Drugs used in the treatment of gastrointestinal diseases


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Drugs used in the treatment of gastrointestinal diseases

  1. 1. Drugs Used in the Treatmentof Gastrointestinal Diseases By M.H.Farjoo M.D. , Ph.D. Shahid Beheshti University of Medical Science
  2. 2. Drugs Used in the Treatment of Gastrointestinal Diseases Drugs used in peptic disease Laxatives Laxatives habituation Antidiarrheal Agents Antiemetic Agents Inflammatory Bowel Disease (IBD) Drug Pictures
  3. 3. Drugs used in peptic disease Antacids H2-Receptor Antagonists Proton Pump Inhibitors (PPI) Mucosal Protective Agents Prostaglandin Analogs
  4. 4. Antacids A single dose of antacid given 1 hour after a meal neutralizes gastric acid for to 2 hours Magnesium hydroxide causes an osmotic diarrhea Aluminum hydroxide causes constipation All antacids may affect the absorption of other medications by binding the drug Antacids should not be given within 2 hours of doses of tetracyclines, fluoroquinolones, itraconazole, and iron
  5. 5. H2-Receptor Antagonists Four H2 antagonists are  Cimetidine  Ranitidine  Famotidine  Nizatidine H2 antagonists reduce acid secretion stimulated by histamine as well as by gastrin and cholinomimetic agents H2 antagonists are very effective at inhibiting nocturnal acid but not as much on meal-stimulated acid secretion
  6. 6. H2-Receptor Antagonists Cont,d Clinical uses  Gastroesophageal reflux disease (GERD)  Peptic ulcer disease  Prevention of bleeding from stress-related gastritis Cimetidine when used long-term or in high doses, may cause gynecomastia or impotence in men and galactorrhea in women
  7. 7. Proton Pump Inhibitors (PPI) Five proton pump inhibitors are:  Omeprazole  Lansoprazole  Rabeprazole  Pantoprazole  Esomeprazole Proton pump inhibitors inhibit both fasting and meal-stimulated secretion
  8. 8. Proton Pump Inhibitors (PPI) Cont,d Clinical uses  Gastroesophageal reflux disease (GERD)  Peptic ulcer disease  H pylori–associated ulcers  NSAID-associated ulcers  Prevention of rebleeding from peptic ulcers  Nonulcer dyspepsia  Prevention of stress gastritis  Gastrinoma and other hypersecretory conditions
  9. 9. Mucosal Protective Agents Sucralfate  The negatively charged sucrose sulfate binds to positively charged proteins in the base of ulcers or erosion, forming a physical barrier
  10. 10. Prostaglandin Analogs Misoprostol, analog of PGE1, has both acid inhibitory and mucosal protective properties It is used for prevention of NSAID-induced ulcers in high-risk patients Diarrhea and cramping abdominal pain occurs in 10–20% of patients It should NOT be used during pregnancy or in women of childbearing potential
  11. 11. Laxatives Bulk-forming laxatives  Are indigestible, hydrophilic colloids that absorb water  2 drugs are: psyllium, methylcellulose Stool surfactant agents (softeners)  Soften stool material, permitting water and lipids to penetrate  2 drugs are: glycerin suppository, mineral oil
  12. 12. laxatives Cont,d Osmotic laxative  They are nonabsorbable sugars or salts  Drugs are:  Magnesium oxide (milk of magnesia)  sorbitol  lactulose  High doses of osmotically active agents produce prompt bowel evacuation (purgation) within 1–3 hours
  13. 13. laxatives Cont,d Stimulant Laxatives  directly stimulate enteric nervous system and colonic electrolyte and fluid secretion  May be required in patients who are neurologically impaired and in bed-bound patients  Long-term use of these agents probably is safe  They include:  Anthraquinone Derivatives: Aloe, senna, and cascara occur naturally in plants  Castor Oil  Bisacodyl
  14. 14. Antidiarrheal Agents Opioid agonists  Loperamide, Diphenoxylate Kaolin & pectin  Kaolin is a naturally occurring hydrated magnesium aluminum silicate and pectin is an indigestible carbohydrate derived from apple Bile salt binding resins  Cholestyramine, Colestipol may decrease diarrhea caused by excess fecal bile acids
  15. 15. Emetic Stimuli
  16. 16. Antiemetic drugs
  17. 17. Antiemetic Agents Promethazine Diphenhydramine & dimenhydrinate Hyoscine (scopolamine), is one of the best agents for the prevention of motion sickness Metoclopramide is a dopamine D2 receptor antagonists & a “Prokinetic” agent
  18. 18. Antiemetic Agents Cont,d Metoclopramide also blocks dopamine D2 receptors in the chemoreceptor trigger zone Used for:  Gastroesophageal reflux disease (GERD)  Impaired gastric emptying  Prevention of vomiting
  19. 19. Antiemetic Agents Cont,d Adverse effects of metoclopramide :  The most common are : insomnia, anxiety, and agitation in 20% of patients, especially the elderly  Extrapyramidal effects (dystonias, akathisia, parkinsonian features) occur in 25% of patients given high doses  Elevates prolactin levels
  20. 20. The IntestinalImmune System.In the healthystate
  21. 21. The IntestinalImmune Systemin Health andDisease.
  22. 22. Inflammatory Bowel Disease (IBD) Drugs that deliver 5-ASA to various distal segments of the small bowel or the colon are used Drugs include:  Sulfasalazine  Olsalazine  Balsalazide
  23. 23. mesalazine
  24. 24. mesalazine
  25. 25. mesalazine
  26. 26. mesalazine
  27. 27. mesalazine
  28. 28. Summary In English
  29. 29. Thank you Any question?