TRNG I HC Y DC CN TH

KHOA DC
B MN DC L DC LM SNG

TI LIU HNG DN

THC TP H
(DC S I HC H 5 NM)

LU HNH NI B
CN TH NM 2015

MC LC
DANH MC T VIT TT ....................................................................................1
DANH MC BNG, BIU .....................................................................................2
PHN 1. HNH NH N THUC .......................................................................3
n thuc 1 ......................................................................................................3
n thuc 2 ......................................................................................................4
PHN 2. TNG QUAN V BNH..........................................................................5
2.1. Cao huyt p .............................................................................................5
2.2. H ct sng (thoi ha ct sng) ...............................................................6
2.3. Vim d dy ..............................................................................................8
2.4. Vim hng .................................................................................................9
PHN 3. NH GI N THUC .....................................................................11
3.1. n thuc 1 .............................................................................................11
3.1.1. nh gi tnh hnh s dng thuc ....................................................12
3.1.2. Phn tch s dng thuc nh gi can thip .................................22
3.2. n thuc 2 .............................................................................................25
PHN 4. XUT NNG CAO HOT NG DC LM SNG BNH
VIN ......................................................................................................................31
TI LIU THAM KHO ......................................................................................41
PH LC ...............................................................................................................42

DANH MC T VIT TT
T vit tt
AG II
ANTACID
BN
BYT
DLS
DS
DTQGVN
DHP
T
HA
HDL
HP
HTT
JNC VII

ngha
Angiotensin II
Thuc khng acid
Bnh nhn
B Y t
Dc lm sng
Dc s
Dc th quc gia Vit Nam
Dihydropyridin
i tho ng
Huyt p
Lipoprotein t trng cao
Helicobacter pylori
Hng tm thn
Bo co ln th VII ca Lin y ban quc gia v phng nga,

LDL
LS
NSAIDs
PNC
TBMMN
THA

pht hin, nh gi v iu tr cao huyt p

Lipoprotein t trng thp
Lm sng
Thuc gim au khng vim khng steroid
Penicillin
Tai bin mch mu no
Tng huyt p

DANH MC BNG, BIU

Bng 3.1. nh gi tnh hnh s dng thuc trn bnh nhn n thuc 1 ...........12
Bng 3.2. Cc tng tc thuc trong n theo Sch tng tc thuc v ch khi ch
nh (BYT Vit Nam) n thuc 1.......................................................................15
Bng 3.3. Cc tng tc thuc trong n theo trang MEDSCAPE.COM n
thuc 1 ....................................................................................................................17
Bng 3.4. Cc tng tc thuc trong n theo trang DRUGS.COM n thuc 1
............................................................................................................................... ..19
Bng 3.5. Gio dc bnh nhn n thuc 1 ........................................................21
Bng 3.6. nh gi tnh hnh s dng thuc trn bnh nhn n thuc 2 ...........26
Bng 3.7. Cc tng tc thuc trong n theo trang DRUGS.COM n thuc 2
............................................................................................................................... ..29
Bng 3.8. Gio dc bnh nhn n thuc 2 ........................................................26

PHN 1. HNH NH N THUC

n thuc 1:

n thuc 2:

PHN 2. TNG QUAN V BNH

2.1.

CAO HUYT P [10]

2.1.1. Triu chng lm sng:

Phn ln bnh nhn THA khng c triu chng c nng, pht hin bnh
c th do o HA thng quy hoc khi c bin chng (TD = TBMMN).
Triu chng ca ngi bnh khi c, c th nm trong ba nhm:
Do HA cao.
Do bnh mch mu ca THA.
Do bnh cn gy ra THA (THA th pht).
Cc triu chng do chnh mc HA cao c th l: nhc u, xy xm, hi
hp, d mt v bt lc. Nhc u thng ch xy ra khi c THA nng.
Thng nhc u vng chm, sau gy v thng vo bui sng.
2.1.2. Cn lm sng theo di v chn on:
Cc xt nghim c bn cn thc hin cho tt c bnh nhn THA.
Huyt , dung tch hng cu.
Ure mu, creatinin mu.
Tng phn tch nc tiu (ng, m, hng cu, cn lng).
ng mu, cholesterol mu, triglyceride mu, HDL, LDL.
Acid urique.
Phim lng ngc.
in tm .
Siu m tim.
2.1.3. Nguyn tc iu tr:
H HA n mc mong mun < 140/90mmHg hoc < 130/80 trn bnh
nhn c km T hoc suy thn mn m khng b tc dng ph ca
thuc hoc xut hin triu chng nh chng mt, bun ng, gim kh
nng t v
Khng h HA nhanh qu nhm gim tc dng khng mong mun.
Cn ch n t l y nh ca thuc (trough and peak ratio) nhm bo
v HA sut 24 gi.
La chn thuc u tin iu tr THA cn quan tm n bnh ni khoa
phi hp. Trong mt s trng hp s c ch nh bt buc.
2.1.4. Mc tiu iu tr:
Mc tiu chung ca iu tr THA l gim tt bnh tim mch, thn v gim t vong.
Nhm t mc tiu ny, theo JNC VII cn thay i li sng v t tr s HA <

140/90mmHg. Ring vi bnh nhn c km T hoc bnh thn mn, mc HA cn

t l di 130/80mmHg.
2.1.5. Cc nhm thuc iu tr:
Li tiu.
Thuc chn beta.
Thuc c ch men chuyn.
Chn th th angiotensin II (chn AGII).
Cc thuc c ch calci.
Cc thuc h huyt p khc: chn th th alpha1 v alpha 2.
Thuc c ch giao cm trung ng khng chn lc.
Thuc c ch thn kinh ngoi vi.
2.1.6. Cc vn cn t vn:
Ch n ung.
Thay i li sng.
2.2.

H CT SNG (THOI HA CT SNG) [8]

2.2.1. Triu chng lm sng:

Triu chng ton thn:
Thoi ha khp n thun khng c thay di v cc biu hin ton thn.
Khi c cc thay i ton thn th cn i tm nguyn nhn gy nn cc thay
i ny.
Triu chng lm sng thoi ha ct sng:
ct sng c: au phn sau ca ct sng v ty thuc vo v tr ca
t sng hoc a m b tn thng. au c th lan ln vng chm,
pha trc ngc, vng ai vai, cnh tay, cng tay v bn tay.
Thoi ha ct sng tht lng c th biu hin bng mt trong s cc
tnh trng bnh l sau: hp ng sng ct sng tht lng, bnh l r
thn kinh do hp l lin hp, au lng cp khng c tn thng r,
au lng mn khng c tn thng r v au ct sng tht lng vi
cc biu hin tn thng r thn kinh.
2.2.2. Cn lm sng theo di v chn on:
Xt nghim mu v dch khp
Xt nghim hnh nh
X quang
Cng hng t
Siu m khp
Ni soi khp
2.2.3. Nguyn tc iu tr:

iu tr thoi ha khp i hi phi phi hp nhiu bin php bao gm cc phng

php khng dng thuc v phng php dng thuc.
2.2.4. Mc tiu iu tr:
Nhm gim cc triu chng au v ci thin chc nng vn ng ca ngi bnh.
Cc ri lon v au v chc nng vn ng c lin quan nhiu n cc tnh trng
vim, yu cc c, tnh trng lng lo v khng n nh ti khp. Do , vic iu tr
cng cn nhm vo vic khc phc cc ri lon ny.
2.2.5. Cc nhm thuc iu tr:
Gim au: Paracetamol l thuc gim au nn c chn u tin cho cc
bnh nhn thoi ha khp.
Thuc chng vim khng steroid: l nhm ch yu iu tr au trong
thoi ha khp.
Cc thuc chng thoi ha khp lm thay i tin trin bnh hay cc
thuc chng thoi ha khp tc dng chm, thng c dng ko di v
c th phi hp vi nhau.
Tim ni khp bng corticosteroid
Tim acid hyaluronid
Ni soi khp
S dng huyt tng giu tiu cu v t bo gc
Phu thut thay khp.
2.2.6. Cc vn cn t vn:
Cc bin php khng dng thuc
Ch n ung, tp luyn
2.3.

VIM D DY [1], [8]

2.3.1. Triu chng lm sng:

au bng ch yu vng thng v l triu chng gn nh l hng nh
ca bnh ny. au c th t mc kh chu, m n d di. Ty thuc
vo v tr lot, tnh cht au c t nhiu khc bit:
Lot hnh t trng thng xut hin lc i hoc sau ba n 2 3 gi,
au tri ln v m, n vo hoc s dng cc thuc trung ha acid th
au nhanh.
Lot d dy: ty v tr lot m v tr au v hng lan ca tnh cht
au c th khc nhau. Thng au sau n trong khong vi chc pht
n vi gi. p ng vi ba n v thuc trung ha acid cng km
hn so vi lot hnh t trng.

C th c cc triu chng: bun nn, nn, chn n, cm gic nng rt,

y bng, st cn, chua.
Khm bng: thng khng thy g c bit, i khi c th thy bng
trng hoc co cng nh.
2.3.2. Cn lm sng theo di v chn on:
Chp d dy t trng c Barite
Ni soi d dy t trng
Chp ct lp vi tnh
Test xc nh H.P
Thm d acid dch v ca d dy.
2.3.3. Nguyn tc iu tr:
Da trn c s sinh l bnh loi tr cc yu t gy bnh nh stress,
xon khun Helicobacter pylori, tng tit acid dch v,
Bnh thng ha chc nng d dy.
Tng cng cc qu trnh ti to nim mc, loi tr cc bnh km theo.
2.3.4. Mc tiu iu tr:
Gim yu t gy lot.
Tng cng yu t bo v nim mc d dy.
Dit tr Helicobacter pylori.
2.3.5. Cc nhm thuc iu tr:
Cc thuc trung ha acid dch v (Antacid)

Thuc c ch H2

Thuc c ch bm proton

Sucralfat

Cc Anticholinergic

Cc thuc khng H.P

2.3.6. Cc vn cn t vn:
Cch s dng thuc
Ch n ung.
2.4.

VIM HNG [9]

2.4.1. Triu chng lm sng:

Giai on u: Biu hin t ngt sau mt t cm cm
St cao 39o, run ry, au nhc mnh my, i khi ni sng.
Nut au d di, au lan ln tai khi nut
Hng lan ta hay khu tr vng Amidan
Hch c.
Giai on tit ba trng
Hi th hi.
Li d
B u khe Amidan.

Tiu t
Thng c cc triu chng i km nh chy mi, vim thanh qun,
vim kt mc.
N c th l khi u ca mt bnh nhim trng trm trng hn nh
bch hu, pht ban, si, thy u,..
N cng c th l hu qu ca s nhim c t bn ngoi do Iod, thy
ngn, ch,..
Tin trin c th ko di hay ti pht.
2.4.2. Cc nhm thuc iu tr:
Khng sinh: thng dng nhm PNC
Khng vim
Gim au, h st.
2.4.3. Cc vn cn t vn:
T vn bnh nhn ngh ngi, gi m v cc bin php iu tr ti ch: st trng
vng hng...

PHN 3. NH GI N THUC
3.1.

N THUC 1

10

3.1.1. nh gi tnh hnh s dng thuc (Mu 1)

PHIU NH GI TNH HNH S DNG THUC

Ngy: 27-07-2015
H v tn bnh nhn: Trn Vn Theo

Tui: 63

Nam

Chn on bnh: Cao huyt p v cn (nguyn pht) - H ct sng (thoi ha

ct sng) - Vim d dy v t trng
Bng 3.1. nh gi tnh hnh s dng thuc trn bnh nhn
TT
1

Tiu ch
C ng v hnh thc
ca qui ch k n
C k thc phm chc
nng trong n thuc

C/
khng

Minh chng

Khng

khng?
Trong n c k 2 thuc
3

cng hot cht, cng

Khng

nhm tc dng khng

V vn ph hp vi chn on
a) C vn BN c
Bnh nhn c 3 vn cn iu tr: cao
chn on nhng

huyt p v cn, h ct sng, vim d

BN cha c thuc

dy v t trng.

trong n/bnh n

Cao huyt p v cn iu tr vi

khng?

Tanatril Tad 10mg 100s (Imidapril),

Khng

Diezar (Amlodipin), Suncardivas

6.25 (Carvedilol)
H ct sng iu tr vi Patest
(Mephenesin) v Meloxicam 15mg
Vim d dy v t trng iu tr vi
Omepraglobe (Omeprazol)

b) C thuc trong n/
bnh n m khng

Khng

11

khng c chn on
(d thuc) khng?
c) Ch nh thuc

Theo t hng dn s dng:

trong n/bnh n

Tanatril tad, Diezar v Suncardivas

khng ph hp T

u c ch nh trong iu tr cao

hng dn s dng

huyt p
Patest c ch nh trong iu tr h

hoc/v DTQG
VN

tr trong cc trng hp co tht gy

Khng

au nh chng ct sng thoi ha

nn ph hp
Meloxicam 15mg ch nh trong iu
tr lu di bnh vim t sng dng
thp nn ph hp
Omepraglobe ch nh iu tr cc
bnh ngn ngy bnh lot d dy, t
trng v vim thc qun d dy

Thuc trong n
5

KHNG ph hp vi

Khng

tnh trng bnh l v c

a ngi bnh

6
a) C ghi Y v

Thc hin theo quy ch k n

K n theo ng Quyt nh s

NG theo quy ch

04/2008/Q-BYT ngy 01/02/2008 v

k n hoc hng

quy ch k n thuc trong iu tr ngoi

dn s dng thuc
trong BV hay
khng?

tr ca B Y T v theo ng Thng t
s 23/2011/TT-BYT ngy 10/6/2011 ca
B Y t Hng dn s dng thuc trong
cc c s y t c ging bnh

b) C ghi Y v Khng Omepraglobe: theo t hng dn

NG v

omepraglobe s dng 1 ln /ngy. Theo

12

Liu dng

gio trnh dc lm sng II omepraglobe

Khong cch dng

nn dng trc bui n sang 30 pht

Thi im dng (so

Khng ghi r cch dng vi mi thuc

c th theo ng Quyt nh s

vi ba n.)
ng dng

04/2008/Q-BYT ngy 01/02/2008 v

Dng thuc trn cc

quy ch k n thuc trong iu tr ngoi

tr ca B Y T v theo ng Thng t

i tng c bit,
Thi

gian

s 23/2011/TT-BYT ngy 10/6/2011 ca

dng

B Y t Hng dn s dng thuc

(ngy) ca cc thuc
khng?
c) C KHNG nh
s th t ngy dng
cc nhm thuc c
bit: phng x, Gy

Khng

nghin, HTT, Khng

sinh, corticoid, iu

7
8

tr lao hay khng?

C tng tc thuc
trong n** hay khng?
Nhng yu t lm

Tc dng ph:

bnh nhn km tun

Suncardivas: nhc u, au c, mt

th:
Tc dng ph
Nhiu thi im
dng thuc?
Gi tin

mi, kh th
Omepraglobe: ni dt da, nn, au
u
Patest: mt mi, bun ng, u oi,
yu c
Diezar: ph c chn, nhc u, chng
mt
Tanatril: ho, chng mt, nhc u
Meloxicam: thiu mu, ri lon mu,

13

gim bch cu
**

Kt qu xt tng tc thuc:

Bng 3.2. Cc tng tc thuc trong n theo Sch tng tc thuc v ch khi
ch nh (BYT Vit Nam)
CP
STT
1

TNG

MC

BIN PHP HN

HU QU

CH, KHC PHC

TC
Amlodipin

Mc

Mc d c s tng tc Tnh n bi cnh

Carvedilol

2: Cn

dng h huyt p, vn sinh l ca ngi

thn

gp vi phi hp ny. bnh.

trng

Tuy nhin, nn cnh thuc vo mc tiu

Tt

ph

gic, do c thm tnh iu tr chnh (au

cht gim lc co c tht ngc hoc tng
(k

di

dng huyt p) v thi gian

thuc nh mt vi iu tr vi thuc ny
cht chn beta) ng hoc thuc kia. C th
suy tim c kim sot c tht bi trong iu
hay khng. ngi tr tng huyt p.
suy mch vnh, gin
mch do DHP gy
nn c th dn n
nhp tim nhanh phn
x va phi bi thuc
2

Amlodipin

Mc

chn beta.
Gim tc dng chng Cn cung cp y

Meloxicam

2: Cn

tng huyt p; cc nc cho bnh nhn

thn

thuc chng vim c theo di chc nng

trng

ch

tng

hp thn ( thanh lc

prostaglandin l cht creatinin). Kim tra

gy dn mch v hoc s n nh huyt p

14

dn n gi mui ng mch, c bit

nc. Nguy c suy khi bt u iu tr.
thn cp bnh nhn Thn trng c bit
mt nc.

khi

phi

hp

indomethacin

vi
hoc

cc dn cht salicylate
liu

cao.

Khuyn

ngi bnh t theo

3

Meloxicam

Mc

di u n huyt p.
Lm gim tc dng h Tt nht l trnh phi

Carvedilol,

2: Cn

huyt p; gim li hp. Nu cn phi

Amlodipin,

thn

tiu ng thi c hp, ch nn phi hp

Imidapril

trng

nguy c lm tng c ngn ngy (nhiu kh

tnh ca thuc chng nng t gy tai bin),
vim khng steroid nhng

nu

thng

i vi thn, c bit xuyn phi hp, cn

l vi indomethacin. phi b nc y
Ngoi

ra, cho ngi bnh, gim

indomethacin c th st chc nng thn

cc thuc chng vim (

thanh

lc

khng steroid khc creatinin), gim st

lm tng nguy c tng huyt p v gi cho
kali

mu

khi

cc huyt p n nh (c

thuc ny phi hp khi phi tng liu

vi thuc li tiu gi thuc

chng

tng

kali. C ch cn cha huyt p nu cn), c

r v phc tp. C th bit khi bt u phi
lin quan n tng hp.
hp prostaglandin ti

15

thn cn cho bi tit

Na, duy tr lu lng
mu qua thn v bi
niu. Khi tng hp
prostaglandin thn
b thuc chng vim
khng steroid cn tr,
lu lng mu qua
thn v s o thi
nc tiu b gim.
Bng 3.3. Cc tng tc thuc trong n theo trang MEDSCAPE.COM
CP
STT
1

TNG

Mc

BIN PHP HN

HU QU

CH, KHC PHC

TC
Meloxicam Thn trng

Meloxicam tng tc Hn ch phi hp. Nu

cn theo

i khng lm gim bt buc phi s dng

Carvedilol

di

tc

dng

ca phi hp th phi theo

carvedilol, cn theo di cht ch v bo

di cht ch. S dng ngay cho bc s nu
NSAIDs ko di (>1 gp cc tc dng khng
tun), NSAiDs lm mong mun.
gim

tng

hp

prostaglandin.
Meloxicam
carvedilol

v
u

lm

tng kali huyt.

2

Carvedilol

Tng tc

Carvedilol

v Hn ch phi hp. Nu

khng

Amlodipine u lm bt buc phi s dng

Amlodipin

ng k

tng anti-hypertensive phi hp th phi theo

16

channel blocking. C di cht ch v bo

nguyn c dn n ngay cho bc s nu
cc tng tc nguy gp cc tc dng khng
him, cn gim st mong mun.
cht ch khi dng
chung.

Omeprazol

Thn trng

Omeprazole tng tc Hn ch phi hp. Nu

e-

cn theo

dng ca Carvedilol bt buc phi s dng

Carvedilol

di

bng cch tc dng phi hp th phi theo

ln s chuyn ha bi di cht ch v bo
enzyme CYP2C9/10.

ngay cho bc s nu
gp cc tc dng khng

Meloxicam Thn trng

mong mun.
Meloxicam tng tc Hn ch phi hp. Nu

- Imidapril

cn theo

i khng lm gim bt buc phi s dng

di

tc

dng

ca phi hp th phi theo

Imidapril khng ng di cht ch v bo

k. NSAIDs lm gim ngay cho bc s nu
tng

hp gp cc tc dng khng

prostaglandin.

mong mun.

Bng 3.4. Cc tng tc thuc trong n theo trang DRUGS.COM

CP
STT
1

TNG

MC

TC
Amlodipine

Thn trng,

HU QU
Carvedilol

BIN PHP HN
CH, KHC PHC
v Bo ngay cho bc s

- Carvedilol cn theo di. Amlodipine c th nu nhng triu chng

gy tc dng lm trn khng ht sau mt
h huyt p v vi ngy hoc tin trin

17

gim nhp tim. Bn nng hn. Bn cn c

c th gp cc tc s iu chnh liu hoc
dng ph: au u, theo di ca bc s
chng

mt,

hoa m bo an ton khi s

mt, ngt hoc lm dng

phi

hp

hai

thay i nhp tim, thuc ny. Trnh li xe

mch. Nhng tc hoc vn hnh my
dng

ph

trn mc nguy him cho

thng thy giai n khi bit nh hng

on u iu tr, ca thuc ln c th,
sau khi tng liu cn thn khi thay i t
hoc iu tr li sau th. Bo cho bc s v
thi

gian

on.

gin cc loi thuc khc s

dng cng, khng t
ngng s dng khi
khng c ch nh ca
bc s.

Amlodipine

Thn trng,

Trc khi s dng Cn iu chnh liu

- Meloxicam cn theo di. meloxicam nn bo hoc theo di huyt p

cho bc s trong thng
trng hp s dng ngng
ng
amlodipine.

xuyn.
s

Nu
dung

thi meloxicam khi ang s

S dng phi hp c th

phi hp c th gy h huyt p.
3

lm tng huyt p.
Bo cho bc s khi C th cn iu chnh

Carvedilol -

Thn trng,

Meloxicam

cn theo di. phi hp thuc. S liu hoc s gim st

phi hp co th cht ch ca bc s khi
lm gim tc dng phi hp thuc.

18

ca

carvedilol

trong vic iu tr
cao huyt p, c
bit

khi

dng

meloxicam thng
xuyn.
DS tng hp 3 kt qu trn, nh gi v ngh bin php phng trnh
tng tc thuc: Cc thuc trong n khi phi hp c th xy ra cc tng tc gy
hu qu nghim trng (Meloxicam Carvedilol, Carvedilol Amlodipine). V vy,
nu s dng phi hp th phi c s gim st cht ch v bo ngay vi bc s iu tr
khi c cc du hiu hoc tc dng khng mong mun. Hoc c th s dng thuc
thay th (nh ngh trong mu 2) vi liu iu chnh.

Bng 3.5. Gio dc bnh nhn

STT

GIO DC

C TH

BNH NHN

Meloxicam: ung 1 vin vo bui sng sau khi n.

Omepraglobe: ung 1 vin vo bui sng trc n t
30-60 pht
Cch dng thuc

Diezar: ung 1 vin vo bui chiu sau n

c th

Tanatril: ung 1 vin vo bui sng sau n

Patest: ung 1 vin vo bui sng sau n, 1 vin vo
bui chiu sau n
Suncardivas: ung vin vo bui sng sau n,

Thay i li sng

vin vo bui chiu sau n

Bnh nhn nn tp thoi quen n nht khng dng
qu nhiu thc n c v mn, tp luyn th dc vi
cc ng tc va v nh, trnh vn ng qu sc. C
ch n ung hp l giu calci v trnh dng bia

19

ru thuc l v cc cht kch thch

TNG KT:
n thuc cha ng theo mu do B Y t quy nh do thiu phn hng dn s
dng thuc, li dn v ni dung ti khm.
Cc thuc trong n c nhiu tng tc.
ng v hnh thc quy ch k n, thuc ph hp vi chn on.

20

3.1.2. Phn tch s dng thuc nh gi can thip

Bnh vin: .
Khoa: .. M bnh n / n thuc: .

MU PHN TCH S DNG THUC

(Ban hnh km theo Thng t s 31/2012/TT-BYT ngy 20 thng 12 nm 2012 ca
B Y t)
(Lu ti khoa dc)
Dc s: ..
Ngy: ....
H v tn ngi bnh: Trn Vn Tui: 53

Khoa:
Nam/N:

Can thip s*: ....

Nam

Theo
Chn on: .
Thuc lin quan (tn hot cht): ________________________________
M t vn cn can thip trn ngi bnh:
Tng tc gia cc thuc dng chung.
Imidapril c th gy ho khan nh hng n gic ng bnh nhn ( cao
tui) ng thi gy tng tc vi cc thuc h huyt p khc.
Meloxicam gy tng tc c hi vi cc thuc h huyt p dng chung
M t can thip xut thc hin trn ngi bnh:
Khng dng imidapril.
Thay carvedilol bng losartan. Liu dng: Losartan 50mg sng 1 vin.
Thay meloxicam bng paracetamol. Liu dng: paracetamol 500mg ngy 2
ln, 1 vin/ln

Can thip s*: do dc s lm sng nh s trong qu trnh thc hin can thip.
TM TT CAN THIP THC HIN
Pht hin vn trong:

xut can thip:

21

Hi tin Thi im ngiThi imCan thip c xut vi:

s

bnh nhp vin

ngi bnhBc s iu tr

n Trong qu trnhxut vin

thuc

theo

di

ngi

bnh

Bc s i

hc/ni tr
Y t Ngi bnh

Khc:

Yu cu can thip c:
Trao i trc tip

Vn bn

Khc:

L DO CAN THIP
CAN THIP
1. Ch nh khng ph hp/ k n a. Ngng dng thuc Gim dn liu
thuc trng lp trong n/ thi gian b. ngh thm thuc mi/ dng li
dng thuc qu di

mt thuc

2. Bnh khng c ch nh thuc/ c. Thay thuc/i thuc

thi gian dng thuc qu ngn

d. Thay i ng dng thuc/dng

3. Thuc t tin v c th thay th bo ch

bng thuc khc

e. Thay i liu/ s ln dng thuc

4. Thuc khng phi la chn u tin

f. Thay i k thut a thuc/ thi

5. ng dng/ Dng bo ch khng im dng thuc

thch hp

g. T vn ti u qu trnh theo di

6. Chng ch nh tuyt i/tng ngi bnh

i

/ ngh hi chn chuyn khoa

7. Liu dng 1 ln hoc liu hng ngy h. T vn, hng dn cho ngi bnh
qu thp/ qu cao

i. Tr li cu hi lin quan ca cn b

8. K thut a thuc/thao thc khng y t lin quan n s dng thuc

hp l

j. Kim tra li bnh n/ chun b t

9. Thi im dng thuc khng hp l vn v dc khi xut vin

10. Tc dng khng mong mun
11. Tng tc thuc
12. Theo di iu tr cha hp l

k. Khc:

22

13. Tun th iu tr km
14. Tr li cc cu hi ca cn b y t
lin quan n s dng thuc
15. Cc vn dc chnh
16. Khc:

CHP NHN CAN THIP CA CN B Y T

ng

M t:

Khng ng
ng mt phn v/hoc cha thc
hin theo kin can thip
Khng p dng trong trng hp ny
Dc s lm sng
(K v ghi r h tn)

23

3.2.

N THUC 2

24

PHIU NH GI TNH HNH S DNG THUC

Ngy: 27-07-2015
H v tn bnh nhn: Trn Sng Ngc

Tui: 54

Chn on bnh: Cao huyt p v cn (nguyn pht) Vim d dy v t trng,

Vim hng cp
Bng 3.6. nh gi tnh hnh s dng thuc trn bnh nhn
TT
1

Tiu ch
C ng v hnh thc ca
qui ch k n
C k thc phm chc
nng trong n thuc
khng?
Trong n c k 2 thuc

3
4

cng hot cht, cng

C/
khng

Minh chng

C
Khn
g
Khn

g
nhm tc dng khng
V vn ph hp vi chn on
a) C vn BN c
Bnh nhn c chn on cao
chn on nhng BN

huyt p v cn, vim d dy v t

cha c thuc trong

trng, vim hng cp

n/bnh n khng?

Cao huyt p iu tr vi
Khn
g

Losartan 25mg
Vim d dy t trng iu tr vi
Prazodom
Vim hng cp iu tr vi
Pulracef, Alphachymotrypsin,
Ambroxol, Fexaphar

b) C thuc trong n/
bnh n m khng
khng c chn on
(d thuc) khng?

Khn
g

25

c) Ch nh thuc trong

Theo t hng dn s dng:

n/bnh n khng

Losartan c ch nh trong iu

ph hp T hng

tr tng huyt p nn ph hp
Prazodom c ch nh trong iu

dn s dng hoc/v
DTQG VN,

tr vim lot d dy t trng nn

ph hp
Alphachymotrypsin c ch nh
Khn
g

trong trong cc chng ph do vim

nn ph hp vi vim hng cp
Ambroxol c ch nh trong
trng hp cc bnh cp tnh
ng h hp nn ph hp vi
vim hng cp
Fexaphar c ch nh trong vim
hng nn ph hp vi vim hng
cp

Thuc trong n KHNG

5

ph hp vi tnh trng

Khn

bnh l v c a ngi

bnh
6

Thc hin theo quy ch k n

a) C ghi Y v
K n theo ng Quyt nh s
NG theo quy ch

04/2008/Q-BYT ngy 01/02/2008 v

k n hoc hng

quy ch k n thuc trong iu tr

dn s dng thuc
trong BV hay khng?

ngoi tr ca B Y T v theo ng
Thng t s 23/2011/TT-BYT ngy
10/6/2011 ca B Y t Hng dn s
dng thuc trong cc c s y t c

b) C ghi Y v

Khn

ging bnh
Theo t hng dn s dng Prazodom

26

NG v

s dng 1 vin/ngy

Liu dng.

K n theo ng Quyt nh s

Khong cch dng.

04/2008/Q-BYT ngy 01/02/2008 v

Thi im dng (so vi

quy ch k n thuc trong iu tr

ba n.)
ng dng
Dng thuc trn cc i
tng c bit.
Thi gian dng (ngy)

ca cc thuc khng?
c) C KHNG nh s

ngoi tr ca B Y T v theo ng
Thng t s 23/2011/TT-BYT ngy
10/6/2011 ca B Y t Hng dn s
dng thuc trong cc c s y t c
ging bnh

th t ngy dng cc
nhm thuc c bit:
phng x, gy nghin,
HTT, khng sinh,
corticoid, iu tr lao

7
8

hay khng?
C tng tc thuc trong
n** hay khng?
Nhng yu t lm bnh

Tc dng ph:

nhn km tun th:

Pulracef: ph mch, nga, pht

Tc dng ph
Nhiu thi im
dng thuc?
Gi tin

ban.
Ambroxol:pht ban, phn ng kiu
phn v cp tnh, nng, kh ming,
tng cc transaminase.
Fexophar: bun ng, mt mi, au
u.
Prazodom: bun nn, tiu chy, to
bn.
Losartan: h huyt p, mt ng,

27

chong vng.
Alphachymotrypsin: m ay,
nga
**

Kt qu xt tng tc thuc:

Khng c tng tc cc thuc trong n theo Sch tng tc thuc v ch khi ch

inh.
Khng c tng tc cc thuc trong n theo trang MEDSCAPE.COM
http://reference.medscape.com/drug-interactionchecker
Bng 3.7. Cc tng tc thuc trong n theo trang DRUGS.COM
ST

CP TNG

TC
Cefuroxim Lansoprazole

MC

BIN PHP HN

HU QU

CH, KHC PHC

Khng khuyn co Nn ngng s dng
dng

chung lansoprazole trong khi

cefuroxim

v iu tr bng cefuroxim

lansoprazole.

hoc bc s nn ch

Lansoprazole lm nh s dng mt loi

gim acid d dy khng sinh khc.
1

nn c th lm
gim hp thu v
nng trong mu
ca

cefuroxime

dn n gim tc
dng

ca

cefuroxim.
DS tng hp 3 kt qu trn, nh gi v ngh bin php phng trnh
tng tc thuc: Tng tc thuc khng gy ra hu qu nghim trng nn bnh
nhn c th s dng thuc bnh thng.
Bng 3.8. Gio dc bnh nhn

28

STT

GIO DC BNH NHN

C TH
Vi Pulracef, Losartan, Ambroxol v
Fexophar ung 1 vin bui sng sau n
v 1 vin bui chiu sau n.

Cch dng thuc c th

Vi Alphachymotrypsin ung 2 vin bui

sng sau n v 2 vin bui chiu sau n.
Vi Prazodom ung 1 vin bui sng
trc n v 1 vin bui chiu trc gi
n.
Bnh nhn nn n nht trnh n thc n
cha nhiu mui, trnh cc cht kch

Thay i li sng

thch nh bia ru thuc l. Bnh nhn

nn tp thi quen n ung ng gi gic,
khng nn dng cc thc phm qu nng
cng nh qu lnh.

TNG KT:
n thuc ng v hnh thc theo mu ca b Y t, s dng thuc ph hp vi
chun on ca bnh nhn tuy nhin thiu ngy ti khm, ni dung ti khm, li
dn. Tuy c tng tc nhng khng nh hng nhiu n hiu qu iu tr nn c
th chp nhn c.

29

PHN 4. XUT NNG CAO HOT NG DC LM

SNG BNH VIN
Cu 1. Vn bn php lut no mi nht qui nh v hot ng
DLS bnh vin?
Co hiu lc t ngy, thng, nm no?
Tr li: Thng t s 31/2012/TT- BYT Hng dn hot ng dc lm sng trong
bnh vin. C hiu lc t 04/02/2013.
Cu 2. iu kin trin khai hot ng
dc lm sng nh th no? V c s
vt cht, v con ngi, Bnh vin i hc Y dc Cn Th co iu kin no?
Tr li: iu kin ca dc s lm sng Dc s chuyn trch lm cng tc dc
lm sng l dc s i hc v phi p ng mt trong ba iu kin sau:
1. c o to lin tc v c chng ch thc hnh dc lm sng.
2. c o to i hc chuyn ngnh nh hng dc lm sng.
3. c o to sau i hc chuyn ngnh dc l - dc lm sng.
iu kin bo m v nhn lc v c s vt cht
1. Nhn lc:
a) Dc s lm sng phi c o to v cp nht thng xuyn cc hng
dn iu tr ca Vit Nam, ca th gii, ti liu v y dc c lin quan,
cc vn khoa hc, cng ngh phc v hot ng thc hnh dc lm
sng;
b) Dc s lm sng phi c tham d cc hi tho khoa hc, lp hc
chuyn tip cn vi dc lm sng trong nc, khu vc v trn th
gii.
2. C s vt cht:
a) Trang thit b: phi c h thng my vi tnh, ni mng internet, my in,
my fax, in thoi;
b) Bn, gh lm vic, t sch;
c) Ti liu, sch, bo, tp ch, phn mm tra cu thng tin thuc khoa hc:
phi c ti thiu cc ti liu, sch, bo, tp ch, phn mm tra cu thng

30

tin thuc thuc danh mc u tin phi c theo Ph lc 1 c ban hnh

km theo Thng t ny.
Bnh vin i hc Y dc Cn Th c iu kin trin khai hot ng dc
lm sng.
Cu 3. Cc vn bn php lut no co lin quan, h tr hot ng
dc lm sng
bnh vin? Nu r cc iu khon, ni dung co lin quan.
Thng t s 22/2012/TT-BYT: Quy nh t chc v hot ng ca khoa dc
bnh vin iu 11. Yu cu, chc trch, nhim v ca dc s lm cng tc dc
lm sng
1. Yu cu v trnh ti thiu l dc s i hc.
2. Chc trch, nhim v:
a) Chu trch nhim v thng tin thuc trong bnh vin, trin khai mng li theo
di, gim st, bo co tc dng khng mong muc ca thuc v cng tc cnh
gic dc.
b) T vn v s dng thuc an ton, hp l cho Hi ng thuc v iu tr, cn
b y t v ngi bnh.
c) Tham gia theo di, kim tra, gim st vic k n thuc ni tr v ngoi tr
nhm y mnh vic s dng thuc an ton, hp l v hiu qu.
d) Hng dn v kim tra vic s dng thuc trong bnh vin; chu trch nhim
tnh ton hiu chnh liu i vi ngi bnh cn iu chnh liu; c quyn
xem xt thay th thuc (nu pht hin thy c tng tc trong k n, k n
cng hot cht, thuc trong kho ca khoa Dc ht) bng thuc tng ng
ng thi thng tin li cho khoa lm sng bit v thng nht vic thay th
thuc.
e) Tham gia nghin cu khoa hc v bi dng nghip v chuyn mn cho cc
thnh vin trong khoa v hc vin khc theo s phn cng.
f) Thc hin mt s nhim v khc khi c Trng khoa Dc yu cu.
g) Chu trch nhim trc Trng khoa Dc v nhim v c phn cng.
S 21/2013-BYT: Quy nh v t chc v hot ng ca hi ng thuc v
iu tr trong bnh vin.

31

Q 68-TTg: Chin lc pht trin ngnh Dc quc gia n 2020, tm nhn

2030: 50% BV tuyn tnh, trung ng; 30% nhn lc Dc l Dc s lm
sng
S 1088/Q-BYT: Quyt nh v vic ban hnh hng dn hot ng gim
st phn ng c hi ca thuc (ADR) ti cc c s khm, cha bnh. iu
1. Ban hnh km theo Quyt nh ny Hng dn hot ng gim st phn
ng c hi ca thuc (ADR) ti cc c s khm bnh, cha bnh.
S 23/2011/TT-BYT: Hng dn s dng thuc ti cc c s c ging bnh.
Chng 2: hng dn s dng thuc (iu 4 n iu 8)
iu 4. Tng hp thuc ti khoa lm sng
1. iu dng vin tng hp thuc, ha cht t bnh n vo s tng hp thuc
hng ngy (theo mu Ph lc 10), sau tng hp thuc dng ca c khoa vo
Phiu lnh thuc (theo mu Ph lc 1), ring Phiu lnh ha cht, Phiu lnh vt
t y t tiu hao (theo mu Ph lc 2, 3) tng hp hng tun.
2. Thuc gy nghin, thuc hng tm thn, thuc phng x phi c phiu lnh
thuc ring theo quy nh hin hnh.
3. Phiu lnh thuc phi c Trng khoa hoc thy thuc c Trng khoa y
quyn bng vn bn ph duyt. Phiu lnh thuc vo ngy ngh v i vi cc
trng hp ngh cp thuc t xut, bc s, y s trc c php k phiu lnh
thuc.
4. S tng hp v cc phiu lnh thuc phi c ghi chp r rng, y ni
dung, chnh xc, khng vit tt, trng hp sa cha phi k xc nhn bn
cnh.
iu 5. Khoa Dc t chc cp pht thuc bo m cht lng v hng
dn s dng thuc
1. Kim duyt n thuc, phiu lnh thuc hng ngy trc khi cp pht.
2. T chc pht thuc hng ngy v thuc b sung theo y lnh. Pht thuc kp thi
bo m ngi bnh c dng thuc ng thi gian.

32

3. Thuc cp pht l khng cn nguyn bao gi phi c ng gi li trong bao

b kn kh v c nhn ghi tn thuc, nng (hm lng), hn dng. Vic ra l
thuc phi bo m thc hin trong mi trng v sinh sch s v thao tc hp
v sinh.
4. Ty theo iu kin, tnh chuyn khoa ca bnh vin, khoa Dc thc hin pha
ch thuc theo y lnh v cp pht di dng pha sn s dng.
5. Khoa Dc t chi cp pht thuc trong cc trng hp phiu lnh, n thuc
c sai st. Phiu lnh hoc n thuc thay th thuc sau khi c kin ca dc
s khoa Dc phi c ngi k phiu lnh (hoc k n thuc) k xc nhn
bn cnh.
6. Thng bo nhng thng tin v thuc: tn thuc, thnh phn, tc dng dc l,
tc dng khng mong mun, liu dng, p dng iu tr, gi tin, lng tn tr.
7. Khoa Dc lm u mi trnh Lnh o bnh vin bo co phn ng c hi ca
thuc (theo mu Ph lc 5) v gi v Trung tm Quc gia v Thng tin thuc v
theo di phn ng c hi ca thuc ngay sau khi x l.
iu 6. Trch nhim ca khoa lm sng trong vic cho ngi bnh dng
thuc
1. Trc khi ngi bnh dng thuc:
a) Cng khai thuc dng hng ngy cho tng ngi bnh bng cch thng bo
cho ngi bnh trc khi dng thuc, ng thi yu cu ngi bnh hoc
ngi nh k nhn vo Phiu cng khai thuc (theo mu Ph lc 7). Phiu
cng khai thuc kp u hoc cui ging bnh.
b) Hng dn, gii thch cho ngi bnh tun th iu tr.
c) Kim tra thuc (tn thuc, nng , hm lng, liu dng mt ln, s ln dng
thuc trong 24 gi, khong cch gia cc ln dng thuc, thi im dng
thuc v ng dng thuc) so vi y lnh, kim tra hn s dng v cht lng
cm quan ca thuc. Khi pht hin nhng bt thng trong y lnh nh ch
nh s dng thuc qu liu quy nh, ng dng khng hp l hoc dng

33

nhiu thuc ng thi gy tng tc, iu dng vin phi bo co vi thy

thuc iu tr hoc thy thuc trc.
d) Chun b phng tin v thuc:
Chun b phng tin cho ngi bnh dng thuc: khay thuc, nc ung
hp v sinh i vi trng hp ngi bnh dng thuc ung, l ng thuc
ung theo gi cho tng ngi bnh;
Phng tin vn chuyn thuc phi m bo sch s, sp xp gn gng, d
thy;
Chun b sn sng hp thuc cp cu v phc chng sc i vi thuc phi
dng ng tim;
Chun b dung dch tim cho ngi bnh phi pha ng dung mi, th tch
v theo quy nh ca nh sn xut.
2. Trong khi ngi bnh dng thuc
a) m bo v sinh chng nhim khun.
b) m bo 5 ng:
ng ngi bnh;
ng thuc;
ng liu dng;
ng ng dng;
ng thi gian.
c) Trc tip chng kin ngi bnh dng thuc v theo di pht hin kp thi cc
bt thng ca ngi bnh trong khi dng thuc.
3. Sau khi ngi bnh dng thuc
a) Theo di ngi bnh:
Theo di thng xuyn kp thi x tr cc bt thng ca ngi bnh. Ghi
chp y cc din bin lm sng ca ngi bnh vo h s bnh n.
Bc s iu tr c trch nhim theo di tc dng ca thuc v x l kp thi cc
tai bin do dng thuc, ghi s theo di phn ng c hi ca thuc (theo mu
Ph lc 5).

34

b) Ghi c th s thuc iu tr cho mi ngi bnh, mi khi thc hin xong mt

thuc phi nh du thuc thc hin.
c) Bo qun thuc cn li (nu c) theo ng yu cu ca nh sn xut.
d) X l v bo qun dng c lin quan n dng thuc cho ngi bnh theo
ng quy nh.
iu 7. Qun l, bo qun thuc ti khoa lm sng
1. Thuc trong t trc thuc cp cu phi theo ng danh mc v c s c
ph duyt v c bo qun theo ng quy nh v yu cu ca nh sn xut.
2. Thuc gy nghin, thuc hng tm thn, tin cht v thuc phng x cn qun
l, boqun theo quy nh hin hnh.
3. iu dng vin c phn cng kim tra, i chiu tn thuc, nng /hm
lng, s lng, cht lng, dng bo ch ca thuc trong phiu lnh thuc khi
nhn thuc t khoa Dc v khi bn giao thuc cho iu dng vin chm sc.
4. iu dng vin khi pht hin s dng nhm thuc, mt thuc, thuc hng cn
bo co ngay cho ngi qun l cp trn trc tip c bin php x l kp thi
v ngh lm r nguyn nhn, trch nhim.
5. Thuc d ra do thay i y lnh, do ngi bnh chuyn khoa, ra vin, chuyn
vin hoc t vong (sau y gi chung l xut vin) c tng hp (theo mu
Ph lc 4), c xc nhn ca trng khoa lm sng hoc ngi c trng khoa
lm sng y quyn bng vn bn v tr li khoa Dc trong vng 24 gi. i
vi thuc gy nghin, thuc hng tm thn, thuc phng x d ra phi lp bin
bn v tr thuc theo quy nh hin hnh.
6. Tng hp thuc, ho cht, vt t y t tiu hao ca tng ngi bnh trc khi ra
vin chuyn phng Ti chnh - K ton thanh ton vin ph.
7. Thc hin bn giao s lng thc t v thuc v dng c cho kp trc sau v ghi
S bn giao thuc thng trc v S bn giao dng c thng trc (theo mu
Ph lc 8, 9).
8. Nghim cm vic c nhn vay, mn, i thuc.
iu 8. Bo co

35

1. Khi xy ra cc trng hp c bit (tai bin, nhm ln) v s dng thuc cc

bnh vin cn x l ngay v bo co v c quan qun l cp trn trc tip.
2. Bo co phn ng c hi ca thuc (theo mu Ph lc 5) v c quan qun l cp
trn trc tip v Trung tm Quc gia v thng tin thuc v theo di phn ng c
hi ca thuc.
3. Bo co s dng thuc gy nghin, thuc hng tm thn, thuc phng x theo
quy nh hin hnh ca B Y t.
Cu 4. Vai tr cua H i ng Thuc v iu tr trong bnh vin? Thnh phn cua
H i ng Thuc v iu tr trong bnh vin?
Tr li: Ngy 04/07/1997 B Y t ban hnh ch th 03/BYT-CT v thng t 08/BYTCT v vic Hng dn t chc, chc nng v nhim v ca Hi ng thuc v
iu tr bnh vin nhm mc ch qun l s dng thuc hp l, an ton, kinh t
trong khu vc bnh vin.
Vai tr:
T vn thng xuyn cho ban gim c v cung ng, s dng thuc an ton,
hp l v hiu qu.
Thc hin tt chnh sch quc gia v thuc trong bnh vin, c th ha cc
phc iu tr ph hp vi iu kin bnh vin.
Thnh phn:
Ty theo hng bnh vin, Hi ng c t nht 5 thnh vin tr ln, bao gm cc
thnh phn sau y:
1. Ch tch Hi ng l Gim c hoc Ph Gim c bnh vin ph trch
chuyn mn;
2. Ph Ch tch Hi ng kim y vin thng trc l trng khoa Dc bnh
vin;
3. Th k Hi ng l trng phng K hoch tng hp hoc dc s khoa
Dc hoc c hai thnh vin ny;
y vin gm:

36

Trng mt s khoa iu tr ch cht, bc s chuyn khoa vi sinh v iu dng

trng bnh vin;
Cc bnh vin hng II tr ln c thm y vin dc l hoc dc s dc lm
sng;
Trng phng Ti chnh - K ton.
Cu 5. Lp k hoch thng tin thuc cho bnh nhn trong bnh vin trong 6
thng cui nm 2015:
Tr li:
1. Mc ch, yu cu:
Mc ch:
Cp nht cc thng tin v thuc ti cc bnh nhn v ngi nh bnh nhn
nhm nng cao hiu bit v thuc iu tr, nng cao hiu qu iu tr, m
bo hp l, an ton, trnh lm dng thuc.
Tr li, cung cp thng tin gii quyt cc cu hi v thng tin thuc m bnh
nhn v ngi nh bnh nhn t ra.
Yu cu: Khoa dc phi hp vi cc bc s lm sng trong vic cung cp thng
2.

tin, t vn s dng thuc.

Ni dung thng tin:
Thuc cn k n v thuc khng k n
Tn thuc do nh sn xut t.
Tn hot cht hoc tn gc (tn genegic).
Ch nh.
Cch dng.
Tc dng ph.
Chng ch nh v nhng iu phi phng.
Yu cu v ni dung thng tin:
Khch quan, chnh xc, trung thc, mang tnh khoa hc, r rng v dt khot.
Thng tin thuc cho bnh nhn cn c ni dung ngn gn, d hiu vi cc hnh
thc thng tin n gin, c gng tn dng cc phng tin truyn thng sn c
nhm gip bnh nhn hiu r li ch v tc hi ca thuc, tun th cc hng

dn iu tr, m bo thc hin s dng thuc hp l v an ton.

3. nh gi phn hi thng tin, mc tip thu ca bnh nhn:
Thc hin kho st, kt hp vi cc khoa lm sng, nh gi mc hiu qu
ca qu trnh thng tin thuc n bnh nhn.

37

nh gi da trn vic bnh nhn thay i nhn thc, s dng thuc mt cch

4.

hiu qu, hp l, an ton.

Hnh thc kho st, nh gi:
Trc tip.
Bng cu hi.
T chc thc hin:
Dc s lm sng ph trch cung cp cc thng tin thuc theo danh mc n cc

khoa lm sng.
Phi hp vi cc khoa lm sng t chc i n trc tip cc phng bnh thc
hin thng tin thuc cho bnh nhn v gia nh bnh nhn.
T chc cc bui gp mt, hi tho t vn, gio dc cho bnh nhn v ngi nh
bnh nhn.
B tr khu vc t vn s dng thuc.
Da vo kt qu t c ca qu trnh thng tin thuc cho bnh nhn trong
thng u tin, ln k hoch cho nhng thng tip theo.
Cu 6. xut nng cao hot ng
dc lm sng bnh vin:
Tr li:
V mt nhn lc: Ch trng tuyn chn ngun nhn c o c v nng lc. Tp
trung o to cc sinh vin c am m vi lnh vc lm sng bnh vin c c
hi tip cn v hc hi kin thc. Hc tp kinh nghim ca cc bnh vin ln
trong v ngoi nc phc v cho thc t ti bnh vin bng cch lin kt o
to vi cc n v c cht lng.
To h thng lin kt vi vi cc bn vin ln kp thi cp nht thng tin
quan trng nh cc bo co ADR, co thuc mi, k thut mi p nhu cu
cp thit trong vic phng v cha bnh.

38

TI LIU THAM KHO

1. B mn Dc l Dc lm sng (2014), Gio trnh Dc lm sng 2,
Khoa Dc Trng i hc Y dc Cn Th.
2. B mn Dc l Dc lm sng (2014), Gio trnh Dc l 2, Khoa Dc
Trng i hc Y dc Cn Th.
3. B Y t (2012), Hng dn hot ng Dc lm sng trong bnh vin,
Thng t s 31/2012/TT-BYT.
4. B Y t (2011), Hng dn s dng thuc trong cc c s y t c ging
bnh, Thng t s 23/2011/TT-BYT.
5. B Y t (2008), Quy ch k n thuc trong iu tr ngoi tr, Quyt nh s
04/2008/Q-BYT.
6. B Y t (2013), Quy nh v t chc v hot ng ca H i ng Thuc v
iu tr trong bnh vin, Thng t 21/2013/TT-BYT.
7. B Y t (2014), Tng tc thuc v ch khi ch nh, Nh xut bn Y hc.
8. Ng Qu Chu (2012), Bnh hc ni khoa tp 2, Nh xut bn Y hc, trang
24, 188.
9. Nhan Trng Sn (2012), Tai mi hng nhp mn, Nh xut bn Y hc, trang
280.
10. Phm Nguyn Vinh (2008), Bnh hc tim mch tp 2, NXB Y hc, trang
230, 258.
Trang web:
11. http://reference.medscape.com/drug-interactionchecker
12. http://www.drugs.com/interactions-check.php?drug_list=1720,531-0,1549-0,1750-0
13. http://www.drugs.com/interactions-check.php?drug_list=5590,1086-0,1433-0,1489-0
14. http://kcb.vn/vanban/quyet-dinh-so-042008qd-byt-ngay01022008-ve-viec-ban-hanh-quy-che-ke-don-thuoc-trongdieu-tri-ngoai-tru

39

PH LC
Ph lc 1. Thuc s dng trong 2 mu n
ST
T

Bit dc

Tanatril

2
3
4

Diezar
Melorich
Patest
Omepraglobe

5
6
1
2

20mg
Suncardivas
Pulracef
Alphachymotryps
in

Ambroxol 30mg

Losartan 25mg

Fexophar 60mg

Prazodom

Hot cht
N S 1
Imidapril

Hm

Dng bo

ng

lng

ch

dng

hydrrochloride
Amlodipin
Meloxicam
Mephenesin

10mg

Vin nn

Ung

5mg
7.5mg
250mg

Vin nn
Vin nn
Vin nn

Ung
Ung
Ung

Omeprazole

20mg

Vin nang

Ung

Vin nn

Ung

Vin nn

Ung

4.2mg

Vin nn

Ung

30mg

Vin nn

Ung

25mg

Vin nn

Ung

60mg

Vin nn

Ung

Vin nang

Ung

Carvedilol
6.25mg
N S 2
Cefuroxime
250mg
Chymotrypsin
Ambroxol
hydroclorid
Losartan kali
Fexofenadin
hydroclorid
Lansoprazol (1)

(1) 30mg

Domperidon (2)

(2) 10mg

40

Ph lc 2. Minh chng ti liu tham kho

STT
Ngun ti liu
Thng tin
1
Bnh hc tim mch tp 2 (2008), Nh xut bn Y Thng tin v bnh
2

hc, trang 230, 258

cao huyt p
Bnh hc ni khoa tp 2 (2012), Nh xut bn Y Thng tin v bnh h

hc, trang 188

ct sng
Bnh hc ni khoa tp 2 (2012), Nh xut bn Y Thng tin v bnh
hc, trang 24

vim lot d dy t

Gio trnh Dc l 2 (2014)

trng
Tai mi hng nhp mn (2012), Nh xut bn Y Thng tin v bnh

hc, trang 280

vim hng cp
Tng tc thuc v ch khi ch nh (2014), Thng tin v tng
Nh xut bn Y hc

tc thuc

http://reference.medscape.com/druginteractionchecker
http://www.drugs.com/interactions-check.php?
drug_list=172-0,531-0,1549-0,1750-0
http://www.drugs.com/interactions-check.php?
6

drug_list=559-0,1086-0,1433-0,1489-0
Gio trnh Dc lm sng 2 (2014)

Thng tin v
Omeprazole ung vo

http://kcb.vn/vanban/quyet-dinh-so-042008qd-

bui sng trc n

Thng tin v vic k

byt-ngay-01022008-ve-viec-ban-hanh-quy-che-

n thuc trong iu

ke-don-thuoc-trong-dieu-tri-ngoai-tru

tr ngoi tr

41

Ph lc 3. Minh chng tra cu tng tc thuc

Theo trang MEDSCAPE.COM
http://reference.medscape.com/drug-interactionchecker
.....................................................................................................................................

42

Theo trang DRUGS.COM

http://www.drugs.com/interactions-check.php?drug_list=172-0,531-0,1549-0,17500

43

http://www.drugs.com/interactions-check.php?drug_list=559-0,1086-0,14330,1489-0

44

http://www.drugs.com/interactions-check.php?drug_list=5590,1086-0,1433-0,1489-0