Thận trọng khi dùng thuốc ức chế men chuyển

man trong khi diing

thuoc ufc che

men chuyen

Ngay nay, viec dilu tri eao huye't ap khong

chi la ha sd do ma cdn bao gdm vigc ngdn

ngffa cdc nguy cd de'n cdc cd quan dich, Xet

trgn gde dd nay, thude ffe chg' men ehuyen (angiotensin

converting enzyme inhibitor: ACEI) cd mgt sd Uu thg':

Trong ngan ngda nguy cd ddng mach vanh, thud'c

khong gay ha huyg't dp td thg' ddng, ro'i loan chdc

nang sinh due, ngu lim nhd nhdm chen calci. Trong

ngdn ngda nhdi mau cd tim, ACEI khong ldm giam

K'" huye't, tdng dddng huyet nhd nhdm ldi tieu. Mat

Idiac, nhdm ACEI khdng gay ba't ldi eho ngddi ddi

thao dddng, hen suyln nhd nhdm chen beta. Uu the

nay khdng han la tinh vddt trdi, bdi le d cde khia

canh khdc, ACEI cung cd mat kem hdn, nhdng nhd

vao dd ma ACEI ngoai viee dung eho ngddi cao huye't

dp binh thddng (khdng kem theo benh khdc) cdn dimg

cho ngddi cao huye't dp cd kem theo eae benh khae

(suy tim sung huyet, rdi loan chdc ndng that trai,

suy giam chdc ndng than nhe vffa, dai thao dUdng

typ II, benh than eua ngddi ddi thao dddng typ II co

protein nieu cao, sau nhdi mdu cd tim), Ngddi cao tudi

thddng kem cac benh nay ndn dung ACEI co thuan

ldi hdn, Tuy nhien, thud'c gay mpt sd tac dung phu

nen ngddi dimg can than trgng va phai dung thud'c

theo chi dinh bdc sT.

Cac thudc dc che men chuyen co tac dung phu la

gay ho khan

-fr DS.BUIVANUY

- Gdy ho khan: Thud'c kich thich phg' quan gay ho

khan, c6 khi dai ddng, Idiong thudc nao chffa khoi. Ni'u

thud'c gdy ho kh£m nhe, ed thi chia lilu trong ngdy ra

dung nhilu lan se dd hdn, song phan ldn phai thay

bdng thudc khdc. Vi du: khi dang dung ACEI d^ ha

huye't dp chda suy tim phi dai tim, cd the thay b^ng

chen thu the angiotensin II (nhd sartan).

- Gdy phu thdn kinh mgch: Do lam giam sUphdn

huy ngn thud'c ldm tang ndng do cha't gdy viem

bradyldnin, gay phii than kinh mach cimg vdi ho

khan. Phu mach cd the xay ra d mat moi lUdi thanh

mon thanh quan, ban chan ban tay, mat ed, Mdc d§

tuy thud'c, ng'u nhe se tff khoi khi ngdng dung, neu

ndng ngffng dimg ngay va cd bien phap dilu tri h6 trp.

- Ldm hg tdng K* mdu khi dung vai lgi niiu: ACEI

dd cd tinh lam tang K* mdu. Niu phd'i hdp vdi mgt thuSc

ldi tieu lam mat K"" nhff thiazid thi trong mpt thdi gian

nhat dinh, K* mau se d mdc dn dinh. Song ng'u dimg

thude ldi tiiu bai tiet K* lieu cao hay keo dai thi K* se

bi mat nhieu hdn tang, se gay ha K+ mdu. Neu phdi hdp

ACEI vdi thuo'c Ipi nieu tig't kidm K* nhff spironolacton

thi se ldm tang K"" mau. Doi tchi bac si phai phdi hpp

ACEI vdi ca hai loai nay vdi lilu thich hdp de cd thi

bu trff viec tdng giam K* lan nhau lam giam bdt sUm^t

can bdng K". Trong thdc te, cd nhiftig biet ddpc vifa

chda ACEI vira chda thudc lpi nieu (nhu Zestoretic chita

lisinoprit + thiazid), Nhffng hiet ddpc nay chi dimg cho

ngddi benh khi can song phai theo doi. Da phan cdn lai

la cac thudc ddn, khi can bac si se chpn thud'c ldi ni^u,

thdi diem, lieu Idpng phdi hdp thich hdp.

- Gdy tut huyit dp dot nggt: Cd the gay ha huyS't

dp qua mffc ngay luc dimg lieu khdi dau. Sd ha huyS^t

dp nay cd the chi nhe, thoang qua, cung cd the manh,

keo dai vdi mpt so ngddi, dae biet la d ngUdi suy tim

suy than, dimg kem thuoc ldi tiiu, dang dung chddO

an gidi han mud'i, dang tham tach, bi tieu chay, non

mda. Khi ha huye't dp qua mffc cd the dan tdi tai hiiti

thi phai giam lieu hoac hoac ngimg thud'c lpi tieu (neu

cd dimg kem) hodc giam lieu ngdng diing ACEI (nS'u

can). Sau khi huye't dp khdi phuc, tiep tuc diing thudc

lai, vdi sd kiem sodt chat ehe, De tranh hien tflpng

nay, bae si thddng eho lieu khdi dau tha'p, sau d6

tang dan cho dat mffc ha huyet dp nhu mong mudn.

THUOC & SCc KHOE sd 502 (15.6.2014)