Clinical using of drugs in digestive diseases treatment

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Clinical using of drugs in digestive diseases
treatment
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Digestive diseases

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Gastritis
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Gastritis

• Aspirin NSAID Gastritis
• Alcohol
• Alcohol and certain other chemicals can cause
  inflammation and injury to the stomach. This is
  strictly dose related in that a lot of alcohol is
  usually needed to cause gastritis. Social or
  occasional alcohol use is not damaging to the
  stomach although alcohol does stimulate the
  stomach to make acid.

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Gastritis treatment
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Peptic ulcer disease (PUD) is a very common
ailment, affecting one out of eight persons in
the United States. The causes of PUD have
gradually become clear. With this understanding
have come new and better ways to treat ulcers and
even cure them
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PEPTIC ULCER DISEASE

• Helicobacter pylori (H. pylori)

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PEPTIC ULCER DISEASE Symptoms
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PEPTIC ULCER DISEASE

• Therapy of PUD has undergone profound changes.
  There are now available very effective
  medications to supress and almost eliminate the
  outpouring of stomach acid. These
  acid-suppresssing drugs have been dramatically
  effective in relieving symptoms and allowing
  ulcers to heal. If an ulcer has been caused by
  aspirin or an arthritis drug, then no subsequent
  treatment is usually needed. Avoiding these
  latter drugs, should prevent ulcer recurrence.
  The second major change in PUD treatment has
  been the discovery of the H. pylori infection.
  When this infection is treated with antibiotics,
  the infection, and the ulcer, do not come back.
  Increasingly, physicians are not just suppressing
  the ulcer with acid-reducing drugs, but they are
  also curing the underlying ulcer problem by
  getting rid of the bacterial infection. If this
  infection is not treated, the ulcers invariably
  recur. There are a number of antibiotic
  programs available to treat H. pylori and cure
  ulcers. Working with the patient, the physician
  will select the best treatment program available

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Treatment of peptic ulcer

• Antimicrobial agents (tetracycline, bismuth
  subsalicylate, and metronidazole) to eradicate H.
  pylori infection
• Misoprostol (a prostaglandin analog) to inhibit
  gastric acid secretion and increase carbonate and
  mucus production, to protect the stomach lining
• Antacids to neutralize acid gastric contents by
  elevating the gastric pH, thus protecting the
  mucosa and relieving pain
• Avoidance of caffeine and alcohol to avoid
  stimulation of gastric acid secretion
• Anticholinergic drugs to inhibit the effect of
  the vagal nerve on acid-secreting cells
• H2 blockers to reduce acid secretion
• Sucralfate, mucosal protectant to form an
  acid-impermeable membrane that adheres to the
  mucous membrane and also accelerates mucus
  production
• Dietary therapy with small infrequent meals and
  avoidance of eating before bedtime to neutralize
  gastric contents
• Insertion of a nasogastric tube (in instances of
  gastrointestinal bleeding) for gastric
  decompression and rest, and also to permit iced
  saline lavage that may also contain
  norepinephrine
• Gastroscopy to allow visualization of the
  bleeding site and coagulation by laser or cautery
  to control bleeding
• Surgery to repair perforation or treat
  unresponsiveness to conservative treatment, and
  suspected malignancy.

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• Ranitidine (Ranitidin)
• Forms of production 0,15 g and 0,3 g tablets and
  ampoules with 2 ml of 2,5 solution.

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RECOMMENDATIONS OF HELICOBACTER PYLORI
ERADICATION
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A typical quadruple therapy
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Ulcers associated with NSAIDs

• omeprazole 20mg daily is preferable to ranitidine
  150mg twice daily as the respective rates of
  healing are 80 and 63.
• H2RAs are slow to heal the ulcers if the
  offending drug is not stopped and so, under these
  conditions, a PPI is preferred.
• H pylori eradication is no more effective than
  omeprazole alone to heal ulcers, but if the
  infection is present, then eradication will
  reduce the rate of relapse.
• H pylori is not associated with an increased risk
  of ulcer with NSAIDs in the elderly but there is
  an increased risk of bleeding.

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• Motilium
• Form of production 0,01 g tablets

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LAXATIVES AND CATHARTICS

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

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Constipation
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Indications for Use

• 1. To relieve constipation in pregnant women,
  elderly clients whose abdominal and perineal
  muscles have become weak and atrophied, children
  with megacolon, and clients receiving drugs that
  decrease intestinal motility (eg, opioid
  analgesics, drugs with anticholinergic effects)
• 2. To prevent straining at stool in clients with
  coronary artery disease (eg, postmyocardial
  infarction), hypertension, cerebrovascular
  disease, and hemorrhoids and other rectal
  conditions
• 3. To empty the bowel in preparation for bowel
  surgery or diagnostic procedures (eg,
  colonoscopy, barium enema)
• 4. To accelerate elimination of potentially toxic
  substances from the GI tract (eg, orally ingested
  drugs or toxic compounds)
• 5. To prevent absorption of intestinal ammonia in
  clients with hepatic encephalopathy
• 6. To obtain a stool specimen for parasitologic
  examination
• 7. To accelerate excretion of parasites after
  anthelmintic drugs have been administered
• 8. To reduce serum cholesterol levels (psyllium
  products)

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Laxatives

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

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Contraindications to Use

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DietThe following foods should be eaten daily in
adequate amounts
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Antidiarrheals
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Antidiarrheals drugs
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• Antidiarrheal drugs are indicated in the
  following circumstances
• 1. Severe or prolonged diarrhea (gt2 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 Crohns 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

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Contraindications to Use

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