内容讲稿课件-chapter30.drugs for digestive disorders

DrugsforDigestiveYECaseAmaledriver,30yrsIntermittentupperabdominalpainfor3yrs,worseathunger,betteraftermeal,hadhypnalgia（夜间痛）Withsourregurgitation（反酸）andbelching（嗳气）Tarry（柏油样便）4days.Gastroscope(胃镜)foundanulceratduodenalbulbarHp(+)Diagnosis:duodenalbulbarulcerwithEffectsofDrugsontheDigestiveDigestivesystemanddrugtherapyhaveareciprocal互惠)relationship.SomemedicationscauseGIsymptoms;conversely,someGIdisordersaltertheabsorptionandmetabolismofdrugs(liverfailure)DrugsaffectingtheGItractdrugsusedinacid-pepticdisorders(DigestantsAntiemeticsLaxatives(泻药Cholagogue(利胆Othersincludecholinergics,anticholinergicscorticosteroidsandanti-§1DrugsforPepticThegastrointestinaltracthaveitsownprotectivemechanismsandthisisgenerallyinabalancewithdestructivefactorsCellprotectivemechanismsinSecretionofmucusandDilutionofgastricacidbyfoodandPreventionofdiffusionofHCLfromthestomachlumenbackintothegastricmucosalPresenceofprostaglandinAlkalinizationofgastricsecretionsbypancreaticjuicesandbileCellDestructiveEffectsinGastricacid,secretedbyparietalParietalcells（壁细胞）containreceptorsforacetylcholineandhistamine,allofwhichstimulategastricacidAcetylcholineisreleasedbyvagusnerveendingsinresponsestimuli,suchasthinkingaboutGastrin(胃泌素)isahormonereleasedbythestomachandduodenuminresponsetofoodingestionAffectsparietalcellswhichinturncausesgastricacidtobereleasedinstomach.HistamineisreleasedfromcellsinthegastricmucosaandintonearbyparietalFactorsaffectinggastricacidCelldestructiveeffectsH.pylori(helicobacterpylori，HP，幽门螺旋杆菌)isagramnegativebacteriumfoundinthegastricmucosaofmostptswithchronicgastritis,affectmucosalfunction.1983年，WarrenandMarshallseparateHelicobacterPylorifromhumangastricmucosalIn75%ofthosewithgastriculcersandin90%ofclientswith（十二指肠）Spreadbyoralfecalroute（粪口途径）orbyiatrogenic（医源性Pepsin（胃蛋白酶）isaproteolyticenzymethathelpsdigestproteinfoodsandalsocandigestthestomachwallDrugs,alcohol,DrugtacticsfordigestiveInhibitdestructiveEnhanceprotectiveneutralizesmorethan90%ofgastricthepHto yinhibitsconversionofpepsinogentopepsin,theactivityofFormadrugmembraneovertheulcercalciumcarbonate(碳酸钙aluminumhydroxide(氢氧化铝magnesiumsodiumbicarbonate(碳酸氢钠,小苏打Drugsinhibitgastricacid1.H2receptorcimetidine（西咪替丁,(法莫替丁),Nizatiding(尼扎替丁)Vagal(迷走）stimulationcausesreleaseofhistaminefromcellsinstomach,actsonreceptorsinparietalcells>>>>increasesHCLproduction.S.E:CimetidineaffectstheProtonPumpinhibitorsAlsocalledH+-K+-ATPaseStronginhibitorsofgastricacidBindirreversiblytothegastricprotonpumppreventthereleaseofgastricacidfromparietalSuppressesacidsecretioninresponsetoallstimuliincludinghistamine,gastric,andantiH.Arethedrugsoffirstchoiceinerosive（腐蚀性食管炎）erosivegastritisandZollinger-MoreeffectivethanH2RA;FastersymptomreliefandfasterhealingSideeffectsarenausea,omeprazole（losec,奥美拉唑）1st 2nd 3rdAnticholinegics&GastrinRMcholinoceptorPirenzepine(哌仑西平GastrinreceptorProglumide(丙谷胺InhibitHClIncreasemucousMucosalprotectiveGastricmucosalCellMucus－HCO3-misoprostol（米索前列醇thederivativeofInhibitHClIncreasemucusandHCO3-IncreasebloodflowandmucosalContraindicatedinwomenofchildbearingageandduringpregnancy.MayinduceabortionSucralfate硫糖铝possiblebindtotheulcerandformaprotectivebarrierbetweenthemucosaandgastricacid,pepsinandbilesalts;andstimulatingprostaglandinsynthesisbismuthpotassiumcitrate(枸橼酸铋钾Bindwithpepsinanddecreaseitsbindtotheulcerandformaprotectivebarrierbetweenthemucosaandgastricacid,pepsinAntihelicobacterContraindication:renalAgentsAgainstH.pylori(抗幽门H.Pyloriaresensitivetomanyantibacterialdrugs,butit’sdifficulttoeradicate(根除)ifnotusethemcombinedRequirescombinationoftwoantimicrobialsandaPPIoranH2RAUseamoxicillin,clarithromycin,metronidazoleortetracyclineforantibioticportionMorethanantimicrobialisindicatedtoBismuthcompoundisaddedforitsantibacterialeffectsaswellasincreasingtheHCO3-andmucouscontentsofthestomachAddinganH2RAorPPIdecreasesS/EandhastenshealingGeneralusedcombination阿莫替林铋制剂（bismuth§2ModulatorsofDigestivesystemfunctionI.Digestants（助消化药DilutedAntiemeticDrugs(止吐药Thevomitingcenter,chemoreceptortriggerzone(CTZ,催吐化学感受区)andGItractcontainbenzodiazepine,cholinergic,dopamine,histamine,opiateandserotoninreceptorsthatarestimulatedbyemetogenic（催吐drugsandtoxinsForexample:chemotherapymaystimulatetheCTZwhichthenthevomitingMotionsickness（舟车晕浪）—changesinbodyreceptorsininnerear>>transmittedtotheCTZandthevomiting1.H1receptorDiphenhydramine(苯海拉明Dimenhydrinare(茶苯海明,乘晕宁2.Mcholinoceptor3.D2receptorThiethylperazine硫乙拉嗪Domperidone(多潘立酮,吗丁啉4.5-HT3receptorDrugspromotegastrointestinal 利）:5-HT4receptoragonist,enhanceAchreleaseBethanechol:MceptorNeostigmine:AchEMetoclopramide甲氧氯普胺GIdopamineRantagonistAntidiarrheals&Diarrheaisasymptomofnumerousconditionsthatincreasebowelmotility;causesecretionorretentionoffluidsintheintestinallumenandcauseinflammationorirritationoftheGItract.Endresult:bowelcontentsarerapidlypropelledandabsorptionoffluidsandelectrolytesislimitedCausesofAbuseof Intestinalinfections—E.Coli0157:H7Traveller’sdiarrhea(E.coli),Campylobacter（弯曲杆菌）SalmonellaShigella（志贺氏菌）,rotatInflammatorybowelDruginduced—pseudomembranous（假膜Opiaterelateddrugs:opiumtincture（阿片酊）tincturecamphorcompound（复方樟脑酊Defenoxinwithatropine—Diphenoxylatewithatropine—Bismuthsubsulicylate（次水杨酸铋Medicinalcharcoal（活性炭Whenstomachandduodenumare（膨胀）withfood,gastrocolic（胃结肠）andduodenocolic（十二指肠结肠）reflexesareinitiatedThecerebralcortexcontrolsthedefecationreflex（排便反射）sothatdefecationcan ceptabletimesandplacesInpeoplewhoinhibitthedefecationreflexorfailtorespondtotheurgetodefecate,constipationdevelopscontactcathartics（刺激性泻药，接触性泻药osmoticlaxatives（渗透性泻药，容积性泻药surface-activeagents（润滑性泻药LaxativesarechemicalsubstancesthatacttofacilitatepassageofbowelCathartics—apurgative（净化的）actionofthebowelsactionisstrongerandgenerallyproduceseliminationofliquidstoolsIndicationsforObtainstoolAccelerateexcretionofparasitesafteranthelminthics（驱肠虫药）startedAccelerateeliminationofpotentiallytoxicPreventstrainingat（延时）stool,Relieveconstipati