Transcript عوارض جانبی داروهای گوارشی

‫دکتر محمد طاهر بروشکی‬
‫گروه فارماکولوژی‬
‫دانشکده پزشکی مشهد‬
‫‪1389‬‬
‫آنتی کولینرژیکها‬
‫‪ -H2‬بلوکرها‬
‫مهار کننده های پمپ پروتون آنتی اسیدها‬
‫ملین ها‬
‫آنتی کولینرژیکها‬
‫کلپرمین‬
‫داروهای پروکینتیک‬
‫مصرف از راه خوراكي‪،‬‬
‫به جز سايمتيدين‪:‬‬
‫ژينكوماستي (دوز باال)‬
‫كاهش قواي جنس ي در مردان (تغيیر در متابوليسم‬
‫استروژن)‪ ،‬مهار آنزيمهاي سيتوكروم‬
‫عدم عارضه جانبي مهم‬
Unlike cimetidine, ranitidine does not
seem to affect cytochrome P450 to
any great extent, and therefore is
considered to have little effect on the
metabolism of other drugs
Ranitidine
Adverse Effects (mainly by parentral forms)
Effects on the cardiovascular system:. Bradycardia, AV
block and cardiac arrest has been reported .
Also a +ve inotropic effect.
Effects on the endocrine system: gynaecomastia,
loss of libido, and impotence less than cimetidine
….. Ranitidine
Effects on the nervous system: confusion,
loss of color vision, aggressiveness, lethargy,
somnolence, disorientation, depression,
hallucinations and severe headache,
Effects on the liver: hepatotoxicity
Famotidine
Adverse Effects
Effects on the cardiovascular system: 40 mg daily by
mouth reduced cardiac output and stroke volume.
Also bradycardia and AV block has been reported
Effects on the endocrine system: transient
hyperprolactinaemia and glactorrhoea
Effects on the nervous system: convulsions and mental
deterioration in elderly patients with renal failure,
Nizatidine
Unlike cimetidine, nizatidine does not
seem to affect cytochrome P450 to any
great extent, and therefore is
considered to have little effect on the
metabolism of other drugs
Nizatidine
Adverse Effects
Effects on the cardiovascular system: has been reported
to reduce heart rate, also tachycardia, bradycardia,
orthostatic hypotension and syncope have been reported
rarely with rapid intravenous injection
Some patients taking nizatidine may experience excessive
sweating and urticaria; anaemia may also occur
….. Nizatidine
Nizatidine is considered to have little or no
anti-androgenic activity although there are
isolated reports of gynaecomastia and
impotence
Omeprazole
Lansoprazole
Rabeprazole
Pantoprazole
Omeprazole Side effects
Some of the most frequent side effects of
omeprazole are;
headache, diarrhea, abdominal pain, nausea,
dizziness, trouble awakening and sleep
deprivation
Proton pump inhibitors may be associated with a
greater risk of hip fractures, and clostridium difficileassociated diarrhea
Pantoprazole
This medication may affect the results of
certain lab tests
(pantoprazole can cause a false positive for
THC)
… Lansoprazole Side effects
Infrequent:
dry mouth, insomnia, drowsiness, blurred vision, rash,
pruritus
Rarely and very rarely:
taste disturbance, liver dysfunction, peripheral oedema,
hypersensitivity reactions
Severe:
Gastro-intestinal disturbances (such as nausea
1.3%, abdominal pain 2.1%, diarrhea 3.8%)
… Rabeprazole Side effects
The most common is headache in 2.4% of patients
Diarrhea, vomiting, nausea, abdominal pains,
Constipation, meteorism, dry mouth, increased or
decreased appetite, asthenia, anxiety, vertigo,
Sleeplessness, thrombocytopenia, skin eruption
Granulocytopenia, leukocytopenia, Erythema,
myalgia, arthralgia, muscle or bone pain
Prokinetic drugs
‫متوكلوپراميد‬
‫آنتاگونيست دوپامین است‪:‬‬
‫بروز عوارض اكستراپیراميدال‬
‫افزايش حركات قسمت فوقاني دستگاه گوارش‬
‫اثر آن با آنتي كولينرژيكها آنتاگونیزه مي شود‬
‫بعنوان افزايش دهنده ترشح شیر‬
‫‪Cisapride‬‬
‫جانشین متوكلوپراميد‪ ،‬بدون عوارض مركزي‬
‫تحریک گیرنده های ‪ 5-HT4‬و افزایش ‪cAMP‬‬
‫عوارض‪:‬‬
‫ایجاد آریتمی جدی و گاها کشنده قلبی شامل؛‬
‫تاکیکاردی بطنی و فیبریالسیون بطنی‬
… Domperidone
Adverse Effects
galactorrhoea or gynaecomastia: plasma
prolactin increased
Effects on the cardiovascular system: Sudden
death , ventricular arrhythmias with parenteral
products
Extrapyramidal effects: such as acute dystonic
reactions
Colpermin
Active ingredient: Peppermint oil
Indications And Clinical Uses:
For the symptomatic relief of abdominal pain,
distension, flatulence and gas associated with the
irritable bowel syndrome (IBS).
… Colpermin
Adverse Reactions:
Reactions may include heartburn and hypersensitivity
to peppermint oil or menthol, which is rare and
includes erythematous skin rash, headache,
bradycardia, muscle tremor and ataxia
Not to be used in Children under 15 years of age
Misoprostol
Adverse Effects
The commonest adverse effect of misoprostol is
diarrhoea.
Other gastrointestinal effects include abdominal
pain, dyspepsia, flatulence, and nausea and
vomiting
…. Misoprostol
Increased uterine contractility and abnormal
vaginal bleeding (including menorrhagia and
intermenstrual bleeding) have been reported.
Other adverse effects include skin rashes,
headache, and dizziness. Hypotension is rarely
seen at doses recommended for peptic ulcer
disease.
‫آنتي كولينرژيكها‬
‫مصرف اين داروها به دليل ايجاد خشكي دهان و‬
‫كاهش حركات پريستالتيك روده ها محدود شده‬
‫هيوسین ان‪-‬بوتيل برومايد‬
‫دي سيكلومین‬
‫پروپانتيلن‬
‫كليدينيوم‪C -‬‬
‫بالدونا پي‪-‬بي‬
‫عوارض جانبي آنتي كولينرژيكها‬
‫مهمترين عوارض كالسيك آنتي كولينرژيكها عبارتند از‪:‬‬
‫تاري ديد‪ ،‬احتباس ادرار‪ ،‬ميدرياز‪ ،‬خشكي دهان‪ ،‬يبوست و تاكيكاردي‬
‫عالئم مسموميت شديد با آتروپين عبارتست از‬
‫قرمزي پوست‪ :‬ناش ي از ديالتاسيون عروق پوستي‬
‫خشكي دهان ‪ :‬ناش ي از مهار ترشح بزاق‬
‫داغي ‪ :‬ناش ي از جلوگيري از تعريق‬
‫هيپراكتيويتي ‪ :‬ناش ي از تحريك كورتكس مغز‬
Antacids
Side effects from antacids vary depending
on individual and other medications they
may be taking at the time.
Those who experience side effects most
commonly suffer from changes in bowel
functions, such as diarrhea, constipation,
or flatulence.
…. Antacids
Milk-alkali syndrome,
which is serious toxicity and can be fatal
Aluminum hydroxide:
may lead to the formation of insoluble aluminiumphosphate-complexes, with a risk for
hypophosphatemia and osteomalacia
Al(OH)3 + 3HCl → AlCl3 + 3H2O
…. Antacids
Magnesium hydroxide:
has laxative properties. Magnesium may
accumulate in patients with renal failure
leading to hypermagnesemia, with
cardiovascular and neurological
complications
Mg(OH)2 + 2HCl → MgCl2 + 2H2O
Laxative Abuse:
occurs when a person attempts to get rid of
unwanted calories, lose weight.
laxative abuse is serious and dangerous,
often resulting in a variety of health complications
and sometimes causing life-threatening risks.
Health consequences of laxative abuse
Upset of electrolyte and mineral balances.
Sodium, potassium, magnesium, and phosphorus
Severe dehydration
may cause tremors, weakness, blurry vision, fainting,
kidney damage, and, in extreme cases, death
Internal organ damage
may result, including stretched or “lazy” colon, colon
infection, Irritable Bowel Syndrome, and, rarely, liver
damage. Chronic laxative abuse may contribute to risk of
colon cancer.
‫شاد و سالمت باشید‬