H Thn KinhT ng(H Thn Kinh Thc Vt)

H thng thn kinh thc vt (TKTV):Cn c gi l:H thng thn kinh dinh dng

H thng thn kinh t ng (TKT)

H thng thn kinh tng

H thng thn kinh khng tu

Thnh phn chnh ca h thng TKTVH Giao cm (Sympathetic system)H i giao cm (Para_Sympathetic system) hay h ph giao cm.C hai h thng ny c bt ngun t nhng nhn thuc h thng thn kinh trung ng (Central Neurvous System _ CNS)

C xng H thng TK ngoi binH TK bn thH TKTV (h TKT)H TK PH GIAO CM H TK GIAO CMTc ng chn lcTc ng lan taC trn, tuyn & c tim Ngun: www.pharmamotion.com

Nguyn u _ Bm tnT cung no hoc ct sng si tin hch

n cc c quan hiu ng (c tim, c trn v t bo cc tuyn)

Cu trcH giao cmH i giao cmSi tin hchHchSi hu hch

Cu trcH giao cmSi tin hch:Ngn.Xut pht t si TK ngc D1 L3.Tit Acetyl cholin (A.Ch)Si hu hchHchH i giao cmSi tin hch:Di.Xut pht t si dy s III, VII, IX, X v r cng 2,3,4.Tit A.ChSi hu hchHch

Cu trcH giao cmSi tin hchSi hu hch:Di.Xut pht t hch, kt thc ti c quan hiu ng.Tit Nor Epinephrine (NE)1 Si tin hch tip xc # 20 si hu hch kch thch thng lan to.HchH i giao cmSi tin hchSi hu hch:Ngn.

Tit A.Ch.

1 Si tin tip xc 1 si hu hch Kch thch thng khu tr hn.Hch

Cu trcH giao cmSi tin hchSi hu hchHch:Ch yu l chui hch dc 2 bn ct sng.Hch trc t sng on bng.Chui hch h v.H i giao cmSi tin hchSi hu hchHch:Hch nm trn c quan hiu ng.

C tia mng mtNt SA & AV, ht His-Purkinje, c tim Tuyn kh ph qunD dyThnRut nonBng quang, niu oTuyn di li, di hm, Mang taiC dng lngTuyn m hiMch muH TK Giao CmHch cnh ct sngHch trc ct sngNgun: www.pharmamotion.com

H TK PH GIAO CM (Craniosacral Outflow)GenitaliaBladderI TRNGTHNng mt, Ti mtRUT NOND DYTUYN KH PH QUNNT SA & AV C VNG MNG MTLacrimal GlandTUYN DI LI & DI HMTUN MANG TAINgun: www.pharmamotion.com

Ho cht trung gian dn truyn tkC 2 loi : A.Ch v NE

Ngun gc:A.Ch c tng hp v gii phng t si Cholinergic.

NE c gii phng t si Adrenergic

3 giai on ca s dn truyn TKKhi ta kch thch cc dy tk th u tn cng ca dy tk s tit ra HCTGDTTK lm trung gian cho s dn truyn:

Gia si tin hch v si hu hch.

Gia dy tk vi c quan hiu ng.

3 giai on ca s dn truyn TKCc cht TGDTTK n mng hu synap kt hp to phc hp: Cht TGDT-Rc

- phc hp cht TGDT-Rc thay i tnh thm ca mng vi ion Na+ (hoc K+, Cl-) ht kh cc mng, to in th sau synap a n p ng sinh hc (vd co tht c, tng s bi tit ca tuyn).

3 giai on ca s dn truyn TKKt thc tc ng ca cht TGDTTK: bng enzyme hoc bng cch thu hi v ni d tr.

(1) Cholin c vn chuyn qua mng c s h tr Na+(2) A.Ch c vn chuyn c H+ h tr ging 1 ngun nng lng.S SINH TNG HP ACETYLCHOLIN (A.Ch)

S SINH TNG HP NOR EPINEPHINE

RECEPTOR CA H I GIAO CM

Receptor

C quan

p ng

Nicotinic

- C (NM)

Khe khp TK c

C co

- Thn kinh

(NN)

. hch t ng

. ty thng thn

. CNS

kh cc v kch thch neuron hu hch

bi tit Catecholamine

khng r

Muscarinic

- M1

hch, CNS

Khng r

- M2

Nt xoang

Nt A-V

C nh, c tht

lm chm s kh cc

lm ( tc dn truyn

( thi gian hot ng in ( ( sc co bp ca tim

- M3

C trn (ni chung)

C trn ng niu:

*C bi niu (detrusor)

*C vng tam gic, c vng bng quang.

Tuyn bi tit

co tht

co

gin

( s bi tit

RECEPTOR CA H GIAO CM

Rc

C quan p ng

p ng

(1

- C trn : mch mu, ng niu sinh dc, c tia mng mt

- Co

- C trn ng rut

- Gan

- Tim

- Gin

- Ly gii Glycogen, ( tn to ng

- Tng sc co bp

(2

- Tn cng thn kinh

- C trn mch mu

- Tb ( tuyn ty

-( phng thch NE

-Co mch

-( tit Insulin

(1

Tim

Juxtaglomerullar cells

( sc co bp c tim, ( nhp tim, ( tc dn truyn

( bi tit Renin

(2

- C trn ni chung (k c c trn mch mu/ c vn)

- C xng

- Gan

- gin

- ly gii glycogen, ( ti hp thu K+ vo c

- ging (1

(3

- M cht b nhn

- Ly gii Lipid

THUC KCH THCH H GIAO CM(CNG GIAO CM)Bs. L Kim Khnh

MC TIU HC TP1. Phn loi thuc theo tc ng trc tip v gin tip2. Trnh by c ch tc ng, tc ng dc lc, dc ng hc, tc dng khng mong mun, ch nh v chng ch nh3. ng dng iu tr

THUC KCH THCH H GIAO CMCC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin)2. NOREPINEPHRIN (Noradrenalin)3. DOPAMIN: (Intropin)4. ISOPROTERENOL: (Isuprel)5. PHENYLEPHEDRIN:6. CLONIDIN (Catapressan)

CC THUC KCH THCH GIN TIP H GIAO CM 1. EPHEDRIN2. AMPHETAMIN

CC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin)C ch tc dng: hot ha tt c nhng Receptor (Rc) ca h giao cm.

Tc dng dc l:

1. H thng tim mch:-Trn mch: liu cao gy co mch ngoi bin (tc dng 1), liu thp(

Tc dng dc l:2. Cc c quan khc:-H hp: gin kh ph qun.-Tiu ha: gin c trn/ tiu ha.-Tit niu: gin c bi niu, co c vng BQ

3. Chuyn ha:-Tng phn hy Glycogen (2).-Gim tit Insulin (2). ng huytCC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin) (tt)

Dc ng hc:-Hp thu: tt qua ng tim v ti ch, khng dng bng ng ung v b phn hy bi men MAO, COMT h tiu ha v gan.

-o thi: qua thn.

-T1/2 : ngn, vi pht.CC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin) (tt)

* Ch nh:Chng d ng.iu tr hen.Cc tnh trng tt huyt p.Ngng tim t ngt (tim vo tnh mch trung tm hoc truyn tnh mch nh git).Phi hp vi thuc t ko di tg t/dCC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin) (tt)

*Chng ch nh:Tng huyt p.Cng gip.

*Tc dng ph:Lo u, hi hp (kch thch TKTW).Lon nhp tim CC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin) (tt)

CC THUC KCH THCH TRC TIP H GIAO CM 1. EPINEPHRIN (Adrenalin) (tt)Dng trnh by:ng tim 1ml=1mg Adrenalin Hydrochlorid.Liu chng sc:TDD 0,1- 0,5ml dung dch Adrenalin 0,1%

Tc dng dc l:-Tc ng trn 1 v 1 ging Epinephrin nhng t tc ng trn 2 gy co mch mnh sc cn ngoi bin, huyt p.

-t tc ng trn chuyn ha.CC THUC KCH THCH TRC TIP H GIAO CM 2. NOREPINEPHRIN (Noradrenalin)

Dc ng hc:-Ging Epinephrin.-Gy co mch mnh nn d gy hoi t ti ch tim nn tim truyn nh git tnh mch.Dng trnh by: ng 1ml=1mg

Ch nh: nng huyt p.CC THUC KCH THCH TRC TIP H GIAO CM 2. NOREPINEPHRIN (Noradrenalin) (tt)

Tc dng dc l: T/ trn cc Rc gy p ng khc nhau ph thuc vo liu:

-Liu thp: tc dng trn Rc-Dopaminergic (D1) gy gin mch thn lng mu n thn, lc cu thn.

-Liu trung bnh: tc ng trn 1 tng sc co bp c tim.

-Liu cao: kch thch gy co mch.CC THUC KCH THCH TRC TIP H GIAO CM 3. DOPAMIN: (Intropin)

Ch nh:Tt c cc trng hp shock, ring shock do gim th tch phi bi hon y th tch trc khi dng Dopamin.Chng ch nh:-Trnh dng chung cc thuc IMAO, hoc phi gim liu.-Qu liu: Biu hin ca cng giao cm nh bun nn, i ma, lon nhp tim, tng huyt p.Dng trnh by: ng 200mg/5mlCC THUC KCH THCH TRC TIP H GIAO CM 3. DOPAMIN: (Intropin) (tt)

C ch tc dng : kch thch giao cm (kch thch Rc , t tc ng trn RC ).

Tc dng dc l:-Rc 1: Gy tng sc co bp c tim, tng nhp tim (mnh hn Epinephrin).

-Rc 2 : Gy gin mch, v gin hu ht cc c trn trong c c trn kh ph qun.CC THUC KCH THCH TRC TIP H GIAO CM 4. ISOPROTERENOL: (Isuprel)

Dc ng hc: Ch yu b ph hy bi men COMT, t b nh hng bi men MAO do tc dng di hn Epinephrin v Norepinephrin.

Ch nh:-Hen.-Kch thch tim trong nhng trng hp: ngng tim, ri lon nhp chm, hi chng Stokes-Adams.CC THUC KCH THCH TRC TIP H GIAO CM 4. ISOPROTERENOL: (Isuprel) (tt)

CC THUC KCH THCH TRC TIP H GIAO CM 4. ISOPROTERENOL: (Isuprel) (tt)Cc bit dc khc:IsoprenalinNovodrinAleudrinDng trnh by:vin 10-20mgng 1ml=0,5mg (Isoprenalin)Dng phun

Dn xut ca Isoproterenol (chn lc 2) Metaproterenol (Alupent). Terbutalin (Brethine, Bricanyl). Albuterol (Salbutamol): Ventolin. Pirbuterol (Maxair). Bitolterol mesylat (Tornalate).CC THUC KCH THCH TRC TIP H GIAO CM 4. ISOPROTERENOL: (Isuprel) (tt)

C ch v tc dng dc l:-Kch thch chn lc 1.-Gy co mch, tng huyt p.

Ch nh:-Chng xung huyt trn mi.-Gin ng t.Cc dn xut khc:Naphazolin (Privine).Xylometazolin (Otrivin).CC THUC KCH THCH TRC TIP H GIAO CM 5. PHENYLEPHEDRIN:

C ch : Kch thch chn lc trung ng gy gim tit Norepinephrin gim nhp tim, gim trng lc giao cm h huyt p.Dc ng hc:-Hp thu tt qua ng ung.-o thi qua thn.-T1/2 = 6 - 24 gi.Ch nh: Cao huyt p.Tc dng ph: Kh ming, an thn.Cc thuc tng t:- Guanfacin (Tenex).- Guanebenz (Mytensin).CC THUC KCH THCH TRC TIP H GIAO CM 6. CLONIDIN (Catapressan)

TM TTTNH CHN LC TNG I CA CHT CH VN TRN RcEPINEPHRIN: 1= 2, 1= 2NOREPINEPHRIN: 1= 2, 1>>> 2DOPAMIN: D1>> >> ISOPROTERENOL: 1= 2 >>>> PHENYLEPHEDRIN: 1> 2>>>> CLONIDIN: 2> 1>>>>

CC THUC KCH THCH GIN TIP H GIAO CM1. EPHEDRINC ch: Kch thch tn cng thn kinh giao cm, gy tng tit Epinephrin v Norepinephrin.

Tc dng dc l:Kch thch thn kinh trung ng, gy khoan khoi, bt mt mi, gim bun ng.

Tc dng hip ng vi cc thuc kch thch TKT, i khng vi thuc m v thuc ng (Vd: Cortidasmyl gm c Phenobarbital +Ephedrin+ Prednison)

Kch thch trung tm h hp v vn mch hnh no, gy tng thng kh phi.

Kch thch receptor 1 tim, gy tng chc nng tun hon.

Dc ng hc:Khng b men MAO v men COMT ph hy nn b chuyn ha chm.Thi tr chm.

Ch nh:Xung huyt mi.D ng tai mi hng.

Tc dng ph:Tng huyt p.Lon nhp tim.Kh ng.CC THUC KCH THCH GIN TIP H GIAO CM1. EPHEDRIN (tt)

C ch: ging Ephedrin.Tc dng dc l:Gy hng phn, gim mt mi, tng thnh tch thi u (> Ephedrin)Tc dng cng giao cm yu hn Ephedrin.Gim n ngon do gim thu nhn thc n (tc dng vng di i) gim bo ph.

Tc dng ph:Bun nn, chong vng, nh trng ngc.Suy nhc tinh thn.CC THUC KCH THCH GIN TIP H GIAO CM 2. AMPHETAMIN

Mt s dn xut ca Amphetamin (Metamphetamin, dimethoxyamphetamin)kch thch thn kinh trung ng rt mnh, gy lon thn u xp vo cht ma ty.CC THUC KCH THCH GIN TIP H GIAO CM 2. AMPHETAMIN

THUC HOT HO H CHOLINERGIC (CNG I GIAO CM)Bs. L Kim Khnh

MC TIU HC TP1- Phn nhm thuc kch thch h Cholinergic

2- Trnh by c ch, tc dng dc l

3- ng dng lm sng

THUC HOT HO H CHOLINERGIC (CNG I GIAO CM)THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP

THUC KCH THCH RC CHOLINERGIC BNG TC NG GIN TIP

1. Cholin ester:Acetyl Cholin Methacholine (Provocholin)Bethanechol (Urecholin) Carbachol (Isopto, Carbachol) 2. Cc cht cng i giao cm khcPilocarpine: RcM.Muscarine: RcMArecoline: RcN THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :C ch tc dng :Tc ng trn Rc Muscarinic, Rc Nicotinic ca t bo hiu ng bin i chc nng ca c quan .

TIM MCHNhp

Dn truyn A-V

Sc co bp c tim

Mch

C TRN V TUYN BI TiTTiu ha

H hp

Tit niu

Mt

I GIAO CMGIAO CM

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP : c tnh dc l:H thng tim mch : gy 4 hiu ng : - gin mch- nhp tim (chronotropic (-)- tc dn truyn nt xoang, nt nh tht (dronotropic (-), (c tht < nh)- sc co bp c tim (inotropic (-))ng tiu ha :- vn ng (km nn i . . .)- Kch thch s bi tit- trng lc v bin co tht

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :ng niu :- nhu ng ca ng niu- Co tht c detrusor (c bi niu), gin c vng v trigone (vng tam gic)- sc cha bng quang, tiu khng t chMt :- co tht c vng mng mt gy co ng t- gim nhn p (co c vng v c mi lm m rng ng Schlemm gip thu dch thot ra d dng).Cc tc ng khc : - tit tt c cc tuyn : m hi, nc mt, tiu ha, kh ph qunCo tht kh ph qun:

TH TH NICOTINICCHchp cm th quan/xoang cnh, quai MC

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :Nicotinic : -Th th Nicotinic/tm ng TK c Co c.-Kch thch hch giao cm, hch i giao cm, tu thng thn-Kch thch ha cm th quan ng mch cnh v thn ng mch ch.-Kch thch h giao cm trung ng

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :Ch nh:Bethanechol: iu tr trng bng, y hi v b tiu sau m.

Carbachol: + co ng t/phu thut c thu tinh th.

THUC KCH THCH RC CHOLINERGIC BNG TC NG TRC TIP :Ch nh:(Cc cht cng i giao cm khc)-Glaucom (bnh tng nhn p)-Pilocarpine: thuc gim p lc trong mt cho Glaucome gc ng/m to dng i ra d dng cho th dch v gim tit dch

Da vo cu trc ha hc chia lm 3 nhm :Nhm 1: alcohol mang nhm amonium bc 4 EDROPHONIUM

Nhm 2: acid carbamic ca alcohol mang nhm amonium bc 4 hoc bc 3 : CARBAMATES V NEOSTIGMINE, PHYSOSTIGMIN

Nhm 3: nhng dn xut hu c ca acid phosphoric:+ phosphate hu c+ IsofluphateTHUC KCH THCH RC CHOLINERGIC GIN TIP

C ch tc dng :Gn kt vi men AChE lm tch t A.Ch ni sinh cng i giao cm ngoi bin v trung ng

i su hn v cu trc phn t, gn kt AChE thay i theo 3 nhm, v ngi ta chia ra :- Gn kt c hi phc : nhm 1 v 2- Gn kt khng hi phc : nhm 3

Ch : * nhm 1 : s gn kt tn ti 2 - 10 * nhm 2 : s gn kt tn ti 30 - 6hTHUC KCH THCH RC CHOLINERGIC GIN TIP

c tnh :biu hin du hiu Muscarinic v NicotinicTHUC KCH THCH RC CHOLINERGIC GIN TIP

THUC KCH THCH RC CHOLINERGIC GIN TIPBiu hin Muscarinic (ging ng c nm Amanita Muscaria) ph thuc vo ng hp thu. H hp : nng ngc, kh th, rale m Tiu ha : bun nn , i, au bng tiu chy Da : m hi , run c cc b Mt : co ng t, au mt, xung huyt kt mc Nng : tng tit nc bt, tot m hi, chy nc mt, chm nhp tim, tt HA, tiu tiu khng t ch.

Biu hin Nicotinic (t nh n nng) Mt mi, yu c Run c lan ta Lit c (c t.ng trung ng), nng nht l lit c h hpCNS : bn chn ni lp mt phn x th cheynes - stoke , co git, hn m v lit c h hpRi lon huyt ng hc : tc ng trung tm vn mch gy tt huyt pCui cng bnh nhn t vong trong tnh trng suy h hp.THUC KCH THCH RC CHOLINERGIC GIN TIP

Ch phm :- Physostigmine (Eserine)- Neostigmin (Prostigmin).-Pyridostigmin (Mestinon)-Edrophonium (Tensilon)ng dng iu tr :Lit rut c nng, mt trng lc bng quang (chn Neostigmine)Glaucoma (chn Physostigmine) Nhc c (Neostigmin, Pyridostigmin, Edrophonium). Edrophonium c dng lm test chn on bnh nhc c.THUC KCH THCH RC CHOLINERGIC GIN TIP

1- Tc ng no sau y khng phi do hot ho h i giao cm (ph giao cm):a. Tng nhp timb. Tng trng lc c trn ng tiu hoc. Co tht c vn (c xng)d. Co tht c detrusor (c bi niu)e. S bi tit dch d dy

2-Thuc cng i giao cm dng trong trng bng v gim nhu ng rut sau phu thut:a. Acetylcholine (ACh)b. Methacholinec. Carbachold. Bethanechole. Pilocarpine

3- Neostigmine i khng s gin c do:a. Pancuroniumb. Succinylcholinec. Diazepamd. Nicotine

4- AntiChE dng chn an nhc c:a. Edrophonium chlorideb. Ambenonium chloridec. Phospho hu cd. Physostigmine salicylatee. Pyridostigmine bromide

ANTIMUSCARINIC

(THUC I KHNG TI TH TH MUSCARINIC)BS. L KIM KHNH

NGUN GC:T NHINTNG HP & BN TNG HPATROPINSCOPOLAMINMETHANTHELINHOMATROPINTC NG CHUYN BIT HN

C CH TC DNGACETYL CHOLINRc MUSCARINICRc NICOTINICRc M2Rc M3TIMC TRNTUYN

C CH TC DNGACETYL CHOLINRc MUSCARINICTIMC TRNTUYN- NT DN TRUYN A-V SC CO BP C TIM- CO THT C TRN- TIT CC TUYN

C CH TC DNGi khng cnh tranh vi A.Ch/Rc Muscarinic mt tc dng ca AChANTIMUSCARINIC

C CH TC DNGACETYL CHOLINRc MUSCARINICTIMC TRNTUYN- Nhp tim DN TRUYN A-V SC CO BP C TIM- CO THT C TRN- TIT CC TUYNANTIMUSCARINIC(-)

TC DNG CU ATROPIN1.H thn kinh trung ng (CNS):-tc dng rt t.-Liu cao kch ng o gic, hn m.

TC DNG CU ATROPIN2. Mt: (td >72h)

-ng t: gin

-Lit c th mi mt kh nng iu tit khng th tp trung vng gn

-Gim tit nc mt kh mt.

- nhn p (do c ch thot th dch)

TC DNG CU ATROPIN3. Tim mchTim: - nhp tim, t nh hng HA v CO

Tun hon: -Liu nh: khng nh hng-Liu ln: gin mch di da da

TC DNG CU ATROPIN4. ng tiu ha:-Gin c trn ng rut, co tht, nhu ng.- tit dch v, tit nc bt (kh ming, nut kh...)

5. ng h hp -Gin kh ph qun- tit dch ng h hp

TC DNG CU ATROPIN6. C trn khc :-ng niu: gin niu qun v i b thn, co c vng bng quang.-ng mt: gin nh.-T cung: tc dng khng ng k.

7. Tuyn m hi : -Lm cho da nng v kh.-Tng nhit ( c bit tr ), c s gim tit m hi cng ng gp lm tng nhit .

DC NG HC: (ATROPIN)Trong phn t c nhm Amonium bc III c th tc dng ln h TKTW.

Hp thu d dng qua ng ung v tim.

Chuyn ha gan, T1/2 =2 h, tg tc ng: 4-8h, ngoi tr mt: > 72h.

Bi tit thn di dng khng i.

CNG DNG ATROPINMt: dng khm mt, soi y mt

Gim au do co tht c trn: d dy, rut, ng mt, ng niu.

Hen ph qun (dn xut: Ipratronium- Atrovert*)

Block A-V v chm nhp do cng p.

Tin m.

Run git trong bnh Parkinson

TC DNG CU SCOPOLAMIN

Lit i giao cm: (#Atropin) tc ng mnh ln mng mt, s bi tit dch.

c ch h TKTW > Atropin + an thn

CNG DNG SCOPOLAMINBnh Parkinson.

Tin m.

Chng say tu xe.

Nh mt soi y mt.

CC CHT TNG HP V BN TNG HPHOMATROPINT/D NHANH HN ATROPIN-KHM Y MT (mt tr v bt 24h)- NHU NG TIU HOCyclopentolatTropicamidT/D CHUYN BITNG T

CC CHT TNG HP V BN TNG HPT/D GIM TIT ACID DCH VMethanthelinPropanthelinPirenzepinTelenzepin

CC CHT TNG HP V BN TNG HPT/D CHNG CO THT C TRN-Dicyclomin (Bentyl*)-Oxybutylin (Ditropan*)

CC CHT TNG HP V BN TNG HPBenztropin Mesylat (Congentyl*)Trihexyphenidyl (Artane*) BiperidenT/D CHUYN TR PARKINSON

NG CGin ng t, lit th mi ( liu gim tit dch d dy hoc chng co tht).

C th kch ng, cung snX tr: c ch bng Anti AChE, chng co git bng Diazepam

CHNG CH NHGlaucome (gc ng)

Ph i tin lit tuyn.

1-Mt bn nam n phng cp cu sau khi ung cht g khng r: tng thn nhit, da v nng, ng t gin, nhp tim nhanh, c th do:a. Propranololb. Prazosinc. Guanethidined. Atropine

2-Tc dng no sau y khng b chn bi Atropine and Scopolamine?a. Chm nhpb. Tng tit nc btc. Co tht kh ph qund. Co tht c vne. Co ng t

THUC TC NG TRN TH TH NICOTINICGm c:1. Thuc tc ng ti th th Nicotinic hch t ng (Rc NN): Thuc lit hch 2. Thuc tc ng ti th th Nicotinic tm ng thn kinh c (Rc NM):Thuc gin c vn

THUC LIT HCHBs. L Kim Khnh

C CH TC DNGi khng cnh tranh vi ACh ti th th Nicotinic lm mt hiu ng ca Acetyl Cholin trn c 2 hch giao cm v i giao cm.Ty vo s chim u th ca h TKTV tng m, thuc s c t/d phong ta tc dng u th .

TC DNG CA THUC LIT HCH TRN TNG M

MChim u thHiu qu cu thuc1. ng mch- Gin mch, lng mu ngoi vi, HA2. Tnh mch- Gin mch mu ngoi bin gin mu tnh mch tr v, gim CO 3. TimpNhanh nhp tim4. Mng mt C mipGin ng t, lit c th mi5. ng tiu hapGim trng lc nhu ng to bn6. ng niup ng nc tiu7. Tit nc btpKh ming8. Tit m hiGim tit m hi

CH NHTng HAKim sot HA bn phu thut phnh mch cp: do thuc va c t/d h p, va c ch px giao cm.h HA trong phu thut thn kinh hn ch chy mu.

CH PHM

Mecamylamin (Inversine): dng vin ung.Trimethaphan (Arfonad): dng tim, truyn tnh mch.

THUC GIN C VNBs. L Kim Khnh

C CH TC DNGTranh chp vi Acetyl Cholin ti th th Nicotinic tm ng thn kinh c lit c.

Tc dng dc lS lit c khng ng u, theo th t:Lit c mi mt.Lit c t chi.Lit c thn mnh.Lit c h hp, cui cng l c honh.Khi hi phc s theo th t ngc li

ng dngGin c trong gy m.Mm c trong phu thut chnh hnh v thc hin cc th thut nh: ni soi, gp d vt

THUCT nhin:D- tubocurarin.Tng hp:GallaminPancuronium.Vecuronium.Atracurium.Mivacurium.

THUC GIN C

Bs. L Kim Khnh

MC TIU HC TPTrnh by cc phn sau y v thuc gin c vn:1- Phn lai v c ch tc ng

2- c im lit c/ mi nhm

3- i khng v ng vn

4- ng dng lm sng

I CNG

I CNG

I CNGThuc GIN C: lm gin anhoc gim s lan truyn xung ng /khe khp TK-c hoc khe khp TK (hch t ng)

Cc thuc GIN C tng tc trn cng 1 lai Receptor (Rc Nicotinic)

PHN LOIACETYL CHOLINRc MUSCARINICRc NICOTINICRc M2Rc M3TIMC TRNTUYNRc NMT bo c xng

PHN LOIACETYL CHOLINRc NICOTINIC/ tb c xngCO C

PHN LOIDa vo c tnh: C hoc KHNG tnh kh cc ti phin tn vn ng

KHNG KH CC (nhm cnh tranh- competitive agents): CURARE v cc cht tng hp.

KH CC (depolarizing agents):SUCCINYLCHOLIN

PHN LOIACETYL CHOLINRc NICOTINIC/MNG TBGIN CCNH TRANHKH CC-CURARE-HP CHT TNG HP-SUCCINYLCHOLIN-DECAMETHONIUMX

LCH SCURARE u tin c th dn Chu M sd nh lai cht c tm vo tn sn th (th cht l do lit c vn ng).

1805: tm ra ngun gc thc vt.

1856: Claud Bernard chng minh t/d duy nht ca Curare ti tm ng tk- c.

1932: dng cho bn un vn.

1942: TN u tin lm thuc gin c.

C CH TC NGNHM CNH TRANH:i khng cnh tranh vi Ach ti RcN/ tm ng thn kinh- c.

NHM KH CC:Ht kh cc mng ko di s kch thch lp i lp li co c cc b tm thi v sau c ch dn truyn TK-c

C IM DC L: LIT CTubo- Curarine (CURARE): th t: c mi mt c t chi c c c thn mnh c lin sn cui cng: c hanh.

Khi phc hi theo th t ngc li.

C IM DC L: LIT CNhm kh cc:co c cc b tm thi (qs: c ngc v bng)

lit c: c, cnh tay, chn (cng lc) trong khi c: mt, nhai, li, hu, hng ch yu nh.

C IM DC L: Tc ng ti hchNhm cnh tranh: gy c ch ti hch v ty thng thn HA, nhp tim

Nhm kh cc: tc ng ny km hn.

C IM DC L: Gii phng HistaminBiu hin: co tht KPQ, h HA, tng tit nc bt v dch KPQ.

Tim tnh mch nhanh tt HA nhanh v nng.Tc ng ny r nht i vi D-Tubocurarinet gp vi cc dn xut ca aminosteroid.

C IM DC L: i khng v ng vni khng vi Tubo- Curarine l AntiCholinesterase: NEOSTIGMIN, PHYSOSTIGMIN.

*C th lm trm trng thm cc p.ng ph: co tht KPQ, h HA nn thng ph hp thm Atropin.*Antihistamin: khuyn dng trc d phng.

ng vn: vi nhm kh cc l AntiCholinesterase

C TNH-Ngng th.-Suy h hp.-Lit h hp (do qu liu).

DC NG HCTubo-Curarine: l nhng Amin bc 4 hp thu km qua ng tiu ha bi tit qua nc tiu.

SUCCINYLCHOLIN: b thy phn nhanh chng bi Butyryl- Cholinesterase/gan v huyt tng.

NG DNG LM SNGPhi hp vi thuc m lm gin c phu thut (c bit l thnh bng).

Mm c trong ni soi thc qun, kh qun.

PHN NHM

1- CNH TRANH:*TUBOCURINE.*ATRACURIUM PANCURONIUM (Pavulon) ROCURONIUM (Esmeron) VECURONIUM (Norcuron)2- KH CC:SUCCINYLCHOLIN DECAMETHONIUM

SO SNH VI SUXAMETHONIUMSUXAMETHONIUM gy 1 s t/d ph:Rung cau c sau m.Tng nhn p.Tng p lc ni s.Tng Kali mu.Chm phc hi bn thiu PseudoCholinesterase.St cao c tnh.U IM: khi pht nhanh, thi gian tc dng ngn.

CC YU CU 1 THUC GIN C L TNG(Booj v Crul, 1983)C ch t/ khng kh ccKhi pht nhanh.Thi gian tc dng ngn.Hot lc caoNhanh phc hi.Khng tch ly.Khng c t/d ph tim mch.Khng phng thch Histamin.Ho gii c bng c ch men Cholinesterase.C cht chuyn ha bt hot.

*