This power point presentation will be helpful for Pharmacy, Medical and paramedical students. it consists of" what are the common GIT disorders and their pharmacological management "
Both duodenal and gastric ulcer diseases are closely associated with Helicobacter pylori infection. An infected individual has an estimated lifetime risk of 10 -20% for the development of peptic ulcer disease, which is at least 3-4 fold higher than in non-infected subjects. Many drugs are being used as inhibitors of acid secretion and antacids are also effectively used. New potential drugs are also developed and introduced for acid related disease. Combination therapy like triple and quadruple therapy more effective for removal of Helicobacter pylori. Homeopathy and Ayurvedic therapy are also consider as treatment of ulcer. Role of surgery can be option for the bleeding ulcer or ant severe case.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents & emesis
Both duodenal and gastric ulcer diseases are closely associated with Helicobacter pylori infection. An infected individual has an estimated lifetime risk of 10 -20% for the development of peptic ulcer disease, which is at least 3-4 fold higher than in non-infected subjects. Many drugs are being used as inhibitors of acid secretion and antacids are also effectively used. New potential drugs are also developed and introduced for acid related disease. Combination therapy like triple and quadruple therapy more effective for removal of Helicobacter pylori. Homeopathy and Ayurvedic therapy are also consider as treatment of ulcer. Role of surgery can be option for the bleeding ulcer or ant severe case.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents & emesis
Presentation on Antacids and antiulcer drugs. Introduction to ulcers, classification of antiulcer drugs, their pharmacological actions, uses and adverse effects.
Lecture slides for MBBS Undergraduate Medical students. Study material was taken from Essentials of pharmacology by KD Tripathi. Figures were searched from google.
This slide is based upon prokinetic agents with detailed descriptions of their dosage to be taken with their respective usage in conditions and effects to be careful. I hope you will get the best of your knowledge from the respective material.
Autacoids - pharmacological actions and drugs related to them. SIVASWAROOP YARASI
Autacoids or "autocoids" are biological factors which act like local hormones, have a brief duration, and act near the site of synthesis. The word autacoids comes from the Greek "autos" (self) and "acos" (relief, i.e. drug).
Peptic ulcers are open sores that develop on the inside lining of esophagus, stomach and/or the upper portion of small intestine. Peptic ulcer occur mainly due to imbalance between aggressive and defensive factors in the stomach.
Presentation on Antacids and antiulcer drugs. Introduction to ulcers, classification of antiulcer drugs, their pharmacological actions, uses and adverse effects.
Lecture slides for MBBS Undergraduate Medical students. Study material was taken from Essentials of pharmacology by KD Tripathi. Figures were searched from google.
This slide is based upon prokinetic agents with detailed descriptions of their dosage to be taken with their respective usage in conditions and effects to be careful. I hope you will get the best of your knowledge from the respective material.
Autacoids - pharmacological actions and drugs related to them. SIVASWAROOP YARASI
Autacoids or "autocoids" are biological factors which act like local hormones, have a brief duration, and act near the site of synthesis. The word autacoids comes from the Greek "autos" (self) and "acos" (relief, i.e. drug).
Peptic ulcers are open sores that develop on the inside lining of esophagus, stomach and/or the upper portion of small intestine. Peptic ulcer occur mainly due to imbalance between aggressive and defensive factors in the stomach.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
6. Various Gastrointestinal Disorders
• Acid reflux and
oesophagitis.
• Anal fissure.
• Appendicitis.
• Barrett's oesophagus.
• Cancer of the bowel.
• Cancer of the liver.
• Cancer of the oesophagus.
• Cancer of the pancreas.
• Cancer of the stomach.
• Cholecystitis.
• Coeliac disease.
• Constipation.
• Crohn's disease.
• Cystic Fibrosis.
• Diarrhoea.
• Diverticula.
• Duodenal ulcer.
• Dyspepsia.
• Gallstones.
• Gastroenteritis
• Piles (haemorrhoids).
• Helicobacter pylori
and stomach pain.
• Hernia.
• Hiatus hernia.
• Irritable bowel syndrome.
• Mesenteric adenitis.
• Pancreatitis.
• Itchy bottom.
• Pyloric stenosis
• Blood in stools (faeces),
called rectal bleeding.
• Peptic ulcer.
• Threadworms.
• Toddler's diarrhoea.
• Ulcerative colitis.
• Amoebiasis
7. Dyspepsia
Dyspepsia: Pain or discomfort in the upper abdomen
Symptoms: Epigastric discomfort, Fullness or bloating, Excessive, Flatus, Nausea..
Cause: Peptic ulcer disease (10%), Esophagitis (15%), No significant abnormality (non-
ulcer dyspepsia or functional dyspepsia - 75%)
Diagnosis: Functional (non-ulcer) dyspepsia, IBS,GORD, Biliary pain - eg, gallstones,
Achalasia, Medication-induced dyspepsia (NSAIDs, steroids, calcium antagonists, nitrates,
theophyllines and bisphosphonates), Aerophagia, Oesophageal spasm, Oesophageal cancer
or stomach cancer, Offer lifestyle advice, ie stopping smoking, more regular meals, ceasing
excessive alcohol consumption.
8. Pharmacological Treatment: Antacids
H2 Receptor Antagonists
Proton Pump Inhibitors
ANTACIDS
Definition: Antacids are a group (class) of medicines which help to neutralise
the acid content of stomach.
Mechanism of action:
• Neutralize the gastric acid.
• Reduce the concentration of H+ ions and total load of acids in gastric
secretion.
• Strengthen the gastric mucosa.
• Increases the pH of gastric acid secretion thus neutralize the pepsin.
9. Acid Neutralizing Capacity: No. of meq. Of 0.1 N solution of HCL need to bring pH at 3.5
within 15 minutes.
Types of Antacids
Type Example ADR
Systemic NaHco3 Systemic alkalosis
Non-systemic CaCo3, Constipation
Mg(OH)3 Diarrhoea
Al(OH)3 Constipation
10. Important points
• Non-systemic antacids are preferred over systemic antacids because systemic
antacids may cause systemic alkalosis.
• Liquid antacids have greater buffering capacity than antacid tablets.
• Combination of Al(OH)3 & Mg(OH)3 antacids are generally used because
More sustained action
Dose of individual antacids can be reduced in the combination.
Constipation effect of Al(OH)3 can be countered with diarrheal effect of Mg(OH)3.
• Calcium containing antacids are not preferred because:
constipation
acid rebound
delay in ulcer healing and pain relief
11. Precautions
• Al(OH)3: patients with dehydration, intestinal obstructions
• Antacids + Milk: Milk alkali syndrome
• Renal impairment
Interactions:
• Tetracycline/ Fluroquionlones
• Decreases the effect of sucralfate
• Destroy the coating of enteric coated tablets.
• Alters the absorption of : Anticholinergic, cimetidine, ranitidine, iron products, isoniazid,
digoxin, phenothiazine
14. Mechanism of action:
• Prevents the action of histamine on H2 receptors.
• Decreases concentration of H ions and reduces the gastric acid secretion.
• Promotes healing of ulcers.
Examples:
Name of drug Ring Relative potency Dose ( active ulcer) Maintenance dose
Cimetidine Imidazole 1 800 mg 400 mg
Ranitidine Furan 4-10 300 mg 150 mg
Famotidine Thiazole 4-10 40 mg 20 mg
Nizatidine Thiazole 20-50 300 mg 150 mg
15. ADR:
Interactions:
Name of drug ADR
Common Headache, Dizziness
Cimetidine Thrombocytopenia, Agranulocytosis, aplastic anaemia, haematological disorders,
gynacomestia and impotency
Ranitidine Hepatotoxicity, Bradycardia
Cimetidine + Ranitidine Hepatotoxicity
Cimetidine lowers the Cyt.P450
enzyme
Theophylline, phenytoin, phenobarbitone,
phenothiazine, digoxin, lidocaine, warfarin
Reduced metabolism
Cimetidine reduces hepatic
clearance
Propranolol, lidocaine
Cimetidine Antacids Reduced absorption
H2 receptor antagonists Azoles Reduced efficacy
16. PROTON PUMP INHIBITORS
Mechanism of action:
• Proton pump: K/H ATPase
• Proton pump consists of sulfhydryl group near proton pump binding site in the luminal
canalicular membrane. PPIs forms stable disulphide linkage with this specific sulfodryl
group and inactivates the proton pump which leads to shutting off the acid secretion.
• PPIs are more rapidly effective than other agents.
• PPIs are most effective in healing of erosion ulcers.
17. Examples:
ADR:
• Well tolerated.
• Minor GIT (nausea, vomiting, diarrhoea) and CNS (Dizziness).
• Can be used for several years without significant side effects.
Drug Dose / day
Omeprazole 20 mg
Esomeprazole 20 mg
Pantoprazole 40 mg
Lansoprazole 30 mg
Rabeprazole 20 mg
18. Interaction:
Imp. Points:
• For children: Omeprazole, Esomprazole, Lansoprazole
• Highest bioavailability: Lansoprazole
• Highest protein binding: Pantoprazole
• Only PPI available in dual-delay release capsule formation: Dexlansoprazole
• For heart burn: Omeprazole, Lansoprazole
• Orally disintegration PPI: Lansoprazole
• Enteric coated formulation: Rabeprazole, Pantoprazole
• Delayed release capsule: Omeprazole, Esomprazole, Lansoprazole
PPIs
Clopidogrel Decreased antiplatelet effect
Diazepam, Warfarin, Phenytoin Decreased absorption
Ketoconazole, Ampicillin, Iron Decreased absorption
19. Gastroesophagial Reflux Disease
Definition: Retrograde movement of the gastric content from stomach to the esophagus.
Cause:
• TLESR (Transient Lower Esophagus Sphincter Relaxation)
• Lower Esophagus Sphinter reduced pressure
Types:
• Reflux Esophagitis: Reflux leads to the inflammation (with or without erosion of
ulcerations).
• Non-erosive reflux disease: Lack of oesophagus injury.
20.
21. Risk factors:
Increased intra-abdominal pressure, poor oesophageal peristalsis, smoking, alcohol, fat,
coffee. Obesity, Tight clothes, Big meals and drugs (tricyclic antidepressants,
anticholinergics, nitrates and calcium-channel blockers) Pregnancy.
Symptoms:
Heartburn rising from the stomach or lower chest up towards the neck, that is related to
meals, lying down, stooping and straining.
Investigations: Endoscopy
Treatment: Antacids
H2 Receptor Antagonist
Proton Pump Inhibitors
22. Peptic Ulcer
Definition:
• Ulcers are lesions on the walls of gastrointestinal tract.
• The term 'peptic ulcer' is used to describe ulcers that are caused by too much acid in the
stomach. This includes stomach ulcers and also ulcers in the first part of the gut (small
intestine) known as the duodenum.
• Stomach ulcers are less common than duodenal ulcers
Types of ulcers: Duodenal ulcer, Gastric ulcer, Stress ulcer, Zollinger-Ellison syndrome,
Stomach ulcer and drug induced ulcers.
23.
24. Types of ulcer
Type of ulcer Description
Duodenal ulcer Occurs in duodenum bulb ( first few centimtres of
duodenum)
Gastric ulcer Occurs in antrum or antral-fundal junction
Stress ulcer Occurs due to trauma, stress or severe injury
Zollinger-Ellison syndrome When intractable ulcers accompanied by the extreme
gastric hyperacidity
Stomach ulcer Most common type of ulcer.
Drug induced ulcer NSAIDs
25. Peptic ulcer disease pathogenesis
NSAIDs H. Pylori Hyper secretary states
Alterations in mucosal defence
mechanism
Acid and Pepsin
Ulceration
26. Risk factors of ulcer
Risk Factors Mechanism
Alcohol Cause severe irritation of gastric mucosa
Helicobacter pylori This is the bacteria lives in acidic environment.
Corticosteroids
NSAIDs Prevents the synthesis of prostaglandins which have protective
mechanism on gastric mucosa.
Cause mucosal injury by back diffusion of H+ ions in the
gastric mucosa.
Genetic factor Patients with “ O” blood group are more prone to ulcers
Smoking Damage of gastric mucosa
Caffeine It contains peptides that stimulates the release of gastrin
hormone that increase the flow of gastric juice
Disease Rheumatoid arthritis, Hyperthyroidism, Alcoholic cirrhosis,
Emphysema
28. SUCRALFATE
It is un-absorbable disaccharide containing sucrose and aluminium.
MOA: It forms protective coat on gastric mucosa.
Dose: 1 gm. 3-4 times/day.
ADR: Constipation.
Interaction: Ciprofloxacin, Cimetidine, Iron, Digoxin and Phenytoin
29. PROSTAGLANDINS
Prostaglandins have cyto-protective action on gastric mucosa.
Prostaglandins are indicated mainly for NSAIDs induced peptic ulcers.
Example: Misoprostol
MOA:
• By decreasing gastric acid secretion
• Muco-protective action
Dose for NSAID-induced gastric ulcers : 200 mcg four times daily with food.
ADR: Nausea, Stomach crams, Diarrhoea.
30. BISMUTH SUBSALICYLATE
MOA:
• Prevents the adhesion of helicobacter pylori to the gastric mucosa
• Slow down the growth of H. Pylori
• Inhibits the secretion of proteolytic enzymes
ADR: CNS toxicity (Neurotoxicity )
Dose: 524 mg orally every 30 to 60 minutes as needed not to exceed 8 doses in any 24 hour
period.
31. GIT ANTICHOLINERGIC
MOA:
Acts by inhibiting the basal and stimulated gastric acid secretion.
Examples: Atropine, Belladonna and Propanthaline
Imp.
Mainly given in night
Given to patients who do not respond to H2RA
Contraindicated to patients with gastric ulcers because these drugs slow down gastric
emptying time
32. Constipation
Decreased frequency of faecal elimination or passing of Hard, Dry and Painful stools.
Cause: Low intake of fluids and fibrous food
Treatment : Laxatives (laxatives acts by soften the stools and also increase frequency of
faecal elimination )
Types of laxatives
• Bulk forming laxatives (First line therapy)
• Hyperosmotic laxatives (Second line therapy)
• Stimulant laxatives (Third line therapy)
• Emollient laxatives
• Saline laxatives
• Lubricant laxatives
33. Types of laxatives, examples and their mechanism of action
Type of laxative Examples Mechanism
Bulk forming
laxative
Psyllium, Methyl cellulose,
calcium polycarbophill, wheat
detrain
Increase absorption of water, soften the stool
and increase bulk which stimulates peristalsis
Hyperosmotic
laxative
Glycerine, Polyethylene glycol
3350
Creates osmotic ingredient to pull water into
small and large intestine
Stimulant laxative Senna, Bisacodyl Alters water and electrolyte absorption in
intestine and also stimulates peristalsis
movement
Emollient laxative Docusate sodium Softening of stool by easy movement of water
into stool
Saline laxative Magnesium citrate
Magnesium hydroxide
Sodium phosphate
Lubricant laxative Mineral oil, liquid paraffin
34. Diarrhoea
Definition: Increased frequency of faecal elimination or passing of watery stool.
Classification of diarrhoea:
Type of diarrhoea Description
Osmotic diarrhoea This occurs due to the excessive fluid pulling in the
gastrointestinal tract. Occur when patients is on fasting
Secretary diarrhoea Occurs due to the damage of intestinal mucosa results in more
secretion of water and electrolytes
Motility type diarrhoea Occurs due to increased intestinal motility which leads to rapid
movement of food and electrolytes and provides no sufficient
time for absorption of food
35. Type of diarrhoea based on causative organism
Treatment:
• Fluid and Electrolytes replacement with ORS
• Antiperistalsis drug: Loparamide
• Probiotics
• Lactase
• Bismuth subsalicylate
Type of diarrhoea Causative organism
Viral diarrhoea Norovirus
Bacterial diarrhoea E. Coli, Staphylococcus aurous, Salmonella, Shizella, Vibrio cholera
Protozoal diarrhoea Giardia, Entamoeba histolytica
36. ORS
For fluid and electrolyte replacement.
Composition of ORS (WHO Formula) :
Directions of use:
• Dissolve in 1 Litre drinking water
• Do not boil solution
Dose:
Use 1 sachet over a 24 hours
Sodium chloride 2.6 gm
Potassium chloride 1.5 gm
Trisodium citrate 2.9 gm
Glucose anhydrous 13.5 gm
37. ANTI-PERISTALSIS DRUG
Agents: Loperamide
MOA: It stimulates micropoid receptors on circular and longitudinal walls of small and large
intestine thus inhibits peristalsis movement
Dose: 4 mg orally after the first loose stool, then 2 mg orally after each unformed stool
(Maximum dose: 16 mg per day)
ADR: Torsades de Pointes, cardiac arrest, and death have been reported with use of higher
than recommended doses.
Contraindications:
• Children below 6 years of age
• Colitis
• Acute bacterial diarrhoea
38. PROBIOTICS
Definition: Use of exogenous administration of bacteria to normalize GIT bacterial flora
Agents: Lactobacillus
MOA: Lactobacillus used to establish normal GIT flora. It creates acidic environment
which is unfavourable for pathogenic microorganisms.
Dosage:
Lactobacillus:
• 1-2 capsules orally each day
• 1-10 billion colony forming units (CFU) per day orally divided in three to four times a day
• 8 oz yogurt two times a day
ADR: flatulence and constipation
39. LACTASE
It is an enzyme responsible for digestion of milk.
Persons deficiency of lactase enzymes can not digest milk and get diarrhoea
like symptom after taking milk
Lactase enzyme is indicated for patients with lactase deficiency
Dose: 3,000-9,000 units PO with meals or dairy food
40. Amoebiasis
Causative organism: Entamoeba histolytica
Types of amoebiasis
• Intestinal amoebiasis: affects intestine
• Extra intestinal amoebiasis: affects lungs, liver and brain.
Life cycle of E. Histolytica
• Inactive form: Cyst
• Active form: Traphozoit
Cyst (inactive form) enters in intestine from contaminated water and food. In intestine cysts
converted into traphozoits (active form) . remains in colon and may spread into other
organs.
41. Anti amoebic drugs
Tissue amoebiasis luminal amoebiasis
Intestinal and Extra intestinal Extra intestinal
Metronidazole Chloroquine
Tinidazole
Secnidazole
Alkaloids: Emetin & Dihydroemetin
Antibiotics Amides Others
Tetracycline Diloxonide Furoate Iodoquinol
Quinacrine
42. Drug Mechanism of action ADR
Metronidazole Disruption of helical structure
of bacterial DNA
Nausea, vomiting, epigastric
pain, metallic taste.
Tinidazole Same
Diloxonide furoate Same
Iodoquinol Kills traphozoit Optic neuritis, atrophy,
peripheral neuropathy
Interferes with thyroid test
results
Quinacrine Inhibits DNA metabolism Should not take with
primaquine (Primaquine
toxicity), Psoriasis
Tetracycline Protein synthesis inhibitor GIT distress, hypersensitivity,
phototoxic, hepatotoxicity
