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‫ﻧﻈﺎﻡﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺍﻟﻤﻘﺎﻳﻴﺲ ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء‬ ‫ﺍﻟﻜﻴﻤﻴﺎءﺍﻟﻄﺒﻴﺔ ‪III‬‬

‫ﺍﻟﻮﺣﺪﺓ‪:‬ﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ ﻋﻼﺝ ﺍﻻﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﻤﻌﺪﻳﺔ ﺍﻟﻤﻌﻮﻳﺔ‬

‫ﺍﻟﻔﺼﻞ‪:1‬‬
‫ﺍﻟﻤﻘﺎﻳﻴﺲﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻄﺎﻗﺔ‬
‫ﺳﺎﻡﺩﻭﺑﺎﻭﻓﺎﺭﻡ‪ .‬ﺗﺸﻴﻢ‪ .‬ﺩﻛﺘﻮﺭﺍﻩ‪.‬‬

‫ﺃﻧﺎ‪ .‬ﻣﻌﺮﻓﺘﻲ‬

‫ﺍﻟﻘﻲءﻫﻮ ﻃﺮﺩ ﻻ ﺇﺭﺍﺩﻱ ﻟﻤﺤﺘﻮﻯ ﺍﻟﻤﻌﺪﺓ ﻣﻦ ﺧﻼﻝ ﺍﻟﻔﻢ‪ .‬ﻳﺒﺪﺃ ﺍﻟﻘﻲء ﺑﺘﺤﻔﻴﺰ ﻣﻨﻄﻘﺔ ﺗﺤﻔﻴﺰ ﺍﻟﻤﺴﺘﻘﺒﻼﺕ‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ)‪ (CTZ‬ﻓﻲﺑﻮﺳﺘﺮﻳﻤﺎﻣﻨﻄﻘﺔﺍﻟﻨﺨﺎﻉ ﺍﻟﻤﺴﺘﻄﻴﻞﺃﻭ ﻣﻨﺒﻬﺎﺕ ﻣﻦ ﺍﻟﺠﺰء ﺍﻟﻌﻠﻮﻱ ﻣﻦ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ ﺇﻟﻰ ﻣﺮﻛﺰ‬
‫ﺍﻟﺘﻘﻴﺆﻋﻦ ﻃﺮﻳﻖ ﺍﻟﺘﻨﺒﻴﻪ ﺍﻟﺪﻫﻠﻴﺰﻱ‪ CTZ .‬ﻟﺪﻳﻬﺎ ﺍﻟﺪﻭﺑﺎﻣﻴﻦ )‪ ، (2D‬ﻛﻮﻟﻴﻨﻲ ‪ ،‬ﺳﻴﺮﻭﺗﻮﻧﻴﻦ )‪ ، (3HT-5‬ﻣﺴﺘﻘﺒﻼﺕ‬
‫‪1‬‬‫ﺍﻷﻓﻴﻮﻥ ‪،‬ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﻣﺴﺘﻘﺒﻼﺕ ﺍﻟﻤﺎﺩﺓ ‪ ، P‬ﻓﻲ ﺣﻴﻦ ﺃﻥ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺪﻫﻠﻴﺰﻱ ﻏﻨﻲ ﺑﺎﻟﻤﺴﻜﺎﺭﻳﻨﻴﻚ ﻭﺍﻟﻬﺴﺘﺎﻣﻴﻦ ‪H‬‬
‫ﻣﺴﺘﻘﺒﻼﺕ‪.‬‬

‫ﻗﺪﻳﺘﺴﺒﺐ ﺍﻟﻘﻲء ﺍﻟﻤﺴﺘﻤﺮ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺪﻳﺪﺓ ﻓﻲ ﺣﺪﻭﺙ ﺧﻠﻞ ﻓﻲ ﺗﻮﺍﺯﻥ ﺍﻟﻤﺎء ﻭﺍﻟﻜﻬﺎﺭﻝ‪ .‬ﻧﺘﻴﺠﺔ ﻟﺬﻟﻚ ‪،‬‬
‫ﻳﻤﻜﻦﺭﺅﻳﺔ ﻗﻼء ﻧﻘﺺ ﻛﻠﻮﺭ ﺍﻟﺪﻡ ﻭﻗﻠﺔ ﺍﻟﺒﻮﻝ ﻭﺟﻔﺎﻑ ﺍﻟﻔﻢ ﻭﺍﻟﺤﻤﻰ ﻭﺍﻟﻐﻴﺒﻮﺑﺔ‪ .‬ﺍﻟﻘﻲء ﻫﻮ ﺍﻟﻌﺮﺽ ﺍﻟﺮﺉﻴﺴﻲ ﻟﺪﻭﺍﺭ‬
‫ﺍﻟﺤﺮﻛﺔ‪.‬ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻚ ‪ ،‬ﻳﺤﺪﺙ ﺍﻟﻘﻲء ﻓﻲ ﺍﻟﺼﺒﺎﺡ ‪ ،‬ﻓﻲ ﺍﻟﻤﺮﺍﺣﻞ ﺍﻷﻭﻟﻰ ﻣﻦ ﺍﻟﺤﻤﻞ ‪ ،‬ﺑﻌﺪ ﺗﻨﺎﻭﻝ ﺍﻷﺩﻭﻳﺔ ﺍﻟﻤﺜﺒﻄﺔ‬
‫ﻟﻠﺨﻼﻳﺎ ‪،‬ﻭﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪.‬‬

‫‪II.‬ﻭﻛﻼء ‪EMETIC‬‬

‫ﻋﻮﺍﻣﻞﺍﻟﻘﻲء ﻫﻲ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﺴﺒﺐ ﺍﻟﻘﻲء‪ .‬ﻭﻫﻲ ﺗﺴﺘﺨﺪﻡ ﺑﺸﻜﻞ ﺧﺎﺹ ﻓﻲ ﺣﺎﻻﺕ ﺍﻟﺘﺴﻤﻢ ﻭﺗﺰﺩﺍﺩ ﺍﻟﺘﺄﺛﻴﺮﺍﺕ‬
‫ﻋﻨﺪﺗﻨﺎﻭﻟﻬﺎ ﺑﻜﻤﻴﺎﺕ ﻛﺒﻴﺮﺓ ﻣﻦ ﺍﻟﻤﺎء‪ .‬ﻣﻦ ﻏﻴﺮ ﺍﻟﻤﺮﻏﻮﺏ ﻓﻴﻪ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻤﻘﻴﺉﺎﺕ ﻓﻲ ﺣﺎﻻﺕ ﻓﻘﺪﺍﻥ ﺍﻟﻮﻋﻲ ﺃﻭ ﺷﺒﻪ‬
‫ﺍﻟﻐﻴﺒﻮﺑﺔﻭﻓﻘﺪﺍﻥ ﺍﻹﺩﺭﺍﻙ ﻭﺗﺴﻤﻢ ﺍﻟﻜﺤﻮﻝ ﻭﺍﻟﺘﺴﻤﻢ ﺑﻤﺮﻛﺒﺎﺕ ﻛﺎﻭﻳﺔ ﺃﻭ ﻣﻨﺘﺠﺎﺕ ﺑﺘﺮﻭﻟﻴﺔ ﺃﻭ ﺯﻳﻮﺕ ﻋﻄﺮﻳﺔ‪.‬‬

‫ﺃ‪.‬ﺍﻟﻤﻘﻴﺉﺎﺕ ﺍﻟﻤﺤﻴﻄﻴﺔ ﺍﻟﻤﻔﻌﻮﻝ‬

‫‪.1‬ﺷﺮﺍﺏ ﺍﻳﺒﻴﻜﺎﻙ‬

‫ﺃﺣﺪﺃﻛﺜﺮ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﺳﺘﺨﺪﺍﻣﺎً ﻫﻮ ﺷﺮﺍﺏ ﻋﺮﻕ ﺍﻟﺬﻫﺐ‪ .‬ﻭﻫﻮ ﻣﻘﻴﺊ ﺳﺮﻳﻊ ﺍﻟﻤﻔﻌﻮﻝ ﺣﻴﺚ ﺗﻌﻤﻞ ﻣﻜﻮﻧﺎﺗﻪ )ﻗﻠﻮﻳﺪﺍﺕ‬
‫ﺍﻟﻨﺒﺎﺕﺑﺸﻜﻞ ﺭﺉﻴﺴﻲ ﺳﻴﻔﺎﻳﻠﻴﻦ ‪ ،‬ﻭﻣﻴﺜﻴﻞ ﺳﻴﻔﺎﻳﻠﻴﻦ )ﺇﻳﻤﻴﺘﻴﻦ(( ﻣﺤﻠﻴﺎً ﻋﻦ ﻃﺮﻳﻖ ﺗﻬﻴﺞ ﺍﻟﻐﺸﺎء ﺍﻟﻤﺨﺎﻃﻲ ﻓﻲ ﺍﻟﻤﻌﺪﺓ‬
‫ﻭﺑﺸﻜﻞﻣﺮﻛﺰﻱ ﻋﻦ ﻃﺮﻳﻖ ﺗﺤﻔﻴﺰ ﻣﻨﻄﻘﺔ ﺍﻟﺰﻧﺎﺩ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺍﻟﻨﺨﺎﻋﻲ ﻟﻠﺤﺚ ﻋﻠﻰ ﺍﻟﺘﻘﻴﺆ‪ .‬ﻭﻣﻊ ﺫﻟﻚ ‪ ،‬ﻻ ﻳﻨﺒﻐﻲ ﺍﻟﺨﻠﻂ ﺑﻴﻦ‬
‫ﺷﺮﺍﺏﻋﺮﻕ ﺍﻟﺬﻫﺐ ﻭﻣﺴﺘﺨﻠﺺ ﻋﺮﻕ ﺍﻟﺬﻫﺐ‪ .‬ﻳﺤﺘﻮﻱ ﻣﺴﺘﺨﻠﺺ ‪ Ipecac‬ﻋﻠﻰ ﺃﺭﺑﻌﺔ ﻋﺸﺮ ﻣﺮﺓ ﺃﻛﺜﺮ ﺗﺮﻛﻴﺰﺍً ﻣﻦ ﺍﻟﺸﺮﺍﺏ‬
‫ﻭﻳﻤﻜﻦﺃﻥ ﻳﺘﺴﺒﺐ ﻓﻲ ﺍﻟﻮﻓﺎﺓ‪.‬‬

‫‪.2‬ﻛﺒﺮﻳﺘﺎﺕ ﺍﻟﻨﺤﺎﺱ )‪ ،4CuSO‬ﻣﺤﻠﻮﻝ ‪(٪1‬‬

‫ﺗﻤﺖﺍﻟﺪﻋﻮﺓ ﺇﻟﻰ ﻛﺒﺮﻳﺘﺎﺕ ﺍﻟﻨﺤﺎﺱ ﺑﺎﻋﺘﺒﺎﺭﻫﺎ ﻣﻘﻴﺉﺎً ﺳﺮﻳﻊ ﺍﻟﻤﻔﻌﻮﻝ ﻻﺳﺘﺨﺪﺍﻣﻬﺎ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻟﻔﻮﺭﻱ ﻟﻠﺘﺴﻤﻢ ﻋﻦ‬
‫ﻃﺮﻳﻖﺍﻻﺑﺘﻼﻉ‪ .‬ﻛﻤﺎ ﺃﻧﻪ ﻳﺴﺘﺨﺪﻡ ﻛﻤﺒﻴﺪ ﻟﻠﻄﺤﺎﻟﺐ ‪ ،‬ﻭﻣﺒﻴﺪ ﻟﻠﻔﻄﺮﻳﺎﺕ ﺍﻟﺰﺭﺍﻋﻴﺔ ‪ ،‬ﻭﻣﺒﻴﺪ ﻟﻸﻋﺸﺎﺏ‪.‬‬

‫‪.3‬ﻛﺒﺮﻳﺘﺎﺕ ﺍﻟﺰﻧﻚ )‪ ،4ZnSO‬ﻣﺤﻠﻮﻝ ‪(٪1‬‬

‫ﺇﻧﻪﻣﻘﻴﺊ ﺳﺮﻳﻊ‪ .‬ﻛﻤﺎ ﺃﻧﻪ ﻳﺴﺘﺨﺪﻡ ﻛﻤﻜﻤﻞ ﻏﺬﺍﺉﻲ ﻓﻲ ﺣﺎﻻﺕ ﻧﻘﺺ ﺍﻟﺰﻧﻚ‪.‬‬

‫‪6‬‬
 ‫ﻧﻈﺎﻡﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺍﻟﻤﻘﺎﻳﻴﺲ ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء‬ ‫ﺍﻟﻜﻴﻤﻴﺎءﺍﻟﻄﺒﻴﺔ ‪III‬‬

‫‪.4‬ﻃﺮﻃﺮﺍﺕ ﺃﻧﺘﻴﻤﻮﻥ ﺍﻟﺒﻮﺗﺎﺳﻴﻮﻡ‬

‫ﺇﻧﻪﻣﻘﻴﺊ ﻳﺤﻘﻖ ﻋﻤﻠﻪ ﻣﺒﺎﺷﺮﺓ ﻋﻠﻰ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ .‬ﻻ ﻳﺰﺍﻝ ﻳﺴﺘﺨﺪﻡ ﻛﻤﻌﺮﻕ ﺃﻭ ﻣﻘﺸﻊ ﻓﻲ‬
‫ﻣﺨﺎﻟﻴﻂﺍﻟﺴﻌﺎﻝ‪.‬‬

‫ﻣﻘﻴﺉﺎﺕﺗﻌﻤﻞ ﻣﺮﻛﺰﻳﺎ‬

‫‪.1‬ﺃﺑﻮﻣﻮﺭﻓﻴﻦ‬

‫ﻳﺘﻢﺍﺳﺘﺨﺪﺍﻣﻪ ﻛﻤﻠﺢ ﻫﻴﺪﺭﻭﻛﻠﻮﺭﻳﺪ ﻧﺼﻔﻲ‪.‬‬ ‫•‬

‫ﻳﺘﻢﺍﻟﺤﺼﻮﻝ ﻋﻠﻴﻪ ﻣﻦ ﺗﺴﺨﻴﻦ ﺍﻟﻤﻮﺭﻓﻴﻦ ﻋﻨﺪ ‪ 140‬ﺩﺭﺟﺔ ﻣﺉﻮﻳﺔ ﻣﻊ ‪ ٪35‬ﺣﻤﺾ ﺍﻟﻬﻴﺪﺭﻭﻛﻠﻮﺭﻳﻚ ﺗﺤﺖ ﺍﻟﻀﻐﻂ‪.‬‬ ‫•‬
‫ﺇﻧﻪﻳﻌﻤﻞ ﻣﺒﺎﺷﺮﺓ ﻋﻠﻰ ﻣﻨﻄﻘﺔ ﺍﻟﺰﻧﺎﺩ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪.‬‬ ‫•‬
‫ﻳﺴﺒﺐﺍﻟﻨﺸﻮﺓ ﻭﺍﻟﺮﻋﺸﺔ ﻭﺍﻟﺤﺮﻛﺔ ﺍﻟﻤﺴﺘﻤﺮﺓ ‪ ،‬ﻭﻓﻲ ﻫﺬﻩ ﺍﻟﺤﺎﻟﺔ‬ ‫•‬
‫ﻳﺴﺘﺨﺪﻡﺍﻟﻨﺎﻟﻮﻛﺴﻮﻥ ﻛﻤﻀﺎﺩ‪.‬‬
‫ﺇﻧﻪﻏﻴﺮ ﻓﻌﺎﻝ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻭﻳﺴﺘﺨﺪﻡ ﺗﺤﺖ ﺍﻟﺠﻠﺪ‪.‬‬ ‫•‬
‫• )‪6aR( -6-methyl-5،6،6a، 7-tetrahydro-4‬ﺡ‪-‬‬

‫ﺩﻳﺒﻨﺰﻭ]ﺩﻱ ‪ ،‬ﺯ[ ﻛﻴﻨﻮﻟﻴﻦ ‪-10،11-‬ﺩﻳﻮﻝ‬

‫ﺛﺎﻟﺜﺎ‪.‬ﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﻘﻲء‬

‫ﻣﻀﺎﺩﺍﺕﺍﻟﻘﻲء ﻫﻲ ﺍﻷﺩﻭﻳﺔ ﺍﻟﺘﻲ ﺗﻤﻨﻊ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء‪.‬‬

‫ﺗﺮﻭﺑﺎﻥﻗﻠﻮﻳﺪﺍﺕ ‪A.‬‬

‫ﻳﻤﺎﺭﺳﻮﻥﺗﺄﺛﻴﺮﻫﻢ ﻋﻦ ﻃﺮﻳﻖ ﻣﻨﻊ ﺍﻟﻤﺴﺎﺭﺍﺕ ﺍﻟﻌﺼﺒﻴﺔ ﻣﻦ ﺍﻷﺫﻥ ﺍﻟﺪﺍﺧﻠﻴﺔ ﺇﻟﻰ ﺍﻟﻨﻮﻯ ﺍﻟﺪﻫﻠﻴﺰﻱ ﻭﻣﺮﻛﺰ ﺍﻟﻘﻲء ﻓﻲ‬
‫ﺍﻟﺘﻜﻮﻳﻦﺍﻟﺸﺒﻜﻲ‪.‬‬

‫‪.1‬ﻫﻴﻮﺳﻴﻦ‬

‫• )‪-9- (1R ، 2R ، 4S ، 5S ، 7S‬ﻣﻴﺜﻴﻞ‪-3-‬ﺃﻭﻛﺴﺎ ‪-9-‬ﺁﺯﺍﺗﺮﻳﺴﻴﻜﻠﻮ ]‪-7- yl )2،43.3.1.0‬‬

‫‪-3- (2S[ nonan‬ﻫﻴﺪﺭﻭﻛﺴﻲ‪ -2-‬ﻓﻴﻨﻴﻞ ﺑﺮﻭﺑﺎﻧﻮﺍﺕ‬

‫ﻧﻈﺮﺍًﻷﻥ ﻧﺒﻀﺎﺕ ﺍﻷﺫﻥ ﺍﻟﺪﺍﺧﻠﻴﺔ ﻳﺘﻢ ﺗﻮﺳﻄﻬﺎ ﺑﻮﺍﺳﻄﺔ ﺃﺳﺘﻴﻞ ﻛﻮﻟﻴﻦ ‪ ،‬ﻓﺈﻥ‬ ‫•‬
‫ﺍﻟﻬﻴﻮﺳﻴﻦﻳﻤﺎﺭﺱ ﺗﺄﺛﻴﺮﺍً ﻗﻮﻳﺎً ﻣﻀﺎﺩﺍً ﻟﻠﻘﻰء ﻓﻲ ﺩﻭﺍﺭ ﺍﻟﺤﺮﻛﺔ‪.‬‬
‫ﺇﻧﻪﻟﻴﺲ ﺍﻟﺨﻴﺎﺭ ﺍﻟﺼﺤﻴﺢ ﻟﻌﻼﺝ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء ﺑﺨﻼﻑ ﺩﻭﺍﺭ ﺍﻟﺤﺮﻛﺔ‪.‬‬ ‫•‬

‫‪.2‬ﻫﻴﻮﺳﻴﺎﻣﻴﻦ‬

‫• ])‪-3- (2S( -8-methyl-8-azabicyclo ]3.2.1[ octan-3-yl[ )1S ، 5R‬ﻫﻴﺪﺭﻭﻛﺴﻲ‪-2-‬‬

‫ﻓﻴﻨﻴﻞﺑﺮﻭﺑﺎﻧﻮﺍﺕ‬

‫ﺇﻧﻪﺍﻟﻤﺘﺼﺎﻋﺪ )‪ (L‬ﻣﻦ ﺍﻷﺗﺮﻭﺑﻴﻦ )ﺍﻷﺗﺮﻭﺑﻴﻦ ﻫﻮ ﺧﻠﻴﻂ ﺭﺍﺳﻴﻤﻲ(‪.‬‬ ‫•‬

‫‪7‬‬
 ‫ﻧﻈﺎﻡﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺍﻟﻤﻘﺎﻳﻴﺲ ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء‬ ‫ﺍﻟﻜﻴﻤﻴﺎءﺍﻟﻄﺒﻴﺔ ‪III‬‬

‫ﺏ‪ -1‬ﺍﻟﺨﺼﻮﻡ‬

‫ﻭﻫﻲﻣﻦ ﻣﺸﺘﻘﺎﺕ ﺍﻟﺒﻨﺰﻫﻴﺪﺭﻳﻞ ﻭﺗﺴﺘﺨﺪﻡ ﻓﻲ ﺍﻟﻮﻗﺎﻳﺔ ﻭﺍﻟﻌﻼﺝ ﻣﻦ ﺩﻭﺍﺭ ﺍﻟﺤﺮﻛﺔ‪.‬‬ ‫•‬

‫ﻳﺘﻢﺃﺧﺬﻫﻢ ﺳﺎﻋﺔ ﻭﻧﺼﻒ ﻗﺒﻞ ﺍﻟﺮﺣﻠﺔ‪ .‬ﺗﺘﻜﺮﺭ ﺍﻟﺠﺮﻋﺔ ﻛﻞ ‪ 4‬ﺳﺎﻋﺎﺕ‪.‬‬ ‫•‬

‫ﻳﻌُﺘﻘﺪﺃﻥ ﻫﺬﻩ ﺍﻟﻤﺮﻛﺒﺎﺕ ﻟﻬﺎ ﺗﺄﺛﻴﺮﻫﺎ ﻓﻲ ﺍﻷﺫﻥ ﺍﻟﺪﺍﺧﻠﻴﺔ‪.‬‬ ‫•‬

‫‪.1‬ﺩﻳﻤﻴﻨﻬﻴﺪﺭﻳﻨﺎﺕ‬

‫‪)-2‬ﺛﻨﺎﺉﻲ ﻓﻴﻨﻴﻞ ﻣﻴﺜﻮﻛﺴﻲ( ‪-‬ﻥ ‪ ،‬ﻥ‪-‬ﺩﻳﻤﻴﺜﻴﻞ ﺇﻳﺜﻴﻞ ﺃﻣﻴﻦ‬ ‫•‬

‫‪-8‬ﻛﻠﻮﺭﻭﺛﻮﻓﻴﻠﻠﻴﻨﺎﺕ‬
‫ﻭﻫﻮﻣﻠﺢ ‪-8‬ﻛﻠﻮﺭﻭﺛﻴﻮﻓﻴﻠﻴﻦ ﻣﻦ ﺩﻳﻔﻴﻨﻬﻴﺪﺭﺍﻣﻴﻦ‪.‬‬ ‫•‬
‫ﺡ‪ -1‬ﺍﻟﻌﺪﺍء ﻓﻲ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺪﻫﻠﻴﺰﻱ ← ﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﺪﺍء‪.‬‬ ‫•‬
‫ﺧﺼﺎﺉﺼﻪﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﻤﺴﻜﺎﺭﻳﻦ ﺗﻌﺰﺯ ﻓﻌﺎﻟﻴﺘﻪ‪.‬‬

‫‪-8‬ﻛﻠﻮﺭﻭﺛﻴﻮﻓﻴﻠﻴﻦ ← ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﺍﻟﻤﺜﻴﺮﺓ )ﺣﺼﺎﺭ ﻣﺴﺘﻘﺒﻼﺕ ﺍﻷﺩﻳﻨﻮﺯﻳﻦ‬ ‫•‬

‫( ﻣﺜﻞ ﺍﻟﻬﻠﻮﺳﺔ ﻭﺍﻹﺛﺎﺭﺓ‪.‬‬

‫‪.2‬ﻣﻴﻜﻠﻴﺰﻳﻦ‬

‫ﺑﻴﺒﻴﺮﺍﺯﻳﻦ (‪1- )p-Chlorobenzhydryl( -4- )m-methylbenzyl‬‬ ‫•‬

‫‪.3‬ﻛﻠﻮﺭﻓﻴﻨﻮﻛﺴﺎﻣﻴﻦ‬

‫• }‪-4) -1] -2‬ﻛﻠﻮﺭﻭﻓﻴﻨﻴﻞ( ‪ -1-‬ﻓﻴﻨﻴﻠﺜﻮﻛﺴﻲ[ ﺇﻳﺜﻴﻞ{ ﺛﻨﺎﺉﻲ ﻣﻴﺜﻴﻞ ﺃﻣﻴﻦ‬

‫ﺍﻟﻔﻴﻨﻮﺛﻴﺎﺯﻳﻨﺎﺕ ‪C.‬‬

‫ﻣﺸﺘﻘﺎﺕﺍﻟﻔﻴﻨﻮﺛﻴﺎﺯﻳﻦ ﺍﻟﻤﺴﺘﺒﺪﻟﺔ ﺑﺒﻴﺒﺮﺍﺯﻳﻦ ﻣﺜﻞ ﺍﻟﺒﻴﺮﻓﻴﻨﺎﺯﻳﻦ ﻫﻲ ﻣﻀﺎﺩ ﻟﻠﻘﻰء‪.‬‬ ‫•‬

‫ﺗﻈﻬﺮﺁﺛﺎﺭﻫﺎ ﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﻘﻰء ﻋﻦ ﻃﺮﻳﻖ ﻣﻨﻊ ﻣﺴﺘﻘﺒﻼﺕ ﺍﻟﺪﻭﺑﺎﻣﻴﻦ ﻓﻲ ﻣﻨﻄﻘﺔ ﺑﻮﺳﺘﺮﻳﻤﺎ‪.‬‬ ‫•‬

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 ‫ﻧﻈﺎﻡﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺍﻟﻤﻘﺎﻳﻴﺲ ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء‬ ‫ﺍﻟﻜﻴﻤﻴﺎءﺍﻟﻄﺒﻴﺔ ‪III‬‬

‫ﺩ‪.‬ﻣﺸﺘﻘﺎﺕﺑﻨﺰﺍﻣﻴﺪ ﻭﺑﻨﺰﻳﻤﻴﺪﺍﺯﻭﻟﻮﻥ‬

‫ﻣﺸﺘﻘﺎﺕﺑﻨﺰﺍﻣﻴﺪ ﻭﺑﻨﺰﻳﻤﻴﺪﺍﺯﻭﻟﻮﻥ ﺗﻌﻤﻞ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ ﻣﺴﺘﻘﺒﻼﺕ ﺍﻟﺪﻭﺑﺎﻣﻴﻦ ﻓﻲ ﻣﻨﻄﻘﺔ‬ ‫•‬

‫ﺑﻮﺳﺘﺮﻳﻤﺎ ‪،‬ﻭﺧﺎﺻﺔ ﺩ‪2.‬ﻧﻮﻉ ﻓﺮﻋﻲ‪.‬‬
‫ﻫﺬﻩﺍﻟﻤﺠﻤﻮﻋﺔ ﻣﻦ ﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء ﻟﻴﺴﺖ ﻓﻌﺎﻟﺔ ﺑﻤﺎ ﻳﻜﻔﻲ ﻓﻲ ﺩﻭﺍﺭ ﺍﻟﺤﺮﻛﺔ‪.‬‬ ‫•‬
‫ﻳﺘﻢﺍﺳﺘﺨﺪﺍﻣﻬﺎ ﻟﺘﻐﻴﺮﺍﺕ ﺍﻟﺤﺮﻛﺔ ﻓﻲ ﺍﻟﻤﻌﺪﺓ ﻛﻤﻨﺸﻄﺎﺕ ﺗﻤﻌﺠﻴﺔ ﻭﻋﻮﺍﻣﻞ ﻣﻀﺎﺩﺓ ﻟﻠﻘﻰء ﻟﻌﺴﺮ ﺍﻟﻬﻀﻢ‬ ‫•‬
‫ﻭﻋﺴﺮﺍﻟﻬﻀﻢ ﻭﺁﻻﻡ ﺷﺮﺳﻮﻓﻲ ﻭﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء‪.‬‬

‫ﺗﺸﺘﻤﻞﻣﺸﺘﻘﺎﺕ ﺍﻟﺒﻨﺰﺍﻣﻴﺪ ﻋﻠﻰ ﻣﻴﺘﻮﻛﻠﻮﺑﺮﺍﻣﻴﺪ ﻭﺑﺮﻭﻣﻮﺑﺮﺍﻳﺪ ﻭﺗﺮﻳﻤﻴﺜﻮﺑﻨﺰﺍﻣﻴﺪ‪.‬‬ ‫•‬

‫ﺩﻭﻣﺒﻴﺮﻳﺪﻭﻥﻣﺸﺘﻖ ﻣﻦ ﺑﻨﺰﻳﻤﻴﺪﺍﺯﻭﻟﻮﻥ‪.‬‬ ‫•‬

‫‪.1‬ﻣﻴﺘﻮﻛﻠﻮﺑﺮﺍﻣﻴﺪ‬

‫ﻭﻫﻮﻋﺎﻣﻞ ﺣﺮﻛﻲ ﻣﻌﺪﻱ ﻳﺴﺘﺨﺪﻡ ﻓﻲ ﻋﻼﺝ ﻣﺮﺽ ﺍﻟﺠﺰﺭ ﺍﻟﻤﻌﺪﻱ ﺍﻟﻤﺮﻳﺉﻲ ‪ ،‬ﻭﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻟﻐﺜﻴﺎﻥ‬ ‫•‬
‫ﻭﺍﻟﻘﻲء)ﻣﺜﻞ ﺧﺰﻝ ﺍﻟﻤﻌﺪﺓ ﺍﻟﺴﻜﺮﻱ( ‪ ،‬ﻭﻟﺘﺤﻔﻴﺰ ﺇﻓﺮﺍﻍ ﺍﻟﻤﻌﺪﺓ‪.‬‬

‫ﻻﻳﺰﻳﺪ ﻣﻦ ﺇﻓﺮﺍﺯ ﺣﻤﺾ ﺍﻟﻤﻌﺪﺓ‪.‬‬ ‫•‬

‫‪90٪‬ﻳﻤﺘﺺ ﺷﻔﻮﻳﺎ ‪ ،‬ﺭ‪ 2.5-5.51/2‬ﺳﺎﻋﺔ ‪ ،‬ﺣﻮﺍﻟﻲ ‪ ٪40‬ﻳﺮﺗﺒﻂ ﺑﺒﺮﻭﺗﻴﻨﺎﺕ ﺍﻟﺒﻼﺯﻣﺎ‪.‬‬ ‫•<‬

‫‪.2‬ﺩﻭﻣﺒﻴﺮﻳﺪﻭﻥ‬

‫ﺇﻧﻪﻳﺴﺮﻉ ﺍﻟﺘﻤﻌﺞ ﺍﻟﻤﻌﺪﻱ ﺍﻟﻤﻌﻮﻱ ‪ ،‬ﻭﻳﺴﺒﺐ ﺇﻃﻼﻕ ﺍﻟﺒﺮﻭﻻﻛﺘﻴﻦ ‪ ،‬ﻭﻳﺴﺘﺨﺪﻡ ﻛﻤﻀﺎﺩ ﻟﻠﻘﻰء ﻭﺃﺩﺍﺓ‬ ‫•‬
‫ﻓﻲﺩﺭﺍﺳﺔ ﺁﻟﻴﺎﺕ ﺍﻟﺪﻭﺑﺎﻣﻴﻦ‪.‬‬
‫ﻟﻌﻼﺝﻋﺴﺮ ﺍﻟﻬﻀﻢ ﻭﺣﺮﻗﺔ ﺍﻟﻤﻌﺪﺓ ﻭﺍﻷﻟﻢ ﺍﻟﺸﺮﺳﻮﻓﻲ ﻭﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء‪.‬‬ ‫•‬

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 ‫ﻧﻈﺎﻡﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺍﻟﻤﻘﺎﻳﻴﺲ ﻭﻣﻀﺎﺩﺍﺕ ﺍﻟﻘﻲء‬ ‫ﺍﻟﻜﻴﻤﻴﺎءﺍﻟﻄﺒﻴﺔ ‪III‬‬

‫‪93٪‬ﻳﻤﺘﺺ ﺷﻔﻮﻳﺎ ‪ ،‬ﺭ‪ 7.51/2‬ﺳﺎﻋﺔ ‪ ،‬ﺣﻮﺍﻟﻲ ‪ ٪93-91‬ﻳﺮﺗﺒﻂ ﺑﺒﺮﻭﺗﻴﻨﺎﺕ ﺍﻟﺒﻼﺯﻣﺎ‪.‬‬ ‫•‬

‫ﻣﻀﺎﺩﺍﺕ‪-5‬ﻫﻴﺪﺭﻭﻛﺴﻲ ﺗﺮﻳﺒﺘﺎﻣﻴﻦ‬

‫‪-5‬ﻫﻴﺪﺭﻭﻛﺴﻲ ﺗﺮﻳﺒﺘﺎﻣﻴﻦ )‪ (3HT-5‬ﺍﻟﻤﻀﺎﺩﺍﺕ ﻣﻔﻴﺪﺓ ﺟﺪﺍً ﻭﻓﻌﺎﻟﺔ ﻓﻲ ﻋﻼﺝ ﺍﻟﻘﻲء ﺍﻟﻨﺎﺗﺞ ﻋﻦ ﺗﺜﺒﻴﻂ ﺍﻟﺨﻼﻳﺎ ﺃﻭ‬
‫ﺍﻹﺷﻌﺎﻉ‪.‬‬

‫‪.1‬ﺃﻭﻧﺪﺍﻧﺴﻴﺘﺮﻭﻥ‬

‫ﻳﺴﺘﺨﺪﻡﺃﻭﻧﺪﺍﻧﺴﻴﺘﺮﻭﻥ ﻟﻤﻨﻊ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء ﺍﻟﻤﺮﺗﺒﻂ ﺑﺎﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻟﻠﺴﺮﻃﺎﻥ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪.‬‬ ‫•‬

‫ﻳﻈﻬﺮﺍﻟﻨﺸﺎﻁ ﺍﻟﻤﺮﻛﺰﻱ ﻭﺍﻟﻤﺤﻴﻄﻲ‪.‬‬ ‫•‬

‫ﻳﺒﺪﻭﺃﻥ ﺍﻟﻘﻲء ﺍﻟﺬﻱ ﻳﺤﺪﺙ ﺃﺛﻨﺎء ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻧﺎﺗﺞ ﻋﻦ ﺇﻓﺮﺍﺯ ﺍﻟﺴﻴﺮﻭﺗﻮﻧﻴﻦ ﻣﻦ ﺧﻼﻳﺎ‬ ‫•‬
‫ﺍﻷﻣﻌﺎءﺍﻟﻤﻌﻮﻳﺔ‪ .‬ﻳﻌﻤﻞ ﺃﻭﻧﺪﺍﻧﺴﻴﺘﺮﻭﻥ ﻋﻦ ﻃﺮﻳﻖ ﻣﻨﻊ ﺍﻟﻨﻬﺎﻳﺎﺕ ﺍﻟﻌﺼﺒﻴﺔ ﻓﻲ ﺍﻷﻣﻌﺎء ‪ ،‬ﻣﻤﺎ ﻳﻘﻄﻊ‬
‫ﺗﺪﻓﻖﺍﻟﻨﺒﻀﺎﺕ ﺇﻟﻰ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪.‬‬

‫ﻓﻴﺘﺎﻣﻴﻦﺏ ‪) 6‬ﺑﻴﺮﻳﺪﻭﻛﺴﻴﻦ ﻫﻴﺪﺭﻭﻛﻠﻮﺭﻳﺪ(‬

‫‪-5‬ﻫﻴﺪﺭﻭﻛﺴﻲ ‪-6-‬ﻣﻴﺜﻴﻞ‪-3،4-‬ﺑﻴﺮﻳﺪﻳﻨﺪﻳﻤﻴﺘﺎﻧﻮﻝ ﻫﻴﺪﺭﻭﻛﻠﻮﺭﻳﺪ‪.‬‬ ‫•‬

‫ﺍﻟﺪﻭﺍءﺍﻟﻤﻔﻀﻞ ﻟﻌﻼﺝ ﺍﻟﻐﺜﻴﺎﻥ ﻭﺍﻟﻘﻲء ﺍﻟﻤﺮﺗﺒﻄﻴﻦ ﺑﺎﻟﺤﻤﻞ‪.‬‬ ‫•‬

‫ﺩﻛﺘﻮﺭﺳﺎﻡ ﺩﻭﺑﺎ ﻓﺎﺭﻡ‪ .‬ﺗﺸﻴﻢ‪ .‬ﺩﻛﺘﻮﺭﺍﻩ‪.‬‬

‫ﺍﻟﻤﺮﺍﺟﻊ‪ .Akgün et al .1:‬ﻓﺎﺭﻣﺎﺳﻮﺗﻴﻚ ﻛﻴﻤﻴﺎ ؛‬
‫؛‪2. Drugbank.com‬‬
‫‪https://pubchem.ncbi.nlm.nih.gov3. Pubchem‬؛‬
‫‪4. Wilson & Gisvold's، Textbook of Organic Medical Medical and Pharmaceutical Chemistry، 12th edn.‬‬
‫ﺍﻟﺒﺮﻣﺠﻴﺎﺕ‪ChemDraw 12 .1:‬؛‬
‫‪2. ChemSketch‬‬

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