Department of
Lecture 5 anesthesia
pharmacoloy
GIT Disorders Lecturer
اﺿطراﺑﺎت اﻟﺟﮭﺎز اﻟﮭﺿﻣﻲ
Dr.Firas
Al Dabbagh
___________________________________________________
DRUGS USED TO TREAT PEPTIC ULCER DISEASE
AND GASTROESOPHAGEAL REFLUX DISEASE.
.اﻷدوﯾﺔ اﻟﻣﺳﺗﺧدﻣﺔ ﻟﻌﻼج ﻣرض اﻟﻘرﺣﺔ اﻟﮭﺿﻣﯾﺔ وﻣرض اﻻرﺗﺟﺎع اﻟﻣﻌدي اﻟﻣرﯾﺋﻲ
The two main causes of peptic ulcer disease are infection with gram-
negative Helicobacter pylori and the use of nonsteroidal anti-
inflammatory drugs (NSAIDs). Increased hydrochloric acid (HCl)
secretion and inadequate mucosal defense against gastric acid also
play a role. Treatment approaches include 1) eradicating the H. pylori
infection, 2) reducing secretion of gastric acid with the use of PPIs or
H2-receptor antagonists, and/or 3) providing agents that protect the
gastric mucosa from damage, such as misoprostol and sucralfate.
اﻟﺳﺑﺑﺎن اﻟرﺋﯾﺳﯾﺎن ﻟﻣرض اﻟﻘرﺣﺔ اﻟﮭﺿﻣﯾﺔ ھﻣﺎ اﻟﻌدوى ﺑﺑﻛﺗﯾرﯾﺎ اﻟﻣﻠوﯾﺔ اﻟﺑواﺑﯾﺔ ﺳﻠﺑﯾﺔ اﻟﻐرام واﺳﺗﺧدام اﻟﻌﻘﺎﻗﯾر
ﺗﻠﻌب زﯾﺎدة إﻓراز ﺣﻣض اﻟﮭﯾدروﻛﻠورﯾك.(اﻟﻣﺿﺎدة ﻟﻼﻟﺗﮭﺎﺑﺎت ﻏﯾر اﻟﺳﺗﯾروﯾدﯾﺔ )ﻣﺿﺎدات اﻻﻟﺗﮭﺎب ﻏﯾر اﻟﺳﺗﯾروﺋﯾدﯾﺔ
( اﻟﻘﺿﺎء ﻋﻠﻰ ﻋدوى1 ﺗﺷﻣل طرق اﻟﻌﻼج.ﺿﺎ
ً دورا أﯾ
ً ( وﻋدم ﻛﻔﺎﯾﺔ دﻓﺎع اﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ ﺿد ﺣﻣض اﻟﻣﻌدةHCl)
(3 أو/ و،H2 ( ﺗﻘﻠﯾل إﻓراز ﺣﻣض اﻟﻣﻌدة ﺑﺎﺳﺗﺧدام ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون أو ﻣﺿﺎدات ﻣﺳﺗﻘﺑﻼت2 ،اﻟﻣﻠوﯾﺔ اﻟﺑواﺑﯾﺔ
. ﻣﺛل اﻟﻣﯾزوﺑروﺳﺗول واﻟﺳوﻛراﻟﻔﺎت،ﺗوﻓﯾر ﻋواﻣل ﺗﺣﻣﻲ اﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ ﻓﻲ اﻟﻣﻌدة ﻣن اﻟﺗﻠف
1
1.H2-receptor antagonists and regulation of gastric acid secretion.
. وﺗﻧظﯾم إﻓراز ﺣﻣض اﻟﻣﻌدةH2 ﻣﺿﺎدات ﻣﺳﺗﻘﺑﻼت.1
By competitively blocking the binding of histamine to H2
receptors, these agents reduce the secretion of gastric acid.
The four drugs used in the United States—cimetidine , ranitidine ,
famotidine , and nizatidine —potently inhibit (greater than 90%) basal,
food-stimulated, and nocturnal secretion of gastric acid.
Cimetidine was the first histamine H2-receptor antagonist. However,
its utility is limited by its adverse effect profile and drug–drug interactions.
Therapeutic uses: The use of these agents has decreased with
the advent of PPIs.
. ﺗﻘﻠل ھذه اﻟﻌواﻣل ﻣن إﻓراز ﺣﻣض اﻟﻣﻌدة، ﺑﺷﻛل ﺗﻧﺎﻓﺳﻲH2 ﻣن ﺧﻼل ﻣﻧﻊ ارﺗﺑﺎط اﻟﮭﯾﺳﺗﺎﻣﯾن ﺑﻣﺳﺗﻘﺑﻼت
وﻧﯾزاﺗﯾدﯾن ﺗﻣﻧﻊ ﺑﺷﻛل ﻓﻌﺎل، ﻓﺎﻣوﺗﯾدﯾن، راﻧﯾﺗﯾدﯾن، ﺳﯾﻣﯾﺗﯾدﯾن- اﻷدوﯾﺔ اﻷرﺑﻌﺔ اﻟﻣﺳﺗﺧدﻣﺔ ﻓﻲ اﻟوﻻﯾﺎت اﻟﻣﺗﺣدة
. واﻟﻠﯾﻠﻲ ﻟﺣﻣض اﻟﻣﻌدة، اﻟﻣﺣﻔز ﺑﺎﻟﻐذاء،( اﻹﻓراز اﻟﻘﺎﻋدي٪90 )أﻛﺛر ﻣن
ﻓﺈن ﻓﺎﺋدﺗﮫ ﻣﺣدودة ﺑﺳﺑب ﺗﺄﺛﯾره اﻟﺿﺎر، وﻣﻊ ذﻟك.H2 ﻛﺎن اﻟﺳﯾﻣﯾﺗﯾدﯾن أول ﻣﺿﺎد ﻟﻣﺳﺗﻘﺑﻼت اﻟﮭﺳﺗﺎﻣﯾن
.واﻟﺗﻔﺎﻋﻼت اﻟدواﺋﯾﺔ
. اﻧﺧﻔض اﺳﺗﺧدام ھذه اﻟﻌواﻣل ﻣﻊ ظﮭور ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون: اﻻﺳﺗﺧداﻣﺎت اﻟﻌﻼﺟﯾﺔ
___________________________________________________
a. Peptic ulcers: All four agents are equally effective in promoting the
healing of duodenal and gastric ulcers. However, recurrence is common if
H. pylori is present and the patient is treated with these agents alone.
Patients with NSAID-induced ulcers should be treated with PPIs, because
these agents heal and prevent future ulcers more effectively than H2
antagonists do.
b. Acute stress ulcers: These drugs are given as an intravenous
infusion to prevent and manage acute stress ulcers associated with high
risk patients in intensive care units. However, because tolerance may
occur with these agents in this setting, PPIs have gained favor for this
indication.
. ﺟﻣﯾﻊ اﻟﻌواﻣل اﻷرﺑﻌﺔ ﻟﮭﺎ ﻧﻔس اﻟﻘدر ﻣن اﻟﻔﻌﺎﻟﯾﺔ ﻓﻲ ﺗﻌزﯾز ﺷﻔﺎء ﻗرﺣﺔ اﻻﺛﻧﻲ ﻋﺷر واﻟﻣﻌدة: اﻟﻘرﺣﺔ اﻟﮭﺿﻣﯾﺔ. أ
ﯾﺟب ﻋﻼج. ﻓﺈن اﻟﺗﻛرار أﻣر ﺷﺎﺋﻊ ﻓﻲ ﺣﺎﻟﺔ وﺟود اﻟﻣﻠوﯾﺔ اﻟﺑواﺑﯾﺔ وﯾﺗم ﻋﻼج اﻟﻣرﯾض ﺑﮭذه اﻟﻌواﻣل وﺣدھﺎ،وﻣﻊ ذﻟك
،اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن اﻟﻘرﺣﺔ اﻟﻧﺎﺟﻣﺔ ﻋن ﻣﺿﺎدات اﻻﻟﺗﮭﺎب ﻏﯾر اﻟﺳﺗﯾروﺋﯾدﯾﺔ ﺑﺎﺳﺗﺧدام ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون
ﻷن ھذه اﻟﻌواﻣل ﺗﺷﻔﻲ وﺗﻣﻧﻊ اﻟﻘرح اﻟﻣﺳﺗﻘﺑﻠﯾﺔ ﺑﺷﻛل أﻛﺛر ﻓﻌﺎﻟﯾﺔ ﻣن ﻣﺿﺎداتH2.
ﯾﺗم إﻋطﺎء ھذه اﻷدوﯾﺔ ﻋﻠﻰ ﺷﻛل ﺣﻘن ﻓﻲ اﻟورﯾد ﻟﻣﻧﻊ وإدارة ﻗرح اﻹﺟﮭﺎد اﻟﺣﺎدة اﻟﻣرﺗﺑطﺔ: ﻗرح اﻹﺟﮭﺎد اﻟﺣﺎدة. ب
ﻧظرا ﻻﺣﺗﻣﺎل ﺣدوث ﺗﺳﺎﻣﺢ ﻣﻊ ھذه اﻟﻌواﻣل ً ، وﻣﻊ ذﻟك.ﺑﺎﻟﻣرﺿﻰ ذوي اﻟﻣﺧﺎطر اﻟﻌﺎﻟﯾﺔ ﻓﻲ وﺣدات اﻟﻌﻧﺎﯾﺔ اﻟﻣرﻛزة
ً
.ﺗﻔﺿﯾﻼ ﻟﮭذا اﻟﻣؤﺷر (PPIs) ﻓﻘد اﻛﺗﺳﺑت ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون،ﻓﻲ ھذا اﻹﻋداد
2
c. Gastroesophageal reflux disease (GERD):
Low doses of H2, are effective for the treatment of heartburn (GERD)
in only about 50% of patients. H2-receptor antagonists act by stopping
acid secretion. Therefore, they may not relieve symptoms for at least
45 minutes. Antacids more quickly and efficiently neutralize stomach
acid, but their action is only temporary. For these reasons, PPIs are
now used preferentially in the treatment of GERD, especially for
patients with severe heartburn.
:(GERD) ﻣرض اﻟﺟزر اﻟﻣﻌدي اﻟﻣرﯾﺋﻲ. ج
ﺗﻌﻣل. ﻓﻘط ﻣن اﻟﻣرﺿﻰ٪50 ( ﻟدى ﺣواﻟﻲGERD) ﻓﻌﺎﻟﺔ ﻓﻲ ﻋﻼج ﺣرﻗﺔ اﻟﻣﻌدةH2 ﺗﻌﺗﺑر اﻟﺟرﻋﺎت اﻟﻣﻧﺧﻔﺿﺔ ﻣن
دﻗﯾﻘﺔ ﻋﻠﻰ45 ﻓﺈﻧﮭﺎ ﻗد ﻻ ﺗﺧﻔف اﻷﻋراض ﻟﻣدة، وﻟذﻟك. ﻋن طرﯾﻖ إﯾﻘﺎف إﻓراز اﻟﺣﻣضH2 ﻣﺿﺎدات ﻣﺳﺗﻘﺑﻼت
ﻟﮭذه. ﻟﻛن ﺗﺄﺛﯾرھﺎ ﻣؤﻗت ﻓﻘط، ﺗﻌﻣل ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ﻋﻠﻰ ﺗﺣﯾﯾد ﺣﻣض اﻟﻣﻌدة ﺑﺷﻛل أﺳرع وأﻛﺛر ﻛﻔﺎءة.اﻷﻗل
ﺧﺎﺻﺔ ﻟﻠﻣرﺿﻰ اﻟذﯾن، ﺗُﺳﺗﺧدم ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون اﻵن ﺑﺷﻛل ﺗﻔﺿﯾﻠﻲ ﻓﻲ ﻋﻼج ارﺗﺟﺎع اﻟﻣريء،اﻷﺳﺑﺎب
.ﯾﻌﺎﻧون ﻣن ﺣرﻗﺔ ﺷدﯾدة ﻓﻲ اﻟﻣﻌدة
Pharmacokinetics: :اﻟﺣرﻛﯾﺔ اﻟدواﺋﯾﺔ
After oral administration, the H2 antagonists distribute widely
throughout the body (including into breast milk and across the
placenta) and are excreted mainly in urine. Cimetidine, ranitidine, and
famotidine are also available in intravenous formulations. The half-life
of all of these agents may be increased in patients with renal
dysfunction, and dosage adjustments are needed.
ﻋﻠﻰ ﻧطﺎق واﺳﻊ ﻓﻲ ﺟﻣﯾﻊ أﻧﺣﺎء اﻟﺟﺳم )ﺑﻣﺎ ﻓﻲ ذﻟك ﺣﻠﯾب اﻟﺛديH2 ﺗﺗوزع ﻣﺿﺎدات،ﺑﻌد ﺗﻧﺎوﻟﮫ ﻋن طرﯾﻖ اﻟﻔم
.ﺿﺎ اﻟﺳﯾﻣﯾﺗﯾدﯾن واﻟراﻧﯾﺗﯾدﯾن واﻟﻔﺎﻣوﺗﯾدﯾن ﻓﻲ ﺗرﻛﯾﺑﺎت ورﯾدﯾﺔ
ً ﯾﺗوﻓر أﯾ.وﻋﺑر اﻟﻣﺷﯾﻣﺔ( وﺗﻔرز ﺑﺷﻛل رﺋﯾﺳﻲ ﻓﻲ اﻟﺑول
. وﯾﻠزم ﺗﻌدﯾل اﻟﺟرﻋﺔ،ﯾﻣﻛن زﯾﺎدة ﻋﻣر اﻟﻧﺻف ﻟﺟﻣﯾﻊ ھذه اﻟﻌواﻣل ﻓﻲ اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن ﺧﻠل ﻛﻠوي
___________________________________________________
Adverse effects: :اﻵﺛﺎر اﻟﺿﺎرة
In general, the H2 antagonists are well tolerated. Cimetidine can have
endocrine effects. These effects include gynecomastia and galactorrhea
(continuous release/discharge of milk).
Cimetidine inhibits several cytochrome P450 isoenzymes and can
interfere with the metabolism of many other drugs, such as warfarin. All
H2 antagonists may reduce the efficacy of drugs that require an acidic
environment for absorption, such as ketoconazole.
وﺗﺷﻣل ھذه. ﯾﻣﻛن أن ﯾﻛون ﻟﻠﺳﯾﻣﯾﺗﯾدﯾن ﺗﺄﺛﯾرات ﻋﻠﻰ اﻟﻐدد اﻟﺻﻣﺎء. ﺑﺷﻛل ﺟﯾدH2 ﯾﺗم ﺗﺣﻣل ﻣﺿﺎدات، ﺑﺷﻛل ﻋﺎم
.(إﻓراز اﻟﺣﻠﯾب اﻟﻣﺳﺗﻣر/اﻟﺗﺄﺛﯾرات اﻟﺗﺛدي وﺛر اﻟﻠﺑن )إﻓراز
وﯾﻣﻛن أن ﯾﺗداﺧل ﻣﻊ اﺳﺗﻘﻼب اﻟﻌدﯾد ﻣن اﻷدوﯾﺔP450 ﯾﺛﺑط اﻟﺳﯾﻣﯾﺗﯾدﯾن اﻟﻌدﯾد ﻣن ﻧظﺎﺋر إﻧزﯾﻣﺎت اﻟﺳﯾﺗوﻛروم
ﻣﺛل، ﻗد ﺗﻘﻠل ﻣن ﻓﻌﺎﻟﯾﺔ اﻷدوﯾﺔ اﻟﺗﻲ ﺗﺗطﻠب ﺑﯾﺋﺔ ﺣﻣﺿﯾﺔ ﻟﻼﻣﺗﺻﺎصH2 ﺟﻣﯾﻊ ﻣﺿﺎدات. ﻣﺛل اﻟوارﻓﺎرﯾن،اﻷﺧرى
.اﻟﻛﯾﺗوﻛوﻧﺎزول
3
2. PPIs: Proton Pump Inhibitors.
. ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون: ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون.2
The available PPIs include esomeprazole, lansoprazole omeprazole,
pantoprazole and rabeprazole. Omeprazole, esomeprazole, and
lansoprazole are available over-the counter for short-term treatment of
GERD.
. وراﺑﯾﺑرازول، وﺑﺎﻧﺗوﺑرازول، وأوﻣﯾﺑرازول، وﻻﻧﺳوﺑرازول، ﺗﺷﻣل ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون اﻟﻣﺗﺎﺣﺔ إﯾزوﻣﯾﺑرازول
.ﯾﺗوﻓر أوﻣﯾﺑرازول وإﯾﺳوﻣﯾﺑرازول وﻻﻧﺳوﺑرازول ﺑدون وﺻﻔﺔ طﺑﯾﺔ ﻟﻌﻼج ارﺗﺟﺎع اﻟﻣريء ﻋﻠﻰ اﻟﻣدى اﻟﻘﺻﯾر
Actions: These agents are prodrugs with an acid-resistant enteric coating
to protect them from premature degradation by gastric acid. At standard
doses, PPIs inhibit both basal and stimulated gastric acid secretion by
more than 90%.
ھذه اﻟﻌواﻣل ﻋﺑﺎرة ﻋن ﻋﻘﺎﻗﯾر أوﻟﯾﺔ ذات ﻏﻼف ﻣﻌوي ﻣﻘﺎوم ﻟﻸﺣﻣﺎض ﻟﺣﻣﺎﯾﺗﮭﺎ ﻣن اﻟﺗﺣﻠل اﻟﻣﺑﻛر ﺑواﺳطﺔ:اﻹﺟراءات
ﺗﻣﻧﻊ ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون إﻓراز ﺣﻣض اﻟﻣﻌدة اﻟﻘﺎﻋدي واﻟﻣﺣﻔز ﺑﻧﺳﺑﺔ ﺗزﯾد، ﻓﻲ اﻟﺟرﻋﺎت اﻟﻘﯾﺎﺳﯾﺔ.ﺣﻣض اﻟﻣﻌدة
.%90 ﻋن
Therapeutic uses: The PPIs are superior to the H2 antagonists in
suppressing acid production and healing ulcers. Thus, they are the preferred
drugs for stress ulcer treatment and prophylaxis and for the treatment of
GERD,
. ﻓﻲ ﺗﺛﺑﯾط إﻧﺗﺎج اﻟﺣﻣض وﺷﻔﺎء اﻟﻘرﺣﺔH2 ﺗﺗﻔوق ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون ﻋﻠﻰ ﻣﺿﺎدات:اﻻﺳﺗﺧداﻣﺎت اﻟﻌﻼﺟﯾﺔ
. ﻓﮭﻲ اﻷدوﯾﺔ اﻟﻣﻔﺿﻠﺔ ﻟﻌﻼج ﻗرﺣﺔ اﻹﺟﮭﺎد واﻟوﻗﺎﯾﺔ ﻣﻧﮭﺎ وﻟﻌﻼج ارﺗﺟﺎع اﻟﻣريء،وﺑﺎﻟﺗﺎﻟﻲ
If an H2-receptor antagonist is needed, it should be taken well after the
PPI, because H2 antagonists reduce the activity of the proton pump.
ﻷن، ﻓﯾﺟب ﺗﻧﺎوﻟﮭﺎ ﺑﻌد ﻓﺗرة طوﯾﻠﺔ ﻣن ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون،H2 إذا ﻛﺎﻧت ھﻧﺎك ﺣﺎﺟﺔ إﻟﻰ ﻣﺿﺎدات ﻣﺳﺗﻘﺑﻼت
. ﺗﻘﻠل ﻣن ﻧﺷﺎط ﻣﺿﺧﺔ اﻟﺑروﺗونH2 ﻣﺿﺎدات
Pharmacokinetics: :اﻟﺣرﻛﯾﺔ اﻟدواﺋﯾﺔ
All of these agents are effective orally. Formmaximum effect, PPIs should
be taken 30 to 60 minutes before breakfast or the largest meal of the day.
إﻟﻰ30 ﯾﺟب ﺗﻧﺎول ﻣﺛﺑطﺎت ﻣﺿﺧﺔ اﻟﺑروﺗون ﻗﺑل، ﻟﻠﺣﺻول ﻋﻠﻰ أﻗﺻﻰ ﺗﺄﺛﯾر.ﻛل ھذه اﻟﻌواﻣل ﻓﻌﺎﻟﺔ ﻋن طرﯾﻖ اﻟﻔم
. دﻗﯾﻘﺔ ﻣن اﻹﻓطﺎر أو أﻛﺑر وﺟﺑﺔ ﻓﻲ اﻟﯾوم60
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3. Antacids ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ.3
Antacids are weak bases that react with gastric acid to form water and a
salt to diminish gastric acidity. Because pepsin (a proteolytic enzyme) is
inactive at a pH greater than 4, antacids also reduce pepsin activity.
ﻧظرا ﻷن
ً .ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ھﻲ ﻗواﻋد ﺿﻌﯾﻔﺔ ﺗﺗﻔﺎﻋل ﻣﻊ ﺣﻣض اﻟﻣﻌدة ﻟﺗﻛوﯾن اﻟﻣﺎء واﻟﻣﻠﺢ ﻟﺗﻘﻠﯾل ﺣﻣوﺿﺔ اﻟﻣﻌدة
ﺿﺎ
ً أﯾ ﻓﺈن ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ﺗﻘﻠل،4 اﻟﺑﯾﺑﺳﯾن )إﻧزﯾم ﻣﺣﻠل ﻟﻠﺑروﺗﯾن( ﯾﻛون ﻏﯾر ﻧﺷط ﻋﻧد درﺟﺔ ﺣﻣوﺿﺔ أﻛﺑر ﻣن
.ﻣن ﻧﺷﺎط اﻟﺑﯾﺑﺳﯾن
Therapeutic uses: :اﻻﺳﺗﺧداﻣﺎت اﻟﻌﻼﺟﯾﺔ
Antacids are used for symptomatic relief of peptic ulcer disease and
GERD, and they may also promote healing of duodenal ulcers. They
should be administered after meals for maximum effectiveness.
ً وﻗد ﺗﻌزز أﯾ،ﺗُﺳﺗﺧدم ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ ﻟﺗﺧﻔﯾف أﻋراض ﻣرض اﻟﻘرﺣﺔ اﻟﮭﺿﻣﯾﺔ واﻻرﺗﺟﺎع اﻟﻣﻌدي اﻟﻣرﯾﺋﻲ
ﺿﺎ
. وﯾﻧﺑﻐﻲ أن ﺗدار ﺑﻌد وﺟﺑﺎت اﻟطﻌﺎم ﻟﺗﺣﻘﯾﻖ أﻗﺻﻰ ﻗدر ﻣن اﻟﻔﻌﺎﻟﯾﺔ.ﺷﻔﺎء ﻗرﺣﺔ اﻻﺛﻧﻲ ﻋﺷر
Adverse effects: : اﻵﺛﺎر اﻟﺿﺎرة
Aluminum hydroxide tends to cause constipation, whereas
magnesium hydroxide tends to produce diarrhea. Preparations
that combine these agents aid in normalizing bowel function.
Absorption of the cations from antacids (Mg2+, Al3+, Ca2+) is
usually not a problem in patients with normal renal function;
however, accumulation and adverse effects may occur in
patients with renal impairment.
ﺗﺳﺎﻋد. ﺑﯾﻧﻣﺎ ﯾﻣﯾل ھﯾدروﻛﺳﯾد اﻟﻣﻐﻧﯾﺳﯾوم إﻟﻰ اﻟﺗﺳﺑب ﻓﻲ اﻹﺳﮭﺎل،ﯾﻣﯾل ھﯾدروﻛﺳﯾد اﻷﻟوﻣﻧﯾوم إﻟﻰ اﻟﺗﺳﺑب ﻓﻲ اﻹﻣﺳﺎك
اﻣﺗﺻﺎص اﻟﻛﺎﺗﯾوﻧﺎت ﻣن ﻣﺿﺎدات اﻟﺣﻣوﺿﺔ.اﻟﻣﺳﺗﺣﺿرات اﻟﺗﻲ ﺗﺟﻣﻊ ﺑﯾن ھذه اﻟﻌواﻣل ﻓﻲ ﺗطﺑﯾﻊ وظﯾﻔﺔ اﻷﻣﻌﺎء
ﻗد،( ﻋﺎدة ﻻ ﯾﻣﺛل ﻣﺷﻛﻠﺔ ﻓﻲ اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن وظﺎﺋف اﻟﻛﻠﻰ اﻟطﺑﯾﻌﯾﺔ؛ وﻣﻊ ذﻟك+Mg2+، Al3+، Ca2)
.ﯾﺣدث ﺗراﻛم وآﺛﺎر ﺿﺎرة ﻓﻲ اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن اﺧﺗﻼل ﻛﻠوي
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