Sách được biên soạn trong dự án “Nâng cao chất lượng đào tạo dược sĩ tại Việt Nam” do Hà Lan tài trợ. Nội dung sách cung cấp cho sinh viên Y, Dược những nguyên lý và các thông tin cơ bản trong dược lâm sàng và trong sử dụng thuốc điều trị các bệnh thường gặp tại Việt Nam. Dược lâm sàng hiện nay là một trong những vấn đề ưu tiên tại các bệnh viện.
TRUONG DAI HOC DUOC HA NQI DAI HQC GRONINGEN, HA LAN universityof groningen DlT AN NPT-VNM-240 DLPaC LAM SANG • NHtTNG NGUYEN LY CO BAN VA SU* DUNG THUOC TRONG DIEU TRI TAP I CAC NGUYEN LY CO BAN TRONG DlTOC LAM SANG (Ta"i b£n Ian this nhat) Chu bien: GS TS Hoang Thj Kim Huyen GS TS J.R.B.J Brouwers NHA XUAT BAN Y HQC HA NQI - 2014 £r, •'•.» "" *'r >• »•: ' •^.j sjr $ •/• • ;*/: ;Jl: V ' sft ?'3 :;> fi :vavjJh • '-/?' CHU BIEN: GS TS Hoang Thj Kim Huyen GS TS J.R.B.J Brouwcrs M: Hi THAM GIA BIEN SOAN: Cac tac gia Viet Nam TS Nguyen Hoang Anh Truang Da hoc Dugc Ha Ngi PGS TS Nguyen Thanh Binh Trirong Da hgc Dugc Ha Ngi TS Nguyen Tuan Dung Truang Da hgc Y Dugc TP Ho Chi Minh ThS Nguyen Thuy Duong Truong Da hgc Dugc Ha Noi TS Duong Xuan Chir Truong Da hgc Y Dirge Can Tho ThS Nguyen Thu Hang Truong Da PGS TS Nguyen Dang Hoa Truong Da hgc Dirge Ha Ngi TS Vu Dinh Hoa Truong Da hgc Dugc Ha Ngi GS TS Hoang Thi Kim Huyen Truong Da hgc Dugc Ha Ngi ThS Duong Thj Ly Huong Truong Da hgc Dugc Ha Ngi TS Nguyen Thi Lien Huong Truang Da hgc Dugc Ha Ngi ThS Le Kim Khanh Trirong Da hgc Y Dugc Can Tho PGS TS Nguyen Ngoc Khoi Trirong Da hgc Y Dugc TP Ho Chi Minh TS Phan Quynh Lan Trirong Da TS Nguyen Thj Lap Truong Da hgc Dugc Ha Ngi GS TS V6 Xuan Minh Truang Da hgc Dugc Ha Ngi hoc Du'oc Ha Noi Jl S •:•' • hoc Duoc Ha Noi ' PGS TS Nguyen Hai Nam Truang Da hgc Dugc Ha Noi TS Vo Thanh Plurong Nha Truong Da hgc Y Dugc TP Ho Chi Minh ThS Do Thj Nguyet Que Truang Da hgc Dugc Ha Ngi ThS Pham Thi Thuy Van Truong Da hgc Dugc Ha Ngi TS Dao Thi Vui Truang Da hgc Dugc Ha Ngi TS Tran Van Tuan Truong Da hgc Y Dugc Thai Nguyen PGS TS Nguyen Manh Tuyen Truong Da hoc Duoc Ha Noi -A AC Hi,'T f-i^i Cac tac gia Ha Lan GS TS J.R.B.J Brouvvers Centre of Pharmacy, University of Groningen, the Netherlands GS TS M.J.Postma Centre of Pharmacy, University of Groningen, the Netherlands GS TS C de Vries GS TS.H.W Frijlink University of Bath, United Kingdom Centre of Pharmacy, University of Groningen, the Netherlands GS TS L.T.W de Jong van den Berg Centre of Pharmacy, University of Groningen, the Netherlands GS TS.JJ.de Gier Centre of Pharmacy, University of Groningen, the Netherlands GS.TS Kees van Grootheest Centre of Pharmacy, University of Groningen, the Netherlands TS Frank Jansman Deventer Ziekenhuizen, the Netherlands GS TS A.J.M Loonen Centre of Pharmacy, University of Groningen, the Netherlands TS E.N van Roon Medisch Centrum Leeuwarden, the Netherlands K Taxis Centre of Pharmacy, University of Groningen, the Netherlands TS Herman J Woerdenbag Centre of Pharmacy, University of Groningen, the Netherlands GS TS B Wilffert Centre of Pharmacy, University of Groningen, the Netherlands GS TS J Zaagsma Centre of Pharmacy, University of Groningen, the Netherlands BAN THI/ KY: PGS TS Nguyen Hai Nam ThS Vu Thuy Duong BIEN TAP BAN THAO PGS TS Nguyen Hai Nam LOI GIC» THIEU Du an "Nang cao chat lugng dao tao dugc sy lam sang tai Viet Nam de dap ung yeu cau cap thiet ve su dung thuoc an toan, hop ly, hieu qua cua cong dong" (NPTVNM-240), tai trg boi Chinh phu Ha Lan thong qua Chuong trinh tang cuang nang lire the che cho giao due va dao tao sau thong (NUFFIC), da dugc thuc hien nam (2007-2011) vai sir tham gia cua truang dai hoc y dugc ca nuac g6m truang Dai hgc Dugc Ha Ngi, truang Dai hoc Y Duoc Ho Chi Minh, truang Dai hgc Y Dugc Thai Nguyen, truang Dai hgc Y Thai Binh, truang Dai hgc Y Dugc Hue va truang Dai hgc Y, Dugc Can Tha Du an da dat dugc cac muc tieu quan trgng nhu i) xay dung dugc chuong trinh dao tao ve dugc lam sang dap ung cac ve su dung thuoc an toan, hieu qua, tiet kiem, gop phan tang cuang chat lugng phuc vu y te a Viet Nam; ii) bien soan cac tai lieu ve phuong phap giang day va giao trinh ve dugc lam sang va cac noi dung lien quan; iii) phat trien ky nang va phuong phap giang day cho dugc si lam sang; iv) xay dung dugc ca so du lieu true tuyen ve thuoc Cuon sach "Duac lam sang: Nhung nguyen ly ca ban va su dung thuoc rfiiu tri" GS TS Hoang Thi Kim Huyen va GS TS J.R.B.J Brouwers chu bien dugc bien soan khuon kho hoat dong cua du an nh4m cung cap cho giang vien, sinh vien giang day hgc tap lTnh vuc y - duoc nhung nguyen ly va thong tin ca ban nhat dugc lam sang va sir dung thuoc dieu tri cac benh thuang gap tai Viet Nam Ban Quan ly du an xin chanh cam an Chinh phu Ha Lan da ho trg kinh phi cho viec bien soan cuon sach; xin tran trgng cam on lanh dao Bo Y te da quan tarn tao dieu kien thuan lgi cho qua trinh to chuc bien soan va tham dinh cuon sach Dae biet, Ban Quan ly du an xin cam an GS TS Hoang Thi Kim Huyen va GS TS J.R.B.J Brouwers da danh nhieu cong sue to chuc bien soan cuon sach; xin cam on sir dong gop quy bau cua tap the cac tac gia da danh nhieu thai gian tham gia bien soan cuon sach T.M BAN QUAN LY DlT AN NPT -VNM -240 Giam doc PGS TS Le Viet Hung ' 6ri ;.' ;,.;u ^'r'.yjMi ) A, U ,,,-V.f u\ ^\./\ >AT 9;\uoY\ Tranj Loi gioi thieu Loi noi dau Mot so tu viet tat Chuong 11 Dugc dong hgc lam sang 13 Hoang Thi Kim Huyin, B Wilffert Chu'0'ng2 Dang thuoc va duong dung 37 Vo Xuan Minh, H.J Woerdenbag, H W Frijlink Chirong Phuong phap thiet ke thu nghiem lam sang 68 Nguyen Hoang Anh, K Taxis Chuong Ung dung y hgc dua tren bang chung thuc hanh su dung 87 thuoc Nguyen Hoang Anh, Nguyin Dang Hoa, J.R.B.J Brouwers Chuo'ng Phan ung co hai cua thuoc va canh giac dugc 112 Pham Thi Thuy Van, Kees van Grootheest Chuong Tuong tac thuoc 137 Nguyen Tuan Dung, E.N van Roon Chinmg Tuong ky, tuong hgp va on dinh cua thuoc 161 Nguyen Tuan Dung, J.R.B.J Brouwers Chuong Dich te dugc hgc ' 187 Nguyen Thanh Blnh, C de Vries Chuong Kinh te dugc 211 Nguyen Thanh Blnh, Maarten J Postma Chuong 10 Sir dung thuoc cho cac d6i tugng dac biet Phan Quynh Lan, C de Vries, J.R.B.J Brouwers, K Taxis, L T W de Jong van den Berg 230 Chuong 11 Hoa sinh lam sang thuc hanh dugc lam sang 259 Nguyin Thi Lap, J.R.B.J Brouwers Chuong 12 287 Cham soc dugc Hoang Thi Kim Huyin, J.J de Gier ;\>\ • ,'U> :*'.''• V:'.->U ' \ • it; Tin; A J: wt •.;»•'•>' .i- V-Tt)'U.'; •_:,: .•-> JilV;,, ' [/•''' ,T./M Cii '•»,u iv -,^s: "• ,>\": \ :*' 'fiVUii'} ••i,y ijii.b^> '>'/ vr.rjn '* !.!llii't(' •:>;••'!> ;ff •!> i i ,'•.i>i \ '••'')lit.: O'O MM: i oiio ;;6urfJ ;jr «/b irc5 'A ' > ?UiA 'ASV'/VSV') ,- • < 10 "! f.T :{roi,'il ) Thdng tin benh bdi lua Tuoi khoe tuoi Idp tuoi tuoi Vi benh Gidi hay thai dudng Cd thai Dang nudi b^ng sua me gap dudng, tang huyet ap sue khoe va can phai dieu trj cam sau sinh va can phai dieu tri dung cho phu nu cho bii cd the qua he than kinh trung uang, gay buon nau hoac gay ao giac tu dd lam giam tap trung edng viec Dieu can 294 - Ty l$ mac benh tai dja phuang tai thdi diem BN nhap vidn - Dieu tri khdng dung thuoc Nguyen tic dieu tri - Dieu trj bang thuoc: Can nhac muc dich can dat dugc dung thuoc: Kha nang chua khdi? Giam trieu chung? - Giai quyet dau hieu, trieu chung va cac bat thudng tren chi so xet nghiem Muc dich dieu tri - Cai thidn: thuoc *Cholesterol toan phin: < 200mg/dL nhan bao gdm: tang huyet ap, hut thuoc ia, tien su gia nhat bat luang LDL-C dieu trj, qua trinh thang den dudng bien lien vet the dan nhieu, an dai thao 296 tri 297 ••"•' Hen phe quan Mdc 60 FEVi hoac PEF > 80-85% Muc 6q f'MPJi fi-'u'- FEVt hoac PEF > 80% Muc dQ dugc them vao de kiem soat lau dai, su cai thien the hien vdng 1-2 tuan vdi hieu qua toi da vdng 4-8 tuan - Khi benh nang len phai dieu tri ndi tru, can tdi 3-7 de chuc nang phoi trd trinh dieu trj benh nhan can dugc hudng dan sat ket qua dieu trj cho BN Nhirng dieu *• 298 ^ •S Thudc dung khdng cd chi djnh: khdng phu hgp vdi chan doan, khdng cd benh an nhdm 299 Phat sinh benh mdi dang dieu tri Can thiet phai diing thuoc de du phdng nhim lam giam nguy ca de tang Neu tao lap dugc mdi quan he tdt thi DSLS se cd the phat hien cac nguyen nhan khdng dai dieu trj ) Mudn lam nghT, lo ngudi dugc tu van, ciia cao nhat biet hay gap khd khan giai thich ve benh va each dieu trj vi gap phai nhieu la chi DSLS ndi Ludn quan sat ngudi dugc tu van va tiep nhan phan hdi ve cac thdng tin dua Khdng nen chi neu lien quan den tien trinh dieu trj Khi 300 Ure 10,6 mmol/L (Binh thudng: 3-8 mmol/L) Creatinin 67 jamol/L (Binh thudng: < 90 umol/L) Glucose mau liic ddi 18 mmol/L (Binh thudng: - mmol/L) A - Nhdn dinh ciia DSLS: - Khdng kiem soat dugc dudng huyet -> Phai tim nguyen nhan! (tuan thu dieu trj?, lieu khdng dii benh nang them theo tudi tac? stress ) - Ure tang nhung creatinin lai binh thudng! -> cd the mat nude DTD?, mat la thang ndng, dae biet phan thudng bdsung kali dung NSAID; trudc nhung phai theo ve benh DTD Hudng dan BN each kiem tra 302 - Theo ddi Ca 3.2 Mgt ngudi Day la tinh khdng de y va ban each su dung S - Thu thdp thdng tin tiengudi duac tu van: - Mua thudc - Ngudi bj benh la tre em hay ngudi ldn Neu la tre em thi tuoi bao nhieu? - Da mua - Cdc thdng tin ve tinh trgng benh va dieu trj tai nha, vi vay thdng tin Day la trudng hgp mua BN chi cd dugc nhd phdng van De cd dugc thdng tin chinh xac, DSLS can cd kien thuc ve benh Vdi cac nude cd nganh dugc lam sang phat trien, DSLS dugc coi la ngudi chan doan benh dau tien vdi cac benh thdng thudng (cam, ciim, tao bdn, ia chay ) Bj ia chay lau chua? - Phan (mau, mui)? - Moi di ngoai may lan? Benh nhan tinh tao hay met mdi? Tinh trang tieu tien? - Cd sot? ndn? A - Nhdn dinh cua DSLS: P - Lap ke hogch CSD cho BN: cho uong (so trang benh xau di can KET ngu cong nhan (BN) la rat can thiet Nhung mong muon cua BN nhu cau ve thudc tat ca ddi hoan vdi benh van de chii va phdng can cu vao danh gia hop tac chat che nhiem vu 303 hieu qua tdt nhat *.»v % B II diing E I, II va III dung C Ill diing Xay dung mdt ke hoach dieu trj he thdng va lien tuc ve thudc cho benh nhan: thudng xet III Sir trd ve binh thudng ciia cac chi so xet nghiem can lam sang ddc tinh 305 Pharmaceutical NHA XUAT BAN Y HOC DTjdC LAM SANG NHUNG NGUYEN LY CU BAN VA SUf DUNG THUOC TRONG DIEU TRI TAP 1: CAC NGUYEN L? CO BAN TRONG Dl/OC LAM SANG Chiu trach nhiem xuat ban ô> TONG GIAM DOC CHU HUNG Cl/ONG Bien tap vien: BS DANG CAM THUY SCfa ban in: DANG CAM THUY Trinh bay bia: Kt vi tinh: NGUYET THU TRAN THANH TO In 1.000 cuon, kho 19 x 27 cm tai Cong ty in Y hpc So dang ky ke hoach xuat ban: 1760 - 2014/CXB/6 - 123/YH So' xuat ban: 317/QD-YH 17/9/2014 In xong va nop lull chieu quy III nam 2014 ... (mg/h hoac mg.ph "1) )inf la toe truyen thuoc vao tTnh mach (mg.h'hoac mg.ph "1) CI: thai cua thuoc (L.h"1 hoac mL.ph "1) Css: nong thuoc d trang thai can blng (mg.L"1 hoac mg.mL "1) 1.4 Thai gian... dugc cho sin cac tai lieu chuyen khao Tu CI da biet va Cp, ta cd dugc Oe|: Dei (mg.h "1) = CI (L.h "1) x Cp (mg.L "1) CI la trj so hang djnh vdi moi thuoc kha nang bai xuat chua bj bao hoa Nhu vay... 19 Cltoan phan ^uhan • ^Igan ' ^1 ~ Clth$n rV Clgan Dan vi cua CI thudng la mL/ph (L.ph "1) ho§c L/h (L.h "1) Neu cac tai lieu ghi mL.ph"1.kg"1 hay L.ph"1.kg"1 thi tinh CI cho benh nhan, ta phai