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ALIMENTARY SYSTEM DRUGS, Assignment 2
Pharmacology II KPC10202
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ALIMENTARY SYSTEM DRUGS
Oral & Throat 
Antiseptic
Generic name: Povidone iodine
Trade name: Betadine/Pharmadine
Dosage: As 1% solution: Rinse or gargle 10 mL undiluted solution with an equal volume of warm water for 30 seconds 4 times daily for up to 14 days, or as directed.
Side effects: Significant: Hypo- or hyper-thyroidism (long-term). Rarely, hypersensitivity reactions; conjunctival hyperaemia, superficial punctuate keratitis, cytotoxicity (ophth).
Indication: Acute infections of the lining of the mouth and throat
Contraindication: History of abnormal thyroid function or goitre (e.g. nodular colloid goitre, endemic goitre, Hashimoto’s thyroiditis).
Antibiotics
Generic name: Neomycin/Polymyxin B/Bacitracin/Pramoxine Trade name: Neosporin Plus
Dosage: Apply in a quantity sufficient to cover the affected area twice a day.
Side effects: Irritation, burning, redness
Indication: Bacterial infection
Contraindication: Hypersensitivity to neomycin or other aminoglycosides. Infants <1 year.
Antiemetics
Antihistamine
Generic name: Promethazine
Trade name: Phenergan/Phenadoz
Dosage: 2.5-25 mg every 4-6 hours, as needed.
Side effects: Significant: Anticholinergic effects (e.g. blurred vision, xerostomia, constipation, urinary retention), CNS depression, extrapyramidal symptoms, including akathisia, tardive dyskinesia, pseudoparkinsonism and acute dystonic reactions; orthostatic hypotension, leucopenia and agranulocytosis, cholestatic jaundice, photosensitivity, impaired core body temperature regulation; lowered seizure threshold.
Indication: nausea and vomiting, Motion sickness.
Contraindication: Coma, compromised respiratory function, at risk for respiratory failure (e.g. COPD, sleep apnoea), lower respiratory tract symptoms, including asthma, bronchiectasis, bronchitis; CNS depression of any cause. Children <2 years; children with symptoms suggestive of Reye’s syndrome or hepatic disease. SC and intra-arterial administration. Concurrent use with or within 14 days of stopping MAOI.
Anticholinergic
Generic name: Scopolamine
Trade name: Hyoscine
Dosage: Apply 1 patch behind the ear at least 4-12 hours before (preferably 12 hours) before an anticipated exposure to motion, then every 3 days as needed
Side effects: Dry mouth, sleepiness, urinary retention, agitation
Indication: Motion sickness, nausea, vomiting
Contraindication: Hypersensitivity to scopolamine, belladonna alkaloids, or any component in the formulation, Closed-angle glaucoma
Prokinetic
Generic name: Metoclopromide
Trade name: Maxolon/Reglan
Dosage: 10 milligrams (mg) four times a day, taken 30 minutes before each meal and at bedtime for 2 to 8 weeks.
Side effects: Significant: Dystonic reactions, akathisia, parkinsonian symptoms, tardive dyskinesia, methaemoglobinaemia, circulatory collapse, severe bradycardia, cardiac arrest, QT prolongation, sinus arrest, torsades de pointes. depression, suicidal ideation; gynaecomastia, galactorrhoea, amenorrhoea and impotence secondary to hyperprolactinaemia.
Indication: nausea and vomiting
Contraindication: Patient with gastrointestinal perforation, haemorrhage or mechanical obstruction, suspected or known pheochromocytoma or other catecholamine-releasing paragangliomas, history of neuroleptic or drug-induced tardive dyskinesia, seizure disorder (e.g. epilepsy), Parkinson’s disease, known history of methaemoglobinaemia with metoclopramide or nicotinamide adenine dinucleotide-cytochrome b5 reductase (NADH-Cyb5R) deficiency. Concomitant use with drugs which may cause extrapyramidal reactions (e.g. antipsychotics, levodopa). Children <1 year.
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Antidiarrheal **
Opioids
Generic name: Loperamide
Trade name: Imodium
Dosage: Initially, 4 mg daily; adjusted until 1-2 solid stools a day are obtained, which is usually achieved with maintenance dose of 2-12 mg daily.
Side effects: Significant: Gastrointestinal effects (e.g. constipation, abdominal pain or distension, blood in stool, ileus, toxic megacolon), syncope, ventricular tachycardia. Rarely, anaphylaxis and anaphylactic shock.
Indication: Acute & chronic diarrhoea
Contraindication: Acute dysentery (characterised by bloody stools and high fever), acute ulcerative colitis, abdominal pain without diarrhoea, bacterial enterocolitis caused by invasive organisms (e.g. Salmonella, Shigella, Campylobacter), pseudomembranous colitis associated with the use of broad-spectrum antibiotics; conditions wherein inhibition of peristalsis must be avoided (e.g. ileus, megacolon, toxic megacolon, constipation, abdominal distension).
Adsorbents
Generic name: Bismuth subsalicylate
Trade name: Pepto Bismol Dosage: 2 tablets (262 mg/tab) or 30 ml (regular strength) orally every ½-1 hour as needed; maximum daily dose: 8 regular-strength doses or 4 extra-strength doses.
Side effects: constipation; or dark colored stools.
Indication: temporarily relieve diarrhea, travelers' diarrhea, and upset stomach due to overindulgence in food and drink, including heartburn, indigestion, nausea, gas, belching, and fullness.
Contraindication: Hypersensitivity to bismuth, aspirin, other salicylates. Infectious diarrhea, high fever, von Willebrand disease, hemorrhage, ulcer or gastrointestinal bleeding with black or bloody stool, hemophilia.
Oral Rehydration Salts
Oral rehydration salts (ORS) are a mixture of electrolytes (salts) and carbohydrates (in the form of sugar) dissolved in water.
Dosage: Dissolve contents of 1 sachet in 250 mL cool, boiled water. Adult 250 mL 4 times for 1st 2 hr up to 12 times daily. Childn 2-5 yr 250 mL 3 times for 1st 2 hr up to 6 times daily; <2 yr 250 mL for 1st 2 hr up to tds.
Contents: Per sachet NaCl 650 mg, KCl 375 mg, trisodium citrate 725 mg, anhydrous glucose 3.375 g.
Indications: Oral rehydration in acute diarrhea & cholera.
Side effects: Hypernatremia, nausea, vomiting, diarrhea, abdominal cramps, oedema, hyperkalemia.
Contraindications: Gastro-intestinal obstruction, oliguric or anuric failure, or when parenteral rehydration therapy is Indicated as in severe dehydration or intractable vomiting.
Peptic Ulcer
Antacids
Systemic effect
Generic name: Sodium bicarbonate
Trade name: Antacids
Dosage: 1-5 g 4-6 hourly as necessary. Alternatively, 0.65-2.6 g 4 hourly.
Side effects: Significant: Metabolic alkalosis, hypernatraemia; fluid and/or solute overload (IV); tissue necrosis, vascular irritation or sloughing (IV extravasation); decreased CSF pressure and intracranial haemorrhage (rapid IV inj in neonates).
Gastrointestinal disorders: Abdominal pain, flatulence, spontaneous stomach rupture, nausea, vomiting, unpleasant taste.
Indication: Metabolic acidosis, dyspepsia.
Contraindication: Metabolic or respiratory alkalosis, hypocalcaemia, hypochlorhydria, severe pulmonary oedema, unknown abdominal pain. IV: Conditions with Na intake restrictions (e.g. renal failure), hypoventilation, history of urinary calculi, coexisting K depletion, hypernatraemia. Patient with chloride loss due to vomiting or continuous gastrointestinal suction. IV: Concomitant use with diuretics known to produce hypochloraemic alkalosis.
Non systemic effect
Generic name: Magnesium trisilicate
Trade name: Antacids
Dosage: Tablet form – can take 1 to 2 tablets that need to be chewed before consume and can be taken up to 6 times daily before food. Liquid form – 15ml or 1 tablespoon can be taken up to 6 times daily before food.
Side effects: Irregular heartbeats, weakness or severe fatigue, or persistent stomach ache.
Indication: Relieving indigestion and heartburn.
Contraindication: Severe renal failure, hypophosphataemia and in patients who must control sodium intake e.g. congestive heart failure, hypertension, cirrhosis of the liver. Should not be administered to patients with metabolic or respiratory alkalosis, hypocalcaemia or hypochlorhydria.
Histamine2 blocker
Generic name: Famotidine
Trade name: Zantac
Dosage: 20 mg bid for 6-12 weeks or up to 40 mg bid if there is oesophageal erosion. Maintenance: 20 mg bid.
Side effects: Blood and lymphatic system disorders: Rarely, Thrombocytopenia, agranulocytosis, pancytopenia, leucopenia. Cardiac disorders: Arrhythmia, atrioventricular block, palpitations. Ear and labyrinth disorders: Tinnitus.
Indication: Duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease (GERD).
Contraindication: Hypersensitivity to famotidine itself or any component of the formulation.
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