Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
The document discusses various methods used in pharmacovigilance including spontaneous reporting systems, case series, stimulated reporting, active surveillance methods like sentinel sites and drug event monitoring, use of registries, observational studies like cross-sectional, case-control and cohort studies, targeted clinical investigations and descriptive studies. It also outlines the key aims and shared responsibilities of pharmacovigilance among drug companies, regulatory authorities, doctors, pharmacists and nurses.
This document discusses adverse drug reactions (ADRs), which are unwanted effects that occur when taking medications. It notes that ADRs are a major cause of hospital admissions and deaths. ADRs are more common in elderly patients due to multiple medications, health issues, and altered drug metabolism. ADRs can be type A, which are dose-dependent and predictable, or type B, which are unpredictable and idiosyncratic. The document emphasizes that carefully selecting drugs and dosages based on a patient's individual characteristics can help reduce the risks of ADRs. Monitoring programs work to detect ADRs and improve drug safety.
The document discusses the history of adverse drug reactions and defines an adverse drug reaction. It describes several important incidents that increased awareness and regulation of drug safety, such as reactions to sulfanilamide in 1937 which led to the establishment of the FDA. It also discusses the thalidomide incident in the 1960s and the teratogenic effects it caused. The document estimates the incidence of adverse drug reactions for hospital inpatients and admissions. It examines various types of adverse drug reactions and factors that can influence them.
Drug interactions their types, examples and roleYousra Ashraf
Drug interactions occur when two or more substances administered together alter their effects on the body. There are two main types of drug interactions - pharmacodynamic interactions, which involve drugs acting on the same receptors or tissues, and pharmacokinetic interactions, which alter a drug's absorption, distribution, metabolism, or excretion. Common examples of drug-drug interactions include aspirin increasing the effects of anticoagulants like warfarin and antibiotics affecting blood thinners. Food and disease can also interact with drugs. It is important for pharmacists to monitor for potential interactions and advise patients.
Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
The document discusses various methods used in pharmacovigilance including spontaneous reporting systems, case series, stimulated reporting, active surveillance methods like sentinel sites and drug event monitoring, use of registries, observational studies like cross-sectional, case-control and cohort studies, targeted clinical investigations and descriptive studies. It also outlines the key aims and shared responsibilities of pharmacovigilance among drug companies, regulatory authorities, doctors, pharmacists and nurses.
This document discusses adverse drug reactions (ADRs), which are unwanted effects that occur when taking medications. It notes that ADRs are a major cause of hospital admissions and deaths. ADRs are more common in elderly patients due to multiple medications, health issues, and altered drug metabolism. ADRs can be type A, which are dose-dependent and predictable, or type B, which are unpredictable and idiosyncratic. The document emphasizes that carefully selecting drugs and dosages based on a patient's individual characteristics can help reduce the risks of ADRs. Monitoring programs work to detect ADRs and improve drug safety.
The document discusses the history of adverse drug reactions and defines an adverse drug reaction. It describes several important incidents that increased awareness and regulation of drug safety, such as reactions to sulfanilamide in 1937 which led to the establishment of the FDA. It also discusses the thalidomide incident in the 1960s and the teratogenic effects it caused. The document estimates the incidence of adverse drug reactions for hospital inpatients and admissions. It examines various types of adverse drug reactions and factors that can influence them.
Drug interactions their types, examples and roleYousra Ashraf
Drug interactions occur when two or more substances administered together alter their effects on the body. There are two main types of drug interactions - pharmacodynamic interactions, which involve drugs acting on the same receptors or tissues, and pharmacokinetic interactions, which alter a drug's absorption, distribution, metabolism, or excretion. Common examples of drug-drug interactions include aspirin increasing the effects of anticoagulants like warfarin and antibiotics affecting blood thinners. Food and disease can also interact with drugs. It is important for pharmacists to monitor for potential interactions and advise patients.
Therapeutic drug monitoring- Descriptive questions and answers.docxDipeshGamare
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in biological fluids to optimize drug therapy for patients. TDM is useful for drugs with a narrow therapeutic index, non-linear pharmacokinetics, and a concentration-response relationship between blood levels and effects. Factors like patient demographics, dosage regimen, sampling time, and concomitant medications must be considered when interpreting TDM results to properly individualize drug dosing for each patient.
Amendments in Schedule Y in 2013,2014 inserted three new rules, new appendix XII: compensation in case of injury or death during clinical trial, amendments in ICD and appendix V inform consent form format.
Pharmacovigilance is the monitoring of medications to detect adverse effects. It is needed because pre-marketing clinical trials are limited in detecting all potential adverse reactions. Pharmacovigilance aims to identify new or increased risks, understand underlying causes, and improve prescribing and regulation based on benefit-risk analysis. Spontaneous reporting by healthcare professionals is the primary method, with centers collecting reports to identify signals, educate providers, and communicate risks to patients.
MedWatch is the FDA's program for monitoring the safety of medical products. It allows voluntary reporting of adverse events by the public and healthcare professionals. Reports are collected in a database and monitored by FDA professionals. The FDA uses these reports to identify safety issues, communicate new safety information to the public and healthcare providers, and take regulatory actions like requiring label changes or product recalls when needed. The goal is to help protect public health by ensuring the safety of drugs, medical devices and other medical products.
This document discusses off-label use of drugs, which refers to prescribing approved medications for indications, populations, doses, or administration routes that are not included in the drug's official approved labeling by regulatory agencies. The document defines off-label use and provides examples. It discusses the frequency, motivations, types based on dose, age, indications, routes of administration. It also discusses perspectives of different stakeholders and regulations governing off-label use in the US, UK, and India. Studies on the prevalence of off-label prescribing in Indian pediatric and psychiatry patients are mentioned.
This document discusses how drugs can interact with food in several ways:
1) Drugs can affect the absorption, distribution, metabolism, and excretion of nutrients. For example, some drugs form complexes that decrease nutrient absorption or change the gastric environment in ways that impair absorption.
2) Food can also affect the absorption, distribution, metabolism, and excretion of drugs. Certain foods may interact with drugs and decrease their absorption or increase their excretion from the body.
3) Long term drug use can sometimes lead to nutritional deficiencies by increasing metabolism or excretion of vitamins, minerals, and other nutrients. Supplementation may be needed for patients on chronic drug therapy.
The document discusses the harmful effects of the drug thalidomide, which was prescribed to pregnant women in the late 1950s and early 1960s to combat morning sickness. When taken during pregnancy, thalidomide caused severe birth defects in babies, most notably shortened or absent limbs. The document profiles several individuals who were born with thalidomide-related birth defects and outlines their lives and accomplishments despite facing disabilities due to the drug. It warns that even a single dose of thalidomide taken during pregnancy can cause severe, irreversible birth defects in the developing fetus.
Advesre drug reaction- Types, Reporting, Evaluation, Monitoring, Preventing &...Suhas Reddy C
This document discusses adverse drug reactions (ADRs), including their definition, classification, types, reporting, evaluation, monitoring, prevention and management. It defines an ADR as an unintended reaction to a drug that occurs at normal doses. ADRs can be classified based on incidence (very common to very rare) or severity (mild to severe). Types of ADRs include dose-dependent (Type A), unpredictable hypersensitivity reactions (Type B), continuous effects of long-term drug use (Type C), and withdrawal reactions (Type E). The document outlines what information should be reported for an ADR, who is responsible for reporting, when and how to report ADRs, and where completed reports should be submitted
In this presentation i tried to explain in detail about cohort studies, their types, how to conduct them, their outcomes, and how to calculate sample size of these studies.
This document provides an overview of pharmacoeconomics, including its history, definitions, types of evaluations, and limitations. Pharmacoeconomics developed in the 1970s to analyze the costs of drug therapy. It is concerned with the economic impact of pharmaceutical products and services on individuals, health systems, and society. There are several types of pharmacoeconomic evaluations including cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis, which are used to compare drug programs and therapies. Pharmacoeconomic studies can be conducted during various phases of drug development and are used by industry, government, and private sectors to make decisions about research, pricing, and insurance coverage.
The document discusses various approaches to drug discovery, including pharmacological, toxicological, and preclinical trials. It describes the components of pharmacological evaluation including selectivity testing, pharmacological profiling in vitro and in vivo, and safety pharmacology testing of major organ systems like central nervous system, cardiovascular, and respiratory systems. The goal of preclinical trials is to determine if a new drug works and is safe to test in humans using animal models and evaluating its pharmacological effects, toxicity, and safety pharmacologically.
Regulation in clinical trial, Schedule Y and recent amendmentsDr. Siddhartha Dutta
Regulatory framework of India, Acts and Regulations for conduct of clinical trial in India, Schedule Y, approval of new chemical entity and recent amendments
An adverse drug reaction (ADR) is an undesirable effect of a drug that occurs at normal dosages during normal use. ADRs can occur after a single dose or prolonged administration and may be beneficial or harmful effects. Major causes of ADRs include drug-drug and drug-food interactions that can alter pharmacokinetics and pharmacodynamics. ADRs are classified as Type A-E with Types A and B being dose-related and idiosyncratic reactions respectively. Over 2 million serious ADRs occur yearly in the US, resulting in 100,000 deaths making ADRs a leading cause of death. Troglitazone was withdrawn from the market in 2000 due to idiosyncratic
This document discusses drugs that can induce birth defects and the challenges of epidemiological research on this topic. It notes that 3-4% of live births experience major birth defects, and 40-90% of women consume at least one drug during pregnancy. Various drug classes like antibiotics, anticoagulants, NSAIDs, alcohol, and high-dose vitamin A are mentioned as potential teratogens. Methodological issues addressed include the rarity of specific birth defects requiring large sample sizes, recall bias in studies, and the need for cohort and case-control study designs. Solutions discussed involve different types of cohort studies and reviewing case reports to better understand adverse drug effects and design further research.
Hepatic disease can significantly alter the pharmacokinetics and pharmacodynamics of drugs due to changes in drug metabolism, transport, and clearance in the liver. The degree of liver impairment is assessed using tests like the Child-Pugh score, with higher scores indicating more severe impairment. Drugs eliminated primarily by the liver or highly bound to albumin are more likely to require dosage adjustments in patients with hepatic disease due to potential changes in metabolism, protein binding, and clearance. The fraction of the drug metabolized and properties of its active metabolites also influence whether dosage adjustment is necessary.
This document discusses various software used in pharmacoepidemiology research. It describes statistical analysis packages like SAS and SPSS that are commonly used to analyze collected data. It also mentions more specialized software like WinBUGS, EpiInfo, and STATA designed for large dataset analysis. Decision-making software like CLEO and TREEAGE are explained. Spreadsheet programs like MS Excel are also used. The benefits of software include reduced analysis time and ability to identify patterns in large data. Potential issues include cost and complexity of software. Training is needed to ensure proper use.
Pharmacovigilance is the science of monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify and evaluate previously unreported adverse reactions. It aims to improve patient care and safety, public health, benefit-risk assessment of medicines, and understanding of pharmacovigilance. Similarly, materiovigilance monitors medical devices and hemovigilance monitors the blood transfusion system to protect patient safety. Adverse events following immunization (AEFI) surveillance also monitors vaccine safety. Together these systems aim to enhance safety across all medical treatments.
This document discusses therapeutic drug monitoring of lithium, which is used to treat acute mania and bipolar disorder. It outlines the optimal plasma concentration ranges for treatment of mania and prophylaxis, as well as toxic concentration ranges that can cause side effects like renal impairment. TDM is essential for lithium due to its narrow therapeutic index and many drug and disease interactions that influence lithium concentrations. Proper sampling time and monitoring of both lithium levels and clinical response are important for safe and effective treatment.
The document outlines procedures for identifying, recording, and reporting adverse reactions and serious adverse reactions that may occur during clinical trials. It defines key terms like adverse events, adverse reactions, serious adverse reactions, and suspected unexpected serious adverse reactions. It describes the responsibilities of investigators and sponsors in assessing adverse events, reporting serious adverse reactions to licensing authorities within 14 days, and ensuring medical care for subjects experiencing adverse reactions. Flowcharts are provided to illustrate the processes for identifying adverse reactions and determining expectedness and implications for reporting.
Brian Strom discusses drug safety and the limitations of pre-marketing clinical trials in accurately detecting adverse drug reactions (ADRs). Post-marketing studies using pharmacoepidemiological methods are needed to further evaluate drug safety in large populations over long time periods. Pharmacoepidemiology applies epidemiological study designs like cohort studies and case-control studies to examine drug use and ADRs in real-world settings. However, drug safety research is challenging given issues like confounding factors, measurement of drug exposure, and potential conflicts of interest. Strom argues for increased focus on common ADRs rather than just rare events to better understand drug safety.
The document discusses drugs used to treat peptic ulcers, gastroesophageal reflux disease, diarrhea, and constipation. It describes the causes of peptic ulcers including H. pylori infection and NSAID use. Treatment involves eradicating H. pylori, reducing gastric acid with H2 blockers or proton pump inhibitors, and protecting the gastric mucosa. Various classes of drugs are covered that act on these mechanisms including antimicrobials, H2 blockers, proton pump inhibitors, prostaglandins, and antacids.
Therapeutic drug monitoring- Descriptive questions and answers.docxDipeshGamare
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in biological fluids to optimize drug therapy for patients. TDM is useful for drugs with a narrow therapeutic index, non-linear pharmacokinetics, and a concentration-response relationship between blood levels and effects. Factors like patient demographics, dosage regimen, sampling time, and concomitant medications must be considered when interpreting TDM results to properly individualize drug dosing for each patient.
Amendments in Schedule Y in 2013,2014 inserted three new rules, new appendix XII: compensation in case of injury or death during clinical trial, amendments in ICD and appendix V inform consent form format.
Pharmacovigilance is the monitoring of medications to detect adverse effects. It is needed because pre-marketing clinical trials are limited in detecting all potential adverse reactions. Pharmacovigilance aims to identify new or increased risks, understand underlying causes, and improve prescribing and regulation based on benefit-risk analysis. Spontaneous reporting by healthcare professionals is the primary method, with centers collecting reports to identify signals, educate providers, and communicate risks to patients.
MedWatch is the FDA's program for monitoring the safety of medical products. It allows voluntary reporting of adverse events by the public and healthcare professionals. Reports are collected in a database and monitored by FDA professionals. The FDA uses these reports to identify safety issues, communicate new safety information to the public and healthcare providers, and take regulatory actions like requiring label changes or product recalls when needed. The goal is to help protect public health by ensuring the safety of drugs, medical devices and other medical products.
This document discusses off-label use of drugs, which refers to prescribing approved medications for indications, populations, doses, or administration routes that are not included in the drug's official approved labeling by regulatory agencies. The document defines off-label use and provides examples. It discusses the frequency, motivations, types based on dose, age, indications, routes of administration. It also discusses perspectives of different stakeholders and regulations governing off-label use in the US, UK, and India. Studies on the prevalence of off-label prescribing in Indian pediatric and psychiatry patients are mentioned.
This document discusses how drugs can interact with food in several ways:
1) Drugs can affect the absorption, distribution, metabolism, and excretion of nutrients. For example, some drugs form complexes that decrease nutrient absorption or change the gastric environment in ways that impair absorption.
2) Food can also affect the absorption, distribution, metabolism, and excretion of drugs. Certain foods may interact with drugs and decrease their absorption or increase their excretion from the body.
3) Long term drug use can sometimes lead to nutritional deficiencies by increasing metabolism or excretion of vitamins, minerals, and other nutrients. Supplementation may be needed for patients on chronic drug therapy.
The document discusses the harmful effects of the drug thalidomide, which was prescribed to pregnant women in the late 1950s and early 1960s to combat morning sickness. When taken during pregnancy, thalidomide caused severe birth defects in babies, most notably shortened or absent limbs. The document profiles several individuals who were born with thalidomide-related birth defects and outlines their lives and accomplishments despite facing disabilities due to the drug. It warns that even a single dose of thalidomide taken during pregnancy can cause severe, irreversible birth defects in the developing fetus.
Advesre drug reaction- Types, Reporting, Evaluation, Monitoring, Preventing &...Suhas Reddy C
This document discusses adverse drug reactions (ADRs), including their definition, classification, types, reporting, evaluation, monitoring, prevention and management. It defines an ADR as an unintended reaction to a drug that occurs at normal doses. ADRs can be classified based on incidence (very common to very rare) or severity (mild to severe). Types of ADRs include dose-dependent (Type A), unpredictable hypersensitivity reactions (Type B), continuous effects of long-term drug use (Type C), and withdrawal reactions (Type E). The document outlines what information should be reported for an ADR, who is responsible for reporting, when and how to report ADRs, and where completed reports should be submitted
In this presentation i tried to explain in detail about cohort studies, their types, how to conduct them, their outcomes, and how to calculate sample size of these studies.
This document provides an overview of pharmacoeconomics, including its history, definitions, types of evaluations, and limitations. Pharmacoeconomics developed in the 1970s to analyze the costs of drug therapy. It is concerned with the economic impact of pharmaceutical products and services on individuals, health systems, and society. There are several types of pharmacoeconomic evaluations including cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis, which are used to compare drug programs and therapies. Pharmacoeconomic studies can be conducted during various phases of drug development and are used by industry, government, and private sectors to make decisions about research, pricing, and insurance coverage.
The document discusses various approaches to drug discovery, including pharmacological, toxicological, and preclinical trials. It describes the components of pharmacological evaluation including selectivity testing, pharmacological profiling in vitro and in vivo, and safety pharmacology testing of major organ systems like central nervous system, cardiovascular, and respiratory systems. The goal of preclinical trials is to determine if a new drug works and is safe to test in humans using animal models and evaluating its pharmacological effects, toxicity, and safety pharmacologically.
Regulation in clinical trial, Schedule Y and recent amendmentsDr. Siddhartha Dutta
Regulatory framework of India, Acts and Regulations for conduct of clinical trial in India, Schedule Y, approval of new chemical entity and recent amendments
An adverse drug reaction (ADR) is an undesirable effect of a drug that occurs at normal dosages during normal use. ADRs can occur after a single dose or prolonged administration and may be beneficial or harmful effects. Major causes of ADRs include drug-drug and drug-food interactions that can alter pharmacokinetics and pharmacodynamics. ADRs are classified as Type A-E with Types A and B being dose-related and idiosyncratic reactions respectively. Over 2 million serious ADRs occur yearly in the US, resulting in 100,000 deaths making ADRs a leading cause of death. Troglitazone was withdrawn from the market in 2000 due to idiosyncratic
This document discusses drugs that can induce birth defects and the challenges of epidemiological research on this topic. It notes that 3-4% of live births experience major birth defects, and 40-90% of women consume at least one drug during pregnancy. Various drug classes like antibiotics, anticoagulants, NSAIDs, alcohol, and high-dose vitamin A are mentioned as potential teratogens. Methodological issues addressed include the rarity of specific birth defects requiring large sample sizes, recall bias in studies, and the need for cohort and case-control study designs. Solutions discussed involve different types of cohort studies and reviewing case reports to better understand adverse drug effects and design further research.
Hepatic disease can significantly alter the pharmacokinetics and pharmacodynamics of drugs due to changes in drug metabolism, transport, and clearance in the liver. The degree of liver impairment is assessed using tests like the Child-Pugh score, with higher scores indicating more severe impairment. Drugs eliminated primarily by the liver or highly bound to albumin are more likely to require dosage adjustments in patients with hepatic disease due to potential changes in metabolism, protein binding, and clearance. The fraction of the drug metabolized and properties of its active metabolites also influence whether dosage adjustment is necessary.
This document discusses various software used in pharmacoepidemiology research. It describes statistical analysis packages like SAS and SPSS that are commonly used to analyze collected data. It also mentions more specialized software like WinBUGS, EpiInfo, and STATA designed for large dataset analysis. Decision-making software like CLEO and TREEAGE are explained. Spreadsheet programs like MS Excel are also used. The benefits of software include reduced analysis time and ability to identify patterns in large data. Potential issues include cost and complexity of software. Training is needed to ensure proper use.
Pharmacovigilance is the science of monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify and evaluate previously unreported adverse reactions. It aims to improve patient care and safety, public health, benefit-risk assessment of medicines, and understanding of pharmacovigilance. Similarly, materiovigilance monitors medical devices and hemovigilance monitors the blood transfusion system to protect patient safety. Adverse events following immunization (AEFI) surveillance also monitors vaccine safety. Together these systems aim to enhance safety across all medical treatments.
This document discusses therapeutic drug monitoring of lithium, which is used to treat acute mania and bipolar disorder. It outlines the optimal plasma concentration ranges for treatment of mania and prophylaxis, as well as toxic concentration ranges that can cause side effects like renal impairment. TDM is essential for lithium due to its narrow therapeutic index and many drug and disease interactions that influence lithium concentrations. Proper sampling time and monitoring of both lithium levels and clinical response are important for safe and effective treatment.
The document outlines procedures for identifying, recording, and reporting adverse reactions and serious adverse reactions that may occur during clinical trials. It defines key terms like adverse events, adverse reactions, serious adverse reactions, and suspected unexpected serious adverse reactions. It describes the responsibilities of investigators and sponsors in assessing adverse events, reporting serious adverse reactions to licensing authorities within 14 days, and ensuring medical care for subjects experiencing adverse reactions. Flowcharts are provided to illustrate the processes for identifying adverse reactions and determining expectedness and implications for reporting.
Brian Strom discusses drug safety and the limitations of pre-marketing clinical trials in accurately detecting adverse drug reactions (ADRs). Post-marketing studies using pharmacoepidemiological methods are needed to further evaluate drug safety in large populations over long time periods. Pharmacoepidemiology applies epidemiological study designs like cohort studies and case-control studies to examine drug use and ADRs in real-world settings. However, drug safety research is challenging given issues like confounding factors, measurement of drug exposure, and potential conflicts of interest. Strom argues for increased focus on common ADRs rather than just rare events to better understand drug safety.
The document discusses drugs used to treat peptic ulcers, gastroesophageal reflux disease, diarrhea, and constipation. It describes the causes of peptic ulcers including H. pylori infection and NSAID use. Treatment involves eradicating H. pylori, reducing gastric acid with H2 blockers or proton pump inhibitors, and protecting the gastric mucosa. Various classes of drugs are covered that act on these mechanisms including antimicrobials, H2 blockers, proton pump inhibitors, prostaglandins, and antacids.
This document discusses nephrotoxic drugs and their impact on kidney function. It begins by explaining how renal damage from drugs can cause significant health issues like acute kidney injury and chronic kidney disease, as well as increasing medical costs. It then identifies several common classes of drugs that can cause nephrotoxicity, such as antibiotics, chemotherapy agents, antihypertensives, and NSAIDs. The document discusses mechanisms of nephrotoxicity for different drug classes and regions of the kidney. It also examines renal biomarkers that can help identify kidney injury earlier than serum creatinine. Finally, it provides examples of renal protective strategies like dose adjustments, monitoring, and hydration that can reduce the nephrotoxic risks of certain
The document discusses Drug Induced Kidney Disease (DIKD), specifically drug induced nephrotoxicity. It notes that DIKD is a common complication of various therapeutic agents that can cause abnormalities in acid-base balance, electrolytes, urine sediment, decline in glomerular filtration rate, and increased creatinine and BUN. It identifies several classes of drugs that commonly cause nephrotoxicity like aminoglycosides, amphotericin B, and cisplatin. It also discusses risk factors, clinical presentation, prevention, and various pathological mechanisms of nephrotoxicity including tubular epithelial cell damage, acute tubular necrosis, osmotic nephrosis, and hemodynamically mediated kidney
This document discusses antiemetic, antidiarrheal, and laxative agents. It provides examples of common antiemetic drugs like ondansetron and metoclopramide that are used to treat nausea and vomiting from chemotherapy, motion sickness, and other causes. Antidiarrheal drugs mentioned include loperamide and diphenoxylate that decrease motility to control non-infectious diarrhea. Laxatives discussed stimulate the GI tract and include bisacodyl, senna, and magnesium sulfate to treat constipation from low fiber diets, bed rest, or to prepare for certain medical procedures.
Dysgeusia is an impairment of the sense of taste. It can be caused by autoimmune diseases, nerve damage, medication therapy, or psychological disorders. Common causes include Sjogren's syndrome, chemotherapy drugs, and depression. A diagnosis involves taste and smell tests as well as imaging to check for structural changes. Treatment may include zinc supplementation or modifying food flavors. Risks of dysgeusia include malnutrition and death if left untreated.
1. Diarrhea results from an imbalance of fluid and electrolyte secretion and reabsorption in the gut and can be caused by infection, motility disorders, IBS, or secretory tumors.
2. Oral rehydration therapy with a glucose-electrolyte solution is the first priority to maintain fluid and electrolyte balance, especially for mild to moderate diarrhea.
3. Drugs may also be used such as antimotility drugs like opioids, antispasmodics like anticholinergics, and anti-infectives depending on the cause of diarrhea.
A seminar on Molecular mechanisms of drug induced cardio toxicityAkshata Nadgowda
This document summarizes the molecular mechanisms of drug-induced cardiotoxicity. It discusses how drugs can cause cardiotoxicity through several mechanisms, including disrupting ion homeostasis, impairing energy metabolism, and inducing apoptosis and necrosis in heart cells. It describes signaling pathways like mitochondrial permeability transition, Bcl-2 family proteins, caspases, cytokines and p38 MAPK that mediate cell death. Gene regulation pathways like AP-1, TEF-1, SRF and NFATs that are involved in cardiac hypertrophy are also summarized. Specific mechanisms of doxorubicin-induced cardiotoxicity involving oxidative stress, myofibrillar deterioration and calcium dysregulation are also outlined.
1) Lipids and proteins are metabolized through multi-step processes in the body. Lipids undergo absorption, lipolysis, beta-oxidation, and ketogenesis. Proteins are broken down through transamination and oxidative deamination.
2) Beta-oxidation of fatty acids in the mitochondria generates acetyl-CoA which enters the Krebs cycle to produce energy. Ketone bodies are formed from acetyl-CoA when carbohydrate intake is low.
3) Protein metabolism involves transferring amino groups through transamination and removing them via oxidative deamination, providing substrates for other metabolic pathways. The carbon skeletons are used for energy or substrate production.
This document is an edited collection of chapters on nephrotoxic mechanisms of drugs and environmental toxins. It contains contributions from over 100 experts in the fields of nephrology, pharmacology, toxicology, and pathology. The preface provides an overview of nephrotoxicity, noting that while many toxicants were developed to help mankind, prolonged or widespread use has revealed adverse kidney effects. It also discusses various mechanisms of renal injury, including physical/chemical interactions, immunological effects, metabolic alterations, and interference with cellular energetics or transport. The goal of the volume is to summarize current knowledge, identify unanswered questions, and stimulate new research into the complex ways toxins can damage the kidneys.
Tauhid Ahmed Bhuiyan, PharmD presented a document on drug-induced acute kidney injury. The document discussed the background, epidemiology and overview of acute kidney injury. It reviewed the pathogenic mechanisms and prevention strategies of drug-induced acute kidney injury. It also evaluated the implications of computerized clinical decision support systems for medication dosing in patients with renal insufficiency.
1. This document discusses various drugs that can induce oral diseases and conditions. It describes how drugs like tetracycline, antidepressants, antihypertensives can cause staining, swelling, dry mouth, and gingival enlargement.
2. Antimalarial drugs like chloroquine are noted to often cause blue or brown pigmentation on the hard palate. Antipsychotics may cause either dry mouth or excessive salivation depending on their effects.
3. The mechanisms by which various drugs cause these oral conditions are explained, such as how tetracycline can stain developing enamel or how anticholinergics reduce saliva production.
The document discusses drug-induced osteoporosis, focusing on glucocorticoids, aromatase inhibitors, androgen deprivation therapy, Depo-provera, proton pump inhibitors, and selective serotonin reuptake inhibitors. It summarizes their effects on bone loss and fracture risk, mechanisms of action, and treatment approaches. Key findings include rapid bone loss associated with glucocorticoid use, increased fracture risk from aromatase inhibitors and androgen deprivation therapy for cancer patients, and conflicting data on fracture risk from proton pump inhibitor use.
This document discusses drug-induced ototoxicity, beginning with definitions and an overview of the anatomy of the outer, middle, and inner ear. It then covers various classes of ototoxic drugs like aminoglycoside antibiotics, loop diuretics, NSAIDs, antineoplastic agents, and topical antimicrobials. For each drug class, it discusses mechanisms of toxicity, clinical presentations, risk factors, prevention, and pathological findings. It also includes a case presentation of a patient experiencing tinnitus and worsening hearing loss.
This document discusses contrast-induced nephropathy (CIN). It describes the types of contrast agents used, risk factors for CIN, methods for prevention including volume expansion with intravenous or oral hydration, and diagnostic criteria for CIN. The nephrotoxic effects of contrast agents increase with higher osmolality, larger volume, repeated or intra-arterial administration, and can be prevented through adequate hydration before and after exposure.
Drug induced liver disease can have a variety of presentations, from acute hepatitis to chronic cholestatic conditions. Making an accurate diagnosis requires correlating the clinical presentation and liver injury pattern with the temporal relationship to suspected medications, exclusion of alternative causes, and considering factors like dechallenge/rechallenge responses and precedents of the drug causing hepatotoxicity. International criteria provide guidance on evaluating suspected cases and assigning levels of certainty regarding causality.
Molecular mechanism of drug induced hepatotoxicityMadhava Priya
This document discusses molecular mechanisms of drug-induced hepatotoxicity. It begins with an introduction to hepatotoxicity and classification into intrinsic and idiosyncratic types. Mechanisms of liver damage include direct cell stress, mitochondrial impairment, and immune reactions. Specific drugs that commonly cause liver injury are also identified, such as acetaminophen, nonsteroidal anti-inflammatory drugs, and isoniazid. Patterns of injury include hepatocellular, cholestatic and mixed. Genetic and non-genetic risk factors also contribute to drug-induced liver damage. Images are also provided showing examples of liver damage.
The document discusses drug information centers and poison information centers. It provides details on:
- The history and development of the first drug information centers (DICs) and poison control centers (PCCs) in the 1960s in the US and other countries.
- The aims of DICs and PCCs, which include providing drug and poison information to health professionals, developing treatment guidelines, conducting research and education.
- The staffing of DICs and PCCs, which typically includes pharmacists, pharmacy technicians, toxicologists and other professionals.
- The services provided by DICs and PCCs, such as answering drug and poison inquiries via phone/email, publishing
This document provides information on diarrhea, including its definition, types, causes, symptoms, diagnostic evaluations, management, and nursing considerations. Diarrhea is defined as 3 or more loose stools per day. It can be classified as acute or chronic based on duration. Causes include viral, bacterial, and parasitic infections. Management involves rehydration, antidiarrheal medications, and antibiotics in some cases. Key nursing diagnoses for patients with diarrhea include deficits in fluid volume and nutrition.
Diarrhea- easy ppt for Nurses
definition of Diarrhea
types of Diarrhea
risk factors of Diarrhea
Clinical manifestations of Diarrhea
Assessment & Diagnostic tests of Diarrhea
Management of Diarrhea
Medical management
Nursing Management
This document discusses antidiarrheal drugs and treatment of diarrhea and constipation. It defines diarrhea and describes causes such as infection, IBD, IBS. Pathophysiology involves increased secretion and motility. Treatment goals are rehydration using oral rehydration solutions and anti-motility drugs like loperamide. Constipation causes include drugs, disease, lifestyle factors. Treatment involves dietary fiber, fluids, exercise, and laxatives as needed. Laxatives include stimulant, bulk-forming, osmotic, and lubricant types.
Inflammatory bowel disease (IBD) includes chronic disorders like ulcerative colitis and Crohn's disease that cause inflammation in the intestines. Genetic factors contribute to IBD risk, and symptoms include abdominal pain, diarrhea, and bloody stools. Treatment involves lifestyle changes, medications like 5-aminosalicylates and immunosuppressants to reduce inflammation, and sometimes surgery for severe cases.
This document discusses gastroesophageal reflux disease (GERD). It defines GERD as a chronic condition caused by prolonged reflux of gastric contents into the esophagus, potentially causing esophagitis. It describes the anatomy and physiology related to GERD, including the lower esophageal sphincter. Risk factors include hiatal hernia, obesity, smoking, diet, medications and certain diseases. Diagnosis involves history, physical exam, barium swallow, endoscopy and pH monitoring. Treatment includes lifestyle changes, antacids, H2 blockers, PPIs, surgery and endoscopic procedures. Complications can include esophagitis, stricture, Barrett's esophagus and adenocarc
Diarrhea is defined as three or more loose or watery bowel movements in 24 hours. It can be caused by bacterial, viral, or parasitic infections, certain foods or medications, stress, intestinal disorders, etc. Diarrhea is classified as acute (lasting less than 2 weeks) or chronic (lasting over 2 weeks) and can be inflammatory, non-inflammatory, secretory, or related to motility disorders. Treatment involves rehydration, replacing electrolytes, dietary changes, and use of antimotility or adsorbent drugs. Antibiotics may be used for infectious causes of diarrhea.
This document summarizes key information about inspecting and diagnosing diseases of the stomach and duodenum. It describes common complaints like abdominal pain, dyspepsia, gastrointestinal bleeding, and weight loss. It then discusses specific symptoms in more detail, including the timing and characteristics of pain, nausea, vomiting, eructation, and appetite changes. Finally, it lists potential organic causes of dyspepsia and gastrointestinal bleeding that would require further investigation.
1. Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, causing symptoms or mucosal injury. It is often caused by a dysfunctional lower esophageal sphincter.
2. Symptoms of GERD include heartburn and regurgitation. Complications include esophagitis, strictures, and Barrett's esophagus which increases cancer risk.
3. Treatment involves lifestyle modifications and medication to reduce acid production like PPIs. Severe cases may require surgery to reinforce the lower esophageal sphincter.
Nausea and vomiting are the most common manifestations of gastrointestinal (GI) diseases. Although nausea and vomiting can occur independently, they are usually closely related and treated as one problem.
This document summarizes anti-ulcer drugs. It discusses the causes of ulcers including H. pylori infections and NSAID use. The main types of ulcers are described along with signs and symptoms. Treatment includes eradicating H. pylori, decreasing acid secretion through proton pump inhibitors or H2 receptor blockers, and protecting the stomach lining with drugs like misoprostol or sucralfate. Proton pump inhibitors are now the most potent way to decrease acid production and promote ulcer healing.
This document summarizes various acid peptic diseases. It defines acid peptic disease as a collection of diseases involving excessive acid secretion or diminished mucosal defense in the stomach and nearby gastrointestinal tract. It then briefly describes several conditions under this category including gastroesophageal reflux disease (GERD), gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer, Zollinger-Ellison syndrome, and Meckel's diverticulum ulcer. For each condition, it provides details on symptoms, causes, diagnostic methods, and treatment approaches.
This document discusses gastritis, irritable bowel syndrome (IBS), their epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, management, and nursing care. It provides details on the types and causes of gastritis and IBS. It notes that the prevalence of H. pylori infection and IBS increases with age. Management involves lifestyle changes, medications, dietary modifications, and treatment of underlying infections or conditions. Nursing focuses on education, dietary guidance, monitoring for complications, and addressing patient anxiety.
Drug-induced diarrhea is caused by around 700 drugs and accounts for 7% of all adverse drug effects. Common causes include antibiotics, laxatives, anticancer drugs, and NSAIDs. Antibiotics can lead to overgrowth of Clostridium difficile bacteria and cause pseudomembranous colitis. Risk factors for antibiotic-associated diarrhea (AAD) include prolonged or repeated antibiotic use, advanced age, underlying illnesses, hospitalization, and immunosuppression. Treatment involves rehydration, replacing the causative antibiotic, and antibiotics like metronidazole or vancomycin for C. difficile infections. Probiotics may help restore the intestinal bacterial balance.
Drugs used in git system (GIT - Laxatives /purgatives , drugs used to treat p...Vinitkumar MJ
CLASS FOR OPHTHALMIC ASSISTANT STUDENTS ( O.A. STUDENTS 2nd year .
educational purpose
short description regarding GIT SYSTEM & drugs used to treat diarrhoea , peptic ulcer diseases , irritable bowel syndrome , IBS, antimotility drugs & laxatives /purgatives etc..
This document provides an overview of irritable bowel syndrome (IBS), including its definition, prevalence, demographics, pathophysiology, clinical features, diagnosis, differential diagnosis, severity assessment, management, and prognosis. Some key points are:
- IBS is a functional bowel disorder characterized by abdominal pain associated with changes in bowel habits. It predominantly affects those aged 15-65 and is more common in women.
- The pathophysiology involves altered gut motility, visceral hypersensitivity, abnormal gas handling, low-grade inflammation, food sensitivities, abnormal gut microbiota, and central nervous system dysregulation.
- Diagnosis is based on symptoms meeting certain criteria and exclusion of organic diseases. Management focuses on
The document discusses constipation and diarrhea. It defines constipation as difficult or incomplete emptying of the bowels accompanied by hard or dry stool. Common causes are low-fiber diet, dehydration, and medications. Signs include abdominal pain and straining. Complications are rectal bleeding and hemorrhoids. Diagnosis is based on history and exams. Treatment involves laxatives, fiber, fluids and exercise. The document also defines diarrhea as 3 or more loose stools per day. Causes can be infections, lactose intolerance, or medications. Symptoms are urgent watery stools with cramps. Complications include dehydration. Treatment focuses on fluid replacement and anti-diarrheal medications.
This document discusses anti-diarrheal drugs used to treat different types of diarrhea. It defines diarrhea and describes its causes, symptoms, and pathophysiology. It discusses rehydration therapy using oral rehydration salts and nutrition therapy for diarrhea patients. The document outlines specific antimicrobials used to treat infectious diarrhea and probiotics to restore gut flora. Drugs used for inflammatory bowel disease like mesalazine, corticosteroids, immunosuppressants, and TNF-α inhibitors are mentioned. Finally, it discusses non-specific anti-diarrheal drugs that are absorbents, antisecretory, and antimotility agents like loperamide, diphenoxylate, and racecadotril.
Similar to Drug-Induced Gastrointestinal Diseases (ADRs) (20)
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
2. OUTLINE
I. Dysgeusia
II. Upper GIT Ulceration
III. Dyspepsia
IV. GIT Hemorrhage
V. Antibiotic-induced diarrhea and
antibiotic-associated
(pseudomembranous) colitis (AAC)
4. DYSGEUSIA
• Distortion in the perception of a
correct taste
• Altered taste sensation
• It may manifest as an unusual, bitter,
metallic taste or distaste for food
• Hypogeusia - blunting or decreased
sense of taste
• Ageusia – total loss of taste
5. Dysgeusia
• The mechanism of drug-related
taste disturbance appears to
involve:
- interference with the chemical
composition or flow of saliva
- direct effects on taste receptor
function or signal transduction
6. Dysgeusia
• Changes in taste are a frequently
reported side effect of a wide
range of medications, including
macrolide antibiotics, antifungals,
ACE inhibitors.
7. Medications known to cause
Dysgeusia
• Captopril and Zofenopril (sulfhydryl
compounds)
Impaired or salty taste is common
complaint, common cause of taste
disturbances
• Systemic Griseofulvin
Renders particular foods tasteless, with
worsening symptoms corresponding to
duration of drug administration
8. Medications known to cause
Dysgeusia
• Penicillamine
Has been known to cause a
partial or total loss of taste
• Lithium carbonate & Tetracycline
–Saliva can have traces of the
drug, giving rise to a metallic
flavor in the mouth
9. Medications known to cause
Dysgeusia
• Metronidazole &
Chlorhexidine have been found to
interact with metal ions that
associate with the cell membrane.
11. Dysgeusia
• For many drugs where taste
disturbance is a side effect, it
appears to be dose-
related, and resolves within
weeks of discontinuation of
the offending agent.
• Type of ADR: Augmented
13. UPPER GASTROINTESTINAL
ULCERATION
• Ulcer – a break in the skin extending
to all its layers, or in the mucous
membrane lining the alimentary
tract, that fails to heal and is often
accompanied by inflammation.
• Parts included in upper GI
–Esophagus
–Stomach
–Duodenum
The Bantam Medical Dictionary
16. Mechanism
• Aspirin and Non-steroidal anti-
inflammatory agents
–Inhibit gastric mucosal
prostaglandin synthesis by
inhibiting the COX enzyme system
altering prostaglandin-associated
GI defense mechanisms
17. Mechanism
• Aspirin and Non-steroidal anti-
inflammatory agents
–Both COX-1(produces prostaglandins known
to protect the GI mucosa) and COX-2
(primarily present at sites of inflammation)
enzymes are inhibited.
18. Mechanism
• Aspirin and Non-steroidal anti-
inflammatory agents
– inhibition of COX-2 by traditional NSAIDs
accounts for the anti-inflammatory effect of
the drugs while the inhibition of COX-1 can
lead to NSAID toxicity and associated side
effects
–Type of ADR: Continuous
19. Cox-1 and Cox-2 Activity of
Selected NSAIDs
NSAID COX-1 COX-2
In Vitro Inhibitory Activity
Ketorolac +++++ +
Indomethacin ++++ +
Naproxen +++ +
Ibuprofen +++ +
Piroxicam ++ ++
Sulindac ++ ++
Diclofenac ++ +++
Celecoxib + +++
Meloxicam + +++
Etodolac + +++
+ Minimal Activity; ++ Some activity; +++ Significant activity;
++++ High activity; +++++ Very High activity
20. Mechanism
• Bisphosphonates
–Only nitrogen-containing
bisphosphonates (i.e.
Alendronate, risedronate &
pamidronate) have been implicated
–Several mechanisms have been
suggested, but the most probable
mechanism is direct topical irritation
–Ulcers are not seen during IV
administration
21. Mechanism
• Bisphosphonates
–Prolonged contact of the tablet with
the esophageal tissue may occur
when the patient takes a tablet in
the supine position or without
sufficient water.
–Type of ADR: Augmented
22. Mechanism
• Potassium Chloride preparations
–May induce GI damage caused by
direct irritation from the high
concentrations of KCl in the GI
mucosa
–Type of ADR: Augmented
23. Mechanism
• Doxycycline and Ferrous Sulfate
• Drug-induced ulceration associated
with these drugs may be the result
of a low pH when the drug is
dissolved, causing erosions and
inflammation of the esophageal
mucosa
• Type of ADR: Augmented
24. Drugs That May Cause Upper GI
Ulceration
Drug Most common site of ulceration Incidence
ASA Stomach 10-15
Bisphosphonates Esophagus 0.2-0.4
Corticosteroids Stomach 0.4
COX-1 NSAIDs Stomach 10-15
COX-2 NSAIDs Stomach 5-8
Doxycycline Esophagus Unknown
Ferrous Sulfate Esophagus, Stomach Unknown
KCl Esophagus, Stomach 8-19
Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
25. Mechanisms of Drug-Induced
Upper GI Ulceration
Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
Medication Mechanism
ASA COX-1 inhibition
NSAIDs COX-1 inhibition
KCl Direct irritant
Corticosteroids Controversial
Doxycycline Direct irritant
Ferrous Sulfate Direct irritant
Bisphosphonates Direct irritant
26. II. Treatment options for Management of
Drug-Induced Upper GI Ulceration
Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
Medication Action
All Discontinue medication if possible
ASA, NSAIDs Eradicate HP
Heal ulcer with PPI, misoprostol
Consider maintenance for prevention of
recurrence with PPI, misoprostol, or an NSAID
with a lower risk of ulceration
Bisphosphonates,
KCl, Tetracyclines
Consider other medications, administer
medication with sufficient water
Bisphosphonates Avoid taking medication with meals
Avoid a recumbent position for at least 1
hour after medication, medication with
sufficient water
28. DYSPEPSIA
• Indigestion (dyspepsia) is a vague
feeling of discomfort in the upper belly
or abdomen during or right after eating.
This may include:
–A feeling of heat, burning, or pain in the
area between the navel and the lower part
of the breastbone
–A feeling of fullness that is bothersome
and occurs soon after the meal begins or
when it is over
29. Dyspepsia
• It is important to recognize that
dyspepsia/uninvestigated dyspepsia
relates to a symptom complex rather
than a true diagnosis or single
medical disease/condition. In fact,
dyspepsia may be indicative of a
variety of possible conditions that
may be the cause of the patient's
dyspeptic symptoms.
30. Medications causing Dyspepsia
• Non-steroidal anti-inflammatory drugs
(NSAID) e.g. aspirin, ibuprofen,
naproxen, diclofenac.
• Corticosteroids e.g. prednisolone,
prednisone.
• Estrogens
• Bisphosphonates
• Certain antibiotics (Rifampin)
31. Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
DYSPEPSIA & DIU
• The presence of dyspepsia in a
patient taking medications that
produce DIU does not always indicate
that an ulcer is present but should
raise suspicion.
33. GIT HEMORRHAGE
• Gastrointestinal (GI) bleeding refers to
any bleeding that starts in the
gastrointestinal tract.
• Bleeding may come from any site along
the GI tract, but is often divided into:
–Upper GI bleeding: The upper GI tract
includes the esophagus, stomach, and
first part of the small intestine.
–Lower GI bleeding: The lower GI tract
includes much of the small intestine,
large intestine or bowels, rectum, and
anus.
34. Medications causing GIT
Hemorrhage
• NSAIDs
–Ketorolac has the highest COX-1
activity and has the highest risk of
GI bleeding of all the NSAIDs
–Indomethacin & Ibuprofen also
have significant proportion of COX-
1 activity compared to COX-2
–Type of ADR: Continuous
35. Medications causing GIT
Hemorrhage
• Corticosteroids
–Have long been implicated as a cause of
GI hemorrhage but the exact
mechanism is not clear.
–However, it has been proposed that
these agents impair mucosal healing
through reduction of epithelial
regeneration.
–Research suggests that the incidence is
small
38. DIARRHEA
• Diarrhea – increased
frequency of bowel movements
(≥3/d), decreased stool
consistency, and/or increased
stool weight (>200g/d)
39. DIARRHEA
• Arises from two basic mechanisms:
–Decreased absorption of water
and electrolytes
–Increased active secretion of
water and electrolytes in GIT
• Result in a net secretion that
causes an increase in stool volume
& weight
40. DIARRHEA
• Drugs increasing active secretion
alter intestinal motility
–Drug-altered intestinal motility is
attributed to 3 different mechanisms:
1. Reduction of contact time in the small
intestine
2. Premature emptying of the colon
3. Bacterial overgrowth
41. Antibiotic-induced diarrhea
• Drug-induced diarrhea
associated with
chemotherapeutic agents is well
recognized, particularly with
Fluorouracil (10-80%) and
Irinotecan (50-80%).
Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
42. Mechanism
• Antineoplastics increase active
secretion and destroy the intestinal
mucosa of the small & large intestines,
causing exudative mechanisms.
• Additionally, they may affect the
absorptive, secretory, or motility
functions of the gut
• Type of ADR: Type A
Drug-Induced Diseases by Tisdale, J.E.; Miller, D.A.
45. Mechanism
• The mechanism for diarrhea resulting
from pseudomembranous colitis is
bacterial proliferation. (Clostridium
difficile)
• The bacteria secretes:
enterotoxin A – adheres to the brush-
border membrane of enterocytes,
inducing lesions and an inflammatory
response, and;
cytotoxin B – may also cause GI mucosal
damage
46. Mechanism
• The use of clindamycin, broad-spectrum
antibiotics such as cephalosporin, or any
penicillin-based antibiotic such
as amoxicillin causes the normal
bacterial flora of the bowel to be altered.
In particular, when the antibiotic kills off
other competing bacteria in the
intestine, any bacteria remaining will
have less competition for space and
nutrients.
47. Other Antibiotics that cause AAC
• Ciprofloxacin (<1%)
• Chloramphenicol
• Cloxacillin
• Erythromycin
• Gentamicin
• Rifampin (1-10%)
48. Management of AAD & AAC
Management of antibiotic-induced diarrhea
Discontinue offending drug/change to another drug if
possible
Lower (adjust dose) if possible
Implement low residual diet
Provide rehydration and maintenance of fluid electrolytes
Clostridium difficile must be eliminated as the cause of
diarrhea before implementation of antiperistaltic drugs
For Clostridium difficile and pseudomembranous colitis,
initiate metronidazole (first line) or oral vancomycin
49. References:
• Remington: The Science & Practice of Pharmacy, 19th
Edition
• Drug-Induced Diseases: Prevention, Detection and
Managemet; Drug-Induced Diseases by Tisdale, J.E.;
Miller, D.A.
• McGraw-Hill Drug Handbook; Schull, P.D.
• http://www.nlm.nih.gov/medlineplus/ency/article/003
133.htm
• http://www.dwp.gov.uk/publications/specialist-
guides/medical-conditions/a-z-of-medical-
conditions/dyspeptic-disorders/
• http://www.nlm.nih.gov/medlineplus/ency/article/003
260.htm