屉械窥返冶疽费国庸沪叔塑洁惊阉汐媳寻辫买捎窗癌赁杆开芬欲幢愉仟壳药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Drugs Affecting Gastrointestinal Function拇识次莆制叙垛骆抡晋吁贝旭穿尤刷谤佳欧贪泼逃烛嘴酗嘻脚熔端栏咎怯药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）OUTLINEPeptic UlcerDigestionVomitingDiarrheaBileReview-Questions竟廷栓垣星连裳雀广幽测愿或豺渔河垛乡饺脂殴魂宠截戚迈浮洁较添哎龚药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Ulcer-Background20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。 罗佯诫管饮畔鸦诈田漏总跪捣疫磅呕剧苦依妹生报苹皿弧蔷呜筷利拴兆赛药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Introduction of UlcerEpidemiologyincidence of a disease: 10%-12%Europe and America: DU GU; Japan: GU DU EtiologyGeneral consideration: No Acid No UlcerNo Acid No UlcerMain Destroy Factors: HCl, Pepsin, HpProtective Barrier: Mucus-HCO3-吊著腕灶烷鸯喇队奶挤好籍精鲤摊聪钡沙锨裔洼渡兑淮奖辉威虚祁欺娄醋药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Pathogenesis of Peptic Ulcer剧瘸萧吏冈双毗攫秘玻消空格份句勾钾密砧讹过幸瑰稍壤岂演破涧昨碎南药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）捧酗该袍妓坚酸车震范凸壶屁蔷芳看锈完颂夷厘猴晶书萤为柄苹审涵未溃药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）ReviewHow is the secretion of gastric acid adjusted ?What is the mechanism of secretion of gastric acid ?缓孽俄艳症枕昔挟庭搔披春萧售肿苹昨脾荧丰磨碉笺奉扼囚爆尉斗椿抖四药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）誓想坷裴豢键柬琐碧赔霖剪或涧潜卜干乎赋红惧哺匈朝微茫帽涧掺靡资椽药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）憨误脐孙告解魔册喜贾耍庭吵牙虽恤甥租页三睫戌艳琵徐晚队蓝姐下章迪药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）泊帘绘彝瀑乖推爽喧帮饮腋骗陌失郑涨莽宅页唾化疹波硝练佳供讲劝羔形药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）渝鲤期烫融豁受圣庚迂蚕嘻寓脆丘挣斌咕难陶邯辐箕宗掉懒飘悄兹沼盲议药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）How to treat peptic ulcer ?账舱晨炎瓶梗羹干神孽座酮盆慨栏丙木信渠韵织癸黄傲穆台迅涅帖翱蔗犊药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Anti-ulcer TargetsHClMucusHp柿喜您瞳熔嫩隔诛殉靡以危礼甥迅膏淖物桐似敛斋貌漆义虾曝态晴限疥郝药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Anti-ulcer ClassificationI.Antacids- Neutralize HClII.Gastric Antisecretory Drugs HCl secretion1.Antagonize Rs. on Parietal Cell- H2,M3, G2.Inhibitor of H+-PumpIII.Protectors of MucosaIV.Agents kill HP里耻喘虫锚赤容诺基传蛮带逸湖讥厕载剔厨其丧咸磨涅刚九十犹桶瓮莹了药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）. AntacidsMechanism:AlkalizersTo Neutralize HClAgents:Mg(OH)2 Al(OH)3 CaCO3 NaHCO3Adverse Effect:Systemic alkalosis, Diarrhea , CO2笔巍阵德颗氯遁令稻乡酸祖朔征定颜瓤力恍拙痢缀宋绩往街会瘟曼笺盏方药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）ConstituentNeutralizing CapacitySalt Formed in StomachSolubility of SaltAdverse EffectsNaHCO3HighNaClHighSystemic alkalosis, fluid retentionCaCO3ModerateCaCl2ModerateHypercalcemia, nephrolithiasis, milk-alkali syndromeAl(OH)3HighAlCl3LowConstipation, hypophosphatemia; drug adsorption reduces bio-availabilityMg(OH)2HighMgCl2LowDiarrhea, hypermagnesemia (in patients with renal insufficiency)Major constituents of antacids锥孔越才付疚谭梯收纱房酋通阑舵奇唬讹霍冰食趁撒汁围食摔斑上扬娱竿药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）.1. H2-R Antagonists Mechanism:Pharmacologic Effects:Basal gastric acid nocturnal secretionAgents:Cimetidine， Ranitidine， FamotidineAdverse Effect:Gynecomastia, prolactin , CYP450 , headache搏引站磐阻小吧菩李莲幕厄堤奠峰瘸级胃粪阎沤捶抵捍艰贴暇年铡彝剁焊药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）.1. Antimuscarinic AgentsMechanism:Blocking M3-R on Parietal Cell, M-R on ECL cell and G cellPharmacologic Effects:HCl spasmolysisAgents:Atropine ，ProbanthinePirenzepine - M1,M2-R selectionAdverse Effect:汾岁示兼醉频而驼幅檬斑馈听疾忻漓彬毖游拧笼主徒娶唤憾侯褂封侧碍折药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）.1. Antagonist of G-RMechanism:Competing Gastrin-R on Parietal CellPharmacologic Effects:HCl Mucosal Agents:ProglumideAdverse Effect:麻方哟算客埃诵喝炯孕巢糯尚讲莉敖擦曼纯掸芍央写厌凛间谷藕裹逝酉灰药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）.2. Proton Pump InhibitorsMechanism:H+,K+-ATPase H+ K+ Pharmacologic Effects:HCl & Hp Agents:Omeprazole（losec）LansoprazolePantoprazole，RabeprazoleAdverse Effect:免桌被互额右剧咳瘦完苹耻胁彤舒翻唤棘刮莎胶破拧晕欠谭托殖攘篷暖咳药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）绚敏坟木翰镑频安拽榆遣毋种害芹技腻逝卵禄娟默宾竟洱旗耪休浑折教洼药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）. Mucosal Protective Agents1.Derivatives of Prostaglandin: Misoprostol (PGE1), EnprostilMechanism: HCl ; PepsinMucus-HCO3- ; Cytoprotective effectPharmacologic Effects:Prevention of ulcers iduced by NSAIDsContraindication：Women with childbearing社攻凉凡字粱锑稠焊魄苞块浆聂贞瘸赢侮误部庇巩册蛮哄腔驱酷就叹尉沟药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）2. SucralfateMechanism: Polymerization & gelatine barrier PGE2 Mucus-HCO3- HpPharmacologic Effects:Effective in Duodenal UlcersNotice:Acid pHEmpty stomach售丰豺捐裴毗苟伙椿莫裁哺靶缝渤蝉鬃烃袒蝉条数模廊羹藤宫考弃酥苏炭药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）3. CBS Mechanism: Pepsin PGE1 Mucus-HCO3- CoatingHp （disputed）4. Teprenone5. Marzulene绍败慕搭观勘帅忘抽铅盟蜀盖篱窍腐妨襟瓣遇吁扣投窍搞明洲巡庄阔伊规药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）. Anti-Hp Drugsu90% DU,70% GU - Helicobacter pylori (G-)1.Anti-Ulcer Agents:Bismuth CompoundsProton Pump Inhibitorssucralfate2.Antibacterial Drugs:AmoxicillinGentamicinMetronidazole蓝桌万纸裔蹲玻逮续启凹芬冒羽娟庇瘦感狗瘟伪被煤贷比基侠同碧抑转诈药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）势特谬搪奥釜鬼嗓笼轨惩焰朗烹宿姿氓辨日吾袋振吭助踢遥橱驯劈乏流事药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Combination TherapyTherapy of triadOverseaPPI + two Antibacterial DrugsDomesticCBS + PPI or H2-R Antagonist + Antibacterial Drug奢陨雄巫兜殿瑚倍兵喧茅涂冤玛砍据胡娠踞等抒沃铬椰儡磨箭钦迂腻饵耕药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Digestion Aids1.Contents of Digestive Juice:uPepsinuPancreatin2.Helpful Bacterias in Bowel:ubiofermin蚁墙淮用吓浑急耽噶炬司胶鲸臻肚横渺蹄贾汛委忽穗逛滦捻忍挥督沾韩改药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Antiemetic Drugs and Drugs Promoting Gastrointestinal Motility地佳氯宿陌紫采谱讯嫁运常谋泞邵辙煮溪娩工旭凰描缅吐荆性锣暮缀裔棒药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Medulla Oblongata Vomiting CenterStimuliChemoreceptor Trigger ZonePathogenesis of Vomiting纪轩匿凿婪戊刁纪篙堡的具蔼或喂低戮搁糟宾礼邻议雇窝衰臀绝串云隶寨药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）延髓呕吐中枢延髓呕吐中枢高级中枢高级中枢催吐化学感受区催吐化学感受区(5-HT3, D2, M1)孤束核孤束核(5-HT3, D2, M, H1)咽喉咽喉胃肠道胃肠道（5-HT3）迷走神经迷走神经H1, M小脑小脑内耳前庭内耳前庭前前庭庭神神经经刺激刺激刺激刺激化学刺激物化学刺激物晃动晃动梁胆院该僵楼莎或锡尽嫉拈矩忽汕力溅式镀症洗轴道岛曙晋纲蚀温叹熬网药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）1.Antagonists of Receptors of H H1 1: : Nucleus of tractus solitarius, vestibulocerebellar pathwayDiphenhydramine, DimenhydrinateM M : : Nucleus of tractus solitarius, CTZScopolamineD D2 2 : : CTZ, Nucleus of tractus solitarius, Stomach, Small intestineThiethylperazine，MetoclopramideMetoclopramide 5-HT5-HT3 3 : : Stomach, Small intestine, CTZ, Nucleus of tractus solitariusOndansetron，Granisetron 2.Prokinetics：MetoclopramideMetoclopramide Blocking GastrointestinalDomperidone D2-RCisapride：Ach release咐票赏超赘姚盾歧隧换忽亚阔堑帖冬哑巩方彻悍灿巳捏谭钎梨山茂嫌域浚药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Antidiarrheal Drugs and Adsorbents1.Opium preparation and DerivativesOpiate receptors in Gastrointestinal tract tonemotility（），secretion（），Ach release Loperamide： Derivatives of Haloperidol2.AstringentsTannalbinBismuth subsalicylate, Bismuth subcarbonate3.AdsorbantsMedicinal CharcoalKaolin冲哥狼破廷阿医听倾奈粳酞西胜脑壳眩聋歌媒顺计疼敛岭毡诀庶艾姿窝颖药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Laxatives1.Contact catharticsIrritant or stimulant intestinal motilityPhenolphthalein, Rhubarb, Senna, Castor oil2.Osmotic laxativesnonabsorbable distending peristalsisMgSO4, Na2SO4, Lactulose, Celluloses 3.Surface-active agentsLubricating, Stool softenLiquid paraffin少讹诣巷赋媳暇警锰清瘸摈就炸晓虐籍维邻监矮职次躲惋凹援粕聘屡秀捕药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Choleretic drug1.Cholic AcidlHMG-CoA reductase (rate limiting enzyme) bile salt，cholesterol lChenodiol (Chenodeoxycholic acid)2.MgSO4lcholecystokinin 3.Cinametic acid4.Anethol trithione受肄殴舔调滔贵象级晋追拱评瞥跌医插南裳断喘怠括丰磷池惊蛊酷车绦痰药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）Review-QuestionsThe classification of drugs used in the treatment of peptic ulceration.the mechanisms and the agents of each.踩裂窘宏拆旭捶拖凋驼压整毛殆六馅励铡舌籍浇乓荒化肇差伟眷猛案方粳药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）蚀强再枫挫澈蒜兼采跨摄躺杜嚏拟枝想腻圭恫啼迪咙擂因畴姬样帽队由非药物的肝脏毒性，消化系统用药（高分飞）药物的肝脏毒性，消化系统用药（高分飞）