ANTI EMETICS AND ANTI DIARRHEALS

ANTI EMETICS

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ANTIDIARRHEALS

Acute gastroenteritis is a major cause of mortality. Infants and young children are particularly at risk. WHO estimates that there are more than 1000 million cases of acute diarrhea annually, in developing countries, with 3-4 million deaths.

CAUSES OF ACUTE DIARHOEA

INFECTIOUS
1) TOXIN MEDIATED
Bacillus Cereus Staphylococcal enterotoxin Clostridial enterotoxin Plant toxins Heavy metals

2) INFECTIVE FOOD POISONING

Rotavirus gastro enteritis Salmonella E. Coli Shigella Clostridium difficile

3) PROTOZOAL
Giardiasis Amoebic dysentery

NON INFECTIOUS
1) GASTROINTESTINAL Acute diverticulitis Inflammatory bowel disease Bowel malignancy

2) METABOLIC UPSET Ketosis (Diabetic) Vasoactive intestinal peptide release

Uraemia
Carcinoid syndrome

3) GENERALIZED ILLNESS
Sepsis

Pneumonia
Malaria

4) DRUGS
NSAIDS

Cytotoxic agents
Antibiotics

Bacillus cereus food poisoning

In all patients presenting with diarrhoea it

is important to identify and eliminate the

cause where possible.

The drugs used for treating diarrhoea are

discussed.

1) CODEINE PHOSPHATE A useful agent for symptomatic control of diarrhoea. It is obtained from opium. 2) MORPHINE + KAOLIN Kaolin and morphine mixture (British Pharmaceutical Codex) is a time honored remedy containing only small quantities of morphine. It is taken as a liquid

3) CONGENERS OF PETHIDINE a) Diephenoxylate; It is combined with atropine in the preparation LOMOTIL. b) Loperamide Has a relatively selective action on GIT. In travellers diarrhea loperamide reduces the frequency of passage of feces and duration of illness. It may cause dryness of mouth

4) CANNABINOID RECEPTOR AGONISTS Reduce gut motility by decreasing Ach release from enteric nerves . 5) BISMUTH SUBSALICYLATE Used for travellers diarrhea. Prevents 75% of diarrheas in areas of high risk. It decreases fluid secretion in the bowel.

6) ANTISPASMODICS
Muscuranic receptor antagonists. They

suppress GIT motility by inhibiting

parasympathetic activity a) Propantheline b) Dicyclomine Dicyclomine is thought to have some additional direct relaxant action on GIT

7) ADSORBANTS Kaolin, pectin, chalk, charcoal, methylcellulose. These agents act by adsorbing microorganisms and toxins and protecting the intestinal mucosa