1. Pharmacology of drugs affecting GIT

2. Peptic Ulcer Disease
Imbalance between mucosal defensive factors and aggressive factors
Major defensive – mucus and bicarbonate
Major aggressive – gastric acid, H. pylori, nonsteroidal anti-inflammatory drugs, pepsin

4. Defensive factors
Prevent the stomach and duodenum from being harmed (self-digestion).
Mucus – continually secreted, protective effect
Bicarb – secreted from endothelial cells, neutralized hydrogen ions
Blood flow – good blood flow helps to maintain mucosal integrity
Prostaglandins – stimulate secretion of bicarb and mucus and help promote blood flow, suppress secretion of gastric acid

5. Aggressive factors
Helicobacter pylori – gram negative bacteria, can live in stomach and duodenum
May breakdown mucus layer, inflammatory response to presence of the bacteria may breakdown defenses, also produces urease – forms CO2 and ammonia which are toxic to mucosa

7. Pepsin Smoking NSAIDS – inhibit the production of prostaglandins
Decrease blood flow, decrease mucus production and bicarb synthesis, promote gastric acid secretion
Gastric Acid – also needs to be present for ulcer to form – activates pepsin and injures mucosa

8. Nondrug therapy Diet – change in eating pattern, 5-6 small meals a day
Smoking cessation, NSAID and ASA should be avoided whenever possible, avoid alcohol

9. Antibacterial drugs Combinations must be used
Bismuth – disrupts cell wall of H. pylori, pepto-bismol
Clarithromycin – inhibits protein synthesis
Amoxicillin – disrupts cell wall, good when given with omeprazole
Tetracyclin – inhibits protein synthesis
Metronidazole – resistance,

10. Histamine 2-receptor antagonists
Suppress secretion of gastric acid (activation of H2 receptors promotes secretion of gastric acid)
Cimetidine - first available, oral, IV, IM
May take up to twelve weeks for ulcer to be healed
Therapeutic uses – ulcers, GERD, Zollinger-ellison syndrome, aspiration pneumonitis, heartburn, indigestion

13. Proton Pump Inhibitors
Suppress secretion of gastric acid
Omeprazole – prilosec – prodrug that converts to active form in parietal cells of stomach – inhibits enzyme that generates gastric acid
Ulcers, GERD, Zollinger-Ellison syndrome
May contribute to development of gastric tumors?

15. Sucralfate Creates a protective barrier against acid and pepsin
Form sticky gel that coats ulcer portion
Given every 6 hours
Very few side effects – minimal systemic absorption

16. misoprostol
Cytotec – prevention of gastric ulcers caused by long-term NSAID therapy
Replacement for endogenous prostaglandins

17. Antacids Peptic ulcers and GERD Neutralize acid
Dosing – 7 times per day

18. Almagel
Combined drug which contains gel of aluminum hydroxide, magnesium oxide and D-sorbit
170 ml bottles

19. Schemes of combined treatment of gastric ulcer
De-nol + amoxycillin
De-nol + metronidazole
Omeprazole + amoxycillin + clarythromycin
De-nol + clarythromycin + metronidazole
De-nol + controlok + amoxycilin + clarythromycin

20. Laxatives
Laxative effect – production of a soft formed stool over a period of 1 or more days
Catharsis – prompt, fluid evacuation of the bowel, more intense
Function of the colon – water and electrolyte absorption
Bowel evacuation – individual
Dietary fiber

21. Indications for laxative use
Pain associated with bowel movements
To decrease amount of strain under certain conditions
Evacuate bowel prior to procedures or examinations
Remove poisons
To relieve constipation caused by pregnancy or drugs

22. Just because laxatives are available without a prescription doesn't mean that they're without risk. Warning: Use of stimulant laxatives over a long period may lead to dependence and might permanently damage intestine and colon

23. Classifications I – osmotic (high doses)
II – osmotic (low doses), stimulant except castor oil – most frequently abused
III – bulk-forming, surfactant

24. Bulk-forming Identical to fiber – soften fecal mass, increasing bulk
Temporary treatment of constipation, preferred for patients with inflammatory bowel diseases
May help with diarrhea

25. Adverse reactions Not absorbed – no systemic effects
Must take with sufficient water
Intestinal, esophageal obstruction
Metamucil, citrucel

26. Surfactant laxatives Bisacodyl, castor oil
Stimulate intestinal motility
Increase water and electrolytes in intestinal lumen
Produce stool within 6-12 hours

27. Bisakodil

28. Guttalax

29. Miscellaneous laxatives
Mineral oil
Lactulose
Glycerin suppository
Polyethylene glycol-electrolyte solutions

30. Laxative abuse
Most common cause of constipation
Teaching

31. Choleretics of plant origin
Stigma of corn
Common immortelle
Dog-rose
Choleretics of plant origin

32. Tocopherole acetate (Tocopheroli acetas)
Vitamin E is produced in many forms: 5 %, 10 % and 30 % oil solution in 10, 20 and 50 ml bottles; elastic capsules with 0,1 and 0,2 ml of 50 % solution in oil; ampoules with 1 ml of 5 %, 10 % and 30 % oil solutions.

33. Carsil Legalon

34. Mechanism of action of legalon

35. Is produced in 5 ml ampoules and in capsules
Essentiale
Is produced in 5 ml ampoules and in capsules

36. Lipostabil

37. Pancreatin (Panсreatinum)
Is produced in 0,25 g and 0,5 g dragee (tablets).

38. Panzynorm forte

39. Festal, Enzistal,
Mezym-forte

40. No-spa, nicospan

41. Baralgin

42. Bil-berries St. John’s wort

43. Pepper mint Chamomile