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PHARMACOLOGY of gastrointestinal tract II. Secretion and motility disorders

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Title: PHARMACOLOGY of gastrointestinal tract II. Secretion and motility disorders


1
PHARMACOLOGY of gastrointestinal tract
II.Secretion and motility disorders
2
When is the medication necessary ?
  • motility disorders (vomiting, reflux, abnormal
    passages, irritable bowel syndrome, colic,
    ...)resorption disorders (disorders of GIT
    enzymes secretion, malabsorption)peptic lesions
    (ulceration GD)inflammatory disease (bowel,
    hepatitis, ...)
  • excessive food intake (antiobesity drugs)
  • gastrointestinal bleeding (prophylaxis and
    treatment)

3
Medicines for diseases of the gastrointestinal
tract
  • pharmacotherapy of functional and motor
    disordersantiemeticsprokineticantispasmodics
  • pharmacotherapy of peptic ulcer disease -
    proton pump inhibitors
  • - antihelicobacterial treatment - histamine H2
    receptor antagonists - chelates based on bismuth
    salts,antacids

4
Medicines for diseases of the gastrointestinal
tract
  • pharmacotherapy of motoric and functional GIT
    disorders. laxativesantidiarrheal
    drugseubiotics, antihaemorrhoidaliapharmacother
    apy of digestion disturbancessubstitution of
    digestive enzymes

5
Medicines for diseases of the gastrointestinal
tract
  • nonspecific intestines inflammation
    pharmacotherapy. anti-inflammatory
    therapy      - corticosteroids      -
    aminosalicylates      - biological
    treatmentpharmacotherapy of liver and bile
    pathsbiol. treatmentinterferonsantispasmodics
    hepatoprotectives

6
Pharmacotherapy of functional gastrointestinal
disorders
  • nausea and vomiting
  • motility disorders of the proximal part of the
    GITfunctional dyspepsiaspasm of hollow organs
    (colic)gastroesophageal reflux disease
    (heartburn, regurgitation)
  • motility disorders of the distal part of the
    GITdiarrheaconstipation

7
Nausea and vomiting
  • nausea only subjective feeling
  • vomiting can lead to metabolic disruption (loss
    of potassium, water, HCl, negative energ.
    balances), the risk of aspiration of vomit,
    mucous rupture - bleedingthe need for
    prevention and treatmentimportance especially in
    oncology

8
antiemetics
9
Nausea and vomiting - control
  • vomiting center (medulla oblongata)CAVE is not
    protected by a HE barrier - easy penetration of
    toxins!!signal receptionafferent neural
    pathways        - from the periphery and other
    GIT tissues (larynx, stomach, myocardium,
    ...)        - from the CNS (psychogenic stimuli,
    intracranial hypertension, ...)        - from
    the vestibule. disorders (Meniere's ch., motion
    sickness)afferent humoral stimuli        -
    toxins (bacterial, uremia, ...), drugs
    (cytostatics,          digoxin, morphine),
    endocrine disorders (pregnancy, ...)effector 
    efferent pathways - n phrenicus -
    diaphragm                   - Spinal nerves of
    the stomach and esophagus

10
Medication with frequent occurrence of nausea and
vomiting
  • cytostatics (cisplatina,)
  • analgesics (opiates, NSAD,)
  • cardiotonics (digoxin,)
  • antibiotics (erytromycin,)
  • metformin
  • antiparkinsonics (bromcryptin, L-DOPA, )
  • antiepileptics (fenytoin, carbamazepin,)
  • methylxantins (theophylin)
  • anaesthetics (inhalatory and i.v.)

11
Patophysiology of nausea and vomiting
cortex psych. impuls migraine, (ACH)
chemoreceptors alcohol, emetics, cytotox.
drugs, irradiation, gravidity, (DA,SE)
Centrum for vomit.
vestibul. apparat. kinet. impuls, hyperstimulatio
n (H, ACH)
  • Antiemetics
  • antag. SE rec. 5HT3
  • antag. DA rec. D2
  • antag. rec. H1
  • anticholinergics

pharyng, stomach mechan. and chemical imp. (H)
12
Antiemetics by mode of action
  • neurotransmitter drugs with antiemetic effect
  • serotonin serotonin rec. 5-HT3 antagonists
    (setrons) - (ondansetron, granisetron,
    ...)histamine H1 histamine. rec. antagonists
    (moxastin, ...)dopamine dopamine rec. D2
    antagonists                                  -
    the type of neuroleptics (prochlorperazine,
    ...)                                             
         - type of prokinetics (metoclopramide
    , ...)                                           
                        acetylcholine
    anticholinergics (scopolamine, ...)

13
ANTIEMETICS - SETRONS
  • SEROTONERGIC 5-HT3 rec. ANTAG.
  • competitive or non-compet. blockade              
            most effective antiemetics     -
    blockade of the signal/
  • excitement in      the periphery of the
  • gastrointestinal tract,
  • aswell as in the chemo-
  • receptor center 
  • very valuable in oncology

serotonin5HT
14
Setrons and emetic reflex
GIT peripheral emetic 5- HT3 rec.
CNS


central emetic rec. 5- HT3
aferent fiber of n. vagus
15
Possible inhibition of serotoninergic rec. -
antiemetics a psychopharmacs
antidepres. inhib. MAO
triptans
anxiolytics
anxiolytics
atyp. anti- psychotics
setrone
SSRI antidepress.
16
Structural formulas of serotonine and setrons
ondansetron ZOFRAN, granisetron KYTRIL ,
tropisetron NAVOBAN,
17
ANTIEMETICS - SETRONS
  • ondansetron (Zofran)
  • competit. bound displacement through ? Ser
    concentration
  • granisetron (Kyril)
  • noncompetive, more reliable effect, longer
    duration (1 day)
  • palonosetron (Aloxi)
  • noncompet., most reliable and the longest effect
    (5 days)
  • ADVE headaches, intestinal motility disorders
    (especially constipation, abd. cramps, diarrhea),
    fatigue, sleepiness and insomnia
  • Indications vomiting in oncology

18
ANTIEMETICS - SETRONS
  • palonosetron, ondansetron, ...    - oxidase
    polymorphic CYP2D6 substrates    - risk of
    effect failure in fast/extensive
    metabolisers      or the co-medication with
    CYP2D6 inducersgranisetron     - is not a
    substrate of CYP2D6 oxidase     - reliable effect

19
ANTIEMETICS neurokinine antag.
  • aprepitant (Emend)
  • comb. effect substance P antag. (block
    neurokininového rec.) 5-HT3 rec.inhibitor. -
    significant antiemetic effect, potentiates the
    effect of setronsIndications Vomiting in
    Oncology comb. effect antag. substance P
    (blockade of neurokinine rec.) inhib. 5-HT3
    rec.
  • potentiates the effect of setrones
  • indication vomiting in oncology
  • setron dexametason aprepitant

20
ANTIEMETICS
  • H1 rec ANTAGONISTS
  • effectively inhibits stimuli from the vestibule.
    apparatus
  • kinetosis and treatment of dizzinessside effects
    (ADVE) sleepiness, dry mouth, ...moxastin
    (KINEDRYL) embramin (Medrin)diphenhydramine

21
ANTIEMETICS
D2 rec. DOPAMINERGIC ANTAGONISTS inhibit mainly
emetic stimuli from the periphery GIThave
prokinetic properties - increase gastrointestinal
motility,     psychosedative or supportive
effects type of neuroleptics - also
psychosedataion     thietylperazin (Torecan),
prochlorperazine, ... type of prokinetics -
increased motility of the aesophagus and
stomach     metoclopramide (Cerucal) ?
penetration through HE barrier, extrapyramidal
disorders      domperidone (Motilium) - does not
penetrate to the CNS
22
Dopamine receptors
23
ANTIEMETICS with complex effect
  • Thietylperazin (Torecan)
  • Blockade of - dopamin D2
  • - histamine H1
  • - muskarin
  • Remarcable antiemetic and antivertiginous effect
  • p.o., i.m., supp. application

24
ANTIEMETICS
  • ANTICHOLINERGICS
  • muskarin rec. blockade
  • also spazmolytic effect
  • only adjuvant treatment
  • scopolamin (adjuvant treatment ), atropin

25
Antiemetics indication considering cause of
nausea and vomiting
  • Vestibular vomiting and kinetosis
    antihistaminics (moxastin), combinations with
    anticholinergics
  • GIT affection
  • - with spasms anticholinergics (scopolamin)
  • - with kinetik disorders DA dopaminergic
    rec. (metoklopramid, domperidon, ev.
    thiethylperazin)
  • Vomiting in oncology selective serotonin 3 rec.
    (5HT3) inhib. (ondansetron, granisetron,
    palonosetron), combination with neurokinin rec.
    (aprepitant) inhib. corticoids (dexametazon)

26
Antiemetics indication considering cause of
nausea and vomiting
  • Vomiting following opioids dopaminergic antag.
    and histaminic H2 rec. antag. (thietylperazin),
    ev. anticholinergika
    (skopolamin)
  • Vomiting in pregnancy in light hyperemesis -
    diet, in severe parent. fluid, setrons
    (ondasetron), antihistaminic agents, antag. DA
    (thietylperazin, metoklopramid) or corticoids,
    larg interindividual differences in responses
    but empiric treatment is important

27
Prokinetic drugs
28
PROKINETIC DRUGS
  • regulate gastrointestinal propulsive motility
  • increase peristaltic movements of the esophagus
  • stimulation of gastric motility and emptying
  • accelerate passage through the intestine

29
PROKINETIC DRUGS principle of treatment
  • ? ACH
  • (inhib. of degradation)

? DA stimulation receptor (blockade)
30
PROKINETIC DRUGS
  • Antagonists at peripheral dopamine rec. D2
  • dopamine stimulates GIT peristaltic movements
  • Agonists of acetylcholine in plexus myentericus
  • acetylcholine stimulates GIT peristaltic
    movements
  • acetylcholinesterase inhibitors - ? ACH in
    synapses

31
Prokinetic drugs D2 rec. antagonists
  • ? ton. aesophag. sfincter
  • - convenient in GE reflux
  • ? stomachal evacuation
  • - in gastroparesis
  • ? effect in lower GIT part disorders (intestine)

32
Prokinetic drugs antagonists of D2receptors
  • indication
  • symptomatic gastroesophageal reflux    (in comb.
    with inhibitory drugs. of gastric secretion)-
    Duodenogastric reflux- Dysmotility type of
    functional dyspepsia- Nausea and vomiting
    associated with cytotoxic therapy- Postoperative
    gastroparesis
  • metoclopramid (Cerucal, Degan)
  • frequent ADRs 10-20also central -
    extrapyramidal disorders (tremor, ...),
    drowsinessperipheral - diarrheahyperprolactinemi
    a - galactorrhoea, breast pain, abnormal
    cyclecheap, fast and short acting - 1-2 pm, but
    many ADV. Effectsshould not be used for a long
    time (weeks)

33
Prokinetic drugs D2 rec. antagonists
  • domperidon (Motilium)
  • more selective effect on D2 reconly peripheral
    antagonistic eff. on D2 rec.does not penetrate
    the HE barrier? effect antiemetic, prokinetic
    effect ? ?ADRs central type, remains
    hyperprolactinemia, the risk of
    arrhythmiasfewer ADRs weaker antiemet. effect,
    longer working 4-6 hours

34
Prokinetic drugs with dual effect
  • itoprid (Ganaton)
  • Peripheral antagonist at D2 receptor
  • acetylcholinesterase inhibitor (Inh. ACHE)
  • ADVERSE eff. diarrhea, hypersalivation or
    hyperprolactinemia
  • more expensive than others, highly effective,
    well tolerated, "gold standard rapid onset of
    effect in approx. 30 minutes, duration of eff.
    for 6-8 hrs

35
Prokinetic drugs effect mostly in the proximal
GIT part
  • INDICATIONS
  • ??? aesophageal reflux
  • ?? stomach evacuation
  • functional dyspepsy
  • gastroparesis
  • ? intestinal motility
  • (postoperative paralytic ileus)
  • KI GI obstruction, GIT bleeding

36
Treatment of lower parts of GIT
  • prokinetic drugs less effective in the
    intestine, itoprid
  • neostigmin acetylcholin esterasis inhib.
    shortlasting infusion risk of
    arrhythmias
  • erytromycin prokinetic peptid motilin in
    subantibiotical or ATB doses in intestinal
    paresis and gastroparesis
  • botulotoxin A neurotoxin inhibits presynapt.
    ACH release (chemical dennervation), for
    intestinal emptying disorders

37
Prokinetic drugs dopamine D2 antagonists
  • indications- Symptomatic gastroesophageal
    reflux    (in combination with drugs inhibiting
    gastric secretion)- Duodenogastric reflux-
    Dysmotility type of functional dyspepsia- Nausea
    and vomiting associated with cytotoxic therapy-
    Postoperative gastroparesis

38
Spasmolytic drugs
39
SPASMOLYTIC DRUGS 1. neurotropic
  • parasympatholytics
  • - atropine-like quarternary structure
    (potassium) - hydrophilic
  • N-butyl scopolamine, oxyphenonium, poldin,
    fenpiverin, otilium etc.
  • Use used for smooth muscels contraction,
    especially in tubular organs of the GIT - to
    prevent spasms of the stomach, intestine or
    urinary bladder, GIT dyskinesis
  • Combinations

40
Spasmolytic drugs 2. musculotropic
  • musculotropic direct effect in the muscle
  • -papaverine-like
  • papaverine, drotaverine, alverine, mebeverine,
    pitofenon, pinaverine (GIT Ca channel blocker)
    etc.
  • Use to prevent spasms of the stomach, intestine
    or urinary bladder, GIT dyskinesis..
  • Combinations

41
3. Spasmoanalgetic drugs
  • A) Combinations analgesics spasmolytics
  • pitofenon, fenpiverine etc.
  • B) Analgesics with spasmolytic effectiveness
    metamizol /NOVALGIN/, pethidin /DOLSIN/
  • Brand names ALGIFEN, SPASMOPAN,
  • Use symptomatic painful spasms of GIT or urinary
    tract (bladder, kidney colics), spastic migraine,
    dysmenorrhea, instrumental checkup

42
(No Transcript)
43
Drugs used for therapy of GIT disorders A/
motility stimulation - prokinetic drugs (upper
GIT tract)- laxatives (back/lower GIT tract))
B/ motility inhibition - spasmolytic
(sfincters)- antidiarhoics
44
Humoral control of GIT motility and secretion
  • endocrinne peptides
  • - gastrin (secretion)
  • - other. vazoact. peptides (motility)
  • paracrinne local mediators
  • stimulatory - acetylcholine (?motilitysecretion)
  • - serotonin (stimulated
    by acetylcholine)
  • relaxant - NO (? motility)
  • - dopamine (? motility)
  • - encephalins (opioid rec. -
    ? motility)

45
drugs used in the treatment of obesity
46
Obesity
  • metabolic syndrome, risk factors include
  • high blood pressure,
  • obesity (abdominal type),
  • high glycaemia (insulinoresistence),
    dyslipidemia...

47
The evolution of mankind
Human life style..
48
Antiobezitics
  • anorectics - acts centrally (?
    appetite)phentermin (Adipex)
  •       - Sympatomimet. amines - NA and DA
    release      - Serotonin reuptake
    inhibitorsblockers pancreatic lipase -
    operating at    enterocyte level, increased fat
    in the stoolsendocannabinoids    - Blocking
    cannabinoid rec. 1 (rec. EC-1)    - Acting
    centrally in the CNS (? appetite) and      
    peripherally in adipocytes (lipid control.,
    and       carbohydrates. metabol.)

49
Anorectic drugs - sympatomimetic amines
  • stimulate the release of noradrenaline dopamine
    in the hypothalamusdecreases appetite and
    stimulation of thermogenesisfor the risk of
    dependence and pulmonary hypertension they are
    not     recommended!!Indications clinically
    very significant obesity withheld for more than 3
    monthsPhentermine (Adipex)

50
Anorectics increasing serotonine availability
  • interfere with reverse serotonin absorption and
    norepinephrine in the hypothalamus ? ? serotonin
    norepinephrine in the CNS

51
Anorectics increasing the availability of
serotonin
  • decrease appetite (through serotonin influence)
    and increase thermogenesis (? stimulation)positiv
    e effect on lipidogram and hypertensionlittle
    risk of addictionindication in clin. confess.
    obesity (especially in DM)Side effects
    insomnia, dry mouth, constipationCIs for the
    treatment of inhibitors. MAOIs (antidepressants)
    and serotonin agonists (antimigren.)sibutramine
    (Meridia, Reductil)

52
Inhibitors of lipase
  • inhibit gastric. and pancreatic lipase - lipid
    degradation and inhibit resorption
  • increased lipid excretion in faeces not absorbed
    - flatulence, diarrhea (often imperative) - an
    educational

53
Inhibition of intestinal lipase
54
Lipase inhibitors - orlistat
  • peptide derivative of lipstatin
    Streptomycesvirtually not absorbed
  • reduce resorption of trigycerides about 30Side
    effects diarrhea, abdominal pain,
    flatulenceorlistat (Xenical)

55
The pathway to the fit-centre
  • t

56
Laxatives
57
Daily balanced secretion and absorption of
liquids in the GIT
58
Constipation - aetiology
  • functional - ? motility (dyspepsia ?
    ileus)mechanical obstructionmetabolic disorders
  • dehydrationinnervation disorder, autonomic
    dysfunction,iatrogennic after use of some
    medicinal products

59
Pharmacologically induced constipation
  • anticholinergic drugs and sympatomimetic drugs
  • opioids
  • Ca channell blockers (e.g. verapamil)
  • diuretics
  • antacids
  • antihistamine drugs
  • psychotropic drugs
  • NSA
  • Ferrum salts

60
Indications of laxatives
  • painful emptyingtorpid constipation bothersome
    for the patientexamination before procedures
    requiring intestinal emptyingalleviation of
    congestion induced by medicines or during
    pregnancyacceleration passages in intoxication

Contraindications of laxatives
inflammatory bowel diseaseacute abdomenchronic
abuse of laxatives
61
Laxatives
  • contact
  • - senna, bisacodyl, fenolftalein, natrium
    picosulphate
  • osmotic
  • lactulosis, sulphate and magnesium hydroxide,
    glycerine, chloride channel activators
  • volume
  • methylcelulosis
  • softening
  • paraffin oil

62
Volume laxatives
  • mechanism of action
  • Increase of volume of stool hydrophilic ?
    stimulating of peristalsis by increase of volume,
    need of liquid intake, volume laxatives arent
    absorbed
  • Side eff. flatulency
  • seed coat of ribgrass english plantain
    Plantaginis ovatae testa, Ispaghula Husk)
  • tea, effect in 24 hrs., maximal eff. after 2
    - 3 days
  • methylcellulose, agar

63
Stimulating laxatives
  • mechanism of action increase of peristaltic
    movements
  • stimulation of nerves in colon (primary eff.)
  • inhibition of Na pump - inflow of electrolytes to
  • lumen secondary stimulation of peristaltic
    movements in small intestine colon
  • rapidity of action 4 - 12 hrs, supp. tens of
    min.
  • SEgt intestinal cramps, second. slack of intestine
  • possible damage of mucosa, appl. only for days

64
Laxative - stimulating, contact
  • a/ bisacodyl (low toxicity)
  • tablets for night, morning effect
  • Supp. morning dosage eff. after 15 min. 1 hr.
  • b/ senna
  • natural glycosides
  • Short-term treatment
  • c/ phenolphthalein
  • Eff. in colon - after 10 - 14 hrs (dosage in
    evening)
  • enterohepatal circulation eff. for several days
  • SE Colouring of urine and stool, rash

65
Laxative drugs stimulating, contact
  • antraquinone
  • derivat. of anthracen bound to glycides
    (glycosides)
  • not changed passage to colon, where bacterias
    hydrolyze vazbu a uvolní antraceny
  • stimul. of plexus myentericus
  • blocking of active transport of natrium
  • ? dual stimulation peristaltics
  • nástup za 6-12 hodin
  • nepodávat v tehotenství, exkrece do mléka!!!

66
Laxative drugs - osmotic
  • Lactulosis (favorite)
  • Non resorbable disacharide
  • cleavage in colon to ? resorbable fructosis and
    galactosis ? absorption of water
  • Effect after 12-24 hrs.
  • Glycerol
  • suppositories effect after 15 - 30 minutes
  • Hydroxide and magnesium sulphate
  • ? solubility, non resorbable, absorption of water

67
Laxatives - osmotic
  • macrogol - polyethylenglykol (Fortrans)
  • effective laxative used espec. before examination
    of colon
  • Non resorbable macromolecule
  • Application espec. with salinic laxatives
  • advantageous before colonoscopy and surg.
    procedures
  • effective, but low tolerable laxative
    /convulsions/
  • effect after 1-3 hr.

68
Chloridový kanál aktivne reguluje sekreci Na a
vody do lumen streva
69
Aktivátory chloridového kanálu nová skupina
osmotických laxativ
  • aktivací chloridového kanálu se zvýší pasivní
    sekrece natria a vody do lumen streva
  • úprava zácpy u vetšiny nemocných s chron. zácpou,
    šetrný prístup vhodný i k dlouhodobé lécbe
  • lubiproston (v registracním rízení)

70
Principles of therapy of habitual constipation
(functional)
  • I. step
  • increase of roughage (fiber)
  • increase of physical activity
  • rehearsal of defecation reflex
  • low amount of osmotic laxatives
  • II. step
  • Increase dosis of osmotic laxative, or
  • add contact laxative (bisacodyl)
  • III. step
  • add laxative according optim. individ. effect

71
Antidiarrheal agents
72
Causes of acute diarrhea (lt14 days)
  • infection
  • Medicinal products (drugs)
  • ischemic colitis
  • thrombosis of a. mesenterica or v. mesenterica
  • Diverticulitis acuta

73
Causes of chronic diarheas (gt14 days)
  • inflammatory - non specific and iradiation
    colitis
  • osmotic - disorders of absorption - pancreat.
    insuf.,
  • secretory - carcinoid syndr., ZE syn.,
  • motility disordes - irritable bowel syndrome,
    neurologic disord.
  • artefact - abuse of laxatives

74
Antidiarrheal therapy
  • Diarrhea is compensatory physiologic response of
    organism, it is appropriate to treat according to
    cause and not to treat only symptoms
  • Mechanisms of therapy
  • Decrease exposition by toxins (adsorbent therapy)
  • decelerate motility prolongate time for
    reabsorption of electrolytes (opioids,
    anti-motility drugs)
  • elimination of infectious pathogens if applicable
    (ATB)
  • Colonization of bowel with physiol. flora
    (probiotics)

75
Anti-diarrheal therapy - adsorbent drugs
  • Non absorbable, povrchove velmi aktivní látky
    schopné na povrch navázat toxiny a tak je
    inaktivovat
  • effective espec. during bowel infections
  • Carbo adsorbens, kaoline
  • diosmectitum - Smecta magnesium-aluminium
    silicate, high adsorbent capacity - favorite

76
Antidiarrheal therapy antisecretory drugs and
antimotility drugs
  • direct stimulation of opioid recept. type ?
  • deceleration of passage and secretion in colon
  • loperamid (Imodium) opioid, analogue of
    pethidine
  • is not resorbed
  • induces decreased tonus of muscles of small
    intestine
  • increases tonus of m. sphincter ani
  • decreases secretion in gastrointestinal tract
  • tinct. opii

77
Protiprujmová lécba antisekrecní léky a
antimotilika
  • ? nabídky endogenních opiátu enkefalinu
  • blokáda enkefalinázy (degradace enkef.) ?
    nabídku enkef., stimulace opiových recept.
  • (napr. racecadotril není v CR)

78
Antidiarrheal therapy
  • bowel germicidal agents (bowel antiseptics)
  • non absorbable chemotherapeutics
  • non absorbable antibiotics
  • antibacterial effect predominantly on pathogens
    (salmonela, shigela), less on physiol. flora
  • antimycotic effect (candida)
  • antiprotozoic effect (amoeba,..)

79
Anti-diarrheal therapy - chemotherapeutic
  • cloroxine (Endiaron)
  • - quinolone chemotherapeutic agent
  • - effect on G- and G
  • - if used longer (gt4 wks) neurotoxic
  • - appropriate for prophylaxis
  • nifuroxazide (Ercefuryl)
  • suitable for prophylaxis
  • fluoroquinolones - cipro-, norfloxo- or ofloxacin

80
Antidiarrheal therapy antibiotics
  • rifaximin (Normix)
  • - bakteriostatic and bactericidal ATB
  • with G and G- spectrum
  • - is not resorbed
  • - rapid risk of resistance (relatively)
  • - for treatment, less suitable for prevention

81
Travelers diarrhea - treatment
  • Non specific treatment
  • rehydratation, diet
  • bowel adsorbents - carbo adsorbens, diosmectit
    (Smecta)
  • antimotility loperamide (Imodium)
    contraindication if diarrhea with blood is
    present (dysenteria) or with temperature
  • probiotics

82
Cestovatelský prujem - lécba
  • kauzální u bakteriálních prujmu
  • ATB jen u težších prubehu (teploty,) ci pri
    nutnosti zamezit šírení
  • chloroxin (Endiaron), nifuroxazid (Ercefuryl)
  • fluorochinolony - ciprofloxacin, norfloxacin,
    ofloxacin
  • rifaximin (Normix)
  • kauzální u virových (zejm. deti)
  • metronidazol, event. dle etiologie

83
  • probiotika (eubiotika) - lyofilizovaná,
    životaschopná kultura nepatog. kmenu E.coli ci
    Saccharomyces
  • modulace strevní mikroflory, obnovení fyziol.
    osídlení strev
  • indikace probiotik podpurná lécba
  • dráždivý tracník, ch. prujem bez org. príciny,
    meteorismus
  • zácpa, zejména funkcní
  • nespec. strevní zánety, infekcní kolitida,
    snížení dysmikrobie po ATB

84
substituce tráv. enzymu a HCl
85
Léciva k substitucní lécbe poruch trávení
  • acida (kys. chlorovodíková, kys. citronová) pri
    achlorhydrii s dyspepsií
  • pankreatické enzymy
  • obsah amyláz, proteát a lipázy - multienzymy
  • substutuce zevní sekrece
  • úcinné jen vyšší dávky
  • v kyselém prostredí inaktivovány (acidorezist.
    tbl., event. komb. s anacidy

86
Thank you for attention
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