Antidiarrheal Drugs Treatment of Ulcerative Colitis

1. Antidiarrheal Drugs &Treatment of Ulcerative Colitis

3. Diseases affecting the GIT: - Infections ( Bacterial, Fungal, Viral, Parasitic…etc ) - Tumors ( Benign, Malignant ) - Inflammatory Diseases - Peptic Ulcer Disease ** Emetics, Antiemetics, laxatives=purgatives, antidiarrheal Agents, Antispasmodics…etc many are OTC drugs

4. Normal bowel movement: An average, healthy person has anywhere from three bowel movements a day to three a week, depending on that person's diet. Normally the stool (the material that is passed in a bowel movement) has a texture something like clay Diarrhea Diarrhea is not a disease, but a symptom of some other problem characterized by either more frequent bowel movement and/or the texture of the stool is thin and sometimes watery

5. Causes of diarrhea: - Diet ( eating something that is difficult to digest ) - Genetic Disorder ( lactase deficiency ) - Infection ( bacterial, viral, fungal, parasitic ) - Toxic - Drug-induced - Stress (IBS)

6. Diarrhea may be classified into: - Acute ( sudden onset ) Food induced ( traveler’s ) - Chronic ( 2 weeks or longer ) IBD, Stress or Irritable bowel syndrome **Antidiarrheal drugs help control or relieve diarrhea and some of the symptoms that go along with it e.g abdominal pain or cramps

7. Goals of treatment: Control the loss of fluids Identify and treat cause Provide symptomatic relief ( antidiarrheal drugs ) Refer to physician if: Persists for several days Blood in stool Severe abdominal pain, cramps

8. Description Antidiarrheal drugs work in several ways: 1. Locally acting agents ( Adsorbents ): Kaolin often combined with Pectin ( Kaopectate® ) Most widely used preparation available in powder dosage form This product adsorbs bacterial toxins, binds water and decreases mucus secretion

9. Bismuth subsalicylate ( Pepto-Bismol®; oral tablets ) Also adsorbs bacterial toxins, decreases the secretion of fluid into the intestine and inhibits the activity of bacteria 2. Centrally acting agents ( Inhibit defecation reflex ): Codeine Has limited use because it leads to tolerance, addiction and withdrawal manifestations

10. Diphenoxylate (+ Atropine= Lomotil® ) Opium-like drug with less addictive properties Widely used combined with Atropine (an Anticholinergic ) Loperamide ( Imodium® ) Produces rapid and sustained inhibition of the peristaltic reflex slowing the passage of stools through the intestines which will allow more time for water and salts in the stools to be absorbed back into the body

11. 3. Octreotide It is a synthetic somatoststin analog Highly effective in relieving diarrhea of Carcinoid Syndrome Given SC or in an IV infusion Antidiarrheal medications: Can cause constipation ( major side effect ), Low back pain, headache, distension, rash, abdominal pain, dizziness, dry mouth

12. Ulcerative Colitis ( UC ) Ulcerative colitis is an inflammatory bowel disease (IBD) that causes chronic inflammation of the digestive tract It is characterized by abdominal pain and diarrhea. Like Crohn's disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications.

13. Ulcerative colitis usually affects only the innermost lining of the large intestine (colon) and rectum. It occurs only through continuous stretches of the colon, unlike Crohn's disease, which occurs in patches anywhere in the digestive tract and often spreads deep into the layers of affected tissues

14. Etiology of UC: Unknown, unclear - Heredity - autoimmune reaction - Inflammatory reaction - Stress ( precipitates symptoms rather than causes UC )

15. Diagnosis of UC - Clinical manifestations Abdominal pain, diarrhea, bloody diarrhea - Endoscopy, biopsy Complications of UC - Toxic megacolon The most serious acute complication of ulcerative colitis that occurs when the colon becomes paralyzed, resulting in no bowel movement or passing gas

16. Signs and symptoms of toxic megacolon include fever, abdominal pain and swelling, weakness and disorientation If toxic megacolon isn't treated, the colon may rupture, causing peritonitis, a life-threatening condition requiring emergency surgery. Other complications to UC include: - Perforated colon, severe dehydration - Liver disease - Inflammation of the skin, joints and eyes - Colon cancer

17. Treatment of UC: There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission Ulcerative colitis treatment usually involves either drug therapy or surgery The goal of medical treatment is to reduce the inflammation that triggers the signs and symptoms

18. A. Anti-inflammatory drugs Anti-inflammatory drugs are often the first step in the treatment of IBD. They include: - Sulfasalazine It is a sulfa drug, in the gut is converted to sulfapyridine and 5-ASA ( 5-amino salicylates ) Sulfapyridine has no antiinlammatory effect, absorbed to systemic circulation and responsible for most of the side effects to sulfasalazine including allergy 5-ASA remains in the colon and has good antiinflammatory effect -

19. - Mesalamine and olsalazine These medications tend to have fewer side effects than sulfasalazine has. - Balsalazide This drug is similar to sulfasalazine, but produces fewer side effects

20. - Corticosteroids Corticosteroids can help reduce inflammation, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity, high blood pressure, type II diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of steroid drugs is not advised

21. Use corticosteroids only in cases of moderate to severe inflammatory bowel diseases that don't respond to other treatments Steroids may be used in conjunction with other medications as means to induce remission For example, steroids may be used with an immune system suppressor — the steroids can induce remission, while the immune system suppressors can help maintain remission

22. B. Immune system suppressors These drugs also reduce inflammation, but they target the immune system rather than treating inflammation itself. Immunosuppressant drugs include: - Azathioprine and Mercaptopurine These drugs have been recently approved to treat UC Because azathioprine and mercaptopurine act slowly, they are sometimes initially combined with a corticosteroids

23. - Cyclosporine It is a potent drug which is normally reserved for people who don't respond well to other medications - Infliximab This drug is a monoclonal antibody effective in patients with moderate to severe UC who don't respond to or can't tolerate other treatments It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF)

24. Nicotine skin patches These skin patches - the same kind smokers use - seem to provide short-term relief from flare-ups of ulcerative colitis for some people, especially people who formerly smoked

25. Other medications In addition to controlling inflammation, some medications may help relieve UC signs and symptoms. - Anti-diarrheals - Pain relievers. For mild pain e.g headache use acetaminophen . NSAIDs are contraindicated because they lead to diarrhea - Iron supplements. If patients have chronic intestinal bleeding, they may develop iron deficiency anemia

26. Surgery If diet and lifestyle changes, drug therapy or other treatments don't relieve signs and symptoms of UC, surgery is recommend