Digestive System Medications: Protecting and Regulating

Posted on Nov 20, 2024 in Biology

Digestive System Medications

Mucosal Protective Agents

  • Sulcralfate: Forms a protective film on the stomach lining, preventing erosion and promoting healing.
  • Carbenoxolone: Derived from licorice, stimulates mucus secretion for stomach wall protection. Caution in hypertensive patients due to potential fluid retention.

Secretion Inhibitors

  • H2 Antihistamines (cimetidine, ranitidine, famotidine): Inhibit hydrochloric acid (HCl) secretion, used for gastric/duodenal ulcers and esophagitis. Possible side effects include diarrhea, constipation, and dizziness.
  • Proton Pump Inhibitors (omeprazole): Inhibit the H+ pump, reducing HCl secretion. Potential side effects: headaches, diarrhea, skin rashes.

Gastric Protectors

Antiulcer medications used for conditions like reflux esophagitis, peptic ulcers, NSAID-induced gastropathy, and Zollinger-Ellison syndrome.

  • Omeprazole and Lansoprazole: Irreversibly inhibit the proton pump, providing long-lasting acid suppression.

Omeprazole

Composition: 20mg omeprazole per capsule.
Action: Selective proton pump blocker, antiulcer.
Dosage: Single dose after breakfast. Refer to link for detailed administration guidelines.
Side Effects: Rare; nausea, headaches, diarrhea, flatulence, rash (mild and transient).
Contraindications: Hypersensitivity to omeprazole. Not recommended for children, pregnant, or nursing mothers.
Presentation: Cartons of 7 or 14 capsules.

Lansoprazole

Composition: 30mg lansoprazole per capsule.
Action: Selective proton pump blocker, antiulcer.
Indications: Duodenal ulcer, gastric ulcer, reflux esophagitis, Zollinger-Ellison syndrome.
Dosage: Duodenal ulcer: 1 capsule/day for 4 weeks. Gastric ulcer: 1 capsule/day for 4-8 weeks. Reflux esophagitis: 1 capsule/day for 8 weeks.
Side Effects: Rare; diarrhea, constipation, nausea, headache, rash (mild and transient).
Contraindications: Hypersensitivity, pregnancy, lactation. Refer to link for more information.
Presentation: Cartons of 20 or 30 capsules with enteric-coated granules.

H2 Antihistamines (Cimetidine, etc.)

Inhibit acid secretion by blocking H2-histamine receptors. Refer to link for production details.

Cimetidine (Injectable)

Composition: 300mg cimetidine per 2ml ampoule.
Action: H2 receptor antagonist, antiulcer, inhibits gastric acid secretion.
Dosage: Adults: 300mg IM every 6-8 hours. Pediatric: 5-10mg/kg IM every 6-8 hours.
Presentation: Box of 100 blisters.

Famotidine

Composition: Tablets of 20mg and 40mg.
Action: H2 receptor inhibitor, antiulcer.
Dosage: Peptic Ulcer: 40mg orally once at night. Relief within 4 weeks for most patients.
Contraindications: Pregnancy, breastfeeding, children under 12 (safety not established).
Presentation: 20mg tablets (pack of 20), 40mg tablets (pack of 10).

Mulcatel (Sucralfate)

Action: Forms a protective barrier over ulcers, preventing acid attack. Not absorbed systemically.
Composition: 10g sucralfate per 100ml suspension.
Indications: Gastric and duodenal ulcers, reflux esophagitis in adults and children.
Dosage: Adults: 10ml (1 tablespoon) 4 times daily, 30 minutes before meals and at bedtime, for at least 4 weeks.
Presentation: 200ml bottle.

Prostaglandins (Misoprostol)

Increase stomach wall resistance to acids and block acid secretion at high doses. Refer to link for more information.

Misotrol (Misoprostol)

Composition: 200mcg misoprostol per tablet.
Indications: Prevention of NSAID-induced gastric ulcers, treatment of active duodenal and gastric ulcers.
Dosage: Prevention of NSAID-induced ulcers: 200mcg orally 4 times daily.
Presentation: Bottle of 28 tablets.

Other Agents

  • Dicitrate Bismuthate Tripotassium: Forms a protective mucosal layer, potential effect against Helicobacter pylori.
  • Acexamato Zinc: Stabilizes and inhibits histamine secretion.
  • Pirenzepine: Cholinergic nerve blocker, reduces acid secretion. May cause dry mouth and blurred vision.

Antacids

Types

  • Systemic: Rapid action but may cause rebound acidity (e.g., sodium bicarbonate).
  • Non-systemic: Slower action, forms non-absorbable salts (e.g., aluminum, calcium, magnesium salts).

Ideal Antacid Properties

  • Neutralizes pH to 3-4 rapidly and for a sustained period.
  • Does not inactivate pepsin.

Drugs for Gastroesophageal Reflux and Esophagitis

  • Bethanechol: Increases lower esophageal sphincter tone, reducing reflux.
  • Metoclopramide: Increases sphincter tone, improves gastric emptying.
  • Domperidone: Similar to metoclopramide, without central nervous system effects.

Emetics and Antiemetics

Emetics

Induce vomiting for acute poisoning.

  • Ipecac: Stimulates gag reflex.
  • Apomorphine: Morphine derivative, central action.

Antiemetics

Used to treat vomiting, many are neuroleptics.

  • Phenothiazines (diethyl-perazine) and Antihistamines (cyclizine): Central action.
  • Metoclopramide: Combined action.
  • Cleboprida: Central action, potential extrapyramidal side effects.
  • Alizaprida: Central action, fewer side effects than cleboprida.
  • Cisapride: Peripheral action.
  • Ondansetron, Granisetron, Tropisetron: Serotonin 5HT3 receptor antagonists, used for chemotherapy-induced vomiting.

Antidiarrheals and Laxatives

Antidiarrheals

Used for traveler’s diarrhea, rehydration is essential.

  • Narcotics: Reduce peristalsis (e.g., codeine, diphenoxylate, loperamide).
  • Lactobacillus: Restores intestinal flora, effectiveness questionable.

Laxatives and Purgatives

Facilitate bowel movements.

  • Bulk-forming: Increase stool volume (e.g., bran, agar-agar).
  • Osmotic: Draw water into the intestine (e.g., magnesium sulfate, lactulose).
  • Stool Softeners: Soften stool for easier passage (e.g., paraffin oil, glycerin suppositories).
  • Contact Laxatives: Stimulate bowel movements (e.g., phenolphthalein, castor oil, senna).

Antispasmodic Drugs

:
Used to treat colic pain (typical of an ulcer caused by an obstructed hollow increased peristalsis to overcome the obstruction). Sometimes by irritation of the wall increases peristalsis giving a similar picture.

Anticholinergics:
hyoscine butylbromide and atropine: Decreased peristalsis.

Opiates:
papaverine: an alkaloid from the poppy. Elentece intestinal transit and reducing pain. They can make you constipated.

Analgesics
metamizol: has spasmodic action.
Viadil:
Composition:
Tablets: Each tablet contains: Pargeverina Hydrochloride 5 mg. Drops: Each ml solution contains: Pargeverina Hydrochloride 5 mg. Injection: Each 1 ml ampoule contains: Pargeverina Hydrochloride 5 mg.
Therapeutic Action: Antispasmodic.
Uses: Antispasmodic those for the treatment of visceral syndromes, acute or chronic, whose main component is the smooth muscle spasm. Gastrointestinal spasms of the biliary tract, urinary tract and female genital tract. Symptomatic treatment of nausea and vomiting.
Dosage:
Parenteral use (IV or IM): Adults: 1-4 ampoules per day, slow inoculation. Children: ¼ – ½ ampoule according to age, 3 times a day (slow).
Presentations:
Drops: bottle containing 15 ml. Grageas: a pack containing 10 tablets. Injection: package containing 2 ampoules of 1 ml. Clinical packaging containing 100 vials of 1 ml.