Dc cac yto qdinh tac dung cua thuoc

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Bi Ging dc l i hc y Dc Cn Th

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  • 1. 1 Trng i Hc Y Dc Cn Th Khoa Dc Mn: Dc L Hc BIN I V CM TH CA C TH I VI THUC
  • 2. 2 Mc tiu: K c cc yu t quyt nh tc dng ca thuc. Phn bit s dung np v khng dung np thuc. Phn bit c hin tng quen thuc v nghin thuc. Vn dng nhng kin thc hc vo trong thc t hot ng ngh nghip.
  • 3. 3 1.1. CC YU T THUC V THUC: Thay i v cu trc lm thay i dc lc hc ca thuc. Thay i v cu trc lm thay i dc ng hc ca thuc. Liu lng dng: Mt s loi liu dng thuc thng dng: Liu ti thiu. Liu iu tr. Liu ti a. Liu c. Liu cht. Cn c vo thi gian dng thuc, cn c liu: Mt ln (Liu dng vo mt ln). Mt ngy (Liu dng trong mt ngy). Mt t (Liu dng cho c mt qu trnh iu tr). 1. CC YU T QUYT NH TC DNG CA THUC
  • 4. 4 1.1. CC YU T THUC V THUC: Dng thuc: Trng thi ca dc cht. T dc phi hp trong dng thuc. K thut bo ch. Dung mi ha tan cc dc cht trong cc dng thuc lng. 1. CC YU T QUYT NH TC DNG CA THUC CHT LNG THUC
  • 5. 5 1.2. CC YU T THUC V NGI BNH: 1.2.1. c im v tui: a. TR EM Tr em, c bit tr s sinh c nhng c im khc ngi ln: Chc nng gan, thn cha hon chnh. Kh nng lin kt thuc vi protein huyt tng km. Hng ro mu no cha hon chnh. Thuc lc v thi tr qua thn cn km. Do vy tr em d b ng c thuc hn ngi ln. 1. CC YU T QUYT NH TC DNG CA THUC
  • 6. 6 1.2. CC YU T THUC V NGI BNH: 1.2.1. c im v tui: b. NGI CAO TUI Ngi gi: Cc chc nng c th gim. Kh nng thch nghi ca c th du km. Sc khng gim. Do vy phi thn trng khi dng thuc cho ngi gi, phi iu chnh ch v liu lng thuc. 1. CC YU T QUYT NH TC DNG CA THUC
  • 7. 7 1.2. CC YU T THUC V NGI BNH: 1.2.2. Gii tnh: Vi ph n, ngoi c im khc bit v trng lng c th so vi nam gii, cn c nhng thi k sinh l cn c lu . Ch thn trng 3 thi k sau: 1. CC YU T QUYT NH TC DNG CA THUC Thi k kinh nguyt Thi k thai nghn Thi k cho con b
  • 8. 8 1.2. CC YU T THUC V NGI BNH: 1.2.3. Cn nng. 1.2.4. Trng thi sinh l v bnh l. Mt s thuc ch c tc dng i vi trng thi bnh l. V d: Paracetamol ch c tc dng h nhit ngi ang st. Mt s bnh gy nh hng n t l thuc t do trong mu. V d: bnh x gan, chn thng, phng, Mt s thuc d gy tai bin khi dng trong trng hp ang mc mt s bnh..V d: Suy tim khng dng cc thuc lm tng huyt p; Suy thn khng dng cc khng sinh h Aminosid, Sulfamid khng khun. 1. CC YU T QUYT NH TC DNG CA THUC
  • 9. 9 1.2. CC YU T THUC V NGI BNH: 1.2.5. Ging ni. 1.2.6. Trng thi c th. Qu nhy cm vi thuc do bm sinh hay do thu nhn. 1.2.7. Cch dng thuc. Dng thuc lin tip trong thi gian di, c th tr nn quen thuc. 1.2.8. Ch n ung. 1. CC YU T QUYT NH TC DNG CA THUC
  • 10. 10 1.3. NH HNG CA THC N, NC UNG TI TC DNG CA THUC : Nhn chung thuc c hp thu tt nht ng tiu ha khi i. Mt s thuc b chm hp thu hay gim tc dng do thc n. Ch n thiu protein, lipid s lm chm chuyn ha mt s thuc gan. 1.4. THI IM DNG THUC. 1.5. NHNG YU T THUC V NGOI GII : Nhit mi trng. nh sng, tia cc tm. S tp hp ca loi vt. Ma v chu k ngy m. 1. CC YU T QUYT NH TC DNG CA THUC
  • 11. 11 2.1. PHN NG C HI CA THUC (ADVERSE DRUG REACTION-ADR): ADR ca thuc l mt phn ng c hi , khng nh trc v xut hin liu lng thng thng. Tai bin do thuc c th nh, c th nng; c th biu hin ngay sau khi dng thuc hoc xut hin sau mt thi gian, c khi rt lu. Cc biu hin c th l: sc qu mn, gy tn thng da v nim mc, tn thng nh trn cc h c qua nh h hp, thn kinh, tit niu, tim mch, ni tit, tiu ha,. Thng thng cc thuc c dng rng ri li hay gy tai bin nh: khng sinh, sulfamid, thuc chng lao, thuc chng st rt, thuc tim mch, thuc ng v thn kinh, thuc chng vin, gim au, h st.. 2. NHNG TRNG THI TC DNG C BIT CA THUC
  • 12. 12 2.1. PHN NG C HI CA THUC (ADVERSE DRUG REACTION-ADR): 2. NHNG TRNG THI TC DNG C BIT CA THUC
  • 13. 13 2.2. PHN NG D NG: D ng thuc cng l mt AR. y l phn ng kiu khng nguyn-khng th. Do thuc l mt protein l, c phn t lng cao. Cng c trng hp do sn phm chuyn ha ca thuc gy d ng. Cc phn ng d ng thuc khng lin quan n liu lng thuc dng, s ln dng v thng c d ng cho. 2.3. TAI BIN THUC DO RI LON DI TRUYN: Thng do thiu enzym bm sinh, mang tnh di truyn trong gia nh hay chng tc. V d: Thiu men G6PD hoc Glutathion reductase s d b thiu mu tan huyt khi dng primaquin, quinin, sulfamid,.. 2. NHNG TRNG THI TC DNG C BIT CA THUC
  • 14. 14 3.1. HNG PHAN ( EXCITATION) La hien tng tang cng chc nang va hoat ong cua cac tang, cac mo, cac te bao, nhat la te bao than kinh, cua toan c the. Chu y phan biet: Kch thch (Stimulation) Kch ng (Irritation) 3.2. C CHE ( DEPRESSION) La hien tng giam thieu chc nang va hoat ong cua cac tang, cac mo, cac te 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 15. 15 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH 3.3. S DUNG NP THUC (Dung nhn thuc): L xu hng tng thu nhn ca c th i vi mt thuc mi to ra c mt p ng, m trc ch cn mt liu thp hn cng c mt p ng i vi dc phm nh vy. Tnh cht: Ch xy ra i vi mt s tc ng ca thuc. Gy hi chng cai thuc.
  • 16. 16 3.3. S DUNG NP THUC (Dung nhn thuc): 3.3.1. S dung np bm sinh: C nguyn nhn t yu t di truyn. 3.3.2. S dung np thu nhn: L trng thi gim p ng vi thuc khi s dng thuc nhiu ln, v vy cn tng liu t hiu lc nh lc ban u. Cn phn bit mt s khi nim: i. S lm dng thuc (abuse). ii. S dng sai thuc (misuse). iii. S min dch nhanh (Tachyphylaxis). iv. S l thuc thuc (Dependence). 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 17. 17 S LM DNG THUC: L tnh trng mi bt u s dng cc cht c tc dng tm thn, l hnh vi c th ngn chn c. S L THUC THUC (DEPENDENCE): L mt tnh trng lm dng thuc mc cao, vi cc tnh cht sau: S dng thuc nhiu ln hoc liu cao hn bnh thng bt chp cc tc ng c hi v tm l v th xc. Dung np thuc r. C hi chng cai thuc khi ngng thuc t ngt. Khng th ngng hoc gim liu duy tr cm gic khoan khoi v ngn hi chng cai thuc. 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 18. 18 S L THUC THUC (DEPENDENCE) Trong s l thuc thuc, c th chia ra: i. S l thuc v tm l. ii. S l thuc v thn th. iii. S quen thuc (Habituation). iv. S nghin thuc (Addiction). 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 19. 19 S L THUC THUC (DEPENDENCE) a. S quen thuc: L mc nh ca l thuc thuc, vi c trng: C s thm mun nhng khng bt buc dng thuc. C mt s l thuc no v mt tinh thn. t hoc khng c nh gia tng liu dng. Hu qu tai hi c th xy ra, nhng ch nh hng n c nhn. 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 20. 20 S L THUC THUC (DEPENDENCE) b. S nghin thuc: L mc nng ca l thuc thuc, vi c trng: C s thm mun khng th nhn c, bt buc phi dng thuc v tm cch kim cho c thuc bng bt c phng tin g. C mt s l thuc c v tinh thn v th xc. C nh gia tng liu dng r rt. C nhng thay i v t cch, c hi cho x hi. 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 21. 21 3.4. S KHNG DUNG NP THUC: Mt s c th c phn ng mnh vi thuc, hiu ng dc lc xy ra liu thp hn nhiu so vi liu iu tr. liu tr liu ca ngi bnh thng c th c biu hin triu chng ng c. 3.4.1. S khng dung np thuc bm sinh hay c ng: L p ng bt thng sau khi s dng thuc liu u tin. 3.4.2. S khng dung np thuc thu nhn hay s qu mn: L s tng dn tnh nhy cm i vi mt thuc, cng l phn ng gia khng nguyn v khng th. D ng thuc (Allergy). Sc phn v (Anaphylaxis). 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 22. 22 3.5. S KHNG THUC: L hin tng xy ra sau khi vi khun, k sinh trng trong c th tip xc lu ngy vi thuc. 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH
  • 23. 23 3.6. S NG C THUC: L tnh trng hy hoi thc th hoc c nng sng, sau khi hp thu thuc di bt k hnh thc no. C hai hnh thc: Ng c cp tnh. Ng c mn tnh hay ng c trng din. 3. NHNG HIN TNG DC L XUT HIN TRONG QU TRNH TC NG CA THUC LN C TH