Bai soan TT DLS.pdf

N THUC 1

N - 21 tui Vim trt d dy, nhim H. pylori

NHN XT LIU DNG, CCH DNG 10 ngy u cc thuc tr Nexium

1. Amoxicilin

Sng 1v Ti 1v

500 mg x 20v Khng b nh hng bi thc n, ung chung esomeprazol bui ti

2. Getlox (Levofloxacin)

Sng 1v Ti 1v

500 mg x 20v Thc n lm gim hp thu. Trc ba n 1h hay sau n 2h

Ung trc ba sng 1 gi + sau ba ti 2 gi

3. Antibio

Sng 1 gi Ti 1 gi

1 g x 20 gi

Cn nhc dng hay khng. Ung khi tiu chy, ung xa khng sinh

4. Magne B6

Sng 1v Ti 1v

20v Ung cch levofloxacin v lm gim hp thu KS quinolol

5. Nexium (Esomeprazol)

Ti ung 1v

40 mg x 15v Thc n lm gim hp thu esomeprazol

Ung trc khi n 30 pht 1gi, bui ti trc khi i ng

Thuc Tc dng ch nh C ch tc ng Chng ch nh ADR Lu

Amoxicilin

Nhim khun h hp, tit

niu, ng mt, da, c, vim

hng, vim amidan Lot dd-

tt, H. pylori

c ch sinh tng hp

mucopeptid ca thnh t

bo vi khun, ph gram

(+) v 1 t gram (-)

E. coli, Sal, Shi

Tin s d ng bt

k peni no

pht ban, qu mn,

bun nn, tiu chy

Thng 250 mg -500 mg, 8h/ln.

1g/ngy chia 2 ln + clari + PPI

=> 10-14 ngy (triple therapy)

1g/ngy chia 3 ln + PPI

=> phc 2 thuc

Getlox

Levofloxacin

Vim da, vim ng h hp,

vim ng tiu, vim mng

no, tiu chy DLch

Dng trong phc cu vn

2 KS + 1 PPI

c ch enzym tho xon

topoisomerase IV v DNA

gyrase => ngn cn s

ti bn hay sao chp AND

ca vi khun

Qu mn cm Tn thng gn, dy

chng, gn Achilles

=> ngng s dng nu

au, sng, vim, hoc

tn thng gn xy ra

Nhy cm nh sng

iu tr tiu chy du lch: PO 500

mg/ngy/ln trong 1-3 ngy

Ung cch xa ba n (trc n 1

gi/sau n 2 gi) v thc n lm

gim hp thu.

Antibio

L. acidophillus

NSX: Organon

Cn bng h VK rut Antibio gn vo thnh rut, pht trin v chng li vi khun gy bnh

bng c ch:

- thay i pH ng rut;

- tit cc cht c tnh khng khun

- tc ng khng enterotoxine

- kch thch h min nhim

Ngi ln: ung 2 gi x BID

Tng tc vi tetracyclin lm ngn

hp thu tetracyclin.

Ch cch dng trong trng hp

ny (1)

Thuc Tc dng ch nh C ch tc ng Chng ch nh ADR Lu

Magne-B6

Mg lactat

470 mg

Pyridoxine

chlorhydrat

5 mg

Thiu Mg nng

Ri lon chc nng ca nhng

cn lo u i km vi tng

thng kh khi cha c iu tr

c hiu => tng co git

Mg gim tnh kch thch

ca neurone v s dn

truyn neurone - c

Vit B6 l coenzyme, tham

gia vo nhiu qu trnh

chuyn ha

Suy thn nng

Clr ngng khng sinh v bo ngay vi bc s hoc n cc TTYT xt nghim v iu tr.

(2): Bnh Crohn l mt qu trnh vim v lot xy ra tng (lp) su hn ca thnh rut. Vng rut b bnh ph bin nht l phn thp ca rut non (on

tip gip rut non v rut gi, gi l vng Hi- manh trng - ileum). V vy ngi ta cn gi bnh Crohn l vim hi manh trng (ileocolotis).

TNG TC THUC

Amoxicilin-B6, Levofloxacin-B6: amox v levofloxacin nh hng tc ng ca B6 do thay i h VK rut. Tng tc nh hoc ko ng k.

Mg-levofloxacin: Cc ch phm cha Mg, Al, Zn thng gy gim hp thu KS quinolon.

Esomeprazol-thc n: thc n lm gim hp thu esomeprazol 33-53% ung trc ba n t nht 1 gi.

THNG TIN THM: Cc phc iu tr vim lot d dy t trng c H. pylori (theo th t s dng)

Phc 3 thuc u tay: 1 PPI + 2 KS, thng dng amox+clarithromycin, thay amox bng metronidazol khi bnh nhn d ng peni.

Phc 4 thuc: Phc 3 thuc u tay + bismuth nitrat

Phc ni tip:

5 ngy u: 1 PPI + 1 KS (thng l amox)

5 ngy sau: thay amox bng clarithromycin/metronidazol/Tinidazol.

Phc cu vn: 1 PPI + 2 KS, thay 1 KS trong 2 KS ca phc 3 thuc u tay bng levofloxacin/rifabutin.

1. Cc phc kinh in iu tr trong 7 ngy

Phc 3 thuc: PPI hoc RBC (Ranitidine Bismuth Citrate) phi hp vi 2 khng sinh

PPI + Amoxicillin 1000 mg + Clarithromycin 500 mg x 2 ln ngy, iu tr trong 7 ngy

PPI + Clarithromycin 500 mg + Metronidazole hoc Tinidazole 500 mg x 2 ln ngy, iu tr trong 7 ngy

PPI + Amoxicillin 1000 mg + Metronidazole hoc Tinidazole 500 mg x 2 ln ngy, iu tr trong 7 ngy

PPI gm cc thuc: Omeprazole 20 mg, Lanzoprazole 30 mg, Pantoprazole 40 mg, Rabeprazole 20 mg, Esomeprazole 20 mg hoc 40 mg.

Phc 4 thuc: PPI + BMT

(PPI + Metronidazole 500 mg) 2 ln ngy + (Bismuth 120 mg + Tetracycline 500 mg) 4 ln ngy, iu tr trong 7 ngy.

2. Cc phc kinh in, iu tr 14 ngy

Phc 3 thuc

(PPI + Amoxicillin 1g + Clarithromycin 500 mg hoc Metronidazole, v hoc Tinidazole 500 mg) 2 ln ngy, 14 ngy

Phc 4 thuc

(Bismuth + Metronidazole 500 mg + Tetracycline 500 mg) 3 ln ngy + PPI 2 ln ngy, iu tr trong 14 ngy.

3. Phc iu tr ni tip

5 ngy u: PPI + Amoxicillin 1 g 2 ln/ngy

5 ngy sau: PPI + Clarithromycin 500 mg + Metronidazole/ Tinidazole 500 mg 2 ln/ngy

4. Phc cu vn hay phc s dng cc khng sinh mi.

Trong trng hp iu tr tht bi vi phc 3 thuc kinh in v hoc k c phc 4 thuc, vic iu tr tip theo cn da trn kt qu khng sinh .

Ty trng hp c th v ht sc linh hot, c s dng mt loi khng sinh mi nh Levofloxacin, Rifabutin, v hoc Furazolidone thay th Clarithromycin

hoc Metronidazole trong cc phc 3 thuc kinh in.

NHN XT:

n thuc c 1 PPI + amox + levofloxacin dng phc cu vn. Nu bnh nhn mi mc bnh th dng ngay phc ny l ko hp l, nu

bnh nhn mc bnh lu ngy, dng 3 phc trn m ko hiu qu th s dng phc ny l hp l.

Liu dng: cha nhn xt c v liu dng c th cho phc cu vn ko tm c!!!

S dng KS nhiu nguy c ri lon h VK rut b sung antibio cn nhc

Mg-B6: c k c th do bnh nhn cn tr (21 tui) gp cng thng do bnh tt hoc cng vic/hc tp, tuy nhin n thuc ko chn on c

th l bnh nhn b cng thng hay vn g khc nn c th l cng thng do bnh tt + b sung Mg

CH SINH HOT:

n ung y , ng ba, hn ch n cc thc n d kch ng d dy (nhiu gia v hoc v cay, chua), chia nh cc ba n trong ngy

C ch tc ng ca KS ln H.p??????

N THUC 2

N 38 tui Vim d dy

NHN XT LIU DNG, CCH DNG cho 14 ngy

1. Rabeprazole 20 mg (Rabsun) 28 vin Dng liu 20 mg/ngy cho vim d dy H.p (-)

Ngy ung 2 ln, mi ln 1 vin, trc n Ung 30 pht trc ba n

2. Almagate 1g/5ml (Yumangel) 42 gi Ung xa ba n hay khi c triu chng, nn i thnh phosphat nhm

Ngy ung 3 ln, mi ln 1 gi, sau n 2 gi trnh mt phosphat (dng phosphalugen)

3. Mosaprid 5 mg (Zurma) 42 vin Liu 15 mg/ngy => ng liu, ung trc n

Ngy ung 3 ln, mi ln 1 vin, trc n

4. Enzystal 42 vin Ung nguyn vin, khng nhai, khng b

Ngy ung 3 ln, mi ln 1 vin, trc n Ung trong hay sau ba n

Tn thuc Tc dng ch nh ADR Chng ch nh Lu

Rabsun 20mg

Rabeprazole natri

Vin nn bao tan

trong rut

Nhm: PPI

Thuc c ch bm proton

- iu tr ngn hn bnh tro

ngc d dy (GERD) (c lot

d dy hay khng)

- iu tr ngn hn lot dd

- iu tr di hn bnh l tng

tit dch tiu ha

Che lp du hiu ung th d dy

Tng nguy c gy xng hng,

c tay v ct sng (sd > 1 nm)

nng Mg mu c th dn

n co git, ng kinh, lon nhp.

Tng nguy c nhim trng HH

Tiu chy, bun nn, suy nhc,

cng c, nhc u.

Ngi mn cm vi bt

c thnh phn no ca

thuc

PN cho con b

Tr < 18 tui

Category B

GERD 20mg/ngy

Lot d dy:

+ HP(+): 40mg/ngy x 7 ngy.

+ HP(-): 20mg/ngy x 4 tun.

Ung trc n 30 v ko b, nhai m

phi nut nguyn vin

Yumangel

Almagate 1g/5ml

Al2Mg6(OH)14(CO3)20

ngm 4H2O

Nhm: antacid

iu tr triu chng ca vim

lot d dy t trng, bnh tro

ngc d dy v d acid

Mt Phosphat gy xp xng, c

thn, to bn, tng s pht trin

ca cc loi vk c hi (HP, BKoch)

BN Suy gim nng

phosphate trong mu,

Mn cm tp thuc

Trnh dng chung vi cc loi thuc

khac do lm gim hp thu, dng lu

ngy => rebound

1 gi/1 ln x 3 ln ngy ung xa ba n

hoc khi c triu chng

Zurma 5mg

Mosaprid citrat

Tng tc lm rng d dy.

Tro ngc d dy thc qun

Ph, tiu chy, au bng, bun

nn, kh ming, nhc u , chong

vng.

Ngi qu mn vi bt

c thnh phn no ca

thuc.

15mg/ngy

C ch: Chn lc trn 5HT4

tit acetylcholin

Enzystal

Pancreatin 192 mg

Cao mt b 25 mg

Hemicellulase 50 mg

Ch nh trong trng hp kh

tiu, n ko iu

V l enzym h tr tiu ha

=> dng bao tan tong rut

au ming, bun nn, co tht ph

qun, au hu mn, pht ban, co

cng c bng, tiu chy

Qu mn vi thnh

phn ca thuc, tt

mt, vng da.

Ung nguyn vin, ko nhai, ko b.

1-2v/ln x 3 ln/ngy

Ung trong hay sau ba n

Nhn xt:

Rabeprazol: nu xt nghim H.p (+) th nn dng liu l 40 mg

Almagate: ch nn dng khi c triu chng v nn i thnh dng phosphate nhm trnh mt phosphat xng.

Mosaprid l thuc tng tit acetylcholine, m acetylcholine li lm tng hot ng ca bm proton (d gy nn lot) nhng trong n ny c s dng 1 thuc

c ch bm proton l rabeprazol => hp l

Cc thuc trong n dng tr triu chng ca vim d dy (thng l k c biu hin ng k, hoc c th l chng tro ngc nn, n kh tiu, au),

ng thi bo v vim khng tin trin thnh lot.

Nhm gy to bn nn phi hp Magne nhun trng => khc phc tc dng c hi ca nhm

Enzystal: Sau khi thc n t d dy xung rut do cha thm dch tiu ha d dy (b tng xung nhanh hn bnh thng) nn xung rut cn b sung

men tiu ha cung cp dinh dng

Li dn ca BS:

Cn nhc nh bnh nhn v cch s dung thuc nh rabeprazol v enzystal th ko c b, nhai m phi nut nguyn vin.

Cn dn bnh nhn v cc tc dng ph ca thuc

Kh nng gy xng ca v h Mg huyt ca rabeprazol

Lm mt phosphate ca Almagate v cn dn bnh nhn n nhiu thc phm cha phosphate.

Nhc nh bnh nhn nu bnh nhn mun c thai hoc ang cho con b th phi ngng dng rabeprazol hoc n BS hoc DS c t vn.

N THUC 3

N 56 tui Vim d dy t trng, HP (+) NHN XT LIU DNG, CCH DNG

1. Captomed 500 mg (Clarithromycin) 20 vin ng phc 3 thuc

Ngy ung 2 ln, mi ln 1 vin, sau n Sng 1 vin Chiu 1 vin (trc n cho tin)

2. Holdamox 500 (Amoxicillin 500 mg) 40 vin Sng 1 vin Chiu 1 vin (trc n cho tin)

Ngy ung 2 ln, mi ln 2 vin

3. Patoprazol Stada 40 mg (Pantoprazol) 20 vin Ung sau ba n do dng thuc tng tc tho rng dd

Ngy ung 2 ln, mi ln 1 vin, sau n

4. Dogmatil Cap. 50 mg (Sulpirid 50 mg) 20 vin Nn thay bng Mg-B6.

Ngy ung 2 ln, mi ln 1 vin, sau n Sng 1 Chiu 1

5. Domperidon (Domperidon 10 mg) 20 vin Phi thay domperidol = metoclopramid

Ngy ung 2 ln, mi ln 1 vin, sau n

6. Varogel 20 gi Dng xa cc thuc khc -

Ngy ung 2 ln, mi ln 1 gi, sau n 20 pht Nn dng sau n t nht 30 pht

Tn thuc Tc dng ch nh Tc dng ph Chng ch nh Lu

Captomed 500mg

Clarithromycin

Vim tai gia, vim hng,

vim amidan, vim da, vim

lot d dy do HP,

Vim rut kt mng gi, bun nn,

chng mt, nhc u, tiu chy

D ng vi bt c thnh

phn no ca thuc

Category C

iu tr HP: 500mg/ln x 2 ln/ngy

Holdamox 500

Amoxicillin 500 mg

Vim tai gia, vim hng,

vim amidan, vim da, vim

lot d dy do HP,

C th gy vim rut kt mng gi,

gy bun nn, chng mt, nhc

u, tiu chy

D ng vi bt c thnh

phn no ca thuc

Category B

iu tr HP: 1g/ln x 2 ln/ngy

Liu iu tr c th 1g 2g/ngy

Pantoprazol 40 mg Thuc c ch bm proton

ch nh: tro ngc d dy,

vim lot d dy t trng,

Nhc u, tiu chy, hi, mt

ng, nguy c gy xng hng, c

tay v ct sng (sd >1 nm),

[Mg2+] mu => co git, ng kinh,

lon nhp.

D ng vi bt c thnh

phn no ca thuc

Khi ung ko b ko nhai m phi ung

nguyn vin.

iu tr vim lot d dy HP(+):

40mg/ln x 2 ln/ngy.

Categoty B

Dogmatil cap 50mg

Sulpirid 50mg

1vin/ln x BID

Nhm benzamid

Lm gia tng trng lc on

di c vng thc qun

iu tr ngn hn triu chng

lo u

- Tng Prolactin mu tm thi, hi

phc, c th v kinh, tng tit sa,

v to nam gii

- Tng cn, h HA th ng

- Hi chng ngoi thp, gim mt

phn khi s dng vi thuc khng

lit rung anticholinergic

U ty thng thn (do

c nguy c gy tai bin

cao huyt p nng)

CC p/hp Levodopa

- St cao l 1 yu t ca hi chng c

tnh do thuc lon TK => ngng t

- Gy bun ng => lu ngi vn

hnh my mc hoc li tu xe.

- E qua thn => gim liu suy thn

- Trnh ung ru, nc tri cy ln

men

Tn thuc Tc dng ch nh Tc dng ph Chng ch nh Lu

Domperidon

(domperidon 10mg)

Thuc chng nn

i khng dopamin

Tr triu chng bun nn v

nn nng, c bit ngi

bnh ang iu tr bng thuc

c t bo.

Tr tr/chng bun nn, nn,

cm gic chng, nng vng

thng v, kh tiu sau ba

n do t/n chm xung rut

Chy sa, ri lon kinh nguyt, mt

kinh, v to hoc au tc v do tng

prolactin huyt thanh

=> c th gp ngi bnh dng

thuc liu cao di ngy

Nn sau khi m.

Chy mu tiu ha

Tc rut c hc.

Tr nh di 1 tui.

Dng domperidon di

ngy hay thng xuyn

Domperidon khng gy qui thai. Tuy

nhin, an ton, trnh dng thuc

cho ngi mang thai.

Khng dng thuc cho PN cho con b.

10mg/ln x 2 ln/ ngy, ung trc n

30

Varogel

Al(OH)3

Al2O3

Mg(OH)2

Thuc khng acid c tc dng

lm gim nhanh chng, hiu

qu v ko di i vi cc

triu chng do tng acid d

dy v y hi.

Tr triu chng ca vim lot

d dy t trng

Tro ngc dd v d acid

Mt Phosphat gy xp xng, c

thn, tng s pht trin ca cc loi

vk c hi (HP, BKoch)

ngi mn cm vi bt

c thnh phn no ca

thuc

Thn trng: ngi suy

thn. Khng nn dng

cho tr < 3 thng tui.

Tr < 1 tui ch dng

khi tht cn thit.

Trnh dng ng thi vi cc thuc

khc do lm gim hp thu, dng lu

ngy lm tng nguy c lot d dy.

=> dng cch xa

1 gi 5 - 10ml/1 ln x 2 ln ngy ung

xa ba n (30 hoc 2 gi sau n)

hoc khi c triu chng

Nhn xt: ECT = Vin bao tan trong rut =

Nu dng domperidon cng vi cc thuc khng acid hoc thuc c ch tit acid th phi ung domperidon trc ba n v phi ung cc thuc khng acid

hoc thuc c ch tit acid sau ba n.

Bnh nhn l n b vim lot d dy c HP(+) c ch nh clarithromycin, amoxicillin v pantoprazol theo phc 3 thuc.

Tng tc thuc:

- clarithromycin + domperidone: clarithromycin s lm tng nng v tc ng ca domperidone bi nh hng h enzym CYP3A4.

- aluminum hydroxide + sulpiride: hydroxit nhm s lm gim mc v tc ng ca sulpiride bng cch tng pH d dy.

- pantoprazole + sulpiride: pantoprazole s lm gim nng v tc ng ca sulpiride bng cch tng pH d dy.

- sulpiride + domperidone

sulpiride v domperidone: tng c ch h dopaminergic, tng cc triu chng ngoi thp v hi chng thn kinh c tnh.(tng t vi metoclopramid)

- clarithromycin + domperidone

tng khong QTc gy lon nhp => thay domperidone. C th s dng metoclopramid c cng tc dng nhng ko gy tng tc vi clarithromycin.

=> C th b bt sulpiride ra khi toa do tng tc vi nhiu thuc trong toa v tc dng ca sulpirid trong toa ch gia tng trng lc on di c vng

thc qun ngn thc n tro ngc ln v tc dng ph qu nhiu. thay th domperidone thnh metoclopramid trnh tng tc vi clarithromycin.

Li khuyn cho bnh nhn: Cn khuyn bnh nhn tun th cht ch phc iu tr d triu chng c gim, ung pantoprazol th ko nn b, nhai m

phi nut trn vin. Bo ngay cho bc s nu c triu chng tiu chy nng.

N S 4

Nam, 32 tui

Hi chng rut kch thch (K58), Bnh gan khc (K76)

THUC: IU TR 15 NGY

1. Mabin 100mg (trimebutine) S lng: 45 vin trc n

Sng: 01 Tra: 00 Chiu: 01 Ti:01

2. Antibio 75mg (Lactobacillus acidophilus) S lng: 45 gi trc n

Sng: 01 Tra: 00 Chiu: 01 Ti: 01

3. Dogmatil 50mg (Sulpiride) S lng: 30 vin trc n

Sng: 01 Tra: 00 Chiu: 00 Ti: 01

4. Legalon 70mg (Silymarin) S lng: 30 vin trc n

Sng: 01 Tra: 00 Chiu: 00 Ti: 01 Liu thng 2 vin x 2-3 ln/ngy

Tn thuc Ch nh Tc dng ph Chng ch nh Liu dng- cch dng

Mabin

(Trimebutine)

- Ri lon chc nng tiu ha.

- Hi chng rut kch thch.

- Tr em: nn tr, to bn, tiu chy.

To bn, tiu chy, si bng, nn,

bun nn, kh tiu, kht nc.

Qu mn - Ngi ln: 100mg-200mg x TID

*Trc ba n.

Antibio

(Lactobacillus

acidophilus)

Phng nga v iu tr cc ri lon

tiu ha.

Cung cp cht dinh dng hu dng

cho hot ng tiu ha.

Thuc c th ngn cn s hp thu

tetracycline.

Qu mn vi thnh

phn thuc

- Ngi ln: 1 gi, 3 ln/ngy.

- Tiu chy: 4-8 gi/ngy.

- To bn: 6 gi/ngy

- RLTH do KS:

+ D phng: 2 gi/ ngy.

+ iu tr: 4-8 gi/ngy.

*Pha vi nc ngui ung.

Dogmatil

(Sulpiride)

Trng thi thn kinh c ch

- Bun ng, ng g, hi chng

ngoi thp.

- V to n ng, gim khoi

cm, lnh cm, cn, tit sa.

- H huyt p t th.

- BN bit hay nghi

ng b u ty thng

thn (do nguy c tai

bin cao HA nng).

- Ngi ln: 2-4 vin/ngy

(100-200 mg/ngy).

Legalon

(Silymarin)

iu tr cc ri lon chc nng tiu ha

trong cc bnh v gan.

- Tiu chy, au d dy.

- D ng.

- Qua mn vi thnh

phn ca thuc.

- 2 vin x 2-3 ln/ngy.

* Li dn ca bc s: 1 thng sau ti khm: kim tra men gan

* Nhn xt:

- Tnh trng ca bnh nhn:

+ Hi chng rut kch thch l 1 tnh trng bnh l cha xc nh c nguyn nhn, biu hin ch yu l cc triu chng ca i trng. mc trung bnh

v nng, bnh nhn c th b nh hng v mt tm l v tm thn iu tr ch yu l theo cc triu chng ni tri kt hp vi ch sinh hot ph

hp, ci thin cht lng sng ca bnh nhn, gim nh cc triu chng lm sng.

+ Bnh gan khc: cng c th dn n nhng ri lon v chc nng tiu ha.

- Thuc c k:

Thuc Liu dng iu tr

Mabin

(Trimebutine)

Ph hp - Hi chng rut kch thch.

Antibio

(Lactobacillus acidophilus)

Ph hp - Triu chng c hi chng rut kch thch.

Dogmatil

(Sulpiride)

Ph hp - Triu chng trn thn kinh ca hi chng rut kch thch.

Legalon

(Silymarin)

t hn liu c khuyn co - Triu chng trn tiu ha.

- Bo v t bo gan.

- Ch sinh hot v n ung:

+ n nhiu cht x, ung nhiu nc.

+ Trnh cc thc n d kch thch nh bia, ru, c ph, thc n cay chua, cht bo, thc n d to men.

+ Ch lm vic iu , tng hot ng th lc, to gic ng su, ng , trnh tnh trng cng thng.

N S 5

N 60 tui, Vim khp dng thp khc M06- Phc 20 ngy

STT Tn thuc VT S lng NHN XT LIU DNG CCH DNG

1 Furosemid 40 mg (MKP)

Ung 1 ln x vin

Vin 10 Ung bui sng trc khi n v thc n lm gim hp thu

2 Glucosamin sulfat 250 mg (Glucogon)

Ung 2 ln x 2 vin

Vin 80 Ung trc ba n 15 pht => Sng 1 vin, Chiu 1 vin

3 Methyl prednisolon 16 mg (Vipredni)

Ung 1 ln x 1 vin

Vin 10 Ung sau n sng, khi bng no => Sng 1 vin

4 Trimafort (Mg(OH)2, Al(OH)3)

Ung 1 ln x 1 gi

Gi 20 Ung 30 pht sau khi n

5 Piracetam (Dopropy 1200 mg)

Ung 2 ln x 1 vin

Vin 40 Ung Sng 1 vin, chiu 1 vin

6 Pantoprazol 40 mg (Razopral 40 mg KP)

Ung 1 ln x 1 vin

Vin 20 Ung trc n 30 pht

Khng nhai hay b vin, nut nguyn vin vi nhiu nc

Tn thuc Ch nh Tc dng ph Chng ch nh Lu

Furosemid Thuc li tiu quai Henle

Ph phi cp, ph do tim, gan, thn.

iu tr tng huyt p.

Mt cn bng in gii BN

duy gan, suy thn

H huyt p th ng.

Mn cm vi furosemid dn xut

sulfonamid

Liu 20 mg/ngy

=> dng trong Ph nh

Thc n lm gim hp thu

Glucogon

Glucosamin sulfat

iu tr cc bnh vim khp cp v

mn tnh.

au bng, i tiu phn lng,

bun nn.

Qu mn vi cc thnh phn ca

thuc.

2v/ln, 2 ln/ngy.

Ung trc ba n 15

Vipredni

Methyl prednisolon

16mg

Thuc chng vim, chng d ng .

Vim khp dng thp.

TDP Corticoid: mt ng, tng

ngon ming, kh tiu, c

thy tinh th, glaucom, ph..

Nhim khun nng tr sc nhim

khun, lao mng no.

1v/ngy, ung sau ba n

sng

Trimafort

Mg(OH)2, Al(OH)3

Simethicon

au cp tnh hay mn tnh trong vim

lot dd t trng

nng, kh tiu

Tiu chy, to bn, trng

bng, mt phosphat xng

Tr < 14 tui, BN suy thn nng,

3 thng u thai k

Simethicon loi b hi

ng tiu ha

Dng cch thuc khc 1-2h

Dopropy

Piracetam

Suy gim tr nh km tp trung

ngi cao tui.

Mt mi, bun nn tiu chy,

nhc u mt ng.

Ngi suy thn, suy gan. 1v/ln x BID

Liu: 2,4 g/ngy => c

Razopral

Pantoprazole

iu tr trng hp cn gim tit acid:

- Lot d dy t trng

- Vim thc qun tro ngc GERD

Nhc u, tiu chy, au

bng. Dng lu di gy mt

Magnesi huyt thanh

Qu mn cm D phng lot ngi c

yu t nguy c liu 20-40

mg/ngy

TNG TC THUC:

- Fusoremid tng tc Methyl prednisolon: au nhc c, mt cm gic ngon, mt mi chng mt, hay nhm ln => Dng Piracetam ci thin tr nh

- Al(OH)3 tng tc thc n => dng sau 2-3 gi

THNG TIN THM

Piracetam (dn xut vng ca acid gamma amino-butyric, GABA) c coi l mt cht c tc dng hng tr (ci thin chuyn ha ca t bo thn kinh

Thuc cng nhm: piracetam, oxiracetam, aniracetam, etiracetam, pramiracetam, tenilsetam, suloctidil, tamitinol

=> ci thin kh nng hc tp v tr nh. Piracetam c tc ng mnh nht.

Cc c ch ca Piracetam:

- Tc ng ln mt s cht dn truyn thn kinh nh acetylcholin, noradrenalin, dopamin...

- Thay i s dn truyn TK v gp phn ci thin mi trng chuyn ha, tng khng ca no i vi tnh trng thiu oxy.

- Tng s huy ng v s dng glucose m khng l thuc vo s cung cp oxy, to thun li cho con ng pentose v duy tr tng hp nng lng no.

Thuc khng c tc dng gy ng, an thn, hi sc, gim au, an thn kinh hoc bnh thn kinh cng nh khng c tc dng ca GABA.

iu tr di ngy cc hi chng tm thn thc th ngi cao tui: 1,2 - 2,4 g mt ngy

NHN XT CHUNG

Thuc tr vim khp dng thp: Glucosamin sulfat, Methylprednisolol,

Thuc tr ph khi vim khp: Furosemid

Thuc khc phc tc dng ph lot d dy t trng: Pantoprazol, Trimafort

Thuc khc phc tng tc Furosemid Methyl prednisolol: Piracetam

=> Thuc khng hp l Trimafort: Lm gim hp thu cc thuc khc, torng TH ny nu BN khng b vim lot dd t trng m ch phng lot th dng PPI

Nu dng b sung Mg phng thit Mg huyt thanh => dng ch phm m Magne dng hp thu c l Magnesi lactat (Mg-B6), fumarat, succinat

BNH HC VIM KHP DNG THP

Biu hin lm sng: Vim khp dng thp l mt bnh t min kh in hnh ngi, di dng vim mn tnh nhiu khp ngoi bin vi biu hin kh

c trng: sng, au khp, cng khp bui sng v i xng hai bn. Ngoi ra, ngi bnh cn c cc biu hin ton thn (mt mo, xanh xao, st gy

st) v tn thng cc c quan khc.

Yu t dng thp (Rheumatoid Fator RF) v /hoc anti-CCP*

* Anti-CCP l mt xt nghim ELISA, nhm xc nh IgG ca mt t khng th trong huyt thanh hoc huyt tng c hiu vi peptide c tng hp t

gan dng vng, cyclic citrullinated peptide CCP, n gip cho chn on sm bnh VKDT RA (2004)

N THUC 14

N: 85 tui

au ct sng lng NHN XT V LIU DNG CCH DNG

Tn thuc

Hot cht Tc dng, ch nh ADR Chng ch nh Lu c bit

Mephenesin

VD: Descotyl

Gin c vn tc ng TW

iu tr cc cn au do co tht

thng gp trong: vo c, au

lng, au tht lng, chn thng

TK v trong phc hi chc nng.

Nn, bun nn, ng g, ban

ngoi da do d ng.

D ng nng, km h huyt p.

- C tin s d ng vi mt trong cc

thnh phn ca thuc,

- Ri lon chuyn ha porphyrin

KHNG NN DNG khi ang

c thai hoc cho con b.

Meloxicam Vim khp dng thp,

iu tr triu chng ngn bnh:

- vim xng khp cp tnh mc

trm trng

- vim cng t sng.

Kh tiu, vim nhim ng h

hp trn, ph, chong vng, au

u, bun nn, au bng, tiu

chy, y hi, pht ban

Du hiu v triu chng ca cc

m lin kt c xng (au lng,

co tht c, au c xng)

Qu mn, tin s b chng my ay,

ph mch, co tht ph qun, vim mi

trm trng, hoc sc khi kt hp vi

aspirin hoc cc thuc NSAID khc.

Nhy cm vi aspirin, bnh hen suyn,

polyp mi.

Trnh dng thuc trong 3

thng cui thai k v c kh

nng ng sm ng ng

mch ca bo thai.

1 Mephenesin 250 mg S lng: 30 vin Dng sau ba n

Sng: 1 Tra: 0 Chiu: 1 Ti: 0

Liu trong cc ti liu l 2-4 vin/ngy 3 ln

2 Meloxicam 7,5 mg S lng: 15 vin Meloxicam liu n thng thng l 15 mg/ngy.


iu tr lu di ngi cao tui: 7,5 mg/ngy.

3 Trimetazidine 20 mg S lng: 30 vin Ung trc ba n


4 Cinnarizin 25 mg S lng: 30 vin Ung sau khi n gim kch ng d dy


5 Domperidon 10 mg S lng: 30 vin Phi ung thuc 15 - 30 pht trc ba n.


6 B.A.R (BAR) S lng: 60 vin


Theo ch nh: ung 3 ln mi ln 1 2 vin

Trimetazidin Trong tim mch: bnh tim thiu

mu cc b (iu tr d phng

cc cn au tht ngc di chng

nhi mu c tim)

iu tr h tr cc triu chng

chng mt v tai.

Trong nhn khoa: ri lon th

gic c ngun gc tun hon.

Ri lon nh ng tiu ha:

bun nn, nn.

Mn cm vi thuc

Trnh dng cho PNCT, PN cho con b

Ung thuc vi mt t nc

vo trc ba n.

Liu thng thng: mi ln

ung 1 vin x 2-3 ln/ngy.

Cinnarizin Phng say tu xe.

Ri lon tin nh: chng mt,

tai, bun nn, nn trong bnh

Mnire.

Thn kinh trung ng: Ng g.

Tiu ha: Ri lon tiu ha.

Mn cm vi cinarizin hoc bt c mt

thnh phn no ca thuc.

Lon chuyn ha porphyrin.

Gy au vng thng v. Ung thuc

sau ba n c th kch ng d dy

Bnh Mnire: cn chng

mt t pht, tai, cm

gic dy tai, ic, c th b

nn i. Khng r nguyn

nhn

Domperidon iu tr triu chng bun nn v

nn nng, c bit ngi bnh

ang dng thuc c t bo.

iu tr triu chng bun nn,

nn, cm gic chng v nng

vng thng v, kh tiu sau ba

n do thc n chm xung rut.

Ri lon ngoi thp v bun ng

xy ra vi t l rt thp v hay

do ri lon tnh thm ca hng

ro mu - no hoc do qu liu.

Liu cao di ngy: Chy sa, RL

kinh nguyt, mt kinh, v to hay

au tc v do tng prolactin

Nn sau khi m.

Chy mu ng tiu ha.

Tc rut c hc.

Tr nh di 1 tui.

Dng domperidon thng xuyn hay

di ngy.

Nu dng domperidon cng

vi cc antacid hoc thuc

c ch tit acid th phi:

- PO domper. trc ba n

- PO antacid sau ba n.

Tn thuc


B.A.R Pharamadic

Bm bm

Actiso

Rau ng

- Dng cho nhng ngi thiu nng gan,

vim gan gy mt mi, kh tiu, vng da,

mn nht, l nga, b i tiu tin, to bn.

- Gii c, chng d ng. c bit suy gim

chc nng gan do dng nhiu bia ru.

- X va ng mch, m trong mu cao.

Cha c bo co Khng dng cho bnh nhn mn cm

vi bt c thnh phn no ca thuc.

Vim tc mt, ng dn mt

Ph n c thai

Rau ng = Bin sc

Bit dc khc Boganic

Khng c tng tc no ng k

Liu dng ca mephenesin trong ti liu thng l 6 12 vin 250 mg mi ngy nhng gp vi n thuc ch nh kiu 2 vin/ ngy nh th ny => Tm thm

phc tr liu mi kt lun c.

BP h tr cho ngi cao tui:

Tp th dc nh nhng ty theo sc mnh v bnh ca mnh, v d nh thot v a m th khng th tp th dc nh cc bnh khc c, cn phi tun

theo li t vn ca bc s iu tr (v d nh phi i b trn nn phng khng i xe p, xe my, t nhng ni gy xc, mp m, nhiu g...).

Cc ng tc i b hoc tp th dc cho ngi thoi ha ct sng cng rt cn tham kho kin ca bc s iu tr.

Nguyn nhn gy au ct sng?

au lng c hai loi nguyn nhn c bn sau y: do tc ng c hc v do hin tng vim.

o au lng do tc ng c hc: y l loi au lng hay gp la tui trng thnh v c bit l ngi cao tui (NCT) nh: thoi ha ct sng,

thot v a m, gai i ct sng... Thoi ha ct sng thng hay xy ra v tr sn khp v a m, bi hin tng trng lc ca c th qu nng tc

ng hng ngy ln ct sng v c tc ng ca trng lc ln vai gy ri tc ng xung h thng t sng (v d nh ngi lm vic nhiu gi khng

vn ng). Khi ct sng b thoi ha, triu chng au lng c th hin kh sm v cng chnh v c hin tng au lng rt kh chu m buc ngi

bnh phi i khm. Ngoi cc nguyn nhn do thoi ha ct sng cn c nhng nguyn nhn thuc v c hc nh mang vc nng, thay i t th t

ngt hoc bng, b khng cn xng...

o au lng do hin tng vim: trong cc nguyn nhn gy vim c th xy ra ngay ti ct sng nh: vim a m, lao ct sng, ung th ct sng,

vim khp cng chu... Cng c nhiu trng hp au lng nhng li do vim nhim mt c quan khc trong c th nh: vim phn ph n gii

(vim tiu khung, vim bung trng...), vim d dy - t trng, vim ng tit nit niu (do si hoc do vi khun)... Cc loi bnh kiu nh th ny

thng gy au lng mt cch m v au lng cng mt lc vi cc triu chng chnh ca bnh (v d nh ngi b au d dy, si tit niu). Nhng

nguyn nhn ny cng thng gp NCT nhiu hn ngi cn tr tui.

KIN RING: Nhn xt cch dng thuc ca bc s < phn ny a ra kin b con ng gp>

Cc thuc ny dng ch yu tr triu chng:

- au lng: Dng Mephenesin, meloxicam

- Chng mt, tai, bun nn, kh tiu: dng cinnarizin, trimetazidin, domperidol

- tng tc dng mt gan, gii c gan: dng B.A.R

=> C th b c khai bnh: au lng, kh tiu, au thng v, hay chng mt tai, hay bun nn

V c b cao tui m dng kh nhiu thuc th ny th c th c 2 l do:

1. C b yn tm v cc triu chng kh chu s gim, tin tng vo tr liu v cm thy t tin, bnh au lng s bt (ch yu do tm l)

2. Bc s k n khi c cc xt nghim khc v tnh trng bnh ca c b, c th c suy gan nn dng thuc gii c gan, tr thiu nng

gan, cc thuc tr triu chng c th gip cuc sng BN thoi mi hn

N THUC 15

NAM: 57 tui

K phi giai on IIIB COPD giai on II NHN XT V LIU DNG CCH DNG

Lu ca bc s: n bi dng ; n nhiu cam, chui

Tn thuc


Medrol 16 mg

Methylprednisolol

Tc dng:

Chng vim, chng d

ng v c ch min

dch r rt

Ch nh:

Liu php khng

c hiu cn n tc

dng chng vim v

gim min dch ca

glucocorticoid

Trong iu tr K

Trong iu tr thn

h nguyn pht

Thng gp: Mt ng, thn kinh d b

kch ng, tng ngon ming, kh tiu, rm

lng, T, au khp, c thy tinh th,

glaucoma, chy mu cam.

t gp: Hi chng Cushing, ph, THA, lot

d dy, bun nn, nn, chng bng,

vim lot thc qun, chng mt, teo da,

thm tm, tng sc t m, c ch trc

tuyn yn - thng thn, chm ln, khng

dung np glucose, gim kali huyt, nhim

kim, v kinh, gi natri v nc, tng

glucose huyt, vim ty, Yu c, long

xng, gy xng.

Nhim khun nng, tr sc nhim khun v

lao mng no.

Qu mn vi Methylpredinisolol

ang dng vaccin virus sng.

Thng tn da do virus, nm hoc lao.

Thn trng

S dng thn trng nhng ngi bnh

long xng, ngi mi ni thng mch

mu, ri lon tm thn, lot d dy, lot t

trng, i tho ng, tng huyt p, suy

tim v tr ang ln,

Ngi cao tui: liu thp nht + tg ngn

nht c th.

Dng tg di hay c

stress, ngng t ngt

c th suy tuyn thng

thn cp

Tr em c th nhy

cm hn vi s c ch

tuyn thng thn khi

iu tr thuc bi.

Nu c ch trc vg

di i tuyn yn

tuyn thng thn gim

liu glucocorticoid t t,

khng ngng t ngt.

1 Medrol 16 mg S lng: 14 vin Methyl prednisolol


Sng 2 vin

2 Nexium 40 mg S lng: 20 vin Esomeprazol PPI


Ung trc n 30 pht

3 Kaleoride 0,6 g S lng: 40 vin Ung trong ba n + nhiu nc

Trong ba n tra: 1 Trong ba n ti: 1

Ngy 2 ln, mi ln 1 vin

4 Tatanol Codein S lng: 40 vin Dng thuc cch nhau t nht 4 gi

Ngy 2 ln, mi ln 1 vin

5 Berodual MDI S lng: 1 l 2 nht, 3 ln xt hng

Tn thuc Tc dng, ch nh ADR Chng ch nh Lu c bit

Nexium 40 mg

Esomeprazole

Phng nga lot d

dy, t trng do dng

glucocorticoid/ NSAID

BN c nguy c

Bun nn, nn

Tiu chy, to bn, y hi

Qu mn vi thuc.

D phng ti pht lot

d dy, t trng 20-40

mg/ngy.

Ch : Dng bo ch c bit khng b, nut nguyn vin vi nhiu nc

Kaleoride 0,6 g

Kali clorid

C th dng n

60 mmol (1 mmol

=> 75 mg)

0,6 g = 8 mmol

iu tr gim K+ huyt

ngi iu tr bng

glucocorticoid ko di

Khi dng lu di kali clorid, c th xy ra

tng kali mu (phi ngng ngay)

Tiu chy, bun nn, au d dy, kh

chu, hoc trng bng nh, nn.

Th nng hoc kh th

Tiu chy, bun nn, au bng thng xy

ra khi dng thuc ung, phi ung cng

thc n hoc phi pha long.

Tng kali mu => do tng thm kali c

th gy ngng tim.

Thc qun b chn p, d dy chm tiu,

tc rut, hp mn v => do cn tr kali

clorid qua d dy - rut, nng kali cao

ti ch c th gy kch ng d dy rut

nng hn

Thn trng: ngi cao tui

Nhp tim khng u l

du hiu lm sng sm

nht ca tng kali mu

v c pht hin d

dng bng in tm

Tatanol codein

Acetaminophen

500mg

Codein phosphat

30mg

iu tr ho khan

Gim au

To bn, bun ng,

Chng mt, bun nn, nn.

Rt him khi b co tht ph qun, d ng

da, c ch h hp.

- BN mn cm vi tp ca thuc.

- BN suy gan nng, suy h hp, hen suyn.

- Ph n c thai v cho con b.

- Tr em cn nng di 15 kg

Cc ln dng cch nhau

t nht 4h, suy thn

nng (t nht 8h)

Berobudal MDI

Fenoterol 0,05 mg

Ipratropium 0,02

mg

COPD do co tht ph

qun c phc hi nh:

hen ph qun, vim

ph qun mn tnh

c/khng km theo kh

ph thng

Run c xng nh, bn chn, lo lng, nh

trng ngc, tng nhp tim, hoa mt hay

nhc u.

Kh ming, kch ng hng hay phn ng d

ng, ho. B tiu.

Bnh c tim tc nghn ph i, lon nhp

nhanh. Qu mn vi cc cht ging atropin

MDI = Metered-dose

inhaler => ngha l ng

thuc ht phn liu

Dng bo ch c bit ung khi bng rng

MR: Modified release => phng thch bin i

SR: Sustained release => phng thch duy tr

ER: Extended release => phng thch ko di

CR: Controled release => phng thch kim sot

Thuc tr COPD: Berobudal MDI, Tatanol Codein tr ho, Medrol

Thuc gim au: Tatanol Codein, medrol h tr gim au

Thuc khc phc TDP ca corticoid: Nexium, Kaleorid

Cu 1: V sao n nhiu cam chui?

V nn n cc loi rau c qu, cc thc phm c cha nhiu vitamin A, C, E (cc vitamin ny c tc dng gim cc gc xy ha do khi thuc l v qu trnh

vim mn tnh ca bnh to ra).

Cu 2: Ba n?

Ngi bnh nn chia nh ba n, trnh n qu no c th gy kh th (n khong 5-6 ba/ngy). Thc phm nn c ch bin nh d nhai, trnh phi

gng sc khi n. Nn n tng ming nh, nhai chm, k. To khng kh vui ti trong khi n ngi bnh c cm gic n ngon ming

Cu 3: V sao phi n b dng ngi COPD?

BN COPD cn nng lng cho hot ng h hp cao hn 10 ln so vi ngi bnh thng. Tuy nhin, tnh trng kh th tng ln khi n

Khong 50-75% bnh nhn COPD b suy dinh dng => BS khuyn nn n b dng. Ba n ca ngi b COPD nn t cm, nhiu tht c.

Tnh trng dinh dng km lm ngi bnh cm thy mt mi, kh th nhiu hn, d b nhim trng, nht l vim phi; t lm tng nguy c nhp vin v

nhng t bnh cp. Bnh nhn COPD thng ht th nhanh v su nn mt nhiu nc hn qua ng h hp. V vy, cn ung nhiu hn ngi bnh

thng b li lng nc mt qua ng h hp v lm long m, gip khc m tt hn. Mi ngy, bnh nhn nn ung 2 - 3 l nc.

Cu 4: V sao ba n t cm, nhiu tht c?

Qu trnh chuyn ha thc n nh hng n sc khe bnh nhn COPD v n tiu th oxy, to ra nng lng v kh CO2 (thi qua ng th)

S chuyn ha cht bt ng to ra lng CO2 cao hn so vi cht bo v m; khin c th cn th nhanh v su hn thi CO2, dn n hin tng

nhanh mt c h hp, lm tng tnh trng suy h hp t cp, nhng khng nh hng trn bnh nhn n nh. S chuyn ha cht bo, m v m

to ra t CO2 t hn nn t nh hng n s h hp.

Cu 5: BNH HC COPD

COPD l thut ng vit tt ca t ting Anh: Chronic Obstructive Pulmonary Disease (COPD) c ngha l bnh phi tc nghn mn tnh. Bnh rt thng gp,

yu t nguy c chnh gy bnh l thuc l, thuc lo

Triu chng: vim nim mc ng th mn tnh gy gim t t, khng hi phc cc gi tr chc nng thng kh phi.

Yu t nguy c: Nam, trn 40 tui, ht thuc lu nm

Cc giai on bnh (http://www.bvdaihoc.com.vn/chamsochohap/topic_detail.asp?ID=42)

COPD giai on 0: ho, khc m ko di, chc nng h hp hon ton bnh thng.

COPD giai on 1: ngi bnh ho, khc m ko di vo bui sng nhng khng kh th, chc nng h hp FEV1 > 80% nhng FEV1/FVC < 70%.

COPD giai on 2: ngi bnh c th c ho, khc m hay khng, thm d chc nng h hp cho thy tc nghn ng th mc nh: tr s FEV1

trong khong 50 80% so vi gi tr d on ngi bnh thng.

COPD giai on 3: ngi bnh c th c ho, khc m hay khng, thm d chc nng h hp cho thy tc nghn ng th mc trung bnh: tr s

FEV1 trong khong 30 50% so vi gi tr d on ngi bnh thng.

COPD giai on 4: ngoi triu chng ho, khc m ko di, ngi bnh cn kh th ban u ch xut hin khi gng sc, sau ny xut hin c lc ngh

ngi, thm d chc nng h hp cho thy tc nghn ng th mc nng: tr s FEV1 < 30 % so vi gi tr d on ngi bnh thng.

Cu 6: Bnh hc K phi

Ung th phi t bo nh:

Ung th phi khng t bo nh: chia lm 4 giai on theo k hiu s latin: giai on IA, IB; giai on IIA, giai on IIB; giai on IIIA, giai on IIIB; giai

on IVA, giai on IVB.

Ung th giai on mun ko di s sng: Ha tr phi hp carboplatin vi paclitaxel, dng thuc c ch tyrosin kinase EGFR

Cu 7: Tng tc ca tc thuc trong n?

Khng c tng tc quan trng

Tng tc vi ru: Paracetamol (ging n 16)

Cu 8: Cch dng ng thuc ht phn liu?

CCH S DNG EVOHALER (BNH HT XT NH LIU: MDI)

B1. Cm bnh thuc xt dc ngc, lc nh 4 5 ln

B2. M np bnh xt

B3. Th ra tht ht

B4. Ngm kn bnh xt gia hai h rng nhng khng cn. Khp mi xung

quanh ming bnh xt

B5. Hi nga u, ht vo tht chm v su, ng thi n bnh xt v ht

cng nhiu cng tt

B6. Nn th 10 giy, sau th ra nh

Ln 2: ngh 2 pht bc 1 n bc 6

B7. Sc hng tht sch ngay sau khi xt thuc

CCH S DNG NG HT BT KH

B1. Vn v m np y ng thuc

B2. Gi bnh v tr thng ng, vn phn qua bn phi n ht mc,

sau vn ngc v tr ban u, s nghe 1 ting click ( ng thng ng

bt thuc khng ra ngoi)

B3: Ngm kn ng thuc v ht vo bng ming tht mnh v tht su cho

n khi khng ht ni na, ly ng thuc ra, ngm ming li trong vi giy

Sau khi th li bnh thng, nu cn ht 1 hi na th lm li bc 2 v 3

B4: y np ng thuc li, sc ming tht k sau ht thuc bng nc l

trnh nhng tc dng ph ca thuc c th gy ra ti hng.

N THUC 16

NAM: 11 tui

Vim h hp trn + st N3 NHN XT V LIU DNG CCH DNG

Li dn ca bc s: ti khm khi st cao, , kh th, bnh nng hn.

Trnh ung lnh, nn ung nhiu nc, kh nc mui

Tn thuc

Hot cht Tc dng, ch nh Tc dng ph Chng ch nh Lu c bit

TRACLOR

Cefaclor 250 mg

Nhim khun h

hp do VK nhy cm,

b khi tht bi vi

thuc CTQG

Trong bnh vim

nhim do VK (tai gia

cp; vim da, phn

mm do t cu; vim

hng; bng quang...)

Thng gp: Ban da, tiu chy (nu tiu chy rt nng

do C. difficile => dng metronidazol, vancomycin)

t gp: Tng t bo lympho, gim bch cu, gim bch

cu trung tnh. Bun nn, nn, nga, ni my ay.

Him gp: Phn ng phn v, st, Stevens - Johnson,

hoi t biu b nhim c (hi chng Lyell), ban da mn

m ton thn.

C th gy vim i trng mng gi, ng kinh

Tin s d ng vi KS

cephalosporin.

Cefaclor hp thu tt sau

khi ung lc i

Thc n lm chm hp

thu, nhng tng lng thuc

c hp thu vn khng i

i vi vim hng cp do

Streptococcus nhm A tan

mu beta, thuc u tay l

Peni V phng thp tim.

1 Cefaclor (Traclor), 250 mg vin ung S lng: 6 Dng 2 ln 1 ngy KHI BNG I


2 Serratiopeptidase 10 mg vin ung S lng: 6 Vin bao tan trong rut, 10 mg 20.000 IU


Nut nguyn vin, khng nhai, ung SAU KHI N

3 Dextromethorphan 15 mg vin ung S lng: 6 15 mg, 6 - 8 gi/ln, ti a 60 mg/24 gi.


4 Paracetamol 325 mg vin ung S lng: 9 Vin bao phim, ung 3 ln / ngy


Khi st 38,5 oC

5 Vitamin C 500 mg vin ung S lng: 6 Liu ti a cha c TDP l 2g => hp l


Ung nhiu nc sau khi n no trnh kch ng

6 Natri clorid (Efticol) 0,9%/10 ml Chai nh mi S lng: 3 Nh hc mi 1-3 git, ngy 1-3 ln hay nhiu hn

Sng: 3 Tra: 3 Chiu: 3 Ti: 0 5 git

Tn thuc

Hot cht Tc dng, ch nh Tc dng ph Chng ch nh Lu c bit

SERRATIO-

PEPTIDASE

10 mg

Vim sau PT, chn thng,

ph v sng do vim BN tr

Trong bnh vim nhim do

VK (tai gia cp; vim hng;

bng quang...)

Kh khc m khi vim PQ,

lao phi,

Phn ng mn cm: ni mn

=> ngng s dng thuc.

Ri lon tiu ha: tiu chy, bing n,

kh chu d dy, bun nn hoc nn

Mu: him gp, khuynh hng xut

huyt (chy mu cam, khc ra mu)

Qu mn vi Serra.

Thn trng:

Bnh nhn ri lon

ng mu

Bnh nhn suy gan

hay suy thn nng

Nut nguyn vin

Khng c nhai

Ung sau khi n

Dng ng thi vi thuc chng ng

c th lm tng hiu qu chng ng.

DEXTRO-

METHORPHAN

15 mg

Gim ho

iu tr triu chng ho do

hng v PQ b kch thch khi

cm lnh thng thng hoc

khi ht phi cht kch thch

Ho khng c m, mn tnh

Thng gp: Mt mi, chng mt,

nhp tim nhanh, bun nn, bng da

t gp: Ni my ay.

Him gp: Ngoi ban, bun ng nh,

ri lon tiu ha. Hnh vi k quc do

ng c, c ch h thn kinh trung

ng v suy h hp c th xy ra khi

dng liu qu cao.

C th gy bun ng, trnh cc thuc

c ch thn kinh trung ng v ru.

Qu mn cm.

ang iu tr cc

thuc c ch MAO

v c th gy: st

cao, chng mt,

HA, chy mu no,

t vong.

Tr em < hai tui.

Thuc gim ho c tc dng ln

tr/tm ho hnh no.

Khng c tc dng gim au

t tc dng an thn.

Ch : Ngn chn ho lm gim c

ch bo v quan trng ca phi, do

vy dng thuc gim ho cha hn l

cch tt nht, c bit l tr nh.

Dng Dextromethorphan m

suy h hp, c ch TKTW =>

gii c bng Naloxon

PARACETAMOL 325 mg

Thuc gim au h nhit

Dng khi st cao 38,5 oC

Pht ban, my ay

Nn, tiu chy

C bnh tim, phi,

thn hay gan, thiu

mu nhiu ln.

Thiu men G6PD

Ch : BN phenyl keto niu

VITAMIN C 500 mg

Ch nh off-label: phng cm,

chng lin vt thng

Dng tng khng

Thng tng oxalat niu

t gp: tiu chy, bun nn, nng

Si thn

Thalessimia

Thiu G6PD

Vitamin C c tnh acid yu nn ung

sau ba n t kch ng d dy

NATRI CLORID 0,9%/10 ml Efticol

Nght mi, s mi, vim mi

d ng

Dung dch sinh l tng i an ton Suy tim sung huyt

Suy thn nng

y kn chai thuc sau khi dng

Trnh nhim bn u chai thuc

Tt nht dng trong vng 15 ngy

sau khi m chai

TNG TC THUC TRONG N

BNH HC: Vim h hp trn:

ng h hp trn bao gm mi, hu, hng, xoang v c thanh qun. H thng h hp trn c chc nng ch yu l ly khng kh bn ngoi c th, lm

m, si m v lc khng kh trc khi a vo phi.

Dch t: Vim ng h hp trn l mt chng bnh thng gp hng nm, mc ti din, nhiu ln thng xut hin theo ma, nht l ma ng, ma hanh

kh, trng vi ma ca bnh hen, vim ph qun mn, vim phi. i tng mc bnh ch yu thng l tr em. (ngy bc s k 25/10 trng ma ng)

a phn nguyn nhn gy ra vim ng h hp trn l cc virus. Ngoi ra chng ta c th gp cc nguyn nhn khc nh vi khun, nm, bi, kh c. C

th k ra y mt s loi vi rt in hnh nh: virus Rhino, Corona, cm Parainfluenza, Adeno, virus h hp hp bo RSV. Mt s loi vi khun cng thng

gp trong bnh vim ng h hp trn l lin cu khun tan mu nhm A, ph cu khun, Haemophilus influenzae, mt s loi nm...

c im: Vim ng h hp trn khng phi l mt bnh m l mt t hp bnh bao gm: cm lnh, vim mi hng, vim hng, vim xoang, vim thanh

qun. Mc d c nhiu bnh n l khc nhau nhng chng u c mt s biu hin chung rt d nhn thy.

Nhng triu chng ch yu bao gm: st cao, ht hi, s mi, chy mi, ngt mi, tc mi, au rt hng, ho, khn ting, lc ting, ging mi,

khn c c khi mt ting, mt mi, au u, au mi c khp

c im quan trng ca vim ng h hp trn l thi gian bnh ngn, tc biu hin bnh nhanh v cc biu hin mang tnh t. Chnh v th m st

trong cc bnh ca vim ng h hp trn thng l st cao v thnh cn. Thn nhit thng l 39oC tr ln (dng para h st)

=> Trong trng hp tr em khng th ung thuc v c th sc do ho khi nut vin => Cch x l c ngh thay th:

- Dng dng bo ch khc ng ung, dng lng: siro, thuc bt ha vo nc dng bm xilanh (khng c ng tim), bm vo ming => tr t nut

- Dng thuc t trc trng: vim t trc trng paracetamol

N S 6

N 55 tui, Thoi ha khp gi T/ Suy tnh mch chn.

NHN XT LIU DNG CCH DNG

1. Meloxicam 7,5 mg (Meloxicam) Ung sau n khi bng no => gim kch ng

Sng 1 Tra 0 Chiu 1 Ti 0 28 vin

2. TV-omeprazol 20 mg (Omeprazol) Ung 30 pht trc khi n,

Sng 1 Tra 0 Chiu 1 Ti 0 28 vin Ung 1 vin 20 mg duy nht vo bui sng

3. Zennif 250 mg (Glucosamin sulfat) Thng ung trc n 15 pht

Sng 1 Tra 0 Chiu 1 Ti 0 28 vin => Ung 30 pht trc khi n lun d tun th

4. Hapacol codein vin (Paracetamol + Codein phosphat) Nu ch dng h st th chuyn qua paracetamol cho tt

Sng 1 Tra 0 Chiu 1 Ti 0 20 vin V gim au dng melexicam

5. Sinbre 50 mg (Diacerein) 2 tun u dng 1 vin vo bui n ti (ung sau n)

Sng 1 Tra 0 Chiu 0 Ti 0 12 vin 2 tun sau tng liu 2 vin/ngy

6. Daflon 500 mg (Diosmin + Hesperidin)

Sng 1 Tra 0 Chiu 1 Ti 0 28 vin Nut nguyn vin, khng b, khng nhai

Thuc gim au: hapacol codein, meloxicam

Thuc gim au khng vim: meloxicam

Thuc tr thoi ha khp: 2 thuc trn + glucosamine + sinbre

Thuc tr suy tnh mch: daflon.

Tn thuc Ch nh ADR Chng ch nh, thn trng Lu

Meloxicam

Vin nn (NSAID) chn

lc COX2 > 50 ln COX1

cc du hiu v triu

chng ca vim xng

khp

- Lot d dy

- Tiu chy, chng mt, ri lon

tiu ha, ph n, y hi, au

u, bun nn, pht ban,

Mn cm 7,5 mg 1 n 2 ln/ ngy

TV omeprazol

Vin bao tan trong rut

Phng nga tc dng ph

ca NSAID ln d dy

Nhc u, bun ng, chng

mt, bun nn, nn, au bng,

to bn, chng bng

Dng lu mt Mg huyt thanh

- Qu mn vi thuc.

- Thn trng u c tnh (thuc che

lp cc triu chng nn lm

mun chn on)

Ung trc n 30 pht

Liu 20-40 mg ty TH

Hapacol codein

Paracetamol 500 mg

Codein phosphat 8 mg

Gim au trung ng

H st

Chng mt, bun ng, mt ng,

mt phng hng, nga da,

Bun nn, kh ming, to bn

Suy gan, suy h hp

Tr em < 15 tui

PNCT

1-2 vin x 4 ln/ngy

Max: 8 ln/ ngy

Zennif 250 mg

(Glucosamine)

Thoi ha xng khp

Vim quanh khp

Long xng, gy xng

teo khp,

Vim khp mn v cp

Ri lon tiu ha, thng nh

v thong qua

Cn theo di ng huyt

thng xuyn trn bnh nhn

tiu ng.

Chng ch nh:

PNCT + cho con b

Tr < 18 tui

Thoi ha khp nh: 2 vin/ln

BID duy tr trong 6 tun.

Thoi ha khp nng: 2 v/ln

TID ung trong 3 n 4 thng.

Liu trong n l 1 vin/ln x

2/ngy hi t th phi

Diacerein Tr di hn bnh thoi ha

khp (vim xng khp +

cc bnh c lin quan).

Tiu chy hoc i phn lng

trong sut nhng ngy u

dng thuc, nc tiu c th c

mu vng sm,

Qu mn

Cn nhc dng Diacerein cho

nhng bnh nhn c ri lon

ng rut trc , c bit l

i trng d b kch thch.

2 tun u dng 1 vin vo

bui n ti (ung sau n)

2 tun sau tng liu BID

Daflon

Diosmin 450 mg

Hesperidin 50 mg

Vin nn bao phim

Dng trong iu tr cc ri

lon tun hon tnh mch

(chn sng au, bt rt)

iu tr cc triu chng

ca cn tr cp.

- Mt mi, chong vng, nhc

u, ri lon gic ng, chut

rt, tt HA t th.

- Ri lon d dy thng thng

v ri lon thn kinh thc vt

(cm gic bt an), khng cn

ngng iu tr.

Qu mn

Tin s ph Quincke.

Suy tim mt b cha iu tr.

Suy thn nng, suy gan nng.

Gim kali mu.

PNCT + Cho con b

Trong suy tnh mch

=> dng 2 vin/ngy

Thn trng dng cho ngi li

xe & vn hnh my.

- Diacerein c th lm tng nhanh thi gian thc n qua rut: 2 tun u: 1 vin/ngy 2 tun sau: 2 vin/ ngy

- Bc s nn quyt nh thi gian iu tr em li hiu qu. Diacerein c khi pht hiu qu chm v tc dng c li quan st c sau 2-4 tun iu tr

=> bnh nhn khng nn ngng iu tr trc khi hiu qu ca thuc c thy r rng.

- V Diacerein khng c ch tng hp prostaglandin, thuc khng gy hi cho d dy, v vy c th c k n an ton vi mt thuc khng vim

khng steroid (NSAID) trong 2-4 tun iu tr u tin.

- Rein l dn xut anthraquinon

Nguyn tc chung trong iu tr thoi ho khp:

- Lm gim triu chng au.

- Duy tr, hoc iu tr phc hi chc nng ca cc khp.

- Hn ch s tn ph.

- Trnh cc tc dng c do dng thuc.

Cc thuc dng trong iu tr thoi khp c th chia ra cc nhm sau: (trong n mnh dng thuc in m)

Cc thuc chng vim gim au.

Cc thuc gim au n thun.

Cc thuc iu tr chng co cng c

Cc thuc tc dng ko di.

Cc thuc lm thay i cc cu trc sn.

Cc thuc tc dng ko di lm gim triu chng thoi ho khp:

a. Glucosamin sulfat: thuc c tc dng tng tng hp cc tinh cht sn pro glycan v glucosaminoglycan lm tng tnh n hi ca tinh cht sn, thay i

cu trc sn khp. Liu 500 mg x 3 ln /ngy

b. Chondroitin sulfat

c. Diacerein ( Artrodar, Diasant) Nhm thuc tr liu mi y l dn cht acetylate ca cht dihydro anthraquinone rein. Diacerein c ch

interleukine 1(IL- 1beta), c tc dng chng vim iu tr vim xng, thoi ha khp.

C ch t/d: c ch s sn xut v hot ng ca cht Cytokine IL-1 tin vim v tin d ha c lp nng v lp su ca sn, mng hot dch v cc thnh

phn ca cht cn bn ngoi tb nh Proteoglycan, aggrecan, acid hyaluronic v cht to keo type II).

CCH PHNG NGA BNH SUY TNH MCH CHN:

Khuyn co: nn trnh ng lu, ngi nhiu, nht l nhn vin vn phng, khng nn ngi lm vic mt ch lin tc trong sut bui lm vic,

tranh th gii lao, i li vn ng vi pht trong khong thi gian lm vic t 30 - 60 pht.

Trong lc ngi lm vic, c th phi hp cc bi tp vn ng chn nh co dui cc ngn chn, gp dui c chn, nhn gt... mu lu chuyn tt

hn. n nhiu rau qu, cht x, vitamin. Nn tp th dc gim cn nh: bi li, i xe p, tp dng sinh.

C 3 bin chng m ngi mc bnh suy v gin tnh mch chn c th gp phi l: huyt khi (mu ng), xut huyt (chy mu) v lot chn.

Vic iu tr bnh suy tnh mch mn tnh chi di i hi s kt hp gia dng thuc, phu thut v vt l tr liu

THNG TIN THM

Diosmin: c nhiu trong ma d, Dioscorea persimilis

Hesperidin: c nhiu trong v gia cc loi qu h cam; tng tnh bn mao mch. Dng trong suy tnh mch chi di mn tnh v trong tr tr.

N S 7

Nam, 21 tui. Vim mi d ng.

Vim mi d ng dng: antiHistamin + khng vim + alpha-agonist + cromolyn

Phc 1 tun:

1. DESLER 5mg ung 7 vin Desloratadin

Sng 1

2. IMMURONG 80mg 14 vin Thymomodulin (ung sau n)

Sng 1 chiu 1

3. MARIMER nh mi 1 l NaCl

Sng 1 Chiu 1

4. MENISON 4 mg ung 14 vin Methylprednisolol PO tc dng ton thn => nhiu tc dng ph, nn i thnh dng kh dung tc ng ti ch

Sng 1 Chiu 1 => Dng Fluticasol, Budesonic MDI

5. REVCLAV 625 mg 14 vin Acid clavuclanic + Amoxicillin

Sng 1 Chiu 1

Tn thuc Tc dng/ch nh ADR Chng ch nh Lu c bit

DESLER 5mg

Desloratadin

Vin nn bao phim

Vim mi d ng

Desloratadin

AntiH1 th h 2

DX decarboethoxy c hot tnh

Nhc u, chong, bun

nn, kh ming, vim thc

qun, tiu chy, ho

Qu mn

liu ngi suy gan, suy thn.

- xp loi C

- qua sa m, nn ngng thuc

hoc ngng cho b.

- Liu 5 mg QD

IMMURONG 80 mg

Thymomodunline.

Vin nang

Nhim vi khun hoc virus

Bnh d ng, bnh RL t nhim

Phng + iu tr gim bch cu

tin pht hoc th pht

RLTH, au bng, i ngoi

vi tn xut nh

Qu mn Ngi ln: Dng t 1-2 vin/

ln, 2 ln trong ngy.

Tr em: 1 vin/ngy.

Ung sau khi n.

MARIMER

NaCl

nh mi (chai xt)

Nght mi, s mi

Vim mi d ng

Dung dch sinh l

=> tng i an ton

Suy tim sung huyt

Suy thn nng

MENISON 4mg

Methylprednisolon

vin nn

Vim da, vim mi d ng

Max: 60 mg/ngy

=> Tt nht l chuyn qua

dng dng tc dng ti ch, kh

dng Fluticasol, budesonic

Ging corticoid ni chung Nhim khun nng, tr sc nhim

khun v lao mng no.

Qu mn vi methylprednisolon.

Thng tn da do virus, nm, lao

ang dng vaccin virus sng.

Ging corticoid ni chung

Xp loi C

Liu khi u 4-48 mg/ngy

REVCLAV 625 mg

Amoxicillin 500 mg

Clavuclanic 125 mg

Nhim khun ho hp

Vim ph qun

Tiu chy, ban nga

Ch n ngi bnh c tin s

vng da/ri lon chc nng gan do

dng amoxicilin v clavulanat hay

cc penicilin v acid clavulanic gy

tng nguy c mt trong gan.

i tng suy gim chc nng

gan, suy thn, qu mn.

PNCT: cat. C

Cho con b: khng gy hi cho

tr tr khi d ng.

Thymomodulin l mt cht chit xut c t tuyn c b, gm mt s peptide vi khi lng phn t dao ng trong khong t 1 n 10 kD.

Mc d l peptid nhng thuc vn cn hot tnh khi dng ng ung.

Thymomodulin hp thu in vitro hoc invivo u cho thy tc dng cm ng s trng thnh ca cc t bo T. Pht huy kh nng ca t bo lympho T bng

nhng tc ng t ln lympho B v i thc bo.

Methylprednisolon tc dng ton thn => tc dng ph nhiu => thay bng kh dung th tt hn

Tc dng ca cc thuc

Bin lun c hay khng c nhim khun

- Amox+clavuclanat: tr nhim khun.

- Thymomodulin: h tr tr nhim khun

- Desloratadin + methylprednisolon: tr triu chng

Hp l ch nh:

- Liu: ng

Hng dn s dng:

- n no ri ung thuc, ung nhiu nc (corticoid dng ngn hn => MDI)

- Khng t dng thm antiH1 nu thy triu chng khng ci thin.

- D b tiu chy n sa chua/men tiu ho khi ngng hay dng bp khng dng thuc

- V sinh mi bng dd NaCl sau khi ra ngoi.

Khng nn dng thuc chng nght mi dng xt hoc nh qu 7 ngy. Vic lm dng n s gy hin tng sinh l phn hi, khin bnh nhn nght mi

nng hn, phi tng liu, dn n tnh trng vim mi do thuc v nghin thuc, rt kh iu tr.

N S 8

N 20 tui ; au u cng c

1. Acetaminophen 500 mg (Panadol) 14 vin

Ngy 2 ln, mi ln 1 vin, sau n

2. Gbapentin 300 mg (Neurontin) 28 vin


3. Swellmind 28 vin


4. Magne B6 28 vin


5. Tolperison 50 mg (Mydocalm) 28 vin


Tn thuc Ch nh CC ADR Ch

Acetaminophen

500mg (PANADOL)

Gim au

H nhit

Bnh tim, phi, thn, gan

Qu mn

Thiu G6PD

Ban da, st do thuc

Thng tn nim mc

Khng t dng gim au:

Ngi ln > 10 ngy, Tr em > 5 ngy

Khng dng paracetamol cho ngi ln

v tr em t iu tr st cao (trn

39,5OC), st ko di trn 3 ngy, hoc

st ti pht

Gabapentin

300 mg

(NEURONTIN)

H tr tr K (3+)

Tr au dy TK (18+)

Qu mn thnh phn

Khng nn dung cho PNCT,

cho con b

Vn ng mt phi hp, rung

git nhn cu, mt mi, chng

mt, ph, bun ng, gim tr

nh. Kh tiu, kh ming, to

bn, au bng, tiu chy.ph,

au c, khp, mn nga

Thn trng khi li xe

SWELLMIND

Ginkgo Biloba

B1, B3

Vinpocetine

Cholin Bitartrate

Quercetin

Suy tun hon no - suy

gim tr nh.

Tai bin v sau tai bin

mch mu no

Ri lon TK th gic v

tun hon thn kinh.

Ngi ln: mi ngy ung: 1-2 vin

trong ba n hoc nhiu hn khi c

hng dn ca thy thuc.

Tn thuc Ch nh CC ADR Ch

MAGIE B6 Thiu Mg2+ huyt nng,

ring bit hay kt hp.

iu tr cc ri lon chc

nng trong nhgn4 c lo

u km tng thng kh

Suy thn nng

Clr Gin c tc ng TW

Nhc c nng

Qu mn

Ban nga, yu c, h huyt

ap, bun nn, i ma

Dng thuc khi no

L dng vin nn bao phim

Liu TID (tng liu 150 450 mg)

Thuc gin c tc ng trung ng Tolperisone

Nh lm bn vng mng v gy t cc b,

C ch 1: Mydocalm c ch s dn truyn trong cc si thn kinh nguyn pht v cc nron vn ng => c ch c cc phn x a synap v n synap.

C ch 2: qua s c ch dng Ca2+ nhp vo synap, ngi ta cho rng cht ny c ch gii phng cht vn chuyn. Trong thn no, Mydocalm c ch ng

phn x li - ty sng.

Mydocalm ci thin tun hon ngoi bin, tc dng ny khng ph thuc vo nhng tc dng gp trong h thn kinh trung ng; v c th lin quan n tc

dng chng co tht nh v tc dng khng adrenergic ca tolperisone

Kt lun chnh xc l au u cng c, cn t nht 1 trong 2 triu chng

- Khng bun nn hay nn

- Khng c triu chng s nh sng hay ting ng

Thiu 2 triu chng => au na u

Bnh au u gm: au u cng c, au na u v au do u

Yu t thun li khi pht cn au u

+ Mt ng hoc ng qu nhiu

+ Ung nhiu ru

+ Lm vic trong mi trng n o.

+ Cng thng trong gia nh hay ngoi x hi.

iu tr khng dng thuc: Ngh ngi, p khn lnh, gc m hoc tm nc m ko di di vi hoa sen c th lm gim nh au u khng thng xuyn

N S 9

Chn on: vim mi hng, ri lon tiu ho.

i tng: tr em (38 thng 12 ngy tui)

1. OFFISS 100 mg 2 gi T 3 tui n 8 tui: 80 mg/ln, ngy 2 ln

Ngy ung 2 ln, mi ln gi

2. BETAMETHASONE 0,5 mg 4 vin Betamethason ung trong 2 ngy => c th do kinh nghim BS

Ngy ung 2 ln, mi ln 1 vin

3. TARABUTIN 100 mg 2 vin Trimebutin Ung trc khi n

Ngy ung 2 ln, mi ln vin

4. ZILERTAL 100 mg 2 vin Cetirizin Ung cng hay ngoi ba n


5. FLAMILIUM 10 mg 2 vin Domperidon trc n 15 30 pht


6. PARACETAMOL 500 mg 4 vin Ung lc st trn 37,8

Ngy ung 2 ln, mi ln 1/3 vin

IBUPROFEN 200 mg 4 vin Ung lc st trn 37,8 , ung khi no

Ngy ung 2 ln, mi ln 1/3 vin

Tn thuc Tc dng/ch nh Tc dng ph Chng ch nh Lu c bit

OFFISS

Cefpodoxim

100 mg

Nhim trng HH gia v di cc

chng nhy cm.

Trong NT HH trn thay Peni.

Bun nn, tiu chy, pht ban

D ng cephalosporin v ri lon

chuyn ho porphyrin

Xp loi B

BETAMETHASONE

Bethamethasone

0,5 mg vin nn

Khng vim corticoid

Thng dng liu 0,5 n 5 mg.

Xem n corticoid B tiu ng, tm thn,

Lot d dy v hnh t trng

- xp loi C

- Ging cc corticoid khc

TARABUTIN

Trimebutin

100 mg vin nn

Hi chng rut kch thch

Lot d dy

Tro ngc d dy, thc qun

Ri lon tiu ho, kh ming, bun

ng, mt mi, chng mt, nhc u,

cm gic nng lnh, ni mn

Qu mn Khng nn dng cho ph

n c thai v tr em di

12 tui.

Thn trng PN cho con b


ZILERTAL

Cetirizine

AntiH1 th h 1

Vim mi d ng

AHFS quy nh tr

Tng tc thuc

Paracetamol tng c tnh khi dng chung vi ru

Ibuproefen lm tng c tnh ca ru

Ibuprofen tng c tnh khi dng chung vi betamethasone.

Paracetamol: Corticosteroid cm ng cc enzym gan, c th lm tng to thnh mt cht chuyn ha ca paracetamol c i vi gan. Do , tng nguy c

nhim c gan nu corticosteroid c dng cng vi paracetamol liu cao hoc trng din.

cefpodoxime + ibuprofen: cefpodoxime lm tng nng hay tc dng ca ibuprofen do cnh tranh o thi thn. Tng tc nh khng ng ch .

Domperidone c ch CYP3A4.

Betamethasone: b chuyn ha qua CYP3A4 v c ch CYP3A4

Phi hp ibu v para gim liu l hip lc b sung gim tc dng ph

Tc dng ca cc thuc

Bnh nhn b vim mi c nghi ng nhim khun, c st, ri lon tiu ho trong trng hp ny l kh tiu v nn (hay xy ra tr)

OFISS: tr nhim khun h hp

BETAMETHASONE: chng vim, ng thi lm gim triu chng s mi, nght mi

ZILERTAL: tr triu chng s mi, nght mi

TARABUTIN, FLAMILIUM: tr ri lon tiu ho: kh tiu, bun nn.

PARACETAMOL v IBUPROFEN: h st.

Liu

o Cefpodoxim: hi thp so vi liu hng dn trong dc th.

o Betamethasone: OK

o Tarabutin: khng tm c liu cho tr em, tnh theo cng thc thy nh vy cng n

o Cetirizin: ch nn dng 5 mg/ngy, theo k n nh vy l cao.

o Domperidone: OK

o Paracetamol: OK

o Ibuprofen: khng cn thit 4 ln, do ibuprofen c thi gian tc ng di hn paracetamol nn khong 3 ln l OK. C th ch cn ung khi st. tuy

nhin iu ny cng khng quan trng lm.

N S 10

Nam 82 tui, Tng huyt p v cn, ri lon lipid huyt, thiu mu c tim mn tnh


1. ADALAT LA (Nifedipin) 15 vin

Sng 1

2. Allopurinol 300 mg - 15 vin

Sng 1

3. Atorvastatin 10 mg 15 gam

Chiu 1

4. Trimetazidin MR 35 mg 30 vin

Sng 1 Chiu 1

5. Aspirin 81 mg 15 vin

Tra 1

6. TV-Omeprazol 20 mg 30 vin

Sng 1 Chiu 1

TN THUC TC DNG CH NH LIU ADR CHNG CH NH LU KHI S DNG

Adalat LA 30mg

(Nifedipine)

Thuc chn knh calci (iu

tr au tht ngc v tng

huyt p)

D phng au tht ngc,

c bit khi c yu t co

mch nh trong au tht

ngc kiu Prinzmetal.

Tng huyt p.

Hi chng Raynaud

Tng huyt p:

Vin LA: 10-40 mg QD

ngy ung 2 ln

30-90 mg ngy QD

20-100 mg QD

Ph mt c chn, au

u, mt mi, chng

mt, nng bng

mt, nh trng ngc,

tim p nhanh, Bun

nn, a chy hoc to

bn.

Sc do tim.

Hp M ch nng.

NMCT trg vng 1 thng

Cn au cp trong au

tht ngc n nh mn,

nht l trong au tht

ngc khng n nh.

Ri lon chuyn ha

porphyrin.

Sau khi bt u iu tr, nu

thy cn au do thiu mu

cc b xut hin hoc cn

au hin c nng ln nhanh

chng => ngng thuc.

Phi gim liu khi c tn

thng gan, i tho ng.

Nifedipin c th c ch

chuyn d .

Allopurinol

300mg

Lm gim acid uric huyt

Khi dng aspirin 81 mg =>

tng uric huyt

Liu ti thiu cho ngi

ln: 100mg, liu trung

bnh 200-400mg/ngy,

chia 2-4 ln, bnh

nng: 600-800mg/24h

Bun nn tiu chy,

ni mn , tng

phosphate kim, tng

men gan

D ng vi allopurinol,

ph n c thai v cho

con b

Ngng thuc nu thy tiu

au tiu ra mu, sng mi

ming, kch ng mt, nn

ung nhiu nc

TN THUC TC DNG CH NH LIU ADR CHNG CH NH LU KHI S DNG

Atorvastatine

10mg

(atorvastatin

calcium)

Phng chng bnh v tim

mch v h lipid huyt (kt

hp thuc chn canxi

phng chng cao huyt p

v cc vn tim mch)

10mg/ln/ngy RLTH(au bng, bun

nn, to bn, tiu

chy, y hi, kh

tiu) nhc u, au c,

au khp, vim hng,

Bnh gan tin trin,

ph n c thai v cho

con b

Category X

Trimetazidin

Stada MR 35mg

(trimetazidine)

Bnh tim thiu mu cc b

(iu tr d phng cc cn

au tht ngc di chng nhi

mu c tim).

1 vin x 2 ln/ngy

(bui sng v bui ti)

ung trong ba n

bun nn, nn, nhc

u, chng mt.

Mn cm hoc khng

dung np

khng nn dng cho ph n

c thai, cho con b.

Aspirin 81mg D phng th pht nhi

mu c tim v t qu

nhng ngi bnh c tin

s v nhng bnh ny

81mg/ln/ngy Nn, kh tiu, kh chu

thng v, nng,

au d dy, lot dd

rut, yu c

Suy thn, suy gan

Cl di 30 ml/pht

Qu mn NSAID

TV-omeprazol

20mg

Thuc c ch bm proton

ch nh: tro ngc d dy,

vim lot d dy t trng,

GERD 20mg/ngy

Ung trc n 30 v

ko b, nhai m phi

nut nguyn vin

Nhc u, bun ng,

chng mt. Bun nn,

nn, au bng, to

bn, chng bng. Mt

ng, ri lon cm gic,

chng mt, mt mi.

Che lp du hiu ung

th d dy

Ngi mn cm vi bt

c thnh phn no ca

thuc

Omeprazol lm gim chuyn

ha nifedipin t nht l 20%

v c th lm tng tc dng

ca nifedipin

Tng nguy c gy xng

hng, c tay v ct sng (sd

qu 1 nm).

Nhn xt:

Trong n ny th nifedipin va atorvastatin dng chung phi hp phng chng tng huyt p cho bnh nhn. Atorvastatin iu tr chng ri lon lipid huyt

Trimetazidine trong n iu tr chng thiu mu c tim v phong nga au tht ngc. Aspirin chng ng mu nga huyt khi lm tc mch.

Trong n ny c omeprazol chc l dng nga tc dng ph gy lot ca aspirin nhng m liu 40mg/ngy th qu cao v lm tng tc dng ca

nifedipin ln cao c th gy c tnh.

Tng tc:

nifedipine + atorvastatin

nifedipine tng tc dng ca atorvastatin thong qua chuyn ha ca enzyme CYP 3A4

nifedipine + atorvastatin

nifedipine lm gim tc dng ca atorvastatin bng knh P-glycoprotein (MDR1)

=> Cn theo di nng 2 thuc ny trong mu ca bnh nhn

N S 11

Nam 55 tui, rung nh, T typ 2, cao huyt p v cn


1. Digoxin 0,25 mg - 15 vin

Sng 0,5 vin (Th 7, CN khng dng)

2. Imdur 30 mg - 30 vin Isosorbid mononitrat

Tra 1

3. Tanatril 5 mg 30 vin Imidapril

Sng, sau n 1

4. Plavix 75 mg 30 vin Clopidogrel

Sng sau n no

5. Diammicron MR 30 mg 60 vin Gliclazie

Sng 2 vin

6. Glucophage 1000 mg 60 vin Metformin

1 vin sau n sng, chiu

Tn thuc Ch nh ADR Chng ch nh Lu c bit

Digoxin

0,25mg

Suy tim, rung nh v cung

ng nh nht l khi c tn

s tht qu nhanh, nhp

nhanh trn tht kch pht.

Tiu ha: Chn n, bun

nn, nn.

Blc tim hon ton tng cn, blc

nh - tht hai;

lon nhp trn tht gy bi hi

chng Wolff - Parkinson - White;

bnh c tim ph i tc nghn

Suy thn, thiu nng gip => chnh liu v

theo di cht ch.

Tnh nhy cm vi ADR tng ln ngi c

gim kali huyt, tng calci huyt v ngi

cao tui.

IMDUR 30mg

Isosorbid

mononitrat

iu tr d phng TN, gim

cn au tht ngc

Nhc u, H huyt p,

chng mt v bun nn

C tin s nhy cm vi hot cht

hoc bt c t dc no, sc, h

huyt p, bnh c tim ph i tc

nghn v vim mng ngoi tim.

Khi ang iu tr bng Imdur, khng c

dng sildenafil (Viagra).

Tanatril 5mg

Imidapril

Tng huyt p.

THA do nhu m thn.

(Khng dng trong vng 24

gi trc khi phu thut)

au u, hoa mt, h huyt

p qu c i khi bun nn,

nn, kh chu d dy v

au bng. Tng kali huyt

thanh c th xy ra

- Qu mn, tin s ph mch

- ang iu tr lm gim LDL bng

dextran cellulose sulfate

- Nhng bnh nhn c thm

phn vi mng acrylonitrile

methallyl sulfonate sodium

Bt u vi liu thp, theo di tnh trng

bnh nhn, c th tng liu dn dn: BN

tng huyt p nng, BN ang thm phn lc

mu, BN ang iu tr li tiu, c bit l

nhng ngi va bt u iu tr li tiu,

bnh nhn cn phi n king mui tuyt i.

Thn trong li xe, vn hnh my

Tn thuc Ch nh ADR Chng ch nh Lu c bit

Plavix 75mg

Clopidogrel

Gim tai bin ca x va

ng mch, iu tr au tht

ngc khng n nh

Ph, tng huyt p,

Nhc u, chng mt.

au bng, kh tiu, tiu

chy, bun nn

Qu mn vi thuc, chy mu

bnh l hot ng nh vim lot

d dy hoc xut huyt ni s.

Nu tri qua phu thut, ngng clopidogrel 7

ngy trc . Xut huyt tiu ha:

Clopidogrel ko di thi gian chy mu. Suy

gan: S dng thn trng bnh nhn b

bnh gan nng c th chy mu tng.

Diamicron MR

30mg

Gliclazide

i tho ng khng ph

thuc insulin typ 2 m ch

n king n thun khng

kim sot c glucose -

huyt.

Ri lon tiu ha, bun nn,

au u, pht ban...

i tho ng typ 1

Hn m, tin hn m v T

Suy gan nng, suy thn nng.

D ng sulfamid

Phi hp vi miconazol vin.

Nhim khun nng hoc chn

thng nng, phu thut ln.

Trong khi dng gliclazid vn phi theo ch

n king. iu s gip gliclazid pht huy

y tc dng.

Gliclazid nn dng cho ngi cao tui b i

tho ng.

Glucophage

1000mg

Metformin

iu tr bnh i tho ng

khng ph thuc insulin (typ

II)

Chn n, bun nn, nn,

tiu chy, y thng v,

to bn, nng, ban, my

ay, cm th vi nh sng.

Nhim acid lactic.

Ngi bnh c trng thi d ha

cp tnh, nhim khun, chn

thng (iu tr bng insulin).

Gim chc nng thn

Qu mn vi metformin hoc cc

thnh phn khc.

Nhim acid chuyn ha

...

Metformin c bi tit ch yu qua thn,

nguy c tch ly v nhim acid lactic tng ln

theo mc suy gim chc nng thn.

Metformin khng ph hp iu tr cho

ngi cao tui, thng c suy gim chc

nng thn

Phi ngng iu tr vi metformin 2 - 3 ngy

trc khi chp X quang dng cn quang cha

iod, v trong 2 ngy sau khi chiu chp.

Phi ngng dng metformin khi tin hnh

cc phu thut. Khng dng metformin

ngi bnh suy gim chc nng gan.

TNG TC THUC

Thuc tng tc C ch H qu Mc Cch x tr

Digoxin- Metformin

cnh tranh o

thi thuc qua

ng thn (cation)

tng tc dng ca metformin, c th dn n

mt tnh trng e da tnh mng c gi l

nhim acid lactic ny c th gy ra suy nhc,

tng bun ng, nhp tim chm, au c, kh th,

au bng, cm thy chong vng , v ngt xu

ng k

Theo di

cht ch.

iu chnh liu lng v kim tra lng ng trong

mu thng xuyn hn. Ni vi bc s v tt c cc

loi thuc khc ang s dng, bao gm vitamin v

tho dc. Khng ngng s dng bt c loi thuc

m khng ni vi bc s.

Digoxin Imidapril

PHN TCH - BNH N THUC

V mt ch nh:

iu tr rung nh: Digoxin + Plavix

iu tr T Type II: Diamicron + Glucophage

iu tr Cao huyt p v cn: Tanatril + Imdur

Thuc Liu lng, dng bo ch Cch dng, thi gian dng thuc

Digoxin Ok, nn ung mi ngy (ti sao t7 v cn ko

ung?)

Dng vin c rnh b, hp thu chm khi c thc n

Imdur Phng thch ko di, ung nguyn vin Ung lc bng i vi lng nhiu nc, nn ung vo bui sng (trc ba n tra)

Tanatril ok ok

Plavix ok Ko b nh hng bi thc n

Diamicron ok Ung vo ba n sng

Glucophage Liu cao (thng thng 500mg*2ln/ngy) Ung vo ba n sng v ti

N THUC 12

N 59 tui Cao huyt p, tiu ng RL Lipid mu


1. Nifedipin 20 mg - 20 vin

BID x 1 vin

2. Bisoprolol 5 mg 10 vin

BID x vin

3. Gliclazid 80 mg 20 vin

BID x 1 vin

4. Metformin 10 vin

QD x 1 vin

5. Atorvastatin 10 mg 10 vin

Sng 2 vin

Tn thuc Tc dng/ ch nh Tc dng ph Chng ch nh Lu c bit

Nifedipin

20mg

Thuc chn knh calci

iu tr au tht ngc v THA

D phng au tht ngc, c bit khi

c yu t co mch nh trong au tht

ngc kiu Prinzmetal.

Tng huyt p.

Hi chng Raynaud

Ph mt c chn, au u,

mt mi, chng mt, nng

bng mt, nh trng

ngc, tim p nhanh, Bun

nn, a chy hoc to bn.

Sc do tim.

Hp M ch nng.

NMCT trg vng 1 thng

Cn au cp trong au tht ngc

n nh mn, nht l trong au

tht ngc khng n nh.

Ri lon chuyn ha porphyrin.

Sau khi bt u iu tr, nu thy cn

au do thiu mu cc b xut hin

hoc cn au hin c nng ln nhanh

chng => ngng thuc.

Phi gim liu khi c tn thng gan,

i tho ng.

Nifedipin c th c ch chuyn d .

Bisocar 5mg

Bisoprolol

Cao huyt p H huyt p, nhp tim chm,

lnh u chi, Mt ng, mt

mi, chng mt, trm cm,

th , bun ng, hay qun,

lo u, au u, ni lu li.

Pht ban, ni m ay, rng

tc, Kh mt, m mt, tai,

au hng, Bun nn, nn

ma, tiu chy, to bn, au

bng, kh ming.

Qu mn vi thuc chn bta;

xoang nhp tim chm, suy tim, sc

tim.

Mang thai: Loi C. Tr em: An ton

v hiu qu cha c thit lp. Sc

phn v: c th gy t vong. i tho

ng: C th che du cc triu

chng ca h ng huyt (v d

nh, nhp tim nhanh, thay i huyt

p). Bnh mch mu ngoi bin: C

th kt ta hoc triu chng ca suy

ng mch trm trng thm. Suy /

gan, suy thn: Gim liu hng ngy.

Glycozide

80mg

Glyclazid

T khng ph thuc insulin typ 2

m ch n king n thun khng

kim sot c glucose - huyt (nn

dng cho ngi cao tui).

ri lon tiu ha, bun nn,

au u, pht ban...

H ng huyt qu mc

i tho ng ph thuc insulin

(typ 1).

Hn m hay tin hn m do i

tho ng.

Suy gan nng, suy thn nng.

C tin s d ng vi sulfonamid

v cc sulfonylur khc.

Phi hp vi miconazol vin.

Nhim khun nng hoc chn

thng nng, phu thut ln.

Trong khi dng gliclazid vn phi theo

ch n king. iu s gip

gliclazid pht huy y tc dng.

Khi dng phi hp vi cc thuc khc

c tc dng tng hoc gim tc dng

h ng huyt, cn phi iu chnh

liu ca gliclazid cho thch hp. Trong

trng hp suy thn, suy gan, cn

phi gim liu.

Glucofine Metformin

T type II n tr liu, khi khng

th iu tr tng glucose huyt bng

ch n n thun.(ng thi vi

mt sulfonylur khi ch n v khi

dng metformin hoc sulfonylur n

thun khng c hiu qu kim sot

glucose huyt mt cch y ).

RL Tiu ha, Ban, my ay,

cm th vi nh sng.

Gim nng vitamin B12.

Nhim acid lactic.

Gim chc nng thn

Qu mn vi metformin hoc cc

thnh phn khc.

Nhim acid chuyn ha

...

Metformin c bi tit ch yu qua

thn, nguy c tch ly v nhim acid

lactic tng ln theo mc suy gim

chc nng thn.

...

Alipid 10mg

Atorvastatin

cholesterol ton phn + cholesterol

LDL ngi bnh tng cholesterol

mu gia nh ng hp t, b tr cho

cc cch iu tr h lipid khc.

Nhc u, chng mt, suy

nhc, mt ng, d cm, To

bn, tiu chy, y hi, kh

tiu, au bng, bun nn.

Tng men gan

Mang thai v cho con b

Tc ng c xng: tiu c vn vi

ri lon chc nng thn th cp. Xem

xt bnh c trong cc bnh nhn c

au c lan ta, au c hoc yu, hoc

tng ng k ca CPK.

TNG TC THUC

Thuc tng tc C ch H qu Mc Cch x tr

Nifedipin-

Atorvastatin

Nifedipine c

ch CYP3A4

Tc ng ln

bm ngc P-

glycoprotein

(MDR1)

Tng hiu qu ca Atorvastatin lm tng tc

dng ph nh tn thng gan v mt tnh

trng him gp nhng nghim trng gi l tiu

c vn c lin quan n s phn hy ca cc

m c xng: c th gy tn thng thn v

thm ch t vong.

Gim hiu qu ca Atorvastatin

ng k- cn

theo di cht ch

iu chnh liu lng hoc theo di thng xuyn

s dng mt cch an ton c hai thuc. Bo bc s

khi au c, Nn i khm bc s ngay lp tc nu b

st, n lnh, au khp hoc sng, chy mu bt

thng hoc bm tm, ni m ay, nga, chn n,

mt mi, bun nn, nn, nc tiu sm mu, v /

hoc vng da hoc mt, v chng c th l nhng

du hiu v triu chng ca tn thng gan.

Bisoprolol-

Nifedipine

C hai u

chn knh

H huyt p qu mc, gim nhp tim, nhc

u, chng mt, chong, ngt xu

ng k- Cn

theo di cht ch

Hy cho bc s bit nu bn pht trin cc triu

chng ny v khng bin mt sau mt vi ngy, iu

chnh liu lng hoc theo di thng xuyn hn.

Trnh li xe hay vn hnh my mc nguy him cho

n khi bn bit cc loi thuc nh hng nh th

no n bn, v cn thn khi ng ln t t th ngi

hoc nm

Nifedipine-

Metformin

(medscape.com)

Nifedipine lm

tng hp thu

rut ca

Metformin

Tng tc dng ca metformin, c th dn n

tnh trng e da tnh mng do nhim acid

lactic, gy ra suy nhc, bun ng, nhp tim

chm, au c, kh th, au bng, cm thy

chong vng , v ngt xu.

Thiu s- Ko ng

k

Cn iu chnh liu lng v phi kim tra lng

ng trong mu thng xuyn hn.

Bisoprolol-

Metformin

Gy h ng huyt: au u, chng mt,

bun ng, cng thng, run, i, yu, nh

trng ngc.

Trung bnh Thng xuyn theo di lng ng trong mu, iu

chnh liu lng

PHN TCH - BNH N THUC

V mt ch nh:

iu tr cao huyt p: Nifedipine + Bisocar

iu tr Tiu ng: Glycozide + Glucofine

iu tr Ri lon lipid mu: Alipid

Thuc Liu lng, dng bo ch Cch dng, thi gian dng thuc

Nifedipin Vin nn, phng thch chm ko di Ung nguyn vin, ko b nh hng bi thc n

Bisocar Nn ung 1 vin/ 1 ln trong ngy Ko b nh hng bi thc n

Glycozide 2v 80mg ung 1 ln trong ngy (thng) Ung vo ba n sng

Glucofine Thng 1v 500mg* 2 ln/ngy Ung vo ba n sng v ti cho dung np tt hn

Alipid ok Ung vo bt c lc no, ko ph thuc thc n

N THUC 13

Nam 60 tui Cao huyt p ang iu tr, suy thn mn, thoi ha a khp, vim d dy


1. Furosemid 40 mg - 15 vin

BID x vin, sau n

2. Pantoprazol 40 mg 30 vin

BID x 1 vin, sau n

3. Domperidon 10 mg 30 vin

BID x 1 vin, sau n

4. Shinapril 30 vin Enalpril

BID x 1 vin, sau n

5. Aluminum phosphat gel 12,38 g 10 gi

BID x 1 gi, trc n

Suy thn khng dng li tiu thiazid => dng li tiu quai (hp l)


Furosemid Ph phi cp; ph do tim, gan, thn v cc loi ph khc; tng huyt p khi c tn thng thn; tng calci huyt. Liu iu tr ph v tng huyt p l 40 n 80 mg/ngy, trng hp nh c th dng 20 mg/ngy.

Tc dng khng mong mun ch yu xy ra khi iu tr liu cao (chim 95% trong s phn ng c hi). Hay gp nht l mt cn bng in gii (5% ngi bnh iu tr), ch yu ngi bnh gim chc nng gan v vi ngi bnh suy thn khi iu tr liu cao ko di. Thng gp, Gim th tch mu trong trng hp liu php iu tr liu cao. H huyt p th ng, h K, Na, Mg,Cl, Ca huyt, tng acid uric huyt, nhim kim do gim clor huyt

Mn cm

Thn trng vi nhng ngi bnh ph i tuyn tin lit hoc i kh v c th thc y b tiu tin cp. Thi k mang thai: xp loi C, qua hng ro nhau thai vo thai nhi v gy ri lon nc v cht in gii cho thai nhi, nhiu trng hp gim tiu cu tr s sinh c thng bo. V vy, trong 3 thng cui thai k, thuc ch c dng khi khng c thuc thay th, v ch vi liu thp nht trong thi gian ngn. Lm ngng tit sa.

Pantoprazole

stada

(theo AHFS)

Hi lu d dy-thc qun Tng tit dch tiu ho U t trng

U d dy Hi chng Crohn lin quan n u x. Liu tng tit dch v do bnh l: 40mg x2ln/ngy, chnh liu theo p ng v dung np ca bnh nhn

ng ung, ngn hn (khng qu 8 tun): nhc u, tiu chy, y hi, au bng, pht ban, hi, mt ng, tng ng huyt. Di hn: (12 thng): au u, au bng, bun nn, nn, xt nghim chc nng gan bt thng.

Qu mn vi pantoprazole v bt k thnh phn no trong cng

thc, hoc vi cc benzimidazole khc.

Trong thai k: xp loi B. Qua sa m, nguy c cho tr ang b.


Domperidone iu tr triu chng bun nn v nn nng, c bit ngi bnh ang iu tr bng thuc c t bo. iu tr triu chng bun nn, nn, cm gic chng v nng vng thng v, kh tiu sau ba n do thc n chm xung rut. Ngi ln: C 4 n 8 gi, ung mt liu 10 - 20 mg (ti a 1 mg/kg), hoc t thuc vo trc trng 30 n 60 mg.

Domperidon kh qua c hng ro mu - no v t c kh nng hn metoclopramid gy ra cc tc dng thn kinh trung ng nh phn ng ngoi thp hoc bun ng. Ri lon ngoi thp v bun ng xy ra vi t l rt thp v thng do ri lon tnh thm ca hng ro mu - no (tr non, tn thng mng no) hoc do qu liu. Chy sa, ri lon kinh nguyt, mt kinh, v to hoc au tc v do tng prolactin huyt thanh c th gp ngi bnh dng thuc liu cao di ngy.

Nn sau khi m. Chy mu ng tiu ha.

Tc rut c hc. Tr nh di 1 tui. Dng domperidon thng xuyn hoc di ngy.

Ch c dng domperidon khng qu 12 tun cho ngi bnh Parkinson. Ch dng khi cc bin php chng nn khc, an ton hn khng c tc dng. Phi gim 30 - 50% liu ngi bnh suy thn v cho ung thuc lm nhiu ln trong ngy. Domperidon khng gy qui thai. Tuy nhin, an ton, trnh dng thuc cho ngi mang thai. Domperidon bi tit vo sa m vi nng thp; khng dng thuc cho ngi cho con b.

Shinapril Tng huyt p. Suy tim (gim t vong v bin chng ngi suy tim c triu chng v ngi lon nng tht tri khng triu chng). Sau nhi mu c tim (huyt ng hc n nh). Bnh thn do i tho ng (tng hoc khng tng huyt p). Suy thn tun tin mn. Tng huyt p v cn: ngi ln: Liu khi 2,5 - 5 mg/ngy. Liu duy tr thng thng t 10 - 20 mg, ung mt ln hng ngy; gii hn liu thng thng cho ngi ln: 40 mg/ngy. iu tr ng thi vi thuc li tiu

Thng gp, ADR > 1/100 H thn kinh: Nhc u, chng mt, mt mi, mt ng, d cm, lon cm. Tiu ha: Ri lon v gic, a chy, bun nn, nn v au bng. Tim mch: Ph mch, h huyt p nng, h huyt p t th ng, ngt, nh trng ngc, v au ngc. Da: Pht ban.

H hp: Ho khan, c th do tng kinin m hoc prostaglandin phi

D ng hoc qu mn vi thuc. Ph mch khi mi bt u iu tr nh cc cht c ch ACE ni chung. Hp ng mch thn hai bn thn hoc hp ng mch thn ngi ch c mt thn. Hp van ng mch ch, v bnh c tim tc nghn nng. H huyt p c trc.

Ngi gim chc nng thn. i vi ngi nghi b hp ng mch thn, nh lng SCr trc khi bt u iu tr. Thi k mang thai: C (3 thng u), D(6 thng cui) ACEi c th gy bnh v t vong cho thai nhi v tr s sinh khi ngi m mang thai s dng thuc. S dng thuc trong 3 thng gia v 3 thng cui ca thai k c th gy bnh dn n cht thai v tn thng cho tr s sinh, gm Phi ngng dng enalapril cng sm cng tt sau khi pht hin c thai. Thi k cho con b Enalapril bi tit vo sa m. nguy c v tc dng c hi cho tr b sa m rt thp liu thng thng.

Aluminium

phosphat gel

Vim thc qun, vim d dy cp v mn tnh, lot d dy - t trng, kch ng d dy, cc hi chng tha acid nh rt bng, chua, v hin tng tit nhiu acid, th d trong thi k thai nghn.

Thng gp: To bn.

Cc trng hp mn cm vi nhm hoc cc ch phm cha nhm.

Trnh iu tr liu cao lu di ngi bnh suy thn. Thi k mang thai: trnh dng lu di, liu cao. Thi k cho con b: qua sa m nhng khng nh hng n tr.

Tng tc thuc:

- Domperidone c c tnh gia tng khi dng chung vi furosemid

- Enalapril c c tnh gia tng khi dng chung vi furosemid

- Cn c nh hng khng tin liu c khi dng chung vi enalapril

Tc dng thuc:

Furosemid: li tiu quai, thch hp dng cho ngi b tng huyt p c bnh thn do t nh hng n lc cu thn.

Enalapril: tr tng huyt p, cng thch hp cho ngi b bnh thn lun.

Pantoprazole: tr vim d dy

Domperidone: gip gim triu chng kh chu ca vim d dy (y bng, khng tiu, bun nn v nn)

Aluminium phosphat gel: bo v nim mc.

Ni chung thy n ny hp l, ch tr vic khng thy dng thuc gim au cho bnh thoi ho khp. C th bnh l mn tnh, bc s tm trnh

dng corticoid trong thi gian iu tr bnh d dy trnh tc dng ph ln tiu ho.

Liu:

- Furosemid: ok

- Pantoprazole: ok

- Domperidon: ok

- Enalapril: ok

- Aluminium phosphat gel: ok

Hng dn dng thuc

- Furosemid: khng nn ung bui ti, ung ngy 1 ln cng c

- Pantoprazole, domperidone: ung trc khi n 30 pht.

- Enalapril: sao cng c

- Gel: trc n 15-30 pht, cch cc thuc khc t nht 2 gi.

Documents

Bai soan TT DLS.pdf