farmaci dell’apparato gastrointestinale · ipotesi a “cellula singola” e a “2 cellule” mc...
TRANSCRIPT
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Farmaci dell’apparatogastrointestinale
(ulcera, reflusso, vomito, diarrea, stipsi)
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Secrezione dell’acido cloridrico nelle cellule pari etali gastriche
Pompaprotonica
H/K ATPasi
Gastrina, Istamina, Acetilcolina
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Acetilcolina controllo nervoso
Istamina controllo paracrino
Gastrina controllo endocrino
Controllo della secrezione acida
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Ipotesi a “cellula singola” e a “2 cellule”
MC = mast cellMR = rec. muscarinicoGR = rec. gastrinaPGR = rec. PGE 2
CCKA/B
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Modulazione della secrezione dell’acido gastrico
Somatostina
-
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L'ulcera peptica è un'ulcera circoscritta che colpisce la mucosa di una zona del tratto digerente superiore
esposta all'azione del succo gastrico.
A seconda dell'area di localizzazione, l'ulcera peptica viene definita duodenale o gastrica.
Ulcera peptica
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°°
Farmaci per Farmaci per ll ’’ulcera pepticaulcera peptica
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Farmaci antimicrobici
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Helicobacter pyloriassociato a mucosa gastrica
Gram-negativo, microaerophilic, and acidophilic bacterium (resistente a acido)
Warren e Marshall Nobel 2005
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.
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Terapia triplice (2 settimane)claritromicina + amoxicillina (o metronidazolo) + PPI
Terapia quadruplice (2 settimane)tetraciclina + bismuto + metronidazolo + H2 antagonista
Bismuto = inibisce pepsina e aumenta secrez. muco
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Farmaci anti H2
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Modulazione della secrezione dell’acido gastrico
Somatostina
-
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Somministrazione e destino della cimetidina
30% inattivato in fegato
70%
Ranitidina, nizatidina> 5-10 volteFamotidina > 20-50 volte
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Effetto della cimetidina nella stimolazione dell’acido gastrico mediata dal betazolo e nella secrezione di pepsina
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Interazioni farmacologiche con la cimetidina e effetti collaterali
Effetti collaterali
Cefalea, capogiro, diarrea, dolore muscolare, confusione-allucinazioni (in anziani), antiandrogeno (ginecomastia-galattorreariduzione spermatozoi)
Ketoconazolo assorbimento
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Farmaci inibitori dellapompa protonica
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Inibizione della secrezione acida mediata dall’ omeprazolo
AP = aminopirina (accumulo di AP nei canali secreta goghi)
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Interazioni farmacologiche e effetti collaterali
Aumento di batteri nello stomacoAumento secrezione gastrina e ipocloridria(tumori)Bassi livelli di vit. B12
Omeprazolo interferisce con ossidazione di:warfarin, fenitoina, diazepam, ciclosporina
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Farmaci prostaglandinici
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Modulazione della secrezione dell’acido gastrico
Somatostina
-
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Effetti del misoprostolo nelle complicazioni gastriche in pazienti con artrite reumatoide
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(alluminio idrossido + sucrosio solfato)
Alginati
Scarsamente utilizzati per gli effetti collaterali anti M3
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Farmaci antiacidie protettivi
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(alluminio idrossido + sucrosio solfato)
Alginati
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Farmaci usati nel controllodel vomito
Taccuino sanitatisXIV secolo
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Fattori che influenzano il vomito
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Farmaci usati per il trattamento della nausea e del vomito
Bloccanti recettore H1Cinnarizina, ciclizina, prometazina, difenidramina
Bloccanti recettori muscariniciScopolamina
Bloccanti recettori 5HT3, D2 Ondansetron, metoclopramide
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Recettori 5HT3 e vomito
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(idrossidolasetron)
Farmaci usati per il controllo della nausea e del vomito indotti dalla
chemioterapia
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meclizina, dimenidrinato
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Confronto della potenza dei farmaci antiemetici
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Efficacia dell’attività contro gli episodi emetici ch e si verificano nelle prime 24h di trattamento con il cisplatino
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Farmaci usati nelladiarrea e nella stipsi
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Farmaci usati per trattare la diarrea
antimotilità
adsorbenti
inibizione PG, trasporto liquidied elettroliti
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Farmaci usati per trattare la stipsi
stimolanti, irritanti
aumento massa, osmotici
emollienti
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