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Farmacologie > Terapia UGD si BRGE > Flashcards

Terapia UGD si BRGE Flashcards

1
Q

IPP - reprezentanti

A 
Omeprazol
Esomeprazol
Lansoprazol
Pantoprazol
Rabeprazol
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2
Q

Mecanism de actiune IPP

A

blocarea ireversibila a ATPazei H+/K+ dependente prin legarea covalenta de enzima

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3
Q

Activare IPP

A

Promedicamente - dupa absorbtie, se concentreaza in in canaliculele secretorii ale cel parietale (mediu acid) unde sunt transformare in sulfenamide tetraciclice care se leaga de pompa de protoni

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4
Q

Indicatii IPP

A

Ulcer gastro-duodenal
BRGE
Sindrom Zollinger-Ellison (de electie)
Eradicarea HP

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5
Q

Administrarea IPP

A

Oral - dimineata cu 30 min inainte de masa

Parenteral

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6
Q

Farmacocinetica IPP

A

Absorbtie buna dupa admin orala
Metabolizare extensiva hepatica (CYP2C19, CYP3A4)
Eliminare renala sau prin scaun (lansoprazol)

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7
Q

Reactii adverse IPP

A

Mascheaza simptomatologia cancerului gastric
Hipomagneziemie
Hipergastrinemie
Hipersecretie acida de rebound la intreruperea brusca a tratamentului
Creste riscul de infectii pulmonare si digestive cu C diff
Creste incidenta fracturii de col femural la femei

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8
Q

Interactiuni medicamentoase IPP

A

Datorita metabolizarii prin sist CYP450 - warfarina, diazepam, ciclosporina, fenitoina, teofilina
Scaderea aciditatii gastrice - diminua abs ketoconazol, Fe, ampicilina, digoxin
Scade ef antiagregant al clopidogrelului

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9
Q

Antagonisti H2 reprezentanti

A

Cimetidina
Famotidina
Ranitidina
Nizatidina

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10
Q

Antagonistii H2 - mecanism de actiune

A

Blocarea competitiva a R H2 pentru His -> impiedica efectele excito-secr gastrice ale His

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11
Q

Indicatii anti-H2

A

UGD
BRGE, esofagita de reflux
Sindrom Zollinger Ellison
Tratamentul de intretinere si prevenirea recurentelor in UGD

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12
Q

Farmacocinetica anti-H2

A 
Administrare orala, abs buna, Bd medie
Leg P plasmatice mica
Metab hep redusa
Eliminare renala -> ! reducerea dozelor in IR
Trece BFP si in lapte
! TOLERANTA
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13
Q

Reactii adverse - CIMETIDINA

A

Ginecomastie, galactoree, oligospermie si impotenta (blocheaza R androgenici)
Hipersecretie acida de rebound la intreruperea brusca a tratamentului
Creste riscul evenimentelor toxice prin inhibarea sistemului enzimatic al CYP450

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14
Q

Mecanism de actiune antiacide

A

Neutralizeaza aciditatea (baze slabe), reduc activitatea pepsinei -> actiune simptomatica

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15
Q

Clasificare antiacide

A
  1. SISTEMICE - se absorb, iar la doze mari produc acidoza metabolica
  2. NESISTEMICE - nu se absorb, nu modif ech AB
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16
Q

Farmacocinetica antiacide

A

Administrare orala - Bd cea mai buna pentru formele lichide

Efect prelungit daca sunt administrate dupa masa

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17
Q

Indicatii antiacide

A

Boala ulceroasa
Manifestari sporadice BRGE
Pirozis - tratament simptomatic

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18
Q

Interactiuni medicamentoase antiacide

A

Scad absorbtia medicamentelor administrate simultan - pauza 2h
Scad absorbtia compusilor care necesita mediu acid

19
Q

Hidroxidul de aluminiu - actiune

A

Lenta si durabila - antipeptica (absoarbe si inactiveaza pepsina), leaga acizii biliari, creste eliminarea fecala de fosfati, intarzie golirea stomacului

20
Q

Hidroxid de Al - reactii adverse

A

Constipatie
Carenta de fosfati (tratament cronic)
Fenomene toxice in IR (osteodistrofie + miopatie proximala + encefalopatie)

21
Q

Compusii de magneziu - actiune

A 
rapida, intensa, scurta
Nu se absorb -> saruri insolubile care se elimina prin scaun
Proprietati laxative (asoc cu comp de Al)
22
Q

Carbonatul de calciu - actiune

A

rapida, intensa, durabila
hipersecretie acida de rebound
efect antidiareic

23
Q

Carbonat de Ca - RA

A

Hipercalcemie cronica
Calculoza renala
Constipatie, balonare, flatulenta
Sindrom lapte-alcaline (alcaloza metabolica + hipercalcemie + IR)

24
Q

Bicarbonatul de Na

A

Antiacid sistemic -> prod alcaloza metabolica
Produce distensie gastrica si balonare
CI: IC, HTA, IR

25
Q

Simeticona

A

surfactant cu ef antispumant
scade RGE
reduce balonarea si flatulenta

26
Q

Misoprostol - mecanism de actiune

A

Analog de PGE2 -> scade secretia de HCl, ef citoprotector, amelioreaza circulatie, favorizeaza procesele de vindecare

27
Q

Farmacocinetica misoprostol

A

Absorbtie buna
Metabolizare hepatica
Eliminare renala

28
Q

Indicatii misoprostol

A

ulcere digestive dupa utilizarea AINS

UD

29
Q

Misoprostol - RA

A

Favorizeaza contractia musculaturii netede (efect ocitocic) - diaree (trecatoare), colici, poate declansa avortul sau nasterea prematura

30
Q

Misoprostol - CI

A

Sarcina

31
Q

Sucralfat - mecanism de actiune

A

Zaharoza sulfatata + Al(OH)3 - elibereaza Al, se incarca negativ, se leaga de mucine => gel complex cu rol protect (Adera mai ales de ulcer), leaga SB, ef antiinflamator, creste secr si vascozit mucusului, stimuleaza secr PG

32
Q

Sucralfat - indicatii

A 
UD
gastropatie, UG cu reflux biliar
profilaxia ulcerelor de stres
mucosita orala si proctita post iradiere
ulcere rectale solitare
33
Q

Administrare sucralfat

A

Inainte de masa (30 min - 1h) si seara la culcare (4/zi)

34
Q

RA sucralfat

A

Constipatie

xerostomie, fen toxice, cefalee, greturi, varsaturi, rash, laringospasm

35
Q

CI sucralfat

A

IR - datorita cont de Al

36
Q

Subcitratul de bismut coloidal - actiune

A

Pp in prez HCl -> depozit cristalin pe resturile P de la supraf lez ulceroase (!activ doar in prez nisei ulceroase) cu rol protector
Actiune toxica pe HP

37
Q

Bi subcitrat - RA & CI

A

RA: greturi, innegrirea scaunului
CI: IR, sarcina, asoc cu antiacide/lapte

38
Q

Acidul alginic

A

Efect protector al muc (gel vascos) si adsorbant

I: BRGE, gatrite, ulcer post-AINS

39
Q

Tripla terapie de eradicare a HP

A

Omeprazol (orice alt IPP) + Amoxicilina 2x1000mg + Claritromicina 2x500mg/Metronidazol 2x500 mg
timp de 14 zile

40
Q

Terapia cvadrupla de eradicare a HP

A

IPP + Bismut subcitrat coloidal 4x120 mg + Metronidazol 2x500 mg + Tetraciclina 4x500 mg
timp de 14 zile

41
Q

Terapia secventiala de eradicare a HP

A

IPP + Amoxicilina 2g/zi timp de 5-7 zile
apoi IPP + tinidazol 5-7 zile
apoi IPP + claritromicina 5-7 zile

42
Q

Terapia de intretinere pentru prevenirea activarii ulcerului

A

Antagonisti H2 (Ranitidina, Famotidina, Nizatidina) seara la culcare

43
Q

Tratamentul ulcerelor induse de folosirea medicamentelor (AINS)

A

IPP 40mg + Misoprostol 4x200microg/zi

Farmacologie (8 decks)

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