Diploma in pharmacy 2nD year NOTES Pharmacology

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 Diploma in Pharmacy 2nd Year
Pharmacology
Chapter 8 : Drugs Acting on Gastro Intestinal Tract
Topics Page No
Drugs Acting on Gastro Intestinal Tract 3
Definition, classification, pharmacological 3
actions, dose, indications, and contraindications
of
 Anti-ulcer drugs 3
 Anti-emetics 4
 Laxatives and purgatives 5
 Anti-diarrheal drugs 6
 pharmacology
Chapter 8
Drugs Acting on Gastro Intestinal Tract
Anti- Ulcer Drugs
 Ulcer : A sore ( wound ) develops on the lining of the oesophagus , Stomach , or small
intestine.
 If ulcer is in stomach it is called Gastric Ulcer,
 If in Duodenum it is called Duodenal Ulcer,
 If both type of ulcer is called Peptic Ulcer.
 The Drugs are used to treat ulcer / Sore are called anti ulcer drugs

Classification
1) Anti-secretory Agents ( reduce gastric acid secretion )
 H2 Antagonists : Cimetidine , Ranitidine.
 Proton Pump inhibitors : Omeprazole , pantoprazole , Lansoprazole, raeprazole.
 Anti-cholinergic drugs : pirenzepine.
 Prostaglandin Analogues : Misoprostol , Enprostil.
2) Antacids : ( Neutralize gastric acid)
 Systemic : Sodium Bicarbonate , Sodium citrate .
 Non- Systemic : Magnesium Hydroxide , aluminium Hydroxide Gel , Magaldrate ,
Calcium Carbonate.
3) Ulcer Protectives : Sucralfate and Colloidal Bismuth Subcitrate ( CBS)
4) Ulcer Healing Drugs : Carbenoxolone sodium.
5) Anti- Helicobacter pylori Drugs : amoxicilin , Metronidazole , Clarithromycine.

Pharmacological Action
 Pirenzepine :
 It reduces gastric acid secretion therefore it is used in peptic ulcer.
 It also reduces Muscle Spasm.
 Sodium Bicarbonate :
 It is a water soluble, Strong base.
 It gives immediate effect but has a short duration of action.

Indications
 In peptic Ulcer
 Ulcer Healing
 Ulcer Pain
 Bleeding peptic ulcer
  To relieve heart burn.
 Mouth ulcer.

Contraindication
 Hepatic failure
 Renal Impariment
 Hypersensitivity
 Pregnancy

Doses
 Cimetidine 0.02g tab. bd
 Ranitidine 0.15 g tab. Bd
 Sucralfate 10ml four time a day
 Carbenoxolone 20-50 mg 4 time a day

Anti – Emetics
 Anti-emetics are effective against vomiting and nausea.
 They are used to treat motion sickness and side effects of opioid analgesics, general
anaesthetics, and chemotherapy against cancer.

Classification
I. Anti Cholinergic drugs : Hyoscine , Dicyclomine .
II. H1 Anti-Histaminics : Promethazine , Diphenhydramine , Cyclizine .
III. Neuroleptics : Chlorpromazine , Haloperidol .
IV. Prokinetic drugs : Metoclopramide , Domperidone .
V. 5-HT3 Antagonist : Ondansetron , Granisetron .
VI. Adjuvant Anti-emetics : Dexamethasone , Benzodiazepines , Canabinoids .

Pharmacological Action
 Anti-emetics work by targeting specific neurotransmitters and receptors in the brain and gut
that are involved in the control of nausea and vomiting

Indications
 They are used to treat Vomiting
 To treat nausea .
 To treat Motion sickness .
 To treat post anaesthetic nausea and vomiting .
 Morning sickness ( vomiting during pregnancy , in first three months )
Contraindications
 Hypersensitivity
 Coma
 Severe CNS depression etc,

Doses
 Hyoscine 0.2 – 0.4 mg oral
 Promethazine 25 mg twice a day
 Domperidone 10 – 40 mg TDS
 Cinnarizine 75 mg OD

Laxative ( Purgative )
 The drugs are used to treat constipation are called laxative .
 These drugs make the stool soft and increase the bowel movement and ease to Defecate ( to
pass stool) .
 If the laxatives are taken in high dose and cause diarrhoea( watery stool) it is called purgative .

Classification
 Bulk Forming - Dietary fiber : Bran , Psyllium , Ispagula , Methylcelulose .
 Stool softener : Docusates ( DOSS) , Liquid paraffin.
 Stimulant : Senna , Cascara sagrada , castor oil .
 Osmotic Purgatives : Mag. sulphate . Mag. Hydroxide

Pharmacological Action
 Bulk Forming - Dietary fiber : Bran , Psyllium , Ispagula , Methylcelulose These drugs
increase the weight and size of stool by absorbing water, and make the stool soft , so stool
passes easily.
 Stool softener : Docusates ( DOSS) , Liquid paraffin. It is a surfactant ingredient ( a substance
when it is added to a liquid , reduces its surface tension , so that increases its spreading and
wetting property ) It mixes the water in bowel with the stool and softens it.
 Stimulant : Senna , Cascara sagrada , castor oil . They increase the peristalsis movement by
direct acting on the enteric nervous system and ease the stool passage.
 Osmotic Purgatives : Mag. sulphate . Mag. hydroxide These agents stimulate the intestine to
absorb water in excess amount from the body and pore the water into stool , so stool becomes
soft and easier to pass out.
Indications
 Constipation
 Preoperative bowel preparation
 Fecal impaction
 Hemorrhoids
 Anal fissures

Contraindications
 Abdominal pain
 Nausea, and vomiting
 Rectal bleeding
 Gastrointestinal obstruction
 Diarrhea
 Inflammatory bowel disease

Dose
 Docusates 100-400 mg /day
 Liquid paraffin 15-30 ml /day
 Senna 10-40 mg at bed time
 Mag. sulphate 5-15 g in 150 ml water

Anti Diarrhoeal Drugs

 Diarrhoea : it a condition in which patients pass loss and watery Stool more than three times
a day .
 Acute Diarrhoea : If diarrhoea continues for 1-2 days it is called Acute diarrhoea .
 And if continues for more than 2 days it is called prolonged diarrhoea.
 In diarrhoea motility of GIT increased , fluid absorption decreased and causes a loss of water
and electrolytes in the body ( Na+)
 The drugs are used to treat diarrhoea are called anti- Diarrhoeal drugs .

Classification
 Anti-Motility agents : Morphine , Codeine , Loperamide ,Bismuth subsalicylate.
 Cannabinoids Receptor Agonist : Tetrahydrocannabinol.
 Adsorbents : Kaolin , Pectine, Chalk , Charcoal , methyl Cellulose.
 Anti-spasmodic Agents : dicyclomine , Mebeverine.
 Anti-Microbial drugs : refaximin , ciprofloxacin.
 Probiotics : Lactobacillus , Bifidobacterium.
Pharmacological Action
 Anti-Motility agents : Morphine , Codeine , Loperamide ,Bismuth subsalicylate. these drugs
decrease the ability of intestine to contract.
 Cannabinoids Receptor Agonist : tetrahydrocannabinol . The drugs reduce the intestinal
motility by decreasing the release of Acetylcholine from enteric nerve ( The nervous system
controls the function of GIT).
 Adsorbents : Kaolin , Chalk , Charcoal , methyl Cellulose . They absorb water , toxin ,and
bacteria from GIT , and give relief.
 Anti-spasmodic Agents : dicyclomine , Mebeverine . They relax the smooth muscles and rid
from spasm and pain in bowel.
 Anti-Microbial drugs : refaximin , ciprofloxacin . These drugs kill the microorganism or
prevent their growth.
 Probiotics : Lactobacillus , Bifidobacterium . These are good bacteria of large intestine , if
diarrhoea is due to lack of them , the use of Probiotics treats the diarrhoea.

Indications
 Treat diarrhea
 To reducs intestinal motility
 Abdominal Pain
 Spasm etc

Contraindication
 Gastrointestinal obstruction
 Inflammatory bowel disease
 Allergic reactions
 Renal and hepatic impairment
 Fecal incontinence

Doses
 Codeine 60mg Tds
 Loperamide 4 mg 2 mg after per motion
 Probiotic ( Econorm ) 250 mg
 Kaolin 26.2 mg after each loss motion
 Methyl Cellulose 2 tabs .1000 mg with 8 oz of water
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