【藥事知多D】Bismuth Subsalicylate vs Tetracycline?鷸蚌相爭,漁人得利?
藥罐子曾經說過Bismuth Subsalicylate是四合一療法(Quadruple Therapy)的其中一員,適用於治療對幽門螺旋桿菌(Helicobacter pylori, H. pylori)呈陽性的腸胃潰瘍(H. pylori-positive Ulcers)。[1]
既然是「四」合一療法,除了Bismuth Subsalicylate外,自然還有三位尚未登場的三巨頭湊成四天王。
一般而言,其餘三種藥分別是Metronidazole、Omeprazole、Tetracycline。
不過任誰都知道所有組合總有合得來、合不來的時候。
其中這四天王裡面便有兩種藥鬧不和……
這兩種藥便是Bismuth Subsalicylate、Tetracycline。
這場內訌的肇因是Bismuth Subsalicylate在酸性的環境下(胃液)便可能會進化成為Bismuth Oxychloride,然後黏附在胃壁上形成一層薄膜,如同「烏蠅紙」一樣吸附胃黏膜主細胞(Gastric Chief Cell)所分泌的胃蛋白酶(Pepsin),抑制胃蛋白酶的活性。
不過Tetracycline偏偏就是同時能夠被吸附在Bismuth Subsalicylate這張「烏蠅紙」上,便可能會妨礙Tetracycline在腸道的吸收,削弱藥效。
所以要是需要服用Tetracycline,一般建議至少相隔兩小時服用,目的在製造不在場證明,盡量減低兩者同時在胃部相遇的機會,避免出現藥物相沖的機會。
不過凡事總有例外。
實際上,這種四合一療法便是一個例外。
為什麼?
答案很簡單,因為這一次的戰場是胃壁而對手是幽門螺旋桿菌。
唔……這到底有什麼關係呢?
其實幽門螺旋桿菌一直屯兵胃壁,牢牢依附在胃壁上,據險自守,在這個情況下,最理想的服用時間反而不是分開服用,因為這可能會促進Tetracycline在腸道的吸收,減少藥物停留在胃部的時間,從而便可能會分散兵力,反而可能會削弱藥效,不利用藥。
一般建議最理想的服用時間其實是同時服用[2],反其道而行之,刻意讓Bismuth Subsalicylate跟Tetracycline合兵,減少Tetracycline在腸道的吸收,爭取Tetracycline停留在胃部的時間,從而集中兵力發揮最理想的藥效。
所以這次用藥方略反而是盡量減少生體可用率(Bioavailability),簡單說,生體可用率愈低,效果反而愈理想。
在兵法上,這是一種「奇正之變(《孫子兵法.兵勢》)」。
在這裡,奇正互變,兵家大忌反成致勝之道。
對,在用藥上,還是需要因時制宜,臨場應變。
用藥之道,存乎一心。
在相當程度上,用藥如用兵便是這個意思。
常言道:「鷸蚌相爭,漁人得利。」在這個例子裡,鷸、蚌分別便是Bismuth Subsalicylate、Tetracycline,至於不用問,漁人當然是用藥者,對吧?
能夠將用藥這門科學與藝術的結晶發揮到極致,當然是一個上乘的漁人!
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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Reference:
1. Malfertheiner P, Bazzoli F, Delchier JC, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet. 2011;377:905.
2. Janis Bonat, Catherine Dragon, Virginia P. Arcangelo. Gastroesophageal Reflux Disease and Peptic Ulcer Disease. In: Pharmacotherapeutics for Advanced Practice: A Practical Approach. Lippincott, Williams, & Wilkins. 2nd ed. 2006;29:372-385.
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【藥事知多D】一物兩用:Bismuth Subsalicylate
同一種藥同時往往可以有不同的用途。
看,單是一粒亞士匹靈(Aspirin),不同的劑量便已經有不同的用途。
不過就算是同一種藥、同一種作用原理,還是可以有兩種用途。
例如Bismuth Subsalicylate。
那到底是哪兩種用途呢?
唔……首先給大家兩個提示:
第一,Bismuth Subsalicylate在酸性的環境下(胃液)便可能會進化成為Bismuth Oxychloride,然後黏附在胃壁上形成一層薄膜,如同「烏蠅紙」一樣吸附胃黏膜主細胞(Gastric Chief Cell)所分泌的胃蛋白酶(Pepsin),抑制胃蛋白酶的活性。
第二,Bismuth Subsalicylate還有一種與眾不同的特性,便是可能會干擾幽門螺旋桿菌(Helicobacter pylori, H. pylori)的細胞壁、蛋白質、三磷酸腺苷(Adenosine Triphosphate, ATP)合成,癱瘓幽門螺旋桿菌的新陳代謝,同時干擾細胞膜(Cell Membrane)的滲透功能,誘發幽門螺旋桿菌的體內出現滲漏,殺滅幽門螺旋桿菌。[1]
所以Bismuth Subsalicylate有資格成為四合一療法(Quadruple Therapy)的其中一員,適用於治療對幽門螺旋桿菌呈陽性的腸胃潰瘍(H. pylori-positive Ulcers)。[2]
對,Bismuth Subsalicylate的第一個用途便是胃藥。
至於要是大腸,場景不同,角色便會不同,劇情便會不同……
既然Bismuth Subsalicylate這張「烏蠅紙」可能會吸附胃蛋白酶,自然便可能會吸附其他東西,在相當程度上,Bismuth Subsalicylate算是一種吸附劑(Adsorbents),直達大腸後,便可能會吸附腸道內的刺激物、致病原、毒素,然後透過大便一同排出體外,從而可能會排除這些病源,達到止瀉的效果。
除此之外,既然Bismuth Subsalicylate可能會殺滅幽門螺旋桿菌,自然還可能會殺滅腸道內的細菌,同樣可能會排除這些病源,達到止瀉的效果。
對,Bismuth Subsalicylate的第二個用途便是止瀉藥。
還有一般相信Bismuth Subsalicylate還可能會增加水分、電解質的吸收,減少腸腔內的水分,所以還是一種抗分泌劑(Antisecretory Agents),讓水狀的大便呈固體狀,從而能夠紓緩腹瀉。
據說Bismuth Subsalicylate還可能會在腸道裡進行水解(Hydrolysis)產生水楊酸(Salicylic Acid),從而可能會抑制其中一種前列腺素(Prostaglandin, PG)的產生,紓緩腸道炎症,減慢腸道蠕動,達到止瀉的效果。
其中Bismuth Subsalicylate較常用於預防、治療旅行者腹瀉(Traveler's Diarrhea, TD),俗稱「水土不服」。[3]
所以Bismuth Subsalicylate既是胃藥,又是止瀉藥,一言以蔽之,便是腸胃藥。
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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Reference:
1. Lambert JR, Midolo P. The actions of bismuth in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther. 1997;11(Suppl 1):27-33.
2. Malfertheiner P, Bazzoli F, Delchier JC, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet. 2011;377:905.
3. Steffen R, DuPont HL, Heusser R, et al. Prevention of travelers’ diarrhea by the tablet form of bismuth subsalicylate. Antimicrob Agents Chemother. 1986;29:625-7.
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【藥事知多D】胃藥知多D:Bismuth Subsalicylate
根據藥理,常用的胃藥主要可以分為抗酸劑(Antacid)例如鹼鹽和制酸劑例如H2受體拮抗劑(H2 Antagonist)、質子泵抑制劑(Proton Pump Inhibitor, PPI)兩類。
不論是抗酸劑還是制酸劑,最終的目的還是減少胃酸,主要用來治療、預防一些胃病,例如胃痛、胃灼熱、胃潰瘍、胃液倒流。
那市面上又有沒有一些胃藥,既不抗酸又不制酸,既不中和胃酸又不抑制胃酸呢?
哈哈……各位聰明的看倌一定會知道答案當然是「有」,不然這篇文章怎麼能夠繼續寫下去?
對,答案是有的。
這種非典型胃藥便是Bismuth Subsalicylate。
誠如上文所述,在藥理上,Bismuth Subsalicylate既不是抗酸劑,又不是制酸劑,不過偏偏就是一種胃藥。
跟抗酸劑、制酸劑不同,Bismuth Subsalicylate主要有以下四個作用原理:
第一,Bismuth Subsalicylate在酸性的環境下(胃液)便可能會進化成為Bismuth Oxychloride,然後黏附在胃壁上形成一層薄膜,如同「烏蠅紙」一樣吸附胃黏膜主細胞(Gastric Chief Cell)所分泌的胃蛋白酶(Pepsin),抑制胃蛋白酶的活性。
胃蛋白酶主要負責消化胃裡的蛋白質,固然能夠消化食物裡的蛋白質,更加能夠消化胃壁細胞(Parietal Cells)裡的蛋白質,所以抑制胃蛋白酶的活性,在相當程度上,便可能會減少胃液對胃部的刺激。
第二,Bismuth Subsalicylate可能會黏附在胃潰瘍的傷口上形成一種物理性屏障,如同敷料一樣減少傷口繼續受到胃液的刺激,促進傷口癒合。[1][2]
第三,Bismuth Subsalicylate可能會促進前列腺素(Prostaglandin, PG)的產生,增加胃壁黏液分泌,如同加厚城牆一樣鞏固胃壁黏膜抗衡胃酸。
第四,Bismuth Subsalicylate可能會促進胃壁黏膜分泌重碳酸鹽(Bicarbonate, HCO3-)這種鹼鹽,中和胃酸,從而加強胃壁的自我保護功能。
跟其他胃藥不同,Bismuth Subsalicylate還有一種與眾不同的特性,便是可能會干擾幽門螺旋桿菌(Helicobacter pylori, H. pylori)的細胞壁、蛋白質、三磷酸腺苷(Adenosine Triphosphate, ATP)合成,癱瘓幽門螺旋桿菌的新陳代謝,同時干擾細胞膜(Cell Membrane)的滲透功能,誘發幽門螺旋桿菌的體內出現滲漏,殺滅幽門螺旋桿菌。[3]
所以Bismuth Subsalicylate有資格成為四合一療法(Quadruple Therapy)的其中一員,適用於治療對幽門螺旋桿菌呈陽性的腸胃潰瘍(H. pylori-positive Ulcers)。[4]
在副作用上,因為這種胃藥一般採取「無差別」的吸附模式,所以其他藥物同樣可能會被吸附在這張「烏蠅紙」上,便可能會減少藥物的吸收,從而削弱藥效。
所以要是需要服用其他藥物,一般建議至少相隔兩小時服用,盡量減低兩者同時在胃部相遇的機會,避免出現藥物相沖的機會。
除此之外,Bismuth Subsalicylate還可能會在消化道裡跟細菌體內的硫化氫(Hydrogen Sulfide, H2S)產生化學反應轉化成為硫化鉍(Bismuth Sulfide, Bi2S3),因為硫化鉍是黑色,所以可能會弄污舌頭、染黑大便。
還有因為Bismuth Subsalicylate含有鉍(Bismuth)、水楊酸(Salicylic Acid)這兩種成分,所以還可能會出現兩者所帶來的副作用:
一、鉍
因為鉍主要透過腎臟排出體外,所以要是腎功能不佳,這些重金屬離子便可能會不斷積聚在人體裡面,日積月累,便可能會超標構成毒性,損害神經系統,所以未必適用於對一些腎衰竭(Renal Failure)人士服用。
二、水楊酸
因為Bismuth Subsalicylate可以產生水楊酸,所以不適用於對亞士匹靈(Aspirin)產生過敏的人士服用,同時避免超出建議劑量,減低出現水楊酸中毒的風險。
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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Reference:
1. Lambert JR, Way DJ, King RG, Eaves ER, Hansky J. Bismuth pharmacokinetics in the human gastric mucosa. Gastroenterology. 1988;94: A248.
2. Koo J, Ho J, Lam SK, Wong J, Ong GB. Selective coating of gastric ulcer by tripotassium dicitrato-bismuthate in the rat. Gastroenterology. 1982;82:864-70.
3. Lambert JR, Midolo P. The actions of bismuth in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther. 1997;11(Suppl 1):27-33.
4. Malfertheiner P, Bazzoli F, Delchier JC, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet. 2011;377:905.
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Girly when I tell you this took forever to edit...? Finally, here is the video of me reacting to (and very poorly "animating") a fanfic about me and @Corpse Husband and a bunch of other canceled people! ??♀️ Let me know who you're shipping in the comments ?
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I know I said I was going to film this months ago but I was in the middle of moving so I forgot about it until now ? It took forever to edit this one bc my sister said we should add visuals which was actually quite fun ?
I'm currently working on subtitles, I know it's hard to hear my sister bc she didn't have a mic ??♀️ @YouTube please bring back community contributions :(
I know this is a longer video which I don't really do that often anymore, but I still hope you enjoy! And yes I included Pewdiepie instead of David Dobrik in the thumbnail because I have a theory that David actually said those things about Valentine to get back into her life because he saw everyone was shipping Vorpse ?
'til next time!
♡ xo
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triple h ig 在 Jessica Vu Youtube 的精選貼文
The weather is getting warmer, which means hot girl summer is here ? Today's makeup tutorial is on my updated everyday sunkissed makeup look in partnership with COVERGIRL! I included a lot of no makeup makeup tricks for an effortlessly flawless look, perfect for those sunny beach days ?#COVERGIRLPartner #EasyBreezyBeautiful
FOLLOW ME!
✧ IG: https://www.instagram.com/jessyluxe
✧ PODCAST: https://anchor.fm/volumeup
✧ TIKTOK: https://www.tiktok.com/@jessyluxe
✧ TWITTER: https://twitter.com/luxejessy
✧ SPOTIFY: https://bit.ly/jessyluxe
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Hello! Do you have any summer plans? I've been fully vaccinated for a while now, so I'm excited to travel again soon! I'm actually visiting NYC in July ❤️ I just know it's going to be so humid ?
I noticed the "no makeup" makeup look is in lately, so here's my take...with winged liner ? I can't do my makeup without it ? A lot of you guys said you prefer natural makeup looks on Instagram, so I hope you like this one! I learned so many mini techniques to enhance natural makeup during quarantine..but I know I've been doing a lot of neutrals lately, so the next one will be more avant-garde/artsy, I promise!
Other life updates: my little sister is staying with me for the summer, so you may see her more often on random LIVUs/livestreams/videos. Please welcome her kindly!
'til next time!
♡ xo
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P R O D U C T S
EYES ⁺
˖ O-Lens Colored Contact Lenses ("Russian Velvet Brown") https://bit.ly/3fQ5VpC
˖ Kosas Brow Pop Clean Dual-Action Defining Eyebrow Pencil ("Brown Black") https://go.magik.ly/ml/17tv2/
˖ Too Faced Born This Way Multi-Use Super Coverage Sculpting Concealer ("Almond") https://go.magik.ly/ml/13rs5/
˖ Kosas Air Brow Clear + Clean Lifting Treatment Eyebrow Gel https://go.magik.ly/ml/17tv6/
˖ Kaja Spiked Ginger Beauty Bento Bouncy Shimmer Eyeshadow Trio ("01 Nude Apricot", "03 Toffee") https://go.magik.ly/ml/17txy/
˖ CoverGirl Perfect Point Plus Liquid Liner ("Espresso") https://bit.ly/3ii2KbL
˖ Kaja Chocolate Dahlia Beauty Bento Bouncy Shimmer Eyeshadow Trio ("03 Brown Sugar") https://go.magik.ly/ml/13rr2/
˖ CoverGirl Lash Blast Clean Volume Mascara ("Black Brown") https://bit.ly/3cfznTx
˖ Gucci Beauty Stylo Contour Des Yeux Kohl Eyeliner ("03 Chocolat") https://go.magik.ly/ml/17tz4/
˖ Freck The Original Freckle ("Freck Noir") https://bit.ly/3vUHNaL
FACE ⁺
˖ Laneige Glowy Makeup Serum https://go.magik.ly/ml/13rs3/
˖ Pat McGrath Labs Skin Fetish Sublime Perfection Foundation ("Light Medium 10") https://go.magik.ly/ml/17tz5/
˖ Too Faced Born This Way Multi-Use Super Coverage Sculpting Concealer ("Almond") https://go.magik.ly/ml/13rs5/
˖ CoverGirl Simply Ageless Instant Wrinkle Blurring Pressed Powder ("Translucent") https://bit.ly/352pt41
˖ ColourPop Sugar Frosted Cheek Palette ("Trifle", "Cookie Crumble") https://go.magik.ly/ml/17tz6/
˖ VT Cosmetics Triple Shading Contour Palette (no longer available)
˖ Make Up For Ever Star Lit Powder ("2 Frozen Gold") https://go.magik.ly/ml/13rsa/
˖ Freck The Original Freckle ("Freck Noir") https://bit.ly/3vUHNaL
LIPS ⁺
˖ Gucci Beauty Crayon Contour Des Levres Lip Liner ("01 Nude") https://go.magik.ly/ml/17tzj/
˖ CoverGirl Outlast All Day Lip Color in New Neutrals ("110 Ripe Peach") https://bit.ly/3pmBz0S
˖ Freck The Original Freckle ("Freck Noir") https://bit.ly/3vUHNaL
˖ Patrick Ta Beauty Major Sculpt Creme Contour & Powder Bronzer Duo ("She's Statuesque") https://go.magik.ly/ml/17tzv/
TOOLS ⁺
˖ Sigma Beauty Line Perfector Brush E68 https://go.magik.ly/ml/17tso/
˖ IT Brushes for Ulta Airbrush All-Over Shadow Brush #119 https://go.magik.ly/ml/17tsu/
˖ Sigma Beauty Waterline Liner Brush E17 (no longer available - similar: https://go.magik.ly/ml/17tss/)
˖ Shiseido Eyelash Curler https://go.magik.ly/ml/16owl/
˖ Em Cosmetics Daydream Cushion Tinted SPF https://go.magik.ly/ml/17tsw/
˖ CoverGirl Simply Ageless Instant Wrinkle Blurring Pressed Powder Sponge https://bit.ly/352pt41
˖ ColourPop Blush Brush https://go.magik.ly/ml/13rst/
˖ ColourPop Small Tapered Brush E9 https://go.magik.ly/ml/kpq4/
˖ Zoeva Powder Brush #106 https://go.magik.ly/ml/17tu3/
WEARING ⁺
˖ Gold Hoop Earrings (discontinued)
˖ Small Gold Necklace (Vietnam)
˖ Maria Pascual Gold Deco Necklace https://bit.ly/3cl42ir
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T E C H
˖ CAMERA
Canon EOS Rebel T6i DSLR
https://amzn.to/2PcG1Mk
˖ LENS
EF-S 18-55mm IS STM Kit Lens
https://amzn.to/2P7wAxx
˖ LIGHTING
GVM Great Video Maker 800D RGB LED Panel Video Light Kit 3200K-5600K
https://go.magik.ly/ml/17tru/
˖ EDITING PROGRAM
Final Cut Pro X 10.5
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M U S I C
˖ chobizzy - LUSH KARMA 2 https://soundcloud.com/soohyungcho/lush-karma-2
˖ luvbyrd - doja cat kiss me more lofi https://youtu.be/spzUbsqiJWk
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? BUSINESS EMAIL: jessica@rare.global
FTC: Sponsored by CoverGirl ? Some links listed are affiliate links which help out the channel if you make a purchase through them ? and some products used I received in PR („• ֊ •„)
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