Asthma Update

Tng k thuc timNgi bo co:TS.DS. V Th HT Dc lm sng Khoa DcHu, ngy 06 thng 10 nm 2016Bnh vin Trng i hc Y Dc Huo to ginh cho iu dng

Mc tiunh ngha tng k thucTng k xy ra khi no?Cn lm g phng tng k?Lm th no bn bit mt phi hp thuc c tng k/tng hp vi nhau hay khng?Cn t cu hi g?Tm d liu tng hp u?Lm th no din gii d liu ny?

Gii thiuNhiu thuc c th c k ng thi cho mt bnh nhn nngKhong trn 30% cc thuc dng ph bin l tng k hoc khng n nh khi thm hay phi hp vi cc dch hay thuc khc.Ti khoa cp cu:Tng k chim ti 25% sai st thuc [Taxis v Barber 2004]26% tng k l nguy him n tnh mng bnh nhn [Tissot et al. 2004]C ti 80% thuc IV c pha ch vi dung mi sai [Coussins et al. 2005]

Tng k thuc l vn quan trng bo m dng thuc an ton hiu qu

nh nghaTng k thuc = l mt phn ng gia cc thuc sau khi trn vi nhau khng cn an ton hay hiu qu cho bnh nhn.Tng hp thuc = kh nng cc thuc sau khi trn ln vn an ton v hiu qu. n nh = khong thi gian bo qun dung dch thuc m nng thuc vn bo m an ton v hiu qu. c im ca tng k :Thay i mucKt ta/kt tinh

KHNG phi tt c tng k u nguy him, mt s vn bnh thng.Thay i muImipenem-cilastatin hoc dobutamine c th lm i mu nhng KHNG PHI l du hiu ca tng k.cKhi pha ceftazidime (TV-ZIDIM, FORTUM 1g) vi dung mi, kh CO2 c gii phng v c th gy c. Cn i 1-2 pht CO2 bay ht.Kt ta/kt tinhCiprofloxacin kt ta khi dung dch c lm lnh. Khng bo qun t lnh.

Cc loi tng k

Tng k Vt l Tng k Ha hcTng k iu tr (Tng tc thuc)Xy ra bn trong c th/sau khi BN dng thuc Xy ra bn ngoi c th/trc khi BN dng thuc

Tng k iu tr = Tng tc thuc(Therapeutic incompatibility = Drug Interaction) Tng tc gia hai thuc xy ra trong c th ca bnh nhn sau khi dng cc thuc, lm gim an ton v hiu qu iu tr.C chDc ng hc: hp thu, phn b, chuyn ha, thi tr (vd: Ciprofloxacin v Maalox).Dc lc hc: i khng/hip lc ti ch tc dng (vd: Coumadin v Vitamin K)

Tng k Vt lTng tc gia 2 hay nhiu cht dn n thay i mu, mi, v, nht v hnh thi.

LoiCch phng trnhKhng tanKhng dng thuc b kt taTrnh trn cc thuc c pha trong cc dung mi c bit vi cc thuc khc Khi tim nhiu thuc IV, chun b ring mi thuc trong mt bm timKhng trn ln/cHin tng hp thTo khThay i pH

Tng k Vt lKt tinh ca Midazolam do pH khng thch hp [Riemann et al. 2005].

Kt tinh ca Diazepam.

Tng k vt l vi vt liu chaPhn ng vt l khng nhn thy gia thuc v vt liu nha gy hiu ng hp th thuc b bt ng mt trong ca bnh cha hay ng truyn lm gim nng v gim lng thuc dng cho bnh nhn. [Trisel 1996]. V d: propofol

Tng k Ha hcKt qu ca vic thay i phn t v dn n phn hy thuc.

Loi phn ng ha hc Cch phng trnhThy phnBo qun thuc trong cc cha chng m hay dng cht chng mPhn ng Oxy hang thuc trong cc hp mu h phchPhn ng KhTrnh xa cc cht khQuang phnDng cha chng nh sng

Tng k Ha hcKt tinh ha hc ca Midazolam v Ketamine [Riemann et al. 2005].

Tng k xy ra khi no ?Thuc v dung mi khng ph hp02 thuc tng k:Trn cng nhau: vd: trong cng mt ng truyn v/hoc bnh chaTim thuc ny sau thuc khc, nhng dng chung ng truynThuc v t dc (cht bo qun, dd m, cht n nh)Thuc v vt liu bnh cha (vd: nha PVC) hay thit b y khoa

Yu t nh hng gy TKYu tBin php phngnh sngTrnh nh sng (vd: Amphotericin B, cisplatin v metronidazole)Nhit Bo qun nhit thch hp (thng NP 25-300C hay T lnh 2-80C)Nng Xc nh nng tng hp ca cc 2 thucKhc nhau v pHXem bng tng hp thucThi gian dd n nhDng trong thi gian thuc cn n nhTh t trnTrn ring tng thuc theo th t (vd: lun thm phospho sau calcium vo Dung dch dinh dng truyn)

V DNhit Cefazolin n nh nhit phng trong 24 h nhng trong t lnh th n nh trong 14 ngyNng Bactrim 5 ml/75 ml Dextrose 5% trong nc: n nh trong 2 h, trong khi 5 ml/125 ml n nh trong 6 h

Nhng thuc tng k khi phi hp vi bt k thuc no khcNhm aminoglycosideChlordiazepoxideDiazepamCc Glycoside tim (digoxin)PentobarbitalPhenytoinSecobarbitalNaHCO3 (Sodium bicarbonate)Theophylline

Nhng thuc vi kh nng tng hp hn chClonidineDobutamineDopamineAdrenalin/Nor-adrenalinGlycerol trinitrateMilrinonSodium nitroprusside

Hu qu ca TK l - hacKt taKt tinhMt mui mui mii vGim tc dngTng tc dngTc dng mi

Hu qu v sc khe BNTn thng m/c quanGy thuyn tc mch mu do kt tinh hay phn tch thucKch ng m do thay i pHTht bi iu tr

Hu qu kinh t Tc dng c hi ca TK thuc gy ko di thi gian nm vin ca BN v tng chi ph iu tr.Cc bin chng h hp nghim trng gy bi tng tc thuc-thuc c th lm tng chi ph y t thm $76.400/mt BN.

Cc chin lc phng trnhLun tra cu ti liu, hi Dc s kim tra tng k Cc cu hi thng gp:Pha thuc trong Dung mi no ?Trn ln 2 dd thuc vi nhau c khng ? Truyn 2 dd thuc ng thi qua ng truyn ch Y c c khng ?Dung dch sau khi pha long nn bo qun nhit bao nhiu ? V c th dng trong thi gian bao lu ?

Tnh hung 1C th trn chung dung dch Amikacin v dung dch Amphotericin B HOC cho truyn cng mt ln qua cng truyn ch Y c hay khng ?

Cch 1: Bng tra tng hp Tng k

Kim tra Tng k

Amikacin + Amphotericin B: TK >> Khng c trn chung hay truyn qua cng ch Y

Tnh hung 1-p n

Cch 2: SchDc th Vit Nam, Vidal, MIMS

Kim tra Tng k

Cch 2: Sch Dc th VNKim tra Tng k

AmikacinAmphotericin B

Cch 3: Tra online bng StabilisKim tra Tng k

www.stabilis.org

Cch 3: Tra online bng StabilisKim tra Tng k

www.stabilis.org

Cch 3: Tra online bng StabilisKim tra Tng k

Du cho X = C tng k >>> Khng c trn vi nhau

Cch 4: Hi Dc s T Dc lm sngNu c cu hi lin quan n tng k, bo qun, pha ch thuc, iu dng c th lin h:TS.DS. V Th H, ph trch T Dc lm sng Khoa Dc, BV Trng H Y Dc Hu. Lin lcin thoi: 0961 765 846Email: havothipharma@gmail.com. in mu Hi p Thng tin thuc

Kim tra Tng k

Mu Hi p Thng tin thuc

Cc chin lc phng trnh2. Chun ha cc protocol pha ch thuc

Tnh hung 2Cch pha CEFOTAXONE 1g cho bnh nhn ?

Cc chin lc phng trnh2. Chun ha cc protocol pha ch thuc

Cc nguyn tc 1. Gim ti thiu s thuc trn cng nhau trong cng mt dung dch.2. Trn k khi thm mt thuc vo ch phm pha ch.3. Dng cc dung dch mi pha pha ch.4. Lun kim tra ng dung mi, thuc v nng cui cng trc khi pha ch. 5. Lu khi thm cc t dc nh hng n Tng k (vd: thm PO4 vo TPN)6. Cc dung dch nn c dng ngay sau khi trn hoc trong ca s n nh8. Kim tra bng mt sn phm cui sau khi pha ch v s ton vn, r r, vn c, tiu phn, mu, v pha ch thch hptrc khi dng.9. Ghi nhn r rng, y : thuc, nng , tn bnh nhn.

Cc chin lc phng trnh3. Thc hin dng cc nguyn tc khi tim/truyn

4. Cc bin php x l khi c tng k:Kim tra xem c ng dng khcCn lp k hoch dng thuc tch ring nhauDng thuc khc nhau v thi gian v a im timRa h thng truyn IV bng dung mi trung tnh (NaCl 0.9%) trc khi truyn thuc khc

Cc chin lc phng trnh

Cc chin lc phng trnh khcOmniflushng tim cha sn dung dch NaCl 0.9% sc ra ng tim IV

Cc chin lc phng trnhCertofix Multilumen Catheterscatheter c nhiu ng tch ri

Cc bin php phng trnhIntrapur v Sterifix Infusion Filterng truyn c mng lc gi cc tiu phn rn. Khi thit b tc l ch du c TK xy ra.

Cc bin php phng trnhNeutrapurng truyn khng cha nha PVC: phng tng tc gia vi thuc vi PVC nh Taxol.

Tng ktNguy c chnh ca TKThuc vi dung miThuc vi thucThuc vi vt liu cha/h thng truynChin lc phng TKTra ti liuChun ha quy trnh pha ch, timD liu TK trong y vnCn nh gi xem liu d liu c th c p dng cho trng hp ca bn.

Lng gi

Tho lunDc s cn bin son nhng ti liu g h tr iu dng lin quan n tng k thuc v pha ch thuc ?Dc s cn tin hnh cc hot ng g h tr iu dng trong vic s dng thuc ?

Ti liu tham kho1. Standard for Infusion Therapy Royal College of Nursing 3rd 2010. Trang 12. 2. Drug Incompatibility. Rish Prevention in Infusion Therapy. B. Braun Melsungen AG. 3. B Y t. Dc th Vit Nam.

Nu bn mun i nhanh, hy i mt mnh. Nu bn mun i xa, hy i cng nhau. Danh ngn Phi ChuXin cm n mi ngi ch lng nghe!