عوارض جانبی داروهای گوارشی
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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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عوارض جانبی داروهای گوارشی

دکتر محمد طاهر بروشکی

گروه فارماکولوژی

دانشکده پزشکی مشهد

1389


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گروههای دارویی

H2- بلوکرها آنتی کولینرژیکها

مهار کننده های پمپ پروتون آنتی اسیدها

آنتی کولینرژیکها ملین ها

داروهای پروکینتیک کلپرمین


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Histamine H2-AntagonistsH2- Blockers


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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 جانبي مهمcimetidine, 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 جانبي مهم

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 جانبي مهم

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 جانبي مهم

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,


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Nizatidine جانبي مهم

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


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Nizatidine جانبي مهم

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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….. جانبي مهمNizatidine

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


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Proton Pomp Inhibitors جانبي مهم(PPIs)

Omeprazole

Lansoprazole

Rabeprazole

Pantoprazole


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Omeprazole جانبي مهم

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 جانبي مهم

This medication may affect the results of certain lab tests

(pantoprazole can cause a false positive for THC)


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جانبي مهمLansoprazole

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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جانبي مهمRabeprazole

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


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Prokinetic جانبي مهم drugs


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متوكلوپراميد جانبي مهم

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 جانبي مهم

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


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جانبي مهمDomperidone

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 جانبي مهم

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).


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جانبي مهمColpermin

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


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Misoprostol جانبي مهم

Adverse Effects

The commonest adverse effect of misoprostol is diarrhoea.

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


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…. جانبي مهمMisoprostol

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.


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آنتي كولينرژيكها جانبي مهم

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


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عوارض جانبي آنتي كولينرژيكها جانبي مهم

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


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Antacids جانبي مهم

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.


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…. Antacids جانبي مهم

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


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…. Antacids جانبي مهم

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


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Laxatives جانبي مهم(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.


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Health consequences of laxative abuse جانبي مهم

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.