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

500 mg x 20v

Khng b nh hng bi thc n, ung chung esomeprazol bui ti

500 mg x 20v

Thc n lm gim hp thu. Trc ba n 1h hay sau n 2h

Sng 1v Ti 1v
2. Getlox (Levofloxacin)
Sng 1v Ti 1v
3. Antibio

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

1 g x 20 gi

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

Sng 1 gi Ti 1 gi
4. Magne B6

20v

Ung cch levofloxacin v lm gim hp thu KS quinolol

40 mg x 15v

Thc n lm gim hp thu esomeprazol

Sng 1v Ti 1v
5. Nexium (Esomeprazol)
Ti ung 1v
Thuc
Amoxicilin

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

Tc dng ch nh

C ch tc ng
ch

sinh

tng

Chng ch nh

Nhim khun h hp, tit

hp

niu, ng mt, da, c, vim

mucopeptid ca thnh t

hng, vim amidan Lot dd-

bo vi khun, ph gram

tt, H. pylori

(+) v 1 t gram (-)

ADR

Tin s d ng bt

pht ban, qu mn,

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

k peni no

bun nn, tiu chy

1g/ngy chia 2 ln + clari + PPI

=> 10-14 ngy (triple therapy)
1g/ngy chia 3 ln + PPI

E. coli, Sal, Shi

Getlox

Vim da, vim ng h hp,

c ch enzym tho xon

Levofloxacin

vim ng tiu, vim mng

Lu

=> phc 2 thuc

Qu mn cm

Tn thng gn, dy

iu tr tiu chy du lch: PO 500

topoisomerase IV v DNA

chng, gn Achilles

mg/ngy/ln trong 1-3 ngy

no, tiu chy DLch

gyrase => ngn cn s

=> ngng s dng nu

Ung cch xa ba n (trc n 1

Dng trong phc cu vn

ti bn hay sao chp AND

au, sng, vim, hoc

gi/sau n 2 gi) v thc n lm

2 KS + 1 PPI

ca vi khun

tn thng gn xy ra

gim hp thu.

Nhy cm nh sng
Antibio

Cn bng h VK rut

Antibio gn vo thnh rut, pht trin v chng li vi khun gy bnh

Ngi ln: ung 2 gi x BID

L. acidophillus

bng c ch:

Tng tc vi tetracyclin lm ngn

NSX: Organon

- thay i pH ng rut;

hp thu tetracyclin.

- tit cc cht c tnh khng khun

Ch cch dng trong trng hp

- tc ng khng enterotoxine

ny

- kch thch h min nhim

(1)

Thuc

Tc dng ch nh

C ch tc ng

Chng ch nh

ADR

Magne-B6

Thiu Mg nng

Mg gim tnh kch thch

Suy thn nng

Mg lactat

Ri lon chc nng ca nhng

ca neurone v s dn

Clr <30 ml/pht.

470 mg

cn lo u i km vi tng

truyn neurone - c

trc khi b calcium.

Pyridoxine

thng kh khi cha c iu tr

Vit B6 l coenzyme, tham

Ngi ln:

chlorhydrat

c hiu => tng co git

gia vo nhiu qu trnh

Thiu Mg nng : 6 vin/24 gi.

chuyn ha

Tng co git: 4 vin/24 gi

5 mg

Tiu chy, au bng

Lu
Khi c thiu calcium i km th
trong a s trng hp phi b Mg

Nexium

Tro ngc dd - thc qun

c ch tit acid do c ch

Qu mn cm

Dng lu: vim teo dd

Ung t nht 1 gi trc ba n

Esomeprazol

Lot dd - t trng

ko hi phc bm proton

- Esomepraxol

Cc PPI c lin quan vi

(antacid c th c s dng ng

Esomeprazole n v kha

- Benzimidazol

tng nguy c nhim

thi khi cn gim au), ko nhai

bm proton tt hn thuc

trng h hp

hoc nghin.

R-omeprazole, do kim

Nhc u, chng mt,

Esomeprazol lm mt Mg

sot pH d dy tt hn.

tiu chy, bun nn,

trong huyt thanh nn phi

Vin nn

(2)

Hi chng Crohn

Vin DR

y hi, to bn

b sung Mg l hp l

(1) Trong trng hp tiu chy nh c th:

Ung nhiu nc v cc cht lng khc thay th cht dch b mt do tiu chy.

n mm, nht v trnh cc loi thc phm nhiu gia v hay thc n c du m c th lm nng thm tiu chy.

n nhiu ba n nh thay v mt vi ba n ln hn

Nu thc hin cc bp trn m din tin tiu chy khng bt th mi dng n cc ch phm sinh hc nh antibio, probiotic
Nu bnh tiu chy nng trm trng => 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)
Ngy ung 2 ln, mi ln 1 vin, trc n

28 vin

Dng liu 20 mg/ngy cho vim d dy H.p (-)

Ung 30 pht trc ba n

2. Almagate 1g/5ml (Yumangel)

Ngy ung 3 ln, mi ln 1 gi, sau n 2 gi

42 gi

Ung xa ba n hay khi c triu chng, nn i thnh phosphat nhm

trnh mt phosphat (dng phosphalugen)

3. Mosaprid 5 mg (Zurma)
Ngy ung 3 ln, mi ln 1 vin, trc n

42 vin

Liu 15 mg/ngy => ng liu, ung trc n

4. Enzystal
Ngy ung 3 ln, mi ln 1 vin, trc n

42 vin

Ung nguyn vin, khng nhai, khng b

Ung trong hay sau ba n

Tn thuc

Tc dng ch nh

ADR

Chng ch nh

Rabsun 20mg

Lu

Thuc c ch bm proton

Che lp du hiu ung th d dy

Ngi mn cm vi bt

Category B

Rabeprazole natri

- iu tr ngn hn bnh tro

Tng nguy c gy xng hng,

c thnh phn no ca

GERD 20mg/ngy

Vin nn bao tan

ngc d dy (GERD) (c lot

c tay v ct sng (sd > 1 nm)

thuc

Lot d dy:

trong rut

d dy hay khng)

nng Mg mu c th dn

PN cho con b

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

Nhm: PPI

- iu tr ngn hn lot dd

n co git, ng kinh, lon nhp.

Tr < 18 tui

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

- iu tr di hn bnh l tng

Tng nguy c nhim trng HH

Ung trc n 30 v ko b, nhai m

tit dch tiu ha

Tiu chy, bun nn, suy nhc,

phi nut nguyn vin

cng c, nhc u.
Yumangel

iu tr triu chng ca vim

Mt Phosphat gy xp xng, c

BN Suy gim nng

Trnh dng chung vi cc loi thuc

Almagate 1g/5ml

lot d dy t trng, bnh tro

thn, to bn, tng s pht trin

phosphate trong mu,

khac do lm gim hp thu, dng lu

Al2Mg6(OH)14(CO3)20

ngc d dy v d acid

ca cc loi vk c hi (HP, BKoch)

Mn cm tp thuc

ngy => rebound

ngm 4H2O

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

Nhm: antacid

hoc khi c triu chng

Zurma 5mg

Tng tc lm rng d dy.

Ph, tiu chy, au bng, bun

Ngi qu mn vi bt

15mg/ngy

Mosaprid citrat

Tro ngc d dy thc qun

nn, kh ming, nhc u , chong

c thnh phn no ca

C ch: Chn lc trn 5HT4

vng.

thuc.

tit acetylcholin

Enzystal

Ch nh trong trng hp kh

au ming, bun nn, co tht ph

Qu

mn

vi

Pancreatin 192 mg

tiu, n ko iu

qun, au hu mn, pht ban, co

phn

ca

Cao mt b 25 mg

V l enzym h tr tiu ha

cng c bng, tiu chy

mt, vng da.

Hemicellulase 50 mg

=> dng bao tan tong rut

thnh

thuc,

tt

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)

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

20 vin

ng phc 3 thuc
Sng 1 vin Chiu 1 vin (trc n cho tin)

2. Holdamox 500 (Amoxicillin 500 mg)

Ngy ung 2 ln, mi ln 2 vin

40 vin

Sng 1 vin Chiu 1 vin (trc n cho tin)

3. Patoprazol Stada 40 mg (Pantoprazol)

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

20 vin

Ung sau ba n do dng thuc tng tc tho rng dd

4. Dogmatil Cap. 50 mg (Sulpirid 50 mg)

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

20 vin

Nn thay bng Mg-B6.

Sng 1 Chiu 1

5. Domperidon (Domperidon 10 mg)

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

20 vin

Phi thay domperidol = metoclopramid

6. Varogel
Ngy ung 2 ln, mi ln 1 gi, sau n 20 pht

20 gi

Dng xa cc thuc khc Nn dng sau n t nht 30 pht

Tn thuc

Tc dng ch nh

Tc dng ph

Chng ch nh

Lu

Captomed 500mg

Vim tai gia, vim hng,

Vim rut kt mng gi, bun nn,

D ng vi bt c thnh

Category C

Clarithromycin

vim amidan, vim da, vim

chng mt, nhc u, tiu chy

phn no ca thuc

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

lot d dy do HP,
Holdamox 500

Vim tai gia, vim hng,

C th gy vim rut kt mng gi,

D ng vi bt c thnh

Category B

Amoxicillin 500 mg

vim amidan, vim da, vim

gy bun nn, chng mt, nhc

phn no ca thuc

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

lot d dy do HP,

u, tiu chy

Thuc c ch bm proton

Nhc u, tiu chy, hi, mt

D ng vi bt c thnh

Khi ung ko b ko nhai m phi ung

ch nh: tro ngc d dy,

ng, nguy c gy xng hng, c

phn no ca thuc

nguyn vin.

vim lot d dy t trng,

tay v ct sng (sd >1 nm),

Pantoprazol 40 mg

Liu iu tr c th 1g 2g/ngy

iu tr vim lot d dy HP(+):

2+

[Mg ] mu => co git, ng kinh,

40mg/ln x 2 ln/ngy.

lon nhp.

Categoty B

Dogmatil cap 50mg

Lm gia tng trng lc on

- Tng Prolactin mu tm thi, hi

U ty thng thn (do

- St cao l 1 yu t ca hi chng c

Sulpirid 50mg

di c vng thc qun

phc, c th v kinh, tng tit sa,

c nguy c gy tai bin

tnh do thuc lon TK => ngng t

1vin/ln x BID

iu tr ngn hn triu chng

v to nam gii

cao huyt p nng)

- Gy bun ng => lu ngi vn

lo u

- Tng cn, h HA th ng

CC p/hp Levodopa

hnh my mc hoc li tu xe.

Nhm benzamid

- Hi chng ngoi thp, gim mt

- E qua thn => gim liu suy thn

phn khi s dng vi thuc khng

- Trnh ung ru, nc tri cy ln

lit rung anticholinergic

men

Tn thuc

Tc dng ch nh

Tc dng ph

Domperidon

Tr triu chng bun nn v

Chy sa, ri lon kinh nguyt, mt

Nn sau khi m.

Domperidon khng gy qui thai. Tuy

(domperidon 10mg)

nn nng, c bit ngi

kinh, v to hoc au tc v do tng

Chy mu tiu ha

nhin, an ton, trnh dng thuc

Thuc chng nn

bnh ang iu tr bng thuc

prolactin huyt thanh

Tc rut c hc.

cho ngi mang thai.

i khng dopamin

c t bo.

=> c th gp ngi bnh dng

Tr nh di 1 tui.

Khng dng thuc cho PN cho con b.

Tr tr/chng bun nn, nn,

thuc liu cao di ngy

Dng domperidon di

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

ngy hay thng xuyn

30

cm gic chng, nng vng

Chng ch nh

Lu

thng v, kh tiu sau ba

n do t/n chm xung rut
Varogel

Thuc khng acid c tc dng

Mt Phosphat gy xp xng, c

ngi mn cm vi bt

Trnh dng ng thi vi cc thuc

Al(OH)3

lm gim nhanh chng, hiu

thn, tng s pht trin ca cc loi

c thnh phn no ca

khc do lm gim hp thu, dng lu

Al2O3

qu v ko di i vi cc

vk c hi (HP, BKoch)

thuc

ngy lm tng nguy c lot d dy.

Mg(OH)2

triu chng do tng acid d

Thn trng: ngi suy

=> dng cch xa

dy v y hi.

thn. Khng nn dng

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

Tr triu chng ca vim lot

cho tr < 3 thng tui.

xa ba n (30 hoc 2 gi sau n)

d dy t trng

Tr < 1 tui ch dng

hoc khi c triu chng

Tro ngc dd v d acid

khi tht cn thit.

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)
Sng: 01

Tra: 00

Chiu: 01

Tra: 00

Chiu: 01

Tra: 00

Chiu: 00

Tra: 00

Tn thuc

Chiu: 00

trc n

S lng: 30 vin

trc n

S lng: 30 vin

trc n

Ti: 01

4. Legalon 70mg (Silymarin)

Sng: 01

S lng: 45 gi
Ti: 01

3. Dogmatil 50mg (Sulpiride)

Sng: 01

trc n

Ti:01

2. Antibio 75mg (Lactobacillus acidophilus)

Sng: 01

S lng: 45 vin

Ti: 01

Liu thng 2 vin x 2-3 ln/ngy

Ch nh

Tc dng ph

Mabin

- Ri lon chc nng tiu ha.

To bn, tiu chy, si bng, nn,

(Trimebutine)

- Hi chng rut kch thch.

bun nn, kh tiu, kht nc.

Chng ch nh
Qu mn

Liu dng- cch dng

- Ngi ln: 100mg-200mg x TID
*Trc ba n.

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

Antibio

(Lactobacillus
acidophilus)

Phng nga v iu tr cc ri lon

Thuc c th ngn cn s hp thu

Qu mn vi thnh

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

tiu ha.

tetracycline.

phn thuc

- Tiu chy: 4-8 gi/ngy.

Cung cp cht dinh dng hu dng

- To bn: 6 gi/ngy

cho hot ng tiu ha.

- RLTH do KS:
+ D phng: 2 gi/ ngy.
+ iu tr: 4-8 gi/ngy.
*Pha vi nc ngui ung.

Dogmatil

Trng thi thn kinh c ch

(Sulpiride)

- Bun ng, ng g, hi chng

- BN bit hay nghi

ngoi thp.

ng b u ty thng

- V to n ng, gim khoi

thn (do nguy c tai

cm, lnh cm, cn, tit sa.

bin cao HA nng).

- Ngi ln: 2-4 vin/ngy

(100-200 mg/ngy).

- H huyt p t th.
Legalon

iu tr cc ri lon chc nng tiu ha

- Tiu chy, au d dy.

- Qua mn vi thnh

(Silymarin)

trong cc bnh v gan.

- D ng.

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
Mabin

Liu dng

iu tr

Ph hp

- Hi chng rut kch thch.

Ph hp

- Triu chng c hi chng rut kch thch.

Ph hp

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

t hn liu c khuyn co

- Triu chng trn tiu ha.

(Trimebutine)
Antibio
(Lactobacillus acidophilus)
Dogmatil
(Sulpiride)
Legalon
(Silymarin)

- 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
1

Tn thuc

VT

S lng

NHN XT LIU DNG CCH DNG

Furosemid 40 mg (MKP)

Vin

10

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

Vin

80

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

Vin

10

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

Gi

20

Ung 30 pht sau khi n

Vin

40

Ung Sng 1 vin, chiu 1 vin

Vin

20

Ung trc n 30 pht

Ung 1 ln x vin
2

Glucosamin sulfat 250 mg (Glucogon)

Ung 2 ln x 2 vin

Methyl prednisolon 16 mg (Vipredni)

Ung 1 ln x 1 vin

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

Ung 1 ln x 1 gi

Piracetam (Dopropy 1200 mg)

Ung 2 ln x 1 vin

Pantoprazol 40 mg (Razopral 40 mg KP)

Ung 1 ln x 1 vin
Tn thuc

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

Tc dng ph

Chng ch nh

Thuc li tiu quai Henle

Mt cn bng in gii BN

Mn cm vi furosemid dn xut

Liu 20 mg/ngy

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

duy gan, suy thn

sulfonamid

=> dng trong Ph nh

iu tr tng huyt p.

H huyt p th ng.

Glucogon

iu tr cc bnh vim khp cp v

au bng, i tiu phn lng,

Qu mn vi cc thnh phn ca

2v/ln, 2 ln/ngy.

Glucosamin sulfat

mn tnh.

bun nn.

thuc.

Ung trc ba n 15

Vipredni

Thuc chng vim, chng d ng .

TDP Corticoid: mt ng, tng

Nhim khun nng tr sc nhim

1v/ngy, ung sau ba n

Methyl prednisolon

Vim khp dng thp.

ngon ming, kh tiu, c

khun, lao mng no.

sng

Furosemid

Ch nh

16mg

Lu

Thc n lm gim hp thu

thy tinh th, glaucom, ph..

Trimafort

au cp tnh hay mn tnh trong vim

Tiu chy, to bn, trng

Tr < 14 tui, BN suy thn nng,

Simethicon loi b hi

Mg(OH)2, Al(OH)3

lot dd t trng

bng, mt phosphat xng

3 thng u thai k

ng tiu ha

Simethicon

nng, kh tiu

Dopropy

Suy gim tr nh km tp trung

Mt mi, bun nn tiu chy,

Piracetam

ngi cao tui.

nhc u mt ng.

Razopral

iu tr trng hp cn gim tit acid:

Nhc u, tiu chy, au

Pantoprazole

- Lot d dy t trng

bng. Dng lu di gy mt

yu t nguy c liu 20-40

- Vim thc qun tro ngc GERD

Magnesi huyt thanh

mg/ngy

Dng cch thuc khc 1-2h

Ngi suy thn, suy gan.

1v/ln x BID
Liu: 2,4 g/ngy => c

Qu mn cm

D phng lot ngi c

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
1

NHN XT V LIU DNG CCH DNG

S lng: 30 vin

Mephenesin 250 mg
Sng:
Tra:
1

Chiu:

Ti:

Meloxicam 7,5 mg
Sng:
Tra:
1

Chiu:

Ti:

Trimetazidine 20 mg
Sng:
Tra:
1

Chiu:

Ti:

Cinnarizin 25 mg
Sng:
Tra:
1
Domperidon 10 mg
Sng:
Tra:
1
B.A.R (BAR)
Sng:
2

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

S lng: 15 vin

Chiu:

Chiu:

Ti:

Ti:

Dng sau ba n

Meloxicam liu n thng thng l 15 mg/ngy.

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

S lng: 30 vin

Ung trc ba n

S lng: 30 vin

Ung sau khi n gim kch ng d dy

S lng: 30 vin

Phi ung thuc 15 - 30 pht trc ba n.

0
S lng: 60 vin

Tra:

Chiu:

Ti:

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

Tn thuc
Hot cht
Mephenesin

Gin c vn tc ng TW

Nn, bun nn, ng g, ban

- C tin s d ng vi mt trong cc

KHNG NN DNG khi ang

VD: Descotyl

iu tr cc cn au do co tht

ngoi da do d ng.

thnh phn ca thuc,

c thai hoc cho con b.

thng gp trong: vo c, au

D ng nng, km h huyt p.

- Ri lon chuyn ha porphyrin

Vim khp dng thp,

Kh tiu, vim nhim ng h

Qu mn, tin s b chng my ay,

Trnh dng thuc trong 3

iu tr triu chng ngn bnh:

hp trn, ph, chong vng, au

ph mch, co tht ph qun, vim mi

thng cui thai k v c kh

- vim xng khp cp tnh mc

u, bun nn, au bng, tiu

trm trng, hoc sc khi kt hp vi

nng ng sm ng ng

trm trng

chy, y hi, pht ban

aspirin hoc cc thuc NSAID khc.

mch ca bo thai.

- vim cng t sng.

Du hiu v triu chng ca cc

Nhy cm vi aspirin, bnh hen suyn,

m lin kt c xng (au lng,

polyp mi.

Tc dng, ch nh

ADR

Chng ch nh

Lu c bit

lng, au tht lng, chn thng

TK v trong phc hi chc nng.
Meloxicam

co tht c, au c xng)

Trimetazidin

Trong tim mch: bnh tim thiu

Ri lon nh ng tiu ha:

Mn cm vi thuc

Ung thuc vi mt t nc

mu cc b (iu tr d phng

bun nn, nn.

Trnh dng cho PNCT, PN cho con b

vo trc ba n.

cc cn au tht ngc di chng

Liu thng thng: mi ln

nhi mu c tim)

ung 1 vin x 2-3 ln/ngy.

iu tr h tr cc triu chng
chng mt v tai.
Trong nhn khoa: ri lon th
gic c ngun gc tun hon.
Cinnarizin

Domperidon

Phng say tu xe.

Thn kinh trung ng: Ng g.

Mn cm vi cinarizin hoc bt c mt

Bnh Mnire: cn chng

Ri lon tin nh: chng mt,

Tiu ha: Ri lon tiu ha.

thnh phn no ca thuc.

mt t pht, tai, cm

tai, bun nn, nn trong bnh

Lon chuyn ha porphyrin.

gic dy tai, ic, c th b

Mnire.

Gy au vng thng v. Ung thuc

nn i. Khng r nguyn

sau ba n c th kch ng d dy

nhn

iu tr triu chng bun nn v

Ri lon ngoi thp v bun ng

Nn sau khi m.

Nu dng domperidon cng

nn nng, c bit ngi bnh

xy ra vi t l rt thp v hay

Chy mu ng tiu ha.

vi cc antacid hoc thuc

ang dng thuc c t bo.

do ri lon tnh thm ca hng

Tc rut c hc.

c ch tit acid th phi:

iu tr triu chng bun nn,

ro mu - no hoc do qu liu.

Tr nh di 1 tui.

- PO domper. trc ba n

nn, cm gic chng v nng

Liu cao di ngy: Chy sa, RL

Dng domperidon thng xuyn hay

- PO antacid sau ba n.

vng thng v, kh tiu sau ba

kinh nguyt, mt kinh, v to hay

di ngy.

n do thc n chm xung rut.

au tc v do tng prolactin

Tn thuc
Hot cht
B.A.R Pharamadic

- Dng cho nhng ngi thiu nng gan,

Bm bm
Actiso
Rau ng

Tc dng, ch nh

ADR

Lu c bit

Khng dng cho bnh nhn mn cm

Rau ng = Bin sc

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

vi bt c thnh phn no ca thuc.

Bit dc khc Boganic

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

Vim tc mt, ng dn mt

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

Cha c bo co

Chng ch nh

Ph n c thai

chc nng gan do dng nhiu bia ru.

- X va ng mch, m trong mu cao.

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...

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
1

Medrol 16 mg
Sng:
1

Tra:

Chiu:

Nexium 40 mg
Sng:
Tra:
1

NHN XT V LIU DNG CCH DNG

Chiu:

Kaleoride 0,6 g
Trong ba n tra: 1

Ti:

S lng: 14 vin

Methyl prednisolol
Sng 2 vin

S lng: 20 vin

Esomeprazol PPI
Ung trc n 30 pht

S lng: 40 vin

Ung trong ba n + nhiu nc

Ngy 2 ln, mi ln 1 vin

Ti:

Trong ba n ti: 1

Tatanol Codein

S lng: 40 vin

Dng thuc cch nhau t nht 4 gi

Ngy 2 ln, mi ln 1 vin

Berodual MDI

S lng: 1 l

2 nht, 3 ln xt hng

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

Tn thuc
Hot cht

Tc dng, ch nh

ADR

Chng ch nh

Tc dng:

Thng gp: Mt ng, thn kinh d b

Nhim khun nng, tr sc nhim khun v

Chng vim, chng d

kch ng, tng ngon ming, kh tiu, rm

lao mng no.

stress, ngng t ngt

ng v c ch min

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

Qu mn vi Methylpredinisolol

c th suy tuyn thng

Medrol 16 mg

dch r rt

glaucoma, chy mu cam.

ang dng vaccin virus sng.

thn cp

Methylprednisolol

Ch nh:

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

Thng tn da do virus, nm hoc lao.

khng

d dy, bun nn, nn, chng bng,

Thn trng

cm hn vi s c ch

c hiu cn n tc

vim lot thc qun, chng mt, teo da,

S dng thn trng nhng ngi bnh

tuyn thng thn khi

dng chng vim v

thm tm, tng sc t m, c ch trc

long xng, ngi mi ni thng mch

iu tr thuc bi.

gim

tuyn yn - thng thn, chm ln, khng

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

dung np glucose, gim kali huyt, nhim

trng, i tho ng, tng huyt p, suy

di i tuyn yn

Liu

php

min

dch

ca

glucocorticoid

Lu c bit
Dng tg di hay c

Tr em c th nhy

Nu c ch trc vg

Trong iu tr K

kim, v kinh, gi natri v nc, tng

tim v tr ang ln,

tuyn thng thn gim

Trong iu tr thn

glucose huyt, vim ty, Yu c, long

Ngi cao tui: liu thp nht + tg ngn

liu glucocorticoid t t,

xng, gy xng.

nht c th.

khng ngng t ngt.

h nguyn pht

Tn thuc
Nexium 40 mg

Tc dng, ch nh
Phng nga lot d

Bun nn, nn

Esomeprazole

dy, t trng do dng

Tiu chy, to bn, y hi

glucocorticoid/

NSAID

BN c nguy c

ADR

Chng ch nh
Qu mn vi thuc.

Lu c bit
D phng ti pht lot
d dy, t trng 20-40

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

mg/ngy.

Kaleoride 0,6 g

iu tr gim K+ huyt

Khi dng lu di kali clorid, c th xy ra

Tng kali mu => do tng thm kali c

Nhp tim khng u l

Kali clorid

ngi iu tr bng

tng kali mu (phi ngng ngay)

th gy ngng tim.

du hiu lm sng sm

C th dng n

glucocorticoid ko di

Tiu chy, bun nn, au d dy, kh

Thc qun b chn p, d dy chm tiu,

nht ca tng kali mu

60 mmol (1 mmol

chu, hoc trng bng nh, nn.

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

v c pht hin d

=> 75 mg)

Th nng hoc kh th

clorid qua d dy - rut, nng kali cao

dng bng in tm

Tiu chy, bun nn, au bng thng xy

ti ch c th gy kch ng d dy rut

ra khi dng thuc ung, phi ung cng

nng hn

thc n hoc phi pha long.

Thn trng: ngi cao tui

0,6 g = 8 mmol

Tatanol codein

iu tr ho khan

To bn, bun ng,

- BN mn cm vi tp ca thuc.

Cc ln dng cch nhau

Acetaminophen

Gim au

Chng mt, bun nn, nn.

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

t nht 4h, suy thn

Rt him khi b co tht ph qun, d ng

- Ph n c thai v cho con b.

nng (t nht 8h)

500mg
Codein phosphat

da, c ch h hp.

- Tr em cn nng di 15 kg

30mg
Berobudal MDI

COPD do co tht ph

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

Bnh c tim tc nghn ph i, lon nhp

MDI = Metered-dose

Fenoterol 0,05 mg

qun c phc hi nh:

trng ngc, tng nhp tim, hoa mt hay

nhanh. Qu mn vi cc cht ging atropin

inhaler => ngha l ng

Ipratropium 0,02

hen ph qun, vim

nhc u.

mg

ph

Kh ming, kch ng hng hay phn ng d

qun

mn

tnh

c/khng km theo kh

thuc ht phn liu

ng, ho. B tiu.

ph thng
Dng bo ch c bit ung khi bng rng
MR: Modified release => phng thch bin i

ER: Extended release => phng thch ko di

SR: Sustained release => phng thch duy tr

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 FEV 1
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)

CCH S DNG NG HT BT KH

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

B1. Vn v m np y ng thuc

B2. M np bnh xt

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

B3. Th ra tht ht

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

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

bt thuc khng ra ngoi)

quanh ming bnh xt

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

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

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

cng nhiu cng tt

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

B6. Nn th 10 giy, sau th ra nh

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

Ln 2: ngh 2 pht bc 1 n bc 6

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

B7. Sc hng tht sch ngay sau khi xt thuc

N THUC 16
NAM: 11 tui
Vim h hp trn + st N3
1

Cefaclor (Traclor), 250 mg vin ung

Sng:
Tra:
Chiu:
1
0

Ti:

Tra:

Chiu:

Dextromethorphan 15 mg vin ung

Sng:
Tra:
Chiu:
1
0
Paracetamol 325 mg vin ung
Sng:
Tra:
Chiu:
1
1
Vitamin C 500 mg vin ung
Sng:
Tra:
1
0

Chiu:

Ti:

Tra:

Chiu:

Dng 2 ln 1 ngy KHI BNG I

S lng: 6

Vin bao tan trong rut, 10 mg 20.000 IU

Nut nguyn vin, khng nhai, ung SAU KHI N

S lng: 6

15 mg, 6 - 8 gi/ln, ti a 60 mg/24 gi.

S lng: 9
o
Khi st 38,5 C

Vin bao phim, ung 3 ln / ngy

S lng: 6

Liu ti a cha c TDP l 2g => hp l

Ung nhiu nc sau khi n no trnh kch ng

S lng: 3

Nh hc mi 1-3 git, ngy 1-3 ln hay nhiu hn

Ti:

Ti:

Ti:

Natri clorid (Efticol) 0,9%/10 ml Chai nh mi

Sng:

S lng: 6
0

Serratiopeptidase 10 mg vin ung

Sng:

NHN XT V LIU DNG CCH DNG

Ti:

5 git

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

Nhim

khun

Tc dng ph

hp do VK nhy cm,
b khi tht bi vi

Chng ch nh

Lu c bit

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

Tin s d ng vi KS

do C. difficile => dng metronidazol, vancomycin)

cephalosporin.

Cefaclor hp thu tt sau

khi ung lc i

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

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

thu, nhng tng lng thuc

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

c hp thu vn khng i

nhim do VK (tai gia

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

cp; vim da, phn

m ton thn.

Streptococcus nhm A tan

mm do t cu; vim

C th gy vim i trng mng gi, ng kinh

mu beta, thuc u tay l

TRACLOR

thuc CTQG

Cefaclor 250 mg

Trong

bnh

vim

hng; bng quang...)

Thc n lm chm hp

i vi vim hng cp do

Peni V phng thp tim.

Tn thuc

Tc dng, ch nh

Hot cht

Tc dng ph

Vim sau PT, chn thng,

ph v sng do vim BN tr
SERRATIO-

PEPTIDASE

VK (tai gia cp; vim hng;

10 mg

bng quang...)

Trong bnh vim nhim do

Kh khc m khi vim PQ,

Lu c bit

Phn ng mn cm: ni mn

Qu mn vi Serra.

Nut nguyn vin

=> ngng s dng thuc.

Thn trng:

Khng c nhai

Ri lon tiu ha: tiu chy, bing n,

Bnh nhn ri lon

Ung sau khi n

kh chu d dy, bun nn hoc nn

Chng ch nh

Mu: him gp, khuynh hng xut

huyt (chy mu cam, khc ra mu)

ng mu
Bnh nhn suy gan
hay suy thn nng

Dng ng thi vi thuc chng ng

c th lm tng hiu qu chng ng.

lao phi,
Gim ho

Thng gp: Mt mi, chng mt,

iu tr triu chng ho do

DEXTROMETHORPHAN
15 mg

nhp tim nhanh, bun nn, bng da

Qu mn cm.
ang iu tr cc

Thuc gim ho c tc dng ln

tr/tm ho hnh no.

hng v PQ b kch thch khi

t gp: Ni my ay.

thuc c ch MAO

Khng c tc dng gim au

cm lnh thng thng hoc

Him gp: Ngoi ban, bun ng nh,

v c th gy: st

t tc dng an thn.

khi ht phi cht kch thch

ri lon tiu ha. Hnh vi k quc do

cao, chng mt,

Ho khng c m, mn tnh

ng c, c ch h thn kinh trung

HA, chy mu no,

Ch : Ngn chn ho lm gim c

ng v suy h hp c th xy ra khi

t vong.

ch bo v quan trng ca phi, do

Dng

Dextromethorphan

dng liu qu cao.

suy h hp, c ch TKTW =>

C th gy bun ng, trnh cc thuc

gii c bng Naloxon

c ch thn kinh trung ng v ru.

Thuc gim au h nhit

o

PARACETAMOL Dng khi st cao 38,5 C

325 mg

Pht ban, my ay
Nn, tiu chy

Tr em < hai tui.

vy dng thuc gim ho cha hn l

cch tt nht, c bit l tr nh.

C bnh tim, phi,

Ch : BN phenyl keto niu

thn hay gan, thiu

mu nhiu ln.
Thiu men G6PD

VITAMIN C
500 mg

Ch nh off-label: phng cm,

Thng tng oxalat niu

Si thn

Vitamin C c tnh acid yu nn ung

chng lin vt thng

t gp: tiu chy, bun nn, nng

Thalessimia

sau ba n t kch ng d dy

Dng tng khng

Nght mi, s mi, vim mi

NATRI CLORID
0,9%/10 ml
Efticol

d ng

Thiu G6PD
Dung dch sinh l tng i an ton

Suy tim sung huyt

y kn chai thuc sau khi dng

Suy thn nng

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)
Sng 1

Tra 0

Ung sau n khi bng no => gim kch ng

Chiu 1

Ti 0

28 vin

2. TV-omeprazol 20 mg (Omeprazol)
Sng 1

Tra 0

Chiu 1

Ung 30 pht trc khi n,

Ti 0

28 vin

3. Zennif 250 mg (Glucosamin sulfat)

Sng 1

Tra 0

Chiu 1

Thng ung trc n 15 pht

Ti 0

28 vin

4. Hapacol codein vin (Paracetamol + Codein phosphat)

Sng 1

Tra 0

Chiu 1

Ti 0

Tra 0

=> Ung 30 pht trc khi n lun d tun th

Nu ch dng h st th chuyn qua paracetamol cho tt

20 vin

5. Sinbre 50 mg (Diacerein)
Sng 1

Ung 1 vin 20 mg duy nht vo bui sng

V gim au dng melexicam

2 tun u dng 1 vin vo bui n ti (ung sau n)

Chiu 0

Ti 0

12 vin

2 tun sau tng liu 2 vin/ngy

Ti 0

28 vin

Nut nguyn vin, khng b, khng nhai

6. Daflon 500 mg (Diosmin + Hesperidin)

Sng 1

Tra 0

Chiu 1

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

Meloxicam

cc du hiu v triu

- Lot d dy

Vin nn (NSAID) chn

chng ca vim xng

- Tiu chy, chng mt, ri lon

lc COX2 > 50 ln COX1

khp

tiu ha, ph n, y hi, au

Chng ch nh, thn trng

Lu

Mn cm

7,5 mg 1 n 2 ln/ ngy

u, bun nn, pht ban,

TV omeprazol

Phng nga tc dng ph

Nhc u, bun ng, chng

- Qu mn vi thuc.

Ung trc n 30 pht

Vin bao tan trong rut

ca NSAID ln d dy

mt, bun nn, nn, au bng,

- Thn trng u c tnh (thuc che

Liu 20-40 mg ty TH

to bn, chng bng

lp cc triu chng nn lm

Dng lu mt Mg huyt thanh

mun chn on)

Hapacol codein

Gim au trung ng

Chng mt, bun ng, mt ng,

Suy gan, suy h hp

1-2 vin x 4 ln/ngy

Paracetamol 500 mg

H st

mt phng hng, nga da,

Tr em < 15 tui

Max: 8 ln/ ngy

Bun nn, kh ming, to bn

PNCT

Codein phosphat 8 mg

Zennif 250 mg

Thoi ha xng khp

Ri lon tiu ha, thng nh

Cn

(Glucosamine)

Vim quanh khp

v thong qua

thng xuyn trn bnh nhn

BID duy tr trong 6 tun.

tiu ng.

Thoi ha khp nng: 2 v/ln

Long xng, gy xng

teo khp,
Vim khp mn v cp
Diacerein

theo

di

ng

huyt

Thoi ha khp nh: 2 vin/ln

Chng ch nh:

TID ung trong 3 n 4 thng.

PNCT + cho con b

Liu trong n l 1 vin/ln x

Tr < 18 tui

2/ngy hi t th phi

Tr di hn bnh thoi ha

Tiu chy hoc i phn lng

Qu mn

2 tun u dng 1 vin vo

khp (vim xng khp +

trong

Cn nhc dng Diacerein cho

bui n ti (ung sau n)

cc bnh c lin quan).

dng thuc, nc tiu c th c

nhng bnh nhn c ri lon

2 tun sau tng liu BID

mu vng sm,

ng rut trc , c bit l

sut

nhng

ngy

i trng d b kch thch.

Daflon

Dng trong iu tr cc ri

- Mt mi, chong vng, nhc

Qu mn

Trong suy tnh mch

Diosmin 450 mg

lon tun hon tnh mch

u, ri lon gic ng, chut

Tin s ph Quincke.

=> dng 2 vin/ngy

Hesperidin 50 mg

(chn sng au, bt rt)

rt, tt HA t th.

Suy tim mt b cha iu tr.

Vin nn bao phim

iu tr cc triu chng

- Ri lon d dy thng thng

Suy thn nng, suy gan nng.

ca cn tr cp.

v ri lon thn kinh thc vt

Gim kali mu.

Thn trng dng cho ngi li

(cm gic bt an), khng cn

PNCT + Cho con b

xe & vn hnh my.

ngng iu tr.
-

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 tc dng ko di.

Cc thuc gim au n thun.

Cc thuc lm thay i cc cu trc sn.

Cc thuc iu tr chng co cng c

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

14 vin

Thymomodulin (ung sau n)

Sng 1
2. IMMURONG 80mg
Sng 1

chiu 1

3. MARIMER nh mi
Sng 1

14 vin

Methylprednisolol PO tc dng ton thn => nhiu tc dng ph, nn i thnh dng kh dung tc ng ti ch
=> Dng Fluticasol, Budesonic MDI

Chiu 1

5. REVCLAV 625 mg
Sng 1

NaCl

Chiu 1

4. MENISON 4 mg ung
Sng 1

1 l

14 vin

Acid clavuclanic + Amoxicillin

Chiu 1

Tn thuc

Tc dng/ch nh

ADR

DESLER 5mg

Vim mi d ng

Nhc u, chong, bun

Desloratadin

Desloratadin

nn, kh ming, vim thc

Vin nn bao phim

AntiH1 th h 2

qun, tiu chy, ho

Chng ch nh
Qu mn

Lu c bit
- xp loi C
- qua sa m, nn ngng thuc

liu ngi suy gan, suy thn.

DX decarboethoxy c hot tnh

hoc ngng cho b.

- Liu 5 mg QD

IMMURONG 80 mg

Nhim vi khun hoc virus

RLTH, au bng, i ngoi

Qu mn

Ngi ln: Dng t 1-2 vin/

Thymomodunline.

Bnh d ng, bnh RL t nhim

vi tn xut nh

Vin nang

Phng + iu tr gim bch cu

Tr em: 1 vin/ngy.

tin pht hoc th pht

Ung sau khi n.

ln, 2 ln trong ngy.

MARIMER

Nght mi, s mi

Dung dch sinh l

Suy tim sung huyt

NaCl

Vim mi d ng

=> tng i an ton

Suy thn nng

MENISON 4mg

Vim da, vim mi d ng

Ging corticoid ni chung

Nhim khun nng, tr sc nhim

Ging corticoid ni chung

Methylprednisolon

Max: 60 mg/ngy

khun v lao mng no.

Xp loi C

vin nn

=> Tt nht l chuyn qua

Qu mn vi methylprednisolon.

Liu khi u 4-48 mg/ngy

dng dng tc dng ti ch, kh

Thng tn da do virus, nm, lao

dng Fluticasol, budesonic

ang dng vaccin virus sng.

nh mi (chai xt)

REVCLAV 625 mg

Nhim khun ho hp

Amoxicillin 500 mg

Vim ph qun

Tiu chy, ban nga

Clavuclanic 125 mg

Ch n ngi bnh c tin s

i tng suy gim chc nng

vng da/ri lon chc nng gan do

gan, suy thn, qu mn.

dng amoxicilin v clavulanat hay

PNCT: cat. C

cc penicilin v acid clavulanic gy

Cho con b: khng gy hi cho

tng nguy c mt trong gan.

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

Ngy 2 ln, mi ln 1 vin, sau n

3. Swellmind

28 vin

Ngy 2 ln, mi ln 1 vin, sau n

4. Magne B6

28 vin

Ngy 2 ln, mi ln 1 vin, sau n

5. Tolperison 50 mg (Mydocalm)

28 vin

Ngy 2 ln, mi ln 1 vin, sau n

Tn thuc

Ch nh

CC

ADR

Ch

Acetaminophen

Gim au

Bnh tim, phi, thn, gan

Ban da, st do thuc

Khng t dng gim au:

500mg (PANADOL)

H nhit

Qu mn

Thng tn nim mc

Ngi ln > 10 ngy, Tr em > 5 ngy

Thiu G6PD

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

H tr tr K (3+)

Qu mn thnh phn

Vn ng mt phi hp, rung

300 mg

Tr au dy TK (18+)

Khng nn dung cho PNCT,

git nhn cu, mt mi, chng

cho con b

mt, ph, bun ng, gim tr

(NEURONTIN)

Thn trng khi li xe

nh. Kh tiu, kh ming, to

bn, au bng, tiu chy.ph,
au c, khp, mn nga
SWELLMIND

Suy tun hon no - suy

Ngi ln: mi ngy ung: 1-2 vin

Ginkgo Biloba

gim tr nh.

trong ba n hoc nhiu hn khi c

B1, B3

Tai bin v sau tai bin

hng dn ca thy thuc.

Vinpocetine

mch mu no

Cholin Bitartrate

Ri lon TK th gic v

Quercetin

tun hon thn kinh.

Tn thuc
MAGIE B6

Ch nh
Thiu Mg

2+

huyt nng,

ring bit hay kt hp.

CC
Suy thn nng

ADR

Ch

Tiu chy v au bng.

Ung vi nhiu nc

Clr <30 ml/pht.

iu tr cc ri lon chc
nng trong nhgn4 c lo
u km tng thng kh
Tolperisone 50 mg

Tng trng lc c, co

Nhc c nng

Ban nga, yu c, h huyt

Dng thuc khi no

(MYDOCALM)

tht c, cc co tht km

Qu mn

ap, bun nn, i ma

L dng vin nn bao phim

theo cc bnh vn ng

Liu TID (tng liu 150 450 mg)

iu tr cc bnh nghn
mch, bnh Little + bnh
no khc km theo lon
trng lc c.
=> Gin c tc ng TW
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

4 vin

Betamethason ung trong 2 ngy => c th do kinh nghim BS

2 vin

Trimebutin Ung trc khi n

2 vin

Cetirizin Ung cng hay ngoi ba n

2 vin

Domperidon trc n 15 30 pht

4 vin

Ung lc st trn 37,8

4 vin

Ung lc st trn 37,8 , ung khi no

Ngy ung 2 ln, mi ln gi

2. BETAMETHASONE 0,5 mg
Ngy ung 2 ln, mi ln 1 vin
3. TARABUTIN 100 mg
Ngy ung 2 ln, mi ln vin
4. ZILERTAL 100 mg
Ngy ung 2 ln, mi ln vin
5. FLAMILIUM 10 mg
Ngy ung 2 ln, mi ln vin
6. PARACETAMOL 500 mg
Ngy ung 2 ln, mi ln 1/3 vin
IBUPROFEN 200 mg
Ngy ung 2 ln, mi ln 1/3 vin
Tn thuc

Tc dng/ch nh

OFFISS

Nhim trng HH gia v di cc

Cefpodoxim

chng nhy cm.

100 mg

Trong NT HH trn thay Peni.

BETAMETHASONE

Khng vim corticoid

Bethamethasone

Thng dng liu 0,5 n 5 mg.

Tc dng ph
Bun nn, tiu chy, pht ban

Chng ch nh
D ng cephalosporin v ri lon

Lu c bit
Xp loi B

chuyn ho porphyrin

Xem n corticoid

B tiu ng, tm thn,

- xp loi C

Lot d dy v hnh t trng

- Ging cc corticoid khc

Qu mn

Khng nn dng cho ph

0,5 mg vin nn
TARABUTIN

Hi chng rut kch thch

Ri lon tiu ho, kh ming, bun

Trimebutin

Lot d dy

ng, mt mi, chng mt, nhc u,

n c thai v tr em di

100 mg vin nn

Tro ngc d dy, thc qun

cm gic nng lnh, ni mn

12 tui.
Thn trng PN cho con b

Tn thuc

Tc dng/ch nh

Tc dng ph

ZILERTAL

Vim mi d ng

Hay gp nht l hin tng ng g.

Cetirizine

AHFS quy nh tr <= 5 tui dng

Khc: mt mi, kh ming, vim

AntiH1 th h 1

ceftirizine cho vim mi d ng v

hng, chng mt, nhc u, bun

ni m ay (v cn) th liu ti a

nn.

Chng ch nh
Qu mn

Lu c bit
Chnh liu suy gan, thn
Thn trng vn hnh my

l 5mg/ngy, ung 1 ln trong

ngy.
FLAMILIUM

Triu chng bun nn v nn nng

Chy sa, ri lon kinh nguyt, mt

Nn sau khi m.

Phi gim 30 - 50% liu

Domperidone

Tr em: C 4 n 8 gi, ung mt

kinh, v to hoc au tc v do tng

Chy mu ng tiu ha.

ngi bnh suy thn v cho

10 mg

liu 0,2 0,4 mg/kg (hoc mi

prolactin huyt thanh

Tc rut c hc.

ung thuc lm nhiu ln

ngy t vo trc trng 4 mg/kg,

RL ngoi thp, bun ng (rt thp)

Tr nh < 1 tui.

trong ngy.

chia lm nhiu ln).

Dng domperidon thng xuyn

hoc di ngy.

PARACETAMOL

Gim au

Bnh tim, phi, thn, gan

Ban da, st do thuc

Paracetamol

H nhit

Qu mn

Thng tn nim mc

500 mg

Thiu G6PD

IBUPROFEN

NSAID khng vim

St, mi mt, Chng bng, bun

Mn cm vi ibuprofen.

Ibuprofen

Tr em: Liu ung thng thng

nn, nn, nhc u, hoa mt chng

Lot d dy t trng tin trin.

200 mg

gim au hoc st l 20 - 30 mg/kg

mt, bn chn, Mn nga, ngoi ban

Qu mn vi aspirin hay vi

th trng/ngy, chia lm nhiu liu

Lot d dy t trng

NSAIDs khc.

Xp loi c

Trimebutin (tarabutin) l mt thuc mi trong iu tr ri lon d dy, rut, c tc dng chn lc h thn kinh v d dy, rut, cn thit cho vic iu iu
ho nhu ng d dy, rut, ngoi ra cn kch thch nhu ng y d dy rut rt cn cho vic iu tr cc ri lon khc nh hi chng rut d b kch thch,
khng nh cc thuc khng cholinergic khc l tc ng ln h thn kinh t tr. Tarabutin khng c tc dng ln chc nng rut bnh thng, v cng khng
c tc dng ngoi nh gin ng t v m hi. Tarabutin t ra an ton khi dng iu tr lu di, cng nh an ton cho tr em v ngi gi.
Domperidon l cht khng dopamin, c tnh cht tng t nh metoclopramid hydroclorid. Do thuc hu nh khng c tc dng ln cc th th dopamin
no nn domperidon khng c nh hng ln tm thn v thn kinh. Domperidon kch thch nhu ng ca ng tiu ha, lm tng trng lc c tht tm v v
lm tng bin m rng ca c tht mn v sau ba n, nhng li khng nh hng ln s bi tit ca d dy. Thuc dng iu tr triu chng bun nn
v nn cp, c bun nn v nn do dng levodopa hoc bromocriptin ngi bnh Parkinson.

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.

Betamethasone: OK

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

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

Domperidone: OK

Paracetamol: OK

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
NHN XT LIU DNG CCH DNG
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

Adalat LA 30mg

Thuc chn knh calci (iu

Tng huyt p:

Ph mt c chn, au

Sc do tim.

Sau khi bt u iu tr, nu

(Nifedipine)

tr au tht ngc v tng

Vin LA: 10-40 mg QD

u, mt mi, chng

Hp M ch nng.

thy cn au do thiu mu

huyt p)

ngy ung 2 ln

mt,

bng

NMCT trg vng 1 thng

cc b xut hin hoc cn

D phng au tht ngc,

30-90 mg ngy QD

mt, nh trng ngc,

Cn au cp trong au

au hin c nng ln nhanh

c bit khi c yu t co

20-100 mg QD

tim p nhanh, Bun

tht ngc n nh mn,

chng => ngng thuc.

mch nh trong au tht

nn, a chy hoc to

nht l trong au tht

Phi gim liu khi c tn

ngc kiu Prinzmetal.

bn.

ngc khng n nh.

thng gan, i tho ng.

Tng huyt p.

Ri lon chuyn ha

Nifedipin

Hi chng Raynaud

porphyrin.

chuyn d .

nng

CHNG CH NH

LU KHI S DNG

th

ch

Allopurinol

Lm gim acid uric huyt

Liu ti thiu cho ngi

Bun nn tiu chy,

D ng vi allopurinol,

Ngng thuc nu thy tiu

300mg

Khi dng aspirin 81 mg =>

ln: 100mg, liu trung

ni

ph n c thai v cho

au tiu ra mu, sng mi

tng uric huyt

bnh 200-400mg/ngy,

phosphate kim, tng

con b

ming, kch ng mt, nn

chia

men gan

2-4

ln,

bnh

nng: 600-800mg/24h

mn

tng

ung nhiu nc

TN THUC

TC DNG CH NH

LIU
10mg/ln/ngy

ADR

CHNG CH NH

RLTH(au bng, bun

Bnh gan tin trin,

Atorvastatine

Phng chng bnh v tim

10mg

mch v h lipid huyt (kt

nn,

(atorvastatin

hp thuc chn canxi

chy,

calcium)

phng chng cao huyt p

tiu) nhc u, au c,

v cc vn tim mch)

au khp, vim hng,

Trimetazidin

Bnh tim thiu mu cc b

1 vin x 2 ln/ngy

Stada MR 35mg

(iu tr d phng cc cn

(bui sng v bui ti)

(trimetazidine)

au tht ngc di chng nhi

ung trong ba n

to

bn,

tiu

ph n c thai v cho

hi,

kh

con b

bun nn, nn, nhc

LU KHI S DNG
Category X

Mn cm hoc khng

khng nn dng cho ph n

u, chng mt.

dung np

c thai, cho con b.

Nn, kh tiu, kh chu

Suy thn, suy gan

mu c tim v t qu

thng v, nng,

Cl di 30 ml/pht

nhng ngi bnh c tin

au d dy, lot dd

Qu mn NSAID

s v nhng bnh ny

rut, yu c

mu c tim).
Aspirin 81mg

D phng th pht nhi

81mg/ln/ngy

TV-omeprazol

Thuc c ch bm proton

GERD 20mg/ngy

Nhc u, bun ng,

Ngi mn cm vi bt

Omeprazol lm gim chuyn

20mg

ch nh: tro ngc d dy,

Ung trc n 30 v

chng mt. Bun nn,

c thnh phn no ca

ha nifedipin t nht l 20%

vim lot d dy t trng,

ko b, nhai m phi

nn,

thuc

v c th lm tng tc dng

nut nguyn vin

bn, chng bng. Mt

ca nifedipin

ng, ri lon cm gic,

Tng nguy c gy xng

chng mt, mt mi.

hng, c tay v ct sng (sd

Che lp du hiu ung

qu 1 nm).

au

bng,

to

th d dy
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
NHN XT LIU DNG CCH DNG
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

Suy tim, rung nh v cung

Tiu ha: Chn n, bun

Blc tim hon ton tng cn, blc

Suy thn, thiu nng gip => chnh liu v

0,25mg

ng nh nht l khi c tn

nn, nn.

nh - tht hai;

theo di cht ch.

lon nhp trn tht gy bi hi

Tnh nhy cm vi ADR tng ln ngi c

chng Wolff - Parkinson - White;

gim kali huyt, tng calci huyt v ngi

bnh c tim ph i tc nghn

cao tui.

tht

qu

nhanh,

nhp

nhanh trn tht kch pht.

IMDUR 30mg

iu tr d phng TN, gim

Nhc u, H huyt p,

C tin s nhy cm vi hot cht

Khi ang iu tr bng Imdur, khng c

Isosorbid

cn au tht ngc

chng mt v bun nn

hoc bt c t dc no, sc, h

dng sildenafil (Viagra).

mononitrat

huyt p, bnh c tim ph i tc

nghn v vim mng ngoi tim.

Tanatril 5mg

Tng huyt p.

au u, hoa mt, h huyt

- Qu mn, tin s ph mch

Bt u vi liu thp, theo di tnh trng

Imidapril

THA do nhu m thn.

p qu c i khi bun nn,

- ang iu tr lm gim LDL bng

bnh nhn, c th tng liu dn dn: BN

nn, kh chu d dy v

dextran cellulose sulfate

tng huyt p nng, BN ang thm phn lc

au bng. Tng kali huyt

- Nhng bnh nhn c thm

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

thanh c th xy ra

phn vi mng acrylonitrile

nhng ngi va bt u iu tr li tiu,

methallyl sulfonate sodium

bnh nhn cn phi n king mui tuyt i.

(Khng dng trong vng 24

gi trc khi phu thut)

Thn trong li xe, vn hnh my

Tn thuc

Ch nh

ADR

Chng ch nh

Lu c bit

Plavix 75mg

Gim tai bin ca x va

Ph, tng huyt p,

Qu mn vi thuc, chy mu

Nu tri qua phu thut, ngng clopidogrel 7

Clopidogrel

ng mch, iu tr au tht

Nhc u, chng mt.

bnh l hot ng nh vim lot

ngy

ngc khng n nh

au bng, kh tiu, tiu

d dy hoc xut huyt ni s.

Clopidogrel ko di thi gian chy mu. Suy

chy, bun nn

trc

Xut

huyt

tiu

ha:

gan: S dng thn trng bnh nhn b

bnh gan nng c th chy mu tng.

Diamicron MR

i tho ng khng ph

Ri lon tiu ha, bun nn,

i tho ng typ 1

Trong khi dng gliclazid vn phi theo ch

30mg

thuc insulin typ 2 m ch

au u, pht ban...

Hn m, tin hn m v T

n king. iu s gip gliclazid pht huy

Gliclazide

n king n thun khng

Suy gan nng, suy thn nng.

y tc dng.

kim sot c glucose -

D ng sulfamid

Gliclazid nn dng cho ngi cao tui b i

huyt.

Phi hp vi miconazol vin.

tho ng.

Nhim

khun

nng

hoc

chn

thng nng, phu thut ln.

Glucophage

iu tr bnh i tho ng

Chn n, bun nn, nn,

Ngi bnh c trng thi d ha

Metformin c bi tit ch yu qua thn,

1000mg

khng ph thuc insulin (typ

tiu chy, y thng v,

cp

nguy c tch ly v nhim acid lactic tng ln

Metformin

II)

to bn, nng, ban, my

thng (iu tr bng insulin).

theo mc suy gim chc nng thn.

ay, cm th vi nh sng.

Gim chc nng thn

Metformin khng ph hp iu tr cho

Nhim acid lactic.

Qu mn vi metformin hoc cc

ngi cao tui, thng c suy gim chc

thnh phn khc.

nng thn

Nhim acid chuyn ha

Phi ngng iu tr vi metformin 2 - 3 ngy

...

trc khi chp X quang dng cn quang cha

tnh,

nhim

khun,

chn

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
Digoxin- Metformin

C ch

H qu

Mc

Cch x tr

cnh

tranh

tng tc dng ca metformin, c th dn n

ng k

iu chnh liu lng v kim tra lng ng trong

thi

thuc

qua

mt tnh trng e da tnh mng c gi l

Theo di

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

nhim acid lactic ny c th gy ra suy nhc,

cht ch.

loi thuc khc ang s dng, bao gm vitamin v

ng thn (cation)

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

tho dc. Khng ngng s dng bt c loi thuc

au bng, cm thy chong vng , v ngt xu

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

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

ung?)
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
NHN XT LIU DNG CCH DNG
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

Thuc chn knh calci

Ph mt c chn, au u,

Sc do tim.

Sau khi bt u iu tr, nu thy cn

20mg

iu tr au tht ngc v THA

mt mi, chng mt, nng

Hp M ch nng.

au do thiu mu cc b xut hin

D phng au tht ngc, c bit khi

bng mt, nh trng

NMCT trg vng 1 thng

hoc cn au hin c nng ln nhanh

c yu t co mch nh trong au tht

ngc, tim p nhanh, Bun

Cn au cp trong au tht ngc

chng => ngng thuc.

ngc kiu Prinzmetal.

nn, a chy hoc to bn.

n nh mn, nht l trong au

Phi gim liu khi c tn thng gan,

Tng huyt p.

tht ngc khng n nh.

i tho ng.

Hi chng Raynaud

Ri lon chuyn ha porphyrin.

Nifedipin c th c ch chuyn d .

H huyt p, nhp tim chm,

Qu mn vi thuc chn bta;

Mang thai: Loi C. Tr em: An ton

lnh u chi, Mt ng, mt

xoang nhp tim chm, suy tim, sc

v hiu qu cha c thit lp. Sc

mi, chng mt, trm cm,

tim.

phn v: c th gy t vong. i tho

Bisocar 5mg
Bisoprolol

Cao huyt p

th , bun ng, hay qun,

ng: C th che du cc triu

lo u, au u, ni lu li.

chng ca h ng huyt (v d

Pht ban, ni m ay, rng

nh, nhp tim nhanh, thay i huyt

tc, Kh mt, m mt, tai,

p). Bnh mch mu ngoi bin: C

au hng, Bun nn, nn

th kt ta hoc triu chng ca suy

ma, tiu chy, to bn, au

ng mch trm trng thm. Suy /

bng, kh ming.

gan, suy thn: Gim liu hng ngy.

Glycozide

T khng ph thuc insulin typ 2

ri lon tiu ha, bun nn,

i tho ng ph thuc insulin

Trong khi dng gliclazid vn phi theo

80mg

m ch n king n thun khng

au u, pht ban...

(typ 1).

ch n king. iu s gip

Glyclazid

kim sot c glucose - huyt (nn

H ng huyt qu mc

Hn m hay tin hn m do i

gliclazid pht huy y tc dng.

tho ng.

Khi dng phi hp vi cc thuc khc

Suy gan nng, suy thn nng.

c tc dng tng hoc gim tc dng

C tin s d ng vi sulfonamid

h ng huyt, cn phi iu chnh

v cc sulfonylur khc.

liu ca gliclazid cho thch hp. Trong

Phi hp vi miconazol vin.

trng hp suy thn, suy gan, cn

dng cho ngi cao tui).

Nhim

khun

nng

hoc

chn

phi gim liu.

thng nng, phu thut ln.

Glucofine
Metformin

T type II n tr liu, khi khng

RL Tiu ha, Ban, my ay,

Gim chc nng thn

Metformin c bi tit ch yu qua

th iu tr tng glucose huyt bng

cm th vi nh sng.

Qu mn vi metformin hoc cc

thn, nguy c tch ly v nhim acid

ch n n thun.(ng thi vi

Gim nng vitamin B12.

thnh phn khc.

lactic tng ln theo mc suy gim

mt sulfonylur khi ch n v khi

Nhim acid lactic.

Nhim acid chuyn ha

chc nng thn.

...

...

dng metformin hoc sulfonylur n

thun khng c hiu qu kim sot
glucose huyt mt cch y ).
Alipid 10mg

cholesterol ton phn + cholesterol

Nhc u, chng mt, suy

Tng men gan

Tc ng c xng: tiu c vn vi

Atorvastatin

LDL ngi bnh tng cholesterol

nhc, mt ng, d cm, To

Mang thai v cho con b

ri lon chc nng thn th cp. Xem

mu gia nh ng hp t, b tr cho

bn, tiu chy, y hi, kh

xt bnh c trong cc bnh nhn c

cc cch iu tr h lipid khc.

tiu, au bng, bun nn.

au c lan ta, au c hoc yu, hoc

tng ng k ca CPK.

TNG TC THUC
Thuc tng tc

C ch

Nifedipin-

Nifedipine

Atorvastatin

ch CYP3A4

H qu

Mc

Cch x tr

Tng hiu qu ca Atorvastatin lm tng tc

ng

dng ph nh tn thng gan v mt tnh

theo di cht ch

k-

cn

iu chnh liu lng hoc theo di thng xuyn

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

trng him gp nhng nghim trng gi l tiu

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

c vn c lin quan n s phn hy ca cc

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

Tc ng ln

m c xng: c th gy tn thng thn v

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

bm ngc P-

thm ch t vong.

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

glycoprotein

Gim hiu qu ca Atorvastatin

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

(MDR1)

du hiu v triu chng ca tn thng gan.

Bisoprolol-

C hai u

H huyt p qu mc, gim nhp tim, nhc

ng k- Cn

Hy cho bc s bit nu bn pht trin cc triu

Nifedipine

chn knh

u, chng mt, chong, ngt xu

theo di cht ch

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-

Nifedipine lm

Tng tc dng ca metformin, c th dn n

Thiu s- Ko ng

Cn iu chnh liu lng v phi kim tra lng

Metformin

tng hp thu

tnh trng e da tnh mng do nhim acid

ng trong mu thng xuyn hn.

(medscape.com)

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

Trung bnh

Thng xuyn theo di lng ng trong mu, iu

rut

ca

Metformin

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

chong vng , v ngt xu.

Bisoprolol-

Gy h ng huyt: au u, chng mt,

Metformin

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

chnh liu lng

trng ngc.
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
NHN XT LIU DNG CCH DNG
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)
Tn thuc
Furosemid

Tc dng/ch nh

Tc dng ph

Ph phi cp; ph do tim,

gan, thn v cc loi ph
khc; tng huyt p khi c
tn thng thn; tng calci
huyt.

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.

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.

Liu iu tr ph v tng
huyt p l 40 n 80
mg/ngy, trng hp nh c
th dng 20 mg/ngy.

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

Chng ch nh

Lu c bit

Tn thuc

Tc dng/ch nh

Tc dng ph

Chng ch nh

Lu c bit

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
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, 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.

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.

Aluminium
phosphat gel

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.