Nhi\u1ec1u lo\u1ea1i t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – thu\u1ed1c ti\u1ec1m \u1ea9n nh\u1eefng nguy c\u01a1 cao th\u00ec \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o ngay trong toa thu\u1ed1c. Ho\u1eb7c trong qu\u00e1 tr\u00ecnh k\u00ea \u0111\u01a1n th\u00ec th\u1ea7y thu\u1ed1c c\u0169ng \u0111\u00e3 c\u00f3 s\u1ef1 c\u00e2n nh\u1eafc, t\u01b0 v\u1ea5n. Nh\u01b0ng t\u01b0\u01a1ng t\u00e1c gi\u1eefa thu\u1ed1c – th\u1ee9c \u0103n th\u00ec \u00edt ng\u01b0\u1eddi bi\u1ebft \u0111\u1ebfn. Do v\u1eady, trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh, n\u1ebfu kh\u00f4ng hi\u1ec3u \u0111\u01b0\u1ee3c s\u1ef1 t\u01b0\u01a1ng t\u00e1c n\u00e0y th\u00ec ch\u1ebf \u0111\u1ed9 \u0103n h\u00e0ng ng\u00e0y c\u00f3 th\u1ec3 ti\u1ec1m \u1ea9n nguy c\u01a1 \u1ea3nh h\u01b0\u1edfng qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. Sau \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u2013 th\u1ee9c \u0103n ph\u1ed5 bi\u1ebfn.<\/p>\n
1. C\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m v\u00e0 th\u1ee9c \u0103n ch\u1ee9a tyramine<\/strong><\/p>\n Hay c\u00f2n g\u1ecdi l\u00e0 c\u00e1c IMAOs – nh\u00f3m thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m Inhibitor Mono Amino Oxydase nh\u01b0: nialamide, phenelzin, iproniazid, selegiline… C\u00e1c thu\u1ed1c n\u00e0y ng\u0103n c\u1ea3n kh\u00f4ng cho men oxy h\u00f3a kh\u1eed amin \u0111\u01a1n c\u1ee7a c\u00e1c ch\u1ea5t h\u00f3a h\u1ecdc trung gian d\u1eabn truy\u1ec1n th\u1ea7n kinh. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c nguy hi\u1ec3m khi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c chung v\u1edbi m\u1ed9t s\u1ed1 th\u1ee9c \u0103n, th\u1ee9c u\u1ed1ng nh\u01b0: ph\u00f4 mai \u0111\u1ec3 l\u00e2u, th\u1ecbt qua ch\u1ebf bi\u1ebfn n\u01b0\u1edbng, c\u00e1 hun kh\u00f3i, th\u1ecbt \u01b0\u1edbp mu\u1ed1i, b\u01a1, chu\u1ed1i, d\u01b0a c\u1ea3i, chocolate, r\u01b0\u1ee3u \u0111\u1ecf… C\u00e1c lo\u1ea1i th\u1ee9c \u0103n n\u00e0y c\u00f3 ch\u1ee9a ch\u1ea5t tyramine. Do t\u01b0\u01a1ng t\u00e1c gi\u1eefa ch\u1ea5t tyramine v\u1edbi c\u00e1c ho\u1ea1t ch\u1ea5t c\u00f3 trong c\u00e1c IMAOs d\u1eabn t\u1edbi t\u01b0\u01a1ng t\u00e1c nghi\u00eam tr\u1ecdng l\u00e0 l\u00e0m t\u0103ng huy\u1ebft \u00e1p k\u1ecbch ph\u00e1t, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/p>\n 2. C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u00e0 c\u00e1c lo\u1ea1i rau c\u1ea3i<\/strong><\/p>\n \u0110\u00e1ng l\u01b0u \u00fd \u1edf \u0111\u00e2y l\u00e0 thu\u1ed1c kh\u00e1ng vitamin K l\u00e0 nh\u1eefng ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng m\u00e1u t\u1ed5ng h\u1ee3p nh\u01b0: warfarin, sintrom, indandion… do thu\u1ed1c c\u00f3 c\u1ea5u tr\u00fac g\u1ea7n gi\u1ed1ng nh\u01b0 vitamin K n\u00ean c\u1ea3n tr\u1edf vi\u1ec7c kh\u1eed vitamin K. Thu\u1ed1c kh\u00e1ng vitamin K l\u00e0 m\u1ed9t thu\u1ed1c c\u00f3 kho\u1ea3ng tr\u1ecb li\u1ec7u h\u1eb9p, t\u01b0\u01a1ng t\u00e1c v\u1edbi nhi\u1ec1u lo\u1ea1i th\u1ee9c \u0103n. Do v\u1eady, khi u\u1ed1ng thu\u1ed1c n\u00e0y th\u00ec c\u1ea7n h\u1ea1n ch\u1ebf c\u00e1c lo\u1ea1i th\u1ef1c ph\u1ea9m gi\u00e0u kali nh\u01b0: b\u1eafp c\u1ea3i xanh, c\u1ee7 c\u1ea3i, s\u00fap l\u01a1, c\u1ea3i Bruxen, c\u00e1c lo\u1ea1i c\u1ea3i c\u00f3 m\u00e0u l\u00e1 c\u00e0ng s\u1eadm c\u00e0ng ch\u1ee9a nhi\u1ec1u vitamin K… Do c\u00e1c lo\u1ea1i th\u1ef1c ph\u1ea9m n\u00e0y l\u00e0m m\u1ea5t t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c kh\u00e1ng \u0111\u00f4ng, \u0111\u1eb7t b\u1ec7nh nh\u00e2n \u0111\u1ed1i m\u1eb7t v\u1edbi nguy c\u01a1 cao b\u1ecb t\u0103ng huy\u1ebft kh\u1ed1i. N\u00ean \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng th\u00ec ngo\u00e0i vi\u1ec7c th\u01b0\u1eddng xuy\u00ean ph\u1ea3i theo d\u00f5i ch\u1ec9 s\u1ed1 INR (international normalized ratio) th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 ki\u1ec3m so\u00e1t hi\u1ec7u l\u1ef1c c\u1ee7a thu\u1ed1c kh\u00e1ng \u0111\u00f4ng c\u00f2n c\u1ea7n thi\u1ebft l\u1eadp ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng th\u00edch h\u1ee3p.<\/p>\n 3. Kh\u00e1ng sinh v\u00e0 s\u1eefa<\/strong><\/p>\n C\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb s\u1eefa nh\u01b0 yaourt, ph\u00f4 mai, b\u01a1, s\u1eefa, kem… \u0111\u1ec1u ch\u1ee9a calcium. M\u1eb7c d\u00f9 \u0111\u00e2y l\u00e0 m\u1ed9t vi l\u01b0\u1ee3ng quan tr\u1ecdng cho s\u1ef1 s\u1ed1ng, s\u1ef1 ph\u00e1t tri\u1ec3n x\u01b0\u01a1ng, c\u00f3 l\u1ee3i cho s\u1ee9c kh\u1ecfe\u2026 nh\u01b0ng c\u00e1c s\u1ea3n ph\u1ea9m c\u1ee7a s\u1eefa l\u1ea1i l\u00e0m b\u1ea5t ho\u1ea1t, l\u00e0m gi\u1ea3m h\u1ea5p thu, m\u1ea5t t\u00e1c d\u1ee5ng c\u1ee7a m\u1ed9t s\u1ed1 kh\u00e1ng sinh nh\u01b0: levofloxacine, ciprofloxacin, doxycyclin, tetracyclin… C\u1ea7n khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n ch\u1ec9 n\u00ean d\u00f9ng c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ch\u1ee9a calcium tr\u01b0\u1edbc tr\u01b0\u1edbc 1 gi\u1edd ho\u1eb7c sau 2 gi\u1edd u\u1ed1ng kh\u00e1ng sinh.<\/p>\n 4. N\u01b0\u1edbc b\u01b0\u1edfi & m\u1ed9t s\u1ed1 thu\u1ed1c tr\u1ecb b\u1ec7nh m\u1ea1n t\u00ednh<\/strong><\/p>\n Cyp3A4 l\u00e0 m\u1ed9t lo\u1ea1i enzym chuy\u1ec3n h\u00f3a, lo\u1ea1i enzym n\u00e0y chuy\u1ec3n h\u00f3a nhi\u1ec1u lo\u1ea1i thu\u1ed1c c\u0169ng nh\u01b0 nhi\u1ec1u lo\u1ea1i ch\u1ea5t \u0111\u1ed9c th\u00e0nh nh\u1eefng ch\u1ea5t \u00edt \u0111\u1ed9c h\u01a1n ho\u1eb7c d\u1ec5 b\u00e0i ti\u1ebft h\u01a1n ho\u1eb7c c\u1ea3 hai. N\u01b0\u1edbc b\u01b0\u1edfi c\u00f3 ch\u1ee9a furanocoumarins, \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc enzym CYP3A4, d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 tr\u1ea7m tr\u1ecdng do t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – th\u1ef1c ph\u1ea9m. T\u01b0\u01a1ng t\u00e1c n\u00e0y l\u00e0m kh\u1ea3 n\u0103ng chuy\u1ec3n h\u00f3a c\u1ee7a\u00a0 Cyp3A4.<\/p>\n M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c nh\u01b0: thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p, HIV, statins, thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch… c\u1ea7n ph\u1ea3i c\u00f3 s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a Cyp3A4. Nh\u01b0ng n\u1ebfu u\u1ed1ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y c\u00f9ng n\u01b0\u1edbc b\u01b0\u1edfi s\u1ebd l\u00e0m gia t\u0103ng hi\u1ec7u l\u1ef1c c\u1ee7a thu\u1ed1c do b\u1ecb \u1ee9c ch\u1ebf chuy\u1ec3n h\u00f3a d\u1eabn \u0111\u1ebfn gia t\u0103ng n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u. K\u1ebft qu\u1ea3 l\u00e0 t\u1ea1o ra m\u1ed9t l\u01b0\u1ee3ng thu\u1ed1c qu\u00e1 li\u1ec1u. Khi qu\u00e1 li\u1ec1u c\u00e1c statins c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn ho\u1ea1i t\u1eed c\u01a1, h\u1ea1 \u00e1p nguy hi\u1ec3m \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c huy\u1ebft \u00e1p… \u0111\u00f4i khi d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/p>\n 5. Th\u1ef1c ph\u1ea9m gi\u00e0u iod v\u00e0 thu\u1ed1c kh\u00e1ng gi\u00e1p<\/strong><\/p>\n C\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng gi\u00e1p nh\u01b0: methimazole, PTU… b\u1ecb l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb khi d\u00f9ng chung v\u1edbi th\u1ef1c ph\u1ea9m gi\u00e0u iod. Do \u0111\u00f3, n\u1ebfu u\u1ed1ng thu\u1ed1c n\u00e0y m\u00e0 \u0103n th\u1ef1c ph\u1ea9m gi\u00e0u iod th\u00ec hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c b\u1ecb gi\u1ea3m, \u0111\u00f2i h\u1ecfi ph\u1ea3i s\u1eed d\u1ee5ng li\u1ec1u cao h\u01a1n so v\u1edbi li\u1ec1u th\u00f4ng th\u01b0\u1eddng. Nh\u01b0 v\u1eady c\u0169ng \u0111\u1ed3ng ngh\u0129a v\u1edbi s\u1ef1 gia t\u0103ng nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5: ph\u00e1t ban, n\u1ed5i m\u1ec1 \u0111ay, b\u1ec7nh gan… C\u00e1c lo\u1ea1i th\u1ef1c ph\u1ea9m gi\u00e0u iod nh\u01b0: h\u1ea3i s\u1ea3n, c\u00e1 bi\u1ec3n, t\u1ea3o bi\u1ec3n, mu\u1ed1i…<\/p>\n 6. N\u01b0\u1edbc t\u00e1o v\u00e0 & c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c b\u1ebb, nghi\u1ec1n…<\/strong><\/p>\n M\u1ed9t s\u1ed1 thu\u1ed1c khi d\u00f9ng ph\u1ea3i h\u00f2a tan v\u1edbi n\u01b0\u1edbc (ho\u1eb7c b\u1ec7nh nh\u00e2n kh\u00f3 u\u1ed1ng, kh\u00f3 nu\u1ed1t \u0111\u00e3 nghi\u1ec1n nh\u1ecf ho\u1eb7c th\u00e1o v\u1ecf nang b\u00ean ngo\u00e0i)… \u0111\u1ec3 u\u1ed1ng, nh\u01b0ng n\u1ebfu cho thu\u1ed1c v\u00e0o n\u01b0\u1edbc tr\u00e1i c\u00e2y, n\u01b0\u1edbc t\u00e1o… \u0111\u1ec3 d\u1ec5 u\u1ed1ng th\u00ec sai l\u1ea7m. V\u00ec thu\u1ed1c c\u00f3 th\u1ec3 b\u1ecb ph\u00e1 v\u1ee1 c\u1ea5u tr\u00fac, l\u00e0m thay \u0111\u1ed5i d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc… c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ea5t ho\u1eb7c gi\u1ea3m hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ho\u1eb7c x\u1ea3y ra \u0111\u1ed9c t\u00ednh.<\/p>\n T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n S\u00e1ch D\u01b0\u1ee3c l\u00fd – D\u01b0\u1ee3c l\u00e2m s\u00e0ng; C\u1ea9m nang MSD MANUAL<\/p>\n ———————<\/p>\n Th\u00f4ng tin li\u00ean h\u1ec7:<\/p>\n KHOA D\u01af\u1ee2C – B\u1ec6NH VI\u1ec6N HUY\u1ec6N C\u1ee6 CHI<\/p>\n \u0110\u1ecba ch\u1ec9: 1307 T\u1ec9nh L\u1ed9 7, x\u00e3 An Nh\u01a1n T\u00e2y, huy\u1ec7n C\u1ee7 Chi, TP. H\u1ed3 Ch\u00ed Minh<\/p>\n S\u1ed1 \u0111i\u1ec7n tho\u1ea1i: 028 37946 443<\/p>\n","protected":false},"excerpt":{"rendered":" Nhi\u1ec1u lo\u1ea1i t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – thu\u1ed1c ti\u1ec1m \u1ea9n nh\u1eefng nguy c\u01a1 cao th\u00ec \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o ngay trong toa thu\u1ed1c. Ho\u1eb7c trong qu\u00e1 tr\u00ecnh k\u00ea \u0111\u01a1n th\u00ec th\u1ea7y thu\u1ed1c c\u0169ng \u0111\u00e3 c\u00f3 s\u1ef1 c\u00e2n nh\u1eafc, t\u01b0 v\u1ea5n. Nh\u01b0ng t\u01b0\u01a1ng t\u00e1c gi\u1eefa thu\u1ed1c – th\u1ee9c \u0103n th\u00ec \u00edt ng\u01b0\u1eddi bi\u1ebft \u0111\u1ebfn. Do v\u1eady, trong […]<\/p>\n","protected":false},"author":4,"featured_media":8715,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[2],"tags":[],"_links":{"self":[{"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/posts\/8714"}],"collection":[{"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8714"}],"version-history":[{"count":2,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/posts\/8714\/revisions"}],"predecessor-version":[{"id":8717,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/posts\/8714\/revisions\/8717"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=\/wp\/v2\/media\/8715"}],"wp:attachment":[{"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8714"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8714"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/benhvienhuyencuchi.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8714"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}