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CLINICAL PHARMACOLOGY OF GASTROINTESTINAL AGENTS

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CLINICAL PHARMACOLOGY OF GASTROINTESTINAL AGENTS Treatment of peptic ulcer Antimicrobial agents (tetracycline, bismuth subsalicylate, and metronidazole) to eradicate ... – PowerPoint PPT presentation

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Title: CLINICAL PHARMACOLOGY OF GASTROINTESTINAL AGENTS


1
CLINICAL PHARMACOLOGY OF GASTROINTESTINAL AGENTS
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Treatment of peptic ulcer
  • Antimicrobial agents (tetracycline, bismuth
    subsalicylate, and metronidazole) to eradicate H.
    pylori infection
  • Misoprostol (a prostaglandin analog) to inhibit
    gastric acid secretion and increase carbonate and
    mucus production, to protect the stomach lining
  • Antacids to neutralize acid gastric contents by
    elevating the gastric pH, thus protecting the
    mucosa and relieving pain
  • Avoidance of caffeine and alcohol to avoid
    stimulation of gastric acid secretion
  • Anticholinergic drugs to inhibit the effect of
    the vagal nerve on acid-secreting cells
  • H2 blockers to reduce acid secretion
  • Sucralfate, mucosal protectant to form an
    acid-impermeable membrane that adheres to the
    mucous membrane and also accelerates mucus
    production
  • Dietary therapy with small infrequent meals and
    avoidance of eating before bedtime to neutralize
    gastric contents
  • Insertion of a nasogastric tube (in instances of
    gastrointestinal bleeding) for gastric
    decompression and rest, and also to permit iced
    saline lavage that may also contain
    norepinephrine
  • Gastroscopy to allow visualization of the
    bleeding site and coagulation by laser or cautery
    to control bleeding
  • Surgery to repair perforation or treat
    unresponsiveness to conservative treatment, and
    suspected malignancy.

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  • Ranitidine (Ranitidin)
  • Forms of production 0,15 g and 0,3 g tablets and
    ampoules with 2 ml of 2,5 solution.

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RECOMMENDATIONS OF HELICOBACTER PYLORI
ERADICATION
  • omeprazole 20mg
  • amoxicillin 1000mg
  • clarithromycin 500mg, all twice daily for 7 days.
  • An alternative regimen with a similar eradication
    rate of around 90 is
  • omeprazole 20mg
  • clarithromycin 250mg
  • metronidazole 400mg, again all twice daily for 7
    days.

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A typical quadruple therapy
  • a PPI twice a day
  • bismuth 120 mg four times a day
  • metronidazole 400 mg three times a day
  • oxytetracycline 500 mg four times a day, all for
    7 days.

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Ulcers associated with NSAIDs
  • omeprazole 20mg daily is preferable to ranitidine
    150mg twice daily as the respective rates of
    healing are 80 and 63.
  • H2RAs are slow to heal the ulcers if the
    offending drug is not stopped and so, under these
    conditions, a PPI is preferred.
  • H pylori eradication is no more effective than
    omeprazole alone to heal ulcers, but if the
    infection is present, then eradication will
    reduce the rate of relapse.
  • H pylori is not associated with an increased risk
    of ulcer with NSAIDs in the elderly but there is
    an increased risk of bleeding.

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  • Motilium
  • Form of production 0,01 g tablets

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LAXATIVES AND CATHARTICS
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Indications for Use
  • 1. To relieve constipation in pregnant women,
    elderly clients whose abdominal and perineal
    muscles have become weak and atrophied, children
    with megacolon, and clients receiving drugs that
    decrease intestinal motility (eg, opioid
    analgesics, drugs with anticholinergic effects)
  • 2. To prevent straining at stool in clients with
    coronary artery disease (eg, postmyocardial
    infarction), hypertension, cerebrovascular
    disease, and hemorrhoids and other rectal
    conditions
  • 3. To empty the bowel in preparation for bowel
    surgery or diagnostic procedures (eg,
    colonoscopy, barium enema)
  • 4. To accelerate elimination of potentially toxic
    substances from the GI tract (eg, orally ingested
    drugs or toxic compounds)
  • 5. To prevent absorption of intestinal ammonia in
    clients with hepatic encephalopathy
  • 6. To obtain a stool specimen for parasitologic
    examination
  • 7. To accelerate excretion of parasites after
    anthelmintic drugs have been administered
  • 8. To reduce serum cholesterol levels (psyllium
    products)

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Contraindications to Use
  • Laxatives and cathartics should not be used in
    the presence of undiagnosed abdominal pain. The
    danger is that the drugs may cause an inflamed
    organ (eg, the appendix) to rupture and spill GI
    contents into the abdominal cavity with
    subsequent peritonitis, a life-threatening
    condition. Oral drugs also are contraindicated
    with intestinal obstruction and fecal impaction.

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Antidiarrheals
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  • Antidiarrheal drugs are indicated in the
    following circumstances
  • 1. Severe or prolonged diarrhea (gt2 to 3 days),
    to prevent severe fluid and electrolyte loss
  • 2. Relatively severe diarrhea in young children
    and older adults. These groups are less able to
    adapt to fluid and electrolyte losses.
  • 3. In chronic inflammatory diseases of the bowel
    (ulcerative colitis and Crohns disease), to
    allow a more nearly normal lifestyle
  • 4. In ileostomies or surgical excision of
    portions of the ileum, to decrease fluidity and
    volume of stool
  • 5. HIV/AIDS-associated diarrhea
  • 6. When specific causes of diarrhea have been
    determined

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Contraindications to Use
  • Contraindications to the use of antidiarrheal
    drugs include diarrhea caused by toxic materials,
    microorganisms that penetrate intestinal mucosa
    (eg, pathogenic E. coli, Salmonella, Shigella),
    or antibiotic-associated colitis. In these
    circumstances, antidiarrheal agents that slow
    peristalsis may aggravate and prolong diarrhea.
    Opiates (morphine, codeine) usually are
    contraindicated in chronic diarrhea because of
    possible opiate dependence. Difenoxin,
    diphenoxylate, and loperamide are contraindicated
    in children younger than 2 years of age.

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Chronic pancreatitis
  • There is no cure for chronic pancreatitis. Once
    the pancreas is damaged, then it is not able to
    return to normal function and there is always the
    potential for further attacks. Treatment is,
    therefore, directed towards preventing attacks,
    controlling the pain and treating the
    complications.Preventing symptoms
    worseningPatients with chronic pancreatitis
    should avoid alcohol altogether. If the
    pancreatitis is due to excess alcohol
    consumption, then this is essential. If it is due
    to other causes, then it seems sensible to avoid
    a substance which is capable of damaging the
    pancreas.If an underlying cause has been
    identified then this should be treated. Disorders
    of calcium metabolism and of fat metabolism will
    be treated appropriately. Your doctor may
    recommend removal of the gall bladder if
    pancreatitis is thought to be caused by gall
    stones.

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Chronic pancreatitis
  • Preventing attacksThe long-standing principle
    has been to try and rest the pancreas. This
    involves giving pancreatic supplements such as
    Creon (which contain pancreatic enzymes in high
    concentration) together with drugs which reduce
    acid secretion by the stomach. Patients should
    also follow a low-fat diet. These measures
    reduce the presence of fat in the duodenum,
    reduce acid in the duodenum and reduce the need
    for pancreatic enzyme secretion. These measures
    are very successful in about a third of patients,
    moderately successful in a third and unhelpful in
    a third.Some eminent specialists have supported
    the use of antioxidants in the treatment of
    chronic pancreatitis. These antioxidants include
    selenium and vitamin C.

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Chronic pancreatitis
  • Control of painThis is a very important aspect
    of the treatment of chronic pancreatitis.
    Pancreatic pain varies in severity from mild
    (controllable with simple analgesics such as
    paracetamol (eg Panadol)) to severe (requiring
    morphine-like drugs for control).In addition to
    the preventive measures listed above, the basic
    principle is to use the drug lowest down the
    analgesic ladder which controls the pain. Since
    the pain is often worse at night and since both
    body and mind are at their lowest ebb in the
    early hours of the morning, the lowest rung of
    the analgesic ladder may be pethidine or morphine
    (eg MST continus tablets). Since the pain is
    chronic and severe, there is a fine line between
    adequate analgesia and addiction.
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