GIT Lecture Notes PDF

Pharmaceutical Studies D. Alaa Yahya Khalifa Faculty of Pharmacy UMST GASTRO INTESTINAL TRACT (GIT) Objectives: Introduction Common GIT conditions DRUGS ACTING ON GASTRO INTESTINAL TRACT (GIT) Introduction  Digestion is the process of breaking down food into those substan...

Pharmaceutical Studies D. Alaa Yahya Khalifa Faculty of Pharmacy UMST GASTRO INTESTINAL TRACT (GIT) Objectives: Introduction Common GIT conditions DRUGS ACTING ON GASTRO INTESTINAL TRACT (GIT) Introduction  Digestion is the process of breaking down food into those substances that can be used by the body and those that are to be discharged as waste. Food contains essential chemicals called nutrients that enable the body to function normally: proteins, carbohydrates, fats, vitamins, minerals and water. The body can absorb some nutrients, but it has to break down, or digest others in order to use them for energy. Mouth Digestion process begins in the mouth where food is crushed and ground into smaller pieces by the teeth, chewed by the helping of the tongue and made wet by mixing it with saliva which moistens food for easier passage and begins the breakdown of starches. Saliva contains enzymes that break down carbohydrates into sugar. Pharynx It is a cavity at the back of the mouth that has muscles, connective tissue and mucous membranes. It is a passageway leading from the mouth to the esophagus. The lining of the pharynx secretes mucus to lubricate it and helps in smooth propulsion of food down to the esophagus and reduce irritation. Esophagus It is a muscular tube and a passage through which food travels from the mouth - after it is swallowed - to the stomach; also called the gullet. It is a food pipe that extends from the throat through the chest, ending at the stomach. The walls of the esophagus propel food to the stomach by rhythmic waves of muscular contractions called peristalsis. It also prevents reflux of gastric contents. Stomach It is a sac like part of the digestive tract in which food is stored until partially digested. The stomach wall, which have muscles, break up the food still more. The juices of the stomach, which are sent out from the inner layer of the stomach wall, continue the process of digestion which was started in the mouth. Water, salts and some sugars are absorbed directly into the bloodstream through the stomach wall. The remaining food is mixed with acid and an enzyme called pepsin. It becomes a soupy substance called chyme. The chyme moves from the stomach into the small intestine. Small Intestine It is the longest part in the digestive tract, in which digestion is completed. After the chyme moves from the stomach into the small intestine, it mixes with juices from the liver and pancreas. Starches are broken down into sugars. Proteins are split into smaller particles. Fats are changed to fatty acids. The digested materials pass into the blood stream through the intestinal cells. The food passes from the middle part of the small intestine into the lower part, whose walls are covered with tiny things that stick out and look like hairs. These are known as villi. Their function is to take in the nourishment from the food. Large Intestine Large intestine is a long tube like organ of digestive system. It connects the small intestine at the one end and the anus at the other. It consists of four parts: cecum, rectum, anal canal and colon which consist of three colons: Ascending colon, transverse colon and descending colon. In the large intestine, no more food is digested. Most of the liquid is taken in from the material which has not been digested, and the remainder is thrown out of the body as material which can't be used. All the remaining of food go to the large intestine. It is described as a big farm of bacteria. The function of the large intestine is to absorb water, salts minerals, some nutrients and electrolytes. Whatever food is left undigested moves into the colon, then the rectum. Large intestine forms and propels feces toward the rectum for elimination. The rectum acts as a temporary storage site for feces before it is eliminated through the anal canal. The stool is thickened through water absorption and mixed with mucus as a lubricating substance for easy passage. Large intestine is (5) feet in length, shorter and thicker in diameter than the small intestine. Anus It is an opening at the end of the large intestine after the rectum. It is the end of gastro-intestinal tract. The part of the digestive system through which the stool leaves the body. It consists of tissues, muscles and veins. Accessory Organs (1) Liver The liver controls and regulates most chemical levels in the blood. It secretes yellow or orange fluid called bile. Bile helps to breakdown fats, preparing them for further digestion and absorption. All the blood leaving the stomach and intestines passes through the liver. It breakdown, balances and creates the nutrients. Liver metabolizes drugs into forms that are easier to be used. It breaks down Amino Acid which can be toxic to the body. (2) Pancreas Pancreas is considered as an organ of the digestive system and endocrine system by regulating blood sugar levels by secreting the hormone insulin. As a part of digestive system it secretes pancreatic juice in the duodenum. This juice contains bicarbonate which neutralizes acid entering the duodenum from the stomach and digestive enzymes which breakdown carbohydrates, proteins and fats in food entering the duodenum from the stomach. (3) Gallbladder It is a small pear-shaped organ found in the right side of the abdomen, just beneath your liver. It holds and stores digestive fluid called bile that is produced by the liver and released into the small intestine. It helps to breakdown fatty foods in the duodenum. (4) Saliva Glands They are glands produce saliva through a system of ducts. They have many benefits for the oral cavity and health in general: Protection: They consist of proteins that lubricate and protect both the soft and hard tissues of the oral cavity. Antimicrobial action: They can prevent microbial growth. Digestion: Saliva contains amylase, which convert starch into glucose. Common GIT conditions Dyspepsia: Dyspepsia is also called indigestion. It is usually brought about by poor dietary habits. Ingesting fatty foods, rich foods, spicy foods, an excess of alcohol, incomplete chewing of food, sleeping directly after eating, and weakness of digestive process or irregular meals. It also caused by gastric cancer and gastric and duodenal ulceration. Symptoms: belching, stomach pain, feeling that the stomach is overfull (fullness), early satiety, sour taste and nausea. :ُ‫ؼ‬ٌٙ‫ء ا‬ٛ‫س‬ ‫ي األؽؼّخ‬ٚ‫ تٕب‬.‫ئخ‬١‫خ اٌس‬١‫ب اٌؼبداد اٌـزائ‬ٙ‫ْ سجج‬ٛ‫ى‬٠ ‫ػبدح ِب‬ٚ.ُ‫ؼ‬ٌٙ‫ؼب ثؼسش ا‬ ً ٠‫ؼُ أ‬ٌٙ‫ ػسش ا‬ّٝ‫س‬٠ٚ ‫َ ِجبششح‬ٌٕٛ‫ا‬ٚ ،ًِ‫ػذَ ِؼؾ اٌطؼبَ ثشىً وب‬ٚ ،‫ي‬ٛ‫ ششة اٌىس‬ٟ‫اإلفشاؽ ف‬ٚ ،ً‫اث‬ٛ‫خ ثبٌت‬١ٕ‫األؽؼّخ اٌـ‬ٚ ،‫خ‬١ٕ٘‫اٌذ‬ ‫تمشزبد اٌّؼذح‬ٚ ‫سجت سشؽبْ اٌّؼذح‬٠ ٗٔ‫ وّب أ‬.‫خجبد‬ٌٛ‫ ػذَ أتظبَ ا‬ٚ‫ؼُ أ‬ٌٙ‫خ ا‬١ٍّ‫ػؼف ػ‬ٚ ،ً‫ثؼذ األو‬ ‫اٌشجغ اٌّجىش‬ٚ ‫س ثبِتالء اٌّؼذح‬ٛ‫اٌشؼ‬ٚ ‫آالَ اٌّؼذح‬ٚ ‫ذح ِثً اٌتدشؤ‬٠‫ؼُ أػشاع ػذ‬ٌٙ‫ ٌؼسش ا‬.‫ ػشش‬ٟٕ‫االث‬ٚ.ْ‫ب‬١‫اٌـث‬ٚ ‫اٌطؼُ اٌسبِغ‬ٚ Gastro Esophageal Reflux Disease (GORD) or (GERD): Gastro Esophageal Reflux is the reverse movement of food from stomach and esophagus to the mouth. The lower esophagus sphincter closes the esophagus to prevent the movement of the acidity from the stomach to the mouth. Sometimes it happens that the amount of acidity becomes so much with high concentration which forced the lower esophagus sphincter to open and the food return back. It is a damage in the mucous membrane causes many symptoms referring to unusual reflux (reverse movement) of the stomach acid to the esophagus then to the mouth. It may happen for many reasons: much and high concentration of acidity, unusual relaxation and weakness of esophagus lower muscle and rupture in the diaphragm. Symptoms: acid regurgitation, heart burn, esophagitis, ulceration and dysphagia. ( ٟ‫ئ‬٠‫ اٌّش‬ٞ‫ِشع اٌدضس اٌّؼذ‬GORD) ( ٚ‫أ‬GERD): ِٓ ‫ػخ‬ّٛ‫ء ٌّٕغ زشوخ اٌس‬ٞ‫ء اٌّش‬ٞ‫خ ٌٍّش‬١ٍ‫ تـٍك اٌؼؼٍخ اٌؼبطشح اٌسف‬.ُ‫ اٌف‬ٌٝ‫ء إ‬ٞ‫اٌّش‬ٚ ‫خ ٌٍطؼبَ ِٓ اٌّؼذح‬١‫ اٌسشوخ اٌؼىس‬ٛ٘ ٟ‫ئ‬٠‫ اٌّش‬ٞ‫االستدبع اٌّؼذ‬ ٛ٘ٚ.ٜ‫ع اٌطؼبَ ِشح أخش‬ٛ‫سخ‬ٚ ‫ء‬ٞ‫خ ٌٍّش‬١ٍ‫ فتر اٌؼؼٍخ اٌؼبطشح اٌسف‬ٌٝ‫ إ‬ٞ‫ؤد‬٠ ‫ ِّب‬ٌٟ‫ض اٌؼب‬١‫ػخ ِغ اٌتشو‬ّٛ‫خ اٌس‬١ّ‫بٔب ً أْ تضداد و‬١‫سذث أز‬٠ٚ.ُ‫ اٌف‬ٌٝ‫اٌّؼذح إ‬ ‫سذث رٌه‬٠ ‫ لذ‬.ُ‫ اٌف‬ٌٝ‫ء ثُ إ‬ٞ‫ اٌّش‬ٌٝ‫خ) ٌسّغ اٌّؼذح إ‬١‫ (زشوخ ػىس‬ٞ‫ش ػبد‬١‫ استدبع ؿ‬ٌٝ‫ش إ‬١‫ذ ِٓ األػشاع تش‬٠‫سجت اٌؼذ‬٠ ٟ‫ اٌـشبء اٌّخبؽ‬ٟ‫ػجبسح ػٓ تٍف ف‬ ٟ‫ئ‬٠‫ اٌّش‬ٞ‫ االستدبع اٌّؼذ‬.‫ اٌسدبة اٌسبخض‬ٟ‫تّضق ف‬ٚ ‫ء‬ٞ‫خ ٌٍّش‬١ٍ‫ اٌؼؼٍخ اٌسف‬ٟ‫ػؼف ف‬ٚ ٞ‫ش ػبد‬١‫ استخبء ؿ‬،ٌٟ‫ػب‬ٚ ‫ش‬١‫ػخ وج‬ّٛ‫ض ز‬١‫ تشو‬:‫ذح‬٠‫ألسجبة ػذ‬.‫ػسش اٌجٍغ‬ٚ ‫اٌتمشذ‬ٚ ‫ء‬ٞ‫بة اٌّش‬ٙ‫اٌت‬ٚ ‫زشلخ اٌّؼذح‬ٚ ‫اٌّشتجؾ ثبستدبع اٌسّغ‬ Flatulence: It is a feeling of fullness and discomfort caused by gas in the alimentary canal. It is caused by swallowed air with food and liquid or intestinal bacteria. Excessive flatulence can usually be treated by making changes to your diet and lifestyle. :‫أتفبش‬ َ‫اء ِغ اٌطؼب‬ٌٛٙ‫ٕدُ ػٓ اثتالع ا‬٠ٚ.‫خ‬١ّ‫ؼ‬ٌٙ‫ اٌمٕبح ا‬ٟ‫االٔضػبج إٌبتح ػٓ اٌـبصاد ف‬ٚ ‫س ثبالِتالء‬ٛ‫ اٌشؼ‬ٛ٘.‫خ‬٠ٛ‫ اٌّؼ‬ٚ‫ب اٌسبئٍخ أ‬٠‫ش‬١‫اٌجىت‬ٚ Ulcer: Ulcer is an erosion or un-penetrated sore in the stomach or duodenum. It is any area or mucous membrane that lacking its normal protective cover (superficial loss of tissue). There are four factors that constitute the defensive mechanism against ulcer which are: 1.Mucous Membrane. 2.Bicarbonate. 3.Prostaglandin. 4.Mucosal Blood Flow. :‫لشزخ‬ ٟ‫ (فمذاْ سطس‬ٟ‫ؼ‬١‫ اٌطج‬ٟ‫ال‬ٌٛ‫ ؿالفٗ ا‬ٌٝ‫فتمش إ‬٠ ٟ‫ ؿشبء ِخبؽ‬ٚ‫ ِٕطمخ أ‬ٞ‫ أ‬ٛ٘.‫ ػشش‬ٟٕ‫ االث‬ٚ‫ اٌّؼذح أ‬ٟ‫ش ِختشلخ ف‬١‫ لشزخ ؿ‬ٚ‫ تآوً أ‬ٟ٘ ‫اٌمشزخ‬.)‫ٌألٔسدخ‬ :ٟ٘ٚ ‫ث اٌمشزخ‬ٚ‫خ ػذ زذ‬١‫خ اٌذفبػ‬١ٌ٢‫اًِ تشىً ا‬ٛ‫ٕ٘بن أسثؼخ ػ‬.ٟ‫اٌـشبء اٌّخبؽ‬.‫ٔبد‬ٛ‫ىشث‬١‫ث‬.ٓ٠‫ستبخالٔذ‬ٚ‫اٌجش‬.ٟ‫تذفك اٌذَ اٌّخبؽ‬ Mucous Membrane: The moist, inner lining of stomach in the mucous membrane makes mucus (a thick, protective slippery fluid) also called mucosa. It covers the surface of the internal stomach. Its function in the stomach is to protect it from stomach acid. Also it stops the pathogens and dirt from entering the body and also it absorbs and transform nutrients. Bicarbonate (HCO3): It is a base (alkali) compound secreted by the pancreas and acts in neutralizing HCL and pepsin in the stomach. :ٟ‫اٌـشبء اٌّخبؽ‬ ‫ؼب اٌـشبء‬ ً ٠‫ أ‬ّٝ‫س‬٠ )‫ صٌك‬ٟ‫لبئ‬ٚٚ ‫ه‬١ّ‫ٓ اٌّخبؽ (سبئً س‬٠ٛ‫ تى‬ٍٝ‫ ػ‬ٟ‫ اٌـشبء اٌّخبؽ‬ٟ‫خ اٌشؽجخ ٌٍّؼذح ف‬١ٍ‫تؼًّ اٌجطبٔخ اٌذاخ‬ ِٓ ‫سبش‬ٚ‫األ‬ٚ ‫ّٕغ ِسججبد األِشاع‬٠ ٗٔ‫ وّب أ‬.‫تٗ ِٓ زّغ اٌّؼذح‬٠‫ زّب‬ٟ٘ ‫ اٌّؼذح‬ٟ‫فتٗ ف‬١‫ظ‬ٚ.ٍٟ‫ سطر اٌّؼذح اٌذاخ‬ٟ‫ـط‬٠.ٟ‫اٌّخبؽ‬.‫ب‬ٌٙٛ‫س‬٠ٚ ‫خ‬١‫ّتض اٌؼٕبطش اٌـزائ‬٠ٚ ُ‫ي اٌدس‬ٛ‫دخ‬ ( ‫ٔبد‬ٛ‫ىشث‬١‫ث‬HCO3):.‫ اٌّؼذح‬ٟ‫ٓ ف‬١‫جس‬١‫اٌج‬ٚ ‫ه‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫ذ زّغ ا‬١١‫ تس‬ٍٝ‫ؼًّ ػ‬٠ٚ ‫بط‬٠‫فشصٖ اٌجٕىش‬٠ )ٍٞٛ‫ (ل‬ٞ‫ ِشوت لبػذ‬ٛ٘ٚ Prostaglandin (PG): Prostaglandins are active lipids and hormone like substances. They participate in a wide range of body functions. They control processes such as inflammation, blood flow, the formation of blood clots. They are important in the prevention and treatment of peptic ulcer disease. They inhibit gastric secretion, stimulate mucous and bicarbonate secretion and increase gastric blood volume. They are found in high concentration in the gastric mucosa and gastric juice. They protect the gastric mucosa. ( ‫البروستاجالندين‬PG):.ُ‫ظبئف اٌدس‬ٚ ِٓ ‫اسؼخ‬ٚ ‫ػخ‬ّٛ‫ ِد‬ٟ‫ْ ف‬ٛ‫شبسو‬٠.‫ٔبد‬ِٛ‫ش‬ٌٙ‫اد تشجٗ ا‬ِٛٚ ‫ْ ٔشطخ‬ٛ٘‫ د‬ٟ٘ ٓ٠‫ستبخالٔذ‬ٚ‫اٌجش‬ ِٓ ‫اٌؼالج‬ٚ ‫خ‬٠‫لب‬ٌٛ‫ ا‬ٟ‫ّخ ف‬ِٙ ٟ٘ٚ.َ‫ٓ خٍطبد اٌذ‬٠ٛ‫تى‬ٚ َ‫تذفك اٌذ‬ٚ ‫بة‬ٙ‫بد ِثً االٌت‬١ٍّ‫ ػ‬ٟ‫ْ ف‬ّٛ‫تسى‬٠ ُٙٔ‫إ‬ ٟ‫بدح زدُ اٌذَ ف‬٠‫ص‬ٚ ‫ٔبد‬ٛ‫ىشث‬١‫اٌج‬ٚ ‫ض إفشاص اٌّخبؽ‬١‫تسف‬ٚ ،‫ب تّٕغ إفشاص اٌّؼذح‬ٙٔ‫ أ‬.‫خ‬١ّ‫ؼ‬ٌٙ‫ِشع اٌمشزخ ا‬ ٟ‫ اٌـشبء اٌّخبؽ‬ّٟ‫ب تس‬ٙٔ‫ أ‬.‫ش اٌّؼذح‬١‫ ػظ‬ٟ‫ف‬ٚ ‫ ٌٍّؼذح‬ٟ‫ اٌـشبء اٌّخبؽ‬ٟ‫ض ػب ٍي ف‬١‫دح ثتشو‬ٛ‫خ‬ِٛ ٟ٘ٚ.‫اٌّؼذح‬.‫ اٌّؼذح‬ٟ‫ف‬ Mucosal Blood Flow: Mucosal Blood Flow helps in strengthening the thickness of the mucous membrane by increasing the blood flow. Also helps in healing the damaged cell. There are four factors that constitute the aggressive factors that cause ulcer occurrence which are: 1. Hydrochloric Acid (HCL) 2. Pepsin 3. Non –Steroidal Anti Inflammatory Drugs (NSAIDS) 4. Helicobacter Pylori (H. pylori) :ٟ٘ٚ ‫ث اٌمشزخ‬ٚ‫خ اٌّسججخ ٌسذ‬١ٔ‫ا‬ٚ‫اًِ اٌؼذ‬ٛ‫اًِ تشىً اٌؼ‬ٛ‫ٕ٘بن أسثؼخ ػ‬ )‫ه‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫ه (زّغ ا‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫زّغ ا‬ ٓ١‫جس‬١‫اٌج‬ ( ‫خ‬٠‫ذ‬٠ٚ‫ش‬١‫ش اٌست‬١‫بثبد ؿ‬ٙ‫خ اٌّؼبدح ٌالٌت‬٠ٚ‫ األد‬NSAIDs) ( ٞ‫س‬ٍٛ١‫ثبوتش ث‬ٛ‫ى‬١ٍ١٘H. pylori) Hydrochloric Acid (HCL): Hydrochloric acid is secreted from the parietal cells within the stomach lining. It is a compound of elements such as hydrogen and chloride. The main function of HCL in stomach is to activate the pepsinogen into pepsin. It serves the purposes of protection by killing some bacteria by the high acidic environment which is ingested with food. HCL helps our bodies to breakdown, digest and absorb protein. Approximately (2) liters of HCL are secreted daily into our stomach. Pepsin: It is a stomach digestive enzyme that serves to digest proteins found in ingested food. It breaks down proteins into smaller peptides units. It is produced in the stomach by HCL work and it is active only in an acidic environment, and like acid, is believed to be injurious to the lining of the stomach, duodenum and esophagus. :)‫ه‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫ه (زّغ ا‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫زّغ ا‬ ‫خ ٌـ‬١‫س‬١‫فخ اٌشئ‬١‫ظ‬ٌٛ‫تتّثً ا‬ٚ.‫ذ‬٠‫س‬ٍٛ‫اٌى‬ٚ ٓ١‫خ‬ٚ‫ذس‬١ٌٙ‫ ِشوت ِٓ ػٕبطش ِثً ا‬ٛ٘ٚ.‫خ داخً ثطبٔخ اٌّؼذح‬٠‫ب اٌدذاس‬٠‫ه ِٓ اٌخال‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫تُ إفشاص زّغ ا‬٠ HCL ٟ‫ف‬.َ‫ب ِغ اٌطؼب‬ٌٙٚ‫تُ تٕب‬٠ ٟ‫خ اٌت‬١ٌ‫خ اٌؼب‬١‫ئخ اٌسّؼ‬١‫ب ثبٌج‬٠‫ش‬١‫اع اٌجىت‬ٛٔ‫ك لتً ثؼغ أ‬٠‫خ ػٓ ؽش‬٠‫خذَ أؿشاع اٌسّب‬٠.ٓ١‫جس‬١‫ اٌج‬ٌٝ‫ٍٗ إ‬٠ٛ‫تس‬ٚ ٓ١‫خ‬ٕٛ١‫جس‬١‫ؾ اٌج‬١‫ تٕش‬ٟ‫اٌّؼذح ف‬.‫ ِؼذتٕب‬ٟ‫ب ً ف‬١ِٛ٠ ‫ه‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫) ٌتش ِٓ زّغ ا‬2( ‫مبسة‬٠ ‫تُ إفشاص ِب‬٠.ٓ١‫ت‬ٚ‫اِتظبص اٌجش‬ٚ ُ‫٘ؼ‬ٚ ‫ش‬١‫ تىس‬ٍٝ‫ه أخسبِٕب ػ‬٠‫س‬ٍٛ‫و‬ٚ‫ذس‬١ٌٙ‫سبػذ زّغ ا‬٠ :ٓ١‫جس‬١‫اٌج‬ ‫ اٌّؼذح‬ٟ‫تُ إٔتبخٗ ف‬٠.‫ذاد أطـش‬١‫زذاد ثجت‬ٚ ٌٝ‫ٕبد إ‬١‫ت‬ٚ‫ش اٌجش‬١‫َ ثتىس‬ٛ‫م‬٠.‫ي‬ٚ‫ اٌطؼبَ اٌّتٕب‬ٟ‫دح ف‬ٛ‫خ‬ٌّٛ‫ٕبد ا‬١‫ت‬ٚ‫ ٘ؼُ اٌجش‬ٍٝ‫ؼًّ ػ‬٠ ‫ اٌّؼذح‬ٟ‫ ف‬ّٟ‫ُ ٘ؼ‬٠‫ إٔض‬ٛ٘ٚ ًّ‫ك ػ‬٠‫ػٓ ؽش‬HCL.‫ء‬ٞ‫اٌّش‬ٚ ‫ ػشش‬ٟٕ‫االث‬ٚ ‫ؼش ثجطبٔخ اٌّؼذح‬٠ ٗٔ‫ؼتمذ أ‬٠ ‫ِثً اٌسّغ‬ٚ ،‫خ‬١‫ئخ اٌسّؼ‬١‫ اٌج‬ٟ‫ ٔشؾ فمؾ ف‬ٛ٘ٚ Non –Steroidal Anti Inflammatory Drugs (NSAIDS): Non –Steroidal Anti Inflammatory Drugs (NSAIDS) disrupt the production of prostaglandin in the stomach. NSAIDS slow the production of the protective mucus in the stomach and change its structure. They interfere with the stomach's ability to protect itself from gastric acidity. They work to reduce pain by blocking the enzymes that are involved in the production of prostaglandin, which is a class of lipids made by the body that have an effect on pain receptors. Helicobacter Pylori (H. pylori): It is a gram – negative bacteria that can cause an infection in the stomach or duodenum. It is the most common cause of peptic ulcer disease. H. pylori can also inflame and irritate the stomach lining (gastritis). ( ‫خ‬٠‫ذ‬٠ٚ‫ش‬١‫ش اٌست‬١‫بثبد ؿ‬ٙ‫خ اٌّؼبدح ٌالٌت‬٠ٚ‫ األد‬NSAIDs): ( ‫خ‬٠‫ذ‬٠ٚ‫ش‬١‫ش اٌست‬١‫بثبد ؿ‬ٙ‫خ اٌّؼبدح ٌالٌت‬٠ٚ‫ األد‬NSaids) ‫ش‬١‫بة ؿ‬ٙ‫ تؼًّ ِؼبداد االٌت‬.‫ اٌّؼذح‬ٟ‫ٓ ف‬٠‫ستبخالٔذ‬ٚ‫تؼطً إٔتبج اٌجش‬.‫ػخ اٌّؼذح‬ّٛ‫ب ِٓ ز‬ٙ‫خ ٔفس‬٠‫ زّب‬ٍٝ‫ب تتذاخً ِغ لذسح اٌّؼذح ػ‬ٙٔ‫ أ‬.ٗ‫ت‬١ٕ‫ش ث‬١١‫تـ‬ٚ ‫ اٌّؼذح‬ٟ‫ ف‬ٟ‫ال‬ٌٛ‫ إثطبء إٔتبج اٌّخبؽ ا‬ٍٝ‫خ ػ‬٠‫ذ‬١‫ئ‬ٚ‫ش‬١‫اٌست‬ ٟ‫اٌت‬ٚ ُ‫ب اٌدس‬ٙ‫ظٕؼ‬٠ ٟ‫ْ اٌت‬ٛ٘‫ فئخ ِٓ اٌذ‬ٛ٘ٚ ،ٓ٠‫ستبخالٔذ‬ٚ‫ إٔتبج اٌجش‬ٟ‫ تشبسن ف‬ٟ‫ّبد اٌت‬٠‫ك ِٕغ اإلٔض‬٠‫ً األٌُ ػٓ ؽش‬١ٍ‫ تم‬ٍٝ‫تؼًّ ػ‬.ٌُ‫ ِستمجالد األ‬ٍٝ‫ش ػ‬١‫ب تؤث‬ٌٙ ( ٞ‫س‬ٍٛ١‫ثبوتش ث‬ٛ‫ى‬١ٍ١٘H. pylori): ٓ‫ّى‬٠.‫خ‬١ّ‫ؼ‬ٌٙ‫ػب ٌّشع اٌمشزخ ا‬ٛ١‫ اٌسجت األوثش ش‬ٛ٘ٚ.‫ ػشش‬ٟٕ‫ االث‬ٚ‫ اٌّؼذح أ‬ٟ‫ ف‬ٜٚ‫ّىٓ أْ تسجت ػذ‬٠ َ‫ب سبٌجخ اٌدشا‬٠‫ش‬١‫ ثىت‬ٟ٘ٚ.)‫بة اٌّؼذح‬ٙ‫ح ثطبٔخ اٌّؼذح (اٌت‬١ٙ‫ت‬ٚ ‫بة‬ٙ‫ اٌت‬ٌٝ‫ؼب إ‬ ً ٠‫خ أ‬١‫اث‬ٛ‫خ اٌج‬٠ٌٍّٛ‫ ا‬ٞ‫أْ تؤد‬ 4.1. The Discovery of Helicobacter Pylori (H. pylori): In the year 1982, two American scientists; Barry, J. Marshal and J. Robin Warrant discovered helicobacter pylori which is a spiral shape bacteria that born, lives and increases in the stomach lining. In a research paper, they stated that stomach acid, tension and spicy food are not the only cause of peptic ulcer and H. pylori is another dangerous factor that causes peptic ulcer also. It also causes stomach cancer, gastritis and esophagitis. It transmits through polluted food and dirty water. In 2005 they won Noble Prize for this discovery. 4.2. How does H. pylori cause ulcer? H. pylori is found in the stomach of 30 -50% of the world's population. It may live in an inactive form in the lining walls of the stomach of a person for many years. It doesn't cause any symptoms unless it becomes active It can't live in an acidic environment (media) so that stomach acid is its frit enemy. For this reason, it escapes and hide in the stomach wall using it as a protector from acid. It digs holes in the wall of the stomach so as to live under the mucous membrane (between the M.M and S.W). This place is a non – acidic media, so it is a suitable climate for it to live in. After that it begins to produce and secrete a great amount of urea which produces ammonia that neutralizes the stomach acidity, making it disable to support the stomach in fulfilling its function properly. When does peptic ulcer occur? Peptic ulcer occurs when the balance between the aggressive factors and defensive mechanism is disrupted. Vomiting: Vomiting is to expel the contents of the stomach forcibly through the mouth. Causes of Vomiting: Cancer chemotherapy Gastrointestinal infection Early pregnancy Motion sickness Mountain sickness General anesthesia Some medications Alcohol and analgesic opioids Post operation vomiting Pain – fever - drugs Diarrhea: Diarrhea is a frequent and excessive passage of liquid feces. Causes of Diarrhea: Food poisoning An allergic reaction to food or drug. An infection of the gastrointestinal tract (viral – bacterial – fungal) Thyroid gland. Diabetes mellitus Problems in pancreas Increase of bile in colon Constipation: Constipation is the passage of hard stools less frequently. Causes of Constipation: Lack of mobility Lack of taking fluids Lack of taking fibers Pregnancy Tumor (blockage in the intestine) Irritable Bowel Syndrome: Sometimes an in consistency occurs between the acetylcholine and its receptor in regulating the digestive process. Also a disturbance in intestine peristalsis due to different causes such as anxiety, tension, stress, some types of food or drinks or some psychological factors. The result of all that is an irritability of the GIT in the digestive process a thing which leads to the occurrence of abdominal pain. Sometimes the peristalsis increases and causes diarrhea, other times the peristalsis stops and causes constipation or the two occur in a consequence. :‫ّح‬١ٙ‫ْ اٌّت‬ٌٛٛ‫ِتالصِخ اٌم‬ ‫ ألسجبة‬ٞٛ‫ اٌتّؼح اٌّؼ‬ٟ‫ؼب ً اػطشاة ف‬٠‫أ‬ٚ.ُ‫ؼ‬ٌٙ‫خ ا‬١ٍّ‫ُ ػ‬١‫ تٕظ‬ٟ‫ِستمجٍٗ ف‬ٚ ٓ١ٌٛ‫ً و‬١‫ت‬١‫ٓ األس‬١‫سذث تٕبسك ث‬٠ ْ‫ب‬١‫ ثؼغ األز‬ٟ‫ف‬ ‫ح‬١ٙ‫ ت‬ٛ٘ ‫دخ وً رٌه‬١‫ ٔت‬.‫خ‬١‫اًِ إٌفس‬ٛ‫ ثؼغ اٌؼ‬ٚ‫ثبد أ‬ٚ‫ اٌّشش‬ٚ‫اع األؽؼّخ أ‬ٛٔ‫ثؼغ أ‬ٚ ٟ‫اٌؼـؾ إٌفس‬ٚ ‫تش‬ٛ‫اٌت‬ٚ ‫ِختٍفخ ِثً اٌمٍك‬ ْ‫ب‬١‫ أز‬ٟ‫ف‬ٚ ،‫بي‬ٙ‫سجت اإلس‬٠ٚ ‫ضداد اٌتّؼح‬٠ ْ‫ب‬١‫ ثؼغ األز‬ٟ‫ ف‬.ٓ‫ اٌجط‬ٟ‫ث آالَ ف‬ٚ‫ زذ‬ٌٝ‫ إ‬ٞ‫ؤد‬٠ ‫ؼُ ِّب‬ٌٙ‫خ ا‬١ٍّ‫ ػ‬ٟ‫ ف‬ّٟ‫ؼ‬ٌٙ‫بص ا‬ٙ‫اٌد‬.‫دخ ٌزٌه‬١‫سذث االثٕبْ ٔت‬٠ ٚ‫سجت اإلِسبن أ‬٠ٚ ‫لف اٌتّؼح‬ٛ‫ت‬٠ ٜ‫أخش‬ Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines. IBS is a chronic condition that you'll need to manage long term. Symptoms: Cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. Only a small number of people with IBS have severe symptoms. More-serious symptoms include: Weight loss Diarrhea at night Rectal bleeding Iron deficiency anemia Unexplained vomiting Pain that isn't relieved by passing gas or a bowel movement Some people can control their symptoms by managing diet, lifestyle and stress. More- severe symptoms can be treated with medication and counseling. Hemorrhoids: Anus consists of muscles, tissues and veins. Sometimes these veins extends for a long time during the day due to different reasons such as hard stools and constipation. Here bleeding, pain and blood on feces occurs. Then an inflammation increases the extension of this vessel and preventing its returning to its normal volume. Causes: (1) Constipation (2) Obesity (3) Lack of mobility (4) Cough ‫ٍخ خالي‬٠ٛ‫سدح ٌفتشح ؽ‬ٚ‫بْ تّتذ ٘زٖ األ‬١‫ ثؼغ األز‬ٟ‫ف‬ٚ.‫سدح‬ٚ‫األ‬ٚ ‫األٔسدخ‬ٚ ‫ْ اٌششج ِٓ اٌؼؼالد‬ٛ‫تى‬٠ ٞ‫ؤد‬٠ ُ‫ِٓ ث‬ٚ.‫ اٌجشاص‬ٟ‫اٌذَ ف‬ٚ ٌُ‫األ‬ٚ ‫ف‬٠‫سذث إٌض‬٠ ‫ ٕ٘ب‬.‫اإلِسبن‬ٚ ‫َ ألسجبة ِختٍفخ ِثً اٌجشاص اٌظٍت‬ٛ١ٌ‫ا‬.ٟ‫ؼ‬١‫ زدّٗ اٌطج‬ٌٝ‫دح إ‬ٛ‫ِٕؼٗ ِٓ اٌؼ‬ٚ ‫ػبء‬ٌٛ‫بدح اتسبع ٘زا ا‬٠‫ ص‬ٌٝ‫بة إ‬ٙ‫االٌت‬ DRUGS ACTING ON GASTRO INTESTINAL TRACT (GIT) 1. Antacid 2. Anti-flatulence 3. Anti-secretary H2 receptor antagonists Proton pump inhibitors 4. Ulcer treatment H. pylori treatment Cytoprotective agents 5. Antispasmodics (anticholinergics) 6. Anti-emetics 7. Anti-diarrhea 8. Laxatives 9. IBS treatment 10. Anti-hemorrhoidal drugs 1. Antacids: Antacid are combination of various salts of calcium, magnesium, aluminum or sodium bicarbonate. They are a class of drugs used to treat conditions caused by the acid that is produced by the stomach. The stomach naturally secretes an acid called hydrochloric acid (HCL) that helps to breakdown proteins. This acid causes the contents of the stomach to be acidic in nature. It happens that the stomach acid becomes more than the quantity needed for digestion. The stomach, duodenum and esophagus are protected from much acidity by several protective mechanisms. When there is too much acid or the protective mechanisms are inadequate, the lining of the stomach , duodenum or esophagus may become damaged by the acid, giving rise to inflammation, ulcerations and their various gastrointestinal symptoms such as acid indigestion, nausea, abdominal pain, sour stomach, stomach upset and heart burn (due to gastroesophageal reflux disease GERD). Mechanism of Action: Antacid reduce acidity by neutralizing (counter acting) the stomach acid in which aluminum, calcium, magnesium or sodium bicarbonates act as bases (alkalis) to neutralize stomach acid (HCL) which is secreted by the stomach during digestion. Antacids also reduce the amount of acid that is refluxed into the esophagus or emptied into the duodenum. Also antacid works by inhibiting the activity of pepsin (A digestive enzyme produced in the stomach. It is active only in an acidic environment and like acid, is believed to be injurious to the lining of the stomach, duodenum and esophagus). Some antacids contain ingredients that can cause diarrhea, such as magnesium, or constipation, such as aluminum. They can be neutralized by combining them into one drug. Indications: Dyspepsia associated with accumulation of gases – rapid relief of the symptoms of heart burn – hyperacidity associated with peptic ulcer, gastritis and reflux esophagitis – post operative digestion. Contraindication: Hypersensitivity to any of the ingredients of the product, neonates – infants – hypophosphatemia. Side effects: Diarrhea – constipation – nausea – vomiting –abdominal cramps 2. Anti-flatulents Mechanism of Action Antacid drugs also contain simethicone, an ingredient that helps the body to get rid of gas, see table 6. Simethicone is a non-toxic silicone-based surface active agent with an efficient de-foaming action which relieves flatulence by dispersing and preventing the formation of the mucous surrounded by gas pockets in gastrointestinal tract. It is an anti-flatulent which acts in both the stomach and intestine by changing the surface tension of the gas bubbles causing them to coalesces, thus gas is freed and eliminated more easily. This process leads to alleviation of dyspepsia and reduction of the severity of gas pain. Indications: Relive of the painful symptoms of the excess gas in the digestive tract – post operative gaseous distention – functional dyspepsia – spastic or irritable colon- preparing for endoscopic, sonographic investigations of the stomach or bowels. Contraindication: Obstructive gastrointestinal disorders  3. Anti-secretary drugs 3.1. H2 Receptor Antagonist What is histamine? Histamine is an organic, nitrogenous, vital compound produced by an action of fecal bacteria on protein materials. It is a substance that plays a major role in many allergic reactions. It is the method of informing about the allergy to something in the environment. Histamine is involved in local immune responses as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain and spinal cord. ‫ٓ؟‬١ِ‫ستب‬ٌٙ‫ ا‬ٛ٘ ‫ِب‬ ‫ ِبدح‬ٟ٘ٚ.‫خ‬١ٕ١‫ت‬ٚ‫اد اٌجش‬ٌّٛ‫ ا‬ٍٝ‫خ ػ‬٠‫ب اٌجشاص‬٠‫ش‬١‫ٕتح ثفؼً اٌجىت‬٠ ٞٛ١‫ ز‬ٟٕ١‫خ‬ٚ‫تش‬١ٔ ٞٛ‫ ِشوت ػؼ‬ٛ٘ ٓ١ِ‫ستب‬ٌٙ‫ا‬ ٟ‫ء ِب ف‬ٟ‫خ تدبٖ ش‬١‫مخ اإلثالؽ ػٓ اٌسسبس‬٠‫ب ؽش‬ٙٔ‫ إ‬.‫خ‬١‫د اٌفؼً اٌتسسس‬ٚ‫ذ ِٓ سد‬٠‫ اٌؼذ‬ٟ‫ب ف‬١‫س‬١‫سا سئ‬ٚ‫تٍؼت د‬ ‫ اٌمٕبح‬ٟ‫خ ف‬١‫خ‬ٌٛٛ١‫ظبئف اٌفس‬ٌٛ‫ُ ا‬١‫وزٌه تٕظ‬ٚ ‫خ‬١ٍ‫خ اٌّس‬١‫ االستدبثبد إٌّبػ‬ٟ‫ٓ ف‬١ِ‫ستب‬ٌٙ‫شبسن ا‬٠ٚ.‫ئخ‬١‫اٌج‬.ٟ‫و‬ٛ‫اٌسجً اٌش‬ٚ ‫ ٌٍذِبؽ‬ٟ‫ؼًّ وٕبلً ػظج‬٠ٚ ‫خ‬١ّ‫ؼ‬ٌٙ‫ا‬ Role of histamine in Gastro Intestinal Tract: In the stomach, histamine type (2) stimulates the parietal cells to produce the gastric acid required for digestion. Adverse effect of too much histamine: When a person has too much histamine, peptic ulcer may develop because too much histamine is produced, stimulating secretion of excess stomach acid. Ulcers can cause stomach pain, nausea, vomiting and chronic diarrhea may also occurs. Mechanism of action of drugs acting on H2 receptor: H2 (histamine type 2) receptor antagonists regulate gastric acid secretion by stopping the parietal cells of the stomach lining from responding to histamine. This reduces the amount of acid or (gastric acidity). H2 blockers can help to reduce acid reflux related symptoms such as heart burn. Indications: Reflux esophagitis(GERD), Peptic ulcers, Zollinger-Ellison syndrome, Prophylaxis of stress-induced ulcers. Contraindication: Pregnancy – breast feeding – renal impairment. Side effects: Headache – dizziness – diarrhea – depression – altered liver function test – confusion – gynecomastia – hallucination in elderly – impotence. No Generic Name Trade Name Dosage Form and Concentration 1 Famotidine Famodar Tabs. 20 mg – 40 mg. 2 Ranitidine Zanatac Tabs. 150 mg–300 mg 50 mg IV/IM inj. 3 Cimetidine Tagamet Tabs 200 mg. – 400 mg. – inj. 4 3.2. Proton Pump Inhibitors (PPIs): Definition of Proton Pump Proton pump is a special kind of transporter protein (a chemical system) that push hydrogen and ions to area of high concentration. It is the terminal stage in gastric acid secretion. It is found in the parietal cells on the stomach lining. Proton pump stimulates H2 receptor which is found in the parietal cells of the stomach, therefore it stimulates the pump from inside to stimulate the secretion of HCL and pepsin. Proton Pump Inhibitors Mechanism of Action Proton pump inhibitors suppress the gastric acid secretion by inhibiting the proton pump at the secretary surface of the gastric parietal cell. This action blocks the final stage of gastric acid formation (production), and this reduces gastric acidity and leads to inhibition of gastric acid secretion. Significance of Proton Pump Inhibitors Work: Decreasing the acid in the stomach can aid the healing of duodenal ulcers and reduce the pain from indigestion and heart burn. Indications: Gastric ulcer –duodenal ulcer – reflux esophagitis – Gastroesophageal reflux disease (GERD) – NSAIDS associated gastric and duodenal ulcer – eradication of H. pylori combined with appropriate antibiotics – treatment of Zollinger – Ellison syndrome (growth in the pancreas). Contraindication: Hypersensitivity to any of the constituents of the drug – Pregnancy – breast feeding. Side effects: Common: Diarrhea – vomiting – nausea – headache – stomach pain – flatulence. Uncommon: dry mouth – dizziness – urticaria and disturbed sleep (insomnia). 4. Ulcer treatment 4.1. H. pylori treatment: Triple Therapy PPI: Omeprazole tabs. 20 mg. (bid - twice a day). Anti-bacterial: Clarithromycin tabs 500 mg (bid - twice a day) and Amoxicillin tabs 1g (b.d - twice a day) or Metronidazole tabs. 500 mg (bid - twice a day) for 1 -2 weeks. OCA: omeprazole (20mg) + clarithromycin (500mg) and amoxicillin (1 g). OCM: omeprazole 20mg, clarithromycin 500mg and metronidazole 400mg. PPI, clarithromycin 500 mg bid and Tinidazole 500mg bid. The most powerful PPI against H.pylori is omeprazole while the most powerful antibiotic against H. pylori is clarithromycin. Quadruple Therapy PPI: Omeprazole tabs. 20 mg. (bid - twice a day), Anti-bacterial: Amoxicillin tabs. 1000 mg. (bid - twice a day), Clarithromycin tabs. 250 - 500 mg. (bid - twice a day), Metronidazole tabs. 250 - 500 mg. (bid - twice a day) for 1 -2 weeks. 4.2. Cyto-protective Agents: Sucralfate It is a drug used for prophylaxis and treatment of gastric ulcer, duodenal ulcer, gastritis and gastroesophageal reflux. It is well known that ulcer alone stimulates and increases acid secretion. Sucralfate is an antagonist of ulcer that acts in the stomach lining through sticking on the positions of ulcer in the stomach protecting these ulcerated places from salt and acids. It works by building or making a protective, viscous, sticky, white gel layer (on an acidic media) over or covering ulcerations so as to protect them and the stomach tissues from more damages and help in healing of the injuries and ulcerations. Also the healing of mucous membrane a thing that reduces the effect of acid which causes its ulcer. It is like a painting inside a crystal bottle. The brand name of this medication is Carafate®. Misoprostol It is a drug like prostaglandin; acts in reducing the secretion of stomach acid and the protection of stomach lining namely the parietal cells. It acts on protecting stomach from acidic secretion by stimulating the production of mucous which protect the gastrointestinal tract. Misoprostol increases the blood flow to the parietal cells an act that increase the cohesiveness and thickness of the mucous membrane. It is used in the prophylaxis of peptic ulcer that is caused by taking too much NSAIDS such as Aspirin, Ibuprofen, Naproxen, Diclofenac and Meloxicam which are used for the relieving of pain in general. Prostaglandins are chemical substances produced by some organs in the body such as stomach. In stomach, prostaglandin protects the mucous layer from the ulcerative effect of NSAIDS. These analgesics, in their act to relive pain, cause ulcer because they inhibit the production of prostaglandin in the stomach. The manufactured prostaglandin (PGE2) such as Misoprostol which is taken orally, replaces the prostaglandin which was inhibited by the work of NSAIDS. So, it protects the stomach lining from ulcer. Misoprostol causes uterine contractions which causes abortion and early birth, for that, it shouldn't be used during pregnancy. 5. Antispasmodics (Anti - cholinergic) Mechanism of Action of Antispasmodics: Acetylcholine controls the contractions and relaxation of stomach and intestines, when it increases its rate in contracting the smooth muscles through its receptor, muscarine, the peristalsis increases and that leads to the feeling of spasm or colic. Antispasmodic drugs reduce the contractions of the smooth muscles by blocking the muscarinic receptors. Preventing the acetylcholine from binding to its receptor, muscarine. Indications: Colic – Gastro intestinal tract muscle spasm and Motion sickness. Contraindications: Prostatic enlargement – myasthenia gravis – paralytic ileus – pyloric stenosis and glaucoma. Side effects: Dry mouth – flushing and dry skin – constipation – urine retention – glaucoma and confusion in elderly. No Group Generic Name Trade Name Dosage Form and Concentration 1 Anti-muscarinic Atropine sulphate Atropine-Jayson.4-.6 mg/ml IV Inj Hyoscine Buscopan / Scopinal 10 mg tabs butyl bromide 5 mg syrup 20mg/ml inj 2 Anti-muscarinic + Mebeverine Duspain/Duspatlin/Ser 135 mg caps -200 mg Anti-spasmotic enil/Dupain 3 Anti-muscarinic + Prifinium bromide Riabal 30 mg tabs Anti-spasmotic 7.5 mg/5ml oral drops 15mg/2ml inj 6. Anti-emetics Mechanism of Action of Antiemetic Drugs: Anti-emetic drugs work by blocking the receptors in the gut that trigger nausea and vomiting in the vomiting center in the brain. Anti-emetics blocking these receptors from responding to neurotransmitters such as Serotonin and dopamine which are found in the central nervous system (CNS) and the gut. Also anti emetic drugs inhibit the secretion and reduce the stimulation of histamine which is responsible for allergy and stimulates the vomiting center in the brain by sending the histamine to the bloodstream a thing which causes allergy against some types of food and causes nausea and vomiting. Anti-emetics increase the gastric and duodenal contractions and facilitate gastric emptying. They also increase esophageal peristalsis and lower esophageal sphincter. So, anti-emetic drugs acting directly on the stomach by increasing the rate at which it moves food into the bowel. Indications: Treatment of allergic conditions – motion sickness – nausea and vomiting of pregnancy – vomiting associated with other drugs and anesthesia – post operative vomiting – nausea and vomiting caused by Meniere’s disease. Contraindications: Allergy to the substance – if increased GIT motility harmful Asthma/ promethazine Side effects: Dry mouth – drowsiness – dizziness – headache – tiredness – blurred vision – weight gain – fatigue – allergic skin reactions – gastrointestinal disturbances - nervousness.  No Group Generic Name Trade Name Dosage Form and Concentration 1 Anti-histamines Cinnarzine Stugeron / Cinazin 15-25-75 mg tabs/ caps 2 D. Antagonists Domperidone Motilat/Zydom/ Motilium 10 mg tabs 10 mg/ml oral drops 5mg/5 ml susp. Metoclopramide Pasperon 10 mg tabs 5 mg/ml inj 3 Pyridoxine(VitB6) + Vomizal/Vominor 25 mg/25 mg tabs Meclizine 4 Phenothiazine Chlorpromazine Largectel 25-50 mg tabs 25 mg IM inj Promethazine Phenergan 25 mg tabs /Promegan/cityrgan/ 25 mg/ml inj Histazin 5 mg/5ml syrup prochlorperazine Stabil 5 mg tab 5 HT3 – 5 antagonists Ondansetron Ondal/ Emeset/ Vomiz/ 4 mg-8 mg tabs setron inj. 4mg/2ml or 2mg/ml IV/IM inj 7. Anti-diarrhea Drugs Mechanism of Action of Anti-diarrhea Drugs: To push the undesired food, the acetylcholine stimulates the muscarinic receptors to contract quickly. To inhibit the muscarinic effects, anti-diarrhea drugs reduce the peristalsis of the intestines which work rapidly to wash the viruses or bacteria. So, the intestine muscles relax and stop contracting. This also reduces the feces volume and increases its viscosity. No Generic Name Trade Name Dosage Form and Concentration 2 Loperamide Imodal/Imodium/ 2 mg tabs Yesalopera 2 mg caps 3 Diphenozylate + Diaxine 2.5mg +.025 mg tabs Atropine Indications: Acute and chronic diarrhea. Contraindications: Acute dysentery – colitis. Side effects: Abdominal pain – dizziness – nausea – flatulence – vomiting – constipation – headache – dry mouth – urine retention – tension – irritability and mental confusion in elderly.  8. Laxatives Laxatives are drugs promote the evacuation of the bowels. Indications: Relief of constipation – colon evacuation prior to radiological examination of the abdomen – endoscopy and abdominal surgery – empty a woman bowel before giving birth – appendicitis Contraindications: Inflammation of the bowel (large, small) – blocked bowel (intestinal obstruction) – severe dehydration Side effects: Abdominal pain or cramp – dizziness – nausea – vomiting – abdominal stomach pain – blood in the stool – heamorrhoidal constipation – sluggishness of the bowels (colon) No Laxative Mechanism of action Generic Names Trade Names Dosage Form and type Concentration 1 Stimulant They increase Bisacodyl Laxin/ Lax 5-10 mg tabs Laxatives peristalsis tab/Bisadyl Supp. Sennae+ other natural extracts Eucarbon Tabs Aloe/Cascara/Castor oil 2 Osmotic They increase the Lactulose Duphalac 10mg/15ml Laxatives water content of the Sachet feces 667g/L solution Sodium salts Enemax/ 6mg +16 mg (Disodium phosphate+ Microenema rectal enema Monosodium phosphate) Glycerin Supp. Adult/pediatric 3 Bulk Increase the volume Normacol Sachets Forming of non-absorbable Laxatives solid residue just like dietary fibers: e.g. Grain – Fruits – Vegetables 4 Faceal They soften the Docusate Sodium - It is Softeners feces a surfactant that act as a detergent (becomes emulsified with stool and soften it to make its passage easy). Liquid parafin 5 Bowel Sodium Picosulphate Lexeol PI/ Tabs Cleansing Picolax 7.5 mg/ml oral Solutions drops 9. Irritable Bowel Syndrome (IBS) treatment Mechanism of Action: IBS drugs relax the intestine and regulate the rapid stability of the digestive process by reducing the irritability of the bowels. Indications: Gastrointestinal disorders caused by anxiety and tension – hyper-motility of the gastrointestinal tract and diarrhea – nervous dyspepsia - spastic or irritable colon – colitis - No Generic Name Trade Name Dosage Form and Concentration 1 Chlordiazepoxide + Clidinium bromide Bralix/Librax/ Epirax 5 mg +2.5 mg tabs 2 Diazepam + Clidinium bromide Distedon 2 mg +2.5 mg tabs 3 Chlordiazepoxide HCL + Propantheline bromide Medospas 4 mg + 10 mg Caps 4 Chlordiazepoxide + Amitriptyline HCL Hayapoxide 5 mg+ 12.5mg tab 10. Anti Hemorrhoidal Drugs Mechanism of Action: Anti-Hemorrhoid drugs reduce the inflammation and pain. In addition to treatment of the main cause of hemorrhoid such as constipation see table 13. No Drug class Generic Name Trade Name Dosage Form and Concentration 1 Steroids Hydrocortisone Hydrosone 1% cream/ointment anti-inflammatory 2 Local anesthetic Lidocaine Liocaine 2% gel 3 Soothing agents Menthol 4 Combined therapy Flucoinolone acetonide+ Lidocaine+ Proctoheal Ointment Menthol+ Bismuth Subgallate Tribenoside+ Lidocaine Haemoproct 5%+2% cream/ suppositories Lidocaine+ Hydrocortisone Xyloproct 50mg+2.5mg oint. 5 Herbal remedies Sealar Ointment 6 Micronized Purified Flavonoid Fraction Daflon 500 mg caps Exercise Exercise 1: Find any medicine or drug used at home to treat any GIT related disease or symptom. Write about the following: 1. Generic and trade name or the main composition 2.How it was prescribed i.e. prescription or OTC 3.How it is used and for how long 4.Any adverse effects or side effects described by the patient after starting the course. 5.What is your personal recommendation for the patient