苯妥英钠片使用说明书

苯妥英钠片使用 说明书 房屋状态说明书下载罗氏说明书下载焊机说明书下载罗氏说明书下载GGD说明书下载 【药品名称】 通用名:苯妥英钠片 汉语拼音:Bentuoyingna Pian 英文名:Phenytoin Sodium Tablets 曾用名:Dilantin 大仑丁 商品名: 本品的主要成分为苯妥英钠，其化学名为:5,5-二苯基-2,4-咪唑烷二酮钠盐，化学结构式为: ONa H N N O 分子式:CHNNaO 151122 分子量:274.25 【性状】 本品为白色片或薄膜衣片。 【药理毒理】 本品为抗癫癎药、抗心律失常药。治疗剂量不引起镇静催眠作用，1.动物实验证明，本品对超强电休克、惊厥的强直相有选择性对抗作用，而对阵挛相无效或反而加剧，故其对癫癎大发作有良效，而对失神性发作无效。其抗癫癎作用机制尚未阐明，一般认为，增加细胞钠离子外流，减少钠离子内流，而使神经细胞膜稳定，提高兴奋阈，减少病灶高频放电的扩散。2.另外本品缩短动作电位间期及有效不应期，还可抑制钙离子内流，降低心肌自律性，抑制交感中枢，对心房、心室的异位节律点有抑制作用，提高房颤与室颤阈值。3.其稳定细胞膜作用及降低突触传递作用，而具抗神经痛及骨骼肌松弛作用。4.本品is large and ample power and local society, construction after consultation with the local power supply Department near the site established a provisional transformer 315KVA and for on-site construction, electricity and electricity. While spare 1-200Kw generators in case of power failure. 5, communication in the project Department in construction fixed telephone (mobile support), fax machines and other communications tools to guarantee full-time dispatchers on duty 24 hours to remain with the owner, the engineer, railway departments as well as the design of close contacts, ensure smooth construction of the project. 3.2.2. the construction coordination 1, coordination with the owner (1) meet the owners project pre-construction preparations such as land acquisition and relocation, create conditions as soon as possible, and construction team approaching construction in a timely manner. (2) attend owners ' associations project coordination and complete the work. 2, and design coordination unit (1) strictly in accordance with the drawings and design units provides optimization recommendations, without consent of the design, not arbitrarily changed the design. (2) the problems in construction drawings, design units and owners and supervisory reporting in a timely manner, and to advise on the design, handling design changes after construction. (3) actively assisted by project manager and design unit in engineering there are temporary problems, works well. 3, in coordination 可抑制皮肤成纤维细胞合成(或)分泌胶原酶。还可加速维生素D代谢，可引起淋巴结肿大，有抗叶酸作用，对造血系统有抑制作用，可引起过敏反应，有酶诱导作用，静脉用药可扩张周围血管。 【药代动力学】 口服吸收较慢，85~90%由小肠吸收，吸收率个体差异大，受食物影响。新生儿吸收甚差。口服生物利用度约为79%，分布于细胞内外液，细胞内可能多于细胞外，表观分布容积为0.6L/kg。血浆蛋白结合率为88~92%，主要与白蛋白结合,在脑组织内蛋白结合可能还高。口服后4~12小时血药浓度达峰值。主要在肝脏代谢，代谢物无药理活性，其中主要为羟基苯妥英(约占50~70%)，此代谢存在遗传多态性和人种差异。存在肠肝循环，主要经肾排泄，碱性尿排泄较快。T为7~42小时,长期服用苯妥英钠的患者，T1/21/2可为15~95小时，甚至更长。 应用一定剂量药物后肝代谢(羟化)能力达饱和，此时即使增加很小剂量，血药浓度非线性急剧增加，有中毒危险，要监测血药浓度。有效血药浓度为10~20mg/L，每日口服300 mg，7~10日可达稳态浓度。血药浓度超过20mg/L时易产生毒性反应，出现眼球震颤;超过30mg/L时，出现共济失调;超过40mg/L时往往出现严重毒性作用。能通过胎盘，能分泌入乳汁。 【适应症】 适用于治疗全身强直-阵孪性发作、复杂部分性发作(精神运动性发作、颞叶癫癎)、单纯部分性发作(局限性发作)和癫癎持续状态。也可用于治疗三叉神经痛，隐性营养不良性大疱性表皮松解(recessive dystrophic epidermolysis bullosa)，发作性舞蹈手足徐动症，发作性控制障碍(包括发怒、焦虑和失眠的兴奋过度等的行为障碍疾患)，肌强直症及三环类抗抑郁药过量时心脏传导障碍等。本品也适用于洋地黄中毒所致的室性及室上性心律失常，对其他各种原因引起的心律失常疗效较差。 【用法用量】 抗癫癎 成人常用量:每日250~300mg，开始时100 mg，每日二次，1~3周内增加至250~300 mg，分三次口服，极量一次300mg，一日500mg。由于个体差异及饱合药动学特点，用药需个体化。应用达到控制发作和血药浓度达稳态后，可改用长效(控释)制剂，一次顿服。如发作频繁，可按体重12~15 mg/kg，分2~3次服用，每6小时一次，第二天开始给予100mg(或按体重1.5~2mg/kg )，每日3次直到调整至恰当剂量为止。小is large and ample power and local society, construction after consultation with the local power supply Department near the site established a provisional transformer 315KVA and for on-site construction, electricity and electricity. While spare 1-200Kw generators in case of power failure. 5, communication in the project Department in construction fixed telephone (mobile support), fax machines and other communications tools to guarantee full-time dispatchers on duty 24 hours to remain with the owner, the engineer, railway departments as well as the design of close contacts, ensure smooth construction of the project. 3.2.2. the construction coordination 1, coordination with the owner (1) meet the owners project pre-construction preparations such as land acquisition and relocation, create conditions as soon as possible, and construction team approaching construction in a timely manner. (2) attend owners ' associations project coordination and complete the work. 2, and design coordination unit (1) strictly in accordance with the drawings and design units provides optimization recommendations, without consent of the design, not arbitrarily changed the design. (2) the problems in construction drawings, design units and owners and supervisory reporting in a timely manner, and to advise on the design, handling design changes after construction. (3) actively assisted by project manager and design unit in engineering there are temporary problems, works well. 3, in coordination 儿常用量:开始每日5mg/kg，分2~3次服用，按需调整，以每日不超过250 mg为度。维持 2，量为4~8 mg/kg或按体表面积250 mg/m分2~3次服用，如有条件可进行血药浓度监测。 抗心律失常 成人常用:100,300 mg，一次服或分2~3次服用，或第一日10,15mg/kg，第2,4日7.5,10mg/kg，维持量2,6mg/kg。 小儿常用量:开始按体重5 mg/kg，分2~3 2，次口服，根据病情调整每日量不超过300mg，维持量4,8 mg/ kg，或按体表面积250mg/m分2~3次口服。 胶原酶合成抑制剂 成人常用量 开始每日2~3 mg/kg分2次服用，在2~3周内，增加到患者能够耐受的用量，血药浓度至少达8µg/ml。一般每日100~300 mg。 【不良反应】 本品副作用小，常见齿龈增生，儿童发生率高，应加强口腔卫生和按摩齿龈。长期服用后或血药浓度达30μg/ml可能引起恶心，呕吐甚至胃炎，饭后服用可减轻。神经系统不良反应与剂量相关，常见眩晕、头痛，严重时可引起眼球震颤、共济失调、语言不清和意识模糊，调整剂量或停药可消失; 较少见的神经系统不良反应有头晕、失眠、一过性神经质、颤搐、舞蹈症、肌张力不全、震颤、扑翼样震颤等。可影响造血系统，致粒细胞和血小板减少，罕见再障;常见巨幼红细胞性贫血，可用叶酸加维生素B防治。可引起12过敏反应，常见皮疹伴高烧，罕见严重皮肤反应，如剥脱性皮炎，多形糜烂性红斑，系统性红斑狼疮和致死性肝坏死、淋巴系统何杰金病等。一旦出现症状立即停药并采取相应 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 。小儿长期服用可加速维生素D代谢造成软骨病或骨质异常;孕妇服用偶致畸胎;可抑制抗利尿激素和胰岛素分泌使血糖升高，有致癌的报道。 【禁忌症】 禁用:对乙内酰脲类药有过敏史或阿斯综合征、?~?度房室阻滞，窦房结阻滞、窦性心动过缓等心功能损害者。 【注意事项】 1.对乙内酰脲类中一种药过敏者，对本品也过敏。2.有酶诱导作用，可对某些诊断产生干扰，如地塞米松试验，甲状腺功能试验，使血清碱性磷酸酶、谷丙转氨酶、血糖浓度升高;3.用药期间需检查血象，肝功能、血钙、口腔、脑电图、甲状腺功能并经常随访血药浓度，防止毒性反应;其妊娠期每月测定一次、产后每周测定一次血药浓度以确定是否需要调整剂量。4.下列情况应慎用:嗜酒，使本品的血药浓度降低;贫血，增加严重感染的危险性;心血管病(尤其老人);糖尿病，可能升高血糖;肝肾功能损害，改变本药的is large and ample power and local society, construction after consultation with the local power supply Department near the site established a provisional transformer 315KVA and for on-site construction, electricity and electricity. While spare 1-200Kw generators in case of power failure. 5, communication in the project Department in construction fixed telephone (mobile support), fax machines and other communications tools to guarantee full-time dispatchers on duty 24 hours to remain with the owner, the engineer, railway departments as well as the design of close contacts, ensure smooth construction of the project. 3.2.2. the construction coordination 1, coordination with the owner (1) meet the owners project pre-construction preparations such as land acquisition and relocation, create conditions as soon as possible, and construction team approaching construction in a timely manner. (2) attend owners ' associations project coordination and complete the work. 2, and design coordination unit (1) strictly in accordance with the drawings and design units provides optimization recommendations, without consent of the design, not arbitrarily changed the design. (2) the problems in construction drawings, design units and owners and supervisory reporting in a timely manner, and to advise on the design, handling design changes after construction. (3) actively assisted by project manager and design unit in engineering there are temporary problems, works well. 3, in coordination 代谢和排泄;甲状腺功能异常者。 【孕妇及哺乳期妇女用药】 本品能通过胎盘，可能致畸，但有认为癫癎发作控制不佳致畸的危险性大于用药的危险性，应权衡利弊。凡用本品能控制发作的患者，孕期应继续服用，并保持有效血浓，分娩后再重新调整。产前一个月应补充维生素K，产后立即给新生儿注射维生素K减少出血危险。本品可分泌入乳汁，一般主张服用苯妥英的母亲避免母乳喂养。 【儿童用药】 小儿由于分布容积与消除半衰期随年龄而变化，因此应经常作血药浓度测定。 新生儿或婴儿期对本品的药动学较特殊，临床对中毒症状评定有困难，一般不首先采用。学龄前儿童肝脏代谢强，需多次监测血药浓度以决定用药次数和用量。 【老年患者用药】 老年人慢性低蛋白血症的发生率高，治疗上合并用药又较多，药物彼此相互作用复杂，应用本品时须慎重，用量应偏低，并经常监测血药浓度。 【药物相互作用】 1.长期应用对乙酰氨基酚患者应用本品可增加肝脏中毒的危险，并且疗效降低。 2. 为肝酶诱导剂，与皮质激素、洋地黄类(包括地高辛)、口服避孕药、环孢素、雌激素、左旋多巴、奎尼丁、土霉素或三环抗抑郁药合用时，可降低这些药物的效应。 3.长期饮酒可降低本品的浓度和疗效，但服药同时大量饮酒可增加血药浓度;与氯霉素、异烟肼、保泰松、磺胺类合用可能降低本品代谢使血药浓度增加，增加本品的毒性;与抗凝剂合用，开始增加抗凝效应，持续应用则降低。 4.与含镁、铝或碳酸钙等合用时可能降低本品的生物利用度，两者应相隔2~3小时服用。 5.与降糖药或胰岛素合用时，因本品可使血糖升高，需调整后两者用量。6. 原则 组织架构调整原则组织架构设计原则组织架构设置原则财政预算编制原则问卷调查设计原则 上用多巴胺的患者，不宜用本品。 7. 本品与利多卡因或心得安合用时可能加强心脏的抑制作用。 8.虽然本品消耗体内叶酸，但增加叶酸反可降低本品浓度和作用。 9. 苯巴比妥或扑米酮对本品的影响，变化很大，应经常监测血药浓度;与丙戊酸类合用有蛋白结合竞争作用，应经常监测血药浓度，调整本品用量。 10.与卡马西平合用，后者血浓降低。如合并用大量抗精神病药或三环类抗抑郁药可能癫痫发作，需调整本品用量。 【药物过量】 可出现视力模糊或复视，笨拙或行走不稳和步态蹒跚、精神紊乱，严重的眩晕或嗜睡，幻觉、恶心、语言不清。治疗:无解毒药，仅对症治疗和支持疗法，催吐，is large and ample power and local society, construction after consultation with the local power supply Department near the site established a provisional transformer 315KVA and for on-site construction, electricity and electricity. While spare 1-200Kw generators in case of power failure. 5, communication in the project Department in construction fixed telephone (mobile support), fax machines and other communications tools to guarantee full-time dispatchers on duty 24 hours to remain with the owner, the engineer, railway departments as well as the design of close contacts, ensure smooth construction of the project. 3.2.2. the construction coordination 1, coordination with the owner (1) meet the owners project pre-construction preparations such as land acquisition and relocation, create conditions as soon as possible, and construction team approaching construction in a timely manner. (2) attend owners ' associations project coordination and complete the work. 2, and design coordination unit (1) strictly in accordance with the drawings and design units provides optimization recommendations, without consent of the design, not arbitrarily changed the design. (2) the problems in construction drawings, design units and owners and supervisory reporting in a timely manner, and to advise on the design, handling design changes after construction. (3) actively assisted by project manager and design unit in engineering there are temporary problems, works well. 3, in coordination 洗胃，给氧，升压，辅助呼吸，血液透析。 【 规格 视频线规格配置磁共振要求常用水泵型号参数扭矩规格钢结构技术规格书 】 (1)50mg (2)100mg is large and ample power and local society, construction after consultation with the local power supply Department near the site established a provisional transformer 315KVA and for on-site construction, electricity and electricity. While spare 1-200Kw generators in case of power failure. 5, communication in the project Department in construction fixed telephone (mobile support), fax machines and other communications tools to guarantee full-time dispatchers on duty 24 hours to remain with the owner, the engineer, railway departments as well as the design of close contacts, ensure smooth construction of the project. 3.2.2. the construction coordination 1, coordination with the owner (1) meet the owners project pre-construction preparations such as land acquisition and relocation, create conditions as soon as possible, and construction team approaching construction in a timely manner. (2) attend owners ' associations project coordination and complete the work. 2, and design coordination unit (1) strictly in accordance with the drawings and design units provides optimization recommendations, without consent of the design, not arbitrarily changed the design. (2) the problems in construction drawings, design units and owners and supervisory reporting in a timely manner, and to advise on the design, handling design changes after construction. (3) actively assisted by project manager and design unit in engineering there are temporary problems, works well. 3, in coordination