Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 bai giang gay me hoi suc i file 1

Th o~ hap thu nhanh qua ong tieu hoa do khuyech tan thu dQng r6i q jh~ thong cua den gan va bi phan Imytai day truce khi vao hQ tuan hoanl D0vay neu cho ucn phai dung lieu cao gap 2 - 3

" ? BAI GIANG

DUNG CHO £)~I HQC VA SAU £)~I HQC

"

TAP I•

khac nhu cocain Cung v6i rnorphin tv nhien, hien nay cac 10<;1.imorphinban t6ng h<;1pva t6n h p cia ra d6i v6i cau true don gian han nhung c6 tacdung rnanh han, nhanh han.

O£ln dclY nh6 phat hi0n diroo cac receptor d~c hi~u ella morphin vamorphin noi sinh nen cluing ta eta hi6u 1'6 them ve co che tac d1,lng cua'chung Giarn dau ho mOl'phin ngay carig dLiQc s-i.'tdung nhicu han ch£ngnlnrng trorig dicu tri cac chung dau ca'p tinh (giam dau sau m6, t1'on m6 ).,,"' con up d\lng d~digu tri citechung nau men tinh nhu uug tlllr giai doanplIoi,gay te Vtlng, dam rOi

, Day la loai giam dau trung u (jng manh llhi1t duqc sild\Ing nhi €u tro ng

~,\ sau m6 Tuy nhien C lllr'U phai 1a thuoc ly tli0 g vi con c6 tae d~mg ph1,lkllong mong muo'n, nhf{t I,I t1'en bQ may ho h£ip

By lllol'phin chia hai h.li:

+ LO~li co nh<1n piperidin-phenanthren gam: morphin, codein,

heroin C6 tac cl\ll1g t.ren th~n kinh trung Liang

411

Th o~ hap thu nhanh qua ong tieu hoa do khuyech tan thu dQng r6i q (j

h~ thong cua den gan va bi phan Imytai day truce khi vao hQ tuan hoanl D0vay neu cho uc)n phai dung lieu cao gap 2 - 3 Mn lieu tiern moi co tac dung f!,

~ Dat hau men, diroi l udi, tiern duoi da, tiern b~p, tiern tinh mneli~ v.v Thuo~ c6 tac dung nhanh, rnanh nhu n kha nha u ve cuorig dQ, t}lb r~gian, co dia, lieu hrorig, toc do VaG v.v vi thu<')c kh6ng bi phan huy QUI\

Morphin Pethidin Fentanyl Alfentanyl

Thuoc h9 morphin phan phoi nhanh (; dic kh V l ;iC nhieu tUfrn hoan n If:

nao, gan, th0-n, p 6i, Iach, tim 81,1phan phoi clla thuoc (; h~ thAn k i n

trung liang va dao thai ph\1 thuQC VaG ty 1$ d~u / rntoc va tinh tan trong rn a

clla thuoc.

Morphin tan trong md yeu, qua han rao mau nao kh6 khan Chi' c6 t~ l~

nho clla lieu (0, 1 - 0,0 1 %) tac d \1 ng tren h$ thong th1:ln k i nh tr u ng uong

(central neruous system SNC) nen co tac cl\lng cl1:)m Dao thai Clla morplilin

tu 8NC ve hQ tuAn hoan ch0-m, ben tri&n khong song song giua huyet dQn

clla SNC v i huyet tt.long nen thuoc tilc d\ll1g keo el:'l i

Fentany1 tan trong md nhiC~u nen phan phoi n11anh VaG SNC DQng 119c

clla thuoe trong SNC ty IQ thu0-n voi huyet tuong l1en CCl tae d\mg n an ,

ng; ' ~n (hAng 27.1) '1'inh tan trong mU nhieu cling quyet dinh 81) Lich luy thu6'e

tro g md 81,1phan phoi nhieu ella fentanyl trong md q yet dinh S\ tai phan

phoi eh$,m ella n6 tu 8NC ve hQ tu~n hoan nen (1'1 /2~) th0i gian ban dn

thai ch$.m han morphin

Alfentan l c6 th6' beh phan p116i (Vd) thap nht{L va th0i gian ban dao tHih

(Tl/2~) n ~n nhat nen c6 U1C dVng nh0nh, ng~n.

Tat ca Opiate dEb qua rau thai,' nen m~ nghiQn morph i n thi n6ng QQ

thuoe (; nao thai nhi lOn h(jn 3 lcin nong dQ thuoc ('J nao me; Tuy nhien nong

' 1 (de ra bi suy dinh during, d e non do giarn tiet hormon huon thai

.matotropin, roi 10:;Lnhanh vi tan hung phan, tang phan X:;L,tang tru n

~, i'a chay, tang- tiet m6 hoi v.v giong nhu trieu chung eai nghien) Vdi me

i c6 the say thai, de non v.v

I Chuy e n hoa va th a i tnr

~ Tat ca c c IO:;Limorphin diroc chuyen hoa d gan, say ra tai cung Ivai noi

~t£i-J"lt theo mot co ehe hoa Oxydoreduetion (eytoehrom P450) h a, ucuroeo jugaison (gIueuronyI transferase) Cac chat chuyen hoa tan trong

~3cduoc thai tru qua th?n theo nude ti6u ra ngoai (30%) M9t 1vc;Jngnho

!L ¥3mat, mot phan nho qua m6 hoi, sua, mtae bot

i~~

~ ;

~WI:~DL1QC LIJC HQCt (Pharamacodynamique)

~.:>.

i Tac dyng tren than kinh trung Lfdng

~, HQ morphin co thS gay ue ehe ho$c kfch thich h9 th~n kinh trung Vo'ng,~(\C) Neu ue che se gay tac d\lng giam clau, ue che ho ha'p, gay ngu, mQt so

~;J ~ '!1thay d6i di~n nao d6 (Electro-eneephalographie) Neu kfeh thich SNC se

liP :-co d6ng tv, buon non, non

~ ' '':,

~ir 1 Tac dljng gi a m dau:

~ Day la tac d\lng chinh v6i o$e diSm m0nh, 6n o~nh, xu[{t hi~n ngay tu

~ ~ i:;~'nh6,J tang len theo ty 19thu(m eho Wi khi bao hoa toi da

~'

~;1: 2 T G d~mg g a y ngu:

~~: Do uc che chQn lQctren SNC, tac cl\lng 16n h$ th n Limbique, tuy nhien

~ 6 :n lam me ngay ca khi eho lieu eao

Ii Tren dien nao dO'(EEG):

~""

~ Khi dung lieu 100 ~lg fentanyl hO(lC sufentan l ct~ khdi me m6 ·tim se

f m: fthi~n song a ch$.m, song y nhanh vii riii rae co song 5 (delta)

1' #.

~tJ4"G a c fac dung khEic:

~." An th~n, sing khoai, co d6 g tv d lieu cao gay co gi$.t, ilO giac, roi lO l; ln

~ b?o clai thd kiSu Cheynes-Stokes r6i ngung thd Lam gia111thS tich kh£

in : ~thon (Vt) do tae d\lng len th~n kinh Vi)n dQng co' lien svijn lam thd gap,

~n t nan nhat la trong gay te tuy song

~ - - ~ - ,,

Thuoc c6 th6 gay co cung long nguc nhat la doi voi mot so morphin m:fL ~ !

(fentanyl, sufentanyl ) khi dung lau; keo dai, qua leu lYc che ho hap ':Iil~~phu thuoc vao tu6i (gia, trc em bi nhieu han) Thuoc gay ire che ho do(1(" cw

trung tam ho, co tao dung ngay 6li~u thap nhat Th oc gay co that phe~ i

do tiet histarnin

3 Tac dunq tren tim mach: Nhin chung it anh huon

C6 thE;gay nlrip cham xoan do kich thich nhan day x ( }san nao t&~~

4, c6 th6 dung atropin d6 dieu tr; thi het

Do c6 tiet histamin n811gay gian 1110.ch(dong mach va tinh 1110.c' "IIvay c6 th6 gay tut huyet ap nhat la khi c6 giam khoi luong tuan ho~~

H9 morphin gay buon n6n va n6n do kich thich vung cam th\l hoa h t{' " itrung tam non Nhf{t la sau 1116do c6 giam truan h,tc d0 day va tang tru!Xli

H9 morphin lam tang tnWng h,tc co th&t bang quang, lam giam tnl~l\l'Cva ho0.t d9ng co clQcbang quang nen gay bi dili nhat la gay te tu s~C6 th6 lam tan ti6t ADH (nQi tiet to chon bai niQu) gay dai it Ii

J~

Morphin gay co dong tli do kich thich nhan giao cam Edinger- W estR~clla th~n kinh vQ_ndQn nh8.n du, lam giam ap h,tcnh8.n c~u, roi 100.n i~tiet m&t, gay hi0 tlt0 g rung gi~t nhan c~u (Nystagmus) .~

Na1111973, vi$n n hien cuu Snyder; Terenius va Simon dong th(ji c~

xac d~nh dU0CEe eptor d<ItchiQu clla morphin Chung (5 nao that va th~ - ' ~ j

clla Rolando d t U) T song clla' dQng vQ_tc6xuang song va 6 trong nao t$.p tr~

chinh d h0 vi~n, dUdi doi, doi nao va nhan duoi d<Itcbi0t (5 cac tn,lc th~n ~(Nevraxe) (5 vung d~n truyen va vung t$.phClPcac cam giac dau Ngoai r 1!8con c6 6 c c vung th~n kinh chi phoi rUQt vung h i trang (Auer-Ba £.- 4

l1eceptor clla Opiate co nhi~u l00i va co tac d\lng khac nhau:

Re eptor Mu ( ~l)c6 tac d\lng giam dau, uc che ho hap, tac d\ll1g len t iln

m0.ch,rU9t, dl?-day, gay thb a, khoan khoai co dong tli ~Receptor Delta (8) c6 tac d\ln tuang ta voi receptor Mu ve cac tac d1;lg :nhu: giam ho hap, ch$.m nhjp tim, san khoai, quen thuoc

Receptor Kappa (K) co tac d\lng giam dau, an th~n

Re eptor Sigma (L::) c6 Uic d\lng gay roi lo"m th~n kinh th\l'C v$.t, gi~

IV RECEPTOR CUA MORPHIN

Receptor Epsilon (2) tac dVng con chlia r o

' V

'.;,

,V co CHE GIAM DAU CUA MORPHIN:

Sa u khi tim duoc recepto r c u a mo rphin va endorm orp h in t hi vie c c a t

: [\ gh l a tac dung giarn dau c 6 khac han.

· 'I' r u c k i a c h o d n d t h a n na o c6 hai n oi ch u a nhi ti u r e e p t or c u a

; morph in va do l a n i l a m g iarn d a u cua Op i at va e ndormorphin, n un g

: a hi eu n tr oi c h a n at t rf boi le k i tie rn t h a n morph in va o d6 t hi ta c d u ng

; g1 am da u k h6 ng nh a nh va manh ha n.

S a u n ay gia: t h ic h qu a t rinh giarn d a u nhu s a u : Su d ~ n truyen ca m giac

.•.iau la do sci m ye lin ? (A) va sci k h6 n c 6 myelin ( C) dam nhan d a tu n oai

vi VaG tr un g uong d e l en nao Cac kich thich true ti f) p hay gian tep (dau,

n n g, l a n h ) r ih an ca m nay du oc c hu yen v e t ru ng ta m q ua sci A v a C d c n

·sung sa u tuy so n va heat ho a e<'lCs Qi n eu ron d th6 k eo Ro la ndo (l o II va,HI, s ung sa u tu y so n g) 'I :q_ id ay sQi C tie t ch at P (la m tii n d ~ n truyen cam

: gl aC d a u ve t ung t a m ) d e k i c h thich t ~ n cun & du a i g ai cua neuron lOpV r6i

~;: b ~ t c heo sa n b6 P a leo - Spino - T~ a l a miqu e de d ~ n t ruy e n ca m g iac dau v e

· U ) \ d6 i th ~- v o nao N hl i n co th e chung ta c6 c o ch§' c! oi ph6 bu trlt nhu s a u:

; tr <?- i lOpII v a III b et ra ch a t o nke p h alin (E) ch at nay kc t helP vo i c a c r e cept o r

d~li c c h e' s Qi C tiet ch at P d 6 l a m g ia m va t r i~t tie u cl ~ n t ru ye n c ac kich

", tr h ich d a u t u n g oq_i v ~ ve t run g tam Hun het dau.

~.1.3 Khi phol hQfJvai IMAO gfiy phan u'ng m~Jnhnhu~run , cung (t21, co gi~t,

ru n g g i ~t nh a n d u , t hd nh a nh, sot cao V i} c 6 t h § tang h uyct a p d 9 t n g Q t , va

: :1'2 0 h oi , g i a n d 6 g t li do kich t hi ch t h rl n lci n h tr un g uo n g, nh a t 18 khi dun g

! [ L£\O ket hQp voi Pethidin.

I

:2 1.Tat ca thuoc huy giao c a m: re s erpin, aldom e t khi kcthqp v(ii

O piate c6 t h§ gay t v t hu yet a p n ( 111g

1 2 Ket hqp va i scopo/amin l a m ta ng t fl c ch;ll1 g la m dtu cu a morphin , giam

!i l~ng, tan g tinh tr ? n m a t tri nho, tan g U 1C dVn g su y h hap cua morph i n

: ]_ 1 Thuoc me: Opi a te ket hQp v o i cac 10 "l i thu oc me gay ta n tac dVng suy

~k,h a p

' ] _2. Cac thuoc ho'i sue (An a leptic) l a m ti l n h 6 ha p, de gay co g j ~l t v.v .

4 15

Morphin it tan trong md nhat cua nh6m morphin ChiQCs11 dung

lam sang, tn kiern yeu, trorig luo g phan tv 285, h~ so ph

dgtu/nvOc=6 Ty 19 ion hoa khoarig 79%(; pH 7,4 va 85% (jpH 7,2 H~ so

ly pKa = 7,93 Morp in co dinh vdi protein huyat tuong 30-35% rna chu

vd i albumin

Morphin chuy~n hoa chu yeu (j gan (80%) tharih chat kh n heatthea ba phuong thirc kh ac nhau: Glucuroconjugaison, Sulfocojugaiso

N-demethylatior, d~ th anh diin xuat glucuroconjuges 3,6 Diin x at L

tan trong nuoc hem morphin, q a rat it hang rao mau nao (5 n6ng d9thucng Dao thai chu ycu q a nuoc ti~u duci dang glucuroconju

Khoarig 70-80% diroc dao thai 48 giG dgtu qua n uoc ti~u, khoarig' duo: dang kh6ng thay d6i va 1 % dudi dan normorphin 5% dao thaim~t, phan

Morphin c6 thGi gian ban dao thai (T 1 / 2~) ng~n so voi cac lo<;ti0

khac khoimg 2,5 giG, th~ tich phan phoi (Vd) 3,2 L /kg, d9 thanh

15ml/phu qua rau thai tot, (ban 27.3) Sau nhieu nghien cuu

thay kh6ng c6 slj thay d6i ve dVQcdQng hQc(jn liGi xCigan, suy th~n

c6 slj u d9ng cac san ph§'m chuy6n hoa Glucuror.onjl lge khi suy th~n

.Ban 27.4 'rac dy.ng giam dau cua morphin (j giua

dextromoromid, thdi gian giam dau lau nhat cua hQ morphin

Morphin c6 tac d\lng giam dau m0.nh va 6n dtnh, lieu cao c6 th6 gay

me, C'J gi~t, ao giac, roi lo~n y thuc.:,it thay d6i llIu llIQng mau nao, tu

n6 ph\l thuQc VaGPaC02 va ap h ,iC dQng m~ch

Gay tang ap IljCn9iSQ.Tren di9n nao do mat s6ng a va xuat hi~n s6n

, 4 2. 'tee dl.!ng tren tim mecn

4.3 Tee dl.!ng tren ho hap

o

q ua n

4.4 cec tee dunq ktuic:

5 chI d!nh

5~2.Gay me: dtIng d~ giam dau trong me)'khi duy tri me

5 3 Dung de ' giam dau sau m6 hoc).ccac b¢nh dau m9-n tinh (ung thu' giai

i.1 Tuy£jt dOl: hQi chung dau bl,lng d{p chLia 1'0 nguyen nh:1n, tang nh<%t.y

1 2 Tuong dOl: hen phc quan, di ling, suy ho hap, suy th<%tnn~ng, soc chiiy

f Lieu IWJng:

417

1 Tinh ch a t Iy ha il : (Bang 27.1) gan gio'ng giua mcrphin va fentan l T

2. Chuyen ha il: Chu yeu d gan 50-75%, cac chat chuyen hoa d oc dao 1

d6 i ) va 70% dao t h a i qua mat Tran g do c hat chu y en hca ch inh la n orpet :

3 DLtc;1Cdonq hoc (bang 27.~): Thuo'c c6 thoi gian ban dao thai va tli~

5 Ch i d!nh: d~ tien me, giam dau sau m6, giam dau tron mel

6 Chong chI d!nh

ap lvc nQiS Q

7 Lieu ILfc;1ng

Te tuy s6n : 1,2 - 1,4 mg/kg

1 Dtroc d9n9 h9C ( Ph a rm acoc in etque)

1.1 SI/ htrp thu cue thuoc

Fentan l d6 dan hap thu ban nhieu duong' khac nhau Khi uon g thuoc

Fentan l phan phoi nhanh (j nhirrig khu vue co rihieu tuan hoan nhir:

'I'huoc co thoi gian ban ( 1[10 thai (T1/2~)k oang 3,7 gid d n u i len, tre em

~-khoang 2 gio C6 su tu n phan giua tac dVn rat ng~n va dao thai ch~m

~cia thuoc do tnh rat tan trong m d clla thu e nen qua hang rao mEtl.lnao

! n anh vi v~y thu c c6 tac dVn nhanh va ng~n

Khi dung lieu cao va nh~c l?i nhieu l~n se gay hi9n tllQn tich luy va tai

phan phoi co th§ t?O ra thong khi cEnh(PIC) thli phat d&nden c6 th§ gay lic

~he ho hap thli phat Lien ket voi protein huyet tlld g (albumin) 6 -8 %

pKa = 8,4; th6 tich phan ph i (Vel) = 4 L /kg d n lldi lOn, trc em = 3L / k g.

Thuoc qua rau thai t6t

i 1 3 Chuy6n hod

1'h 6c ch:uy~n hoa (j gan 70-8 % nh0 h thon Mono oxygenases b<'in c c

:,p an ling N-Desalk latio oxydative va phan ling thu phan dd t? O ra ca

r ~Ibatkh6 g hOSltdQngNorfentan l Dcspropionyl-fentan l

1 4 Dao thai

1'huoc dao thai qua nltoc tidu 90% duoi d~lng chuY6n hO{lkhon ho?t

,l.o gva 6% dlloi d?ng kh6ng thay d6i MQtph~n qua m?t

2 1 Tac dl : J17gtren tha ' n kinh trung uong:

Khi tiem t1nh m<;lchthuoc c6 tilc c1~Ulggiam dau sau 30 giay, tac dVng tai

Th oc c6 tac d\lng giam dau rn,p"lh hdn morp in tu 50 den 100 l~n, c6 ta

i~ng lam diu, tho dkin dao Kh6n gay n u ga, t?u n ien fentan l lam ?tan

t.!C dVng gay n u cua cac 10<;lihuac m e khac a lieu cao thuac co the gay

a'1h tr<;lngquen nhu'ng kh6ng thu'dng xu en

2 2 Tee dl:mg tren t im mech :

thi het

2.3 T a c d~mg tre n h 6 h al)

2 4 Cac tac d(m g kh ac

Tang ap l\1'CdtlC5ng m~t.

3.s& dl;lng thuoc trong l a m s a ng: Fentanyl d1.1'c;Jc trinh bay 19 1 0 m l co 500

3.1 Dung trong g a y me

co khi d~t nQi khi quan.

fen t an y l d § g i a rn da u b 0 i vi co che' t ac d n cua morphin chi' d cac 6

t huoc gay su y ho h a p h oa c ng9 d 9 C n e u qu a li e u.

Du ng giam dau t o g te t uy song hoac ngoai rnang cung: fentanyl co

t, rinh mach, hoac sV dung b~n may (peA) d dieu tri giarn dau, duy tri may

t ho rat tot

morphin va fentanyl co pKa thap 6,5 (bang 26a.l)

~,~50 va dao thai qua nuac ti§u duai d(_lngdO chuy6n hoa khong hO(_ltd9ng

!:v a kh6ng thay d6i

,§,~hoang90 phut Neu xo gan s6 Umg tu 90 - 219 phut va d9 thanh thai huyet

,t)Jdng giam Nhung d b~nh nhan suy th0n it thay d6i tac dVng clla thuoc

~jbimg26aA)

4 OU<;1cI~{c hc;>c:

ipan tac dVng rat ng~n chi' b~n 1/3 fentany Khi tiem tInh l11(_lchco tac

~n toi da sau 1 phut 6lieu 5 - 10 Fg tac dVng keo dai 8- 10 phut, lieu 20

-·W ~lg tac dVng keo dai 20 phut Thuoc lam ch~m nh1p tim vua, glam tieu,

tb\l oxyco tim, uc che h6 hap m"l.l1h ay giclm t~n sf)thO'va co th6 ngung th

,lihi dung lieu cao hO<;tctiem nhanh Gay co th~t phe <1u n ; bu6n non, non,

5 1 chi cJjnh:giam dau tro g m6 cho tat dl cac ky thu~t me, gay me ngoF,li

t: ""1i ho<7tcdi.c cU9Cm6 n ~n, te n oai mang cling

5 2 Chong chi cJjnh :su tebao gan n?ng, di lIng voithuoc, tre em dltai 2 tu6i

5.3 2 H 6 h f /p ho tro:

Du y t ri me 1 u g/kg, tre em 7 -1 4 u g/kg , cu 15 d e n 20 ph u t tiem nHAc

T ho i gian m6 t u 30 - 60 ph u t khd i me 40 - 80 ug/kg, t re e m 2 0

u g/k Du y tr me 1 - 1, 5 ~ lg/kg ban g b a m t e rn di e n

Thoi gia n m6 trcn 60 phut khoi me 8 0 - 150 u /k Du y tri me 1

-~l g/kg/ phu t b a n born h em dien.

To n goai rn ang cling: l ie u l uong 15 - 20 ~ l g / kg

S u l fe n ta n l J a elfi n su a t c u a f entany l Con g thuc hoa hoc duoc t i n

1 Tinh chat Iy - hca

70 p g / k Thuoc d UQCch u y6n hoa chu y e u d gan va dao thai cac san pl

2. Tinh chat duc;JC Iy:

3. chT dinh:

4 Chong chi dinh:

I

(l i z Cho cec cuoc mo ' tren 2 gi&

~ t - Khdi me 1 ~lg / k~ / gid / TM. Trong d6 75 % t6ng lieu dUQCtiern luc khdi m~,

~!' G ay me cho mf tim: Khdi me 8 - 10 ug/k Nhung luc cua xuorig u c can

~ { ; cho lieu bo sung 5 - 10 ~lg/kg ctetranh dau cho benh nhan Duy tri me

~ , 25 - 50 f.lgll§.n theo muc de) me cua b¢nh nh a r ~ NgUdi ta thay r~ng neu

~ " dlm g lieu 12 - 30 ~g/kg cho m6 tim thi c6 the nit nQi khi quim sau

12-I ~ ' , ,

; 18 g lCi

~::

I~U:,Cho te ngoai mang cLin g

~ : - Giam ctau trong m6 l;glfC, tiet n i Q u ) chinh hinh : Dung lieu ban (l§.u

~ ,i; ;, -: _ 0 , 75~l g / kg pha loa n g v6i ::'8!TI l nltdc c~lt se giam dau khoang 4 - 8 gid,

hlr Giam dau trong san khoa: Li6'u G01us 15 - 20 ~g pha vo i 10 ml nltoc

~ c t va ket hc;p voi thu6c te nhll marcain ,1 6 gi a m aau trong de Chu y

~ "" ,'

~ , t,~ " : • , _ : , kh6n g vUQt qua lieu 30f.lg .

I - Gi a m dau s au m6 de: Lieu bolus 25 f l g pha voi 10m l nuoc cat va

thu6c te marcairn ho~c xylocain,

Gi am dau cho m6 cac l00i : Lieu bolus 0,75 ).l g/ kg pha voi 10 ml nudc cat , :! ~ tiem nh~c 1 0i voi lieu 25 - 50 ~lgll [ ln.

itri~ i irr:.;]ri e ng bi~t : C0nh t 0 nh doi kh{mg va doi khan g,

r - C0nh tranh d6i khang g am : nalorphin, benzomorphin , bupreno r ph i n,

f nalbuphin thuoc co bc dVn g doi kh~m g t ling p :1 n

~ ', - D o i khang th\]'c s \]' gam : na l oxon (Narcan)

~;~

l~lIm:g-t rong lam sang 1111a.

~ :JtT i nh ch a t Iy ho a: 18.ch a t C 0 nh tranh d6i kh a n g, r at tan trong ma ,

1.2. Chuy e n hoe

Phan 10n thuoc chu en hoa 6 gan, phan

'I'hci gian PIC huyet tucng khoa ng 60 phu

a) Ti n ce nn t ranh :

nho tao than Nor-mort If!J~

So vdi cac tinh chat deu giang cac loai morp in, tu nhien cu ng d9 ~:.:, i~

hem morphin C6 tac dung giarn dau nhanh, ngan (15phut), uc che h6 hi '~i " ll.

lieu trcn 20 ug Lam cham nhip tim do tac d ng Vagal, cod n tu, tan& ~"

luc duorig mat va ca tac dung khac '~

C6 tinh dai khang nhung yeu han 10 Ian naloxon Thuoc d i khang ~ I fjl l

mot SOtac du g ella morphin nhu: giarn dau, ire che' h6 hap, co don tu , ri ~l !

d ng tim mach, co tron 'I'ac dung giarn dau nhanh sau 1 - 2 phu keo ~

- 4 gld khi tiern tinh mach

1.4 SLidL,lng

Thu c <.long ong 2 1111chua 10 mg C6 th6 tiem tinh mq.ch hoi;ictiern

lieu thud g dung 2 mg-5mg Hi9 nay kh n dung nua

2 Naloxon (Narcan) Iii chat doi khang thy'c sy'

2 2 Chuyen ~oa: Thl~OCc~uy~n h,o.8.~han~ dga~ va dao thai qu~ nu(i~: & ~:;t

2.3 DU'Q'CdQng hQc. rImoe co thaI glan ban huy (TI/2a) = 4 phut, thOlgJI

ban dao th,h khoang 60 phut, th6 tich phan phoi (Vd) 2,5 lk ;~

bap se chuyen nhanh c c tac d1,lngcua morphm nhu mat ta a ' ·

giam dau, mat su h6 hap, mat bu n n6 , non Lam tlnh n anh,

ngQt, ret run, th n anh, tang nhtp tim, tan huyet ap, tan sue ;

2.6 SU' dLJng trang lam sang: Thuoc d n o g 1 ml chua 0,4 mg Naloxon.

Chat en kepha l in

Sci thaf) kinh ella lop V

B a ng 27 3. T hai g ian ba n d ao t hai ( T 1 2 jJ),th e tich p h en p hOi (Vd) do thanh tha s i h r a

tuang ( C I), n n g d 9 h i ? U qua t oi th ie u (Cm E ).

B a g 27.4: Li e u giam dau cue cec dan x u{;/tmor p hin alieu 20 mgflOkg

Hlnh 27 2 Cong thuc hoa hoc cac thuoc giam dau trung Lldng

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