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عوارض جانبی داروهای گوارشی. دکتر محمد طاهر بروشکی گروه فارماکولوژی دانشکده پزشکی مشهد 1389. گروههای دارویی. H2 - بلوکرها آنتی کولینرژیکها مهار کننده های پمپ پروتون آنتی اسیدها آنتی کولینرژیکها ملین ها داروهای پروکینتیک کلپرمین. Histamine H 2 -Antagonists H 2 - Blockers .

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slide1

عوارض جانبی داروهای گوارشی

دکتر محمد طاهر بروشکی

گروه فارماکولوژی

دانشکده پزشکی مشهد

1389

slide2

گروههای دارویی

H2- بلوکرها آنتی کولینرژیکها

مهار کننده های پمپ پروتون آنتی اسیدها

آنتی کولینرژیکها ملین ها

داروهای پروکینتیک کلپرمین

slide4

مصرف از راه خوراكي، عدم عارضه جانبي مهم

به جز سايمتيدين:

ژينكوماستي (دوز بالا)

كاهش قواي جنسي در مردان (تغيير در متابوليسم

استروژن)، مهار آنزيمهاي سيتوكروم

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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

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Ranitidine

Adverse Effects (mainly by parentral forms)

Effects on the cardiovascular system:. Bradycardia, AV block and cardiac arrest has been reported .

Also a +veinotropic effect.

Effects on the endocrine system: gynaecomastia, loss of libido, and impotence less than cimetidine

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….. 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

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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,

slide9

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

slide10

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

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….. Nizatidine

Nizatidine is considered to have little or no anti-androgenic activity although there are isolated reports of gynaecomastia and impotence

slide12

Proton Pomp Inhibitors(PPIs)

Omeprazole

Lansoprazole

Rabeprazole

Pantoprazole

slide13

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 difficile-associated diarrhea

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Pantoprazole

This medication may affect the results of certain lab tests

(pantoprazole can cause a false positive for THC)

slide15

… 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%)

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… 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

slide18

متوكلوپراميد

آنتاگونيست دوپامين است:

بروز عوارض اكستراپيراميدال

افزايش حركات قسمت فوقاني دستگاه گوارش

اثر آن با آنتي كولينرژيكها آنتاگونيزه مي شود

بعنوان افزايش دهنده ترشح شير

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Cisapride

جانشين متوكلوپراميد، بدون عوارض مركزي

تحریک گیرنده های 5-HT4 و افزایش cAMP

عوارض:

ایجاد آریتمی جدی و گاها کشنده قلبی شامل؛

تاکیکاردی بطنی و فیبریلاسیون بطنی

slide20

… 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

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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).

slide22

… 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

slide23

Misoprostol

Adverse Effects

The commonest adverse effect of misoprostol is diarrhoea.

Other gastrointestinal effects include abdominal pain, dyspepsia, flatulence, and nausea and vomiting

slide24

…. 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.

slide25

آنتي كولينرژيكها

مصرف اين داروها به دليل ايجاد خشكي دهان و

كاهش حركات پريستالتيك روده ها محدود شده

هيوسين ان-بوتيل برومايد

دي سيكلومين

پروپانتيلن

كليدينيوم- C

بلادونا پي-بي

slide26

عوارض جانبي آنتي كولينرژيكها

مهمترين عوارض كلاسيك آنتي كولينرژيكها عبارتند از:

تاري ديد، احتباس ادرار، ميدرياز، خشكي دهان، يبوست و تاكيكاردي

علائم مسموميت شديد با آتروپين عبارتست از

قرمزي پوست:ناشي از ديلاتاسيون عروق پوستي

خشكي دهان : ناشي از مهار ترشح بزاق

داغي : ناشي از جلوگيري از تعريق

هيپراكتيويتي : ناشي از تحريك كورتكس مغز

slide27

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.

slide28

…. Antacids

Milk-alkali syndrome,

which is serious toxicity and can be fatal

Aluminum hydroxide:

may lead to the formation of insoluble aluminium-phosphate-complexes, with a risk for hypophosphatemia and osteomalacia

Al(OH)3 + 3HCl →AlCl3 + 3H2O

slide29

…. 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

laxatives also known as purgatives or aperients

Laxatives(also known as purgatives or aperients)

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.

slide31

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.

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