*For medical professionals for reference
Gastrointestinal Organization for review, do you know what the prescription is wrong?
Writing | Shi Chunhuan
GERD) It refers to the reflux of the stomach and duodenal content to the esophagus, causing the chemical and inflammatory changes in the esophagus, throat, respiratory tract chemistry, and inflammation, causing acid, heartburn, Cough, asthma and other symptoms of symptoms.GERDs drug therapy includes acidic suppression agents, anti -acid agents and gastrointestinal activation drugs [1].
1.Acid suppression agent
The commonly used acidic suppressing agents that are currently commonly used include histamine H2 receptor blockers, (PPI) Competitive acid stasis (P-CAB) with potassium ions.
The histamine H2 receptor blocking agent can inhibit gastric acid secretion through competitive combination of H2 receptors.PPIs are irreversible to inhibit the activity of proton pumps through covalent combination of wall cell activation, and then inhibit gastric acid secretion.P-CAB has potassium ions in the proton pump in a competitive binding activation and non-activated state, which can inhibit the activity of the proton pump reversible, thereby inhibiting gastric acid secretion.
The current research shows that the efficacy of PPI in alleviating the symptoms of GerD and healing esophagealitis is better than the H2 receptor blocker, and the efficacy of P-CAB is not inferior to PPI.PPI and P-CAB are the preferred drugs for the initial treatment and maintenance of Gerd.
2. Anticine
Anticated agent can directly and neutralize the stomach acid, increase the stomach in the stomach, and increase the stomach.pH value.The commonly used anti -acid agents such as aluminum hydroxide, aluminum carbonate, and alginate, etc.Short -term use of anti -acid agents can help quickly alleviate the symptoms of reflux and heartburn.
3. Gastrointestinal promotional drugs
The mechanism of gastrointestinal activation drugs is different, commonlyGastrointestinal activation drugs include:
Dopamine D2 receptor antagonists such as metharine, gastricin receptor agonist such as erythromycin and its analogy, peripheralityDopamine D2 receptor antagonists such as doppophalidone, selective 5-hydroxylin 4 receptor agonist such as Moshili, with dual effects of dopamine D2 receptor block and acetylcholine enzyme inhibitory, and 5-hydroxylin 4Remnant agonists and dopamine receptor antagonists such as Sininiply.Gastrointestinal activation drugs may be effective in alleviating the symptoms of patients with GERD, but it has no promotion effect on the healing of mucosa in the endoscopy.
Lets look at 2 centers of prescriptions
Case 1
Patient information: Female, 41 years old, 162cm tall, weighing 54kg, current medical history, stomach burning sensation, hidden pain in the back of the sternum, abdominal distension and qi after meals, not accompanied by abdominal pain, no abdominal pain, Nausea, vomiting, chest tightness, shortness of breath, etc.
Gastroscopy Tips: .familyID = "35NHL21T"> Duo Panlone tablets 30mg QD PO
Analysis:
1) UsageIn terms of dosage. Omeprazole enteropolic tablets are usually once or 2 times a day. The daily frequency frequency frequency of 3 times in the prescription may lead to excessive drugs and increase adverse reactions to adverse reactions.risk.It is recommended to adjust the frequency of administration to 1 to 2 times a day.Due to the short period of time of the drug, Doramone tablets are usually 3 times a day, and the prescription polypolidone tablets once a day. The frequency of administration is too small. It should be changed 3 times a day.10mg each time.
2) Drug interaction. PPI (such as Omeprazole) and power -promoting drugs (such as Dorazone) are often jointly used in the treatment of GerD to improve the efficacy.However, there are interactions between these two drugs.Active pills may accelerate gastrointestinal motility, reduce the stay time of acid suppression in the stomach, and reduce the absorption of acidic drugs.At the same time, acidic suppression may reduce the biological utilization of dynamic drugs.It is recommended to avoid this interaction, the two medicines should be taken at least 1h.This can ensure that each drug can be fully absorbed in the stomach and play its healing role.
Case 2
Patient Information: Female, 59 years old
Clinical Diagnosis: GERD , coronary heart diseasePrescription:
AspirinEnteric tablet 100mg TID Oral Oral
hydrogenate chopidoglytic tablets 75mg QD orally
Omeprazole entero -soluble capsule 20mg QD oral You can view prescription analysis and medication recommendations ~
References:
[1] Chinese Medical Association Gastrointestinal Dynamics Group, gastrointestinal functional disease collaboration group, esophageal disease collaboration group. China gastroesophageal reflux diagnosis and treatment specifications [J]. Chinese digestive magazine, 2023, 43 (9):588-598.
Editor in charge: Leaf
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