MUC LUC T ONGCHNG I. M AU.......................................................................................................... 31.1. Gii thieu mon hoc ....................................................................................................... 31.2. Dc ong hoc............................................................................................................... 41.2.1. S hap thu............................................................................................................... 51.2.2. Phan bo ................................................................................................................. 111.2.3. Chuyen hoa (bien oi sinh hoc) ........................................................................... 131.2.4. Bai thai ................................................................................................................. 131.3. Dc lc hoc ................................................................................................................ 161.3.1. Receptor (ni tiep nhan, iem ch) .................................................................... 161.3.2. Cac cach tac dung cua thuoc................................................................................ 181.3.3. Tng tac gia hai dc pham (thuoc) ................................................................ 181.4. Nhng yeu to anh hng en tac du ng cua dc pham........................................ 201.4.1. Cac yeu to ben trong c the ................................................................................. 201.4.2. Yeu to ngoai c the (lien quan en thuoc) .......................................................... 211.5. Thong tin ve mot loai thuoc ...................................................................................... 221.5.1. Ten thuoc.............................................................................................................. 221.5.2. Ch nh va chong ch nh (indications va contraindications) ............................ 221.5.3. Lieu lng va ng cung cap (Dosage va Administration) ............................... 231.5.4. Dang trnh bay (Presention) ................................................................................. 231.5.5. Bao quan (storage) ............................................................................................... 231.5.6. Han dung (expiration date) .................................................................................. 231.5.7. Thi gian ngng thuoc (Withholding periods) ..................................................... 23Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnCHNG IDC LY AI CNG Gii thieu mon hoc Dc ong hoc Dc lc hoc Nhng yeu to anh hng en tac du ng cua dc pham Thong tin ve mot loai thuocTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn1 Chng I. M AU1.1. Gii thieu mon hocDclyhoc(Pharmacology)lamonhocnghiencuvenguyenlyvanhng quiluattaconglannhaugiathuocvicthesinhvat,ecapennhngkienthc lch s, nguo n goc, ca u truc cua thuoc. S tac ong va c che ve so phan cua thuoc trong c the, cong dung cung nh tai bien khi s dung thuoc, trong o chia la m 2 phan: - Dc ong hoc (pharmacokinetics): nghien cu ve tac ong cua c the oi vi thuoc hay so phan cua thuoc trong c the qua cac qua trnh ha p thu, phan bo, chuyen hoa va ao thai.- Dc lc hoc (pharmacodynamics): nghie n cu ve tac ong cua thuoc oi vi c the ve mat tnh chat cng o va th i gian.Thuoc: la nhng chat (t nhien, tong hp hay ban tong hp) khi c a vao c the sinh vat se co tac ong lam thay oi chc nang cua c the. S thay oi nay co the la hu ch trongtrng hp ieu tr hoac co the gay tac hai trong trng hp ngo oc. Do oranhgiigiathcan,thuocvachatocthngkhongroret,nophuthuocnhieu yeu to, trong o yeu to lieu lng la quan trong. Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnHnh 1.1 S o bieu dien cac qua trnh dc lc hoc va dc ong hoc lien quan ti tac dung thuoc1.2. Dc ong hocDconghoclamonhocdientabangtoanhocvetocovamcohapthu, phan phoi va ao thai cua thuoc trong c the. Mon hoc nay chu yeu lam ro moi lien he gia so lng thuoc va lan s dung thuoc, cng o va thi gian tac ong. Hien nay co chieu hng tang ap dung hieu biet ve dc ong hoc e s dung thuoc tren lam sang, ac biet la s ca the hoa lieu dung. Sau ay la 3 thong so dc ong quan trong:1. He so thanh thai (clearance): Bie u th kha nang a o thai thuoc cu a c the.2. The tch phan phoi (volume distribution): La c so khoang bieu kien trong c the co the cha thuo c.SINH KHA DUNGPHAN PHOI HE SO THANH THAILieu dungNong o thuoc trong tuan hoanThuoc chuyen hoa va ao thaiThuoc chuyen hoa va ao thaiNong o thuoc trong tuan hoanTac ong dc lyap ng lam sangHiep lcS dungoc tnhDC ONG HOCDC LC HOCTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn3. Sinh kha dung (bioavailability): Laty le thuoc hap thu vao he tuan hoan so vi lieu dung.Cac ng dung thuoc va ao thai thuoc chnh laquatrnhdcphamthamnhapvaonoimoitrng.Dudung ng cho thuoc nao dc pham muon en cac receptor e phat sinh tac ong dc lc thngphaiiquamothaynhieumangtebao,dooshapthuthuocphuthuocban chat cua mang te bao.T ngoai vao trong co 3 lp chnh- ac biet co lp keratin (lp sng) ngoai cung.- Thng b: la mo lien ket chong gom co si collagen, s i an hoi, mach mau, si than kinh va ca c phan phu nh tuye n mo hoi, nang long.

Tiem tnh mach Tiem bap

Phan Nc tieuTnh machcaChat chuyen hoang mat Sa mo hoi

Tiemtrong voKh th ra Dang htTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn- Ha b: la to chc a c biet tr thanh mo m.Lp sng gom te bao chat co bao tng a hoan toan b keratin hoa. Cau tru c cua lp nay day a c do s gan ke t chat che gia cac te bao. Lp sng c coi nh ha ng rao chechrattotcuadabikhobthuygiaibicactacnhannhacid,baseloanghay enzym.- Lp sng la hang ra o can tr thuoc tha m qua da.- Hap thu thuoc qua da phu thuoc he so phan chia D/N cua thuocChat tan trong lipid qua lp bieu b hoac tuyen ba nang long, tuyen mo hoi. Chat khong tan trong lipid dang nhu tng qua tuyen ba va tuyen mo hoi.

- Tnh hoa tan cua dc pham: thuoc dang dung dch nc de hap thu hn dung dch dau, dung dch dang treo hoac dang ran. V dang dung dch nc thuoc c hoa tan nhanh chong vao pha nc ni hap thu.- Nongodc phamtai nihapthu: nongo naycangln th shapthucang nhanh oi vi cac thuoc qua mang bang cach khuech tan qua lp lipid.- pH ni hap thu: trong c the co 2 ni ma s thay oi pH rat ln, pH dch v 1,5 -7, pH nc tieu 4,5 - 7,5. oi vi acid rat yeu nh phenytoin va nhieu barbiturat pKa > Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn7,5chuyeudangkhongionhoatatcamoipH.olanhngacidmashapthu khong tuy thuo c pH. Acid co pKa = 2,5-7,5, s thay oi pH lam thay o i ty le ion hoa va khong ion hoa, cac acid nay hap thu de trong moi trng acid. Cac acid co pKa< 2,5 th phan khong ion hoa rat thap nen s hap thu rat cham ngay ca trong moi trng acid. 1.2.1.1. Cac phng cach van chuyen(1) Van chuyen thu ong (khuech tan)- Thuoc t ni co nongo cao khuechtan en ni co nong o thap, o la s van chuyentheochieugradiennongo,khuechtanthuandong.Tocokhuechtantyle thuanvigradiennongo2benmangvahesophanlylipid/nccuathuoc.Heso lipid khong ion hoa/he so phan phoi nc cang ln th toc o khue ch tan cang nhanh cho en khi at trang thai tnh, nong o thuoc t do 2 ben mang te bao can bang. oi vi nhng chat ion hoa,tuy mc oion hoa cuacac phant thuoc va gradiennongo cac ion, hieu so pH gia 2 ben mang te bao se quyet nh s phan phoi khong eu cua thuo c o.-Nhngthuoctoanmanh,kiemyeuhoacnhngchatphanccmanhnhmuoi amoniumbacIVratkhovtquamangtebao.Nhngchattanctrongncco lngphantnho( ruot > mo than kinh(2) Van chuyen chu ong (tch cc) Mangtebaocungcapchatchuyench chos vanchuyen,nencon cgoi la van chuyen chuyen ch. Van chuyen tch cc co cac ac iem sau: tnh chon loc cao, canhtranh vi chat giong nhau, can cung cap nang lng, can co chat chuyen ch (chat mang), van chuyen ngc chieu gradien nong o, co hien tng bao hoa. Van chuyen tch cc rat t lien quan en o hap thu, ma la c che tac dung quan trong cua thuocco tac ong len acid amin, ng, vitamin(cac chat noi sinh) hoaccac chat dan truyen than kinh van chuyen qua mang te bao than kinh, mang li mach mau, cau than va mang tebao gan. Co mot so thuoc co o ion hoa cao nhng lai de dang xuyen qua mang te bao. V duxuyenquamanghongcaucuaglucose,xuyenquamangthankinhcholinergiccua Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnacetylcholin; nhngchat nay ket hp vi chat chuyen ch e tang o hoa tan trong m nh o xuyen qua c lp lipid cua mang roi khuech tan vao ben trong te bao.

Thuoc c hap thu qua niem mac da day, ruot non- u iem: ng cap thuoc nay tien li, de thc hien va an toan nhat.- Nhc iem: s hap thu phu thuoc nhieu yeu to nh tnh trang cua da day ruot, thanhphanthc an. ngcapnaythuocco thebmattacdungdoopHthapcua dchvvacacenzymtieuhoacothephahuythuoc.oivigiasuc,vieccungcap thuocbangnguongcanphaichuyvelieulng,vcothesekhongcungcapu, ac biet la trng hp tron vao thc an, nc uong. Them vao o, ng ca p nay khong nensdungoivicacthuoccomuivkhochu,gaykchng,cacthuoccotnhion hoa.

Thuoc khuechtan thu ong dochenh lechnong o, domao mach ln nen nhieu phan t thuoc qua c.-uiem: thuocchapthunhanhvanhanhcotacong.Capthuocbang ng tiem chch se giai quyet c nhng han che cua ng uong, lieu dung nho hn lieu cho uong.- Nhc iem: ng tiem chch oi hoi ieu kien vo trung, ngi cap thuoc phai co ky thuat. Thuoc du ng cho ng tiem chch thng at tien, kem an toan va gay au. Thuoc ha p thu qua mo di da trc tien phai khue ch tan trong gian bao chat, sau o tham qua noi mo mao mach. Do o, s hap thu thuoc tuy thuoc vao:- o nht cua gian bao chat: thanh phan quan trong tao o nht cua gian bao chat la acid hyagluronic.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn- Tnh tham cua mao mach: muon thay oi toc o hap thu qua mo d i da can chuong thay oi o nht cua gian bao chat hoac thay oi tnh tham mao mach. V du: khi muon giamtoc ohapthu ongthitangthigiantac ongoivi thuocco tac ong ngannhpenicilline,heparin,insulinvagiamoctnhnhprocaindungchatgayco mach(procain-epinephrine),dungtadcdangkeotkhuechtanetangonht (pectin,gelatin).Khimuontangtocohapthukhichchdungdchangtrngdung men hyagluronidase e giam o nh t, dung cha t dan mach. Thuoc se co tac du ng sau 30-60 phut, lieu dung thng ch bang 1/3 lieu uong.Nen tranh dung ng nay cho cac thuo c co tnh kch ng, gay xot.Thuoc co tac dung nhanh hn khoang 10 - 30 phut, lieu dung bang 1/2 lieu uong. Dung e tiem cac dung dch nc, dung dch dau hay nhu dch dau nh loai glycoside tr tim, kch to sinh duc, cac corticosteroid. Co the tiem cac thuoc ma ng tiem di da gay au xo t. ay thuoc khong phai c hap thu na ma la tham nhap nhanh chong va toan ven vao he tuan hoan chung, co tac dung sau 30 giay en 5 phut, lieu cap bang 1/2-1/4 lieu uong. ng tiem nay thng ap dung cho cac trng hp cap cu hoac can thuoc co tac dung tc th i. Canhetscthantrongkhidungngcapnay,neuchchmotlngln(250-1000ml)canluysangtrngvihuyettng,tococapthuocchametranhs thay oi can bang cac chat keo trong huyet tng, luon theo doi ca c phan ng cua c thekhi tiem thuoc va dung moi thng dung la nc, tuyet oi khong s dung cac dung moi la cac chat dau, chat khong tan v co the gay nghen mach, tranh dung cac chat gay tieu huyet, gay ket tua ca c thanh phan cua mau hay co hai cho c tim. Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnVi be mat hap thu ln cung mang li mao mach phat trien cua phuc mo, thuoc c hap thu nhanh chong gan bang ng tiem tnh mach. S dung ng cap na y can chu y tranh gay viem nhiem, thung ruot, bang quang.ng cap nay thng dung khi can cap mot lng ln thuoc trong thi gian ngan ma ng tiem tnh mach kho thc hien. Tiem trong da (intradermic, I.D) Thnggaptrongcacthnghiemlaoto(tuberculintest)hoacthdngvi khang sinh.(3) Cac ng cap thuoc khac ng tham qua ma ng nhay kh qua n, cuong phoi, b mo phe nangThng ap dung cho cac thuoc bay hi hoac de bay hi, kh dung. Thuoc se c hap thu qua dien tch rong ln cua bo may ho hap va mang mao quan va he tuan hoan chung. ng trc trang (rectum mucosa) ac iem hap thu: hap thu chat tan trong lipid va t ion hoa. Thuoc se tranh c tacongchuyenhoataiganvacuadchtieuhoavvaylieudungnhohnlieucho uong. Cothe dungcho cacthuocco mui vkhochu. Tuy nhien,ngcap nay ch ap dung cho cac thuoc khong b huy bi men penicillinase. ng boi ngoai da, at vao am ao, t cung...ng boi ngoa i da: cho tac dung tai cho o i hoi phai hoa tan c trong chat beo nh m, vaseline,lanoline.ethuoc chap thunhanhchongnen chasatmat dae ong tuyenmohoi mrong vacac maomach trngn,tron themcac chat gaytrng mach nh nicotinamid hoac cac chat gay kch ng nh salicylate metyl.1.2.2. Phan bo The dch gom dch ngoai bao va dch noi bao, trong o pH dch ngoai bao (pH =7,4) ln hn noi bao (pH=7). Nhng thuoc co tnh acid yeu b ion hoa dch ngoai bao nen nong o o cao hn v khong phan phoi vao ben trong te bao c. Nhng thuoc Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnkiem yeu th kha c, o pH hi kiem dch ngoai bao, khong ion hoa, thuoc vao c ben trong mang te bao nen nong o thuoc ngoai bao cao hn. Noi chung, a so cac thuoc eu phan bo nhieu hn dch ngoai bao, ngay ca nhng thuoc co o khuech tan ln nh cac thuoc tan trong nc, cac ion Na+, Cl-cung vay. Bi v muon vao ben trong dch noi bao phai nh en c che van chuyen tch cc. Nhng thuoc tan trong dau va nhng thuoc co kha nang gan ket vi cac thanh phan cau tao ben trong tebao th c phan phoi va o tan ben trong.Trongquatrnhvanongcuaphantthuoc,scanbangnongothuoccac dch, cac mo noi chung la bien ong, s phan bo thuoc trong c the la khong ong eu.

Thuoc vao he tuan hoan chung se c phan bo chu yeu en nitac ong,t o sinhratacongdcly.Trckhiattitrangthaicanbangong,thuoccphan phoi u tien en nhng ni co lng mau nhieu nhat nh tim, gan, than, nao. Trang thai nay do lng mau c bm en va lng mau tai cho quyet nh. Sauothuocc nhanhchongphanphoilai eenc,da b,mva cactang. Toc o phan phoi lai tuy thuoc vao lng mau en, o hoa tan trong dau va o gan ket vi protein. Nhng thuoc co o gan ket cao va ben vng rat kho phan phoi en ni tac ong,chuyenhoakhovathaitrcham,saukhicphanphoithuocbcvaogiai oan chuyen hoa, bai thai. Nhng thuoc co to c o phan bo nhanh, thuoc dung lieu cao 1 lan hay nh ng thuoc cbosungnongolientucthuocsecphanbolainhieulan.Trctien,thuoc c a vao d tr cac mo t o phan bo en cac ni khac xuoi theo dong chay cua mau, en mo ch va phat huy tac dung. Du c phan bo au, thuoc cung co the nam dang t do hoac ket hp vi cac thanh phan khac cua mo.Viecphanbothuocmauphuthuocvaosovtrganvaailccuathuocvi protein. mo, s phan bo phu thuoc ly hoa tnh cua thuoc, mc o tuan hoan tai mo va ai lc cua thuoc vi mo.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn Chuyen hoa thuoc hay bien oi sinh hoc cua thuoc la khau quan trong khong the thieu c trong toan bo qua trnh thuoc tac ong en c the va x ly cua c the oi vi thuocmacuoicungsecho4ketqua:chuyenhoathuocthanhchatvohoat,chuyen thuoc ban au von khong co tac dung dc ly thanh chat co hoat tnh, chuyen thuoc co hoat tnh nay thanh chat co hoat tnh khac, tao ra vat chat co oc tnh.Chuyeudohemicrosomescuaganamnhan,ngoaira,concotaiphoi,than, lach... thong qua cacphan ng oxy hoa, kh, thuy phan, tong hpac biet la phan ng lien hp v i acid glucuronic e tao thanh nhng phan t ester co cc cao, tan trong nc, kho tham qua mang te bao, khong con hoat tnh dc l c va de ao thai ra ngoai. - Yeu to ditruyen: skhiem khuyetmen do di truyen anhhngtram trong en qua trnh chuyen hoa thuoc chang han nh thieu men pseudocholinesterase lam tr hoan thuy phan succinyl choline keo dai tac du ng liet c cua thuoc.-Yeutokhongditruyen:Tngtacgiathuocvathuoc,cungmotlucdung2 hoac nhieu loai thuoc th chuyen hoa cua moi thuoc noi chung b cham lai, thuoc b huy cham. ay la ng ao thai chu yeu cua cac chat co cc, tan trong nc, phan t lng nho (PM < 500) hoac cac thuoc b chuyen hoa cham. S ao thai thuoc qua than gom co3 tien trnh loc cau than, tai hap thu va ba i tiet ong than.(1) Loc cau thanDangthuoctdocungnhchuyenhoachatcuanotronghuyettngquac condangkethpthkhongquacmangloccuacauthan.Tysuatlocvatylegan ket thuoc co anh hng en toc o qua loc, thuoc se c bai thai rat cham khi ty suat Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnlocgiamvaoganketcuathuoccao.Cchenayphuthuoclngthuocganvao protein huyet thanh vatoc o loc cua cau than.Hau het thuoc c loc qua cau than tr dang gan vao protein huyet tng. S loc qua cau than chu anh hng cua cac yeu to sau:- Kch thch phan t thuoc: ng knh cua lo mao mach cau than khoang 50A0, s locquacauthanbhanchevicacthuoccongknhd>20A0,conkhithuocco ng knh d = 42A0th khong the loc qua cau than.- ien tch phan t thuoc: thuoc mang ien tch qua ca u than cham hn chat khong mang ien tch v co tng tac tnh ien gia phan t c loc va ien tch am tren thanh maomach.Vdu:Sulfatdextralocchamhndextratrungtnhngaycakhikchthc phan t cua chung tng ng.- Hnhdangphantthuoc:Skhacbietvehnhdangbachieucuaaiphant thuoc han che s loc qua cau than. V du cac phan t hnh cau (nh protein) loc qua cau than kho hn cac pha n t duoi thang nh dextran.(2) S khuech tan thu ongQuatrnhthuocitlong ongthanvaomautheocachthuong,xayra oivi cac thuoc tan trong lipid va khong ion hoa. S khuech tan thu ong pH nc tieu (4,5 8,0), chu ong thay oi pH nc tieu gay ao thai thuoc theo y muon do lam tang dang thuoc ion hoa. Vdu:Neungoocchatkiemyeu(quinidin,amphetamin..)nenacidhoanc tieu(bangNH4CL).Neungoocthuoclaacidyeu(phenylbutazon,streptomycin, tetracyclin, lumminan) nen kiem hoa n c tieu (bang NaHCO3).(3) S bai tiet chu o ng qua ong thanQua trnh nay chu yeu theo c che van chuyen tch cc, can co chat chuyen ch, ngcchieuvigradiennongovacohientngbaohoa.Haithuoccocungcche bai thai giong nhau se co canh tranh c che v du nh penicilline va probenecid, ket qua Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vncanhtranhcchelaprobenecidcbaithairangoaitrc.Cohaihethongvan chuyen chnh ong than.-Hethongvanchuyenanionhuc:vanchuyenpenicillin,salicylat,acid ethacrynic, probenecid, phenylbutazon, dan xuat glucuro, sulfo hp.-Hethongvanchuyencation:vanchuyenmecamylamin,tolazolin, hexamethonium,morphin,procain,neostigmin,quinin,amilord,triamterenvacachp chat noi sinh nh catecholamin, histamin, cholin va thiamin.Moi thuoc co to c o bai tiet toi a (transport maximum = Tm) rieng, co thuoc pha i qua chuyen hoa mi c bai tiet (chat lien hp). S bai tiet chu ong quan trong trong aothaithuocvcacanionvacationthngganvaoproteinhuyettngnenkholoc quacauthan.Sbaitietchuongthaithuochieuquavanhanh.Motthuoccao thai qua than co t1/2 < 2 gi co ngha la co 1 phan c bai tiet qua than. Co thuoc c bai tiet qua ong than nhng t1/2 dai hn v co tai hap thu thu ong ong uon xa.He thong bai tiet nay van chuyen chu ong can chat mang nen co hien tng bao hoa (khi nong o thuoc cao) va hien tng canh tranh. Hien tng canh tranh e bai tiet giacacthuoccoynghalamsang.Scanhtranhsauaylacolivematsdung thuoc:probenecidcanhtranhebaitietquaongthanvipenicillin,ketquala probenecid c bai tiet lam giam bai tiet penicillin nen keo dai thi gian tac dung cua penicillin. o la ieu mong muon trong tr lieu v thi gian tac ong cua penicillin ngan. Co khiscanhtranhebaitietgiacacthuocgaytachainhprobenecid,khangviem khongsteroid(nhsalicylat)canhtranhbaitietvimethotrexat,lamgiambaitietva lamtangnongohuyettngcuamethotrexatgayoctnh.Tngtkhanghistamin H2lamgiambaitietprocainamidnenlamtangnongohuyettngcuachatchuyen hoacohoattnhcuaprocainamidlaN-acetylprocainamid,gayoc.Quinin,verapamil. diltiazen,flecainid,aminodaronlamgiambaitietdigoxinnenlamtangnongohuyet cua digoxin gap 2 la n.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnS tai hap thu t long ong than vao mau theo s khuech tan thu ong. Gradien nong o mat trongva mat ngoai te bao ong than lam cho cac phan t chuyen dch t ni co nong o cao e n ni co nong o thap di hnh thc khue ch tan. Nhng chat acid yeu khong phan c c va nhng chat kiem yeu ca ong ln gan va ongln xa.Nhngchat tan trong m c ongthan tai hap thu nhieu hnchat tan trong nc. Nhng chat ion hoa, phan cc trai lai b ong than bai thai ra ngoa i. Do o pH nc tieu anh hng en tai hap thu. Cac thuoc kiem yeu hoac acid yeu chu anh hng rat ln khi o pH bien thien t 5-8. V du: acid salicilic, mot thuoc toan yeu, gap phai s bien thien pH nc tieu t 6,4 kiem hoa len 8 th s bai thai cua no se tang 4-6 lan, cac thuoc khong phan cc se t 1% giam xuong 0,04%. ieu nay c ng dung trong viec giai oc tren nguyen tac la tang cac dang ion hoa cua thuoc, la m thuoc de tan trong nc t o de thai ra ngoai. 1. Cac chat tan trong nc c bai thai chu yeu qua ng tieu. 2. Cac chat khong tan trong nc c bai thai chu yeu qua phan.3. Cac chat kh, de bay hi c bai thai chu yeu qua ng ho hap.4. Cac kim loai nang (As, Hg...) c bai thai chu yeu qua da, mo hoi.

La bat c thanh phan nao cua te bao, ket hp vi thuo c va khi au mot chuoi cac hien tng sinh hoa e dan en ca c tac ong dc lc. Ve ban chat hoa hoc, receptorla cac ai phant sinhhoc nh acidnucleic,lipid mang te bao nhng ha u het chung co ban chat protein, go m cac loai protein nh sau:- Protein ieu hoa: lam trung gian cho cac chat noi sinh nh chat truyen than kinh, autacoids, hormon.- Enzyme nh dehydofolat redutase la receptor cua methotrexat.- Protein van chuyen: Na+ , K+ ATPase la receptor cua glycosid tr tim.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnHoat tnh sinh hoc cua thuoc phu thuoc va o ai lc cua thuoc va receptor cung hoa t tnh ban the. Ai lc c bieu th bang hang so phan ly KD. KD cang nho nong o hon hp (thuoc receptor cang ln tc thuoc gan nhieu vao receptor) Hoat tnh ban the = kha nang phat sinh tac ong cua hon hp (thuoc receptor).D: thuoc R: receptor

Lien ket gia receptor vi thuoc la cac lien ket ion, hydro, k nc, vanderwal va lienketconghoatr.Trongolienketconghoatrbenvngnhatnenthigiantac ong se dai neu co lien ket nay. - Tnh chon loc cao oi vi chat chu van (agonites).Nhatla nhngchat chu van kch thch noisinh nhchat dan truyenthankinh, kchto hoacnhngchat co hoattnh noi sinh. Can c vao chat chu van noi sinh ma at ten cho receptor nh cholinoreceptor, adenoreceptor, dopaminergic. - Tnh chon loc cao o i vi chat oi van (antagonistes). Chat oi khang canh tranh la cho da quan trong e phan nh cac thu the N1, N2, H1, H2 ..- Tnh nha y cam cao oi vi hieu ng sinh hoc. Ch can mot nong o nho chat chu van cung u tao ne n hieu ng sinh ly, sinh hoa ro ret.- Receptor khong phai la c chat cua men hoac chat canh tranh vi men. Receptor cothelalipoproteinhoacglycoprotein,cothetaothanhmenhoacnvthyeucua men nhng khong phai la c chat cua men nen khong b receptor pha huy.K1DR D + RK2[ D][ R] [ DR]KD =Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn - Tac dung tai cho : la tac dung xuat hien ngay ni ta cung cap thuoc.V du: sat trung da, diet vi khuan ta i cho- Tac dung phan xa: tac dung dc ly co c thong qua s dan truyen kch thch t ni cung cap thuo c en c quan kha c qua he than kinh trung ng.V du: ngi ammoniac; kch thch tuan hoan, ho hap- Tac dung chon lo c: la tac dung rieng, ac hieu oi vi 1 hoac 1 so c quan. V du: digitalin (Coramin) co tac dung u tien tren tim- Tac dung trc tiep va gian tiep: tac dung gian tiep la hau qua cua tac dung trc tiep. V du: tac dung trc tiep cua cafein la tang cng tuan hoan, tac dung gian tiep la gay li tieu- Tac dung chnh va tac dung phu : tac dung chnh la muc ch can at cua ieu tr, tac dung phu la tac dung khong mong muon, co khi con gay oc cho c the. Do o, cac nha ieu che dc pham luc nao cung co gang han che hoac loai bo hoan toan tac dung phu cua thuoc.Vdu:tacdungchnhcuaChloramphenicollatieudietvikhuangaybenh,tac dung phu la gay suy tuy, thieu mau vo tao.

(1) nh ngha Dc pham A goi la hiep lc vi dc pham B khi A lam tang hoat tnh cua B ve 3 phng dien: thu ngan tiem thi, tang cng o ta c ong, tang thi gian tac ong.(2) Phan loai - Hiep lc bo sung: la s hiep lc khi hoat tnh phoi hp cua hai dc pham bang tong hoat tnh cua moi dc pham khi dung rieng re. Cong thc: C = a + bTrong o: a la hoat tnh ban the cua Ab la hoat tnh ban the cua BTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnC la hoat tnh ban the cua A+BV du: Scopalamin va morphin. Penicilline va streptomycine-Hieplcboitang:khihoattnhcuahaidcphamlnhntonghoattnhcua moi dc pham khi dung rieng re.Cong thc: C > a + b V du: Bactrim = Sulfamethazol + Trimethoprim(3) C che C che trc tiep: hiep lc do tac ong tren ni hap thu.-Hieplctrencungnitiepthu:Quinidinvacloroquincunggantren DNAcua nhan ky sinh trung sot ret.- Hiep lc tren ni tiep thu khac nhau: Atropin va epinephrine cung lam m rong connginhngtacongtrenhainitiepthukhacnhau.Atropinc chetacongthu hep con ngi cua acetylcholin tren c vong. C che gian tiep: hiep lc tren cac giai oan hap thu, phan bo, chuyen hoa va ao thai thuoc. Vdu:phoihppenicillinevipropenecidlamkeodaithigiantacongcua penicilline v ca hai canh tranh e ba i tiet ong than. Y ngha trong ieu trPhoi hp thuoc lam tang hoat tnh ma khong lam tang oc tnhTranh hien tng e khang thuoc Tuy nhien, s hiep lc co the gay oc hai trong cac phoi hp sau: - Thuoc an than v i ru ethylic- Glycosid loai igital vi muoi Ca2+- Cac chat c che hoa t nang cua MAO vi norepinepherin hay epinephrine.

(1)nhngha:haidcphamoikhangnhaukhihoattnhcuamottronghai dc pham lam giam hay tieu huy hoa t tnh dc pha m kia.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn(2) Phan loai oi khang do trung hoa phan ng hoa hoc: tac ong cua cyanur b tieu huy bi hyposulfit Na, ng dung e giai oc cyanur. oi khang canh tranh va khong canh tranhoi khang canh tranh: la loai oi khang hoan toan trc tiep v tranh gianh cung ni tiep thu. V du: Acetylcholine va atropin, histamin va thuoc khang histamin.- oi khang canh tranh thuan nghch: khi chat oi khang khong gan chat vao ni tiepthu.Doo,khitangnongochatchuvangaylai hoatnangcuachatnay.Vdu: Acetylcholine va atropin.- oi khang canh tranh khong thuan nghch: khi chat oi khang gan chat vao ni tiep thu. V du: cha t khang epinephrine nh dipenamid, phenoxybenzamin.oi khang khong canh tranh: chat oi khang tac ong vao ni tiep thu khac vi nitiepthuchoathoabichatchuvan.Vdupapaverinlachatoikhangkhong canh tranh cua BaCl2 hoac acetylcholin ta i c trn cua ruo t, t cung nen du co tang nong o BaCl2 hoac acetylcholin cung khong gay lai hoat nang cua chat nay. Y ngha trong ie u trTranh phoi hp hai dc pham oi khang dan en la m giam hieu lc thuocGiai oc trong trng hp ngo o c1.4. Nhng yeu to anh hng en tac du ng cua dc pham1.4.1. Cac yeu to ben trong c the (1) Tuoi tac giasucnon,hethongchuyenhoachahoanchnhnhthieuenzymeUDP glucuronyltransferasenendengoockhidungcacthuoccchuyenhoatheocach glucurohpnhChloramphenicolgayhoichngxamthunonvadebnhiemoc billirubin,trongkhigiasucgiachcnangcuacaccquantrenabgiamnenkhi dung thuoc cho cac oi tng tren can phai than trong.S gan thuoc vao protein huyet tng kem.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnHang rao mau nao cha hoan chnh v vay can than trong khi dung thuoc tac o ng len he than kinh trung ng.Hethongbaithaithuocquathancungchahoanchnhnenthuoccbaithai cham hn thu tr ng thanh. (2) Tronglng:cancvaotronglnghoacdientchbematctheetnh lieu lng thuoc can cap.(3) Phaitnh:mconhaycamvithuoccuathucvathucaicothekhac nhau. V du: con cai nhay cam v i thuoc ngu, strychnin hn con c.(4) Trang thai c the: mot so ca the nhay cam vi thuoc do bam sinh hay do thau nhan., th ngay nhng lieu nho cung co the gay ra phan ng d doi, co khi nguy hiem en tnh mang.(5) Cachdungthuoc:lienquanenhientngquenthuoc,lethuocthuoc,e khang thuoc.(6) ieukiendinhdng:trongthcan,proteinacbietlienquanenhien tng gan ket thuoc cung nh cac enzym chuyen hoa thuoc.(7) Tnh trang benh ly: ac biet la cac benh ve gan than lam thuocchuyen hoa va bai thai cham nen de gay ngo oc. Benh viem gan hoac x gan lam giam ham lng cytochromeP450 gannenchuyenhoanhieuthuocbgiamnhpyramydon, mepropamate.Cacthuocbaithaichuyeuquathannhglycosid,quinidinkhisdung can chu y oi vi thu mac cac benh ve than e tranh tch luy va gay ngo o c. (1) Chat lng cu a dc pham: hang san xuat, ieu kien bao quan...(2) Cau truc hoa hoc: 1 thay oi (du rat nho) ve cau tao hoa hoc cua dc pham cung anh hng en tac dung cua d c pham o.V du: PABA yeu to sinh trng cua vi khuan Sulfonamid: thuo c chong vi khuan(3) Tnh chat vat ly : co lien quan e nTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vno hoa tan trong n c va trong lipid e thuoc c hap thu vao trong c theo boc hi: oi v i cac loai thuoc me bay hiDang bao che: bot, nc, dung dch treo...(4) S hieu biet trong s dung- Lieu dung va nong o: lieu toi thieu co tac dung (lieu ngng): lng thuoc cho vao c the e bat au co tac dung.Lieuieutr(thngcaohnlieungng):csdunglamsangnhammuc ch khoi phuc chc nang bnh thng cua c the va gay ro i loan benh ly.Lieu gay oc (cao hn lieu ieu tr): lieu bat au co nhng benh ly oc hai.Lieu gay chet (LD50) gay chet 50% ong vat th nhgiem.- Nhp cung cap thuoc: phu thuoc vao thi gian ban huy (T1/2) cua thuoc. T1/2 la thi gian can thie t e nong o thuoc trong huye t tng giam i mot na.Nhp cung cap thuo c (khoang cach gia cac lan s dung)3-4 lan / ngay neu T1/2 t vai phut - 4 gi2 lan / ngay neu T1/2 t 4 gi - 10 gi1 lan / ngay neu T1/2 t tren 12 gi

Mot biet dc thng co 3 ten chu ye u sau:Ten khoa hoc (chemical name): c goi theo cau tao hoa hoc cua biet dc o, ten nay co khi khong c ghi tren nhan thuoc.Ten hoat chat (generic), V du: ten hoa t chat (oxytetracyclin)Ten thng mai: Terramycin (PFIZER) Ch nh: s dung thuoc trong trng hp nao? benh g ?.Chongchnh:khongcphepsdungthuoctrongnhngtrnghpcuthe nham e phong oc tnh va cac tai bien khi dung thuo c.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vnNgoai ra co the co phan than trong khi dung thuoc (precaution). Lieulngsethayoituytheongcapthuoc,loaigiasucvamucchs dung.

Lien quan en ng cap thuoc: - Bot tron vao thc an (Feed additive), nc uong (drinking water)- Vien uong (tablet)- Siro uong (syrup)- Kem an (cream)- Bot pha tiem (powder for injection)- Dung dch tiem (solution for injection)- Dung dch xt (spray)...

Qui nh phng cach bao quan nham tranh lam h hong cac hoat chat trong biet dc-Cho biet thi han toi a co the dung thuoc. Trongthu y, ngisdung thuocconcan chu y enthigianngngthuoctrc khi giet mo (oi vi heo tht, bo tht, ga tht...), trc khi s dung cac suc san (sa, mat ong, trng ga...) e am bao van e an toan thc pham.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn12 Chng 2. THUC TC DNG TR THN KINH C C CH H THN KINH TRUNG NG c m Trcnm1845,iutrbngphngphpgiiphuchacphbindobi th/u phng php tha ng to ra trng thi mo nm 1845146 h/u qa gy mca nitrous oxidev c tnh gy mca c chloroform v diethyl ether c cng nhn. Nhng thng tin ny nhanh ch ng tr th nh thac gy m cho ngnh dc thi by gi ng thi chng cng lc c cht u ti n ca nhm thuc m bay hi.Nm1929,cyclopropancgiithiunhmtthucmbayhith4.Trong4 thac n y ch c nitrous oxid cj n c s dng trn lm sng cho n ng y nay ther rcyc/opropan th d gy chy n cj n ch/oroorm g y c cho gan.C cngh/ ncutiptheovthucmbayhimchngcctnhkhnggy ch yn cngnhkhngcctnhcaokhngngngphttrin,vonm1956 tmthyHalothan (LT)nyhn,haichtetherhalogenho cgiithiul en/arane (TC) r /so/arane () c dc tnh ca cc loi thucm bayhi c / mg/mirtnhiutuynhi nthacm dngquangti mch/chrncsdngrngr / hn. nh nghaThac m/cht khi cp vo c th s tc ng l n h thn kinh trung ng sinh ra trng thi ng,uti n/ smtthcv cmgic,knl sgi nngh ho nto ncacvn,nhng khang / mo trn cc hot ng ca h tun ho n rha hp. C ch tc ng ca thuc mC nhi 'W W' 't sinh l thn kinh Thac mc ch cu trc li. Thac mgn v o //p/d ca m ng t b o g y cn tr trao i Na+ qua m ng do ngn cn s kh cc ca m ng t b o n n c ch s dn truyn ca lung thn kinh.t dc l thn kinhC c nron nhy cm phn bit vi thuc m T b o sng lng ty sng rt nhy cm vi thuc mS gim hot tnh ca nron v ng n y / m g/m dn truyn cm gic theo ng tyi th k c cm gic au (giai on 1). Giai on c ch ldo s kch thch cc nron c ch c ng ri s l m d d ng cc nron k/ch th/chTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn2 Thac m lm suy nhc cu trc li truyn ln a n c ch phn x ty g y g/ n c (giai on 3). Cc nron ca trung tm h hp vrn mch h nh ty tng i t nhy cm ri thucm (giai on 4). Dc ng hc Thac m/cht kh hoc cht lng d bay hi trc ti n r o phi, sang mu ri n n o gy tc ng. S thm nhp v o phi ph thuc nng thuc mtrong kh/ h/t r o rs thang kh/ phi.S thm nhp t phi v o m a ph thuc nng thuc mtrong m a t/nh thm ca th nh ph nang v c bit tnh hj a tan ca thuc mtrong m akh/ ch s n y c ng cao thac mc ng tan nh/u trong mu nnt lc cng trong ng mch chm, t cn bng trong n o chm r ry g y cm ng chm. Thuc mn o /t tan trong m a g y cm ng nhanh. Thac m/cht kh hoc cht lng d bay hi c o thi qua phi, mt phn c th t/ch t trong cc m m, sau cng o thi qua thn hoc qua phi. Thac m ng tnh mch othiqua ngtiudngmthottnh.Halothan / thacmbay hiduy nhtcj nsdng, khong 30% halothan c b chayn ha th nh gc t do (chlorotrifluoroethyl) gy c cho gan. ethoy/aran / ether ha/othan h a h/n nay t c d ng r n 5 thac b chuyn ha th nh /aor voxalategycgan.Enflurancngtofluornhngvislngrtt,cj n2 /tb chaynha. Timlc ca thucmdng ng hhpc biuth bng nngph nang ti th/u(MACm/n/mam/rero/arConcentrat/on)/ nng thacmtatmospherecncti ph nang 50% bnh nhn khng p ng vi mt kch thch au c ti a chan ha.ithucm c mtMACxcnhnhngMAC,nhngMACcththayi ricc bnh nhn t y theo tai, tnh trng t/m mch, cc thuc c s dng phi hp. h/ s dng c ng / cnh/uthucm thg/ trMACcachng cnglcvinhau. /dMethoxyflurancMAC 16 ngha lc16 ph n t kh ht v o /methoy/aran Thacmdngngtnhmch othiquangtiusaukhibchuynha th nh dng mt hot tnh. N2O c MAC> 100 lthac myu nht. Dc lc hcTc ng tr n t/mmch: halothan, enfluran v isoenfluran u l mg/mhuyt p t lvi nng trong ph nang ca chng.Tc ng tr n ha hp: tt c thuc m dng ng h hp u lm suy nhc h hp; nhiu nht l/so/aran ren/aran /t nht ld/ethy/ etherTc ng tr n n o: thac m/ m g/m chuyn ha n o nhng lm tng lu lng n o do g/m sc cng mch n oTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn3Tc ng tr n thn: thuc m/ m g/m tc ca cu thn v lu lng thn do g/m sc cn mch thn.Tc ng tr n gan: thac m dng ng h hp l m g/m lu lng gan t 1545 so ri trc khi gy m a ca vic dc m ng trong phu thut ng chng shock, co git ng trong g y ng, gim au Cc giai on ca thuc m Giai on 1: Gim auThcj n tnh nhng bun ng, p ng vi kch thch au gim. Mc gim au thay i /n gia cc thuc, rnht vi eter vn/troas oxid nhng km vi ha/othan Giai on 2: Kch thchT khi th mt thc n khi bt u h hp c nhp iu. Th mt thc, khng cj n p ng vi kch thch ngoi tr kch thch au. Lc n y thac mc ch v n o / m mt s khng ch ca v n o i ri cc trung tm vn ng di v kh/n th trng thi kch ng, giy gia, pht t/ng k a trong hng, bn chn c ng kiu nga phi, h hp su vchm, m mt m rng, ng tgin, chthi ma, cc chtnncthlt qua khqun gyvi mphirc thdn ntrong Giai on 3: Phu thutThac mc ch vng di v vta sng gy mt thc, mt phn x, gi n c r n /a/ on n y cth nhn bit khi s h hp u, tip theo lphn x ng m mt khi kch thch gic mc, ngng c ng mt, h hp tr n n chm v u n, nhp tim vhayt p bnh thng. t c d ng trong thy S d ng qa//u thuc ms dn ti ms aa hp u nhng chmC hon ton gi n thmm nhnPhn v nc tiu b / thi ra ngo /t phn x m mth/t c th gim, th run vco mch Giai on 4: Tt h yThac mc ch trungkhu h hp vrn mch h nh ta gy lit h hp ho n to n dn n ngng h hp vngng tim, th c th cht sau 3 4 ph t ry khng nn vt qu giaiTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn4on 3.h/ ngng s dng thuc mhot ng ca trung khu thn kinh hi phc theo th t ngc /i (hot ng ca trung khu n o mt sau th hi phc trc). ng tai bin lc gy m v cch ph Chy nc bt, nn maCho thnhn i ti th/u 12 gi trc phu thutTim Atropin l m g/m tit nc bt Shock c im: tt huyt p, th gi y g/a do ty sng b c ch.Can th/p: tng huyt p bng cch truyn mu, truyn dch, d ng c c /oi thac kch th/ch thn kinh nh: Nikethamide, mphetam/n Cae/n Camphorate thn nhitCn gi m th lc gy m (dng n hng ngoi si m). n ca thuc m hi pht nhanh v m du, hi phc nhanh. hong cch an to n rng. / n c hon ton, mt thc, gim au c ch phn x ni tng. t nh hng chc nng sng (tim mch, h hp) bo v phn x. hang b chuyn ho th nh cht c v o thi nhanh./n nay khng c thuc m no t tt c cc ti a chan tr n ch/nh r ry phi phi hp /i dng cc u im v/oi b nhc im ca tng thuc. la chn thuc m Tr a bj : etam/neChm o: o/et// etam/ne arb/ta/ sod/ameo: Pentobarb/ta/ Th/openta/ sod/amga: Ketamine c m dng ng tnh mch1. Tnh ch W hi pht mnhanh r 2 /do:t tan trong lipid n n qaa h ng r o m a n o rt nhanh.Ph n phi nhanh n cc m c lu lng mu cao (n o t/m gan thn) T c dng ngn hn (203ph t) dchayn ha rt chm do ti phn phi n c c ma clu lng mu thp (m m, c vn nn nng trong n o g/m nhanh, t c dng gy mchm dt Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn5nhanh) S gim lu lng tim (suy tim sung huyt) th t l mu n n o tng (v c th lun u tin ti mu cho n o) r ry phi gim liu thuc trnh suy thn k/nh trang ng nng, tri li nutnglulngtim(lolng thiqu,nhimc tuyn g/ p) thtngliuthucm ibnh nh n cao tai n n d ng //u thuc mthp r c/u lng tim thp, khi tht c th gim vg/m thanh thi thuc.hn chang thi g/an b n hy ca thuc m dng ng tnh mch u d / r ry nu ti m tnhmchlplinhiulncthgytchtthuctrongcvnvm mn nbnhnhntnh chm.Vryn ndaytrm bngccthuccthigianbn hyngn(14g/)nhketamin,methohe/ta/ m/dao/am droper/do/ etom/date propoo/ 2. Ch | QK Cm ng m : hu ht thuc m ng tnh mch c d ng cm ng m trc kh/ d ng thac m ng h hp. Thiopental lthac cm ng mthang dng nht, etopidate vpropoo/ /cht thay th. Tt c u duy tr t c dng 203 ph t nu ti m tnh mch. ym daytrtrongc cphuthutngn,khngcnth mthacmngh hp: propoo/ ketam/n m/dao/am Phi hp duy tr mkh/ cn tc dng gim au vg y ng: thuc m/oi narcot/c (t/ m tnh mch). sung cho thuc m ng h hp.i thuc m c m khng bay hi

u trc ha hcL chtchuynhacaacidBarbituric.Acidbarbituricl ac/dmnh,rtdphn /yn n khang thm v o thn kinhtrung ng v ry khng c tc dnggy ng. arb/tarat /ac/dya /t phn ly, phn khng phnly tan ctrong lipidvthm qua c h ng r o m a n onhaa tha/ ao gm nhiu loi thuc c tc dng gy md / hoc ngn.arb/taratecchgiiphngacetylcholin,norepinephrinv g/atamate cng c h/u qatr nr pentobarb/ta/toth nhm/met/cc g/mauctorat y Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn6thac v o //u, ng cp, dc ng hc ca thuc v/o / iu tr. Ngo / ra h/u qu ca thuc cth thay i bi tui v iu kin vt l ca bnh nhn hoc bi s hin din ca thuc khc.hng thuc nhm barbiturat suy yu cm gic v ng r n o / m g/m hot ng ca dy thn kinh vn ng vto ra s gim au nhng liu thp. Mt v / barbiturat nh phenobarbital c s dng nh thuc chng co git bi v ch ng ckhuynh hng gim hot ng ca dy thn k/nh rn ng nhng gim au khng ng k. ngi, n c xem nh l nhng barbiturat l m g/m s chuyn ng linh hot ca mt (REMrap/d eye morement) g y ra trng thi ng.u ht cc lo / barb/tarat cth /ngay n nh n g y say g/m chc nng h hp nhng mt s lo / th cth kch thch nh. Nhng liu an thn hoc gy ng, s gim nhp h hp tng t nh trong sinh l g/c ng bnh thng. Khi tng liu, s suyyu trungtm h hp h nh ty tng ln kt qu l g/m nhp th, hn ms a rL S ngngh hp khong 4gi thp hn nhng liu m n/ngay n nh n g y ngng tim.Thac c s dng ch trn mo, chng c bit nhy cm vi nh hng l m say g/m chc nng h hp ca barbiturat. Tr n ch barb/tarateg y chng timp nhanh, ctim co li vi khng vi tng s ngoi bi n (tota/ peripheral). Barbiturat l nguyn nhn lm rn vnha ng ca h thng c trn rat. Tuy nhi n nhng nh hng n y th khang at hin nhiu du h/ulm s ngarb/tarate/ mg/mnhycmcaacuic ng(endp/ate)d ythnkinh rn ng viacetylcholin, dolmthgi n nhcxng.Dobih thng bp ckhngthgi n ho n to n s gi n ngh nhng c xng khc c l cn thit cho th tc g/i phu. Cha c nh hng chnh xc tr n thn ca barbiturate, nhng mt v / s h hi r thn c thxyratiptheochngthiumukhisdngquliu.Chcnng ganthcngchacnh hngchnhxckhicsdngcptnhnhngkhi d ngbarb/taratk od /g ynhycmvi enyme h thng microsomal ca gan th c chng minh (c bit lphenobarb/ta/)c dbarb/tarat / mg/m ti a th oxy tt ccc m, khnglm thayi mc chayn h a th c o lng khi d ng //u an thn.Mc chuyn hac bnc th gim dnn kt qa lg/m nhit c th khi barbiturat c d ng nhng liu gy m Phenobarb/ta/ sod/am d /arb/ta/ sod/amd /mobarb/ta/ sod/am trang bnhPentobarb/ta/ sod/amngnSecobarb/ta/ sod/amngnTh/openta/ sod/amrt ngnTh/ama/y/ sod/am rt ngnTh/a/barb/tone sod/am rt ngnTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn7 n haarb/tarate bchuyn habienzyme microsomgan nhmthC5,cccht chayn ha // n hp vi acid glucuronic ri b o thi qua nc tiu. Kim h a nc tiu lm tng s o thi n y arb/tarate g y cm ng enzyme microsome gan nn lm tng tc chuyn ha ca chnh n rc c cht ni sinh v ngoi sinh cng chuyn ha qua microsom gan. nhnthn,gyng:phihpviccthuckhctrccrilonchcnngv t/ ah a sng vim niu o, bnh ng h hp.L m g/ n c, chng co git: thng d ng phenobarb/ta/ cthi gian tc ng d /Gy m: dng barbiturat c tc ng cc ngn nh thiopental. Tng tc thucRuethylicv c cchtcchthnkinhtrungngkhclmtngctnhcabarbiturate.Barbituratethngphihpvigriseofulvin,hormonsteroid, d/pheny/hydanto/nc c dn xut coumarin, vitaminD c tnh ca barbituratesT/ m qanhanh hoc qu liuTry ha hp, phi cp cu bng th oxy huyt n o m ng n oSay gan tr n c c thb bnh gan khi dng nhm barbiturates tc ng ngnKhng dng cho th s sinh do khong an to n hp vthi gian tc ng ko d /1. Pentobarbital sodium- C 'WU 'Ri '- Tnh ch W'yD'''N 'P i, cm u tr ''G 'E W'WL'W 'R'G ' W' hj a tan trong nc va/coho/ pa75 /coho/ hoc propylene glycol c kt hp v o dang dch tim tng tnh n nh, khng n n pha r o dang dch c tnh acid.hngdungdchhocnhngthuccbitlctnhtnghpvi pentobarb/ta/ sod/am:dangdchdextrose(IV),dungdchti m/ngers/ngers/actate Sa//nephchp Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

detrosesa//nphc hp dextroseRingers, phc hpdextrose/ngers /actate am/kac/n sa/ate am/nophy///natrop/nsa/phatca/c/amch/or/dcephap/r/nsod/amch/oramphen/co/sod/am sacc/natehya/aron/dasehydromorphoneC///doca/nC/neot/gm/nmethy/sa/phate scopa/am/n r sod/am b/carbonate sod/am /od/ne th/openta/ sod/am rrerapam/n C/hng dung dch hoc nhng thuc c bit l khng tng hp ri pentobarb/ta/ sod/am: benqa/nam/dC/batorphano/tartratech/oroma/nC/c/met/d/nC/ch/orphen/ram/n ma/eate code/n photphate d/phenhyram/n C/ droper/do/ phentany/ c/trate proper/do/ phentany/ c/trateg/ycopyrro/atehydrocort/so/sod/amsacc/natehydroy/neC//nsa//nmeper/d/nC/ na/baph/ne C/ norep/nephr/ne b/tartrate oytetracyc//n C/ pen/c////nepotass/am- Ch th nghi n lo i g rco g/t cho m o rchhang dng iu tr co git do bi ng c //doca/nePentobarbitalcsdngnhthucgimauv g yt chonga,bj heodcu. Thngdngsaukhi t/ mthactinmgimliupentobarbitalv tr nht cdngph. Pentobarb/ta// th nhphnhotngchnhtrong nhngdungdchm g/ pchobnhnhnmc bnh nan y cht khng au n.- ang hoc cp qua ng trc tr ng Thac bt u c tc dng t 10 15 ph t saa kh/ ang, khong 1 ph t saa kh/ t/ m/ngnhnhngthuckhctrongnhmbarbiturat,pentobarbitalphnphi nhanhch ng nhu htcc mca cthnhng tptrung caonhtgan vn o 3545 thac li nktvi prote/n hayt tng, thuc qua c nhau tha/ rsa.Pentobarbitalcchuynhagan,b /thiquanctiu.Thnhaili,c b/td rcu, chuyn ha pentobarbital rt nhanh.- Ch bnh tim hoc bnh h thng h hp hang d ng //u cao cho bnh nhn b vi m thn cp hoc suy gim chc nng h hp, bnh gan.h/ t/ m tnh mch phi ti m tht chm. Thuc c th l m g/m chc nng h hp khi gy m.Mockhuynhhngcbitnhycmvihiuqul mg/m auhthnghahpca barb/taratrrycnchkhisdngcholo /n y o cnhycmvinhhngca barbiturate hn mo ci.- B n chtrong th phc kh/d ng//ugym arb/taratec thgykchngkhitimdi damchmungoibi n khng dng ng tim ng mch.- narcot/c Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

phenoth/a/ne ant/h/stam/n ra/pro/c ac/d rch/oramphen/co/ h tha m g//pentobab/ta/g qa/n/d/ntheophy///nmetron/dao/e Pentobarb/ta/ ph arosem/de cthnh tr cth m a c - Li ng:n tho: 24mgkgt/ m t y mcho ch : 13mg kg t/ m tCh mm d 12 gcon t/ m t L mm dn heo: 2 mgkg th T/n heo: 2 4 mgkg th m tg y tr ng g/2. Thiopental sodium - C - Tnh ch m u tr thd a tr ng j a tan trong n c Th/openta/cpa76 r/m L loibarbituratetcngrt ngn,l thucm ctc ngmnh, nhanhv ngh h ch/oramphen/co/sod/amsacc/natehyag/aron/dasehydrocort/so/sod/amsacc/nateneot/gm/n methy/sa/phateo/to/npentobarb/ta/sod/amphenobarb/ta/sod/ampotasa/amch/or/de scopa/am/n r sod/am /od/ne rtabocarar/ne ch/or/deh /actate am/kac/nsa/phateatrop/nsa/phateben/qa/nam/decephap/r/nsod/amch/oproma/n code/nphotphatd/menhyr/nateepher/nsa/phateg/ycopyrro/atehydromorphone/nsa//n /erorphano/b/tartratemeper/d/nmetaram/no/morph/nesa/phatenorep/nephr/neb/tartrate pen/c////nepotas/am Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn - Ch th vsod/am ch kh c r/ch day nh - mt tr trth / ngmTha o n o saa o b r ma m oTha c b / th kho4 thaj n ho Th/openta/ cth - Ch t/ m tm- B o cth nh tr m thu c cth m t n mhypog/ycem/a- Li ng: li mcho ti 35 mg / kg, ti m t // 15 mgkg t/ m t - 3. Thiabarbitone sodium L/ chm o: 72 mgkg t/ m t L/ ag ym chong 33mgkgt/ mt c th m th (2) KETAMIN Cu trc ho hc Tnh chtetam/nc m atr 25261oC j atantrongn )r a/coho/(1g14m/)hangtrr d/aepam trong c ng mm ho m t ( bag) r cth Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn11 Dc lc hcetam/n/ /oithucm hotngnhanh.KetamincchGABAv cngcn tr seroton/n norep/nephr/ne rdopam/n n o nto ra trng thi m giai on 1 r2 khang cgiai on 3. Tr n m o saa kh/ d ng etam/n cth gy gim th n nh/t trung bnh 16oC Saa kh/ t/ m tnh mch khong 306 g/ y t/ m bp t 3 ph t ketam/n bt u hot ng. S hi sc s k o d / nu ketamin c s dng phi hp vi barbiturat, benzodiazepines, hoc narcotics.etam/n //oi thuc gy mrg y mt cm gic c tc ng mnh. liu c tc ng gy m r g ymtcmgic(1mg/kg)sl mchobnhnhnathin h nhr/t chb/tvimi trng xung quanh, bnh nhn xut hin trng thi khng ng, mt m, nhng c ng t do v thc. Thuc cng c th gy o gic nh hng n tm thn nhng trng hp d ng qa//u. C ch tc ng: c ch cht dn truynT c dng: gy mngn, gim au do can thip v o h/u ng m ng t b o kh/ chu cht dn traynthnkinhac/dg/atam/cetam/n/ chtgy mquang tnhmchduynhtckch th/ch t/m mch: nhp tim, huyt p ng mch v cung lng tim u tng rrt. Ketamin lm tng /ang mu, tng ti a th oxy n oT c dng ph: Tng tit nc bt do cn d ng trop/n / m cht tin m (1 mg1 kg th trng).i lon tm thn (phj ng nga bng Diazepam)Tng nh nhp tim v tng huyt petam/n/ chtgymquangtnhmchduynhtckchthchtimmch: nhptim, hayt p ng mch v cung lng tim u tng rrt. Ketamin l m tng lung mu, tng ti a th oy n oetam/n khang nh hng n chc nng h hp liu thng thng nhng d ng //u cao s l m g/m chc nng h hp. Dc ng hcetam/n ph n phi n hu ht trong c th nhng tp trung cao nht n o gan phi vma m. Thuc li n kt vi protein huyt tng khong 50% nga, 53 ch, 3753 m oKetamin c chuyn ha gan vb / thi dng cj n hot tnh trong nc tiu. ng ch nhetam/nchngchnhvinhng bnh nhnnhycm vin,c thtngplc cah thnkinhtrungng.Trnnhngconvtcduhiumtmuj /hi cngimliuketamin. hng bnh nhn cng gip c th tng huyt huyt p v nhp tim nu d ng ketam/n hng du h/u trong th y th cha c bit.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn12t m o rn m sau khi d ng ketam/n r ry n n kt hp vi cht bi trn gic mc bo r mt trnh cc chn thng, ngn nga s kh gic mc. Bi v ketam/n cth lm tng p sut m acn thnvngaycgy xuthuyt saukhigii phu l rtcao.Khngcnthitphich n loi thc n cho n v nc ung cang cp cho th trc khi gii phu nhng cnhng ngh l nn ngng thc n khong 6 gi trc khi gii phu.hong 20% s m o d ng ketam/n gp tnh trng co git sau khi d ng //u iu tr. C th gy au v tr tim. gim bt nhng nh hng do bi qu nhy cm vi thuc hoc nhng du h/u khc ca h thn kinh t tr, atropine hoc glycopyrrolate thng c ti m kt hp.uKetaminc xemnhlcchscaotrongtrliu(khong 5gi hochnkhi sos nh ri pentobarbital). Khi d ng thac vi liu qu mc hoc ti m nhanh s xy ra du hiu suy gim ha hp c th iu tr bng cch s dng cc thuctr sc. Yoh/mb/ne ri 4aminopyridine c xut s dng nh mt cht i vn ch yu. Tng tc thucarcot/cbarb/tarates hoc diazepam nu c phi hp c th ko d / thi gian g y mca ketam/nh/sdngvihalothane,tcdnggym caKetaminc thkod /r nhhng k/ch th/ch t/m ca ketamin c th b c ch. Tng t, chloramphenicol (ngoi ti a h a) cth ko d /h/uqugym ca ketam/nThyro/dhormoneskhidngngthiviketamincthgy tng huyt p v tim p nhanh ngi vproprano/o/ cth c li trong iu tr nhng nh hngn y Sacc/ny/ cho//ne rtabocarar/ne g y nh hng hoc ko d / s suy gim ha hp. u d +Diazepam0.5mg/kgIVdiazepam,saudngketamin10mg/kgIV(ooth 1) /dao/am 6622mgkghoc IV, sau d ng ketam/n 6611mgkg(ansager 1)+Xylazine2.2mg/kgIM,sau10phttimketamin11mg/kgIM.Chc trng lng >22.7 kg th g/m liu ca c hai thuc khong 25% (Booth, 1988).trop/n44mgkgsaa15ph tt/ptcchoxylazin1.1mg/kg,IM,5 ph t sau dng ketamin 22mg/kg, IM (Booth, 1988). thpAtropinhocglycopyrrolatetrckhiti ketamingimbtsnhycmcadcphm,24mgkghoc1133mgkg(ar/d 15)j :T/ mtrop/nhocxylazin,sauti mketam/n2mgkg(Tharmonr enson Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn1316) + Tim Atropin, sau tim ketamin 11mg/ kg IM. ko d / thi gian gim au v tng thi gian gy mn n t/ m th m ketam/n 24mgkg etam/n 22mgkg kt hp vi acepromazin 1.1mg/kg , IM (Swindle, 1985).t/ m tnh mch 2 5 mg kg th trng liu uL/u duy tr bng//u u, cch nhaa 1 ph t Thac d ng cho c c /o / g/a s c

Thac md ng cho t/u gia sc (Ch m o)T/n mbng Atropin liu 1 mg / 10 kg th trngSaa 1 ph t ch/ch o/et// u d Ch : 725 mgkg th trng (ti m bp), 51 mgkg th trng (ti m tnh mch)o: 115 mgkg th trng (ti m bp); 7,5 mg/kg th trng (ti m tnh mch) u trc ho hc

t ha hcentany/ c/trate cm a trng, dng bt tinh th, tan yu trong nc va/coho/ khang m / r, pKa = 8.3 vnh/t tan chy 147152oCentany/ c/trate /mt butyrephenone an thn, c m a trng n v ng s ng khang chnh dng nht nh hoc c dng ht kt tinh ln. Hj a tan nc (1g/10 L) v a/coho/ (1g6m/) khang m /r,pKa=7.6nh/ttanchy14414oChng snphmthngmiInnovarvnnoraret p khong 335 o qun/ tnh bn vng/ tnh cnh tranhngthucti mhay/thytinhthcboqunnhitphj ngr tr nh nh s ng nnorarc thtnghpvic cchtsau:W,lactatedRingers,D5trong /actate/ngers potass/am ch/or/de rsod/am b/carbonateTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn14 Dc lc hch mbatyrephenones(r/dnhDroperidol)cxemnhlmtlpthucan thnvg/mau (hiuqugimauthphnphenothiazines)hotng nh mtcht chng nn,gim hotngcadythnkinhvnngv cch catecho/am/ncahthnkinhtrungng (dopam/nnorep/nephr/ne)Tr nch,QQRYDU |Oj P|W Q|P F| ||WRQH||F D|WK Q|NLQK|P t |Yl m gi P|K W|i S| Q mch. Tr n mo, gy tng nhp tim Innovar gy tng nhp tim. dng/ch nhentany/trongth y chcchophpd ngtr nch thcsdngmt mnh g y m anthn cho tiu phu, nha khoa, phu thutchnh hnh c c thao t c phu thut trong thi g/an ngn. N gp phn ngn chn tnh kch ng tr n ch. Fentanyl/ Droperidol c s dng nh thac an thn/ gy mtr n m o Dc ng hcot ng ca thuc s xy ra sau khi ti m tnh mch trong vj ng r / ph t rd / hn khng ngksoviti mbp.Tr nm osaakh/t/ mSh/uqutcng yrasau203ph t To n b thuc c chuyn ha gan vb / thi qua nc tiu. Hiu lc ca thuc ko d / 34 ph t saa kh/ t/ m tnh mch, hu ht ths c an thn khong v / g/ sau khi ti m saa kh/ ngng g ym Cnkhong 15g/chhiphcho nto nsaakh/g ym thacbngngtnh mch. ng ch nh/ch Khngcbsungthucv othcncpchoth.Sdngchvicc thaccc thac l mm du h thn kinh trung ng, cn g/m liu d ng c c thac mkh c kh/ d ng kt hp nnorarL/u d ng capentobarbital cn cgim khong 4gi saukhid ngnnorart/ m mch ngoi vi c th gy kch ng cc ma ang qaanh cn trnh s thot mch. Ch sn c c th khng hiu qu g y mca Innovar liu thng thng nhng chng cng gy r ng mnh t/t nh/u nc bt, ti a chy. t li/cnh bot li ca Innovar tr n chbao gm i tiu, y hi, suy gim h hp, gy au, g/t nh n cu. Tim p chm vt/t nhiu nc bt cth thy nu th khng c iu tr vi atropin hoc c c thac i giao cm khc. Hi chng c gi l oody chestcth xy ra sau khi ti m tnh mchnhanh.Hthngbpthtv ng ngctrn nrnchcv / mcntrsthbnhthng nhng c th iu tr vi na/oon c c thac d n c. Kch thch thn kinh trung ng, tht iu vn ng, hot ng bt thng c th thy heo sau khi ti m bp.uTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn15a//u l m nh hng nhiu nht n h thng h hp v hoc c ch h thn k/nh trang ng.Th misinhnhycmvinhhngcathuchnthtrng thnh.Cctnhckhc bao gm suy yu tim mch, r ng mnh co cng c v co g/t. Naloxon lthac c chn iu tr suy gim h hp.uquliunghi mtrng,cnd ngna/oonth m//u/pli,n nk/mtracht ch g/mbtccnhhngcanaloxontrckhifentanyltticcmcdi ct(subto/c) nsdngccthitbtrhhptrongtrnghpsuy g/mchcnnghhp.4aminopyrimidin c chng minh lhot ng nh cht i khng vi droperidol tr n ch liu 5mgkg t/ m tnh mch. Pentobarbital (6.6mg/kg) dng trong iu tr cc nh hng tr n h thn kinh trung ng (co g/t), dui thng hoc co cng c c. Tng tc thucC cthacl m mduthnkinhkh c(thackhnghistamin,phenothiazines, barb/tarates thac an thn, alcohol,) c th lm suy nhc h thn kinh trung ng v h h hp khi c s dng vifentanyl (opiate).Thuc m/oiopiateth chng chnhivibnh nhnang d ng c cchtcchmonoaminoxidase(MOA) (tkhicdt14ngt ny. i vi droper/do/ (batyrephenones) c c cht l mm du thn kinh trung ng nh(barbiturates,narcotic,)cthgysuynhchthnkinhtrungngnu cs dng vi (butyrephenones). u d Cn ngn ngatnhtrng timp chm vt/tnhiunc bt,atropin(0.045 mgkg S) hoc glycopyrrolate nn c ti m khong 15pht trc khi ti m tnh mch hoc tim ng thi vi t/ m bp.a)/mau,anthn:1ml/6.81kg(1115m/kg)t/ mbphoc1ml/11.3527kg (37m/kg) t/ m tnh mch.b)y m :1m/12kg t/ m bp hoc 1ml/11.35273kg t/ m tnh mch. Cn t/ m th m c c /oi thuc m nh barbiturates, halothane khong 10 pht sau khi ti m t/ m bp v1 ph t saa kh/ t/ m tnh mch.c) an thn: 0.35m/55kg t/ m tnh mch. T/n m : 1m/2kg t/ m bp.Gyml md ndd y:1m/13kgpha/o ngtrongdangdchccha mai,ti m chm tnh mch (Morgan, 19) 1m/kgthtrng,SQ,hiuqucaonhtxyragia306ph tsaakh/t/ m (randyrTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn16eath 17)

u trc ho hc

t ha hcL mtimidazobenzodiazepin,midazolamcm atrngnv ngs ngdngbt t/nhth ripKa=6.15.Tnhhj atantrongchtlngcamidazolamHCltu thacv opnhit 25oC rp34 13 mg m/dao/am C/ hj a tan trong 1ml nc. o qun/ tnh n nh/ tnh tng hpo qun nhit phj ng (153oC) tr nhnh s ngMidazolamctnhtnghpvichtsau:D5W,lactatedRingers,atropinsa/phate entany/ c/trate g/ycopyrro/ate hydoy/ne C/ prometha/ne C/ saatany/ c/trate ketam/n C/ meper/d/ne C/ morph/ne sa/phate na/baph/ne C/ scopo/am/n r Dc lc hc/dao/am th hin hot tnh dc lc tng t benzodiazepin. dng/ch nhh/ kt hp vi cc thuc mch/u lc mnh (ketamin hoc fentanyl) to hiu qa an thn cao ngi, midazolam l m g/m nh hng ca dreamlike, tngp sat mch mu vnhp tim do ketam/n g y rah/sos nhriccthucd ngg ym cmngnhmthiobarbiturate(thiamylal,th/obenta/) m/dao/am ch/u qu l m g/m au tr n t/m phi thp hn, l mt cht c th hj a tan trong nc, c th trn ln vi mt v / cht khc, vkhang c khuynh hng tch ly trong c th saa kh/ d ng //u lp li./dao/amrtchiuqukhid ngmtmnhnhchtgycmngm /c ngdng thac tr n / m s ng trong thy cng nh vic phi hp vi cc loi thuc kh c n n cs ch dn. Dc ng hcSaa kh/ t/ m bp, midazolamhp thurt nhanhvgn nh hon ton(khong 1) c Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn17d c cchphmmidazolambntr nthtrngkhngd ngqaa ngungnhngmidazolam c hp thu rt tt sau khi ung. T l thuc li n kt ri protein rt cao (947) rqaa h ng r o m a n o mt cch nhanh chng.Thaccchuynhagan.Chtchuynhacj nhottnhchnhth nh(hydroxymidazolam)nhngbivthigianbnhycanrtngnv hot ngdclchc chm hn nn hiu qu lm sng khng ng k. ngi, thi g/an b n hy vthi gian hot ng ca thuc trong huyt thanh c xem nh ngn hn diazepam. Thi gian bn hy ca diazepam ngi khong 2 gi trong kh/ m/dao/am khong 30 gi. ng ch nh/ch nh nhn nhy cm vi benzodiazepines, tng nh np cp tnh v ry cn trnh tim ng mch v nh bnh nhn b bnh gan thn, sung huyt tim c th l m b / thi thuc chm. Cn ch tr n bnh nhn b hn mshock say g/m h hp i ri thuc, phn phi ca midazolam v o sa th cha c bit nhng benzodiazepin kh c rc c cht chuyn ha ca chng th ph n phi v o sa vcth g y nh hng tr n h thn kinh trung ng. t li/c Thacgynhhngnnhphhp,nhptim,huytp.Suygimhhp thngthy tr n bnh nhn nhn thuc nhm narcotic hoc COPD. Bt li thng thy khong 1% nhng >5% tr nbnhnhnnhnmidazolam:gy auchti mdng ccb,auu,bannn,imavnc. Tng tc thucS dng barbiturates hoc cc thuc l mm du thn kinh trung ng khc c th gy tng say g/m h hp n mc nguy him. Narcotic (bao gm Innovar) c th gy tng nh hng gy ng ca midazolam vg y g y g/m th n nh/t khi d ng chang ri meperidine. Midazolam c th g y g/m liu quy nh ca cc thuc m bay hi hay thiopental. u d Chm o: 66 22mgkghoc IV. Nga: 0.01144 mgkg(andsager 1) u trc ho hcC12 1 Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

Tnh chtLm n a d//sopropy/pheno/) ang dm d ch nh 225mgm/ g/ycero/ 12mgm/ /ec/th/n tr Propoo/ cj n Bo qun/ tnh n nh/ tnh tng hpangdmpropoo/c ch m tm Dc lc hcPropoo/ /ch kh ho c ch ch c m ch g y m(sabenesthet/c)propoo/ g y an th ch nh r/ m qaanh nt/mm propoo/baog h Tha mtha ng // nh/khang cho t/nh ch m g/ S dng/ ch nh o trong kh/ qaho Dc ng hcSaa kh/ t/ m t o h ng r o m a n o r msaa 1 ph t Th 5 ph t 5 than k prote/n hay tha/ hj a tan cao trong //p/d r r o trong s Th s r nhanh to nh c c chcj n ho / thch n m o ra khang t chThph hg/ Chng ch nh/ch /an to n cho sinh snPropoo/ ch nh ph o cthan s an th S n bndc n t/mm / m say Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

g/ propoo/ cn k rnh y th h/ y c c tha kh c s thnb o b nh Propoo/ cth t/nh an to n kh/ sd mang tha/ th ch rngh/ g/s/nh Bt li/cnh botha mtr (cyanos/s)n n c(25 // m s / // g y g/ph ngh/stam/n nh nr g yph msay y r m g/ g/ nc n/th c cht/ mtd/aepam Tay nh/ n rng th c th n b /n e/nbodyh a ch th nhe/nbodydob hn y n n thay th a ph/a tr n r m m c Tng tc thuc (aceproma/nop/ates)c th m n m r b/kh/ c c tha ng m say y g/an bnh phn b mm dth c rC ctha m 45 cimetidine)hoc fentanyl, halothane cth ko d i thi gian bnh phc nu d ng kt h Liu d ngChvm oa) 4mgkg(abbe// 14)b) an th kgph tc) t/ 25kgthTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn Sanderson rcng s, 1993).d) 6 mgkgtr n thkhe khong 25% liu c tnh c cp sau mi 30 g/ y cho n cho n khi c th lunng v o kh/ qan. Saukhi cm ng, khong thi gian gy mch khong 2.54 ph ty mday tr n n s dng thuc m bay hi hoc tip tc cp propofol 0.4mg/kg/pht.(7) ETOMIDATE Cu trc ho hcC12

12

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2tom/date (m/date) /mt thuc cm ng mcmt s tnh cht ha hc khc ri nhm barb/tarater benod/aep/nh/t/ mtnhmch,tnhtrngmtthc sxyrasau1phtvtrc 5 pht, bnh nhn ho n to n tnh to sau 714 ph t Thac c chuyn ha nhanh gan vhayt tng.Mc d thi gian bnhy ca thuckhong 4gi tuy nhi n h/u qu ca thuc tr n / m s ng rt thp sau 115 g/.tom/dateth/utcdngl mg/mauvccctnhl mg/ nc,gymyc(myoc/onas) kh/ t/ m ry, s dng ng thi cc thuc c ch thn kinh c nh sacc/ny/ cho//n c bit l trong trnghp lun ng v o b n trong kh/ qan s i theosau . Khngging nh barb/tarate etom/date ch gy suy gim nh cu trc ca vng di i v say g/m h hp vt/m mch cng khng ng k.o bi tnh t nh hng n tim mch vthi gian tc ng ngn, etomidate c s dng cmngm tr nbnhnhncnguycrirocaohoc khangmankoditcngca benzodiazepin. Gy my c, gy aa v tr t/ m /t c dng ph thng thy ca etomidate.Thac c kh nng c ch p ng ca v thng thn, y lg/i hn ch yu ca chng r li ch lm s ng ca chng. Bnh nhn s tnh li nhanh chng vri khi trng thi mu h phi tri au n trong khi gii phu hoc thao tc, trong trng hp n y bnh nhn cn c gim au,timtnhmchnarcotics thngchiuqu.C3loinarcoticsthngcdngl m g/m au.entany/ (SL) /cht u ti n n xut th 2 ca n la/entany/ (LT) rsa/entany/ (ST) Tt c 3 loi narcotics tng hp ny u c t/nh cht dc l ging nh morph/ne hng thuc ny thng c s dng l m mt cm gic au do thi gian tc ng tng i ngn vg/ p n nh thn kinh t tr bng cch c ch thn kinh giao cm kch thch cm Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

gic au v ry c tc dng gim rt mnh cho gii phu.Tt c 3 loi thuc trn u c hiu lc gim au mnh hn morphine. Nhng //u tng ng th ch ng g y say g/m h hp mc ging nhau. //u g y mc c thac n y g y tnh trng sressreemtcchtng idobimc thay itimmch rtthpvg/mhotng cahthnkinhgiaocm.Khi cpthuctrcgiiphu,btcthucn odgystressvmt s/nh /b lm dng trong trng hp soi thanh qun, lun ng v o kh/ qan vrch da. Cc thuc n y cj n cs dngchobnh nhn byu sckhng c kh nng dung nptt ri hu htcc /oi thuc m bay hi. /entany/ (LT)chbng h/u lccafentanyl, thigian tc ngch bng 1/3 hoc(515 ph t) r ry alfentanyl c xem l narcotic tc ng ngn. Alfentanyl thng c cp qua ng tnh mch li n tc duy tr trng thi mc da/entany/ cthi gian tc ng ngn nhng hiu qu tr n / m s ng s k o d / do s chm phn phi li thuc t n o n m c v ma m.L/ulplicthpdngkodihnhiuqucathucnhngnid trthuc trong c thtr n n b ohj a ri thuc vnng thuc trong mu stng / n h/g y mbng a/entany/ cn ch n cc du hiu suy gim h hp ca thrcn chun b phng php iu tr thch hp. c m bay hiso/arane en/arane r ha/othane / bachtgy m bay hi c ngdng trong g y mthc tin. Chng lc c cht lng d bay hi. Nitrous oxid, l mt cht kh ri cc tnh cht gy mn thng c kt hp vi mt cht lng d bay hi khc gim bt hiu lc gy msaa kh/ g/i phu.n v liu d ng cho thac m bay hi nitrous oxide khng c tnh bng m///grams hay m//////ters //u ca chng c tnh bng phn trm thuc m bay hi trong cmt hn hp kh mbnh nhn ht v o So s nh g/a cc thuc th c l m bi so snh phn trm bc hi ca mi hp cht cn to ra trng thi m t ha hcLthac mdng xng hi, halothan khng mu, kh chy, c mi c trng kt hp gia chloroformvng(sweet),vnng.Halothantanyutrongnc r toth nhhnhpvi a/coho/ Trng lc ri ng ca halothan l172 r p sat bc hi l243 mm g C ca halothan trong oy /7 o qun/ tnh n nh/ tnh cnh tranhTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

Halothan c bo qun nhit di 40oC trong vt cha kn. Tnh n nh ca halothan ch yu c kt hp vi thymol vammon/a Thymo/ khang / m bc hi v ry ncth l m cho chtbayhibinthnhmuvng.Khngcs dngcccht b/nm ahngchtbin m a cth c l m sch bi d/ethy/ etheru c hi m, halothan bc hi c th phn ng vi vt bng nhm, ng thau, ch Cao sa rc c cht do khc trong hn hp vi halothan c th l m g/m nhanh t c dng ca chng. Dc lc hcCchtcngcahuhtthucmbayhithkhangcbitr ch ngc thquy nh/u chc nng ca t b o thn kinh n o bi hot ng ca lp lipid m ng t v / nh hng dc lc hc ca halothan bao gm: suy nhc thn kinh trung ng, suy gim trung tm iu hj a nh/t c th, tng lu lng mu n n o g/m h hp, gim thn nhit, co mch v/ m say yu c tim.C (m/n/ma/ a/reo/ar concentrat/on ) trongkh/ 2 ca halothanrt khc nhaa:ch 76 m o 2 nga= 0.88; ngi = 0.76. Mt v / yu t l m b/n i C (nh/t , cc thuc / m say g/m chc nng ca h thn kinh trung ng, tai, ang c bnh cp tnh) dng/ch nha/othan c d ng / m thac mtrong thy do bi tnh an to n h/u lc cao, c th kim sot trong khi dng, khng chy, gi tng i thp. Dc lc hcHalothan c hp thu nhanh chng qua phi. Khong 12% thuc hp thu c chayn ha bi gan to th nh tr//aoroacet/c ac/d (s lng thp), chlorine v gc brom/de tt c chng c b / thi qua nc tiu. Phn ln thuc hp thu s c b / thi li qua phi vcai c ng /thi qua hi th. Halothan cj n c phn phi v o sa. ng ch nh/ ch / an to na/othan chng ch nh cho bnh nhn c tin s d gia tng thn nhit hoc ng c gan kh/d ngha/othansayg/mchcnnggan,tngnhptim,chn thngu.Trnngvt, ha/othan cth gy qui thai v ry ch d ng kh/ cn thit. t li/cnh boCth l mg/m thnnhitv iunyc lin quan n liu.Hi chnggim th n nh/tstress (hyperthem/a stress) thng thy tr n heo nga, ch, vm o a/othan cth gy suy tim, g/mnhptim.Tcdngl mg/mthnnhitca a/othanc thiutrbngdobutamin. Lidocaine c dngiu tr hoc ngn ngasgim nhp timdohalothan. ngi, v ng da (aand/ce) rhoi t gan sau khi gy m c bit rt r Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

nhhngn y trongth ythchacbittuynhi nha/othanschng ch nhtrong tng lai nu triu chng st do halothan cha c gii thch, v ng da r nhng du hiu khc do ng c gan xy ra. Tng tc thucAcetaminophen khng c dng nh thuc l m g/m au trn th sau khi c gy mbng halothani v ha/othane / m cho c tim nhy cm vi nh hng ca cht kch thch thn k/nh g/ao cm, c bit cc catecholamin, bao gm dopam/n ep/nephr/ne norep/nephr/ne epher/ne metaram/no/ u cn d ng c c thac n y n n s dng ch vcn gim l/u nu cc triu chng bt li xy ra.C cthaccchthnkinhcloikhngkhcc(nondepo/ar//ng) am/nog/ycos/des //ncomyc/ne cn ch khi kt hp vi thuc mha/othan r cth / m phong b thn kinh c.tcchgintip,dtabocarar/nec duhiugygimhuytpkhid ngkt hpvi ha/othan t hp ng thi succinylcholine vi cc loi thuc m bay hi (ha/othan cyc/opropan nitrous oxid, diethyl ether) lm gia tng nh hng tr n t/m (tim p chm, lon nhp tim, kh th) rtr n bnh nhn nhy cm gy gia tng nh/t n mc nguy him. u d Ch m o: a) 3 (//u u); 0.515(//u duy tr) (Pap/ch 12) b) 535 (abbe//) 14)ga: 23(re/ser 12) u trc ho hcL mttronghaithacmetherhalogenha(enfluranevisoflurane)cs dngtr n / ms ngn/aranec h/ulcbngkhongmtcahalothane,MAC canl 16cden/arane g/ngvihalothannhiukhacnh tuy nhi n rnc imkhc nhau viccsosnhsau y:T/nhhj atancaenfluranetrongmuv mamthmctrunggiangia ha/othanr/so/arane ry, tnh gy m nhanh hn halothan vchm hn isoflurane. hong 95 //u b / thi khng qua ng phi.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn24 n/arane cng ging nh ha/othane / m g/m huyt p. Tuy nhi n en/arane ch yu gy d n n mch ngoi vi nhng lm suy gim co tht tim. T kt qa l m g/m huyt p, enflurane gy g/m lu lng mu n thn do gim lng nc tiu.Tuy nhin, qua ng ung enflurane / m g/m lu lng mu n tim gy ra cc du h/u nghi m trng khngmong muntr n bnh nhn mc bnhtim, khng l m thay inhp tim.Enflurane t nh hng n tim hn halothan.n/araneg y sayg/mchc nngh hp ph thucliu cngnh lm say g/m p ng catrungtmhhpdol mg/mlngoxigenvtnglngcarbon d/o/detrong m acn p ng lc mu bng oxy nh mt phn x bo v.n/arane / m d n c t cung tng t halothan v ry cn lu kh/ s dng tr n thmang tha/n/araneg yd nhcxngtthnhalothanenhnghiuqun ykhangcngha trong r/c gii phu cc xoang chnh bn trong c th v ry vic th m c c cht c ch thn kinh c th rt quan trng trong nhiu trng hp.nh hng duynht cathuc m en/aran / to ra mhnh in n o tng t nhng bnh nhn mc chng ng kinh. Enflurane c phi lthac gy co git hay khang th rn cj n ang tranh /an, nhng nhiu kinh nghim tr n / m s ng r loi thuc mn y cho thy c th s dng an to nchohuhtccbnhnhn, khangg ycog/tngoitrd ng//urtcao.Gingnh ha/othane en/arane lm tng s trao i cht vmc ti a th oxi n o d n mch mu n o tnglng mu n n o rCPt v / b o c ot ngh/m cho thy c s h hi gan trn do enflurane nhng hoi t gan doen/aranethchacbit,ngayckhithucccpchobnh nh nbgimoxihuyt ngh/ m trng. u trc ho hc t ha hcLmt loi thuc m bay hi, isoflurane th khang m a khang d chy, cht lng n nh, Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn25c mi hng nhm / ether 20oC, trng lc ri ng ca enflurane l 146 r p sat bay hi l 23 mmg o qun/tnh n nh/ tnh nh tranhIsoflurane c bo qunnhit phj ng n khang btc ng binhsng nhnggi trong rt cha kn, chng nh sng.Isoflurane khng lm h hi vt dng bng nhm, ng thau, th/c, st Dc lc hcTngthalothane,MACcaenfluranetrongkh/2thkh cnhaatheo/o /: ch 15 nga=1.31, ngi= 1.2. dng/ch nhso/arane /mt thucm bay hi m n c mt s nhng thun li nht nh hn so vi ha/othane hay metho//arane do bi n l m g/m bt hiu qu ca thac gim au trn c tim v kh nng nhy cm vi catecholamin s dng n mt c ch an to n tr n bnh nhn b bnh gan, thn. Gi th nh ca isoflurane cao hn methoxyflurane v halothane l im bt li. Dc ng hcIsoflurane c hp thu nhanh chng t ph nang. N c phn phi nhanh v o n o ri qaa nhaa tha/ Phn ln thuc c b / thi qua phi, ch khong 17 thac c chuyn ha gan rch mt lng nh fluoride c to th nh t li/cnh boChng gim huyt p c th xy ra v lin quan n lia Say g/m chc nng h hp cng phthucliu,nh hng nh ti a h a(bannn,ima, tc rat)cbitrt r Say t/m tim p chm cng c th xy ra. Tng tc thucTcngtrnctimca isoflurangingnhhiuqucaccthuckchth/ch thnkinh g/ao cm (dopamine, epinephrine, epherine, metaraminol,) ch v cn kim tra cn thn.Thac phong b thn kinh c khng kh cc, aminoglycosides, lincomycines cn c ch kh/kthpviccthucm ha/ogenh a rc thgy ngnchnthn kinhc.Kt hpng thisuccinylcholineviccloithucmbayhi(halothan, cyc/opropann/troaso/dd/ethy/ ether)lmgiatngnhhngtr nt/m(t/m pchm, lonnhptim,khth)v tr n bnh nhn nhy cm gy gia tng nhit n mc nguy him. u: tng t halothane.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

(4) NITROUS OXIDE Tnh cht ha hc/troas o/de khang m a khang m / r / trong dng mth nh th nkhang th t mong ma nh t/nh / m g/ /troas o/de h kh c c h/ S dng/troaso/dekhanghj atanm n or r n o o hj a m b /th trang(concentrat/on)c o kho7 nr35 2 cthang / m mTay nh/ n sn c n (amnes/a) s kh/ knarcot/cs ho kh c r ng c c /o ch7 /troas o/de 353 kh/ o/ 52 ha/othane en/arane ho t y tha o C c tnh trr nh n) C c ch nh nha cn ngh /c /troaso/dec nt/mm mg/thcang sa y c kh/ n thg/ao c o k m c d ng benod/aep/ne hohhoc th d ng cho b n/troas o/de c s thn trong sg y c c d tr n h th c tnh/troas o/de cth j n t c h b/ 2.1.1. Thuc an thn Thuc ng vchng co git ng // Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

(1) BARBITURATES Cu trc ho hcC t cd k/nhr g yng ng// ng /Phenobarb/tone: ch/ y 3 / y 3 / (2) BROMIDES Tnh cht ha hcrom/dec m atr /d nh/ t/nhth j a tan trong n brom/de12m/) Potass/am brom/de ch brom/deTr brom/des ma /o m kng d Dc lc hc k m g/n ho chay om ngt o/ m ng t h ch Ch nh d ngmmnhpheno/barb/ta/(haypr/m/don)thkhangchok h ch ngphenobarb/ta/thc th ngm mnhbrom/de kho c saa kh/ d ng brom/de Dc ng hc n ngob o brom/de khang // n k prote/n hay o rs Chng ch nhThg/rthb n cho ths/nh s th chTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn28c chng minh. S dng thuc cho th m hoc th non u nh hng n sc tng trng ca th nh bo/bt li/mautrongthigianngnthngthytr nch kh/d ngbrom/dekthpphenobarb/ta/ g c s xy ra nu gim au ko d / ri cc triu chng ng ngn, tht iu vn ng, r ng mnh rnhng biu hin khc ca thnkinh trung ng. / m/ ch cth xy ra tr n chnu trong iu tr kthp bromide vi pr/m/don hay phenobarb/ta/ cth gy ra i ma, ti a chy, to bn, pht ban ( ngi).u dng ngung potassiumbromide liu cao vnhanhs xy ra rilon cp tnh h t/ a h au/ ng c cp tnhg c thng thy hn nhng liu m n t/nh nhng ng c cp tnh cng t/m n vi c cduhiunhauc,ngtkhnguv phnxkm.Kthp dngngunghoc ng ngoi ti a h a sod/am ch/or/de ngoi ti a h a g/acose rthac li tiu (nh furosemic) th s l m g/m bt tc hi do ng c cp t/nh hoc m n t/nh o thac b / thi chm, d b ng c kh/ d ng / a d / ban ng, ri lon phi hp ng tc. Tng tc thucg c bromide c th xy ra nu ion chloride trong ng ti a h a b gim thp v ry s ngayh/mchobnhnhnd ngkhuphnchmlngmuithp. Ngcli,bsungsodium ch/or/de r o khu phn c th l m g/m mc bromidetrong hayt thanhgip hn ch co git. Do bibromidectcdnganthndodcth kthpviccthucanthnkhc(CNSsedating drags)Thaclitiu (d/aret/cs)c thnhhngb /thibromidedosnhhngnliu nha cu (dosage reqa/rement) u d ng cho chri mc ch trn an thn kinh chng co git ch, liu d ng: 3 1 g/n (ang). u trc ho hcTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn29C2

24C/ S t ha hcCh/orproma/ne/ dnxutcapropylaminophenothyazine,chlorpromazinel prototyp/c phenoth/a/ne cm a trng n trng kem, khng m / cr ng, dng bt tinh th. Hj a tan trong nc (1g/1ml) va/coho/ (1g15m/) j a tan trong nc v trng to th nh dang dch ti m cp 35hngchphmcbitlctnhtnghpkhiphihpti mriCh/orproma/ne C/: tt c cc cht lng c th ti m tnh mch, acid ascorbic, atropin sa/phate batorphano/ tatrate d/phenhydram/nedroper/do/entany/c/trateg/ycopyrro/atehepar/nsod/amhydromorphone C/hydroy/neC///doca/neC/meper/d/nemetoc/operam/demetaram/no/b/tatrate morph/nesa/phatepentao/ne/actateproma/neC/prometha/nescopa/am/neC/rtetracyc//ne C/hngchphmcbitlkhngtnghpvichlorpromazineHCl:am/nophy//ne amphoter/c/nch/oramphen/co/sod/amsacc/natech/oroth/a/desod/amd/menhydr/nate meth/c////ne sod/am methohe/ta/ sod/am nac////n sod/am pen/c////nepotass/am pentobarb/ta/ sod/am phenobarb/ta/ sod/am rth/openta/ sodium. Tnh tng hp ph thuc v o c c yu t nh p nh/t vcht pha lo ng c s dng. nhTr n / m s ng ch/orproma/ne d ng / m thac an thn, chng nn ma th nh, ngn tit apomorphine gy i trn ch nhng khng c tc dng tr n m o Ngn i ma do morphin tr n chnhng khng ngn c i ma do sulphate ng hoc d/g/ta//s g/ycos/de Dc ng hcChlorpromazine c hp thu nhanh sau khi ung, chuyn ha gan. Thuc cng c hp thanhanhqaat/ mbpnhngtcdngchmhnsoviti mtnhmch. Ch/orproma/neph n phikhpcthv tp trungn ocaohntronghuyt tng5ch/orproma/netronghayt tnglinktviproteinhuyttng (phnlnvialbumin).Thuccchuynhaganvthn nhng bi thi thac cha c bit rc bit tr n chrm oTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn30 ng ch nh/ ch Nndngngti mtnhmchvthaccthgysngvxtcnuti mbp tc nhanh t li/ cnh boCh/oroma/nec thgyhichngextrapyrimidalm okh/d ng//ucao. hngdu h/u bao gm r ng mnh (tremor) ran ry, khng linh ng v khng c th gi n ng mc. Gy cht (/ethagry) t/ a chy, mt kh nng co tht c vj ng hu mn. Gy mt iu hj a nga do vy nga d b kch thch vtr n n hang d chnh v ry ng y nay ch/oroma/nert t c s dng tr n nga. Tng tc thucgcPhysotigmincthbnhhngbichloromazine.Ngcbithuc d/tc paraqaatbtngl nbichloromazine.Barbiturates,narcoticscth tnghiuqukhiphihp phenoth/a/nes a/n/d/ne phi hp vi phenothiazine l m g/m au tr n t/m C c thac chng ti a chy(Kaolin/pect/nb/smashsabsa//c//ate) r c cchtkhngacid(antacids)gimhpthuc dng qua ng ang. Propranolon kt hp vi phenothiazine c th tng nng ca c hai cht ny trong mu. Phenothiazine ngn chn th th ? adreneg/c nu d ng ep/nephr/ne sau . Chuyn h a phenyto/n b gim nu dng ng thi vi phenoth/a/ne ot ng ca Procain c th b nh hng bi phenothiazine. Dipyron kt hp vi phenothiazine l m g/m thn nhit nghi m trng. u d Chng nn: 0.5mg/kgP, ti m bp (De oro 16)/m au: 3mg/kg P, ng ung.T/n m: di 1.1mg/kg, IM 115 g/ trc khi gii phu (Booth, 1988).Chng nn: 0.05mg/kg, IV hoc 0.5mg/kg, SQ./ n c do co git tetanus: 2mg/kg, IM (Morgan, 1988)j : 221 mgkg1 44 mg kg(oard 16)L/u ung: 1 2 mgkg th trng, 2 4 /n / ng yT/ m bp: 0,5 1 mgkg th trng, 2 4 /n / ng yT/ m tnh mch: 0,5 mg / kg th trng, 2 4 /n / ng ynh Colic nga: 1,5 mg / kg th trng, ti m bp

Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn31 u tr cC16

13C/2 t ha hcL benod/aep/nd/aepamc m atrngnm ar ngdngbttinhth, khangm / nh/t tan chy 131135oC, pKa =3.4. Diazepam khng ng lc u nhng rt ng sau khi nm / aj atantrongnc(1g/333ml),cn(1g/25ml),tankm trongpropy/eng/yco/thpvi beno/c ac/d hoc sodium benzoate to th nh dang dch ti m cp 626 Dc lc hc/aepamcngnhnhngbenzodiazepinkhc lmsuynhcvngivr ng dii ca n o r ry n c tc dng an thn , gi n c vchng co git. C ch hot ng cha c bit r nhng nguyn l cbn baogm: ikhngvi serotonin,tng giiphng hoc toiukin cho gamma am/nobatyr/c ac/d hot ng, gim gii phng acetyl n ohng receptor c bitca benzodiazepin cnh v n o thn,gan, phi v t/m ca ng vt hu nh, nhng lo / kh c th cha c bit. nhn thn, gi n c, tng tn h thm n, chng co git. Dc ng hc/aepam hp thu nhanh qua ng ung, mc cao nht trong huyt tng khong 3 ph t n 2 gi sau khi ung. Thuc hj a tan mnh trong lipid vph n phi khp c th, c th v o sa; n qua c h ng r o m a n o r// n kt rt mnh ri protein huyt tng.Diazepam c chuyn ha gan to th nh chayn ha cht bao gm: desmethy/d/aepam (nord/aepam)temaepamr oaepamnhngchtn y// nkt riglucuronicv b /thiqua nc tiu. ng ch nh/ ch T/ m chm khi ti m tnh mch tr n thnh, c th gy nghn mch, shock, khang d ng cho thmang tha/ rnaa/ con S dng ch i vi bnh nhn b bnh gan thn, suy nhc hoc giyu.Thuccthgimkhnngcathl mr/c. Thconcsinhratthm nhn Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn32benzodiazepines tc ng ngn vi liu qu cao trc khi sinh s b chng kh th, suy yu p ng chayn h a ri stress /nh. t li/ cnh boThay i hot ng m o (d ng, suy nhc, hnh vi khc thng) sau khi d ng d/aepam ngo /ra nhngthngtingnycho bitdiazepamcj nnhhngn gan khidngquang ang. Tng tc thucChayn ha ca d/aepam cth gim van thn qu mc c th xy ra nu d ng chang ri c cthacsau:cimetidin,erythromycine,isoniazid,ketoconazole, proprano/o/r ra/pro/cac/d ntac/dsnhhngnhpthuthucv rycncpthuccchnhau2gitrnhkhnng tng tc ny.Tc ng dc lc ca digoxin c th gia tng, kim tra cc mc digoxin trong hayt thanh hoc cc triu chng ng c. Rifampin nh hng n cc enzyme ca h thng microsomalgan r/ m g/m hot tnh dc lc ca benod/aep/nes u lng

n thn: 0.26mgkg25mgkg P (organ 1)ng kinh: 0,51mgkg Co g/t: 14mgkg Kch thch tnh thm n: 0.0515mgkg ng kinh:0.51mgkg Thac ti m: 2 m/1 mgL/u d ng t/ m bp: 0,2 mg / kg th trng

u trc ho hcC1 22 2STai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn33 t ha hcL dnxutcaphenothiazincm ar ngkhangm /rng,dngbt.Hj a tantrong nc (1g/27ml), alcohol ( 1g/13ml), chloroform (1g/3ml). Dc lc hcceproma/n/ mtphenothiazinectcdnganthn,ngnchnreceptorca dopam/n ph/a saa synapse h thn kinh trung ng v ry ngn gii phng dopamin do nh hng n nh/t c th, mc chuyn ha c bn, ng kinh, p sat mch mu, cn bng hormon vs tnh t o nh ng cho chm o trong trng hp d ng da, chng i vg y mTr n nga, d ng g y tccb.c sdng nhlthucanthntr nheo bj th,cu v d ceproma/ne cj nc dnggimnhhngtngthnnhitdo ha/othanetr nnhngheonhycm.Ngo /ra phenoth/a/necj nkh ngt cngkiu cho//n(ant/cho//nerg/c)kh ngh/stam/nchngcotht, ngn chn th th ? adrenerg/c Trong thy aceproma/n d ng ch yu vi mc ch gy m Tc ngdc lcca acepromazin baogm: chng nn,chng co thtvt c nggim th n nh/t. Mt v / ngh/ n cu cho bit, acepromazin c tc ng chng co g/t nhng v mt th y cho thy khng n n d ng phenoth/a/ne cho thb ng kinh hoc nhng tn thng c th dn n co g/t.ceproma/ne cth l m g/m nhp h hp nhng rt t hoc khng li n qaan n cht kh trongmu(bloodgas),b ohj aphocoxyhaemoglobin.Liu phthucv osgim hematocrit thngthykhong30phtsaukhid ng tr n ngavch Chshematocrit nga g/m 50% so vi trc khi d ng go / ra / m say yu p sut mu trong ng mch tr n chg y tng p sut tnh mch trung tm. Dc ng hcDc ng hc ca c nghi n cu tr n nga (Ballard vcng s, 1982). Thac c ph nphivithtchlnvhn99%linktviprote/nhayt tng.Tcngchm,khong 15ph t saa kh/ t/ m tnh mch. Hiu qu cao nht t 306 ph t saa t/ mceproma/ne chayn ha gan vb / thi qua nc tiu dng cht chuyn h a // n kt hockhngli nkt.Chtchuynhactmthytrongnc t/ungakhong 96gisaukhi d ng thac. ng ch nhChtrong s dng hoc d ng //u thp i vi th b suy gim chc nng gan, bnh tim vsuy nhc cth.Donh hng l mg/mhuytp, acepromazine chngchnhi vi nhng Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn34bnh nh n b gim oxi huyt vshock T/ m chm tnh mch. Acepromazine khng c hiu qu l m g/m au. Ch nhy cm ri thuc hn cc loi khc nh gim huyt p, suy gim chc nng tim mch. u lng T/n m :3 5mgkg n thn: 0.0252mgkg y m : 12 mgkg n thn: 0.051 mgkg :n thn: 1mg/kg, IM. n thn: 0.012 mgkg ng ung: d ng cho chm oL/u d ng: 1 3 mgkg th trngng chch: KomisirastressL/u d ng: 5 1 mgkg th trng u trc ho hc t ha hcLcht i vn benzodiazepin, flumazenil ldn xut 1,4/m/daobenod/aep/nenod/azepintnghpviccchtsau:lactatedRingers,D5Whocnc maibnh thng. Dc lc hc/amaen// /cht c ch cnh tranh ca benzodiazepines ti receptor benod/aep/ne h thn kinh trung ng. N gy trung hj a t c dng an thn ca benod/aep/n Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

dng/ch nhFlumazenilcsdngphhytcdngcasaukhibenzodiazepinc d ng//u iu tr hoc d ng qa//u. Flumazenil rt hu hiu trong iu tr bnh n o c bit lbnh m n t/nh khcha. Dc ng hcFlumazenilthngdngngti mtnhmch.Ncphnphinhanhv cng c chayn ha nhanh gan. ngi, thi gian bn hy ca thuc trung bnh khong 1 gi. ng ch nh/ch /an to n/amaen// chng ch nh cho bnh nhn nhy cm vi n hoc nhng benod/aep/n kh c /amaen// cng khng c d ng cho bnh qu liu nghi m trng thac chng trm cm 3 vj ng liucao,Flumazenil g yqa /tha/mtv / th th/ngh/m.Trongthigianmangthaich c d ng thac khi cn thit. t linh bongi,Flumazenilngkinhmtv /bnhnhn.Ngo /ra/amaen//cj n g yphn ng ti ch ti m / ma, gi n mch da, mt thng bng, tht iu vn ng, o gic. Tng tc thucFlumazenilkhnglmthayidcnghccabenzodiazep/n/uquca nhng benzodiazepin tc ng ko d / s c tng l n saa kh/ t c dng ca /amaen// g/m xung. u lng Chtivncabenzodiazepines:25mgkg(ednarsk/12)1mgkg(/k/ 12) c gim auThacgimaul thacl mg/mhocmtcmgic auvkhngtcngl n ngay n nhn gy au. Khc vi thuc mthac gim au khng l m mt cc cm gic khc.Cha/ /oi thuc gim au: Thac gim au gy ng hay gy nghin: morphine vc c thac g/m au loi op/o/d C c thac n y / m g/m cc cn au ni tng. Thac gim au h st hay gim au khng gy nghin: aspirin vdn xut sa//cy/at c c thac n y ct c dng l m g/m au ngun gc ngoi bi n / m h st v kh ng r/ m cm gic auCha/ /oi cm gic au:Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

Cm gic au ngun gc ngoi bin: thng ls au c xc nh v tr do s dn truyn cm gic t nhng u tn c ng cm gic da i n v n o nh au rng, au c Cm gic au phn tn su: ls au khng xc nh v tr, cc cm gic bt ngan t cc c quan ni tng su nh d d y t/m phi. Q|F P|Li F|D|Fy|||Q URQ| Nron 1: nron lng cc (nron T) tn c ng da, ni tng i n sng sau ty sng. Nron 2: i t ty sng ln i th. Nron 3: t i th l n r n oi th l ni chn lc nhng cm gic a ln v n o r c nh nhng phn ng thc rt c tnh bo v nh m rng con ngi, tng nhp tim vha hp, co mch hoc gi n mch, b / t/t dch Tt c to th nh du hiu ca s au. n o ph n t/ch cm gic au v xc nh phn ng i ph. T b o T ca sng ty sng g/ vai trjqaan trng trong dn truyn cm gic au. Cm gic au ch khi pht khi tn s nhng ang/crikhitbonytrnngng.Khickch th/chmnhtb ot/tccchtnh prostag/and/n / m nhy cm receptor gy au to xung lc theo ng cm gic au v trung ng. C cthacl mg/mauc chtnghpprostaglandinnnngncnphtsinhccxunglcgy au. c s dng thuc gm aua)Nniutrsmtrckhicnauxyra,ngnaucptrthnhaum n t/nhkhcha.b) Thaclcch c bnnhng iutr bngtml, vt l (xoa bp, nhitlnh) cngl m tng tc dng ca thuc gim au.c)Lachnthucthchhpnht:TheoWHO(1986)iutraum nt/nhtheo k/ubc thang (nu cn au ko di hoc gia tng).Giai on 1: khng opioid (nh NSAIDs)Giai on 2: khng opioid + thuc phi hpGiai on 3: opioid yu + khng opioid + thuc phi hpGiai on 4: opio/d mnh + khng opioid vthac phi hpd) Ti u ha ng s dng:ng ung thng dng nht nhng khng hiu lc vi loi au nng (ung th t/n trin ) rphi dng thng xuy n (morph/ne 23 g/ ung 1 ln) v ry phi thay bng morphine vph ng th/ch chm hoc d ng cht c t1/2 di nh methadon. ng ti m trayn tnh mch c nhiu u im hn ng ung v ( hp thu thay i vkhi pht chm). Bt li ca ti m trayn tnh mch lphi m k/m r o tnh mch, ti m trayn di da trnh c nhc im . ng Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn

cho thac qua da c s dng th nh cang ri fentanyl /oi opioid tan trong lipid.iutinlicangthmthucquadalngin,khnggytnthngm nhng khang chan c nng trong mu trong thi gian ngn t c tc gim au ti u chottcbnhnhn.ngti mngo /m ngcng r t/ mtrongrnhmamtlngthuc nh n gn v tr tc ng n n h/u /c gim au rt tt vi rt t hiu lc to n th n C c thac t tan trong //p/d (morph/ne) khi pht tc ng chm nhng thi gian gim au ko di, ngc li ccthactannhiutronglipid(nh methadone, meperidine,fentanyl, sulfentanyl) khi phttc ng nhanh nhng thi gian gim au ngn (do thuc khuch tn nhanh v ri n o nhanhe) Cth ha //u d ng: mt im chung ca opioid gim au lkh c b/t ln v //u gim au ti u gia cc bnh nhn. Khc phc iu bng cch ti m trayn tnh mch c chun .) gay n tc s dng thuc gim au tr au do ung th Chn thuc gim au th/ch hp Xc nh liu d ng da tr n nha cu bnh nhn Ch liu chia u trong ng y tr nh d ng kh/ cn.ng chn trc cn au, trnh cn au xy ra mi d ng thac /m n mc thp nht tc dng an thn vc c t c dng ph khcn s dng ng ung bt c khi n o cth iu tr sm bun nn vt o b n S dng thuc phi hp bt c khi n o cn ang np v/ thuc thuc khng phi lrn ng quan tm(1) ANALGINna/g/n /mt loi thuc c ch thn kinh trung ng. Analgin 2 Tnh chtna/g/n cbn cht ha hc lnatr/ methy/am/nopheny/ d/methy/pyra/onmethansa/onatna/g/n 2 cha cc th nh phn vi hm lng sau:na/g/n 2gTai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn38ang ma/ rcht bo qun V1m/Chphml mtdungdchtrongsut,khngm ac ptrongphmvi5,07 ng trong ng 2mL. Bo qun trnh nh sng.ngAnalgin tng t nh Pyramidon, c tc dng ni bt l m g/m au, ct nhanh cn au v /plichcnngsinhlbnhthngcahotngthnkinh.Ngo / rathaccj nc t cdng chng thp khp vct c dng gii nhit, h st trong chng mc nht nh. nhTrong thy hc, Analgin c d ng trong: iu tr cc chng au d d yrat cp tnh gy au d di nh hi chng au bng nga, chng bng y hi cp tnh lo / nha/ /i, nh c kh nng khi phc hot ng ti a h a rbnh thng ha nhu ng rut. iutrbnhgi ndd ycptnhkmtheoaubng(n nphihpviccloi thac chng l n men) iu tr vi m phong thp c, thp khp, au dy thn kinh u lng T/ m thac v o bp tht, di da hay tnh mch vi liu:Tr a bjnga:12m/Ln, dcu:515m/Ch :25m/ t ha hcCodein t tan trong nc nhng d tan trong cn. Codein c m a trng, mn,dng bt tinh th. Dc lc hcCodein c dng l m g/m ho, gim cn au nh rt tt. nhDngngungivithnhl mg/mautrongtrnghpsalicilate khangch/uquhocnhngthucgimaudngngngoiti ah a khckhngmbo.Ncng c s dng nh mt cht chng ho hoc chng t/ a chy. Dc ng hcSaakh/ang,nhngmuicodeinhpthurtnhanh,d ngthacquangung c h/u qa hp thu bng 2/3 ng ngoi tiu ha, tc ng sau 30 pht, hiu qu g/m au c th ko d / Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn3946g/;thuccchuynhaganv b /thiqua nctiu,thuccthquanhauthai,qua sa. ng ch nhTt c cc thuc gim au n n s dng ch i vi cc th b nhc nng tuyn g/ p bnh thn,khngd ngchoth nhycmvithacgimaugyng (narcot/c)th g/ yu,bnhtt; t/ a chy do ng c thc n cho n khi thc n b / thi ht ra ngo / hoc d ng /p li trong cc trng hp vi m rat.Khng dng codein trong cc trng hp chn thng vng u, tng p sut m a n o hoc cc cn bnh cp tnh xoang bng (au bng nga). Lu tr n bnh nhn mc bnh ng ha hp hoc suy gim chc nng h hp cp tnh. hang d ng kt hp vi sn phm c cha acetaminophene cho m oT c dng gim au yu hn Morphin, nhng mnh hn cc thuc gim au h st kh c t li/cnh boCode/n ckh nng dung np tt tuy nhi n bt li cng c th xy ra c bit liu cao hoc //u lp li. Thng thy tc dng gy ng. Ngo / ra cj n nh hng n d d yrat bao gm bing n, i ma, to bn, tc rut, co tht ng ty vng mt. Tr n m o thac c th gy kch thch h thn kinh trung ng nh d b kch ng, r ng mnh co g/t.u/ ng c cp tnha//u dn n suygim h hp vthn kinhtrung ng hu htcc lo / nh hng kh c bao gm suy tim mch, gim thn nhit, nhc trng c xng. Naloxon c dng iu tr suy gim h hp. Khi qu liu nghi m trng, n n d ng //u lp li naloxon vcn tun th cht ch tc hi ca naloxon c th g/m bt trc khi c c mc di c t (subtoxic) ca codein c th t c. Tng tc thucC c/oithucm thackhnghistamin,phenothiazin,barbiturate,thucan thn, alcohollmtngsuygimhhpv thnkinhtrungngkhiphihpvi meper/d/neC c thac kh ng cho//nerg/c kt hp vi codein lm tng tnh trng to bn. ngi, meperidin (phc hpli nktvicodein)cchngchnhtnht15 ng ysaakh/nhnMOA(monoamine oxidase inhibitots) (t c d ng trong thy)T c d Q|SK ||k |Wi R|EyQ|| F|FK |K|K S| ng / a cth gy nghinKhng dng cho trng hp ho c nhiu m v g y t/ch m ph qun./ng n, i, to bn, tc rut, co tht ng dn mt vty.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn40 u d Chng ho: 0.13mgkg P/m au: 0.51mgkgPChng ti a chy: 0.255mgkg P(cho ang)0.36mg kg th trng, ng y3 /n. u trc ho hcC17

1

3Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn41 torph/n //ca//ot ch/nh ch/t xut t nha cy thuc phin (Papaver somn/eram L) ri t l 9 1 Thac c Bng A.orph/n cdng kt tinh hnh k/m m a trng, khng m / r rt ng, kh tan trong nc. C c mai clohydrat vsa/at d hj a tan hn trong nc, tan trong ru vhngthuctnghpvimorphinesulphate:Atropinsulphate,benzquinamidC/ barorphano/tartratech/oproma/nC/d/phenhyhydram/nC/dobatam/nC/droper/do/ entany/ c/trate g/ycopyrro/ate hydroy/ne C/metoc/obram/de pentaoc/ne /actate proma/ne C/ scopo/am/n r rsacc/ny/cho//ne ch/or/dehng thuc khng tng hp vi morphine sulphate: aminophyl//n ch/oroth/a/d sod/am hepar/n sod/am meper/d/n pentobarb/ta/ sod/am phenobarb/ta/ sod/am phenyto/n sod/am sod/am b/carbonate rth/obenta/ sod/amai dc dng lc/ohydrat ngm 3H2O.Trong c th, Morphin li n kt vi protein huyt tng. Chng b v hot gan th nh c c dn cht glycurono hay sunfo kt hp, c b / t/t qua ng nc t/u v ng mt (chu trnh rat gan)ngorph/n /thac an thn mnh, c tc ng l n tt c cc chng au. Nc nh tr n c c th th Morphin. S c nh n y g y n n s hot ha cc nron c ch ca ty sng vtr n ty mch ng phong b thng tin au n ty vthn kinh trung ng.T cdnggimaucaMorphinphthucv o //ulng,ngchothucv t/nhnhy cm ca c th. Morphinlcht gy nghin vg y trng thi sng khoi, i lc km theo hoang tng, o gic.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn42/as cphnngivithucrtkhcnhauv phnlnchng(nga,la,tru, bj d/n,m o) b/u hinbnchn. Morphinlchtkchthchnga khiti m dida,nhng lcht / mm du khi ti m tnh mch, nn c dng iu tr chng au bng nga.Thac gy gi n mch, l m chm nhp tim nh.Thac gy tc dng thay i tr n trang t m g y nanThac c ch nhu ng rut, l m say yu b / t/t dch tiu ha, tng trng lc cc c tht (cch/u hng gy to bn, gi nc tiu). nh Cc cn au d di, cp tnh b n ngo / (da n/ m mc) hay su (xng khp, ni tng) ca cc lo / g/a s cL mduauto nth nt/ mtnhmchtrongccchngaubngnga(riliu 255g mt hay hai ln ti m) Cng c d ng ri liu thp trong chng au d d y do h v m rng. Dc lc hc o nga, cu, dbj rheo rt c hiu qu khid ng orph/ne trongkh/ chngi vloi linh trng khc khng nhy vi Morph/neC ch v mo u i khi d ng orph/ne nga, thnha/ /i vheo th khang /ng nh meperidin, morph/ne cth gy phng thch histamin t t b o mastorph/ne ch/u qu chng ho tr n chtay nh/ n thac c th l m g/m thn nh/t tr n chrth. Ngc li thn nhit c th gia tng bjdnga vm o Gy co ng t ngi, th vch. Trn ngi, morphine c s dng nh cht / m g/m au trong iu tr chng nhi mu c t/m rsang hayt tim, ls /a chn ti u trong iu tr hi chng t/m phi ch.orph/ne cth gy gim nhu ng vg/m s tit dch d d y rat. Tr n chmorph/ne g yg/mnhungrutv dnntobn.Stitdchdd yr dch mtcthgimsaukhi tim nhng sau HCl ca dch d d y cth tng liorph/nc thgytiunhiu,nhngliucao(>2.4mg/kgP,IV)stitnctiu c th g/m do gii phng hormone ADH (antidiuretic hormon), lngay n nh n g y tng sc trng bng qaang r ry c th gy kh khn khi i tiu. Dc ng hcorph/ne c hp thu khi ti m tnh mch, ti m bp, qua trc tr ng Tp trung nh/u nht thn,gan,phi,thpnhtn oqaanhaatha/nhngmcthphn tmthynhumvmorph/ne dng t do tm thy c xng. Morphine gy n th mi sinh nu cp thac cho thtrong thi gian mang thai, qaa sa m d liu nh.Tai lieu chia se tai: wWw.SinhHoc.edu.vnTai lieu chia se tai: wWw.SinhHoc.edu.vn43Thaccchuynhaganv b /thiquathn.Dom ochaynhakhng ho nto n qua ng n y r ry thi gian bn hy thuc c th ko d / nga, thi gian bn hy ca thuc trong hayt thanh c bit lkhong 88 pht sau kh/ d ng //u 0.1mg/ kg P, IV. Nhng liu c th ph t h/n trong huyt thanh khong 48 gi v 6 ngy trong nc tiu. Thi gian bn hy thuc tr n m o khong 3 g/. Morphine c s dng trong iu tr cc cn aa cp tnh ch, bjnga, heo, dcu; d ng / m thac tin m ch vheo chng ho, chng ti a chy v mt s bt thng tr n t/m ch ng ch nhLu c c trng hp bnh sau: bnh thn, nhng bnh cp tnh xoang bng (co//c) bnh ng niu, thg/yu u lngMorphin clohydrat dng ti m tnh