Drug acting on digestive system

Drugs affecting the GI system are used in the treatment of gastric acidity, peptic ulcers, and gastroesophageal reflux disease (GERD), bowel motility disorders (gastroparesis [delayed gastric emptying due to partial paralysis of the stomach muscles], constipation, and diarrhea), and for the treatment of nausea and vomiting.

1. DRUGS ACTING ON DIGESTIVE SYSTEM JAI NARAIN VYAS UNIVERSITY, JODHPUR ASSISTANT PROFESSOR:- ASHWIN SINGH CHOUHAN DEPARTMENT:- PHARMACOLOGY E-MAIL:[email protected]

2. What do you mean by drug acting on digestive system ASC JNVU PHARMACY, JODHPUR

3. The Gastrointestinal (GI) Tract Includes the Mouth, Stomach, Small Intestine ( Duodenum, Jejunum, and Ileum ), Large Intestine ( Cecum and Colon ), Rectum, Anus, and Its Accompanying Exocrine Glands ( The Salivary Glands, The Pancreas, and the Gallbladder). Drugs Affecting the GI System are Used In the Treatment of Gastric Acidity, Peptic Ulcers, and Gastroesophageal Reflux Disease (GERD), Bowel Motility Disorders Constipation, and Diarrhea), and For the Treatment of Nausea and Vomiting. ASC JNVU PHARMACY, JODHPUR

4. Carminatives Digestant Bitter Drugs used in constipation Purgatives Laxatives Antispasmodics Antacids Drugs used in peptic ulcer Antiemetic and emetics antidiarrhoeals ASC JNVU PHARMACY, JODHPUR

5. ASC JNVU PHARMACY, JODHPUR CARMINATIVE These Are Drugs Which Helps In Expulsion ( Removal) of Gases From Stomach and Intestine. EXAMPLES :- Asafoetida , Ginger, Coriander Etc USES :- Treatment of Flatulence ( gas in stomach), Used In Colic ( Pain In Stomach )

6. MECHANISM OF ACTION These Compounds Facilitates an Increase In Gastric Emptying and are Mildly Irritating To The So, That Peristalsis Is Increased, There By Relieving Gastric Mucosa. Cramping and Expelling Gas. These Act By : Mild Irritation Resulting In Increased GI Motility. Liberating Carbon dioxide.   Peristalsis :- the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wave-like movements that push the contents of the canal forward ASC JNVU PHARMACY, JODHPUR

7. ASC JNVU PHARMACY, JODHPUR DIGESTANT Digestants are Drugs Which Enhance the Process of Digestion. Examples :- Pepsin, Renin , pancreatin etc. Pepsin ( Digest Protein ) Amino Acid Renin ( Chymosin ) Caseinogen Insoluble Casein Pancreatin Amylase, Trypsin , Lipase RENIN :- Coagulated Milk ( milk curdling enzyme )

8. ASC JNVU PHARMACY, JODHPUR BITTER These Agents Stimulate Taste Buds a nd Produces Reflex Secretion of Gastric Juice . EXAMPLES :- Chirata , Gentian USES :- Treatment of Anorexia (Loss of Appetite) Appetizers:- secretion of gastric juice called appetite

9. DRUG USED IN CONSTIPATION ASC JNVU PHARMACY, JODHPUR

10. Laxatives, purgatives, or cathartics are substances that loosen stools and increase bowel movements . They are used to treat and/or prevent constipation. Constipation is the infrequent or difficult evacuation of the faeces. ASC JNVU PHARMACY, JODHPUR

11. ASC JNVU PHARMACY, JODHPUR PURGATIVE Purgative Is a Medicine That Remove Unwanted Waste From Body( Defecation ) Examples :- Plantago Seeds ( Isabgol ) , Milk of Magnesia ( Osmotic Purgative), Methyl Cellulose ( Bulk Purgative) USES - Treatment of Constipation.

12. ASC JNVU PHARMACY, JODHPUR LAXATIVES Laxatives and Purgatives are Substances That Loosen Stools and Increase Bowel Movements Isabgol Is Good Remedy Used as Laxative USE :- Treatment of Constipation.

13. ASC JNVU PHARMACY, JODHPUR THREE TYPES OF LAXATIVES ARE KNOWN: Laxative Or Aperients : Milder Action, Elimination of Soft But Formed Stools. Onset Of Action: 12-72 Hours . Purgative : Purgative are Moderate Laxative. Onset Of Action: 6-8 Hours. Cathartic : Stronger Action Resulting In More Fluid Evacuation. Onset Of Action: 0.5-3 Hours (Oral), 2-15 Minutes (Rectal).

14. ASC JNVU PHARMACY, JODHPUR CLASSIFICATION : Bulk forming : Dietary fibre : Ispaghula ( Plantago ), Methylcellulose Stool softener : Docusate (DOSS), Liquid paraffin Stimulant purgatives : Senna , Sodium picosulfate , Castor oil Osmotic purgatives [Saline (Osmotic) Cathartics]: Magnesium salts : sulfate, hydroxide; Sodium salts : sulfate, phosphate; Sodium. Potassium. tartrate ; Lactulose

15. ASC JNVU PHARMACY, JODHPUR MECHANISM OF ACTION All purgatives increase the water content of faeces by: A hydrophilic or osmotic a ction , retaining water and electrolytes in the intestinal lumen-increase volume of colonic content and make it easily propelled. Acting on intestinal mucosa , decrease net absorption of water and electrolyte; intestinal transit is enhanced indirectly by the fluid bulk. Increasing propulsive activity as primary action-allowing less time for absorption of salt and water as a secondary effect.

16. ASC JNVU PHARMACY, JODHPUR ANTISPASMODIAC A Median That Relieve From Muscle Pain Especially Smooth Muscle Such as In Bowel Wall CLASSIFICATION :- ( Antimuscarinics / Anticholinergics ):- Dicyclomine , Belladonna, Hysine , Atropine ( Smooth muscle relaxant ) :- Peppermint etc

17. ASC JNVU PHARMACY, JODHPUR ANTACID Antacids are the drugs which are used to neutralise the gastric contents. Antacid occurs due to excessive secretion of HCL in stomach. Classification of Antacid Systemic antacid ( absorbable ):- systemic antacids are soluble absorbable and capable to produce synthetic alteration or alkalosis. Examples :- NaHCo 3

18. ASC JNVU PHARMACY, JODHPUR Non-systemic Antacids ( Non-absorbable ):- These are Not Absorbable To A Significant extent and Thus Do Not extent The appreciable non- systemic antacids. Examples :- Mg salts, Al salts, calcium bicarbonate etc Aluminum Containing Antacids :- Aluminum Hydroxide, Dihydroxy Aluminum Sodium Hydroxide. Calcium Containing Antacids :- Calcium Carbonate. Tribasic Calcium Phosphate. Magnesium Containing Antacids :- Magnesium Hydroxide, Magnesium Oxide.

19. ASC JNVU PHARMACY, JODHPUR IDEAL PROPERTIES OF ANTACIDS It Should Be Insoluble In Water and Has Fine Particle From. It Should Not Be Absorbable and Cause Systemic Alkalosis. It Should Be Stable and Does Not Produce Any Side Effects. It Should Be Readily Available. It Should Cause Laxative or Constipatic Effect. The Reaction Between Antacid and HCL Should Not Produces Large Volume of Gas. It Should Buffer In Ph Range of 4-6.

20. H + NaHCo 3 Acid secretion Parietal cell HCL Digestion Juice Antacid NaHCo 3 Food Will Initiate Acid Secretion H 2 Co 3 H 2 O + CO 2 HCL Glass of Digestion juice HCL Add Antacid tablet NaHCo 3 in HCL glass 1 3 2 Remove acid form HCL glass Mechanism Action Of Antacid Drug ASC JNVU PHARMACY, JODHPUR Discomfort due to acidity

21. PARIETAL CELLS Parietal Cells Secrete Hydrochloric Acid and Chief Cells Secrete Digestive  Enzymes  Such as Pepsin. These Cells Secrete Their Products When Activated by Signals From The  Body  Such as  Hormones  and Neurotransmitters. MUCUS LAYER It is a protective barrier to  stomach  acid, bile salts, pancreatic enzymes, macromolecules. The  mucus  lining your  stomach  helps prevent your  stomach  lining from the negative effects of excessive exposure to acid or pepsin. ASC JNVU PHARMACY, JODHPUR

22. ASC JNVU PHARMACY, JODHPUR DRUGS USED IN PEPTIC ULCER

23. ASC JNVU PHARMACY, JODHPUR PEPTIC ULCER( Antiulcer Drugs) Antiulcer drugs are used in the treatment of gastric and duodenal ( peptic ulcer). Antiulcer drugs promoting ulcer healing. Why peptic ulcer occur? Helicobacter pylori bacteria also responsible for ulcer production. Imbalance between aggressive and defensive factors responsible for peptic ulcer. Aggressive Factor Acid Pepsin Bile H.Pylori Drugs (NSAIDS) smoking and alcohol Defensive Factor Mucous Membrane HCO3, Prostaglandin phospholipids

24. ASC JNVU PHARMACY, JODHPUR CLASSIFICATION OF PEPTIC ULCER/ ANTIULCER DRUG Reduction Gastric Acid Secretion Antihistamine Receptor Antagonist:- Cimetidine , Ranitidine etc. Anticholinergic Drug:- Belladonna, Atropine etc. Proton Pump Inhibitors (PPIs):- Omeprazole , Pantoprazole etc. Prostaglandin Analogues:- Misoprostol . Neutralize Gastric Acid ( Antacid) Systemic:- Sodium Bicarbonate, Sodium Citrate etc. Non-systemic:- Magnesium Hydroxide, Aluminum Hydroxide Gel, Calcium Carbonate Etc Anti Helicobacter Pylori Drug:- Clarithromycin , Amoxicillin, Tetracycline Etc Ulcer Protective :- Sucralfate , Colloidal Bismuth Subcitrate etc. Ulcer Healing :- Carbenoxolone Sodium.

25. Acid secretion Parietal cell Mucus protective layer Mechanism Action Of peptic ulcer Drug ASC JNVU PHARMACY, JODHPUR Acid prevention Acid attack protective Ulcer generation Ulcer protective :- sucralfate , bismuth colloidal subcitrate Antacid :- Aluminum Hydroxide Gel, Magnesium Hydroxide H 2 histamine Inhibitor antagonist: Cimetidine Ranitidine DRUGS Inhibiting Gastric Acid Secretion K + H + K + H + Neutralize acid H.pylori Bind Antagonist Proton Pump Inhibitors (PPIs):- Omeprazole , Pantoprazole etc. Antibiotic Clarithromycin , Amoxicillin HCL Digestion Juice

26. ASC JNVU PHARMACY, JODHPUR MOA OF ANTIULCER DRUG Inhibitor Are Reduced Acid Stimulate Vagus Nerve Stimulate Ach Histamine + H 2 Receptor More Acid Secrete( HCL) Ulcer - Activated release of histamine Anticholinergic Ach release H 2 receptor blocker - Proton pump inhibitors suppress acid secretion - Antacid Neutralize acid secretion

27. ASC JNVU PHARMACY, JODHPUR ANTIEMETIC AND EMETICS VOMITING : It's Not A Disease Its Indication of Certain Diseases Vomiting Occur Due To Stimulation of Vomiting Center That Respond To Inputs From: Chemoreceptor Trigger Zone (CTZ) Stimulation. Disturbance of Vestibular System. Higher Cortical Center Stimulation (CNS). The Periphery (Pharynx, GIT) Via Sensory Nerves.

28. ASC JNVU PHARMACY, JODHPUR Three Types of Vomiting:- Morning Sickness:- starting 3 month of Pregnancy. Motion Sickness :- Travelling Time. Diarrhea Sickness:- Eating Junk Foods. EMETICS This are Drugs Which Produce Vomiting. Classification Of Emetic Stimulate of CTZ :- apomorphine , morphine etc Irritants of Gastrointestinal Mucosa :- mustard, copper sulphate , sodium chloride etc

29. ANTIEMETICS:   It Is a Drug That Is Effective Against Vomiting and Nausea. CLASSIFICATION OF ANTIEMETIC Anticholinergic Drug :- Hyosine , Dyclomine H1 Antihistaminic Drug :- Promethazine , Doxylamine Neuroleptics ( D2 Blockers) :- Chlorpromazine Prokinetic :- Metoclopramide , Domperidone 5-HT3 Antagonist :- Ondansetron . Ramosetron NK1 Receptors Antagonist :- Aprepitant Other Drugs :- Dexamethasone , Benzodiazepine ASC JNVU PHARMACY, JODHPUR

30. ASC JNVU PHARMACY, JODHPUR CTZ Blood Vessels Cortex Bad smell bad matter Medulla oblongata 5HT PG Ear osssicles vibrate ( motion sickness) 5HT Release and activated CTZ Mechanism Action Of Antiemetic Drug G.I.T Cerebellum VC Brain

31. ASC JNVU PHARMACY, JODHPUR Neurotransmitter Classification Antiemetic Drug Mechanism of Action Acetylcholine (M1) Anticholinergics scopolamine Blocks ACh receptors in vestibular system Histamine (H1) Antihistamines meclizine Blocks H1 receptors and thus blocks ACh in vestibular system Dopamine (DA2) Dopamine antagonists prochlorperazine Blocks dopamine in CTZ and may block ACh Dopamine and ACh (DA2 and M1) Prokinetics metoclopramide Blocks dopamine in CTZ and stimulates ACh in GI tract Serotonin (5HT) Serotonin antagonists ondansetron Blocks serotonin in GI tract, CTZ, and VC Substance P (NK1) Neurokinin antagonists aprepitant Inhibits substance P neurokinin receptors Cannabinoid (CB1) Tetrahydrocannabinols (THC) dronabinol or medical marijuana Activated CB1 receptor leading to inhibitory effects on cerebral cortex

32. ASC JNVU PHARMACY, JODHPUR DIARRHOEA More Frequently Passage of Poorly Formed Stool. W.H.O = 3 or More Than 24 Hours Cause Increase Secretion By Intestinal Mucosa. Increase Luminal Osmotic Pressure Inflammatory of Mucosa Decrease Electrolyte and Water Absorption= H 2 O in stool Microbial Infection Other cause – infection, toxin, anxiety, drug induced. Virus- rotavirus, corona virus , astrovirus Bacteria- E-coli, salmonella, Vibrio cholerae

33. ANTIDIARREAL DRUG Antidiarrheal  Is a Drug That Is Used To Slow Down or Stop Loose Stools ( Diarrhea ). The First Category Refers to antidiarrhoeal adsorbents. They work best on mild chronic diarrhoea. Kaolin is an example The Second Category Refers to inhibitors of intestinal movement. They control diarrhoea by producing a direct relieving effect on intestinal peristalsis. Diphenoxylate and loperamide are common examples.

34. ASC JNVU PHARMACY, JODHPUR CLASSIFICATION OF ANTIDIARREAL DRUG Antimicrobial Agents:- Norfloxacin , Ciprofloxacin, Metronidazole Etc Probiotics ( Good Bacteria ) :- Lactobacillus, Bacillus Etc For Inflammatory Bowel Disease:- 5- Amino Salicyclic Acid :- Salfosalazine , Osalazine , Mesalazine Etc Glucocorticoids :- Predenisolone , Hydrocortisone Etc Immunosuppressant :- Azithioprene , Methotrixate Etc Non Specific Antidiarreal Agents Absorbant :- Kaolin , Isapghula , Methycellulose Etc Anti Secretory :- Bisubsalicylate , Anticholinergic Etc Antimotility :- Codeen , Loperamide Etc

35. ASC JNVU PHARMACY, JODHPUR THERE ARE THREE COMMON MECHANISMS OF ACTION OF ANTIDIARRHEAL MEDICATIONS Adsorbents , Which Help Eliminate The Toxin or Bacteria From The GI Tract . Antimotility  Agents Which Slow Peristalsis. Probiotics Which Help To Restore The Normal Bacteria Found In The Lower Intestine. Oral Rehydration Agents May Also Be Used In Patients With  Diarrhea To Replace Fluid And Electrolyte Loss, But They Do Not Treat The  Diarrhea .

36. Mechanism Action of Adsorbent Adsorbent Medications Work By Coating The Walls Of The GI Tract And Binding The Causative Bacteria Or Toxin For Elimination From The GI Tract Through The Stool. Bismuth Subsalicylate Also Decreases The Flow Of Fluids And Electrolytes Into The Bowel, Reducing Inflammation Within The Intestine. Mechanism Action of Antimotility Antimotility Medications Help To Treat  Diarrhea  By Slowing Peristalsis. There Are Two Categories Of Antimotility Medication:  Anticholinergics And Opiate-like Medication. Mechanism Of Action of Anticholinergics Hyoscyamine Is An Anticholinergic That Works On The Smooth Muscle Of The GI Tract To Inhibit Propulsive Motility And Decreases Gastric Acid Secretion. Mechanism Of Action of Probiotics Probiotics Help Replenish Normal Bacterial Flora In The Gastrointestinal Tract. ASC JNVU PHARMACY, JODHPUR

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