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TRU'ONG CAO BANG KY THUAT Y TE 16

GIA 0 TRINH

DIA)C LAM SAN
SACH D TAO MAK Si CA IiANG

1111

lien seal]:
Ds. Nguysra Th Phirung Nhung
Ds. TrAn Thi Tha Nga
Ds, NgtayL Ti-q, Thu
Ds, NO Thi Nga

Tai

hanh nOi b0

Da Nang, thang 08 nail/ 2012


a
I


Tryong Cao Dang K9 Thudt Y Te II Da Ang

Giao trinh &lac lOrn sang

GIOI THIEU MON HOC VA CAC NGUYEN TAC
Si' DUNG THUOC AN TOAN HOP LY
Muc tieu:
I. Trinh bay chivy dinh nghia ,myc lieu cho hoc Dirge lam sang
2. Neu va phcin tich cluqc 4 tieu chudn can thiet trong lira ch9n thuoc an tam
3.Neu clu9c nhrtng n9i dung ctra huang o'd'n diet! tri
4.Phan tich dttqc 4 ksi ming ma Arc lam sang coin co de thirc hien cluvc huang datz
(lieu Fri tot.

1. Dai ctrung
1.1. Dinh nghia
"Dupe lam sang IA mon h9c cua nganh Duoc nham t6i uu hoa viec Sir dyng thuOc trong
dieu tri va phOng benh tren co se• nhCing kien thirc ve DLIVC, Y va Sinh h9c".
1.2. Vai net ve sir ra doti va phat trien cua mon Duvc lam sang
Co hai yeu to clan den skrra dai mon h9c Duoc lam sang:
- Khach quan: Su phat trier' nhanh ch6ng trong linh vvc san xuAt thu6c lam cho thi twang
thu6c vira phong phis ye so Wong &roc chat mai, vira da clang ve chung loci voi sir ra dai nhieu
clang bac che
(clang giai phOng Ice() dai, giai phong CO kiem soat,, dang bao tan trong runt...)
khac han cac clang kinh,dien da gay khong it long tong cho thay thuoc.
dO nay sinh nhu cau
ttr phia nguai ke don ye sty co mat ben canh h9 cac &roc si vai nhiem vu to van va huang clan
sir dung thuoc, do IA cac &roc si lam sang.
-Chu quan: Ben canh viec 1)6 sung vao chuong trinh dao tao nhieu kien thirc lien quan den
Y - Sinh h9c, sty ra dal mon Duoc d6ng h9c lam sang la nen tang quan trong de cac d-9c si lam
sang hoat Ong thanh cong.
Duoc d6ng h9c lam sang la mon hoc Oa vao viec xac dinh nong d6 thuoc trong mau va
dich sinh vat dm nguai sir dyng thu6c. Mon h9c nay ra dal la nha c6 nhang phuong tien hien
dai cho phep xac dinh chive nhang ruing d6 thuoc rat nhO trong mOi truang mau hoac dich sinh
vat (nude tieu, nuac b9t) cua nguti sir dyng.

Nhu vay vai tra cua dirgc si lam sang khOng chi cung cap cac thong tin lien quan den
thu6c ma con cho cac bac si dieu tri biet &roc n6ng do thuoc de co the hieu chinh lai lieu hyong
cho phu hop vai tang ca the va trang thai benh 15,, lam cho hieu qua dieu tri chac chan hon va
ngan chan &roc nguy co ng6 d6c hoac gap tac dyng khong mong mirk do qua lieu.
1.3. Val net ve mon h9c cluvc lam sang teen The gied va 0, Vie't Nam
The giai:
Duoc lam sang la mot mon h9c rat tre so vai cac mon h9c truyen thong TA co cua ca hai
nganh Y - Woe. Mon h9c nay duoc khai sinh o M5, vao nhCrng nam 60 oh the kj, XX.
Tai chau Au, sir ra doi cCia Duoc lam sang muon hon khoang I0 nam tirc la khoang nhang
nam 70. Duoc lam sang &roc chinh thirc dira vao giang day a bac dai h9c M5 nam 1964 va
Phap nam 1984.
Tai chau A, nhang ntrac chiu anh huang cua M5, nhieu nhu. Thai Lan, Philipin,
Singapore..:, Duoc lam sang phat trien rat som va hien nay d5 co nhieu thanh qua nhat dinh
trong he th6ng dieu tri.
Tai chau Phi, th6ng qua cac dy• an ve chain soc sire khoe cua T6 chirc Y t6 The giai
(WHO), cac to chirc phi Chinh
kien thirc duac lam sang da tham nhap vao Zimbabwe,
Zambia, Ghana... nha cac chuong trinh tai tro dao tao ve sir dyng thuoc an toan - hop
Tai Viet Nam
Nay lam sang du nhap vao Viet Nam nam 1990 tir chuong trinh sir dyng thuoc an toan hop 15, vai sir tai trg cua to chirc "Tarn nhin the giai Australia".
Nhan thirc cluoc tam quan liar-1g cua mon hoc nay, Truang Dai hoc Duoc Ha N6i d5 ti'en
phong trong viec dua mon Duoc lam sang vao dao tao a bac dai h9c tir nam 1993. B6 mon


Trinerng Cao Ding Ky Tita't Y Ti II Da Nang

Ciao trinh dupc leim sang

Dugc lam sang duoc BO Y to ding nhin nam 1998 tai Trtamg Dai h9c Disoc Ha N6i. Ci:ing
trong th6i gian nay, hoat d6ng Dugc lam sang &roc ma r6ng

quy me Ca ntrac. Theo quyet
Binh cua Vy Dieu tri - BO Y te, cac to Duoc lam sang duoc hinh thanh tai nhieu benh vien
sir ket hop cila ca Y va Duoc. Mon h9c Duoc lam sang duce dua vao giang day khong chi tai
Trubrig Dai 11QC Duoc Ha NOi ma ca Trutng Dai hoc Y - Duoc thanh pho HO Chi Minh,
Trubrig dai h9c Y - Duoc Hu8, Twang Dai hoc Y khoa Thai Nguyen, H9c vien Quan y

1.4. Myc tieu cho hoc phan Ihrov lam sang
Sau khi h9c xong h9c phan nay, hoc vien co kha nang:
(1). Trinh bay duoc nhang kien thirc co ban lien quan den sir dyng thuoc va phOng ngEra
phan irng co hai do thu6c (ADR) gay ra.
(2). Liet ke va phan tich dugc nhimg nguyen tic sir dyng an toan - hop IY ciia 3 nhom
thu6c th6ng dyng:
- Khang sinh.
- Vitamin va chat khoang.
- Thu& chong viem (cau true steroid va kh6ng steroid).
(3). Huang dan SO' dyng dtxoc mot so thuoc trong dieu tri 2 nhOm benh thong th.u6ng theo
cac nguyen tic an toan - hop ly:
- Benh lien quan den r6i loan h6 hap: Hen phe quan.
- Benh lien quan den r6i loan tieu hoa: Tao b6n va tieu chay.
2. Nhirng not dung va cacti titp can dm dtrov sy lam sang de dyt dirge myc tieu sir

dyng thaw an Wan - hsrp
Sir dyng dupe thuoc hop ly (SDTHL) la nhiem vu quan trong cua nganh y te. De dat myc
tieu nay trach nhiem triic Wei) thu6c ve ba d6i Wong: Ngu6i ke don (bac si dieu tri), duoc si lam
sang (DSLS) va ngt.r6i sir dyng thu6c, trong dO DSLS dOng vai tr6 la cau not giira bac si - ngt.r6i
dua ra y lenh va nguei sir dyng - ngtreyi phai thkrc hien y, lenh. De SDTHL truac het phai ch9n
duoc thuoc hop IY. Hop ly la phai can nhac sao cho chi so Hieu qua/Riii ro va Hieu qua/Chi phi
dat cao nhat.
Tuy nhien, mot thu6c hop ly phai nam trong mot dan hop ly, nghia la ngoai ,tieuchuan
timg thu6c rieng bit can phai tinh den nhieu mat khac, trong do ba van de quan

hop ly
trong nhat ,la:
- Phoi hop thu6c phai dimg (khong co along tac bAt
- Kha nang tuan thu dieu tri cua nguiyi benh cao (s6 lin dung trong ngay it, kha nang chi
tra phi' hop vai nguai benh);
- Co chi dan dung thuoc dung.
Muon
dking thuoc hop ly kh6ng chi can den cac kien thirc lien quan den thu6c va benh
ma con phai dua cac kien thirc nay len ngubi benh Cu the, co nghia la phai hieu ro cac clic diem
cua nguai benh nhu cac benh mac kern (gan, thin, tim, phoi...), cac bat thuaTig ve sinh ly (be°
phi, co thai...), tu6i tac (tre em, ngu6i gia...) den ,cac th6i quen (nghien ruou, thuoc la, an
kieng...) va
hoan canh kinh te. Nhu viy trong dieu tri phai tinh den ngu6i benh chin khOng
phai chi la benh don thuan.
Sau day la mot so nOi dung cu the lien quan den sir dyng thu6c an toan - hop !Y.
2.1. Cac ti'eu.chuan Ikra chyn thaw an tan - hop IS,:
Bon tieu chuan can thiet trong Ikra chon thuoc an toan - hop ly:
I. Hieu qua dieu tri tot: H
2 .An toan cao: A
3. Tien dung (D8 su dyng): T
4. Kinh te (Re nhat so vai cac thuoc da dat ba tieu chuan tren): K
- Hieu qua la kha nang khOi benh tot, tjf le benh nhan duoc chira khOi cao.
- An toan la kha nang xuat hien tac dyng khOng mong muon thap, nghia la ty le Hieu
qua/Nguy co rii ro cao.
- Tien dyng hay de su. dyng bao g6m each dua thuoc, so Ian dung thu6c trong ngay... phu
hap, cang don gian cang tot.
2


Gioo frinh chivy kin? sang

Truang Cao Hang Ky ThuOt Y Te II De Nang

•

- Kinh to co the tinh theo chi phi tien coa loaf thuoc do cho 1 ngay dieu trj (Lieu DDD)
hoac cho ca lieu trinh dieu trj. Gia thuoc CO the chgn la thuOc san xuat trong nute hoac cua
ngoai nhap. CO nhang truOng hgp ngtrai to tinh vao chi phi dieu trj ca tien cua cac xet nghiem
can lam sang‘can phai lam khi sir dyng thuoc.
CO nhieu tai lieu can dua vao them mot tieu chuan "San co" nghia la thu6c phai coo co
dieu trj, nhu• vay la phai uu tien cho !Mang thu6c nAm trong danh myc thuOc thiet yeti.
2.2 Cac not dung cua "htro•ng dan diet] tri"
Don thuoc hay benh an china dung nhang thong tin tren giay cua bac sji dieu trj d6i vof
benh nhan
Trien khai nhang thOng tin nay la twang an dieu trj
Co 2 not dung can huang dan:
- Huang an cliing thuoc.
- Huang dan theo dgt .dieu trj:
+ The nao la tien trien tot
+ Cac dau hieu nhan biet tien luang xau di, phai ngimg hoac phai chuyen len tuyen tren.
2.2.1 litro5vg dan thing thaw:
- Giai thich cho benh nhan tac dyng cua nhang thuoc CO trong don, vi dy ringer lactat de
bit nuac va dien giai do sbenh nhan mat nuac qua nang, khi kha nang bit nuac theo duang u6ng
khong dap Cmg du nhu cau cua co the.
- Trong nhang truang hop khac, khi ma viec dieu trj do benh nhan ty. lam hoac nguai nha
benh nhan tro glop, vi du phai u6ng khang sinh, u6ng thu6c ha sot... tha phai giai thach can
than c6ch thuc hien, giai thOch tam quan trong : neu khyng lam se CO nguy co gO de 119 ty. giac
tuan tilt)?
Sau khi dan d6, phai kiem tra xem nguti nghe dO hieu chua bAng each bAt ho nhAc lai.
2.2.2 Hung dan theo d6i hay con pi la giam sat dieu tra

Day la budc giai thich va chi dan cho benh nhan hoac nguai nha benh nhan ( trong twang
hap nay la benh nhan nhi nho tuoi)
Nha,ng not dung chi an bao gam:
- Tie tyc cho bu?( xem d6 tuoi benh nhan )
- Dieu chinh la' che d6 an, de y xem lieu chau bi ia chay co phai do an uOng khong?Neu
dung thO. loci tar thCrc an dO kh6i khau phan
- Theo did sot de kjp thei phat hien neu benh nang them
- Neu khOi thO. ngirng dieu trj va can benh nhan cac bin phap de tranh tai phat
- Neu benh dO• thO. phai toi khOm de thay d6i cach thirc dieu trj
- Neu benh kh6ng chuyen bien hoac CO xu hang nang them thOn phai kiem tra coc ky
nang sau:
+ Lieu lugng CO du khong?
+ Benh nhan kh6ng tuan thii dieu tri?(ngirng qua sarn khi chua kh6i hAn nen tai phat?)
+ Thu6c chgn khyng thach hgp?( gOy tOc dyng phy non benh nhOn ty. y 1)6 dieu trj?)
+ Phac do Iva chgn qua phi:1.c tap?( lam benh nhan kho titan thii)
Vic thvc hien
,
Nitta. vas, viec ke don hap chi la mat khOu trong sir dyng thuoc hop
tot don thuoc dO dong mat vai tri rat quan trong giSip cho dieu trj thanh conga dO ding chinh la
nhiem vy cua nguti dsls trong dieu trj.
2.3. Cac ky Wang can co cua DSLS khi htrefng da'n dieu tri
Huang clan dieu trj la nhiem vy cua DSLS. De huang dan dieu tri tot, ngoai DSLS can có
cac lcy nang sau:
(I). Kji nang giao tiep voi benh nhan
(2). Kji nang thu thap thong tin
(3). Ky nang danh gia thong tin.
(4). Kji nang truyen dat thong tin.
Nhu da neu phan tren, muon dieu trj thanh cOng thi ngoai y6u to nArn \ang thu6c va
benh con phai biet ro ve benh nhan va tao duac sv hgp tac cua h9 trong dieu tri. Voi nhang
3

Trirong Cao &mg Ky Thuat Y Te H Da Nang

GO° trinh chrov lcim sang

truang hap dieu tri ngan ngay, sir tuan thu cua nguai .benh
dang han. Thy nhien trong truang
hap benh man tinh hoc keo dai nhieu ngay thi van de tra nen khO khan hon nhieu. Ket qua dieu
tri cac benh man tinh khong phai loc nao ciing nhir muon. Vas/ khi g5p that bai hoc khi ket
qua diet' tri chu'a dat yeu cau thi phai lam gi de dat myc tieu (lieu tri da d5t ra.
Nei dung cu the 6 moi ky nang:
1. Ky Wang giao tie!) veri 14nh nhan
De thus hien dugc ky nang nay, DSLS phai tao lap m6i quan he gAn gui voi benh nhan
boi vi de dieu tri tot khong the khong co skr.hap tac phia benh nhan. Mu6n lam chivy nhu vay
phai lam cho benh nhan hieu dirge IS/ do dieu tri, phuang thirc dieu tri va nhung viec ma h9 can
lam de tham gia vao dieu tri,thanh c6ng.
Khi benh nhan hieu ve benh thi h9 se tu gide chap hanh y lenh va nhieu truang hop glop
bac si tim ra nguyen nhan that bai do quan he cal ma vai thay thu6c.
2. Ky Hang thu thb thong tin
Thu thap thong tin lien quan den d5c diem cua benh nhan (tu6i, gioi, thOi quen, nghe
ThOng tin thu thap phai ty mj/ vu chinh xac. Thuang thi qua trinh nay dugc lam tir Ian
kham benh dAu tien trudc khi bat dau thiet lap the de dieu tri nhung cling c6 the chtra khai thac
het ho5c lai xuat hien nhang tinhhu6ng mai lien quan den benh.
3.1(5, nang danh gia thong tin
Danh gia cac thong tin lien quan den viec ang thuoc trong qua trinh dieu tri la met viec
lam can thiet truac khi dua ra ket Van va bien phap can,thiep. Phai danh gia dugc cac thong tin
lien quan den viec dung thuoc,trong qua trinh dieu tri de tim ra nguyen nhan that bai (neu g5p).
Nguyen nhan that bai trong dieu tri rat phac tap, trong dO viec benh nhan ty• y bO thuoc hoc sCr
gap. Nhang nguyen nhan nays c6 the

dyng khong dung lieu, khong du thai gian la rat
lien quan den tac dung phy cua thuOc, cung co the
the do gia .thanh thu6c qua cao so vai dieu kien
kinh te. That bai dieu tri cting co the do phac do di khOng con phu hgp.do benh tien trien nang
them (vai nguai cao tuoi, do tuoi tac ngay met cao nen nhieu benh mac kern han, thi du xuat
hien them ,benh tieu duang ho5c xa vua deng mach cOng lam cho huyet al) khong the binh on
va i mCrc
dugc naa...).
Khi tim &Jac nguyen nhan, DSLS co the glop nguai benh thyv hien lai y lenh de lap lai
mat lich trinh dieu tri dung.
4. Icy Hang truyen dat thong tin
Cac thong tin phai truyen dat co lien quan den huang dan dimg thu6c viatheo dOi dieu
De thkrc hien myc dich huang clan dieu tri tot, nguai DSLS phai huang dan chinh xac va
tSi my each thCrc thuc hien y lenh bao gam viec dOng thu6c va cac dau hieu can nhan biet ve tien
trien theo chieu huang xau cua benh.
Muon lam tot viec nay, nguti DSLS phai tao lap du'gc long tin tir phia benh nhan va
phu'ong phap kiem tra kha nang nhan thirc cua h9 vai cac thong tin dirge truyen dat; thuang thi
nen de, nghi benh nhan hoc nguti nhl.t benh nhan (vai benh nhan nhO tuoi hoc nguai bi benh
tam than...) nhac lai.
Vi dy: Cac thong tin lien quan den gia Wang thu6c, each u6ng thu6c la nhang thong tin
benh nhan mac benh man tinh nhu benh lao, benh tang huyet ap,... thong thuang g5p nhat.
tin ve do dai lieu trinh dieu tri ma benh nhan phai thuc hien la rat quan trong. Nhang thong tin
lien quan den each thirc theo doi tien trien cua benh tai nha (thi dy each kiem tra huyet Ai)), chu
kS/ tai kham... la nhimg thong tin phai truyen dat va phai xac dinh chac ch5n benh nhan daa hieu _
va tin tuang thuc hien.
Ke't luan:
SO• dyng thuoc hap IS/ la myc tieu d5t ra voi ca nganh y te, trong dO vai tre cua nguai dugc si lam sung la rat quan trong.
Lva ch9n &lac met thuoc hgp IS/ la viec lam dau tien; nhiem vu nay khong chi nguai ke
dan phai lam ma ca cua DSLS .

4


Tr irong Cao Bang K9 Thudt Y Te II Da NZing

Giao trinh &toy Icim sang

Lya chon thuoc hop IY nham till& lap duoc mot phac do dieu tri hop ly cho benh 'than.
Trong khau nay, nhiem vu Inrang clan diet] tri thuec ye DSLS.
MOt phac do diet] tri &roc thiet lap dimg la rat quan trong nhung neu thkrc hien khong
&mg (khoang cach dkra thuOc, gio' uOng thuiSc, cach sir dyng cac clang bao che) thi hieu qua dieu
tri se' khong the dat throe. Nhu vay, vai tre ngubi DSLS xuyen soot tir khaki dau den khaki cuoi.
NhEi.ng not dung tren chin!' la nhiem vu ma ngirei DSLS phai hoc hOi va ren luyen de gop
phan thkrc hien myc tieu sir dking thuoc an toan - hop ly ma nganh y to clat ra


Gicio trinh dux Icini sang

Trtrong Cao Dang K9 Thitat Y 7-"Z. II Da Nang

CAC THONG SO MAX BONG HOC CO BAN
MVC TIEU
1.Neu &coy Binh nghia cac thOng ca ban: AUC, Vd, CL va t 1,2 (lac trung cho
giai (loan trong chu ki titan hoan cira thudc trong ca the.
2. Trinh bay &toy cach tinh cac thong so.:AUC, Vd, CI va ti/2.
3. Neu Y nghia cac thong so nay trong diet, tri.
NQI DUNG
Thu6c muon co tic dyng toan than phi tham nhap vao yang tuan hoan tir vi , tri
thuoc va theo vong tuan hoan den vi tri tic dyng. Qua trinh tuan hoan nay lam cho thuoc dutc
phan b6 den m9i to chircyong ca the.

SO phan cua thuoc trong co the phy thu6c vao 4 qua trinh: hap thu (A), phan b6 (D),
chuyen h6a (M), thai trir (E); do la cac d4c tinh ve dutc Ong h9c cua thu6c. Cac qua trinh nay
duty phan anh thong qua nhang thong so dupe dOng hoc, trong do co 4 th6ng so ca ban c6
nhieu y nghia nhat trong thkrc hanh lam, sang la:
- Dien tich duti dutrig cong 'long dO-thei gian AUC.
- The tich phan b6 Vd.
- He so thanh thai (Clearance=Cl).
- Thai gian ban thai hay nU'a dti sinh h9c (t1/2 ).
ThOng qua cac thong so nay, chUng ta c6 the quyet dinh lieu Itrang can dim vao cua m6i
thu6c, khoang cach giaa cac ran dui thu6c ho4c hieu chinh 141 lieu luang trong cac twang h9p
benh nhan co nhang bat thutng ve sinh ly, benh
Chuyen luan nay se Ian hitt giai thieu 4 thong so dutc dOng hoc co ban: cach tinh toan
va y nghia lam sang.
TICH DU'QI DU'O'NG CONG (AUC-Area Under the Curve)

L L Dull niein ve dien tich dual dtthng cong
thu6c trong
theo
Dien tich ,dtc61 chco'ng cong (bleu diensky bien thien cua n6ng
thoi gian) bleu thi tuvng trung cho luveng thuoc vao airov vOng tuan hoan clang con hoot
tinh sau rn'Ot theri gian.
Don vi tinh AUC la mg:1-1.1:1 hoc
Neu ta tam chap nhan tat ca lutng thuoc vao duty vOng tuan hoan chung a cl4ng con ho4t
tInh se phat huy tic dung duac ly thi
che.

AUC7

cho phep danh gia duty chat luring cua cl4ng bao

1.2.Cdch tinh dien tich dirai dirong con theo plitrowg phdp thvc nghiem

De Inh AUC, cach don gian nhAt la cat &tong cong thcrc nghi'em thanh nhieu phan nhO
tinh AUC to tong cac dien tich thu dutc.

1.3.12 nghia

1.3.1. Tir gia tri dien tich dtrai throrg cong, to co 114 tinh thrgc sinh khci dyng
(Bioavaibility) czia thuoc
Sinh kha dung (SKD) la th6ng so bleu thi ti le thuoc vao dutc yang tuan hoan chung
Ong can hoqt tinh so vai lieu cla dung (F%), t6c dO (Tmax) va cutng do (Cmax) thu6c tham
nhap cluac vao vOng tuan hoar' chung.
6


Gido trinh dtrav lani sang

Tnterng Cao Dang Ky Thuat Y Te II Da Nang

Nhu• vay, khi nOi d6n SKD ta de cap an 3 dai luvng: F%, Tmax va Cmax.
Hai the pham cua ding mot hoat chat, ding lieu dung, dung duCmg dua thuoc duvc coi la
along duang sinh h9c (Bioequivalence) khi 3 dai lugng nay giao dOng 6. mix dO cho phdp
(thudng trong khoang 80 den 125%); Tuy nhien, qui dinh thudng chi doi vai AUC con 2 dai
ludng Tmax va Cmax khong bat buOc.
1.3.2. Co 2 Toni sinh kith dyng
- Sinh kha dung ituy?t d6i: la ti I6 giira tri s6 AUC thu dirdc khi dua thu6c ngoai du6ng
tinh mach (thong thudng la dudng Wong) so vol tri so AUC dua qua du6ng tinh mach cua cling
mot thuoc.
, AUC D
F%tuy6t doi

P" x
x100
AUC,,, Dp0
1\16u thu6c duve dua qua dtramo tinh mach (I.V) thi F=1. Can n6u.thu6c dua ngoai cludng
tinh mach thi luon co mot luvng nhat dinh bi ton hao khi di tir vi tri hap thu vao mat' hoac bi
mat hoat tinh khi qua gan, do d6 F luon <1.
Voi nhung thuoc kh6ng the dimg cludng tinh mach, ngudi ta CO th6 sir dyng clang thuoc
long (dung dich, h8n dich uong) d6 so sanh..
mot thuOc dot > 50% la co the chap nhan duvc. Khi SKD >
Sinh kha dyng tuy't dOi
80% thi co th6 coi kha nang than nhap
thu6c uong vao mat!, clang x.Ap xi &rang sinh mach,
lieu tri khi bi b6nh Ong; nhang
con neu SKD < 50% thi clang uong thuang kho, dat yeti
truOng hdp nay, lieu Wang thudng phai
hon lieu dem rat nhieu.
cling mOt
- Sinh kha dung twang d6i:, la ti I6 so sanh giira 2 gia tri sinh kha dyng
hoat chat, cling mot duang dua thuoc, ding mot mac lieu, nhung cua 2 nha san xuat khac nhau
cua 2 clang bao the khac nhau.
F cua hang A
F%tuang doi = GGGGGGGG
F cua hang B
Vi khi so sanh, nguOi ta thuang &mg cling mot milt lieu nen phuong trinh tren co th6 vi6t
nhu sau:
A UChang A
x100
FV0(A/B)—
A UChAng B
SKD tuung d6i thudng cludc sir dyng nham so sanh thu6c cua mot nha san xuat nao dO

vai mot thuoc dang luu hanh co uy tin tren thi trudng (thudng la clang uong) hoac cua mot clang
vien thuoc wing clang 'Ong.
Gia tri sinh kha dyng (F) lien quan mat thi6t den dO h6a tan cua ch6 pham (chivy danh gia
qua trac nghi6m h6a tan).
2. THE 'ITCH PHAN BO (Vd, VD)

2. /.Khcii niOn va dinh nghia the tick phan bo
co the phy thuOc vao 2
Kha nang khuech tan cua mOt thuOc nao dO vao cac to chirc
yeu to:
- H6 s6 phan 1)6 lipid/nude cua thu6c.
- Ban chat cua to chirc ma thu6c than nhap.
Vi du:
-Cac thuoc gay me thuang co chi so lipid/nudc cao nen than dirdc vao to bao than kinh.
Tac dyng gay me cang mph khi chi so nay cang cao. Cling vi m6i lien quan nay nen luvng
7


Gicio trinh dirge lcim sang

Trtrong Cao Dang Ky Thuat Y Te II Da Ndng

thuoc gay me danh cho nguti beo phi thirtng cao hon ngirti binh thutng co cung can nang va
qua trinh hoi phyc sau khi gay me O. nguti beo phi aing chasm hem.
-Cac thuoc co chi so lipid/nutc thap nhis theophylin, gentamicin...khuech tan tot vao
cac to chirc co nhieu nirac; a tre so sinh, nhat IA tre de ,thieu thang, tj/ le' nu& cua co the chiem
70-75%, do do the Veil phan 1)6 cua nhitng loci nay IA rat Ion.
Vi du:
Vd cua thephylin cua tre so sinh IA I L/kg trong khi do o tre 5 tuoi (ti le ny& cua toan co
the chi con 60%) la 0,48L/kg.

De bleu thi skr phan bo cua thu6c trong co the, ngtsti to dimg thOng so Vd:
DxF
Tong lugng thuoc dua vao co the (P)
Vd —
Cp
Nang d6 thuoc trong huyet tuong (Cp)
Don vi cua Vd la L hoac L/kg.
Dinh nghia:
, The tich phan bó (con goi la the tich phan bó bleu kien), bleu thi mat the tich can phai
co de' wan ba luong thueic clugc clua yew co the phan boa 'long do bang nang do trong huyet
tzrang.
The tich phan 1)6 khong bleu thi mot the tich sinh ly thkrc; the tich nay khong co lien
quan gi den the tich mau, huyet tuong, huyet thanh hoac phan mite cua co the.
nhang doi tuong khong co nhang
Tri s6 Vd thirtng duoc tinh san va co the sir dyng
bat thirang ve sinh ly hoac khong co benh gan, than tram trong.

2.2. Y nghia

the tich phan ba cho truck,
mat nong
nang clO Cp new do.
D

to co the tinh chivy lieu hrowg thuoc can cltra de dal dirge

Vd x Cp

F

O day:
D: lieu thu6c can dim
(g,mg).
F : IA sinh kha dyng cua thuoc
(%).
(g/L, mg/mL)
Cp: Wang dO thuoc trong huyet tuong
Vi du:
The tich phan 1)6 cua digoxin la 7L/kg. Tinh lieu digoxin can dua theo &rang tinh mach
de dat dugs nang d6 dieu tri trong mau IA I mcg/L.
Cach giai:
VI truang hap nay thuoc dua qua throng tinh mach nen sinh kha dyng cua thu6c (F)
bang 1.
Nhu vay:
D=7 L/kg x 1 mcg/L = 7mcg/kg
3. iO THANH THAII CUA THUOC (Clearance — CL)

3.I.Dinh nghia
DO thanh 19c hoac dO thanh thai cua thuoc (Clearance — CI) bieu thi kha nang cua mot co
quan nao dO cua co the (thutng IA gan va than) lac sach thu6c ra khOi huyet tuong khi mau tuan
hoan qua co quan dO thutng dirge tinh theo ml/ph hay I/h.
3.2.Nherng tong that' fink dO Mania thdi cua thu4c (Cl rhueld
3.2.1. Tinh cho thanh thai cua thaw fir t6c (10 thai trir qua ntrov lieu
8


Giao irinh chror Icini sang

Trzrong Cao ajng Ky Thuot }' TA II Da Ming

Ciing nhu• khi tinh do thanh thai creatinin (Clcr), ngu.6.i .ta tinh toc dO thai nil. thuoc a
dong con hoot tinh theo nit& tieu bang cach thu gom nude tieu sau khi cliing thuoc va dinh
A'
lupng nong dO thuoc con hoot tinh trong mac tieu, tir dO tinh ra CI thlivC•

Cu x Vu
cidni6c

Cp

O day:
- Clthu6c : la do thanh 19c thu6c (mL/ph).
: nong do thuoc o dong con hoot tinh trong nude tieu (mg/mL)
- Cu
- Vu
: the tich nu& tieu trong I phtlt (mL/ph)
: nong d6 thuoc a clang con hoot tinh trong huyet Wang (mg/mL)
- Cp
(thuang Cp duvc,do trang thai thu6c dot can bang Css).
(Cu x Vu) chinh la toc dO bai xuat cua thuoc, do dO cong thac tren can duvc viet dual
deng:
1) el

Clthuoc

Cp

O day:
(mg/ph)
- Vel : toc de bai xuat cua thuoc qua gan va/hoac then

(el. = elimination —.bai xuat)
(mg/mL)
- Cp : nong do thu6c trong huyet tuung
*Chit y:
Neu mot thuoc co he so phan bo vao hong cau cao (thi du cac thu6c ch6ng sot ret) thi
cong thirc tinh clearance se la:
1) el

Clan& =
b

clay: Cb la nong do thu6c trong mau toan phan (Ci.nau )
Dan vi tinh do thanh thai ctia thuoc (Clthu6c), c6 the la mL/ph hoac mL/ph/kg, bleu thi so
mililit huyet Wang duct gan hoac than lac sach thuoc trong thai gian I phut.
tuan hoar) cCia
Tri so atilt& thyv chat ding chi IA mot tri so Ao, co tinh ly thuyet vi
mau qua cac co quan IA h6i kw, lap di lap lai lien tuc va thkrc to thu6c chi duac lac sach hoan
toan ra khOi huyet twang sau mot khoang thei gian 7xt112 (xem "thei gian ban thai").
Tuy nhien, cach tinh nay khO thyt hien vi viec gom tau nu& tieu trong nhieu gia rat
phirc tap.
3.2.2. Minh tir litu luvng va din tich dtroi dterng cong

FxD
Clthuoc

AUC

O day:

•

- F: la sinh kha. dyng.
D : la lieu dung.
- AUC : la dien tich dual dutng cong.
He so thanh thai trong cac bang có son vdi moi looi thuoc thu.ang la Cl toan
t u thi co
t, ble
toan
nang loci bO thuoc ra khOi huyet thanh, huyet tuong cua tat ca cac co quan ba ix uat trong
Tuy nhien, chi CO 2 ca quan gan, than la co
the nhtt• gan, than, phoi, da, nuac bat, tuyen
kha nang lac thuoc monh nhat, con Itygng thuoc &roc bai xuat qua cac co quan con lai rat nhe,
va it coy nghia. Vi vay :
Cltoan phan = C !than +Clgan + CIcaquan khac
athan

+ C !gall

Vi du:
9


Truong Cao Hang Ks, Thor Y Te II Da Ncing

Ghia trinh duvrc lam sang

- Theophylin co Citoan phAn = 0,65 ml/ph/kg. Dugc biet theophylin IA thu6c dugc chuyen
hga 90% asan , c6 nghia IA Cl gan--z0,59m1/ph/kg.
Neu tinh cho mot nguai co trong lugng 50kg thi Clganz:,0,60 ml/ph/kg x50kg = 30m1/ph
gian 1 philt, se co 30m1 huyet tuong dugc gan I9c sach khoi

co nghia la cir sau mat khoang
theophylin.
- Cephalecin co CltOn phAn = 300m1/ph, chat nay it bi chuyen h6a gan ma chii yeti bAi
xuat qua then tgi 91%, truang hgp nay Clthan rat quan trong vgi Cephalexin : Clthan =300m1/ph x
0,91 = 273 ml/ph.
Nhu vay, trong trutng hap benh nhan CO nhang ton thuang nang ye chac nang than thi
kha nang [pal xuat Cephalexin bi giant it ret va nguy ca qua lieu se cao, trai lai vai theophylin
thi su ton thuang than it co nguy ca gay d6c vi thuc chat chi co mot lugng rat nh6 theophylin
dugc loci b6 theo &rang nay.
- Propranolol ang IA mat thu6c dugc I9c sach cho yeu a gan (z--,100%), tri so CI =
840m1/ph trong trutng hap nay dugc coi nhu
3.3. c' nghia
chug du gay bao hga, he bai xuat thu0c thi
-Trong pham vi lieu lieu tri, khi M
clearance la mot tri so hang dinh nghia IA cir,sau mot khoang thai gian nhat Binh lao co mot ti le
hang dinh cita thuoc clugc 19c sach khoi huyet tuong. "toc do bai xuat thay dal ti le thuan vgi su
thay cloi nang c16 thuoc trong huyet tuong theo qua trinh dang .hoc bac 1".
Trai !al, neu lieu dung qua Ion va co the thanh 19c thuoc bi bac) hOa thi qua trinh bai xuat
thu6c se Wan theo qua trinh dong h9c bac 0 nghia IA sau mat khoang thai gian nhAt Binh co mot
lung thu6c co Binh bi loai khoi huyet tuong. Trong twang hgp nay, clearance khong h5ng dinh
nCra ma se giao clang.
4.THOI GIAN AN THAI (Tin)
43. Dinh nghia
Khai niem t112 (half-life) clugc bleu thi theo 2 nghia:
-t112 a hay tu2 hap thu IA thai gian can thiet de mot nira lugng thu6c da uo'ng vao dugc
vOng tuan, hoan.,
Neu thuoc dugc dua qua &rang tinh mahcj hoc &rang tiem bAp thi pha nya kOng co
hoc khong clang ke, nhu vay ko co ti,2 a.
-t112 3 hay t1/2 bai xuat IA thai gian can thiet de nong d6 thu6c trong mau giarn di mat
nira.

thai trir.
t u2 p can g9i IA thai gian ban thai hay nth
Trong thuc hanh dieu tri, nguai ta sir dung t112 nay.
4.2. Catch tinh Mei gian ban Mai
Tinh try'c tie!) tir elto thi
Dua vac) do thi ban logarit (LnC-t) IA catch don gian nhat. Tit. 2 mix nong do 100 va 50,
d$
ta CO 2 gia tri t tuong irng IA t=0 vat t=2; nhu vay ti,2 = 2. Ta cling co the tinh tir 2 mix
khac: 50 va 25, ski chenh lech ve thai gian se IA t50 = 2 va t25 = 4, nhu vay t112 cang bang 2. Ta _
dO cho thay tri so t112 khong phu thuoc vao nong c16 thu6c trong mau.
4.3.

caa tri s 11/2

Lien quan giira thai gian ban thai va prang tharoc Ayr thiii trir
-Qui tac 5 x tu2: tia thai diem 5 x t112 tra di, Iugng thuoc trong mau hAu nhu khong thay
cl0i nEra vi lung thuoc tai cac to chirc da bao hga, lung thuoc tham nhep vao to chirc bang
I0


Trirong Coo Bang Ky Thuat Y rd II Do Nang

Gicio trinh &roc !Om sang

luting thuoc &roc thai trir, ngubi ta goi the.' diem nay la thol diem thutic dgt trong thai can
bang.
Bang 1.1. Lien quan giira t112 va luting thuoc &roc thai tru
Luvng thubc duvc thai trir
St) lAn
t1/2

1
2
3
4
5
6
7

cx,i

50
75
88
94
97
98
99

hoan toan ra khoi co the sau 7 x t112 vi lac
-Qui tic 7 x t112 : thuoc &rot coi la [pal
nay nong d6 thuoc trong matt chi can chua day
day 1% so v6i n6ng d6 ban dau. De thay thuoc,
ngtrai ta phai ch6 It nhat 7 x tu2 de tranh hien tuvng tich lay.
5. KET LUAN
Nam yang cac thong so duvc Ong h9c giap cac duvc,si lam sang c6 di) kha nang to van
cho thay thuoc trong viec Itra chon thuoc phi.' hop vai ca the ngubi berth va nang cao kha nang
su dyng thu6c mot cach an toan va hieu qua.
Cac kien thac trong chuong nay se gitlp cho cac &roc si hieu &roc cac th6ng tin ve duvc
d6ng h9c trinh bay trong cac tai lieu ye thuoc: cac don twang clan, Duvc this Qu6c gia, Vidal,

Martindal... hoc khi doc cac bai bao nghien cau ve thuoc. Day cling la kien tht:rc co ban cho
duvc si khi nghien ciru thu6c moi, danh gia thuoc hoc dank gia tuong throng sinh h9c.


Giao trinh chtqc lam sang

Trtrang Cao Hang K9 Thu at Y Te II Da Nang

XET NGHItM SINH HOA
LAM SANG VA NHAN DINH KET QUA

®

G

TIEU
Trinh bay chew mgt so xet nghiem .sinh hria: creatinin huyelt thanh,
creatinin, tire.
Trinh bay therir nit so xet nghiem huye;t hoc: hang cdu, bgch cat', tie'u cdu.

thanh thai -

I. ;OAT VAN DE
Trong tong tac chan doan va dieu tri benh, vai tr6 dia xet nghiem rat quan trang vi no ghlp db•
bac si lam sang chan doan theo dal va (lieu tri benh nhan mot each chinh xac, the nen hau het
cac ket qua sinh h6a lam sang la dinh lugng, doi hoi ket qua dual hinh thirc va don vi cu the
Vi du: Glucose: 89 mg/dl (70-110)
II. DON VI DO LUNG THUIfING St). DUNG TRONG KET QUA XET NGHIEM
Hien nay nhieu tai lieu sach bao va cac labo sir dung ca hai don vi Cu va don viqu6c to mai do
quen su dung. Trong khi HOi nghi y to the gi6i 1977 TA chap nh:an sir dung he th6ng don vi quoc

te, cho nen co nhang he so chuyen doi to don vi di sang don vi mai hoc ngugc W. Bang thi du
sau day
Xet nghiem
Acetaminophen
Albumin
Ammonia
Anticonvulsant drugs
Carbamazepine
Phenobarbital
Phenytoin
Valproic acid
Bilirubine
Bromide
Calcium
Chloride
Cholesterol
Cortisol
Creatinine
Digoxin
Estriol
Ferritin
Folic acid
Gentamicine
Glucose
Haptoglobin
HDL cholesterol
HCG
Ig A
Ig D
Ig E

Ig G
Ig M

Don vi thuong dfing
µg/m L
g/100mL
µg/100mL

He s6 chuyen d6i (X)
6,61
144,9
0,59

1,tg/mL
ug/mL
Rg/mL
1.tg/mL
mg/100mL
ptg/mL
mg/100mL
mEq/L
mg/100mL
µg/m L
mg/100mL
ng/I00mL
µg/m L
µg/m L
µg/100mL
µg/m L
mg/100mL

mg/100mL
ug/mL
U/L
mg/100mL
mg/I 00mL
mg/100mL
mg/100mL
mg/I00mL

4,32
4,31
3,96
6,93
17,1
0,0125
0,25
1
0,026
0,0276
88,4
1,28
3,47
2,2
22,7
2,22
0,056
0,118
0,026
--0,0625
0,054

0,005
0,067
0,01 I
I2

Don vi qu6c to (SI)
µmol/L
µmon
µmon
i.tmol/L
µmon
i.tmol/L
µmol/L
pmol/L
/
!Amon
mmol/L
mmol/L
mmol/L
mmol/L
µmon
i.unol/L
nmol/L
nmol/L
prnol/L
nmol/L
1.tmol/L
s
mmol/L
µmon,

mmol/L
--µmon
1.tmol/L
nmol/L
µmon
µmon


Truorg Cao Hang K9 Thuat Y Te 11 Do Nang
Insulin
Ketones(Acetoacetate)
LDL cholesterol
Magnesium
Phosphorus
Phenylamine
Potassium
Quinidine
Salicylate
Sodium
Theophylline
TSH
Thyroxine
Transferrin
Triglycerides
Urea
Urea N
Uric acid
VLDL cholesterol
Vitamin B12
Gases

Enzymes

Girio trinh chtor lam sang

pg/mL
1.tU/mL
mg/L
mg/100mL
mg/100m L
mg/100mL
mg /L
mEq/L
i.tg/mL
mg/100mL
mEq/L
pg/mL
mU/L
i.tg/100mL
mg/100mL
mg/I 00m L
mg/100mL
mg/100mL
mg/I00mL
mg/100mL
pg/mL
mmHg
U/L

0,174
7,25

0,111
0,026
0,41
0,323
6,05
I
3,09
0,0724
1
5,55
--12,9
0,11
0,0114
0,166
0,356
59,5
0,026
0,738
0,133
1,67* 10-8

nmol/L
nmol/L
mmol/L
mmol/L
mmol/L
i_mIm11
i 0 1/I'
/L
mmol/L

mmol/L
mmol/L
mmol/L
i.t.mol/L
--nmol/L
!Amon
mmol/L
mmol/L
mrnol/L
µmon
mmol/L
pmol/L
kPa
katal/L

HI. MOT SO XET NGHIP/1 HOA SINH VA BIN Lt.1.01
1. MOt so xet nghi?m h6a sinh
1.1 Uri' (Urea),
Ure IA san pham thodi hOa chInh ciia Protein dtrac tao thanh gan va dao thai chit yeu qua
nu& tieu. M6t so ph6ng xet nghi'em dinh luang tire dual clang nito ure mail BUN (blood urea
nitrogen), tri so binh thuang Ur 8-20 mg% hay 3- 7,4 mmol/L.
O Tang ure matt : do an nhieu protid, sat, benh than ( viem cau than, Ong than, suy than
cap, man)
o Giarn : suy gan Ong agiai doan cu6i hiem gap
® He so thanh thai ure binh thuong 75mL/phut, he s6 nay giam 6 ngtrai suy than.
L2 Creatinine
Creatinine IA san pham thoai haa ctla phosphocreatine, mot chat du. tr.°. nang Itrangcoo trong ca.
Tri se; binh thirOng tir 0,5 — 1,5 mg% hay 44 — 132 µmon,. Creatinine dao thai ra nuac tieu chit
yeu do I9c o cau th5n, creatinine Riau chroc ,coi IA xet nghiem tot hon so vai ure mau.
O Creatinine tang trong suy th5n, bi tieu.

1.3 He so thanh thai creatinine (clearance creatinine0
D6 thanh thai creatinine IA so luvng can cho th5n thai trir hoan toan ch5t do ra nuoc tieu trong
khoang thai gian nhat dinh (I phOt). D6 thanh thai &lac tinh bang cong tht:rc sau:
V
phut) —
U: n6ng d6 creatinine mg/L nu6c tieu
V: the tich nude tieu/ 1 phut
P: n6ng d6 creatinine mg/L huyet thanh
o Binh thuang he so thanh thai tit. 70-140 ml/phut
13


GO° trinh dux lam sang

Trirdeng Cao Hang Ky Thuat Y Te" II Da Niing
• Suy then: he so thanh thai < 70 ml/phut

® He se') thanh thai creatinine la xet nghiem danh gia chac nang then tot hon creatinin,
nhung MI6 thkrc hien han vi phai ley !mac tieu 24 gia va benh nhan phai ley dAy du
nutc tieu trong 24 gia, neu khong tuan thu thi ket qua se sai loch.
2. My so xet nghi01 huytt hoc
CO nhieu xet nghiem huyet hoc nhts cong thirc mau, dOng cam Riau, toc do rang mau...
Trong bai nay khu tro xet nghiem cong thac mau:
Trong mau có 3 loci huyet cau:, hong cau, bach cau, tieu cau. Xet nghiem cong thirc mau tire
phan tich cac thanh phan huyet cau, nhieu 14 may hien nay phan tich duoc cong thurc bach cau
va cho rat nhieu th6ng so giop,cho chan doan va theo dOi tien trien cua benh, mat khac giup cho
viec theo dOi tac dung cua thuoc.
2.1 116'ng cAu

Chirc nang chinh cua hangcAu la chuyen van oxy hit vao

phai den cac mO qua vai tro cua
huyet cau to hay huyet sac t o (hemoglobin).
SO Itron4 h6ng cau ngtrai binh thutng : 4,0 — 5,0 * 1012/I
Huyet sac to (hemoglobin) Hb nam trong hong cau va cau tao boi Heme va Globine
o Nong dO huyet sac too nguti binh thutng : Hb = 130 -150 g/I
o

Nam cao han

Hematocrit: xet nghiem thtrang dung theo dOi ski thieu mau hay sir tang giam hang cAu.

•

Hematocrie la ti le phan tram giira huyet tuang va hong cau. Nguti to do bang cach quay
Ii tam may trong Ong mao quan de lAng hoan toan hang au va tinh ti le giCia 2 lop huyet
tuung va hang cAu.

•

Binh thtrang ; 38-50%

O Nam cao hon
2.2 Chi so hiring au

Cac chi so nay thutng dung de phan loci thieu mau.
MCV ,(mean cell volume): the tich trung binh cua hang cAu &roc tinh de xac dinh kich thutc
hang cau
Pemtat ocr
Ct7
1119. !Ei

o

;

Binh thutrig: 80-100 femtolit (fl)

O MCV < 80 fl: thieu mau, hang cAu nhO gap nhieu trong benh hang cAu tron, nhO di truyen: la benh thieu mau tieu huyet do bet thutng dm protein mang hang cAu.
•

MCV >100 fl: thieu mau hong cAu to, la benh thieu mau do thieu vitamin B12, acid folic,
CO the an thieu hoac do hap thu kern bai cac hOa chat, thuac hay tkr khang the chang to
bao da day hoac khang the chang y6u to not tai da day.

INCH (mean cell hemoglobin): Lung HB trung binh cila hang cau
Hizyet s,-1c tO
—
So i_-rcr
0

Binh thutng 30-32 pg

MCHC (mean cell hemoglobin concentration): Nang do HB trung binh cua hang cAu
Hz v.:4t s‘c tO
r ii r
He?iiatocrit
14


Throng Cao Hang Ky Thucit Y T" 11 Da Njng

•
o

Gicio trinh Ave an sang

Binh thtrOng 320-340 g/1
MCHC dung danh gia tinh chat clang sac, ua sac hoac nhirgc sac.
o Thieu mau nhtrac sac: kich thiro.c h6ng cAu nhO, Hb ha nhieu hon h6ng cAu
o Thieu mau clang sac: kich thu6c h6ng cAu binh thub.ng, HB va so Itrung heng
cAu ha song song.
o Thieu mau uu sac: kich thu6c heng cAu to, Hb ha it hon s6 lung heng cau,
trong mau co nhieu h6ng cAu kheng 16, to.
i)

3. B#ch, cAu
Bach cau gitip co. the chong Iaitaac nhan gay benh bang qua trinh thkrc bao hoac qua trinh mien
dich. Can ca vao hinh clang va cAu troc, ngubi to chia bach cAu thanh 5 foal:
O Bach cau trung
Neutrophile 55-75%
• Bach cAu u.a. acid: Eosinopile 1-5%
O Bach cAu ua base: Basophile 0-2%
O Bach cAu mon: Monocyte 2-10%
• Bach cAu lympho: Lymphocyte 20-35%
3.1

cAu 110 trung tinh
o Binh thtrang 1,8 — 8* 109/1
O La y6u to quan trong trong sty de khang sinh ra
tuy xu'ong chaa nhi&J enzyme thily
phan, vai tro la thy.c bao. Tang trong trublighogp nhi6m khuan cap tinh: ap-xe ngoai da,

viem h9ng, viem tai, viem ph6i, viem runt thira, nhiem trung huyet...

3.2 Bach cAu da nhan u'a acid
o Binh thu&ng 0 -4,5 * 109/1
O Bach cAu da nhdn ua acid ding gieng bach cau da nhan trung tinh, sinh ra tir tuy xuong,
dOng vai tro de khang ctla co the.
o Tang trong cac benh di tang, hen suyen, ben ki sinh trung nhlem giun, san.
o Giam 0 trang thai soc, benh Cushing, da thuong.
3.3 Bach cAu da nhan tra base
o Binh thub-ng: 0 -2 *109/1: so lung rat thap, tang nh9 trong benh di tang.
3.4 ach can mono
o Binh thiremg 2,0-10,0 * 109/1
• Hoat clOng thkrc bao nay dm bach au mo vi sau khi &roc tuy xuong sinh ra vao mau
mot thai gian ngan r6i di vao m6, 0. day chOng co the rai mo de tro' thanh dai thtyc bac,
luu cl6ng den cac vung viem nhiem va the hien vai tro dai thirc bao cac vi khuan, h6ng
cAu gia, bach cAu trung tinh bi chet, ki sinh trung cac mo bi hoai
o Ngoai ra bach cau co vai tro khai Ong qui trinh mien dich
o Bach cAu mono tang trong nhiem khuan cap tinh va man tinh nhu lao, cram, viem gan,
ung
sau khi sir dung cortisol, giam rat hi6m gap.
3.5

can Lympho
O Binh thu.Ong 2,0-3,0 * 109/1
O Co rat sarn, trong thai, to bao có kha nang mien dich g'om 2 loai:
15


Trtrong Cao Hang Ky Thuat Y TA 11 Da Wing

cAA-(tolk.' rk•C\-L. (U:c_t)

Gicio trinh dux lam sang

o Lympho B: chirc nang mien dich,-the; san xuat ra cac khang the km Ong trong
mau de chong lai tac nhan gay banh...
va
o Lympho T: chac nang mien dich to bao, kha nang gay d6c to bao, giiip
che, tao ra cac cytokine, tham gia vao qua trinh chong thai ghdp.
• Sy tang giam lympho thu.ang thay46i trong mot s6 banh nhi8t-n virus va nhi6m khuan
nhu. viem khdp, phai Crng Pa-rai-V6i thu6c (phenytoin, acid amino salycilic...).
o Khi s6 lupng lympho giam banh nhan bi suy giam mien dich
3.6 Tieu eau
O Binh thtrang 200-400 * 109/1
• La nhang to bao khong nhan, chire nang hoat cl6ng trong qua trinh (long mau. Khi mach
mau bi ton thuang, tieu eau tap trung Iai nai ton thuong tao thanh khi tieu cau l'Ap kin.
Vi the khi tieu cau giam se gay xuat huyet.
o Tieu cau giam trong cac banh suy tuy, ung this, nhrem khuan, nhiem sieu vi (sat xuat
huyet) va do nhi'em d6c mot so hda chat..
kha nang ket
O Cac thu6c gay giam tieu cau nhu. chloraphalycolhepanin..., thuoc
dinh tieu cau aspirin..
TAI LIEU THAM IGIA0
1.Gido trinh giang day mon dudc lam sang ,B6 mon Dude lam sang- Dai h9c y dtrac thanh ph6
H6 Chi Minh, 2008
2. Sinh ly hoc, B6 mon Sinh IS/ hoc- Tru.ang Dai h9c y Ha N6i, Nha xuat ban Y hoc, 2006

(

16

TrtrerngCao gang Ky Thuat Y Td II Da !Wing

Gicio trinh chivy lam sang

TOCING TAC THUOC
MUC TIED
e Trinh bay chivy cac loci tirang tac giira thuoc- thuoc.
® Trinh bay va giai thich mat so ttrang tac gifia thuoc va thtiv an, do wing.
I. TIflING TAC GIU'A THUOC VA THUOC
1. Khai niem can ban
tircrng lac thaw
Sy along tac thuoc duoc bieu hien bang sy thay d6i dugc Ong hoc hay hoat tinh duoc ly cua
mot thu6c bai,m6t thu6c khac,khi sir dyng ding mot
hai .hay nhieu thir thu6c.
Trong thyc to diet] tri, sy phoi hop thuoc la viec khong the tranh kh6i va se clan den sy tuong
tac thuoc bai sty can thiep cua nhieu yeu to.
• Ve mat dugc Itrc hoc: tac d6ng trkre tiep tren rcceptor (ciing hoac nhang receptor khac
nhau)
•

Ve mat dugc dong hoc: tac dOng gian tie') khong qua receptor (xay ra trong qua trinh
hap thu, phan bo, chuyen h6a, thai vb.)

2. Phan loai
2 loai: lam gia tang tac dyng dugc ly hay lam giam tac dting duoc ly. Tuy nhien, cach phan loai
nay khong giai thich co che
twang tac thuoc.
Tuang tac bao ham y nghia tac dOng 118 twang., co nghia la co sy tac Ong hai chieu.

Tuong tac mot chieu chi co mot ben gay ra twang tac va mot ben chiu anh hisang cua sy along
tac.
2.1 Twang tac ye mat dtrot Ong
Ket qua lam sang co the xay ra:
Tang hoac giam tac d6ng tri lieu. ,
Co phan
phy khong mong muon.
Xuat hien dOc tinh.
2.1.1 Tiwng tic lam thay doi sty hip thu cua thaw
2.1.1.1 Thay doi yeu to Ii hoa:
pH dich vi: chat,kiem (NaHCO3) lam giam sy hap thu cua nhitng thu6c acid yeu co pKa 2,5
den 7.5 nhu thuoc khang viem khOng steroid, khang vietamin K, penicillin disOng mong. Chat
thuoc CO pKa tir 5-11, vi du
acid anh twang den sy hap thu cac thu6c base yeu, (lac bit dal
tetrecyclin- cimetidine (cimetidine lam giam sy hap thu tetracyclin do ire the bai tiet dich
Tao phac hay chelat: tetracyclin tao muoi chelat vai Fe++Fe(S0.4). Hau qua la lam cho ca
tetracyclin va Fe(SO4) giant tac dyng.
2.1.1.2 Thay doi yeu to cluryc
thu6c 6 da day va anh twang
Thay doi,toc d6 lam rI)ng day: do anh huang thai gian
den sy hap thu thuoc. roc d6 lam trong da day gia tang lam tang, sy hap thu thuOc. Vi dy
metoclorpramid lam tang sy hap thu cua cac thuoc khac do lam tang toc d6 lam reing da day.
Lam bien ,doi he vi sinh vat dung runt: khoang 40% digoxin dung throng uOng bi chuyen h6a
boi vi khuan dung runt tao thanh clang kh6ng hoat tinh.,
Thay doi nhu cl6ng runt: lam tang hoac giam t6c d6 hap thu cua thuoc. Vi dy metoclopramid
lam tang nhu d6ng runt nen lam giam hap thu digoxin (WON uemg, Nhung metoclopramide lam
tang sty hap thu cyclosporine do lam tang toc d6 lam re3ng da day.
2.1.2 Tu'o'ng tac lam thay doi sir phan bo dm thaw
Trong sy phan b6 thuoc thi chi CO thuoc 6 clang ty do mai co tac dyng dupc ly va c6 the phan
ph6i tai m6.

I7


GO° trinh chrac loin sang

Trtrerng Cao DOng
J K9 Thuat Y Te II Da Aljng

Sy tuang tac xay ra huyet tuong: Acid valproic clay diazepam ra khOi not gan protein do dO
lam tang Wong c18 diazepam a clang ty do, dua den sy tang tac Ong dm diazepam va can phai
chinh lieu.
Si tuong tac xay ra mo: Quinidin tuang tranh voi digoxin trong sy gAn vao protein, lam cho
nong d8 digoxin trong mau tang cao. Can phai giam lieu digoxin khi phOi hop 2 thuoc tren.

2.1.3 Tucrng tac lam thay doi sty chuyen hoa cua thaw
Hoat tinh enzyme gan la mot thong so c6 vai tr6 chu yeu voi so phan cua thu6c trong co the.
Neu cac thu6c dung d6ng thai c6 anh , huang den hoat tinh men cytochrome P450 (CYP) tren
microsom gan, lam thay doi skr chuyen hOa qua gan cua thuoc khac va do da sinh kha dyng
thay cl6i theo.
Thu& cam ang men gan: lam tang hoat tinh enzyme, nghia la lam tang qua trinh sinh chuyen
neu chat chuyen hoa la chat \4
hoa cua thu6c, lam giam hoat tinh hay mat hieu lyc cua
thuoc trong huyet twang kh6ng dat den ngutng tac dOng. Tuy nhien, chat
hoat va nong
chuyen h6a co hoat tinh thi hien along cam (mg co the lam tang tac dyng tri lieu.
Thu& ire the men gan: lam Ice° dai thai gian hieu lyc cua thuoc, lam cham sir dao thai va tang
lions c18 thuoc. Dieu nay co the cian den d8c tin va hau qua tily thuOc vao chi so tri lieu cua
thuoc.

2.1.4 Ttrang tac lam thay doi Sticlao,thai .ctia thutic
Thong tac trong qua trinh IQC qua tieu caihro sy day thu8c ra khOi not gan protein lam cho
nong d8 thu6c tang cao va do do sy loc qua tieu cAu tang. Vi dy tuang tac aminoglycoside va
digoxin.
Twang tac trong qua trinh tai hap thu: qua trinh tai hap thu bi anti Wang boi nong d8 va tinh
tan trong lipid cua thu6c tren mang to bao. Phan ta thu6c a clang khong ion h6a aloe uu tien
han, dang ion hoa va CS/ le giaa 2 clang nay phy thuoc vao pH nuactieu va pKa cua thuoc. Vi dy:
thuoc loi tieu thiazide lam tang pH nude tieu va lam giam c18 nong do kh6ng ion h6a mot s6
thuoc do do lam tang skr thai tra va giam tac d8ng tri lieu thuoc co he so thanh thai a than cao.
Tuang tac trong qua trinh bai tiet: probenecid tuang tranh voi penicillin o not gan vao protein a
6ng tiet lam kdo dai tac dking cua penicillin.

2.2 Ttro'ng tic yt mat dirge Ikrc
2.2.1 Tac d'Ong doi khang: xay ra khi tac Ong cua thu6c doi nghich vai tac dOng cua mot
thu6c khac.
Doi khang canh tranh: khi co sy tranh clanh sung not tiep thu, vi dy: pilocarpin va atropine.
Doi khang khong canh tranh: khi co skr canh tranh khong ding not tiep thu, vi dy: papaverin va
bari clorid.

2.2.2 Tic (tong
hip lire:
,•
Hip Ikrc 1)6 sung: A+B = A+B, vi dy I3-blockers va thu6c loi tieu thiazide.
Hiep lyc bOi tang A+B = C >> A+ B, vi du trimethoprim va sulphonamid.
H. TtrONG TAC GIffA, THUOC- THITC AN — DO UONG
1. Turing tac giUa that& voi ruvu
0 nguti nghien ruou co sy Cic the lien hop glucuronid cua mot s6 thu6c.
Ruou lam tang tac dyng cua nhang thu6c tac Ong tren than kinh trung uo-ng nhu thu6c khang
histamine, barbituric, thu6c tri benh tam than.
Clopropamid, metronidazole co tac Ong disulfiram vai cac triu chang dO mat, ha &rang

huyet, non, tim dap manh, chOng mat, kho tha, mO mat...

2. Twang tac gi&a thaw voi thtic An
Trong da so truOng hop, tuong tac xay ra 6 giai (Joan hap thu, dan den Sct thay d6i c18 hap thu
cua thu6c. Thac an lam giam hap thu cua ampicillin, captopril, levodopa, licomycin...,, lam
cham hap thu
amoxicillin, cimetidine, digoxin, furosemide, sulfadiazine...,lam tang hap thu dia. lithium, griseofulvin, dicourmarol, diazaepam, phenytoin...

I8


Trtrang Cao gang Ky Thuat Y T'd II Da A18ng

Giao trinh dupv lam sang

PHAN U'NG CO HAI CUA THUOC
MRJC TIEU
Trinh bay duff dinh nghia, ccich phan loaf cac phan ring co hal cira thuac.
G
Giai thich dtrqc cac yeu to lien quan den phan arg ca hal cirri thuoc.
I. KHAI IS4M
thuac (ADR-Adverse Drug Reaction) la phan ang d6c hal, khong dinh
Phan Crng, có hai
truck, xuat hien a lieu thuang diing cho nguai de pheng benh, than doan hay chi.la benh hoac
nham thay dal mat chirc nang sinh Ii. Dinh nghia nay khong bao gam cac truang hgp dOng sai
thuoc hay &mg kh6ng dOng lieu chi dinh.
II. PHAN LORI
1 Phan Ioai theo tinh chat &rem li,
Thi du
. Dinh nghia

Loai
I-14 throng huyet do tiem insulin.
Gia tang
o
C the du doan dugc
A
do
thuoc
13
Tim
cham
Phg thuac vao lieu dung
(Augmented)
adrenergic.
Thuang gap
Chay mau do thuoc khang (long
Hiem khi gay tir vong
Phan Crng di Crng vai penicillin
,
La
thuang
Khong
du
doan
dugc
B (Bizzarre)
KH6ng lien quan den lieu Ho4i to to bao gan cap do
halothan
diing
Suy tily do clormaphenicol

Khong thuang gap
Ty le mac benh va Cu vong
cao
do
chUng
Cushing
La phan Crng chi xay ra sau Hai
Man tinh
C
prednisolone
mat thai gian diet] tri lau dai
(Continuous)
Rai lo4n chirc nang d4i trang do
dOng thuoc xo.
LA phan Crng xuat hien sau Ung thtr do tac nhan alkyl hoa
D (Delayed)
Cham
khi da ngung dieu tri trong trong dieu tri Hodgkin.
Di clang xuong mat a tre em co
mat thai gian
me dUng isotretionin
E (Ending of Hai chang La phan Crng xay ra sau khi Suy tuy6n thugng thAn sau khi
ngung dOng thuoc, dac biet la dung diet' tri glucocorticoi,.
ngung
use)
prednisolone.
khi ngung dot ngat
thuoc
Co giAt khi ngirng thuac chong
co giAt nhu. phenobarbital.

2. Phan loai theo tinh chat ciaa.phan irng‘
Lo4i A (qua mac): nguyen nhan co the do qua lieu, do sir nhay cam cCia nguai benh vo i thuoc,
do sir ket hop kh6ng thich hop (chang han sir ket hap giCra mot chat irc che men gan voi 1116t
thuoc ,dugc chuyen hOa gan, dAn den nong do thuoc trong huyet tuang tang len va dau hieu
qua lieu co the xuat hien).
Loa' B (14 thuang, khong du. doan dugc): nguyen nhan co the lien quan trang thai lam sang cua
benh nhan, do di Crn , do bAt thuo'ng di tru en, do qua nhay cam...
A
Tien chuan so sanh
Khong
Co
Tac dung dugc ly co the du doan dugc
KhOng
CO
Phu thuac lieu sCr dung
Thap
Cao
Ty suAt benh
Cao
Thap
Ty le W. vong
NgUng thuOc
Dieu chinh lieu
Dieu tri
19


Giao trinh cheav lam sang

Trirong Cao Hang Kf Thuat Y Te II Da Nang

3. Phan 14 cltya theo bleu hi0 lam sang cua ADR
e Bieu hien tren da va niem mac: not me day, ngaa, rash da, loet niem ,mac.
® Bieu hien tim mach: r6i loan nhip tim, suy tim, tang hay giam huyet Ap..
• Bieu hien O. he tieu hoa: loet da day, td trang, dai trang, xuat huyet tieu hOa.
® Bieu hien a hes tiet nieu sinh dyc: suy then, roi loan kinh nguyet..
• Bieu hien &than kinh trung yang va ngoai vi: CO giet, h6n
o Biel] hien a chirc nang clang mau: suy tOy, giam tieu cau, hong eau, bach cau hat, r6i
loan clang mau..
® Bieu hien a he thong,co xuang: loang xuang, viem gan, dirt gan..
• Bieu hien O. he not tiet: suy thugng then, cuang giap..
• Bleu hien toan than.
® Bieu hien o• co quan khac.
III. CAC YEU TO NGUY CUA ADR
1. Thu6c
Chat [Yong thu6c:
• Chat Itrong hoat chat: d6 tinh khiet cua hoat chat IA van de can quan tam.
• Ta duct vi co the lam thay d6i sir hap thu thu6c, vi du thay the glycerin bang ethylene
glycol trong h8n dich sulfanilamide lam chet nguai.
© Qua trinh san xuat
© Bac) quan
2. Wnh nhan
Gioi tinh: ADR thuang xay ra phi,' nu hon nam
Tu6i tac: ADR thuang xay ra a ngtrai gia tren 60 tuoi do sy• nhay cam va so !yang thuk clUng
nhi'eu hon so vol ngu.O.i tre.
co thai gay bien clang tre em.
Phy nu• eó thai: thalidomide IA thuoc an than dung cho phy
Benh ly: suy then thuang gay bien d6i nhieu ve &rat lye cua thuk. Stress, ,nh6i mau co tim,
!Yong al glycoprotein tang len, dan den sy lien ket girra thu6c co tinh kiem yeu vai protein nay
se tang len nhu propranolol, quinidine..

Sy thieu but men chuyen do di truyen: thieu men Glucose 6 phosphate dehydrogenase gay tieu
huyet benh nhan thieu men nay khi sir dyng thuoc oxy hOa nhu• aspirin, primaquin, dapson,
thuang gap a nglayi Dia Trung Hai, chau Phi, Dong Nam A.
3, Bac sis
Bac si can cc') kien thirc tot ve duoc ly cua thuoc.
Y dire
IV. BIN PHAP HAN CHE A
Trtrac khi ke clan, phai danh gia dirge cal loi va hal do thu6c mang lai boi vi ADR khong tach
kh6i tac dung c6 lgi ma thuoc mang lai.
Theo dOi cac phan tang co hal.
ThOng bao cac ADR tram trong hoac cac phan Ong nghi nga IA do thuoc gay ra.

20


Trirong Cao Hang Ky Thuat Y Te II Da Arcing

Gieo trinh chive lam sang

THONG TIN THUOC
MVC TIED
1. Let ke duor nit so cach phcin loaf thong tin thudc
2. Liet ke cludr n17E-mg not dung thong tin thuoc cho 170nh nhdn via cho can 170 y to
3. PhOn tich thror cat btrck ccin lam nheim thief Idp nit guy trinh thong tin thucic CO hieu
quo.
NOI DUNG
Tren the gi6i, thuat
" thong tin thu6cATTT) bat au duvc de cap nhieu vac nhang
narn dau cua thap kj/ 60. TTT co the hieu mot each don gian IA cac thong tin gan lien vai thuoc,
cac thong tin nay thuong duvc in trong cac tai lieu tham khao hay can g9i IA cac nguon thOng

tin. Tuy nhien de hieu rO ye khai niem TTT thtreng phai clAt thuat ngir nay trong cac ngt canh
cu the, di kern voi cac thuat ngir khac nhu:
- Chuyen gia/ &roc si / nguti cung cap
- Trung tam/ dich vu/ thkrc hanh
- Chile nAng/ ky nAng
Nhom cac khai niem dau tien de cap den vai tre cua cac ca nhan lam cong tac thOng tin
thu6c, nhom khai niem thir hai chu trong vao cac dia diem din ra hoat d6ng TTT, con nhOm
khai niem thir ba lien quan,den Wang Ikrc TTT
Hien nay, vai thkrc to vo cling da clang va phirc tap dm cac thu6c lieu tri cling nhu. cac tai
lieu lien quan den thu6c, thuat nga TTT thutng duvc gan lien vai cac khai niem "trung tarn
TTT", va " chuyen gia TTT", CO nghia IA not den TIT la nOi den vai tr6 chuyen mon h6a ca
din:7c sy ding nhun6i den mot he th6ng th6ng tin host d6ng vai cac chirc trach chuyen, biet
Su phat trien cua cac trung tam th6ng tin thuoc va cac chuyen gia thong tin thuoc IA diem
kh6i dau cua khai niem &roc lam sang, dAt nen tang de cac duvc sy chia se trach nhiem vol cac
bac sy trong viec sCr dung thuoc cho benh nhan.
1. Phan loai thong tin thaw
CO nhieu cach phan loai thong tin khac nhau, sau day la mot so each phan loai thong tin
hay duvc ap dung
1.1. Phan lo#i thong tin theo doi tuwg cluw thong tin
1.1.1 Th6ng tin cho can b6 y to
- Cho ca nhan:
+ Thay thuOc ke don
+ Y td dieu dutng
+ Dirgc sy benh vien, ma hang
+ NgLr6i ban thu6c
- Cho mot to chirc:
+ H6i dong thuoc va dieu tri
+ Bao hiem y to
1.1.2 Thong tin cho ngutri sir dung
- Benh nhan, nguti dung thuoc

- Nhan dan, ngubi tieu dung thuoc
L2 Phan 1100 thong tin theop(ii dung chuyen biet cua thong tin
1.2.1 Cac thong tin lien quan den d4c tinh va each sir dung cua thuoc
- Thong tin lien quan den clang bao the va sinh kha dung cua thuoc
- Thong tin ve duvc lye hoc
- ThOng tin ye duvc d6ng h9c
- Th6ng tin ve danh gia sir dung ,Iva ch9n thu6c
- ThOng tin ye hutng clan sir dung thuoc( che d6 lieu, phac do dieu tri,
21

khi dung...)


GO° trinh &toy lam sang

Trtrang Cao Hang Ky Thuat Y Te II Da Nang

- Thong tin va ADR, va dOc tinh cua thuOc
- Thong tin ve tac dyng gay quai thai, dOt Nen..
- ThOng tin ye Su' elyng thu6c cho cac dOi tuong dac biet
- Thong tin ye dO on dinh, tinh tuong ky, cua thuoc
- Thong tin ye tuong tac thuoc
1.2.2 Cac th6ng tin ve luat, chinh sach y te, so dang 14..
1.2.3 Th6ng tin va gia ca
1.3 Phan loai thong tin theo nguon thong tin
NguOn thong tin thutng dugc chia thanh ba loai: nguon th6ng tin thir nhat, nguOn thong
tin thir hai, nguOn th6ng tin thir ba. Viet phan loai nay dkra vao nguOn gOc ,thanh phan , chirc
nang dm thong tin.
1.3.1 Nguon th6ng tin tha nhat
La cac bai bao, cong trinh got clang tai day du tren cac tap chi hoac dua len man internet,

cac bao cao chuyen mon, khcia luan tOt, nghiO
sinh vien,
tay phong thi nghiem...Cac
thOng tin nay thutng do tac gia cong b6 cac nghien
ctia ,minh ma khOng co St/ can thiep,
danh gia dm ben thir hai. Khi sir dyng nguon th6ng tin thir nhat, nguti ,sir dyng thong tin có the
xac dinh dugc phuong phap nghien cat!, ket qua nghien ciru va cac kat luan cy the ma tac gia
dat dugc . Hien nay nguon th6ng tin thir nhat.dang phat trien rat mph me, tren the giai co tren
20 000 tap chi y sinh h9c có ten tuoi duoc xuat ban hang nam, chin ke cac thong tin dupe cong
1)6 dual clang bao cao khoa h9c hay dua len mpg...
1.3.2 Nguon thong tin tha hai
Bao gom he th6ng muc lyc cac thong tin hoac cac bai torn tat cua cac thOng tin thuOc
npOn thOng tin tha nhat, dugc.sap xep theo cac chii
hhat dinh. Khi muon tim hieu mot van
de cy the, nguti sir dyng co the tham,khao ngu6n th6ng tin thir hai de co dugc mot danh myc
cac thOng tin có lien quan hoac co the dgc tom tat cac thong tin ding chi] de vai van de minh
quan tam. Nhu vay ngu6n th6ng tin tha hai giup nguti sir, dking tiep can van de mot cach toan
din hon, nhung khi muon‘hieu day du mot thong tin cy the nao do, nguti
dyng phai quay
lai nguOn thong tin ban dau . Hien nay, da CO cac nguon thong tin this hai Itru tat trong CDROM hoac dua len mang internet, gimp nguti
dyng tim thong tin a dang va nhanh along
hon.
1.3.3 NguOn thong tin thir ba
La cac thong tin dupe xay dung bang each tong hqp cac thong tin tir hai nguOn thOng tin
tren. Tac gia cua nguOn thong tin thir ba thutng la cac chuyen gia y6 thuOc trong mot linh vyt
nao do; tir cac kien thac chuyen sau trong linh VkiC do h9 se phan tich tong hgp cac thong tin
lien quan de dua ra thong tin mang tinh khai quat ve mot van de. Cac thong tin thuOc nguOn
thong tin thir ba thutng dupe cong 136 cluti dang sach giao khoa, cac bang hutng clan lieu tri
chuan...Nguti sir dung phan
khai that ngu6n thong tin nay vi cac thong tin thtrang ngan

g9n , sue tich va dO khai quat hiala cao ( do da dupe xu 15/ bpi cac chuyen gia). Tuy nhien, nhirgc
diem dm nguon th6ng tin tha ba la tinh cap nhat kern, dO tin cay phy thuOc vac) nang lint cua tac
gia(vi có the co sai sot do thanh kien Hang cua tac gia, sai sot trong qua trinh chuyen tai thong
tin hoac do tac gia kh6ng tap h9p dupe day du cac thong tin ban dau co lien quan hay danh gia
sai Lech cac th6ng tin nay...) va ciing nhu. khi su dyng nguon thong tin thir hai, khi can tim, hieu
chinh xac mot thongtin cy the nao (JO, nguti sir dung có the quay lai ngu6n th6ng tin ban dau.
2.1Ceu eau eiia thong tin thuoe
2.1 Yeu eau Chung
MOt thong tin thu6c phai co clAy du nhung yeu cau sau:
- Khach quan
- Chinh xac
- Trung thyt
- Mang tinh khoa h9c
- RO rang va dirts khoat
2.2 Y'eu eau ye n01 dung
22


Tru&ng Cao Bang K9

GiOo trinh &ray Ian? sang

Thuat Y II Da Nang

N6i dung thong tin tint& phai phu hop ,vai doi along duoc thong tin. Sau day la yeti cau
va not dung cua thong tin thuoc vai mot so doi tuong:

2.2.1 Thong tin thaw cho can bo y to
Thong tin thuoc cung cap cho can b6 y,te• phai la cac, thong tin co not dung mang tinh
chuyen sau ye thuoc. Cac thOng tin nay co the duoc cung cap dual nhieu hinh thirc nhu cung

cap theo yet., cau bo i cac trung tarn thong tin thuOc, thong tin qua h6i thao, bao cao khoa hoc
hoac cac thong tin duoc in an sari trong cac tai lieu tham khao hay dua len rang de can ba y to
khai thac theo nhu cau...
Ve co ban, thOng tin thuOc cho can b6 y to se bao gom cac not dung sau:
Cac thong tin chung ye thuoc: Cac each phan loci thuoc(danh muc thuoc thiet yeu, thuOc
khong can don(OTC), thu6c phai CO don, ma phan loaf giai phh- dieu tri-h6a h9c (ATC), danh
myc cac ten thuoc goc, ten thuong mai, thu6c duoc phdp Itru hanh, so clang
Ca the tac dyng cua thuoc:
- Dac tinh duoc d6ng h9c: hap thu, phan 1)6 ,chuyen hoa, thai trir.
- Cac chi dinh ,ch6ng chi dinh
- Cach dung, lieu ,luong
- Cac phan ang bat loi (ADR) CO the xay ra.
- DOc tinh, bleu hien ng6 d6c, xix tri
- Thong tac va tuong ky, ciia thuoc( thuoc voi thuoc, thuoc vol thirc an, vai nuac uong)
- Thang bac gia ca...,

2.2.2 Thong tin thuoc cho bOh nhan
• thong tin thuoc cho benh nhan lai can c6 not
Khac vai th6ng tin thuoc cho can b6 y te,
dung ngan g9n, de hieu vof cac hinh thirc thong tin don gian, co gang tan dyng cac phuong tien
cho benh nhan hieu rO lai ich va tac
truyen thong san co. Myc Bich thong tin, thuoc nham
cac
huang
clan
dieu
tri,
darn
bao
sir

dyng
thuoc hop ly va an toan
hai
thuoc, tuan
cac not dung sau:
NOi dung thong tin thu& cho benh nhan thuang bao
- Ten thuoc(ten goc, ten biet duoc)
- Tac dyng
- Dal-1g diing , lieu dimg, each dung
- Huang an sir dyng cac dung bao the dac biet
- Huang clan quan sat , theo dOi cac trieu chimg khac 14 trong khi dimg thuoc(nha 1(5/ de
theo dOi ti6p trong nhung Ian diing thu6c sau)
- Nhang trieu chirng cua phan Ong khong mong main , each xir tri
- Ky nang tyr theo doi tac dyn& thu6c,trong qua trinh dieu tri
- Tuong tac thuoc( thu6c- thuoc, thuoc - thuc pham, thuoc- nuot uong)
- Cach bac quan luting thu6c da mua, duoc cap
3.1(F nang thong tin thutic
throc tien hanh, trong phan
Nhieu cong trinh nghien ciru ye ky nang thong tin thu6c
nay trinh bay mot quy trinh th6ng tin thuoc dua tren quy trinh do Host va Kirkwood dua ra nam
1987 vas den nay van duoc ap dyng r6ng rai.
Ve co ban, quy trinh nay se gam cac buoy sau:
BtrOc 1: Xac dinh dac diem cua nguai yeu cau thOng tin
RO rang neu do along yeu cau th6ng tin khac nhau thi not dung dm th6ng tin tra 161 se
khac nhau
Vi du: M6t bac sj% chuyen khoa va mot benh nhan co the ding quan tarn den mot thuoc va
ding dua ra mot cau h6i ban dau nhu nhau nhung not dung th6ng tin tra lof lai phais hoan toan
khac nhau phu hop vai trinh d6 chuyen mon cua m8i nguai. Chinh vi vay ding viec dau tien cua
quy trinh .1a phai xac dinh duoc dac diem cua nguai yeu cau thong tin. Tby theo tang hoan canh
ma co the khai thac cac thong tin Ca nhan khac nhau, nhung bao gi6 cling phai xac dinh cac

nguai yeu cau thong tin:
th6ng tin thiet yeu sau
- Nghe nghiep, trinh d6 chuyen man, cac kien thirc san c6 ye van de yeu cau dupe thong
tin
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