课件：药物的肝脏毒性消化系统用药（高分飞）.ppt

Drugs Affecting Gastrointestinal Function,Gao Fen-Fei,OUTLINE,Peptic Ulcer Digestion Vomiting Diarrhea Bile Review-Questions,Ulcer-Background,20世纪初，与应激、生活、饮食等有关，故主张镇静、休息、饮食治疗。 1910年，Schwarz提出”No Acid No Ulcer” 1971年，Black等发现H2受体。1976年，第一代H2受体拮抗剂西咪替丁用于临床第一次革命。诺贝尔奖。 20世纪80年代中期，质子泵抑制剂（proton pump inhibitor，PPI）奥美拉唑问世。 1983年，澳大利亚学者Warren与Marshall分离出Hp，病因观念转变，再一次革命。根治成为可能。2005年，获诺贝尔奖。,Introduction of Ulcer,Epidemiology incidence of a disease: 10%-12% Europe and America: DU GU; Japan: GU DU Etiology General consideration: No Acid No Ulcer Main Destroy Factors: HCl, Pepsin, Hp Protective Barrier: Mucus-HCO3-,Pathogenesis of Peptic Ulcer,Review,How is the secretion of gastric acid adjusted ? What is the mechanism of secretion of gastric acid ?,How to treat peptic ulcer ?,Anti-ulcer Targets,HCl Mucus Hp,Anti-ulcer Classification,Antacids- Neutralize HCl Gastric Antisecretory Drugs HCl secretion Antagonize Rs. on Parietal Cell- H2,M3, G Inhibitor of H+-Pump Protectors of Mucosa Agents kill HP,. Antacids,Mechanism: AlkalizersTo Neutralize HCl Agents: Mg(OH)2 Al(OH)3 CaCO3 NaHCO3 Adverse Effect: Systemic alkalosis, Diarrhea , CO2,Major constituents of antacids,.1. H2-R Antagonists,Mechanism: Pharmacologic Effects: Basal gastric acid nocturnal secretion Agents: Cimetidine， Ranitidine， Famotidine Adverse Effect: Gynecomastia, prolactin , CYP450 , headache,.1. Antimuscarinic Agents,Mechanism: Blocking M3-R on Parietal Cell, M-R on ECL cell and G cell Pharmacologic Effects: HCl spasmolysis Agents: Atropine ，Probanthine Pirenzepine - M1,M2-R selection Adverse Effect:,.1. Antagonist of G-R,Mechanism: Competing Gastrin-R on Parietal Cell Pharmacologic Effects: HCl Mucosal Agents: Proglumide Adverse Effect:,.2. Proton Pump Inhibitors,Mechanism: H+,K+-ATPase H+ K+ Pharmacologic Effects: HCl & Hp Agents: Omeprazole（losec） Lansoprazole Pantoprazole，Rabeprazole Adverse Effect:,. Mucosal Protective Agents,Derivatives of Prostaglandin: Misoprostol (PGE1), Enprostil Mechanism: HCl ; Pepsin Mucus-HCO3- ; Cytoprotective effect Pharmacologic Effects: Prevention of ulcers iduced by NSAIDs Contraindication： Women with childbearing,2. Sucralfate Mechanism: Polymerization & gelatine barrier PGE2 Mucus-HCO3- Hp Pharmacologic Effects: Effective in Duodenal Ulcers Notice: Acid pH Empty stomach,3. CBS Mechanism: Pepsin PGE1 Mucus-HCO3- Coating Hp （disputed） 4. Teprenone 5. Marzulene,. Anti-Hp Drugs,90% DU,70% GU - Helicobacter pylori (G-) Anti-Ulcer Agents: Bismuth Compounds Proton Pump Inhibitors sucralfate Antibacterial Drugs: Amoxicillin Gentamicin Metronidazole,Combination Therapy,Therapy of triad Oversea PPI + two Antibacterial Drugs Domestic CBS + PPI or H2-R Antagonist + Antibacterial Drug,Digestion Aids,Contents of Digestive Juice: Pepsin Pancreatin Helpful Bacterias in Bowel: biofermin,Antiemetic Drugs and Drugs Promoting Gastrointestinal Motility,Medulla Oblongata Vomiting Center,Stimuli,Chemoreceptor Trigger Zone,Stomach and Abdomminal Musculature,Pathogenesis of Vomiting,延髓呕吐中枢,刺激,晃动,Antagonists of Receptors of H1: Nucleus of tractus solitarius, vestibulocerebellar pathway Diphenhydramine, Dimenhydrinate M : Nucleus of tractus solitarius, CTZScopolamine D2 : CTZ, Nucleus of tractus solitarius, Stomach, Small intestineThiethylperazine，Metoclopramide 5-HT3 : Stomach, Small intestine, CTZ, Nucleus of tractus solitariusOndansetron，Granisetron Prokinetics： Metoclopramide Blocking Gastrointestinal Domperidone D2-R Cisapride：Ach release,Antidiarrheal Drugs and Adsorbents,Opium preparation and Derivatives Opiate receptors in Gastrointestinal tract tonemotility（），secretion（），Ach release Loperamide： Derivatives of Haloperidol Astringents Tannalbin Bismuth subsalicylate, Bismuth subcarbonate Adsorbants Medicinal Charcoal Kaolin,Laxatives,Contact cathartics Irritant or stimulant intestinal motility Phenolphthalein, Rhubarb, Senna, Castor oil Osmotic laxatives nonabsorbable distending peristalsis MgSO4, Na2SO4, Lactulose, Celluloses Surface-active agents Lubricating, Stool soften Liquid paraffin,Choleretic drug,Cholic Acid HMG-CoA reductase (rate limiting enzyme) bile salt，cholesterol Chenodiol (Chenodeoxycholic acid) MgSO4 cholecystokinin Cinametic acid Anethol trithione,Review-Questions,The classification of drugs used in the treatment of peptic ulceration. the mechanisms and the agents of each.,Good Bye!,后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析,主要经营：课件设计，文档制作，网络软件设计、图文设计