课件：I在肿瘤化疗期间的应用价值.ppt

* * proton pump inhibitors have demonstrated gastric acid suppression superior to that of histamine H2-receptor blockers. Proton pump inhibitors have minimal side effects and few significant drug interactions, and they are generally considered safe for long-term treatment. The proton pump inhibitors omeprazole, lansoprazole, rabeprazole,and the recently approved esomeprazole appear to have similar efficacy. Food and Drug Administration (FDA) approved the newest PPI, esomeprazole (Nexium), in 2001. The success of omeprazole in the clinic can be ascribed to the very effective inhibition of gastric acid secretion achieved through specific inhibition of the gastric H+K+-ATPase.This proton pump is located in the secretory membranes of the parietal cell of the gastric mucosa and constitutes the final step of acid secretion. 洛赛克是质子泵抑制剂，其作用于壁细胞胃酸分泌终末步骤中的关键酶H+-K+-ATP酶，使其不可逆地失活，导致壁细胞内的H+不能转移至胃腔而抑制胃酸分泌，并可增加胃粘膜血流，防止胃粘膜相对缺氧造成胃粘膜损害，并促使消化道粘膜损伤后的修复，从而改善胃部不适症状，改善病人的进食状况，提高生活质量，从而提高病人的化疗依从性。 The pharmacokinetics of esomeprazole are time and dose dependent. These data suggest an increased acid inhibitory effect of esomeprazole compared to omeprazole. * * * * Breakthrough emesis presents a difficult situation as correction of refractory ongoing nausea/vomiting is often challenging to reverse. It isgenerally far easier to prevent nausea/vomiting than to treat it. The general principle of breakthrough treatment is to give an additional agent from a different drug class. No one drug class has been shown to be superior for the management of breakthrough emesis, and the choice of agent should be based on assessment of the current prevention strategies used. Some patients may require several agents utilizing differing mechanisms of action. One should strongly consider routine, around-the-clock administration rather than PRN dosing. The PO route is not likely to be feasible due to ongoing vomiting, therefore, rectal or IV therapy is often required. Multiple concurrent agents, perhaps in alte