DC LM SNG

Cu 1: Trnh by tc dng chnh, tc dng KMM, chng ch nh v nguyn tc s dng ca thuc chng
vim corticoid
Cu 2: Trnh by phn loi v c im cc nhm Vitamin
( Cu 1 v 2 thuc ho dc dc l 2 khng c trong dc lm sng)
Cu 3: Trnh by nhng yu t nh hng n thi gian bn thi t1/2
1. nh hng ca tng tc thuc: Tng tc ca thuc c bit l giai on thi tr c th ko di hoc rt
ngn t1/2ca nhng thuc thi tr phn ln dng cn hot tnh qua thn
2. nh hng ca la tui: Tr nh v ngi gi do s yu km hoc suy gim chc nng thn cng lm
thay i t1/2 ca nhng thuc thi tr phn ln dng cn hot tnh qua thn
3. nh hng ca chc nng thn: S suy gim chc nng thn lm chm bi xut thuc do c th ko
di t1/2 ca nhng thuc thi tr phn ln dng cn hot tnh qua thn
4. nh hng ca chc nng gan: S suy gim chc nng gan lm gim qu trnh chuyn ho thuc. Do vy
nhng thuc thi tr phn ln nh chuyn ho thnh dn cht khng cn hot tnh ti gan s b chm bi xut,
tch lu lu hn trong c th, dn n ko di t1/2
Cu 4: Trnh by ngha tr s t1/2
Lin quan gia t1/2 v lng thuc c thi tr
S ln t1/2

Lng thuc c thi tr

50

75

88

94

97

98

99

Quy tc 5x t1/2 : Sau thi gian ny thuc s bo ho cc m trong c th. Lc ny lng thuc vo t chc v
lng thuc thi tr bng nhau v nh vy nng thuc trng thi cn bng
Quy tc 7x t1/2 : L thi gian cn thit thuc c bi xut hon ton ra khi c th
Tr s t1/2 l mt trong nhng yu t quyt nh nhp a thuc. Nhng thuc c t 1/2 di s c a t ln
trong ngy hn loi c t1/2 ngn
Khi chc nng c quan bi xut(gan, thn) b suy gim th t 1/2 b ko di c ngha l thuc b tch lu lu hn
trong c th v nguy c ng c ln hn.
Cu 5: Trnh by tng tc dc lc hc vn dng trong lm sng, cho v d
Tng tc thuc l tc ng qua li gia cc thuc xy ra trong c th khi dng ng thi em n nhng
thay i v tc dng dc l hoc c tnh.
Tng tc dc lc hc xy ra khi cc thuc phi hp c v tr tc dng trn cungd mt th th hoc khc th
th nhng cng ch tc dng gy hu qu tng tc l:
- To ra nhng hip ng c li cho iu tr: V d: dit vi khun gy vim lot d dy t trng
Helicobacter pylori th cn phi hp 2 khng sinh amoxicillin v Clarithromycin vi mt thuc gim tit acid
dch v nh omeprazol s em li t l thnh cng cao hn
- Li dng tc dng i lp nhm gii c thuc: VD Atropin dng gii c Physostigmin do tranh chp
th th M; Naloxon l cht i khng vi morphin do tranh chp th th vi morphin dng gii c
morphin

- Phi hp to tc dng i khng lm gim tc dng dc l hoc tng c tnh: VD S dng ng thi
Cloramphenicol vi erythromycin to ra s cnh tranh ti th th 50S ca Riboxom vi khun, lm gim tc
dng khng khun ca khng sinh; Dng Furosemid gy gim K + mu, lm tng c tnh ca digoxin trn c
tim
Cu 6: Trnh by nhng yu t quyt nh thi im dng thuc, cho v d
- Mc ch dng thuc: VD: Thuc ng ung vo bui ti, Thuc h st gim au ung khi c st, au
- nh hng ca nhp thi gian i vi tc dng sinh hc ca thuc: VD: Cc thuc loi corticoid nn ung
vo bui sng khong 6 8h v y l thi im nng hydrocortisone trong mu t cao nht trong ngy,
nu ung thi gian ny s khng lm nh hng n nhp sinh hc ca tuyn thng thn
- Tng tc ca thuc thc n: Nhng thuc b thc n lm gim hp thu s c ung xa ba n, nhng
thuc khng b nh hng ca thc n nn ung khi n gim tc dng ph trn ng tiu ho; cc thuc
c thc n lm tng hp thu cng c th chn thi im ung vo ba n. VD: Cc loi thuc h st, gim
au khng steroid th nn ung ngay sau ba n v khng b thc n cn tr hp thu v gim tc dng ph l
gy vim lot d dy t trng
- Tng tc gia cc thuc vi nhau: Nhng thuc khi ung cng nhau gy cn tr hp thu ln nhau phi
c ch nh ung cch nhau t nht 2h v thuc no cn hp thu phi c a trc. VD khi ung
Lincomycin cng smecta phi ung lincomycin trc sau 2h mi ung smecta. Nu ung ngc li th do kh
nng gy cn tr b mt hp thu ca smectam ko di nn 2h sau vn khng th dng c lincomycin
Cu 7: Trnh by cch la chn thi im ung thuc
- Ung vo ba n:
+ Nhng thuc kch ng mnh ng tiu ho nh doxycyclin, khng sinh nhm quinolon, mui kali
nhng thuc ny ung vo lc n v thc n khng lm gim hp thu. Nu thuc kch ng ng tiu ho
mnh nhng li b thc n lm gim hp thu th c th ung vo ba n vi iu kin chuyn thuc thnh
dng lng hoc chn dng bo ch thch hp
+ Nhng thuc hp thu qu nhanh lc i trnh tc dng ph do s tng nng t ngt trong mu nh
levodopa, diazepam
+ Nhng thuc c thc n lm tng hp thu nh cc loi vitamin, mui khong, mt s khng sinh chng
nm(ketoconazol)
- Ung xa ba n: ( Ung khong 1h trc ba n hoc 1 -2h sau ba n). Nhm ny gm c:
+ Cc thuc b gim hp thu do thc n nh licomycin
+ Cc dng vin bao tan trong rut nh aspirin
+ Cc thuc km bn trong mi trng acid dch v nh erythromycin, ampicilin
- Thuc c th ung vo thi im tu
Thuc nhm ny l cc thuc khng b gim hp thu do thc n hoc c th b thc n lm chm hp thu. Vi
cc thuc ny ta c th ung vo ba n nu thuc kch thch mnh ng tiu ho hoc khi mun tc dng
thc n gi cho nng thuc trong mu n nh
Cu 8: Trnh by cc bin php hn ch phn ng c hi ca thuc
- Hn ch s thuc dng:
+ Ch k n cc thuc tht s cn thit
+ nu bnh nhn ang s dng ng thi qu nhiu thuc th cn cn nhc tm ngng nhng loi thuc
cha thc s cn thit, cn nh gi c tng tc bt li khng
+ Kim tra v hi bnh nhn v nhng thuc bnh nhn t dng
- Nm vng thng tin v loi thuc ang dng cho bnh nhn
+ Hiu r tnh cht dc l, tng tc, c ch chuyn ho v ADR ca thuc. Ch nn k n nhng thuc c
y thng tin
+ Thng xuyn tham kho, cp nht cc thng tin v thuc v tng tc thuc
+ Thn trng khi k n nhng thuc d xy ra tng tc, c bit l cc tng tc do v tnh nh tng tc
thuc vi thc n, vi ru
- Nm vng thng tin v cc i tng bnh nhn c nguy c cao

Tr em, ngi gi, c c a d ng, c bnh v gan, thn v cc bnh nhn c bt thng v gen
- Theo di st bnh nhn, pht hin sm cc biu hin ca phn ng bt li do thuc v c nhng x tr kp
thi
Cu 9: Trnh by phn loi mc an ton ca thuc i vi ph n c thai
C quan qun l thuc v thc phm m xp thuc thnh 5 loi:
Loi A: Cc nghin cu c kim sot cho thy khng c nguy c i vi bo thai. Cc nghin cu c kim
sot vi s lng ln trn ph n c thai chng minh l khng lm tng nguy c thai bt thng khi dng
thuc cho ngi m mang thai ti bt c thi im no ca thai k
Loi B: Khng c bng chng v nguy c i vi bo thai, Thuocosm c nguy c gy tc hi cho bo thai
trn ng vt nhng cc nghin cu c kim sot v ln khng chng minh c nguy c khi dng trn
ngi; Hoc thuc khng c nguy c trn ng vt nhng cha nghin cu tin cy chng minh an ton
cho ngi
Loi C: C nguy c cho bo thai, Nghin cu trn ngi cha nhng nghin cu trn ng vt chng
minh c nguy c gy tn hi hoc khuyt tt cho bo thai; hoc cha c nghin cu trn ng vt v nghin
cu trn ngi
Loi D: Chc chn c nguy c cho bo thai, cc d liu nghin cu hoc d liu sau khi thuc c lu
hnh trn th trng cho thy thuc c nguy c gy hi cho bo thai, tuy nhin li ch iu tr vt tri nguy
c ri ro; Thuc c chp nhn iu tr trong nhng trng hp bnh nng e do tnh mng ngi m v
khng th tm c thuc thay th an ton hn
Loi X: Chng ch nh cho ph n c thai, tt c mi nghin cu trn ng vt, trn ngi, cc d liu thu
thp sau khi thuc lu hnh trn th trng u khng nh c tc hi cho bo thai v li ch iu tr khng
vt tri nguy c ri ro
Cu 10: Trnh by nguyn tc s dng thuc cho ph n c thai
- Hn ch ti a dng thuc, nn la chn nhng phng php iu tr khng dng thuc
- Trnh khng dng thuc trong 3 thng u thai k
- Dng thuc vi liu thp nht c hiu qu, thi gian ngn nht
- La chn thuc c chng minh l an ton, trnh dng nhng thuc cha c s dng rng ri cho
ph n c thai.
Cu 11: Trnh by nguyn tc chung khi s dng thuc ph n cho con b
- Hn ch ti a dng thuc
- Chonhj thuc an ton cho tr b m, thuc c t l nng sa/huyt tng thp, c thi gian bn thi
ngn
- Trnh dng liu cao, nn dng thi gian ngn nht c hiu qu
- Nn cho tr b ngay trc khi dng thuc
- Cn vt sa b i nu khng cho tr b trong thi gian dng thuc. Sauk hi ngng thuc cn ch thm
mt thi gian thch hp ri mi cho tr b sa m
- Cn nhc gia li ch v nguy c
Cu 12: Trnh by nhng im cn lu khi s dng thuc cho ngi cao tui
- Ri lon tiu ho(to bn), do ngi cao tui hay s dng thuc nhun trng, iu ny lm gim hp
thu thuc
- Gim tr nh: hay qun dng thuc, nhm ln liu
- Mt km: Kh c hng dn nn phi ghi ch to, d c
- Run tay: Khng nn cho ung thuc theo git, lu cc chai thuc kh m
- Thch lm dng thuc, dng ko di qu quy nh
- Long xng nn vn ng t, hay ung thuc khi nm: Lu vi thuc gy lot thc qun
- t kht nn t ung nc: Phi nhc ung hiu nc khi dng cc thuc d lng ng thn nh Co
trimoxazol, cc sulfamid
Cu 13: Trnh by nhng im cn lu khi s dng thuc cho tr em
a. Liu lng thuc dng cho tr em

Liu lng thuc dng cho tr em phi tnh n tui, cn nng v din tch b mt c th, cn c vo kh
nng hon thin ca chc nng gan, thn. Thuc thng tnh liu cho tr em mg/kg. Nhng thuc rt c
nh ho tr liu chng ung th tt nht l nn tnh theo mg/m2 din tch c th
b. La chn ch phm thuc dng cho tr em
- Thuc dng ng ung: Thuc dng ng ung l an ton v tin li nht, thuc nn c mu sc v mi
v hp dn gip tr d ung. Tuy nhin phi trnh trng hp b t dng thuc hay dng nhm thuc c
mu sc, mi v hp dn s gy ng c
Vi tr <5 tui nn dng thuc dng lng. Tr ln hn c th dng thuc dng rn
Khng khuyn khch cha m trn ln thuc vo thc n ca tr v c th gy gim hoc mt tc dng
- Thuc dng ng tim: Nn trnh tim bp cho tr nh. Vi ng tim, truyn tnh mch cn ch
tim truyn vi tc chm v th tch dch cho php dng cho tr
- Thuc t trc trng: y l ng dng thun tin v tr thng khng chu ung thuc, dng ng ny
t tc dng nhanh, thch hp khi tr b nn nhiu, hn m hoc b tc rut. Tuy nhin khng lm dng
ng a thuc ny v c th gy kch ng ti ch
- Thuc dng kh dung: Tr em <5 tui kh dng bnh xt th nh liu v cha bit phi hp ht vo v th
ra ki phun thuc, do my kh dung hoc bung phun thch hp hn
Cu 14: Trnh by cch x tr khi thiu vitamin
- Pht hin nguyn nhn gy thiu v loi b n l vic lm u tin
+ Nu thiu do ri lon hp thu th phi iu tr cc bnh lin quan nh a chy, suy gan, tc mt
+ Thiu do cung cp khng cho nhu cu th phi tng cng thm khu phn n hoc s dng thm
Vitamin v cht khong nu thiu trm trng
- B sung Vitamin v cht khong
+ B sung hp l nht l t thc phm v l ngun cung cp y v cn i nht
+ B sung di dng thuc ch khi thiu trm trng hoc trong trng hp cha c iu kin sa i li
ch n
Chn ch phm: Tt c cc yu t gy thiu Vitamin v cht khong nu trn gy ra nhng ri lon
chuyn ho cc cht, thng t c hin tng thiu n c mt cht tr nguyn nhn thiu do khuyt tt
di truyn v vy vic b sung vitamin v cht khong di dng hn hp c hiu qu hn dng cc cht
n l. T l phi hp ca cc cng thc khc nhau nn khi la chn phi cn c vo nguyn nhn gy
thiu b sung cho ph hp
Cu 15: Trnh by phn loi v c ch tc dng ca cc thuc iu tr to bn
Thuc iu tr to bn thng c phn loi theo c ch tc dng:
- Cc thuc lm tng khi lng phn: L cc dn cht cellulose v pollysaccarid khng tiu ho c v
khng hp thu. Chng ht nc, trng n, lm tng khi lng phn nh kch thch nhu ng rut v
lm gim thi gian lu chuyn cc cht trong ng tiu ho. Tc dng xut hin sau khi ung 12 24h, tc
dng ti a sau 2 3 ngy Thuc an ton, t tc dng ph. Thuc dng c cho ph n c thai v cho
coln b
- Thuc nhun trng thm thu:
+ Cc mui v c( magnesi sulfat, natri sulfat) lm tng p sut thm th trong lng rut, gi nc trong
lng rut do vy lm mm phn. Ngoi ra thuc cn c tc dng kch thch nhu ng rut. Cc mui ny
tc dng sau 15 pht 6h
+ Glycerin c tc dng sau 15-30 pht. Lactose cn 24 48h. Khi dng cc thuc nhm ny cn ung
nhiu nc
Khng nn dng cc thuc nhun trng mui v c th gy ri lon dch v in gii. Khng dng mui
magnesi sulfat cho bnh nhn c bnh tim, thn
- Thuc nhun trng kch thch: Thuc kch thch vo cc u dy thn kinh thnh rut lm tng nhu ng
rut, ng thi gi nc i trng. Thuc c tc dng sau 6 12h nn thch hp dng trc khi i
ng. Khng dng cc thuc ny ko di v gy ri lon nc, in gii

Thuc lm mm phn v lm trn: Thuc ny lm gim cng ca khi phn, lm cho phn d lu
chuyn trong lng rut
Thuc lm mn phn: Gm cc mui calci, kali, natri ca diotyl sulfosuccinat. C tc dng lm gim sc
cng b mt, nc d thm vo phn, lm mm phn
Thuc lm trn lng rut: nh du parafin lng. Thuc lm gim hp thu cc vitamin tan trong du nh A,
D,E,K nn hin t c dng
Cu 16: Trnh by nguyn tc iu tr bnh tiu chy
- Mc ch iu tr l lm tng qu trnh hp thu cc dch trong lng rut, ng thi lm gim nhu ng
rut.
- Vic iu tr bao gi cng gm 2 phn: B nc v in gii; iu tr triu chng. Vi cc trng hp tiu
chy cp tnh khng cn thit phi dng thuc iu tr ch cn b nc v in gii. Ch nn dng thuc
trong trng hp tiu chy mn tnh
- Trng hp tiu chy do nhim khun phi iu tr bng khng sinh, thuc dit k sinh trng
Cu 17: Trnh by phn loi thuc iu tr tiu chy? cho v d
Thuc iu tr bnh tiu chy gm: Thuc lm gim nhu ng rut v nhm thuc hp ph
- Thuc hp ph: Thuc c tc dng hp ph nc lm gim t l nc trong phn. To khun cho phn v
lm gim s ln i ngoi. Cc thuc ny u khng hp thu nn khng gy tc dng ph ton thn. Thuc
lm gim hp thu cc thuc dng ng thi
- Thuc lm gim nhu ng rut: Lm tng qu trnh hp thu nc v in gii ng tiu ho, lm gim
thnh phn nc trong phn. Cc thuc ny lm chm qu trnh thi cc yu t gy nhim khun ra khi
c th, lm ko di triu chng v vy ch nn dng khi tht cn thit. VD: Loperamid hp thu chm v
khng hon ton sau khi ung v t qua hng ro mu no nn t c tc dng n thn kihc btrung ng.,
Codein v diphenoxylat c th gy nghin