PPI使い方
PPI使い方
(「Clinician no. 576」より)
http://www.e-clinician.net/new.html
・NSAIDs、アスピリンの胃潰瘍予防に
・ワーファリンと併用すると、代謝経路が共通のため出血の危険を増す。PTをチェック
・PPIは、H2blockerと違い、PPIが食物などの刺激によって活性化しているほうが効果は高い。夕食後の服用がよい。眠前に飲まない
・分2内服のほうが効果増す
・日本人はピロリ感染率が高いため、胃粘膜委縮ある人が多い。それゆえ胃酸分泌は低下しているはず。 しかし、食事の欧米化とともにピロリ感染率は低下している
・防御系薬剤のほうが薬価が低く、酸分泌抑制で肺炎のリスクが高まったり骨折増加のリスクがあるとも報告ある。
・NSAID インドメタシンはラットに高率で小腸粘膜障害を引き起こす。また、胃・小腸の細菌叢を変化させる可能性がある(bacterial overgrowth, 偽膜性腸炎など)。IBSとの関連が示唆されている
・アスピリン腸溶錠はかえって小腸に粘膜障害を起こす、かもしれない
・逆流性食道炎に対するPPIの有効率は80%以上。しかし、GERDではその有効率は低下する。NERDではPPI抵抗性。
・口内崩壊錠よりも、小さな錠のほうが飲みやすいかも
・骨折リスクを上げる薬は、ステロイド、GnRHとその拮抗薬、アロマターゼ阻害薬、SSRI。PPIもそうかも。5年以上の内服で明らかにリスク増加
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