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[Duoc ly] bai 3 thuoc dieu tri gout
- 1. 12/16/2014 1 THU畛C I畛U TR畛 GT TS.Tr畉n Thanh T湛ng B畛 m担n D動畛c l箪 畉i h畛c Y H N畛i 1 M畛c ti棚u h畛c t畉p Sau khi h畛c xong bi ny sinh vi棚n: Tr狸nh by 動畛c c董 ch畉 t叩c d畛ng, t叩c d畛ng kh担ng mong mu畛n v 叩p d畛ng i畛u tr畛 c畛a c叩c thu畛c colchicin, probenecid, allopurinol 2 G炭t l m畛t b畛nh + Tng acid uric-m叩u + L畉ng 畛ng trong d畛ch bao kh畛p tinh th畛 urat Bi畛u hi畛n l但m sng + L但m sng: s動ng n坦ng 畛 - au 畉c bi畛t l ng坦n ch但n c叩i. S畛i urat 畛 th畉n + C畉n l但m sng: acid uric trong m叩u tng cao (b狸nh th動畛ng 2-5mg/dl) I. 則孫i c働測ng 3 Nguy棚n t畉c i畛u tr畛 g炭t - C畉t c董n c畉p: colchicin, NSAIDs, steroid - Ngn ng畛a s畛 t叩i ph叩t: allopurinol, febuxostat, probenecid - Ch畉 畛 n: + H畉n ch畉 th畛c n ch畛a nhi畛u purin + n nhi畛u rau xanh, hoa qu畉 + U畛ng nhi畛u n動畛c I. 則孫i c働測ng 4
- 2. 12/16/2014 2 II. THU畛C I畛U TR畛 GT allopurinol febuxostat probenecid steroid NSAIDs colchicin Vi棚m kh畛p c畉p Gi畉m acid uric m叩u 5 2.1. COLCHICIN - Alcaloid l畉y t畛 h畉t c畛a c但y t畛i 畛c (Colchicum antumnal L.) 畉c i畛m t叩c d畛ng - T叩c d畛ng i畛u tr畛 畉c hi畛u c董n g炭t c畉p t鱈nh - Gi畉m au v gi畉m vi棚m trong v嘆ng 12 - 24 gi畛 畉u - D湛ng lm test ch畉n o叩n. - Kh担ng c坦 t叩c d畛ng gi畉m au, ch畛ng vi棚m kh畛p kh叩c - Kh担ng lm h畉 acid uric m叩u n棚n kh担ng d湛ng i畛u tr畛 g炭t m畉n 6 2.1. COLCHICIN * C董 ch畉 t叩c d畛ng: - G畉n vo protein ti畛u qu畉n trong BC 畛c ch畉 s畛 di chuy畛n c畛a BC, gi畉m ho畉t t鱈nh th畛c bo c畛a BC - Lm gi畉m gi畉i ph坦ng acid lactic v c叩c enzym g但y vi棚m trong qu叩 tr狸nh th畛c bo. - Ngn c畉n s畉n xu畉t glycoprotein c畛a b畉ch c畉u h畉t n棚n ch畛ng 動畛c c董n g炭t c畉p. - Ngn c畉n s畛 ph但n bo c畛a c叩c t畉 bo 畛 giai o畉n trung k畛 7 8 2.1. COLCHICIN * C董 ch畉 t叩c d畛ng:
- 3. 12/16/2014 3 2.1. COLCHICIN * 畛c t鱈nh: Ph畉n l畛n li棚n quan 畉n t叩c d畛ng 畛c ch畉 s畛 tr湛ng h畛p c畛a tubulin v 畛c ch畉 ph但n bo: - RLTH: th動畛ng g畉p nh畉t bu畛n n担n, n担n, ti棚u ch畉y, au b畛ng (t畛n th動董ng t畉 bo bi畛u m担 ni棚m m畉c ti棚u h坦a) - D湛ng di ngy: 畛c ch畉 tu畛 x動董ng, r畛ng t坦c, vi棚m th畉n kinh, 畛c v畛i th畉n... 9 2.1. COLCHICIN * Ch畛 畛nh: - i畛u tr畛 c董n g炭t c畉p t鱈nh - Ch畉n o叩n vi棚m kh畛p do g炭t - D畛 ph嘆ng g炭t c畉p - K畉t h畛p thu畛c 畛c ch畉 t畛ng h畛p acid uric 畛 tr叩nh s畛 huy 畛ng urat g但y ra c董n g炭t c畉p (1-6 th叩ng) * Ch畛ng ch畛 畛nh: - Suy gan ho畉c suy th畉n n畉ng - Ph畛 n畛 c坦 thai 10 2.2. PROBENECID * 畉c i畛m t叩c d畛ng: - Acid uric l畛c qua c畉u th畉n v 動畛c t叩i h畉p thu 畛 o畉n gi畛a c畛a 畛ng l動畛n g畉n. - Probenecid v畛i li畛u cao 畛c ch畉 t叩i h畉p thu acid uric 畛 畛ng th畉n n棚n lm tng th畉i tr畛 qua n動畛c ti畛u. - Kh担ng c坦 t叩c d畛ng gi畉m au. Khi c畉n gi畉m au, c坦 th畛 d湛ng c湛ng v畛i paracetamol. - Probenecid s畉 m畉t t叩c d畛ng khi d湛ng c湛ng v畛i salicylat. 11 2.2. PROBENECID - D湛ng thu畛c l畛i ni畛u lo畉i thiazid k辿o di lm 畛 urat do 畛c ch畉 bi xu畉t urat 畛 畛ng th畉n. Probenecid 畛i kh叩ng 動畛c t叩c d畛ng ny * T叩c d畛ng KMM: r畉t 鱈t (2-8%): bu畛n n担n, n担n, m畉ng 畛 畛 da, s畛t. Khi lm 叩i nhi畛u acid uric, c坦 th畛 g但y c畉n s畛i urat v畛i c董n qu畉n th畉n (c畉n base ho叩 n動畛c ti畛u). U畛ng nhi畛u n動畛c 畛 tr叩nh s畛i acid uric 畛 th畉n. 12
- 4. 12/16/2014 4 T畉 bo v畛Th畛c n Base purin hypoxanthin xanthin uric acid allopurinol 畛c ch畉 xanthin oxidase Aloxanthin (c嘆n ho畉t t鱈nh) Allopurinol 2.3. ALLOPURINOL * C董 ch畉 t叩c d畛ng: 13 * C董 ch畉 t叩c d畛ng: - Allopurinol l ch畉t 畛ng ph但n c畛a hypoxanthin. - 畛c ch畉 m畉nh xanthin oxidase gi畉m sinh t畛ng h畛p acid uric, gi畉m n畛ng 畛 acid uric m叩u v n動畛c ti畛u - Lm tng n畛ng 畛 trong m叩u v n動畛c ti畛u c叩c ch畉t ti畛n th但n hypoxanthin v xanthin d畛 tan h董n Ngn ng畛a 動畛c s畛 t畉o s畛i acid uric trong th畉n. 2.3. ALLOPURINOL 14 * 畛c t鱈nh: - t 畛c. - Ph畉n 畛ng qu叩 m畉n kho畉ng 3% (m畉n da, s畛t, gi畉m b畉ch c畉u, gan to, au c董). - Trong nh畛ng th叩ng 畉u i畛u tr畛: c坦 th畛 c叩c c董n g炭t c畉p t鱈nh do huy 畛ng acid uric t畛 c叩c m担 d畛 tr畛 c畉n ph畛i h畛p i畛u tr畛 b畉ng colchicin. 2.3. ALLOPURINOL 15 * Ch畛 畛nh - G炭t m畉n t鱈nh - S畛i urat 畛 th畉n - Tng acid uric m叩u th畛 ph叩t do: ung th動, i畛u tr畛 b畉ng thu畛c ch畛ng ung th動, thu畛c l畛i ti畛u lo畉i thiazid... - Tng acid uric m叩u m kh担ng th畛 d湛ng 動畛c probenecid. M畛c ti棚u c畛a i畛u tr畛 l lm gi畉m n畛ng 畛 acid uric m叩u xu畛ng 6mg/dl (360 micro M). 2.3. ALLOPURINOL 16
- 5. 12/16/2014 5 * Li畛u l動畛ng v c叩ch d湛ng: - H畉p thu qua 動畛ng u畛ng kho畉ng 80%, n畛ng 畛 t畛i a trong m叩u sau 30-60 ph炭t. - Allopurinol b畛 chuy畛n ho叩 b畛i xanthin oxydase thnh aloxanthin c嘆n ho畉t t鱈nh ch畛 c畉n u畛ng thu畛c ngy 1 l畉n. Allopurinol vi棚n 100 - 300 mg Li畛u 畉u 100mg, tng d畉n t畛i 300mg/ngy tu畛 theo n畛ng 畛 acid uric m叩u. 2.3. ALLOPURINOL 17 CC THU畛C I畛U TR畛 GT 18 Thank you for your attention ! 19 Photo by Thanh Tung Japan 2012