{"id":35847,"date":"2023-06-29T20:50:35","date_gmt":"2023-06-29T13:50:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35847"},"modified":"2023-06-29T20:50:35","modified_gmt":"2023-06-29T13:50:35","slug":"tac-dung-cua-thuoc-chen-kenh-canxi-trong-dieu-tri-benh-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/29\/tac-dung-cua-thuoc-chen-kenh-canxi-trong-dieu-tri-benh-tim\/","title":{"rendered":"T\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c ch\u1eb9n k\u00eanh canxi trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim"},"content":{"rendered":"<p><strong>Ch\u1eb9n k\u00eanh canxi (Calcium Channel Blocker &#8211; CCB) l\u00e0 m\u1ed9t trong nh\u1eefng nh\u00f3m thu\u1ed1c ch\u1ee7 y\u1ebfu trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh tim m\u1ea1ch kh\u00e1c nh\u01b0 thi\u1ebfu m\u00e1u c\u01a1 tim c\u1ee5c b\u1ed9 hay r\u1ed1i lo\u1ea1n nh\u1ecbp tim. C\u01a1 ch\u1ebf ch\u00ednh c\u1ee7a thu\u1ed1c l\u00e0 ng\u0103n c\u1ea3n d\u00f2ng canxi \u0111i qua k\u00eanh \u0111\u1ec3 v\u00e0o t\u1ebf b\u00e0o d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 canxi t\u1ef1 do trong t\u1ebf b\u00e0o gi\u1ea3m t\u1eeb \u0111\u00f3 l\u00e0m gi\u1ea3m co c\u01a1 tim, c\u01a1 tr\u01a1n d\u1eabn \u0111\u1ebfn gi\u1ea3m\u00a0 huy\u1ebft \u00e1p.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-35848 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/8a7a9d12-5f49-42f5-a91e-665aee9420cc-300x300.jpg\" alt=\"chen-kenh-canxi\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/8a7a9d12-5f49-42f5-a91e-665aee9420cc-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/8a7a9d12-5f49-42f5-a91e-665aee9420cc-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/8a7a9d12-5f49-42f5-a91e-665aee9420cc-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/8a7a9d12-5f49-42f5-a91e-665aee9420cc.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng thu\u1ed1c ch\u1eb9n k\u00eanh canxi<\/h2>\n<p><strong>1.1 Ion Canxi (Ca2+) trong c\u01a1 th\u1ec3<\/strong><\/p>\n<p>N\u1ed3ng \u0111\u1ed9 Ca2+ t\u1ef1 do trong b\u00e0o t\u01b0\u01a1ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng \u0111i\u1ec1u h\u00f2a ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o<\/p>\n<p>Ion calci \u0111i v\u00e0o t\u1ebf b\u00e0o th\u00f4ng qua 4 con \u0111\u01b0\u1eddng ch\u00ednh:<\/p>\n<ul>\n<li>C\u00e1c k\u00eanh calci c\u1ed5ng \u0111i\u1ec7n th\u1ebf<\/li>\n<li>C\u00e1c k\u00eanh calci c\u1ed5ng ligand<\/li>\n<li>C\u00e1c k\u00eanh calci \u0111\u01b0\u1ee3c v\u1eadn h\u00e0nh b\u1edfi kho d\u1ef1 tr\u1eef (SOCs)<\/li>\n<li>Trao \u0111\u1ed5i Na+ &#8211; Ca2+<\/li>\n<\/ul>\n<p>C\u00e1c k\u00eanh canxi:<\/p>\n<p>Type L (Long-lasting): C\u01a1 tim , C\u01a1 tr\u01a1n<\/p>\n<p>Type T (Transient): B\u1ed9 ph\u1eadn t\u1ea1o nh\u1ecbp c\u1ee7a tim T\u00e2m nh\u0129<\/p>\n<p>Type N : T\u1eadn c\u00f9ng d\u00e2y th\u1ea7n kinh<\/p>\n<p>Type P\/Q: T\u1eadn c\u00f9ng d\u00e2y th\u1ea7n kinh<\/p>\n<p>Type R : T\u1ebf b\u00e0o th\u1ea7n kinh, T\u1ebf b\u00e0o tua gai<\/p>\n<p><strong>1.2 <\/strong><strong>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/p>\n<p>T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c \u0111\u1ec1u g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n \u03b11 c\u1ee7a k\u00eanh type L<\/p>\n<ul>\n<li>D: V\u1ecb tr\u00ed g\u1eafn c\u1ee7a Diltiazem<\/li>\n<li>N: V\u1ecb tr\u00ed g\u1eafn c\u1ee7a Nifedipine v\u00e0 c\u00e1c DHP<\/li>\n<li>V: V\u1ecb tr\u00ed g\u1eafn k\u1ebft c\u1ee7a Verapamil<\/li>\n<\/ul>\n<p>Khi v\u00e0o c\u01a1 th\u1ec3 thu\u1ed1c ch\u1eb9n k\u00eanh canxi s\u1ebd g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n \u03b11 c\u1ee7a k\u00eanh calci type L tr\u00ean m\u00e0ng TB. B\u00ecnh th\u01b0\u1eddng k\u00eanh n\u00e0y s\u1ebd m\u1edf cho d\u00f2ng calci \u0111i v\u00e0o. Khi thu\u1ed1c g\u1eafn v\u00e0o s\u1ebd ng\u0103n c\u1ea3n d\u00f2ng calci \u0111i qua k\u00eanh \u0111\u1ec3 v\u00e0o t\u1ebf b\u00e0o. N\u1ed3ng \u0111\u1ed9 calci t\u1ef1 do trong t\u1ebf b\u00e0o gi\u1ea3m.\u00a0 T\u1eeb \u0111\u00f3 s\u1ebd<\/p>\n<p>+C\u01a1 tim: Gi\u1ea3m ph\u1ee9c h\u1ee3p Calci-Troponin l\u00e0m gi\u1ea3m s\u1ef1 tr\u01b0\u1ee3t c\u1ee7a myosin l\u00ean Actin. Gi\u1ea3m co c\u01a1 tim.<\/p>\n<p>+ C\u01a1 tr\u01a1n: Gi\u1ea3m ph\u1ee9c h\u1ee3p Ca-Camodulin gi\u1ea3m MLCK, gi\u1ea3m ho\u1ea1t h\u00f3a t\u1ea1o Myosin-P, gi\u1ea3m co c\u01a1 tr\u01a1n<\/p>\n<p><strong>1.3 \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a thu\u1ed1c<\/strong><\/p>\n<ul>\n<li>H\u1ea5p thu ho\u00e0n to\u00e0n PO, t\u00e1c \u0111\u1ed9ng l\u1ea7n \u0111\u1ea7u \u1edf gan n\u00ean gi\u1ea3m sinh kh\u1ea3 d\u1ee5ng. C\u00f3 t\u00e1c d\u1ee5ng r\u00f5 30 \u2013 60 ph\u00fat.<\/li>\n<li>G\u1eafn m\u1ea1nh v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng (70 \u2013 90%)<\/li>\n<li>Amlodipin c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y d\u00e0i n\u00ean d\u00f9ng ng\u00e0y 1 l\u1ea7n; nifedipin, diltiazem, verapamil c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y ng\u1eafn d\u00f9ng nhi\u1ec1u l\u1ea7n.<\/li>\n<li>Gi\u1ea3m li\u1ec1u v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i, suy gan.<\/li>\n<\/ul>\n<p><strong><em>1.4 D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/em><\/strong><\/p>\n<ul>\n<li>\u1ee8c ch\u1ebf s\u1ef1 x\u00e2m nh\u1eadp Ca<sup>++<\/sup> \u00a0v\u00e0o c\u01a1 tim \u1edf pha 2 c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng n\u00ean g\u00e2y gi\u00e3n c\u01a1.<\/li>\n<li>Gi\u00e3n m\u1ea1ch v\u00e0nh n\u00ean t\u0103ng cung c\u1ea5p oxy cho c\u01a1 tim<\/li>\n<li>Gi\u00e3n m\u1ea1ch ngo\u1ea1i vi n\u00ean g\u00e2y gi\u1ea3m h\u1eadu g\u00e1nh v\u00e0 gi\u1ea3m co th\u1eaft c\u01a1 tim g\u00f3p ph\u1ea7n gi\u1ea3m ti\u00eau th\u1ee5 oxy c\u1ee7a c\u01a1 tim<\/li>\n<\/ul>\n<ul>\n<li>Nh\u00f3m kh\u00f4ng Dihydropyridin (non-DHP): T\u00e1c \u0111\u1ed9ng \u01b0u th\u1ebf tr\u00ean m\u1ea1ch, <em>gi\u00e3n m\u1ea1ch v\u00e0nh v\u00e0 m\u1ea1ch ngo\u1ea1i bi\u00ean <\/em>n\u00ean g\u00e2y tim nhanh do ph\u1ea3n x\u1ea1. \u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb <em>kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u1eabn truy\u1ec1n qua n\u00fat nh\u0129 th\u1ea5t<\/em>, <em>\u00edt ho\u1eb7c kh\u00f4ng \u1ee9c ch\u1ebf co b\u00f3p c\u01a1 tim<\/em><\/li>\n<li>Nh\u00f3m Dihydropyridin (DHP): T\u00e1c \u0111\u1ed9ng \u01b0u th\u1ebf tr\u00ean tim, \u1ee9c ch\u1ebf c\u00f3 h\u1ed3i ph\u1ee5c k\u00eanh calci \u1edf n\u00fat xoang v\u00e0 l\u00e0m <em>ch\u1eadm d\u1eabn truy\u1ec1n nh\u0129 th\u1ea5t<\/em>, <em>gi\u1ea3m co b\u00f3p c\u01a1 tim, nh\u1ecbp tim ch\u1eadm<\/em><\/li>\n<\/ul>\n<table width=\"947\">\n<tbody>\n<tr>\n<td width=\"137\">T\u00ean thu\u1ed1c<\/td>\n<td width=\"133\">\u1ee8c ch\u1ebf n\u00fat xoang<\/td>\n<td width=\"153\">\u1ee8c ch\u1ebf n\u00fat nh\u0129 th\u1ea5t<\/td>\n<td width=\"117\">Gi\u00e3n m\u1ea1ch v\u00e0nh<\/td>\n<td width=\"171\">\u1ee8c ch\u1ebf co c\u01a1 tim<\/td>\n<td width=\"234\">Gi\u00e3n m\u1ea1ch, h\u1ea1 HA<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\" width=\"947\">Nh\u00f3m kh\u00f4ng Dihydropyridin (non-DHP)<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Diltiazem<\/td>\n<td width=\"133\">5<\/td>\n<td width=\"153\">4<\/td>\n<td width=\"117\">3<\/td>\n<td width=\"171\">2<\/td>\n<td width=\"234\">3<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Verapamil<\/td>\n<td width=\"133\">5<\/td>\n<td width=\"153\">5<\/td>\n<td width=\"117\">4<\/td>\n<td width=\"171\">4<\/td>\n<td width=\"234\">4<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\" width=\"947\">Nh\u00f3m Dihydropyridin (DHP)<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Amlodipin<\/td>\n<td width=\"133\">1<\/td>\n<td width=\"153\">0<\/td>\n<td width=\"117\">5<\/td>\n<td width=\"171\">1<\/td>\n<td width=\"234\">5<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Nifedipin<\/td>\n<td width=\"133\">1<\/td>\n<td width=\"153\">0<\/td>\n<td width=\"117\">5<\/td>\n<td width=\"171\">1<\/td>\n<td width=\"234\">5<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Felodipin<\/td>\n<td width=\"133\">1<\/td>\n<td width=\"153\">0<\/td>\n<td width=\"117\">5<\/td>\n<td width=\"171\">1<\/td>\n<td width=\"234\">5<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td width=\"137\">Nicardipin<\/td>\n<td width=\"133\">1<\/td>\n<td width=\"153\">0<\/td>\n<td width=\"117\">5<\/td>\n<td width=\"171\">0<\/td>\n<td width=\"234\">5<\/td>\n<td width=\"3\">&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Nifedipine: g\u00e2y t\u0103ng nh\u1ecbp tim ph\u1ea3n x\u1ea1 v\u00e0 co c\u01a1 tim<\/li>\n<li>Amlodipine: \u00edt l\u00e0m t\u0103ng nh\u1ecbp tim ph\u1ea3n x\u1ea1 (do t1\/2 d\u00e0i)<\/li>\n<li>Verapamil: t\u0103ng nh\u1ecbp tim ph\u1ea3n x\u1ea1 b\u1ecb che l\u1ea5p b\u1edfi t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean nh\u1ecbp tim c\u1ee7a thu\u1ed1c<\/li>\n<li>Diltiazem: ban \u0111\u1ea7u t\u0103ng nh\u1ecbp tim ph\u1ea3n x\u1ea1 v\u00e0 t\u0103ng cung l\u01b0\u1ee3ng tim. Sau \u0111\u00f3 nh\u1ecbp tim gi\u1ea3m do t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m tr\u1ef1c ti\u1ebfp nh\u1ecbp tim c\u1ee7a thu\u1ed1c.<\/li>\n<li>CCBs \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 b\u1ea3o v\u1ec7 t\u1ebf b\u00e0o \u1edf c\u00e1c m\u00f4 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5<\/li>\n<li>Nimodipine ch\u1ecdn l\u1ecdc m\u1ed9t ph\u1ea7n tr\u00ean m\u1ea1ch m\u00e1u n\u00e3o<\/li>\n<li>S\u1eed d\u1ee5ng \u0111\u1ec3 l\u00e0m gi\u1ea3m co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o sau xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n<\/li>\n<\/ul>\n<p><strong>1.5. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc thu\u1ed1c ch\u1eb9n k\u00eanh canxi<\/strong><\/p>\n<p>Ch\u1eb9n k\u00eanh canxi\u00a0 s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng h\u1ea5p thu t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u01b0\u1eddng s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng (PO), tr\u1eeb nh\u1eefng ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7c bi\u1ec7t (ti\u00eam IV trong tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n)<\/p>\n<p>Chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan l\u1ea7n \u0111\u1ea7u, sinh kh\u1ea3 d\u1ee5ng th\u1ea5p<\/p>\n<table>\n<tbody>\n<tr>\n<td rowspan=\"2\">&nbsp;<\/p>\n<p><strong>Ph\u00e2n nh\u00f3m<\/strong><\/td>\n<td rowspan=\"2\"><strong>T\u00ean thu\u1ed1c<\/strong><\/td>\n<td colspan=\"4\"><strong>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc (d\u1ea1ng u\u1ed1ng)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>H\u1ea5p thu<\/strong><\/td>\n<td><strong>Ph\u00e2n b\u1ed1<\/strong><\/td>\n<td><strong>Chuy\u1ec3n h\u00f3a<\/strong><\/td>\n<td><strong>Th\u1ea3i tr\u1eeb<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><strong>Non-DHP<\/strong><\/td>\n<td>Verapamil<\/td>\n<td>C\u00f3 t\u00e1c d\u1ee5ng sau 2h.<\/p>\n<p>\u0110\u1ea1t \u0111\u1ec9nh n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng sau 1-2h.<\/p>\n<p>Ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb: 80-400 ng\/mL.<\/p>\n<p>Sinh kh\u1ea3 d\u1ee5ng th\u1ea5p (10%-20%).<\/td>\n<td>G\u1eafn 87%-93% v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. (ch\u01b0a ghi nh\u1eadn t\u01b0\u01a1ng t\u00e1c v\u1edbi wafarin)<\/td>\n<td>Chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan l\u1ea7n \u0111\u1ea7u (\u1ee9c ch\u1ebf CYP 3A4 =&gt; t\u0103ng n\u1ed3ng \u0111\u1ed9 trong m\u00e1u c\u1ee7a 1 s\u1ed1 statin nh\u01b0 atorvastatin, simvastatin,<\/p>\n<p>and lovastatin, c\u0169ng nh\u01b0 ketoconazole)<\/p>\n<p>Ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f2n ho\u1ea1t t\u00ednh (norverapamil).<\/td>\n<td>Th\u1eadn: 75%<\/p>\n<p>Gan: 25%<\/p>\n<p>t<sub>1\/2<\/sub>: 3-7h<\/td>\n<\/tr>\n<tr>\n<td>Diltiazem<\/td>\n<td>C\u00f3 t\u00e1c d\u1ee5ng sau 15-30 ph\u00fat.<\/p>\n<p>\u0110\u1ea1t \u0111\u1ec9nh n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng sau 1-2h.<\/p>\n<p>Ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb: 50-300 ng\/mL.<\/p>\n<p>Sinh kh\u1ea3 d\u1ee5ng th\u1ea5p (45%).<\/td>\n<td>G\u1eafn 80%-86% v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng.<\/td>\n<td>Chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan l\u1ea7n \u0111\u1ea7u (\u1ee9c ch\u1ebf CYP 3A4).<\/p>\n<p>Ch\u1ea5t chuy\u1ec3n h\u00f3a (deacyldiltiazem) c\u00f2n 40% ho\u1ea1t t\u00ednh.<\/td>\n<td>Th\u1eadn: 35%<\/p>\n<p>Gan: 65%<\/p>\n<p>t<sub>1\/2<\/sub>: 4-7h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td rowspan=\"2\">&nbsp;<\/p>\n<p><strong>Ph\u00e2n nh\u00f3m<\/strong><\/td>\n<td rowspan=\"2\"><strong>T\u00ean thu\u1ed1c<\/strong><\/td>\n<td colspan=\"4\"><strong>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc (d\u1ea1ng u\u1ed1ng)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>H\u1ea5p thu<\/strong><\/td>\n<td><strong>Ph\u00e2n b\u1ed1<\/strong><\/td>\n<td><strong>Chuy\u1ec3n h\u00f3a<\/strong><\/td>\n<td><strong>Th\u1ea3i tr\u1eeb<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><strong>DHPs<\/strong><\/td>\n<td>Nifedipine d\u1ea1ng t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i<\/p>\n<p>(D\u1ea1ng t\u00e1c d\u1ee5ng ng\u1eafn ch\u1ec9 c\u00f2n ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p co th\u1eaft m\u1ea1ch v\u00e0nh hay h\u1ed9i ch\u1ee9ng Raynaud)<\/td>\n<td>Ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb: 20-30 ng\/mL, duy tr\u00ec trong 24h (<em>Procardia XL, Adalat LA<\/em>)<\/p>\n<p>Ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb duy tr\u00ec trong 24h, peak dao \u0111\u1ed9ng t\u1eeb 41%-91%<\/td>\n<td>&nbsp;<\/td>\n<td>Chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan l\u1ea7n \u0111\u1ea7u.<\/p>\n<p>Ch\u1ea5t chuy\u1ec3n h\u00f3a <em>kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh<\/em>.<\/td>\n<td>Th\u1eadn: ch\u1ee7 y\u1ebfu<\/td>\n<\/tr>\n<tr>\n<td>Amlodipin<\/td>\n<td>\u0110\u1ea1t \u0111\u1ec9nh n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng sau 6-12h.<\/td>\n<td>&nbsp;<\/td>\n<td>Chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan l\u1ea7n \u0111\u1ea7u (\u1ee9c ch\u1ebf CYP 3A4).<\/p>\n<p>Ch\u1ea5t chuy\u1ec3n h\u00f3a <em>kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh<\/em>.<\/td>\n<td>t<sub>1\/2<\/sub>: <strong>35-48h<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>1.6 Ph\u1ea3n \u1ee9ng ph\u1ee5 c\u1ee7a thu\u1ed1c<\/strong><\/p>\n<ul>\n<li>\u0110au \u0111\u1ea7u, b\u1eebng m\u1eb7t v\u00e0 ch\u00f3ng m\u1eb7t<\/li>\n<li>T\u00e1c d\u1ee5ng ph\u1ee5 t\u00e1o b\u00f3n r\u1ea5t \u0111\u1eb7c tr\u01b0ng, g\u00e2y ra nhi\u1ec1u phi\u1ec1n to\u00e1i, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i<\/li>\n<li>T\u00e1c d\u1ee5ng ph\u1ee5 hi\u1ebfm g\u1eb7p: \u0111au l\u1ee3i, \u0111au th\u01b0\u1ee3ng v\u1ecb, \u0111\u1ed9c cho gan, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n tho\u00e1ng qua<\/li>\n<li>\u1ede ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, verapamil c\u00f3 th\u1ec3 g\u00e2y ra xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/li>\n<\/ul>\n<p>Ph\u00f9 m\u1eaft c\u00e1 ch\u00e2n 2 b\u00ean<\/p>\n<ul>\n<li>T\u1ec9 l\u1ec7 g\u1eb7p c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ea5p t\u00ednh do gi\u00e3n m\u1ea1ch th\u1ea5p do n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u t\u0103ng ch\u1eadm<\/li>\n<li>Hi\u1ebfm g\u1eb7p: h\u1ea1 huy\u1ebft \u00e1p, suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan nh\u01b0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim ho\u1eb7c th\u1eadm ch\u00ed nh\u1ed3i m\u00e1u c\u01a1 tim, thi\u1ebfu m\u00e1u n\u00e3o c\u1ee5c b\u1ed9 v\u00e0 suy th\u1eadn<\/li>\n<li>C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 b\u1ea5t th\u01b0\u1eddng kh\u00e1c: chu\u1ed9t r\u00fat c\u01a1, \u0111au c\u01a1, h\u1ea1 Kali m\u00e1u (th\u00f4ng qua t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u) v\u00e0 s\u01b0ng l\u1ee3i<\/li>\n<li><\/li>\n<\/ul>\n<h2>2. Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c tr\u00ean l\u00e2m s\u00e0ng<\/h2>\n<p>&nbsp;<\/p>\n<p><strong>2.1 Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<ul>\n<li><em>Tr\u1ecb \u0111au th\u1eaft ng\u1ef1c<\/em>, c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi m\u1ecdi d\u1ea1ng \u0111au th\u1eaft ng\u1ef1c, \u0111\u1eb7c bi\u1ec7t hi\u1ec7u qu\u1ea3 v\u1edbi \u0111au th\u1eaft ng\u1ef1c Prinzmetal (diltiazem) nh\u1edd l\u00e0m gi\u00e3n m\u1ea1ch v\u00e0nh<\/li>\n<li><em>Tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/em><em>: <\/em>\u0110\u01b0\u1ee3c xem m\u1ed9t trong nh\u1eefng nh\u00f3m thu\u1ed1c kh\u1edfi tr\u1ecb \u0111\u1ea7u tay t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng c\u00f3 b\u1ec7nh k\u00e8m theo<\/li>\n<li><em>Lo\u1ea1n nh\u1ecbp tim <\/em>(verapamil)<\/li>\n<li><em>H\u1ed9i ch\u1ee9ng Raynaud <\/em>(nifedipin)<\/li>\n<li><em>Ch\u1ea3y m\u00e1u d\u01b0\u1edbi m\u00e0ng nh\u1ec7n <\/em>(nimodipin)<\/li>\n<li>T\u00e1c d\u1ee5ng ph\u1ee5\n<ul>\n<li>\u1ee8c ch\u1ebf d\u00f2ng calci qu\u00e1 \u0111\u1ed9: tim ch\u1eadm, \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n nh\u0129 th\u1ea5t, suy tim sung huy\u1ebft, r\u00f5 nh\u1ea5t l\u00e0 verapamil, \u0111\u1ebfn diltiazem.<\/li>\n<li>Gi\u00e3n m\u1ea1ch qu\u00e1 \u0111\u1ed9: nh\u1ee9c \u0111\u1ea7u, ch\u00f3ng m\u1eaft, h\u1ea1 HA, ch\u1ee9ng \u0111\u1ecf b\u1eebng, h\u1ed3i h\u1ed9p, ph\u00f9 m\u1eaft c\u00e1 ch\u00e2n, ph\u00f9 ph\u1ed5i, t\u00e1o b\u00f3n (verapamil)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>2.2 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>CCB lo\u1ea1i DHP: \u0110TN kh\u00f4ng \u1ed5n \u0111\u1ecbnh, h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u00ean, b\u1ec7nh c\u01a1 tim ph\u00f9 \u0111\u1ea1i t\u1eaft ngh\u1ebdn<\/li>\n<li>CCB lo\u1ea1i non-DHP:\n<ul>\n<li>Suy tim<\/li>\n<li>Gi\u1ea3m d\u1eabn truy\u1ec1n<\/li>\n<li>H\u1ea1 HA n\u1eb7ng<\/li>\n<li>Ph\u1ed1i h\u1ee3p ch\u1ea5t g\u00e2y suy tim, \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n nh\u01b0 \u03b2-blocker, digitalis<\/li>\n<\/ul>\n<\/li>\n<li>T\u01b0\u01a1ng t\u00e1c thu\u1ed1c: Verapamil t\u0103ng n\u1ed3ng \u0111\u1ed9 digoxin (\u1ee9c ch\u1ebf P-glycoprotein v\u1eadn chuy\u1ec3n lo\u1ea1i tr\u1eeb digoxin)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Xem th\u00ean: <a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/cac-tac-dung-phu-cua-thuoc-tim-mach\/\">T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c tim m\u1ea1ch<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u1eb9n k\u00eanh canxi (Calcium Channel Blocker &#8211; CCB) l\u00e0 m\u1ed9t trong nh\u1eefng nh\u00f3m thu\u1ed1c ch\u1ee7 y\u1ebfu trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh tim m\u1ea1ch kh\u00e1c nh\u01b0 thi\u1ebfu m\u00e1u c\u01a1 tim c\u1ee5c b\u1ed9 hay r\u1ed1i lo\u1ea1n nh\u1ecbp tim. C\u01a1 ch\u1ebf ch\u00ednh c\u1ee7a thu\u1ed1c l\u00e0 ng\u0103n c\u1ea3n d\u00f2ng canxi \u0111i qua k\u00eanh \u0111\u1ec3 [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>T\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c ch\u1eb9n k\u00eanh canxi trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1eb9n k\u00eanh canxi l\u00e0 m\u1ed9t trong nh\u1eefng nh\u00f3m thu\u1ed1c ch\u1ee7 y\u1ebfu trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh tim m\u1ea1ch kh\u00e1c\" \/>\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 d\u1ee5ng c\u1ee7a thu\u1ed1c ch\u1eb9n k\u00eanh canxi trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim - 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