Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,消化系统药物,Digestive System Agents,消化系统药物Digestive System Agen,Common gastrointestinal symptoms,Dyspepsia,胃炎,Peptic ulcer disease,胃溃疡,Diarrhea,泄泻,Constipation,便秘,Common gastrointestinal sympto,抗消化性溃疡药,消化性溃疡主要十二指肠溃疡、胃溃疡，其发病系,保护与攻击因子失平衡,有关,。,保护因素,攻击因子,抗消化性溃疡药,抗消化性溃疡药,消化性溃疡主要指发生在胃和十二指肠的慢性溃疡，具有自然缓解和反复发作的特点。,临床主要症状：反酸、嗳气、周期性上腹部疼痛。,发病机制：损伤胃肠粘膜的攻击因子增强或防御因子减弱所致。,抗消化性溃疡药,消化系统药物ppt课件,Types of Ulcers,Type,Duodenal Ulcer,十二指肠,Gastric Ulcer,胃,Location,First part of small intestine,Stomach,Pain,Upper abdomen, slightly to R of midline,Often possible to point to site of pain,Dull & more likely to occur when,stomach is empty,Relieved by food & antacids,Same area but less well localized,Often,aggravated by food,may be associated with N & V,Appetite reduction,Persistent & severe symptoms,Precipitated by smoking and NSAIDs,吸烟，止痛药,Types of UlcersTypeDuodenal Ul,胃壁细胞受体,胆碱受体（,M,）,胃泌素受体,组胺受体（,H,2,）,激活受体，开放钙通道，,最后激活,H,+,K,+,-ATP,酶，,分泌,H,+,到胃内,胃酸分泌,前列腺素受体,前列腺素,E,，保护胃粘膜,.,胃壁细胞受体胆碱受体（M）胃泌素受体组胺受体（H2）激活受体,根据胃酸分泌机制：,H,2,-,受体拮抗剂,H2 blockers,质子泵抑制剂,proton pump inhibitors,中和过量胃酸的抗酸药,antacids,根据胃酸分泌机制：,理想抗酸药应该是作用强、迅速、持久、不吸收、不产气、不引起腹泻或便秘，对粘膜及溃疡面有保护收敛作用。,本类药物作用基本相同，主要区别在于吸收程度、作用快慢、持续时间和不良反应。,抗酸药,理想抗酸药应该是作用强、迅速、持久、不吸收、不产气、不引起腹,抗酸药,弱碱,性物质，,中和胃酸,，减轻对胃粘膜的刺激和腐蚀。,氢氧化镁：,抗酸较强，较快，,有,轻度致泻,作用（,Magnesium Hydroxide,）,氢氧化铝：,抗酸较强，缓慢,，可致,便秘,（,Aluminium hydroxide,）,影响,四环素的吸收（形,成络合物）。,碳酸氢钠：,抗酸弱，快而短暂，可吸收，产生,CO,2,。,用于酸中毒；碱化血及尿液；很少用于抗胃酸,Sodium bicarbonate,一般不单用,抗酸药氢氧化铝：抗酸较强，缓慢，可致便秘（Aluminium,抗组胺药物,组胺的作用,在,20,世纪,40,年代，发现,涉及变态反应，损伤和胃分泌的生理调节,抗组胺药物,有效地减弱组胺的许多反应,抗过敏疾病,(,现在把这批抗组胺药叫作,H,1,受体拮抗剂,),但不能拮抗胃部组胺对胃酸分泌的促进作用,抗组胺药物组胺的作用,H,1,受体和,H,2,受体,存在组胺受体的两个亚型,H,2,受体,在胃壁细胞存在,与胃酸分泌有关,H1受体和H2受体存在组胺受体的两个亚型,H,2,-receptor antagonists,Four FDA-approved:,Cimetidine,西咪替丁 （,Tagamet,）,Ranitidine,雷尼替丁 （,Zantac,）,Famotidine,法莫替丁（,Pepcid,）,H2-receptor antagonistsFour FD,Therapeutic effects:,Promote the healing of gastric and duodenal ulcers (,胃和十二指肠溃疡,),Gastroesophageal reflux dz GERD (,反流性食道炎,),Upper GI bleed GIB (,上消化道出血,),May be effective in stress ulcers (,应激性溃疡,) & peptic esophagitis (,消化性食道炎,),H,2,-receptor antagonists,Therapeutic effects:H2-recepto,H+,K+-ATPase (Proton Pump) inhibitor,Omeprazole,奥美拉唑,(Prilosec),Lansoprazole,兰索拉唑,(Prevacid),Pantoprazole,泮托拉唑,并且作用最强、效力长久，选择性高，副作用小,质子泵抑制剂,Proton pump inhibitors,H+,K+-ATPase (Proton Pump) inh,Therapeutic uses,Gastroesophageal reflux dz GERD,(,反流性食道炎,),有效率达,7585,。,Peptic ulcer,（,消化性溃疡）,服用,16,月，溃疡愈合率达,97,，其它类药物无效用,4,周，愈合率达,90,。,Infection with H. pylori plus(Hp),(,幽门螺杆菌感染,),幽门螺旋杆菌,83%88,转阴。,Upper GI bleed GIB,(,上消化道出血,),Therapeutic usesGastroesophage,Agents Used in infection of Helicobacter Pylori,幽门螺杆菌,（,helicobacter pylori,，,HP,）,为革兰阴性厌氧菌，,在胃十二指肠的粘液层与粘膜细胞之间生长，可产生多种酶及细胞毒素，使粘膜损伤。,是慢性胃炎、消化性溃疡和胃腺癌等胃部疾患发生发展中的一个重要致病因子。,Agents Used in infection of He,FDA-Approved Treatment Regimens for H.pylori Infection,Omeprazole,20mg b.i.d +,Clarithromycin,500mg b.i.d +,Amoxicillin,1g b.i.d for 10 days,Lansoprazole,30mg b.i.d +,Clarithromycin,500mg b.i.d +,Amoxicillin,1g b.i.d for 10 days,Bismuth subsalicylate,525mg q.i.d +,Metronidazole,250mg q.i.d +,Tetracycline,500mg q.i.d 14 days + H2 receptor antagonist 4 wks,FDA-Approved Treatment Regimen,电镜下,幽门螺杆菌,电镜下幽门螺杆菌,有何副作用？有何困难？,有何副作用？有何困难？,Lacteol forte,乳酸杆菌干燥物，抑制腐败细菌生长、繁殖及防止蛋白质发酵，减少肠内产气，促进消化和止泻作用,。,临床应用：消化不良、腹胀,Digestives,助消化药,还有什么其他用途？,Lacteol forteDigestives 助消化药还有,消化系统药物ppt课件,Clinical classification of diarrhea,Type,Mechanism,Causes,Osmotic,渗透性,Unabsorbed solute,Lactase deficit, magnesium antacid excess,Secretory,分泌性,Increased secretion of electrolytes,E. Coli infection, ileal resection, thyroid cancer,Exudative,渗出性,Defective absorption, outpouring of mucus and/or blood,Ulcerative colitis, Crohns disease, leukemia,Motility disorder,传导功能失调,Decreased contact time,Irritable bowel syndrome, diabetic neuropathy,见泻止泻,？,Clinical classification of dia,Loperamide,洛哌丁胺,Loperamide,洛哌丁胺,可抑制肠道平滑肌的收缩，减少肠蠕动,各种原因引起的,非感染性,急、慢性腹泻的对症治疗,Slows intestinal motility, allowing absorption of electrolytes and water through the intestine,Helps relieve cramps and decrease stool frequency,For travelers diarrhea, nonspecific acute diarrhea, or chronic diarrhea associated with inflammatory bowel disease,Side effects: dizziness, constipation,Loperamide洛哌丁胺Loperamide洛哌丁胺,Loperamide,洛哌丁胺,对于伴有肠道感染的腹泻，必须同时应用有效的抗生素治疗。,不应用于需要避免抑制肠蠕动的患者，尤其是肠梗阻、胃肠胀气或便秘的患者。,腹泻患者常发生水和电解质丧失，应适当补充水和电解质。,用药过程中出现便秘或,48,小时仍无效者应停药。,Loperamide洛哌丁胺对于伴有肠道感染的腹泻，必须,Lomotil,Atropine sulfate,25mcg +,diphenoxylate,HCl 2.5mg,地芬诺酯,+,阿托品,Dose: 2 tab tds-qds (max: 8 tab/day),LomotilAtropine sulfate 25mc,乙酰胆碱,acetylcholine,乙酰胆碱acetylcholine,Drug treatment for diarrhea,Kaolin,Adsorbents,For mild nonspecific acute diarrhea,Adsorb,吸附,everything in the GI tract,Negligible systemic absorption,Side effects: constipation, bloating, fullness,Others :,Charcoal, Smecta,Drug treatment for diarrheaKao,思密达,Smecta,蒙脱石散剂,该药不进入血液循环系统，并连同所固定的攻击因子随消化道自身蠕动排出体外,不改变正常的肠蠕动,成人及儿童急、慢性腹泻,如需服用其它药物，建议与该药间隔一段时间,思密达Smecta蒙脱石散剂,便秘,Constipation,Causes:,因素,Disease,tumors, hypothyroidism, diabetic neuropathy,Drug,narcotic analgesics, aluminium-containing antacids, amitriptyline,Psychogenic,depression, eating disorders (anorexia), conscious efforts to withhold stool,Lifestyle,low-fibre diet, inadequate intake of fluids, avoiding the urge to empty the bowel,便秘Constipation Causes:因素,Type of laxatives,Bulk-forming laxatives,e.g Fybogel, fibrosine,Emollient laxatives,e.g Docusate sodium,Lubricant laxatives,e.g Mineral oil,Saline laxatives,e.g Fleet enema,Hyper-osmotic laxatives,e.g. Lactulose, Glycerin,Stimulant laxatives,e.g Senna, Bisacodyl,Type of laxativesBulk-forming,Bulk-forming laxatives,纤维,Considered safest among all laxatives,Safe for long term use,Works in 1 3 days,Sufficient fluid consumption is required (usually a glass),喝足够水,Side effects : bloatedness, abdominal discomfort,Bulk-forming laxatives纤维,消化系统药物ppt课件,Lubricant laxatives,油性,Mineral oil coats and softens stool,Recommended for patients who need to avoid straining (hemorrhoid surgery, childbirth).,Normally short term use,短暂用,Can cause pneumonia if it leaks into the lungs,Not recommended for the elderly, stroke victims, and those with swallowing difficulties,They are prone to aspirate, especially while lying down or at bedtime,Lubricant laxatives油性Mineral o,Hyper-osmotic laxatives,Lactulose type is a special sugar-like laxative,Induce bowel movements by drawing water into the bowel from surrounding body tissues,This provides a soft stool mass and increased bowel action,Often used for long-term,Hyper-osmotic laxativesLactulo,乳果糖,lactulose,乳果糖还具有双糖的渗透活性，可使水、电解质保留在肠腔而产生高渗效果，故又是一种渗透性泻药，因为无肠道刺激性，亦可用于治疗慢性功能性便秘。,糖尿病患者慎用，对半乳糖不能耐受者不宜服用？,乳果糖 lactulose乳果糖还具有双糖的渗透活性，可使水,Stimulant laxatives,Induce bowel movements by increasing the contraction of muscles in the intestines,肠蠕动,Normally for short term use,短暂用,Usually takes 8 to 20 hours to work,Side effects include cramps, excess fluid loss,Prone to abuse,滥用,番泻叶,senokot,，,比沙可啶,bisacodyl,Stimulant laxativesInduce bowe,Prokinetic agent,Domperidone,多潘立酮（又名吗丁啉）,(dopamine antagonist),Promotes or increases co-ordination of contractions of the gastrointestinal tract,推动肠胃蠕动,for fullness, nausea, bloatedness, belching, heartburn,（胀气，恶心）,Taken half hr before food,Prokinetic agentDomperidone多潘立,问题,如果你的病人有胃溃疡或胃炎，你会避免给它哪一类的中药、方剂？,你如何用中药治疗幽门螺旋菌所引起的胃炎、胃溃疡？,Creon,得每通和,Enzyplex,的功能与用途。,乳酸杆菌干燥物还有什么其他功能、用途？,Metoclopramide,，,domperidone,还有什么功能、用途？,Loperamide,，,diphenoxylate,与哪一类中药相似？,问题如果你的病人有胃溃疡或胃炎，你会避免给它哪一类的中药、方,