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Thuoc tieu dom va ho tro dieu tri benh duong ho hap

Thuoc siro tieu dom.

Thuoc tieu dom va ho tro dieu tri benh duong ho hap la thu rat can cho nhieu nguoi benh tu tre so sinh den cu gia, nhat la trong mua dong xuan va nhung khi thay doi thoi tiet.

 Tren thi truong thuoc nuoc ta co nhieu loai thuoc co tac dung nay, trong do cac loai thuoc tieu dom do tac dung lam gay cau noi disulfure cua cac glycoprotein chiem 90% tong so cac loai thuoc tieu dom. Chung co nhung dac diem chung va nhung dac diem rieng rat khac nhau.

Dac diem chung

Co che tieu dom: Chung lam gay cau noi disulfure cua cac glycoprotein (con goi la mucoprotein) lam cho tan chat nhay nhot dac quanh; neu chat nay o bo phan ho hap duoc goi la dom can duoc tong ra khoi bo may ho hap nho tac dung co hoc cua phan xa ho. Trong khi do chat nhay bao ve da day cung bi pha vo (vi cung loai glycoprotein) do do tranh dung cho nguoi co viem loet da day ta trang tien trien. Tranh dung phoi hop voi thuoc giam ho. Tranh dung voi thuoc giam tiet phe quan.

Tac dung ngoai y: Co the gay buon non, tieu chay, dau da day; neu co, can giam lieu.

Lieu trinh dung thuoc: Neu khong co chi dinh cua bac si chi nen dung thuoc tu 3-7 ngay.

Cac loai thuoc tieu dom do tac dung lam gay cau noi disulfure cua cac glycoprotein

Hoat chat thuoc loai nay co: ambroxol; bromhexin; carbocystein; acetrylcystein; N, S - Methyl diacetylcysteinate... Do khuon kho bai bao chung toi de cap den 4 chat thong dung.

Ambroxol: Ambroxol la mot trong 10 chat chuyen hoa cua bromhexin co tac dung tieu nhay, long dom. Khi vao co the, ambroxol hap thu nhanh va gan nhu hoan toan, khuyech tan nhanh tu mau den cac mo, co nong do thuoc cao nhat trong mo phoi. 2 gio sau khi uong, thuoc dat nong do toi da trong huyet tuong; sinh kha dung dat 70%. Ambroxol gia tang san xuat chat dien hoat o phoi, o niem mac xoang va tai mui hong, kich thich hoat dong cua he long chuyen lam tang su thanh thai chat nhay o duong ho hap va cac xoang tai mui hong. Khi phoi hop voi khang sinh co pho khang khuan rong nhu amoxicillin, ampicillin, cephalexin, cefuroxim, erythromycin, doxycyclin. Ambroxol se lam tang do tap trung cua khang sinh tai mo nhiem khuan. Ngoai ra, ambroxol khong co tuong tac bat loi voi bat cu thuoc nao khac dung cung luc.

Chi dinh: Cac benh cap va man tinh duong ho hap co dom. Dac biet trong cac dot cap tinh cua viem phe quan man, hen phe quan, viem phe quan dang hen, viem xoang tai mui hong, viem tai giua tiet dich. Benh bui phoi, viem thanh quan cap va man. Phong cac bien chung phoi cho benh nhan sau cap cuu, sau mo. Ho tro khang sinh khi nhiem khuan nang duong ho hap. Lam sach phe quan de chup Xquang.

Chong chi dinh: Qua man voi ambroxol, ho ra mau va cac dieu “tranh” da noi o phan dac diem chung.

Than trong: Phu nu mang thai 3 thang dau.

Dang thuoc: Vien 30mg, dung dich uong 15mg/5ml. Dung dich tiem 15mg/2ml.

Biet duoc: Ngoai ten ambroxol con co cac biet duoc ambril, ambro, bronchopront, halixol, mucosolvan, muxol, mubroxol, mucolyse, sekrol. Do la chua ke ten cac biet duoc phoi hop giua ambroxol voi cac duoc chat khac.

Bromhexin hydroclorid: Bromhexin la chat dieu hoa va tieu nhay duong ho hap. Thuc an lam tang sinh kha dung cua bromhexin (nen uong thuoc ngay sau khi an) sinh kha dung cua thuoc duong uong chi dat 25%, thoi gian thuoc bat dau co tac dung cham, phai 2-3 ngay (48-72 gio) sau moi co hieu luc tren lam sang (neu tiem, chi sau 15 phut la co tac dung). Khi vao co the, bromhexin chuyen hoa chu yeu o gan thanh 10 chat khac nhau, trong do ambroxol la chat co hoat tinh tieu nhay, long dom va lam tang nong do khang sinh trong mo phoi va phe quan.

Chi dinh: Nhu ambroxol; tru cac truong hop hen phe quan, viem phe quan dang hen.

Chong chi dinh: Qua man voi bromhexin; nguoi co benh hen va tien su co benh hen va cac dieu “tranh” da noi o phan dac diem chung.

Than trong: Nguoi benh suy gan, suy than nang. Nguoi cao tuoi, nguoi qua yeu khong co suc khac dom. Phu nu mang thai hoac dang thoi ky cho con bu.

Dang thuoc: Vien 8mg va 4mg, con ngot, xiro. Thuoc tiem: ong 2ml = 4mg.

Biet duoc: Ngoai ten bromhexin con co cac biet duoc: bidivon, bisolvon, bivo, bixovom, broma, disolvon, dosulvon, mucine, paxirasol... do la chua ke cac biet duoc phoi hop giua bromhexin voi cac duoc chat khac.

Carbocystein: Carbocystein la chat tieu nhay duong ho hap giup khac dom de dang, giam ho, giam viem, giam kho tho. Carbocystein lam tang hap thu cua natri amoxicillin neu dung cung luc.

Chi dinh: Cac benh cap, man tinh duong ho hap (tren hoac duoi) co tang tiet chat nhay nhu: viem phe quan (cap va man) viem thanh quan. Khi phe thung, gian phe quan, viem xoang, mui, tai, chay dich ong tai, giam tang tiet dich truoc phau thuat.

Chong chi dinh: Qua man voi carbocystein. Phu nu co thai hoac dang thoi ky cho con bu. Tre so sinh va tre con bu (nhu nhi) duoi 12 thang va cac dieu “tranh” da noi o phan dac diem chung.

Dang thuoc: Vien 375mg xiro nguoi lon 5%. Xiro tre em 2%, hon dich uong 2%.

Biet duoc: Ngoai ten carbocystein co cac biet duoc nhu: flemex, fluditex 2% va 5%. Mucopront, mucusan, rhinathiol, solmux, solmuxpediatric... do la chua ke cac biet duoc phoi hop giua carbocystein voi cac duoc chat khac.

Acetylcystein: Acetylcystein co tac dung dieu hoa tiet nhay, tieu nhay (nhu co che da noi o tren). Khoi phuc nong do glutathion cua gan do co che, khi vao co the acetylcystein duoc gan khu thanh cystein; cystein kich thich gan tong hop glutathion, khoi phuc nong do glutathion cua gan bi suy giam vi phan ung khu doc chat do chuyen hoa cua paracetamol (N - acetyl - benzoquinonimin) thanh chat khong doc. Do do acetylcystein duoc su dung de giai doc khi qua lieu paracetamol (tiem truyen tinh mach hoac uong acetylcystein lieu cao).

Tuong ky: Acetylcystein la chat khu nen tuong ky voi cac chat chong oxy hoa (trong thuoc, thuc an, thuc uong); tuong ky voi cac chat dong, sat, niken va cao su (ke ca tiep xuc voi dung cu chua cac chat nay). Tuong ky ly hoa voi mot so khang sinh nhu natri ampicillin, penicillin, oxacillin, tetracyclin, erythromycinlactobionat, amphotericin B, oleandomycin. Do do cam dung cung luc cac chat noi tren voi acetylcystein (muon dung phai cach xa 3 gio, sau khi uong acetylcystein).

Chi dinh: Dieu tri cac chung roi loan ve tiet dich cua niem mac duong ho hap va tai mui hong. Tieu nhay nhot trong benh nhay nhot (mucoviscidocis). Dieu tri viem ket mac kho (hoi chung Sjogren) con goi la chung khong co nuoc mat (dung thuoc nho mat dung dich 5%). Giai doc khi qua lieu paracetamol (tiem truyen tinh mach hoac uong dung dich acetylcystein 5%. Dung cang som cang tot, trong khoang 8 gio sau khi ngo doc thi co hieu qua. Neu qua 15 gio thi khong hieu qua, tot nhat la duong uong.

Chong chi dinh: Tien su hen (voi tat ca cac dang thuoc: tiem, uong, nho mat, hit... chua acetylcystein) va cac dieu “tranh” da ghi o phan dac diem chung.

Than trong: Giam sat chat che nguoi dung acetylcystein co nguy co hen, neu co phai ngung thuoc ngay va dung thuoc phun mu gian phe quan nhu salbutamol de cap cuu. Tiem truyen qua nhanh hoac lieu qua cao acetylcystein co the tu vong trong khi dieu tri nhiem doc paracetamol.

Dang thuoc: Vien, goi bot uong hoac com uong. Thuoc tiem dung dich 20%, nho mat dung dich 5% (chi co trong benh vien).

Biet duoc: Ngoai ten acetylcystein co nhieu biet duoc nhu: ACC, acemux, exomuc, mitux, meko mucosol, mucolator, mucomyst, mysoven, turant.     

DS. Tran Xuan Thuyet