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the most potent suppressors of gastric acid secretion are inhibitors of the gastric h+,k+-atpase (proton pump) (figure 36–2a). in typical doses, these drugs diminish the daily production of acid (basal and stimulated) by 80% to 95%. five proton pump inhibitors are available for clinical use: omeprazole (prilosec, rapinex, zegerid) and its s-isomer, esomeprazole (nexium), lansoprazole (prevacid), rabeprazole (aciphex), and pantoprazole (protonix). these drugs have different substitutions on their pyridine and/or benzimidazole groups but are remarkably similar in their pharmacological properties (see appendix ii). omeprazole is a racemic mixture of r- and s-isomers; the s-isomer, esomeprazole (s-omeprazole), is eliminated less rapidly than r-omeprazole, which theoretically provides a therapeutic advantage because of the increased half-life. despite claims to the contrary, all proton pump inhibitors have equivalent efficacy at comparable doses. proton pump inhibitors are prodrugs that require activation in an acid environment. after absorption into the systemic circulation, the prodrug diffuses into the parietal cells of the stomach and accumulates in the acidic secretory canaliculi. here, it is activated by proton-catalyzed formation of a tetracyclic sulfenamide (figure 36–2), trapping the drug so that it cannot diffuse back across the canalicular membrane. the activated form then binds covalently with sulfhydryl groups of cysteines in the h+,k+-atpase, irreversibly inactivating the pump molecule. acid secretion resumes only after new pump molecules are synthesized and inserted into the luminal membrane, providing a prolonged (up to 24- to 48-hour) suppression of acid secretion, despite the much shorter plasma half-lives (0.5 to 2 hours) of the parent compounds. because they block the final step in acid production, the proton pump inhibitors are effective in acid suppression regardless of other stimulating factors. the most potent suppressors of gastric acid secretion are inhibitors of the gastric h+,k+-atpase (proton pump) (figure 36–2a). in typical doses, these drugs diminish the daily production of acid (basal and stimulated) by 80% to 95%. five proton pump inhibitors are available for clinical use: omeprazole (prilosec, rapinex, zegerid) and its s-isomer, esomeprazole (nexium), lansoprazole (prevacid), rabeprazole (aciphex), and pantoprazole (protonix). these drugs have different substitutions on their pyridine and/or benzimidazole groups but are remarkably similar in their pharmacological properties (see appendix ii). omeprazole is a racemic mixture of r- and s-isomers; the s-isomer, esomeprazole (s-omeprazole), is eliminated less rapidly than r-omeprazole, which theoretically provides a therapeutic advantage because of the increased half-life. despite claims to the contrary, all proton pump inhibitors have equivalent efficacy at comparable doses. proton pump inhibitors are prodrugs that require activation in an acid environment. after absorption into the systemic circulation, the prodrug diffuses into the parietal cells of the stomach and accumulates in the acidic secretory canaliculi. here, it is activated by proton-catalyzed formation of a tetracyclic sulfenamide (figure 36–2), trapping the drug so that it cannot diffuse back across the canalicular membrane. the activated form then binds covalently with sulfhydryl groups of cysteines in the h+,k+-atpase, irreversibly inactivating the pump molecule. acid secretion resumes only after new pump molecules are synthesized and inserted into the luminal membrane, providing a prolonged (up to 24- to 48-hour) suppression of acid secretion, despite the much shorter plasma half-lives (0.5 to 2 hours) of the parent compounds. because they block the final step in acid production, the proton pump inhibitors are effective in acid suppression regardless of other stimulating factors.
Laatste Update: 2014-04-24
Gebruiksfrequentie: 1
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apa ini masih ada
这个还有吗
Laatste Update: 2022-02-19
Gebruiksfrequentie: 1
Kwaliteit:
Referentie:
selama persediaan masih ada
applies multiply
Laatste Update: 2019-04-18
Gebruiksfrequentie: 1
Kwaliteit:
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selama stock masih ada.
while stock is still in stock
Laatste Update: 2024-06-09
Gebruiksfrequentie: 1
Kwaliteit:
Referentie:
berlaku selama persediaan masih ada
while supplies last
Laatste Update: 2019-04-12
Gebruiksfrequentie: 1
Kwaliteit:
Referentie:
masih ada syarat yang harus dilengkapi
there are still obstacles
Laatste Update: 2012-04-22
Gebruiksfrequentie: 1
Kwaliteit:
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dia menjawab: "masih ada tambahan?"
it will say, "are there any more (to come)?"
Laatste Update: 2014-07-03
Gebruiksfrequentie: 2
Kwaliteit:
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Waarschuwing: Bevat onzichtbare HTML-opmaak
masih berada di episode menunggu
masih berada di episode menunggu
Laatste Update: 2024-01-26
Gebruiksfrequentie: 1
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biarlah kita merendahkan diri dan menyerah, karena mungkin harapan masih ada
he putteth his mouth in the dust; if so be there may be hope.
Laatste Update: 2012-05-06
Gebruiksfrequentie: 1
Kwaliteit:
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saya perhatikan anda akrab sekali dg pacar saya
my girlfriend
Laatste Update: 2024-08-30
Gebruiksfrequentie: 1
Kwaliteit:
Referentie:
wabah virus covid 19 masih ada saat ini, covid 19 awalnya berasal dari china
the covid 19 virus outbreak still exists today, covid 19 originally came from china
Laatste Update: 2022-03-23
Gebruiksfrequentie: 1
Kwaliteit:
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nama saya adalah saya sendiri
my name is myself
Laatste Update: 2021-08-30
Gebruiksfrequentie: 1
Kwaliteit:
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saya memiliki nenek. hussband nya adalah saya
i have a grandmother. her hussband is my
Laatste Update: 2016-03-21
Gebruiksfrequentie: 2
Kwaliteit:
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hal berkesan saya selama liburan kemarin itu adalah saya mendapatkan banyak waktu bersama keluarga saya, walaupun saya dan keluarga tidak pergi berlibur
my memorable thing during the holidays was that i got a lot of time with my family, even though my family and i didn't go on vacation
Laatste Update: 2024-01-03
Gebruiksfrequentie: 1
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terima kasih telah menginformasikan kami waktu kedatangan anda. dengan senang hati, anda bisa melakukan check in pada pukul 11.30. jika ada pertanyaan lebih lanjut. jangan sungkan untuk bertanya kepada kami
Laatste Update: 2024-05-08
Gebruiksfrequentie: 1
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