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Clinical pharmacology of gastrointestinal agents. D igestive diseases. Gastritis. Gastritis. Aspirin & NSAID Gastritis Alcohol
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Gastritis Aspirin & NSAID Gastritis Alcohol Alcohol and certain other chemicals can cause inflammation and injury to the stomach. This is strictly dose related in that a lot of alcohol is usually needed to cause gastritis. Social or occasional alcohol use is not damaging to the stomach although alcohol does stimulate the stomach to make acid.
Peptic ulcer disease (PUD) is a very common ailment, affecting one out of eight persons in the United States. The causes of PUD have gradually become clear. With this understanding have come new and better ways to treat ulcers and even cure them
PEPTIC ULCER DISEASE Helicobacter pylori (H. pylori)
PEPTIC ULCER DISEASE Therapy of PUD has undergone profound changes. There are now available very effective medications to supress and almost eliminate the outpouring of stomach acid. These acid-suppresssing drugs have been dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, then no subsequent treatment is usually needed. Avoiding these latter drugs, should prevent ulcer recurrence. The second major change in PUD treatment has been the discovery of the H. pylori infection. When this infection is treated with antibiotics, the infection, and the ulcer, do not come back. Increasingly, physicians are not just suppressing the ulcer with acid-reducing drugs, but they are also curing the underlying ulcer problem by getting rid of the bacterial infection. If this infection is not treated, the ulcers invariably recur. There are a number of antibiotic programs available to treat H. pylori and cure ulcers. Working with the patient, the physician will select the best treatment program available
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.
Ranitidine (Ranitidin) Forms of production: 0,15 gand 0,3 g tablets and ampoules with 2 ml of 2,5 % solution.
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.
Motilium Form of production: 0,01 g tablets
Constipation can be defined as infrequent or hard pellet stools, or difficulty in evacuating stool. Passing one or more soft, bulky stools every day is a desirable goal. While troublesome, constipation is not usually a serious disorder. However, there may be other underlying problems causing constipation and, therefore, testing is often recommended. LAXATIVES AND CATHARTICS
Indications for Use • 1. To relieve constipation in pregnant women, elderlyclients whose abdominal and perineal muscles havebecome weak and atrophied, children with megacolon,and clients receiving drugs that decrease intestinalmotility (eg, opioid analgesics, drugs with anticholinergiceffects) • 2. To prevent straining at stool in clients with coronaryartery disease (eg, postmyocardial infarction), hypertension,cerebrovascular disease, and hemorrhoids andother rectal conditions • 3. To empty the bowel in preparation for bowel surgery ordiagnostic procedures (eg, colonoscopy, barium enema) • 4. To accelerate elimination of potentially toxic substancesfrom the GI tract (eg, orally ingested drugs or toxiccompounds) • 5. To prevent absorption of intestinal ammonia in clientswith hepatic encephalopathy • 6. To obtain a stool specimen for parasitologic examination • 7. To accelerate excretion of parasites after anthelminticdrugs have been administered • 8. To reduce serum cholesterol levels (psyllium products)
Laxatives There are two main types of laxatives: stimulants (chemical) and saline (liquid or salt). They occasionally help temporary constipation problems. However, chronic use of laxatives, especially stimulant laxatives is discouraged because the bowel becomes dependent upon them. Bowel regularity should occur without laxatives. An occasional enema is preferrable over the chronic use of laxatives.
DietThe following foods should be eaten daily in adequate amounts
Antidiarrheal drugs are indicated in thefollowing circumstances: • 1. Severe or prolonged diarrhea (>2 to 3 days), to preventsevere fluid and electrolyte loss • 2. Relatively severe diarrhea in young children and olderadults. These groups are less able to adapt to fluid andelectrolyte losses. • 3. In chronic inflammatory diseases of the bowel (ulcerativecolitis and Crohn’s disease), to allow a more nearlynormal lifestyle • 4. In ileostomies or surgical excision of portions of theileum, to decrease fluidity and volume of stool • 5. HIV/AIDS-associated diarrhea • 6. When specific causes of diarrhea have been determined
Contraindications to Use Contraindications to the use of antidiarrheal drugs include diarrheacaused by toxic materials, microorganisms that penetrateintestinal mucosa (eg, pathogenic E. coli, Salmonella,Shigella), or antibiotic-associated colitis. In these circumstances,antidiarrheal agents that slow peristalsis may aggravateand prolong diarrhea. Opiates (morphine, codeine) usuallyare contraindicated in chronic diarrhea because of possible opiatedependence. Difenoxin, diphenoxylate, and loperamide arecontraindicated in children younger than 2 years of age.
