【藥事知多D】止嘔藥知多D：Aprepitant

藥罐子相信沒有多少人會喜歡服藥，更加相信沒有多少人會喜歡服化療藥。
　　
這也難怪。相較而言，化療藥的副作用實在較多、較大、較廣。

那哪一種副作用較可怕呢？
　　
首先說到化療藥，常見的副作用主要是骨髓抑制(Myelosuppression)、口腔黏膜炎(Oral Mucositis)、脫髮(Alopecia)、噁心、嘔吐(Nausea & Vomiting)、腹瀉(Diarrhoea)、不育(Infertility)等等。
　　
唔……不用問，當然是不育。
　　
還有一個，恐怕是噁心、嘔吐吧？
　　
為什麼？
　　
說到底，「不育」是化療藥的後果，而「噁心、嘔吐」則是化療藥的過程，甚至前夕……
　　
這話怎麼解？
　　
其實真正的可怕並不在這些副作用所帶來的痛苦，而在這些副作用所產生的恐懼……
　　
首先說到噁心、嘔吐，依照發生時間的長短，一般可以分為兩種，主要如下：
　　
第一，急性嘔吐(Acute Emesis)，發生在化療24小時內。
　　
第二，延遲性嘔吐(Delayed Emesis)，發生在化療24小時後。
　　
除此之外，不說不知道，跟其他副作用不同，要是一些用藥者過往在接受化療期間曾經出現噁心、嘔吐，這些經歷便可能會在用藥者的心裡蒙上一層揮之不去的陰影，在心理上，便可能會產生一種無形的恐懼，一朝被蛇咬，十年怕草繩，從而在準備接受化療前，單是看這些化療藥，連碰都不用碰，便已經開始嘔吐，稱為預期性嘔吐(Anticipatory Emesis)。
　　
簡單說，單是這種恐懼，就算不服藥，便已經能夠誘發噁心、嘔吐。
　　
你們說，可不可怕？
　　
好！要是這種化療而導致的噁心、嘔吐(Chemotherapy-induced Nausea and Vomiting, CINV)，其中一種止嘔藥便是Aprepitant。
　　
在藥理上，Aprepitant是一種NK1受體拮抗劑(NK1 Receptor Antagonist)，主要透過阻斷P物質(Substance P)來改善化療而導致的噁心、嘔吐。
　　
不過Aprepitant一般不會孤軍作戰，大多會搭配其他藥一同使用，主要是類固醇（例如Dexamethasone）、選擇性血清素再回收抑制劑(Selective Serotonin Reuptake Inhibitors, SSRIs)（例如Dolasetron、Granisetron、Ondansetron、Palonosetron），兵分三路，三路夾擊，用來預防這種化療而導致的噁心、嘔吐。

（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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With the change in food and environment when I travel, I’m very prone to having diarrhoea.. 😫 It is important for me to take good care of my own health and wellbeing to avoid any disruptions during my travels. 😖
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I’m sure most of us have experienced diarrhoea once in their lifetime that affects us, not only physically but emotionally and socially! It can be tough if I do not have any proper medication, especially when I’m travelling. That’s why I always go prepared. ☺️
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For more info on how you too can look after your health, check out www.smecta.com.my Do you have a story of how you have dealt with diarrhoea? Let me know in the comments!
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❤️ Doing the exact thing 🤱 while I write this love letter to all the breastfeeding mamas, with her eyes gazing afar but her little hands toying with my other nip 😑😳😵

Having a baby in your hand, latching the little mini me who may have been on your (@@) the whole night; on and off on and off, your eye bags are as thick as the salmon 🍣 sashimi that you are imagining having or you may just wish to have that luxury to lie down on your comfy bed to sleep 😴 beside the knocked out husband 🤨 already..

All of this, I’m sure many of you are familiar with, as much as you may need that beauty sleep 💤 but hope you know some day when you look back to see what you have achieve thru the long nights nourishing and producing your golden liquid which has millions of living cells that consists of immune boosting white blood cells and stem cells for healing ❤️‍🩹 and organ development, proteins for growth and protect neurons in their brain, amino acids that helps to induce sleep, probiotics (good bacteria) for healthier gut and prevents infection from entering their bloodstreams, more than 40 enzymes, abundance of hormones, vitamins and minerals and importantly antibodies protection by neutralising bacteria’s and viruses - the list can go on and on… but Yes, we do have that kind of super power! #wow #soamazing right??

Everything your baby needed, varies over time as well, apart from these amazing benefits - it’s easier to digest and your baby will less likely to have constipation or diarrhoea, and lesser risk of SID (sudden infant death) as well as obesity and diabetes in adulthood which in years to come they really have YOU, mama to thank for, even though now both of you may not seen it yet.. 👍🏻

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Feeling bored at home and love spicy food? Can try this #spicychallenge then. I thought it was all okay until when I need to visit toilet the next day hahaha. PEDAS tapi sedap~

PS: Make sure you get your water ready.

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益生菌專題 －張世華腸胃肝臟科專科醫生＠FindDoc.com

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（一）街訪：有聽過什麼是益生菌嗎？ 00:00

（二）醫生解話：什麼是益生菌？ 00:32

（三）街訪：什麼食物會含有益生菌？ 01:01

（四）醫生解答：益生菌經過胃酸還能生存嗎？1:15

（五）醫生解答：如何選擇益生菌產品？01:33

（六）醫生解答：日常飲食能補充益生菌嗎？01:48

（七）醫生解答：應該補充多少益生菌？02:18

（八）醫生解答：年紀大壞菌會變多，所以更需要吃益生菌？02:29

（九）醫生解答：益生菌能當補品吃嗎？02:57

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1. Magro, F., Gionchetti, P., Eliakim, R., Ardizzone, S., Armuzzi, A., Acosta, M. B., …Raine, T. (2017). ECCO Guideline / Consensus Paper Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis . Part 1 : Definitions , Diagnosis , Extra-intestinal Manifestations , Pregnancy , Cancer Surveillance , Surgery , and Ileo-anal Pouch Disorders, Journal of Crohn’s and Colitis, 11(6), 649–670. doi: 10.1093/ecco-jcc/jjx008
2. Allen, SJ., Martinez, E. G., Gregorio, G. V., & Dans, L. F.(2010) Probiotics for treating acute infectious diarrhoea. Cochrane Database of Systematic Reviews 2010, (11). doi: 10.1002/14651858.CD003048.pub3
3. Didari, T., Mozaffari, S., Nikfar, S., and Abdollahi, M. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World journal of gastroenterology, 21(10), 3072–3084. doi:10.3748/wjg.v21.i10.3072


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訂閱電子報，下載 vocab worksheet：http://bit.ly/fla-nl


1) You know what, be right back. I got a diarrhea/diarrhoea. I’ll call you when I’m done, okay?

2) Thank you for your compliment.

3) I’m sorry. You’ve got the wrong person.

4) I’m not your angel, nor an angel. I’m actually quite a devil and I’m not sure if you can handle it.

5) My boyfriend is standing right behind you.



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