B 19, drugs for diarrhoea & constipation
-
Upload
aimst-university-malaysia -
Category
Health & Medicine
-
view
951 -
download
10
description
Transcript of B 19, drugs for diarrhoea & constipation
![Page 1: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/1.jpg)
Drugs for treating Diarrhoea
Dr. Badar Uddin Umar MBBS, MPhil
![Page 2: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/2.jpg)
DiarrhoeaDiarrhoea
There is imbalance between secretion and reabsorption of fluid and electrolytes.
Treatment is aimed at restoration of fluid and electrolyte balance first.
Then treatment of the cause.
![Page 3: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/3.jpg)
Causes of Diarrhoea:Causes of Diarrhoea:
1. Infection with enteric organism
2. Inflammatory bowel disease
3. Malabsorption due to disease
4. Disorder of gut motility
5. Secretory tumors – rare
![Page 4: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/4.jpg)
TreatmentTreatment Fluid and electrolyte treatment:
Oral rehydration salt (ORS) The WHO/UNICEF
recommended formulation is:
Sodium chloride 3.5 g/l
Potassium chloride 1.5 g/l
Sodium citrate 2.9 g/l
Anhydrous glucose 20 g/l
Total osmolarity 311mmol/l
![Page 5: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/5.jpg)
TreatmentTreatment Fluid and electrolyte treatment:
‘Reduced osmolarity Oral rehydration salt’ (ORS) WHO/UNICEF recommended formulation is:
Sodium chloride 2.6 g/l
Potassium chloride 1.5 g/l
Sodium citrate 2.9 g/l
Anhydrous glucose 13.5 g/l
Total osmolarity 245 mmol/l
This is also known as Neo Saline
![Page 6: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/6.jpg)
Antidiarrhoeal drugsAntidiarrhoeal drugs
Antimotility drugs: Opioids:
Codeine
Diphenoxylate
Loperamide
Opium tincture
Morphine
Drugs increasing viscosity of gut contents: Kaolin & Pectin Methylcellulose Chalk Activated Attapulgite
![Page 7: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/7.jpg)
Antidiarrhoeal drugsAntidiarrhoeal drugsAntidiarrhoeal drugsAntidiarrhoeal drugs
Anticholinergics: Belladonna
Atropine
Propantheline
Dicyclomine HCl
Mebeverine
Miscellaneous: Peppermint oil
Vegetable astringents
![Page 8: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/8.jpg)
Antimotility drugsAntimotility drugs Opioids have significant constipating
effects
They increase colonic phasic segmenting activity through inhibition of presynaptic cholinergic nerves in the submucosal and myenteric plexuses and lead to increased colonic transit time and fecal water absorption
They also decrease mass colonic movements and the gastrocolic reflex
![Page 9: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/9.jpg)
Loperamide is a nonprescription opioid agonist
It does not cross the blood-brain barrier and has no analgesic properties or potential for addiction
Tolerance to long-term use has not been reported
It is typically administered in doses of 2 mg taken one to four times daily
Antimotility drugs cont….Antimotility drugs cont….
![Page 10: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/10.jpg)
Diphenoxylate is another opioid agonist Has no analgesic properties in standard
doses Higher doses have CNS effects Prolonged use can lead to opioid
dependence Commercial preparations commonly
contain small amounts of atropine to discourage overdosage (2.5 mg diphenoxylate with 0.025 mg atropine)
The anticholinergic properties of atropine may contribute to the antidiarrheal action
Antimotility drugs cont….Antimotility drugs cont….Antimotility drugs cont….Antimotility drugs cont….
![Page 11: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/11.jpg)
KAOLIN & PECTIN Kaolin is a naturally occurring
hydrated magnesium aluminum silicate (attapulgite)
Pectin is an indigestible carbohydrate derived from apples
Both appear to act as absorbents of bacteria, toxins, and fluid, thereby decreasing stool liquidity and number
They may be useful in acute diarrhea but are seldom used on a chronic basis
![Page 12: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/12.jpg)
A common commercial preparation is Kaopectate
The usual dose is 1.2-1.5 g after each loose bowel movement (maximum: 9 g/d)
Kaolin-pectin formulations are not absorbed and have no significant adverse effects except constipation
They should not be taken within 2 hours of other medications (which they may bind)
KAOLIN & PECTIN
![Page 13: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/13.jpg)
C. Antimicrobial therapyC. Antimicrobial therapy
Cause Drug of 1st choice Alternative drug
Cholera For younger children: ErythromycinFor adults: Tetracycline
Co-trimoxazole
Shigellosis Nalidixic acidCo-trimoxazole
PivmecillinamAmpicillin
Acute intestinal amoebiasis
Metronidazole Tinidazole
Acute giardiasis
Metronidazole
![Page 14: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/14.jpg)
Some special diarrhoeal conditions:
Travelers' diarrhoea
Specific infective diarrhoea
Drug induced diarrhoea
Secretory diarrhoeas due to carcinoid tumor and vipomas treated with octreotide
• A VIPoma (also known as Verner Morrison syndrome• A rare endocrine tumor, usually (about 90%) originating from non-β islet cell of the
pancreas• Produce vasoactive intestinal peptide (VIP)• It may be associated with multiple endocrine neoplasia type
![Page 15: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/15.jpg)
Precautions Antidiarrhoeal agents may be used safely in
patients with mild to moderate acute diarrhea
However, they should not be used in patients with bloody diarrhea, high fever, or systemic toxicity because of the risk of worsening the underlying condition
They should be discontinued in patients whose diarrhea is worsening despite therapy
![Page 16: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/16.jpg)
Other anti diarrhoeals Bile salt-binding resins-
cholestyramine and colestipol decrease diarrhea caused by excess fecal bile acids
The usual dose is 4-5 g one to three times daily before meals
Adverse effects include-
– bloating, flatulence, constipation, fecal impaction and exacerbation of fat malabsorption
![Page 17: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/17.jpg)
OctreotideSomatostatin, a 14 amino acid
peptide, released in the gastrointestinal tract and pancreas from paracrine cells, D-cells, and enteric nerves as well as from the hypothalamus
![Page 18: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/18.jpg)
Effects of Somatostatin : It inhibits the secretion of numerous
hormones and transmitters, including gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, pancreatic polypeptide, vasoactive intestinal peptide, and 5-HT
It reduces intestinal fluid secretion and pancreatic secretion
It slows gastrointestinal motility and inhibits gallbladder contraction
![Page 19: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/19.jpg)
It induces direct contraction of vascular smooth muscle, leading to a reduction of portal and splanchnic blood flow
It inhibits secretion of some anterior pituitary hormones
Effects of Somatostatin cont..
![Page 20: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/20.jpg)
Octreotide Is a synthetic octapeptide with actions
similar to somatostatin
When administered intravenously, it has a serum half-life of 1.5 hours
It also may be administered by subcutaneous injection, resulting in a 6 – 12 hour duration of action
A longer-acting formulation is available for once-monthly depot intramuscular injection
![Page 21: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/21.jpg)
Clinical Uses Secretory diarrhea caused by
gastrointestinal neuroendocrine tumors (carcinoid, VIPoma)
Diarrhea due to vagotomy or dumping syndrome
Diarrhea caused by short bowel syndrome or AIDS
Pancreatic fistula
Pituitary tumors
![Page 22: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/22.jpg)
Nitazoxanide
Rotavirus is a leading cause of morbidity and mortality in children younger than 5 years
A 3-day course of nitazoxanide significantly reduced the duration of rotavirus disease in hospitalized paediatric patients
* The Lancet, Volume 368, Issue 9530, Pages 124 - 129, 8 July 2006
![Page 23: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/23.jpg)
Treatment of Constipation
![Page 24: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/24.jpg)
What is constipation?
![Page 25: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/25.jpg)
Laxatives/purgatives
These are drugs that promote evacuation of bowels-Laxatives/ aperient:
– Milder in action
– Produces soft but formed stool
Purgatives/ cathartics:– Stronger acting
– Produces fluid stool
*Many laxatives in higher doses act as purgatives
![Page 26: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/26.jpg)
Laxatives
Chronic use of laxatives may make you… dependent
![Page 27: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/27.jpg)
Management of constipation
Avoid highly refined diet
Avoid aluminium containing antacids & Iron
Take Plenty of vegetables, fruits and milk
![Page 28: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/28.jpg)
Don’t use laxatives
![Page 29: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/29.jpg)
Eat a diet with high roughage
![Page 30: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/30.jpg)
Management of constipation
Drink a cup of warm water/ tea/ coffee half an hour before breakfast
Mild exercise for bed ridden patients, patients of old ages are required to improve tone of abdominal muscles
Anxiety and worry to be avoided
![Page 31: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/31.jpg)
Drug classes used as laxatives/ Types of laxatives
Bulk laxatives
Faecal softeners
Stimulant laxatives
Osmotic laxatives
![Page 32: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/32.jpg)
Bulk Laxatives
Isapghula huskMethyl celluloseBranPsyllium (Plantago)SterculinIndigestible vegetables
![Page 33: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/33.jpg)
Isapghula husk
How it should be taken?
Indigestible vegetables: act within 1-3 hrs
![Page 34: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/34.jpg)
Isapghula husk
Contain natural colloidal mucilage
Absorbs water in the gut
Forms a gelatinous mass
![Page 35: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/35.jpg)
Stimulant Laxatives (Contact Laxatives)
Bisacodyl (Dulculax): – Powerful purgatives
– Orally given, act within 6-10 hrs.
– Suppository act within 15-30 min.
Senna (Laxena): – Acts within 8-12 hours
Castor oil (Fixed oil)
![Page 36: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/36.jpg)
Mechanism of action of stimulant purgatives
Stimulate motor activity by irritating the mucosa
Causes accumulation of water and electrolytes in the gut lumen by– altering absorption
– inhibit Na+K+ATPase at the basolateral membrane of villous cells
– cAMP activation leads to increased secretion
– PG synthesis also increases secretion
![Page 37: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/37.jpg)
Adverse effects of stimulant purgativesExcessive purgationFluid and electrolyte imbalanceHypokalemiaColonic atony in long term useContra-indicated in-
– pregnancy as it can cause abortion– subacute or chronic intestinal
obstruction
![Page 38: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/38.jpg)
Osmotic LaxativesLactulose( Disaccharide):
– Very good in hepatic encephalopathy
– Fermented to Lactic & Acetic acid and prevents ammonia producing organisms
Magnesium sulfate: – Useful when powerful effect is
required
![Page 39: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/39.jpg)
Osmotic Laxatives
Remain unabsorbed in GITRetain water osmoticallyDistend in the gut Increase peristalsisMg ions release cholecystokinin
adding to their purgative action
Mg salts are contraindicated in renal failure, sodium salts are contraindicated in CHF
![Page 40: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/40.jpg)
Lactulose Semisynthetic disaccharide of
fructose and lactoseNot digested, not absorbed in
small intestineRetains water In the colon broken down by
bacteria in to osmotically active products
![Page 41: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/41.jpg)
Adverse effects of lactulose
FlatulenceCramps and Nausea due to very sweet taste
![Page 42: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/42.jpg)
Faecal Softeners
Milk of magnesia
Liquid paraffin:
– For short term use only
– Has lot of complications
Mineral oil
![Page 43: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/43.jpg)
Common indications for laxatives1. Functional constipation
– Spastic constipation– Atonic constipation
2. Bed-ridden patientsMyocardial infarction, stroke, fracture and post-
operative pts.
3. To avoid straining at stool4. Preparation of bowel for surgery,
colonoscopy & radiography5. After certain anthelmintics6. Food/ drug poisoning
![Page 44: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/44.jpg)
Contraindications of laxativesUndiagnosed abdominal pain, colic or
vomitingSecondary constipation due to
– Stricture, obstruction etc.– Hypothyroidism– Hypercalcemia– Malignancies– Some drugs like-opiates, sedatives,
anticholinergics, antidepressants, antihistamines, iron, clonidine, verapamil, laxative abuse itself
![Page 45: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/45.jpg)
SLOsAt the end of the lecture students should be able to-
43.1 list the drugs used in the treatment of constipation
43.2 list the drugs used for the treatment of diarrhoea
43.3 Describe the mechanism of action of drugs acting in constipation and list other uses of these drugs
43.4 Describe mechanism of action and side effects of antidiarrhoeals
![Page 46: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/46.jpg)
Questions?
![Page 47: B 19, drugs for diarrhoea & constipation](https://reader035.fdocuments.in/reader035/viewer/2022062220/559078201a28ab24568b4601/html5/thumbnails/47.jpg)
ThanksThanks