surgical medication

外科用藥

 

外科藥物的使用，只是輔助的角色。

結腸蠕動

 

刺激性

抑制性

荷爾蒙

l           Cholecystokinine

l           Gastrin

l           Vasopressin

l           Serotonin↑(Carcinoid)

l           Glucagon

l           Secretin

l           Prostagalndins

l           Serotonin ↓

自律神經

l           Parasympathomimetics

ü          Bethanecol (Urecholine)

l           Sympatholytics

ü          α-Imidazoline

ü          β- Propranolol (Inderol)

l           Sympathomimetics★

ü          α

ü          β1 & β2

l           Parasympatholytics※

ü          Atropine

ü          Scopolamine (Buscopan)

其他藥物

l           Opiate (Morphine)

l           Antihistamine

l           Antidepressive

l           Antiparkinson

反射性

1.         Gastrocolic

2.         Colonic distention

3.         Laxatives

 

★ Sympathomimetics

                            i.                Alpha－Epinephrine (Adrenaline) ,Norepinephrine (Levophed)

                           ii.                Beta 1－ Isuprel (Isoproterenol)

                         iii.                Beta 2－ Bronchodilator

 

※Parasympatholytics Atropine like

                            i.                Probanthine－抑制膀胱收縮

                           ii.                Bentyl(Dicyclomine)－結腸、輸尿管、膽管和子宮（眼及心臟無作用）

                         iii.                Primperan(Metoclopramide) －作用於小腸和大腸

                        iv.                Trancolon(Mepenzolate) －作用於右結腸，若用於左結腸要3顆

                         v.                Duspataline(Mebeverine)－作用於左結腸

 

  

瀉藥cathatics、緩瀉劑Laxatives

分類

作用

舉例

潤滑軟化劑 Emollient or Softener

利用多醣類及纖維素溶於水中後而形成潤性膠(Emollient gel）

ü          Mineral oil

ü          ConstipJohn

溶脹性瀉藥 Bulk-forming

Psyllium hydrophilic mucilloid （洋車前子）

ü          Konsyl 12~72hr

ü          Metamucil

Sterculia BP 62% + Frangula BPC 8%

ü          Normacol plus

鹽類瀉藥 Saline Cathatics

Magnesium 作用約5小時後，鎂離子與水份結合，增加體積，刺激腸道蠕動

ü          MagVac

ü          Mag citrate

ü          Mag hydroxide

ü          AMG

Sodium

ü          GoLytely

刺激性瀉藥 Irritant Cathatics

Ricinoleic acid（小腸）

ü          Caster oil

Diphenylmethane口服藥於6小時後作用，塞劑半小時後作用，結腸化學性刺激

ü          Dulcolax (Bisacodyl)

Anthraquinone 作用於大腸，刺激直腸收縮，注意會導致 Melanosis coli, Albuminuria, Hematuria

ü          Sennapur

ü          Sennakort

ü          Through

ü          Cascara

大腸直腸癌化學治療

1.         5-Fluorouracil (Pyrimidine analogs) 阻斷 Thymidylate synthetase

                            i.                5-FU 500mg/amp：IV chemotherapy

                           ii.                FT-207 200mg/cap

                         iii.                5-FU ointment：直腸癌局部侵犯使用

2.         Leucovorine 15mg/vial

3.         Levamisole 50mg/tab

慢性潰瘍性結腸炎 CUC

1.         Asacol enema/ suppository ( Mesalazine) ：5-AminoSalicylic acid

2.         Sulfasalazine (Azafidine)

肛門用藥

1.         Suppository

                            i.                Indomethacin suppository：減少 tenesmus

                           ii.                Faktu suppository (Policresulen+Cinchocaine) below 25oC

2.         Enema

                            i.                Cort enema (Hydrocortisone)：用於 factitial proctitis

                           ii.                Evac enema (Fleet enema)：化學性刺激

                         iii.                Acetate enema ：減少 tenesmus

3.         Ointment

                            i.                Neomycin

                           ii.                Posterisan forete (fortified) 10, 25gm/tube 油性

1.         Polyvalent colibacilli + Hydrocortisone 0.25% (Alcohol free)

                         iii.                Kanalog in orabase or Zinc Oxide：局部皮膚潰爛使用

其他用藥

1.         Antidiarrhea

                            i.                Imodium(Loperamide) 2mg/tab

                           ii.                Cholestyramine (Questran) ：膽汁酸（bile acid）的吸附，減少腹瀉

2.         Psychosomatics

                            i.                Antipsychotics

1.         Phenothiazine－Novamine (Prochlorperazine) 要注意 Extrapyramidal side effect (EPS) 與 Haloperidol作用類似

2.         Butyrophenone－Haloperidol

                           ii.                Antianxiety

1.         Propanediol－Equanil

2.         Benzodiazepine－Valium(Diazepam), Librium, Serenol, Erispan, Xanax

3.         Antihistamie－Vistaril

4.         Barbituate

                         iii.                Antidepressant

1.         Tricyclics－Imipramine (Tofranil)有Atropine-like side effect

2.         MAO inhibitor－

                        iv.                Antiserotonin－Mesyrel

3.         Pain control

                            i.                Codeine phosphate 30mg/cap

                           ii.                Demerol (Meperidine) 50mg/cap

                         iii.                Morphine

4.         Antibiotics

                            i.                Lofatin (Cefotaxitin), Kefzol

                           ii.                Flagyl (Fasigyn), Anegyn (Mebendazole), Cleocin (Clindamycin)

                         iii.                Vancomycin 250mg/cap：Pseudomembraneous colitis (Clostridium difficile)

5.         Antihelmintics

                            i.                Combantrin：針對蛔蟲、蟯蟲

                           ii.                Vermox (Mebendazole)：針對鞭形蟲、鉤蟲

6.         Steroids

                            i.                Prednisolone 5mg/tab

                           ii.                Solucortef 100mg/amp

                         iii.                Solumedrol 500mg/amp

7.         Sulinton (Sulindac) 200mg/tab：減少 FAP polyposis

8.    Sprase (Hyaluroniase)：Mucolytic enzyme分解 hyaluronic acid