INDEX

1 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 LOCAL ANAESTHETICS
LAs are drugs which upon topical application or local injection causes reversible loss of sensory perception, especially
of pain, in restricted area of the body.

LA blocks generation & conduction of nerve impulse at all parts of neuron where they come in contact, without
causing any structural damage. Thus, not only sensory but also motor impulses are interrupted when LA is applied to
mixed nerve, resulting in musclular paralysis & loss of autonomic control as well.

Classification:-

1. Injectable (i) Low potency & Short duration

 Procaine
 Chlroprocaine

(ii) Intermediate potency & duration

 Lidocaine (Lignocaine)
 Prilocaine

(iii) High potency & Long duration

 Tetracaine
 Bupivacaine
 Cinchocaine

2. Surface (i) Soluble

 Lidocaine (Lignocaine)
 Tetracaine
 Cocaine

(ii) Insoluble
 Benzocaine
 Oxethazaine

Mechanism of action :-

Concentration of LA increases

Rate of rise of AP & maximum depolarization decreases

Slowing of conduction

Fails to reach the thresold potential

Conducation block

2 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 GENERAL ANAESTHETICS

GAs are drugs which produce reversible loss of all sensation & conciousness.

The cardinal fetures of GA are;

 Loss of all sensations, especially pain
 Sleep & Amnesia
 Immobility & muscle relaxation
 Abolition of somatic & autonomic reflexs

Classification:-

1. Inhalational (i) Gas

 Nitrous oxide (N2O)

(ii) Volatile liquids

 Ether
 Isoflurane
 Desflurane
 Enflurane

2. Intravenous (i) Inducing agents

 Propofol
 Etomidate
 Thiopentone

(ii) Slower acting drugs

 Benzodiazepines
- Diazepam
- Lorazepam
- Midazolam

 Dissociative :- Catemine

 Opioid analgesia :- Fentanyl

Comparative features of general and local anaesthesia :-

LOCAL ANAESTHESIA GENERAL ANAESTHESIA
1. Site of action Peripheral nerves CNS
2. Area of body involved Restricted area Whole body
3. Consciousness Unaltered Lost
4. Care of vital functions Usually not needed Essential
5. Physiological trespass Low High
6. Poor health patient Safer Risky
7. Use in non-cooperative patient Not possible Possible
8. Major surgery Cannot be used Preferred
9. Minor surgery Preferred Not preferred

3 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 CNS DEPRESSANTS

1. Sedatives :- are the drugs which reduces excitement, calms the subject without producing sleep, though
drowsiness can be produced. Commonly used as Anxiolytics.

2. Hypnotics :- are th drugs which induce or maintain sleep similar to normal arousable sleep.

Sedatives & Hypnotics both are CNS depressants with somewhat differing time action & dose relationship.

Treatment of insomnia is the most important use of this class of drugs.

Classification:-

1. Barbiturates (i) Long acting

 Phenobarbitone

(ii) Short acting

 Butobarbitone
 Pentobarbitone

(iii) Ultra short acting

 Thiopentone

2. Benzodiazepines (i) Hypnotic

 Diazepam
 Flurazepam
 Alprazolam
 Triazolam

(ii) Anti-anxiety
 Diazepam
 Alprazolam
 Oxazepam
 Lorazepam

(iii) Anti-convulsant
 Zopiclone
 Zolpidem
 Zaleplon

3. Newer Non-Benzodiazepine Hypnotics  Zopiclone

 Zolpidem
 Zaleplon

Tranquilizer :- is an old term meanins ‘A drug which reduces mental tension & produces calmness without inducing
sleep or depressing mental faculties.’ E.g, benzodiazepines.

4 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 Non-Steroidal Anti-inflammatory Drugs & Antipyretics – Analgesics

ANTIPYRETICS :- are the drugs which reduce body temperature in fever but do not cause hypothermia in
normothermic individulas.

ANALGESICS :- are the drugs which relieve pain without causing loss of conciousness.

Classification:-

1. Non-selective COX inhibitors (i) Salicylates

(Traditional NSAIDs)  Aspirin

(COX = cylco-oxygenase) (ii) Propionic acid derivatives

 Ibuprofen
 Ketoprofen

(iii) Anthranilic acid derivative

 Mephenamic acid

(iv) Aryl-acetic acid derivatives

 Diclofenac
 Aceclofenac

(v) Oxicam derivatives

 Piroxicam
 Tenoxicam

(vi) Pyrrolo-pyrrole derivatives

 Ketorolac

(vii) Indole derivative

 Indomethacin

2. Preferential COX-2 inhibitors  Nimesulide

 Meloxicam
 Nabumetone

3. Selective COX-2 inhibitors  Celecoxib

 Etoricoxib
 Parecoxib

4. Analgesic-Antipyretics, (i) Para-amino-phenol derivative

with poor anti-inflammatory action  Paracetamol (Acetaminophen)

(ii) Pyrazolon derivatives

 Metamizol
 Propiphenazone

(iii) Benzoxazocine derivative

 Nefopam

5 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

Uses :-

(i) As analgesic for headache, backache, myaglia, joint pain, pulled muscle, toothache, dysmenorrhoea.
(ii) As antipyretic It is efffective in fever of any origin; dose same as analgesics. Anti-pyretics are not usefull in fever
due to heat stroke.
(iii) In Acute rheumatic fever
(iv) In Rheumatoid arthritis
(v) In Osteoartheritis

Mechanism of action :-

Antipyresis mechanism :- Fever during infection is produced through the generation of pyrogenes which induce
PGE2 (Prostaglandin E2, Also known as Dinoprostone ) production in hypothalamus – raise its temperature set point.
NSAIDs block the action of pyrogene & reduces body temperature.

Analgesia mechanism :- PGs induce hyperalgesia by affecting the transducing property of free nerve ending. NSAIDs
do not affect the tenderness induced by direct application of PGs, but block the pain sensitizing mechanism induced
by analgesic substances. So, they are more effective againts inflammation associated pain.

Side effects :-

 Nausea
 Vomiting
 Epigastric distress
 Increased occult blood loss in stool
 Gastric mucosal damage
 Peptic ulceration

6 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-EPILEPTICTS

Antiepilepticts are the drugs usefull in treatment of epilepsy. Epilepsy is a collective term for a group of chronic
seizures having common sudden and transient episodes of disterbance of consiousness and/or a charecteristic body
movement and sometimes autonomic hyperactivity.

Classification:-

1. Barbiturate  Phenobarbitone

2. Deoxybarbiturate  Primidone

3. Hydantoin  Phenytoin
 Fosphenytoin

4. Iminostilbene  Carbamazepine
 Oxcarbazepine

5. Succinimide  Ethosuximide

6. Alophatic Carboxylic Acid  Valproic acid

 Divalprox

7. Benzodiazepines  Clonazepam
 Diazepam
 Lorazepam
 Clobazam

8. Phenyltriazine  Lamotrigine

9. Cyclic GABA analouge  Gabapentin

10. Newer Drugs  Vigabatrin

 Topiramate
 Tiagabine
 Zonisamide
 Levetiracetam

7 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-HYPERTENSIVE

These drugs used to lower blood pressure in hypertension.

Classification:-

1. Diuretics (i) Thiazides

 Chlorothalidone
 Indapamide

(ii) High ceilling

 Flurasemide

(iii) K+ Sparing
 Spironolactone
 Amiloride

2. ACE inhibitors  Captopril

 Lisinopril
 Ramipril
 Enalapril

3. Angiotensin (AT1) receptor blockers  Losartan

 Irbesartan
 Valsartan
 Candesartan

4. Calcium channel blockers  Lacidipine

 Felodipine
 Amlodipine

5. β adrenergic blockers  Propranolol

 Metaprolol
 Atenolol

6. α adrenergic blockers  Terazosin

 Doxazosin

7. β + α adrenergic blockers  Labetalol

 Carvedilol

8. Central sympatholytic  Clonidine

 Methyldopa

9. Vasodilators (i) Arteriolar

 Minoxidil
 Diazoxide

(ii) Arteriolar + venous

 Sodium nitroprusside

8 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-ANGINAL

Antianginal drugs are those that prervent, abort or terminate attacks of angina pectoris.

Angina pectoris ls a pain syndrome due to indurction of an adverse oxygen supply / demand situation in a portion of
the myocardium.

Classification:-

1. Nitrates (i) Short acting :-

 Glyceryl trinitrate (GTN)

(ii) Long acting :-

 Isosorbide dinitrate
 Erythrityl tetranitrate
 Pentaerythritol tetranitrate

2. β Blocker  Propranolol
 Metoprolol
 Atenolol

3. Calcium Channel Blockers (i) Phenyl alkylamine :-

 Verapamil

(ii) Benzothiazepine :-
 Diltiazem

(iii) Dihydropyridines :-
 Nifedipine
 Felodipine
 Amlodipine
 Nitrendipine

4. Potassium Channel Opener  Nicorandil

5. Others  Dipyridamole
 Trimetazidine
 Ranolazine
 Ivabradine
 Oxyphedrine

ANTIPLATELET DRUGS :- These are drugs which interfere with platelet function and are useful in the prophylaxis
of thromboembolic disorders. E.g, Aspirin, Ticlopidine, Sulfinpyrazone, Clopidogrel.

9 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 HYPOLIPIDAEMIC DRUGS

These are drugs which lower the levels of lipids and lipoproteins in blood.

The hypolipidaemic drugs have attracted considerable attention because of their potential to prevent cardiovascular
disease by retarding the accelerated atherosclerosis in hyperlipidaemic individuals.

Classification:-

1. HMG-CoA reductase inhibitors (Statins)  Lovastatin

 Simvastatin
 Pravastatin,
 Atorvastatin
 Rosuvastatin
 Pitavastatin

2. Bile acid sequestrants (Resins)  Cholestyramine

 Colestipol

3. Lipoprotein lipase activators  Clofibrate

 Gemfibrozil
 Bezafibrate
 Fenofibrate

4. Lipolysis and triglyceride synthesis inhibitor  Nicotinic acid

5. Others  Ezetimibe
 Gugulipid

HAEMOPOETICS :- are substances required in the formation of blood and are used for treatment of Anaemias.

COAGULANTS :- These are substances which promote coagulation and are indicated in haemorrhagic states.

Fresh whole blood or plasma provide all the factors needed for coagulation and are the best therapy for deficiency
of any clotting factor; also they act immediately. Other drugs used to restore haemostasis are :-

1. Vitamin K
K1 (from plants, fat-soluble)
K3 (synthetic) (i) Fat-soluble :- Menadione (ii)Water-soluble :- Menadione sod. Bisulfite

2. Miscellaneous
Fibrinogen (human), Antihaemophilic factor, Desmopressin, Adrenochrome monosemicarbazone, Rutin, Ethamsylate

10 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 BRONCHODIALATORES
These are the agents used to relax smooth muscles of bronchioles. They should be used only when an element of
bronchoconstriction is present and not routinely.

Classification:-

1. β2 Sympathomietics  Salbutamol
 Terbutaline
β 2 receptor stimulation  Bambuterol
 Salmeterol
increased cAMP formation
 Formoterol
in bronchial muscle cell
They are fastest acting bronchodilators when inhaled.
relaxation
They should be coutiously used in hypertensives & heart patients.

2. Methylxanthines  Theophylline (anhydrous)

Three actions:-
Release of Ca2+ from sarcoplasmic reticulum
Inhibition of phosphodiesterase (PDE)
Blockade of adenosine receptors
 Aminophylline
 Doxophylline
 Choline theophyllinate
 Hydroxyethyl theophylline
They have been extensively used in asthma but not considered as a first
line drugs any more.

3. Anticholinergics  Ipratropium bromide

 Tiotropium bromide
Atropinic drugs cause bronchodilatation by
blocking cholinergic constrictor tone; act
primarily in the larger airways.

 Salbutamol (ASTHALIN, DERIHALER – 100µg metered dose inhaler)

 Terbutaline (TERBUTALINE, BRICAREX - 2.5-5mg tab., 3mg/5ml syrup, 0.5mg/ml inj.)
 Aminophylline (AMINOPHYLLINE - 100mg tab.,250mg/10ml inj.)
 Hydroxyethyl theophylline (DERIPHYLLIN – 100mg tab., 250mg/2ml inj.)

AEROSOLS / INHALANTS :- is a colloid system in which solid or liquid particles are suspended in a gas especially a
suspension of a drug or other substance to be dispensed in a fine spray or mist. E.g, ASTHALIN.

Four classes of antiasthma drugs are available for inhalational use, viz. β2 agonists, anticholinergics, cromoglycate
& glucocorticoids. They are aimed at delivering the drug to the site of action so that lower dose is needed &
systemic side effects are minimized. Faster action of bronchodilators can be achieved compared to oral
administration. Most asthma patients are now maintained on inhaled medication only.

Aerosols are of two types :- (i) use drug in solution :- pressurized metered dose inhaler (pMDI), nebulizers
(ii) use drug as dry powder :- spinhaler, rotahaler

11 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 EXPECTORANTS

These are drugs which increase bronchial secretion or reduce its viscosity, facilating its removal by coughing.

Classification:-

1. Bronchial secretion enhancers  Sodium or Potassium citrate

 Potassium iodide
 Guaiphenesin (Glyceryl guaiacolate)
 Balsum of Tolu
 Vasaka
 Ammonium chloride

2. Mucolytics  Bromhexine
 Ambroxol
 Acetyl cysteine
 Carbocisteine

Bronchial secretion enhancers

Sodium and potassium citrate are considered to increase bronchial secretion by salt action.

Potassium iodide is secreted by bronchial glands and can irritate the airway mucosa. Prolonged use can affect
thyroid function and produce iodism. It is not used now.

Guaiphenesin, vasaka, tolu balsum are plant products which are supposed to enhance bronchial secretion and
mucociliary function while being secreted by tracheobronchial glands.

Ammonium salts are nauseating—reflexly increase respiratory secretions.

Mucolytics

Bromhexine A derivative of the alkaloid vasicine obtained from Adhatoda vasica (Vasaka), is a potent mucolytic and
mucokinetic, capable of inducing thin copious bronchial secretion.
Dose:- adults 8mg TDS, children 1–5 years 4mg BD, 5–10 years 4mg TDS.
BROMHEXINE 8mg tablet, 4 mg/5 ml elixir.

Ambroxol A metabolite of bromhexine having similar mucolytic action, uses and side effects.
Dose:- 15–30mg TDS.
AMBRIL, AMBROLITE, AMBRODIL, MUCOLITE 30 mg tab, 30 mg/5ml liquid, 7.5mg/ml drops.

Acetylcysteine It opens disulfide bonds in mucoproteins present in sputum—makes it less viscid, but has to be
administered directly into the respiratory tract.
MUCOMIX 200mg/ml inj in 1,2,5 ml amps; injectable solution may be nebulized/instilled through trachiostomy tube.

Carbocisteine liquefies viscid sputum in the same way as acetylcysteine and is administered orally (250–750mg TDS).
MUCODYNE 375 mg cap, 250 mg/5 ml syr.

12 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 DIGESTANTS
These are substances intended to promote digestion of food. A number of proteolytic, amylolytic and lipolytic
enzymes are marketed in combination formulations and are vigorously promoted for dyspeptic symptoms, and as
appetite stimulants or health tonics.

They are occasionally beneficial, only when elaboration of enzymes in G.I.T. is deficient. Their routine use in tonics
and appetite improving mixtures is irrational.

1. Pepsin May be used along with HCl in gastric achylia due to atrophic gastritis, gastric carcinoma, pernicious
anaemia, etc.

2. Papain It is a proteolytic enzyme obtained from raw papaya. Its efficacy after oral ingestion is doubtful.

3. Pancreatin It is a mixture of pancreatic enzymes obtained from hog and pig pancreas. It contains amylase, trypsin
and lipase.

4. Diastase and Takadiastase These are amylolytic enzymes obtained from the fungus Aspergillus oryzae.

Preparations:-

DIGEPLEX (Diastase 62.5 mg, pepsin 20 mg per 10 ml after dissolving the tablet in sorbitol base provided)

DIZEC (Pancreatin 250 mg, sod. Tauroglycocholate 50 mg, Methyl polysiloxane 25 mg tab.)

DIMOL (40 mg tab. single ingredient – Methyl polysiloxane)

CARMINATIVES
These are drugs which promote the explusion of gases from the G.I.T. and give a feeling of warmth & comfort in the
epigastrium.

Commonly used drugs are :-

 Sodium bicarbonate (0.6 – 1.5 g.)

 Oil peppermint (0.06 – 0.1 ml)
 Tincture cardamom (1 – 2 ml)
 Oil of dil (0.06 – 0.2 ml)
 Tincture ginger (0.6 – 1 ml)

Sodium bicarbonate reacts with gastric HCL & envolves CO2 which rapidly distands stomach, relaxes LES & brings
about erructation.

The others are condiments and spices, contain volatile oil, which by their mild irritant action & flavour relax LES &
increase G.I.T. motility.

Used for :- flatulent dyspepsia

(LES Lower Esophageal Sphincter)

13 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-ULCER
Anti-ulcer drugs are those which are effective in the treatment of peptic ulcer either reduce/ neutralize gastric acid
or increase mucosal resistance to acid pepsin attack & protects and heals the ulcer surface or are anti H.pyroli
bacteria.

Peptic ulcer (especially duodenal) is a chronic remitting and relapsing disease lasting several years. The goals of
antiulcer therapy are :-
• Relief of pain
• Ulcer healing
• Prevention of complications (bleeding, perforation)
• Prevention of relapse.

Classification:-

1. Reduction Of Gastric Acid Secretion (i) H2 antihistamines

 Cimetidine
 Ranitidine
 Famotidine
 Roxatidine

(ii) Proton pump inhibitors

 Omeprazole
 Esomeprazole
 Lansoprazole
 Pantoprazole
 Rabeprazole

(iii) Anticholinergic drugs

 Propantheline
 Oxyphenonium
 Pirenzepine

(iv) Prostaglandin analogue

 Misoprostol

2. Neutralization Of Gastric Acid (ANTACIDS) (i) Systemic

 Sodium bicarbonate,
 Sodium citrate

(ii) Nonsystemic
 Magnesium hydroxide
 Aluminium hydroxide
 Calcium carbonate

3. Ulcer Protectives  Sucralfate

4. Anti-H. Pylori  Amoxicillin

 Metronidazole
 Tinidazole

14 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 LAXATIVES
These are drugs that promote evacuation of bowels.

(a) Laxative or aperient :- milder action, elimination of soft but formed stools.
(b) Purgative or cathartic :- stronger action resulting in more fluid evacuation.

Many drugs in low doses act as laxative and in larger doses as purgative.

Classification:-

1. Bulk forming Dietary fibre :-

 Bran
 Psyllium (Plantago)
 Ispaghula
 Methylcellulose

2. Stool softener  Docusates (DOSS)

 Liquid paraffin

3. Stimulant purgatives (i) Diphenylmethanes

 Phenolphthalein
 Bisacodyl
 Sodium picosulfate

(ii) Anthraquinones (Emodins)

 Senna
 Cascara sagrada

(iii) 5-HT4 agonist

 Prucalopride

(iv) Fixed oil

 Castor oil

4. Osmotic purgatives  Magnesium salts :- sulfate, hydroxide

 Sodium salts :- sulfate, phosphate
 Lactulose

Psyllium & Ispaghula (ISOGEL- 27g./ 30g., FYBOGEL 3.5g./ 5.4g. powder)

Docusates (LAXICON 100mg tab.; 125mg/50ml enema, DOSLAX 150mg cap.)

Bisacodyl (DULCOLAX 5mg tab.)

Sodium picosulfate (LAXICARE, CREMALAX 10mg tab.)

Senna (GLAXENNA, SOFSENNA 12mg tab.)

AGAROL (liquid paraffin 9.5ml, phenophthalein 400mg, agar 60mg / 30ml emulsion)

15 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

Type of stools and latency of action of purgatives employed in usually recommended doses

Soft, formed faeces (take 1–3 days) Semifluid stools (take 6–8 hrs) Watery evacuation (take 6–8 hrs)
 Bulk forming  Phenolphthalein  Saline purgatives
 Docusates  Bisacodyl  Castor oil
 Liquid paraffin  Sod. Picosulfate
 Lactulose  Senna

Mechanism of action :-

All purgatives increase the water content of the faeces by :-

(a) A hydrophilic or osmotic action, retaining water and electrolytes in the intestinal lumen—increase volume of
colonic content and make it easily propelled.

(b) Acting on intestinal mucosa, decrease net absorption of water and electrolyte; intestinal transit is enhanced
indirectly by the fluid bulk.

(c) Increasing propulsive activity as primary action—allowing less time for absorption of salt and water as a
secondary effect.

Purgative abuse :-

Some individuals are obsessed with using purgatives regularly. This may be the reflection of a psychological problem.
Others use a purgative casually, obtain thorough bowel evacuation, and by the time the colon fills up for a proper
motion (2–3 days) they get convinced that they are constipated and start taking the drug regularly. Chronic use of
purgatives must be discouraged. Once the purgative habit forms, it is difficult to break. Dangers of purgative abuse
are:

1. Flairing of intestinal pathology, rupture of inflamed appendix.

2. Fluid and electrolyte imbalance, especially hypokalaemia.
3. Steatorrhoea, malabsorption syndrome.
4. Protein losing enteropathy.
5. Spastic colitis.

16 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-DIARRHOEALS
These are the agents useful in the management of diarrhoea.

Diarrhoea is too frequent, often too precipitate passage of poorly formed stools. It is defined by WHO as 3 or more loose or
watery stools in a 24 hour period. In pathological terms, it occurs due to passage of excess water in faeces.This may be due to:-

• Decreased electrolyte and water absorption.

• Increased secretion by intestinal mucosa.
• Increased luminal osmotic load.
• Inflammation of mucosa and exudation into lumen.

Principles of management :-

1. Rehydration (i) IV rehydration :- When fluid loss is severe i.e, >10% of

body weight.
New formula WHO-ORS Total osmolarity 245 mOsm/L
Content Concentrations
NaCl : 2.6 g Na+ — 75 mM
(ii) Oral rehydration :- When fluid loss is mild.
KCl : 1.5 g K+ — 20 mM
Trisod. citrate : 2.9 g Cl¯ — 65 mM (available as ORETRAL-A, ELECTROBION, ELECTRAL 21 g sachet for
Glucose : 13.5 g Citrate — 10 mM 1000 ml; WALYTE, RELYTE 4.2 g sachet for 200 ml)
Water : 1 L Glucose — 75 mM

2. Maintenance Of Nutrition Contrary to traditional view, patients of diarrhoea should not be

starved. Fasting decreases brush border disaccharidase enzymes &
reduces absorption of salt, water & nutrients; may lead to
malnutrition if diarrhoea is prolonged or recurrent.

Feeding during diarrhoea has been shown to increase intestinal

digestive enzymes and cell proliferation in mucosa.

Simple foods like breast milk or ½ strength buffalo milk, boiled

potato, rice, chicken soup, banana, sago, etc. should be given as soon
as the patient can eat.

3. Drug Therapy

(i) Specific antimicrobial drugs (ii) Non-specific anti-diarrhoeal drugs

A. Antimicrobials are of no value In diarrhoea due to
noninfective causes, such as :- Class Drug Use
 Irritable bowel syndrome (IBS) Absorbants Ispaghula Irritable bowel syndrom
(IBS)
 Coeliac disease Psyllium
Methyl cellulose Ileostomy diarrhoea
 Pancreatic enzyme deficiency
Colostomy diarrhoea
 Thyrotoxicosis
Antisecretory Sulfasalazine Ulceritive colitis
B. Antimicrobials are useful only in severe disease (but not in Mesalazine Inflammatory bowel
diseases (IBD)
mild cases) :- Atropine
Octreotide Travellers’ diarrhoea
 Travellers’ diarrhoea Diarrhoea in AIDS
 Shigella enteritis Racecadotril
Acute secretory
 Nontyphoid Salmonella diarrhoea
 Yersinia enterocolitica
Antimotility Codein Travellers’ diarrhoea
C. Antimicrobials are regularly useful in :- Loperamide Idiopathic diarrhoea
 Cholera Diphenoxylate After anal surgery,
 Clostridium difficile colostomy
 Amoebiasis

17 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-EMETICS
These are drugs used to prevent or suppress vomiting.

Vomiting occurs due to stimulation of the emetic (vomiting) centre situated in the medulla oblongata. Multiple
pathways can elicit vomiting.

Classification:-

1. Anticholinergics  Hyoscine
 Dicyclomine

2. H1 antihistaminics  Promethazine
 Diphenhydramine
 Dimenhydrinate
 Doxylamine
 Meclozine (Meclizine)
 Cinnarizine

3. Neuroleptics (D2 blockers)  Chlorpromazine

 Triflupromazine
 Prochlorperazine
 Haloperidol

4. Prokinetic drugs  Metoclopramide

 Domperidone
 Cisapride
 Mosapride
 Itopride

5. 5-HT3 antagonists  Ondansetron

 Granisetron
 Palonosetron
 Ramosetron

6. Adjuvant antiemetics  Dexamethasone

 Benzodiazepines
 Dronabinol
 Nabilone

Doxylamine (DOXINATE, VOMNEX, NOSIC 10mg with pyridoxine 10mg tab.)

Domperidone (DOMSTAL, DOMPERON, NORMETIC 10mg tab.; 1mg/ml syrup)

Ondansetron (EMSET, OSETRON, EMSETRON 4,8mg tabs.; 2mg/ml inj. In 2ml & 4ml amps.)

Granisetron (GRANICIP, GRANISET 1mg,2mg tabs; 1mg/ml inj. In 1ml & 3ml amps.)

18 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 HEPATOPROTECTIVES

These are the agents usefull for prevention & treatment of hepatic diseases.

Prevention :-

Some but not all liver disease can be prevented by,

 Vaccination- hep.A & B
 Practicing good hygine
 Avoiding drinking
 Practicing safe sexual practice
 Avoiding toxic substances
 Proper use of medicines
 Well balanced food intake

Treatments :-

 Anti-hepatotoxic
 Hepatotropic
 Hepatoprotective

Usefull herbs :-

 Bhringraja (Eclipta alba)

 Yastimadhu (Glycyrrhiza glabra)
 Punarnava (Boerhavia diffusa)
 Apamarga (Achyranthus aspera)
 Kiratatikta (Swertia chirata)

Marketed formulatons :-

 LIV-52
 LIMARIN

19 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 DIURETICS

Diuretics are the drugs which increase the urine formation together with natriuresis. E.g, Furosemide, Thiazides

Only a few drugs produce diuresis by increasing GFR, and these are relatively weak in action. Most of the diuretics
used to therapeutically act by interfering with sodium re-absorption by the tubules.

Classification :-

1. Thiazide diuretics  Chlorothiazide

 Chlorthalidone
 Hydrochlorothiazide
 Indapamide

2. Loop diuretics  Torsemide

 Furosemide
 Bumetanide

3. Potassium-sparing diuretics  Amiloride

 Triamterene
 Eplerenone

Usefull in :-

 CHF (Congestive Heart Failure)

 Odema
 High blood pressure
 Arrhythmia

Most common side effects :-

 Headache
 Dizziness
 Thirst
 Gout
 Diarrhoea
 Skin rashes
 Muscle cramps
 Kidney failure

20 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17

 ANTI-DIURETICS

These are drugs that reduce urine volume particularly in diabetes insipidus.

Classification :-

1. Antidiuretic hormone (ADH-Vasopressin)  Desmopressin

 Lypressin
 Terlipressin

2. Thiazide diuretics  Amiloride

3. Miscellaneous  Indomethacin
 Chlorpropamide
 Carbamazepine

USES :-

 Diabetes insipidus
 Bedwetting in children & nocturia in adults
 Renal concentration test
 Haemophillia
 Before abdominal radiography

LITHOTRIPTICS :- These are the drugs which break down the calculi either renal or ureteric.

In modern pharmacology there are no substances that have lithotriptic capebility & are harmless to the patients.

Some Ayurvedic formulations having lithotriptic action :-

 Shweta parpati
 Palash kshara
 Goksuradi guggulu
 Pashanbheda churna

21 Alpesh B. Munjani, J.S. Ayurveda Mahavidhyalaya. Oct-17