Bai 29 Virus- Vaccin

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


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

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...


i cng


i cng

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.

* 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


i cng

Phn loi virus:

* 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...


Phn loi virus (tip theo):

i cng

Mt s cc virus DNA gy bnh


i cng
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


i cng
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


i cng

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)

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


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.


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.



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


* Qu trnh nhn ln ca HIV

Bm dnh

Gii phng

Xm nhp

Tch v

Nhn ln

Protease

Nucleoside reverse transcriptase


* 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.


HIV-AIDS V thuc iu tr



* 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



* 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)



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.


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

Mt s thuc c th

Zidovudin

Lamivudin

Stavudin

Indinavir

Nevirapin

Saquinavir


*. 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)


*. 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
(Thuc c ch enzym sao m ngc) (tip theo)


*. 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

*. 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.


2. Lamivudin (Combivir; Lamzidivir)


Cc thuc khng HIV


Cc thuc khng HIV

2. Lamivudin (Combivir; Lamzidivir)


*. 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).


*. 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)


Tham kho


*. 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)


Tham kho


*. 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



- 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 )


Tham kho


*. 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)


Tham kho


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


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


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


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)


*. 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).

Acyclovir
(Zovirax, Avirax)


*. 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

Acyclovir
(Zovirax, Avirax)


*. 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.

Acyclovir
(Zovirax, Avirax)


*. 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 %

Acyclovir
(Zovirax, Avirax)


- 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.


2. Ganciclovir

Tham kho

- 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.


3. Famociclovir


Tham kho

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


C- Cm thuc phng v iu tr


*. 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


*. 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...


- 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


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



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.



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.


D- 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)


*. 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)


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.


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.


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.


*. 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


*. 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


*. 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


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.


2- Vaccin phng bnh di (tip theo)

Cc 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


*. 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


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


*. 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

Documents

Bai 29 Virus- Vaccin