عوارض جانبی داروهای گوارشی

1. عوارض جانبی داروهای گوارشی دکتر محمد طاهر بروشکی گروه فارماکولوژی دانشکده پزشکی مشهد 1389

2. گروههای دارویی H2- بلوکرها آنتی کولینرژیکها مهار کننده های پمپ پروتون آنتی اسیدها آنتی کولینرژیکها ملین ها داروهای پروکینتیک کلپرمین

3. Histamine H2-AntagonistsH2- Blockers

4. 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

5. 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

6. 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

7. ….. 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

8. 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,

9. 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

10. 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

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

12. Proton Pomp Inhibitors(PPIs) Omeprazole Lansoprazole Rabeprazole Pantoprazole

13. 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

14. Pantoprazole This medication may affect the results of certain lab tests (pantoprazole can cause a false positive for THC)

15. … 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%)

16. … 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

17. Prokinetic drugs

18. 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

19. 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

20. … 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

21. 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).

22. … 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

23. Misoprostol Adverse Effects The commonest adverse effect of misoprostol is diarrhoea. Other gastrointestinal effects include abdominal pain, dyspepsia, flatulence, and nausea and vomiting

24. …. 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.

25. 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

26. 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

27. 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.

28. …. 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

29. …. 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

30. 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.

31. 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.

32. شاد و سلامت باشید