制酸药-抑酸药-胃粘膜保护药

制酸药-抑酸药-胃粘膜保护药 常用制酸药 制酸药:是无机弱碱类～能直接中和胃酸～形成盐和水～从而提高胃液pH值～降低胃蛋白酶活性～降低十二指肠酸负荷～减轻胃酸对十二指肠黏膜的刺激～以缓解疼痛～促进溃疡愈合。抗酸药按吸收过程可分为吸收性抗酸药,又称为全身性抗酸药～大剂量可引起碱中毒,和难吸收性抗酸药,局部性抗酸药,～现有的多种抗酸药因抗酸作用的强、弱不同～而发生作用的速缓、维持时间的长短不同。 制酸药的剂型以液体,如凝胶,最好～粉剂次之～片剂最差。应用单一品种的抗酸药有一定的不良反应～且在临床上达不到满意的效果～因而在临床上多采用几种抗酸药组成复方制剂以互相取长补短～以减少不良反应。常见的副作用:腹胀、食欲不振、钠潴留致高血压、软骨病或骨质疏松、代谢性碱中毒、肾功能损害等。作为止痛的辅助用药。 常用制酸药物及作用特点: 碳酸氢钠:小苏打～作用强～起效快而短暂。中和胃酸时产生CO～可引起嗳气、腹2 胀～继发性的胃酸分泌增加～口服后可被肠道吸收～导致碱血症和碱化尿液。 氢氧化铝:抗酸作用较强、起效缓慢～作用持久。作用后产生的氧化铝有收敛、止血和致便秘作用。长期服用可影响肠道对磷酸盐的吸收。 氧化镁:中和胃酸作用强～作用缓和而持久～不产生CO～肠道难吸收～不会引起碱2 血症。产生的氯化镁可引起腹泻。 2+氢氧化镁:抗酸作用较强较快～Mg有导泻作用～少量吸收后经肾排出～如肾功能不良可引起血镁过高。 三硅酸镁:抗酸作用较弱～作用慢而持久～在胃内生成胶状二氧化硅对溃疡面有保护作用。 2+碳酸钙:抗酸作用较强～作用快而持久。可产生CO气体～进入小肠的Ca可促进胃2 泌素的分泌～引起反跳性胃酸分泌增加。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 常用的抑酸药 1.抗胆碱能药—M胆碱受体阻断剂 1 药理:具有选择性的抗胆碱能药物～对胃壁细胞的毒蕈(xun)碱受体有高度亲和力～而对平滑肌～心肌和唾液腺等的毒蕈碱受体的亲和力低～故应用一般治疗剂量时～仅能抑制胃酸分泌～而很少有其它抗胆碱药物对瞳孔、胃肠平滑肌、心脏、唾液腺和膀胱肌等的副作用 禁忌症:?对本品过敏者禁用。?孕妇禁用。?青光眼和前列腺肥大。 常用药物:哌仑西平,Prenzepine〕、替仑西平,Telenzepine,、佐仑西平,Zolenzepine,等。与哌仑西平相比～替仑西平具有作用强～而佐仑西平具有生物利用度高等优点。哌仑西平:成人口服常用剂量为50mg～1日2次～早晚餐前一个半小时服用。疗程以4，6周为宜。症状严重者～1日量可加大到150mg～分3次服。需长期治疗的病人～可连续服用3个月。 2.H受体拮抗剂: 目前～临床上广泛应用的H受体拮抗剂按药理作用可分四代～其中第22 一代代表药物为西咪替丁、第二代代表药物为雷尼替丁、第三代代表药物为法莫替丁、第四代代表药物为罗沙替丁。第三代的法莫替丁为强效品种～第四代的罗沙替丁为生物利用度最高的品种。 药理:组胺与H受体拮抗剂结合后～首先激活作为受体一部分的腺苷酸环化酶～催化胃2 ，，壁细胞的ATP生成cAMP～最后在H,K,ATP酶和蛋白激酶参与下分泌胃酸～H受体拮2抗剂能选择性地与组胺H受体结合～竞争性地拮抗组胺对H受体的作用～从而抑制胃酸22 分泌。 常用药物: 化学分中文名 外文名 生物利能否透过抗雄激素对细胞色素 类 用度% 血脑屏障 作用 P450系统 的影响 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 第一咪唑类 西咪替cimetid60，80 能 有 有 代 丁 ine 第二呋喃类 雷尼替ranitid50，60 透过量较无 较小 代 丁 ine 少 第三噻唑类 尼扎替nizatid90，95 不能 无 无 代 丁 ine 法莫替famotid40，50 不能 无 无 丁 ine 第四哌啶甲罗沙替roxatid90，不能 无 无 代 苯类 丁 ine 100 用法及用量: 西米替丁:口服:每次200-400mg～1日800-1600mg,静脉注射或滴注:每次200-600mg～4-6小时1次～1日剂量不宜超过2g。也可直接肌肉注射。西米替丁可透过血脑屏障～干扰中枢神经系统活动～少数可有精神障碍～因此有肝性脑病者禁用。 雷尼替丁: 口服～一次150mg,一次1片,～一日2次～或一次300mg,一次2片,睡前1次。 法莫替丁:口服～20mg/次～2次/d或睡前1次服20-40mg,缓慢静脉注射或静脉滴注20mg～1日2次,间隔12小时,。法莫替丁抑制胃酸分泌的能力较雷尼替丁强7.5倍～较西米替丁强40倍。法莫替丁作用时间长～每12,给药1次～能够持续有效抑制胃酸分泌～提高胃内P,值。不透过血脑屏障～不抑制细胞色素P450药物代谢系统～因而无明显药物间相互作用。 尼扎替丁:作用于雷尼替丁相似～但生物利用度更高～不抑制肝药酶～无抗雄激素作用～也不影响血催乳素浓度。 罗沙替丁抑制胃酸的能力和雷尼替丁大致相同～他的生物利用度不受进食影响～不需用空rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 腹服药,不受抗酸药影响～可同时应用抗酸药～缓解疼痛。 副作用:头痛、头晕、乏力、嗜睡、恶心、呕吐、腹泻、皮疹、心率增加、血压升高、颜面潮红、月经不调、肝、肾功能损害和粒细胞减少等,具有抗雄性激素作用～停药后可消失。孕妇和肝肾功能不全者慎用,哺乳妇女使用时应停止哺乳。 3.质子泵抑制剂:药理机制:质子泵抑制剂本身是一类无活性的前体药～进入肠道 吸收以后进入血液～由于其为弱碱性～所以很快就被吸引到壁细胞分泌小管的高酸环境中～在 ，，胃壁细胞的管池及分泌小管的细胞膜上分布着H,K,ATP酶～该酶是介导胃酸分泌的最 +++–终途径～能将细胞外的K泵入细胞内～而将H泵出细胞外～H与CL结合形成胃酸。质子泵抑制剂(PPI)通过非竞争性不可逆的对抗作用～抑制胃壁细胞内的质子泵～产生较H受2体阻滞剂更强更持久的抑酸效应。因而对基础、夜间胃酸和五肽胃泌素、试餐等刺激的胃酸分泌有极明显的抑制作用～是目前已发现的作用最强的一类胃酸分泌抑制剂。 常用药物及用法: 奥美拉唑,洛赛克,:口服20mg/次～1-2次/d,静滴40mg/12小时,奥美拉唑,OME,是目前临床应用最广泛的质子泵抑制剂～在通常剂量,20-40mg/d,下～可抑制24小时酸分泌?90%～迅速控制症状和使溃疡愈合。 兰索拉唑,达克普隆,:口服 30mg/次～1-2次/d, 潘妥拉唑,泰美尼克,:在酸性条件下较OME化学稳定性好～生物利用度高～与肝脏细胞色素P450酶无相互作用～副反应很少,口服40 mg/次～1-2次/d,静滴40mg/12小时。 雷贝拉唑,波利特,:药物解离能力强～对质子泵的抑制速度和强度优于奥美拉唑和兰索拉唑～不经细胞色素P450酶药物系统代谢～主要通过非酶代谢途径代谢转化成硫醚～无药物间相互作用,口服 10 mg/次～1-2次/d, 埃索美拉唑,耐信,:埃索美拉唑,ESO,是单S型异构体的质子泵抑制剂～ESO与OME相比～仅小部分通过肝脏的细胞色素P450药物系统代谢～因此药物首过代谢率低～血浆浓度高～生物利用度高达89%～24小时内对胃酸的抑制作用更持久更有效。同时吸收迅速～rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 口服后约1-2小时血浆药物浓度达到高峰。口服 40 mg/次～1-2次/d PPI不良反应较小～迄今总体上的临床报道与评价较好。如奥美拉唑～它在人群中的耐受性较好～仅约有1%患者出现头痛、腹泻、便秘、腹痛、恶心、呕吐和胃肠胀气反应～极少发生红斑、丘疹、瘙痒、眩晕、肢端麻木、嗜睡、失眠和疲倦反应。 不良反应:恶心、胀气、腹泻、便秘、上腹痛等,皮疹、胆红素升高也有发生～一般是轻微和短暂的～大多不影响治疗,长期使用本品可能引起高胃泌素血症,严重肾功能不全及婴幼儿禁用,严重肝功能不全者慎用～必要时剂量减半。 胃粘膜保护药 具有保护和增强胃黏膜防御机能的一类药物统称为胃黏膜保护剂。胃黏膜保护剂的作用不仅在于保护胃肠道黏膜屏障～还具有细胞保护作用～并能促进粘液分泌～增强粘液屏障作用。这类药物进入胃肠道后可迅速与黏膜结合,尤其是与受损黏膜相结合后形成薄膜,覆盖在黏膜表面,使之不再受到各种有害物质(消化液、药物等)的侵袭,起隔离作用。黏膜保护剂还可促使消化道黏膜细胞分泌黏液等保护性物质,有促进黏膜修复的作用。 1胶体铋:胶体铋是一种复合性铋盐。在酸性环境中与蛋白质螯合～从而构成一层防止酸 +和胃蛋白酶侵袭的保护屏障,与粘液形成一种复合物～构成防止H弥散的屏障。胶体铋还可减少胃蛋白酶的排出和活性～促进前列腺素的分泌～对胃粘膜起保护作用。同时干扰HP的代谢～使菌体与粘膜上皮失去粘附作用～有杀灭HP的作用。 临床常用药物:枸橼酸铋钾～胶体果胶铋 慢性肾功能不全者慎用～有便秘、恶心、一过性转氨酶升高等副反应～还可出现舌苔、牙齿黑染、黑便等～大量长期应用可发生脑病。 2硫糖铝:是硫酸化二糖和氢氧化铝的复合物～在酸性胃液中～凝聚成糊状粘稠物～附着于胃、十二指肠粘膜便面～阻止胃蛋白酶侵袭溃疡面～有利于粘膜上皮细胞的再生和阻止氢离子向粘膜内逆弥散～促进溃疡的愈合。硫糖铝能吸附胃液中得胆盐～对促进溃疡愈合有一定的作用。本药宜在每次进餐前1小时服1g～连服4-6周为一疗程。副作用轻微～rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 如便秘、口干、皮疹、眩晕、嗜睡等。 3前列腺素:米索前列醇,misoprostol)能抑制胃酸的分泌～增加胃十二指肠粘膜粘液/碳酸氢盐分泌～增加粘膜血流量～加强胃肠粘膜的防卫能力～使胃粘膜免受酸、NSAIDs、酒精、胆汁等因子的损害～加速粘膜修复。不良反应主要是腹泻～孕妇慎用～能引起子宫收缩。 4其他:用于保护胃粘膜的药物还有铝碳酸镁、替普瑞酮,施维舒,、双八面体蒙脱石,思密达,、生长抑素、表皮生长因子等。铝碳酸镁作用于病变部位～可持续阻止胆酸和胃蛋白酶对胃粘膜的损伤～迅速中和胃酸～增强对胃粘膜保护因子的作用。替普瑞酮能促进胃粘液中重碳酸盐、糖蛋白和磷脂等防御因子的分泌～前列腺素的合成～改善胃粘膜血流～促进溃疡愈合。双八面体蒙脱石对胃肠道粘膜有很强的吸附能力～能与粘液糖蛋白结合～提高粘膜屏障对攻击因子的防御能力。生长抑素可抑制胃酸的分泌～促进溃疡愈合。表皮生长因子促进粘膜的再生和修复～促进前列腺素的合成～增强胃粘膜屏障作用。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities