iu tr v gim tc dng khng mong mun + Lm thay i tc dng dc l + Lm thuc tr thnh cht i khng tc dng + Cc ng phn quang hc hay ng phn hnh hc thuc cng lm thay i cng tc dng hay lm thay i hon ton tc dng ca thuc + Sn xut thuc c hiu gn vo cc di typ ca cc Rp b) Thay i cu trc lm thay i dc ng hc ca thuc - Cu trc thuc thay i lm tnh cht l ho ca thuc thay i nh hng n tan ca thuc trong nc hay lipid, n s gn thuc vo protein, ion ho ca thuc v bn vng ca thuc c) Dng thuc - Trng thi ca dc cht + tn : nh, mn, din tip xc tng nn hp thu nhanh + Dng v nh hnh v tinh th : d tan v d hp thu - T dc + nh hng n ho tan v khuych tn ca thuc - K thut bo ch v dng thuc + nh hng n Hot tnh ca thuc c bn vng Dc cht c gii phng vi tc n nh Dc cht c gii phng ti ni cn tc dng Thuc c sinh kh dng cao 3. V ngi dng thuc a) c im v tui ( tr em ) + S gn thuc vo protein huyt tng cn t , thuc y bilirubin khi phc hp proteinbilirubin gy ng c bilirubin + H enzym chuyn ho thuc cha y + H thi tr thuc cha pht trin + H TK, h thng hng ro mu no cha pht trin nn nhy cm v thuc d ngm qua + T bo cha nhiu nc nn khng chu c thuc gy mt nc + M v c quan ang pht trin nn thn trong khi dng thuc b) c im v gii ( n ) - Thi k c kinh nguyt : Ch dng thuc khi vo thi k - Thi k mang thai : + 3 thng u d gy d tt bm sinh + 3 thng gia nh hng xu n s pht trin ca bo thai chc phn pht trin cc c quan + 3 thng cui : c th gy sy thai hay non - Thi k cho con b + Nhiu thuc thi tr qua sa gy c cho con

 Cng Dc L inh Ngc H Dy3

THUC C CH THN KINH TRUNG NG Cu 10 : Thuc t Novocain Bi lm - Thuc c bng B , tng hp - L thuc t mang ng ni ester, tan trong nc - Khng thm qua nim mc, khng lm co mch, nhng c tc dng phong ta hch nn lm gin mch v h huyt p , khi gy t nn phi hp vi adrenalin lm co mch tng thi gian gy t - Dng lm thuc gy t dn truyn, dung dch 1% - 2% v khng qu 3mg/kg cn nng - c tnh : d ng, co git c ch thn kinh trung ng Cu 11 : Thuc ng Barbiturat ( tc dng, ch nh ) Bl lm 1. Tc dng dc l - Trn thn kinh + c ch TKT , + An thn : chng co git, ng kinh do lm gim tnh kch thch ca v no + Vi liu gy m, barbiturat c ch tu sng, lm gim phn x a synap v c th lm gim p lc DNT khi dng liu cao - Trn h h hp + c ch trc tip trung khu h hp hnh no nn lm gim bin v tn s nhp th, gim s dng O2 no, gy ho ht hi, co tht thanh qun , liu cao gy hu hoi trung khu h hp lm gim p ng vi CO2, - Trn h thng tun hon + Vi liu gy ng t nh hng n h thng tun hon + liu gy m thuc lm gim lu lng tim v h HA + liu c gy c ch tim 2. Ch nh - An thn - Chng co git - Gy ng, tin m - Gin c, gim au do co tht - Chng ng kinh ( trnh dng vi cc thuc c ch h TKT )

 Cng Dc L inh Ngc H Dy3

Cu 12 : Morphin (dc ng hc, tc dng, c ch, ch nh ) Bi lm 1. Dc ng hc - Hp thu + D hp thu qua ng tiu ho, ch yu t trng , hp thu nhanh qua ng tim di da hay bp - Phn phi + huyt tng 1/3 c gn vi protein,thuc phn phi hu ht cc m ( gan, lch, thn, phi.. ) v tr tc dng ch yu h TKT, qua hng ro mu no v nhau thai tham gia vo chu trnh gan-rut - Chuyn ho + gan lin hp vi acid glucuronic v kh N-metyl, T1/2 khong 2-3 h - Thi tr + Bi tit ch yu qua thn dng 3-glucuronid-morphin + Thi gian bn thi t 2,5-3h + Mt phn nh bi tit qua mt , m hi, nc bt, sa m, d dy .. 2. Tc dng dc l v c ch tc dng a) Tc dng gim au - Gim au c tnh chn lc, tng ngng nhn cm vi au, khng gy ri lon tri gic, loi tr c mi cm gic gy au - c ch xung ng au mang tnh tch hp trn cu trc TKT - Ch yu vi cc cn au su, khng c hay t tc dng vi cn au nh hay nng b) C ch - Do kt hp vi cc loi Rp + Rp ( muy) : gim au, gim h hp, co ng t, lin quan n cm xc + Rp ( kappa) : gim au, xc cm, an thn + Rp ( delta ) : gn chn lc vi enkephalin tham gia vo tc dng gim au + Rp ( sigma ) : t lin quan ti iu tr, gin tip tc dng n nhn thc, tm thn v vn ng - Khi Morphin gn v Rp th + c ch dn truyn cm gic au + Lm tng ngng au, thay i tnh cht au v trng thi tm l bnh nhn + Gim gii phng cht dn truyn trung gian + c ch cc Rp vng sau synp + Lm mt tc dng gy au ca cht P + Lm m knh K+, thay i s gn v thu hi Ca2+ vo ngn dy tk lm thay i s dn truyn ca dy tk b) Tc dng gy ng - Liu cao gy gim hot ng tinh thn v gy ng - Liu thp gy bn chn mt ng - Trn h TKT c tc dng c ch c) Tc dng gy sng khoi - Liu iu tr gy cm gic sng khoi d chu + Tng cng cm gic dng tnh : tng hot ng cc c quan tnh gic, xc gic + Cm gic m tnh : lo u cng thng s hi d) Tc dng c ch h hp - liu iu tr : tc dng trc tip ln trung khu h hp gy c ch h hp - liu cao : c ch mnh trung khu h hp v tn s v bin , nhy cm vi thai nhi, tr em, - C ch : Gim nhy ca trung khu h hp vi nng CO2 trong mu ( kch thch Rp ) e) Tc dng c ch ho - Tc dng c ch trung khu gy ho g) Tc dng khc 10

 Cng Dc L inh Ngc H Dy3

- Tc dng trn vng di i : mt thng bng, iu ha nhit - Tc dng trn ni tit : c ch gii phng Hormon hng sinh dc, v thng thn - Tc dng trn c trn : Gim nhu ng rut, c c vng gy b i, co c kh ph qun - Gy nn liu iu tr , liu cao th c ch trung khu nn - Co ng t : kch thch dy III - Tng phn x tu - Tc dng trn tim mch : chm mch do kt dy X v gii phng Histamin, liu cao gy h HA - Tc dng trn bi tit : gim tit dch mt , tu, d dy, m hi ... - Tc dng trn chuyn ho : gim oxy ho gy tch lu acid, ph - Tc dng trn da : gy dn mch da, gy nga 3. Ch nh - Gim au i vi nhng cn au ln, d di, hay cc thuc gim au khc khng c tc dng - au sau phu thut, ung th giai on cui ( khng dng qu 7 ngy ) - Tin m - Ph phi cp th nh v va - Gim ho - Chng i lng 4. Chng ch nh - au bng ngoi khoa cp cha chn on xc nh r nguyn nhn - Chn thng s no, nguy c gim HA, tng p lc ni s, co git - Suy h hp, hen ph qun - Tr em < 5 tui, ph n c thai hay ang cho con b - Ng c ru, thuc ng Barbiturat, CO v cc thuc c ch h hp khc - Chng ch nh tng i vi bnh gan v thn mn tnh

11

 Cng Dc L inh Ngc H Dy3

Cu 13 : Cc dn cht tng hp thay th Morphin Bi Lm 1. Pethidin ( Meperidin, Dolosal, Dolacgan ) - Tc dng : gim au, an thn, c ch h hp, co c trn, t gy nn, h HA, tng lu lng tim lm tim p nhanh - Tc dng ph : t c hn morphin, bun nn, nn, c th c tc dng trn h TKT - Dc ng hc : D hp thu qua cc ng dng, sau khi ung 50% thuc thi qua chuyn ho ti gan, T1/2 = 3h , gn vi protein khong 60% - Ch nh : gim au, tin m, liu lng ung/0,05g/ln dng 2-3 ln/ngy , tim bp 1ml(1%) 0,05g/ln tim 3ln/ngy - Chng ch nh : nh Morphin 2. Loperamid ( Altocel, Imodium, Lopemid ) - Tc dng : t tc dng trn h thn kinh trung ng, lm gim nhu ng rut, gim tit dch ng tiu ho tng trng , tng trng lc c tht hu mn, tng vn chuyn dch v cht in gii qua nim mc rut lm gim s mt nc v in gii - Tc dng ph : To bn, au bng, bun nn, mt mi, chng mt, nhc u ... - Dc ng hc : Hp thu 40% qua ng tiu ho, 97% thuc gn vi protein huyt tng, T1/2 7-14h, thi tr qua phn, nc tiu di dng chuyn ho ( 30-40%) v cn hot tnh - Ch nh : iu tr a chy cp v mn - Chng ch nh : + a chy c kt hp vim rut kt c mng gi , trng bng + Hi chng phn ly + Tn thng gan, tr em di 6 tui 3. Methadon ( Dolophin, Amidon, Phenadon ) - Tc dng : Tng t morphin nhng nhanh hn v ko di hn,gim au mnh hn pethidin t gy to bn nhng gy bun nn v nn - Tc dng ph : Gy tng tit m hi, tng BC lympho, tng protein mu - Dc ng hc : Hp thu tt qua ng tiu ho, 90% gn vi protein, chuyn ho qua gan v thi tr theo nc tiu v mt , T1/2 15-40h - Ch nh : Dng gim au v cai nghin morphin, herpin 4. Fentanyl ( Sublimaze, Fetanest, Leptanal ) - Tc dng : gim au mnh gp 100 ln morphin, tc dng nhanh sau 3-5 tim IV ko di 1-2 h - Dc ng hc : Tim IM hay IV, 80% thuc gn vi protein huyt tng , phn b mt phn trong DNT, rau thai v sa . Thuc chuyn ho ti gan v mt hot tnh, thi tr qua nc tiu - Tc dng ph : + Ton thn : chng mt, n ln, o gic + Tiu ho : bun nn, nn, to bn, co tht ti mt + Tun hon : chm nhp tim, h HA thong qua, nh trng ngc hi hp + H hp : th nhanh, suy h hp, ngt th + C xng : Co cng c lng ngc, git rung + Mt : co ng t - Ch nh + Gim au trong v sau phu thut + Phi hp vi droperidol gim au v an thn + Phi hp trong gy m - Chng ch nh + Cc trng hp au nh + Nhc c + Thn trong trong cc bnh phi mn, CTSN v tng p lc ni s , bnh tim ... 5. Propoxyphen 12

 Cng Dc L inh Ngc H Dy3

- Tc dng : gim au km - Dc ng hc : sau ung 1-2h t Cmax trong mu, chuyn ho ch yu ti gan , T1/2 6-12h , - Tc dng ph : Gy c ch h hp, co git, hoang tng v o gic, c vi tim - Ch nh : gim au nh v trung bnh, phi hp vi aspirin hay acetaminophen 6. Cc opioid c tc dng hn hp ( Pentazocin ) - Tc dng : An thn, gim au v c ch h hp, liu cao lm tng HA v nhp tim - Dc ng hc : D hp thu qua ng tiu ho, sau 1-3h t Cmax trong mu, T1/2 4-5h , thuc chuyn ho ln 1 ti gan nn ch c 20% vo vng tun hon, thuc qua c hng ro rau thai - Tc dng ph : an thn, v m hi, chng mt, bun nn v nn, c ch h hp liu cao - Ch nh : Trong cn au nng, mn tnh, hoc cc thuc gim au khc khng c tc dng

13

 Cng Dc L inh Ngc H Dy3

Cu 14 : Benzodiazepin ( tc dng, ch nh ) Bi lm 1. Tc dng - Trn h TKT : c ch c bit trn h thng li hot ho i th, h vin v tu sng, o + C tc dng an thn gii lo, lm gim xc cm qu mc, gim lo u bn chn , trng thi hung hn cng thng thn kinh + Gy ng, to cho gic ng n nhanh khng c tc dng gy t + Chng co git, gim trng lc c - Tc dng ngoi bin + Gin mch vnh khi tim IV + Liu cao phong to thn kinh c - C ch + BZD gn vi cc Rp c hiu vi n trn h thng TKT, bnh thng khi khng c BDZ cc Rp ca BZD b mt protein ni sinh chim gi GABA khng gn c vo Rp ca h GABA-ergic knh Cl- ca neuron b ng li. Khi c mt BZD y protein ni sinh v chim Rp GABA gn vo Rp ca n m knh Cl- Cl- i t ngoi vo trong t bo gy u cc ho 2. Tc dng khng mong mun - Gim tr nh - Bn chn lo lng, o gic, tim p nhanh 3. Ch nh - An thn - Gy ng - Chng co gt, tin m - Gin c, gim au do co tht - Chng ng kinh Cu 15 : Thuc an thn ch yu dn xut ca phenothiazin ( tc dng, ch nh ) Bi lm Clopromazin ( Largactil , Plegomazin , Aminazin ) 1. Tc dng dc l - Trn h TKT + Gy trng thi th v tm thn vn ng, khng c tc dng gy ng, + Gim cm gic thao cung vt v + Gy hi chng ngoi b thp ~ Parkison, ng tc cng , tng trng lc c + Gim thn nhit do c ch trung khu iu nhit + Chng nn do c ch trung khu nn sn no tht IV + c ch trung tm trng lc giao cm iu ho vn mch + Vn ng : liu cao gy gi nguyn t th - Trn h thng TKTV + Tc dng hu ' : dn ng t, to bn, gim tit dch, nc bt, m hi.. + Tc dng phong to Rp 1 adrenergic ngoi bin - Trn h ni tit + Lm tng tit prolactin gy chy sa v chng v to n ng + Lm gim tit FSH v LH gy c ch phng non v mt kinh - Tc dng khng H1 : yu 2. Ch nh - Lon thn kinh, tm thn phn lit, thao cung, hoang tng v o gic - Sn git - Tin m, gy m h thn nhit, h HA - Chng nn, chng au, an thn, chng rung tim ,chng nga 14

 Cng Dc L inh Ngc H Dy3

Cu 16 : Thuc an thn dn xut ca Butirophenol ( tc dng, ch dnh ) Bi lm Haloperidol 1. Tc dng dc l - c ch cc phn x t nhin v phn x c iu kin - c ch trng thi kch thch tm thn vn ng , c ch mnh thao cung - c ch mnh hoang tng - Lm mt o gic nhanh - Tc dng an thn chng lo u vi liu thp - Khng c hay t tc dng hu v gy ng do khng gn vo Rp 1 v H1 2. Ch nh - Cc trng thi thao cung hoang tng - Cc trng thi hong lon tm thn cp v mn tnh, tm thn phn lp - Chng nn, nn do thuc chng K hay sau chiu x Cu 17 : C ch tc dng ca thuc h st - gim au - chng vim Bi lm 1. Tc dng gim au - Tc dng vi cc chng au nh khu tr, au do vim - Khng c tc dng vi au ni tng, khng gy ng, khng gy nghin - Do lm gim PGF2 nn cc CVPS gim tnh cm th ca cc dy cm gic vi cc cht gy au 2. Tc dng h st - liu CVPS ch lm h thn nhit trn nhng ngi st do mi nguyn nhn - Khi VK, c t xm nhp c th kch thch BC sn xut cht gy st ni ti nh cytokin ( IL1 , IL6 ), interferon, TNF hot ho prostaglandin synthetase tng PG gy st theo c ch tng sn nhit v gim thi nhit. Thuc CVPS c ch prostaglandin synthetase PG st do qu trnh thi nhit - Do khng c tc dng n nguyn nhn gy st khi thuc b thi tr st tr li 3. Tc dng chng vim - Cc CVPS c tc dng trn hu ht cc loi vim do - c ch sinh PG do c ch cyclooxygenase lm PGE2 v F1 l nhng cht trung gian ho hc ca phn ng vim - Lm bn vng mng lysosom gii phng cc enzym phn gii do c ch qu trnh vim - i khng vi cht trung gian ho hc ca phn ng vim do tranh chp vi c cht ca enzym , c ch di chuyn BC, c ch kt hp KN-KT

15

 Cng Dc L inh Ngc H Dy3

Cu 18 : Aspirin Bi lm 1. Tc dng dc l - H st v gim au, khng gy h thn nhit - Chng vim : ch c tc dng khi dng liu cao - Tc dng thi tr acid uric : liu thp 1-2g/ngy acid uric qua nc tiu do bi xut OLX , liu cao 2-3g/ngy i nhiu urat do c ch THT uric OLN - Tc dng trn tiu cu v ng mu : + Liu thp 40-325mg/ngy c ch cyclooxygenase ca tiu cu thromboxan A2 ng vn tiu cu + Liu cao c ch cyclooxygenase ca thnh mch PG I2 l cht chng kt dnh v lng ng tiu cu ng vn tiu cu - Tc dng trn ng tiu ho : Gy lot d dy do PGE l cht kch thch tit cht nhy bo v nim mc d dy 2. Dc ng hc - B ion ho d dy khuych tn qua mng hp thu vo mu 50-80% gn vi protein huyt tng, s cn li phn hu thnh salicylic b chuyn ho gan, T1/2 ~6h thi tr qua nc tiu 50%/24h 3. c tnh - Dng lu gy bun nn, tai, nhc u, ic .. - c ng : ph, my ay, mn, hen - Xut huyt d dy - Ng c vi liu trn 10g, kch thch h hp lm th nhanh su 4. Liu lng v ch phm - Acexal, Aspro,Polopirin : vin nn 0,5g ung 1-6g/ngy chia lm nhiu ln - Aspegic : dng mui, 1 l ~ 0,5g aspirin tim IV hay IM liu 1-4l/ngy - Aspirin pH8 : vin nn cha 0,5g aspirin, dng ng ung, t Cmax sau 7h, T1/2 > 6h

16

 Cng Dc L inh Ngc H Dy3

Cu 19 : Voltaren ( Diclofenac natri ) Bi lm - L dn xut ca acid phenylacetic - Tc dng + Chng vim trong vim khp mn tnh tng t nh aspirin + So vi aspirin tc dng ph trn h tiu ho t hn nhiu + i khi gp vim gan vng da - Dc ng hc + T1/2 1-2h, nhng thuc tch lu dch bao khp nn tc dng vn gi c lu - Ch phm v liu lng : vin 50-100mg , ung 100-150mg/ngy

Cu 20 : Cc thuc h st - gim au - chng vim mi nhm Oxicam Bi lm - L nhm thuc gim vim mi c nhiu u im - Tc dng : + Chng vim mnh, liu iu tr ch bng 1/6 so vi cc thuc th h trc, tc dng au xut hin nhanh, na h sau khi ung - Dc ng hc : + T1/2 di khong 2-3ngy, dng liu duy nht trong 24h, thuc gn vo protein ti 99% nn d c nguy c tch lu thuc + Thuc t tan trong m nn d thm vo t chc bao khp b vim, t thm vo m thn kinh nn gim c nhiu tai bin - Tc dng khng mong mun : + Thng nh v t l thp so vi cc CVPS khc ngay c khi dng thuc ko di - Ch nh + Dng trong cc trng hp vim mn ko di - Ch phm v liu lng + Piroxicam ( Feldene ) 10-40mg/ngy : nhiu tai bin nn khng dng + Tenoxicam ( Tilcotil ) 20mg/ngy + Meloxicam ( Mobic ) 7,5-15mg/ngy

17

 Cng Dc L inh Ngc H Dy3

Cu 21 : Thuc iu tr bnh Parkinson ( tc dng , ch nh ) Bi lm 1. Thuc cng h dopaminergic Levodopa ( l-dopa, Dihydrooxyphenyl alanin, DOPA ) - Tc dng dc l : + Chng Parkinson + Tc dng ni tit : Gin tip kch thch tuyn yn gim bi tit prolactin + Tc dng trn h tim mch : lm tng nh nhp tim, c th gy lon nhp do kch thch vo Rp 1 ca h Adrenergic - Tc dng khng mong mun + Levodopa khng qua c hng ro mu no nn lng dopa v noadrenalin ngoi vi tng cao gy nn tc dng khng mong mun + Ri lon tiu ho : nn, chn n , gim cn + ng tc bt thng : ming - li - mt - cc chi, c , gy + Ri lon tm thn : trm cm, l ln, hoang tng + Ri lon tim mch : Tt HA, lon nhp, suy tim - Ch nh + Levodopa ( Dopar, Larodopa ) vin 100-250 hay 500mg Ch nh nghim ngt, theo di ti BV, ung liu dn, chia lm nhiu ln trong ngy, ung sau ba n , liu trung bnh 3-3,5g Ch : Khi ang dng l-dopa, khng nn dng cc thuc c ch IMAO do c th gy cn HA , liu cao B6 c th lm tc dng ca l-dopa + Phi hp Levodopa vi cc thuc phong to dopa decarboxylase Modopar : vin nang cha 0,6g levodopa + 0,015g bensarazid Sinemet : vin nn 100 v 250 mg cha levodopa + _methyldopahydrazin hoc carbidopa t l 10/1 Amantadin ( mantadix, Symadin ) vin nang 100 mg / ln x 2 ln /ngy Bromocriptin: vin nn 2,5mg, vin nang 5mg, liu u 2,5mg x 2ln/ngy, tng dn liu ti a 100mg.ngy Pergolid ( Permax ) vin 0,05mg, 0,25 mg v 1 mg. Selegilin ( Eldepryl ) vin 5 mg 2. Thuc hu ph giao cm trung ng - Tc dng hu ' dng phi hp vi levodopa - Nhc im : khng cholinergic ngoi bin lm gin ng t, ming kh, to bn, khng dng cho ngi nhn p, ph i tin lit - Loi thin nhin : Hyoscyamin 0,1-0,5mg, Atropin sulfat 0,3-0,6mg, Scopolamin 0,25-1mg - Loi tng hp + Trihexylphenidyl (Artan, Parkinan ) vin 2 v 5mg, ung 6-12mg/ngy chia nhiu ln + Dietazin ( Diparcol ) ung 0,05g/ngy , dn ti 0,2 - 1g + Procyclindin (Kemadin): 5-20mg/ngy, + Orphenadrin(Disipal): 150-400mg/ngy

18

 Cng Dc L inh Ngc H Dy3

Cu 22 : Thuc chng ng kinh Hydantoin ( tc dng v ch nh ) Bi lm 1. Tc dng - Phenytoin c tc dng chng mi th ng kinh nht l ng kinh ln nhng khng gy c ch ton b h thn kinh trung ng - Khng c hiu lc vi cc cn ng kinh nh - Tc dng trn cn co git ng kinh ~ phenolbarbital nhng khng gy an thn v ng - Tc dng lm n nh mng t bo thn kinh v c tim nn c tc dng chng lon nhp 2. Tc dng khng mong mun - Da v nim mc : Vim li qu sn, mn da, lupus ban - Mu : thiu mu HC do thiu acid folic, gim BC - Tiu ho : cn au bng cp - Thn kinh : lin quan n liu , rung git nhn cu, mt phi hp vn ng, ri lon tm thn - Xng : ci xng hay mm xng do ri lon chuyn ho VD 3. Ch nh - Chng ng kinh cc cn ln - Khng dng trong cc cn ng kinh nh khng c cn co git - Phetonyl ( Dihydan, Dilantin ) vin nn 30-100mg, liu u 3-5mg/kg, ng tim 50mg/ml tim IV < 50mg/pht

19

 Cng Dc L inh Ngc H Dy3

Cu 23 : Thuc chng trm cm Bi lm 1. Thuc chng trm cm loi 3 vng - Trn TKT : + Khng gy gi nguyn t th, khng gy h thn nhit, au nh + Ko di tc dng ca barbiturat + Khng cholinergic trung ng v ngoi bin + Chng co git + i khng nhiu tc dng ca reserpin do ngn cn c tc dng lm cn d tr catecholamin ca reserpin - Trn TKTV + Tng tc dng ca adrenalin v noradrenalin do c ch thu hi catecholamin + i khng tc dng vi cc thuc cng giao cm gin tip do lm tnh thm ca mng si trc vi catecholamin + Liu cao, c ch trung khu gy h HA, lu lng tim, khng phng tinh + Hu ' lm gin ng t, nhu ng rut + Tc dng khng Histamin - Trn tim mch + Liu thp lm HA , liu cao c ch c tim, cung lng tim v HA + Chng lon nhp, liu cao gy bloc nh tht 2. Thuc c ch MonoAminOxydase ( IMAO ) - Tc dng h HA, khng dng HA + Di tc dng ca IMAO cc NA u tn cng cc dy cao, tc dng theo c ch iu ho ngc, c ch hot tnh ca tyrosin hydroxylase lm NA + gan cc MAO b c ch tyramin khng b kh amin s tp trung u mt cc dy b dopamin oxydase ''O'' octapamin tranh chp vi NA + Khi xung tc xut hin khng gii phng NA m gii phng octopamin khng c tc dng p - Tc dng chng au tht ngc : khng lm gin mch vnh, lm nhu cu s dng O2 ca c tim - Ko di tc dng ca barbiturat do IMAO c ch microsom gan do lm chm s ph hu barbiturat

20

 Cng Dc L inh Ngc H Dy3

Cu24 : Thuc iu ho hot ng tm thn Lithi ? Bi lm 1. Tc dng - Tc dng an thn + Khng c tc dng trn ngi bnh thng, tc dng ca phenolbarbital, khng tng tc vi reserpin + i khng vi tc dng kch thn ca imipramin, amphetamin - Tc dng khc + Liu 1-1,5mEq/kg tim IV gy HA, trn c tim lm nhp co bp v chng lon nhp 2. Dc ng hc - Ung d hp thu, t Cmax sau 30-120', khng gn vi protein huyt tng - Vo thn, tim d hn vo gan, c, kh qua hng ro mu-no, CDNT ~ 40-50% huyt tng - Thi qua thn 95%, 40-70% thi trong ngy u, sau chm dn sau 10-14 ngy 3. C ch - Trao i ion qua mng ch yu ca Na+ , K+ v Ca2+ + K+ gi kh nng cho t bo sn sng kh cc + Na+ thc hin kh cc v gii phng nng lng d tr t bo + Ca2+ gii phng cht trung gian ho hc - Thng qua 4 knh + Knh Na+ K+ - ATPase : y 3Na+ ra v nhp vo 2K+ + Knh r Na+ : Xung tc kch thch lm Na+ vo nhanh + Bm trao i Na+ - Na+ + Bm trao i Na+ - Ca2+ : y Na+ ra thu Ca2+ vo gii phng cht trung gian ho hc - Lithi + Thay th cho Na+ knh r Na+ v bm Na+ - Na+ nhp vo t bo + Li+ vo t bo s thay th cho Na+ + Na+ trong t bo s trao i Na+ - Ca2+ + Ca2+ t do trong t bo gii phng cht trung gian ho hc 4. Ch nh - D phng cn tin trin ca bnh hng trm cm - Kt hp thuc an thn ch yu cn hng cm - Kt hp thuc chng trm cm trm cm 5. Chng ch nh - Mi suy thn cp v mn do cn tr thi tr - Mi suy tim v ri lon nc in gii - Cao huyt p, dng thuc li niu - Ph n c thai 3 thng u - Ngi tr tu km pht trin hay suy yu tuyn gip 6. Tc dng ph v c tnh - Nh : kht, nn, chng mt, run tay, i nhiu, ung nhiu, ln cn, ph ... - Va : Nn, tiu chy, run tay mnh, kh nut, chng mt ... - Nng : Ri lon tri gic, mm c, phn x v rung git nhn cu, hn m ... 7. Liu lng v ch phm - Lithi carbonat ( Li2CO3 ) vin teralit 250mg = 6,8 mEq - Lithi gluconat ( Neurothilium ) dung dch ung, ng 5ml = 1g lithi gluconat = 5 mEq - Liu u 10 - 15mEq/l/ngy , dn . Duy tr tu CLi mu, ngy 2-3 ln

21

 Cng Dc L inh Ngc H Dy3

THUC KCH THCH H THN KINH THC VT Cu 25 : Thuc kch thch h M-cholin Bi lm 1. Acetylcholin - Chuyn ho + Acetylcholin c t cholin v AcetyCoA di s xc tc ca Cholin-Acetyl-tranferase + Sau khi tc dng ln Rp ca h cholinergic mng sau synap th b bt hot di tc dng ca Cholinesterase + Ach l cht trung gian ho hc ca h Cholinergic c tc dng rt phc tp - Liu thp 10 g/kg tim IV tc dng ch yu ln hu hch ' + Chm nhp tim, gin mch v h HA + nhu ng rut + Gy co tht c trn kh qun + Co tht kh qun v tit nc bt v tuyn m hi - Liu cao hoc khi h M-cholin b c ch : tc dng ln cc hch thc vt, tu thng thn ( H N) + Lm nhp tim, co mch HA + Kch thch h hp thng qua phn x xoang cnh + Hng phn Rp cholin vng di v v thn no gy tng ng kiu parkinson - p dng : + Ach b hu nhanh trong c th, tc dng ngn v t ngt nn t s dng 2. Cc ester cholin khc - Tc dng + Thuc c tc dng ging Ach nhng tc dng di hn v khng b cholinesterase ph hu - Ch nh + Bnh nhn p + Lm chm nhp tim trong cc trng hp tim nhanh kch pht + Vim ng mch + To bn, b i sau m - Thuc + Bentanechol (Urecholin ) : ung 5-30 mg , vin 5-10-25-50 mg , tim di da 2,5-5 mg x 3-4 ln/ngy + Carbachol : ung 0,5-2 mg/ngy , tim di da 0,5-1 mg/ngy + Muscarin + Pilocarin ( pilocarpinum ) : nh mt

22

 Cng Dc L inh Ngc H Dy3

Cu 26 : Thuc c ch h M-cholin Bi lm Atropin ( thuc c bng A ) 1. Tc dng - L cht i khng tranh chp vi ACh Rp ca h M-cholin, ch liu cao mi thy c tc dng i khng trn h N-cholin - Trn mt + Lm gin ng t , kh nng iu tit + Lm tng nhn p, gin c mi - Trn tuyn bi tit : tit nc bt, m hi v dch d dy - Trn c trn : Hu co tht c trn cc tng rng, nhu ng rut, gin c trn ph qun khi ang co tht - Trn trung tm h hp : Kch thch nh nn c th dng hen - Tim : + Liu thp kch thch dy X, chm nhp tim, + Liu cao : c ch Rp Muscarinic ca tim gy nhp nhanh - Mch : Lm dn mch da khng nh hng n HA - TKT : c ch hot tnh cc trung khu di v, ri lon tin nh - Liu cao : gy mch nhanh, gin ng t, lit iu tit mt, xung huyt da v nhit c th, kch thch trn no gy thao cung o gic 2. Ch nh - Dng lm thuc tin m - au do co tht c trn cc tng rng - Nh mt, soi y mt hay vim mng mt , gic mc - nhim c nm, thuc phong to cholinesterase - Block nh tht, tim p chm do cng ' - Bnh v hi chng Parkinson - Trong cc cn hen 3. Chng ch nh - Bnh nhn p - B i do ph tuyn tin lit 4. Ch phm - Atropin sulfat - Cn thuc Belladon : cha 0,03 % alcaloid - Cao kh Belladol : cha 1,5 % alcaloid, ung 10-20mg/ngy x 2 ln/ngy - Scopolamin - Homatropin

23

 Cng Dc L inh Ngc H Dy3

Cu 27 : Thuc kch thch h N-cholin Bi lm 1. Tc dng - Tc dng trn tim mch + Pha I : h HA tm thi + Pha II : HA mnh + Pha III : H HA ko di - Trn h hp : kch thch lm tng bin v tn s - Mt : Gin ng t - H tiu ho : tit dch, nhu ng rut 2. C ch - Ban u Nicotin kch thch hch ', trung tm c ch tim hnh no tim p chm v h HA - Tip theo Nicotin kch thch hch , trung tm vn mch tim p nhanh, HA, nhu ng rut , Kch thch thng thn lm tit adrenalin Rp xoang cnh kch thch trung khu h hp - Sau cng : kit qu do b kch thch qu mc v h HA ko di 3. Ch phm - Nicotin : c tnh cao, khng dng , dng nghin cu - Lobelin : l Alcaloid ca Lobelia inflata dng kch thch h hp - Xititon : l alcaloid ca Themopsis, tc dng ~ Lobelin

24

 Cng Dc L inh Ngc H Dy3

Cu 28 : Thuc c ch N-cholin Bi lm I. Thuc c ch N-cholin ca hch 1. c im - Thuc ngn cn lung xung ng t si tin hch n si hu hch - Cnh tranh vi cc ACh ti Rp mng sau synap ti hch 2. Tc dng - ng mch nh ( ) : gin mch, h HA - Tnh mch ( ) : gin mch, tr tun hon, cung lng tim - Tim ( ' ) : tim p nhanh - ng t ( ' ) : gin - Rut ( ' ) : nhu ng v trng lc, gy to bn - Bng quang ( ' ) : b tiu tin - Tuyn nc bt ( ' ) : tit, kh ming 3. Tc dng ph - H HA t th ng, ri lon mch no, mch vnh v tit niu do phong to hch - tit dch, nhu ng rut, kh ming to bn, gin ng t do phong to hch ' 4. Ch nh - Bnh huyt p - H HA iu khin trong phu thut - Ph phi cp 5. Ch phm - Tetra-ethyl-amoni ( TEA ) : tim IM 0,25-0,5 g/ln x 1-2 ln/ngy - Hexametoni : tc dng mnh hn TEA 10-20 ln - Pentametazon ( pendiomid ) : tc dng ko di ~ 60' - Methioplegium ( arfonad ) II. Thuc c ch N-cholin c vn 1. Tc dng - Ngn lung xung ng thn kinh ti c bn vn ng gin c - Th t lit c : C mi mt, c mt, c, c chi trn, c chi di, c bng, c lin sn, c honh - c ch trung khu h hp - Gin mch, h HA 2. Ch nh - Thuc gin c trong phu thut v cc th thut ngoi khoa - Sn khoa : m ly thai - Thuc chng co git 3. Ch phm - Tranh chp vi ACh bn vn ng : d-Tubocurarin , Galamin - Tc ng nh ACh : Succinylcholin ( myorelaxin ) , Dercametaoni bromid

25

 Cng Dc L inh Ngc H Dy3

Cu 29 : Thuc cng TCT v ( adrenalin v noradrenalin ) Bi lm I. Adrenalin 1. Tc dng ( trn c Rp v ) - Trn tim mch : + Lm tim p nhanh v mnh ( Rp ) + Lm p lc t ngt quai ch v xoang cnh, gy phn x p qua dy herinh v cyon lm cng dy X tim p chm + Co mch mt s vng: mch da v tng ( Rp ) + Gin mch c vn v mch phi ( Rp ) Kt qu l lm HAmax nhng HAmin nn HAtb khng tng - Trn ph qun + t c tc dng trn ngi bnh thng nhng lm gin mnh trn ngi b co tht ph qun do hen + Ct cn hen nng nhng mt tc dng ln sau - Trn chuyn ho : hu glycogen gan to glucose Glc mu , chuyn ho c bn 2. Ch nh - Ngng tim t ngt - p trc tip vo vt thng bn ngoi cm mu - Trn vi thuc t lm thi gian v hiu lc gy t 2. Ch phm - Adrenalin chlohydrat : ng 1ml = 1mg II. Noradrenalin 1.Tc dng - Kch thch trn c Rp v nhng ch yu trn Rp 1 v t tc dng trn Rp - Kch thch Rp nn co mch HA ( max v min ) HAtb - t tc dng trn Rp nn t nh hng ti nhp tim khng gy phn x cng ph v - Tc dng lu hn Adrenalin nn khng c giai on HA - Tc dng trn ph qun yu do c Rp 2 - Tc dng trn dinh dng v chuyn ho km adrenlain 2. Ch nh - Cp cu nng HA trong trng hp tru tim mch, sock bng, sock chn thng - Liu : ng 1ml = 1mg , truyn nh git IV 1-4 mg/250-500ml dd glucose ng trng , khng tim SC hay IM do lm co mch ko di, gy hoi t ni tim 3. Ch phm - Dopamin : ng 200mg/5ml , truyn IV 2-5g/kg/pht

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 Cng Dc L inh Ngc H Dy3

Cu 30 : Thuc cng chn lc Rp Bi lm 1. Metaraminol ( Aramin ) - Tc dng : cng , co mch v tng co bp tim - Ch nh : Nng HA trong trng hp gim HA t ngt, trong sock v chn thng - Thuc : + Tim IV 0,5 5mg trong trng hp cp cu + Truyn IV dung dch 10mg/1ml + C th tim IM hay SC , ng 1ml = 0,01 g metaraminol bitartrat 2. Phenylephrin ( Neosynephrin ) - Tc dng : u tin trn 1, tc dng co mch HA ko di, khng mnh bng NA, khng nh hng n nhp tim, khng kch thch TKT v khng lm Glc huyt - Ch nh : Nh Noradrenalin - Thuc : + Tim IM 5-10 mg + Truyn IV 10-15mg/1000ml dung dch Glc ng trng 3. Clonidin ( Catapressan ) - Tc dng + Cng Rp 2 trc synap T gy HA ngn, + Tun hon : Lm gim gii phng NA neuron gy nhp tim, trng lc , lu lng mu no, tng, thn, mch vnh, dn n HA + Tiu ho : Gim bi tit nc bt, m hi, dch v + TKT : Tc dng an thn, gim au gy mt mi - Ch nh + Tng HA th va v nng + Trong cai nghin ma tu - Chng ch nh + Cc trng thi trm cm - Liu lng + Vin 0,15mg, ung liu tng dn ti 6 vin/ngy

27

 Cng Dc L inh Ngc H Dy3

Cu 31: Thuc cng chn lc Rp Bi lm 1. Cc tc dng chnh - Tc dng gin ph qun : cc nhnh ph qun, c bit cc nhnh ph qun nh c nhiu Rp 2 - Tc dng dn mch : Tc dng ln 2 , gin mch c vn, mch no, mch vnh. rut do lm HA nhanh v mnh - Tc dng trn tim : Cng 1 , tng tn s, sc co bp, tc dn truyn v kh nng ti mu cho tim - Tc dng trn c t cung : Cng 2, gin t cung, gim co tht, dng da sy thai 2. Ch nh - Chm nhp thng xuyn - Hen ph qun - Ri lon tun hon km theo h HA - Tru mch, suy tim v chong 3. Ch phm - Isoproterenol (isuprel, aleudrin, ..) - Metaproterenal ( orciprenalin, metaprel ) - Albuteral (salbutamol, ventolin ) - Ethylephrin (effortil) - lsoxsuprin ( duvadilan )

Cu 32 : Thuc hu _Adrenergic Bi lm - Tc dng: + Gin mch h huyt p - Tc dng ph: + D gy h huyt p t th ng + Nhp tim nhanh + Co ng t + Nn, a lng - Ch nh: + Cn tng huyt p, chn on u tu thng thn, iu tr bnh Raynaud - Cc thuc v liu lng + Nhm haloalkylamin ( phenoxybenzamin, dibenamin ) : vin nang 10mg, ung 2-10 vin/ngy + Dn xut imidazolin ( tolazolin, phentolamin ) : Tolazolin ( Priscol, Divascon ) ung hay tim IM 25-50mg/ngy, Phentalamin ( Regitin ) ung 20-40mg/ngy + Prazosin : ung 1-20 mg/ngy + Alkaloid nhn indol ( ergotamin, ergometrin, yohimbin ) : ergotamin ung 4-6mg/ngy hay tim SC 0,1-0m5 mg/ngy , yohimbin 5-10 mg/ngy

28

 Cng Dc L inh Ngc H Dy3

Cu 33 : Thuc hu _Adrenergic Bi lm 1. Tc dng chnh : - Hu giao cm - Trn tim : + Gim nhp tim + Gim lc co bp ca c tim + Gim lu lng tim + Gim s dng oxi ca c tim - Trn kh qun : Gy co tht - Trn chuyn ho : c ch hu glycogen v lipid - Trn Thn : gim tit renin, h HA trn ngi c HA cao - Tc dng n nh mng : ging quinidin gim tnh thm ca mng t bo c tim vi ion natri. 2. Ch nh : - Cn au tht ngc - Lon nhp tim : lon nhp do cng giao cm, nhp nhanh v cn - Tng huyt p. - Cng tuyn gip. - Chng au na u ( hi chng migraine ). 3. Chng ch nh : - Suy tim - Block nh tht. - Nhp xoang chm. - Hen ph qun. - i tho ng. 4. Tng tc thuc : - Cc thuc gy cm ng cc enzym, chuyn ho gan nh phenyltoin, rifampin, phenobarbital... s lm tng chuyn ho, gim tc dng ca thuc hu beta adrenergic - Cc thuc chng vim phi steroid lm gim tc dng h huyt p ca cc thuc hu giao cm beta . - Hip ng vi cc thuc chn knh calci, cc thuc h huyt p. 5. Ch phm : + Propranolol ( inderal, avlocardyl ). Vin 40mg v 160mg. Ung 120 mg - 160 mg / ngy. + Oprenolol (Trasicor) + Acebutolol ( Sectran ). + Labetalol ( Trandate ) + Atenolon (Tenormin)

29

 Cng Dc L inh Ngc H Dy3

THUC CHNG NHIM KHUN V NHIM N BO Cu 34 : Cc loi Sulfamid ( tc dng v ch nh ) Bi lm L cht tng hp dn xut ca Sulfanilamid 1. Tc dng v c ch - L cht km khun - c ch tranh chp vi PABA trong qu trnh acid folic ca vi khun - c ch hydrofolat synthetase - Ph khng khun rng hu ht cc cu khun v trc khun Gr(-) , Gr(+) 2. Phn loi - Hp thu nhanh v thi tr nhanh : Sulfadiazin, Sulfafurazon ( Gantrisin ) , Sulfamethoxazol ( Gantanol ) , t Cmax sau 2-4h, T1/2 6-8h, thi tr 95%/24h - Loi hp thu rt t : Sulfaguanidin ( Ganidan ) , salazosulfapiridin ( Salazopyrin ) - Loi thi tr chm : Sulfadoxin ( Fanasil ), T1/2 7-9 ngy - Loi dng ti ch : Sulfacetamid , mafenid, t hay kh tan trong nc 3. Ch phm v cch dng - Vim ng tit niu + Sulfadiazin : vin nn 0,5g + Sulfamethoxazol ( Gantanol ) : vin nn 0,5g + Sulfafurazon ( Gantrisin ) : vin nn 0,5g + Ngy u ung 2g x 4 ln, ngy sau 1g x 4 ln x 5-10 ngy - Nhim khun tiu ho + Sulfaguanidin ( Ganidan ) : vin nn 0,5g, ung 3-4g/ngy + Sulfasalazin ( Azalin ) : vin nn 0,5g, ung 3-4g/ngy - Dng bi ti ch + Bc Sulfadiazin ( Silvaden ) 10mg/g kem bi

30

 Cng Dc L inh Ngc H Dy3

Cu 35 : Phn loi khng sinh , nguyn tc chung khi s dng khnh sinh Bi Lm I. Phn loi khng sinh ( cn c vo cu trc ho hc ) 1. Nhm -lactam - Phn nhm cc Penicilin, - Phn nhm cc Cephalosporin (th h 1, 2, 3, 4) 2. Aminoglycosid : ( Streptomycin, Gentamycin, Kanamycin, Spectinomycin, ... ) 3. Lincosamid : ( Lincomycin, Clindamycin). 4. Macrolid : ( Erythromycin , Oleandomycin, Spiramycin, Clarithromycin, ... ). 5. Phenicol : ( Cloramphenicol , Thiamphenicol) 6. Tetracylin: ( Tetracyclin, oxytetracyclin, Doxycyclin, Minocyclin) 7. Rifamycin : Rifamycin , Rifampin. 8. Khng sinh a Peptid: Polymycin, Bacitracin. 9. Nhm tng hp - Quinolon + Nhm Quinolon kinh in + Nhm Quinolon mi : rosoxacin, Pefloxacin, ofloxacin, Ciprofloxacin, - Dn xut ca 5- Nitro- imidazo l: ( Flagyl , Metronidazol ), Sulfanilamid 10 . Nhm khng sinh chng nm : Nystatin, Amphotericin B, Griseofulvin II. Nguyn tc dng thuc khng sinh 1. Ch s dng khng sinh khi c nhim khun 2. Chn ng khng sinh 3. Chn dng thuc thch hp 4. Phi s dng liu. 5. Phi s dng thi gian quy nh 6. S dng khng sinh d phng hp l 7. Ch phi hp khng sinh khi tht cn thit

31

 Cng Dc L inh Ngc H Dy3

Cu 36 : Cc Penicillin t nhin v dn xut bn tng hp Bi lm I. Penicillin t nhin 1. Tc dng + Cu khun Gr(+) t cu, lin cu, ph cu v + Cu khun Gr(-) : lu cu, mng no cu + Trc khun Gr(+) : Un vn, than, bch cu, ho g + Xon khun giang mai Tc dng mnh trn cc VK ang giai on phn chia, t c tc dng trn VK khng giai on phn chia, kt hp vi nhm tetracylin v cloramphenicol th tc dng - Khng tc dng trn trc khun Gr(-) : l, thng hn v E.coli - T cu tit _lactamase - Trc khun lao v cc loi nm 2. C ch tc dng - c ch to vch VK do thuc to phc vi tranpeptidase l enzym ni cc peptidoglycan VK khng to c vch, do cc thuc km lm tc dng ca KS 3. Ch phm - Benzylpenicilin ( Penicilin G ) : - Procain-Penicilin : tc dng ko di - Benzathin-penicilin : Tc dng ko di 4 tun - Phenoxypenicilin ( Penicilin V ) II. Cc Penicilin bn tng hp 1. Mc ch - sc chng ca thuc vi s ph hu ca penicilinase - Gi thuc n nh pH d dy - M rng ph tc dng khng khun 2. Ch phm - Cc penicilin khng _lactamase ( Penicilin M ) + Ampicilin, Amoxicilin, Hetacilin : hp thu tt, t gy thch ng ng tiu ho - Penicilin ph rng + Carboxypenicilin (carbennicilin, ticarcilin) + Ureidopenicilin (mezlocilin, azlocilin, piperaclin) - Penicilin ph tc dng hp + Pivmecilinam : tc dng ln E.coli, Salmolella, shigella Cu 38 : Cc khng sinh c ch _lactamase Bi lm Tc dng - L acid clavulanic v sulbactam c tc dng khng sinh yu nhng gn khng hi phc vi _lactamase v c i lc cao vi _lactam - Phi hp vi khng sinh nhm _lactam s lm bn vng v cng hot tnh ca khng sinh ny Ch phm - Acid clavulanic + Amoxicilin = Augmentin : vin nn 250,500mg, l 500mg - Acid clavulanic + Ticarcilin = Claventin - Sulbactam + Ampicilin = Unasyn : vin nn 220mg , ng tim 500-1000mg - Tazobactam + Piperacilin = Zosyn

32

 Cng Dc L inh Ngc H Dy3

Cu 39 : Cc Cephalosporin ( tc dng v ch nh ) Bi lm - L khng sinh ph rng 1. Th h I : Cafalotin, Cefazolin, Cefalexin, Cefaclor, Cefadroxil - c im tc dng + Ph tc dng gn ging Ampicilin v Meticilin + Khng sinh dit khun Gr(+) mnh, trc khun Gr(-), trc khun ng rut ( E.coli, thng hn, l ) , cc t cu tit Penicilinase - Khng tc dng vi + T cu vng + Virus v vi khun Gr(-) k kh - Ch nh + Nhim khun m bnh cn cha r + Phi hp vi Aminoglycosid + Nhim khun do t cu v vim thn 2. Th h II : Cefamandol, Cefoxitin, Cefuroxim, Zinacef ... - c im tc dng + Ph tc dng mnh, hn th h I + Tc dng mnh vi c _lactamase + Tc dng dit c vi khun gy bnh ng rut + Tc dng dit c vi khun k kh nhng yu - Ch nh + Nhim khun Gr(-) + Nhim khun phi, vng bng + Nhim khun tit niu, ph khoa, da + Bnh lu khng Penicilin 3, Th h III : Cefotaxim, Ceftriaxon, ceftazidim, Suprax - c im tc dng + Ph rng, qua c hng ro mu no + Dit VK Gr(+) yu hn th h I + Dit VK Gr(-) mnh hn th h I v II + Dit trc khun rut khng th h I do tit _lactamase - Ch nh + Cc nhim khun nghim trng + Khi VK khng Cephalosporin th h I v II + Vim mng no do VK Gr(-) 4. Th h IV : Cefepim bit dc Maxipim - Tc dng + Mnh hn th h III + Dit c VK Gr(+) v Gr(-) - Ch nh + Dng trong vim phi, vim mng no v nhim khun huyt

33

 Cng Dc L inh Ngc H Dy3

Cu 40 : Streptomycin ( tc dng, ch nh v c tnh ) Bi lm 1. Tc dng - Gn vo tiu phn 30S ca ribosom VK c sai m mARN b gin on - Ph tc dng + VK Gr(+) : t cu, ph cu, lin cu + VK Gr(-) : Salmonella, Shigella, Haemophilus... + Xon khun giang mai + L KS chng lao hng u 2. Ch nh - iu tr lao : phi hp vi khng sinh khc - Mt s nhim khun tit niu, dch hch, Brucella : phi hp vi tetracyclin - Nhim khun huyt do lin cu : phi hp vi penicilin G 3. c tnh - Gy tn thng dy VIII ri lon tin nh v c tai gy chng mt, mt iu ha mt thnh lc, c th gy tn thng khng hi phc - c cho thn v phn ng qu mn - Tc dng mm c, c th gy ngng h hp do lit c h hp - Khng dng cho ph n c thai v ngi nhc c Cu 41 : Cc khng sinh nhm aminoglycosid ( tc dng v ch nh ) Bi lm 1. Tc dng - Khng sinh dit khun ph tc dng rng : Gr(+) v Gr(-) - Ch yu trn vi khun Gr(-) : cu khun, trc khun - Phi hp vi Penicilin G dit lin cu, do cn tr to vch VK to iu kin cho AG thm vo trong VK n ch ribosom - C th tc dng trn n bo, sn dy 2. Tc dng ph - Gy tn thng dy VIII ri lon tin nh v c tai gy chng mt, mt iu ha mt thnh lc, c th gy tn thng khng hi phc - c cho thn v phn ng qu mn - Tc dng mm c, c th gy ngng h hp do lit c h hp - Khng dng cho ph n c thai v ngi nhc c 3. C ch - AG dit khun, c ch VK mc ribosom - Streptomycin gn vo tiu phn 30S ca ribosom - Cc aminoglycosid khc gn c vo tiu phn 30S v 50S ca ribosom 4. Ch nh - iu tr lao : Streptomycin, Kanamycin - Mt s nhim khun tit niu, dch hch, Brucella : Gentamycin, Tobramycin - Nhim khun huyt do lin cu : Gentamycin - iu tr nhim khun bnh vin : Amikacin

34

 Cng Dc L inh Ngc H Dy3

Cu 42 : Cc Lincosamid ( tc dng, ch nh ) Bi lm 1. Tc dng - Khng sinh dit khun dng c ng ung v tim - C ch : c ch protein ca Vk, gn vo tiu phn 50S ca ribosom lm cn tr to a peptid 2. Tc dng ph - Vim rut kt mc gi ( dng di ngy ) : i lng, co cng c thnh bng v st - Gy ri lon tiu ho - Vim tnh mch, h HA, vim li v ri lon v gic 3. Ch nh - Lincomycin : nhim khun Gr(+) : t cu, lin cu, ph cu - Clindamycin : + Nhim vi khun k kh m o, rut + Nhim khun khung chu ( Nhim khun sinh dc n ) + Nhim khun phi + Nhim khun huyt + Nhim t cu, lin cu, ph cu Cu 43 : Erythromycin Bi lm 1. Tc dng - Thuc c tc dng km khun, nhng cng c tc dng dit khun trn nhng chng VK nhy cm vi nng cao : t cu, lin cu - C ch : Thuc gn vo tiu phn 50S ca ribosom c ch protein + C ch tc dng ~ Lincosamid, Macrolid v Cloraphenicol c ch i khng khng dng phi hp 2. Ch nh - Nhim khun h hp, rng - hm - ming, tit niu - sinh dc - Bnh do Rickettsia, Toxoplasma, vim c t cung, niu o ... - Vim m t bo, mch bch huyt, tai-mi-hng, mi mt ... - Nhim khun ton thn do lu cu - D ng do _lactam - iu tr d phng : vim mng trong tim do lin cu, vim khp, vim mng no 3. Ch phm - Erythromycin estolat, propionat : ng ung - Erythromycin ethylsuccinat : Tim bp ( IM ) - Erythromycin glucoheptonat : Tim tnh mch ( IV )

35

 Cng Dc L inh Ngc H Dy3

Cu 44 : Oleandomycin v Spiramicin ( tc dng v ch nh ) Bi lm 1. Tc dng : dit khun - Cu khun Gr(-), v VK Gr(+), - Vi khun k kh, xon khun giang mai v Leptospira - Cc chng ni bo Mycoplasma, Chlamydia, Rickettsia, Toxoplasma - Dit Helycobacter pyroly : iu tr vim lot DD_HTT - iu tr VCTC v d phng thp khp cp - Chng vim nht l trong VPQ v hen quen glucocorticoid 2. Ch nh - Oleandomycin + Nhim khun ng h hp, rng-hm-mt, sinh dc tit niu + Cc chng ni bo gy vim c t cung, trc trng, niu o ... + Vim m t bo, mch bch huyt, tai-mi-hng, mi mt ... + Nhim khun ton thn do lu cu + Vim lot DD-HTT + D phng thp khp cp, vim mng trong tim do lin cu - Spiramicin + Nhim lu cu, ph cu nhng ngi d ng vi _lactamin + Cha toxoplasma ph n mang thai + iu tr d phng cho ngi tip xc vi vim mng no tu + Vim xng khp do t cu + iu tr amip nhng khng c tc dng vi l amip gan

36

 Cng Dc L inh Ngc H Dy3

Cu 45 : Chloramphenicol ( Chlorocid ) , tc dng v ch nh Bi lm 1. Tc dng - Ph tc dng rng c VK Gr(-) v Gr(+) - Rickettsia - c bit trn VK gy thng hn - C ch : c ch protein ca VK do c ch tiu phn 50S ca ribosom 2. c tnh - Liu cao di ngy gy suy tu - Gy thiu mu - Vim dy thn kinh th gic, ngoi bin, m sng - Gy phn x qu mn, m ay, phn v - Hi chng xm : nn, th nhanh, tm xm, ng lm, tru tim mch v t vong - Ri lon tiu ho 3. Ch nh - iu tr thng hn : phi hp Ampicilin, Amoxicilin, Biseptol - Nhim khun ng rut - Nhim rickettsia - Nhim khun mt v tai - Vim mng no : phi hp vi cephalosporin th h III - Nhim khun h TKT : phi hp Penicilin G v Mentronidazon - Nhim khun Brucella, Tularemia, hoi th sinh hi...

Cu 46 : Tetracyclin ( tc dng v ch nh ) Bi lm 1. Tc dng - Thuc km khun c ph khng khun rng nht hin nay - Tc dng trn + Cu khun Gr(+) v Gr(-) : km penicilin + Trc khun Gr(+) i kh v k kh + Trc khun Gr(-), trc khun m xanh t nhy cm + Xon khun , Rickettsia, amip, Trichomonas - C ch : Gn vo tiu phn 30S ca ribosom lm ngn cn ARNt chuyn acid amin vo chui polipeptid 2. Ch nh - Nhim Rickettsia - Nhim Mycoplasma pneumoniae - Nhim Chlamidia : vim phi, ph qun, vim xoang , mt ht ... - Bnh ly truyn qua ng tnh dc - Nhim trc khun : Brucella, t, E.coli - Trng c

37

 Cng Dc L inh Ngc H Dy3

Cu 47 : Rifampicin ( tc dng v ch nh ) Bi lm 1. Tc dng - Dit vi khun lao v phong - Cu khun Gr(+) : T cu vng, t cu da, lin cu v lu cu - Vi khun Gr(-), E.coli, trc khun m xanh, Haemophilus influenzae, Nesseria meningitidis - Dit c VK trong v ngoi t bo - Trong mi trng acid tc dng mnh gp 5 ln 2. Tc dng khng mong mun - Pht ban - Ri lon tiu ho : bun nn v nn - St - Ri lon to mu - Vng da, vim gan gp ngi c tin s bnh gan, nghin ru 2. Ch nh - iu tr lao v phong - Ch phm Rifampicin ( Rifampicin, Rimactan, Rifadin ) vin nang hoc vin nn 150-200mg - Phi hp vi cc thuc chng lao khc khng dng n c - Liu 10-20mg/kg x 1ln/ngy, ti a 600mg/24h - Khng dng thuc ngi suy chc nng gan Cu 48 : Metronidazol ( tc dng v ch nh ) Bi lm 1. Tc dng - Dit amip ngoi rut v amip thnh rut (apxe gan, no, phi, lch ) - iu tr Trichomolas ng niu-sinh dc , bnh do Giardia lamblia v cc VK k kh bt buc - C ch : Trong cc VK k kh v ng vt nguyn sinh, 5-Nitro b kh cht trung gian c vi t bo kt hp vi cu trc xon ca AND v cc si AND cht t bo 2. Tc dng ph - Tiu chy, bun nn, sn da - au u, chng mt, bun ng - Ri lon thn kinh, gy cn ng kinh, vim a dy thn kinh ... - Vim tu , nc tiu xm mu do cht chuyn ho ca thuc 3. Ch phm v ch nh - Metronidazol ; vin nn 250, 500 mg , dch treo Metronidazol benzoat - L amip cp rut : 750mg, ngy ung 3 ln x 5-10 ngy - Apxe gan do amip v amip trong cc m : 500-750mg/ln/24h ngy 3 ln x 5-10 ngy , tr em 30-40 mg/kg/24h chia 3 ln x 5-10 ngy - Nhim Trichomolas vaginalis - Bnh do Giardia lamblia : 260 mg/ln ngy 3 ln trong 5-7 ngy , tr em 15mg/kg/24h chia 3 ln dng 5-10 ngy - Nhim khun k kh, vim mng trong tim, nhim khun toan thn, apxe no, vim mng no c m, vim lot li cp v vim chn rng

38

 Cng Dc L inh Ngc H Dy3

Cu 52 : Cc thuc iu tr phong Bi lm 1. DAPSON (DDS) - Tc dng km khun, khng dit khun - C ch : Do c c ch ~ PABA c ch tranh chp vi PABA trong qu trnh acid folic , c ch dihydrofolat synthetase - Ch nh : Phi hp vi clofazimin hay rifampin 2. RIFAMPIN - L khng sinh dit khun phong v lao mnh - Thuc khuych tn vo m thn kinh km nn khng lm triu chng thn kinh do trc khun phong gy nn - Ch nh : Phi hp vi cc thuc phong khc 3. CLOFAZIMIN - Tc dng km khun phong - C ch : Gn vo AND lm c ch s nhn i ca AND - Hp thu nhanh v tch lu lu trong m, thi tr qua thn ch yu - Ch nh : Phi hp vi DAPSON v RIFAMPIN trong iu tr phong 4. Ngoi ra cn c cc thuc khc - Sulfoxon : C ch, tc dng ~ DAPSON - Thalidomid : Tc dng an thn - Ethionamid : Tc dng km khun v dit khun, dng thay th cho clofazimin Cu 53: Phn loi thuc st rt Bi lm 1. Thuc dit th v tnh trong HC - Cloroquin (Aralen, Avloclor, Malarivon, Nivaquin ) + Hiu lc cao vi th v tnh trong HC ca c 4 loi KSTSR, tc dng va phi vi giao bo P.vivax , P.malariae , P.ovale , khng nh ti giao bo ca P.falciparum + C ch : c ch polymerase lm tch lu heme gy c lm ly gii KSTSR , c ch AND v ARNpolymerase ngn cn nucleoprotein - Quinin + Tc dng nhanh hiu lc cao vi th v tnh ca c 4 loi, dit c giao bo ca P.vivax, P.malariae , t hiu lc vi P.falciparum - Fansidar + Dit th v tnh trong HC ca P.falciparum , yu vi P.vivax, khng nh hng n giao bo v giai on gan ca P.falciparum v P.vivax + C ch : c ch enzym acid folic VK khng c AND v ARN - Mefloquin ( Eloquin, Larianm Mephaquin ) + Tc dng mnh vi th v tnh trong HC ca P.falciparum v P.vivax, nhng khng dit c giao bo ca P.falciparum v th gan ca P.vivax - Artemisinin v cc dn xut + Dit th v tnh ca loi, khng c tc dng trn giai on gan - Halofantrin ( Halfan ) + Dit th v tnh ca P.falciparum, khng c tc dng trn giai on gan, th thoa trng v giao bo 2. Thuc dit giao bo ( Primaquin ) - Tc dng tt vi th ngoi HC ban u gan ca P.falciparum v cc th ngoi HC mun ca P.vivax v P.ovalae 39

 Cng Dc L inh Ngc H Dy3

Cu 54 : Cloroquin ( tc dng v ch nh ) Bi lm 1. Tc dng - Hiu lc cao vi th v tnh trong HC ca c 4 loi KSTSR, tc dng va phi vi giao bo P.vivax , P.malariae , P.ovale , khng nh ti giao bo ca P.falciparum - C ch : c ch polymerase lm tch lu heme gy c lm ly gii KSTSR , c ch AND v ARNpolymerase ngn cn nucleoprotein 2. Tc dng ph - Liu : au u, chng mt, bun nn, au bng, a chy, ri lon th gic... - Liu cao ko di : gy tan mu, thnh lc, nhm ln, bnh gic mc, rng tc, h HA .. 3. Ch nh - Dng iu tr v phng st rt - Dng trong th SR nh v va khng dng trong SR nng v c bin chng - D phng cho ngi i vo vng SR lu hnh - Dit amip gan, vim a khp dng thp, lupus ban Cu 55 : Quinin ( tc dng v ch nh ) Bi lm 1. Tc dng - Tc dng nhanh hiu lc cao vi th v tnh ca c 4 loi, dit c giao bo ca P.vivax, P.malariae , t hiu lc vi P.falciparum - C ch : + c ch polymerase lm tch lu heme gy c lm ly gii KSTSR , c ch AND v ARNpolymerase ngn cn nucleoprotein - Kch ng ti ch : kch ng DD gy bun nn, nn - Tim SC : gy apxe v khun - Tim IV : gy gin mch, c ch c tim, h HA, - C trn : co bp t cung 2. iu tr - iu tr SR nng do P.falciparum, v SR c tnh - Kt hp vi Tetracyclin, fasidar... - Hiu lc km nn khng dng t cp do P.vivax, P.malariae v P.ovale, khng dng khi P.falciparum cn nhy cm vi cloroqin - Ch nh cho ph n c thai - t dng phng bnh

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 Cng Dc L inh Ngc H Dy3

Cu 56 : Primaquin , Quinocid ( tc dng , ch nh ) Bi lm 1. Tc dng - Tc dng tt vi th ngoi HC ban u gan ca P.falciparum v cc th ngoi HC mun ca P.vivax v P.ovalae do trnh c ti pht. - Thuc dit c giao bo ca c 4 th nn c tc dng chng ly lan 2. Tc dng ph - Liu : au bng, kh chu vng thng v - Liu cao : bun nn v nn - c ch tu xng gy thiu mu v tan mu 3. Ch nh - iu tr st rt do P.vivax v P.ovale - Phi hp vi cc thuc dit th v tnh trong HC - iu tr trong cng ng ct ng lan truyn ca KSTSR, c bit P.falciparum khng cloroquin Cu 57 : Pyrimethamin ( tc dng v ch nh ) Bi lm - L thuc phi hp gia Sulfadoxin 500mg + Pyrimethamin 25 mg 1. Tc dng - Pyrimethamin l dn xut ca diaminopyrimidin tc dng chm vi cc th v tnh trong HC ca 4 loi KSTSR - Thuc c ch cc th hu tnh pht trin trong c th mui nn c tc dng ngn chn s lan truyn SR trong cng ng 2. Ch nh - iu tr SR do P.falciparum khng cloroquin - Phi hp vi Quinin - D phng cho ngi i vo vng c dch lu hnh trong thi gian di 3. Chng ch nh - D ng vi thuc, ngi b bnh mu, gan, thn nng v ph n c thai - Thn trng khi dng thuc vi ph n cho con b, ngi thiu G6PD, hen ph qun 4. Liu lng - iu tr SR : ung 25mg Sulfadoxin + 1,25 mg pyrimethamin/kg - D phng SR : ung 1 vin/tun hoc 3 vin/thng

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 Cng Dc L inh Ngc H Dy3

Cu 58 : Fansidar ( tc dng v ch nh ) Bi lm 1. Tc dng - Dit th v tnh trong HC ca P.falciparum , yu vi P.vivax, khng nh hng n giao bo v giai on gan ca P.falciparum v P.vivax + C ch : c ch enzym acid folic VK khng c AND v ARN 2. Ch nh - iu tr SR do P.falciparum khng cloroquin - Phi hp vi Quinin - D phng cho ngi i vo vng c dch lu hnh trong thi gian di 3. Chng ch nh - D ng vi thuc, ngi b bnh mu, gan, thn nng v ph n c thai - Thn trng khi dng thuc vi ph n cho con b, ngi thiu G6PD, hen ph qun 4. Liu lng - iu tr SR : ung 25mg Sulfadoxin + 1,25 mg pyrimethamin/kg - D phng SR : ung 1 vin/tun hoc 3 vin/thng Cu 59 : Mefloquin ( tc dng v ch nh ) Bi lm - L thuc dn xut ca 4-quinolin-methanol 1. Tc dng - Tc dng mnh n th v tnh trong HC ca P.falciparum v P.vivax nhng khng dit c giao bo ca P.falciparum v th gan ca P.vivax - C hiu qu cao trn cc KST a khng cc thuc SR khc nh cloroquin, pyrimethamin 2. Tc dng ph - Liu phng bnh : bun nn, nn, tiu chy, au u, chng mt - Liu cao: cc triu chng trn km theo tai, ri lon tri gic, lon tm thn, 3. Ch nh - iu tr v d phng SR do P.falciparum khng thuc - Chng ch nh + Tin s bnh tm thn, ng kinh, lon nhp + Tr em < 3 thng , ngi suy gan, suy thn - Thn trng + Ngi li xe, vn hnh my mc + Ph n c thai, tr em < 2 tui

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 Cng Dc L inh Ngc H Dy3

Cu 60 : Artemisinin ( tc dng v ch nh ) Bi lm 1. Tc dng - Dit th v tnh trong HC c 4 loi KSTSR, k c P.falciparum khng cloroquin - Khng c tc dng trn giai on gan, trn thoa trng v giao bo ca Plasmodium 2. Tc dng ph - Ri lon tiu ho - Nhc u chng mt v hoa mt - Chm nhp tim 3. Ch nh - iu tr SR nh c 4 loi Plasmodium - iu tr SR nng do P.falciparum a khng thuc hoc SR c tnh - Liu lng + Artemisinin : ngy u 20mg/kg , ngy 2-5 : 10mg/kg + Artesunat : ngy u 4mg/kg , ngy 2-5 : 2mg/kg Cu 62 : Emetin v Dehydroemetin Bi lm 1. Tc dng - Dit amip trong cc m, t c tc dng trn amip rut - C ch : Cn tr s chuyn dch phn t ARNm dc theo ribosom nn c ch khng phc hi s protein ca amip 2. Tc dng khng mong mun - Phn ng ti ch : au, apxe v trng - TK c : mt mi, au c - Tim : h HA, nhp tim nhanh v lon nhp - Tiu ho : Bun nn, nn, au bng v a chy 3. Ch nh - L amip nng - Apxe gan do amip

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 Cng Dc L inh Ngc H Dy3

Cu 63 : Tc dng iu tr amip v trng roi ca Metronidazol Bi lm 1. Tc dng - Dit amip ngoi rut (apxe gan, no, phi... ) v amip thnh rut - Dit amip th hot ng nhng t nh hng n th kn - Tc dng iu tr Trichpmolas ng niu-sinh dc, bnh do Giardia lamblia v cc VK k kh bt buc - C ch : Trong cc VK k kh v ng vt nguyn sinh, 5-Nitro b kh cht trung gian c vi t bo kt hp vi cu trc xon ca AND v cc si AND cht t bo 2. Tc dng ph - Tiu chy, bun nn, sn da - au u, chng mt, bun ng - Ri lon thn kinh, gy cn ng kinh, vim a dy thn kinh ... - Vim tu , nc tiu xm mu do cht chuyn ho ca thuc 3. Ch phm v ch nh - Metronidazol ; vin nn 250, 500 mg , dch treo Metronidazol benzoat - L amip cp rut : 750mg, ngy ung 3 ln x 5-10 ngy - Apxe gan do amip v amip trong cc m : 500-750mg/ln/24h ngy 3 ln x 5-10 ngy , tr em 30-40 mg/kg/24h chia 3 ln x 5-10 ngy - Nhim Trichomolas vaginalis - Bnh do Giardia lamblia : 260 mg/ln ngy 3 ln trong 5-7 ngy , tr em 15mg/kg/24h chia 3 ln dng 5-10 ngy - Nhim khun k kh, vim mng trong tim, nhim khun toan thn, apxe no, vim mng no c m, vim lot li cp v vim chn rng Cu 64 : Thuc ty giun theo c ch lm lit giun Bi lm 1. C ch - Gy u cc ho lm c giun p ng vi acetylcholin c tc dng lm giun lit mm, mt kh nng bm vo thnh rut nn b nhu ng rut tng ra ngoi - Phong b dn truyn thn kinh ca c giun lm c giun co cng mt kh nng bm v b tng ra ngoi 2. Ch phm - Pyrantel pamoat ( Cobantril, Combantrin, Helmex, Helmintox ) - Pipemazin ( Antepar, Vermitox, Pripsen ) - Levam isol (Ergamisol, Solaskil, Ketrax ) - Diethylcarbamazin ( Banocid, Hetrazan, Loxuran, Notezin ) - Ivermectin Cu 65 : Thuc ty giun theo c ch c ch ngun dinh dng Bi lm 1. Tc dng - Hiu qu cao trn cc giai on trng thnh v u trng ca giun a, kim, tc, mc, m - Dit c trng giun a v mc, nang sn - C ch : Thuc lin kt tiu qun KST, c ch s trng hp tiu qun thnh vi tiu qun hp thu Glc cn d tr glycogen, ATP giun bt ng v cht c ch h Fumarat reductase c hiu ty th t bo giun 2. Ch phm - Mebendazol ( Furgaca, Vermox, Mebutar, Nemasole ) - Albendazol ( Albenza, Eskazole, Zeben, Zentel ) - Thiabendazol ( Mintezol ) 44

 Cng Dc L inh Ngc H Dy3

Cu 66 : Cc thuc iu tr sn Bi lm 1. C ch - Lm tnh thm mng t bo sn vi Ca2+ lm sn co cng v lit, mt tnh bm dnh v b tng ra ngoi bi nhu ng rut - c ch s oxy ho nh hng n chuyn ho nng lng ca giun sn, c ch thu nhp Glc, khng bm c vo thnh rut v b y ra ngoi 2. Ch phm - Niclosamid ( Cestocida, Yomesan, Tredemine, Niclocide ) - Praziquantel ( Biltricid, Cisticid, Droncit, Cesol ) - Metrifornat ( Bilarcil ) - Oxamniquin ( Mansil, Vansil )

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