CLASS FOR OPHTHALMIC ASSISTANT STUDENTS ( O.A. STUDENTS 2nd year . educational purpose short description regarding GIT SYSTEM & drugs used to treat diarrhoea , peptic ulcer diseases , irritable bowel syndrome , IBS, antimotility drugs & laxatives /purgatives etc..

1. DRUGS USED IN GIT SYSTEM : PEPTIC ULCER /ANTISPASMODICS/
ANTIMOTILITY/ LAXATIVES & PURGATIVES
Dr. Vinit Kumar
Pharmacology for O.A 2nd year students

2. Topics
• Peptic Ulcer Disease
• Constipation
• Diarrhea
• Emesis
• Digestion

3. What is basically peptic ulcer ?
• Peptic ulcers are sores that develop in the lining of the stomach,
lower esophagus, or small intestine. They're usually formed as a
result of inflammation caused by the bacteria H. pylori, as well as
from erosion from stomach acids. Peptic ulcers are a fairly common
health problem.

5. Peptic Ulcer Disease
Factors that
Increase Acidity
Factors that
Protect Against
Acidity

6. Peptic Ulcer Disease
• Factors Increasing
– H. pylori
– NSAIDs
– Acidic agents
– Pepsin
– Smoking
• Factors Decreasing
– Mucus production
– Buffers
– Blood flow
– Prostaglandins

7. Regulation of Gastric Acid
Secretion

8. PEPTIC ULCER : Definition :
• A lesion in the lining (mucosa) of the digestive tract, or GIT / gastro
intestinal tract typically in the stomach or duodenum, caused by the
digestive action of pepsin and stomach acid.

9. Causes of peptic ulcer :
• The most common causes of peptic ulcers are infection with the
bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin
and nonsteroidal anti-inflammatory drugs (NSAIDs) .
• Stress and spicy foods do not cause peptic ulcers.
• Smoke , alcohol
• Family history of peptic ulcer

10. m/c sign & symptoms of peptic ulcer
• dull pain in the stomach.
• weight loss.
• not wanting to eat because of pain.
• nausea or vomiting.
• bloating.
• feeling easily full.
• burping or acid reflux.
• heartburn, which is a burning sensation in the chest)

11. What is the difference between peptic ulcer & gastric ulcer
• Gastric and duodenal ulcers are open sores in the lining of the digestive tract. ...
Gastric ulcers form in the lining of the stomach. Duodenal ulcers develop in the
lining of the duodenum, which is the upper part or first part of the small intestine

12. Peptic ulcer :

14. H2 Receptor Antagonists
• Inhibits gastric acid secretion
• No effect on H1 receptors
• cimetidine (Tagamet®)
• ranitidine (Zantac®)
• famotidine (Pepcid®)
• nizatidine (Axid®)

15. H2 Receptor Antagonists
• Indications:
– PUD
– GERD
– Prevention of aspiration pneumonia

16. Proton Pump Inhibitors
• K+H+ATPase (Proton Pump)
• Irreversible inhibition
– Must synthesize new enzyme
– Long duration
• omeprazole (Prilosec®)
• lansoprazole (Prevacid®)

17. Anticholinergics
• pirenzepine (Gastrozepine®)
• Other anticholinergics have too many side
effects and are not used

18. Prostaglandin Analog
• misoprostol (Cytotec®)
– Approved for treating PUD due to long term
NSAID use

19. Antacids
• Increase pH of gastric environment
• Hydroxides
– Aluminum
– Magnesium
• Carbonates
– Calcium

20. Antacids
• Most OTC drugs are combinations
– DiGel®
– Amphojel®
– Maalox®
– Milk of Magnesia®
– Mylanta®

21. Antispasmodic drugs used in GIT
• An antispasmodic is a pharmaceutical drug or other agent that
suppresses muscle spasms

22. what are the side effects of antispasmodic drugs ?
• Side Effects. Dizziness, drowsiness, weakness, blurred vision, dry
eyes, dry mouth, nausea, constipation, and abdominal bloating may
occur.

23. What is IBS ?
• Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine.
Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea
or constipation, or both. ... Some people can control their symptoms by managing
diet, lifestyle and stress. Alternating Constipation and Diarrhea. ...
• Changes in Bowel Movements. ...
• Gas and Bloating. ...
• Food Intolerance. ...
• Fatigue and Difficulty Sleeping

24. WHAT IS THE MAIN CAUSE OF IBS
• The cause of irritable bowel syndrome is currently unknown. It is
thought to result from a combination of abnormal gastrointestinal
(GI) tract movements, increased awareness of bodily functions, and a
disruption in the communication between the brain and the GI tract.

30. what is Laxatives or purgatives ? & its uses ?
• Laxatives or purgatives are substances that loosen stools and increase
bowel movements.
• They are used to treat and prevent constipation.

31. • The active ingredients in saline laxatives are mostly magnesium,
sulfate, citrate, and phosphate ions. These ions draw water into the
intestines.
• The additional water softens the stool, increases pressure within the
intestines, and increases intestinal contractions resulting in the
discharge of softer stool.

32. what ingredients are laxatives ?
• Stool softener Active ingredients: docusate sodium and docusate
calcium. ...
• Bulk-forming laxative. Active ingredients: psyllium, methylcellulose,
and calcium polycarbophil. ...
• Lubricant laxative. ...
• Hyperosmotic laxative. ...
• Saline laxative. ...
• Stimulant laxative

33. Stool Formation
Water absorbed in colon (~90%)
– Excessive absorption
• Constipation: hard, dehydrated stool
• Increases strain on defecation
• Harmful for subset of patients
– Recent episiotomy, colostomy, hemorrhoids,
cardiovascular disease
– Inadequate absorption
• Diarrhea: soft, non-formed, liquid stool

34. Terms
Laxative Production of soft, formed
stool over 1 or more days
Cathartic Rapid, intense fluid evacuation
of bowel.

35. Laxatives
• Bulk forming
• Surfactants
• Stimulants
• Osmotics

36. Laxatives / purgatives

38. Bulk Forming Laxatives
• Absorb water
• Soften and enlarge
stool
• Fecal swelling
promotes peristalsis
• methylcellulose
(Citrucel®)
• psyllium (Metamucil®)
• Polycarbophil

39. Surfanctant Laxatives
• Lowers surface
tension
– Facilitates water
penetration
• Docusate salts
– Colace®
– Modane Soft®)

40. Stimulant Laxatives
• Stimulate peristalsis
• Increases water and
electrolytes secretion
into intestinal lumen
• Decreases water and
electrolyte
reabsorption
• Phenylolpthalein
– (Ex-Lax®, Feen-a-
Mint®, Correctol®)
• bisacodyl (Ducolax®)

41. Osmotic Laxatives
• Poorly absorbed salts
remain in fecal matter
• Pull water into lumen
• Magnesium hydroxid
(Milk of Magnesia®)

42. Does laxatives help in weight loss ?
• It is true that laxatives may help increase weight loss, but the results
are only temporary.
• Several types of laxatives work by pulling water from your body into
the intestines, allowing stool to absorb more water for an easier
passage.

43. what are the side effects of laxatives ?
• rectal bleeding.
• bloody stools.
• severe cramps or pain.
• weakness or unusual tiredness.
• dizziness.
• confusion.
• skin rash or itching.

44. Antimotility drugs
• Antimotility agents are drugs used to decrease the symptoms of diarrhea.
• These include loperamide , diphenoxylate with atropine (Lomotil), and opiates /
opium, codeine, and morphine.

45. what is the meaning of antimotility ?
• inhibiting or slowing gastrointestinal motility
• An antimotility agent that relieves the symptoms of diarrhea by
slowing intestinal movement.

49. Most common side effects of antimotility drugs
• Side effects. Adverse drug reactions most commonly associated with
loperamide are constipation
• dizziness
• nausea
• abdominal cramps.

51. HOME WORK ?
1. What are the parts of human gastro intestinal system / GIT ?
2. What is peptic ulcer ? What are the causes ? What is difference
between – peptic ulcer & gastric ulcer ?
3. Classify the the drugs used to treat peptic ulcer diseases ?
4. Enumerate names of some antacids Or H2 receptor blocker drugs &
PPI ( proton pump inhibitors ) /
5. What is antispasmodic ? What are the side effects of antispasmodic
drugs ?
6. What is IBS ( irritable bowel syndrome) ? What are the causes of IBS ?
7. Classify some antispasmodic drugs ?
8. What are the uses of antispasmodic drugs ?

52. • 9. What is laxative or purgatives ? What are the ingredients in that ?
• 10. what are the types of laxatives ? Classify that & name some drugs ?
• 11. what are the uses of laxatives / purgatives ? & what are side effects
of laxatives ?
. 12. Name some antimotility drugs ? What is the definition of diarrhea?
. 13. what are the uses & side effects of antimotility drugs ?
. 14. what is the meaning of antimotility ?