afams alimentary tract and metabolism (insert dari) eo 003.01 part 17

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Alimentary Tract and Metabolism(Insert Dari)

EO 003.01 Part 17

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Lesson Overview(Insert Dari)

• Review of the alimentary tract (gastrointestinal tract)

• Overview of therapeutic classes

• Drugs for acid related disorders- Antacids- Drugs used in peptic ulcer disease and gastroesophageal reflux disease- Other drugs used in acid related disorders

• Drugs for functional GI disorders- Drugs for functional bowel disorders- Belladonna derivatives- Propulsives

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Lesson Overview(Insert Dari)

• Antidiarrheals, Intestinal Antiinflammatories and Antiinfectives.

- Antibiotics - Intestinal Adsorbents- Electrolytes with Carbohydrates- Antipropulsives

• Drugs used in Diabetes- Insulin and Analogues- Blood Glucose Lowering Agents

• Vitamins

• Mineral Supplements

• Other Alimentary Tract and Metabolism Products

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The Alimentary Tract (The Gastrointestinal Tract) (Insert Dari)

نکفیه غده

مری

کبد

کیسه صفرااثناعشر

اپندکس

سیکم

جوفدهن

زبان

نکفیه غده

معدهپانکرا س

مقعد

رکتومکولون سیگوئید

بلعوم

جیجیونوم

الیوم

دندان

کولون نازله

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What I need to know as a pharmacy technician(Insert Dari)

In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under

(A)Alimentary Tract and Metabolism

For each of these medications students must obtain an understanding of:

(1) Mechanism of Action

(2) Indications (Uses)

(3) Efficacy

(4) Side Effects

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A02 Drugs for Acid Related Disorders(Insert Dari)

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Mechanism of Action Reduces the acidity of stomach and duodenal contents by combining with hydrochloric acid and producing salt and water.

معده محتوی اسیدیتیبا را واثناعشر

یکجاشدن اسید باهایدروکلوریکمیدهد کاهش یا خنثیمیسازد را وآب ونمک

Indication (Uses)

• GERD

• Acid indigestion

• Peptic Ulcers

سوزی دل سوءهاضمه

اسید پیپتیک قرحات

Antacids ها اسید انتی

استعمال مورد

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Side Effects

• Diarrhea – Mg+2 and Na+ containing antacids

• Constipation – Al+3 and Ca+2 containing products

– اسیدهای انتی اسهالدارای و Mg+2که

Na+ اند

– اسید انتی قبضیتدارای که و Al+3های

Ca+2 اند

جانبی عوارض


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Important Points

• Don’t take within 2 hours before or after taking another medication.

• Liquid preparations need to be shaken thoroughly.

• Chew tablets completely before swallowing.

تا اسید ساعت 2انتیادویه از بعد یا پیش

نشود گرفته دیگر مایع مستحضرات

از پیش است ضرورشور خوب استفاده

شود داده پیش آن های تابلیت

شود جویده کامال ازبلع


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A02B – Drugs for Peptic Acid Disease and Gastroesophageal Reflux Disease

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Histamine H2 Antagonistsهای آخذه هستامین H2 انتاگونستهای

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Mechanism of Action

• Histamine H2 agonists reduce the secretion of gastric acid .

• This allows ulcerated areas to heal and relieves symptoms of reflux.

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Indications (Uses)

• Gastric or duodenal ulcers

• GERDمعدی • درقرحات

استفاده واثناعشریمیشود

محتوی • که درامراضبرگشت مری به معده

استفاده مینماید،)GERDمیشود(


استعمال مورد

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Side Effects

• Low incidence of adverse reactions

• Mild and transient diarrhea, dizziness, fatigue

های • العمل عکس وقوعاست کمتر ناگوار

وگذری، • خفیف اسهال. گی خسته سرگنسی،


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Mechanism of Action

•Suppress gastric acid secretion via a different mechanism compared to H2 receptor antagonists.

•This also allows ulcerated areas to heal and relieves symptoms of reflux.

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Indications (Uses)

• Gastric and duodenal ulcers

• GERD

واثناعشر • معده قرحاتبه • معدوی محتوی برگشت مرض

معصره شدن مأوف از ناشی مری)GERDکاردیا(

Proton Pump Inhibitorsپمپ پروتون های کننده نهی

استعمال

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Side Effects

• Most common are headache, diarrhea, and abdominal pain.

• Less common include: nausea, flatulence, constipation and dry mouth.

اسهاالت، • سردری،بسیار بطنی ودرد

است معمول

وباد، • نفخ دلبدی،دهن خشکی و قبضیت

است معمول کمتر


جانبی عوارض

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Important PointsUsually administered 30 min before breakfast.

Swallowed whole, not chewed or crushed.

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A02X - Other Drugs for Acid Related Disorders(Insert Dari)

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Sucralfateسکرالفیت

Mechanism of Action

• Forms a complex with the exudates of the stomach lining.

• The complex forms a protective layer over a duodenal ulcer, thus aiding in healing of the ulcer.

Indication (Uses)

• Treatment of duodenal ulcers

Side Effects

• Usually mild, but may cause constipation.

تأثیر طرزاستر • را معده که اگزودات با

را مغلق ترکیب یک نمودهمیدهد تشکیل

قشر • یک مغلق ترکیب اینقرحات باالی را محافظویوبه داده، تشکیل اثناعشرقرحه درالتیام ترتیب این

. مینماید کمک

: استعمال مورداثناعشر • قرحات تداوی در

. میگیرد قرار استفاده مورد

: عوارضجانبی بوده، • خفیف معموال

سبب دارد امکان درحالیکه. گردد قبضیت

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A03 – Drugs for Functional Gastrointestinal Disorders

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A03A Drugs for Functional Bowel Disorders(Insert Dari)

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Drotaverine(Insert Dari)

Mechanism of Action Works to decrease contractions of the intestine (decreases movement).

Indication (Use)• Spasm of muscles in the GI tract• Gastric and duodenal ulcers

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Side Effects• May cause abnormal heart rhythm. • Constipation• Sweating may occur.

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A03B Belladonna and Derivatives (Insert Dari)

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Atropine(Insert Dari)

Mechanism of Action Antispasmodic agent meaning that it slows down the muscle contractions in the intestine.

Indications• Primarily used to increase cardiac output (found in crash carts and emergency cabinets). • Not longer used as a treatment to improve GI function.

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Hyoscine(Insert Dari)

Mechanism of ActionAntispasmodic agent meaning that it slows down the muscle contractions in the intestine

Indication (Use)• It is used to slow the speed in the stomach and GI (gastrointestinal) tract.• It is used to treat loose stools (diarrhea).• It is used to treat muscle spasms of the GI (gastrointestinal) tract, gallbladder system, or urinary system.

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Side Effects of Hyoscine(Insert Dari)

Rare but serious:• Very bad dizziness or passing out.• Change in thinking clearly and with logic.• Not able to pass urine.• Not sweating during activities or in warm temperatures.• A fast heartbeat or a heartbeat that does not feel normal

More common:• Feeling sleepy.• Dizziness.• Blurred eyesight.• Hard stools (constipation).• Dry mouth.• Headache.

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A03F Propulsives(Insert Dari)

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Mechanism of action

Increase the motility (movement) of the upper GI tract.

قسمت در را حرکاتمعدی طرق علوی

میدهد افزایش معائی

Indications (Uses)

Metoclopramide• is used to treat heartburn.• is used to stop or treat upset

stomach and throwing up.• is used to treat

gastroesophageal reflux disease.

Domperidone • is used to stop upset stomach

and throwing up.• is used to treat poor stomach

clearing/emptying.

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Propulsives(Insert Dari)

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Side Effects of Propulsives(Insert Dari)

Metoclopramide:Rare but more serious side effects can

include:

• Very bad dizziness

• Twitching.

• Change in thinking clearly and with logic.

• Shakiness, trouble moving around, or stiffness.

More common:

• Feeling lightheaded, sleepy, having blurred eyesight.

• Headache.

• Stomach pain.

• Loose stools (diarrhea).

• Not able to sleep

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Side Effects of Propulsives(Insert Dari)

Domperidone:Rare but more serious side effects can include:

• A fast heartbeat.

• A heartbeat that does not feel normal.

• Very bad dizziness or passing out.

• Enlarged breasts.

• A lump in the breast, breast soreness, or nipple discharge.

• Period (menstrual) changes. Periods become less often or stop.

• Seizures.

More common:

• Headache.

• Dry mouth.

• Hot flashes.

:میتوکلوپراماید

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Important Points for Propulsives

(Insert Dari) Metoclopramide

• Administered 30 minutes before meals.

Domperidone

• Administered 15 to 30 minutes before meals and at bedtime.

میتوکلوپرامایداز 30• قبل دقیقه

تطبیق غذا صرفمیشود

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A06 Laxatives(Insert Dari)

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Bisacodyl(Insert Dari)

Mechanism of Action

Causes the intestinal muscles to contract causing a bowel movement to occur.

Indication (Use)

To treat constipation

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Side Effects

• Stomach pain and cramps.

• Gas (flatulence).

• Diarrhea.

Efficacy

Generally if taken before bed will produce a bowel movement in the morning.

Bisacodyl(Insert Dari)

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Lactulose(Insert Dari)

Mechanism of Action

Causes water to move into the intestine which stimulates muscle contractions, causing a bowel movement.

Indication (Use)

• It is used to treat hard stools (constipation).

• It is used to stop or treat changes in thinking caused by very bad liver disease.

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Lactulose(Insert Dari)

Side Effects

• Stomach pain or heartburn.

• Upset stomach or throwing up.

• Loose stools (diarrhea).

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Psyllium (Ipaghol Chilka) Powder(Insert Dari)

Mechanism of Action

Fibrous substance which forms bulk in the intestine causing bowel movements to occur.

Indication (Uses)

To treat constipation

Side Effects

• Loose bowel movements (diarrhea).

• Stomach/intestine discomfort

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Antidiahrreals, Intestinal Antiinflammatories and Anti-infectives

اسهاالت ضد (Insert Dari)ادویه

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Antiinfective: Rifamixin (Insert Dari)

Mechanism of ActionPrevents the replication of bacteria.

Indication (Uses) It is used to treat diarrhea caused by a bacterial infection.

Side Effects • Gas.• Headache.• Dizziness.• Belly pain.• Upset stomach.• Feeling tired or weak.

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Intestinal Adsorbents : Activated Carbon (Charcoal) (Insert Dari)

Mechanism of ActionPrevents the absorption of toxic substances from the intestines.

Indication • It is used to treat some poisonings.• It is used to ease too much gas in the stomach

Side Effects• Belly pain.• Upset stomach or throwing up.• Hard stools (constipation).• Loose stools (diarrhea).

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Oral Rehydration : Electrolytes(Insert Dari)

Mechanism of ActionProvides electrolytes (salts).

IndicationDiarrhea Prolonged diarrhea can cause loss of salts from the body which causes dehydration.

Side Effects- Upset stomach

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Antipropulsive: Loperamide(Insert Dari)

Mechanism of Action

Decreases intestinal peristalsis (contraction of intestinal muscles which is usually increased when a patient has diarrhea).

Indication (Use)

• Diarrhea

Insert Dariکاهش را امعا استداری حرکاتدرهنگام( معموال حرکات میدهد

( میابد افزایش اسهاالت

استفاده موارداسهال•

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Loperamide(Insert Dari)

Side Effects

Feeling lightheaded• Belly pain.• Upset stomach (throwing up)• Stools (constipation).

Serious but rare side effects• high fever, black and tarry

stools

Important Points

If dosed as a 2mg tablet the maximum dose per day is 8 tablets or 16 mg.

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A10 Medications Used in Diabetes(Insert Dari)

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A10A Insulin and Analogues

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Mechanism of Action

Allows the cells of the body to take up sugar from the bloodstream.

Indication

It is used to lower blood sugar in patients with high blood sugar (diabetes).

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(Insert Dari) Side Effects• Low blood sugar may occur. • Upset stomach or throwing up. • Weight gain.• Irritation where the shot is

given.

Signs of low blood sugar may be dizziness, headache, feeling sleepy, feeling weak, shaking, a fast heartbeat, confusion, hunger, or sweating. Keep glucose tablets or liquid glucose on hand for low blood sugar.

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(Insert Dari)

Important Points

• Administered via subcutaneous injection or IV.

• Subcutaneous injection are generally administered to the abdomen or upper leg.

• For subcutaneous injection it is important to tell patients to rotate the injection site.

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A10B Blood Glucose Lowering Drugs(Insert Dari)

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Mechanism of ActionAll work to lower the blood sugar in patients with high blood sugar (diabetes). Can include the following mechanisms:

(1)Increase the production of insulin within the body. (2)Decrease the production of sugar from the liver. (3)Increasing the response of cells to insulin = more uptake of sugar by the cells of the body.

Indication For the treatment of high blood sugar (diabetes).

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Important Points

Metformin and Glimepiride should be taken before a meal (15 min before).

Pioglitazone can be taken at any time of the day.

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Side Effects Metformin Diarrhea (very common), upset stomach, gas and feeling tired or weak.

Glimepiride Low blood sugar, upset stomach and stomach.

Pioglitazone Low blood sugar, weight gain and feeling tired or weak.

Symptoms of Low Blood Sugar: dizziness, headache, feeling sleepy, feeling weak, shaking, a fast heartbeat, confusion, hunger, or sweating. When patients have these symptoms they should take sugar right away (i.e. juice).

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A11 Vitamins(Insert Dari)

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Vitamins (Insert Dari)

Vitamins are vital nutrients that our body obtains from food (our body cannot produce these compounds on its own).

Indication

A diagnosed vitamin deficiency. Some common indications are listed below:

Multivitamin – used to supplement a poor diet, often in patients who are unable to eat very much. Special formulations exist for pregnant patients.

Vitamin D + Calcium - osteoporosis, rickets, osteomalacia

Vitamin C – Scurvy

Vitamin K – Used to counteract the effects of anticoagulants such as warfarin.

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Vitamins(Insert Dari)

Side effects

Vitamins are generally well tolerated and tend to have minimal side effects.

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A12 Mineral Supplements (Insert Dari)

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Minerals (Insert Dari)

Minerals are chemical elements required by living organisms other than (carbon, oxygen, hydrogen and nitrogen).

Indications

Calcium- Treatment of low calcium, cardiac disturbances, adjunctive treatment of rickets and osteomalacia. Important in prevention of osteoporosis

Zinc – zinc deficiency.

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Minerals (Insert Dari)

Side Effects

Some products may cause nausea.

Important Points

The maximum amount of calcium that can be absorbed by the body at a given time is 500 mg. If a patient is taking more than 500 mg they must spread the dose throughout the day.

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A16 Other Alimentary Tract and Metabolism Products(Insert Dari)

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Drugs Used in the treatment of liver complications(Insert Dari)

Both drugs are combination products meaning they have more than one active ingredient.

Betaine Glucuronidate / Nicotinamide (Jetepar®)

L.Ornithine / L.Aspartate / Nicotinamide/ Riboflavin (Hepamerz®)

Mechanism

Reduces the amount of ammonia in the blood which is a problem in liver disease and can cause problems with awareness and ability to think logically.

Indications

Liver Disease

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Drugs Used in the treatment of liver complications(Insert Dari)

Side Effects

• Upset stomach, nausea for both medications.

• Betaine Glucuronidate / Nicotinamide (Jetepar®) may also cause a mild breath odour.

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Questions?(Insert Dari)

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In-class Assignment (Insert Dari)

This assignment will consist of 10 questions which are to be completed individually. Once complete the instructor will review the answers with the class.

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1. Which of the following is NOT a class of drugs used to treat acid related disorders?

(Insert Dari)

A) Antacids

B) H2 Receptor Antagonists

C) Propulsives

D) Proton Pump Inhibitors

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1. Answer: Which of the following is NOT a class of drugs used to treat acid related disorders?

(Insert Dari)

A) Antacids

B) H2 Receptor Antagonists

C) Propulsives

D) Proton Pump Inhibitors

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2. What time of day should a patient take a proton pump inhibitor ?

(Insert Dari)

A) Before bed

B) Any time of day as long as it is the same time each day

C) At dinner time

D) 30 min before breakfast

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3. Match the following drugs used in the treatment of acid related disorders with their drug class

(Insert Dari)

A) Ranitidine

B) Pantoprazole

C) Sucralfate

D) Aluminum Hydroxide/

Magnesium Hydroxide

1) Antacid

2) H2 receptor antagonists

3) Proton Pump Inhibitor

4) Other

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3. Match the following drugs used in the treatment of acid related disorders with their drug class

(Insert Dari)

A) Ranitidine (2) H2 receptor antagonists

B) Pantoprazole (3) Proton Pump Inhibitor

C) Sucralfate (4) Other

D) Aluminum Hydroxide/

Magnesium Hydroxide

(1) Antacid

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4. List whether the following drugs are laxatives or antipropulsives

(Insert Dari)

A) Bisacodyl

B) Lactulose

C) Loperamide

D) Psyllium

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4. List whether the following drugs are laxatives or antipropulsives

(Insert Dari)

A) Bisacodyl - laxative

B) Lactulose - laxative

C) Loperamide - antipropulsive

D) Psyllium - laxative

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5. Match the following with their mechanism of action(Insert Dari)

A) Rifamixin

B) Activated Carbon (charcoal)

C) Loperamide

D) Hyoscine

1) Decreases intestinal contractions that usually occur when a patient has diarrhea

2) Prevents bacteria from replicating

3) Prevents muscle spasms from occurring in the GI tract

4) Prevents toxic substances from being absorbed from the GI tract

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5. Match the following with their mechanism of action(Insert Dari)

A) Rifamixin (2) Prevents bacteria from multiplying

B) Activated Carbon (charcoal) (4) Prevents toxic substances from being absorbed from the GI tract

C) Loperamide (1) Decreases intestinal contractions that usually occur when a patient has diarrhea

D) Hyoscine (3) Prevents muscle spasms from occuring in the GI tract.

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6. Fill in the blanks: Insulin can be given to patients via ____________ and _____________ administration.

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6. Fill in the blanks: Insulin can be given to patients via subcutaneous injection and intravenous administration.

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7. Which of the following is NOT a symptom of low blood sugar?

(Insert Dari)

A) Dizziness

B) Headache

C) Sleepy

D) Increase in urination

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8. Which of the following drugs is used to lower blood sugar in diabetic patients?

(Insert Dari)

A) Loperamide

B) Pantoprazole

C) Metformin

D) Calcium

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8. Answer: Which of the following drugs is used to lower blood sugar in diabetic patients?

(Insert Dari)

A) Loperamide

B) Pantoprazole

C) Metformin

D) Calcium

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9. Which of the following statements best describes a vitamin?

(Insert Dari)

A) A substance that the body can produce on its own.

B) Vital nutrients that our body obtains from food

C) Chemical elements required by living organisms.

D) Carbon, Hydrogen, Oxygen and Nitrogen

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10. How much Calcium can the body absorb at once?(Insert Dari)

A) 500 mg

B) 200 mg

C) 100 mg

D) There is not limit on how much the body can absorb at once

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afams alimentary tract and metabolism (insert dari) eo 003.01 part 17

Documents

acid related disorders

a03 drugs

antacids a02b drugs

functional gi disorders

secretion of gastric

gastric acid secretion

hydrochloric acid

effectsinsert daria02