CLINICAL PHARMACY IN GASTROENTEROLOGY Digestive diseases Gastritis Gastritis Aspirin & NSAID Gastritis Alcohol Alcohol and certain other chemicals can cause inflammation and injury to the stomach. This is strictly dose related in that a lot of alcohol is usually needed to cause gastritis. Social or occasional alcohol use is not damaging to the stomach although alcohol does stimulate the stomach to make acid. Alcohol and certain other chemicals can cause inflammation and injury to the stomach. This is strictly dose related in that a lot of alcohol is usually needed to cause gastritis. Social or occasional alcohol use is not damaging to the stomach although alcohol does stimulate the stomach to make acid. Gastritis treatment Peptic ulcer disease (PUD) is a very common ailment, affecting one out of eight persons in the United States. The causes of PUD have gradually become clear. With this understanding have come new and better ways to treat ulcers and even cure them PEPTIC ULCER DISEASE Helicobacter pylori (H. pylori) PEPTIC ULCER DISEASE Symptoms PEPTIC ULCER DISEASE Therapy of PUD has undergone profound changes. There are now available very effective medications to supress and almost eliminate the outpouring of stomach acid. These acid- suppresssing drugs have been dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, then no subsequent treatment is usually needed. Avoiding these latter drugs, should prevent ulcer recurrence. The second major change in PUD treatment has been the discovery of the H. pylori infection. When this infection is treated with antibiotics, the infection, and the ulcer, do not come back. Increasingly, physicians are not just suppressing the ulcer with acid-reducing drugs, but they are also curing the underlying ulcer problem by getting rid of the bacterial infection. If this infection is not treated, the ulcers invariably recur. There are a number of antibiotic programs available to treat H. pylori and cure ulcers. Working with the patient, the physician will select the best treatment program available Treatment of peptic ulcer Antimicrobial agents (tetracycline, bismuth subsalicylate, and metronidazole) to eradicate H. pylori infection Antimicrobial agents (tetracycline, bismuth subsalicylate, and metronidazole) to eradicate H. pylori infection Misoprostol (a prostaglandin analog) to inhibit gastric acid secretion and increase carbonate and mucus production, to protect the stomach lining Misoprostol (a prostaglandin analog) to inhibit gastric acid secretion and increase carbonate and mucus production, to protect the stomach lining Antacids to neutralize acid gastric contents by elevating the gastric pH, thus protecting the mucosa and relieving pain Antacids to neutralize acid gastric contents by elevating the gastric pH, thus protecting the mucosa and relieving pain Avoidance of caffeine and alcohol to avoid stimulation of gastric acid secretion Avoidance of caffeine and alcohol to avoid stimulation of gastric acid secretion Anticholinergic drugs to inhibit the effect of the vagal nerve on acid-secreting cells Anticholinergic drugs to inhibit the effect of the vagal nerve on acid-secreting cells H2 blockers to reduce acid secretion H2 blockers to reduce acid secretion Sucralfate, mucosal protectant to form an acid-impermeable membrane that adheres to the mucous membrane and also accelerates mucus production Sucralfate, mucosal protectant to form an acid-impermeable membrane that adheres to the mucous membrane and also accelerates mucus production Dietary therapy with small infrequent meals and avoidance of eating before bedtime to neutralize gastric contents Dietary therapy with small infrequent meals and avoidance of eating before bedtime to neutralize gastric contents Insertion of a nasogastric tube (in instances of gastrointestinal bleeding) for gastric decompression and rest, and also to permit iced saline lavage that may also contain norepinephrine Insertion of a nasogastric tube (in instances of gastrointestinal bleeding) for gastric decompression and rest, and also to permit iced saline lavage that may also contain norepinephrine Gastroscopy to allow visualization of the bleeding site and coagulation by laser or cautery to control bleeding Gastroscopy to allow visualization of the bleeding site and coagulation by laser or cautery to control bleeding Surgery to repair perforation or treat unresponsiveness to conservative treatment, and suspected malignancy. Surgery to repair perforation or treat unresponsiveness to conservative treatment, and suspected malignancy. Ranitidine (Ranitidin) Forms of production: 0,15 g and 0,3 g tablets and ampoules with 2 ml of 2,5 % solution. RECOMMENDATIONS OF HELICOBACTER PYLORI ERADICATION A typical quadruple therapy Ulcers associated with NSAIDs omeprazole 20mg daily is preferable to ranitidine 150mg twice daily as the respective rates of healing are 80% and 63%. ranitidine H2RAs are slow to heal the ulcers if the offending drug is not stopped and so, under these conditions, a PPI is preferred. H pylori eradication is no more effective than omeprazole alone to heal ulcers, but if the infection is present, then eradication will reduce the rate of relapse. H pylori is not associated with an increased risk of ulcer with NSAIDs in the elderly but there is an increased risk of bleeding. Motilium Form of production: 0,01 g tablets LAXATIVES AND CATHARTICS Constipation can be defined as infrequent or hard pellet stools, or difficulty in evacuating stool. Passing one or more soft, bulky stools every day is a desirable goal. While troublesome, constipation is not usually a serious disorder. However, there may be other underlying problems causing constipation and, therefore, testing is often recommended. Constipation Indications for Use 1. To relieve constipation in pregnant women, elderly clients whose abdominal and perineal muscles have become weak and atrophied, children with megacolon, and clients receiving drugs that decrease intestinal motility (eg, opioid analgesics, drugs with anticholinergic effects) 2. To prevent straining at stool in clients with coronary artery disease (eg, postmyocardial infarction), hypertension, cerebrovascular disease, and hemorrhoids and other rectal conditions 3. To empty the bowel in preparation for bowel surgery or diagnostic procedures (eg, colonoscopy, barium enema) 4. To accelerate elimination of potentially toxic substances from the GI tract (eg, orally ingested drugs or toxic compounds) 5. To prevent absorption of intestinal ammonia in clients with hepatic encephalopathy 6. To obtain a stool specimen for parasitologic examination 7. To accelerate excretion of parasites after anthelmintic drugs have been administered 8. To reduce serum cholesterol levels (psyllium products) Laxatives There are two main types of laxatives: stimulants (chemical) and saline (liquid or salt). They occasionally help temporary constipation problems. However, chronic use of laxatives, especially stimulant laxatives is discouraged because the bowel becomes dependent upon them. Bowel regularity should occur without laxatives. An occasional enema is preferrable over the chronic use of laxatives. Contraindications to Use Diet The following foods should be eaten daily in adequate amounts Antidiarrheals Antidiarrheals drugs Antidiarrheal drugs are indicated in the following circumstances: 1. Severe or prolonged diarrhea (>2 to 3 days), to prevent severe fluid and electrolyte loss 2. Relatively severe diarrhea in young children and older adults. These groups are less able to adapt to fluid and electrolyte losses. 3. In chronic inflammatory diseases of the bowel (ulcerative colitis and Crohns disease), to allow a more nearly normal lifestyle 4. In ileostomies or surgical excision of portions of the ileum, to decrease fluidity and volume of stool 5. HIV/AIDS-associated diarrhea 6. When specific causes of diarrhea have been determined Contraindications to Use Contraindications to the use of antidiarrheal drugs include diarrhea caused by toxic materials, microorganisms that penetrate intestinal mucosa (eg, pathogenic E. coli, Salmonella, Shigella), or antibiotic-associated colitis. In these circumstances, antidiarrheal agents that slow peristalsis may aggravate and prolong diarrhea. Opiates (morphine, codeine) usually are contraindicated in chronic diarrhea because of possible opiate dependence. Difenoxin, diphenoxylate, and loperamide are contraindicated in children younger than 2 years of age.