De Cuong Duoc Ly

DC L I CNG

Cu 1 : Vn chuyn thuc qua mng sinh vt , nghaBi lm1. 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 munb) 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 hoc) 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 thp2. 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 lng3. 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

Cu 2 : Hp thu thuc qua ng ung v tim, nghaBi lmPh thuc- ho tan ca thuc- pH ti ch hp thu- Nng thuc, phn b mch mu ti vng hp thu- Din tch vng hp thu1. 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 chung2. 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 ...

Cu 3 : Phn phi thuc trong c th v nghaBi lmC 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 receptor1. 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 tr2. 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 ng4. 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

Cu 4 : Chuyn ho thuc trong c th, ngha thc tinBi lmChuyn ho thuc trong c th chia lm 2 pha1. 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 lngCyt-P450X-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, amidaseRNO2 ---- 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 thuc2. 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

Cu 5 : Thi tr thuc qua gan v thn , nghaBi Lm1. 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 thn2. 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

Cu 6 : Cc tc dng ca thuc ( chnh - ph, ti ch - ton thn ), nghaBi lm1. 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 thn2. 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 ) , nghaBi lm1. 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 mun2. 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

Cu 8 : Cc c ch tc dng ch yu ca thucBi lm1. 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 bo3. 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..

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 lm1. V thuca) 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 Rpb) 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 thucc) 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 vngDc cht c gii phng vi tc n nhDc cht c gii phng ti ni cn tc dngThuc c sinh kh dng cao3. V ngi dng thuca) c im v tui ( tr em )+ S gn thuc vo protein huyt tng cn t , thuc y bilirubin khi phc hp protein-bilirubin 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 thucb) 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

THUC C CH THN KINH TRUNG NG

Cu 10 : Thuc t NovocainBi 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 lm1. 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 tim2. 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 )

Cu 12 : Morphin (dc ng hc, tc dng, c ch, ch nh )Bi lm1. 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 dnga) 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 nngb) 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 tkb) 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 chc) 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 hid) 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 hog) Tc dng khc- 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 nga3. 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 lng4. 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

Cu 13 : Cc dn cht tng hp thay th MorphinBi Lm1. 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 Morphin2. 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 tui3. 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, herpin4. 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- 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 acetaminophen6. 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

Cu 14 : Benzodiazepin ( tc dng, ch nh )Bi lm1. 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 ho2. Tc dng khng mong mun- Gim tr nh- Bn chn lo lng, o gic, tim p nhanh3. 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 lmClopromazin ( 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 : yu2. 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 ngaCu 16 : Thuc an thn dn xut ca Butirophenol ( tc dng, ch dnh )Bi lmHaloperidol1. 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 H12. 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 vimBi lm1. 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 au2. 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 li3. 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

Cu 18 : AspirinBi lm1. 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 dy2. 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%/24h3. 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 su4. 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

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 OxicamBi 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

Cu 21 : Thuc iu tr bnh Parkinson ( tc dng , ch nh )Bi lm1. Thuc cng h dopaminergicLevodopa ( 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 500mgCh nh nghim ngt, theo di ti BV, ung liu dn, chia lm nhiu ln trong ngy, ung sau ba n , liu trung bnh 3-3,5gCh : 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 decarboxylaseModopar : vin nang cha 0,6g levodopa + 0,015g bensarazidSinemet : vin nn 100 v 250 mg cha levodopa + _methyldopahydrazin hoc carbidopa t l 10/1Amantadin ( mantadix, Symadin ) vin nang 100 mg / ln x 2 ln /ngyBromocriptin: vin nn 2,5mg, vin nang 5mg, liu u 2,5mg x 2ln/ngy, tng dn liu ti a 100mg.ngyPergolid ( Permax ) vin 0,05mg, 0,25 mg v 1 mg.Selegilin ( Eldepryl ) vin 5 mg2. 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

Cu 22 : Thuc chng ng kinh Hydantoin ( tc dng v ch nh )Bi lm1. 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 nhp2. 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 VD3. 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

Cu 23 : Thuc chng trm cmBi lm1. 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 tht2. 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

Cu24 : Thuc iu ho hot ng tm thn Lithi ?Bi lm1. 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 nhp2. 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 ngy3. 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 hc4. 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 cm5. 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

THUC KCH THCH H THN KINH THC VT

Cu 25 : Thuc kch thch h M-cholinBi lm1. 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 dng2. 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

Cu 26 : Thuc c ch h M-cholinBi lmAtropin ( 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 gic2. 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 hen3. Chng ch nh- Bnh nhn p- B i do ph tuyn tin lit4. 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

Cu 27 : Thuc kch thch h N-cholinBi lm1. 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 rut2. 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 di3. 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

Cu 28 : Thuc c ch N-cholinBi lmI. Thuc c ch N-cholin ca hch1. 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 hch2. 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 ming3. 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 cp5. 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 vn1. 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 HA2. Ch nh- Thuc gin c trong phu thut v cc th thut ngoi khoa- Sn khoa : m ly thai- Thuc chng co git3. Ch phm- Tranh chp vi ACh bn vn ng : d-Tubocurarin , Galamin- Tc ng nh ACh : Succinylcholin ( myorelaxin ) , Dercametaoni bromid

Cu 29 : Thuc cng TCT v ( adrenalin v noradrenalin )Bi lmI. Adrenalin1. 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 bn2. 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 t2. Ch phm- Adrenalin chlohydrat : ng 1ml = 1mgII. Noradrenalin1.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 adrenlain2. 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 tim3. Ch phm- Dopamin : ng 200mg/5ml , truyn IV 2-5g/kg/pht

(Cu 30 : Thuc c-ng chn lc Rp Bi lm1. Metaraminol ( Aramin ) , co mch v tng co bp tim(- Tc dng : c-ng - Ch nh : Nng HA trong tr-ng hp gim HA t ngt, trong sock v chn th-ng- Thuc :+ Tim IV 0,5 - 5mg trong tr-ng hp cp cu+ Truyn IV dung dch 10mg/1ml+ C th tim IM hay SC , ng 1ml = 0,01 g metaraminol bitartrat2. Phenylephrin ( Neosynephrin ) Glc huyt( HA ko di, khng mnh bng NA, khng nh h-ng n nhp tim, khng kch thch TKT v khng lm (1, tc dng co mch (- Tc dng : u tin trn - Ch nh : Nh- Noradrenalin- Thuc :+ Tim IM 5-10 mg+ Truyn IV 10-15mg/1000ml dung dch Glc ng tr-ng3. Clonidin ( Catapressan )- Tc dng HA ngn,(2 tr-c synap T gy (+ C-ng Rp HA( l-u l-ng mu no, tng, thn, mch vnh, dn n (, ( tr-ng lc ( nhp tim, ( gy (+ Tun hon : Lm gim gii phng NA neuron + Tiu ho : Gim bi tit n-c 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 l-ng+ Vin 0,15mg, ung liu tng dn ti 6 vin/ngy

(Cu 31: Thuc c-ng chn lc Rp Bi lm1. Cc tc dng chnh2(- Tc dng gin ph qun : cc nhnh ph qun, c bit cc nhnh ph qun nh c nhiu Rp HA nhanh v mnh(2 , gin mch c vn, mch no, mch vnh. rut do lm (- Tc dng dn mch : Tc dng ln 1 , tng tn s, sc co bp, tc dn truyn v kh nng t-i mu cho tim(- Tc dng trn tim : Cng da sy thai(2, gin t cung, gim co tht, dng (- Tc dng trn c t cung : C-ng 2. Ch nh- Chm nhp th-ng xuyn- Hen ph qun- Ri lon tun hon km theo h HA- Tru mch, suy tim v chong3. Ch phm- Isoproterenol (isuprel, aleudrin, ..)- Metaproterenal ( orciprenalin, metaprel )- Albuteral (salbutamol, ventolin )- Ethylephrin (effortil)- lsoxsuprin ( duvadilan )

_Adrenergic(Cu 32 : Thuc hu 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 th-ng thn, iu tr bnh Raynaud- Cc thuc v liu l-ng+ 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

_Adrenergic(Cu 33 : Thuc hu Bi lm1. Tc dng chnh :(- Hu giao cm - Trn tim : + Gim nhp tim+ Gim lc co bp ca c tim+ Gim l-u l-ng 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 ng-i 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 c-ng giao cm, nhp nhanh v cn- Tng huyt p.- C-ng 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. T-ng 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)

THUC CHNG NHIM KHUN V NHIM N BO

Cu 34 : Cc loi Sulfamid ( tc dng v ch nh )Bi lmL cht tng hp dn xut ca Sulfanilamid1. Tc dng v c ch- L cht km khun acid folic ca vi khun(- c ch tranh chp vi PABA trong qu trnh - 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 n-c3. 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

Cu 35 : Phn loi khng sinh , nguyn tc chung khi s dng khnh sinhBi LmI. Phn loi khng sinh ( cn c vo cu trc ho hc ) -lactam(1. Nhm - 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 ), Sulfanilamid10 . Nhm khng sinh chng nm : Nystatin, Amphotericin B, Griseofulvin

II. Nguyn tc dng thuc khng sinh1. Ch s dng khng sinh khi c nhim khun2. Chn ng khng sinh3. Chn dng thuc thch hp4. Phi s dng liu.5. Phi s dng thi gian quy nh6. S dng khng sinh d phng hp l7. Ch phi hp khng sinh khi tht cn thit

Cu 36 : Cc Penicillin t nhin v dn xut bn tng hpBi lmI. Penicillin t nhin1. 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 nm2. 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 KS3. 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 hp1. 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 khun2. 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 _lactamaseBi lmTc 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 nyCh 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

Cu 39 : Cc Cephalosporin ( tc dng v ch nh )Bi lm- L khng sinh ph rng1. 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 thn2. 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 Penicilin3, 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

Cu 40 : Streptomycin ( tc dng, ch nh v c tnh )Bi lm1. 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 u2. 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 G3. 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 lm1. 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 dy2. 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 c3. 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 ribosom4. 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

Cu 42 : Cc Lincosamid ( tc dng, ch nh )Bi lm1. 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 peptid2. 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 gic3. 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 : ErythromycinBi lm1. 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 hp2. 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 no3. Ch phm- Erythromycin estolat, propionat : ng ung- Erythromycin ethylsuccinat : Tim bp ( IM )- Erythromycin glucoheptonat : Tim tnh mch ( IV )

Cu 44 : Oleandomycin v Spiramicin ( tc dng v ch nh )Bi lm1. 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 glucocorticoid2. 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

Cu 45 : Chloramphenicol ( Chlorocid ) , tc dng v ch nhBi lm1. 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 ribosom2. 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 ho3. 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 lm1. 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 polipeptid2. 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

Cu 47 : Rifampicin ( tc dng v ch nh )Bi lm1. 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 ln2. 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 ru2. 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 lm1. 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 bo2. 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 thuc3. 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 52 : Cc thuc iu tr phongBi lm1. 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 rtBi lm1. 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 bo2. 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.ovalaeCu 54 : Cloroquin ( tc dng v ch nh )Bi lm1. 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 nucleoprotein2. 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 lm1. 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 cung2. 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

Cu 56 : Primaquin , Quinocid ( tc dng , ch nh )Bi lm1. 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 lan2. 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 mu3. 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 mg1. 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 ng2. 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 di3. 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 qun4. 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 58 : Fansidar ( tc dng v ch nh )Bi lm1. 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 ARN2. 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 di3. 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 qun4. 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-methanol1. 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, pyrimethamin2. 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

Cu 60 : Artemisinin ( tc dng v ch nh )Bi lm1. 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 Plasmodium2. Tc dng ph- Ri lon tiu ho- Nhc u chng mt v hoa mt- Chm nhp tim3. 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 DehydroemetinBi lm1. 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 amip2. 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 chy3. Ch nh- L amip nng- Apxe gan do amip

Cu 63 : Tc dng iu tr amip v trng roi ca MetronidazolBi lm1. 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 bo2. 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 thuc3. 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 giunBi lm1. 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 ngoi2. 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 dngBi lm1. 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 chtc ch h Fumarat reductase c hiu ty th t bo giun2. Ch phm- Mebendazol ( Furgaca, Vermox, Mebutar, Nemasole )- Albendazol ( Albenza, Eskazole, Zeben, Zentel )- Thiabendazol ( Mintezol )Cu 66 : Cc thuc iu tr snBi lm1. 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 ngoi2. Ch phm- Niclosamid ( Cestocida, Yomesan, Tredemine, Niclocide )- Praziquantel ( Biltricid, Cisticid, Droncit, Cesol )- Metrifornat ( Bilarcil )- Oxamniquin ( Mansil, Vansil )