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Lưu ý khi dùng thuốc lợi tiểu

Thuốc lợi tiểu là thuốc có tác dụng làm tăng sự đào thải muối và nước ở thận, do đó làm đi tiểu tiện nhiều hơn. Thuốc lợi tiểu thường được chỉ định trong các trường hợp tăng huyết áp, suy tim, bị phù.

Trong điều trị tăng huyết áp thường chọn thuốc có tác dụng thải natri vừa phải và kéo dài (như nhóm thiazid). Còn điều trị phù, sự lựa chon thuốc sẽ tùy thuộc vào mức độ cần thải muối. Muốn có tác dụng nhanh, đặc biệt trong phù phổi, các nhà điều trị thường dùng thuốc có tác động ở quai Henlé uống và cả tiêm tĩnh mạch. Trong suy thận, người ta chỉ có thể dùng thuốc tác động ở quai chứ không dùng các nhóm thuốc khác.

Trong điều trị, người bệnh cần tuyệt đối tuân thủ theo đúng liệu trình dùng thuốc do bác sĩ chỉ định. Có người cho rằng, dùng thuốc lợi tiểu đi tiểu nhiều là “thoát dương”, giảm kỷ, yếu thận và liệt dương nên đã không tuân thủ điều trị, bỏ thuốc nửa chừng. Điều này không nên, chỉ có spironolacton dùng liều cao và lâu ngày có thể gây tình trạng “yếu sinh lý” nhưng ngưng thuốc sẽ hồi phục. Vì vậy, người bệnh nên báo cho thầy thuốc biết tác dụng ngoại ý để thầy thuốc xử trí bằng cách thay thuốc khác chứ không nên tự ý bỏ thuốc.

Giống như mọi trường hợp cần điều trị kéo dài, khi đang dùng thuốc lợi tiểu cần tránh tương tác thuốc bất lợi. Tức là khi đang dùng thuốc lợi tiểu không nên tự ý dùng đồng thời các thuốc khác mà phải hỏi ý kiến của bác sĩ điều trị. Hoặc phải kể cho bác sĩ rõ các thuốc đang dùng khi được chỉ định thuốc lợi tiểu để bác sĩ chỉ định thuốc thích hợp. Ví dụ: thuốc lợi tiểu tác động ở quai Henlé nếu dùng đồng thời với kháng sinh cephalosporin sẽ làm tăng độc tính của cephlosporin và bác sĩ sẽ tránh cho dùng thuốc kiểu phối hợp này.

Trong cơ thể, chất điện giải natri và kali đồng hành khăng khít với nhau. Các thuốc lợi tiểu thông dụng (nhóm thiazid và tác động ở quai Henlé) có tác dụng thải natri đồng thời làm mất kali. Kali đóng vai trò rất quan trọng trong co bóp tim và duy trì thể trạng tốt. Vì vậy, người dùng thuốc lợi tiểu nên ăn nhiều chuối, uống nhiều nước cam để được bổ sung kali. Hoặc dùng thuốc lợi tiểu mà lại có triệu chứng vọp bẻ (chuột rút), yếu cơ, mệt mỏi, khát nhiều, bất an, mạch nhanh phải đến bác sĩ khám ngay. Có khi bác sĩ cho dùng thêm thuốc bù kali mới giải quyết được tình trạng mất kali do dùng thuốc lợi tiểu

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Lưu ý khi dùng thuốc lợi tiểu

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