- D~n xuat benzamid: sulpirid, remoxiprid.
THUOC CHONG TRAM CAM
1.D~ CU'dNG
1.1.Khai niem v~ tr§.m cam va thuoc chong tr§.m cam
_ Tram cam la mQt trang thai tam than benh ly, bi~u hien qua trinh uc che toan bQhoat dQngtam than. Ba r6i loan coban cua tram cam la giam khi sac, giam hoat dQngva giam hung thu, Cac trieu chtmg tram cam g6m: met moi, chan an, mat ngu, giam t~p trung chu y, giam tl;i tin, budn chan, that vong, y tudng tQi15i,bi quan v~ tuong lai, co y tudng hay hanh vitl,t sat ... _ Thu6c chong trim cam lam mat cac tinh trang u sau, buon chan, that
vong... l~p lai can bang v~ tam than.
1.2.Co che tac dung- ph an loai thuoc chong tr§.m cam
Dua theo co che tac dung, chia thuoc chong tram cam thanh 4 nhom (bang 3.9). Bang 3.9. Phan loai thuoc chong tram cam theo co che tac dl,lng
Nh6m thuoe Coehe tae dl,mg Cae thuoe
LJcche monoamin oxydase IMAO khOng ch9n 19C Phenelzin, isocarboxazid,
(IMAO) tranylcypromin
IMAO ch9n 19C Moclobemid, toloxaton
Chong tnlm cam ba vong LJcche thu hoi noradrenalin va Amitriptylin, imipramin, serotonin nortriptylin, trimipramin,
desipramin ...
Uc che Ch9n 19Cthu hoi LJcche ch9n 19Cthu hoi Fluoxetin, fluvoxamin,
serotonin serotonin paroxetin va sertralin.
Cac thuoc khac Tac dl,mg theo cac Cd che khac Amoxapin, maprotilin,
nhau nonifensin, trazodon,
mianserin, ifrindol, bupropion, nefazodon ...
2. THUDCtic CUE MONOAMIN OXYDASE (IMAO)
2.1.IMAO khong ch(;m19C
Dztf/c d(jng hlJc
Cac thu6c d~u hap thu t6t qua dudng tieu hoa, nhung tac d\lng ch6ng trAm cam ding chi co sau 1- 2 tuAn dung thu6c. Chuy~n hoa d gan t~o chat chuy~n hoa con ho~t tinh. Thai tru chu yeu qua nuoc ti~u.
Ttic dung va cache'
Enzym MAO co nhieu trong ty th~ d nao (MAOJ va d cac me nhu gan, ruot, ph6i, mach mau ... (MAOB). MAO Ia enzym quan trong tham gia vao chuyen hoa va lam mit hoat tinh cua cac chit trung gian hoa hoc co ban chit la cac monoamin nhu: noradrenalin, serotonin, dopamin.
Thuoc lMAO khong chon loc co tac dung uc che ca MAOA va MAOB lam tang cac chit trung gian h6a hoc d ca trung uong va ngoai vi. Vi vay, gay nhieu tac dung khong mong muon.
- Tren tam than: thuoc c6 tac dung chdng tram cam. Khac vdi thuoc chong tram cam ba yang, IMAO khong chon lQCgay tang van dQng va gay sang khoai dnguoi binh thuong.
- Cac tac dung khac (khong dU<;1Cap dung trong dieu 'tri):
+Gian mach, ha huyet ap.
+Giam sa dung oxy, chong con dau thl1t nguc.
Chi dinh.
Cactrang thai trllm cam.
Tac d¥ng khong mong muon
So voi cac nh6m thu5c ch5ng trllm cam khac, cac thu5c IMAO gay tac dl,lngkhong mong mu5n nhigu va n(mg hdn nen ngay nay it dung.
- Thu5c thudng gay kich thich, mit ngu., thao cueSng,hi l~n, ao giac, run cd, co gi~t, h:;thuyet ap the dung.
- Gay viem gan, t6n thudng te bao gan.
- Gay tudng tac voi nhigu lo:;tithu5c, thuc an va deSu5ng nen d~ gay dQcvoi cd th~. Vi v~y, khi dung cac thu5c lMAO phai rit th~n trQng vg che dQ an u5ng.
Chong chi dinh
M~n cam voi thu5c. Suy gan.
B~nh tim m:;tch. B~nh dQngkinh.
TUdng tac thuoc
Khong ph5i h<;1pcac thu5c lMAO voi nhau, khong ph5i h<;1pcac thu5c lMAO voi thu5c ch5ng trllm cam ba yang, thu5c giam dau gay nghi~n, thu5c cUdnggiao cam va thuc an c6 chua nhigu tyramin (phomat, chu5i, rU<;1uyang do).
- Voi thu5c ch5ng trllm cam ba yang: gay tang kich dQng,co gi~t.
- Voi thu6c chong tram cam uc che' chon IQcthu h6i serotonin: d~ gay hQi chung serotonin (bi~u hien: tieu chay, tim d~p nhanh, va m6 hoi, run rfty, hi l~n, hon me).
- Voi thu6c cuong a- adrenergic va cuong giao cam gian tiep: gay tang huyet ap kich phat, s5t cao, c6 th~ ti':tvong.
- Voi ruou: gay dau d~u, budn non.
- Voi thuc an c6 chua tyramin: gay tang huyet ap dQt ngQt... Cdc tluuk: trong nhom
Di~n hinh c6 phenelzin, isocarboxazid va tranylcypromin.
Cac thuoc chong trAm cam IMAO khong chon IQc c6 nhieu dQc tinh va tuong tac vdi nhieu thu6c ciing nhu thuc an, nen ngay nay it dung.
2.2. IMAO chon loc
La cac thuoc uc che chon loc MAOA d nao, c6 tac dung chong tram cam tuong tu loai uc che khong chon loc. Thu6c khong tac dung tren MAOB d ngoai vi, t6 chuc, vi v~y it tac d\mg khong mong mu6n va dQc tinh hdn nh6m UC che' khong chQn lQc.
Hai thu6c IMAO chQn lQc thong d\lng la toloxaton va moclobemid, c6 tac d\lng tudng tlj nhau, dUQcchi dtnh trong cac tr:;tng thai trAm cam, chung lo:;tn tam thAn, vo cam.
Thu6c khong dUQcdung khi thao cu6ng, hoang tUdng va khong ph6i hQp voi nh6m IMAO khong chQn lQc.
Ligu dung:
- Toloxaton: 200mg x 3 l~n/ 24h. Vien nang 200mg. - Moclobemid: 300- 600mg/ 24h. Vien nen 150mg.
3. THUOC CHONG TRAM cAMBA VONG
Dli(/C d9ng h9C
Thu6c hfip thu khong hoan toan qua dUdng tieu h6a. Sau khi u6ng 3-4 gid, thu6c d:;tt n6ng dQt6i da trong mau. Lien ke't voi protein huye't tudng tren 90%, phan b6 nhanh vao cac t6 chuc gan, nao, th~n. Chuy~n h6a d gan t:;tothanh cac chfit chuy~n h6a c6 ho:;tt tinh m:;tnh hdn chfit m~. Thdi gian ban thai tii 15-50 gid. Thu6e thai trii ehu ye'u qua nuoe ti~u.
Tac d¥ng va cd che'
- Tren tam thAn: thu6c c6 tac d\lng ch6ng trAm cam, lam mfit cac tr:;tng thai u sAu, bu6n chan, thfit vQng, tang cUdng ho:;tt dQng tam thAn, c6 tac d\lng t6t voi cac d:;tng tam thAn v~n dQng, r6i lo:;tn gific ngU, kern an, giam can. Tac d\lng thudng xu fit hi~n ch~m (sau 1- 2 tu~n dung thu6c) va keo dai.
Coche:
+Tram cam la do thieu hut noradrenalin, serotonin, dopamin hoac tien chat cua cac catecholamin la phenyletylamin d trung uong,
+ Thuoc chong tram cam ba vong lic che' thu h6i noradrenalin va
serotonin ve cac hat d1,1trfi d ngon day than kinh, lam tang n6ng dQcac chat. nay d khe synap, lam tang phan ling vdi receptor d rnang sau synap nen co UtCdung chong tram cam.
- Ngoai ra, thuoc can khang cholinergic d trung uong va ngoai vi gay cac tac dung sau:
+Tren than kinh trung uong: phan IOn cac thuoc co tac dung an than tit
nhe den manh (trit protriptylin). Tuy nhien, tac dung an than cua thuoo giam dan khi dung lien tuc.
+Tren than kinh th1,1Cvat:
H~ giao cam: lieu thap, thudc trc che thu h6i noradrenalin, gay kich thich giao cam, lam tang hoat dQng cua tim, tang huyet ap. Lieu cao, thuoc gay huy a-adrenergic lam giam luu hrong tim, gian mach, ha huyet ap. Ngoai ra, can co tac dung chong loan nhip.
H~ pho giao cam: thu5c lic che h~ muscarinic gi5ng atropin, gay gian d6ng tl:t, giam tiet dich.
Ngoai ra, thu5c can co tac dl,lng khang histamin nh~.
Chi dinh
- Tr~ng thai tr:1m cam cac lo~i (nQiva ngo~i sinh). - Dau do nguyen nhan th:1n kinh.
- Dai d:1md tre em tren 6 tu6i va ngtidi IOn.
Tac dlfng khong mong muon
- Gay r5i lo~n th:1n kinh va tam th:1n nhu: hoang tUdng, ao giac, ac mQng, 10 liing, hi Iftn, bu6n ngu ho:)c mat ngu, mat thang bling, run, co gi~t ... thudng g:)p khi moi dieu trio
- Tren th:1n kinh th1,1Cv~t: gay h~ huyet ap the dling, kho mi~ng, tao bon ... - Chuy~n hoa: them an, an vo dQ,tang can.
- NQi tiet: r5i lo~n kinh nguy~t, giam tinh dl,lC...
Chongchi djnh
- Mftn cam voi thu5c. - Hoang tUdng, ao giac.
- R5i lo~n tim m~ch, xdvua dQng m~ch.