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Responding to symptoms of minor ailments


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Responding to symptoms of minor ailments

  1. 1. * SUBMITED BY : KHALIDA REHMANI REG NO : 16AB1TOO19 UNDER THE GUIDELINES OF: MR. RAMESH Vignan pharmacy college ;vadlamudi; approved by AICTE; Pharmacy council of India; new delhi;govt of AP ;affiliated to JNTUK ;kakinada.
  2. 2. * •Nausea and vomiting are the most commonly seen complaints in the patients suffering from gastro intestinal disorders and chronic conditions like cancer. •Nausea is a symptom , which is subjective and an unpleasant sensation of urge to vomit. •It is followed by variety of autonomic signs such as pallor , sweating , tachycardia , salivation and increased respiratory rate . •Vomiting or emesis is the reflux expulsion of the stomach contents via the oesophagus and mouth and is usually associated with nausea and retching. •Retching is an involuntary but unsuccesfull effort to vomit
  3. 3. ETIOLOGY: *Nausea and vomiting are experienced in various clinical situations like gastrointestinal tract obstruction, mucosal lesions such as ulcers , inflammation , liver diseases etc *Cardio vascular diseases such as renal failure, hyperparathyroidism , adrenal insufficiency ,pregnancy and diabetic ketoacidosis CLINICAL PRESENTATION: The signs and symptoms of vomiting include, •Dehydration •Weight loss •Mental confusion •Reduced skin tuger •Increased thirst, hypotension Muscle weekness and cardiac disturbances and alkalosis
  4. 4. PATHOPHYSIOLOGY: These are the three consecutive phases of emesis Nausea Vomiting Retching  Nausea is an urge to vomit and is associated with gastric stasis and may be considered as a separate singular symptom.  Retching is a labored movement of abdominal and thoracic muscles before vomiting .  The final phase of emesis is vomiting , the forceful expulsion of gastric contents caused by GI retro peristalsis .  Vomiting is mainly mediated via stimulation of vomiting centre .
  5. 5. •The afferent fibres from the sensory receptors in the pharynx , stomach , intestine , and other visceral organs directly connect to vomiting centre through the values and sphlanchic nerve stimulate the vomiting centre. •Variety of stimulus such as sight , smell , medicines , toxins , metabolites , and motion sickness may stimulate the chemoreceptor trigger zone[CTZ] to initiate the vomiting reflex. When the vomiting centre is stimulated the efferent impulses are sent to salivary , vasomotor and respiratory centre . •Five major , transmitter systems are involved in this process . receptors are present in vomiting centre and chemo trigger zone . •When they receive stimulus they act via there respective receptors to produce emesis .
  6. 6. •The main neuro transmitters involved in the process of vomiting are: •Dopaminergic •Histaminic •5-hydroxytryptamine •Cholinergic •Substance P •The dopaminergic receptors are present in the CTZ and GI tract. •The dopamine agonists like apomorphine and levodopa are thought to mediate via this pathway. •Where as in motion sickness there is imbalance in the cholinergic and adrenergic system in the region of the medulla near the vomiting centre and CTZ or directly stimulate CTZ.
  7. 7. •The chemotherapeutic agents produce nausea and vomiting through serotonin stimulating the receptor located on afferent vagal nerve terminals to initiate the vomiting reflex. •Substance P – a neuropeptide that belongs to tachykinin family is found in the higher concentration in the nucleus tractus solitaries and the area postrema of CNS . •The actions of substance P are mediated through NK1 receptor. PHARMACOLOGICAL MANAGEMENT: Medications in the management of nausea and vomiting are classified as: Ant acids and antisecretory agents Eg: magnesium and aluminium hydroxide containing tablets and suspensions. Histamine 2-receptor antagonists: Eg :cimetidine , famotidine ,nizatidine and ranitidine.
  8. 8. Proton pump inhibitors: Eg : omeprazole , esomeprazole , lansoprazole , pantoprazole, and rabeprazole. Anticholinergics : Eg : scopolamine : 0.5 mg every 72 hours. Antihistamines : Eg :diphenhydramine :10-150 mg every 4-6 hours needed. Dopamine antagonists : Eg : chlorpromazine :10-25mg Q4-6 hr ,promethazine :12.5 - 25mg Q 4-6hour needed , domperidone dose of 10mg 8th hourly. Serotonin antagonists : Eg :ondansetron :32mg 4 prior to chemotherapy as single dose or 1.5mg per kg prior to chemotherapy, repeat every 4- 8 hr or 8mg orally prior to chemotherapy.
  9. 9. DYSPEPSIA: •The term ‘dyspepsia’is derived from greek word .The meaning of dyspepsia is “improper digestion and is used to describe upper abdominal discomfort , usually related to food or alcohol intake or certain medications like antibiotics , non steroidal anti inflammatory drugs [NSAID], digoxin , bisphosphonates , theophylline . .
  10. 10. Aetiology : •Peptic ulcer disease. •Gastro esophageal reflux disease with or without esophagitis •Malignancy or functional or idiopathic dyspepsia •Smoking and stressfull lifestyle may also contribute to the development of dyspepsia. •Chronic dyspepsia is defined as recurrent symptoms that include epigastric pain , abdominal bloating , belching , nausea , vomiting , and early satiety .
  11. 11. Pathophysiology : •Several pathophysiologic mechanisms are involved in the development of functional dyspepsia , including visceral hypersensitivity , both in the stomach and the duodenum , impaired gastric accommodation , antral over distension , delayed gastric emptying , and abnormal duodeno jejuna motility . •Acute infrequent dyspepsia is commonly associated with irregular intake of food , regular intake of alcohol , cigarette smoking and stress. •Chronic dyspepsia is related to peptic ulcer disease , esophageal reflex disease H pylori infection and the malignancy . Irritable bowel syndrome may also contribute to functional dyspepsia
  12. 12. CLINICAL PRESENTATION: SIGNS AND SYMPTOMS: •Persistent vomiting •Constant severe pain •Concomitant weight loss •Dysphasia •Hematemesis or melena warrants endoscopy •Abdominal and extra gastrointestinal complaints •Anxiety or depression •Early satiety •Anorexia •Jaundice •GI bleeding
  13. 13. MANAGEMENT OF DYSPEPSIA: Non pharmacological management: •Lifestyle modifications •Balanced diet •Smoking cessation •Reduced intake of alcohol •Weight reduction through aerobics •Reduced intake of caffeine and fatty foods Pharmacological therapy: Antacids •Ant acids cause mucosal protection by neutralising the acid and forming a coat on damaged tissue. •Supensions are more effective than tablets .Antacids should be taken regularly in a dose of 15 ml to relieve the symptoms. Eg : mixture of aluminium and magnesium salts
  14. 14. H2 receptor antagonists: •Ranitidine and famotidine block the action of histamine on H2 receptors of the parietal cells thus reducing the basal and stimulated gastric acid secretion. •Due to good therapeutic efficacy Famotidine 20mg ;BID or 40 mg;OD and ranitidine in 150mg ,BID or 300mg ; OD are effective in providing relief in dyspepsia . Anti secretory agents: •Proton pump inhibitors [PPIs] binds irreversibly to the Na+ K+ ATPase pump and inhibits the terminal step in the acid production . •They are more effective when taken 30-60min before the first meal on an empty stomach . Eg: omeprazole 20mg OD; Rabeprazole 20 mg ,Lansoprazole 30mg OD ; Pantaprazole 40 mg.
  15. 15. DIARRHEA •Diarrhea is defined as an increase in fluidity and frequency of stools •Normally an healthy human individual defecate about 200 grams of stool per day. But during diarrhoea , more than 200 gram stool containing 70-95% water will be produced and the frequency increased upto 5-20 times a day. •In severe cases 1.4 L water will be lost. •Dysentery is called low volume bloody diarrhoea. •Diarrhea may be due to ingested contaminated food or water with virus, bacteria or protozoan pathogens.
  16. 16. . Pathophysiology : Diarrhea occurs due to imbalances between absorption and secretion of water and electrolytes. It may be associated with a specific disease of intestine or secondary to the disease outside the intestine. The principal mechanisms of diarrhea : •Change in the active ion transport by either decreased sodium absorption or an increased chloride secretion. •Change in intestinal motility. •Increase in luminal osmolarity •Increase in tissue hydrostatic pressure •Malabsorption
  17. 17. MANAGEMENT: Prevention of excessive water and electrolyte loss are the main strategies in the management of diarrhea. Non –pharmacological management: •Eating balanced diet and avoiding solid foods and dairy products atleast for 24 hours. •In replenishing the lost electrolytes by oral rehydration salts. •ORS formula can also be made at home by mixing a pinch a of salt into 200ml of water and cooled water with one tea spoon full of sugar.
  18. 18. Eg: loperamide –used in acute and chronic diarrhea; initially 4mg then 2mg after each stool but should not exceed 16mg per day. Pharmacological management: Anti motility drugs:These drugs delay the transit of intraluminal content or increase the gut capacity prolonging contact and absorption Adsorbents :Adsorbents are used to provide symptomatic relief. Eg: kaolin –pectin given at a dosage range of 30 – 120 ml after each stool. Antisecretory agents: They are often used to treat travellers diarrhea. Eg :Bismuth sub salicylate
  19. 19. Bacterial replacement agents: Lactobacillus preparations are intented to replace the colonic microflora therby retoring the intestinal function and suppressing the growth of pathogenic microorganisms. Octreotide : It is the synthetic analogue of endogenous somatostatin. It is given to the symptomatic treatment of carcinoid tumours and vasoactive peptide secreting tumours. It acts by blocking the release of serotonin and other active peptides and thus controls diarrhea. Antibacterial agents: Flouroquinolones such as Norfloxacin 400mg ; or ciprofloxacin 500mg ;oflaxacin 200mg.combinations of flouruquinolones and anti amoebic agents are also used to control infective bloody diarrheas.
  20. 20. CONSTIPATION :- •Constipation is defined as an infrequent bowel action of twice a week or less then involves straining to pass hard stools accompanied by a sensation of pain or incomplete evacuation . •Constipation appears to be more common in upto 20% in elderly people 8% in middle aged and 3% of young people .
  21. 21. Pathophysiology :- *The upper GIT tract is responsible for ingestion and digestion of the food ,where as lower GIT is responsible for conserving body water and electrolytes , drying the feces and elimination . *The remains of undigested food are swept along the GI tract through peristalisis .These peristaltic waves eventually move the faeces from the colon to the rectum and induce urge to defecate .
  22. 22. Normally there is net uptake of fluid in the intestine and response to osmotic gradiants involving the absorption and secretion ions , absorption of sugars and amino acids under the influence of ANS. By the time stool reaches the rectum it becomes more solid and consistency because most of the water has been absorbed
  23. 23. *Normally there is net uptake of fluid in the intestine and response to osmotic gradiants involving the absorption and secretion ions , absorption of sugars and amino acids under the influence of ANS. *In some situation absorption increases will generally lead to constipation. Agents that alter intestinal motility either directly or by acting on ANS , effect transit time of food . * A slower transit time will lead to the formation of hot stools and constipation Managements :- Non-pharmacalogical treatment :- •Increased intake of water upto 2 litres •Avoidence of excess intake of coffee or tea. •Consuming foods that contain more fibres such as fruits, vegetables and cerels.. •An increased level of exercise.
  24. 24. Pharmacological therapy :- Emollient laxatives (docusates) :- *These surfactant agents in various salts work by facilitating the mixing of aqueous and fatty materials in GIT.They may increase water and electrolyte secretion in the small and large bowel. *They result in softening of stools within 1-2 days . Emollient laxatives are not effective in treating constipation, but are used mainly to prevent constipation. Lubricants : *Mineral oil is the only lubricant laxative in the routine use and acts by coating stool and allowing easier passage. *It decreases colonic absorption of water,there by increasing stool weight and stool transit time.
  25. 25. Lactotulose and sorbitol: *Lactulose is a disaccharide that causes osmotic effect retained in the colon. *It is not generally recommended as first line therapy ,as it is costly and not much effective than milk of magnesia. Saline cathartics: *Saline cathartics are composed of relatively poorly absorbed ions such as magnesium , sulphate , phosphate , citrate,whose action is to retain fluid in GIT. *Can be taken orally or rectally. *Agents like milk of magnesia(8% suspension of magnesium hydroxide.
  26. 26. Castor oil: *Castor oil is metabolised in liver in to an active compound ricinoleic acid. *This acid stimulates secretory process, decreases glucose absorption, promotes intestinal motilitywithin 1-3 hours after administration. Glycerine : *Usually administered 3 gm and is most safest of all drugs for children *It occasionally causes rectal irritation.