THUC IU TR LOT D DY-T TRNG

THUC IU TR LOT D DY-T TRNGPhan Th Nh Qunh, MSc.B mn Ha DcKhoa Dc, i hc Y Dc HuI CNGNguyn nhn lot d dy - t trng:Mt cn bng ga yu t gy lot (HCl, pepsin) v yu t chng lot (cht nhy nim mc v s ti sinh ca t bo biu m)Nhim vi khun Helicobacter pylori, vi khun lm tn thng mng nhy

I CNGC s ca cch iu tr:Ci thin cn bng gia yu t tn cng v yu t bo v:Hn ch yu t gy lot: gim nng ion H+Gia tng s bo v nh cc cht bo v mng nhyLoi tr vi khun Helicobacter pyloriTc ng ca cc thuc dng trong iu tr:Gim auGia tng s lnh soPhng nga bin chngGim ti phtI CNGCC THUC I KHNG TI TH TH HISTAMIN H2THUC KHNG HISTAMIN H2C ch tc dng:i khng cnh tranh thun nghch vi histamin ti receptor H2Dc ng hc:Hp thu: nhanh rutChuyn ha: qua ganCimetidin, ranitidin, famotidin chuyn ha qua gan ln u (SKD 50%)Nizatidin t b chuyn ha ln u (SKD 100%)Thi tr: qua thnTHUC KHNG HISTAMIN H2Tc ng dc lc:c ch receptor H2: gim tit dch v acid c kch thch bi histamin, gastrin, kch thch ph v

Tc ng khng lin quan n c ch receptor H2: c ch enzym chuyn ha thuc Cyt. P450Cimetidin c ch mnhRanitidin t tc ngFamotidin, nizatidin khng tc ngTHUC KHNG HISTAMIN H2Tng tc thuc:Gim hp thu mt s thuc nh ketoconazol do c ch tit acidCimetidin ko di t1/2 ca mt s thuc chuyn ha qua Cyt P450 nh wafarin, phenytoin, theophyllin, phenobarbital, do c tc dng c ch h ny c ch alcol dehydrogenase lm tng hp thu alcol (tr famotidin)Cnh tranh bi tit qua ng thn vi mt s thuc nh procainamidTHUC KHNG HISTAMIN H2Ch nh:Tr chng tro ngc d dy-thc qun (GERD)Bnh lot d dyLot d dy do NSAIDsPhng nga chy mu d dy do stress

c tnh:D dung npTc dng ph 1-2%, thng gp: tiu chy, to bn, chng mt, au u, mt mi, pht ban,Cimetidin c nhiu tc dng ph nht (5%)

THUC KHNG HISTAMIN H2Hot cht v tc dngCng thcCimetidin: c ch cytocrom P450 nh hng n nhiu thuc khc khi tr liu phi hpRanitidin: C i lc vi cytocrom P450 km cimetidin 4 ln nn nguy c tng tc thuc rt thpFamotidin: Thc t khng tng tc vi cytocrom P450Nizatidin

CC THUC C CH BM PROTONTHUC C CH BM PROTON (PPI)C ch tc dng:c ch khng thun nghch H+ - K+ ATPaseDc ng hc:Hp thu km khi bng noT1/2 ngn (1,5h)Tc ng dc lc:c ch tit acid c bn (lc i) v s tit acid do ba nTc dng ph:An tonTc dng ph 1-5%: tiu chy, nhc u, au bng

THUC C CH BM PROTON (PPI)Ch nh:Tr chng tro ngc d dy-thc qun (GERD)Bnh lot d dy do H. pyloriLot d dy do NSAIDsPhng nga ti pht chy mu d dy do lotTr kh tiu khng do lotPhng nga chy mu d dy do stressHi chng Zollinger Ellison v cc ca tng acid khc

13THUC C CH BM PROTON (PPI)Hot cht v cu toCng thcOmeprazol: Nhn benzimidazol b th v tr s 5 bi nhm methoxyNhn pyridin b th bi methoxy v tr 4, dimethyl v tr 3 v 5LanzoprazolNhn pyridin b th bi trifluoroethoxy v tr 4, methyl v tr 3

PantoprazolNhn benzimidazol b th v tr s 5 bi nhm difluoromethoxyNhn pyridin b th bi methoxy v tr 3 v 4

CC THUC KHNG ACIDTHUC KHNG ACID (ANTACID)C ch tc dng:Trung ha acid dch v: Cc antacid l cc base yu phn ng vi HCl dch v to mui v ncDo lm tng pH dch v nn cng ng thi c ch hot tnh pepsin, lm mnh thm hng ro cht nhy c ch H. pyloriDc ng hc:Mc hp thu khc nhau:NaHCO3 v Na2C2O4 khng b trung ha hp thu hon ton nhim kim tm thiAl3+, Mg2+, Ca2+ hp thu km hnTHUC KHNG ACID (ANTACID)Thnh phn v tc dng ph:

Thnh phnKh nng trung ha acidTc dng phNaHCO3CaoNhim kim ton thn, gi ncCaCO3Trung bnhTng calci huyt, si thn, hi chng sa-kimAl(OH)3CaoTo bn, gim phosphat huytMg(OH)2CaoTiu chy, tng magie huyt (BN suy thn)THUC KHNG ACID (ANTACID)Ch nh:Lm gim triu chng lot d dy: gim au, chua, kh tiuUng 1-3h sau n v trc khi i ng

Chng ch nh-thn trng:Cc antacid c cha Ca v Mg: Thn trng khi c bnh thn nngAntacid c NaHCO3: CC khi c tng HA, suy tim sung huyt, bnh thn nng v phAntacid c Al: Trnh s dng lu di, thn trng khi c mt nc hoc nghn rut, suy thnThn trng vi ngi cao18THUC KHNG ACID (ANTACID)Tng tc thuc:Cn tr cc thuc cn mi trng acid dch v hp thu: digoxin, phenytoin, isoniazid, ketoconazol, thuc bao tan rutAntacid cha cc ion ha tr 2,3 s to ni chelat lm gim hp thu mt s thuc nh ciprofloxacin, tetracyclinAntacid c nhm (tr nhm phosphat) to mui khng tan vi phospho lm gim phospho huyt khng dng chung vi sucralfatTHUC BO V NIM MC D DYTHUC BO V NIM MC D DYSucralfat hay aluminumHp cht bismuthMisoprostolSUCRALFATL mt disaccharid sulfat haC ch tc dng:To hng ro bo vKch thch thnh lp prostaglandin v NaHCO3Tc dng ph:t tc dng ph v khng hp thu qua rutTo bn, kh mingDng lu di lm gim phosphat huytTng tc thuc:Lm gim SKD ca phenytoin, theophyllin, quinin, amitriptylin, ketoconazol, L thydroxin22HP CHT BISMUTHBismuth subsalicylat, Tripotassium dicitrato bismuthatC ch tc dng:Bo v ti chKch thch tng hp prostaglandinc ch H. pyloriTc dng ph:Dng lu di b bnh no, lon dng xng, en vm ming do tng Bi3+ trong muSuy thn lm gim o thi bismuth thn trng vi ngi suy thn v ngi ln tui23MISOPROSTOLL dn xut methyl ca prostaglandin E2C ch tc dng:Kch thch tit dch nhy v NaHCO3Duy tr lu lng mu n nim mc d dyGim sn xut histamin gim tit H+Tc dng ph: au bng, tiu chy (30% BN), chut rtChng ch nh:Thai k (v co c t cung gy sy thai)Antacid c MgTHANK YOU!