Download - Obat GIT Gizi 2013
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Drugs Used In Drugs Used In
Gastrointestinal DiseasesGastrointestinal Diseases
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Peptic Ulcers
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OBAT ULKUS PEPTIKUMOBAT ULKUS PEPTIKUMPatogenesis ulkus peptikum• 1. Sekresi asam lambung yang berlebih• 2. Menurunnya efek proteksi dari mukosa• 3. Infeksi Helicobacter Pylori ( HP)
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1. Antasida1. Antasida
• Basa lemah : Mg(OH)2 , MgSiO3 , Al(OH)3 CaCO3 Ca(HCO3)2 NaHCO3
• Mekanisme kerja: netralisasi asam
lambung→mengurangi keasaman lambung→mengurangi aktivitas pepsin
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2. Gastric antisecretory drugs2. Gastric antisecretory drugs2. H2-R antagonists 2.1 mechanism: block H2-R→ reduce the secretion of
gastric acid→↓the volume of gastric acid & acidity
2.2 clinical uses: • peptic ulcer • zollinger-ellison syndrome • gastroesophageal reflux
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2.3 adverse reaction2.3 adverse reaction::
• ) Antiandrogenic effect : gynecomastia, impotency, galactorrhea
• ) Inhibit cytochrome P450 catalyzed oxidative drug metabolism pathway→ reduce clearance of other drugs
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• Cimetidine: 400 mg bid 4W→80% healing • Ranitidine 1) Antisecretive effect is 10 times that
of Cimetidine . 2)Less effect on hepatic microsomal
metabolism system. 3)Longer duration and less
antiandrogenic effect
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• Famotidine, Nizatidine: 1) Antisecretive effect is 30 times that
of Cimetidine . 2) Have no effect on hepatic
microsomal metabolism system.• Ebrotidine: 1) ↑Expression of EGF and
PDGF→stimulate proliferation of epithelium
2) increase mucus secretion
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2.2. M1- R antagonist:M1- R antagonist: Pirenzepin Pirenzepin
3. Proton pump inhibitors Omeprazole, lansoprazole, rabeprazole, pantoprazole.
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Mechanism of actionMechanism of action
• Require activation in the acid environment of the secretory canaliculus of the parietal cell
• Inhibit H+-K+ ATPase irreversibly and inhibit over 95% of gastric acid secretion
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• Clinical uses: superior to H2-R antagonists.
• Adverse reactions: 1) inhibits gastric secretion→overgrowth
of bacteria. 2) hypergastrinemia.
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4. gastrin-receptor antagonists: 4. gastrin-receptor antagonists: - proglumide - proglumide
Mucosal protective agents prostaglandins: Misoprostol1) inhibit gastric secretion 2) promote mucus secretionclinical uses: NSAID-induced ulcer adverse reactions: dose-dependent
diarrhea, stimulate uterus
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2. sucralfate2. sucralfate
3. bismuth potassium citrate mechanism of action: 1) selective binding to an ulcer, coating
it and protecting it from acid and pepsin. 2) Inhibit pepsin activity
3) stimulate mucous production
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mechanism of action: 4) increase prostaglandin synthesis. 5) antimicrobial activity against H pylori clinical use: when combined with antibiotics
(metronidazole and tetracycline), ulcer healing rates of up to 98% have been seen.
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Antibacterial agentsAntibacterial agents
• metronidazole, • tetracycline
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Cerebral Centers Affecting Vomiting
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antiemetic drugsantiemetic drugs
• 1. 5-HT3 inhibitor ondansetron : used in the prevention of chemotherapy-
induced and postoperative nausea and vomiting
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2. dopamine antagonists:2. dopamine antagonists:
• Metoclopramide mechanism block D2-receptor in CTZ adverse reaction: extrapyramidal symptoms, especially dystonias
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DomperidoneDomperidone
• block gastrointestinal D-receptor • difficultly penetrate BBB, have no
extrapyramidal symptoms
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laxativeslaxatives
• bulking laxatives: MgSO4, • irritant or stimulant laxatives: castor oil• stool softeners: liquid paraffin, glycerin
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Antidiare
• Tipe of antidiare– Opiates and opiate-related agents– Diphenoxylate with atropine– Adsorbents; Kaopectate– Antidiarrheal combinations