gastrointestinal agents

5,646 views
5,413 views

Published on

0 Comments
13 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,646
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
341
Comments
0
Likes
13
Embeds 0
No embeds

No notes for slide

gastrointestinal agents

  1. 1. Gastrointestinal Drugs Anatomy Diseases Therapeutic Agents
  2. 2. GIT Structure & Function <ul><li>Continuous tube </li></ul><ul><li>Function to convert complex food substances to simpler compounds </li></ul><ul><li>Absorbed into the bloodstream and used by cells </li></ul><ul><li>Excretes solid waste from the body </li></ul>
  3. 3. Anatomy
  4. 4. Esophagus Lower Esophageal Sphincter LES tone Stomach Body Pylorus Delayed Gastric Emptying Duodenum
  5. 5. Electron Micrograph of the small intestine in cross section
  6. 6. Damaged Mucosal Tissue in Peptic Ulcer Disease
  7. 7. GI Transit Time Composition <ul><li>Time it takes for material to pass from one end of the GIT to the other </li></ul><ul><li>SLOW  increase absorption </li></ul><ul><ul><ul><li>Constipation </li></ul></ul></ul><ul><li>FAST  decrease absorption </li></ul><ul><ul><ul><li>diarrhea </li></ul></ul></ul><ul><li>Layers of smooth muscle </li></ul><ul><li>Glandular lining </li></ul><ul><ul><li>Secrete gastric juice (enzymes) & HCL </li></ul></ul><ul><li>Bacteria </li></ul><ul><li>Mucous membranes </li></ul><ul><ul><li>Protect tract from abrasion </li></ul></ul>
  8. 8. GIT Diseases <ul><li>Peptic Disease </li></ul><ul><ul><li>Gastric Ulcers </li></ul></ul><ul><ul><ul><li>Helicobacter pylori (H.Phylori) </li></ul></ul></ul><ul><ul><ul><ul><li>Promotes breakdown of gastric mucosal barrier for unknown reasons given triggers </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Prevpak, Helidac, TCN-Metronidazole-bismuth </li></ul></ul></ul></ul><ul><ul><li>Duodenal Ulcers </li></ul></ul><ul><ul><li>Stress & Drug Induced Ulcers </li></ul></ul><ul><ul><li>GERD (Gastro esophageal reflux disease) </li></ul></ul>
  9. 9. GERD <ul><li>Reflux of gastric or duodenal contents into the esophagus </li></ul><ul><li>Symptoms – heartburn, regurgitation, chronic cough, hoarseness </li></ul><ul><li>Complications – aspiration, perforation, hemorrhage, obstruction, malnutrition </li></ul><ul><li>Incidence – 10 % population have daily heartburn – 36% have one episode/month </li></ul>
  10. 10. GERD Treatment Non-Drug Drug <ul><li>Elevate head in bed </li></ul><ul><li>Stop smoking </li></ul><ul><li>Reduce weight </li></ul><ul><li>Avoid large meals </li></ul><ul><li>Avoid irritating foods </li></ul><ul><li>Avoid irritating meds </li></ul><ul><li>Modify Diet </li></ul><ul><ul><li>ETOH, chocolate, coffee, tea, peppermint </li></ul></ul><ul><li>Antacids </li></ul><ul><li>H2-antagonists </li></ul><ul><li>Proton Pump Inhibitors </li></ul><ul><li>Coating Agents </li></ul><ul><ul><li>Sucralfate (Carafate) </li></ul></ul><ul><li>Prostaglandins E </li></ul><ul><ul><li>Misoprostol (Cytotec) </li></ul></ul>
  11. 11. ANTACIDS
  12. 12. Therapeutic Agents ~~Antacids <ul><li>Aluminum hydroxide-magnesium hydroxide (Maalox, Mylanta) </li></ul><ul><li>Aluminum hydroxide (Amphojel) </li></ul><ul><li>Magnesium hydroxide (MOM) </li></ul><ul><li>Alginic Acid (Gaviscon) </li></ul><ul><ul><li>“ Raft of foam” </li></ul></ul><ul><li>MOA </li></ul><ul><ul><ul><li>Partially neutralize existing stomach acid </li></ul></ul></ul><ul><ul><ul><li>Short term relief, take 1-3 hr. after meals </li></ul></ul></ul>
  13. 13. Antacid M O A
  14. 14. Histamine 2 Blockers
  15. 15. Therapeutic Agents ~~ H2 Receptor Antagonists <ul><li>Cimetidine(Tagamet </li></ul><ul><li>Famotidine (Pepcid) </li></ul><ul><li>Ranitidine (Zantac) </li></ul><ul><ul><ul><li>Blocks gastric acid and pepsin secretion by competitive inhibition of histamine at the H2 receptors on the gastric parietal cells. This inhibits gastric acid secretion (release). </li></ul></ul></ul><ul><ul><ul><li>Decrease histamine effect, reduce acid production </li></ul></ul></ul>
  16. 16. H2 Blocker MOA
  17. 17. Proton Pump Inhibitors
  18. 18. Proton Pump Inhibitors <ul><li>Esomeprazole (Nexium) </li></ul><ul><li>Lansoprazole (Prevacid) </li></ul><ul><li>Omeprazole (Prilosec) </li></ul><ul><li>Pantoprazole (Protonix) </li></ul><ul><li>Rabeprazole (Aciphex) </li></ul><ul><ul><ul><li>Work directly on active pumps to significantly inhibit acid production. </li></ul></ul></ul><ul><ul><ul><li>Decreases stomach HCL acid secretion </li></ul></ul></ul><ul><ul><ul><li>Allow enough acid for normal digestion </li></ul></ul></ul><ul><ul><ul><li>Promotes healing in 90% of patients </li></ul></ul></ul>
  19. 19. P P I's MOA
  20. 20. Remember the neurotransmitters?
  21. 21. Treatment Agents cont. <ul><li>Sucralfate (Carafate) </li></ul><ul><ul><li>Provides protective barrier to mucosa </li></ul></ul><ul><ul><li>Acid protective </li></ul></ul><ul><li>Metoclopramide (Reglan) </li></ul><ul><ul><li>Promotes gastric emptying </li></ul></ul>
  22. 22. Antidiarrheals <ul><li>Complications of Diarrhea </li></ul><ul><li>Therapeutic Agents </li></ul><ul><ul><li>Opium (Paregoric) </li></ul></ul><ul><ul><li>Diphenoxylate-atropine (Lomotil) </li></ul></ul><ul><ul><ul><li>Controlled drug C-V </li></ul></ul></ul><ul><ul><li>Loperamide (Imodium) </li></ul></ul>
  23. 23. Constipation ~~ Therapeutic Agents <ul><li>Emoll/Lubricants </li></ul><ul><ul><ul><li>Dioctyl sodium sulfosuccinate (Colace, DSS) </li></ul></ul></ul><ul><ul><ul><li>Glycerin </li></ul></ul></ul><ul><ul><ul><li>NA phosphate (Fleets) </li></ul></ul></ul><ul><ul><ul><li>Lactulose (Rx) </li></ul></ul></ul><ul><li>Stimulants </li></ul><ul><ul><ul><li>Bisacodyl (Dulcolax) </li></ul></ul></ul><ul><ul><ul><li>Senna (Senakot) </li></ul></ul></ul>
  24. 24. Constipation Agents cont. <ul><li>Bulk Forming </li></ul><ul><ul><ul><li>Methylcellulose </li></ul></ul></ul><ul><ul><ul><li>Psyllium (Metamucil) </li></ul></ul></ul><ul><ul><ul><li>Dietary FIBER </li></ul></ul></ul><ul><li>Bowel Evacuant </li></ul><ul><ul><li>Polyethylene glycol-electrolyte (PEG, GoLYTELY) </li></ul></ul><ul><li>Antiflatulents </li></ul><ul><ul><li>Simethicone </li></ul></ul>
  25. 25. Anatomy of Vomiting Chemo Receptor Trigger Zone Vomiting Center Smell Center Sight Center Vestibular Stimulation GI tract Skeletal Muscle Dopamine, Serotonin, Opiate Receptors
  26. 26. Mechanisms Underlying Nausea and Vomiting
  27. 27. Antiemetics~ OTC Rx <ul><li>Cyclizine (Marezine) </li></ul><ul><li>Dimenhydrinate (Dramamine) </li></ul><ul><li>Diphenhydramine (Benadryl) </li></ul><ul><li>Meclizine (Antivert, Bonine) </li></ul><ul><li>Herbals </li></ul><ul><ul><li>Ginger </li></ul></ul><ul><ul><li>Peppermint Oil </li></ul></ul><ul><li>Hydroxyzine (Atarax </li></ul><ul><li>Metoclopramide (Reglan) </li></ul><ul><li>Ondasetron (Zofran) </li></ul><ul><li>Prochlorperazine (Compazine) </li></ul><ul><li>Promethazine (Phenergan) </li></ul><ul><li>Trimethobenzamide (Tigan) </li></ul>
  28. 28. Eaten Alive – Parasites and their Human Hosts
  29. 29. Parasites Schistosoma mansoni (6,650 x electron micrograph) Large worm is male with female's head projecting from a middle fold. Permanant mating position 300 eggs/day released
  30. 30. ...the larvae head for the nearest snail host
  31. 31. ...they gobble up whole cell debris...
  32. 32. Even when potent drugs are found, parasites refuse to surrender.
  33. 33. Therapeutic Management <ul><li>Improve Hygiene </li></ul><ul><li>Control Vector & intermediate hosts </li></ul><ul><li>Vaccines </li></ul><ul><li>Traveler’s Diarrhea </li></ul><ul><ul><li>Tetracycline </li></ul></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Septra/Bactrim </li></ul></ul><ul><li>Mebendazole (Vermox) </li></ul><ul><li>Niclosamide (Niclocide) </li></ul><ul><li>Praziquantel (Biltricide) </li></ul><ul><li>Thiabendazole (Mintezol) </li></ul>
  34. 34. Malaria <ul><li>Infection </li></ul><ul><li>Chloroquine (Aralen) </li></ul><ul><li>Hydroxychloroquine (Plaquenil) </li></ul><ul><li>Mefloquine (Lariam) </li></ul><ul><li>Doxycycline (Vibramycin) </li></ul><ul><li>Quinine </li></ul><ul><li>Malarone </li></ul>
  35. 35. Irritable Bowel Syndrome <ul><li>5-HT3 Receptor Distribution </li></ul><ul><ul><li>CNS 5% </li></ul></ul><ul><ul><li>GIT 95% </li></ul></ul><ul><li>5-HT3 Receptor Antagonists </li></ul><ul><ul><li>Lotronex </li></ul></ul><ul><ul><li>Zelnorm </li></ul></ul><ul><li>Special Ordering </li></ul><ul><li>Cardiac Safety </li></ul>
  36. 37. Summary Slide <ul><li>GIT Structure & Function </li></ul><ul><li>GERD Treatment Non-Drug/Drug </li></ul><ul><li>Therapeutic Agents </li></ul><ul><ul><li>Antacids </li></ul></ul><ul><ul><li>H2 Receptor Antagonists </li></ul></ul><ul><ul><li>Proton Pump Inhibitors </li></ul></ul><ul><li>Antidiarrheals </li></ul><ul><li>Constipation </li></ul>
  37. 38. Summary Slide (cont.) <ul><li>Antiemetics~ </li></ul><ul><ul><li>OTC </li></ul></ul><ul><ul><li>Rx </li></ul></ul><ul><li>Obesity </li></ul><ul><ul><li>Anorectic Agents </li></ul></ul><ul><ul><li>Non Drug Methods </li></ul></ul>

×