THUC IU TR LOT D

DY-T TRNG
Phan Th Nh Qunh, MSc.
B mn Ha Dc

Khoa Dc, i hc Y Dc Hu

I CNG

Nguyn nhn lot d dy - t trng:

Mt

cn bng ga yu t gy lot (HCl, pepsin) v yu

t chng lot (cht nhy nim mc v s ti sinh ca
t bo biu m)
Nhim vi khun Helicobacter pylori, vi khun lm
tn thng mng nhy

I CNG

C s ca cch iu tr:
Ci

v:

thin cn bng gia yu t tn cng v yu t bo

Hn ch yu t gy lot: gim nng ion H+

Gia tng s bo v nh cc cht bo v mng nhy

Loi

tr vi khun Helicobacter pylori

Tc ng ca cc thuc dng trong iu tr:

Gim

au
Gia tng s lnh so
Phng nga bin chng
Gim ti pht

I CNG
Phn loi

Thuc tng
cng yu t
bo v

Thuc hn ch
yu t gy lot

Thuc khng tit

tc ng tng qut

Thuc khng acid

dch v tc ng
ti ch

Thuc khng
cholin

Anionic

Thuc i khng
ti th th H2 ca
histamin

Cationic

Thuc c ch bm
proton

Thuc tr nhim
khun
Helicobacter
pylori

Thuc tng ti
mu d dy, tng
tit nhy

Hai KS v mt
thuc lm lnh vt
lot

Thuc bo v nim
mc

Hai KS v mt
khng tit

CC THUC I KHNG TI TH
TH HISTAMIN H2

THUC KHNG HISTAMIN H2

C ch tc dng:
i

khng cnh tranh thun nghch vi histamin ti

receptor H2

Dc ng hc:
Hp

thu: nhanh rut

Chuyn ha: qua gan

Cimetidin, ranitidin, famotidin chuyn ha qua gan ln u

(SKD 50%)
Nizatidin t b chuyn ha ln u (SKD 100%)

Thi

tr: qua thn

THUC KHNG HISTAMIN H2

Tc ng dc lc:
c

ch receptor H2: gim tit dch v acid c kch

thch bi histamin, gastrin, kch thch ph v

Tc

ng khng lin quan n c ch receptor H2:

c ch enzym chuyn ha thuc Cyt. P450
Cimetidin c ch mnh
Ranitidin t tc ng
Famotidin, nizatidin khng tc ng

THUC KHNG HISTAMIN H2

Tng tc thuc:
Gim

hp thu mt s thuc nh ketoconazol do c ch

tit acid
Cimetidin ko di t1/2 ca mt s thuc chuyn ha
qua Cyt P450 nh wafarin, phenytoin, theophyllin,
phenobarbital, do c tc dng c ch h ny
c ch alcol dehydrogenase lm tng hp thu alcol
(tr famotidin)
Cnh tranh bi tit qua ng thn vi mt s thuc
nh procainamid

THUC KHNG HISTAMIN H2

Ch nh:
Tr

chng tro ngc d dy-thc qun (GERD)

Bnh lot d dy
Lot d dy do NSAIDs
Phng nga chy mu d dy do stress

c tnh:
D

dung np
Tc dng ph 1-2%, thng gp: tiu chy, to bn,
chng mt, au u, mt mi, pht ban,
Cimetidin c nhiu tc dng ph nht (5%)

THUC KHNG HISTAMIN H2

Hot cht v tc dng
Cimetidin: c ch cytocrom P450
nh hng n nhiu thuc khc
khi tr liu phi hp
Ranitidin: C i lc vi cytocrom
P450 km cimetidin 4 ln nn nguy
c tng tc thuc rt thp
Famotidin: Thc t khng tng
tc vi cytocrom P450
Nizatidin

Cng thc

CC THUC C CH BM PROTON

THUC C CH BM PROTON (PPI)

C ch tc dng:
c

ch khng thun nghch H+ - K+ ATPase

Dc ng hc:
Hp

thu km khi bng no

T1/2 ngn (1,5h)

Tc ng dc lc:
c

ch tit acid c bn (lc i) v s tit acid do ba

Tc dng ph:
An

ton
Tc dng ph 1-5%: tiu chy, nhc u, au bng

THUC C CH BM PROTON (PPI)

Ch nh:
Tr

chng tro ngc d dy-thc qun (GERD)

Bnh lot d dy do H. pylori
Lot d dy do NSAIDs
Phng nga ti pht chy mu d dy do lot
Tr kh tiu khng do lot
Phng nga chy mu d dy do stress
Hi chng Zollinger Ellison v cc ca tng acid khc

THUC C CH BM PROTON (PPI)

Hot cht v cu to
Omeprazol:
Nhn benzimidazol b th v tr s 5
bi nhm methoxy
Nhn pyridin b th bi methoxy v
tr 4, dimethyl v tr 3 v 5
Lanzoprazol
Nhn pyridin b th bi trifluoroethoxy
v tr 4, methyl v tr 3
Pantoprazol
Nhn benzimidazol b th v tr s 5
bi nhm difluoromethoxy
Nhn pyridin b th bi methoxy v
tr 3 v 4

Cng thc

CC THUC KHNG ACID

THUC KHNG ACID (ANTACID)

C ch tc dng:
Trung

ha acid dch v: Cc antacid l cc base yu

phn ng vi HCl dch v to mui v nc
Do lm tng pH dch v nn cng ng thi c ch
hot tnh pepsin, lm mnh thm hng ro cht nhy
c ch H. pylori

Dc ng hc:
Mc

hp thu khc nhau:

NaHCO3 v Na2C2O4 khng b trung ha hp thu hon ton

nhim kim tm thi
Al3+, Mg2+, Ca2+ hp thu km hn

THUC KHNG ACID (ANTACID)

Thnh phn v tc dng ph:

Thnh phn

Kh nng trung

Tc dng ph

NaHCO3

Cao

Nhim kim ton thn, gi

nc

CaCO3

Trung bnh

Tng calci huyt, si thn,

hi chng sa-kim

Al(OH)3

Cao

To bn, gim phosphat

huyt

Mg(OH)2

Cao

Tiu chy, tng magie

huyt (BN suy thn)

ha acid

THUC KHNG ACID (ANTACID)

Ch nh:
Lm

gim triu chng lot d dy: gim au, chua,

kh tiu
Ung 1-3h sau n v trc khi i ng

Chng ch nh-thn trng:

Cc

antacid c cha Ca v Mg: Thn trng khi c

bnh thn nng
Antacid c NaHCO3: CC khi c tng HA, suy tim
sung huyt, bnh thn nng v ph
Antacid c Al: Trnh s dng lu di, thn trng khi
c mt nc hoc nghn rut, suy thn
Thn trng vi ngi cao

THUC KHNG ACID (ANTACID)

Tng tc thuc:
Cn

tr cc thuc cn mi trng acid dch v hp

thu: digoxin, phenytoin, isoniazid, ketoconazol, thuc
bao tan rut
Antacid cha cc ion ha tr 2,3 s to ni chelat lm
gim hp thu mt s thuc nh ciprofloxacin,
tetracyclin
Antacid c nhm (tr nhm phosphat) to mui
khng tan vi phospho lm gim phospho huyt
khng dng chung vi sucralfat

THUC BO V NIM MC D DY

THUC BO V NIM MC D DY
Sucralfat hay aluminum
Hp cht bismuth
Misoprostol

SUCRALFAT
L mt disaccharid sulfat ha
C ch tc dng:

To

hng ro bo v
Kch thch thnh lp prostaglandin v NaHCO3

Tc dng ph:
t

tc dng ph v khng hp thu qua rut

To bn, kh ming
Dng lu di lm gim phosphat huyt

Tng tc thuc:
Lm

gim SKD ca phenytoin, theophyllin, quinin,

amitriptylin, ketoconazol, L thydroxin

HP CHT BISMUTH
Bismuth subsalicylat, Tripotassium dicitrato
bismuthat
C ch tc dng:

Bo

v ti ch
Kch thch tng hp prostaglandin
c ch H. pylori

Tc dng ph:
Dng

lu di b bnh no, lon dng xng, en vm

ming do tng Bi3+ trong mu

Suy thn lm gim o thi bismuth thn trng vi

ngi suy thn v ngi ln tui

MISOPROSTOL

L dn xut methyl ca prostaglandin E2

C ch tc dng:
Kch
Duy

thch tit dch nhy v NaHCO3

tr lu lng mu n nim mc d dy
Gim sn xut histamin gim tit H+

Tc dng ph:
au

bng, tiu chy (30% BN), chut rt

Chng ch nh:
Thai

k (v co c t cung gy sy thai)
Antacid c Mg

THANK YOU!