Clinical using of drugs in Clinical using of drugs in digestive diseases digestive diseases

treatmenttreatment

DDigestive diseasesigestive diseases

GastritisGastritis

GastritisGastritisAspirin & NSAID GastritisAspirin & NSAID Gastritis

AlcoholAlcohol Alcohol and certain other chemicals can cause Alcohol and certain other chemicals can cause

inflammation and injury to the stomach. This inflammation and injury to the stomach. This is strictly dose related in that a lot of alcohol is strictly dose related in that a lot of alcohol is usually needed to cause gastritis. Social or is usually needed to cause gastritis. Social or occasional alcohol use is not damaging to the occasional alcohol use is not damaging to the stomach although alcohol does stimulate the stomach although alcohol does stimulate the stomach to make acid.stomach to make acid.

GGastritis treatmentastritis treatment

Peptic ulcer disease (PUD) is a very common Peptic ulcer disease (PUD) is a very common ailment, affecting one out of eight persons in the ailment, affecting one out of eight persons in the United States. The causes of PUD have gradually United States. The causes of PUD have gradually

become clear. With this understanding have come become clear. With this understanding have come new and better ways to treat ulcers and even cure new and better ways to treat ulcers and even cure

themthem

PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE

Helicobacter pylori (H. pylori)Helicobacter pylori (H. pylori)

PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE SymptomsSymptoms

PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE Therapy of PUD has undergone Therapy of PUD has undergone

profound changes. There are now available very profound changes. There are now available very effective medications to supress and almost effective medications to supress and almost eliminate the outpouring of stomach acid. eliminate the outpouring of stomach acid. These acid-suppresssing drugs have been These acid-suppresssing drugs have been dramatically effective in relieving symptoms dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, then no caused by aspirin or an arthritis drug, then no subsequent treatment is usually needed. subsequent treatment is usually needed. Avoiding these latter drugs, should prevent Avoiding these latter drugs, should prevent ulcer recurrence. ulcer recurrence.

The second major change in PUD treatment has The second major change in PUD treatment has been the discovery of the H. pylori infection. been the discovery of the H. pylori infection. When this infection is treated with antibiotics, When this infection is treated with antibiotics, the infection, and the ulcer, do not come back. the infection, and the ulcer, do not come back. Increasingly, physicians are not just suppressing Increasingly, physicians are not just suppressing the ulcer with acid-reducing drugs, but they are the ulcer with acid-reducing drugs, but they are also curing the underlying ulcer problem by also curing the underlying ulcer problem by getting rid of the bacterial infection. If this getting rid of the bacterial infection. If this infection is not treated, the ulcers invariably infection is not treated, the ulcers invariably recur. recur.

There are a number of antibiotic programs There are a number of antibiotic programs available to treat H. pylori and cure ulcers. available to treat H. pylori and cure ulcers. Working with the patient, the physician will Working with the patient, the physician will select the best treatment programselect the best treatment program available available

TreatmentTreatment of peptic ulcer of peptic ulcer Antimicrobial agents (tetracycline, bismuth subsalicylate, Antimicrobial agents (tetracycline, bismuth subsalicylate,

and metronidazole) to eradicate and metronidazole) to eradicate H. pyloriH. pylori infection infection Misoprostol (a prostaglandin analog) to inhibit gastric acid Misoprostol (a prostaglandin analog) to inhibit gastric acid

secretion and increase carbonate and mucus production, to secretion and increase carbonate and mucus production, to protect the stomach lining protect the stomach lining

Antacids to neutralize acid gastric contents by elevating the Antacids to neutralize acid gastric contents by elevating the gastric pH, thus protecting the mucosa and relieving pain gastric pH, thus protecting the mucosa and relieving pain

Avoidance of caffeine and alcohol to avoid stimulation of Avoidance of caffeine and alcohol to avoid stimulation of gastric acid secretion gastric acid secretion

Anticholinergic drugs to inhibit the effect of the vagal nerve Anticholinergic drugs to inhibit the effect of the vagal nerve on acid-secreting cells on acid-secreting cells

H2 blockers to reduce acid secretion H2 blockers to reduce acid secretion Sucralfate, mucosal protectant to form an acid-impermeable Sucralfate, mucosal protectant to form an acid-impermeable

membrane that adheres to the mucous membrane and also membrane that adheres to the mucous membrane and also accelerates mucus production accelerates mucus production

Dietary therapy with small infrequent meals and avoidance Dietary therapy with small infrequent meals and avoidance of eating before bedtime to neutralize gastric contents of eating before bedtime to neutralize gastric contents

Insertion of a nasogastric tube (in instances of Insertion of a nasogastric tube (in instances of gastrointestinal bleeding) for gastric decompression and gastrointestinal bleeding) for gastric decompression and rest, and also to permit iced saline lavage that may also rest, and also to permit iced saline lavage that may also contain norepinephrine contain norepinephrine

Gastroscopy to allow visualization of the bleeding site and Gastroscopy to allow visualization of the bleeding site and coagulation by laser or cautery to control bleeding coagulation by laser or cautery to control bleeding

Surgery to repair perforation or treat unresponsiveness to Surgery to repair perforation or treat unresponsiveness to conservative treatment, and suspected malignancy. conservative treatment, and suspected malignancy.

Ranitidine (Ranitidin) Forms of production: 0,15 g and 0,3 g tablets and ampoules with 2 ml of

2,5 % solution.

RECOMMENDATIONS OF

HELICOBACTER PYLORI ERADICATION

A typical quadruple therapyA typical quadruple therapy

Ulcers associated with NSAIDsUlcers associated with NSAIDs omeprazole 20mg daily is preferable to omeprazole 20mg daily is preferable to

ranitidineranitidine 150mg twice daily as the respective 150mg twice daily as the respective rates of healing are 80% and 63%. rates of healing are 80% and 63%.

H2RAs are slow to heal the ulcers if the H2RAs are slow to heal the ulcers if the offending drug is not stopped and so, under offending drug is not stopped and so, under these conditions, a PPI is preferred. these conditions, a PPI is preferred.

H pylori eradication is no more effective than H pylori eradication is no more effective than omeprazole alone to heal ulcers, but if the omeprazole alone to heal ulcers, but if the infection is present, then eradication will infection is present, then eradication will reduce the rate of relapse. reduce the rate of relapse.

H pylori is not associated with an increased H pylori is not associated with an increased risk of ulcer with NSAIDs in the elderly but risk of ulcer with NSAIDs in the elderly but there is an increased risk of bleeding. there is an increased risk of bleeding.

MotiliumMotiliumForm of production: Form of production: 0,0,001 1 g tabletsg tablets

LAXATIVES AND CATHARTICSLAXATIVES AND CATHARTICSConstipationConstipation can be defined can be defined as infrequent or hard pellet as infrequent or hard pellet stools, or difficulty in stools, or difficulty in evacuating stool. Passing evacuating stool. Passing one or more soft, bulky one or more soft, bulky stools every day is a stools every day is a desirable goal. While desirable goal. While troublesome, constipation is troublesome, constipation is not usually a serious not usually a serious disorder. However, there disorder. However, there may be other underlying may be other underlying problems causing problems causing constipation and, therefore, constipation and, therefore, testing is often testing is often recommended. recommended.

ConstipationConstipation

Indications for UseIndications for Use 1. To relieve constipation in pregnant women, elderly1. To relieve constipation in pregnant women, elderly

clients whose abdominal and perineal muscles haveclients whose abdominal and perineal muscles have become weak and atrophied, children with megacolon,become weak and atrophied, children with megacolon, and clients receiving drugs that decrease intestinaland clients receiving drugs that decrease intestinal motility (eg, opioid analgesics, drugs with motility (eg, opioid analgesics, drugs with anticholinergicanticholinergic effects)effects)

2. To prevent straining at stool in clients with coronary2. To prevent straining at stool in clients with coronary artery disease (eg, postmyocardial infarction), artery disease (eg, postmyocardial infarction), hypertension,hypertension, cerebrovascular disease, and cerebrovascular disease, and hemorrhoids andhemorrhoids and other rectal conditionsother rectal conditions

3. To empty the bowel in preparation for bowel surgery 3. To empty the bowel in preparation for bowel surgery oror diagnostic procedures (eg, colonoscopy, barium diagnostic procedures (eg, colonoscopy, barium enema)enema)

4. To accelerate elimination of potentially toxic 4. To accelerate elimination of potentially toxic substancessubstances from the GI tract (eg, orally ingested drugs from the GI tract (eg, orally ingested drugs or toxicor toxic compounds)compounds)

5. To prevent absorption of intestinal ammonia in 5. To prevent absorption of intestinal ammonia in clientsclients with hepatic encephalopathywith hepatic encephalopathy

6. To obtain a stool specimen for parasitologic 6. To obtain a stool specimen for parasitologic examinationexamination

7. To accelerate excretion of parasites after 7. To accelerate excretion of parasites after anthelminticanthelmintic drugs have been administereddrugs have been administered

8. To reduce serum cholesterol levels (psyllium 8. To reduce serum cholesterol levels (psyllium products)products)

LaxativesLaxatives

There are two main types of There are two main types of laxatives: laxatives: stimulants (chemical)stimulants (chemical) and and saline saline (liquid or salt).(liquid or salt). They occasionally help They occasionally help temporary constipation problems. However, temporary constipation problems. However, chronic use of laxatives, especially chronic use of laxatives, especially stimulant laxatives is discouraged because stimulant laxatives is discouraged because the bowel becomes dependent upon them. the bowel becomes dependent upon them. Bowel regularity should occur without Bowel regularity should occur without laxatives. laxatives. An occasional enema is An occasional enema is preferrable over the chronic use of preferrable over the chronic use of laxatives.laxatives.

Contraindications to UseContraindications to Use

DietDietThe following foods should be eaten daily in The following foods should be eaten daily in

adequate amountsadequate amounts

Antidiarrheals

Antidiarrheals drugs

Antidiarrheal drugs are indicated in the following circumstances:

• 1. Severe or prolonged diarrhea (>2 to 3 days), to prevent severe fluid and electrolyte loss

• 2. Relatively severe diarrhea in young children and older adults. These groups are less able to adapt to fluid and electrolyte losses.

• 3. In chronic inflammatory diseases of the bowel (ulcerative colitis and Crohn’s disease), to allow a more nearly normal lifestyle

• 4. In ileostomies or surgical excision of portions of the ileum, to decrease fluidity and volume of stool

• 5. HIV/AIDS-associated diarrhea• 6. When specific causes of diarrhea have been determined

Contraindications to UseContraindications to Use

Contraindications to the use of Contraindications to the use of antidiarrheal drugs include diarrheaantidiarrheal drugs include diarrhea caused by toxic materials, caused by toxic materials, microorganisms that penetratemicroorganisms that penetrate intestinal mucosa (eg, pathogenic intestinal mucosa (eg, pathogenic E. E. coli, Salmonella,coli, Salmonella, ShigellaShigella), or ), or antibiotic-associated colitis. In these antibiotic-associated colitis. In these circumstances,circumstances, antidiarrheal agents antidiarrheal agents that slow peristalsis may aggravatethat slow peristalsis may aggravate and prolong diarrhea. Opiates and prolong diarrhea. Opiates (morphine, codeine) usually(morphine, codeine) usually are are contraindicated in chronic diarrhea contraindicated in chronic diarrhea because of possible opiatebecause of possible opiate dependence. Difenoxin, dependence. Difenoxin, diphenoxylate, and loperamide arediphenoxylate, and loperamide are contraindicated in children younger contraindicated in children younger than 2 years of age.than 2 years of age.