教案chf-du20151.等多个文件peptic ulcer.pptxVIP

Chapter 8DRUGS USED IN PEPTIC ULCER Yan Hua Du, PhD, professor Department of PharmacologyEsophageal ulcerDuodenal ulcerGastricl ulcerWhat is Peptic Ulcer (消化性溃疡)?A peptic ulcer disease is an ulcer (defined as mucosal erosions equal to or greater than 0.5cm) of an area of the gastrointestinal tract exposed to the acid and pepsin secretion.Morbidity: 10%-12%Peptic Ulcers十二指肠溃疡 胃溃疡 Aggressive FactorsH.pylori NSAIDsAcidPepsinSmoking…Defensive FactorsMucusBicarbonateBlood flowProstaglandinsDefensive FactorsMucusBicarbonateBlood flowProstaglandinsAggressive FactorsH.pylori NSAIDsAcidPepsinSmoking…Pathophysiology Disruption of balance between Aggressive factors and Defensive factorsWhat is the cause of Peptic ulcers? Helicobacter pylori(幽门螺旋杆菌) Mucosal resistance to acid ? NSAIDs (非甾体类抗炎药） Ethanol Smoking Severe physiologic stressGastrin-secreting tumors (Zollinger-Ellison syndrome,卓-艾综合征)H. pyloriAcid-peptic ulcer with H. pylori colonizationH. pyloriGastritisPeptic ulcersGastric adenocarcinoma Who are they ?Nobel prize Medicine – 2005 Discovery of H.pylori its role in ulcerBarry J MarshallJ. Robin WarrenDrug Therapeutic Strategies For PUD↓ Aggressive factors Neutralizing over-secretion of acid Blocking acid secretion H2, M3 and G antagonists (receptor blockers). Eradication of H. pylori (antibiotics)↑Defense factors Repair mucosaEnhance mucosal protection and alkaline barrier (Sucralfate,硫糖铝；Bismuth,铋剂）++Ach，乙酰胆碱++_+Histamine, 组胺+Prostaglandin, 前列腺素Gastrin，胃泌素 Gastric acid secretion(胃酸分泌）AntacidsM3H+ H+Ca2+H2H+,K+-ATPaseProton Pump(质子泵）cAMPPCa2+K+GGastric LumenParietal cellAll Antacids are OTC drugs.Antacids (抗酸药）-The oldest RemedyPrototype:Aluminium Hydroxide（氢氧化铝） Magnesium Hydroxide （氢氧化镁）Calcium Carbonate (碳酸钙)Mechanism of action:weak bases, Neutralize secreted acid rapidly. Adverse effects:Al salts cause constipation.Mg salts cause diarrhea. Ca salts cause acid rebound. AnticholinergicsInhibited by PPIsAchH2 antagonists+++Histamine_Misoprostol，米索前列醇+PG+GastrinPr