Transcript EO 003.01 - Part 17 - The Alimentary Tract and Metabolism

Alimentary Tract and Metabolism
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EO 003.01 Part 17
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Lesson Overview
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• Review of the alimentary tract
(gastrointestinal tract)
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• Overview of therapeutic classes
• Drugs for acid related disorders
- Antacids
- Drugs used in peptic ulcer disease and
gastroesophageal reflux disease
- Other drugs used in acid related
disorders
• Drugs for functional GI disorders
- Drugs for functional bowel disorders
- Belladonna derivatives
- Propulsives
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Lesson Overview
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• Antidiarrheals, Intestinal Antiinflammatories
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and Antiinfectives.
- Antibiotics
- Intestinal Adsorbents
- Electrolytes with Carbohydrates
- Antipropulsives
• Drugs used in Diabetes
- Insulin and Analogues
- Blood Glucose Lowering Agents
• Vitamins
• Mineral Supplements
• Other Alimentary Tract and Metabolism
Products
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‫)‪The Alimentary Tract (The Gastrointestinal Tract‬‬
‫)‪(Insert Dari‬‬
‫جوف دهن‬
‫دندان‬
‫زبان‬
‫غده نکفیه‬
‫غده نکفیه‬
‫بلعوم‬
‫مری‬
‫کبد‬
‫معده‬
‫پانکراس‬
‫جیجیونوم‬
‫کیسه صفرا‬
‫کولون نازله‬
‫اثناعشر‬
‫الیوم‬
‫سیکم‬
‫کولون سیگوئید‬
‫اپندکس‬
‫رکتوم‬
‫مقعد‬
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What I need to know as a pharmacy technician
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In this lecture we will cover the drugs listed
in the ANA Formulary which are classified
according to the ATC system under
(A) Alimentary Tract and Metabolism
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For each of these medications students must
obtain an understanding of:
(1) Mechanism of Action
(2) Indications (Uses)
(3) Efficacy
(4) Side Effects
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A02 Drugs for Acid Related Disorders
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Antacids ‫انتی اسید ها‬
Mechanism of Action
Reduces the acidity of stomach
and duodenal contents by
combining with hydrochloric
acid and producing salt and
water.
Indication (Uses)
• GERD
• Acid indigestion
• Peptic Ulcers
‫اسیدیتی محتوی معده‬
‫واثناعشر را با یکجاشدن‬
‫باهایدروکلوریک اسید خنثی‬
‫یا کاهش میدهد ونمک وآب را‬
‫میسازد‬
‫مورد استعمال‬
‫دل سوزی‬
‫سوءهاضمه اسید‬
‫قرحات پیپتیک‬



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Antacids ‫انتی اسید ها‬
‫عوارض جانبی‬
Side Effects
• Diarrhea – Mg+2 and Na+
containing antacids
‫ اسهال – انتی اسیدهای که‬
‫ اند‬Na+ ‫ و‬Mg+2 ‫دارای‬
•
‫قبضیت – انتی اسید های که‬
‫ اند‬Ca+2 ‫ و‬Al+3 ‫دارای‬
Constipation – Al+3 and
Ca+2 containing products

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Antacids ‫انتی اسید ها‬
Important Points
• Don’t take within 2 hours
before or after taking
another medication.
• Liquid preparations need to
be shaken thoroughly.
• Chew tablets completely
before swallowing.
‫ ساعت پیش یا‬2 ‫انتی اسید تا‬
‫بعد از ادویه دیگر گرفته‬
‫نشود‬
‫مستحضرات مایع ضرور‬
‫است پیش از استفاده خوب‬
‫شور داده شود‬
‫تابلیت های آن پیش ازبلع‬
‫کامال جویده شود‬
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

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A02B – Drugs for Peptic Acid Disease and
Gastroesophageal Reflux Disease
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Histamine H2 Antagonists
‫ انتاگونست های آخذه های‬H2‫هستامین‬
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Histamine H2 Antagonists
‫ انتاگونست های آخذه های‬H2‫هستامین‬
Mechanism of Action
• Histamine H2 agonists
reduce the secretion of
gastric acid .
• This allows ulcerated areas
to heal and relieves
symptoms of reflux.
Indications (Uses)
• Gastric or duodenal ulcers
• GERD
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‫مورد استعمال‬
‫•درقرحات معدی واثناعشری‬
‫استفاده میشود‬
‫•درامراض که محتوی معده به‬
‫ استفاده‬،‫مری برگشت مینماید‬
)GERD(‫میشود‬
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Histamine H2 Antagonists
‫ انتاگونست های آخذه های‬H2‫هستامین‬
Side Effects
• Low incidence of adverse
reactions
• Mild and transient diarrhea,
dizziness, fatigue
‫•وقوع عکس العمل های‬
‫ناگوار کمتر است‬
،‫•اسهال خفیف وگذری‬
.‫ خسته گی‬،‫سرگنسی‬
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Proton Pump Inhibitors
‫نهی کننده های پروتون پمپ‬
Mechanism of Action
•Suppress gastric acid secretion
via a different mechanism
compared to H2 receptor
antagonists.
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•This also allows ulcerated
areas to heal and relieves
symptoms of reflux.
Indications (Uses)
• Gastric and duodenal ulcers
• GERD
‫استعمال‬
‫•قرحات معده واثناعشر‬
‫• مرض برگشت محتوی معدوی به مری ناشی‬
)GERD(‫از مأوف شدن معصره کاردیا‬
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Proton Pump Inhibitors
‫نهی کننده های پروتون پمپ‬
Side Effects
• Most common are
headache, diarrhea, and
abdominal pain.
•
Less common include:
nausea, flatulence,
constipation and dry mouth.
‫عوارض جانبی‬
‫ ودرد‬،‫ اسهاالت‬،‫•سردری‬
‫بطنی بسیار معمول است‬
‫ قبضیت و‬،‫ نفخ وباد‬،‫•دلبدی‬
‫خشکی دهن کمتر معمول است‬
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Proton Pump Inhibitors
‫نهی کننده های پروتون پمپ‬
Important Points
Usually administered 30 min
before breakfast.
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Swallowed whole, not chewed
or crushed.
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A02X - Other Drugs for Acid Related Disorders
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‫‪Sucralfate‬‬
‫سکرالفیت‬
‫طرز تأثیر‬
‫•با اگزودات که معده را استر نموده‬
‫یک ترکیب مغلق را تشکیل میدهد‬
‫•این ترکیب مغلق یک قشر‬
‫محافظوی را باالی قرحات اثناعشر‬
‫تشکیل داده‪ ،‬وبه این ترتیب درالتیام‬
‫قرحه کمک مینماید‪.‬‬
‫مورد استعمال‪:‬‬
‫•در تداوی قرحات اثناعشر مورد‬
‫استفاده قرار میگیرد‪.‬‬
‫عوارض جانبی‪:‬‬
‫•معموال خفیف بوده‪ ،‬درحالیکه‬
‫امکان دارد سبب قبضیت گردد‪.‬‬
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‫‪Mechanism of Action‬‬
‫‪• Forms a complex with the‬‬
‫‪exudates of the stomach lining.‬‬
‫‪• The complex forms a‬‬
‫‪protective layer over a‬‬
‫‪duodenal ulcer, thus aiding in‬‬
‫‪healing of the ulcer.‬‬
‫)‪Indication (Uses‬‬
‫‪• Treatment of duodenal ulcers‬‬
‫‪Side Effects‬‬
‫‪• Usually mild, but may cause‬‬
‫‪constipation.‬‬
A03 – Drugs for Functional
Gastrointestinal Disorders
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A03A Drugs for Functional Bowel Disorders
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Drotaverine
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Mechanism of Action
Works to decrease contractions of
the intestine (decreases movement).
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Indication (Use)
• Spasm of muscles in the GI tract
• Gastric and duodenal ulcers
Side Effects
• May cause abnormal heart rhythm.
• Constipation
• Sweating may occur.
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A03B Belladonna and Derivatives
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Atropine
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Mechanism of Action
Antispasmodic agent meaning that it
slows down the muscle contractions in
the intestine.
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Indications
• Primarily used to increase cardiac
output (found in crash carts and
emergency cabinets).
• Not longer used as a treatment to
improve GI function.
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Hyoscine
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Mechanism of Action
Antispasmodic agent meaning that
it slows down the muscle
contractions in the intestine
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Indication (Use)
• It is used to slow the speed in the
stomach and GI (gastrointestinal)
tract.
• It is used to treat loose stools
(diarrhea).
• It is used to treat muscle spasms
of the GI (gastrointestinal) tract,
gallbladder system, or urinary
system.
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Side Effects of Hyoscine
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Rare but serious:
• Very bad dizziness or passing out.
• Change in thinking clearly and with
logic.
• Not able to pass urine.
• Not sweating during activities or in
warm temperatures.
• A fast heartbeat or a heartbeat that
does not feel normal
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More common:
• Feeling sleepy.
• Dizziness.
• Blurred eyesight.
• Hard stools (constipation).
• Dry mouth.
• Headache.
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A03F Propulsives
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Mechanism of action
Increase the motility
(movement) of the upper GI
tract.
Indications (Uses)
Propulsives
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‫حرکات را در قسمت علوی‬
‫طرق معدی معائی افزایش‬
‫میدهد‬
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Metoclopramide
• is used to treat heartburn.
• is used to stop or treat upset
stomach and throwing up.
• is used to treat
gastroesophageal reflux
disease.
Domperidone
• is used to stop upset stomach
and throwing up.
• is used to treat poor stomach
clearing/emptying.
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Side Effects of Propulsives
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Metoclopramide:
Rare but more serious side effects can
include:
• Very bad dizziness
• Twitching.
• Change in thinking clearly and
with logic.
• Shakiness, trouble moving
around, or stiffness.
More common:
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•
Feeling lightheaded, sleepy,
having blurred eyesight.
• Headache.
• Stomach pain.
• Loose stools (diarrhea).
• Not able to sleep
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Side Effects of Propulsives
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Domperidone:
Rare but more serious side effects can
include:
• A fast heartbeat.
• A heartbeat that does not
feel normal.
• Very bad dizziness or
passing out.
• Enlarged breasts.
• A lump in the breast, breast
soreness, or nipple discharge.
• Period (menstrual)
changes. Periods become less
often or stop.
• Seizures.
More common:
:‫میتوکلوپراماید‬
• Headache.
• Dry mouth.
• Hot flashes.
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Important Points for Propulsives
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Metoclopramide
• Administered 30 minutes
before meals.
Domperidone
• Administered 15 to 30
minutes before meals and at
bedtime.
‫میتوکلوپراماید‬
‫دقیقه قبل از صرف‬30 •
‫غذا تطبیق میشود‬
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•
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A06 Laxatives
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Bisacodyl
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Mechanism of Action
Causes the intestinal muscles to
contract causing a bowel
movement to occur.
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Indication (Use)
To treat constipation
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Bisacodyl
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Side Effects
• Stomach pain and cramps.
• Gas (flatulence).
• Diarrhea.
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Efficacy
Generally if taken before bed
will produce a bowel
movement in the morning.
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Lactulose
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Mechanism of Action
Causes water to move into the
intestine which stimulates
muscle contractions, causing a
bowel movement.
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Indication (Use)
• It is used to treat hard
stools (constipation).
• It is used to stop or treat
changes in thinking caused
by very bad liver disease.
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Lactulose
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Side Effects
• Stomach pain or heartburn.
• Upset stomach or throwing
up.
• Loose stools (diarrhea).
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Psyllium (Ipaghol Chilka) Powder
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Mechanism of Action
Fibrous substance which forms
bulk in the intestine causing
bowel movements to occur.
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Indication (Uses)
To treat constipation
Side Effects
• Loose bowel movements
(diarrhea).
• Stomach/intestine
discomfort
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Antidiahrreals, Intestinal
Antiinflammatories and Anti-infectives
‫( ادویه ضد اسهاالت‬Insert Dari)
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Antiinfective: Rifamixin
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Mechanism of Action
Prevents the replication of bacteria.
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Indication (Uses)
It is used to treat diarrhea caused by a
bacterial infection.
Side Effects
• Gas.
• Headache.
• Dizziness.
• Belly pain.
• Upset stomach.
• Feeling tired or weak.
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Intestinal Adsorbents : Activated Carbon (Charcoal)
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Mechanism of Action
Prevents the absorption of toxic
substances from the intestines.
Indication
• It is used to treat some
poisonings.
• It is used to ease too much gas
in the stomach
Side Effects
• Belly pain.
• Upset stomach or throwing
up.
• Hard stools (constipation).
• Loose stools (diarrhea).
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Oral Rehydration : Electrolytes
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Mechanism of Action
Provides electrolytes (salts).
Indication
Diarrhea
Prolonged diarrhea can cause loss
of salts from the body which causes
dehydration.
Side Effects
- Upset stomach
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Antipropulsive: Loperamide
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Mechanism of Action
Decreases intestinal peristalsis
(contraction of intestinal
muscles which is usually
increased when a patient has
diarrhea).
Indication (Use)
• Diarrhea
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(‫حرکات استداری امعا را کاهش میدهد‬
‫حرکات معموال درهنگام اسهاالت‬
)‫افزایش میابد‬
‫موارد استفاده‬
‫• اسهال‬
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Loperamide
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Side Effects
Feeling lightheaded
• Belly pain.
• Upset stomach (throwing up)
• Stools (constipation).
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Serious but rare side effects
• high fever, black and tarry
stools
Important Points
If dosed as a 2mg tablet the
maximum dose per day is 8
tablets or 16 mg.
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A10 Medications Used in Diabetes
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A10A Insulin and Analogues
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Mechanism of Action
Allows the cells of the body to
take up sugar from the
bloodstream.
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Indication
It is used to lower blood sugar
in patients with high blood
sugar (diabetes).
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A10A Insulin and Analogues
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Side Effects
• Low blood sugar may
occur.
• Upset stomach or throwing
up.
• Weight gain.
• Irritation where the shot is
given.
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Signs of low blood sugar may
be dizziness, headache,
feeling sleepy, feeling weak,
shaking, a fast heartbeat,
confusion, hunger, or
sweating. Keep glucose
tablets or liquid glucose on
hand for low blood sugar.
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A10A Insulin and Analogues
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Important Points
• Administered via
subcutaneous injection or
IV.
• Subcutaneous injection are
generally administered to
the abdomen or upper leg.
• For subcutaneous injection
it is important to tell
patients to rotate the
injection site.
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A10B Blood Glucose Lowering Drugs
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A10B Blood Glucose Lowering Drugs
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Mechanism of Action
All work to lower the blood sugar in
patients with high blood sugar
(diabetes). Can include the following
mechanisms:
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(1) Increase the production of insulin
within the body.
(2) Decrease the production of sugar
from the liver.
(3) Increasing the response of cells to
insulin = more uptake of sugar by
the cells of the body.
Indication
For the treatment of high blood sugar
(diabetes).
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A10B Blood Glucose Lowering Drugs
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Important Points
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Metformin and Glimepiride should be
taken before a meal (15 min before).
Pioglitazone can be taken at any time
of the day.
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A10B Blood Glucose Lowering Drugs
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Side Effects
Metformin
Diarrhea (very common), upset
stomach, gas and feeling tired or
weak.
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Glimepiride
Low blood sugar, upset stomach
and stomach.
Pioglitazone
Low blood sugar, weight gain and
feeling tired or weak.
Symptoms of Low Blood Sugar: dizziness,
headache, feeling sleepy, feeling weak,
shaking, a fast heartbeat, confusion, hunger,
or sweating. When patients have these
symptoms they should take sugar right away
(i.e. juice).
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A11 Vitamins
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Vitamins
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Vitamins are vital nutrients that our
body obtains from food (our body
cannot produce these compounds on its
own).
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Indication
A diagnosed vitamin deficiency. Some
common indications are listed below:
Multivitamin – used to supplement a poor
diet, often in patients who are unable to eat
very much. Special formulations exist for
pregnant patients.
Vitamin D + Calcium - osteoporosis,
rickets, osteomalacia
Vitamin C – Scurvy
Vitamin K – Used to counteract the effects of
anticoagulants such as warfarin.
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Vitamins
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Side effects
Vitamins are generally well
tolerated and tend to have
minimal side effects.
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A12 Mineral Supplements
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Minerals
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Minerals are chemical elements
required by living organisms
other than (carbon, oxygen,
hydrogen and nitrogen).
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Indications
Calcium- Treatment of low
calcium, cardiac disturbances,
adjunctive treatment of rickets
and osteomalacia. Important in
prevention of osteoporosis
Zinc – zinc deficiency.
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Minerals
(Insert Dari)
Side Effects
Some products may cause nausea.
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Important Points
The maximum amount of calcium that
can be absorbed by the body at a given
time is 500 mg. If a patient is taking
more than 500 mg they must spread the
dose throughout the day.
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A16 Other Alimentary Tract and Metabolism Products
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Drugs Used in the treatment of liver complications
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Both drugs are combination products
meaning they have more than one active
ingredient.
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Betaine Glucuronidate / Nicotinamide
(Jetepar®)
L.Ornithine / L.Aspartate / Nicotinamide/
Riboflavin (Hepamerz®)
Mechanism
Reduces the amount of ammonia in the blood
which is a problem in liver disease and can
cause problems with awareness and ability to
think logically.
Indications
Liver Disease
AFAMS
Drugs Used in the treatment of liver complications
(Insert Dari)
Side Effects
• Upset stomach, nausea for both
medications.
• Betaine Glucuronidate / Nicotinamide
(Jetepar®) may also cause a mild breath
odour.
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Questions?
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In-class Assignment
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This assignment will consist of 10 questions
which are to be completed individually.
Once complete the instructor will review the
answers with the class.
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AFAMS
1. Which of the following is NOT a class of drugs used to
treat acid related disorders?
(Insert Dari)
A)
B)
C)
D)
Antacids
H2 Receptor Antagonists
Propulsives
Proton Pump Inhibitors
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AFAMS
1. Answer: Which of the following is NOT a class of drugs
used to treat acid related disorders?
(Insert Dari)
A)
B)
C)
D)
Antacids
H2 Receptor Antagonists
Propulsives
Proton Pump Inhibitors
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2. What time of day should a patient take a proton pump
inhibitor ?
(Insert Dari)
A) Before bed
B) Any time of day as long as
it is the same time each day
C) At dinner time
D) 30 min before breakfast
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2. What time of day should a patient take a proton pump
inhibitor ?
(Insert Dari)
A) Before bed
B) Any time of day as long as
it is the same time each day
C) At dinner time
D) 30 min before breakfast
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3. Match the following drugs used in the treatment of acid
related disorders with their drug class
(Insert Dari)
A)
B)
C)
D)
Ranitidine
Pantoprazole
Sucralfate
Aluminum Hydroxide/
Magnesium Hydroxide
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1) Antacid
2) H2 receptor antagonists
3) Proton Pump Inhibitor
4) Other
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3. Match the following drugs used in the treatment of acid
related disorders with their drug class
(Insert Dari)
A) Ranitidine (2) H2 receptor
antagonists
B) Pantoprazole (3) Proton
Pump Inhibitor
C) Sucralfate (4) Other
D) Aluminum Hydroxide/
Magnesium Hydroxide
(1) Antacid
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4. List whether the following drugs are
laxatives or antipropulsives
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A)
B)
C)
D)
Bisacodyl
Lactulose
Loperamide
Psyllium
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4. List whether the following drugs are
laxatives or antipropulsives
(Insert Dari)
A)
B)
C)
D)
Bisacodyl - laxative
Lactulose - laxative
Loperamide - antipropulsive
Psyllium - laxative
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5. Match the following with their mechanism of action
(Insert Dari)
A)
B)
C)
D)
Rifamixin
Activated Carbon (charcoal)
Loperamide
Hyoscine
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1) Decreases intestinal contractions
that usually occur when a patient
has diarrhea
2) Prevents bacteria from replicating
3) Prevents muscle spasms from
occurring in the GI tract
4) Prevents toxic substances from
being absorbed from the GI tract
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5. Match the following with their mechanism of action
(Insert Dari)
A) Rifamixin (2) Prevents bacteria
from multiplying
B) Activated Carbon (charcoal) (4)
Prevents toxic substances from
being absorbed from the GI tract
C) Loperamide (1) Decreases
intestinal contractions that usually
occur when a patient has diarrhea
D) Hyoscine (3) Prevents muscle
spasms from occuring in the GI
tract.
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6. Fill in the blanks: Insulin can be given to patients via
____________ and _____________ administration.
(Insert Dari)
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6. Fill in the blanks: Insulin can be given to patients via
subcutaneous injection and intravenous administration.
(Insert Dari)
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7. Which of the following is NOT a symptom of low blood
sugar?
(Insert Dari)
A)
B)
C)
D)
Dizziness
Headache
Sleepy
Increase in urination
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7. Which of the following is NOT a symptom of low blood
sugar?
(Insert Dari)
A)
B)
C)
D)
Dizziness
Headache
Sleepy
Increase in urination
Insert Dari
AFAMS
8. Which of the following drugs is used to lower blood
sugar in diabetic patients?
(Insert Dari)
A)
B)
C)
D)
Loperamide
Pantoprazole
Metformin
Calcium
Insert Dari
AFAMS
8. Answer: Which of the following drugs is used to lower
blood sugar in diabetic patients?
(Insert Dari)
A)
B)
C)
D)
Loperamide
Pantoprazole
Metformin
Calcium
Insert Dari
AFAMS
9. Which of the following statements best describes a
vitamin?
(Insert Dari)
A) A substance that the body
can produce on its own.
B) Vital nutrients that our body
obtains from food
C) Chemical elements required
by living organisms.
D) Carbon, Hydrogen, Oxygen
and Nitrogen
Insert Dari
AFAMS
9. Which of the following statements best describes a
vitamin?
(Insert Dari)
A) A substance that the body
can produce on its own.
B) Vital nutrients that our body
obtains from food
C) Chemical elements required
by living organisms.
D) Carbon, Hydrogen, Oxygen
and Nitrogen
Insert Dari
AFAMS
10. How much Calcium can the body absorb at once?
(Insert Dari)
A) 500 mg
B) 200 mg
C) 100 mg
D) There is not limit on how
much the body can absorb
at once
Insert Dari
AFAMS
10. How much Calcium can the body absorb at once?
(Insert Dari)
A) 500 mg
B) 200 mg
C) 100 mg
D) There is not limit on how
much the body can absorb
at once
Insert Dari
AFAMS