11/15/2013
1
PGS. TS. Nguyn Ngc Khi
BM. Dc lm sng, Khoa Dc
H Y Dc TP.H Ch Minh
1
S DNG THUC TRN I TNG C BIT
C th ha vic s dng thuc
2
Bnh Ngi bnh
Tnh trng sinh l
Tnh trng bnh l
DC NG HC
DC LC HC
11/15/2013
2
C th ha vic s dng thuc
3
Cc i tng c bit
Tr em
Ngi cao tui
Ph n c thai
Ph n cho con b
Ngi suy gan
Ngi suy thn
Mc tiu
1. Trnh by c s thay i v hp thu - phn b - chuyn
ha thi tr ngi mang thai, tr em
2. Trnh by c nguyn tc s dng thuc nhng i tng
ny
3. Trnh by c cch s dng mt s thuc chnh nhng
i tng ny
4
11/15/2013
3
Ni dung
1. S dng thuc cho ph n c thai /cho con b
2. S dng thuc cho tr s sinh v tr em
5
S dng thuc cho ph n c thai
6
11/15/2013
4
S dng thuc cho ph n c thai
7
1957 1962
Thalidomid
S dng thuc cho ph n c thai
8
Phn chia t bo
2 TB 4 TB 8 TB
Ti phi
6 ngy
< 17 ngy: gy sy thai,
nu thai vn pht trin khng b nh hng
Saladin: Anatomy & Physiology: The Unity of Form
and Function, Fifth Edition, The McGrawHill Companies, 2010
11/15/2013
5
S dng thuc cho ph n c thai
9
Tnh mch m
ng mch m
Saladin: Anatomy & Physiology: The Unity of Form and Function, Fifth Edition, The McGrawHill Companies, 2010
S dng thuc cho ph n c thai
10
DD
qua dng bo
Dinh dng qua nhau thai
Pha
dng bo Pha
Nhau thai
TUN
Saladin: Anatomy & Physiology: The Unity of Form and Function, Fifth Edition, The McGrawHill Companies, 2010
11/15/2013
6
S dng thuc cho ph n c thai
11
Thuc (MW < 1000)
Thuc (MW >1000)
Khuch tn th ng
Khuch tn th ng
Lp dng bo
Mao mch bo thai
Mu t m
Protein
vn chuyn
Vn chuyn thuc qua nhau t m sang thai nhi
James M Ritter, A Textbook of Clinical Pharmacology and Therapeutics, Hodder Arnold, 2008
S dng thuc cho ph n c thai
12
1757 ngy: Thi k phi/to thnh c quan
Thalidomid Androgen ACEI
Cc thuc c t bo Progestogen Carbamazepin
Ru Danozol Carbimazol
Warfarin Diethylstilbestrol Phenytoin
Retinoid ng v phng x
Thuc chng ng kinh Vi loi vaccin sng
Ribavarin Lithium
Cc thuc c kh nng gy qui thai
11/15/2013
7
S dng thuc cho ph n c thai
13
Thi k thai
Cc c quan tip tc pht trin v hon thin
Thai t nhy cm hn thi k phi
Cc cht c lm gim tnh hon thin v cu trc v chc
nng ca cc c quan: TKTW, mt, rng, tai, b phn sinh
dc ngoi
S dng thuc cho ph n c thai
14
Tc dng ca thuc trn bo thai v tr s sinh
Thuc Tc dng c th c Ghi ch
ACEI Thiu oxy mu (thai nhi v
tr s sinh), h huyt p, ri
lon chc nng thn, thiu
i, chm tng trng trong
t cung
Theo di thai nhi nu
iu tr lu di trong
ba thng th hai
hoc th ba
-blocker nh
atenolol
Chm nhp tim tr s sinh,
h huyt p v tng ng
huyt
Triu chng thng
nh v ci thin trong
vng 48 gi. Khng
c tc dng lu di
11/15/2013
8
S dng thuc cho ph n c thai
15
Thuc Tc dng c th c Ghi ch
Corticosteroid
(liu cao)
c ch tuyn thng thn
thai nhi
Ph thuc liu v
khong cch iu tr
NSAID ng ng ng mch sm
(nh hng tun hon thai
nhi) v suy thn ca thai nhi
(gim lng nc tiu)
Trnh s dng sau
tun 28. Nu phi s
dng, theo di
thng xuyn tun
hon thai nhi
Opioid Triu chng cai thuc tr
s sinh
Suy h hp
Nguy c nu s
dng lu di
Nguy c nu s
dng gn khi sinh
Tc dng ca thuc trn bo thai v tr s sinh
S dng thuc cho ph n c thai
16
Thuc Tc dng c th c Ghi ch
Phenothiazin Triu chng cai thuc tr
s sinh v triu chng ngoi
thp thong qua
Quan st t nht 48
gi. Cc triu chng
c th ko di trong
vi tun
Thuc chng
trm cm ba
vng (TCA)
v SSRI
Triu chng cai thuc tr
s sinh
Nguy c nu s
dng lu di v /
hoc gn lc sinh.
Quan st t nht 48
gi
Roger Walker, Clinical Pharmacy and Therapeutics, 5e, Churchill Livingstone, 2012
Tc dng ca thuc trn bo thai v tr s sinh
11/15/2013
9
S dng thuc cho ph n c thai
17
ADME THUC
i ma Lm trng d dy Nhu ng rut
Cm ng CYP 450
Ch.ha
Hp thu
Th tch phn b Albumin huyt tng
N. thuc ( )
Thi tr Lu lng mu qua thn
James M Ritter,
A Textbook of Clinical Pharmacology
and Therapeutics, Hodder Arnold, 2008
S dng thuc cho ph n c thai
18
Nhu ng rut, d dy gim 30-40% ba thng th 2 v 3
nh hng s hp thu ca thuc ung
Thng kh ph nang, lu thng mu phi tng 30%, nim mc
d xung huyt, lu lng mu da tng thn trong khi s
dng thuc ng h hp, bi ngoi da hay t m o
Gin mch ti ch, lng mu vo c vn v s ti mu vo m
ngoi bin tng s hp thu khi tim bp tng
Cui thai k, lung mu chm hn chi di tim vo mng,
i s hp thu khng u, tim tay v vai hp thu tt hn
ADME / A S hp thu
11/15/2013
10
S dng thuc cho ph n c thai
19
Th tch mu ca m tng khong 20% gia thai k, khong 50%
cui thai k v bnh thng li sau khi sinh
nh hng s phn b (thuc tan nhiu trong nc)
Nng albumin gim khng cn hiu chnh liu v nguyn
nhn ny
Lng m tng 3-4 kg tng th tch phn b cc thuc tan
nhiu trong lipid (thuc ng , gy m..)
ADME D / S phn b
S dng thuc cho ph n c thai
20
Tng hot ng ca enzym
cytochrom P450 CYP3A4, CYP2D6, CYP 2A6 v CYP 2C9
enzym uridin 5'-diphosphat glucuronosyltransferase (UGT)
(UGT1a1, UGT1A4 v UGT2B7)
Gim hot ng ca CYP1A2 and CYP2C19
Kh d on
ADME M / S chuyn ha
11/15/2013
11
S dng thuc cho ph n c thai
21
Trong vng vi tun u ca thai k, tc lc cu thn (GFR)
tng khong 50% v tip tc tng.
Do , nhng loi thuc ny c bi tit ch yu khng thay i
qua thn nh lithium, digoxin v penicilin
tng s thanh thi
nng n nh (steady state concentration) thp hn.
Lu : Ampicilin Cefuroxim Ceftazidim Cefazolin Pipericilin
Atenolol Sotalol Digoxin Lithium Dalteparin sodium
Enoxaparin sodium
ADME E / S thi tr
S dng thuc cho ph n c thai
22
Phn loi theo FDA
A
B
C
D
X
Phn loi Australia
A
B1
B2
B3
C
D
X
Phn loi Thy in
A
B1
B2
B3
C
D
Phn loi thuc trn thai k
11/15/2013
12
S dng thuc cho ph n c thai
23
Phn loi nh ngha
A dng rng ri cho PNCT c chng minh khng gy hi, d tt
B c chng minh khng gy d dng trn sc vt. dng cho mt s lng c hn PNCT khng thy lm tng t l gy hi, d tt
C C th gy tc dng c hi cho thai nhi do tc dng dc l Khng gy d tt
D B nghi ng hoc cho rng lm tng t l d tt hay hy hoi khng hi phc thai nhi
X Nguy c cao gy d tt, hy hoi vnh vin thai nhi
Phn loi thuc trn thai k Theo FDA
S dng thuc cho ph n c thai
24
Phn loi nh ngha
A
Th lm sng trn 1 lng ln PNCT v khng c
bt k mt nguy c no trn bo thai.
B1 Th trn lm sng vi s lng PNCT gii hn v
th trn sc vt khng thy nguy c no.
B2
Th trn lm sng vi s lng PNCT gii hn
khng thy bt k mt nguy c no nhng th
nghim trn sc vt khng c y hay
khng c thc hin.
Phn loi thuc trn thai k Theo Australia
11/15/2013
13
S dng thuc cho ph n c thai
25
Phn loi nh ngha
B3
Th trn lm sng vi s lng PNCT gii hn
m khng thy bt k mt nguy c no nhng
th nghim trn sc vt cho thy gia tng nguy
c trn bo thai.
C C hi trn bo thai hay tr s sinh m khng
gy ra d tt. Tc dng c th c o ngc.
D Thuc gy hoc tng nguy c ph hy bo
thai. Thuc cng c th c tc dng dc l ph.
X Khng s dng cho PNCT hay nghi ng c thai.
Phn loi thuc trn thai k Theo Australia
S dng thuc cho ph n c thai
26
Kh nng nh hng xu cho pht trin thai nhi.
Hu nh khng th xc nh cc nh hng nh
Thay i sinh l ca b m.
Kh khn trong nghin cu
Nn gi nh tt c cc loi thuc c hi cho n khi
c kim chng
Nguyn tc dng thuc
11/15/2013
14
S dng thuc cho ph n c thai
27
Gim thiu dng thuc
S dng liu lng nh nht c hiu qu
Thai nhi l nhy cm nht trong ba thng u
c hng dn v vic s dng thuc trong thai k
Nguy c ca ht thuc l, ru, thuc khng k n
Nguyn tc dng thuc
S dng thuc cho ph n c thai
28
Cc khng sinh an ton nht trong thai k l cc penicillin
v cephalosporin
Trimethoprim gy qui thai (l thuyt - i khng acid folic)
Aminoglycosid: gy c tnh trn tai.
Fluoroquinolon (Vd: ciprofloxacin): nn trnh
Metronidazol (qui thai ng vt)
cn nhc trong nhim trng huyt
Khng virus: khng nn s dng
Khng sinh
11/15/2013
15
S dng thuc cho ph n c thai
29
Paracetamol: gim au nh (aspirin)
Ibuprofen: khng vim NSAID (khi cn)
Opioid qua nhau thai.
Pethidin: gim au khi sinh c ch trung tm h hp
M nghin opioid hi chng cai thuc cho tr
chlorpromazin
Gim au
S dng thuc cho ph n c thai
30
Bun nn v i ma (ph bin trong giai on u)
Khng dng thuc: chia nh ba n, nng cao u
Promethazin hoc cyclizin: khng histamin,
Prochlorperazin: thay th thuc trn khi khng hiu qu
Metoclopramid: an ton v hiu qu (khi sinh, cui thai k),
khng khuyn co s dng thng xuyn trong giai on u ca
thai k
Thuc chng nn
11/15/2013
16
S dng thuc cho ph n c thai
31
Thuc khng acid: gim triu chng
Cimetidin v ranitidin: khng nh hng thai nhi
Sucralfat: khuyn co (khng hp thu)
Omeprazol (+ c ch bm proton) khng d liu
Misoprostol: chng ch nh v gy sy thai
Thuc tr lot d dy
S dng thuc cho ph n c thai
32
Methyldopa hoc labetalol: Cao huyt p trong thai k
Hydralazin: truyn nhm gim huyt p trong tin sn git
Nifedipin phng thch c KS: c s dng i vi cao huyt p
trong thai k
Thuc li tiu: khng nn bt u iu tr
c ch men chuyn angiotensin v i khng th th
angiotensin II: khng s dng
Thuc tim mch
11/15/2013
17
Sd thuc cho ngi ang cho con b
33
Sd thuc cho ngi ang cho con b
34
Vai tr ca sa m
Vi tr:
Dinh dng (carbohydrat, protein, lipid, acid amin, vitamin, khong
cht), sc min dch, pht trin tr no, cc cht khc
Vi ngi m:
Tr li vc dng c, gim nguy c ung th v, c t cung
11/15/2013
18
Sd thuc cho ngi ang cho con b
35
Yu t nh hng n lng thuc qua sa m
Thuc dng ngi m: loi thuc, tnh cht ca thuc, liu dng,
ng dng
Yu t lin quan n bi tit sa: lng sa sn xut (b nh
hng bi thc n, thuc)
Lng sa thc t tr b
Sd thuc cho ngi ang cho con b
36
Yu t nh hng n lng thuc qua sa m
Thuc d vo sa
Tan trong lipid
Phn t lng nh
Lin kt km protein huyt tng
Base yu (pH sa< pH huyt tng)
Roger Walker, Clinical Pharmacy and
Therapeutics, 5e, Churchill Livingstone, 2012
11/15/2013
19
Sd thuc cho ngi ang cho con b
37
Cc thuc lm gim tit sa
Estrogen: trong thuc nga thai
Androgen
Levodopa, bromocriptin
Li tiu thazid
IMAO
Clomiphen: thuc tr v sinh
Vitamin B6 liu cao
Ergotamin, dihydroergotamin.
Sd thuc cho ngi ang cho con b
38
Cc thuc lm tng tit sa
Thuc khng th th dopamin:
Domperidon (MOTILIUM)
Metoclopramid (PRIMPERAN)
Thuc tr ri lon tm thn: haloperidol, clopromazin,
11/15/2013
20
Sd thuc cho ngi ang cho con b
39
Nguyn tc s dng
Hn ch s dng thuc.
Chn thuc an ton cho tr b m, t l qua sa thp, thi tr
nhanh.
Trnh dng thuc liu cao, ko di.
Cn nhc li ch/ nguy c.
Nn cho tr b trc khi dng thuc.
Sd thuc cho ngi ang cho con b
40
Lu
C th dn n ng c tr s sinh nu thuc vo sa vi lng
c tc dng.
Thuc c t bo
Ergotamin
Octreotid
Thuc nhun trng kch thch
Sulphonylurea
Li tiu thiazid
Vitamin A/dn xut retinoid (vd etretinat)
Amiodaron
Aspirin
Benzodiazepin
Cloramphenicol
Ciclosporin
Ciprofloxacin
Cocain
Thuc nga thai
Nhng thuc khng s dng khi ang cho con b
11/15/2013
21
S dng thuc cho tr s sinh/tr em
41
S dng thuc cho tr s sinh/tr em
42
Phn loi tui tr em
Phn loi tr em Tui
S sinh thiu thng (premature) Sinh khi < 38 tun thai
S sinh thng (newborn, neonate)
Di 1 thng tui
Tr 1 nm tui (infant, baby) T thng 1 12 thng tui
Tr nh (young child) > 1 n 6 tui
Tr ln (older child) > 6 n 12 tui
Thanh thiu nin (adolescent) > 12 n 18 tui
11/15/2013
22
S dng thuc cho tr s sinh/tr em
43
ADME / A S hp thu ng ung (tr < 1 tui)
Yu t c im H qu
Acid dch v pH d dy cao
-Gim hp thu thuc c tnh
acid yu: aspirin, phenytoin,
phenobarbital
-Thi gian thuc lu d dy
lu
-Gim thi gian lu ca
thuc ti rut
Gim SKD theophylin
PTKD (SKD tr 1 tui: 50%,
tr ln , ngi ln 80%)
Tc lm rng d dy
Chm hn ngi ln
Nhu ng rut Mnh hn tr ln
S dng thuc cho tr s sinh/tr em
44
ADME / A S hp thu ng ung (tr < 1 tui)
Yu t c im H qu
H enzym, acid mt
Cha hon chnh: amylase v
lipase thp
-Enzym amylase: khng phn
tch ester: cloramphenicol
palmitat
-Gim hp thu thuc, vitamin
tan /lipid
Nim mc tiu ha
Cha hon chnh
11/15/2013
23
S dng thuc cho tr s sinh/tr em
45
ADME / A S hp thu
Tr em: ung (lng)
Km chnh xc v liu lng
Hp thu nhanh hn
Lu cc thuc c tc dng ph nng cao
v khng hiu qu nu nng y thp
(carbamazepin v theophylin).
ng ung (tr < 1 tui)
S dng thuc cho tr s sinh/tr em
46
ADME / A S hp thu ng tim
Yu t c im H qu
C bp Nh
Kh bit chnh xc SKD
Ti mu Cha y
ng qua da
Yu t c im H qu
Da Mng Kh nng thm thuc mnh,
khng sd lidocain, corticoid... Nc ti da Cao (tr thiu
thng)
11/15/2013
24
S dng thuc cho tr s sinh/tr em
47
ADME / A S hp thu
Tr s sinh:
Qua ng tiu ha: chm
Tim: tim tnh mch
Da mng v hp thu qua da c tnh ton thn nu s dng ch
phm ti ch (corticosteroid mnh)
ng tim / qua da
S dng thuc cho tr s sinh/tr em
48
ADME / A S hp thu
Khi khng dng c ng ung: ang m, i ma,
nhu ng rut chm / tng nhanh hay t ng ht mi-d dy.
Trnh c chuyn ha pha 1 qua gan
Tr s sinh: cha d liu, gy chn thng
C ch trong nhiu trng hp
H st: paracetamol
An thn: cloralhydrat
Chng co git: diazepam
To bn: glycerin
ng trc trng
11/15/2013
25
S dng thuc cho tr s sinh/tr em
49
ADME / A S hp thu
Nim mc rt mng, nhiu mch mu
Thuc gy co mch, hp thu nhanh mnh c th gy ng c
Cc thuc naphazolin, ephedrin, pseudoephedrin: khng dng
tr < 2 tui
Nim mc mi
S dng thuc cho tr s sinh/tr em
50
ADME D / S phn b
Lng m: tng i thp + Lng nc: cao
Gim phn b cc thuc tan trong cht bo
(v d: diazepam)
Albumin huyt tng thp + Tnh cht gn kt thay i
Gn kt thuc - protein huyt tng gim tr s sinh
Tng tnh thm qua hng ro mu no
tng nguy c tc dng ph trn thn kinh trung ng
.
11/15/2013
26
S dng thuc cho tr s sinh/tr em
51
T l nc v dch ngoi bo
La tui Tng lng nc
(%)
Dch ngoi bo (%)
S sinh thiu thng 85 50
S sinh thng 75 45
3 thng 75 30
1 nm 60 25
Ngi ln 60 20
ADME D / S phn b
S dng thuc cho tr s sinh/tr em
52
ADME M / S chuyn ha
Oxy ha,
Kh ha, Thy phn
Phn ng lin hp
PHN CC
CHUYN HA CHT
(D tan trong nc, thi tr ra khi c th)
GIM
GIM
11/15/2013
27
S dng thuc cho tr s sinh/tr em
53
ADME M / S chuyn ha
Enzym mono-oxygenase: 2-40% so vi ngi ln
Glucoronosyltransferase lin hp morphin, cloramphenicol, bilirubin:
hon thin khi tr 3 tui
Tuy nhin: c dao ng, khng phi l quy lut
S dng thuc cho tr s sinh/tr em
54
ADME M / S chuyn ha
Mi sinh: enzym gan cha pht trin (tr non thng)
Cloramphenicol "hi chng xm
Sau 4 tun: Pht trin nhanh
T l gan / trng lng c th > 50% so vi ngi ln
Tng chuyn ha
Thuc iu tr ngi m kch thch enzym tr s sinh
(v d: barbiturat)
Phenobarbiton chuyn ha nhanh
(do cm ng enzym gan ln hn)
11/15/2013
28
S dng thuc cho tr s sinh/tr em
55
ADME E / S thi tr
Thn (lc, bi tit v ti hp thu): gim tr s sinh
Tc lc cu thn (GFR) tng nhanh trong bn tun u tin
thay i trong thi tr thuc
Tr sinh sm
48 gi 18 gi
5-22 ngy tui 6 gi
Tr sinh bnh thng
1-4 tun tui 3 gi
Ngi ln 2 gi
Giai on pht trin T1/2 ca gentamicin /huyt tng
S dng thuc cho tr s sinh/tr em
56
ADME E / S thi tr
Tui GFR - lc cu thn
(mL/pht)
B s sinh thng
B 2 thng tui
B 6 thng tui
B 3 tui
Ngi ln
30 - 40
70 - 80
100 - 110
100 - 150
120 - 150
11/15/2013
29
S dng thuc cho tr s sinh/tr em
57
ADME E / S thi tr Phng trnh Schwartz
CrCl (mL/min/1,73 m2) = k (chiu cao - cm)/SCr
Tui k
Nh cn 1 tui 0,33
Sinh thng 1 tui 0,45
1-12 tui 0,55
14-21 tui (n) 0,55
14-21 tui (nam) 0,70
Schwartz et al. 1987.
/wEPDwU
S dng thuc cho tr s sinh/tr em
58
Tnh liu tr em
Tr < 1 tui: (Fried)
Liu = tui (thng) x liu ngi ln/ 150
Tr > 1 tui: (Young)
Liu = tui (nm) x liu ngi ln/ (tui + 12)
Tr > 2 tui: (Clark)
Liu = cn nng (kg) x liu ngi ln/ 70
Tr bo ph tnh theo cn nng l tng (CNLT)
CNLT = [chiu cao (cm)2 x 1,65]/ 1000
Thuc c khong tr liu hp, tnh theo din tch da
Liu = Din tch da (m2) x liu ngi ln/ 1,8
11/15/2013
30
S dng thuc cho tr s sinh/tr em
59
Tnh liu tr em
Tnh liu Tnh t liu ngi ln
p dng
Theo cn nng Ph bin nht
Theo tui Trng hp cn nng b thay i hay khng c o
Theo din tch b mt c th
Cn chnh xc: thuc tr ung th, thuc c khong tr liu hp
S dng thuc cho tr s sinh/tr em
60
Nguyn tc dng thuc
Tr em khng phi l ngi ln thu nh
1. S cn thit ca iu tr
Nhim virus, khng cn dng khng sinh
Nhiu bnh tr em t khi khng cn iu tr
Khng dng ba bi cloramphenicol, sulfamid.
11/15/2013
31
S dng thuc cho tr s sinh/tr em
61
Nguyn tc dng thuc
2. La chn thuc thch hp
Tr s sinh
Chloramphenicol c cao tr s sinh, ch dng trong
nhng trng hp ring bit (vim np thanh qun,
mng no do H. influenzae)
Sulfamid gy vng da nhn no tr s sinh
Camphor, menthol: lit h hp
Thuc co mch naphazolin, ephedrin: tng huyt p, v
m hi, tm ti
S dng thuc cho tr s sinh/tr em
62
Nguyn tc dng thuc
2. La chn thuc thch hp
Tr < 2 tui
Khng dng
Thuc tiu chy: diphenoxylat, loperamid
Thuc chng nn: metoclopramid (Primperan)
Thuc co mch: phenylpropanolamin, ephedrin,
pseudoephedrin
11/15/2013
32
S dng thuc cho tr s sinh/tr em
63
Nguyn tc dng thuc
2. La chn thuc thch hp
Tr < 6 tui
Khng dng
Tetracylin ph hy men rng (< 7 tui)
Aspirin h st gy hi chng Reye (nn dng paracetamol)
Codein, dn cht thuc phin (cn anticholeric, paregoric).
Khng dng ba bi cloramphenicol, sulfamid.
S dng thuc cho tr s sinh/tr em
64
Nguyn tc dng thuc
3. La chn ng dng thuc thch hp
Tr s sinh
Tim tnh mch.
Liu chnh xc lng, ch n s cn bng dch
Tr em di nm tui: c th kh nut
Ung ch phm hng / v d chu
Ch phm lng
11/15/2013
33
S dng thuc cho tr s sinh/tr em
65
Nguyn tc dng thuc
3. La chn ng dng thuc thch hp
Bi da
CORTICOID
C th tng ng dng ton thn
c ch trc h i - tuyn yn - thng thn:
Chm ln
HC Cushing
Cc loi tinh du, menthol, long no, methyl salicylatgy suy (lit)
h hp.
S dng thuc cho tr s sinh/tr em
66
3. La chn ng dng thuc thch hp
Bnh xt (salbutamol): thng ch sd tr em trn 10 tui
Nh hn: spacer
Tim bp ch c s dng
khi cn thit (au hn)
S dng t trc trng:
khi tim tnh mch kh khn.
tr b i ma.
Nguyn tc dng thuc
11/15/2013
34
S dng thuc cho tr s sinh/tr em
67
Lu
Nhng khc bit v p ng thuc tr em
(thng tr < 1 tui)
H thn kinh trung ng
H tim mch
H thng iu ha thn nhit
D ng da
S dng thuc cho tr s sinh/tr em
68
Lu
Tc dng khng mong mun bt thng tr em
Chm ln: corticoid.
Xm rng vnh vin: tetracyclin.
Tng p lc s no: corticoid, acid nalidixic, qu liu vitamin A,
vitamin D, nitrofurantoin
Vng da: novobiocin, sulfamid, vitamin K3.
Dy th sm: androgen.
Bin dng sn khp: fluoroquinolon
11/15/2013
35
S dng thuc cho tr s sinh/tr em
69
Tc dng ph
Tc dng bt li ca cc loi thuc tr em c tng t nh
ngi ln.
Ngoi ra:
Corticosteroid mn (bao gm c liu cao corticosteroid
dng ht) c ch tng trng.
Aspirin: trnh sd tr em di 16 tui hi chng Reye
Tetracyclin xng v rng
Fluoroquinolon tn hi sn
Top Related