{"id":25795,"date":"2023-04-22T22:40:15","date_gmt":"2023-04-22T15:40:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25795"},"modified":"2023-04-22T22:40:15","modified_gmt":"2023-04-22T15:40:15","slug":"tuong-tac-thuoc-giua-amiodarone-va-fentanyl","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/tuong-tac-thuoc-giua-amiodarone-va-fentanyl\/","title":{"rendered":"T\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl"},"content":{"rendered":"

Amiodarone v\u00e0 Fentanyl l\u00e0 hai lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nhau trong l\u00e2m s\u00e0ng. Tuy nhi\u00ean, khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi, ch\u00fang c\u00f3 th\u1ec3 g\u00e2y ra t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, l\u00e0m thay \u0111\u1ed5i t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c v\u00e0 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n. <\/strong>\u0110\u1ec3 gi\u1ea3m thi\u1ec3u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl, c\u00e1c chuy\u00ean gia khuy\u1ebfn c\u00e1o r\u1eb1ng b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 suy gi\u1ea3m qu\u00e1 m\u1ee9c h\u00f4 h\u1ea5p v\u00e0 h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng. Ngo\u00e0i ra, c\u00e1c b\u00e1c s\u0129 c\u1ea7n c\u00e2n nh\u1eafc \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c ho\u1eb7c ch\u1ecdn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c n\u00e0y.<\/strong><\/p>\n

V\u00ec v\u1eady, vi\u1ec7c hi\u1ec3u r\u00f5 v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd c\u1ee7a b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u chung\u00a0<\/strong><\/h2>\n

C\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – thu\u1ed1c c\u00f3 th\u1ec3 x\u1ea3y ra khi c\u00e1c thu\u1ed1c t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u00e1c ch\u1ea5t trong c\u01a1 th\u1ec3 nh\u01b0 enzyme, protein, hormone ho\u1eb7c khi ch\u00fang c\u1ea1nh tranh v\u1edbi nhau trong vi\u1ec7c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c receptor tr\u00ean t\u1ebf b\u00e0o. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – thu\u1ed1c, c\u00e1c nh\u00e0 khoa h\u1ecdc s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c – thu\u1ed1c trong \u0111\u00f3 c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00f9ng l\u00fac v\u00e0 t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1. K\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c h\u01b0\u1edbng d\u1eabn v\u1ec1 s\u1eed d\u1ee5ng thu\u1ed1c an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n cho b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

\"T\u01b0\u01a1ng
T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/figcaption><\/figure>\n

2.Th\u00f4ng tin thu\u1ed1c v\u1ec1 Amiodarone<\/strong><\/h2>\n

2.1 Nh\u00f3m d\u01b0\u1ee3c l\u00fd v\u00e0 ch\u1ec9 \u0111\u1ecbnh<\/h3>\n

Amiodarone<\/a> l\u00e0 thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp nh\u00f3m III\u00a0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp nhanh tr\u00ean th\u1ea5t nh\u01b0 rung t\u00e2m nh\u0129, ng\u0103n ng\u1eeba nguy c\u01a1 cao nh\u1ecbp nhanh th\u1ea5t (VT). Amiodarone \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf giai \u0111o\u1ea1n c\u1ea5p t\u00ednh l\u00e0 rung nh\u0129 v\u1edbi \u0111\u00e1p \u1ee9ng th\u1ea5t nhanh v\u00ec \u0111\u00e3 ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3 t\u1ea7n s\u1ed1 th\u1ea5t v\u00e0 chuy\u1ec3n th\u00e0nh nh\u1ecbp xoang v\u00e0 duy tr\u00ec nh\u1ecbp xoang \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 v\u00e0 \u0111\u00e1p \u1ee9ng th\u1ea5t nhanh. Amiodarone c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t kh\u00e1c, bao g\u1ed3m cu\u1ed3ng nh\u0129, n\u00fat AV (nh\u0129 th\u1ea5t) kh\u00e1ng tr\u1ecb v\u00e0 nh\u1ecbp tim nhanh v\u00e0o l\u1ea1i AV (SVT). Ngo\u00e0i ra, Amiodarone c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t<\/span><\/p>\n

\"Amiodarone\"
Amiodarone<\/figcaption><\/figure>\n

2.2 C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng<\/span><\/h3>\n

Amiodarone thu\u1ed9c nh\u00f3m thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp nh\u00f3m III v\u00ec ng\u0103n d\u00f2ng Kali g\u00e2y t\u00e1i c\u1ef1c c\u01a1 tim trong qu\u00e1 tr\u00ecnh t\u00e1i c\u1ef1c \u1edf giai \u0111o\u1ea1n th\u1ee9 ba c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. T\u1eeb \u0111\u00f3, l\u00e0m t\u0103ng th\u1eddi gian c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u0169ng nh\u01b0 th\u1eddi gian tr\u01a1 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ebf b\u00e0o c\u01a1 tim (t\u1ebf b\u00e0o c\u01a1), l\u00e0m gi\u1ea3m t\u00ednh d\u1ec5 b\u1ecb k\u00edch th\u00edch c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tim c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u trong vi\u1ec7c ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp tim b\u1ea5t th\u01b0\u1eddng. Amiodarone t\u00e1c \u0111\u1ed9ng v\u00e0o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c th\u1ee5 th\u1ec3 beta-adrenergic, k\u00eanh Natri v\u00e0 k\u00eanh Canxi v\u00e0 l\u00e0m gi\u1ea3m t\u00ednh t\u1ef1 \u0111\u1ed9ng c\u1ee7a n\u00fat SA (xoang nh\u0129) l\u1eabn t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n c\u1ee7a n\u00fat AV<\/span><\/p>\n

2.3 T\u00e1c d\u1ee5ng ph\u1ee5\u00a0<\/span><\/h3>\n

C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn khi s\u1eed d\u1ee5ng Amiodarone \u1edf ng\u01b0\u1eddi b\u1ec7nh: ho, ch\u00f3ng m\u1eb7t, s\u1ed1t nh\u1eb9, kh\u00f3 th\u1edf, nh\u1ea1y c\u1ea3m v\u1edbi \u00e1nh s\u00e1ng, run c\u01a1,tay, chuy\u1ec3n \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng, y\u00eau tay ho\u1eb7c ch\u00e2n, t\u00ea ho\u1eb7c ng\u1ee9a ran \u1edf ng\u00f3n tay, ng\u00f3n ch\u00e2n, ng\u1ea5t x\u1ec9u. M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n: da kh\u00f4, lo l\u1eafng, nh\u1ecbp tim nhanh ho\u1eb7c kh\u00f4ng \u0111\u1ec1u, \u0111au s\u01b0ng \u1edf b\u00ecu, t\u0103ng ho\u1eb7c gi\u1ea3m c\u00e2n b\u1ea5t th\u01b0\u1eddng, kh\u00f3 ng\u1ee7, m\u1ec7t m\u1ecfi b\u1ea5t th\u01b0\u1eddng\u00a0<\/span><\/p>\n

2.4 Tri\u1ec7u ch\u1ee9ng qu\u00e1 li\u1ec1u\u00a0<\/span><\/h3>\n

Li\u00ean h\u1ec7 v\u1edbi b\u00e1c s\u0129 ngay n\u1ebfu c\u00f3 nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o qu\u00e1 li\u1ec1u bao g\u1ed3m: h\u1ea1 huy\u1ebft \u00e1p, s\u1ed1c, nh\u1ecbp tim ch\u1eadm, block AV v\u00e0 nhi\u1ec5m \u0111\u1ed9c gan<\/span><\/p>\n

2.5 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh\u00a0<\/span><\/h3>\n

Amiodarone ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb block tim \u0111\u1ed9 hai ho\u1eb7c \u0111\u1ed9 ba kh\u00f4ng c\u00f3 m\u00e1y t\u1ea1o nh\u1ecbp tim, b\u1ec7nh nh\u00e2n b\u1ecb k\u00edch th\u00edch s\u1edbm (h\u1ed9i ch\u1ee9ng Wolff-Parkinson-White) v\u00e0 rung nh\u0129 \u0111\u1ed3ng th\u1eddi, b\u1ec7nh nh\u00e2n c\u00f3 kho\u1ea3ng QT k\u00e9o d\u00e0i ban \u0111\u1ea7u, d\u1ecb \u1ee9ng,…<\/span><\/p>\n

3.Th\u00f4ng tin thu\u1ed1c v\u1ec1 Fentanyl<\/strong><\/h2>\n

3.1 Nh\u00f3m d\u01b0\u1ee3c l\u00fd v\u00e0 ch\u1ec9 \u0111\u1ecbnh\u00a0<\/span><\/h3>\n

Fentanyl l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c d\u1ea1ng thu\u1ed1c phi\u1ec7n t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au v\u1eeba \u0111\u1ebfn n\u1eb7ng. Fentanyl m\u1ea1nh g\u1ea5p 100 l\u1ea7n so v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c d\u1ea1ng thu\u1ed1c phi\u1ec7n kh\u00e1c nh\u01b0 Morphine, Heroin ho\u1eb7c Oxycodone. Fentanyl thu\u1ed9c nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au g\u00e2y nghi\u1ec7n<\/span><\/p>\n

\"Fentanyl\"
Fentanyl<\/figcaption><\/figure>\n

3.2 C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng\u00a0<\/span><\/h3>\n

Fentanyl di chuy\u1ec3n trong m\u00e1u ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch li\u00ean k\u1ebft v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 opioid c\u1ee7a c\u01a1 th\u1ec3, \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c v\u00f9ng n\u00e3o ki\u1ec3m so\u00e1t c\u01a1n \u0111au v\u00e0 c\u1ea3m x\u00fac.<\/span><\/p>\n

3.3 T\u00e1c d\u1ee5ng ph\u1ee5\u00a0<\/span><\/h3>\n

Fentanyl c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, bao g\u1ed3m: tr\u00ean tim (nh\u1ecbp tim nhanh\/nh\u1ecbp tim ch\u1eadm, th\u1eadm ch\u00ed lo\u1ea1n nh\u1ecbp); tr\u00ean th\u1ea7n kinh (bao g\u1ed3m nh\u1ee9c \u0111\u1ea7u v\u00e0 ch\u00f3ng m\u1eb7t th\u01b0\u1eddng xuy\u00ean); tr\u00ean da v\u00e0 m\u00f4 d\u01b0\u1edbi da (ng\u1ee9a, ra m\u1ed3 h\u00f4i, ph\u1ea3n \u1ee9ng da t\u1ea1i ch\u1ed7); tr\u00ean ti\u00eau h\u00f3a (bu\u1ed3n n\u00f4n, n\u00f4n, t\u00e1o b\u00f3n, kh\u00f4 mi\u1ec7ng, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a); tr\u00ean t\u00e2m th\u1ea7n (bu\u1ed3n ng\u1ee7, ch\u00e1n \u0103n, c\u0103ng th\u1eb3ng)<\/span><\/p>\n

3.4 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh\u00a0<\/span><\/h3>\n

Kh\u00f4ng s\u1eed d\u1ee5ng Fentanyl trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p: qu\u00e1 m\u1eabn c\u1ea3m, \u0111au c\u1ea5p t\u00ednh ng\u1eafn sau ph\u1eabu thu\u1eadt (do kh\u00f4ng th\u1ec3 ch\u1ec9nh li\u1ec1u trong m\u1ed9t th\u1eddi gian ng\u1eafn), r\u1ed1i lo\u1ea1n nghi\u00eam tr\u1ecdng h\u1ec7 th\u1ea7n kinh v\u00e0 ng\u01b0\u1eddi b\u1ec7nh ch\u01b0a bao gi\u1edd d\u00f9ng opioid<\/span><\/p>\n

4.T\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl<\/strong><\/h2>\n

4.1 M\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng t\u00e1c \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1eeb nhi\u1ec1u ngu\u1ed3n<\/span><\/h3>\n

Medscape: Nghi\u00eam tr\u1ecdng\u00a0<\/span><\/p>\n

Drugs interactions checker: Nghi\u00eam tr\u1ecdng\u00a0<\/span><\/p>\n

Micromedex drug interaction: Nghi\u00eam tr\u1ecdng\u00a0<\/span><\/p>\n

Lexicomp: Nghi\u00eam tr\u1ecdng\u00a0<\/span><\/p>\n

4.2 C\u01a1 ch\u1ebf v\u00e0 c\u00e1ch x\u1eed tr\u00ed t\u01b0\u01a1ng t\u00e1c gi\u1eefa Amiodarone v\u00e0 Fentanyl<\/span><\/h3>\n

Amiodarone g\u00e2y \u1ee9c ch\u1ebf enzyme CYP3A4 chuy\u1ec3n h\u00f3a Fentanyl \u1edf gan do \u0111\u00f3 vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 huy\u1ebft \u00e1p nh\u1ecbp tim ch\u1eadm v\u00e0 gi\u1ea3m hi\u1ec7u su\u1ea5t l\u00e0m vi\u1ec7c c\u1ee7a tim<\/span><\/p>\n

Theo d\u00f5i c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 suy gi\u1ea3m qu\u00e1 m\u1ee9c h\u00f4 h\u1ea5p v\u00e0 h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng. N\u1ebfu c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u ho\u1eb7c \u0111\u1ed5i ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Amiodarone v\u00e0 Fentanyl l\u00e0 hai lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nhau trong l\u00e2m s\u00e0ng. Tuy nhi\u00ean, khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi, ch\u00fang c\u00f3 th\u1ec3 g\u00e2y ra t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, l\u00e0m thay \u0111\u1ed5i t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c v\u00e0 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n. \u0110\u1ec3 gi\u1ea3m […]<\/p>\n","protected":false},"author":54,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12],"tags":[],"yoast_head":"\nT\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl - Vinmec<\/title>\n<meta name=\"description\" content=\"M\u1eb7c d\u00f9, Amiodarone v\u00e0 Fentanyl \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau nh\u01b0ng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1eabn g\u00e2y ra t\u01b0\u01a1ng t\u00e1c nghi\u00eam tr\u1ecdng\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"T\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa Amiodarone v\u00e0 Fentanyl - 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