Giáo trình dược lâm sàng sách đào tạo dược sỹ đại học cao đẳng tập 1.PDF

BQYTE TRU'ONG CAO BANG KY THUAT Y TE 16 GIA TRINH DIA)C LAM SAN SACH D TAO MAK Si CA IiANG 1111 lien seal]: Ds Nguysra Th Phirung Nhung Ds TrAn Thi Tha Nga Ds, NgtayL Ti-q, Thu Ds, NO Thi Nga Tai hanh nOi b0 Da Nang, thang 08 nail/ 2012 a I Tryong Cao Dang K9 Thudt Y Te II Da Ang Giao trinh &lac lOrn sang GIOI THIEU MON HOC VA CAC NGUYEN TAC Si' DUNG THUOC AN TOAN HOP LY Muc tieu: I Trinh bay chivy dinh nghia ,myc lieu cho hoc Dirge lam sang Neu va phcin tich cluqc tieu chudn can thiet lira ch9n thuoc an tam 3.Neu clu9c nhrtng n9i dung ctra huang o'd'n diet! tri 4.Phan tich dttqc ksi ming ma Arc lam sang coin co de thirc hien cluvc huang datz (lieu Fri tot Dai ctrung 1.1 Dinh nghia "Dupe lam sang IA mon h9c cua nganh Duoc nham t6i uu hoa viec Sir dyng thuOc dieu tri va phOng benh tren co se• nhCing kien thirc ve DLIVC, Y va Sinh h9c" 1.2 Vai net ve sir doti va phat trien cua mon Duvc lam sang Co hai yeu to clan den skrra dai mon h9c Duoc lam sang: - Khach quan: Su phat trier' nhanh ch6ng linh vvc san xuAt thu6c lam cho thi twang thu6c vira phong phis ye so Wong &roc chat mai, vira da clang ve chung loci voi sir dai nhieu clang bac che (clang giai phOng Ice() dai, giai phong CO kiem soat,, dang bao tan runt ) khac han cac clang kinh,dien da gay khong it long tong cho thay thuoc dO sinh nhu cau ttr phia nguai ke don ye sty co mat ben canh h9 cac &roc si vai nhiem vu to van va huang clan sir dung thuoc, IA cac &roc si lam sang -Chu quan: Ben canh viec 1)6 sung vao chuong trinh dao tao nhieu kien thirc lien quan den Y - Sinh h9c, sty dal mon Duoc d6ng h9c lam sang la nen tang quan de cac d-9c si lam sang hoat Ong cong Duoc d6ng h9c lam sang la mon hoc Oa vao viec xac dinh nong d6 thuoc mau va dich sinh vat dm nguai sir dyng thu6c Mon h9c dal la nha c6 nhang phuong tien hien dai cho phep xac dinh chive nhang ruing d6 thuoc rat nhO mOi truang mau hoac dich sinh vat (nude tieu, nuac b9t) cua nguti sir dyng Nhu vay vai tra cua dirgc si lam sang khOng chi cung cap cac thong tin lien quan den thu6c ma cho cac bac si dieu tri biet &roc n6ng thuoc de co the hieu chinh lai lieu hyong cho phu hop vai tang ca the va trang thai benh 15,, lam cho hieu qua dieu tri chac chan hon va ngan chan &roc nguy co ng6 d6c hoac gap tac dyng khong mong mirk qua lieu 1.3 Val net ve mon h9c cluvc lam sang teen The gied va 0, Vie't Nam The giai: Duoc lam sang la mot mon h9c rat tre so vai cac mon h9c truyen thong TA co cua ca hai nganh Y - Woe Mon h9c duoc khai sinh o M5, vao nhCrng nam 60 oh the kj, XX Tai chau Au, sir doi cCia Duoc lam sang muon hon khoang I0 nam tirc la khoang nhang nam 70 Duoc lam sang &roc chinh thirc dira vao giang day a bac dai h9c M5 nam 1964 va Phap nam 1984 Tai chau A, nhang ntrac chiu anh huang cua M5, nhieu nhu Thai Lan, Philipin, Singapore :, Duoc lam sang phat trien rat som va hien d5 co nhieu qua nhat dinh he th6ng dieu tri Tai chau Phi, th6ng qua cac dy• an ve chain soc sire khoe cua T6 chirc Y t6 The giai (WHO), cac to chirc phi Chinh kien thirc duac lam sang da tham nhap vao Zimbabwe, Zambia, Ghana nha cac chuong trinh tai tro dao tao ve sir dyng thuoc an toan - hop Tai Viet Nam Nay lam sang du nhap vao Viet Nam nam 1990 tir chuong trinh sir dyng thuoc an toan hop 15, vai sir tai trg cua to chirc "Tarn nhin the giai Australia" Nhan thirc cluoc tam quan liar-1g cua mon hoc nay, Truang Dai hoc Duoc Ha N6i d5 ti'en phong viec dua mon Duoc lam sang vao dao tao a bac dai h9c tir nam 1993 B6 mon Trinerng Cao Ding Ky Tita't Y Ti II Da Nang Ciao trinh dupc leim sang Dugc lam sang duoc BO Y to ding nhin nam 1998 tai Trtamg Dai h9c Disoc Ha N6i Ci:ing th6i gian nay, hoat d6ng Dugc lam sang &roc ma r6ng quy me Ca ntrac Theo quyet Binh cua Vy Dieu tri - BO Y te, cac to Duoc lam sang duoc hinh tai nhieu benh vien sir ket hop cila ca Y va Duoc Mon h9c Duoc lam sang duce dua vao giang day khong chi tai Trubrig Dai 11QC Duoc Ha NOi ma ca Trutng Dai hoc Y - Duoc HO Chi Minh, Trubrig dai h9c Y - Duoc Hu8, Twang Dai hoc Y khoa Thai Nguyen, H9c vien Quan y 1.4 Myc tieu cho hoc phan Ihrov lam sang Sau h9c xong h9c phan nay, hoc vien co kha nang: (1) Trinh bay duoc nhang kien thirc co ban lien quan den sir dyng thuoc va phOng ngEra phan irng co hai thu6c (ADR) gay (2) Liet ke va phan tich dugc nhimg nguyen tic sir dyng an toan - hop IY ciia nhom thu6c th6ng dyng: - Khang sinh - Vitamin va chat khoang - Thu& chong viem (cau true steroid va kh6ng steroid) (3) Huang dan SO' dyng dtxoc mot so thuoc dieu tri nhOm benh thong th.u6ng theo cac nguyen tic an toan - hop ly: - Benh lien quan den r6i loan h6 hap: Hen phe quan - Benh lien quan den r6i loan tieu hoa: Tao b6n va tieu chay Nhirng not dung va cacti titp can dm dtrov sy lam sang de dyt dirge myc tieu sir dyng thaw an Wan - hsrp Sir dyng dupe thuoc hop ly (SDTHL) la nhiem vu quan cua nganh y te De dat myc tieu trach nhiem triic Wei) thu6c ve ba d6i Wong: Ngu6i ke don (bac si dieu tri), duoc si lam sang (DSLS) va ngt.r6i sir dyng thu6c, dO DSLS dOng vai tr6 la cau not giira bac si - ngt.r6i dua y lenh va nguei sir dyng - ngtreyi phai thkrc hien y, lenh De SDTHL truac het phai ch9n duoc thuoc hop IY Hop ly la phai can nhac cho chi so Hieu qua/Riii ro va Hieu qua/Chi phi dat cao nhat Tuy nhien, mot thu6c hop ly phai nam mot dan hop ly, nghia la ngoai ,tieuchuan timg thu6c rieng bit can phai tinh den nhieu mat khac, ba van de quan hop ly nhat ,la: - Phoi hop thu6c phai dimg (khong co along tac bAt - Kha nang tuan thu dieu tri cua nguiyi benh cao (s6 lin dung it, kha nang chi tra phi' hop vai nguai benh); - Co chi dan dung thuoc dung Muon dking thuoc hop ly kh6ng chi can den cac kien thirc lien quan den thu6c va benh ma phai dua cac kien thirc len ngubi benh Cu the, co nghia la phai hieu ro cac clic diem cua nguai benh nhu cac benh mac kern (gan, thin, tim, phoi ), cac bat thuaTig ve sinh ly (be° phi, co thai ), tu6i tac (tre em, ngu6i gia ) den ,cac th6i quen (nghien ruou, thuoc la, an kieng ) va hoan canh kinh te Nhu viy dieu tri phai tinh den ngu6i benh chin khOng phai chi la benh don thuan Sau day la mot so nOi dung cu the lien quan den sir dyng thu6c an toan - hop !Y 2.1 Cac ti'eu.chuan Ikra chyn thaw an tan - hop IS,: Bon tieu chuan can thiet Ikra chon thuoc an toan - hop ly: I Hieu qua dieu tri tot: H An toan cao: A Tien dung (D8 su dyng): T Kinh te (Re nhat so vai cac thuoc da dat ba tieu chuan tren): K - Hieu qua la kha nang khOi benh tot, tjf le benh nhan duoc chira khOi cao - An toan la kha nang xuat hien tac dyng khOng mong muon thap, nghia la ty le Hieu qua/Nguy co rii ro cao - Tien dyng hay de su dyng bao g6m each dua thuoc, so Ian dung thu6c phu hap, cang don gian cang tot Gioo frinh chivy kin? sang Truang Cao Hang Ky ThuOt Y Te II De Nang • - Kinh to co the tinh theo chi phi tien coa loaf thuoc cho dieu trj (Lieu DDD) hoac cho ca lieu trinh dieu trj Gia thuoc CO the chgn la thuOc san xuat nute hoac cua ngoai nhap CO nhang truOng hgp ngtrai to tinh vao chi phi dieu trj ca tien cua cac xet nghiem can lam sang‘can phai lam sir dyng thuoc CO nhieu tai lieu can dua vao them mot tieu chuan "San co" nghia la thu6c phai coo co dieu trj, nhu• vay la phai uu tien cho !Mang thu6c nAm danh myc thuOc thiet yeti 2.2 Cac not dung cua "htro•ng dan diet] tri" Don thuoc hay benh an china dung nhang thong tin tren giay cua bac sji dieu trj d6i vof benh nhan Trien khai nhang thOng tin la twang an dieu trj Co not dung can huang dan: - Huang an cliing thuoc - Huang dan theo dgt dieu trj: + The nao la tien trien tot + Cac dau hieu nhan biet tien luang xau di, phai ngimg hoac phai chuyen len tuyen tren 2.2.1 litro5vg dan thing thaw: - Giai thich cho benh nhan tac dyng cua nhang thuoc CO don, vi dy ringer lactat de bit nuac va dien giai sbenh nhan mat nuac qua nang, kha nang bit nuac theo duang u6ng khong dap Cmg du nhu cau cua co the - Trong nhang truang hop khac, ma viec dieu trj benh nhan ty lam hoac nguai nha benh nhan tro glop, vi du phai u6ng khang sinh, u6ng thu6c sot tha phai giai thach can than c6ch thuc hien, giai thOch tam quan : neu khyng lam se CO nguy co gO de 119 ty giac tuan tilt)? Sau dan d6, phai kiem tra xem nguti nghe dO hieu chua bAng each bAt ho nhAc lai 2.2.2 Hung dan theo d6i hay pi la giam sat dieu tra Day la budc giai thich va chi dan cho benh nhan hoac nguai nha benh nhan ( twang hap la benh nhan nhi nho tuoi) Nha,ng not dung chi an bao gam: - Tie tyc cho bu?( xem d6 tuoi benh nhan ) - Dieu chinh la' che d6 an, de y xem lieu chau bi ia chay co phai an uOng khong?Neu dung thO loci tar thCrc an dO kh6i khau phan - Theo did sot de kjp thei phat hien neu benh nang them - Neu khOi thO ngirng dieu trj va can benh nhan cac bin phap de tranh tai phat - Neu benh dO• thO phai toi khOm de thay d6i cach thirc dieu trj - Neu benh kh6ng chuyen bien hoac CO xu hang nang them thOn phai kiem tra coc ky nang sau: + Lieu lugng CO du khong? + Benh nhan kh6ng tuan thii dieu tri?(ngirng qua sarn chua kh6i hAn nen tai phat?) + Thu6c chgn khyng thach hgp?( gOy tOc dyng phy non benh nhOn ty y 1)6 dieu trj?) + Phac Iva chgn qua phi:1.c tap?( lam benh nhan kho titan thii) Vic thvc hien , Nitta vas, viec ke don hap chi la mat khOu sir dyng thuoc hop tot don thuoc dO dong mat vai tri rat quan giSip cho dieu trj conga dO ding chinh la nhiem vy cua nguti dsls dieu trj 2.3 Cac ky Wang can co cua DSLS htrefng da'n dieu tri Huang clan dieu trj la nhiem vy cua DSLS De huang dan dieu tri tot, ngoai DSLS can có cac lcy nang sau: (I) Kji nang giao tiep voi benh nhan (2) Kji nang thu thap thong tin (3) Ky nang danh gia thong tin (4) Kji nang truyen dat thong tin Nhu da neu phan tren, muon dieu trj cOng thi ngoai y6u to nArn \ang thu6c va benh phai biet ro ve benh nhan va tao duac sv hgp tac cua h9 dieu tri Voi nhang Trirong Cao &mg Ky Thuat Y Te H Da Nang GO° trinh chrov lcim sang truang hap dieu tri ngan ngay, sir tuan thu cua nguai benh dang han Thy nhien truang hap benh man tinh hoc keo dai nhieu thi van de tra nen khO khan hon nhieu Ket qua dieu tri cac benh man tinh khong phai loc nao ciing nhir muon Vas/ g5p that bai hoc ket qua diet' tri chu'a dat yeu cau thi phai lam gi de dat myc tieu (lieu tri da d5t Nei dung cu the moi ky nang: Ky Wang giao tie!) veri 14nh nhan De thus hien dugc ky nang nay, DSLS phai tao lap m6i quan he gAn gui voi benh nhan boi vi de dieu tri tot khong the khong co skr.hap tac phia benh nhan Mu6n lam chivy nhu vay phai lam cho benh nhan hieu dirge IS/ dieu tri, phuang thirc dieu tri va nhung viec ma h9 can lam de tham gia vao dieu tri,thanh c6ng Khi benh nhan hieu ve benh thi h9 se tu gide chap hanh y lenh va nhieu truang hop glop bac si tim nguyen nhan that bai quan he cal ma vai thay thu6c Ky Hang thu thb thong tin Thu thap thong tin lien quan den d5c diem cua benh nhan (tu6i, gioi, thOi quen, nghe ThOng tin thu thap phai ty mj/ vu chinh xac Thuang thi qua trinh dugc lam tir Ian kham benh dAu tien trudc bat dau thiet lap the de dieu tri nhung cling c6 the chtra khai thac het ho5c lai xuat hien nhang tinhhu6ng mai lien quan den benh 3.1(5, nang danh gia thong tin Danh gia cac thong tin lien quan den viec ang thuoc qua trinh dieu tri la met viec lam can thiet truac dua ket Van va bien phap can,thiep Phai danh gia dugc cac thong tin lien quan den viec dung thuoc,trong qua trinh dieu tri de tim nguyen nhan that bai (neu g5p) Nguyen nhan that bai dieu tri rat phac tap, dO viec benh nhan ty• y bO thuoc hoc sCr gap Nhang nguyen nhan nays c6 the dyng khong dung lieu, khong du thai gian la rat lien quan den tac dung phy cua thuOc, cung co the the gia thu6c qua cao so vai dieu kien kinh te That bai dieu tri cting co the phac di khOng phu hgp.do benh tien trien nang them (vai nguai cao tuoi, tuoi tac met cao nen nhieu benh mac kern han, thi du xuat hien them ,benh tieu duang ho5c xa vua deng mach cOng lam cho huyet al) khong the binh on va i mCrc dugc naa ) Khi tim &Jac nguyen nhan, DSLS co the glop nguai benh thyv hien lai y lenh de lap lai mat lich trinh dieu tri dung Icy Hang truyen dat thong tin Cac thong tin phai truyen dat co lien quan den huang dan dimg thu6c viatheo dOi dieu De thkrc hien myc dich huang clan dieu tri tot, nguai DSLS phai huang dan chinh xac va tSi my each thCrc thuc hien y lenh bao gam viec dOng thu6c va cac dau hieu can nhan biet ve tien trien theo chieu huang xau cua benh Muon lam tot viec nay, nguti DSLS phai tao lap du'gc long tin tir phia benh nhan va phu'ong phap kiem tra kha nang nhan thirc cua h9 vai cac thong tin dirge truyen dat; thuang thi nen de, nghi benh nhan hoc nguti nhl.t benh nhan (vai benh nhan nhO tuoi hoc nguai bi benh tam than ) nhac lai Vi dy: Cac thong tin lien quan den gia Wang thu6c, each u6ng thu6c la nhang thong tin benh nhan mac benh man tinh nhu benh lao, benh tang huyet ap, thong thuang g5p nhat tin ve dai lieu trinh dieu tri ma benh nhan phai thuc hien la rat quan Nhang thong tin lien quan den each thirc theo doi tien trien cua benh tai nha (thi dy each kiem tra huyet Ai)), chu kS/ tai kham la nhimg thong tin phai truyen dat va phai xac dinh chac ch5n benh nhan daa hieu _ va tin tuang thuc hien Ke't luan: SO• dyng thuoc hap IS/ la myc tieu d5t voi ca nganh y te, dO vai tre cua nguai dugc si lam sung la rat quan Lva ch9n &lac met thuoc hgp IS/ la viec lam dau tien; nhiem vu khong chi nguai ke dan phai lam ma ca cua DSLS Tr irong Cao Bang K9 Thudt Y Te II Da NZing Giao trinh &toy Icim sang Lya chon thuoc hop IY nham till& lap duoc mot phac dieu tri hop ly cho benh 'than Trong khau nay, nhiem vu Inrang clan diet] tri thuec ye DSLS MOt phac diet] tri &roc thiet lap dimg la rat quan nhung neu thkrc hien khong &mg (khoang cach dkra thuOc, gio' uOng thuiSc, cach sir dyng cac clang bao che) thi hieu qua dieu tri se' khong the dat throe Nhu vay, vai tre ngubi DSLS xuyen soot tir khaki dau den khaki cuoi NhEi.ng not dung tren chin!' la nhiem vu ma ngirei DSLS phai hoc hOi va ren luyen de gop phan thkrc hien myc tieu sir dking thuoc an toan - hop ly ma nganh y to clat Gicio trinh dux Icini sang Trtrong Cao Dang K9 Thitat Y 7-"Z II Da Nang CAC THONG SO MAX BONG HOC CO BAN MVC TIEU 1.Neu &coy Binh nghia cac thOng ca ban: AUC, Vd, CL va t 1,2 (lac trung cho giai (loan chu ki titan hoan cira thudc ca the Trinh bay &toy cach tinh cac thong so.:AUC, Vd, CI va ti/2 Neu Y nghia cac thong so diet, tri NQI DUNG Thu6c muon co tic dyng toan than phi tham nhap vao yang tuan hoan tir vi , tri thuoc va theo vong tuan hoan den vi tri tic dyng Qua trinh tuan hoan lam cho thuoc dutc phan b6 den m9i to chircyong ca the SO phan cua thuoc co the phy thu6c vao qua trinh: hap thu (A), phan b6 (D), chuyen h6a (M), thai trir (E); la cac d4c tinh ve dutc Ong h9c cua thu6c Cac qua trinh duty phan anh thong qua nhang thong so dupe dOng hoc, co th6ng so ca ban c6 nhieu y nghia nhat thkrc hanh lam, sang la: - Dien tich duti dutrig cong 'long dO-thei gian AUC - The tich phan b6 Vd - He so thai (Clearance=Cl) - Thai gian ban thai hay nU'a dti sinh h9c (t1/2 ) ThOng qua cac thong so nay, chUng ta c6 the quyet dinh lieu Itrang can dim vao cua m6i thu6c, khoang cach giaa cac ran dui thu6c ho4c hieu chinh 141 lieu luang cac twang h9p benh nhan co nhang bat thutng ve sinh ly, benh Chuyen luan se Ian hitt giai thieu thong so dutc dOng hoc co ban: cach tinh toan va y nghia lam sang TICH DU'QI DU'O'NG CONG (AUC-Area Under the Curve) L L Dull niein ve dien tich dual dtthng cong thu6c theo Dien tich ,dtc61 chco'ng cong (bleu diensky bien thien cua n6ng thoi gian) bleu thi tuvng trung cho luveng thuoc vao airov vOng tuan hoan clang hoot tinh sau rn'Ot theri gian Don vi tinh AUC la mg:1-1.1:1 hoc Neu ta tam chap nhan tat ca lutng thuoc vao duty vOng tuan hoan chung a cl4ng ho4t tInh se phat huy tic dung duac ly thi che AUC7 cho phep danh gia duty chat luring cua cl4ng bao 1.2.Cdch tinh dien tich dirai dirong theo plitrowg phdp thvc nghiem De Inh AUC, cach don gian nhAt la cat &tong cong thcrc nghi'em nhieu phan nhO tinh AUC to tong cac dien tich thu dutc 1.3.12 nghia 1.3.1 Tir gia tri dien tich dtrai throrg cong, to co 114 tinh thrgc sinh khci dyng (Bioavaibility) czia thuoc Sinh kha dung (SKD) la th6ng so bleu thi ti le thuoc vao dutc yang tuan hoan chung Ong can hoqt tinh so vai lieu cla dung (F%), t6c dO (Tmax) va cutng (Cmax) thu6c tham nhap cluac vao vOng tuan hoar' chung Gido trinh dtrav lani sang Tnterng Cao Dang Ky Thuat Y Te II Da Nang Nhu• vay, nOi d6n SKD ta de cap an dai luvng: F%, Tmax va Cmax Hai the pham cua ding mot hoat chat, ding lieu dung, dung duCmg dua thuoc duvc coi la along duang sinh h9c (Bioequivalence) dai lugng giao dOng mix dO cho phdp (thudng khoang 80 den 125%); Tuy nhien, qui dinh thudng chi doi vai AUC dai ludng Tmax va Cmax khong bat buOc 1.3.2 Co Toni sinh kith dyng - Sinh kha dung ituy?t d6i: la ti I6 giira tri s6 AUC thu dirdc dua thu6c ngoai du6ng tinh mach (thong thudng la dudng Wong) so vol tri so AUC dua qua du6ng tinh mach cua cling mot thuoc , AUC D F%tuy6t doi P" x x100 AUC,,, Dp0 1\16u thu6c duve dua qua dtramo tinh mach (I.V) thi F=1 Can n6u.thu6c dua ngoai cludng tinh mach thi luon co mot luvng nhat dinh bi ton hao di tir vi tri hap thu vao mat' hoac bi mat hoat tinh qua gan, d6 F luon 50% la co the chap nhan duvc Khi SKD > Sinh kha dyng tuy't dOi 80% thi co th6 coi kha nang than nhap thu6c uong vao mat!, clang x.Ap xi &rang sinh mach, lieu tri bi b6nh Ong; nhang neu SKD < 50% thi clang uong thuang kho, dat yeti truOng hdp nay, lieu Wang thudng phai hon lieu dem rat nhieu cling mOt - Sinh kha dung twang d6i:, la ti I6 so sanh giira gia tri sinh kha dyng hoat chat, cling mot duang dua thuoc, ding mot mac lieu, nhung cua nha san xuat khac cua clang bao the khac F cua hang A F%tuang doi = GGGGGGGG F cua hang B Vi so sanh, nguOi ta thuang &mg cling mot milt lieu nen phuong trinh tren co th6 vi6t nhu sau: A UChang A x100 FV0(A/B)— A UChAng B SKD tuung d6i thudng cludc sir dyng nham so sanh thu6c cua mot nha san xuat nao dO vai mot thuoc dang luu hanh co uy tin tren thi trudng (thudng la clang uong) hoac cua mot clang vien thuoc wing clang 'Ong Gia tri sinh kha dyng (F) lien quan mat thi6t den dO h6a tan cua ch6 pham (chivy danh gia qua trac nghi6m h6a tan) THE 'ITCH PHAN BO (Vd, VD) /.Khcii niOn va dinh nghia the tick phan bo co the phy thuOc vao Kha nang khuech tan cua mOt thuOc nao dO vao cac to chirc yeu to: - H6 s6 phan 1)6 lipid/nude cua thu6c - Ban chat cua to chirc ma thu6c than nhap Vi du: -Cac thuoc gay me thuang co chi so lipid/nudc cao nen than dirdc vao to bao than kinh Tac dyng gay me cang mph chi so cang cao Cling vi m6i lien quan nen luvng Gicio trinh dirge lcim sang Trtrong Cao Dang Ky Thuat Y Te II Da Ndng thuoc gay me danh cho nguti beo phi thirtng cao hon ngirti binh thutng co cung can nang va qua trinh hoi phyc sau gay me O nguti beo phi aing chasm hem -Cac thuoc co chi so lipid/nutc thap nhis theophylin, gentamicin khuech tan tot vao cac to chirc co nhieu nirac; a tre so sinh, nhat IA tre de ,thieu thang, tj/ le' nu& cua co the chiem 70-75%, do the Veil phan 1)6 cua nhitng loci IA rat Ion Vi du: Vd cua thephylin cua tre so sinh IA I L/kg o tre tuoi (ti le ny& cua toan co the chi 60%) la 0,48L/kg De bleu thi skr phan bo cua thu6c co the, ngtsti to dimg thOng so Vd: DxF Tong lugng thuoc dua vao co the (P) Vd — Cp Nang d6 thuoc huyet tuong (Cp) Don vi cua Vd la L hoac L/kg Dinh nghia: , The tich phan bó (con goi la the tich phan bó bleu kien), bleu thi mat the tich can phai co de' wan ba luong thueic clugc clua yew co the phan boa 'long bang nang huyet tzrang The tich phan 1)6 khong bleu thi mot the tich sinh ly thkrc; the tich khong co lien quan gi den the tich mau, huyet tuong, huyet hoac phan mite cua co the nhang doi tuong khong co nhang Tri s6 Vd thirtng duoc tinh san va co the sir dyng bat thirang ve sinh ly hoac khong co benh gan, than tram 2.2 Y nghia the tich phan ba cho truck, mat nong nang clO Cp new D to co the tinh chivy lieu hrowg thuoc can cltra de dal dirge Vd x Cp F O day: D: lieu thu6c can dim (g,mg) F : IA sinh kha dyng cua thuoc (%) (g/L, mg/mL) Cp: Wang dO thuoc huyet tuong Vi du: The tich phan 1)6 cua digoxin la 7L/kg Tinh lieu digoxin can dua theo &rang tinh mach de dat dugs nang d6 dieu tri mau IA I mcg/L Cach giai: VI truang hap thuoc dua qua throng tinh mach nen sinh kha dyng cua thu6c (F) bang Nhu vay: D=7 L/kg x mcg/L = 7mcg/kg iO THANH THAII CUA THUOC (Clearance — CL) 3.I.Dinh nghia DO 19c hoac dO thai cua thuoc (Clearance — CI) bieu thi kha nang cua mot co quan nao dO cua co the (thutng IA gan va than) lac sach thu6c khOi huyet tuong mau tuan hoan qua co quan dO thutng dirge tinh theo ml/ph hay I/h 3.2.Nherng tong that' fink dO Mania thdi cua thu4c (Cl rhueld 3.2.1 Tinh cho thai cua thaw fir t6c (10 thai trir qua ntrov lieu Giao trinh chtqc lam sang Trtrang Cao Hang K9 Thu at Y Te II Da Nang XET NGHItM SINH HOA LAM SANG VA NHAN DINH KET QUA ® G TIEU Trinh bay chew mgt so xet nghiem sinh hria: creatinin huyelt thanh, creatinin, tire Trinh bay therir nit so xet nghiem huye;t hoc: hang cdu, bgch cat', tie'u cdu thai - I ;OAT VAN DE Trong tong tac chan doan va dieu tri benh, vai tr6 dia xet nghiem rat quan trang vi no ghlp db• bac si lam sang chan doan theo dal va (lieu tri benh nhan mot each chinh xac, the nen hau het cac ket qua sinh h6a lam sang la dinh lugng, doi hoi ket qua dual hinh thirc va don vi cu the Vi du: Glucose: 89 mg/dl (70-110) II DON VI DO LUNG THUIfING St) DUNG TRONG KET QUA XET NGHIEM Hien nhieu tai lieu sach bao va cac labo sir dung ca hai don vi Cu va don viqu6c to mai quen su dung Trong HOi nghi y to the gi6i 1977 TA chap nh:an sir dung he th6ng don vi quoc te, cho nen co nhang he so chuyen doi to don vi di sang don vi mai hoc ngugc W Bang thi du sau day Xet nghiem Acetaminophen Albumin Ammonia Anticonvulsant drugs Carbamazepine Phenobarbital Phenytoin Valproic acid Bilirubine Bromide Calcium Chloride Cholesterol Cortisol Creatinine Digoxin Estriol Ferritin Folic acid Gentamicine Glucose Haptoglobin HDL cholesterol HCG Ig A Ig D Ig E Ig G Ig M Don vi thuong dfing µg/m L g/100mL µg/100mL He s6 chuyen d6i (X) 6,61 144,9 0,59 1,tg/mL ug/mL Rg/mL 1.tg/mL mg/100mL ptg/mL mg/100mL mEq/L mg/100mL µg/m L mg/100mL ng/I00mL µg/m L µg/m L µg/100mL µg/m L mg/100mL mg/100mL ug/mL U/L mg/100mL mg/I 00mL mg/100mL mg/100mL mg/I00mL 4,32 4,31 3,96 6,93 17,1 0,0125 0,25 0,026 0,0276 88,4 1,28 3,47 2,2 22,7 2,22 0,056 0,118 0,026 0,0625 0,054 0,005 0,067 0,01 I I2 Don vi qu6c to (SI) µmol/L µmon µmon i.tmol/L µmon i.tmol/L µmol/L pmol/L / !Amon mmol/L mmol/L mmol/L mmol/L µmon i.unol/L nmol/L nmol/L prnol/L nmol/L 1.tmol/L s mmol/L µmon, mmol/L µmon 1.tmol/L nmol/L µmon µmon Truorg Cao Hang K9 Thuat Y Te 11 Do Nang Insulin Ketones(Acetoacetate) LDL cholesterol Magnesium Phosphorus Phenylamine Potassium Quinidine Salicylate Sodium Theophylline TSH Thyroxine Transferrin Triglycerides Urea Urea N Uric acid VLDL cholesterol Vitamin B12 Gases Enzymes Girio trinh chtor lam sang pg/mL 1.tU/mL mg/L mg/100mL mg/100m L mg/100mL mg /L mEq/L i.tg/mL mg/100mL mEq/L pg/mL mU/L i.tg/100mL mg/100mL mg/I 00m L mg/100mL mg/100mL mg/I00mL mg/100mL pg/mL mmHg U/L 0,174 7,25 0,111 0,026 0,41 0,323 6,05 I 3,09 0,0724 5,55 12,9 0,11 0,0114 0,166 0,356 59,5 0,026 0,738 0,133 1,67* 10-8 nmol/L nmol/L mmol/L mmol/L mmol/L i_mIm11 i 1/I' /L mmol/L mmol/L mmol/L mmol/L i.t.mol/L nmol/L !Amon mmol/L mmol/L mrnol/L µmon mmol/L pmol/L kPa katal/L HI MOT SO XET NGHIP/1 HOA SINH VA BIN Lt.1.01 MOt so xet nghi?m h6a sinh 1.1 Uri' (Urea), Ure IA san pham thodi hOa chInh ciia Protein dtrac tao gan va dao thai chit yeu qua nu& tieu M6t so ph6ng xet nghi'em dinh luang tire dual clang nito ure mail BUN (blood urea nitrogen), tri so binh thuang Ur 8-20 mg% hay 3- 7,4 mmol/L O Tang ure matt : an nhieu protid, sat, benh than ( viem cau than, Ong than, suy than cap, man) o Giarn : suy gan Ong agiai doan cu6i hiem gap ® He so thai ure binh thuong 75mL/phut, he s6 giam ngtrai suy than L2 Creatinine Creatinine IA san pham thoai haa ctla phosphocreatine, mot chat du tr.° nang Itrangcoo ca Tri se; binh thirOng tir 0,5 — 1,5 mg% hay 44 — 132 µmon, Creatinine dao thai nuac tieu chit yeu I9c o cau th5n, creatinine Riau chroc ,coi IA xet nghiem tot hon so vai ure mau O Creatinine tang suy th5n, bi tieu 1.3 He so thai creatinine (clearance creatinine0 D6 thai creatinine IA so luvng can cho th5n thai trir hoan toan ch5t nuoc tieu khoang thai gian nhat dinh (I phOt) D6 thai &lac tinh bang cong tht:rc sau: V phut) — U: n6ng d6 creatinine mg/L nu6c tieu V: the tich nude tieu/ phut P: n6ng d6 creatinine mg/L huyet o Binh thuang he so thai tit 70-140 ml/phut 13 GO° trinh dux lam sang Trirdeng Cao Hang Ky Thuat Y Te" II Da Niing • Suy then: he so thai < 70 ml/phut ® He se') thai creatinine la xet nghiem danh gia chac nang then tot hon creatinin, nhung MI6 thkrc hien han vi phai ley !mac tieu 24 gia va benh nhan phai ley dAy du nutc tieu 24 gia, neu khong tuan thu thi ket qua se sai loch My so xet nghi01 huytt hoc CO nhieu xet nghiem huyet hoc nhts cong thirc mau, dOng cam Riau, toc rang mau Trong bai khu tro xet nghiem cong thac mau: Trong mau có loci huyet cau:, hong cau, bach cau, tieu cau Xet nghiem cong thirc mau tire phan tich cac phan huyet cau, nhieu 14 may hien phan tich duoc cong thurc bach cau va cho rat nhieu th6ng so giop,cho chan doan va theo dOi tien trien cua benh, mat khac giup cho viec theo dOi tac dung cua thuoc 2.1 116'ng cAu Chirc nang chinh cua hangcAu la chuyen van oxy hit vao phai den cac mO qua vai tro cua huyet cau to hay huyet sac t o (hemoglobin) SO Itron4 h6ng cau ngtrai binh thutng : 4,0 — 5,0 * 1012/I Huyet sac to (hemoglobin) Hb nam hong cau va cau tao boi Heme va Globine o Nong dO huyet sac too nguti binh thutng : Hb = 130 -150 g/I o Nam cao han Hematocrit: xet nghiem thtrang dung theo dOi ski thieu mau hay sir tang giam hang cAu • Hematocrie la ti le phan tram giira huyet tuang va hong cau Nguti to bang cach quay Ii tam may Ong mao quan de lAng hoan toan hang au va tinh ti le giCia lop huyet tuung va hang cAu • Binh thtrang ; 38-50% O Nam cao hon 2.2 Chi so hiring au Cac chi so thutng dung de phan loci thieu mau MCV ,(mean cell volume): the tich trung binh cua hang cAu &roc tinh de xac dinh kich thutc hang cau Pemtat ocr Ct7 1119 !Ei o ; Binh thutrig: 80-100 femtolit (fl) O MCV < 80 fl: thieu mau, hang cAu nhO gap nhieu benh hang cAu tron, nhO di truyen: la benh thieu mau tieu huyet bet thutng dm protein mang hang cAu • MCV >100 fl: thieu mau hong cAu to, la benh thieu mau thieu vitamin B12, acid folic, CO the an thieu hoac hap thu kern bai cac hOa chat, thuac hay tkr khang the chang to bao da day hoac khang the chang y6u to not tai da day INCH (mean cell hemoglobin): Lung HB trung binh cila hang cau Hizyet s,-1c tO — So i_-rcr Binh thutng 30-32 pg MCHC (mean cell hemoglobin concentration): Nang HB trung binh cua hang cAu Hz v.:4t s‘c tO r ii r He?iiatocrit 14 Throng Cao Hang Ky Thucit Y T" 11 Da Njng • o Gicio trinh Ave an sang Binh thtrOng 320-340 g/1 MCHC dung danh gia tinh chat clang sac, ua sac hoac nhirgc sac o Thieu mau nhtrac sac: kich thiro.c h6ng cAu nhO, Hb nhieu hon h6ng cAu o Thieu mau clang sac: kich thu6c h6ng cAu binh thub.ng, HB va so Itrung heng cAu song song o Thieu mau uu sac: kich thu6c heng cAu to, Hb it hon s6 lung heng cau, mau co nhieu h6ng cAu kheng 16, to i) B#ch, cAu Bach cau gitip co the chong Iaitaac nhan gay benh bang qua trinh thkrc bao hoac qua trinh mien dich Can ca vao hinh clang va cAu troc, ngubi to chia bach cAu foal: O Bach cau trung Neutrophile 55-75% • Bach cAu u.a acid: Eosinopile 1-5% O Bach cAu ua base: Basophile 0-2% O Bach cAu mon: Monocyte 2-10% • Bach cAu lympho: Lymphocyte 20-35% 3.1 cAu 110 trung tinh o Binh thtrang 1,8 — 8* 109/1 O La y6u to quan trong sty de khang sinh xu'ong chaa nhi&J enzyme thily phan, vai tro la thy.c bao Tang trublighogp nhi6m khuan cap tinh: ap-xe ngoai da, viem h9ng, viem tai, viem ph6i, viem runt thira, nhiem trung huyet 3.2 Bach cAu da nhan u'a acid o Binh thu&ng -4,5 * 109/1 O Bach cAu da nhdn ua acid ding gieng bach cau da nhan trung tinh, sinh tir xuong, dOng vai tro de khang ctla co the o Tang cac benh di tang, hen suyen, ben ki sinh trung nhlem giun, san o Giam trang thai soc, benh Cushing, da thuong 3.3 Bach cAu da nhan tra base o Binh thub-ng: -2 *109/1: so lung rat thap, tang nh9 benh di tang 3.4 ach can mono o Binh thiremg 2,0-10,0 * 109/1 • Hoat clOng thkrc bao dm bach au mo vi sau &roc xuong sinh vao mau mot thai gian ngan r6i di vao m6, day chOng co the rai mo de tro' dai thtyc bac, luu cl6ng den cac vung viem nhiem va the hien vai tro dai thirc bao cac vi khuan, h6ng cAu gia, bach cAu trung tinh bi chet, ki sinh trung cac mo bi hoai o Ngoai bach cau co vai tro khai Ong qui trinh mien dich o Bach cAu mono tang nhiem khuan cap tinh va man tinh nhu lao, cram, viem gan, ung sau sir dung cortisol, giam rat hi6m gap 3.5 can Lympho O Binh thu.Ong 2,0-3,0 * 109/1 O Co rat sarn, thai, to bao có kha nang mien dich g'om loai: 15 Trtrong Cao Hang Ky Thuat Y TA 11 Da Wing cAA-(tolk.' rk•C\-L (U:c_t) Gicio trinh dux lam sang o Lympho B: chirc nang mien dich,-the; san xuat cac khang the km Ong mau de chong lai tac nhan gay banh va o Lympho T: chac nang mien dich to bao, kha nang gay d6c to bao, giiip che, tao cac cytokine, tham gia vao qua trinh chong thai ghdp • Sy tang giam lympho thu.ang thay46i mot s6 banh nhi8t-n virus va nhi6m khuan nhu viem khdp, phai Crng Pa-rai-V6i thu6c (phenytoin, acid amino salycilic ) o Khi s6 lupng lympho giam banh nhan bi suy giam mien dich 3.6 Tieu eau O Binh thtrang 200-400 * 109/1 • La nhang to bao khong nhan, chire nang hoat cl6ng qua trinh (long mau Khi mach mau bi ton thuang, tieu eau tap trung Iai nai ton thuong tao tieu cau l'Ap kin Vi the tieu cau giam se gay xuat huyet o Tieu cau giam cac banh suy tuy, ung this, nhrem khuan, nhiem sieu vi (sat xuat huyet) va nhi'em d6c mot so hda chat kha nang ket O Cac thu6c gay giam tieu cau nhu chloraphalycolhepanin , thuoc dinh tieu cau aspirin TAI LIEU THAM IGIA0 1.Gido trinh giang day mon dudc lam sang ,B6 mon Dude lam sang- Dai h9c y dtrac ph6 H6 Chi Minh, 2008 Sinh ly hoc, B6 mon Sinh IS/ hoc- Tru.ang Dai h9c y Ha N6i, Nha xuat ban Y hoc, 2006 ( 16 TrtrerngCao gang Ky Thuat Y Td II Da !Wing Gicio trinh chivy lam sang TOCING TAC THUOC MUC TIED e Trinh bay chivy cac loci tirang tac giira thuoc- thuoc ® Trinh bay va giai thich mat so ttrang tac gifia thuoc va thtiv an, wing I TIflING TAC GIU'A THUOC VA THUOC Khai niem can ban tircrng lac thaw Sy along tac thuoc duoc bieu hien bang sy thay d6i dugc Ong hoc hay hoat tinh duoc ly cua mot thu6c bai,m6t thu6c khac,khi sir dyng ding mot hai hay nhieu thir thu6c Trong thyc to diet] tri, sy phoi hop thuoc la viec khong the tranh kh6i va se clan den sy tuong tac thuoc bai sty can thiep cua nhieu yeu to • Ve mat dugc Itrc hoc: tac d6ng trkre tiep tren rcceptor (ciing hoac nhang receptor khac nhau) • Ve mat dugc dong hoc: tac dOng gian tie') khong qua receptor (xay qua trinh hap thu, phan bo, chuyen h6a, thai vb.) Phan loai loai: lam gia tang tac dyng dugc ly hay lam giam tac dting duoc ly Tuy nhien, cach phan loai khong giai thich co che twang tac thuoc Tuang tac bao ham y nghia tac dOng 118 twang., co nghia la co sy tac Ong hai chieu Tuong tac mot chieu chi co mot ben gay twang tac va mot ben chiu anh hisang cua sy along tac 2.1 Twang tac ye mat dtrot Ong Ket qua lam sang co the xay ra: Tang hoac giam tac d6ng tri lieu , Co phan phy khong mong muon Xuat hien dOc tinh 2.1.1 Tiwng tic lam thay doi sty hip thu cua thaw 2.1.1.1 Thay doi yeu to Ii hoa: pH dich vi: chat,kiem (NaHCO3) lam giam sy hap thu cua nhitng thu6c acid yeu co pKa 2,5 den 7.5 nhu thuoc khang viem khOng steroid, khang vietamin K, penicillin disOng mong Chat thuoc CO pKa tir 5-11, vi du acid anh twang den sy hap thu cac thu6c base yeu, (lac bit dal tetrecyclin- cimetidine (cimetidine lam giam sy hap thu tetracyclin ire the bai tiet dich Tao phac hay chelat: tetracyclin tao muoi chelat vai Fe++Fe(S0.4) Hau qua la lam cho ca tetracyclin va Fe(SO4) giant tac dyng 2.1.1.2 Thay doi yeu to cluryc thu6c da day va anh twang Thay doi,toc d6 lam rI)ng day: anh huang thai gian den sy hap thu thuoc roc d6 lam da day gia tang lam tang, sy hap thu thuOc Vi dy metoclorpramid lam tang sy hap thu cua cac thuoc khac lam tang toc d6 lam reing da day Lam bien ,doi he vi sinh vat dung runt: khoang 40% digoxin dung throng uOng bi chuyen h6a boi vi khuan dung runt tao clang kh6ng hoat tinh., Thay doi nhu cl6ng runt: lam tang hoac giam t6c d6 hap thu cua thuoc Vi dy metoclopramid lam tang nhu d6ng runt nen lam giam hap thu digoxin (WON uemg, Nhung metoclopramide lam tang sty hap thu cyclosporine lam tang toc d6 lam re3ng da day 2.1.2 Tu'o'ng tac lam thay doi sir phan bo dm thaw Trong sy phan b6 thuoc thi chi CO thuoc clang ty mai co tac dyng dupc ly va c6 the phan ph6i tai m6 I7 GO° trinh chrac loin sang Trtrerng Cao DOng J K9 Thuat Y Te II Da Aljng Sy tuang tac xay huyet tuong: Acid valproic clay diazepam khOi not gan protein dO lam tang Wong c18 diazepam a clang ty do, dua den sy tang tac Ong dm diazepam va can phai chinh lieu Si tuong tac xay mo: Quinidin tuang tranh voi digoxin sy gAn vao protein, lam cho nong d8 digoxin mau tang cao Can phai giam lieu digoxin phOi hop thuoc tren 2.1.3 Tucrng tac lam thay doi sty chuyen hoa cua thaw Hoat tinh enzyme gan la mot thong so c6 vai tr6 chu yeu voi so phan cua thu6c co the Neu cac thu6c dung d6ng thai c6 anh , huang den hoat tinh men cytochrome P450 (CYP) tren microsom gan, lam thay doi skr chuyen hOa qua gan cua thuoc khac va da sinh kha dyng thay cl6i theo Thu& cam ang men gan: lam tang hoat tinh enzyme, nghia la lam tang qua trinh sinh chuyen neu chat chuyen hoa la chat \4 hoa cua thu6c, lam giam hoat tinh hay mat hieu lyc cua thuoc huyet twang kh6ng dat den ngutng tac dOng Tuy nhien, chat hoat va nong chuyen h6a co hoat tinh thi hien along cam (mg co the lam tang tac dyng tri lieu Thu& ire the men gan: lam Ice° dai thai gian hieu lyc cua thuoc, lam cham sir dao thai va tang lions c18 thuoc Dieu co the cian den d8c tin va hau qua tily thuOc vao chi so tri lieu cua thuoc 2.1.4 Ttrang tac lam thay doi Sticlao,thai ctia thutic Thong tac qua trinh IQC qua tieu caihro sy day thu8c khOi not gan protein lam cho nong d8 thu6c tang cao va do sy loc qua tieu cAu tang Vi dy tuang tac aminoglycoside va digoxin Twang tac qua trinh tai hap thu: qua trinh tai hap thu bi anti Wang boi nong d8 va tinh tan lipid cua thu6c tren mang to bao Phan ta thu6c a clang khong ion h6a aloe uu tien han, dang ion hoa va CS/ le giaa clang phy thuoc vao pH nuactieu va pKa cua thuoc Vi dy: thuoc loi tieu thiazide lam tang pH nude tieu va lam giam c18 nong kh6ng ion h6a mot s6 thuoc do lam tang skr thai tra va giam tac d8ng tri lieu thuoc co he so thai a than cao Tuang tac qua trinh bai tiet: probenecid tuang tranh voi penicillin o not gan vao protein a 6ng tiet lam kdo dai tac dking cua penicillin 2.2 Ttro'ng tic yt mat dirge Ikrc 2.2.1 Tac d'Ong doi khang: xay tac Ong cua thu6c doi nghich vai tac dOng cua mot thu6c khac Doi khang canh tranh: co sy tranh clanh sung not tiep thu, vi dy: pilocarpin va atropine Doi khang khong canh tranh: co skr canh tranh khong ding not tiep thu, vi dy: papaverin va bari clorid 2.2.2 Tic (tong hip lire: ,• Hip Ikrc 1)6 sung: A+B = A+B, vi dy I3-blockers va thu6c loi tieu thiazide Hiep lyc bOi tang A+B = C >> A+ B, vi du trimethoprim va sulphonamid H TtrONG TAC GIffA, THUOC- THITC AN — DO UONG Turing tac giUa that& voi ruvu nguti nghien ruou co sy Cic the lien hop glucuronid cua mot s6 thu6c Ruou lam tang tac dyng cua nhang thu6c tac Ong tren than kinh trung uo-ng nhu thu6c khang histamine, barbituric, thu6c tri benh tam than Clopropamid, metronidazole co tac Ong disulfiram vai cac triu chang dO mat, &rang huyet, non, tim dap manh, chOng mat, kho tha, mO mat Twang tac gi&a thaw voi thtic An Trong da so truOng hop, tuong tac xay giai (Joan hap thu, dan den Sct thay d6i c18 hap thu cua thu6c Thac an lam giam hap thu cua ampicillin, captopril, levodopa, licomycin ,, lam cham hap thu amoxicillin, cimetidine, digoxin, furosemide, sulfadiazine ,lam tang hap thu dia lithium, griseofulvin, dicourmarol, diazaepam, phenytoin I8 Trtrang Cao gang Ky Thuat Y T'd II Da A18ng Giao trinh dupv lam sang PHAN U'NG CO HAI CUA THUOC MRJC TIEU Trinh bay duff dinh nghia, ccich phan loaf cac phan ring co hal cira thuac G Giai thich dtrqc cac yeu to lien quan den phan arg ca hal cirri thuoc I KHAI IS4M thuac (ADR-Adverse Drug Reaction) la phan ang d6c hal, khong dinh Phan Crng, có hai truck, xuat hien a lieu thuang diing cho nguai de pheng benh, than doan hay chi.la benh hoac nham thay dal mat chirc nang sinh Ii Dinh nghia khong bao gam cac truang hgp dOng sai thuoc hay &mg kh6ng dOng lieu chi dinh II PHAN LORI Phan Ioai theo tinh chat &rem li, Thi du Dinh nghia Loai I-14 throng huyet tiem insulin Gia tang o C the du doan dugc A thuoc 13 Tim cham Phg thuac vao lieu dung (Augmented) adrenergic Thuang gap Chay mau thuoc khang (long Hiem gay tir vong Phan Crng di Crng vai penicillin , La thuang Khong du doan dugc B (Bizzarre) KH6ng lien quan den lieu Ho4i to to bao gan cap halothan diing Suy tily clormaphenicol Khong thuang gap Ty le mac benh va Cu vong cao chUng Cushing La phan Crng chi xay sau Hai Man tinh C prednisolone mat thai gian diet] tri lau dai (Continuous) Rai lo4n chirc nang d4i trang dOng thuoc xo LA phan Crng xuat hien sau Ung thtr tac nhan alkyl hoa D (Delayed) Cham da ngung dieu tri trong dieu tri Hodgkin Di clang xuong mat a tre em co mat thai gian me dUng isotretionin E (Ending of Hai chang La phan Crng xay sau Suy tuy6n thugng thAn sau ngung dOng thuoc, dac biet la dung diet' tri glucocorticoi, ngung use) prednisolone ngung dot ngat thuoc Co giAt ngirng thuac chong co giAt nhu phenobarbital Phan loai theo tinh chat ciaa.phan irng‘ Lo4i A (qua mac): nguyen nhan co the qua lieu, sir nhay cam cCia nguai benh vo i thuoc, sir ket hop kh6ng thich hop (chang han sir ket hap giCra mot chat irc che men gan voi 1116t thuoc ,dugc chuyen hOa gan, dAn den nong thuoc huyet tuang tang len va dau hieu qua lieu co the xuat hien) Loa' B (14 thuang, khong du doan dugc): nguyen nhan co the lien quan trang thai lam sang cua benh nhan, di Crn , bAt thuo'ng di tru en, qua nhay cam A Tien chuan so sanh Khong Co Tac dung dugc ly co the du doan dugc KhOng CO Phu thuac lieu sCr dung Thap Cao Ty suAt benh Cao Thap Ty le W vong NgUng thuOc Dieu chinh lieu Dieu tri 19 Giao trinh cheav lam sang Trirong Cao Hang Kf Thuat Y Te II Da Nang Phan 14 cltya theo bleu hi0 lam sang cua ADR e Bieu hien tren da va niem mac: not me day, ngaa, rash da, loet niem ,mac ® Bieu hien tim mach: r6i loan nhip tim, suy tim, tang hay giam huyet Ap • Bieu hien O he tieu hoa: loet da day, td trang, dai trang, xuat huyet tieu hOa ® Bieu hien a hes tiet nieu sinh dyc: suy then, roi loan kinh nguyet • Bieu hien &than kinh trung yang va ngoai vi: CO giet, h6n o Biel] hien a chirc nang clang mau: suy tOy, giam tieu cau, hong eau, bach cau hat, r6i loan clang mau ® Bieu hien a he thong,co xuang: loang xuang, viem gan, dirt gan • Bieu hien O he not tiet: suy thugng then, cuang giap • Bleu hien toan than ® Bieu hien o• co quan khac III CAC YEU TO NGUY CUA ADR Thu6c Chat [Yong thu6c: • Chat Itrong hoat chat: d6 tinh khiet cua hoat chat IA van de can quan tam • Ta duct vi co the lam thay d6i sir hap thu thu6c, vi du thay the glycerin bang ethylene glycol h8n dich sulfanilamide lam chet nguai © Qua trinh san xuat © Bac) quan Wnh nhan Gioi tinh: ADR thuang xay phi,' nu hon nam Tu6i tac: ADR thuang xay a ngtrai gia tren 60 tuoi sy• nhay cam va so !yang thuk clUng nhi'eu hon so vol ngu.O.i tre co thai gay bien clang tre em Phy nu• thai: thalidomide IA thuoc an than dung cho phy Benh ly: suy then thuang gay bien d6i nhieu ve &rat lye cua thuk Stress, ,nh6i mau co tim, !Yong al glycoprotein tang len, dan den sy lien ket girra thu6c co tinh kiem yeu vai protein se tang len nhu propranolol, quinidine Sy thieu but men chuyen di truyen: thieu men Glucose phosphate dehydrogenase gay tieu huyet benh nhan thieu men sir dyng thuoc oxy hOa nhu• aspirin, primaquin, dapson, thuang gap a nglayi Dia Trung Hai, chau Phi, Dong Nam A 3, Bac sis Bac si can cc') kien thirc tot ve duoc ly cua thuoc Y dire IV BIN PHAP HAN CHE A Trtrac ke clan, phai danh gia dirge cal loi va hal thu6c mang lai boi vi ADR khong tach kh6i tac dung c6 lgi ma thuoc mang lai Theo dOi cac phan tang co hal ThOng bao cac ADR tram hoac cac phan Ong nghi nga IA thuoc gay 20 Trirong Cao Hang Ky Thuat Y Te II Da Arcing Gieo trinh chive lam sang THONG TIN THUOC MVC TIED Let ke duor nit so cach phcin loaf thong tin thudc Liet ke cludr n17E-mg not dung thong tin thuoc cho 170nh nhdn via cho can 170 y to PhOn tich thror cat btrck ccin lam nheim thief Idp nit guy trinh thong tin thucic CO hieu quo NOI DUNG Tren the gi6i, thuat " thong tin thu6cATTT) bat au duvc de cap nhieu vac nhang narn dau cua thap kj/ 60 TTT co the hieu mot each don gian IA cac thong tin gan lien vai thuoc, cac thong tin thuong duvc in cac tai lieu tham khao hay can g9i IA cac nguon thOng tin Tuy nhien de hieu rO ye khai niem TTT thtreng phai clAt thuat ngir cac ngt canh cu the, di kern voi cac thuat ngir khac nhu: - Chuyen gia/ &roc si / nguti cung cap - Trung tam/ dich vu/ thkrc hanh - Chile nAng/ ky nAng Nhom cac khai niem dau tien de cap den vai tre cua cac ca nhan lam cong tac thOng tin thu6c, nhom khai niem thir hai chu vao cac dia diem din hoat d6ng TTT, nhOm khai niem thir ba lien quan,den Wang Ikrc TTT Hien nay, vai thkrc to vo cling da clang va phirc tap dm cac thu6c lieu tri cling nhu cac tai lieu lien quan den thu6c, thuat nga TTT thutng duvc gan lien vai cac khai niem "trung tarn TTT", va " chuyen gia TTT", CO nghia IA not den TIT la nOi den vai tr6 chuyen mon h6a ca din:7c sy ding nhun6i den mot he th6ng th6ng tin host d6ng vai cac chirc trach chuyen, biet Su phat trien cua cac trung tam th6ng tin thuoc va cac chuyen gia thong tin thuoc IA diem kh6i dau cua khai niem &roc lam sang, dAt nen tang de cac duvc sy chia se trach nhiem vol cac bac sy viec sCr dung thuoc cho benh nhan Phan loai thong tin thaw CO nhieu cach phan loai thong tin khac nhau, sau day la mot so each phan loai thong tin hay duvc ap dung 1.1 Phan lo#i thong tin theo doi tuwg cluw thong tin 1.1.1 Th6ng tin cho can b6 y to - Cho ca nhan: + Thay thuOc ke don + Y td dieu dutng + Dirgc sy benh vien, ma hang + NgLr6i ban thu6c - Cho mot to chirc: + H6i dong thuoc va dieu tri + Bao hiem y to 1.1.2 Thong tin cho ngutri sir dung - Benh nhan, nguti dung thuoc - Nhan dan, ngubi tieu dung thuoc L2 Phan 1100 thong tin theop(ii dung chuyen biet cua thong tin 1.2.1 Cac thong tin lien quan den d4c tinh va each sir dung cua thuoc - Thong tin lien quan den clang bao the va sinh kha dung cua thuoc - Thong tin ve duvc lye hoc - ThOng tin ye duvc d6ng h9c - Th6ng tin ve danh gia sir dung ,Iva ch9n thu6c - ThOng tin ye hutng clan sir dung thuoc( che d6 lieu, phac dieu tri, 21 dung ) GO° trinh &toy lam sang Trtrang Cao Hang Ky Thuat Y Te II Da Nang - Thong tin va ADR, va dOc tinh cua thuOc - Thong tin ve tac dyng gay quai thai, dOt Nen - ThOng tin ye Su' elyng thu6c cho cac dOi tuong dac biet - Thong tin ye dO on dinh, tinh tuong ky, cua thuoc - Thong tin ye tuong tac thuoc 1.2.2 Cac th6ng tin ve luat, chinh sach y te, so dang 14 1.2.3 Th6ng tin va gia ca 1.3 Phan loai thong tin theo nguon thong tin NguOn thong tin thutng dugc chia ba loai: nguon th6ng tin thir nhat, nguOn thong tin thir hai, nguOn th6ng tin thir ba Viet phan loai dkra vao nguOn gOc ,thanh phan , chirc nang dm thong tin 1.3.1 Nguon th6ng tin tha nhat La cac bai bao, cong trinh got clang tai day du tren cac tap chi hoac dua len man internet, cac bao cao chuyen mon, khcia luan tOt, nghiO sinh vien, tay phong thi nghiem Cac thOng tin thutng tac gia cong b6 cac nghien ctia ,minh ma khOng co St/ can thiep, danh gia dm ben thir hai Khi sir dyng nguon th6ng tin thir nhat, nguti ,sir dyng thong tin có the xac dinh dugc phuong phap nghien cat!, ket qua nghien ciru va cac kat luan cy the ma tac gia dat dugc Hien nguon th6ng tin thir nhat.dang phat trien rat mph me, tren the giai co tren 20 000 tap chi y sinh h9c có ten tuoi duoc xuat ban hang nam, chin ke cac thong tin dupe cong 1)6 dual clang bao cao khoa h9c hay dua len mpg 1.3.2 Nguon thong tin tha hai Bao gom he th6ng muc lyc cac thong tin hoac cac bai torn tat cua cac thOng tin thuOc npOn thOng tin tha nhat, dugc.sap xep theo cac chii hhat dinh Khi muon tim hieu mot van de cy the, nguti sir dyng co the tham,khao ngu6n th6ng tin thir hai de co dugc mot danh myc cac thOng tin có lien quan hoac co the dgc tom tat cac thong tin ding chi] de vai van de minh quan tam Nhu vay ngu6n th6ng tin tha hai giup nguti sir, dking tiep can van de mot cach toan din hon, nhung muon‘hieu day du mot thong tin cy the nao do, nguti dyng phai quay lai nguOn thong tin ban dau Hien nay, da CO cac nguon thong tin this hai Itru tat CDROM hoac dua len mang internet, gimp nguti dyng tim thong tin a dang va nhanh along hon 1.3.3 NguOn thong tin thir ba La cac thong tin dupe xay dung bang each tong hqp cac thong tin tir hai nguOn thOng tin tren Tac gia cua nguOn thong tin thir ba thutng la cac chuyen gia y6 thuOc mot linh vyt nao do; tir cac kien thac chuyen sau linh VkiC h9 se phan tich tong hgp cac thong tin lien quan de dua thong tin mang tinh khai quat ve mot van de Cac thong tin thuOc nguOn thong tin thir ba thutng dupe cong 136 cluti dang sach giao khoa, cac bang hutng clan lieu tri chuan Nguti sir dung phan khai that ngu6n thong tin vi cac thong tin thtrang ngan g9n , sue tich va dO khai quat hiala cao ( da dupe xu 15/ bpi cac chuyen gia) Tuy nhien, nhirgc diem dm nguon th6ng tin tha ba la tinh cap nhat kern, dO tin cay phy thuOc vac) nang lint cua tac gia(vi có the co sai sot kien Hang cua tac gia, sai sot qua trinh chuyen tai thong tin hoac tac gia kh6ng tap h9p dupe day du cac thong tin ban dau co lien quan hay danh gia sai Lech cac th6ng tin ) va ciing nhu su dyng nguon thong tin thir hai, can tim, hieu chinh xac mot thongtin cy the nao (JO, nguti sir dung có the quay lai ngu6n th6ng tin ban dau 2.1Ceu eau eiia thong tin thuoe 2.1 Yeu eau Chung MOt thong tin thu6c phai co clAy du nhung yeu cau sau: - Khach quan - Chinh xac - Trung thyt - Mang tinh khoa h9c - RO rang va dirts khoat 2.2 Y'eu eau ye n01 dung 22 Tru&ng Cao Bang K9 GiOo trinh &ray Ian? sang Thuat Y II Da Nang N6i dung thong tin tint& phai phu hop ,vai doi along duoc thong tin Sau day la yeti cau va not dung cua thong tin thuoc vai mot so doi tuong: 2.2.1 Thong tin thaw cho can bo y to Thong tin thuoc cung cap cho can b6 y,te• phai la cac, thong tin co not dung mang tinh chuyen sau ye thuoc Cac thOng tin co the duoc cung cap dual nhieu hinh thirc nhu cung cap theo yet., cau bo i cac trung tarn thong tin thuOc, thong tin qua h6i thao, bao cao khoa hoc hoac cac thong tin duoc in an sari cac tai lieu tham khao hay dua len rang de can ba y to khai thac theo nhu cau Ve co ban, thOng tin thuOc cho can b6 y to se bao gom cac not dung sau: Cac thong tin chung ye thuoc: Cac each phan loci thuoc(danh muc thuoc thiet yeu, thuOc khong can don(OTC), thu6c phai CO don, ma phan loaf giai phh- dieu tri-h6a h9c (ATC), danh myc cac ten thuoc goc, ten thuong mai, thu6c duoc phdp Itru hanh, so clang Ca the tac dyng cua thuoc: - Dac tinh duoc d6ng h9c: hap thu, phan 1)6 ,chuyen hoa, thai trir - Cac chi dinh ,ch6ng chi dinh - Cach dung, lieu ,luong - Cac phan ang bat loi (ADR) CO the xay - DOc tinh, bleu hien ng6 d6c, xix tri - Thong tac va tuong ky, ciia thuoc( thuoc voi thuoc, thuoc vol thirc an, vai nuac uong) - Thang bac gia ca , 2.2.2 Thong tin thuoc cho bOh nhan • thong tin thuoc cho benh nhan lai can c6 not Khac vai th6ng tin thuoc cho can b6 y te, dung ngan g9n, de hieu vof cac hinh thirc thong tin don gian, co gang tan dyng cac phuong tien cho benh nhan hieu rO lai ich va tac truyen thong san co Myc Bich thong tin, thuoc nham cac huang clan dieu tri, darn bao sir dyng thuoc hop ly va an toan hai thuoc, tuan cac not dung sau: NOi dung thong tin thu& cho benh nhan thuang bao - Ten thuoc(ten goc, ten biet duoc) - Tac dyng - Dal-1g diing , lieu dimg, each dung - Huang an sir dyng cac dung bao the dac biet - Huang clan quan sat , theo dOi cac trieu chimg khac 14 dimg thuoc(nha 1(5/ de theo dOi ti6p nhung Ian diing thu6c sau) - Nhang trieu chirng cua phan Ong khong mong main , each xir tri - Ky nang tyr theo doi tac dyn& thu6c,trong qua trinh dieu tri - Tuong tac thuoc( thu6c- thuoc, thuoc - thuc pham, thuoc- nuot uong) - Cach bac quan luting thu6c da mua, duoc cap 3.1(F nang thong tin thutic throc tien hanh, phan Nhieu cong trinh nghien ciru ye ky nang thong tin thu6c trinh bay mot quy trinh th6ng tin thuoc dua tren quy trinh Host va Kirkwood dua nam 1987 vas den van duoc ap dyng r6ng rai Ve co ban, quy trinh se gam cac buoy sau: BtrOc 1: Xac dinh dac diem cua nguai yeu cau thOng tin RO rang neu along yeu cau th6ng tin khac thi not dung dm th6ng tin tra 161 se khac Vi du: M6t bac sj% chuyen khoa va mot benh nhan co the ding quan tarn den mot thuoc va ding dua mot cau h6i ban dau nhu nhung not dung th6ng tin tra lof lai phais hoan toan khac phu hop vai trinh d6 chuyen mon cua m8i nguai Chinh vi vay ding viec dau tien cua quy trinh 1a phai xac dinh duoc dac diem cua nguai yeu cau thong tin Tby theo tang hoan canh ma co the khai thac cac thong tin Ca nhan khac nhau, nhung bao gi6 cling phai xac dinh cac nguai yeu cau thong tin: th6ng tin thiet yeu sau - Nghe nghiep, trinh d6 chuyen man, cac kien thirc san c6 ye van de yeu cau dupe thong tin 23 Giao trinh dtive lam sang Trirong Cao Hang K9 Thud! Y Te II Da Niing - Ten , tuOi, dia chi, so dien thoai, se) fax, dia chi e-mail cle co the lien he mot each thuan tien nhat Bulk 2: Thu thap cac th6ng tin co ban cc') lien quan tir ngutri yeu cau thong tin Thyc chat, cac thong tin co ban có lien quan chinh la cac thong tin de tra 161 chinh xac cau,_ hoi:" Tai khach hang lai yeu cau tim kiem th6ng tin ,thuoc nay?"Nhu vay, cac thong tin c16 trine tiep hay gian tiepquyet dinh not dung th6ng tin thuoc can tim kiem Tuy nhien neu Tat tryc tiep cau hai nhu tren thi da so khach hang se kh8ng tra 161 duce theo mong muon cua nguOi timtin Vi vay tiep xac vOi ngutri yeu cau thong tin, nhiem vu cua ngutri lam cong tac thong tin thu6c kh8ng chi don thuan ghi nhan cau hOi ban dau cua h9 ma cOn phai khai thac mOtise thong tin lien quan BtrO'c 3: Xac dinh va phan loci yeu cau co ban cua khach hang Ti hinh he thong trung tam th6ng tin thuOc, da co nhieu nghien,ciru duvc ti& hanh nham danh gia hieu qua cua hoat long thong tin Hien thong tin thu6c la mot hinh thav dich vu, nen mot nhiIng tie chi danh gia co ban IA thong tin tra 161 co dap rng dugc yeu cau cua khach hang hay khong? Sau da xac dinh &roc yeu cau co ban cua khach hang, nhiem vu tiep theo la phan loci yeu cast' theo tirng,nhOm not dung nhat dinh Btkrc 4: Tim kiem thong tin Can cir vac not dung chuyen biet cua thong tin tim kiem, ngutri lam cong tac thong tin thuoc se hya chgn nguon thong tin thich hop de tim cac thong tin clap ang yeu cau Bulk 5: Danh gia, phan tich , tong hgp thong tin Trude cung cap thong tin cho khach hang, nguai lam cong tac thong tin thuoc phial danh gia chat hyong th6ng tin vira tim duvc buOc KS% nang danh gia thong tin la mot ICy nang rat kh6, del hOi phai co kien thirc chuyen sau ve, nhieu linh y cluvc hoc Vol sir bung no thong tin, nhu hien nay, có mot van de co the co rat nhieu thong tin co lien quan, vi vay thong tin tim kiem &roc bat buck phai qua phan tich danh gia, sau d6 moi tong hop kien tra 16i dila den khach hang Btrdc 6: Tra of thong tin Thy theo yeu cau cua khach hang ma thong tin se dugc tra 161 dual nhieu hinh thirc:itra 16i tra 16i bang phieu tra 161 tin va cOn theo mieng , tra 161 qua dien thoai, qua thu/thu dien yeu cau cua khach hang de ch9n hinh thirc thich hop Can km y neu gap truang hop c6 nhieu tai lieu mau than thi chi nen dua cho khach hanh cac tai lieu phi hop vai thong tin da dugc phan tich tong hop 0' budc 4.Ktt luan Trong linh vyc ngudi &roc Nhu cau ve, thong tin thuOc mot cap thiet va da sy dOng vai trO rat quan trong, la nguai cung cap thong tin thuoc cho bac s'y, nhan vien y to va ca ngu.61 benh Bang viec sir dung hieu qua cac nguon thong tin thu6c, dugc sy/ se' phai ch9n cho dugc nguOn th6ng tin phi hop va du'a cau tra lai sau da phan tich danh gia De dat duvc myc tieu nay, viec trao doi ca ve chuyen mon va kji nang th6ng tin can dugc hinh that-1h ngOi tren ghe nha trutmg va can lien tuc du'ac doi mai va phat trien _ suot qua trinh hoat dOng chuyen mon sau nay, c6 nhu vay duvc s-y mai dam nhan throe vai trO xa hOi phan cong, la "chuyen gia ve thuoc" 24 Gicio trinh chrar loin sang Trtro•ng Cao Djng K9 Thu at Y Te II Da Njng CAC DU'dNG DU'A THUOC VA CACH SLR DUNG M1TC TIEU: Saar hoc xong bai hoc, sinh vien c6 kha tiling: Phcin tich chrqc uzr, nlyr9c diem cua mOt so cluziwg dim thuoc thong dyng: - Qua &rang lieu hoa: clOt thr6i ltrol, u6ng, 6101 tryr trang - Ngoai chr&ng tieu hoa: tiem 1Wip, tiem trnh mach, tiem duyil da qua clworg ho Htro-ng dan citc9c ccich sfr dung thutic theo nhiing cht&ng dimg net! tren NOT DUNG: DliA THUOC QUA DliONG TIEU HOA DuOng tieu 116a hay can g9i IA ong tieu hoa bao g6m mieng, thuc quan, da day, ru6t non, runt giA, true trang 1.1 DOt diroi lweri Mieng khong phai la nal hap thu thirc an nhung Lai day c6 mot mang krol mao mach kha phong pito, dac biet IA ben ma va (tat dudi rat thuan lien cho viec hap thu thu6c Day IA mot dtrOng dua thu6c thuan Igi, de thuc hien, lai an toan vi neu co hien tugng qua lieu thi lap tire c6 the loci trir thu6c Vien dat dual luti (sublingual tablet) dugc dung vdi muc dich gay tac dung toan than, dugc chat dugc hap thu nhanh va chuyen thong ve tim khong qua d4i tun hoan dO thuoc phat huy tac dung nhanh va tranh duvc tac d6ng phia dual &rang tieu h6a, tranh dugc su pha huy cua men chuyen hoa thu6c gan De dat dual vien phai mong ( tranh gay Om), giai phOng dugc chat nhanh (ra vOng — philt ) Dang dat duoi luti thu.Ong ap dung cho nhom thuoc tim mach va hormone Nhugc diem cua &rang dua thu6c IA Tat thu6c thuOng gay phan xatit mac b9t kern theo phan xa nu6t, lam cho mot luvng thu6c bi mat di trai xu6ng da day va ru6t; vi \fay dung vien ngam phai han the phan xa nu6t DtrOng dua thu6c chi dUng voi nhung thu6c kh6ng gay loet niem mac mieng, de clang hap thu tai day va dimg vai lieu nh6 Cac clang bao the theo throng thuOng dat MO/ so thuoc (lira chrai hr51: Cac glycerin gian mach vanh dOng chtrng dau that nguc nhu nitroglycerin (glycerin trinitrat, vien nen 0,5mg ), isosorbit dinitrat (vien nen 5mg, 10mg, 20mg), nifedipin (adalat clang nang 10mg) M6t s6 thu6c b6 (nhusita ong chia), mot se) hormone sinh duc (estrogen, progesteron) 1.2 D(it trye trang Truc trang (con g9i IA runt thong) IA clop cu6i cung cua ong tieu h6a, thong ngoai He' th6ng tinh mach true trang kha phong phu IA dieu kien thuan Igi cho viec hap thu thu6c Thu6c dua vao true trang CO o clang vien dan Thu6c dan giai phOng dugc chat nhanh, sau [lea tan dugc hap thu vac) tinh mach truc trang di ve tinh mach chil, phan Idn (50 — 70%) thu6c khong thong qua tinh mach cua gan sau hAp thu nen tranh duct sty phan hity tai gan, ngoai can tranh dugc sir tac (16ng cua dich vi va he men cua &Ong tieu 116a so vOi dung duai clang &mg 25 Gicio trinh chivy leim sang Tru•Ong Cao Hang Ky Thuat Y Te II Do Nang Thuic dan rat thich hgp cho ngtrai kho uong thuic (sit cao, tre nhO ), hoac khong uong clugc (tac runt, non nhieu, lion me); thuan tien vii nhang thuic c6 mui vi khO chin de gay ban non, non, nhang chat kich ang dugng tieu hOa manh (cloral hydrat) Tuy nhien, nhugc diem cua thuic dan IA sinh kha dyng that than-1g vi qua trinh hap thu phy thu6c nhieu y6u to nhu ban chat cila dugc chat va ta dugc, kj% thuat bao che, sinh 1)% truc trang thai gian bi benh Dang bao che thlrang IA vien clan de chay nhi'et d6 cao nen kh6 bao quan, dee bret o hau n6ng nhu nugc ta dieu kien kh6ng c6 ta lanh Gia dat Mot so thuejc thtrowg dat truy trang: - Thu6c 114 sit: paracetamon - Thu& ching co giet, an thin: diazepam, clorahydrat Nang along thuoc dat khac: - Thu& trimg dugc clang de dat am dao, cho yeti de dieu tri cac trieu chirng viem nhiZm tai chi!), dieu tri nam hoac cam mau - Ngoai thuic trang ra, de dat vao am dao c6 dang vien nen va nang mem - Trong phy khoa, nguai ta can che clang thuic ching thy thai giai phOng dugc chat lien tyc nem dual clang dyng cu dat tir cung 1.3 , Diriing wing Thu6c uong IA clang thuoc dang qua &rang tieu hOa Hau het cac thuOc deu c6 the dua qua &rang nit nhang trugng hgp hog chat kh6ng hap thy runt, bi phan hay bai men tieu hOa hoac bi pha hay qua nhieu qua gan vOng tuan hoan dal.] Duang uong CO rn6t so dec diem chung sau day: Uu ciri'm: La dugng clang thuic don gran, thuan tien nhat, nguai benh c6 the ty• dung thuOc; an toan hon so vii clugng tiern; clang bao cite san c6 va thuOng IA re hon cac clang thuic khac ® Nhzroc - Thuic dang qua duang uong chiu mot so tac Ting bat Lai sinh kha dyng nhu: + Phai trai qua mot bac thang pH thay dii qua nhieu (tor khoang pH la O da day cho den pH IA o dai trang), nhieu dugc chat chi ben hay chi dugc hap thu o mot khoang pH nhat dinh + 13i tac ding dm he men, he vi khuan dung tieu hoa + 13i chuyen hOa qua gan Ian clau + Bi chuyen hOa bai thirc an -KhO kiem soat dugc thai gian van chuyen cua clang thuic dugng tieu hem, thai gian xuat hien tac dyng caa thuic Wing cham han so vii cac duang dua thuic khac Do vay, lua chin dang thuic clang de uong, vien nen dugc dung phi bier] nhat nhung lai IA clang uong c6 sinh kha dyng dao d6ng nhat Vi vay, de dam bao ph& huy dtrov ddy du tac dyng cua cac clang thuoc nang, can intang dOnngtedri Xing twin the' dung che.' de) dung thuoc nhte sau: - Neu dung dang vien, ca clang vien nen Ian vien nang, lugng nuac dua thuic deu phai nhieu (mOt c6c msoc to khoang 150 — 200 ml) - Vol tre em va ngubi cao tuii, nen dung vien pha dung dich, hon dich, vien sui bit de tranh nghen, sec, hoac dinh thuc quan MOt se; clang thuoc uong: Pho bien nhat IA clang vien: vien nen hoac vien nang Thuic clang long (siro, potio) hoac cac loci c6m pha dang 'Ong sir dyng: day IA dang thich hap nhat cho tre nho va nguwoif gia vi 26 ... co the the gia thu6c qua cao so vai dieu kien kinh te That bai dieu tri cting co the phac di khOng phu hgp.do benh tien trien nang them (vai nguai cao tuoi, tuoi tac met cao nen nhieu benh mac... co chi so lipid/nudc cao nen than dirdc vao to bao than kinh Tac dyng gay me cang mph chi so cang cao Cling vi m6i lien quan nen luvng Gicio trinh dirge lcim sang Trtrong Cao Dang Ky Thuat Y Te... dugc KhOng CO Phu thuac lieu sCr dung Thap Cao Ty suAt benh Cao Thap Ty le W vong NgUng thuOc Dieu chinh lieu Dieu tri 19 Giao trinh cheav lam sang Trirong Cao Hang Kf Thuat Y Te II Da Nang Phan