Diahorrea

mainly loose stools are known diarrhea. this presentation helpful for students.

1. ANTI –DIARRHEAL DRUGS Presented by : RINKA JUNEJA Department of PHARMACOLOGY ISF college of pharmacy ,MOGA

2. Contents Defination Types of diahorrea Etiology of diahorrea Epidemiology of diahorrea Pathophysiology of diahorrea Sign & symptoms Pharmacology References

3. Definition Diarrhea is too frequent ,often too precipitate passage of poorly formed stools. It is defined by WHO 3 or more loose or watery stools in a 24 hour period. In pathological terms, it occurs due to the passage of excess water in faces. It may due to Decreased electrolyte and water absorption. Increased secretion by intestinal mucosa.

4. Types of diahorrea There are three clinical types of diarrhoea: acute watery diarrhoea – lasts several hours or days, and includes cholera; acute bloody diarrhoea – also called dysentery; and persistent diarrhoea – lasts 14 days or longer

5. Etiology of diarrhoea Diahorrea usually may symptom of gastroenteritis an infection of bowl. It is caused by : Hepatitis virus CMV Rota virus Salmonella and shigella – food poisoning

6. Epidemiology Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable. Each year diarrhoea kills around 525 000 children under five. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year. Diarrhea is a leading cause of malnutrition in children under five years old.

7. Pathophysiology Four general pathophysiologic mechanisms disrupt water and electrolyte balance, leading to diarrhea, and are the basis of diagnosis and therapy. These are:- (a) a change in active ion transport by either decreased sodium absorption or increased chloride secretion; (b) change in intestinal motility ; (c) increase in luminal osmolarity; and (d) increase in tissue hydrostatic pressure .

8. Clinical presentation of diarrhoea Signs and symptoms onset of nausea, vomiting, abdominal pain, headache, fever Bowel movements are frequent . Laboratory tests Stool analysis studies include examination for microorganisms, blood, mucus, fat, osmolality, pH, electrolyte and mineral concentration, and cultures. Stool test kits are useful for detecting gastrointestinal viruses,(rotavirus).

9. Pharmacology Pharmacology of diarrhea mainly contain :- Rehydration therapy Nutrition therapy Anti microbial therapy

10. Oral rehydration salts (WHO-ORS) Rehydration with ORS is usually sufficient for management of moderate dehydration from acute diarrhoea, regardless of etiology, which can be safely and effectively treated in over 90% of cases by the use of ORS. ORS is absorbed in the small intestine even during diarrhoea, thus replacing the water and electrolytes lost in the faces . A particular advantage of this is that ORS may be used as home treatment to prevent dehydration

11. Nutrition therapy Patients of diarrhea should not be starved. Simple food like : breast milk, boiled potato, rice, chicken soup, banana, etc should be given to the patient When a patient have diarrhea than some on the main nutrients are lost : sodium ,potassium, water ,proteins, vitamins and calories . BLAND foods are given to the diahorrea patients.

12. Anti microbial therapy One or more antimicrobial agents is almost routinely prescribed to most of the patients of diarrhea Such drugs have limited role in overall treatment of diarrheal diseases, the reason are Bacterial pathogen is responsible for only fraction of class. Anti microbial alter the course of illness (bacterial diarrhoea) Anti microbial may prolong the carrier site.

13. OPIATES AND THEIR DERIVATIVES Most opiates act through peripheral and central mechanisms with the exception of loperamide, which acts only peripherally Loperamide is antisecretory; it inhibits the calcium-binding protein calmodulin, controlling chloride secretion. Loperamide, available as 2-mg capsules or 1 mg/5 mL solution

14. ADSORBENTS Adsorbents are used for symptomatic relief. These products, many not requiring a prescription, are nontoxic, but their effectiveness remains unproven. Adsorbents are nonspecific in their action; they adsorb nutrients, toxins, drugs, and digestive juices.

15. Polycarbophil as an effective adsorbent Polycarbophil absorbs 60 times its weight in water and can be used to treat both diarrhea and constipation

16. ANTISECRETORY AGENTS Bismuth subsalicylate appears to have antisecretory, anti-inflammatory, and antibacterial effects As a nonprescription product, it is marketed for indigestion, relieving abdominal cramps, and controlling diarrhea, including traveler’s diarrhea. .The usual adult dose is 2 tablets or 30 mL every 30 minutes to 1 hour up to 8 doses per day.

17. Inflammatory bowl disease It is the chronic or inflammatory disease of the ileum, colon or both that associated with systematic infestations It is idiopathic ,but occurs to have an important immune component triggered by variety of factors. Two major types of IBD: ulcerative colitis (uc) and crohns’s disease.

18. Drugs for IBD Drug used in IBD are grouped as: 5 amino salicylic acid (ASA) compounds Glucocorticoids Immunosuppressant's TNF alpha inhibitors

19. 5- ASA Compounds SULFASALAZINE Compound of 5-ASA with sulfa pyridine linked through an azo bond ,and has specific therapeutic effect in IBD. Poorly absorbed from ileum. It inhibits the both COX and LOX decreased production Drug :- SULAZOPYRIN 0.5G TAB

20. Immunosuppressant Immunosuppressant play an important role in long term management of IBD, Especially (CRD) About 60% patients with CRD and UC require immunosuppressant therapy. Risk of chronic immunosuppressant must be weighted in each patient . Azathioprine Methotrexate TnFalpha inhibitor

21. TNFalpha inhibitors Infliximab : It is chimera anti –TnF alpha antibody indicated in sevre active CrD and UC which has not improved with I.V corticosteroids and immuno suppressants Infused I.V every 2-8 weeks.

22. References Joseph T.Dipiro “Pharmacotherapy”, a pathophysiological approach ,6 edition pg no 677-684. DuPont HL. Diarrheal diseases in the developing world. Infect Dis clin North Am 1995;9:313–324. Everhart JE, ed. Digestive Disease in the United States: Epidemiology and Impact . NIH Publication 94-1447. Bethesda, MD, National Institutes Health , 1994.

23. Thompsom RF, Bass DM, Hoffman SL. Travel vaccine. Infect Dis Clin North Am 1999;13:149–167 World Health Organization, http\\ www.WHO .int accessed on 11 April 2019.