DRUG USED IN GASTRO INTESTINAL DISEASE By A.

Ariyoga
Many Drugs Have aplications in the treatment of gastro intestinal disease - motility - digestion - secretion - absorption - peptic ulcers - delayed gastric emptying in adequat propolsion - diarrhea - infections and inflamation

DRUG USED IN PEPTIC ULCERS DISEASE

Pathogenesis of peptic ulcers not completely understood Secretion of acid by gastric parietal cells regulated by - Histamin - Asetylcholine - Gastrin

Figure :

AGE ! F"# $" !#"% "F GAS!#&$ A$&'&!( A ' !#EA!)E ! "F PEP!&$ *%$E#S Antacids H+ #eceptor antagonists )ucosal protective agents "thers agents

Antacids - Alumunium hydro,ide - $alcium carbonate - )agnesium hydro,ide - Sodium bicarbonate - )agnesium trisili-ate H ! Hista"in r#c#$tor%&'oc(#rs - $imetidine - #anitidine - Famatidine - i.atidine Mucosa' $rot#cti)# ag#nts - Sucralfate - $olloidal bismuth &nhibitors of proton pump - "mepra.ol - %ansopra.ol Prostag'andins - )isoprostal Anti"icro&ia' ag#nts - Amo,icillin - /ismuth compounds - $laritromycin - )etronida.ole - !etracycline

Antacids Sodiu" Bicar&onat

NaHCO* + HC' NaC' + H O + CO - Active ingredient in bac-ing soda - Highly soluble absorbed rapidly from the gut promote systemic al-olosis and fluid retention ot recommended for long-term use A'u"iniu" Hydro,id# A'-OH.* + * HC' A'C'* + H O

"nset of action : %ate 'uration of action : %ong - "ften causes constipation - /inds certain drugs : eg0 tetracycline Phospate *sed to therapeutic advantage in patients 1ith chronic renal failure and bone dis2 Ca'ciu" Car&onat# Ca Co* + Hc' CaC' + H O + Co - )ore slo1ly than sodium bicarbonate - 3ery effective in neutraly.ing in gastric acid - 456 produced is absorbed potensial - hypercalcemia - mil- al-ali syndrome - acid rebound not recommended for long term use Magn#siu" Hydro,id# 7 )il- of )agnesia )g8"H9+ : + Hcl )g$l+ : + H+"

- Prolonging its neutrali.ing effect - )agnesium salts cathartic effect - A small absorbed renal insufficiency Magn#siu" Trisi'i(at# )g+ Si;5<8nH+"9 :=H! + mg:: : ;S4"+:8n:+9H+" - S4"+ - adsorbent - Siliceous nephroliths

H HISTAMIN RECEPTOR ANTAGONITS

> $imetidine ? > #anitidine ? + ma@or drugs in use - $apable of over A56 reduction in based food stimulated0 and nocturnal secretion of gastric acid after a single dose - Promoting the healing of duodenal and gastric ulcers and preventing their recurrence2 > Famotidine > i.atidine P/ar"aco'ogica' Pro$#rti#s - H+ #ec An2 $ompetitively inhibit the interaction of histamine 1ith H+ receptor - Highly selective - Absorption0 Fate and E,cretion - H+ #ec2 An2 2 rapidly and 1ell absorbed after oral ad2 2 pea- $ : 4 or + hours 2 bioavailability i. : A46 2 t B : +-; hours 4-; hours : ni.atidine 2 E,c : urine

- Adverse effects : - headache - di..iness and nausea - myalgia0 s-in rashes

- itching - 'rug interactions : - Antacid - Ceta-ena.ole - cyt2 P2=D5 In&itors o0 H+1 2+ ATP as# "mepra.ole %ansopra.ole &nhibition of gastric acid secretion 'o not affect gastric motility Absorption : rapidly /ioavailability : E56 AD6 bound to plasma protein t B : ;5-=5 )etabolism : hepatic E,c : urine Adverse effects - gastrointestinal - $2)2S

Sucra'0at# - $ytoprotective agents - Alumunium sucrose sulfate - #ecently developed for use in peptic ul2 dis2 selective binding toneocrotic ulcer tissue - Effective in healing of duodenal ulcers ot absorbed systemically - Fe1 side effects have been reported - &g = times daily on an empty stomach

PROSTAGLANDIN ANALOGS
PG E 3 3 PGI 3

Predominant PG synthesi.ed the gastric mucosa &nhibit the secretion acid Stimulate the secretion of F mucus and bicarbonat

Miso$rosto' - 42D deo,y 4G hydro,y 4G-metyl PGE4 - Available in the *2S - Effective in treating - duodenal and - gastric ulcers inhibits gastric acid secretion produce cyproprotective effects

Pancr#atic En4i"# R#$'ac#"#nt Product !1o mayor types of preparation in use ? ? - Pancrelipase ? - Pancreatin amylase trypsim lipase

Pepsime Pancreatime 'yastase 'ehidrocyolate acid

La,ati)#s Irritant or sti"u'ant 'a,ati)#s $astor oil $ascara ? Senna ? Aloes ?

'ifenilmetane

- Phenolphtalien ? ? Anthra-inon - /isacodyl ? peristalsis is stimulated

Bu'( La,ati)# - )ethylcellulose - Psyllium seed - Agar Hydrophylic colloids Stoo' so0t#n#rs - )ineral oil - Glycerin suppositories - 'ioctyl sodium sulfosuccinate Agents that become emulsified 1ith stool serve to soften it ma-e possage easier

Drugs $ro"oting Gastrointestinal motility > /ethanecol cholinergic agonist > )etoclopramide - Facilitating small bo1el inhibition - Gastric motor failure - Particularly diabetic gastroporesis - After vagotomy - 'isorders of gastric emptying - Gastroesophageal reflu, disease - cancer chemotherapy - #apidly absorbed - Pea- $ : =5 F 4+5H - t B : = hours - E,cretion : -idneys - 45 mg = times daily - neal - bed time

Antidiarr/#a' Drugs )ost 1idelly used prescription drugs 42 'ipheno,ylate 81ith atropine9 analog of meperidine +2 %operamide haloperidol mechanisme of action : similar to that of the opioids - Caolin ? adsorbents - Pectin ? also 1idely used

Drugs Us#d in T/# Tr#at"#nt o0 Bo5#' C/ranic In0'a""atory Bo5#' dis#as# u'c#rati)# co''itis c/ro/"6s dis#as# - $orticosteroids - "ther immunosuppressive agents Su'0asa'a4in# combines F sulfapyridine - D aminosalicylic acid poorly absorbed from the intestine )"A un-no1n cytoprotective role I ;-=g daily individed doses A4odisa'icy'at#