bai 29 virus- vaccin
DESCRIPTION
dược lý về virus và vaccinTRANSCRIPT
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Bi 29
thuc chng
virus v vaccin -
thuc chng virus v vaccin
Mc tiu hc tp
1. Trnh by c khi nim c bn v virus gy bnh, bnh do virus: AIDS, Herpes virus, cm, vim gan B.
2. HIV: S nhn ln, ng ly nhim, phn loi thuc iu tr HIV/AIDS
3.Trnh by c phn loi thuc iu tr HIV, mt s thuc chnh: zidovudin, lamivudin.
Trnh by c 1 s thuc c th tr herpes virus: acyclovir.
Trnh by c mt s thuc c th iu tr cm: tamiflu, rimantadin
Virus
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thuc chng virus v vaccin
Mc tiu hc tp
1. Trnh by c khi nim v vaccin, phn loi vaccin, tc dng khng mong mun, nguyn tc BQ v dng vaccin phng bnh
2. Tn, mt bit dc, tc dng, ch nh, cch dng, cch bo qun ca: vaccin phng vim gan B; bnh di; bi lit; bch hu, un vn, ho g.
Vaccin
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Khi nim:
- Virus (cn gi l siu VK) l nhm vi sinh vt cha c cu trc TB, v cng b nh, khng quan st c bng knh hin vi thng, ch cha 1 loi acid nucleic, k sinh bt buc trong cc TB sng, iu khin h thng trao i cht ca TB ch m sao chp acid nucleic, protein,...ri tin hnh lp ghp trng thnh, sinh sn.
- Bn thn khng t nhn ln c m hon ton ph thuc vo TB ch nn cng l c ch gy bnh.
- Vn c kh nng biu hin nhng tnh cht c bn ca s sng:
+ Duy tr c ni ging qua cc th h m vn gi tnh n nh v c im ca virus trong t bo cm th thch hp.
+ Virus gy ra nhiu loi bnh nguy him nh dch cm, vim ng h hp, u ma, thu u, zona, bnh AID'S, v c th l nguyn nhn gy ung th...
thuc chng virus v vaccin
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thuc chng virus v vaccin
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Cu to cc virus:
- Acid nucleic: gia li, ch cha hoc ADN hoc ARN.
- V capsid: nhiu phn t protein ging nhau sp xp theo mt trt t nht nh v bao bc bo v acid nucleic.
- C th c:
+ Mng bc lipid (pha ngoi v)
+ Glucoprotein (pha ngoi mng bc): gai nh gip virus bm vo t bo ch.
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* Da vo c im ca acid nucleic:
- Virus DNA: acid nucleic cha ADN
- Virus RNA: acid nucleic cha ARN
Cch phn loi ny rt chnh xc nhng kh nh v ch cho thy cc h virus m khng bit c th phm gy ra cc bnh c th
thuc chng virus v vaccin
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Phn loi virus:
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* Phn loi theo triu chng hc:
- S gii phng virus ra khi TB thng lm tiu hu v gy cht TB gy nn cc triu chng LS ca bnh.
- Thun li cho LS nhng khng chnh xc v 1 VR c th gy ra nhiu bnh cnh LS, ngc li 1 bnh cnh lm sng cng c th do nhiu loi VR gy nn. Gm:
+ VR gy bnh ph bin: qua ng mu gy bnh pht ban ngoi da: bnh u ma, bnh si, Rubella, st vng, st xut huyt,...
+ VR gy bnh h thng thn kinh: bnh bi lit, di, no, Herpes simplex, si, u,...
+ VR khu tr da, c, nim mc: Herpes simplex tub 1 gy bnh quanh nim mc ming, tub 2 gy bnh nmc ng SD, zona,...
+ VR gy bnh mt: Adenovirus, Herpes virus, au mt dch,...
+ VR gy bnh gan:gy vim gan A,B,...; HerpesVR, RubellaVR,...
+ Virus ly lan qua ng tnh dc: HIV, Herpes virus, HBV,...
* Ngoi ra c th phn loi VR theo hnh dng, cc lp bc ca VR...
thuc chng virus v vaccin
Phn loi virus (tip theo):
i cng
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Mt s cc virus DNA gy bnh
thuc chng virus v vaccin
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VirusBnhVaccinHerpes simplex typ 1 (HSV1)St phng daC Herpes simplex typ 2(HSV2)Herpes sinh dcC Herpes zoster(varicella)Thu uCAdenovirus ngiBnh ng h hp trnCha c Varilau maCVirus hepatitis (HBV)Vim gan B cp - mnC -
Mt s cc virus RNA gy bnh
thuc chng virus v vaccin
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VirusBnhVaccinEnterovirusBi litCAlphavirusVim noCRubivirusSi RubellaCVirus diDiCParainfluenzavirusVim ng h hp cpCha cPneumovirusVim ng h hp cp tr emC HIVBnh AID'S v cc bnh phc hp c lin quan AIDSCha c -
thuc chng virus v vaccin
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Nguyn tc phng v iu tr bnh do virus
* Phng bnh: S dng vaccin
* iu tr: Dng thuc khng VR. Trong nhiu bnh nhim VR, nh im ca s sao chp ca VR l vo ngay trc lc triu chng LS xut hin. V vy, t hiu qu iu tr LS tt nht th nn bt u iu tr sm. Cc thuc khng VR cn phi ngn cn s xm nhp ca VR vo TB v phi c hot tnh vi VR trong TB tc phi c tnh c hiu.
- Thuc khng VR c ch mt hoc 1 s khu trong chu k sao chp VR (hin nay ch yu c ch tng hp acid nucleic ca VR).
- Thuc khng VR thng gy c TB (hot ng sao chp ca TB thc hin trong TB vt ch, mun dit VR phi xm nhp c vo trong TB)
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Cc ni dung chnh
A. HIV-AIDS v thuc iu tr
B. Herpes virus v thuc iu tr
C.Cm v thuc iu tr
D. Vaccin
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thuc chng virus v vaccin
A- HIV-AIDS V thuc iu tr
1. i cng v HIV/AIDS
* Bnh AID'S:
- Hi chng suy gim min dch mc phi.
- Thi gian bnh t 10-12 nm c khi hn (15 nm).
- Biu hin r nht : l lot ton thn, d nhim nhiu loi vi khun, nm v virus khc gy nn tnh trng bnh phc tp
*Nguyn nhn: Do virus HIV (human immunodeficiency virus).
C 2 tp: HIV1 v HIV2
* Ly truyn: + Mu v truyn mu
+ Tim chch ma ty
+ Sinh hot tnh dc
+ M-con.
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thuc chng virus v vaccin
1. i cng v HIV/AIDS (tip theo)
* S nhn ln ca HIV trong t bo min dch : (tham kho)
1. Virus gn kt vi t bo
2. Cc thnh phn virus (ARN v enzym cc loi) ha vo bo tng t bo ch
3. ARN VR c sao ngc thnh ADN, nh enzym sao m ngc ca VR
4. H gen virus (dng ADN) vo nhn t bo, thm nhp h gen t bo ch nh enzym ha ng ca virus
5. Sao chp ADN virus nh enzym polyme ha ARN II ca TB ch.
A- HIV-AIDS V thuc iu tr
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thuc chng virus v vaccin
1. i cng v HIV/AIDS
* S nhn ln ca HIV trong t bo min dch(tip theo)
6. Cc ARN virus thot nhn vo bo tng v cc ARN thng tin (ARNm) tng hp cc protein virus :
- Cc ARNm kch thc nh sinh cc protein iu hnh ca HIV
- Cc ARNm kch thc trung bnh v ln sinh cc protein cu trc ca virus.
7. Lp ghp cc protein virus vi 2 phn t ARN mi sinh hnh thnh mt virus mi
8. VR mi mc gai, xuyn thng mng TB thot ra mi trng ngoi
A- HIV-AIDS V thuc iu tr
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* Qu trnh nhn ln ca HIV
Bm dnh
Gii phng
Xm nhp
Tch v
Nhn ln
Protease
Nucleoside reverse transcriptase
1. i cng v HIV/AIDS (tip theo)
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* Hai enzym quan trng vi qu trnh nhn ln ca HIV
Nucleoside reverse transcriptase (NRT): enzym sao m ngc, virus ha ADN t bo ch, gip virus nhn ln.
Protease (P): gip tch ch polyprotein thn virus, to ra cc virus mi.
thuc chng virus v vaccin
HIV-AIDS V thuc iu tr
1. i cng v HIV/AIDS (tip theo)
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thuc chng virus v vaccin
* Thuc c ch enzym sao m ngc:
NRTI (Nucleoside reverse transcriptase inhibitors)
- C ch tc dng:
+ Thuc vo ni bo, chuyn sang dng hot ha "triphosphat", gn cht vo RNA ca virus
+ c ch cnh tranh enzym sao m ngc, ngn cn s VR ha DNA TB ch, lm ngng tr s nhn ln ca virus.
- Cc thuc: Zidovudin, lamivudin, stavudin, didanosin, ...
2. Phn loi thuc iu tr HIV/AIDS
A- HIV-AIDS V thuc iu tr
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thuc chng virus v vaccin
* Thuc phong b protease: PI (Protease inhibitors)
- C ch tc dng:
Thuc gn thun nghch vi HIV-protease, cn tr s tch ch polyprotein tin thn VR, to ra cc VR mi khng hon thin, khng kh nng thm nhp vo TB MD ch.
- Cc thuc: Saquinavir, ritonavir, indinavir, nelfinavir, ...
2. Phn loi thuc iu tr HIV/AIDS (tip theo)
A- HIV-AIDS V thuc iu tr
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thuc chng virus v vaccin
3. Phi hp thuc trong iu tr HIV/AIDS
- Khi dng c lp 1 thuc, virus s nhanh t bin khng li, phi phi hp nhiu thuc trong phc iu tr.
- Cch phi hp :
+ Phi hp 2-3 thuc NRTI (1)
+ Phi hp 2 NRTI + 1 PI(2)
+ Phi hp 2 NRTI + 2 PI (3)
- Cch (2) v (3) chm b HIV khng, v vy bnh nhn dng c di ngy hn.
A- HIV-AIDS V thuc iu tr
4. S khng thuc ca virus
- Virus khng li thuc nhanh nh kh nng t bin linh hot nu dng c lp 1 thuc.
- D c khng cho gia cc thuc cng c ch tc dng
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Mt s thuc c th
Zidovudin
Lamivudin
Stavudin
Indinavir
Nevirapin
Saquinavir
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thuc chng virus v vaccin
*. Dc ng hc
- Hthu ng tiu ho, gim khi dng cng ba n nhiu cht bo
- Vo c dch no tu.
- Thi tr phn ln qua nc tiu.
*. Tc dng
Phong b s hnh thnh DNA ca HIV bng c ch enzym sao m ngc.
Cc thuc khng HIV
Zidovudin (Aridothymidin, AZT)(Thuc c ch enzym sao m ngc)
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thuc chng virus v vaccin
*. Ch nh
- iu tr nhim HIV/AIDS (ch yu ko di cuc sng, gim nhim khun c hi, ci thin c triu chng bnh v gim tc pht trin thnh bnh AIDS).
- Cc bin chng lin quan n HIV/AIDS
- Phng ly truyn HIV t m sang con khi mang thai.
*. Tc dng khng mong mun
- c ch tu xng gy: thiu mu, gim bch cu trung tnh.
- Da: ni ban, nhim sc t mng tay, rng lng, tc v hoi t da
- Gan: vim gan mt, thoi ho m.
- Ri lon tiu ho (au bng, bun nn, nn, tiu chy)
- Ri lon TK (au u, mt ng, chng mt, l ln, hng cm, )
Cc thuc khng HIV
Zidovudin (Aridothymidin, AZT)(Thuc c ch enzym sao m ngc) (tip theo)
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thuc chng virus v vaccin
*. Tng tc thuc
- Gim chuyn ho ca AZT: probenecid, paracetamol.
- Gim bi xut ca AZT: dapson, amphotericin B.
- Tng c tnh ca AZT: thuc gy c vi t bo, suy tu, c vi thn (ganciclovir, ribavirin, vincristin, vinblastin,...)
*.Chng ch nh v thn trng
- Bch cu trung tnh hoc hemoglobin thp.
- Ngi mn cm thuc, ngi ang dng thuc chng phn bo.
- Thn trng vi bnh nhn suy ty xng, thiu mu v suy thn.
- Ch : thng xuyn kim tra cng thc mu.
* Cch dng
Ung, gim liu BN suy thn, suy gan v thiu mu nng.
* Ch phm
Vin nn, vin nang 100, 250, v 300 mg. Siro 50 mg/ ml
Cc thuc khng HIV
Zidovudin (Aridothymidin, AZT)(Thuc c ch enzym sao m ngc) (tip theo)
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*. Dc ng hc:
- Hp th nhanh ng tiu ha. Thuc vo c bo thai v sa m. Chuyn ha gan v thi tr qua nc tiu.
*. Tc dng:
- Hot tnh khng virus ni bo, bao gm HIV v vim gan B.
- u im ca lamivudin l t c vi tu xng
*. Ch nh:
- Phi hp vi zidovudin (AZT) iu tr HIV cho ngi ln v tr em trn 12 tui; ung lu di
- iu tr vim gan B mn tnh: Ngi ln, iu tr ko di cn c theo di ca thy thuc.
thuc chng virus v vaccin
2. Lamivudin (Combivir; Lamzidivir)
(Thuc c ch enzym sao m ngc) (tip theo)
Cc thuc khng HIV
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thuc chng virus v vaccin
Cc thuc khng HIV
2. Lamivudin (Combivir; Lamzidivir)
(Thuc c ch enzym sao m ngc)
*. Tc dng khng mong mun: (Ngng thuc s dn ht)
- au d dy, nn, tiu chy, chn n, y bng;
- Cm gic t, nga, bng rt hoc au chn tay;
- St, xut huyt, mt mi, chng mt, s mi.
*. Chng ch nh:
- BN mn cm vi cc thnh phn thuc.
- Lng bch cu thp;
*. Thn trng:
- Ph n mang thai, cho con b. BN suy gan, thn
- Trc khi dng lamivudin iu tr vim gan B mn tnh, phi kim. tra xem bnh nhn c mc HIV khng (iu tr vim gan B liu thp s to c hi cho HIV khng thuc).
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thuc chng virus v vaccin
*. Tc dng:
- Ging Zidovudin, c tc dng c khi virus khng li AZT.
*. Ch nh:
- iu tr HIV ngi ln sau khi dng zidovudin di hn;
- Kt hp vi cc thuc chng HIV khc (tr AZT).
*. Cch dng v liu lng:
- C th dng cho tr em trn 3 thng tui
- Gim mt na liu vi ngi thiu nng thn.
*. Dng bo ch: Vin 100 v 150mg.
Cc thuc khng HIV
3. Stavudin (Zerit; Stavudine Stada)
(Thuc c ch enzym sao m ngc)
Tham kho
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thuc chng virus v vaccin
*. Tc dng khng mong mun:
- au thn kinh ngoi bin; tng nng enzym gan (hi gan)
- Cc triu chng khc: thiu mu, st, ban , cm gic mt mi, bun nn, au u; c vi ty xng gy lon cng thc mu; c th gy pht trin t t bo non (ung th), bnh bch huyt.
*. Thn trng:
- Ngi c tin s bnh thn kinh ngoi vi; bnh gan, ty, thiu nng thn.
- Ngi d ng vi thuc; ph n c thai v cho con b.
*. Dng bo ch: Vin nang 30mg
*. Bo qun: Trnh nh sng.
Cc thuc khng HIV
3. Stavudin (Zerit; Stavudine Stada)
(Thuc c ch enzym sao m ngc)
Tham kho
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thuc chng virus v vaccin
*. Dc ng hc
- Hp thu nhanh qua ng tiu ho, gim khi thc n c nhiu cht bo.
- Lin kt vi protein huyt tng khong 60%. Chuyn ho bng oxy ho bi cytocrom P450 v lin hp vi acid glucuronic.
- Thi tr ch yu qua phn, ch 20 % thi qua nc tiu, T1/2=1.8h.
*. Tc dng
- Gn thun nghch vi protease ca virus, ngn cn s ct cc protein tin cht ca virus.
- Thuc thng c phi hp vi cc thuc khng RT
Cc thuc khng HIV
4. Indinavir (Crixivan )
(thuc c ch protease)
Tham kho
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thuc chng virus v vaccin
*. Tc dng khng mong mun
- Thng gp : bun nn, nn ma, tiu chy
- Ri lon th gic, mt mi, au u chng mt, suy thn, ri lon phn b m, tng ng huyt, cc phn ng d ng nh ban da, nga.
*. Liu dng
- Ung cch xa ba n.
*. Tng tc thuc
- Tng nng thuc trong huyt tng ca: gim au gy ng, chng lon nhp (amiodazon), cc khng histamin, benzodiazepin, rifampicin.
- Mt s thuc lm tng nng indinavir trong huyt tng: cc azol chng nm .
Cc thuc khng HIV
4. Indinavir (Crixivan )
(thuc c ch protease)
Tham kho
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thuc chng virus v vaccin
*. Dc ng hc:
- Hp thu km ng tiu ha; sinh kh dng 4%, vin nang mm dng mesilat cao hn vin nn dng base. T1/2 = 13h. Chuyn ha mnh gan; thi tr ch yu qua phn. Thuc kh vo no.
*. Ch nh, cch dng v liu lng:
- Phi hp vi cc thuc c ch RT iu tr HIV giai on sm.
*. Tc dng khng mong mun: Chung nh ni indinavir.
- Ung ko di gy vim ty, thn; lot nim mc ming.
*. Thn trng: Tng t indinavir.
*. Dng bo ch: Vin nang mm gelatin 300 v 600mg.
*. Bo qun: ng trong bao b kn.
Cc thuc khng HIV
5. Saquinavir mesilat (Fortovase; Invirase)
(thuc c ch protease)
Tham kho
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thuc chng virus v vaccin
Mt s bit dc phi hp thuc
1. Lamzidivir:
*. Thnh phn
Lamivudin150mg
Zidovudin300mg
T dcv.
*. Ch nh: iu tr HIV ngi ln v tr em trn 12 tui.
*. Liu dng: Ung 1 vin/ln 2 ln/24h.
*. Chng ch nh v thn trng:
- Bnh nhn mn cm vi cc thnh phn vin thuc;
- Lng bch cu thp; tr em di 12 tui; ph n mang thai 3 thng u;
- Dng thuc lamzidivir khng nn cho con b.
Cc thuc khng HIV
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thuc chng virus v vaccin
Mt s bit dc phi hp thuc
2. Nevitro:
*. Thnh phn:
Stavudin 40mg
Lamivudin150mg
Nevirapin200mg
*. Ch nh: Phng v iu tr HIV.
*. Liu dng: Ngi ln 60kg, ung 1 vin/ln 2 ln/24h.
*. Chng ch nh:
- BN cy ghp ph tng; suy gan, thn, ty; mu nhim acid lactic
- Tr em; ph n mang thai v cho con b; ngi gi.
Cc thuc khng HIV
Tham kho
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thuc chng virus v vaccin
B - Herpes virus v thuc iu tr
*. Cc bnh do Herpes virus gy ra :
- Herpes simplex virus (HSV 1 v 2) : Gy bnh da, nim mc, ming, thc qun, no, ng sinh dc, trc trng
- Varicella-Zoster virus (VZV): Gy bnh thu u, zona
- Epstein Barr virus (EBV): Gy bnh tng bch cu n nhn.
- Cytomegalovirus (CMV): Gy bnh vim vng mc BN AIDS.
*. Thuc iu tr Herpes virus:
- Acyclovir, ganciclovir, penciclovir, idoxuridin
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thuc chng virus v vaccin
Thuc iu tr Herpes Virus
*. Dc ng hc
- C th dng ng ung, tim hoc dng ti ch.
- Hp thu theo ng ung 15- 30%, thc n khng nh hng.
- Phn b rng ri (dch c th, no, thn, phi, gan...)
- Lin kt vi protein huyt tng ~ 20 %. Thi tr qua thn, T1/2=3h.
*. Ph tc dng
- c hiu trn virus Herpes : Herpes simplex 1, Herpes simplex 2 Varicella zoster (VZV) v 1 s virus Epstein barr (EBV).
- Tc dng tt trong iu tr vim no th nng do virus Herpes, cc bnh herpes sinh dc, ming, gic mc v tr s sinh.
- c ch chn lc vi cc VR gy bnh hn vi TB ch
Acyclovir(Zovirax, Avirax)
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thuc chng virus v vaccin
*. C ch
- Acyclovir l dn xut guanosin, khi vo c th to thnh acyclovir triphosphat l dng c hot tnh (nh men ni bo thymidinkinase v mt s men khc) .
- Acyclovir triphosphat c ch tng hp ADN v s nhn ln ca virus bng cch c ch chn lc ADN polymerase ca virus, phong b pht trin ko di phn t AND, km hm VR pht trin.
- Tc dng trn c 4 loi Herpes virus, c bit HSV1.
- liu iu tr thuc khng nh hng ti t bo bnh thng (men thymidinkinase ca t bo vt ch t nhy cm vi thuc).
Thuc iu tr Herpes Virus
Acyclovir(Zovirax, Avirax)
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thuc chng virus v vaccin
*. Ch nh
- D phng v iu tr cc bnh do nhim VR Herpes (simplex 1 v simplex 2) da, nim mc, thn kinh v sinh dc.
- Tr nhim virus zoster gy bnh zona cp nh: zona mt, phi, TK.
- D phng v iu tr nhim virus ngi suy gim min dch, cy ghp c quan, bnh thu u. Phng nhim Herpes tr s sinh
*. Cch dng
- Ung
- Truyn
- Bi
Thuc iu tr Herpes Virus
Acyclovir(Zovirax, Avirax)
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thuc chng virus v vaccin
*. Tc dng khng mong mun (Ph thuc liu dng v ng dng)
- ng ung: bun nn, nn, a chy, au bng, au u, ban da.
- ng tim: au v vim TM ni tim, RL chc nng thn, ph.
- SP chuyn ho gy c vi gan, TK, tu xng
- Dng ngoi: gy kch ng, nng rt, au ni bi thuc.
*. Thn trng:
PN c thai, cho con b; thiu nng thn, gan, tu xng.
*. Tng tc thuc
- Kt hp vi zidovudin gy tng trng thi ng l m
- Probenecid lm tng thi acyclovir, gim tc dng.
- Ketoconazol, amphotericin B tng tc dng ca acyclovir.
Thuc iu tr Herpes Virus
Acyclovir(Zovirax, Avirax)
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thuc chng virus v vaccin
*. Liu dng
- Tr Herpes simplex:
+ Ngi ln: 200- 400/ln 5 ln/ ngy x 5 ngy
+ Tr em tu theo tui dng t 1/2 n 1 liu ngi ln
- Tr thu u v zona
+ Ngi ln: 800 mg/ln 5 ln / ngy, t iu tr 7 ngy
+ Tr em : 20 mg/kg (ti a 800 mg) 4 ln / ngy
*. Ch phm
Vin nn, nang 200, 400 v 800 mg.
Bt pha tim 250, 500 v 1000 mg
Hn dch ung 5 g/125 ml, 4 g/ 50 ml
Dng dng ngoi: kem , thuc m 3% v 5 %
Thuc iu tr Herpes Virus
Acyclovir(Zovirax, Avirax)
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thuc chng virus v vaccin
- Gaciclovir vo c th cng c phosphoryl ha thnh triphosphat, ri gy c ch ADN polymerase ca virus.
- Ph tc dng tng t acyclovir nhng ch yu dng iu tr vim vng mc do Cytomegalic.
- Tc dng khng mong mun nng hn acyclovir: gim bch cu trung tnh, gy c vi t bo, bo thai, c th gy qui thai.
Thuc iu tr Herpes Virus
2. Ganciclovir
Tham kho
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- Ch yu iu tr zona cp v herpes sinh dc.
- Tc dng khng mong mun: au u, bun nn, c vi tuyn tin lit v l 1 tc nhn gy ung th.
Thuc iu tr Herpes Virus
3. Famociclovir
thuc chng virus v vaccin
Tham kho
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i cng:
Nguyn nhn:
- Do virus nhm Orthomyxovirus gy ra, gm 3 tp: A, B, C.
- Tp A, C gy bnh c ngi, V. Tp B ch gy cm ngi.
- Tp A c phn thnh nhiu loi khc nhau:
+ H1N1: gy cm Ty Ban Nha
+ H2N2 gy cm Chu
+ H3N2 gy cm Hng Kng
+ H5N1 gy nguy c dch cm ton cu 2006-2007.
+ H7N7, H1N2, H9N2, H7N2, H7N3, H10N7.
Thuc iu tr: c ch VR cng on ci b mng acid nhn tin thn virus
- Oseltamivir (Tamiflu)
- Rimantadin.HCl
- Ribavirin
thuc chng virus v vaccin
C- Cm thuc phng v iu tr
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thuc chng virus v vaccin
*. Dc ng hc
- C th dng qua ng ung, tim tnh mch v kh dung.
- Phn b tt vo cc m tr no, chuyn ho gan v thi tr ch yu qua nc tiu.
*. Ph tc dng
- Rng gm: VR hp bo ng h hp, Influenza, Herpes simplex.
- Tc dng tt vi st Lissa v vim gan A cp.
*. C ch tc dng (ch yu nghin cu trn Influenza)
- Thuc c ch to thnh guanosin triphosphat , dn n gin tip c ch tng hp ARNm ca virus v c ch ARN polymerase
- Cc virus khng cn tng hp ARN m trong t bo vt ch nh Rhinovirus, Enterovirus thng khng ribavirin.
Ribavirin (Rivazole)
Thuc phng v iu tr cm
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thuc chng virus v vaccin
*. Ch nh (dng cho tr em v ngi tr tui)
- Ch yu iu tr nhim virus hp bo h hp, cm do virus Influenza tup A, B;
- Tr st Lissa, st xut huyt do virus
- C th dng trong giai on mi nhim HIV, vim gan A,B cp...
*. Tc dng khng mong mun
- Thiu mu, tng bilirubin, tng acid uric.
- Dng ko di theo ng ung: ri lon tiu ho, thn kinh.
- ng kh dung c th gy kch ng ti ch.
*. Chng ch nh: khng dng cho ph n c thai.
*. Dng dng:
- Vin nn, nang; siro; kh dung; thuc tim
Thuc phng v iu tr cm
Ribavirin (Rivazole)
-
Oseltamivir phosphat (Tamiflu )
TC: Bt kt trng, d tan/nc.
TD: Km hm virus cm tp A, B, C pht trin do c ch enzym neuraminidase.
DH: Hp thu ng tiu ha, chuyn ha gan, SKD 70%, t1/2 = 3h, thi tr qua nc tiu.
C: Phng v iu tr cm, c bit cm tp A.
LD: iu tr: 75 mg x 2 ln/ngy x 5 ngy
Phng: 75mg/ngy x 3 ngy (phng 6 tun)
TDP: C th gy nh hng thn kinh gy trm cm, hoang tng
thuc chng virus v vaccin
Thuc phng v iu tr cm
Tham kho
-
Rimantadin HCi (Flumadin, Roflual)
TC: Bt kt trng.
TD: Km hm virus pht trin do c ch s ci v ca virus.
DH: Hp thu 15-30% qua ng tiu ha, tp trung cht nhy mi cao hn huyt tng, thi tr qua thn. t1/2= 24-33h.
C: iu tr cm tp A.
thuc chng virus v vaccin
Thuc phng v iu tr cm
Tham kho
-
1. i cng
*. Khi nim
- Ch phm cha khng nguyn (TB vi khun bt hot, cc mnh c bit ca vi sinh vt gy bnh hoc c t vi sinh).
- Vo c th, ngi nhn sinh khng th, to min dch ch ng vi bnh nhim do VK, VR hay c t ca chng.
thuc chng virus v vaccin
D- vaccin
-
thuc chng virus v vaccin
D- vaccin
*. Phn loi vaccin
- Vaccin VK: Cha khng nguyn VK; to min dch vi cc VK. VD: BCG min dch lao phi; ATC-HIB min dch H. influenzae,...
- Vaccin virus: Cha khng nguyn virus; to min dch bnh do vius. VD: vaccin phng vim gan B, vaccin phng cm v.v...
- Vaccin hn hp: Cha hai hoc nhiu khng nguyn ca cc VSV gy bnh khc nhau; ch 1t mi tim, gy MD vi nhiu bnh nhim.
- Huyt thanh gii c t: Cha cc khng nguyn c t vi sinh mt c tnh; to min dch, trit tiu tc dng ca c t khi nhim bnh. VD: huyt thanh chng un vn, huyt thanh chng rn cn v.v
1. i cng (tip theo)
-
thuc chng virus v vaccin
*. Tc dng khng mong mun :
- Tim: Ni mn, vim hoc p xe ch tim;
- Phn ng phn v: st, au u, kh chu; xut hin sau 1-2h;
- D ng ton thn vi ch phm sinh hc;
- Mi loi c th c cc tc dng khng mong mun khc.
*. Nguyn tc bo qun :
- Theo di hn dng nhp mi v xut c ng thi hn;
- Cch ly: cht khng khun, khng virus; nh sng, nhit cao;
- Khng dng ethanol st khun dng c tim chng.
- Theo ng ch bo qun c hng dn i km hp vaccin;
D- vaccin
1. i cng (tip theo)
-
thuc chng virus v vaccin
2- Mt s ch phm vaccin thng dng
D- vaccin
Tn vaccinTc dng v ch nhCch s dngTrimovax (Php)- Si, quai b, Rubella: (vim no, ic, v sinh)- NL, TE > 12t: mi 1; mi 2 sau 4 nm (tim bp, di da).ACT-HIB (Php)- Min dch H. influenzae(Vim phi, no, tai, hng)- TE< 6thng: 3 mi/3-6 thng- TE < 12 thng: 2 mi/4 thng (Tim bp, di da).Sau 1 nm tim thm 1 mi. Vim no Nht Bn B (VN)- Min dch vim no do virus Nht Bn B. (Lit, ri lon tm thn, TK)- Tim di da: TE, NLt 1: 1 mi/tun/2 tun;t 2: sau 1 nm tim 1 mi;Ti chng: sau 3 nm , 1 mi. -
thuc chng virus v vaccin
2- Mt s ch phm vaccin thng dng (tip theo)
D- vaccin
Tn vaccinTc dng v ch nhCch s dngVim gan B (VN, B)Min dch virus vim gan B(Vim, x, ung th gan)- IM, IS : TE, NLMi 1/thng; mi 2/ thng; Mi 3 vo thng th 6.Sau 5 nm tim mi 4.VaccinBCG Min dch bnh lao phi- Tim di da c vai:1-12 tui: Tim 1 liu;> 13 tui: Tim 2 liu, cch nhau 6-10 tun/liu. -
thuc chng virus v vaccin
2- Mt s ch phm vaccin thng dng (tip theo)
D- vaccin
Tn vaccinTc dng v ch nhCch s dngVaxigrip (Php)Min dch cm- Tim bp, di da: TE < 8 t, 2 mi 1/thng; 2 thng.NL, 1 mi/nm (ma ng)Vaccin ATHThanh SAT (Php)Min dch un vn:- Phng chung- Mang thai, b thng- Tim bp, di da:t u: 2-3 mi/6 thng;t 2: 1 mi sau t 1 nm;t 3: Sau 10 nm tim 1 mi;Vt thng nga un vn: tim km HT SAT hai v tr. -
thuc chng virus v vaccin
*. Dng thuc: c hai loi
1. Hn dch khng nguyn b mt virus vim gan B (HBsAg), ch to bng ti t hp DNA t nm men.
2. Hn dch khng nguyn b mt, phn lp t huyt tng ca vt mang l virus vim gan B hoc virus khc bt hot.
*. Tc dng: To min dch, phng ly nhim virus vim gan B
*. Ch nh:
- Tim phng vim gan B cho ngi kho mnh, mi la tui.
- Tim phng bt buc cho cc i tng c nguy c cao nh: tim chch, ng tnh luyn i, truyn mu nhiu ln, chy thn nhn to, nhn vin y t tip xc thng xuyn vi mu v.v
1- Vaccin phng vim gan B
Cc vaccin
-
thuc chng virus v vaccin
*. Cch dng v liu lng:
- Lc vaccin to hn dch ng nht trc khi tim.
- Tim bp: c delta cnh tay (ngi ln), mt trc i (tr em), tuyt i khng tim tnh mch. Tim mng hiu qa thp.
*. Vaccin phng vim gan B ca Vit nam, B v Israel:
- Tim 3 mi: u, th hai sau 1 thng v th 3 sau mi u 6 thng. Tim nhc li sau 5 nm (tng cng 4 mi/5 nm);
- Tr s sinh nn tim mi u ngay sau sinh.
- Liu tim: 10 hoc 20g/mi (ngi ln); 5 hoc 10g/mi (tr em). Ngi suy gim min dch, tim 40g/mi.
*. Tc dng khng mong mun: Nh ni chung vi vaccin.
*. Bo qun: nhit 2-8o C; trnh ng lnh; trnh nh sng.
1- Vaccin phng vim gan B (tip theo)
Cc vaccin
-
thuc chng virus v vaccin
*. Bnh di:
- Do ch, mo nui hoc ng vt hoang d b nhim virus gy vim no, truyn sang ngi lnh sau vt cn, co hoc tip xc vi nc di.
*. Vaccin phng di: C hai dng: ng kh v hn dch.
*. Tc dng:
- To min dch ch ng, phng v chng nhim virus di.
- Thi gian xut hin tc dng: Hnh thnh khng th ch ng sau tim 7 n 10 ngy; duy tr c 2 nm hoc lu hn.
*. Ch nh
- Phng cho nhng ngi c nguy c: nhn vin th y, kim lm, hun luyn th, ngi nui ch, tr em hay chi vi ch, mo
- Tim iu tr sau khi b ch, mo cn.
*. Cch dng v liu lng: Ty theo tnh hung
2- Vaccin phng bnh di
Cc vaccin
-
thuc chng virus v vaccin
Cc tnh hung tim phng v iu tr di
2- Vaccin phng bnh di (tip theo)
Cc vaccin
Mc nhimLoi tip xciu tr nn p dng IS con vt hay cho n, con vt lim trn da lnhKhng iu tr nu cbnh s r rng IIGy vt co, cn khng chy muTim ngay vaccin IIIVt cn, co xuyn thng da;Nim mc nhim nc di ch, moTim ngay vaccin vhuyt thanh khng di -
*. Phng bnh ch ng:
Tim bp hoc trong da 0,5ml vo cc ngy 0; 7 v 21 hoc 28 (3 liu).
*. iu tr sau phi nhim:
- Ra sch vt cn bng nhiu nc, x phng, sau bi cn 70%.
- Tim d phng ln u: tim 5 mi vo cc ngy 0; 3; 7; 14 v 28. Ngi nhim III phi tim liu 20UI/kg huyt thanh khng di (loi ngun gc ngi) vo ngy 0.
- c tim d phng: tim 2 mi vo ngy 0 v 3 vi ngi tim cch 5 nm tr li. Tim 5 mi vi ngi tim phng qa 5 nm.
*. Vaccin phng di sn xut ti Vit nam : dng ng kh, dng tim trong da dung dch ho tan liu tim vi 0.7ml dung mi km theo.
thuc chng virus v vaccin
2- Vaccin phng bnh di (tip theo)
Cc vaccin
-
thuc chng virus v vaccin
*. C 2 loi vaccin phng bi lit:
- Vaccin bi lit ung: vaccin Sabin. Cha hhp VR sng gim c lc
- Vaccin bi lit tim: vaccin salk, IPV. Cha VR bi lit bt hot bng nhit v formaldehyd; dng hn dch m c.
- L cht lng mu hng hoc cam; d b hng do nhit v AS.
*. Tc dng:
- To min dch vi virus gy bi lit cho tr em v ngi ln; hiu qu t 100%.
- Hiu lc sau chng 7 ngy. Sau t tim chng ng ch dn c th min dch sut i.
3- Vaccin phng bi lit
Cc vaccin
-
thuc chng virus v vaccin
*. Ch nh:
- Tim phng cho tr 6 n 12 tun tui, tr em v thiu nin n 18 tui cha c tim chng, du khch n vng c virus bi lit thnh dch hay bi lit ang lu hnh.
*. Cch dng v liu lng: Tim di da 0,1ml/ln.
- Tim 3 mi: hai ln tim u cch nhau 1 - 2 thng; mi tim th ba nn tin hnh sm nht l sau mi th hai 6 thng v khng c chm qu 2 nm .
- Cng c bng mi tim th t, 4 nm sau ln tim th ba; cn thit thm mt liu b sung sau .
*. Bo qun: Lun nhit 4-10o C; trnh nh sng.
3- Vaccin phng bi lit (tip theo)
Cc vaccin
-
thuc chng virus v vaccin
4- Vaccin bch hu- un vn - ho g
*. Tnh cht:
- Hn hp gm gii c t bch hu, un vn v thnh phn khng nguyn tinh ch ca virus gy ho g hoc ch l cc mnh virus bt hot. Cht mang v c l hydroxyd nhm.
- n v : Liu 1 mi tim 0,5ml cha: 30 UI gii c t bch hu, 40 UI gii c t un vn v 4 UI khng nguyn virus ho g.
- Hn dch khi tch lp: dch c mu vng, cn mu trng xm. Khi dng lc k, l thuc phi to thnh huyn dch ng nht.
*. Tc dng:
- Sau t tim chng s to min dch ng thi cho 3 bnh: Bch hu, un vn, ho g. Thi gian min dch sau khi tim t nht l 10 nm
Cc vaccin
-
thuc chng virus v vaccin
*. Ch nh, cch dng v liu lng:
- Tim phng cho tr em t 2 n 10 tui: Tim bp 0,5ml/mi tim 3 mi/1-2 thng; 6 thng sau mi 3, tim mi 4; mi th 5 tim vo lc 6 tui.
- Khng c hiu qa khi tim cho tr ln v ngi trng thnh.
*. Ch : Khng tim cho tr cn ang st, d ng hoc shock.
*. Dng bo ch: L vaccin hoc ng tim nh liu 0,5ml hn dch.
*. Tc dng khng mong mun: Nh ni chung ca cc vaccin.
*. Bo qun:
- 2-8o C; trnh ng lnh v nh sng.
- Khi m phi dng ht l; b ng bng phi hy b.
4- Vaccin bch hu- un vn - ho g (tip theo)
Cc vaccin
-
Tr li ngn cc cu t 1 n 4:
1. Cu trc virus n gin, t bn thn khng...(A)...c;
2. Tc dng ca thuc NRTI l...(A)...sao m ngc.
3. Nguyn tc m bo cht lng vaccin:
(A). nhit thp (B).... (C)....
4. Chng ch nh v thn trng khi dng vin Lamzidivir:
(A).... (B). Lng bch cu thp (C). Mang thai
Phn bit ng/sai (/S) cc cu t 5 n 8:
5. Ph n mang thai nn hn ch dng acyclovir.
6. Tim vaccin c th b d ng nng.
7. Phi trnh ng lnh khi bo qun vaccin.
8. Tt c cc bnh do virus u phng c bng vaccin.
Chn 1 tr li ng nht cho cc cu t 9 n 10:
9. Cc gii php phng chng virus hiu qa:
A. V sinh, sach sB. Ung thuc phng
C. Tim vaccin ch ngD. Ch cn A v B
10. Ch nh ca acyclovir:
A. iu tr HIV/AIDS B. iu tr cm C. iu tr Herpes da, nim mc D. C A, B v C