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Farma clinica-gastro

Farma clinica-gastro

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Published by tatiana

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Published by: tatiana on Jun 17, 2009
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05/11/2014

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Farmacologie clinicaDigestiv I
Ulcer pepticMedicatie pentru:Eradicarea HPAntisecretoareAntiacideProtectoare
Reflux gastroesofagianProkinetice
ConstipatiaPolizaharide celulozaEmolienteLubrifianteStimulante – laxativeLaxative osmotice
DiareeaAntiinflamatoareOpioideRehidratare
Emeza
Medicatia antiulceroasa
Categorie mecanismExempleMecanism actiuneAntiacideMg, oxid, hidroxidNeutralizareAnticolinergicePropantelinaBlocheaza receptorii muscariniciAntagonisti receptori H2CimetidinaBlocheaza r H2ProstaglandineleMisoprostolScade AMPc, scade HProtectoareSucralfat de bismutProtejeaza mucoasaSupresie HPInhibitori ai pompei protOmeprazolScade ATPaza (H, K)Scade HAntimicrobieneClaritromicinAnti HPFarmacoterapia antiulceroasa
Ulcer si HP +
(D=90-95%, G=50-80%)AntisecretoareOmeprazol40 mg/ziLansoprazol15-30 mg/ziPantoprazol40 mg/zisauBl r H2Cimetidina800 mg/zi noapteaRanitidina300 mg/zi noapteaFamotidina40 mg/zi noaptea
 
ProtectoarePrep bismut525 mg x 4/ziAntimicrobiene-Metronidazol400 mg x 3/zisauTinidazol PRIMA OPTIUNE-Claritromicin500 mg x 2/zisauAmoxicilin500 mg x 3/ziDurata standard: 2 saptamaniEradicare 87-91%
Ulcer si HP -
DuodenalBl r H2Cimetidina800 mg/zi noapteasauRanitidina300 mg/zi noapteaFamotidina 40 mg/zi noaptea Nizatidina300 mg/zi noapteaDurata: 4-8 saptamaniVindecare 80-95%GastricBl r H2Cimetidina400 mg x 2/zi noapteasauRanitidina150 mg x 2/zi noapteaDurata: 10-12 saptamaniVindecare: 90%Control gastrosec + biopsieSuspiciune: malignPersistenta ulcer: rezectiaUlcerIntoleranta la scaderea aciditatiiSucralfatul (complex dizaharid cu hidroxid de aluminiu)Adera la baza ulceratieiComplex cu pepsina si sarurile biliareCreste productia locala de bicarbonatCreste productia de mucusSupresia HPAciditatea modest redusaDoze: 1 g x 4/zi, 1 h inaintea meselor si la culcareDurata: max 8 saptamaniTratament intretinere: 1 g/ziEf secundare: constipatia1. Ulcer activBl r H2Cimetidina800 mg/ziRanitidina300 mg/ziFamotidina 40 mg/zi
 
Se administreaza intre cina si culcare2. Inhibitori ai pompei de protoni – se administreaza dimineata, inaintea micului dejunOmeprazol 20 mgLanzoprazol 30 mgPandoprazol3. Tratament de intretinerea. Bl r H2Cimetidina800 mg/zi noapteaRanitidina300 mg/zi noapteaFamotidina 40 mg/zi noaptea b. Inhibitori ai pompei de protoniOmeprazol 20 mgLanzoprazol 30 mgPandoprazolc. Preventia ulcerului indus de AINS: Nisoprostol200 mcg x 3/ziInhibitori de pompa de protonInteractiuni medicamentoaseCimetidina scade activitatea citP450:1.scade emtabolismul hepatic2.scade emtabolismul benzodiazepinelor 3.bloc canalele de Ca4.carbamazepina5.labetolol6.metoprolol7.metronidazol8.fenitoin9.ADT10.chinidina11.teofilinaRanitidina, Famotidina, Nizatidina nu inhiba citP450Efecte adverse: cefalee, somnolenta, fatigabilitate, stari confuze, halucinatii, insomnie, greata, voma,discomfort digestiv, diaree, constipatie, trombocitopenie, alopecie, ginecomastie, inapetenta, artalgie.Efecte secundareCimetidina: Vezi mai sus + galactoreeRanitidina, famotidina: nu interfera cu citP450, nu au efecte semnificative antiandrogeniceOmeprazolul, Lanzoprazol: hipergastrinemia secundara de rebound, hiperplazia mucoasei gastrice
Antiacide
Saruri de Al si Mg (hidroxid de Al si Mg)Comp de Al – constipatie

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