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Drugs Acting on the Gastrointestinal
tract
GIT related disorders

    In appetence                                                       Other disorders
Appetite stimulants                                                    Different drugs




                                                                      Diarrhoea
        Acids
     Antiacids                                                  Antidiarhoeal



                      Indigestion                          Constipation
                      Digestants                          Laxatives and cathartics

                                    Vomiting/Emesis
                                    Emetics/antiemetics
Introduction
 Most of the GIT disorders are related
  with motility
 Non specific treatment of GIT disorders
  may be useful by
  - Correction of fluid and electrolyte
  balance
  - Rest of the GIT
  - Diet modification
  - Provision of nutritional support
  - Alleviation of visceral pain
Appetite stimulants
   Benzodiazepines
   Cyproheptadine
   Glucorcorticoids
   Bitters
   Zinc
Appetite stimulants
 Benzodiazepines
  - Diazepam
  - Oxazepam
Mode of action- Stimulation of GABA
Clinical use – Most in cats, less in Horses, dogs and
    goats
Admn – Oral
Cyproheptadine
It suppreses the satiety center in the
   brain by acting as serotonin and
   Histamine (H1) antagonist
Clinica use – in cats and human, not in
   dogs
Adverse effects – Excitement and
   aggressive behavior in some cats
Glucocorticoids
Examples
  - Prednisolone
  - Dexamethazone
Mode of action – may be induce
  euphoria
Adverse effects – Immunosuppression
  and gastric ulcers may result
Bitters
These are plant derived compounds
  containing alkaloids such as Nux
  vomica
Mode of action – They stimulate
  salivation
Zinc
It is essential for the sensation of taste;
   therefore zinc supplements may
   increase appetite in zinc-deficient
   animals
ANTACIDS
They include
- Acid secretion inhibitors
- Proton pump inhibitors
- Locally acting antacids
- Gastric protectants
Acid secretion inhibitors
Histamine (H2) blockers
  - Cimetidine
  - Ranitidine
Mode of action – H2 stimulates the
  proton (acid) pump in parietal cells.
  H2 blockers block the H2 receptors
  hence decrease HCL secretion
Proton pump inhibitors
Example Omeprazole
Mode of action – they inhibit H+-K+-
  ATPase hence reduce hydrogen
  secretion
Locally acting antacids
They include
- Aluminum salts (Aluminum hydroxide,
   Aluminum carbonate, Aluminum
   silicate)
- Magnesium salts (Magnesium oxide
   (milk of magnesia), Magnesium
   tricilicate
- They act by neutralizing gastric HCL
Gastric protective
Example is Sucralfate
This is a sucrose sulfate-aluminum
  hydroxide complex
Mode of action – it polymerizes to a
  viscous gel. The sulfate groups bind
  to proteins in ulcerated tissue and
  protect ulcers from acids and pepsin
DIGESTANTS
Introduction
Definition - Digestants are a group of
  drugs used to promote the process of
  digestion in the gastrointestinal tract
They include
  - Pancrelipase
  - Bile acids and salts
Pancrelipase
It consists of pancreatic enzymes (e.g.
   lipase, amylase, trypsin)

Clinical use – Used to treat exocrine
  pancreatic insufficiency in dogs, cats
  and birds
Bile acids and salts
They include;
  - Bile acids (e.g. cholic acid,
  chenodeoxycholic acid)
  - Semisynthetic bile acid derivatives
  (e.g. dehydrocholic acid)
  - Sodium salts of bile acids
Mode of action – they stimulate
  choleresis (bile flow)
EMETICS
They include
  - Centrally acting emetics
     Apomorphine
     Xylazine
  - Peripherally acting emetics
     Sodium Chloride
     Syrup of ipecac (from Ipecacuanha)
    Copper sulfate, zinc sulfate,
     hydrogen peroxide
ANTI EMETICS
They include
  - Antidopaminergic agents
  - Antihistamines
  - Anticholinergic agents
  - Miscellaneous antiemetics
Antidopaminergic agents
Phenothiazine drugs
  Acepromazine
  Chlorpromazine
  Promazine
  Prochlorperazine
Metoclopramide
Butyrophenones
  Droperidol
  Haloperidol
Antihistamines
 Dimenhydrinate
 Diphenhydramine
 Promethazine
Anticholinergic agents
   Aminopentamide
   Propantheline
   Isopropamide
   Darbazine (isopropamide plus
    prochlorperazine)
Miscellaneous antiemetics
Intestinal protectants and adsorbents
  (kaolin, pectin, bismuth salts)

Locally acting gastric antacids (Mg
  hydroxide, Mg silicate, Al hydrox., Al
  silicate) may reduce vomiting caused
  by gastric hyperacidity
LAXATIVES AND CATHARTICS
They are used for
  - Relief of acute non-dietary
  constipation
  - Removal of poisons from the
  gastrointestinal tract
  - Prevention of Tenesmus in
  advanced pregnancy or prolapse
  - Evacuation of bowel prior to surgery
  or radiography
LAXATIVES AND CATHARTICS
They include
  - Osmotic cathartics
  - Irritant cathartics
  - Bulk laxatives
  - Lubricants
  - Surfactants
Osmotic cathartics


Examples
  - Mg sulfate (Epsom salt), Mg oxide
  - Sodium sulfate (Glauber’s salt)
  - Polyethylene glycol electrolyte
  solutions
  - Sodium phosphate and sodium
  tartrate mixtures (fleet enemas)
Irritant cathartics
Examples
  - Castor oil
  - Aloe
  - Senna
  - Cascara sagrada
Bulk laxatives
Examples
  - Methylcellulose
  - Agar
  - Psyllium
  - Wheat bran
Lubricants and surfactants
Lubricants - Mineral oil (liquid
  petrolatum) and white petrolatum

Surfactants – Docusate
ANTI DIARHOEAL DRUGS
They include
  - Opiates
  - Anticholinergic agents
  - Protectants and adsorbent agents
Opiates
They include
  - Paregoric – a camphorated tincture
     of opium
  - Diphenoxilate
  - Loperamide
  - Codeine
Anticholinergic agents
They include
  - Methoscopolamine
  - Aminopentamide
  - Propantheline
  - Isopropamide
Protectants and adsorbent agents
Preparations
  - Kaolin-pectin suspensions
  - Bismuth sub-salicylate
DRUGS USED TO TREAT
 INFLAMMATORY BOWEL DISEASE
Examples
  - Sulfasalazine
  - Olsalazine
  - Tylosin
  - Metronidazole
DRUGS FOR TREATMENT OF RUMINANT
GASTROINTESTINAL DISORDERS

Several groups
  - Agents for inducing closure of the
     esophageal groove
  - Ruminotorics
  - Rumen antacids
  - Rumen acidifiers
  - Viscosity-altering (antibloat) agents
Agents for inducing closure of the
esophageal groove
Example
  - Milk
  - Sodium bicarbonate (10% to calves)
  - Copper sulfate (5% to calves, 2% to
     lambs)
  -
Ruminotorics
They include
  - Bitters
  - Cholinergics
  - Opiate antagonists (eg naloxone)
  - Rumen fluid transfer
Rumen antacids
Examples include
  - Magnesium oxide
  - Magnesium carbonate
  - Aluminum hydroxide
  - Calcium carbonate
  - Ammonium carbonate
Rumen Acidifiers
Example
  - Vinegar
  - 4%-5% Acetic acid
Viscosity-altering (anti-bloat) agents
Preparations include
  - Poloxalene
  - Polymerized methyl silicone
  - Mineral oil and
  - Vegetable oil (e.g. soybean, peanut,
     sunflower oil).

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Drugs Acting on the Gastrointestinal Tract

  • 1. Drugs Acting on the Gastrointestinal tract
  • 2. GIT related disorders In appetence Other disorders Appetite stimulants Different drugs Diarrhoea Acids Antiacids Antidiarhoeal Indigestion Constipation Digestants Laxatives and cathartics Vomiting/Emesis Emetics/antiemetics
  • 3. Introduction  Most of the GIT disorders are related with motility  Non specific treatment of GIT disorders may be useful by - Correction of fluid and electrolyte balance - Rest of the GIT - Diet modification - Provision of nutritional support - Alleviation of visceral pain
  • 4. Appetite stimulants  Benzodiazepines  Cyproheptadine  Glucorcorticoids  Bitters  Zinc
  • 5. Appetite stimulants  Benzodiazepines - Diazepam - Oxazepam Mode of action- Stimulation of GABA Clinical use – Most in cats, less in Horses, dogs and goats Admn – Oral
  • 6. Cyproheptadine It suppreses the satiety center in the brain by acting as serotonin and Histamine (H1) antagonist Clinica use – in cats and human, not in dogs Adverse effects – Excitement and aggressive behavior in some cats
  • 7. Glucocorticoids Examples - Prednisolone - Dexamethazone Mode of action – may be induce euphoria Adverse effects – Immunosuppression and gastric ulcers may result
  • 8. Bitters These are plant derived compounds containing alkaloids such as Nux vomica Mode of action – They stimulate salivation
  • 9. Zinc It is essential for the sensation of taste; therefore zinc supplements may increase appetite in zinc-deficient animals
  • 10. ANTACIDS They include - Acid secretion inhibitors - Proton pump inhibitors - Locally acting antacids - Gastric protectants
  • 11. Acid secretion inhibitors Histamine (H2) blockers - Cimetidine - Ranitidine Mode of action – H2 stimulates the proton (acid) pump in parietal cells. H2 blockers block the H2 receptors hence decrease HCL secretion
  • 12. Proton pump inhibitors Example Omeprazole Mode of action – they inhibit H+-K+- ATPase hence reduce hydrogen secretion
  • 13. Locally acting antacids They include - Aluminum salts (Aluminum hydroxide, Aluminum carbonate, Aluminum silicate) - Magnesium salts (Magnesium oxide (milk of magnesia), Magnesium tricilicate - They act by neutralizing gastric HCL
  • 14. Gastric protective Example is Sucralfate This is a sucrose sulfate-aluminum hydroxide complex Mode of action – it polymerizes to a viscous gel. The sulfate groups bind to proteins in ulcerated tissue and protect ulcers from acids and pepsin
  • 15. DIGESTANTS Introduction Definition - Digestants are a group of drugs used to promote the process of digestion in the gastrointestinal tract They include - Pancrelipase - Bile acids and salts
  • 16. Pancrelipase It consists of pancreatic enzymes (e.g. lipase, amylase, trypsin) Clinical use – Used to treat exocrine pancreatic insufficiency in dogs, cats and birds
  • 17. Bile acids and salts They include; - Bile acids (e.g. cholic acid, chenodeoxycholic acid) - Semisynthetic bile acid derivatives (e.g. dehydrocholic acid) - Sodium salts of bile acids Mode of action – they stimulate choleresis (bile flow)
  • 18. EMETICS They include - Centrally acting emetics Apomorphine Xylazine - Peripherally acting emetics Sodium Chloride Syrup of ipecac (from Ipecacuanha) Copper sulfate, zinc sulfate, hydrogen peroxide
  • 19. ANTI EMETICS They include - Antidopaminergic agents - Antihistamines - Anticholinergic agents - Miscellaneous antiemetics
  • 20. Antidopaminergic agents Phenothiazine drugs Acepromazine Chlorpromazine Promazine Prochlorperazine Metoclopramide Butyrophenones Droperidol Haloperidol
  • 22. Anticholinergic agents  Aminopentamide  Propantheline  Isopropamide  Darbazine (isopropamide plus prochlorperazine)
  • 23. Miscellaneous antiemetics Intestinal protectants and adsorbents (kaolin, pectin, bismuth salts) Locally acting gastric antacids (Mg hydroxide, Mg silicate, Al hydrox., Al silicate) may reduce vomiting caused by gastric hyperacidity
  • 24. LAXATIVES AND CATHARTICS They are used for - Relief of acute non-dietary constipation - Removal of poisons from the gastrointestinal tract - Prevention of Tenesmus in advanced pregnancy or prolapse - Evacuation of bowel prior to surgery or radiography
  • 25. LAXATIVES AND CATHARTICS They include - Osmotic cathartics - Irritant cathartics - Bulk laxatives - Lubricants - Surfactants
  • 26. Osmotic cathartics Examples - Mg sulfate (Epsom salt), Mg oxide - Sodium sulfate (Glauber’s salt) - Polyethylene glycol electrolyte solutions - Sodium phosphate and sodium tartrate mixtures (fleet enemas)
  • 27. Irritant cathartics Examples - Castor oil - Aloe - Senna - Cascara sagrada
  • 28. Bulk laxatives Examples - Methylcellulose - Agar - Psyllium - Wheat bran
  • 29. Lubricants and surfactants Lubricants - Mineral oil (liquid petrolatum) and white petrolatum Surfactants – Docusate
  • 30. ANTI DIARHOEAL DRUGS They include - Opiates - Anticholinergic agents - Protectants and adsorbent agents
  • 31. Opiates They include - Paregoric – a camphorated tincture of opium - Diphenoxilate - Loperamide - Codeine
  • 32. Anticholinergic agents They include - Methoscopolamine - Aminopentamide - Propantheline - Isopropamide
  • 33. Protectants and adsorbent agents Preparations - Kaolin-pectin suspensions - Bismuth sub-salicylate
  • 34. DRUGS USED TO TREAT INFLAMMATORY BOWEL DISEASE Examples - Sulfasalazine - Olsalazine - Tylosin - Metronidazole
  • 35. DRUGS FOR TREATMENT OF RUMINANT GASTROINTESTINAL DISORDERS Several groups - Agents for inducing closure of the esophageal groove - Ruminotorics - Rumen antacids - Rumen acidifiers - Viscosity-altering (antibloat) agents
  • 36. Agents for inducing closure of the esophageal groove Example - Milk - Sodium bicarbonate (10% to calves) - Copper sulfate (5% to calves, 2% to lambs) -
  • 37. Ruminotorics They include - Bitters - Cholinergics - Opiate antagonists (eg naloxone) - Rumen fluid transfer
  • 38. Rumen antacids Examples include - Magnesium oxide - Magnesium carbonate - Aluminum hydroxide - Calcium carbonate - Ammonium carbonate
  • 39. Rumen Acidifiers Example - Vinegar - 4%-5% Acetic acid
  • 40. Viscosity-altering (anti-bloat) agents Preparations include - Poloxalene - Polymerized methyl silicone - Mineral oil and - Vegetable oil (e.g. soybean, peanut, sunflower oil).