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lupo__
16.04.2013, 17:33
Die Frage lautete, welche Maßnahme/Therapie konservativerweise bei der hypertrophen Pylorusstenose am wenigsten bringen würde, Auswahlmöglichkeiten:
- Scopolamin
- Atropin
- Oberkörper hoch
- häufige kleine Mahlzeiten
- Verapamil

Die Dozentenlösung lautet Verapamil. Allerdings findet man in der Fachinfo zu Scopolamin-Augentropfen ganz klar eine Anwendungsbeschränkung bei Pylorusstenose. Sonst findet man in der Roten Liste keinerlei zugelassenen Präparate zur oralen Anwendung; lediglich ein TTS bei Reisekrankheit. Atropin wird von der nicht aktuellen Leitlinie der Deutschen Gesellschaft für Kinderchirurgie nicht empfohlen, weil wenig wirksam. Verapamil macht in 0,1-1% der Fälle laut Fachinfo zwar Obstipation und Übelkeit, aber das ist wohl kaum ernsthaft abfragbares Prüfungswissen und eine enge Kontraindikation (vgl. §§ 14,29 ÄApprO).

Die Frage gehört aus der Wertung, ganz klar.

THawk
16.04.2013, 17:46
Ich denke, dass es bei Verapamil bleiben wird. Insgesamt ist heute die konservative Therapie nicht mehr etabliert; früher wurden aber als Medikamente sowohl Atropin als auch Scopolamin benutzt. Und Oberkörperhochlagerung sowie häufige kleine Mahlzeiten sind natürlich sinnvoll und werden auch heute noch bis zur Operation gemacht.
Damit bleibt Verapamil das Medikament mit der geringsten zu erwartenden Wirkung.

marc.b11
16.04.2013, 20:33
eigtl. ist doch klar, dass scopolamin und athropin beides zentral wirksame Parasympatholytika sind, insofern kann man nicht eines von beiden ankreuzen und das andere nicht und beide können nicht die gesuchte Antwort sein.

lupo__
16.04.2013, 21:30
eigtl. ist doch klar, dass scopolamin und athropin beides zentral wirksame Parasympatholytika sind, insofern kann man nicht eines von beiden ankreuzen und das andere nicht und beide können nicht die gesuchte Antwort sein.

Mich interessiert nicht die Intention des Fragestellers, der wissen will, ob ich einen Ca-Antagonisten vom Verapamil-Typ von zwei Parasympathikolytika auseinanderhalten kann. Wenn, dann sollten beide Stoffe wenigstens irgendwo in den Standard-Lehrbüchern zu finden sein (ich sehe da nichts im Speer oder im Koletzko oder in sonst einem Lehrbuch). Der eine Stoff hat nicht mal eine Zulassung in Deutschland (s.o.) und die beiden anderen Applikationsformen haben die Magenausgangsstenose als Anwendungsbeschränkung. Oder kurz: Ich hatte die Wahl zwischen einem nicht für die Krankheit dokumentierten, nicht zugelassenen Antivertiginosum und einem für die Krankheit wirkungslosen Medikament.

Ich hab jetzt auch schon im NCBI und beim NHS-NICE gesucht - kein Wort von hypertropher Pylorusstenose und Scopolamin.

Kackbratze
16.04.2013, 23:04
Du schaust zu weitläufig.
Im Müller "Chirurgie für Studium und Praxis" ist es unter konservativer Therapie angegeben.

Studien zu Atropin und Pylorusstenose findest Du bei PubMed.

StycleJet
16.04.2013, 23:21
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16.04.2013, 23:59
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