Gastrointestinal Agents

Course Title : Inorganic Pharmacy-II Course No.: PHR 107

Course Teacher : Shahana Sharmin

Glands of the Stomach

1. Cardiac 2. Pyloric 3. Gastric*

The stomach is divided into three functional areas, each with specific glands. The cardiac zone (cells), the uppermost area of the stomach by the cardiac sphincter, contains the cardiac glands. The pyloric zone is the lowermost part of the stomach and contains the pyloric glands. The greater part of the body of the stomach, the fundus, contains the gastric glands. The gastric glands play the most significant role in acidrelated disorders.

Cells of the Gastric Gland

Parietal cells
Produce and secrete HCl Primary site of action for many acid-controller drugs

Hydrochloric Acid
Secreted by the parietal cells when stimulated by food Maintains stomach at pH of 1 to 4 Secretion also stimulated by: Large fatty meals Excessive amounts of alcohol Emotional stress

Gastrointestinal Agents

Definition:
Agents used to treat gastrointestinal disturbances are known as gastrointestinal agents. Various inorganic agents used to treat GIT disorder.

Products for altering gastric pH i.e. - Acidifying agent - Antacids Protective for intestinal inflammation Adsorbents for intestinal toxins Saline cathartics or laxatives for constipation

Gastrointestinal agents

Products for altering pH

Acidifying agent Agents used to increase the stomach pH is known as Acidifying agents. e.g. Ammonium chloride, Calcium chloride, dilute HCl etc. can be used to treat Achlorhydria. Lack of Hydrochloric acid (HCl) in stomach is known as Achlorhydria.

Antacids

Antacids are substances which reduce gastric acidity resulting in an increase in the pH of stomach & and duodenum. It is itself basic in nature. Weak bases are used for this purpose. e.g. Al(OH)3, Mg(OH)2, NaHCO3

Antacids
Gastric activity occurs due to excessive secretion of HCl in stomach due to various reasons. Gastritis (a general inflammation of gastric mucosa) Peptic ulcer or oesophageal ulcer ( lower end of oesophagus) Gastric ulcer (stomach) Duodenum ulcer

Antacids

Criteria for antacids The antacids should not be absorber or cause systemic alkalosis*. It should not be constipative or laxatives. It should exert effect rapidly and over a long period of time The antacid should buffer in the range of pH 4-6. Reaction of antacid with HCl should not cause large evolution of gas. Should probably inhibit pepsin activity.
*Alkalosis : Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma (alkalemia). Generally alkalosis is said to occur when pH of the blood exceeds 7.45. The opposite condition is acidosis.

Antacids

Classification : There are two types of Antacids - Systemic - Non-systemic

Systemic antacids

It is soluble & systemically absorbed. Capable of producing systemic alkalosis. e.g. NaHCO3 Sodium carbonate is water soluble & potent neutralizer, but it is not suitable for peptic ulcer because of risk of ulcer perforation due to production of carbon dioxide in stomach. As it may lead to alkalosis may worsen edema and congestive heart failure because of sodium ion load.

Systemic antacids NaHCO3

Preparation of NaHCO3 : 1. By passing strong brine containing high concentration of ammonia through a carbonated tower where it is saturated with carbon dioxide under pressure. The ammonia & carbon dioxide reacts to form ammonia bicarbonate which is allowed to react with NaCl to precipitate NaHCO3 which is separated by filtration. NH3 + H2O + CO2 NH4HCO3 NH4HCO3 + NaCl NaHCO3

Systemic antacids NaHCO3

Preparation of NaHCO3 : 2. it can also be prepared by covering sodium carbonate crystals with water and passing carbon dioxide to saturation. Na2CO3 + H2O + CO2 NaHCO3

Systemic antacids NaHCO3

Flow chart of Rebound acidity :

NaHCO3 + HCl cell
pH

Alkaline media

Stimulation of oxgentic Secretion of HCl to balance the acidity Need excess NaHCO3 acidity Excess HCl

Then again rebound acidity

Reaction occurs & form alkaline media

Secretion of HCl

Stimulation of oxgentic cell occurs (Rebound acidity)

Ulcer

Infection of stomach

Non-systemic antacids

They are insoluble & poorly absorbed systemically. e.g. Al(OH)3, Mg(OH)2, CaCO3 etc. In case of Mg(OH)2 , it has low water solubility and has the power to absorb and inactive pepsin and to protect ulcer base. In case of Al(OH)3 , it is a weak and slow reacting antacid. In case of CaCO3 , it is a potent antacid with rapid acid neutralizing capacity, but in long term use it can cause hypercalciuria, hypercalcemia and formation of calcium stone in kidney.

Aluminium containing Antacids

Forms: Aluminum Hydroxide Gel (suspension) contain aromatics and sweetening not more than 0.5% preservatives Dried Aluminum Hydroxide Gel (powder) colloidial great adsorptive powers amphoteric characters

Magnesium Containing Antacids

Forms :
MAGNESIUM CARBONATE Carbonate of Magnesia, Heavy Magnesium Carbonate. Dissolves as carbonate and hydroxide are consumed. MAGNESIUM HYDROXIDE Used as laxatives in high doses (salt action). MILK OF MAGNESIA Suspension of magnesium hydroxide. with citric acid to minimize the interaction of glass and magnesium hydroxide Very popular antacid and laxative. MAGNESIUM HYDROXIDE Magnesia. Light Magnesium Oxide hydrolyzes faster than heavy to Magnesium hydroxide. Magnesia added to water to avoid formation of hard lump arsenic antidote.

Calcium Containing Antacids

Forms : CALCIUM CARBONATE Precipitated chalk Fast action Found in combinations with Mg antacids In Lozenges and Oral suspension TRIBASIC CALCIUM PHOSPHATE Precipitated Calcium Phosphate, Tertiary Calcium Phosphate, Calcium Phospate Found in nature as phosphrite (phosphate rock) and apatite No gas produced (no flatulence) Does not alkalize the system

Non-systemic antacids Al(OH)3

Aluminum Antacids are Nonsystemic and widely used and are buffer in the pH 3-5 region. Aluminum hydroxide is recognized in two forms in USP 1. Gel USP XVIII: White viscose suspension, small amount of clear liquid may separate constantly pH 5.5-8.0 USP permits inclusion of flavoring and antimicrobial agent. 2. Dried Gel USP XVIII: White, colorless, tasteless, amorphous powder, insoluble in water and alcohol.

Non-systemic antacids Al(OH)3

Al(OH)3 :
Aluminium containing antacids are widely used which are buffer in the pH 3-5 region. It is recognised in two forms in USP. 1. Al(OH)3 gel : White viscous suspension, small amount of clear liquid may separate constantly pH 5.5-8.0 USP permits inclusion of flavoring & antimicrobial agent.

2. Dried Al(OH)3 gel : White colorless, testless, amorphous powder, insoluble in water & alcohol.

Non-systemic antacids Al(OH)3

Therapeutic uses of Al(OH)3 : 1. Al(OH)3 gel is used for the treatment of - Peptic ulcer - Peptic esophegitis - Gastric hyperacidity - Phosphate nephrotithiasis 2. It is infrequently used in the treatment of diarrhaea & cholera. 3.It is also used against the hyperachlorhydria of ulcer patient. 4.It is also used as - Antiseptic & antidiarrhoeal agent - Anticholera [Al(OH)3 dried] - Desicant [Al(OH)3 dried)]

Non-systemic antacids Al(OH)3

Acid neutralization by Al(OH)3 :

Al(OH)3 is considered as ideal antacid. It is soluble in acidic media. The overall mode of action of an Al-base antacid proceeds in a series of steps depending on the amount of antacid & the pH. Antacid reacts with water to form a complex. Al(OH)3 + 3H2O [Al(H2O)3. (OH)3]0
Complex (Base)

Non-systemic antacids Al(OH)3

Acid neutralization by Al(OH)3 cont.
The complex is soluble in acid media.

[Al(H2O)3. (OH)3]0 + H3O+

Base acid

[Al(H2O)4. (OH)2]+ + H2O

conjugated acid conjugated base

[Al(H2O)4. (OH)2]+ + H3O+ [Al(H2O)5. (OH)]++ + H3O+

[Al(H2O)5. (OH)]++ + H2O [Al(H2O)6]+++ + H2O Hexaquoaluminium ion

This H3O+ acid is present in the stomach.

Non-systemic antacids Al(OH)3

Constipation Mechanism of Al(OH)3 :

Al(OH)3 + 3HCl ----- AlCl3 + 3H2O

Soluble

Al3+ + PO43- ----- AlPO4

Insoluble

Cl- ------------ Reabsorbed

Non-systemic antacids Al(OH)3

Commercial Preparation of Al(OH)3 gel : Aluminium hydroxide gel is an aqueous suspension of hydrated aluminium oxide with different amounts of basic aluminium carbonate & bicarbonate. When a hot solution of K-alum is added slowly to a hot solution of Na2CO3, (at 700C), Al(OH)3 is produced. Na2CO3+K2SO4. Al2(SO4)3+ H2O -- K2SO4+Na2SO4+Al(OH)3 + CO2 Method of Preparation : It is prepared by dissolving sodium carbonate in hot water & the solution is filtered. To the filtrate add clear solution of alum (Aluminium salt, chloride or sulphate) in water with constant stirring. Add more of water and remove all gas. The Aluminium Hydroxide precipitate out, collect the precipitate , wash and suspend in sufficient purified water.

Non-systemic antacids Al(OH)3

Reaction occurred during preparation of Al(OH)3 gel:

2Al2(SO4)3 + 6Na2CO3

6Na2SO4 + 2Al2(CO3)3 2H-OH

4Al(OH)3 + 6H2CO3

6H2O + 6CO2

Non-systemic antacids Al(OH)3

Purification :
The ppt Al(OH)3 is washed thoroughly with hot water until it is free from SO4-2 ion which is confirmed with the addition of some BaCl2 to the filtrate. Filtrate + BaCl2 -- BaSO4 (SO4-2 present) -- No change (SO4-2 absent)

Adjustment of the gel :

The gel is adjusted with distilled water. Al(OH)3 gel USP is a suspension containing the equivalent of not less than 3.6% & not more than 4.4% of Al2O3 per 100 g of Al(OH)3.

Improvement of the formulation :

The following substances are added -1. Viscosity imparting agent : Glycerin 2. Flavoring agent (0.01-0.05%): Peppermint oil 3. Sweetening agent : Sucrose or saccharin 4. Preservative (0.1 0.5%) : Sodium Benzoate

Non-systemic antacids Al(OH)3

Assay of Al(OH)3: Accurately weigh 5gm and dissolve in 3ml HCl by warming on water bath, cool to below 20 C and dilute to 100ml with water. To 20ml of the above solution add 40ml of 0.05M disodium EDTA, 80ml water, 0.15ml methyl orange/red and neutralize by the dropwise addition of 1M sodium hydroxide. Again warm on water bath for 30 min, add 3gm hexamine and titrate with 0.05M lead nitrate using 0.5ml xylenol orange as indicator. Each ml of 0.05M disodium EDTA 0.002549 gm of Al2O3

Non-systemic antacids Al(OH)3

Advantages of Al(OH)3 : 1. Long duration of action. 2. Does not produce systemic alkalosis. 3. ANC is high.
Disadvantages of Al(OH)3 : 1. Slow onset of action. 2. Phosphorous depletion. 3. Osteomalacia (Softening of the bones due to a lack of vitamin D) & Osteoporosis (Thinning of bone tissue and loss of bone density over time). 4. Neurotoxicity in renal failure. Dose : 500 mg to 1800 mg 3 to 6 times a day between meals & bedtime

Non-systemic antacids
Al(OH)3

Pharmacological action of Al(OH)3 : It neutralizes the excess gastric acid and prevent the hyperacidity. After neutralization the available Al3+ conc. is raised which in turn gives rise to some astringent and antiseptic property. Pepsin & intestinal bacteria are absorbed by Al(OH)3, gel and thus acts as a absorbent in the prevention of ulcer creation. Due to its astringent and demulcent properties it forms a protective coating over the ulcer creator. It stimulates mucous secretion which enhances the mucosal barrier to acid.

Non-systemic antacids Mg(OH)2

Mg(OH)2 : There are a large no. of Mg containing antacids. The Mg cation causes this group of antacids to be laxatives. They usually used in combination with Al & Ca antacid in an attempt to neutralize, constipative & laxative actions.

Non-systemic antacids Mg(OH)2

Preparation of Mg(OH)2 :
They can be prepared by treating Mg salt with NaOH resulting Mg(OH)2 precipitate & Na salts.

MgSO4 + 2NaOH = Mg(OH)2 MgCl2 + 2NaOH = Mg(OH)2

+ Na 2So 4 + 2NaCl

Non-systemic antacids Mg(OH)2

Assay of Mg(OH)2 :
Transfer about 400 mg of the sample, previously dried at 105oC for 2h and accurately weighed, into a conical flask. Add 25 ml of 1 N sulfuric acid and, after solution is complete, add methyl red TS and titrate the excess acid with 1 N sodium hydroxide. Each ml of 1 N sulfuric acid used to neutralize the magnesium hydroxide is equivalent to 29.16 mg of Mg(OH)2. 1 N NaOH, H2SO4+Mg(OH)2 - MgSO4 + 2H2O 1000 ml of N NaOH = 1N Mg(OH)2

Non-systemic antacids Mg(OH)2

Mechanism of action of Mg(OH)2 :

Mg(OH)2 is very less soluble & only goes into solution when there is acid & already contain minute amount of anion present in the stomach. In presence of acid Mg(OH)2 will dissolve the following way acid Mg(OH)2 Mg(OH)2
(solid)

Dissolved

Mg(OH)2 Mg(OH)+

(dissolved)

Mg(OH)+ + (OH)Mg++ + (OH)-

Now, (OH)- is the determine factor which will participate with

Non-systemic antacids Mg(OH)2

Mechanism of action of Mg(OH)2 cont. :

proton from gastric HCl along with water & thus neutralizes the acid, leaving the counterpart Mg+2 HCl ------ H+ + ClH2O + H+ ------- H3O+ (OH)- + H3O+ ----- 2H2O Now Mg binds with Cl- to form insoluble MgCl2 which is mainly responsible for laxative actions. Mg++ + 2 Cl- ------ MgCl2

Non-systemic antacids Mg(OH)2

Laxative mechanism of Mg(OH)2 :

Mg(OH)2 + 2HCl = MgCl2 + 2H2O

Non-systemic antacids Mg(OH)2

Advantages of Mg(OH)2 :
1. Fast onset of action. 2. No systemic alkalosis. 3. High ANC.

Disadvantages of Mg(OH)2 :
1. Short duration of actions. 2. Laxative 3. Hypermagnesia.

Dose of Mg(OH)2 :

300 mg to 600 mg as antacid per day. 2 to 4 gm as cathartic per day.

Milk of Magnesia

It is a 7-8.5% w/w suspention of magnesium hydroxide, which may contain 0.1% citric and not more then 0.05% of a volatile oil or a blend of volatile oils, suitable for flavoring purpose.
It is a white, opaque, more or less viscous suspension from varying proportion of water usually separate on standing and has a pH of about 10. Storage at temperature not exceeding 35C not freezed.

Does: As antacid: 5 ml four times a day, As cathartic: 15 to 30 ml daily.

Antacids & Antiflatulents

Simethicone
Simethicon is a mixture of full methylated linear siloxane polymers containing repeating units of the formula [-(CH3)2 SiO2]n, stabilized with trimethylsiloxy end- bulking units of the formula [(CH3)3 SiO-] and silicon dioxide. Translucent, gray, viscous fluid, Sp. gravity 0.064 0.984, viscosity not less then 300 centistokes at 25C.

CH 3 CH 3 S O CH 3

CH 3 Si O CH 3

CH 3 Si CH 3 n CH 3

Use: Antiflatulent, gastric protective to deform gastric juice in order to decrease the tendency to gastro esophageal reflux. Dose: 40-80 mg (tablet) 4 times a day after each meal & at bedtime.

Protectives or Adsorbents

Criteria :
Treatment for mild diarrhea Contain antibacterial agent Decreases peristalsis Adsorbent-protective adsorb toxins, bacteria, and viruses.

Protectives or Adsorbents

BISMUTH-CONTAINING PRODUCTS astringent antiseptic BISMTUH SUBNITRATE White Bismuth Non-irritant intestinal antiseptic Also used in gastric ulcer and inflammations BISMUTH SUBCARBONATE Basic Bismuth Carbonate Protective and antacid Radiopaque contrast medium ACTIVATED CHARCOAL Adsorbent for diarrhea Antidote for certain poisoning

Protectives or Adsorbents

Magnesium Trisilicate :
It is a compound of MgO and SiO2 containing varying proportion of water. Due to method of manufacture, it is more likely to be a mixture of magnesium metaslicate (MgSiO3) and colloidal SiO2, with varying amount of water.

Preparation of Magnesium Trisilicate :

Na4Si3O8 + MgCl2/MgSO4 Mg 2Si 3O8 + NaCl/Na2SO4

Protectives or Adsorbents

Mechanism of Magnesium Trisilicate : It has protective, neutralizing & laxative activity.

MgSi3O8 + 4HCl = 2MgCl2 + H4Si3O8 2H2SiO3 + SiO2 + nH2O collidal mixture

Advantage: 1. Protective action of ulcer Disadvantage: Siliceous nephrolith, Diarrhea. Does: usually 1-16 gm daily (4 times) Use: As antacid, as adsorbent/ protective.

Saline Cathartics or laxatives

Saline cathartics or purgatives are agents that quicken and increase evacuation from the bowl. Laxatives are mild cathartics.

Cathartics are used: To ease defecation in patients with painful hemorrhoids or other rectal disorders. To avoid excessive straining and concurrent increase in abdominal pressure in patients with hernias or to avoid potentially hazardous rise in B.P. During defecation in patients with hypertension, cerebral coronary or other arterial disease To relieve acute constipation or to remove solid material from intestinal tract prior to certain roentgenographic studies.

Saline Cathartics or laxatives

1.

Four types of laxatives are known:

Stimulant Laxatives local irritation on the intestinal tract Bulk-forming Laxatives made from cellulose that swell when wet, stimulating peristalsis Emollient Laxatives stool softeners Saline Cathartics increasing the osmotic load

2.

3. 4.

Examples of Saline Cathartics or laxatives

Stimulants include phenolphthalein, aloin, cascara extract, rhubarb extract, senna extract, podophyllin, castor oil, bisacodyl, calomel etc. Bulk forming laxatives are made from cellulose, sodium carboxyl methyl cellulose and karaya gum. The emollient laxatives act either as lubricants facilitating the passage of compacted fecal material or as stool softeners. E.g mineral oil, d-octyl sodium sulfosuccinate, an anionic surface active agent. Saline cathartics act by increasing the osmotic load of the GIT. They are salts of poorly absorbable anions H2PO4- (biphosphate), -HPO42- (phosphate), sulphates, tartarates, andsoluble magnesium salt.

Saline Cathartics or laxatives

Use of saline cathartics :

1. Saline cathartics are water soluble and are taken with large quantities of water. This prevents excessive loss of water from body fluids and reduces nausea vomiting if a too hypertonic solution should reach the stomach. They act in the intestine and a full cathartic dose produces a water evacuation within 3-6 hrs. 2. They are used for bowel evacuation before radiological, endoscopic and surgical procedures and also to expel parasite and toxic materials.

Side effects :

Small amounts of these drugs may be absorbed in the blood causing occasional toxicity. The absorption of magnesium may cause marked CNS depression while that of sodium worsens the existing congestive cardiac failure (CCF).

Antacid combinations

Every single compound among antacid have some side effect especially when used for longer period or used in elderly patients. To avoid certain side effects associated with antacids, combinations of antacids are used such as : (i) Magnesium and aluminium containing preparation e.g. magnesium hydroxide a fast acting antacid with aluminium hydroxide which is a slow acting antacid. (ii) Magnesium and calcium containing preparation where one is laxative and the later one is constipative in nature

Advantages of antacid combinations

Different advantages are given below --

1. To balance laxative & constipation action :

When laxatives & constipating compound are formulated in mixture, the gastro-intestinal disturbances may not occur or less occur. Al(OH)3 + Mg(OH)2 less or no GI disturbances. 250 mg 400 mg (Constipating agent) (Laxative) 2. To maintain fastation & solvation : To increase total buffering time, a fasting acting compound with slow acting antacid are formulated in mixtures. NaHCO3 + Mg(OH)2 or MgCO3 Maintain fastation & solvation

Advantages of antacid combinations cont

3. To reduce toxicity : In a single entity antacids may cause high toxicity. So to reduce toxicity antacids are formulated in a mixture. 4.To increase patient tolerance : Mixture antacids increase the patient tolerance rather than by multiple separate preparation. 5. For bone formation : Long time continuous use of Al+++ may produce lack of PO4 3- which inhibit the bone formation. Al(OH)3 + HCl AlCl3 + H2O AlCl3
Al3+ + PO4
3-

Al3+ + 3ClAlPO4

ANC

ANC may be defined as a no. of mili equivalent of 1 N HCl that brought to pH 3.5 within 15-60 minutes by an unit of antacid preparation. Antacids are compared quantitatively in terms of ANC. ANC depends on crystal form, precipitants used, presence of reactive suspension agents.

Achlorhydria
Achlorihydria is the absence of hydrochloric acid in the gastric secretion. Patients with this condition fall into one of the two conditions : 1. Those who remains free of gastric hydrochloric acid after stimulation with histamine phosphate. Causes : This type of achlorihydria includes those patient with - Subtotal gastrectomy - Atropic gastritis (Chronic gastritis with atropy of the membranes and glands) - Carcinoma of the stomach - Gastric palyps, etc.

Achlorhydria
Treatment : Dilute hydrochloric acid N.F. has been utilized to relative this type of achlorhydria. In order to avoid exposure of dental enamel to hydrochloric acid, the use of drinking straw laid well back on the tongue has been recommended or the use of equivalent product such as glutamic acid hydrochloride which is administrated in capsule. Dose : The usual 5 ml dose of diluted HCl N.F. added to 200 ml of water provides about 15mEq of acid.

Achlorhydria

Those in whom there is normally a lack of gastric hydrochloric acid , but who responds to stimulation by histamine. Causes : Patients with this type of achlorhydria includes those with -Chronic nephritis -Chronic alcoholism -Tuberculosis -Hyperthyroidism -Pellagra (caused by lack of vit B and protein) -Normal individual after the age of 50. Treatment : Administration of histamine phosphate.

Achlorhydria

Symptoms of achlorhydria : The symptoms of achlorhydria can vary with the associated disease, but generally include 1. Mild diarrhea 2. Frequent bowel movement 3. Epigastric pain 4. Sensitivity to spicy foods 5. Pernicious anemia due to lack of intrinsic factor. 6. Lack of pepsin activity due to increased pH. 7. Protien metabolism

Diarrhea

Definition :
Diarrhea is a frequent passage of uniformed watery bowel movements. Very briefly, it results when some factors impairs digestion or absorption, thereby the intestinal content is increased & cell damage is started. This increased bulk of intestinal tract stimulates peristalsis, propelling the intestinal contents to the anus (i.e. the fluids come from the body)

Causes of Diarrhea :

Diet Gastro-intestinal infections Certain damage Psychogenic factors Inflammation or irritation of the mucosa of the intestines.

Diarrhea

Classification :

Diarrhea may be of several types :

Acute diarrhea :

Acute Diarrhea Caused by toxins, chemical poisons, drugs, allergy, disease Chronic Diarrhea Result from gastrointestinal surgery, carcinomas, chronic inflammatory

Acute diarrhea may be caused by

Bacterial toxins Chemical poisons Drugs Some disease Allergy

Diarrhea

Mechanism of acute diarrhea :

These agents for causing acute diarrhea causes effects ranging from tissue damage to irritation to that of causing electrolytes to flow from body fluids into the intestinal tract, there by increasing the osmotic load of the intestinal tract.

Chronic diarrhea :
Chronic diarrhea can result from

GI surgery Carcinoma Chronic inflammatory conditions Various absorptive defects

Diarrhea

Treatment :
Most products for the treatment of diarrhea will consist of
Adsorbent properties : These agents supposedly absorb toxins, bacteria & viruses along with providing a protective coating of the intestinal mucosa. For example Bismuth salt, Special clays & activated charcoal etc. Antispasmodic : These agents act directly on the smooth muscles of the gut to produce a spasm-like effect which decrease peristalsis & increased segmentation. Antimicrobial agent : It is only effective if there is an actual infection in the intestinal tract or during epidermis previously shows to be caused by a micro-organism.

Dehydration

Dehydration is the condition resulting from excessive water loss of body fluids. Causes :
Excessive loss of water from body such as sweating, cholera, diarrhea, haemohhrage. Reduction of total quantity of electrolytes. From fluid deprivation. Injection of hypertonic solution. Sunken of eye ball. Dryness of tongue Wrinkles of skin. Dryness & roughness of skin. Oral rehydration salt (ORS) Ringers injection Lactated Ringers injection NaCl injection Dextrose & NaCl injection Dextrose injection

Sign of dehydration:

Treatment :

CONSTIPATION

Constipation is the infrequent defecation with passage of unduly hard and dry fecal material or sluggish action of the bowels. It may cause due to Predisposing factors No regular bowel habits from childhood A person who resist the natural urge to defecate. Causing the fecal material which remains in the colon to loss fluid to become relatively hard & dry. Intestinal due to lack of mucous secretion Intestinal spasm. Emotion Drugs Diets

Treatments :

Plenty of fresh vegetables, fruits, milk & abundance of water. Saline cathertics : e.g. Sodium- bi-phosphate

ORS

ORS is used in the replacement of fluid & electrolytes lost through dehydration (Diarrhea). Mainly they contain salt of Na & K & anhydrous glucose or dextrose. Criteria : It should contain an alkalizing agent to counter acidosis (As acid increases with increased quantity of electrolytes) It should be simple to use in hospital & at home. It should be palatable & acceptable. It should be readily available It should replace the electrolyte deficit adequately & safely. It should enhance optimally the absorption of water & electrolytes.

Why K or Al CO3 is not produced during the preparation of Al(OH)3 ?

When a hot solution of K-Alum is added to a hot solution of NaCO3 (at 700C), Al(OH)3 in produced.
Na2CO3 + K2SO4. Al2(SO4)3

In this reactions, no K2CO3 & Na2CO3 & Al2(CO3)3 is produced. Reasons : K-Alum is a double salt (K2SO4. Al2(SO4)3). And actually the Al2(SO4)3 part of K-alum reacts with the NaCO3 & form Al2(CO3)3. The reactions does not occur with K2SO4 , so the number of K is equal in the both side of reaction. This Al2(CO3)3 ppt is dissociated by hot water into Al(OH)3. So K or Al carbonate is not produced.
Al2(CO3)3 + H2O Al(OH)3 + CO2 Al2(SO4)3 + Na2CO3 Al2(CO3)3 + Na2SO4

K2SO4+Na2SO4+ Al(OH)3 + CO2

What are the solutions of electrolytes that are given intravenously?c

Electrolytes used in IV : Solution of electrolytes are given intravenously to meet normal fluid and electrolytes requirements or to replenish substantial defects or continuing losses when the patient is nauseated or vomiting & is unable to take adequate by mouth. The following electrolytes solution of intravenous infusion may be listed -a) Sodium containing electrolytes solution :

b) Potassium containing electrolytes solution :

NaCl solution Na-lactate injection Monobasic Na phosphate Na3PO4 injection Na-citrate & citric acid solution NaHCO3 solution Na-acetate solution.

C) Calcium Containing electrolytes solution :

Latated ringers injection Ringers injection Calcium Gluconate

Potassium Injection Ringers injection Latated ringers injection Potassium gluconate

NaHCO3 is very effective antacids with strong limitations - explain

Systemic antacid are those which are soluble in water and absorbed through the membrane of intestine in to the blood circulation (systemic). Such as Sodium bicarbonate is a systemic antacid. Sodium Bicarbonate has a very rapid onset of action but its duration of action is short. It causes a sharp increase gastric pH upto or above 7.

NaHCO3 is very effective antacids with strong limitations explain cont..

The other limitations of this systemic antacids are -

The proteolytic action of pepsin act in pH 1.8-3.5. As NaHCO3 raises the pH upto 7 or above, the action of pepsin is hampered. To maintain the gastric pH, rebound acidity occurs. Absorption of sodium ion causes systemic alkalosis increasing the pH of blood of systemic circulation which ultimately results over excitability of nervous system. Sodium retention can be caused by the absorbed sodium ion. It is a great problem for those patients who have sodium-restricted diet as sodium is responsible for raising of blood pressure. Sodium bicarbonate is definitely not indicated for those patients who need antacid therapy for even limited period of time. It inhibits the absorption of Tetracycline from the gastrointestinal tract.

Why citric acid is added in the preparation of milk of magnesia ?

Milk of magnesia , USP is a suspension of magnesium hydroxide containing not less than 7% and not more than 8.5% of Mg(OH)2 . For purposes of minimizing the alkalinity of milk of magnesia 0.1% citric acid is added. Normally, Mg(OH)2 ionizes into Mg2+ & OH- ion. The citric acid upon addition reacts immediately to form magnesium citrate which ionizes to supply magnesium ion & citrate ion. Mg(OH)2 Mg2++ 2 OH- ---------(i) Mg3(C6H5O7) 3Mg2++ 2C6H5O73- ---------(ii)
This increases the concentration of Mg2+ ions. According to the law of mass action, forces the reaction to the left (expressed by equation-i). Such as action decreases hydroxide ion concentration giving the product a milder & less chalky taste. The alkalinity contributed by the glass container is like wise counteracted.

Additional questions..

Why antibiotic & antacid is not given together? Give some examples of Al & Mg containing antacids? Write down the side effect or contraindication of Mg(OH)2 antacid therapy? Why non-systemic antacids does not produce systemic alkalosis? Write down some market preparation of antacids? Why its a great problem to put Na2CO3 in K-alum?