This document provides an overview of drugs that affect the digestive system. It discusses how the digestive system and drug therapy have a reciprocal relationship, with some drugs causing GI symptoms and some GI disorders altering drug absorption. Several classes of drugs are described, including laxatives, antacids, H2 receptor antagonists, proton pump inhibitors, antiemetics, and others. The mechanisms of action, indications, and side effects of these drugs are summarized. Nursing considerations for administering some of these medications are also reviewed.
Effects of diabetes on gastrointestinal systemhealthuseful
complications of diabetes that affect the digestive system, including gastroparesis, delayed stomach emptying, constipation, diarrhoea, and other digestive issues. These Effects of diabetes on gastrointestinal systeml and other health problems. Learn how diabetes affects the GI system, what symptoms to watch for, and how to manage these problems and prevent further complications.
Effects of diabetes on gastrointestinal systemhealthuseful
complications of diabetes that affect the digestive system, including gastroparesis, delayed stomach emptying, constipation, diarrhoea, and other digestive issues. These Effects of diabetes on gastrointestinal systeml and other health problems. Learn how diabetes affects the GI system, what symptoms to watch for, and how to manage these problems and prevent further complications.
Gastroparesis is a condition in which a human stomach cannot empty itself of food in a normal manner. Gastroparesis disorder is also known as delayed gastric emptying.
The gastrointestinal tract is the tract or passageway of the digestive system that leads from the mouth to the anus.
GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.
The hollow organs that make up the GI tract are mouth, esophagus, stomach, small intestine, large intestine and anus.
The GI tract contains all the major organs of the digestive system, in humans and other animals.
Digestive disorders are among the most common problems in health care.
Approximately 30-40% adults claim to have frequent indigestion.
Indigestion
Peptic ulcer
Carcinoma of the Stomach
Gastric Surgery
Dumping Syndrome
Constipation
Diarrohoea
Steatorrhoea
Lactose Intolerance
Coeliac Disease
Tropical sprue
Irritable Bowel Syndrome
Inflammatory Bowel Diseases
Intestinal Gas and Flatulence
Diverticular Disease
Indigestion also called dyspepsia which means discomfort in the upper digestive tract.
Indigestion can be caused by dietary indulgences-excessive volumes of food or high intake of fat, sugar, caffeine, spices or alcohol or both.
Symptoms : vague abdominal pain
Bloating
Nausea
Regurgitation and belching
If it is prolonged it can lead to gastro-oesophagul reflux, gastritis, peptic ulcer disease, delayed gastric emptying, gall bladder disease or cancer.
It can be treated by eating slowly, chewing thoroughly and not eating or drinking excessively.
Localized erosion of the mucosal lining of those portions of the alimentary tract that come in contact with the gastric juice.
This disintegration of tissues can also result in necrosis.
Ulcers occurs in oesophagus, stomach, jejunum and duodenum but majority of ulcers are found in the duodenum.
All the ulcers have same symptoms and same response to treatment regardless of location.
Mechanism of ulcer formation
Three vital mechanisms are the mucus layer, prostaglandins and probably the urogastrone /epidermal healing factor(URO/EHF).
These mechanisms can protect the stomach against HCL up to twice the maximum concentration which the stomach is capable of secreting.
The mucous layer, viscous gel is ideally suited for its function of protection from chemical and physical hazards of water proofing and lubrication.
The second line of defence are prostaglandins.
Third line of defence that is urogastrone plays important role by inhibiting gastric acid secretion and by stimulation of cell proliferation and regeneration for healing the ulcer.
If mucosal line is broken then underlying layers of the stomach are exposed to the effect of concentrated acid which results in peptic ulcer.
Duodenal Ulcer :
Peptic ulcer that develops in first part of the small intestine.
Hypersecretion of acid
Tissue resistance is normal
Acid hypersecretion is due to increased number of parietal cells and impaired rapid gastric emptying with loss of buffering effect.
Excess production of acid and pepsin is the primary factor.
Gastric Ulcer
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Gastroparesis is a condition in which a human stomach cannot empty itself of food in a normal manner. Gastroparesis disorder is also known as delayed gastric emptying.
The gastrointestinal tract is the tract or passageway of the digestive system that leads from the mouth to the anus.
GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.
The hollow organs that make up the GI tract are mouth, esophagus, stomach, small intestine, large intestine and anus.
The GI tract contains all the major organs of the digestive system, in humans and other animals.
Digestive disorders are among the most common problems in health care.
Approximately 30-40% adults claim to have frequent indigestion.
Indigestion
Peptic ulcer
Carcinoma of the Stomach
Gastric Surgery
Dumping Syndrome
Constipation
Diarrohoea
Steatorrhoea
Lactose Intolerance
Coeliac Disease
Tropical sprue
Irritable Bowel Syndrome
Inflammatory Bowel Diseases
Intestinal Gas and Flatulence
Diverticular Disease
Indigestion also called dyspepsia which means discomfort in the upper digestive tract.
Indigestion can be caused by dietary indulgences-excessive volumes of food or high intake of fat, sugar, caffeine, spices or alcohol or both.
Symptoms : vague abdominal pain
Bloating
Nausea
Regurgitation and belching
If it is prolonged it can lead to gastro-oesophagul reflux, gastritis, peptic ulcer disease, delayed gastric emptying, gall bladder disease or cancer.
It can be treated by eating slowly, chewing thoroughly and not eating or drinking excessively.
Localized erosion of the mucosal lining of those portions of the alimentary tract that come in contact with the gastric juice.
This disintegration of tissues can also result in necrosis.
Ulcers occurs in oesophagus, stomach, jejunum and duodenum but majority of ulcers are found in the duodenum.
All the ulcers have same symptoms and same response to treatment regardless of location.
Mechanism of ulcer formation
Three vital mechanisms are the mucus layer, prostaglandins and probably the urogastrone /epidermal healing factor(URO/EHF).
These mechanisms can protect the stomach against HCL up to twice the maximum concentration which the stomach is capable of secreting.
The mucous layer, viscous gel is ideally suited for its function of protection from chemical and physical hazards of water proofing and lubrication.
The second line of defence are prostaglandins.
Third line of defence that is urogastrone plays important role by inhibiting gastric acid secretion and by stimulation of cell proliferation and regeneration for healing the ulcer.
If mucosal line is broken then underlying layers of the stomach are exposed to the effect of concentrated acid which results in peptic ulcer.
Duodenal Ulcer :
Peptic ulcer that develops in first part of the small intestine.
Hypersecretion of acid
Tissue resistance is normal
Acid hypersecretion is due to increased number of parietal cells and impaired rapid gastric emptying with loss of buffering effect.
Excess production of acid and pepsin is the primary factor.
Gastric Ulcer
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Any of a large group of organic compounds occurring in foods and living tissues and including sugars, starch, and cellulose. They contain hydrogen and oxygen in the same ratio as water (2:1) and typically can be broken down to release energy in the animal body.
Chemically, carbohydrates are defined as “optically active polyhydroxy aldehydes or ketones or the compounds which produce units of such type on hydrolysis”.
Chemistry
Chemistry is the branch of science that deals with the composition, structure and properties of matter.
Chemistry is also called the science of atoms and molecules.
Chemistry is the study of matter and the changes it undergoes.
Nursing
Nursing is a profession within the healthcare sector focused on the care of individuals, families and communities so they may attain, maintain or recover optimal health and quality of life.
Nurses may be differentiated from the other healthcare providers by their approach to patient care, training and scope of practice.
Chemistry in nursing is very important, as it sets the basis for understanding the medications that are being administered to certain patients
Nurses must understand how particular medicines will react in different patients. This helps to avoid wrong combinations of drugs that can lead to adverse effects.
Nursing programs feature different chemistry courses, including biochemistry, pharmacology, general level chemistry and organic chemistry. All of these courses play an important role in helping nurses understand different organic compounds, chemical equations, chemical reactions and chemical processes.
Therefore, chemistry knowledge allows nurses to understand the effects of different medicines when used alone or in combination with others.
The nurse must understand the present condition of the patient, importance and difference in sodium, potassium, chloride, bicarbonate, oxygen and many other elements and electrolytes in the body. This understanding will guide the nurse to identify if there is an electrolyte imbalance.
Thus, it is vital for nurses to have the skills to take care of their patients emotionally, but it is also important that the nurse have the necessary knowledge to interpret data regarding the patient condition to treat physically accurately and in a timely manner.
The term matter refers to anything that occupies space and has mass. All matter is made up of substances called elements, which have specific chemical and physical properties and cannot be broken down into other substances through ordinary chemical reactions.
There are two ways of classifying the matter:
(A) Physical Classification
Matter can exist in three physical states:
Solids
Liquids
Gases.
(B) Chemical classification
Based upon the composition, matter can be divided into two main types:
Pure Substances
Mixtures.
1. Solids
The solid state is one of the fundamental states of matter.
Solids differ from liquids and gases by the characteristic of rigidity.
The molecules of solids are tightly packed because of strong intermolecular forces; they only oscillate about their mean positions.
Whereas, liquids and gases possess the property of fluidity and can easily flow.
Solids can be defined as the state of matter which has definite shape and volume and has a rigid structure.
Solids possess the least compressibility and thermal expansion.Example: Iron (Fe)
2. Liquid
The molecules in a liquid are
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Effects of Drugs on the Digestive
System
Digestive system and drug therapy have a reciprocal
relationship
Some medications cause GI symptoms (e.g. EES);
conversely, some GI disorders alter the absorption
and metabolism of drugs (liver failure)
Drugs affecting the GI tract include: laxatives,
antidiarrheals, antiemetics, drugs used in acid-peptic
disorders . Others include cholinergics (Aricept)
anticholinergics (atropine), corticosteroids and anti-
infectives.
3. Review physiology of the digestive system
Organs and some associated disorders
Oral cavity-stomatitis
Esophagus-GERD
Stomach—peptic ulcers, gastritis
Small intestine—malabsorption, Inflammatory bowel
Large intestine—diarrhea, constipation
Pancreas—pancreatitis, Diabetes, ARDS
Gallbladder—cholestasis,cholelithiasis, cholecystitis
Liver—hepatitis, cirrhosis
4. Cell protective mechanisms in
stomach
Secretion of mucus and bicarbonate
Dilution of gastric acid by food and secretions
Prevention of diffusion of HCL from the
stomach lumen back into the gastric mucosal
lining
Presence of prostaglandin E
Alkalinization of gastric secretions by
pancreatic juices and bile
5. Cell Destructive Effects in Stomach
Gastric acid, secreted by parietal cells
Paretal cells contain receptrors for
acetylcholine, gastrin and histamine, all of
which stimulate gastric acid production
Acetylcholine is released by vagus nerve
endings in response to stimuli, such as thinking
about food
6. Cell destructive effects cont.
Gastrin is a hormone released by the stomach
and duodenum in response to food ingestion.
Affects parietal cells which in turn causes
gastric acid to be released in stomach.
Histamine is released from cells in the gastric
mucosa and diffuses into nearby parietal cells
Pepsin is a proteolytic enzyme that helps
digest protein foods and also can digest the
stomach wall
7. Cell destructive effects
H. pylori is a gram negative bacterium found in
the gastric mucosa of most clients with chronic
gastritis
In 75% of those with gastric ulcers and in 90%
of clients with duodenal ulcers
Spread by oral fecal route or by iatrogenic
spread
Thought to affect mucosal function
8. Peptic Ulcer Disease
Gastric Ulcers
Associated with stress, NSAIDs or H. pylori
Manifested by painless bleeding
Take longer to heal than duodenal ulcers
When associated w/stress, can occur at any age
With H. pylori and NSAIDs generally are in
6th or 7th decade
chronic
9. PUD cont.
Duodenal Ulcers
Can occur at any age
Occur equally in men and women
Manifested by abdominal pain
Associated with cigarette smoking
Also associated with NSAIDs and H. pylori
10. Peptic Ulcer and Acid Reflux
Disorders
Characterized by ulcer formation in the
esophagus, stomach or duodenum
Occurs in areas that are exposed to gastric acid
and pepsin
Gastric and duodenal ulcers are more common
than esophageal ulcers
Parietal cells contain receptors for
acetylcholine—implication of which is
stimulation by/of vagus
11. Upper GI Disorders
Gastritis—acute or chronic inflammatory reaction of
gastric mucosa.
Usually will see peptic ulcers with gastritis
Non-steroidal anti-inflammatory Drug Gastropathy
Occurs with damage to mucosa by ASA or other
NSAIDs
Chronic ingestion causes irritation of the gastric
mucosa, inhibits the synthesis of prostaglandins
(which protect mucosal lining) and increasess the
synthesis of leukotrienes and other substances that
can cause mucosal damage
12. Selected Upper Gastrointestinal
Disorders
Review p. 853 in text
Include Gastritis
Nonsteroidal anti-Inflammatory Drug Gastropathy
Stress Ulcers
Zollinger-Ellison Syndrome-rare; excessive secretion
of gastric acid and a high incidence of ulcers. Caused
by gastrin-secreting tumors in pancreas, stomach or
duodenum. Often malignant.
13. Gastroesophageal Reflux Disease
Most common disorder of the esophagus
Characterized by regurgitation of gastric contents into
the esophagus
Occurs most often after a meal
Worse when recumbent
Caused by incompetent lower esophageal sphincter
Foods that cause relaxation include: etoh, caffeine,
fats, chocolate, cigarrette smoking, gastric distention
and medications (beta adrenergic blockers, calcium
channel blockers, nitrates)
14. GERD cont.
Occurs in men, women, and children
Common during pregnancy
More common after 40 years of age
15. Classifications and Individual Drugs
Antacids—alkaline substances that neutralize
acids. Raising the pH to approximately 3.5
neutralizes more than 90% of gastric acid and
inhibits conversion of pepsinogen to pepsin.
Commonly used antacids are aluminum,
magnesium, and calcium compounds.
16. Antacids
Antacids vary in onset of active and dosage needed
for neutralization
Aluminum compounds require large doses for
effectiveness. They can cause constipation,
hypophosphatemia and osteomalacia.
Magnesium based antacids have more rapid onset
than Al++ but can cause diarrhea and
hypermagnesemia
Calcium compounds can cause hypercalcemia and
hypersecretion of gastric acid==“rebound”
17. Antacids
May be in combinations such as aluminum and
magnesium hydroxide
Decreases the diarrhea and constipation
Most antacids are pregnancy category C
Antacids may be used in children
Antacides with magnesium are contraindicated
because hypermagnesemia may result
Additives such as simethicone may be added
pills are as effective as liquids
18. Use in Older Adults
Smaller doses as they secrete less acid
May have some renal compromise
Older adults often take large doses of NSAIDs
H2 receptor antagonists sometimes cause more
side effects
Sucralfate is well tolerated
PPIs are drugs of choice in this population
19. Helicobacter pylori
Requires combination of two antimicrobials and a
PPI or an H2RA
Use amoxicillin, clarithromycin, metronidazole or
tetracycline for antibiotic portion
More than antimicrobial is indicated to prevent
resistance
Bismuth compound is added for its antibacterial
effects as well as increasing the HCO3- and mucous
contents of the stomach
Adding an H2RA or PPI decreases S/S and hastens
healing
20. Histamine 2 Receptor Antagonists
Histamine release causes contraction of
smooth muscle in bronchi, GI tract, increases
permeability of capillaries,stimulation of
sensory nerve endings and strong stimulation
of gastric acid secretion
Vagal stimulation causes release of histamine
from cells in stomach, acts on receptors in
parietal cells>>>>increases HCL production.
Called H2 receptors
21. Histamine 2 Receptor Antagonists
Traditional antihistamines or H1 receptor
antagonists generally reduce the effects of
histamine in the body but do not block
histamine effects on gastric acid production.
Replaced as first choice drugs by the PPIs
Prototype is cimetidine
Generally are pregnancy category B
May have multiple drug interactions and SE
Available OTC and by Rx
22. H2RA
Reduce dosage in pregnancy
Cimetidine affects the cytochrome p450 drug
metabolizing system in the liver; may cause
confusion and antiadrogenic effects (gynecomastia)
Ranitidine more powerful
Use for up to 8 weeks
May be used long term but with variable dosing
Antacids may be given concurrently to relieve pain
23. Proton Pump inhibitors
Strong inhibitors of gastric acid secretion
Bind irreversibly to the gastric proton pump to
prevent the release of gastric acid from parietal cells
Suppresses acid secretion in response to all primary
stimuli including histamine, gastric, and acetylcholine
Are the drugs of first choice in erosive esophagitis,
erosive gastritis and Zollinger-Ellison
24. PPIs
More effective than H2RA
Faster symptom relief and faster healing
Used in prevention of esophagitis
Tx H. pylori associated ulcers
Side effects are nausea, diarrhea and HA
Long term effects??? Implications??
25. Prostaglandin
Naturally occurring prostaglandin E is
produced by mucosal cells of the stomach and
duodenum. It inhibits gastric acid secretion
and increases mucous and bicarbonate,
mucosal blood flow and mucosal repair. With
inhibition of Prostaglandin E, erosion and
ulceration of the gastric mucosa may occur.
Implications
26. Cytotec (misoprostol)
Synthetic form of prostaglandin E
Indicated for clients at high risk for GI
ulceration and bleeding and in those who take
NSAIDs
Contraindicated in women of childbearing
age and during pregnancy (see text p. 862)
May induce abortion
Side effects include diarrhea and abdominal
cramping
27. Sucralfate
Preparation of sulfated sucrose and aluminum
hydroxide that binds to normal and ulcerated mucosa
Mechanism of action is unclear
Thought to possible bind to the ulcer and form a
protective barrier between the mucosa and gastric
acid, pepsin and bile salts; and stimulating
prostaglandin synthesis
Effective in healing duodenal ulcers and in prevention
of recurrence
28. Sucralfate
Side effects include constipation and dry
mouth
Must be given Bid
Cannot be given with an antacid, H2RA or PPI
May bind other drugs and prevent their
absorption
Give 2 hours before or after other drugs
29. Effects of Acid Suppressant Drugs
on Nutrients
Dietary folate, iron and Vitamin B12 are better
absorbed from an acidic environment
Less acidic environment can cause deficiencies
of these nutrients
Sucralfate interferes with the absorption of the
fat soluble vitamins
Magnesium containing antacids interfere with
absorption of Vitamin A
31. Antiemetics
Used to prevent or treat nausea and vomiting
Vomiting is the expulsion of stomach contents
through the mouth
Vomiting can occur w/o nausea
32. Origin of vomiting
Vomiting center is located in medulla
oblongata
Stimuli are relayed to the vomiting center from
the periphery (gastric mucosa, peritoneum,
intestines, joints(?)) and centrally (from the
cerebral cortex; vestibular apparatus and from
neurons in the fourth
ventricle==chemoreceptor trigger zone) sites
33. The vomiting center, chemoreceptor trigger zone and
GI tract contain benzodiazepine, cholinergic,
dopamine, histamine, opiate and serotonin receptors
that are stimulated by emetogenic drugs and toxins
For example: chemotherapy may stimulate the CTZ
which then signals the vomiting center
Motion sickness—changes in body
motion>>stimulate receptors in inner
ear>>transmitted to the CTZ and the vomiting center
34. Triggering the vomiting center
Efferent impulses cause glottic closure
Contraction of abdominal muscles and
diaphragm
Relaxation of the GE sphincter
Reverse peristalsis
Projection or expulsion
35. Causes of nausea and vomiting
Pain
Emotional disturbances
Radiation therapy
Motion sickness
Drug therapy: especially with alcohol, ASA,
digoxin, anticancer drugs, antimicrobials,
estrogen preparations and Opioids
36. Causes of Nausea and Vomiting
GI disorders such as inflammation of the GI
tract, liver, gallbladder, pancreas, impaired GI
motility and muscle tone (gastroparesis) and
ingestion of food that is irritating to the
mucosa
Cardiovascular, infectious, neurologic or
metabolic disorders
37. Antiemetic Drugs
Most have anticholinergic, antidopaminergic,
antihistaminic or antiserotonergic effects
Generally are more effective in prophylaxis
than treatment
Most act on the vomiting center, the
chemoreceptor trigger zone, the cerebral
cortex, vestibular apparatus or any of the
above
38. Antiemetic Drugs
Phenothiazines—CNS depressants used in psychoses
Block dopamine from receptor sites in the brain
Act on CTZ and the vomiting center
Not all phenothiazines are anti-emetics
Cause drowsiness
Prochlorperazine (Compazine) and promethazine
(Phenergan) are examples
Some are pregnancy category B, others C, should
check 1st
39. Side effects continued
Extrapyramidal symptoms which include:
Dyskinesias (rhythmic movements), dystonias
(rhythmic jerks) and akathesia (inability to sit
still) related to dopamine receptor blockade
40. Antihistamines
Prevent histamine from exerting its widespread
effects on the body
Classic antihistamines or H1 receptor blocking
agents are thought to block the action of
acetylcholine in the brain (anticholinergic)
Indicated in Motion sickness
Examples are Dramamine, hydroxyzine
(Vistaril), meclizine (Antivert)
41. Corticosteroids
May affect prostaglandin activity in the
cerebral cortex
Dexamethasone and methyprednisolone are
commonly used in the management of
chemotherapy induced emesis, usually in
combination with other anti-emetics
42. Benzodiazepine antianxiety drugs
Not classic anti-emetics but often used in
multidrug regimens to prevent nausea and
vomiting associated with cancer chemotherapy
Inhibit cerebral cortex input to the vomiting
center
May give to those with anticipatory nausea
before chemotherapy
Example is Ativan (lorazepam)
43. 5 Hydroxytryptamine (5-HT3 or
Serotonin)Receptor Antagonists
Ondansetron, granisetron and dolasetron are
used to prevent or treat moderate to severe
nausea and vomiting r/t cancer chemotherapy,
radiation therapy and postoperatively
Some anticancer drugs seem to affect a subset
of 5-HT3 recptors in the CTZ and the GI tract
These drugs antagonize receptors both
peripherally (GI) and in the CTZ to prevent
activation
44. 5-HT3 receptor antagonists cont.
Can be given IV or orally
Side effects are mild to moderate and include:
diarrhea, headache, dizziness, constipation,
muscle aches and transient liver enzymes
elevation
Ondansetron (Zofran) is the prototype
Metabolized by the liver
45. Miscellaneous Antiemetics
Dronabinol (Marinol) is a cannabinoid used in
the management of nausea and vomiting
associated with anticancer drugs and
unrelieved by other drugs.
Schedule III under federal narcotic laws
Withdrawal S/S may occur
Sleep disturbances
46. Reglan
Prokinetic that increases GI motility and the
rate of gastric emptying by increasing the
release of acetylcholine from nerve edings in
the GI tract
Can cause decreased n/v associated with
gastroparesis
Has central antiemetic effects, antagonizes the
action of dopamine
Can be given IV, PO or IM
47. Reglan continued
Side effects include sedation, restlessness, and
extrapyramidal reactions
May increase the effects of alcohol and
cyclosporine and decrease the effects of
cimetidine and digoxin (decrease time for
passage)
48. Emetrol
Phosphorated carbohydrate solution
Hyperosmolar solution with phosphoric acid
OTC
Felt to work by reducing smooth muscle
contraction in the GI tract
50. Contraindications
When can delay or prevent diagnosis
When s/s of toxicity may be masked
Reglan is relatively contraindicated in
Parkinson’s disease because it further dples
dopamine
51. Management Considerations
5-HT3 antagonists 1st choice in chemotherapy
induced or postoperative N/V
Drugs with anticholinergic and antihistaminic
properties are preferred for motion sickness
If ambulatory, opt for drug that causes less
sedation
Phenergan is used for its antihistaminic,
antiemetic and sedative effects
52. Management Considerations cont.
Phenothiazines can have serious side effects
Reglan may be preferred for non-obstructive
gastric retention
54. Chemotherapy-induced Nausea and
Vomiting
Chemo may be given during sleeping hours
Decrease food intake few hours before Tx
Antiemetics should be given before the emetogenic
Tx and may be given for 2-3 days
5-HT2 receptor antagonists are drugs of choice for
this indication
Reglan is valid option but may need to give
diphenhydramine to prevent the EPS
Sometimes combo of steroid and 5-HT3 RA useful
55. Laxatives and Cathartics
When stomach and duodenum are distended with
food, gastrocolic and duodenocolic reflexes are
initiated
The cerebral cortex controls the defecation reflex so
that defecation can occur at acceptable times and
places
In people who inhibit the defecation reflex or fail to
respond to the urge to defecate, constipation develops
56. Laxatives are chemical substances that act to
facilitate passage of bowel contents
Cathartics—a purgative action of the bowels,
action is stronger and generally produces
elimination of liquid stools
57. Indications for Use
Reduce cholesterol
Obtain stool sample
Accelerate excretion of parasites after anthelminthics
started
Accelerate elimination of potentially toxic substances
(Kayexalate)
Pre-op
Prevent straining at stool w/CAD, hemorrhoids
Relieve constipation in pregnancy, in the elderly; in
children with megacolon, and in those w/decreased
motility
58. Laxatives and cathatics should not be used in
the presence of undiagnosed abdominal pain
Could cause an inflamed organ to rupture
Oral agents are contraindicated in intestinal
obstruction and fecal impaction
59. Laxatives
Bulk-forming laxatives—Citrucel, Metamucil
Surfactant Laxatives—mainly prevent
straining. They allow water to penetrate stool
and act as detergent to facilitate admixing of
fat and water in the stool. Colace (docusate) or
Surfak.
Saline—magnesium citrate. Nulytely.Increase
osmotic pressure in intestinal lumen.Not safe
for frequent use. Affect fluids and lytes.
60. Cathartics
Stimulant type are the strongest and most
abused
Cascara,bisacodyl, castor oil and senna
products
Mineral oil is a lubricant laxative. It slows
colonic absorption of water.
61. Other
Lactulose—a disaccharide that is not absorbed from
the GI tract. Pulls water into intestinal lumen. Used to
treat constipation and hepatic encephalopathy.
Lactulose reduces production of ammonia in the
intestine. Can affect lyte and water balance.
Sorbitol—monosaccharide that puls water into the
intestinal lumen and has laxative effects. It is given
with Kayexalate (potassium removing resin to treat
hyperkalemia).
62. Laxative Abuse
Public health problem in elderly
Use in patients with cancer
What is normal?
What are some measures to prevent
constipation?
63. Safety in Use
Saline cathartics must be used cautiously in the
renally impaired
Lactulose may be indicated in those with
hepatic encephalopathy
Seen frequently in form of enemas in
hyperkalemia in hospital
64. Antidiarrheals
Diarrhea is a symptom of numerous conditions
that increase bowel motility; cause secretion or
retention of fluids in the intestinal lumen and
cause inflammation or irritation of the GI
tract. End result: bowel contents are rapidly
propelled and absorption of fluids and
electrolytes is limite.d
65. Causes of Diarrhea
Abuse of laxatives
Intestinal infections—E. Coli 0157:H7 (can
result in a hemolytic uremic syndrome),
Traveller’s diarrhea (E. coli), Campylobacter
jejuni, Salmonella, Shigella, rotatvirus
Inflammatory bowel diseases
Drug therapy—pseudomembranous colitis—
Clostridium difficile (anaerobic, spore forming
rods)
67. Antibacterials
Azithromycin for Traveller’s diarrhea
Cipro—E.coli, Camylobacter, Shigella
EES—amebiasis
Flagyl—Clostridium difficile
Bactrim-Traveller’s diarrhea
Vancomycin—Clostridium difficile, even in
form of enemas
68. Miscellaneous
Questran—Crohns’. Binds and inactivates bile
salts in the intestine.
Octreotide—diarrhea associated with HIV,
carcinoid tumors, cancer therapies or
intractable diarrhea caused by other drugs.
Pancreatin—pancreatic enzymes used for
replacement in patients w/deficiency of
pancreatic enzymes