dr prashant's www.pharmacology4students'com Topic Drugs for Peptic Ulcer Antiametic Drugs by: Dr. Nirav Shah, Dr. Prashant M.D. www.pharmacology4students.com Drprashant.editor@gmail.com dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com VOMITING Vomiting occurs due to stimulation of the emetic (vomiting) center situated in medulla oblongata.   ANTIEMETICS These are drugs used to prevent or suppress vomiting. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com CLASSIFICATION : 1.Anticholinergics Hyoscine, Dicyclomine 2. H1 antihistaminics Promethazine, Diphenhydramine, Cyclizine, Meclozine, Cinnarizine 3. Neuroleptics Chlopromazine, Prochlorperazine, Haloperidol etc. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 4.Prokinentic drugs Metoclopramide, Domperidone, Cisapride, Mosapride 5. 5-HT3 antagonists Ondansetron, Granisetron 6. Adjuvant antimetics Dexamethasone, Benzodiazepines, Cannabinoids. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com ANTICHOLINEGRICS 1. most effective drug for motion sickness. 2. brief duration of action. 3. Produces sedation and other anticholinergic side effects. 4. Suitable only for short brisk journies. 5. It acts probably by blocking conduction of nerve impulses across a cholinergic pathway from the vestibular apparatus to the vomiting center. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 6. It is non effective in vomiting of other etiologies. 7. Applied behind the pinna, it suppresses motion sickness while producing only mild side effects. 8. Dicyclomine – It has been used for prophylaxis of motion sickness and for morning sickness. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com H1 ANTHIHISTAMINICS 1. Some antihistaminics are antiemetic. 2. They are useful mainly in motion sickness and morning sickness, postoperative and some other forms of vomiting. 3. Their antiemetic effect appears to be based on anticholinergic, antihistaminic and sedative properties. a.They afford protection of motion sickness. b.They produce sedation and dryness of mouth. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Cycline meclozine 1. These are less sedative and less anticholinergic. 2. Meclozine is long acting, protects against sea sickness. 3. It is also protective for motion sickness. 4. All antimotion sickness drugs are more effective when taken ½ -1 hour before journey. 5. It is better to avoid them for morning sickness. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com NEUROLOPTICS 1. These are potent antiemetics. 2. Drug induced and postanesthetic nausea and vomiting. 3. Disease induced vomiting: gastroenteritis, liver disease, migraine etc. 4. Radiation sickness vomiting. 5. Morning sickness. 6. They are not effective in motion sickness. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 7. Produce significant degree of sedation. 8. Used primarily as an antiemetic rather than as antipsychotic. 9. Extrapyramidal side effects are the most important limiting features. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Prokinetic drugs 1. Drugs which promote gastrointestinal transit and speed gastric emptying. 2. Widely used antiemetic. Actions 1. More prominent effect on upper g.i.t., increases gastric peristalsis. 2. Speeds gastric emptying, specially if it was slow. 3. It also increases intestinal peristalsis. 4. But has no significant action on colonic motility and gastric secretion. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com CNS 1. Metoclopramide is an effective antiemetic. 2. Gastrokinetic action may contribute to the antiemetic effect. 3. Not useful as an antipsychotic. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com D2 antagonism 1. Dopamine is an inhibitory transmitter in g.i.t. 2. Normally acts to delay gastric emptying when food is present in stomach. 3. It also appears to cause gastric dilation and LES relaxation. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 4. Metoclopramide blocks D2 receptors and has an opposite effect. 5. Hastening gastric emptying and enhancing LES tone. 6. The central antidipaminergic (D2) action of metoclopramide on CTZ is clearly responsible for its antiemetic property. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 5-HT4 agonism 1. It acts in the g.i.t. to enhance ACh release. 2. Results from 5-HT4 receptor activation. 3. Which promote ACh release from, 4. The gastric hurrying and LES tonic effects are mainly due to this action. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com PHARMACOKINETICS 1. Metoclopramide is rapidly absorbed orally, crosses placenta and is secreted in milk. 2. it. enters brain, dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com INTERACTIONS 1. It hastens the absorption of many drugs, e.g. aspirin, diazepam. ADVERSE EFFECTS 1. Extrapyramidal side effects,diarrhoea, muscle dystonias are the main side effects. 2. parkinsomism and gynaecomastia. 3. It should not be used lactation. Though the amount secreted in milk is small, but suckling infant may develop loose motions, dystonia, myoclonus. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com USES 1. Antiemetic. 2. Gastrokinetic 3. Dyspepsia. 4. Gastroesophageal reflux disease. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com CISAPRIDE 1. cisapride-It is a prokinetic 3. Facilitates motility throughout g.i.t. including colon. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 4. Oral bioavailability of cisapride is ~33%. 5. Cisapride is a prokinetic drug without antidopaminergic side effects, but abdominal cramps and diarrhoea can occur. 6. Primary indication of cisapride has been GERD. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com 5-HT3 ANTAGONISTS Ondansetron 1-It controls cancer chemotherapy/radiotherapy induced vomiting . 2-highly effective in postoperative nausea and vomiting as well. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Pharmacokinetics Oral bioavailability of ondansetron is 60-70% due to first pass metabolism. . dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com CARMINATIVES These are drugs which promote the expulsion of gases from the . GIT and give a feeling of warmth and comfort in the epigastrium. DIGESTANTS These are substances intended to promote digestion of food. As appetite stimulants and health tonics. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q.1 Name three H2 Antihistaminic drugs? A. Cimitidine, Ranitidine, Roxatidine, Loxatidine, Femotidine. Q.2 Name three Proton pump inhibitor drugs? A. Omeprazole, Lensoprazole, Pantoprazole, Robeprezole. Q.3 Name two Anticholinergics used in treatment of Peptic ulcer? A. Piranzepine, Oxypnenonium. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q.4 Name of two Prostaglandin Analogues used in Peptic ulcer? A. Misoprosol, Enprostil, Rioprostil.   Q.5 Name two systemic Antacids? A. Sodium bi carbonate, sodium citrate. Q.6 What is Magaldrate? A. Nonsystemic antacids. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q.7 Name one Ulcer healing Agents ? A. Carbenoxolone sod .   Q.8 Name three drugs regime for H.pylori treatment ? A. Tebacudine, Tenidacole, rnetrunidawle, Arnaxialin, claritnromvcin Q.9 Name two side effects of cimetidine A. Headache, dry mouth, rashes dizziness CMS effect conational state convulsion coma. dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q.10 Name two Ulcer prote ctive drugs ? A. Collidal Bismuth Subcitrate, Sucral Fate Q11. Name five uses of H.Blockers ? A. Tetracycline Tenedazole Amoxycylene Q12. Name two drawbacks of Magnesium Antacids ? A. Poorly absorbed, in soluble, diarhhoea dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q13. Name two side effects of Aluminum Antacids ? A. Weak & slowly reacting Q14.Name two side effects of Colloidal Bismutli Sub citrate ? A. Diarrhoea, dizyness, Headache Q15. Name two contraindications of Emetics? A. Acid Poisoning, CNS stimulant dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q16. Name two emetics ? A. Epomorphin   Q17. Name two Antichrolinergic ? A. Hyoscine, dicyclomine Q18. Name two Antihistaminic Anticmetic ? A. Promethazine, cyclizine dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q19. Name two Narcoleptics ? A. Chlorpromazine, Haloparidol   Q20. Name two Prokinetic drugs ? A. Metoclopramide, Domperidon Q21. Name two 5HT3 Antagonists ? A. Granisetrom, Ondancitron dr prashant's www.pharmacology4students'com

dr prashant's www.pharmacology4students'com Q22. Name DOC of Motion sickness ? A. Hyosine, Q23. What is the mechanism of action of metoclopromide ? A. D2 antogonism, 5HT4 & 5HT3 antogonism Q24. DOC for chemotnerapy induced vomiting ? A. Ondansetron.   Q25. Name two gall stone dissolving drugs ? A. Chemodiol, Ursodiol dr prashant's www.pharmacology4students'com

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