B\u00e0i so\u1ea1n t\u1eeb 1 b\u1ea1n nam K15a1 (XH) t\u1ed5ng h\u1ee3p kh\u00e1 \u0111\u1ea7y \u0111\u1ee7 m\u1ee5c ti\u00eau c\u1ed1t l\u00f5i m\u1ed7i b\u00e0i h\u1ecdc, s\u00e1t \u0111\u1ec1 thi k15<\/p>\n
I. THU\u1ed0C T\u00c1C D\u1ee4NG TR\u00caN H\u1ec6 TK TH\u1ef0C V\u1eacT<\/p>\n
C\u00e2u 1: Ph\u00e2n lo\u1ea1i h\u1ec7 TK th\u1ef1c v\u1eadt theo d\u01b0\u1ee3c l\u00fd?<\/p>\n[\u200bIMG] H\u1ec7 TK th\u1ef1c v\u1eadt<\/p>\n
H\u1ec7 cholinergic H\u1ec7 adrenergic<\/p>\n[\u200bIMG] (Acetylcholin) (Catecholamin)<\/p>\n[\u200bIMG]\n[\u200bIMG][\u200bIMG] H\u1ec7 M H\u1ec7 N<\/p>\n[\u200bIMG] H\u1eadu h\u1ea1ch H\u1ea1ch C\u01a1 v\u00e2n H\u1eadu h\u1ea1ch giao c\u1ea3m<\/p>\n
ph\u00f3 giao c\u1ea3m th\u1ef1c v\u1eadt<\/p>\n[\u200bIMG][\u200bIMG] Receptor \u03b1 Receptor \u03b2<\/p>\n
\u03b11 \u03b12 \u03b21 \u03b22<\/p>\n
(Sau (Tr\u01b0\u1edbc<\/p>\n
Synapse) Synapse)<\/p>\n
IA. THU\u1ed0C T\u00c1C D\u1ee4NG TR\u00caN H\u1ec6 CHOLINERGIC<\/p>\n
C\u00e2u 2: Tr\u00ecnh b\u00e0y t\u00e1c d\u1ee5ng v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a acetylcholin, pilocarpin v\u00e0 atropin?<\/p>\n
1. Acetylcholin (k\u00edch th\u00edch h\u1ec7 M)<\/p>\n
1) T\u00e1c d\u1ee5ng:<\/p>\n
– V\u1edbi li\u1ec1u th\u1ea5p (10 \u03bcg\/kg tr\u00ean ch\u00f3), t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu tr\u00ean h\u1eadu h\u1ea1ch ph\u00f3 giao c\u1ea3m:<\/p>\n
+ L\u00e0m ch\u1eadm nh\u1ecbp tim, gi\u00e3n m\u1ea1ch, h\u1ea1 HA<\/p>\n
+ T\u0103ng nhu \u0111\u1ed9ng ru\u1ed9t<\/p>\n
+ Co th\u1eaft ph\u1ebf qu\u1ea3n g\u00e2y c\u01a1n hen<\/p>\n
+ Co \u0111\u1ed3ng t\u1eed<\/p>\n
+ T\u0103ng ti\u1ebft d\u1ecbch, n\u01b0\u1edbc b\u1ecdt v\u00e0 m\u1ed3 h\u00f4i<\/p>\n
Atropin l\u00e0m m\u1ea5t ho\u00e0n to\u00e0n nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y<\/p>\n
– V\u1edbi li\u1ec1u cao (1 mg\/kg tr\u00ean ch\u00f3) v\u00e0 tr\u00ean s\u00fac v\u1eadt \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u00eam tr\u01b0\u1edbc = atropin sulfat, acetylcholin g\u00e2y t\u00e1c d\u1ee5ng gi\u1ed1ng nicotin: l\u00e0m t\u0103ng nh\u1ecbp tim, co m\u1ea1ch, t\u0103ng HA v\u00e0 k\u00edch th\u00edch h\u00f4 h\u1ea5p qua ph\u1ea3n x\u1ea1 xoang c\u1ea3nh<\/p>\n
– Tr\u00ean TK trung \u01b0\u01a1ng: l\u00e0m t\u0103ng ph\u1ea3n x\u1ea1 t\u1ee7y, gi\u1ea3i ph\u00f3ng hormon tuy\u1ebfn y\u00ean, t\u00e1c d\u1ee5ng tr\u00ean v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i l\u00e0m h\u1ea1 th\u00e2n nhi\u1ec7t, \u0111\u1eafp tr\u1ef1c ti\u1ebfp v\u00e0o v\u1ecf n\u00e3o g\u00e2y co gi\u1eadt\u2026<\/p>\n
2) \u00c1p d\u1ee5ng l\u00e2m s\u00e0ng: v\u00ec c\u00f3 amin b\u1eadc 4 n\u00ean ko qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u \u2013 n\u00e3o \u0111\u1ec3 v\u00e0o TKTW, b\u1ecb ph\u00e2n h\u1ee7y nhanh n\u00ean \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng. Ch\u1ec9 d\u00f9ng \u0111\u1ec3 l\u00e0m gi\u00e3n m\u1ea1ch trong b\u1ec7nh Raynaud ho\u1eb7c c\u00e1c bi\u1ec3u hi\u1ec7n ho\u1ea1i t\u1eed<\/p>\n
2. Pilocarpin (k\u00edch th\u00edch h\u1ec7 M)<\/p>\n
1) T\u00e1c d\u1ee5ng:<\/p>\n
– K\u00edch th\u00edch m\u1ea1nh h\u1eadu h\u1ea1ch ph\u00f3 giao c\u1ea3m, t\u00e1c d\u1ee5ng l\u00e2u h\u01a1n acetylcholin<\/p>\n
– Tr\u00ean s\u00fac v\u1eadt \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u00eam tr\u01b0\u1edbc = atropin: pilocarpin l\u00e0m t\u0103ng HA<\/p>\n
– Trong c\u00f4ng th\u1ee9c ch\u1ec9 c\u00f3 amin b\u1eadc 3 n\u00ean qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u \u2013 n\u00e3o \u0111\u1ec3 v\u00e0o TKTW: li\u1ec1u nh\u1eb9 k\u00edch th\u00edch, li\u1ec1u cao \u1ee9c ch\u1ebf<\/p>\n
2) \u00c1p d\u1ee5ng l\u00e2m s\u00e0ng: th\u01b0\u1eddng d\u00f9ng dd 0.5-1% \u0111\u1ec3 nh\u1ecf m\u1eaft \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng t\u0103ng nh\u00e3n \u00e1p<\/p>\n
3. Atropin (\u1ee9c ch\u1ebf h\u1ec7 M)<\/p>\n
1) T\u00e1c d\u1ee5ng:<\/p>\n
– L\u00e0 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng tranh ch\u1ea5p v\u1edbi acetylcholin \u1edf receptor M, c\u00f3 \u00e1i l\u1ef1c m\u1ea1nh h\u01a1n acetylcholin 10 l\u1ea7n<\/p>\n
– Ch\u1ec9 v\u1edbi li\u1ec1u cao, ti\u00eam \u0110M m\u1edbi th\u1ea5y t\u00e1c d\u1ee5ng tr\u00ean h\u1ea1ch v\u00e0 b\u1ea3n v\u1eadn \u0111\u1ed9ng c\u01a1 v\u00e2n<\/p>\n
– C\u00e1c t\u00e1c d\u1ee5ng th\u01b0\u1eddng th\u1ea5y:<\/p>\n
+ T\u00e1c d\u1ee5ng tr\u00ean tim ph\u1ee9c t\u1ea1p:<\/p>\n
(+) Li\u1ec1u th\u1ea5p: k\u00edch th\u00edch trung t\u00e2m d\u00e2y X \u1edf h\u00e0nh n\u00e3o l\u00e0m tim \u0111\u1eadp ch\u1eadm<\/p>\n
(+) Li\u1ec1u cao: \u1ee9c ch\u1ebf c\u00e1c receptor M \u1edf tim l\u00e0m tim \u0111\u1eadp nhanh<\/p>\n
+ \u00cdt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn HA v\u00ec nhi\u1ec1u h\u1ec7 m\u1ea1ch ko c\u00f3 d\u00e2y ph\u00f3 giao c\u1ea3m<\/p>\n
+ Gi\u1ea3m nhu \u0111\u1ed9ng ru\u1ed9t (khi nhu \u0111\u1ed9ng ru\u1ed9t t\u0103ng)<\/p>\n
+ Gi\u00e3n ph\u1ebf qu\u1ea3n (nh\u1ea5t l\u00e0 ph\u1ebf qu\u1ea3n b\u1ecb co th\u1eaft v\u00ec c\u01b0\u1eddng ph\u00f3 giao c\u1ea3m)<\/p>\n
+ Gi\u00e3n \u0111\u1ed3ng t\u1eed<\/p>\n
+ Gi\u1ea3m ti\u1ebft d\u1ecbch, n\u01b0\u1edbc b\u1ecdt v\u00e0 m\u1ed3 h\u00f4i<\/p>\n
+ Li\u1ec1u \u0111\u1ed9c, t\u00e1c d\u1ee5ng tr\u00ean n\u00e3o g\u00e2y k\u00edch th\u00edch, thao cu\u1ed3ng, \u1ea3o gi\u00e1c, cu\u1ed1i c\u00f9ng l\u00e0 h\u00f4n m\u00ea v\u00e0 ch\u1ebft do li\u1ec7t h\u00e0nh n\u00e3o<\/p>\n
\u0110i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c = thu\u1ed1c kh\u00e1ng cholinesterase<\/p>\n
2) \u00c1p d\u1ee5ng l\u00e2m s\u00e0ng:<\/p>\n
– \u0110i\u1ec1u tr\u1ecb ch\u1ee9ng ch\u1eadm nh\u1ecbp tim do \u1ea3nh h\u01b0\u1edfng c\u1ee7a d\u00e2y X<\/p>\n
– \u0110i\u1ec1u tr\u1ecb c\u00e1c ch\u1ee9ng \u0111au do co th\u1eaft, c\u1eaft c\u01a1n hen<\/p>\n
– Nh\u1ecf m\u1eaft dung d\u1ecbch atropin sulfat 0.5-1% l\u00e0m gi\u00e3n \u0111\u1ed3ng t\u1eed \u0111\u1ec3 soi \u0111\u00e1y m\u1eaft ho\u1eb7c \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u1ed1ng m\u1eaft<\/p>\n
– Ti\u1ec1n m\u00ea<\/p>\n
– \u0110i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c phospho h\u1eefu c\u01a1 v\u00e0 ng\u1ed9 \u0111\u1ed9c n\u1ea5m muscarin<\/p>\n
C\u00e2u 3: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a nicotin v\u00e0 thu\u1ed1c li\u1ec7t h\u1ea1ch?<\/p>\n
1. Nicotin (k\u00edch th\u00edch h\u1ec7 N)<\/p>\n
– T\u00e1c d\u1ee5ng tr\u00ean h\u1ea1ch:<\/p>\n
+ Li\u1ec1u th\u1ea5p (0.02-1 mg\/kg ti\u00eam TM ch\u00f3): k\u00edch th\u00edch<\/p>\n
+ Li\u1ec1u cao (10-30 mg\/kg ti\u00eam TM ch\u00f3): k\u00edch th\u00edch qu\u00e1 m\u1ee9c g\u00e2y li\u1ec7t h\u1ea1ch v\u00e0 sau \u0111\u00f3 l\u00e0 tranh ch\u1ea5p v\u1edbi acetylcholin<\/p>\n
– T\u00e1c d\u1ee5ng:<\/p>\n
+ Tr\u00ean tim m\u1ea1ch g\u00e2y t\u00e1c d\u1ee5ng 3 pha: h\u1ea1 HA t\u1ea1m th\u1eddi, t\u0103ng HA m\u1ea1nh, cu\u1ed1i c\u00f9ng l\u00e0 h\u1ea1 HA k\u00e9o d\u00e0i<\/p>\n
+ Tr\u00ean h\u00f4 h\u1ea5p: k\u00edch th\u00edch l\u00e0m t\u0103ng bi\u00ean \u0111\u1ed9 v\u00e0 t\u1ea7n s\u1ed1<\/p>\n
+ Gi\u00e3n \u0111\u1ed3ng t\u1eed, t\u0103ng ti\u1ebft d\u1ecbch, t\u0103ng nhu \u0111\u1ed9ng ru\u1ed9t<\/p>\n
– Nguy\u00ean nh\u00e2n:<\/p>\n
+ L\u00fac \u0111\u1ea7u nicotin k\u00edch th\u00edch h\u1ea1ch ph\u00f3 giao c\u1ea3m v\u00e0 trung t\u00e2m \u1ee9c ch\u1ebf tim \u1edf h\u00e0nh n\u00e3o l\u00e0m tim \u0111\u1eadp ch\u1eadm, h\u1ea1 HA<\/p>\n
+ Ngay sau \u0111\u00f3, nicotin k\u00edch th\u00edch h\u1ea1ch giao c\u1ea3m, trung t\u00e2m v\u1eadn m\u1ea1ch v\u00e0 c\u00e1c c\u01a1 tr\u01a1n l\u00e0m tim \u0111\u1eadp nhanh, t\u0103ng HA, gi\u00e3n \u0111\u1ed3ng t\u1eed v\u00e0 t\u0103ng nhu \u0111\u1ed9ng ru\u1ed9t. \u0110\u1ed3ng th\u1eddi k\u00edch th\u00edch t\u1ee7y th\u01b0\u1ee3ng th\u1eadn (coi nh\u01b0 h\u1ea1ch giao c\u1ea3m kh\u1ed5ng l\u1ed3) ti\u1ebft adrenalin, qua c\u00e1c receptor nh\u1eadn c\u1ea3m h\u00f3a h\u1ecdc \u1edf xoang \u0110M c\u1ea3nh k\u00edch th\u00edch l\u00ean trung t\u00e2m h\u00f4 h\u1ea5p<\/p>\n
+ Cu\u1ed1i c\u00f9ng l\u00e0 giai \u0111o\u1ea1n li\u1ec7t h\u1ea1ch do k\u00edch th\u00edch qu\u00e1 m\u1ee9c l\u00e0m h\u1ea1 HA k\u00e9o d\u00e0i<\/p>\n
2. Thu\u1ed1c li\u1ec7t h\u1ea1ch (\u1ee9c ch\u1ebf h\u1ec7 N)<\/p>\n
– Tranh ch\u1ea5p v\u1edbi acetylcholin t\u1ea1i receptor \u1edf m\u00e0ng sau synapse -> ng\u0103n c\u1ea3n lu\u1ed3ng xung \u0111\u1ed9ng TK t\u1eeb s\u1ee3i ti\u1ec1n h\u1ea1ch t\u1edbi s\u1ee3i h\u1eadu h\u1ea1ch. T\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c li\u1ec7t h\u1ea1ch ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh \u01b0u th\u1ebf c\u1ee7a h\u1ec7 giao c\u1ea3m hay ph\u00f3 giao c\u1ea3m t\u1ea1i c\u01a1 quan<\/p>\n
– 2 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng:<\/p>\n
(1) Arfonad: d\u00f9ng \u0111\u1ec3 h\u1ea1 HA c\u00f3 ki\u1ec3m so\u00e1t trong m\u1ed5 x\u1ebb ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ph\u00f9 ph\u1ed5i c\u1ea5p<\/p>\n
(2) Inversin: li\u1ec1u cao c\u00f3 th\u1ec3 k\u00edch th\u00edch TKTW v\u00e0 phong t\u1ecfa b\u1ea3n v\u1eadn \u0111\u1ed9ng c\u01a1 v\u00e2n<\/p>\n
C\u00e2u 4: T\u00e1c d\u1ee5ng, c\u01a1 ch\u1ebf v\u00e0 \u00e1p d\u1ee5ng c\u1ee7a 2 lo\u1ea1i cura (\u1ee9c ch\u1ebf h\u1ec7 N)?<\/p>\n
1. T\u00e1c d\u1ee5ng<\/p>\n
– Cura t\u00e1c d\u1ee5ng \u01b0u ti\u00ean tr\u00ean h\u1ec7 N c\u1ee7a c\u01a1 v\u00e2n: ng\u0103n c\u1ea3n lu\u1ed3ng xung \u0111\u1ed9ng TK t\u1edbi b\u1ea3n v\u1eadn \u0111\u1ed9ng c\u01a1 v\u00e2n -> l\u00e0m gi\u00e3n c\u01a1 theo th\u1ee9 t\u1ef1: c\u01a1 mi, c\u01a1 m\u1eb7t, c\u01a1 c\u1ed5, c\u01a1 chi tr\u00ean, c\u01a1 chi d\u01b0\u1edbi, c\u01a1 b\u1ee5ng, c\u01a1 li\u00ean s\u01b0\u1eddn v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 c\u01a1 ho\u00e0nh<\/p>\n
– \u1ee8c ch\u1ebf tr\u1ef1c ti\u1ebfp trung t\u00e2m h\u00f4 h\u1ea5p \u1edf h\u00e0nh n\u00e3o, l\u00e0m gi\u00e3n m\u1ea1ch, h\u1ea1 HA, l\u00e0m co th\u1eaft kh\u00ed qu\u1ea3n do gi\u1ea3i ph\u00f3ng histamin<\/p>\n
– H\u1ea7u h\u1ebft \u0111\u1ec1u mang amin b\u1eadc 4 n\u00ean ko h\u1ea5p thu \u0111\u01b0\u1ee3c, ph\u1ea3i d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam<\/p>\n
2. C\u01a1 ch\u1ebf<\/p>\n
1) Lo\u1ea1i tranh ch\u1ea5p v\u1edbi acetylcholin \u1edf b\u1ea3n v\u1eadn \u0111\u1ed9ng:<\/p>\n
+ L\u00e0m cho b\u1ea3n v\u1eadn \u0111\u1ed9ng ko kh\u1eed c\u1ef1c \u0111\u01b0\u1ee3c (g\u1ecdi l\u00e0 cura ch\u1ed1ng kh\u1eed c\u1ef1c). C\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng v\u1edbi thu\u1ed1c m\u00ea (d\u00f9ng sau khi BN \u0111\u00e3 m\u00ea), thu\u1ed1c ng\u1ee7, thu\u1ed1c an th\u1ea7n<\/p>\n
+ \u0110\u01b0\u1ee3c chia l\u00e0m 3 lo\u1ea1i theo th\u1eddi gian t\u00e1c d\u1ee5ng:<\/p>\n
(+) Lo\u1ea1i t\u00e1c d\u1ee5ng d\u00e0i: td sau 4-6 ph\u00fat, k\u00e9o d\u00e0i 120-180 ph\u00fat. \u01afu \u0111i\u1ec3m: \u00edt t\u00e1c d\u1ee5ng tr\u00ean h\u1ec7 tu\u1ea7n ho\u00e0n v\u00e0 ko l\u00e0m gi\u1ea3i ph\u00f3ng histamin). Vd: pancuronium<\/p>\n
(+) Lo\u1ea1i t\u00e1c d\u1ee5ng TB: td sau 2-4 ph\u00fat, k\u00e9o d\u00e0i 60-90 ph\u00fat. Vd: rocuronium<\/p>\n
(+) Lo\u1ea1i t\u00e1c d\u1ee5ng ng\u1eafn: t\u00e1c d\u1ee5ng sau 2-4 ph\u00fat, k\u00e9o d\u00e0i 12-18 ph\u00fat<\/p>\n
+ Gi\u1ea3i \u0111\u1ed9c = thu\u1ed1c phong t\u1ecfa cholinesterase<\/p>\n
2) Lo\u1ea1i t\u00e1c d\u1ee5ng nh\u01b0 acetylcholin:<\/p>\n
+ L\u00e0m cho b\u1ea3n v\u1eadn \u0111\u1ed9ng kh\u1eed c\u1ef1c qu\u00e1 m\u1ea1nh, g\u00e2y bi\u1ebfn c\u1ef1c d\u1eabn t\u1edbi li\u1ec7t c\u01a1 nh\u01b0ng tr\u01b0\u1edbc khi li\u1ec7t c\u01a1 c\u00f3 th\u1ec3 g\u00e2y gi\u1eadt c\u01a1 do k\u00edch th\u00edch qu\u00e1 m\u1ee9c. Vd: succinylcholin<\/p>\n
+ C\u00e1c thu\u1ed1c phong t\u1ecfa cholinesterase l\u00e0m t\u0103ng \u0111\u1ed9c t\u00ednh. Ko c\u00f3 thu\u1ed1c gi\u1ea3i \u0111\u1ed9c<\/p>\n
3. \u00c1p d\u1ee5ng<\/p>\n
1) Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n
+ L\u00e0m m\u1ec1m c\u01a1 trong ph\u1eabu thu\u1eadt, ch\u1ec9nh h\u00ecnh, \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n
+ L\u00e0m gi\u00e3n n\u1edf l\u1ed3ng ng\u1ef1c trong h\u00f4 h\u1ea5p nh\u00e2n t\u1ea1o<\/p>\n
+ Ch\u1ed1ng co gi\u1eadt trong cho\u00e1ng \u0111i\u1ec7n, u\u1ed1n v\u00e1n, ng\u1ed9 \u0111\u1ed9c ch\u1ea5t k\u00edch th\u00edch TK<\/p>\n
2) Ch\u00fa \u00fd: 1 s\u1ed1 thu\u1ed1c khi d\u00f9ng chung v\u1edbi cura lo\u1ea1i gi\u1ed1ng cura c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng, l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng li\u1ec7t c\u01a1 c\u1ee7a cura n\u00ean c\u1ea7n gi\u1ea3m li\u1ec1u:<\/p>\n
+ C\u00e1c thu\u1ed1c m\u00ea nh\u01b0 ether, halothan<\/p>\n
+ C\u00e1c kh\u00e1ng sinh nh\u01b0 neomycin, streptomycin<\/p>\n
+ Quinin, quinidin<\/p>\n
C\u00e2u 5: C\u01a1 ch\u1ebf, tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m \u0111\u1ed9c c\u00e1c ch\u1ea5t phong t\u1ecfa kh\u00f4ng h\u1ed3i ph\u1ee5c cholinesterase?<\/p>\n
1. C\u01a1 ch\u1ebf<\/p>\n
– Phospho h\u1eefu c\u01a1 k\u1ebft h\u1ee3p v\u1edbi cholinesterase \u1edf v\u1ecb tr\u00ed g\u1eafn este = li\u00ean k\u1ebft CHT b\u1ec1n v\u1eefng, kh\u00f3 \u0111\u01b0\u1ee3c th\u1ee7y ph\u00e2n \u0111\u1ec3 h\u1ed3i ph\u1ee5c tr\u1edf l\u1ea1i, \u0111\u00f2i h\u1ecfi c\u01a1 th\u1ec3 ph\u1ea3i t\u1ed5ng h\u1ee3p cholinesterase m\u1edbi<\/p>\n
– \u1ee8c ch\u1ebf m\u1ea1nh c\u1ea3 cholinesterase th\u1eadt v\u00e0 gi\u1ea3<\/p>\n
– Vd: parathion, h\u01a1i \u0111\u1ed9c chi\u1ebfn tranh sarin\u2026<\/p>\n
2. Tri\u1ec7u ch\u1ee9ng: c\u00e1c d\u1ea5u hi\u1ec7u ng\u1ed9 \u0111\u1ed9c c\u1ea5p ph\u1ea3n s\u00e1nh s\u1ef1 tr\u00e0n ng\u1eadp acetylcholin \u1edf to\u00e0n b\u1ed9 h\u1ec7 cholinergic:<\/p>\n
– D\u1ea5u hi\u1ec7u k\u00edch th\u00edch h\u1ec7 M: c\u00e2u 2 (acetylcholin)<\/p>\n
– D\u1ea5u hi\u1ec7u k\u00edch th\u00edch h\u1ec7 N: li\u1ec7t c\u01a1, suy h\u00f4 h\u1ea5p<\/p>\n
– D\u1ea5u hi\u1ec7u k\u00edch th\u00edch th\u1ea7n kinh TW: m\u1ea5t ph\u1ea3n x\u1ea1, nh\u1ecbp th\u1edf Cheyne \u2013 Stokes, co gi\u1eadt, h\u00f4n m\u00ea<\/p>\n
3. \u0110i\u1ec1u tr\u1ecb<\/p>\n
1) \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n:<\/p>\n
+ Thu\u1ed1c h\u1ee7y h\u1ec7 M: atropin sulfat ti\u00eam TM li\u1ec1u 1-2 mg, c\u00e1ch 5-10 ph\u00fat 1 l\u1ea7n cho \u0111\u1ebfn khi h\u1ebft tri\u1ec7u ch\u1ee9ng k\u00edch th\u00edch h\u1ec7 M ho\u1eb7c b\u1eaft \u0111\u1ea7u c\u00f3 d\u1ea5u hi\u1ec7u ng\u1ed9 \u0111\u1ed9c atropin<\/p>\n
+ Thu\u1ed1c ho\u1ea1t h\u00f3a cholinesterase: 2 \u2013 PAM. D\u00f9ng ngay sau ng\u1ed9 \u0111\u1ed9c 24-48 gi\u1edd, d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi atropin<\/p>\n
2) \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/p>\n
+ Thay qu\u1ea7n \u00e1o, r\u1eeda v\u00f9ng da ti\u1ebfp x\u00fac v\u1edbi ch\u1ea5t \u0111\u1ed9c, r\u1eeda d\u1ea1 d\u00e0y (ng\u1ed9 \u0111\u1ed9c \u0111\u01b0\u1eddng u\u1ed1ng)<\/p>\n
+ Th\u1edf oxy<\/p>\n
+ Ch\u1ed1ng co gi\u1eadt = diazepam (5-10 mg ti\u00eam TM) ho\u1eb7c natri thiopental (2.5% ti\u00eam TM)<\/p>\n
+ \u0110i\u1ec1u tr\u1ecb s\u1ed1c<\/p>\n
IB. THU\u1ed0C T\u00c1C D\u1ee4NG TR\u00caN H\u1ec6 ADRENERGIC<\/p>\n
C\u00e2u 6: Chu tr\u00ecnh chuy\u1ec3n h\u00f3a c\u1ee7a catecholamin t\u1ea1i ng\u1ecdn d\u00e2y th\u1ea7n kinh giao c\u1ea3m?<\/p>\n
– Catecholamin b\u1ecb m\u1ea5t ho\u1ea1t t\u00ednh b\u1edfi 2 enzym MAO v\u00e0 COMT:<\/p>\n
+ MAO: c\u00f3 nhi\u1ec1u trong ty th\u1ec3. Phong t\u1ecfa MAO th\u00ec l\u00e0m t\u0103ng catecholamin \u1edf m\u00f4<\/p>\n
+ COMT: n\u1eb1m ngo\u00e0i t\u1ebf b\u00e0o, c\u00f3 nhi\u1ec1u \u1edf gan v\u00e0 th\u1eadn. Phong t\u1ecfa COMT th\u00ec k\u00e9o d\u00e0i th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a catecholamin ngo\u1ea1i bi\u00ean<\/p>\n
– Adrenalin v\u00e0 noradrenalin sau khi \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng s\u1ebd t\u00e1c d\u1ee5ng l\u00ean c\u00e1c receptor \u03b1 v\u00e0 \u03b2:<\/p>\n
+ T\u00e1c d\u1ee5ng c\u01b0\u1eddng \u03b1 c\u00f3 t\u00ednh ch\u1ea5t k\u00edch th\u00edch: co c\u01a1 tr\u01a1n (tr\u1eeb c\u01a1 tr\u01a1n th\u00e0nh ru\u1ed9t l\u00e0 gi\u00e3n)<\/p>\n
+ T\u00e1c d\u1ee5ng c\u01b0\u1eddng \u03b2 c\u00f3 t\u00ednh ch\u1ea5t \u1ee9c ch\u1ebf: gi\u00e3n c\u01a1 tr\u01a1n (tr\u1eeb c\u01a1 tim l\u1ea1i l\u00e0m tim \u0111\u1eadp nhanh v\u00e0 m\u1ea1nh)<\/p>\n
– \u03b2 \u0111\u01b0\u1ee3c chia l\u00e0m 2 lo\u1ea1i: \u03b21 (t\u00e1c d\u1ee5ng tr\u00ean tim v\u00e0 chuy\u1ec3n h\u00f3a lipid), \u03b22 (gi\u00e3n m\u1ea1ch, gi\u00e3n kh\u00ed \u0111\u1ea1o v\u00e0 chuy\u1ec3n h\u00f3a \u0111\u01b0\u1eddng)<\/p>\n
– \u03b1 \u0111\u01b0\u1ee3c chia l\u00e0m 2 lo\u1ea1i: \u03b11 (n\u1eb1m sau synapse, g\u00e2y co m\u1ea1ch, t\u0103ng HA), \u03b12 (n\u1eb1m tr\u01b0\u1edbc synapse, c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u h\u00f2a)<\/p>\n
– Dopamin ch\u1ee7 y\u1ebfu t\u00e1c d\u1ee5ng tr\u00ean TKTW, th\u1eadn v\u00e0 c\u00e1c t\u1ea1ng: th\u00f4ng qua receptor \u03b4<\/p>\n
C\u00e2u 7: Ph\u00e2n bi\u1ec7t t\u00e1c d\u1ee5ng c\u1ee7a adrenalin, noradrenalin v\u00e0 dopamin?<\/p>\n
1. Adrenalin<\/p>\n
T\u00e1c d\u1ee5ng tr\u00ean c\u1ea3 \u03b1 v\u00e0 \u03b2:<\/p>\n
– Tr\u00ean tim:<\/p>\n
+ K\u00edch th\u00edch \u03b21 l\u00e0m tim \u0111\u1eadp nhanh v\u00e0 m\u1ea1nh, t\u0103ng HA t\u1ed1i \u0111a, t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9t ng\u1ed9t \u1edf quai \u0110M ch\u1ee7 v\u00e0 xoang \u0110M c\u1ea3nh n\u00ean xu\u1ea5t hi\u1ec7n ph\u1ea3n x\u1ea1 gi\u1ea3m \u00e1p<\/p>\n
+ K\u00edch th\u00edch \u03b11 g\u00e2y co m\u1ea1ch \u1edf 1 s\u1ed1 v\u00f9ng (da, t\u1ea1ng), k\u00edch th\u00edch \u03b22 g\u00e2y gi\u00e3n m\u1ea1ch \u1edf 1 s\u1ed1 v\u00f9ng kh\u00e1c (c\u01a1 v\u00e2n, ph\u1ed5i). Do \u0111\u00f3: HA t\u1ed1i thi\u1ec3u ko thay \u0111\u1ed5i ho\u1eb7c c\u00f3 khi gi\u1ea3m nh\u1eb9, HA TB ko t\u0103ng ho\u1eb7c t\u0103ng nh\u1eb9 trong th\u1eddi gian ng\u1eafn<\/p>\n
+ L\u00e0m gi\u00e3n v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u1ea1ch v\u00e0nh (k\u00e8m theo l\u00e0m t\u0103ng c\u00f4ng n\u0103ng v\u00e0 chuy\u1ec3n h\u00f3a c\u01a1 tim) -> ko d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb co th\u1eaft m\u1ea1ch v\u00e0nh<\/p>\n
– Tr\u00ean ph\u1ebf qu\u1ea3n:<\/p>\n
+ L\u00e0m gi\u00e3n ph\u1ebf qu\u1ea3n + co m\u1ea1ch \u1edf ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n<\/p>\n
+ C\u00f3 hi\u1ec7n t\u01b0\u1ee3ng quen thu\u1ed1c<\/p>\n
– Tr\u00ean chuy\u1ec3n h\u00f3a:<\/p>\n
T\u0103ng tho\u00e1i h\u00f3a glycogen \u1edf gan, t\u0103ng glucose m\u00e1u, t\u0103ng acid b\u00e9o t\u1ef1 do trong m\u00e1u, t\u0103ng chuy\u1ec3n h\u00f3a c\u01a1 b\u1ea3n<\/p>\n
2. Noradrenalin<\/p>\n
T\u00e1c d\u1ee5ng m\u1ea1nh tr\u00ean \u03b1, r\u1ea5t y\u1ebfu tr\u00ean \u03b2, cho n\u00ean:<\/p>\n
– L\u00e0m co m\u1ea1ch, t\u0103ng HA t\u1ed1i thi\u1ec3u v\u00e0 HA trung b\u00ecnh (m\u1ea1nh h\u01a1n adrenalin 1.5 l\u1ea7n)<\/p>\n
– T\u00e1c d\u1ee5ng tr\u00ean tim, tr\u00ean ph\u1ebf qu\u1ea3n v\u00e0 tr\u00ean chuy\u1ec3n h\u00f3a r\u1ea5t y\u1ebfu<\/p>\n
– Tham gia v\u00e0o c\u01a1 ch\u1ebf gi\u1ea3m \u0111au, \u0111i\u1ec1u h\u00f2a th\u00e2n nhi\u1ec7t c\u01a1 th\u1ec3<\/p>\n
3. Dopamin<\/p>\n
Tr\u00ean h\u1ec7 tim m\u1ea1ch, t\u00e1c d\u1ee5ng ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u:<\/p>\n
– Li\u1ec1u th\u1ea5p 1-2 \u03bcg\/kg\/ph\u00fat (li\u1ec1u th\u1eadn): k\u00edch th\u00edch \u03b4 l\u00e0m gi\u00e3n m\u1ea1ch th\u1eadn, m\u1ea1ch t\u1ea1ng v\u00e0 m\u1ea1ch v\u00e0nh<\/p>\n
– T\u1ea1i th\u1eadn, li\u1ec1u th\u1eadn c\u1ee7a dopamin l\u00e0m t\u0103ng n\u01b0\u1edbc ti\u1ec3u, t\u0103ng th\u1ea3i Ca2+, Na+, K+, [\u200bIMG], t\u0103ng s\u1ea3n xu\u1ea5t prostaglandin E2 l\u00e0m gi\u00e3n m\u1ea1ch th\u1eadn<\/p>\n
– Li\u1ec1u trung b\u00ecnh > 2-10 \u03bcg\/kg\/ph\u00fat: k\u00edch th\u00edch \u03b21 l\u00e0m tim \u0111\u1eadp nhanh v\u00e0 m\u1ea1nh<\/p>\n
– Li\u1ec1u cao > 10 \u03bcg\/kg\/ph\u00fat: k\u00edch th\u00edch \u03b11 g\u00e2y co m\u1ea1ch, t\u0103ng HA<\/p>\n
C\u00e2u 8: Ph\u00e2n bi\u1ec7t t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c c\u01b0\u1eddng \u03b21 v\u00e0 \u03b22: isoproterenol, dobutamin v\u00e0 salbutamol?<\/p>\n
1. Isoproterenol<\/p>\n
T\u00e1c d\u1ee5ng \u01b0u ti\u00ean tr\u00ean \u03b21 v\u00e0 \u03b22<\/p>\n
2. Dobutamin<\/p>\n
T\u00e1c d\u1ee5ng \u01b0u ti\u00ean tr\u00ean \u03b21. Dobutamin c\u00f3 2 \u0111\u1ed3ng ph\u00e2n: \u0111\u1ed3ng ph\u00e2n (-) c\u00f3 t\u00e1c d\u1ee5ng c\u01b0\u1eddng \u03b11, \u0111\u1ed3ng ph\u00e2n (+) c\u00f3 t\u00e1c d\u1ee5ng h\u1ee7y \u03b11. C\u1ea3 2 \u0111\u1ed3ng ph\u00e2n \u0111\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng c\u01b0\u1eddng \u03b2, nh\u01b0ng \u0111\u1ed3ng ph\u00e2n (+) m\u1ea1nh h\u01a1n \u0111\u1ed3ng ph\u00e2n (-) 10 l\u1ea7n<\/p>\n
3. Salbutamol<\/p>\n
T\u00e1c d\u1ee5ng \u01b0u ti\u00ean tr\u00ean \u03b22. Li\u1ec1u cao k\u00edch th\u00edch \u03b21<\/p>\n
C\u00e2u 9: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c h\u1ee7y giao c\u1ea3m?<\/p>\n
1. \u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p catecholamin<\/p>\n
– Thu\u1ed1c hay \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0 \u03b1 methyldopa: phong t\u1ecfa dopa decarboxylase, l\u00e0m dopa ko chuy\u1ec3n th\u00e0nh dopamin v\u00e0 5 \u2013 hydroxytryptophan ko chuy\u1ec3n th\u00e0nh 5 \u2013 hydroxytryptamin: l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng catecholamin \u1edf trung \u01b0\u01a1ng (g\u00e2y an th\u1ea7n) v\u00e0 ngo\u1ea1i bi\u00ean (g\u00e2y h\u1ea1 HA)<\/p>\n
– C\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh g\u1eafn catecholamin v\u00e0o c\u00e1c h\u1ea1t l\u01b0u tr\u1eef<\/p>\n
2. Gi\u1ea3m d\u1ef1 tr\u1eef catecholamin trong c\u00e1c h\u1ea1t<\/p>\n
– Reserpin:<\/p>\n
+ C\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh g\u1eafn catecholamin v\u00e0o c\u00e1c h\u1ea1t l\u01b0u tr\u1eef<\/p>\n
+ L\u00e0m gi\u1ea3i ph\u00f3ng t\u1eeb t\u1eeb catecholamin trong c\u00e1c h\u1ea1t l\u01b0u tr\u1eef ra b\u00e0o t\u01b0\u01a1ng \u0111\u1ec3 MAO ph\u00e1 h\u1ee7y<\/p>\n
3. Ng\u0103n c\u1ea3n gi\u1ea3i ph\u00f3ng catecholamin<\/p>\n
– Bretylium:<\/p>\n
+ C\u01a1 ch\u1ebf ch\u01b0a r\u00f5, c\u00f3 th\u1ec3 l\u00e0 bretylium l\u00e0m cho m\u00e0ng c\u00e1c h\u1ea1t l\u01b0u tr\u1eef gi\u1ea3m t\u00ednh th\u1ea5m v\u1edbi Ca2+<\/p>\n
+ C\u00f3 t\u00e1c d\u1ee5ng g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/p>\n
+ V\u00ec c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 (sung huy\u1ebft ni\u00eam m\u1ea1c m\u0169i, kh\u00f3 th\u1edf, h\u1ea1 HA) n\u00ean \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng<\/p>\n
4. Thay th\u1ebf catecholamin = c\u00e1c ch\u1ea5t trung gian h\u00f3a h\u1ecdc gi\u1ea3<\/p>\n
– 1 s\u1ed1 ch\u1ea5t ko c\u00f3 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd, nh\u01b0ng chi\u1ebfm ch\u1ed7 c\u1ee7a catecholamin v\u00e0 c\u0169ng \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng ra d\u01b0\u1edbi xung \u0111\u1ed9ng k\u00edch th\u00edch d\u00e2y giao c\u1ea3m nh\u01b0 1 ch\u1ea5t trung gian h\u00f3a h\u1ecdc, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ch\u1ea5t trung gian h\u00f3a h\u1ecdc gi\u1ea3:<\/p>\n
+ \u03b1 methyldopa t\u1ea1o th\u00e0nh \u03b1 methylnoradrenalin: chi\u1ebfm ch\u1ed7 c\u1ee7a noradrenalin<\/p>\n
+ Thu\u1ed1c \u1ee9c ch\u1ebf MAO: tyramin chuy\u1ec3n th\u00e0nh octopamin<\/p>\n
+ Guanethidin: chi\u1ebfm ch\u1ed7 c\u1ee7a noradrenalin<\/p>\n
C\u00e2u 10: T\u00e1c d\u1ee5ng v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a thu\u1ed1c h\u1ee7y \u03b1 giao c\u1ea3m?<\/p>\n
1) T\u00e1c d\u1ee5ng:<\/p>\n
+ V\u00ec phong t\u1ecfa \u03b1 n\u00ean l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng t\u0103ng HA c\u1ee7a noradrenalin, \u0111\u1ea3o ng\u01b0\u1ee3c t\u00e1c d\u1ee5ng t\u0103ng HA c\u1ee7a adrenalin<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ea3o ng\u01b0\u1ee3c t\u00e1c d\u1ee5ng t\u0103ng HA c\u1ee7a adrenalin \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch l\u00e0: c\u00e1c mao m\u1ea1ch c\u00f3 c\u1ea3 2 lo\u1ea1i receptor \u03b1 v\u00e0 \u03b2, adrenalin t\u00e1c d\u1ee5ng tr\u00ean c\u1ea3 2. B\u00ecnh th\u01b0\u1eddng, t\u00e1c d\u1ee5ng tr\u00ean \u03b1 chi\u1ebfm \u01b0u th\u1ebf n\u00ean l\u00e0m t\u0103ng HA. Khi d\u00f9ng thu\u1ed1c phong t\u1ecfa \u03b1, adrenalin ch\u1ec9 c\u00f2n t\u00e1c d\u1ee5ng tr\u00ean \u03b2 n\u00ean l\u00e0m gi\u00e3n m\u1ea1ch, h\u1ea1 HA<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb: THA, ch\u1ea9n \u0111o\u00e1n u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn, h\u1ed9i ch\u1ee9ng Raynaud<\/p>\n
3) C\u00e1c thu\u1ed1c:<\/p>\n
– Dibenzylin, dibenamin<\/p>\n
– Phentolamin<\/p>\n
– Prazosin<\/p>\n
– Alkaloid n\u1ea5m c\u1ef1a g\u00e0 (ergotamin)<\/p>\n
C\u00e2u 11: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, t\u00e1c d\u1ee5ng ph\u1ee5, \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a thu\u1ed1c h\u1ee7y \u03b2?<\/p>\n
\u1ee8c ch\u1ebf tranh ch\u1ea5p v\u1edbi isoproterenol \u1edf c\u00e1c receptor<\/p>\n
1) T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd: 4<\/p>\n
– Kh\u1ea3 n\u0103ng h\u1ee7y \u03b2: t\u00ednh ch\u1ea5t chung duy nh\u1ea5t<\/p>\n
+ Tr\u00ean tim: h\u1ee7y \u03b21<\/p>\n
+ Tr\u00ean ph\u1ebf qu\u1ea3n: h\u1ee7y \u03b22<\/p>\n
+ Tr\u00ean th\u1eadn: gi\u1ea3m ti\u1ebft renin g\u00e2y h\u1ea1 HA<\/p>\n
+ Tr\u00ean chuy\u1ec3n h\u00f3a: \u1ee9c ch\u1ebf h\u1ee7y glycogen v\u00e0 h\u1ee7y lipid<\/p>\n
– T\u00e1c d\u1ee5ng \u1ed5n \u0111\u1ecbnh m\u00e0ng: l\u00e0m gi\u1ea3m t\u00ednh th\u1ea5m c\u1ee7a m\u00e0ng v\u1edbi s\u1ef1 trao \u0111\u1ed5i ion -> \u0111i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp tim<\/p>\n
– C\u00f3 ho\u1ea1t t\u00ednh n\u1ed9i t\u1ea1i k\u00edch th\u00edch \u03b2: 1 s\u1ed1 thu\u1ed1c phong t\u1ecfa \u03b2 khi g\u1eafn v\u00e0o receptor l\u1ea1i c\u00f3 t\u00e1c d\u1ee5ng k\u00edch th\u00edch 1 ph\u1ea7n -> h\u1ea1n ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a ch\u00ednh n\u00f3<\/p>\n
– T\u00ednh ch\u1ecdn l\u1ecdc:<\/p>\n
+ Lo\u1ea1i t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc tr\u00ean \u03b21: metoprolol<\/p>\n
+ Lo\u1ea1i t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc tr\u00ean \u03b22: butoxamin<\/p>\n
2) T\u00e1c d\u1ee5ng ph\u1ee5:<\/p>\n
Do phong t\u1ecfa \u03b2<\/p>\n
Ko do phong t\u1ecfa \u03b2<\/p>\n
+ Tim: suy tim<\/p>\n
+ M\u1ea1ch: h\u1ed9i ch\u1ee9ng Raynaud<\/p>\n
+ Ph\u1ed5i: co th\u1eaft ph\u1ebf qu\u1ea3n<\/p>\n
+ TK: m\u1ec7t m\u1ecfi<\/p>\n
+ Chuy\u1ec3n h\u00f3a: h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, t\u0103ng triglycerid m\u00e1u<\/p>\n
+ H\u1ed9i ch\u1ee9ng da \u2013 m\u1eaft \u2013 tai<\/p>\n
+ Vi\u00eam ph\u00fac m\u1ea1c x\u01a1 c\u1ee9ng<\/p>\n
+ Ung th\u01b0 v\u00fa, ung th\u01b0 tuy\u1ebfn \u1ee9c<\/p>\n
3) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
– Ch\u1ec9 \u0111\u1ecbnh: \u0111au th\u1eaft ng\u1ef1c, lo\u1ea1n nh\u1ecbp tim, THA<\/p>\n
– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/p>\n
+ Suy tim, hen ph\u1ebf qu\u1ea3n<\/p>\n
+ Ko d\u00f9ng chung v\u1edbi insulin v\u00e0 c\u00e1c sulfamid h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00ec c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ed9t ng\u1ed9t<\/p>\n
II. KH\u00c1NG SINH KH\u00c1NG KHU\u1ea8N<\/p>\n
C\u00e2u 12: \u0110\u1ecbnh ngh\u0129a kh\u00e1ng sinh, t\u00e1c d\u1ee5ng k\u00ecm khu\u1ea9n v\u00e0 di\u1ec7t khu\u1ea9n?<\/p>\n
1) Kh\u00e1ng sinh l\u00e0 nh\u1eefng ch\u1ea5t do vi sinh v\u1eadt ti\u1ebft ra ho\u1eb7c nh\u1eefng ch\u1ea5t h\u00f3a h\u1ecdc b\u00e1n t\u1ed5ng h\u1ee3p, t\u1ed5ng h\u1ee3p, v\u1edbi n\u1ed3ng \u0111\u1ed9 r\u1ea5t th\u1ea5p, c\u00f3 kh\u1ea3 n\u0103ng k\u00ecm h\u00e3m s\u1ef1 ph\u00e1t tri\u1ec3n ho\u1eb7c di\u1ec7t \u0111\u01b0\u1ee3c vi khu\u1ea9n<\/p>\n
2) Kh\u00e1ng sinh k\u00ecm h\u00e3m s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a vi khu\u1ea9n g\u1ecdi l\u00e0 kh\u00e1ng sinh k\u00ecm khu\u1ea9n, kh\u00e1ng sinh di\u1ec7t \u0111\u01b0\u1ee3c vi khu\u1ea9n g\u1ecdi l\u00e0 kh\u00e1ng sinh di\u1ec7t khu\u1ea9n. T\u00e1c d\u1ee5ng k\u00ecm khu\u1ea9n v\u00e0 di\u1ec7t khu\u1ea9n th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o:<\/p>\n
T\u1ef7 l\u1ec7 [\u200bIMG]\n
Khi t\u1ef7 l\u1ec7 n\u00e0y > 4: kh\u00e1ng sinh c\u00f3 t\u00e1c d\u1ee5ng k\u00ecm khu\u1ea9n, khi t\u1ef7 l\u1ec7 n\u00e0y g\u1ea7n = 1: kh\u00e1ng sinh c\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n<\/p>\n
C\u00e2u 13: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00e2n lo\u1ea1i c\u1ee7a nh\u00f3m \u03b2 lactam?<\/p>\n
1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/p>\n
C\u00e1c \u03b2 lactam g\u1eafn v\u1edbi transpeptidase (hay PBP: Penicillin Binding Protein), enzym x\u00fac t\u00e1c cho s\u1ef1 n\u1ed1i peptidoglycan \u0111\u1ec3 t\u1ea1o v\u00e1ch vk. C\u00e1c \u03b2 lactam t\u1ea1o ph\u1ee9c b\u1ec1n v\u1eefng v\u1edbi transpeptidase, \u1ee9c ch\u1ebf t\u1ea1o v\u00e1ch vi khu\u1ea9n, l\u00e0m ly gi\u1ea3i ho\u1eb7c bi\u1ebfn d\u1ea1ng vi khu\u1ea9n<\/p>\n
– V\u00e1ch vi khu\u1ea9n gram (+) c\u00f3 m\u1ea1ng l\u01b0\u1edbi peptidoglycan d\u00e0y t\u1eeb 50-100 ph\u00e2n t\u1eed, l\u1ea1i \u1edf ngay b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o n\u00ean d\u1ec5 b\u1ecb t\u1ea5n c\u00f4ng<\/p>\n
– V\u00e1ch vi khu\u1ea9n gram (-) ch\u1ec9 d\u00e0y t\u1eeb 1-2 ph\u00e2n t\u1eed, nh\u01b0ng l\u1ea1i \u0111\u01b0\u1ee3c che ph\u1ee7 b\u00ean ngo\u00e0i b\u1edfi 1 l\u1edbp lipopolysaccarid: nh\u01b0 1 h\u00e0ng r\u00e0o ko th\u1ea5m KS, mu\u1ed1n c\u00f3 t\u00e1c d\u1ee5ng, KS ph\u1ea3i khu\u1ebfch t\u00e1n qua \u0111\u01b0\u1ee3c \u1ed1ng d\u1eabn c\u1ee7a m\u00e0ng ngo\u00e0i (amoxicillin v\u00e0 1 s\u1ed1 cephalosporin)<\/p>\n
2. Ph\u00e2n lo\u1ea1i v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb<\/p>\n
1) C\u00e1c penicillin:<\/p>\n
1.1) Penicillin G:<\/p>\n
+ Ph\u1ed5 kh\u00e1ng khu\u1ea9n:<\/p>\n
(1) C\u1ea7u khu\u1ea9n gram (+): li\u00ean c\u1ea7u (nh\u1ea5t l\u00e0 lo\u1ea1i tan huy\u1ebft \u03b2), ph\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u ko s\u1ea3n xu\u1ea5t penicillinase<\/p>\n
(2) C\u1ea7u khu\u1ea9n gram (-): l\u1eadu c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u<\/p>\n
(3) Tr\u1ef1c khu\u1ea9n gram (+) \u00e1i kh\u00ed (than, b\u1ea1ch h\u1ea7u) v\u00e0 y\u1ebfm kh\u00ed (clostridium ho\u1ea1i th\u01b0 sinh h\u01a1i)<\/p>\n
(4) Xo\u1eafn khu\u1ea9n giang mai<\/p>\n
+ \u0110\u1ed9c t\u00ednh: so v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c: t\u1ef7 l\u1ec7 g\u00e2y d\u1ecb \u1ee9ng kh\u00e1 cao (1-10%)<\/p>\n
1.2) Penicillin kh\u00e1ng penicillinase: Methicillin<\/p>\n
+ Ph\u1ed5 kh\u00e1ng khu\u1ea9n v\u00e0 th\u1eddi gian t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 penicillin G, nh\u01b0ng c\u01b0\u1eddng \u0111\u1ed9 t\u00e1c d\u1ee5ng y\u1ebfu h\u01a1n<\/p>\n
+ Ch\u1ec9 \u0111\u1ecbnh: nhi\u1ec5m t\u1ee5 c\u1ea7u s\u1ea3n xu\u1ea5t penicillinase (t\u1ee5 c\u1ea7u v\u00e0ng)<\/p>\n
+ \u0110\u1ed9c t\u00ednh: vi\u00eam th\u1eadn k\u1ebd, \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng \u1edf li\u1ec1u cao<\/p>\n
1.3) Penicillin A: ph\u1ed5 r\u1ed9ng (amoxicillin)<\/p>\n
Tr\u00ean gram (+): t\u00e1c d\u1ee5ng nh\u01b0 penicillin G, nh\u01b0ng c\u00f3 th\u00eam t\u00e1c d\u1ee5ng tr\u00ean 1 s\u1ed1 gram (-): e. coli, proteus, shigella, salmonella<\/p>\n
1.4) Penicillin kh\u00e1ng tr\u1ef1c khu\u1ea9n m\u1ee7 xanh: carboxypenicillin<\/p>\n
D\u00f9ng trong \u0111i\u1ec1u tr\u1ecb: tr\u1ef1c khu\u1ea9n m\u1ee7 xanh, proteus, tr\u1ef1c khu\u1ea9n kh\u00e1ng penicillin. Th\u01b0\u1eddng l\u00e0 nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n, nhi\u1ec5m khu\u1ea9n sau b\u1ecfng, vi\u00eam ph\u1ed5i<\/p>\n
2) C\u00e1c cephalosporin:<\/p>\n
Th\u1ebf h\u1ec7 1<\/p>\n
(cefalexin)<\/p>\n
+ Ph\u1ed5 kh\u00e1ng khu\u1ea9n g\u1ea7n v\u1edbi methicillin v\u00e0 penicillin A<\/p>\n
+ B\u1ecb cephalosporinase ph\u00e1 h\u1ee7y<\/p>\n
Th\u1ebf h\u1ec7 2<\/p>\n
(cefuroxim)<\/p>\n
+ T\u00e1c d\u1ee5ng tr\u00ean gram (-) > th\u1ebf h\u1ec7 1<\/p>\n
+ Kh\u00e1ng \u0111\u01b0\u1ee3c cephalosporinase<\/p>\n
Th\u1ebf h\u1ec7 3<\/p>\n
(ceftriaxone)<\/p>\n
+ T\u00e1c d\u1ee5ng tr\u00ean gram (-) > th\u1ebf h\u1ec7 2<\/p>\n
+ Nhi\u1ec1u thu\u1ed1c qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u n\u00e3o: \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o<\/p>\n
Th\u1ebf h\u1ec7 4<\/p>\n
(cefepim)<\/p>\n
+ T\u00e1c d\u1ee5ng tr\u00ean gram (-) > th\u1ebf h\u1ec7 3, b\u1ec1n v\u1edbi \u03b2 lactamase h\u01a1n th\u1ebf h\u1ec7 3<\/p>\n
+ Ch\u1ec9 \u0111\u1ecbnh: nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram (-) \u00e1i kh\u00ed \u0111\u00e3 kh\u00e1ng v\u1edbi 3 th\u1ebf h\u1ec7<\/p>\n
Th\u1ebf h\u1ec7 5<\/p>\n
(ceftarolin)<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh: nhi\u1ec5m t\u1ee5 c\u1ea7u v\u00e0ng kh\u00e1ng methicillin, ph\u1ebf c\u1ea7u kh\u00e1ng penicillin, tr\u1ef1c khu\u1ea9n m\u1ee7 xanh v\u00e0 c\u1ea7u khu\u1ea9n ru\u1ed9t<\/p>\n
3) C\u00e1c carbapenem:<\/p>\n
– Imipenem: ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ea5t r\u1ed9ng (\u00e1i kh\u00ed + y\u1ebfm kh\u00ed)<\/p>\n
– Ertapenem: ph\u1ed5 kh\u00e1ng khu\u1ea9n t\u01b0\u01a1ng t\u1ef1 imipenem, nh\u01b0ng m\u1ea1nh h\u01a1n tr\u00ean gram (-)<\/p>\n
4) C\u00e1c monobactam: aztreonam<\/p>\n
– K\u00e9m t\u00e1c d\u1ee5ng tr\u00ean gram (+) v\u00e0 vk k\u1ef5 kh\u00ed. T\u00e1c d\u1ee5ng m\u1ea1nh tr\u00ean gram (-), t\u01b0\u01a1ng t\u1ef1 cephalosporin th\u1ebf h\u1ec7 3 ho\u1eb7c aminosid<\/p>\n
– Kh\u00e1ng \u0111\u01b0\u1ee3c \u03b2 lactamase<\/p>\n
C\u00e2u 14: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, \u0111\u1ed9c t\u00ednh v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a nh\u00f3m aminosid?<\/p>\n
1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/p>\n
Sau khi x\u00e2m nh\u1eadp v\u00e0o vi khu\u1ea9n, aminosid g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n 30 S c\u1ee7a ribosom, g\u00e2y \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p protein theo 3 c\u00e1ch:<\/p>\n
– Can thi\u1ec7p v\u00e0o ph\u1ee9c h\u1ee3p m\u1edf \u0111\u1ea7u h\u00ecnh th\u00e0nh chu\u1ed7i peptid<\/p>\n
– G\u00e2y \u0111\u1ecdc sai m\u00e3 mARN<\/p>\n
– Ng\u0103n c\u1ea3n s\u1ef1 d\u1ecbch chuy\u1ec3n c\u1ee7a ribosom tr\u00ean mARN<\/p>\n
2. \u0110\u1ed9c t\u00ednh<\/p>\n
1) \u0110\u1ed9c v\u1edbi d\u00e2y TK VIII: \u0111\u1ed9c t\u00ednh \u1edf \u0111o\u1ea1n ti\u1ec1n \u0111\u00ecnh th\u01b0\u1eddng nh\u1eb9 v\u00e0 ng\u1eebng thu\u1ed1c s\u1ebd kh\u1ecfi (streptomycin, gentamycin), \u0111\u1ed9c t\u00ednh \u1edf \u0111o\u1ea1n \u1ed1c tai c\u00f3 th\u1ec3 g\u00e2y \u0111i\u1ebfc v\u0129nh vi\u1ec5n k\u1ec3 c\u1ea3 ng\u1eebng thu\u1ed1c (kanamycin, amikacin)<\/p>\n
2) \u0110\u1ed9c v\u1edbi th\u1eadn:<\/p>\n
– Th\u1ea3i tr\u1eeb v\u00e0 t\u00edch l\u0169y nhi\u1ec1u \u1edf v\u1ecf th\u1eadn<\/p>\n
– G\u00e2y suy th\u1eadn<\/p>\n
3) Li\u1ec1u r\u1ea5t cao: t\u00e1c d\u1ee5ng m\u1ec1m c\u01a1 ki\u1ec3u cura l\u00e0m li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p<\/p>\n
4) D\u1ecb \u1ee9ng: c\u00f3 th\u1ec3 g\u1eb7p vi\u00eam da do ti\u1ebfp x\u00fac v\u1edbi nh\u00e2n vi\u00ean y t\u1ebf<\/p>\n
3. \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb<\/p>\n
1) Streptomycin: ph\u1ed5 kh\u00e1ng khu\u1ea9n<\/p>\n
– Gram (+)<\/p>\n
– Gram (-)<\/p>\n
– Xo\u1eafn khu\u1ea9n giang mai<\/p>\n
– L\u00e0 KS h\u00e0ng \u0111\u1ea7u ch\u1ed1ng tr\u1ef1c khu\u1ea9n lao<\/p>\n
2) Gentamycin:<\/p>\n
Ph\u1ed1i h\u1ee3p v\u1edbi \u03b2 lactam: cho t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng t\u0103ng m\u1ee9c ch\u1ed1ng l\u1ea1i proteus, pseudomonas v\u00e0 c\u00e1c tr\u1ef1c khu\u1ea9n gram (-) kh\u00e1ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c<\/p>\n
3) Kanamycin: th\u01b0\u1eddng d\u00f9ng ph\u1ed1i h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb lao<\/p>\n
4) Neomycin<\/p>\n
5) Amikacin: l\u00e0 thu\u1ed1c c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng nh\u1ea5t trong nh\u00f3m, kh\u00e1ng \u0111\u01b0\u1ee3c c\u00e1c enzym l\u00e0m b\u1ea5t ho\u1ea1t aminosid<\/p>\n
C\u00e2u 15: C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, \u0111\u1ed9c t\u00ednh v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a kh\u00e1ng sinh nh\u00f3m chloramphenicol, tetracyclin, macrolid, quinolon, sulfamid?<\/p>\n
1. Chloramphenicol: (k\u00ecm khu\u1ea9n)<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– Chloramphenicol g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n 50 S c\u1ee7a ribosom: ng\u0103n c\u1ea3n mARN g\u1eafn v\u00e0o ribosom, \u0111\u1ed3ng th\u1eddi \u1ee9c ch\u1ebf enzym transferase n\u00ean aa \u0111\u01b0\u1ee3c m\u00e3 h\u00f3a ko g\u1eafn v\u00e0o polypeptid<\/p>\n
– \u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p protein c\u1ee7a ty th\u1ec3 \u1edf t\u1ebf b\u00e0o \u0111\u1ed9ng v\u1eadt c\u00f3 v\u00fa, h\u1ed3ng c\u1ea7u \u0111\u1ed9ng v\u1eadt c\u00f3 v\u00fa (v\u00ec ribosom c\u1ee7a ty th\u1ec3 c\u0169ng l\u00e0 lo\u1ea1i 70 S nh\u01b0 vi khu\u1ea9n)<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
Gram (+), gram (-), xo\u1eafn khu\u1ea9n, th\u01b0\u01a1ng h\u00e0n v\u00e0 ph\u00f3 th\u01b0\u01a1ng h\u00e0n<\/p>\n
2. Tetracyclin: (k\u00ecm khu\u1ea9n)<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
Tetracyclin g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n 30 S c\u1ee7a ribosom: ng\u0103n c\u1ea3n tARN chuy\u1ec3n aa v\u00e0o v\u1ecb tr\u00ed A tr\u00ean ph\u1ee9c h\u1ee3p mARN \u2013 ribosom<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
– Ph\u1ed5 kh\u00e1ng khu\u1ea9n: r\u1ed9ng (k\u00e9m tr\u00ean proteus v\u00e0 tr\u1ef1c khu\u1ea9n m\u1ee7 xanh)<\/p>\n
– Ch\u1ec9 \u0111\u1ecbnh: d\u1ec5 g\u00e2y kh\u00e1ng thu\u1ed1c n\u00ean ch\u1ec9 d\u00f9ng v\u1edbi vi khu\u1ea9n trong t\u1ebf b\u00e0o:<\/p>\n
+ Nhi\u1ec5m rickettsia, mycoplasma, brucella, t\u1ea3, l\u1ef5, e. coli<\/p>\n
+ Tr\u1ee9ng c\u00e1, b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c<\/p>\n
3. Macrolid: (k\u00ecm khu\u1ea9n)<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
Macrolid g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n 50S c\u1ee7a ribosom: \u1ee9c ch\u1ebf d\u1ecbch chuy\u1ec3n c\u1ee7a tARN t\u1eeb v\u1ecb tr\u00ed nh\u1eadn sang v\u1ecb tr\u00ed cho<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
– Ph\u1ed5 kh\u00e1ng khu\u1ea9n: t\u01b0\u01a1ng t\u1ef1 penicillin G<\/p>\n
– Ch\u1ec9 \u0111\u1ecbnh: BN d\u1ecb \u1ee9ng v\u1edbi penicillin<\/p>\n
4. Quinolon: (di\u1ec7t khu\u1ea9n)<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– \u1ee8c ch\u1ebf ADN gyrase (enzym th\u00e1o xo\u1eafn ADN) -> ng\u0103n c\u1ea3n s\u1ef1 t\u1ed5ng h\u1ee3p ADN c\u1ee7a vi khu\u1ea9n. Ngo\u00e0i ra c\u00f2n t\u00e1c d\u1ee5ng tr\u00ean mARN: \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p protein c\u1ee7a vi khu\u1ea9n<\/p>\n
– Quinolon th\u1ebf h\u1ec7 I (acid nalidixic): ch\u1ec9 \u1ee9c ch\u1ebf ADN gyrase -> ko t\u00e1c d\u1ee5ng tr\u00ean tr\u1ef1c khu\u1ea9n m\u1ee7 xanh<\/p>\n
– C\u00e1c fluoroquinolon t\u00e1c d\u1ee5ng tr\u00ean 2 enzym \u0111\u00edch: ADN gyrase v\u00e0 topoisomerase IV n\u00ean ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng h\u01a1n, ho\u1ea1t t\u00ednh kh\u00e1ng khu\u1ea9n m\u1ea1nh h\u01a1n (10-30 l\u1ea7n)<\/p>\n
+ Quinolon th\u1ebf h\u1ec7 II: tr\u00ean gram (-): hi\u1ec7u l\u1ef1c kh\u00e1ng ADN gyrase m\u1ea1nh h\u01a1n, tr\u00ean gram (+): hi\u1ec7u l\u1ef1c kh\u00e1ng topoisomerase IV m\u1ea1nh h\u01a1n<\/p>\n
+ Quinolon th\u1ebf h\u1ec7 III: t\u00e1c d\u1ee5ng c\u00e2n b\u1eb1ng tr\u00ean c\u1ea3 2 enzym n\u00ean ph\u1ed5 kh\u00e1ng khu\u1ea9n m\u1edf r\u1ed9ng tr\u00ean gram (+). Vi khu\u1ea9n kh\u00f3 kh\u00e1ng thu\u1ed1c h\u01a1n v\u00ec ph\u1ea3i \u0111\u1ed9t bi\u1ebfn 2 l\u1ea7n tr\u00ean 2 enzym \u0111\u00edch<\/p>\n
+ Ph\u1ed5 kh\u00e1ng khu\u1ea9n: gram (+), gram (-), tr\u1ef1c khu\u1ea9n m\u1ee7 xanh<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
– Nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p, ti\u00eau h\u00f3a, ti\u1ebft ni\u1ec7u \u2013 sinh d\u1ee5c\u2026<\/p>\n
– Ph\u1ed1i h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb lao: ciprofloxacin v\u00e0 ofloxacin (\u0111\u1eb7c bi\u1ec7t l\u00e0 lao kh\u00e1ng thu\u1ed1c)<\/p>\n
5. Sulfamid: (k\u00ecm khu\u1ea9n)<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– \u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p acid folic t\u1eeb PABA. Do c\u00f3 c\u1ea5u tr\u00fac h\u00f3a h\u1ecdc g\u1ea7n gi\u1ed1ng PABA n\u00ean sulfamid \u0111\u00e3 tranh ch\u1ea5p v\u1edbi PABA -> vk s\u1ebd l\u1ea5y nh\u1ea7m c\u01a1 ch\u1ea5t PABA v\u1edbi sulfamid<\/p>\n
– Ngo\u00e0i ra, sulfamid c\u00f2n \u1ee9c ch\u1ebf enzym dihydrofolat synthetase<\/p>\n
– C\u00e1c vk c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng tr\u1ef1c ti\u1ebfp acid folic t\u1eeb m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i th\u00ec ko ch\u1ecbu \u1ea3nh h\u01b0\u1edfng c\u1ee7a sulfamid<\/p>\n
2) \u00c1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb:<\/p>\n
Ph\u1ed5 kh\u00e1ng khu\u1ea9n: h\u1ea7u h\u1ebft gram (+) v\u00e0 gram (-). Tuy nhi\u00ean, t\u1ef7 l\u1ec7 kh\u00e1ng thu\u1ed1c v\u00e0 kh\u00e1ng ch\u00e9o gi\u1eefa c\u00e1c sulfamid r\u1ea5t cao n\u00ean h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng<\/p>\n
6. \u0110\u1ed9c t\u00ednh<\/p>\n
Quinolon<\/p>\n
Tetracyclin<\/p>\n
Macrolid<\/p>\n
– R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, d\u1ecb \u1ee9ng ngo\u00e0i da<\/p>\n
– Th\u1ea7n kinh: t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd<\/p>\n
– Tr\u00ean \u0111\u1ed9ng v\u1eadt c\u00f2n non: h\u1ee7y ho\u1ea1i m\u00f4 s\u1ee5n<\/p>\n
– Tr\u00ean tr\u1ebb nh\u1ecf: toan chuy\u1ec3n h\u00f3a, \u0111au v\u00e0 s\u01b0ng kh\u1edbp, \u0111au c\u01a1<\/p>\n
– Vi\u00eam, \u0111\u1ee9t g\u00e2n Achilles (hi\u1ebfm g\u1eb7p)<\/p>\n
– R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/p>\n
– V\u00e0ng r\u0103ng tr\u1ebb em: tetracyclin l\u1eafng \u0111\u1ecdng v\u00e0o r\u0103ng trong th\u1eddi k\u1ef3 \u0111\u1ea7u c\u1ee7a s\u1ef1 v\u00f4i h\u00f3a<\/p>\n
– \u0110\u1ed9c v\u1edbi gan v\u00e0 th\u1eadn<\/p>\n
– C\u00e1c r\u1ed1i lo\u1ea1n \u00edt g\u1eb7p: d\u1ecb \u1ee9ng, xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u\u2026<\/p>\n
– R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, d\u1ecb \u1ee9ng ngo\u00e0i da<\/p>\n
– Clindamycin: g\u00e2y vi\u00eam ru\u1ed9t k\u1ebft gi\u1ea3 m\u1ea1c, n\u1eb7ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong<\/p>\n
– Erythromycin v\u00e0 Tri Acetyl Oleandomycin: g\u00e2y vi\u00eam gan \u1ee9 m\u1eadt, v\u00e0ng da<\/p>\n
Chloramphenicol<\/p>\n
Sulfamid<\/p>\n
– Suy t\u1ee7y<\/p>\n
– Th\u1ea7n kinh: nh\u1ee9c \u0111\u1ea7u, vi\u00eam d\u00e2y TK th\u1ecb gi\u00e1c<\/p>\n
– H\u1ed9i ch\u1ee9ng x\u00e1m: g\u1eb7p \u1edf nh\u0169 nhi sau khi d\u00f9ng li\u1ec1u cao theo \u0111\u01b0\u1eddng ti\u00eam: n\u00f4n, \u0111au b\u1ee5ng, t\u00edm t\u00e1i, tr\u1ee5y tim m\u1ea1ch v\u00e0 t\u1eed vong (nguy\u00ean nh\u00e2n l\u00e0 do gan ch\u01b0a tr\u01b0\u1edfng th\u00e0nh)<\/p>\n
– \u1ede BN th\u01b0\u01a1ng h\u00e0n n\u1eb7ng, d\u00f9ng ngay li\u1ec1u cao chloramphenicol: vi khu\u1ea9n ch\u1ebft gi\u1ea3i ph\u00f3ng qu\u00e1 nhi\u1ec1u n\u1ed9i \u0111\u1ed9c t\u1ed1 c\u00f3 th\u1ec3 g\u00e2y tr\u1ee5y tim m\u1ea1ch v\u00e0 t\u1eed vong<\/p>\n
– R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/p>\n
– Th\u1ea7n kinh: nh\u1ee9c \u0111\u1ea7u, \u00f9 tai<\/p>\n
– Gan: tranh ch\u1ea5p v\u1edbi bilirubin \u0111\u1ec3 g\u1eafn v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng, d\u1ec5 g\u00e2y v\u00e0ng da<\/p>\n
– M\u00e1u: thi\u1ebfu m\u00e1u tan m\u00e1u (do thi\u1ebfu G6PD), suy t\u1ee7y<\/p>\n
– Tr\u00ean th\u1eadn: s\u1ecfi th\u1eadn, \u0111\u00e1i m\u00e1u, v\u00f4 ni\u1ec7u (\u0111i\u1ec1u tr\u1ecb = u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc v\u00e0 base h\u00f3a n\u01b0\u1edbc ti\u1ec3u)<\/p>\n
– Ngo\u00e0i da: c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng t\u1eeb nh\u1eb9 \u0111\u1ebfn r\u1ea5t n\u1eb7ng nh\u01b0 h\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson, h\u1ed9i ch\u1ee9ng Lyell (sulfamid th\u1ea3i tr\u1eeb ch\u1eadm)<\/p>\n
C\u00e2u 16: Nguy\u00ean t\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng sinh an to\u00e0n v\u00e0 h\u1ee3p l\u00fd?<\/p>\n
1) Ch\u1ec9 d\u00f9ng kh\u00e1ng sinh khi c\u00f3 nhi\u1ec5m khu\u1ea9n. D\u00f9ng c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t<\/p>\n
2) Ch\u1ec9 \u0111\u1ecbnh theo ph\u1ed5 t\u00e1c d\u1ee5ng<\/p>\n
3) D\u00f9ng \u0111\u1ee7 li\u1ec1u, ko d\u00f9ng li\u1ec1u t\u0103ng d\u1ea7n<\/p>\n
4) D\u00f9ng \u0111\u1ee7 th\u1eddi gian (th\u01b0\u1eddng l\u00e0 5-7 ng\u00e0y)<\/p>\n
5) Ch\u1ecdn thu\u1ed1c theo d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/p>\n
6) Ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c: khi nhi\u1ec5m khu\u1ea9n c\u00f3 \u1ed5 m\u1ee7, ho\u1ea1i t\u1eed m\u00f4<\/p>\n
III. THU\u1ed0C \u0110I\u1ec0U TR\u1eca HEN PH\u1ebe QU\u1ea2N<\/p>\n
C\u00e2u 17: C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hen, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hen th\u00f4ng d\u1ee5ng?<\/p>\n
1. Thu\u1ed1c l\u00e0m gi\u00e3n ph\u1ebf qu\u1ea3n<\/p>\n
a, Thu\u1ed1c c\u01b0\u1eddng \u03b22 adrenergic:<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– L\u00e0m t\u0103ng ho\u1ea1t t\u00ednh adenyl cyclase -> t\u0103ng chuy\u1ec3n ATP th\u00e0nh AMP v\u00f2ng trong t\u1ebf b\u00e0o g\u00e2y gi\u00e3n ph\u1ebf qu\u1ea3n<\/p>\n
– Khi d\u00f9ng d\u01b0\u1edbi d\u1ea1ng kh\u00ed dung: \u1ee9c ch\u1ebf gi\u1ea3i ph\u00f3ng histamin v\u00e0 leukotrien kh\u1ecfi d\u01b0\u1ee1ng b\u00e0o \u1edf ph\u1ed5i, gi\u1ea3m t\u00ednh th\u1ea5m c\u1ee7a mao m\u1ea1ch ph\u1ed5i, \u1ee9c ch\u1ebf phospholipase A2, t\u0103ng kh\u1ea3 n\u0103ng ch\u1ed1ng vi\u00eam c\u1ee7a corticoid kh\u00ed dung<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
– Lo\u1ea1i c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn (SABA): salbutamol, terbutalin\u2026 d\u00f9ng c\u1eaft c\u01a1n hen<\/p>\n
– Lo\u1ea1i c\u00f3 t\u00e1c d\u1ee5ng d\u00e0i (LABA): salmeterol, formoterol\u2026 d\u00f9ng d\u1ef1 ph\u00f2ng d\u00e0i h\u1ea1n v\u00e0 ki\u1ec3m so\u00e1t hen<\/p>\n
b, D\u1eabn xu\u1ea5t c\u1ee7a xanthine (theophylin):<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
\u1ee8c ch\u1ebf phosphodiesterase \u2013 enzym gi\u00e1ng h\u00f3a AMP v\u00f2ng, l\u00e0m t\u0103ng AMP v\u00f2ng trong t\u1ebf b\u00e0o g\u00e2y gi\u00e3n ph\u1ebf qu\u1ea3n<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
– Theophylin<\/p>\n
– Aminophylin<\/p>\n
c, Thu\u1ed1c h\u1ee7y ph\u00f3 giao c\u1ea3m:<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
\u0110\u1ed1i kh\u00e1ng tranh ch\u1ea5p v\u1edbi acetylcholin t\u1ea1i receptor tr\u00ean c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n v\u00e0 tr\u00ean tuy\u1ebfn nh\u1ea7y g\u00e2y: gi\u00e3n c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n v\u00e0 gi\u1ea3m ti\u1ebft d\u1ecbch<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
– Ipratropium<\/p>\n
– Oxitropium<\/p>\n
2. Thu\u1ed1c ch\u1ed1ng vi\u00eam<\/p>\n
a, Glucocorticoid:<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– \u1ee8c ch\u1ebf enzym COX l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p prostaglandin t\u1eeb acid arachidonic<\/p>\n
– Ph\u1ee5c h\u1ed3i \u0111\u00e1p \u1ee9ng c\u1ee7a \u03b22 v\u1edbi c\u00e1c thu\u1ed1c c\u01b0\u1eddng \u03b22 adrenergic<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
Budesonid, seretide: salmeterol v\u00e0 fluticason propionat<\/p>\n
b, Thu\u1ed1c \u1ed5n \u0111\u1ecbnh d\u01b0\u1ee1ng b\u00e0o:<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
– \u1ee8c ch\u1ebf d\u01b0\u1ee1ng b\u00e0o \u1edf ph\u1ed5i gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian h\u00f3a h\u1ecdc do \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch ho\u1eb7c do t\u01b0\u01a1ng t\u00e1c kh\u00e1ng nguy\u00ean \u2013 kh\u00e1ng th\u1ec3 IgE<\/p>\n
– \u1ee8c ch\u1ebf t\u00e1c d\u1ee5ng ho\u1ea1t h\u00f3a c\u1ee7a c\u00e1c peptid h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng tr\u00ean b\u1ea1ch c\u1ea7u trung t\u00ednh, \u01b0a acid ho\u1eb7c \u0111\u01a1n nh\u00e2n<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
Natri cromoglicat<\/p>\n
c, Thu\u1ed1c kh\u00e1ng leukotrien:<\/p>\n
1) C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
\u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p leukotrien t\u1eeb acid arachidonic (do \u1ee9c ch\u1ebf enzym 5 \u2013 lipoxygenase) ho\u1eb7c ng\u0103n c\u1ea3n t\u00e1c d\u1ee5ng c\u1ee7a leukotrien (do \u0111\u1ed1i kh\u00e1ng v\u1edbi LTD4)<\/p>\n
2) C\u00e1c thu\u1ed1c th\u00f4ng d\u1ee5ng:<\/p>\n
– Zileuton (\u1ee9c ch\u1ebf enzym 5 \u2013 lipoxygenase)<\/p>\n
– Zafirlukast (\u0111\u1ed1i kh\u00e1ng v\u1edbi LTD4)<\/p>\n
IV. THU\u1ed0C KH\u00c1NG HISTAMIN H1<\/p>\n
C\u00e2u 18: Ph\u00e2n lo\u1ea1i thu\u1ed1c kh\u00e1ng d\u1ecb \u1ee9ng v\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng?<\/p>\n
1. Ph\u00e2n lo\u1ea1i: d\u1ef1a v\u00e0o d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc, t\u00e1c d\u1ee5ng, c\u00e1c thu\u1ed1c kh\u00e1ng histamin H1 \u0111\u01b0\u1ee3c chia th\u00e0nh 2 th\u1ebf h\u1ec7:<\/p>\n
1) Th\u1ebf h\u1ec7 I: g\u1ed3m c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 \u0111i qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o d\u1ec5 d\u00e0ng, t\u00e1c d\u1ee5ng tr\u00ean c\u1ea3 H1 trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i bi\u00ean, c\u00f3 t\u00e1c d\u1ee5ng an th\u1ea7n m\u1ea1nh, ch\u1ed1ng n\u00f4n v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic gi\u1ed1ng atropin<\/p>\n
Vd: chlorpheniramin, promethazin\u2026<\/p>\n
2) Th\u1ebf h\u1ec7 II: g\u1ed3m c\u00e1c thu\u1ed1c r\u1ea5t \u00edt \u0111i qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o, \u00edt t\u00e1c d\u1ee5ng tr\u00ean H1 trung \u01b0\u01a1ng, ch\u1ec9 t\u00e1c d\u1ee5ng tr\u00ean H1 ngo\u1ea1i bi\u00ean, ko c\u00f3 t\u00e1c d\u1ee5ng an th\u1ea7n, ch\u1ed1ng n\u00f4n v\u00e0 ko c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic<\/p>\n
Vd: astemizol, cetirizin, loratadin\u2026<\/p>\n
2. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/p>\n
\u0110\u1ed1i kh\u00e1ng tranh ch\u1ea5p thu\u1eadn ngh\u1ecbch v\u1edbi histamin t\u1ea1i receptor H1<\/p>\n
C\u00e2u 19: T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd, t\u00e1c d\u1ee5ng ph\u1ee5, C\u0110, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c kh\u00e1ng histamin H1?<\/p>\n
1. T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd<\/p>\n
1) T\u00e1c d\u1ee5ng kh\u00e1ng histamin: (-> C\u0110)<\/p>\n
\u0110\u1ed1i kh\u00e1ng ho\u00e0n to\u00e0n v\u1edbi histamin t\u1ea1i c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n v\u00e0 ti\u00eau h\u00f3a l\u00e0m gi\u00e3n c\u00e1c c\u01a1 n\u00e0y, \u0111\u1ed1i kh\u00e1ng 1 ph\u1ea7n tr\u00ean tim m\u1ea1ch l\u00e0m gi\u1ea3m t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch<\/p>\n
2) T\u00e1c d\u1ee5ng tr\u00ean TKTW: (-> C\u0110)<\/p>\n
\u1ee8c ch\u1ebf TKTW. C\u00e1c thu\u1ed1c th\u1ebf h\u1ec7 II (\u01b0a n\u01b0\u1edbc v\u00e0 c\u00f3 \u00e1i l\u1ef1c v\u1edbi H1 ngo\u1ea1i bi\u00ean) \u00edt c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean TKTW<\/p>\n
3) T\u00e1c d\u1ee5ng kh\u00e1ng cholinergic<\/p>\n
4) T\u00e1c d\u1ee5ng ch\u1ed1ng say t\u00e0u xe, ch\u1ed1ng n\u00f4n, ch\u1ed1ng ho (-> C\u0110)<\/p>\n
2. T\u00e1c d\u1ee5ng ph\u1ee5<\/p>\n
1) Do t\u00e1c d\u1ee5ng kh\u00e1ng histamin: r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, lo\u1ea1n nh\u1ecbp tim<\/p>\n
2) Do t\u00e1c d\u1ee5ng tr\u00ean TKTW: an th\u1ea7n, bu\u1ed3n ng\u1ee7, ch\u00f3ng m\u1eb7t\u2026<\/p>\n
3) Do t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic: kh\u00f4 mi\u1ec7ng, b\u00ed ti\u1ec3u\u2026<\/p>\n
4) Qu\u00e1 li\u1ec1u: co gi\u1eadt (tr\u1ebb em)<\/p>\n
3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/p>\n
1) \u1ede PN c\u00f3 thai: ko d\u00f9ng cyclizin v\u00e0 d\u1eabn xu\u1ea5t (c\u00f3 th\u1ec3 g\u00e2y qu\u00e1i thai)<\/p>\n
2) Ko d\u00f9ng chung: thu\u1ed1c th\u1ebf h\u1ec7 II v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men gan<\/p>\n
3) Ko d\u00f9ng chung v\u1edbi benzodiazepin v\u00e0 r\u01b0\u1ee3u<\/p>\n
4) Khi l\u00e1i xe, v\u1eadn h\u00e0nh m\u00e1y m\u00f3c<\/p>\n
V. THU\u1ed0C \u0110I\u1ec0U TR\u1eca LO\u00c9T D\u1ea0 D\u00c0Y – T\u00c1 TR\u00c0NG<\/p>\n
C\u00e2u 20: C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng v\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng?<\/p>\n
1. Thu\u1ed1c kh\u00e1ng acid: trung h\u00f2a acid trong d\u1ecbch v\u1ecb<\/p>\n
1) Mg(OH)2:<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
Mg(OH)2 + HCl \u2192 MgCl2 + H2O<\/p>\n
+ Xu\u1ed1ng ru\u1ed9t non: Mg2+ t\u00e1c d\u1ee5ng v\u1edbi [\u200bIMG]v\u00e0 [\u200bIMG]t\u1ea1o th\u00e0nh mu\u1ed1i r\u1ea5t \u00edt tan ho\u1eb7c ko tan -> ko \u0111\u01b0\u1ee3c h\u1ea5p thu v\u00e0 \u0111\u00e0o th\u1ea3i ra ngo\u00e0i<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: ti\u00eau ch\u1ea3y<\/p>\n
2) Al(OH)3:<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
Al(OH)3 + 3HCl \u2192 AlCl3 + 3H2O<\/p>\n
+ Xu\u1ed1ng ru\u1ed9t non: Al3+ t\u00e1c d\u1ee5ng v\u1edbi [\u200bIMG]t\u1ea1o th\u00e0nh mu\u1ed1i ko tan -> ko \u0111\u01b0\u1ee3c h\u1ea5p thu v\u00e0 \u0111\u00e0o th\u1ea3i ra ngo\u00e0i<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: t\u00e1o b\u00f3n<\/p>\n
3) Ch\u1ebf ph\u1ea9m ph\u1ed1i h\u1ee3p Mg(OH)2 v\u00e0 Al(OH)3: Maalox -> gi\u1ea3m b\u1edbt t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a 2 thu\u1ed1c<\/p>\n
4) NaHCO3:<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
NaHCO3 + HCl \u2192 NaCl + H2O + CO2<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5:<\/p>\n
+ Do h\u1ea5p thu nhanh v\u00e0o m\u00e1u n\u00ean g\u00e2y ph\u00f9<\/p>\n
+ \u0110\u1ea7y h\u01a1i<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng ti\u1ebft acid h\u1ed3i \u1ee9ng (t\u0103ng ti\u1ebft acid sau khi ng\u1eebng thu\u1ed1c)<\/p>\n
2. Thu\u1ed1c l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft HCl v\u00e0 pepsin \u1edf d\u1ea1 d\u00e0y<\/p>\n
1) Thu\u1ed1c kh\u00e1ng histamin H2:<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
+ \u1ee8c ch\u1ebf c\u1ea1nh tranh v\u1edbi histamin t\u1ea1i receptor H2 v\u00e0 ko c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean receptor H1 -> ng\u0103n c\u1ea3n b\u00e0i ti\u1ebft d\u1ecbch v\u1ecb do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o l\u00e0m t\u0103ng ti\u1ebft histamin t\u1ea1i d\u1ea1 d\u00e0y<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5:<\/p>\n
+ Ch\u1ee9ng v\u00fa to \u1edf \u0111\u00e0n \u00f4ng v\u00e0 thi\u1ec3u n\u0103ng t \u00ec n h d \u1ee5 c khi d\u00f9ng cimetidin k\u00e9o d\u00e0i (do kh\u00e1ng androgen)<\/p>\n
– C\u00e1c thu\u1ed1c:<\/p>\n
+ Cimetidin<\/p>\n
+ Ranitidin<\/p>\n
+ Famotidin<\/p>\n
+ Nizatidin<\/p>\n
2) Thu\u1ed1c \u1ee9c ch\u1ebf H+\/K+ – ATPase (b\u01a1m proton):<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
+ \u1ede t\u1ebf b\u00e0o th\u00e0nh, ti\u1ec1n thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh, g\u1eafn v\u00e0o b\u01a1m proton, \u1ee9c ch\u1ebf ko h\u1ed3i ph\u1ee5c b\u01a1m n\u00e0y -> l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft acid do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o (v\u00ec \u0111\u00e2y l\u00e0 con \u0111\u01b0\u1eddng chung cu\u1ed1i c\u00f9ng c\u1ee7a s\u1ef1 b\u00e0i ti\u1ebft acid)<\/p>\n
+ B\u00e0i ti\u1ebft acid ch\u1ec9 tr\u1edf l\u1ea1i sau khi b\u01a1m proton m\u1edbi \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, nhi\u1ec5m khu\u1ea9n ti\u00eau h\u00f3a, t\u0103ng gastrin m\u00e1u<\/p>\n
– C\u00e1c thu\u1ed1c:<\/p>\n
+ Omeprazol<\/p>\n
+ Esomeprazol<\/p>\n
+ Pantoprazol<\/p>\n
+ Lansoprazol<\/p>\n
+ Rabeprazol<\/p>\n
3. Thu\u1ed1c b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y<\/p>\n
1) Bismuth:<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/p>\n
+ T\u0103ng ti\u1ebft d\u1ecbch nh\u1ea7y v\u00e0 bicarbonat -> \u1ee9c ch\u1ebf ho\u1ea1t t\u00ednh c\u1ee7a pepsin<\/p>\n
+ T\u1ea1o ph\u1ee9c v\u1edbi protein t\u1ea1i \u1ed5 lo\u00e9t, b\u1ea3o v\u1ec7 \u1ed5 lo\u00e9t ch\u1ed1ng l\u1ea1i s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a acid v\u00e0 pepsin<\/p>\n
+ Di\u1ec7t HP<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: \u0111en mi\u1ec7ng, \u0111en ph\u00e2n<\/p>\n
2) Sucralfat (ph\u1ee9c h\u1ee3p c\u1ee7a Al(OH)3 v\u00e0 sulfat sucrose):<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: g\u1eafn v\u1edbi protein t\u1ea1i \u1ed5 lo\u00e9t, b\u1ea3o v\u1ec7 \u1ed5 lo\u00e9t ch\u1ed1ng l\u1ea1i s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a acid v\u00e0 pepsin. Ngo\u00e0i ra c\u00f2n k\u00edch th\u00edch s\u1ea3n xu\u1ea5t prostaglandin (E2, I1) t\u1ea1i ch\u1ed7, n\u00e2ng pH d\u1ecbch v\u1ecb<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: t\u00e1o b\u00f3n<\/p>\n
3) Misoprostol (prostaglandin E1 t\u1ed5ng h\u1ee3p):<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: k\u00edch th\u00edch c\u01a1 ch\u1ebf b\u1ea3o v\u1ec7 \u1edf ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y, gi\u1ea3m b\u00e0i ti\u1ebft acid, t\u0103ng li\u1ec1n v\u1ebft lo\u00e9t ho\u1eb7c d\u1ef1 ph\u00f2ng lo\u00e9t do d\u00f9ng NSAIDs<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5: ti\u00eau ch\u1ea3y, s\u1ea9y thai<\/p>\n
4. Kh\u00e1ng sinh di\u1ec7t HP<\/p>\n
Ph\u00e1c \u0111\u1ed3 ph\u1ed5 bi\u1ebfn nh\u1ea5t, hi\u1ec7u qu\u1ea3 cao, chi ph\u00ed h\u1ee3p l\u00fd: d\u00f9ng 3 thu\u1ed1c trong 1 tu\u1ea7n g\u1ed3m 1 thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton v\u00e0 2 trong 3 kh\u00e1ng sinh: amoxicillin, clarithromycin v\u00e0 metronidazol<\/p>\n
XXIII. D\u01af\u1ee2C \u0110\u1ed8NG H\u1eccC<\/p>\n
C\u00e2u 21: S\u1ef1 h\u1ea5p thu thu\u1ed1c?<\/p>\n
1) C\u00e1c \u0111\u01b0\u1eddng h\u1ea5p thu thu\u1ed1c v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
Qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/p>\n
+ Qua ni\u00eam m\u1ea1c d\u01b0\u1edbi l\u01b0\u1ee1i: \u0111i th\u1eb3ng v\u00e0o tu\u1ea7n ho\u00e0n qua TM c\u1ea3nh<\/p>\n
+ Qua ru\u1ed9t non: vi\u00ean bao tan trong ru\u1ed9t, vi\u00ean ph\u00f3ng th\u00edch ch\u1eadm<\/p>\n
+ Qua tr\u1ef1c tr\u00e0ng: 50% chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf gan, \u0111\u01b0\u1ee3c h\u1ea5p thu qua TM tr\u1ef1c tr\u00e0ng tr\u00ean, gi\u1eefa v\u00e0 d\u01b0\u1edbi<\/p>\n
Qua \u0111\u01b0\u1eddng ti\u00eam<\/p>\n
+ Ti\u00eam d\u01b0\u1edbi da: \u0111au, h\u1ea5p thu ch\u1eadm<\/p>\n
+ Ti\u00eam b\u1eafp: \u00edt \u0111au h\u01a1n, h\u1ea5p thu nhanh h\u01a1n<\/p>\n
+ Ti\u00eam TM: ko c\u00f2n s\u1ef1 h\u1ea5p thu<\/p>\n
Qua \u0111\u01b0\u1eddng kh\u00e1c<\/p>\n
+ Qua h\u00f4 h\u1ea5p: h\u1ea5p thu nhanh, ko chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf gan<\/p>\n
+ Qua th\u1ea7n kinh trung \u01b0\u01a1ng: c\u00f3 h\u00e0ng r\u00e0o m\u00e1u \u2013 n\u00e3o ng\u0103n c\u1ea3n, ph\u1ea3i \u0111\u01b0a v\u00e0o b\u1eb1ng \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng<\/p>\n
+ Qua da: ph\u1ee5 thu\u1ed9c v\u00e0o h\u1ec7 s\u1ed1 D\/N c\u1ee7a thu\u1ed1c, \u0111\u1ed9 hydrat h\u00f3a c\u1ee7a l\u1edbp s\u1eebng. G\u00e2y t\u00e1c d\u1ee5ng t\u1eeb n\u00f4ng \u0111\u1ebfn s\u00e2u ho\u1eb7c to\u00e0n th\u00e2n<\/p>\n
2) \u0110i\u1ec1u ki\u1ec7n \u0111\u1ec3 thu\u1ed1c \u0111\u01b0\u1ee3c h\u1ea5p thu:<\/p>\n
– Ko ho\u1eb7c r\u1ea5t \u00edt b\u1ecb ion h\u00f3a (ph\u1ea7n thu\u1ed1c ko b\u1ecb ion h\u00f3a m\u1edbi qua \u0111\u01b0\u1ee3c m\u00e0ng sinh h\u1ecdc)<\/p>\n
– Tan trong n\u01b0\u1edbc (m\u1edbi v\u00e0o \u0111\u01b0\u1ee3c m\u00e1u v\u00e0 d\u1ecbch gian b\u00e0o) v\u00e0 trong lipid (m\u1edbi qua \u0111\u01b0\u1ee3c m\u00e0ng sinh h\u1ecdc \u0111\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng)<\/p>\n
3) C\u00e1ch \u0111\u1ec3 1 ph\u00e2n t\u1eed thu\u1ed1c \u0111i qua m\u00e0ng sinh h\u1ecdc:<\/p>\n
– L\u1ecdc qua c\u00e1c \u1ed1ng d\u1eabn (tan trong n\u01b0\u1edbc, ko tan trong lipid)<\/p>\n
– Khu\u1ebfch t\u00e1n th\u1ee5 \u0111\u1ed9ng (tan trong n\u01b0\u1edbc v\u00e0 lipid, c\u00f3 n\u1ed3ng \u0111\u1ed9 cao \u1edf b\u1ec1 m\u1eb7t m\u00e0ng sinh h\u1ecdc)<\/p>\n
– V\u1eadn chuy\u1ec3n t\u00edch c\u1ef1c:<\/p>\n
+ V\u1eadn chuy\u1ec3n t\u00edch c\u1ef1c nguy\u00ean ph\u00e1t: c\u1ea7n NL<\/p>\n
+ V\u1eadn chuy\u1ec3n t\u00edch c\u1ef1c th\u1ee9 ph\u00e1t: ko c\u1ea7n NL (\u0111i theo ch\u1ea5t mang v\u00e0 b\u1eadc thang n\u1ed3ng \u0111\u1ed9)<\/p>\n
– C\u00e1c h\u00ecnh th\u1ee9c kh\u00e1c:<\/p>\n
+ Nh\u1eadp v\u00e0o: vitamin B12<\/p>\n
+ Xu\u1ea5t b\u00e0o: acetylcholin<\/p>\n
+ Th\u1ef1c b\u00e0o: thu\u1ed1c kh\u00e1ng ung th\u01b0<\/p>\n
+ \u1ea8m b\u00e0o: vitamin A, D<\/p>\n
4) Th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a s\u1ef1 h\u1ea5p thu: sinh kh\u1ea3 d\u1ee5ng (F)<\/p>\n
– \u0110N: l\u00e0 t\u1ef7 l\u1ec7 % l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o \u0111\u01b0\u1ee3c v\u00f2ng tu\u1ea7n ho\u00e0n \u1edf d\u1ea1ng c\u00f2n ho\u1ea1t t\u00ednh v\u00e0 t\u1ed1c \u0111\u1ed9 h\u1ea5p thu thu\u1ed1c so v\u1edbi li\u1ec1u \u0111\u00e3 d\u00f9ng<\/p>\n
– Ph\u00e2n lo\u1ea1i:<\/p>\n
+ F t\u01b0\u01a1ng \u0111\u1ed1i = [\u200bIMG]: so s\u00e1nh F c\u1ee7a c\u00f9ng 1 thu\u1ed1c nh\u01b0ng kh\u00e1c nhau v\u1ec1 d\u1ea1ng b\u00e0o ch\u1ebf<\/p>\n
+ F tuy\u1ec7t \u0111\u1ed1i = [\u200bIMG]: so s\u00e1nh F c\u1ee7a c\u00f9ng 1 thu\u1ed1c nh\u01b0ng kh\u00e1c nhau v\u1ec1 \u0111\u01b0\u1eddng d\u00f9ng<\/p>\n
– C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn sinh kh\u1ea3 d\u1ee5ng:<\/p>\n
+ Chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf gan<\/p>\n
+ T\u00ednh tan c\u1ee7a thu\u1ed1c<\/p>\n
+ T\u00ednh \u1ed5n \u0111\u1ecbnh c\u1ee7a thu\u1ed1c<\/p>\n
+ T\u00ednh ch\u1ea5t c\u1ee7a d\u1ea1ng b\u00e0o ch\u1ebf<\/p>\n
C\u00e2u 22: S\u1ef1 ph\u00e2n ph\u1ed1i thu\u1ed1c?<\/p>\n
1) C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e2n b\u1ed1 thu\u1ed1c trong c\u01a1 th\u1ec3<\/p>\n
2) S\u1ef1 g\u1eafn thu\u1ed1c v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng<\/p>\n
– Cung l\u01b0\u1ee3ng tim v\u00e0 l\u01b0u l\u01b0\u1ee3ng m\u00e1u<\/p>\n
– T\u00ednh th\u1ea5m c\u1ee7a mao m\u1ea1ch<\/p>\n
– S\u1ef1 g\u1eafn thu\u1ed1c v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng:<\/p>\n
+ Albumin<\/p>\n
+ \u03b2 \u2013 globulin<\/p>\n
+ \u03b11 \u2013 glycoprotein<\/p>\n
+ Lipoprotein<\/p>\n
– S\u1ef1 g\u1eafn thu\u1ed1c v\u00e0o m\u00f4<\/p>\n
– T\u00ednh th\u00e2n d\u1ea7u c\u1ee7a thu\u1ed1c<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m:<\/p>\n
+ Ko chuy\u00ean bi\u1ec7t<\/p>\n
+ T \u2013 P: ko ho\u1ea1t t\u00ednh, ko chuy\u1ec3n h\u00f3a, ko \u0111\u00e0o th\u1ea3i<\/p>\n
+ Kh\u1ea3 n\u0103ng g\u1eafn kh\u00e1c nhau<\/p>\n
+ C\u00f3 hi\u1ec7n t\u01b0\u1ee3ng c\u1ea1nh tranh<\/p>\n
+ C\u00f3 hi\u1ec7n t\u01b0\u1ee3ng b\u00e3o h\u00f2a<\/p>\n
– \u00dd ngh\u0129a:<\/p>\n
+ L\u00e0m d\u1ec5 h\u1ea5p thu, ch\u1eadm th\u1ea3i tr\u1eeb<\/p>\n
+ T \u2013 P l\u00e0 kho d\u1ef1 tr\u1eef thu\u1ed1c<\/p>\n
+ Khi protein huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m -> t\u0103ng n\u1ed3ng \u0111\u1ed9 thu\u1ed1c t\u1ef1 do -> t\u0103ng \u0111\u1ed9c t\u00ednh<\/p>\n
+ Trong \u0111i\u1ec1u tr\u1ecb, l\u00fac \u0111\u1ea7u d\u00f9ng li\u1ec1u t\u1ea5n c\u00f4ng \u0111\u1ec3 b\u00e3o h\u00f2a v\u1ecb tr\u00ed g\u1eafn<\/p>\n
+ Nhi\u1ec1u thu\u1ed1c c\u00f3 th\u1ec3 c\u00f9ng g\u1eafn v\u00e0o 1 v\u1ecb tr\u00ed c\u1ee7a protein huy\u1ebft t\u01b0\u01a1ng. Vd: BN d\u00f9ng tolbutamid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0110T\u0110, nay \u0111au kh\u1edbp -> d\u00f9ng th\u00eam phenylbutazon -> \u0111\u1ea9y tolbutamid ra d\u1ea1ng t\u1ef1 do -> h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ed9t ng\u1ed9t<\/p>\n
3) S\u1ef1 g\u1eafn thu\u1ed1c v\u00e0o m\u00f4<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m:<\/p>\n
+ C\u00f3 th\u1ec3 l\u00e0 \u0111\u00edch t\u00e1c \u0111\u1ed9ng (t\u00e1c d\u1ee5ng ch\u00ednh)<\/p>\n
+ C\u00f3 th\u1ec3 ko ph\u1ea3i \u0111\u00edch t\u00e1c \u0111\u1ed9ng (t\u00e1c d\u1ee5ng ph\u1ee5)<\/p>\n
– \u00dd ngh\u0129a:<\/p>\n
+ T\u0103ng th\u1ec3 t\u00edch ph\u00e2n ph\u1ed1i<\/p>\n
+ T\u0103ng kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c<\/p>\n
+ T\u00edch l\u0169y thu\u1ed1c trong m\u00f4<\/p>\n
+ K\u00e9o d\u00e0i th\u1eddi gian t\u00e1c d\u1ee5ng<\/p>\n
4) Th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a s\u1ef1 ph\u00e2n ph\u1ed1i: th\u1ec3 t\u00edch ph\u00e2n ph\u1ed1i (Vd)<\/p>\n
– \u0110N: l\u00e0 th\u1ec3 t\u00edch ko c\u00f3 th\u1ef1c ch\u1ee9a to\u00e0n b\u1ed9 l\u01b0\u1ee3ng thu\u1ed1c \u0111\u01b0a v\u00e0o c\u01a1 th\u1ec3 \u0111\u1ec3 c\u00f3 n\u1ed3ng \u0111\u1ed9 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng trong huy\u1ebft t\u01b0\u01a1ng<\/p>\n
Vd = [\u200bIMG]\n
– \u00dd ngh\u0129a:<\/p>\n
+ Vd nh\u1ecf nh\u1ea5t l\u00e0 = th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng v\u00e0 ko c\u00f3 gi\u1edbi h\u1ea1n tr\u00ean. Vd c\u00e0ng l\u1edbn -> thu\u1ed1c c\u00e0ng g\u1eafn nhi\u1ec1u v\u00e0o m\u00f4<\/p>\n
+ Khi bi\u1ebft Vd -> t\u00ednh \u0111\u01b0\u1ee3c D \u0111\u1ec3 \u0111\u1ea1t Cp mong mu\u1ed1n<\/p>\n
C\u00e2u 23: S\u1ef1 chuy\u1ec3n h\u00f3a thu\u1ed1c?<\/p>\n
1) M\u1ee5c \u0111\u00edch<\/p>\n
2) V\u1ecb tr\u00ed chuy\u1ec3n h\u00f3a v\u00e0 c\u00e1c enzym ch\u00ednh x\u00fac t\u00e1c cho chuy\u1ec3n h\u00f3a<\/p>\n
Chuy\u1ec3n thu\u1ed1c th\u00e0nh d\u1ea1ng c\u00f3 c\u1ef1c, d\u1ec5 b\u1ecb ion h\u00f3a -> \u00edt tan trong lipid, kh\u00f3 g\u1eafn v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng, kh\u00f3 th\u1ea5m qua m\u00e0ng sinh h\u1ecdc, tan trong n\u01b0\u1edbc v\u00e0 d\u1ec5 b\u1ecb th\u1ea3i tr\u1eeb<\/p>\n
– Ni\u00eam m\u1ea1c ru\u1ed9t: protease, lipase<\/p>\n
– Huy\u1ebft t\u01b0\u01a1ng: esterase<\/p>\n
– Ph\u1ed5i: oxydase<\/p>\n
– Vi khu\u1ea9n ru\u1ed9t: reductase<\/p>\n
– TK trung \u01b0\u01a1ng: decarboxylase<\/p>\n
– Gan: l\u00e0 n\u01a1i chuy\u1ec3n h\u00f3a ch\u00ednh, ch\u1ee9a h\u1ea7u h\u1ebft c\u00e1c enzym<\/p>\n
3) C\u00e1c ph\u1ea3n \u1ee9ng \u1edf pha I: ph\u1ea3n \u1ee9ng ko li\u00ean h\u1ee3p<\/p>\n
4) C\u00e1c ph\u1ea3n \u1ee9ng \u1edf pha II: ph\u1ea3n \u1ee9ng li\u00ean h\u1ee3p<\/p>\n
– Ph\u1ea3n \u1ee9ng oxy h\u00f3a<\/p>\n
– Ph\u1ea3n \u1ee9ng kh\u1eed<\/p>\n
– Ph\u1ea3n \u1ee9ng th\u1ee7y ph\u00e2n<\/p>\n
– Li\u00ean h\u1ee3p v\u1edbi acid glucuronic, acid sulfuric, aa (glycin), glutathion<\/p>\n
– Acetyl h\u00f3a, methyl h\u00f3a<\/p>\n
5) C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 chuy\u1ec3n h\u00f3a thu\u1ed1c<\/p>\n
6) Th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a s\u1ef1 chuy\u1ec3n h\u00f3a: h\u1ec7 s\u1ed1 ly tr\u00edch (E)<\/p>\n
– Tu\u1ed5i<\/p>\n
– Di truy\u1ec1n:<\/p>\n
+ Xu\u1ea5t hi\u1ec7n enzym ko \u0111i\u1ec3n h\u00ecnh<\/p>\n
+ Thi\u1ebfu G6PD<\/p>\n
– Y\u1ebfu t\u1ed1 b\u1ec7nh l\u00fd<\/p>\n
– Y\u1ebfu t\u1ed1 ngo\u1ea1i lai:<\/p>\n
+ Thu\u1ed1c g\u00e2y c\u1ea3m \u1ee9ng enzym chuy\u1ec3n h\u00f3a: phenylbutazon<\/p>\n
+ Thu\u1ed1c g\u00e2y \u1ee9c ch\u1ebf enzym chuy\u1ec3n h\u00f3a: cimetidin<\/p>\n
– H\u1ec7 s\u1ed1 ly tr\u00edch \u1edf ru\u1ed9t EI: t\u1ef7 l\u1ec7 thu\u1ed1c chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf ru\u1ed9t<\/p>\n
– H\u1ec7 s\u1ed1 ly tr\u00edch \u1edf gan EH: t\u1ef7 l\u1ec7 thu\u1ed1c \u0111\u00e3 h\u1ea5p thu chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf gan<\/p>\n
– H\u1ec7 s\u1ed1 ly tr\u00edch \u1edf ph\u1ed5i EP: t\u1ef7 l\u1ec7 thu\u1ed1c \u0111\u00e3 h\u1ea5p thu chuy\u1ec3n h\u00f3a l\u1ea7n 1 \u1edf ph\u1ed5i<\/p>\n
C\u00e2u 24: S\u1ef1 th\u1ea3i tr\u1eeb thu\u1ed1c?<\/p>\n
1) Th\u1ea3i tr\u1eeb qua th\u1eadn:<\/p>\n
– C\u00e1c qu\u00e1 tr\u00ecnh:<\/p>\n
+ L\u1ecdc \u1edf c\u1ea7u th\u1eadn: ph\u1ee5 thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc, \u0111i\u1ec7n t\u00edch v\u00e0 h\u00ecnh d\u1ea1ng ph\u00e2n t\u1eed<\/p>\n
+ B\u00e0i ti\u1ebft ch\u1ee7 \u0111\u1ed9ng qua \u1ed1ng th\u1eadn: nh\u1edd ch\u1ea5t mang v\u00e0 c\u00f3 s\u1ef1 c\u1ea1nh tranh<\/p>\n
+ Khu\u1ebfch t\u00e1n th\u1ee5 \u0111\u1ed9ng qua \u1ed1ng th\u1eadn (t\u00e1i h\u1ea5p thu): c\u00e1c thu\u1ed1c tan trong lipid, ko b\u1ecb ion h\u00f3a \u1edf pH n\u01b0\u1edbc ti\u1ec3u<\/p>\n
– \u00dd ngh\u0129a:<\/p>\n
+ L\u00e0m gi\u1ea3m th\u1ea3i tr\u1eeb \u0111\u1ec3 ti\u1ebft ki\u1ec7m thu\u1ed1c: th\u1eadn th\u1ea3i probenecid (r\u1ebb ti\u1ec1n, \u00edt t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb) v\u00e0 gi\u1eef l\u1ea1i penicillin (\u0111\u1eaft ti\u1ec1n, c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb)<\/p>\n
+ L\u00e0m t\u0103ng th\u1ea3i tr\u1eeb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c: base h\u00f3a n\u01b0\u1edbc ti\u1ec3u<\/p>\n
+ Gi\u1ea3m li\u1ec1u trong tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn<\/p>\n
2) Th\u1ea3i tr\u1eeb qua m\u1eadt<\/p>\n
3) Th\u1ea3i tr\u1eeb qua ph\u1ed5i<\/p>\n
– C\u00e1c thu\u1ed1c c\u00f3 TLPT l\u1edbn<\/p>\n
– C\u00e1c thu\u1ed1c c\u00f3 c\u1ef1c<\/p>\n
– C\u00e1c thu\u1ed1c c\u00f3 chu k\u1ef3 gan \u2013 ru\u1ed9t<\/p>\n
– L\u01b0u \u00fd: kh\u00e1ng sinh l\u00e0m gi\u1ea3m vk \u0111\u01b0\u1eddng ru\u1ed9t -> gi\u1ea3m enzym \u03b2 \u2013 glucuronidase -> gi\u1ea3m chu k\u1ef3 gan \u2013 ru\u1ed9t<\/p>\n
– C\u00e1c ch\u1ea5t bay h\u01a1i: r\u01b0\u1ee3u, tinh d\u1ea7u<\/p>\n
– C\u00e1c ch\u1ea5t kh\u00ed: halothan<\/p>\n
4) Th\u1ea3i tr\u1eeb qua s\u1eefa<\/p>\n
5) Th\u1ea3i tr\u1eeb qua c\u00e1c \u0111\u01b0\u1eddng kh\u00e1c<\/p>\n
– C\u00e1c thu\u1ed1c c\u00f3 TLPT nh\u1ecf<\/p>\n
– C\u00e1c thu\u1ed1c tan nhi\u1ec1u trong lipid<\/p>\n
– Qua t\u00f3c: asen<\/p>\n
– Qua ni\u00eam m\u1ea1c (m\u1eaft, m\u0169i)<\/p>\n
– Qua m\u1ed3 h\u00f4i v\u00e0 tuy\u1ebfn n\u01b0\u1edbc b\u1ecdt<\/p>\n
6) Th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a s\u1ef1 th\u1ea3i tr\u1eeb:<\/p>\n
– \u0110\u1ed9 thanh th\u1ea3i (CL):<\/p>\n
+ \u0110N: l\u00e0 kh\u1ea3 n\u0103ng 1 c\u01a1 quan trong c\u01a1 th\u1ec3 th\u1ea3i tr\u1eeb ho\u00e0n to\u00e0n 1 thu\u1ed1c ra kh\u1ecfi huy\u1ebft t\u01b0\u01a1ng khi m\u00e1u tu\u1ea7n ho\u00e0n qua c\u01a1 quan \u0111\u00f3<\/p>\n
CL = [\u200bIMG]\n
+ CL = CL (gan) + CL (th\u1eadn) + CL (c\u00e1c m\u00f4 kh\u00e1c)<\/p>\n
+ \u00dd ngh\u0129a:<\/p>\n
(+) Thu\u1ed1c c\u00f3 CL l\u1edbn -> \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb nhanh, t1\/2 ng\u1eafn<\/p>\n
(+) D\u00f9ng CL \u0111\u1ec3 t\u00ednh Cp<\/p>\n
(+) \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u trong tr\u01b0\u1eddng h\u1ee3p suy gan, suy th\u1eadn<\/p>\n
– Th\u1eddi gian b\u00e1n th\u1ea3i (t1\/2):<\/p>\n
+ \u0110N:<\/p>\n
(+) t1\/2 \u03b1 (t1\/2 h\u1ea5p thu): th\u1eddi gian c\u1ea7n thi\u1ebft \u0111\u1ec3 1\/2 l\u01b0\u1ee3ng thu\u1ed1c \u0111\u00e3 d\u00f9ng h\u1ea5p thu v\u00e0o tu\u1ea7n ho\u00e0n<\/p>\n
(+) t1\/2 \u03b2 (t1\/2 th\u1ea3i tr\u1eeb): th\u1eddi gian c\u1ea7n thi\u1ebft \u0111\u1ec3 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng c\u00f2n l\u1ea1i 1\/2<\/p>\n
+ \u00dd ngh\u0129a:<\/p>\n
(+) t1\/2 t\u1ef7 l\u1ec7 ngh\u1ecbch v\u1edbi CL. Khi CL thay \u0111\u1ed5i -> t1\/2 thay \u0111\u1ed5i -> c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u ho\u1eb7c kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c li\u1ec1u<\/p>\n
(+) 5 l\u1ea7n t1\/2: n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh. 7 l\u1ea7n t1\/2: thu\u1ed1c \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb ho\u00e0n to\u00e0n ra kh\u1ecfi huy\u1ebft t\u01b0\u01a1ng<\/p>\n
(+) \u0110\u1ed1i v\u1edbi m\u1ed7i thu\u1ed1c: th\u1eddi gian b\u00e1n th\u1ea3i gi\u1ed1ng nhau cho m\u1ecdi li\u1ec1u d\u00f9ng -> suy ra kho\u1ea3ng c\u00e1ch d\u00f9ng thu\u1ed1c<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u00e0i so\u1ea1n t\u1eeb 1 b\u1ea1n nam K15a1 (XH) t\u1ed5ng h\u1ee3p kh\u00e1 \u0111\u1ea7y \u0111\u1ee7 m\u1ee5c ti\u00eau c\u1ed1t l\u00f5i m\u1ed7i b\u00e0i h\u1ecdc, s\u00e1t \u0111\u1ec1 thi k15 I. THU\u1ed0C T\u00c1C D\u1ee4NG TR\u00caN H\u1ec6 TK TH\u1ef0C V\u1eacT C\u00e2u 1: Ph\u00e2n lo\u1ea1i h\u1ec7 TK th\u1ef1c v\u1eadt theo d\u01b0\u1ee3c l\u00fd? [\u200bIMG] H\u1ec7 TK th\u1ef1c v\u1eadt H\u1ec7 cholinergic H\u1ec7 adrenergic [\u200bIMG] (Acetylcholin) …<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,41],"tags":[],"class_list":["post-1999","post","type-post","status-publish","format-standard","","category-mon-co-so","category-duoc-ly"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1999"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1999\/revisions"}],"predecessor-version":[{"id":2000,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1999\/revisions\/2000"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1999"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}