Drugs used in diarrhoea, laxatives .pptx

drugs used in diarrhoea

1. DRUGS USED IN DIARRHOEA DR. AHMED ABDUL BARI HAZARI DEPARTMENT OF PHARMACOLOGY MTMC

2. What is Diarrhoea? It is the frequent passage of poorly formed, liquid stools. It is defined by WHO as 3 or more loose or watery stools in a 24-hour period. In pathological terms, it occurs due to passage of excess water in faeces .

3. Pathophysiology Jejumum – freely permeable to salt & water Colon – Na + K + ATPase Ileum - Na + K + ATPase - Glucose facilitated Na + absorption (Na + - glucose cotransporter)

4. Action of cyclic nucleotides on electrolyte transport in the intestine Cholera toxin, ETEC, Staph. aureus , Salmonella Clostridium difficile, E. histolytica

5. Causes of Diarrhoea Infections Drugs: antibiotics, antacids, SSRIs, laxatives etc. IBS & IBD Carcinoid tumour Anxiety and stress

6. Steps in Treatment Replacement of fluid and electrolytes. Maintenance of nutrition. Drug therapy.

7. FLUID AND ELECTROLYTE REPLACMENT

8. Oral rehydration Intravenous rehydration

9. Oral rehydration Used only in mild-moderate fluid loss (5-10 % BW). NaCl 2.6 g KCl 1.5 g Trisod . Citrate 2.9 g Glucose 13.5 g Water 1 litre

10. Oral rehydration solution Potassium is an important constituent. Base is added to correct acidosis. The molar ratio of glucose should be equal to or somewhat higher than Na +

11. Non- diarrhoeal uses of ORS: Postsurgical, postburn and post-trauma maintenance of hydration and nutrition (in place of i.v. infusion). Heat stroke. During changeover from intravenous to enteral alimentation.

12. Intravenous rehydration Used only when fluid loss is severe (> 10% BW). Or when patient is unable to take enough oral fluids due to weakness, vomiting etc. Normal saline, ringer lactate. Volume equivalent to 10% BW over 2-4 hours.

13. MAINTENANCE OF NUTRITION Fasting can reduce intestinal enzymes and absorption of salt, water and nutrients. Simple foods to be started as soon as the patient can eat.

14. DRUG THERAPY

15. Specific antimicrobial drugs. Nonspecific anti- diarrhoeal agents.

16. Antimicrobials ANTIMICROBIALS ARE USEFUL IN: Cholera: tetracycline, norfloxacin/ciprofloxacin Amoebiasis/Giardiasis: metronidazole Clostridium difficile: metronidazole, vancomycin Travellers’ diarrhoea: Rifaximin, ciprofloxacin Shigella and Salmonella enteritis EPEC

17. ANTIMICROBIALS ARE OF NO VALUE: Irritable bowel syndrome. Pancreatic enzyme deficiency. Thyrotoxicosis . Rotaviral diarrhoea .

18. Nonspecific agents ADSORBENTS: Kaolin Pectin Activated charcoal

19. ANTIMOTILITY DRUGS: These are opioids. They: Increase bowel tone, reduce propulsive movements. Diminish intestinal secretions. Enhance absorption. Examples: Codeine, loperamide, diphenoxylate. USES: Noninfective diarrhoeas only. CONTRAINDICATED in CHILDREN and ACUTE INFECTIVE DIARRHOEAS

20. ANTISECRETORY DRUGS: Racecadotril Enkephalinase inhibitor. Used in acute secretory diarrhoeas . Not contraindicated in children.

21. PROBIOTICS Lactobacillus, Bifidobacteria Used in antibiotic associated diarrhoea, traveller’s diarrhoea. May cause infections (rare).

22. Zinc in Paediatric Diarrhoea With ORS, reduces the duration and severity of acute diarrhoea episodes in children below 5 years of age. 10-20 mg/day for 10-14 days.

23. Drugs for inflammatory bowel disease (IBD) Sulfasalazine, mesalazine , olsalazine , balsalazide . Corticosteroids: Prednisolone. (Acute exacerbations) Immunosuppressants: Azathioprine, methotrexate. TNF α inhibitors: Infliximab.

24. Sulfasalazine 5-aminosalicylic acid (5-ASA) with sulfapyridine linked through an azo bond. Local anti-inflammatory effect: inhibits cytokine, PAF, TNF α , COX and LOX. USES: 1) Maintaining remission in Ulcerative colitis. 2) Rheumatoid arthritis. A/E: Rashes, fever, vomiting, headache, anaemia.

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