{"id":33236,"date":"2023-05-13T14:41:52","date_gmt":"2023-05-13T07:41:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33236"},"modified":"2023-05-13T14:42:04","modified_gmt":"2023-05-13T07:42:04","slug":"thuoc-doi-khang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/thuoc-doi-khang\/","title":{"rendered":"T\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic trong COPD"},"content":{"rendered":"

Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng muscarinic (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c kh\u00e1ng cholinergic) l\u00e0 thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh (COPD), \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u00e0m gi\u1ea3m ch\u1ee9ng kh\u00f3 th\u1edf v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng khi g\u1eafng s\u1ee9c.<\/strong><\/p>\n

1. T\u1ed5ng quan ngu\u1ed3n g\u1ed1c <\/strong>thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic<\/strong><\/h1>\n

C\u00e1c alkaloid kh\u00e1ng cholinergic c\u00f3 ho\u1ea1t t\u00ednh d\u01b0\u1ee3c l\u00fd t\u1ed3n t\u1ea1i trong r\u1ec5, h\u1ea1t v\u00e0 l\u00e1 c\u1ee7a nhi\u1ec1u lo\u1ea1i c\u00e2y belladonna. \u0110i\u1ec1u quan tr\u1ecdng nh\u1ea5t trong s\u1ed1 c\u00e1c ancaloit t\u1ef1 nhi\u00ean n\u00e0y l\u00e0 atropine v\u00e0 scopolamine.<\/p>\n

Atropa belladonna, c\u00e2y \u00e1c qu\u1ef7 ch\u1ebft ng\u01b0\u1eddi, ch\u1ee9a ch\u1ee7 y\u1ebfu l\u00e0 atropine alkaloid. Alkaloid t\u01b0\u01a1ng t\u1ef1 c\u0169ng c\u00f3 trong Datura stramonium, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 Jamestown ho\u1eb7c c\u1ecf d\u1ea1i jimson, c\u1ecf h\u00f4i, t\u00e1o gai v\u00e0 t\u00e1o qu\u1ef7. Ch\u1ea5t alkaloid scopolamine (hyoscine) \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y ch\u1ee7 y\u1ebfu trong c\u00e2y Hyoscyamus niger (henbane) v\u00e0 Scopolia carniolica.<\/p>\n

Vi\u1ec7c s\u1eed d\u1ee5ng chi\u1ebft xu\u1ea5t t\u1eeb nh\u1eefng c\u00e2y n\u00e0y \u0111\u1ec3 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p v\u00e0 co th\u1eaft ph\u1ebf qu\u1ea3n b\u1eaft ngu\u1ed3n t\u1eeb h\u00e0ng ngh\u00ecn n\u0103m tr\u01b0\u1edbc \u1edf \u1ea4n \u0110\u1ed9 v\u00e0 \u0111\u01b0\u1ee3c \u00a0ng\u01b0\u1eddi Anh \u0111\u01b0a v\u00e0o y h\u1ecdc ph\u01b0\u01a1ng T\u00e2y v\u00e0o \u0111\u1ea7u th\u1ebf k\u1ef7 19. Atropine sau \u0111\u00f3 \u0111\u01b0\u1ee3c Mein c\u00f4 l\u1eadp \u1edf d\u1ea1ng tinh khi\u1ebft v\u00e0o n\u0103m 1831. N\u0103m 1867, Bezold v\u00e0 Bloebaum ch\u1ec9 ra r\u1eb1ng atropine ng\u0103n ch\u1eb7n t\u00e1c \u0111\u1ed9ng l\u00ean tim c\u1ee7a k\u00edch th\u00edch ph\u1ebf v\u1ecb, v\u00e0 5 n\u0103m sau, Heidenhain ph\u00e1t hi\u1ec7n ra r\u1eb1ng n\u00f3 ng\u0103n ch\u1eb7n s\u1ef1 ti\u1ebft n\u01b0\u1edbc b\u1ecdt do k\u00edch th\u00edch d\u00e2y ch\u1eb1ng nh\u0129. N\u0103m 1859, c\u00f3 b\u00e1o c\u00e1o r\u1eb1ng m\u1ed9t c\u01a1n hen n\u1eb7ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng b\u1eb1ng c\u00e1ch ti\u00eam atropine v\u00e0o d\u00e2y th\u1ea7n kinh ph\u1ebf v\u1ecb .<\/p>\n

Kh\u00f3i t\u1eeb l\u00e1 c\u1ee7a nh\u1eefng c\u00e2y n\u00e0y \u0111\u00e3 tr\u1edf th\u00e0nh s\u1ef1 chu\u1ea9n b\u1ecb \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 gi\u1ea3m co th\u1eaft ph\u1ebf qu\u1ea3n; c\u00e1c ch\u1ebf ph\u1ea9m atropine d\u1ea1ng h\u00edt v\u00e0 to\u00e0n th\u00e2n \u0111\u00e3 s\u1edbm c\u00f3 s\u1eb5n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hen suy\u1ec5n. V\u1edbi s\u1ef1 ra \u0111\u1eddi c\u1ee7a ephedrine v\u00e0 epinephrine trong th\u1ebf k\u1ef7 20, vi\u1ec7c s\u1eed d\u1ee5ng atropine v\u00e0 c\u00e1c ch\u1ea5t li\u00ean quan \u0111\u1ec3 gi\u1ea3m co th\u1eaft ph\u1ebf qu\u1ea3n \u0111\u00e3 gi\u1ea3m. Li\u1ec7u ph\u00e1p kh\u00e1ng cholinergic m\u1ed9t l\u1ea7n n\u1eefa l\u1ea1i \u0111i \u0111\u1ea7u trong li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb gi\u00e3n ph\u1ebf qu\u1ea3n v\u1edbi s\u1ef1 ra \u0111\u1eddi c\u1ee7a c\u00e1c d\u1eabn xu\u1ea5t b\u1eadc b\u1ed1n t\u1ed5ng h\u1ee3p c\u1ee7a atropine, bao g\u1ed3m ipratropium bromide v\u00e0 tiotropium bromide.<\/p>\n

\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 C\u00e2y Belladonna \u1edf \u1ea4n \u0110\u1ed9 – Ngu\u1ed3n: Wikipedia<\/strong><\/figcaption><\/figure>\n

2. Sinh l\u00fd c\u1ee7a nh\u00f3m thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic<\/strong><\/h2>\n

H\u1ec7 th\u1ea7n kinh \u0111\u1ed1i giao c\u1ea3m \u0111\u00f3ng vai tr\u00f2 ch\u00ednh trong vi\u1ec7c \u0111i\u1ec1u h\u00f2a tr\u01b0\u01a1ng l\u1ef1c ph\u1ebf qu\u1ea3n. Ph\u1ea7n l\u1edbn c\u00e1c d\u00e2y th\u1ea7n kinh t\u1ef1 ch\u1ee7 trong \u0111\u01b0\u1eddng th\u1edf c\u1ee7a con ng\u01b0\u1eddi l\u00e0 c\u00e1c nh\u00e1nh c\u1ee7a d\u00e2y th\u1ea7n kinh ph\u1ebf v\u1ecb, c\u00f3 c\u00e1c s\u1ee3i ti\u1ec1n h\u1ea1ch \u0111i v\u00e0o ph\u1ed5i \u1edf r\u1ed1n ph\u1ed5i v\u00e0 \u0111i d\u1ecdc theo \u0111\u01b0\u1eddng d\u1eabn kh\u00ed v\u00e0o ph\u1ed5i. M\u1ed9t lo\u1ea1t c\u00e1c k\u00edch th\u00edch c\u00f3 th\u1ec3 g\u00e2y ra s\u1ef1 gia t\u0103ng ph\u1ea3n x\u1ea1 trong ho\u1ea1t \u0111\u1ed9ng giao c\u1ea3m g\u00f3p ph\u1ea7n g\u00e2y co th\u1eaft ph\u1ebf qu\u1ea3n. Acetylcholine (ACh) l\u00e0 ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh n\u1ed9i sinh t\u1ea1i c\u00e1c \u0111\u1ea7u d\u00e2y th\u1ea7n kinh cholinergic, v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c trung gian th\u00f4ng qua c\u00e1c th\u1ee5 th\u1ec3 cholinergic nicotinic v\u00e0 muscarinic.<\/p>\n

\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: Role of ACh and muscarinic receptors in the lung – Researchgate<\/strong><\/figcaption><\/figure>\n

2.1. Nicotinic receptors<\/strong><\/h3>\n

C\u00e1c th\u1ee5 th\u1ec3 nicotinic n\u1eb1m tr\u00ean c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh h\u1ea1ch v\u00e0 \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t b\u1edfi ACh \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng t\u1eeb c\u00e1c s\u1ee3i ph\u1ebf v\u1ecb tr\u01b0\u1edbc h\u1ea1ch. C\u00e1c th\u1ee5 th\u1ec3 n\u00e0y \u0111\u01b0\u1ee3c k\u00edch th\u00edch b\u1edfi ch\u1ea5t ch\u1ee7 v\u1eadn nicotinic v\u00e0 b\u1ecb \u1ee9c ch\u1ebf b\u1edfi ch\u1ea5t \u0111\u1ed1i kh\u00e1ng nicotinic nh\u01b0 hexamethonium. Ch\u00fang kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 b\u1edfi c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u1ed1i kh\u00e1ng muscarinic hi\u1ec7n c\u00f3.<\/p>\n

2.2. Muscarinic receptors<\/strong><\/h3>\n

C\u00e1c th\u1ee5 th\u1ec3 muscarinic \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y ch\u1ee7 y\u1ebfu tr\u00ean c\u00e1c t\u1ebf b\u00e0o t\u1ef1 ch\u1ee7 \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi c\u00e1c d\u00e2y th\u1ea7n kinh ph\u00f3 giao c\u1ea3m h\u1eadu h\u1ea1ch. C\u00f3 \u00edt nh\u1ea5t 5 lo\u1ea1i ph\u1ee5 c\u1ee7a th\u1ee5 th\u1ec3 muscarinic. \u00cdt nh\u1ea5t 3 trong s\u1ed1 n\u00e0y \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong ph\u1ed5i:<\/p>\n

    \n
  • Th\u1ee5 th\u1ec3 M1<\/strong> hi\u1ec7n di\u1ec7n tr\u00ean c\u00e1c t\u1ebf b\u00e0o h\u1ea1ch quanh ph\u1ebf qu\u1ea3n, n\u01a1i c\u00e1c d\u00e2y th\u1ea7n kinh tr\u01b0\u1edbc h\u1ea1ch truy\u1ec1n t\u00edn hi\u1ec7u \u0111\u1ebfn c\u00e1c d\u00e2y th\u1ea7n kinh sau h\u1ea1ch.<\/li>\n
  • Th\u1ee5 th\u1ec3 M2<\/strong> c\u00f3 tr\u00ean d\u00e2y th\u1ea7n kinh h\u1eadu h\u1ea1ch<\/li>\n
  • Th\u1ee5 th\u1ec3 M3<\/strong> c\u00f3 tr\u00ean c\u01a1 tr\u01a1n<\/li>\n<\/ul>\n

    C\u00e1c th\u1ee5 th\u1ec3 M1 v\u00e0 M3 l\u00e0m trung gian cho t\u00e1c d\u1ee5ng co th\u1eaft ph\u1ebf qu\u1ea3n c\u1ee7a d\u00e2y th\u1ea7n kinh ph\u1ebf v\u1ecb. C\u00e1c s\u1ee3i ph\u1ebf v\u1ecb kh\u1edbp th\u1ea7n kinh v\u00e0 k\u00edch ho\u1ea1t c\u00e1c th\u1ee5 th\u1ec3 nicotinic v\u00e0 M1 muscarinic trong c\u00e1c h\u1ea1ch \u0111\u1ed1i giao c\u1ea3m c\u00f3 trong th\u00e0nh \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

    C\u00e1c s\u1ee3i sau h\u1ea1ch ng\u1eafn gi\u1ea3i ph\u00f3ng ACh, ho\u1ea1t \u0111\u1ed9ng tr\u00ean c\u00e1c th\u1ee5 th\u1ec3 muscarinic M3 trong c\u01a1 tr\u01a1n \u0111\u01b0\u1eddng th\u1edf. C\u00e1c tuy\u1ebfn d\u01b0\u1edbi ni\u00eam m\u1ea1c c\u0169ng \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ed1i giao c\u1ea3m v\u00e0 ch\u1ee7 y\u1ebfu c\u00f3 c\u00e1c th\u1ee5 th\u1ec3 M3.<\/p>\n

    S\u1ef1 k\u00edch ho\u1ea1t c\u00e1c th\u1ee5 th\u1ec3 M1 v\u00e0 M3 b\u1edfi ACh v\u00e0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 c\u1ee7a n\u00f3 k\u00edch th\u00edch s\u1ef1 b\u00e0i ti\u1ebft c\u1ee7a c\u00e1c tuy\u1ebfn kh\u00ed qu\u1ea3n v\u00e0 g\u00e2y co th\u1eaft ph\u1ebf qu\u1ea3n. M\u1eb7t kh\u00e1c, vi\u1ec7c k\u00edch ho\u1ea1t c\u00e1c th\u1ee5 th\u1ec3 M2 s\u1ebd h\u1ea1n ch\u1ebf s\u1ea3n xu\u1ea5t th\u00eam ACh v\u00e0 b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i s\u1ef1 co th\u1eaft ph\u1ebf qu\u1ea3n qua trung gian ph\u00f3 giao c\u1ea3m. D\u1ef1a tr\u00ean \u0111i\u1ec1u n\u00e0y, m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng muscarinic l\u00fd t\u01b0\u1edfng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb COPD s\u1ebd ch\u1ec9 \u1ee9c ch\u1ebf c\u00e1c th\u1ee5 th\u1ec3 M1 v\u00e0 M3 v\u00e0 lo\u1ea1i b\u1ecf c\u00e1c th\u1ee5 th\u1ec3 M2.<\/p>\n

    Atropine (nguy\u00ean m\u1eabu c\u1ee7a ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 muscarinic) ng\u0103n ch\u1eb7n t\u00e1c d\u1ee5ng c\u1ee7a ACh b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n c\u1ea1nh tranh s\u1ef1 g\u1eafn k\u1ebft c\u1ee7a n\u00f3 v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 muscarinic trong h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng (CNS), h\u1ea1ch ngo\u1ea1i bi\u00ean v\u00e0 t\u1ea1i c\u00e1c v\u1ecb tr\u00ed t\u00e1c \u0111\u1ed9ng th\u1ea7n kinh tr\u00ean c\u01a1 tr\u01a1n, c\u01a1 tim v\u00e0 c\u00e1c tuy\u1ebfn b\u00e0i ti\u1ebft. Atropin \u1ee9c ch\u1ebf s\u1ef1 b\u00e0i ti\u1ebft c\u1ee7a m\u0169i, mi\u1ec7ng, h\u1ea7u, ph\u1ebf qu\u1ea3n v\u00e0 do \u0111\u00f3 g\u00e2y kh\u00f4 ni\u00eam m\u1ea1c \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. Bi\u1ec3u hi\u1ec7n n\u00e0y \u0111\u01b0\u1ee3c xem l\u00e0 ch\u1ec9 \u0111i\u1ec3m \u0111\u1eb7c bi\u1ec7t n\u1ebfu b\u00e0i ti\u1ebft qu\u00e1 m\u1ee9c v\u00e0 l\u00e0 c\u01a1 s\u1edf cho vi\u1ec7c s\u1eed d\u1ee5ng atropine v\u00e0 scopolamine trong thu\u1ed1c ti\u1ec1n m\u00ea. Tuy nhi\u00ean, s\u1ef1 \u1ee9c ch\u1ebf b\u00e0i ti\u1ebft ch\u1ea5t nh\u1ea7y v\u00e0 \u1ee9c ch\u1ebf thanh th\u1ea3i ch\u1ea5t nh\u1ea7y l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n c\u1ee7a atropine \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

    Atropine \u0111\u1eb7c bi\u1ec7t hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi co th\u1eaft ph\u1ebf qu\u1ea3n do thu\u1ed1c c\u01b0\u1eddng giao c\u1ea3m nh\u01b0 methacholine; n\u00f3 c\u0169ng \u0111\u1ed1i kh\u00e1ng m\u1ed9t ph\u1ea7n s\u1ef1 co th\u1eaft ph\u1ebf qu\u1ea3n do histamin v\u00e0 bradykinin g\u00e2y ra. Tuy nhi\u00ean, n\u00f3i chung, c\u00e1c ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 muscarinic \u00edt g\u00e2y ra s\u1ef1 phong t\u1ecfa t\u00e1c d\u1ee5ng c\u1ee7a ACh t\u1ea1i c\u00e1c v\u1ecb tr\u00ed th\u1ee5 th\u1ec3 nicotinic. Do \u0111\u00f3, li\u1ec1u c\u1ef1c cao atropine ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c li\u00ean quan \u0111\u1ec3 t\u1ea1o ra b\u1ea5t k\u1ef3 m\u1ee9c \u0111\u1ed9 phong t\u1ecfa n\u00e0o \u0111\u1ed1i v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 nicotinic ch\u1ee7 y\u1ebfu \u1edf \u0111i\u1ec3m n\u1ed1i th\u1ea7n kinh c\u01a1.<\/p>\n

    2.3. S\u1ef1 kh\u00e1c nhau gi\u1eefa kh\u00e1ng muscarinic b\u1eadc 3 v\u00e0 b\u1eadc 4 c\u1ee7a <\/strong>thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic<\/strong><\/h3>\n

    Thu\u1ed1c amoni b\u1eadc 4 (nh\u01b0 ipratropium) l\u00e0 c\u00e1c d\u1eabn xu\u1ea5t t\u1ed5ng h\u1ee3p c\u1ee7a c\u00e1c h\u1ee3p ch\u1ea5t amoni b\u1eadc 3 c\u00f3 trong t\u1ef1 nhi\u00ean (nh\u01b0 atropine).<\/p>\n

    C\u1ea5u tr\u00fac c\u1ee7a c\u00e1c h\u1ee3p ch\u1ea5t amoni b\u1eadc 4 l\u00e0m cho ch\u00fang h\u00f2a tan t\u1ef1 do trong n\u01b0\u1edbc nh\u01b0ng kh\u00f4ng h\u00f2a tan trong ch\u1ea5t b\u00e9o; do \u0111\u00f3, r\u1ea5t kh\u00f3 \u0111\u1ec3 c\u00e1c h\u1ee3p ch\u1ea5t n\u00e0y v\u01b0\u1ee3t qua c\u00e1c r\u00e0o c\u1ea3n sinh h\u1ecdc m\u00e0 c\u00e1c h\u1ee3p ch\u1ea5t amoni b\u1eadc ba nh\u01b0 atropine c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng v\u01b0\u1ee3t qua. H\u1ea7u h\u1ebft c\u00e1c \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd gi\u00fap ph\u00e2n bi\u1ec7t c\u00e1c h\u1ee3p ch\u1ea5t amoni b\u1eadc b\u1ed1n v\u1edbi atropine l\u00e0 do \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y:<\/p>\n

      \n
    • C\u00e1c h\u1ee3p ch\u1ea5t amoni b\u1eadc 3 h\u00f2a tan trong lipid, d\u1ec5 h\u1ea5p th\u1ee5 v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e1ng k\u1ec3, bao g\u1ed3m nh\u1ecbp tim nhanh, kh\u00f4 mi\u1ec7ng, \u0111\u1ecf b\u1eebng da, m\u1edd m\u1eaft v\u00e0 thay \u0111\u1ed5i t\u00e2m tr\u1ea1ng<\/li>\n
    • Do c\u00e1c h\u1ee3p ch\u1ea5t c\u00f3 c\u1ea5u tr\u00fac amoni b\u1eadc 4 h\u1ea5p thu k\u00e9m sau khi u\u1ed1ng n\u00ean \u00edt g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n<\/li>\n
    • C\u00e1c h\u1ee3p ch\u1ea5t b\u1eadc 4 th\u01b0\u1eddng th\u1ec3 hi\u1ec7n m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng ng\u0103n ch\u1eb7n nicotinic cao h\u01a1n v\u00e0 do \u0111\u00f3 c\u00f3 kh\u1ea3 n\u0103ng c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u01a1 \u1edf li\u1ec1u l\u01b0\u1ee3ng g\u1ea7n \u0111\u00fang h\u01a1n v\u1edbi li\u1ec1u l\u01b0\u1ee3ng g\u00e2y ra s\u1ef1 ng\u0103n ch\u1eb7n muscarinic.<\/li>\n<\/ul>\n

      Ipratropium bromide t\u1ea1o ra t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 atropine khi m\u1ed7i thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Ch\u00fang bao g\u1ed3m gi\u00e3n ph\u1ebf qu\u1ea3n, nh\u1ecbp tim nhanh v\u00e0 \u1ee9c ch\u1ebf ti\u1ebft n\u01b0\u1edbc b\u1ecdt. Tuy nhi\u00ean, kh\u00f4ng gi\u1ed1ng nh\u01b0 atropine, ipratropium thi\u1ebfu t\u00e1c d\u1ee5ng \u0111\u00e1ng k\u1ec3 \u0111\u1ed1i v\u1edbi h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng (CNS), \u0111\u01b0\u1ee3c h\u1ea5p thu k\u00e9m t\u1eeb ph\u1ed5i ho\u1eb7c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 kh\u00f4ng \u1ee9c ch\u1ebf thanh th\u1ea3i ni\u00eam m\u1ea1c. Do \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng ipratropium \u1edf b\u1ec7nh nh\u00e2n COPD tr\u00e1nh \u0111\u01b0\u1ee3c s\u1ef1 t\u00edch t\u1ee5 gia t\u0103ng c\u1ee7a d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi v\u00e0 s\u1ef1 \u0111\u1ed1i kh\u00e1ng c\u1ee7a ch\u1ea5t ch\u1ee7 v\u1eadn beta-adrenergic l\u00e0m t\u0103ng thanh th\u1ea3i ch\u1ea5t nh\u1ea7y g\u1eb7p ph\u1ea3i v\u1edbi atropine.<\/p>\n

      Ngay c\u1ea3 khi ipratropium bromide \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi l\u01b0\u1ee3ng g\u1ea5p nhi\u1ec1u l\u1ea7n li\u1ec1u khuy\u1ebfn c\u00e1o, nh\u1ecbp tim, huy\u1ebft \u00e1p, ch\u1ee9c n\u0103ng b\u00e0ng quang, nh\u00e3n \u00e1p ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed3ng t\u1eed c\u00f3 r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 thay \u0111\u1ed5i. T\u00ednh ch\u1ecdn l\u1ecdc n\u00e0y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c h\u1ea5p thu thu\u1ed1c r\u1ea5t k\u00e9m hi\u1ec7u qu\u1ea3 t\u1eeb ni\u00eam m\u1ea1c \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p ho\u1eb7c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.<\/p>\n

      Ngu\u1ed3n tham kh\u1ea3o<\/strong>:<\/p>\n

        \n
      • Raed A Dweik, MD, FACP, FCCP, FRCP(C), FCCM, FAHA, \u201cRole of muscarinic antagonist therapy in COPD\u201d, UPTODATE 2023.<\/li>\n<\/ul>\n
        usechatgpt init success<\/div>\n
        usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"

        Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng muscarinic (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c kh\u00e1ng cholinergic) l\u00e0 thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh (COPD), \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u00e0m gi\u1ea3m ch\u1ee9ng kh\u00f3 th\u1edf v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng khi g\u1eafng s\u1ee9c. 1. T\u1ed5ng quan ngu\u1ed3n g\u1ed1c […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nT\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic trong COPD - Vinmec<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng muscarinic (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c kh\u00e1ng cholinergic) l\u00e0 thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i\" \/>\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\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c \u0111\u1ed1i kh\u00e1ng Muscarinic trong COPD - 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