2. scope
1.Anti-emetics drugs; ก ก F
2.Agents for treatment of peptic ulcer : ก
3.Antidiarrheal drugs : ก ก F F
4.Anticonstipation ; กF ก F ก -> laxatives and
cathartics
5.Antiflatulants ; ก F ˂
4. ก F
ก ก F ก ก
F F ก ก ก F ก F ก
2 F ˈ ก2 F ˈ ก
: F( F ) / /
5. ก ก ก F
Cerebral cortex(higher center)
NK1,GABA
Pain,smell,sight,taste→ ←Memory,fear,
hearing,stress,
thinking
Vomit center
H1,5-HT3,D2,M1
CTZ area postrema
D2,NK1,
5-HT3,M1,H1,opioid
Cytotoxic,opioid→
Cardiac glycoside
Nucleus tractus solitarius
Stomach
Small intestine
5-HT3,D2,NK1,
opioid
Gastric irritation
Infect at GI,Ipecac
cytotoxic,radiation
Nucleus tractus solitarius
(NTS)
5-HT3,D2,M1,H1,NK1
Glossopharyngeal nerve
Trigerminal nerve
F
Vestibular system
H1,M1
(motion sickness)
Vomiting reflex
Neuronal pathways
Factors cause N/V
6. F( F ) ก F ก ก N/V
Vomitting center ( F ) กก F
ก F( F ) F
1.Cerebral cortex (higher center) กF1.Cerebral cortex (higher center) กF
Stimulants N/V: ก ก F
ก ก
7. F( F ) ก F ก ก N/V
2.Chemoreceptor trigger zone (CTZ)
area postrema F Medulla ( F
Blood Brain Barrier) F กBlood Brain Barrier) F ก
CTZ
Stimulants N/V: opioid ,cardiac glycosides ,cytotoxic
8. F( F ) ก F ก ก F
3.Vestibular system ( ก F F )
vestibular F F ก
acetylcholine histamine F vomitting center Facetylcholine histamine F vomitting center F
ก
Stimulants N/V :ก (motion sickness)
9. 4.Stomach,small intestine F vagus nerve
F nucleus tractus solitarius (NTS) ก nucleus
F fibers F vomitting center
e.g.Cytotoxic ก serotonin ก
F( F ) ก F ก ก F
e.g.Cytotoxic ก serotonin ก
Enterochromaffin like cell F ก (+) 5-HT3
receptors F vagus nerve N/V
Stimulants N/V : cytotoxics , gastric irritation , ipecac,
ก GI, ก (radiation)
10. 5.Glossopharyngeal nerve Trigerminal nerve
F F nucleus tractus
solitarius (NTS) F F F vomitting center
F( F ) ก F ก ก F
solitarius (NTS) F F F vomitting center
13. Dystonia :
ก F ก F F ก ก
F F F F ˁ
Extrapyramidal side effect (EPS)
F F F F ˁ
1.http://www.youtube.com/watch?v=VHGzUxnuvwQ
2.http://www.youtube.com/watch?v=N_daWx-qcaw
14. Extrapyramidal side effect (EPS)
Parkinsonism:
ก ก F ก ก F / F
ก F (posture) กก F (posture) ก
http://www.youtube.com/watch?v=j86omOwx0Hk
15. Tardive dyskinesia :
ก F ก F F
F ˁ ก ก ก F ˈ
Extrapyramidal side effect (EPS)
F ˁ ก ก ก F ˈ
F F F F ก ก/
F กF
16. Extrapyramidal side effect (EPS)
Tardive dyskinesia :
ก ก ก ก ก
ʾ ก ก F ก กʾ ก ก F ก ก
ก ก 2 F
http://www.youtube.com/watch?v=FUr8ltXh1Pc
17. Anticipatory CINV
(Anticipatory chemo therapy-induced nausea and vomiting)
ˈ ก กF ก F
ก ก ก ก ก N/V กก ก ก ก ก N/V ก
กF F
Stimulants : ก F ก ก ก
ก ก ก F กF
19. Nausea and vomiting ก
Delayed nausea and vomiting :
ก F F ก F 24 hr
F F 5-7 FF F 5-7 F
20. Anti-emetics drugs
1. Muscarinic M1 antagonist
2. Dopamine D2 antagonist
3. Histamine H1 antagonists
ʽ ก
(receptor) ก F F F
Histamine H1 antagonists
4. 5-HT3 antagonist
5. Substance P antagonist
6. Pyridoxine (Vit B6)
7. Benzodiazepines
8. Steroids
21. 1)Anti-emetics drugs ;Muscarinic M1 antagonist
e.g.Scopolamine (hyoscine)
ก ก : ʽ ก muscarinic M1 receptor
Common ADR: ADR ˈ ก antimuscarinicCommon ADR: ADR ˈ ก antimuscarinic
effect F ก F F F F ก
22. 2)Anti-emetics drugs;Dopamine D2 antagonist
e.g. Domperidone(Motilium®),Metoclopramide(Plasil®),
(Chlorpromazine,Perphenazine,Haloperidol,Droperidol)
ก ก :
1. ʽ ก dopamine D receptor CTZ NTS
ก ก :
1. ʽ ก dopamine D2 receptor CTZ NTS
( ก F domperidone F F Blood brain barrier ;
BBB) F F CTZ F )
23. 2)Anti-emetics drugs;Dopamine D2 antagonist
2. ʽ ก 5 HT3 receptors GI ,
e.g.Metoclopramide (high dose)
3. F Fก
ก / F (gastroprokinetic)
e.g.Domperidone , Metoclopramide
24. 2)Anti-emetics drugs;Dopamine D2 antagonist
ADR: F ก F ก ก ก F
Domperidone/metoclopramide
↑ก prolactin hyperprolactinemia-related side
effects F gynecomastia galactorrhea
↑ก prolactin hyperprolactinemia-related side
effects F gynecomastia galactorrhea
ก F domperidone .........
Metoclopramide ( Fdomperidone < F BBB;<EPS)
Extrapyramidal side effect (EPS) F F
esp. F ˁ (cause.tardive dyskinesia )
25. 2)Anti-emetics drugs;Dopamine D2 antagonist
Domperidone /metoclopramide ;
Take the tablets 30 minutes before each meal and
bedtimebedtime
26. 3)Anti-emetics drugs;Histamine H1 antagonists
e.g.Dimenhydrinate(Dramamine®)(+antimuscarinics)
,Diphenhydramine(Benadryl®), promethazine,meclizine
ก ก:ก ก:
ʽ ก histamine H1 receptor F vestibular system
/vomitting center
Common ADR: F ก F F ก
27. 4)Anti-emetics drugs;5-HT3 antagonist :
e.g.Ondansetron(Onsia®),Granisetron,Dolasetron,Tropisetron
ก ก:
ʽ ก 5-HT3 receptor F ก (CTZ, NTS)ʽ ก 5-HT3 receptor F ก (CTZ, NTS)
visceral afferent vagus nerve
Common ADR: F / F ก F
Serious ADR : QT prolong ( F ˁ ก ˂
ก ) cardiac arrhythmia
28. 4)Anti-emetics drugs;5-HT3 antagonist :
F ondansetron
first dose :30 minutes before the start of chemotherapy
1 to 2 hours before the start of radiation therapy1 to 2 hours before the start of radiation therapy
1 hour before surgery.
Additional doses are sometimes taken one to three times a
day during chemotherapy or radiation therapy and for 1 to 2
days after the end of treatment.
29. 5)Anti-emetics drugs;Substance P antagonist ; NK1 receptor antagonist:
e.g.aprepitant
ก ก :
ʽ ก F F substance P ก F NK1 receptor NTSʽ ก F F substance P ก F NK1 receptor NTS
ก cerebral cortex ก F
vomitting center
Common ADR : F F
30. 6)Anti-emetics drugs;Others; Pyridoxine (Vit B6)
ก ก:
B6 ˈ coenzyme F Glutamic decarboxylase
ก ก Glutamic acid ˈ GABAก ก Glutamic acid ˈ GABA
Glutamic acid((+)N/V) -------------------> GABA ((-)N/V)
ADR : F F if ≥2000 mg/day
Glutamic decarboxylase/B6
31. 7)Anti-emetics drugs ;Others;Benzodiazepines
e.g. lorazepam (Ativan®)
ก ก:
ก benzodiazepine GABAA-receptor ionorphoreก benzodiazepine GABAA-receptor ionorphore
complex F GABA F GABAA receptor
ก F ˂ ก Anticipatory CINV
amnestic antianxiety effects
Common ADR : F (amnesia)
34. ก ก F ก ก F
ก ก F
1.Motion
sickness ˆ ก
HistamineH1 antagonists:
e.g.dimenhydrinate,meclizine
Effective if take before ½ hr travel
( receptor
M1,H1)
Effective if take before ½ hr travel
MuscarinicM1 antagonists :
e.g.scopolamine ( F
Effective if take 4 hrs before travel
Effective : 3days
35. ก ก F ก ก F
ก ก F
2.Morning
sickness
N/V in pregnancy
Select safety to fetus
Vitamin
B6 +doxylamine (firstsickness Select safety to fetus B6 +doxylamine (first
line) or vit B6 only
H1 antagonists
e.g.dimenhydrinate
D2 antagonist
e.g.metoclopramide
36. ก ก F
3.Postoperative
N/V (PONV)
N/V after surgery
opioid:relief pain
opioid:(+)CTZ
5-HT3 antagonists (all.gold
standard)
D antagonists
ก ก F ก ก F
opioid:(+)CTZ D2 antagonists
e.g.metoclopramide,droperidol
M1 antagonists
e.g.scopolamine
H1 antagonist
e.g.promethazine
37. ก ก F ก ก F
ก ก F
4.Radiotherapy-
inducedN/V
(RINV)
Mechanism ~ cytotoxic D2 antagonists
e.g.metoclopramide
5-HT antagonists(all.)(RINV) 5-HT3 antagonists(all.)
38. ก ก F ก ก F
ก ก F
5.Chemo
therapy-
induced
cytotoxic
1.CTZ
2. F ก
5-HT3 antagonist(all.acute/delayed)
gold standard
D antagonists (acute type)induced
N/V(CINV)
2. F ก D2 antagonists (acute type)
e.g.metoclopramide
*Steroids (acute/delayed)
e.g.dexamethasone,methylprednisolone
*Benzodiazepines (anticipatoryCINV)
e.g.lorazepam
39. ก ก F ก ก F
ก ก F
5.Chemo
therapy-induced
N/V(CINV)
*NK1 receptor antagonist(acute /delayed)
e.g.Aprepitant
N/V(CINV)
(*) ก F ˈ F
F ก 5-HT3 metoclopramide
40. ก ก F ก ก F
ก ก F
6.Combine tx
for Acute CINV
- 5-HT3antagonist+steroid(best treatment)
effective than single drug and lower S/E
than metoclopramide+steroid and others
for Acute CINV effective than single drug and lower S/E
than metoclopramide+steroid and others
41. ก ก F ก ก F
ก ก F
7.Gastroenteritis
( F ก )
- D2 antagonists
e.g. metoclopramide( F ก ) e.g. metoclopramide
8.Gastroparesis
(ก F ก
F )
- D2 antagonists
e.g. metoclopramide ,domperidone
42. ก
Agents for treatment of peptic ulcer
Antacid
Anti-secretory drug
Mucosal resistance(Cytoprotective)Mucosal resistance(Cytoprotective)
Misc.
-Rebamipide
- ก (Eradication) H.pylori
NSAIDs-induced peptic ulcer
43. Parietal cells mucosa ก
Receptor ( ) ก F ก ก ก
F ก ก F ก ก F
ก ก
F ก ก F ก ก F
receptor
Second messenger
F H+/K+ ATPase or gastric proton pump
44. ก F F ก ก ก
Receptor ก F ก
ก F (Receptor)
Histamine-2 receptor HistamineHistamine-2 receptor
(H2 receptor)
Histamine
Muscarinic -3 receptor Acetylcholine
CCK2 receptor Gastrin
45. F ก F
1.Second messenger
ก F F กก ก F
Second messenger กF F ก กSecond messenger กF F ก ก
F
Second messenger F ก
ก ก กก ก F
46. F ก F
2.Phosphate Binders
F ก phosphate
F phosphate form ˈ insolubleF phosphate form ˈ insoluble
compound ก ก
60. 1.Antacids ( ก )
F ก F F F
rapid onset : within 5-15 min
duration : 15 min-1 hrduration : 15 min-1 hr
F ก
F F F
ก F F ก F ก
ก F F
61. 1.Antacids ( ก )
ADR : Aluminium salt ( F ก), Magnesium salt
( F )
Drug interaction (DI) :Drug interaction (DI) :
↓ absorption F F (absorption & dissolution
depend on acid)
enteric coated F กF ก
62. 1.Antacids ( ก )
antacid (aluminium salt) ก phosphate ก
phosphate F ˈ phosphate binder F ˁ
Drug interaction (DI) :
phosphate F ˈ phosphate binder F ˁ
ก sucralfate ก gastric mucosa
66. 2.1 H2 receptor antagonist (H2RA)
food : not affect to absorption
Treatment
DU : 6-8 wk if not cure F F ก 2-4 wkDU : 6-8 wk if not cure F F ก 2-4 wk
GU : 8 wk if large ulcer F 12 wk
* if recurrent > 3 / ʾ
67. ADR:
F F / F ก F
F F F
2.1 H2 receptor antagonist (H2RA)
F F F
cimetidine (antiandrogen effect) in men/high dose
/long term ก gynecomastia/impotence
68. 2.1 H2 receptor antagonist (H2RA)
Drug interaction (DI)
antacid , sucralfate : ↓ absorption of H2RA
F antacid/sucralfate F ก H RA F FF antacid/sucralfate F ก H2RA F F
2 hr
69. 2.2 Proton pump inhibitor (PPI)
e.g.omeprazole(Losec®),lansoprazole(Prevacid®),
pantoprazole(Controloc®),rabeprazole(Pariet®),
esomeprazole (Nexium®)esomeprazole (Nexium )
ก ก
parent compound(not active)-------->active metabolites
F ก H+/K+ATPase non-competitive
/irriversible ( ; ก F F F)
can use once daily before meal ~ 1/2 hr
ACID CONDITION
70. ก / ก F H2RA
Food delays absorption
ADR :
2.2 Proton pump inhibitor (PPI)
ADR :
F F F ˁ F F F F F F ก
F
71. 2.2 Proton pump inhibitor (PPI)
Drug interaction (DI)
PPIs ก metabolize ก Cytochrome
P450 enzyme (CYP450)
ก ก metabolize F CYP450
P450 enzyme (CYP450)
ก ก metabolize F CYP450
F ก F ↑warfarin,phenytoin level
- monitor response phenytoin
- maybe adjust dose of warfarin/monitor INR,PT
72. ก F PPI (enteric coated tablet) F ˁ F NG tube
NG tube (Nasogastric tube )
ก F F ก
F กF ก
F
F / กF F ˁ F
F ก
73. Enteric coated tablet/granules
F ก F ก F ก
ก ก (capsule) ก กก ก (capsule) ก ก
Enteric coating ก F F F
F ก
ก granules ก F ก กF
ก F ก+ ก
74. omeprazole (miracid® )
delayed-release capsule/multiple unit granules system
enteric-coated granules
ก F PPI (enteric coated tablet) F ˁ F NG tube
enteric-coated granules
Capsule :dissolves in gastric acid
Granules :base-labile coating dissolves in small
intestine
75. rabeprazole (pariet®)
delayed-release tablet or enteric-coated tablet
drug is absorbed in the intestine
ก F PPI (enteric coated tablet) F ˁ F NG tube
drug is absorbed in the intestine
** F / rabeprazole F NG tube**
Coated ; ก ก
76. Omeprazole
1. ก capsule
2. granules NG F
Gastric : ˈ ก
ก F PPI (enteric coated tablet) F ˁ F NG tube
Gastric : ˈ ก (protect the base-labile granules)
e.g. F F flush ก F
Small intestine : ˈ F ( F ก )
e.g.8.4%NaHCO3 F flush F ก F
77. Mucosal resistance ;Cytoprotective
ก ก ˂ ก F F ก
ก F
Cytoprotective agents :Cytoprotective agents :
Sucralfate
Bismuth preparation
Prostaglandin analogues
87. Misc. ;Rebamipide (mucosta®):
ก ก ( / ):
↑ PGE2 ก F ก
↑ ก/ ก ก
↑ก ก ก↑ก ก ก
F ก F ก
F ก F F ก/ F ก
ก F interleukin-8 (IL-8) ก
ก Helicobacter pylori F (IL-8- inflammation)
90. ก (Eradication) H.pylori (HP)
Helicobacter pylori :
ก ก
F F ก ก กF F ก ก ก
(urease enz.) F urea ammonia+CO2
ammonia : ก ก , ก acid
hypersecretion , F ก gastric atrophy
ก ˈ cancer cell F
91. ก (Eradication) H.pylori (HP)
ก H. pylori
( )
PPI-based triple therapy
PPI bid + amoxicillin 1 g bid + clarithromycin 500
7-14PPI-based triple therapy
PPI bid + amoxicillin 1 g bid + clarithromycin 500
mg bid
PPI bid + metronidazole400 mg bid +
clarithromycin500 mg bid
PPI bid + amoxicillin1 g bid + metronidazole400
mg bid
7-14
92. ก (Eradication) H.pylori (HP)
ก H. pylori
( )
Bismuth-basedquadruple therapy
PPI bid + bismuth 240-525 mg bid +
14
PPI bid + bismuth 240-525 mg bid +
metronidazole400 mg bid or tid + tetracycline500
mg qid
PPI bid + bismuth 240-525 mg bid +metronidazole
400 mg bid or tid + clarithromycin500 mg bid
93. ก (Eradication) H.pylori (HP)
ก H. pylori
( )
Sequentialtherapy
PPI bid + amoxicillin 1 g bid ˈ 5 F F
10
PPI bid + amoxicillin 1 g bid ˈ 5 F F
PPI bid + metronidazole400-500 mg bid +
clarithromycin 1000 mg od 500 mg bid ˈ
5
94. ก (Eradication) H.pylori (HP)
ก H. pylori
( )
Levofloxacin-basedtriple therapy 10Levofloxacin-basedtriple therapy
PPI bid + levofloxacin250 mg (or 500 mg) bid +
amoxicillin1 g bid
10
Rifabutin-basedtriple therapy: 7-10 days
PPI bid + rifabutin 150 mg bid + amoxicillin1 g bid
10
95. ก (Eradication) H.pylori (HP)
ก H. pylori
( )
Concomitanttherapy 10Concomitanttherapy
PPI bid + amoxicillin1 g bid + clarithromycin500
mg bid + metronidazole 400 mg tid
10
* ก ก ก ก *
* ก F ˁ ก ก ก ก ˈ ก*
96. ก (Eradication) H.pylori (HP)
PPI-based triple therapy sequential therapy
Bismuth-based quadruple therapy
Levofloxacin-based triple therapy
ก F F
or
Levofloxacin-based triple therapy
Rifabutin-based triple therapy
Concomitant therapy
or
or
or
101. ˆ (High risk)
> 60 ʾ
ก F
ก/ ก ก /ก/ ก ก /
F NSAIDs F ก corticosteroids
F NSAIDs ก F ก F
NSAIDs กก F 1 F ก
F F ก anticoagulants eg. warfarin
102. NSAIDs induced peptic ulcer
ก ก (Treatment)
1. NSAIDs : H2RA ∼ PPIs
2. F NSAIDs F : Drugs of choice :PPIs2. F NSAIDs F : Drugs of choice :PPIs
Drugs of choice ; ก F ˈ ก ก ก ก F F
F F
105. F F (diarrhea)
1. F
2. F F ก กก F
antibiotic (eg.clindamycin,tetracycline),antibiotic (eg.clindamycin,tetracycline),
ก
ก F
ก F
กก
F F colon cancer, hyperthyroidism
106. ก ก ก F F
1. ก F กF
ก F ( ˁ / )
F IV :F IV :
ORS (oral rehydration salt) :
(Electrolyte=Na,K,Cl,HCO3) + ก
108. ก ก ก F F
2.ก ก ก F F กก
2.1 F F ก (toxigenic diarrhea)
ก epithelial cell F F ก Fก epithelial cell F F ก F
enterotoxin ก
ก e.g.Vibrio cholerae ,E.Coli F F ˁ
F ˈ ก
*Enterotoxin :toxin ก F F F ก ก F *
109. ก ก ก F F
2.2 F F กก ก F F
(invasive diarrhea)
ก ก ก Fก ก ก F
ก e.g.shigella, salmonella, E.coli
110. ก ก ก F F
F ก ˈ
Shigella ( F )
e.g.TMP/SMX (bactrim®),norfloxacin,ciprofloxacine.g.TMP/SMX (bactrim®),norfloxacin,ciprofloxacin
Salmonella typhi ( F ก F F F )
e.g.TMP/SMX (bactrim®),ceftriaxone,ciprofloxacin
Vibrio cholerae( ก )
e.g.TMP/SMX(bactrim®),doxycycline,norfloxacin
111. ก ก ก F F
3. ก ก ก F F
ก F / ก F F F
3.1 ก F3.1 ก F
3.2 F ก ก
3.3 Intraluminal agents
3.4 Bulk forming agents
3.5 Bile acid binder
112. 3.1 ก F
Opioid derivatives -Loperamide; Imodium®
-Diphenoxylate+atropine;Lomotil®
ก ก :ก F opioid receptors Fก ก :ก F opioid receptors F
ก
ก F ก F
ก ก F F
/
119. 3.4 Bulk forming agents
e.g.Psylium(AGIOLAX®,METAMUCIL®,FYBOGEL®)
F F/ ก ก ก F
F กF ก
ก ก : F ˈ กF F
ADR F F F ก F
120. 3.5 Bile acid binder
e.g.Cholestyramine (Questran®)
ก ก : ก ก toxin (clostridium
difficile toxin)difficile toxin)
F ก antibiotic associated diarrhea F F
ก ก F
ADR: F ก F ก
121. Cholestyramine ก bile acid
ก F F ก F F ก
ก bile acid ก
ก ก ก F ก F bile acid
3.5 Bile acid binder
ก ก ก F ก F bile acid
(cholesterol ˈ )
↓cholesterol
ก ↑LDL receptor
↑ ก catabolism LDL
↓ LDL ก
124. Antibiotic associated diarrhea
F ก diarrhea F ก ก e.g.
1. Osmotic diarrhea
2. Bile salt diarrhea2. Bile salt diarrhea
3. ↑Small intestine motility
4. Microorganism infection
125. 1.Osmotic diarrhea
↓ (non absorbable carbohydrate) F F
F F non absorbable carbohydrate FF F non absorbable carbohydrate F
osmotic diarrhea
126. 2. Bile salt diarrhea
↓ F F( )
F bile salt F F
↑ bile salt↑ bile salt
ก F ก colonic fluid ก
F
127. 3. ↑↑↑↑Small intestine motility
F e.g. erythromycin
ก F motilin receptor F กก F motilin receptor F ก
F ก
F
129. Antibiotic associated diarrhea
Cause
Drug : ampicilln,amoxycilln,cefixime,
fluoroquinolone(1-2%) bactrim (<1%)fluoroquinolone(1-2%) bactrim (<1%)
Organism : Clostridium difficle infection
*10% of total.cause but serious complication
then Death ก F Clostridium difficile diarrhea*
130. ก ก Clostridium difficile diarrhea
ก F : +supportive tx
ก :metronidazole (oral) 10-14
*If not relieve ,no tolerance to drug ,pregnancy,*If not relieve ,no tolerance to drug ,pregnancy,
<10 years old , severe colitis*
vancomycin (oral) 10-14
131. ก ก F ก ก F F
ก
F opioid derivative (eg.+atropine) :serious S/E
F F ก / กF F ก / ก
: F ก ก + ก
/
/ ก F e.g. ORS
132. ก ก F ก ก F F
F
:
FF
loperamide (limited safety information)
diphenoxylate ( ก )
138. Bulk -forming laxatives
F ˈ กF ก ก e.g.
ก ก ก
FF
ก ก (Ispaghula seed ,Plantago,
Psyllium) ;AGIOLAX®,METAMUCIL®,FYBOGEL®
F
ก F F methylcellulose
139. ก ก
F ก F / F ก GI
ก F F ˈ ก
Bulk -forming laxatives
ก F F ˈ ก
F ˈ กF F F
ก F ก F F F
F F F
140. F F 1 wk
Fก ก F ก F F F
Bulk -forming laxatives
141. ADR;
fiber F ( F) gas
F F F
Bulk -forming laxatives
F F F
fiber + F F
Drug interaction ; ก ก
F ก 2 hr
** ก ก ก F ก F/ **
142. Lubricant laxatives
F ˈ ก e.g.
Mineral oil (synonym)
F (synonym)F (synonym)
liquid paraffin (synonym)
ELP(Emulsion of liquid paraffin) (synonym)
143. ก ก ;
F F F ก
F F
Lubricant laxatives
F F
ก ก F F F ก ˈ ก
ก ˈ ก F F
144. ADR;
lipoid pneumonia ( ก ) ก ก
F
Lubricant laxatives
F
- F F กF
- F F กF F ˁ F F
- ก F : ก ก/ F ˁ / F ˁ
145. ก ก F ˀˊ
F F
F F F ( ;drug interaction)
Lubricant laxatives
F F F ( ;drug interaction)
Drug interaction;
ก F
(vit D def. F ก
) F F
146. Stool softeners /emollient laxatives
e.g. Docusate
ก ก
F F F FF F F F
กF F F F
ก ก F
** F F F F ก ; F/
**
147. ADR ; F ก F
F F F
Stool softeners /emollient laxatives
Drug interaction;
ก F mineral,phenolpthalein
Toxic of mineral oil, phenolpthalein
148. e.g. ก(senna) , bisacodyl (dulcolax®),phenolpthalein,
F (castor oil), dehydrocholic acid(Decholin® )
ก ก;
Stimulant laxatives
ก ก;
ก F ก F
F ก ก ก F
ก / F
ก ก / ก F F ก ก
149. ADR;
Bisacodyl e.g. F F
Phenolpthalein e.g. ˆ ˈ
Stimulant laxatives
Phenolpthalein e.g. ˆ ˈ
Castor oil ( F ) e.g. ก ** F F
F F F F**
ก dehydrocholic acid e.g. F
163. Others ; ก (enemas)
e.g.
(tap water)
ก =NaCl = eg.unison enemaก =NaCl = eg.unison enema
sorbitol
F (soap solution)
ก ก; ก ก
F ก F ก F
ก 15-30
164. ก ก F
:
bulk forming agents + life modification
(ก ก กก ก ʿกก F ˈ ) F F ∆ laxatives(ก ก กก ก ʿกก F ˈ ) F F ∆ laxatives
F ก :
/ ก F F
bisacodyl /senna /M.O.M >1 wk F F
ก F
165. ก ก F
F ˁ ก ก ก F
bulk forming agents
ก ก F ก ก Fก ก F ก ก F
lubricant/stool softener F ก F bulk forming agents
F ก ก e.g. F F
saline laxatives (high dose)
166. ก ก F
F ˁ / F
bulk forming agents F F bisacodyl
/senna/M.O.M/(lactulose;low dose) F F F F F/senna/M.O.M/(lactulose;low dose) F F F F F
F ( F F F F ก )
docusate/bulk forming agent
**stimulant laxatives use if necessary but not use
Castor oil**
167. ก ก F
ก ก ก ก :
ก ก e.g.glycerin
suppo/ กsuppo/ ก
F F F F F F ; M.O.M./senna
F ˁ F ก :
saline laxatives e.g.magnesium sulfate,osmotic laxatives