Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 bai giang gay me hoi suc i file 4 het

Loai hypnomidat 125 mg/ml Pha dung dich muoi hoac glucose Q~ng trucng, slt dung troi!'Jlig cac phau thuat trung binh hoac dai Lieu luong khci me 0,25-0,4 mg/kg - Voi phau thuat khoang gic: Lieu nap 0,1 mg/kg 10 phut - Lieu tri 0,01 rng/kg/phut Voi phau thuat tren gio: Slt dung nhu phau thuat khoang gid Sau gid tri lieu 0,005 mg/kg/phut Chit y: Giarn lieu voi benh nhan co suy gan, tu6i cao va cac benh nhan kha nang giam luu luong tim VI TVdNG TAc THUOC - Voi cac thuoc ire che than kinh: gay cham tinh Morphin: ire che h6 hap keo dai Slt dung voi etomidat Tac Q9ng qua laivdi chuyen hoa corticoid Lam ngung tre san xuat cortisol va aldosteron VII DUNG THUOC QuA LIEU Gay suy ho hap: h6 tro h6 hap Kh6ng co thuoc doi khang 516 30 THUOC GIAN co Phan Dinh , ~ Ky ? I TOM TAT L!CH SLf Tu lau nguoi Indien d Nam My dung mot loai thuoc a9c t§:m VaGmui ten d§ san ban thu vat Day la mot phuc hop H{ytil hai loai cay: Cay chondrodendron tomentosum thuoc ho tiet de (Menispcrrnaceae) Cay Strychnos thuoc ho rna tien (Loganiacea) Narn 1745 La Condamine dua vao Phap va narn 1774 nghien cuu ve mat sinh 15' dau tien duoc tien hanh tai Leyden (Ha Lan) Narn 1825 Charles Waterton, Brodie, Martius nghisn cuu va thay chat c6 tac dung gay liet th~n kinh co Narn 1851 Claude Bernard nghien cuu trer; ech va co ket luan quan "Curare gay doc d chi) lien ket than kinh co rna kh6ng gay doc cho than kinh va co" 1869 Crum Brown va Fraser tien hanh t6ng hop chat gian co, truce a6 Rabuteau aa khang dinh cac muoi amonium bac deu co tinh gian co 1886 - 1887 Boehm chiet xuat til cay Chondrodrndron tomentosum alcaloide kiem b$.c ba (ternaire) ket tinh, kh6ng c6 hoC?-ttinh la: ClsH19N03: curin C2oH23N03: protucurin C19H21 N03: protocuridin duoc va m9t base b$.c (quaternaire) rat hoC?-td9ng: C19H21N04:tubocurarin va til r~ lOQ-i cay Scholtz phan l$.p au'Qcch[(t bebeerinla chat c16ngphan cua curin 1935 King phan l$.p auc;lc dextro tubo curarin, m9t base b$.c c6 chua amonium b$.c ket tinh va rat hoC?-td9ng 1938 Mac Intyre, Gill va King chiet xuat dttc;lCintocostrin tinh khiet ket tinh 1940 Bennett b~t d~u dung VaG ml.lc aich dieu tri ad phong cac chan thttOng co gi$.t gay 1942 Griffith va Johnson dung curare gay me 1943 Wintersteiner va Dutcher chiet xuat til C tomentosum d-tubocurarin (giong King) auc;lc: 517 alcalcid hac d6ng phan c6 c6ng thuc C36H3s06N2 va alcaloid d6ng phan trai (levogyre) va chirng minh ding: mot m at c6 th6 chuyen cac alcaloid cua curare tu l.u~,C.'''''' c6 N hoa tri kh6ng heat dong N c6 hoa tri c6 heat tinh gian ' mat khac c6 th& tang tinh gian co cua d tubocurarine bang each methyl U'"""~It "" gac OH tu d cuci Na m 1947 Bovct rna ta chat gallamine (flaxedil) Ngoai ra: Tu cay Strychnos Wieland, Schmid va Kerrer chiet xuat duoc c c6 tac dung giorig tubocurarin Narn 1887 Dominguez va Altamirano thay hat cay (Erythrina) thuoc ho papilionceae (canh buorn) d chau Uc va Phi, sau Folkers phan l$.p dVQCchat ~ Erythroidin mot alc2!!iJl~.:ln bac cung c6 tinh liQt co r6 nhung thoi gian tac dung ngan Quinin va cac d§.n chat cua n6 cung c6 tinh liet co nhung duoc dung lam sang rat it L, , Trong qua trinh nghien cuu t6ng h bdi hang chvc ngan Na(sodium), calci va ion K(poL-lssium) Thl,l th§ d6ng th(ji cung la b9 p ng~t mq.ch, kh6ng c6 acetylcholin thi kenh d6ng va luang di@nbi c~t kenh la st,t ki$n co ban quan ni~m ve chuy§n v?n th~n kinh co nh dn chu y la n6 dien bien phl,l thuQc VaGnhieu yeu to Con doi v6i cac chat gian co khv cvc nhlt succynilcholin, deca nium ~6 tac elVng giong nhv acetylcholin, g~n vao thV th~ choli cung lam cho mang te bao co khv cvc gay co co, nhung vi cac chat d6ng dvng (agonists) kh6ng bi acetylcholinesterase pha huy nen gay tugay tac dvng k:9"(biphasic) d~u co co sau d6 giai1 co 520 '~- t ~" Acetylcholin nhanh chong bi pha huy bdi acetylcholinesterase nen kenh chi m6 thoi gian ngan (lmilliseconde), mang te bao co tr6 ve trang thai nghi (tai cue) mot thoi gian dai truoc co mot kich thich mdi tiep den Cac chat d6ng tac dung (succynilcholine, decamethonium) khorig bi thai tru tai khe tiep hop cua ban cuoi van dorig rna chi thai tru VaG huyet tucng nen hieu qua khv cue keo dai, hien tuong khu cue cua tam van dQng cac chat gay hie d~u du Ion d~ dat den ngudng kich thich co co 1111ung co S8 nhanh chong thich nghi voi tinh trang khu cue keo dai cua tam van dQng va ngirng bi kich thich d§.n den ky I(prosJ'I blockade) l~' ~; ii"~ ".' ( ~: + l a Ta biet r~ng tr0.ng thai ngh!, di~n the mang te bao tu -70 den -90 mV ~' dUQe tri co mQt ty l~ Na+/K+ va ho0.t dQng bom ATP (adenosine it, triphosphatase pump) Di$n the ngh! - 90 mV la h$ qua gay bO'idC)th~m ~: thau qua mang te bao clla K+ lOn hon Na+, vi the K+ te bao gap 50 llin ~: K+ 0' ngoai va Na+ ngoai tebao lOn hon Na+ tebao 30 l~n ~i Hi$n tUQng khv cvc khO'i dliu lu6ng Na+ di VaGte bao neu kh6ng co gi ~i ngan can thi di$n the mang tu -90 mV co th§ d0.t toi + 50 mV, nhung ~~,cti~n the mang d0.t Wi mV thi K+ b~t dliu di ngoai te bao va h0.n che muc ~:!' di$n the ij + 10 mY Sau khv Cl,tc nh6 bom ATP ma muc chenh ion Na+/K+ ',7 h6i phvc l?i nh'lt truoc va chCidQi mQt kich thich moi ThCii gian , di$n the mang dang h6i phl,lCdUQcxem nh'li thCiiky tro vi khong th§ khv cVe ; dUQc.MQt ho0.t dQng di$n the tv n6 Ian truyen h0 thap di$n the mang ke ben khoang 15mV dll d§ m& kenh Na+ va mang S8 khv cVc, day dUQCcoi la ~:-mQt hi$n tUQng "tat cD ho~c khong" vi d0.t den ngudng thi qua trinh ~ 58 dien bien tiep tvc chu LtGnkhi mEmg khv cvc hOEm toano Khi khv cVc IDEmgco, Na+ cti VaGva khiji d&u cho Ca dUQcgiai phong khoi th§ luai bao Wong va Ca S8 ho0.t hoa co che actin - myosin sQi co di den co co ~ Kenh Na+ cd ho~t d9ng theo ba ky Hol?t dQng thong qua dQ chenh di~n the I f I f: !l0l, • ~~ t[ Ngung f.~ ~ '", ~ ~, rJ_,r ho?t d9ng cac dien bien ben van dC)chenh di$n the Hbi phvc di~n the ngh! hic khong dC)che'nh lQch di~n the Kenh nAy phi1i trai qua ctll b'ltac truoc b~t dau chu kY tiep theo ~, Neu sv dVng 10l?i gian co khli cVc thi hic tam v~n dQng khv ~; clic, co se uuy tri (5 buck ~ dan de'n buoc h8i phvc di$n the nghl va co S8 d ~ tq.ng thai phong be I (phase I blockade) Dieu dan den xu huang cho ~"'rl-mgco che thCii ky phong be I qua kenh Na+ co Kenh Na+ dUQc ~,ughi la c6 hai cVa khac MQt k8nh phv thuQc di¢n the, kenh ~,phV thuQc thCii gian Trong tinh tr0.ng ngh! cva phV thuQc thCii gian mO',tuy r.>?y ion khong di qua Khi khli cVe, clta phV thuQc di~n the mO'va hic d6 vi ("ita phV thu9c'thdi gian m6 n6n Na+ di vaG te bao co Thdi gian rat ngl'in t ~+ tt ~ r ~, !J ~;~ 521 dien the' m6 thi cua phu thuoc thci gian dong ngung luong di chuyen ion Cua phu thuoc dien the se md chung nao acetylcholin hoac chat gian co khir cue kich thich tr en thu sau cua phu thuoc cholinergic Thong thucng acetylcholin nhanh chong bi thuy phan va phu thuoc dien the se d6ng cho phep cva phu thuoc thai gian mCiva ' phuc tinh trang kerih binh thuorig Nhung ne'u cua phu thuoc di¢n the tri tinh trarig md thi cua phu thuoc thoi gian tri tirih trang va ion Na ' kh6ng qua kenh, Duy tri tinh trang khv cuc lau dai d§.n den trinh diroc coi nhu mot su thich nghi, tinh trang gian co xay phat phong be cua phV thuQC thai gian clla Na+ Giam man cam Khi acetylcholin hoI:J.cmQt chat c16ngtac dvng khac tac dQng len tam dQng vdi thai gian keo dai thi mang clla tam v~n dQng khong tri gay khv cvc nhu ban diiu Cac dap ling giam va d(;l.tt6i tinh tr(;l.ng vung giin nhu tinh tr(;l.ngnghl MI:J.cd~u di¢n the' m~mg da h6i ph1,lc den muc thuang nhung sv v~n chuy~n th~n kinh cd bt phong be suot thCii chat d6ng tac dVng t6n t(;l.i.Day la S\i giam dap ung v6i kich thich th~ mat m§.n cam 311 hien dien clla cac thu th~ mat m§.n cam lam cuang dQ v~n chuy~n th~l~ kinl~ cCi.Nhu v~y,' h¢ thong Cd se de bt ph hCinb6i cac chat nguc;c tac dVng (antagonist) nhu d - tubocurarine, chat tac dVng mQt 111inhgay nen tinh tr"mg mat m§.n cam Chat nguqc tac g~n ch?t thv th~ lilaC rn£l.ncam va giu phan tv tinh tri;l.ng chat dU Theo th(ji gian tic dVng: :~n~~hi) clIe Cvc ng~n Ngil.n + + J~;" I ~ t ~j,'.~ 11 t + Trung binh + Dai Theo cau truc hoa h9c + Steroidal + Benzylisoquinolin + Choline ester Non cholin ester -I- DUdc Iuc iv hoc D~