Gastrointestinal drugs .ppt

8/10/2019 Gastrointestinal drugs .ppt

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Farmakoterapi

Pada Gangguang Sistem Pencernaan


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Classification

Drugs for treatment of peptic ulcers

Drugs for adjusting the function of

digestion

Drugs promoting gastrointestinal motility

Antiemetic drugs

laxatives


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Drugs for peptic ulcers

Classification of peptic ulcer:

Duodenal (DU) Gastric (GU)

Role of pepsin in peptic ulcer disease:

Secreted gastric acid plus effects ofpepsin promote tissue injury


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Peptic ulcer disease: an imbalance between

aggressive factors (gastric acid pepsin bacteria)

and protective factors (gastric mucus,bicarbonate, prostaglandins)

Regulation of gastric acid secretion-- many

factors (chemical, neural, hormonal)


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Stimulation:

Gastrin-most potent stimulant

Activation of postganglionic

vagal fibers


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Drugs for peptic ulcers-----antacids

Action

Neutralize secreted acid

Reduce gastric acidity

Pepsin inactive

Reduce destroy factors


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Drugs for peptic ulcers-----antacids

A magnesium hydroxide

B magnesium trislilicate

C aluminum hydrocide

D Calcium carbonate F Sodium bicarbonate


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1 NaHCO3+HCl NaCl+H2O+CO2

2 AlOH3 aluminium hydroxide

Al

OH

3+3HCl AlCl3 +3H2O 3 MgOH2 magnesium hydroxide

MgOH2+2HCl MgCl2 +2H2 O

4 Mg2Si3O8 magnesium trisilicate

Mg2Si3O8+4HCl 2MgCl2+3SiO2+2H2O

5 CaCO3 calcium carbonate

CaCO3+2HCl CaCl2+H2O+CO2


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Gastric antisecretory drugs

antagonisit of H2 receptor

decrease the H+ secretion

Basal gastric acid

food-stimulated gastric acid


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H2 Receptor Antagonists

A cimetidine +

B ranitidine ++

C famotidine +++

Effective inhibitor of stimulated and non-

stimulated gastric acid secretion Healing rates: similar between antacids and H2

receptor antagonists


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Effective inhibitor of stimulated and

non-stimulated gastric acid secretion

Healing rates: similar between

antacids and H2 receptor

antagonists


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Mucosal protective agents

Prostaglandins

reduction in basal and stimulated gastric

acid secretion;

enhanced mucosa resistance to injury

(PGE1/PGE2).


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Mucosal protective agents

Bismuth compounds

Mechanism of Action

cytoprotective effects compounds bind to the ulcer base, stimulating

mucus and prostaglandin production

antibacterial effect

inhibition of proteolytic, lipolytic, and ureaseactivities

Coating and protecting the ulcer crater


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Clinical use of Bismuth compounds

In monotherapy:

------- eradicate H. pylori in

about 20 of patients

combination with antibiotics

-------eradicate H. pylori in up to 95%

of patients.


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Sucralfate

binds to ulcer bed (granulation tissue, not to

gastric or duodenal mucosa)

decreases proton diffusion to the ulcer base

may increase endogenous tissue prostaglandins

and may bind epidermal growth factors andother growth factors-- improving mucosal

defense


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antimicrobials

activity against H.pylori

clarithromycin, amoxicillin, tetracycline


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Drugs for adjusting the function of

digestion

drugs of aid digestive

A pepsin

B pancreatin

C lactasin


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antiemetic drugs and drugs promoting

gastrointestinal motility

antiemetic drugs:

H-1 receptor blocker : diphenhydramine

Chloropromazine

M-receptor blocker : scopolamine


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drugs promoting gastrointestinal motility

Metoclopramide

domperidone blocking D2-receptor

Cisapride


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Metoclopramide

1) Blocking the DA2 receptor in

CTZ

2)

Blocking the DA2 receptor inGastrointestinal


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domperidone

blocking DA2-receptor in

Gastrointestinal


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Cisapride

Increase release of the Ach


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Gastrointestinal drugs .ppt

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