GI pharmacology


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GI pharmacology

  3. 3. SUMMARYPeptic ulcer disease/dyspepsiaGERDConstipationDiarrhoeaIrritable bowel syndrome
  4. 4. Peptic Ulcer Disease OR DyspepsiaPeptic ulcers: Peptic ulcer disease refers to painful soresor ulcers in the lining of the stomach or duodenum.Dyspepsia: upper abdominal pain/discomfort(also known as indigestion or upset stomach)
  5. 5. Peptic Ulcer Disease OR Dyspepsia CAUSES:• Not single cause.• Can occur at any age• Occur equally in men and women• Ulcers can be caused by: Helicobacter pylori• Drugs: (NSAIDs),• Excess acid production from gastrinomas• Zollinger-Ellison syndrome.
  6. 6. Peptic Ulcer Disease OR Dyspepsia Symptoms:• Burning pain( in the middle or upper stomach )• Bloating• Heartburn• Nausea or vomiting
  7. 7. Medication used in Peptic Ulcer Disease OR DyspepsiaDirected towards relieving pain, acceleratingulcer healing, and minimizing reoccurrence •H2 receptor antagonists •Proton pump inhibitors •Antacids •Sucralfate •Bismuth compounds •Antibiotics
  8. 8. H2 receptor antagonists Peptic Ulcer Disease OR Dyspepsia medicationCimetidine, Ranitidine, Famotidine, Nizatidine• Competitive and selective inhibition of histamine H-2 receptor• Suppress 24 hr gastric secretion by 70%• Less effective than PPICaution: renal failure, pregnancy, breast feedingSide effects: Well tolerated, less than 3% adverse effects Diarrhoea, headache, drowsiness, fatigue, constipation. Rarely pancreatitis, bradycardia, confusion.
  9. 9. H2 receptor antagonists Peptic Ulcer Disease OR Dyspepsia medicationTherapeutic effects:Promote the healing of gastric and duodenal ulcersGastroesophageal reflux Disease [GERD]Upper GI bleed [GIB]May be effective in stress ulcers & pepticesophagitis
  10. 10. H2 receptor antagonistsPeptic Ulcer Disease OR Dyspepsia medication
  11. 11. H2 receptor antagonists Peptic Ulcer Disease OR Dyspepsia medication RANITIDINE 15OMG TAB RANITIDINE 50MG INJECTIONSRanitidine Tablets : The maximum dose is 300 mg every 24 hoursInjection: Raniditine injections may be used inhospitals under specific circumstances when thepatient is not able to swallow tablets. The usual doseof ranitidine injection is 50 mg every six / eight hoursgiven intravenously or intramuscularly .
  12. 12. Proton pump inhibitorsOmeprazole (20-40mg), Lansoprazole (15 – 30mg),Pantoprazole(20-40mg), Esomeprazole(20-40mg),Rabeprazole(20mg).Prodrugs activated in acidic secretory canaliculiInhibit gastric H+K+ ATPase irreversiblyDecrease acid secretion by up to 95% for up to 48 hoursUse: Ulcers, GERD, Zollinger-Ellison SyndromeSide effects Generally well tolerated Gastrointestinal disturbance, headache, dizziness. impotence, gynaecomastia. May increase risk of GI infections (reduced acidity).
  13. 13. Proton pump inhibitors Proton pump inhibitors
  15. 15. AntacidsAlkaline substances that neutralizeacids. It neutralizes more than 90% ofgastric acid and inhibits conversion ofpepsinogen to pepsin.
  16. 16. Antacids Compounds• Magnesium hydroxide• Aluminium hdroxide• Magnesium trisilicate• Magnesium-aluminum mixtures• Calcium carbonate• Sodium bicarbonate
  17. 17. AntacidsMechanism: Alkalizers: To Neutralize HClAntacids Used For: Indigestion, Gastritis, Heartburn, Gastroesophageal reflux disease Peptic ulcerAdverse Effect: Systemic alkalosis, Diarrhea , CO2
  18. 18. Antacids
  19. 19. AntacidsMagnesium hydroxide 100 mgAluminium hydroxide 405 mg Moxal Suspension Moxal Tablets
  20. 20. Antacids DOSAGE:12 years and older: take 2 to 4teaspoonfuls OR 1-2 Tablets four times aday or as directed by a physician.Children under 12 years: consult aphysician.Adult and children who take largeamounts of antacids that containaluminum may also be at risk for calciumloss, which can lead to osteoporosis
  21. 21. Sucralfate &Misoprostol
  22. 22. Antacid treatment relieves symptoms?1) Rapidly2) By complete neutralization of gastric acid3) By eradicating H.pylori4) By protecting mucosa from acidANSWER : Rapidly.Antacids work by neutralizing acid temporally and coatingthe stomach
  23. 23. GERDGASTROESOPHAGEL REFLUX DISEASEAbnormal reflux of gastriccontents into oesophagusmucosal damageCauses: 1) Overproduction of acid/pepsin 2) Over relaxation of the Lower Esophageal Sphincter
  24. 24. GERD GASTROESOPHAGEL REFLUX DISEASEPossible problems with GERD Esophageal strictures Esophageal ulcers Perforations Hemorrhage Aspiration Motility disorders
  25. 25. MedicationH-2 receptor antagonistsPPIAntacidsProkinetics
  26. 26. Prokinetics Metoclopramide : commonly used to treat nausea including that which is due to chemotherapy and that occurring post operatively. Evidence also supports its use for gastroparesis (poor stomach emptying) and gastroesophageal reflux diseaseSide Effects: sedation, extrapiramidaleffects, increased prolactin and aldosteronerelease
  28. 28. METOCLOPRAMIDE TABLETS 10MGMETOCLOPRAMIDE INJECTIONS 10MGDosage - Children:Oral: 0.1-0.2 mg/kg/dose up to 4 times/day I.M., I.V.: 0.1 mg/kg/dose up to 4 times/dayDosage - Adults: Oral: 10-15 mg/dose up to 4 times/day 30 minutes before meals or food and at bedtime; single doses of 20 mg are occasionally needed for provoking situations
  29. 29. ConstipationConstipation happens when the colon absorbstoo much water, or if the muscles in the colonare contracting slowly or poorly so that thestool moves too slowly and loses more water Causes Dietary (fibre), drugs, hormonal disturbances, neurogenic disorders systemic illnesses, IBS colonic motility disorder of defecation or evacuation
  30. 30. Laxatives: Drugs used to loosen thestool, most often taken to treat theconstipationClassification:Bulk-formingStimulantFaecal softenersOsmotic laxativesBowel cleansing solutionsForm: Oral Rectal-suppositories, enemasGeneral Contraindications: intestinal perforationand obstruction
  31. 31. Bulk-forming laxativesIncrease faecal mass whichstimulates peristalsisIspaghula (Fybogel, Isogel)Methylcellulose (Cevelac)Sterculia (Normacol)Side effects: Flatulence,abdominal distension, GIobstruction, rarelyhypersensitivityContraindication: Intestinalobstruction, colonic atony, faecalimpaction
  32. 32. Stimulant LaxativesIncrease intestinal motilityDiphenylmethane derivativesBisacodylAnthraquinone LaxativesSenna (plant derivative)Docusate SodiumStimulant and softeningGlycerol suppositoriesSide effects: cramps, diarrhoea,hypokalaemia
  33. 33. Faecal softeners / Emollients Sodium docusate (stimulant and softening) Arachis oil enema for impacted faeces Liquid Paraffin (oral solution)
  34. 34. Osmotic laxatives Osmotically mediated water retentionNondigestible sugars and alcohols LactuloseMagnesium salts Phosphates (rectal, Fleet) Sodium citratePolyethylene Glycol Movicol
  35. 35. LAXATIVE
  36. 36. Bulk-Forming Laxative Bulk laxative HuskStimulant Laxatives: Senna Bisacodyl GlycerinOsmotic laxatives: Lactulose Syrup Phostate enemaFaecal softeners Not Available
  37. 37. DiarrhoeaDefinition Diarrhoea is the frequent passing of loose or watery stools. Mechanism Increased osmotic load Excessive secretion (electrolytes and water) Exudation of protein and fluid Altered motility (rapid transit)ManagementRehydration.Antimicrobial therapy.Antimotility drugs
  38. 38. Antimotility drugsOpioids Used in medicine as a long acting anti- diarrhoeal. Inhibits peristalsis and gastrointestinal secretions.Loperamide – Imodium Dosage: 4 mg followed by 2mg doses (16mg/d max) Overdose: paralytic ileus, CNS depression Caution in IBD (toxic megacolon)Codeine phosphateOther Bismuth subsalicylate
  39. 39. Q) Which of these oil is not a laxative 1) Olive Oil 2) Corn Oil 3) Liquid Paraffin 4) GlycerinAnswer : corn oil is used for cooking only• Liquid paraffin coats the bowel to lubricate the passagematerial.• Glycerin works by holding water in the intestine thussoftening and speeding the passage of the stools.• Olive Oil also use a small dose ( one or two tablespoons) for amild case of constipation
  40. 40. Irritable bowel syndrome IBS is a digestive disorder with its symptoms of chronic abdominal pain and major disturbance of bowel functioning CauseThe exact cause of irritable bowelsyndrome (IBS) is not known
  41. 41. TreatmentDietary modificationPsychological therapiesFibre – binding water (diarrhoea and constipation)Antispasmodics Anticholinergic , Hyoscine, Methscopolamine Mebeverine:Tricyclic antidepressantsAnalgesic and neuromodulatory propertiesLoperamide, codeine
  42. 42. Antispasmodics Hyoscine butylbromide• Antimuscarinics • Reduce motility • Quaternary amines • CI: angle-closure-glaucoma, mysthenia, paralytic ileus, pyloric stenosis and prostatic enlargement • SE: constipation, transient bradycardia, reduced bronchial secretions, urinary urgency etc
  43. 43. Diet recommendation forGastrointestinal Disease
  44. 44. DyspepsiaIntake: Eating foods that arenaturally low in calories likefruits, vegetables, grains, low-fatdairy products and lean proteinsAvoid:Fatty, spicy or acidic foods, carbonated beverages, caffeine and alcohol
  45. 45. GERD and HeartburnIntake: Leafy green vegetable and fruits likebanana and applesAvoid: citrus fruits, chocolate, caffeine, alcohol,fatty or fried foods, garlic, onions, mint, spicyfoods and tomato-based foods.
  46. 46. Constipation Intake : Eating 20-35 g of fiber a day and drinking at least 8 glasses of water a day can help prevent constipationAvoid : High in sugary products and fat
  47. 47. IBSIntake: Dietary and High-fiber foodsinclude fruits, vegetables and whole grainsAvoid: Beans, cabbage, broccoli,cauliflower, apple juice, grape juice,bananas, nuts and raisins may helpdecrease gas caused by IBS.
  48. 48. CONCLUSION The internal ulcers occur mainly on themucous membrane inside the gastrointestinaltract. The usual symptoms of these ulcers arecontinuous stomach pain, inflammation andbleeding. Mostly internal ulcers occur due to thepresence of excess acid in our body. This acid develops in the human body due tothe sedentary lifestyle and poor diet. Advice the patients to change lifestyle andintake high dietary and high fiber food.